Uveitis

Infection

Brief Report

Helicobacter pylori Infection in Anterior Uveitis*
L. Otasevic, A. Walduck, T.F. Meyer, T. Aebischer, C. Hartmann, N. Orlic, U. Pleyer

Abstract
Background: Despite intensive research, the etiology of acute anterior uveitis (AAU) remains poorly defined. Infection with gram-negative bacteria such as Yersinia, Salmonella, Shigella, and Chlamydia have already beensuggested as a possible trigger event for AAU. Helicobacter pylori is also a gram-negative bacterium, shares the lipopolysaccharides, but did not attract the attention of many ophthalmologists until recently. Having in mind the relatively high incidence of H. pylori infection in the population, we propose that H. pylori may also be a trigger factor for AAU. Patients and Methods: The presence ofanti-H. pylori antibodies in matching serum and aqueous humor samples of 15 idiopathic AAU patients was determined using a commercial Western blot assay. Control serum and aqueous humor were obtained from five patients undergoing cataract surgery. Results: Six out of 15 AAU patients (40%) were serumpositive for H. pylori, and half of these (n = 3) also had anti-H. pylori antibodies in the aqueoushumor. All five aqueous humor and sera controls tested negative for H. pylori infection. Conclusion: These are the first results demonstrating anti-H. pylori antibodies in the aqueous humor of AAU patients. Further studies are needed to demonstrate whether this antibody is indeed locally produced. Our data may provide first evidence for a causative link between H. pylori infection and AAU.
Infection2005; 33: 82–85 DOI 10.1007/s15010-005-4068-6

tive and noninfective stimuli. Despite major advances in diagnostic techniques, however, 35-50% of these patients remain “idiopathic.” 50% of acute anterior uveitis (AAU) patients are HLA-B27 positive, and half of these patients also have spondyloarthropathies (SpA). The reason why these diseases frequently appear together is still unknown. Severaltheories have been proposed to explain the association between HLA-B27, infectious agents and the manifestation of AAU/SpA. It has been proposed that after gastrointestinal infection, live bacteria that are resident in mucosa may constantly release antigenic material into the circulation and stimulate a persistent immune reaction. Indeed, ileocolonoscopic studies have demonstrated the presence ofgut inflammation in 66% of AAU patients [2]. A compromised intestinal barrier could allow penetration of pathogenic microorganisms into the tissue provoking an immune reaction, and consequently lesions in distant tissues and organs such as the eye. The same scenario could also take place in the stomach. Serological studies have shown elevated levels of serum antibodies to various gram-negativebacteria in AAU and SpA patients [3–6]. In addition, bacterial fragments, but not triggering bacteria, have been found in the joints of patients with reactive arthritis [5]. Laboratory studies have also shown that gram-negative bacteria share uniquely high sequence homologies with the HLA-B27 molecule [5]. Antigenic similarities between these bacteria and host com-

Introduction
Anterior uveitisrefers to inflammation of the iris and ciliary body and is the most common form of intraocular inflammation, but clarification of its etiology remains a challenge for clinicians. Anterior uveitis is the leading cause of severe visual handicap in the younger population resulting in significant morbidity and socioeconomic burden [1]. Uveitis is thought to occur as a consequence of both infec-

L.Otasevic, C. Hartmann, N. Orlic Dept. of Ophthalmology, Charité, Humboldt University, Berlin, Germany A. Walduck, T.F. Meyer, T. Aebischer Max-Planck Institute for Infection Biology, Dept. Molecular Biology, Berlin U. Pleyer (corresponding author) Dept. of Ophthalmology, Charité, Humboldt University, Augustenburger Platz 1, 13353 Berlin, Germany; Phone: (+49/30) 450-554052, Fax: -554901, e-mail:...