Eye lens regeneration from own stem cells: ‘a paradigm shift in cataract surgery’

A NEW study describes a pioneering new cataract treatment – tested in animals and in a small trial with human patients – where, after the cloudy lens is removed, the eye grows a new lens from its own stem cells. The researchers – including teams from the University of California-San Diego (UCSD), Sun Yat-sen University in Guangzhou and Sichuan University, both in China – describe their new regenerative medicine approach in a paper published in the journal Nature.
The treatment was tested in 12 babies born with cataracts. It resulted in significantly fewer surgical complications than current treatments, say the researchers. Sight was improved in all 12 patients. “We believe that our new approach will result in a paradigm shift in cataract surgery and may offer patients a safer and better treatment option in the future.” Being born with a lens that is cloudy or shortly becomes so is rare, but it is a significant cause of blindness in children. Estimates suggest it affects around 3 out of 10,000 children, although this rate varies throughout the world.
The clouded lens stops light getting to the retina, resulting in significant loss of vision. Current treatments can be difficult and result in complications in very young patients. Most children need to wear glasses after cataract surgery. In the new study, the team used the ability of stem cells to grow new tissue. They did not use the more common approach – where stem cells are taken out of the patient, grown in the lab and then put back in the patient. This method can introduce disease and raise the risk of immune rejection.
Instead, the team coaxed stem cells in the patients’ eyes to regrow the lenses. So-called endogenous stem cells are stem cells that are naturally already in place, ready to regenerate new tissue in the case of injury or some other problem. In the case of the human eye, the endogenous stem cells – known as lens epithelial stem cells (LECs) – generate replacement lens cells throughout a person’s life, although production wanes with age.
Current approaches to cataract surgery remove LECs along with the faulty lens – any few that are left can generate some lens cells, but the growth is random and disorganized in infants, resulting in no useful vision, note the researchers. The approach the researchers describe in their paper has two important differences to conventional cataract surgery: it leaves the lens capsule intact, and it stimulates LECs to form a new lens. The lens capsule is a thin membrane that helps give the lens its required shape to function.
The researchers first tested the method in rabbits and macaques and showed it allowed LECs that stayed in the eye to regenerate functional lenses. The researchers then ran a small human trial in patients under the age of 2. Twelve infants were treated with the new approach, while 25 other babies received the standard cataract procedure.

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