Lee Bryanna J, Afshari Natalie A
Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, California, USA.
Curr Opin Ophthalmol. 2023 Jan 1;34(1):3-8. doi: 10.1097/ICU.0000000000000910. Epub 2022 Nov 14.
Cataract is one of the leading causes of blindness worldwide and surgery is the only available treatment. Pharmacological therapy has emerged as a potential approach to combat the global shortage of surgery due to a lack of access and resources. This review summarizes recent findings in pharmacological treatment and delivery, focusing on drugs that target oxidative stress and the aggregation of crystallins.
Antioxidants and oxysterols have been shown to improve or reverse lens opacity in cataract models. N-acetylcysteine amide and N-acetylcarnosine are two compounds that have increased bioavailability over their precursors, alleviating the challenges that have come with topical administration. Studies have shown promising results, with topical N-acetylcarnosine clinically decreasing lens opacity. Furthermore, lanosterol, and more recently 5-cholesten-3b,25-diol (VP1-001), have been reported to combat the aggregation of crystallins in vivo and ex vivo . Delivery has improved with the use of nanotechnology, but further research is needed to solidify these compounds' therapeutic effects on cataracts and improve delivery methods to the lens.
Although further research in drug dosage, delivery, and mechanisms will need to be conducted, pharmacologic therapies have provided new strategies and treatments for the reversal of cataracts.
白内障是全球失明的主要原因之一，手术是唯一可用的治疗方法。由于缺乏手术途径和资源，药物治疗已成为应对全球手术短缺的一种潜在方法。本综述总结了药物治疗和给药方面的最新研究结果，重点关注针对氧化应激和晶状体蛋白聚集的药物。
抗氧化剂和氧固醇已被证明可改善或逆转白内障模型中的晶状体混浊。N-乙酰半胱氨酸酰胺和N-乙酰肌肽是两种比其前体具有更高生物利用度的化合物，减轻了局部给药带来的挑战。研究显示了有前景的结果，局部应用N-乙酰肌肽在临床上可降低晶状体混浊度。此外，已报道羊毛甾醇以及最近的5-胆甾烯-3β,25-二醇（VP1-001）在体内和体外均可对抗晶状体蛋白的聚集。通过使用纳米技术，药物递送已有所改善，但需要进一步研究以巩固这些化合物对白内障的治疗效果并改善向晶状体的递送方法。
尽管需要在药物剂量、递送和作用机制方面进行进一步研究，但药物治疗已为白内障的逆转提供了新的策略和治疗方法。
