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Kahaly GJ, Dolman PJ, Wolf J, Giers BC, Elflein HM, Jain AP, Srinivasan A, Hadjiiski L, Jordan D, Bradley EA, Stan MN, Eckstein A, Pitz S, Vorländer C, Wester ST, Nguyen J, Tucker N, Sales-Sanz M, Feldon SE, Nelson CC, Hardy I, Abia-Serrano M, Tedeschi P, Janes JM, Xu J, Vue P, Macias WL, Douglas RS. Proof-of-concept and Randomized, Placebo-controlled Trials of an FcRn Inhibitor, Batoclimab, for Thyroid Eye Disease. J Clin Endocrinol Metab 2023; 108:3122-3134. [PMID: 37390454 PMCID: PMC10655547 DOI: 10.1210/clinem/dgad381] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 06/21/2023] [Accepted: 06/26/2023] [Indexed: 07/02/2023]
Abstract
CONTEXT Inhibition of the neonatal fragment crystallizable receptor (FcRn) reduces pathogenic thyrotropin receptor antibodies (TSH-R-Ab) that drive pathology in thyroid eye disease (TED). OBJECTIVE We report the first clinical studies of an FcRn inhibitor, batoclimab, in TED. DESIGN Proof-of-concept (POC) and randomized, double-blind placebo-controlled trials. SETTING Multicenter. PARTICIPANTS Patients with moderate-to-severe, active TED. INTERVENTION In the POC trial, patients received weekly subcutaneous injections of batoclimab 680 mg for 2 weeks, followed by 340 mg for 4 weeks. In the double-blind trial, patients were randomized 2:2:1:2 to weekly batoclimab (680 mg, 340 mg, 255 mg) or placebo for 12 weeks. MAIN OUTCOME Change from baseline in serum anti-TSH-R-Ab and total IgG (POC); 12-week proptosis response (randomized trial). RESULTS The randomized trial was terminated because of an unanticipated increase in serum cholesterol; therefore, data from 65 of the planned 77 patients were analyzed. Both trials showed marked decreases in pathogenic anti-TSH-R-Ab and total IgG serum levels (P < .001) with batoclimab. In the randomized trial, there was no statistically significant difference with batoclimab vs placebo in proptosis response at 12 weeks, although significant differences were observed at several earlier timepoints. In addition, orbital muscle volume decreased (P < .03) at 12 weeks, whereas quality of life (appearance subscale) improved (P < .03) at 19 weeks in the 680-mg group. Batoclimab was generally well tolerated, with albumin reductions and increases in lipids that reversed upon discontinuation. CONCLUSIONS These results provide insight into the efficacy and safety of batoclimab and support its further investigation as a potential therapy for TED.
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Affiliation(s)
- George J Kahaly
- Department of Medicine I, Johannes Gutenberg University (JGU) Medical Center, 55131 Mainz, Germany
| | - Peter J Dolman
- Department of Ophthalmology and Visual Sciences, Vancouver General Hospital, University of British Columbia, Vancouver, BC V5Z 3N9, Canada
| | - Jan Wolf
- Department of Medicine I, Johannes Gutenberg University (JGU) Medical Center, 55131 Mainz, Germany
| | - Bert C Giers
- Department of Ophthalmology, Johannes Gutenberg University (JGU) Medical Center, 55131 Mainz, Germany
| | - Heike M Elflein
- Department of Ophthalmology, Johannes Gutenberg University (JGU) Medical Center, 55131 Mainz, Germany
| | - Amy P Jain
- Department of Ophthalmology, Cedars Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Ashok Srinivasan
- Department of Radiology, University of Michigan, Ann Arbor, MI 48109, USA
| | - Lubomir Hadjiiski
- Department of Radiology, University of Michigan, Ann Arbor, MI 48109, USA
| | - David Jordan
- Department of Ophthalmology, University of Ottawa Eye Institute, Ottawa, ON K1H 8L6, Canada
| | | | - Marius N Stan
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN 55905, USA
| | - Anja Eckstein
- Department of Ophthalmology, University Hospital Essen, 45147 Essen, Germany
| | - Susanne Pitz
- Department of Ophthalmology, Orbitazentrum, Bürgerhospital Frankfurt, 60318 Frankfurt, Germany
| | - Christian Vorländer
- Department of Endocrine Surgery, Bürgerhospital Frankfurt, 60318 Frankfurt, Germany
| | - Sara T Wester
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - John Nguyen
- Department of Ophthalmology and Visual Sciences, West Virginia University, Morgantown, WV 26506, USA
| | - Nancy Tucker
- Toronto Retina Institute, Toronto, ON M5T 3L9, Canada
| | - Marco Sales-Sanz
- Department of Ophthalmology, University Hospital Ramon y Cajal, 28034 Madrid, Spain
| | - Steven E Feldon
- Department of Ophthalmology, Flaum Eye Institute, University of Rochester, Rochester, NY 14642, USA
| | - Christine C Nelson
- W.K. Kellogg Eye Center, University of Michigan, Ann Arbor, MI 48105, USA
| | - Isabelle Hardy
- Department of Ophthalmology, University of Montreal, Montreal, QC H3T 1J4, Canada
| | | | | | | | - Jing Xu
- Immunovant, Inc., New York, NY 10018, USA
| | - Peter Vue
- Immunovant, Inc., New York, NY 10018, USA
| | | | - Raymond S Douglas
- Department of Ophthalmology, Cedars Sinai Medical Center, Los Angeles, CA 90048, USA
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Riedl JC, Pfeffer N, Giers BC, Schuster AK, Vossmerbaeumer U. Postoperative results after iris reconstruction with an Artificialiris ® implant with consideration of the cause of the iris defects. Eur J Ophthalmol 2023; 33:1946-1951. [PMID: 36788137 DOI: 10.1177/11206721231156204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
PURPOSE To test the hypothesis that severely damaged eyes are more likely to experience postoperative complications after an ArtificialIris® (AI) implantation than other iris defects. METHODS Patients after iris reconstruction with an AI were included in this consecutive case series of the Department of Ophthalmology, University of Mainz, Germany. Best-corrected visual acuity (BCVA), objective refraction (KR 8900 Topcon, Tokyo, Japan) and Scheimpflug imaging of the anterior segment with Pentacam® (Oculus, Wetzlar, Germany)and postoperative complications were evaluated. RESULTS Thirty-two eyes of 32 patients after AI implantation were included, separated in partial or total aniridia in a closed globe (group 1, n = 16) and after perforating globe injury (group 2, n = 16). Two or more previous surgeries in the corresponding eye were found in two patients (12.5%) in group 1 and eleven patients (69%) in group 2 (p = 0.001). The time span between initial trauma or iris defect and AI implantation was not significantly related to the occurrence and severity of postoperative complications (p = 0.89). Postoperative complications were classified into mild and severe and showed no differences between group 1 and group 2 (mild: 1 vs. 0; p = 0.52; severe: 5 vs. 6 p = 0.8). CONCLUSION AI implantation is a treatment option for various iris defects. An individual, case-based decision should be made with strict indication also considering other possible methods for pupil reconstruction. The postoperative outcome is not affected by the time point of AI implantation. So, an implantation is already possible as early as six weeks after the previous trauma.
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Affiliation(s)
- Jana C Riedl
- Department of Ophthalmology, University Medical Center, Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Nora Pfeffer
- Department of Ophthalmology, University Medical Center, Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Bert C Giers
- Department of Ophthalmology, University Medical Center, Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Alexander K Schuster
- Department of Ophthalmology, University Medical Center, Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Urs Vossmerbaeumer
- Department of Ophthalmology, University Medical Center, Johannes Gutenberg-University Mainz, Mainz, Germany
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Zimmermann M, Giers BC, Beck A, Bell K, Zimmermann H, Hechtner M, Hoffmann EM, Pfeiffer N, Lorenz K. Short- and long-term agreement and reproducibility of 48-hours intraocular pressure measurements in glaucoma patients. BMC Ophthalmol 2021; 21:262. [PMID: 34154547 PMCID: PMC8218517 DOI: 10.1186/s12886-021-02003-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 05/19/2021] [Indexed: 11/22/2022] Open
Abstract
Background Glaucomatous eyes often show strong intraocular pressure (IOP) fluctuations and individual measurements at different time points are necessary for personalized therapy. To survey IOP variations 48-hours diurnal and nocturnal IOP measurements were performed on two consecutive days. Aims of this study were to investigate the short-term repeatability of 48-hours measurements within one patient’s IOP profile and long-term repeatability between two separate IOP profiles of the same patient. Methods A retrospective cohort study was performed evaluating data of 90 glaucoma patients in a German university medical center between 2006 and 2013. All patients underwent two separate diurnal IOP profiles of 48 h. IOP was measured at 8 am, 2 pm, 6 pm, 9 pm using Goldmann applanation tonometry and at 12 midnight using Perkins tonometry in supine position on two consecutive days. Intraclass correlation coefficients (ICC) were calculated to evaluate agreement for the same time points (each time point agreement) and for consecutive measurements within the IOP profiles (between time point agreement). ICC ≤ 0.4 was defined as poor agreement, 0.4–0.75 as moderate and ≥ 0.75 as excellent. Differences between time points were investigated by Bland Altman plots. Results Each time point measurements of profile 1 showed moderate to excellent agreement (ICCs 0.62–0.93). There was a moderate to excellent agreement for measurements between time points of profile 1 (ICCs day one 0.57–0.86, day two 0.71–0.90). Profile 2 was performed at a median interval of 12.0 months (quartiles 11.0 to 21.0). Each time point agreements within profile 2 showed ICCs from 0.23 to 0.81. It showed moderate to excellent agreement for changes between time points (ICCs 0.53–0.94). Day two demonstrated ICCs from 0.74 to 0.88. Long term IOP repeatability (over both pressure profiles) showed moderate to good agreement (ICCs 0.39–0.67). Conclusions Short and long-term agreement of IOP measurements evaluated by diurnal IOP profiles is moderate to good. Due to mostly moderate agreements, which we believe represent IOP fluctuations, we conclude that it is necessary to perform 48-hours IOP profiles to gain a better overview of the individual IOP fluctuations.
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Affiliation(s)
- Marion Zimmermann
- Department of Ophthalmology, Augenklinik und Poliklinik, University Medical Center of the Johannes Gutenberg-University, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Bert C Giers
- Department of Ophthalmology, Augenklinik und Poliklinik, University Medical Center of the Johannes Gutenberg-University, Langenbeckstraße 1, 55131, Mainz, Germany.
| | - Anna Beck
- Department of Ophthalmology, Augenklinik und Poliklinik, University Medical Center of the Johannes Gutenberg-University, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Katharina Bell
- Department of Ophthalmology, Augenklinik und Poliklinik, University Medical Center of the Johannes Gutenberg-University, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Herwig Zimmermann
- Department of Ophthalmology, Augenklinik und Poliklinik, University Medical Center of the Johannes Gutenberg-University, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Marlene Hechtner
- University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
| | - Esther M Hoffmann
- Department of Ophthalmology, Augenklinik und Poliklinik, University Medical Center of the Johannes Gutenberg-University, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Norbert Pfeiffer
- Department of Ophthalmology, Augenklinik und Poliklinik, University Medical Center of the Johannes Gutenberg-University, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Katrin Lorenz
- Department of Ophthalmology, Augenklinik und Poliklinik, University Medical Center of the Johannes Gutenberg-University, Langenbeckstraße 1, 55131, Mainz, Germany
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Giers BC, Tandogan T, Auffarth GU, Choi CY, Auerbach FN, Sel S, Mayer C, Khoramnia R. Hydrophilic intraocular lens opacification after posterior lamellar keratoplasty - a material analysis with special reference to optical quality assessment. BMC Ophthalmol 2017; 17:150. [PMID: 28830376 PMCID: PMC5568293 DOI: 10.1186/s12886-017-0546-8] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 08/14/2017] [Indexed: 11/24/2022] Open
Abstract
Background Laboratory analysis and optical quality assessment of explanted hydrophilic intraocular lenses (IOLs) with clinically significant opacification after posterior lamellar keratoplasty (DMEK and DSAEK). Methods Thirteen opacified IOLs after posterior lamellar keratoplasty, 8 after descemet stripping automated endothelial keratoplasty (DSAEK), 3 after descemet membrane endothelial keratoplasty (DMEK) and 2 after both DSAEK and DMEK were analysed in our laboratory. Analyses included optical bench assessment for optical quality, light microscopy, scanning electron microscopy (SEM) and energy dispersive X-Ray spectroscopy (EDS). Results In all IOLs the opacification was caused by a thin layer of calciumphosphate that had accumulated underneath the anterior optical surface of the IOLs in the area spared by the pupil/anterior capsulorhexis. The calcifications lead to a significant deterioration of the modulation transfer function across all spatial frequencies of the affected IOLs. Conclusions The instillation of exogenous material such as air or gas into the anterior chamber increases the risk for opacification of hydrophilic IOLs irrespective of the manufacturer or the exact composition of the hydrophilic lens material. It is recommended to avoid the use of hydrophilic acrylic IOLs in patients with endothelial dystrophy that will likely require procedures involving the intracameral instillation of air or gas, such as DMEK or DS(A)EK.
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Affiliation(s)
- Bert C Giers
- International Vision Correction Research Centre and the David J. Apple International Laboratory for Ocular Pathology, Department of Ophthalmology, University of Heidelberg, INF 400, 69120, Heidelberg, Germany
| | - Tamer Tandogan
- International Vision Correction Research Centre and the David J. Apple International Laboratory for Ocular Pathology, Department of Ophthalmology, University of Heidelberg, INF 400, 69120, Heidelberg, Germany
| | - Gerd U Auffarth
- International Vision Correction Research Centre and the David J. Apple International Laboratory for Ocular Pathology, Department of Ophthalmology, University of Heidelberg, INF 400, 69120, Heidelberg, Germany
| | - Chul Y Choi
- Department of Ophthalmology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Florian N Auerbach
- International Vision Correction Research Centre and the David J. Apple International Laboratory for Ocular Pathology, Department of Ophthalmology, University of Heidelberg, INF 400, 69120, Heidelberg, Germany
| | - Saadettin Sel
- International Vision Correction Research Centre and the David J. Apple International Laboratory for Ocular Pathology, Department of Ophthalmology, University of Heidelberg, INF 400, 69120, Heidelberg, Germany
| | - Christian Mayer
- Eye Clinic, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany
| | - Ramin Khoramnia
- International Vision Correction Research Centre and the David J. Apple International Laboratory for Ocular Pathology, Department of Ophthalmology, University of Heidelberg, INF 400, 69120, Heidelberg, Germany.
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Giers BC, Klein D, Mendes-Madeira A, Isiegas C, Lorenz B, Haverkamp S, Stieger K. Outer Plexiform Layer Structures Are Not Altered Following AAV-Mediated Gene Transfer in Healthy Rat Retina. Front Neurol 2017; 8:59. [PMID: 28280483 PMCID: PMC5322291 DOI: 10.3389/fneur.2017.00059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Accepted: 02/09/2017] [Indexed: 01/18/2023] Open
Abstract
Ocular gene therapy approaches have been developed for a variety of different diseases. In particular, clinical gene therapy trials for RPE65 mutations, X-linked retinoschisis, and choroideremia have been conducted at different centers in recent years, showing that adeno-associated virus (AAV)-mediated gene therapy is safe, but limitations exist as to the therapeutic benefit and long-term duration of the treatment. The technique of vector delivery to retinal cells relies on subretinal injection of the vector solution, causing a transient retinal detachment. Although retinal detachments are known to cause remodeling of retinal neuronal structures as well as significant cell loss, the possible effects of this short-term therapeutic retinal detachment on retinal structure and circuitry have not yet been studied in detail. In this study, retinal morphology and apoptotic status were examined in healthy rat retinas following AAV-mediated gene transfer via subretinal injection with AAV2/5.CMV.d2GFP or sham injection with fluorescein. Outer plexiform layer (OPL) morphology was assessed by immunohistochemical labeling, laser scanning confocal microscopy, and electron microscopy. The number of synaptic contacts in the OPL was quantified after labeling with structural markers. To assess the apoptotic status, inflammatory and pro-apoptotic markers were tested and TUNEL assay for the detection of apoptotic nuclei was performed. Pre- and postsynaptic structures in the OPL, such as synaptic ribbons or horizontal and bipolar cell processes, did not differ in size or shape in injected versus non-injected areas and control retinas. Absolute numbers of synaptic ribbons were not altered. No signs of relevant gliosis were detected. TUNEL labeling of retinal cells did not vary between injected and non-injected areas, and apoptosis-inducing factor was not delocalized to the nucleus in transduced areas. The neuronal circuits in the OPL of healthy rat retinas undergoing AAV-mediated gene transfer were not altered by the temporary retinal detachment caused by subretinal injection, the presence of viral particles, or the expression of green fluorescent protein as a transgene. This observation likely requires further investigations in the dog model for RPE65 deficiency in order to determine the impact of RPE65 transgene expression on diseased retinas in animals and men.
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Affiliation(s)
- Bert C Giers
- Department of Ophthalmology, Justus-Liebig-University Giessen , Giessen , Germany
| | - Daniela Klein
- Department of Ophthalmology, Justus-Liebig-University Giessen , Giessen , Germany
| | | | | | - Birgit Lorenz
- Department of Ophthalmology, Justus-Liebig-University Giessen , Giessen , Germany
| | - Silke Haverkamp
- Max-Planck-Institute for Brain Research, Frankfurt, Germany; Institute of Cellular and Molecular Anatomy, Goethe-University Frankfurt, Frankfurt, Germany
| | - Knut Stieger
- Department of Ophthalmology, Justus-Liebig-University Giessen , Giessen , Germany
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