Sobering solution for scarring conjunctivitis

A drug already used to treat alcohol abuse has had promising results in eye cells donated from patients who suffer from scarring conjunctivitis.

Scarring conjunctivitis is one aspect of mucous membrane pemphigoid, an autoimmune disorder that triggers inflammation in the membranes in the eye and other parts of the body.

In the eye, the inflammation leads to scarring and blindness, in one out of five patients with the ocular form.

Until now, the only treatment option was immune suppression drugs. While these do suppress the inflammation, this frequently has little effect on tissue scarring and the medication can have undesirable side effects.

To find an alternative, a team of researchers from University College London (UCL), Moorfields Eye Hospital and Duke University in the US compared cells from patients with the condition against their healthy counterparts.

UCL PhD student, Dr Sarah Ahadome, told OT that people with scarring conjunctivitis had higher cellular levels of the enzyme aldehyde dehydrogenase 1 (ALDH1). This enzyme creates a protein involved in inflammation – and most importantly, scarring – in the body.

There is a drug already on the market that can block this enzyme’s activity, disulfiram, which is used to stop the enzymes that process alcohol in the body in cases of alcohol abuse.

So Dr Ahadome looked at how eye drops with disulfiram would impact the mice with the scarring conjunctivitis condition. This study – supported by funding from Fight for Sight, Moorfields Eye Charity and UCL Business – found that inflammation and scarring were both significantly reduced with the disulfiram treatment.

Dr Ahadome explained: “Seeing that disulfiram decreased both the inflammation and the scarring in mice with scarring conjunctivitis was very exciting.”

Disulfiram also made eye cells donated from patients behave more like normal cells, Dr Ahadome emphasised, adding: “It was a privilege to stand in front of most of these patients – who gave me pieces of their eye tissue for this research – to tell them the good news that we had found in our data.”

By directly and specifically targeting the inflammatory and pro-scarring enzyme, the potential new scarring conjunctivitis drug could be a far better option for patients, Dr Ahadome said.

“Safety wise, this is going to be a huge step up,” she highlighted.

Dr Ahadome said the drug might also have potential as a treatment for trachoma, which has caused an estimated six million people worldwide to go blind, as well as severe ocular allergies.

Her fellow researchers, UCL’s Professor John Dart, Professor Julie Daniels and Professor David Abraham, are now planning a human clinical trial using the drug, she added.