The microbiome and HLA-B27-associated acute anterior uveitis

• Published in: Nature reviews. Rheumatology Vol. 14; no. 12; pp. 704 - 713
• Main Authors: Rosenbaum, James T., Asquith, Mark
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 01.12.2018; Nature Publishing Group
• Subjects: 692/4023/1670/2766/1827; 692/420/2489/144; 692/420/2780; 692/698/2741/2135; 692/699/249/1313; Animals; Ankylosing spondylitis; Arthritis; Care and treatment; Development and progression; Dysbacteriosis; Gastrointestinal Microbiome - immunology; Gene expression; Genetic aspects; Health aspects; Histocompatibility antigen HLA; Histocompatibility antigens; HLA histocompatibility antigens; HLA-B27 Antigen - metabolism; Humans; Immune privilege; Immune response; Immunity, Innate; Immunological tolerance; Inflammatory diseases; Intestinal microflora; Intestine; Market shares; Medicine; Medicine & Public Health; Microbiomes; Microbiota; Microbiota (Symbiotic organisms); Pathogenesis; Psoriatic arthritis; Review Article; Rheumatic diseases; Rheumatology; Sales forecasting; Spondylarthropathies - immunology; Spondylarthropathies - microbiology; Spondylitis; Uveitis; Uveitis, Anterior - immunology; Uveitis, Anterior - microbiology; United States
• ISSN: 1759-4790; 1759-4804; 1759-4804
• DOI: 10.1038/s41584-018-0097-2

Acute anterior uveitis (AAU) and the spondyloarthritis (SpA) subtypes ankylosing spondylitis, reactive arthritis and psoriatic arthritis are among the inflammatory diseases affected by the biology of the intestinal microbiome. In this Review, the relationship between AAU, SpA and the microbiome is discussed, with a focus on the major SpA risk gene HLA-B*27 and how it is associated with both intestinal tolerance and the loss of ocular immune privilege that can accompany AAU. We provide four potential mechanisms to account for how dysbiosis, barrier function and immune response contribute to the development of ocular inflammation and the pathogenesis of AAU. Finally, potential therapeutic avenues to target the microbiota for the clinical management of AAU and SpA are outlined. Both spondyloarthritis and uveitis are associated with HLA-B27 positivity. This Review discusses this overlap and how the intestinal microbiome and dysbiosis might contribute to the development of both diseases. Key points Acute anterior uveitis (AAU) is the most common, clinically apparent, extra-articular manifestation of ankylosing spondylitis. Both AAU and ankylosing spondylitis are strongly associated with HLA-B27. HLA-B27 affects the composition of the gut microbiome, which in turn can modify the immune system and thereby affect health and disease. The intestinal microbiome is strongly implicated in the pathogenesis of AAU and ankylosing spondylitis. Although the mechanisms by which the intestinal microbiome cause AAU and ankylosing spondylitis are incompletely understood, a great potential exists to treat or prevent ankylosing spondylitis and AAU by altering the microbiome.