Naltrexone as a Novel Therapeutic for Diabetic Corneal Complications

Diabetes is a widespread autoimmune disorder that affects nearly 10% of the adult population in the United States. In addition to the primary disease, there are numerous complications associated with inflammation including abnormalities of the heart, visual system, and peripheral nervous system. More than half of the individuals with diabetes will have one or more ocular related complications such as dry eye disease (DED), keratopathy, or retinopathy. Research over the last 3 decades has focused on the role of the opioid growth factor – opioid growth factor receptor (OGF-OGFr) axis as a regulatory system that maintains homeostasis in corneal epithelialization and tear secretion. In diabetes, OGF appears to be dysregulated resulting in decreased cell replication and increased corneal surface sensitivity. Utilization of naltrexone as a topical therapeutic to block the OGF-OGFr axis results in reversal of dry eye and restoration of corneal sensitivity and rates of corneal re-epithelialization. Naltrexone treatment at dosages that are substantially lower than systemically approved doses appear to be safe and effective therapy for corneal surface abnormalities associated with diabetes.