|Year : 1978 | Volume
| Issue : 4 | Page : 26-29
HLA antigens in acute anterior uveitis in North Indians
S Sen Gupta, IS Jain, GC Jain, SD Deodhar
Deptt. of Pathology, Ophthalmology and Rehumatology, PIMER, Chandigarh, India
S Sen Gupta
Department of Pathology, Ophthalmology and Rheumatology, Postgraduate Institute of Medical Education and Research, Chandigarh-160012
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Gupta S S, Jain I S, Jain G C, Deodhar S D. HLA antigens in acute anterior uveitis in North Indians. Indian J Ophthalmol 1978;26:26-9
Major histocompatibility complex (MHC) is termed HLA in man. This has been located on the 6th pair of chromosomes. Genes included in this complex control the strongest transplantation (histocompatibility antigens). These antigens are present on the leukocytes and other tissues of the body. The region is further subdivided into A, B, C and D loci. Since the autosomal chromosomes are paired, considering only A and B loci, each individual may have a set of four different antigens, two of which (one belonging to A locus and one to B locus) are inherited from the father and two (one belonging to A locus and one to B locus) from the mother.
Besides the importance of HLA in organ transplantation, during the recent years, the association of some of the HLA antigens with several diseases has been reported. The classical example of such an association is that of HLA-B27 with ankylosing spondylitis (AS). Upto 88-96% of the Caucasian patients suffering from ankylosing spondylitis possess B27 in contrast to 4-8% in the controls,. subHLA study conducted on North Indian patients of AS revealed the incidence to be 94% as compared to 3.3% in the controls,.
Acute anterior uveitis is often associated with several systemic disorders. It is frequently associated with ankylosing spondylitis, Reiter's disease, tuberculosis, syphilis, gonorrhea, viral infections and sarcoidosis but 45% cases remain of unknown etiology. The discovery that 55% of Caucasian patients suffering from acute anterior uveitis possess B27, stimulated the present study on North Indian patients.
| Materials and Methods|| |
28 patients attending the uveitis clinic at Postgraduate Institute of Medical Education and Research, Chandigarh were referred for HLA typing after the detailed ophthalmological examination. Twenty patients were males and eight were females. Twenty two patients aged 16-45 years. Twelve patients had unilateral ocular involvement and sixteen had binocular involvement. Eighteen patients reported during the first attack while the rest had recurrent attacks. Duration of illness varied from a few days to several years. Routine investigations included blood counts, E.S.R., urine and stool examination, Rose-Wala, latex fixation, Montoux test and X-Ray Chest. Patients were referred to Rheumatology clinic for further investigations. X-Rays of sacroiliac joints were done where indicated.
Patients attended eye department because of their ocular problems and on detailed investigations, ninteen were found to have associated illness.
HLA typing was done by two stage lymphocytoxicity micromethod, using a battery of 80 well defined HLA antisera. The controls for the study included 60 healthy individuals.
| Results|| |
The results of HLA antigens in the patients and controls are given in [Table - 1].
The significant findings were decrease in the incidence of Al (P value<0.05) and increase in the incidence of A9(P value<0.05) and B27 (P value<0.001) in patients as compared to controls. There was no statistically significant difference in the incidence of other HLA antigens.
Correlation of HLA-B27 with associated diseases is shown in [Table - 2][Table - 3]
Out of eleven patients with HLA-A9, eight were positive for HLA-B27 as well. Three of these had definite ankylosing spondylitis, one had Reiters disease each pulmonary tuberculosis and lepromatous leprosy. Two patients did not have associated disease.
| Discussion|| |
HLA typing in 28 patients of acute anterior uveitis revealed that HLA-B27 was present in 64.3% as compared to 3.3% in controls. The difference was highly significant (P value< 0.001). It is important to note that ninteen patients had associated disease and B27 was present in 15 patients (80%). Ten cases of anterior uveitis associated with ankylosing spondylitis (8 classical and 2 probable) were positive for B27 (100%) compared to 94% in classical ankylosing spondylitis alone. One patient each having Reiter's disease, active pulmonary tuberculosis, lepromatous leprosy and urethritis were also positive for B27. Out of three female patients with urinary tract infection, only one was positive for B27.
Significant association of HLA-B27 in cases of acute anterior uveitis with diseases like ankylosing spondylitis, Reiters disease and other infectious diseases like tuberculosis, lepromatous leprosy and urethritis may be of great value. If the patient presents with acute anterior uveitis and is positive for HLA-B27, one must seriously investigate for a rheumatologic disorder, urinary tract infection or systemic bacterial infection. HLA-B27 was present in 3 out 9 cases (33%) with no associated diseases,. The number of cases being small HLA antigens were not analysed separately.
Combination of A9 and B27 in eight patients of acute anterior uveitis seems to be interesting specially the association of ankylosing spondylitis in three cases and Reiter's in one. In our initial study on 17 cases of definite AS, three had A9 and B27 combination, two of them had acute anterior uveitis. Thus A9 and B27 combination seem to be more commonly associated with acute anterior uveitis and AS.
Association of HLA-B27 in 64.3% cases of acute anterior uveitis, though an interesting observation does not explain the occurrence of disease in the absence of B27 in 36% cases with associated disease and 67% with no associated disease, This obviously indicates that there are factors in addition to the presence of HLA-B27 that make a person susceptible to disease like acute anterior uveitis. Several mechanism have been postulated. Since HLA antigens are present on the surface of the cells, they may function as receptors capable of binding microbial agents, viruses or other substances of pathological significance. It is possible that the B27 gene has relationship with a linked "susceptibility" and/or "Immune response" genes and the expression of the disease occurs only when appropriate genes or their products are able to adequately interact. Thus a combination of factors like microbe host antigenic identity, immunological responsiveness, genetically determined susceptibility and other external and internal enviromental factors may finally determine the susceptibility of a given individual to disease and that holds true for acute anterior uveitis as well.
Presence of HLA-B27 in cases of acute anterior uveitis and other seronegative spondyloarthropathies makes one postulate a common etiopathogenic mechanism underlying these diseases.
| Summary|| |
HLA typing was done in 28 cases of acute anterior uveitis. HLA-B27 was found in eighteen patients (64.3%) as compared to 3.3% in the controls (P value<0.001). Ninteen patients had associated disease and fourteen of these were positive for B27. Associated diseases of significance in the B27 positive cases were ankylosing spondylitis classical (8), ankylosing spondylitis probable (2), lepromatous leprosy (1), pulmonary tuberculosis(l) and urinary tract infection(2). Incidence of A9 was high in patients (P value<0.05). A9 & B27 combination was found in eight cases. Six of these had associated diseases, ankylosing spondylitis(3), Reiter's disease (1), lepromatous leprosy(l) and pulmonary tuberculosis(l). There was also decrease in the frequency of HLA-Al in the patients (P value<0.05). Association of HLAB27 with acute anterior uveitis is similar to that in Caucasian patients but decrease in the incidence of Al and increase in the incidence of A9 found in Indian patients has not been reported in the Caucasian series. Association of AS and B 27 in cases of acute anterior uveitis with ankylosing spondylitis seems to be an interesting finding and needs further investigation in larger series of ankylosing spondylitis with acute anterior uveitis.
| Acknowledgements|| |
We are extremely grateful to Dr. D.C.O. James, West-minister Hospital, London for the supply of HLA antisera. Authors are thankful to Miss Saraswati Gupta and Miss Saroj Walia for their excellent technical help.
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[Table - 1], [Table - 2], [Table - 3]