To investigate the association between serum amyloid A (SAA) protein and the clinical features of acute anterior uveitis (AAU), and to evaluate the disease activity and treatment effect in relation to SAA levels.
AAU patients and healthy individuals were recruited from October 2016 to August 2017 at the Department of Uveitis, in the Eye Hospital of Wenzhou Medical University. Related demographic, clinical characteristics, and therapeutic data were analyzed.
One hundred and eight AAU patients and 18 healthy controls were included in this study. Serum SAA levels in AAU patients were significantly higher than those of healthy controls (p all < 0.0001). Significantly higher SAA levels were found in AS+AAU patients than those in AS−AAU patients (p < 0.05). SAA levels were also significantly higher in patients with HLA-B27+AAU compared with those with HLA-B27−AAU (p < 0.05). Furthermore, in each of the AAU subgroups, higher SAA levels were observed in the active state than those in the inactive state (p all < 0.05). In addition, SAA levels were positively correlated to anterior chamber cell counts (r = 0.492, p < 0.0001). ROC curve analysis revealed that SAA had an AUC value of 0.727 for detecting active inflammation (Youden’s index = 0.38). SAA decreased with effective treatments (p = 0.0002).
Serum levels of SAA were elevated in AAU patients. The increased levels of SAA were correlated with AS and HLA-B27 status. SAA levels were also positively correlated to disease activity and decreased with effective treatments. These findings suggest that SAA is associated with AAU, with a potential role in monitoring inflammatory processes and assessing the efficacy of therapy.
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Jabs DA, Nussenblatt RB, Rosenbaum JT, Standardization of Uveitis Nomenclature Working Group Standardization of uveitis nomenclature for reporting clinical data. Results of the First International Workshop. Am J Ophthalmol. 2005;140:509–16.
Chang JH, Wakefield D. Uveitis: a global perspective. Ocul Immunol Inflamm. 2002;10:263–79.
Eklund KK, Niemi K, Kovanen PT. Immune functions of serum amyloid A. Crit Rev Immunol. 2012;32:335–48.
Ye RD, Sun L. Emerging functions of serum amyloid A in inflammation. J Leukoc Biol. 2015;98:923–9.
Lucherini OM, Lopalco G, Cantarini L, Emmi G, Lopalco A, Venerito V, et al. Critical regulation of Th17 cell differentiation by serum amyloid-A signalling in Behcet’s disease. Immunol Lett. 2018;201:38–44.
Aygunduz M, Bavbek N, Ozturk M, Kaftan O, Kosar A, Kirazli S. Serum beta 2-microglobulin reflects disease activity in Behcet’s disease. Rheumatol Int. 2002;22:5–8.
Mao L, Dong H, Yang P, Zhou H, Huang X, Lin X, et al. MALDI-TOF/TOF-MS reveals elevated serum haptoglobin and amyloid A in Behcet’s disease. J Proteome Res. 2008;7:4500–7.
Lopalco G, Lucherini OM, Vitale A, Talarico R, Lopalco A, Galeazzi M, et al. Putative role of serum amyloid-A and proinflammatory cytokines as biomarkers for Behcet’s Disease. Medicine. 2015;94:e1858.
Sota J, Vitale A, Rigante D, Orlando I, Lucherini OM, Simpatico A, et al. Correlation of serum amyloid-A levels, clinical manifestations, treatment, and disease activity in patients with Behcet’s Disease. Isr Med Assoc J. 2018;20:517–21.
Londono J, Romero-Sanchez MC, Torres VG, Bautista WA, Fernandez DJ, Quiroga Jde A, et al. The association between serum levels of potential biomarkers with the presence of factors related to the clinical activity and poor prognosis in spondyloarthritis. Rev Bras Reumatol. 2012;52:536–44.
Yorston D, Whicher J, Chambers R, Klouda P, Easty D. The acute phase response in acute anterior uveitis. Trans Ophthalmol Soc UK. 1985;104:166–70.
Mitulescu TC, Stavaru C, Voinea LM, Banica LM, Matache C, Predeteanu D. The role of vitamin D in immuno-inflammatory responses in ankylosing spondylitis patients with and without acute anterior uveitis. J Med Life. 2016;9:26–33.
Sack GH Jr., Zachara N, Rosenblum N, Talbot CC Jr., Kreimer S, Cole R, et al. Serum amyloid A1 (SAA1) protein in human colostrum. FEBS Open Bio. 2018;8:435–41.
Urieli-Shoval S, Cohen P, Eisenberg S, Matzner Y. Widespread expression of serum amyloid A in histologically normal human tissues. Predominant localization to the epithelium. J Histochem Cytochem. 1998;46:1377–84.
Ma Y, Tao Y, Lu Q, Jiang YR. Intraocular expression of serum amyloid a and interleukin-6 in proliferative diabetic retinopathy. Am J Ophthalmol. 2011;152:678–685 e672.
Wang WH, McNatt LG, Pang IH, Hellberg PE, Fingert JH, McCartney MD, et al. Increased expression of serum amyloid A in glaucoma and its effect on intraocular pressure. Investig Ophthalmol Vis Sci. 2008;49:1916–23.
Hwang YG, Balasubramani GK, Metes ID, Levesque MC, Bridges SL Jr., Moreland LW. Differential response of serum amyloid A to different therapies in early rheumatoid arthritis and its potential value as a disease activity biomarker. Arthritis Res Ther. 2016;18:108.
Shen C, Sun XG, Liu N, Mu Y, Hong CC, Wei W, et al. Increased serum amyloid A and its association with autoantibodies, acute phase reactants and disease activity in patients with rheumatoid arthritis. Mol Med Rep. 2015;11:1528–34.
Jung SY, Park MC, Park YB, Lee SK. Serum amyloid a as a useful indicator of disease activity in patients with ankylosing spondylitis. Yonsei Med J. 2007;48:218–24.
Cantarini L, Giani T, Fioravanti A, Iacoponi F, Simonini G, Pagnini I, et al. Serum amyloid A circulating levels and disease activity in patients with juvenile idiopathic arthritis. Yonsei Med J. 2012;53:1045–8.
Bauer D, Kasper M, Walscheid K, Koch JM, Muther PS, Kirchhof B, et al. Multiplex cytokine analysis of aqueous humor in juvenile idiopathic arthritis-associated anterior uveitis with or without secondary glaucoma. Front Immunol. 2018;9:708.
Lee HJ, Kim JH, Kim SW, Joo HA, Lee HW, Kim YS, et al. Proteomic analysis of serum amyloid A as a potential marker in intestinal Behcet’s Disease. Dig Dis Sci. 2017;62:1953–62.
Robinson PC, Claushuis TA, Cortes A, Martin TM, Evans DM, Leo P, et al. Genetic dissection of acute anterior uveitis reveals similarities and differences in associations observed with ankylosing spondylitis. Arthritis Rheumatol. 2015;67:140–51.
Robinson PC, Leo PJ, Pointon JJ, Harris J, Cremin K, Bradbury LA, et al. The genetic associations of acute anterior uveitis and their overlap with the genetics of ankylosing spondylitis. Genes Immun. 2016;17:46–51.
Wakefield D, Yates W, Amjadi S, McCluskey P. HLA-B27 anterior uveitis: immunology and immunopathology. Ocul Immunol Inflamm. 2016;24:450–9.
Rosenbaum JT, Asquith M. The microbiome and HLA-B27-associated acute anterior uveitis. Nat Rev Rheumatol. 2018;14:704–13.
Huang X, Ye Z, Cao Q, Su G, Wang Q, Deng J, et al. Gut microbiota composition and fecal metabolic phenotype in patients with acute anterior uveitis. Investig Ophthalmol Vis Sci. 2018;59:1523–31.
Sano T, Huang W, Hall JA, Yang Y, Chen A, Gavzy SJ, et al. An IL-23R/IL-22 circuit regulates epithelial serum amyloid A to promote local effector Th17 responses. Cell. 2015;163:381–93.
We would like to thank all of the donors that participated in the present study. This study was supported by the Innovation Research Program of the Eye Hospital (YNCX201608), National Natural Science Foundation of China (31771390), Key Research Program of the Eye Hospital (YNZD201402), Wenzhou Science and Technology Foundation (Y20160457), General Program of the Eye Hospital (YNKT201601), National Students’ Innovation Training Program (201810343005), XinMiao Talents Program of Zhejiang Province (2018R413036).
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Dai, ML., Fan, S., Li, Z. et al. Correlation of serum amyloid A levels, clinical manifestations, treatment, and disease activity in patients with acute anterior uveitis. Eye 34, 1672–1678 (2020). https://doi.org/10.1038/s41433-019-0740-4
Frontiers in Immunology (2021)