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Raz D, Ben-Yaakov K, Levi M, Bertolin M, Ferrari S, Ponzin D, Busin M, Leiba H, Marcovich AL, Eisenberg-Lerner A, Rotfogel Z. Mitochondria Transplantation Promotes Corneal Epithelial Wound Healing. Invest Ophthalmol Vis Sci 2024; 65:14. [PMID: 38848077 PMCID: PMC11166225 DOI: 10.1167/iovs.65.6.14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Accepted: 05/10/2024] [Indexed: 06/13/2024] Open
Abstract
Purpose The integrity of the corneal epithelium is essential in maintaining normal corneal function. Conditions disrupting the corneal epithelial layer range from chemical burns to dry eye disease and may result in impairment of both corneal transparency and sensation. Identifying factors that regulate corneal wound healing is key for the development of new treatment strategies. Here, we investigated a direct role of mitochondria in corneal wound healing via mitochondria transplantation. Methods Human corneal epithelial cells (hCECs) were isolated from human corneas and incubated with mitochondria which were isolated from human ARPE-19 cells. We determined the effect of mitochondria transplantation on wound healing and proliferation of hCECs. In vivo, we used a mouse model of corneal chemical injury. Mitochondria were isolated from mouse livers and topically applied to the ocular surface following injury. We evaluated the time of wound repair, corneal re-epithelization, and stromal abnormalities. Results Mitochondria transplantation induced the proliferation and wound healing of primary hCECs. Further, mitochondria transplantation promoted wound healing in vivo. Specifically, mice receiving mitochondria recovered twice as fast as control mice following corneal injury, presenting both enhanced and improved repair. Corneas treated with mitochondria demonstrated the re-epithelization of the wound area to a multi-layer appearance, compared to thinning and complete loss of the epithelium in control mice. Mitochondria transplantation also prevented the thickening and disorganization of the corneal stromal lamella, restoring normal corneal dehydration. Conclusions Mitochondria promote corneal re-epithelization and wound healing. Augmentation of mitochondria levels via mitochondria transplantation may serve as an effective treatment for inducing the rapid repair of corneal epithelial defects.
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Affiliation(s)
- Daniel Raz
- Ophthalmology Research Laboratory, Department of Ophthalmology, Kaplan Medical Center, Israel
- Institute of Biochemistry, Food Science and Nutrition, The Robert H. Smith Faculty of Agriculture, Food and Environment, The Hebrew University of Jerusalem, Rehovot, Israel
| | - Keren Ben-Yaakov
- Ophthalmology Research Laboratory, Department of Ophthalmology, Kaplan Medical Center, Israel
| | - Michal Levi
- Ophthalmology Research Laboratory, Department of Ophthalmology, Kaplan Medical Center, Israel
- Department of Ophthalmology, Kaplan Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | | | | | - Diego Ponzin
- Fondazione Banca degli Occhi del Veneto, Venice, Italy
| | - Massimo Busin
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy
- Department of Ophthalmology, Ospedali Privati Forlì “Villa Igea,” Forlì, Italy
- Istituto Internazionale per la Ricerca e Formazione in Oftalmologia, Forlì, Italy
| | - Hana Leiba
- Ophthalmology Research Laboratory, Department of Ophthalmology, Kaplan Medical Center, Israel
- Department of Ophthalmology, Kaplan Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | - Arie L. Marcovich
- Ophthalmology Research Laboratory, Department of Ophthalmology, Kaplan Medical Center, Israel
- Department of Ophthalmology, Kaplan Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | - Avital Eisenberg-Lerner
- Ophthalmology Research Laboratory, Department of Ophthalmology, Kaplan Medical Center, Israel
| | - Ziv Rotfogel
- Ophthalmology Research Laboratory, Department of Ophthalmology, Kaplan Medical Center, Israel
- Department of Ophthalmology, Kaplan Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Israel
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Bian Y, Jurkunas U. Ocular Chemical Injuries and Limbal Stem Cell Deficiency (LSCD): An Update on Management. Int Ophthalmol Clin 2024; 64:31-48. [PMID: 38525980 DOI: 10.1097/iio.0000000000000487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/26/2024]
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Çınar H, Temizsoylu MD, İpek V. Comparative evaluation of platelet-rich plasma, autologous blood serum, and umbilical cord serum for corneal healing after penetrating keratoplasty in New Zealand rabbits. Exp Eye Res 2024; 240:109779. [PMID: 38176514 DOI: 10.1016/j.exer.2023.109779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 11/24/2023] [Accepted: 12/31/2023] [Indexed: 01/06/2024]
Abstract
This study aimed to evaluate the effects of platelet-rich plasma (PRP), autologous blood serum (ABS), and umbilical cord serum (UCS) on corneal healing following penetrating keratoplasty (PK). A total of 120 New Zealand white rabbits, forty were designated as donors, while the remaining eighty rabbits were randomly divided into four groups after undergoing PRP Group (n = 20), ABS Group (n = 20), UCS Group (n = 20) and Control Group (n = 20). Corneal opacity score, corneal vascularization, corneal staining, histopathological analysis, and immunohistochemical analysis (including CD4+, CD8+, and major histocompatibility complex [MHC] II) were assessed at postoperative 1, 2, 3, and 12 weeks. The results showed that corneal opacity score and corneal vascularization did not differ significantly among the groups. However, corneal staining was found to be statistically higher in the PRP group (0.40 ± 0.60) compared to the other groups (p = 0.011). Immunohistochemical examination revealed no significant differences in CD4+, CD8+, and MHC II levels among the groups. Notably, in all groups, CD4+, CD8+, and MHC II levels were significantly higher at 12 weeks compared to other time points. PRP, ABS, and UCS demonstrated positive effects on corneal healing after PK. However, among the three products, PRP exhibited a superior healing effect compared to ABS and UCS crucial in the postoperative period following PK procedures, as they significantly impact visual quality, graft transparency, graft survival, and prevention of stromal resorption caused by infections. Despite the avascular nature of the cornea and its immune privilege, failure to resolve epithelial defects (ED) commonly observed after PK can result in irreversible scarring and ulceration, leading to graft rejection. While epithelial defects are observed in 14-100% of cases on the first postoperative day, approximately 3-7% of them persist as non-healing ED in subsequent periods. In conclusion, our study demonstrated that PRP, ABS, and UCS have a positive effect on corneal healing after PK.
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Affiliation(s)
- Harun Çınar
- Department of Surgery, Faculty of Veterinary Medicine, Burdur Mehmet Akif Ersoy University, Burdur, Turkey.
| | - Mustafa Doğa Temizsoylu
- Department of Surgery, Faculty of Veterinary Medicine, Burdur Mehmet Akif Ersoy University, Burdur, Turkey
| | - Volkan İpek
- Department of Patology, Faculty of Veterinary Medicine, Burdur Mehmet Akif Ersoy University, Burdur, Turkey
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Bhujel B, Oh SH, Kim CM, Yoon YJ, Chung HS, Ye EA, Lee H, Kim JY. Current Advances in Regenerative Strategies for Dry Eye Diseases: A Comprehensive Review. Bioengineering (Basel) 2023; 11:39. [PMID: 38247916 PMCID: PMC10813666 DOI: 10.3390/bioengineering11010039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 12/17/2023] [Accepted: 12/26/2023] [Indexed: 01/23/2024] Open
Abstract
Dry eye disease (DED) is an emerging health issue affecting millions of individuals annually. Ocular surface disorders, such as DED, are characterized by inflammation triggered by various factors. This condition can lead to tear deficiencies, resulting in the desiccation of the ocular surface, corneal ulceration/perforation, increased susceptibility to infections, and a higher risk of severe visual impairment and blindness. Currently, the clinical management of DED primarily relies on supportive and palliative measures, including the frequent and lifelong use of different lubricating agents. While some advancements like punctal plugs, non-steroidal anti-inflammatory drugs, and salivary gland autografts have been attempted, they have shown limited effectiveness. Recently, there have been promising developments in the treatment of DED, including biomaterials such as nano-systems, hydrogels, and contact lenses for drug delivery, cell-based therapies, biological approaches, and tissue-based regenerative therapy. This article specifically explores the different strategies reported so far for treating DED. The aim is to discuss their potential as long-term cures for DED while also considering the factors that limit their feasibility and effectiveness. These advancements offer hope for more effective and sustainable treatment options in the future.
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Affiliation(s)
| | | | | | | | | | | | | | - Jae-Yong Kim
- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Republic of Korea; (B.B.); (S.-H.O.); (C.-M.K.); (Y.-J.Y.); (H.-S.C.); (E.-A.Y.); (H.L.)
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Kawahara A. Treatment of Dry Eye Disease (DED) in Asia: Strategies for Short Tear Film Breakup Time-Type DED. Pharmaceutics 2023; 15:2591. [PMID: 38004570 PMCID: PMC10674215 DOI: 10.3390/pharmaceutics15112591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 10/19/2023] [Accepted: 11/03/2023] [Indexed: 11/26/2023] Open
Abstract
Dry eye disease (DED) is a multifactorial disorder in which tear fluid homeostasis is lost, resulting in increased tear film osmolarity and ocular surface irritation. In Asia, the short tear film breakup time-type DED, which has become a global problem in recent years, is common. While the mainstay of DED treatment in the West is the suppression of inflammation, the first goal of treatment is the stabilization of the tear film in Asia. To date, artificial tears and steroid eye drops have been the main treatment for DED. However, artificial tears require frequent administration of eye drops and thus pose adherence problems, while steroids have problems with side-effects (cataracts, increased intraocular pressure). This review evaluates the new generation therapies in Asia based on what is known about them and demonstrates that they are more effective for DED than traditional therapies such as artificial tears and steroids. Based on considerations, it is proposed that the optimal treatment for the short tear film breakup time-type DED is the initial application of mucin-secretion-enhancing eye drops (long-acting diquafosol) and oral supplements; and if additional treatment is needed, cyclosporine eye drops and the adjunctive therapies presented in this review are added.
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Affiliation(s)
- Atsushi Kawahara
- Yoshida Eye Hospital, 2-31-8, Hondori, Hakodate 041-0851, Hokkaido, Japan
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Thia ZZ, Ho YT, Shih KC, Tong L. New developments in the management of persistent corneal epithelial defects. Surv Ophthalmol 2023; 68:1093-1114. [PMID: 37301520 DOI: 10.1016/j.survophthal.2023.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 05/24/2023] [Accepted: 06/05/2023] [Indexed: 06/12/2023]
Abstract
A persistent epithelial defect (PED) is a corneal epithelial defect that failed to heal after 2weeks. It is a condition that carries much morbidity, and our understanding of PED remains poor, with current treatment methods often having unsatisfactory outcomes. With PEDs becoming more prevalent, more efforts are required to establish reliable treatment modalities. Our reviews describe the causes of PEDs and the different approaches developed to manage them, as well as their associated limitations. Emphasis is placed on understanding various advances in the development of new treatment modalities. We have also described a case of a woman with a background of graft-versus-host disease on long-term topical corticosteroids who developed complicated PED involving both eyes. The current approach to managing PEDs generally involves exclusion of an active infection, followed by treatment modalities that aim to encourage corneal epithelial healing. Success rates, however, remain far from desirable, as treatment remains challenging due to multiple underlying etiologies. In summary, advances in the development of new therapies may be able to facilitate progress in the understanding and treatment of PED.
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Affiliation(s)
- Zhang Zhe Thia
- Singapore Eye Research Institute, Singapore, Singapore; National University Hospital, Singapore, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Yik To Ho
- Hong Kong University, Pok Fu Lam, Hong Kong
| | | | - Louis Tong
- Singapore Eye Research Institute, Singapore, Singapore; Singapore National Eye Center, Singapore, Singapore; Duke-NUS Medical School, Singapore, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
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Choi AJ, Hefley BS, Nicholas SE, Cunningham RL, Karamichos D. Novel Correlation between TGF-β1/-β3 and Hormone Receptors in the Human Corneal Stroma. Int J Mol Sci 2023; 24:13635. [PMID: 37686439 PMCID: PMC10487450 DOI: 10.3390/ijms241713635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Revised: 08/22/2023] [Accepted: 08/30/2023] [Indexed: 09/10/2023] Open
Abstract
This study investigated the interplay between transforming growth factor beta (TGF-β1/T1 and TGF-β3/T3), and sex hormone receptors using our 3D in vitro cornea stroma model. Primary human corneal fibroblasts (HCFs) from healthy donors were plated in transwells at 106 cells/well and cultured for four weeks. HCFs were supplemented with stable vitamin C (VitC) and stimulated with T1 or T3. 3D construct proteins were analyzed for the androgen receptor (AR), progesterone receptor (PR), estrogen receptor alpha (ERα) and beta (ERβ), luteinizing hormone receptor (LHR), follicle-stimulating hormone receptor (FSHR), gonadotropin-releasing hormone receptor (GnRHR), KiSS1-derived peptide receptor (KiSS1R/GPR54), and follicle-stimulating hormone subunit beta (FSH-B). In female constructs, T1 significantly upregulated AR, PR, ERα, FSHR, GnRHR, and KiSS1R. In male constructs, T1 significantly downregulated FSHR and FSH-B and significantly upregulated ERα, ERβ, and GnRHR. T3 caused significant upregulation in expressions PR, ERα, ERβ, LHR, FSHR, and GNRHR in female constructs, and significant downregulation of AR, ERα, and FSHR in male constructs. Semi-quantitative Western blot findings present the interplay between sex hormone receptors and TGF-β isoforms in the corneal stroma, which is influenced by sex as a biological variable (SABV). Additional studies are warranted to fully delineate their interactions and signaling mechanisms.
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Affiliation(s)
- Alexander J. Choi
- North Texas Eye Research Institute, University of North Texas Health Science Center, Fort Worth, TX 76107, USA; (A.J.C.); (B.S.H.); (S.E.N.)
- Department of Pharmaceutical Sciences, University of North Texas Health Science Center, Fort Worth, TX 76107, USA;
| | - Brenna S. Hefley
- North Texas Eye Research Institute, University of North Texas Health Science Center, Fort Worth, TX 76107, USA; (A.J.C.); (B.S.H.); (S.E.N.)
- Department of Pharmaceutical Sciences, University of North Texas Health Science Center, Fort Worth, TX 76107, USA;
| | - Sarah E. Nicholas
- North Texas Eye Research Institute, University of North Texas Health Science Center, Fort Worth, TX 76107, USA; (A.J.C.); (B.S.H.); (S.E.N.)
- Department of Pharmaceutical Sciences, University of North Texas Health Science Center, Fort Worth, TX 76107, USA;
| | - Rebecca L. Cunningham
- Department of Pharmaceutical Sciences, University of North Texas Health Science Center, Fort Worth, TX 76107, USA;
| | - Dimitrios Karamichos
- North Texas Eye Research Institute, University of North Texas Health Science Center, Fort Worth, TX 76107, USA; (A.J.C.); (B.S.H.); (S.E.N.)
- Department of Pharmaceutical Sciences, University of North Texas Health Science Center, Fort Worth, TX 76107, USA;
- Department of Pharmacology and Neuroscience, University of North Texas Health Science Center, Fort Worth, TX 76107, USA
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Balboa Miró M, Monés Llivina A, Romanic Bubalo N, Arango Rodríguez A, Sabala Llopart A, Valldeperas X. Umbilical cord serum for the management of severe bilateral corneal chemical burn in a pediatric patient. J Fr Ophtalmol 2023; 46:e126-e128. [PMID: 36804113 DOI: 10.1016/j.jfo.2022.09.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 08/03/2022] [Accepted: 09/19/2022] [Indexed: 02/17/2023]
Affiliation(s)
- M Balboa Miró
- Ophthalmology Department, Germans Trias y Pujol Hospital, Carretera de Canyet N/N, 08916 Badalona, Barcelona, Spain.
| | - A Monés Llivina
- Ophthalmology Department, Germans Trias y Pujol Hospital, Carretera de Canyet N/N, 08916 Badalona, Barcelona, Spain
| | - N Romanic Bubalo
- Ophthalmology Department, Germans Trias y Pujol Hospital, Carretera de Canyet N/N, 08916 Badalona, Barcelona, Spain
| | - A Arango Rodríguez
- Ophthalmology Department, Germans Trias y Pujol Hospital, Carretera de Canyet N/N, 08916 Badalona, Barcelona, Spain
| | - A Sabala Llopart
- Ophthalmology Department, Germans Trias y Pujol Hospital, Carretera de Canyet N/N, 08916 Badalona, Barcelona, Spain
| | - X Valldeperas
- Ophthalmology Department, Germans Trias y Pujol Hospital, Carretera de Canyet N/N, 08916 Badalona, Barcelona, Spain
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Kumar A, Chaurasiya D, Sultan S, Soni D, Kubrey S, Singh P, Verma S, Mohan RR, Sharma B. Therapeutic Profile of Human Umbilical Cord Blood Serum and Autologous Serum Therapies in Treatment of Ocular Surface Disorders: A Pilot Study. J Ocul Pharmacol Ther 2023; 39:36-47. [PMID: 36607768 DOI: 10.1089/jop.2022.0107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Purpose: Umbilical cord blood serum (UCBS) is an effective adjunctive treatment along with conventional therapy in ocular surface disorders (OSDs). It aids in rapid ocular surface restoration thereby achieving epithelial integrity, in addition to improvement in subjective and objective parameters. The study aims to compare the efficacy of human umbilical cord blood serum and autologous serum (AS) in treatment of OSD. Methods: A prospective randomized study was conducted on 101 eyes diagnosed with OSD resulting from dry eye disease (DED; n = 40), acute chemical burn (ACB; n = 21), and ocular allergy (OA; n = 40). Randomization was done in Group I, administered with AS, and Group II with UCBS. Outcomes evaluated were visual acuity (VA), eye sensation score (ESS), ocular surface disease index (OSDI), tear break-up time (TBUT), Schirmer's value, Corneal Fluorescein Score, epithelial defect, limbal ischemia, corneal clarity (CC), and improvement in grade of severity. Statistical analysis was done using Wilcoxon signed-rank, Wilcoxon rank sum, Chi-square, and Z-test with a significance level (P ≤ 0.05). Results: In DED, Group II showed significant improvement in VA, ESS, and OSDI by the 7th day, whereas the mean Schirmer, TBUT, and corneal fluorescein staining score improved by 3 months. In ACB, Group II showed improvement in VA, reepithelialization, reduction in limbal ischemia, and CC by 3 months. In OA, Group II showed improvement in ESS by day 7. Conclusion: Human umbilical cord blood serum is more effective than AS in restoring ocular surface.
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Affiliation(s)
- Akhilesh Kumar
- Department of Ophthalmology, Gandhi Medical College, Bhopal, India
| | | | - Shabana Sultan
- Department of Obstetrics and Gynecology, Gandhi Medical College, Bhopal, India
| | - Deepak Soni
- Department of Ophthalmology, All India Institute of Medical Sciences, Bhopal, India
| | - Suraj Kubrey
- Department of Ophthalmology, Gandhi Medical College, Bhopal, India
| | - Priti Singh
- Department of Ophthalmology, All India Institute of Medical Sciences, Bhopal, India
| | - Sunil Verma
- Department of Ophthalmology, All India Institute of Medical Sciences, Bhopal, India
| | - Rajiv R Mohan
- Department of Ophthalmology, College of Veterinary Medicine, Surgery and Mason Eye Institute, University of Missouri, Columbia, Missouri, USA
| | - Bhavana Sharma
- Department of Ophthalmology, Gandhi Medical College, Bhopal, India.,Department of Ophthalmology, All India Institute of Medical Sciences, Bhopal, India
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Mini-Conjunctival Limbal Autograft (Mini-CLAU) Using Platelet-Rich Plasma Eye Drops (E-PRP): A Case Series. Cornea 2022:00003226-990000000-00145. [PMID: 36730781 DOI: 10.1097/ico.0000000000003156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 08/14/2022] [Indexed: 02/04/2023]
Abstract
PURPOSE The purpose of this study was to introduce a new method of limbal stem cell transplantation using autologous platelet-rich plasma (E-PRP) eye drops for unilateral total limbal stem cell deficiency. METHODS Patients with total unilateral limbal stem cell deficiency due to chemical burn underwent mini-conjunctival limbal autograft using autologous E-PRP drops. One small limbal block, measuring 2 × 2 mm, was harvested from the patients' contralateral healthy eye and transplanted to the diseased eye. All patients received E-PRP drops until achieving complete corneal epithelialization. Subsequent corneal transplantation was performed in eyes with significant stromal opacification. Corneal buttons obtained during corneal transplantation underwent immunohistochemistry for the evaluation of limbal stem cell markers (ABCG2 and P63). Visual acuity, epithelial healing, corneal clarity, and regression of corneal conjunctivalization/vascularization were evaluated after surgery. RESULTS Ten patients with acid (n = 7) or alkali (n = 3) burn were included. The mean follow-up period was 21.7 ± 5.8 months (range, 12-32 months). Corneas were completely reepithelialized within 14.9 ± 3.5 days (range, 11-21 days). Corneal conjunctivalization/vascularization dramatically regressed 1 to 2 months after surgery in all cases, and corneal clarity considerably improved in 7 patients. In the 3 eyes with significant stromal opacification, subsequent optical penetrating keratoplasty was performed. The ocular surface was stable throughout the follow-up period in all eyes. BSCVA improved to 0.60 ± 0.0.32 and 0.46 ± 0.0.25 logMAR in eyes with and without corneal transplantation, respectively, at the final follow-up visit. ABCG2 and P63 markers were detected on corneal buttons after keratoplasty. CONCLUSIONS Based on our clinical and laboratory findings, mini-conjunctival limbal autograft using E-PRP can be considered as a promising alternative to ocular surface reconstruction.
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Widyaningrum R, Wu YW, Delila L, Lee DY, Wang TJ, Burnouf T. In vitro evaluation of platelet extracellular vesicles (PEVs) for corneal endothelial regeneration. Platelets 2022; 33:1237-1250. [PMID: 35949054 DOI: 10.1080/09537104.2022.2105829] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
Corneal endothelial cells (CECs) slowly decrease in number with increasing age, which is a clinical issue as these cells have very limited regenerative ability. Therapeutic platelet biomaterials are increasingly used in regenerative medicine and cell therapy because of their safety, cost-effective manufacture, and global availability from collected platelet concentrates (PCs). Platelet extracellular vesicles (PEVs) are a complex mixture of potent bioactive vesicles rich in molecules believed to be instrumental in tissue repair and regeneration. In this study we investigated the feasibility of using a PEVs preparation as an innovative regenerative biotherapy for corneal endothelial dysfunction. The PEVs were isolated from clinical-grade human PC supernatants by 20,000 × g ultracentrifugation and resuspension. PEVs exhibited a regular, fairly rounded shape, with an average size of <200 nm and were present at a concentration of approximately 1011 /mL. PEVs expressed cluster of differentiation 41 (CD41) and CD61, characteristic platelets membrane markers, and CD9 and CD63. ELISA and LC-MS/MS proteomic analyses revealed that the PEVs contained mixtures of growth factors and multiple other trophic factors, as well as proteins related to extracellular exosomes with functional activities associated with cell cadherin and adherens pathways. CECs treated with PEVs showed increased viability, an enhanced wound-healing rate, stronger proliferation markers, and an improved adhesion rate. PEVs did not exert cellular toxicity as evidenced by the maintenance of cellular morphology and preservation of corneal endothelial proteins. These findings clearly support further investigations of PEV biomaterials in animal models for translation as a new CEC regeneration biotherapy.
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Affiliation(s)
- Rifa Widyaningrum
- International PhD Program in Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.,Department of Ophthalmology, Faculty of Medicine Public Health and Nursing, Universitas Gadjah Mada-Dr Sardjito General Hospital, Yogyakarta, Indonesia
| | - Yu-Wen Wu
- Graduate Institute of Biomedical Materials and Tissue Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei, Taiwan
| | - Liling Delila
- Graduate Institute of Biomedical Materials and Tissue Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei, Taiwan
| | - Deng-Yao Lee
- Graduate Institute of Biomedical Materials and Tissue Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei, Taiwan
| | - Tsung-Jen Wang
- Department of Ophthalmology, Taipei Medical University Hospital, Taipei, Taiwan.,Department of Ophthalmology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Thierry Burnouf
- Graduate Institute of Biomedical Materials and Tissue Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei, Taiwan.,International PhD Program in Biomedical Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei, Taiwan.,International PhD Program in Cell Therapy and Regeneration Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
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Peyrecave-Capo X, Saulnier N, Maddens S, Gremillet B, Desjardins I. Equine Umbilical Cord Serum Composition and Its Healing Effects in Equine Corneal Ulceration. Front Vet Sci 2022; 9:843744. [PMID: 35372560 PMCID: PMC8970184 DOI: 10.3389/fvets.2022.843744] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Accepted: 01/25/2022] [Indexed: 11/21/2022] Open
Abstract
Background Human autologous serum (AS) and umbilical cord serum (UCS) both contain growth and neurotrophic factors that promote corneal healing. Aim Our objectives were to compare equine AS and UCS cytokine and growth factor profiles and to assess the safety and clinical feasibility of the therapeutic use of UCS eye drops in cases of spontaneous complex ulcers. Study Design Prospective clinical trial. Methods Vitamin A insulin growth factor, platelet-derived growth factor-BB, transforming growth factor (TGF)-β1 (enzyme-linked immunosorbent assay), interleukin (IL)-1β, IL-6, interferon-γ, and monocyte chemoattractant protein 1 concentrations were determined in 10 AS collected from different horses and 10 UCS sampled at delivery. Six client-owned horses presenting with complex non-healing corneal defects of >5 mm2 were included in a clinical trial and treated with conventional therapy and conditioned UCS drops for 8–15 days. Ulcer surface and time to complete epithelialization were recorded. Results Median concentrations of vitamin A, insulin growth factor, and platelet-derived growth factor-BB were not significantly different in AS compared with UCS (respectively, 14.5 vs. 12.05 μg/ml; 107.8 vs. 107.3 pg/ml; and 369.1 vs. 924.2 pg/ml). TGF-β1 median concentration in UCS was significantly higher than in AS (3,245 vs. 2571pg/ml) (p = 0.04). IL-1β, IL-6, interferon-γ, and monocyte chemoattractant protein 1 concentrations were variable in AS and undetectable in UCS. The corneal median ulcerative area was 37.2 mm2 (6.28–57.14 mm2) and had a duration of 4–186 days (median 19 days). All lesions healed within 13–42 days (median 17 days). No adverse effects nor recurrences within 1 month were noticed. Limitations The sample size was small. Spontaneous corneal epithelial defects presented with variable clinical characteristics. There were no age-matched control horses to assess corneal healing time and rate. Conclusion and Clinical Significance Equine UCS may be beneficial, as it contains no pro-inflammatory cytokines and a greater concentration of TGF-β1 compared with AS. Topical UCS appears safe and may potentially be used as adjunctive therapy for equine complex non-healing ulcers.
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Affiliation(s)
- Xavier Peyrecave-Capo
- Equine Department, Faculty of Veterinary Medicine, VetAgro-Sup, University of Lyon, Marcy l'Etoile, France
| | | | | | - Bérengère Gremillet
- Department of Clinical Sciences, Veterinary Medicine, University of Liège, Sart-Tilman, Liège, Belgium
| | - Isabelle Desjardins
- Equine Department, Faculty of Veterinary Medicine, VetAgro-Sup, University of Lyon, Marcy l'Etoile, France
- *Correspondence: Isabelle Desjardins
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Use of Acellular Umbilical Cord-Derived Tissues in Corneal and Ocular Surface Diseases. MEDICINES 2021; 8:medicines8020012. [PMID: 33572327 PMCID: PMC7916115 DOI: 10.3390/medicines8020012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 01/28/2021] [Accepted: 01/29/2021] [Indexed: 11/25/2022]
Abstract
Blood derived products have become a valuable source of tissue for the treatment of ocular surface diseases that are refractory to conventional treatments. These can be obtained from autologous or allogeneic sources (patient’s own blood or from healthy adult donors/umbilical cord blood, respectively). Allogeneic cord blood demonstrates practical advantages over alternatives and these advantages will be discussed herein. Umbilical cord blood (UCB) can be divided, generally speaking, into two distinct products: first, mononuclear cells, which can be used in regenerative ophthalmology, and second, the plasma/serum (an acellular fraction), which may be used in the form of eyedrops administered directly to the damaged ocular surface. The rationale for using umbilical cord serum (UCS) to treat ocular surface diseases such as severe dry eye syndrome (DES), persistent epithelial defects (PED), recurrent epithelial erosions, ocular chemical burns, graft versus host disease (GVHD), among others, is the considerably high concentration of growth factors and cytokines, mimicking the natural healing properties of human tears. Allogeneic serum also offers the opportunity for therapeutic treatment to patients who, due to poor heath, cannot provide autologous serum. The mechanism of action involves the stimulation of endogenous cellular proliferation, differentiation and maturation, which is highly efficient in promoting and enhancing corneal epithelial healing where other therapies have previously failed.
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Nosrati H, Alizadeh Z, Nosrati A, Ashrafi-Dehkordi K, Banitalebi-Dehkordi M, Sanami S, Khodaei M. Stem cell-based therapeutic strategies for corneal epithelium regeneration. Tissue Cell 2020; 68:101470. [PMID: 33248403 DOI: 10.1016/j.tice.2020.101470] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 11/11/2020] [Accepted: 11/11/2020] [Indexed: 12/13/2022]
Abstract
Any significant loss of vision or blindness caused by corneal damages is referred to as corneal blindness. Corneal blindness is the fourth most common cause of blindness worldwide, representing more than 5% of the total blind population. Currently, corneal transplantation is used to treat many corneal diseases. In some cases, implantation of artificial cornea (keratoprosthesis) is suggested after a patient has had a donor corneal transplant failure. The shortage of donors and the side effects of keratoprosthesis are limiting these approaches. Recently, researchers have been actively pursuing new approaches for corneal regeneration because of these limitations. Nowadays, tissue engineering of different corneal layers (epithelium, stroma, endothelium, or full thickness tissue) is a promising approach that has attracted a great deal of interest from researchers and focuses on regenerative strategies using different cell sources and biomaterials. Various sources of corneal and non-corneal stem cells have shown significant advantages for corneal epithelium regeneration applications. Pluripotent stem cells (embryonic stem cells and iPS cells), epithelial stem cells (derived from oral mucus, amniotic membrane, epidermis and hair follicle), mesenchymal stem cells (bone marrow, adipose-derived, amniotic membrane, placenta, umbilical cord), and neural crest origin stem cells (dental pulp stem cells) are the most promising sources in this regard. These cells could also be used in combination with natural or synthetic scaffolds to improve the efficacy of the therapeutic approach. As the ocular surface is exposed to external damage, the number of studies on regeneration of the corneal epithelium is rising. In this paper, we reviewed the stem cell-based strategies for corneal epithelium regeneration.
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Affiliation(s)
- Hamed Nosrati
- Department of Tissue Engineering and Applied Cell Sciences, School of Advanced Technologies, Shahrekord University of Medical Sciences, Shahrekord, Iran.
| | - Zohreh Alizadeh
- Endometrium and Endometriosis Research Center, Hamadan University of Medical Sciences, Hamadan, Iran; Department of Anatomical Sciences, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Ali Nosrati
- School of Mechanical Engineering, College of Engineering, University of Tehran, Tehran, Iran
| | - Korosh Ashrafi-Dehkordi
- Department of Molecular Medicine, School of Advanced Technologies, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Mehdi Banitalebi-Dehkordi
- Department of Molecular Medicine, School of Advanced Technologies, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Samira Sanami
- Department of Medical Biotechnology, School of Advanced Technologies, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Mohammad Khodaei
- Department of Materials Science and Engineering, Golpayegan University of Technology, Golpayegan, Iran
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Gouveia RM, Connon CJ. Biomechanical Modulation Therapy-A Stem Cell Therapy Without Stem Cells for the Treatment of Severe Ocular Burns. Transl Vis Sci Technol 2020; 9:5. [PMID: 33240564 PMCID: PMC7671857 DOI: 10.1167/tvst.9.12.5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 09/07/2020] [Indexed: 12/16/2022] Open
Abstract
Ocular injuries caused by chemical and thermal burns are often unmanageable and frequently result in disfigurement, corneal haze/opacification, and vision loss. Currently, a considerable number of surgical and pharmacological approaches are available to treat such injuries at either an acute or a chronic stage. However, these existing interventions are mainly directed at (and limited to) suppressing corneal inflammation and neovascularization while promoting re-epithelialization. Reconstruction of the ocular surface represents a suitable but last-option recourse in cases where epithelial healing is severely impaired, such as due to limbal stem cell deficiency. In this concise review, we discuss how biomechanical modulation therapy (BMT) may represent a more effective approach to promoting the regeneration of ocular tissues affected by burn injuries via restoration of the limbal stem cell niche. Specifically, the scientific basis supporting this new therapeutic modality is described, along with our growing understanding of the role that tissue biomechanics plays in stem cell fate and function. The potential impact of BMT as a future treatment option for the management of injuries affecting tissue compliance is also further discussed.
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Affiliation(s)
- Ricardo M Gouveia
- Biosciences Institute, Faculty of Medical Sciences, The Medical School, Newcastle University, Newcastle upon Tyne, UK
| | - Che J Connon
- Biosciences Institute, Faculty of Medical Sciences, The Medical School, Newcastle University, Newcastle upon Tyne, UK
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Dua HS, Ting DSJ, Al Saadi A, Said DG. Chemical eye injury: pathophysiology, assessment and management. Eye (Lond) 2020; 34:2001-2019. [PMID: 32572184 PMCID: PMC7784957 DOI: 10.1038/s41433-020-1026-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 05/27/2020] [Accepted: 06/04/2020] [Indexed: 11/09/2022] Open
Abstract
Chemical eye injury (CEI) is an acute emergency which can threaten sight and life. These commonly occur at home or the workplace with the former being generally mild and the latter more severe and bilateral. Major workplace accidents involve other parts of the body and can be associated with inhalation or ingestion of the chemical. Alkali injuries cause damage by saponification of tissue and deeper penetration as a consequence. Acid injuries cause rapid coagulation of tissue, which impedes penetration and limits damage. Irritants such as alcohols, cause superficial epithelial denudation. Severe chemical insult can affect all anterior segment structures causing iris, pupil and lens abnormalities. Eye pressure is variably affected and can be low or high or start as one and rapidly change to the other. Chorioretinal changes in the form of vasculopathy are seen and ascribed to be secondary to anterior segment inflammation rather than due to the direct effect of CEI. Final outcome related to structure and function is determined by the injurious agent, duration of exposure, nature of treatment and the rapidity with which it is instituted. Prevention of further damage by profuse and prolonged eye wash, after ascertaining pH of both eyes, together with exploration and removal of all particulate matter, is the key. Other management principles include a complete and thorough assessment, control of inflammation, facilitation of healing and prevention and management of sequelae and complications. Intraocular pressure is often forgotten and must be assessed and managed. Management often requires a multidisciplinary approach.
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Affiliation(s)
- Harminder S Dua
- Academic Ophthalmology, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, UK.
- Department of Ophthalmology, Queen's Medical Centre, Nottingham, UK.
| | - Darren Shu Jeng Ting
- Academic Ophthalmology, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, UK
- Department of Ophthalmology, Queen's Medical Centre, Nottingham, UK
| | - Ahmed Al Saadi
- Department of Ophthalmology, Zayed Military Hospital, Abu Dhabi, UAE
| | - Dalia G Said
- Academic Ophthalmology, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, UK
- Department of Ophthalmology, Queen's Medical Centre, Nottingham, UK
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17
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Corneal Neurotization and Novel Medical Therapies for Neurotrophic Keratopathy. CURRENT OPHTHALMOLOGY REPORTS 2020. [DOI: 10.1007/s40135-020-00254-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Abstract
Purpose of Review
Neurotrophic keratopathy (NK) is a degenerative corneal disease characterized by decreased corneal sensibility and impaired corneal healing. In this article, we review surgical techniques for corneal neurotization (CN) and novel medical therapies for the treatment of NK.
Recent Findings
In recent decades, there has been a paradigm shift in the treatment strategies for NK. New minimally invasive direct and indirect CN approaches have demonstrated efficacy at improving best-corrected visual acuity and central corneal sensation while decreasing surgical morbidity. In addition, several targeted medical therapies, such as recombinant human nerve growth factor (rhNGF), regenerating agents (RGTA), and nicergoline, have shown promise in improving corneal epithelial healing. Of these options, cenegermin (Oxervate®, Dompé), a topical biologic medication, has emerged as an approved medical treatment for moderate to severe NK.
Summary
NK is a challenging condition caused by alterations in corneal nerves, leading to impairment in sensory and trophic function with subsequent breakdown of the cornea. Conventional therapy for NK depends on the severity of disease and focuses primarily on protecting the ocular surface. In recent years, numerous CN techniques and novel medical treatments have been developed that aim to restore proper corneal innervation and promote ocular surface healing. Further studies are needed to better understand the long-term efficacy of these treatment options, their target populations, and the potential synergistic efficacy of combined medical and surgical treatments.
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Orlando N, Pellegrino C, Valentini CG, Bianchi M, Barbagallo O, Sparnacci S, Forni F, Fontana TM, Teofili L. Umbilical cord blood: Current uses for transfusion and regenerative medicine. Transfus Apher Sci 2020; 59:102952. [PMID: 32972860 DOI: 10.1016/j.transci.2020.102952] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The past 20 years of experience with umbilical cord blood transplantation have demonstrated that cord blood is effective in the treatment of a spectrum of diseases, including hematological malignancies, bone marrow failure, hemoglobinopathies, and inborn errors of metabolism. However, only a few number of umbilical cord blood units collected have a cell content adequate for an allogenic hematopoietic stem cell transplantation. In the meanwhile, there is an increasing interest in exploiting cord blood derivatives in different fields. In this review, we will summarize the most recent updates on clinical applications of umbilical cord blood platelet derivatives for regenerative medicine, and we will revise the literature concerning the use of umbilical cord blood for autologous or allogeneic transfusion purposes. The methodological aspect and the biological characteristics of these products also will be discussed.
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Affiliation(s)
- Nicoletta Orlando
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Claudio Pellegrino
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Caterina Giovanna Valentini
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Maria Bianchi
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Ombretta Barbagallo
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Sabrina Sparnacci
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Franca Forni
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Tecla Maria Fontana
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Luciana Teofili
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Sezione di Ematologia, Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore, Rome, Italy.
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Soleimani M, Naderan M. Management Strategies of Ocular Chemical Burns: Current Perspectives. Clin Ophthalmol 2020; 14:2687-2699. [PMID: 32982161 PMCID: PMC7501954 DOI: 10.2147/opth.s235873] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 08/20/2020] [Indexed: 11/25/2022] Open
Abstract
Ocular chemical burns are absolute ophthalmic emergencies and require immediate management to minimize devastating sequelae. Management of alkali and acid burns is started at the scene of the accident by copious irrigation. Treatment is directed at improving epithelial integrity and stromal stability, reduction of undue inflammation, and prevention or timely management of complications. To ascertain the best possible outcome, numerous biological medications and surgical interventions have been merged into conventional therapeutic regimens. These include autologous and umbilical cord serum preparations, platelet-rich plasma, amniotic membrane transplantation, limbal stem-cell transplantation, and anti-angiogenic agents.
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Affiliation(s)
- Mohammad Soleimani
- Ocular Trauma and Emergency Department, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Morteza Naderan
- Ocular Trauma and Emergency Department, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
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20
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Giannaccare G, Carnevali A, Senni C, Logozzo L, Scorcia V. Umbilical Cord Blood and Serum for the Treatment of Ocular Diseases: A Comprehensive Review. Ophthalmol Ther 2020; 9:235-248. [PMID: 32107737 PMCID: PMC7196109 DOI: 10.1007/s40123-020-00239-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Indexed: 12/30/2022] Open
Abstract
Several blood derivatives have been proposed for the treatment of various ocular diseases that affect either the anterior or the posterior segment of the eye. Blood sources may range from the patient’s own peripheral blood (autologous) to donor tissues, mainly allogeneic peripheral blood and umbilical cord blood (UCB). The utilization of the latter permits the collection of a large amount of serum all at once, and is characterized by therapeutic feasibility in patients with a poor general condition or anemia and blood dyscrasia. Products derived from UCB have two potential uses. First, serum in the form of eye drops can be applied topically onto the ocular surface to efficiently treat anterior segment disorders such as dry eye syndrome or corneal epithelial defects with different etiologies. The rationale for and efficacy of this application derive from the high concentrations of biologically active components and growth factors in UCB, which can nourish the ocular surface. Second, UCB is a source of stem cells, which are used in the field of regenerative medicine because they differentiate into various mature cells, including corneal and retinal cells. Therefore, UCB-derived stem cells have been proposed as a replacement therapy for the treatment of retinal and optic nerve diseases, given that current standard treatments often fail. The present review explores the clinical results that have been obtained using UCB-derived products in the field of ophthalmology, as well as the current limitations of those products in this field. Furthermore, given the promising development of UCB-based therapies, possible future directions in this area are discussed.
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Affiliation(s)
- Giuseppe Giannaccare
- Department of Ophthalmology, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Adriano Carnevali
- Department of Ophthalmology, University Magna Graecia of Catanzaro, Catanzaro, Italy.
| | - Carlotta Senni
- Ophthalmology Unit, S.Orsola-Malpighi University Hospital, Bologna, Italy
| | - Laura Logozzo
- Department of Ophthalmology, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Vincenzo Scorcia
- Department of Ophthalmology, University Magna Graecia of Catanzaro, Catanzaro, Italy
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21
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Serum eye drops for the treatment of ocular surface diseases: a systematic review and meta-analysis. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2019; 17:200-209. [PMID: 31246562 DOI: 10.2450/2019.0080-19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 05/15/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND The use of blood-derived eye drops for topical treatment of ocular surface diseases has progressively increased in recent years. MATERIALS AND METHODS To evaluate the use of serum eye drops in ocular surface disorders, we performed a systematic search of the literature. RESULTS In this systematic review, we included 19 randomised controlled trials (RCTs) investigating the use of serum eye drops in 729 patients compared to controls. For the quantitative synthesis, we included only 10 RCTs conducted in patients with dry eye syndrome comparing autologous serum to artificial tears. At 2-6 weeks, no clear between-group differences in Schirmer test (MD 1.05; 95% CI: -0.17-2.26) and in fluorescein staining (MD -0.61; 95% CI: -1.50-0.28) were found (very low-quality evidence, down-graded for inconsistency, serious risk of biases, and serious imprecision). Slightly higher increase in tear film break-up time (TBUT) scores in autologous serum compared to control (MD 2.68; 95% CI: 1.33-4.03), and greater decrease in ocular surface disease index (OSDI) in autologous serum compared to control (MD -11.17; 95% CI: -16.58 - -5.77) were found (low quality evidence, down-graded for serious risk of bias, and for inconsistency). For the Schirmer test, fluorescein staining and TBUT, data were also available at additional follow-up timing (2-12 months): no clear between-group differences were found, and the quality of the evidence was graded as low/very-low. CONCLUSIONS In patients with dry eye syndrome, it is unclear whether or not the use of autologous serum compared to artificial tears increases Schirmer test and fluorescein staining scores at short-term and medium-/long-term follow up. Some benefit at short-term follow up for the outcome of TBUT and OSDI was observed, but the quality of the evidence was low.
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22
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Bernabei F, Roda M, Buzzi M, Pellegrini M, Giannaccare G, Versura P. Blood-Based Treatments for Severe Dry Eye Disease: The Need of a Consensus. J Clin Med 2019; 8:E1478. [PMID: 31533289 PMCID: PMC6780616 DOI: 10.3390/jcm8091478] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 09/05/2019] [Accepted: 09/12/2019] [Indexed: 01/08/2023] Open
Abstract
The use of blood-based eye drops as therapy for various diseases of the ocular surface has become increasingly popular in ophthalmic practice during recent years. The rationale for their use is based on the promotion of cellular proliferation and migration thanks to the supply of metabolically active substances, in particular growth factors. Blood-derived eye drops have been used for the treatment of several ocular surface disorders, such as dry eye disease, corneal ulcer, persistent epithelial defect, neurotrophic keratitis, ocular surface burn, recurrent corneal erosion, and limbal stem-cell deficiency. Both autologous (from patients themselves) and heterologous (from adult donors or from cord blood sampled at birth)-derived products exist, and each source has specific pros and cons. Despite an extensive literature, several issues are still under debate and the aim of this manuscript is to review the indications, preparation methods and storage, characterization of content, rationale for clinical outcomes, patient stratification, length of treatment, and rationale for repeated treatments at disease relapse. A rationale based on a "5 Ws and 2 Hs" protocol is proposed as a way of thinking, with the attempt to clarify Who, Why, When, Where, What, and How to use these treatment options.
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Affiliation(s)
- Federico Bernabei
- Ophthalmology Unit, Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Alma Mater Studiorum University of Bologna, S.Orsola-Malpighi Teaching Hospital, 40138 Bologna, Italy.
| | - Matilde Roda
- Ophthalmology Unit, Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Alma Mater Studiorum University of Bologna, S.Orsola-Malpighi Teaching Hospital, 40138 Bologna, Italy.
| | - Marina Buzzi
- Emilia Romagna Cord Blood Bank-Transfusion Service, S.Orsola-Malpighi Teaching Hospital, 40138 Bologna, Italy.
| | - Marco Pellegrini
- Ophthalmology Unit, Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Alma Mater Studiorum University of Bologna, S.Orsola-Malpighi Teaching Hospital, 40138 Bologna, Italy.
| | - Giuseppe Giannaccare
- Department of Ophthalmology, University Magna Graecia of Catanzaro, 88100 Catanzaro, Italy.
| | - Piera Versura
- Ophthalmology Unit, Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Alma Mater Studiorum University of Bologna, S.Orsola-Malpighi Teaching Hospital, 40138 Bologna, Italy.
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23
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Bizrah M, Yusuf A, Ahmad S. An update on chemical eye burns. Eye (Lond) 2019; 33:1362-1377. [PMID: 31086244 PMCID: PMC7002428 DOI: 10.1038/s41433-019-0456-5] [Citation(s) in RCA: 67] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 02/06/2019] [Accepted: 04/02/2019] [Indexed: 01/20/2023] Open
Abstract
Ocular chemical injuries vary in severity, with the more severe end of the spectrum having profound visual consequences and medicolegal implications. Grading of ocular injuries is critical for determining acute treatment and visual prognosis. Poor immediate management results in more challenging treatment of acute disease. Similarly, poorly controlled acute disease results in more treatment-resistant chronic ocular disease. Despite several decades of research and public health initiatives, simple and effective interventions such as wearing protective eyewear and immediate irrigation of eyes remain as key challenges. Education and prevention are therefore important public health messages. Hurdles in the acute management of disease include poor evidence-base for commonly used treatments (e.g. based on experimental animal studies), reduced treatment adherence rates and high clinic non-attendance rates. The evolution of treatment strategies, particularly limbal stem cell transplantation, has revolutionised the visual and cosmetic outcomes in chronic phases of disease. It is therefore increasingly important to consider tertiary referral for patients with limbal stem cell failure or vision-limiting corneal scarring.
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Affiliation(s)
- Mukhtar Bizrah
- Imperial College Healthcare NHS Trust, Western Eye Hospital, 153-173 Marylebone Road, London, NW1 5QH, UK.
| | - Ammar Yusuf
- UCL Institute of Ophthalmology, 11-43 Bath Street, London, EC1V 9EL, UK
| | - Sajjad Ahmad
- Moorfields Eye Hospital NHS Foundation Trust, 162 City Road, London, EC1V 2PD, UK
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24
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Jang CH, Lee J, Kim G. Synergistic effect of alginate/BMP-2/Umbilical cord serum-coated on 3D-printed PCL biocomposite for mastoid obliteration model. J IND ENG CHEM 2019. [DOI: 10.1016/j.jiec.2018.12.046] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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25
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Borderie VM, Levy O, Georgeon C, Bouheraoua N. Simultaneous penetrating keratoplasty and amniotic membrane transplantation in eyes with a history of limbal stem cell deficiency. J Fr Ophtalmol 2018; 41:583-591. [PMID: 30166235 DOI: 10.1016/j.jfo.2018.01.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Revised: 12/28/2017] [Accepted: 01/09/2018] [Indexed: 01/05/2023]
Abstract
PURPOSE To describe the outcomes of simultaneous penetrating keratoplasty (PK) and amniotic membrane transplantation (AMT) performed both as a ring-shaped graft and as a temporary patch in eyes with a history of limbal stem cell deficiency (LSCD). METHODS Prospective observational case series including 48 simultaneous PK/AMT procedures (48 patients) in eyes with a history of partial or total LSCD. Patients with total LSCD were first treated with limbal stem cell transplantation. The preoperative indication was graft failure in 58.3% of cases. Most recipients (89.6%) were at high-risk for rejection. RESULTS The mean graft reepithelialization time was 29.2±30.8 days. Graft reepithelialization was achieved in 30 days in 70.8% of cases. No AMT-related adverse events were observed. The mean time from keratoplasty-to-last visit was 84.5±54.5 months. The 3-year graft survival rate was 62.5%. Recurrence of corneal epithelial defects after graft reepithelialization (47.9%) was associated with lower graft survival (P=0.004). In eyes with successful grafts at the last visit, the mean LogMAR visual acuity was 1.90 (20/1575)±5 lines before keratoplasty and 0.89 (20/155)±10 lines at 5 years. A ring of amniotic membrane was visible between the graft stroma and the corneal epithelium on slit-lamp examination and optical coherence tomography in all successful cases. CONCLUSIONS In this series of eyes with a history of LSCD and at high-risk of rejection, simultaneous PK and AMT were associated with satisfactory graft survival and no additional adverse events.
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Affiliation(s)
- V M Borderie
- CIC 1423, Pierre et Marie Curie University Paris 06, Centre Hospitalier National d'Ophtalmologie des XV-XX, Institut de la Vision, 28, rue de Charenton, 75571 Paris, France.
| | - O Levy
- CIC 1423, Pierre et Marie Curie University Paris 06, Centre Hospitalier National d'Ophtalmologie des XV-XX, Institut de la Vision, 28, rue de Charenton, 75571 Paris, France
| | - C Georgeon
- CIC 1423, Pierre et Marie Curie University Paris 06, Centre Hospitalier National d'Ophtalmologie des XV-XX, Institut de la Vision, 28, rue de Charenton, 75571 Paris, France
| | - N Bouheraoua
- CIC 1423, Pierre et Marie Curie University Paris 06, Centre Hospitalier National d'Ophtalmologie des XV-XX, Institut de la Vision, 28, rue de Charenton, 75571 Paris, France
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26
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Buzzi M, Versura P, Grigolo B, Cavallo C, Terzi A, Pellegrini M, Giannaccare G, Randi V, Campos EC. Comparison of growth factor and interleukin content of adult peripheral blood and cord blood serum eye drops for cornea and ocular surface diseases. Transfus Apher Sci 2018; 57:549-555. [PMID: 29929885 DOI: 10.1016/j.transci.2018.06.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 05/31/2018] [Accepted: 06/05/2018] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Various blood-derived products have been proposed for the topical treatment of ocular surface diseases. The aim of the study was to compare the different content of Growth Factors (GFs) and Interleukins (ILs) in peripheral blood (PB-S) and Cord Blood (CB-S) sera. MATERIALS AND METHODS Sera were obtained from 105 healthy adult donors (PB-S) and 107 umbilical/placental veins at the time of delivery (CB-S). The levels of epithelial-GF (EGF), fibroblast-GF (FGF), platelet-derived-GF (PDGF), insulin-GF (IGF), transforming-GF alpha (TGF-α,) and beta 1-2-3 (TGF-β1-β2-β3), vascular endothelial-GF (VEGF), nerve-GF (NGF), Interleukin (IL)-1β,IL-4,IL-6,IL-10, and IL-13 were assessed by Bio-Plex Protein Array System (Bio-Rad Laboratories, CA, USA). The Mann-Whitney test for unpaired data was applied to compare GFs and ILs levels in the two sources. The associations among each GF/IL level and the obstetric data for CB-S and hematological characteristics for PB-S were also investigated. RESULTS The levels of EGF, TGF-α, TGF-β2, FGF, PDGF, VEGF, NGF, IL-1B, IL-4, IL-6, IL-10, and IL-13 were significantly higher in CB-S compared to PB-S. Conversely, the levels of IGF-1, IGF-2, and TGF-β1 were significantly higher in PB-S. The female sex and the weight of the child showed a significant association in predicting EGF and PDGF levels. CONCLUSION A significantly different content in those GFs and ILs was demonstrated in the two blood sources. Since each GF/IL selectively regulates different cellular processes involved in corneal healing, the use of PB-S or CB-S should be chosen on the basis of the cellular mechanism to be promoted in each clinical case.
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Affiliation(s)
- M Buzzi
- Emilia Romagna Cord Blood Bank-Transfusion Service, S.Orsola-Malpighi Teaching Hospital, Bologna, Italy
| | - P Versura
- Ophthalmology Unit, DIMES, Alma Mater Studiorum University of Bologna and S.Orsola-Malpighi Teaching Hospital, Bologna, Italy.
| | - B Grigolo
- RAMSES Laboratory, Department of Research & Innovation, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - C Cavallo
- RAMSES Laboratory, Department of Research & Innovation, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - A Terzi
- Emilia Romagna Cord Blood Bank-Transfusion Service, S.Orsola-Malpighi Teaching Hospital, Bologna, Italy
| | - M Pellegrini
- Ophthalmology Unit, DIMES, Alma Mater Studiorum University of Bologna and S.Orsola-Malpighi Teaching Hospital, Bologna, Italy
| | - G Giannaccare
- Ophthalmology Unit, DIMES, Alma Mater Studiorum University of Bologna and S.Orsola-Malpighi Teaching Hospital, Bologna, Italy
| | - V Randi
- Emilia Romagna Cord Blood Bank-Transfusion Service, S.Orsola-Malpighi Teaching Hospital, Bologna, Italy
| | - E C Campos
- Ophthalmology Unit, DIMES, Alma Mater Studiorum University of Bologna and S.Orsola-Malpighi Teaching Hospital, Bologna, Italy
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Han SB, Liu YC, Mohamed-Noriega K, Mehta JS. Application of Novel Drugs for Corneal Cell Regeneration. J Ophthalmol 2018; 2018:1215868. [PMID: 29854423 PMCID: PMC5954904 DOI: 10.1155/2018/1215868] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Revised: 02/26/2018] [Accepted: 03/27/2018] [Indexed: 11/18/2022] Open
Abstract
Corneal transplantation has been the only treatment method for corneal blindness, which is the major cause of reversible blindness. However, despite the advancement of surgical techniques for corneal transplantation, demand for the surgery can never be met due to a global shortage of donor cornea. The development of bioengineering and pharmaceutical technology provided us with novel drugs and biomaterials that can be used for innovative treatment methods for corneal diseases. In this review, the authors will discuss the efficacy and safety of pharmacologic therapies, such as Rho-kinase (ROCK) inhibitors, blood-derived products, growth factors, and regenerating agent on corneal cell regeneration. The promising results of these agents suggest that these can be viable options for corneal reconstruction and visual rehabilitation.
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Affiliation(s)
- Sang Beom Han
- Department of Ophthalmology, Kangwon National University Hospital, Kangwon National University, Chuncheon, Republic of Korea
| | - Yu-Chi Liu
- Singapore National Eye Centre, Singapore
- Singapore Eye Research Institute, Singapore
- Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Karim Mohamed-Noriega
- Department of Ophthalmology, Faculty of Medicine, University Hospital “Jose E. Gonzalez”, Autonomous University of Nuevo Leon, Monterrey, NL, Mexico
| | - Jodhbir S. Mehta
- Singapore National Eye Centre, Singapore
- Singapore Eye Research Institute, Singapore
- Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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Evaluation of the Role of Umbilical Cord Serum and Autologous Serum Therapy in Reepithelialization After Keratoplasty: A Randomized Controlled Clinical Trial. Eye Contact Lens 2018; 43:324-329. [PMID: 27196995 DOI: 10.1097/icl.0000000000000277] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate the role of umbilical cord serum (UCS) and autologous serum (AS) therapy in reepithelialization of corneal graft after keratoplasty in a randomized controlled trial. METHODS A total of 105 eyes with epithelial defect (ED) after keratoplasty (penetrating keratoplasty-67 and anterior lamellar keratoplasty-38) on the first postoperative day were included in the study. The eyes were randomized into three groups: UCS (n=35), AS (n=35), and artificial tears (AT) (n=35). All patients received standard postoperative medical therapy. The primary outcome measure was time to epithelialization, and secondary outcome measures were best-corrected visual acuity and graft clarity. RESULTS The ED healed completely in 103 eyes. The mean time for complete reepithelialization was 2.5±2.1, 3.1±2.2, and 4.5±1.4 days in UCS, AS, and AT groups, respectively. The mean percentage decrease in the size of the ED was significantly better in the UCS and AS groups as compared with the AT group (P=0.001). The rate of reepithelialization was comparable between the AS and UCS groups (P=0.3). On bivariate analysis, significant correlation was found between the mean size of postoperative ED, grade of the donor cornea (P=0.001), and the presence of preoperative ED (P=0.001). No complications were associated with the use of serum therapy. CONCLUSION Most of the cases of postkeratoplasty corneal ED can be managed with AT only. The serum therapy (AS/UCS) helps in the faster reepithelialization of postkeratoplasty ED as compared with AT and may be considered as a treatment option for early epithelial healing.
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Asena L, Alkayid H, Altınörs DD. Corneal Epithelial Wound Healing and Management Strategies. PLASTIC AND THORACIC SURGERY, ORTHOPEDICS AND OPHTHALMOLOGY 2018. [DOI: 10.1007/15695_2017_65] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
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Regenerative Therapies in Dry Eye Disease: From Growth Factors to Cell Therapy. Int J Mol Sci 2017; 18:ijms18112264. [PMID: 29143779 PMCID: PMC5713234 DOI: 10.3390/ijms18112264] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 10/09/2017] [Accepted: 10/28/2017] [Indexed: 02/07/2023] Open
Abstract
Dry eye syndrome is a complex and insidious pathology with a high level of prevalence among the human population and with a consequently high impact on quality of life and economic cost. Currently, its treatment is symptomatic, mainly based on the control of lubrication and inflammation, with significant limitations. Therefore, the latest research is focused on the development of new biological strategies, with the aim of regenerating affected tissues, or at least restricting the progression of the disease, reducing scar tissue, and maintaining corneal transparency. Therapies range from growth factors and cytokines to the use of different cell sources, in particular mesenchymal stem cells, due to their multipotentiality, trophic, and immunomodulatory properties. We will review the state of the art and the latest advances and results of these promising treatments in this pathology.
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Treatment of acute ocular chemical burns. Surv Ophthalmol 2017; 63:214-235. [PMID: 28935121 DOI: 10.1016/j.survophthal.2017.09.005] [Citation(s) in RCA: 94] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Revised: 09/08/2017] [Accepted: 09/11/2017] [Indexed: 01/15/2023]
Abstract
Ocular chemical burns are an ophthalmic emergency and are responsible for 11.5%-22.1% of ocular injuries. Immediate copious irrigation is universally recommended in acute ocular burns to remove the offending agent and minimize damage. Conventional medical therapy consists of the use of agents that promote epithelialization, minimize inflammation, and prevent cicatricial complications. Biological fluids such as autologous serum, umbilical cord blood serum, platelet-rich plasma, and amniotic membrane suspension are a rich source of growth factors and promote healing when used as adjuncts to conventional therapy. Surgical treatment of acute ocular burns includes the debridement of the necrotic tissue, application of tissue adhesives, tenoplasty, and tectonic keratoplasty. Amniotic membrane transplantation is a novel surgical treatment that is increasingly being used as an adjunct to conventional treatment to promote epithelial healing, minimize pain, and restore visual acuity. Various experimental treatments that aim to promote wound healing and minimize inflammation are being evaluated such as human mesenchymal and adipose stem cells, beta-1,3 glucan, angiotensin-converting enzyme inhibitors, cultivated fibroblasts, zinc desferrioxamine, antifibrinolytic agents, antioxidants, collagen cross-linking, and inhibitors of corneal neovascularization.
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Blood derived eye drops for the treatment of cornea and ocular surface diseases. Transfus Apher Sci 2017; 56:595-604. [DOI: 10.1016/j.transci.2017.07.023] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Revised: 07/26/2017] [Accepted: 07/30/2017] [Indexed: 12/30/2022]
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Rizk M, Aziz J, Shorr R, Allan DS. Cell-Based Therapy Using Umbilical Cord Blood for Novel Indications in Regenerative Therapy and Immune Modulation: An Updated Systematic Scoping Review of the Literature. Biol Blood Marrow Transplant 2017; 23:1607-1613. [PMID: 28602892 DOI: 10.1016/j.bbmt.2017.05.032] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Accepted: 05/30/2017] [Indexed: 11/18/2022]
Abstract
Cell-based therapy using umbilical cord blood (UCB) is being used increasingly in novel applications. To balance heightened public expectations and ensure appropriateness of emerging cell-based treatment choices, regular evidence-based assessment of novel UCB-derived therapies is needed. We performed a systematic search of the literature and identified 57 studies (814 patients) for analysis. Sixteen of these studies (353 patients) included a control group for comparison. The most commonly reported novel indication for therapy was neurologic diseases (25 studies, 476 patients), including studies of cerebral palsy (12 studies, 276 patients). Other indications included diabetes mellitus (9 studies, 149 patients), cardiac and vascular diseases (7 studies, 24 patients), and hepatic diseases (4 studies, 106 patients). Most studies administered total nucleated cells, mononuclear cells, or CD34-selected cells (31 studies, 513 patients), whereas 20 studies described the use of UCB-derived mesenchymal stromal cells. The majority of reports (46 studies, 627 patients) described cellular products obtained from allogeneic sources, whereas 11 studies (187 patients) used autologous products. We identified 3 indications where multiple prospective controlled studies have been published: 4 of 4 studies reported clinical benefit in cerebral palsy, 1 of 3 studies reported benefit for cirrhosis, and 1 of 3 studies reported biochemical response in type 1 diabetes), although heterogeneity among the studies precluded meaningful pooled analysis of results. We anticipate a more clear understanding of the clinical benefit for specific indications once more controlled studies are reported. Patients should continue to be enrolled on registered clinical trials for novel therapies. Blood establishments, transplantation centers, and regulatory bodies need to prepare for greater clinical demand.
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Affiliation(s)
- Mina Rizk
- Regenerative Medicine and Clinical Epidemiology Programs, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Joseph Aziz
- Regenerative Medicine and Clinical Epidemiology Programs, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Risa Shorr
- Library Services, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - David S Allan
- Regenerative Medicine and Clinical Epidemiology Programs, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Blood and Marrow Transplantation, Department of Medicine (Hematology), The Ottawa Hospital, Ottawa, Ontario, Canada; University of Ottawa, Ottawa, Ontario, Canada.
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Efficacy of 2-Month Treatment With Cord Blood Serum Eye Drops in Ocular Surface Disease: An In Vivo Confocal Microscopy Study. Cornea 2017; 36:915-921. [DOI: 10.1097/ico.0000000000001257] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Evidence-Based Update on Ocular Chemical Injuries. CURRENT OPHTHALMOLOGY REPORTS 2017. [DOI: 10.1007/s40135-017-0120-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Baradaran-Rafii A, Eslani M, Haq Z, Shirzadeh E, Huvard MJ, Djalilian AR. Current and Upcoming Therapies for Ocular Surface Chemical Injuries. Ocul Surf 2016; 15:48-64. [PMID: 27650263 DOI: 10.1016/j.jtos.2016.09.002] [Citation(s) in RCA: 104] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Revised: 09/01/2016] [Accepted: 09/02/2016] [Indexed: 01/11/2023]
Abstract
Chemical injuries frequently result in vision loss, disfigurement, and challenging ocular surface complications. Acute interventions are directed at decreasing the extent of the injury, suppressing inflammation, and promoting ocular surface re-epithelialization. Chronically, management involves controlling inflammation along with rehabilitation and reconstruction of the ocular surface. Future therapies aimed at inhibiting neovascularization and promoting ocular surface regeneration should provide more effective treatment options for the management of ocular chemical injuries.
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Affiliation(s)
| | - Medi Eslani
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Zeeshan Haq
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Ebrahim Shirzadeh
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Michael J Huvard
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Ali R Djalilian
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, Illinois, USA.
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Sharma N, Singh D, Maharana PK, Kriplani A, Velpandian T, Pandey RM, Vajpayee RB. Comparison of Amniotic Membrane Transplantation and Umbilical Cord Serum in Acute Ocular Chemical Burns: A Randomized Controlled Trial. Am J Ophthalmol 2016; 168:157-163. [PMID: 27210276 DOI: 10.1016/j.ajo.2016.05.010] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Revised: 05/09/2016] [Accepted: 05/11/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE To compare the efficacy of topical umbilical cord serum drops (UCS) and amniotic membrane transplantation (AMT) in acute ocular chemical burns. DESIGN Randomized controlled trial. METHODS setting: Tertiary care hospital. STUDY POPULATION Forty-five eyes with acute chemical burns of grade III, IV, and V (Dua's classification) presenting within the first week of injury were randomized into 3 groups (15 each). Patients with perforation/impending corneal perforation were excluded from the study. INTERVENTION Groups 1, 2, and 3 received UCS with medical therapy (MT), AMT with MT, and MT alone, respectively. MAIN OUTCOME MEASURE Time to complete epithelialization. RESULTS The mean time to complete epithelialization was 56.7 ± 14.9, 22.0 ± 10.2, and 22.9 ± 10.1 days in MT, AMT, and UCS groups, respectively, with a significant difference between MT and AMT (P = .001) and between MT and UCS (P = .001), but not between UCS and AMT (P = .9). Improvement in pain score was better with UCS than AMT (P value: .012, .002, and .012 on days 7, 14, and 21, respectively). Corneal clarity was better in the UCS group at 21 (P = .008) and 30 days (P = .002), but not at 3 months (P = .9). By month 3, visual outcome, symblepharon, tear film status, and lid abnormalities were comparable between the 3 groups. CONCLUSIONS UCS and AMT, as an adjuvant to standard medical therapy in acute chemical injury, are equally efficacious. UCS has the advantage of faster improvement in corneal clarity, better pain control, and avoidance of surgery in an inflamed eye.
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Conway ED, Stiles J, Townsend WM, Weng HY. Comparison of the in vitro anticollagenase efficacy of homologous serum and plasma on degradation of corneas of cats, dogs, and horses. Am J Vet Res 2016; 77:627-33. [DOI: 10.2460/ajvr.77.6.627] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Bakunowicz-Łazarczyk A, Urban B. Assessment of therapeutic options for reducing alkali burn-induced corneal neovascularization and inflammation. Adv Med Sci 2016; 61:101-12. [PMID: 26651127 DOI: 10.1016/j.advms.2015.10.003] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Revised: 09/25/2015] [Accepted: 10/22/2015] [Indexed: 02/03/2023]
Abstract
This article aims to review and provide the current knowledge of the possibilities of topical treatment of corneal neovascularization due to alkali burns, evidenced by laboratory experiments, in vitro studies, and clinical trials published in the specialized literature. Authors present clinically relevant treatment of corneal neovascularization used in clinical practice, potential antiangiogenic topical therapeutics against corneal neovascularization, which are under investigation, and anti-angiogenic gene-therapy.
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Sosne G, Rimmer D, Kleinman H, Ousler G. Thymosin Beta 4. VITAMINS AND HORMONES 2016; 102:277-306. [DOI: 10.1016/bs.vh.2016.04.012] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Anitua E, Muruzabal F, Tayebba A, Riestra A, Perez VL, Merayo-Lloves J, Orive G. Autologous serum and plasma rich in growth factors in ophthalmology: preclinical and clinical studies. Acta Ophthalmol 2015; 93:e605-14. [PMID: 25832910 DOI: 10.1111/aos.12710] [Citation(s) in RCA: 104] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2014] [Accepted: 02/06/2015] [Indexed: 01/22/2023]
Abstract
The use of blood derivatives represents an alternative therapeutic approach that is gaining interest in regenerative medicine due to its potential to stimulate and accelerate tissue healing. Autologous serum eye drops and platelet-enriched plasma eye drops are being used in the treatment of different ophthalmological disorders. In this review, we summarize the different blood-derived formulations used in the treatment and care of ocular surface disorders. The biological basis and use of autologous serum and plasma rich in growth factors are deeply evaluated as well as the challenges to be addressed in the future in this new generation of blood-derived therapies.
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Affiliation(s)
| | | | - Ali Tayebba
- Microbiology & Immunology; Walter G. Ross Chair in Ophthalmic Research; Ocular Surface Center; Bascom Palmer Eye Institute; University of Miami Miller School of Medicine; Miami Florida USA
| | - Ana Riestra
- Fernandez-Vega Ophthalmological Institute; Eye Research Foundation; University of Oviedo; Oviedo Spain
| | - Victor L. Perez
- Microbiology & Immunology; Walter G. Ross Chair in Ophthalmic Research; Ocular Surface Center; Bascom Palmer Eye Institute; University of Miami Miller School of Medicine; Miami Florida USA
| | - Jesus Merayo-Lloves
- Fernandez-Vega Ophthalmological Institute; Eye Research Foundation; University of Oviedo; Oviedo Spain
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Human Serum Eye Drops in Eye Alterations: An Insight and a Critical Analysis. J Ophthalmol 2015; 2015:396410. [PMID: 26504592 PMCID: PMC4609447 DOI: 10.1155/2015/396410] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2015] [Accepted: 07/07/2015] [Indexed: 12/13/2022] Open
Abstract
Human serum contains a physiological plethora of bioactive elements naturally released by activated platelets which might have a significant effect on the regeneration of corneal layers by stimulating the cell growth. This mechanism supported the use of human serum eye drops in some ocular diseases associated with dystrophic changes and alterations of the tear film, such as persistent corneal epithelial defects and dry eye syndrome. We focused our effort on potential benefits and limitations of the use of human serum eye drops when conventional therapies failed. We reviewed the recent literature by reporting published studies from 2010 to 2014. Despite the limited evaluated study populations, most of the clinical studies have confirmed that serum eye drop therapy is effective in corneal healing by reducing ocular symptom, particularly during the short-term follow-up. In addition, three recent published studies have shown the efficacy of the serum eye drop therapy in comparison to traditional ones in intractable patients. Besides, reported ongoing clinical studies confirmed the open debate regarding the use of biologic tools for cornea regeneration. Results from these studies might open novel challenges and perspectives in the therapy of such refractory patients.
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Soni NG, Jeng BH. Blood-derived topical therapy for ocular surface diseases. Br J Ophthalmol 2015; 100:22-7. [DOI: 10.1136/bjophthalmol-2015-306842] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Accepted: 06/21/2015] [Indexed: 11/03/2022]
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Targeting growth factor supply in keratopathy treatment: comparison between maternal peripheral blood and cord blood as sources for the preparation of topical eye drops. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2015; 14:145-51. [PMID: 26192781 DOI: 10.2450/2015.0020-15] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Accepted: 03/05/2015] [Indexed: 11/21/2022]
Abstract
BACKGROUND Epitheliotrophic growth factors (GF) can be supplied topically to patients with severe keratopathy through a variety of blood-derived products. We compared GF content in adult peripheral blood serum (PB-S) and cord blood serum (CB-S) as potential sources of GF. To limit inter-individual variability the assessment was performed in maternal-child pairs at the time of delivery. MATERIAL AND METHODS The amounts of epidermal GF (EGF), insulin-like GF (IGF), transforming GF-beta (TGF-β), vascular endothelial GF (VEGF) in CB units collected from the umbilical vein and PB from mothers (each group n=30) were estimated by enzyme-linked immunosorbent assays. Obstetric characteristics and haematological data were recorded from the archives of the Emilia Romagna Cord Blood Bank. Statistical evaluations were performed by Wilcoxon's test and correlations between variables were determined using Spearman's (ρ) coefficient; p-values <0.05 were considered statistically significant. RESULTS EGF, TGF-β and VEGF levels were significantly higher in CB-S than in PB-S (median 1,254.4 vs 646.0 pg/mL, 51.3 vs 38.4 μg/mL and 686.8 vs 30 pg/mL, respectively; all p<0.0001) whereas IGF content was significantly higher in PB-S than in CB-S (159.9 vs 53.5 pg/mL, respectively; p<0.0001). In CB-S, the CD34(+) cell concentration appeared to be related to EGF, IGF and TGF-β levels whereas white blood cell count appeared to be related to EGF and TGF-β levels. VEGF levels showed no relation to the haematological parameters considered. Platelet counts were not related to GF level in either CB or PB. DISCUSSION The GF content in the two blood sources was different, with CB containing larger amounts. Each GF selectively regulates cellular processes involved in corneal healing, so the use of PB or CB should be targeted to supply specific GF on the basis of the type and severity of the keratopathy.
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Nugent RB, Lee GA. Ophthalmic use of blood-derived products. Surv Ophthalmol 2015; 60:406-34. [PMID: 26077627 DOI: 10.1016/j.survophthal.2015.03.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Revised: 03/23/2015] [Accepted: 03/25/2015] [Indexed: 12/23/2022]
Abstract
There is a wide spectrum of blood-derived products that have been used in many different medical and surgical specialties with success. Blood-derived products for clinical use can be extracted from autologous or allogeneic specimens of blood, but recombinant products are also commonly used. A number of blood derivatives have been used for a wide range of ocular conditions, from the ocular surface to the retina. With stringent preparation guidelines, the potential risk of transmission of blood-borne diseases is minimized. We review blood-derived products and how they are improving the management of ocular disease.
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Affiliation(s)
| | - Graham A Lee
- City Eye Centre, Brisbane, Queensland, Australia; Department of Ophthalmology, University of Queensland, Brisbane, Queensland, Australia.
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Wirostko B, Rafii M, Sullivan DA, Morelli J, Ding J. Novel Therapy to Treat Corneal Epithelial Defects: A Hypothesis with Growth Hormone. Ocul Surf 2015; 13:204-212.e1. [PMID: 26045234 DOI: 10.1016/j.jtos.2014.12.005] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Revised: 12/01/2014] [Accepted: 12/01/2014] [Indexed: 10/23/2022]
Abstract
Impaired corneal wound healing that occurs with ocular surface disease, trauma, systemic disease, or surgical intervention can lead to persistent corneal epithelial defects (PCED), which result in corneal scarring, ulceration, opacification, corneal neovascularization, and, ultimately, visual compromise and vision loss. The current standard of care can include lubricants, ointments, bandage lenses, amniotic membranes, autologous serum eye drops, and corneal transplants. Various inherent problems exist with application and administration of these treatments, which often may not result in a completely healed surface. A topically applicable compound capable of promoting corneal epithelial cell proliferation and/or migration would be ideal to accelerate healing. We hypothesize that human growth hormone (HGH) is such a compound. In a recent study, HGH was shown to activate signal transducer and activators of transcription-5 (STAT5) signaling and promote corneal wound healing by enhancing corneal epithelial migration in a co-culture system of corneal epithelial cells and fibroblasts. These effects require an intact communication between corneal epithelia and fibroblasts. Further, HGH promotes corneal wound healing in a rabbit debridement model, thus demonstrating the effectiveness of HGH in vivo as well. In conclusion, HGH may represent an exciting and effective topical therapeutic to promote corneal wound healing.
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Affiliation(s)
- Barbara Wirostko
- Jade Therapeutics, Inc., University of Utah Research Park, Salt Lake City, UT; Moran Eye Center, University of Utah, Salt Lake City, UT, USA
| | - MaryJane Rafii
- Jade Therapeutics, Inc., University of Utah Research Park, Salt Lake City, UT
| | - David A Sullivan
- Schepens Eye Research Institute, Massachusetts Eye & Ear Infirmary, and Department of Ophthalmology, Harvard Medical School, Boston, MA
| | - Julia Morelli
- Jade Therapeutics, Inc., University of Utah Research Park, Salt Lake City, UT
| | - Juan Ding
- Schepens Eye Research Institute, Massachusetts Eye & Ear Infirmary, and Department of Ophthalmology, Harvard Medical School, Boston, MA.
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48
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Yoon KC. Use of umbilical cord serum in ophthalmology. Chonnam Med J 2014; 50:82-5. [PMID: 25568842 PMCID: PMC4276795 DOI: 10.4068/cmj.2014.50.3.82] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Revised: 11/19/2014] [Accepted: 11/20/2014] [Indexed: 12/27/2022] Open
Abstract
Among blood preparations, serum has been topically used in the management of various ocular diseases in ophthalmology. Like peripheral blood serum, umbilical cord blood serum contains a high concentration of essential tear components, growth factors, neurotrophic factors, vitamin A, fibronectin, prealbumin, and oil. Umbilical cord serum can provide basic nutrients for epithelial renewal and can facilitate the proliferation, migration, and differentiation of the ocular surface epithelium. Eye drops made from umbilical cord serum have been applied to treat various ocular surface diseases, including severe dry eye with or without Sjögren's syndrome, ocular complications in graft-versus-host disease, persistent epithelial defects, neurotrophic keratopathy, recurrent corneal erosions, ocular chemical burn, and surface problems after corneal refractive surgery. Because mesenchymal stem cells from umbilical cord blood can be used to regenerate corneal tissue and retinal nerve cells, umbilical cord serum might be applied for tissue engineering and regenerative medicine in the future.
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Affiliation(s)
- Kyung Chul Yoon
- Department of Ophthalmology and Research Institute of Medical Sciences, Chonnam National University Medical School and Hospital, Gwangju, Korea
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49
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Jang YS, Jang CH, Cho YB, Kim M, Kim GH. Tracheal regeneration using polycaprolactone/collagen-nanofiber coated with umbilical cord serum after partial resection. Int J Pediatr Otorhinolaryngol 2014; 78:2237-43. [PMID: 25465447 DOI: 10.1016/j.ijporl.2014.10.022] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2014] [Revised: 10/16/2014] [Accepted: 10/19/2014] [Indexed: 01/10/2023]
Abstract
OBJECTIVES We developed a PCL/collagen nanofiber (PC-NF) scaffold/human umbilical cord serum (hUCS) to facilitate epithelial cell migration after implantation in order to promote regeneration of the tracheal epithelium without having a cell source. MATERIALS AND METHODS The isolated chodrocytes from bovine auricle were used to evaluate the cellular activities cultured in the scaffolds with or without hUCS. A 4mm wide/8mm long, full thickness anterior defect was created in the tracheal rings of rats. An anterior tracheal defect was implanted with a PCL/collagen-NF scaffold (PC-NF) in the control group (n=7), and a PCL/collagen-NF coated with hUCS scaffold (PCU-NF) was implanted in the experimental group (n=7). All rats were sacrificed at 7 weeks postoperatively. The cervical trachea, including the implant site, was resected, and gross and histological examinations were performed. RESULTS The viable cells of PCU-NF scaffold were significantly higher than that of the PCL and PC-NF scaffold at 7 days; the result can be due to the exceptional biological growth factors of the hUCS. The steromicroscopic finding showed that the artificial trachea was covered by perichondrium without dislocation or granulation at 7 weeks postsurgery. When compared to the control group, the PCU-NF group showed a completely regenerated tracheal wall with luminal epilthelization. CONCLUSION As a results of this study, the PCU-NF scaffold promoted cartilage and epithelial regeneration over the artificial trachea without graft inflammation. Partial tracheal reconstruction using PCU-NF scaffold is suitable for enhancing cartilage and epithelial regeneration.
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Affiliation(s)
| | - Chul Ho Jang
- Department of Otolaryngology, Chonnam National University Medical School, Gwangju, South Korea.
| | - Yong Beom Cho
- Department of Otolaryngology, Chonnam National University Medical School, Gwangju, South Korea
| | - Minseong Kim
- Department of Bio-Mechatronics, Sungkyunkwan University (SKKU), Suwon, South Korea
| | - Geun Hyung Kim
- Department of Bio-Mechatronics, Sungkyunkwan University (SKKU), Suwon, South Korea.
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50
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Sharma N, Lathi SS, Sehra SV, Agarwal T, Sinha R, Titiyal JS, Velpandian T, Tandon R, Vajpayee RB. Comparison of umbilical cord serum and amniotic membrane transplantation in acute ocular chemical burns. Br J Ophthalmol 2014; 99:669-73. [PMID: 25370084 DOI: 10.1136/bjophthalmol-2014-305760] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Accepted: 10/19/2014] [Indexed: 11/04/2022]
Abstract
PURPOSE To compare the efficacy of umbilical cord serum (UCS) with amniotic membrane transplantation (AMT) in cases of acute ocular chemical burns. METHODS In a retrospective, interventional, comparative case series, 55 eyes with grades III, IV and V chemical burns (Dua's classification) who presented within 3 weeks of injury were evaluated. Patients were treated with conventional medical (CM group, 20 eyes) management alone or combined with either UCS (UCS group, 17 eyes) or AMT (AMT group, 18 eyes). The parameters evaluated were time to epithelialisation, epithelial defect diameter, epithelial defect area, corneal clarity, tear break-up time (TBUT), Schirmer test and best-corrected vision. RESULTS UCS and AMT groups showed early epithelialisation as compared with the CM group (Kaplan-Meier analysis=0.01). Mean time for healing of epithelial defect was 57.7±29.3, 27.4±19.0, 41.1±28.9 days in the CM, UCS and AMT groups, respectively (p=0.02). Mean TBUT at the last follow-up was 8.6±0.7, 10.3±1.1, 9.4±1.2 s in the CM, UCS and AMT groups, respectively (p=0.02). The mean Schirmer value at the last follow-up was 13.7±1.0, 16.9±3.0 and 13.2±1.5 mm in the CM, UCS and AMT groups, respectively (p=0.01). The visual outcomes and the occurrence of corneal vascularisation, symblepheron, ectropion and entropion were comparable in between the groups. CONCLUSIONS Our study suggests that the UCS therapy may be a better alternative to AMT in acute moderate to severe (grades III, IV and V) ocular chemical burns, as it avoids surgical manoeuvre in already inflamed eyes.
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Affiliation(s)
- Namrata Sharma
- Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Shiv Shankar Lathi
- Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Sri Vatsa Sehra
- Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Tushar Agarwal
- Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Rajesh Sinha
- Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Jeewan S Titiyal
- Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Thirumurthy Velpandian
- Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Radhika Tandon
- Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Rasik B Vajpayee
- Centre for Eye Research Australia, University of Melbourne, Melbourne, Victoria, Australia Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia
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