Mechanisms of blood-retinal barrier disruption related to intraocular inflammation and malignancy

IF 18.6 1区 医学 Q1 OPHTHALMOLOGY Progress in Retinal and Eye Research Pub Date : 2024-01-17 DOI:10.1016/j.preteyeres.2024.101245
Oren Tomkins-Netzer , Rachael Niederer , John Greenwood , Ido Didi Fabian , Yonatan Serlin , Alon Friedman , Sue Lightman
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Abstract

Blood-retinal barrier (BRB) disruption is a common accompaniment of intermediate, posterior and panuveitis causing leakage into the retina and macular oedema resulting in vision loss. It is much less common in anterior uveitis or in patients with intraocular lymphoma who may have marked signs of intraocular inflammation. New drugs used for chemotherapy (cytarabine, immune checkpoint inhibitors, BRAF inhibitors, EGFR inhibitors, bispecific anti-EGFR inhibitors, MET receptor inhibitors and Bruton tyrosine kinase inhibitors) can also cause different types of uveitis and BRB disruption. As malignant disease itself can cause uveitis, particularly from breast, lung and gastrointestinal tract cancers, it can be clinically difficult to sort out the cause of BRB disruption. Immunosuppression due to malignant disease and/or chemotherapy can lead to infection which can also cause BRB disruption and intraocular infection.

In this paper we address the pathophysiology of BRB disruption related to intraocular inflammation and malignancy, methods for estimating the extent and effect of the disruption and examine why some types of intraocular inflammation and malignancy cause BRB disruption and others do not. Understanding this may help sort and manage these patients, as well as devise future therapeutic approaches.

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与眼内炎症和恶性肿瘤有关的视网膜血屏障破坏机制
血-视网膜屏障(BRB)破坏是中度、后度和全葡萄膜炎的常见并发症,会导致渗漏到视网膜和黄斑水肿,从而导致视力下降。这种情况在前葡萄膜炎或眼内淋巴瘤患者中要少见得多,这些患者可能有明显的眼内炎症症状。用于化疗的新药(阿糖胞苷、免疫检查点抑制剂、BRAF 抑制剂、表皮生长因子受体抑制剂、双特异性抗表皮生长因子受体抑制剂、MET 受体抑制剂和布鲁顿酪氨酸激酶抑制剂)也会引起不同类型的葡萄膜炎和 BRB 破坏。由于恶性疾病本身也会引起葡萄膜炎,尤其是乳腺癌、肺癌和胃肠道癌症,因此临床上很难分清 BRB 干扰的原因。本文探讨了与眼内炎症和恶性肿瘤有关的BRB破坏的病理生理学、估计破坏程度和影响的方法,并研究了为什么某些类型的眼内炎症和恶性肿瘤会导致BRB破坏,而另一些则不会。了解这一点有助于对这些患者进行分类和管理,以及设计未来的治疗方法。
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来源期刊
CiteScore
34.10
自引率
5.10%
发文量
78
期刊介绍: Progress in Retinal and Eye Research is a Reviews-only journal. By invitation, leading experts write on basic and clinical aspects of the eye in a style appealing to molecular biologists, neuroscientists and physiologists, as well as to vision researchers and ophthalmologists. The journal covers all aspects of eye research, including topics pertaining to the retina and pigment epithelial layer, cornea, tears, lacrimal glands, aqueous humour, iris, ciliary body, trabeculum, lens, vitreous humour and diseases such as dry-eye, inflammation, keratoconus, corneal dystrophy, glaucoma and cataract.
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