1
|
Atalay E, Altuğ B, Çalışkan ME, Ceylan S, Özler ZS, Figueiredo G, Lako M, Figueiredo F. Animal Models for Limbal Stem Cell Deficiency: A Critical Narrative Literature Review. Ophthalmol Ther 2024; 13:671-696. [PMID: 38280103 PMCID: PMC10853161 DOI: 10.1007/s40123-023-00880-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 12/19/2023] [Indexed: 01/29/2024] Open
Abstract
This literature review will provide a critical narrative overview of the highlights and potential pitfalls of the reported animal models for limbal stem cell deficiency (LSCD) and will identify the neglected aspects of this research area. There exists significant heterogeneity in the literature regarding the methodology used to create the model and the predefined duration after the insult when the model is supposedly fully fit for evaluations and/or for testing various therapeutic interventions. The literature is also replete with examples wherein the implementation of a specific model varies significantly across different studies. For example, the concentration of the chemical, as well as its duration and technique of exposure in a chemically induced LSCD model, has a great impact not only on the validity of the model but also on the severity of the complications. Furthermore, while some models induce a full-blown clinical picture of total LSCD, some are hindered by their ability to yield only partial LSCD. Another aspect to consider is the nature of the damage induced by a specific method. As thermal methods cause more stromal scarring, they may be better suited for assessing the anti-fibrotic properties of a particular treatment. On the other hand, since chemical burns cause more neovascularisation, they provide the opportunity to tap into the potential treatments for anti-neovascularisation. The animal species (i.e., rats, mice, rabbits, etc.) is also a crucial factor in the validity of the model and its potential for clinical translation, with each animal having its unique set of advantages and disadvantages. This review will also elaborate on other overlooked aspects, such as the anaesthetic(s) used during experiments, the gender of the animals, care after LSCD induction, and model validation. The review will conclude by providing future perspectives and suggestions for further developments in this rather important area of research.
Collapse
Affiliation(s)
- Eray Atalay
- Department of Ophthalmology, Eskişehir Osmangazi University Medical School, Eskişehir, Turkey
| | - Burcugül Altuğ
- Cellular Therapy and Stem Cell Production Application, Research Centre (ESTEM), Eskişehir Osmangazi University, Eskişehir, Turkey
| | | | - Semih Ceylan
- Eskişehir Osmangazi University Medical School, Eskişehir, Turkey
| | | | | | - Majlinda Lako
- Biosciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Francisco Figueiredo
- Biosciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK.
- Department of Ophthalmology, Royal Victoria Infirmary, Newcastle University, Newcastle upon Tyne, NE1 4LP, UK.
| |
Collapse
|
2
|
Chaudhary S, Kate A, Chappidi K, Basu S, Shanbhag SS. Safety and Efficacy of Contact Lenses in Eyes After Simple Limbal Epithelial Transplantation. Cornea 2023; 42:1513-1519. [PMID: 36728263 DOI: 10.1097/ico.0000000000003228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 11/28/2022] [Indexed: 02/03/2023]
Abstract
PURPOSE The aim of this study was to evaluate the safety and efficacy of contact lenses (CLs) in eyes after simple limbal epithelial transplantation (SLET) for limbal stem cell deficiency (LSCD). METHODS This retrospective study included 61 eyes with partial or total LSCD which underwent SLET and were fitted with corneal or scleral rigid gas-permeable CLs. The primary outcome measure was best-corrected visual acuity (BCVA) with CLs. RESULTS The median age at presentation was 22 years. The most common cause of LSCD was chemical injury [47/61 eyes (77%)]. Twenty-seven eyes (44%) were fitted with corneal rigid gas-permeable lenses, while 34 eyes (56%) were prescribed scleral lenses. The median duration of interval between SLET and CL trial was 10 months (interquartile range: 4-17). The median preoperative BCVA was logarithm of minimal angle of resolution (logMAR) 1.8. This improved to logMAR 1 ( P < 0.001) after SLET and to logMAR 0.6 ( P < 0.001) with CLs. Eyes with chemical injury (logMAR 1 vs. 0.6, P = 0.0001), grade 1 (logMAR 0.8 vs. 0.4, P < 0.0001), and grade 2 (logMAR 0.9 vs. 0.6, P = 0.004) corneal scarring had better improvement in BCVA with CLs. No complications were noted until the last follow-up visit. CONCLUSIONS CLs, both corneal and scleral lenses, provide significant visual improvement in eyes after SLET with residual corneal scarring. These can be safely prescribed in such eyes without any adverse effects. This option can be considered before offering keratoplasty in these eyes.
Collapse
Affiliation(s)
- Simmy Chaudhary
- The Cornea Institute, KAR Campus, L V Prasad Eye Institute, Hyderabad, India
- Bausch & Lomb Contact Lens Centre, L V Prasad Eye Institute, Hyderabad, India
| | - Anahita Kate
- The Cornea Institute, L V Prasad Eye Institute, Vijaywada, India
| | - Kiranmayi Chappidi
- The Cornea Institute, L V Prasad Eye Institute, Vijaywada, India
- Brien Holden Institute of Optometry and Vision Sciences, L V Prasad Eye Institute, Hyderabad, India
| | - Sayan Basu
- The Cornea Institute, KAR Campus, L V Prasad Eye Institute, Hyderabad, India
- Centre for Ocular Regeneration (CORE), L V Prasad Eye Institute, Hyderabad, India; and
- Brien Holden Eye Research Centre (BHERC), L V Prasad Eye Institute, Hyderabad, India
| | - Swapna S Shanbhag
- The Cornea Institute, KAR Campus, L V Prasad Eye Institute, Hyderabad, India
| |
Collapse
|
3
|
Jurkunas UV, Yin J, Johns LK, Li S, Negre H, Shaw KL, Samarakoon L, Ayala AR, Kheirkhah A, Katikireddy K, Gauthier A, Ong Tone S, Kaufman AR, Ellender S, Hernandez Rodriguez DE, Daley H, Dana R, Armant M, Ritz J. Cultivated autologous limbal epithelial cell (CALEC) transplantation: Development of manufacturing process and clinical evaluation of feasibility and safety. SCIENCE ADVANCES 2023; 9:eadg6470. [PMID: 37595035 PMCID: PMC10438443 DOI: 10.1126/sciadv.adg6470] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 07/18/2023] [Indexed: 08/20/2023]
Abstract
To treat unilateral limbal stem cell (LSC) deficiency, we developed cultivated autologous limbal epithelial cells (CALEC) using an innovative xenobiotic-free, serum-free, antibiotic-free, two-step manufacturing process for LSC isolation and expansion onto human amniotic membrane with rigorous quality control in a good manufacturing practices facility. Limbal biopsies were used to generate CALEC constructs, and final grafts were evaluated by noninvasive scanning microscopy and tested for viability and sterility. Cultivated cells maintained epithelial cell phenotype with colony-forming and proliferative capacities. Analysis of LSC biomarkers showed preservation of "stemness." After preclinical development, a phase 1 clinical trial enrolled five patients with unilateral LSC deficiency. Four of these patients received CALEC transplants, establishing preliminary feasibility. Clinical case histories are reported, with no primary safety events. On the basis of these results, a second recruitment phase of the trial was opened to provide longer term safety and efficacy data on more patients.
Collapse
Affiliation(s)
- Ula V. Jurkunas
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Jia Yin
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Lynette K. Johns
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Sanming Li
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Helene Negre
- Connell and O'Reilly Families Cell Manipulation Core Facility, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Kit L. Shaw
- Connell and O'Reilly Families Cell Manipulation Core Facility, Dana-Farber Cancer Institute, Boston, MA, USA
| | | | | | - Ahmad Kheirkhah
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Kishore Katikireddy
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Alex Gauthier
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Stephan Ong Tone
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Aaron R. Kaufman
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Stacey Ellender
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | | | - Heather Daley
- Connell and O'Reilly Families Cell Manipulation Core Facility, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Reza Dana
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Myriam Armant
- TransLab, Translational Research Program, Boston Children’s Hospital, Boston, MA, USA
| | - Jerome Ritz
- Connell and O'Reilly Families Cell Manipulation Core Facility, Dana-Farber Cancer Institute, Boston, MA, USA
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
4
|
Giachos I, Angelidis CD, Doumazos S, Tzavara C, Palioura S. Outcomes of Combined Penetrating Keratoplasty and Limbal Stem Cell Transplantation: A Meta-Analysis on Simultaneous Versus Sequential Surgery. Cornea 2023; 42:787-796. [PMID: 36853592 DOI: 10.1097/ico.0000000000003261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
PURPOSE The objective of this study is to perform a systematic review and meta-analysis of the published studies on limbal stem cell transplantation (LSCT) combined with penetrating keratoplasty (PK) performed either simultaneously or sequentially. METHODS An extensive search was conducted in the MEDLINE and Google Scholar databases. Prospective and retrospective trials and case series reporting on the outcomes of LSCT with PK were included. Primary outcomes were the stability of the ocular surface and the rejection and/or failure of the corneal graft. RESULTS A total of 209 eyes from 13 studies were included in the simultaneous group and 489 eyes from 33 studies in the sequential group. Ocular surface stability was 88% [95% confidence interval (CI), 79%-96%] for sequential cases and 64% (95% CI, 43%-82%) for simultaneous cases ( P = 0.001). The graft failure rate was 15% (95% CI, 6%-26%) for sequential cases and 44% (95% CI, 31%-58%) for simultaneous cases ( P < 0.001). For cases performed sequentially, subgroup analysis revealed a stable ocular surface in 97% (95% CI, 91%-100%) of autograft cases and 63% (95% CI, 45%-80%) of allograft cases ( P < 0.001). The graft failure rate in sequential cases was 7% (95% CI, 0%-18%) for autografts and 34% (95% CI, 18%-52%) for allografts ( P < 0.001). CONCLUSIONS Sequential LSCT followed by PK demonstrated superior results in terms of ocular surface stability and graft retention compared with simultaneous LSCT and PK. Limbal stem cells of autologous origin fare better than allogeneic ones in sequential cases.
Collapse
Affiliation(s)
- Ioannis Giachos
- First Department of Ophthalmology, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Constantine D Angelidis
- First Department of Ophthalmology, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Spyros Doumazos
- First Department of Ophthalmology, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Chara Tzavara
- Department of Biostatistics, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Sotiria Palioura
- Athens Eye Experts, Athens, Greece; and
- Department of Ophthalmology, University of Cyprus Medical School, Nicosia, Cyprus
| |
Collapse
|
5
|
Zdraveva E, Bendelja K, Bočkor L, Dolenec T, Mijović B. Detection of Limbal Stem Cells Adhered to Melt Electrospun Silk Fibroin and Gelatin-Modified Polylactic Acid Scaffolds. Polymers (Basel) 2023; 15:polym15030777. [PMID: 36772078 PMCID: PMC9919663 DOI: 10.3390/polym15030777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 01/25/2023] [Accepted: 01/31/2023] [Indexed: 02/05/2023] Open
Abstract
Limbal stem cells (LSCs) are of paramount importance in corneal epithelial tissue repair. The cornea becomes opaque in case of limbal stem cell deficiency (LSCD), which may cause serious damage to the ocular visual function. There are many techniques to restore damaged epithelium, one of which is the transplantation of healthy cultured LSCs, usually onto a human amniotic membrane or onto bio-based engineered scaffolds in recent years. In this study, melt electrospun polylactic acid (PLA) was modified by silk fibroin or gelatin and further cultured with LSCs originating from three different donors. In terms of physicochemical properties, both modifications slightly increased PLA scaffold porosity (with a significantly larger pore area for the PLA/gelatin) and improved the scaffolds' swelling percentage, as well as their biodegradation rate. In terms of the scaffold application function, the aim was to detect/visualize whether LSCs adhered to the scaffolds and to further determine cell viability (total number), as well as to observe p63 and CK3 expressions in the LSCs. LSCs were attached to the surface of microfibers, showing flattened conformations or 3D spheres in the formation of colonies or agglomerations, respectively. All scaffolds showed the ability to bind the cells onto the surface of individual microfibers (PLA and PLA/gelatin), or in between the microfibers (PLA/silk fibroin), with the latter showing the most intense red fluorescence of the stained cells. All scaffolds proved to be biocompatible, while the PLA/silk fibroin scaffolds showed the highest 98% viability of 2.9 × 106 LSCs, with more than 98% of p63 and less than 20% of CK3 expressions in the LSCs, thus confirming the support of their growth, proliferation and corneal epithelial differentiation. The results show the potential of these bio-engineered scaffolds to be used as an alternative clinical approach.
Collapse
Affiliation(s)
- Emilija Zdraveva
- Department of Fundamental Natural and Engineering Sciences, Faculty of Textile Technology, University of Zagreb, 10000 Zagreb, Croatia
| | - Krešo Bendelja
- Center for Research and Knowledge Transfer in Biotechnology, University of Zagreb, 10000 Zagreb, Croatia
| | - Luka Bočkor
- Center for Applied Bioanthropology, Institute for Anthropological Research, 10000 Zagreb, Croatia
| | - Tamara Dolenec
- Department of Transfusion and Regenerative Medicine, Sestre Milosrdnice University Hospital Center, 10000 Zagreb, Croatia
| | - Budimir Mijović
- Department of Fundamental Natural and Engineering Sciences, Faculty of Textile Technology, University of Zagreb, 10000 Zagreb, Croatia
- Correspondence:
| |
Collapse
|
6
|
Ying PX, Fu M, Huang C, Li ZH, Mao QY, Fu S, Jia XH, Cao YC, Hong LB, Cai LY, Guo X, Liu RB, Meng FK, Yi GG. Profile of biological characterizations and clinical application of corneal stem/progenitor cells. World J Stem Cells 2022; 14:777-797. [PMID: 36483848 PMCID: PMC9724387 DOI: 10.4252/wjsc.v14.i11.777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Revised: 11/08/2022] [Accepted: 11/23/2022] [Indexed: 12/13/2022] Open
Abstract
Corneal stem/progenitor cells are typical adult stem/progenitor cells. The human cornea covers the front of the eyeball, which protects the eye from the outside environment while allowing vision. The location and function demand the cornea to maintain its transparency and to continuously renew its epithelial surface by replacing injured or aged cells through a rapid turnover process in which corneal stem/progenitor cells play an important role. Corneal stem/progenitor cells include mainly corneal epithelial stem cells, corneal endothelial cell progenitors and corneal stromal stem cells. Since the discovery of corneal epithelial stem cells (also known as limbal stem cells) in 1971, an increasing number of markers for corneal stem/progenitor cells have been proposed, but there is no consensus regarding the definitive markers for them. Therefore, the identification, isolation and cultivation of these cells remain challenging without a unified approach. In this review, we systematically introduce the profile of biological characterizations, such as anatomy, characteristics, isolation, cultivation and molecular markers, and clinical applications of the three categories of corneal stem/progenitor cells.
Collapse
Affiliation(s)
- Pei-Xi Ying
- Department of Ophthalmology, Zhujiang Hospital, The Second Clinical School, Southern Medical University, Guangzhou 510280, Guangdong Province, China
| | - Min Fu
- Department of Ophthalmology, Zhujiang Hospital, Southern Medical University, Guangzhou 510280, Guangdong Province, China
| | - Chang Huang
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai 200030, China
- NHC Key Laboratory of Myopia, Fudan University, Shanghai 200030, China
- Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai 200030, China
| | - Zhi-Hong Li
- Department of Cardiology, State Key Laboratory of Organ Failure Research, Guangdong Provincial Key Lab of Shock and Microcirculation, Nanfang Hospital, Southern Medical University, Guangzhou 510550, Guangdong Province, China
| | - Qing-Yi Mao
- The Second Clinical School, Southern Medical University, Guangzhou 510515, Guangdong Province, China
| | - Sheng Fu
- Hengyang Medical School, The University of South China, Hengyang 421001, Hunan Province, China
| | - Xu-Hui Jia
- The Second Clinical School, Southern Medical University, Guangzhou 510515, Guangdong Province, China
| | - Yu-Chen Cao
- The Second Clinical School, Southern Medical University, Guangzhou 510515, Guangdong Province, China
| | - Li-Bing Hong
- The Second Clinical School, Southern Medical University, Guangzhou 510515, Guangdong Province, China
| | - Li-Yang Cai
- The Second Clinical School, Southern Medical University, Guangzhou 510515, Guangdong Province, China
| | - Xi Guo
- Medical College of Rehabilitation, Southern Medical University, Guangzhou 510515, Guangdong Province, China
| | - Ru-Bing Liu
- The Second Clinical School, Southern Medical University, Guangzhou 510515, Guangdong Province, China
| | - Fan-ke Meng
- Emergency Department, Zhujiang Hospital, Southern Medical University, Guangzhou 510280, Guangdong Province, China
| | - Guo-Guo Yi
- Department of Ophthalmology, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510655, Guangdong Province, China
| |
Collapse
|
7
|
Jurkunas U, Johns L, Armant M. Cultivated Autologous Limbal Epithelial Cell Transplantation: New Frontier in the Treatment of Limbal Stem Cell Deficiency. Am J Ophthalmol 2022; 239:244-268. [PMID: 35314191 DOI: 10.1016/j.ajo.2022.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 01/27/2022] [Accepted: 03/08/2022] [Indexed: 11/19/2022]
Abstract
PURPOSE Taking into consideration prior human experience with treating limbal stem cell deficiency (LSCD) with cultivated limbal epithelial cells (CLEC) from other countries, we have set a goal to optimize and standardize the techniques of CLEC preparation (called CALEC by our group) for the clinical trial in the United States. METHODS We performed an extensive literature review of all human trials, case series, and reports involving autologous cultivated limbal epithelial cell transplantation. Allogeneic cultivated limbal epithelial cell transplantations were reported only when combined with autologous studies. We also searched prior animal data aiding in detailing regulatory toxicology requirements. RESULTS Between 1997 and 2020, the analysis of human trials revealed 21 studies on autologous grafts, and 13 studies analyzing both autologous grafts and allogeneic grafts. Of a total of 34 studies, 6 studies used good manufacturing process (GMP) facilities, and 11 studies had no animal-derived products or murine feeder layers, whereas only 1 study had both. Overall, the treatment with autologous CLEC grafts was 68.9% successful. In total there were 6 preclinical studies using rabbits, serving as surrogate studies to assess the safety and toxicity of cultivated limbal epithelial cells for human trials. Based on prior human experience, we further optimized the manufacturing conditions with GMP-grade and serum and animal-free reagents, and developed cell characterization assays for the CALEC product release. CONCLUSIONS These data were used to develop a novel and consistent manufacturing process using only qualified and validated reagents for performing the first clinical trial on CALEC transplantation to treat LSCD in the United States.
Collapse
Affiliation(s)
- Ula Jurkunas
- From the Schepens Eye Research Institute (U.J., L.J.), Massachusetts Eye and Ear, Boston, Massachusetts, USA.
| | - Lynette Johns
- From the Schepens Eye Research Institute (U.J., L.J.), Massachusetts Eye and Ear, Boston, Massachusetts, USA
| | - Myriam Armant
- TransLab (M.A.), Translational Research Program, Boston Children's Hospital, Boston, Massachusetts, USA
| |
Collapse
|
8
|
Valdivia E, Bertolin M, Breda C, Carvalho Oliveira M, Salz AK, Hofmann N, Börgel M, Blasczyk R, Ferrari S, Figueiredo C. Genetic Modification of Limbal Stem Cells to Decrease Allogeneic Immune Responses. Front Immunol 2021; 12:747357. [PMID: 34956181 PMCID: PMC8696204 DOI: 10.3389/fimmu.2021.747357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 11/23/2021] [Indexed: 11/22/2022] Open
Abstract
Limbal stem cell (LSC) transplantation is the only efficient treatment for patients affected by LSC deficiency (LSCD). Allogeneic LSC transplantation is one of the most successful alternative for patients with bilateral LSCD. Nevertheless, the high variability of the human leukocyte antigens (HLA) remains a relevant obstacle to long-term allogeneic graft survival. This study characterized the immunologic properties of LSCs and proposed a genetic engineering strategy to reduce the immunogenicity of LSCs and of their derivatives. Hence, LSC HLA expression was silenced using lentiviral vectors encoding for short hairpin (sh) RNAs targeting β2-microglobulin (β2M) or class II major histocompatibility complex transactivator (CIITA) to silence HLA class I and II respectively. Beside the constitutive expression of HLA class I, LSCs showed the capability to upregulate HLA class II expression under inflammatory conditions. Furthermore, LSCs demonstrated the capability to induce T-cell mediated immune responses. LSCs phenotypical and functional characteristics are not disturbed after genetic modification. However, HLA silenced LSC showed to prevent T cell activation, proliferation and cytotoxicity in comparison to fully HLA-expressing LSCs. Additionally; HLA-silenced LSCs were protected against antibody-mediated cellular-dependent cytotoxicity. Our data is a proof-of-concept of the feasibility to generate low immunogenic human LSCs without affecting their typical features. The use of low immunogenic LSCs may support for long-term survival of LSCs and their derivatives after allogeneic transplantation.
Collapse
Affiliation(s)
- Emilio Valdivia
- Institute of Transfusion Medicine and Transplant Engineering, Hannover, Germany
| | | | - Claudia Breda
- Fondazione Banca degli Occhi del Veneto, Venice, Italy
| | | | | | - Nicola Hofmann
- German Society for Tissue Transplantation (DGFG), Hannover, Germany
| | - Martin Börgel
- German Society for Tissue Transplantation (DGFG), Hannover, Germany
| | - Rainer Blasczyk
- Institute of Transfusion Medicine and Transplant Engineering, Hannover, Germany
| | | | | |
Collapse
|
9
|
Bonnet C, González S, Roberts JS, Robertson SYT, Ruiz M, Zheng J, Deng SX. Human limbal epithelial stem cell regulation, bioengineering and function. Prog Retin Eye Res 2021; 85:100956. [PMID: 33676006 PMCID: PMC8428188 DOI: 10.1016/j.preteyeres.2021.100956] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 02/21/2021] [Accepted: 02/26/2021] [Indexed: 12/13/2022]
Abstract
The corneal epithelium is continuously renewed by limbal stem/progenitor cells (LSCs), a cell population harbored in a highly regulated niche located at the limbus. Dysfunction and/or loss of LSCs and their niche cause limbal stem cell deficiency (LSCD), a disease that is marked by invasion of conjunctival epithelium into the cornea and results in failure of epithelial wound healing. Corneal opacity, pain, loss of vision, and blindness are the consequences of LSCD. Successful treatment of LSCD depends on accurate diagnosis and staging of the disease and requires restoration of functional LSCs and their niche. This review highlights the major advances in the identification of potential LSC biomarkers and components of the LSC niche, understanding of LSC regulation, methods and regulatory standards in bioengineering of LSCs, and diagnosis and staging of LSCD. Overall, this review presents key points for researchers and clinicians alike to consider in deepening the understanding of LSC biology and improving LSCD therapies.
Collapse
Affiliation(s)
- Clémence Bonnet
- Cornea Division, Stein Eye Institute, University of California, Los Angeles, CA, 90095, USA; Cornea Department, Paris University, Cochin Hospital, AP-HP, F-75014, Paris, France
| | - Sheyla González
- Cornea Division, Stein Eye Institute, University of California, Los Angeles, CA, 90095, USA
| | - JoAnn S Roberts
- Cornea Division, Stein Eye Institute, University of California, Los Angeles, CA, 90095, USA
| | - Sarah Y T Robertson
- Cornea Division, Stein Eye Institute, University of California, Los Angeles, CA, 90095, USA
| | - Maxime Ruiz
- Cornea Division, Stein Eye Institute, University of California, Los Angeles, CA, 90095, USA
| | - Jie Zheng
- Basic Science Division, Stein Eye Institute, University of California, Los Angeles, CA, 90095, USA
| | - Sophie X Deng
- Cornea Division, Stein Eye Institute, University of California, Los Angeles, CA, 90095, USA.
| |
Collapse
|
10
|
Goals and Challenges of Stem Cell-Based Therapy for Corneal Blindness Due to Limbal Deficiency. Pharmaceutics 2021; 13:pharmaceutics13091483. [PMID: 34575560 PMCID: PMC8466237 DOI: 10.3390/pharmaceutics13091483] [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: 07/30/2021] [Revised: 09/09/2021] [Accepted: 09/13/2021] [Indexed: 12/13/2022] Open
Abstract
Corneal failure is a highly prevalent cause of blindness. One special cause of corneal failure occurs due to malfunction or destruction of the limbal stem cell niche, upon which the superficial cornea depends for homeostatic maintenance and wound healing. Failure of the limbal niche is referred to as limbal stem cell deficiency. As the corneal epithelial stem cell niche is easily accessible, limbal stem cell-based therapy and regenerative medicine applied to the ocular surface are among the most highly advanced forms of this novel approach to disease therapy. However, the challenges are still great, including the development of cell-based products and understanding how they work in the patient's eye. Advances are being made at the molecular, cellular, and tissue levels to alter disease processes and to reduce or eliminate blindness. Efforts must be coordinated from the most basic research to the most clinically oriented projects so that cell-based therapies can become an integrated part of the therapeutic armamentarium to fight corneal blindness. We undoubtedly are progressing along the right path because cell-based therapy for eye diseases is one of the most successful examples of global regenerative medicine.
Collapse
|
11
|
Xiao YT, Qu JY, Xie HT, Zhang MC, Zhao XY. A Comparison of Methods for Isolation of Limbal Niche Cells: Maintenance of Limbal Epithelial Stem/Progenitor Cells. Invest Ophthalmol Vis Sci 2021; 61:16. [PMID: 33320169 PMCID: PMC7745628 DOI: 10.1167/iovs.61.14.16] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Purpose Limbal niche cells (LNCs) play a vital role in the maintenance of limbal epithelial stem/progenitor cells (LESCs). Four methods have been reported to isolate and expand LNCs: digestion by collagenase alone (C-LNC), collagenase following dispase removal of the limbal epithelium (DC-LNC), dissection of dispase-isolated limbal epithelial sheets (D-LNC), and explant cultures of limbal stromal tissues (Ex-LNC). This study aimed to isolate LNCs using those four methods and to compare their capacity to maintain LESCs. Methods LNCs were isolated from the rat corneal limbus by the following methods: C-LNC, DC-LNC, D-LNC, and Ex-LNC. Quantitative real-time PCR and immunofluorescence staining were used to analyze the expression of embryonic stem cell (ESC) markers. The ability to maintain LESCs was assessed on the basis of colony-forming capacity and the expression of progenitor, proliferation, and differentiation markers in three-dimensional (3D) Matrigel and Transwell systems. Notch signaling of LESCs supported by different LNCs in Transwell inserts was analyzed by quantitative real-time PCR. Results DC-LNCs exhibited lower expression of CK12 during isolation and expansion. Among P4-expanded LNCs, DC-LNCs expressed significantly higher levels of Sox2, Oct4, Nanog, and N-cadherin than C-LNCs, D-LNCs, and Ex-LNCs. Compared with other LNCs, DC-LNCs were more effective in maintaining LESCs with higher holoclone-forming efficiency, greater expression of ΔNp63α and Ki67, and lower expression of CK12. DC-LNCs were also more capable of downregulating Notch signaling of LESCs. Conclusions DC-LNCs were more effective in expressing ESC markers and maintaining LESCs compared to other LNCs. This study identifies an optimal method for the isolation of LNCs in tissue engineering and ocular surface reconstruction.
Collapse
Affiliation(s)
- Yu-Ting Xiao
- Department of Ophthalmology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, People's Republic of China
| | - Jing-Yu Qu
- Department of Ophthalmology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, People's Republic of China
| | - Hua-Tao Xie
- Department of Ophthalmology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, People's Republic of China
| | - Ming-Chang Zhang
- Department of Ophthalmology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, People's Republic of China
| | - Xin-Yue Zhao
- Department of Ophthalmology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, People's Republic of China
| |
Collapse
|
12
|
Xiao YT, Xie HT, Liu X, Duan CY, Qu JY, Zhang MC, Zhao XY. Subconjunctival Injection of Transdifferentiated Oral Mucosal Epithelial Cells for Limbal Stem Cell Deficiency in Rats. J Histochem Cytochem 2020; 69:177-190. [PMID: 33345682 DOI: 10.1369/0022155420980071] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Rat limbal niche cells (LNCs) have been proven to induce transdifferentiation of oral mucosal epithelial cells (OMECs) into corneal epithelial-like cells termed transdifferentiated oral mucosal epithelial cells (T-OMECs). This investigation aimed to evaluate the effect of subconjunctival T-OMEC injections on alkali-induced limbal stem cell deficiency (LSCD) in rats. LNCs were cocultured with OMECs in the Transwell system to obtain T-OMECs, with NIH-3T3 cells serving as a control. Subconjunctival injection of single T-OMEC or OMEC suspension was performed immediately after corneal alkali injury. T-OMECs were prelabeled with the fluorescent dye CM-DiI in vitro and tracked in vivo. Corneal epithelial defect, opacity, and neovascularization were quantitatively analyzed. The degree of corneal epithelial defect (from day 1 onward), opacity (from day 5 onward), and neovascularization (from day 2 onward) was significantly less in the T-OMEC group than in the OMEC group. Cytokeratin 12 (CK12), pigment epithelium-derived factor, and soluble fms-like tyrosine kinase-1 were expressed at a higher rate following T-OMEC injection. Some CM-DiI-labeled cells were found to be coexpressed with CK12, Pax6, and ΔNp63α in the corneal epithelium after subconjunctival injection. Subconjunctival injection of T-OMECs prevents conjunctival invasion and maintains a normal corneal phenotype, which might be a novel strategy in the treatment of LSCD.
Collapse
Affiliation(s)
- Yu-Ting Xiao
- Department of Ophthalmology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hua-Tao Xie
- Department of Ophthalmology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xin Liu
- Department of Ophthalmology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Chao-Ye Duan
- Department of Ophthalmology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Jing-Yu Qu
- Department of Ophthalmology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ming-Chang Zhang
- Department of Ophthalmology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xin-Yue Zhao
- Department of Ophthalmology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| |
Collapse
|
13
|
A new standardized immunofluorescence method for potency quantification (SMPQ) of human conjunctival cell cultures. Cell Tissue Bank 2020; 22:145-159. [PMID: 33051810 DOI: 10.1007/s10561-020-09874-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 10/04/2020] [Indexed: 10/23/2022]
Abstract
The aim of this study is to set up a standardized and reproducible method to determine the potency (= stem cell content) of human conjunctival cell cultures by means of immunofluorescence-based analyses. This will help the development of new Advanced Therapy Medicinal Products (ATMPs) to use in future cell therapy clinical studies when fewer cells are available to perform the quality controls. To achieve this purpose, a reference standard was investigated and the expression levels of ΔNp63α (considered as a marker of conjunctival stem cells) was correlated to cell size. The limbal hTERT cells were used as reference standard to define the expression value of ΔNp63α. The mean intensity value of limbal hTERT cells ranging between 15 and 20 µm in diameter was used to distinguish between ΔNp63α bright and not bright cells. As ΔNp63α bright expression was mainly seen in the smaller cell size group (10-15 µm), we defined as conjunctival stem cells (= potency) those cells which were bright and with sizes between 10 and 15 µm. Assays on cells from clonal analyses were used to validate the method, as they do allow to observe a decrease in potency (Holoclones > Meroclones > Paraclones). The stem cell content of conjunctival grafts was found to be 11.3% ± 5.0 compared to 21.9% ± 0.6, 9.0% ± 8.1 and 0% from Holoclones, Meroclones and Paraclones, respectively. This new method, here named as Standardized Method for Potency Quantification, will allow to detect the potency in conjunctival cell cultures, thus obtaining a quality control assay responding to the GMP standards required for ATMP release.
Collapse
|
14
|
Hernáez-Moya R, González S, Urkaregi A, Pijoan JI, Deng SX, Andollo N. Expansion of Human Limbal Epithelial Stem/Progenitor Cells Using Different Human Sera: A Multivariate Statistical Analysis. Int J Mol Sci 2020; 21:ijms21176132. [PMID: 32854428 PMCID: PMC7503296 DOI: 10.3390/ijms21176132] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 08/23/2020] [Accepted: 08/24/2020] [Indexed: 12/13/2022] Open
Abstract
Transplantation of human cultured limbal epithelial stem/progenitor cells (LESCs) has demonstrated to restore the integrity and functionality of the corneal surface in about 76% of patients with limbal stem cell deficiency. However, there are different protocols for the expansion of LESCs, and many of them use xenogeneic products, being a risk for the patients’ health. We compared the culture of limbal explants on the denuded amniotic membrane in the culture medium—supplemental hormone epithelial medium (SHEM)—supplemented with FBS or two differently produced human sera. Cell morphology, cell size, cell growth rate, and the expression level of differentiation and putative stem cell markers were examined. Several bioactive molecules were quantified in the human sera. In a novel approach, we performed a multivariate statistical analysis of data to investigate the culture factors, such as differently expressed molecules of human sera that specifically influence the cell phenotype. Our results showed that limbal cells cultured with human sera grew faster and contained similar amounts of small-sized cells, higher expression of the protein p63α, and lower of cytokeratin K12 than FBS cultures, thus, maintaining the stem/progenitor phenotype of LESCs. Furthermore, the multivariate analysis provided much data to better understand the obtaining of different cell phenotypes as a consequence of the use of different culture methodologies or different culture components.
Collapse
Affiliation(s)
- Raquel Hernáez-Moya
- Department of Cell Biology and Histology, School of Medicine and Nursing, Biocruces Bizkaia Health Research Institute, University of the Basque Country UPV/EHU, 48940 Leioa, Bizkaia, Spain;
| | - Sheyla González
- Cornea Division, Stein Eye Institute, University of California, Los Angeles, CA 90095, USA; (S.G.); (S.X.D.)
| | - Arantza Urkaregi
- Department of Applied Mathematics and Statistics and Operational Research, Biocruces Bizkaia Health Research Institute, University of the Basque Country UPV/EHU, 48940 Leioa, Bizkaia, Spain;
| | - Jose Ignacio Pijoan
- Clinical Epidemiology Unit, Cruces University Hospital, Biocruces Bizkaia Health Research Institute, 48903 Barakaldo, Bizkaia, Spain;
| | - Sophie X. Deng
- Cornea Division, Stein Eye Institute, University of California, Los Angeles, CA 90095, USA; (S.G.); (S.X.D.)
| | - Noelia Andollo
- Department of Cell Biology and Histology, School of Medicine and Nursing, Biocruces Bizkaia Health Research Institute, University of the Basque Country UPV/EHU, 48940 Leioa, Bizkaia, Spain;
- Correspondence: ; Tel.: +34-94-601-3295
| |
Collapse
|
15
|
Nieto-Nicolau N, Martínez-Conesa EM, Velasco-García AM, Aloy-Reverté C, Vilarrodona A, Casaroli-Marano RP. Xenofree generation of limbal stem cells for ocular surface advanced cell therapy. Stem Cell Res Ther 2019; 10:374. [PMID: 31801638 PMCID: PMC6894225 DOI: 10.1186/s13287-019-1501-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 11/09/2019] [Accepted: 11/20/2019] [Indexed: 12/13/2022] Open
Abstract
Background Limbal stem cells (LSC) sustain the corneal integrity and homeostasis. LSC deficiency (LSCD) leads to loss of corneal transparency and blindness. A clinical approach to treat unilateral LSCD comprises autologous cultured limbal epithelial stem cell transplantation (CLET). CLET uses xenobiotic culture systems with potential zoonotic transmission risks, and regulatory guidelines make necessary to find xenofree alternatives. Methods We compared two xenofree clinical grade media and two feeder layers. We used CnT07, a defined commercial medium for keratinocytes, and a modified xenofree supplemented hormonal epithelial medium with human serum (XSHEM). Optimal formulation was used to compare two feeder layers: the gold standard 3T3 murine fibroblasts and human processed lipoaspirate cells (PLA). We tested the expressions of ΔNp63α and cytokeratin 3 and 12 by qPCR and immunofluorescence. Morphology, viability, clonogenicity, proliferation, and cell growth assays were carried out. We also evaluated interleukin 6 (IL-6) and stromal-derived factor 1 (SDF-1) by qPCR and ELISA. Results XSHEM maintained better LSC culture viability and morphology than CnT07. Irradiated PLA feeder cells improved the undifferentiated state of LSC and enhanced their growth and clonogenicity stimulating IL-6 secretion and SDF-1 expression, as well as increased proliferation and cell growth when compared with irradiated 3T3 feeder cells. Conclusions The combination of XSHEM and PLA feeder cells efficiently sustained LSC xenofree cultures for clinical application. Moreover, PLA feeder layers were able to improve the LSC potential characteristics. Our results would have direct clinical application in CLET for advanced therapy. Graphical abstract ![]()
Collapse
Affiliation(s)
- Nuria Nieto-Nicolau
- Barcelona Tissue Bank, Banc de Sang i Teixits (BST), Barcelona, Spain.,Institute of Biomedical Research (IIB-Sant Pau; SGR1113), Barcelona, Spain
| | - Eva M Martínez-Conesa
- Barcelona Tissue Bank, Banc de Sang i Teixits (BST), Barcelona, Spain.,Institute of Biomedical Research (IIB-Sant Pau; SGR1113), Barcelona, Spain
| | - Alba M Velasco-García
- Department of Surgery, School of Medicine & Hospital Clinic de Barcelona, University of Barcelona, Barcelona, Spain
| | - Caterina Aloy-Reverté
- Barcelona Tissue Bank, Banc de Sang i Teixits (BST), Barcelona, Spain.,Institute of Biomedical Research (IIB-Sant Pau; SGR1113), Barcelona, Spain
| | - Anna Vilarrodona
- Barcelona Tissue Bank, Banc de Sang i Teixits (BST), Barcelona, Spain.,Institute of Biomedical Research (IIB-Sant Pau; SGR1113), Barcelona, Spain
| | - Ricardo P Casaroli-Marano
- Barcelona Tissue Bank, Banc de Sang i Teixits (BST), Barcelona, Spain. .,Institute of Biomedical Research (IIB-Sant Pau; SGR1113), Barcelona, Spain. .,Department of Surgery, School of Medicine & Hospital Clinic de Barcelona, University of Barcelona, Barcelona, Spain.
| |
Collapse
|
16
|
Shukla S, Shanbhag SS, Tavakkoli F, Varma S, Singh V, Basu S. Limbal Epithelial and Mesenchymal Stem Cell Therapy for Corneal Regeneration. Curr Eye Res 2019; 45:265-277. [DOI: 10.1080/02713683.2019.1639765] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Sachin Shukla
- Center for Ocular Regeneration (CORE), L V Prasad Eye Institute, Hyderabad, India
| | - Swapna S Shanbhag
- Tej Kohli Cornea Institute, L V Prasad Eye Institute, Hyderabad, India
| | - Fatemeh Tavakkoli
- Center for Ocular Regeneration (CORE), L V Prasad Eye Institute, Hyderabad, India
| | - Shobhit Varma
- Tej Kohli Cornea Institute, L V Prasad Eye Institute, Hyderabad, India
| | - Vivek Singh
- Center for Ocular Regeneration (CORE), L V Prasad Eye Institute, Hyderabad, India
| | - Sayan Basu
- Center for Ocular Regeneration (CORE), L V Prasad Eye Institute, Hyderabad, India
- Tej Kohli Cornea Institute, L V Prasad Eye Institute, Hyderabad, India
| |
Collapse
|
17
|
Shanbhag SS, Nikpoor N, Rao Donthineni P, Singh V, Chodosh J, Basu S. Autologous limbal stem cell transplantation: a systematic review of clinical outcomes with different surgical techniques. Br J Ophthalmol 2019; 104:247-253. [PMID: 31118185 DOI: 10.1136/bjophthalmol-2019-314081] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 04/09/2019] [Accepted: 04/22/2019] [Indexed: 12/13/2022]
Abstract
PURPOSE To conduct a systematic review on outcomes of three different techniques of autologous limbal stem cell transplantation (LSCT): conjunctival-limbal autografting (CLAu), cultivated limbal epithelial transplantation (CLET) and simple limbal epithelial transplantation (SLET), in unilateral limbal stem cell deficiency (LSCD). METHODS Literature searches were conducted in MEDLINE (Ovid), Embase, Web of Science and Cochrane Central Register. Standard systematic review methodology was followed using Meta-analysis of Observational Studies in Epidemiology guidelines. Studies with a sample size of more than 10 eyes were included. The primary outcome measure of efficacy was restoration of a completely epithelised, stable and avascular corneal surface (anatomical success). The secondary outcome measure of efficacy was improvement in best-corrected visual acuity of two-lines or greater (functional success). RESULTS The review identified 22 non-comparative case series, which included 1023 eyes. Ocular burns were the major (88%) indication for surgery. Overall, at a median postoperative follow-up of 1.75 years, autologous LSCT for unilateral LSCD showed anatomical and functional success rates of 69% and 60%, respectively, without any serious adverse events in the donor eye. The follow-up duration and indications for surgery were comparable across all groups (p>0.05). The anatomical and functional success rates of SLET (78%; 68.6%) and CLAu (81%; 74.4%) were comparable, and significantly better than those of CLET (61.4%; 53%; p=0.0048). CONCLUSION Autologous LSCT is a safe and effective treatment for unilateral LSCD. In the absence of randomised controlled trials, existing evidence clearly suggests that clinical outcomes are better with SLET and CLAu as compared with CLET.
Collapse
Affiliation(s)
- Swapna S Shanbhag
- Tej Kohli Cornea Institute, LV Prasad Eye Institute, Hyderabad, India
| | - Neda Nikpoor
- Byers Eye Institute, Stanford University, Stanford, California, USA
| | | | - Vivek Singh
- Center for Ocular Regeneration (CORE), LV Prasad Eye Institute, Hyderabad, India
| | - James Chodosh
- Cornea and Refractive Surgery Service, MEEI, Boston, Massachusetts, USA
| | - Sayan Basu
- Center for Ocular Regeneration (CORE), LV Prasad Eye Institute, Hyderabad, India
| |
Collapse
|
18
|
Systematic review and meta-analysis investigating autograft versus allograft cultivated limbal epithelial transplantation in limbal stem cell deficiency. Int Ophthalmol 2019; 39:2685-2696. [PMID: 30826943 DOI: 10.1007/s10792-019-01092-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 02/23/2019] [Indexed: 12/13/2022]
Abstract
PURPOSE Currently, regenerative medicine has attracted much attention among researchers investigating new methods to treat ocular surface diseases. Based on this new concept, cultivated limbal epithelial transplantation (CLET), whether in the form of autograft or allograft, has emerged as a promising surgical procedure for treating limbal stem cell deficiency (LSCD). Given that there is no updated comparison between autograft and allograft CLETs, the present review and meta-analysis aims to compare and determine the efficacy of two different CLET techniques, autologous versus allogeneic, based on a literature review of relevant studies. METHODS A comprehensive search of electronic databases, including PubMed, Web of Science, Cochrane Library, Embase and Scopus, for related articles was performed in March 2018 to obtain relevant articles and to conduct a meta-analysis investigating the success rate of ocular surface regeneration and two-line improvement in best-corrected visual acuity (BCVA) using autograft versus allograft transplantations. RESULTS A total of 30 studies, including 1306 eyes from 1288 patients with LSCD, with a sample size ranging from 6 to 200 and follow-up period of 0.6-156 months, were reviewed. Of 1306 eyes, 982 (75.2%) underwent autograft and 324 (24.8%) received allografts from living or deceased donors. Meta-analysis revealed that there was no significant difference between autograft and allograft CLETs in terms of success rate and two-line BCVA improvement. The prospective studies showed a zero difference between the two groups; only two retrospective studies included in the analysis pulled the autografts up to 1.82 and 1.2 times more than allografts in terms of success rate and two-line BCVA improvement, respectively [pooled OR 1.82 (95% CI 0.80-4.11); pooled OR 1.2 (95% CI 0.54-2.65)]. There was no statistically significant evidence of bias in the meta-analysis in terms of success rates and two-line BCVA improvement. CONCLUSIONS The present analysis revealed no significant differences in success rates or visual improvement between autograft and allograft surgical techniques.
Collapse
|
19
|
Lužnik Z, Kopitar AN, Lapajne L, Pižem J, Ferrari S, Ihan A, Hawlina M, Schollmayer P. Identification and characterization of dendritic cell subtypes in preserved and cultured cadaveric human corneolimbal tissue on amniotic membrane. Acta Ophthalmol 2019; 97:e184-e193. [PMID: 30182472 DOI: 10.1111/aos.13854] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Accepted: 05/20/2018] [Indexed: 12/11/2022]
Abstract
PURPOSE Rejection is the leading cause of failure of limbal allogafts. Resident dendritic cell (DC) maturation plays a critical role in host allosensitization. There are two lineages: myeloid (mDC) and lymphoid (pDC), with different biological properties. The aim was to analyse the distribution of DC subtypes in limbal explant cultures on amniotic membrane (AM), cultivated on either the epithelial or stromal side and to compare the results with directly isolated cells from cadaveric whole corneoscleral tissue divided into specific areas. METHODS The expression of CD11c (mDC), CD303/CD123 (pDC) and costimulatory molecules CD80, CD86 and activation markers HLA-DR, CD83 was investigated by flow cytometry. Additionally, the corneal epithelium marker CK12 and ABCB5, a new epithelial stem cell marker, were investigated. RESULTS Cells positive for pDC and mDC markers were found in all examined areas, with a nonsignificant prevalence of pDC. In limbal explant cultures on AM, the percentage of pDC and mDC was similar, with no statistically significant difference between cultures on epithelial or stromal sides of AM. However, with ex vivo limbal explant cultivation on AM, the pDC content declined significantly (p < 0.05) and the ABCB5 marker was likewise statistically significantly reduced. CONCLUSION This is the first study to characterize the distribution of pDC and mDC subsets in cultured and noncultured human corneolimbal tissue. Additionally, ABCB5 positive cells were identified. These findings might be important for future strategies, allowing preparation of corneolimbal allografts with optimal stem cell content for a longer lasting therapeutic effect.
Collapse
Affiliation(s)
- Zala Lužnik
- Eye Hospital University Medical Centre Ljubljana Slovenia
| | - Andreja Nataša Kopitar
- Institute of Microbiology and Immunology Faculty of Medicine University of Ljubljana Ljubljana Slovenia
| | - Luka Lapajne
- Eye Hospital University Medical Centre Ljubljana Slovenia
| | - Jože Pižem
- Institute of Pathology Faculty of Medicine University of Ljubljana Ljubljana Slovenia
| | | | - Alojz Ihan
- Institute of Microbiology and Immunology Faculty of Medicine University of Ljubljana Ljubljana Slovenia
| | - Marko Hawlina
- Eye Hospital University Medical Centre Ljubljana Slovenia
| | | |
Collapse
|
20
|
Liu L, Nielsen FM, Emmersen J, Bath C, Østergaard Hjortdal J, Riis S, Fink T, Pennisi CP, Zachar V. Pigmentation Is Associated with Stemness Hierarchy of Progenitor Cells Within Cultured Limbal Epithelial Cells. Stem Cells 2018; 36:1411-1420. [PMID: 29781179 DOI: 10.1002/stem.2857] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Revised: 04/26/2018] [Accepted: 05/07/2018] [Indexed: 12/15/2022]
Abstract
Ex vivo cultured human limbal epithelial stem/progenitor cells (hLESCs) are the main source for regenerative therapy of limbal stem cell deficiency (LSCD), which is worldwide one of the major causes of corneal blindness. Despite many stemness-associated markers have been identified within the limbal niche, the phenotype of the earliest hLESCs has not been hitherto identified. We sought to confirm or refute the use of tumor protein p63 (p63) and ATP binding cassette subfamily B member 5 (ABCB5) as surrogate markers for hLESCs early within the limbal differentiation hierarchy. Based on a robust fluorescence-activated cell sorting and subsequent RNA isolation protocol, a comprehensive transcriptomic profile was obtained from four subpopulations of cultured hLESCs. The subpopulations were defined by co-expression of two putative stem/progenitor markers, the p63 and ABCB5, and the corneal differentiation marker cytokeratin 3. A comparative transcriptomic analysis yielded novel data that indicated association between pigmentation and differentiation, with the p63 positive populations being the most pigmented and immature of the progenitors. In contrast, ABCB5, either alone or in co-expression patterns, identified more committed progenitor cells with less pigmentation. In conclusion, p63 is superior to ABCB5 as a marker for stemness. Stem Cells 2018;36:1411-1420.
Collapse
Affiliation(s)
- Lei Liu
- Laboratory for Stem Cell Research, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark.,Department of Pediatric Surgery, First Hospital of Jilin University, Changchun, Jilin, People's Republic of China
| | - Frederik Mølgaard Nielsen
- Laboratory for Stem Cell Research, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Jeppe Emmersen
- Laboratory for Stem Cell Research, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Chris Bath
- Department of Ophthalmology, Aalborg University Hospital, Aalborg, Denmark
| | | | - Simone Riis
- Laboratory for Stem Cell Research, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Trine Fink
- Laboratory for Stem Cell Research, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Cristian Pablo Pennisi
- Laboratory for Stem Cell Research, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Vladimir Zachar
- Laboratory for Stem Cell Research, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| |
Collapse
|
21
|
Optimized Protocol for Regeneration of the Conjunctival Epithelium Using the Cell Suspension Technique. Cornea 2018; 38:469-479. [DOI: 10.1097/ico.0000000000001670] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
|
22
|
Figueiredo GS, Salvador-Culla B, Baylis OJ, Mudhar HS, Lako M, Figueiredo FC. Outcomes of Penetrating Keratoplasty Following Autologous Cultivated Limbal Epithelial Stem Cell Transplantation. Stem Cells 2018; 36:925-931. [DOI: 10.1002/stem.2803] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 12/11/2017] [Accepted: 02/05/2018] [Indexed: 02/06/2023]
Affiliation(s)
- Gustavo S. Figueiredo
- Department of Ophthalmology; Royal Victoria Infirmary; Newcastle upon Tyne United Kingdom
- Institute of Genetic Medicine, Newcastle University; Newcastle upon Tyne United Kingdom
| | - Borja Salvador-Culla
- Department of Ophthalmology; Royal Victoria Infirmary; Newcastle upon Tyne United Kingdom
| | - Oliver J. Baylis
- Department of Ophthalmology; Royal Victoria Infirmary; Newcastle upon Tyne United Kingdom
- Institute of Genetic Medicine, Newcastle University; Newcastle upon Tyne United Kingdom
| | - Hardeep S. Mudhar
- Department of Histopathology; Royal Hallamshire Hospital; Sheffield United Kingdom
| | - Majlinda Lako
- Institute of Genetic Medicine, Newcastle University; Newcastle upon Tyne United Kingdom
| | - Francisco C. Figueiredo
- Department of Ophthalmology; Royal Victoria Infirmary; Newcastle upon Tyne United Kingdom
- Institute of Genetic Medicine, Newcastle University; Newcastle upon Tyne United Kingdom
| |
Collapse
|
23
|
Nguyen KN, Bobba S, Richardson A, Park M, Watson SL, Wakefield D, Di Girolamo N. Native and synthetic scaffolds for limbal epithelial stem cell transplantation. Acta Biomater 2018; 65:21-35. [PMID: 29107055 DOI: 10.1016/j.actbio.2017.10.037] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2017] [Revised: 10/22/2017] [Accepted: 10/25/2017] [Indexed: 12/13/2022]
Abstract
UNLABELLED Limbal stem cell deficiency (LSCD) is a complex blinding disease of the cornea, which cannot be treated with conventional corneal transplants. Instead, a stem cell (SC) graft is required to replenish the limbal epithelial stem cell (LESC) reservoir, which is ultimately responsible for regenerating the corneal epithelium. Current therapies utilize limbal tissue biopsies that harbor LESCs as well as tissue culture expanded cells. Typically, this tissue is placed on a scaffold that supports the formation of corneal epithelial cell sheets, which are then transferred to diseased eyes. A wide range of biological and synthetic materials have been identified as carrier substrates for LESC, some of which have been used in the clinic, including amniotic membrane, fibrin, and silicon hydrogel contact lenses, each with their own advantages and limitations. This review will provide a brief background of LSCD, focusing on bio-scaffolds that have been utilized in limbal stem cell transplantation (LSCT) and materials that are being developed as potentially novel therapeutics for patients with this disease. STATEMENT OF SIGNIFICANCE The outcome of patients with corneal blindness that receive stem cell grafts to restore eye health and correct vision varies considerably and may be due to the different biological and synthetic scaffolds used to deliver these cells to the ocular surface. This review will highlight the positive attributes and limitations of the myriad of carriers developed for clinical use as well as those that are being trialled in pre-clinical models. The overall focus is on developing a standardized therapy for patients, however due to the multiple causes of corneal blindness, a personal regenerative medicine approach may be the best option.
Collapse
Affiliation(s)
- Kim N Nguyen
- School of Medical Sciences, University of New South Wales, Sydney, Australia
| | - Samantha Bobba
- Prince of Wales Hospital Clinical School, Sydney, Australia
| | | | - Mijeong Park
- School of Medical Sciences, University of New South Wales, Sydney, Australia
| | | | - Denis Wakefield
- School of Medical Sciences, University of New South Wales, Sydney, Australia
| | - Nick Di Girolamo
- School of Medical Sciences, University of New South Wales, Sydney, Australia.
| |
Collapse
|
24
|
Ghoubay-Benallaoua D, de Sousa C, Martos R, Latour G, Schanne-Klein MC, Dupin E, Borderie V. Easy xeno-free and feeder-free method for isolating and growing limbal stromal and epithelial stem cells of the human cornea. PLoS One 2017; 12:e0188398. [PMID: 29149196 PMCID: PMC5693460 DOI: 10.1371/journal.pone.0188398] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Accepted: 11/06/2017] [Indexed: 12/13/2022] Open
Abstract
Epithelial and stromal stem cells are required to maintain corneal transparency. The aim of the study was to develop a new method to isolate and grow both corneal stromal (SSC) and epithelial limbal (LSC) stem cells from small human limbal biopsies under culture conditions in accordance with safety requirements mandatory for clinical use in humans. Superficial limbal explants were retrieved from human donor corneo-scleral rims. Human limbal cells were dissociated by digestion with collagenase A, either after epithelial scraping or with no scraping. Isolated cells were cultured with Essential 8 medium (E8), E8 supplemented with EGF (E8+) or Green’s medium with 3T3 feeder-layers. Cells were characterized by immunostaining, RT-qPCR, colony forming efficiency, sphere formation, population doubling, second harmonic generation microscopy and differentiation potentials. LSC were obtained from unscraped explants in E8, E8+ and Green’s media and were characterized by colony formation and expression of PAX6, ΔNP63α, Bmi1, ABCG2, SOX9, CK14, CK15 and vimentin, with a few cells positive for CK3. LSC underwent 28 population doublings still forming colonies. SSC were obtained from both scraped and unscraped explants in E8 and E8+ media and were characterized by sphere formation, expression of PAX6, SOX2, BMI1, NESTIN, ABCG2, KERATOCAN, VIMENTIN, SOX9, SOX10 and HNK1, production of collagen fibrils and differentiation into keratocytes, fibroblasts, myofibroblasts, neurons, adipocytes, chondrocytes and osteocytes. SSC underwent 48 population doublings still forming spheres, Thus, this new method allows both SSC and LSC to be isolated from small superficial limbal biopsies and to be primary cultured in feeder-free and xeno-free conditions, which will be useful for clinical purposes.
Collapse
Affiliation(s)
- Djida Ghoubay-Benallaoua
- Institut de la Vision, Sorbonne Universités, INSERM, CNRS UMR 7210, UPMC Univ Paris 06, Paris, France.,Centre Hospitalier National d'Ophtalmologie des Quinze-Vingts, Paris, France
| | | | - Raphaël Martos
- Institut de la Vision, Sorbonne Universités, INSERM, CNRS UMR 7210, UPMC Univ Paris 06, Paris, France
| | - Gaël Latour
- Laboratoire Imagerie et Modélisation en Neurobiologie et Cancérologie, Univ. Paris-Sud, CNRS, Université Paris-Saclay, Orsay, France
| | - Marie-Claire Schanne-Klein
- Laboratoire d'Optique et Biosciences, Ecole polytechnique, CNRS, INSERM U1182, Université Paris-Saclay, Palaiseau, France
| | - Elisabeth Dupin
- Institut de la Vision, Sorbonne Universités, INSERM, CNRS UMR 7210, UPMC Univ Paris 06, Paris, France
| | - Vincent Borderie
- Institut de la Vision, Sorbonne Universités, INSERM, CNRS UMR 7210, UPMC Univ Paris 06, Paris, France.,Centre Hospitalier National d'Ophtalmologie des Quinze-Vingts, Paris, France
| |
Collapse
|
25
|
Lužnik Z, Breda C, Barbaro V, Ferrari S, Migliorati A, Di Iorio E, Ferrari B, Griffoni C, Grassetto A, Elbadawy HM, Bertolin M. Towards xeno-free cultures of human limbal stem cells for ocular surface reconstruction. Cell Tissue Bank 2017; 18:461-474. [DOI: 10.1007/s10561-017-9632-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Accepted: 05/15/2017] [Indexed: 12/27/2022]
|
26
|
Safety of Cultivated Limbal Epithelial Stem Cell Transplantation for Human Corneal Regeneration. Stem Cells Int 2017; 2017:6978253. [PMID: 28465692 PMCID: PMC5390601 DOI: 10.1155/2017/6978253] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Accepted: 03/08/2017] [Indexed: 12/13/2022] Open
Abstract
Ex vivo cultivated limbal stem cell transplantation is a promising technique for the treatment of limbal stem cell deficiency. While the results of the clinical trials have been extensively reported since the introduction of the technique in 1997, little has been reported regarding the potential health risks associated with production processes and transplantation techniques. Culture procedures require the use of animal and/or human-derived products, which carry the potential of introducing toxic or infectious agents through contamination with known or unknown additives. Protocols vary widely, and the risks depend on the local institutional methods. Good manufacturing practice and xeno-free culture protocols could reduce potential health risks but are not yet a common practice worldwide. In this review, we focus on the safety of both autologous- and allogeneic-cultivated limbal stem cell transplantation, with respect to culture processes, surgical approaches, and postoperative strategies.
Collapse
|
27
|
Shah R, Puranik C, Mohamed A, Sangwan VS. Cultivated limbal epithelial transplantation and penetrating keratoplasty postchemical injury: a 14-year follow-up. BMJ Case Rep 2017; 2017:bcr-2016-217372. [PMID: 28179383 DOI: 10.1136/bcr-2016-217372] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
An 11-year-old girl presented to our tertiary eye care centre with a 9-month-old history of lime injury in the left eye in 1999 with vision of counting fingers close to the face. She initially underwent superficial keratectomy with amniotic membrane graft in 1999. Subsequently, cultivated limbal epithelial transplantation was performed in 2001 which improved her vision to 20/400. Following development of pannus and symblepharon in the left eye, she underwent pannus resection and conjunctival limbal autograft in 2002 and, a month later, optical penetrating keratoplasty (PK) following which her vision improved to 20/125. She was under regular follow-up, underwent exotropia correction and subsequent levator palpebrae superioris resection for ptosis and was maintaining good vision. On her last follow-up 14 years after PK in 2016, her vision in the left eye was 20/40 with lipid keratopathy and her right eye showed no signs of focal limbal stem cell deficiency.
Collapse
Affiliation(s)
- Ritu Shah
- L V Prasad Eye Institute, Tej Kohli Cornea Institute, Hyderabad, Telangana, India
| | - Charuta Puranik
- L V Prasad Eye Institute, Tej Kohli Cornea Institute, Hyderabad, Telangana, India
| | - Ashik Mohamed
- Ophthalmic Biophysics Laboratory, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Virender S Sangwan
- L V Prasad Eye Institute, Centre for Ocular Regeneration, Hyderabad, Telangana, India
| |
Collapse
|
28
|
Perazzi A, Bonsembiante F, Gelain ME, Patruno M, Di Iorio E, Migliorati A, Iacopetti I. Cytology of the healthy canine and feline ocular surface: comparison between cytobrush and impression technique. Vet Clin Pathol 2017; 46:164-171. [PMID: 28117903 DOI: 10.1111/vcp.12450] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Impression cytology (IC) is a noninvasive technique in which filters are used to sample superficial layers of ocular epithelium. OBJECTIVES The aim of this study was to compare cytology specimens obtained by IC and cytobrush from healthy canine and feline eyes. METHODS Dogs and cats were prospectively sampled using polytetrafluorethylene filters on the right eye, and cytobrush on the left eye. Wright-Giemsa-stained specimens were evaluated by 2 observers. Cellularity, preservation, and morphology of cells and presence of goblet and inflammatory cells were scored with a 4-grade scale. Inter-observer agreement and effects of topical anesthesia were analyzed. RESULTS In 20 canine IC samples, 10 showed good cellularity (score 2-3) and 13 good preservation. Superficial epithelial cells (SEC) were present in 13/20 of IC, while basal-intermediate cells (BIC) were seen in 14/20. In 6/20 and 7/20, goblet and inflammatory cells were noted, respectively. In 20 cats, 15 of IC showed good cellularity and 14 good preservation, and SEC were present in 16/20 of IC and BIC in 17/20. In 13/20 and 3/20 cats, goblet cells and inflammatory cells were noted, respectively. Canine cytobrush specimens appeared well preserved (9/20) and had good cellularity (8/20). In feline cytobrush specimens, good preservation and cellularity were observed in 16/20 and 14/20, respectively. In both species, all cell types were present without a clear separation. There was moderate to fair agreement about cellular morphology in IC between observers. Specimens obtained with and without anesthesia were comparable. CONCLUSION Impression cytology allowed collection of samples with maintained cytoarchitecture, while cytoplasmatic and nuclear details were often difficult to evaluate.
Collapse
Affiliation(s)
- Anna Perazzi
- Department of Animal Medicine, Production and Health, University of Padua, Padua, Italy
| | - Federico Bonsembiante
- Department of Comparative Biomedicine and Food Science, University of Padua, Padua, Italy
| | - Maria Elena Gelain
- Department of Comparative Biomedicine and Food Science, University of Padua, Padua, Italy
| | - Marco Patruno
- Department of Comparative Biomedicine and Food Science, University of Padua, Padua, Italy
| | - Enzo Di Iorio
- Department of Molecular Medicine, University of Padua, Padua, Italy
| | | | - Ilaria Iacopetti
- Department of Animal Medicine, Production and Health, University of Padua, Padua, Italy
| |
Collapse
|
29
|
Lužnik Z, Hawlina M, Ferrari S, Ponzin D, Schollmayer P. Ocular surface reconstruction in limbal stem cell deficiency: current treatment options and perspectives. EXPERT REVIEW OF OPHTHALMOLOGY 2017. [DOI: 10.1080/17469899.2017.1263568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Zala Lužnik
- Eye Hospital, University Medical Centre, Ljubljana, Slovenia
| | - Marko Hawlina
- Eye Hospital, University Medical Centre, Ljubljana, Slovenia
| | - Stefano Ferrari
- Fondazione Banca degli Occhi del Veneto Onlus, Via Paccagnella 11, Venezia Zelarino, Italy
| | - Diego Ponzin
- Fondazione Banca degli Occhi del Veneto Onlus, Via Paccagnella 11, Venezia Zelarino, Italy
| | | |
Collapse
|
30
|
Busin M, Breda C, Bertolin M, Bovone C, Ponzin D, Ferrari S, Barbaro V, Elbadawy HM. Corneal Epithelial Stem Cells Repopulate the Donor Area within 1 Year from Limbus Removal for Limbal Autograft. Ophthalmology 2016; 123:2481-2488. [DOI: 10.1016/j.ophtha.2016.08.018] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Revised: 08/15/2016] [Accepted: 08/16/2016] [Indexed: 10/21/2022] Open
|
31
|
Elbadawy HM, Mirabelli P, Xeroudaki M, Parekh M, Bertolin M, Breda C, Cagini C, Ponzin D, Lagali N, Ferrari S. Effect of connexin 43 inhibition by the mimetic peptide Gap27 on corneal wound healing, inflammation and neovascularization. Br J Pharmacol 2016; 173:2880-93. [PMID: 27472295 PMCID: PMC5055138 DOI: 10.1111/bph.13568] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Revised: 06/30/2016] [Accepted: 07/16/2016] [Indexed: 12/13/2022] Open
Abstract
Background and Purpose The connexin 43 (Cx43) mimetic peptide Gap27 was designed to transiently block the function of this gap junction. This study was undertaken to investigate the effect of Gap27 on corneal healing, inflammation and neovascularization. Experimental Approach The effect of Gap27 on wound healing, inflammation and vascularization was assessed in primary human corneal epithelial cells (HCEC) in vitro and whole human corneas ex vivo, and in an in vivo rat wound healing model. Key Results Gap27 enhanced the wound closure of HCEC in vitro and accelerated wound closure and stratification of epithelium in human corneas ex vivo, but did not suppress the corneal release of inflammatory mediators IL‐6 or TNF‐α in vivo. In human corneas ex vivo, F4/80 positive macrophages were observed around the wound site. In vivo, topical Gap27 treatment enhanced the speed and density of early granulocyte infiltration into rat corneas. After 7 days, the expressions of TNF‐α and TGFβ1 were elevated and correlated with inflammatory cell accumulation in the tissue. Additionally, Gap27 did not suppress VEGF release in organotypic culture, nor did it suppress early or late VEGFA expression or neovascularization in vivo. Conclusions and Implications Gap27 can be effective in promoting the healing of superficial epithelial wounds, but in deep stromal wounds it has the potential to promote inflammatory cell migration and accumulation in the tissue and does not suppress the subsequent neovascularization response. These results support the proposal that Gap27 acts as a healing agent in the transient, early stages of corneal epithelial wounding.
Collapse
Affiliation(s)
- Hossein Mostafa Elbadawy
- Department of Pharmacology and Toxicology, College of Pharmacy, Taibah University, AlMadinah AlMunawwarah, Saudi Arabia. .,International Center for Ocular Physiopathology, The Veneto Eye Bank Foundation, Venice, Italy.
| | - Pierfrancesco Mirabelli
- Department of Ophthalmology, Institute for Clinical and Experimental Medicine, Faculty of Health Sciences, Linkoping University, Linkoping, Sweden
| | - Maria Xeroudaki
- Department of Ophthalmology, Institute for Clinical and Experimental Medicine, Faculty of Health Sciences, Linkoping University, Linkoping, Sweden
| | - Mohit Parekh
- International Center for Ocular Physiopathology, The Veneto Eye Bank Foundation, Venice, Italy
| | - Marina Bertolin
- International Center for Ocular Physiopathology, The Veneto Eye Bank Foundation, Venice, Italy
| | - Claudia Breda
- International Center for Ocular Physiopathology, The Veneto Eye Bank Foundation, Venice, Italy
| | - Carlo Cagini
- Department of Ophthalmology, Perugia General Hospital, University of Perugia, Perugia, Italy
| | - Diego Ponzin
- International Center for Ocular Physiopathology, The Veneto Eye Bank Foundation, Venice, Italy
| | - Neil Lagali
- Department of Ophthalmology, Institute for Clinical and Experimental Medicine, Faculty of Health Sciences, Linkoping University, Linkoping, Sweden
| | - Stefano Ferrari
- International Center for Ocular Physiopathology, The Veneto Eye Bank Foundation, Venice, Italy
| |
Collapse
|
32
|
Fasolo A, Pedrotti E, Passilongo M, Marchini G, Monterosso C, Zampini R, Bohm E, Birattari F, Franch A, Barbaro V, Bertolin M, Breda C, Di Iorio E, Ferrari B, Ferrari S, Meneguzzi M, Ponzin D. Safety outcomes and long-term effectiveness of ex vivo autologous cultured limbal epithelial transplantation for limbal stem cell deficiency. Br J Ophthalmol 2016; 101:640-649. [DOI: 10.1136/bjophthalmol-2015-308272] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Revised: 07/11/2016] [Accepted: 07/30/2016] [Indexed: 11/03/2022]
|
33
|
Abstract
Over the past 10 to 15 years, the availability of new materials and technologies has resulted in revolutionary concepts for contact lenses being proposed that go well beyond correcting vision. These novel uses include their prescribing to deliver topical ocular and systemic drugs, assist with ocular surface disease management, and limit the progression of myopia and novel methods to display visual information. How likely are these concepts to become commercially available, how successful will they be, and what are the potential issues to consider for them to come to market? To answer these questions, a panel of four experts were invited to discuss the benefits and pitfalls of these technologies and what challenges lay ahead of these concepts before their availability. Their responses provide a fascinating insight for the clinician into the likelihood of such revolutionary contact lenses being available in a clinical setting.
Collapse
|
34
|
Barbaro V, Nasti AA, Raffa P, Migliorati A, Nespeca P, Ferrari S, Palumbo E, Bertolin M, Breda C, Miceli F, Russo A, Caenazzo L, Ponzin D, Palù G, Parolin C, Di Iorio E. Personalized Stem Cell Therapy to Correct Corneal Defects Due to a Unique Homozygous-Heterozygous Mosaicism of Ectrodactyly-Ectodermal Dysplasia-Clefting Syndrome. Stem Cells Transl Med 2016; 5:1098-105. [PMID: 27151912 DOI: 10.5966/sctm.2015-0358] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Accepted: 03/10/2016] [Indexed: 12/13/2022] Open
Abstract
UNLABELLED : Ectrodactyly-ectodermal dysplasia-clefting (EEC) syndrome is a rare autosomal dominant disease caused by mutations in the p63 gene. To date, approximately 40 different p63 mutations have been identified, all heterozygous. No definitive treatments are available to counteract and resolve the progressive corneal degeneration due to a premature aging of limbal epithelial stem cells. Here, we describe a unique case of a young female patient, aged 18 years, with EEC and corneal dysfunction, who was, surprisingly, homozygous for a novel and de novo R311K missense mutation in the p63 gene. A detailed analysis of the degree of somatic mosaicism in leukocytes from peripheral blood and oral mucosal epithelial stem cells (OMESCs) from biopsies of buccal mucosa showed that approximately 80% were homozygous mutant cells and 20% were heterozygous. Cytogenetic and molecular analyses excluded genomic alterations, thus suggesting a de novo mutation followed by an allelic gene conversion of the wild-type allele by de novo mutant allele as a possible mechanism to explain the homozygous condition. R311K-p63 OMESCs were expanded in vitro and heterozygous holoclones selected following clonal analysis. These R311K-p63 OMESCs were able to generate well-organized and stratified epithelia in vitro, resembling the features of healthy tissues. This study supports the rationale for the development of cultured autologous oral mucosal epithelial stem cell sheets obtained by selected heterozygous R311K-p63 stem cells, as an effective and personalized therapy for reconstructing the ocular surface of this unique case of EEC syndrome, thus bypassing gene therapy approaches. SIGNIFICANCE This case demonstrates that in a somatic mosaicism context, a novel homozygous mutation in the p63 gene can arise as a consequence of an allelic gene conversion event, subsequent to a de novo mutation. The heterozygous mutant R311K-p63 stem cells can be isolated by means of clonal analysis and given their good regenerative capacity, they may be used to successfully correct the corneal defects present in this unique case of ectrodactyly-ectodermal dysplasia-clefting syndrome.
Collapse
Affiliation(s)
| | | | - Paolo Raffa
- Department of Molecular Medicine, University of Padua, Padua, Italy
| | | | - Patrizia Nespeca
- Department of Molecular Medicine, University of Padua, Padua, Italy
| | | | - Elisa Palumbo
- Department of Biology, University of Padua, Padua, Italy
| | | | - Claudia Breda
- Fondazione Banca degli Occhi del Veneto, Venice, Italy
| | - Francesco Miceli
- Department of Neuroscience, University of Naples Federico II, Naples, Italy
| | | | - Luciana Caenazzo
- Department of Molecular Medicine, University of Padua, Padua, Italy
| | - Diego Ponzin
- Fondazione Banca degli Occhi del Veneto, Venice, Italy
| | - Giorgio Palù
- Department of Molecular Medicine, University of Padua, Padua, Italy
| | - Cristina Parolin
- Department of Molecular Medicine, University of Padua, Padua, Italy
| | - Enzo Di Iorio
- Fondazione Banca degli Occhi del Veneto, Venice, Italy Department of Molecular Medicine, University of Padua, Padua, Italy
| |
Collapse
|
35
|
Barbaro V, Nasti AA, Del Vecchio C, Ferrari S, Migliorati A, Raffa P, Lariccia V, Nespeca P, Biasolo M, Willoughby CE, Ponzin D, Palù G, Parolin C, Di Iorio E. Correction of Mutant p63 in EEC Syndrome Using siRNA Mediated Allele-Specific Silencing Restores Defective Stem Cell Function. Stem Cells 2016; 34:1588-600. [PMID: 26891374 DOI: 10.1002/stem.2343] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Revised: 12/14/2015] [Accepted: 01/01/2016] [Indexed: 12/19/2022]
Abstract
Ectrodactyly-Ectodermal dysplasia-Clefting (EEC) syndrome is a rare autosomal dominant disease caused by heterozygous mutations in the p63 gene and characterized by limb defects, orofacial clefting, ectodermal dysplasia, and ocular defects. Patients develop progressive total bilateral limbal stem cell deficiency, which eventually results in corneal blindness. Medical and surgical treatments are ineffective and of limited benefit. Oral mucosa epithelial stem cells (OMESCs) represent an alternative source of stem cells capable of regenerating the corneal epithelium and, combined with gene therapy, could provide an attractive therapeutic avenue. OMESCs from EEC patients carrying the most severe p63 mutations (p.R279H and p.R304Q) were characterized and the genetic defect of p.R279H silenced using allele-specific (AS) small interfering RNAs (siRNAs). Systematic screening of locked nucleic acid (LNA)-siRNAs against R279H-p63 allele in (i) stable WT-ΔNp63α-RFP and R279H-ΔNp63α-EGFP cell lines, (ii) transient doubly transfected cell lines, and (iii) p.R279H OMESCs, identified a number of potent siRNA inhibitors for the mutant allele, which had no effect on wild-type p63. In addition, siRNA treatment led to longer acquired life span of mutated stem cells compared to controls, less accelerated stem cell differentiation in vitro, reduced proliferation properties, and effective ability in correcting the epithelial hypoplasia, thus giving rise to full thickness stratified and differentiated epithelia. This study demonstrates the phenotypic correction of mutant stem cells (OMESCs) in EEC syndrome by means of siRNA mediated AS silencing with restoration of function. The application of siRNA, alone or in combination with cell-based therapies, offers a therapeutic strategy for corneal blindness in EEC syndrome. Stem Cells 2016;34:1588-1600.
Collapse
Affiliation(s)
- Vanessa Barbaro
- Research Centre, Fondazione Banca degli Occhi del Veneto, 30174, Venice, Italy
| | - Annamaria A Nasti
- Department of Molecular Medicine, University of Padua, 35121, Padua, Italy
| | | | - Stefano Ferrari
- Research Centre, Fondazione Banca degli Occhi del Veneto, 30174, Venice, Italy
| | - Angelo Migliorati
- Department of Molecular Medicine, University of Padua, 35121, Padua, Italy
| | - Paolo Raffa
- Department of Molecular Medicine, University of Padua, 35121, Padua, Italy
| | - Vincenzo Lariccia
- Department of Biomedical Sciences and Public Health, School of Medicine, University "Politecnica delle Marche", 60120, Ancona, Italy
| | - Patrizia Nespeca
- Department of Molecular Medicine, University of Padua, 35121, Padua, Italy
| | - Mariangela Biasolo
- Department of Molecular Medicine, University of Padua, 35121, Padua, Italy
| | - Colin E Willoughby
- Department of Eye and Vision Science, Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, United Kingdom
| | - Diego Ponzin
- Research Centre, Fondazione Banca degli Occhi del Veneto, 30174, Venice, Italy
| | - Giorgio Palù
- Department of Molecular Medicine, University of Padua, 35121, Padua, Italy
| | - Cristina Parolin
- Department of Molecular Medicine, University of Padua, 35121, Padua, Italy
| | - Enzo Di Iorio
- Research Centre, Fondazione Banca degli Occhi del Veneto, 30174, Venice, Italy.,Department of Molecular Medicine, University of Padua, 35121, Padua, Italy
| |
Collapse
|
36
|
Tominac Trcin M, Dekaris I, Mijović B, Bujić M, Zdraveva E, Dolenec T, Pauk-Gulić M, Primorac D, Crnjac J, Špoljarić B, Mršić G, Kuna K, Špoljarić D, Popović M. Synthetic vs natural scaffolds for human limbal stem cells. Croat Med J 2016; 56:246-56. [PMID: 26088849 PMCID: PMC4500975 DOI: 10.3325/cmj.2015.56.246] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Aim To investigate the impact of synthetic electrospun polyurethane (PU) and polycaprolactone (PCL) nanoscaffolds, before and after hydrolytic surface modification, on viability and differentiation of cultured human eye epithelial cells, in comparison with natural scaffolds: fibrin and human amniotic membrane. Methods Human placenta was taken at elective cesarean delivery. Fibrin scaffolds were prepared from commercial fibrin glue kits. Nanoscaffolds were fabricated by electrospinning. Limbal cells were isolated from surpluses of human cadaveric cornea and seeded on feeder 3T3 cells. The scaffolds used for viability testing and immunofluorescence analysis were amniotic membrane, fibrin, PU, and PCL nanoscaffolds, with or without prior NaOH treatment. Results Scanning electron microscope photographs of all tested scaffolds showed good colony spreading of seeded limbal cells. There was a significant difference in viability performance between cells with highest viability cultured on tissue culture plastic and cells cultured on all other scaffolds. On the other hand, electrospun PU, PCL, and electrospun PCL treated with NaOH had more than 80% of limbal cells positive for stem cell marker p63 compared to only 27%of p63 positive cells on fibrin. Conclusion Natural scaffolds, fibrin and amniotic membrane, showed better cell viability than electrospun scaffolds. On the contrary, high percentages of p63 positive cells obtained on these scaffolds still makes them good candidates for efficient delivery systems for therapeutic purposes.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | - Maja Popović
- Maja Popović, Department of Biology, Faculty of Veterinary Medicine, University of Zagreb, Heinzelova 55, Zagreb, Croatia,
| |
Collapse
|
37
|
Preservation of Ocular Epithelial Limbal Stem Cells: The New Frontier in Regenerative Medicine. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2016; 951:179-189. [DOI: 10.1007/978-3-319-45457-3_15] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
|
38
|
Mittal V, Jain R, Mittal R, Vashist U, Narang P. Successful management of severe unilateral chemical burns in children using simple limbal epithelial transplantation (SLET). Br J Ophthalmol 2015; 100:1102-8. [DOI: 10.1136/bjophthalmol-2015-307179] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Accepted: 10/25/2015] [Indexed: 11/03/2022]
|
39
|
Limbal Stem Cell Deficiency: Current Treatment Options and Emerging Therapies. Stem Cells Int 2015; 2016:9798374. [PMID: 26788074 PMCID: PMC4691643 DOI: 10.1155/2016/9798374] [Citation(s) in RCA: 91] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Accepted: 08/18/2015] [Indexed: 12/15/2022] Open
Abstract
Severe ocular surface disease can result in limbal stem cell deficiency (LSCD), a condition leading to decreased visual acuity, photophobia, and ocular pain. To restore the ocular surface in advanced stem cell deficient corneas, an autologous or allogenic limbal stem cell transplantation is performed. In recent years, the risk of secondary LSCD due to removal of large limbal grafts has been significantly reduced by the optimization of cultivated limbal epithelial transplantation (CLET). Despite the great successes of CLET, there still is room for improvement as overall success rate is 70% and visual acuity often remains suboptimal after successful transplantation. Simple limbal epithelial transplantation reports higher success rates but has not been performed in as many patients yet. This review focuses on limbal epithelial stem cells and the pathophysiology of LSCD. State-of-the-art therapeutic management of LSCD is described, and new and evolving techniques in ocular surface regeneration are being discussed, in particular, advantages and disadvantages of alternative cell scaffolds and cell sources for cell based ocular surface reconstruction.
Collapse
|
40
|
Sehic A, Utheim ØA, Ommundsen K, Utheim TP. Pre-Clinical Cell-Based Therapy for Limbal Stem Cell Deficiency. J Funct Biomater 2015; 6:863-88. [PMID: 26343740 PMCID: PMC4598682 DOI: 10.3390/jfb6030863] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Revised: 08/10/2015] [Accepted: 08/21/2015] [Indexed: 12/13/2022] Open
Abstract
The cornea is essential for normal vision by maintaining transparency for light transmission. Limbal stem cells, which reside in the corneal periphery, contribute to the homeostasis of the corneal epithelium. Any damage or disease affecting the function of these cells may result in limbal stem cell deficiency (LSCD). The condition may result in both severe pain and blindness. Transplantation of ex vivo cultured cells onto the cornea is most often an effective therapeutic strategy for LSCD. The use of ex vivo cultured limbal epithelial cells (LEC), oral mucosal epithelial cells, and conjunctival epithelial cells to treat LSCD has been explored in humans. The present review focuses on the current state of knowledge of the many other cell-based therapies of LSCD that have so far exclusively been explored in animal models as there is currently no consensus on the best cell type for treating LSCD. Major findings of all these studies with special emphasis on substrates for culture and transplantation are systematically presented and discussed. Among the many potential cell types that still have not been used clinically, we conclude that two easily accessible autologous sources, epidermal stem cells and hair follicle-derived stem cells, are particularly strong candidates for future clinical trials.
Collapse
Affiliation(s)
- Amer Sehic
- Department of Oral Biology, Faculty of Dentistry, University of Oslo, Sognsvannsveien 10, Oslo 0372, Norway.
| | - Øygunn Aass Utheim
- Department of Ophthalmology, Oslo University Hospital, Kirkeveien 166, Oslo 0407, Norway.
| | - Kristoffer Ommundsen
- Department of Medical Biochemistry, Oslo University Hospital, Kirkeveien 166, Oslo 0407, Norway.
| | - Tor Paaske Utheim
- Department of Oral Biology, Faculty of Dentistry, University of Oslo, Sognsvannsveien 10, Oslo 0372, Norway.
- Department of Medical Biochemistry, Oslo University Hospital, Kirkeveien 166, Oslo 0407, Norway.
| |
Collapse
|
41
|
In Vivo Confocal Microscopy 1 Year after Autologous Cultured Limbal Stem Cell Grafts. Ophthalmology 2015; 122:1660-8. [DOI: 10.1016/j.ophtha.2015.04.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Revised: 03/27/2015] [Accepted: 04/06/2015] [Indexed: 10/23/2022] Open
|
42
|
Bobba S, Chow S, Watson S, Di Girolamo N. Clinical outcomes of xeno-free expansion and transplantation of autologous ocular surface epithelial stem cells via contact lens delivery: a prospective case series. Stem Cell Res Ther 2015; 6:23. [PMID: 25889475 PMCID: PMC4396082 DOI: 10.1186/s13287-015-0009-1] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Revised: 12/10/2014] [Accepted: 02/17/2015] [Indexed: 12/13/2022] Open
Abstract
Introduction Depletion of limbal stem cells leads to a debilitating condition known as limbal stem cell deficiency, characterised by impaired corneal wound healing and poor vision. The aim of this study was to determine whether delivering progenitor cells on a contact lens is a viable and effective alternative to current transplantation techniques, which are complicated by biological and xenogeneic materials. Methods Sixteen eyes of 16 patients who had total (n = 14) and partial (n = 2) limbal stem cell deficiency (chemical burns, five eyes; iatrogenic causes, four eyes; aniridia, three eyes; trachoma-induced, two eyes; contact lens over-wear, one eye; and cicatrising conjunctivitis, one eye) and who had failed prior therapy were recruited prospectively into the study. Autologous limbal (n = 7) or conjunctival epithelial (n = 9) biopsies were harvested from patients and placed on the concave surface of silicone hydrogel contact lenses. Cells were expanded in culture with autologous serum and transplanted onto the ocular surface. Results Restoration of a transparent avascular and clinically stable corneal epithelium was attained in 10 of 16 eyes (63%) at a median follow-up time of 2.5 years (range of 0.8 to 5.8 years). Although minor complications occurred in two eyes of two patients because of contact lens insertion or removal, these were not associated with long-term sequelae. Conclusions This is the first and largest study to evaluate the mid-term outcomes of autologous limbal/conjunctival stem cell transplantation via a US Food and Drug Administration-approved contact lens, demonstrating that delivery of ocular progenitor cells via this procedure offers a viable, effective, and xeno-free alternative to current transplantation methodologies. Trial registration Australian New Zealand Clinical Trials Registry ACTRN012607000211460. Registered 17 April 2007.
Collapse
Affiliation(s)
- Samantha Bobba
- School of Medical Sciences, University of New South Wales, High Street, Kensington, Sydney, 2052, Australia. .,Faculty of Medicine, University of New South Wales, High Street, Kensington, Sydney, 2052, Australia.
| | - Sharron Chow
- School of Medical Sciences, University of New South Wales, High Street, Kensington, Sydney, 2052, Australia.
| | - Stephanie Watson
- Save Sight Institute, University of Sydney, 8 Macquarie Street, Sydney, 2000, Australia. .,Sydney Eye Hospital, 8 Macquarie Street, Sydney, 2000, Australia. .,Faculty of Medicine, University of New South Wales, High Street, Kensington, Sydney, 2052, Australia.
| | - Nick Di Girolamo
- School of Medical Sciences, University of New South Wales, High Street, Kensington, Sydney, 2052, Australia.
| |
Collapse
|
43
|
Potential Role of Induced Pluripotent Stem Cells (IPSCs) for Cell-Based Therapy of the Ocular Surface. J Clin Med 2015; 4:318-42. [PMID: 26239129 PMCID: PMC4470127 DOI: 10.3390/jcm4020318] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2014] [Revised: 12/24/2014] [Accepted: 01/04/2015] [Indexed: 02/07/2023] Open
Abstract
The integrity and normal function of the corneal epithelium are crucial for maintaining the cornea’s transparency and vision. The existence of a cell population with progenitor characteristics in the limbus maintains a dynamic of constant epithelial repair and renewal. Currently, cell-based therapies for bio replacement—cultured limbal epithelial transplantation (CLET) and cultured oral mucosal epithelial transplantation (COMET)—present very encouraging clinical results for treating limbal stem cell deficiency (LSCD) and restoring vision. Another emerging therapeutic approach consists of obtaining and implementing human progenitor cells of different origins in association with tissue engineering methods. The development of cell-based therapies using stem cells, such as human adult mesenchymal or induced pluripotent stem cells (IPSCs), represent a significant breakthrough in the treatment of certain eye diseases, offering a more rational, less invasive, and better physiological treatment option in regenerative medicine for the ocular surface. This review will focus on the main concepts of cell-based therapies for the ocular surface and the future use of IPSCs to treat LSCD.
Collapse
|
44
|
Science and Art of Cell-Based Ocular Surface Regeneration. INTERNATIONAL REVIEW OF CELL AND MOLECULAR BIOLOGY 2015; 319:45-106. [DOI: 10.1016/bs.ircmb.2015.07.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
|
45
|
Sheth R, Neale MH, Shortt AJ, Massie I, Vernon AJ, Daniels JT. Culture and Characterization of Oral Mucosal Epithelial Cells on a Fibrin Gel for Ocular Surface Reconstruction. Curr Eye Res 2014; 40:1077-87. [PMID: 25380127 DOI: 10.3109/02713683.2014.978477] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
AIM OF THE STUDY To develop a clinical grade fibrin gel for the culture of oral mucosal epithelial cells (OMEC) intended for ocular surface reconstruction in the treatment of limbal stem cell deficiency (LSCD). MATERIALS AND METHODS Transparent fibrin gels composed of fibrinogen and thrombin were developed for the culture of epithelial cells. Oral mucosa was harvested from the buccal region of healthy volunteers and cultured as explants on fibrin gels. Tranexamic acid (TA), a clinically approved anti-fibrinolytic agent was added to prevent the fibrin gel from digesting due to cellular activity. The gels were stained for p63α (as a marker of poorly differentiated epithelial cells), CK19, CK13 and CK3 (expressed by OMEC). Epithelial cell stratification was observed using hematoxylin-eosin staining. RESULTS Addition of TA prevented gels from dissolving during the culture period. OMEC proliferated on the fibrin gel and attained confluence over a 2-week period (±2 d) and exhibited a typical epithelial, cobblestone morphology. Basal OMEC exhibited positive staining for p63α while the superficial cells exhibited positive staining for CK3. The cells expressed a strong immunoreactivity for CK19 and CK13 suggesting that they retained a normal oral epithelial phenotype. CONCLUSION Fibrin gels, maintained in the presence of TA, to control the rate of substrate degradation, provide a more robust yet transparent substrate for the culture and transplantation of cultured OMEC. The fibrin gels are easily standardized, the components commercially available, and produced from clinically approved materials. The resulting stratified OMEC-derived epithelium displays characteristics similar to that of a human cornea, e.g. CK3 expression. The conventional dependence on a murine feeder layer for support of epithelial cells is unnecessary with this technique and hence, provides for an attractive alternative for treatment of LSCD.
Collapse
Affiliation(s)
- Radhika Sheth
- a Cells for Sight, Transplantation and Research Programme, University College London Institute of Ophthalmology , London , UK .,b Ocular Biology and Therapeutics Division , University College London Institute of Ophthalmology , London , UK and
| | - Michael H Neale
- a Cells for Sight, Transplantation and Research Programme, University College London Institute of Ophthalmology , London , UK .,b Ocular Biology and Therapeutics Division , University College London Institute of Ophthalmology , London , UK and
| | - Alex J Shortt
- a Cells for Sight, Transplantation and Research Programme, University College London Institute of Ophthalmology , London , UK .,b Ocular Biology and Therapeutics Division , University College London Institute of Ophthalmology , London , UK and.,c Moorfields Eye Hospital National Health Service Foundation Trust , London , UK
| | - Isobel Massie
- b Ocular Biology and Therapeutics Division , University College London Institute of Ophthalmology , London , UK and
| | - Amanda J Vernon
- a Cells for Sight, Transplantation and Research Programme, University College London Institute of Ophthalmology , London , UK .,b Ocular Biology and Therapeutics Division , University College London Institute of Ophthalmology , London , UK and
| | - Julie T Daniels
- a Cells for Sight, Transplantation and Research Programme, University College London Institute of Ophthalmology , London , UK .,b Ocular Biology and Therapeutics Division , University College London Institute of Ophthalmology , London , UK and
| |
Collapse
|
46
|
Sangwan VS, Jain R, Basu S, Bagadi AB, Sureka S, Mariappan I, Macneil S. Transforming ocular surface stem cell research into successful clinical practice. Indian J Ophthalmol 2014; 62:29-40. [PMID: 24492499 PMCID: PMC3955067 DOI: 10.4103/0301-4738.126173] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
It has only been a quarter of a century since the discovery of adult stem cells at the human corneo-scleral limbus. These limbal stem cells are responsible for generating a constant and unending supply of corneal epithelial cells throughout life, thus maintaining a stable and uniformly refractive corneal surface. Establishing this hitherto unknown association between ocular surface disease and limbal dysfunction helped usher in therapeutic approaches that successfully addressed blinding conditions such as ocular burns, which were previously considered incurable. Subsequent advances in ocular surface biology through basic science research have translated into innovations that have made the surgical technique of limbal stem cell transplantation simpler and more predictable. This review recapitulates the basic biology of the limbus and the rationale and principles of limbal stem cell transplantation in ocular surface disease. An evidence-based algorithm is presented, which is tailored to clinical considerations such as laterality of affliction, severity of limbal damage and concurrent need for other procedures. Additionally, novel findings in the form of factors influencing the survival and function of limbal stem cells after transplantation and the possibility of substituting limbal cells with epithelial stem cells of other lineages is also discussed. Finally this review focuses on the future directions in which both basic science and clinical research in this field is headed.
Collapse
Affiliation(s)
- Virender S Sangwan
- Clinical Trial Center, Dr. Paul Dubord Chair in Cornea, L V Prasad Eye Institute, Hyderabad, Andhra Pradesh, India
| | | | | | | | | | | | | |
Collapse
|
47
|
Shortt AJ, Bunce C, Levis HJ, Blows P, Doré CJ, Vernon A, Secker GA, Tuft SJ, Daniels JT. Three-year outcomes of cultured limbal epithelial allografts in aniridia and Stevens-Johnson syndrome evaluated using the Clinical Outcome Assessment in Surgical Trials assessment tool. Stem Cells Transl Med 2014; 3:265-75. [PMID: 24443006 DOI: 10.5966/sctm.2013-0025] [Citation(s) in RCA: 83] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Limbal stem cell deficiency (LSCD) is an eye disorder in which the stem cells responsible for forming the surface skin of the cornea are destroyed by disease. This results in pain, loss of vision, and a cosmetically unpleasant appearance. Many new treatments, including stem cell therapies, are emerging for the treatment of this condition, but assessment of these new technologies is severely hampered by the lack of biomarkers for this disease or validated tools for assessing its severity. The aims of this study were to design and test the reliability of a tool for grading LSCD, to define a set of core outcome measures for use in evaluating treatments for this condition, and to demonstrate their utility. This was achieved by using our defined outcome set (which included the Clinical Outcome Assessment in Surgical Trials of Limbal stem cell deficiency [COASTL] tool) to evaluate the 3-year outcomes for allogeneic ex vivo cultivated limbal epithelial transplantation (allo-CLET) in patients who had bilateral total LSCD secondary to aniridia or Stevens-Johnson syndrome. The results demonstrate that our new grading tool for LSCD, the COASTL tool, is reliable and repeatable, and that improvements in the biomarkers used in this tool correlate positively with improvements in visual acuity. The COASTL tool showed that following allo-CLET there was a decrease in LSCD severity and an increase in visual acuity up to 12 months post-treatment, but thereafter LSCD severity and visual acuity progressively deteriorated.
Collapse
Affiliation(s)
- Alex J Shortt
- Cells for Sight Transplantation and Research Programme and Ocular Biology and Therapeutics Division, University College London Institute of Ophthalmology, London, United Kingdom; Moorfields Eye Hospital National Health Service Foundation Trust, London, United Kingdom; University College London Clinical Trials Unit, London, United Kingdom
| | | | | | | | | | | | | | | | | |
Collapse
|
48
|
Shaharuddin B, Ahmad S, Meeson A, Ali S. Concise review: immunological properties of ocular surface and importance of limbal stem cells for transplantation. Stem Cells Transl Med 2013; 2:614-24. [PMID: 23817133 DOI: 10.5966/sctm.2012-0143] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Cornea transplantation has been considered to be different from other solid organ transplantation because of the assumed immune-privileged state of the anterior chamber of the eye. Three major lines of thought regarding the molecular mechanisms of immune privilege in the eye are as follows: (a) anatomical, cellular, and molecular barriers in the eye; (b) anterior chamber-associated immune deviation; and (c) immunosuppressive microenvironment in the eye. However, cornea transplants suffer allograft rejection when breached by vascularization. In recent developments, cellular corneal transplantation from cultivated limbal epithelial cells has shown impressive advances as a future therapy. The limbal stem cell niche contains stem cells that promote proliferation and migration and have immunosuppressive mechanisms to protect them from immunological reactions. Limbal stem cells are also noted to display an enhanced expression of genes for the antiapoptotic proteins, a property that is imperative for the survival of transplanted tissues. Further investigation of the molecular mechanisms regulating the immune regulation of limbal stem cells is relevant in the clinical setting to promote the survival of whole corneal and limbal stem cell transplantation.
Collapse
Affiliation(s)
- Bakiah Shaharuddin
- Institute of Genetic Medicine, Newcastle University, Newcastle-Upon-Tyne, United Kingdom
| | | | | | | |
Collapse
|
49
|
Bath C. Human corneal epithelial subpopulations: oxygen dependent ex vivo expansion and transcriptional profiling. Acta Ophthalmol 2013; 91 Thesis 4:1-34. [PMID: 23732018 DOI: 10.1111/aos.12157] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Corneal epithelium is being regenerated throughout life by limbal epithelial stem cells (LESCs) believed to be located in histologically defined stem cell niches in corneal limbus. Defective or dysfunctional LESCs result in limbal stem cell deficiency (LSCD) causing pain and decreased visual acuity. Since the first successful treatment of LSCD by transplantation of ex vivo expanded LESCs in 1997, many attempts have been carried out to optimize culture conditions to improve the outcome of surgery. To date, progress in this field of bioengineering is substantially hindered by both the lack of specific biomarkers of LESCs and the lack of a precise molecular characterization of in situ epithelial subpopulations. The aim of this dissertation was to optimize culture systems with regard to the environmental oxygen concentration for selective ex vivo expansion of LESCs and to analyse in situ subpopulations in human corneal epithelium using a combination of laser capture microdissection and RNA sequencing for global transcriptomic profiling. We compared dissociation cultures, using either expansion on γ-irradiated NIH/3T3 feeder cells in serum-rich medium or expansion directly on plastic in serum-free EpiLife medium, using a range of physiologically relevant oxygen concentrations (2%, 5%, 10%, 15% and 20%). Using immunocytochemistry and advanced fluorescence microscopy, cells were characterized regarding growth, cell cycle distribution, colony-forming efficiency (CFE), phenotypes and cytomorphometry. Limbal epithelial cells expanded in 2% O2 exhibited slow growth, low fraction of cells in S/G2 , high CFE, high expression of stem cell markers ABCG2 and p63α, and low fraction of differentiation marker CK3 resembling a LESC phenotype. The effect of hypoxia to maintain LESCs in culture was not dependent on the system used for propagation (Bath et al. 2013a). Laser capture microdissection was used to isolate cellular subpopulations in situ from the spatially defined differentiation pathway in human corneal epithelium according to an optimized protocol for maintenance of expression profiles. Isolated total RNA from basal limbal crypts (BLCs), superficial limbal crypts (SLCs), paracentral/central cornea and limbal stroma was amplified and converted to fragmented cDNA libraries for use in deep paired-end next-generation sequencing. Global transcriptional profiling was carried out using bioinformatics. The location of primitive cells in BLCs, migratory and activated cells in SLCs and differentiated cells in paracentral/central cornea was evident from mapping of significantly upregulated genes in each compartment to the gene ontology (GO). Interestingly, many GO terms in BLCs were also involved in neurogenic processes, whereas many GO terms in SLCs were related to vasculature. Mapping upregulated genes in BLCs to pathway annotations in Kyoto Encyclopedia of Genes and Genomes described many active pathways as signalling and cancer-associated pathways. We supply extensive information on possible novel biomarkers, reveal insight into both active pathways and novel regulators of LESCs such as Lrig1 and SOX9 and provide an immense amount of data for future exploration (Bath et al. 2013b). Selective ex vivo expansion of LESCs in hypoxia and the comprehensive molecular characterization of corneal epithelial subpopulations in situ are expected to be beneficial for the future treatment of LSCD by cultured limbal epithelial transplantation.
Collapse
Affiliation(s)
- Chris Bath
- Department of Ophthalmology, Aalborg University Hospital, Aalborg, Denmark
| |
Collapse
|
50
|
Lal I, Panchal BU, Basu S, Sangwan VS. In-vivo expansion of autologous limbal stem cell using simple limbal epithelial transplantation for treatment of limbal stem cell deficiency. BMJ Case Rep 2013; 2013:bcr-2013-009247. [PMID: 23704435 DOI: 10.1136/bcr-2013-009247] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
A 20-year-old man from Bangladesh suffered accidental alkali injury to his right eye in May 2010 leading to total limbal stem cell deficiency. An amniotic membrane graft was performed 5 days after the accident and the patient presented to our institute 6 months later. On ocular examination, his best corrected visual acuity (BCVA) was 20/50 with a 360° pannus at the periphery and central area was spared but had stromal scarring. He underwent simple limbal epithelial transplantation (SLET) taking a limbal biopsy from his left eye and was prescribed steroid and antibiotic eye drops postoperatively as per the standard regimen. At 2 year follow-up, the patient's ocular surface is stable with improvement in BCVA to 20/25 post-SLET.
Collapse
Affiliation(s)
- Ikeda Lal
- Cornea and Anterior Segment Service, LV Prasad Eye Institute, Kallam Anji Reddy Campus, L V Prasad Marg, Banjara Hills, Hyderabad, Andhra Pradesh, India
| | | | | | | |
Collapse
|