Recent progress of nanomedicine in managing dry eye disease

Cyclic cell-penetrating peptide-engineered ceria nanoparticles for non-invasive alleviation of ultraviolet radiation-induced cataract

Oxidative stress, which results from the accumulation of free radicals, plays a substantial role in cataract formation. Antioxidants have shown promise in mitigating or even preventing this process. However, delivering antioxidants noninvasively to the anterior segment of the eye has been a significant challenge. In this study, we developed ceria nanoparticles modified with cyclic cell-penetrating peptides to overcome the obstruction of the dense corneal barrier on topical drug delivery. Our results demonstrated that modified ceria nanoparticles with cell-penetrating peptides (CPPs) facilitate the opening of tight junctions in human corneal epithelial cells. This characteristic considerably enhances the trans-corneal transport of nanoparticles and improves cellular uptake efficiency, while also contributing to their intracellular enrichment toward mitochondria. Further experiments confirmed that the modified ceria nanoparticles effectively counteracted ferroptosis induced by oxidative stress in lens epithelial cells both in vitro and in vivo, substantially reducing cataract formation. The successful development of ceria nanoparticles modified with cyclic cell-penetrating peptides (cCPPs) opens new avenues for research in cataract prevention and treatment. Additionally, the modified ceria nanoparticles could serve as a noninvasive drug delivery system, which holds remarkable potential for advancing drug delivery in diseases affecting the anterior segment of the eye.

Nano-based drug delivery systems for the treatment of non-infectious uveitis

Background

Uveitis is one of the most prevalent causes of global visual impairment. The current approaches to treating non-infectious uveitis (NIU) involve the utilization of corticosteroids, immunosuppressant and biologics agents. Nevertheless, the intricate ocular anatomy barriers and adverse side effects of the drugs pose significant obstacles to effective treatment outcomes.

Main text

To improve drug bioavailability and therapeutic outcomes for NIU while minimize side effects, researchers are committed to developing novel nano-based drug delivery systems (DDS), which have the capacity to achieve targeted delivery, increase bioavailability, achieve sustained release, reduce side effects and improve therapeutic effects. Thus, DDS based on nanotechnology, including liposome, dendrimer, hydrogels, nanoparticles, nanomicelles, nanosuspensions and nanoemulsions have emerged as promising alternatives to conventional ocular delivery methods for the management of NIU.

Conclusions

In this review, we summarize the current therapeutic challenges faced by NIU and describe various nano-based intraocular DDS involved in the treatment of NIU. It is concluded that nano-based DDS is an appealing approach to addressing the unmet needs for the treatment of NIU.

Quercetin loaded biogenic squalene nano-lipid carriers for the treatment of dry eye syndrome

In this study, quercetin-incorporated squalene nanostructured lipid carriers (QS-NLCs) were developed to mitigate the pathological conditions of dry eye disease (DED). The melt emulsification method was used to prepare QS-NLCs. The resulting NLCs have 93.74 ± 9.32 nm particle size, 43.8 ± 5.42 % drug loading and showed good stability for 90 days at different storage conditions. The structural characterization of NLCs was carried out through DSC, FTIR, and XRD, and the morphological study was conducted using TEM analysis. The morphological study emphasised no agglomeration was present in the formulation, and further -31.47 ± 2.18 mV zeta potential supported the TEM analysis. Also, the QS-NLCs showed a release pattern in which more than 70 % of the drug was released in the medium in 1 h. After that, a sustained release pattern was observed for 6 h. However, QS-NLCs also showed higher ex-vivo corneal permeation, i.e., ∼2.5-fold, as compared to free quercetin. Also, no significant difference was observed in the moisture retention capacity of NLCs when compared with control glycerin. Further, the QS-NLCs showed good anti-inflammatory and cytotoxicity activities against RAW 264.7 and HCECs cell lines, respectively. Furthermore, 18.22 ± 1.23 mm of Schirmer score in a 5-day tear production study and a 2.79-fold increased half-life (T1/2), 3.02-fold enhanced area under the curve (AUC0-∞), and 2.88-fold higher mean retention time (MRT0-∞) were obtained which signified the higher bioavailability of QS-NLCs with higher ocular tolerance ensured by modified Draize test. Most importantly, the proposed QS-NLCs improved the pharmacological activities of quercetin against DED.

Hyaluronan-modified nanoceria for dry eye disease treatment

Dry eye disease (DED), a prevalent ocular disorder, affects nearly half the global population, bringing enormous health and economic burden. Currently, the predominant treatments for DED involve the administration of artificial tears, which is often hindered by continuous administration and constant reactive oxygen species (ROS) stimulus. Therefore, hyaluronan (HA)-modified cerium oxide (CeO2) nanoparticles, HA-CeO2, were developed to achieve simultaneous ROS scavenging and enhanced tear film stability. HA-CeO2 was demonstrated to effectively scavenge ROS while concurrently downregulating the expression of inflammatory factors, such as MMP9 and IL-1β. Moreover, the anti-oxidative and anti-inflammatory effects of HA-CeO2 were further confirmed through a DED mouse model. In addition, the biocompatibility and safety of HA-CeO2 make it a promising treatment option for DED associated with inflammation and oxidative stress, offering novel insights into utilizing nanozymes in treating inflammation-oxidative stress-related diseases.

Bringing ophthalmology into the scientific world: Novel nanoparticle-based strategies for ocular drug delivery

The distinctive benefits and drawbacks of various drug delivery strategies to supply corneal tissue improvement for sense organs have been the attention of studies worldwide in recent decades. Static and dynamic barriers of ocular tissue prevent foreign chemicals from entering and inhibit the active absorption of therapeutic medicines. The distribution of different medications to ocular tissue is one of the most appealing and demanding tasks for investigators in pharmacology, biomaterials, and ophthalmology, and it is critical for cornea wound healing due to the controlled release rate and increased drug bioavailability. It should be mentioned that the transport of various types of medications into the different sections of the eye, particularly the cornea, is exceedingly challenging because of its distinctive structure and various barriers throughout the eye. Nanoparticles are being studied to improve medicine delivery strategies for ocular disease. Repetitive corneal drug delivery using biodegradable nanocarriers allows a medicine to remain in different parts of the cornea for extended periods of time and thus improve administration route effectiveness. In this review, we discussed eye anatomy, ocular delivery barriers, as well as the emphasis on the biodegradable nanomaterials ranging from organic nanostructures, such as nanomicelles, polymers, liposomes, niosomes, nanowafers, nanoemulsions, nanosuspensions, nanocrystals, cubosomes, olaminosomes, hybridized NPs, dendrimers, bilosomes, solid lipid NPs, nanostructured lipid carriers, and nanofiber to organic nanomaterials like silver, gold, and mesoporous silica nanoparticles. In addition, we describe the nanotechnology-based ophthalmic medications that are presently on the market or in clinical studies. Finally, drawing on current trends and therapeutic approaches, we discuss the challenges that innovative optical drug delivery systems confront and propose future research routes. We hope that this review will serve as a source of motivation and inspiration for developing innovative ophthalmic formulations.

Implications of nanotechnology for the treatment of Dry Eye Disease: Recent advances

Managing Dry Eye Disease (DED), a prevalent condition affecting the ocular surface, remains challenging despite advancements in diagnostics and therapies. Current treatments primarily involve lubricating eye drops and anti-inflammatory medications, which often require prolonged use and generally provide only symptomatic relief. The current study focuses on improving DED treatments through nano-drug delivery technologies and advanced formulations. These systems aim to address the limitations of conventional therapies by providing extended, targeted, and sustained drug release. The development of innovative nanomaterials offers improved precision, control, and customization for DED management. By enabling controlled and sustained drug release, these nano-drug delivery systems could offer longer-lasting relief, addressing the chronic nature of DED more effectively than current symptomatic therapies. Future research should focus on integrating multiple therapeutic agents within these systems to simultaneously target inflammation and tear film instability. This review examines the potential of nano-based materials for DED treatment, with a particular emphasis on lipid-based, polymer-based and polysaccharide-based systems.

An exploration of the ocular mysteries linking nanoparticles to the patho-therapeutic effects against keratitis

Microbial keratitis, a sight-threatening corneal infection, remains a significant global health concern. Conventional therapies using antimicrobial agents often suffers from limitations such as poor drug penetration, side effects, and occurrence of drug resistance, with poor prognosis. Novel treatment techniques, with their unique properties and targeted delivery capabilities, offers a promising solution to overcome these challenges. This review delves into timely update of the state-of-the-art advance therapeutics for keratitis treatment. The diverse microbial origins of keratitis, including viral, bacterial, and fungal infections, exploring their complex pathogenic mechanisms, followed by the drug resistance mechanisms in keratitis pathogens are reviewed briefly. Importantly, the emerging therapeutic techniques for keratitis treatment including piezodynamic therapy, photothermal therapy, photodynamic therapy, nanoenzyme therapy, and metal ion therapy are summarized in this review showcasing their potential to overcome the limitations of traditional treatments. The challenges and future directions for advance therapies and nanotechnology-based approaches are discussed, focusing on safety, targeting strategies, drug resistance, and combination therapies. This review aims to inspire researchers to revolutionize and accelerate the development of functional materials using different therapies for keratitis treatment.

Supramolecular Engineering of Nanoceria for Management and Amelioration of Age-Related Macular Degeneration via the Two-Level Blocking of Oxidative Stress and Inflammation

Age-related macular degeneration (AMD), characterized by choroidal neovascularization (CNV), is the global leading cause of irreversible blindness. Current first-line therapeutics, vascular endothelial growth factor (VEGF) antagonists, often yield incomplete and suboptimal vision improvement, necessitating the exploration of novel and efficacious therapeutic approaches. Herein, a supramolecular engineering strategy to construct moringin (MOR) loaded α-cyclodextrin (α-CD) coated nanoceria (M@CCNP) is constructed, where the hydroxy and newly formed carbonyl groups of α-CD interact with the nanoceria surface via O─Ce conjunction and the isothiocyanate group of MOR inserts deeply into the α-CD cavity via host-guest interaction. By exploiting the recycling reactive oxygen species (ROS) scavenging capability of nanoceria and the anti-inflammation properties of MOR, the two-level strike during AMD pathogenesis can be precisely blocked by M@CCNP. Remarkably, excellent therapeutic efficacy to CNV is observed in vivo, achieving over 80% reduction in neovascularization and over 60% reduction in leakage area. In summary, the supramolecular engineered nanoceria provides an efficient approach for amelioration of AMD by blocking the two-level strike, and presents significant potential as an exceptional drug delivery platform, particularly for ROS-related diseases.

Drug in Drug: Quorum Sensing Inhibitor in Star-Shaped Antibacterial Polypeptides for Inhibiting and Eradicating Corneal Bacterial Biofilms

Biofilm-related bacterial keratitis is a severe ocular infection that can result in drastic vision impairment and even blindness. However, the therapeutic efficiency of clinical antibiotic eyedrops is often compromised because the bacteria in the biofilms resist bactericide via the community genetic regulation, namely, bacterial quorum sensing. Herein, quercetin (QCT)-loaded star-shaped antibacterial peptide polymer (SAPP), QCT@SAPP, is developed based on a "drug" in a "drug" strategy for inhibiting and eradicating Pseudomonas aeruginosa biofilms on the cornea. The natural antibacterial peptide-mimic SAPP with the positively charged amphipathic structure not only enables QCT@SAPP to penetrate the biofilms readily but also selectively adheres to the highly negatively charged P. aeruginosa, releasing the loaded QCT into the bacteria to regulate quorum sensing by inhibiting lasI, lasR, rhlR, and rhlI. Thanks to its robust bactericidal ability from SAPP, QCT@SAPP can eliminate more than 99.99% of biofilms. Additionally, QCT@SAPP displayed outstanding performance in relieving ocular inflammation by significantly downregulating pro-inflammatory cytokines and profiting from scavenging reactive oxygen species by releasing QCT, which finally helps to restore visual function. In conclusion, QCT@SAPP, with good compatibility, exerts excellent therapeutic effects in a bacterial keratitis mice model, making it a promising candidate for controlling bacterial biofilm-induced infections, including bacterial keratitis.

Insular infraorbital neurovascular pedicle labial salivary gland transplantation for the treatment of severe dry eye disease: an IDEAL stage 0, 1 and 2a study

Objectives

To address the lack of nerve and blood supply after labial salivary gland transplantation (LSGT) resulting in glandular atrophy. We designed a modified LSGT, called insular infraorbital neurovascular pedicle LSGT, and evaluated the postoperative efficacy.

Design

This is a prospective, single-centre, self-contained study.

Setting

The research was conducted at Beijing Tongren Hospital, Capital Medical University from July 2019 to March 2024.

Participants

Eight patients (nine eyes) with severe dry eye disease (DED) were enrolled in this study.

Interventions

All patients underwent insular infraorbital neurovascular pedicle LSGT and were followed up for at least 6 months postoperatively.

Main outcome measure

Key evaluation indices were best-corrected visual acuity (BCVA), Ocular Surface Disease Index (OSDI) score, tear break-up time (TBUT), Corneal Fluorescence Staining (CFS) score, and Schirmer I test (SIT).

Results

With a mean follow-up of 17.56±11.72 months, BCVA improved in four eyes and stabilized in five. OSDI score decreased from 59.33±14.37 to 26.27±10.14 (p<0.001). SIT improved from 0.00±0.00 mm to 5.44±2.01 mm (p<0.0001). TBUT increased from 0.23±0.48 s to 5.48±4.67 s (p=0.008). CFS scores decreased from 12.56±2.65 to 7.56±3.09 (p<0.001). All glands remained viable with good blood supply, and no serious complications were observed.

Conclusion

Insular infraorbital neurovascular pedicle LSGT for severe DED is a feasible and effective treatment, maintaining good secretory capacity and blood supply long-term.

Trial registration number

ChiCTR2200056015.

Corneal Mucin-Targeting Liposome Nanoplatforms Enable Effective Treatment of Dry Eye Diseases by Integrated Regulation of Ferroptosis and Inflammation

The incidence of dry eye disease (DED) has been increasing annually worldwide, creating an urgent need for new therapies. Due to the multifactorial mechanism underlying DED, traditional medications focused on decreasing ocular surface inflammation have been unable to address all the harmful factors and fail to achieve a complete clinical cure. Ferroptosis, a new form of programmed cell death characterized by lipid peroxidation, has become a pivotal contributor to dry eye oxidative stress-driven pathology. Therefore, therapeutic targeting of ferroptosis may be an attractive option for dry eye management. Herein, a sialic acid-targeting peptide-modified liposome loaded with Cyclosporine A (CsA), a typical anti-inflammatory drug, and Ferrostatin-1 (Fer-1), a selective ferroptosis inhibitor, is developed termed as CF@SNPs, for combing and sustaining DED treatment. This multifunctional liposomal encapsulation demonstrates excellent aqueous solubility; moreover, the sialic acid-targeting peptide prolongs ocular surface retention, further enhancing therapeutic efficacy. The CF@SNPs treatment comprehensively alleviates DED symptoms, including improving corneal defects, augmenting goblet cell count, and restoring tear secretion. Specifically, CF@SNPs attenuate dry eye pathology by suppressing p53-SLC7A11-GSH-dependent ferroptosis and TNF-α-associated inflammatory cascades, accompanied by favorable biocompatibility in vivo. These results underscore the promising potential of this superior nano-formulation for DED pharmacotherapy.

Impact of inflammasomes on the ocular surface

PURPOSE OF REVIEW

The ocular surface is prone to inflammation due to exposure to environmental irritants and pathogens. Inflammasomes are intracellular, multiprotein complexes that communicate potentially dangerous signals to the immune system. The identification of inflammasomes in various inflammatory ocular surface conditions can aid in the development of therapeutics to treat these chronic inflammatory conditions.

RECENT FINDINGS

Several inflammasomes have been associated with ocular surface disorders including dry eye disease, keratitis, and allergies. Mechanisms for activation of these inflammasomes with regards to specific disorders have been explored in models to aid in the development of targeted treatments.

SUMMARY

Research efforts continue to characterize the types of inflammasomes and activators of these in inflammatory ocular surface conditions. Various therapies targeting specific inflammasome types or pyroptosis are being tested preclinically to assess effects on decreasing the associated chronic inflammation.

Gut microbiota and eye diseases: A review

Recent studies reveal that alterations in gut microbiota play a significant role in the progression of various diseases, including those affecting the eyes. The association between gut microbiota and eye health is an emerging focus of research. This review seeks to summarize the connection between the gut microbiome and specific eye conditions, such as ocular surface diseases, funduscopic disorders and immune-mediated eye diseases. Gut microbiota may influence these conditions by regulating the immune system or altering metabolites, thereby contributing to disease development. Strategies like probiotics, antibiotics, dietary modifications, and fecal transplants show promise in addressing these issues. This review examines how the gut microbiome may be linked to the pathogenesis of eye diseases, providing fresh therapeutic perspectives for ophthalmology.

Anti-oxidative mesoporous polydopamine-based hypotensive nano-eyedrop for improved glaucoma management

Conventional hypotensive eye drops remain suboptimal for glaucoma management, primarily due to their limited intraocular bioavailability and the growing concern regarding ocular surface side effects. Therefore, there is an urgent need to develop innovative intraocular pressure (IOP)-lowering formulations that not only possess enhanced corneal penetration ability but also provide ocular surface protection. Herein, anti-oxidative mesoporous polydopamine nanoparticles (MPDA NPs) were explored as a nano-carrier for Brimonidine to address the above issues. Nearly monodisperse MPDA NPs with obvious nanopores were successfully prepared by template-removal method and used for encapsulation of Brimonidine benefiting from their high specific surface area. Interestingly, the PEGylated and drug loaded MPDA-PEG@Brim NPs showed a near neutral surface charge, which is expected to enhance intraocular drug delivery. Consequently, much higher concentration of Brimonidine in the aqueous humor was found after topical administration of MPDA-PEG@Brim nano-dispersion as compared to free Brimonidine solution. Accordingly, superior IOP reduction effect was achieved for the nano-formulation in both hypertensive and normotensive rat eyes. Moreover, MPDA-PEG NPs showed good capability in scavenging diverse free radicals, alleviating intracellular oxidative stress, and mitigating ocular surface oxidative level in a mouse model of preservative-induced dry eye. In addition, the excellent biosafety of this novel Brimonidine nanodrug was confirmed both in vitro and in vivo. Therefore, the present work may shed light on the development of next generation hypotensive formulations for extended ocular surface protection and glaucoma management.

Rosmarinic acid-grafted gelatin nanogels for efficient diquafosol delivery in dry eye disease therapy

Dry eye disease (DED) is a prevalent ocular disorder characterized by unstable tear film condition with loss of aqueous or mucin, excessive oxidative stress, and inflammation, leading to discomfort and potential damage to the ocular surface. Current DED therapies have shown restricted therapeutic effects such as frequent dosing and temporary relief with potential unwanted side effects, urgently necessitating the development of innovative efficient therapeutic approaches. Herein, we developed rosmarinic acid (RosA) conjugated gelatin nanogels loading diquafosol sodium (DQS), DRGNG, for simultaneous ROS-scavenging and mucin-secreting DED treatment. Mechanically, DRGNG suppressed the ROS production, reduced inflammatory factors, and prompted mucin secretion in vitro and in vivo. The whole transcriptome RNA sequencing in vitro further provided a detailed analysis of the upregulation of anti-oxidant, anti-inflammatory, and mucin-promotion pathways. Therapeutically, both in evaporative DED and aqueous deficient DED models, the dual-functional DRGNG could prolong the retention time at the ocular surface, efficiently suppress the oxidative stress response, reverse ocular surface morphology, and recover tear film homeostasis, thus alleviating the DED when the dosage is halved compared to the commercial Diquas®. Our findings contribute to developing innovative therapies for DED and offer insights into the broader applications of nanogels in ocular drug delivery and oxidative stress-related conditions.

Neurotoxicity and Developmental Neurotoxicity of Copper Sulfide Nanoparticles on a Human Neuronal In-Vitro Test System

Nanoparticles (NPs) are becoming increasingly important novel materials for many purposes, including basic research, medicine, agriculture, and engineering. Increasing human and environmental exposure to these promising compounds requires assessment of their potential health risks. While the general direct cytotoxicity of NPs is often routinely measured, more indirect possible long-term effects, such as reproductive or developmental neurotoxicity (DNT), have been studied only occasionally and, if so, mostly on non-human animal models, such as zebrafish embryos. In this present study, we employed a well-characterized human neuronal precursor cell line to test the concentration-dependent DNT of green-manufactured copper sulfide (CuS) nanoparticles on crucial early events in human brain development. CuS NPs turned out to be generally cytotoxic in the low ppm range. Using an established prediction model, we found a clear DNT potential of CuS NPs on neuronal precursor cell migration and neurite outgrowth, with IC50 values 10 times and 5 times, respectively, lower for the specific DNT endpoint than for general cytotoxicity. We conclude that, in addition to the opportunities of NPs, their risks to human health should be carefully considered.

Nanoceria-Mediated Cyclosporin A Delivery for Dry Eye Disease Management through Modulating Immune-Epithelial Crosstalk

Dry eye disease (DED) affects a substantial worldwide population with increasing frequency. Current single-targeting DED management is severely hindered by the existence of an oxidative stress-inflammation vicious cycle and complicated intercellular crosstalk within the ocular microenvironment. Here, a nanozyme-based eye drop, namely nanoceria loading cyclosporin A (Cs@P/CeO2), is developed, which possesses long-term antioxidative and anti-inflammatory capacities due to its regenerative antioxidative activity and sustained release of cyclosporin A (CsA). In vitro studies showed that the dual-functional Cs@P/CeO2 not only inhibits cellular reactive oxygen species production, sequentially maintaining mitochondrial integrity, but also downregulates inflammatory processes and repolarizes macrophages. Moreover, using flow cytometric and single-cell sequencing data, the in vivo therapeutic effect of Cs@P/CeO2 was systemically demonstrated, which rebalances the immune-epithelial communication in the corneal microenvironment with less inflammatory macrophage polarization, restrained oxidative stress, and enhanced epithelium regeneration. Collectively, our data proved that the antioxidative and anti-inflammatory Cs@P/CeO2 may provide therapeutic insights into DED management.

Recent Advances in Nanotechnology for the Treatment of Dry Eye Disease

Dry eye disease (DED) incidence is continuously growing, positioning it to become an emergent health issue over the next few years. Several topical treatments are commonly used to treat DED; however, reports indicate that only a minor proportion of drug bioavailability is achieved by the majority of eye drops available on the market. In this context, enhancing drug ability to overcome ocular barriers and prolonging its residence time on the ocular surface represent a new challenge in the field of ocular carrier systems. Therefore, research has focused on the development of multi-functional nanosystems, such as nanoemulsions, liposomes, dendrimers, hydrogels, and other nanosized carriers. These systems are designed to improve topical drug bioavailability and efficacy and, at the same time, require fewer daily administrations, with potentially reduced side effects. This review summarizes the different nanotechnologies developed, their role in DED, and the nanotechnology-based eyedrops currently approved for DED treatment.