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Hosny OH, Abd-Elkareem M, Ali MM, Ahmed AF. Advanced platelet-rich fibrin promotes healing of induced corneal ulcer in donkeys (Equus asinus). Sci Rep 2023; 13:21824. [PMID: 38071242 PMCID: PMC10710484 DOI: 10.1038/s41598-023-48933-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Accepted: 12/01/2023] [Indexed: 12/18/2023] Open
Abstract
Ulcerative keratitis is a common disease in horses which may cause blindness. To prevent secondary bacterial and fungal infections and promote quick re-growth of the epithelial layer, different treatment approaches have been employed. This study aimed to examine the effects of advanced platelet-rich fibrin (A-PRF) gel on the healing process of experimentally induced corneal ulcers in donkeys. Nine healthy adult donkeys were used for the study. The donkeys were divided into two groups: the control group, where no medication was applied to the corneal ulcer, and the A-PRF gel group, where A-PRF gel was applied once a day on specific days after ulcer induction. The healing process was evaluated through various examinations and analyses. The results demonstrated that the A-PRF gel group showed significant improvement in the corneal ulcer area, with epithelial and stromal regeneration. At day 35, about 60% of the A-PRF group showed negative fluorescein uptake. Additionally, fewer complications were observed during the healing process compared to the control group. In conclusion, A-PRF gel is an important and safe therapeutic option for controlling ocular surface infection and promoting corneal healing. We recommend using A-PRF gel as an alternative approach, avoiding eyelid suturing, and minimizing corneal irritation.
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Affiliation(s)
- Omar H Hosny
- Department of Surgery, Anesthesiology and Radiology, Faculty of Veterinary Medicine, Assiut University, Assiut, 71526, Egypt.
| | - Mahmoud Abd-Elkareem
- Department of Cell and Tissues, Faculty of Veterinary Medicine, Assiut University, Assiut, 71526, Egypt
| | - Magda M Ali
- Department of Surgery, Anesthesiology and Radiology, Faculty of Veterinary Medicine, Assiut University, Assiut, 71526, Egypt
| | - Ahmed F Ahmed
- Department of Surgery, Anesthesiology and Radiology, Faculty of Veterinary Medicine, Assiut University, Assiut, 71526, Egypt
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2
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Posarelli M, Romano D, Tucci D, Giannaccare G, Scorcia V, Taloni A, Pagano L, Borgia A. Ocular-Surface Regeneration Therapies for Eye Disorders: The State of the Art. BIOTECH 2023; 12:48. [PMID: 37366796 DOI: 10.3390/biotech12020048] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 06/10/2023] [Accepted: 06/13/2023] [Indexed: 06/28/2023] Open
Abstract
The ocular surface is a complex structure that includes cornea, conjunctiva, limbus, and tear film, and is critical for maintaining visual function. When the ocular-surface integrity is altered by a disease, conventional therapies usually rely on topical drops or tissue replacement with more invasive procedures, such as corneal transplants. However, in the last years, regeneration therapies have emerged as a promising approach to repair the damaged ocular surface by stimulating cell proliferation and restoring the eye homeostasis and function. This article reviews the different strategies employed in ocular-surface regeneration, including cell-based therapies, growth-factor-based therapies, and tissue-engineering approaches. Dry eye and neurotrophic keratopathy diseases can be treated with nerve-growth factors to stimulate the limbal stem-cell proliferation and the corneal nerve regeneration, whereas conjunctival autograft or amniotic membrane are used in subjects with corneal limbus dysfunction, such as limbal stem-cell deficiency or pterygium. Further, new therapies are available for patients with corneal endothelium diseases to promote the expansion and migration of cells without the need of corneal keratoplasty. Finally, gene therapy is a promising new frontier of regeneration medicine that can modify the gene expression and, potentially, restore the corneal transparency by reducing fibrosis and neovascularization, as well as by stimulating stem-cell proliferation and tissue regeneration.
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Affiliation(s)
- Matteo Posarelli
- St. Paul's Eye Unit, Department of Corneal Diseases, Royal Liverpool University Hospital, Liverpool L7 8YE, UK
- Ophthalmology Unit, Department of Medicine, Surgery and Neuroscience, University of Siena, 53100 Siena, Italy
| | - Davide Romano
- Eye Clinic, Department of Neurological and Vision Sciences, University of Brescia, 25123 Brescia, Italy
- Eye Unit, University Hospitals of Leicester, NHS Trust, Leicester LE1 5WW, UK
| | - Davide Tucci
- Department of Biomedical and Surgical Sciences, Section of Ophthalmology, S. Maria Della Misericordia Hospital, University of Perugia, 06123 Perugia, Italy
| | - Giuseppe Giannaccare
- Department of Ophthalmology, University Magna Græcia of Catanzaro, 88100 Catanzaro, Italy
| | - Vincenzo Scorcia
- Department of Ophthalmology, University Magna Græcia of Catanzaro, 88100 Catanzaro, Italy
| | - Andrea Taloni
- Department of Ophthalmology, University Magna Græcia of Catanzaro, 88100 Catanzaro, Italy
| | - Luca Pagano
- St. Paul's Eye Unit, Department of Corneal Diseases, Royal Liverpool University Hospital, Liverpool L7 8YE, UK
| | - Alfredo Borgia
- St. Paul's Eye Unit, Department of Corneal Diseases, Royal Liverpool University Hospital, Liverpool L7 8YE, UK
- Eye Unit, Humanitas-Gradenigo Hospital, 10153 Turin, Italy
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3
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Wróbel-Dudzińska D, Przekora A, Kazimierczak P, Ćwiklińska-Haszcz A, Kosior-Jarecka E, Żarnowski T. The Comparison between the Composition of 100% Autologous Serum and 100% Platelet-Rich Plasma Eye Drops and Their Impact on the Treatment Effectiveness of Dry Eye Disease in Primary Sjogren Syndrome. J Clin Med 2023; 12:jcm12093126. [PMID: 37176566 PMCID: PMC10179661 DOI: 10.3390/jcm12093126] [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: 04/02/2023] [Revised: 04/22/2023] [Accepted: 04/23/2023] [Indexed: 05/15/2023] Open
Abstract
PURPOSE The aim of the study was to compare the difference in composition between 100% autologous serum (AS) and 100% platelet-rich plasma (PRP) eye drops and assess their impact on the clinical outcomes after the treatment of severe dry eye (DE) in primary Sjogren Syndrome patients (pSS). MATERIALS AND METHODS This is an interventional, non-randomized, comparative, three-month study. 22 patients with severe DE in pSS were treated with 100% AS (22 eyes) and 100% PRP (22 eyes) eye drops 5 times per day in monotherapy mode. The quantifications of growth factors (GFs) such as fibroblast growth factor (FGF), epidermal growth factor (EGF), vascular endothelial growth factor (VEGF), platelet-derived growth factor (PDGF), nerve growth factor (NGF), transforming growth factor (TGF-b), insulin-like growth factor (IGF), fibronectin, and substance p in hemoderivates were done. The main outcome measures were: Ocular Surface Disease Index (OSDI), Best Corrected Visual Acuity (BCVA), the Schirmer test, tear break-up time (TBUT), corneal and conjunctival staining according to the Oxford scale, conjunctival hyperaemia, and Meibomian gland parameters. The results were compared at baseline, 1 month, and 3 months following the treatment. The clinical results were correlated with the concentration of GFs in the biological tear substitutes. RESULTS Significant differences were observed in the concentration of FGF (4.42 ± 0.86 vs. 15.96 ± 7.63, p < 0.0001), EGF (4.98 ± 0.97 vs. 39.06 ± 20.18, p < 0.0001), fibronectin (929.6 ± 111.5 vs. 823.64 ± 98.49, p = 0.0005), VEGF (175.45 ± 65.93 vs. 717.35 ± 488.15, p < 0.0001), PDGF AB (619.6 ± 117.30 vs. 349.66 ± 79.82, p < 0.0001), NGF (85.22 ± 23.49 vs. 8.29 ± 9.06, p < 0.0001), PDGF (935.38 ± 434.26 vs. 126.66 ± 54.41, p < 0.0001), substance p (112.58 ± 27.28 vs. 127.51 ± 26.56, p = 0.0125) in PRP compared to AS. The level of TGF-β was undoubtedly higher in AS than in PRP (1031.37 ± 330.23 vs. 726.03 ± 298.95, p = 0.0004). No significant differences between AS and PRP were observed in the concentration of IGF. Therapy with blood products relieved the signs and symptoms in pSS DE patients. There was a statistically significant improvement in BCVA, the Schirmer test, TBUT, Meibomian gland parameters, and the reduction of the OSDI scores, Oxford staining, and conjunctiva hyperaemia in each of the groups. However, the clinical changes were more significant in the PRP group. There were numerous correlations between the level of GFs and the mean change in clinical outcomes. No adverse events were reported. CONCLUSIONS Despite the fact that blood derivatives differ in composition, they seem to be effective and safe in the treatment of severe DE in pSS patients. The signs and symptoms of DE were reduced in both groups, but only the mean change in OSDI was statistically significant. A greater reduction in OSDI scores was observed in the PRP group. The obtained results and the composition of haemoderivates may indicate the superiority of PRP in relieving the symptoms of DE in pSS patients compared to AS.
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Affiliation(s)
- Dominika Wróbel-Dudzińska
- Department of Diagnostics and Microsurgery of Glaucoma, Medical University of Lublin, 20-059 Lublin, Poland
| | - Agata Przekora
- Independent Unit of Tissue Engineering and Regenerative Medicine, Medical University of Lublin, 20-059 Lublin, Poland
| | - Paulina Kazimierczak
- Independent Unit of Tissue Engineering and Regenerative Medicine, Medical University of Lublin, 20-059 Lublin, Poland
| | | | - Ewa Kosior-Jarecka
- Department of Diagnostics and Microsurgery of Glaucoma, Medical University of Lublin, 20-059 Lublin, Poland
| | - Tomasz Żarnowski
- Department of Diagnostics and Microsurgery of Glaucoma, Medical University of Lublin, 20-059 Lublin, Poland
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Anitua E, de la Fuente M, Sánchez-Ávila RM, de la Sen-Corcuera B, Merayo-Lloves J, Muruzábal F. Beneficial Effects of Plasma Rich in Growth Factors (PRGF) Versus Autologous Serum and Topical Insulin in Ocular Surface Cells. Curr Eye Res 2023; 48:456-464. [PMID: 36695530 DOI: 10.1080/02713683.2023.2173237] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
PURPOSE In the last few decades, several blood derived products such as platelet-rich plasma (PRP), plasma rich in growth factors (PRGF) and autologous serum (AS) have been used for the treatment of ocular surface disorders. Recently, insulin has been proposed to be used as an alternative for the treatment of ocular surface diseases. The aim of this study was to evaluate the biological potential of PRGF eye drops in comparison with AS and insulin on ocular surface cells. METHODS Blood from three healthy young donors was collected to obtain autologous serum (AS) eye drops and plasma rich in growth factors (PRGF) eye drops. Insulin (Actrapid®) was diluted at 1 and 0.2 IU/mL. The biological potential of PRGF, AS and insulin was assessed by proliferation in HCE, HK and HConF cells. Wound healing assay was performed in HCE cells after incubation with the different treatments. HConF and HK cells were differentiated to myofibroblast after treatment with 2.5 ng/mL of TGF-β1 and then incubated with all treatments. RESULTS PRGF eye drops induced significantly higher proliferation rate compared to AS or insulin in HConF and HK cells, but not in HCE cells. In addition, the percentage of wound healing area was significantly reduced after PRGF treatment in comparison with AS or insulin treatment. Furthermore, PRGF significantly reduced the number of myodifferentiated cells compared to AS and insulin at both concentrations analyzed. CONCLUSION The results obtained in the present study show that PRGF increases the biological activity of the ocular surface cells and reduces the expression of fibrosis marker compared to insulin or AS. TRANSLATIONAL RELEVANCE The present study suggests that plasma rich in growth factors eye drops are a more effective therapy than insulin and autologous serum eye drops for the treatment of ocular surface diseases.
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Affiliation(s)
- Eduardo Anitua
- BTI Biotechnology Institute, Vitoria, Spain.,University Institute for Regenerative Medicine and Oral Implantology, UIRMI (UPV/EHU-Fundación Eduardo Anitua), Vitoria, Spain
| | - María de la Fuente
- BTI Biotechnology Institute, Vitoria, Spain.,University Institute for Regenerative Medicine and Oral Implantology, UIRMI (UPV/EHU-Fundación Eduardo Anitua), Vitoria, Spain
| | | | - Borja de la Sen-Corcuera
- BTI Biotechnology Institute, Vitoria, Spain.,University Institute for Regenerative Medicine and Oral Implantology, UIRMI (UPV/EHU-Fundación Eduardo Anitua), Vitoria, Spain
| | - Jesús Merayo-Lloves
- Instituto Universitario Fernández-Vega, Universidad de Oviedo, Oviedo, Spain.,Fundación para la Investigación y la Innovación Biosanitaria de Asturias (FINBA), Oviedo, Spain
| | - Francisco Muruzábal
- BTI Biotechnology Institute, Vitoria, Spain.,University Institute for Regenerative Medicine and Oral Implantology, UIRMI (UPV/EHU-Fundación Eduardo Anitua), Vitoria, Spain
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5
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Prucha VJ, Egerbacher M, Tichy A, Nell B. Effects of diluted povidone iodine on viability and migration of canine corneal epithelial and stromal cells in tissue culture. Res Vet Sci 2022; 151:1-9. [DOI: 10.1016/j.rvsc.2022.04.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 04/19/2022] [Accepted: 04/28/2022] [Indexed: 11/15/2022]
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6
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Soifer M, Tovar A, Wang M, Mousa HM, Yennam S, Sabater AL, Pflugfelder S, Perez VL. A multicenter report of the use of plasma rich in growth factors (PRGF) for the treatment of patients with ocular surface diseases in North America. Ocul Surf 2022; 25:40-48. [PMID: 35489588 DOI: 10.1016/j.jtos.2022.04.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 04/22/2022] [Accepted: 04/23/2022] [Indexed: 12/31/2022]
Abstract
PURPOSE To investigate the efficacy and safety of plasma rich in growth factors (PRGF) eyedrops in the management of patients with ocular surface diseases in North America. METHODS Multicenter interventional case series of patients using PRGF eyedrops for the first time. A cohort of patients was analyzed for corneal staining score at initial visit and at 3 months of therapy with PRGF. Another cohort responded to a 10-item questionnaire that evaluated patients' satisfaction and safety, which included the symptom assessment questionnaire in dry eye (SANDE) score, after 6 months of PRGF treatment. RESULTS A total of 153 patients were analyzed. Of these, 102 were reviewed for corneal epitheliopathy and 99 patients responded to the questionnaire. The mean (±SD) age of the population was 63.7 ± 17 years and 72.5% were female. The clinical indications for PRGF usage were dry eye (60%), neurotrophic keratopathy (15%), dormant corneal ulcers (12%), limbal stem cell deficiency (10%), and cicatrizing conjunctivitis (4%). At the final visit, 74.3% of patients showed an improvement of their corneal staining. Those who had punctate epithelial erosions or epithelial defects were reduced from 76.5% to 47% and 23.5%-7.8% respectively (p < 0.0001). Symptoms, measured via SANDE score, significantly decreased from a median of 90 to 34.6 out of 100 points on follow-up (p < 0.0001). Only one patient (0.98%) complained of ocular burning sensation as a side effect. CONCLUSIONS This multicentric study demonstrates the safety and efficacy of the use of PRGF for treating signs and symptoms in patients with significant ocular surface diseases.
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Affiliation(s)
- Matias Soifer
- Department of Ophthalmology, Duke Eye Center, Duke University School of Medicine, Durham, NC, USA
| | - Arianna Tovar
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Margaret Wang
- Department of Ophthalmology, Baylor College of Medicine, Houston, TX, USA
| | - Hazem M Mousa
- Department of Ophthalmology, Duke Eye Center, Duke University School of Medicine, Durham, NC, USA
| | - Sowmya Yennam
- Department of Ophthalmology, Baylor College of Medicine, Houston, TX, USA
| | - Alfonso L Sabater
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | | | - Victor L Perez
- Department of Ophthalmology, Duke Eye Center, Duke University School of Medicine, Durham, NC, USA.
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7
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Rodríguez Calvo‐de‐Mora M, Domínguez‐Ruiz C, Barrero‐Sojo F, Rodríguez‐Moreno G, Antúnez Rodríguez C, Ponce Verdugo L, Hernández Lamas MDC, Hernández‐Guijarro L, Villalvilla Castillo J, Fernández‐Baca Casares I, Prat Arrojo I, Borroni D, Alba‐Linero C, Zamorano‐Martín F, Moreno‐Guerrero A, Rocha‐de‐Lossada C. Autologous versus allogeneic versus umbilical cord sera for the treatment of severe dry eye disease: a double-blind randomized clinical trial. Acta Ophthalmol 2022; 100:e396-e408. [PMID: 34137177 DOI: 10.1111/aos.14953] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 05/31/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE To measure the effects of Autologous serum (AS), Allogeneic Serum (HS) and Umbilical Cord serum (CS) eye drops in severe dry eye disease (DES), as well as to characterize and quantify several molecules in the three sera (albumin, fibronectin; Vitamin A and E; IgG, IgA and IgM; Transforming growth factor β; Epithelial growth factor). METHODS Randomized, double-blind, single-centre, three-arm (AS, HS and CS) clinical trial. Sixty-three subjects were included with severe DES, 21 in each arm of the study. Visual acuity, Schirmer test, Breakup time (BUT), lissamine green, fluorescein staining measurements and a questionnaire were performed prior to treatment, and after one-month and three-month follow-up. RESULTS There was a significant main effect of time on visual acuities, Schirmer and BUT tests and fluorescein and lissamine green staining measurements and questionnaire scores (p = 0.015, p = 0.002, p < 0.001, p < 0.001, p = 0.031 and p < 0.001, respectively), although there was no significant interaction between time and serum type, nor between serum type and the test performed. Regarding the concentration of molecules, in our study AS contained significantly higher concentrations of IgA, IgG and fibronectin whereas HS contained significantly higher concentration of IgM, vitamins A and E, TGF and albumin. Contrary to previous reports, CS did not show higher concentration of any of the molecules analysed. CONCLUSIONS AND RELEVANCE The three sera were effective in the treatment of severe DES. CS did not contain a higher proportion of molecules compared to AS/HS. More research is needed to assess the effect of AS in patients with DES and autoimmune diseases.
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Affiliation(s)
- Marina Rodríguez Calvo‐de‐Mora
- Ophthalmology Department Hospital Regional Universitario Málaga Spain
- Qvision Department of Ophthalmology Vithas Almería Spain
| | | | | | | | | | | | | | | | | | | | | | - Davide Borroni
- The Veneto Eye Bank Foundation Venice Italy
- Department of Doctoral Studies Riga Stradins University Riga Latvia
| | | | | | | | - Carlos Rocha‐de‐Lossada
- Qvision Department of Ophthalmology Vithas Almería Spain
- Ophthalmology Department Hospital Virgen de las Nieves Granada Spain
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8
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Anitua E, Muruzabal F, Pino A, Prado R, Azkargorta M, Elortza F, Merayo-Lloves J. Proteomic Characterization of Plasma Rich in Growth Factors and Undiluted Autologous Serum. Int J Mol Sci 2021; 22:ijms222212176. [PMID: 34830053 PMCID: PMC8618701 DOI: 10.3390/ijms222212176] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 11/03/2021] [Accepted: 11/09/2021] [Indexed: 12/21/2022] Open
Abstract
Over the last three decades, there has been special interest in developing drugs that mimic the characteristics of natural tears for use it in the treatment of several ocular surface disorders. Interestingly, the composition of blood plasma is very similar to tears. Therefore, different blood-derived products like autologous serum (AS) and plasma rich in growth factors (PRGF) have been developed for the treatment of diverse ocular pathologies. However, scarce studies have been carried out to analyze the differences between both types of blood-derived products. In the present study, blood from three healthy donors was drawn and processed to obtain AS and PRGF eye drops. Then, human corneal stromal keratocytes (HK) were treated with PRGF or undiluted AS. Proteomic analysis was carried out to analyze and characterize the differential protein profiles between PRGF and AS, and the differentially expressed proteins in HK cells after PRGF and AS treatment. The results obtained in the present study show that undiluted AS induces the activation of different pathways related to an inflammatory, angiogenic, oxidative stress and scarring response in HK cells regarding PRGF. These results suggest that PRGF could be a better alternative than AS for the treatment of ocular surface disorders.
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Affiliation(s)
- Eduardo Anitua
- BTI—Biotechnology Institute, 01007 Vitoria, Spain; (F.M.); (A.P.); (R.P.)
- University Institute for Regenerative Medicine and Oral Implantology—UIRMI (UPV/EHU-Fundación Eduardo Anitua), 01007 Vitoria, Spain
- Correspondence:
| | - Francisco Muruzabal
- BTI—Biotechnology Institute, 01007 Vitoria, Spain; (F.M.); (A.P.); (R.P.)
- University Institute for Regenerative Medicine and Oral Implantology—UIRMI (UPV/EHU-Fundación Eduardo Anitua), 01007 Vitoria, Spain
| | - Ander Pino
- BTI—Biotechnology Institute, 01007 Vitoria, Spain; (F.M.); (A.P.); (R.P.)
- University Institute for Regenerative Medicine and Oral Implantology—UIRMI (UPV/EHU-Fundación Eduardo Anitua), 01007 Vitoria, Spain
| | - Roberto Prado
- BTI—Biotechnology Institute, 01007 Vitoria, Spain; (F.M.); (A.P.); (R.P.)
- University Institute for Regenerative Medicine and Oral Implantology—UIRMI (UPV/EHU-Fundación Eduardo Anitua), 01007 Vitoria, Spain
| | - Mikel Azkargorta
- Proteomics Platform, CIC bioGUNE, CIBERehd, ProteoRed-ISCIII, Bizkaia Science and Technology Park, 48160 Derio, Spain; (M.A.); (F.E.)
| | - Felix Elortza
- Proteomics Platform, CIC bioGUNE, CIBERehd, ProteoRed-ISCIII, Bizkaia Science and Technology Park, 48160 Derio, Spain; (M.A.); (F.E.)
| | - Jesús Merayo-Lloves
- Instituto Oftalmológico Fernández-Vega, Fundación de Investigación Oftalmológica, Universidad de Oviedo, 33012 Oviedo, Spain;
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9
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Álvarez de Toledo Elizalde J, López García S, Benítez Del Castillo JM, Durán de la Colina J, Gris Castejón O, Celis Sánchez J, Herreras Cantalapiedra JM. Aniridia and the ocular surface: Medical and surgical problems and solutions. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2021; 96 Suppl 1:15-37. [PMID: 34836585 DOI: 10.1016/j.oftale.2021.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 04/12/2021] [Indexed: 06/13/2023]
Abstract
Congenital aniridia is a multisystemic genetic disease due to a mutation in PAX6 gene which severely affects the development and functionality of the human eyes. In patients affected by the mutation, aside from the absence or defects of iris tissue formation, abnormalities in position or opacities of the crystalline lens, macular hypoplasia, ocular surface disease is the main cause of visual loss and the deterioration of the quality of life of most patients. Limbal stem cell deficiency combined with tear film instability and secondary dry eye cause aniridic keratopathy which, in advanced stages, ends up in corneal opacification. In this paper, the actual knowledge about congenital aniridia keratopathy physiopathology and medical and surgical treatment options and their efficacy are discussed. Indications and results of topical treatments with artificial tears and blood-derivatives in its initial stages, and different surgical techniques as limbal stem cell transplantation, keratoplasty and keratoprostheses are reviewed. Finally, recent advances and results in regenerative medicine techniques with ex vivo stem cell cultivation or other types of cultivated cells are presented.
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Affiliation(s)
| | - S López García
- Hospital Universitario Severo Ochoa, Leganés, Madrid, Spain
| | - J M Benítez Del Castillo
- Cátedra de Oftalmología, Hospital Clínico San Carlos, Universidad Complutense, Clínica Rementería, Madrid, Spain
| | - J Durán de la Colina
- Cátedra de Oftalmología, Universidad del País Vasco, Instituto Clínico-Quirúrgico de Oftalmología, Bilbao, Spain
| | - O Gris Castejón
- Departamento de Córnea y Superficie Ocular, Instituto de Microcirugía Ocular de Barcelona (IMO), Barcelona, Spain
| | - J Celis Sánchez
- Unidad de Córnea y Superficie ocular, Hospital La Mancha-Centro, Alcázar de San Juan, Spain
| | - J M Herreras Cantalapiedra
- Instituto Universitario de Oftalmobiología Aplicada (IOBA) de la Universidad de Valladolid, Servicio de Oftalmología del Hospital Clínico Universitario de Valladolid, Valladolid, Spain
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10
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Amin S, Jalilian E, Katz E, Frank C, Yazdanpanah G, Guaiquil VH, Rosenblatt MI, Djalilian AR. The Limbal Niche and Regenerative Strategies. Vision (Basel) 2021; 5:vision5040043. [PMID: 34698278 PMCID: PMC8544688 DOI: 10.3390/vision5040043] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 08/27/2021] [Accepted: 09/16/2021] [Indexed: 12/17/2022] Open
Abstract
The protective function and transparency provided by the corneal epithelium are dependent on and maintained by the regenerative capacity of limbal epithelial stem cells (LESCs). These LESCs are supported by the limbal niche, a specialized microenvironment consisting of cellular and non-cellular components. Disruption of the limbal niche, primarily from injuries or inflammatory processes, can negatively impact the regenerative ability of LESCs. Limbal stem cell deficiency (LSCD) directly hampers the regenerative ability of the corneal epithelium and allows the conjunctival epithelium to invade the cornea, which results in severe visual impairment. Treatment involves restoring the LESC population and functionality; however, few clinically practiced therapies currently exist. This review outlines the current understanding of the limbal niche, its pathology and the emerging approaches targeted at restoring the limbal niche. Most emerging approaches are in developmental phases but show promise for treating LSCD and accelerating corneal regeneration. Specifically, we examine cell-based therapies, bio-active extracellular matrices and soluble factor therapies in considerable depth.
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Affiliation(s)
- Sohil Amin
- Department of Ophthalmology and Visual Sciences, University of Illinois Chicago, Chicago, IL 60612, USA; (S.A.); (E.J.); (E.K.); (C.F.); (G.Y.); (V.H.G.); (M.I.R.)
| | - Elmira Jalilian
- Department of Ophthalmology and Visual Sciences, University of Illinois Chicago, Chicago, IL 60612, USA; (S.A.); (E.J.); (E.K.); (C.F.); (G.Y.); (V.H.G.); (M.I.R.)
| | - Eitan Katz
- Department of Ophthalmology and Visual Sciences, University of Illinois Chicago, Chicago, IL 60612, USA; (S.A.); (E.J.); (E.K.); (C.F.); (G.Y.); (V.H.G.); (M.I.R.)
| | - Charlie Frank
- Department of Ophthalmology and Visual Sciences, University of Illinois Chicago, Chicago, IL 60612, USA; (S.A.); (E.J.); (E.K.); (C.F.); (G.Y.); (V.H.G.); (M.I.R.)
| | - Ghasem Yazdanpanah
- Department of Ophthalmology and Visual Sciences, University of Illinois Chicago, Chicago, IL 60612, USA; (S.A.); (E.J.); (E.K.); (C.F.); (G.Y.); (V.H.G.); (M.I.R.)
- Richard and Loan Hill Department of Bioengineering, University of Illinois Chicago, Chicago, IL 60612, USA
| | - Victor H. Guaiquil
- Department of Ophthalmology and Visual Sciences, University of Illinois Chicago, Chicago, IL 60612, USA; (S.A.); (E.J.); (E.K.); (C.F.); (G.Y.); (V.H.G.); (M.I.R.)
| | - Mark I. Rosenblatt
- Department of Ophthalmology and Visual Sciences, University of Illinois Chicago, Chicago, IL 60612, USA; (S.A.); (E.J.); (E.K.); (C.F.); (G.Y.); (V.H.G.); (M.I.R.)
| | - Ali R. Djalilian
- Department of Ophthalmology and Visual Sciences, University of Illinois Chicago, Chicago, IL 60612, USA; (S.A.); (E.J.); (E.K.); (C.F.); (G.Y.); (V.H.G.); (M.I.R.)
- Correspondence:
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11
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Kynurenic Acid Accelerates Healing of Corneal Epithelium In Vitro and In Vivo. Pharmaceuticals (Basel) 2021; 14:ph14080753. [PMID: 34451850 PMCID: PMC8398234 DOI: 10.3390/ph14080753] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Revised: 07/26/2021] [Accepted: 07/28/2021] [Indexed: 11/17/2022] Open
Abstract
Kynurenic acid (KYNA) is an endogenous compound with a multidirectional effect. It possesses antiapoptotic, anti-inflammatory, and antioxidative properties that may be beneficial in the treatment of corneal injuries. Moreover, KYNA has been used successfully to improve the healing outcome of skin wounds. The aim of the present study is to evaluate the effects of KYNA on corneal and conjunctival cells in vitro and the re-epithelization of corneal erosion in rabbits in vivo. Normal human corneal epithelial cell (10.014 pRSV-T) and conjunctival epithelial cell (HC0597) lines were used. Cellular metabolism, cell viability, transwell migration, and the secretion of IL-1β, IL-6, and IL-10 were determined. In rabbits, after corneal de-epithelization, eye drops containing 0.002% and 1% KYNA were applied five times a day until full recovery. KYNA decreased metabolism but did not affect the proliferation of the corneal epithelium. It decreased both the metabolism and proliferation of conjunctival epithelium. KYNA enhanced the migration of corneal but not conjunctival epithelial cells. KYNA reduced the secretion of IL-1β and IL-6 from the corneal epithelium, leaving IL-10 secretion unaffected. The release of all studied cytokines from the conjunctival epithelium exposed to KYNA was unchanged. KYNA at higher concentration accelerated the healing of the corneal epithelium. These favorable properties of KYNA suggest that KYNA containing topical pharmaceutical products can be used in the treatment of ocular surface diseases.
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12
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Anitua E, de la Sen-Corcuera B, Orive G, Sánchez-Ávila RM, Heredia P, Muruzabal F, Merayo-Lloves J. Progress in the use of plasma rich in growth factors in ophthalmology: from ocular surface to ocular fundus. Expert Opin Biol Ther 2021; 22:31-45. [PMID: 34275392 DOI: 10.1080/14712598.2021.1945030] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Introduction: The use of blood derivatives and especially Plasma rich in growth factors (PRGF), for regenerative purposes has been a common trend along the last decades in the field of oral surgery, dermatology, orthopedics, and more recently in ophthalmology.Areas covered: PRGF is a type of platelet-rich plasma that is being explored for the treatment of ocular injuries. The present review article highlights 50 ophthalmology-related publications about the application of PRGF in the treatment of acute and chronic pathologies in ophthalmology as well as most relevant challenges and future prospects.Expert opinion: PRGF technology provides a wide range of formulations that can be used therapeutically in many different acute and chronic ocular pathologies. In addition to eye drops enriched with autologous growth factors, PRGF enables the preparation of both immunologically safe and fibrin-based formulations. Recent advances in the field have promoted PRGF storage for 12 months under freezing conditions, its daily use for 7 days at room temperature and the freeze-dried formulation. The thermally treated immunosafe formulation has shown promising clinical results for the treatment of several diseases such as Sjögren syndrome, graft versus host disease or cicatrizing conjunctivitis. In addition, several fibrin formulations have been preclinically evaluated and clinically incorporated as an adjuvant to ocular surface or glaucoma surgeries, dermal fat graft procedures, limbal stem cell expansion and retinal surgeries. The present review explores the latest scientific and clinical data, current challenges, and main prospects of this technology for the treatment of several ocular injuries.
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Affiliation(s)
- E Anitua
- Regenerative medicine, Biotechnology Institute (BTI), Vitoria, Spain.,Regenerative medicine, University Institute for Regenerative Medicine and Oral Implantology (UIRMI), Vitoria, Spain
| | - B de la Sen-Corcuera
- Regenerative medicine, Biotechnology Institute (BTI), Vitoria, Spain.,Regenerative medicine, University Institute for Regenerative Medicine and Oral Implantology (UIRMI), Vitoria, Spain
| | - G Orive
- Regenerative medicine, Biotechnology Institute (BTI), Vitoria, Spain.,Regenerative medicine, University Institute for Regenerative Medicine and Oral Implantology (UIRMI), Vitoria, Spain.,NanoBioCel Group, School of Pharmacy, University of the Basque Country (UPV/EHU), Oviedo, Vitoria-Gasteiz, Spain
| | - R M Sánchez-Ávila
- Regenerative medicine, Biotechnology Institute (BTI), Vitoria, Spain
| | - P Heredia
- Regenerative medicine, Biotechnology Institute (BTI), Vitoria, Spain.,Regenerative medicine, University Institute for Regenerative Medicine and Oral Implantology (UIRMI), Vitoria, Spain
| | - F Muruzabal
- Regenerative medicine, Biotechnology Institute (BTI), Vitoria, Spain.,Regenerative medicine, University Institute for Regenerative Medicine and Oral Implantology (UIRMI), Vitoria, Spain
| | - J Merayo-Lloves
- Instituto Universitario Fernández-Vega, Fundación de Investigación Oftalmológica, Universidad de Oviedo, Spain
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13
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Asena L, Gökgöz G, Helvacıoğlu F, Özgün G, Deniz EE, Dursun Altinors D. Effects of topical Coenzyme Q10, Xanthan Gum and Sodium Hyaluronate on corneal epithelial wound healing. Clin Exp Optom 2021; 105:378-384. [PMID: 34134604 DOI: 10.1080/08164622.2021.1932433] [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: 10/21/2022] Open
Abstract
Clinical Relevance: Effective treatment of corneal epithelial defects is crucial to prevent secondary infectious keratitis and visual impairment due to loss of corneal transparency. Therefore, it is important to determine the effect of different topical agents on corneal wound healing response.Background: The aim was to compare the effects of three different eye drops on corneal epithelial wound healing in an experimental model.Methods: Twenty-four eyes of 24 female BALB/c mice were included. A 2 mm central corneal epithelial defect was created. Topical Coenzyme Q10 + Vitamin E D-α-TPGS 4 × 1 was applied to Group A (n = 6), topical Sodium hyaluronate + Xanthan Gum + 0.3% Nethylmicine 4 × 1 to Group B (n = 6) and topical Sodium hyaluronate 4 × 1 to Group C (n = 6). Group D (n = 6) was the control group without treatment. Clinical scoring according to corneal fluorescein staining and histopathological evaluations was performed.Results: Clinical scores according to corneal fluorescein staining were similar in all groups on days 1 (p = 0.05), 2 (p = 0.15) and 3 (p = 0.62). Electron microscopy revealed disruption of intercellular junctions between corneal epithelial cells and intracellular vacuole formation in all groups except Group A. Corneal epithelial thickness and superficial epithelial microvillus arrangement were close to normal in Group A.Conclusion: Although there was no difference in clinical scores between groups, electron microscopy revealed a better organised epithelium with normal configuration of microvilli and less vacuolisation in Group A.
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Affiliation(s)
- Leyla Asena
- Department of Ophthalmology, Başkent University Faculty of Medicine, Ankara, Turkey
| | - Gülşah Gökgöz
- Department of Ophthalmology, Başkent University Faculty of Medicine, Ankara, Turkey
| | - Fatma Helvacıoğlu
- Department of Histology and Embryology, Başkent University Faculty of Medicine, Ankara, Turkey
| | - Gonca Özgün
- Department of Pathology, Başkent University Faculty of Medicine, Ankara, Turkey
| | - Emine Ebru Deniz
- Department of Pathology, Başkent University Faculty of Medicine, Ankara, Turkey
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14
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Gandolfi M, Brandão C, Pellizon C, Hirota I, Barros R, Hussein A, Merlini N, Takahira R, Mesquita L. Allogenic platelet-rich plasma in induced ulcers in rat’s cornea. ARQ BRAS MED VET ZOO 2021. [DOI: 10.1590/1678-4162-12214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
ABSTRACT The objective in this study was to evaluate the clinic effect of applying allogenic platelet-rich plasma (PRP) heated or not, for treating cornea ulcers, including the dosage of PDGF-BB in the cornea. The ulcers were induced, standardizing the left eye from 81 rats (Ratus norvegicus, albinus variety), assigned randomly into three groups (N=27): control group (CG) which did not receive any topic treatment; heated PRP group (GA) and PRP group (GP), which received topical treatment every eight hours for five days. Each group underwent evaluation at 24 hours (M1), three days (M3) and five days (M5). The clinical exam evaluated the opacity, vascularization and corneal repair. The corneal PDGF-BB was dosed through the ELISA method. The corneal opacity was decreased in PRP-treated animals (GA and GP) and corneal repair time reduced when compared to CG at M1 and M5. Furthermore, GP showed greater vascularization at M3 compared to M1. Applied allogenic PRP eye drops, heated or not, speed up corneal healing, and reduce corneal repair time. However, the corneal PDGF concentration was not altered in any of the treatments.
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Affiliation(s)
| | | | | | | | - R. Barros
- Universidade Estadual Paulista, Brazil
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15
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Matysik-Woźniak A, Turski WA, Turska M, Paduch R, Łańcut M, Piwowarczyk P, Czuczwar M, Rejdak R. Tryptophan as a Safe Compound in Topical Ophthalmic Medications: In Vitro and In Vivo Studies. Ocul Immunol Inflamm 2021; 30:940-950. [PMID: 33616466 DOI: 10.1080/09273948.2020.1856883] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Background: To evaluate the effects of tryptophan (TRP) on normal human corneal and conjunctival epithelium in vitro and the re-epithelization of corneal erosion in rabbits.Materials and methods: Corneal epithelial cell (10.014 pRSV-T) and conjunctival epithelial cell (HC0597) cultures were used. The cellular metabolism, viability, secretion of IL-1β, IL-6, IL-10, cytoskeleton organization, transwell migration were determined. Cells were incubated in the presence of TRP at 1-100 μM. After corneal de-epithelization rabbits received TRP drops (100 μM), 5 times a day.Results: TRP increased conjunctival epithelium metabolism at 50 μM and increased the viability of corneal epithelium at 100 μM. TRP (10 μM) enhanced the production of IL-6 by the corneal epithelium and had no effect on IL-1β and IL-10.Conclusions: TRP had no influence on the cellular cytoskeleton but induced a significant pseudopodia projection in both epithelia. TRP did not influence corneal re-epithelization in vivo. TRP was not toxic for corneal and conjunctival epithelia.
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Affiliation(s)
- Anna Matysik-Woźniak
- Department of General Ophthalmology, Medical University of Lublin, Lublin, Poland
| | - Waldemar A Turski
- Department of Experimental and Clinical Pharmacology, Medical University of Lublin, Lublin, Poland
| | - Monika Turska
- Department of Pharmacology, Faculty of Health Sciences, Medical University of Lublin, Lublin, Poland.,School of Molecular Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Roman Paduch
- Department of General Ophthalmology, Medical University of Lublin, Lublin, Poland.,Department of Virology and Immunology, Institute of Microbiology and Biotechnology, Maria Curie-Skłodowska University, Lublin, Poland
| | - Mirosław Łańcut
- Center for Experimental Medicine, Medical University of Lublin, Lublin, Poland
| | - Paweł Piwowarczyk
- 2nd Department of Anesthesiology and Intensive Care Unit, Medical University of Lublin, Lublin, Poland
| | - Mirosław Czuczwar
- 2nd Department of Anesthesiology and Intensive Care Unit, Medical University of Lublin, Lublin, Poland
| | - Robert Rejdak
- Department of General Ophthalmology, Medical University of Lublin, Lublin, Poland
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16
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Plasma Rich in Growth Factors Enhances Cell Survival after in Situ Retinal Degeneration. Int J Mol Sci 2020; 21:ijms21207442. [PMID: 33050198 PMCID: PMC7590176 DOI: 10.3390/ijms21207442] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 09/24/2020] [Accepted: 10/08/2020] [Indexed: 01/21/2023] Open
Abstract
PURPOSE The purpose of this study was to examine the effect of plasma rich in growth factors (PRGFs) under blue light conditions in an in vivo model of retinal degeneration. METHODS Male Wistar rats were exposed to dark/blue light conditions for 9 days. On day 7, right eyes were injected with saline and left eyes with PRGF. Electroretinography (ERG) and intraocular pressure (IoP) measurements were performed before and after the experiment. After sacrifice, retinal samples were collected. Hematoxylin and eosin staining was performed to analyze the structure of retinal sections. Immunofluorescence for brain-specific homeobox/POU domain protein 3A (Brn3a), choline acetyltransferase (ChAT), rhodopsin, heme oxygenase-1 (HO-1), and glial fibrillary acidic protein (GFAP) was performed to study the retinal conditions. RESULTS Retinal signaling measured by ERG was reduced by blue light and recovered with PRGF; however, IoP measurements did not show significant differences among treatments. Blue light reduced the expression for Brn3a, ChAT, and rhodopsin. Treatment with PRGF showed a recovery in their expressions. HO-1 and GFAP results showed that blue light increased their expression but the use of PRGF reduced the effect of light. CONCLUSIONS Blue light causes retinal degeneration. PRGF mitigated the injury, restoring the functionality of these cells and maintaining the tissue integrity.
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17
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Hernáez-Moya R, González S, Urkaregi A, Pijoan JI, Deng SX, Andollo N. Expansion of Human Limbal Epithelial Stem/Progenitor Cells Using Different Human Sera: A Multivariate Statistical Analysis. Int J Mol Sci 2020; 21:ijms21176132. [PMID: 32854428 PMCID: PMC7503296 DOI: 10.3390/ijms21176132] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 08/23/2020] [Accepted: 08/24/2020] [Indexed: 12/13/2022] Open
Abstract
Transplantation of human cultured limbal epithelial stem/progenitor cells (LESCs) has demonstrated to restore the integrity and functionality of the corneal surface in about 76% of patients with limbal stem cell deficiency. However, there are different protocols for the expansion of LESCs, and many of them use xenogeneic products, being a risk for the patients’ health. We compared the culture of limbal explants on the denuded amniotic membrane in the culture medium—supplemental hormone epithelial medium (SHEM)—supplemented with FBS or two differently produced human sera. Cell morphology, cell size, cell growth rate, and the expression level of differentiation and putative stem cell markers were examined. Several bioactive molecules were quantified in the human sera. In a novel approach, we performed a multivariate statistical analysis of data to investigate the culture factors, such as differently expressed molecules of human sera that specifically influence the cell phenotype. Our results showed that limbal cells cultured with human sera grew faster and contained similar amounts of small-sized cells, higher expression of the protein p63α, and lower of cytokeratin K12 than FBS cultures, thus, maintaining the stem/progenitor phenotype of LESCs. Furthermore, the multivariate analysis provided much data to better understand the obtaining of different cell phenotypes as a consequence of the use of different culture methodologies or different culture components.
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Affiliation(s)
- Raquel Hernáez-Moya
- Department of Cell Biology and Histology, School of Medicine and Nursing, Biocruces Bizkaia Health Research Institute, University of the Basque Country UPV/EHU, 48940 Leioa, Bizkaia, Spain;
| | - Sheyla González
- Cornea Division, Stein Eye Institute, University of California, Los Angeles, CA 90095, USA; (S.G.); (S.X.D.)
| | - Arantza Urkaregi
- Department of Applied Mathematics and Statistics and Operational Research, Biocruces Bizkaia Health Research Institute, University of the Basque Country UPV/EHU, 48940 Leioa, Bizkaia, Spain;
| | - Jose Ignacio Pijoan
- Clinical Epidemiology Unit, Cruces University Hospital, Biocruces Bizkaia Health Research Institute, 48903 Barakaldo, Bizkaia, Spain;
| | - Sophie X. Deng
- Cornea Division, Stein Eye Institute, University of California, Los Angeles, CA 90095, USA; (S.G.); (S.X.D.)
| | - Noelia Andollo
- Department of Cell Biology and Histology, School of Medicine and Nursing, Biocruces Bizkaia Health Research Institute, University of the Basque Country UPV/EHU, 48940 Leioa, Bizkaia, Spain;
- Correspondence: ; Tel.: +34-94-601-3295
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18
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Antioxidant Role of PRGF on RPE Cells after Blue Light Insult as a Therapy for Neurodegenerative Diseases. Int J Mol Sci 2020; 21:ijms21031021. [PMID: 32033116 PMCID: PMC7037919 DOI: 10.3390/ijms21031021] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 01/29/2020] [Accepted: 01/31/2020] [Indexed: 12/17/2022] Open
Abstract
Oxidative stress has a strong impact on the development of retinal diseases such as age-related macular degeneration (AMD). Plasma rich in growth factors (PRGF) is a novel therapeutic approach in ophthalmological pathologies. The aim of this study was to analyze the antioxidant effect of PRGF in retinal epithelial cells (EPR) in in vitro and ex vivo retinal phototoxicity models. In vitro analyses were performed on ARPE19 human cell line. Viability and mitochondrial status were assessed in order to test the primary effects of PRGF. GSH level, and protein and gene expression of the main antioxidant pathway (Keap1, Nrf2, GCL, HO-1, and NQO1) were also studied. Ex vivo analyses were performed on rat RPE, and HO-1 and Nrf2 gene and protein expression were evaluated. The results show that PRGF reduces light insult by stimulating the cell response against oxidative damage and modulates the antioxidant pathway. We conclude that PRGF’s protective effect could prove useful as a new therapy for treating neurodegenerative disorders such as AMD.
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19
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Ibares-Frías L, Gallego-Muñoz P, Orive G, Anitua E, Cantalapiedra-Rodríguez R, Merayo-Lloves J, Martínez-García M. Potential Effect of Plasma Rich in Growth Factors-Endoret in Stromal Wound Healing in Additive Surgery. Ophthalmic Res 2019; 63:203-212. [DOI: 10.1159/000501507] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 06/17/2019] [Indexed: 11/19/2022]
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20
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Han KE, Park MH, Kong KH, Choi E, Choi KR, Jun RM. Therapeutic effects of three human-derived materials in a mouse corneal alkali burn model. Cutan Ocul Toxicol 2019; 38:315-321. [PMID: 30741024 DOI: 10.1080/15569527.2019.1573244] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Purpose: To compare the therapeutic effects of human derivatives in a mouse alkali burn model. Methods: The right eyes of mice were injured using NaOH. After alkali injury, one of the following agents was topically administered for 7 d: human amniotic membrane (hAM) suspension, human umbilical cord serum (hUCS), and human peripheral blood serum (hPBS), or saline. The epithelial defect areas on days 1, 2, and 3 degrees of opacity on days 2, 3, and 7, and corneal neovascularization (NV) areas on day 7 were evaluated. Histologic examination and mRNA expression levels of tumour necrosis factor (TNF)-α, interleukin (IL)-6, vascular endothelial growth factor (VEGF), matrix metalloproteinase (MMP)-2, MMP-8, and MMP-9 were also evaluated on day 7. Results: The epithelial defect areas in the hUCS group were smaller than those in the control and hPBS groups on day 3 (p < .05, respectively). The epithelial defect areas in the hAM suspension group showed smaller than those in the control and hPBS groups on days 1 and 2 (p < .05, respectively). The degrees of opacity were lower in all treatment groups than that of the saline control group on day 7 (p < .05, respectively). Corneal NV areas were not different among groups on day 7 (p = 0.20). The expression levels of TNF-α, IL-6, MMP-8, and MMP-9 mRNA and the infiltration of the inflammatory cells in all treatment groups were lesser than those in the control group on day 7 (p< .05, respectively). Conclusions: All treatments reduced inflammatory reactions and corneal opacity development. Corneal reepithelialization was faster in the hUCS group.
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Affiliation(s)
- Kyung Eun Han
- Department of Ophthalmology, Institute of Ophthalmology and Optometry, Ewha Womans University College of Medicine , Seoul , Korea
| | - Mi Hye Park
- Department of Obstetrics and Gynecology, Ewha Womans University College of Medicine , Seoul , Korea
| | | | - Euno Choi
- Department of Pathology, Ewha Womans University College of Medicine , Seoul , Korea
| | - Kyu-Ryong Choi
- Department of Ophthalmology, Institute of Ophthalmology and Optometry, Ewha Womans University College of Medicine , Seoul , Korea
| | - Roo Min Jun
- Department of Ophthalmology, Institute of Ophthalmology and Optometry, Ewha Womans University College of Medicine , Seoul , Korea
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21
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Suárez-Barrio C, Etxebarria J, Hernáez-Moya R, Del Val-Alonso M, Rodriguez-Astigarraga M, Urkaregi A, Freire V, Morales MC, Durán JA, Vicario M, Molina I, Herrero-Vanrell R, Andollo N. Hyaluronic Acid Combined with Serum Rich in Growth Factors in Corneal Epithelial Defects. Int J Mol Sci 2019; 20:ijms20071655. [PMID: 30987108 PMCID: PMC6480555 DOI: 10.3390/ijms20071655] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 03/29/2019] [Accepted: 03/30/2019] [Indexed: 12/30/2022] Open
Abstract
The aim of this study is to assess if an adhesive biopolymer, sodium hyaluronate (NaHA), has synergistic effects with s-PRGF (a serum derived from plasma rich in growth factors and a blood derivative that has already shown efficacy in corneal epithelial wound healing), to reduce time of healing or posology. In vitro proliferation and migration studies, both in human corneal epithelial (HCE) cells and in rabbit primary corneal epithelial (RPCE) cultures, were carried out. In addition, we performed studies of corneal wound healing in vivo in rabbits treated with s-PRGF, NaHA, or the combination of both. We performed immunohistochemistry techniques (CK3, CK15, Ki67, ß4 integrin, ZO-1, α-SMA) in rabbit corneas 7 and 30 days after a surgically induced epithelial defect. In vitro results show that the combination of NaHA and s-PRGF offers the worst proliferation rates in both HCE and RPCE cells. Addition of NaHA to s-PRGF diminishes the re-epithelializing capability of s-PRGF. In vivo, all treatments, given twice a day, showed equivalent efficacy in corneal epithelial healing. We conclude that the combined use of s-PRGF and HaNA as an adhesive biopolymer does not improve the efficacy of s-PRGF alone in the wound healing of corneal epithelial defects.
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Affiliation(s)
- Carlota Suárez-Barrio
- Department of Cell Biology and Histology, School of Medicine and Nursing, University of the Basque Country, BioCruces Health Research Institute, Begiker, 48940 Leioa, Spain.
| | - Jaime Etxebarria
- Department of Cell Biology and Histology, School of Medicine and Nursing, University of the Basque Country, BioCruces Health Research Institute, Begiker, 48940 Leioa, Spain.
- Department of Ophthalmology, University Hospital of Cruces, BioCruces Health Research Institute, Begiker, 48903 Barakaldo, Spain.
| | - Raquel Hernáez-Moya
- Department of Cell Biology and Histology, School of Medicine and Nursing, University of the Basque Country, BioCruces Health Research Institute, Begiker, 48940 Leioa, Spain.
| | - Marina Del Val-Alonso
- Department of Cell Biology and Histology, School of Medicine and Nursing, University of the Basque Country, BioCruces Health Research Institute, Begiker, 48940 Leioa, Spain.
| | - Maddalen Rodriguez-Astigarraga
- Department of Cell Biology and Histology, School of Medicine and Nursing, University of the Basque Country, BioCruces Health Research Institute, Begiker, 48940 Leioa, Spain.
| | - Arantza Urkaregi
- Department of Applied Mathematics and Statistics and Operational Research, BioCruces Health Research Institute, 48940 Leioa, Spain.
| | - Vanesa Freire
- Department of Cell Biology and Histology, School of Medicine and Nursing, University of the Basque Country, BioCruces Health Research Institute, Begiker, 48940 Leioa, Spain.
- R & D Department, Instituto Clínico-Quirúrgico de Oftalmología, 48006 Bilbao, Spain.
| | - María-Celia Morales
- Department of Cell Biology and Histology, School of Medicine and Nursing, University of the Basque Country, BioCruces Health Research Institute, Begiker, 48940 Leioa, Spain.
| | - Juan Antonio Durán
- R & D Department, Instituto Clínico-Quirúrgico de Oftalmología, 48006 Bilbao, Spain.
- Department of Dermatology, Otorhinolaryngology and Ophthalmology, School of Medicine and Nursing, University of the Basque Country, BioCruces Health Research Institute, Begiker, 48940 Leioa, Spain.
| | - Marta Vicario
- Pharmaceutical Innovation in Ophthalmology (InnOftal) UCM Research Group 920415. Department of Pharmaceutics and Food Technology, Faculty of Pharmacy, Complutense University, 28040 Madrid, Spain.
| | - Irene Molina
- Pharmaceutical Innovation in Ophthalmology (InnOftal) UCM Research Group 920415. Department of Pharmaceutics and Food Technology, Faculty of Pharmacy, Complutense University, 28040 Madrid, Spain.
| | - Rocío Herrero-Vanrell
- Pharmaceutical Innovation in Ophthalmology (InnOftal) UCM Research Group 920415. Department of Pharmaceutics and Food Technology, Faculty of Pharmacy, Complutense University, 28040 Madrid, Spain.
| | - Noelia Andollo
- Department of Cell Biology and Histology, School of Medicine and Nursing, University of the Basque Country, BioCruces Health Research Institute, Begiker, 48940 Leioa, Spain.
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22
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Yazdanpanah G, Jabbehdari S, Djalilian AR. Emerging Approaches for Ocular Surface Regeneration. CURRENT OPHTHALMOLOGY REPORTS 2019; 7:1-10. [PMID: 31275736 DOI: 10.1007/s40135-019-00193-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Purpose of review In this manuscript, the recent advancements and novel approaches for regeneration of the ocular surface are summarized. Recent findings Following severe injuries, persistent inflammation can alter the rehabilitative capability of the ocular surface environment. Limbal stem cell deficiency (LSCD) is one of the most characterized ocular surface disorders mediated by deficiency and/or dysfunction of the limbal epithelial stem cells (LESCs) located in the limbal niche. Currently, the most advanced approach for revitalizing the ocular surface and limbal niche is based on transplantation of limbal tissues harboring LESCs. Emerging approaches have focused on restoring the ocular surface microenvironment using (1) cell-based therapies including cells with capabilities to support the LESCs and modulate the inflammation, e.g., mesenchymal stem cells (MSCs), (2) bio-active extracellular matrices from decellularized tissues, and/or purified/synthetic molecules to regenerate the microenvironment structure, and (3) soluble cytokine/growth factor cocktails to revive the signaling pathways. Summary Ocular surface/limbal environment revitalization provide promising approaches for regeneration of the ocular surface.
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Affiliation(s)
- Ghasem Yazdanpanah
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Sayena Jabbehdari
- 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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Strategies for reconstructing the limbal stem cell niche. Ocul Surf 2019; 17:230-240. [PMID: 30633966 DOI: 10.1016/j.jtos.2019.01.002] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 10/21/2018] [Accepted: 01/07/2019] [Indexed: 12/19/2022]
Abstract
The epithelial cell layer that covers the surface of the cornea provides a protective barrier while maintaining corneal transparency. The rapid and effective turnover of these epithelial cells depends, in part, on the limbal epithelial stem cells (LESCs) located in a specialized microenvironment known as the limbal niche. Many disorders affecting the regeneration of the corneal epithelium are related to deficiency and/or dysfunction of LESCs and the limbal niche. Current approaches for regenerating the corneal epithelium following significant injuries such as burns and inflammatory attacks are primarily aimed at repopulating the LESCs. This review summarizes and assesses the clinical feasibility and efficacy of current and emerging approaches for reconstruction of the limbal niche. In particular, the application of mesenchymal stem cells along with appropriate biological scaffolds appear to be promising strategies for long-term revitalization of the limbal niche.
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Anitua E, de la Fuente M, Muruzabal F, Sánchez-Ávila RM, Merayo-Lloves J, Azkargorta M, Elortza F, Orive G. Differential profile of protein expression on human keratocytes treated with autologous serum and plasma rich in growth factors (PRGF). PLoS One 2018; 13:e0205073. [PMID: 30312303 PMCID: PMC6193583 DOI: 10.1371/journal.pone.0205073] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Accepted: 09/17/2018] [Indexed: 11/22/2022] Open
Abstract
Purpose The main objective of this study is to compare the protein expression of human keratocytes treated with Plasma rich in growth factors (PRGF) or autologous serum (AS) and previously induced to myofibroblast by TGF-β1 treatment. Methods Blood from healthy donor was collected and processed to obtain AS and PRGF eye drops. Blood derivates were aliquoted and stored at -80°C until use. Keratocyte cells were pretreated for 60 minutes with 2.5 ng/ml TGF-β1. After that, cells were treated with PRGF, AS or with TGF-β1 (control). To characterize the proteins deregulated after PRGF and AS treatment, a proteomic approach that combines 1D-SDS–PAGE approach followed by LC–MS/MS was carried out. Results Results show a catalogue of key proteins in close contact with a myofibroblastic differentiated phenotype in AS treated-cells, whereas PRGF-treated cells show attenuation on this phenotype. The number of proteins downregulated after PRGF treatment or upregulated in AS-treated cells suggest a close relationship between AS-treated cells and cytoskeletal functions. On the other hand, proteins upregulated after PRGF-treatment or downregulated in AS-treated cells reveal a greater association with processes such as protein synthesis, proliferation and cellular motility. Conclusion This proteomic analysis helps to understand the molecular events underlying AS and PRGF-driven tissue regeneration processes, providing new evidence that comes along with the modulation of TGF-β1 activity and the reversion of the myofibroblastic phenotype by PRGF.
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Affiliation(s)
- Eduardo Anitua
- BTI—Biotechnology Institute, Vitoria-Gasteiz, Spain
- University Institute for Regenerative Medicine and Oral Implantology—UIRMI (UPV/EHU-Fundación Eduardo Anitua), Vitoria-Gasteiz, Spain
- * E-mail: (GO); (EA)
| | - María de la Fuente
- BTI—Biotechnology Institute, Vitoria-Gasteiz, Spain
- University Institute for Regenerative Medicine and Oral Implantology—UIRMI (UPV/EHU-Fundación Eduardo Anitua), Vitoria-Gasteiz, Spain
| | - Francisco Muruzabal
- BTI—Biotechnology Institute, Vitoria-Gasteiz, Spain
- University Institute for Regenerative Medicine and Oral Implantology—UIRMI (UPV/EHU-Fundación Eduardo Anitua), Vitoria-Gasteiz, Spain
| | | | - Jesús Merayo-Lloves
- Instituto Universitario Fernández-Vega, Universidad de Oviedo, Oviedo, Spain
| | - Mikel Azkargorta
- Proteomics Platform, CIC bioGUNE, CIBERehd, ProteoRed-ISCIII, Bizkaia Science and Technology Park, Derio, Spain
| | - Felix Elortza
- Proteomics Platform, CIC bioGUNE, CIBERehd, ProteoRed-ISCIII, Bizkaia Science and Technology Park, Derio, Spain
| | - Gorka Orive
- BTI—Biotechnology Institute, Vitoria-Gasteiz, Spain
- University Institute for Regenerative Medicine and Oral Implantology—UIRMI (UPV/EHU-Fundación Eduardo Anitua), Vitoria-Gasteiz, Spain
- NanoBioCel Group, Laboratory of Pharmaceutics, School of Pharmacy, University of the Basque Country UPV/EHU, Paseo de la Universidad 7, Vitoria-Gasteiz, Spain
- Biomedical Research Networking Centre in Bioengineering, Biomaterials, and Nanomedicine (CIBER-BBN), Vitoria-Gasteiz, Spain
- * E-mail: (GO); (EA)
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Effects of 20% Human Serum on Corneal Epithelial Toxicity Induced by Benzalkonium Chloride: In Vitro and Clinical Studies. Cornea 2018; 37:617-623. [PMID: 29300263 DOI: 10.1097/ico.0000000000001475] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Benzalkonium chloride (BAK), the most commonly used preservative in ophthalmic solutions, is known to cause toxicity in the corneal epithelium. In this study, we investigated the effects of 20% human serum in cultures of BAK-damaged human corneal epithelial cells (hCECs) and in patients with toxic corneal epitheliopathy induced by BAK-containing eye drops. METHODS hCECs were exposed to various concentrations of BAK (0%, 0.002%, 0.02%, and 0.2%) in the presence or absence of 20% human serum. After 24 hours, the metabolic activity, proliferation, apoptosis, and proinflammatory cytokine expression were evaluated in the cells. Also, cell migration was assessed using a scratch test. In the clinical study, 24 patients with toxic corneal epitheliopathy secondary to BAK-containing antiglaucoma eye drops were treated with topical application of 20% autologous serum, and corneal epithelial integrity was evaluated. RESULTS BAK induced cytotoxicity in hCECs by inhibiting the metabolic activity, proliferation, and migration and by increasing apoptosis in a concentration-dependent manner. The level of proinflammatory cytokine IL-8 was elevated in BAK-treated cells. Addition of 20% human serum to the cultures significantly promoted the cell metabolic activity, proliferation, and migration while markedly reducing apoptosis. In line with the in vitro results, corneal punctate epithelial erosions were decreased from a National Eye Institute scale score of 4.2 ± 2.1 to 1.3 ± 1.7 in 20 of 24 patients (84%) after treatment with 20% autologous serum. CONCLUSIONS Data demonstrate that 20% human serum is effective in treating BAK-induced cytotoxicity in hCECs and provides a basis for using 20% autologous serum for patients with preservative-induced corneal epitheliopathy.
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Sánchez-Avila RM, Merayo-Lloves J, Fernández ML, Rodríguez-Gutiérrez LA, Rodríguez-Calvo PP, Fernández-Vega Cueto A, Muruzabal F, Orive G, Anitua E. Plasma rich in growth factors eye drops to treat secondary ocular surface disorders in patients with glaucoma. Int Med Case Rep J 2018; 11:97-103. [PMID: 29760570 PMCID: PMC5937507 DOI: 10.2147/imcrj.s153918] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose To evaluate the efficacy and safety of plasma rich in growth factors (PRGF) eye drops in patients with glaucoma with secondary ocular surface disorders (OSDs) due to surgeries and topical hypotensive drugs use. Materials and methods A retrospective case-series study design was used including six patients (eight eyes) diagnosed with glaucoma who received surgical (nonpenetrating deep sclerectomy and/or trabeculectomy) and medical treatments (hypotensive eye drops) to control intraocular pressure (IOP) and who developed secondary OSDs, unresponsive to conventional treatments. Patients were treated with PRGF eye drops (four times a day). Outcome measures were ocular surface disease index (OSDI), best-corrected visual acuity (BCVA, in logarithm of the minimum angle of resolution), visual analog scale (VAS), frequency and severity of symptoms, and IOP. The safety of the treatment was also evaluated. Results Six patients (seven eyes with open-angle glaucoma and one eye with uveitic glaucoma) treated with PRGF eye drops were evaluated. Mean age was 71 years (SD=7.2, range 58–79 years). Five were female and one was male. The mean treatment time was 21.8 weeks (SD=9.0, range 12–36 weeks). The mean time to reach closure of the corneal ulcer was 14.5 (SD=5.5) weeks. A statistical significant reduction in OSDI scale (50.6%), VAS frequency (53.1%), VAS severity (42.0%), and a 41.8% improvement in BCVA were observed (p<0.05). IOP also decreased by 16.6% (p=0.010). Only one of the six patients reported itching in both eyes as an adverse event (AE); however, the patient continued with the PRGF eye drops until the end of therapy; the remaining patients did not report any AEs during the follow-up period. Conclusions In patients with glaucoma and secondary OSDs refractive to conventional treatments, the treatment with PRGF eye drops could be considered a possible therapeutic option, because it demonstrates an improvement in the signs and symptoms of the ocular surface, as well as a better control of the IOP. This is an initial research work that can open doors for future research to confirm these findings.
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Affiliation(s)
- Ronald M Sánchez-Avila
- University Institute Fernández-Vega, Ophthalmological Research Foundation, University of Oviedo, Oviedo, Spain
| | - Jesus Merayo-Lloves
- University Institute Fernández-Vega, Ophthalmological Research Foundation, University of Oviedo, Oviedo, Spain
| | - Maria Laura Fernández
- University Institute Fernández-Vega, Ophthalmological Research Foundation, University of Oviedo, Oviedo, Spain.,Quilmes Eye Center, Buenos Aires, Argentina
| | | | - Pedro Pablo Rodríguez-Calvo
- University Institute Fernández-Vega, Ophthalmological Research Foundation, University of Oviedo, Oviedo, Spain
| | - Andres Fernández-Vega Cueto
- University Institute Fernández-Vega, Ophthalmological Research Foundation, University of Oviedo, Oviedo, Spain
| | - Francisco Muruzabal
- University Institute for Regenerative Medicine and Oral Implantology (UIRMI), University of the Basque Country, Eduardo Anitua Foundation, Vitoria, Spain.,Biotechnology Institute (BTI), Vitoria, Spain
| | - Gorka Orive
- University Institute for Regenerative Medicine and Oral Implantology (UIRMI), University of the Basque Country, Eduardo Anitua Foundation, Vitoria, Spain.,Biotechnology Institute (BTI), Vitoria, Spain.,Laboratory of Pharmacy and Pharmaceutical Technology, Faculty of Pharmacy, University of the Basque Country, Vitoria, Spain.,Networking Biomedical Research Center on Bioengineering, Biomaterials and Nanomedicine, CIBER-BBN, Vitoria, Spain
| | - Eduardo Anitua
- University Institute for Regenerative Medicine and Oral Implantology (UIRMI), University of the Basque Country, Eduardo Anitua Foundation, Vitoria, Spain.,Biotechnology Institute (BTI), Vitoria, Spain
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27
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Anitua E, Muruzabal F, Prado R, Merayo-Lloves J. PRGF in equine corneal cells: A standardised protocol is the key to achieve accurate results. Equine Vet J 2018; 50:274-275. [PMID: 29392806 DOI: 10.1111/evj.12798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- E Anitua
- Eduardo Anitua Foundation for Biomedical Research, Vitoria, Spain.,Biotechnology Institute (BTI), Vitoria, Spain.,University Institute for Regenerative Medicine and Oral Implantology - UIRMI (UPV/EHU-Fundación Eduardo Anitua), Vitoria, Spain
| | - F Muruzabal
- Eduardo Anitua Foundation for Biomedical Research, Vitoria, Spain.,Biotechnology Institute (BTI), Vitoria, Spain.,University Institute for Regenerative Medicine and Oral Implantology - UIRMI (UPV/EHU-Fundación Eduardo Anitua), Vitoria, Spain
| | - R Prado
- Eduardo Anitua Foundation for Biomedical Research, Vitoria, Spain.,Biotechnology Institute (BTI), Vitoria, Spain.,University Institute for Regenerative Medicine and Oral Implantology - UIRMI (UPV/EHU-Fundación Eduardo Anitua), Vitoria, Spain
| | - J Merayo-Lloves
- Instituto Universitario Fernández-Vega. Fundación de Investigación Oftalmológica, Oviedo, Spain
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Balal S, Than J, Nesaratnam N, Sharma BAR, Enson J, Sharma A. Reply to Anitua et al: Searching for the best blood-derived eye drops. Eye (Lond) 2018; 32:473-474. [DOI: 10.1038/eye.2017.183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Anitua E, Prado R, Muruzabal F, Orive G. Searching for the best blood-derived eye drops. Eye (Lond) 2018; 32:472-473. [DOI: 10.1038/eye.2017.182] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
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30
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Etxebarria J, Sanz-Lázaro S, Hernáez-Moya R, Freire V, Durán JA, Morales MC, Andollo N. Serum from plasma rich in growth factors regenerates rabbit corneas by promoting cell proliferation, migration, differentiation, adhesion and limbal stemness. Acta Ophthalmol 2017; 95:e693-e705. [PMID: 28266180 DOI: 10.1111/aos.13371] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Accepted: 11/18/2016] [Indexed: 12/22/2022]
Abstract
PURPOSE To evaluate the regenerating potential and the mechanisms through which the autologous serum derived from plasma rich in growth factors (s-PRGF) favours corneal wound healing in vitro and in vivo. METHODS We compared the effect of various concentrations of s-PRGF versus fetal bovine serum (FBS) and control treatment in rabbit primary corneal epithelial and stromal cells and wounded rabbit corneas. Cell proliferation was measured using an enzymatic colorimetric assay. In vitro and in vivo wound-healing progression was assessed by image-analysis software. Migration and invasion were evaluated using transfilter assays. Histological structure was analysed in stained sections. Protein expression was evaluated by immunohistochemistry. RESULTS s-PRGF promoted the robust proliferation of epithelial cultures at any concentration, similar to FBS. Likewise, s-PRGF and FBS produced similar re-epithelialization rates in in vitro wound-healing assays. In vivo, s-PRGF treatment accelerated corneal wound healing in comparison with control treatment. This difference was significant only for 100% s-PRGF treatment in our healthy rabbit model. Histological analysis confirmed normal epithelialization in all cases. Immunohistochemistry showed a higher expression of cytokeratins 3/76 and 15, zonula occludens-1 and alpha-smooth muscle actin proteins as a function of s-PRGF concentration. Notably, keratocyte density in the anterior third of the stroma increased with increase in s-PRGF concentration, suggesting an in vivo chemotactic effect of s-PRGF on keratocytes that was further confirmed in vitro. CONCLUSION s-PRGF promotes proliferation and migration and influences limbal stemness, adhesion and fibrosis during corneal healing.
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Affiliation(s)
- Jaime Etxebarria
- Department of Cell Biology and Histology; School of Medicine and Nursing; BioCruces Health Research Institute; University of the Basque Country; Begiker; Leioa Spain
- Department of Ophthalmology; BioCruces Health Research Institute; University Hospital of Cruces; Begiker; Barakaldo Spain
| | - Sara Sanz-Lázaro
- Department of Cell Biology and Histology; School of Medicine and Nursing; BioCruces Health Research Institute; University of the Basque Country; Begiker; Leioa Spain
| | - Raquel Hernáez-Moya
- Department of Cell Biology and Histology; School of Medicine and Nursing; BioCruces Health Research Institute; University of the Basque Country; Begiker; Leioa Spain
| | - Vanesa Freire
- Department of Cell Biology and Histology; School of Medicine and Nursing; BioCruces Health Research Institute; University of the Basque Country; Begiker; Leioa Spain
- R & D Department; Instituto Clínico-Quirúrgico de Oftalmología; Bilbao Spain
| | - Juan A. Durán
- R & D Department; Instituto Clínico-Quirúrgico de Oftalmología; Bilbao Spain
- Department of Ophthalmology; School of Medicine and Nursing; BioCruces Health Research Institute; University of the Basque Country; Begiker; Leioa Spain
| | - María-Celia Morales
- Department of Cell Biology and Histology; School of Medicine and Nursing; BioCruces Health Research Institute; University of the Basque Country; Begiker; Leioa Spain
| | - Noelia Andollo
- Department of Cell Biology and Histology; School of Medicine and Nursing; BioCruces Health Research Institute; University of the Basque Country; Begiker; Leioa Spain
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Jones L, Downie LE, Korb D, Benitez-del-Castillo JM, Dana R, Deng SX, Dong PN, Geerling G, Hida RY, Liu Y, Seo KY, Tauber J, Wakamatsu TH, Xu J, Wolffsohn JS, Craig JP. TFOS DEWS II Management and Therapy Report. Ocul Surf 2017; 15:575-628. [DOI: 10.1016/j.jtos.2017.05.006] [Citation(s) in RCA: 578] [Impact Index Per Article: 72.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Accepted: 05/03/2017] [Indexed: 02/06/2023]
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32
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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: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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33
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Topical Coenzyme Q10 Eye Drops as an Adjuvant Treatment in Challenging Refractory Corneal Ulcers: A Case Series and Literature Review. Eye Contact Lens 2017; 43:73-80. [DOI: 10.1097/icl.0000000000000229] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Autologous method for ex vivo expansion of human limbal epithelial progenitor cells based on plasma rich in growth factors technology. Ocul Surf 2017; 15:248-256. [PMID: 28115245 DOI: 10.1016/j.jtos.2017.01.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Revised: 01/17/2017] [Accepted: 01/18/2017] [Indexed: 01/05/2023]
Abstract
PURPOSE Develop an autologous culture method for ex vivo expansion of human limbal epithelial progenitor cells (LEPCs) using Plasma Rich in Growth Factors (PRGF) as a growth supplement and as a scaffold for the culture of LEPCs. METHODS LEPCs were cultivated in different media supplemented with 10% fetal bovine serum (FBS) or 10% PRGF. The outgrowths, total number of cells, colony forming efficiency (CFE), morphology and immunocytochemistry against p63- α and cytokeratins 3 and 12 (CK3-CK12) were analyzed. PRGF was also used to elaborate a fibrin membrane. The effects of the scaffold on the preservation of stemness and the phenotypic characterization of LEPCs were investigated through analysis of CK3-CK12, ABCG-2 and p63. RESULTS LEPCs cultivated with PRGF showed a significantly higher growth area than FBS cultures. Moreover, the number of cells were also higher in PRGF than FBS, while displaying a better morphology overall. CFE was found to be also higher in PRGF groups compared to FBS, and the p63-α expression also differed between groups. LEPCs cultivated on PRGF membranes appeared as a confluent monolayer of cells and still retained p63 and ABCG-2 expression, being negative for CK3-CK12. CONCLUSIONS PRGF can be used in corneal tissue engineering, supplementing the culture media, even in a basal media without any other additives, as well as providing a scaffold for the culture.
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Riestra AC, Alonso-Herreros JM, Merayo-Lloves J. Platelet rich plasma in ocular surface. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2016; 91:475-490. [PMID: 27062018 DOI: 10.1016/j.oftal.2016.03.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Revised: 02/28/2016] [Accepted: 03/01/2016] [Indexed: 06/05/2023]
Abstract
The use of platelet-rich preparations has experienced a significant increase in recent years due to its role in tissue-repair and regeneration. The aim of this study is to examine the available evidence regarding the application of plasma rich in growth factors, and its variations, on the ocular surface. A review is also presented on the effects of platelet-derived growth factors, the implications of the preparation methods, and the existing literature on the safety and efficacy of these therapies in ocular surface diseases. Despite the widespread use of platelet preparations there is no consensus on the most appropriate preparation method, and growth factors concentration vary with different systems. These preparations have been used in the treatment of ocular surface diseases, such as dry eye or persistent epithelial defects, among others, with good safety and efficacy profiles, but further studies are needed to compare to the currently available alternatives.
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Affiliation(s)
- A C Riestra
- Instituto Universitario Fernández-Vega, Fundación de Investigación Oftalmológica, Universidad de Oviedo, Oviedo, España.
| | | | - J Merayo-Lloves
- Instituto Universitario Fernández-Vega, Fundación de Investigación Oftalmológica, Universidad de Oviedo, Oviedo, España
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Anitua E, Muruzabal F, de la Fuente M, Riestra A, Merayo-Lloves J, Orive G. PRGF exerts more potent proliferative and anti-inflammatory effects than autologous serum on a cell culture inflammatory model. Exp Eye Res 2016; 151:115-21. [DOI: 10.1016/j.exer.2016.08.012] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Revised: 07/26/2016] [Accepted: 08/23/2016] [Indexed: 01/15/2023]
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Tahmaz V, Gehlsen U, Sauerbier L, Holtick U, Engel L, Radojska S, Petrescu-Jipa VM, Scheid C, Hallek M, Gathof B, Cursiefen C, Steven P. Treatment of severe chronic ocular graft-versus-host disease using 100% autologous serum eye drops from a sealed manufacturing system: a retrospective cohort study. Br J Ophthalmol 2016; 101:322-326. [PMID: 27267447 DOI: 10.1136/bjophthalmol-2015-307666] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2015] [Revised: 04/12/2016] [Accepted: 05/12/2016] [Indexed: 11/04/2022]
Abstract
BACKGROUND/AIMS To analyse patients with chronic ocular graft-versus-host disease (GvHD) under treatment with 100% autologous serum eye drops from a sealed manufacturing system. METHODS 17 patients with chronic ocular GvHD received 100% autologous serum eye drops from single use vials manufactured in a sealed system. Retrospective analysis included visual acuity, corneal staining, frequency of artificial tears, ocular symptoms by means of a questionnaire and information on subjective side effects and cost compensation. RESULTS Data of prior to autologous serum eye drops therapy and at a 6-month follow-up were obtained. They demonstrated a significant increase in visual acuity (logMAR oculus dexter/right eye (OD) 0.5±0.32 to 0.4±0.3; oculus sinister/left eye (OS) 0.6±0.35 to 0.3±0.35; p=0.177/0.003) and significant improvement in corneal staining (Oxford grading scheme: OD from 3±1.03 to 2±1.43, OS from 4±1.0 to 2±1.09, p=0.004/0.001) and ocular symptoms (ocular surface disease index: 88±20.59 to 63±22.77; p=0.02). Frequency of artificial tears was reduced and no side effects were reported. Patient satisfaction was 100%, and cost compensation by health insurance reached 80%. CONCLUSIONS 100% autologous serum eye drops using a sealed manufacturing system were efficient in improving the ocular surface, patient symptoms and visual acuity without side effects. It seems to be safe to use 100% autologous serum despite earlier suspicions regarding immune complex accumulations and exacerbation of ocular surface inflammation. The potential effects of serum levels of systemic immunosuppressives through readministration onto the ocular surface need to be elucidated.
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Affiliation(s)
- Volkan Tahmaz
- Department of Ophthalmology, Medical Faculty, University of Cologne, Cologne, Germany.,Competence Center for Ocular GvHD, Medical Faculty, University of Cologne, Cologne, Germany.,Cluster of Excellence: Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany
| | - Uta Gehlsen
- Department of Ophthalmology, Medical Faculty, University of Cologne, Cologne, Germany.,Competence Center for Ocular GvHD, Medical Faculty, University of Cologne, Cologne, Germany.,Cluster of Excellence: Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany
| | - Laura Sauerbier
- Department of Ophthalmology, Medical Faculty, University of Cologne, Cologne, Germany.,Competence Center for Ocular GvHD, Medical Faculty, University of Cologne, Cologne, Germany.,Cluster of Excellence: Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany
| | - Udo Holtick
- Department I of Internal Medicine, Medical Faculty, University of Cologne, Cologne, Germany
| | - Lisa Engel
- Department of Ophthalmology, Medical Faculty, University of Cologne, Cologne, Germany.,Competence Center for Ocular GvHD, Medical Faculty, University of Cologne, Cologne, Germany
| | - Stela Radojska
- Institute of Transfusion Medicine, Medical Faculty, University of Cologne, Cologne, Germany
| | | | - Christof Scheid
- Competence Center for Ocular GvHD, Medical Faculty, University of Cologne, Cologne, Germany.,Department I of Internal Medicine, Medical Faculty, University of Cologne, Cologne, Germany
| | - Michael Hallek
- Competence Center for Ocular GvHD, Medical Faculty, University of Cologne, Cologne, Germany.,Cluster of Excellence: Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany.,Department I of Internal Medicine, Medical Faculty, University of Cologne, Cologne, Germany
| | - Birgit Gathof
- Competence Center for Ocular GvHD, Medical Faculty, University of Cologne, Cologne, Germany.,Institute of Transfusion Medicine, Medical Faculty, University of Cologne, Cologne, Germany
| | - Claus Cursiefen
- Department of Ophthalmology, Medical Faculty, University of Cologne, Cologne, Germany.,Competence Center for Ocular GvHD, Medical Faculty, University of Cologne, Cologne, Germany
| | - Philipp Steven
- Department of Ophthalmology, Medical Faculty, University of Cologne, Cologne, Germany.,Competence Center for Ocular GvHD, Medical Faculty, University of Cologne, Cologne, Germany.,Cluster of Excellence: Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany
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Anitua E, Muruzabal F, de la Fuente M, Merayo J, Durán J, Orive G. Plasma Rich in Growth Factors for the Treatment of Ocular Surface Diseases. Curr Eye Res 2016; 41:875-82. [PMID: 26828610 DOI: 10.3109/02713683.2015.1104362] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
PURPOSE The purpose of this work is to describe and review the technology of plasma rich in growth factors (PRGF), a novel blood derivative product, in the treatment of ocular surface disorders. METHODS To demonstrate the importance of this technology in the treatment of ocular pathologies, a thorough review of the preclinical and clinical literature results obtained following use of the different therapeutic formulations of PRGF was carried out. A literature search for applications of PGRF plasma in the ophthalmology field was carried out using the PubMed database. RESULTS PRGF involves the use of patient's own biologically active proteins, growth factors, and biomaterial scaffolds for therapeutic purposes. This procedural technology is gaining interest in regenerative medicine due to its potential to stimulate and accelerate the tissue healing processes. The versatility and biocompatibility of this technology opens the door to a personalized medicine on ocular tissue regeneration. This review discusses the state of the art of the new treatments and technologies developed to promote ocular surface tissue regeneration. The standardized protocol that has been developed to source eye drops from PRGF technology is also described. The preclinical research, together with the most relevant clinical applications are summarized and discussed. CONCLUSIONS The preliminary results suggest that the use of PRGF to enhance ocular tissue regeneration is safe and efficient.
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Affiliation(s)
- Eduardo Anitua
- a Department of R&D , Biotechnology Institute (BTI) , Vitoria , Spain.,b Department of R&D , Fundación Eduardo Anitua , Vitoria , Spain
| | | | | | - Jesús Merayo
- c Fundación de Investigación Oftalmológica , Instituto Oftalmológico Fernández-Vega , Oviedo , Spain
| | - Juan Durán
- d Department of R&D , Instituto Clínico-Quirúrgico de Oftalmología , Bilbao , Spain.,e Department of Ophthalmology, School of Medicine and Dentistry, BioCruces Health Research Institute , University of the Basque Country , Leioa , Spain
| | - Gorka Orive
- a Department of R&D , Biotechnology Institute (BTI) , Vitoria , Spain.,b Department of R&D , Fundación Eduardo Anitua , Vitoria , Spain
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Afsharkhamseh N, Movahedan A, Gidfar S, Huvard M, Wasielewski L, Milani BY, Eslani M, Djalilian AR. Stability of limbal stem cell deficiency after mechanical and thermal injuries in mice. Exp Eye Res 2015; 145:88-92. [PMID: 26607808 DOI: 10.1016/j.exer.2015.11.012] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Revised: 11/11/2015] [Accepted: 11/12/2015] [Indexed: 12/15/2022]
Abstract
We studied the reproducibility and stability of limbal stem cell deficiency (LSCD) in mice following controlled injuries to the corneal and limbal epithelia. In one method, corneal and limbal epithelia were entirely removed with a 0.5 mm metal burr. In the other, limbus to limbus epithelial removal with the burr was followed by thermal injury to the limbus. These two methods were compared with a previously published one. Unwounded corneas were used as control. The corneas were examined monthly for three months by slit lamp with fluorescein staining. Immunofluorescence staining for cytokeratin 12 and 8 on corneal wholemount and cross sections were performed to determine the phenotype of the epithelium. Mechanical shaving of the epithelium, with or without thermal injury, resulted in a reproducible state of LSCD marked by superficial neovascularization, reduce of keratin 12 expression and presence of goblet cells on the cornea. The phenotype was stable in 100% of the eyes up to at least three months. Thermal injury produced a more severe phenotype with more significant stromal opacification. These corneal injury models may be useful for studying the mechanisms leading to limbal stem cell deficiency.
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Affiliation(s)
- Neda Afsharkhamseh
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, USA
| | - Asadolah Movahedan
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, USA
| | - Sanaz Gidfar
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, USA
| | - Michael Huvard
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, USA
| | - Lisa Wasielewski
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, USA
| | - Behrad Y Milani
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, USA
| | - Medi Eslani
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, USA
| | - Ali R Djalilian
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, USA.
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Preservation of Biological Activity of Plasma and Platelet-Derived Eye Drops After Their Different Time and Temperature Conditions of Storage. Cornea 2015; 34:1144-8. [DOI: 10.1097/ico.0000000000000489] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Kang NH, Lee S, Jun RM. Comparison of epitheliotrophic factors in autologous serum eyedrops from sera of chronic renal failure patients vs. normal controls. Graefes Arch Clin Exp Ophthalmol 2015; 253:1705-12. [DOI: 10.1007/s00417-015-3056-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Revised: 05/08/2015] [Accepted: 05/11/2015] [Indexed: 10/23/2022] Open
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Anitua E, de la Fuente M, Muruzabal F, Riestra A, Merayo-Lloves J, Orive G. Plasma rich in growth factors (PRGF) eye drops stimulates scarless regeneration compared to autologous serum in the ocular surface stromal fibroblasts. Exp Eye Res 2015; 135:118-26. [PMID: 25708868 DOI: 10.1016/j.exer.2015.02.016] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Revised: 12/29/2014] [Accepted: 02/13/2015] [Indexed: 11/26/2022]
Abstract
Autologous serum (AS) eye drops was the first blood-derived product used for the treatment of corneal pathologies but nowadays PRGF arises as a novel interesting alternative to this type of diseases. The purpose of this study was to evaluate and compare the biological outcomes of autologous serum eye drops or Plasma rich in growth factors (PRGF) eye drops on corneal stromal keratocytes (HK) and conjunctival fibroblasts (HConF). To address this, blood from healthy donors was collected and processed to obtain autologous serum (AS) eye drops and plasma rich in growth factors (PRGF) eye drops. Blood-derivates were aliquoted and stored at -80°C until use. PDGF-AB, VEGF, EGF, FGFb and TGF-β1 were quantified. The potential of PRGF and AS in promoting wound healing was evaluated by means of proliferation and migration assays in HK and HConF. Fibroblast cells were induced to myofibroblast differentiation after treatment with 2.5ng/mL of TGF-β1. The capability of PRGF and AS to prevent and inhibit TGF-β1-induced differentiation was evaluated. Results showed significant higher levels of all growth factors analyzed in PRGF eye drops compared to AS. Moreover, PRGF eye drops enhanced significantly the biological outcomes of both HK and HConF, and reduced TGF-β1-induced myofibroblast differentiation in contrast to autologous serum eye drops (AS). In summary, these results suggest that PRGF exerts enhanced biological outcomes than AS. PRGF may improve the treatment of ocular surface wound healing minimizing the scar formation compared to AS. Results obtained herein suggest that PRGF protects and reverses the myofibroblast phenotype while promotes cell proliferation and migration.
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Affiliation(s)
- E Anitua
- Biotechnology Institute (BTI), Vitoria, Spain
| | | | - F Muruzabal
- Biotechnology Institute (BTI), Vitoria, Spain
| | - A Riestra
- Fundación de Investigación Oftalmológica, Instituto Oftalmológico Fernández-Vega, Oviedo, Spain
| | - J Merayo-Lloves
- Fundación de Investigación Oftalmológica, Instituto Oftalmológico Fernández-Vega, Oviedo, Spain
| | - G Orive
- Biotechnology Institute (BTI), Vitoria, Spain.
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