The microbiome in HLA-B27-associated disease: implications for acute anterior uveitis and recommendations for future studies

The pathogenesis of human leukocyte antigen (HLA)-B27-associated diseases such as acute anterior uveitis (AAU) and ankylosing spondylitis (AS) remains poorly understood, though Gram-negative bacteria and subclinical bowel inflam-mation are strongly implicated. Accumulating evidence from animal models and clinical studies supports several hypotheses, including HLA-B27-dependent dysbiosis, altered intestinal permeability, and molecular mimicry. However, the existing literature is hampered by inadequate studies designed to establish cau-sation or uncover the role of viruses and fungi. Moreover, the unique disease model afforded by AAU to study the gut microbiota has been neglected. This re-view critically evaluates the current literature and prevailing hypotheses on the link between the gut microbiota and HLA-B27-associated disease. We propose a new potential role for HLA-B27-driven altered antibody responses to gut micro-biota in disease pathogenesis and outline recommendations for future well-controlled human studies, focusing on AAU.

Automated summary

Though the pathogenesis of HLA-B27-associated diseases such as AAU and AS is not well understood, evidence suggests a link to Gram-negative bacteria and subclinical bowel inflammation. The existing literature lacks adequate studies on causation and the role of viruses and fungi, and the unique disease model of AAU to study the gut microbiota has been neglected.