الفهرس 
Basic immunologyOnly 14 pages are availabe for public view
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Abstract
Biological agents are one of the newest classes of therapeutic proteins selectively targeting the immune mediators of the inflammatory process known as cytokines.
Cytokines are proteins secreted by the cells of immunity that mediate many of the functions of these cells, as tumor necrosis factor, interleukins and interferons.
Biological agents provide new options for patients with refractory and sight threatening inflammatory disorders and may be more effective and less toxic treatment than conventional immunosuppressive agents.
They include monoclonal antibodies, soluble receptors and cytokines themselves. They have been increasingly used in the treatment of ocular inflammatory diseases.
There is now current evidences of the effectiveness for their use in ophthalmology in non infectious uveitis, inflammatory macular edema, scleritis, optic neuritis, and in some eye tumors.
Tumor necrosis factor-α (TNF-α) is a well known pro-inflammatory cytokine that has been shown to play a key role in inflammatory disease. TNF-α inhibition with antibodies has been found to suppress experimental autoimmune uveitis. TNF-α inhibitors include infliximab and adalimumab which are monoclonal antibodies against TNF-α and etanercept, a soluble TNF-α receptor.
Interferon alpha-2a (IFN-α2a) was found to be successful in the treatment of uveitis associated with Behcet’s disease. It is a cytokine released by somatic cells in viral infections which exerts antiviral, antiproliferative, antiangiogenic, and immunomodulatory effects.
However, given high cost as well as the limited long-term safety data, we do not routinely recommend biologics as first-line therapy for most patients. These agents should be used with caution by experienced clinicians. The present work aims to provide a broad and updated review of the current and in-development systemic biologic agents for the treatment of ophthalmological diseases.
Biological agents have rare but serious side effects, and a clinician should rule out the presence of concurrent active or latent infections or hepatic and hematologic contraindications before treatment initiation, and should be completely aware of all their side effects with continuous monitoring during treatment.
In general, antibodies created fully or in part from nonhuman DNA(e.g., infliximab) are more likely to cause hypersensitivity reactions and to result in the creation of neutralizing antibodies when compared to fully humanized (e.g., adalimumab) antibodies. This is why infliximab is always given with a second immunosuppressive agent, typically methotrexate, to suppress the formation of such unwanted antibodies, whereas use of a second agent in association with adalimumab is optional.
IFNalpha therapy has been known to cause a variety of ocular lesions. Typical lesions include cotton wool spots and retinal hemorrhages at the posterior fundus , particularly around the optic disc secondary to retinal ischemia which usually appear within three months of the onset of therapy The incidence of retinopathy is thought to depend on the initial dose of IFNalpha and patients receiving high dosages.The retinopathy may disappear spontaneously during therapy or rapidly after stopping therapy.
Yet, a journey to discover the ideal medication that is universally and rapidly effective, well tolerated, affordable, and with durable efficacy is to be continued.