Innovative Glaucoma Therapies: Vaccines, Stem Cells, SLT

Following are excerpts from the October 20, 2005 President’s Briefing Teleconference with Jack Cioffi, MD.

TOM BRUNNER: This is our second President’s Briefing Teleconference. Dr. Jack Cioffi will be our guest. He is the Chairman of the Glaucoma Research Foundation’s Scientific Advisory Committee, and he is the Chief of Ophthalmology and Director of Glaucoma Service at the Devers Eye Institute in Portland, Oregon. He’s also Editor of the Journal of Glaucoma and he’s on the Executive Committee of the American Glaucoma Society. Our topic is “Innovative Glaucoma Therapies: Vaccines, Stem Cells, SLT.

JACK CIOFFI, MD: I’ll start with the vaccine question. Although there are a few other groups around the world working on this, there’s a group in Israel that is led by Dr. Michal Schwartz, who has been very keen on the idea of developing a vaccine not only for glaucoma but for other neurodegenerative diseases. Various labs have thought about ways of protecting nerve cells from further damage by exposing the body to a vaccine, and the body then develops defenses, if you will.

TOM BRUNNER: So you’re using the immune system?

JACK CIOFFI, MD: Yes, using the patient’s own immune system to prevent further neuro-degeneration or loss of nerve cells. Until recently, the development of a vaccine had never been imagined for things like spinal cord injury or glaucoma. So it’s a novel approach. The exciting part is that we may have an answer in the short term, even in the next 3 to 10 years, as to whether this approach is going to be realistic. And when you start linking your research to things like multiple sclerosis and spinal cord injury, then the pace of research gets pushed ahead.

So it’s not ready for primetime. It’s not a vaccine that any of us are going to have in our hands tomorrow, but human testing is ongoing, and not only for glaucoma but in other areas.

TOM BRUNNER: So there are actually vaccines that are being tested in humans as we speak?

JACK CIOFFI, MD: There are. It’s unclear how far along they are in terms of a vaccine for glaucoma, but absolutely in other neurodegenerative diseases.

EMMETT SKINNER: If the vaccine treatment for glaucoma is successful, would there be a regeneration or growth of nerve tissue?

JACK CIOFFI, MD: The vaccines right now are not really aimed at regeneration. Regeneration by and large really comes from stem cell research, cells that could perhaps fix or even grow new nerve cells to replace the ones that have been damaged by glaucoma. So again the vaccines, like the other therapies that we have, are really about stabilization and preventing any further progression. So that heightens the reason why we want to make sure we diagnose glaucoma early, so that we give ourselves a running chance before too much damage is done.

PAT PEYSER: The question that I have is about SLT. Can you can tell us how SLT works, and which types of glaucoma patients it is appropriate for?

SLT stands for Selective Laser Trabeculoplasty. For approximately 20 years, we’ve had available a variety of different lasers to treat glaucoma, but the most common type of laser used to treat open angle glaucoma, which is by far the most common type of glaucoma in the US, is something called Argon Laser Trabeculoplasty, or ALT. Argon lasers burn things. They put small burns in the drainage system of our eye and it makes the drainage system work better.

More recently, SLT has been developed, and it is a kinder and gentler laser if you will. It doesn’t cause the same burns. The selective part, the “S” in SLT, means it only targets cells that have a bit of pigment in them, so instead of causing large burns, it causes little local reactions, but it still stimulates that same pathway, and still stimulates the white blood cells to clean up the drainage system. And by doing that, it lets the drainage system work better so the pressure goes down.

BARBARA MCGUINNESS: How long has SLT treatment been around?

JACK CIOFFI, MD: It’s been around for about four to five years. It’s gained more widespread usage over the last couple of years. The real promise and the reason ALT is not as sought after by many people is that once you’ve done it once or perhaps twice, you can’t really redo it many times, and SLT holds the promise that it may be repeatable many times. And if that’s true, it may be a great adjunct. We don’t know that yet, and those studies are being done now.

PAT PEYSER: Is there any reason to believe that having the SLT procedure would in any way compromise the effect of the vaccine that you were talking about earlier? Is there any interaction between the two?

JACK CIOFFI, MD: Probably not. SLT and all the laser procedures, as well as eye drops, work on the fluid flow in the front of the eye by decreasing the amount fluid made, or helping the fluid get out of the eye better, to decrease the pressure. These vaccines are aimed at the problems in the nerve at the back of the eye, so they’re probably different. They’re probably not linked, and doing one of these things now won’t inhibit you from having a vaccine treatment later if one becomes available.

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Related Scientific Articles:

Neurodegeneration and Neuroprotection in Glaucoma: Development of a Therapeutic Neuroprotective Vaccine by Dr. Michal Schwartz, Weizmann Institute of Science, Rehovot, Israel.

Last reviewed on February 22, 2013

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