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Editors Selection IGR 7-3

Basic research: Immunoregulation

Comment by Martin Wax on:

20826 Prevalence of serum autoantibodies and paraproteins in patients with glaucoma, Hammam T; Montgomery D; Morris D et al., Eye, 2008; 22: 349-353

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The manuscript by Hammam et al. (103) is one of the growing numbers of studies on glaucoma and immuno-regulation. Almost 400 citations are now in the literature and over 80 are directed, as is this one, on autoanti-bodies in patients with glaucoma (see Journal of Glaucoma 2008; 17:79-84 for an excellent review; abstract 116). In the current study, the authors looked at the serum antibodies of about 95 patients for the presence of antinuclear antigens (ANA), autoantibodies to extractable nuclear antigens (ENA) and anti-double strand DNA. In addition, they performed protein electrophoresis and looked at serum immunoglobulin levels. They found increased risk among the NTG patients for ANA and ENA, as well as elevated IgA levels, but no evidence of monoclonal gammopathies (paraproteinemias) in the NTG group. In the POAG cohort, they found increased risk for ENA as well as similarly elevated IgA immunoglobulin as well as 2/32 monoclonal gammopathies. In general, the patients with NTG had a slightly higher incidence of positive ANAs, and their titers were somewhat higher.

The serum findings are noteworthy and point yet again to a curious association of immunoregulatory findings in patients with NTG as well as POAG, but are less useful in identifying whether these changes are epiphenomenon or causally related to the disease process as has been proposed by others. The low incidence of paraproteinemias in the NTG group is a curious finding as is the somewhat higher incidence of paraproteinemias on the POAG (6%) and control groups (9%),

Immunoregulatory systems as evidenced by serum fi ndings again appear to be different in NTG patients vs. POAG patients and controls

although the overall incidence rates observed in this study are not unusual taken as a whole (about 2% in patients over 60). The difference in these findings versus previous reports of higher incidence rates in NTG patients may be due to differences in patient cohort. In the present study, patients came from a general clinic in addition to a subspecialist referral, whereas Wax (Am J Ophthalmol 1994; 117: 561-568) relied on referred tertiary care patients only. The main contribution of the study is the confirmation that immunoregulatory systems as evidenced by serum findings again appear to be different in NTG patients vs. POAG patients and controls. Thus, humoral immunity may indeed be a relevant factor in the etiology of NTG based on the strength of the growing number of these associative observations. However, the precise role of the autoantibody differences found in these patients remains to be determined.

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