Human Uvea Research Articles

BOTULINUM NEUROTOXIN (BONT/A) AS AN INDUCER OF ACUTE ANTERIOR UVEITIS IN HLA B27 PATIENTS : A LITERATURE REVIEW

Background : HLA B27 related acute anterior uveitis is a chronic recurrent inflammation of uvea mainly in anterior chamber. The underlying mechanism seems to involves autoimmunity and autoinflammatory. Antigen has been proposed as a trigger, but its precise role is unclear. Aim : We systematically searched evidence for the involvement of antigen, including BoNT/A in triggering HLA-B27 associated disease. Methods : We searched four data base including Pubmed, Ebscohost, Sciencedirect, and Google Scholar. We also review the immunologic response to BoNT/A, its amino acid sequence, and homology with human protein Results: Eight studies reviewed which include the role of antigen in triggering uveitis. Four studies favour autoinflammatory pathway which involves B27 homodimer formation and its interaction with TH-17. Four studies favour autoimmunity pathway which involves molecular mimicry and activation of self reactive CD8+ T-Cells. All of which centralize the role of dendritic cells as antigen presenting cells. Five studies describe immune response to BoNT/A. BoNT/A capable of activating innate and immune system. Using BLAST program from NCBI, we found BoNT/A homology with cytokeratine 8. Conclusion : Two possible pathway on how antigen might trigger HLA B27 AAU. The first is through uveitogenic capacity of the antigen. The second mechanism is through homodimer formation. BoNT/A might induce uveitis in HLA B27 individual through induction of homodimer and activation of self-reactive CD8+ T-Cells due to shared homology with cytokeratine 8 that is extensively expressed in human uvea

Lymphatic Markers in the Adult Human Choroid.

Reports of lymphatics in the posterior human uvea are contradictory. We systematically analyzed the choroid by combining various lymphatic markers, following recently established guidelines for the immunohistochemical detection of ocular lymphatics. Human choroids were prepared for flat mount serial cryosectioning. Sections were processed for immunohistochemistry of the lymphatic markers LYVE-1, PDPN, PROX1, FOXC2, VEGFR3, CCL21, and combined with α-smooth muscle-actin and 4',6-diamidino-2-phenylendole (DAPI). Single, double, and triple marker combinations were documented using confocal microscopy. Messenger RNA analysis for CCL21, FOXC2, LYVE-1, PDPN, PROX, and VEGFR3 was performed in choroid and skin. In the choroid, CCL21 immunoreactivity was detected in choroidal blood vessels, intrinsic choroidal neurons, and numerous small cells of the choroidal stroma. These small cells were not colocalized with PROX1 and PDPN, while a subpopulation of cells showed immunoreactivity for CCL21 and LYVE-1, and very occasionally PDPN-only+ cells were detected. Nuclei positive for PROX1 were never detected in the choroid, and vessel-like structures immunoreactive for LYVE-1, PDPN, or CCL21 (other than blood vessels) were never observed. Immunoreactivity of VEGFR3 was absent in the majority of choroidal blood vessels, but present in choriocapillaris, while other structures positive for VEGFR3 were not detected. Nonvascular smooth muscle cells were lacking VEGFR3-immunoreactivity. Messenger RNA analysis detected all lymphatic markers investigated and confirmed immunohistochemical results. By combining several lymphatic markers, single cells expressed these markers, but classical lymphatic vessels were not detected in the human choroid. Therefore, the healthy adult human choroid must be considered alymphatic, at least with the markers applied here.

Topography of Lymphatic Markers in Human Iris and Ciliary Body.

Reports of lymphatics in the anterior human uvea are contradictory. This might be caused due to a certain topography, which has not been considered yet. Therefore, here we systematically analyze iris and adjacent ciliary body with immunohistochemistry by combining various lymphatic markers. Human iris and ciliary body were obtained from cornea donors and prepared for cryosectioning. Cross sections of tissue blocks at 12/3/6/9 o'clock position and at corresponding intersections (1:30/4:30/7:30/10:30) were processed for immunohistochemistry of LYVE-1, PDPN, PROX1, FOXC2, VEGFR3, and CCL21, and when necessary, these lymphatic markers were combined with CD31, α-smooth muscle-actin, CD68, and 4',6-diamidino-2 phenylindole dihydrochloride (DAPI). Double, triple, and quadruple marker combinations were documented using confocal microscopy. Numerous podoplanin+ cells were mainly located at the anterior border of the iris while LYVE-1+ cells were distributed throughout the nonpigmented part. Both cell populations were PROX1/FOXC2/CCL21/VEGFR3-. Blood vessels, iris smooth muscles, and individual cells were VEGFR3+. While PDPN+ cells were rarely detected posteriorly of the iris root, many LYVE-1+ cells were present within the ciliary body muscle and villi. Within the muscle, occasionally PDPN+ vessel-like structures were detectable, but these were never colocalized with LYVE-1. Similar vessel-like structures were VEGFR3+/PROX1-/CCL21-, but CD31+. Further, ciliary muscle fibers and ciliary epithelium were immunoreactive for VEGFR3/CCL21, but were LYVE-1/PDPN-. A certain topography of structures at the various uvea-positions investigated was not obvious. The majority of LYVE-1+ cells displayed immunoreactivity for CD68. Lymphatic vessels colocalizing for at least two lymphatic markers were not detectable. Therefore, if present, putative lymphatic channels of the anterior uvea might display a different marker panel than generally presumed.

Lymphatic drainage from the eye: A new target for therapy.

Lowering intraocular pressure (IOP) has been central to glaucoma care for over a century. In order to prevent sight loss from disease, there has been considerable focus on medical and surgical methods to improve fluid drainage from the eye. In spite of this, our understanding of exactly how aqueous humor leaves the eye is not complete. Recently, lymphatic vessels have been discovered in the human uvea, with studies showing lymphatic fluid outflow in several models, in addition to evidence for their pharmacological enhancement. The presence of a lymphatic outflow system points to an exciting, expanded understanding of how fluid and particulate materials such as proteins move out of the eye, and how IOP may be regulated. We coin the term "uveolymphatic pathway"-to reflect a comprehensive and compelling new target for glaucoma and an exciting opportunity for future investigations to better understand the eye in health and disease.

Calcium regulation by temperature-sensitive transient receptor potential channels in human uveal melanoma cells

Uveal melanoma (UM) is both the most common and fatal intraocular cancer among adults worldwide. As with all types of neoplasia, changes in Ca2+ channel regulation can contribute to the onset and progression of this pathological condition. Transient receptor potential channels (TRPs) and cannabinoid receptor type 1 (CB1) are two different types of Ca2+ permeation pathways that can be dysregulated during neoplasia. We determined in malignant human UM and healthy uvea and four different UM cell lines whether there is gene and functional expression of TRP subtypes and CB1 since they could serve as drug targets to either prevent or inhibit initiation and progression of UM. RT-PCR, Ca2+ transients, immunohistochemistry and planar patch-clamp analysis probed for their gene expression and functional activity, respectively. In UM cells, TRPV1 and TRPM8 gene expression was identified. Capsaicin (CAP), menthol or icilin induced Ca2+ transients as well as changes in ion current behavior characteristic of TRPV1 and TRPM8 expression. Such effects were blocked with either La3+, capsazepine (CPZ) or BCTC. TRPA1 and CB1 are highly expressed in human uvea, but TRPA1 is not expressed in all UM cell lines. In UM cells, the CB1 agonist, WIN 55,212-2, induced Ca2+ transients, which were suppressed by La3+ and CPZ whereas CAP-induced Ca2+ transients could also be suppressed by CB1 activation. Identification of functional TRPV1, TRPM8, TRPA1 and CB1 expression in these tissues may provide novel drug targets for treatment of this aggressive neoplastic disease.

Infiltrating macrophages in extratumoural tissues after brachytherapy of uveal melanoma

To compare distribution of macrophages in extratumoural ocular tissues in enucleated eyes with irradiated and nonirradiated uveal melanomas to find out how irradiation affects distribution of macrophages so as to gain insight into their potential routes of migration and changes in local inflammatory responses. Thirty-four matched pairs of primarily enucleated nonirradiated and secondarily enucleated irradiated eyes with choroidal and ciliary body melanoma were stained with mAb PG-M1, and the extratumoural immunopositive elements were counted under the microscope. Main outcome variables were the number of macrophages in the sclera underlying the tumour, in the choroid adjacent to the tumour, and in the ciliary body. The number of macrophage aggregates in the anterior ipsi- and contralateral episclera adjacent to the limbus was also counted. Macrophages were more numerous within the sclera under the tumour in irradiated eyes when compared to primarily enucleated eyes (median 1514 versus 619/mm², p = 0.0001), and more aggregates of episcleral macrophages adjacent to the limbus were found after irradiation (ipsilateral side, median 132 versus 0, p = 0.0034; contralateral side, median 79 versus 0, p = 0.014). In primarily enucleated eyes, increasing numbers of tumour-infiltrating macrophages were associated with presence of higher numbers of macrophages in the ciliary body (p = 0.003) and the adjacent choroid (p = 0.044), whereas in the irradiated eyes, increasing numbers of tumour-infiltrating macrophages (p = 0.010) and increasing extent of necrosis (p < 0.001) were associated with higher numbers of intrascleral macrophages underlying the tumour. Resident macrophages are present in extratumoural tissues in eyes with uveal melanoma. Brachytherapy may alter their route of migration and increase the number of macrophages in the sclera and episclera. Histopathologically detectable episcleral aggregates of macrophages adjacent to the limbus are detected predominantly after irradiation, a population of which is clinically visible as episcleral deposits after irradiation.

The Normal Human Choroid Is Endowed with a Significant Number of Lymphatic Vessel Endothelial Hyaluronate Receptor 1 (LYVE-1)–Positive Macrophages

Lymphatic vessel endothelial hyaluronic acid receptor (LYVE-1) is a newly discovered lymphatic endothelium-specific marker that is also expressed by a subpopulation of macrophages. To date, there is no report on its expression in the posterior human uvea. The purpose of this study was to investigate the expression of LYVE-1 in normal human choroids. Eyes of body/cornea donors (55-89 years of age; 4-9 hours postmortem) were obtained. Choroids were dissected and prepared for cryosections followed by immunohistochemistry with anti-human LYVE-1 antiserum and immunogold labeling. In addition, anti-human antibodies against macrophage markers (CD68, MHC class II) and lymphatic (podoplanin) and blood vascular endothelium (CD31, vWF) were used. For documentation, light-, fluorescence-, confocal laser scanning-, and electron-microscopy were used. The normal human choroidal stroma contained 274 +/- 86 LYVE-1 positive cells/mm(2). The cells displayed irregular shapes with a relatively uniform diameter of 32 mum. Costaining with CD68 and negativity for CD31, podoplanin, and melan-A/HMB45, as well as electron microscopic features, suggest these LYVE-1(+) cells to be macrophages. Besides that, no classic LYVE-1(+)/podoplanin(+) lymphatic vessels were detected within the normal adult human choroid. The normal adult human choroid does not contain typical lymph vessels, but is endowed with a significant number of LYVE-1 positive macrophages. These cells may be involved in choroidal hyaluronic acid metabolism or contribute to temporary formation of lymphatic channels under inflammatory conditions.

Expression of toll-like receptor 4 and its associated lipopolysaccharide receptor complex by resident antigen-presenting cells in the human uvea.

To investigate the in vivo expression of toll-like receptor 4 (TLR4) and its associated lipopolysaccharide (LPS) receptor complex in the human eye. Normal human ocular tissues were evaluated for in vivo TLR4, MD-2, and CD14 mRNA and protein expression by RT-PCR and immunohistochemistry, respectively. The distribution patterns and phenotypes of the cells expressing these proteins were further characterized by confocal microscopy and double-label immunofluorescence studies. Normal human uvea, retina, sclera, and conjunctiva constitutively expressed TLR4, MD-2, and CD14 mRNA. The protein expression of these molecules was restricted, however, to resident antigen-presenting cells (APCs) in the normal human uvea, consisting mainly of HLA-DR(+) dendritic cells (DCs). These APCs endowed with the complete LPS receptor complex appeared to be strategically positioned in perivascular and subepithelial locations for surveying blood-borne or intraocular LPS. In contrast, other cell types of the normal human cornea, conjunctiva, retina, and sclera did not express TLR4/MD-2 protein in vivo as detectable by immunohistochemistry. The present study demonstrates for the first time that resident APCs in the normal human uvea express TLR4 and its associated LPS receptor complex. This has significant implications for the understanding of normal ocular immunity as well as unraveling the potential role of Gram-negative bacteria in the pathogenesis of acute anterior uveitis (AAU).

Humoral immune response directed against LEDGF in patients with VKH

Vogt–Koyanagi–Harada disease is an autoimmune systemic disorder. In Vogt–Koyanagi–Harada disease, inflammatory disorders occur in multiple organs containing melanocytes, including uvea (resulting in acute bilateral panuveitis), skin (resulting in vitiligo and alopecia), central nervous system (resulting in meningitis) and inner ears (resulting in hearing loss and tinnitus). These inflammatory aspects are attributed to the destruction of melanocytes through immunological mechanisms. Studies have been carried out to elucidate the exact etiology and target autoantigen in Vogt–Koyanagi–Harada disease, but much remains to be investigated. Identification of target autoantigen is important to understand the etiology of autoimmune diseases, and for development of antigen-specific immuno-modulation therapy. To identify the target autoantigens in Vogt–Koyanagi–Harada disease, we made use of an immunoscreening of a bovine uveal cDNA expression library with serum samples obtained from patients with Vogt–Koyanagi–Harada disease. We identified an immunoreactive cDNA clone that encodes bovine lens epithelium derived growth factor. mRNA of human lens epithelium derived growth factor was determined by reverse transcription-polymerase chain reaction and it was expressed in human uvea, retina and melanocytes. Immunoglobulin G (IgG) autoantibodies were quantitated in an enzyme-linked immunosorbent assay, using recombinant human lens epithelium derived growth factor. The prevalence of IgG anti-lens epithelium derived growth factor autoantibodies in patients with Vogt–Koyanagi–Harada disease was significantly higher than that in healthy controls (66.7% versus 21.6%, P<0.001). On the other hand, the prevalence of the autoantibody in patients with panuveitis of other etiology, Behçet's disease and sarcoidosis, was almost same as that in healthy controls. These results suggest that the humoral immune response agonist lens epithelium derived growth factor is not a mere secondary phenomena caused by uveal tissue damage.

Mast cell heterogeneity in the human uvea.

To identify chymase- and tryptase-positive mast cells in the human uvea, and to study their associations with different types of resident uveal cells, uveal specimens from 24 human donor eyes were cryosectioned in sagittal and tangential planes. Enzyme histochemical staining of chymase was combined with immunohistochemical staining for tryptase, detected with the APAAP method. Fluorescence immunohistochemistry was performed with antibodies against c-kit, alpha smooth muscle actin, protein gene product (PGP) 9.5, CD45, and HLA-DR. In different uveal compartments, the total amounts of mast cells were calculated and the distributions of chymase and tryptase were quantified. All uveal mast cells were c-kit and CD45 positive and HLA-DR negative. No association existed between mast cells and actin-containing cells. Only a few mast cells were in close association with PGP 9.5-labeled nerve fibers. In the choroid, most mast cells were located in the inner central part (mean density = 48.9/mm(2)), and contained both chymase and tryptase (96%). The ciliary muscle contained numerous mast cells (mean density = 33.7/mm(2)), many of them tryptase positive but chymase negative (63%). In the pars plana, a high number of chymase-positive, tryptase-negative mast cells were found (20%). In the iris only a few mast cells were present. Although the choroid contains the most common subtype of mast cells, a unique situation concerning the distribution of chymase and tryptase is present in the anterior uveal tissues. A possible role for these cells in the special immunological situation of the anterior eye chamber merits further investigation.

Morphologic and immunocytochemical characterization of four human uveal cell lines (melanoma- and melanocytes-derived)

PURPOSE. To characterize three cell lines from human uveal melanomas and one ocular melanocyte cell line to study the specificity of several antigens in the malignant transformation of melanocytic uveal cells. METHODS. Light microscopy (LM), transmission electron microscopy (TEM), and immunocytochemical techniques were used in the characterization of OCM-1, SP 6.5, and MKT-BR human uveal melanoma cell lines and UW-1 normal melanocyte cell line from human uvea. Several monoclonal antibodies (MoAbs) S-100, HMB-45, MNF-116, PAL-M1, NK1/C-3, IND-1, and MAAMA were used. RESULTS. All cell lines showed an epithelioid/spindle morphology with occasional multinucleated cells, and nuclear pleomorphism. TEM showed intracytoplasmatic premelanosomes. Incubation with HMB-45 MoAb was positive in all cell lines. PAL-M2, NK1/C-3, MAAMA, and IND-1 MoAbs stainings were positive with variable intensity. MNF-116 MoAb showed negative staining in the four lines, and S-100 MoAb was also negative except for the UW-1 cell line. CONCLUSIONS. Human uveal melanoma cell lines OCM-1, SP 6.5, and MKT-BR and the ocular melanocyte cell line UW-1 exhibited maintenance of some structural and ultrastructural characteristics of melanocytic cells. All four MoAbs, PAL-M2, NK1/C3, IND-1, and MAAMA against cutaneous melanoma-associated antigens stained positively all melanoma cell lines as well as the melanocytic cell line, suggesting that in vitro proliferation of melanocytes could modify their antigenic expression.

Expression of HLA Antigens on the Human Uvea

We examined the expression of HLA antigens on post-mortem human uveal tissues and on cultured uveal cells. There was no in vivo expression of class I or class II antigens in these tissues, except for the blood vessel endothelium which expressed class I but not class II antigens. Tissue cultured uveal cells were found to express class I antigens. The effect of interferon-alpha and interferon-gamma on the in vitro expression of these antigens was examined. Class I HLA antigen expression was enhanced by both interferon-alpha and interferon-gamma, while class II HLA antigens were induced on up to 100% of cultured cells, but only by interferon-gamma. These findings are discussed in their relation to immune mechanisms occurring in ocular inflammatory disorders.

HLA-antigens in the human uvea.

With the use of monoclonal antibodies in an indirect immunofluorescence technique we studied the distribution of Class I (HLA-ABC and B27) and Class II (HLA-DR) antigens in the human uvea. W6/32, directed against the core of HLA-ABC antigens, was used to study the distribution of Class I antigens. The anterior border layer of the iris, the non-pigmented and pigmented epithelium and the external basement membrane of the ciliary body and the vascular endothelium in the uvea showed a positive staining for Class I antigens. B27/M1, directed against an epitope of the HLA-B27 antigen, and the control antibody A11/Aw24, which was directed against an epitope of HLA-A11, revealed the same distribution pattern in respectively HLA-B27 and HLA-A11 positive donor eyes. The intensity of their staining was much weaker than the staining with W6/32. Class II antigens were studied with OkIa1, an antibody directed against the core of HLA-DR antigens. HLA-DR antigens were detectable on single cells scattered throughout the entire uvea. These cells did not seem to relate to any anatomical entity. No staining for Class II antigens was seen in the uveal blood vessel endothelium. The expression of HLA-antigens in the uvea is compatible with the distribution in other tissues. These findings suggest that the expression of HLA-B27 in the human uvea does not explain why the eye is one of the target tissues in HLA-B27 associated disease.

The expression of HLA-antigens in the human anterior uvea.

The expression of MHC Class I and Class II antigens was investigated in the human uvea using monoclonal antibodies in an indirect immunofluorescence technique. The anterior border layer of the iris, the non-pigmented and pigmented epithelium of the ciliary body, the external basement membrane of the ciliary body and the vascular endothelium in the uvea showed a positive staining for Class I antigens. The endothelium lining the bloodvessels in the uvea expressed the highest density of Class I antigens. Class II antigens were found only on single cells spread throughout the entire uvea. These cells did not seem to relate to any anatomical entity. No staining for Class II antigens was detected in the uveal blood vessel endothelium. The expression of HLA-antigens in the uvea may provide insight in the pathogenesis of certain HLA associated uveitis entities.

Malignant melanomas of the human uvea: 25-year follow-up of cases in Denmark, 1943--1952.

All cases (302) of malignant intraocular melanomas in Denmark between 1943--1952 were followed up and evaluated 25 years after enucleation, which was the treatment used immediately after diagnosis during that period. The follow-up percentage was 99, 82% of the total being dead at the time of follow-up, bringing the real course of the malignant uveal melanoma in a traditionally treated series nearer to the truth. The same series was analysed in 1963 and 1970. Three-quarters of the patients were hospitalized immediately before and/or in the process of dying. In the series of choroidal and/or ciliary body melanoma the autopsy frequency was 36. Death with metastases took place in 51% (150). Orbital recurrence was found in 2.5% and 8--12% of cases with extrascleral extension had orbital recurrence. This appeared at an average of 2 years after enucleation and 10% of metastases appeared within the first 6 months post-operatively, more than half within 3 years. The peak incidence was during the first year after enucleation. No second peak was observed. However, metastases appeared even after 23 years. The probability of being alive without metastases after 25 years was found to be 40%, assuming that the patient did not die of another cause. The prognosis was estimated using various clinical and histopathological parameters. Women below the age of 40 had a better prognosis than women above that age. Small tumours, spindle shaped cells, no invasion and low pigment content of tumour were all in favour of a good prognosis. Of the iris melanomas from the period dealt with, only one died with metastasis. The present lively discussion on early enucleation or conservative management is reported and finally the attitude of the Ophthalmic Tumour Centre towards therapy is indicated.

Antibodies to uvea in the eye

Uveal proteins could act as autoantigens in certain cases of uveitis. In this study, an antigen made from the soluble proteins of human uvea and pigment epithelium has been utilized for the determinat

Antibodies to Uvea in the Eye

Uveal proteins could act as autoantigens in certain cases of uveitis. In this study, an antigen made from the soluble proteins of human uvea and pigment epithelium has been utilized for the determinat