Topical Insulin in Neurotrophic Keratopathy: A Review of Current Understanding of the Mechanism of Action and Therapeutic Approach

Jaworski, Marcin; Lorenc, Anna; Leszczyński, Rafał; Mrukwa-Kominek, Ewa

doi:10.3390/pharmaceutics16010015

Cited by 8 publications

(7 citation statements)

References 39 publications

(94 reference statements)

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“…It is worth noting that topical insulin has been explored and has shown promising outcomes in the management of diabetic keratopathy [170]. Mechanistically, insulin has the ability to counteract the downregulation of the PI3K/Akt axis linked to ROS.…”

Section: Counteracting Oxidative Stress and Inflammationmentioning

confidence: 99%

Diabetic Keratopathy: Redox Signaling Pathways and Therapeutic Prospects

Buonfiglio,

Wasielica-Poslednik,

Pfeiffer

et al. 2024

Antioxidants

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Diabetes mellitus, the most prevalent endocrine disorder, not only impacts the retina but also significantly involves the ocular surface. Diabetes contributes to the development of dry eye disease and induces morphological and functional corneal alterations, particularly affecting nerves and epithelial cells. These changes manifest as epithelial defects, reduced sensitivity, and delayed wound healing, collectively encapsulated in the context of diabetic keratopathy. In advanced stages of this condition, the progression to corneal ulcers and scarring further unfolds, eventually leading to corneal opacities. This critical complication hampers vision and carries the potential for irreversible visual loss. The primary objective of this review article is to offer a comprehensive overview of the pathomechanisms underlying diabetic keratopathy. Emphasis is placed on exploring the redox molecular pathways responsible for the aberrant structural changes observed in the cornea and tear film during diabetes. Additionally, we provide insights into the latest experimental findings concerning potential treatments targeting oxidative stress. This endeavor aims to enhance our understanding of the intricate interplay between diabetes and ocular complications, offering valuable perspectives for future therapeutic interventions.

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Section: Counteracting Oxidative Stress and Inflammationmentioning

confidence: 99%

Diabetic Keratopathy: Redox Signaling Pathways and Therapeutic Prospects

Buonfiglio,

Wasielica-Poslednik,

Pfeiffer

et al. 2024

Antioxidants

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“…Interestingly, a recent culture study with ocular surface cells showed that drops from plasma rich in growth factors were superior to topical insulin at two different concentrations (1 and 0.2 IU/m) in promoting wound healing and reducing the fibrosis process [ 115 ]. Currently, no universal protocol exists regarding treatment with topical insulin, as studies apply different preparation methods, dosages, concentrations, and types of drops [ 116 , 117 ].…”

Section: The Role Of Insulin and Effect Of Diabetesmentioning

confidence: 99%

The Role of Insulin-like Growth Factor (IGF) System in the Corneal Epithelium Homeostasis—From Limbal Epithelial Stem Cells to Therapeutic Applications

Woronkowicz,

Roberts,

Skopiński

2024

Biology

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The corneal epithelium, comprising three layers of cells, represents the outermost portion of the eye and functions as a vital protective barrier while concurrently serving as a critical refractive structure. Maintaining its homeostasis involves a complex regenerative process facilitated by the functions of the lacrimal gland, tear film, and corneal nerves. Crucially, limbal epithelial stem cells located in the limbus (transitional zone between the cornea and the conjunctiva) are instrumental for the corneal epithelium integrity by replenishing and renewing cells. Re-epithelialization failure results in persistent defects, often associated with various ocular conditions including diabetic keratopathy. The insulin-like growth factor (IGF) system is a sophisticated network of insulin and other proteins essential for numerous physiological processes. This review examines its role in maintaining the corneal epithelium homeostasis, with a special focus on the interplay with corneal limbal stem cells and the potential therapeutic applications of the system components.

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“…The systematic review carried out, covering a thorough search of various databases (PubMed, Scopus, Science Direct, Scielo, Bireme, Google Scholar and Web of Science), provided an indepth analysis of the use of insulin eye drops in the treatment of neurotrophic corneal ulcers. Jaworski et al [3], in their review of the current understanding of the mechanism of action and therapeutic approach, emphasised the importance of understanding corneal insulin receptors, highlighting the need for further studies to fully elucidate this process. It serves as a crucial foundation for understanding the molecular and pharmacological aspects involved in the proposed treatment.…”

Section: State-of-the-art Research Into the Use Of Insulin Eye Drops ...mentioning

confidence: 99%

“…Researchers have contributed significantly to this analysis, offering diverse and enriching perspectives. Such as Jaworski et al [3], who emphasised the importance of assessing the response of corneal insulin receptors. They also highlighted clinical variables related to the expression of these receptors, providing insights into possible correlations with the clinical efficacy of the treatment.…”

Section: Analysis Of Clinical Variables Outcomes and Safety Measures ...mentioning

confidence: 99%

“…The concatenation of the findings of the systematic review on the use of insulin eye drops in the treatment of neurotrophic corneal ulcers revealed a range of perspectives, trends and recommendations from the various authors involved in the studies. The following summarises the opinions of each author in this regard: More recently, Jaworski et al [3] provided an up-to-date understanding from a molecular perspective, which may be a knowledge gap, especially in clinical efficacy, essential to understanding the mechanisms involved in clinical efficacy. According to Khilji et al [5],the direct clinical approach with the use of insulin eye drops contributed to the creation of practical recommendations in the approach to corneal neurotrophic ulcers, suggesting the real applicability of the treatment.…”

Section: Main Trends Knowledge Gaps and Recommendations In The Field ...mentioning

confidence: 99%

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Use and Efficacy of Insulin Eye Drops in Neurotrophic Corneal Ulcers: A Systematic Literature Review

Amorim,

Filho,

Júnior

et al. 2024

JAMMR

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This research aimed to analyse the use and efficacy of insulin eye drops in the treatment of neurotrophic corneal ulcers by means of a systematic literature review. To this end, relevant studies found in various databases were analysed, including PubMed, Scopus, Science Direct, Scielo, Bireme, Google Scholar and Web of Science. The selected studies were assessed in terms of their objectives, methodology, results and conclusions, with the aim of providing a comprehensive understanding of the current state of evidence on the subject. From the articles by Serrano-Giménez et al. [1], Wang et al. [2] Jaworski et al ([3], Tong et al. [4], Khilji et al. [5], Moreker et al. [6], Soares et al. [7], CUARTERO-MARTINEZ et al. [8], Lorente-Pascua et al. [9], Erin et al. [10], Diaz-Valle et al [11], Dana et al. [12] and Ruiz-Lozano et al. [13], trends, knowledge gaps and recommendations for clinical practice and future research were identified. As a result, the studies analysed showed a variety of outcomes in relation to the efficacy and safety of insulin eye drops in the treatment of neurotrophic corneal ulcers. There was also a lack of standardisation in the methods used and the evaluation measures, highlighting the need for a more uniform approach in subsequent studies. The main trends identified indicate that insulin eye drops can be effective in treating corneal neurotrophic ulcers, especially in refractory stages. However, there is a need for further research to define more precise diagnostic criteria and more standardised assessment measures. In conclusion, this systematic review has provided a solid basis for future research into the use of insulin eye drops in the treatment of corneal neurotrophic ulcers. The recommendations resulting from this study have the potential to inform clinical practice and guide future research in this field, with the aim of improving these procedures for patients with this specific ophthalmological condition.

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Topical Insulin in Neurotrophic Keratopathy: A Review of Current Understanding of the Mechanism of Action and Therapeutic Approach

Cited by 8 publications

References 39 publications

Diabetic Keratopathy: Redox Signaling Pathways and Therapeutic Prospects

Diabetic Keratopathy: Redox Signaling Pathways and Therapeutic Prospects

The Role of Insulin-like Growth Factor (IGF) System in the Corneal Epithelium Homeostasis—From Limbal Epithelial Stem Cells to Therapeutic Applications

Use and Efficacy of Insulin Eye Drops in Neurotrophic Corneal Ulcers: A Systematic Literature Review

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