GENETIC AND CLINICAL DETERMINANTS FOR THE T-CELL MEDIATED IMMUNE-RESPONSE AGAINST THE CORNEA SPECIFIC PROTEIN BCP-54

T cell mediated immune responses against the cornea specific protein B CP 54 have been observed in patients with uveitis, Fuchs' heterochromi c cyclitis, and corneal disease. The pathophysiological role of this a nti-BCP 54 response in corneal disease is not known. In order to ascer tain whether the presence of such an immune response is related to the corneal disease itself or related to genetic influences, the anti-BCP 54 response was determined in 104 patients with severe corneal diseas e, using a monocyte migration inhibition assay. The results were compa red with the presence of a variety of ocular parameters as well as wit h the distribution of HLA antigens in these patients. While only 7% of healthy controls responded to BCP 54, 37% of the patients showed a po sitive response (p = 0.002); in particular, patients with previous gra ft rejection, non-herpetic keratitis, and bullous keratopathy reacted against BCP 54. No relation with known risk factors for corneal transp lantation, such as corneal neovascularisation, was observed. No signif icant association with the presence of any of the HLA antigens was obs erved. It was concluded that the main inducer of an anti-BCP 54 respon se is corneal disease itself, and that the presence of corneal disease is able to break the immunological privilege typical of normal cornea s.