Introduction
Retinopathy is a pathological alteration of the optical blood vessels in the retina. The weakening of the blood vessels damages the retina. This causes loss of vision or permanent blindness. The current treatment regimen involves medications, laser surgery, or vitrectomy.
However, the permanent cure of the problem is not known. Stem Cells for Retinopathy Treatment are emerging as regenerative solutions that potentially aid in new blood vessel formation.
Retinopathy: Causes
Retinopathy is caused due two significant factors:
- Diabetic Retinopathy: Caused due to uncontrolled blood sugar. High glucose levels in the blood result in swelling of blood vessels, resulting in leaky fluid
- Hypertensive Retinopathy: Caused due to uncontrolled blood pressure. This results in thickening of the retinal artery, resulting in blockage, swelling of the optic nerves and bleeding.
- Other Factors: Autoimmune disease, medications, blood disorders, malignancies.
Among all the above factors, diabetic retinopathy is the most common, leading to ocular complications. The International Diabetes Federation reported more than 537 million individuals affected with diabetic retinopathy in 2021. The estimate reflects an increase in cases to 783 million cases by 2045.
Symptoms
The symptoms associated with retinopathy include:
- Blurred or Distorted vision
- Change in colour vision/ Colour blindness
- Nyctalopia (night blindness)
- Myodesopsias (eye floaters)
- Scotomas (blind spots)
- Vision loss and low vision
The symptom’s appearance depends on the severity of the disease.
The Role of Stem Cells in Eye Disorder Treatments
Stem cells for retinopathy treatment have opened a new perspective by targeting retinal degeneration. It release growth factors and essential proteins that promote cellular regeneration and healing of damaged retinal cells. Stem cells lead to:
- Boost cellular repair
- Reduce inflammation
- Slow progression of vision loss
Mesenchymal stem cells (MSCs) are among the most researched for retinopathy treatments. This is supported by:
- MSCs possess anti-inflammatory properties, reducing retinal inflammation that leads to a decline in vision decline
- MSCs secrete neuroprotective factors, safeguard existing retinal cells and prevent further damage
MSCs improves visual acuity when introduced at an early stage of the disease.
How Stem Cells for Retinopathy Treatment Work?
Stem Cells for Diabetic Neuropathy Treatment intend a complete cure of the disease. The current status of stem cell therapy implies the injection of stem cells at desirable numbers in the damaged area. This results in the promotion of tissue regeneration, prevents further decline of the healthy cells, and slows retinal degeneration progression.
Type of Stem Cells in Retinopathy Treatment
Optic nerve atrophy stem cell treatment varies depending on the stem cell type. This includes:
Adipose-derived Stem Cells
- Multipotent MSCs, capable of differentiating into distinct cell types
- Enhances insulin sensitivity and aids in the regeneration of β-cells
- Possesses immunomodulatory effects, reduces inflammation, and prevents cellular apoptosis.
- Extracellular vesicles released from MSCs (microRNA-192) introduce an anti-inflammatory response.
Bone marrow-derived-MSCs
- Versatile, can differentiate into various cell types:
- Exosomes derived from these cells inhibits the Wnt/β-catenin pathway, reduce inflammation and oxidative stress.
- Increases vascular density, protection from diabetic retinal vasculature
- Gene modulation (IL-13) promotes cellular survival.
- However, the use of triggering pro-inflammatory and anti-tumorigenic responses pertains potential risk in clinical application.
Umbilical cord-derived-MSCs
- Multipotent capability, can differentiate into neural, mesodermal and other cell types.
- Exosomes derived from these cells carry miR-17-3p that administers an anti-inflammatory and anti-oxidative response.
- Promotes neuroprotection and reduces vascular dysfunction
*NOTE: Each type of stem cell possesses a distinct mechanism, therapeutic response and safety profile. Intense research is desirable for optimizing their use in retinopathy.
Stem Cell Therapy for Retinopathy: Steps Involved
Retinopathy Treatment by stem cells is a multistep process. This involves:
- Patient’s assessment Clinicians conduct a detailed assessment of the patient’s disease severity, medical history, and design a suitable treatment.
- Harvesting and isolation of MSCs from donor tissues
- Cells undergo testing, cultivation, and differentiation under a controlled environment. This enables optimal growth, rigorous purification and activation of the therapeutic potential.
- Stem cells are administered in the form of an injection or intravenously into the eye.
- Stem cells, upon introduction, promote tissue regeneration, enhance blood flow and reduce inflammation.
- Aftercare, clinicians recommend suitable aftercare based on the stem cell therapy response and the patient’s specific needs.
Clinical Research and Evidence on Stem Cell Treatment for Retinopathy
Globally, various clinical studies have focused on unveiling clinical evidence on Eye Disorder Stem Cell Treatment research for retinopathy. Some of the research studies include:
Study 1
MSCs’ role in neuroprotective and axon regeneration on retinal ganglion cells (RGC)
Group: Ben Mead and Stanislav Tomarev, 2017
Model: In-vivo Model
Outcome: RGC loss was reduced by ≈30% in comparison with the untreated retina (80-90% loss)
Approximately 50% of the RGC function and integrity were restored
Strong neuroprotective and regenerative potential in CNS neurons [1]
Study 2
MSCs’ secreted factors delay Photoreceptor cell apoptosis
Group: Yuji Inoue and team, pre-2010
Model: In-vivo
Outcome: conditioned medium increased total retinal cells and photoretinal cells by 1.6 and 1.4 folds
MSCs transplantation delays retinal degeneration
MSCs’ paracrine signaling potentially slowed photoreceptor loss [1]
Study 3
MSCs’ implantation role in degenerative macular disease and Stargardt’s disease
Group: Kahraman et al., 2020
Model: Pilot Study on Humans
Outcome: 7 out of 8 patients showed improvement in visual acuity, while the control group showed a continuous decline in vision
Potential improvement in retinal degenerative conditions [1]
Study 4
Meta-Analysis of MSCs Therapy for Diabetic Retinopathy
Group: Meta-analysis, 2019 (analysis of various preclinical and clinical studies)
Outcome: Intravitreal administration of MSCs in diabetic retinopathy patients showed reduced leakage, apoptotic cell death, oxidative stress and RGC loss
MSCs differentiated into pericyte-like cells address the key pathological loss [1]
Limitations
- A limited standardized procedure has been established for
- Currently, the clinical trial studies are at the pilot stage
- Long-term clinical trials in a larger population are desirable to establish its long-term safety and efficacy
Potential Risks
Transplantation for the treatment of Eye Disorders by stem cells poses a potential low risk. However, some concerns include:
- Autogenous stem cells are associated with the risk of immune rejection
- Highly processed cells are prone to genetic mutation
- Theoretical possibility to develop a tumour
Ethical Concerns
Ethical concerns associated with stem cell therapy mainly focus on cell sourcing and the patient’s communication. Some ethical concerns include:
- Ethical sourcing: Umbilical cord stem cells and adult stem cells are more suitable; the use of embryonic stem cells is controversial
- Patient’s Consent: Patients must be informed about the detailed treatment process and associated risks
- Trail Approval: Conduct human trials only after approval from the national ethical committee approval
- Truthful Promotions: No false claims or misleading information spread in public
Regulatory Framework in India
Stem cells used for therapy must fall under GMP and GLP standards
The internal ethics board in a medical institution monitors patients’ safety, research procedures and procedural honesty
*Advancells, India, is a leading laboratory that works on cutting-edge technology in stem cell research for retinopathy. The laboratory ensures the maintenance of superior quality stem cells and free from any contamination.
Macular Degeneration Patient Success Stories
Conclusion
Retinopathy Treatment by stem cells is definitely the future in medicine. Indisputably, the significant commitment underlies more successful long-term clinical trial outcomes. Recently, safety data have emerged in various Phase I and Phase II clinical trials. It is a potential curative option in reversing retinopathy.
References
- Yacu T, Gallicchio VS. Stem Cells as Potential Regenerative Treatment for Retinal Degenerative Diseases and Diabetic Retinopathy. J Stem Cell Res. 2022;4(1):1-0.
- Singh MS, Park SS, Albini TA, Canto-Soler MV, Klassen H, MacLaren RE, Takahashi M, Nagiel A, Schwartz SD, Bharti K. Retinal stem cell transplantation: Balancing safety and potential. Progress in retinal and eye research. 2020 Mar 1;75:100779.
FAQ’s
Q- Is retinopathy curable?
No, retinopathy till data is not curable. The current treatment regime for retinopathy focuses on its management and is not reversible.
Q- Is retinopathy and diabetic retinopathy the same?
No, diabetic retinopathy is the most common form of retinopathy that is associated with retinal damage due to weakening of blood vessels. Prolonged high glucose in blood results in leakage, blockage or abnormal blood vessel growth of retinal cells.
Q- Can stem cell therapy cure retinopathy?
Stem cells can potentially slow the damage to retinal neurons and aid in the restoration of vision. However, complete reversal of the condition and long-term safety of the treatment are yet to be established.
Q- Is stem cell therapy for retinopathy safe?
Yes, stem cell therapy for retinopathy is generally safe and shows promise in the reversal of the condition. No systemic side effects or tumour formation have been reported in clinical studies. However, establishing long-term safety and efficacy is yet to be established.
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