1
|
Khachigian LM, Liew G, Teo KYC, Wong TY, Mitchell P. Emerging therapeutic strategies for unmet need in neovascular age-related macular degeneration. J Transl Med 2023; 21:133. [PMID: 36810060 PMCID: PMC9942398 DOI: 10.1186/s12967-023-03937-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 01/27/2023] [Indexed: 02/23/2023] Open
Abstract
Neovascular age-related macular degeneration (nAMD) is a major cause of visual impairment and blindness. Anti-vascular endothelial growth factor (VEGF) agents, such as ranibizumab, bevacizumab, aflibercept, brolucizumab and faricimab have revolutionized the clinical management of nAMD. However, there remains an unmet clinical need for new and improved therapies for nAMD, since many patients do not respond optimally, may lose response over time or exhibit sub-optimal durability, impacting on real world effectiveness. Evidence is emerging that targeting VEGF-A alone, as most agents have done until recently, may be insufficient and agents that target multiple pathways (e.g., aflibercept, faricimab and others in development) may be more efficacious. This article reviews issues and limitations that have arisen from the use of existing anti-VEGF agents, and argues that the future may lie in multi-targeted therapies including alternative agents and modalities that target both the VEGF ligand/receptor system as well as other pathways.
Collapse
Affiliation(s)
- Levon M. Khachigian
- grid.1005.40000 0004 4902 0432Vascular Biology and Translational Research, Faculty of Medicine and Health, School of Medical Sciences, University of New South Wales, Sydney, NSW 2052 Australia
| | - Gerald Liew
- grid.476921.fCentre for Vision Research, Westmead Institute for Medical Research, University of Sydney, Westmead, Australia
| | - Kelvin Y. C. Teo
- grid.419272.b0000 0000 9960 1711Singapore National Eye Centre and Singapore Eye Research Institute, Singapore, Singapore ,grid.4280.e0000 0001 2180 6431Duke-NUS Graduate Medical School, National University of Singapore, Singapore, Singapore
| | - Tien Y. Wong
- grid.419272.b0000 0000 9960 1711Singapore National Eye Centre and Singapore Eye Research Institute, Singapore, Singapore ,grid.4280.e0000 0001 2180 6431Duke-NUS Graduate Medical School, National University of Singapore, Singapore, Singapore ,grid.12527.330000 0001 0662 3178Tsinghua Medicine, Tsinghua University, Beijing, China
| | - Paul Mitchell
- grid.476921.fCentre for Vision Research, Westmead Institute for Medical Research, University of Sydney, Westmead, Australia
| |
Collapse
|
2
|
Tang S, Ruan Z, Ma A, Wang D, Kou J. Effect of vitamin K on wound healing: A systematic review and meta-analysis based on preclinical studies. Front Pharmacol 2022; 13:1063349. [PMID: 36532748 PMCID: PMC9755209 DOI: 10.3389/fphar.2022.1063349] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 11/25/2022] [Indexed: 12/03/2022] Open
Abstract
Background: In recent years, many studies have found that vitamin K is beneficial to wound healing. However, some research results seem to be in conflict. The purpose of this study was to evaluate the effect of vitamin K on wound healing.Methods: We systematically and comprehensively searched the PubMed, Web of Science, Embase, Cochrane library, China National Knowledge Infrastructure (CNKI), VIP and Wanfang eletronic databases. We applied revman5.3 software to calculate the weighted mean difference (WMD) of 95% confidence interval (CI) of animal and cell groups to evaluate the effect of vitamin K on wound healing. Two researchers independently selected studies and used the Cochrane Collaboration tool to assess the risk of bias in the included studies. The overall quality of evidence was assessed using the Recommendation, Assessment, Development and Evaluation (GRADE) working group approch.Results: Among the 1081 articles searched, 6 articles (16 studies in total) met the inclusion criteria. The results of quantitative analysis showed that vitamin K was beneficial to increase the wound healing rate in animal models [rat model: WMD = 27.45 (95% CI: 13.46, 41.44); p = 0.0001], but the opposite result was obtained in cell experiments [WMD = −33.84 (95% CI: −56.90, −10.79); p = 0.004].Conclusion: This meta-analysis hits that vitamin K could affect the process of wound healing, especially in animal models. While we could not know the clear role at present, which requires larger scale research. In addition, the concentration and safe dose of vitamin K also deserve further study.
Collapse
Affiliation(s)
- Saiqing Tang
- Second School of Clinical Medicine, Shaanxi University of Chinese Medicine, Xianyang, China
| | - Zhen Ruan
- Xianyang Central Hospital, Xianyang, China
| | - Axue Ma
- Second School of Clinical Medicine, Shaanxi University of Chinese Medicine, Xianyang, China
| | - Dong Wang
- Second School of Clinical Medicine, Shaanxi University of Chinese Medicine, Xianyang, China
- Medical Research and Experiment Center, Shaanxi University of Chinese Medicine, Xianyang, China
- Shaanxi Key Laboratory of Research on TCM Physical Constitution and Disease Prevention and Treatment, Xianyang, China
- *Correspondence: Dong Wang,
| | - Jiushe Kou
- Second Affiliated Hospital of Shaanxi University of Chinese Medicine, Xianyang, China
| |
Collapse
|
3
|
Poor SH, Weissgerber G, Adams CM, Bhatt H, Browning DJ, Chastain J, Ciulla TA, Ferriere M, Gedif K, Glazer LC, Joondeph BC, Normand G, Sheth V, Watters C, Grosskreutz CL. A Randomized, Double-Masked, Multicenter Trial of Topical Acrizanib (LHA510), a Tyrosine Kinase VEGF-Receptor Inhibitor, in Treatment-Experienced Subjects With Neovascular Age-Related Macular Degeneration. Am J Ophthalmol 2022; 239:180-189. [PMID: 35247334 DOI: 10.1016/j.ajo.2022.02.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 02/17/2022] [Accepted: 02/17/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate whether topical acrizanib (LHA510), a small-molecule vascular endothelial growth factor receptor inhibitor, could suppress the need for anti-vascular endothelial growth factor therapy over a 12-week period in patients with neovascular age-related macular degeneration. DESIGN A phase 2 multicenter randomized double-masked, vehicle-controlled proof-of-concept study. METHODS Trial includes n = 90 patients with active choroidal neovascularization due to neovascular age-related macular degeneration and under anti-vascular endothelial growth factor treatment. All patients received an intravitreal injection of ranibizumab at baseline and were retreated when there was evidence of disease recurrence (rescue). Patients were randomized 1:1 to receive topical LHA510 or vehicle for 12 weeks. Drops were administered twice a day for 8 weeks and then 3 times a day for the last 4 weeks. MAIN OUTCOME MEASURE The primary outcome was the number of patients requiring rescue over 84 days of topical dosing. Key secondary outcome measures were time to first rescue, total number of ranibizumab injections, changes in central subfield thickness, and changes of visual acuity from baseline to day 84. RESULTS The extended per protocol set included 70 patients of whom 25 of 33 patients in the LHA510 group (75.8%) and 25 of 37 patients in the placebo group (67.6%) required rescue by day 84 (P = .8466). Secondary and subgroup analysis did not support evidence of efficacy. Twenty-one of 46 patients administered LHA510 developed a reversible corneal haze that resolved with cessation of treatment and did not recur in patients restarted at once daily frequency. CONCLUSION In spite of extensive optimization for topical efficacy, LHA510 failed to demonstrate clinical efficacy.
Collapse
|
4
|
Epidermal Growth Factor Receptor Expression in the Corneal Epithelium. Cells 2021; 10:cells10092409. [PMID: 34572058 PMCID: PMC8470622 DOI: 10.3390/cells10092409] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 08/31/2021] [Accepted: 09/07/2021] [Indexed: 01/12/2023] Open
Abstract
A properly functioning cornea is critical to clear vision and healthy eyes. As the most anterior portion of the eye, it plays an essential role in refracting light onto the retina and as an anatomical barrier to the environment. Proper vision requires that all layers be properly formed and fully intact. In this article, we discuss the role of the epidermal growth factor receptor (EGFR) in maintaining and restoring the outermost layer of the cornea, the epithelium. It has been known for some time that the addition of epidermal growth factor (EGF) promotes the restoration of the corneal epithelium and patients using EGFR inhibitors as anti-cancer therapies are at increased risk of corneal erosions. However, the use of EGF in the clinic has been limited by downregulation of the receptor. More recent advances in EGFR signaling and trafficking in corneal epithelial cells have provided new insights in how to overcome receptor desensitization. We examine new strategies for overcoming the limitations of high ligand and receptor expression that alter trafficking of the ligand:receptor complex to sustain receptor signaling.
Collapse
|
5
|
Baratta RO, Del Buono BJ, Schlumpf E, Ceresa BP, Calkins DJ. Collagen Mimetic Peptides Promote Corneal Epithelial Cell Regeneration. Front Pharmacol 2021; 12:705623. [PMID: 34483909 PMCID: PMC8415399 DOI: 10.3389/fphar.2021.705623] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 07/12/2021] [Indexed: 01/08/2023] Open
Abstract
The cornea of the eye is at risk for injury through constant exposure to the extraocular environment. A highly collagenous structure, the cornea contains several different types distributed across multiple layers. The anterior-most layer contains non-keratinized epithelial cells that serve as a barrier to environmental, microbial, and other insults. Renewal and migration of basal epithelial cells from the limbus involve critical interactions between secreted basement membranes, composed primarily of type IV collagen, and underlying Bowman's and stromal layers, which contain primarily type I collagen. This process is challenged in many diseases and conditions that insult the ocular surface and damage underlying collagen. We investigated the capacity of a collagen mimetic peptide (CMP), representing a fraction of a single strand of the damaged triple helix human type I collagen, to promote epithelial healing following an acute corneal wound. In vitro, the collagen mimetic peptide promoted the realignment of collagen damaged by enzymic digestion. In an in vivo mouse model, topical application of a CMP-containing formulation following a 360° lamellar keratectomy targeting the corneal epithelial layer accelerated wound closure during a 24 h period, compared to vehicle. We found that the CMP increased adherence of the basal epithelium to the underlying substrate and enhanced density of epithelial cells, while reducing variability in the regenerating layer. These results suggest that CMPs may represent a novel therapeutic to heal corneal tissue by repairing underlying collagen in conditions that damage the ocular surface.
Collapse
Affiliation(s)
| | | | | | - Brian P Ceresa
- Department of Ophthalmology and Visual Sciences, University of Louisville School of Medicine, Louisville, KY, United States
| | - David J Calkins
- Department of Ophthalmology and Visual Sciences, Vanderbilt Eye Institute, Vanderbilt University Medical Center, Nashville, TN, United States
| |
Collapse
|
6
|
Kandhasamy S, Liang B, Yang DP, Zeng Y. Antibacterial Vitamin K3 Carnosine Peptide-Laden Silk Fibroin Electrospun Fibers for Improvement of Skin Wound Healing in Diabetic Rats. ACS APPLIED BIO MATERIALS 2021; 4:4769-4788. [PMID: 35007027 DOI: 10.1021/acsabm.0c01650] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
The utilization of a multifunctional bioactive molecule functionalized electrospun dressing in tissue repair and regenerative function is a prominent therapeutic strategy for preparing efficient biomaterials to promote chronic wound healing. Designing robust and highly efficient antibacterial agents in resistance against microbes and bacterial infections is a key challenge for accelerating diabetic wound healing until today. In this study, we developed a vitamin K3 carnosine peptide (VKC)-laden silk fibroin electrospun scaffold (SF-VKC) for diabetic wound healing. The structural confirmation of synthesized VKC was characterized by 1H NMR, 13C NMR, electrospray ionization mass spectrometry (ESI-MS), and attenuated total reflection Fourier transform infrared (ATR-FTIR) spectroscopy analysis, and the cell viability of VKC was evaluated by the CCK-8 assay in HFF1 and NIH 3T3 cells. VKC shows excellent cell viability on both cell lines, and the VKC and SF-VKC electrospun mats exhibited excellent antibacterial activity against both Gram-positive (Staphylococcus aureus) and Gram-negative (Escherichia coli and Pseudomonas aeruginosa) bacteria. Prepared SF and SF-VKC fibrous mats were well characterized, and the SF-VKC nanofiber mat presented good biodegradability, adhesiveness, unique mechanical property, expedient water uptake property, sustained drug release, and excellent biocompatibility for chronic wound healing. The in vitro tissue engineering study depicted excellent cell migration and cell-cell interaction in the NIH 3T3 cells over the VKC-impregnated silk fibroin (SF-VKC) mat. A higher population of cell migration was observed in cells' denuded area (scratched region) compared to the native SF fibrous mat. Interestingly, our results demonstrated that the prepared VKC-impregnated SF mat had potentially promoted the STZ-induced diabetic wound healing in a shorter period than the pure SF mat. Thus, obtained in vitro and in vivo outcomes suggest that the VKC-laden SF electrospun fibrous mat could be a better and inexpensive fibrous antibacterial biomaterial to elicit earlier re-epithelialization and efficient matrix remodeling for accelerating chronic infected wound reconstruction in skin diabetic wound healing applications.
Collapse
Affiliation(s)
- Subramani Kandhasamy
- Department of Respiratory Diseases, Clinical Center for Molecular Diagnosis and Therapy, The Second Affiliated Hospital of Fujian Medical University, Quanzhou 362000, China
| | - Bo Liang
- Department of Endocrinology and Metabolism, The Second Affiliated Hospital of Fujian Medical University, Quanzhou 362000, China
| | - Da-Peng Yang
- College of Chemical Engineering and Materials Science, Quanzhou Normal University, Quanzhou, Fujian 362000, China
| | - Yiming Zeng
- Department of Respiratory Diseases, Clinical Center for Molecular Diagnosis and Therapy, The Second Affiliated Hospital of Fujian Medical University, Quanzhou 362000, China
| |
Collapse
|
7
|
Puri S, Sun M, Mutoji KN, Gesteira TF, Coulson-Thomas VJ. Epithelial Cell Migration and Proliferation Patterns During Initial Wound Closure in Normal Mice and an Experimental Model of Limbal Stem Cell Deficiency. Invest Ophthalmol Vis Sci 2021; 61:27. [PMID: 32790859 PMCID: PMC7441334 DOI: 10.1167/iovs.61.10.27] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Purpose Establishing the dynamics of corneal wound healing is of vital importance to better understand corneal inflammation, pathology, and corneal regeneration. Numerous studies have made great strides in investigating multiple aspects of corneal wound healing; however, some aspects remain to be elucidated. This study worked toward establishing (1) if epithelial limbal stem cells (LSCs) are necessary for healing all corneal wounds, (2) the mechanism by which epithelial cells migrate toward the wound, and (3) if centrifugal epithelial cell movement exists. Methods To establish different aspects of corneal epithelial wound healing we subjected mice lacking hyaluronan synthase 2 (previously shown to lack LSCs) and wild-type mice to different corneal debridement injury models. Results Our data show that both LSCs and corneal epithelial cells contribute toward closure of corneal wounds. In wild-type mice, removal of the limbal rim delayed closure of 1.5-mm wounds, and not of 0.75-mm wounds, indicating that smaller wounds do not rely on LSCs as do larger wounds. In mice shown to lack LSCs, removal of the limbal rim did not affect wound healing, irrespective of the wound size. Finally, transient amplifying cells and central epithelial cells move toward a central corneal wound in a centripetal manner, whereas central epithelial cells may move in a centrifugal manner to resurface peripheral corneal wounds. Conclusions Our findings show the dimensions of the corneal wound dictate involvement of LSCs. Our data suggest that divergent findings by different groups on the dynamics of wound healing can be in part owing to differences in the wounding models used.
Collapse
Affiliation(s)
- Sudan Puri
- College of Optometry, University of Houston, Houston, Texas, United States
| | - Mingxia Sun
- College of Optometry, University of Houston, Houston, Texas, United States
| | - Kazadi N Mutoji
- College of Optometry, University of Houston, Houston, Texas, United States
| | - Tarsis F Gesteira
- College of Optometry, University of Houston, Houston, Texas, United States
| | | |
Collapse
|
8
|
Korntner S, Lehner C, Gehwolf R, Wagner A, Grütz M, Kunkel N, Tempfer H, Traweger A. Limiting angiogenesis to modulate scar formation. Adv Drug Deliv Rev 2019; 146:170-189. [PMID: 29501628 DOI: 10.1016/j.addr.2018.02.010] [Citation(s) in RCA: 71] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Revised: 01/22/2018] [Accepted: 02/26/2018] [Indexed: 02/06/2023]
Abstract
Angiogenesis, the process of new blood vessel formation from existing blood vessels, is a key aspect of virtually every repair process. During wound healing an extensive, but immature and leaky vascular plexus forms which is subsequently reduced by regression of non-functional vessels. More recent studies indicate that uncontrolled vessel growth or impaired vessel regression as a consequence of an excessive inflammatory response can impair wound healing, resulting in scarring and dysfunction. However, in order to elucidate targetable factors to promote functional tissue regeneration we need to understand the molecular and cellular underpinnings of physiological angiogenesis, ranging from induction to resolution of blood vessels. Especially for avascular tissues (e.g. cornea, tendon, ligament, cartilage, etc.), limiting rather than boosting vessel growth during wound repair potentially is beneficial to restore full tissue function and may result in favourable long-term healing outcomes.
Collapse
|