IU School of Medicine professor’s discoveries could transform the treatment of a rare eye disorder that can lead to blindness.
Affecting 1 in 2,000 people, neurotrophic keratopathy is a rare cause of blindness caused by a lack of nerve supply to the cornea. Patients with neurotrophic keratopathy experience a loss of sensation in the surface of their eye, and because they can’t protect the eye, they usually go blind due to scarring and ulceration of the cornea.
Dr. Gregory Borschel, James Joseph Harbaugh Jr. Professor of Plastic Surgery at the IU School of Medicine and the chief of plastic surgery at Riley Hospital for Children, along with Konstantin Feinberg, an assistant research professor of surgery at the IU School of Medicine, have dedicated their research to developing treatments for neurotrophic keratopathy and nerve injuries. They are seeking partnerships to take their research to market.
Borschel’s lab brings together biomedical engineers, neuroscientists and surgeons to foster nerve regeneration and advance care of patients. Borschel treats both children and adults who have developed neurotrophic keratopathy resulting from tumors, infections and trauma.
“Currently, about 90 percent of patients coming to Indianapolis from other states or countries are children,” Borschel said. “The only available drug treatment fails to prevent progression of the disease in 30 percent or more of patients and is very expensive, at a cost of $100,000 per treatment. It also exerts only a very weak healing effect.”
Recently, Borschel and Feinberg discovered that in the absence of Schwann cells, which are cells that maintain the health of the cornea, ulcers and scarring occur. In patients affected by this disorder, they reasoned, cytokines ordinarily produced by these Schwann cells may rescue affected corneas from ulceration, helping them heal and maintain their clarity. Indeed, in animal studies, denervated corneas were able to heal experimental wounds at a greatly accelerated rate and maintain clarity when given eyedrops containing some of the Schwann cell produced proteins.
In related research, Borschel and Feinberg found that a synthetic small molecule enabled a similar effect. When they co-administered this small molecule with the FDA-approved drug, they saw a marked improvement in the health of the denervated corneas. They hope to use these drugs to replace the need for — or augment the impact of — surgery.
Additionally, ophthalmologists don’t have the ability to easily diagnose and detect neurotrophic keratopathy with current instrumentation. To bridge this gap and provide an early detection tool, Borschel developed a user-friendly, disposable and inexpensive device that tests corneal sensation for patients to determine their risk level and disease progression of neurotrophic keratopathy. The disposable device also significantly lowers the risk of spreading infectious diseases between patients and improves clinician’s ability to diagnose the disease.
In another project, the transplant immunosuppressive drug Tacrolimus was utilized to enhance nerve regeneration following nerve injuries when the drug was delivered from a polymer wrap at the site of nerve repair in experimental studies.
“Since patients rarely recover full function after a nerve injury, this drug/device combination could be a game changer for patients suffering from nerve injuries,” Borschel said.
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