(Investigative Ophthalmology and Visual Science. 2000;41:3856-3861.)
© 2000
by The Association for Research in Vision and Ophthalmology, Inc.
Impaired Eosinophil Recruitment to the Cornea in P-SelectinDeficient Mice in Onchocerca volvulus Keratitis (River Blindness)
Jussuf T. Kaifi1,
Laurie R. Hall1,
Carlos Diaz1,
Joseph Sypek2,
Eugenia Diaconu1,
Jonathan H. Lass1 and
Eric Pearlman1
1 From the Departments of Medicine, Ophthalmology, and Pathology, Case Western Reserve University and University Hospitals of Cleveland, Cleveland, Ohio; and
2 Genetics Institute/Wyeth Ayerst Research, Andover, Massachusetts.
 |
Abstract
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PURPOSE. A murine model of helminth-induced keratitis (river blindness) that is
characterized by a biphasic recruitment of neutrophils (days 13) and
eosinophils (days 3+) to the cornea has been developed. The purpose of
this study was to determine the relative contribution of P- and
E-selectin in recruitment of these inflammatory cells from limbal
vessels to the corneal stroma.
METHODS. P- and E-selectin gene knockout (-/-) mice were immunized with
antigens extracted from the parasitic helminth Onchocerca
volvulus. One week after the last immunization, parasite
antigens were injected directly into the corneal stroma. Mice were
killed on days 1 and 3 postchallenge, and eyes were immunostained with
either anti-eosinophil major basic protein (MBP) or with
anti-neutrophil Ab. The number of cells in the cornea was determined by
direct counting.
RESULTS. Recruitment of eosinophils to the cornea was significantly impaired in
P-selectin-/- mice (63.9% fewer eosinophils on day 1
[P = 0.0015], and 61% fewer on day 3
[P < 0.0001]) compared with control C57BL/6
mice. In contrast, P-selectin deficiency had no effect on neutrophil
recruitment to the cornea. There was no inhibition of eosinophil and
neutrophil migration to the corneas of E-selectin-/-
mice, indicating that there is no direct role for this adhesion
molecule in helminth-induced keratitis.
CONCLUSIONS. The present study demonstrates that P-selectin is an important mediator
of eosinophil recruitment to the cornea. P-selectin interactions may
therefore be potential targets for immunotherapy in eosinophil-mediated
ocular inflammation.
 |
Introduction
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Leukocyte migration into the tissue is a multistep process,
beginning with selectinmediated, low-affinity rolling of leukocytes
along activated vascular endothelium.1
Continued stimulus
leads to high-affinity adhesion mediated by integrins and members of
the immunoglobulin superfamily.1
In the presence of
chemotactic signals, subsets of leukocytes migrate across the
endothelial cell layer into the tissue, and the nature of the leukocyte
infiltrate depends on the specific vascular adhesion cell molecules and
chemotactic cytokines that are expressed at the site. In the cornea,
for example, migration of neutrophils in a murine model of herpes
simplex keratitis is regulated by expression of platelet endothelial
cell adhesion molecule (PECAM) 1.2
In contrast to herpes simplex and Pseudomonas keratitis, the
murine model for Onchocerca volvulus keratitis (river
blindness) is characterized by recruitment of eosinophils and
neutrophils to the cornea in a biphasic manner, with neutrophils
preceding and being replaced by eosinophils.3
4
5
Our
previous studies using this model demonstrated that eosinophil
migration to the cornea is tightly regulated by chemotactic and
regulatory cytokines, including IL-4, IL-12, and
eotaxin6
7
8
9
and that recruitment of neutrophils and
eosinophils to the central cornea is dependent on the presence of
specific antibody.3
In the present study, we used mice deficient in P- or E-selectin to
examine the role of these adhesion molecules in recruitment of
neutrophils and eosinophils from the limbal vessels to the cornea. We
found that the absence of P-selectin significantly impaired recruitment
of eosinophils but not neutrophils to the cornea, whereas E-selectin
deficiency had no effect on migration of either cell type. These
findings may have implications for other causes of ocular inflammation
in which neutrophils and eosinophils are involved.
 |
Methods
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Source of Mice
Mice deficient in E-selectin10
and
P-selectin11
on a C57BL/6 background were obtained from
Taconic (Germantown, NY). Age- and sex-matched C57BL/6 mice were
obtained from Taconic as controls. All mice were genotyped by PCR
analysis using P-selectin specific primers (sense: TTG TAA ATC AGA AGG
AAG TGG; antisense: AGA GTT ACT CTT GAT GTA GAT CTC C) and E-selectin
primers (sense: GGA CTG TGT AGA GAT TTA CAT CC; antisense: GCA GGT GTA
ACT ATT GAT GGT). All mice were treated in accordance with the ARVO
Statement for the Use of Animals in Ophthalmic and Vision Research.
Preparation of O. volvulus Antigens
O. volvulus parasites were isolated from s.c. nodules
that had been surgically removed from infected patients in Cameroon
(nodules were kindly provided by Janet Bradley at Salford University,
United Kingdom). Worms recovered after digestion with collagenase
(Sigma, St. Louis, MO) were homogenized in HBSS using a mortar and
pestle, insoluble material was separated by centrifugation, and
the protein concentration was determined using BioRad protein
assay (BioRad, Richmond, CA).
Induction of O. volvulus Keratitis
Animals received three weekly s.c. immunizations with 10 µg
O. volvulus antigens in a 1:1 ratio with adjuvant containing
squalene (Aldrich Chemical, Milwaukee, WI), Tween 80 (Fisher,
Fair Lawn, NJ), and pluronic acid (BASF, Parsippany,
NJ).6
To inject parasite material into the corneal stroma, mice were
anesthetized by intraperitoneal injection of 200 µl of a 1.2%
solution of 2,2,2-tribromoethanol (Aldrich) containing 2.5%
2-methyl-2-butanol (tertiary amyl alcohol; Aldrich) dissolved in
dH2O.12
The epithelial layer was
scarified using a 30-gauge needle, and 10 µg of O.
volvulus antigens in 5 µl were injected into the corneal stroma
using a 33-gauge needle attached to a Hamilton syringe (Hamilton, Reno,
NV). Corneal opacification was monitored daily by slit lamp examination
and evaluated as described previously.6
Briefly, clinical
scores were graded on the intensity and extent of corneal opacity,
measured in 0.5-U increments, using the following guidelines: 0, no
pathology, cornea is transparent; 1, slight opacity; 2, moderate
opacity; and 3, severe opacity, underlying iris not visible.
Immunohistochemical Analysis of the Cornea
Eyes were fixed overnight in 10% formaldehyde (Sigma), processed
by standard methods, and embedded in paraffin. To detect eosinophils,
5-µm sections were immunostained with rabbit antisera to major basic
protein (MBP) as described previously.3
5
Biotinylated
goat anti-rabbit Ig (Dako, Carpenteria, CA) was used as the secondary
Ab. Neutrophils were detected using the rat mAb 7/4 (Serotec, Oxford,
United Kingdom) diluted 1/100, followed by biotinylated rabbit anti-rat
Ig (BioGenex, San Ramon, CA). After incubation with secondary Ab,
sections were incubated with alkaline phosphataseconjugated
streptavidin (Dako). Positive reactivity was visualized using Vector
Red Substrate containing Levamisole (Vector Laboratories, Burlingame,
CA) and counterstained with modified Harris hematoxylin
(Richard-Allen, Kalamazoo, MI). Cells were visualized by fluorescence
microscopy and counted in a masked fashion. To assess migration of
cells to the central cornea, peripheral, paracentral, and central
regions of the cornea were defined as distance from the peripheral
(limbal) vessels as described.3
Briefly, neutrophil and
eosinophil numbers for each section were determined in the peripheral
regions (0 to
500 µm from each limbus), paracentral regions
(
5001000 µm from each limbus), and the central region of each
cornea (
10001500 µm from each limbus). Because there are two
peripheral and paracentral regions per section, values from each region
were combined.
Differential Blood Leukocyte Counts
Blood was collected retro-orbitally, and differential counts were
determined after staining with modified Wright-Giemsa stain (Diff-Quik;
Dade Diagnostics, Aguada, Puerto Rico).
Measurement of Antigen-Specific Isotype Responses in the Sera
Sera were collected when animals were euthanatized and assayed for
antibody by ELISA as described.3
Immulon-4 ELISA plates
(Dynatech, Chantilly, VA) were coated overnight with 50 µl of 1
µg/ml parasite antigens. After blocking with 1% fetal bovine serum,
dilutions of mouse sera were incubated for 2 hours at room temperature,
washed, and incubated with biotinylated goat anti-mouse
isotype-specific antibodies (Southern Biotechnology, Birmingham, AL).
Reactivity was determined after incubation with peroxidase-labeled
anti-goat IgG (Santa Cruz Biotechnology, Inc., Santa Cruz, CA), and
tetramethyl benzidine (TMB; Zymed, San Francisco, CA) was used as a
substrate. Reaction was stopped after 10 minutes with 1 N HCl.
Absorbance was measured at 450 nm on a kinetic microplate reader
(Molecular Devices Corporation, Sunnyvale, CA).
Total Serum IgE
Total serum IgE was detected by two-site ELISA using rat
anti-mouse IgE mAbs R35-72 and biotinylated R35-92 (PharMingen,
San Diego, CA). Immulon-4 ELISA plates were coated overnight with
R35-72. After blocking with 10% fetal bovine serum, mouse sera were
incubated for 1 hour at 37°C. Purified mouse IgE,
(
-TNP),
(PharMingen) was used to generate a standard curve. The plates were
then incubated with biotinylated R35-92 and streptavidin-peroxidase
(Sigma). Positive reactivity was determined using tetramethyl
benzidine.
IL-5 Production by Spleen Cells
Spleens were removed 3 days after intrastromal injection and
homogenized, and erythrocytes were lysed using cold 0.01 M Tris (pH
7.2) containing 0.85% ammonium chloride. Cells were washed three times
and resuspended at 1 x 107/ml RPMI-1640
containing 10% heat-inactivated fetal bovine serum, 1 mM sodium
pyruvate, 2 mM L-glutamine, 20 mM Hepes, 100 U/ml
penicillin, and 100 µg/ml streptomycin. Duplicate wells containing
1 x 106 cells were incubated with 10
µg/ml parasite antigens for 72 hours at 37°C in 5%
CO2. IL-5 in cell culture supernatant was
measured by two-site ELISA using mAbs TRFK-5 and TRFK-4, and
recombinant IL-5 (PharMingen) was used as a standard. Positive
reactivity was determined using tetramethyl benzidine.
Statistics
Statistical significance between control C57BL/6 mice and P- or
E-selectindeficient mice was determined using an unpaired Students
t-test (Prism Graph Pad Software, San Diego, CA). A value of
P < 0.05 was considered to be significant.
 |
Results
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Impaired Eosinophil Recruitment to the Cornea in
P-SelectinDeficient Mice
To determine whether expression of P- and E-selectin is important
in eosinophil migration to the cornea, C57BL/6 and mice deficient in
either E- or P-selectin were immunized s.c. and injected intrastromally
with O. volvulus antigens. Mice were killed on day 1 or day
3, and eosinophils were detected using Ab to major basic protein. Our
previous studies demonstrated that eosinophil recruitment to the cornea
is gradual, with more eosinophils in the cornea on day 3 than on day 1
after intrastromal injection.3
5
As shown in Figure 1
, the total number of eosinophils per 5-µm section was not
significantly different between C57BL/6 and E-selectindeficient mice
at either time point, indicating that E-selectin is not essential for
eosinophil recruitment to the cornea. In contrast, eosinophil migration
was significantly impaired in the P-selectindeficient mice both on
day 1 and day 3 after intrastromal injection (Figs. 1
2)
. On day 1, the number of eosinophils per corneal section was reduced
by 63.9%, and on day 3, eosinophil numbers were reduced by 61%.
Although fewer eosinophils were detected in
P-selectin-/- mice, the distribution of these
cells in the peripheral, paracentral, and central regions of the cornea
was similar (day 3, peripheral, paracentral, central: C57BL/6: 60.4%,
30.8%, 8.8%, respectively; P-selectin-/-:
57.4%, 32%, 10.6%, respectively).

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Figure 1. The effect of E- and P-selectin deficiency on eosinophil migration to
the cornea. C57BL/6, E-selectin-/-, and
P-selectin-/- mice were immunized s.c. and injected
intrastromally with antigens from the parasitic helminth
Onchocerca volvulus as described in Methods. Mice were
killed on day 1 and day 3, and eyes were fixed in formalin. Sections (5
µm) were immunostained with rabbit antisera to eosinophil major basic
protein and visualized using Vector Red. Total eosinophil numbers per
section were determined by direct counting and are presented as the
mean ± SEM of five mice per group. There was no significant
difference in eosinophils in C57BL/6 and E-selectin-/-
mice on day 1 or 3. However, the difference between C57BL/6 and
P-selectin-/- mice was highly significant at both time
points (day 1: P = 0.0015; day 3:
P < 0.0001). These experiments were repeated twice
(total of three experiments) with similar results.
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Figure 2. Impaired eosinophil recruitment to the corneal stroma in
P-selectin-/- mice. C57BL/6 and
P-selectin-/- were immunized s.c. and injected
intrastromally with helminth antigens, and eosinophils were detected as
described in the legend to Figure 1
. Corneas from animals killed on day
3 were immunostained with antisera to eosinophil MBP and visualized by
bright field (A, C) and fluorescence
(B, D) microscopy. Photomicrographs show the
limbal region of the corneal stroma of a C57BL/6 (A,
B) and a P-selectin-/- mouse
(C, D). Note impaired migration of
eosinophils to the cornea of P-selectin-/-
mouse compared with C57BL/6 mouse. V, limbal vessel. Original
magnification, x200.
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Neutrophil Recruitment to the Cornea in P- and
E-SelectinDeficient Mice
In contrast to eosinophils, neutrophil migration to the cornea in
O. volvulus keratitis peaks in the first 24 hours after
intrastromal injection and then rapidly declines.3
5
To determine the effect of P- and E-selectin deficiency on neutrophil
recruitment to the cornea, C57BL/6, P- and E-selectin gene knockout
mice were immunized and injected intrastromally as described above.
Animals were killed on either day 1 or day 3, and 5-µm corneal
sections were immunostained with mAb 7/4, which is specific for murine
neutrophils. The total number of neutrophils in E- and P-selectin gene
knockout mice was not significantly different from C57BL/6 mice at
either time point after intrastromal injection (Fig. 3)
. Furthermore, there were no differences in the distribution of
neutrophils throughout the peripheral, paracentral, and central part of
the cornea (data not shown). These data indicate that neither P- nor
E-selectin is required for neutrophil migration from the limbal vessels
to the cornea.

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Figure 3. Neutrophil migration to the cornea in E- and P-selectindeficient
mice. C57BL/6, E-selectin-/-, and
P-selectin-/- mice were immunized and injected
intrastromally with parasite antigens (see Fig. 2
). Mice were killed on
day 1 (left) or day 3 (right). Eyes were
fixed in formalin, and neutrophils were detected in 5-µm sections
after immunostaining with mAb 7/4 and Vector Red. No significant
differences were noted among any of the strains of mice at either time
point (P > 0.05). Similar results were obtained in
two repeat experiments.
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Systemic Responses to O. volvulus Antigens in P-
and E-SelectinDeficient Mice
We recently demonstrated an essential role for antibody-mediated
recruitment of eosinophils and neutrophils to the cornea.3
To assess whether altered Ab responses contribute to the impaired
eosinophil migration observed in P-selectin-/-
mice, we measured isotype responses in selectin-deficient mice
immunized with parasite antigens. As shown in Figure 4A
, IgG1 was elevated compared with IgG2a in all three strains of mice,
consistent with development of a Th2 response. However, there were no
differences in titer of parasite-specific IgG1, IgG2a, IgG2b, or IgG3
in P- and E-selectin-/- mice compared
with C57BL/6 mice. Furthermore, total serum IgE levels were increased
but not significantly different among the three groups (C57BL/6,
2.41 ± 0.36 µg/ml; E-selectin-/-,
3.36 ± 0.51 µg/ml; and P-selectin-/-,
2.93 ± 0.53 µg/ml).

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Figure 4. O. volvulusstimulated antibody, IL-5 and eosinophil
production in P- and E-selectin-/- mice. C57BL/6,
E-selectin-/-, and P-selectin-/- mice were
immunized as described in Figure 1
. (A) Serial dilutions of
sera from each group of mice were pooled and assayed for
parasite-specific IgG isotypes by ELISA. (B) IL-5 production
by antigen-stimulated splenocytes was assayed by two-site ELISA, and
blood eosinophilia was determined by direct counting. Data are
means ± SEM from five mice per group. There was no significant
difference (P > 0.05) in isotypes, IL-5 production, or
blood eosinophils between C57BL/6 and
P-selectin-/- mice or between C57BL/6 and
E-selectin-/- mice. These observations were
reproduced in two additional experiments.
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To determine whether impaired eosinophil recruitment in
P-selectin-/- mice might be attributed to a
deficiency in systemic IL-5 or eosinophil production, we examined IL-5
production in parasite antigenstimulated splenocytes and determined
blood eosinophilia. There was no effect of P-selectin deficiency on
IL-5 production (Fig. 4B)
. IL-4 and IFN-
were also unaffected (data
not shown). Furthermore, there was no significant difference
(P > 0.05) in blood eosinophils between C57BL/6 and
P-selectin-/- mice or between C57BL/6 and
E-selectin-/- mice (Fig. 4B)
.
Taken together, these data indicate that P-selectindependent
eosinophil recruitment to the cornea is not due to altered development
of parasite-specific T- or B-cell responses.
Corneal Opacification in P- and E-SelectinDeficient Mice
To determine whether P- or E-selectin expression is important in
development of corneal opacification, mice were examined by slit lamp
microscopy, and the degree of corneal opacification was scored as
described in the Methods. As shown in Figure 5
, the severity of corneal opacification was not significantly different
in any of the three strains, indicating that expression of P- and
E-selectin is not essential for development of corneal disease.

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Figure 5. O. volvulusinduced corneal opacification in
E-selectin-/- and P-selectin-/- mice.
C57BL/6, E-selectin-/-, and P-selectin-/-
mice were immunized s.c. and injected into the corneal stroma with
soluble O. volvulus antigens. Corneal opacification was
monitored daily by slit lamp examination, and clinical scores were
assessed based on the intensity and extent of opacity as described in
Methods. Data are means ± SEM of five mice per group. These data
are representative of three repeat experiments.
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Discussion
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The selectin family contains P-, E-, and L-selectin and has a
common structure with an N-terminal lectin domain.1
L-selectin is present constitutively on most leukocytes and has been
shown to participate in leukocyte adherence to vascular
endothelium.1
In contrast, P-selectin is present only in
platelets and vascular endothelial cells, where it is prestored in
granules for rapid translocation to the cell surface. E-selectin
expression requires de novo synthesis; however, both P- and E-selectin
are important molecules in transmigration of neutrophils and
eosinophils into tissues. These selectins mediate low-affinity rolling
of leukocytes, and blockade of selectin-mediated interactions has been
shown to inhibit inflammatory responses in animal models of allergic
asthma, peritonitis, and allergic conjunctivitis.11
13
14
15
16
17
The rationale for the present study was to determine whether there is a
role for P- and E-selectin in recruitment of eosinophils and
neutrophils to the cornea. Our findings demonstrate that P-selectin is
essential for maximal recruitment of eosinophils to the cornea, but has
no apparent role in neutrophil migration to this site. E-selectin has
no direct effect on recruitment of either cell type to the cornea.
Furthermore, our observations show that P-selectin deficiency has no
effect on development of parasite-specific T- and B-cell responses or
on blood eosinophilia, indicating that the effect of P-selectin
deficiency in this model is only on eosinophil recruitment to the
cornea.
Our results are consistent with earlier reports demonstrating a role
for P-selectin, but not E-selectin, in recruitment of eosinophils to
the peritoneal or the pleural cavities in mouse models of
lipopolysaccharide-mediated peritonitis and allergic
asthma.13
14
15
18
These observations are also consistent
with a role for P-, but not E-selectin, in eosinophil tethering to
vascular endothelial cells under in vitro flow
conditions.19
Using a model of ragweed-induced conjunctivitis, Strauss and
coworkers16
showed that systemic injection of a soluble
form of P-selectin glycoprotein ligand (PSGL)1 abrogated eosinophil
migration to the conjunctiva and completely ablated clinical signs of
allergic conjunctivitis. However, in contrast to our findings, they
also noted that coadministration of mAbs to E- and P-selectin
inhibits eosinophil migration, but antiP-selectin alone had no
significant effect.16
With regard to neutrophils, our studies showed that neither P- nor
E-selectin deficiency had any effect on neutrophil recruitment to the
cornea. This observation differs from other models in which neutrophil
migration to the skin or the peritoneal cavity is diminished in
P-selectin-/- mice.11
17
The
discrepancy between these and our findings may result from differences
in the activation state of the vascular endothelial cells, kinetics of
expression of P- and E-selectin in the different models, or differences
in expression of other cellular adhesion molecules on limbal vessels.
Our previous studies demonstrated that eosinophil migration to the
cornea is regulated by specific cytokines, including IL-4, IL-5, and
IL-12.6
7
8
IL-4 and IL-5deficient mice have fewer
eosinophils in the cornea than controls, whereas mice given recombinant
IL-12 have increased eosinophils along with elevated chemokine
expression.6
7
8
Although we have yet to determine the
underlying mechanisms, it is possible that P-selectin is involved in
IL-4dependent eosinophil migration, because IL-4 upregulates
P-selectin expression on endothelial cells in vitro, and eosinophil
tethering to IL-4stimulated endothelial cells is
P-selectindependent.20
Furthermore, eosinophils bind
with greater avidity to P-selectin than neutrophils under in vitro flow
conditions.21
In the present study, we found that the severity of corneal
opacification was not reduced in P-selectin-/-
mice, despite the pronounced effect on eosinophil recruitment. There
are at least two explanations for this observation. First, the number
of eosinophils was not completely diminished; therefore, the
eosinophils that do migrate into the cornea in
P-selectin-/- mice may degranulate and induce
stromal disease. Second, it is possible that in the absence of
eosinophils, neutrophils mediate the stromal damage that results in
corneal opacification. This notion is supported by our earlier findings
that IL-5 gene knockout mice, which do not produce eosinophils, develop
keratitis that is mediated by neutrophils.5
Most likely,
both cell types contribute to keratitis, because under conditions where
neutrophil and eosinophil migration to the cornea is impaired, as in
antibody-deficient (µMT) mice, corneal opacification is completely
inhibited.3
We have yet to determine the basis for the reduction in neutrophil
numbers in the cornea after eosinophils are recruited. It is likely
that the neutrophils undergo IL-2dependent apoptosis as described for
herpes simplex keratitis.22
In addition, mature
neutrophils may be irrevocably committed to autocrine death because of
coexpression of cell-surface Fas and FasL.23
Any
contribution of eosinophils to neutrophil apoptosis is likely to be
indirect, probably by modulating the local cytokine
environment.24
25
Because there is no difference in
neutrophil numbers in the cornea in P-selectindeficient mice, despite
the paucity of eosinophils (i.e., neutrophil numbers decrease in both
strains by day 3), it is unlikely that P-selectin expression is
important in this phenomenon.
Although the present study demonstrates a role for specific adhesion
molecules in murine O. volvulus keratitis, we cannot
extrapolate these findings directly to human disease, that is, river
blindness, because it is not feasible to obtain corneas from infected
individuals. However, as in the murine model, neutrophils and
eosinophils are prominent in the skin of O.
volvulusinfected individuals with dermatitis.26
27
Furthermore, mediators such as eotaxin are implicated in
onchodermatitis and the murine model of keratitis.9
27
These observations are consistent with the notion that similar
inflammatory mediators are involved in human disease and in mouse
models.
In summary, our studies demonstrate that P-selectin expression is
essential for eosinophil recruitment to the cornea. Blockade of
P-selectin interactions may therefore be important in ocular
onchocerciasis and in other ocular allergic disorders in which
eosinophils are implicated.
 |
Acknowledgements
|
|---|
The authors thank Carol Luckey for performing the genotyping assays
and Fred Heinzel and Richard Silver for critical review of the
manuscript.
 |
Footnotes
|
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Supported by National Institutes of Health Grants EY10320 (EP), EY06913 (LRH), and EY11373 (JHL); Burroughs Wellcome New Investigator Award 0720 (EP); Ohio Lions Research Foundation; and the Research to Prevent Blindness Foundation. JTK is a recipient of a scholarship award from the German National Merit Foundation, Studienstiftung des deutschen Volkes.
Submitted for publication March 31, 2000; revised June 16, 2000; accepted July 21, 2000.
Commercial relationships policy: N.
Corresponding author: Eric Pearlman, Division of Geographic Medicine, Case Western Reserve University, School of Medicine, W137, 2109 Adelbert Road, Cleveland, OH 44106-4983. exp2{at}po.cwru.edu
 |
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