|Year : 1977 | Volume
| Issue : 3 | Page : 1-4
Immunoglobulins in trachoma
HV Nema1, Ratanmala Gupta1, Usha Shenoy2
1 Department of Ophthalmology, Institute of Medical Sciences, Banaras Hindu University, Varanasi-5, India
2 Department of Pathology, Institute of Medical Sciences, Banaras Hindu University, Varanasi-5, India
H V Nema
3, Medical Enclave, Banaras Hindu University, Varanasi-221 005
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Nema H V, Gupta R, Shenoy U. Immunoglobulins in trachoma. Indian J Ophthalmol 1977;25:1-4
With the isolation of TRIC-agent, attempts have been made to study the immunology of trachoma with a view to improve the results of chemotherapy and possibly to immunize the vulnerable population against the disease., However, there is a growing evidence to suggest that TRIC-agent produces a weak immunological response and therefore, the trachoma antigen gives a disappointing skin test and a variable complements fixation test.
Recently, increasing interest has been taken in studying immunoglobulin in body secretions and fluids since they are thought to be important local agents for the host defence mechanism in infectious disease process. Most of the work on immunoglobulins in trachoma originated from United States of America where the disease is seen in pockets., McClellan et al, studied serum and tear immunoglobulins in Navajo children with trachoma, and reported elevation of serum IgG and lowering of tear IgG and IgA in trachomatous children.
Considering the paucity of report on immunoglobulins in trachoma from our country and regional biological differences in the strains of TRIC-agent, a study was undertaken to determine the immunoglobulins levels in the serum and tears of Indian trachomatous patients.
| Materials and Method|| |
Thirty one proved cases of trachoma were selected from the out patient department of Bhuwalka Eye Hospital, Institute of Medical Sciences, Banaras Hindu University, Varanasi. The diagnosis of trachoma was based on clinico-cytological examination as recommended by W.H.O. Expert Committee on trachoma. Each case was examined with the help of slit-lamp-biomicroscope (X 16). The age of the patients ranged between 16 and 62 years and the series comprised of 19 males and 12 females. 20 healthy non-trachomatous individuals well matched for age and sex to trachomatous cases were also selected for the control.
Five ml. of blood was collected for separation of serum. Tears were collected from the lower fornix with the help of a micro-pipette by capillary action without inducing any lacrimation. Tears were expressed from the pipette into the Derham's tubes. IgG, IgA and IgM in serum and tears were estimated by single radial diffusion technique of Fahey.
The mean and standard deviations of each immunoglobulin class in trachomatous and non-trachomatous cases were calculated and student `t' test compared the immunoglobulin classes in the two groups.
| Observation|| |
Serum Immunoglobulins. In 20 normal cases (control group), highest and lowest values of serum IgG were found to be 1500 mg% and 780 mg% respectively with a mean of 1172± 202.46. Serum IgA ranged between 240 mg% and 450 mg% with a mean of 322.75±51.69 and serum IgM level ranged between 135 mg% and 350 mg% with a mean of 229.0+50.56 [Table - 1]
In trachomatous group of 31 cases, serum immunoglobulin could be estimated in 28 cases only. Serum IgG showed variation from 800 mg% to 1644 mg% with a mean of 1309.107± 252.746. Serum IgA ranked between 180 mg% and 355 mg% with a mean of 257.142-55.363. Serum IgM ranged between 100 mg% and 350 mg% with a mean of 203.00±66.105 [Table - 2].
Tear Immunoglobulins. In normal group, the range of 1gG was 8-25% with a mean of 11.5±3 62. The range of IgA was 8-25 mg% with a mean of 16.1±3.75 [Table - 1]. No IgM could be detected in normal individuals.
In trachomatous group of 31 cases tear immunoglobulins could be studied in 23 cases only. The tear IgG level ranged between 12 mg% and 45 mg with a mean of 32.043±13. 421, while IgA ranged between 12 mg% and 47 mg% with a mean of 28.434 + 9.787. IgM could be detected in a solitary tear sample [Table - 2].
| Discussions|| |
Serum Immunoglobulins. Although trachoma is a localised inflammation of the conjunctiva and cornea (Kerato-conjunctivitis), it is indeed capable of altering the serum immunoglobulin concentrations as evident by our observations. Serum immunoglobulin G in trachomatous patients rises significantly as compared to the serum IgG level in the control (p 0.005). However, the level of serum IgA in trachomatous group shows a highly significant fall in comparison to the serum IgA level in control (p 0.001). While the levels of serum 1gM in trachoma tons and non-trachomatous groups do not differ statistically (p 0.20).
The rise of serum IgG in trachoma in the present study is in complete agreement with the report of McClellan, Bettman and Allansmith but these workers, however, obtained insignificant difference in the serum levels of IgG and IgM between trachomatous and non-trachomatous subjects.
Isa found elevation of serum IgG in the patients experimentally infected with TRICagent. Still there is not enough evidence to suggest that the rise of IgG in serum could be accounted for additional antibodies production. In a study on Tunitian trachomatous children, it was inferred that the trachoma antibodies belong to IgG class. Presently, no explanation can be advanced for the rise of serum IgG and fall of IgA in the serum of trachomatous patients. Nevertheless, it indicates that a localised prolonged follicular hypertrophy in conjunctiva may produce an alteration in the immune component of the body.
Tear Immunoglobulins. Sufficient amount of IgA and IgG are found in the tears of normal subjects in the present series Our tear immunoglobulin concentration differs from that of Sen et al, who could obtain IgG only in traces in the tears of normal Indian people. But American workers, sub reported much higher levels of IgG and IgA in the tears of non-trachomatous Navajo children than that of our's.
It is observed that IgG and IgA in tears of trachomatous subjects are significantly higher than that of nontrachomatous group (p 0.001). This finding is in striking contrast to those of McClellan, Bettman and Allansmith, who found significantly lower levels of IgG and IgA in the tear of trachomatous children as compared to nontrachomatous. IgM could only be detected in one tear sample from trachomatous eye against none from the normal ones.
The increase of immunoglobulin IgG and IgA in tears of trachomatous subjects may either be related to increased permeability of conjunctival vessels resulting in leakage of serum proteins into the tears or to local synthesis of immunoglobulins. The presence of high level of IgA in tears and depletion of its level in serum in trachoma patients support the former conjecture. In spite of the fact that trachoma can produce local as well as systemic immunological reponse, it's doubtful whether these humoural antibodies can provide sufficient protection against the TRIC infection, since the disease is notorious for relapses and reinfections.
| Summary|| |
Serum and tear immunoglobulins (IgG, IgA and IgM) were estimated in 20 normal and 31 trachomatous subjects by single radial diffusion technique of Fahey. It was observed that serum IgG was raised and serum IgA was lowered in trachomatous subjects, while no difference was found in the level of serum IgM. Both IgG and IgA were raised in the tears of trachomatous patients. Possible explanations are advanced for the rise of tear immunoglobulins in trachoma. The role of these immunoglobulins in providing the immunity against the TRIC infection is doubtful.
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[Table - 1], [Table - 2], [Table - 3]