Title : Targeting immunological pathways in Behcet's Uveitis
Abstract:
Behçet’s disease (BD) is a rare, chronic, multisystem inflammatory disorder that primarily affects blood vessels of all sizes. Clinically, it is characterised by recurrent oral and genital ulcers, skin lesions, and ocular involvement, particularly uveitis, which can lead to significant visual morbidity. Despite decades of research, the precise pathogenesis of Behçet’s disease remains incompletely understood. Its heterogeneity and overlapping features with both autoimmune and autoinflammatory conditions complicate efforts to delineate its immunological underpinnings.
Recent advances in immunology have highlighted the pivotal role of dysregulated cytokine networks in the pathogenesis of BD, especially in ocular manifestations. Among these, interleukin-17 (IL-17)—a pro-inflammatory cytokine produced primarily by Th17 cells—has emerged as a central player. IL-17 is known to promote neutrophilic inflammation and tissue damage, mechanisms believed to contribute to the recurrent and relapsing nature of Behçet’s uveitis. As a result, IL-17 has become a target of interest for therapeutic intervention.
Secukinumab, a fully human monoclonal antibody that selectively inhibits IL-17A, has demonstrated efficacy in several IL-17–mediated disorders such as psoriasis, ankylosing spondylitis, and psoriatic arthritis. Given the immunopathogenic similarities between these diseases and BD, there is growing interest in the potential application of secukinumab in managing Behçet’s uveitis. However, current clinical data remain limited, with only a few case reports and small-scale studies suggesting benefit in refractory cases. Larger, controlled studies are necessary to determine its true therapeutic value.
In this review, we present an updated overview of the immunological landscape of Behçet’s disease, with a particular focus on the mechanisms driving ocular inflammation. We explore the rationale behind targeting cytokines such as IL-17, and we evaluate the emerging evidence supporting the use of secukinumab as an immunomodulatory therapy in Behçet’s uveitis.
Furthermore, we discuss the limitations of current therapeutic strategies and the unmet need for targeted treatments that can offer sustained disease control with minimal side effects. By analysing both mechanistic insights and available clinical outcomes, this review aims to contribute to the optimisation of treatment algorithms for Behçet’s uveitis. Ultimately, expanding the therapeutic arsenal with biologics such as secukinumab could significantly improve quality of life, reduce ocular complications, and enhance long-term prognosis for patients living with this complex disease.
