Russian National Eye Academy lauds the research
Breakthrough by NCRM
Moscow 28 September 2007. The State Institute of Eye Diseases of the Russian Academy of Medical Sciences lauded the Research team of Nichi-In Centre for Regenerative Medicine (NCRM), an Indo-Japan joint venture institute based at Chennai for their breakthrough achievement of being able to transport corneal stem cells at Indian climate without refrigeration and also grow them after transportation of upto 48 Hrs in their lab, which has not been previously reported. The preliminary report of this study was presented at the Asia ARVO meeting at Singapore in March 2007, seeing which Prof. Tatiana Kiseleva* and Prof. Sergey Avetisov (Director of the Russian Academy) had invited Dr Abraham, Director, NCRM for a guest lecture in their annual meeting on corneal diseases held at Moscow 28-29 Sep’2007 and the final data of the study was presented which received an overall appreciation of the attendees.
This development is going to help the rural population in India where without having a well equipped stem cell culture facility (which needs at least 1.5 Crore Rupees for set up) the small clinics can avail the corneal stem cell expansion services from a nearby lab within 300 km reach, thereby curing the corneal endothelial disease of thousands of patients every year, prevalent in rural areas in a cost effective manner. The work done this time has been a team effort among NCRM, Chennai, Joseph Eye Hospital, Trichy, India, Waseda University-Polymer Sciences Research Division headed by Prof. Yuichi Mori and Dr. Shiro Amano of Tokyo University School of Medicine-Dept of Ophthalmology.
Human cornea has five layers among which the external most epithelial layer and internal endothelial layers are of the utmost functional importance. Though the outer epithelial layer could be repaired using stem cells as reported already, not many could find a solution to diseases such as Bullous Keratopathy which occur in the inner endothelial layer, because until recently it was thought that the endothelial cells being very fragile and sensitive, cannot be grown in laboratory and also they don’t possess stem cells. It was Dr Amano who successfully could identify, isolate and multiply in their lab, the corneal endothelial precursor cells (CEPCs) and have proven in animal models** that endothelial diseases could be cured by CEPCs. It is also to be noted that the endothelial cells pump nutrition to the outer epithelium of the cornea, once they are diseases it may also affect the entire cornea over a period. Now that the CEPCs proven of their existence and treatment potentials, the novel finding by NCRM is the mode of transportation and further expansion with Japanese technology.
The CEPC isolation and multiplication needs a state-of-the-art stem cell facility, which is very expensive. Though Dr Amano could achieve it in their set up, reproducing the same in each small clinic or hospital even in district headquarters of the country are not feasible thereby such latest treatment get restricted to only big metros. NCRM with a vision of taking this to rural areas, started a research project with Joseph Eye Hospital, Trichy in March 2006. Different preservation cocktails were used to find the viability of CEPCs while transporting from Trichy to Chennai taking between 8 Hrs (Hand carry-Train transport) and 48 Hrs (Courier dispatch) and one concoction of a Hydrogel based cocktail could not only successfully preserve the cells, but also could expand them in lab. Repetition of the work over a period of one year and evaluation of the cells transported and expanded using the appropriate and latest prevailing investigations (RT-PCR etc) have proven the authenticity of the work.
By having achieved this, NCRM envisages a practical feasibility wherein the CEPCs culture expanded in NCRM laboratory in Chennai, if could reach within 36 Hrs any hospital of ophthalmology through ordinary (No refrigeration) courier service, could be transplanted to a patient suffering from Bullous Keratopathy as a treatment. The experts in this area are now consulted about the further necessary tests if any to confirm the safety efficacy before starting clinical application.
Indian Scenario of Corneal Blindness: Among the total preventable or treatable corneal blindness one-third is due to endothelial diseases. This is approximately expected to be around 30,000 per year in India. Among the 30,000 who are affected every year, only one-tenth gets a corneal transplantation due to lack of donor eyes. In corneal transplantation the total cornea is transplanted even though the other portions such as epithelium are normal. Moreover one cornea from an eye can help cure only one eye of a patient. By this layer-specific approach and by applying multiplied cells to several fold, apart from leaving the non-diseased native portion of the eye to preserve the integrity of the native cornea of the patient, more than one patient could be treated by cells taken from one donor-eye.
* DrTatiana Kiseleva is a Professor in the State Academy of Eye Diseases and a visiting faculty at the National Institute of Health (NIH), Bethesda, USA..
**Tatsuya Mimura, Seiichi Yokoo, Makoto Araie, Shiro Amano, Satoru Yamagami, “Treatment of Rabbit Bullous Keratopathy with Precursors Derived from Cultured Human Corneal Endothelium” Investigate Opthalmology & Visual Science, October 2005, Volume:46, No.:10, 3637-3644