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Vujosevic S, Lupidi M, Donati S, Astarita C, Gallinaro V, Pilotto E. Role of inflammation in diabetic macular edema and neovascular age-related macular degeneration. Surv Ophthalmol 2024; 69:870-881. [PMID: 39029747 DOI: 10.1016/j.survophthal.2024.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 07/09/2024] [Accepted: 07/15/2024] [Indexed: 07/21/2024]
Abstract
Diabetic macular edema (DME) and neovascular age-related macular degeneration (nAMD) are multifactorial disorders that affect the macula and cause significant vision loss. Although inflammation and neoangiogenesis are hallmarks of DME and nAMD, respectively, they share some biochemical mediators. While inflammation is a trigger for the processes that lead to the development of DME, in nAMD inflammation seems to be the consequence of retinal pigment epithelium and Bruch membrane alterations. These pathophysiologic differences may be the key issue that justifies the difference in treatment strategies. Vascular endothelial growth factor inhibitors have changed the treatment of both diseases, however, many patients with DME fail to achieve the established therapeutic goals. From a clinical perspective, targeting inflammatory pathways with intravitreal corticosteroids has been proven to be effective in patients with DME. On the contrary, the clinical relevance of addressing inflammation in patients with nAMD has not been proven yet. We explore the role and implication of inflammation in the development of nAMD and DME and its therapeutical relevance.
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Affiliation(s)
- Stela Vujosevic
- Department of Biomedical, Surgical and Dental Sciences University of Milan, Milan, Italy; Eye Clinic, IRCCS MultiMedica, Milan, Italy
| | - Marco Lupidi
- Eye Clinic, Department of Experimental and Clinical Medicine, Polytechnic University of Marche, Ancona, Italy.
| | - Simone Donati
- Department of Medicine and Surgery, University of Insubria of Varese, Varese, Italy
| | - Carlo Astarita
- AbbVie S.r.l., SR 148 Pontina, Campoverde, LT 04011, Italy
| | | | - Elisabetta Pilotto
- Department of Neuroscience-Ophthalmology, University of Padova, Padova, Italy
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Pilotaz F, Loftsson T. Aqueous eye drop formulations: Cyclodextrins as enabling excipients. ANNALES PHARMACEUTIQUES FRANÇAISES 2024:S0003-4509(24)00110-X. [PMID: 39127321 DOI: 10.1016/j.pharma.2024.08.003] [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: 06/16/2024] [Revised: 07/30/2024] [Accepted: 08/06/2024] [Indexed: 08/12/2024]
Abstract
Cyclodextrins are enabling pharmaceutical excipients that solubilize and stabilize drugs in aqueous formulations. Cyclodextrins possess very favorable pharmacokinetic and toxicological profiles and are commonly used in marketed drug products for oral and parenteral administration. However, their use in ophthalmic products is still very limited. Cyclodextrins have a broad range of physical properties that are specifically appropriate for designing topical ophthalmic dosage forms. Additionally, both the regulatory and intellectual property environments have been cleared over the last years and should foster their use for designing new drugs for ophthalmic use.
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Affiliation(s)
- Frédéric Pilotaz
- Horus-Pharma, Département des Opérations Industrielles, 22, allée Camille-Muffat, bât. Inedi 5, 06200 Nice, France.
| | - Thorsteinn Loftsson
- Faculty of Pharmaceutical Sciences, School of Health Sciences, University of Iceland, Hofsvallagata 53, 107 Reykjavik, Iceland
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Yan A, Jones C, Demirel S, Chhablani J. Diabetic macular edema: Upcoming therapies. Graefes Arch Clin Exp Ophthalmol 2024:10.1007/s00417-024-06595-7. [PMID: 39069568 DOI: 10.1007/s00417-024-06595-7] [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: 05/31/2024] [Revised: 07/16/2024] [Accepted: 07/18/2024] [Indexed: 07/30/2024] Open
Abstract
Diabetic macular edema (DME) is a serious vision-threatening complication that can arise at any stage of diabetic retinopathy. Primary treatment involves anti-vascular endothelial growth factor (VEGF) agents, which are highly effective but associated with challenges, such as the need for frequent injections, relapses, and resistance to therapy. Therefore, there has been a growing interest in developing new treatments that offer similar or superior outcomes in DME. This review article explores emerging treatments, including WNT agonists, gene therapy, protein inhibitors, and, most importantly, the first-ever non-invasive and oral drugs. The evolving therapies in diabetic retinopathy offer hope for continued improvement in vision loss associated with one of the most common chronic conditions worldwide.
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Affiliation(s)
- Audrey Yan
- Department of Medicine, West Virginia School of Osteopathic Medicine, Lewisburg, WV, USA
| | - Crandall Jones
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Sibel Demirel
- Department of Ophthalmology, Ankara University School of Medicine, Ankara, Turkey
| | - Jay Chhablani
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
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Thareja A, Leigh T, Hakkarainen JJ, Hughes H, Alvarez-Lorenzo C, Fernandez-Trillo F, Blanch RJ, Ahmed Z. Improving corneal permeability of dexamethasone using penetration enhancing agents: First step towards achieving topical drug delivery to the retina. Int J Pharm 2024; 660:124305. [PMID: 38852749 DOI: 10.1016/j.ijpharm.2024.124305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 06/03/2024] [Accepted: 06/04/2024] [Indexed: 06/11/2024]
Abstract
With an ever-increasing burden of vision loss caused by diseases of the posterior ocular segment, there is an unmet clinical need for non-invasive treatment strategies. Topical drug application using eye drops suffers from low to negligible bioavailability to the posterior segment as a result of static and dynamic defensive ocular barriers to penetration, while invasive delivery systems are expensive to administer and suffer potentially severe complications. As the cornea is the main anatomical barrier to uptake of topically applied drugs from the ocular surface, we present an approach to increase corneal permeability of a corticosteroid, dexamethasone sodium-phosphate (DSP), using a novel penetration enhancing agent (PEA). We synthesised a novel polyacetylene (pAc) polymer and compared its activity to two previously described cell penetrating peptide (CPP) based PEAs, TAT and penetratin, with respect to increasing transcorneal permeability of DSP in a rapid ex-vivo porcine corneal assay over 60 min. The transcorneal apparent permeability coefficients (Papp) for diffusion of pAc, and fluorescein isothiocyanate (FITC) conjugated TAT and penetratin were up to 5 times higher (p < 0.001), when compared to controls. When pAc was used in formulation with DSP, an almost 5-fold significant increase was observed in Papp of DSP across the cornea (p = 0.0130), a significant 6-fold increase with TAT (p = 0.0377), and almost 7-fold mean increase with penetratin (p = 0.9540). Furthermore, we investigated whether the PEAs caused any irreversible damage to the barrier integrity of the corneal epithelium by measuring transepithelial electrical resistance (TEER) and immunostaining of tight junction proteins using zonula occludens-1 (ZO-1) and occludin antibodies. There was no damage or structural toxicity, and the barrier integrity was preserved after PEA application. Finally, an in-vitro cytotoxicity assessment of all PEAs in human retinal pigment epithelium cells (ARPE-19) demonstrated that all PEAs were very well-tolerated, with IC50 values of 64.79 mM for pAc and 1335.45 µM and 87.26 µM for TAT and penetratin, respectively. Our results suggest that this drug delivery technology could potentially be used to achieve a significantly higher intraocular therapeutic bioavailability after topical eye drop administration, than currently afforded.
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Affiliation(s)
- Abhinav Thareja
- Neuroscience and Ophthalmology Group, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, West Midlands, United Kingdom.
| | - Thomas Leigh
- School of Chemistry, University of Birmingham, Edgbaston, Birmingham B15 2TT, West Midlands, United Kingdom; Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin 2, Ireland.
| | | | - Helen Hughes
- Pharmaceutical and Molecular Biotechnology Research Centre (PMBRC), School of Science & Computing, Department of Science, South East Technological University, Cork Road, Waterford City X91 K0EK, Ireland.
| | - Carmen Alvarez-Lorenzo
- Departamento de Farmacología, Farmacia y Tecnología Farmacéutica, I+DFarma, Facultad de Farmacia, iMATUS and Health Research Institute of Santiago de Compostela (IDIS), Universidade de Santiago de Compostela, 15782 Santiago de Compostela, Spain.
| | - Francisco Fernandez-Trillo
- School of Chemistry, University of Birmingham, Edgbaston, Birmingham B15 2TT, West Midlands, United Kingdom; BioMedNano Group, Centro de Investigacións Científicas Avanzadas (CICA), Facultade de Ciencias Rúa As Carballeiras, Universidade da Coruna, 15008 A Coruña, Galicia, Spain.
| | - Richard J Blanch
- Neuroscience and Ophthalmology Group, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, West Midlands, United Kingdom; Academic Department of Military Surgery & Trauma, Royal Centre for Defence Medicine, United Kingdom; Department of Ophthalmology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, West Midlands, United Kingdom; Centre for Trauma Sciences Research, University of Birmingham, Edgbaston, Birmingham B15 2TT, West Midlands, United Kingdom.
| | - Zubair Ahmed
- Neuroscience and Ophthalmology Group, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, West Midlands, United Kingdom; Centre for Trauma Sciences Research, University of Birmingham, Edgbaston, Birmingham B15 2TT, West Midlands, United Kingdom.
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Marto-Costa C, Toffoletto N, Salema-Oom M, Antunes AMM, Pinto CA, Saraiva JA, Silva-Herdade AS, Alvarez-Lorenzo C, Serro AP. Improved triamcinolone acetonide-eluting contact lenses based on cyclodextrins and high hydrostatic pressure assisted complexation. Carbohydr Polym 2024; 331:121880. [PMID: 38388063 DOI: 10.1016/j.carbpol.2024.121880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 01/25/2024] [Accepted: 01/26/2024] [Indexed: 02/24/2024]
Abstract
Contact lenses (CLs) constitute an advantageous platform for the topical release of corticosteroids due to their prolonged contact with the eye. However, the lipophilic nature of corticosteroids hampers CLs' ability to release therapeutic amounts. Two approaches to improve loading and release of triamcinolone acetonide (TA) from poly(2-hydroxyethyl methacrylate)-based hydrogels were investigated: adding 2-hydroxypropyl-β-cyclodextrin (HP-β-CD) to the monomers solution before polymerization (HEMA/i-CD) and an hydrogels' post-treatment with HP-β-CD (HEMA/p-CD). The effect of HP-β-CD and sterilization by high hydrostatic pressure (HHP) on the hydrogel properties (water content, oxygen and ion permeability, roughness, transmittance, and stiffness) was evaluated. The HEMA/i-CD hydrogels had stronger affinity for TA, sustaining its release for one day. HHP sterilization promoted the formation of cyclodextrin-TA complexes within the hydrogels, improving their drug-loading capacity »60 %. Cytotoxicity and irritability tests confirmed the safety of the therapeutic CLs. TA released from the hydrogels permeated through ocular tissues ex vivo and showed anti-inflammatory activity. Finally, a previously validated mathematical model was used to estimate the ability of the TA-loaded CLs to deliver therapeutic drug concentrations to the posterior part of the eye. Overall, HP-β-CD-containing CLs are promising candidates for the topical ocular application of TA as an alternative delivery system to intraocular injections.
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Affiliation(s)
- Carolina Marto-Costa
- Centro de Química Estrutural (CQE) - Institute of Molecular Sciences and Chemical Engineering Department, Instituto Superior Técnico - University of Lisbon, Av. Rovisco Pais, 1049-001 Lisboa, Portugal; Egas Moniz Center for Interdisciplinary Research (CiiEM), Egas Moniz School of Health & Science, Campus Universitário, Quinta da Granja, 2829-511 Monte da Caparica, Almada, Portugal.
| | - Nadia Toffoletto
- Centro de Química Estrutural (CQE) - Institute of Molecular Sciences and Chemical Engineering Department, Instituto Superior Técnico - University of Lisbon, Av. Rovisco Pais, 1049-001 Lisboa, Portugal; Egas Moniz Center for Interdisciplinary Research (CiiEM), Egas Moniz School of Health & Science, Campus Universitário, Quinta da Granja, 2829-511 Monte da Caparica, Almada, Portugal.
| | - Madalena Salema-Oom
- Egas Moniz Center for Interdisciplinary Research (CiiEM), Egas Moniz School of Health & Science, Campus Universitário, Quinta da Granja, 2829-511 Monte da Caparica, Almada, Portugal.
| | - Alexandra M M Antunes
- Centro de Química Estrutural (CQE) - Institute of Molecular Sciences and Chemical Engineering Department, Instituto Superior Técnico - University of Lisbon, Av. Rovisco Pais, 1049-001 Lisboa, Portugal.
| | - Carlos A Pinto
- LAQV-REQUIMTE, Chemical Engineering Department, University of Aveiro, Campus Universitário de Santiago, 3810-193 Aveiro, Portugal.
| | - Jorge A Saraiva
- LAQV-REQUIMTE, Chemical Engineering Department, University of Aveiro, Campus Universitário de Santiago, 3810-193 Aveiro, Portugal.
| | - Ana S Silva-Herdade
- Instituto de Bioquímica, Instituto de Medicina Molecular, Faculdade de Medicina - University of Lisbon, Av. Prof. Egas Moniz, 1649-028 Lisboa, Portugal.
| | - Carmen Alvarez-Lorenzo
- Departamento de Farmacología, Farmacia y Tecnología Farmacéutica, I+DFarma (GI-1645), Facultad de Farmacia, Instituto de Materiales (iMATUS) and Health Research Institute of Santiago de Compostela (IDIS), Universidade de Santiago de Compostela, 15782 Santiago de Compostela, Spain.
| | - Ana Paula Serro
- Centro de Química Estrutural (CQE) - Institute of Molecular Sciences and Chemical Engineering Department, Instituto Superior Técnico - University of Lisbon, Av. Rovisco Pais, 1049-001 Lisboa, Portugal; Egas Moniz Center for Interdisciplinary Research (CiiEM), Egas Moniz School of Health & Science, Campus Universitário, Quinta da Granja, 2829-511 Monte da Caparica, Almada, Portugal.
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Cheng Z, Liu X. Comparing the efficacy of glucocorticoids and anti-VEGF in treating diabetic macular edema: systematic review and comprehensive analysis. Front Endocrinol (Lausanne) 2024; 15:1342530. [PMID: 38586457 PMCID: PMC10995385 DOI: 10.3389/fendo.2024.1342530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 03/07/2024] [Indexed: 04/09/2024] Open
Abstract
Introduction The aim of this study was to better understand the efficacy of various drugs, such as glucocorticoids and anti-vascular endothelial growth factors (VEGF), in the treatment of diabetic macular edema (DME), and to evaluate various clinical treatment regimens consisting of different therapeutic measures. Methods This study included randomized controlled trials up to February 2023 comparing the efficacy of corticosteroid-related therapy and anti-VEGF therapy. PubMed, the Cochrane Library, and Embase were searched, and the quality of the studies was carefully assessed. Finally, 39 studies were included. Results Results at 3-month followup showed that intravitreal injection of bevacizumab (IVB) + triamcinolone acetonide (TA) was the most beneficial in improving best-corrected visual acuity and reducing the thickness of macular edema in the center of the retina in patients with DME. Results at 6-month follow-up showed that intravitreal dexamethasone (DEX) was the most effective in improving patients' bestcorrected visual acuity and reducing the thickness of central macular edema. Discussion Overall, IVB+TA was beneficial in improving best-corrected visual acuity and reducing central macular edema thickness over a 3-month follow-up period, while DEX implants had a better therapeutic effect than anti-VEGF agents at 6 months, especially the patients with severe macular edema and visual acuity impaired. Systematic review registration https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=397100, identifier CRD42023397100.
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Affiliation(s)
- Zhi’ang Cheng
- Department of Ophthalmology, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, China
| | - Xiaoyong Liu
- Department of Ophthalmology, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, China
- Department of Ophthalmology, The Affiliated Shunde Hospital of Jinan University, Foshan, Guangdong, China
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Bhatnagar A, Ting DSW, Weng CY. Treatment Options for Diabetic Macular Edema. Int Ophthalmol Clin 2024; 64:57-69. [PMID: 38146881 DOI: 10.1097/iio.0000000000000518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2023]
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Thng ZX, Bromeo AJ, Mohammadi SS, Khatri A, Tran ANT, Akhavanrezayat A, T T Than N, Nguyen KS, Yoo WS, Mobasserian A, Or CCM, Nguyen QD. Recent advances in uveitis therapy: focus on selected phase 2 and 3 clinical trials. Expert Opin Emerg Drugs 2023; 28:297-309. [PMID: 38129984 DOI: 10.1080/14728214.2023.2293049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 12/06/2023] [Indexed: 12/23/2023]
Abstract
INTRODUCTION Uveitis is a heterogeneous group of ocular conditions characterized by inflammation of the uveal tract. It is a leading cause of blindness in developed countries and exerts significant psychological, social, and economic impact on both patients and the larger society. While there are numerous pharmacotherapy options, posterior segment noninfectious uveitis remains a significant challenge to treat due to its severity, chronicity, and high recurrence rates. AREAS COVERED The index review highlights the unmet needs of uveitis pharmacotherapy and its research and the shortcomings of existing ocular and systemic therapeutic options for noninfectious uveitis. The more promising novel ocular drug delivery methods and therapeutic targets/drugs are discussed, and evidence from the clinical trials is evaluated. EXPERT OPINION There has been incredible growth in the number of treatment options available to uveitis patients today, especially with the new generation of biologic drugs. Available evidence suggests that these newer options may be superior to conventional immunosuppressive therapies in terms of efficacy and side effect profiles. Further high-quality research and additional clinical trials will be needed to clarify their roles in the stepladder treatment approach of noninfectious uveitis.
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Affiliation(s)
- Zheng Xian Thng
- Byers Eye Institute, Stanford University, Palo Alto, California, USA
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore
| | - Albert John Bromeo
- Byers Eye Institute, Stanford University, Palo Alto, California, USA
- Asian Eye Institute, Makati, Philippines
| | - S Saeed Mohammadi
- Byers Eye Institute, Stanford University, Palo Alto, California, USA
| | - Anadi Khatri
- Byers Eye Institute, Stanford University, Palo Alto, California, USA
- Birat Aankha Aspatal, Biratnagar, Nepal
- Department of Ophthalmology, Birat Medical College and Teaching Hospital, Kathmandu University, Biratnagar, Nepal
| | - Anh N T Tran
- Byers Eye Institute, Stanford University, Palo Alto, California, USA
| | | | - Ngoc T T Than
- Byers Eye Institute, Stanford University, Palo Alto, California, USA
| | - Khiem S Nguyen
- Byers Eye Institute, Stanford University, Palo Alto, California, USA
| | - Woong-Sun Yoo
- Byers Eye Institute, Stanford University, Palo Alto, California, USA
- Department of Ophthalmology, Gyeongsang National University College of Medicine, and Gyeongsang National University Hospital, Jinju, Republic of Korea
| | | | | | - Quan Dong Nguyen
- Byers Eye Institute, Stanford University, Palo Alto, California, USA
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Loukovaara S, Korhonen A, Niskanen L, Haukka J. Development of diabetic macular oedema shows associations with systemic medication - An epidemiological study. Acta Ophthalmol 2023. [PMID: 37789702 DOI: 10.1111/aos.15778] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 08/15/2023] [Accepted: 09/18/2023] [Indexed: 10/05/2023]
Abstract
PURPOSE To identify associations between systemic drugs and the incidence of diabetic macular oedema (DME). Of interest was to find beneficial and/or deleterious associations of used drugs. METHODS A historic cohort design based on administrative data. Study population consisted of 150 353 individuals with diabetes. Endpoint event was the development of DME (ICD-10 H36.01), censoring events were death or study end December 2017. The follow-up started between 1997 and 2010. The systemic medication consisted of 95 substances. We constructed a nested case-control study design comparing 2630 cases with DME to 13 144 age- and sex-matched controls without DME. Results are reported as odds ratios (ORs) with 95% confidence intervals (CIs) based on conditional logistic regression models. RESULTS Incidence rate for DME was 1.80 per 1000 person-years (95% CI 1.73-1.87). In all, we observed a lower incidence rate of DME in females (IRR 0.57; 95% CI 0.52-0.62) compared to males. Exposure to hormone replacement therapy estradiol (OR 0.42; 0.25-0.68), temazepam (0.23; 0.08-0.62) and allopurinol (0.61; 0.43-0.86) were associated with lower risk of DME, while use of insulin or insulin analogue (3.30; 2.99-3.64), sulfonylureas (1.21; 1.05-1.40), diuretic furosemide (1.90; 1.61-2.24), calcium channel blocker amlodipine (1.53; 1.34-1.75), ACE inhibitors ramipril (1.66; 1.46-1.89) and enalapril (1.38; 1.16-1.64) were associated with an increased risk of DME. CONCLUSIONS Large-scale studies examining the incidence of DME are lacking. Our findings suggest that associations of systemic medications with the incidence of DME may shed light on the pathogenesis of complex DME, encouraging further studies.
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Affiliation(s)
- Sirpa Loukovaara
- Individualized Drug Therapy Research Program, University of Helsinki, Helsinki, Finland
- Unit of Vitreoretinal Surgery, Department of Ophthalmology, Helsinki University Hospital, Helsinki, Finland
| | - Ani Korhonen
- Individualized Drug Therapy Research Program, University of Helsinki, Helsinki, Finland
| | - Leo Niskanen
- Päijät-Häme Central Hospital, Lahti and Eira Hospital, Helsinki Finland and University of Eastern Finland, Kuopio, Finland
| | - Jari Haukka
- Department of Public Health, University of Helsinki, Helsinki, Finland
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Kannan RM, Pitha I, Parikh KS. A new era in posterior segment ocular drug delivery: Translation of systemic, cell-targeted, dendrimer-based therapies. Adv Drug Deliv Rev 2023; 200:115005. [PMID: 37419213 DOI: 10.1016/j.addr.2023.115005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 06/16/2023] [Accepted: 07/04/2023] [Indexed: 07/09/2023]
Abstract
Vision impairment and loss due to posterior segment ocular disorders, including age-related macular degeneration and diabetic retinopathy, are a rapidly growing cause of disability globally. Current treatments consist primarily of intravitreal injections aimed at preventing disease progression and characterized by high cost and repeated clinic visits. Nanotechnology provides a promising platform for drug delivery to the eye, with potential to overcome anatomical and physiological barriers to provide safe, effective, and sustained treatment modalities. However, there are few nanomedicines approved for posterior segment disorders, and fewer that target specific cells or that are compatible with systemic administration. Targeting cell types that mediate these disorders via systemic administration may unlock transformative opportunities for nanomedicine and significantly improve patient access, acceptability, and outcomes. We highlight the development of hydroxyl polyamidoamine dendrimer-based therapeutics that demonstrate ligand-free cell targeting via systemic administration and are under clinical investigation for treatment of wet age-related macular degeneration.
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Affiliation(s)
- Rangaramanujam M Kannan
- Center for Nanomedicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Departments of Chemical and Biomolecular Engineering and Materials Science and Engineering, Johns Hopkins University, Baltimore, MD, USA.
| | - Ian Pitha
- Center for Nanomedicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Glaucoma Center of Excellence, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Kunal S Parikh
- Center for Nanomedicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Center for Bioengineering Innovation & Design, Johns Hopkins University, Baltimore, MD, USA; Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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11
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Sapowadia A, Ghanbariamin D, Zhou L, Zhou Q, Schmidt T, Tamayol A, Chen Y. Biomaterial Drug Delivery Systems for Prominent Ocular Diseases. Pharmaceutics 2023; 15:1959. [PMID: 37514145 PMCID: PMC10383518 DOI: 10.3390/pharmaceutics15071959] [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: 05/02/2023] [Revised: 06/26/2023] [Accepted: 07/13/2023] [Indexed: 07/30/2023] Open
Abstract
Ocular diseases, such as age-related macular degeneration (AMD) and glaucoma, have had a profound impact on millions of patients. In the past couple of decades, these diseases have been treated using conventional techniques but have also presented certain challenges and limitations that affect patient experience and outcomes. To address this, biomaterials have been used for ocular drug delivery, and a wide range of systems have been developed. This review will discuss some of the major classes and examples of biomaterials used for the treatment of prominent ocular diseases, including ocular implants (biodegradable and non-biodegradable), nanocarriers (hydrogels, liposomes, nanomicelles, DNA-inspired nanoparticles, and dendrimers), microneedles, and drug-loaded contact lenses. We will also discuss the advantages of these biomaterials over conventional approaches with support from the results of clinical trials that demonstrate their efficacy.
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Affiliation(s)
- Avin Sapowadia
- Department of Biomedical Engineering, University of Connecticut, Storrs, CT 06269, USA
| | - Delaram Ghanbariamin
- Department of Biomedical Engineering, University of Connecticut, Storrs, CT 06269, USA
- Department of Biomedical Engineering, University of Connecticut Health Center, Farmington, CT 06030, USA
| | - Libo Zhou
- Department of Biomedical Engineering, University of Connecticut, Storrs, CT 06269, USA
| | - Qifa Zhou
- Department of Biomedical Engineering and Ophthalmology, University of Southern California, Los Angeles, CA 90089, USA
| | - Tannin Schmidt
- Department of Biomedical Engineering, University of Connecticut, Storrs, CT 06269, USA
- Department of Biomedical Engineering, University of Connecticut Health Center, Farmington, CT 06030, USA
| | - Ali Tamayol
- Department of Biomedical Engineering, University of Connecticut, Storrs, CT 06269, USA
- Department of Biomedical Engineering, University of Connecticut Health Center, Farmington, CT 06030, USA
| | - Yupeng Chen
- Department of Biomedical Engineering, University of Connecticut, Storrs, CT 06269, USA
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