Stem Cell Surgery and Growth Factors in Retinitis Pigmentosa Patients: Pilot Study after Literature Review

Paolo Giuseppe Limoli, Enzo Maria Vingolo, Celeste Limoli, Marcella Nebbioso, Paolo Giuseppe Limoli, Enzo Maria Vingolo, Celeste Limoli, Marcella Nebbioso

Abstract

To evaluate whether grafting of autologous mesenchymal cells, adipose-derived stem cells, and platelet-rich plasma into the supracoroideal space by surgical treatment with the Limoli retinal restoration technique (LRRT) can exert a beneficial effect in retinitis pigmentosa (RP) patients. Twenty-one eyes underwent surgery and were divided based on retinal foveal thickness (FT) ≤ 190 or > 190 µm into group A-FT and group B-FT, respectively. The specific LRRT triad was grafted in a deep scleral pocket above the choroid of each eye. At 6-month follow-up, group B showed a non-significant improvement in residual close-up visus and sensitivity at microperimetry compared to group A. After an in-depth review of molecular biology studies concerning degenerative phenomena underlying the etiopathogenesis of retinitis pigmentosa (RP), it was concluded that further research is needed on tapeto-retinal degenerations, both from a clinical and molecular point of view, to obtain better functional results. In particular, it is necessary to increase the number of patients, extend observation timeframes, and treat subjects in the presence of still trophic retinal tissue to allow adequate biochemical and functional catering.

Keywords: autograft; embryonic stem cells (ESCs); growth factor (GF); hereditary retinal disease; induced pluripotent stem cells (iPSCs); limoli retinal restoration technique (LRRT); mesenchymal stem cell (MSC); retinitis pigmentosa; spectral domain-optical coherence tomography (SD-OCT).

Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
The suprachoroidal autograft obtained by the Limoli retinal restoration technique (LRRT) allows placing adipose stromal cells, adipose tissue-derived stem cells (ADSCs), and platelets (PLTs), obtained from PLT-rich plasma (PRP), close to the choroid. The production of growth factors (GFs), typical of these cells is poured directly into the choroidal flow, helping to maintain retinal cell trophism.
Figure 2
Figure 2
The best corrected visual acuity (BCVA), in logarithm of the minimum angle of resolution (logMAR) units, was stable after suprachoroidal autograft or increased (+4.51%) in patients with foveal thickness (FT) >190 µm (13 eyes) (B-FT group, green bars). LRRT: Limoli retinal restoration technique; T0: Baseline; T180: At 6 months from surgery. A-FT group with FT ≤190 µm (8 eyes, blue bars).
Figure 3
Figure 3
Close-up visus, in points (pts), change post-Limoli retinal restoration technique (LRRT) depending on foveal thickness (FT). Six months after surgery (T180) from the baseline (T0), close-up visus was stable in group A-FT (FT ≤ 190 µm, blue bars) and increased in group B-FT (FT > 190 µm, green bars). The increase was + 20.79%, corresponding to useful reading area (6–10 pts: Book, journal, etc.). Average at T0 was 25.88 (±20.28 SD) and at T180 was 26.13 (±21.03 SD) in group A-FT. Average at T0 was 15.15 (±5.85 SD) and at T180 was 12.00 (±4.00 SD) in group B-FT.
Figure 4
Figure 4
At 6 months (T180) from Limoli retinal restoration technique (LRRT), there was a more relevant to, +32.70%, for sensitivity in the group with foveal thickness (FT) > 190 µm (B-FT, green bars). Sensitivity in group A-FT (blue bars) was +15.41%. Average at T0 was 5.45 (±6.79 SD) and at T180 was 6.29 (±8.10 SD) in group A-FT. Average at T0 was 3.15 (±6.44 SD) and at T180 was 4.18 (±7.78 SD) in group B-FT.
Figure 5
Figure 5
Retinitis pigmentosa (RP) patient with thinner foveal thickness (FT) A) The retinal cell population is small, foveal structures are often dystrophic, and the photoreceptor/retinal pigment epithelium/Bruch’s membrane/choriocapillaris complex is no longer recognizable. (B,C) The microperimetric sensitivity after surgery changed from 2 to 1.4 dB, and best corrected visual acuity (BCVA) changed from 0.097 to 0.155 logarithm of the minimum angle of resolution (logMAR).
Figure 6
Figure 6
Retinitis pigmentosa (RP) patient with foveal thickness (FT) > 190 µm (group B-FT). (A) The retinal cell population is large, foveal structures are still intact, and the photoreceptor/retinal pigment epithelium/Bruch’s membrane/choriocapillaris complex is recognizable. (B,C) The microperimetric sensitivity after surgery changed from 14.41 to 16.61 dB and bivariate contour ellipse area (BCEA) (see central oval circles), used for fixation stability evaluation, changed from 2.0 to 0.9 using microperimetry (MY) device. Best corrected visual acuity (BCVA) changed from 0.045 to 0.000 logmar of the minimum angle of resolution (logMAR).
Figure 7
Figure 7
Retinitis pigmentosa (RP) patient compliance analysis at 6 months post-surgery depending on foveal thickness (FT). Compliance was good in 71.43% of all cases (groups A-FT and B-FT). Patients reported seeing better, but the percentage reached 84.62% in those with FT > 190 µm. In the improved group, 11 eyes (73.33%) belonged to group B-FT (green bars), and 4 (26.67%) to group A-FT (blue bars).

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Source: PubMed

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