Zusammenfassung
Nichtinfektiöse Formen der Uveitis sind durch einen Zusammenbruch der immunologischen Toleranz charakterisiert. In Tiermodellen konnten verschiedene Zytokine als lösliche Botenstoffe identifiziert werden, die entscheidend an der Regulation des Immunsystems während der Induktion, Progression und Remission der okulären Entzündung beteiligt sind. Diese Übersichtsarbeit analysiert den aktuellen Wissensstand über die Rolle der Zytokine für die Uveitis und dessen Relevanz für die klinische Diagnostik. Untersuchungen des Kammerwassers und des Serums von Uveitispatienten zeigen eine vermehrte Konzentration proinflammatorischer sowie eine Verminderung antiinflammatorischer Zytokine. Zusätzlich wurden Sequenzvarianten von Zytokingenen (single nucleotide polymorphisms) beschrieben, die das Expressionsniveau verändern und mit einem erhöhten Erkrankungsrisiko verbunden sind. Diese Studien wurden jedoch nur an kleinen oder heterogenen Patientengruppen durchgeführt. Zudem sind die Resultate teilweise widersprüchlich. Daher spielte die Analyse von Zytokinen bislang keine Rolle in der Routinediagnostik der Uveitis. Neue Multiplexverfahren der Zytokinanalyse liefern jedoch umfassendere Daten zum Verständnis der komplexen Regulation des Immunsystems im Verlaufe der intraokulären Entzündung. Dadurch kann es in Zukunft möglich werden, die für den einzelnen Patienten relevanten Mechanismen der Immunreaktion quantitativ zu beschreiben, um die individuelle Prognose einschätzen und gezielt die für den Patienten optimale Therapieform auswählen zu können.
Abstract
Non-infectious uveitis is characterised by a breakdown of immunological tolerance. Several cytokines could be identified as important regulators of the immune system during induction, progression and remission of ocular inflammation in animal models. This review analyses the current knowledge on cytokines in uveitis and their relevance for diagnostic purposes. Elevated levels of pro-inflammatory and decreased concentrations of anti-inflammatory cytokines were detected in the aqueous humor and serum of uveitis patients. In addition, single nucleotide polymorphisms of cytokine genes altering expression levels were found to be associated with an increased risk of uveitis. These studies, however, included only small or heterogenous patient populations. Moreover, the reported data are partially inconsistent. Thus, the analysis of cytokines does not play a role in the routine diagnostic process of uveitis so far. New multiplex techniques for cytokine analysis will provide comprehensive data for a better understanding of the complex regulation of the immune system during intraocular inflammation. This may lead to a quantitative description of the immunological mechanisms of uveitis in the individual patient to improve the prognostic evaluation and select the most efficient treatment.
Schlüsselwörter
Intraokulare Entzündungen - Zytokine - Diagnostik - Single nucleotide polymorphism
Key words
intraocular inflammation - cytokines - diagnosis - single nucleotide polymorphisms
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Kathrin Greiner,MD, PhD
St. John Eye Hospital
P. O. Box 19960
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Israel
Phone: ++ 9 72/2/5 82 83 25
Fax: ++ 9 72/2/5 82 83 27
Email: greiner@doctors.org.uk
