Abstract
Background: Non-infectious uveitis (NIU) is a severe intra ocular inflammation, which frequently requires prompt systemic immunosuppressive therapy (IMT) to halt the development of vision-threatening complications. IMT is considered when NIU cannot be treated with corticosteroids alone, which is unpredictable in advance. Previous studies have linked blood cell subsets to glucocorticoid sensitivity, which suggests that the composition of blood leukocytes may early identify patients that will require IMT.Objective: To map the blood leukocyte composition of NIU and identify cell subsets that stratify patients that required IMT during follow-up.Methods: We performed controlled flow cytometry experiments measuring a total of 37 protein markers in the blood of 30 IMT free patients with active non-infectious anterior, intermediate, and posterior uveitis, and compared these to 15 age and sex matched healthy controls. Results from manual gating were validated by automatic unsupervised gating using FlowSOM.Results: Patients with uveitis displayed lower relative frequencies of Natural Killer cells and higher relative frequencies of memory T cells, in particular the CCR6+ lineages. These results were confirmed by automatic gating by unsupervised clustering using FlowSOM. We observed considerable heterogeneity in memory T cell subsets and abundance of CXCR3-CCR6+ (Th17) cells between the uveitis subtypes. Importantly, regardless of the uveitis subtype, patients that eventually required IMT in the course of the study follow-up exhibited increased CCR6+ T cell abundance before commencing therapy.Conclusion: High-dimensional immunoprofiling in NIU patients shows that clinically distinct forms of human NIU exhibit shared as well as unique immune cell perturbations in the peripheral blood and link CCR6+ T cell abundance to systemic immunomodulatory treatment.
Highlights
Non-infectious uveitis (NIU) is an umbrella term for a family of intraocular inflammatory conditions that collectively affect more than one in 1,000 individuals and account for ∼10% of preventable blindness in Western countries [1, 2]
Uveitis was deemed active if there were clinical complaints in combination with one of the following features: anterior chamber cells (AU), vitritis (IU), cystoid macular edema (CME) on optical coherence tomography (OCT) or fluorescence angiography, or vasculitis or papillitis on fluorescence angiography (BU/IU) [20, 21]
Unsupervised hierarchical clustering of the 50 leukocyte subsets with the largest variance between the groups revealed two overarching sample clusters: 1 cluster of 30 samples of which 90% were uveitis samples, and a second cluster that contained mostly controls samples (88% of samples). This analysis revealed that overall it was possible to distinguish uveitis patients from healthy controls considering the abundance of multiple leukocyte populations in blood, (Figure 1C), predominantly T cells
Summary
Non-infectious uveitis (NIU) is an umbrella term for a family of intraocular inflammatory conditions that collectively affect more than one in 1,000 individuals and account for ∼10% of preventable blindness in Western countries [1, 2]. This typically recurrent or chronic disorder may lead to poor visual outcome and low quality of life if undertreated [3, 4]. Non-corticosteroid systemic immunosuppressive therapy (IMT) is often necessary to control inflammation and should be introduced when NIU is not controlled with corticosteroids alone or corticosteroid-sparing agents are required because of long term use or intolerance to corticosteroids [6]. Previous studies have linked blood cell subsets to glucocorticoid sensitivity, which suggests that the composition of blood leukocytes may early identify patients that will require IMT
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