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Trujillo Cubillo L, Gurdal M, Zeugolis DI. Corneal fibrosis: From in vitro models to current and upcoming drug and gene medicines. Adv Drug Deliv Rev 2024; 209:115317. [PMID: 38642593 DOI: 10.1016/j.addr.2024.115317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 02/29/2024] [Accepted: 04/18/2024] [Indexed: 04/22/2024]
Abstract
Fibrotic diseases are characterised by myofibroblast differentiation, uncontrolled pathological extracellular matrix accumulation, tissue contraction, scar formation and, ultimately tissue / organ dysfunction. The cornea, the transparent tissue located on the anterior chamber of the eye, is extremely susceptible to fibrotic diseases, which cause loss of corneal transparency and are often associated with blindness. Although topical corticosteroids and antimetabolites are extensively used in the management of corneal fibrosis, they are associated with glaucoma, cataract formation, corneoscleral melting and infection, imposing the need of far more effective therapies. Herein, we summarise and discuss shortfalls and recent advances in in vitro models (e.g. transforming growth factor-β (TGF-β) / ascorbic acid / interleukin (IL) induced) and drug (e.g. TGF-β inhibitors, epigenetic modulators) and gene (e.g. gene editing, gene silencing) therapeutic strategies in the corneal fibrosis context. Emerging therapeutical agents (e.g. neutralising antibodies, ligand traps, receptor kinase inhibitors, antisense oligonucleotides) that have shown promise in clinical setting but have not yet assessed in corneal fibrosis context are also discussed.
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Affiliation(s)
- Laura Trujillo Cubillo
- Regenerative, Modular & Developmental Engineering Laboratory (REMODEL), Charles Institute of Dermatology, Conway Institute of Biomolecular & Biomedical Research and School of Mechanical & Materials Engineering, University College Dublin (UCD), Dublin, Ireland
| | - Mehmet Gurdal
- Regenerative, Modular & Developmental Engineering Laboratory (REMODEL), Charles Institute of Dermatology, Conway Institute of Biomolecular & Biomedical Research and School of Mechanical & Materials Engineering, University College Dublin (UCD), Dublin, Ireland
| | - Dimitrios I Zeugolis
- Regenerative, Modular & Developmental Engineering Laboratory (REMODEL), Charles Institute of Dermatology, Conway Institute of Biomolecular & Biomedical Research and School of Mechanical & Materials Engineering, University College Dublin (UCD), Dublin, Ireland.
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Liu Y, Hong J. Mesenchymal Stem Cell-Laden In Situ-Forming Hydrogel for Preventing Corneal Stromal Opacity. Cornea 2024; 43:609-626. [PMID: 38289027 PMCID: PMC10980177 DOI: 10.1097/ico.0000000000003475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 10/26/2023] [Accepted: 12/06/2023] [Indexed: 04/01/2024]
Abstract
PURPOSE The aims of this study were to construct a mesenchymal stem cell (MSC)-laden in situ-forming hydrogel and study its effects on preventing corneal stromal opacity. METHODS The native gellan gum was modified by high temperature and pressure, and the rabbit bone marrow MSCs were encapsulated before adding Ca 2+ to initiate cross-linking. The effects of the hydrogel on 3D culture and gene expression of the rabbit bone marrow MSCs were observed in vitro. Then, the MSC-hydrogel was used to repair corneal stromal injury in New Zealand white rabbits within 28 days postoperation. RESULTS The short-chain gellan gum solution has a very low viscosity (<0.1 Pa·s) that is ideal for encapsulating cells. Moreover, mRNA expressions of 3D-cultured MSCs coding for corneal stromal components (decorin, lumican, and keratocan) were upregulated (by 127.8, 165.5, and 25.4 times, respectively) ( P < 0.05) on day 21 in vitro and were verified by Western blotting results. For the in vivo study, the corneal densitometry of the experimental group was (20.73 ± 1.85) grayscale units which was lower than the other groups ( P < 0.05). The MSC-hydrogel downregulated mRNA expression coding for fibrosis markers (α-smooth muscle actin, vimentin, collagen type 5-α1, and collagen type 1-α1) in the rabbit corneal stroma. Furthermore, some of the 5-ethynyl-2'-deoxyuridine (EdU)-labeled MSCs integrated into the upper corneal stroma and expressed keratocyte-specific antigens on day 28 postoperation. CONCLUSIONS The short-chain gellan gum allows MSCs to slowly release to the corneal stromal defect and prevent corneal stromal opacity. Some of the implanted MSCs can integrate into the corneal stroma and differentiate into keratocytes.
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Affiliation(s)
- Yinan Liu
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China; and
- Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Beijing, China
| | - Jing Hong
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China; and
- Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Beijing, China
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Singh VK, Kethiri AR, Pingali T, Sahoo A, Salman M, Koduri MA, Prasad D, Bokara KK, Basu S, Singh V. Development and validation of a reliable rabbit model of limbal stem cell deficiency by mechanical debridement using an ophthalmic burr. Exp Eye Res 2023; 236:109667. [PMID: 37758156 DOI: 10.1016/j.exer.2023.109667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 09/06/2023] [Accepted: 09/24/2023] [Indexed: 10/03/2023]
Abstract
A simple and reproducible method is necessary to generate reliable animal models of limbal stem cell deficiency (LSCD) for assessing the safety and efficacy of new therapeutic modalities. This study aimed to develop and validate a rabbit model of LSCD through mechanical injury. The corneal and limbal epithelium of New Zealand White rabbits (n = 18) were mechanically debrided using an ophthalmic burr (Algerbrush II) with a 1.0-mm rotating head after 360° conjunctival peritomy. The debrided eyes were serially evaluated for changes in corneal opacity, neo-vascularization, epithelial defect and corneal thickness using clinical photography, slit lamp imaging, fluorescein staining, and anterior segment optical coherence tomography scanning (AS-OCT). Following this, an assessment of histopathology and phenotypic marker expression of the excised corneas was conducted. The experimental eyes were grouped as mild (n = 4), moderate (n = 10), and severe (n = 4) based on the grade of LSCD. The moderate group exhibited abnormal epithelium, cellular infiltration in the stroma, and vascularization in the central, peripheral, and limbal regions of the cornea. The severe group demonstrated central epithelial edema, peripheral epithelial thinning with sparse goblet cell population, extensive cellular infiltration in the stroma, and dense vascularization in the limbal region of the cornea. A significant decrease in the expression of K12 and p63 (p < 0.0001) was observed, indicating the loss of corneal epithelium and limbal epithelial stem cells in the LSCD cornea. This study demonstrates that the Alger brush-induced mechanical debridement model provides a reliable model of LSCD with comprehensive clinic-pathological features and that is well suited for evaluating novel therapeutic and regenerative approaches.
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Affiliation(s)
- Vijay Kumar Singh
- Prof. Brien Holden Eye Research Centre, L V Prasad Eye Institute, Hyderabad, Telangana, India; Centre for Ocular Regeneration (CORE), L V Prasad Eye Institute, Hyderabad, Telangana, India
| | | | - Tejaswini Pingali
- Prof. Brien Holden Eye Research Centre, L V Prasad Eye Institute, Hyderabad, Telangana, India; Centre for Ocular Regeneration (CORE), L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Abhishek Sahoo
- Prof. Brien Holden Eye Research Centre, L V Prasad Eye Institute, Hyderabad, Telangana, India; Centre for Ocular Regeneration (CORE), L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Mohd Salman
- Prof. Brien Holden Eye Research Centre, L V Prasad Eye Institute, Hyderabad, Telangana, India; Centre for Ocular Regeneration (CORE), L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Madhuri Amulya Koduri
- Prof. Brien Holden Eye Research Centre, L V Prasad Eye Institute, Hyderabad, Telangana, India; Centre for Ocular Regeneration (CORE), L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Deeksha Prasad
- Prof. Brien Holden Eye Research Centre, L V Prasad Eye Institute, Hyderabad, Telangana, India; Centre for Ocular Regeneration (CORE), L V Prasad Eye Institute, Hyderabad, Telangana, India
| | | | - Sayan Basu
- Prof. Brien Holden Eye Research Centre, L V Prasad Eye Institute, Hyderabad, Telangana, India; Centre for Ocular Regeneration (CORE), L V Prasad Eye Institute, Hyderabad, Telangana, India; Shantilal Shanghvi Cornea Institute, L V Prasad Eye Institute, Hyderabad, Telangana, India.
| | - Vivek Singh
- Prof. Brien Holden Eye Research Centre, L V Prasad Eye Institute, Hyderabad, Telangana, India; Centre for Ocular Regeneration (CORE), L V Prasad Eye Institute, Hyderabad, Telangana, India.
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Joshi VP, Chatterjee S, Basu S. Relationship of Density, Depth, and Surface Irregularity of Superficial Corneal Opacification with Visual Acuity. Curr Eye Res 2023; 48:536-545. [PMID: 36724802 DOI: 10.1080/02713683.2023.2173786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
PURPOSE To explore the relationship between the density, depth, and surface irregularity of superficial corneal opacities and vision. METHODS This prospective imaging study included 19 patients with unilateral superficial corneal opacification due to scarring post-microbial keratitis. Each eye underwent an assessment of uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), contact lens corrected visual acuity (CLCVA), and Scheimpflug and anterior segment optical tomography imaging. Regression analysis was performed to detect the association between density, depth of scarring, and the surface irregularity in terms of higher order aberrations (HOA), and keratometry and UCVA, CLCVA, and the difference between BSCVA and CLCVA. RESULTS The mean logMAR UCVA, BSCVA, and CLCVA were 0.76, 0.35, and 0.28, respectively. The corneal scars had a mean thickness of 158.7 ± 61 µ and density of 65.73 ± 24.46 GSU. Bivariate analysis model for UCVA showed an association with Z42 secondary astigmatism (p = 0.02), Z44 quadrafoil (p = 0.01), combined coma Z3 ± 1(p = 0.03), and combined HOA Z3-Z6 (p = 0.045), out of which Z44 Quadrafoil (p = 0.04) was most significant with multivariate analysis. Bivariate analysis for BCVA-CLVA showed association with Z31 coma horizontal (p = 0.04), Z33 oblique trefoil (p = 0.02), Z40 primary spherical aberration (p = 0.008), and Z5 - 5 (p = 0.007), out of which Z31 horizontal coma (p = 0.04) and Z40 spherical aberration (p = 0.009) were significant on multivariate analysis. Change in densitometry, corneal thickness, epithelial:stromal reflectivity ratio, scar depth, and keratometry did not show any significant association with UCVA, BSCVA-CLCVA, or CLCVA. CONCLUSION In superficial corneal stromal scarring, deranged surface irregularity parameters like higher-order aberrations affect the final visual acuity more than the depth or density of the opacity.
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Affiliation(s)
- Vineet Pramod Joshi
- Shantilal Shanghvi Cornea Institute, LV Prasad Eye Institute, Hyderabad, India.,Professor Brien Holden Eye Research Centre, LV Prasad Eye Institute, Hyderabad, India
| | - Subhajit Chatterjee
- Cataract, Refractive Surgery and Contact Lens Services, LV Prasad Eye Institute, Hyderabad, India
| | - Sayan Basu
- Shantilal Shanghvi Cornea Institute, LV Prasad Eye Institute, Hyderabad, India.,Professor Brien Holden Eye Research Centre, LV Prasad Eye Institute, Hyderabad, India
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Baraya M, Moore J, Lopes BT, Wu R, Bao F, Zheng X, Consejo A, Abass A. Limitations of Reconstructing Pentacam Rabbit Corneal Tomography by Zernike Polynomials. BIOENGINEERING (BASEL, SWITZERLAND) 2022; 10:bioengineering10010039. [PMID: 36671611 PMCID: PMC9854916 DOI: 10.3390/bioengineering10010039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 12/22/2022] [Accepted: 12/27/2022] [Indexed: 12/30/2022]
Abstract
The study aims to investigate the likelihood of Zernike polynomial being used for reconstructing rabbit corneal surfaces as scanned by the Pentacam segment tomographer, and hence evaluate the accuracy of corneal power maps calculated from such Zernike fitted surfaces. The study utilised a data set of both eyes of 21 rabbits using a reverse engineering approach for deductive reasoning. Pentacam raw elevation data were fitted to Zernike polynomials of orders 2 to 20. The surface fitting process to Zernike polynomials was carried out using randomly selected 80% of the corneal surface data points, and the root means squared fitting error (RMS) was determined for the other 20% of the surface data following the Pareto principle. The process was carried out for both the anterior and posterior surfaces of the corneal surfaces that were measured via Pentacam scans. Raw elevation data and the fitted corneal surfaces were then used to determine corneal axial and tangential curvature maps. For reconstructed surfaces calculated using the Zernike fitted surfaces, the mean and standard deviation of the error incurred by the fitting were calculated. For power maps computed using the raw elevation data, different levels of discrete cosine transform (DCT) smoothing were employed to infer the smoothing level utilised by the Pentacam device. The RMS error was not significantly improved for Zernike polynomial orders above 12 and 10 when fitting the anterior and posterior surfaces of the cornea, respectively. This was noted by the statistically non-significant increase in accuracy when the order was increased beyond these values. The corneal curvature calculations suggest that a smoothing process is employed in the corneal curvature maps outputted by the Pentacam device; however, the exact smoothing method is unknown. Additionally, the results suggest that fitting corneal surfaces to high-order Zernike polynomials will incur a clinical error in the calculation of axial and tangential corneal curvature of at least 0.16 ± 01 D and 0.36 ± 0.02 D, respectively. Rabbit corneal anterior and posterior surfaces scanned via the Pentacam were optimally fitted to orders 12 and 10 Zernike polynomials. This is essential to get stable values of high-order aberrations that are not affected by Zernike polynomial fittings, such as comas for Intracorneal Ring Segments (ICRS) adjustments or spherical aberration for pre-cataract operations. Smoothing was necessary to replicate the corneal curvature maps outputted by the Pentacam tomographer, and fitting corneal surfaces to Zernike polynomials introduces errors in the calculation of both the axial and tangential corneal curvatures.
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Affiliation(s)
- Mohamed Baraya
- Department of Production Engineering and Mechanical Design, Faculty of Engineering, Port Said University, Port Said 42526, Egypt
| | - Jessica Moore
- Department of Civil Engineering and Industrial Design, School of Engineering, University of Liverpool, Liverpool L69 3GH, UK
| | - Bernardo T. Lopes
- Department of Civil Engineering and Industrial Design, School of Engineering, University of Liverpool, Liverpool L69 3GH, UK
- Department of Ophthalmology, Federal University of Sao Paulo, Sao Paulo 04017-030, Brazil
| | - Richard Wu
- Brighten Optix Corporation, Shilin District, Taipei 11167, Taiwan
| | - FangJun Bao
- Eye Hospital, Wenzhou Medical University, Wenzhou 325035, China
| | - XiaoBo Zheng
- Eye Hospital, Wenzhou Medical University, Wenzhou 325035, China
| | - Alejandra Consejo
- Department Applied Physics, University of Zaragoza, 50009 Zaragoza, Spain
| | - Ahmed Abass
- Department of Production Engineering and Mechanical Design, Faculty of Engineering, Port Said University, Port Said 42526, Egypt
- Department of Mechanical, Materials and Aerospace Engineering, School of Engineering, University of Liverpool, Liverpool L69 3GH, UK
- Correspondence:
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Beckmann L, Cai Z, Margolis M, Fang R, Djalilian A, Zhang HF. Recent advances in optical coherence tomography for anterior segment imaging in small animals and their clinical implications. Ocul Surf 2022; 26:222-233. [PMID: 36195237 PMCID: PMC10040227 DOI: 10.1016/j.jtos.2022.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 08/16/2022] [Accepted: 08/17/2022] [Indexed: 12/05/2022]
Abstract
Anterior segment optical coherence tomography (AS-OCT) is a rapidly evolving area of OCT imaging, providing high-resolution and non-invasive volumetric imaging of the anterior segment. This review focuses on recent advances in AS-OCT imaging in small animals, which we categorize into ultrahigh-resolution, spectroscopic, magnetomotive, polarization-sensitive, and angiographic AS-OCTs. We summarize their technical foundations, review their applications to small animal imaging, and briefly discuss their current and future clinical applications.
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Affiliation(s)
- Lisa Beckmann
- Department of Biomedical Engineering, Northwestern University, Evanston IL, USA
| | - Zhen Cai
- Department of Biomedical Engineering, Northwestern University, Evanston IL, USA; Currently with Department of Ophthalmology, Tongji Medical College, HuaZhong University of Science and Technology, Wuhan, Hubei, China
| | - Mathew Margolis
- Department of Ophthalmology and Visual Science, University of Illinois at Chicago, Chicago IL, USA
| | - Raymond Fang
- Department of Biomedical Engineering, Northwestern University, Evanston IL, USA
| | - Ali Djalilian
- Department of Ophthalmology and Visual Science, University of Illinois at Chicago, Chicago IL, USA
| | - Hao F Zhang
- Department of Biomedical Engineering, Northwestern University, Evanston IL, USA.
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Role of AS-OCT in Managing Corneal Disorders. Diagnostics (Basel) 2022; 12:diagnostics12040918. [PMID: 35453966 PMCID: PMC9030521 DOI: 10.3390/diagnostics12040918] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 03/29/2022] [Accepted: 03/30/2022] [Indexed: 11/17/2022] Open
Abstract
Optical coherence tomography (OCT) is analogous to ultrasound biometry in the cross sectional imaging of ocular tissues. Development of current devices with deeper penetration and higher resolution has made it popular tool in clinics for visualization of anterior segment structures. In this review, the authors discussed the application of AS-OCT for diagnosis and management of various corneal and ocular surface disorders. Further, recent developments in the application of the device for pediatric corneal disorders and extending the application of OCT angiography for anterior segment are introduced.
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In vivo biocompatibility evaluation of in situ-forming polyethylene glycol-collagen hydrogels in corneal defects. Sci Rep 2021; 11:23913. [PMID: 34903788 PMCID: PMC8668970 DOI: 10.1038/s41598-021-03270-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 12/01/2021] [Indexed: 12/26/2022] Open
Abstract
The available treatment options include corneal transplantation for significant corneal defects and opacity. However, shortage of donor corneas and safety issues in performing corneal transplantation are the main limitations. Accordingly, we adopted the injectable in situ-forming hydrogels of collagen type I crosslinked via multifunctional polyethylene glycol (PEG)-N-hydroxysuccinimide (NHS) for treatment and evaluated in vivo biocompatibility. The New Zealand White rabbits (N = 20) were randomly grouped into the keratectomy-only and keratectomy with PEG-collagen hydrogel-treated groups. Samples were processed for immunohistochemical evaluation. In both clinical and histologic observations, epithelial cells were able to migrate and form multilayers over the PEG-collagen hydrogels at the site of the corneal stromal defect. There was no evidence of inflammatory or immunological reactions or increased IOP for PEG-collagen hydrogel-treated corneas during the four weeks of observation. Immunohistochemistry revealed the presence of α-smooth muscle actin (α-SMA) in the superior corneal stroma of the keratectomy-only group (indicative of fibrotic healing), whereas low stromal α-SMA expression was detected in the keratectomy with PEG-collagen hydrogel-treated group. Taken together, we suggest that PEG-collagen may be used as a safe and effective alternative in treating corneal defect in clinical setting.
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Chen Y, Dong L, Kong B, Huang Y, Zhong S, Connon C, Tan J, Yang S, Sun W, Mi S. Effects of Gelatin Methacrylate Hydrogel on Corneal Repair and Regeneration in Rats. Transl Vis Sci Technol 2021; 10:25. [PMID: 34935910 PMCID: PMC8711000 DOI: 10.1167/tvst.10.14.25] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Purpose This study investigates the repairing process of rat cornea after surgery of lamellar keratoplasty (LKP) and evaluates the effects of gelatin methacrylate (GelMA) hydrogel. Methods In the LKP group, the lamellar stroma matrixes of Sprague-Dawley rats were transplanted to enhanced green fluorescent protein rats, whereas those in the GelMA group were also embedded with a GelMA hydrogel during the corneal transplantation. Grafted eyes were harvested on days seven, 30, and 90. Hematoxylin and eosin staining, immunofluorescence staining, scanning electron microscopy, optical coherence tomography, and a slit-lamp microscope were used to study the process of corneal restoration and regeneration. Results A total of 42 rats were analyzed, including 18 rats in each of the experimental group and six rats in the control group. After three months, the infiltration degree of inflammatory cells differed between the LKP group and the GelMA group (P < 0.001). Moreover, in multiple comparisons in corneal thickness, significant difference was observed between the LKP group and the GelMA group. There was also divergence in the results between the LKP group and the control group (P < 0.001, P < 0.001). At the same time, the expression of α-smooth muscle actin (α-SMA) and transforming growth factor (TGF)-β1 varied distinctly between the LKP group and the GelMA group (P < 0.05, P < 0.001). Conclusions Significant differences were demonstrated between the LKP group and the GelMA group in inflammatory cell infiltration, corneal thickness, as well as the expression of α-SMA and TGF-β1. Those differences indicate the ability of GelMA hydrogel to support alleviation in corneal stroma fibrosis and show the influences of fibrosis in the dysfunction of corneal refractive power. Translational Relevance Our research provides new ideas for the future development of LKP and tissue-engineered corneas.
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Affiliation(s)
- Yun Chen
- Macromolecular Platforms for Translational Medicine and Bio-Manufacturing Laboratory, Tsinghua-Berkeley Shenzhen Institute, Shenzhen, P.R. China.,Open FIESTA Center, International Graduate School at Shenzhen, Tsinghua University, Shenzhen, P.R. China
| | - Lina Dong
- Macromolecular Platforms for Translational Medicine and Bio-Manufacturing Laboratory, Tsinghua-Berkeley Shenzhen Institute, Shenzhen, P.R. China
| | - Bin Kong
- Macromolecular Platforms for Translational Medicine and Bio-Manufacturing Laboratory, Tsinghua-Berkeley Shenzhen Institute, Shenzhen, P.R. China
| | - Yu Huang
- Biomanufacturing Engineering Laboratory, International Graduate School at Shenzhen, Tsinghua University, Shenzhen, P.R. China
| | - Suyi Zhong
- Institute of Optical Imaging and Sensing, Shenzhen Key Laboratory for Minimal Invasive Medical Technologies, Graduate School at Shenzhen, Tsinghua University, Shenzhen, P.R. China
| | - Che Connon
- Biosciences Institute, Newcastle University
| | - Jiaqi Tan
- Open FIESTA Center, International Graduate School at Shenzhen, Tsinghua University, Shenzhen, P.R. China
| | - Siming Yang
- Key Laboratory of Wound Repair and Regeneration of PLA, Chinese PLA General Hospital, Medical College of PLA, Beijing, P.R. China
| | - Wei Sun
- Macromolecular Platforms for Translational Medicine and Bio-Manufacturing Laboratory, Tsinghua-Berkeley Shenzhen Institute, Shenzhen, P.R. China.,Department of Mechanical Engineering, Biomanufacturing Center, Tsinghua University, Beijing, P.R. China.,Department of Mechanical Engineering, Drexel University, Philadelphia, PA, USA
| | - Shengli Mi
- Macromolecular Platforms for Translational Medicine and Bio-Manufacturing Laboratory, Tsinghua-Berkeley Shenzhen Institute, Shenzhen, P.R. China.,Open FIESTA Center, International Graduate School at Shenzhen, Tsinghua University, Shenzhen, P.R. China.,Department of Mechanical Engineering, Biomanufacturing Center, Tsinghua University, Beijing, P.R. China
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Kate A, Mudgil T, Basu S. Longitudinal Changes in Corneal Epithelial Thickness and Reflectivity following Simple Limbal Epithelial Transplantation: An Optical Coherence Tomography-Based Study. Curr Eye Res 2021; 47:336-342. [PMID: 34605742 DOI: 10.1080/02713683.2021.1988985] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE To describe the changes in corneal epithelial thickness and reflectivity following simple limbal epithelial transplantation (SLET) using anterior segment optical coherence tomography (ASOCT). METHODS This was a prospective imaging study of 31 eyes of 29 patients who had undergone autologous or allogeneic SLET for limbal stem cell deficiency and had stable, avascular surfaces postoperatively. ASOCT scans of all four quadrants were taken preoperatively and at 1-week, 1-month, 3-month, 6-month, and 1-year postoperative time points in the eyes undergoing SLET. Baseline scans were also taken from the normal eye in unilateral cases. The following parameters were obtained from the scans: (i) epithelial thickness (ET), (ii) stromal thickness, (iii) total corneal thickness, (iv) epithelial reflectivity (ER), (v) stromal reflectivity, and (vi) epithelial/stromal (ES) reflectivity ratio. RESULTS Chemical injury (24 eyes, 77.4%) was the most common indication for surgery. There was a significant improvement in the ET (184.8 ± 117.1 vs 60.3 ± 10 µm, p < .0001) and ER (144.5 ± 26.4 vs 120.9 ± 28.9, p < .0001) within the initial postoperative period following SLET, which remained stable at the end of 1 year follow-up. There was no difference in the ET of the post-SLET and normal eyes after the 3-month timepoint and this normalization was maintained until the end of the first year. A significant normalization was also noted in the ES reflectivity ratio at the end of 1 year (2.1 ± 0.8 vs 1 ± 0.2, p < .001). A significant correlation was found between the final visual acuity and the total corneal thickness (r = 0.942, p = .005). CONCLUSION There is a significant improvement in the epithelial thickness and reflectivity of the cornea in eyes undergoing SLET. ASOCT provides a reliable objective measure of these changes and can be used to monitor the outcomes in these eyes postoperatively.
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Affiliation(s)
- Anahita Kate
- The Cornea Institute, KVC Campus, LV Prasad Eye Institute, Vijayawada, India
| | - Tanvi Mudgil
- The Cornea Institute, GMRV Campus, LV Prasad Eye Institute, Visakhapatnam, India
| | - Sayan Basu
- The Cornea Institute, KAR Campus, LV Prasad Eye Institute, Hyderabad, India.,Prof. Brien Holden Eye Research Centre (BHERC), LV Prasad Eye Institute, Hyderabad, India
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High-Resolution Optical Coherence Tomography Angiography Characteristics of Limbal Stem Cell Deficiency. Diagnostics (Basel) 2021; 11:diagnostics11061130. [PMID: 34205702 PMCID: PMC8233779 DOI: 10.3390/diagnostics11061130] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 06/02/2021] [Accepted: 06/17/2021] [Indexed: 12/15/2022] Open
Abstract
This study aimed to identify the anterior segment high-resolution optical coherence tomography (HR-OCT) and HR-OCT angiography (HR-OCTA) features suggestive of limbal stem cell deficiency (LSCD) as confirmed by both impression cytology (IC) and in vivo confocal microscopy (IVCM). This was a single-centre prospective cross-sectional study including 24 eyes of 22 patients with clinical suspicion of LSCD based on peripheral superficial corneal vascularisation and scarring. On IC and IVCM, performed and interpreted by blinded observers, 12 eyes each were diagnosed with and without LSCD. Additionally, 10 eyes of 5 healthy volunteers with no ocular pathology were also imaged. The 136 HR-OCT/A images of these 34 eyes were analysed with respect to 12 imaging parameters; the parameters most suggestive of LSCD were identified and the sensitivity and specificity were calculated. In the LSCD group, the most common aetiology was ocular chemical burns (83%), whereas in the non-LSCD group, the most common aetiology was viral keratitis (67%). Multiple logistic regression analysis revealed that mean epithelial reflectivity, mean stromal reflectivity, and mean superficial vascular density were the parameters that were diagnostic of LSCD on HR-OCT/A (p < 0.0001). A ratio of the mean epithelial reflectivity to stromal reflectivity of >1.29 corresponded with a high sensitivity (91.7%) and specificity (98.75%); while a mean superficial vascular density score of >0.38 corresponded with a sensitivity of 97.9% and specificity of 73.8%. In conclusion, HR-OCT/A as a non-invasive imaging modality could prove to be a useful tool for confirming the diagnosis of LSCD, with potential clinical and research applications.
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Chandru A, Agrawal P, Ojha SK, Selvakumar K, Shiva VK, Gharat T, Selvam S, Thomas MB, Damala M, Prasad D, Basu S, Bhowmick T, Sangwan VS, Singh V. Human Cadaveric Donor Cornea Derived Extra Cellular Matrix Microparticles for Minimally Invasive Healing/Regeneration of Corneal Wounds. Biomolecules 2021; 11:532. [PMID: 33918484 PMCID: PMC8066719 DOI: 10.3390/biom11040532] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 03/24/2021] [Accepted: 03/25/2021] [Indexed: 01/10/2023] Open
Abstract
Biological materials derived from extracellular matrix (ECM) proteins have garnered interest as their composition is very similar to that of native tissue. Herein, we report the use of human cornea derived decellularized ECM (dECM) microparticles dispersed in human fibrin sealant as an accessible therapeutic alternative for corneal anterior stromal reconstruction. dECM microparticles had good particle size distribution (≤10 µm) and retained the majority of corneal ECM components found in native tissue. Fibrin-dECM hydrogels exhibited compressive modulus of 70.83 ± 9.17 kPa matching that of native tissue, maximum burst pressure of 34.3 ± 3.7 kPa, and demonstrated a short crosslinking time of ~17 min. The fibrin-dECM hydrogels were found to be biodegradable, cytocompatible, non-mutagenic, non-sensitive, non-irritant, and supported the growth and maintained the phenotype of encapsulated human corneal stem cells (hCSCs) in vitro. In a rabbit model of anterior lamellar keratectomy, fibrin-dECM bio-adhesives promoted corneal re-epithelialization within 14 days, induced stromal tissue repair, and displayed integration with corneal tissues in vivo. Overall, our results suggest that the incorporation of cornea tissue-derived ECM microparticles in fibrin hydrogels is non-toxic, safe, and shows tremendous promise as a minimally invasive therapeutic approach for the treatment of superficial corneal epithelial wounds and anterior stromal injuries.
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Affiliation(s)
- Arun Chandru
- Pandorum Technologies Private Limited, Bangalore, Karnataka 560100, India; (P.A.); (S.K.O.); (K.S.); (V.K.S.); (T.G.); (S.S.); (M.B.T.)
| | - Parinita Agrawal
- Pandorum Technologies Private Limited, Bangalore, Karnataka 560100, India; (P.A.); (S.K.O.); (K.S.); (V.K.S.); (T.G.); (S.S.); (M.B.T.)
| | - Sanjay Kumar Ojha
- Pandorum Technologies Private Limited, Bangalore, Karnataka 560100, India; (P.A.); (S.K.O.); (K.S.); (V.K.S.); (T.G.); (S.S.); (M.B.T.)
| | - Kamalnath Selvakumar
- Pandorum Technologies Private Limited, Bangalore, Karnataka 560100, India; (P.A.); (S.K.O.); (K.S.); (V.K.S.); (T.G.); (S.S.); (M.B.T.)
| | - Vaishnavi K. Shiva
- Pandorum Technologies Private Limited, Bangalore, Karnataka 560100, India; (P.A.); (S.K.O.); (K.S.); (V.K.S.); (T.G.); (S.S.); (M.B.T.)
| | - Tanmay Gharat
- Pandorum Technologies Private Limited, Bangalore, Karnataka 560100, India; (P.A.); (S.K.O.); (K.S.); (V.K.S.); (T.G.); (S.S.); (M.B.T.)
| | - Shivaram Selvam
- Pandorum Technologies Private Limited, Bangalore, Karnataka 560100, India; (P.A.); (S.K.O.); (K.S.); (V.K.S.); (T.G.); (S.S.); (M.B.T.)
| | - Midhun Ben Thomas
- Pandorum Technologies Private Limited, Bangalore, Karnataka 560100, India; (P.A.); (S.K.O.); (K.S.); (V.K.S.); (T.G.); (S.S.); (M.B.T.)
| | - Mukesh Damala
- Brien Holden Eye Research Center, LV Prasad Eye Institute, Hyderabad, Telangana 500034, India; (M.D.); (D.P.); (S.B.); (V.S.S.)
| | - Deeksha Prasad
- Brien Holden Eye Research Center, LV Prasad Eye Institute, Hyderabad, Telangana 500034, India; (M.D.); (D.P.); (S.B.); (V.S.S.)
| | - Sayan Basu
- Brien Holden Eye Research Center, LV Prasad Eye Institute, Hyderabad, Telangana 500034, India; (M.D.); (D.P.); (S.B.); (V.S.S.)
- Center for Ocular Regeneration (CORE), LV Prasad Eye Institute, Hyderabad, Telangana 500034, India
| | - Tuhin Bhowmick
- Pandorum Technologies Private Limited, Bangalore, Karnataka 560100, India; (P.A.); (S.K.O.); (K.S.); (V.K.S.); (T.G.); (S.S.); (M.B.T.)
| | - Virender Singh Sangwan
- Brien Holden Eye Research Center, LV Prasad Eye Institute, Hyderabad, Telangana 500034, India; (M.D.); (D.P.); (S.B.); (V.S.S.)
- Center for Ocular Regeneration (CORE), LV Prasad Eye Institute, Hyderabad, Telangana 500034, India
| | - Vivek Singh
- Brien Holden Eye Research Center, LV Prasad Eye Institute, Hyderabad, Telangana 500034, India; (M.D.); (D.P.); (S.B.); (V.S.S.)
- Center for Ocular Regeneration (CORE), LV Prasad Eye Institute, Hyderabad, Telangana 500034, India
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Saccu G, Menchise V, Giordano C, Delli Castelli D, Dastrù W, Pellicano R, Tolosano E, Van Pham P, Altruda F, Fagoonee S. Regenerative Approaches and Future Trends for the Treatment of Corneal Burn Injuries. J Clin Med 2021; 10:jcm10020317. [PMID: 33467167 PMCID: PMC7830803 DOI: 10.3390/jcm10020317] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 01/12/2021] [Accepted: 01/14/2021] [Indexed: 12/13/2022] Open
Abstract
Ocular chemical and thermal burns are frequent causes of hospitalization and require immediate interventions and care. Various surgical and pharmacological treatment strategies are employed according to damage severity. Controlling inflammation and neovascularization while promoting normal ocular surface anatomy and function restoration is the principal aim. In the most severe cases, when epithelial healing is severely affected, reconstruction of the ocular surface may be a valid option, which, however, requires expertise, adequate instruments, and qualified donors. Numerous endogenous and exogenous strategies have been considered for corneal repair. Among these, stem cells and their derivatives have offered numerous attractive possibilities in finding an effective way in stimulating corneal regeneration. Limbal epithelial stem cells and mesenchymal cells from the ocular tissue as well as from various sources have demonstrated their effectiveness in dampening neovascularization, scarring, and inflammation, while promoting epithelialization of the injured cornea. Moreover, a plethora of cytokines and growth factors, and extracellular vesicles, which constitute the secretome of these cells, work in concert to enhance wound healing. In this review, we provide an update on the recent potential therapeutic avenues and clinical applications of stem cells and their products in corneal regeneration after burn injury, as well as current imaging strategies for monitoring therapeutic efficacy and damage resolution.
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Affiliation(s)
- Gabriele Saccu
- Department of Molecular Biotechnology and Health Sciences, Molecular Biotechnology Center, University of Turin, 10126 Turin, Italy; (G.S.); (D.D.C.); (W.D.); (E.T.)
| | - Valeria Menchise
- Institute of Biostructure and Bioimaging, National Research Council, Molecular Biotechnology Center, 10126 Turin, Italy
- Correspondence: (V.M.); (F.A.); (S.F.); Tel.: +39-0116706423 (S.F.)
| | - Cristina Giordano
- Ophthalmology Veterinary Practice, c.so Galileo Ferraris 121, 10126 Turin, Italy;
| | - Daniela Delli Castelli
- Department of Molecular Biotechnology and Health Sciences, Molecular Biotechnology Center, University of Turin, 10126 Turin, Italy; (G.S.); (D.D.C.); (W.D.); (E.T.)
| | - Walter Dastrù
- Department of Molecular Biotechnology and Health Sciences, Molecular Biotechnology Center, University of Turin, 10126 Turin, Italy; (G.S.); (D.D.C.); (W.D.); (E.T.)
| | | | - Emanuela Tolosano
- Department of Molecular Biotechnology and Health Sciences, Molecular Biotechnology Center, University of Turin, 10126 Turin, Italy; (G.S.); (D.D.C.); (W.D.); (E.T.)
| | - Phuc Van Pham
- Laboratory of Stem Cell Research and Application, and Stem Cell Institute, VNUHCM University of Science, Ho Chi Minh City 08000, Vietnam;
| | - Fiorella Altruda
- Department of Molecular Biotechnology and Health Sciences, Molecular Biotechnology Center, University of Turin, 10126 Turin, Italy; (G.S.); (D.D.C.); (W.D.); (E.T.)
- Correspondence: (V.M.); (F.A.); (S.F.); Tel.: +39-0116706423 (S.F.)
| | - Sharmila Fagoonee
- Institute of Biostructure and Bioimaging, National Research Council, Molecular Biotechnology Center, 10126 Turin, Italy
- Correspondence: (V.M.); (F.A.); (S.F.); Tel.: +39-0116706423 (S.F.)
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Cogswell D, Sun M, Greenberg E, Margo CE, Espana EM. Creation and grading of experimental corneal scars in mice models. Ocul Surf 2020; 19:53-62. [PMID: 33259950 DOI: 10.1016/j.jtos.2020.11.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 11/15/2020] [Accepted: 11/16/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE To develop a stromal wound healing model and a reliable scar classification score system that correlates photographic evaluation with changes in the structure and organization of the extracellular matrix. MATERIALS AND METHODS We tested three stromal injury techniques in adult C57BL/6 mice. Technique 1, a lineal partial thickness keratotomy in the horizontal axis. Technique 2, corneal epithelial and stromal debridement using a diamond burr in the horizontal axis, and technique 3, a combination of techniques 1 and 2. To assess intra-observer and inter-observer agreement between two examiners evaluating formed stromal scars, stereo microscopic photographs of anterior segment were scored by two masked examiners at around 1-month. Depending on the severity of opacification and the area of involvement, scars were classified on a scale from 0 to 3 based on a modified Fantes haze scale. Extracellular matrix composition as well as matrix organization, macrophage infiltration and neovascularization were evaluated with immunofluorescence and second harmonic generation (SHG) microscopy. RESULTS Technique 1 created mild scars, with a score of 0.5 ± 0.43, while techniques 2 (score 2.1 ± 0.45) and 3 (score 2 ± 0.66), created dense scars with a higher score. A significant difference in scar severity score was noted between the 3 techniques (one way ANOVA, p < 0.0001). Masked graders demonstrated excellent agreement (intraclass correlation = 0.927 [95% confidence interval: 0.87-0.96]). The severity of scars noted at stereo microscopy correlated with the severity of changes in extracellular matrix in the stroma as demonstrated by the expression of collagens I, IV and fibronectin and evaluation of matrix hierarchical organization. In contrast to mild scarring, moderate and severe scars had increased expression of CD31 and CD68, markers of vascular endothelial cells and macrophages, respectively. CONCLUSION Mouse models of stromal scarring using simple surgical techniques are described. Corneal scars can be consistently classified by two observers. Grading of scar severity positively correlates with changes in extracellular matrix composition, disorganization and cell infiltration.
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Affiliation(s)
- Devon Cogswell
- From the Cornea, External Disease Service, Department of Ophthalmology, University of South Florida, Tampa, FL, USA
| | - Mei Sun
- From the Cornea, External Disease Service, Department of Ophthalmology, University of South Florida, Tampa, FL, USA
| | - Erin Greenberg
- From the Cornea, External Disease Service, Department of Ophthalmology, University of South Florida, Tampa, FL, USA
| | - Curtis E Margo
- From the Cornea, External Disease Service, Department of Ophthalmology, University of South Florida, Tampa, FL, USA; Pathology and Cell Biology, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Edgar M Espana
- From the Cornea, External Disease Service, Department of Ophthalmology, University of South Florida, Tampa, FL, USA; Molecular Pharmacology and Physiology, University of South Florida, Tampa, FL, USA.
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