|Year : 1980 | Volume
| Issue : 3 | Page : 131-134
Electrophoretic pattern of serum proteins in uveitis
RPS Bhatia1, PK Shukla2, AK Tewari1
1 Department of Ophthalmology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
2 Department of Pathology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
3 Gurudham, Durgakund Road, Varanasi-221001
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Bhatia R, Shukla P K, Tewari A K. Electrophoretic pattern of serum proteins in uveitis. Indian J Ophthalmol 1980;28:131-4
The suggestion has been made that certain types of uveitis are caused by autoantibodies rendered foreign by combination of polysaccharide-antigen complex,. A determination of the electrophoretic pattern is of value in a few cases of uveitis, where it may reveal abnormalities in the globulin fraction of the serum. In one study by Goode, the patients with anterior uveitis were often found to have hypergammaglobulinemia whereas those with hypogammaglobulinemia were seen often to be afflicted with posterior uveitis. Tarasikova observed that changes in the blood protein spectrum may be a good indicator to the activity of uveitis and its course.
There is evidence to suggest that a few protein fractions, either derived from the offending organism or from the host tissue (autogen) itself, play a mischievous but significant role in the production of uveitis Which of the protein fractions triggers the inflammatory process in uveitis is not yet established with confidence. The present study was done to find out the correlation of the uveitis, on the basis of the segment of uvea involved, with the serum protein changes.
| Materials and methods|| |
29 patients of uveitis, of both sexes, in different age groups, were included. Depending upon the segment of uvea involved, the uveitis cases were further classified as-18 cases of interior uveitis, 7 cases of panuveitis and 4 cases of posterior uveitis. The control group of 20 healthy individuals was selected only after ensuring that they did not suffer from any local or systemic pathology like cirrhosis of liver, tuberculosis, congestive heart failure, hepatoma etc., which could possibly alter the protein level in the serum. Persons with the history of repeated infections anywhere in the body, were not included in the control group.
A determination of the total serum proteins and the serum protein fractions was carried out in uveitis patients and in control group. The serum protein estimation was done by Nesslerization method. Paper electrophoresis was carried out in a closed trough, horizontal strip electrophoresis apparatus on Whatman filter paper No. 1. A direct current of 250 volts at 10-12 milliamperes was applied for 6-7 hours and rest of the technique for staining and dye elution was followed as described in Beckman technical bulletin (1965).
| Observations|| |
A fall in the total serum protein was noticed in all the cases of uveitis but was statistically significant in anterior uveitis only. Similarly a fall in the mean value of albumin (hypoalbuminemia) was observed in all the three types but was statistically significant in anterior and panuveitis. Fail was more in anterior than in panuveitis. Concurrent with fall in the mean value of albumin, a rise was noticed in the mean value of globulins (hyperglobulinemia), which was maximum in anterior uveitis and least in posterior uveitis. A fall in the mean value of A:G ratio was seen in all the three types-maximum in anterior and minimum in pan-uveitis.
A fall in the mean value of alpha-1 globulin was observed in all the three types, significant in pan and posterior uveitis only. Fall was more in pan uveitis than in posterior uveitis, though this difference was non-significant. A significant rise in the mean value of alpha-2 globulin was marked in anterior uveitis as against a statistically non-significant fall of mean values in pan and posterior uveitis. A statistically significant rise in mean value of beta-globulin was observed in anterior and pan uveitis patients against a non-significant fall in posterior uveitis. Hypergammaglobulinemia of statistically significant level was noticed in all the three types. It was maximum in posterior uveitis and minimum in anterior uveitis, [Table - 1].
| Discussion|| |
The pathology of the descript, non-specific type of uveitis, which forms the major group, may be explained on the hypothesis that it is dependant on an underlying hypersensitivity of the uveal tissue and is mediated by an antigen-antibody reaction.
Hypergammaglobulinemia to a statistically significant level, that occurred in all cases of uveitis in our series of study, well supports the hypothesis of hypersensitivity reaction with antigen-antibody union. This is contrary to the findings of Goodner where posterior uveitis cases more often presented with hypogammaglobulinemia.
Incidence of the inflammatory process in descript, non-specific type of uveitis depends more upon the constitutional and immunological condition of the tissue than on the particular organism concerned. The typical inflammatory phenomenon, due to dilatation and increased permeability of the small blood vessels of the uvea, which is known to have rich vascularity, is responsible for fall in the total serum proteins and that in albumin level which was noticed in all the three types of uveitis in our study.
Anterior uveitis patients presented with a significant rise in alpha-2 globulin, though the alpha-1 globulin level showed a non-significant fall. This may be taken in favour of some amount of infective element in the aetiology of these cases. On the other hand the posterior uveitis cases showed a highly significant rise in gamma globulin level, though the beta-globulin level had a non-significant fall. This is again acknowledging to some extent the fact that hypersensitivity plays a role of its own in posterior uveitis cases. Patients with pan uveitis presented a mixed picture depending upon whether anterior or posterior uvea was predominantly affected. Here we found in our study a highly significant rise of beta-globulin and a significant rise in gamma globulin level associated with a highly significant fall in alpha-I globulin level and a non significant fall in alpha-2 globulin value, thus showing a major involvement of posterior uvea in patients of panuveitis of descript, non-specific type.
The above changes were not of same degree in individual members of a particular group for the reason that individuals have their inherent immunological idiosyncrasies and as such their response to a particular reaction differs. Degree of exposure and individual's nutritional and immunological status (excluding the effect of any super-imposed systemic disease process) may be a contributing factor to this variation.
These observations may be of some value in establishing the diagnosis of descript, non-specific type of uveitis which has been discussed in the light of various reports in the literature.
| Summary|| |
29 cases of uveitis were compared with 20 control cases for the electrophoretic pattern of serum protein fractions. The study revealed a statistically significant fall in the total serum proteins and hypoalbuminemia with a concurrent hypergammaglobulinemia in most cases of uveitis. High levels of alpha-2 and betaglobulin with a subnormal alpha-1 globulin level were seen in majority of anterior uveitis cases while most of the posterior uveitis cases presented with a fall in alpha- I globulin level associated with a subnormal alpha-2 and betaglobulin levels. Cases of panuveitis revealed a mixed picture in serum proteins fractions. The possible interpretations of the above findings have been discussed.
| References|| |
Fernando, 1960, Arch, Ophthalmol. 63 : 515.
Woods, A.C., 1961, Endogenous inflammation of the uveal tract. The Williams and Wilkins Co., Baltimore.
Goodner, E., 1968, Discussion on nonspecific tests. In clinical methods in Uveitis (Aronson, S., Gamble C., Goodner E. and O'Connor G, (Eds.), The C.V. Mosby Co., St. Louis, 1968. P. 196.)
Tarasikova, 0.1., 1970, Ophthalmol. zh. 25: 380.
Aronson, S.B., 1960, Amer. J. Ophthalmol. 49: 629.
Beckman Technical Bulletin., 1965, R.C.T.B.M., 007, B. Jan. 1965.
[Table - 1]