Drug delivery systems in glaucoma – Current innovations and future perspectives

IF 3.7 3区 医学 Q1 OPHTHALMOLOGY
Shayne S. Tan, Tina T. Wong
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Abstract

Glaucoma is the leading cause of irreversible visual loss worldwide, and as yet, there is no cure. The only evidence-based treatment to slow progression is by lowering intraocular pressure (IOP). Despite the development of new topical medications to reduce IOP, the major limitation of eyedrops lies in human and anatomical factors, namely patient compliance and poor bioavailability, making current medical glaucoma treatment ineffective. In this manuscript, we summarise the limitations of traditional topical anti-glaucoma therapy and study current drug delivery systems to lower IOP, with focus on the only two that have made FDA-approval- Durysta and iDose TR. We highlight their limitations and discuss real-world economic challenges that make it prohibitively difficult for these drug delivery systems to be more widely adopted in daily practice. In this perspective, we also introduce gene therapy as a novel therapeutic option to target downstream pathways of IOP regulation, neuroprotection of the optic nerve, and reducing mitochondrial stress to delay the progression of glaucoma. We discuss promising results of gene therapy for glaucoma treatment in in vivo animal models as well. We also explore the concept of novel nanoparticle-based drug delivery systems, which have the advantage of being highly modifiable and customisable, able to incorporate large amounts of cargo while maintaining a high transfection efficacy, and at a fraction of the cost. Lastly, we propose that nanomedicine, in conjunction with gene therapy, offers a promising solution to the aforementioned challenges of current glaucoma therapy, and can herald a new era of sustained glaucoma treatment.
青光眼的药物输送系统-当前的创新和未来的展望。
青光眼是全球范围内导致不可逆视力丧失的主要原因,目前尚无治愈方法。减缓进展的唯一循证治疗是降低眼压(IOP)。尽管有新的局部药物来降低IOP,但眼药水的主要局限性在于人和解剖因素,即患者的依从性和生物利用度差,使得目前的青光眼药物治疗无效。在这篇文章中,我们总结了传统局部抗青光眼治疗的局限性,并研究了目前降低IOP的药物输送系统,重点是仅有的两种已获得fda批准的药物输送系统——Durysta和iDose TR。我们强调了它们的局限性,并讨论了现实世界的经济挑战,这些经济挑战使得这些药物输送系统难以在日常实践中得到更广泛的应用。从这个角度来看,我们还介绍了基因治疗作为一种新的治疗选择,针对IOP调节的下游途径,视神经的神经保护,减少线粒体应激,以延缓青光眼的进展。我们还讨论了基因治疗青光眼在体内动物模型中的有希望的结果。我们还探索了基于纳米颗粒的新型药物输送系统的概念,该系统具有高度可修改和可定制的优势,能够在保持高转染效率的同时纳入大量货物,并且成本很低。最后,我们提出纳米医学与基因治疗相结合,为当前青光眼治疗的上述挑战提供了一个有希望的解决方案,并可以预示着青光眼持续治疗的新时代。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
8.10
自引率
18.20%
发文量
197
审稿时长
6 weeks
期刊介绍: The Asia-Pacific Journal of Ophthalmology, a bimonthly, peer-reviewed online scientific publication, is an official publication of the Asia-Pacific Academy of Ophthalmology (APAO), a supranational organization which is committed to research, training, learning, publication and knowledge and skill transfers in ophthalmology and visual sciences. The Asia-Pacific Journal of Ophthalmology welcomes review articles on currently hot topics, original, previously unpublished manuscripts describing clinical investigations, clinical observations and clinically relevant laboratory investigations, as well as .perspectives containing personal viewpoints on topics with broad interests. Editorials are published by invitation only. Case reports are generally not considered. The Asia-Pacific Journal of Ophthalmology covers 16 subspecialties and is freely circulated among individual members of the APAO’s member societies, which amounts to a potential readership of over 50,000.
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