RNA Therapeutics Is The New Hope In Retinal Diseases – Is India Ready For A Visionary Future?

Among our five senses, the eyes are the primary gateway to connecting with the world. Our eyes allow us to perceive and interpret by giving us a vision of the world. What if we lost this vision? Well, according to WHO, around 2.2 billion people in the world suffer from vision impairment, and retinal diseases are the leading cause.

However, through current treatments like laser therapy, corticosteroids and anti-VEGF injections we can treat the retinal diseases but can’t cure them permanently. But we need to thank the cutting-edge technology because of brings promising solutions to cure these diseases through RNA therapeutics permanently. By using RNA-based molecules such as messenger RNA (mRNA) and small interfering RNA (siRNA), this targets directly the disease-causing genes at the molecular level and ensure long-lasting improvement in visions.

While the United States, Europe, China and many other countries have made a significant advancement in RNA therapeutics by investing in research, clinical trials and developing advanced technologies, India is still suffering. Henceforth, although RNA therapeutics is promising, the question is, is India ready for this change and address the growing retinal diseases rate?

Understanding retinal diseases

Retinal diseases are considered to be the condition when the sensitive tissue at the back of the eye, the retina, is affected and leads to vision impairment. Retinal is responsible to create vision by converting light into electrical signals. Different types of diseases affect the retina and if these are untreated may cause blindness.

Inherited Retinal Disease (IRD) is a genetic condition where people often face progressive vision loss and this often leads to blindness. These diseases are typically inherited and developed over time and even can be present during birth. Some examples of these diseases can be Laber congenital amaurosis, retinitis pigmentosa and so on.

The most common disease in the retinal area is Age-related Macular Degeneration (AMD). It mainly blurs the central vision of the eye by affecting the macula and is a common condition among people over the age of 60. It does not lead to complete blindness rather gradually affects central vision and old people suffer in small tasks like reading, driving and so on.

Retinal tear is another common retinal diseases among people. It happens when the clear and gel-like substance at the central, known as vitreous, begins to shrink and pull away from the retina. The vitreous tug in the retina and lead to a tear or hole and if this condition is untreated this can lead to retinal detachment.

Among diabetic patients, diabetic retinopathy is a common disease. In this disease, the tiny blood vessels of the retina deteriorate and start to leak fluid into and under the retina causing vision impairment. It can lead to complete blindness if untreated.

Effectiveness of RNA therapeutics in retinal diseases

With the advancement of modern technology, RNA therapeutics have been noted to bring revolution in treating different retinal disorders. However, siRNA, a double-stranded RNA molecule, is one of the key therapies used to cure retinal diseases by silencing the specific genes that cause disease.

For example, in diabetic retinopathy, the vascular endothelial growth factor (VEGF) gets overproduced to stimulate the abnormal blood vessels in the retina leading to fluid leak. The siRNA silenced the VEGF gene to minimise the excessive growth of these blood vessels which can ensure a long-lasting solution for diabetic patients.

mRNA therapy is also a proven therapy to cure retinal diseases. In conditions like Retinitis Pigmentosa (RP), and Leber Congenital Amaurosis (LCA), where certain genes are absent or mutated, the mRNA helps to deliver the correct genetic information to the cells of the retina that helps in producing the missing protein and reverse the progression of the disease.

CRISPR-Cas9 technology is also a proven RNA therapeutic to cure inherited retinal disorders. These conditions caused by genetic mutations that can lead to abnormal functions of the retina can be treated by treating the mutation at the DNA level. However, some of the RNA therapeutics like those targeting diabetic retinopathy and wet AMD are currently undergoing clinical trials in ophthalmology.

Moreover, different gene therapies like the RPE65, the FDA-approved gene therapy have been proven to treat IRD conditions. India has a higher prevalence of IRDs compared to other global countries. Other RNA-based therapies like ASOs have also proven to treat critical conditions like spinal muscular atrophy. 

Is India ready for this?

In India, especially in rural India, people are suffering from different retinal diseases, especially IRDs. India has been identified to have a higher prevalence. Every 1 in 372 people in rural South India, every 1 in 930 in urban South India and every 1 in rural Central India have a higher prevalence of IRDs.

However, although significant steps have been adopted by other developed countries, India is suffering in making advancements due to a lack of public awareness, barriers to research and lack of accessibility.

In India, most people are not aware of the potential of RNA-based treatments. Besides patients, healthcare professionals are also unaware of how RNA therapeutics work, its mechanism and potentiality. Henceforth, this knowledge gap might create challenges for India to fully implement RNA therapeutics.

Unlike other countries like China, the US and others that have invested in research, India faces barriers to developing a strong infrastructure for research and development. India has been known for its genetic diversity which creates complications in the identification of some specific mutations that cause retinol diseases on a regional basis. The research infrastructure of India often lacks of expertise and resources to complete gene-based studies for different regional retinal disorders.

In rural areas of India, the lack of accessibility to reach to cutting-edge treatments has been creating a challenging environment to implement the RNA-based therapies. Moreover, higher costs of RNA-based therapies also create inaccessibility of these therapies to lower-income group people.

Steps recommended to India to be ready for change

India can avail the full potential of RNA-based therapeutics by adopting some significant steps. First of all, India needs to priortise genetic research to understand the mutation profiles of individuals with IRDs. In this process, the collaboration with the local institutions and healthcare providers will be highly significant to spread awareness among people in rural and urban areas.

Even collaboration with tech startups to further invest in RNA-based therapies can help in tailoring the diverse genetic makeup in India. This collaboration can enable precise medication in addressing the IRD. Moreover, research initiatives taken by India need to be highly concentrated to understand and enhance the genetic databases and biotechnology infrastructure. As the Indian GDP is growing with a CAGR of 8.4%, investing in such research and collaboration might be easier and more effective.

As lack of awareness is one of the biggest problems in addressing IRDs through RNA therapeutics, India can use social media as a great weapon here. Indian government, as well as the pharma companies, needs to spread awareness of the intensity of retinal diseases and RNA therapeutics role in it might be helpful for India to be ready to adopt this life-changing therapies.

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