[Anti-cytokine and anti-lymphocyte monoclonal antibodies in the treatment of thyroid associated ophthalmopathy].

Abstract

Graves' ophthalmopathy or thyroid associated ophthalmopathy (TAO) is an autoimmune disease of the orbit involving both the retroorbital connective tissue and the extraocular muscles, but its pathogenesis is still incompletely understood. Examination of retroorbital tissues in the initial inflammatory phase of TAO reveals an accumulation of hydrophilic glycosaminoglycans, increased fat volume, marked T and B lymphocytic infiltration, and presence of many pro-inflammatory cytokines and growth factors. Peripheral blood levels of pro-inflammatory cytokines released from T and B lymphocytes (IFN-gamma, IL-1beta, IL-2, slL-2R TNF-alpha, IL-6, IL-6R) and antibodies of TSH receptor (TRAb) secreted from B lymphocytes are markers of the immune system activity. Updated the efficacy of the new anti-cytokine and anti-lymphocyte treatment of the Graves' ophthalmopathy has been revived. We described the first positive results of anti-B lymphocyte (anti-CD20; rituximab) and anti-TNF-alpha monoclonal antibodies (infliximab; etanercept) administration as new therapeutic options in the treatment of patients with active TAO. A randomized prospective study are needed to determine whether rituximab, infliximab or etanercept prove sufficiently effective in reducing the inflammatory symptoms of TAO, and whether they can be administered safely for a prolonged period without side effects.