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Retinal Stem Cell Gene Therapy: Revolutionizing Vision

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There has been an immense rise in people who have lost their eyesight due to retinal diseases. Several trials are underway.

Medically reviewed by

Dr. Aditi Dubey

Published At January 1, 1970
Reviewed AtMarch 1, 2024

Introduction

There has been a failure involving conventional techniques to regenerate the damaged retina for treating degenerative retinal diseases. Several animal and human models on trials are being explored using stem cells to repair retinal malfunctions. In addition to treating age-related diseases like macular degeneration, stem cells were also used to treat genetic diseases that lead to the gradual loss of retinal photoreceptor cells. It is the retinal degeneration that remains the major cause of vision loss. Stem cells have focused on repairing and regenerating those damaged retinal cells. Several types of stem cells have been used in preclinical and clinical trials to understand how efficient their use has been in reversing retinal degeneration.

What Is Retinal Stem Cell Gene Therapy?

Retinal stem cell gene therapy is an experimental approach mainly aimed at treating various retinal diseases. It combines the use of stem cells and genetic intervention. It repairs the damaged cells within the retina, thereby improving and restoring vision in patients affected by age-related macular degeneration (AMD), retinitis pigmentosa, and other degenerative diseases. Several preclinical and clinical trials have paved the way for using stem cells for transplantation; the elements derived from the stem cells have proved clinically beneficial and have shown measurable improvement.

What Are the Etiology for Retinal Degenerative Diseases?

There is the inclusion of both the genetic and the non-genetic factors, which leads to the loss of photoreceptor cells. The age-related macular degeneration (AMD) remains the most common one, which leads to the loss of vision. There is yet another disorder known as retinitis pigmentosa (RP), which occurs due to X-linked recessive mutations, contributing to the degeneration of the photoreceptor cells and eventual loss of vision. Diabetic retinopathy is a disorder that is characterized by chronic hyperglycemia. Although the use of conventional therapies for treating the conditions mentioned above has proved to have improved disease prognosis, repeated administration is required to diminish the progression of the disease. Gene therapy applies only to patients with specific mutations.

What Are the Key Components of Retinal Stem Cell Therapy?

The key components include:

  • Stem Cells: These can differentiate into different types of cells, including those found in the retina.

  • Genetic Intervention: This involves modifying and introducing genes to achieve therapeutic effects. Retinal stem cell gene therapy involves the introduction of therapeutic genes into stem cells. These genes serve various purposes, such as promoting cell survival, enhancing the production of specific proteins, and correcting the genetic mutations associated with retinal disorders.

  • Transplantation: Once the stem cells are modified with the desired therapeutic effects, they are transplanted into the patient’s eyes and directed to the damaged retinal areas.

  • Regeneration and Repair: The transplanted stem cells are intended to differentiate into functional retinal cells, replacing damaged or dysfunctional Cells. This regeneration and repair process, facilitated by the therapeutic genes, aims to improve the overall health and function of the retina.

  • Treatment of Retinal Disorders: It is mainly aimed at disorders that present with loss of photoreceptor cells.

  • Clinical Trials: The research and development are still in the experimental stage, and the ongoing trials are mainly seeking to evaluate the safety and efficacy of the approach.

How Does Gene Therapy Work for Retinal Disorders?

It involves the introduction of therapeutic genes into the retina cells to address genetic mutations, promote cell survival, and enhance the production of specific proteins. The aim is to correct and compensate for the genetic abnormalities that contribute to the development and progression of retinal diseases. It mainly identifies genetic abnormalities. Genetic testing and molecular diagnosis help pinpoint the underlying genetic factors contributing to the disease. The therapeutic gene is selected once the genetic abnormality is identified. Vectors, often modified viruses carrying therapeutic genes, are used to introduce the genes into the retinal cells. Infusion or injection is used to administer the patient’s eyes with therapeutic genes. Intravitreal or subretinal injections are the two forms used depending on the treatment approach. Once integrated into the retinal cells, therapeutic genes instruct cells to produce missing or defective proteins. Gene therapy seeks to correct the mutations, followed by monitoring and follow-ups.

Is Retinal Stem Cell Gene Therapy Currently Available?

Retinal stem cell therapy is in the experimental stage and has not been widely approved for clinical use. A significant approach has been made in preclinical and early-phase clinical trials. The clinical trials are under the experimental stage for evaluating the safety and efficacy of stem cell gene therapy of retinal stem cell therapy in human subjects. These trials help the researchers understand the potential benefits and risks of the treatment and gather the data to support regulatory approval in the future. The field of gene therapy is dynamic, with ongoing research leading to new developments and advancements. Patients and healthcare providers should stay informed about the latest research findings and updates on the field.

Are There Risks and Side Effects Associated With Retinal Gene Therapy?

Retinal gene therapy is associated with potential risks and side effects:

  • Immune Responses: The body’s immune system may recognize the viral vectors used in gene therapy as foreign invaders, leading to immune responses.

  • Inflammatory Reactions in the Eyes: Inflammatory reactions might be triggered due to the introduction of viral vectors or therapeutic genes.

  • Off-Target Effects: The therapeutic genes may unintentionally affect the other tissues and biological processes.

  • Complications of Surgical Procedures: Surgeries carry their complications, including bleeding, infection, and damage to other ocular structures.

  • Long-Term Effects: Monitoring is necessary to look for any effects that last longer than usual.

  • Limited Efficacy: The extent of visual efficiency varies amongst individuals.

  • Ethical Considerations: Includes informed consent, privacy, and potential for germline modifications.

What Are the Challenges in Implementing Retinal Stem Cell Gene Therapy?

The challenges include safety concerns. Efficacy, the variability in patients' responses, and the influence of the disease stage can impact the therapy’s efficacy. Optimal cell source: identifying the most suitable source of stem cells is still challenging. Precision in gene editing or gene delivery is crucial as well. The long-term stability of these genes is still a challenge.

Conclusion:

The development and implementation of advanced gene therapies come with associated costs and challenges related to accessibility. Ensuring these therapies are affordable, scalable, and accessible to a broad population presents a significant hurdle. Addressing these challenges is a must.

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Dr. Aditi Dubey
Dr. Aditi Dubey

Ophthalmology (Eye Care)

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