Helicobacter Pylori IgG Antibodies In Aqueous Humor And Serum Of Subjects With Primary Glaucoma In Our Local Population

Purpose: Glaucoma is one of the commonest causes of blindness in theworld, and a progressive optic neuropathy that may have a multifactorial cause,which remains largely unknown. It is accepted to divide to Primary open-angleglaucoma (POAG) and primary angle-closure glaucoma(PACG)by the angle.It is now clear that the mechanism of PACG,but the mechanism of POAGremain unknown. The initial triggering mechanism that induce aqueousoutflow obstruction,or increase the susceptibility of ocular tissues toglaucomatous damage. Accumulating evidence suggests pathogeneticassociations between POAG, endothelium-dependent vascular dysregulation,and impaired ocular blood flow. Moreover, autoimmune mechanisms may beresponsible for eliciting or accentuating injury to the optic nerve, which resultsin glaucomatous damage in at least some glaucoma patients. There isincreasing evidence, from both clinical and experimental observations, thatinflammation plays an important role in the development of glaucoma. Somestudies have suggested that Helicobacter pylori may be the etiologic agent ofthe inflammatory process. But the significance of such an association remainsuncertain because of the conflicting findings reported by various studies.H.pylori is a Gram-negative, microaerophilic bacterium. Pathologic andclinical studies have convincingly proved the etiologic role of H.pylori in thedevelopment of chronic gastritis and peptic ulcer disease, and also suggestedthat H.pylori infection is a risk factor for gastric cancer. The severity of gastricdamage and eventual clinical outcome of H. pylori infection are determined bya combination of host, genetic and bacterial virulence factors. In addition, H.pylori contributes has been implicated in numerous extra-digestive conditions,including cerebrovascular disease, vascular disorders, coronary heart disease and some autoimmune conditions such as Sjogren's syndrome and immunethrombocytopenic purpura. Kountouras et al have established a higherprevalence of H. pylori infection in the sera of patients with POAG in a Greekpopulation, suggesting a possible causal link between H. pylori and glaucoma.But some scholar found no association between exposure to H. pyloriinfection and POAG in their study. Our comparative study was carried out toinvestigate levels of anti–Helicobacter pylorispecific IgG antibodies in theaqueous humor and serum of patients with primary open angle glaucoma(POAG group), primary angle-closure glaucoma (PACG group), and a controlgroup of patients with cataract, and to investigate whether Helicobacter pyloriinfection is associated with POAG.Methods: The POAG patients come from the xingtai ophthalmologichospital in nov,2010to Aug,2011, the PACG patients and cataract comefrom the second hospital of hebei medical university in the same time.Aqueous humor was aspirated at the beginning of glaucoma surgery from25eyes of25patients with POAG, from30eyes of30patients with PACG and atthe beginning of phakoemulsification cataract surgery from33eyes of33cataract patients, about0.06ml,stored at70℃in the laboratory freezer bloodsamples were collected on the day of surgery from all patients,3ml,sampleswere centrifuged at4000g for10min to obtain serum, then aliquoted andstored at70℃in the laboratory freezer until assay(between20to25day).This investigation included a total of88aqueous humor and serum wasmeasured by means of colloidal gold marker immunodotting percolation. Allanalyses were performed with SPSS13.0software, variables between thethree groups were compared by the analysis of variance, the χ2test wasapplied to the prevalence of anti-H. pylori specific IgG antibody.Results: This investigation included a total of88serum samples andaqueous humor,25from the POAG patients,30from the PACG patients and33from the cataract patients, There was no statistical difference among the studygroups in mean age and sex, Patients with glaucoma exhibited a higher meantreated intraocular pressure(IOP)than the cataract patients, There was no significant difference in the POAG patients and PACG patients. Mean defect(MD) in the three group don"t significant difference. The anti-H.pylori-specific IgG antibody was detected in the serum samples frompatients with19/25(76%) POAG patients,18/30(43.3%) PACG patients and10/33(30.3%) cataract (control) patients, it is significantly increased in POAGgroup than PACG group and control group (P=0.014and P=0.001,respectively), No difference was observed between PACG group and controlgroup (P=0.283). However,6/25(24%) POAG patients,7/30(23.3%)PACGpatients and7/33(21.1%)cataract patients detected the anti-H. pylori-specificIgG antibody in the aqueous humor, and were not statistically different fromthose of group.Conclusions: However, no significant association are found in theaqueous humor samples between the POAG group, PACG group and cataractpatients, H.pylori-specific IgG antibody levels are significantly increased inthe serum samples of patients with POAG group. It may be because ofexperiments reagent or the titer in the aqueous humor samples lower than theserum samples, It is possible that the increased titer of anti-H. pylori IgGantibodies serum samples of POAG indirect evidence for the role of thedamage caused by glaucomatous optic neuropathy. So this study suggests thatH.pylori infection may be associated with an increased risk for POAG, thesefindings support a role for H. pylori infection in the development ofPOAG.Nevertheless, future studies in large glaucoma cohorts throughout theclinical range and utilizing all glaucoma parameters are needed to test thehypothesis that the presence of IgG antibodies to H. pylori may adverselyinfluence progression of glaucomatous neuropathy.