THE PROBLEM

The corneal endothelium (CE) is the inner layer of the cornea (transparent front portion of the eye) that plays a key role in maintaining corneal clarity, and keeping vision clear. The CE is composed of corneal endothelial cells (CECs) and damage to these CECs results in fluid accumulation in the cornea, reduction in vision, and eye pain. Fuchs endothelial corneal dystrophy (FECD) is the most common disease of the CE affecting approximately 4% of the population over the age of 40, and is the leading indication for corneal transplantation worldwide. FECD is an age-related disease with a female predilection characterized by CEC death and formation of abnormal collagen deposits called guttae. There are limited options for the treatment of FECD, which usually involves corneal transplant surgery, however this comes with associated risks. Therefore, there is a significant unmet need to understand what causes FECD and to develop new treatment strategies, such as regenerative cell therapy and gene therapy.

THE APPROACH

Our research aims to understand what causes FECD, including environment, genetics, and other signalling pathways; and what regulates CEC migration using live imaging to observe the movement of CECs in tissues from FECD patients. We are the first to show that FECD CECs migrate faster than normal CECs, and are currently investigating what regulates this process. 

Our research also aims to understand if there are different CECs that make up the CE in normal corneas and if there are differences that occur in FECD. Our goal is to identify and better characterize corneal endothelial stem cells and to try to accelerate the development of new treatments for FECD and CEC regeneration. We also aim to develop personalized medicine for FECD, where a sample of diseased CECs is harvested, and engineered outside the eye in the laboratory where they can be genetically modified using gene therapy, and administered back into the same patient as a treatment. We also strive that our research methods can be extended to other eye conditions where corneal regeneration is important, and can ultimately positively impact the health of people living with vision loss.