Biosynthesized Multivalent Lacritin Peptides Stimulate Exosome Production in Human Corneal Epithelium

Targeting Iron - Respiratory Reciprocity Promotes Bacterial Death

Discovering new bacterial signaling pathways offers unique antibiotic strategies. Here, through an unbiased resistance screen of 3,884 gene knockout strains, we uncovered a previously unknown non-lytic bactericidal mechanism that sequentially couples three transporters and downstream transcription to lethally suppress respiration of the highly virulent P. aeruginosa strain PA14 - one of three species on the WHO's 'Priority 1: Critical' list. By targeting outer membrane YaiW, cationic lacritin peptide 'N-104' translocates into the periplasm where it ligates outer loops 4 and 2 of the inner membrane transporters FeoB and PotH, respectively, to suppress both ferrous iron and polyamine uptake. This broadly shuts down transcription of many biofilm-associated genes, including ferrous iron-dependent TauD and ExbB1. The mechanism is innate to the surface of the eye and is enhanced by synergistic coupling with thrombin peptide GKY20. This is the first example of an inhibitor of multiple bacterial transporters.

Isolation and Characterization of Human Conjunctival Mesenchymal Stromal Cells and Their Extracellular Vesicles

Purpose

The purpose of this study was to isolate and culture human conjunctival mesenchymal stromal cells (Conj-MSCs) from cadaveric donor tissue, and to obtain and characterize their extracellular vesicles (EVs) and their effect on conjunctival epithelium.

Methods

Stromal cells isolated from cadaveric donor conjunctival tissues were cultured and analyzed to determine whether they could be defined as MSCs. Expression of MSC markers was analyzed by flow cytometry. Cells were cultured in adipogenic, osteogenic, and chondrocyte differentiation media, and stained with Oil Red, Von Kossa, and Toluidine Blue, respectively, to determine multipotent capacity. EVs were isolated from cultured Conj-MSCs by differential ultracentrifugation. EV morphology was evaluated by atomic force microscopy, size distribution analyzed by dynamic light scattering, and EVs were individually characterized by nanoflow cytometry. The effect of EVs on oxidative stress and viability was analyzed in in vitro models using the conjunctival epithelial cell line IM-HConEpiC.

Results

Cultured stromal cells fulfilled the criteria of MSCs: adherence to plastic; expression of CD90 (99.95 ± 0.03% positive cells), CD105 (99.04 ± 1.43%), CD73 (99.99 ± 0.19%), CD44 (99.93 ± 0.05%), and absence of CD34, CD11b, CD19, CD45 and HLA-DR (0.82 ± 0.91%); and in vitro differentiation into different lineages. Main Conj-MSC EV subpopulations were round, small EVs that expressed CD9, CD63, CD81, and CD147. Conj-MSC EVs significantly decreased the production of reactive oxygen species in IM-HConEpiCs exposed to H2O2 in similar levels than adipose tissue-MSC-derived EVs and ascorbic acid, used as controls.

Conclusions

It is possible to isolate human Conj-MSCs from cadaveric tissue, and to use these cells as a source of small EVs with antioxidant activity on conjunctival epithelial cells.

Protein and polypeptide mediated delivery to the eye

Hybrid or recombinant protein-polymers, peptide-based biomaterials, and antibody-targeted therapeutics are widely explored for various ocular conditions and vision correction. They have been noted for their potential biocompatibility, potency, adaptability, and opportunities for sustained drug delivery. Unique to peptide and protein therapeutics, their production by cellular translation allows their precise modification through genetic engineering. To a greater extent than drug delivery to other systems, delivery to the eye can benefit from the combination of locally-targeted administration and protein-based specificity. Consequently, a range of delivery platforms and administration methods have been exploited to address the ocular delivery of peptide and protein biomaterials. This review discusses a sample of preclinical and clinical opportunities for peptide-based drug delivery to the eye.

A synthetic tear protein resolves dry eye through promoting corneal nerve regeneration

Corneal architecture is essential for vision and is greatly perturbed by the absence of tears due to the highly prevalent disorder dry eye. With no regenerative therapies available, pathological alterations of the ocular surface in response to dryness, including persistent epithelial defects and poor wound healing, result in life-long morbidity. Here, using a mouse model of aqueous-deficient dry eye, we reveal that topical application of the synthetic tear protein Lacripep reverses the pathological outcomes of dry eye through restoring the extensive network of corneal nerves that are essential for tear secretion, barrier function, epithelial homeostasis, and wound healing. Intriguingly, the restorative effects of Lacripep occur despite extensive immune cell infiltration, suggesting tissue reinnervation and regeneration can be achieved under chronic inflammatory conditions. In summary, our data highlight Lacripep as a first-in-class regenerative therapy for returning the cornea to a near homeostatic state in individuals who suffer from dry eye.

Currently, there are no regenerative treatments for ocular pathologies due to dry eye. Efraim et al. demonstrate the synthetic tear peptide Lacripep as a regenerative therapy capable of restoring the damaged, dysfunctional ocular surface to a near homeostatic state through promoting nerve regeneration in the presence of chronic inflammation.

Lacripep for the Treatment of Primary Sjögren's-Associated Ocular Surface Disease: Results of the First-In-Human Study

PURPOSE

The purpose of this study was to assess the safety, tolerability, dosing, and efficacy of the active 19 amino acid fragment of lacritin (Lacripep), a broad regulator of ocular surface homeostasis, in the treatment of ocular surface disease associated with primary Sjögren's syndrome.

METHODS

Two hundred four subjects were randomized to receive vehicle, 22 μM Lacripep, or 44 μM Lacripep 3 times daily for 28 days, preceded by a 14-day run-in and followed by 14-day washout. Outcome measures were corneal fluorescein staining (CFS), lissamine conjunctival staining, Schirmer with anesthesia, tear break-up time, SANDE scoring, and visual analog scale assessment of symptoms.

RESULTS

This study established the safety and tolerability of topical treatment with Lacripep in patients with primary Sjögren's syndrome. There were few adverse events: Only mild irritation was found in less than 3 percent of patients dosed with Lacripep. Total CFS and Eye Dryness Score were not significantly changed at day 28. Post hoc analysis of patients with Eye Dryness Severity scores of 60 or greater at baseline revealed significant improvements in inferior CFS at 14 and 28 days and complaints of burning and stinging at 14 days. Significant improvement in regional lissamine conjunctival staining was seen at 14 and 28 days.

CONCLUSIONS

This first-in-human study of Lacripep in patients with primary Sjögren's syndrome demonstrated clinically significant improvements in specific signs and symptoms on which to base future studies. This study established safety and tolerability and potential metrics of efficacy in patients with moderate to severe disease. Further work on appropriate dosing and concentration is ongoing.