Association Between Torque Teno Virus and Systemic Immunodeficiency in Patients With Uveitis With a Suspected Infectious Etiology
Authors: Sajiki Ai Fujita , Koyanagi Yoshito , Ushida Hiroaki , Kawano Kenichi , Fujita Kosuke , Okuda Daishi , Kawabe Mitsuki , Yamada Kazuhisa , Suzumura Ayana , Kachi Shu , Kaneko Hiroki , Komatsu Hiroyuki , Usui Yoshihiko , Goto Hiroshi , Nishiguchi Koji M. 
Published: January 2023

Importance

Torque teno virus positivity in the aqueous humor of uveitis patients could be associated with systemic immunodeficiency.

Objective

We explored the correlation between the presence of torque teno virus in the aqueous humor of uveitis patients and clinical information, including immunodeficiency history.

Design

This was a retrospective, cross-sectional study.

Setting

All participants were recruited at Nagoya University Hospital, Tokyo Medical University Hospital, or Yokkaichi Municipal Hospital between April 2017 and March 2022.

Participants

The participants were 58 uveitis patients with a suspected infectious etiology and 24 controls with cataract or age-related macular degeneration.

Main Outcomes and Measures

We used quantitative polymerase chain reaction to test all subjects for torque teno virus and multiplex polymerase chain reaction to test uveitis subjects for common ocular pathogens. When possible, both serum and aqueous humor samples were tested. Ocular torque teno virus positivity was compared with age, sex, and a history of systemic immunodeficiency with logistic analysis.

Results

Torque teno virus positivity was found in 7 of 31 cases (23%) with herpetic uveitis, 3 of 27 cases (11%) with nonherpetic uveitis, and 0 of 24 controls (0%). Among patients with herpes infection, positivity for torque teno virus was found in 3 of 7 patients (43%) with cytomegalovirus retinitis, 1 of 12 (8%) patients with iridocyclitis, 1 of 7 patients (14%) with acute retinal necrosis, and 2 of 4 patients (50%) with Epstein–Barr virus–related uveitis. Cytomegalovirus retinitis patients showed a significantly higher rate of ocular torque teno virus infection than controls (P= .008). Serum analysis revealed torque teno virus positivity in 9 of 10 cases (90%) with uveitis and in all 8 controls (100%). Age- and gender-adjusted logistic analysis revealed a correlation between ocular torque teno virus positivity and systemic immunodeficiency (P= .01), but no correlations between ocular torque teno virus and age, gender, or viral pathogenic type.

Conclusion and Relevance

This study found that positivity for ocular torque teno virus was correlated with a clinical history of systemic immunodeficiency. This suggests that ocular torque teno virus is a biomarker of systemic immunity.

Key points

Question

What is the correlation between torque teno virus (TTV) in the aqueous humor of patients with uveitis and the clinical characteristics of these patients?

Findings

In this retrospective, cross-sectional study that included 82 patients, ocular TTV was found to be present in 39% of uveitis patients with underlying immunodeficiency and 8% of patients without underlying immunodeficiency; these findings showed statistical significance.

Meaning

In patients with uveitis, the presence of ocular TTV may represent systemic immunodeficiency.