Anti-retinal Autoantibodies in Hydroxychloroquine Eye Toxicity

Area of Science:

• Ophthalmology
• Rheumatology
• Immunology

Background:

• Autoimmune retinopathy and hydroxychloroquine (HCQ)-related retinal toxicity share clinical similarities.
• This suggests a potential role for autoimmunity in HCQ retinopathy.

Purpose of the Study:

• To investigate the association between circulating antiretinal autoantibodies (AAbs) and HCQ retinal toxicity.
• To determine if patients with HCQ retinal toxicity are more likely to have AAbs compared to controls.

Main Methods:

• Plasma samples from 270 patients with systemic lupus erythematosus (SLE) on HCQ were tested for anti-retinal AAbs using immunoblotting.
• Patients were assessed for HCQ retinal toxicity and other risk factors via chart review.
• Multivariate logistic regression was used to compare AAb frequencies between patients with and without retinal toxicity.

Main Results:

• Patients with HCQ retinal toxicity had significantly higher rates of anti-arrestin AAbs (60.7% vs 30.6%) and anti-pyruvate kinase M2 AAbs (46.4% vs 28.1%).
• A higher mean number of total anti-retinal AAbs was observed in patients with HCQ eye toxicity (3.0 vs 2.04).
• The presence of anti-arrestin antibodies was linked to a 3.2-fold increased odds of developing HCQ eye toxicity, even after accounting for other risk factors.

Conclusions:

• Anti-retinal AAbs are more prevalent in SLE patients experiencing HCQ retinal toxicity.
• Anti-arrestin AAbs are associated with an increased risk of HCQ eye toxicity.
• Anti-retinal AAbs may serve as a valuable biomarker for identifying HCQ eye toxicity.