Abstract
BackgroundThe purpose of this study is to investigate the aqueous humor (AH) T lymphocyte subsets and cytokines of acute retinal necrosis (ARN) to elucidate the immunologic inflammatory features of this disorder.MethodsThree patients with ARN infected with varicella zoster virus (VZV) who underwent multiple intravitreal injections of ganciclovir were enrolled in this study. The control group consisted of four non-infectious patients with acute anterior uveitis (AAU). Flow cytometric analysis was performed on the lymphocyte subsets from the AH and peripheral blood (PB) samples during the active phase of intraocular inflammation. Five inflammatory cytokines were measured in each AH sample and various clinical characteristics were also assessed.ResultsVZV deoxyribonucleic acid (DNA) was detected by real-time polymerase chain reaction (PCR) in AH from all the ARN patients, who showed higher CD8+ T lymphocytes population in AH than the AAU patients (p = 0.006). CD4/CD8 ratios of T lymphocytes and the percentage of CD8 + CD25+ T lymphocytes in AH were significantly lower in ARN than in AAU (p = 0.006; p = 0.012). In the ARN patients, the percentages of CD4+ and CD8+ T lymphocytes in AH were higher than those found in PB. The percentage of CD4 + CD25+ T lymphocytes in AH was significantly higher than the proportion in PB in the AAU patients (p = 0.001). Immunoregulatory cytokine Interleukin-10 in AH was significantly elevated in the ARN patients in comparison with the case of the AAU patients (p = 0.036). In ARN, the copy number of VZV DNA in AH positively correlated with the percentage of CD8+ T lymphocytes in AH and negatively correlated with the CD4/CD8 ratio in AH during the course of disease treatment (p = 0.009, r = 0.92; p = 0.039, r = − 0.834).ConclusionThe ARN patients caused by VZV had different intraocular T lymphocyte subsets and cytokines profile than those of the non-infectious patients. High percentages of CD8+ T lymphocytes and low CD4/CD8 T cell ratios may be a potential biomarker for diagnosis of viral-infectious uveitis. T lymphocytes examination at the inflammatory sites has the potential to become a useful research tool for differentiating viral and non-viral uveitis.
Highlights
The purpose of this study is to investigate the aqueous humor (AH) T lymphocyte subsets and cytokines of acute retinal necrosis (ARN) to elucidate the immunologic inflammatory features of this disorder
The purpose of this study was to undertake a comprehensive detailed investigation of the types and distribution of T lymphocytes present in aqueous humor (AH) and peripheral blood (PB) in patients with confirmed virus-induced uveitis, i.e., Acute retinal necrosis (ARN), and provide new insights into the immunological mechanisms that may be important in regulating ocular inflammation following varicella zoster virus (VZV) infection
This study described the immunological features of the AH and PB T lymphocytes population in patients with viral infections or non-infectious uveitis
Summary
The purpose of this study is to investigate the aqueous humor (AH) T lymphocyte subsets and cytokines of acute retinal necrosis (ARN) to elucidate the immunologic inflammatory features of this disorder. It keeps difficult to find out the cause of uveitis at early stage for clinicians [1]. Since the intraocular cytokine environment and molecular mechanisms and the infiltrating intraocular inflammatory cells or cytokines varied remarkably between viral infectious uveitis and non-viral infectious uveitis [7], it may be a potential way to analyzing the intraocular inflammatory cells and cytokines for clinicians to partially confirm the presumed viral-induced uveitis, even when the real-time polymerase chain reaction (PCR) of specific viruses is negative. Acute retinal necrosis (ARN) is an infectious viral uveitis syndrome which presents itself as a necrotizing retinitis and may lead to a fatal visual outcome. ARN is most commonly caused by varicella zoster virus (VZV), herpes simplex 1 and 2 (HSV-1, HSV-2), cytomegalovirus (CMV), and infrequently, Epstein-Barr virus (EBV) [8]. VZV is the most common cause, followed by HSV (types 1 and 2) [9]
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