New understanding of the role of cytokines in the pathogenesis of Graves' ophthalmopathy.

Cytokines play a key role in the development of Graves' ophthalmopathy (GO). These molecules are produced in the orbit of GO patients by infiltrating inflammatory cells as well as orbital fibroblasts. Locally produced cytokines stimulate fibroblast proliferation and their production of glycosaminoglycans, which result in accumulation of extracellular matrix and oedema with consequent proptosis. In addition to these direct effects, cytokines can modulate the immune reaction in GO by increasing major histocompatibility complex (MHC) class II, adhesion molecules, CD40, prostaglandin and heat shock protein expression in the orbit, thereby having a role in localising and augmenting the inflammatory response.