Magnetic Cells in Endothelial Cell Transplantation

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This month, News in Review highlights selected papers from the original papers sessions at AAO 2023. Each was chosen by an Annual Meeting Program Committee subspecialty chair because it presents important news or illustrates a trend in the field. Only four subspecialties are included here; papers sessions will also be held in five other fields. For more information, see the Mobile Meeting Guide (aao.org/mobile).

Data gathered by researchers in a phase 1 clinical trial suggest that the use of magnetic cells in endothelial cell transplantation may have a role in the treatment of corneal edema. The specialized cells contain magnetic nanoparticles that allow them to be localized and retained on the endothe­lium when an external magnetic field is applied to the eye for a short period after cell injection.

MAGNETIC CELL THERAPY. An illustration indicates where injection and patch are placed.

Cultured cell injection. Study author Ellen Koo, MD, at the University of Mi­ami Bascom Palmer Eye Institute, said the prospective, open-label study was conducted at seven sites, two associated with Bascom Palmer and the other five located at sites across the United States. The primary goal was to determine the safety profile and tolerability of EO2002, magnetic cultured human corneal endothelial cells (hCEC). The researchers were also interested in sec­ondary outcomes, including improve­ment in BCVA and changes in corneal thickness.

Study partici­pants had all been diagnosed with corneal edema related to endothe­lial dysfunction. In Group 1, differing cell doses were injected into 21 patients across seven cohorts. “We had groups that were assigned to Descemet membrane strip­ping, endothelial brushing, no brushing or stripping, or, for example, injection only,” said Dr. Koo. Each participant received an EO2002 injection with the cells (made by biotechnology compa­ny Emmecell) at a dose of either 0.05 × 10⁶, 0.15 × 10⁶, 0.5 × 10⁶, or 1 × 10⁶ cells. The injections were made into the anterior chamber by several experienced cornea surgeons. This was followed by the application of an external magnetic eye patch. The researchers are currently enrolling another 21 participants, in Group 2, as part of a double-masked, randomized trial that is investigating any outcome variation associated with different cell doses, said Dr. Koo, noting that all enrolled participants receive an injection of cells—there is no control group in the study.

Dose-dependent gains. All patients in Group 1 remained free of adverse reactions, such as unstable intraocu­lar pressure and inflammation at 26 weeks, with none requiring keratoplas­ty. BCVA scores indicated a positive dose-dependent response; patients who received higher-dose injections expe­rienced the largest increase in vision gain.

Safety check. According to the authors, no safety issues were iden­tified during the trial. What’s more, prior studies show that the magnetic nanoparticles used in the cell delivery technology clear the body and pose no risk to patients undergoing MRI scans.¹ 

Promising alternative. Current treatments for corneal edema second­ary to endothelial dysfunction include keratoplasty or corneal transplant, said Dr. Koo, noting that serious complica­tions can result from these procedures, including graft failure, graft rejection, and fungal keratitis. By contrast, the magnetic-hCEC transplants, delivered through a straightforward procedure that requires no additional surgical training, have a very low rejection risk, she said.

The use of this proprietary technol­ogy in ophthalmology could prove to be a more accessible and affordable nonsurgical treatment for patients with corneal edema than other current treat­ments, said Dr. Koo. This new approach “could potentially be revolutionary in addressing eyes that have had previous graft failures and are at risk for future endothelial keratoplasty failure,” said Dr. Koo, noting that this method, if it passes future research phases, could also help address the global shortage of donor cornea grafts.

—Julie Monroe, MSN, RN, CIC

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1 Ruhparwar A et al. Thorac Cardiovasc Surg. 2006;54(7):447-451.

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Relevant financial disclosures: Dr. Koo—Emmecell: S.

For full disclosures and the disclosure key, see below.

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