Implications of Birdshot-Like Uveitis on the Pathogenesis of Birdshot Chorioretinopathy

Sun, Michel M.; Gordon, Lynn K.; Levinson, Ralph D.

doi:10.1001/jamaophthalmol.2019.0214

Cited by 3 publications

(2 citation statements)

References 6 publications

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“…This interesting case suggests that unleashing the anti-tumoural immune reaction by ICIs mimics BU, even in the absence of HLA-A29. This might support the theory that BU is the result of melanoma/ tumour immune surveillance with cross-reactive anti-melanocytic auto-immunity in the eye and might explain why BU is almost exclusively found in middle-aged whites, as they are more prone to developing melanoma [13].…”

Section: Discussionsupporting

confidence: 72%

Relapse of Birdshot Uveitis after Stopping Immunosuppressive Treatment and Starting Immune Checkpoint Inhibitors for Lung Cancer

Alsaddi¹,

Hondeghem²,

Schauwvlieghe³

2022

Case Rep Ophthalmol

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A 56-year-old Caucasian woman with birdshot uveitis had to stop immunosuppressive treatment with adalimumab due to metastatic squamous lung carcinoma. She was subsequently treated with chemotherapy and pembrolizumab, an immune checkpoint inhibitor (ICI). After stopping adalimumab and starting pembrolizumab, the patient had an inflammatory relapse of birdshot uveitis with macular oedema. Birdshot uveitis is triggered by an unknown antigen presented on the HLA-A29 molecule which activates cytotoxic T-cells. Although immunosuppressive therapy effectively stabilizes birdshot uveitis, it might induce a higher risk of developing cancer. Treatment with ICIs, on the other hand, might exacerbate birdshot uveitis by increasing anti-tumoural immune reaction and inducing off-target autoimmunity.

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Section: Discussionsupporting

confidence: 72%

Relapse of Birdshot Uveitis after Stopping Immunosuppressive Treatment and Starting Immune Checkpoint Inhibitors for Lung Cancer

Alsaddi¹,

Hondeghem²,

Schauwvlieghe³

2022

Case Rep Ophthalmol

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“… 67 This article raised the question whether BU is the result of an autoimmune reaction triggered by neoplastic (skin) changes. 68 69 According to this theory, a processed neoplastic antigen is presented by the antigen presenting cell on the surface of the HLA A29 molecule, resulting in activation of T cells. This cellular immune response is targeted to the inciting tumour cells, but might cross-react with ocular structures, such as choroidal melanocytes.…”

Section: Discussionmentioning

confidence: 99%

Efficacy and safety of abatacept to treat active birdshot uveitis: a prospective open label interventional proof-of-concept trial

Schauwvlieghe

Calster

Herbort³

et al. 2022

Br J Ophthalmol

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Background/aimsBirdshot uveitis (BU) is a chronic autoimmune posterior uveitis, mostly affecting middle-aged Caucasians. There is a strong association with HLA-A29 and T-cell activation. Safety and efficacy of abatacept, an inhibitor of T-cell costimulation, is tested in active BU.MethodsFifteen patients with active BU were treated with monotherapy of weekly subcutaneous injections of abatacept 125 mg/mL. Time-to-treatment failure was evaluated as a primary outcome. The secondary objective was to evaluate the utility of different outcome measures to monitor disease activity. Safety was evaluated by adverse event reporting and serial blood analyses.ResultsAt the year-1 endpoint, there was significant improvement in vitreous haze grade (p=0.0014), central choroidal thickness (CCT) (p=0.0011), Fluorescein Angiography (FA) Score (p=0.0014), Indocyanine Green Angiography (ICGA) Score (p<0.001) and total dual FA-ICGA Score (p<0.001). Best corrected visual acuity (BCVA) (p=0.8354) and central retinal thickness (CRT) (p=0.3549) did not change significantly. There were no serious adverse events reported. In total, 4 out of 15 patients left the trial during year 1 of whom 2 experienced treatment failure.ConclusionsAbatacept is very efficacious to treat both retinal vasculitis and choroiditis in patients with BU and is well tolerated. BCVA and CRT are inadequate to monitor disease activity. On the other hand, CCT is a promising non-invasive tool to detect treatment response in early active BU and dual FA-ICGA Score is very helpful to evaluate retinal vasculitis and choroiditis quantitatively.Trial registration numberNCT03871361.

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γδ T cells in autoimmune uveitis pathogenesis: A promising therapeutic target

Zhang

Liu

Xiao

et al. 2023

Biochemical Pharmacology

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Implications of Birdshot-Like Uveitis on the Pathogenesis of Birdshot Chorioretinopathy

Cited by 3 publications

References 6 publications

Relapse of Birdshot Uveitis after Stopping Immunosuppressive Treatment and Starting Immune Checkpoint Inhibitors for Lung Cancer

Relapse of Birdshot Uveitis after Stopping Immunosuppressive Treatment and Starting Immune Checkpoint Inhibitors for Lung Cancer

Efficacy and safety of abatacept to treat active birdshot uveitis: a prospective open label interventional proof-of-concept trial

γδ T cells in autoimmune uveitis pathogenesis: A promising therapeutic target

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