Anterior Uveitis-Complement System

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Anterior Uveitis Anterior Uveitis AU Anterior uveitis AU is one of the most common types of ocular inflammation that occurred in the uveal tract including the iris anterior part of ciliary body or both. Iridocyclitis and iritis are two typical subtypes of AU. The inflammation of iridocyclitis gives priority to the ciliary body along with iris while iritis is the inflammation of the anterior chamber and iris. In anterior uveitis patients excessive infiltration of neutrophils macrophages and lymphocytes can cause permanent damage to the ocular tissue. According to its clinical course clinical appearance granulomatous or non-granulomatous infectious or non-infectious etc. anterior uveitis is classified as acute or chronic anterior uveitis. Symptoms and Signs of Anterior Uveitis • Red sore and inflamed eye • Burning of the eye • Blurred vision • Sensitivity to light • Irregular-shaped pupil • Blacked out sclera • Dark spots in the visual • Headaches • Dilated ciliary vessels • Cells and flare in the anterior chamber • Keratic precipitate • Busacca nodules

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Fig.1 Uveitis results from imbalance between inflammatory mechanisms and regulatory mechanisms. Mé rida 2015 Without effective and timely treatment AU may lead to severe complication glaucoma cataract or retinal edema etc. compared with permanent ocular damage and loss of vision. AU is responsible for the rise of intraocular pressure which may lead to glaucoma. Moreover cystoid macular edema CME is proved to be associated with the AU-caused fluid accumulation in the macula. Causes of Anterior Uveitis The exact pathogenesis of AU is not clear while there is a diverse set of accepted etiologies that span a wide spectrum of genetic infectious and noninfectious causes. • Immune-mediated noninfectious Causes Th17 T cell sub-population that bear T-cell receptors is activated in AU patients. To prevent the autoreactivity of T cells and protect the eyes microglia and dendritic cells in the eye produce a large amount of TGF-β and other suppressive cytokines including IL-10. • Genetic Factors There are some strong genetic factors that predispose the anterior uveitis onset including HLA-B27 a class I major histocompatibility complex and the PTPN22 genotype. HLA-B27 is closely associated with ankylosing spondylitis which is a

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chronic systemic disease characterized by inflammation of both sacroiliac joints and the spine and the most common extra-articular manifestation is anterior uveitis. • Infectious Causes Strong evidence has pointed to reactivation of viruses herpes simplex varicella zoster etc. parasites and fungi as important causes of anterior uveitis. Bacterial infection is another significant contributing factor in the pathogenesis of AU. • Complement Complement and complement regulatory proteins CRegs in the pathogenesis of anterior uveitis have been addressed and recognized especially C3 and complement receptor 3 CR3. The presence of complement was critical for local production of cytokines IFN-γ and IL-10 chemokines IP-10 and adhesion molecules ICAM-1 and LECAM-1 in anterior uveitis.

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