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T. M. OBrien, D. G. Telander, C. E. Thirkill; Autoimmunity Involving Immunologically Privileged Retinal Antigens. Invest. Ophthalmol. Vis. Sci. 2010;51(13):836.
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In many cases, the cause of a loss of tolerance to specific retinal antigens within the immunologically privileged eye remains a mystery. However, as different immunologically distinct subgroups are increasingly recognized, it follows that each member of each group must have experienced the same antigenic stimulus. In the case of cancer patients, the cause of the abnormality usually involves the cancer expressing the specific retinal antigen involved. Other, less easily explained anti-retina activity develops as a complication of retinal degenerations that may include an inflammatory component of no known cause. This study compared the anti-retina activity of two Melanoma-Associated Retinopathy (MAR) patients with two AMD patients described as ‘poor-responders’ to anti-VEGF therapy.
Serum obtained from each patient was evaluated for anti-retina, and anti-retinal pigment epithelium (RPE) activity by Western blot analyses. Anti-retina antibody activity was compared with that recorded from 100 normal volunteer members of the Women’s Health Initiative (WHI).
All four patients were producing antibodies not apparent in the immunologic activity of members of the WHI. The two MAR patients had antibody activity with a 20 kd retinal protein previously described in the immunologic activity of a melanoma patient. Their antibody reactions included activity with a 57 kd RPE protein encountered before as a complication of Cancer Associated Retinopathy. Antigenic analysis of the two ‘non-responders’ revealed abnormal antibody activity with a 22 kd retinal antigen expressed within the nerve fiber layer, and extending into the optic nerve.
In the case of the MAR patients their shared immunologic activity with the same ocular antigens may eventually be traced to their malignancies expressing these proteins. That seen in the AMD patients is less easily explained, but invites the continued search for additional examples of 22 kd hypersensitivity, and any shared pathologic experience that might incite the commonality.
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