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Autoimmunity, Autoinflammation and Infection in Uveitis

Forrester, JV; Kuffova, L; Dick, AD; (2018) Autoimmunity, Autoinflammation and Infection in Uveitis. American Journal of Ophthalmology , 189 pp. 77-85. 10.1016/j.ajo.2018.02.019. Green open access

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Abstract

PURPOSE: To review the pathogenesis of uveitis in light of recent advances in our understanding of innate and adaptive immune responses and their regulation. DESIGN: A perspective. METHODS: The methods included a review of prevailing views on the pathogenesis of uveitis, and an analysis of developments in immunology which impact on its conceptual basis, particularly the concept of immunological tolerance and its loss in autoimmunity. Importantly, the role of infection in the pathogenesis of uveitis is evaluated. RESULTS: The results comprise a re-appraisal of the pathogenesis of anterior versus posterior uveitis in the context of the blood-retinal barrier and its relation to autoimmune, auto-inflammatory and infectious uveitis. Autoimmunity is seen as a possible cause of certain forms of uveitis but definitive proof is lacking. Auto-inflammatory disease, involving activated innate immune mechanisms, is considered causative in a second set of uveitis conditions. A place for infection in uveitis generally is proposed within a unifying concept for the pathogenesis of uveitis. CONCLUSION: Infection may be implicated directly or indirectly in many forms of non-infectious or undifferentiated uveitis. In addition to the growing recognition that foreign antigen, including re-activatable infectious agents, might hide within ocular tissues, the possibility that a dysregulated microbiome might generate T cells which cause immune-mediated ocular inflammation has now been demonstrated experimentally. An uncontrolled, over-exuberant host immune response may cause continuing irreversible tissue damage even after the infection has been cleared.

Type: Article
Title: Autoimmunity, Autoinflammation and Infection in Uveitis
Location: United States
Open access status: An open access version is available from UCL Discovery
DOI: 10.1016/j.ajo.2018.02.019
Publisher version: https://doi.org/10.1016/j.ajo.2018.02.019
Language: English
Additional information: This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions.
Keywords: Autoimmunity, Autoinflammation, Infection, Uveitis
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences > Institute of Ophthalmology
URI: https://discovery.ucl.ac.uk/id/eprint/10045312
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