Eye and Immunogenetic Features of Sarcoidosis - Full Text View

Study Description

Brief Summary:

This study will evaluate patients with sarcoidosis to understand how the disease affects the body. Sarcoidosis is a disease that results from inflammation of body tissues. The lungs, lymph nodes in the chest, skin and eyes are most commonly affected. As the disease progresses, small lumps, or granulomas, appear in the affected tissues. In most cases, the granulomas clear up, but in cases where they do not heal and disappear, the tissues tend to remain inflamed. Eye inflammation (uveitis) associated with sarcoidosis can cause various eye diseases, sometimes leading to blindness. This study will examine the clinical, immunological and genetic features of ocular sarcoidosis.

Patients 6 years of age and older with sarcoidosis may be eligible for this study. Candidates are screened with the following procedures:

Completion of a questionnaire with medical, social and demographic information
Blood draw for laboratory tests
Complete eye examination, including measurement of eye pressure and dilation of the pupils to examine the back of the eye. Fluorescein angiography may be done. This test involves injecting a dye into a vein in the arm. The dye travels to the blood vessels in the eyes. A camera flashes a blue light into the eye and takes pictures of the retina that show whether the dye has leaked from the blood vessels into the retina. Other photographs of the eye may also be taken using a special camera.

Participants are followed in conjunction with their local eye doctor as required by the status of their disease. Patients whose disease is stable are seen for an initial examination and followed every 12 months for 3 years.

Condition or disease
Sarcoidosis Uveitis

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Detailed Description:

BACKGROUND

Sarcoidosis is a multi-systemic granulomatous disease. The lungs, thoracic lymph nodes, the skin and the eyes are the most commonly affected organs. Most patients with sarcoidosis present with respiratory symptoms. Sarcoid uveitis is usually suspected when ocular inflammation is found in conjunction with suggestive serological and radiological studies. Currently, the diagnosis of sarcoidosis requires the demonstration of non-caseating granulomas on biopsy; but even this is not always diagnostic; more sensitive and specific noninvasive tools are needed.

Ophthalmic involvement has been reported in as many as 40% of patients with sarcoidosis, but most series report ophthalmic findings in approximately 25% of patients who develop chronic, systemic sarcoidosis. Uveitis associated with sarcoidosis can be very diverse, including: acute non-granulomatous or chronic granulomatous iridocyclitis, vitritis, retinal vasculitis, choroiditis with choroidal granulomas and papillitis secondary to optic nerve granulomas; and it can cause ocular morbidity due to a high incidence of glaucoma and cataracts. Other ophthalmic findings include lacrimal gland enlargement, secondary Sjogren's disease, scleritis, orbital gland involvement, secondary proliferative retinopathy, subretinal neovascularization, and optic neuropathy.

To better evaluate and diagnose patients, we also need to improve our ability to predict susceptibility and prognosis, especially among African-Americans. Current epidemiologic studies of sarcoidosis indicate that in the United States, African Americans have about a threefold higher age-adjusted annual incidence, 35.5/100,000, compared with Caucasians, 10.9/100,000. In addition, African Americans with chronic sarcoidosis are more likely to develop ocular manifestations than whites. The study of ocular sarcoidosis is important because it is a leading inflammatory cause of blindness and ocular morbidity. In large surveys of patients with uveitis, approximately 5% of patients were found to have ocular sarcoidosis, and approximately 10% of these patients become blind in at least one eye.

AIMS:

AIM 1: CLINICAL ANALYSIS:

Documentation of:

Clinical features of sarcoidosis associated uveitis
Chronological association of ocular disease to histopathologic diagnosis of sarcoidos
Family history of sarcoidosis
Previous therapies and response
Ocular status compared with systemic disease status, current and historical Environmental exposure history

AIM 2: IMMUNOLOGICAL ANALYSIS:

One of the goals of this study is to determine the diagnostically important cytokines in biopsy-proven ocular sarcoidosis.

The chemokine profile of the Peripheral Blood Mononuclear Cells and Broncho-Alveolar Lavage Fluid (BALF) of pulmonary sarcoidosis patients has been reported and many cytokines have been implicated in the pathogenesis of this disease.

Serum Level for

A. TNF alpha

B. MIP-1 alpha

C. IL-8

D. IL-2

E. TGF Beta

F. INF gamma
Immunophenotyping of whole blood cells and BALF by flow cytometry

Focus on:

A. T cell sub-typing (examples: CD4, CD8)

B. NK cell sub-typing (examples:CD56, KIR)
TLRs sub-typing

AIM 3: GENETIC ANALYSIS:

Serum analysis for HLA Class I and II typing

A cohort of 100 patients with biopsy-proven sarcoidosis will be recruited from the Uveitis and Ocular Immunology Clinic at the National Eye Institute and the Pulmonary Clinic at the National Heart Lung and Blood Institute.

FUTURE AIMS:

We aim to characterize the TLR activation profile in patients with ocular sarcoidosis, and compare them to patients with pulmonary sarcoidosis and normal volunteers. Using this immuno-genetic classification scheme, in conjunction with HLA typing, we hope to develop novel diagnostic and/or prognostic criteria for sarcoidosis. In addition, the TLR activation profile may allow risk stratification for different sarcoidosis phenotypes.

METHODS:

A cohort of 100 patients with biopsy-proven sarcoidosis will be recruited from the Uveitis and Ocular Immunology Clinic at the National Eye Institute and the Pulmonary Clinic at the National Heart Lung and Blood Institute. After obtaining informed consent, the patients will be invited to participate in the study. After appropriate enrollment, they will undergo the following

Completion of a questionnaire, with medical, social and demographic data
A complete ophthalmologic examination
Baseline serologic analysis
Baseline serum analysis for immunologic analysis
HLA-Typing
Patients who are quiescent will be seen at baseline with a second visit at 1 year
Patients who are active will be treated appropriately, by their referring ophthalmologist or on a treatment protocol at the National Eye Institute

Study Design

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Study Type :	Observational
Enrollment :	100 participants
Official Title:	Ocular and Immuno-Genetic Manifestations of Sarcoidosis
Study Start Date :	September 18, 2006
Study Completion Date :	December 10, 2007

Resource links provided by the National Library of Medicine

MedlinePlus related topics: Sarcoidosis

Genetic and Rare Diseases Information Center resources: Uveal Diseases

U.S. FDA Resources

Eligibility Criteria

Information from the National Library of Medicine

Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the contacts provided below. For general information, Learn About Clinical Studies.

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Ages Eligible for Study:	6 Years and older (Child, Adult, Older Adult)
Sexes Eligible for Study:	All
Accepts Healthy Volunteers:	No

Criteria

INCLUSION CRITERIA:
1. Participants must be at least 6 years old
2. Participants must have biopsy-proven sarcoidosis
3. Participant must be able to consent to participating in the protocol
4. For minors, consent by an adult will be necessary

EXCLUSION CRITERIA:

We will exclude participants who are unable or unwilling to give blood at the designated times in the protocol

Contacts and Locations

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT00379275

Locations

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United States, Maryland
National Institutes of Health Clinical Center, 9000 Rockville Pike
Bethesda, Maryland, United States, 20892

Sponsors and Collaborators

National Eye Institute (NEI)

More Information

Publications:

Jabs DA, Johns CJ. Ocular involvement in chronic sarcoidosis. Am J Ophthalmol. 1986 Sep 15;102(3):297-301.

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ClinicalTrials.gov Identifier:	NCT00379275
Other Study ID Numbers:	060239 06-EI-0239
First Posted:	September 21, 2006 Key Record Dates
Last Update Posted:	July 2, 2017
Last Verified:	December 10, 2007

Keywords provided by National Institutes of Health Clinical Center (CC):


Sarcoidosis Uveitis Pulmonary Sarcoidosis	HLA-Typing Cytokines Serum Markers

Additional relevant MeSH terms:

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Uveitis Sarcoidosis Uveal Diseases	Eye Diseases Lymphoproliferative Disorders Lymphatic Diseases