Eye drops for all types of EB (2025)

“We are extremely grateful for the support from DEBRA UK, which has enabled us to pursue this important research.”

Researchers are developing a lubricating eye-drop based on gellan gum that will help reduce eye symptoms in EB. They have compared their formulation to commercially available eye drops and found that it provides better protection for the cornea. They are continuing to adjust the formulation of the eye drop and study its long-term effectiveness and whether it can be combined with other treatments.

The researchers are developing an eye drop made from gellan gum, a food additive (E418). It is made by bacteria and used instead of gelatin (an animal product) in vegan sweets. By dissolving different concentrations of gellan gum in water, they can make a ‘fluid-gel’ eye drop that is easy to apply and may be better than currently available eye drops at preventing the scarring on the eye that causes pain and vision problems for many people living with EB.

Research leader:

Liam is a Professor of Biomaterials, appointed the youngest professor in the history of the University of Birmingham at the age of 32, and the Founder-Director of the Healthcare Technologies Institute at the University of Birmingham. He has established a strong track record of developing novel materials/technologies to the point of clinical application. This has resulted in a range of high impact works (including over 7000 citations from more than 150 papers; H-index of 45) and generated over 20 patents in the field. He has been involved in raising >£30m from the research councils (EPSRC, BBSRC, MRC, NC3Rs), the NIHR and charities (Wellcome), and currently sits on the DPFS and i4i panels, and on the EPSRC Strategic Advisory Team for Healthcare Technology. He will take responsibility for running of the project.

Co-researchers:

Dr Richard Moakes is a lecturer in healthcare materials and GMP production manager in the Advanced Therapies Facility. Richard has a strong background in soft-materials and has worked extensively with the eye drop, having formulated, and manufactured it for clinical trial. Therefore, he will advise on the manufacturer and re-classification of the eye drop product.

Prof Anthony Metcalfe is Industrial Professor of Wound Healing at the University of Birmingham. He has over 25 years’ experience of developing and commercialising wound healing and scar reduction therapies taking these through to Phase III Clinical Trials. Throughout his career, translating novel therapies, he has developed a strong background in commercialisation and regulation. As such, he will provide advice and assistance in the translational pathway for the technology and its onward translation.

Prof Adrian Heagerty is a consultant dermatologist and honorary professor of dermatology within the University Hospitals NHS Trust in Birmingham. Adrian is the lead clinician for the Midlands and North of England, in the National epidermolysis bullosa Adult Service. He has been involved in the care and research into EB for 35 years. He will help to coordinate patient and public involvement, as he is currently in contact with ca. 320 patients with EB, and provide expertise surrounding the disease.

Ms Saaeha Rauz is a Reader in Translational Ophthalmology at the University of Birmingham and honorary consultant ophthalmologist specialising in ocular diseases such as severe dry eye. As part of her specialty, Saaeha is an expert in the areas of Pemphigoid, Stevens-Johnson Syndrome and Sjogren’s Syndrome all with very similar symptomatology and outcomes to EB. She is PI and Chief Investigator of the two first-in-human fluid gel Phase I clinical trials of the eye drop. She will therefore be valuable in understanding the ocular aspect of the programme.

Mr Amit Patel is a consultant ophthalmologist at University Hospitals NHS Trust. He provides routine eye care for the large cohort of adult patients with epidermolysis bullosa seen in the half national EB service, based in the Trust. He will therefore provide much of insight into patient eye care and routine monitoring.

Collaborator:

Dr Holly Chinnery, University of Melbourne, Australia.

“The drops that are currently used tend to stay on the eye for short periods of time, meaning that they must be used over and over again throughout a day. In this project, we are trying to solve this problem by introducing a new eye drop that has been shown to stay on the surface of the eye for a much longer time. This will mean that patients need to apply their drops much less frequently. In the longer-term, these eye drop could be filled with molecules that can prevent scarring from occurring. We hope that this will provide patients with more freedom and a greater quality of life.”

– Prof Liam Grover

Grant Title: High-retention, lubricating eye drops to enhance quality of life in EB patients.

One of the side-effects of many types of EB is damage on the surface of the eyes, caused by scraping of the eyelid over an already sensitive eye. This can result in pain, scarring and potentially blindness. The damage caused by this process is a vicious cycle – damage to the eye reduces lubrication, which makes the eye more prone to damage.

At the moment, clinicians try to break the cycle by providing eye drops, which allow the eye lid to glide over the surface of the eye. The drops that are currently used tend to stay on the eye for short periods of time, meaning that they must be used over and over again throughout a day.

In this project, we are trying to solve this problem by introducing a new eye drop that has been shown to stay on the surface of the eye for a much longer time. This will mean that patients need to apply their drops much less frequently. In the longer-term, these eye drop could be filled with molecules that can prevent scarring from occurring. We hope that this will provide patients with more freedom and a greater quality of life.

The proposed work is of direct importance to patients with all forms of epidermolysis bullosa (EB) likely to develop dry eye symptomology, but particularly recessive dystrophic and junctional subtypes where blistering/ulceration of the ocular surfaces is most common.

This project will repurpose an eye-drop technology that is currently in the very late stages of development and make it ready for large-scale deployment to EB patients with ocular surface damage. This project will lever >£4m of research council investment (MRC and NIHR) that has enabled us to scale-up, manufacture, and collect toxicological data on the drop, to enable first-in-human trials. By the time the project starts, we will have completed first-in-human safety trials with healthy volunteers and will be moving towards treating patients with severe dry eye (NIHR) and microbial keratitis (MRC). For this reason, we feel that the work could have a major impact for patients within a period of two years.

To achieve this, the overarching aims of this project will be to:

1. With clinicians and patient groups, understand the requirements (in terms of disease) and needs of the final product, to provide a usable life-enhancing therapy.
2. Understand the underpinning science behind lubrication and rubbing between tissues within the ocular cavity to prevent blistering.
3. Characterise and compare the fluid gel eye drops to current treatment options in terms of both lubricity and retention.
4. Undertake the necessary steps to reclassify the eye drop from a medical product to medical device.

Our research team is dedicated to understanding and addressing the complex ocular complications faced by individuals with Epidermolysis Bullosa (EB). EB is a rare genetic condition that causes the skin and mucous membranes to be extremely fragile, resulting in blisters and wounds with minimal friction or trauma. This condition can also affect the eyes, leading to a range of complications, including corneal damage and the formation of scar tissue on the surface of the eye, known as ocular fibrosis. These complications can severely affect vision and the quality of life for individuals with EB.

The Role of Gellan Gum in Protecting the Eye

In response to these challenges, we are developing an innovative eye drop formulation that uses gellan gum, a bacterial sugar, as its primary ingredient. Gellan gum is a natural polysaccharide that has shown great promise in forming gel-like structures. In our research, we have discovered that gellan gum can help protect the delicate cells of the cornea from damage caused by friction—an issue that is particularly important for individuals with EB. The friction caused by blinking, combined with the fragility of the corneal surface, makes the eyes of EB patients more susceptible to damage.

Our gellan gum-based eye drop has been shown to have significant lubricating properties, creating a protective layer on the corneal surface. This layer helps reduce the friction that occurs during blinking and protects the cells from damage. We have been able to fine-tune the gel’s formulation, adjusting the concentration of gellan gum to ensure it is both effective in its protective function and comfortable for application. These adjustments mean the eye drop can be tailored to meet the specific needs of individuals with EB, providing relief from ocular symptoms without causing discomfort.

Preventing Ocular Fibrosis

One of the most exciting aspects of our research is the potential for the gellan gum eye drop to prevent or slow down the development of ocular fibrosis—a condition that occurs when scar tissue forms on the cornea. Ocular fibrosis can lead to vision loss, making it a major concern for individuals with EB. Our studies have shown that gellan gum-based eye drops can prevent the activation of certain genes that are involved in fibrosis, offering a potential solution to this challenging issue. This ability to block the formation of scar tissue is critical in preserving vision and improving the long-term quality of life for individuals with EB.

Customising the Gel for Maximum Effectiveness

Our team is continuously working to optimise the formulation of the eye drop. We have explored how adjusting the concentration of gellan gum affects the gel’s properties, such as its viscosity (thickness) and lubricating ability. This research has led to the discovery that by tweaking the gellan gum concentration, we can maintain a gel that is easy to apply and highly effective at preventing damage to the cornea. This customisation is vital because it ensures that the gel can be used safely and comfortably while providing maximum protection.

Additionally, we have tested the gel’s performance alongside commercial eye drops and found that our gellan gum-based formulation provides superior protection for the cells on the cornea, even in conditions of high shear stress—such as when the eye blinks. This suggests that the fluid gel could be a game-changer in managing the ocular symptoms of EB, offering better results than current commercial options.

Understanding the Science Behind the Gel

Beyond just creating a protective barrier, we are diving deeper into understanding the exact mechanisms by which the gellan gum eye drop works. We are investigating how it interacts with the cells of the cornea, particularly focusing on the ways it may prevent the damaging effects of friction and inhibit the formation of scar tissue. By gaining a better understanding of these mechanisms, we hope to develop more targeted, user-friendly treatments for managing the ocular symptoms associated with EB.

Collaboration with DEBRA UK and Public Input

We are extremely grateful for the support from DEBRA UK, which has enabled us to pursue this important research. Through this collaboration, we have been able to make great strides in improving the lives of individuals with EB, particularly in terms of managing their ocular health. We also greatly value the input of the public and those directly affected by EB. Co-producing this work with individuals who have lived experience of EB has been an incredibly valuable aspect of our research. Their insight ensures that we are not just working in a lab, but creating real-world solutions that will benefit patients in their daily lives.

We believe that our work will make a significant impact on the lives of people with EB, and we are committed to continuing our research to bring new treatments to those who need them. Our research is not just about science for science’s sake; it is about improving the quality of life for people who face real challenges every day.

Looking Ahead: What’s Next?

As we continue with this research, we will further refine the formulation of the gellan gum-based eye drop and conduct more studies to understand its long-term effectiveness. We are also investigating the possibility of combining the eye drop with other treatments to provide a comprehensive solution for managing ocular symptoms in EB patients. Our goal is to ensure that individuals with EB have access to effective, easy-to-use treatments that help them maintain their eye health and prevent complications such as ocular fibrosis.

Conclusion

In conclusion, our research is making important progress in developing a solution to protect the eyes of individuals with EB from friction-related damage and the development of ocular fibrosis. Through the use of gellan gum-based eye drops, we are not only creating a product that is effective in protecting the corneal cells but also one that is comfortable for patients to use. We are committed to advancing our understanding of how this gel works and ensuring it can make a real difference in the lives of people with EB.

With the ongoing support of DEBRA UK and the valuable input from those directly affected by EB, we are confident that our work will continue to pave the way for better treatment options and improved quality of life for individuals with EB. (From 2025 final report.)

Our team is undertaking research to better understand and address ocular complications in individuals with Epidermolysis Bullosa (EB). EB can affect the eye in a significant way, with patients experiencing increased susceptibility to corneal damage due to friction and trauma. We are currently developing a lubricating eye drop made from a bacterial sugar called gellan gum, which shows promise in protecting against friction-related damage to cells of the cornea.

Through our studies, we have observed that gellan gum-based eye drops may help prevent ocular fibrosis—a condition where scar tissue forms on the surface of the cornea, leading to vision problems. By adjusting the amount of gellan gum in our eye drop, we are able to customise the gel to remain easy to apply while effectively safeguarding against friction-related damage to cells of the cornea. This customisation ensures that the gel can protect the delicate cells on the corneal surface without causing discomfort during application.

Our ongoing research aims to go deeper into understanding the mechanisms underlying the protective effects of the gellan gum eye drop to develop user-friendly treatments for managing ocular symptoms in EB patients.

We are grateful for the support of DEBRA UK and its supporters, which allows us to pursue this important research. (From 2024 progress report).