RETINITIS PIGMENTOSA

RETINITIS PIGMENTOSA
Definition

A variety of eye problems that affect the retina is called retinitis pigmentosa. This eye defect is making it hard to see due to changes how the retina responds to light. Patients affected with retinitis pigmentosa lose their vision slowly over time, though, often they will not become totally blind, and the speed of vision loss may vary from patient to patient.

As retinitis pigmentosa is genetically related, it can be passed on within families. See the short video about how the eye works.

Symptoms

The following ways may affect the vision loss with retinitis pigmentosa:

  • Night blindness results that you cannot see anything in the dark, although you may experience healthy vision at daylight.
  • Your gradual loss of peripheral vision will result in a so-called “tunnel vision.” For details see also the enclosed slideshow.
  • When we see details sharply because our eyes focus straight ahead, allowing us to drive and read well, we have a good "Central Vision." Loss of central vision makes it hard to do detailed tasks.
  • Some patients may have difficulties in seeing different colors.
Treatment
Traditional Treatment

Unfortunately, there is no specific treatment for RP. Scientists are concentrating on researching how retinitis pigmentosa is passed on in generations in order to find new treatment methods.

Early research is indicating that certain vitamins, like vitamin A palmitate, may support patients with RP and specialized eye clinics may recommend which vitamins you should take to help such a condition. Also, certain eyedrops may help to reduce swelling of the retina.

Cataracts, the clouding of the eye’s lens may be treated with surgery and is considered to be supportive for some RP patients.ARGUS II, an “artificial retina” implant, may be helpful for some patients with severe vision loss due to retinitis pigmentosa.

Investigational stem cell treatment has shown however encouraging results,  Unfortunately, there is currently no cure with traditional treatment possible, and therefore, therapies are limited. To support the management of RP following medications may be prescribed:

  • So-called fat-soluble vitamins, like Vitamin A, vitamin E, or ascorbic acid (Vitamin C).
  • Acetazolamide, methazolamide, so-called Carbonic anhydrase inhibitors
  • Calcium-channel blockers (e.g., diltiazem)

The following are considered to have potential side effects in patients with RP and are less recommendable:

  • Accutane, Isotretinoin
  • Viagra, Sildenafil
  • Vitamin E, in high dosage

Surgical procedures of RP often involves cataract extraction or more recently a potentially retinal implant in adults. There are however also various investigational procedure available to manage Retinitis Pigmentosa. Those include:

  • Placement of retinal prosthesis or phototransducing chip
  • The Transplantation of retinal or retinal pigment epithelial (RPE) tissue
  • Surgical placement of growth factors
  • Placement of retinal prosthesis or phototransducing chip
  • Subretinal gene therapy
  • Mesenchymal stem cell therapy
Cellular Treatments

Characterized by progressive loss of photoreceptors, which eventually leads to retinal degeneration and atrophy retinitis pigmentosa, RP belongs to a  group of inherited retinal disorders. Exact pathogenesis and etiology of this condition have however until now not been clear, although many therapies have been investigated in animals and clinical trials.

Stem cells are the natural repair system for the body to replace other cells that die off throughout the normal course of life. Especially Mesenchymal stem cell therapy has made some encouraging progress, besides having shown already an excellent safety profile in treating various conditions in animal and human beings. As these stem cells furthermore, derived from adults, they do not have the same ethical concerns or restrictions that embryonic stem cells do.

CellularStem Treatment Protocol

In our affiliated clinics, we, in general, plan to administer 3 to 4 injections of Mesenchymal stem cells for the RP condition in accordance with the feasibility on clinical evaluation of the patient's condition at the time of the admission.

Site of injection are:

  1. Intravenous Infusion: Injection of stem cells intravenously into the bloodstream.
  2. Intrathecal: Injection into the cerebro-spinal fluid via lumbar puncture placed in the spinal column.
  3. Retrobulbar: Injection is given into the soft tissue present behind the eyeball.
  4. As applicable and needed.

Our standard protocol for eye conditions which will be reconfirmed upon the clinical evaluation of the patient at the time of admission patients will stay 7 days in our affiliated clinic in Delhi where both eyes may be treated during that time.

According to the doctor’s experience, in our associated hospital, if there are chances of any infection in the eye, it will be visible in 48 hours of giving RB in one eye and accordingly the 2nd injection can be planned as per the above schedule. This is the protocol we have been following in all eye conditions and has given a safety gap of 3 days for injection between both the eyes.

Allogeneic Stem Cells from Umbilical Cord

Mesenchymal stem cells (MSC) are derived from bone marrow, adipose tissues, umbilical cords or other tissues and are anti-inflammatory. These anti-inflammatory cells have unique properties that make them attractive as therapy for autoimmune diseases. Unlike with other stem cells, MSCs lack the properties that enable the immune system to detect them as being foreign. For this condition, we are using only Umbilical cord-derived stem cells, as they are more naïve and have more proliferative nature and regeneration power as compared to any other source.

The advantage of our Umbilical cord-derived mesenchymal stem cells are:

  • Donors and recipients do not have to match for treatment to be successful, reducing the risk of rejection.
  • Recipients do not need to ablate (remove) their cells with chemotherapy, reducing their risk of infection.

Expanded, save passage 2, Mesenchymal stem cells have potentially the highest therapeutic effect as each injection contains about 20 Million stem cells. As we are providing 4 injections we increase the stem cell population in a body by about 100 Million stem cells.

Treatment costs

Please note that treatment costs are depending on the medical history and condition. For further details we suggest to please complete our Patient Application Form, - see under contact - stipulating your condition and treatment request, and send it to our Delhi or Europe office. We actively strive to reply to any request either immediate or latest within two working days with details.

Quality of Stem Cells

It is planned to administer 3 to 4 injections of Mesenchymal stem cells in accordance with the feasibility on clinical evaluation of the patient's condition at the time of the admission.

Licensed physicians administer the stem cells intravenously (IV), intrathecal and retrobulbar for this condition. Stem cells used are certified by the lab providing the cells to our partner clinics.

Medical Procedure Treatment

As with any medical procedure, a consent form between the clinic and the patient has to be signed at the time of the procedure.

Side effects and Follow up

When it comes to side effects, our patients have not experienced serious side effects from the stem cells treatment, and we are monitoring the well-being of our patients in the first 24 to 48 hours by a dedicated patient coordinator.

Our stem cell treatment does not end with the procedure in our partner clinics. We care about how you are doing after you return home. So, we will monitor your post-treatment progress on a regular basis. The proper follow-up, i.e., 1, 3, 6, 12, 24 months, also helps us evaluate the effectiveness of our treatments and improve our protocols based on observed outcomes even further.

Clinical Trials, Studies & General Information

According to ClinicalTrials.gov statistic, in August 2017 there had been 131 trials for Retinitis Pigmentosa registered, out of it 11 are Stem Cell Ophthalmology Treatment Studies.

https://clinicaltrials.gov/ct2/results?cond=Retinitis+Pigmentosa+and+stem+cells&term=&cntry1=&state1=&Search=Search#tableTop

Slide Show: About Retinitis Pigmentosa

https://www.slideshare.net/mariamkashif10/retinitis-pigmentosa-24108218?next_slideshow=1

Retinitis Pigmentosa - Stem Cell Research & Medical Publication

Neural Regen Res. 2016 April; 11(4): 652–656. doi:  10.4103/1673-5374.180753

Human umbilical cord blood-derived stem cells and brain-derived neurotrophic factor protect injured optic nerve: viscoelasticity characterization / PMCID: PMC4870926

Xue-man Lv,1 Yan Liu,2 Fei Wu,3 Yi Yuan, M.D.,1,* and Min Luo4

http://pubmedcentralcanada.ca/pmcc/articles/PMC4870926/

Retinitis Pigmentosa - Stem Cell Research & Medical Publication

Can J Ophthalmol. 2010 Aug;45(4):333-41. doi: 10.3129/i10-077.
Current approaches and future prospects for stem cell rescue and regeneration of the retina and optic nerve.

Dahlmann-Noor A1Vijay SJayaram HLimb AKhaw PT.
https://www.ncbi.nlm.nih.gov/pubmed/20648090

Retinitis Pigmentosa - Stem Cell Research & Medical Publication

J Clin Invest. 2004 Sep 15; 114(6): 755–757. doi:  10.1172/JCI200422930

Bone marrow–derived stem cells preserve cone vision in retinitis pigmentosa
Lois E.H. Smith  PMCID: PMC516270

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC516270/

Retinitis Pigmentosa - Stem Cell Research & Medical Publication

Stem Cell Research / Volume 14, Issue 3, May 2015, Pages 243-257
Stem cell treatment of degenerative eye disease

BenMeadab MartinBerrya AnnLogana Robert A.H.Scotta WendyLeadbeatera1 Ben A.Schevenb1
https://www.sciencedirect.com/science/article/pii/S1873506115000306

Retinitis Pigmentosa - Stem Cell Research & Medical Publication
DOI: 10.3390/ijms150814456 · Source: PubMed

Recent Advances of Stem Cell Therapy for Retinitis Pigmentosa

Yuxi He , Yan Zhang , Xin Liu, Emma Ghazaryan, Ying Li, Jianan Xie and Guanfang Su
https://www.researchgate.net/publication/264941063_Recent_Advances_of_Stem_Cell_Therapy_for_Retinitis_Pigmentosa

Retinitis Pigmentosa - Stem Cell Research & Medical Publication