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Steven Yeh, MD; Zhuqing Li, MD, PhD; Farzin Forooghian, MD; Frank S. Hwang, MD; Matthew A. Cunningham, MD; Seth Pantanelli, BS, MS; Julie C. Lew, MD; Keith K. Wroblewski, MD; Susan Vitale, PhD; Robert B. Nussenblatt, MD, MPH

Arch Ophthalmol. 2009;127(4):407-413.

Objective  To evaluate CD4⁺Foxp3⁺ (forkhead box P3) T-regulatory cell populations in patients with uveitis and to determine if T-regulatory cell populations are associated with disease features.

Methods  Patients with uveitis were evaluated for CD4⁺Foxp3⁺ T-regulatory cells by flow cytometry. Systemic and ocular diagnoses, disease activity, and the presence of cystoid macular edema were reviewed. Percentages of CD4⁺Foxp3⁺ lymphocytes were compared for patients with inactive vs active disease, systemic vs ocular diagnoses, and the presence or absence of cystoid macular edema. Real-time polymerase chain reaction testing was performed on 2 patients with extremely low CD4⁺Foxp3⁺ cell populations to assess Foxp3 mRNA.

Results  A total of 20 patients with intermediate uveitis, posterior uveitis, and panuveitis were evaluated. The mean age was 40.6 years and the mean visual acuity was 20/57. Percentages of CD4⁺Foxp3⁺ cells were lower in patients with active compared with inactive uveitis (P < .05). No differences in T-regulatory cells were observed between the other subgroups. Two patients with recalcitrant uveitis who demonstrated less than 1% CD4⁺Foxp3⁺ lymphocytes showed extremely low or absent Foxp3 mRNA.

Conclusion  T-regulatory cells are reduced in patients with active compared with inactive disease. Severe depletion of CD4⁺Foxp3⁺ T cells and Foxp3 mRNA in 2 patients with severe uveitis suggests that loss of the T-regulatory cells of uveitis may be a salient feature in certain patients.

Author Affiliations: Laboratory of Immunology (Drs Yeh, Li, Forooghian, Hwang, Cunningham, Lew, Wroblewski, and Nussenblatt and Mr Pantanelli), and Department of Epidemiology and Clinical Research, National Eye Institute, National Institutes of Health, Bethesda, Maryland (Drs Forooghian and Vitale); and the Department of Ophthalmology, Walter Reed Army Medical Center, Washington, DC (Dr Wroblewski).

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