Acute anterior uveitis is an inflammatory disorder that involves the iris and parts of the ciliary body. Anterior uveitis with marked cellular infiltration is often associated with Behçet’s disease, ankylosing spondylitis, Reiter’s syndrome, and HLA B27-associated uveitis in patients who have acute anterior uveitis report photophobia. Other symptoms may include redness, tearing, and reduced vision. Findings on examination are characteristic and include ciliary injection, keratitic precipitates, cells, and protein flare in the aqueous and miosis with posterior synechiae. Although corticosteroids remain the mainstay of therapy for uveitis some patients are resistant to steroids. Furthermore, corticosteroids have a wide range of significant side effects, such as cataract, increase of intraocular pressure, increased susceptibility to microbial infection. The cascade of biological events leading to endotoxin-induced uveitis (EIU) initiated by lipopolysaccharide (LPS) injection is not clearly understood. Adhesion molecules and cytokines play a crucial role in the pathogenesis of uveitis. ICAM-1, P-selectin, TNFα, IL-1, and IL-6 are involved in the inflammatory process that occurs in uveitis.
1 2 3 4 5 Cellular infiltration involves sequential steps of rolling, adhesion, and migration of leukocytes. The selectin family is a group of molecules involved in the first rolling phase, and their function precedes the roles of the other cell-adhesion molecules, such as ICAM-1 and leukocyte integrins. P-selectin is expressed in the vessels of the rat iris after LPS induction of EIU.
1 An increased expression of ICAM-1 occurs in the iris of patients with uveitis, indicating an immunoregulatory function for adhesion molecules in the pathogenesis of uveitis.
6 Expression of ICAM-1 has also been observed on the vascular endothelium of the rat ciliary body during EIU.
7 8 Cytokines have been implicated as important mediators in the pathogenesis of EIU in the rat. Injection of TNFα, IL-1, IL-6, IL-8, IL-13, or IFN-γ into rat eyes causes acute uveitis that resembles the response to LPS.
9 10 11 12 Moreover, increased levels of TNFα and other cytokines are found in the aqueous humor after injection of LPS.
13 The inducible nitric oxide synthase-nitric oxide (iNOS-NO) pathway is also involved in the pathogenesis of EIU in rats. Epithelial cells of the iris-ciliary body and cells infiltrating the anterior segment of the eye are the major source of NO.
13 14 15 16 Evidence is accumulating that much of the NO-related injury may be due to the generation of peroxynitrite.
17 NO and peroxynitrite cause apoptosis in a variety of cell types through the activation of nuclear enzyme poly(ADP-ribosyl) synthetase (PARS).
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