Nous avons sélectionné des patients atteints d’une TO biologiquement confirmée et avons exploré les différences cliniques et biologiques de deux groupes de patients, l’un en France, l’autre en Colombie. Dans notre hypothèse de départ, les souches sud-américaines, seraient plus virulentes et elles pourraient jouer un rôle crucial dans la sévérité et l’évolution de la TO. Nous avons constaté, chez les patients colombiens, de plus grandes lésions de la rétine et une plus grande proportion de lésions maculaires, dans un contexte inflammatoire vitréen plus sévère. Le cytoquinome oculaire confirme une forte réponse inflammatoire chez les patients européens centrée sur l’IL-17, mais cette réponse Th17 est absente chez les sujets colombiens. L’IL-6 et l’IL-13 sont au contraire fortement augmentées chez ces derniers. Nous avons également démontré que certaines cytokines étaient associées à certaines caractéristiques cliniques comme la sévérité de l’inflammation ou la récurrence. Des travaux préliminaires nous ont permis de débuter une modélisation de ces affactions oculaires en employant une souche de type II et une souche atypique de T. gondii. Nous avons aussi évalué la possibilité d’effectuer des traitements ciblés en intraoculaires par transfection in vivo. Conclusion: Nous avons constaté des différences cliniques et biologiques entre les patients colombien et français. Il semble y avoir une régulation souche dépendante de la production d’IFN-y et d’IL-17. Ces différences pourraient contribuer à expliquer la plus grande sévérité des toxoplasmoses oculaires en Colombie. En se basant sur nos résultats nous pouvons envisager d’explorer des traitements immunomodulateurs plus ciblés. / Ocular involvement, mainly retinochoroiditis, is one of the most severe sequelae of Toxoplasma gondii infection. However, the pathophysiological mechanisms of retinal destruction are poorly understood. Several studies suggested a more frequent and more severe ocular involvement in South American infections compared with European infections, probably due to different T. gondii strains (Type I/III, and atypical vs. Type II). To compare the clinical characteristics and biological and immunological responses in a single study and using the same parameters, in Colombian and French patients with active ocular toxoplasmosis (OT), as well as to study the local cytokinome in aqueous humor of these patients and correlate it with the clinical features. We prospectively collected and compared the clinical features of patients with active OT, evaluated at the Department of Ophthalmology of Strasbourg University Hospital and of Quindio University Health-Center. Results of biological tests in the collected aqueous humor samples were compared between Colombian and French patients: the pattern of protein recognition by immunoblotting (IB); the relative diagnostic sensitivities of IB and Polymerase Chain Reaction (PCR); and the cytokine and chemokine profiles. We found that Colombian and French OT patients presented not only different clinical characteristics but also biological characteristics, and that more virulent South American strains might be responsible for these differences, due to a disruption of the protective effects of interferon gamma (IFN-γ). Retinal lesions were 50% greater in Colombian patients. Macular localization leading to visual impairment was observed in 56% of Colombian cases, compared with 13% of French patients. Moreover, more vitreous inflammation and vasculitis were observed in Colombian patients. However, cytokine assays of the aqueous humor showed upregulation of inflammatory responses in European patients, notably IL-17, which we did not observe in Colombian patients. In a mouse model, intraocular tachyzoite injection of type II and atypical T. gondii strains resulted in differences in parasite multiplication and pathology similar to those observed in human infections. Production of IL-17 and other inflammatory markers, like IL-6, MCP-1, and the Th17 transcription factor ROR-γt was observed upon infection with the type II PRU strain, but was much less with the atypical LEF strain. In a previous work, the cytokine and mRNA patterns showed an upregulation of Th1 responses, notably IFN-γ production, in French patients, and anti-IL-17A antibody markedly diminished clinical damage and retinal inflammation, and also diminished parasite proliferation. In contrast to these previous findings in French patients, the cytokinome of aqueous humor of OT Colombian patients showed a downregulation of Th1 and Th17 responses and an upregulation of the Th2 response. Correlation between the clinical characteristics of Colombian patients with active OT and the levels of cytokines in aqueous humor (AH) showed that local production of cytokines differed between patients with OT, and particular cytokine levels were related to more severe clinical characteristics. Some cytokines were related to a higher number of recurrences.There are clinical and biological differences between Colombian and French patients with OT. There seem to be strain-specific differences in IL-17 and IFN-γ induction, which play an important role in the pathogenesis of this disease. These differences should be considered when thinking in perspectives of any possible immune-modulatory treatment in OT.

Einleitung: Die Wundheilung kornealer Endothelzellen erfolgt hauptsächlich durch Migration benachbarter Zellen. Die Endothelzellen sind in vivo ständig in Kontakt mit Kammerwasser (KW). TGF-ß2 und Ascorbin- säure (AS) sind in hoher Konzentration im KW enthalten. Der Einfluß von humanem KW, TGF-ß2 und AS auf Proliferation und Migration boviner kornealer Endothelzellen (BCEC) in Kultur wurde untersucht. Methoden: Proliferation: BCEC der 1.Passage wurden zu 1,5x104 Zellen/Well ausgesät. Mit frischem Medium und Zusatz von humanem KW (10% und 100%), TGF-ß2 (0,1; 1 und 10 ng/ml) und AS (50, 100 und 200 µg/ml) wurden die Kulturen für 72 oder 96 h inkubiert und anschließend gezählt. Migration: Konfluente Zellkulturen der 1.Passage wurden verwendet. Mit einem modifizierten Trepan (Durchmesser 5,5 mm) wurde eine zentrale, zirkuläre "Wunde" gesetzt. Die Kulturen wurden mit frischem Medium, das humanes KW, TGF-ß2 und AS in den o. g. Konzentrationen enthielt, für 72 oder 96 h inkubiert. Zur Auswertung wurden die in den Wundbereich migrierten Zellen an 5 verschiedenen Stellen, ausgehend vom Wundrand, gezählt. Ergebnisse: Die Proliferation der BCEC wurde durch humanes KW (unverdünntes KW: nahezu 100%; 10%iges KW: 30%) und Ascorbinsäure (ca. 90% bei AS 200 µg/ml) gehemmt. TGF-ß2 stimulierte die Proliferation bis zu einem 3fachen Wert der Kontrollen. Die Migration wurde durch humanes KW (unverdünntes KW: nahezu 100%; 10%iges KW: 30%) und TGF-ß2 (ca. 50% bei allen Konzentrationen) gehemmt. AS hatte einen stimulierenden Einfluß (20-50%) auf die Migration. Schlußfolgerung: Noch ist unklar, welche Substanzen im KW für den proliferationshemmenden Einfluß auf korneale Endothelzellen verantwortlich sind. Sowohl AS als auch TGF-ß2 zeigten einen gegensätzlichen Effekt auf Proliferation und Migration kultivierter BCEC. Die Bedeutung dieser Beobachtungen für die Wundheilung humaner kornealer Endothelzellen in vivo ist Gegenstand weiterer Untersuchungen. / Purpose: Corneal endothelial cells are non-proliferating, wound healing primarily occurs by migration of adjacent cells. Endothelial cells in vivo are constantly exposed to aqueous humor (AH). Elevated concentrations of TGF-ß2 and ascorbic acid (AA) are present in aqueous humor. The influence of human AH, TGF- ß2 and AA on proliferation and migration of bovine corneal endothelial cells in vitro was investigated. Methods: Proliferation assays: BCEC at first passage were seeded at 1.5x104 cells/well. Fresh medium containing human AH (10% and 100%), TGF-ß2 (0,1;1 and 10 ng/ml) and AA (50, 100 and 200 µg/ml) was added to the cells. 72 or 96 hours later the cells were counted. Migration assays: BCEC at first passage were grown to confluency. A central, circular "wound" was made with an especially designed trephine (diameter 5.5 mm). The cultures were incubated with fresh medium containing human AH, TGF-ß2 and AA in the same concentrations for 72 or 96 hours. The cells were then counted in five randomly chosen sections from the wound edge. Results: Proliferation of BCE cells was inhibited by human AH (pure AH: nearly 100%, 10% AH: 30%) and AA (about 90% at 200 µg/ml). TGF-ß2 stimulated the proliferation up to 3 fold compared to the controls. Migration was inhibited by human AH (pure AH: nearly 100%, 10% AH: 30%) and TGF-ß2 (about 50% at all concentrations). AA had a stimulatory effect (20-50%) on migration. Conclusion: Presently, it remains unknown which substances in AH are responsible for the inhibiting effect on corneal endothelial proliferation. Both TGF-ß2 and AA showed to have a differential effect on proliferation and migration of cultured BCE cells. The significance of these observations for wound healing of human corneal endothelial cells in vivo has to be investigated.

Σκοπός της μελέτης ήταν ο ποσοτικός προσδιορισμός των ιχνοστοιχείων βαρέων μετάλλων του ψευδαργύρου, καδμίου και χαλκού στο υδατοειδές υγρό ασθενών με ψευδοαποφολίδωση και η μέτρηση του δυναμικού οξειδοαναγωγής στο υδατοειδές αυτών των ασθενών. Υλικό και μέθοδοι: Δείγματα υδατοειδούς υγρού ελήφθησαν κατά την εγχείρηση καταρράκτη από 14 ασθενείς με PEX σύνδρομο (7 άνδρες και 7 γυναίκες) και 21 ασθενείς με καταρράκτη αλλά χωρίς PEX (9 άνδρες και 12 γυναίκες). Τα δείγματα διατηρήθηκαν στους -24C μέχρι την ανάλυση. Τα επίπεδα των τριών μετάλλων και στις δύο ομάδες προσδιορίστηκαν, για πρώτη φορά στην Οφθαλμολογία, με τη μέθοδο της βολταμετρίας με χρήση ηλεκτροδίων υαλώδους γραφίτη με υμένιο υδραργύρου, ενδεικτικού ηλεκτροδίου λευκόχρυσου και αναφοράς Ag/AgCl. Εφαρμόσθηκε η τεχνική της ανοδικής βολταμετρίας απογύμνωσης με τετραγωνικούς παλμούς και έγινε σύγκριση των τιμών ανάμεσα στις δύο ομάδες. Η στατιστική επεξεργασία των αποτελεσμάτων έγινε με το Mann-Whitney test (p<0.05) Στη συνέχεια, κατά τον ίδιο τρόπο, δείγματα υδατοειδούς ελήφθησαν από 13 ασθενείς με PEX (7 άνδρες/6 γυναίκες) και 22 ασθενείς χωρίς PEX (7 άνδρες/15 γυναίκες). Η μέτρηση του δυναμικού οξειδοαναγωγής γινόταν αμέσως μετά την απόκτηση του κάθε δείγματος και για το σκοπό αυτό χρησιμοποιήθηκε για πρώτη φορά στην Οφθαλμολογία, ένα μικροηλεκτρόδιο λευκοχρύσου μαζί με ένα ενσωματωμένο ηλεκτρόδιο αναφοράς Ag/AgCl/KCl. Η στατιστική ανάλυση των αποτελεσμάτων έγινε με το t-test για ανεξάρτητα δείγματα (p<0.05). Αποτελέσματα: O Cu βρέθηκε στατιστικά σημαντικά χαμηλότερος στην PEX ομάδα σε σχέση με τη φυσιολογική ομάδα (p<0.05), ενώ ο Zn και το Cd δεν παρουσίασαν καμία συσχέτιση στο υδατοειδές υγρό ασθενών με ψευδοαποφολίδωση. Το δυναμικό οξειδοαναγωγής ήταν στατιστικά σημαντικά υψηλότερο στο υδατοειδές των ασθενών με PEX σύνδρομο. Συμπεράσματα: Στην παρούσα εργασία εφαρμόζεται για πρώτη φορά, η ανοδική βολταμετρία απογύμνωσης για τον προσδιορισμό στο υδατοειδές υγρό του Zn, Cd και Cu και η μέτρηση του δυναμικού οξειδοαναγωγής στο υδατοειδές. Τόσο τα στατιστικώς σημαντικά χαμηλότερα επίπεδα Cu στο υδατοειδές ασθενών με PEX, όσο και το υψηλότερο δυναμικό οξειδοαναγωγής στο υδατοειδές αυτών των ασθενών ενισχύουν την παθογενετική θεωρία του οξειδωτικού στρες του PEX συνδρόμου. / To determine the Zn, Cd and Cu concentrations in aqueous humor of patients with PEX syndrome and to evaluate the overall oxidative status of the aqueous in this group by measuring the reduction-oxidation (redox) potential in the aqueous samples. Material and methods: Samples from aqueous humor were collected during cataract extraction from 14 patients with PEX syndrome (7 male/7 female) and 21 patients without PEX (9 male/12 female). All samples were stored in -24C until analyzed. The levels of selected trace elements in both groups were assayed for the first time in the field of Ophthalmology, with anodic stripping voltammetry, using the square wave differential pulse technique. In this analytical procedure a glassy carbon mercury film electrode, a platinum indicator and a reference Ag/AgCl electrode were used. Finally the metal levels in all samples were compared between the two groups using the Mann-Whitney test (p<0.05). Similarly, samples were collected during cataract extraction from 13 patients (7 male/6 female) with PEX syndrome and 22 normal patients (7 male/15 female). A platinum electrode together with a reference electrode Ag/AgCl/KCl was used for the first time in Ophthalmology, for the measurement of the apparent redox potential in the aqueous humor. The independent samples t-test was used to compare aqueous redox potential between the study and control group. Statistical significance was set at 0.05. Results: Cu was found significantly lower in the PEX than in the control group (p<0.05), whereas Zn and Cd had no statistical differences between the two groups. The redox potential was found significantly higher in patients with PEX syndrome than in normal patients (p<0.05). Conclusions: In the present study we represent the first successful application of ASV in eye research for the determination of aqueous Zn, Cd and Cu concentrations and the meauserment of aqueous redox potential. The significantly lower Cu concentrations and the higher redox potential in aqeous humor of PEX syndrome support the role of increased oxidative stress in the development of PEX.

Pseudoexfoliation (PEX) syndrome is an age-related condition characterized by the production and accumulation of extracellular fibrillary material in the anterior segment of the eye. PEX predisposes for several pathological conditions, such as glaucoma and complications during and after cataract surgery. The pathogenesis of PEX is not yet fully understood. It is multifactorial with genetics and ageing as contributing factors. We aimed to study the proteome in aqueous humor (AH) in PEX in order to increase the knowledge about its pathophysiology. Therefore, we developed sampling techniques and evaluated separation methods necessary for analyzing small sample volumes. Other objectives were to study the lens capsule in eyes with PEX regarding small molecules, and to investigate the association between PEX and cataract surgery in a population-based 30-year follow-up study. Samples of AH from eyes with PEX and control eyes were collected during cataract surgery. In pooled, and individual samples, various liquid based separation techniques and high resolution mass spectrometry were utilized. For quantitation, various methods for labeling, and label free techniques were applied. Lens capsules were collected from some of the patients, and analysed by imaging mass spectrometry. A cohort of 1,471 elderly individuals underwent a comprehensive ophthalmological examination at baseline. Medical information was obtained by questionnaires, and from medical records. Incident cases of cataract surgery were identified by review of medical records. In the initial study, several techniques were explored for protein detection, and a number of proteins were identified as differentially expressed. In the individually labelled samples, changes in the proteome were observed. Eyes with PEX contained higher levels of proteins involved in inflammation, oxidative stress, and coagulation, suggesting that these mechanisms are involved in the pathogenesis in PEX. The levels of β/γ-crystallins were significantly increased in PEX, which is a novel finding. In the lens capsules from individuals with PEX, changes in the lipid composition was observed with time-of-flight secondary ion mass spectrometry. These changes remain to be elucidated. By multivariate analysis, lens opacities were the first, and PEX the second most important predictor for cataract surgery, the later accounting for a 2.38-fold increased risk for cataract surgery.

Ocular involvement, mainly retinochoroiditis, is one of the most severe sequelae of Toxoplasma gondii infection. However, the pathophysiological mechanisms of retinal destruction are poorly understood. Several studies suggested a more frequent and more severe ocular involvement in South American infections compared with European infections, probably due to different T. gondii strains (Type I/III, and atypical vs. Type II). To compare the clinical characteristics and biological and immunological responses in a single study and using the same parameters, in Colombian and French patients with active ocular toxoplasmosis (OT), as well as to study the local cytokinome in aqueous humor of these patients and correlate it with the clinical features. We prospectively collected and compared the clinical features of patients with active OT, evaluated at the Department of Ophthalmology of Strasbourg University Hospital and of Quindio University Health-Center. Results of biological tests in the collected aqueous humor samples were compared between Colombian and French patients: the pattern of protein recognition by immunoblotting (IB); the relative diagnostic sensitivities of IB and Polymerase Chain Reaction (PCR); and the cytokine and chemokine profiles. We found that Colombian and French OT patients presented not only different clinical characteristics but also biological characteristics, and that more virulent South American strains might be responsible for these differences, due to a disruption of the protective effects of interferon gamma (IFN-γ). Retinal lesions were 50% greater in Colombian patients. Macular localization leading to visual impairment was observed in 56% of Colombian cases, compared with 13% of French patients. Moreover, more vitreous inflammation and vasculitis were observed in Colombian patients. However, cytokine assays of the aqueous humor showed upregulation of inflammatory responses in European patients, notably IL-17, which we did not observe in Colombian patients. In a mouse model, intraocular tachyzoite injection of type II and atypical T. gondii strains resulted in differences in parasite multiplication and pathology similar to those observed in human infections. Production of IL-17 and other inflammatory markers, like IL-6, MCP-1, and the Th17 transcription factor ROR-γt was observed upon infection with the type II PRU strain, but was much less with the atypical LEF strain. In a previous work, the cytokine and mRNA patterns showed an upregulation of Th1 responses, notably IFN-γ production, in French patients, and anti-IL-17A antibody markedly diminished clinical damage and retinal inflammation, and also diminished parasite proliferation. In contrast to these previous findings in French patients, the cytokinome of aqueous humor of OT Colombian patients showed a downregulation of Th1 and Th17 responses and an upregulation of the Th2 response. Correlation between the clinical characteristics of Colombian patients with active OT and the levels of cytokines in aqueous humor (AH) showed that local production of cytokines differed between patients with OT, and particular cytokine levels were related to more severe clinical characteristics. Some cytokines were related to a higher number of recurrences.There are clinical and biological differences between Colombian and French patients with OT. There seem to be strain-specific differences in IL-17 and IFN-γ induction, which play an important role in the pathogenesis of this disease. These differences should be considered when thinking in perspectives of any possible immune-modulatory treatment in OT.