Injection of Stem Cells Around the Lacrimal Gland: Proof That Mesenchymal Stem Cells Help with Dry Eye and Other Disorders.

The injection of Stem Cells Around the Lacrimal Gland has been performed in dogs with good success as noted below. This has also been tried in humans with Sjögren's syndrome with good results but it has not been published yet. I am hoping to start a funded protocol to study stem cell injections into the Meibomian Glands and around the Lacrimal Gland in our severe dry eye patients. We would use Autologous Stem Cells: a patient's own stem cells.

This study below shows the benefit of Allogeneic (not your own stem cells) Mesenchymal Stem cells injected near the dog's lacrimal gland. These dogs had Keratoconjunctivitis sicca (KCS), also known as “dry eye syndrome, which is usually due to lacrimal gland inflammation. This treatment could theoretically work on humans who have Sjögren's syndrome is primarily a lacrimal gland inflammation. However, Sjögren's syndrome also destroys meibomian glands and I believe anyone who has stage 3 (advanced; staging depends on which staging you use) MG loss, should have an SJO test: not just anti-Ro, anti-La. I have picked up early Sjögren's  in many patients because of a positive SJO test for early Sjögren's syndrome antibodies before the anti-Ro and anti-La became positive. 

After they did liposuction on the dogs and isolated the stem cells with collagenase, they inserted a syringe through the conjunctival fornix of the superior eyelid, into the dorsolateral region of the ocular bulb, below the orbital ligament close to the lacrimal gland. The remaining 0.2 ml of cell suspension was injected into the third eyelid Lacrimal gland, which was accessed through the bulbar face of the third eyelid. 

The only treatment allowed for animals in this study, besides the MSC transplantation itself, was the use of artificial tears (sodium hyaluronate 0.2%) in the cases of severe KCS, which is used in order to maintain animal comfort. This type of lubricant has topical and immediate action and does not interfere with tear production. The administration of the artificial tear occurred three times per day over the first 30 days after MSC transplantation.

An improvement was seen in about 28 days with 1 injection. 
Here is before and after photos of the corneas of the dogs: the column on the left A-D is before stem cell injections. The column on the very right is after injection A"-D":

For our protocol, we would be using  Autologous (your own stem cells) and injecting them into the canal of the meibomian gland.

Here is more information below.

Cell Med. 2016 Dec 3; 8(3): 63–77.

Published online 2016 Oct 18. doi:  10.3727/215517916X693366

PMCID: PMC5165646

Allogeneic Mesenchymal Stem Cell Transplantation in Dogs With Keratoconjunctivitis Sicca

Maura K. W. Bittencourt,* 1 Michele A. Barros,† 1 João Flávio P. Martins,† Jose Paulo C. Vasconcellos,* Bruna P. Morais,† Celine Pompeia,‡ Matheus Domingues Bittencourt,§ Karine dos Santos Evangelho,¶ Irina Kerkis,‡ andCristiane V. Wenceslau‡

Keratoconjunctivitis sicca (KCS), also known as “dry eye syndrome,” is a common ocular disease in dogs resulting from lacrimal gland (LG) inflammation and decreased tear production. KCS can occur either as a quantitative deficiency in the aqueous component of tears or as a qualitative deficiency in the lipid or mucin layers of the tear film, causing tear film instability, with potential damage to the ocular surface1. This damage is characterized by the presence of mucoid ocular discharge, conjunctival hyperemia, blepharospasm, recurrent corneal ulceration, corneal vascularization, fibrosis, and, eventually, corneal pigmentation. In severe cases, dense corneal opacification (clouding) or corneal perforation secondary to deep ulceration can lead to blindness or even loss of the eye2–4. The diagnosis of quantitative KCS is based on typical ocular surface changes, as well as on dysfunction in tear production, which is evaluated by biomicroscopy of the anterior segment and by the Schirmer tear test (STT), respectively. The STT determines whether the eye produces enough tears to keep it moist and ranges from normal (15–25 mm/min), mild (9–14 mm/min), moderate (>4 to 8 mm/min), to severe (≤4 mm/min)3.

Any condition that impairs the ability to produce adequate amounts of tear film can result in KCS2. Local immune-mediated disease is the most widely accepted cause of KCS based on histopathology of tear-producing glands and on the clinical response to immunomodulators2,5,6. However, other systemic diseases may also be associated with KCS, such as infection with canine distemper virus, hypothyroidism, diabetes mellitus, and Cushing’s disease7. In addition, systemic administration of pharmaceutical agents for long periods and at high doses has also been reported to cause dry eye8. The most common treatment for KCS is the prescription of immunosuppressive drugs, such as cyclosporine and tacrolimus, which may need to be used indefinitely9. Furthermore, some authors believe a small number of dogs are resistant to the action of cyclosporine10. It is important to explain to the owner that the dog with KCS needs constant care, such as removal of secretions from around the eyes many times a day to minimize irritation of the eyelids, conjunctiva, and cornea. Thus, efforts are being made to develop alternative therapies to inhibit the immune response and inflammatory processes in order to reduce the suffering of animals with KCS and the need for their constant care.

It is known that mesenchymal stem cells (MSCs) are powerful regulators of the immune response and that they have been shown to be effective in treating various immune disorders in human and animal models11–19. Previous studies have already demonstrated safety aspects of MSC transplantation into the LG and tear production improvement after MSC transplantation in dogs with KCS20–22. However, it remains unclear whether MSC transplantation is efficient and leads to a good prognosis—tear production levels reverting to normal—in cases of severe KCS, especially in the long term. We thereby carried out the present study to evaluate the effects of MSC transplantation into LGs on tear production and clinical signs in dogs with mild–moderate versus severe KCS.

Veterinary patients, such as dogs, are increasingly recognized as critical translational models of human diseases because the etiopathogenesis of canine diseases is similar to that of humans23, particlularly regarding Sjögren’s syndrome24,25. Sjögren’s syndrome is a systemic autoimmune disease diagnosed by its two most common symptoms—dry eyes and dry mouth24. For this reason, canine KCS studies may aid in the development of therapeutic interventions that can benefit humans. Over the last few years, there has been an increase in the demand for sophisticated therapies, such as the use of stem cells, in animal companion care, which has led to a surge in stem cell studies using dogs26. These studies should provide a unique opportunity for assessing both efficacy and safety of human adult stem cell therapies that can be translated to human medicine.

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