2 · Matrix, regenerative agents & supportive devices
RGTA — CACICOL® (poly-carboxymethylglucose sulfate, OTR4120)
Review — modulators of corneal healing › 2 · Matrix, regenerative agents & supportive devices › RGTA — CACICOL® (poly-carboxymethylglucose sulfate, OTR4120)
RGTA — CACICOL® (poly-carboxymethylglucose sulfate, OTR4120)
Matrix-regenerating agent · heparan-sulfate mimetic · OTR3 (D. Barritault). Cacicol (human eye drops) — discontinued. The molecule remains available in veterinary medicine under the name Clerapliq®.
Oxford III–IV
Weak–Moderate
Human: withdrawn
Veterinary: present
Mechanism of action"Matrix therapy": a biodegradable polysaccharide mimicking heparan sulfate, resistant to mammalian glycanases/heparanases. Replaces destroyed HS, binds structural proteins (collagens, fibronectin, laminin), and re-protects heparin-binding growth factors (FGF, TGF-β, VEGF) in their native conformation → restoration of the matrix microenvironment. It is not a growth factor and has no intrinsic pharmacological/antibiotic activity.
IndicationsNeurotrophic corneal ulcers and refractory PEDs, delayed epithelial healing after cross-linking (CXL)/refractive surgery, dystrophic/recurrent ulcers.
Route & dosageSingle-dose eye drops. Distinctive feature: very low dosing frequency — 1 drop every 2 days (sometimes 1–2×/week), as the product is non-degradable and long-acting. Applied in the evening, for several weeks until closure.
Level of evidenceOxford III–IV (case series, no large corneal RCT) · Scale: Weak–Moderate (consistent positive series, without randomized confirmation).
| FDA | Not approved/not cleared in the USA — not marketed. |
|---|---|
| EU MA | CE-marked MD (matrix therapy) — no drug MA. The human version Cacicol has been in clinical use since ~2008. |
| France (human) | Cacicol: discontinued — the human eye drops are no longer available. |
| Veterinary | Clerapliq® (OTR3, distributed by TVM/Virbac) — same active substance (RGTA/OTR4120), a veterinary MD available for corneal ulcers in dogs/cats. |
| Asia | Availability variable/limited depending on the country. |
Since Cacicol's withdrawal, RGTA technology no longer exists as a registered human eye drop in France; the remaining equivalent product on the market is veterinary Clerapliq (identical molecule). Any human use would constitute an off-label use.
Key studies: Aifa et al., IOVS 2012 (neurotrophic ulcers) — PMID 23150626 ; matrix repair of neurotrophic PEDs, Int J Ophthalmol 2017 — PMID 29259918 ; veterinary RGTA/Clerapliq case series (canine corneal ulcers, Vet Sci 2019) — PMID 31847217.
See also: Gabison E. “Corneal wound-healing agents”. In: SFO 2023 Report — Médicaments et biothérapies en ophtalmologie, chapter 21. Full text, open access (in French).