She said: вЂњThe World Health Organisation estimates that 231 million people live in the regions where trachoma is widespread. As a potential direct mediator of inflammation-induced scarring in the conjunctiva, CTGF could be a suitable target for treatment to halt the progression of scarring trachoma.вЂќДr Dolores M Conroy is Director of Research at Fight for Sight. вЂњOur data suggest that ongoing inflammation in the conjunctiva is associated with CTGF activation, which in turn drives fibrosis and scarring. вЂњCTGF modulates the interaction between cells and the connective tissue, and over activity of CTGF is known to drive scarring disease in the heart, lung and kidney, said Dr Derrick. This is consistent with the local inflammatory feedback loop proposed by Dr Kechagia. There was evidence of ongoing inflammation in the stroma of individuals with trichiasis even when this inflammation was not externally visible on the patientвЂ™s eyelid. The team found that compared to healthy controls, eyelid tissue from people with scarring trachoma contains significantly more of the pro-inflammatory signalling molecules IL-1Beta and S100A7 and pro-scarring connective tissue growth factor (CTGF). It was led by Dr Matthew Burton at the London School of Hygiene and Tropical Medicine. Recent Fight for Sight PhD student Dr Tamsyn Derrick is first author of the second study, published in PLOS. This positive feedback loop between scarring and inflammation may contribute to chronic scarring and suggests that the conjunctival stroma (connective tissue) itself may play a more central role in scarring trachoma than previously thought.вЂќ вЂњOur results show that although IL-6 does not stimulate tissue contraction directly, it activates immune cells (macrophages), which in turn stimulates fibroblast contraction and may drive local inflammation. вЂњIL-6 is an important mediator of inflammation and a previously suggested risk factor for scarring trachoma,вЂќ said Dr Jenny Kechagia, who is first author of the study and did the research for her Fight for Sight PhD studentship. The team has shown that connective tissue cells (fibroblasts) grown from patientsвЂ™ conjunctiva biopsies produce more of a molecule called interleukin 6 (IL-6) compared to fibroblasts from healthy conjunctiva. TrachomaвЂ™s molecular footprintДr Maryse Bailly at UCL Institute of Ophthalmology led the study published today in the journal Scientific Reports. This is painful and eventually leads to blindness. Scarring tightens the eyelids and turns the lashes inward (trichiasis), where they scratch the eyeвЂ™s surface. It can continue on into adulthood with long-term (chronic) inflammation and scarring, even when the infection canвЂ™t be detected.

It begins with repeated childhood infection of the lining of the eyelid (the conjunctiva) by Chlamydia trachomatis bacteria. Trachoma is the worldвЂ™s leading infectious cause of blindness. The results also point to a potential target for treatment. Results from 2 studies suggest that the bodyвЂ™s defence against infection вЂ“ the immune system вЂ“ stays active. New research sheds light on how scarring trachoma can continue long after the infection that starts it has cleared.

Sight control feedback loop