1
|
Berger T, Schlötzer-Schrehardt U, Flockerzi F, Daas L, Flockerzi E, Seitz B. Severe ulcerative keratopathy following implantation of an acellular porcine corneal stromal lenticule in a patient with keratoconus. Cont Lens Anterior Eye 2024; 47:102145. [PMID: 38472013 DOI: 10.1016/j.clae.2024.102145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 03/04/2024] [Accepted: 03/09/2024] [Indexed: 03/14/2024]
Abstract
PURPOSE To report a case of ulcerative keratopathy following implantation of acellular porcine corneal stroma (APCS) in a patient with keratoconus (KC). METHODS A 58 year-old patient initially presented with an ulcerative keratopathy in the left eye. Previously, several corneal procedures (including radial keratotomy, laser-in-situ keratomileusis, crosslinking) were performed for KC. Eight months ago, an APCS lenticule (Xenia corneal implant, Gebauer Medizintechnik GmbH, Neuhausen, Germany) was implanted into a stromal pocket because of progressive keratectasia. Visual acuity was hand movement. Anterior segment optical coherence tomography showed a space between the APCS lenticule and the host stroma. Excimer laser-assisted penetrating keratoplasty (PKP, 8.0/8.1 mm) was performed in the left eye. The corneal explant was investigated by light and transmission electron microscopy. RESULTS Best-corrected visual acuity was 20/40 six weeks after PKP. Light microscopy demonstrated a stromal ulceration down to the APCS lenticule. No stromal cells could be found within the APCS lenticule eight months after implantation. The APCS lenticule did not show a green stain of the collagens with Masson-Goldner staining and exhibited a strong Periodic acid-Schiff positive reaction. Electron microscopy of the APCS lenticule revealed cross-linked collagen lamellae without cellular components. Close to the interface, corneal collagen lamellae of the host cornea were disorganized. Few vital keratocytes were present on the surface of the lenticule and appeared to cause mechanical disruption of the host stroma along the lenticule-stroma interface. CONCLUSION APCS implantation may lead to severe complications such as ulcerative keratopathy in otherwise uncomplicated KC corneas. In such cases, excimer laser-assisted PKP or Deep Anterior Lamellar Keratoplasty are the methods of choice to restore visual acuity.
Collapse
Affiliation(s)
- Tim Berger
- Department of Ophthalmology, Saarland University Medical Center, Homburg, Saar, Germany.
| | | | - Fidelis Flockerzi
- Institute of Pathology, Saarland University Medical Center, Homburg, Saar, Germany
| | - Loay Daas
- Department of Ophthalmology, Saarland University Medical Center, Homburg, Saar, Germany
| | - Elias Flockerzi
- Department of Ophthalmology, Saarland University Medical Center, Homburg, Saar, Germany
| | - Berthold Seitz
- Department of Ophthalmology, Saarland University Medical Center, Homburg, Saar, Germany
| |
Collapse
|
2
|
Li S, Zhang P, Li A, Bao J, Pan Z, Jie Y. Rho-kinase inhibitor alleviates CD4 +T cell mediated corneal graft rejection by modulating its STAT3 and STAT5 activation. Exp Eye Res 2024; 242:109857. [PMID: 38479724 DOI: 10.1016/j.exer.2024.109857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 12/14/2023] [Accepted: 01/03/2024] [Indexed: 03/27/2024]
Abstract
Penetrating keratoplasty remains the most common treatment to restore vision for corneal diseases. Immune rejection after corneal transplantation is one of the major causes of graft failure. In recent years, Rho-associated protein kinase (ROCK) inhibitors have been found to be associated with the activation of the STATs pathway and are widely studied in autoimmune diseases. Therefore, it may be possible that the ROCK inhibitors also participate in the local and systemic immune regulation in corneal transplantation through activation of the STATs pathway and affect the CD4+ T cell differentiation. This study aimed to explore the role of ROCK-STATs pathway in the occurrence of immune rejection in corneal transplantation by applying Y27632, a ROCK inhibitor, to the recipient mice and peripheral CD4+ T cells. We found that Y27632 significantly up-regulated the phosphorylation level of STAT5 in both spleen and lymph nodes, down-regulated the phosphorylation level of STAT3 in the CD4+ T cells in the spleen. It also increased the proportion of CD4+CD25+Foxp3+Helios+ Tregs while decreased CD4+IL17A+ -Th17 cells. Moreover, Y27632 also reduced the proportion of dendritic cells in both spleen and lymph nodes, as well as the expression level of CD86 on their surfaces in the spleen, while the proportion of macrophages was not affected. The expression levels of ROCK1, ROCK2, CD11c and IL-17A mRNA were also found to be low in the graft tissue while the expression of Helios was upregulated. Rho-kinase inhibitor can modulate the balance of Tregs/Th17 by regulating the phosphorylation levels of both STAT3 and STAT5, thereby inhibiting the occurrence of immune rejection in allogeneic corneal transplantation.
Collapse
Affiliation(s)
- Shang Li
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Sciences Key Lab, Beijing, China
| | - Peng Zhang
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Sciences Key Lab, Beijing, China
| | - Ao Li
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Sciences Key Lab, Beijing, China
| | - Jiayu Bao
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Sciences Key Lab, Beijing, China
| | - Zhiqiang Pan
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Sciences Key Lab, Beijing, China
| | - Ying Jie
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Sciences Key Lab, Beijing, China.
| |
Collapse
|
3
|
McCall MA. Pig Models in Retinal Research and Retinal Disease. Cold Spring Harb Perspect Med 2024; 14:a041296. [PMID: 37553210 PMCID: PMC10982707 DOI: 10.1101/cshperspect.a041296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/10/2023]
Abstract
The pig has been used as a large animal model in biomedical research for many years and its use continues to increase because induced mutations phenocopy several inherited human diseases. In addition, they are continuous breeders, can be propagated by artificial insemination, have large litter sizes (on the order of mice), and can be genetically manipulated using all of the techniques that are currently available in mice. The pioneering work of Petters and colleagues set the stage for the use of the pig as a model of inherited retinal disease. In the last 10 years, the pig has become a model of choice where specific disease-causing mutations that are not phenocopied in rodents need to be studied and therapeutic approaches explored. The pig is not only used for retinal eye disease but also for the study of the cornea and lens. This review attempts to show how broad the use of the pig has become and how it has contributed to the assessment of treatments for eye disease. In the last 10 years, there have been several reviews that included the use of the pig in biomedical research (see body of the review) that included information about retinal disease. None directly discuss the use of the pig as an animal model for retinal diseases, including inherited diseases, where a single genetic mutation has been identified or for multifactorial diseases such as glaucoma and diabetic retinopathy. Although the pig is used to explore diseases of the cornea and lens, this review focuses on how and why the pig, as a large animal model, is useful for research in neural retinal disease and its treatment.
Collapse
Affiliation(s)
- Maureen A McCall
- Departments of Ophthalmology & Visual Sciences and Anatomical Sciences & Neurobiology, University of Louisville, Louisville, Kentucky 40202, USA
| |
Collapse
|
4
|
Genç H, Tanrıverdi S, Şen MA. Determination of body image and self-efficacy levels in patients after cornea transplantation. ENFERMERIA CLINICA (ENGLISH EDITION) 2024; 34:49-55. [PMID: 38185369 DOI: 10.1016/j.enfcle.2023.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 10/18/2023] [Indexed: 01/09/2024]
Abstract
PURPOSE The study aimed to determine body image and levels after surgery in cornea transplant patients. MATERIALS AND METHODS The population of this cross-sectional study was composed of 383 patients presented to the Eye Bank unit of a University Hospital after corneal transplantation. Sample size of 193 patients was calculated with 0.5 power, a margin of error of 5%, representing 95% of the universe. The data were collected through face-to-face interviews with the patients by the researcher and the study was completed with 178 patients in September-November 2022. The data were collected using a Patient Information Form, the Body Image Scale, and the General Self-Efficacy Scale. Parametric tests, Pearson Correlation, Student's t-test, and One-Way Analysis of Variance tests were performed were used in the data analysis. RESULTS It was determined that the mean Body Image Scale score of the transplant patients participating in the study was 159.41 ± 36.99 and the mean Self-Efficacy Scale score was 30.37 ± 8.31. When the comparison of the mean scores was examined, the difference between the mean scores of gender, marital status, occupation, and body image scale was statistically significant (p < .05), while the difference between the self-efficacy mean scores was not statistically significant (p > .05). There was a positive, moderately strong significant relationship between body image and the self-efficacy of the patients (p < .01) (r = .57). CONCLUSION It was found that the patient's body image and self-efficacy levels were high, and self-efficacy increased as the body image increased.
Collapse
Affiliation(s)
- Hasan Genç
- Dicle University Atatürk Faculty of Health, Diyarbakır, Turkey
| | | | - Mehmet Ali Şen
- Atatürk Vocatıonal School of Health Services, Diyarbakır, Turkey
| |
Collapse
|
5
|
Shibru MG, Ali ZM, Alali S, Alkhoori H, Corridon PR. Keeping an eye on sustainable regeneration. Regen Med 2023; 18:891-895. [PMID: 37554104 DOI: 10.2217/rme-2023-0142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 07/21/2023] [Indexed: 08/10/2023] Open
Affiliation(s)
- Meklit G Shibru
- Department of Immunology & Physiology, College of Medicine & Health Sciences, Khalifa University of Science & Technology, Abu Dhabi, United Arab Emirates
| | - Zehara M Ali
- Department of Immunology & Physiology, College of Medicine & Health Sciences, Khalifa University of Science & Technology, Abu Dhabi, United Arab Emirates
| | - Sumayya Alali
- Department of Immunology & Physiology, College of Medicine & Health Sciences, Khalifa University of Science & Technology, Abu Dhabi, United Arab Emirates
| | - Hessa Alkhoori
- Department of Immunology & Physiology, College of Medicine & Health Sciences, Khalifa University of Science & Technology, Abu Dhabi, United Arab Emirates
| | - Peter R Corridon
- Department of Immunology & Physiology, College of Medicine & Health Sciences, Khalifa University of Science & Technology, Abu Dhabi, United Arab Emirates
- Center for Biotechnology, Khalifa University of Science & Technology, Abu Dhabi, United Arab Emirates
- Biomedical Engineering & Healthcare Engineering Innovation Center, Khalifa University, Abu Dhabi, United Arab Emirates
| |
Collapse
|
6
|
Hao Y, Zhou J, Tan J, Xiang F, Qin Z, Yao J, Li G, Yang M, Zeng L, Zeng W, Zhu C. Preclinical evaluation of the safety and effectiveness of a new bioartificial cornea. Bioact Mater 2023; 29:265-278. [PMID: 37600931 PMCID: PMC10432718 DOI: 10.1016/j.bioactmat.2023.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 07/03/2023] [Accepted: 07/05/2023] [Indexed: 08/22/2023] Open
Abstract
Cross-linking agents are frequently used to restore corneal properties after decellularization, and it is especially important to select an appropriate method to avoid excessive cross-linking. In addition, how to promote wound healing and how to improve scar formation require further investigation. To ensure the safety and efficacy of animal-derived products, we designed bioartificial corneas (BACs) according to the criteria for Class III medical devices. Our BACs do not require cross-linking agents and increase mechanical strength via self-cross-linking of aldehyde-modified hyaluronic acid (AHA) and carboxymethyl chitosan (CMC) on the surface of decellularized porcine corneas (DPCs). The results showed that the BACs had good biocompatibility and transparency, and the modification enhanced their antibacterial and anti-inflammatory properties in vitro. Preclinical animal studies showed that the BACs can rapidly regenerate the epithelium and restore vision within a month. After 3 months, the BACs were gradually filled with epithelial, stromal, and neuronal cells, and after 6 months, their transparency and histology were almost normal. In addition, side effects such as corneal neovascularization, conjunctival hyperemia, and ciliary body hyperemia rarely occur in vivo. Therefore, these BACs show promise for clinical application for the treatment of infectious corneal ulcers and as a temporary covering for corneal perforations to achieve the more time.
Collapse
Affiliation(s)
- Yansha Hao
- Department of Anatomy, Engineering Research Center for Organ Intelligent Biological Manufacturing of Chongqing, key Lab for Biomechanics and Tissue Engineering of Chongqing, Third Military Medical University, Chongqing, 400038, China
- Engineering Research Center of Tissue and Organ Regeneration and Manufacturing, Ministry of Education, Chongqing, 400038, China
- State Key Laboratory of Trauma, Burnand Combined Injury, Chongqing, China
| | - Jingting Zhou
- Department of Anatomy, Engineering Research Center for Organ Intelligent Biological Manufacturing of Chongqing, key Lab for Biomechanics and Tissue Engineering of Chongqing, Third Military Medical University, Chongqing, 400038, China
- Engineering Research Center of Tissue and Organ Regeneration and Manufacturing, Ministry of Education, Chongqing, 400038, China
- State Key Laboratory of Trauma, Burnand Combined Injury, Chongqing, China
| | - Ju Tan
- Department of Anatomy, Engineering Research Center for Organ Intelligent Biological Manufacturing of Chongqing, key Lab for Biomechanics and Tissue Engineering of Chongqing, Third Military Medical University, Chongqing, 400038, China
- Engineering Research Center of Tissue and Organ Regeneration and Manufacturing, Ministry of Education, Chongqing, 400038, China
- State Key Laboratory of Trauma, Burnand Combined Injury, Chongqing, China
| | - Feng Xiang
- Department of Anatomy, Engineering Research Center for Organ Intelligent Biological Manufacturing of Chongqing, key Lab for Biomechanics and Tissue Engineering of Chongqing, Third Military Medical University, Chongqing, 400038, China
- Engineering Research Center of Tissue and Organ Regeneration and Manufacturing, Ministry of Education, Chongqing, 400038, China
- State Key Laboratory of Trauma, Burnand Combined Injury, Chongqing, China
| | - Zhongliang Qin
- Department of Anatomy, Engineering Research Center for Organ Intelligent Biological Manufacturing of Chongqing, key Lab for Biomechanics and Tissue Engineering of Chongqing, Third Military Medical University, Chongqing, 400038, China
- Engineering Research Center of Tissue and Organ Regeneration and Manufacturing, Ministry of Education, Chongqing, 400038, China
- State Key Laboratory of Trauma, Burnand Combined Injury, Chongqing, China
- Zhong Zhi Yi Gu Research Institute, Chongqing Jiukang Medical Research Institute Co., Ltd.,. China
| | - Jun Yao
- Hong Chang Biotechnology Co., Ltd, Guangzhou, 510700, China
| | - Gang Li
- Department of Anatomy, Engineering Research Center for Organ Intelligent Biological Manufacturing of Chongqing, key Lab for Biomechanics and Tissue Engineering of Chongqing, Third Military Medical University, Chongqing, 400038, China
- Engineering Research Center of Tissue and Organ Regeneration and Manufacturing, Ministry of Education, Chongqing, 400038, China
- State Key Laboratory of Trauma, Burnand Combined Injury, Chongqing, China
| | - Mingcan Yang
- Department of Anatomy, Engineering Research Center for Organ Intelligent Biological Manufacturing of Chongqing, key Lab for Biomechanics and Tissue Engineering of Chongqing, Third Military Medical University, Chongqing, 400038, China
- Engineering Research Center of Tissue and Organ Regeneration and Manufacturing, Ministry of Education, Chongqing, 400038, China
- State Key Laboratory of Trauma, Burnand Combined Injury, Chongqing, China
| | - Lingqin Zeng
- Department of Anatomy, Engineering Research Center for Organ Intelligent Biological Manufacturing of Chongqing, key Lab for Biomechanics and Tissue Engineering of Chongqing, Third Military Medical University, Chongqing, 400038, China
- Engineering Research Center of Tissue and Organ Regeneration and Manufacturing, Ministry of Education, Chongqing, 400038, China
- State Key Laboratory of Trauma, Burnand Combined Injury, Chongqing, China
| | - Wen Zeng
- Department of Cell Biology, Third Military Army Medical University, Chongqing, 400038, China
| | - Chuhong Zhu
- Department of Anatomy, Engineering Research Center for Organ Intelligent Biological Manufacturing of Chongqing, key Lab for Biomechanics and Tissue Engineering of Chongqing, Third Military Medical University, Chongqing, 400038, China
- Engineering Research Center of Tissue and Organ Regeneration and Manufacturing, Ministry of Education, Chongqing, 400038, China
- State Key Laboratory of Trauma, Burnand Combined Injury, Chongqing, China
| |
Collapse
|
7
|
TIGIT-Fc Prolongs Corneal Allograft Survival in Mice by Upregulating TIGIT/CD226 Expression and the Proportion of Helios + Foxp3 + Treg Cells. Transplantation 2023; 107:372-381. [PMID: 35876368 DOI: 10.1097/tp.0000000000004257] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND Reduction of graft rejection remains key issue for supporting long-term graft retention after corneal transplantation. The relevance of Treg in reduction of corneal allografts rejection has been demonstrated. It has been recently reported that in addition to Foxp3, Helios is also considered to be a marker of activated Treg. Helios + Foxp3 + Treg are considered to be the true immunosuppressive Treg. TIGIT is an immunosuppressive costimulatory molecule that was found to be highly expressed on the surface of Helios + Foxp3 + Treg. METHODS In this study, we aimed to explore whether supplementing TIGIT would result in an expansion and activation of Helios + Foxp3 + Treg thus to mediate an immune tolerance following corneal transplantation by administering topically and systemically TIGIT-Fc treatment in murine models. RESULTS TIGIT-Fc treatment significantly improved the survival of corneal allograft compared with the control group. TIGIT-Fc treatment increased TIGIT/CD226 expression, the proportion of Helios + Foxp3 + Treg cells and an enhanced ex vivo suppressive effect from peripheral lymph nodes isolated Treg cells. Furthermore, the expression of Helios in corneal grafts was upregulated, whereas expression of CD226 and production of aqueous interferon-γ and VEGF were reduced by TIGIT-Fc treatment. CONCLUSIONS TIGIT-Fc treatment could specifically upregulate Helios + Foxp3 + Treg-mediated immune response after allogeneic corneal transplantation via TIGIT/CD226-CD155 pathway which improves the survival of allografts.
Collapse
|
8
|
Analysis of SARS-CoV-2 in Corneal Tissue of Deceased Asymptomatic Novel Coronavirus Disease 2019 Donors. Cornea 2022; 41:1559-1563. [DOI: 10.1097/ico.0000000000003127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 07/01/2022] [Indexed: 11/26/2022]
|
9
|
Furtado M, Chen L, Chen Z, Chen A, Cui W. Development of fish collagen in tissue regeneration and drug delivery. ENGINEERED REGENERATION 2022. [DOI: 10.1016/j.engreg.2022.05.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
|
10
|
Sahoo S, Jamil Z, Sahu SK, Ali MH, Priyadarshini SR, Das S. Comparison of Corneal Tissue Profile of Pseudophakic and Phakic Donors. Eye Contact Lens 2022; 48:180-184. [PMID: 34775454 DOI: 10.1097/icl.0000000000000863] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/26/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE To compare the endothelial quality of corneas obtained from pseudophakic donors with age-matched phakic controls. METHODS Retrospective analysis of 100 corneas each from pseudophakic and phakic eyes with donor age ≥60 years in both the groups was performed. The endothelial cell density, coefficient of variation, and percentage of hexagonal cells obtained by specular microscopy were compared between the two groups. The cut-off level of endothelial cell density (ECD) taken for optical keratoplasty was 2,000 cells/mm2. RESULTS The male and female donors constituted 60% (n=120) and 40% (n=80), respectively. The mean age of the donors was 66.9±7.3 years in the phakic group and 69.9±7.7 years in pseudophakic group. The mean ECD in the phakic group was 2757.6±328.5 cells/mm2 and that in the pseudophakic group was 2225.5±471.9 cells/mm2 (P<0.0001). The mean coefficient of variation in the phakic group was 37.1±5.0 and that in the pseudophakic group was 38.6±11.1 (P=0.234). The mean percentage of hexagonality in the phakic group and the pseudophakic group was 52.0±6.4% and 51.2±7.2%, respectively (P=0.414). Both in univariate and multivariate linear regression analysis, age of the donor was found to be negatively associated in predicting ECD (P=0.002 and P=0.003, respectively). Sixty-nine and thirty-three corneas from the phakic and pseudophakic donor pool were used respectively. CONCLUSION Difference in ECD between the phakic and the pseudophakic donor group was found to be statistically significant. The ECD in the pseudophakic group was found to be above the cut-off limit required for keratoplasty. Hence, pseudophakic corneas may also be used for transplantation.
Collapse
Affiliation(s)
- Sonali Sahoo
- Cornea & Anterior Segment Service (S.S., Z.J., S.K.S., S.R.P., S.D.), L V Prasad Eye Institute, Bhubaneswar, Odisha, India; and Biostatistics Department (M.H.A.), L V Prasad Eye Institute, Hyderabad, Telangana, India
| | | | | | | | | | | |
Collapse
|
11
|
Miura S, Habibabady ZA, Pollok F, Connolly M, Pratts S, Dandro A, Sorrells L, Karavi K, Phelps C, Eyestone W, Ayares D, Burdorf L, Azimzadeh A, Pierson RN. Effects of human TFPI and CD47 expression and selectin and integrin inhibition during GalTKO.hCD46 pig lung perfusion with human blood. Xenotransplantation 2022; 29:e12725. [PMID: 35234315 PMCID: PMC10207735 DOI: 10.1111/xen.12725] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Revised: 10/30/2021] [Accepted: 12/17/2021] [Indexed: 01/07/2023]
Abstract
BACKGROUND Loss of barrier function when GalTKO.hCD46 porcine lungs are perfused with human blood is associated with coagulation pathway dysregulation, innate immune system activation, and rapid sequestration of human formed blood elements. Here, we evaluate whether genetic expression of human tissue factor pathway inhibitor (hTFPI) and human CD47 (hCD47), alone or with combined selectin and integrin adhesion pathway inhibitors, delays GalTKO.hCD46 porcine lung injury or modulates neutrophil and platelet sequestration. METHODS In a well-established paired ex vivo lung perfusion model, GalTKO.hCD46.hTFPI.hCD47 transgenic porcine lungs (hTFPI.hCD47, n = 7) were compared to GalTKO.hCD46 lungs (reference, n = 5). All lung donor pigs were treated with a thromboxane synthase inhibitor, anti-histamine, and anti-GPIb integrin-blocking Fab, and were pre-treated with Desmopressin. In both genotypes, one lung of each pair was additionally treated with PSGL-1 and GMI-1271 (P- and E-selectin) and IB4 (CD11b/18 integrin) adhesion inhibitors (n = 6 hTFPI.hCD47, n = 3 reference). RESULTS All except for two reference lungs did not fail within 480 min when experiments were electively terminated. Selectin and integrin adhesion inhibitors moderately attenuated initial pulmonary vascular resistance (PVR) elevation in hTFPI.hCD47 lungs. Neutrophil sequestration was significantly delayed during the early time points following reperfusion and terminal platelet activation was attenuated in association with lungs expressing hTFPI.hCD47, but additional adhesion pathway inhibitors did not show further effects with either lung genotype. CONCLUSION Expression of hTFPI.hCD47 on porcine lung may be useful as part of an integrated strategy to prevent neutrophil adhesion and platelet activation that are associated with xenograft injury. Additionally, targeting canonical selectin and integrin adhesion pathways reduced PVR elevation associated with hTFPI.hCD47 expression, but did not significantly attenuate neutrophil or platelet sequestration. We conclude that other adhesive mechanisms mediate the residual sequestration of human formed blood elements to pig endothelium that occurs even in the context of the multiple genetic modifications and drug treatments tested here.
Collapse
Affiliation(s)
- Shuhei Miura
- Center for Transplantation Sciences, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Cardiovascular Surgery, Teine Keijinkai Hospital, Sapporo, Japan
| | - Zahra A. Habibabady
- Center for Transplantation Sciences, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Franziska Pollok
- Center for Transplantation Sciences, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Anesthesiology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Margaret Connolly
- Center for Transplantation Sciences, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Shannon Pratts
- Center for Transplantation Sciences, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | | | | | | | | | | | - Lars Burdorf
- Center for Transplantation Sciences, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Agnes Azimzadeh
- Center for Transplantation Sciences, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Richard N. Pierson
- Center for Transplantation Sciences, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| |
Collapse
|
12
|
Gesesse E, Fekadu SA, Belete GT. Willingness of corneal donation and its associated factors among adult patients attending Gondar University Comprehensive and Specialized Hospital. PLoS One 2021; 16:e0256102. [PMID: 34415942 PMCID: PMC8378713 DOI: 10.1371/journal.pone.0256102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 07/31/2021] [Indexed: 11/18/2022] Open
Abstract
Introduction Corneal transplantation is the only treatment option for corneal blindness to restore sight. However, there is a disproportionate imbalance between the demand and supply of corneal tissue in Ethiopia. This is because accessing corneal tissue is reliant on people who are willing to donate corneas after death. Objective This study aimed to assess the proportion of willingness to donate cornea and associated factors among adult patients attending at University of Gondar comprehensive and specialized hospital. Method Institutional based cross-sectional study was conducted from July 13 to July 28, 2020, through a face-to-face interview. A total of 451 samples were selected using systematic random sampling. The data were entered into Epidemiological information version 7 and exported to statistical package for social science version 20 for formal analysis. Variables with a P-value of < 0.20 in a bi-variable logistic regression were entered into the multivariable logistic regression and those variables with a p-value of < 0.05 were taken as statistically significant. The strength of association was shown using the odds ratio with a 95% confidence interval. Result A total of 408 adults participated in this study with a response rate of 90% and the proportion of willingness to donate cornea was 179(43.90%). Participants who had a religious belief in Christianity (AOR = 3.23 (95% CI: 1.09–9.57)) and good knowledge about corneal donation (AOR = 5.45(95%CI: 2.69–11.18)) were positively associated with the willingness of corneal donation. On the other side, the age group above 43 years (AOR = 0.31(95% CI: 0.11–0.89) was negatively associated with the willingness of corneal donation. Conclusion The proportion of willingness to donate cornea 43.9% among participants attending Gondar University Comprehensive and Specialized Hospital. Age group greater than 43 years, religion of Christianity and good knowledge were associated with the willingness of corneal donation.
Collapse
Affiliation(s)
- Eyerus Gesesse
- Department of Optometry, School of Medicine, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | - Sofonias Addis Fekadu
- Department of Optometry, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
- * E-mail:
| | - Gizachew Tilahun Belete
- Department of Optometry, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| |
Collapse
|
13
|
Evolution and revolution in corneal transplant surgery. J Cataract Refract Surg 2021; 47:837-838. [PMID: 34173381 DOI: 10.1097/j.jcrs.0000000000000707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
14
|
Islam R, Islam MM, Nilsson PH, Mohlin C, Hagen KT, Paschalis EI, Woods RL, Bhowmick SC, Dohlman CH, Espevik T, Chodosh J, Gonzalez-Andrades M, Mollnes TE. Combined blockade of complement C5 and TLR co-receptor CD14 synergistically inhibits pig-to-human corneal xenograft induced innate inflammatory responses. Acta Biomater 2021; 127:169-179. [PMID: 33785451 DOI: 10.1016/j.actbio.2021.03.047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 02/18/2021] [Accepted: 03/19/2021] [Indexed: 12/20/2022]
Abstract
Inadequate supplies of donor corneas have evoked an escalating interest in corneal xenotransplantation. However, innate immune responses contribute significantly to the mechanism of xenograft rejection. We hypothesized that complement component C5 and TLR co-receptor CD14 inhibition would inhibit porcine cornea induced innate immune responses. Therefore, we measured cytokine release in human blood, induced by three forms of corneal xenografts with or without inhibitors. Native porcine cornea (NPC) induced interleukins (IL-1β, IL-2, IL-6, IL-8, IL-1ra), chemokines (MCP-1, MIP-1α, MIP-1β) and other cytokines (TNF, G-CSF, INF-γ, FGF-basic). Decellularized (DPC) and gamma-irradiated cornea (g-DPC) elevated the release of those cytokines. C5-blockade by eculizumab inhibited all the cytokines except G-CSF when induced by NPC. However, C5-blockade failed to reduce DPC and g-DPC induced cytokines. Blockade of CD14 inhibited DPC-induced cytokines except for IL-8, MCP-1, MIP-1α, and G-CSF, while it inhibited all of them when induced by g-DPC. Combined blockade of C5 and CD14 inhibited the maximum number of cytokines regardless of the xenograft type. Finally, by using the TLR4 specific inhibitor Eritoran, we showed that TLR4 activation was the basis for the CD14 effect. Thus, blockade of C5, when combined with TLR4 inhibition, may have therapeutic potential in pig-to-human corneal xenotransplantation. STATEMENT OF SIGNIFICANCE: Bio-engineered corneal xenografts are on the verge of becoming a viable alternative to allogenic human-donor-cornea, but the host's innate immune response is still a critical barrier for graft acceptance. By overruling this barrier, limited graft availability would no longer be an issue for treating corneal diseases. We showed that the xenograft induced inflammation is initiated by the complement system and toll-like receptor activation. Intriguingly, the inflammatory response was efficiently blocked by simultaneously targeting bottleneck molecules in the complement system (C5) and the TLR co-receptor CD14 with pharmaceutical inhibitors. We postulate that a combination of C5 and CD14 inhibition could have a great therapeutic potential to overcome the immunologic barrier in pig-to-human corneal xenotransplantation.
Collapse
|
15
|
Al-Yousuf N, Al Alawi E, Mahmood A, Alzayani A, Al Sawad H, Alsetri H, Al-Mousawi J, Ali K, Al Khayat M, Naser R. Changing Indications for Penetrating Keratoplasty in Bahrain in a Tertiary Referral Centre. Clin Ophthalmol 2021; 15:1503-1510. [PMID: 33880009 PMCID: PMC8053497 DOI: 10.2147/opth.s304812] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 03/17/2021] [Indexed: 11/16/2022] Open
Abstract
PURPOSE To study the changing indications for Penetrating keratoplasty in Bahrain and to compare them with published data. PATIENTS AND METHODS A Retrospective review of available records of patients who underwent penetrating keratoplasty at a tertiary center in Bahrain (1996-2015). The trend of each indication was analyzed. The study was subdivided into three periods for correlation purposes. Pearson Coefficient r and the p values were used for interpretation of data. The results were compared with similar studies. RESULTS A total of 298 patients underwent keratoplasty in the study period, which is from 1996 until 2015 (missing data 2009-2011). Keratoconus was found to be the leading indication, accounting for 33% of the total cases, followed by trachoma 27%, followed by aphakic and pseudophakic bullous keratopathies 13%. Trachoma showed a statistically significant decreasing trend (p < 0.001), Keratoconus had an increasing trend (p<0.001). Bullous keratopathy showed an increasing trend (p = 0.001) with an abrupt rise after 2012. CONCLUSION Corneal scarring due to old trachoma was the leading indication for keratoplasty 20 years ago in Bahrain. However, due to improvement of health awareness, hygiene, and the socioeconomic status, this has regressed with keratoconus becoming the leading indication from 2002 onwards. A surge of bullous keratopathy was noted after 2012, placing it as the second commonest indication. This may be due to the introduction of phacoemulsification technique for cataract surgery, and perhaps because the nature of the institute being a teaching hospital. Keratoconus is the leading indication and showed an increasing trend. It is recommended to perform a keratoconus screening program for early detection and prevention.
Collapse
Affiliation(s)
- Nada Al-Yousuf
- Department of Ophthalmology, King Abdulla Medical City, Manama, Bahrain
| | | | - Abdulhameed Mahmood
- Department of Ophthalmology, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Amani Alzayani
- Department of Ophthalmology, Salmaniya Medical Complex, Manama, Bahrain
| | - Hajer Al Sawad
- Department of Ophthalmology, Salmaniya Medical Complex, Manama, Bahrain
| | - Hasan Alsetri
- Department of Chemistry and Biochemistry, University of California, Los Angeles, CA, USA
| | | | - Khatoon Ali
- Department of Ophthalmology, Salmaniya Medical Complex, Manama, Bahrain
| | - Maryam Al Khayat
- Department of Ophthalmology, Salmaniya Medical Complex, Manama, Bahrain
| | - Reem Naser
- Department of Ophthalmology, Salmaniya Medical Complex, Manama, Bahrain
| |
Collapse
|
16
|
Isidan A, Liu S, Chen AM, Zhang W, Li P, Smith LJ, Hara H, Cooper DKC, Ekser B. Comparison of porcine corneal decellularization methods and importance of preserving corneal limbus through decellularization. PLoS One 2021; 16:e0243682. [PMID: 33667231 PMCID: PMC7935270 DOI: 10.1371/journal.pone.0243682] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 02/02/2021] [Indexed: 02/06/2023] Open
Abstract
Background The aim of this study is to compare the three previously applied, conventional porcine corneal decellularization methods and to demonstrate the importance of preserving the corneal limbus through decellularization. Methods Fresh, wild-type (with or without) limbus porcine corneas were decellularized using three different methods, including (i) sodium dodecyl sulfate (SDS), (ii) hypertonic saline (HS), and (iii) N2 gas (NG). Post-treatment evaluation was carried out using histological, residual nuclear material, and ultrastructural analyses. Glycerol was used to help reduce the adverse effects of decellularization. The corneas were preserved for two weeks in cornea storage medium. Results All three decellularization methods reduced the number of keratocytes at different rates in the stromal tissue. However, all methods, except SDS, resulted in the retention of large numbers of cells and cell fragments. The SDS method (0.1% SDS, 48h) resulted in almost 100% decellularization in corneas without limbus. Low decellularization capacity of the NG method (<50%) could make it unfavorable. Although HS method had a more balanced damage-decellularization ratio, its decellularization capacity was lower than SDS method. Preservation of the corneoscleral limbus could partially prevent structural damage and edema, but it would reduce the decellularization capacity. Conclusion Our results suggest that SDS is a very powerful decellularization method, but it damages the cornea irreversibly. Preserving the corneoscleral limbus reduces the efficiency of decellularization, but also reduces the damage.
Collapse
Affiliation(s)
- Abdulkadir Isidan
- Transplant Division, Department of Surgery, Indiana University School of Medicine, Indianapolis, Indianapolis, United States of America
| | - Shaohui Liu
- Department of Ophthalmology, Glick Eye Institute, Indiana University School of Medicine, Indianapolis, Indianapolis, United States of America
| | - Angela M. Chen
- Transplant Division, Department of Surgery, Indiana University School of Medicine, Indianapolis, Indianapolis, United States of America
| | - Wenjun Zhang
- Transplant Division, Department of Surgery, Indiana University School of Medicine, Indianapolis, Indianapolis, United States of America
| | - Ping Li
- Transplant Division, Department of Surgery, Indiana University School of Medicine, Indianapolis, Indianapolis, United States of America
| | - Lester J. Smith
- 3D Bioprinting Core, Indiana University School of Medicine, Indianapolis, Indianapolis, United States of America
- Department of Radiology and Imaging Sciences, Indiana University of School of Medicine, Indianapolis, Indianapolis, United States of America
| | - Hidetaka Hara
- Xenotransplantation Program, Department of Surgery, University of Birmingham at Alabama, Birmingham, Alabama, United States of America
| | - David K. C. Cooper
- Xenotransplantation Program, Department of Surgery, University of Birmingham at Alabama, Birmingham, Alabama, United States of America
| | - Burcin Ekser
- Transplant Division, Department of Surgery, Indiana University School of Medicine, Indianapolis, Indianapolis, United States of America
- * E-mail:
| |
Collapse
|
17
|
Chen X, Li T, Qi X, Shi W, Gao H. Clinical Characteristics and Outcomes of Short-term Repeat Corneal Transplantation. Ocul Immunol Inflamm 2021; 30:855-863. [PMID: 33555976 DOI: 10.1080/09273948.2020.1838557] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE To explore the primary indications, direct causes and graft survival of short-term repeat keratoplasty. METHODS An analytical cross-sectional study. RESULTS The primary indications for keratoplasty were infectious keratitis (67.9%) and immune keratopathy (12.8%). The direct causes of graft failure were infectious ulcer (43.6%) and recurrence (30.8%). Pre-operative hypopyon (P = 0.017, HR = 1.757) and use of decellularized porcine corneas as grafts (P = 0.005, HR = 2.690) were independent risk factors for graft failure. The Kaplan-Meier analysis revealed that the 1-year survival rate of 88 repeat grafts was 85.2%, and the 5-year survival rate was 79.2%. The survival rates of the repeat grafts were significantly higher than those of the first grafts (P < 0.001). CONCLUSION Infectious keratitis is the most common indication of short-term graft failure and is often failed by infectious ulcer and keratitis recurrence. While the decellularized porcine cornea is a promising application in developing countries, certain difficulties, such as graft melting, remain unresolved.
Collapse
Affiliation(s)
- Xiunian Chen
- Medical College of Qingdao University, Qingdao, China.,Shandong Eye Institute, Shandong First Medical University & Shandong Academy of Medical Sciences, Qingdao, China
| | - Ting Li
- Shandong Eye Institute, Shandong First Medical University & Shandong Academy of Medical Sciences, Qingdao, China
| | - Xiaolin Qi
- Shandong Eye Institute, Shandong First Medical University & Shandong Academy of Medical Sciences, Qingdao, China
| | - Weiyun Shi
- Shandong Eye Institute, Shandong First Medical University & Shandong Academy of Medical Sciences, Qingdao, China
| | - Hua Gao
- Shandong Eye Institute, Shandong First Medical University & Shandong Academy of Medical Sciences, Qingdao, China
| |
Collapse
|
18
|
Song YW, Chen JY, Li X, Wang L, Pan ZQ. Therapeutic potential of Rho-associated kinase inhibitor Y27632 in corneal endothelial dysfunction: an in vitro and in vivo study. Int J Ophthalmol 2021; 14:19-25. [PMID: 33469479 DOI: 10.18240/ijo.2021.01.03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 08/26/2020] [Indexed: 11/23/2022] Open
Abstract
AIM To investigate the effects of a selective inhibitor of Rho-associated kinase (ROCK), Y-27632, on inbred Wuzhishan porcine corneal endothelial cells (PCECs) in vitro and in vivo studies. METHODS Primary PCECs were trypsinized from Wuzhishan miniature porcine corneal tissues. The optimal concentration of Y-27632 on PCECs was determined through MTT and 5-ethynyl-2'-deoxyuridine (EdU)-labeling assays. Seven New Zealand rabbits were used as a corneal endothelial dysfunction model, and a PCECs suspension supplemented with Y-27632 was injected into the anterior chamber of the rabbits. The progression of rabbit corneal opacity and edema were observed by slit lamp examination. The rabbits were sacrificed, and rabbit globes were enucleated for trypan blue-alizarin red staining, hematoxylin-eosin staining, and immunofluorescence analysis. RESULTS Administration of 100 µmol/L Y-27632 facilitated PCECs' proliferation obviously. The rabbit corneas injected with PCECs suspension and 100 µmol/L Y-27632 were restored to transparency significantly after 14d. CONCLUSION The 100 µmol/L Y-27632 treatment improves PCECs' proliferation significantly. And our results suggest that Y-27632 and PCECs can be used to treat corneal endothelial dysfunction.
Collapse
Affiliation(s)
- Yao-Wen Song
- Shanxi Eye Hospital, Taiyuan 030002, Shanxi Province, China.,Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Science Key Laboratory, Beijing 100730, China
| | - Jun-Yu Chen
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Science Key Laboratory, Beijing 100730, China
| | - Xu Li
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Science Key Laboratory, Beijing 100730, China
| | - Li Wang
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Science Key Laboratory, Beijing 100730, China
| | - Zhi-Qiang Pan
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Science Key Laboratory, Beijing 100730, China
| |
Collapse
|
19
|
Yoon CH, Choi HJ, Kim MK. Corneal xenotransplantation: Where are we standing? Prog Retin Eye Res 2021; 80:100876. [PMID: 32755676 PMCID: PMC7396149 DOI: 10.1016/j.preteyeres.2020.100876] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 05/23/2020] [Accepted: 06/04/2020] [Indexed: 02/08/2023]
Abstract
The search for alternatives to allotransplants is driven by the shortage of corneal donors and is demanding because of the limitations of the alternatives. Indeed, current progress in genetically engineered (GE) pigs, the introduction of gene-editing technology by clustered regularly interspaced short palindromic repeats (CRISPR)-Cas9, and advanced immunosuppressants have made xenotransplantation a possible option for a human trial. Porcine corneal xenotransplantation is considered applicable because the eye is regarded as an immune-privileged site. Furthermore, recent non-human primate studies have shown long-term survival of porcine xenotransplants in keratoplasty. Herein, corneal immune privilege is briefly introduced, and xenogeneic reactions are compared with allogeneic reactions in corneal transplantation. This review describes the current knowledge on special issues of xenotransplantation, xenogeneic rejection mechanisms, current immunosuppressive regimens of corneal xenotransplantation, preclinical efficacy and safety data of corneal xenotransplantation, and updates of the regulatory framework to conduct a clinical trial on corneal xenotransplantation. We also discuss barriers that might prevent xenotransplantation from becoming common practice, such as ethical dilemmas, public concerns on xenotransplantation, and the possible risk of xenozoonosis. Given that the legal definition of decellularized porcine cornea (DPC) lies somewhere between a medical device and a xenotransplant, the preclinical efficacy and clinical trial data using DPC are included. The review finally provides perspectives on the current standpoint of corneal xenotransplantation in the fields of regenerative medicine.
Collapse
Affiliation(s)
- Chang Ho Yoon
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Republic of Korea; Laboratory of Ocular Regenerative Medicine and Immunology, Seoul Artificial Eye Center, Seoul National University Hospital Biomedical Research Institute, Seoul, Republic of Korea
| | - Hyuk Jin Choi
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Republic of Korea; Laboratory of Ocular Regenerative Medicine and Immunology, Seoul Artificial Eye Center, Seoul National University Hospital Biomedical Research Institute, Seoul, Republic of Korea; Department of Ophthalmology, Seoul National University Hospital Healthcare System Gangnam Center, Seoul, Republic of Korea
| | - Mee Kum Kim
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Republic of Korea; Laboratory of Ocular Regenerative Medicine and Immunology, Seoul Artificial Eye Center, Seoul National University Hospital Biomedical Research Institute, Seoul, Republic of Korea.
| |
Collapse
|
20
|
Zheng Q, Zhang Y, Ren Y, Zhao Z, Hua S, Li J, Wang H, Ye C, Kim AD, Wang L, Chen W. Deep anterior lamellar keratoplasty with cross-linked acellular porcine corneal stroma to manage fungal keratitis. Xenotransplantation 2020; 28:e12655. [PMID: 33103812 DOI: 10.1111/xen.12655] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 08/31/2020] [Accepted: 09/23/2020] [Indexed: 01/25/2023]
Abstract
PURPOSE To evaluate the effects of deep anterior lamellar keratoplasty (DALK) with cross-linked acellular porcine corneal stroma (APCS) and post-operative topical tacrolimus treatment in patients with fungal keratitis. METHODS This multicenter prospective study involved 25 cases of fungal keratitis that were treated by DALK with cross-linked APCSs and post-operative topical tacrolimus from December 2013 to November 2014 at the Wenzhou Eye Hospital and the Henan provincial Eye Hospital. Signs of post-operative inflammation, corneal reepithelialization, corneal neovascularization, and graft rejection were assessed, and best corrected visual acuity (BCVA), intraocular pressure (IOP), and APCS graft transparency were monitored for the 12-month follow-up period. RESULTS All 25 patients underwent DALK without Descemet's membrane perforation. Corneal epithelium recovered completely in 17 patients in the first week, and APCS grafts maintained transparency in 18 patients at 1-year follow-up. The mean BCVA significantly improved from 2.16 ± 0.32 (LogMAR) at baseline to 1.56 ± 0.70 at 1-week (P < .001), 0.95 ± 0.57 at 1-month (P < .001), and 0.70 ± 0.51 at 3-month follow-ups (P < .001). The BCVA kept stable at 6-month and 12-month follow-ups. Post-operative topical tacrolimus alleviated the ciliary injection, except in one case which acute stromal rejection occurred. One patient developed fungal reinfection and underwent penetrating keratoplasty. Graft rejection occurred in three patients. No case was noted with graft splitting, elevated IOP or tacrolimus intolerance. CONCLUSIONS DALK using cross-linked APCS combining topical tacrolimus treatment is safe and effective in managing fungal keratitis. It may ameliorate the shortage of corneal donation globally.
Collapse
Affiliation(s)
- Qinxiang Zheng
- School of Ophthalmology and Optometry, Wenzhou Medical University, Zhejiang, China
| | - Yueqin Zhang
- Henan Eye Institute, Henan Eye Hospital, Henan Provincial People's Hospital, Zhengzhou, China
| | - Yueping Ren
- School of Ophthalmology and Optometry, Wenzhou Medical University, Zhejiang, China
| | - Zelin Zhao
- School of Ophthalmology and Optometry, Wenzhou Medical University, Zhejiang, China
| | - Shanshan Hua
- School of Ophthalmology and Optometry, Wenzhou Medical University, Zhejiang, China
| | - Jinyang Li
- School of Ophthalmology and Optometry, Wenzhou Medical University, Zhejiang, China
| | - Haiou Wang
- School of Ophthalmology and Optometry, Wenzhou Medical University, Zhejiang, China
| | - Cong Ye
- School of Ophthalmology and Optometry, Wenzhou Medical University, Zhejiang, China
| | - Andy D Kim
- Department of Ophthalmology, New Zealand National Eye Centre, The University of Auckland, Auckland, New Zealand
| | - Liya Wang
- Henan Eye Institute, Henan Eye Hospital, Henan Provincial People's Hospital, Zhengzhou, China
| | - Wei Chen
- School of Ophthalmology and Optometry, Wenzhou Medical University, Zhejiang, China
| |
Collapse
|
21
|
Gao H, Huang T, Pan Z, Wu J, Xu J, Hong J, Chen W, Wu H, Kang Q, Zhu L, Fu L, Wang L, Li G, Deng Z, Zhang H, Xu H, Zhao Q, Liu H, Wang L, Chen B, Jin X, Huang M, Yang J, Gao M, Zhou W, Xie H, Fu Y, Wen F, Fu C, Zhao S, Yang Y, Fu Y, Yao T, Wang C, Sun X, Gao X, Reziwan M, Deng Y, Li J, Liu L, Zeng B, Bao L, Wang H, Zhang L, Li Z, Yin Z, Wen Y, Zheng X, Du L, Huang Z, Sheng X, Zhang H, Chen L, Yan X, Liu X, Liu W, Liu Y, Liang L, Wu P, Qu L, Cheng J, Zhang H, Qi Q, Tseten Y, Ji J, Yuan J, Jie Y, Xiang J, Huang Y, Yang Y, Li Y, Hou Y, Liu T, Xie L, Shi W. Survey report on keratoplasty in China: A 5-year review from 2014 to 2018. PLoS One 2020; 15:e0239939. [PMID: 33057425 PMCID: PMC7561196 DOI: 10.1371/journal.pone.0239939] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 09/15/2020] [Indexed: 02/05/2023] Open
Abstract
To provide the general information on corneal transplantation (CT) in China, China Cornea Society designed a questionnaire on CT from 2014 to 2018 and entrusted it to 31 committee members for implementation of the survey nationwide. This article presents the results of the survey and compares the indicators used in the survey and those in the annual statistical report released by the Eye Bank Association of America (EBAA). The number of corneal transplantations completed by the 64 hospitals from 2014 to 2018 was respectively 5377, 6394, 7595, 8270 and 8980, totally 36,616 (22,959 male and 13,657 female). The five largest hospitals by the number of corneal transplantations completed 15,994 surgeries in total, accounting for 43.68% of all the surgeries performed in the 64 hospitals. The most common indication for corneal transplantations was corneal leukoma (7683, 20.98%), followed by bacterial keratitis (4209, 11.49%), corneal dystrophies (4189, 11.44%), keratoconus (3578, 9.77%) and corneal perforation (2839, 7.75%). The main surgical techniques were penetrating keratoplasty (PK) (19,896, 54.34%), anterior lamellar keratoplasty (ALK) (13,869, 37.88%). The proportion of PK decreased from 57.97% in 2014 to 52.88% in 2018 while the proportion of ALK increased from 36.04% in 2014 to 37.92% in 2018. The geographical distribution of keratoplasties performed in China is unbalanced. PK and ALK were the main techniques of CT and corneal leukoma, bacterial keratitis and corneal dystrophies were the main indications for CT in China.
Collapse
Affiliation(s)
- Hua Gao
- Department of Ophthalmology, Eye Hospital of Shandong First Medical University, State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Shandong Eye Institute, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, China
- Corneal Disease Group of Ophthalmological Society of Chinese Medical Association (China Cornea Society), Jinan, China
| | - Ting Huang
- Corneal Disease Group of Ophthalmological Society of Chinese Medical Association (China Cornea Society), Jinan, China
- Department of Ophthalmology, State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Centre, Sun Yat-sen University, Guangzhou, China
| | - Zhiqiang Pan
- Corneal Disease Group of Ophthalmological Society of Chinese Medical Association (China Cornea Society), Jinan, China
- Department of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Jie Wu
- Corneal Disease Group of Ophthalmological Society of Chinese Medical Association (China Cornea Society), Jinan, China
- Department of Ophthalmology, No.1 Hospital of Xi’an City, Xian, China
| | - Jianjiang Xu
- Corneal Disease Group of Ophthalmological Society of Chinese Medical Association (China Cornea Society), Jinan, China
- Department of Ophthalmology, Eye and Ear, Nose, Throat Hospital, Fudan University, Shanghai, China
| | - Jing Hong
- Corneal Disease Group of Ophthalmological Society of Chinese Medical Association (China Cornea Society), Jinan, China
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China
| | - Wei Chen
- Corneal Disease Group of Ophthalmological Society of Chinese Medical Association (China Cornea Society), Jinan, China
- Department of Ophthalmology, Eye Hospital of Wenzhou Medical University, Wenzhou, China
| | - Huping Wu
- Department of Ophthalmology, Affiliated Xiamen Eye Center of Xiamen University, Xiamen, China
| | - Qian Kang
- Department of Ophthalmology, Chengdu AiDi Eye Hospital, Chengdu, China
| | - Lei Zhu
- Corneal Disease Group of Ophthalmological Society of Chinese Medical Association (China Cornea Society), Jinan, China
- Department of Ophthalmology, Henan Eye Institute, Henan Eye Hospital, Zhengzhou, China
| | - Lingling Fu
- Department of Ophthalmology, Hefei Puri Ophthalmological Hospital, Hefei, China
| | - Liqiang Wang
- Corneal Disease Group of Ophthalmological Society of Chinese Medical Association (China Cornea Society), Jinan, China
- Department of Ophthalmology, Chinese PLA General Hospital, Medical School of Chinese PLA, Beijing, China
| | - Guigang Li
- Corneal Disease Group of Ophthalmological Society of Chinese Medical Association (China Cornea Society), Jinan, China
- Department of Ophthalmology, TongJi Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhihong Deng
- Department of Ophthalmology, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Hong Zhang
- Corneal Disease Group of Ophthalmological Society of Chinese Medical Association (China Cornea Society), Jinan, China
- Department of Ophthalmology, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Hui Xu
- Department of Ophthalmology, The First Hospital of Jilin University, Changchun, China
| | - Qingliang Zhao
- Department of Ophthalmology, Suzhou Lixiang Eye Hospital, Suzhou, China
| | - Hongshan Liu
- Department of Ophthalmology, Hainan Eye Institute, Hainan Eye Hospital, Haikou, China
| | - Linnong Wang
- Corneal Disease Group of Ophthalmological Society of Chinese Medical Association (China Cornea Society), Jinan, China
- Department of Ophthalmology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Baihua Chen
- Corneal Disease Group of Ophthalmological Society of Chinese Medical Association (China Cornea Society), Jinan, China
- Department of Ophthalmology, Second Xiangya Hospital, Central South University, Changsha, China
| | - Xiuming Jin
- Corneal Disease Group of Ophthalmological Society of Chinese Medical Association (China Cornea Society), Jinan, China
- Department of Ophthalmology, Affiliated Second Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Minghai Huang
- Department of Ophthalmology, Nanning Aier Eye Hospital, Nanning, China
| | - Jizhong Yang
- Department of Ophthalmology, Shanxi Eye Hospital, Taiyuan, China
| | - Minghong Gao
- Corneal Disease Group of Ophthalmological Society of Chinese Medical Association (China Cornea Society), Jinan, China
- Department of Ophthalmology, General Hospital of Northern Theater Command Hospital, Shenyang, China
| | - Wentian Zhou
- Department of Ophthalmology, Affiliated Eye Hospital of Nanchang University, Nanchang, China
| | - Hanping Xie
- Corneal Disease Group of Ophthalmological Society of Chinese Medical Association (China Cornea Society), Jinan, China
- Department of Ophthalmology, The First Hospital Affiliated to Army Medical University, Chongqing, China
| | - Yao Fu
- Corneal Disease Group of Ophthalmological Society of Chinese Medical Association (China Cornea Society), Jinan, China
- Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Feng Wen
- Department of Ophthalmology, Ningbo Eye Hospital, Ningbo, China
| | - Changbo Fu
- Department of Ophthalmology, Xuzhou Municipal Hospital Affiliated to Xuzhou Medical University, Xuzhou, China
| | - Shaozhen Zhao
- Corneal Disease Group of Ophthalmological Society of Chinese Medical Association (China Cornea Society), Jinan, China
- Department of Ophthalmology, Tianjin Medical University Eye Hospital, Tianjin, China
| | - Yanning Yang
- Corneal Disease Group of Ophthalmological Society of Chinese Medical Association (China Cornea Society), Jinan, China
- Department of Ophthalmology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Yanjiang Fu
- Department of Ophthalmology, Daqing Ophthalmologic Hospital, Daqing, China
| | - Tao Yao
- Department of Ophthalmology, Shenyang He Eye Hospital, Shenyang, China
| | - Chaoqing Wang
- Department of Ophthalmology, Jinan Mingshui Eye Hospital, Jinan, China
| | - Xiaonan Sun
- Department of Ophthalmology, The 4th People's Hospital of Shenyang, Shenyang, China
| | - Xiaowei Gao
- Corneal Disease Group of Ophthalmological Society of Chinese Medical Association (China Cornea Society), Jinan, China
- Department of Ophthalmology, 474 Hospital of PLA, Urumchi, China
| | - Maimaitiming Reziwan
- Department of Ophthalmology, Urumqi City Ophthalmology and Otolaryngology Hospital, Urumchi, China
| | - Yingping Deng
- Corneal Disease Group of Ophthalmological Society of Chinese Medical Association (China Cornea Society), Jinan, China
- Department of Ophthalmology, West China Hospital of Sichuan University, Chengdu, China
| | - Jian Li
- Department of Ophthalmology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, China
| | - Limei Liu
- Department of Ophthalmology, Weifang Eye Hospital, Weifang, China
| | - Bo Zeng
- Department of Ophthalmology, General Hospital of the Central Theater of the Chinese People’s Liberation Army, Wuhan, China
| | - Lianyun Bao
- Department of Ophthalmology, Nanjing Ningyi Eye Center, Nanjing, China
| | - Hua Wang
- Corneal Disease Group of Ophthalmological Society of Chinese Medical Association (China Cornea Society), Jinan, China
- Department of Ophthalmology, Xiangya Hospital, Central South University, Changsha, China
| | - Lijun Zhang
- Corneal Disease Group of Ophthalmological Society of Chinese Medical Association (China Cornea Society), Jinan, China
- Department of Ophthalmology, The People’s Third Hospital of Dalian, Dalian Medical University, Dalian, China
| | - Zhiyuan Li
- Department of Ophthalmology, The People's No.1 Hospital of Chenzhou, Chenzhou, China
| | - Zhijian Yin
- Department of Ophthalmology, The First Affiliated Hospital of Dali University, Dali, China
| | - Yuechun Wen
- Department of Ophthalmology, The First Affiliated Hospital of University of Science and Technology of China, Anhui Provincial Hospital, Hefei, China
| | - Xiao Zheng
- Department of Ophthalmology, The Army Characteristic Medical Center, Chongqing, China
| | - Liqun Du
- Department of Ophthalmology, Qilu Hospital of Shandong University, Jinan, China
| | - Zhenping Huang
- Department of Ophthalmology, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Xunlun Sheng
- Department of Ophthalmology, Ningxia Eye Hospital, The People’s Hospital of Ningxia Hui Autonomous Region, Yinchuan, China
| | - Hui Zhang
- Corneal Disease Group of Ophthalmological Society of Chinese Medical Association (China Cornea Society), Jinan, China
- Department of Ophthalmology, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Lizhong Chen
- Department of Ophthalmology, Lunan Eye Hospital, Linyi, China
| | - Xiaoming Yan
- Corneal Disease Group of Ophthalmological Society of Chinese Medical Association (China Cornea Society), Jinan, China
- Department of Ophthalmology, Peking University First Hospital, Beijing, China
| | - Xiaowei Liu
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wenhui Liu
- Department of Ophthalmology, Wuxi Second People's Hospital, Wuxi, China
| | - Yuan Liu
- Department of Ophthalmology, Guizhou Jinglang Eye Hospital, Guiyang, China
| | - Liang Liang
- Department of Ophthalmology, Yichang Central People's Hospital, Yichang, China
| | - Pengcheng Wu
- Department of Ophthalmology, Lanzhou University Second Hospital, Lanzhou, China
| | - Lijun Qu
- Department of Ophthalmology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Jinkui Cheng
- Department of Ophthalmology, Jingzhou First People's Hospital, Jingzhou, China
| | - Hua Zhang
- Department of Ophthalmology, Shijiazhuang No.1 Hospital, Shijiazhuang, China
| | - Qige Qi
- Department of Ophthalmology, Hulunbuir People's Hospital, Hulunbuir, China
| | - Yangkyi Tseten
- Department of Ophthalmology, Tibetan Traditional Tibet Medical Hospital of Tibet Autonomous Region, Lhasa, China
| | - Jianping Ji
- Department of Ophthalmology, State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Centre, Sun Yat-sen University, Guangzhou, China
| | - Jin Yuan
- Corneal Disease Group of Ophthalmological Society of Chinese Medical Association (China Cornea Society), Jinan, China
- Department of Ophthalmology, State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Centre, Sun Yat-sen University, Guangzhou, China
| | - Ying Jie
- Department of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Jun Xiang
- Department of Ophthalmology, Eye and Ear, Nose, Throat Hospital, Fudan University, Shanghai, China
| | - Yifei Huang
- Corneal Disease Group of Ophthalmological Society of Chinese Medical Association (China Cornea Society), Jinan, China
- Department of Ophthalmology, Chinese PLA General Hospital, Medical School of Chinese PLA, Beijing, China
| | - Yuli Yang
- Corneal Disease Group of Ophthalmological Society of Chinese Medical Association (China Cornea Society), Jinan, China
- Department of Ophthalmology, The First Hospital Affiliated to Army Medical University, Chongqing, China
| | - Ying Li
- Corneal Disease Group of Ophthalmological Society of Chinese Medical Association (China Cornea Society), Jinan, China
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yiyi Hou
- Department of Ophthalmology, Eye Hospital of Shandong First Medical University, State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Shandong Eye Institute, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, China
| | - Tong Liu
- Department of Ophthalmology, Eye Hospital of Shandong First Medical University, State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Shandong Eye Institute, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, China
| | - Lixin Xie
- Corneal Disease Group of Ophthalmological Society of Chinese Medical Association (China Cornea Society), Jinan, China
- Department of Ophthalmology, Qingdao Eye Hospital of Shandong First Medical University, State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Shandong Eye Institute, Shandong First Medical University & Shandong Academy of Medical Sciences, Qingdao, China
- * E-mail: , (WS); (LX)
| | - Weiyun Shi
- Department of Ophthalmology, Eye Hospital of Shandong First Medical University, State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Shandong Eye Institute, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, China
- Corneal Disease Group of Ophthalmological Society of Chinese Medical Association (China Cornea Society), Jinan, China
- * E-mail: , (WS); (LX)
| |
Collapse
|
22
|
Effect of Corneal Transplantation on Patient-Reported Outcomes and Potential Predictors: A Systematic Review. Cornea 2020; 39:1463-1472. [PMID: 33017122 DOI: 10.1097/ico.0000000000002412] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
PURPOSE To investigate the effect and potential predictors of corneal transplantation on patient-reported outcomes such as quality of life, visual functioning, and mental health by systematically reviewing the literature. METHODS Studies with 1 preoperative and at least 1 postoperative measurement were searched for in relevant literature databases. Methodological quality was assessed using the Quality Assessment Tool for Quantitative Studies, and effect sizes were calculated. RESULTS Of 1445 unique publications, 14 studies, including 15 study designs, were described in 16 publications. Four randomized controlled trials, 1 controlled clinical trial, 1 cohort study, and 1 before-after study (BA) were of good quality; 6 BAs were of moderate quality; and 2 BAs were of weak quality. Patients generally improved 12 months after transplantation on health-related quality of life (effect size between 0.08 and -3.06), vision-related quality of life (-0.67 and -6.65), visual functioning (-0.55 and -0.63), and subjective visual symptoms (-0.31 and -0.86). Patient satisfaction was high (-0.95). Patients improved on depression (-0.31) but remained stable on anxiety (-0.05) 4 months after transplantation. Predictors of positive outcomes were lower preoperative visual acuity and visual functioning, better postoperative visual factors, younger age, and male sex. CONCLUSIONS Corneal transplantation showed overall beneficial effects on patient-reported outcomes. Knowledge of these effects and predictors might result in better treatment, more patient-centered care, and more realistic expectations on the part of patients and ophthalmologists. Future studies should focus on not only health- and vision-related quality of life but also mental health and labor participation using longitudinal study designs.
Collapse
|
23
|
Qiu T, Cui L, Xu JJ, Hong JX, Xiang J. Reconstruction of the ocular surface by autologous transplantation of rabbit adipose tissue-derived stem cells on amniotic membrane. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:1062. [PMID: 33145281 PMCID: PMC7575941 DOI: 10.21037/atm-20-4368] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background Corneal disease is the second most common cause of blindness in China. Clinically, treatment options for corneal diseases with limbal stem cell deficiency (LSCD) are limited due to a shortage of organ donors and inevitable immune rejection. This study aims to determine the efficacy of reconstructing the ocular surface using autologous cultivated adipose tissue-derived stem cells (ADSCs) and to develop a new clinical treatment for patients with LSCD. Methods A rabbit LSCD model was first established. Two weeks later, the animals were divided into three groups, including the sham group, the amniotic membrane transplantation group, and the ADSC combined with amniotic membrane transplantation group, and underwent surgery. The efficacy of reconstructing the ocular surface using ADSCs was evaluated using immunofluorescent staining, confocal microscopy (CM) observation, H&E staining, immunohistochemical staining, and scanning transmission electron microscopy observation one, two and four weeks after surgery. Results Evaluations of immunofluorescent staining of the cornea pre- and post-surgery yielded significantly lower scores for the corneas in the ADSCs transplantation group than for those in the sham group (F=−7, P=0.002, <0.05) and the amniotic membrane transplantation group (F=−4.67, P=0.018, <0.05) two weeks after surgery. Four weeks after surgery, the corneas of the ADSC combined with amniotic membrane transplantation group were scored significantly lower than those in the sham group (F=−8, P=0.007, <0.05) and the amniotic membrane transplantation group (F=−5.33, P=0.046, <0.05). The data suggest that the use of ADSCs to treat LSCD showed greater efficacy than the other treatment methods. The growth of ADSCs on the corneal surface was examined using confocal and electron microscopes. K3/K12 expression in the corneal epithelium, which was reconstructed by ADSCs, was negative, as shown by immunohistochemical staining. Conclusions Ocular surface reconstruction can be improved by using ADSCs as seed cells and the amniotic membrane as a carrier, thus providing a new therapeutic strategy for patients with LSCD.
Collapse
Affiliation(s)
- Ting Qiu
- Department of Ophthalmology, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lei Cui
- National Engineering Research Center for Tissue Engineering, Shanghai, China
| | - Jian-Jiang Xu
- Department of Ophthalmology, Eye, Ear, Nose, and Throat Hospital of Fudan University, Shanghai, China
| | - Jia-Xu Hong
- Department of Ophthalmology, Eye, Ear, Nose, and Throat Hospital of Fudan University, Shanghai, China
| | - Jun Xiang
- Department of Ophthalmology, Eye, Ear, Nose, and Throat Hospital of Fudan University, Shanghai, China
| |
Collapse
|
24
|
Lu Q, Peng RM, Feng N, Wen MD, He LH, Hong J. Evaluation of reconstructed human corneal endothelium sheets made with porcine Descemet's membrane in vitro and in vivo. Exp Eye Res 2020; 197:108125. [DOI: 10.1016/j.exer.2020.108125] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 06/01/2020] [Accepted: 06/18/2020] [Indexed: 12/13/2022]
|
25
|
Qin L, Gao H, Xiong S, Jia Y, Ren L. Preparation of collagen/cellulose nanocrystals composite films and their potential applications in corneal repair. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2020; 31:55. [PMID: 32504216 DOI: 10.1007/s10856-020-06386-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 05/11/2020] [Indexed: 06/11/2023]
Abstract
As the main component of the natural cornea, collagen (COL) has been widely applied to the construction of corneal repair materials. However, the applications of collagen are limited due to its poor mechanical properties. Cellulose nanocrystals (CNCs) possess excellent mechanical properties, optical transparency and good biocompatibility. Therefore, in this study, we attempted to introduce cellulose nanocrystals into collagen-based films to obtain corneal repair materials with a high strength. CNCs were incorporated at 1, 3, 5, 7 and 10 wt%. The physical properties of these composite films were characterized, and in vitro cell-based analyses were also performed. The COL/CNC films possessed better mechanic properties, and the introduction of CNCs did not affect the water content and light transmittance. The COL/CNC films demonstrated good biocompatibility toward rabbit corneal epithelial cells and keratocytes in vitro. Moreover, the collagen films with appropriate ration of CNCs effectively induced the migration of corneal epithelial cells and inhibited the myofibroblast differentiation of keratocytes. A collagen film with 7 wt% CNCs displayed the best combination of physical properties and biological performance in vitro among all the films. This study describes a nonchemical cross-linking method to enhance the mechanical properties of collagen for use in corneal repair materials and highlights potential application in corneal tissue engineering.
Collapse
Affiliation(s)
- Lanfeng Qin
- School of Biology and Biological Engineering, South China University of Technology, Guangzhou, 510006, China
- National Engineering Research Centre for Tissue Restoration and Reconstruction, Guangzhou, 510006, China
- Guangdong Province Key Laboratory of Biomedical Engineering, South China University of Technology, Guangzhou, 510006, China
| | - Huichang Gao
- School of Medicine, South China University of Technology, Guangzhou, 510006, China.
| | - Sijia Xiong
- National Engineering Research Centre for Tissue Restoration and Reconstruction, Guangzhou, 510006, China
- Guangdong Province Key Laboratory of Biomedical Engineering, South China University of Technology, Guangzhou, 510006, China
- School of Materials Science and Engineering, South China University of Technology, Guangzhou, 510641, China
| | - Yongguang Jia
- National Engineering Research Centre for Tissue Restoration and Reconstruction, Guangzhou, 510006, China
- Guangdong Province Key Laboratory of Biomedical Engineering, South China University of Technology, Guangzhou, 510006, China
- School of Materials Science and Engineering, South China University of Technology, Guangzhou, 510641, China
| | - Li Ren
- National Engineering Research Centre for Tissue Restoration and Reconstruction, Guangzhou, 510006, China.
- Guangdong Province Key Laboratory of Biomedical Engineering, South China University of Technology, Guangzhou, 510006, China.
- School of Materials Science and Engineering, South China University of Technology, Guangzhou, 510641, China.
- Guangzhou Regenerative Medicine and Health Guangdong Laboratory, Guangzhou, 510005, China.
- Sino-Singapore International Joint Research Institute, Guangzhou, 510555, China.
| |
Collapse
|
26
|
A new storage solution for the hypothermic preservation of corneal grafts: an experimental study. Cell Tissue Bank 2020; 21:507-521. [PMID: 32451748 DOI: 10.1007/s10561-020-09838-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 05/15/2020] [Indexed: 10/24/2022]
Abstract
In this experimental study we used for the first time Tiprotec® as a solution for corneal preservation and cold storage. We compared the resultant endothelial cell morphology and viability with this obtained after preservation of the ex-vivo corneas with both usual standard techniques: conventional cold storage (using Eusol-C) and organ culture. This prospective, in vitro, 3-armed parallel study was performed with the use of 90 porcine corneas (examined for their endothelial quality and transparency) randomly selected for preservation in three storage methods (each 30 corneas): organ culture, standard cold storage (Eusol-C) and experimental cold storage (Tiprotec®) Endothelium cell quantity and quality as well as corneal opacification were assessed. The degree of endothelial transparency was significantly reduced over time with all preservation media, without any significant difference among the three groups at any point of time. A reduction in endothelial cell density was also observed with all three preservation media after 30 days of storage without statistically significant differences between groups. The number of hexagonal and pentagonal endothelium cells was significantly reduced overtime in all media with significantly more hexagonal and pentagonal in the organ culture group compared to the cold storage groups. We could show that the cryopreservation medium Tiprotec®, used until now for the preservation of vascular grafts, was of similar quality compared to the medium Eusol-C for the hypothermic storage of corneal tissue for an extended period of time up to 30 days. In comparison to organic culture with culture medium KII, both Tiprotec® and Eusol-C were found less effective in preserving endothelial cell quality, as assessed by the morphometric analysis, and viability, as assessed by the degree of vacuolization at least up to the 30th day of storage. However, both, Tiprotec®- and Eusol-C-preserved corneas demonstrated a certain capacity to recover after their submission in organ culture.
Collapse
|
27
|
Kramp K, Suffo S, Laun D, Bischoff-Jung M, Huber M, Langenbucher A, Seitz B. Analyse von Einflussfaktoren auf die Eignung von kornealem Spendergewebe in der LIONS Hornhautbank Saar-Lor-Lux, Trier/Westpfalz von 2006 bis 2016. Klin Monbl Augenheilkd 2020; 237:1334-1342. [DOI: 10.1055/a-1141-3703] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Zusammenfassung
Hintergrund und Ziel der Studie Vor dem Hintergrund des Missverhältnisses zwischen Hornhautverfügbarkeit und -bedarf war das Ziel der Studie, signifikante Einflussfaktoren auf die Eignung sowie die Verwerfungsgründe von kornealem Spendergewebe zu eruieren und damit die Rate verworfener Hornhäute langfristig zu reduzieren.
Patienten und Methoden 4140 Hornhäute von 2083 Spendern wurden zwischen 2006 und 2016 analysiert. Die untersuchten Einflussgrößen umfassten das Alter, das Geschlecht und die medizinische Vorgeschichte der Spender und Prozessierungsfaktoren wie die Post-mortem-Zeit. Die Daten wurden in eine Microsoft-Access-Datenbank übertragen und mittels logistischer Regressionsanalysen mit SPSS 20.0 statistisch ausgewertet. In einem multiplen Regressionsmodell wurden 6 Einflussfaktoren auf die Eignung des Spendergewebes analysiert. Alle Hornhäute, die nicht für eine elektive Keratoplastik infrage kamen, galten hierbei als ungeeignet.
Ergebnisse Ein hohes Spenderalter > 80 Jahre erwies sich im Vergleich zur Referenzgruppe der Spender < 40 Jahre als signifikant negative Einflussgröße auf die Eignung der Hornhaut (p = 0,001). Auch eine vorangegangene Kataraktoperation minderte signifikant die Eignung (p < 0,001). Männliche Hornhäute waren signifikant weniger geeignet als weibliche Hornhäute (p = 0,028). Ein Hypertonus in der Spendervorgeschichte (p = 0,612), eine vorangegangene Chemotherapie (p = 0,745) oder ein Diabetes mellitus (p = 0,321) zeigten keinen Einfluss auf die Eignung. Sepsis (p = 0,026) und Multiorganversagen (MOV; p < 0,001) als Todesursachen des Spenders resultierten in signifikant höheren Verwerfungsraten aufgrund von Kontamination des Kulturmediums. Hornhäute, bei denen die Blutentnahme mehr als 12 h seit Versterben des Spenders zurücklag, mussten signifikant häufiger wegen einer positiven Spenderserologie verworfen werden (p < 0,001).
Schlussfolgerungen Faktoren wie eine vorangegangene Kataraktoperation und ein hohes Spenderalter verringerten die Eignung des Spendergewebes. Ein Diabetes, ein Hypertonus und eine Chemotherapie in der Spendervorgeschichte zeigten keinen statistisch signifikanten Einfluss auf die Eignung. Todesursachen wie Sepsis und Multiorganversagen erhöhten die Kontaminationsrate des Kulturmediums. Eine postmortale Blutentnahme nach mehr als 12 h geht mit einem erhöhten Risiko für ein positives Serologieergebnis einher.
Collapse
Affiliation(s)
- Kristina Kramp
- Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes (UKS), Homburg/Saar
| | - Shady Suffo
- Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes (UKS), Homburg/Saar
| | - Daniel Laun
- Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes (UKS), Homburg/Saar
| | - Mona Bischoff-Jung
- Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes (UKS), Homburg/Saar
| | - Manuela Huber
- Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes (UKS), Homburg/Saar
| | - Achim Langenbucher
- Institut für Experimentelle Ophthalmologie, Universität des Saarlandes, Homburg/Saar
| | - Berthold Seitz
- Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes (UKS), Homburg/Saar
| |
Collapse
|
28
|
Han Y, Li C, Cai Q, Bao X, Tang L, Ao H, Liu J, Jin M, Zhou Y, Wan Y, Liu Z. Studies on bacterial cellulose/poly(vinyl alcohol) hydrogel composites as tissue-engineered corneal stroma. Biomed Mater 2020; 15:035022. [DOI: 10.1088/1748-605x/ab56ca] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
|
29
|
Are Corneal Patients Accepting the Transplantation? The Cases of University of Gondar, Tertiary Eye Care and Training Center, Ethiopia. J Ophthalmol 2020; 2019:4560649. [PMID: 31915540 PMCID: PMC6930795 DOI: 10.1155/2019/4560649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Revised: 10/06/2019] [Accepted: 10/31/2019] [Indexed: 11/18/2022] Open
Abstract
Background For so long, corneal diseases have been known as one of the leading causes to blindness in the global. This blindness might be due to failure to accept the corneal transplantation. Therefore, this study aimed to determine the prevalence and the root challenges for corneal transplantation acceptance at the University of Gondar tertiary eye care and training center, Ethiopia. Methods An institution-based cross-sectional study was conducted among patients who had an indication for corneal transplantation at the University of Gondar tertiary eye care and training center since January 1, 2017, up to October 30, 2018. A structured questionnaire was used to collect the data and entered into Epi-Info 7 software and analyzed using SPSS version 20. Simple logistic regression was used to identify the associated factors of corneal transplantation acceptance. Associations between outcome and exposure variables were expressed by the adjusted odds ratio with a 95% confidence interval and p value <0.05. Result A total of 116 patients with a mean age of 51 (±21) years participated in the study. The overall acceptance level of corneal transplantation was only 38.8% (95% CI: 29.93, 47.66). Patients with poor knowledge [AOR = 2.41; 95% CI: 1.90, 6.48] and an unfavorable attitude [AOR = 6.33; 95% CI: 2.42, 16.54] were significantly associated with the acceptance of corneal transplantation. Conclusion The study revealed that the corneal transplantation acceptance level was very low. Hence, the government and other concerned stakeholders should give due emphasis to the awareness creation and behavior change communication strategies to increase the acceptance level of corneal transplantation.
Collapse
|
30
|
Isidan A, Liu S, Li P, Lashmet M, Smith LJ, Hara H, Cooper DKC, Ekser B. Decellularization methods for developing porcine corneal xenografts and future perspectives. Xenotransplantation 2019; 26:e12564. [PMID: 31659811 DOI: 10.1111/xen.12564] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 09/11/2019] [Accepted: 10/13/2019] [Indexed: 12/23/2022]
Abstract
Corneal transplantation is the only option to cure corneal opacities. However, there is an imbalance between supply and demand of corneal tissues in the world. To solve the problem of corneal shortage, corneal xenotransplantation studies have been implemented in the past years using porcine corneas. The corneal xenografts could come from (a) wild-type pigs, (b) genetically engineered pigs, (c) decellularized porcine corneas, and (d) decellularized porcine corneas that are recellularized with human corneal cells, eventually with patients' own cells, as in all type of xenografts. All approaches except, the former would reduce or mitigate recipient immune responses. Although several techniques in decellularization have been reported, there is still no standardized protocol for the complete decellularization of corneal tissue. Herein, we reviewed different decellularization methods for porcine corneas based on the mechanism of action, decellularization efficacy, biocompatibility, and the undesirable effects on corneal ultrastructure. We compared 9 decellularization methods including: (a) sodium dodecyl sulfate, (b) triton x-100, (c) hypertonic saline, (d) human serum with electrophoresis, (e) high hydrostatic pressure, (f) freeze-thaw, (h) nitrogen gas, (h) phospholipase A2 , and (i) glycerol with chemical crosslinking methods. It appears that combined methods could be more useful to perform efficient corneal decellularization.
Collapse
Affiliation(s)
- Abdulkadir Isidan
- Transplant Division, Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Shaohui Liu
- Department of Ophthalmology, Glick Eye Institute, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Ping Li
- Transplant Division, Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Matthew Lashmet
- Transplant Division, Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Lester J Smith
- Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, IN, USA.,3D Bioprinting Core, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Hidetaka Hara
- Xenotransplantation Program, Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - David K C Cooper
- Xenotransplantation Program, Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Burcin Ekser
- Transplant Division, Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| |
Collapse
|
31
|
Lim YS, Ok YJ, Hwang SY, Kwak JY, Yoon S. Marine Collagen as A Promising Biomaterial for Biomedical Applications. Mar Drugs 2019; 17:E467. [PMID: 31405173 PMCID: PMC6723527 DOI: 10.3390/md17080467] [Citation(s) in RCA: 135] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 08/06/2019] [Accepted: 08/07/2019] [Indexed: 02/07/2023] Open
Abstract
This review focuses on the expanding role of marine collagen (MC)-based scaffolds for biomedical applications. A scaffold-a three-dimensional (3D) structure fabricated from biomaterials-is a key supporting element for cell attachment, growth, and maintenance in 3D cell culture and tissue engineering. The mechanical and biological properties of the scaffolds influence cell morphology, behavior, and function. MC, collagen derived from marine organisms, offers advantages over mammalian collagen due to its biocompatibility, biodegradability, easy extractability, water solubility, safety, low immunogenicity, and low production costs. In recent years, the use of MC as an increasingly valuable scaffold biomaterial has drawn considerable attention from biomedical researchers. The characteristics, isolation, physical, and biochemical properties of MC are discussed as an understanding of MC in optimizing the subsequent modification and the chemistries behind important tissue engineering applications. The latest technologies behind scaffold processing are assessed and the biomedical applications of MC and MC-based scaffolds, including tissue engineering and regeneration, wound dressing, drug delivery, and therapeutic approach for diseases, especially those associated with metabolic disturbances such as obesity and diabetes, are discussed. Despite all the challenges, MC holds great promise as a biomaterial for developing medical products and therapeutics.
Collapse
Affiliation(s)
- Ye-Seon Lim
- Department of Anatomy, School of Medicine, Pusan National University, Yangsan 50612, Korea
| | - Ye-Jin Ok
- Department of Anatomy, School of Medicine, Pusan National University, Yangsan 50612, Korea
| | - Seon-Yeong Hwang
- Department of Anatomy, School of Medicine, Pusan National University, Yangsan 50612, Korea
| | - Jong-Young Kwak
- Department of Pharmacology, School of Medicine, Ajou University, Suwon 16499, Korea
| | - Sik Yoon
- Department of Anatomy, School of Medicine, Pusan National University, Yangsan 50612, Korea.
| |
Collapse
|
32
|
Che X, Wu H, Jia C, Sun H, Ou S, Wang J, Jeyalatha MV, He X, Yu J, Zuo C, Liu Z, Li W. A Novel Tissue-Engineered Corneal Stromal Equivalent Based on Amniotic Membrane and Keratocytes. Invest Ophthalmol Vis Sci 2019; 60:517-527. [PMID: 30707753 DOI: 10.1167/iovs.18-24869] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose To investigate a novel strategy in constructing tissue-engineered corneal stromal equivalent based on amniotic membrane and keratocytes. Methods The ultrathin amniotic membrane (UAM) was laminated, with corneal stromal cells (CSCs) distributed between the space of the layered UAMs. Calcein AM staining was used to evaluate cellular viability, morphology, and arrangement. Immunostaining, qRT-PCR, and Western blot were performed to detect gene and protein expression in keratocytes. Optical coherence tomography visualized the cross sections and thickness of the UAM construction. The microstructure of the CSC-secreted extracellular matrix (ECM) was investigated by scanning electron microscopy and transmission electron microscopy (TEM). To evaluate the feasibility of the multilayer UAM-CSC lamination for surgery, the corneal substitute was used to perform lamellar keratoplasty. Slit lamp microscopy and corneal fluorescein staining were performed in postsurgery observation. Results The CSCs maintained their keratocyte phenotype and secreted well-organized ECM on the aligned UAM surface. The four-layer UAM-CSC lamination attained half thickness of the human cornea (250 ± 18 μm) after 8 weeks' culture, which also showed promising optimal transparency. In TEM images, the CSC-generated ECM displayed stratified, multilayered lamellae with orthogonal fibril arrangement, which was similar to the human cornea microstructure. Furthermore, the stromal equivalent was successfully preformed in lamellar keratoplasty. Four weeks post surgery, the substitute was well integrated into the recipient cornea and completely epithelialized without myofibroblast differentiation. Conclusions Our study established a novel 3D biomimetic corneal model to replicate the corneal stromal organization with multilayer UAM, which was capable of promoting the development of corneal stroma-like tissues in vitro, establishing a new avenue for basic research and therapeutic potential.
Collapse
Affiliation(s)
- Xin Che
- Department of Ophthalmology, Xiang'an Hospital of Xiamen University; Fujian Provincial Key Laboratory of Ophthalmology and Visual Science, Eye Institute of Xiamen University, School of Medicine, Xiamen University, Xiamen, Fujian, China
| | - Han Wu
- Department of Ophthalmology, Xiang'an Hospital of Xiamen University; Fujian Provincial Key Laboratory of Ophthalmology and Visual Science, Eye Institute of Xiamen University, School of Medicine, Xiamen University, Xiamen, Fujian, China
| | - Changkai Jia
- Department of Ophthalmology, Xiang'an Hospital of Xiamen University; Fujian Provincial Key Laboratory of Ophthalmology and Visual Science, Eye Institute of Xiamen University, School of Medicine, Xiamen University, Xiamen, Fujian, China
| | - Huimin Sun
- Department of Ophthalmology, Xiang'an Hospital of Xiamen University; Fujian Provincial Key Laboratory of Ophthalmology and Visual Science, Eye Institute of Xiamen University, School of Medicine, Xiamen University, Xiamen, Fujian, China
| | - Shangkun Ou
- Department of Ophthalmology, Xiang'an Hospital of Xiamen University; Fujian Provincial Key Laboratory of Ophthalmology and Visual Science, Eye Institute of Xiamen University, School of Medicine, Xiamen University, Xiamen, Fujian, China
| | - Junqi Wang
- Department of Ophthalmology, Xiang'an Hospital of Xiamen University; Fujian Provincial Key Laboratory of Ophthalmology and Visual Science, Eye Institute of Xiamen University, School of Medicine, Xiamen University, Xiamen, Fujian, China
| | - M Vimalin Jeyalatha
- Department of Ophthalmology, Xiang'an Hospital of Xiamen University; Fujian Provincial Key Laboratory of Ophthalmology and Visual Science, Eye Institute of Xiamen University, School of Medicine, Xiamen University, Xiamen, Fujian, China
| | - Xin He
- Department of Ophthalmology, Xiang'an Hospital of Xiamen University; Fujian Provincial Key Laboratory of Ophthalmology and Visual Science, Eye Institute of Xiamen University, School of Medicine, Xiamen University, Xiamen, Fujian, China
| | - Jingwen Yu
- Department of Ophthalmology, Xiang'an Hospital of Xiamen University; Fujian Provincial Key Laboratory of Ophthalmology and Visual Science, Eye Institute of Xiamen University, School of Medicine, Xiamen University, Xiamen, Fujian, China
| | - Chengyou Zuo
- Department of Ophthalmology, Xiang'an Hospital of Xiamen University; Fujian Provincial Key Laboratory of Ophthalmology and Visual Science, Eye Institute of Xiamen University, School of Medicine, Xiamen University, Xiamen, Fujian, China
| | - Zuguo Liu
- Department of Ophthalmology, Xiang'an Hospital of Xiamen University; Fujian Provincial Key Laboratory of Ophthalmology and Visual Science, Eye Institute of Xiamen University, School of Medicine, Xiamen University, Xiamen, Fujian, China.,Xiamen University Affiliated Xiamen Eye Center, Xiamen, Fujian, China
| | - Wei Li
- Department of Ophthalmology, Xiang'an Hospital of Xiamen University; Fujian Provincial Key Laboratory of Ophthalmology and Visual Science, Eye Institute of Xiamen University, School of Medicine, Xiamen University, Xiamen, Fujian, China.,Xiamen University Affiliated Xiamen Eye Center, Xiamen, Fujian, China
| |
Collapse
|
33
|
|
34
|
Finding an Optimal Corneal Xenograft Using Comparative Analysis of Corneal Matrix Proteins Across Species. Sci Rep 2019; 9:1876. [PMID: 30755666 PMCID: PMC6372616 DOI: 10.1038/s41598-018-38342-4] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 12/19/2018] [Indexed: 11/08/2022] Open
Abstract
Numerous animal species have been proposed as sources of corneal tissue for obtaining decellularized xenografts. The selection of an appropriate animal model must take into consideration the differences in the composition and structure of corneal proteins between humans and other animal species in order to minimize immune response and improve outcome of the xenotransplant. Here, we compared the amino-acid sequences of 16 proteins present in the corneal stromal matrix of 14 different animal species using Basic Local Alignment Search Tool, and calculated a similarity score compared to the respective human sequence. Primary amino acid structures, isoelectric point and grand average of hydropathy (GRAVY) values of the 7 most abundant proteins (i.e. collagen α-1 (I), α-1 (VI), α-2 (I) and α-3 (VI), as well as decorin, lumican, and keratocan) were also extracted and compared to those of human. The pig had the highest similarity score (91.8%). All species showed a lower proline content compared to human. Isoelectric point of pig (7.1) was the closest to the human. Most species have higher GRAVY values compared to human except horse. Our results suggest that porcine cornea has a higher relative suitability for corneal transplantation into humans compared to other studied species.
Collapse
|
35
|
Girani L, Xie X, Lei T, Wei L, Wang Y, Deng S. Xenotransplantation in Asia. Xenotransplantation 2019; 26:e12493. [PMID: 30710388 DOI: 10.1111/xen.12493] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/04/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Lea Girani
- Organ Transplant and Clinical Immunology Translational Medicine Key Laboratory of Sichuan Province Sichuan Academy of an Transplant Science & Sichuan Provincial People’s Hospital Chengdu China
| | - Xiaofang Xie
- School of Medicine University of Electronic Science and Technology of China Chengdu China
| | - Tiantian Lei
- School of Medicine University of Electronic Science and Technology of China Chengdu China
| | - Liang Wei
- Organ Transplant and Clinical Immunology Translational Medicine Key Laboratory of Sichuan Province Sichuan Academy of an Transplant Science & Sichuan Provincial People’s Hospital Chengdu China
| | - Yi Wang
- Health Management Center Sichuan Academy of Medical Science & Sichuan Provincial People’s Hospital Chengdu China
- Department of Pharmacy Sichuan Academy of Medical Science & Sichuan Provincial People's Hospital Chengdu China
| | - Shaoping Deng
- Organ Transplant and Clinical Immunology Translational Medicine Key Laboratory of Sichuan Province Sichuan Academy of an Transplant Science & Sichuan Provincial People’s Hospital Chengdu China
- School of Medicine University of Electronic Science and Technology of China Chengdu China
| |
Collapse
|
36
|
Abstract
PURPOSE To analyze the number of discarded donated corneas and the causes associated with discard in southern Brazil. METHODS This retrospective, cross-sectional, and analytic study of donor corneal discards and their associated factors and geospatial distribution was based on a macroregional strategy conducted from 2011 to 2015 in Paraná, southern Brazil. The dataset included all cornea donations from patients who died of cardiac arrest at ages between 3 and 70 years. RESULTS A total of 9290 donor corneas were identified from 4645 donor patients; of these corneas, 4235 (45.6%) were discarded and 5055 (54.4%) transplanted. Mean age of the donors was 51.13 ± 14.30 years. The main causes of discard were positive serology (49.6%), corneal viability (19.8%), corneal tissue quality (8.5%), and others (16.0%). The discard rate was higher in the 50 to 64 year age group. CONCLUSIONS The corneal discard rate was high in all macroregions studied, with positive serology, viability, and quality of the donated corneas being the main causes of discard. Discards were more prevalent in older age groups (50-64 years and 65 or above age groups). Considering the presented results, the assessment process of potential cornea donors should be changed to reduce losses and costs.
Collapse
|
37
|
Turchyn M, Marushchak M, Krynytska I, Klishch I. Clinical efficacy of therapeutic keratoplasty using corneal xenografts in patients with corneal ulcers. Rom J Ophthalmol 2019; 63:257-263. [PMID: 31687628 PMCID: PMC6820485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Objective. to assess the clinical efficacy of keratoplasty using a corneal xenograft in patients with corneal ulcers of various etiologies. Methods. A total of 46 patients (49 eyes) with complicated corneal ulcers (perforated or with impending perforation) have been operated. Freeze-dried corneal xenografts have been used for keratoplasty. Results. Our results showed that postoperative period after xenogeneic keratoplasty in patients with corneal ulcers was uneventful and the transplant underwent gradual resorption. In all patients with non-infected corneal erosions, ulcers healed completely and corneal fistulas were fully closed. The implanted corneal xenograft undergoes complete resorption between 2 to 3 months. Conclusions. Given the shortages of donor material, the demonstrated efficacy of using corneal xenografts in patients with complicated corneal ulcers requiring therapeutic keratoplasty allows recommending corneal xenografts for wide use to relieve inflammation and to preserve the eye.
Collapse
Affiliation(s)
- Mykola Turchyn
- Otolaryngology and Ophthalmology Department, I. Horbachevsky Ternopil State
Medical University, Ternopil, Ukraine
| | - Mariya Marushchak
- Functional and Laboratory Diagnosis Department, I. Horbachevsky Ternopil State
Medical University, Ternopil, Ukraine
| | - Inna Krynytska
- Functional and Laboratory Diagnosis Department, I. Horbachevsky Ternopil State
Medical University, Ternopil, Ukraine
| | - Ivan Klishch
- Functional and Laboratory Diagnosis Department, I. Horbachevsky Ternopil State
Medical University, Ternopil, Ukraine
| |
Collapse
|
38
|
Abstract
Human-induced pluripotent stem cells (hiPSCs) provide a personalized approach to study conditions and diseases including those of the eye that lack appropriate animal models to facilitate the development of novel therapeutics. Corneal disease is one of the most common causes of blindness. Hence, significant efforts are made to develop novel therapeutic approaches including stem cell-derived strategies to replace the diseased or damaged corneal tissues, thus restoring the vision. The use of adult limbal stem cells in the management of corneal conditions has been clinically successful. However, its limited availability and phenotypic plasticity necessitate the need for alternative stem cell sources to manage corneal conditions. Mesenchymal and embryonic stem cell-based approaches are being explored; nevertheless, their limited differentiation potential and ethical concerns have posed a significant hurdle in its clinical use. hiPSCs have emerged to fill these technical and ethical gaps to render clinical utility. In this review, we discuss and summarize protocols that have been devised so far to direct differentiation of human pluripotent stem cells (hPSCs) to different corneal cell phenotypes. With the summarization, our review intends to facilitate an understanding which would allow developing efficient and robust protocols to obtain specific corneal cell phenotype from hPSCs for corneal disease modeling and for the clinics to treat corneal diseases and injury.
Collapse
Affiliation(s)
| | - Rohit Shetty
- Cornea and Refractive Surgery, Narayana Nethralaya, Bengaluru, India
| | - Arkasubhra Ghosh
- GROW Research Laboratory, Narayana Nethralaya Foundation, Bengaluru, India
| |
Collapse
|
39
|
Burdorf L, Harris D, Dahi S, Laird C, Zhang T, Ali F, Shah A, Thompson M, Braileanu G, Cheng X, Sievert E, Schwartz E, Sendil S, Parsell DM, Redding E, Phelps CJ, Ayares DL, Azimzadeh AM, Pierson RN. Thromboxane and histamine mediate PVR elevation during xenogeneic pig lung perfusion with human blood. Xenotransplantation 2018; 26:e12458. [PMID: 30175863 DOI: 10.1111/xen.12458] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 06/29/2018] [Accepted: 07/20/2018] [Indexed: 01/18/2023]
Abstract
BACKGROUND Elevated pulmonary vascular resistance (PVR), platelet adhesion, coagulation activation, and inflammation are prominent features of xenolung rejection. Here, we evaluate the role of thromboxane and histamine on PVR, and their contribution to other lung xenograft injury mechanisms. METHODS GalTKO.hCD46 single pig lungs were perfused ex vivo with fresh heparinized human blood: lungs were either treated with 1-Benzylimidazole (1-BIA) combined with histamine receptor blocker famotidine (n = 4) or diphenhydramine (n = 6), 1-BIA alone (n = 6) or were left untreated (n = 9). RESULTS Six of the nine control experiments (GalTKO.hCD46 untreated), "survived" until elective termination at 4 hours. Without treatment, initial PVR elevation within the first 30 minutes resolved partially over the following hour, and increased progressively during the final 2 hours of perfusion. In contrast, 1-BIA, alone or in addition to either antihistamine treatment, was associated with low stable PVR. Combined treatments significantly lowered the airway pressure when compared to untreated reference. Although platelet and neutrophil sequestration and coagulation cascade activation were not consistently altered by any intervention, increased terminal wet/dry weight ratio in untreated lungs was significantly blunted by combined treatments. CONCLUSION Combined thromboxane and histamine pathway blockade prevents PVR elevation and significantly inhibits loss of vascular barrier function when GalTKO.hCD46 lungs are perfused with human blood. Platelet activation and platelet and neutrophil sequestration persist in all groups despite efficient complement regulation, and appear to occur independent of thromboxane and histamine antagonism. Our work identifies thromboxane and histamine as key mediators of xenolung injury and defines those pathways as therapeutic targets to achieve successful xenolung transplantation.
Collapse
Affiliation(s)
- Lars Burdorf
- Division of Cardiac Surgery, Department of Surgery, University of Maryland School of Medicine, and VA Maryland Health Care System, Baltimore, Maryland.,Center for Transplantation Sciences and Division of Cardiac Surgery, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Donald Harris
- Division of Cardiac Surgery, Department of Surgery, University of Maryland School of Medicine, and VA Maryland Health Care System, Baltimore, Maryland
| | - Siamak Dahi
- Division of Cardiac Surgery, Department of Surgery, University of Maryland School of Medicine, and VA Maryland Health Care System, Baltimore, Maryland
| | - Christopher Laird
- Division of Cardiac Surgery, Department of Surgery, University of Maryland School of Medicine, and VA Maryland Health Care System, Baltimore, Maryland
| | - Tianshu Zhang
- Division of Cardiac Surgery, Department of Surgery, University of Maryland School of Medicine, and VA Maryland Health Care System, Baltimore, Maryland
| | - Franchesca Ali
- Division of Cardiac Surgery, Department of Surgery, University of Maryland School of Medicine, and VA Maryland Health Care System, Baltimore, Maryland
| | - Aakash Shah
- Division of Cardiac Surgery, Department of Surgery, University of Maryland School of Medicine, and VA Maryland Health Care System, Baltimore, Maryland
| | - Mercedes Thompson
- Division of Cardiac Surgery, Department of Surgery, University of Maryland School of Medicine, and VA Maryland Health Care System, Baltimore, Maryland
| | - Gheorghe Braileanu
- Division of Cardiac Surgery, Department of Surgery, University of Maryland School of Medicine, and VA Maryland Health Care System, Baltimore, Maryland
| | - Xiangfei Cheng
- Division of Cardiac Surgery, Department of Surgery, University of Maryland School of Medicine, and VA Maryland Health Care System, Baltimore, Maryland
| | - Evelyn Sievert
- Division of Cardiac Surgery, Department of Surgery, University of Maryland School of Medicine, and VA Maryland Health Care System, Baltimore, Maryland
| | - Evan Schwartz
- Division of Cardiac Surgery, Department of Surgery, University of Maryland School of Medicine, and VA Maryland Health Care System, Baltimore, Maryland
| | - Selin Sendil
- Division of Cardiac Surgery, Department of Surgery, University of Maryland School of Medicine, and VA Maryland Health Care System, Baltimore, Maryland
| | - Dawn M Parsell
- Division of Cardiac Surgery, Department of Surgery, University of Maryland School of Medicine, and VA Maryland Health Care System, Baltimore, Maryland
| | - Emily Redding
- Division of Cardiac Surgery, Department of Surgery, University of Maryland School of Medicine, and VA Maryland Health Care System, Baltimore, Maryland
| | - Carol J Phelps
- Center for Transplantation Sciences and Division of Cardiac Surgery, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | | | - Agnes M Azimzadeh
- Division of Cardiac Surgery, Department of Surgery, University of Maryland School of Medicine, and VA Maryland Health Care System, Baltimore, Maryland.,Center for Transplantation Sciences and Division of Cardiac Surgery, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Richard N Pierson
- Division of Cardiac Surgery, Department of Surgery, University of Maryland School of Medicine, and VA Maryland Health Care System, Baltimore, Maryland.,Center for Transplantation Sciences and Division of Cardiac Surgery, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| |
Collapse
|
40
|
Kim J, Choi SH, Lee HJ, Kim HP, Kang HJ, Kim JM, Hwang ES, Park CG, Kim MK. Comparative efficacy of anti-CD40 antibody-mediated costimulation blockade on long-term survival of full-thickness porcine corneal grafts in nonhuman primates. Am J Transplant 2018; 18:2330-2341. [PMID: 29722120 DOI: 10.1111/ajt.14913] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Revised: 04/06/2018] [Accepted: 04/23/2018] [Indexed: 01/25/2023]
Abstract
Porcine corneas may be good substitutes for human corneas in donor shortage. Therefore, we evaluated the efficacy and safety of an anti-CD40 antibody-based regimen compared with an anti-CD20 antibody-based regimen on the survival of full-thickness corneas in pig-to-rhesus xenotransplant. Thirteen Chinese rhesuses underwent full-thickness corneal xenotransplant. Six were administered anti-CD40 antibody, and the others were administered anti-CD20 antibody, basiliximab, and tacrolimus. Graft survival and changes in lymphocyte, donor-specific and anti-Galα1,3Galβ1,4GlcNAc-R (αGal) antibody, and aqueous complement levels were evaluated. Treatment with the anti-CD40 antibody (>511, >422, >273, >203, >196, 41 days) and anti-CD20 antibody (>470, 297, >260, >210, >184, 134, >97 days) resulted in long-term survival of grafts. In the anti-CD20 group, the number of activated B cells was significantly lower than that in the anti-CD40 group, and the level of aqueous complements at 6 months was significantly higher than the preoperative level. There were no differences in the levels of T cells or donor-specific and anti-αGal antibodies between the 2 groups. In the anti-CD20 group, 3 primates had adverse reactions. In conclusion, both the anti-CD40 antibody- and the anti-CD20 antibody-based protocols were effective for the long-term survival of full-thickness corneal xenografts, but the anti-CD40 antibody-based treatment had fewer adverse effects.
Collapse
Affiliation(s)
- Jaeyoung Kim
- Laboratory of Ocular Regenerative Medicine and Immunology, Seoul Artificial Eye Center, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea
| | - Se Hyun Choi
- Laboratory of Ocular Regenerative Medicine and Immunology, Seoul Artificial Eye Center, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea.,Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea.,Translational Xenotransplantation Research Center, Seoul National University College of Medicine, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea
| | - Hyun Ju Lee
- Laboratory of Ocular Regenerative Medicine and Immunology, Seoul Artificial Eye Center, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea
| | - Hong Pyo Kim
- Laboratory of Ocular Regenerative Medicine and Immunology, Seoul Artificial Eye Center, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea
| | - Hee Jung Kang
- Translational Xenotransplantation Research Center, Seoul National University College of Medicine, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea.,Department of Laboratory Medicine, Hallym University College of Medicine, Anyang, Gyeonggi-do, Korea
| | - Jong Min Kim
- Translational Xenotransplantation Research Center, Seoul National University College of Medicine, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea
| | - Eung Soo Hwang
- Department of Microbiology and Immunology, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Chung-Gyu Park
- Translational Xenotransplantation Research Center, Seoul National University College of Medicine, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea.,Department of Microbiology and Immunology, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Mee Kum Kim
- Laboratory of Ocular Regenerative Medicine and Immunology, Seoul Artificial Eye Center, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea.,Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea.,Translational Xenotransplantation Research Center, Seoul National University College of Medicine, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea
| |
Collapse
|
41
|
Choi HJ, Hyon JY, Lee HK, Song JS, Chung TY, Mo H, Kim J, Kim JE, Yoo H, Lee SH, Kwon I, Kim MK. Standardization of the proceedings for preparing clinical trials of corneal xenotransplantation in South Korea. Xenotransplantation 2018; 26:e12448. [PMID: 30076640 DOI: 10.1111/xen.12448] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 07/02/2018] [Accepted: 07/10/2018] [Indexed: 01/29/2023]
Affiliation(s)
- Hyuk Jin Choi
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea.,Laboratory of Ocular Regenerative Medicine and Immunology, Seoul Artificial Eye Center, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea.,Translational Xenotransplantation Research Center, Seoul National University College of Medicine, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea.,Department of Ophthalmology, Seoul National University Hospital Healthcare System Gangnam Center, Seoul, Korea
| | - Joon Young Hyon
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea.,Executive Council, Korean External Eye Disease Society, Seoul, Korea.,Department of Ophthalmology, Seoul National University Bundang Hospital, Seoul, Korea
| | - Hyung Keun Lee
- Executive Council, Korean External Eye Disease Society, Seoul, Korea.,Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea
| | - Jong-Suk Song
- Executive Council, Korean External Eye Disease Society, Seoul, Korea.,Department of Ophthalmology, Korea University College of Medicine, Seoul, Korea
| | - Tae-Young Chung
- Executive Council, Korean External Eye Disease Society, Seoul, Korea.,Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyojung Mo
- Center for Public Healthcare Education & Training, National Medical Center, Seoul, Korea
| | - Jaeyoung Kim
- Inje University Seoul Paik Hospital, Seoul, Korea
| | | | - Hyounggyoon Yoo
- Department of Clinical Pharmacology and Therapeutics, Seoul National University College of Medicine and Hospital, Seoul, Korea
| | - Seung Hwan Lee
- Department of Clinical Pharmacology and Therapeutics, Seoul National University College of Medicine and Hospital, Seoul, Korea
| | - Ivo Kwon
- Department of Medical Education, School of Medicine, Ewha Womans University, Seoul, Korea
| | - Mee Kum Kim
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea.,Laboratory of Ocular Regenerative Medicine and Immunology, Seoul Artificial Eye Center, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea.,Translational Xenotransplantation Research Center, Seoul National University College of Medicine, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea.,Executive Council, Korean External Eye Disease Society, Seoul, Korea
| |
Collapse
|
42
|
Choi HJ, Yoon CH, Hyon JY, Lee HK, Song JS, Chung TY, Mo H, Kim J, Kim JE, Hahm BJ, Yang J, Park WB, Kim MK. Protocol for the first clinical trial to investigate safety and efficacy of corneal xenotransplantation in patients with corneal opacity, corneal perforation, or impending corneal perforation. Xenotransplantation 2018; 26:e12446. [PMID: 30063072 DOI: 10.1111/xen.12446] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Revised: 05/16/2018] [Accepted: 06/26/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUND Xenotransplantation using fresh porcine corneas has been suggested as a feasible alternative to overcome the shortage of human donor corneas. Successful long-term survival of grafts without evidence of xenozoonosis in clinically applicable pig-to-non-human primate corneal transplantation model has brought researchers close to human clinical trials. Accordingly, we aimed to prepare a clinical trial protocol to conduct the first corneal xenotransplantation. METHODS We developed the clinical trial protocol based on international consensus statement on conditions for undertaking clinical trials of corneal xenotransplantation developed by the International Xenotransplantation Society. Detailed contents of the protocol have been modified with reference to comments provided by ophthalmologists and multidisciplinary experts, including an infectionist, an organ transplantation specialist, a clinical pharmacologist, a neuropsychiatrist, a laboratory medicine doctor, and a microbiologist. RESULTS Two patients with bilateral legal corneal blindness (best-corrected visual acuity ≤20/200 in the better eye and ≤20/1000 in the candidate eye) or with (impending) corneal perforation will be enrolled. During the screening period, participants and their family members will have two separate deep consideration periods before signing informed consent forms. Each patient will undergo corneal xenotransplantation using fresh corneas from Seoul National University miniature pigs. Commercially available immunosuppressants will be administered and systemic infection prophylaxis will be performed according to the program schedule. After transplantation, each patient will be monitored at a specialized clinic to investigate safety up to 2 years and efficacy up to 1 year. CONCLUSIONS A detailed clinical trial protocol for the first corneal xenotransplantation reflecting the global guidelines is provided.
Collapse
Affiliation(s)
- Hyuk Jin Choi
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea.,Laboratory of Ocular Regenerative Medicine and Immunology, Seoul Artificial Eye Center, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea.,Translational Xenotransplantation Research Center, Seoul National University College of Medicine and Seoul National University Hospital Biomedical Research Institute, Seoul, Korea.,Department of Ophthalmology, Seoul National University Hospital Healthcare System Gangnam Center, Seoul, Korea
| | - Chang Ho Yoon
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea.,Laboratory of Ocular Regenerative Medicine and Immunology, Seoul Artificial Eye Center, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea.,Translational Xenotransplantation Research Center, Seoul National University College of Medicine and Seoul National University Hospital Biomedical Research Institute, Seoul, Korea
| | - Joon Young Hyon
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea.,Executive Council, Korean External Eye Disease Society, Seoul, Korea.,Department of Ophthalmology, Seoul National University Bundang Hospital, Seoul, Korea
| | - Hyung Keun Lee
- Executive Council, Korean External Eye Disease Society, Seoul, Korea.,Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea
| | - Jong-Suk Song
- Executive Council, Korean External Eye Disease Society, Seoul, Korea.,Department of Ophthalmology, Korea University College of Medicine, Seoul, Korea
| | - Tae-Young Chung
- Executive Council, Korean External Eye Disease Society, Seoul, Korea.,Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyojung Mo
- Center for Public Healthcare Education & Training, National Medical Center, Seoul, Korea.,Executive Ethical Committee of the Xenotransplantation Research Center, Seoul, Korea
| | - Jaeyoung Kim
- Inje University Seoul Paik Hospital, Seoul, Korea
| | | | - Bong-Jin Hahm
- Department of Psychiatry and Behavioral Science, Seoul National University College of Medicine, Seoul, Korea
| | - Jaeseok Yang
- Department of Surgery, Transplantation Center, Seoul National University Hospital and Transplantation Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Wan Beom Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Mee Kum Kim
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea.,Laboratory of Ocular Regenerative Medicine and Immunology, Seoul Artificial Eye Center, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea.,Translational Xenotransplantation Research Center, Seoul National University College of Medicine and Seoul National University Hospital Biomedical Research Institute, Seoul, Korea.,Executive Council, Korean External Eye Disease Society, Seoul, Korea
| |
Collapse
|
43
|
Liu Y, Zhang Y, Liang Q, Yan C, Wang L, Zhang J, Pan Z. Porcine endothelial grafts could survive for a long term without using systemic immunosuppressors: An investigation of feasibility and efficacy of xeno-Descemet's stripping automated endothelial keratoplasty from WZS-pig to rhesus monkey. Xenotransplantation 2018; 26:e12433. [PMID: 29932259 DOI: 10.1111/xen.12433] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Revised: 05/04/2018] [Accepted: 05/24/2018] [Indexed: 12/29/2022]
Affiliation(s)
- Yang Liu
- Beijing Tongren Eye Center; Beijing Tongren Hospital; Capital Medical University; Beijing Ophthalmology and Visual Sciences Key Laboratory; Beijing China
| | - YingNan Zhang
- Beijing Tongren Eye Center; Beijing Tongren Hospital; Capital Medical University; Beijing Ophthalmology and Visual Sciences Key Laboratory; Beijing China
| | - Qingfeng Liang
- Beijing Institute of Ophthalmology; Beijing Tongren Eye Center; Beijing Tongren Hospital; Capital Medical University; Beijing China
| | - Chao Yan
- Beijing Tongren Eye Center; Beijing Tongren Hospital; Capital Medical University; Beijing Ophthalmology and Visual Sciences Key Laboratory; Beijing China
| | - Li Wang
- Beijing Tongren Eye Center; Beijing Tongren Hospital; Capital Medical University; Beijing Ophthalmology and Visual Sciences Key Laboratory; Beijing China
| | - Jing Zhang
- Beijing Tongren Eye Center; Beijing Tongren Hospital; Capital Medical University; Beijing Ophthalmology and Visual Sciences Key Laboratory; Beijing China
| | - ZhiQiang Pan
- Beijing Tongren Eye Center; Beijing Tongren Hospital; Capital Medical University; Beijing Ophthalmology and Visual Sciences Key Laboratory; Beijing China
| |
Collapse
|
44
|
Liu Y, Zhang J, Zhang Y, Yin M, Miao S, Liang Q, Pan Z. The feasibility and efficacy of preparing porcine Descemet’s membrane endothelial keratoplasty (DMEK) grafts by two techniques: An ex-vivo investigation for future xeno-DMEK. Xenotransplantation 2018; 25:e12407. [PMID: 29756410 DOI: 10.1111/xen.12407] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2017] [Revised: 03/14/2018] [Accepted: 04/13/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Yang Liu
- Beijing Ophthalmology and Visual Sciences Key Laboratory; Beijing Tongren Eye Center; Beijing Tongren Hospital; Capital Medical University; Beijing China
- Department of Ophthalmology; The First Hospital of Lanzhou University; Chengguan District, Lanzhou China
| | - Jing Zhang
- Beijing Ophthalmology and Visual Sciences Key Laboratory; Beijing Tongren Eye Center; Beijing Tongren Hospital; Capital Medical University; Beijing China
| | - Yingnan Zhang
- Beijing Ophthalmology and Visual Sciences Key Laboratory; Beijing Tongren Eye Center; Beijing Tongren Hospital; Capital Medical University; Beijing China
| | - Mingyang Yin
- Beijing Ophthalmology and Visual Sciences Key Laboratory; Beijing Tongren Eye Center; Beijing Tongren Hospital; Capital Medical University; Beijing China
| | - Sen Miao
- Beijing Anzhen Hospital; Capital Medical University; Beijing China
| | - Qingfeng Liang
- Beijing Ophthalmology and Visual Sciences Key Laboratory; Beijing Institute of Ophthalmology; Beijing Tongren Eye Center; Beijing Tongren Hospital; Capital Medical University; Beijing China
| | - Zhiqiang Pan
- Beijing Ophthalmology and Visual Sciences Key Laboratory; Beijing Tongren Eye Center; Beijing Tongren Hospital; Capital Medical University; Beijing China
| |
Collapse
|
45
|
Femtosecond Laser-Assisted Small Incision Endokeratophakia Using a Xenogeneic Lenticule in Rhesus Monkeys. Cornea 2018; 37:354-361. [PMID: 29408829 DOI: 10.1097/ico.0000000000001470] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate the feasibility and safety of xenogeneic endokeratophakia in rhesus monkeys and to explore the effects of a concave lenticule on refractive power. METHODS Three adult New Zealand white rabbits and 6 healthy rhesus monkeys were used. The xenogenic concave grafts were created from the rabbits using a modified small incision lenticule extraction technique; after being cryopreserved in glycerol for 1 week, the grafts were implanted into the monkey recipient corneas. Spherical equivalent (SE), central corneal thickness, and keratometry curvature were assessed preoperatively, 1 week, 1, 4 and 6 months postoperatively. The quality of the xenogenic graft was also assessed by slit-lamp microscopy, in vivo confocal microscopy, and optical coherence tomography with anterior segment imaging. RESULTS The graft appeared to be swollen a day after the operation but reduced considerably after a week. A trend of a lower refractive power (hyperopic shift) was demonstrated in relation to the SE after concave graft implantation. The mean SE increased from -0.60 ± 1.31 (median -0.69, interquartile range -1.00 to 0.50) preoperatively to 0.75 ± 1.27 (median 1.38, interquartile range -0.25 to 1.63) at 1 month postoperatively (P = 0.01). Central corneal thickness was significantly thicker each time after surgery compared with that recorded preoperatively (P < 0.01). The anterior and posterior interface between the graft and stroma was visible during the study. Corneal nerve regeneration was evident at 6 months postoperatively. The xenogeneic concave graft was stable and transparent at follow-up. Severe adverse events or evidence of a rejection response were not observed. CONCLUSIONS Femtosecond laser-assisted small incision endokeratophakia using a xenogeneic corneal lenticule seems to be feasible and safe, which may provide a new method for myopia correction and keratoconus treatment.
Collapse
|
46
|
Liu Y, Zhang Y, Zhang J, Yu J, Liang Q, Pan Z. Specific demographic factors could predict deceased potential cornea donors: A retrospective study from Beijing Tongren Hospital Eye Bank. Medicine (Baltimore) 2017; 96:e8607. [PMID: 29245222 PMCID: PMC5728837 DOI: 10.1097/md.0000000000008607] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Compared with evident cornea donors (ECDs), deceased potential cornea donors (DPCDs) have no obvious donor identifications to reference, which causes many eligible cornea tissues to be wasted. The demographic characteristics of DPCDs might be different from those of ECDs owing to the following different features: donation consent provided by relatives and willingness to donate before death. Thus, the aim of this study is to reveal the demographic characteristics of DPCDs by comparing DPCDs and ECDs.The demographic factors of 138 donors (both DPCDs and ECDs) were collected from the Beijing Tongren Hospital Eye Bank database and analyzed. To differentiate DPCDs from ECDs using the above-mentioned features, we interviewed the relatives of the donors by telephone. The relatives' attitudes toward cornea donation and their suggestions for our donation service were also acquired during the interview. Two logistic regressions were performed to reveal the demographic factors influencing the 2 features and indicate DPCDs.The donors had certain demographic characteristics (elderly, secondary, or tertiary education level, central district resident), and the most frequent cause of death for the donors was a malignant tumor (n = 56, 43.1%). All the relatives had positive attitudes toward cornea donations, and they hoped to increase publicity efforts to encourage more people to donate and establish more convenient and efficient access for cornea donation. In univariate regressions, age (P = .004, >50 years: odds ratio [OR] = 6.89, 95% confidence interval [CI]: 1.82-26.05), marital status (P = .043, divorced: OR = 9.00,95% CI: 1.33-60.80) significantly influenced relative consent, whereas age (P = .001, >50 years: OR = 15.00, 95% CI: 3.00-74.98), and family address (P = .001, central district: OR = 1) were significant factors influencing the willingness to donate before death. In multivariate regression, age (P = .021, >50 years: OR = 8.14, 95% CI: 1.37-48.41) was the only significant factor influencing relative consent. Similarly, age (P = .02, >50 years: OR = 7.55, 95% CI: 1.21-47.25) was the only factor influencing willingness to donate before death.In conclusion, specific demographic factors could indicate DPCDs and might reveal directions and methods for cornea donation coordination in the future.
Collapse
Affiliation(s)
| | | | | | - Jin Yu
- Beijing Tongren Eye Center
| | - Qingfeng Liang
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University; Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing, China
| | | |
Collapse
|
47
|
Guo Y, Ma X, Wu W, Shi M, Ma J, Zhang Y, Zhao E, Yang X. Coordinated microRNA/mRNA expression profiles reveal a putative mechanism of corneal epithelial cell transdifferentiation from skin epidermal stem cells. Int J Mol Med 2017; 41:877-887. [PMID: 29207049 PMCID: PMC5752239 DOI: 10.3892/ijmm.2017.3304] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Accepted: 11/15/2017] [Indexed: 01/09/2023] Open
Abstract
Skin epidermal stem cells (SESCs), which share a single origin with corneal epithelial cells (CECs), are considered to be one of the most ideal seed cells for the construction of tissue engineered corneas. However, the mechanism underlying the transdifferentiation of SESCs to CECs has not been fully elucidated. In the present study, to identify critical microRNAs (miRNAs/miRs) and genes that regulate the transdifferentiation of SESCs to CECs, SESCs and CECs were collected from sheep and used for small RNA sequencing and mRNA microarray analyses. Among the differentially expressed miRNAs and genes, 36 miRNAs were downregulated and 123 genes were upregulated in the CECs compared with those in the SESCs. miR-10b exhibited the largest change in expression between the cell types. Target genes of the 36 downregulated miRNAs were predicted and a computational approach demonstrated that these target genes may be involved in several signaling pathways, including the 'PI3K signaling pathway', the 'Wnt signaling pathway' and the 'MAPK signaling pathway', as well as in 'focal adhesion'. Comparison of these target genes to the 123 upregulated genes identified 43 intersection genes. A regulatory network of these 43 intersection genes and its correlative miRNAs were constructed, and three genes (dedicator of cytokinesis 9, neuronal differentiation 1 and activated leukocyte cell adhesion molecule) were found to have high interaction frequencies. The expression levels of 7 randomly selected miRNAs and the 3 intersection genes were further validated by reverse transcription-quantitative polymerase chain reaction. It was found that miR-10b, the Wnt signaling pathway and the 3 intersection genes may act together and serve a critical role in the transdifferentiation process. This study identified miRNAs and genes that were expressed in SESCs and CECs that may assist in uncovering its underlying molecular mechanism, as well as promote corneal tissue engineering using epidermal stem cells for clinical applications.
Collapse
Affiliation(s)
- Yanjie Guo
- Life Science College, Luoyang Normal University, Luoyang, Henan 471934, P.R. China
| | - Xiya Ma
- Life Science College, Luoyang Normal University, Luoyang, Henan 471934, P.R. China
| | - Weini Wu
- Life Science College, Luoyang Normal University, Luoyang, Henan 471934, P.R. China
| | - Mingyan Shi
- Life Science College, Luoyang Normal University, Luoyang, Henan 471934, P.R. China
| | - Junlong Ma
- Life Science College, Luoyang Normal University, Luoyang, Henan 471934, P.R. China
| | - Yaping Zhang
- Life Science College, Luoyang Normal University, Luoyang, Henan 471934, P.R. China
| | - Erkang Zhao
- Life Science College, Luoyang Normal University, Luoyang, Henan 471934, P.R. China
| | - Xueyi Yang
- Life Science College, Luoyang Normal University, Luoyang, Henan 471934, P.R. China
| |
Collapse
|
48
|
Wong KH, Kam KW, Chen LJ, Young AL. Corneal blindness and current major treatment concern-graft scarcity. Int J Ophthalmol 2017; 10:1154-1162. [PMID: 28730122 DOI: 10.18240/ijo.2017.07.21] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2016] [Accepted: 09/26/2016] [Indexed: 11/23/2022] Open
Abstract
According to World Health Organization, the global prevalence of blindness in 2010 was 39 million people, among which 4% were due to corneal opacities. Often, the sole resort for visual restoration of patients with damaged corneas is corneal transplantation. However, despite rapid developments of surgical techniques, instrumentations and immunosuppressive agents, corneal blindness remains a prevalent global health issue. This is largely due to the scarcity of good quality corneal grafts. In this review, the causes of corneal blindness, its major treatment options, and the major contributory factors of corneal graft scarcity with potential solutions are discussed.
Collapse
Affiliation(s)
- Kah Hie Wong
- Department of Ophthalmology and Visual Sciences, Chinese University of Hong Kong, Hong Kong, China
| | - Ka Wai Kam
- Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong, China
| | - Li Jia Chen
- Department of Ophthalmology and Visual Sciences, Chinese University of Hong Kong, Hong Kong, China.,Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong, China
| | - Alvin L Young
- Department of Ophthalmology and Visual Sciences, Chinese University of Hong Kong, Hong Kong, China.,Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong, China
| |
Collapse
|
49
|
Kim J, Kim DH, Choi HJ, Lee HJ, Kang HJ, Park CG, Hwang ES, Kim MK, Wee WR. Anti-CD40 antibody-mediated costimulation blockade promotes long-term survival of deep-lamellar porcine corneal grafts in non-human primates. Xenotransplantation 2017; 24:10.1111/xen.12298. [PMID: 28393447 PMCID: PMC5464973 DOI: 10.1111/xen.12298] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2016] [Revised: 12/26/2016] [Accepted: 03/01/2017] [Indexed: 01/01/2023]
Abstract
BACKGROUND Corneal xenotransplantation is an effective solution for the shortage of human donor corneas, and the porcine cornea may be a suitable candidate for the donor cornea because of its optical similarity with humans. However, it is necessary to administer additional immunosuppressants to overcome antigenic differences. We aimed to investigate the feasibility of porcine corneas with anti-CD40 antibody-mediated costimulation blockade in a clinically applicable pig-to-non-human primate corneal xenotransplantation model. METHODS Five Chinese rhesus macaques underwent deep-lamellar corneal transplantation using clinically acceptable sized (7.5 mm diameter) porcine corneal grafts. The anti-CD40 antibody was intravenously administered on a programmed schedule. Graft survival, central corneal thickness, and intraocular pressure were evaluated. Changes in effector and memory T and B cell subsets and anti-αGal and donor-specific antibodies were investigated in the blood, and the changes in complement levels in the aqueous humor and blood were evaluated. Memory cell profiles in the anti-CD40 antibody-treated group were compared with those from the anti-CD154 antibody-treated group or rejected controls presented in our previous report. The changes in anti-αGal, non-αGal, and donor-specific antibodies after 6 months were compared with baseline values. RESULTS Anti-CD40 antibody-mediated costimulation blockade resulted in the successful survival of xenocorneal grafts (>389, >382, >236, >201, and >61 days), with 80% reaching 6 months of survival. Injection of anti-CD40 antibody considerably reduced the infiltration of inflammatory cells into the grafts and significantly blocked the complement response in the aqueous humor (P=.0159, Mann-Whitney U test). Systemic expansion of central or effector memory T cells was abrogated in the anti-CD40 antibody-treated primates compared with those in the rejected controls (P<.05, Mann-Whitney U test) or those in the anti-CD154 antibody-treated primates (P>.05, Mann-Whitney U test). The levels of anti-αGal, non-αGal, and donor-specific antibodies at 6 months were not significantly increased compared with baseline levels (P>.05, Wilcoxon signed rank test). CONCLUSIONS An anti-CD40 antibody-mediated blockade appears to be effective immunosuppressive approach for porcine corneal deep-lamellar xenotransplantation in primates.
Collapse
Affiliation(s)
- Jaeyoung Kim
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Republic of Korea
- Laboratory of Ocular Regenerative Medicine and Immunology, Seoul Artificial Eye Center, Seoul National University Hospital Biomedical Research Institute, Seoul, Republic of Korea
- Translational Xenotransplantation Research Center, Seoul National University College of Medicine and Seoul National University Hospital Biomedical Research Institute, Seoul, Republic of Korea
| | - Dong Hyun Kim
- Laboratory of Ocular Regenerative Medicine and Immunology, Seoul Artificial Eye Center, Seoul National University Hospital Biomedical Research Institute, Seoul, Republic of Korea
- Translational Xenotransplantation Research Center, Seoul National University College of Medicine and Seoul National University Hospital Biomedical Research Institute, Seoul, Republic of Korea
- Department of Ophthalmology, Gachon University Gil Medical Center, Incheon, Republic of Korea
| | - Hyuk Jin Choi
- Laboratory of Ocular Regenerative Medicine and Immunology, Seoul Artificial Eye Center, Seoul National University Hospital Biomedical Research Institute, Seoul, Republic of Korea
- Translational Xenotransplantation Research Center, Seoul National University College of Medicine and Seoul National University Hospital Biomedical Research Institute, Seoul, Republic of Korea
- Department of Ophthalmology, Seoul National University Hospital Healthcare System Gangnam Center, Seoul, Republic of Korea
| | - Hyun Ju Lee
- Laboratory of Ocular Regenerative Medicine and Immunology, Seoul Artificial Eye Center, Seoul National University Hospital Biomedical Research Institute, Seoul, Republic of Korea
| | - Hee Jung Kang
- Department of Laboratory Medicine, Hallym University College of Medicine, Anyang, Gyeonggi-do, Republic of Korea
| | - Chung-Gyu Park
- Translational Xenotransplantation Research Center, Seoul National University College of Medicine and Seoul National University Hospital Biomedical Research Institute, Seoul, Republic of Korea
- Department of Microbiology and Immunology, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Eung-Soo Hwang
- Department of Microbiology and Immunology, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Mee Kum Kim
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Republic of Korea
- Laboratory of Ocular Regenerative Medicine and Immunology, Seoul Artificial Eye Center, Seoul National University Hospital Biomedical Research Institute, Seoul, Republic of Korea
- Translational Xenotransplantation Research Center, Seoul National University College of Medicine and Seoul National University Hospital Biomedical Research Institute, Seoul, Republic of Korea
| | - Won Ryang Wee
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Republic of Korea
- Laboratory of Ocular Regenerative Medicine and Immunology, Seoul Artificial Eye Center, Seoul National University Hospital Biomedical Research Institute, Seoul, Republic of Korea
| |
Collapse
|
50
|
Dong X, Hara H, Wang Y, Wang L, Zhang Y, Cooper DK, Dai Y, Pan Z. Initial study of α1,3-galactosyltransferase gene-knockout/CD46 pig full-thickness corneal xenografts in rhesus monkeys. Xenotransplantation 2017; 24. [DOI: 10.1111/xen.12282] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Revised: 11/02/2016] [Accepted: 11/14/2016] [Indexed: 01/17/2023]
Affiliation(s)
- Xiaojuan Dong
- Beijing Ophthalmology & Visual Science Key Laboratory; BeijingTongren Eye Center; Beijing Tongren Hospital; Capital Medical University; Beijing China
| | - Hidetaka Hara
- Department of Surgery; Thomas E. Starzl Transplantation Institute; University of Pittsburgh; Pittsburgh PA USA
| | - Ying Wang
- State Key Laboratory of Reproductive Medicine and Jiangsu Key Laboratory of Xenotransplantation; Nanjing Medical University; Nanjing China
| | - Li Wang
- Beijing Ophthalmology & Visual Science Key Laboratory; BeijingTongren Eye Center; Beijing Tongren Hospital; Capital Medical University; Beijing China
| | - Yingnan Zhang
- Department of Surgery; Thomas E. Starzl Transplantation Institute; University of Pittsburgh; Pittsburgh PA USA
| | - David K.C. Cooper
- Department of Surgery; Thomas E. Starzl Transplantation Institute; University of Pittsburgh; Pittsburgh PA USA
| | - Yifan Dai
- State Key Laboratory of Reproductive Medicine and Jiangsu Key Laboratory of Xenotransplantation; Nanjing Medical University; Nanjing China
| | - Zhiqiang Pan
- Beijing Ophthalmology & Visual Science Key Laboratory; BeijingTongren Eye Center; Beijing Tongren Hospital; Capital Medical University; Beijing China
| |
Collapse
|