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Soluble Fas Ligand and Transforming Growth Factor ₂ in the Aqueous Humor of Patients With Endothelial Immune Reactions After Penetrating Keratoplasty

Thomas Reinhard, MD; Halvard Bönig, MD; Susanne Mayweg; Daniel Böhringer, MD; Ulrich Göbel, MD; Rainer Sundmacher, MD, FRCOphth

Arch Ophthalmol. 2002;120:1630-1635.

Background  Excellent long-term prognosis of penetrating corneal grafts has been explained by the immunological privilege of the cornea and the anterior chamber. In animal models the secretion of transforming growth factor ₂ (TGF-₂) into the anterior chamber and the expression of the Fas ligand on corneal endothelial cells were identified as important for the integrity of the immunological privilege.

Objective  To determine the TGF-₂ and soluble Fas ligand (sFasL) levels in the aqueous humor of patients after penetrating keratoplasty (PK) who have and who do not have immune reactions.

Methods  Anterior chamber puncture was performed in 13 patients who had a cataract without PK (group 1), in 31 patients after PK who did not have immune reactions (group 2), and in 12 patients after PK newly diagnosed as having endothelial immune reactions (group 3). Total TGF-₂ and sFasL were determined via enzyme-linked immunosorbent assay.

Results  Transforming growth factor ₂ was detected in all patients, irrespective of the underlying condition; there was no difference in TGF-₂ levels between the different groups (P = .89, analysis of variance). None of the patients in group 1, 11 of 31 patients in group 2, and 8 of 12 patients in group 3 had detectable sFasL concentrations (P = .002, ² test). Soluble Fas ligand averaged (mean [SD]) 20.8 (31.1) pg/mL in group 2, and 38.1 (33.2) pg/mL (P<.01, analysis of variance) in group 3.

Conclusions  It appears that total TGF-₂ is maintained at high steady-state levels, while the level of sFasL is up-regulated in patients who underwent PK, particularily in the advent of graft rejection.

From the Eye Hospital and Lions Cornea Bank North Rhine Westfalia (Drs Reinhard, Böhringer, and Sundmacher and Ms Mayweg), and the Center of Child Health, Department of Pediatric Hematology and Oncology, Heinrich-Heine University (Drs Bönig and Göbel), Düsseldorf, Germany.