RA-COVID-19 V2 - Recherche - Action Coronavirus disease 2019 - Vague 2

Corneal procurement during and after Sans-CoV-2 pandemic. What microbiologic test should we perform? whar are the risks? – CorDon

Submission summary

Corneal graft is the most frequent graft in the world (about 200000/year) and was however BEFORE the COVID epidemic in great shortage since 1 graft was available for every 70 needed. There are already many contraindications to corneal donation and the level of security is already very high. Many pathogens are sought in the donor's blood while general diseases transmissible by the cornea are totally exceptional due to the absence of blood and lymphatic vessels in the corneal tissue. Hepatitis B and rabies are the only two general diseases that could be transmitted in a very limited number of cases. Nevertheless, since the cornea is exposed to the environment and SARS-CoV-2 is airborne, it is theoretically possible for it to be present on the ocular surface. However, there is no evidence of this. The impact of new donor screening rules and the imposition of new routine virological tests will have a significant impact on the number and cost of corneal grafts. As an example, the Biomedicine Agency (ABM) authorised on May 4th the resumption of therapeutic procurement after the selection of donors without symptoms of respiratory pathology, fever, dyspnoea or asthenia (all symptoms that are not exceptional at the end of life) and the performance of a PCR on nasopharyngeal swabs.
In order to base possible recommendations on robust scientific data and not simply on the precautionary principle, the aim of this project is to rapidly accumulate data over 12 months (with intermediate analysis at M6) on the risk of corneal contamination by SARS-CoV-2. This study will take place in the CHU of St-Etienne and Nantes, which are 2 of the most dynamic teams in terms of the number of procurement. It is currently being extended to the UK, Belgium, Netherlands, Germany, Italy and Spain with funds from each nation.
In parallel, we will carry out an analysis on samples for scientific purposes (ABM authorisation already obtained on 9 April) AND on samples for therapeutic purposes. This strategy will allow us to obtain more data quickly.
Scientific donations will concern all potential donors, including those who have died from COVID, those who carry the virus but died from other causes, those at risk, and finally those not at risk equivalent to donors for therapeutic purposes (but with a "classic" contraindication such as Alzheimer's, Parkinson's etc...). The donations after death of COVID are the only ones that will allow us to know if the cornea can naturally host the virus. We have already taken the first of these samples. On part of the scientific donations, we will carry out experimental work by voluntarily contaminating negative corneas and analyzing the possibility of infection, proliferation in eye banking conditions and transmission to another cornea. We will use our laboratory's innovative bioreactor for this purpose, a true ex vivo experimentation platform. We will test the diagnostic efficacy of fluorescent and blocking nanobodies on this model and on other cell types, in collaboration with the 3rd partner (Dr Alain Roussel, Architecture et Fonction de Macromolécules Biologiques, UMR Univ/CNRS7257).
Donations for therapeutic purposes from the 2 banks in St-Etienne and Nantes will have already had a PCR on nasopharyngeal swab (at their charge). In addition, we will perform a PCR on the graft storage medium just before delivery AND a PCR on the crushed cornea for the rare nasopharyngeal swab PCR+ donors.
All the data collected and the data from the ex vivo experiments will be used to establish final recommendations on whether or not to pre-screen donors for COVID risk and on whether or not to test the corneas.

Project coordinator

Monsieur Gilles THURET (Biologie ingénierie et imagerie de la Greffe de Cornée)

The author of this summary is the project coordinator, who is responsible for the content of this summary. The ANR declines any responsibility as for its contents.

Partner

PHU 7 PHU 7 - Biologie
BiiGC Biologie ingénierie et imagerie de la Greffe de Cornée
AFMB Architecture et fonction des macromolécules biologiques

Help of the ANR 125,076 euros
Beginning and duration of the scientific project: June 2020 - 12 Months

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