This article is more than 5 years old. Information may no longer be current.
Blood-derived therapies show promise in treatment of ocular surface diseases
Regular use of these treatments is limited by a lack of standards and the difficulty and cost of processing whole blood.
Click Here to Manage Email Alerts
Ongoing research increasingly shows that autologous serum and plasma-derived therapies are generally useful in the treatment of ocular surface disorders such as dry eye syndrome and persistent epithelial defect, according to a report.
However, the potential high cost and inconvenience of processing blood products restrict more widespread use of these agents, the authors said.
Autologous serum and plasma-derived products contain growth factors and nutrients that are not present in artificial tears and other pharmacologic therapies for ocular surface disease, according to corresponding author Bennie H. Jeng, MD, MS.
“Artificial tears really provide only lubricants and maybe some chemicals, but they don’t have any of these growth factors,” Jeng told Ocular Surgery News. “Also, most artificial tears don’t have the lipids, a natural substance that really helps maintain the surface. The artificial tears are lubricants, but they don’t provide any of the nutrition. While this is usually adequate for most cases of dry eyes, in many instances of severe ocular surface disease, the lubricants are inadequate, and it’s the nutrients that actually help.”
In the British Journal of Ophthalmology, Jeng and colleagues reviewed existing literature on the use of blood-derived products in the treatment of ocular surface disease.
Autologous serum
The biochemical properties of autologous serum eye drops (ASEs) are similar to those of human tears. Epidermal growth factor, for one, increases the migration and proliferation of corneal epithelial cells. Additionally, fibronectin, vitamin A, and various chemokines, other growth factors and nutrients help maintain the tear film and ocular surface.
“In serum, there are a lot of growth factors, cytokines and various factors that we know help repair the ocular surface,” Jeng said. “These are factors that are present in tears. For the most part in serum, with very few exceptions, these same factors that are known to be good for the epithelium to help it proliferate or migrate are in higher concentrations in the serum, so you’re basically replacing what they don’t have in the tears — we’re supplementing them.”
Availability of ASEs
ASE production is somewhat involved. It involves the collection of whole blood from patients, clotting, centrifugation and collection of the supernatant, and dilution of the supernatant.
However, Jeng said there is a lack of standards governing the production of ASEs and similar agents.
“It’s not FDA approved, and there are no real standards of how to produce this,” he said.
However, some insurance companies in the U.S., such as the Kaiser Permanente Health Care System in Northern California, recently began having autologous serum eye drops as a covered benefit, Jeng said.
“I think that’s a first step,” Jeng said. “In addition, while various hospital pharmacies on a customized level will help produce the serum, now some outpatient compounding pharmacies will also process blood for serum production. So, I think we’re moving toward this becoming more and more mainstream.”
In some countries such as New Zealand, the Netherlands and Scandinavia, blood banks handle blood-derived products. Donor-derived blood products are even being used in some places, Jeng noted.
Other blood-derived products
Other blood-derived products such as umbilical cord serum and platelet-derived plasma extracts are also being investigated, the authors said.
Umbilical cord serum and platelet-derived products have many of the same growth factors and biologic components found in natural tears, such as epidermal growth factor and vitamin A. They may be a viable alternative for patients who are not good candidates for ASE therapy, such as those with graft-versus-host disease or Sjögren’s syndrome.
“It’s more or less the same. There are different components in each one. Again, I don’t know if there are enough data going head to head, plasma vs. serum, which one is better,” Jeng said. “We know that there are growth factors in each one, and there are different ways of producing each one, and the bottom line is that we think that both of them are very good for the epithelium.” – by Matt Hasson
- Reference:
- Soni N, et al. Br J Ophthalmol. 2016;doi:10.1136/bjophthalmol-2015-306842.
- For more information:
- Bennie H. Jeng, MD, MS, can be reached at Department of Ophthalmology and Visual Sciences, University of Maryland School of Medicine, 419 W. Redwood St., Suite 470, Baltimore, MD 21201; email: bjeng@som.umaryland.edu.
Disclosure: Jeng reports no relevant financial disclosures.