Integrative Liver-Targeted Therapy for Diabetic Macular Edema: Combining Tauroursodeoxycholate and Traditional Chinese Medicine.

Diabetic macular edema is seen in the later stages of diabetic retinopathy with current conventional therapies targeting local vascular dysfunction. These therapies provide transient improvement in vision and are often uncomfortable to persons with diabetic macular edema and financially burdensome. Diabetic macular edema, a complication of diabetes cannot be managed without addressing systemic inflammation. Liver metabolism and functions are implicated in diabetes and evidence suggests that hepatic metabolic dysfunctions are linked to the neuroinflammation and vascular dysfunctions observed in diabetic retinopathy. Nutraceutical supplements like Tauroursodeoxycholate (a bile acid) and modified Qi Ju Di Huang Wan (a traditional Chinese medicine formula) have been found to reduce hepatic and retinal oxidative stress, provide anti-apoptotic, anti-inflammatory, neuroprotective and hepatoprotective effects. This study will provide a non-invasive multi-targeted strategy for the management of diabetic macular edema.

Study Overview

• Status: Not yet recruiting
• Conditions: Diabetic Macular Edema (DME)
• Intervention / Treatment: Dietary supplement: Tauroursodeoxycholate (TUDCA); Dietary supplement: Traditional Chinese Medicine (mQJDHW); Drug: placebo capsule

• Study Type: Interventional
• Enrollment (Estimated): 69
• Phase: Phase 2

Contacts and Locations

• Study Contact: Name: Sandra Owusu, OD; Phone Number: 205-222-2837; Email: owusus@uab.edu
• Study Contact Backup: Name: Sarbodeep Paul; Phone Number: 659-253-3319; Email: spaul5@uab.edu

Study Locations

• United States
  • Alabama
    • Birmingham, Alabama, United States, 35243
      • University of Alabama at Birmingham
      • Contact: Sandra Owusu, OD; Phone Number: 205-222-2837; Email: owusus@uab.edu
      • Contact: Sarbodeep Paul; Phone Number: 659-253-3319; Email: spaul5@uab.edu

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

1. Age range 18-89 years
2. Clinical diagnosis of diabetic retinopathy with diabetic macular edema (defined as CST greater than 250 and presence of microglia/macrophages on OCT) with a visual acuity between 20/32 and 20/200.
3. Written informed consent is provided.
4. Males and females
5. Routine laboratory study results CBC and Diff with bilirubin, aspartate aminotransferase and/or alanine aminotransferase, and creatinine within normal limits.

Exclusion Criteria:

1. History of difficulty controlling diabetes or hypertension with changes in medication in the last 3 months.
2. Eye having undergone YAG capsulotomy in the last 3 months.
3. Having other ocular surgeries in the last 6 months (examples include but not limited to cataract surgery, scleral buckle, trabeculectomies, etc.).
4. All women of childbearing potential must have a negative urine pregnancy test at the Screening Visit and throughout the study. Sexually active women participating in the study must use a medically acceptable form of contraception if they are not trying to get pregnant.
5. Chronic infectious disease (e.g. HIV, HCV)
6. Positive urine β-hCG test day of visit or a serum-hCG test within 48 hours prior to the initiation of the study
7. Other ocular diseases or fundus diseases
8. Currently taking an anti-inflammatory medication (e.g. anti-inflammatory agents, glucocorticoids or other immune modulating medications);
9. Use of cyclooxygenase-2 (COX-2) inhibitors for < 6 months prior to study entry or dose changes after study entry. Limited as-needed use is permitted prior to study entry but not during the study.
10. Use of statins that cross the blood brain barrier such as atorvastatin will not be permitted during the study as they have been shown to reduce levels of pro-inflammatory cytokines.
11. Any degree of hepatic or renal insufficiency that in the investigator's judgement would pose a safety risk with TUDCA or mQJDHW.
12. Subjects who based on history or mental status examination have a significant risk of committing suicide, or who are homicidal or violent and who are in the Investigator's opinion in significant imminent risk of hurting others.
13. Subjects who have a medical condition that, in the investigator's opinion, would expose them to an increased risk of a significant adverse event or interfere with assessments of safety and efficacy during the course of the trial.
14. Subjects with a current known infection or who are acutely ill.
15. Subjects with an autoimmune disease (i.e., Lupus, Rheumatoid Arthritis).
16. Subjects with thyroid disorders unless euthyroid at screening.
17. Subjects with cancer not in remission.
18. Inability to attend scheduled study visits, plans for family relocation during the study, or any other criteria that the investigator may determine to be associated with inability to complete the study.
19. Limited mental capacity rendering the subject unable to provide written informed consent or comply with evaluation procedures.
20. History of recent alcohol or drug abuse or noncompliance with treatment or other experimental protocols.
21. Use of any investigational drug/ nutraceuticals within 30 days prior to the baseline visit.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Quadruple

Number of Arms

3

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: Tauroursodeoxycholate (TUDCA) Arm; TUDCA is a bile acid that is available as a supplement. It has been found to provide protection in neuroinflammatory and neurodegenerative diseases. Evidence links it to reducing retinopathy in pre-clinical studies.	Dietary supplement: Tauroursodeoxycholate (TUDCA); TUDCA is a hydrophilic taurine-conjugated form of Ursodeoxycholic acid (UDCA).
Active Comparator: Traditional Chinese medicine (mQJDHW) Arm; Participants in this arm will be administered a standard dose of mQJDHW capsules twice daily for six months. mQJDHW, is a popular traditional Chinese medicine (TCM) formula used by TCM practitioners for managing eye diseases. It has been found to improve ocular health in anterior chamber diseases, uveitis, optic neuropathies and diabetic retinopathy. The various components of this formula, Tribulus terrestris, Paeonia lactiflora, Lycium chinensis, Angelica sinensis, Chrysanthemum morifolium, Paeonia suffruticosa, Dioscorea japonica, Cornus officinalis, Rehmannia glutinosa, Haliotis spp, Alisma plantago-aquatica and Dioscorea oppositifolia, have been found to provide neuroprotection, hepatoprotection, and reduce oxidative stress and neuroinflammation. Available in literature is evidence of the beneficial roles of this formula to systemic and retinal health.	Dietary supplement: Traditional Chinese Medicine (mQJDHW); The components of this formula are Tribulus terrestris, Paeonia lactiflora, Lycium chinensis, Angelica sinensis, Chrysanthemum morifolium, Paeonia suffruticosa, Dioscorea japonica, Cornus officinalis, Rehmannia glutinosa, Haliotis spp, Alisma plantago-aquatica and Dioscorea oppositifolia.
Placebo Comparator: Control (placebo) Arm; Participants will receive capsules with no active ingredient twice daily for six months.	Drug: placebo capsule; The placebo has no active ingredient.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change from baseline in macrophage-like cell density (cells/mm²).	Optical coherence tomography (OCT) images will be taken at each visit to visualize macrophage-like cells (MLC) seen in persons with DME. OCT images will be taken at the study visits and changes in the MLC density will be measured.	Up to three months
Change from baseline in best-corrected visual acuity (ETDRS letters).	Each participant will have their best corrected visual acuity measured by Early Treatment of Diabetic Retinopathy study (ETDRS) chart.	Up to three months
Change from baseline in serum neuroinflammatory makers.	Blood will be drawn and neuroinflammatory and hepatic makers will be assessed at each study visit	Up to three months
Change from baseline in serum hepatic biomarkers.	Blood will be drawn and hepatic makers will be assessed at each study visit.	Up to three months

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change from baseline in macular central subfield thickness (µm).	Participants will have optical coherence tomography imaging at each study visit that will measure macular central subfield thickness. Measuring the change from visit one to the last visit.	Up to three months
Changes from baseline in retinal peripheral capillary free zone (mm²).	Each participant will have optical coherence tomography angiography (OCTA) to measure differences in retinal peripheral capillary free zone.	Up to three months
Changes from baseline in retinal foveal avascular zone (mm²).	Each participant will have optical coherence tomography angiography to measure differences in retinal foveal avascular zone.	Up to three months
Changes from baseline in retinal capillary density (%).	Each participant will have optical coherence tomography angiography to measure differences in retinal capillary density.	Up to three months
Changes from baseline in retinal non-perfusion zones (mm²).	Each participant will have optical coherence tomography angiography to measure differences in retinal non-perfusion zones.	Up to three months

Collaborators and Investigators

• Sponsor: University of Alabama at Birmingham
• Investigators: Principal Investigator: Maria Grant, MD, University of Alabama at Birmingham

Study record dates

Study Major Dates

• Study Start (Estimated): July 1, 2026
• Primary Completion (Estimated): December 31, 2028
• Study Completion (Estimated): December 31, 2028

Study Registration Dates

• First Submitted: March 3, 2026
• First Submitted That Met QC Criteria: March 3, 2026
• First Posted (Actual): March 9, 2026

Study Record Updates

• Last Update Posted (Actual): April 9, 2026
• Last Update Submitted That Met QC Criteria: April 3, 2026
• Last Verified: April 1, 2026

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Therapeutics; Complementary Therapies; Medicine, East Asian Traditional; Medicine, Traditional; Medicine, Chinese Traditional; ursodoxicoltaurine
• Other Study ID Numbers: FWA00005960 - UAB

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: UNDECIDED

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: Yes
• Studies a U.S. FDA-regulated device product: No