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Amar P Patel, Charles E Thirkill, David Gregory Telander, Kang Zhang, Zeljka Smit-McBride, Lawrence S Morse; Retinal and RPE Autoimmunity in AMD: Assessment of Correlation with Degree of Response to Ranibizumab Therapy. Invest. Ophthalmol. Vis. Sci. 2014;55(13):67.
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To determine if neovascular (nv) age-related macular degeneration (AMD) patients differ from population normals and dry AMD patients in the production of anti-retinal pigment epithelium (RPE) or anti-retinal antibody formation; determine if responders differ from non responders (persistent or worsening exudative manifestations of disease after four ranibizumab 0.5mg intravitreal injections at four week intervals) in the production of anti-RPE or anti-retinal antibody formation; determine the change in the production of anti-RPE or anti-retinal antibody formation from baseline to month four follow up in nv AMD patients.
A total of 135 patients were enrolled in this study. 43 patients were enrolled in group 1 (normals), 40 patients in group 2 (dry AMD), 37 patients in group 3 (responders), 8 patients in group 4 (acute non responders), and 7 patients in group 5 (chronic non responders). Blood samples were obtained at baseline during initial enrollment for all groups and at four month follow up for nv AMD patients. Western blot analysis was performed and antibodies to retinal and RPE antigens were recorded.
All groups demonstrated abnormal anti-retinal and anti-RPE antibody responses. The most common antibody response was against retinal and RPE 40, 45, and 47 kd antigens. Antibodies to retinal and RPE antigens did not differ significantly between groups. Antibodies to retinal antigen 55 was found to not be distributed normally (p=0.0031). The antibody was found in 0 dry AMD subjects, 6 normal subjects, and 10 nv AMD subjects. Antibodies to retinal antigens 40 (p=0.0016), 45 (p=0.0041), 47 (p=0.0032), 50 (p=0.026), and 55 (p<0.0001) showed a statistically significant change between baseline and four months in the nv AMD groups. No antibodies to RPE antigens showed a significant change between baseline and four months. There were no antibodies to retinal or RPE antigens that were associated with acute or chronic non responders.
There does not appear to be a difference between the presence of anti-RPE or anti-retinal antibodies in AMD and controls. Antibodies to retinal antigens showed variation between baseline and four month follow up after ranibizumab therapy. A larger study is needed to further evaluate whether autoantibodies play an immediate role in the etiology of AMD or if they are a secondary response to the retinal and RPE damage.
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