title: Mooren ulcer: an immunopathologic study.
abstract: OBJECTIVE
  To determine the pattern and distribution of mononuclear cells, adhesion, and co-stimulatory molecules in the conjunctiva of patients with Mooren ulcer.
  
  
  METHODS
  Conjunctival biopsy specimens were obtained from 6 patients with Mooren ulcer and 6 healthy individuals. Immunohistochemistry was performed on frozen sections of the cryopreserved human conjunctivas using monoclonal antibodies directed against CD1alpha, CD3, CD4, CD8, CD20, CD25, CD57, and CD68 cells; the adhesion molecules E-selectin, vascular cell adhesion molecule-1 (VCAM-1), very late activation-4 (VLA-4), ICAM-1, and LFA-1; and the co-stimulatory molecules CD28, B7-1, B7-2, and CTLA-4.
  
  
  RESULTS
  Differences in expression on the conjunctival epithelium from patients with Mooren ulcer and normal subjects were noted only for VCAM-1, VLA-4, ICAM-1, and LFA-1. The ratio of CD4+/CD8+ cells in Mooren ulcer specimens was significantly higher (3.5-fold). However, in the substantia propria, Mooren ulcer specimens revealed significantly increased numbers of CD1alpha+, CD3+, CD4+, CD20+, CD28+, B7-1+, B7-2+, and CD68+ cells. The ratios of CD4+/CD8+ cells and B7-2+/antigen-presenting cells in Mooren ulcer specimens were significantly higher (5-fold). All tested adhesion molecules showed significant up-regulation in the patients' conjunctivas. Mooren ulcer vascular endothelial cells prominently expressed E-selectin, VCAM-1, VLA-4, and ICAM-1 compared with normal conjunctiva.
  
  
  CONCLUSIONS
  The simultaneous presence of multiple types of inflammatory cells, adhesion, and co-stimulatory molecules in Mooren ulcer conjunctiva suggests that their interaction may contribute to a sustained immune activation as at least part of the pathogenic mechanism of this disorder.
authors.affiliation: Massachusetts Eye Research and Surgery Institute, Cambridge, MA, USA.
authors.forename: Chrysanthi
authors.initials: C
authors.lastname: Kafkala
authors.forename: John
authors.initials: J
authors.lastname: Choi
authors.forename: Panayotis
authors.initials: P
authors.lastname: Zafirakis
authors.forename: Stefanos
authors.initials: S
authors.lastname: Baltatzis
authors.forename: Charalampos
authors.initials: C
authors.lastname: Livir-Rallatos
authors.forename: Blanca
authors.initials: B
authors.lastname: Rojas
authors.forename: C Stephen
authors.initials: CS
authors.lastname: Foster
mesh_terms: D000911:Antibodies, Monoclonal; D015703:Antigens, CD / Q000378:metabolism; D016516:CD4-CD8 Ratio; D015815:Cell Adhesion Molecules / Q000378:metabolism; D002908:Chronic Disease; D003228:Conjunctiva / Q000378:metabolism / Q000473:pathology; D003320:Corneal Ulcer / Q000276:immunology* / Q000473:pathology*; D004848:Epithelium / Q000378:metabolism / Q000473:pathology; D006801:Humans; D007124:Immunoenzyme Techniques; D007963:Leukocytes, Mononuclear / Q000276:immunology; D015854:Up-Regulation
chemical_list: D000911:Antibodies, Monoclonal; D015703:Antigens, CD; D015815:Cell Adhesion Molecules