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Perez VL, Mousa HM, Miyagishima KJ, Reed AA, Su AJA, Greenwell TN, Washington KM. Retinal transplant immunology and advancements. Stem Cell Reports 2024; 19:817-829. [PMID: 38729155 PMCID: PMC11297553 DOI: 10.1016/j.stemcr.2024.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 04/12/2024] [Accepted: 04/15/2024] [Indexed: 05/12/2024] Open
Abstract
Several gaps and barriers remain for transplanting stem cells into the eye to treat ocular disease, especially diseases of the retina. While the eye has historically been considered immune privileged, recent thinking has identified the immune system as both a barrier and an opportunity for eye stem cell transplantation. Recent approaches leveraging scaffolds or cloaking have been considered in other tissues beyond immune suppression. This perspective paper outlines approaches for transplantation and proposes opportunities to overcome barriers of the immune system in stem cell transplantation in the eye.
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Affiliation(s)
- Victor L Perez
- Department of Ophthalmology, Duke University Medical Center, Durham, NC, USA; Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA.
| | - Hazem M Mousa
- Department of Ophthalmology, Duke University Medical Center, Durham, NC, USA
| | | | - Amberlynn A Reed
- National Eye Institute, National Institutes of Health, Bethesda, MD, USA
| | - An-Jey A Su
- Department of Surgery, University of Colorado School of Medicine, CU Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Thomas N Greenwell
- National Eye Institute, National Institutes of Health, Bethesda, MD, USA
| | - Kia M Washington
- Department of Surgery, University of Colorado School of Medicine, CU Anschutz Medical Campus, Aurora, CO 80045, USA.
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Salcedo-Ledesma A, Córdoba A, Zatarain-Barrón NC, Graue-Hernández EO, Garfias Y, Morales Flores N, García-Sánchez GA, García-Santisteban D, Linares-Alba MA, García-Santisteban R, Navas A. Subconjunctival Sirolimus-Loaded Liposomes for the Treatment of Moderate-to-Severe Dry Eye Disease. Clin Ophthalmol 2023; 17:1295-1305. [PMID: 37181078 PMCID: PMC10167993 DOI: 10.2147/opth.s405841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 04/20/2023] [Indexed: 05/16/2023] Open
Abstract
Purpose To determine the effectiveness of subconjunctival application of a novel sirolimus liposomal formulation for the treatment of dry eye. Methods A randomized, triple-blind, Phase II clinical trial. Thirty-eight eyes of 19 patients were included. Nine patients (18 eyes) assigned to the sham group (Sham) and 10 patients (20 eyes) to sirolimus-loaded liposomes group (Sirolimus). The treatment group received three doses of subconjunctival liposome-encapsulated sirolimus and the sham group received three doses of liposomal suspension without sirolimus. Subjective (Ocular Surface Disease Index, OSDI) and measured (corrected distance visual acuity, conjunctival hyperemia, tear osmolarity, Schirmer's test, corneal/conjunctival staining and matrix metalloproteinase-9) variables were measured. Results Sirolimus-entrapped liposomes-treated group OSDI scores changed from 62.19 (± 6.07) to 37.8 (± 17.81) (p=0.0024), and conjunctival hyperemia from 2.0 (± 0.68) to 0.83 (± 0.61) (p<0.0001); Sham group with OSDI scores from 60.02 (± 14.2) to 36.02 (± 20.70) (p=0.01), and conjunctival hyperemia from 1.33 (± 0.68) to 0.94 (± 0.87) (p=0.048). All the other evaluated outcomes only showed significant differences in the sirolimus group: corneal/conjunctival staining score (p=0.0015), lipid layer interferometry (p=0.006), and inferior meibomian gland dropout (p=0.038). No local or systemic adverse effects regarding the medication itself were reported, and the administration route was well accepted. Conclusion Our findings suggest that sub-conjunctival sirolimus-loaded liposomes are effective in reducing both signs and symptoms of dry eye in patients with poorly controlled moderate-to-severe DED, while avoiding other topical administration adverse effects. Further investigation with a larger sample size is required to determine long-term effects.
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Affiliation(s)
- Alfredo Salcedo-Ledesma
- Department of Cornea and Refractive Surgery, Institute of Ophthalmology “Conde de Valenciana”, Mexico City, Mexico
- PECEM MD/PhD Program, Faculty of Medicine, UNAM, Mexico City, Mexico
| | - Andrea Córdoba
- Department of Cornea and Refractive Surgery, Institute of Ophthalmology “Conde de Valenciana”, Mexico City, Mexico
| | - Naomi C Zatarain-Barrón
- Department of Cornea and Refractive Surgery, Institute of Ophthalmology “Conde de Valenciana”, Mexico City, Mexico
| | - Enrique O Graue-Hernández
- Department of Cornea and Refractive Surgery, Institute of Ophthalmology “Conde de Valenciana”, Mexico City, Mexico
| | - Yonathan Garfias
- Department of Biochemistry, Faculty of Medicine, UNAM, Mexico City, Mexico
- Research Unit, Institute of Ophthalmology “Conde de Valenciana”, Mexico City, Mexico
| | - Norma Morales Flores
- Department of Cornea and Refractive Surgery, Institute of Ophthalmology “Conde de Valenciana”, Mexico City, Mexico
| | | | | | | | | | - Alejandro Navas
- Department of Cornea and Refractive Surgery, Institute of Ophthalmology “Conde de Valenciana”, Mexico City, Mexico
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Kate A, Shanbhag SS, Donthineni PR, Amescua G, Quinones VLP, Basu S. Role of topical and systemic immunosuppression in aqueous-deficient dry eye disease. Indian J Ophthalmol 2023; 71:1176-1189. [PMID: 37026249 PMCID: PMC10276741 DOI: 10.4103/ijo.ijo_2818_22] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 12/19/2022] [Accepted: 01/27/2023] [Indexed: 04/08/2023] Open
Abstract
Immunosuppression in aqueous-deficient dry eye disease (ADDE) is required not only to improve the symptoms and signs but also to prevent further progression of the disease and its sight-threatening sequelae. This immunomodulation can be achieved through topical and/or systemic medications, and the choice of one drug over the other is determined by the underlying systemic disease. These immunosuppressive agents require a minimum of 6-8 weeks to achieve their beneficial effect, and during this time, the patient is usually placed on topical corticosteroids. Antimetabolites such as methotrexate, azathioprine, and mycophenolate mofetil, along with calcineurin inhibitors, are commonly used as first-line medications. The latter have a pivotal role in immunomodulation since T cells contribute significantly to the pathogenesis of ocular surface inflammation in dry eye disease. Alkylating agents are largely limited to controlling acute exacerbations with pulse doses of cyclophosphamide. Biologic agents, such as rituximab, are particularly useful in patients with refractory disease. Each group of drugs has its own side-effect profiles and requires a stringent monitoring schedule that must be followed to prevent systemic morbidity. A customized combination of topical and systemic medications is usually required to achieve adequate control, and this review aims to help the clinician choose the most appropriate modality and monitoring regimen for a given case of ADDE.
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Affiliation(s)
- Anahita Kate
- Shantilal Shanghvi Cornea Institue, LV Prasad Eye Institute, Vijayawada, Andhra Pradesh, India
| | - Swapna S Shanbhag
- Shantilal Shanghvi Cornea Institue, LV Prasad Eye Institute, Hyderabad, Telengana, India
| | - Pragnya R Donthineni
- Shantilal Shanghvi Cornea Institue, LV Prasad Eye Institute, Hyderabad, Telengana, India
| | - Guillermo Amescua
- Department of Ophthalmology, Duke Eye Center, Duke University School of Medicine, Durham 27705, NC, USA
| | - Victor L Perez Quinones
- Foster Center for Ocular Immunology, Department of Ophthalmology, Duke Eye Center, Duke University School of Medicine, Durham, North Carolina, USA
| | - Sayan Basu
- Shantilal Shanghvi Cornea Institue, LV Prasad Eye Institute, Hyderabad, Telengana, India
- Center for Ocular Regeneration (CORE), L. V. Prasad Eye Institute, Hyderabad, Telangana, India
- Brien Holden Eye Research Centre, L. V. Prasad Eye Institute, Hyderabad, Telangana, India
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4
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Executive summary: Japanese guidelines for allergic conjunctival diseases 2021. Allergol Int 2022; 71:459-471. [PMID: 36096976 DOI: 10.1016/j.alit.2022.07.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 07/14/2022] [Indexed: 11/23/2022] Open
Abstract
Allergic conjunctival disease (ACD) is an inflammatory disease of the conjunctiva that is mainly caused by type I hypersensitivity response to allergens and accompanied by subjective symptoms and other findings induced by antigens. ACD is classified as allergic conjunctivitis, atopic keratoconjunctivitis, vernal keratoconjunctivitis, and giant papillary conjunctivitis. This article summarizes the third edition of the Japanese guidelines for allergic conjunctival diseases published in 2021 and outlines the diagnosis, pathogenesis, and treatment of ACD. Since the introduction of immunosuppressive eye drops, the treatment strategies for severe ACDs have significantly changed. To clarify the recommended standard treatment protocols for ACD, the advantages and disadvantages of these treatments were assessed using clinical questions, with a focus on the use of steroids and immunosuppressive drugs. This knowledge will assist healthcare providers and patients in taking an active role in medical decision making.
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Jo YJ, Kim JH, Lee JS. The Therapeutic Effects of a 0.03% Tacrolimus Ointment on Childhood Phlyctenular Keratitis. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2021. [DOI: 10.3341/jkos.2021.62.7.888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Purpose: We explored the therapeutic effects of a 0.03% tacrolimus ointment (Protopic) on steroid-resistant phlyctenular keratitis in children. Methods: We enrolled seven eyes of five children with recurrent phlyctenular keratitis despite 3 months of steroid treatment. The topical steroids were tapered and the patients treated with a combination of 0.03% tacrolimus and 0.3% ofloxacin ointment. The logarithm of minimal angle of resolution (logMAR) visual acuity, corneal neovascularization status, and changes in corneal opacity between the baseline and final visit were checked on anterior photographs using Image J software. Results: The average patient age was 6.8 ± 3.0 years (range, 3-9 years) and the treatment duration 8.0 ± 2.0 days (range, 5-10 days). The baseline logMAR visual acuity was 0.42 ± 0.32 and the final value 0.19 ± 0.22. Visual acuity thus improved significantly after treatment (p = 0.026). Corneal neovascularization and phylctenulosis improved in all seven eyes; the fibrotic corneal opacity decreased in two eyes. Conclusions: Topical 0.03% tacrolimus ointment may usefully treat steroid-resistant phlyctenular keratitis of childhood.
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Parikh KS, Omiadze R, Josyula A, Shi R, Anders NM, He P, Yazdi Y, McDonnell PJ, Ensign LM, Hanes J. Ultra-thin, high strength, antibiotic-eluting sutures for prevention of ophthalmic infection. Bioeng Transl Med 2021; 6:e10204. [PMID: 34027091 PMCID: PMC8126818 DOI: 10.1002/btm2.10204] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 11/25/2020] [Accepted: 11/26/2020] [Indexed: 11/17/2022] Open
Abstract
Sutures are applied almost universally at the site of trauma or surgery, making them an ideal platform to modulate the local, postoperative biological response, and improve surgical outcomes. To date, the only globally marketed drug-eluting sutures are coated with triclosan for antibacterial application in general surgery. Loading drug directly into the suture rather than coating the surface offers the potential to provide drug delivery functionality to microsurgical sutures and achieve sustained drug delivery without increasing suture thickness. However, conventional methods for drug incorporation directly into the suture adversely affect breaking strength. Thus, there are no market offerings for drug-eluting sutures, drug-coated, or otherwise, in ophthalmology, where very thin sutures are required. Sutures themselves help facilitate bacterial infection, and antibiotic eye drops are commonly prescribed to prevent infection after ocular surgeries. An antibiotic-eluting suture may prevent bacterial colonization of sutures and preclude patient compliance issues with eye drops. We report twisting of hundreds of individual drug-loaded, electrospun nanofibers into a single, ultra-thin, multifilament suture capable of meeting both size and strength requirements for microsurgical ocular procedures. Nanofiber-based polycaprolactone sutures demonstrated no loss in strength with loading of 8% levofloxacin, unlike monofilament sutures which lost more than 50% strength. Moreover, nanofiber-based sutures retained strength with loading of a broad range of drugs, provided antibiotic delivery for 30 days in rat eyes, and prevented ocular infection in a rat model of bacterial keratitis.
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Affiliation(s)
- Kunal S. Parikh
- Center for NanomedicineThe Wilmer Eye Institute, Johns Hopkins University School of MedicineBaltimoreMarylandUSA
- Department of OphthalmologyThe Wilmer Eye Institute, Johns Hopkins University School of MedicineBaltimoreMarylandUSA
- Center for Bioengineering Innovation & DesignJohns Hopkins UniversityBaltimoreMarylandUSA
- Department of Biomedical EngineeringJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Revaz Omiadze
- Center for NanomedicineThe Wilmer Eye Institute, Johns Hopkins University School of MedicineBaltimoreMarylandUSA
- Department of OphthalmologyThe Wilmer Eye Institute, Johns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Aditya Josyula
- Center for NanomedicineThe Wilmer Eye Institute, Johns Hopkins University School of MedicineBaltimoreMarylandUSA
- Department of Chemical and Biomolecular EngineeringJohns Hopkins UniversityBaltimoreMarylandUSA
| | - Richard Shi
- Center for NanomedicineThe Wilmer Eye Institute, Johns Hopkins University School of MedicineBaltimoreMarylandUSA
- Department of Biomedical EngineeringJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Nicole M. Anders
- Department of OncologySidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Ping He
- Department of OncologySidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Youseph Yazdi
- Center for Bioengineering Innovation & DesignJohns Hopkins UniversityBaltimoreMarylandUSA
- Department of Biomedical EngineeringJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Peter J. McDonnell
- Department of OphthalmologyThe Wilmer Eye Institute, Johns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Laura M. Ensign
- Center for NanomedicineThe Wilmer Eye Institute, Johns Hopkins University School of MedicineBaltimoreMarylandUSA
- Department of OphthalmologyThe Wilmer Eye Institute, Johns Hopkins University School of MedicineBaltimoreMarylandUSA
- Department of Biomedical EngineeringJohns Hopkins University School of MedicineBaltimoreMarylandUSA
- Department of Chemical and Biomolecular EngineeringJohns Hopkins UniversityBaltimoreMarylandUSA
- Department of OncologySidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Justin Hanes
- Center for NanomedicineThe Wilmer Eye Institute, Johns Hopkins University School of MedicineBaltimoreMarylandUSA
- Department of OphthalmologyThe Wilmer Eye Institute, Johns Hopkins University School of MedicineBaltimoreMarylandUSA
- Department of Biomedical EngineeringJohns Hopkins University School of MedicineBaltimoreMarylandUSA
- Department of Chemical and Biomolecular EngineeringJohns Hopkins UniversityBaltimoreMarylandUSA
- Department of OncologySidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of MedicineBaltimoreMarylandUSA
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7
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Wang S, Wang M, Liu Y, Hu D, Gu L, Fei X, Zhang J. Effect of Rapamycin Microspheres in Sjögren Syndrome Dry Eye: Preparation and Outcomes. Ocul Immunol Inflamm 2018; 27:1357-1364. [PMID: 30273514 DOI: 10.1080/09273948.2018.1527369] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Revised: 09/19/2018] [Accepted: 09/19/2018] [Indexed: 12/15/2022]
Abstract
Purpose: To prepare a drug delivery system of rapamycin poly-3-hydroxybutyrate-co-3-hydroxyvalerate microspheres (RPM) and analyze its effect on the eyes of a Sjögren's syndrome mouse model.Methods: RPM was generated using a solvent evaporation method, and observed under light and electron microscopy. No obesity diabetes (NOD) mice with Sjögren's syndrome were randomized into normal saline, empty microspheres, and RPM groups, with healthy Kunming mice as the controls. Dry eye signs were assessed using a slit lamp. Tear secretion, corneal fluorescein, keratoconjunctival rose bengal, and conjunctival impression cytology were recorded.Results: RPM was smooth and spherical, about 20-50 μm in diameter, without agglomeration or adhesion. Mice receiving RPM secreted more tears. And they had a normal corneal histology, exhibiting reduced corneal fluorescein, rose bengal staining, and conjunctival impression cytology.Conclusion: RPM improved the signs of dry eyes, improved tear secretion, decreased corneal endothelial cell injury, and improved histological damage of the cornea in NOD mice.
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Affiliation(s)
- Shasha Wang
- Department of Ophthalmology, Shanghai Jiaotong University Affiliated the First People's Hospital, Shanghai, P. R. China
- Department of Ophthalmology, Shanghai Jing 'an District ShiBei Hospital, Shanghai, P. R. China
| | - Meng Wang
- Department of Ophthalmology, Shanghai Jiaotong University Affiliated the First People's Hospital, Shanghai, P. R. China
| | - Yan Liu
- Department of Ophthalmology, Shanghai Jiaotong University Affiliated the First People's Hospital, Shanghai, P. R. China
| | - Daode Hu
- Department of Pharmacy, Shanghai Jiaotong University Affiliated the First People's Hospital, Shanghai, P. R. China
| | - Lei Gu
- Department of Scientific Research and Education, Branch of the First People's Hospital of Shanghai, Shanghai, P. R. China
| | - Xinfeng Fei
- Department of Ophthalmology, Branch of the First People's Hospital of Shanghai, Shanghai, P. R. China
| | - Jianhong Zhang
- Department of Ophthalmology, Branch of the First People's Hospital of Shanghai, Shanghai, P. R. China
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Elieh Ali Komi D, Rambasek T, Bielory L. Clinical implications of mast cell involvement in allergic conjunctivitis. Allergy 2018; 73:528-539. [PMID: 29105783 DOI: 10.1111/all.13334] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2017] [Indexed: 01/27/2023]
Abstract
The conjunctiva is a common site for the allergic inflammatory response due to it being highly vascularized, having constant exposure to environmental pollutants and allergenic pollens and having a unique conjunctival associated lymphoid tissue. The primary morbidity of anterior surface conjunctival disorders that include allergic conjunctivitis and tear film disorders is associated with its high frequency of involvement rather than its severity, although the more chronic forms can involve the cornea and lead to sight-threatening conditions. Ocular allergy is associated with IgE-mediated mast cell activation in conjunctival tissue leading to the release of preformed mediators including histamine and proteases and subsequent de novo formation of lipid-derived mediators and cytokines that trigger a cascade of cellular and molecular events leading to extensive migration and infiltration of inflammatory cells to the ocular surface. The trafficking of neutrophils, eosinophils, and lymphocytes to the ocular surface is due to establishing various chemokine gradients (mainly CCL11, CCL24, CCL5, MCP-3, and MCP-4), cell surface expression of adhesion molecules (such as VCAM-1 the ligand for VLA-4), and leukocyte adhesion to vascular endothelium. The release of preformed mediators underlies the acute ocular surface response while the secondary influx of inflammatory cells leading to the recruitment and activation of eosinophils and the subsequent activation of Th2 and Th1 lymphocytes at the level of the conjunctiva reflects the late-phase reaction.
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Affiliation(s)
- D. Elieh Ali Komi
- Immunology Research Center; Tabriz University of Medical Sciences; Tabriz Iran
- Department of Immunology; Tabriz University of Medical Sciences; Tabriz Iran
| | - T. Rambasek
- Ohio University Heritage College of Osteopathic Medicine; Athens OH USA
| | - L. Bielory
- Rutgers University Center for Environmental Prediction; New Brunswick NJ USA
- Thomas Jefferson University The Sidney Kimmel Medical College Philadelphia; Philadelphia PA USA
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Sakassegawa-Naves FE, Ricci HMM, Moscovici BK, Miyamoto DA, Chiacchio BB, Holzchuh R, Santo RM, Hida RY. Tacrolimus Ointment for Refractory Posterior Blepharitis. Curr Eye Res 2017; 42:1440-1444. [DOI: 10.1080/02713683.2017.1339805] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Fernando Eiji Sakassegawa-Naves
- Department of Ophthalmology, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Helena Maria Moraes Ricci
- Department of Ophthalmology, Santa Casa de Misericórdia de São Paulo, São Paulo, Brazil
- Department of Ophthalmology, University of São Paulo (USP), São Paulo, Brazil
| | - Bernardo Kaplan Moscovici
- Department of Ophthalmology, Santa Casa de Misericórdia de São Paulo, São Paulo, Brazil
- Department of Ophthalmology, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | | | | | - Ricardo Holzchuh
- Department of Ophthalmology, Santa Casa de Misericórdia de São Paulo, São Paulo, Brazil
- Department of Ophthalmology, University of São Paulo (USP), São Paulo, Brazil
| | - Ruth Muyuki Santo
- Department of Ophthalmology, University of São Paulo (USP), São Paulo, Brazil
| | - Richard Yudi Hida
- Department of Ophthalmology, Santa Casa de Misericórdia de São Paulo, São Paulo, Brazil
- Eye Bank, Santa Casa de Misericórdia de São Paulo, São Paulo, Brazil
- Department of Ophthalmology, University of São Paulo (USP), São Paulo, Brazil
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Individualize treatment for vernal keratoconjunctivitis based on clinical features and personal preferences. DRUGS & THERAPY PERSPECTIVES 2017. [DOI: 10.1007/s40267-017-0405-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Esposito S, Fior G, Mori A, Osnaghi S, Ghiglioni D. An Update on the Therapeutic Approach to Vernal Keratoconjunctivitis. Paediatr Drugs 2016; 18:347-55. [PMID: 27461427 DOI: 10.1007/s40272-016-0185-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Vernal keratoconjunctivitis (VKC) is an inflammatory disease of the ocular surface. It commonly occurs in the first decade of life, has a wide geographical distribution, and usually occurs in warm, dry areas. The pathogenesis of VKC seems to have an immune, nervous, and endocrine basis. The most common eye symptoms are itching, discharge, tearing, eye irritation, redness of the eyes, and photophobia. Although VKC generally has a good prognosis, the lack of clarity regarding the origin of the disease makes treatment a challenge for pediatricians and ophthalmologists. The purpose of this review is to discuss the pathogenesis, clinical features, and diagnostic criteria in VKC, with a focus on its therapeutic management. The selection of a therapeutic scheme from the many available options is based on clinical features and the personal preferences of both physicians and patients. Due to the lack of uniform grading of disease severity, there is no worldwide consensus on first-line and second-line therapeutic approaches. The choice of treatment for long-term moderate to severe VKC includes topical cyclosporine or tacrolimus. Further data are needed to define the minimal effective concentration and the safety of these drugs in eye drops and to clarify the diagnosis of VKC in patients who require these drugs. Finally, while promising newly discovered drugs are expected to enter into clinical practice, further studies on their efficacy and safety are required.
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Affiliation(s)
- Susanna Esposito
- Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Commenda 9, 20122, Milan, Italy.
| | - Giulia Fior
- Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Commenda 9, 20122, Milan, Italy
| | - Alessandro Mori
- Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Commenda 9, 20122, Milan, Italy
| | - Silvia Osnaghi
- Oculistic Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Daniele Ghiglioni
- Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Commenda 9, 20122, Milan, Italy
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12
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Sun Y, Zhao S, Li X, Yan L, Wang J, Wang D, Chen H, Dai J, He J. Local application of rapamycin reduces epidural fibrosis after laminectomy via inhibiting fibroblast proliferation and prompting apoptosis. J Orthop Surg Res 2016; 11:58. [PMID: 27154399 PMCID: PMC4859967 DOI: 10.1186/s13018-016-0391-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Accepted: 04/17/2016] [Indexed: 12/20/2022] Open
Abstract
Background Epidural fibrosis is a common complication after laminectomy. It is associated with intractable lower back pain and additional complications. To date, no study has evaluated whether the local application of rapamycin (RAPA) can inhibit fibroblast proliferation and reduce epidural scar adhesion after laminectomy. The results of the present study showed that the local application of RAPA reduces epidural fibrosis after laminectomy in rats. Methods In this study, 32 male Sprague-Dawley rats were randomly divided into four groups (0.2 mg/ml RAPA-treated group, 0.1 mg/ml RAPA-treated group, 0.05 mg/ml RAPA-treated group and physiological saline group). Laminectomy was performed at the level of lumbar segment 1 to 2, and different concentrations of RAPA or saline were applied to the laminectomy sites for 10 min. Four weeks after laminectomy, the rats were sacrificed, and the degrees of epidural adhesion in each group were evaluated. Macroscopic assessment, analysis of hydroxyproline content, and histological analysis were used to determine the therapeutic effect of the local application of RAPA on the inhibition of fibroblast proliferation and the reduction of epidural fibrosis after laminectomy. Next, we cultured fibroblasts from epidural scar tissues of rats that had undergone laminectomy. Fibroblasts were exposed to the indicated concentrations of RAPA, and western blotting and TUNEL assays were used to assess the effects of RAPA on inhibiting fibroblasts proliferation and promoting fibroblast apoptosis. Results The results of macroscopic assessments, analysis of hydroxyproline content, and histological analyses indicated that RAPA significantly inhibited fibroblast proliferation and reduced epidural fibrosis in the treated groups in the rat model. The western blotting results indicated that the expression levels of the pro-apoptotic proteins cleaved-PARP and Bax were up-regulated, whereas those of Bcl-2 were reduced. TUNEL assay indicated that the apoptosis rates of fibroblasts were significantly increased after exposure to the indicated concentrations of RAPA. Conclusions The local application of RAPA reduced epidural fibrosis after laminectomy by inhibiting the proliferation of fibroblasts, stimulating their apoptosis, and decreasing collagen synthesis. This protocol may be used in new clinical treatment strategies to reduce epidural fibrosis after laminectomy.
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Affiliation(s)
- Yu Sun
- Department of Orthopedics, Clinical medical college of Yangzhou University, Nantong West Road 98, Yangzhou, Jiangsu, 225001, China.,Orthopedics Institute, Subei People's Hospital of Jiangsu Province, Yangzhou, Jiangsu, 225001, China
| | - Shuai Zhao
- Department of Orthopedics, Clinical medical college of Yangzhou University, Nantong West Road 98, Yangzhou, Jiangsu, 225001, China.,Department of Orthopedics, Xiangya Second Hospital, Central South University, Changsha, Hunan, 410012, China.,Orthopedics Institute, Subei People's Hospital of Jiangsu Province, Yangzhou, Jiangsu, 225001, China
| | - Xiaolei Li
- Department of Orthopedics, Clinical medical college of Yangzhou University, Nantong West Road 98, Yangzhou, Jiangsu, 225001, China.,Department of Orthopedics, Xiangya Second Hospital, Central South University, Changsha, Hunan, 410012, China.,Orthopedics Institute, Subei People's Hospital of Jiangsu Province, Yangzhou, Jiangsu, 225001, China
| | - Lianqi Yan
- Department of Orthopedics, Clinical medical college of Yangzhou University, Nantong West Road 98, Yangzhou, Jiangsu, 225001, China. .,Department of Orthopedics, Xiangya Second Hospital, Central South University, Changsha, Hunan, 410012, China. .,Orthopedics Institute, Subei People's Hospital of Jiangsu Province, Yangzhou, Jiangsu, 225001, China.
| | - Jingcheng Wang
- Department of Orthopedics, Clinical medical college of Yangzhou University, Nantong West Road 98, Yangzhou, Jiangsu, 225001, China. .,Department of Orthopedics, Xiangya Second Hospital, Central South University, Changsha, Hunan, 410012, China. .,Orthopedics Institute, Subei People's Hospital of Jiangsu Province, Yangzhou, Jiangsu, 225001, China.
| | - Daxin Wang
- Department of Orthopedics, Clinical medical college of Yangzhou University, Nantong West Road 98, Yangzhou, Jiangsu, 225001, China.,Orthopedics Institute, Subei People's Hospital of Jiangsu Province, Yangzhou, Jiangsu, 225001, China
| | - Hui Chen
- Department of Orthopedics, Clinical medical college of Yangzhou University, Nantong West Road 98, Yangzhou, Jiangsu, 225001, China.,Orthopedics Institute, Subei People's Hospital of Jiangsu Province, Yangzhou, Jiangsu, 225001, China
| | - Jihang Dai
- Department of Orthopedics, Clinical medical college of Yangzhou University, Nantong West Road 98, Yangzhou, Jiangsu, 225001, China.,Orthopedics Institute, Subei People's Hospital of Jiangsu Province, Yangzhou, Jiangsu, 225001, China
| | - Jun He
- Department of Orthopedics, Clinical medical college of Yangzhou University, Nantong West Road 98, Yangzhou, Jiangsu, 225001, China.,Orthopedics Institute, Subei People's Hospital of Jiangsu Province, Yangzhou, Jiangsu, 225001, China
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Ackerman S, Smith LM, Gomes PJ. Ocular itch associated with allergic conjunctivitis: latest evidence and clinical management. Ther Adv Chronic Dis 2016; 7:52-67. [PMID: 26770669 DOI: 10.1177/2040622315612745] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Allergic conjunctivitis is one of the most common allergic conditions worldwide. Its incidence is increasing due to changing climate, pollution, increased pollen loads, and the subject's heightened immunological sensitivity in response to these environmental changes. The pathophysiology predominantly involves immunoglobulin E-related mast-cell activation, with release of histamine and other mediators contributing to the propagation of the response by calling in other immune cells and further inflammation. This article presents the evolution of ocular allergy treatments, from vasoconstrictors, to antihistamines and mast-cell stabilizers, to the dual-acting agents, as well as corticosteroid and immunomodulatory options. Future targets for allergy treatment are also discussed.
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Affiliation(s)
- Stacey Ackerman
- Philadelphia Eye Associates, 1113 Hospital Drive, Suite 302, Willingboro, NJ 08046, USA
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14
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Treatment of Sjögren's syndrome dry eye using 0.03% tacrolimus eye drop: Prospective double-blind randomized study. Cont Lens Anterior Eye 2015; 38:373-8. [DOI: 10.1016/j.clae.2015.04.004] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2014] [Revised: 04/14/2015] [Accepted: 04/14/2015] [Indexed: 11/17/2022]
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15
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Management of Dry Eye in Sjögren’s Syndrome. CURRENT TREATMENT OPTIONS IN RHEUMATOLOGY 2015. [DOI: 10.1007/s40674-015-0026-3] [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]
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16
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Sirolimus formulation with improved pharmacokinetic properties produced by a continuous flow method. Eur J Pharm Biopharm 2015; 94:135-40. [DOI: 10.1016/j.ejpb.2015.05.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Revised: 04/22/2015] [Accepted: 05/14/2015] [Indexed: 11/22/2022]
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Abelson MB, Shetty S, Korchak M, Butrus SI, Smith LM. Advances in pharmacotherapy for allergic conjunctivitis. Expert Opin Pharmacother 2015; 16:1219-31. [PMID: 25943976 DOI: 10.1517/14656566.2015.1040760] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Allergy is the fifth leading group of chronic diseases, affecting as much as 40% of the first-world population. Its pathophysiology has a genetic component, and is driven by the immune system's sensitized response to antigens and environmental factors. As research continues to uncover the mediators responsible for ocular allergy, the development of novel drugs should progress. AREAS COVERED A literature review of allergic conjunctivitis, ocular allergy and their treatment was performed using PubMed and Medline. Additional information is also included from clinicaltrials.gov and associated web sites for drugs currently in clinical trials. EXPERT OPINION The initial step of therapy remains identification and avoidance of allergic triggers. The mainstay of treatment is the new generation of dual-acting antihistamines. Drugs that improve the magnitude and duration of relief, with greater subject responder rates, are gradually making their way into the clinic. Allergic conjunctivitis is a relatively easy disease to study because of the availability of models such as the conjunctival allergen challenge. New classes of drugs that target inflammatory pathways or mediators involved in the early and late-phase allergic response are being screened in these models and we are making progress in identifying the next generation of anti-allergic therapy.
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Affiliation(s)
- Mark B Abelson
- Harvard University, Department of Ophthalmology, Ora, Inc. , 300 Brickstone Square, Andover MA 01810 , USA
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18
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Wan XC, Dimov V. Pharmacokinetic evaluation of topical calcineurin inhibitors for treatment of allergic conjunctivitis. Expert Opin Drug Metab Toxicol 2014; 10:543-9. [PMID: 24490943 DOI: 10.1517/17425255.2014.884070] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Topical calcineurin (Cn) inhibitors delivered via ophthalmic drop is emerging as a potential treatment for severe, immune-mediated forms of allergic conjunctivitis, such as vernal keratoconjunctivitis, atopic keratoconjunctivitis and giant papillary conjunctivitis. AREAS COVERED This article is based on a comprehensive literature search, with information taken from meta-analyses, systematic reviews, treatment guidelines and clinical studies in children and adults. The articles that have been selected evaluate the use of topical Cn inhibitors and their role in the treatment of allergic conjunctivitis. EXPERT OPINION Ophthalmic topical Cn inhibitors have been shown to be safe for short-term use, with minimal systemic absorption and toxicity. For patients with severe, refractory forms of allergic conjunctivitis, topical Cn inhibitors offer a promising treatment option and an alternative to steroidal therapies. The safety profile and efficacy data for topical cyclosporine are more robust compared to that of tacrolimus and pimecrolimus, although larger trials will be needed for all three agents. With more randomized controlled trials involving larger sample sizes and long-term follow-up to establish both efficacy and safety, ophthalmic Cn inhibitors offer exciting treatment possibilities for the prevention of morbidity associated with refractory allergic conjunctivitis.
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Affiliation(s)
- Xiao Chloe Wan
- University of Chicago, Department of Internal Medicine , 5841 South Maryland Ave MC 7082, Chicago, IL 60637 , USA
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Wacker K, Denker S, Hildebrand A, Eberwein P, Reinhard T, Schwartzkopff J. Short-term azithromycin treatment promotes cornea allograft survival in the rat. PLoS One 2013; 8:e82687. [PMID: 24349336 PMCID: PMC3857254 DOI: 10.1371/journal.pone.0082687] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2013] [Accepted: 10/27/2013] [Indexed: 11/21/2022] Open
Abstract
Background Any inflammatory response following corneal transplantation may induce rejection and irreversible graft failure. The purpose of this study is to analyze the anti-inflammatory effect of azithromycin (AZM) following experimental keratoplasty in rats. Methods Corneal transplants were performed between Fisher-donor and Lewis-recipient rats. Recipients were postoperatively treated three times daily with AZM, miglyol, ofloxacin or dexamethasone eye drops. As an additional control, AZM was applied following syngeneic keratoplasty. Furthermore, short-term treatments with AZM for seven days perioperatively or with AZM only three days prior to the transplantation were compared to appropriate controls. All transplants were monitored clinically for opacity, edema, and vascularization. Infiltrating CD45+, CD4+, CD8+, CD25+, CD161+ and CD163+ cells were quantified via immunohistochemistry. Results AZM significantly promoted corneal graft survival compared with miglyol or ofloxacin treatment. This effect was comparable to topical dexamethasone. No adverse AZM effect was observed. Histology confirmed a significant reduction of infiltrating leukocytes. The short-term application of AZM for three days prior to transplantation or for seven days perioperatively reduced corneal graft rejection significantly compared with the controls. Conclusions Along with antibiotic properties, topical AZM has a strong anti-inflammatory effect. Following keratoplasty, this effect is comparable to topical dexamethasone without the risk of steroid-induced adverse effects. Short-term treatment with AZM three days prior to the transplantation was sufficient to promote graft survival in the rat keratoplasty model. We therefore suggest further assessing the anti-inflammatory function of topical AZM following keratoplasty in humans.
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Affiliation(s)
- Katrin Wacker
- Eye Center, Albert-Ludwigs-University of Freiburg, Freiburg im Breisgau, Germany
- * E-mail: (KW); (JS)
| | - Sophy Denker
- Eye Center, Albert-Ludwigs-University of Freiburg, Freiburg im Breisgau, Germany
| | - Antonia Hildebrand
- Eye Center, Albert-Ludwigs-University of Freiburg, Freiburg im Breisgau, Germany
| | - Philipp Eberwein
- Eye Center, Albert-Ludwigs-University of Freiburg, Freiburg im Breisgau, Germany
| | - Thomas Reinhard
- Eye Center, Albert-Ludwigs-University of Freiburg, Freiburg im Breisgau, Germany
| | - Johannes Schwartzkopff
- Eye Center, Albert-Ludwigs-University of Freiburg, Freiburg im Breisgau, Germany
- Eye Clinic, Dres Knapp et Schwartzkopff, Lörrach, Germany
- * E-mail: (KW); (JS)
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Silva-Cunha A, da Silva GR, de Castro WV, Fialho SL. Evaluation of the pharmacokinetics and ocular tolerance of a microemulsion containing tacrolimus. J Ocul Pharmacol Ther 2013; 30:59-65. [PMID: 24199740 DOI: 10.1089/jop.2013.0128] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE Tacrolimus is a potent immunosuppressive agent with limited corneal penetration. Microemulsions can increase the drug solubility and enhance drug absorption in the eye. This work aimed to develop a tacrolimus microemulsion as well as to characterize and to evaluate its ocular tolerance and pharmacokinetics after topical application in rabbits. METHODS The microemulsion was prepared by the titration with the cosurfactant technique and its physical-chemical parameters and stability were determined. The cytotoxicity was evaluated using the corneal epithelium and conjunctiva cell lines. The ocular pharmacokinetic parameters in rabbits were determined and compared with that obtained after instillation of tacrolimus suspension. RESULTS The microemulsion containing tacrolimus was successfully developed. It was nonirritating to rabbits' eyes and it was also not toxic to the corneal and conjunctival cells. When compared to the suspension, the microemulsion containing tacrolimus presented higher values of AUC (2,912.5±245.4 min.ng/mL vs. 1,669.8±93 min.ng/mL) and Cmax (26.8±2.3 ng/mL vs. 20.7±2.8 ng/mL). On the other hand, the Cl/F value was smaller when compared to the suspension that may decrease the number of applications of eye drops. CONCLUSION The developed microemulsion could be an alternative to reduce the systemic adverse effects of tacrolimus and, consequently, increase the patient compliance to the treatment.
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Affiliation(s)
- Armando Silva-Cunha
- 1 Faculty of Pharmacy, Federal University of Minas Gerais , Belo Horizonte, Brazil
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22
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Earla R, Cholkar K, Gunda S, Earla RL, Mitra AK. Bioanalytical method validation of rapamycin in ocular matrix by QTRAP LC-MS/MS: application to rabbit anterior tissue distribution by topical administration of rapamycin nanomicellar formulation. J Chromatogr B Analyt Technol Biomed Life Sci 2012; 908:76-86. [PMID: 23122404 DOI: 10.1016/j.jchromb.2012.09.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2012] [Revised: 08/15/2012] [Accepted: 09/09/2012] [Indexed: 10/27/2022]
Abstract
A novel, fast and sensitive 3200 QTRAP LC-MS/MS method was validated for rapamycin analysis in the rabbit eye following 0.2% administration of nanomicellar eye drop formulation. The LC-MS/MS technique was developed with electrospray ionization (ESI) in positive mode. Rapamycin was extracted from individual eye tissues and fluids by a simple protein precipitation method. Samples were reconstituted in 200μL of 80% of acetonitrile in water containing 0.05% formic acid. Twenty microliter of the sample was injected on LC-MS/MS. Chromatographic separations was achieved on reversed phase C 8 Xterra column, 50mm×4.6mm, 5μm. Multiple reactions monitoring (MRM) transition m/z 936.6/409.3 for rapamycin and 734.4/576.5 for erythromycin were employed as internal standard. The calibration curves were linear r(2)>0.9998 over the concentration range from 2.3ng/mL to 1000.0ng/mL. Rapamycin was found to be stable in ocular tissue homogenates for 6weeks at a refrigerated -80°C and -20°C temperatures. Rapamycin concentration was found to be 2260.7±507.1 (mean±S.D.)ng/g tissue and 585.5±80.1 (mean±S.D.)ng/g tissue in the cornea and iris ciliary muscle, respectively. This method has two advantages. First, a volatile base was used in the extraction procedure, which is easy to evaporate and generate consistent results. Second, the sodium adduct is employed that was stable in non-ammoniated mobile phase. The method demonstrates that absorption of rapamycin by a topical application of 0.2% rapamycin nanomicellar formulation generates therapeutically effective concentrations in the anterior segment of the eye.
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Affiliation(s)
- Ravinder Earla
- UMKC School of Pharmacy, Pharmaceutical Sciences, University of Missouri-Kansas City, 2464 Charlotte Street, 5258 Health Sciences Building, MO 64108, United States
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Di Tommaso C, Bourges JL, Valamanesh F, Trubitsyn G, Torriglia A, Jeanny JC, Behar-Cohen F, Gurny R, Möller M. Novel micelle carriers for cyclosporin A topical ocular delivery: in vivo cornea penetration, ocular distribution and efficacy studies. Eur J Pharm Biopharm 2012; 81:257-64. [PMID: 22445900 DOI: 10.1016/j.ejpb.2012.02.014] [Citation(s) in RCA: 94] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2011] [Revised: 02/22/2012] [Accepted: 02/23/2012] [Indexed: 11/26/2022]
Abstract
Cornea transplantation is one of the most performed graft procedures worldwide with an impressive success rate of 90%. However, for "high-risk" patients with particular ocular diseases in addition to the required surgery, the success rate is drastically reduced to 50%. In these cases, cyclosporin A (CsA) is frequently used to prevent the cornea rejection by a systemic treatment with possible systemic side effects for the patients. To overcome these problems, it is a challenge to prepare well-tolerated topical CsA formulations. Normally high amounts of oils or surfactants are needed for the solubilization of the very hydrophobic CsA. Furthermore, it is in general difficult to obtain ocular therapeutic drug levels with topical instillations due to the corneal barriers that efficiently protect the intraocular structures from foreign substances thus also from drugs. The aim of this study was to investigate in vivo the effects of a novel CsA topical aqueous formulation. This formulation was based on nanosized polymeric micelles as drug carriers. An established rat model for the prevention of cornea graft rejection after a keratoplasty procedure was used. After instillation of the novel formulation with fluorescent labeled micelles, confocal analysis of flat-mounted corneas clearly showed that the nanosized carriers were able to penetrate into all corneal layers. The efficacy of a 0.5% CsA micelle formulation was tested and compared to a physiological saline solution and to a systemic administration of CsA. In our studies, the topical CsA treatment was carried out for 14 days, and the three parameters (a) cornea transparency, (b) edema, and (c) neovascularization were evaluated by clinical observation and scoring. Compared to the control group, the treated group showed a significant higher cornea transparency and significant lower edema after 7 and 13 days of the surgery. At the end point of the study, the neovascularization was reduced by 50% in the CsA-micelle treated animals. The success rate of cornea graft transplantation was 73% in treated animals against 25% for the control group. This result was as good as observed for a systemic CsA treatment in the same animal model. This new formulation has the same efficacy like a systemic treatment but without the serious CsA systemic side effects. Ocular drug levels of transplanted and healthy rat eyes were dosed by UPLC/MS and showed a high CsA value in the cornea (11710 ± 7530 ng(CsA)/g(tissue) and 6470 ± 1730 ng(CsA)/g(tissue), respectively). In conclusion, the applied formulation has the capacity to overcome the ocular surface barriers, the micelles formed a drug reservoir in the cornea from, where a sustained release of CsA can take place. This novel formulation for topical application of CsA is clearly an effective and well-tolerated alternative to the systemic treatment for the prevention of corneal graft rejection.
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Affiliation(s)
- Claudia Di Tommaso
- School of Pharmaceutical Sciences, University of Geneva, University of Lausanne, Geneva, Switzerland
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Mishra GP, Tamboli V, Jwala J, Mitra AK. Recent patents and emerging therapeutics in the treatment of allergic conjunctivitis. ACTA ACUST UNITED AC 2011; 5:26-36. [PMID: 21171952 DOI: 10.2174/187221311794474883] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2010] [Accepted: 12/01/2010] [Indexed: 12/13/2022]
Abstract
Ocular allergy is an inflammatory response of the conjunctival mucosa that also affects the cornea and eyelids. Allergic conjunctivitis includes seasonal allergic conjunctivitis (SAC), perennial allergic conjunctivitis (PAC), vernal keratoconjunctivitis (VKC), atopic keratoconjunctivitis (AKC) and giant papillary conjunctivitis (GPC). In general, allergic conditions involve mast cell degranulation that leads to release of inflammatory mediators and activation of enzymatic cascades generating pro-inflammatory mediators. In chronic ocular inflammatory disorders associated with mast cell activation such as VKC and AKC constant inflammatory response is observed due to predominance of inflammatory mediators such as eosinophils and Th2-generated cytokines. Antihistamines, mast-cell stabilizers, nonsteroidal anti-inflammatory agents, corticosteroids and immunomodulatory agents are commonly indicated for the treatment of acute and chronic allergic conjunctivitis. In recent years newer drug molecules have been introduced in the treatment of allergic conjunctivitis. This article reviews recent patents and emerging therapeutics in the treatment of allergic conjunctivitis.
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Affiliation(s)
- Gyan P Mishra
- Division of Pharmaceutical Sciences, School of Pharmacy, University of Missouri-Kansas City, MO 64108-2718, USA
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Wu XG, Xin M, Yang LN, Shi WY. The Biological Characteristics and Pharmacodynamics of a Mycophenolate Mofetil Nanosuspension Ophthalmic Delivery System in Rabbits. J Pharm Sci 2011; 100:1350-61. [DOI: 10.1002/jps.22356] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2010] [Revised: 06/17/2010] [Accepted: 08/31/2010] [Indexed: 11/11/2022]
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Utine CA, Stern M, Akpek EK. Clinical review: topical ophthalmic use of cyclosporin A. Ocul Immunol Inflamm 2011; 18:352-61. [PMID: 20735287 DOI: 10.3109/09273948.2010.498657] [Citation(s) in RCA: 101] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Cyclosporine A (CsA) is an immunomodulatory agent that primarily inhibits the proliferation and action of T cells. Systemic CsA has been used successfully in solid organ transplantation and noninfectious uveitis. Topical CsA with various formulations has been used in the field of ocular surface diseases since early 1980s. An ophthalmic emulsion 0.05% (Restasis, Allergan, Irvine, CA), was approved by the United States Food and Drug Administration in 2003 to treat dry eye syndrome. This article aims to evaluate the peer-reviewed published scientific literature and to define well-established uses of CsA eyedrops in the field of ocular surface diseases.
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Affiliation(s)
- Canan Asli Utine
- The Ocular Surface Diseases and Dry Eye Clinic, The Wilmer Eye Institute, Johns Hopkins Hospital, 600 N. Wolfe Street, Baltimore, MD 21287, USA
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Williams KA, Kelly TL, Lowe MT, Coster DJ. The influence of rejection episodes in recipients of bilateral corneal grafts. Am J Transplant 2010; 10:921-930. [PMID: 20121748 DOI: 10.1111/j.1600-6143.2009.03002.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
We investigated whether a rejection episode in one graft was associated with rejection in the other graft, in recipients with bilateral corneal transplants. In a prospectively maintained, national register of 14,865 followed corneal grafts, 1476 patients with bilateral penetrating corneal grafts were identified. Occurrence of rejection was a risk factor for graft failure (p < 0.0001). Logistic regression was used to calculate the adjusted odds ratio for rejection in one eye following rejection in the other eye. In the subset of 1118 patients with bilateral grafts but no history of previous grafts or rejections in either eye, the adjusted odds ratio for a rejection episode in the first eye following rejection in the second was 3.27 (95% confidence interval, CI 1.85, 5.79; p < 0.001). The adjusted odds ratio was 2.04 (95% CI 1.07, 3.91; p = 0.03) for rejection in the second eye following rejection in the first. The median time between the first rejection episode in one eye and the first rejection episode in the other eye was 15 months. Patients with bilateral corneal grafts who suffer a graft rejection episode in one eye are at significantly greater odds of suffering a rejection episode in the other corneal transplant.
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Affiliation(s)
- K A Williams
- Department of Ophthalmology, Flinders University, Adelaide, Australia
| | - T-L Kelly
- Department of Ophthalmology, Flinders University, Adelaide, Australia
| | - M T Lowe
- Department of Ophthalmology, Flinders University, Adelaide, Australia
| | - D J Coster
- Department of Ophthalmology, Flinders University, Adelaide, Australia
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- Department of Ophthalmology, Flinders University, Adelaide, Australia
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Shin YJ, Kim MK, Oh JY, Wee WR, Lee JH, Ko JH, Lee HJ, Lee JL, Min BM, Sohn YS. Short-term Efficacy of Topical Immunosuppressive Agents on the Survival of Cultivated Allo-Conjunctival Equivalents. KOREAN JOURNAL OF OPHTHALMOLOGY 2008; 22:123-9. [PMID: 18612231 PMCID: PMC2629933 DOI: 10.3341/kjo.2008.22.2.123] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Purpose To investigate the short-term efficacy of topical immunosuppressive agents on the survival of cultivated allo-conjunctival equivalents. Methods Twenty-five eyes of New Zealand white rabbits were included. Temporal conjunctivae were trephined to a diameter of 7.5 mm, and then cultured allo-conjunctival epithelial cells on amniotic membrane were transplanted onto them. Various immunosuppressants including steroid, cyclosporine, and rapamycin were applied topically four times a day for a week. Epithelial defects and graft edema were graded daily. Numbers of inflammatory cells were measured in H&E. PKH26 and cytokeratin 4 and 7 were immunostained. Results Earlier epithelialization was observed in 1% steroid-treated eyes and defects persisted significantly in 0.5% CsA applied eyes. In histology, PKH26 positive cells considered as donor cells were only found in 1% steroid or 0.01% rapamycin applied eyes. 1% steroid- or 0.01% rapamycin-applied eyes both showed
positive staining for keratin-4 and -7. Inflammatory cells were less found in 1% steroid or 0.01% rapamycin
treated eyes. Conclusions Topical steroid or rapamycin can help to suppress acute inflammation and enhance the acute survival of transplanted conjunctival cells.
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Affiliation(s)
- Young Joo Shin
- Department of Ophthalmology, Dongguk University College of Medicine, Goyang, Korea
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Wang J, Jiang S, Shi H, Lin Y, Wang J, Wang X. Prolongation of corneal xenotransplant survival by T-cell vaccination-induced T-regulatory cells. Xenotransplantation 2008; 15:164-73. [PMID: 18611224 DOI: 10.1111/j.1399-3089.2008.00471.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
Ciclosporin is a calcineurin inhibitor that acts by primarily inhibiting the action of T cells. Clinical trials in the early 1980s demonstrated that systemic ciclosporin was a promising steroid-sparing agent and was also effective in patients who are refractory to treatment with corticosteroids. However, recent years have witnessed the emergence of safer immunosuppressive agents due to the poor side-effect profile of systemic ciclosporin. Topical ciclosporin, however, has a much improved safety profile and is still used to treat a variety of ocular surface disorders including dry eye syndrome, vernal and atopic keratoconjunctivitis, severe blepharitis and high-risk corneal graft patients. This article reviews the uses and safety profile of systemic and topical ciclosporin in ophthalmology, as well as discussing alternative therapeutic agents available.
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Affiliation(s)
- Shahram Kashani
- Ophthalmology Specialist Register, Moorfields Eye Hospital NHS Foundation Trust, 162 City Road, London EC1V 2PD, UK
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The Effect of Cyclosporine A (Restasis) on Recovery of Visual Acuity Following LASIK. J Refract Surg 2008; 24:473-6. [DOI: 10.3928/1081597x-20080501-04] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Abstract
Penetrating keratoplasty is the most widely practiced type of transplantation in humans. Irreversible immune rejection of the transplanted cornea is the major cause of human allograft failure in the intermediate and late postoperative period. This immunological process causes reversible or irreversible damage to the grafted cornea in several cases despite the use of intensive immunosuppressive therapy. Corneal graft rejection comprises a sequence of complex immune responses that involves the recognition of the foreign histocompatibility antigens of the corneal graft by the host's immune system, leading to the initiation of the immune response cascade. An efferent immune response is mounted by the host immune system against these foreign antigens culminating in rejection and graft decompensation in irreversible cases. A variety of donor- and host-related risk factors contribute to the corneal rejection episode. Epithelial rejection, chronic stromal rejection, hyperacute rejection, and endothelial rejection constitute the several different types of corneal graft rejection that might occur in isolation or in conjunction. Corneal graft failure subsequent to graft rejection remains an important cause of blindness and hence the need for developing new strategies for suppressing graft rejection is colossal. New systemic pharmacological interventions recommended in corneal transplantation need further evaluation and detailed guidelines. Two factors, prevention and management, are of significant importance among all aspects of immunological graft rejection. Preventive aspects begin with the recipient selection, spread through donor antigenic activity, and end with meticulous surgery. Prevention of corneal graft rejection lies with reduction of the donor antigenic tissue load, minimizing host and donor incompatibility by tissue matching and suppressing the host immune response. Management of corneal graft rejection consists of early detection and aggressive therapy with corticosteroids. Corticosteroid therapy, both topical and systemic, is the mainstay of management. Addition of immunosuppressive to the treatment regimen helps in quick and long term recovery. Knowledge of the immunopathogenesis of graft rejection may allow a better understanding of the immunological process thus helping in its prevention, early detection and management.
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Affiliation(s)
- Anita Panda
- Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
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35
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Abstract
Topical steroids are routinely used in the postoperative treatment following penetrating keratoplasty. Due to the known side effects such as steroid-response glaucoma, cataract, and surface disorders, a broader armamentarium of topical immunomodulating drugs with comparable efficacy, better tolerance and less side effects is desirable. Cyclosporine A and FK506 eye drops are a promising alternative. A new approach involves subconjunctival drug delivering implants and locally applied antiangiogenic substances, which still have to be tested in clinical studies.
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Affiliation(s)
- F Birnbaum
- Universitätsaugenklinik Freiburg, 79106, Freiburg.
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36
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Van Eyk AD, Van Der Bijl P, Meyer D. In Vitro Diffusion of the Immunosuppressant Tacrolimus Through Human and Rabbit Corneas. J Ocul Pharmacol Ther 2007; 23:146-51. [PMID: 17444803 DOI: 10.1089/jop.2006.0105] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE The aim of this study was to investigate the in vitro diffusion kinetics of tacrolimus (TAC) through rabbit and human corneas, and to evaluate the suitability of rabbit cornea as an in vitro permeability model for human cornea. METHODS A flow-through diffusion apparatus was used for all permeability experiments. The percentage of total (3)H-TAC diffusing across the corneas was determined over 24 h and fractions collected twice-hourly (20 degrees C; 1.5 mL/h). An F test was used for whole-curve comparisons, with a significance level of 5%. RESULTS Steady-state values for TAC across both types of corneas were not reached. Although the percentage of TAC diffusing across rabbit cornea was higher than that found for human cornea up to 18 h, there were no statistically significant differences. The percentages of total TAC diffusing across human and rabbit cornea at the 24-h time points were 0.38% +/- 0.02% and 0.36% +/- 0.01%, respectively. CONCLUSIONS Percentages of total TAC at the 24-h time points were approximately 4.9x and 4.1x higher than those found previously for cyclosporin A across human and rabbit corneas, respectively. Rabbit corneas are a suitable model for human corneas in in vitro permeability studies.
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Affiliation(s)
- Armorél D Van Eyk
- Department of Pharmacology, Faculty of Health Sciences, Stellenbosch University, Tygerberg, South Africa.
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37
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Abstract
PURPOSE The aim of this study was to determine if the concomitant use of ketorolac 0.4% and cyclosporin-A improves patient comfort during the induction phase in treating chronic dry eye disease. METHODS Patients (n = 52) with clinically diagnosed dry eye were randomized to receive either cyclosporin-A monotherapy twice-daily (BID) or a BID adjunctive regimen of ketorolac, followed by the instillation of cyclosporin-A 10 min later. Study visits were at baseline, week 2, and week 6. At each study visit, patients underwent an evaluation for corneal staining, Schirmer's scores, and tear break-up time tests. Patients were asked to rate ocular comfort on a 4-point scale and to complete the ocular surface disease index (OSDI). Changes from baseline readings were recorded at week-2 and week-6 visits, and final patient success on treatment regimen was evaluated at week 6. RESULTS After 6 weeks, the mean ocular comfort score of adjunctive patients improved 2.55 +/- 0.95 points, versus 1.53 +/- 0.91 points for monotherapy (P = 0.309). The adjunctive regimen provided significantly greater corneal staining reductions versus monotherapy, mean reduction in staining of 1.74 +/- 0.9, versus 1.27 +/- 0.56 (P = 0.044). CONCLUSIONS Concurrent ketorolac 0.4% use with cyclosporin-A significantly reduced corneal staining and increased comfort in the induction phase.
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38
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Rubin M, Rao SN. Efficacy of Topical Cyclosporin 0.05% in the Treatment of Posterior Blepharitis. J Ocul Pharmacol Ther 2006; 22:47-53. [PMID: 16503775 DOI: 10.1089/jop.2006.22.47] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
We assessed the efficacy of topical cyclosporin 0.05% ophthalmic emulsion versus tobramycin 0.3%/dexamethasone 0.1% in patients with posterior blepharitis. Posterior blepharitis improved significantly from the initial study visit with both cyclosporin treatment and tobramycin/dexamethasone. Cyclosporin provided greater improvements in Schirmer's scores (P < 0.001) and tear break-up time (P = 0.018) than tobramycin/dexamethasone after 12 weeks of treatment. Eyelid health also improved in both groups, but the mean improvement in meibomian gland secretion quality was significantly greater with cyclosporin than with tobramycin/dexamethasone (P = 0.015). Moreover, a higher percentage of patients in the cyclosporin treatment group had improvements in symptoms of blurred vision, burning, and itching and more cyclosporin-treated patients experienced resolution of lid telangiectasia. The findings in this prospective study suggest that posterior blepharitis can be more effectively treated with cyclosporin than with tobramycin/dexamethasone. These findings should be further evaluated in large-scale, controlled, clinical trials.
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Affiliation(s)
- Michael Rubin
- Department of Ophthalmology, University of Chicago, Chicago, IL 60605, USA
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39
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Holán V. Corneal stromal cells selectively inhibit the production of certain anti-inflammatory cytokines. Expert Rev Clin Immunol 2006; 2:101-108. [DOI: 10.1586/1744666x.2.1.101] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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40
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de Wit D, Lightman S. Emerging approaches to the treatment of uveitis: patents of 2000 – 2004. Expert Opin Ther Pat 2005; 15:861-74. [DOI: 10.1517/13543776.15.7.861] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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