Stem Cell Therapy for Macular Degeneration

Macular degeneration is the main reason for vision loss and blindness among people who are aged 50 years and over. Especially age-related macular degeneration (AMD) is a leading cause of blindness. AMD is a degenerative disease that affects the macula, which is the central area of the retina responsible for the most detailed (or sharp/detailed) vision. As aging becomes more common worldwide, the incidence of macular degeneration is expected to rise, potentially leading to a serious health problem. At the moment, treatments for macular degeneration are only able to relieve signs and symptoms and slow down progression, but they cannot restore the retina. Nevertheless, regenerative medicine, in particular stem cell therapy, is the most promising method to restore the retina.

In general, stem cell treatment is to restore the function of and regenerate cells that have been harmed. And the use of it in the case of macular degeneration involves the replacement of degenerative retinal cells, the supply of retinal pigment epithelium (RPE) cells, and the accomplishment of vision improvement. A new sector of stem cell research and treatment comprises the city of New Delhi in India; however, a few specialized clinics are already providing the most advanced therapies for patients with macular degeneration. Such clinics employ techniques at the forefront of technology, which provides patients who used to have limited treatment possibilities with renewed hope.

This write-up will dwell on the opportunities that stem cell therapy offers in the treatment of macular degeneration in Delhi, India, as well as the therapy science.

Understanding Macular Degeneration

Macular degeneration is a condition that occurs when the macula, the very centre of the retina, is damaged. The retina is at the back of the eye, a structure that is made of light-sensitive tissue that receives light and changes it into electrical signals that the brain can understand. The macula is the part that gives us the central vision, which is the most essential thing for reading, driving, and recognizing faces. Macular degeneration impairs the central vision, while the periphery vision is usually not affected.

The main two types of macular degeneration are:

1. Dry Macular Degeneration (Atrophic): First of all is the dry type of macular degeneration, the most common one, that represents 90 percent of the cases with AMD, and is defined by the gradual thinning and atrophy of the retinal pigment epithelium (RPE) and photoreceptor cells. With the progression of the disease, it depicts a gradual loss of central vision.
2. Wet Macular Degeneration (Exudative): This is the less controlled form of AMD, where new blood vessels growing under the retina are abnormal and leak fluid or blood. It is the leakage from these abnormal blood vessels that quickly damages the macula, leading to severe and rapid loss of vision.

Diagnosing macular degeneration, retinal imaging such as optical coherence tomography (OCT) and fluorescein angiography are usually performed. Although macular degeneration is the leading cause of blindness in the elderly, a combination of hereditary and lifestyle factors, such as smoking, obesity, and high blood pressure, can also contribute to the risk of developing AMD.

The Role of Stem Cells in Treating Macular Degeneration

Stem cell therapy has the potential to restore sight in patients with macular degeneration, which is a leading cause of visual loss. Stem cell therapy can regenerate damaged retinal cells and has been described as following several mechanisms of action to restore vision in patients who have age-related macular degeneration (AMD):

1. Replacement of Damaged Retinal Cells: Stem cells have the ability to differentiate (i.e., mature) into retinal pigment epithelium (RPE) cells and photoreceptors, which are lost/damaged in AMD. By generating new and functional retinal cells, stem cells recreate health in the retina as well as restore vision.
2. Regeneration of the Retinal Pigment Epithelium (RPE): In dry AMD, the RPE layer deteriorates and functions as a degraded support system for photoreceptors. This means that RPE needs to be replaced in order for photoreceptors to work adequately and preserve their function. Since dry AMD typically involves loss/destruction of RPE cells, replenishing these RPE cells will replenish photoreceptors and preserve their function in the retina, as well as slow the advance of dry AMD.
3. Restoration of Photoreceptor Function: Photoreceptors are responsible for light detection and turn light into neural signaling. Stem cell therapy can assist the regeneration of these retinal cells and, ultimately, improve vision in both dry and wet AMD.
4. Anti-inflammatory and neuroprotective properties: Stem cells will release growth factors that promote a decrease in inflammation, an ever-present issue in AMD. These same factors can also protect retinal cells from damage, thus promoting healing and enhancing cell viability.
5. Angiogenesis of healthy neovascularization blood vessels: Wet AMD often includes harmful blood vessels (i.e., utilizing neovascularization) in the disease process, which eventually contributes to irreparable vision loss. Promoting newly formed capillaries from stem cells will not cause any of the same damage that is associated with wet AMD.

Types of Stem Cells Used in Macular Degeneration Treatment

Stem cell programs for macular degeneration utilize different stem cell types with specific regenerative capacities:

• Embryonic Stem Cells (ESCs): ESCs are pluripotent stem cells harvested from pre-implantation embryos. The unique regenerative propensity of ESCs is associated with their ability to differentiate into any cell type, including retinal cell types. Though these cells have regenerative potential for treating macular degeneration, they remain controversial due to their ethical concerns and are restricted in the administration of clinical therapies in several countries, including India.
• Induced Pluripotent Stem Cells (iPSCs): iPSCs are adult differentiated cells that have been genetically reprogrammed to a pluripotent state. While iPSCs have similar regenerative capabilities as ESCs, there continue to be gaps in applying this cell type in techniques to direct differentiation into the subtypes of retinal cells. iPSCs could help with personalized treatment for macular degeneration without the ethical dilemma of ESCs. Studies are being done to manipulate translation in iPSC-directed therapies that can be used for the treatment of macular degeneration in the future.
• Mesenchymal Stem Cells (MSCs): MSCs may also be found in bone marrow, fat tissue, and umbilical cord tissue and have the ability to differentiate into retinal cells, as well as secrete growth factors, which may protect retinal tissues. There are still questions about MSCs raised from various tissues, but their use in clinical trials targeting macular degeneration has shown positive results, and they are probably the least controversial paradigm for cellular therapy.
• Retinal Stem Cells (RSCs): RSCs are stem cells that are situated in the retina and have regenerative potential to replace retinal tissues as they age or become damaged. Though RSCs appear to be a very promising avenue with an additional regenerative capacity to mature retinal cells, their use for the treatment of MACD is still experimental.
• Adult Stem Cells (from the Eye): Stem cells can also be derived from adult eye tissues, particularly retinal tissue, or the ciliary body, which has self-repair capacity with retinal stem cells. These stem cells in the eye are less problematic because, if harvested from the patient’s eye, combining autologous tissue with cellular therapy reinforces the self-repair capacity of the patient for treatment and regeneration of the retinal endpoint.

Stem Cell Therapy for Macular Degeneration in Delhi, India

India, and more specifically Delhi, is now a destination for advanced medical treatment, including stem cell therapy for various ailments. In addition to increasing healthcare infrastructure and skilled health professionals, Delhi is emerging as a center of care for innovative applications of stem cell treatment for macular degeneration. 

A number of hospitals and clinics offering specialized treatment for macular degeneration have implemented stem cell therapy as a new treatment option. These facilities are equipped with the latest technology and have adhered to international standards for stem cell treatments of this nature. These treatment clinics can offer a range of stem cell-based treatments for dry and wet AMD with the goal of improving vision and slowing the progression of the disease.

The Stem Cell Treatment Procedure for Macular Degeneration

The following steps summarize the process of stem cell therapy for macular degeneration:

1. Initial Consultation

First, the individual will receive a complete evaluation from their ophthalmologist or retina doctor. The physician will review medical history, evaluate the severity of macular degeneration from the practitioner’s assessment, and indicate whether stem cell therapy is appropriate.

2. Stem Cell Harvesting

Stem cell collection is performed from the patient (autologous) or collected from a donor (allogeneic), based on therapy type. Autologous stem cells can most commonly be harvested from bone marrow or fat tissue, whereas allogeneic stem cells may come from umbilical cord tissue or from use of a certified stem cell bank.

3. Stem Cell Processing

The stem cells that were harvested are sent to a processing lab for isolation, culture, and expansion to ensure that the correct number of stem cells are collected and embolized with the correct therapeutic potency.

4. Injection into Eye

After the stem cell process is completed, the stem cells will be injected either into the vitreous cavity of the eye or into the retina itself. The procedure is completed under local anesthesia, with a short hospital observation period.

5. Post-Treatment Care

The patient will come back for follow-up to assess potential complications (i.e., infection), as well as to assess for effects of the treatment.

Benefits of Stem Cell Therapy for Macular Degeneration

1. Regenerative Potential: Stem cell therapy could regenerate retinal cells to restore lost function and enhance vision, which is a compelling treatment option for patients with macular degeneration who are not suitable for other traditional options such as anti-VEGF injections or laser surgery.
2. Slowing progression of disease: Stem cell therapy does not have the capacity to reverse the damage that has been done to the retina in advanced disease but can slow the progression of macular degeneration and protect the remaining vision.
3. Personalization of treatment: Stem cell therapy, and specifically iPSCs, could provide a more personal treatment based on what is appropriate for that individual.
4. Minimally invasive: Stem cell therapy and other cellular therapeutics are minimally invasive, as compared with traditional surgical intervention, since the therapy can be delivered simply via an injection into the eye. Reduced discomfort, recovery time, and risks associated with surgery make stem cell therapy a safer option.

Conclusion

New horizons offered by stem cell therapy in the treatment of macular degeneration, a leading cause of vision loss worldwide. Stem cells implement a regenerative approach by repairing damaged retinal cells, regenerating the retinal pigment epithelium, and supporting photoreceptor degeneration, ultimately changing the field’s focus from treating visual impairment through progression to repairing the visual impairment completely or partially. Advanced clinics and hospitals using the latest technology and experienced professionals throughout Delhi, India, offer advanced stem cell therapies for dry and wet AMD. Unlike other treatments for AMD, a stem cell procedure is typically minimally invasive and involves injecting stem cells into the eye. Although results have been promising, clinical research is ongoing to establish long-term safety and efficacy. If patients are considering stem cell treatment, they should go to an accredited center offering personalized care with supportive post-treatment care and continuity of care.

FAQs

1. Which macular degeneration patients could benefit from stem cell therapy?

Stem cell therapy can potentially benefit patients with both dry and wet forms of macular degeneration by regenerating retinal cells and vision.

2. How are stem cells injected for macular degeneration?

Stem cells are routinely injected into the eye’s vitreous cavity or retina through a thin needle under local anesthesia.

3. Are stem cell protocols for macular degeneration associated with safety?

When administered in a certified and credentialed center, stem cell protocols are believed to be safe; however, safety and monitoring continuously assess risks for complications and/or adverse events.

4. What types of stem cells are used for macular degeneration?

Stem cell therapy for macular degeneration employs mesenchymal stem cells (MSCs), induced pluripotent stem cells (iPSCs), and retinal stem cells to obtain different regenerative benefits.