Clinical trial NCT03295292: Limbus-derived Stem Cells for Prevention of Postoperative Corneal Haze
Official title: Pilot Clinical Trial to Assess the Safety of Limbus-derived Corneal Stem Cells in Prevention of Corneal Haze After Photo Therapeutic/Refractive Keratectomy (PTK/ PRK) and Collagen Cross Linking (CXL)
Study type: INTERVENTIONAL
Overall status: UNKNOWN
Phase: PHASE1
Conditions: Corneal Scars and Opacities
Keywords: Phototherapeutic Keratectomy (PTK)
photorefractive Keratectomy (PRK)
Collagen Cross-linking (CXL)
Stem Cell Therapy
Lead sponsor: L.V. Prasad Eye Institute
Sponsor class: OTHER
First posted: 2017-09-27
Enrollment: 15
Sex: ALL
Minimum age (years): 20
Maximum age (years): 40
Standard ages: ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Primary purpose: TREATMENT

Brief summary: This is a investigator-initiated pilot clinical trial to ascertain the safety and efficacy of application of ex-vivo cultivated limbal stem cells in human eyes for treating Corneal Haze after Photo-Therapeutic/Refractive Keratectomy (PTK/ PRK) and Collagen Cross Linking (CXL). Instead of using adjunctive medical therapy like application of MMC (Mitomycin), a technique of cell delivery with fibrin sealant can be used. These cells are harvested from therapeutically accepted and serologically tested cadaveric corneas. The isolated limbal epithelial and mesenchymal or stromal cell suspension will then be cultured in CGMP laboratories and be tested for sterlity. These cells have also been shown to be effective in treating haze in laser refractive surgery in an animal model. Our initial experience of using these cells in a previous clinical trial showed that they were effective in preventing corneal haze in patients with burns and ulcers.

Detailed description: In this pilot clinical trial, patients undergoing Photo Therapeutic/Refractive Keratectomy (PTK/ PRK) and Collagen Cross Linking (CXL), will be given human Limbus-derived Corneal Stem cells to assess the safety of these cells. Cells will be cultivated in a cGMP laboratory using standardized culture technique; from the limbal rims of cadaveric corneoscleral donor tissues that are therapeutically accepted and serologically tested. Briefly the limbal tissue will be cut up into small pieces and digested overnight using an enzyme (Collagenase L). The cells obtained from the digest will be cultured on a petri-dish using 2% serum and growth factors. A mixture of limbal epithelial cells and limbal stromal cells obtained from these cultures will be used in surgical procedures in a ratio of 2:1, after all the sterility checks. Mixed suspension of the limbal epithelial and the stromal cells at a concentration of 50000 cells/uL diluted in the thrombin component of fibrin sealant (TISEEL, Baxter) will be applied. The primary outcome measure is safety of this treatment and the secondary outcome measure is their efficacy that will be assessed at 1 month time points by (1) Clinical photography using a standard method where multiple blinded observers will grade the clinically apparent change in haze and (2) Objective quantification of the amount of light scattering using densitometry analysis function in Oculus Pentacam (OCULUS Optikgeräte GmbH).

Eligibility criteria: Inclusion Criteria:

* Adult patients between20 to 40 years of age
* Meeting standard selection criteria for bilateral PTK/PRK or CXL
* No systemic diseases
* Eligible to give informed consent
* No other ocular co-existing pathologies

Exclusion Criteria:

* Undergoing surgery in only one eye
* Grossly asymmetric pathology
* Refusal to give informed consent
* Not agreeable or uncooperative for corneal imaging
* Unlikely to come for follow-up for 1 month
* International and out-station patients

Primary outcomes:
measure: Maintenance of pre-operative best-spectacle corrected visual acuity
timeFrame: 1 month
Secondary outcomes:
measure: Efficacy in reducing corneal light scatter using Scheimpflug imaging
timeFrame: 1 month
Other outcomes:
Locations:
city: Hyderabad
country: India
facility: LV Prasad Eye Institute
state: Telangana
Study officials:
affiliation: LV Prasad Eye Institute
name: Sayan Basu, MBBS MS
role: PRINCIPAL_INVESTIGATOR
affiliation: LV Prasad Eye Institute
name: Vivek Singh, MSc PhD
role: PRINCIPAL_INVESTIGATOR
affiliation: LV Prasad Eye Institute
name: Jagadesh C Reddy, MBBS MD
role: PRINCIPAL_INVESTIGATOR
affiliation: LV Prasad Eye Institute
name: Pratik Gogri, MBBS MS
role: PRINCIPAL_INVESTIGATOR
References:
citation: Basu S, Hertsenberg AJ, Funderburgh ML, Burrow MK, Mann MM, Du Y, Lathrop KL, Syed-Picard FN, Adams SM, Birk DE, Funderburgh JL. Human limbal biopsy-derived stromal stem cells prevent corneal scarring. Sci Transl Med. 2014 Dec 10;6(266):266ra172. doi: 10.1126/scitranslmed.3009644.
citation: Basu S, Damala M, Singh V. Limbal Stromal Stem Cell Therapy for Acute and Chronic Superficial Corneal Pathologies: Early Clinical Outcomes of The Funderburgh Technique. Investigative Ophthalmology & Visual Science. 2017 Jun 23;58(8):3371-337