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Poudel BK, Robert MC, Simpson FC, Malhotra K, Jacques L, LaBarre P, Griffith M. In situ Tissue Regeneration in the Cornea from Bench to Bedside. Cells Tissues Organs 2021; 211:506-526. [PMID: 34380144 DOI: 10.1159/000514690] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 01/22/2021] [Indexed: 11/19/2022] Open
Abstract
Corneal blindness accounts for 5.1% of visual deficiency and is the fourth leading cause of blindness globally. An additional 1.5-2 million people develop corneal blindness each year, including many children born with or who later develop corneal infections. Over 90% of corneal blind people globally live in low- and middle-income regions (LMIRs), where corneal ulcers are approximately 10-fold higher compared to high-income countries. While corneal transplantation is an effective option for patients in high-income countries, there is a considerable global shortage of corneal graft tissue and limited corneal transplant programs in many LMIRs. In situ tissue regeneration aims to restore diseases or damaged tissues by inducing organ regeneration. This can be achieved in the cornea using biomaterials based on extracellular matrix (ECM) components like collagen, hyaluronic acid, and silk. Solid corneal implants based on recombinant human collagen type III were successfully implanted into patients resulting in regeneration of the corneal epithelium, stroma, and sub-basal nerve plexus. As ECM crosslinking and manufacturing methods improve, the focus of biomaterial development has shifted to injectable, in situ gelling formulations. Collagen, collagen-mimetic, and gelatin-based in situ gelling formulas have shown the ability to repair corneal wounds, surgical incisions, and perforations in in-vivo models. Biomaterial approaches may not be sufficient to treat inflammatory conditions, so other cell-free therapies such as treatment with tolerogenic exosomes and extracellular vesicles may improve treatment outcomes. Overall, many of the technologies described here show promise as future medical devices or combination products with cell or drug-based therapies. In situ tissue regeneration, particularly with liquid formulas, offers the ability to triage and treat corneal injuries and disease with a single regenerative solution, providing alternatives to organ transplantation and improving patient outcomes.
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Affiliation(s)
- Bijay K Poudel
- Département d'Ophtalmologie, Université de Montréal, Montréal, Québec, Canada.,Centre de Recherche, Hôpital Maisonneuve-Rosemont, Montréal, Québec, Canada
| | - Marie-Claude Robert
- Département d'Ophtalmologie, Université de Montréal, Montréal, Québec, Canada.,Centre de Recherche, Hôpital Maisonneuve-Rosemont, Montréal, Québec, Canada.,Département d'Opthalmologie, Centre hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - Fiona C Simpson
- Département d'Ophtalmologie, Université de Montréal, Montréal, Québec, Canada.,Centre de Recherche, Hôpital Maisonneuve-Rosemont, Montréal, Québec, Canada.,Département d'Opthalmologie, Centre hospitalier de l'Université de Montréal, Montréal, Québec, Canada.,Institut du Génie Biomédicale, Université de Montréal, Montréal, Québec, Canada
| | - Kamal Malhotra
- Département d'Ophtalmologie, Université de Montréal, Montréal, Québec, Canada.,Centre de Recherche, Hôpital Maisonneuve-Rosemont, Montréal, Québec, Canada.,Département d'Opthalmologie, Centre hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - Ludovic Jacques
- Département d'Ophtalmologie, Université de Montréal, Montréal, Québec, Canada.,Centre de Recherche, Hôpital Maisonneuve-Rosemont, Montréal, Québec, Canada
| | | | - May Griffith
- Département d'Ophtalmologie, Université de Montréal, Montréal, Québec, Canada.,Centre de Recherche, Hôpital Maisonneuve-Rosemont, Montréal, Québec, Canada.,Département d'Opthalmologie, Centre hospitalier de l'Université de Montréal, Montréal, Québec, Canada.,Institut du Génie Biomédicale, Université de Montréal, Montréal, Québec, Canada
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Plant Recombinant Human Collagen Type I Hydrogels for Corneal Regeneration. REGENERATIVE ENGINEERING AND TRANSLATIONAL MEDICINE 2021. [DOI: 10.1007/s40883-021-00220-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Abstract
Purpose
To determine feasibility of plant-derived recombinant human collagen type I (RHCI) for use in corneal regenerative implants
Methods
RHCI was crosslinked with 1-ethyl-3-(3-dimethyl aminopropyl) carbodiimide (EDC) and N-hydroxysuccinimide (NHS) to form hydrogels. Application of shear force to liquid crystalline RHCI aligned the collagen fibrils. Both aligned and random hydrogels were evaluated for mechanical and optical properties, as well as in vitro biocompatibility. Further evaluation was performed in vivo by subcutaneous implantation in rats and corneal implantation in Göttingen minipigs.
Results
Spontaneous crosslinking of randomly aligned RHCI (rRHCI) formed robust, transparent hydrogels that were sufficient for implantation. Aligning the RHCI (aRHCI) resulted in thicker collagen fibrils forming an opaque hydrogel with insufficient transverse mechanical strength for surgical manipulation. rRHCI showed minimal inflammation when implanted subcutaneously in rats. The corneal implants in minipigs showed that rRHCI hydrogels promoted regeneration of corneal epithelium, stroma, and nerves; some myofibroblasts were seen in the regenerated neo-corneas.
Conclusion
Plant-derived RHCI was used to fabricate a hydrogel that is transparent, mechanically stable, and biocompatible when grafted as corneal implants in minipigs. Plant-derived collagen is determined to be a safe alternative to allografts, animal collagens, or yeast-derived recombinant human collagen for tissue engineering applications. The main advantage is that unlike donor corneas or yeast-produced collagen, the RHCI supply is potentially unlimited due to the high yields of this production method.
Lay Summary
A severe shortage of human-donor corneas for transplantation has led scientists to develop synthetic alternatives. Here, recombinant human collagen type I made of tobacco plants through genetic engineering was tested for use in making corneal implants. We made strong, transparent hydrogels that were tested by implanting subcutaneously in rats and in the corneas of minipigs. We showed that the plant collagen was biocompatible and was able to stably regenerate the corneas of minipigs comparable to yeast-produced recombinant collagen that we previously tested in clinical trials. The advantage of the plant collagen is that the supply is potentially limitless.
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Khosravimelal S, Mobaraki M, Eftekhari S, Ahearne M, Seifalian AM, Gholipourmalekabadi M. Hydrogels as Emerging Materials for Cornea Wound Healing. SMALL (WEINHEIM AN DER BERGSTRASSE, GERMANY) 2021; 17:e2006335. [PMID: 33887108 DOI: 10.1002/smll.202006335] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Revised: 12/15/2020] [Indexed: 06/12/2023]
Abstract
Hydrogel biomaterials have many favorable characteristics including tuneable mechanical behavior, cytocompatibility, optical properties suitable for regeneration and restoration of the damaged cornea tissue. The cornea is a tissue susceptible to various injuries and traumas with a complicated healing cascade, in which conserving its transparency and integrity is critical. Accordingly, the hydrogels' known properties along with the stimulation of nerve and cell regeneration make them ideal scaffold for corneal tissue engineering. Hydrogels have been used extensively in clinical applications for the repair and replacement of diseased organs. The development and optimizing of novel hydrogels to repair/replace corneal injuries have been the main focus of researches within the last decade. This research aims to critically review in vitro, preclinical, as well as clinical trial studies related to corneal wound healing using hydrogels in the past 10 years, as this is considered as an emerging technology for corneal treatment. Several unique modifications of hydrogels with smart behaviors have undergone early phase clinical trials and showed promising outcomes. Financially, this considers a multibillion dollars industry and with huge interest from medical devices as well as pharmaceutical industries with several products may emerge within the next five years.
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Affiliation(s)
- Sadjad Khosravimelal
- Department of Medical Biotechnology, Faculty of Allied Medicine, Iran University of Medical Sciences, Tehran, 1449614535, Iran
- Cellular and Molecular Research Centre, Iran University of Medical Sciences, Tehran, 1449614535, Iran
- Department of Tissue Engineering & Regenerative Medicine, Faculty of Advanced Technologies in Medicine, Iran University of Medical Sciences, Tehran, 1449614535, Iran
| | - Mohammadmahdi Mobaraki
- Department of Biomedical Engineering, Amirkabir University of Technology, Tehran, 1591634311, Iran
| | - Samane Eftekhari
- Department of Medical Biotechnology, Faculty of Allied Medicine, Iran University of Medical Sciences, Tehran, 1449614535, Iran
- Cellular and Molecular Research Centre, Iran University of Medical Sciences, Tehran, 1449614535, Iran
| | - Mark Ahearne
- Trinity Centre for Biomedical Engineering, School of Engineering, Trinity College Dublin, University of Dublin, Dublin, D02 R590, Republic of Ireland
| | - Alexander Marcus Seifalian
- Nanotechnology & Regenerative Medicine Commercialization Centre (NanoRegMed Ltd), London BioScience Innovation Centre, London, NW1 0NH, UK
| | - Mazaher Gholipourmalekabadi
- Cellular and Molecular Research Centre, Iran University of Medical Sciences, Tehran, 1449614535, Iran
- Department of Tissue Engineering & Regenerative Medicine, Faculty of Advanced Technologies in Medicine, Iran University of Medical Sciences, Tehran, 1449614535, Iran
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Integration and remodelling of a collagen anterior lamellar keratoplasty graft in an animal model - A preliminary report. Exp Eye Res 2021; 209:108661. [PMID: 34102207 DOI: 10.1016/j.exer.2021.108661] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 02/24/2021] [Accepted: 06/01/2021] [Indexed: 11/22/2022]
Abstract
There is an international shortage of donor corneas for transplantation to treat the 1.5-2.0 million new cases of blindness secondary to corneal disease. Research has therefore been directed towards the development of artificial corneas using alternative materials such as collagen. The biocompatibility of an acellular collagen-based scaffold for anterior lamellar keratoplasty was investigated in vivo in a rabbit model. This scaffold has previously shown promise as a corneal substitute in vitro. Slit-lamp and Optical Coherence Tomography examinations were carried out at 2 weeks, 1, 2, 3, and 6 months post-operatively. Graft-host integration was investigated using immunohistochemistry of the cornea at 6 months. Results showed that the graft was biocompatible, supported corneal re-epithelialisation, and showed no signs of rejection. Migration of stromal cells into areas of the graft was observed, however this was accompanied by extensive graft digestion. Whilst the scaffold was biocompatible, further modifications to the material or supplementation with matrix metalloproteinase inhibitors are required to bring us closer to a stable and fully integrated corneal substitute.
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Optimization of Collagen Chemical Crosslinking to Restore Biocompatibility of Tissue-Engineered Scaffolds. Pharmaceutics 2021; 13:pharmaceutics13060832. [PMID: 34204956 PMCID: PMC8229326 DOI: 10.3390/pharmaceutics13060832] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 05/26/2021] [Accepted: 05/28/2021] [Indexed: 12/13/2022] Open
Abstract
Collagen scaffolds, one of the most used biomaterials in corneal tissue engineering, are frequently crosslinked to improve mechanical properties, enzyme tolerance, and thermal stability. Crosslinkers such as 1-ethyl-3-(3-dimethylaminopropyl) carbodiimide hydrochloride (EDC) are compatible with tissues but provide low crosslinking density and reduced mechanical properties. Conversely, crosslinkers such as glutaraldehyde (GTA) can generate mechanically more robust scaffolds; however, they can also induce greater toxicity. Herein, we evaluated the effectivity of double-crosslinking with both EDC and GTA together with the capability of sodium metabisulfite (SM) and sodium borohydride (SB) to neutralize the toxicity and restore biocompatibility after crosslinking. The EDC-crosslinked collagen scaffolds were treated with different concentrations of GTA. To neutralize the free unreacted aldehyde groups, scaffolds were treated with SM or SB. The chemistry involved in these reactions together with the mechanical and functional properties of the collagen scaffolds was evaluated. The viability of the cells grown on the scaffolds was studied using different corneal cell types. The effect of each type of scaffold treatment on human monocyte differentiation was evaluated. One-way ANOVA was used for statistical analysis. The addition of GTA as a double-crosslinking agent significantly improved the mechanical properties and enzymatic stability of the EDC crosslinked collagen scaffold. GTA decreased cell biocompatibility but this effect was reversed by treatment with SB or SM. These agents did not affect the mechanical properties, enzymatic stability, or transparency of the double-crosslinked scaffold. Contact of monocytes with the different scaffolds did not trigger their differentiation into activated macrophages. Our results demonstrate that GTA improves the mechanical properties of EDC crosslinked scaffolds in a dose-dependent manner, and that subsequent treatment with SB or SM partially restores biocompatibility. This novel manufacturing approach would facilitate the translation of collagen-based artificial corneas to the clinical setting.
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Abbas M, Atiq A, Xing R, Yan X. Silver-incorporating peptide and protein supramolecular nanomaterials for biomedical applications. J Mater Chem B 2021; 9:4444-4458. [PMID: 33978051 DOI: 10.1039/d1tb00025j] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The natural biomolecules of peptides and proteins are able to form elegant metal incorporating supramolecular nanomaterials through multiple weak non-covalent interactions. The use of toxic chemical reagents to fabricate silver nanoparticles poses a danger to apply them in various biomedical applications. Peptide and protein biomolecules have the potential to overcome this barrier by the supramolecular chemistry approach. In this review, we focus on the self-assembly of peptides and proteins to synthesize silver incorporating supramolecular nanoarchitectures, which in turn enhance the biological properties of these silver nanomaterials being used in nanomedicine. This review aims to illustrate the recent developments in amphiphilic peptides, oligopeptides, collagen, bovine serum albumin (BSA), and human serum albumin (HSA) as capping, stabilizing, and reducing agents to form silver incorporating supramolecular nanostructures. Finally, we provide some biomedical applications of silver-incorporating supramolecular nanomaterials along with future perspectives.
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Affiliation(s)
- Manzar Abbas
- Institute for Molecules and Materials, Radboud University, Heyendaalseweg 135, 6525 AJ Nijmegen, The Netherlands.
| | - Atia Atiq
- Department of Physics, Division of Science and Technology, University of Education, Lahore, Pakistan
| | - Ruirui Xing
- State Key Laboratory of Biochemical Engineering, Institute of Process Engineering, Chinese Academy of Sciences, Beijing 100190, China. and Center for Mesoscience, Institute of Process Engineering, Chinese Academy of Sciences, Beijing 100190, China
| | - Xuehai Yan
- State Key Laboratory of Biochemical Engineering, Institute of Process Engineering, Chinese Academy of Sciences, Beijing 100190, China. and Center for Mesoscience, Institute of Process Engineering, Chinese Academy of Sciences, Beijing 100190, China
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57
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Gao Y, Peng K, Mitragotri S. Covalently Crosslinked Hydrogels via Step-Growth Reactions: Crosslinking Chemistries, Polymers, and Clinical Impact. ADVANCED MATERIALS (DEERFIELD BEACH, FLA.) 2021; 33:e2006362. [PMID: 33988273 DOI: 10.1002/adma.202006362] [Citation(s) in RCA: 75] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 11/24/2020] [Indexed: 06/12/2023]
Abstract
Hydrogels are an important class of biomaterials with the unique property of high-water content in a crosslinked polymer network. In particular, chemically crosslinked hydrogels have made a great clinical impact in past years because of their desirable mechanical properties and tunability of structural and chemical properties. Various polymers and step-growth crosslinking chemistries are harnessed for fabricating such covalently crosslinked hydrogels for translational research. However, selecting appropriate crosslinking chemistries and polymers for the intended clinical application is time-consuming and challenging. It requires the integration of polymer chemistry knowledge with thoughtful crosslinking reaction design. This task becomes even more challenging when other factors such as the biological mechanisms of the pathology, practical administration routes, and regulatory requirements add additional constraints. In this review, key features of crosslinking chemistries and polymers commonly used for preparing translatable hydrogels are outlined and their performance in biological systems is summarized. The examples of effective polymer/crosslinking chemistry combinations that have yielded clinically approved hydrogel products are specifically highlighted. These hydrogel design parameters in the context of the regulatory process and clinical translation barriers, providing a guideline for the rational selection of polymer/crosslinking chemistry combinations to construct hydrogels with high translational potential are further considered.
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Affiliation(s)
- Yongsheng Gao
- School of Engineering and Applied Sciences, Harvard University, Cambridge, MA, 02138, USA
- Wyss Institute of Biologically Inspired Engineering, Boston, MA, 02115, USA
| | - Kevin Peng
- School of Engineering and Applied Sciences, Harvard University, Cambridge, MA, 02138, USA
- Wyss Institute of Biologically Inspired Engineering, Boston, MA, 02115, USA
| | - Samir Mitragotri
- School of Engineering and Applied Sciences, Harvard University, Cambridge, MA, 02138, USA
- Wyss Institute of Biologically Inspired Engineering, Boston, MA, 02115, USA
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58
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Collagen analogs with phosphorylcholine are inflammation-suppressing scaffolds for corneal regeneration from alkali burns in mini-pigs. Commun Biol 2021; 4:608. [PMID: 34021240 PMCID: PMC8140136 DOI: 10.1038/s42003-021-02108-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 03/16/2021] [Indexed: 12/11/2022] Open
Abstract
The long-term survival of biomaterial implants is often hampered by surgery-induced inflammation that can lead to graft failure. Considering that most corneas receiving grafts are either pathological or inflamed before implantation, the risk of rejection is heightened. Here, we show that bioengineered, fully synthetic, and robust corneal implants can be manufactured from a collagen analog (collagen-like peptide-polyethylene glycol hybrid, CLP-PEG) and inflammation-suppressing polymeric 2-methacryloyloxyethyl phosphorylcholine (MPC) when stabilized with the triazine-based crosslinker 4-(4,6-Dimethoxy-1,3,5-triazin-2-yl)-4-methylmorpholinium chloride. The resulting CLP-PEG-MPC implants led to reduced corneal swelling, haze, and neovascularization in comparison to CLP-PEG only implants when grafted into a mini-pig cornea alkali burn model of inflammation over 12 months. Implants incorporating MPC allowed for faster nerve regeneration and recovery of corneal sensation. CLP-PEG-MPC implants appear to be at a more advanced stage of regeneration than the CLP-PEG only implants, as evidenced by the presence of higher amounts of cornea-specific type V collagen, and a corresponding decrease in the presence of extracellular vesicles and exosomes in the corneal stroma, in keeping with the amounts present in healthy, unoperated corneas.
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59
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Lace R, Duffy GL, Gallagher AG, Doherty KG, Maklad O, Wellings DA, Williams RL. Characterization of Tunable Poly-ε-Lysine-Based Hydrogels for Corneal Tissue Engineering. Macromol Biosci 2021; 21:e2100036. [PMID: 33955160 DOI: 10.1002/mabi.202100036] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 03/23/2021] [Indexed: 12/15/2022]
Abstract
A family of poly-ε-lysine hydrogels can be synthesized by crosslinking with bis-carboxylic acids using carbodiimide chemistry. In addition to creating hydrogels using a simple cast method, a fragmented method is used to introduce increased porosity within the hydrogel structure. Both methods have created tunable characteristics ranging in their mechanical properties, transparency, and water content, which is of interest to corneal tissue engineering and can be tailored to specific cellular needs and applications. With a worldwide shortage of cornea donor tissue available for transplant and limitations including rejection and potential infection, a synthetic material that can be used as a graft, or a partial thickness corneal replacement, would be an advantageous treatment method. These hydrogels can be tuned to have similar mechanical and transparency properties to the human cornea. They also support the attachment and growth of corneal epithelial cells and the integration of corneal stromal cells.
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Affiliation(s)
- Rebecca Lace
- Department of Eye and Vision Science, Institute of Life Course and Medical Science, University of Liverpool, Liverpool, L7 8TX, UK
| | - Georgia L Duffy
- Department of Eye and Vision Science, Institute of Life Course and Medical Science, University of Liverpool, Liverpool, L7 8TX, UK
| | - Andrew G Gallagher
- SpheriTech Ltd., Business and Technical Park, The Heath, Runcorn, WA7 4QX, UK
| | - Kyle G Doherty
- Department of Eye and Vision Science, Institute of Life Course and Medical Science, University of Liverpool, Liverpool, L7 8TX, UK
| | - Osama Maklad
- School of Engineering, University of Liverpool, Brownlow Hill, Liverpool, L69 3GH, UK
| | - Donald A Wellings
- SpheriTech Ltd., Business and Technical Park, The Heath, Runcorn, WA7 4QX, UK
| | - Rachel L Williams
- Department of Eye and Vision Science, Institute of Life Course and Medical Science, University of Liverpool, Liverpool, L7 8TX, UK
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Mishan MA, Balagholi S, Chamani T, Feizi S, Soheili ZS, Rezaei Kanavi M. Potential of a novel scaffold composed of human platelet lysate and fibrin for human corneal endothelial cells. Cell Tissue Bank 2021; 23:171-183. [PMID: 33939123 DOI: 10.1007/s10561-021-09931-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 03/08/2021] [Indexed: 12/13/2022]
Abstract
Cell-based therapies have been emerged to find innovative solutions for corneal endothelial dysfunction. The aim of this study is to investigate the suitability of a blended scaffold containing human platelet lysate (HPL) and fibrin not only for cultivating human corneal endothelial cells (HCECs) but also for serving as a scaffold for the respected cells. We isolated HCECs from human donors and encapsulated the cells with three concentrations of HPL/Fibrin scaffold, namely HPL/Fibrin 1, HPL/Fibrin 2 and HPL/Fibrin 3, by adding 28.9, 57.8 and 86.7 mg/dl of fibrinogen to HPL to obtain a final percentage of 10, 20 and 30 % of fibrinogen, respectively. SEM imaging and swelling test were done to characterize the scaffolds. Cell viability assay and cell counting were performed on the cells. HCECs were characterized by morphology and immunocytochemistry. SEM imaging on freeze-dried scaffolds showed higher porosity of HPL/Fibrin 1 and HPL/Fibrin 2 than HPL/Fibrin 3, but larger pores were observed only in HPL/Fibrin 1. Cellular attachment and morphology on HPL/Fibrin 1 were appropriate by SEM imaging. A higher swelling rate was observed in HPL/Fibrin 1. After 3 and 5 days, higher numbers of cells were observed specifically in HPL/Fibrin 1. A higher expression of Na+/K+-ATPase, ZO-1 and vimentin proteins was detected in the HPL/Fibrin 1-cultured HCECs as compared with control (no scaffold). HPL/Fibrin can be used as a suitable scaffold for HCECs while preserving the cells viability. Further investigations are necessitated to approve the beneficial effects of the suggested scaffold for delivering and transplantation of cultivated HCECs into the anterior chamber of the eye.
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Affiliation(s)
- Mohammad Amir Mishan
- Ocular Tissue Engineering Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, No.23, Paidarfard Street, Boostan 9 Street, Pasdaran Avenue, 1666673111, Tehran, Iran
| | - Sahar Balagholi
- Blood Transfusion Research Center, High Institute for Research and Education in Transfusion Medicine, Tehran, Iran
| | | | - Sepehr Feizi
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Mozhgan Rezaei Kanavi
- Ocular Tissue Engineering Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, No.23, Paidarfard Street, Boostan 9 Street, Pasdaran Avenue, 1666673111, Tehran, Iran.
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Ulag S, Uysal E, Bedir T, Sengor M, Ekren N, Ustundag CB, Midha S, Kalaskar DM, Gunduz O. Recent developments and characterization techniques in
3D
printing of corneal stroma tissue. POLYM ADVAN TECHNOL 2021. [DOI: 10.1002/pat.5340] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Songul Ulag
- Center for Nanotechnology & Biomaterials Application and Research (NBUAM) Marmara University Istanbul Turkey
| | - Ebru Uysal
- Department of Bioengineering, Faculty of Chemistry and Metallurgy Yildiz Technical University Istanbul Turkey
| | - Tuba Bedir
- Center for Nanotechnology & Biomaterials Application and Research (NBUAM) Marmara University Istanbul Turkey
| | - Mustafa Sengor
- Center for Nanotechnology & Biomaterials Application and Research (NBUAM) Marmara University Istanbul Turkey
| | - Nazmi Ekren
- Center for Nanotechnology & Biomaterials Application and Research (NBUAM) Marmara University Istanbul Turkey
| | - Cem Bulent Ustundag
- Center for Nanotechnology & Biomaterials Application and Research (NBUAM) Marmara University Istanbul Turkey
- Department of Bioengineering, Faculty of Chemistry and Metallurgy Yildiz Technical University Istanbul Turkey
| | - Swati Midha
- UCL Division of Surgery & Interventional Science University College London (UCL) London UK
| | - Deepak M. Kalaskar
- UCL Division of Surgery & Interventional Science University College London (UCL) London UK
| | - Oguzhan Gunduz
- Center for Nanotechnology & Biomaterials Application and Research (NBUAM) Marmara University Istanbul Turkey
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62
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Pourjabbar B, Biazar E, Heidari Keshel S, Ahani-Nahayati M, Baradaran-Rafii A, Roozafzoon R, Alemzadeh-Ansari MH. Bio-polymeric hydrogels for regeneration of corneal epithelial tissue*. INT J POLYM MATER PO 2021. [DOI: 10.1080/00914037.2021.1909586] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Affiliation(s)
- Bahareh Pourjabbar
- Department of Tissue Engineering and Applied Cell Sciences, School of Advanced Technologies in Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Esmaeil Biazar
- Tissue Engineering group, Department of Biomedical Engineering, Tonekabon Branch, Islamic Azad University, Tonekabon, Iran
| | - Saeed Heidari Keshel
- Department of Tissue Engineering and Applied Cell Sciences, School of Advanced Technologies in Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Milad Ahani-Nahayati
- Department of Tissue Engineering and Applied Cell Sciences, School of Advanced Technologies in Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Reza Roozafzoon
- Department of Tissue Engineering and Applied Cell Sciences, School of Advanced Technologies in Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Advanced Medical Sciences and Technologies, School of Paramedicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Mohammad Hasan Alemzadeh-Ansari
- Ophthalmic Research Center, Department of Ophthalmology, Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Sharifi S, Sharifi H, Guild C, Islam MM, Tran KD, Patzer C, Dohlman CH, Paschalis EI, Gonzalez-Andrades M, Chodosh J. Toward electron-beam sterilization of a pre-assembled Boston keratoprosthesis. Ocul Surf 2021; 20:176-184. [PMID: 33667673 DOI: 10.1016/j.jtos.2021.02.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 02/07/2021] [Accepted: 02/18/2021] [Indexed: 12/26/2022]
Abstract
PURPOSE To evaluate the effects of electron-beam (E-beam) irradiation on the human cornea and the potential for E-beam sterilization of Boston keratoprosthesis (BK) devices when pre-assembled with a donor cornea prior to sterilization. METHODS Human donor corneas and corneas pre-assembled in BK devices were immersed in recombinant human serum albumin (rHSA) media and E-beam irradiated at 25 kGy. Mechanical (tensile strength and modulus, and compression modulus), chemical, optical, structural, and degradation properties of the corneal tissue after irradiation and after 6 months of preservation were evaluated. RESULTS The mechanical evaluation showed that E-beam irradiation enhanced the tensile and compression moduli of human donor corneas, with no impact on their tensile strength. By chemical and mechanical analysis, E-beam irradiation caused a minor degree of crosslinking between collagen fibrils. No ultrastructural changes due to E-beam irradiation were observed. E-beam irradiation slightly increased the stability of the cornea against collagenase-induced degradation and had no impact on glucose diffusion. The optical evaluation showed transparency of the cornea was maintained. E-beam irradiated corneal tissues and BK-cornea pre-assembled devices were stable for 6 months after room-temperature preservation. CONCLUSIONS E-beam irradiation generated no detrimental effects on the corneal tissues or BK-cornea pre-assembled devices and improved native properties of the corneal tissue, enabling prolonged preservation at room temperature. The pre-assembly of BK in a donor cornea, followed by E-beam irradiation, offers the potential for an off-the-shelf, ready to implant keratoprosthesis device.
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Affiliation(s)
- Sina Sharifi
- Disruptive Technology Laboratory, Massachusetts Eye and Ear and Schepens Eye Research Institute, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - Hannah Sharifi
- Disruptive Technology Laboratory, Massachusetts Eye and Ear and Schepens Eye Research Institute, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| | | | - Mohammad Mirazul Islam
- Disruptive Technology Laboratory, Massachusetts Eye and Ear and Schepens Eye Research Institute, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - Khoa D Tran
- Vision Research Laboratory, Lions VisionGift, Portland, OR, USA
| | - Corrina Patzer
- Vision Research Laboratory, Lions VisionGift, Portland, OR, USA
| | - Claes H Dohlman
- Disruptive Technology Laboratory, Massachusetts Eye and Ear and Schepens Eye Research Institute, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - Eleftherios I Paschalis
- Disruptive Technology Laboratory, Massachusetts Eye and Ear and Schepens Eye Research Institute, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - Miguel Gonzalez-Andrades
- Disruptive Technology Laboratory, Massachusetts Eye and Ear and Schepens Eye Research Institute, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA; Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Department of Ophthalmology, Reina Sofia University Hospital and University of Cordoba, Cordoba, Spain.
| | - James Chodosh
- Disruptive Technology Laboratory, Massachusetts Eye and Ear and Schepens Eye Research Institute, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA.
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64
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El Zarif M, Alió JL, Alió Del Barrio JL, De Miguel MP, Abdul Jawad K, Makdissy N. Corneal Stromal Regeneration: A Review of Human Clinical Studies in Keratoconus Treatment. Front Med (Lausanne) 2021; 8:650724. [PMID: 33708786 PMCID: PMC7940685 DOI: 10.3389/fmed.2021.650724] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 01/28/2021] [Indexed: 12/18/2022] Open
Abstract
The use of advanced therapies with stem cells to reconstruct the complex tissue of corneal stroma has gained interest in recent years. Besides, collagen-based scaffolds bioengineering has been offered as another alternative over the last decade. The outcomes of the first clinical experience with stem cells therapy on corneal stroma regeneration in patients with advanced keratoconus were recently reported. Patients were distributed into three experimental groups: Group 1 (G-1) patients underwent implantation of autologous adipose-derived adult stem cells (ADASCs) alone, Group 2 (G-2) received a 120 μm decellularized donor corneal stromal laminas, and Group 3 (G-3) received a 120 μm recellularized donor laminas with ADASCs. A follow up of 36 months of clinical data, and 12 months of confocal microscopy study was performed, the authors found significant clinical improvement in almost all studied mean values of primary and secondary outcomes. Corneal confocal microscopy demonstrated an increase in cell density in the host stroma, as well as in the implanted tissue. Using different approaches, allogenic small incision lenticule extraction (SMILE) implantation was applied in cases with advanced keratoconus. Some authors reported the implantation of SMILE intrastromal lenticules combined with accelerated collagen cross-linking. Others performed intrastromal implantation of negative meniscus-shaped corneal stroma lenticules. Others have compared the outcomes of penetrating keratoplasty (PKP) vs. small-incision Intralase femtosecond (IFS) intracorneal concave lenticule implantation (SFII). Femtosecond laser-assisted small incision sutureless intrasotromal lamellar keratoplasty (SILK) has been also investigated. The published evidence shows that the implantation of autologous ADASCs, decellularized or recellularized human corneal stroma, allogenic SMILE lenticules corneal inlay, and recombinant cross-linked collagen have shown initially to be potentially effective for the treatment of advanced keratoconus. In light of the present evidence available, it can be said that the era of corneal stromal regeneration therapy has been already started.
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Affiliation(s)
- Mona El Zarif
- Optica General, Saida, Lebanon.,Division of Ophthalmology, Universidad Miguel Hernández, Alicante, Spain.,Faculty of Sciences, GSBT Genomic Surveillance and Biotherapy Team, Mont Michel Campus, Lebanese University, Beirut, Lebanon.,Doctoral School of Sciences and Technology, Lebanese University, Hadath, Lebanon
| | - Jorge L Alió
- Division of Ophthalmology, Universidad Miguel Hernández, Alicante, Spain.,Cornea, Cataract and Refractive Surgery Unit, Vissum (Miranza Group), Alicante, Spain
| | - Jorge L Alió Del Barrio
- Division of Ophthalmology, Universidad Miguel Hernández, Alicante, Spain.,Cornea, Cataract and Refractive Surgery Unit, Vissum (Miranza Group), Alicante, Spain
| | - Maria P De Miguel
- Cell Engineering Laboratory, IdiPAZ, La Paz Hospital Research Institute, Madrid, Spain
| | | | - Nehman Makdissy
- Faculty of Sciences, GSBT Genomic Surveillance and Biotherapy Team, Mont Michel Campus, Lebanese University, Beirut, Lebanon
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65
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Chen F, Buickians D, Le P, Xia X, Montague-Alamin SQ, Blanco Varela IB, Mundy DC, Logan CM, Myung D. 3D Printable, Modified Trephine Designs for Consistent Anterior Lamellar Keratectomy Wounds in Rabbits. Curr Eye Res 2021; 46:1105-1114. [PMID: 33474996 DOI: 10.1080/02713683.2020.1868010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
PURPOSE Our goal is to develop a low-cost tool that can be used to create consistent, partial-thickness defects in rabbit and other large animals with minimal surgical training and that can facilitate pre-clinical testing of lamellar and in situ-forming biosynthetic matrix materials for corneal repair. MATERIALS & METHODS In this study, three modified trephines were designed to create deep corneal wound defects with consistent depth in large animals. The modified trephines incorporated either 3D-printed parts made from photopolymerizable resins, or custom-cut commercially available Teflon sheets. Wound defects were imaged with optical coherence tomography (OCT), and the depth was analyzed based on the OCT images. RESULTS The results revealed that an inner-stopper guard trephine had the best performance in creating consistent and precise wound defect depth compared to modified vacuum trephine and custom guard vacuum trephine. A 75% ± 10% cut of the cornea was achieved with the inner-stopper guard trephine. The wound defect depth by created by the inner-stopper guard trephine was independent of the corneal thickness or size of the globes. Although the cut depth of the inner-stopper guard trephine differed by the experience-level of its users, the consistency (standard deviation) of the depth was independent of experience. CONCLUSIONS Our studies provided three cost-efficient animal trephines that can create corneal wounds of consistent depth by lab researchers without extensive training in keratectomy.
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Affiliation(s)
- Fang Chen
- Ophthalmology, Stanford University School of Medicine, Stanford, California, USA.,VA Palo Alto Health Care System, Palo Alto, California, USA
| | - David Buickians
- Ophthalmology, Stanford University School of Medicine, Stanford, California, USA
| | - Peter Le
- Ophthalmology, Stanford University School of Medicine, Stanford, California, USA.,VA Palo Alto Health Care System, Palo Alto, California, USA
| | - Xin Xia
- Ophthalmology, Stanford University School of Medicine, Stanford, California, USA
| | | | | | - David C Mundy
- Ophthalmology, Stanford University School of Medicine, Stanford, California, USA
| | - Caitlin M Logan
- Ophthalmology, Stanford University School of Medicine, Stanford, California, USA
| | - David Myung
- Ophthalmology, Stanford University School of Medicine, Stanford, California, USA.,VA Palo Alto Health Care System, Palo Alto, California, USA.,Chemical Engineering, Stanford University, Stanford, California, USA
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66
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Shahin A, Ramazani S.A A, Mehraji S, Eslami H. Synthesis and characterization of a chitosan/gelatin transparent film crosslinked with a combination of EDC/NHS for corneal epithelial cell culture scaffold with potential application in cornea implantation. INT J POLYM MATER PO 2021. [DOI: 10.1080/00914037.2020.1865349] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Ali Shahin
- Chemical and Petroleum Engineering Department, Sharif University of Technology, Tehran, Iran
| | - Ahmad Ramazani S.A
- Chemical and Petroleum Engineering Department, Sharif University of Technology, Tehran, Iran
| | - Sima Mehraji
- Chemical and Petroleum Engineering Department, Sharif University of Technology, Tehran, Iran
| | - Hamed Eslami
- Department of Biomedical Engineering Biomaterial, Science and Research Branch, Islamic Azad University, Tehran, Iran
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67
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Farasatkia A, Kharaziha M, Ashrafizadeh F, Salehi S. Transparent silk/gelatin methacrylate (GelMA) fibrillar film for corneal regeneration. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2021; 120:111744. [DOI: 10.1016/j.msec.2020.111744] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 10/20/2020] [Accepted: 11/18/2020] [Indexed: 12/13/2022]
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68
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Fertala A. Three Decades of Research on Recombinant Collagens: Reinventing the Wheel or Developing New Biomedical Products? Bioengineering (Basel) 2020; 7:E155. [PMID: 33276472 PMCID: PMC7712652 DOI: 10.3390/bioengineering7040155] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 11/16/2020] [Accepted: 11/23/2020] [Indexed: 02/07/2023] Open
Abstract
Collagens provide the building blocks for diverse tissues and organs. Furthermore, these proteins act as signaling molecules that control cell behavior during organ development, growth, and repair. Their long half-life, mechanical strength, ability to assemble into fibrils and networks, biocompatibility, and abundance from readily available discarded animal tissues make collagens an attractive material in biomedicine, drug and food industries, and cosmetic products. About three decades ago, pioneering experiments led to recombinant human collagens' expression, thereby initiating studies on the potential use of these proteins as substitutes for the animal-derived collagens. Since then, scientists have utilized various systems to produce native-like recombinant collagens and their fragments. They also tested these collagens as materials to repair tissues, deliver drugs, and serve as therapeutics. Although many tests demonstrated that recombinant collagens perform as well as their native counterparts, the recombinant collagen technology has not yet been adopted by the biomedical, pharmaceutical, or food industry. This paper highlights recent technologies to produce and utilize recombinant collagens, and it contemplates their prospects and limitations.
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Affiliation(s)
- Andrzej Fertala
- Department of Orthopaedic Surgery, Sidney Kimmel Medical College, Thomas Jefferson University, Curtis Building, Room 501, 1015 Walnut Street, Philadelphia, PA 19107, USA
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69
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El Zarif M, Alió Del Barrio JL, Arnalich-Montiel F, De Miguel MP, Makdissy N, Alió JL. Corneal Stroma Regeneration: New Approach for the Treatment of Cornea Disease. Asia Pac J Ophthalmol (Phila) 2020; 9:571-579. [PMID: 33181549 DOI: 10.1097/apo.0000000000000337] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Corneal grafting is one of the most common forms of human tissue transplantation. The corneal stroma is responsible for many characteristics of the cornea. For these reasons, an important volume of research has been made to replicate the corneal stroma in the laboratory to find an alternative to classical corneal transplantation techniques.There is an increasing interest today in cell therapy of the corneal stroma using induced pluripotent stem cells or mesenchymal stem cells since these cells have shown to be capable of producing new collagen within the host stroma and even to improve its transparency.The first clinical experiment on corneal stroma regeneration in advanced keratoconus cases has been reported and included. Fourteen patients were randomized and enrolled into 3 experimental groups: (1) patients underwent implantation of autologous adipose-derived adult stem cells alone, (2) patients received decellularized donor corneal stroma laminas, and (3) patients received implantation of recellularized donor laminas with adipose-derived adult stem cells. Clinical improvement was detected with all cases in their visual, pachymetric, and topographic parameters of the operated corneas.Other recent studies have used allogenic SMILE implantation lenticule corneal inlays, showing also an improvement in different visual, topographic, and keratometric parameters.In the present report, we try to summarize the available preclinical and clinical evidence about the emerging topic of corneal stroma regeneration.
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Affiliation(s)
- M El Zarif
- Optica General, Saida, Lebanon
- Division of Ophthalmology, Universidad Miguel Hernández University, Alicante, Spain
- Lebanese University, Faculty of Sciences, Genomic Surveillance and Biotherapy Team, Mont Michel Campus, Lebanon
- Lebanese University, Doctoral School of Sciences and Technology, Hadath, Lebanon
| | - J L Alió Del Barrio
- Cornea, Cataract, and Refractive Surgery Unit, Vissum Corporación, Alicante, Spain
- Division of Ophthalmology, Universidad Miguel Hernández University, Alicante, Spain
| | - Francisco Arnalich-Montiel
- Cornea, Cataract, and Refractive Surgery Unit, Vissum Corporación, Alicante, Spain
- IRYCIS, Ophthalmology Department, Ramón y Cajal University Hospital, Madrid, Spain
| | - María P De Miguel
- Cell Engineering Laboratory, IdiPAZ, La Paz Hospital Research Institute, Madrid, Spain
| | - Nehman Makdissy
- Lebanese University, Faculty of Sciences, Genomic Surveillance and Biotherapy Team, Mont Michel Campus, Lebanon
| | - Jorge L Alió
- Cornea, Cataract, and Refractive Surgery Unit, Vissum Corporación, Alicante, Spain
- Division of Ophthalmology, Universidad Miguel Hernández University, Alicante, Spain
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70
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Nosrati H, Alizadeh Z, Nosrati A, Ashrafi-Dehkordi K, Banitalebi-Dehkordi M, Sanami S, Khodaei M. Stem cell-based therapeutic strategies for corneal epithelium regeneration. Tissue Cell 2020; 68:101470. [PMID: 33248403 DOI: 10.1016/j.tice.2020.101470] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 11/11/2020] [Accepted: 11/11/2020] [Indexed: 12/13/2022]
Abstract
Any significant loss of vision or blindness caused by corneal damages is referred to as corneal blindness. Corneal blindness is the fourth most common cause of blindness worldwide, representing more than 5% of the total blind population. Currently, corneal transplantation is used to treat many corneal diseases. In some cases, implantation of artificial cornea (keratoprosthesis) is suggested after a patient has had a donor corneal transplant failure. The shortage of donors and the side effects of keratoprosthesis are limiting these approaches. Recently, researchers have been actively pursuing new approaches for corneal regeneration because of these limitations. Nowadays, tissue engineering of different corneal layers (epithelium, stroma, endothelium, or full thickness tissue) is a promising approach that has attracted a great deal of interest from researchers and focuses on regenerative strategies using different cell sources and biomaterials. Various sources of corneal and non-corneal stem cells have shown significant advantages for corneal epithelium regeneration applications. Pluripotent stem cells (embryonic stem cells and iPS cells), epithelial stem cells (derived from oral mucus, amniotic membrane, epidermis and hair follicle), mesenchymal stem cells (bone marrow, adipose-derived, amniotic membrane, placenta, umbilical cord), and neural crest origin stem cells (dental pulp stem cells) are the most promising sources in this regard. These cells could also be used in combination with natural or synthetic scaffolds to improve the efficacy of the therapeutic approach. As the ocular surface is exposed to external damage, the number of studies on regeneration of the corneal epithelium is rising. In this paper, we reviewed the stem cell-based strategies for corneal epithelium regeneration.
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Affiliation(s)
- Hamed Nosrati
- Department of Tissue Engineering and Applied Cell Sciences, School of Advanced Technologies, Shahrekord University of Medical Sciences, Shahrekord, Iran.
| | - Zohreh Alizadeh
- Endometrium and Endometriosis Research Center, Hamadan University of Medical Sciences, Hamadan, Iran; Department of Anatomical Sciences, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Ali Nosrati
- School of Mechanical Engineering, College of Engineering, University of Tehran, Tehran, Iran
| | - Korosh Ashrafi-Dehkordi
- Department of Molecular Medicine, School of Advanced Technologies, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Mehdi Banitalebi-Dehkordi
- Department of Molecular Medicine, School of Advanced Technologies, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Samira Sanami
- Department of Medical Biotechnology, School of Advanced Technologies, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Mohammad Khodaei
- Department of Materials Science and Engineering, Golpayegan University of Technology, Golpayegan, Iran
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71
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Hancox Z, Heidari Keshel S, Yousaf S, Saeinasab M, Shahbazi MA, Sefat F. The progress in corneal translational medicine. Biomater Sci 2020; 8:6469-6504. [PMID: 33174878 DOI: 10.1039/d0bm01209b] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Cornea tissue is in high demand by tissue donation centres globally, and thus tissue engineering cornea, which is the main topic of corneal translational medicine, can serve as a limitless alternative to a donated human cornea tissue. Tissue engineering aims to produce solutions to the challenges associated with conventional cornea tissue, including transplantation and use of human amniotic membrane (HAM), which have issues with storage and immune rejection in patients. Accordingly, by carefully selecting biomaterials and fabrication methods to produce these therapeutic tissues, the demand for cornea tissue can be met, with an improved healing outcome for recipients with less associated harmful risks. In this review paper, we aim to present the recent advancements in the research and clinical applications of cornea tissue, applications including biomaterial selection, fabrication methods, scaffold structure, cellular response to these scaffolds, and future advancements of these techniques.
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Affiliation(s)
- Zoe Hancox
- Department of Biomedical and Electronics Engineering, School of Engineering, University of Bradford, Bradford, UK.
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72
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Nosrati H, Abpeikar Z, Mahmoudian ZG, Zafari M, Majidi J, Alizadeh A, Moradi L, Asadpour S. Corneal epithelium tissue engineering: recent advances in regeneration and replacement of corneal surface. Regen Med 2020; 15:2029-2044. [PMID: 33169642 DOI: 10.2217/rme-2019-0055] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Currently, many corneal diseases are treated by corneal transplantation, artificial corneal implantation or, in severe cases, keratoprosthesis. Owing to the shortage of cornea donors and the risks involved with artificial corneal implants, such as infection transmission, researchers continually seek new approaches for corneal regeneration. Corneal tissue engineering is a promising approach that has attracted much attention from researchers and is focused on regenerative strategies using various biomaterials in combination with different cell types. These constructs should have the ability to mimic the native tissue microenvironment and present suitable optical, mechanical and biological properties. In this article, we review studies that have focused on the current clinical techniques for corneal replacement. We also describe tissue-engineering and cell-based approaches for corneal regeneration.
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Affiliation(s)
- Hamed Nosrati
- Department of Tissue Engineering & Applied Cell Sciences, School of Advanced Technologies, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Zahra Abpeikar
- Department of Tissue Engineering & Applied Cell Sciences, School of Advanced Technologies, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Zahra Gholami Mahmoudian
- Department of Anatomical Sciences, Medical School, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mahdi Zafari
- Department of Bacteriology, Pasteur Institute of Iran, Tehran, Iran
| | - Jafar Majidi
- Cellular & Molecular Research Center, Basic Health Science Institute, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Akram Alizadeh
- Department of Tissue Engineering & Applied Cell Sciences, Faculty of Medicine, Semnan University of Medical Sciences, Semnan, Iran
| | - Lida Moradi
- The Ronald O Perelman Department of Dermatology, New York University, School of Medicine, New York, NY 10016, USA.,Department of Cell Biology, New York University, School of Medicine, New York, NY, 10016 USA
| | - Shiva Asadpour
- Department of Tissue Engineering & Applied Cell Sciences, School of Advanced Technologies, Shahrekord University of Medical Sciences, Shahrekord, Iran.,Cellular & Molecular Research Center, Basic Health Science Institute, Shahrekord University of Medical Sciences, Shahrekord, Iran
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73
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Alió Del Barrio JL, Arnalich-Montiel F, De Miguel MP, El Zarif M, Alió JL. Corneal stroma regeneration: Preclinical studies. Exp Eye Res 2020; 202:108314. [PMID: 33164825 DOI: 10.1016/j.exer.2020.108314] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 10/13/2020] [Accepted: 10/15/2020] [Indexed: 12/13/2022]
Abstract
Corneal grafting is one of the most common and successful forms of human tissue transplantation in the world, but the need for corneal grafting is growing and availability of human corneal donor tissue to fulfill this increasing demand is not assured worldwide. The stroma is responsible for many features of the cornea, including its strength, refractive power and transparency, so enormous efforts have been put into replicating the corneal stroma in the laboratory to find an alternative to classical corneal transplantation. Unfortunately this has not been yet accomplished due to the extreme difficulty in mimicking the highly complex ultrastructure of the corneal stroma, and none of the obtained substitutes that have been assayed has been able to replicate this complexity yet. In general, they can neither match the mechanical properties nor recreate the local nanoscale organization and thus the transparency and optical properties of a normal cornea. In this context, there is an increasing interest in cellular therapy of the corneal stroma using Induced Pluripotent Stem Cells (iPSCs) or mesenchymal stem cells (MSCs) from either ocular or extraocular sources, as they have proven to be capable of producing new collagen within the host stroma, modulate preexisting scars and enhance transparency by corneal stroma remodeling. Despite some early clinical data is already available, in the current article we will summary the available preclinical evidence about the topic corneal stroma regeneration. Both, in vitro and in vivo experiments in the animal model will be shown.
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Affiliation(s)
- Jorge L Alió Del Barrio
- Cornea, Cataract and Refractive Surgery Unit, Vissum (Miranza Group), Alicante, Spain; Division of Ophthalmology, Universidad Miguel Hernández, Alicante, Spain
| | - Francisco Arnalich-Montiel
- IRYCIS. Ophthalmology Department. Ramón y Cajal University Hospital, Madrid, Spain; Cornea Unit. Hospital Vissum Madrid (Miranza Group), Madrid, Spain
| | - María P De Miguel
- Cell Engineering Laboratory, IdiPAZ, La Paz Hospital Research Institute, Madrid, Spain
| | | | - Jorge L Alió
- Cornea, Cataract and Refractive Surgery Unit, Vissum (Miranza Group), Alicante, Spain; Division of Ophthalmology, Universidad Miguel Hernández, Alicante, Spain.
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74
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Collagen-based scaffolds with infused anti-VEGF release system as potential cornea substitute for high-risk keratoplasty: A preliminary in vitro evaluation. Heliyon 2020; 6:e05105. [PMID: 33033763 PMCID: PMC7533359 DOI: 10.1016/j.heliyon.2020.e05105] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 08/30/2020] [Accepted: 09/25/2020] [Indexed: 12/13/2022] Open
Abstract
Currently the only widely accepted corneal blindness treatment is human donor cornea transplantation. However, increasing shortage of donor corneas as well as high risk of rejection in some corneal diseases remain two major problems, which limit the success of corneal transplantation. Corneal neovascularization is considered as one of the main risk factors of graft failure. Different cell-free biosynthetic scaffolds fabricated from collagens or collagen-like peptides are being tested as donor cornea substitutes (DCS). Here, we report for the first-time composite biosynthetic DCS with integrated sustained release system of anti-VEGF drug, bevacizumab and their preliminary in vitro validation. We have tethered gold nanoparticles with bevacizumab and integrated into a collagen-based cell-free hydrogel scaffold. Developed grafts preserved good optical properties and were confirmed not toxic to human corneal epithelial cells. Bevacizumab has been shown to constantly releasing from the DCS up to 3 weeks and preserved its anti-angiogenic properties. These results provide background for further use of infused composite biosynthetic DCS with integrated nanosystem of bevacizumab sustained release in corneal disease accompanied by neovascularisation where conventional corneal transplantation might fail.
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75
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Xeroudaki M, Thangavelu M, Lennikov A, Ratnayake A, Bisevac J, Petrovski G, Fagerholm P, Rafat M, Lagali N. A porous collagen-based hydrogel and implantation method for corneal stromal regeneration and sustained local drug delivery. Sci Rep 2020; 10:16936. [PMID: 33037282 PMCID: PMC7547117 DOI: 10.1038/s41598-020-73730-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 09/07/2020] [Indexed: 12/24/2022] Open
Abstract
Biomaterials designed to replace the diseased cornea could be used to treat corneal blindness where human donor tissue is in short supply, but challenges are the integration of biomaterials with host tissue and cells, avoiding a rapid material degradation and maintaining corneal transparency. Additionally, implantation surgery often triggers an aggressive wound healing response that can lead to corneal thinning and opacity. Here, we report a collagen-based hydrogel with transparency and mechanical properties suitable for replacing a substantial portion of a damaged or diseased corneal stroma. The porous hydrogel permitted migration and population by host cells while maintaining transparency and thickness six months after surgical implantation in an in vivo model of human corneal surgery. With a novel hybrid surgical implantation technique inspired by LASIK refractive surgery, rapid wound healing occurred around implants to maintain biomaterial integrity, transparency and function. Host stromal cell repopulation and regeneration of host epithelium and nerves were observed, as necessary steps towards corneal regeneration. Finally, as a proof-of-principle, the hydrogel loaded with a neuroregenerative drug achieved sustained slow-release drug delivery in vitro. The proposed hydrogel and novel implantation technique together represent a therapeutic approach with translational potential for replacing and regenerating diseased corneal stromal tissue.
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Affiliation(s)
- Maria Xeroudaki
- Department of Ophthalmology, Institute for Biomedical and Clinical Sciences, Linköping University, 58183, Linköping, Sweden
| | - Muthukumar Thangavelu
- Department of Ophthalmology, Institute for Biomedical and Clinical Sciences, Linköping University, 58183, Linköping, Sweden
- Department of Biomedical Engineering, Linköping University, 58185, Linköping, Sweden
- LinkoCare Life Sciences AB, 58330, Linköping, Sweden
| | - Anton Lennikov
- Department of Ophthalmology, Institute for Biomedical and Clinical Sciences, Linköping University, 58183, Linköping, Sweden
| | | | - Jovana Bisevac
- Department of Ophthalmology, Centre for Eye Research, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Goran Petrovski
- Department of Ophthalmology, Centre for Eye Research, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Per Fagerholm
- Department of Ophthalmology, Institute for Biomedical and Clinical Sciences, Linköping University, 58183, Linköping, Sweden
| | - Mehrdad Rafat
- Department of Biomedical Engineering, Linköping University, 58185, Linköping, Sweden.
- LinkoCare Life Sciences AB, 58330, Linköping, Sweden.
| | - Neil Lagali
- Department of Ophthalmology, Institute for Biomedical and Clinical Sciences, Linköping University, 58183, Linköping, Sweden.
- Department of Ophthalmology, Sørlandet Hospital Arendal, Arendal, Norway.
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76
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Mahdavi SS, Abdekhodaie MJ, Mashayekhan S, Baradaran-Rafii A, Djalilian AR. Bioengineering Approaches for Corneal Regenerative Medicine. Tissue Eng Regen Med 2020; 17:567-593. [PMID: 32696417 PMCID: PMC7373337 DOI: 10.1007/s13770-020-00262-8] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 04/06/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Since the cornea is responsible for transmitting and focusing light into the eye, injury or pathology affecting any layer of the cornea can cause a detrimental effect on visual acuity. Aging is also a reason for corneal degeneration. Depending on the level of the injury, conservative therapies and donor tissue transplantation are the most common treatments for corneal diseases. Not only is there a lack of donor tissue and risk of infection/rejection, but the inherent ability of corneal cells and layers to regenerate has led to research in regenerative approaches and treatments. METHODS In this review, we first discussed the anatomy of the cornea and the required properties for reconstructing layers of the cornea. Regenerative approaches are divided into two main categories; using direct cell/growth factor delivery or using scaffold-based cell delivery. It is expected delivered cells migrate and integrate into the host tissue and restore its structure and function to restore vision. Growth factor delivery also has shown promising results for corneal surface regeneration. Scaffold-based approaches are categorized based on the type of scaffold, since it has a significant impact on the efficiency of regeneration, into the hydrogel and non-hydrogel based scaffolds. Various types of cells, biomaterials, and techniques are well covered. RESULTS The most important characteristics to be considered for biomaterials in corneal regeneration are suitable mechanical properties, biocompatibility, biodegradability, and transparency. Moreover, a curved shape structure and spatial arrangement of the fibrils have been shown to mimic the corneal extracellular matrix for cells and enhance cell differentiation. CONCLUSION Tissue engineering and regenerative medicine approaches showed to have promising outcomes for corneal regeneration. However, besides proper mechanical and optical properties, other factors such as appropriate sterilization method, storage, shelf life and etc. should be taken into account in order to develop an engineered cornea for clinical trials.
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Affiliation(s)
- S Sharareh Mahdavi
- Department of Chemical and Petroleum Engineering, Sharif University of Technology, 1393 Azadi Ave., Tehran, 11365-11155, Iran
| | - Mohammad J Abdekhodaie
- Department of Chemical and Petroleum Engineering, Sharif University of Technology, 1393 Azadi Ave., Tehran, 11365-11155, Iran.
| | - Shohreh Mashayekhan
- Department of Chemical and Petroleum Engineering, Sharif University of Technology, 1393 Azadi Ave., Tehran, 11365-11155, Iran
| | - Alireza Baradaran-Rafii
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, SBUMS, Arabi Ave, Daneshjoo Blvd, Velenjak, Tehran, 19839-63113, Iran
| | - Ali R Djalilian
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, 1200 W Harrison St, Chicago, IL, 60607, USA
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Tidu A, Schanne-Klein MC, Borderie VM. Development, structure, and bioengineering of the human corneal stroma: A review of collagen-based implants. Exp Eye Res 2020; 200:108256. [PMID: 32971095 DOI: 10.1016/j.exer.2020.108256] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 09/17/2020] [Accepted: 09/18/2020] [Indexed: 01/15/2023]
Abstract
Bio-engineering technologies are currently used to produce biomimetic artificial corneas that should present structural, chemical, optical, and biomechanical properties close to the native tissue. These properties are mainly supported by the corneal stroma which accounts for 90% of corneal thickness and is mainly made of collagen type I. The stromal collagen fibrils are arranged in lamellae that have a plywood-like organization. The fibril diameter is between 25 and 35 nm and the interfibrillar space about 57 nm. The number of lamellae in the central stroma is estimated to be 300. In the anterior part, their size is 10-40 μm. They appear to be larger in the posterior part of the stroma with a size of 60-120 μm. Their thicknesses also vary from 0.2 to 2.5 μm. During development, the acellular corneal stroma, which features a complex pattern of organization, serves as a scaffold for mesenchymal cells that invade and further produce the cellular stroma. Several pathways including Bmp4, Wnt/β-catenin, Notch, retinoic acid, and TGF-β, in addition to EFTFs including the mastering gene Pax-6, are involved in corneal development. Besides, retinoic acid and TGF- β seem to have a crucial role in the neural crest cell migration in the stroma. Several technologies can be used to produce artificial stroma. Taking advantage of the liquid-crystal properties of acid-soluble collagen, it is possible to produce transparent stroma-like matrices with native-like collagen I fibrils and plywood-like organization, where epithelial cells can adhere and proliferate. Other approaches include the use of recombinant collagen, cross-linkers, vitrification, plastically compressed collagen or magnetically aligned collagen, providing interesting optical and mechanical properties. These technologies can be classified according to collagen type and origin, presence of telopeptides and native-like fibrils, structure, and transparency. Collagen matrices feature transparency >80% for the appropriate 500-μm thickness. Non-collagenous matrices made of biopolymers including gelatin, silk, or fish scale have been developed which feature interesting properties but are less biomimetic. These bioengineered matrices still need to be colonized by stromal cells to fully reproduce the native stroma.
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Affiliation(s)
- Aurélien Tidu
- Institut de la Vision, Sorbonne Université, INSERM, CNRS, Centre Hospitalier, National d'Ophtalmologie des 15-20, 75571, Paris, France; Groupe de Recherche Clinique 32, Sorbonne Université, Paris, France
| | - Marie-Claire Schanne-Klein
- Laboratory for Optics and Biosciences, LOB, Ecole Polytechnique, CNRS, Inserm, Université Paris-Saclay, 91128, Palaiseau, France
| | - Vincent M Borderie
- Institut de la Vision, Sorbonne Université, INSERM, CNRS, Centre Hospitalier, National d'Ophtalmologie des 15-20, 75571, Paris, France; Groupe de Recherche Clinique 32, Sorbonne Université, Paris, France.
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78
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Li H, Zhao L, Wang F, Wang H, Dong M, Liu T, Ruan T, Zhou M, Zhou Q, Xie L. Natural cross-linker-stabilized acellular porcine corneal stroma for lamellar keratoplasty. Acta Biomater 2020; 114:270-284. [PMID: 32702529 DOI: 10.1016/j.actbio.2020.07.035] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 07/16/2020] [Accepted: 07/16/2020] [Indexed: 01/12/2023]
Abstract
Acellular porcine corneal stroma (APCS) is a promising alternative to human donor cornea for lamellar keratoplasty (LKP). However, the detergents, enzymes and physical forces used during decellularization unavoidably alter the cornea's extracellular matrix composition and disrupt its ultrastructure, making it less mechanically stable and liable to degradation both in vitro and in vivo. Herein, we systematically analyzed the low biomechanics and easy degradability of APCS in terms of structure and protein composition. Then, we introduced natural cross-linkers, namely proanthocyanidin (PA), epigallocatechin-3-gallate and genipin, to stabilize the APCS that exhibited color variations during crosslinking. Then, we developed a protective crosslinking system by combining cross-linkers with bovine serum albumin (BSA) to reduce color change, maintain transparency and improve the mechanical property of APCS. PA/BSA-crosslinked APCS (PA/BSA-APCS) shows favorable corneal transparency and swelling property; the improved overall and surface corneal biomechanics were comparable to those of human cornea, revealing strong resistance to enzymatic degradation and good biocompatibility. Results from LKP in the rabbit model showed complete re-epithelialization without graft melting, the stitches were scarcely loosened after the operation and more host keratocytes had migrated in PA/BSA-APCS at six months post-operation. Therefore, PA/BSA-APCS could be useful as a corneal substitute for tissue regeneration and the protective crosslinking system could be applicable in other bioengineering fields.
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Affiliation(s)
- Hua Li
- Department of Ophthalmology, Clinical Medical College of Shandong University, Jinan, China; 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
| | - Long Zhao
- 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
| | - Fuyan Wang
- Department of Ophthalmology, Clinical Medical College of Shandong University, Jinan, China; 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
| | - Hongwei Wang
- 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; Qingdao Eye Hospital of Shandong First Medical University, Qingdao, China
| | - Muchen Dong
- 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; Eye Hospital of Shandong First Medical Universtiy, Jinan, China
| | - Ting Liu
- 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; Qingdao Eye Hospital of Shandong First Medical University, Qingdao, China
| | - Ting Ruan
- 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
| | - Mingming Zhou
- 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; Qingdao Eye Hospital of Shandong First Medical University, Qingdao, China
| | - Qingjun Zhou
- 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; Qingdao Eye Hospital of Shandong First Medical University, Qingdao, China.
| | - Lixin Xie
- 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; Qingdao Eye Hospital of Shandong First Medical University, Qingdao, China.
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79
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Fuest M, Yam GHF, Mehta JS, Duarte Campos DF. Prospects and Challenges of Translational Corneal Bioprinting. Bioengineering (Basel) 2020; 7:bioengineering7030071. [PMID: 32640721 PMCID: PMC7552635 DOI: 10.3390/bioengineering7030071] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 07/01/2020] [Accepted: 07/04/2020] [Indexed: 12/13/2022] Open
Abstract
Corneal transplantation remains the ultimate treatment option for advanced stromal and endothelial disorders. Corneal tissue engineering has gained increasing interest in recent years, as it can bypass many complications of conventional corneal transplantation. The human cornea is an ideal organ for tissue engineering, as it is avascular and immune-privileged. Mimicking the complex mechanical properties, the surface curvature, and stromal cytoarchitecure of the in vivo corneal tissue remains a great challenge for tissue engineering approaches. For this reason, automated biofabrication strategies, such as bioprinting, may offer additional spatial control during the manufacturing process to generate full-thickness cell-laden 3D corneal constructs. In this review, we discuss recent advances in bioprinting and biomaterials used for in vitro and ex vivo corneal tissue engineering, corneal cell-biomaterial interactions after bioprinting, and future directions of corneal bioprinting aiming at engineering a full-thickness human cornea in the lab.
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Affiliation(s)
- Matthias Fuest
- Department of Ophthalmology, RWTH Aachen University, 52074 Aachen, Germany
- Correspondence: (M.F.); (D.F.D.C.)
| | - Gary Hin-Fai Yam
- Department of Ophthalmology, University of Pittsburgh, Pittsburgh, PA 15260, USA;
| | - Jodhbir S. Mehta
- Tissue Engineering and Stem Cell Group, Singapore Eye Research Institute, Singapore 169856, Singapore;
- Singapore National Eye Centre, Singapore 169856, Singapore
| | - Daniela F. Duarte Campos
- Institute of Applied Medical Engineering, RWTH Aachen University, 52074 Aachen, Germany
- DWI Leibniz Institute for Interactive Materials, 52074 Aachen, Germany
- Correspondence: (M.F.); (D.F.D.C.)
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80
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Fernández-Pérez J, Madden PW, Ahearne M. Engineering a Corneal Stromal Equivalent Using a Novel Multilayered Fabrication Assembly Technique. Tissue Eng Part A 2020; 26:1030-1041. [PMID: 32368948 PMCID: PMC7580631 DOI: 10.1089/ten.tea.2020.0019] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
To overcome the serious shortage of donor corneas for transplantation, alternatives based on tissue engineering need to be developed. Decellularized corneas are one potential alternative, but their densely packed collagen architecture inhibits recellularization in vitro. Therefore, a new rapid method of recellularizing these constructs to ensure high cellularity throughout the collagen scaffold is needed. In this study, we developed a novel method for fabricating corneal constructs by using decellularized porcine corneal sheets assembled using a bottom-up approach by layering multiple sheets between cell-laden collagen I hydrogel. Corneal lenticules were cut from porcine corneas by cryosectioning, then decellularized with detergents and air-dried for storage as sheets. Human corneal stromal cells were encapsulated in collagen I hydrogel and cast between the dried sheets. Constructs were cultured in serum-free medium supplemented with ascorbic acid and insulin for 2 weeks. Epithelial cells were then seeded on the surface and cultured for an additional week. Transparency, cell viability, and phenotype were analyzed by qPCR, histology, and immunofluorescence. Constructs without epithelial cells were sutured onto an ex vivo porcine cornea and cultured for 1 week. Lenticules were successfully decellularized, achieving dsDNA values of 13 ± 1.2 ng/mg dry tissue, and were more resistant to degradation than the collagen I hydrogels. Constructs maintained high cell viability with a keratocyte-like phenotype with upregulation of keratocan, decorin, lumican, collagen I, ALDH3A1, and CD34 and the corneal epithelial cells stratified with a cobblestone morphology. The construct was amenable to surgical handling and no tearing occurred during suturing. After 7 days ex vivo, constructs were covered by a neoepithelium from the host porcine cells and integration into the host stroma was observed. This study describes a novel approach toward fabricating anterior corneal substitutes in a simple and rapid manner, obtaining mature and suturable constructs using only tissue-derived materials.
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Affiliation(s)
- Julia Fernández-Pérez
- Department of Mechanical and Manufacturing Engineering, School of Engineering, Trinity College Dublin, University of Dublin, Dublin, Ireland.,Trinity Center for Biomedical Engineering, Trinity Biomedical Science Institute, Trinity College Dublin, University of Dublin, Dublin, Ireland
| | - Peter W Madden
- Department of Mechanical and Manufacturing Engineering, School of Engineering, Trinity College Dublin, University of Dublin, Dublin, Ireland.,Trinity Center for Biomedical Engineering, Trinity Biomedical Science Institute, Trinity College Dublin, University of Dublin, Dublin, Ireland
| | - Mark Ahearne
- Department of Mechanical and Manufacturing Engineering, School of Engineering, Trinity College Dublin, University of Dublin, Dublin, Ireland.,Trinity Center for Biomedical Engineering, Trinity Biomedical Science Institute, Trinity College Dublin, University of Dublin, Dublin, Ireland
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81
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Sutureless Femtosecond Laser-Assisted Anterior Lamellar Keratoplasty Using a Bioengineered Cornea as a Viable Alternative to Human Donor Transplantation for Superficial Corneal Opacities. Cornea 2020; 39:1184-1189. [PMID: 32558727 DOI: 10.1097/ico.0000000000002394] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate the safety and efficacy of a bioengineered corneal implant using femtosecond laser-assisted anterior lamellar keratoplasty for superficial corneal opacities. METHODS Six eyes of 6 consecutive patients with superficial corneal stromal opacities involving <220 μm owing to various pathologies were included in the study. Preoperatively, all patients underwent anterior segment optical coherence tomography (Visante; Carl Zeiss Meditec AG) to evaluate the depth of the corneal opacity. All patients underwent sutureless femtosecond laser-assisted anterior lamellar keratoplasty using a bioengineered collagen corneal implant (linkcor). Visual indices, refraction, and keratometry were evaluated preoperatively and 12 months postoperatively. RESULTS Corrected distance visual acuity improved significantly in all patients (P = 0.02). A significant decrease was seen in refractive astigmatism postoperatively (P = 0.04). Flat keratometry reduced significantly 12 months after the intervention (P = 0.04). No intraoperative or early postoperative complications were noticed. All implants were fully covered by healthy epithelium within a month after the surgery and remained clear at follow-up visits. The results of this procedure remained stable throughout the follow-up period. In 1 patient, mild inferior collagen melting and epithelial defect formation occurred at 1-year follow-up. Despite frequent topical corticosteroid therapy the melting progressed, the collagen tissue was removed and the patient was treated accordingly with good visual outcomes. CONCLUSIONS Femtosecond laser-assisted anterior lamellar keratoplasty with bioengineered corneal (linkcor) implantation is an effective treatment for improving vision quality in anterior stromal opacities. This procedure reduces the need for human donor tissue and avoids human donor-related and suturing complications.
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82
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Abstract
Human corneal transplantation (keratoplasty) is typically considered to have superior short- and long-term outcomes and lower requirement for immunosuppression compared to solid organ transplants because of the inherent immune privilege and tolerogenic mechanisms associated with the anterior segment of the eye. However, in a substantial proportion of corneal transplants, the rates of acute rejection and/or graft failure are comparable to or greater than those of the commonly transplanted solid organs. Critically, while registry data and observational studies have helped to identify factors that are associated with increased risk of corneal transplant failure, the extent to which these risk factors operate through enhancing immune-mediated rejection is less clear. In this overview, we summarize a range of important recent clinical and basic insights related to high-risk corneal transplantation, the factors associated with graft failure, and the immunological basis of corneal allograft rejection. We highlight critical research areas from which continued progress is likely to drive improvements in the long-term survival of high-risk corneal transplants. These include further development and clinical testing of predictive risk scores and assays; greater use of multicenter clinical trials to optimize immunosuppressive therapy in high-risk recipients and robust clinical translation of novel, mechanistically-targeted immunomodulatory and regenerative therapies that are emerging from basic science laboratories. We also emphasize the relative lack of knowledge regarding transplant outcomes for infection-related corneal diseases that are common in the developing world and the potential for greater cross-pollination and synergy between corneal and solid organ transplant research communities.
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83
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Stereolithography 3D Bioprinting Method for Fabrication of Human Corneal Stroma Equivalent. Ann Biomed Eng 2020; 48:1955-1970. [DOI: 10.1007/s10439-020-02537-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Accepted: 05/14/2020] [Indexed: 12/22/2022]
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84
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McTiernan CD, Simpson FC, Haagdorens M, Samarawickrama C, Hunter D, Buznyk O, Fagerholm P, Ljunggren MK, Lewis P, Pintelon I, Olsen D, Edin E, Groleau M, Allan BD, Griffith M. LiQD Cornea: Pro-regeneration collagen mimetics as patches and alternatives to corneal transplantation. SCIENCE ADVANCES 2020; 6:6/25/eaba2187. [PMID: 32917640 PMCID: PMC7299624 DOI: 10.1126/sciadv.aba2187] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 05/08/2020] [Indexed: 05/13/2023]
Abstract
Transplantation with donor corneas is the mainstay for treating corneal blindness, but a severe worldwide shortage necessitates the development of other treatment options. Corneal perforation from infection or inflammation is sealed with cyanoacrylate glue. However, the resulting cytotoxicity requires transplantation. LiQD Cornea is an alternative to conventional corneal transplantation and sealants. It is a cell-free, liquid hydrogel matrix for corneal regeneration, comprising short collagen-like peptides conjugated with polyethylene glycol and mixed with fibrinogen to promote adhesion within tissue defects. Gelation occurs spontaneously at body temperature within 5 min. Light exposure is not required-particularly advantageous because patients with corneal inflammation are typically photophobic. The self-assembling, fully defined, synthetic collagen analog is much less costly than human recombinant collagen and reduces the risk of immune rejection associated with xenogeneic materials. In situ gelation potentially allows for clinical application in outpatient clinics instead of operating theaters, maximizing practicality, and minimizing health care costs.
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Affiliation(s)
- Christopher D McTiernan
- Centre de Recherche Hôpital Maisonneuve-Rosemont, Montréal, QC, Canada
- Department of Ophthalmology and Institute of Biomedical Engineering, Université de Montréal, Montréal, QC, Canada
- Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Fiona C Simpson
- Centre de Recherche Hôpital Maisonneuve-Rosemont, Montréal, QC, Canada
- Department of Ophthalmology and Institute of Biomedical Engineering, Université de Montréal, Montréal, QC, Canada
| | - Michel Haagdorens
- Department of Ophthalmology, Visual Optics and Visual Rehabilitation, University of Antwerp, Antwerp, Belgium
| | - Chameen Samarawickrama
- Centre for Vision Research, The Westmead Institute for Medical Research, and Faculty of Medicine and Health, University of Sydney, Sydney, Australia
- Institute for Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Damien Hunter
- Centre for Vision Research, The Westmead Institute for Medical Research, and Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Oleksiy Buznyk
- Institute for Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Per Fagerholm
- Institute for Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Monika K Ljunggren
- Institute for Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Philip Lewis
- School of Optometry and Vision Sciences, Cardiff University, Cardiff, UK
| | - Isabel Pintelon
- Laboratory of Cell Biology and Histology, University of Antwerp, Antwerp, Belgium
| | | | - Elle Edin
- Centre de Recherche Hôpital Maisonneuve-Rosemont, Montréal, QC, Canada
- Department of Ophthalmology and Institute of Biomedical Engineering, Université de Montréal, Montréal, QC, Canada
| | - Marc Groleau
- Centre de Recherche Hôpital Maisonneuve-Rosemont, Montréal, QC, Canada
| | - Bruce D Allan
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK.
| | - May Griffith
- Centre de Recherche Hôpital Maisonneuve-Rosemont, Montréal, QC, Canada.
- Department of Ophthalmology and Institute of Biomedical Engineering, Université de Montréal, Montréal, QC, Canada
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Griffith M, Poudel BK, Malhotra K, Akla N, González-Andrades M, Courtman D, Hu V, Alarcon EI. Biosynthetic alternatives for corneal transplant surgery. EXPERT REVIEW OF OPHTHALMOLOGY 2020. [DOI: 10.1080/17469899.2020.1754798] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- May Griffith
- Department of Ophthalmology, University of Montreal and Maisonneuve-Rosemont Hospital Research Centre, Montreal, QC, Canada
| | - Bijay Kumar Poudel
- Department of Ophthalmology, University of Montreal and Maisonneuve-Rosemont Hospital Research Centre, Montreal, QC, Canada
| | - Kamal Malhotra
- Department of Ophthalmology, University of Montreal and Maisonneuve-Rosemont Hospital Research Centre, Montreal, QC, Canada
| | - Naoufal Akla
- Department of Ophthalmology, University of Montreal and Maisonneuve-Rosemont Hospital Research Centre, Montreal, QC, Canada
| | - Miguel González-Andrades
- Department of Ophthalmology, Reina Sofia University Hospital and University of Cordoba, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Cordoba, Spain
| | - David Courtman
- Department of Medicine, University of Ottawa, and Scientist, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Victor Hu
- London School of Hygiene and Tropical Medicine, International Center for Eye Health, London, UK
| | - Emilio I. Alarcon
- Department of Biochemistry, Microbiology, and Immunology, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
- Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, ON, Canada
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86
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Corneal Xenotransplantation: Anterior Lamellar Keratoplasty. Methods Mol Biol 2020. [PMID: 32002913 DOI: 10.1007/978-1-0716-0255-3_16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
Abstract
Corneal transplantation for the treatment of corneal blindness is challenging in many countries due to the shortage of graft procurement. Xenocorneal transplantation is an interesting alternative to explore despite immunologic rejection, which mainly involves endothelial cells. As anterior lamellar keratoplasty, when indicated, shows less immunologic reaction, we developed and describe below a pig-to-non-human-primate model of anterior lamellar corneal xenograft. This model can be used to assess the efficacy of corneas from genetically modified pigs.
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87
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Wang Y, Ma J, Jiang X, Liu Z, Yang J, Li X. Development of Transparent Acellular Dermal Matrix as Tissue-Engineered Stroma Substitute for Central Lamellar Keratoplasty. Invest Ophthalmol Vis Sci 2020; 61:5. [PMID: 31999820 PMCID: PMC7205104 DOI: 10.1167/iovs.61.1.5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Purpose To improve the transparency of the acellular dermal matrix (ADM) and investigate the optical, mechanical and histologic properties and biocompatibility of transparent ADM (TADM) in lamellar keratoplasty. Methods A stepwise sectioning strategy was applied to determine the transparency distribution of the ADM, and TADM was fabricated accordingly. Transmittance measurements, uniaxial tension testing, and histologic staining were applied to detect its properties. Lamellar keratoplasty was performed in rabbits with TADM, and postoperative evaluations were conducted including the transmittance of the transplant area and histologic staining. Results The transmittance of the ADM increased with increasing depth, and TADM was isolated mechanically at the deepest level. There was a significant improvement in the transmittance of the TADM compared with the ADM, and no significant difference in transmittance between dehydrated TADM and cornea was observed. The elastic modulus of TADM was significantly stronger than that of normal cornea (P = 0.004). TADM consisted of dense collagen fibrils, mainly collagen type I, and the collagen fibril diameter and interfibrillar spacing were determined to be larger than corneal stroma. After lamellar keratoplasty in rabbits, the TADM was well integrated with the host cornea, and transparent cornea without neovascularization was observed at 6 months. Re-epithelization was completed at 1 month, and keratocyte repopulation and collagen remodeling were observed in the graft 3 and 6 months after surgery. Conclusions This study presents the transparency distribution of the ADM and a method for obtaining TADM, which demonstrates ideal transparency, strong mechanical properties, and satisfactory biocompatibility when applied in lamellar keratoplasty.
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Sun X, Yang X, Song W, Ren L. Construction and Evaluation of Collagen-Based Corneal Grafts Using Polycaprolactone To Improve Tension Stress. ACS OMEGA 2020; 5:674-682. [PMID: 31956817 PMCID: PMC6964271 DOI: 10.1021/acsomega.9b03297] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Accepted: 12/18/2019] [Indexed: 05/09/2023]
Abstract
The emergence of innovative surgical procedures using partial thickness corneal transplant has created a need for the development of corneal grafts to replace pathologic corneal tissue. Corneal repair materials have been successfully prepared in the past 10 years, but they were difficult to be used in clinics because of the unbearable tension caused by interrupted suture during routine surgery. However, polycaprolactone (PCL), a medical polymer material, can solve this problem. Therefore, a hierarchical collagen (Col)-based corneal graft with curvature, consisting of a transparent core part composed of collagen in the center and a mechanically robust fixed part containing collagen and polycaprolactone in the edge, was used as a potential corneal graft for corneal repair and regeneration in this study. The hierarchical collagen-based corneal grafts [collagen-polycaprolactone (Col-PCL) membranes] that are capable of mimicking the native cornea were developed based on chemical and thermal crosslinking mechanisms. The water adsorption of Col-PCL membranes could reach over 80% similar to that of human cornea, and its swelling could reach over 400%. More importantly, the formed Col-PCL membranes could resist a larger tensile strength (1.1 ± 0.03 MPa) before rupturing in comparison with pure collagen membranes and polycaprolactone membranes. Furthermore, the biodegradable Col-PCL membranes could facilitate cell adhesion and proliferation as well as cell migration (exhibiting epithelial wound coverage in <5 days), which showed promise as corneal grafts for cornea tissue engineering.
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Affiliation(s)
- Xiaomin Sun
- School
of Materials Science and Engineering, Key Laboratory of Biomedical Engineering
of Guangdong Province, Key Laboratory of Biomedical Materials and Engineering
of the Ministry of Education, and Innovation Center for Tissue Restoration and
Reconstruction, South China University of
Technology, Guangzhou 510006, P. R. China
- National
Engineering Research Center for Tissue Restoration and Reconstruction, Guangzhou 510006, P. R. China
| | - Xiangjing Yang
- School
of Materials Science and Engineering, Key Laboratory of Biomedical Engineering
of Guangdong Province, Key Laboratory of Biomedical Materials and Engineering
of the Ministry of Education, and Innovation Center for Tissue Restoration and
Reconstruction, South China University of
Technology, Guangzhou 510006, P. R. China
- National
Engineering Research Center for Tissue Restoration and Reconstruction, Guangzhou 510006, P. R. China
| | - Wenjing Song
- School
of Materials Science and Engineering, Key Laboratory of Biomedical Engineering
of Guangdong Province, Key Laboratory of Biomedical Materials and Engineering
of the Ministry of Education, and Innovation Center for Tissue Restoration and
Reconstruction, South China University of
Technology, Guangzhou 510006, P. R. China
- National
Engineering Research Center for Tissue Restoration and Reconstruction, Guangzhou 510006, P. R. China
| | - Li Ren
- School
of Materials Science and Engineering, Key Laboratory of Biomedical Engineering
of Guangdong Province, Key Laboratory of Biomedical Materials and Engineering
of the Ministry of Education, and Innovation Center for Tissue Restoration and
Reconstruction, South China University of
Technology, Guangzhou 510006, P. R. China
- National
Engineering Research Center for Tissue Restoration and Reconstruction, Guangzhou 510006, P. R. China
- Sino-Singapore
International Joint Research Institute, Guangzhou 510555, P. R. China
- Guangzhou
Regenerative Medicine and Health Guangdong Laboratory, Guangzhou 510005, P. R. China
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89
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Borrelli M, Geerling G, Spaniol K, Witt J. Eye Socket Regeneration and Reconstruction. Curr Eye Res 2020; 45:253-264. [DOI: 10.1080/02713683.2020.1712423] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- M. Borrelli
- Department of Ophthalmology, University Hospital Duesseldorf, Duesseldorf, Germany
| | - G. Geerling
- Department of Ophthalmology, University Hospital Duesseldorf, Duesseldorf, Germany
| | - K. Spaniol
- Department of Ophthalmology, University Hospital Duesseldorf, Duesseldorf, Germany
| | - J. Witt
- Department of Ophthalmology, University Hospital Duesseldorf, Duesseldorf, Germany
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90
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Fuchs S, Shariati K, Ma M. Specialty Tough Hydrogels and Their Biomedical Applications. Adv Healthc Mater 2020; 9:e1901396. [PMID: 31846228 PMCID: PMC7586320 DOI: 10.1002/adhm.201901396] [Citation(s) in RCA: 89] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 11/23/2019] [Indexed: 02/06/2023]
Abstract
Hydrogels have long been explored as attractive materials for biomedical applications given their outstanding biocompatibility, high water content, and versatile fabrication platforms into materials with different physiochemical properties and geometries. Nonetheless, conventional hydrogels suffer from weak mechanical properties, restricting their use in persistent load-bearing applications often required of materials used in medical settings. Thus, the fabrication of mechanically robust hydrogels that can prolong the lifetime of clinically suitable materials under uncompromising in vivo conditions is of great interest. This review focuses on design considerations and strategies to construct such tough hydrogels. Several promising advances in the proposed use of specialty tough hydrogels for soft actuators, drug delivery vehicles, adhesives, coatings, and in tissue engineering settings are highlighted. While challenges remain before these specialty tough hydrogels will be deemed translationally acceptable for clinical applications, promising preliminary results undoubtedly spur great hope in the potential impact this embryonic research field can have on the biomedical community.
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Affiliation(s)
- Stephanie Fuchs
- Department of Biological and Environmental Engineering, Cornell University, Riley Robb Hall 322, Ithaca, NY, 14853, USA
| | - Kaavian Shariati
- Department of Biological and Environmental Engineering, Cornell University, Riley Robb Hall 322, Ithaca, NY, 14853, USA
| | - Minglin Ma
- Department of Biological and Environmental Engineering, Cornell University, Riley Robb Hall 322, Ithaca, NY, 14853, USA
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91
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Kilic Bektas C, Hasirci V. Cell loaded 3D bioprinted GelMA hydrogels for corneal stroma engineering. Biomater Sci 2020; 8:438-449. [DOI: 10.1039/c9bm01236b] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Tissue engineering aims to replace missing or damaged tissues and restore their functions.
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Affiliation(s)
- Cemile Kilic Bektas
- Department of Biological Sciences
- Middle East Technical University (METU)
- Ankara
- Turkey
- Department of Biotechnology
| | - Vasif Hasirci
- Department of Biological Sciences
- Middle East Technical University (METU)
- Ankara
- Turkey
- Department of Biotechnology
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92
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Lagali N, Rafat M. Femtosecond Laser-Assisted Surgery for Implantation of Bioengineered Corneal Stroma to Promote Corneal Regeneration. Methods Mol Biol 2020; 2145:197-214. [PMID: 32542609 DOI: 10.1007/978-1-0716-0599-8_14] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
The femtosecond laser has achieved widespread use in ophthalmology owing to its ability to deliver focused high energy that is rapidly dissipated and thereby does not damage surrounding tissue outside the precise focal region. Extremely accurate and smooth cuts can be made by the laser, enabling a range of applications in anterior segment surgery. Minimally invasive corneal surgical procedures can be performed using the femtosecond laser, and here we describe the application of such procedures to improve implantation of bioengineered materials into the cornea. Bioengineered corneal tissue, including the collagenous corneal stroma, promises to provide a virtually unlimited supply of biocompatible tissue for treating multiple causes of corneal blindness globally, thereby circumventing problems of donor tissue shortages and access to tissue banking infrastructure. Optimal implantation of bioengineered materials, however, is required, in order to facilitate postoperative wound healing for the maintenance of corneal transparency and avoidance of postoperative complications such as scarring, inflammation, and neovascularization. Moreover, the avoidance of a detrimental physiological physiological wound healing response is critical for facilitating the corneal stromal regeneration enabled by the bioengineered stroma. Without proper implantation, the tissue response will favor inflammation and pathologic processes instead of quiescent keratocyte migration and new collagen production. Here we describe several procedures for optimized biomaterial implantation into the corneal stroma, that facilitate rapid wound healing and regenerative restoration of corneal transparency without the use of human donor tissue. A step-by-step methodology is provided for the use of the femtosecond laser and associated techniques, to enable seamless integration of bioengineered materials into the corneal stroma.
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Affiliation(s)
- Neil Lagali
- Division of Ophthalmology, Institute for Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.
| | - Mehrdad Rafat
- Department of Biomedical Engineering, Linköping University, Linköping, Sweden.,LinkoCare Life Sciences AB, Linköping, Sweden
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93
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Kilic Bektas C, Hasirci V. Cell Loaded GelMA:HEMA IPN hydrogels for corneal stroma engineering. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2019; 31:2. [PMID: 31811387 DOI: 10.1007/s10856-019-6345-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 11/16/2019] [Indexed: 06/10/2023]
Abstract
Stroma is the main refractive element of the cornea and damage to it is one of the main causes of blindness. In this study, cell loaded hydrogels of methacrylated gelatin (GelMA) and poly(2-hydroxyethyl methacrylate) (pHEMA) (8:2) interpenetrating network (IPN) hydrogels were prepared as the corneal stroma substitute and tested in situ and in vitro. Compressive modulus of the GelMA hydrogels was significantly enhanced with the addition of pHEMA in the structure (6.53 vs 155.49 kPa, respectively). More than 90% of the stromal keratocytes were viable in the GelMA and GelMA-HEMA hydrogels as calculated by Live-Dead Assay and NIH Image-J program. Cells synthesized representative collagens and proteoglycans in the hydrogels indicating that they preserved their keratocyte functions. Transparency of the cell loaded GelMA-HEMA hydrogels was increased significantly up to 90% at 700 nm during three weeks of incubation and was comparable with the transparency of native cornea. Cell loaded GelMA-HEMA corneal stroma model is novel and reported for the first time in the literature in terms of introduction of cells during the preparation phase of the hydrogels. The appropriate mechanical strength and high transparency of the cell loaded constructs indicates a viable alternative to the current devices used in the treatment of corneal blindness.
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Affiliation(s)
- Cemile Kilic Bektas
- Department of Biological Sciences, Middle East Technical University (METU), Ankara, Turkey
- Department of Biotechnology, METU, Ankara, Turkey
- BIOMATEN, METU Center of Excellence in Biomaterials and Tissue Engineering, Ankara, Turkey
| | - Vasif Hasirci
- Department of Biological Sciences, Middle East Technical University (METU), Ankara, Turkey.
- Department of Biotechnology, METU, Ankara, Turkey.
- BIOMATEN, METU Center of Excellence in Biomaterials and Tissue Engineering, Ankara, Turkey.
- Department of Medical Engineering, Acıbadem Mehmet Ali Aydınlar University, Istanbul, Turkey.
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94
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Marfurt C, Anokwute MC, Fetcko K, Mahony-Perez E, Farooq H, Ross E, Baumanis MM, Weinberg RL, McCarron ME, Mankowski JL. Comparative Anatomy of the Mammalian Corneal Subbasal Nerve Plexus. Invest Ophthalmol Vis Sci 2019; 60:4972-4984. [PMID: 31790560 PMCID: PMC6886725 DOI: 10.1167/iovs.19-28519] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 10/24/2019] [Indexed: 12/20/2022] Open
Abstract
Purpose The subbasal nerve plexus (SNP) is the densest and most recognizable component of the mammalian corneal innervation; however, the anatomical configuration of the SNP in most animal models remains incompletely described. The purpose of the current study is to describe in detail the SNP architecture in eight different mammals, including several popular animal models used in cornea research. Methods Corneal nerves in mouse, rat, guinea pig, rabbit, dog, macaque, domestic pig, and cow eyes were stained immunohistochemically with antiserum directed against neurotubulin. SNP architecture was documented by digital photomicrography and large-scale reconstructions, that is, corneal nerve maps, using a drawing tube attached to a light microscope. Results Subbasal nerve fibers (SNFs) in mice, rats, guinea pigs, dogs, and macaques radiated centrally from the corneoscleral limbus toward the corneal apex in a whorl-like or spiraling pattern. SNFs in rabbit and bovine corneas swept horizontally across the ocular surface in a temporal-to-nasal direction and converged on the inferonasal limbus without forming a spiral. SNFs in the pig cornea radiated centrifugally in all directions, like a starburst, from a focal point located equidistant between the corneal apex and the superior pole. Conclusions The results of the present study have demonstrated for the first time substantial interspecies differences in the architectural organization of the mammalian SNP. The physiological significance of these different patterns and the mechanisms that regulate SNP pattern formation in the mammalian cornea remain incompletely understood and warrant additional investigation.
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Affiliation(s)
- Carl Marfurt
- Indiana University School of Medicine-Northwest-Gary, Gary, Indiana, United States
| | - Miracle C. Anokwute
- Indiana University School of Medicine-Northwest-Gary, Gary, Indiana, United States
| | - Kaleigh Fetcko
- Indiana University School of Medicine-Northwest-Gary, Gary, Indiana, United States
| | - Erin Mahony-Perez
- Indiana University School of Medicine-Northwest-Gary, Gary, Indiana, United States
| | - Hassan Farooq
- Indiana University School of Medicine-Northwest-Gary, Gary, Indiana, United States
| | - Emily Ross
- Indiana University School of Medicine-Northwest-Gary, Gary, Indiana, United States
| | - Maraya M. Baumanis
- Indiana University School of Medicine-Northwest-Gary, Gary, Indiana, United States
| | - Rachel L. Weinberg
- Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Megan E. McCarron
- Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Joseph L. Mankowski
- Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
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95
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Uyanıklar M, Günal G, Tevlek A, Hosseinian P, Aydin HM. Hybrid Cornea: Cell Laden Hydrogel Incorporated Decellularized Matrix. ACS Biomater Sci Eng 2019; 6:122-133. [DOI: 10.1021/acsbiomaterials.9b01286] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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96
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McLaughlin S, McNeill B, Podrebarac J, Hosoyama K, Sedlakova V, Cron G, Smyth D, Seymour R, Goel K, Liang W, Rayner KJ, Ruel M, Suuronen EJ, Alarcon EI. Injectable human recombinant collagen matrices limit adverse remodeling and improve cardiac function after myocardial infarction. Nat Commun 2019; 10:4866. [PMID: 31653830 PMCID: PMC6814728 DOI: 10.1038/s41467-019-12748-8] [Citation(s) in RCA: 88] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 09/26/2019] [Indexed: 12/21/2022] Open
Abstract
Despite the success of current therapies for acute myocardial infarction (MI), many patients still develop adverse cardiac remodeling and heart failure. With the growing prevalence of heart failure, a new therapy is needed that can prevent remodeling and support tissue repair. Herein, we report on injectable recombinant human collagen type I (rHCI) and type III (rHCIII) matrices for treating MI. Injecting rHCI or rHCIII matrices in mice during the late proliferative phase post-MI restores the myocardium's mechanical properties and reduces scar size, but only the rHCI matrix maintains remote wall thickness and prevents heart enlargement. rHCI treatment increases cardiomyocyte and capillary numbers in the border zone and the presence of pro-wound healing macrophages in the ischemic area, while reducing the overall recruitment of bone marrow monocytes. Our findings show functional recovery post-MI using rHCI by promoting a healing environment, cardiomyocyte survival, and less pathological remodeling of the myocardium.
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Affiliation(s)
- Sarah McLaughlin
- BioEngineering and Therapeutic Solutions (BEaTS), Division of Cardiac Surgery, University of Ottawa Heart Institute, 40 Ruskin street, Ottawa, ON, K1Y4W7, Canada
- Department of Cellular & Molecular Medicine, University of Ottawa, 451 Smyth Road, Ottawa, ON, K1H8M5, Canada
| | - Brian McNeill
- BioEngineering and Therapeutic Solutions (BEaTS), Division of Cardiac Surgery, University of Ottawa Heart Institute, 40 Ruskin street, Ottawa, ON, K1Y4W7, Canada
| | - James Podrebarac
- BioEngineering and Therapeutic Solutions (BEaTS), Division of Cardiac Surgery, University of Ottawa Heart Institute, 40 Ruskin street, Ottawa, ON, K1Y4W7, Canada
- Department of Cellular & Molecular Medicine, University of Ottawa, 451 Smyth Road, Ottawa, ON, K1H8M5, Canada
| | - Katsuhiro Hosoyama
- BioEngineering and Therapeutic Solutions (BEaTS), Division of Cardiac Surgery, University of Ottawa Heart Institute, 40 Ruskin street, Ottawa, ON, K1Y4W7, Canada
| | - Veronika Sedlakova
- BioEngineering and Therapeutic Solutions (BEaTS), Division of Cardiac Surgery, University of Ottawa Heart Institute, 40 Ruskin street, Ottawa, ON, K1Y4W7, Canada
| | - Gregory Cron
- Department of Radiology, Faculty of Medicine, University of Ottawa, 501 Smyth Road, Ottawa, ON, K1H8L6, Canada
| | - David Smyth
- Cardiac Function Laboratory, University of Ottawa Heart Institute, 40 Ruskin street, Ottawa, ON, K1Y4W7, Canada
| | - Richard Seymour
- BioEngineering and Therapeutic Solutions (BEaTS), Division of Cardiac Surgery, University of Ottawa Heart Institute, 40 Ruskin street, Ottawa, ON, K1Y4W7, Canada
| | - Keshav Goel
- BioEngineering and Therapeutic Solutions (BEaTS), Division of Cardiac Surgery, University of Ottawa Heart Institute, 40 Ruskin street, Ottawa, ON, K1Y4W7, Canada
| | - Wenbin Liang
- Department of Cellular & Molecular Medicine, University of Ottawa, 451 Smyth Road, Ottawa, ON, K1H8M5, Canada
- Cardiac Electrophysiology Lab, University of Ottawa Heart Institute, 40 Ruskin street, Ottawa, ON, K1Y4W7, Canada
| | - Katey J Rayner
- Cardiometabolic microRNA Laboratory, University of Ottawa Heart Institute, 40 Ruskin street, Ottawa, ON, K1Y4W7, Canada
- Department of Biochemistry, Microbiology, and Immunology, University of Ottawa, 451 Smyth Road, Ottawa, ON, K1H8M5, Canada
| | - Marc Ruel
- BioEngineering and Therapeutic Solutions (BEaTS), Division of Cardiac Surgery, University of Ottawa Heart Institute, 40 Ruskin street, Ottawa, ON, K1Y4W7, Canada
- Department of Cellular & Molecular Medicine, University of Ottawa, 451 Smyth Road, Ottawa, ON, K1H8M5, Canada
| | - Erik J Suuronen
- BioEngineering and Therapeutic Solutions (BEaTS), Division of Cardiac Surgery, University of Ottawa Heart Institute, 40 Ruskin street, Ottawa, ON, K1Y4W7, Canada.
- Department of Cellular & Molecular Medicine, University of Ottawa, 451 Smyth Road, Ottawa, ON, K1H8M5, Canada.
| | - Emilio I Alarcon
- BioEngineering and Therapeutic Solutions (BEaTS), Division of Cardiac Surgery, University of Ottawa Heart Institute, 40 Ruskin street, Ottawa, ON, K1Y4W7, Canada.
- Department of Biochemistry, Microbiology, and Immunology, University of Ottawa, 451 Smyth Road, Ottawa, ON, K1H8M5, Canada.
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97
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Kilic Bektas C, Burcu A, Gedikoglu G, Telek HH, Ornek F, Hasirci V. Methacrylated gelatin hydrogels as corneal stroma substitutes: in vivo study. JOURNAL OF BIOMATERIALS SCIENCE-POLYMER EDITION 2019; 30:1803-1821. [DOI: 10.1080/09205063.2019.1666236] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Cemile Kilic Bektas
- Departments of Biological Sciences, Middle East Technical University (METU), Ankara, Turkey
- Department of Biotechnology, Middle East Technical University (METU), Ankara, Turkey
- BIOMATEN, METU Center of Excellence in Biomaterials and Tissue Engineering, Ankara, Turkey
| | - Ayse Burcu
- Eye Clinic, University of Health Sciences, Ankara Training and Research Hospital, Ankara, Turkey
| | - Gokhan Gedikoglu
- Department of Medical Pathology, Hacettepe University, Ankara, Turkey
| | - Hande H. Telek
- Eye Clinic, Beytepe Murat Erdi Eker State Hospital, Ankara, Turkey
| | - Firdevs Ornek
- Eye Clinic, University of Health Sciences, Ankara Training and Research Hospital, Ankara, Turkey
| | - Vasif Hasirci
- Departments of Biological Sciences, Middle East Technical University (METU), Ankara, Turkey
- Department of Biotechnology, Middle East Technical University (METU), Ankara, Turkey
- BIOMATEN, METU Center of Excellence in Biomaterials and Tissue Engineering, Ankara, Turkey
- Department of Medical Engineering, Acıbadem Mehmet Ali Aydınlar University, İstanbul, Turkey
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98
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Abstract
The corneal stroma comprises 90% of the corneal thickness and is critical for the cornea's transparency and refractive function necessary for vision. When the corneal stroma is altered by disease, injury, or scarring, however, an irreversible loss of transparency can occur. Corneal stromal pathology is the cause of millions of cases of blindness globally, and although corneal transplantation is the standard therapy, a severe global deficit of donor corneal tissue and eye banking infrastructure exists, and is unable to meet the overwhelming need. An alternative approach is to harness the endogenous regenerative ability of the corneal stroma, which exhibits self-renewal of the collagenous extracellular matrix under appropriate conditions. To mimic endogenous stromal regeneration, however, is a challenge. Unlike the corneal epithelium and endothelium, the corneal stroma is an exquisitely organized extracellular matrix containing stromal cells, proteoglycans and corneal nerves that is difficult to recapitulate in vitro. Nevertheless, much progress has recently been made in developing stromal equivalents, and in this review the most recent approaches to stromal regeneration therapy are described and discussed. Novel approaches for stromal regeneration include human or animal corneal and/or non-corneal tissue that is acellular or is decellularized and/or re-cellularized, acellular bioengineered stromal scaffolds, tissue adhesives, 3D bioprinting and stromal stem cell therapy. This review highlights the techniques and advances that have achieved first clinical use or are close to translation for eventual therapeutic application in repairing and regenerating the corneal stroma, while the potential of these novel therapies for achieving effective stromal regeneration is discussed.
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Affiliation(s)
- Neil Lagali
- Department of Ophthalmology, Institute for Clinical and Experimental Medicine, Faculty of Medicine, Linköping University, Linköping, Sweden.,Department of Ophthalmology, Sørlandet Hospital Arendal, Arendal, Norway
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99
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Dong M, Zhao L, Wang F, Hu X, Li H, Liu T, Zhou Q, Shi W. Rapid porcine corneal decellularization through the use of sodium N-lauroyl glutamate and supernuclease. J Tissue Eng 2019; 10:2041731419875876. [PMID: 31588337 PMCID: PMC6740050 DOI: 10.1177/2041731419875876] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 08/23/2019] [Indexed: 12/17/2022] Open
Abstract
Corneal decellularization represents a promising alternative source of human donor with global shortage. Multiple methods have been developed for the preparation of decellularized porcine corneal stroma. However, most strategies relied on long-time treatment to facilitate the entry of detergents or nucleases, which may cause irreversible ultrastructural damage. Here, we developed a rapid decellularization method for porcine corneal stroma through the combined mild detergent sodium N-lauroyl glutamate (SLG) and supernuclease. Compared with traditional methods, the novel decellularization method allowed the efficient removal of xenoantigen DNA within 3 h, while retaining the ultrastructure, transparency, and mechanical properties of porcine corneas. When transplanted in rabbit model for 1 month, the decellularized porcine corneal grafts presented favorable transparency and biocompatibility without immune rejection. Therefore, the combined use of detergent SLG and supernuclease may serve as a promising method for the clinical use of decellularized porcine cornea.
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Affiliation(s)
- Muchen Dong
- Shandong Eye Hospital, Shandong Eye Institute, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, China
| | - Long Zhao
- 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
| | - Fuyan Wang
- 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
| | - Xiaoli Hu
- 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
| | - Hua Li
- 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
| | - Ting Liu
- 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
| | - Qingjun Zhou
- 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
| | - Weiyun Shi
- Shandong Eye Hospital, Shandong Eye Institute, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, China.,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
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100
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Lei X, Jia YG, Song W, Qi D, Jin J, Liu J, Ren L. Mechanical and Optical Properties of Reinforced Collagen Membranes for Corneal Regeneration through Polyrotaxane Cross-Linking. ACS APPLIED BIO MATERIALS 2019; 2:3861-3869. [DOI: 10.1021/acsabm.9b00464] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Xiaoyue Lei
- School of Materials Science and Engineering, South China University of Technology, Guangzhou 510006, P. R. China
- National Engineering Research Center for Tissue Restoration and Reconstruction, Guangzhou 510006, P. R. China
- Key Laboratory of Biomedical Engineering of Guangdong Province, South China University of Technology, Guangzhou 510006, P. R. China
- Key Laboratory of Biomedical Materials and Engineering of the Ministry of Education, South China University of Technology, Guangzhou 510006, P. R. China
- Innovation Center for Tissue Restoration and Reconstruction, South China University of Technology, Guangzhou 510006, P. R. China
| | - Yong-Guang Jia
- School of Materials Science and Engineering, South China University of Technology, Guangzhou 510006, P. R. China
- National Engineering Research Center for Tissue Restoration and Reconstruction, Guangzhou 510006, P. R. China
- Key Laboratory of Biomedical Engineering of Guangdong Province, South China University of Technology, Guangzhou 510006, P. R. China
- Key Laboratory of Biomedical Materials and Engineering of the Ministry of Education, South China University of Technology, Guangzhou 510006, P. R. China
- Innovation Center for Tissue Restoration and Reconstruction, South China University of Technology, Guangzhou 510006, P. R. China
| | - Wenjing Song
- School of Materials Science and Engineering, South China University of Technology, Guangzhou 510006, P. R. China
- National Engineering Research Center for Tissue Restoration and Reconstruction, Guangzhou 510006, P. R. China
- Key Laboratory of Biomedical Engineering of Guangdong Province, South China University of Technology, Guangzhou 510006, P. R. China
| | - Dawei Qi
- School of Materials Science and Engineering, South China University of Technology, Guangzhou 510006, P. R. China
- National Engineering Research Center for Tissue Restoration and Reconstruction, Guangzhou 510006, P. R. China
- Key Laboratory of Biomedical Engineering of Guangdong Province, South China University of Technology, Guangzhou 510006, P. R. China
| | - Jiahong Jin
- School of Materials Science and Engineering, South China University of Technology, Guangzhou 510006, P. R. China
- National Engineering Research Center for Tissue Restoration and Reconstruction, Guangzhou 510006, P. R. China
- Key Laboratory of Biomedical Engineering of Guangdong Province, South China University of Technology, Guangzhou 510006, P. R. China
| | - Jia Liu
- School of Materials Science and Engineering, South China University of Technology, Guangzhou 510006, P. R. China
- National Engineering Research Center for Tissue Restoration and Reconstruction, Guangzhou 510006, P. R. China
- Key Laboratory of Biomedical Engineering of Guangdong Province, South China University of Technology, Guangzhou 510006, P. R. China
| | - Li Ren
- School of Materials Science and Engineering, South China University of Technology, Guangzhou 510006, P. R. China
- National Engineering Research Center for Tissue Restoration and Reconstruction, Guangzhou 510006, P. R. China
- Key Laboratory of Biomedical Engineering of Guangdong Province, South China University of Technology, Guangzhou 510006, P. R. China
- Key Laboratory of Biomedical Materials and Engineering of the Ministry of Education, South China University of Technology, Guangzhou 510006, P. R. China
- Innovation Center for Tissue Restoration and Reconstruction, South China University of Technology, Guangzhou 510006, P. R. China
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