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Luo S, Jiang H, Li Q, Qin Y, Yang S, Li J, Xu L, Gou Y, Zhang Y, Liu F, Ke X, Zheng Q, Sun X. An adeno-associated virus variant enabling efficient ocular-directed gene delivery across species. Nat Commun 2024; 15:3780. [PMID: 38710714 DOI: 10.1038/s41467-024-48221-4] [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: 09/20/2023] [Accepted: 04/24/2024] [Indexed: 05/08/2024] Open
Abstract
Recombinant adeno-associated viruses (rAAVs) have emerged as promising gene therapy vectors due to their proven efficacy and safety in clinical applications. In non-human primates (NHPs), rAAVs are administered via suprachoroidal injection at a higher dose. However, high doses of rAAVs tend to increase additional safety risks. Here, we present a novel AAV capsid (AAVv128), which exhibits significantly enhanced transduction efficiency for photoreceptors and retinal pigment epithelial (RPE) cells, along with a broader distribution across the layers of retinal tissues in different animal models (mice, rabbits, and NHPs) following intraocular injection. Notably, the suprachoroidal delivery of AAVv128-anti-VEGF vector completely suppresses the Grade IV lesions in a laser-induced choroidal neovascularization (CNV) NHP model for neovascular age-related macular degeneration (nAMD). Furthermore, cryo-EM analysis at 2.1 Å resolution reveals that the critical residues of AAVv128 exhibit a more robust advantage in AAV binding, the nuclear uptake and endosome escaping. Collectively, our findings highlight the potential of AAVv128 as a next generation ocular gene therapy vector, particularly using the suprachoroidal delivery route.
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Affiliation(s)
- Shuang Luo
- Chengdu Origen Biotechnology Co. Ltd, Chengdu, 610036, China
- Key Laboratory of Drug-Targeting and Drug Delivery System of the Education Ministry and Sichuan Province, Sichuan Engineering Laboratory for Plant-Sourced Drug and Sichuan Research Center for Drug Precision Industrial Technology, West China School of Pharmacy, Sichuan University, Chengdu, 610041, China
- Sichuan Provincial Key Laboratory of Innovative Biomedicine, Chengdu, 610036, China
| | - Hao Jiang
- Chengdu Origen Biotechnology Co. Ltd, Chengdu, 610036, China
- Sichuan Provincial Key Laboratory of Innovative Biomedicine, Chengdu, 610036, China
| | - Qingwei Li
- Chengdu Origen Biotechnology Co. Ltd, Chengdu, 610036, China
- Sichuan Provincial Key Laboratory of Innovative Biomedicine, Chengdu, 610036, China
| | - Yingfei Qin
- Chengdu Origen Biotechnology Co. Ltd, Chengdu, 610036, China
| | - Shiping Yang
- Chengdu Origen Biotechnology Co. Ltd, Chengdu, 610036, China
| | - Jing Li
- Chengdu Origen Biotechnology Co. Ltd, Chengdu, 610036, China
| | - Lingli Xu
- Chengdu Origen Biotechnology Co. Ltd, Chengdu, 610036, China
| | - Yan Gou
- Chengdu Origen Biotechnology Co. Ltd, Chengdu, 610036, China
| | - Yafei Zhang
- Chengdu Origen Biotechnology Co. Ltd, Chengdu, 610036, China
| | - Fengjiang Liu
- Innovative Center for Pathogen Research, Guangzhou Laboratory, Guangzhou, 510005, China
| | - Xiao Ke
- Chengdu Origen Biotechnology Co. Ltd, Chengdu, 610036, China.
- Chengdu Kanghong Pharmaceuticals Group Co Ltd, Chengdu, 610036, China.
| | - Qiang Zheng
- Chengdu Origen Biotechnology Co. Ltd, Chengdu, 610036, China.
- Sichuan Provincial Key Laboratory of Innovative Biomedicine, Chengdu, 610036, China.
| | - Xun Sun
- Key Laboratory of Drug-Targeting and Drug Delivery System of the Education Ministry and Sichuan Province, Sichuan Engineering Laboratory for Plant-Sourced Drug and Sichuan Research Center for Drug Precision Industrial Technology, West China School of Pharmacy, Sichuan University, Chengdu, 610041, China.
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Budzinskaya MV, Shelankova AV, Andreeva YS. [Prevention of intraocular pressure elevation following intravitreal injections]. Vestn Oftalmol 2022; 138:240-246. [PMID: 36287162 DOI: 10.17116/oftalma2022138052240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Determining the role of vascular endothelial growth factor (VEGF) in the pathogenesis of intraocular neovascularization prompted the development of anti-VEGF therapy. In general, these intravitreal injections (IVI) are considered relatively safe. One of the side effects that can occur after IVI of anti-VEGF agents is ocular hypertension, it can be acute or persistent. Numerous studies investigating the prevention of ophthalmic hypertension have been carried out in connection with the proven risk of short-term intraocular pressure (IOP) elevation after anti-VEGF injections. Scientific literature describes several methods of preventing intraocular pressure spikes after IVI: prophylactic medications, anterior chamber paracentesis, scleral decompression. Despite the significant number of publications, there is no universal consensus on the necessity of prevention measures for IVI of anti-VEGF drugs since the clinical benefits of slightly reducing the short-term IOP spikes remain unclear. This literature review analyzes the prospects of preventing ocular hypertension after IVI of anti-VEGF agents.
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Prophylactic effect of brinzolamide-brimonidine fixed combination on intraocular pressure spikes after intravitreal anti-VEGF injections. Int Ophthalmol 2021; 41:3191-3198. [PMID: 34114138 DOI: 10.1007/s10792-021-01885-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Accepted: 05/12/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE To evaluate the effect of topical prophylaxis with brinzolamide-brimonidine fixed combination on short-term intraocular pressure (IOP) elevation after intravitreal injections of anti-vascular endothelial growth factors (anti-VEGF). METHODS This prospective comparative study included 56 eyes of 47 patients treated with intravitreal injections of anti-VEGF, and they were randomly divided into two groups. In control group (25 eyes), no prophylactic medication was used, whereas in case group (31 eyes) one drop of a fixed combination of brinzolamide-brimonidine was instilled two hours before the injection. IOP was measured before the injection and at 1 min, 10 min and 30 min post-injection in all eyes. RESULTS The mean IOP before injection at 1 min, 10 min and 30 min post-injection was 16,6 ± 2,8 mmHg, 53,4 ± 12 mmHg, 26,4 ± 5,5 mmHg and 17,9 ± 4 mmHg, respectively, in control group and 15,1 ± 3,4 mmHg, 42,6 ± 8,4 mmHg, 21,4 ± 5,5 mmHg and 12,4 ± 3,5 mmHg, respectively, in case group. At 1 min, 10 min and 30 min post-injection, the mean IOP was significantly lower in case group compared with control group (p < 0,001, p = 0,0014 and p < 0,0001, respectively), but no difference at the pre-injection IOP between the two groups was found (p = 0,09). CONCLUSIONS The prophylactic administration of one drop of brinzolamide-brimonidine fixed combination significantly reduces the IOP spikes during the first 30 min after the intravitreal anti-VEGF injection.
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Shoeibi N, Ghosi Z, Jafari H, Omidtabrizi A. Effect of antiglaucoma agents on short-term intraocular pressure fluctuations after intravitreal bevacizumab injections. Int Ophthalmol 2021; 41:1081-1090. [PMID: 33389369 DOI: 10.1007/s10792-020-01667-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Accepted: 11/27/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE To evaluate the effect of prophylactic pressure-lowering medications on intraocular pressure (IOP) spikes after intravitreal injections (IVIs) METHODS: In this randomized double-blind clinical trial, 74 eyes that were candidates for intravitreal anti-vascular endothelial growth factor (VEGF) injection (IVI) (0.05 mL, 1.25 mg of bevacizumab) were enrolled and sorted randomly into five groups, group 1: topical timolol 0.5% (n = 16); group 2: topical brimonidin (n = 15); group 3: oral acetazolamide 250 mg (n = 14); group 4: intravenous mannitol (1.5 gr/kg) (n = 16); group 5: no intraocular pressure-lowering medication (n = 13). Medications were administered 30-60 min prior to injection. None of the patients had history of glaucoma. Intraocular pressure was measured before (baseline), 5 min after (T5), 10 min after (T10), 15 min after (T15) and 30 min after (T30) IVI using Goldmann Tonometer. RESULTS There was a statistically significant, but relatively weak negative correlation between the amount of vitreous reflux post-IVI intraocular pressure elevation (Spearman's rho = -0.315, p = 0.006). There was no difference of the amount of vitreous reflux (P = 0.196) between study groups. The baseline mean IOP for Groups 1, 2, 3,4 and 5 were 11.19 ± 3.7, 10.07 ± 2.19, 11 ± 2.98, 10.13 ± 3.48 and12.54 ± 2.60 mmHg, respectively. (P = 0.214) There was no difference of peak IOP spike between groups at T5: 37 ± 19.7, 34.80 ± 15.76, 33.43 ± 18.29, 33.56 ± 16.88, 34.92 ± 9.99 mmHg (P = 0.977). There was also no difference of IOP at T10, T15 and T30 between study groups: P = 0.979, P = 0.994 and P = 0.692, respectively. CONCLUSION Although it is advisable to prevent IOP spikes, our study showed that use of prophylactic pressure-lowering medications with every mechanism of action has no effect in IOP spikes following intravitreal bevacizumab injections in non-glaucomatous eyes. Trial registrationThe study was registered with clinicaltrails.gov (ID# NCT02140450). Trial registration date: 05.09.2014.
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Affiliation(s)
- Nasser Shoeibi
- Associate Professor of Ophthalmology, Khatam Eye Hospital, Mashhad University of Medical Sciences, eye research center, Mashhad, Iran
| | - Zina Ghosi
- Resident of Ophthalmology, Khatam Eye Hospital, Mashhad University of Medical Sciences, eye research center, Mashhad, Iran
| | - Habib Jafari
- Anterior Segment Fellow in Ophthalmology, Khatam Eye Hospital, Mashhad University of Medical Sciences, eye research center, Mashhad, Iran
| | - Arash Omidtabrizi
- Vitreoretina Fellowship Student, Khatam Al Anbia Eye Hospital, Mashhad University of Medical Sciences, eye research centerAbutalib crossroad, Ghareni Blvd, Mashhad, Iran.
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Timolol 0.1% in Glaucomatous Patients: Efficacy, Tolerance, and Quality of Life. J Ophthalmol 2019; 2019:4146124. [PMID: 31191995 PMCID: PMC6525866 DOI: 10.1155/2019/4146124] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2018] [Accepted: 02/24/2019] [Indexed: 01/30/2023] Open
Abstract
Glaucoma is a progressive, chronic optic neuropathy characterized by a typical visual field defects. Four main classes of topical medication are actually available on the market: beta-blockers, prostaglandins, alpha2-agonists, and topical carbonic anhydrase inhibitor to treat intraocular pressure (IOP). The aim of this review is to outline the efficacy of timolol and to evaluate the impact of this treatment on patients' quality of life. Among beta-blockers, timolol is most used at three different concentrations: 0.1%, 0.25%, and 0.5%. While the first one is a gel, the other two products are solution. Timolol has few topical side effects, while it has some important systemic side effects on the cardiac and respiratory systems. The balance between efficacy and safety is always the main aspect to care patients. Because of the less efficacy of timolol 0.1% solution, the possibility to use carbomers as vehicle in the gel drops helped timolol 0.1 to be used in clinics, extending the time contact between the active ingredient and the surface of the cornea. Using preservative-free timolol 0.1 for treatment, IOP was at the same level of the other beta-blockers at higher concentration, but it was better tolerated. Preservative-free treatment improved the quality of life reducing dry-eye like symptoms; furthermore, the presence of an artificial tear in the medication bottle could help adherence. The once daily dosing improves compliance.
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Karakurt Y, Ucak T, Taslı G, Agcayazı B, İcel E, Yılmaz H. The Effects of Intravitreal Ranibizumab, Aflibercept or Dexamethasone Implant Injections on Intraocular Pressure Changes. Med Sci Monit 2018; 24:9019-9025. [PMID: 30542050 PMCID: PMC6301255 DOI: 10.12659/msm.910923] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND The aim of this study was to compare the alterations in intraocular pressure (IOP) values during the early postoperative period after intravitreal ranibizumab, aflibercept, or dexamethasone implant injections. MATERIAL AND METHODS In this retrospective study, a total of 188 patients were grouped into 3 groups: the ranibizumab group, the aflibercept group, and the dexamethasone group. Ocular axial length (AXL) and anterior chamber depth (ACD) were measured in the pre-injection period. IOP was measured just before the injection at 1 minute,10 minutes, 1 hour, 1 day, and 1 month after injection. RESULTS There was a transient peak in the ranibizumab group and the aflibercept group at 1 minute that started to decrease at 10 minutes and IOP values returned to preoperative values at approximately 1 hour. Similar alterations were also determined for the dexamethasone group with a lesser increase noted. In the correlation analysis, only alterations in IOP levels at 1 minute were negatively correlated with preoperative AXL values. There was not any correlation between preoperative AXL or ACD values and IOP alterations at any other time points. CONCLUSIONS There was a sudden, transient increase in IOP values after intravitreal ranibizumab or aflibercept injections; which return to normal values in a short time without requirement of any medical treatments. This transient peak was determined to be negatively correlated with the preoperative AXL.
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Affiliation(s)
- Yucel Karakurt
- Department of Ophthalmology, Erzincan University, Faculty of Medicine, Erzincan, Turkey
| | - Turgay Ucak
- Department of Ophthalmology, Erzincan University, Faculty of Medicine, Erzincan, Turkey
| | - Gamze Taslı
- Department of Ophthalmology, Erzincan University, Faculty of Medicine, Erzincan, Turkey
| | - Burcu Agcayazı
- Department of Ophthalmology, Erzincan Mengücek Gazi Education and Research Hospital, Erzincan, Turkey
| | - Erel İcel
- Department of Ophthalmology, Erzincan Mengücek Gazi Education and Research Hospital, Erzincan, Turkey
| | - Hayati Yılmaz
- Department of Ophthalmology, Erzincan Mengücek Gazi Education and Research Hospital, Erzincan, Turkey
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