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LV Prasad Eye Institute does transplant using cells from patient's own body

Cells harvested from patient's healthy eye are transplanted onto the affected eye, doing away with the need for immunosuppressants

LV Prasad Eye Hospital
Dr Virender S Sangwan, Director and founder of the Srujana Centre for Innovation at LV Prasad Eye Institute
Gina Krishnan
Last Updated : Jul 24 2018 | 9:26 PM IST
A burgeoning population and the advent of a range of new pathogenic and lifestyle diseases has made healthcare in India extremely complex. The medical fraternity has risen to the occasion at every step to meet the challenges in maintaining and improving public health, delivering several new molecules and therapeutic procedures to improve the overall well being of the populace. In a new series, Business Standard brings you five institutions that stand out in the field of medical research in India.

Established in 1998, LV Prasad Eye Hospital was probably the only medical institution in India at that time to be set up with a mandate to conduct basic research since inception. “It is the only hospital in the country that spends 15 per cent of its budget on research,” says Dr Virender S Sangwan, Director and founder of the Srujana Centre for Innovation at LV Prasad Eye Institute, Hyderabad, and the Dr Paul Dubord Chair in Cornea, Tej Kohli Cornea Institute, a philanthropic foundation). He joined the institute 20 years ago.

Dr Sangwan started a stem cell research group in 1998, at a time when hardly anybody knew about its applications. Today, the stem cell laboratory is a dedicated clinical manufacturing facility (c-GMP). One of the treatments pioneered under him is limbal cell transplantation in the eye in which LVPEI is a world leader. Another technique pioneered under him is the direct transplantation of stem cells on the surface of the eye instead of in the lab, where the stem cells are grown in a culture and then implanted. “Once the eye has been cleaned, we take a limbal biopsy from the healthy eye, harvest it, and place it bit by bit into the affected eye with biological/fibrin glue,” says Dr Sangwan. The technique is called simple limbal epithelial transplantation, pioneered by the institute. If the limbal cells are harvested from one's own body, then there is no need for immunosuppressant medication. Follow-ups with patients show that they do not require any medication after the wound has healed. But in the case of a transplant from a family member or relative,  immunosuppressants may be required till the graft is live, as there is a chance of rejection.


The other area that the research group is working on is retinal degeneration. It is growing retinal pigmentation epithelial cells from induced pluripotent stem cells. Pluripotent cells are those that can grow into any part of our body.  Animal studies are complete and the group is ready for human studies.

One of the most prevalent types of eye cancer in India is retinal blastoma, which usually occurs during the first few years of human life, and is easy to detect. If ordinary torchlight projected on the eye generates a red reflection, all is fine. But if the reflection is white, a red flag should be raised immediately. If the anomaly is discovered in time, the patient can be treated successfully. 


LVPEI has a number of international collaborations with universities and other organizations such as Harvard Medical School's eye department and Brien Holden Institute in Sydney, Australia. It is also a World Health Organization (WHO) collaborating centre. LVPEI receives competitive grants from DBT and DST based on its projects, and attracts several international grants and offers for collaboration. 

The innovation centre started in 2013 with a hackathon -- the result of a collaboration that came about following a conversation between Dr Sangwan and Ramesh Raskar of MIT Media lab. A hackathon with engineers was first held at BITS Pilani, in which 100 students participated. Now a week-long affair held in July every year, it is a gathering of researchers, design students, innovators, engineering students, doctors, optometrists and scientists. They look for solutions to problems in the field of eye care and may even come out with a working prototype. The idea originates with the doctor looking for solutions. 


Currently, the innovation centre currently has 18 engineers -- mechanical, electronics as well as biomedical, and even a microbiologist. The idea is to work on products which benefit a large population. “ If a product is developed which will impact a large number of people, LVPEI may be willing to make it available to everyone at a low price. But if it is a high-ended product, the institute may look at it differently. 

“About 10 products conceived during the past five years are at various stages of development,” says Dr Sangwan. 


Dr Shivaji, who joined LVPEI after spending a lifetime with Centre for Cellular and Molecular Biology (CCMB) says that the basic research and clinical research are completely inter dependent.” Every research project that is undertaken will translate into clinical practice to help patients.” he adds. The commitment of the group to patient care is uncompromising. The innovation centre has 18 full time engineers who come from different backgrounds, they are mechanical engineers, biomedical engineers as well as electronic engineers.”  Every clinician works with a basic researcher. For e.g., the limbal cell implant was a partnership between both Shivaji and Sangwan. 

However, the institute also does basic research where questions are asked to further knowledge. Once such area is genetics. Headed by Chitra Kannabiran, her team works with clinicians once they identify a disease which may run in  families. They try and identify the gene which cause a particular disease of the eye. The research done by the genetic group may or may not translate into immediate therapeutic outcome but it is absolutely necessary to further understanding.

Thirty-two years of medical records of every patient that has come to LVPEI are digitized. Anyone can pick an area of interest and begin research. “ Hundred per cent of the research done at LVPEI will translate into care for patient, it may not translate into therapy from bench to bedside immediately but we have strict criteria for selecting projects which are relevant to the eye and to future of care. Every researcher has a clinician as a partner,” says Dr Shivaji. 
This is the fifth and the last article in the series.

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