Immune Indicators of Uveitis
Immune Indicators of Uveitis
This study will try to identify markers of immune activity in uveitis patients that correlate
 with the state of disease activity. Uveitis is a group of inflammatory eye diseases that can
 cause vision loss. The study will examine whether certain substances in the blood can predict
 a reactivation of disease before it occurs, and how therapy may influence the activity of
 these substances. Previous studies have found some possible markers called GITR
 (glucocorticoid induced TNF related family receptor), SOCS (suppressors of cytokine
 secretion), and interleukin-15. Markers such as these may help guide physicians in safely
 tapering medicines in uveitis patients.

 Patients 18 years of age and older with sight-threatening uveitis may be eligible for this
 study. Participants are slowly tapered off their medicines when their disease is stable and
 there is no evidence of significant inflammation. If the disease remains inactive during
 tapering, all drug therapy is eventually stopped. Patients have eye examinations about every
 1 to 3 months when the disease is quiet and every 2 to 4 weeks during flare-ups. Blood
 samples are drawn 2 to 3 times a year. In addition, patients may have the following
 procedures if needed:

 -  Eye photography: Eye drops are given to enlarge the pupils for a thorough eye
 examination, and a special camera is used to take photographs.

 -  Fluorescein angiography: This test checks for abnormalities of eye blood vessels. A
 yellow dye is injected into an arm vein and travels to the blood vessels in the eyes.
 Pictures of the retina are taken with a special camera that flashes a blue light into
 the eye. The pictures show if any dye has leaked from the vessels into the retina,
 indicating possible abnormalities.
Indicators of disease activity in supposed autoimmune conditions are actively being sought.
 We have already described the increased expression of GITR-glucocorticoid induced TNF-related
 family receptor during active disease and a decrease in its expression when disease activity
 diminishes. We have preliminary observations in uveitis patients to suggest that suppressors
 of cytokine activity (SOCS) 1, 3, and 5 may also be active during either a Th1 or Th2
 mediated disease. We wish to see if there is a correlation between these markers and whether
 they can serve as an indicator of impending activation of disease before actual clinical
 disease, and how therapy may alter their expression. Patients with uveitis will receive
 standard evaluation and treatment for inflammatory uveitis under this protocol Blood will be
 drawn when specific clinical criteria are reached for correlation of potential markers with
 disease activity.
-  INCLUSION CRITERIA:

 -  Patients with bilateral sight threatening uveitis requiring systemic immunotherapy who
 are 18 years and older are eligible. Disease can be active or quiescent, but subjects
 must be on a minimum prescribed therapy upon enrollment of a dose averaging at least
 20 mg/day (or greater than or equal to 0.25 mg/kg/day) of systemic prednisone or a
 more intensive immunosuppression regimen. More intensive regimens may include from one
 to three anti-inflammatory treatments for uveitis that include any one of the
 following (or related) compounds: corticosteroids (including systemic or periorbital
 administration), topical corticosteroids (when used in combination with other agents),
 cyclophosphamide, cyclosporine, azathioprine, chlorambucil, tacrolimus, leflunomide,
 mycophenolate mofetil, or methotrexate.

 -  Patients who have non-infectious intermediate, posterior, or panuveitis of at least 3
 months duration. Included conditions may include but are not limited to intermediate
 uveitis of the pars planitis subtype, sarcoidosis, the Vogt-Koyanagi-Harada (VKH)
 syndrome, birdshot retinochoroidopathy, retinal vasculitis and sympathetic ophthalmia.

 -  Patients who are 18 years of age or older.

 EXCLUSION CRITERIA:

 Subjects will not be able to enroll if they:

 -  Are unwilling or unable to give blood at the designated times in the protocol.

 -  Have another disease or condition affecting vision that will interfere with obtaining
 study data

 -  Are pregnant