(Investigative Ophthalmology and Visual Science. 2002;43:58-62.)
© 2002
by The Association for Research in Vision and Ophthalmology, Inc.
CC-Chemokine Receptor 3: A Possible Target in Treatment of Allergy-Related Corneal Ulcer
Kazumi Fukagawa1,2,3,
Naoko Okada1,2,
Hiroshi Fujishima1,3,
Toshiharu Nakajima4,
Kazuo Tsubota1,3,
Yoji Takano1,3,
Hiroshi Kawasaki4,
Hirohisa Saito2 and
Koichi Hirai5
1 From the Department of Ophthalmology, Tokyo Dental College, Chiba, Japan; the
2 Department of Allergy, National Childrens Medical Research Center, Tokyo, Japan; the
3 Department of Ophthalmology, Keio University, Tokyo, Japan; and the
4 Department of Clinical Immunology, The Institute of Medical Science, and the
5 Department of Bioregulatory Function, The University of Tokyo, Tokyo, Japan.
 |
Abstract
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PURPOSE. To determine the suppressive effects of antibodies (Abs) against
CC-chemokine receptor (CCR)-1 and CCR-3 on eosinophil chemotaxis
induced by culture supernatant from corneal keratocytes and by tears
from severely allergic patients with corneal ulcer.
METHODS. Primary cultures of human corneal keratocytes were incubated with
interleukin (IL)-4 (33.3 ng/mL) and tumor necrosis factor (TNF)-
(33.3 ng/mL) for 48 hours. In tear samples collected from five severely
allergic patients and three nonallergic control subjects, eosinophils
were immunostained for CCR. Next, eosinophils purified from peripheral
blood were preincubated with or without anti-CCR-1 and anti-CCR-3 Abs
before a Boyden chamber assay was conducted. Recombinant human (rh)
eotaxin, rh-regulated on activation normal T-cell expressed and
secreted (rh-RANTES), culture supernatant from human corneal
keratocytes, and tear samples were used as chemoattractants.
RESULTS. Eosinophils in tears from allergic patients expressed CCR-1 and -3 on
their surfaces. Anti-CCR-1 and -3 Abs each inhibited eosinophil
chemotaxis induced by rh-RANTES. Anti-CCR-3 Ab (but not anti-CCR-1 Ab)
also inhibited eosinophil chemotaxis induced by rh-eotaxin. Anti-CCR-1
and -3 Abs, respectively, inhibited up to 75.2% and 94.6% of
eosinophil chemotaxis induced by culture supernatant, as well as 27.8%
and 74.5% of chemotaxis induced by tear samples.
CONCLUSIONS. Anti-CCR-1 and -3 Abs inhibited eosinophil chemotaxis induced by
culture supernatant from corneal keratocytes and tear samples from
severely allergic patients. Anti-CCR-3 Ab was more effective than
anti-CCR-1 Ab. Inhibition of CCR-3 on eosinophils may be a treatment
for corneal ulcer in patients with ocular allergy.
 |
Introduction
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Corneal ulcer is among the most severe and
treatment-resistant complications associated with ocular allergic
diseases, such as atopic keratoconjunctivitis (AKC)1
2
and
vernal keratoconjunctivitis (VKC).3
4
Eosinophils (EOSs)
and eosinophil cationic protein (ECP) have been found in conjunctival
tissue and in tears of patients with AKC and VKC.4
5
EOS
major basic protein (MBP), detected in corneal plaques in
VKC6
has been shown to inhibit epithelial
migration.7
EOSs therefore appear to participate in
corneal damage in ocular allergic diseases.
CC chemokines, such as eotaxin8
9
and the protein
regulated on activation normal T-cell expressed and secreted
(RANTES),10
are important in recruiting EOS into
tissue affected by allergy. RANTES has been found in tears of patients
with allergic conjunctivitis11
and is produced by
conjunctival12
and corneal cells.13
We have
reported that eotaxin is present in tears of allergic patients with
severe corneal damage, correlating with the number of EOSs in
tears.14
We also have found that interleukin (IL)-4
induces eotaxin production in human corneal keratocytes.15
EOSs are attracted when chemokines interact with CC chemokine receptors
(CCR)-1 and -3 on their surfaces.16
Although RANTES
activates EOS through both CCR-1 and -3, eotaxin is a specific ligand
for CCR-3.17
18
We hypothesized that blocking CCR-1 or -3
would suppress EOS recruitment and could represent a new approach in
the treatment of corneal damage in ocular allergic diseases. We
therefore investigated suppressive effects of anti-CCR-1 and -3
antibodies (Abs) on EOS chemotaxis in vitro induced by culture
supernatant from corneal keratocytes incubated with IL-4 and also by
tears from patients with severe ocular allergic disease.
 |
Materials and Methods
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Tear Collection
All the experiments in this study followed the tenets of the
Declaration of Helsinki. After informed consent was obtained, 100-µL
tear samples were collected from five patients with AKC involving
corneal ulcer (five eyes) and from three nonallergic normal control
subjects (three eyes; Table 1
). To obtain unstimulated basal tears, the tear samples were collected
with microcapillary tubes at the lateral canthus of the eyelid, in
supine patients with heads tilted to the side. No anesthetic was used.
Tear samples were centrifuged immediately at 4°C to remove cells and
transferred to new tubes. Tear samples were stored at -70°C
until further examination.
Immunocytochemistry
Cells from a tear sample (tear 4) were resuspended and
centrifuged by cytospin techniques onto three glass slides for each
sample. Cells on these three slides were stained with anti-CCR-1 Ab (1
µg/mL), anti-CCR-3 Ab (1 µg/mL), or control murine
IgG1 (1 µg/mL) by the following method. Cells
were fixed with 4% paraformaldehyde for 30 minutes at 4°C and
treated with 3% H2O2 in
methanol for 10 minutes at room temperature (RT). After blocking with
Tris-buffered saline (TBS) at pH 7.6 containing 10% normal rabbit
serum for 10 minutes at RT, the cells were allowed to react for 1 hour
at RT with monoclonal IgG1 murine anti-human
CCR-1 Ab (R&D, Minneapolis, MN), dissolved at 1 µg/mL in
phosphate-buffered saline (PBS) supplemented with 10% fetal calf serum
(FCS); anti-human CCR-3 murine monoclonal IgG1 Ab
(clone 444-11; Sato et al.18
), dissolved at 1 µg/mL in
PBS supplemented with 10% FCS; or control mouse
IgG1 (R&D), dissolved at 1 µg/mL in PBS
supplemented with 10% FCS. After they were washed three times with
PBS, cells were incubated with biotinylated rabbit anti-mouse Ig
(Histofine SAB-PO kit; Nichirei, Tokyo, Japan) for 10 minutes at RT.
Cells were then treated with peroxidase-conjugated streptavidin
(Histofine SAB-PO kit, Nichirei) for 5 minutes. Enzyme activity was
developed using substrate solution (Histofine DAB substrate kit;
Nichirei) for 5 minutes at RT in darkness. Cells were then washed and
counterstained with hematoxylin.
Cell Culture
Human corneas were obtained from the American Eye Bank
Association. Human corneal keratocytes were established in culture, as
previously described by Cubitt et al.19
Cells were
cultured in collagen-coated 35-mm culture dishes (Iwaki Co., Tokyo,
Japan) and were studied at the second passage. Purity of each cell type
was assessed by cell morphology and differential activity to
anti-cytokeratin Abs. Corneal keratocytes were stained by for
anti-vimentin Abs (Roche Molecular Biochemicals, Indianapolis,
IN), but not anti-keratin AE1/AE3 (Progen Biotechnik GMBH, Heidelberg,
Germany).
At the second passage, cells were removed from culture dishes by
diluting cultures 1:10 with 0.05% trypsin-0.53 mM EDTA (Gibco BRL,
Grand Island, NY) in PBS and incubating for 5 minutes. Keratocytes were
resuspended in Dulbeccos modified Eagles medium (DMEM; Gibco BRL)
containing 15% FCS, and 100 µL of the cell suspension was
preincubated overnight in a 96-well culture plate. After a wash in PBS,
the culture medium was changed to DMEM without FCS for 24 hours. Cells
were then incubated with rhIL-4 (33.3 ng/mL) and TNF-
(33.3 ng/mL;
all from R&D) for 48 hours. Samples were collected by pipetting, and
the remaining cells were removed by centrifugation at 800g
for 5 minutes. Supernatants were stored at -70°C until further
study.
Immunoreactive eotaxin concentrations in supernatants was measured
using a double-ligand immunoassay using two different mouse monoclonal
Abs (clone 164-4 and clone 174-4) against human eotaxin. The procedure
has been established and described elsewhere.20
For
chemotactic assay, culture supernatants were diluted with culture
medium to result in an eotaxin concentration of 50 ng/mL.
EOS Purification
Human granulocytes were isolated from EDTA-anticoagulated venous
blood from an atopic volunteer (41-year-old male volunteer with
asthma), by using a gradient centrifugation (1.090 g/mL, Percoll;
Pharmacia Upjohn, Uppsala, Sweden;) at RT. Procedures after
centrifugation were performed at 4°C. Red blood cells were removed by
hypotonic lysis. CD16-positive cells were removed using an
immunomagnetic bead technique (MACS). EOS purity (according to
examination of stained cytospin preparations; Diff-Quick,
Kokusai-shiyaku, Kobe, Japan) was 99% ± 1%, and viability based on
trypan blue dye exclusion test results was 99% ± 1%
(n = 10).
Chemotaxis Experiments
Chemotaxis experiments were performed using a modified Boyden
chamber technique. Briefly, 28 µL of medium (RPMI 1640) alone or
medium containing various concentrations of stimulant was placed in
triplicate in the lower chamber. For the experiments with cell culture
supernatants, cell culture medium including IL-4 plus TNF-
was used
as a control. A polycarbonate membrane with a 5-µm pore size
(Nucleopore, Pleasanton, CA) separated the upper and lower chambers.
EOSs (5 x 104) resuspended in RPMI 1640 (50
µL) were placed in each well of the upper chamber, on the upper
surface of the membrane. For inhibition studies using anti-CCR-1 and -3
Abs, EOSs were preincubated with these Abs for 30 minutes at RT. The
chamber then was incubated for 30 minutes at 37°C in a mixture of 5%
CO2 and air and then disassembled. The membrane
was removed and washed in PBS to remove nonmigrating EOSs from the
upper surface, scraped, and stained with Diff-Quik. EOSs were counted
in five random high-power fields (HPFs) by light microscopy, and
chemotactic activity was expressed as the mean number of EOS per HPF.
Statistical Analysis
Statistical analysis was performed by using analysis of variance
(ANOVA) with a post hoc analysis (Fisher protected least significant
difference [PLSD]). P < 0.05 was considered to
indicate significance. Analysis was performed on computer (Statview 4
software; Abacus Concepts, Berkeley, CA).
 |
Results
|
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CCR-1 and -3 Expression on EOSs in Tear Samples
Immunocytochemistry showed CCR-1 and -3 expression on EOSs in a
tear sample from a patient with allergic corneal ulcer (tear 4; Fig. 1
). Conjunctival epithelial cells did not express these receptors.

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Figure 1. Photomicrograph of CCR-1 and -3 on EOSs in tears from a patient with
AKC involving severe corneal damage. The cells in the AKC tear samples
(tear 4) were incubated with anti-CCR-1, anti-CCR-3, or control
IgG1 Abs. Photomicrographs demonstrate immunoreactive CCR-1
(a) and -3 (b). (c) Photomicrograph
demonstrates the absence of staining with control Ab (mouse
IgG1). Magnification, x132.
|
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Suppressive Effect of Anti-CCR-1 and -3 Abs on EOS Chemotaxis
Induced by Eotaxin and RANTES
rh-Eotaxin (0100 ng/mL) and rh-RANTES (0100 ng/mL) each
increased EOS chemotaxis in a dose-dependent manner, from 4.33 ±
1.51 at the baseline to as much as 123.3 ± 23.2 EOS/HPF and from
4.33 ± 1.51 to 118.0 ± 27.3 EOS/HPF, respectively (data not
shown). EOS chemotaxis induced by eotaxin (50 ng/mL) was suppressed by
0.1 to 10 µg/mL anti-CCR-3 Ab (84.4%98.5% suppression), but not
by anti-CCR-1 Ab (Fig. 2a)
. EOS chemotaxis induced by RANTES (50 ng/mL) was suppressed by 0.1
µg/mL anti-CCR-1 or -3 Ab (63.5% and 80.8% suppression,
respectively; Fig. 2b
). The percentage of inhibition was calculated
after subtraction of EOS chemotaxis by culture medium only. RhIL-8 (50
ng/mL) induced EOS chemotaxis (25.5 ± 2.08 EOS/HPF), which was
not inhibited by anti-CCR-1 Ab (1 µg/mL) or anti-CCR-3 Ab (1 µg/mL;
data not shown).

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Figure 2. The suppressive effect of anti-CCR-1 and -3 Abs on EOS chemotaxis
induced by rh-eotaxin and rh-RANTES. In vitro EOS chemotaxis assays
were performed on (a) rh-eotaxin (50 ng/mL) and
(b) rh-RANTES (50 ng/mL). The medium alone (RPM I1640) was
used in negative control experiments. EOSs were preincubated with or
without anti-CCR-1 and/or -3 Abs (0.110 µg/mL) for 30 minutes. EOS
migration, assessed by a modified Boyden chamber technique, is
expressed as the mean number of EOSs per high-power field (hpf).
Results are expressed as the mean ± SD of three separate
experiments. *Significant suppression in migration compared with
positive migration induced by rh-eotaxin or rh-RANTES
(P < 0.05).
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Suppressive Effect of Anti-CCR-1 and -3 Abs on EOS Chemotaxis
Induced by Culture Supernatant from Corneal Keratocytes
Culture supernatant from corneal keratocytes diluted to contain 50
ng/mL eotaxin induced EOS chemotaxis (58.5 ± 14.11 EOS/HPF)
compared with control medium including IL-4 and TNF-
(24.25 ±
2.50 EOS/HPF). EOS chemotaxis induced by culture supernatant was
suppressed by anti-CCR-1 Ab (0.110 µg/mL) and also by anti-CCR-3 Ab
(0.110 µg/mL) in a dose-dependent manner (from 35.0% to 75.2% and
from 25.4% to 94.6% suppression, respectively). The combination of
anti-CCR-1 Ab (0.1 µg/mL) and anti-CCR-3 Ab (0.1 µg/mL) suppressed
68.1% of EOS chemotaxis induced by the culture supernatant of corneal
keratocytes. Anti-CCR-1 Ab (1 µg/mL) plus anti-CCR-3 Ab (1 µg/mL)
nearly eliminated EOS chemotaxis (91.2%; Fig. 3
). The percentage of inhibition was calculated after subtraction of EOS
chemotaxis by culture medium containing IL-4 and TNF-
(24.3
EOS/HPF).
Suppressive Effect of Anti-CCR-1 and -3 Abs on EOS Chemotaxis
Induced by Tear Samples
Four of five tear samples from patients with AKC induced EOS
chemotaxis (17.043.0 EOS/HPF), whereas tear samples from nonallergic
volunteers did not (Table 1)
. Anti-CCR-1 Ab (1 µg/mL) suppressed the
EOS chemotaxis induced by two of the four chemotactically active
samples (72.2% ± 18.7% net chemotaxis, P = 0.018;
Fig. 4 , Table 1
). Anti-CCR-3 Ab (1 µg/mL) suppressed EOS chemotaxis induced
by all four active tear samples (25.5% ± 14.5% net chemotaxis,
P < 0.0001; Fig. 4
, Table 1
). The suppressive effect
of anti-CCR-3 Ab was significantly greater than that of anti-CCR-1 Ab
(P = 0.0009). Net percentages of chemotaxis and
inhibition were calculated after subtraction of EOS chemotaxis by
nonallergic control tears (3.5 EOS/HPF).

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Figure 4. The suppressive effect of anti-CCR-1 and -3 Abs on EOS chemotaxis
induced by tears of patients with severe ocular allergic corneal
damages. In vitro EOS chemotaxis assays were performed on tears of
patients with severe ocular allergic corneal damage. Tears of
nonallergic normal control subjects were used as a negative control.
EOSs were preincubated with or without anti-CCR-1 and -3 Abs (1
µg/mL) for 30 minutes. EOS migration, assessed by a modified Boyden
chamber technique, is expressed as the net percentage of EOS
chemotaxis. Results are expressed as the mean ± SD
(n = 4). Percentage of net chemotaxis was
calculated after subtraction of EOS chemotaxis from nonallergic control
tears (3.5 EOS/HPF). *Significant suppression of migration compared
with positive migration by tear samples from patients;
P = 0.0182); **Significant suppression of migration
compared with positive migration by tear samples from patients
(P < 0.0001) and also by anti-CCR-1 Ab
(P = 0.0009).
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|
 |
Discussion
|
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In this study, anti-CCR-1 and -3 Abs inhibited EOS
chemotaxis-induced by culture supernatant from corneal keratocytes or
by tear samples from severely allergic patients. Anti-CCR-3 Ab was more
effective than anti-CCR-1 Ab. Inhibition of CCR-3 on the EOS surface
may represent a treatment strategy for corneal ulcer in patients with
ocular allergy.
We showed that rh-RANTES and rh-eotaxin induced EOS chemotaxis in a
dose-dependent manner. Whereas RANTES activated EOS through both CCR-1
and -3, eotaxin was specific for CCR-3. In this study, EOS chemotaxis
induced by rh-RANTES was suppressed by anti-CCR-1 or -3 Ab, whereas
EOS chemotaxis induced by rh-eotaxin was suppressed only by anti-CCR-3
Ab. Moreover, EOS chemotaxis induced by rhIL-8 was not inhibited by
these Abs. These results verify that the Abs and experimental
design used in this study were appropriate.
We showed the expression of CCR-1 and -3 on the surface of EOSs in tear
samples from a patient with AKC. The expression of CCR-3 on the surface
of EOSs is constitutive, whereas CCR-1 is inducible. EOSs migrating
into tears are thought to be activated.
IL-421
and TNF-
22
both have been
identified in tears from allergic patients. We have reported that IL-4
and TNF-
induce eotaxin production in human corneal
keratocytes.15
RANTES has been reported to be produced in
keratocytes by TNF-
.13
In this study, culture
supernatant from human corneal keratocytes incubated with IL-4 and
TNF-
induced EOS chemotaxis. Our in vitro method appears to be a
good model for examining EOS recruitment to the cornea in T-helper
(Th)-2dominant situations.
EOS recruitment induced by culture supernatant from human corneal
keratocytes was suppressed by anti-CCR-1 Ab and was more effectively
suppressed by anti-CCR-3 Ab. Although we did not determine the
expression of CCRs on the surface of EOSs used in the chemotactic
study, the EOSs were obtained from a volunteer with asthma, and
therefore may have been activated. The suppressive effect of either
anti-CCR Ab alone was greater than that expected from the results of
simultaneous suppression using both anti-CCR Abs. From these results,
CCR-1 and -3 are likely to interact with each other in EOS chemotaxis.
Although the suppressive effect by the combination of
anti-CCR-1 Ab and -3 Abs seemed to be greater than that by each
anti-CCR Ab, the combined effect was not significant.
Four of five tear samples from patients with AKC induced EOS
chemotaxis. Although the difficulties of tear sampling without
stimulation precluded obtaining sufficient tear sample volume to
determine chemokine concentrations, tear samples that induced EOS
chemotaxis showed activity comparable to 10 to 50 ng/mL of rh-eotaxin.
To our knowledge, this is the first report to examine EOS chemotaxis in
response to tear samples. EOS chemotaxis induced by tears from allergic
subjects may explain EOS recruitment to affected ocular surfaces.
The tear-induced chemotaxis of EOSs was significantly, but not
completely, inhibited by anti-CCR-3 mAb in this study, indicating there
may be some other factors that induce EOS migration through the
receptors other than CCR-1 or -3, such as IL-8, substance-P, or
platelet-activating factor (PAF). However, anti-CCR-3 Ab
suppressed EOS chemotaxis induced by all four chemotactically active
tear samples in this study, indicating that CCR-3 may be a new target
for treatment of corneal tissue damage in severe ocular allergic
disease.
 |
Acknowledgements
|
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The authors thank Kenji Matsumoto for valuable advice and
Yuko Yamamoto for excellent technical assistance.
 |
Footnotes
|
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Submitted for publication January 3, 2001; revised July 31, 2001; accepted August 15, 2001.
Commercial relationships policy: N.
The publication costs of this article were defrayed in part by page charge payment. This article must therefore be marked "advertisement" in accordance with 18 U.S.C.
1734 solely to indicate this fact.
Corresponding author: Kazumi Fukagawa, Department of Ophthalmology, Tokyo Dental College, 5-11-13 Sugano, Ichikawa, Chiba, 272-8513, Japan; br5k-fkgw{at}asahi-net.or.jp.
 |
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