An injection of stem cells into the eye may soon slow or reverse the effects of early-stage age-related macular degeneration, according to new research from scientists at Cedars-Sinai Medical Center, in Los Angeles. Currently, there is no treatment that slows the progression of the disease, which is the leading cause of vision loss in people over 65.

“This is the first study to show preservation of vision after a single injection of adult-derived human cells into a rat model with age-related macular degeneration,” said Shaomei Wang, MD, PhD, lead author of the study published in the journal STEM CELLS and a research scientist in the Eye Program at the Cedars-Sinai Board of Governors Regenerative Medicine Institute.

The stem cell injection resulted in 130 days of preserved vision in laboratory rats, which roughly equates to 16 years in humans.

When animal models with macular degeneration were injected with induced neural progenitor stem cells, which derive from the more commonly known induced pluripotent stem cells, healthy cells began to migrate around the retina and formed a protective layer. This protective layer prevented ongoing degeneration of the vital retinal cells responsible for vision.

Cedars-Sinai researchers in the Induced Pluripotent Stem Cell (iPSC) Core, directed by Dhruv Sareen, PhD, with support from the David and Janet Polak Foundation Stem Cell Core Laboratory, first converted adult human skin cells into powerful induced pluripotent stem cells (iPSC), which can be expanded indefinitely and then made into any cell of the human body. In this study, these induced pluripotent stem cells were then directed toward a neural progenitor cell fate, known as induced neural progenitor stem cells, or iNPCs.

“These induced neural progenitor stem cells are a novel source of adult-derived cells which should have powerful effects on slowing down vision loss associated with macular degeneration,” said Clive Svendsen, PhD, director of the Board of Governors Regenerative Medicine Institute and contributing author to the study. “Though additional pre-clinical data is needed, our institute is close to a time when we can offer adult stem cells as a promising source for personalized therapies for this and other human diseases.”

Next steps include testing the efficacy and safety of the stem cell injection in preclinical animal studies to provide information for applying for an investigational new drug. From there, clinical trials will be designed to test potential benefit in patients with later-stage AMD.

Priority Review for Shire’s Lifitegrast
The FDA accepted the New Drug Application and granted a Priority Review designation for Shire’s lifitegrast, an investigational treatment for dry-eye disease. The FDA is expected to provide a decision on October 25, 2015.

The FDA grants such designation to drugs that have the potential to provide significant improvements in the safety or effectiveness for the treatment, diagnosis or prevention of a serious disease. Drugs with Priority Review designation have an accelerated review target of eight months, instead of the standard of 12 months.

The NDA filing is supported by evidence from four clinical trials with more than 1,800 patients.  REVIEW

New, Fourth Indication for Eylea  The Food and Drug Administration approved Eylea Injection (aflibercept, Regeneron Pharmaceuticals) for the treatment of diabetic retinopathy in patients with diabetic macular edema. In 2014, the FDA granted Eylea Breakthrough Therapy designation and Priority Review for the treatment of diabetic retinopathy in patients with DME. The recommended dosage of Eylea in patients with diabetic retinopathy in DME is 2 mg every two months after five initial monthly injections. Although Eylea may be dosed as frequently as 2 mg every four weeks, additional efficacy was not demonstrated when Eylea was dosed every four weeks compared to every eight weeks. Eylea is available as a single, 2-mg strength intravitreal injection for all approved indications. Eylea was previously approved in the United States for the treatment of wet age-related macular degeneration, macular edema following retinal vein occlusion and diabetic macular edema. The approval of Eylea for the treatment of diabetic retinopathy in DME was based on two-year data from the Phase III VISTA-DME and VIVID-DME studies of 862 patients, which compared Eylea 2 mg monthly, Eylea 2 mg every two months (after five initial monthly injections) or macular laser photocoagulation (at baseline and then as needed). In these studies, on the primary endpoint of mean change in best-corrected visual acuity at one year, patients treated with Eylea monthly or every two months showed statistically significant improvements compared to the control group. Patients in both Eylea groups gained, on average, the ability to read approximately two additional lines on an eye chart compared with almost no change in the control group. A pre-specified secondary endpoint in the studies at year two evaluated diabetic retinopathy severity based on an established grading scale measuring retinal damage. In the VISTA-DME trial, 38 percent of patients receiving Eylea monthly or every two months (after five initial monthly injections) achieved a two-step or better improvement on the diabetic retinopathy severity scale, compared to 16 percent of patients receiving control. In the VIVID-DME trial, approximately 30 percent of patients receiving Eylea monthly or every two months (after five initial monthly injections) achieved a two-step or better improvement on the severity scale, compared to 8 percent of patients receiving control. In these trials at year two, Eylea had a similar overall incidence of adverse events, ocular serious AEs and non-ocular serious AEs across treatment groups and the control group. Arterial thromboembolic events (non-fatal stroke, non-fatal myocardial infarction and vascular death) also occurred at similar rates across treatment groups and the control group. The most frequent ocular treatment emergent AEs observed in the VISTA-DME and VIVID-DME trials included conjunctival hemorrhage, eye pain, cataract and vitreous floaters. The most common non-ocular treatment emergent AEs included hypertension and nasopharyngitis, which occurred with similar frequency in the treatment groups and the control group.