title: Evidence for antigen-specific immune deviation in patients with acute retinal necrosis.
abstract: BACKGROUND
  Because experimental acute retinal necrosis (ARN) induced by herpes simplex virus in mice develops only if mice fail to acquire virus-specific delayed hypersensitivity (DH), although they produce antiviral antibodies (ie, anterior chamber-associated immune deviation), we sought to determine whether a similar inverse correlation exists for patients with varicella-zoster virus (VZV)-induced ARN.
  
  
  METHODS
  Patients with acute, VZV-induced ARN and age-matched control subjects were skin tested with VZV and purified protein derivative antigens to evaluate DH. Varicella-zoster virus-induced ARN was diagnosed using polymerase chain reaction and intraocular antibody quotient. Serum samples were collected and analyzed for anti-VZV and anti-herpes simplex virus antibody titers. Acute retinal necrosis activity was assessed clinically, and DH skin tests were repeated 3 months after onset when ocular recovery had taken place.
  
  
  RESULTS
  Whereas controls displayed intense DH when tested with VZV and purified protein derivative antigens, a subset of patients with ARN displayed absent VZV-specific DH (although their purified protein derivative responses were normal). Patients with the most severe ARN had the lowest DH responses to VZV antigens. Serum anti-VZV antibody titers were higher in patients with ARN than in controls, and antiviral titer correlated inversely with the intensity of anti-VZV DH responses. Varicella-zoster virus-specific DH responses were restored in patients who recovered from ARN.
  
  
  CONCLUSIONS
  Varicella-zoster virus-ARN develops in a setting where DH reactivity to viral antigens is absent, implying that virus-specific DH might ameliorate the severity of ARN.
  
  
  CONCLUSIONS
  Linking virus-specific DH to vulnerability to ARN in individuals infected with VZV might reveal an underappreciated pathogenic mechanism.
authors.affiliation: Department of Ophthalmology, Tokyo Medical University, 6-7-1, Nishishinjuku, Shinjuku-ku, Tokyo 160-0023, Japan. tkezuka@tokyo-med.ac.jp
authors.forename: T
authors.initials: T
authors.lastname: Kezuka
authors.forename: J
authors.initials: J
authors.lastname: Sakai
authors.forename: N
authors.initials: N
authors.lastname: Usui
authors.forename: J W
authors.initials: JW
authors.lastname: Streilein
authors.forename: M
authors.initials: M
authors.lastname: Usui
mesh_terms: D000914:Antibodies, Viral / Q000097:blood; D000956:Antigens, Viral / Q000276:immunology*; D017931:DNA Primers / Q000737:chemistry; D006563:Herpes Zoster Ophthalmicus / Q000276:immunology* / Q000821:virology; D018259:Herpesvirus 1, Human / Q000235:genetics / Q000276:immunology; D014645:Herpesvirus 3, Human / Q000235:genetics / Q000276:immunology*; D006801:Humans; D006968:Hypersensitivity, Delayed / Q000276:immunology* / Q000821:virology; D008875:Middle Aged; D016133:Polymerase Chain Reaction; D015882:Retinal Necrosis Syndrome, Acute / Q000276:immunology* / Q000821:virology; D012882:Skin Tests; D014373:Tuberculin / Q000276:immunology
chemical_list: D000914:Antibodies, Viral; D000956:Antigens, Viral; D017931:DNA Primers; D014373:Tuberculin