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Paleel F, Qin M, Tagalakis AD, Yu-Wai-Man C, Lamprou DA. Manufacturing and characterisation of 3D-printed sustained-release Timolol implants for glaucoma treatment. Drug Deliv Transl Res 2024:10.1007/s13346-024-01589-8. [PMID: 38578377 DOI: 10.1007/s13346-024-01589-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/26/2024] [Indexed: 04/06/2024]
Abstract
Timolol maleate (TML) is a beta-blocker drug that is commonly used to lower the intraocular pressure in glaucoma. This study focused on using a 3D printing (3DP) method for the manufacturing of an ocular, implantable, sustained-release drug delivery system (DDS). Polycaprolactone (PCL), and PCL with 5 or 10% TML implants were manufactured using a one-step 3DP process. Their physicochemical characteristics were analysed using light microscopy, scanning electronic microscopy (SEM), differential scanning calorimetry (DSC) / thermal gravimetric analysis (TGA), and Fourier-transform infrared spectroscopy (FTIR). The in vitro drug release was evaluated by UV-spectrophotometry. Finally, the effect of the implants on cell viability in human trabecular meshwork cells was assessed. All the implants showed a smooth surface. Thermal analysis demonstrated that the implants remained thermally stable at the temperatures used for the printing, and FTIR studies showed that there were no significant interactions between PCL and TML. Both concentrations (5 & 10%) of TML achieved sustained release from the implants over the 8-week study period. All implants were non-cytotoxic to human trabecular cells. This study shows proof of concept that 3DP can be used to print biocompatible and personalised ocular implantable sustained-release DDSs for the treatment of glaucoma.
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Affiliation(s)
- Fathima Paleel
- School of Pharmacy, Queen's University Belfast, BT9 7BL, Belfast, UK
- Faculty of Life Sciences & Medicine, King's College London, SE1 7EH, London, UK
| | - Mengqi Qin
- Faculty of Life Sciences & Medicine, King's College London, SE1 7EH, London, UK
| | | | - Cynthia Yu-Wai-Man
- Faculty of Life Sciences & Medicine, King's College London, SE1 7EH, London, UK.
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2
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Qin M, Yu-Wai-Man C. Glaucoma: Novel antifibrotic therapeutics for the trabecular meshwork. Eur J Pharmacol 2023; 954:175882. [PMID: 37391006 PMCID: PMC10804937 DOI: 10.1016/j.ejphar.2023.175882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 06/23/2023] [Accepted: 06/26/2023] [Indexed: 07/02/2023]
Abstract
Glaucoma is a chronic and progressive neurodegenerative disease characterized by the loss of retinal ganglion cells and visual field defects, and currently affects around 1% of the world's population. Elevated intraocular pressure (IOP) is the best-known modifiable risk factor and a key therapeutic target in hypertensive glaucoma. The trabecular meshwork (TM) is the main site of aqueous humor outflow resistance and therefore a critical regulator of IOP. Fibrosis, a reparative process characterized by the excessive deposition of extracellular matrix components and contractile myofibroblasts, can impair TM function and contribute to the pathogenesis of primary open-angle glaucoma (POAG) as well as the failure of minimally invasive glaucoma surgery (MIGS) devices. This paper provides a detailed overview of the current anti-fibrotic therapeutics targeting the TM in glaucoma, along with their anti-fibrotic mechanisms, efficacy as well as the current research progress from pre-clinical to clinical studies.
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Affiliation(s)
- Mengqi Qin
- King's College London, London, SE1 7EH, UK
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3
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Tanner A, Haddad F, Fajardo-Sanchez J, Nguyen E, Thong KX, Ah-Moye S, Perl N, Abu-Bakra M, Kulkarni A, Trikha S, Lascaratos G, Parnell M, Kailani O, King AJ, Agrawal P, Stead R, Giannouladis K, Rodrigues I, Goyal S, Hysi PG, Lim S, Yu-Wai-Man C. One-year surgical outcomes of the PreserFlo MicroShunt in glaucoma: a multicentre analysis. Br J Ophthalmol 2023; 107:1104-1111. [PMID: 35365491 PMCID: PMC10359526 DOI: 10.1136/bjophthalmol-2021-320631] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 03/13/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND/AIMS To evaluate the efficacy and safety of the PreserFlo MicroShunt glaucoma device in a multicentre cohort study. METHODS All consecutive patients who received the microshunt with mitomycin-C (MMC) 0.4 mg/mL from May 2019 to September 2020 in three UK tertiary centres. Primary outcome at 1 year was a complete success, with failure defined as intraocular pressure (IOP) >21 mmHg or <20% reduction, IOP≤5 mmHg with any decreased vision on two consecutive visits, reoperation or loss of light perception vision. Secondary outcomes were IOP, best-corrected visual acuity, medications, complications, interventions and reoperations. We also performed subgroup analyses for severe glaucoma and assessed risk factors for failure. RESULTS 104 eyes had 1-year follow-up. Complete and qualified success at 1 year were achieved in 51.9% (N=54) and 16.4% (N=17), respectively, and failure occurred in 31.7% (N=33). There was a significant reduction in IOP (mmHg) from preoperatively (23.4±0.8, N=104) to 12 months (14.7±0.6, N=104) (p<0.0001). Antiglaucoma medications also decreased from preoperatively (3.4±0.1, N=104) to 12 months (0.7±0.1, N=104) (p<0.0001). Multivariate analyses showed an association between higher mean deviation and failure (HR 1.055, 95% CI 1.0075 to 1.11, p=0.0227). Complications were hypotony (19.2%; N=20), choroidal detachments (10.6%; N=11), hyphaema (5.8%; N=6) and bleb leak (5.8%; N=6). Needling and 5-fluorouracil injections were performed in 12.5% (N=13) and 33.7% (N=35), respectively, and 11.5% (N=12) required revision surgery. CONCLUSION The PreserFlo MicroShunt with MMC 0.4 mg/mL showed an overall success rate of 68.3% at 1 year, and led to significant IOP and medication reduction with a low rate of adverse effects.
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Affiliation(s)
- Alexander Tanner
- Faculty of Life Sciences & Medicine, King's College London, London, UK
- Department of Ophthalmology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Fadi Haddad
- Department of Ophthalmology, King's College Hospital NHS Foundation Trust, London, UK
| | - Julia Fajardo-Sanchez
- Faculty of Life Sciences & Medicine, King's College London, London, UK
- Department of Ophthalmology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Ethan Nguyen
- Department of Ophthalmology, King's College Hospital NHS Foundation Trust, London, UK
| | - Kai Xin Thong
- Faculty of Life Sciences & Medicine, King's College London, London, UK
- Department of Ophthalmology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Sarah Ah-Moye
- Department of Ophthalmology, King's College Hospital NHS Foundation Trust, London, UK
| | - Nicole Perl
- Department of Ophthalmology, King's College Hospital NHS Foundation Trust, London, UK
| | - Mohammed Abu-Bakra
- Department of Ophthalmology, King's College Hospital NHS Foundation Trust, London, UK
| | - Avinash Kulkarni
- Department of Ophthalmology, King's College Hospital NHS Foundation Trust, London, UK
| | - Sameer Trikha
- Department of Ophthalmology, King's College Hospital NHS Foundation Trust, London, UK
| | - Gerassimos Lascaratos
- Faculty of Life Sciences & Medicine, King's College London, London, UK
- Department of Ophthalmology, King's College Hospital NHS Foundation Trust, London, UK
| | - Miles Parnell
- Department of Ophthalmology, King's College Hospital NHS Foundation Trust, London, UK
| | - Obeda Kailani
- Department of Ophthalmology, King's College Hospital NHS Foundation Trust, London, UK
| | - Anthony J King
- Department of Ophthalmology, Nottingham University Hospitals NHS Foundation Trust, Nottingham, UK
| | - Pavi Agrawal
- Department of Ophthalmology, Nottingham University Hospitals NHS Foundation Trust, Nottingham, UK
| | - Richard Stead
- Department of Ophthalmology, Nottingham University Hospitals NHS Foundation Trust, Nottingham, UK
| | | | - Ian Rodrigues
- Department of Ophthalmology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Saurabh Goyal
- Department of Ophthalmology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Pirro G Hysi
- Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - Sheng Lim
- Faculty of Life Sciences & Medicine, King's College London, London, UK
- Department of Ophthalmology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Cynthia Yu-Wai-Man
- Faculty of Life Sciences & Medicine, King's College London, London, UK
- Department of Ophthalmology, Guy's and St Thomas' NHS Foundation Trust, London, UK
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Thong KX, Andriesei P, Luo J, Qin M, Ng J, Tagalakis AD, Hysi P, Yu-Wai-Man C. Adrenaline blocks key cell cycle genes and exhibits antifibrotic and vasoconstrictor effects in glaucoma surgery. Exp Eye Res 2023; 233:109561. [PMID: 37429521 DOI: 10.1016/j.exer.2023.109561] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 05/04/2023] [Accepted: 06/26/2023] [Indexed: 07/12/2023]
Abstract
Adrenaline is a sympathomimetic drug used to maintain pupil dilation and to decrease the risk of bleeding. The aim of this study was to demonstrate if adrenaline could exert antifibrotic effects in glaucoma surgery. Adrenaline was tested in fibroblast-populated collagen contraction assays and there was a dose-response decrease in fibroblast contractility: matrices decreased to 47.4% (P = 0.0002) and 86.6% (P = 0.0036) with adrenaline 0.0005% and 0.01%, respectively. There was no significant decrease in cell viability even at high concentrations. Human Tenon's fibroblasts were also treated with adrenaline (0%, 0.0005%, 0.01%) for 24 h and RNA-Sequencing was performed on the Illumina NextSeq 2000. We carried out detailed gene ontology, pathway, disease and drug enrichment analyses. Adrenaline 0.01% upregulated 26 G1/S and 11 S-phase genes, and downregulated 23 G2 and 17 M-phase genes (P < 0.05). Adrenaline demonstrated similar pathway enrichment to mitosis and spindle checkpoint regulation. Adrenaline 0.05% was also injected subconjunctivally during trabeculectomy, PreserFlo Microshunt and Baerveldt 350 tube surgeries, and patients did not experience any adverse effects. Adrenaline is a safe and cheap antifibrotic drug that significantly blocks key cell cycle genes when used at high concentrations. Unless contraindicated, we recommend subconjunctival injections of adrenaline (0.05%) in all glaucoma bleb-forming surgeries.
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Affiliation(s)
- Kai Xin Thong
- Faculty of Life Sciences & Medicine, King's College London, London, SE1 7EH, UK
| | - Petru Andriesei
- Faculty of Life Sciences & Medicine, King's College London, London, SE1 7EH, UK
| | - Jinyuan Luo
- Faculty of Life Sciences & Medicine, King's College London, London, SE1 7EH, UK
| | - Mengqi Qin
- Faculty of Life Sciences & Medicine, King's College London, London, SE1 7EH, UK
| | - Jia Ng
- Faculty of Life Sciences & Medicine, King's College London, London, SE1 7EH, UK
| | | | - Pirro Hysi
- Faculty of Life Sciences & Medicine, King's College London, London, SE1 7EH, UK
| | - Cynthia Yu-Wai-Man
- Faculty of Life Sciences & Medicine, King's College London, London, SE1 7EH, UK; Department of Ophthalmology, Guy's and St Thomas' NHS Foundation Trust, London, SE1 7EH, UK.
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5
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Kafetzis KN, Papalamprou N, McNulty E, Thong KX, Sato Y, Mironov A, Purohit A, Welsby PJ, Harashima H, Yu-Wai-Man C, Tagalakis AD. The Effect of Cryoprotectants and Storage Conditions on the Transfection Efficiency, Stability, and Safety of Lipid-Based Nanoparticles for mRNA and DNA Delivery. Adv Healthc Mater 2023; 12:e2203022. [PMID: 36906918 DOI: 10.1002/adhm.202203022] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 02/16/2023] [Indexed: 03/13/2023]
Abstract
Lipid-based nanoparticles have recently shown great promise, establishing themselves as the gold standard in delivering novel RNA therapeutics. However, research on the effects of storage on their efficacy, safety, and stability is still lacking. Herein, the impact of storage temperature on two types of lipid-based nanocarriers, lipid nanoparticles (LNPs) and receptor-targeted nanoparticles (RTNs), loaded with either DNA or messenger RNA (mRNA), is explored and the effects of different cryoprotectants on the stability and efficacy of the formulations are investigated. The medium-term stability of the nanoparticles was evaluated by monitoring their physicochemical characteristics, entrapment and transfection efficiency, every two weeks over one month. It is demonstrated, that the use of cryoprotectants protects nanoparticles against loss of function and degradation in all storage conditions. Moreover, it is shown that the addition of sucrose enables all nanoparticles to remain stable and maintain their efficacy for up to a month when stored at -80 °C, regardless of cargo or type of nanoparticle. DNA-loaded nanoparticles also remain stable in a wider variety of storage conditions than mRNA-loaded ones. Importantly, these novel LNPs show increased GFP expression that can signify their future use in gene therapies, beyond the established role of LNPs in RNA therapeutics.
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Affiliation(s)
| | | | - Elisha McNulty
- Department of Biology, Edge Hill University, Ormskirk, L39 4QP, UK
| | - Kai X Thong
- Faculty of Life Sciences & Medicine, King's College London, London, SE1 7EH, UK
| | - Yusuke Sato
- Faculty of Pharmaceutical Sciences, Hokkaido University, Kita-12, Nishi-6, Kita-ku, Sapporo, 060-0812, Japan
| | - Aleksandr Mironov
- Electron Microscopy Core Facility (RRID: SCR_021147), Faculty of Biology, Medicine and Health, University of Manchester, Manchester, M13 9PT, UK
| | - Atul Purohit
- Oncology Drug Discovery & Women's Health Group, Department of Metabolism, Digestion & Reproduction, Imperial College London, London, W12 0HS, UK
| | | | - Hideyoshi Harashima
- Faculty of Pharmaceutical Sciences, Hokkaido University, Kita-12, Nishi-6, Kita-ku, Sapporo, 060-0812, Japan
| | - Cynthia Yu-Wai-Man
- Faculty of Life Sciences & Medicine, King's College London, London, SE1 7EH, UK
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6
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Ioannou N, Luo J, Qin M, Di Luca M, Mathew E, Tagalakis AD, Lamprou DA, Yu-Wai-Man C. 3D-printed long-acting 5-fluorouracil implant to prevent conjunctival fibrosis in glaucoma. J Pharm Pharmacol 2023; 75:276-286. [PMID: 36617180 PMCID: PMC10813237 DOI: 10.1093/jpp/rgac100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 12/12/2022] [Indexed: 01/09/2023]
Abstract
OBJECTIVES To develop a sustained release 5-fluorouracil (5-FU) implant by three-dimensional (3D) printing to effectively prevent conjunctival fibrosis after glaucoma surgery. METHODS 3D-printed implants composed of polycaprolactone (PCL) and chitosan (CS) were fabricated by heat extrusion technology and loaded with 1% 5-FU. Light microscopy and scanning electron microscopy were used to study the surface morphology. The 5-FU concentration released over 8 weeks was measured by ultraviolet visible spectroscopy. The effects on cell viability, fibroblast contractility and the expression of key fibrotic genes were assessed in human conjunctival fibroblasts. KEY FINDINGS The PCL-CS-5-FU implant sustainably released 5-FU over 8 weeks and the peak concentration was over 6.1 μg/ml during weeks 1 and 2. The implant had a smooth surface and its total weight decreased by 3.5% after 8 weeks. The PCL-CS-5-FU implant did not affect cell viability in conjunctival fibroblasts and sustainably suppressed fibroblast contractility and key fibrotic genes for 8 weeks. CONCLUSIONS The PCL-CS-5-FU implant was biocompatible and degradable with a significant effect in suppressing fibroblast contractility. The PCL-CS-5-FU implant could be used as a sustained release drug implant, replacing the need for repeated 5-FU injections in clinic, to prevent conjunctival fibrosis after glaucoma surgery.
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Affiliation(s)
- Nicole Ioannou
- Faculty of Life Sciences & Medicine, King’s College London, London, UK
| | - Jinyuan Luo
- Faculty of Life Sciences & Medicine, King’s College London, London, UK
- Department of Ophthalmology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Mengqi Qin
- Faculty of Life Sciences & Medicine, King’s College London, London, UK
| | - Matteo Di Luca
- School of Pharmacy, Queen’s University Belfast, Belfast, UK
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7
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Luo J, Tan G, Thong KX, Kafetzis KN, Vallabh N, Sheridan CM, Sato Y, Harashima H, Tagalakis AD, Yu-Wai-Man C. Non-Viral Gene Therapy in Trabecular Meshwork Cells to Prevent Fibrosis in Minimally Invasive Glaucoma Surgery. Pharmaceutics 2022; 14:pharmaceutics14112472. [PMID: 36432663 PMCID: PMC9693853 DOI: 10.3390/pharmaceutics14112472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 11/07/2022] [Accepted: 11/12/2022] [Indexed: 11/18/2022] Open
Abstract
The primary cause of failure for minimally invasive glaucoma surgery (MIGS) is fibrosis in the trabecular meshwork (TM) that regulates the outflow of aqueous humour, and no anti-fibrotic drug is available for intraocular use in MIGS. The myocardin-related transcription factor/serum response factor (MRTF/SRF) pathway is a promising anti-fibrotic target. This study aims to utilise a novel lipid nanoparticle (LNP) to deliver MRTF-B siRNA into human TM cells and to compare its effects with those observed in human conjunctival fibroblasts (FF). Two LNP formulations were prepared with and without the targeting peptide cΥ, and with an siRNA concentration of 50 nM. We examined the biophysical properties and encapsulation efficiencies of the LNPs, and evaluated the effects of MRTF-B silencing on cell viability, key fibrotic genes expression and cell contractility. Both LNP formulations efficiently silenced MRTF-B gene and were non-cytotoxic in TM and FF cells. The presence of cΥ made the LNPs smaller and more cationic, but had no significant effect on encapsulation efficiency. Both TM and FF cells also showed significantly reduced contractibility after transfection with MRTF-B siRNA LNPs. In TM cells, LNPs with cΥ achieved a greater decrease in contractility compared to LNPs without cΥ. In conclusion, we demonstrate that the novel CL4H6-LNPs are able to safely and effectively deliver MRTF-B siRNA into human TM cells. LNPs can serve as a promising non-viral gene therapy to prevent fibrosis in MIGS.
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Affiliation(s)
- Jinyuan Luo
- Faculty of Life Sciences & Medicine, King’s College London, London SE1 7EH, UK
- Department of Ophthalmology, Renmin Hospital of Wuhan University, Wuhan 430060, China
| | - Greymi Tan
- Faculty of Life Sciences & Medicine, King’s College London, London SE1 7EH, UK
| | - Kai Xin Thong
- Faculty of Life Sciences & Medicine, King’s College London, London SE1 7EH, UK
| | | | - Neeru Vallabh
- Department of Eye and Vision Science, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool L69 3BX, UK
| | - Carl M. Sheridan
- Department of Eye and Vision Science, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool L69 3BX, UK
| | - Yusuke Sato
- Faculty of Pharmaceutical Sciences, Hokkaido University, Kita-12, Nishi-6, Kita-ku, Sapporo 060-0812, Japan
| | - Hideyoshi Harashima
- Faculty of Pharmaceutical Sciences, Hokkaido University, Kita-12, Nishi-6, Kita-ku, Sapporo 060-0812, Japan
| | - Aristides D. Tagalakis
- Department of Biology, Edge Hill University, Ormskirk L39 4QP, UK
- Correspondence: (A.D.T.); (C.Y.-W.-M.); Tel.: +44-(0)1695-650923 (A.D.T.); +44-(0)2071-881504 (C.Y.-W.-M.)
| | - Cynthia Yu-Wai-Man
- Faculty of Life Sciences & Medicine, King’s College London, London SE1 7EH, UK
- Correspondence: (A.D.T.); (C.Y.-W.-M.); Tel.: +44-(0)1695-650923 (A.D.T.); +44-(0)2071-881504 (C.Y.-W.-M.)
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8
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Tan G, Ioannou N, Mathew E, Tagalakis AD, Lamprou DA, Yu-Wai-Man C. 3D printing in Ophthalmology: From medical implants to personalised medicine. Int J Pharm 2022; 625:122094. [PMID: 35952803 DOI: 10.1016/j.ijpharm.2022.122094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Revised: 07/26/2022] [Accepted: 08/04/2022] [Indexed: 11/16/2022]
Abstract
3D printing was invented thirty years ago. However, its application in healthcare became prominent only in recent years to provide solutions for drug delivery and clinical challenges, and is constantly evolving. This cost-efficient technique utilises biocompatible materials and is used to develop model implants to provide a greater understanding of human anatomy and diseases, and can be used for organ transplants, surgical planning and for the manufacturing of advanced drug delivery systems. In addition, 3D printed medical devices and implants can be customised for each patient to provide a more tailored treatment approach. The advantages and applications of 3D printing can be used to treat patients with different eye conditions, with advances in 3D bioprinting offering novel therapy applications in ophthalmology. The purpose of this review paper is to provide an in-depth understanding of the applications and advantages of 3D printing in treating different ocular conditions in the cornea, glaucoma, retina, lids and orbits.
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Affiliation(s)
- Greymi Tan
- Faculty of Life Sciences & Medicine, King's College London, London, SE1 7EH, UK
| | - Nicole Ioannou
- Faculty of Life Sciences & Medicine, King's College London, London, SE1 7EH, UK
| | - Essyrose Mathew
- School of Pharmacy, Queen's University Belfast, Belfast, BT9 7BL, UK
| | | | | | - Cynthia Yu-Wai-Man
- Faculty of Life Sciences & Medicine, King's College London, London, SE1 7EH, UK.
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9
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Magan T, Tanner A, Fajardo-Sanchez J, Lim KS, Goyal S, Rodrigues I, Amaya L, Trikha S, Kulkarni A, Hammond C, Lascaratos G, Yu-Wai-Man C. Long-term outcomes in Primary congenital glaucoma, aniridia and anterior segment dysgenesis. Eur J Ophthalmol 2022; 32:2920-2927. [PMID: 35001688 PMCID: PMC9373187 DOI: 10.1177/11206721211073208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Aim To determine the long-term outcomes of a cohort of complex patients with
primary congenital glaucoma, aniridia and anterior segment dysgenesis. Methods Retrospective consecutive series between 1990–2021 in two UK tertiary
centres: Guy's and St Thomas’ NHS Foundation Trust and King's College
Hospital NHS Foundation Trust. We recorded the number and types of surgical
and laser treatments along with preoperative and postoperative data,
including intraocular pressures (IOP) and anti-glaucoma medications. Results A total of 41 eyes of 21 patients were included. Primary diagnoses were
primary congenital glaucoma in 16 eyes (39.0%), aniridia in 14 eyes (34.2%),
and anterior segment dysgenesis in 8 eyes (19.5%). Sixteen eyes (39.0%) had
one or more glaucoma surgery or laser procedures for advanced glaucoma, and
the long-term follow-up was 12.8 ± 3.6 years. There was a significant
decrease in postoperative IOP (mmHg) at 3 months (16.5 ± 1.6;
p = 0.0067), 6 months (18.7 ± 2.1;
p = 0.0386), 12 months (18.6 ± 1.7;
p = 0.0229), 3 years (14.7 ± 1.2;
p = 0.0126), 5 years (15.5 ± 1.8;
p = 0.0330) and 10 years (15.4 ± 2.3;
p = 0.7780), compared to preoperatively (24.1 ± 2.6).
Surgical success (complete and qualified) was 62.5%, 50.0%, 43.8%, 46.2%,
45.5% and 28.6% at 3 months, 6 months, 12 months, 3 years, 5 years and 10
years, respectively. There was no significant change in the number of
anti-glaucoma drugs postoperatively (p > 0.05). Four
eyes (25.0%) had postoperative complications (hyphaema, hypotony) that
resolved after conservative management. Conclusions Surgical management of these complex eyes with advanced glaucoma is
challenging. Overall, the cohort had good surgical outcomes with a
significant decrease in IOP by 36.1% after long-term follow-up.
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Affiliation(s)
- Tejal Magan
- Faculty of Life Sciences & Medicine, 111990King's College London, London, UK.,Department of Ophthalmology, 111990King's College Hospital, London, UK
| | - Alexander Tanner
- Faculty of Life Sciences & Medicine, 111990King's College London, London, UK.,Department of Ophthalmology, 111988St Thomas' Hospital, London, UK
| | - Julia Fajardo-Sanchez
- Faculty of Life Sciences & Medicine, 111990King's College London, London, UK.,Department of Ophthalmology, 111988St Thomas' Hospital, London, UK
| | - Kin Sheng Lim
- Faculty of Life Sciences & Medicine, 111990King's College London, London, UK.,Department of Ophthalmology, 111988St Thomas' Hospital, London, UK
| | - Saurabh Goyal
- Department of Ophthalmology, 111988St Thomas' Hospital, London, UK
| | - Ian Rodrigues
- Department of Ophthalmology, 111988St Thomas' Hospital, London, UK
| | - Luis Amaya
- Department of Ophthalmology, 111988St Thomas' Hospital, London, UK
| | - Sameer Trikha
- Department of Ophthalmology, 111990King's College Hospital, London, UK
| | - Avinash Kulkarni
- Department of Ophthalmology, 111990King's College Hospital, London, UK
| | - Christopher Hammond
- Faculty of Life Sciences & Medicine, 111990King's College London, London, UK.,Department of Ophthalmology, 111988St Thomas' Hospital, London, UK
| | - Gerassimos Lascaratos
- Faculty of Life Sciences & Medicine, 111990King's College London, London, UK.,Department of Ophthalmology, 111990King's College Hospital, London, UK
| | - Cynthia Yu-Wai-Man
- Faculty of Life Sciences & Medicine, 111990King's College London, London, UK.,Department of Ophthalmology, 111988St Thomas' Hospital, London, UK
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10
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Salazar-Quiñones L, Yu-Wai-Man C, De Antonio Ramirez A, Méndez-Hernández CD, Daas A, Garcia Feijoo J, Guzman-Almagro E, Fernández-Pérez C, Sheng Lim K. Peripapillary and optic nerve head vessel density of glaucoma and healthy subjects from Afro-Caribbean and European descent: A pilot study. J Fr Ophtalmol 2021; 45:207-215. [PMID: 34972574 DOI: 10.1016/j.jfo.2021.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 07/13/2021] [Accepted: 07/20/2021] [Indexed: 12/09/2022]
Abstract
PURPOSE To compare the peripapillary and optic nerve head vessel density (PP-ONH VD) between glaucoma patients (all, early, moderated, and advanced) and healthy subjects of Afro-Caribbean descent (AD) and European descent (ED). METHODS This was a cross-sectional study. One eye was evaluated in 90 subjects, including 66 glaucoma patients and 24 healthy subjects, who underwent PP-ONH VD imaging using SPECTRALIS® Optical Coherence Tomography Angiography (OCT-A). We analysed the superficial vascular complex using the AngioTool version 0.6a software. The correlation between the PP-ONH VD and visual field mean deviation (MD) was evaluated using a scatter plot and Spearman's rho correlation coefficient. RESULTS Among the healthy subjects, the AD group had a lower superficial PP-ONH VD [43.29±3.25% (mean±standard deviation)] than the ED group (46.06±1.75%) (P=0.016). Overall, superficial PP-ONH VD did not show any significant differences between the total AD and ED glaucoma patients or in the subgroup analyses (early/moderate/advanced) (AD: 32.73±6.70%, 37.11±5.72%, 32.48±5.73%, 27.76±4.74%, respectively; ED: 33.94±6.89%, 38.52±3.82%, 35.56±4.18%; 27.65±6.31%, respectively) (P>0.05 for all). A strong, statistically significant correlation was established between vessel density and mean deviation among AD and ED glaucoma patients (r=0.709 and r=0.704, respectively) (P<0.001 for both). CONCLUSION This pilot study shows that healthy subjects of AD had lower peripapillary and optic nerve head superficial vessel density than healthy subjects of ED, but no significant differences were found between AD and ED glaucoma groups (all, early, moderate, or advanced).
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Affiliation(s)
- L Salazar-Quiñones
- Department of Ophthalmology, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Instituto de Investigaciones Oftalmológicas Ramón Castroviejo. Departamento de Inmunología, Oftalmología y ORL. Facultad de Medicina. Universidad Complutense, OFTARED, Hospital Clínico San Carlos, Madrid, Spain; King's College London, SE1 7EH, London, United Kingdom
| | - C Yu-Wai-Man
- King's College London, SE1 7EH, London, United Kingdom; Department of Ophthalmology, Saint-Thomas' Hospital, SE1 7EH, London, United Kingdom
| | - A De Antonio Ramirez
- Department of Epidemiology and Preventive Medicine, Hospital Clinico San Carlos, Universidad Complutense, Madrid, Spain
| | - C D Méndez-Hernández
- Department of Ophthalmology, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Instituto de Investigaciones Oftalmológicas Ramón Castroviejo. Departamento de Inmunología, Oftalmología y ORL. Facultad de Medicina. Universidad Complutense, OFTARED, Hospital Clínico San Carlos, Madrid, Spain
| | - A Daas
- Department of Ophthalmology, Saint-Thomas' Hospital, SE1 7EH, London, United Kingdom
| | - J Garcia Feijoo
- Department of Ophthalmology, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Instituto de Investigaciones Oftalmológicas Ramón Castroviejo. Departamento de Inmunología, Oftalmología y ORL. Facultad de Medicina. Universidad Complutense, OFTARED, Hospital Clínico San Carlos, Madrid, Spain
| | - E Guzman-Almagro
- Department of Ophthalmology, Hospital Fundación Jiménez Díaz, Madrid, Spain
| | - C Fernández-Pérez
- Department of Epidemiology and Preventive Medicine, Hospital Clinico San Carlos, Universidad Complutense, Madrid, Spain
| | - K Sheng Lim
- King's College London, SE1 7EH, London, United Kingdom; Department of Ophthalmology, Saint-Thomas' Hospital, SE1 7EH, London, United Kingdom.
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Sherman TEJ, Yu-Wai-Man C, Goyal S, Lim KS. Re: Beckers et al.: Safety and effectiveness of the PRESERFLO® MicroShunt in primary open-angle glaucoma: results from a 2-year multicenter study. Ophthalmol Glaucoma (2021;doi 10.1016/j.ogla.2021.07.008: Jul 28 [Epub ahead of print].). Ophthalmol Glaucoma 2021; 5:e1. [PMID: 34801439 DOI: 10.1016/j.ogla.2021.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 10/12/2021] [Indexed: 10/19/2022]
Affiliation(s)
| | | | - Saurabh Goyal
- St Thomas' Hospital, Department of Ophthalmology, London, UK
| | - Kin Sheng Lim
- St Thomas' Hospital, Department of Ophthalmology, London, UK
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12
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Nagar A, Daas A, Danieliute L, Alaghband P, Yu-Wai-Man C, Amon A, Galvis E, Lim KS. Effect of high-intensity focused ultrasound (HiFU) treatment on intraocular pressure and aqueous humour dynamics: 12 -months results. Eye (Lond) 2021; 35:2499-2505. [PMID: 33159175 PMCID: PMC8377105 DOI: 10.1038/s41433-020-01260-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 09/10/2020] [Accepted: 10/22/2020] [Indexed: 11/08/2022] Open
Abstract
PURPOSE High intensity focused ultrasound (HiFU) is a cyclodestructive therapy for controlling intraocular pressure (IOP) in glaucoma. The mechanism of action is thought to be through destruction of the ciliary epithelium as well as increased uveoscleral outflow. We reviewed the change in aqueous humour dynamics parameters including aqueous humour flow rate, tonographic outflow facility (TOF) and uveoscleral outflow at 12 months. PATIENTS AND METHODS This is a prospective observational study. Consecutive patients with open angle glaucoma (OAG) or ocular hypertension (OHT) requiring further IOP lowering were enroled in the study between August 2016 and January 2017. Patients were commenced on medication washout period prior to baseline and twelve months' visit. RESULTS Sixteen patients (OAG) in the treatment group underwent assessment at twelve months follow up. Mean age was 63.1 ± 11 years. Eleven patients were African/Caribbean and 5 were Caucasian. Nine patients were female and 7 were male. Mean post-washout IOP was reduced by 21% (28.3 ± 5.7 at baseline vs 22.4 ± 8.4 mmHg at 12 months, p = 0.04). Aqueous humour flow rate was reduced by 16% at twelve months (2.40 ± 0.6 at baseline vs 2.02 ± 0.6 µl/min at 12 months, p = 0.0493). There was no statistically significant change in the TOF (0.12 ± 0.09 at baseline vs 0.08 ± 0.05 µl/min/mmHg at 12 months, p = 0.08) or uveoscleral outflow (0.6 ± 1.3 at baseline vs 1.3 ± 0.85 µl/min at 12 months, p = 0.15). CONCLUSION In this study, we demonstrated that the observed IOP reduction was likely due to aqueous humour flow rate reduction. The TOF and uveoscleral outflow were not detectibly changed.
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Affiliation(s)
- Anindyt Nagar
- Department of Ophthalmology, St Thomas' Hospital, London, SE1 7EH, UK
- King's College London, London, SE1 7EH, UK
| | - Arij Daas
- Department of Ophthalmology, St Thomas' Hospital, London, SE1 7EH, UK
- King's College London, London, SE1 7EH, UK
| | - Lina Danieliute
- Department of Ophthalmology, St Thomas' Hospital, London, SE1 7EH, UK
- King's College London, London, SE1 7EH, UK
| | - Pouya Alaghband
- Department of Ophthalmology, St Thomas' Hospital, London, SE1 7EH, UK
- King's College London, London, SE1 7EH, UK
| | - Cynthia Yu-Wai-Man
- Department of Ophthalmology, St Thomas' Hospital, London, SE1 7EH, UK
- King's College London, London, SE1 7EH, UK
| | - Andrew Amon
- Department of Ophthalmology, St Thomas' Hospital, London, SE1 7EH, UK
| | - Elizabeth Galvis
- Department of Ophthalmology, St Thomas' Hospital, London, SE1 7EH, UK
| | - Kin Sheng Lim
- Department of Ophthalmology, St Thomas' Hospital, London, SE1 7EH, UK.
- King's College London, London, SE1 7EH, UK.
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Sanghani A, Kafetzis KN, Sato Y, Elboraie S, Fajardo-Sanchez J, Harashima H, Tagalakis AD, Yu-Wai-Man C. Novel PEGylated Lipid Nanoparticles Have a High Encapsulation Efficiency and Effectively Deliver MRTF-B siRNA in Conjunctival Fibroblasts. Pharmaceutics 2021; 13:382. [PMID: 33805660 PMCID: PMC7998417 DOI: 10.3390/pharmaceutics13030382] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Revised: 03/07/2021] [Accepted: 03/09/2021] [Indexed: 01/07/2023] Open
Abstract
The master regulator of the fibrosis cascade is the myocardin-related transcription factor/serum response factor (MRTF/SRF) pathway, making it a key target for anti-fibrotic therapeutics. In the past, inhibitors and small interfering RNAs (siRNAs) targeting the MRTF-B gene have been deployed to counter fibrosis in the eye, with the latter showing promising results. However, the biggest challenge in implementing siRNA therapeutics is the method of delivery. In this study, we utilised the novel, pH-sensitive, cationic lipid CL4H6, which has previously demonstrated potent targeting of hepatocytes and endosomal escape, to safely and efficiently deliver an MRTF-B siRNA into human conjunctival fibroblasts. We prepared two lipid nanoparticle (LNP) formulations, incorporating targeting cleavable peptide cY in one of them, and measured their physicochemical properties and silencing effect in human conjunctival fibroblasts. Both proved to be non-cytotoxic at a concentration of 50 nM and effectively silenced the MRTF-B gene in vitro, with the targeting cleavable peptide not affecting the silencing efficiency [LNP with cY: 62.1% and 81.5% versus LNP without cY: 77.7% and 80.2%, at siRNA concentrations of 50 nM (p = 0.06) and 100 nM (p = 0.09), respectively]. On the other hand, the addition of the targeting cleavable peptide significantly increased the encapsulation efficiency of the LNPs from 92.5% to 99.3% (p = 0.0005). In a 3D fibroblast-populated collagen matrix model, both LNP formulations significantly decreased fibroblast contraction after a single transfection. We conclude that the novel PEGylated CL4H6-MRTF-B siRNA-loaded LNPs represent a promising therapeutic approach to prevent conjunctival fibrosis after glaucoma filtration surgery.
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Affiliation(s)
- Amisha Sanghani
- Faculty of Life Sciences & Medicine, King’s College London, London SE1 7EH, UK; (A.S.); (J.F.-S.)
- Department of Ophthalmology, St Thomas’ Hospital, London SE1 7EH, UK
| | | | - Yusuke Sato
- Faculty of Pharmaceutical Sciences, Hokkaido University, Kita-12, Nishi-6, Kita-ku, Sapporo 060-0812, Japan; (Y.S.); (H.H.)
| | - Salsabil Elboraie
- Department of Biology, Edge Hill University, Ormskirk L39 4QP, UK; (K.N.K.); (S.E.)
| | - Julia Fajardo-Sanchez
- Faculty of Life Sciences & Medicine, King’s College London, London SE1 7EH, UK; (A.S.); (J.F.-S.)
- Department of Ophthalmology, St Thomas’ Hospital, London SE1 7EH, UK
| | - Hideyoshi Harashima
- Faculty of Pharmaceutical Sciences, Hokkaido University, Kita-12, Nishi-6, Kita-ku, Sapporo 060-0812, Japan; (Y.S.); (H.H.)
| | | | - Cynthia Yu-Wai-Man
- Faculty of Life Sciences & Medicine, King’s College London, London SE1 7EH, UK; (A.S.); (J.F.-S.)
- Department of Ophthalmology, St Thomas’ Hospital, London SE1 7EH, UK
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Gupta A, Kafetzis KN, Tagalakis AD, Yu-Wai-Man C. RNA therapeutics in ophthalmology - translation to clinical trials. Exp Eye Res 2021; 205:108482. [PMID: 33548256 DOI: 10.1016/j.exer.2021.108482] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 01/09/2021] [Accepted: 01/28/2021] [Indexed: 12/12/2022]
Abstract
The use of RNA interference technology has proven to inhibit the expression of many target genes involved in the underlying pathogenesis of several diseases affecting various systems. First established in in vitro and later in animal studies, small interfering RNA (siRNA) and antisense oligonucleotide (ASO) therapeutics are now entering clinical trials with the potential of clinical translation to patients. Gene-silencing therapies have demonstrated promising responses in ocular disorders, predominantly due to the structure of the eye being a closed and compartmentalised organ. However, although the efficacy of such treatments has been observed in both preclinical studies and clinical trials, there are issues pertaining to the use of these drugs which require more extensive research with regards to the delivery and stability of siRNAs and ASOs. This would improve their use for long-term treatment regimens and alleviate the difficulties experienced by patients with ocular diseases. This review provides a detailed insight into the recent developments and clinical trials that have been conducted for several gene-silencing therapies, including ISTH0036, SYL040012, SYL1001, PF-04523655, Sirna-027, QR-110, QR-1123, QR-421a and IONIS-FB-LRX in glaucoma, dry eye disease, age-related macular degeneration, diabetic macular oedema and various inherited retinal diseases. Our aim is to explore the potential of these drugs whilst evaluating their associated advantages and disadvantages, and to discuss the future translation of RNA therapeutics in ophthalmology.
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Affiliation(s)
- Aanchal Gupta
- King's College London, London, SE1 7EH, United Kingdom; Department of Ophthalmology, St Thomas' Hospital, London, SE1 7EH, United Kingdom
| | | | | | - Cynthia Yu-Wai-Man
- King's College London, London, SE1 7EH, United Kingdom; Department of Ophthalmology, St Thomas' Hospital, London, SE1 7EH, United Kingdom.
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15
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Fernando O, Tagalakis AD, Awwad S, Brocchini S, Khaw PT, Hart SL, Yu-Wai-Man C. Development of Targeted siRNA Nanocomplexes to Prevent Fibrosis in Experimental Glaucoma Filtration Surgery. Mol Ther 2018; 26:2812-2822. [PMID: 30301666 PMCID: PMC6277485 DOI: 10.1016/j.ymthe.2018.09.004] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 09/01/2018] [Accepted: 09/05/2018] [Indexed: 11/28/2022] Open
Abstract
RNAi induced by double-stranded small interfering RNA (siRNA) molecules has attracted great attention as a naturally occurring approach to silence gene expression with high specificity. The myocardin-related transcription factor/serum response factor (MRTF/SRF) pathway is a master regulator of cytoskeletal gene expression and, thus, represents a promising target to prevent fibrosis. A major hurdle to implementing siRNA therapies is the method of delivery, and we have, thus, optimized lipid-peptide-siRNA (LPR) nanoparticles containing MRTF-B siRNAs as a targeted approach to prevent conjunctival fibrosis. We tested 15 LPR nanoparticle formulations with different lipid compositions, surface charges, and targeting or non-targeting peptides in human conjunctival fibroblasts. In vitro, the LPR formulation of the DOTMA/DOPE lipid with the targeting peptide Y (LYR) was the most efficient in MRTF-B gene silencing and non-cytotoxic compared to the non-targeting formulation. In vivo, subconjunctival administration of LYR nanoparticles containing MRTF-B siRNAs doubled bleb survival in a pre-clinical rabbit model of glaucoma filtration surgery. Furthermore, MRTF-B LYR nanoparticles reduced the MRTF-B mRNA by 29.6% in rabbit conjunctival tissues, which led to significantly decreased conjunctival scarring with no adverse side effects. LYR-mediated delivery of siRNA shows promising results to increase bleb survival and to prevent conjunctival fibrosis after glaucoma filtration surgery.
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Affiliation(s)
- Owen Fernando
- National Institute for Health Research (NIHR) Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London EC1V 2PD, UK
| | - Aristides D Tagalakis
- Experimental and Personalised Medicine Section, Genetics and Genomic Medicine Programme, UCL Great Ormond Street Institute of Child Health, London WC1N 1EH, UK; Department of Biology, Edge Hill University, Ormskirk L39 4QP, UK
| | - Sahar Awwad
- National Institute for Health Research (NIHR) Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London EC1V 2PD, UK; UCL School of Pharmacy, London WC1N 1AX, UK
| | - Steve Brocchini
- National Institute for Health Research (NIHR) Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London EC1V 2PD, UK; UCL School of Pharmacy, London WC1N 1AX, UK
| | - Peng T Khaw
- National Institute for Health Research (NIHR) Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London EC1V 2PD, UK
| | - Stephen L Hart
- Experimental and Personalised Medicine Section, Genetics and Genomic Medicine Programme, UCL Great Ormond Street Institute of Child Health, London WC1N 1EH, UK
| | - Cynthia Yu-Wai-Man
- National Institute for Health Research (NIHR) Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London EC1V 2PD, UK; King's College London, London SE1 7EH, UK.
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16
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Yu-Wai-Man C, Tagalakis AD, Meng J, Bouremel Y, Lee RMH, Virasami A, Hart SL, Khaw PT. Genotype-Phenotype Associations of IL6 and PRG4 With Conjunctival Fibrosis After Glaucoma Surgery. JAMA Ophthalmol 2017; 135:1147-1155. [PMID: 28975281 DOI: 10.1001/jamaophthalmol.2017.3407] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Importance Postsurgical fibrosis is a critical determinant of the long-term success of glaucoma surgery, but no reliable biomarkers are currently available to stratify the risk of scarring. Objective To compare the clinical phenotype of patients with conjunctival fibrosis after glaucoma surgery with candidate gene expression tissue biomarkers of fibrosis. Design, Setting, and Participants In this cross-sectional study, 42 patients were recruited at the time of glaucoma surgery at the Moorfields Eye Hospital from September 1, 2014, to September 1, 2016. The participants were divided into those with fibrosis and those without fibrosis. Main Outcomes and Measures Genotype-phenotype correlations of the IL6 or PRG4 gene and detailed clinical phenotype. The IL6 and PRG4 protein expression in conjunctival tissues was also assessed using in situ immunohistochemical analysis. Central bleb area, maximal bleb area, and bleb height were graded on a scale of 1 to 5 (1 indicating 0%; 2, 25%; 3, 50%; 4, 75%; and 5, 100%). Bleb vascularity was graded on a scale of 1 to 5 (1 indicating avascularity; 2, normal; 3, mild; 4, moderate; and 5, severe hyperemia). Results A total of 42 patients were recruited during the study period; 28 participants (67%) had previously undergone glaucoma surgery (fibrotic group) (mean [SD] age, 43.8 [3.6 years]; 16 [57%] female; 22 [79%] white), and 14 participants (33%) had not previously undergone glaucoma surgery (nonfibrotic group) (mean [SD] age, 47.7 [6.9] years; 4 [29%] female; 9 [64%] white). The fibrotic group had marked bleb scarring and vascularization and worse logMAR visual acuity. The mean (SD) grades were 1.4 (0.1) for central bleb area, 1.4 (0.1) for bleb height, and 3.4 (0.2) for bleb vascularity. The IL6 gene was upregulated in fibrotic cell lines (mean, 0.040) compared with nonfibrotic cell lines (mean, 0.011) (difference, 0.029; 95% CI, 0.015-0.043; P = .003). The PRG4 gene was also downregulated in fibrotic cell lines (0.002) compared with nonfibrotic cell lines (mean, 0.109; difference, 0.107; 95% CI, 0.104-0.110; P = .03). The study found a strong correlation between the IL6 gene and the number of glaucoma operations (r = 0.94, P < .001) and logMAR visual acuity (r = 0.64, P = .03). A moderate correlation was found between the PRG4 gene and the number of glaucoma operations (r = -0.72, P = .005) and logMAR visual acuity (r = -0.62, P = .03). Conclusions and Relevance IL6 and PRG4 represent potential novel tissue biomarkers of disease severity and prognosis in conjunctival fibrosis after glaucoma surgery. Future longitudinal studies with multiple postoperative measures are needed to validate the effect of these potential biomarkers of fibrosis.
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Affiliation(s)
- Cynthia Yu-Wai-Man
- National Institute for Health Research Biomedical Research Centre at Moorfields Eye Hospital National Health Service Foundation Trust and University College London Institute of Ophthalmology, London, England
| | - Aristides D Tagalakis
- Experimental and Personalised Medicine Section, University College London Great Ormond Street Institute of Child Health, London, England
| | - Jinhong Meng
- Experimental and Personalised Medicine Section, University College London Great Ormond Street Institute of Child Health, London, England
| | - Yann Bouremel
- National Institute for Health Research Biomedical Research Centre at Moorfields Eye Hospital National Health Service Foundation Trust and University College London Institute of Ophthalmology, London, England.,Department of Mechanical Engineering, University College London, London, England
| | - Richard M H Lee
- National Institute for Health Research Biomedical Research Centre at Moorfields Eye Hospital National Health Service Foundation Trust and University College London Institute of Ophthalmology, London, England
| | - Alex Virasami
- Department of Histopathology, Great Ormond Street Hospital for Children National Health Service Foundation Trust, London, England
| | - Stephen L Hart
- Experimental and Personalised Medicine Section, University College London Great Ormond Street Institute of Child Health, London, England
| | - Peng T Khaw
- National Institute for Health Research Biomedical Research Centre at Moorfields Eye Hospital National Health Service Foundation Trust and University College London Institute of Ophthalmology, London, England
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17
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Yu-Wai-Man C, Spencer-Dene B, Lee RMH, Hutchings K, Lisabeth EM, Treisman R, Bailly M, Larsen SD, Neubig RR, Khaw PT. Local delivery of novel MRTF/SRF inhibitors prevents scar tissue formation in a preclinical model of fibrosis. Sci Rep 2017; 7:518. [PMID: 28364121 PMCID: PMC5428058 DOI: 10.1038/s41598-017-00212-w] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Accepted: 02/14/2017] [Indexed: 11/09/2022] Open
Abstract
The myocardin-related transcription factor/serum response factor (MRTF/SRF) pathway represents a promising therapeutic target to prevent fibrosis. We have tested the effects of new pharmacological inhibitors of MRTF/SRF signalling in a preclinical model of fibrosis. CCG-222740, a novel MRTF/SRF inhibitor, markedly decreased SRF reporter gene activity and showed a greater inhibitory effect on MRTF/SRF target genes than the previously described MRTF-A inhibitor CCG-203971. CCG-222740 was also five times more potent, with an IC50 of 5 μM, in a fibroblast-mediated collagen contraction assay, was less cytotoxic, and a more potent inhibitor of alpha-smooth muscle actin protein expression than CCG-203971. Local delivery of CCG-222740 and CCG-203971 in a validated and clinically relevant rabbit model of scar tissue formation after glaucoma filtration surgery increased the long-term success of the surgery by 67% (P < 0.0005) and 33% (P < 0.01), respectively, and significantly decreased fibrosis and scarring histologically. Unlike mitomycin-C, neither CCG-222740 nor CCG-203971 caused any detectable epithelial toxicity or systemic side effects with very low drug levels measured in the aqueous, vitreous, and serum. We conclude that inhibitors of MRTF/SRF-regulated gene transcription such as CCG-222740, potentially represent a new therapeutic strategy to prevent scar tissue formation in the eye and other tissues.
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Affiliation(s)
- Cynthia Yu-Wai-Man
- UCL Institute of Ophthalmology, London, UK. .,National Institute for Health Research (NIHR) Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK. .,Signalling and Transcription Group, Francis Crick Institute, London, UK.
| | | | - Richard M H Lee
- National Institute for Health Research (NIHR) Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
| | - Kim Hutchings
- Vahlteich Medicinal Chemistry Core, College of Pharmacy, University of Michigan, Ann Arbor, MI, USA
| | - Erika M Lisabeth
- Department of Pharmacology and Toxicology, Michigan State University, East Lansing, MI, USA
| | - Richard Treisman
- Signalling and Transcription Group, Francis Crick Institute, London, UK
| | | | - Scott D Larsen
- Vahlteich Medicinal Chemistry Core, College of Pharmacy, University of Michigan, Ann Arbor, MI, USA
| | - Richard R Neubig
- Department of Pharmacology and Toxicology, Michigan State University, East Lansing, MI, USA
| | - Peng T Khaw
- National Institute for Health Research (NIHR) Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
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Tagalakis AD, Maeshima R, Yu-Wai-Man C, Meng J, Syed F, Wu LP, Aldossary AM, McCarthy D, Moghimi SM, Hart SL. Peptide and nucleic acid-directed self-assembly of cationic nanovehicles through giant unilamellar vesicle modification: Targetable nanocomplexes for in vivo nucleic acid delivery. Acta Biomater 2017; 51:351-362. [PMID: 28110069 DOI: 10.1016/j.actbio.2017.01.048] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2016] [Revised: 01/16/2017] [Accepted: 01/16/2017] [Indexed: 12/29/2022]
Abstract
One of the greatest challenges for the development of genetic therapies is the efficient targeted delivery of therapeutic nucleic acids. Towards this goal, we have introduced a new engineering initiative in self-assembly of biologically safe and stable nanovesicle complexes (∼90 to 140nm) derived from giant unilamellar vesicle (GUV) precursors and comprising plasmid DNA or siRNA and targeting peptide ligands. The biological performance of the engineered nanovesicle complexes were studied both in vitro and in vivo and compared with cationic liposome-based lipopolyplexes. Compared with cationic lipopolyplexes, nanovesicle complexes did not show advantages in transfection and cell uptake. However, nanovesicle complexes neither displayed significant cytotoxicity nor activated the complement system, which are advantageous for intravenous injection and tumour therapy. On intravenous administration into a neuroblastoma xenograft mouse model, nanovesicle complexes were found to distribute throughout the tumour interstitium, thus providing an alternative safer approach for future development of tumour-specific therapeutic nucleic acid interventions. On oropharyngeal instillation, nanovesicle complexes displayed better transfection efficiency than cationic lipopolyplexes. The technological advantages of nanovesicle complexes, originating from GUVs, over traditional cationic liposome-based lipopolyplexes are discussed. STATEMENT OF SIGNIFICANCE The efficient targeted delivery of nucleic acids in vivo provides some of the greatest challenges to the development of genetic therapies. Giant unilamellar lipid vesicles (GUVs) have been used mainly as cell and tissue mimics and are instrumental in studying lipid bilayers and interactions. Here, the GUVs have been modified into smaller nanovesicles. We have then developed novel nanovesicle complexes comprising self-assembling mixtures of the nanovesicles, plasmid DNA or siRNA, and targeting peptide ligands. Their biophysical properties were studied and their transfection efficiency was investigated. They transfected cells efficiently without any associated cytotoxicity and with targeting specificity, and in vivo they resulted in very high and tumour-specific uptake and in addition, efficiently transfected the lung. The peptide-targeted nanovesicle complexes allow for the specific targeted enhancement of nucleic acid delivery with improved biosafety over liposomal formulations and represent a promising tool to improve our arsenal of safe, non-viral vectors to deliver therapeutic cargos in a variety of disorders.
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Affiliation(s)
- A D Tagalakis
- Experimental and Personalised Medicine Section, UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London WC1N 1EH, UK.
| | - R Maeshima
- Experimental and Personalised Medicine Section, UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London WC1N 1EH, UK
| | - C Yu-Wai-Man
- National Institute for Health Research (NIHR) Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, 11-43 Bath Street, London EC1V 9EL, UK
| | - J Meng
- Experimental and Personalised Medicine Section, UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London WC1N 1EH, UK
| | - F Syed
- Experimental and Personalised Medicine Section, UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London WC1N 1EH, UK
| | - L-P Wu
- Centre for Pharmaceutical Nanotechnology and Nanotoxicology, Faculty of Health and Medical Sciences, University of Copenhagen, Universitetsparken 2, 2100 Copenhagen, Denmark
| | - A M Aldossary
- Experimental and Personalised Medicine Section, UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London WC1N 1EH, UK
| | - D McCarthy
- UCL School of Pharmacy, 29-39 Brunswick Square, London WC1N 1AX, UK
| | - S M Moghimi
- Centre for Pharmaceutical Nanotechnology and Nanotoxicology, Faculty of Health and Medical Sciences, University of Copenhagen, Universitetsparken 2, 2100 Copenhagen, Denmark; School of Medicine, Pharmacy and Health, Durham University, Stockton-on-Tees TS17 6BH, UK
| | - S L Hart
- Experimental and Personalised Medicine Section, UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London WC1N 1EH, UK
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Yu-Wai-Man C, Khaw PT. Personalized Medicine in Ocular Fibrosis: Myth or Future Biomarkers. Adv Wound Care (New Rochelle) 2016; 5:390-402. [PMID: 27679750 PMCID: PMC5028906 DOI: 10.1089/wound.2015.0677] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2015] [Accepted: 02/04/2016] [Indexed: 02/06/2023] Open
Abstract
Significance: Fibrosis-related events play a part in the pathogenesis or failure of treatment of virtually all the blinding diseases around the world, and also account for over 40% of all deaths. It is well established that the eye and other tissues of some group of patients, for example Afro-Caribbean people, scar worse than others. However, there is a current lack of reliable biomarkers to stratify the risk of scarring and postsurgical fibrosis in the eye. Recent Advances: Recent studies using genomics, proteomics, metabolomics, clinical phenotyping, and high-resolution in vivo imaging techniques have revealed potential novel biomarkers to identify and stratify patients at risk of scarring in different fibrotic eye diseases. Critical Issues: Most of the studies, to date, have been done in animals or small cohorts of patients and future research is needed to validate these results in large longitudinal human studies. Detailed clinical phenotyping and effective biobanking of patient tissues will also be critical for future biomarker research in ocular fibrosis. Future Directions: The ability to predict the risk of scarring and to tailor the antifibrotic treatment regimen to each individual patient will be an extremely useful tool clinically to prevent undertreating, or exposing patients to unnecessary treatments with potential side effects. An exciting future prospect will be to use new advances in genotyping, namely next-generation whole genome sequencing like RNA-Seq, to develop a customized gene chip in ocular fibrosis. Successful translation of future biomarkers to benefit patient care will also ultimately require a strong collaboration between academics, pharmaceutical, and biotech companies.
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Affiliation(s)
- Cynthia Yu-Wai-Man
- National Institute for Health Research (NIHR) Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, United Kingdom
| | - Peng Tee Khaw
- National Institute for Health Research (NIHR) Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, United Kingdom
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Yu-Wai-Man C, Tagalakis AD, Manunta MD, Hart SL, Khaw PT. Receptor-targeted liposome-peptide-siRNA nanoparticles represent an efficient delivery system for MRTF silencing in conjunctival fibrosis. Sci Rep 2016; 6:21881. [PMID: 26905457 PMCID: PMC4764806 DOI: 10.1038/srep21881] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Accepted: 02/03/2016] [Indexed: 12/22/2022] Open
Abstract
There is increasing evidence that the Myocardin-related transcription factor/Serum response factor (MRTF/SRF) pathway plays a key role in fibroblast activation and that knocking down MRTF can lead to reduced scarring and fibrosis. Here, we have developed a receptor-targeted liposome-peptide-siRNA nanoparticle as a non-viral delivery system for MRTF-B siRNA in conjunctival fibrosis. Using 50 nM siRNA, the MRTF-B gene was efficiently silenced by 76% and 72% with LYR and LER nanoparticles, respectively. The silencing efficiency was low when non-targeting peptides or siRNA alone or liposome-siRNA alone were used. LYR and LER nanoparticles also showed higher silencing efficiency than PEGylated LYR-P and LER-P nanoparticles. The nanoparticles were not cytotoxic using different liposomes, targeting peptides, and 50 nM siRNA. Three-dimensional fibroblast-populated collagen matrices were also used as a functional assay to measure contraction in vitro, and showed that MRTF-B LYR nanoparticles completely blocked matrix contraction after a single transfection treatment. In conclusion, this is the first study to develop and show that receptor-targeted liposome-peptide-siRNA nanoparticles represent an efficient and safe non-viral siRNA delivery system that could be used to prevent fibrosis after glaucoma filtration surgery and other contractile scarring conditions in the eye.
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Affiliation(s)
- Cynthia Yu-Wai-Man
- National Institute for Health Research (NIHR) Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, United Kingdom
| | - Aristides D Tagalakis
- Wolfson Centre for Gene Therapy of Childhood Disease, UCL Institute of Child Health, London, United Kingdom
| | - Maria D Manunta
- Wolfson Centre for Gene Therapy of Childhood Disease, UCL Institute of Child Health, London, United Kingdom
| | - Stephen L Hart
- Wolfson Centre for Gene Therapy of Childhood Disease, UCL Institute of Child Health, London, United Kingdom
| | - Peng T Khaw
- National Institute for Health Research (NIHR) Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, United Kingdom
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Yu-Wai-Man C, Tagalakis A, Manunta M, Hart S, Khaw P. Receptor-targeted liposome-peptide-siRNA nanoparticles represent a novel and efficient siRNA delivery system to prevent conjunctival fibrosis. Acta Ophthalmol 2015. [DOI: 10.1111/j.1755-3768.2015.0503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- C. Yu-Wai-Man
- NIHR BRC at Moorfields Eye Hospital and UCL Institute of Ophthalmology, Cell Biology & Ocular Biology and Therapeutics; London United Kingdom
| | - A. Tagalakis
- Gene Therapy; Wolfson Centre for Gene Therapy of Childhood Disease; London United Kingdom
| | - M. Manunta
- Gene Therapy; Wolfson Centre for Gene Therapy of Childhood Disease; London United Kingdom
| | - S.L. Hart
- Gene Therapy; Wolfson Centre for Gene Therapy of Childhood Disease; London United Kingdom
| | - P.T. Khaw
- NIHR BRC at Moorfields Eye Hospital and UCL Institute of Ophthalmology, Cell Biology & Ocular Biology and Therapeutics; London United Kingdom
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Yu-Wai-Man C, Treisman R, Khaw P, Bailly M. Downregulating the Myocardin-related transcription factor/ Serum response factor (MRTF/SRF) pathway is a novel therapeutic approach to prevent post-surgical fibrosis in glaucoma. Acta Ophthalmol 2015. [DOI: 10.1111/j.1755-3768.2015.0500] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- C. Yu-Wai-Man
- NIHR BRC at Moorfields Eye Hospital and UCL Institute of Ophthalmology, Cell Biology & Ocular Biology and Therapeutics; London United Kingdom
| | - R. Treisman
- Francis Crick Institute; Transcription Lab; London United Kingdom
| | - P.T. Khaw
- NIHR BRC at Moorfields Eye Hospital and UCL Institute of Ophthalmology, Cell Biology & Ocular Biology and Therapeutics; London United Kingdom
| | - M. Bailly
- NIHR BRC at Moorfields Eye Hospital and UCL Institute of Ophthalmology, Cell Biology & Ocular Biology and Therapeutics; London United Kingdom
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Yu-Wai-Man C, Tagalakis A, Manunta M, Hart S, Khaw P. Receptor-targeted liposome-peptide-siRNA nanoparticles represent a novel and efficient siRNA delivery system to prevent conjunctival fibrosis. Acta Ophthalmol 2015. [DOI: 10.1111/j.1755-3768.2015.1503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- C. Yu-Wai-Man
- NIHR BRC at Moorfields Eye Hospital and UCL Institute of Ophthalmology; Cell Biology & Ocular Biology and Therapeutics; London United Kingdom
| | - A. Tagalakis
- Wolfson Centre for Gene Therapy of Childhood Disease; Gene Therapy; London United Kingdom
| | - M. Manunta
- Wolfson Centre for Gene Therapy of Childhood Disease; Gene Therapy; London United Kingdom
| | - S.L. Hart
- Wolfson Centre for Gene Therapy of Childhood Disease; Gene Therapy; London United Kingdom
| | - P.T. Khaw
- NIHR BRC at Moorfields Eye Hospital and UCL Institute of Ophthalmology; Cell Biology & Ocular Biology and Therapeutics; London United Kingdom
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Abstract
Ocular fibrosis leads to significant visual impairment and blindness in millions of people worldwide, and is one of the largest areas of unmet need in clinical ophthalmology. The antimetabolites, mitomycin C and 5-fluorouracil, are the current gold standards used primarily to prevent fibrosis after glaucoma surgery, but have potentially blinding complications like tissue damage, breakdown and infection. This review thus focuses on the development of new classes of small molecule therapeutics to prevent post-surgical fibrosis in the eye, especially in the context of glaucoma filtration surgery. We discuss recent advances and innovations in ophthalmic wound healing research, including antibodies, RNAi, gene therapy, nanoparticles, liposomes, dendrimers, proteoglycans and small molecule inhibitors. We also review the challenges involved in terms of drug delivery, duration of action and potential toxicity of new anti-fibrotic agents in the eye.
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Affiliation(s)
- Cynthia Yu-Wai-Man
- National Institute for Health Research (NIHR) Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and University College London (UCL) Institute of Ophthalmology, 11-43 Bath Street, London EC1V 9EL, UK
| | - Peng Tee Khaw
- National Institute for Health Research (NIHR) Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and University College London (UCL) Institute of Ophthalmology, 11-43 Bath Street, London EC1V 9EL, UK
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Abstract
Tissue contraction and fibrosis are major causes of morbidity in the human body. In the eye in particular, fibrosis and scarring are responsible for the pathogenesis or failure of treatment of all major blinding diseases, with postoperative wound healing responses posing a major problem for most ocular surgery on a worldwide scale. This is one of the largest areas of unmet need in ophthalmology, with currently no antifibrotic treatments available clinically. This review focuses on the ubiquitous myocardin-related transcription factor/serum response factor (MRTF-A/SRF) transcription pathway as a potential novel therapeutic target in fibrotic eye diseases. It describes how the MRTF-A/SRF pathway is intricately linked to all the key regulators and pathways in ocular fibrosis, and how it could potentially lead to a new avenue of antifibrotic therapies in the future.
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Affiliation(s)
- Cynthia Yu-Wai-Man
- Department of Ocular Biology and Therapeutics, NIHR Biomedical Research Centre at Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, United Kingdom
| | - Richard Treisman
- Transcription Laboratory, Cancer Research UK London Research Institute, London, United Kingdom
| | - Maryse Bailly
- Department of Cell Biology, UCL Institute of Ophthalmology, London, United Kingdom
| | - Peng Tee Khaw
- Department of Ocular Biology and Therapeutics, NIHR Biomedical Research Centre at Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, United Kingdom
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Yu-Wai-Man C, Smith FE, Firbank MJ, Guthrie G, Guthrie S, Gorman GS, Taylor RW, Turnbull DM, Griffiths PG, Blamire AM, Chinnery PF, Yu-Wai-Man P. Extraocular muscle atrophy and central nervous system involvement in chronic progressive external ophthalmoplegia. PLoS One 2013; 8:e75048. [PMID: 24086434 PMCID: PMC3785524 DOI: 10.1371/journal.pone.0075048] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2013] [Accepted: 08/07/2013] [Indexed: 11/19/2022] Open
Abstract
Background Chronic progressive external ophthalmoplegia (CPEO) is a classical mitochondrial ocular disorder characterised by bilateral progressive ptosis and ophthalmoplegia. These ocular features can develop either in isolation or in association with other prominent neurological deficits (CPEO+). Molecularly, CPEO can be classified into two distinct genetic subgroups depending on whether patients harbour single, large-scale mitochondrial DNA (mtDNA) deletions or multiple mtDNA deletions secondary to a nuclear mutation disrupting mtDNA replication or repair. The aim of this magnetic resonance imaging (MRI) study was to investigate whether the ophthalmoplegia in CPEO is primarily myopathic in origin or whether there is evidence of contributory supranuclear pathway dysfunction. Methods Ten age-matched normal controls and twenty patients with CPEO were recruited nine patients with single, large-scale mtDNA deletions and eleven patients with multiple mtDNA deletions secondary to mutations in POLG, PEO1, OPA1, and RRM2B. All subjects underwent a standardised brain and orbital MRI protocol, together with proton magnetic resonance spectroscopy in two voxels located within the parietal white matter and the brainstem. Results There was evidence of significant extraocular muscle atrophy in patients with single or multiple mtDNA deletions compared with controls. There was no significant difference in metabolite concentrations between the patient and control groups in both the parietal white matter and brainstem voxels. Volumetric brain measurements revealed marked cortical and cerebellar atrophy among patients with CPEO+ phenotypes. Conclusion The results of this study support a primary myopathic aetiology for the progressive limitation of eye movements that develops in CPEO.
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Affiliation(s)
- Cynthia Yu-Wai-Man
- Department of Ophthalmology, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom
| | - Fiona E. Smith
- Institute of Cellular Medicine and Newcastle Magnetic Resonance Centre, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Michael J. Firbank
- Institute for Ageing and Health, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Grant Guthrie
- Department of Ophthalmology, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom
| | - Stuart Guthrie
- Department of Ophthalmology, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom
| | - Grainne S. Gorman
- Department of Neurology, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom
- Wellcome Trust Centre for Mitochondrial Research, Institute for Ageing and Health, The Medical School, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Robert W. Taylor
- Wellcome Trust Centre for Mitochondrial Research, Institute for Ageing and Health, The Medical School, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Douglass M. Turnbull
- Department of Neurology, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom
- Wellcome Trust Centre for Mitochondrial Research, Institute for Ageing and Health, The Medical School, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Philip G. Griffiths
- Department of Ophthalmology, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom
| | - Andrew M. Blamire
- Institute of Cellular Medicine and Newcastle Magnetic Resonance Centre, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Patrick F. Chinnery
- Department of Neurology, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom
- Wellcome Trust Centre for Mitochondrial Research, Institute of Genetic Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Patrick Yu-Wai-Man
- Department of Ophthalmology, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom
- Wellcome Trust Centre for Mitochondrial Research, Institute of Genetic Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom
- * E-mail:
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Yu-Wai-Man C, Petheram K, Davidson AW, Williams T, Griffiths PG. A Supranuclear Disorder of Ocular Motility as a Rare Initial Presentation of Motor Neurone Disease. Neuroophthalmology 2011; 35:38-39. [DOI: 10.3109/01658107.2010.518333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2010] [Revised: 05/31/2010] [Accepted: 07/21/2010] [Indexed: 11/13/2022] Open
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