Sjogren’s Disease: Autoimmune dry eye Part 5
The key question asked of Sjogren’s researchers is – “what does the future look like for Sjogren’s patients?” Fortunately, there are new consortiums of research activities that appear to bode well for a good answer.
Is a consortium of private corporations and government institutions structured to help understand and accelerate treatments for certain autoimmune diseases (Rheumatoid Arthritis and Lupus in particular) that are related to Sjogren’s Disease in some subsets of patients. Founded in 2014, there has been a lot of activity which is slated to continue over at least the next 4 years.
From their website, we find this:
“AMP-AIM” is a next-level evolution of the AMP program. From their website:
https://fnih.org/our-programs/AMP/autoimmune-and-immune-mediated-diseases
“As a next step, AMP AIM is working to refine and extend the single-cell analysis of biopsy (e.g., synovium, kidney, skin, salivary glands) and blood samples to include additional diseases, including psoriasis/psoriatic arthritis and Sjögren’s disease.” Finally, Sjogren’s Disease is getting the much needed spotlight it deserves from a consortium of heavy hitters who are in a great position to figure it out and effectively treat it!!
Dr. Nancy McNamara is an optometrist working at UCSF who notes that the cornea has the most number of nerves per square inch of any portion of the human body, so it perhaps no surprise that it can “hurt” even when we can’t clinically find anything out of place using conventional examination methods (the so-called “pain without stain”). Lacritin is a naturally occurring compound found in tears, which has a profound impact on restoring corneal nerves and the surface cells lining the cornea (epithelial cells). Measuring the amount in tears can help to increase our ability to find Sjogren’s patients, as they commonly have very low values of this compound. Equally exciting is the likelihood of soon treating eyes with extracts of this compound - a product called “Lacripep” (which is a smaller, active ingredient in Lacritin). Of a side interest to me, the company making this product is based in Charlottesville, VA (my Ophthalmology Residency alma mater). A recent study can be found here: https://journals.lww.com/corneajrnl/Fulltext/9900/Lacripep_for_the_Treatment_of_Primary.84.aspx
Dr. Anat Galor is an Ophthalmologist working out of the University of Miami, Bascom Palmer Eye Institute. She headed a small study looking into fecal microbial transfer from healthy donors to the gut of active Sjogren’s patients. Unfortunately, these transfers did not “take” long enough to have a significant impact on the receiving patient’s gut to show significant benefits, but there was enough promising data to turn attention towards a “customized biome transfer,” where needy patients could have pills tailored to the more precise germs required to “fix” their gut-related autoimmunity issues. She also pointed to the promising research using natural anti-autoimmune injections of intravenous immunoglobulins (IVIG) to help with the “pain without stain” corneal nerve pain – so a possible adjunct to the Lacripep treatments mentioned earlier.
Dr. Vidya Sankar referenced the possibility of gene therapy, as this has been increasing used for other diseases and the ability of targeting the diseases salivary glands (and perhaps the tear glands) seems within reach. Regenerative therapies are mostly available only in the form of Autologous Serum Tears for affected eyes currently, but this area appears likely to bear more fruit for our Sjogren’s patients sooner than later. Oxervate is a form of Neurotrophic Growth Factor that is already available to treat damaged corneal nerves and is in studies alongside Lacripep, to see if they can be used in this regenerative way. Neurostimulation with the nasal spray in Tyrvaya, is also under study as it may work in a similar way – but without having to add more drops directly to the surface of the eye.
In my earlier posts, I covered much of what is already available for advanced dry eye treatments common to the care of Sjogren’s patients:
https://www.eyethera.com/blog/segment-10-aampb-what-we-know-about-inflammation
https://www.eyethera.com/blog/segment-10-b-when-we-are-at-war-with-ourselves
https://www.eyethera.com/blog/not-so-secret-weapon-of-dry-eye-treatment-intense-pulsed-light-or-ipl
https://www.eyethera.com/blog/ive-tried-everything-now-what