Neuroscientist Andrew Huberman on Future Treatments for Vision Loss

To bring it back to your work, one of the things that you talked about was eyesight. And regaining eyesight or dealing with people that have weakening eyesight, my eyesight's going to shit, man. Do you have a retinal condition? No. And I'm just old, 52, and just there's a macular degeneration. I mean, I can read my phone. I can read all these text messages that are coming in, 14 new ones since I put my phone down. But I do know for sure that my vision is not as good as it was 10 years ago and certainly not as good as it was 20 years ago. What can be done? Okay. So, there's what can be done now and where we're headed. But I suspect you want to know what can be done now. Fix my eyes. Okay. So, we do have a clinical trial in my lab right now through my affiliation with ophthalmology where people put on VR goggles very separate from the fear-inducing thing. It's actually a very pleasant experience. And we use a particular pattern of stimulation that activates the cells in the eye that are most vulnerable and create vision loss. It stimulates those in a way that reinforces their connections with the brain. That's the logic. So, every cell in your eye has a different function, but some of them, their job is to transmit visual information to the rest of the brain. They're called ganglion cells. We know what patterns of activity make them healthy and what reinforce regeneration. Back in 2016, my lab published a paper showing that that particular pattern of stimulation combined with a particular pattern of gene therapy, so this is one injection into the eye of a gene that triggers growth of these cells, in mice that allowed regeneration of neurons that were damaged and it actually reversed slightly, but it reversed blindness. Completely blind mice were able to see again. Whoa. So, that was in mice. We then took that, built a human clinical trial using just the VR part. However, some people in this trial are receiving injections. It's about once every month, very painless injection into what we call the vitreous of the eye. They shoot it right in the eyeball? Yeah, just a little insulin syringe, go right in, you look that way, boom, a skilled ophthalmologist can do this without any pain or anything. I know it sounds terrible, but it's very straightforward. To inject something called CNTF, ciliary-netrophic factor. The combination of this growth factor plus the visual stimulation, we believe is going to protect cells that would normally be lost from getting lost, so offset vision loss, and potentially restore vision. Now, the results of this trial aren't done, but we are recruiting people for this trial. Jamie, you're in, right? My eyes are good. They're just fine right now. What about prisoners? What about prisoners? It's some prisoners that are really bad people, but they can't see that good. The injection part provided it's done by a skilled ophthalmologist, it's a cinch. You've been through way worse this morning on your way to work, trust me. It's nothing. The other thing is that there was a paper published just recently, a couple weeks ago, not from my lab, but from a group over at University College London, looking at the effects of red light on mitochondria in a different cell type, which are the photoreceptors of the eye. You've got the cells that connect the eye of the brain called the ganglion cells, then you've got the photoreceptors, which take all this photon information, turn it into this incredible thing we call vision, which itself is a whole galaxy of information, but is amazing. Those cells degenerate over time, the photoreceptors, they don't do very well in part because as we age, the mitochondrial function gets disrupted. This study was preliminary. It wasn't very many subjects. I think it was only 20 subjects, maybe it was 12, but getting red light therapy, just viewing a very bright flashes of red light of a particular wavelength. I don't want people going out there and blasting their eyes. Improved vision on vision tests almost immediately. That's a very non-invasive approach. I have one of those red light therapy machines. One of those sheath-sleeves. Yeah, it's probably a little different than this. If you're interested in doing this, let me know and we can potentially plug you into this. What would be the difference between that red light therapy and the other kind of red light therapy? Because I really like that Juve thing. I'm not exactly sure what it does. It's supposed to regenerate collagen and do a bunch of different things that helps you, but it feels good. Yeah, it feels good. It feels good to stay in front of it. One of the things is, remember we're saying that the eyes are actually a piece of brain. Your brain needs to know when to be awake and when to be asleep. One of the best ways to wake up your brain is to view bright light. There are all these people that are fanatic about blue light out there. Viewing bright light in the morning from sunlight is the best thing. Like in Southern California, go outside two to 10 minutes of getting bright light. Then you want to avoid light from 11 p.m. to 4 a.m. Actually it's been shown to suppress melatonin. It can disrupt sleep. It has a lot of problems. You don't really want to be looking at any bright light in the middle of the night. A lot of people get obsessed with blue light being bad. You want bright light during the day and you don't want any bright light at night really, too much of it. People come after me, the blue blockers, I call it, the blue blockinistas have been coming after me recently because I'm out there saying like, it's like, what about the ... It's like, look, the blue blockers will help filter some light. It'll make things less bright. It's hard to see with sunglasses in your house. So be my guest and wear them. But really what you want to do is dim the lights in the evening, deeper sleep, melatonin suppression won't be a problem. That's all good. Get bright light first thing in the morning when you wake up. And then the bright red light is probably having a dual effect. It's probably increasing mitochondria in the photoreceptors if the study is right. I do believe the study is it looks really good to me. Even the person who did it has been in the game a long time, so I trust him. And in addition to that, it's going to wake up your system and get the balance of these hormones like you want cortisol high in the morning and melatonin coming up about 16 hours later before sleep. It's going to put all that into the right rhythm. So I say go ahead and do the red light thing. But if you want to pursue the red light flashes or the VR and maybe even the CNTF injection, we should talk about that. CNTF injection, mean the bacteria, they squirt it right in your eyeball? That's the growth factor. But I'm scared of that. Well, the good news is that the VR, we do have a condition in the study where it's just VR. So it's a daily, essentially neurons like to be active. And these cells that connect the eye to the brain are the most, above all others, the most active neurons and cells in your entire body. Do you know of anybody who's done this where they had the injections in the eyes? Well, oh yeah, many people now in the study have had the injections. And what are the benefits? So I want to be careful here. I can't talk about the results of a clinical trial, but I can say they're promising. And this is inhuman. Just wink. Wink if you think I should do it. Wink if you can fix my eyes. Well, I think if you qualify for the study, I definitely think you should do it. But I can't reveal the results of the study because I actually don't know. In the name of good science, I'm blinded to the conditions. No pun, right? I just don't know. But we have subjects or patients that are as young as 17, as old as 80. The beauty of this is that if you decide not to get the injection, it's completely noninvasive. Okay. How many injections do you have to have? I think it's like once a month for a period of about six months. So would I have to go to the Bay Area once a month? No. So there is another version of this where there's a slow release polymer capsule that's placed into the eye. Oh, Jesus. That sounds even worse. Just inject me and get it over with. Well, someday we will have drops that will get through the vitreous and down there. We work on glaucoma in my lab. People for glaucoma take drops for eye pressure. But getting things into, remember, it's brain. And so there's a reason why you have this tough sclera. I'm not going to be able to think that way. The brain thing is really fucking my head up. The fact that your eyeballs are, you're exposed to brain. Two pieces of the brain. That is so nuts. Two pieces of the brain. And so visual repair is soon going to go the way of two other strategies. And I think we're going to see this in humans in the next couple of years. I'm going to be doing two years because I hate the 10 years thing. We've been hearing the 10 years thing forever. One is the work of someone that you've had on here before, David Sinclair. Love that dude. He's great. He's terrific guy, both for sake of his work on combating aging and also just really have to tip my hat to him because he was really first man in in terms of doing public facing science education through podcasts and things like that. And I'm starting to do that and others are starting to do it. And he deserves credit for that. It puts scientists in a vulnerable place and I think he's doing it with a lot of integrity. He's also got a fun personality. So great guy. Yeah. Yeah. So for him to get the point across. So David's not typically known for doing vision research, but he paired up with another guy lab, a guy named Zhigang he at Harvard Children's Hospital. Someone I know very well. We worked together on a number of things and they took advantage of what are called these Yamanaka factors. Yamanaka won the Nobel prize for finding these four factors that could essentially allow a cell to turn into anything. Any other cell type kind of creates stemness in these cells, make them pluripotent stem cells. The problem was that tends to induce cancers in these cells. So David's lab has combined an anti cancer gene. I think these these workers still not published, but he's talked about them. So I feel comfortable doing this. Suppresses cancer while turning these cells young again. And at least in mice, they see some very encouraging results. So that would be a sort of one injection kind of thing where you go in once, you get the injection and then never again. If I did an injection once a month, how long we talking? How many months do I have to do it for? So the study would probably run for about six months or the embedded capsule, the CNTF capsule combined with the VR. Now you have to put those VR goggles on for 20 minutes a day and watch that. That's easy. You can listen to music, do whatever you want. It's a very passive thing that triggers activity of these cells. The activity is key because we know that neurons, you know, you hear fire together, wire together and all this other stuff. But the fact of the matter is neurons that are quieted, even if you cast an arm, the neurons that support movement of that arm very quickly start to turn off and eventually they can die. So keeping neurons active and alive and healthy involves keeping them literally active electrically. And so that's what the VR component is about. So there's the Sinclair kind of turning back the clock stuff. And then colleagues of mine at Stanford are doing incredible work with neural prostheses, so little robotic retinas, as well as stem cells that are injected into the eye that settle down into your eye and give you the cells that you've lost. And we're not quite there with the human trials yet, but there's a group, the Retinal Repair Initiative. I'm part of this thing. It has a kind of funny name, what it's called the Retinal Dream Team, which is a bunch of people brought together to cure blindness, to solve blindness in a particular disease called neurofibromatosis. So there are dozens of labs working extremely hard on this problem. This is one place where I can say there's been tremendous progress in the last five years. There are clinical trials now, for instance, the one in my lab. And in two or three years, you're going to start seeing people who would normally go blind. You're going to halt that. And you're going to see people who are completely blind. I think eventually those people will see again. Wow. Yeah. That's intense. It's amazing. It's amazing. And you know, blind people, the mental real estate, but like the visual real estate in the brain gets taken over by other functions. There's this guy, Dan Mancina. He's a skateboarder. He's completely blind. He's an amazing guy. And skateboards blind with a cane, rides up to, rides up to curves and handrails, all he's onto him, kick flips out, this kind of stuff. Yeah. And, and I've talked to him a bunch of times because he was having some issues with his sleep because one of the issues that blind people have is because light is controlling when to be alert and when to be asleep. He was having some issues with this. So he contacted me. We're also in touch because we're trying to, he's trying to build skate parks for blind kids so that they can. There he is right there. Oh yeah. Check out Dan. Wow. That's insane. He's such a beast. I mean, most people would be, would be afraid to do this without the, yeah. That's crazy. Yeah. And what's, what's so great about Dan is he also, you know, he's in, that is nuts. He's in graduate school. He's I mean, he is such a, he's tapping things so he knows where they are. But how does he know the scale of the ramp or the pitch of the ramp? He has an internal representation of it. Wow. Yeah. That's bonkers. He's from. I wish he could see how cool it is. There is. Yeah. Yeah. He's, he teaches blind kids like what's possible basically. Wow. Because talk about COVID and being indoors, blind people, I spent a lot of time with blind people because of the visual restoration stuff. And there are people like Dan who are out there trying to get blind people to come out of their rooms to get into society. If you have a dog, you're better off, right? Because the dog, you outsource your vision to the dog. There are now glasses that blind people can wear and walk down the street and it communicates with somebody in a, like a dispatcher who says, oh, you know what? There's someone sketchy over there to your right. You might want to cross the street and it works really well, but it's very expensive. And of course privacy is an issue. You get home, you start undressing, you know, you don't want the person like looking at you in the mirror. Right. You know, or maybe people do, but that's a whole different business, you know, but, but people like Dan are amazing. And I do believe the hope is that people like Dan will eventually see again. Wow. But that's going to require new cells and actually for him, he's going to need new eyes. So Dan actually has had, because he had this Coates disease that led to a retinitis pigmentosa, he had his eyes removed. So whenever people are like, sometimes you'll see on social media, people will say, I don't believe he's blind. It's like, guy doesn't even have eyes. Yeah. So anyway, there's a, that's a whole universe of stuff on, but if you would like to explore visual repair and visual restoration, offsetting vision loss more, be happy to further. Yeah, I would love to. Yeah. I'll be a guinea pig. Let's get the party rolling.