Graves'-related ophthalmopathy: [A] study of proinflammatory serum cytokines profile and peripheral blood T-cell subsets in relation to clinical status and orbital ultrasonography

ABSTRACT

Aim: Graves'-related ophthamopathy [GRO] is an organ -specific autoimmune disease passing into two stages, the stage of active inflammatory disease, which is treated conservatively by anti-inflammatory drugs or radiotherapy, and the inactive fibrotic stage, which is treated surgically. It is rather difficult to distinguish inflammatory from noninflammatory stages. The aim of the present work was to study some proinflammatory cytokines as sICAM, IL-2, and IFN-gamma serum levels, and peripheral blood T-cell subsets, together with orbital Ultrasonography in patients with GRO and their relation to clinical activity score [CAS] and relevant clinical parameters. Subjects and Fourty patients with GRO were enrolled, 30 of whom had inactive GRO and 10 cases had active GRO according to the clinical activity score, in addition to 10 healthy volunteers as a control group. Thorough clinical evaluation and orbital ulttrasonography were done for all patients. Laboratory work included measurement of sICAM, IL-2, IFN-gamma in serum and T-cell subsets in peripheral blood for patients and control. It was found that age, sex, smoking habit, or thyroid hormone status are not different in patients having active compared to inactive GRO, while the duration of the disease was significantly different, being shorter in those having active GRO. Extraocular muscle hyporeflectivity, as shown by orbital ultra-sonography, was significantly correlated with clinical activity score [P <0.01]. Serum sICAM-1, IL-2, and IFN-gamma levels were high in patients compared to controls [40.4=/=5 pg/ml versus 10.4 +/- 3.08 pg/ml, 440 +/- 187.6 pg/ml versus 65.8'24.3 pg/ml, and 479=/=160.3 pg/ml versus 116.4 +/- 24.0 pg/ml, respectively], and those having active GRO showed higher levels compared to those with inactive GRO [46.2 +/- 4.6 pg/ml versus 38.4 +/- 3.4 pg/ml, 707 +/- 149 pg/ml versus 351 +/- 87.6 pg/ml and 705.3 +/- 108.2 pg/ml versus 404.2 +/- 86.5 pg/ml, respectively]. T-cell subsets studied [CD3, CD4, and CD8] in peripheral blood were not different in patients with active GRO compared to those with inactive GRO [75.5 +/- 6.19% versus 71.8 +/- 5.53%, 58.4 +/- 4.62% versus 53.7+7.26%, and 14.8'6.05% versus 14.8 +/- 3.18%, respectively]. Conclusions: It is concluded that the duration of the eye disease and orbital utrasonography added to the clinical activity score could help distinguish patients with active Graves'-related ophthalmopathy, while serum levels of slCAM-1, IL-2, and IFN-gamma as single measurements, or peripheral blood T-cell subset pattern are of little help in this respect