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Torkashvand A, Izadian A, Hajrasouliha A. Advances in ophthalmic therapeutic delivery: A comprehensive overview of present and future directions. Surv Ophthalmol 2024; 69:967-983. [PMID: 38986847 PMCID: PMC11392635 DOI: 10.1016/j.survophthal.2024.07.002] [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: 12/10/2023] [Revised: 06/26/2024] [Accepted: 07/01/2024] [Indexed: 07/12/2024]
Abstract
Ophthalmic treatment demands precision and consistency in delivering therapeutic agents over extended periods to address many conditions, from common eye disorders to complex diseases. This diversity necessitates a range of delivery strategies, each tailored to specific needs. We delve into various delivery cargos that are pivotal in ophthalmic care. These cargos encompass biodegradable implants that gradually release medication, nonbiodegradable implants for sustained drug delivery, refillable tools allowing flexibility in treatment, hydrogels capable of retaining substances while maintaining ocular comfort, and advanced nanotechnology devices that precisely target eye tissues. Within each cargo category, we explore cutting-edge research-level approaches and FDA-approved methods, providing a thorough overview of the current state of ophthalmic drug delivery. In particular, our focus on nanotechnology reveals the promising potential for gene delivery, cell therapy administration, and the implantation of active devices directly into the retina. These advancements hold the key to more effective, personalized, and minimally- invasive ophthalmic treatments, revolutionizing the field of eye care.
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Affiliation(s)
- Ali Torkashvand
- Department of Ophthalmology, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Afshin Izadian
- Electrical and Computer Engineering Technology, Purdue University, West Lafayette, IN, United States
| | - Amir Hajrasouliha
- Department of Ophthalmology, Indiana University School of Medicine, Indianapolis, IN, United States.
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Liu X, Huang K, Zhang F, Huang G, Wang L, Wu G, Ren H, Yang G, Lin Z. Multifunctional nano-in-micro delivery systems for targeted therapy in fundus neovascularization diseases. J Nanobiotechnology 2024; 22:354. [PMID: 38902775 PMCID: PMC11191225 DOI: 10.1186/s12951-024-02614-1] [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: 03/19/2024] [Accepted: 06/03/2024] [Indexed: 06/22/2024] Open
Abstract
Fundus neovascularization diseases are a series of blinding eye diseases that seriously impair vision worldwide. Currently, the means of treating these diseases in clinical practice are continuously evolving and have rapidly revolutionized treatment opinions. However, key issues such as inadequate treatment effectiveness, high rates of recurrence, and poor patient compliance still need to be urgently addressed. Multifunctional nanomedicine can specifically respond to both endogenous and exogenous microenvironments, effectively deliver drugs to specific targets and participate in activities such as biological imaging and the detection of small molecules. Nano-in-micro (NIM) delivery systems such as metal, metal oxide and up-conversion nanoparticles (NPs), quantum dots, and carbon materials, have shown certain advantages in overcoming the presence of physiological barriers within the eyeball and are widely used in the treatment of ophthalmic diseases. Few studies, however, have evaluated the efficacy of NIM delivery systems in treating fundus neovascular diseases (FNDs). The present study describes the main clinical treatment strategies and the adverse events associated with the treatment of FNDs with NIM delivery systems and summarizes the anatomical obstacles that must be overcome. In this review, we wish to highlight the principle of intraocular microenvironment normalization, aiming to provide a more rational approach for designing new NIM delivery systems to treat specific FNDs.
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Affiliation(s)
- Xin Liu
- Department of Ophthalmology, The Third Affiliated Hospital of Chongqing Medical University, Chongqing, 401120, China
| | - Keke Huang
- Department of Ophthalmology, The Third People's Hospital of Chengdu, The Affiliated Hospital of Southwest Jiaotong University, Chengdu, 610031, China
| | - Fuxiao Zhang
- Department of Ophthalmology, The Second People's Hospital of Chengdu, The Affiliated Hospital of Chengdu Medical College, Chengdu, 610031, China
| | - Ge Huang
- Department of Ophthalmology, The Second People's Hospital of Chengdu, The Affiliated Hospital of Chengdu Medical College, Chengdu, 610031, China
| | - Lu Wang
- Department of Ophthalmology, The Second People's Hospital of Chengdu, The Affiliated Hospital of Chengdu Medical College, Chengdu, 610031, China
| | - Guiyu Wu
- Department of Ophthalmology, The Second People's Hospital of Chengdu, The Affiliated Hospital of Chengdu Medical College, Chengdu, 610031, China
| | - Hui Ren
- Department of Ophthalmology, The Second People's Hospital of Chengdu, The Affiliated Hospital of Chengdu Medical College, Chengdu, 610031, China.
| | - Guang Yang
- Department of Ophthalmology, The Second People's Hospital of Chengdu, The Affiliated Hospital of Chengdu Medical College, Chengdu, 610031, China.
| | - Zhiqing Lin
- Department of Ophthalmology, The Second People's Hospital of Chengdu, The Affiliated Hospital of Chengdu Medical College, Chengdu, 610031, China.
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Zhang C, Wang J, Wu H, Fan W, Li S, Wei D, Song Z, Tao Y. Hydrogel-Based Therapy for Age-Related Macular Degeneration: Current Innovations, Impediments, and Future Perspectives. Gels 2024; 10:158. [PMID: 38534576 DOI: 10.3390/gels10030158] [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: 12/29/2023] [Revised: 01/20/2024] [Accepted: 01/23/2024] [Indexed: 03/28/2024] Open
Abstract
Age-related macular degeneration (AMD) is an ocular disease that leads to progressive photoreceptor death and visual impairment. Currently, the most common therapeutic strategy is to deliver anti-vascular endothelial growth factor (anti-VEGF) agents into the eyes of patients with wet AMD. However, this treatment method requires repeated injections, which potentially results in surgical complications and unwanted side effects for patients. An effective therapeutic approach for dry AMD also remains elusive. Therefore, there is a surge of enthusiasm for the developing the biodegradable drug delivery systems with sustained release capability and develop a promising therapeutic strategy. Notably, the strides made in hydrogels which possess intricate three-dimensional polymer networks have profoundly facilitated the treatments of AMD. Researchers have established diverse hydrogel-based delivery systems with marvelous biocompatibility and efficacy. Advantageously, these hydrogel-based transplantation therapies provide promising opportunities for vision restoration. Herein, we provide an overview of the properties and potential of hydrogels for ocular delivery. We introduce recent advances in the utilization of hydrogels for the delivery of anti-VEGF and in cell implantation. Further refinements of these findings would lay the basis for developing more rational and curative therapies for AMD.
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Affiliation(s)
- Chengzhi Zhang
- Department of Ophthalmology, Henan Eye Institute, Henan Eye Hospital, Henan Provincial People's Hospital (People's Hospital of Zheng Zhou University), Zhengzhou 450003, China
- College of Medicine, Zhengzhou University, Zhengzhou 450001, China
| | - Jiale Wang
- Department of Ophthalmology, Henan Eye Institute, Henan Eye Hospital, Henan Provincial People's Hospital (People's Hospital of Zheng Zhou University), Zhengzhou 450003, China
- College of Medicine, Zhengzhou University, Zhengzhou 450001, China
| | - Hao Wu
- Department of Ophthalmology, Henan Eye Institute, Henan Eye Hospital, Henan Provincial People's Hospital (People's Hospital of Zheng Zhou University), Zhengzhou 450003, China
- College of Medicine, Zhengzhou University, Zhengzhou 450001, China
| | - Wenhui Fan
- Department of Ophthalmology, Henan Eye Institute, Henan Eye Hospital, Henan Provincial People's Hospital (People's Hospital of Zheng Zhou University), Zhengzhou 450003, China
- College of Medicine, Zhengzhou University, Zhengzhou 450001, China
| | - Siyu Li
- Department of Ophthalmology, Henan Eye Institute, Henan Eye Hospital, Henan Provincial People's Hospital (People's Hospital of Zheng Zhou University), Zhengzhou 450003, China
- College of Medicine, Zhengzhou University, Zhengzhou 450001, China
| | - Dong Wei
- Department of Ophthalmology, Henan Eye Institute, Henan Eye Hospital, Henan Provincial People's Hospital (People's Hospital of Zheng Zhou University), Zhengzhou 450003, China
- College of Medicine, Zhengzhou University, Zhengzhou 450001, China
| | - Zongming Song
- Department of Ophthalmology, Henan Eye Institute, Henan Eye Hospital, Henan Provincial People's Hospital (People's Hospital of Zheng Zhou University), Zhengzhou 450003, China
| | - Ye Tao
- Department of Ophthalmology, Henan Eye Institute, Henan Eye Hospital, Henan Provincial People's Hospital (People's Hospital of Zheng Zhou University), Zhengzhou 450003, China
- College of Medicine, Zhengzhou University, Zhengzhou 450001, China
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Tsung TH, Tsai YC, Lee HP, Chen YH, Lu DW. Biodegradable Polymer-Based Drug-Delivery Systems for Ocular Diseases. Int J Mol Sci 2023; 24:12976. [PMID: 37629157 PMCID: PMC10455181 DOI: 10.3390/ijms241612976] [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: 07/25/2023] [Revised: 08/12/2023] [Accepted: 08/16/2023] [Indexed: 08/27/2023] Open
Abstract
Ocular drug delivery is a challenging field due to the unique anatomical and physiological barriers of the eye. Biodegradable polymers have emerged as promising tools for efficient and controlled drug delivery in ocular diseases. This review provides an overview of biodegradable polymer-based drug-delivery systems for ocular diseases with emphasis on the potential for biodegradable polymers to overcome the limitations of conventional methods, allowing for sustained drug release, improved bioavailability, and targeted therapy. Natural and synthetic polymers are both discussed, highlighting their biodegradability and biocompatibility. Various formulation strategies, such as nanoparticles, hydrogels, and microemulsions, among others, are investigated, detailing preparation methods, drug encapsulation, and clinical applications. The focus is on anterior and posterior segment drug delivery, covering glaucoma, corneal disorders, ocular inflammation, retinal diseases, age-related macular degeneration, and diabetic retinopathy. Safety considerations, such as biocompatibility evaluations, in vivo toxicity studies, and clinical safety, are addressed. Future perspectives encompass advancements, regulatory considerations, and clinical translation challenges. In conclusion, biodegradable polymers offer potential for efficient and targeted ocular drug delivery, improving therapeutic outcomes while reducing side effects. Further research is needed to optimize formulation strategies and address regulatory requirements for successful clinical implementation.
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Affiliation(s)
- Ta-Hsin Tsung
- Department of Ophthalmology, Tri-Service General Hospital, National Defense Medical Center, Taipei 11490, Taiwan; (T.-H.T.); (Y.-C.T.); (H.-P.L.); (Y.-H.C.)
| | - Yu-Chien Tsai
- Department of Ophthalmology, Tri-Service General Hospital, National Defense Medical Center, Taipei 11490, Taiwan; (T.-H.T.); (Y.-C.T.); (H.-P.L.); (Y.-H.C.)
- Department of Ophthalmology, Taoyuan Armed Forces General Hospital, Taoyuan 325, Taiwan
| | - Hsin-Pei Lee
- Department of Ophthalmology, Tri-Service General Hospital, National Defense Medical Center, Taipei 11490, Taiwan; (T.-H.T.); (Y.-C.T.); (H.-P.L.); (Y.-H.C.)
| | - Yi-Hao Chen
- Department of Ophthalmology, Tri-Service General Hospital, National Defense Medical Center, Taipei 11490, Taiwan; (T.-H.T.); (Y.-C.T.); (H.-P.L.); (Y.-H.C.)
| | - Da-Wen Lu
- Department of Ophthalmology, Tri-Service General Hospital, National Defense Medical Center, Taipei 11490, Taiwan; (T.-H.T.); (Y.-C.T.); (H.-P.L.); (Y.-H.C.)
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Ham Y, Mehta H, Kang-Mieler J, Mieler WF, Chang A. Novel Drug Delivery Methods and Approaches for the Treatment of Retinal Diseases. Asia Pac J Ophthalmol (Phila) 2023; 12:402-413. [PMID: 37523432 DOI: 10.1097/apo.0000000000000623] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 05/30/2023] [Indexed: 08/02/2023] Open
Abstract
This review discusses emerging approaches to ocular drug delivery for retinal diseases. Intravitreal injections have proven to be an effective, safe, and commonly used drug delivery method. However, the optimal management of chronic retinal diseases requires frequent intravitreal injections over extended periods of time. Although this can be achieved in a clinical trial environment, it is difficult to replicate in routine clinical practice. In addition, frequent treatment increases the risk of complications, incurs more costs, and increases the treatment burden for patients and caregivers. Given the aging global population and diabetes pandemic, there is an urgent need for drug delivery methods that support more durable retinal therapy while maintaining the efficacy and safety of currently available intravitreal therapies. Several innovative drug delivery methods are currently being investigated. These include sustained-release implants and depots using prodrugs, microparticles, and hydrogels, surgically implanted reservoirs, gene therapy via submacular injections or suprachoroidal injections, as well as topical and systemic therapies.
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Affiliation(s)
- Yeji Ham
- Sydney Retina Clinic, Sydney, Australia
| | - Hemal Mehta
- Sydney Retina Clinic, Sydney, Australia
- Save Sight Registries, The University of Sydney, Sydney, Australia
- Strathfield Retina Clinic, Sydney, Australia
| | - Jennifer Kang-Mieler
- Department of Biomedical Engineering, Stevens Institute of Technology, Hoboken, NJ
| | | | - Andrew Chang
- Sydney Retina Clinic, Sydney Eye Hospital, The University of Sydney, Sydney, Australia
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Gabai A, Zeppieri M, Finocchio L, Salati C. Innovative Strategies for Drug Delivery to the Ocular Posterior Segment. Pharmaceutics 2023; 15:1862. [PMID: 37514050 PMCID: PMC10385847 DOI: 10.3390/pharmaceutics15071862] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/17/2023] Open
Abstract
Innovative and new drug delivery systems (DDSs) have recently been developed to vehicle treatments and drugs to the ocular posterior segment and the retina. New formulations and technological developments, such as nanotechnology, novel matrices, and non-traditional treatment strategies, open new perspectives in this field. The aim of this mini-review is to highlight promising strategies reported in the current literature based on innovative routes to overcome the anatomical and physiological barriers of the vitreoretinal structures. The paper also describes the challenges in finding appropriate and pertinent treatments that provide safety and efficacy and the problems related to patient compliance, acceptability, effectiveness, and sustained drug delivery. The clinical application of these experimental approaches can help pave the way for standardizing the use of DDSs in developing enhanced treatment strategies and personalized therapeutic options for ocular pathologies.
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Affiliation(s)
- Andrea Gabai
- Department of Ophthalmology, University Hospital of Udine, 33100 Udine, Italy
| | - Marco Zeppieri
- Department of Ophthalmology, University Hospital of Udine, 33100 Udine, Italy
| | - Lucia Finocchio
- Department of Ophthalmology, University Hospital of Udine, 33100 Udine, Italy
- Department of Ophthalmology, Nuovo Ospedale Santo Stefano, 59100 Prato, Italy
| | - Carlo Salati
- Department of Ophthalmology, University Hospital of Udine, 33100 Udine, Italy
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Fan X, Jiang K, Geng F, Lu W, Wei G. Ocular therapies with biomacromolecules: From local injection to eyedrop and emerging noninvasive delivery strategies. Adv Drug Deliv Rev 2023; 197:114864. [PMID: 37156266 DOI: 10.1016/j.addr.2023.114864] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 04/15/2023] [Accepted: 05/03/2023] [Indexed: 05/10/2023]
Abstract
The last two decades have witnessed a continuously increasing number of biomacromolecules approved for the treatment of ocular diseases. The eye possesses multiple protective mechanisms to resist the invasion of exogenous substances, but meanwhile these physiological defense systems also act as strong barriers, impeding absorption of most biomacromolecules into the eye. As a result, local injections play predominant roles for posterior ocular delivery of biomacromolecules in clinical practice. To achieve safe and convenient application of biomacromolecules, alternative strategies to realize noninvasive intraocular delivery are necessary. Various nanocarriers, novel penetration enhancers and physical strategies have been explored to facilitate delivery of biomacromolecules to both anterior and posterior ocular segments but still suffered difficulties in clinical translation. This review compares the anatomical and physiological characteristics of the eyes from those frequently adopted experimental species and profiles the well-established animal models of ocular diseases. We also summarize the ophthalmic biomacromolecules launched on the market and put emphasis on emerging noninvasive intraocular delivery strategies of peptides, proteins and genes.
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Affiliation(s)
- Xingyan Fan
- Key Laboratory of Smart Drug Delivery, Ministry of Education & Department of Pharmaceutics, School of Pharmacy, Fudan University, Shanghai, 201203, PR China
| | - Kuan Jiang
- Key Laboratory of Smart Drug Delivery, Ministry of Education & Department of Pharmaceutics, School of Pharmacy, Fudan University, Shanghai, 201203, PR China; Eye Institute and Department of Ophthalmology, Eye and ENT Hospital, Fudan University, Shanghai, 200030, P.R. China
| | - Feiyang Geng
- Key Laboratory of Smart Drug Delivery, Ministry of Education & Department of Pharmaceutics, School of Pharmacy, Fudan University, Shanghai, 201203, PR China
| | - Weiyue Lu
- Key Laboratory of Smart Drug Delivery, Ministry of Education & Department of Pharmaceutics, School of Pharmacy, Fudan University, Shanghai, 201203, PR China; The Institutes of Integrative Medicine of Fudan University, Shanghai, 200040, PR China
| | - Gang Wei
- Key Laboratory of Smart Drug Delivery, Ministry of Education & Department of Pharmaceutics, School of Pharmacy, Fudan University, Shanghai, 201203, PR China; The Institutes of Integrative Medicine of Fudan University, Shanghai, 200040, PR China; Shanghai Engineering Research Center of ImmunoTherapeutics, Shanghai, 201203, PR China.
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Leung KS, Shirazi S, Cooper LF, Ravindran S. Biomaterials and Extracellular Vesicle Delivery: Current Status, Applications and Challenges. Cells 2022; 11:cells11182851. [PMID: 36139426 PMCID: PMC9497093 DOI: 10.3390/cells11182851] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 09/05/2022] [Accepted: 09/07/2022] [Indexed: 12/14/2022] Open
Abstract
In this review, we will discuss the current status of extracellular vesicle (EV) delivery via biopolymeric scaffolds for therapeutic applications and the challenges associated with the development of these functionalized scaffolds. EVs are cell-derived membranous structures and are involved in many physiological processes. Naïve and engineered EVs have much therapeutic potential, but proper delivery systems are required to prevent non-specific and off-target effects. Targeted and site-specific delivery using polymeric scaffolds can address these limitations. EV delivery with scaffolds has shown improvements in tissue remodeling, wound healing, bone healing, immunomodulation, and vascular performance. Thus, EV delivery via biopolymeric scaffolds is becoming an increasingly popular approach to tissue engineering. Although there are many types of natural and synthetic biopolymers, the overarching goal for many tissue engineers is to utilize biopolymers to restore defects and function as well as support host regeneration. Functionalizing biopolymers by incorporating EVs works toward this goal. Throughout this review, we will characterize extracellular vesicles, examine various biopolymers as a vehicle for EV delivery for therapeutic purposes, potential mechanisms by which EVs exert their effects, EV delivery for tissue repair and immunomodulation, and the challenges associated with the use of EVs in scaffolds.
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Affiliation(s)
- Kasey S. Leung
- Department of Oral Biology, College of Dentistry, University of Illinois Chicago, Chicago, IL 60612, USA
| | - Sajjad Shirazi
- Department of Oral Biology, College of Dentistry, University of Illinois Chicago, Chicago, IL 60612, USA
| | - Lyndon F. Cooper
- School of Dentistry, Virginia Commonwealth University, Richmond, VA 23298, USA
| | - Sriram Ravindran
- Department of Oral Biology, College of Dentistry, University of Illinois Chicago, Chicago, IL 60612, USA
- Correspondence:
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