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      The microbiome and HLA-B27-associated acute anterior uveitis

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      Nature Reviews Rheumatology

      Springer Nature America, Inc

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          Abstract

          <p class="first" id="P1">Acute anterior uveitis (AAU) and related spondyloarthropathies (SpAs) such as ankylosing spondylitis, reactive arthritis and psoriatic arthritis have joined the expanding family of inflammatory disease associated with the biology of the intestinal microbiome. This review discusses why AAU and related SpAs have been incorporated into this paradigm shift for understanding disease pathogenesis. We focus in particular on the major risk gene HLA-B27 and how it may be associated with the loss of intestinal tolerance and ocular immune privilege that may accompany AAU. We discuss how perturbed microbiota composition, intestinal immunity and/or barrier function may contribute to the development of inflammatory responses that ultimately target either self or microbial antigen in the eye. These inflammatory processes may be augmented by translocation of intestinally-derived innate immune stimuli, such as microbe associated molecular patterns (MAMPs). Moreover, gut-derived host immune cells or damage-associated molecular patterns (DAMPs) may contribute to the ocular inflammatory cascade. Finally we discuss the novel therapeutic avenues offered by the microbiota for future clinical management of AAU and spondyloarthropathies. </p>

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          Most cited references 87

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            Commensal microbes can have a substantial impact on autoimmune disorders, but the underlying molecular and cellular mechanisms remain largely unexplored. We report that autoimmune arthritis was strongly attenuated in the K/BxN mouse model under germ-free (GF) conditions, accompanied by reductions in serum autoantibody titers, splenic autoantibody-secreting cells, germinal centers, and the splenic T helper 17 (Th17) cell population. Neutralization of interleukin-17 prevented arthritis development in specific-pathogen-free K/BxN mice resulting from a direct effect of this cytokine on B cells to inhibit germinal center formation. The systemic deficiencies of the GF animals reflected a loss of Th17 cells from the small intestinal lamina propria. Introduction of a single gut-residing species, segmented filamentous bacteria, into GF animals reinstated the lamina propria Th17 cell compartment and production of autoantibodies, and arthritis rapidly ensued. Thus, a single commensal microbe, via its ability to promote a specific Th cell subset, can drive an autoimmune disease. Copyright 2010 Elsevier Inc. All rights reserved.
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              Ulcerative colitis (UC) is difficult to treat, and standard therapy does not always induce remission. Fecal microbiota transplantation (FMT) is an alternative approach that induced remission in small series of patients with active UC. We investigated its safety and efficacy in a placebo-controlled randomized trial.
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                Author and article information

                Journal
                Nature Reviews Rheumatology
                Nat Rev Rheumatol
                Springer Nature America, Inc
                1759-4790
                1759-4804
                October 9 2018
                Article
                10.1038/s41584-018-0097-2
                6597169
                30301938
                © 2018

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