Topical Immunoglobulins for Epithelial Herpes Simplex Keratitis

Kläger, Andreas J.; Büchi, Ernst R.; Osuský, Roman; Burek-Kozlowska, Anna; Morell, A.

doi:10.1159/000310409

Cited by 6 publications

(3 citation statements)

References 5 publications

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“…Interestingly, it has recently been described that in pa tients affected by herpetic keratitis, the topical administra tion of anti-HSV human immunoglobulins seems to in crease the efficacy o f antiviral therapy in the recovery from epithelial keratitis [27]. In spite of the partial results ob tained in this open trial, which are most likely related to the kind of Ig preparation used for local administration, this treatment modality may deserve further attention.…”

Section: Discussionmentioning

confidence: 80%

Effects of the Passive Transfer of Anti-gB Antibodies in a Rabbit Model of HSV-1 -Induced Keratitis

Incorvaia¹,

Manservigi

Parmeggiani³

et al. 1995

Ophthalmologica

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The effectiveness of passively transferred antibodies directed against the secretory form of herpes simplex virus type 1 (HSV-1) glycoprotein B (gB1-s) was tested in a rabbit model of ocular HSV-1 infection. The animals were passively immunized through the intramuscular injection of a homologous polyclonal anti-gB1-s antiserum at different times from the viral ocular challenge (i.e at ––24, 0, +24 and +48 h from infection). The effects observed in this trial were compared with those obtained in an active immunization trial, in which the animals were vaccinated with gBl-s before the ocular infection with HSV-1 (large variant). The results have shown that passive immunization appears quite effective in prophylactic utilization, whereas it is less effective when performed at 24 or 48 h after inoculation. By contrast, active immunization of rabbits proved to be highly effective both in preventing the development of fatal encephalitis and in reducing the severity of corneal lesions.

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Section: Discussionmentioning

confidence: 80%

Effects of the Passive Transfer of Anti-gB Antibodies in a Rabbit Model of HSV-1 -Induced Keratitis

Incorvaia¹,

Manservigi

Parmeggiani³

et al. 1995

Ophthalmologica

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“…Studies have shown that in severe infections, they act synergistically with antibiotics with immunomodulatory and additional anti-inflammatory activity, too [ 40 , 41 ]. While the role of IVIG in severe suppurative keratitis in humans is unclear, a study on a mouse ocular infection model demonstrated that treating epithelial herpes simplex keratitis with topical immunoglobulins attenuates the spread and incidence rate of HSV-1 [ 42 ]. In a recent study, IVIG was used as rescue treatment in a ganciclovir-resistant cytomegalovirus retinitis [ 43 ].…”

Section: Discussionmentioning

confidence: 99%

Nonsurgical Management of Severe Viral Keratitis with Hypopyon and Retrocorneal Plaques: A Case Series

Yang

Yu²,

Zhang³

et al. 2022

Ophthalmol Ther

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Introduction Severe viral keratitis with hypopyon and retrocorneal plaques is easily misdiagnosed as it mimics fungal or bacterial keratitis and is more likely to undergo emergency therapeutic penetrating keratoplasty (TPK) in the presence of active infection, resulting in poor outcomes. This case series offers some important insights for the management strategy of severe viral keratitis. Methods This retrospective case series involved five patients with unilateral severe infectious keratitis with hypopyon over 3 mm and retrocorneal endothelial plaques. Testing for corneal sensation, microscopy, culture, and anterior segment optical coherence tomography (ASOCT) were performed. Results At presentation, all five cases had visual acuity of counting fingers (CF) or worse, large centrally located ulcer with clean ulcer surface, hypopyon, and retrocorneal plaques with reduced corneal sensation. ASOCT demonstrated the presence of retrocorneal plaques with clear space between corneal endothelium and plaques. All cases received systemic and topical ganciclovir and topical steroids. Two patients received intravenous immunoglobulin (IVIG) weekly for 2 weeks. Complete resolution was achieved in all cases except one patient who underwent TPK because of diffuse anterior synechiae of the iris, with recurrence of infection after 10 days. The patients who received IVIG showed resolution earlier compared to the other patients. Conclusions Evaluation of characteristics of retrocorneal plaques by ASOCT and reduced corneal sensation are valuable aids in diagnosis of complicated viral keratitis. Conservative medical management may be a viable option even in severe cases. IVIG may have a role in speedy resolution of severe cases, but more research is needed to confirm this. Supplementary Information The online version contains supplementary material available at 10.1007/s40123-022-00592-x.

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“…Limitations of this treatment are the corneal toxicity associated with its use and the inability to treat resistant strains of the Herpes simplex virus. Consequently, work is currently underway to develop a virus-neutralizing topical antibody therapy (Berdugo et al, 2012;Klager et al, 1993). Bacterial infections of the eye normally respond well to an appropriate antibiotic treatment.…”

Section: Ocular Usementioning

confidence: 99%

Targeted localized use of therapeutic antibodies: a review of non-systemic, topical and oral applications

Jones

Martino

2015

Critical Reviews in Biotechnology

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Therapeutic antibodies provide important tools in the "medicine chest" of today's clinician for the treatment of a range of disorders. Typically monoclonal or polyclonal antibodies are administered in large doses, either directly or indirectly into the circulation, via a systemic route which is well suited for disseminated ailments. Diseases confined within a specific localized tissue, however, may be treated more effectively and at reduced cost by a delivery system which targets directly the affected area. To explore the advantages of the local administration of antibodies, we reviewed current alternative, non-systemic delivery approaches which are in clinical use, being trialed or developed. These less conventional approaches comprise: (a) local injections, (b) topical and (c) peroral administration routes. Local delivery includes intra-ocular injections into the vitreal humor (i.e. Ranibizumab for age-related macular degeneration), subconjunctival injections (e.g. Bevacizumab for corneal neovascularization), intra-articular joint injections (i.e. anti-TNF alpha antibody for persistent inflammatory monoarthritis) and intratumoral or peritumoral injections (e.g. Ipilimumab for cancer). A range of other strategies, such as the local use of antibacterial antibodies, are also presented. Local injections of antibodies utilize doses which range from 1/10th to 1/100th of the required systemic dose therefore reducing both side-effects and treatment costs. In addition, any therapeutic antibody escaping from the local site of disease into the systemic circulation is immediately diluted within the large blood volume, further lowering the potential for unwanted effects. Needle-free topical application routes become an option when the condition is restricted locally to an external surface. The topical route may potentially be utilized in the form of eye drops for infections or corneal neovascularization or be applied to diseased skin for psoriasis, dermatitis, pyoderma gangrenosum, antibiotic resistant bacterial infections or ulcerated wounds. Diseases confined to the gastrointestinal tract can be targeted directly by applying antibody via the injection-free peroral route. The gastrointestinal tract is unusual in that its natural immuno-tolerant nature ensures the long-term safety of repeatedly ingesting heterologous antiserum or antibody materials. Without the stringent regulatory, purity and clean room requirements of manufacturing parenteral (injectable) antibodies, production costs are minimal, with the potential for more direct low-cost targeting of gastrointestinal diseases, especially with those caused by problematic antibiotic resistant or toxigenic bacteria (e.g. Clostridium difficile, Helicobacter pylori), viruses (e.g. rotavirus, norovirus) or inflammatory bowel disease (e.g. ulcerative colitis, Crohn's disease). Use of the oral route has previously been hindered by excessive antibody digestion within the gastrointestinal tract; however, this limitation may be overcome by intelligently applying one or more strate...

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Topical Immunoglobulins for Epithelial Herpes Simplex Keratitis

Cited by 6 publications

References 5 publications

Effects of the Passive Transfer of Anti-gB Antibodies in a Rabbit Model of HSV-1 -Induced Keratitis

Effects of the Passive Transfer of Anti-gB Antibodies in a Rabbit Model of HSV-1 -Induced Keratitis

Nonsurgical Management of Severe Viral Keratitis with Hypopyon and Retrocorneal Plaques: A Case Series

Targeted localized use of therapeutic antibodies: a review of non-systemic, topical and oral applications

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