Rearrangement of immunoglobulin gene in metastatic Waldenström macroglobulinemia to the vitreous.

PURPOSE: To report metastatic Waldenström macroglobulinemia cells with immunoglobulin heavy chain gene rearrangement in the vitreous and the blood. METHODS: A 58-year-old man with Waldenström macroglobulinemia developed bilateral vitreitis. Diagnostic vitrectomy was performed on the left eye. The vitreous cells and the peripheral blood lymphocytes were analyzed using microdissection and polymerase chain reaction amplification. RESULTS: Vitrectomy specimen of the left eye contained a few degenerated cells. Molecular analysis showed immunoglobulin heavy chain gene rearrangement at the third complementary determining region of the vitreal infiltrating cells and peripheral blood lymphocytes. CONCLUSIONS: Waldenström macroglobulinemia rarely metastasizes to the vitreous. Molecular detection of the immunoglobulin heavy chain gene third complementary determining region rearrangement is helpful in the diagnosis of the malignancy. Microdissection combined with polymerase chain reaction is a useful and innovative tool for molecular pathological investigation.

Treatment of uveitis with recombinant human interleukin-13.

AIM: To evaluate the anti-inflammatory cytokine interleukin-13 (IL-13) for the treatment of uveitis. METHODS: Uveitis was induced in monkeys by immunisation with human retinal S-antigen. Starting at the onset of disease, the animals were treated with IL-13 at 25 micrograms/kg, or vehicle control, injected subcutaneously once a day for 28 days. Intraocular inflammation was scored by indirect ophthalmoscopy for a period of 56 days. Circulating leucocyte levels were monitored. RESULTS: Uveitis started unilaterally in all but one animal. IL-13 inhibited inflammation both in the eyes in which the disease was present when the treatment was initiated (p = 0.0001), and in the contralateral initially negative eyes (p = 0.0001). After cessation of therapy, there was a progressive increase of inflammation in the IL-13 treated group. However, the beneficial effect of IL-13 extended into the 4 week follow up period. IL-13 produced an increase in circulating polymorphonuclear neutrophils and a decrease in lymphocytes. CONCLUSION: Administration of IL-13 appears to be a promising modality of treatment for severe uveitis.

Humanized antibodies against the alpha-chain of the IL-2 receptor and against the beta-chain shared by the IL-2 and IL-15 receptors in a monkey uveitis model of autoimmune diseases.

We studied the efficacy and tolerance of humanized Ab interfering with the signal of the IL-2 and IL-15 receptors in a primate model of experimental autoimmune uveoretinitis. The inhibitory effects of humanized anti-Tac (HAT), an anti-IL-2R alpha-chain Ab, and HuMik beta1, an Ab directed at the beta-chain shared by the receptors of IL-2 and IL-15, were tested in culture on the proliferative response of monkey Con A-blast lymphocytes stimulated with IL-2 or IL-15. Uveitis was induced in cynomolgus monkeys by immunization with human recombinant retinal S-antigen. Treatment was initiated at the first sign of disease and consisted of HAT and HuMik beta1, alone or in combination, or vehicle control given by i.v. injection twice a week for 4 wk. Disease was evaluated by ocular funduscopy. The results in culture showed a significant dose-dependent inhibition of the IL-2-driven proliferation of lymphocytes by HAT. HuMik beta1 alone was ineffective against IL-2 stimulation, but had a marked potentiating effect in combination with HAT, independent of IL-15 signaling. IL-15-driven proliferation was inhibited by HuMik beta1, but not by HAT alone or in combination. In monkeys, experimental autoimmune uveoretinitis evolution was significantly inhibited by HAT treatment. HuMik beta1 alone had no effect on the disease. However, when used in combination, the two Ab markedly reduced the severity of ocular inflammation. The Ab were well tolerated. Only three monkeys, treated with HAT alone, made an Ab response against the injected Ab.

Effect of transforming growth factor beta-1 in endotoxin-induced uveitis.

PURPOSE: Transforming growth factor beta-1 (TGF beta-1) can modulate inflammation. Endotoxin-induced uveitis (EIU) is characterized by acute ocular inflammation related to the release of cytokines, including interleukin (IL)-6. The authors investigated the effect of TGF beta-1 on EIU in mice. METHODS: Three independent experiments were performed. Endotoxin-induced uveitis was induced in C3H/HeN mice by an injection of 200 micrograms of lipopolysaccharide (LPS). Two micrograms of TGF beta-1 in 0.1 ml phosphate-buffered saline (PBS) or 0.1 ml PBS alone was administered intraperitoneally at 8 hours after LPS injection. Twenty-four hours after LPS injection, the aqueous humor of the right eyes was collected for leukocyte count, protein concentration, and IL-6 assay. Left eyes were processed for routine histology. RESULTS: TGF beta-1-treated mice showed less ocular inflammation histologically than to the animals that were given PBS. This was confirmed by decreases in leukocyte count, protein concentration, and IL-6 level in the aqueous humor. CONCLUSIONS: TGF beta-1 inhibits the development of EIU. TGF beta-1 may be useful for the modulation of uveitis in humans.

Interleukin 10 inhibits inflammatory cells infiltration in endotoxin-induced uveitis.

BACKGROUND: Endotoxin-induced uveitis (EIU) is a model for acute anterior uveitis associated with a variety of pro-inflammatory cytokines and nitric oxide production. Interleukin 10 (IL-10) down-regulates these inflammatory mediators. We report a study of the effect of systemic administration of IL-10 on the inflammatory parameters of EIU. METHODS: Uveitis was induced in C3H/HeN mice by subcutaneous injection of 200 micrograms lipopolysaccharide (LPS) per mouse. Intraocular inflammation was assessed by leukocyte count and measurement of the protein concentration in the aqueous humor (AH). Mouse recombinant IL-10 at 1000 U or its vehicle alone were administered by three intravenous injections given 4.0 h and 0.5 h before and 8.0 h after LPS injection. RESULTS: The inflammatory cell infiltration in the eyes was significantly reduced in four of five experiments from 40% to 64% in the groups treated with IL-10 compared to the control groups (P < 0.05). In contrast, the level of protein exudation in the anterior chamber (AC) was not significantly affected by IL-10 treatment. CONCLUSION: IL-10 reduces the cellular infiltration in the ocular inflammation produced by endotoxin. This result suggests potential usefulness for IL-10 in the treatment of severe anterior uveitis with a strong cellular component.

Intraocular production of a cytokine (CINC) responsible for neutrophil infiltration in endotoxin induced uveitis.

AIMS/BACKGROUND: The subcutaneous injection of bacterial endotoxin in Lewis rats produces an acute intraocular inflammation evolving over a 24 hour period. This endotoxin induced uveitis (EIU) is characterised by a biphasic protein exudation and a cellular infiltrate composed of macrophages and polymorphonuclear neutrophils (PMNs). This model was used to study the mechanism of cellular infiltration in ocular inflammation. METHODS: EIU was induced by a subcutaneous injection of lipopolysaccharide (LPS) (S typhimurium) at 350 micrograms/kg. The levels of cytokine induced neutrophil chemoattractant (CINC) were measured every 2 hours in the serum and in the aqueous humour by ELISA. The intraocular inflammation was quantified by protein measurement and leucocyte counting. RESULTS: The kinetics of CINC production in the systemic circulation showed a rapid rise, peaking 2 hours after LPS injection, followed by a progressive decline over the next 8 hours. In the eye, the CINC levels increased above the serum levels 10 hours after EIU induction corresponding to the time of cellular infiltration. When leucocyte entry in the eye was inhibited by 56% and 64% with an antiadhesion molecule antibody, there was only a slight reduction in the aqueous humour CINC levels of 9% and 16%, respectively, indicating that CINC was produced by ocular tissue cells. The specific effect of CINC in the eye was confirmed when a direct intraocular injection of 250 ng of purified CINC was followed by significant PMN infiltration, in the absence of protein exudation. CONCLUSION: The data indicate that the production of the CINC chemotactic factor by ocular tissue participates in the inflammatory reaction in EIU.

Protective role of nitric oxide in ocular toxoplasmosis.

AIMS: To evaluate the role of nitric oxide (NO) in ocular involvement during systemic toxoplasmosis. METHODS: C57B1/6 mice were infected with Toxoplasma gondii strain ME49. The synthesis of NO was inhibited by an intraperitoneal injection of aminoguanidine every 8 hours, starting on the day of infection. Control infected mice received phosphate buffered saline vehicle alone. After 14 days, the ocular lesions were evaluated by histopathological examination. The expression of NO synthase induced in the spleen by toxoplasma infection was evaluated by immunostaining. The production of NO by the spleen cells of infected mice was measured by the colorimetric assay of Griess in the supernatant of cultures stimulated with toxoplasma antigen or concanavalin A. RESULTS: The inhibition of NO production in T gondii infected mice resulted in a marked increase in the symptoms of ocular inflammation. We observed a strong induction of NO synthase expression in the spleen of infected animals. In culture, the spleen cells from these mice produced high levels of NO in response to T gondii antigens. This elevation of NO synthesis was suppressed in the presence of aminoguanidine. CONCLUSION: This study indicates that NO plays a crucial role in the protection against T gondii infection as reflected by the severity of the ocular involvement.

Contribution of nitric oxide to the host parasite equilibrium in toxoplasmosis.

We studied the effect of nitric oxide (NO) production on the evolution of toxoplasmosis in C57BL/6 mice. Infection was induced by i.p. injection of Toxoplasma gondii strain ME49. NO synthesis was inhibited by treatment with aminoguanidine, a structural analogue of L-arginine. The severity of infection was evaluated by histopathologic examination of the brain. In the infected mice treated for 2 wk with aminoguanidine, we observed an increase in the number of toxoplasma tachyzoites and intracellular cysts accompanied by an exacerbated inflammation of the brain tissue compared with that in controls. When spleen cells from infected mice were stimulated in culture with toxoplasma Ag, there was a marked cytotoxic effect on cells collected during the acute stage of infection and an inhibition of proliferation of the remaining viable lymphocytes. These effects were correlated with high levels of NO and PGE2 production. The suppression of NO synthesis prevented cell death and restored the lymphocyte proliferative response as well as lymphokine production. The neutralization of IFN-gamma or TNF-alpha had no effect on NO production in the cultures of infected mouse spleen cells. Cultures in which purified macrophages and lymphocytes from infected and naive mice were mixed indicated that the production of NO was dependent on lymphocyte activation. In the later stages of infection, when the production of NO was abating, preventing PGE2 secretion with indomethacin also increased the lymphocyte proliferative response. We conclude that the opposing effects of NO in toxoplasmosis, which protects against Toxoplasma gondii and at the same time limits the immune response, probably contribute to the establishment of the characteristic chronic state of host parasite equilibrium.

Synergistic effect of rapamycin and cyclosporin A in the treatment of experimental autoimmune uveoretinitis.

Immunosuppressive drugs currently available for the treatment of autoimmune diseases display a narrow therapeutic window between efficacy and toxic side effects. The use of combinations of drugs that have a synergistic effect may expand this window and reduce the risk of toxicity. We evaluated the combination effect of rapamycin (Rapa) and cyclosporin A (CsA) in an autoimmune disease model of the eye. The dose-effect relationship of Rapa with CsA was measured in vitro on the inhibition of proliferation of retinal S-Ag-primed lymphocytes. A median effect analysis was performed and a combination index (CI) calculated for 50% inhibition of proliferation. Rapa and CsA were markedly synergistic over a wide dose range (lowest CI = 0.31). Calculated dose reduction factors indicated that Rapa could be reduced nine-fold and CsA reduced five-fold when these drugs were used in combination. These reduced doses were tested in vivo for the treatment of experimental autoimmune uveoretinitis (EAU). Twelve of 15 rats treated with CsA, 2 mg/kg/day, developed EAU with a median severity of 2.5. Fourteen of 15 rats treated with Rapa, 0.01 mg/kg/day, developed EAU with a median severity of 3.25. Complete inhibition of EAU was achieved in all 15 animals treated with the combination of Rapa and CsA (combined vs CsA alone, p < 0.0002; combined vs Rapa alone, p < 0.00001). The demonstrated synergistic relationship between Rapa and CsA will allow the use of reduced doses of each drug to achieve a therapeutic effect. The use of lower doses may reduce the toxicity of these drugs for the treatment of autoimmune uveitis.

Side effects of rapamycin in the rat.

The side effects of Rapamycin was evaluated by histopathological examination of the heart, kidneys, and eyes of treated Lewis rats. Rapamycin was administered during 14 days by continuous intravenous infusions at doses of 0.5, 1.0, and 1.5 mg/kg/day. Focal myocardial infarction was observed in three of five rats with Rapamycin given at 1.5 mg/kg/day and two of 22 rats with 1.0 mg/kg/day. There were no sign of myocardial toxicity at a Rapamycin dose of 0.5 mg/kg/day. The retina of one eye of a rat treated at a dose of 1.5 mg/kg/day had a small area of focal ischemic necrosis. The kidneys were normal at all doses.

Synergism between corticosteroids and Rapamycin for the treatment of intraocular inflammation.

The authors studied the combination effect of corticosteroids with the new immunosuppressant Rapamycin for the treatment of intraocular inflammation. A median-effect analysis, of the combined effect of Rapamycin and dexamethasone, was performed on the inhibition of lymphocyte proliferation in culture. The mathematical formulas allowed for the calculation of combination indices and dose-reduction factors. On the basis of these in-vitro results, treatment with reduced doses of drugs in combination was evaluated in the rat model of experimental autoimmune uveoretinitis. The results showed that Rapamycin and dexamethasone were synergistic over a wide concentration range. The calculated dose reduction factors indicated that an equivalent inhibition of lymphocyte proliferation was achieved with a combination of Rapamycin and dexamethasone reduced by 5-7 and 3-6 fold respectively, compared to the concentration required when each drug was used alone. In animals, there was a significant reduction of the incidence and severity of ocular inflammation with low doses of the drugs in combination. The authors conclude that the observed synergistic effect between Rapamycin and dexamethasone suggests that the use of this drug combination might be advantageous in the treatment of patients with severe uveitis.

The role of nitric oxide in uveitis.

OBJECTIVE: To evaluate the possible role played by nitric oxide in the pathogenesis of uveitis. METHODS: Uveitis was induced in rats with subcutaneous lipopolysaccharide. Lipopolysaccharide stimulates nitric oxide production from L-arginine. The animals were treated with NG-nitro-L-arginine methyl ester, an L-arginine analogue acting as a specific inhibitor of nitric oxide synthesis. Ocular inflammation was evaluated by measuring protein concentration and leukocyte number in the aqueous humor of one eye, and by histopathologic examination of the contralateral eye. RESULTS: Aqueous humor protein levels were reduced 73% to 82% and cellular infiltration was almost abrogated in NG-nitro-L-arginine methyl ester-treated rats compared with controls. The histopathologic examination also showed a similar inhibition of uveal tissue inflammation in treated rats. CONCLUSION: By inhibiting nitric oxide synthesis, NG-nitro-L-arginine methyl ester inhibits the induction of endotoxin-induced uveitis in the rat. This observation demonstrates that nitric oxide is an important mediator of anterior uveitis in this model system and suggests that nitric oxide may also be implicated in human uveitis.

Suppression of S-antigen-induced experimental autoimmune uveoretinitis in Lewis rats by oral administration with CGS-13080, a thromboxane synthetase inhibitor.

Oral administration of CGS-13080 [imidazo (1, 5-alpha) pyridine-5-hexanoic acid], a thromboxane synthetase inhibitor, has been reported to cause a marked reduction in serum thromboxane B2 concentration in humans and animals. Since thromboxane metabolites play an important role in ocular inflammation, the effect of oral CGS-13080 in the development of experimental autoimmune uveoretinitis in Lewis rats has been investigated. Females were immunized with bovine S-antigen (S-Ag). Treatment was started on day 0 of immunization. Animals were divided into three groups. The control group was fed a standard pellet diet, while the treated groups were fed the standard diet supplemented with either a low dose (0.8 g per 10 kg pellet) or a high dose (1.6 g per 10 kg pellet) of CGS 13080. From day 10 after immunization, the eyes of these rats were examined daily for clinical evidence of experimental autoimmune uveoretinitis. On day 14, the eyes were collected for histologic study. The cellular immune responses were evaluated on the draining inguinal lymph nodes. Blood samples were also collected for the measurement of anti-S-Ag antibody production, thromboxane B2 and prostaglandin A2 levels. Clinical disease developed in 73.3% of the control rat group, 30.0% of the low-dose treated group and 17.6% of the high-dose group. The average histologic grade was 1.9 in the control group, 0.65 in low-dose group and 0.32 in high-dose group. Lymphocyte proliferation to S-Ag paralleled the clinical disease scores. Average stimulation indices were 10.9 in the controls, 7.5 in the low-dose group and 2.2 in the high-dose group.(ABSTRACT TRUNCATED AT 250 WORDS)

Human S-antigen: presence of multiple immunogenic and immunopathogenic sites in the Lewis rat.

To identify the immunogenic and immunopathogenic sites present in human S-Antigen (S-Ag), 40 overlapping peptides that span the whole length of the S-Ag molecule were synthesized and tested in the Lewis rat model of experimental autoimmune uveitis. The most pathogenic sequences were 180-200, 340-360 and 350-370. Ten peptide sequences were identified that induced visible inflammation in the eye. A total of 23 peptides gave an in-vitro proliferative response following immunization in animals. The ability to generate an immune response was not linked to the pathogenic capacity of the sequence. The most pathogenic sequence, 340-360, was only weakly proliferative. Peptide 180-200 and peptide 340-360 gave higher T-cell proliferative responses, but these were lower than the maximal proliferative response observed with non-pathogenic sequences. In animals immunized with whole S-Ag, the majority of the determinants did not elicit a proliferative response, indicating that in S-Ag, the majority of the immunogenic determinants are cryptic and are not presented by the APC located in the lymph nodes.

Treatment of autoimmune uveoretinitis in the rat with rapamycin, an inhibitor of lymphocyte growth factor signal transduction.

Rapamycin (RAPA) is a macrolide antibiotic with unique immunosuppressive properties. RAPA inhibits T-cell function by interfering with IL-2 and IL-4 signal transduction. It does not prevent IL-2 production or IL-2R expression. The efficacy of RAPA in the treatment of autoimmune diseases was evaluated using the experimental autoimmune uveoretinitis (EAU) model. EAU was actively induced in Lewis rats by immunization with S-antigen in Hunter's adjuvant. RAPA and control vehicle were administered by continuous intravenous infusion over a 14 day period by miniosmotic pump. RAPA treatment initiated on the day of immunization or 7 days later was found to efficiently inhibit EAU induction. The minimal effective dose was 0.1 mg/kg/d. EAU inhibition was correlated with reduced number of cells in the immunization site draining lymph nodes, as well as with a shift and lowering of the peak of the lymphocyte proliferative response curve. The anti-S-antigen antibody response was delayed by 3 days under RAPA treatment and the serum levels lowered in a dose dependent manner. An initial body weight loss was observed during the first week of drug administration, but there was a normal weight gain afterward.

Inhibition of cellular transfer of experimental autoimmune uveoretinitis by Rapamycin.

The crucial role of CD4(+) T cells in mediating uveitis is well recognized. One treatment strategy of non-infectious uveitis therefore seeks to inhibit T cell function. For that purpose the authors have evaluated the efficacy of Rapamycin (RAPA), an inhibitor of lymphocyte response to growth factors. To reproduce as best as possible the immune system condition during active disease, the adoptive transfer of activated T cells was used to induce experimental autoimmune uveoretinitis (EAU). Treatment with RAPA was delivered by continuous intravenous infusion. The results showed a complete inhibition of EAU transfer at the RAPA dose of 0.1 mg/kg/day. They indicate that RAPA could be a useful immunosuppressant for uveitis therapy.

A new effective and non-harmful chemical adjuvant for the induction of experimental autoimmune uveoretinitis.

The induction of T cell mediated disease models in animals is usually dependent on the use of complete Freund's adjuvant (CFA). In order to avoid the painful side effects of CFA on the animals, we tested the capacity to induce experimental autoimmune uveoretinitis (EAU) with Hunter's adjuvant (HA). This new adjuvant makes use of nonionic copolymer surfactants, and does not cause deleterious effects to animals. We have found that EAU could be efficiently induced in rats with low doses of S-Ag (10 micrograms) in very small quantity of HA (10 microliters). The biologic parameters of EAU induction showed a potent stimulation of lymphocytes proliferation maximal 11 days after immunization, as well as high levels of antibody production.

Treatment of corneal allograft rejection with the cytotoxin IL-2-PE40.

IL-2-PE40 is a recombinant chimeric protein composed of IL-2, fused to a modified pseudomonas exotoxin. This molecule is extremely toxic to activated T cells expressing high-affinity IL-2R. We used this new molecule for selective immunosuppression to treat corneal allograft rejection in the rat, using Fisher and Lewis rats, a strain combination differing only in medial and minor histocompatibility antigens. The effect of IL-2-PE40 on the immunologic response was studied using both a heterotopic corneal graft model and orthotopic grafts. At the dose of 0.31 micrograms/g given intraperitoneally every 12 hr, IL-2-PE40 produced a significant reduction of both total lymph node cells and cytotoxic-T-cell (CTL) activity in draining lymph nodes (DLN) of heterotopically grafted animals. IL-2-PE40 treatment also significantly reduced the clinical rejection score and cumulative rejection rate (CRR) in orthotopic grafts and appears to be a very effective immunosuppressive agent.

Injury of Müller cells increases the incidence of experimental autoimmune uveoretinitis.

Müller cells have been shown to have a dual effect in vitro on autoimmune T helper lymphocytes. In a coculture system, Müller cells have a primary inhibitory effect on the proliferation of T lymphocytes. In conditions where their inhibitory action is suppressed, Müller cells can, however, stimulate T cells. In the present study we evaluated the in vivo effect of Müller cells on actively induced experimental autoimmune uveoretinitis (EAU). Ten millimoles of L-alpha-aminoadipic acid (L-AAA), a specific gliotoxic agent, was injected into the vitreous of one eye of Wistar-Furth (WF) rats (a low EAU responder) on the day of immunization. Control rats were injected similarly with phosphate-buffered saline alone. The rats were immunized with S-antigen in CFA or in CFA alone. The results demonstrate that the incidence of EAU increases twofold in the eyes receiving an intravitreal injection of L-AAA in comparison to the contralateral eyes not receiving an injection. No such difference in EAU incidence was observed in control animals. Some rats that had been immunized with CFA alone after an intravitreal injection of L-AAA demonstrated a small amount of retinal perivascular inflammatory cell infiltrate but did not develop typical EAU lesions. The retinal vasculature was normal on examination by fluorescein angiography after injection of L-AAA. These data suggest that Müller cells can influence the course of uveoretinitis through their interaction with T cells.

Inhibition of T lymphocyte proliferation by retinal glial Müller cells: reversal of inhibition by glucocorticoids.

Study of interactions between retinal glial Müller cells and T lymphocytes have revealed a wide array of reciprocal influences on the functions of these cells. In the present study we show that these interactions can be further modified by corticosteroid hormones. The primary effect of Müller cells on T lymphocytes is an inhibition of the T-cell proliferative response, and it is exerted via a membrane-bound factor. In this report we show that glucocorticoids can reverse the inhibition by suppressing the expression of the Müller cell inhibitory factor. This effect was independent of the action of glucocorticoids on arachidonic acid metabolism.