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Ghosh A, Bera AK, Singh V, Basu S, Pati F. Bioprinting of anisotropic functional corneal stroma using mechanically robust multi-material bioink based on decellularized cornea matrix. BIOMATERIALS ADVANCES 2024; 165:214007. [PMID: 39216318 DOI: 10.1016/j.bioadv.2024.214007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2024] [Revised: 07/08/2024] [Accepted: 08/23/2024] [Indexed: 09/04/2024]
Abstract
Corneal scarring is a common cause of blindness, affecting millions globally each year. A huge gap between the demand and supply of donor tissue currently limits corneal transplantation, the only definitive therapy for patients with corneal scarring. To overcome this challenge, researchers have harnessed the efficacy of 3D bioprinting to fabricate artificial corneal stromal constructs. With all the different bioinks available, the decellularized corneal matrix-based bioprinted construct can fulfill the required biological functionality but is limited by the lack of mechanical stiffness. Additionally, from a biophysical standpoint, it is necessary for an ideal corneal substitute to mimic the anisotropy of the cornea from the central optic zone to the surrounding periphery. In this study, we enhanced the mechanical robustness of decellularized cornea matrix (DCM) hydrogel by blending it with another natural polymer, sonicated silk fibroin solution in a defined ratio. Although hybrid hydrogel has an increased complex modulus than DCM hydrogel, it has a lower in vitro degradation rate and increased opaqueness due to the presence of crystalline beta-sheet conformation within the hydrogel. Therefore, we used this multi-material bioink-based approach to fabricate a corneal stromal equivalent where the outer peripheral corneal rim was printed with a mechanically robust polymeric blend of DCM and sonicated silk fibroin and the central optic zone was printed with only DCM. The bioprinted corneal stroma thus maintained its structural integrity and did not break when lifted with forceps. The two different bioinks were encapsulated with human limbus-derived mesenchymal stem cells (hLMSC) individually and 3D bioprinted in different patterns (concentric and parallel) to attain a native-like structure in terms of architecture and transparency. Thus, the bilayer cornea constructs maintained high cell viability and expressed keratocyte core proteins indicating optimal functionality. This approach helped to gain insight into bioprinting corneas with heterogeneous mechanical property without disturbing the structural clarity of the central optic zone.
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Affiliation(s)
- Anwesha Ghosh
- Department of Biomedical Engineering, Indian Institute of Technology Hyderabad, Kandi, Sangareddy 502284, Telangana, India
| | - Ashis Kumar Bera
- Department of Biomedical Engineering, Indian Institute of Technology Hyderabad, Kandi, Sangareddy 502284, Telangana, India
| | - Vivek Singh
- Centre Ocular Regeneration, Prof. Brien Holden Eye Research Centre L.V. Prasad Eye Institute, Hyderabad 500034, Telangana, India
| | - Sayan Basu
- Centre Ocular Regeneration, Prof. Brien Holden Eye Research Centre L.V. Prasad Eye Institute, Hyderabad 500034, Telangana, India
| | - Falguni Pati
- Department of Biomedical Engineering, Indian Institute of Technology Hyderabad, Kandi, Sangareddy 502284, Telangana, India.
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Nascimento H, Martins TMM, Moreira R, Barbieri G, Pires P, Carvalho LN, Rosa LR, Almeida A, Araujo MS, Pessuti CL, Ferrer H, Pereira Gomes JÁ, Belfort R, Raia S. Current Scenario and Future Perspectives of Porcine Corneal Xenotransplantation. Cornea 2024:00003226-990000000-00715. [PMID: 39413247 DOI: 10.1097/ico.0000000000003723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Accepted: 08/25/2024] [Indexed: 10/18/2024]
Abstract
ABSTRACT Corneal diseases represent a significant cause of blindness worldwide, with corneal transplantation being an effective treatment to prevent vision loss. Despite substantial advances in transplantation techniques, the demand for donor corneas exceeds the available supply, particularly in developing countries. Cornea xenotransplantation has emerged as a promising strategy to address the worldwide scarcity, notably using porcine corneas. In addition to the inherent immune privilege of the cornea, the low cost of porcine breeding and the anatomical and physiological similarities between humans and pigs have made porcine corneas a viable alternative. Nonetheless, ethical concerns, specifically the risk of xenozoonotic transmission and the necessity for stringent biosafety measures, remain significant obstacles. Moreover, the success of xenotransplantation is compromised by innate and adaptive immune responses, which requires meticulous consideration and further studies. Despite these challenges, recent breakthroughs have further contributed to reducing immunogenicity while preserving the corneal architecture. Advances in genetic engineering, such as the use of CRISPR-Cas9 to eliminate critical porcine antigens, have shown promise for mitigating immune reactions. Additionally, new immunosuppressive protocols, such as have techniques like decellularization and the use of porcine-derived acellular matrices, have greatly increased graft survival in preclinical models. Future research must focus on refining immunomodulatory strategies and improving graft preparation techniques to ensure the long-term survival and safety of porcine corneal xenotransplantation in clinical trials in humans.
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Affiliation(s)
- Heloisa Nascimento
- Department of Ophthalmology, Federal University of São Paulo (UNIFESP), Sao Paulo, Brazil
- Faculty of Medicine, University of São Paulo (USP), Sao Paulo, Brazil
| | - Thaís M M Martins
- Department of Ophthalmology, Federal University of São Paulo (UNIFESP), Sao Paulo, Brazil
- Faculty of Medicine, University of São Paulo (USP), Sao Paulo, Brazil
- Federal University of Viçosa (UFV), Viçosa, Brazil; and
| | | | - Gabriel Barbieri
- Department of Ophthalmology, Federal University of São Paulo (UNIFESP), Sao Paulo, Brazil
| | - Pedro Pires
- Faculty of Medicine, University of São Paulo (USP), Sao Paulo, Brazil
| | - Lucimeire N Carvalho
- Department of Ophthalmology, Federal University of São Paulo (UNIFESP), Sao Paulo, Brazil
| | - Larissa R Rosa
- Department of Ophthalmology, Federal University of São Paulo (UNIFESP), Sao Paulo, Brazil
| | - Augusto Almeida
- Faculty of Medicine, University of São Paulo (USP), Sao Paulo, Brazil
| | | | - Carmen Luz Pessuti
- Department of Ophthalmology, Federal University of São Paulo (UNIFESP), Sao Paulo, Brazil
| | - Henrique Ferrer
- Department of Ophthalmology, Federal University of São Paulo (UNIFESP), Sao Paulo, Brazil
| | | | - Rubens Belfort
- Department of Ophthalmology, Federal University of São Paulo (UNIFESP), Sao Paulo, Brazil
- Faculty of Medicine, University of São Paulo (USP), Sao Paulo, Brazil
- Federal University of Viçosa (UFV), Viçosa, Brazil; and
- Vision Institute (IPEPO), Sao Paulo, Brazil
| | - Silvano Raia
- Faculty of Medicine, University of São Paulo (USP), Sao Paulo, Brazil
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Hashimoto Y, Negishi J, Funamoto S, Kimura T, Kobayashi H, Oshika T, Kishida A. Preparation, physico-biochemical characterization, and proteomic analysis of highly transparent corneal extracellular matrices for lamellar keratoplasty and tissue-engineered cornea construction. Mater Today Bio 2024; 28:101241. [PMID: 39328788 PMCID: PMC11426139 DOI: 10.1016/j.mtbio.2024.101241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2024] [Revised: 08/26/2024] [Accepted: 09/10/2024] [Indexed: 09/28/2024] Open
Abstract
Corneal opacity and deformation, which often require corneal transplantation for treatment, are among the leading causes of monocular blindness. To restore corneal clarity and integrity, there is a need for an artificial stroma that not only matches the transparency of donated human cornea but also effectively integrates to the corneal tissue. In this study, a transparent decellularized cornea was successfully developed using the high hydrostatic pressure method with processing conditions optimized for corneal decellularization. Biochemical analyses demonstrated the effective removal of cellular components from the transparent decellularized corneas, while preserving collagen and glycosaminoglycans. Proteome analysis also revealed that core matrisome and matrisome-associated proteins remained following decellularization, similar to the composition observed in untreated corneas. The light transmittance of the transparent decellularized corneas was 86.4 ± 1.5 % in the visible region, comparable to that of donated human corneas. No complications, such as angiogenesis, were observed following interlamellar corneal transplantation in rabbits. The grafts were almost imperceptible immediately following surgery and achieved complete transparency within a few days, becoming indistinguishable even under a microscope. The transparent decellularized cornea presented here has promising potential as a material for application in lamellar keratoplasty.
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Affiliation(s)
- Yoshihide Hashimoto
- Institute of Biomaterials and Bioengineering, Tokyo Medical and Dental University, 2-3-10 Kanda-Surugadai, Chiyoda-ku, Tokyo, 101-0062, Japan
| | - Jun Negishi
- Institute of Biomaterials and Bioengineering, Tokyo Medical and Dental University, 2-3-10 Kanda-Surugadai, Chiyoda-ku, Tokyo, 101-0062, Japan
- Department of Applied Biology, Faculty of Textile Science and Technology, Shinshu University, 3-15-1 Tokida, Ueda, Nagano, 386-8567, Japan
| | - Seiichi Funamoto
- Institute of Biomaterials and Bioengineering, Tokyo Medical and Dental University, 2-3-10 Kanda-Surugadai, Chiyoda-ku, Tokyo, 101-0062, Japan
| | - Tsuyoshi Kimura
- Institute of Biomaterials and Bioengineering, Tokyo Medical and Dental University, 2-3-10 Kanda-Surugadai, Chiyoda-ku, Tokyo, 101-0062, Japan
- Department of Biomedical Engineering, Faculty of Life Science, Toyo University, 48-1 Oka, Asaka-shi, Saitama, 351-8510, Japan
| | - Hisatoshi Kobayashi
- Institute of Biomaterials and Bioengineering, Tokyo Medical and Dental University, 2-3-10 Kanda-Surugadai, Chiyoda-ku, Tokyo, 101-0062, Japan
| | - Tetsuro Oshika
- Department of Ophthalmology, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennoudai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Akio Kishida
- Institute of Biomaterials and Bioengineering, Tokyo Medical and Dental University, 2-3-10 Kanda-Surugadai, Chiyoda-ku, Tokyo, 101-0062, Japan
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Chu X, Yin Y, Chen S, Chen F, Liu H, Zhao S. Suppressive Role of Pigment Epithelium-derived Factor in a Rat Model of Corneal Allograft Rejection. Transplantation 2024; 108:2072-2083. [PMID: 38644534 DOI: 10.1097/tp.0000000000005032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/23/2024]
Abstract
BACKGROUND Immunological rejection is the most common reason for corneal transplantation failure. The importance of T cells in corneal allograft rejection is well demonstrated. Recent studies highlight that pigment epithelium-derived factor (PEDF) plays an immunoregulatory role in ocular diseases by enhancing the suppressive phenotype of regulatory T cells besides its other functions in neurotrophy and antiangiogenesis. METHODS The effects of PEDF on immune rejection were examined in rat models of corneal transplantation using slit-lamp microscope observation, immunohistochemistry, flow cytometry, and Western blot. In vitro, we demonstrated PEDF reduced alloreactive T-cell activation using real-time polymerase chain reaction, flow cytometry, and Western blot. RESULTS Topical administration of PEDF provided corneal transplantation rats with an improved graft survival rate of corneal allografts, reduced hemangiogenesis, and infiltration of immune cells in corneas, in particular, type 17 T helper cells while increased regulatory T cells. Moreover, nerve reinnervation within grafts was promoted in PEDF-treated recipient rats. In vitro, PEDF inhibited alloreactive T-cell activation via the c-Jun N-terminal kinase/c-Jun signaling pathway and upregulated the expressions of interleukin-10 and transforming growth factor-β, emphasizing the suppressive role of PEDF on immune responses. CONCLUSIONS Our results underscore the feasibility of PEDF in alleviating corneal allograft rejection and further illustrate its potential in managing immune-related diseases.
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Affiliation(s)
- Xiaoran Chu
- Department of Cornea and Refractive Surgery, Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, China
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Feliciano AJ, Alaoui Selsouli Y, Habibovic P, Birgani ZNT, Moroni L, Baker MB. Granular polyrotaxane microgels as injectable hydrogels for corneal tissue regeneration. Biomater Sci 2024; 12:4993-5009. [PMID: 39169887 DOI: 10.1039/d4bm00409d] [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: 08/23/2024]
Abstract
Corneal diseases, a leading cause of global vision impairment, present challenges in treatment due to corneal tissue donor scarcity and transplant rejection. Hydrogel biomaterials in the form of corneal implants for tissue regeneration, while promising, have faced obstacles related to cellular and tissue integration. This study develops and investigates the potential of granular polyrotaxane (GPR) hydrogels as a scaffold for corneal keratocyte growth and transparent tissue generation. Employing host-guest driven supramolecular interactions, we developed injectable, cytocompatible hydrogels. By optimizing cyclodextrin (CD) concentrations in thiol-ene crosslinked PEG microgels, we observed improved mechanical properties and thermoresponsiveness while preserving injectability. These microgels, adaptable for precise defect filling, 3D printing or tissue culture facilitate enhanced cellular integration with corneal keratocytes and exhibit tissue-like structures in culture. Our findings demonstrate the promise of GPR hydrogels as a minimally invasive avenue for corneal tissue regeneration. These results have the potential to address transplantation challenges, enhance clinical outcomes, and restore vision.
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Affiliation(s)
- Antonio J Feliciano
- Department of Complex Tissue Regeneration, Maastricht University, MERLN Institute for Technology-Inspired Regenerative Medicine, Maastricht, the Netherlands.
| | - Yousra Alaoui Selsouli
- Department of Instructive Biomaterial Engineering, Maastricht University, MERLN Institute for Technology-Inspired Regenerative Medicine, Maastricht, the Netherlands
| | - Pamela Habibovic
- Department of Instructive Biomaterial Engineering, Maastricht University, MERLN Institute for Technology-Inspired Regenerative Medicine, Maastricht, the Netherlands
| | - Zeinab Niloofar Tahmasebi Birgani
- Department of Complex Tissue Regeneration, Maastricht University, MERLN Institute for Technology-Inspired Regenerative Medicine, Maastricht, the Netherlands.
- Department of Instructive Biomaterial Engineering, Maastricht University, MERLN Institute for Technology-Inspired Regenerative Medicine, Maastricht, the Netherlands
| | - Lorenzo Moroni
- Department of Complex Tissue Regeneration, Maastricht University, MERLN Institute for Technology-Inspired Regenerative Medicine, Maastricht, the Netherlands.
| | - Matthew B Baker
- Department of Complex Tissue Regeneration, Maastricht University, MERLN Institute for Technology-Inspired Regenerative Medicine, Maastricht, the Netherlands.
- Department of Instructive Biomaterial Engineering, Maastricht University, MERLN Institute for Technology-Inspired Regenerative Medicine, Maastricht, the Netherlands
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Clark S, Tapia Lishner SE, Marquez-Curtis LA, Elliott JAW. Using a triphasic model to describe the permeation of dimethyl sulfoxide in porcine corneoscleral discs. Cryobiology 2024; 117:104940. [PMID: 39004199 DOI: 10.1016/j.cryobiol.2024.104940] [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: 03/22/2024] [Revised: 07/08/2024] [Accepted: 07/11/2024] [Indexed: 07/16/2024]
Abstract
Corneal blindness can be treated by keratoplasty but a lack of readily available corneal donor tissue for this procedure remains a challenge. Cryopreservation can facilitate the long-term storage of tissue but effective protocols for cryopreserving cornea have yet to be developed. Mathematical modelling can guide protocol design, but previously used models are not comprehensive. A comprehensive model should describe the tissue's shrink-swell response and the cryoprotectant concentration throughout the tissue during cryoprotectant loading. Such a model exists for articular cartilage based on a biomechanical triphasic approach. We explored the applicability of this model for describing cryoprotectant permeation in porcine corneas by fitting it to experimental data for the permeation of dimethyl sulfoxide into porcine corneoscleral discs. The model provided as good of a fit for corneoscleral discs data as it did for articular cartilage data, presenting promise for its use in the design of cryopreservation protocols for corneas.
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Affiliation(s)
- Shannon Clark
- Department of Chemical and Materials Engineering, University of Alberta, Edmonton, Alberta, Canada
| | | | - Leah A Marquez-Curtis
- Department of Chemical and Materials Engineering, University of Alberta, Edmonton, Alberta, Canada; Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada
| | - Janet A W Elliott
- Department of Chemical and Materials Engineering, University of Alberta, Edmonton, Alberta, Canada; Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada.
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Hoffmann JV, Betancor PK, Maier P, Lapp T, Heinzelmann S, Böhringer D, Lang S, Reinhard T. Changing indications for keratoplasty: monocentric analysis of the past two decades. Graefes Arch Clin Exp Ophthalmol 2024:10.1007/s00417-024-06639-y. [PMID: 39297889 DOI: 10.1007/s00417-024-06639-y] [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: 06/27/2024] [Revised: 08/31/2024] [Accepted: 09/05/2024] [Indexed: 09/21/2024] Open
Abstract
PURPOSE Over the past two decades, lamellar keratoplasty procedures, such as Descemet's Stripping Automated Endothelial Keratoplasty (DSAEK) and Descemet's Membrane Endothelial Keratoplasty (DMEK) as well as Deep Anterior Lamellar Keratoplasty (DALK), have become an integral part of clinical practice. With advances in contact lens fitting for keratoconus management and the implementation of UVA-Riboflavin Crosslinking (CXL), the landscape of keratoplasty indications is undergoing changes. Procedures and indications in a single tertiary care center over the past two decades are reviewed in this retrospective analysis. METHODS Retrospective analysis utilized anonymized electronic data from the LIONS cornea bank Baden-Württemberg, Eye Center Freiburg, spanning from beginning of 2004 to end of 2023. The primary focus was on surgical procedures and indications for keratoplasty. RESULTS The study encompassed a comprehensive analysis of 7130 corneal transplants. Penetrating keratoplasty (PK) exhibited a significant decline from 95% (n = 206, 2004) to 11% (n = 46, 2023), while DMEK increased from 48% (n = 157, 2012) to 82% (n = 347, 2023). Fuchs endothelial dystrophy (FED) emerged as the dominant indication, witnessing a significant increase from 24% (2004, n = 39) to 72% (2023, n = 288). Conversely, keratoconus (KC) showed a reciprocal change from 25% (2004, n = 40) to 4% (2023, n = 17). PK demonstrated a noteworthy indication shift in descending order from Bullous Keratopathy (BK), FED, and KC in 2004 to KC, graft failure, corneal scars, and ulcers in 2023. Repeat keratoplasty following DMEK remained rare, but a discernible upward trend was observed for PK. CONCLUSION This retrospective analysis highlights significant changes in both keratoplasty indications and techniques over the past two decades. DMEK has emerged as a successful intervention for treating endothelial diseases, while PK retains its qualitative indispensability for a wide range of indications. Modern corneal banks are urged to maintain a robust supply of grafts for all surgical techniques in anticipation of potential increased demand in the future, particularly for repeat keratoplasties. KEY MESSAGES What is known • Over the past two decades, lamellar keratoplasty procedures such as DSAEK and DMEK have increasingly replaced penetrating keratoplasty (PK) in clinical practice due to their improved outcomes and reduced complications for certain indications. New Findings • Our study reveals a significant shift in keratoplasty indications, with Fuchs endothelial dystrophy (FED) emerging as the predominant indication, increasing from 24% in 2004 to 72% in 2023, while keratoconus (KC) declined from 25 to 4% during the same period. • Penetrating keratoplasty (PK) has shown a marked decline in use, dropping from 95% of keratoplasties in 2004 to 11% in 2023, whereas DMEK has grown to represent 82% of procedures in 2023. • Despite the rise of DMEK, PK remains vital for a broad spectrum of indications, highlighting the necessity for corneal banks to maintain a versatile supply of grafts to meet diverse clinical needs, particularly in cases of repeat keratoplasties.
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Affiliation(s)
- Jan Vincent Hoffmann
- Eye Center, Medical Center, University Freiburg, Killianstraße 5, 79106, Freiburg im Breisgau, Germany.
| | - Paola Kammrath Betancor
- Eye Center, Medical Center, University Freiburg, Killianstraße 5, 79106, Freiburg im Breisgau, Germany
| | - Philip Maier
- Eye Center, Medical Center, University Freiburg, Killianstraße 5, 79106, Freiburg im Breisgau, Germany
| | - Thabo Lapp
- Eye Center, Medical Center, University Freiburg, Killianstraße 5, 79106, Freiburg im Breisgau, Germany
- Department of Ophthalmology, St. Franziskus Hospital, Muenster, Germany
| | - Sonja Heinzelmann
- Eye Center, Medical Center, University Freiburg, Killianstraße 5, 79106, Freiburg im Breisgau, Germany
| | - Daniel Böhringer
- Eye Center, Medical Center, University Freiburg, Killianstraße 5, 79106, Freiburg im Breisgau, Germany
| | - Stefan Lang
- Eye Center, Medical Center, University Freiburg, Killianstraße 5, 79106, Freiburg im Breisgau, Germany
- Department of Ophthalmology, Brandenburg Medical School, University Hospital Brandenburg, Brandenburg an Der Havel, Germany
| | - Thomas Reinhard
- Eye Center, Medical Center, University Freiburg, Killianstraße 5, 79106, Freiburg im Breisgau, Germany
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Zhang X, Qi X, Lu X, Gao H. Modified tectonic corneoscleral graft technique for treating devastating corneoscleral infections. BMC Ophthalmol 2024; 24:402. [PMID: 39261792 PMCID: PMC11389300 DOI: 10.1186/s12886-024-03669-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2024] [Accepted: 09/03/2024] [Indexed: 09/13/2024] Open
Abstract
BACKGROUND This study aims to evaluate the clinical outcomes and efficacy of a modified tectonic corneoscleral graft (TCG) in patients suffering from devastating corneoscleral infections. METHODS Thirty-eight eyes from 38 patients who underwent the modified TCG were included in this study. The outcomes measured were recurrence rates, best-corrected visual acuity (BCVA), ocular surface stability, postoperative complications, and graft survival. RESULTS Among the 38 patients, 23 had fungal infections, 9 had bacterial infections and 6 had Pythium insidiosum infections. At the final follow-up, with an average duration of 25.1 ± 8.6 months, the rate of monocular blindness decreased from 100 to 58%. Significant improvements in LogMAR BCVA were observed from preoperative to postoperative measurements (P < 0.001). Thirty-two eyes (84.2%) maintained a stable ocular surface. The survival rate of ocular surface stability was 84.2%±5.9% at one year and 57.7%±9.7% at three years post-surgery. Twenty eyes (52.6%) retained a clear graft, with a survival rate for graft clarity was 81.6%±6.3% at one year and 36.0%±10.8% at three years post-surgery. The incidence of immune rejection was 36.8%. Corneal epithelial defects were observed in ten patients, and choroidal detachment occurred in four patients. No cases of elevated intraocular pressure were detected. CONCLUSIONS The modified TCG is effective in eradicating infections, preserving the eyeball, and maintaining useful vision in cases of devastating corneoscleral infections. Regular use of tacrolimus, timely administration of glucocorticoids, and good patient compliance can help mitigate postoperative challenges.
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Affiliation(s)
- Xiaoyu Zhang
- Eye Institute of Shandong First Medical University, Eye Hospital of Shandong First Medical University (Shandong Eye Hospital), 372 Jingsi Road, Jinan, 250021, China
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, 372 Jingsi Road, Jinan, 250021, China
- School of Ophthalmology, Shandong First Medical University, 372 Jingsi Road, Jinan, 250021, China
| | - Xiaolin Qi
- Eye Institute of Shandong First Medical University, Eye Hospital of Shandong First Medical University (Shandong Eye Hospital), 372 Jingsi Road, Jinan, 250021, China
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, 372 Jingsi Road, Jinan, 250021, China
- School of Ophthalmology, Shandong First Medical University, 372 Jingsi Road, Jinan, 250021, China
| | - Xiuhai Lu
- Eye Institute of Shandong First Medical University, Eye Hospital of Shandong First Medical University (Shandong Eye Hospital), 372 Jingsi Road, Jinan, 250021, China
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, 372 Jingsi Road, Jinan, 250021, China
- School of Ophthalmology, Shandong First Medical University, 372 Jingsi Road, Jinan, 250021, China
| | - Hua Gao
- Eye Institute of Shandong First Medical University, Eye Hospital of Shandong First Medical University (Shandong Eye Hospital), 372 Jingsi Road, Jinan, 250021, China.
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, 372 Jingsi Road, Jinan, 250021, China.
- School of Ophthalmology, Shandong First Medical University, 372 Jingsi Road, Jinan, 250021, China.
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Gilger BC, Hasegawa T, Sutton RB, Bower JJ, Li C, Hirsch ML. A chimeric anti-vascularization immunomodulator prevents high-risk corneal transplantation rejection via ex vivo gene therapy. Mol Ther 2024:S1525-0016(24)00595-1. [PMID: 39245940 DOI: 10.1016/j.ymthe.2024.09.007] [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: 06/06/2024] [Revised: 08/06/2024] [Accepted: 09/04/2024] [Indexed: 09/10/2024] Open
Abstract
Corneal blindness affects more than 5 million individuals, with over 180,000 corneal transplantations (CTs) performed annually. In high-risk CTs, almost all grafts are rejected within 10 years. Here, we investigated adeno-associated virus (AAV) ex vivo gene therapy to establish immune tolerance in the corneal allograft to prevent high-risk CT rejection. Our previous work has demonstrated that HLA-G contributes to ocular immune privilege by inhibiting both immune cells and neovascularization; however, homodimerization is a rate-limiting step for optimal HLA-G function. Therefore, a chimeric protein called single-chain immunomodulator (scIM), was engineered to mimic the native activity of the secreted HLA-G dimer complex and eliminate the need for homodimerization. In a murine corneal burn model, AAV8-scIM significantly reduced corneal vascularization and fibrosis. Next, ex vivo AAV8-scIM gene delivery to corneal allografts was evaluated in a high-risk CT rejection rabbit model. All scIM-treated corneas were well tolerated and transparent after 42 days, while 83% of vehicle-treated corneas were rejected. Histologically, AAV-scIM-treated corneas were devoid of immune cell infiltration and vascularization, with minimal fibrosis at the host-graft interface. The data collectively demonstrate that scIM gene therapy prevents corneal neovascularization, reduces trauma-induced corneal fibrosis, and prevents allogeneic CT rejection in a high-risk large animal model.
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Affiliation(s)
- Brian C Gilger
- Department of Clinical Sciences, North Carolina State University, Raleigh, NC 27607, USA; Bedrock Therapeutics, Raleigh, NC 27613, USA
| | - Tomoko Hasegawa
- Department of Ophthalmology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27514, USA; Gene Therapy Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - R Bryan Sutton
- Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA; Bedrock Therapeutics, Raleigh, NC 27613, USA
| | - Jacquelyn J Bower
- Department of Ophthalmology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27514, USA; Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27514, USA
| | - Chengwen Li
- Gene Therapy Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA; Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA; Bedrock Therapeutics, Raleigh, NC 27613, USA
| | - Matthew L Hirsch
- Department of Ophthalmology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27514, USA; Gene Therapy Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA; Bedrock Therapeutics, Raleigh, NC 27613, USA.
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Lee S, Blanco T, Musayeva A, Dehghani S, Narimatsu A, Forouzanfar K, Ortiz G, Kahale F, Wang S, Chen Y, Dohlman TH, Chauhan SK, Dana R. Myeloid-derived suppressor cells promote allograft survival by suppressing regulatory T cell dysfunction in high-risk corneal transplantation. Am J Transplant 2024; 24:1597-1609. [PMID: 38514014 PMCID: PMC11390336 DOI: 10.1016/j.ajt.2024.03.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 02/29/2024] [Accepted: 03/13/2024] [Indexed: 03/23/2024]
Abstract
Highly inflamed and neovascularized corneal graft beds are known as high-risk (HR) environments for transplant survival. One of the primary factors leading to this rejection is reduction in the suppressive function of regulatory T cells (Treg). Our results show that myeloid-derived suppressor cells (MDSC) counteract interleukin-6-mediated Treg dysfunction by expressing interleukin-10. Additionally, MDSC maintain forkhead box P3 stability and their ability to suppress IFN-γ+ Th1 cells. Administering MDSC to HR corneal transplant recipients demonstrates prolonged graft survival via promotion of Treg while concurrently suppressing IFN-γ+ Th1 cells. Moreover, MDSC-mediated donor-specific immune tolerance leads to long-term corneal graft survival as evidenced by the higher survival rate or delayed survival of a second-party C57BL/7 (B6) graft compared to those of third-party C3H grafts observed in contralateral low-risk or HR corneal transplantation of BALB/c recipient mice, respectively. Our study provides compelling preliminary evidence demonstrating the effectiveness of MDSC in preventing Treg dysfunction, significantly improving graft survival in HR corneal transplantation, and showing promising potential for immune tolerance induction.
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Affiliation(s)
- Seokjoo Lee
- Laboratory of Corneal Immunology, Transplantation, and Regeneration, Schepens Eye Research Institute of Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA
| | - Tomas Blanco
- Laboratory of Corneal Immunology, Transplantation, and Regeneration, Schepens Eye Research Institute of Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA
| | - Aytan Musayeva
- Laboratory of Corneal Immunology, Transplantation, and Regeneration, Schepens Eye Research Institute of Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA
| | - Shima Dehghani
- Laboratory of Corneal Immunology, Transplantation, and Regeneration, Schepens Eye Research Institute of Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA
| | - Akitomo Narimatsu
- Laboratory of Corneal Immunology, Transplantation, and Regeneration, Schepens Eye Research Institute of Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA
| | - Katayoon Forouzanfar
- Laboratory of Corneal Immunology, Transplantation, and Regeneration, Schepens Eye Research Institute of Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA
| | - Gustavo Ortiz
- Laboratory of Corneal Immunology, Transplantation, and Regeneration, Schepens Eye Research Institute of Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA
| | - Francesca Kahale
- Laboratory of Corneal Immunology, Transplantation, and Regeneration, Schepens Eye Research Institute of Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA
| | - Shudan Wang
- Laboratory of Corneal Immunology, Transplantation, and Regeneration, Schepens Eye Research Institute of Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA
| | - Yihe Chen
- Laboratory of Corneal Immunology, Transplantation, and Regeneration, Schepens Eye Research Institute of Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA
| | - Thomas H Dohlman
- Laboratory of Corneal Immunology, Transplantation, and Regeneration, Schepens Eye Research Institute of Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA
| | - Sunil K Chauhan
- Laboratory of Corneal Immunology, Transplantation, and Regeneration, Schepens Eye Research Institute of Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA
| | - Reza Dana
- Laboratory of Corneal Immunology, Transplantation, and Regeneration, Schepens Eye Research Institute of Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA.
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11
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Boroumand S, Rahmani M, Sigaroodi F, Ganjoury C, Parandakh A, Bonakdar A, Khani MM, Soleimani M. The landscape of clinical trials in corneal regeneration: A systematic review of tissue engineering approaches in corneal disease. J Biomed Mater Res B Appl Biomater 2024; 112:e35449. [PMID: 39032135 DOI: 10.1002/jbm.b.35449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 04/27/2024] [Accepted: 06/19/2024] [Indexed: 07/22/2024]
Abstract
The limited availability of a healthy donor cornea and the incidence of allograft failure led researchers to seek other corneal substitutes via tissue engineering. Exploring the trend of clinical trials of the cornea with the vision of tissue engineering provides an opportunity to reveal future potential corneal substitutes. The results of this clinical trial are beneficial for future study designs to overcome the limitations of current therapeutic approaches. In this study, registered clinical trials of bio-based approaches were reviewed for corneal regeneration on March 22, 2024. Among the 3955 registered trials for the cornea, 392 trials were included in this study, which categorized in three main bio-based scaffolds, stem cells, and bioactive macromolecules. In addition to the acellular cornea and human amniotic membrane, several bio-based materials have been introduced as corneal substrates such as collagen, fibrin, and agarose. However, some synthetic materials have been introduced in recent studies to improve the desired properties of bio-based scaffolds for corneal substitutes. Nevertheless, new insights into corneal regenerative medicine have recently emerged from cell sheets with autologous and allogeneic cell sources. In addition, the future perspective of corneal regeneration is described through a literature review of recent experimental models.
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Affiliation(s)
- Safieh Boroumand
- Department of Tissue Engineering and Applied Cell Sciences, School of Advanced Technologies in Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mahya Rahmani
- Department of Tissue Engineering and Applied Cell Sciences, School of Advanced Technologies in Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Faraz Sigaroodi
- Department of Tissue Engineering and Applied Cell Sciences, School of Advanced Technologies in Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Camellia Ganjoury
- Medical Nanotechnology and Tissue Engineering Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Azim Parandakh
- Medical Nanotechnology and Tissue Engineering Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Alireza Bonakdar
- Department of Tissue Engineering and Applied Cell Sciences, School of Advanced Technologies in Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Medical Nanotechnology and Tissue Engineering Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad-Mehdi Khani
- Department of Tissue Engineering and Applied Cell Sciences, School of Advanced Technologies in Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Masoud Soleimani
- Department of Tissue Engineering and Applied Cell Sciences, School of Advanced Technologies in Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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12
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Xu X, Wu Y, Gu R, Zhang Z, Liu X, Hu Y, Li X, Lin D, Bao Z. Nanoparticle-hydrogel composite as dual-drug delivery system for the potential application of corneal graft rejection. Eur J Pharm Biopharm 2024; 201:114351. [PMID: 38851460 DOI: 10.1016/j.ejpb.2024.114351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 05/29/2024] [Accepted: 06/06/2024] [Indexed: 06/10/2024]
Abstract
Immune rejection remains the major cause of corneal graft failure. Immunosuppressants (such as rapamycin; RAPA) adjunctive to antibiotics (such as levofloxacin hydrochloride; Lev) are a clinical mainstay after corneal grafts but suffer from poor ocular bioavailability associated with severe side effects. In this study, we fabricated a Lev@RAPA micelle loaded cationic peptide-based hydrogel (NapFFKK) as a dual-drug delivery system by integrating RAPA micelles with Lev into a cationic NapFFKK hydrogel to potentially reduced the risk of corneal graft rejection. The properties of the resulting hydrogels were characterized using transmission electronmicroscopy and rheometer. Lev@RAPA micelles loaded NapFFKK hydrogel provided sustained in vitro drug release without compromising their inherent pharmacological activities. Topical instillation of Lev@RAPA micelles loaded NapFFKK hydrogel resulted in the great ocular tolerance and extended precorneal retention over 60 min, thus significantly enhancing the ocular bioavailability of both Lev and RAPA. Overall, such dual-drug delivery system might be a promising formulation for the suppression of corneal graft failure.
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Affiliation(s)
- Xiaoning Xu
- National Engineering Research Center of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou 325027, China
| | - Yuqin Wu
- National Engineering Research Center of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou 325027, China
| | - Ruiling Gu
- National Engineering Research Center of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou 325027, China
| | - Zhaoliang Zhang
- National Engineering Research Center of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou 325027, China
| | - Xiangyi Liu
- National Engineering Research Center of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou 325027, China
| | - Yuhan Hu
- National Engineering Research Center of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou 325027, China
| | - Xingyi Li
- National Engineering Research Center of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou 325027, China.
| | - Deqing Lin
- National Engineering Research Center of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou 325027, China.
| | - Zhishu Bao
- National Clinical Research Center of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou 325027, China.
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13
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Meng T, Zheng J, Shin CS, Gao N, Bande D, Sudarjat H, Chow W, Halquist MS, Yu FS, Acharya G, Xu Q. Combination Nanomedicine Strategy for Preventing High-Risk Corneal Transplantation Rejection. ACS NANO 2024; 18:20679-20693. [PMID: 39074146 PMCID: PMC11308920 DOI: 10.1021/acsnano.4c06595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2024] [Revised: 07/10/2024] [Accepted: 07/18/2024] [Indexed: 07/31/2024]
Abstract
High-risk (HR) corneal transplantation presents a formidable challenge, with over 50% of grafts experiencing rejection despite intensive postoperative care involving frequent topical eyedrop administration up to every 2 h, gradually tapering over 6-12 months, and ongoing maintenance dosing. While clinical evidence underscores the potential benefits of inhibiting postoperative angiogenesis, effective antiangiogenesis therapy remains elusive in this context. Here, we engineered controlled-release nanomedicine formulations comprising immunosuppressants (nanoparticles) and antiangiogenesis drugs (nanowafer) and demonstrated that these formulations can prevent HR corneal transplantation rejection for at least 6 months in a clinically relevant rat model. Unlike untreated corneal grafts, which universally faced rejection within 2 weeks postsurgery, a single subconjunctival injection of the long-acting immunosuppressant nanoparticle alone effectively averted graft rejection for 6 months, achieving a graft survival rate of ∼70%. Notably, the combination of an immunosuppressant nanoparticle and an anti-VEGF nanowafer yielded significantly better efficacy with a graft survival rate of >85%. The significantly enhanced efficacy demonstrated that a combination nanomedicine strategy incorporating immunosuppressants and antiangiogenesis drugs can greatly enhance the ocular drug delivery and benefit the outcome of HR corneal transplantation with increased survival rate, ensuring patient compliance and mitigating dosing frequency and toxicity concerns.
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Affiliation(s)
- Tuo Meng
- Department
of Pharmaceutics, Virginia Commonwealth
University, Richmond, Virginia 23298, United States
| | - Jinhua Zheng
- Department
of Pharmaceutics, Virginia Commonwealth
University, Richmond, Virginia 23298, United States
- Department
of Ophthalmology, Affiliated Hospital of
Guizhou Medical University, Guiyang, Guizhou 550004, China
| | - Crystal S. Shin
- Michale
E. DeBakey Department of Surgery, Baylor
College of Medicine, Houston, Texas 77030, United States
| | - Nan Gao
- Departments
of Ophthalmology, Anatomy and Cell Biology, Wayne State University School of Medicine, Detroit, Michigan 48201, United States
| | - Divya Bande
- Department
of Pharmaceutics, Virginia Commonwealth
University, Richmond, Virginia 23298, United States
| | - Hadi Sudarjat
- Department
of Pharmaceutics, Virginia Commonwealth
University, Richmond, Virginia 23298, United States
| | - Woon Chow
- Department
of Ophthalmology, Virginia Commonwealth
University, Richmond, Virginia 23298, United States
- Department
of Pathology, Virginia Commonwealth University, Richmond, Virginia 23298, United States
| | - Matthew Sean Halquist
- Department
of Pharmaceutics, Virginia Commonwealth
University, Richmond, Virginia 23298, United States
| | - Fu-Shin Yu
- Departments
of Ophthalmology, Anatomy and Cell Biology, Wayne State University School of Medicine, Detroit, Michigan 48201, United States
| | - Ghanashyam Acharya
- Michale
E. DeBakey Department of Surgery, Baylor
College of Medicine, Houston, Texas 77030, United States
- Department
of Materials Science and Nanoengineering, Rice University, Houston, Texas 77005, United States
| | - Qingguo Xu
- Department
of Pharmaceutics, Virginia Commonwealth
University, Richmond, Virginia 23298, United States
- Department
of Ophthalmology, Virginia Commonwealth
University, Richmond, Virginia 23298, United States
- Center
for Pharmaceutical Engineering; Institute for Structural Biology,
Drug Discovery & Development (ISB3D); and Massey Cancer Center, Virginia Commonwealth University, Richmond, Virginia 23298, United States
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14
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Kilian R, Schmidinger G, Lammer J. The role of graft cross-linking during keratoplasty in patients with corneal melting. Sci Rep 2024; 14:16026. [PMID: 38992130 PMCID: PMC11239913 DOI: 10.1038/s41598-024-66629-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Accepted: 07/03/2024] [Indexed: 07/13/2024] Open
Abstract
The purpose of this study was to investigate the role of corneal crosslinking (CXL) of grafts during keratoplasty (KP) in patients with refractory corneal melting (CM). This is a retrospective case series reporting the clinical outcomes of patients who received a crosslinked corneal graft during penetrating or deep anterior lamellar KP for refractory infectious or sterile CMs. Outcome measures were the recurrence of CM, the time required for epithelial healing following KP, incidence of complications, and necessity for re-transplantation. Twenty eyes of 18 patients with a follow-up of 29.2 ± 15.8 months were included in this study. All but two eyes had undergone previous KPs during the course of their disease (mean 1.9 ± 1.6). After CXL-enhanced KP, three eyes (15%) experienced recurrence of CM, three eyes developed an infectious keratitis and six eyes (30%) required a re-transplantation (three of them within 12 months). The mean time to epithelium closure after CXL-enhanced KP was 63 ± 90 days. The number of postoperative re-transplantations was significantly lower than the number of KPs performed before the CXL-enhanced transplantation (before CXL 1.9 ± 1.6 vs after CXL: 0.3 ± 0.57, p = 0.002). To conclude, CXL of the graft at the time of keratoplasty decreased the need for re-transplantations. However, further studies are needed in order to establish its role in the management of severe CM necessitating therapeutic corneal transplantation.
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Affiliation(s)
- Raphael Kilian
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy
| | - Gerald Schmidinger
- Department of Ophthalmology and Optometry, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Jan Lammer
- Department of Ophthalmology and Optometry, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
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15
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Cruz GKP, Júnior MAF, Mota FM, Maidana GM, Zulin MEG, Frota OP, Santos VEP, Vitor AF. A Descriptive Study of Corneal Graft Failure in Retransplant Patients. Transplant Proc 2024; 56:1129-1133. [PMID: 38744590 DOI: 10.1016/j.transproceed.2024.04.018] [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: 11/28/2023] [Accepted: 04/21/2024] [Indexed: 05/16/2024]
Abstract
OBJECTIVE To identify the main predictors for corneal graft failure in patients who underwent retransplantation. METHOD This is a cross-sectional research with a quantitative and analytical approach, conducted based on data from secondary sources of a Human Eye Tissue Bank (HETB) in Northeast Brazil. Data were collected from the medical charts of all patients transplanted between January 2010 and December 2014. Descriptive statistics were used for the univariate analysis by means of absolute and relative frequencies and means. For the inferential analysis, the chi-square (X²) and the Fisher's Exact tests were used. RESULTS A total of 241 records were reviewed, representing 258 keratoplasties, of which 27 (10.46%) were retransplantations due to corneal graft failure. Of the total, 55.56% of the individuals were female, with a mean age of 58.56 years, 55.56% of the population was brown, and the highest relative frequency of housing found was in the Central Mesoregion. Of the corneal graft failure cases, 88.89% were due to late failure, 30.77% of cases were classified as pseudophakic and 11.57% as aphakic. Through inferential analysis, a statistical association was obtained among the variable "corneal graft failure" and mesoregion of the state, presence of glaucoma, vascularization, and classification of the eye. CONCLUSION The prognosis of keratoplasty is of multifactorial nature. Factors such as mesoregion of the State (place of residence), glaucoma, corneal vascularization, and aphakic eyes represent predictors for graft failure in the analyzed sample.
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Affiliation(s)
| | | | - Felipe Machado Mota
- Federal University of Mato Grosso do Sul, Campo Grande, Mato Grosso do Sul, Brazil.
| | | | | | - Oleci Pereira Frota
- Federal University of Mato Grosso do Sul, Campo Grande, Mato Grosso do Sul, Brazil
| | | | - Allyne Fortes Vitor
- Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
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16
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Lee HJ, Bae EH, Choi JM, Kim H, Kim HJ, Barreda H, Jung SY, Oh JY, Lee RH. Serum Extracellular Vesicle Protein Profiling for Prediction of Corneal Transplant Rejection. Transplantation 2024; 108:1368-1375. [PMID: 38409732 PMCID: PMC11136603 DOI: 10.1097/tp.0000000000004946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2024]
Abstract
BACKGROUND Corneal transplantation is the most common transplant procedure worldwide. Despite immune and angiogenic privilege of the cornea, 50% to 70% of corneal transplants fail in high-risk recipients, primarily because of immune rejection. Therefore, it is crucial to identify predictive biomarkers of rejection to improve transplant survival. METHODS In search for predictive biomarkers, we performed proteomics analysis of serum extracellular vesicles (EVs) in a fully major histocompatibility complex-mismatched (C57BL/6-to-BALB/c) murine corneal transplantation model, wherein 50% of transplants undergo rejection by day 28 following transplantation. RESULTS Our time course study revealed a decrease in the number of serum EVs on day 1, followed by a gradual increase by day 7. A comparative analysis of proteomics profiles of EVs from transplant recipients with rejection (rejectors) and without rejection (nonrejectors) found a distinct enrichment of histocompatibility 2, Q region locus 2, which is a part of major histocompatibility complex-class I of donor C57BL/6 mice, in day 7 EVs of rejectors, compared with nonrejectors, syngeneic controls, or naïve mice. In contrast, serum amyloid A2, a protein induced in response to injury, was increased in day 7 EVs of nonrejectors. CONCLUSIONS Our findings offer noninvasive EV-based potential biomarkers for predicting corneal allograft rejection or tolerance.
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Affiliation(s)
- Hyun Ju Lee
- Department of Ophthalmology, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul 03080, Korea
- Laboratory of Ocular Regenerative Medicine and Immunology, Biomedical Research Institute, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea
| | - Eun-Hye Bae
- Department of Cell Biology and Genetics, Institute for Regenerative Medicine, School of Medicine, Texas A&M University, 1114 TAMU, 206 Olsen Boulevard, College Station, Texas 77845, USA
| | - Jong Min Choi
- Department of Biochemistry, Baylor College of Medicine, Houston, TX 77030, USA
| | - Hyemee Kim
- Department of Cell Biology and Genetics, Institute for Regenerative Medicine, School of Medicine, Texas A&M University, 1114 TAMU, 206 Olsen Boulevard, College Station, Texas 77845, USA
| | - Hyeon Ji Kim
- Department of Ophthalmology, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul 03080, Korea
- Laboratory of Ocular Regenerative Medicine and Immunology, Biomedical Research Institute, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea
| | - Heather Barreda
- Department of Cell Biology and Genetics, Institute for Regenerative Medicine, School of Medicine, Texas A&M University, 1114 TAMU, 206 Olsen Boulevard, College Station, Texas 77845, USA
| | - Sung Yun Jung
- Department of Biochemistry, Baylor College of Medicine, Houston, TX 77030, USA
| | - Joo Youn Oh
- Department of Ophthalmology, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul 03080, Korea
- Laboratory of Ocular Regenerative Medicine and Immunology, Biomedical Research Institute, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea
| | - Ryang Hwa Lee
- Department of Cell Biology and Genetics, Institute for Regenerative Medicine, School of Medicine, Texas A&M University, 1114 TAMU, 206 Olsen Boulevard, College Station, Texas 77845, USA
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17
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Li S, Zhang P, Li A, Bao J, Pan Z, Jie Y. Rho-kinase inhibitor alleviates CD4 +T cell mediated corneal graft rejection by modulating its STAT3 and STAT5 activation. Exp Eye Res 2024; 242:109857. [PMID: 38479724 DOI: 10.1016/j.exer.2024.109857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 12/14/2023] [Accepted: 01/03/2024] [Indexed: 03/27/2024]
Abstract
Penetrating keratoplasty remains the most common treatment to restore vision for corneal diseases. Immune rejection after corneal transplantation is one of the major causes of graft failure. In recent years, Rho-associated protein kinase (ROCK) inhibitors have been found to be associated with the activation of the STATs pathway and are widely studied in autoimmune diseases. Therefore, it may be possible that the ROCK inhibitors also participate in the local and systemic immune regulation in corneal transplantation through activation of the STATs pathway and affect the CD4+ T cell differentiation. This study aimed to explore the role of ROCK-STATs pathway in the occurrence of immune rejection in corneal transplantation by applying Y27632, a ROCK inhibitor, to the recipient mice and peripheral CD4+ T cells. We found that Y27632 significantly up-regulated the phosphorylation level of STAT5 in both spleen and lymph nodes, down-regulated the phosphorylation level of STAT3 in the CD4+ T cells in the spleen. It also increased the proportion of CD4+CD25+Foxp3+Helios+ Tregs while decreased CD4+IL17A+ -Th17 cells. Moreover, Y27632 also reduced the proportion of dendritic cells in both spleen and lymph nodes, as well as the expression level of CD86 on their surfaces in the spleen, while the proportion of macrophages was not affected. The expression levels of ROCK1, ROCK2, CD11c and IL-17A mRNA were also found to be low in the graft tissue while the expression of Helios was upregulated. Rho-kinase inhibitor can modulate the balance of Tregs/Th17 by regulating the phosphorylation levels of both STAT3 and STAT5, thereby inhibiting the occurrence of immune rejection in allogeneic corneal transplantation.
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Affiliation(s)
- Shang Li
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Sciences Key Lab, Beijing, China
| | - Peng Zhang
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Sciences Key Lab, Beijing, China
| | - Ao Li
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Sciences Key Lab, Beijing, China
| | - Jiayu Bao
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Sciences Key Lab, Beijing, China
| | - Zhiqiang Pan
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Sciences Key Lab, Beijing, China
| | - Ying Jie
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Sciences Key Lab, Beijing, China.
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18
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Sun S, Jiang G, Dong J, Xie X, Liao J, Tian Y. Photothermal hydrogels for infection control and tissue regeneration. Front Bioeng Biotechnol 2024; 12:1389327. [PMID: 38605983 PMCID: PMC11007110 DOI: 10.3389/fbioe.2024.1389327] [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: 02/21/2024] [Accepted: 03/18/2024] [Indexed: 04/13/2024] Open
Abstract
In this review, we report investigating photothermal hydrogels, innovative biomedical materials designed for infection control and tissue regeneration. These hydrogels exhibit responsiveness to near-infrared (NIR) stimulation, altering their structure and properties, which is pivotal for medical applications. Photothermal hydrogels have emerged as a significant advancement in medical materials, harnessing photothermal agents (PTAs) to respond to NIR light. This responsiveness is crucial for controlling infections and promoting tissue healing. We discuss three construction methods for preparing photothermal hydrogels, emphasizing their design and synthesis, which incorporate PTAs to achieve the desired photothermal effects. The application of these hydrogels demonstrates enhanced infection control and tissue regeneration, supported by their unique photothermal properties. Although research progress in photothermal hydrogels is promising, challenges remain. We address these issues and explore future directions to enhance their therapeutic potential.
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Affiliation(s)
- Siyu Sun
- College of Biomass Science and Engineering, Sichuan University, Chengdu, China
| | - Guangyang Jiang
- College of Biomass Science and Engineering, Sichuan University, Chengdu, China
| | - Jianru Dong
- College of Biomass Science and Engineering, Sichuan University, Chengdu, China
| | - Xi Xie
- State Key Laboratory of Oral Diseases, National Clinical Research Centre for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Jinfeng Liao
- State Key Laboratory of Oral Diseases, National Clinical Research Centre for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Yongqiang Tian
- College of Biomass Science and Engineering, Sichuan University, Chengdu, China
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19
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Zhu H, Ye J, Wu Y, Cheng Y, Su M, Dai Q, Han Y, Pan J, Wu Z, Chen C, Qiu C, Li W, Liu G, Chu C. A Synergistic Therapy With Antioxidant and Anti-VEGF: Toward its Safe and Effective Elimination for Corneal Neovascularization. Adv Healthc Mater 2024; 13:e2302192. [PMID: 38018632 DOI: 10.1002/adhm.202302192] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Revised: 11/26/2023] [Indexed: 11/30/2023]
Abstract
Corneal neovascularization (CNV) is one of the leading causes of blindness in the world. In clinical practice; however, it remains a challenge to achieve a noninvasive and safe treatment. Herein, a biocompatible shell with excellent antioxidant and antivascularity is prepared by co-assembly of epigallocatechin gallate/gallic acid and Cu (II). After loading glucose oxidase (GOx) inside, the shell is modified with dimeric DPA-Zn for codelivering vascular endothelial growth factor (VEGF) small interfering RNA (VEGF-siRNA). Meanwhile, the Arg-Gly-Asp peptide (RGD) peptide-engineered cell membranes coating improves angiogenesis-targeting and is biocompatible for the multifunctional nanomedicine (CEGs/RGD). After eye drops administration, CEGs/RGD targets enrichment in neovascularization and CEGs NPs enter cells. Then, the inner GOx consumes glucose with a decrease in local pH, which in turn leads to the release of EGCE and VEGF-siRNA. As a result, the nanomedicines significantly reduce angiogenesis and inhibit CNV formation through synergistic effect of antioxidant and antivascular via down-regulation of cluster of differentiation 31 and VEGF. The nanomedicine represents a safe and efficient CNV treatment through the combined effect of antioxidant/gene, which provides important theoretical and clinical significance.
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Affiliation(s)
- Huimin Zhu
- Xiamen University Affiliated Xiamen Eye Center, Eye Institute of Xiamen University, School of Medicine, Xiamen University, Xiamen, 361102, China
| | - Jinfa Ye
- Xiamen University Affiliated Xiamen Eye Center, Eye Institute of Xiamen University, School of Medicine, Xiamen University, Xiamen, 361102, China
| | - Yiming Wu
- Xiamen University Affiliated Xiamen Eye Center, Eye Institute of Xiamen University, School of Medicine, Xiamen University, Xiamen, 361102, China
| | - Yuhang Cheng
- Xiamen University Affiliated Xiamen Eye Center, Eye Institute of Xiamen University, School of Medicine, Xiamen University, Xiamen, 361102, China
| | - Min Su
- Department of Pharmacy, Xiamen Medical College, Xiamen, 361023, China
| | - Qixuan Dai
- State Key Laboratory of Physical Chemistry of Solid Surfaces, The MOE Key Laboratory of Spectrochemical Analysis and Instrumentation, College of Chemistry and Chemical Engineering, Xiamen University, Xiamen, 361005, China
| | - Yun Han
- Xiamen University Affiliated Xiamen Eye Center, Eye Institute of Xiamen University, School of Medicine, Xiamen University, Xiamen, 361102, China
| | - Jintao Pan
- State Key Laboratory of Physical Chemistry of Solid Surfaces, The MOE Key Laboratory of Spectrochemical Analysis and Instrumentation, College of Chemistry and Chemical Engineering, Xiamen University, Xiamen, 361005, China
| | - Zhenyu Wu
- Department of Pharmacy, Xiamen Medical College, Xiamen, 361023, China
| | - Chuan Chen
- Department of Pharmacy, Xiamen Medical College, Xiamen, 361023, China
| | - Chenyue Qiu
- Xiamen University Affiliated Xiamen Eye Center, Eye Institute of Xiamen University, School of Medicine, Xiamen University, Xiamen, 361102, China
| | - Wei Li
- Xiamen University Affiliated Xiamen Eye Center, Eye Institute of Xiamen University, School of Medicine, Xiamen University, Xiamen, 361102, China
| | - Gang Liu
- State Key Laboratory of Physical Chemistry of Solid Surfaces, The MOE Key Laboratory of Spectrochemical Analysis and Instrumentation, College of Chemistry and Chemical Engineering, Xiamen University, Xiamen, 361005, China
- Shen Zhen Research Institute of Xiamen University, Xiamen University, Shenzhen, 518057, China
| | - Chengchao Chu
- Xiamen University Affiliated Xiamen Eye Center, Eye Institute of Xiamen University, School of Medicine, Xiamen University, Xiamen, 361102, China
- Shen Zhen Research Institute of Xiamen University, Xiamen University, Shenzhen, 518057, China
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Bernardes L, Gil J, Costa E, Tavares C, Rosa A, Quadrado MJ, Murta J. Topical tacrolimus in high-risk corneal transplants. Eur J Ophthalmol 2024; 34:140-145. [PMID: 37128645 DOI: 10.1177/11206721231172236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
PURPOSE The purpose of this study was to assess the use of topical tacrolimus ointment in preventing rejection in high-risk corneal grafts, when added to the standard immunosuppressive regimen. METHODS We conducted an observational, retrospective study using clinical data of high-risk patients subjected to penetrating keratoplasty, who were treated with topical tacrolimus ointment 0.2 mg/g twice a day plus topical dexamethasone 0.1 mg/ml 6 id and compared it with a similar control group treated with topical dexamethasone 0.1 mg/ml 6 id alone. High-risk status was attributed to patients with previous ipsilateral corneal graft failure, two or more quadrants with corneal neovascularization or an infectious or inflammatory corneal disease. RESULTS We analysed 53 patients in the trial group versus 53 patients in the control group, with similar age, baseline diagnosis and risk factors, and median follow-up times of 30 and and 24 months, respectively. Survival analysis showed a higher graft survival rate at all follow-up periods for patients treated with topical tacrolimus (p < 0.01). No adverse reactions were reported. DISCUSSION This study shows that topical tacrolimus ointment increases the survival rate of the graft if added to the previous topical steroid regimen in high-risk patients. CONCLUSION Topical tacrolimus is safe and effective in prolonging graft survival in high-risk patients.
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Affiliation(s)
- Luís Bernardes
- Centro Hospitalar e Universitário de Coimbra, EPE, Coimbra, Portugal
| | - João Gil
- Centro Hospitalar e Universitário de Coimbra, EPE, Coimbra, Portugal
| | - Esmeralda Costa
- Centro Hospitalar e Universitário de Coimbra, EPE, Coimbra, Portugal
| | - Cristina Tavares
- Centro Hospitalar e Universitário de Coimbra, EPE, Coimbra, Portugal
| | - Andreia Rosa
- Centro Hospitalar e Universitário de Coimbra, EPE, Coimbra, Portugal
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Maria João Quadrado
- Centro Hospitalar e Universitário de Coimbra, EPE, Coimbra, Portugal
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Joaquim Murta
- Centro Hospitalar e Universitário de Coimbra, EPE, Coimbra, Portugal
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal
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Xeroudaki M, Rafat M, Moustardas P, Mukwaya A, Tabe S, Bellisario M, Peebo B, Lagali N. A double-crosslinked nanocellulose-reinforced dexamethasone-loaded collagen hydrogel for corneal application and sustained anti-inflammatory activity. Acta Biomater 2023; 172:234-248. [PMID: 37866722 DOI: 10.1016/j.actbio.2023.10.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Revised: 09/29/2023] [Accepted: 10/17/2023] [Indexed: 10/24/2023]
Abstract
In cases of blinding disease or trauma, hydrogels have been proposed as scaffolds for corneal regeneration and vehicles for ocular drug delivery. Restoration of corneal transparency, augmenting a thin cornea and postoperative drug delivery are particularly challenging in resource-limited regions where drug availability and patient compliance may be suboptimal. Here, we report a bioengineered hydrogel based on porcine skin collagen as an alternative to human donor corneal tissue for applications where long-term stability of the hydrogel is required. The hydrogel is reinforced with cellulose nanofibers extracted from the Ciona intestinalis sea invertebrate followed by double chemical and photochemical crosslinking. The hydrogel is additionally loaded with dexamethasone to provide sustained anti-inflammatory activity. The reinforced double-crosslinked hydrogel after drug loading maintained high optical transparency with significantly improved mechanical characteristics compared to non-reinforced hydrogels, while supporting a gradual sustained drug release for 60 days in vitro. Dexamethasone, after exposure to crosslinking and sterilization procedures used in hydrogel production, inhibited tube formation and cell migration of TNFα-stimulated vascular endothelial cells. The drug-loaded hydrogels suppressed key pro-inflammatory cytokines CCL2 and CXCL5 in TNFα-stimulated human corneal epithelial cells. Eight weeks after intra-stromal implantation in the cornea of 12 New-Zealand white rabbits subjected to an inflammatory suture stimulus, the dexamethasone-releasing hydrogels suppressed TNFα, MMP-9, and leukocyte and fibroblast cell invasion, resulting in reduced corneal haze, sustained corneal thickness and stromal morphology, and reduced overall vessel invasion. This collagen-nanocellulose double-crosslinked hydrogel can be implanted to treat corneal stromal disease while suppressing inflammation and maintaining transparency after corneal transplantation. STATEMENT OF SIGNIFICANCE: To treat blinding diseases, hydrogel scaffolds have been proposed to facilitate corneal restoration and ocular drug delivery. Here, we improve on a clinically tested collagen-based scaffold to improve mechanical robustness and enzymatic resistance by incorporating sustainably sourced nanocellulose and dual chemical-photochemical crosslinking to reinforce the scaffold, while simultaneously achieving sustained release of an incorporated anti-inflammatory drug, dexamethasone. Evaluated in the context of a corneal disease model with inflammation, the drug-releasing nanocellulose-reinforced collagen scaffold maintained the cornea's transparency and resisted degradation while suppressing inflammation postoperatively. This biomaterial could therefore potentially be applied in a wider range of sight-threatening diseases, overcoming suboptimal administration of postoperative medications to maintain hydrogel integrity and good vision.
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Affiliation(s)
- Maria Xeroudaki
- Division of Ophthalmology, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Mehrdad Rafat
- NaturaLens AB, Linköping, Sweden; LinkoCare Life Sciences AB, Linköping, Sweden; Department of Biomedical Engineering, Linköping University, Linköping, Sweden
| | - Petros Moustardas
- Division of Ophthalmology, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Anthony Mukwaya
- Division of Ophthalmology, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Shideh Tabe
- NaturaLens AB, Linköping, Sweden; LinkoCare Life Sciences AB, Linköping, Sweden
| | - Marco Bellisario
- Division of Ophthalmology, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Beatrice Peebo
- Division of Ophthalmology, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden; Memira Eye Center Scandinavia, Solna, Sweden
| | - Neil Lagali
- Division of Ophthalmology, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden; Department of Ophthalmology, Sørlandet Hospital Arendal, Arendal, Norway.
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Sun J, Wang T, Bian J, Shi W, Ruan Q. Immune tolerance induced in the anterior chamber ameliorates corneal transplant rejection. Clin Immunol 2023; 257:109797. [PMID: 37776968 DOI: 10.1016/j.clim.2023.109797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 09/26/2023] [Indexed: 10/02/2023]
Abstract
The relevance of regulatory T cells (Tregs) in induction of tolerance against corneal allografts has been well established. However, whether Tregs can be induced in the anterior chamber and suppress local alloimmune response after corneal transplantation is largely unknown. In the current study we report that not only can alloantigen specific Tregs be generated in the anterior chamber during corneal transplantation, they also play important roles in suppressing allograft rejection. Allograft rejected mice exhibit reduced Treg induction in the anterior chamber and the ability of aqueous humor and corneal endothelial cells from allograft rejected mice to induce Tregs is compromised. Further analysis revealed that the expression of immune-tolerance-related molecules is significantly decreased. Finally, we demonstrate that increasing Treg cells specifically in the anterior chamber can effectively suppress allograft rejection and exhibits better efficacy in promoting corneal allograft survival than systemic administration of Treg cells. Our current study may provide new ideas for the prevention and treatment of corneal transplant rejection.
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Affiliation(s)
- Jijun Sun
- Eye Institute of Shandong First Medical University, Eye Hospital of Shandong First Medical University (Shandong Eye Hospital), Jinan 250021, China
| | - Ting Wang
- Eye Institute of Shandong First Medical University, Eye Hospital of Shandong First Medical University (Shandong Eye Hospital), Jinan 250021, China
| | - Jiang Bian
- Eye Institute of Shandong First Medical University, Qingdao Eye Hospital of Shandong First Medical University, Qingdao 266071, China
| | - Weiyun Shi
- Eye Institute of Shandong First Medical University, Eye Hospital of Shandong First Medical University (Shandong Eye Hospital), Jinan 250021, China; Eye Institute of Shandong First Medical University, State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Qingdao 266071, China.
| | - Qingguo Ruan
- Eye Institute of Shandong First Medical University, State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Qingdao 266071, China.
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Raiker R, Akosman S, Foos W, Pakhchanian H, Mishra S, Geist C, Belyea DA. Examining the Influence of COVID-19 Infection and Pandemic Restrictions on the Risk of Corneal Transplant Rejection or Failure: A Multicenter Study. Semin Ophthalmol 2023; 38:777-783. [PMID: 37427895 DOI: 10.1080/08820538.2023.2234495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 06/16/2023] [Accepted: 06/22/2023] [Indexed: 07/11/2023]
Abstract
PURPOSE The purpose of this study was to evaluate two aims. The first was whether patients with a history of keratoplasty who developed COVID-19 were at a higher risk of corneal graft rejection or failure. The second was examining whether patients who underwent a new keratoplasty during the first 2 years of the pandemic from 2020-2022 were at a higher risk of the same outcomes compared to those undergoing keratoplasty from 2017-2019 before the pandemic. METHODS A multicenter research network, TriNetX, was used to query for keratoplasty patients with or without a COVID-19 between January 2020 and July 2022. Additionally, the database was also queried to identify new keratoplasties performed from January 2020-July 2022 and compare it to keratoplasties performed during a similar pre-pandemic interval between 2017-2019. 1:1 Propensity Score Matching was utilized to adjust for confounders. Graft complication of either a rejection or failure was assessed within 120 day follow-up using the Cox proportional hazard model and survival analysis. RESULTS A total of 21,991 patients with any keratoplasty history were identified from January 2020-July 2022, of which 8.8% were diagnosed with COVID-19. Matching revealed two balanced cohorts of 1,927 patients where no significant difference in risk of corneal graft rejection or failure among groups ((aHR [95% CI] = 0.76 [0.43,1.34]; p = .244)). Comparing first-time keratoplasties performed in a pandemic period of January 2020-July 2022 to a corresponding pre-pandemic interval from 2017-2019 also similarly revealed no differences in graft rejection or failure in matched analysis (aHR = 0.937[0.75, 1.17], p = .339). CONCLUSIONS This study found no significant increase in the risk of graft rejection or failure in patients with a prior keratoplasty history following COVID-19 diagnosis nor in any patients who had a new keratoplasty done during 2020-2022 when compared to a similar pre-pandemic interval.
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Affiliation(s)
- Rahul Raiker
- Department of Ophthalmology and Visual Sciences, West Virginia University School of Medicine, Morgantown, WV, USA
| | - Sinan Akosman
- Department of Ophthalmology, George Washington University School of Medicine and Health Sciences, Washington, USA
| | - William Foos
- Department of Ophthalmology, George Washington University School of Medicine and Health Sciences, Washington, USA
| | - Haig Pakhchanian
- Department of Ophthalmology, George Washington University School of Medicine and Health Sciences, Washington, USA
| | - Shelly Mishra
- Department of Ophthalmology, George Washington University School of Medicine and Health Sciences, Washington, USA
| | - Craig Geist
- Department of Ophthalmology, George Washington University School of Medicine and Health Sciences, Washington, USA
| | - David A Belyea
- Department of Ophthalmology, George Washington University School of Medicine and Health Sciences, Washington, USA
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Zheng Q, Liu R, Jiang B, Sun J, Wang T, Ruan Q. NF-κB c-Rel Is a Potential Therapeutic Target for Acute Corneal Transplant Rejection. Invest Ophthalmol Vis Sci 2023; 64:16. [PMID: 37962530 PMCID: PMC10653260 DOI: 10.1167/iovs.64.14.16] [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: 08/27/2023] [Accepted: 10/21/2023] [Indexed: 11/15/2023] Open
Abstract
Purpose The purpose of this study was to determine the role of nuclear factor kappa B (NF-κB) c-Rel during acute corneal transplant rejection and whether targeting c-Rel can reduce corneal transplant rejection. Methods Allogeneic corneal transplantation was performed in wild-type and c-Rel-deficient mice. Corneal graft survival rate, opacity, neovascularization, and edema were evaluated by slit-lamp microscopy. Adeno-associated virus 6 (AAV6) expressing c-Rel-specific small hairpin RNA (AAV6-shRel) and the small-molecule compound pentoxifylline (PTXF) were used to reduce c-Rel expression. Enzyme-linked immunosorbent assay was used to determine the expression of inflammatory cytokines. c-Rel expression was determined by quantitative RT-PCR and western blot. The effect of c-Rel inhibition on corneal transplant rejection was examined using a mouse model of acute allogeneic corneal transplantation. Tear production and corneal sensitivity were measured to determine the potential toxicity of AAV6-shRel and PTXF. Results The expression of c-Rel and its inflammatory targets was increased in both mice and patients with corneal transplant rejection. Loss of c-Rel reduced corneal transplant rejection in mouse. Both AAV6-shRel and PTXF were able to downregulate the expression of c-Rel and its inflammatory targets in vitro. Treatment with AAV6-shRel or PTXF reduced corneal transplant rejection in mouse and downregulated the expression of inflammatory cytokines in peripheral blood mononuclear cells from patients with corneal transplant rejection. Treatment with AAV6-shRel or PTXF displayed no side effects on tear production or corneal sensitivity. Conclusions Increased expression of c-Rel is a risk factor for acute corneal transplant rejection, and targeting c-Rel can efficiently reduce corneal transplant rejection.
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Affiliation(s)
- Qian Zheng
- Eye Institute of Shandong First Medical University, State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Qingdao, China
- Eye Institute of Shandong First Medical University, Eye Hospital of Shandong First Medical University (Shandong Eye Hospital), Jinan, China
| | - Ruiling Liu
- Eye Institute of Shandong First Medical University, State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Qingdao, China
| | - Bian Jiang
- Eye Institute of Shandong First Medical University, Qingdao Eye Hospital of Shandong First Medical University, Qingdao, China
| | - Jijun Sun
- Eye Institute of Shandong First Medical University, Eye Hospital of Shandong First Medical University (Shandong Eye Hospital), Jinan, China
| | - Ting Wang
- Eye Institute of Shandong First Medical University, Eye Hospital of Shandong First Medical University (Shandong Eye Hospital), Jinan, China
| | - Qingguo Ruan
- Eye Institute of Shandong First Medical University, State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Qingdao, China
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Chameettachal S, Venuganti A, Parekh Y, Prasad D, Joshi VP, Vashishtha A, Basu S, Singh V, Bokara KK, Pati F. Human cornea-derived extracellular matrix hydrogel for prevention of post-traumatic corneal scarring: A translational approach. Acta Biomater 2023; 171:289-307. [PMID: 37683964 DOI: 10.1016/j.actbio.2023.09.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 08/24/2023] [Accepted: 09/01/2023] [Indexed: 09/10/2023]
Abstract
Corneal scarring and opacification are a significant cause of blindness affecting millions worldwide. The current standard of care for corneal blindness is corneal transplantation, which suffers from several drawbacks. One alternative approach that has shown promise is the use of xenogeneic corneal extracellular matrix (ECM), but its clinical applicability is challenging due to safety concerns. This study reports the innovative use of human cornea-derived ECM to prevent post-traumatic corneal scarring. About 30 - 40% of corneas donated to the eye banks do not meet the standards defined for clinical use and are generally discarded, although they are completely screened for their safety. In this study, human cornea-derived decellularized ECM hydrogel was prepared from the non-transplantation grade human cadaveric corneas obtained from an accredited eye-bank. The prepared hydrogel was screened for its efficacy against corneal opacification following an injury in an animal model. Our in vivo study revealed that, the control collagen-treated group developed corneal opacification, while the prophylactic application of human cornea-derived hydrogel effectively prevented corneal scarring and opacification. The human hydrogel-treated corneas were indistinguishable from healthy corneas and comparable to those treated with the xenogeneic bovine corneal hydrogel. We also demonstrated that the application of the hydrogel retained the biological milieu including cell behavior, protein components, optical properties, curvature, and nerve regeneration by remodeling the corneal wound after injury. The hydrogel application is also sutureless, resulting in faster corneal healing. We envision that this human cornea-derived ECM-based hydrogel has potential clinical application in preventing scarring from corneal wounding. STATEMENT OF SIGNIFICANCE: There are significant challenges surrounding corneal regeneration after injury due to extensive scarring. Although there is substantial research on corneal regeneration, much of it uses synthetic materials with chemical cross-linking methods or xenogeneic tissue-based material devices which have to undergo exhaustive safety analysis before clinical trials. Herein, we demonstrate the potential application of a human corneal extracellular matrix hydrogel without any additional materials for scarless corneal tissue regeneration, and a method to reduce the wasting of donated allogenic corneal tissue from eye banks. We found no difference in efficacy between the usage of human tissues compared to xenogeneic sources. This may help ease clinical translation and can be used topically without sutures as an outpatient procedure.
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Affiliation(s)
- Shibu Chameettachal
- Department of Biomedical Engineering, Indian Institute of Technology Hyderabad, Kandi, Sangareddy 502285, Telangana, India
| | - Animith Venuganti
- Centre for Ocular Regeneration, Prof. Brien Holden Eye Research Centre, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Yash Parekh
- CSIR-Center for Cellular and Molecular Biology, ANNEXE II, Medical Biotechnology Complex, Uppal Road, Hyderabad, Telangana, India
| | - Deeksha Prasad
- Centre for Ocular Regeneration, Prof. Brien Holden Eye Research Centre, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Vineet P Joshi
- Department of Biomedical Engineering, Indian Institute of Technology Hyderabad, Kandi, Sangareddy 502285, Telangana, India; Centre for Ocular Regeneration, Prof. Brien Holden Eye Research Centre, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Anviti Vashishtha
- CSIR-Center for Cellular and Molecular Biology, ANNEXE II, Medical Biotechnology Complex, Uppal Road, Hyderabad, Telangana, India
| | - Sayan Basu
- Centre for Ocular Regeneration, Prof. Brien Holden Eye Research Centre, L V Prasad Eye Institute, Hyderabad, Telangana, India.
| | - Vivek Singh
- Centre for Ocular Regeneration, Prof. Brien Holden Eye Research Centre, L V Prasad Eye Institute, Hyderabad, Telangana, India.
| | - Kiran Kumar Bokara
- CSIR-Center for Cellular and Molecular Biology, ANNEXE II, Medical Biotechnology Complex, Uppal Road, Hyderabad, Telangana, India.
| | - Falguni Pati
- Department of Biomedical Engineering, Indian Institute of Technology Hyderabad, Kandi, Sangareddy 502285, Telangana, India.
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Boychev N, De Arrigunaga S, Zhao Y, Ciolino JB. 2021 Survey of Keratoplasty Postoperative Steroid Management. Cornea 2023; 42:1268-1273. [PMID: 36633636 DOI: 10.1097/ico.0000000000003174] [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: 06/16/2022] [Accepted: 09/01/2022] [Indexed: 01/13/2023]
Abstract
PURPOSE The aim of the study is to investigate US-based ophthalmologists' preferred corneal transplant techniques and postoperative steroid regimen. METHODS Ophthalmologists attending the 2021 Cornea and Eye Banking Forum and/or Cornea Subspecialty Day were surveyed in person. RESULTS Ninety-two ophthalmologists with a median of 13 years (range of 1-35; mean of 14.5; ±9.05 mean ± SD) of experience as attending clinicians were surveyed. One hundred percent of the surgeons performed penetrating keratoplasty, which was followed by 96.7% for Descemet stripping endothelial keratoplasty, 90.2% for Descemet membrane endothelial keratoplasty, and 72.8% for deep anterior lamellar keratoplasty. Prednisolone 1% for postoperative care was the preferred choice across all surveyed keratoplasty techniques and postsurgery time intervals. All surgeons reported steroid administration frequency of 4 times a day in the first month and once a day after 12 months postkeratoplasty. To manage ocular hypertension after corneal transplantation, the leading approach was adding a glaucoma medication (44.6%), and beta-adrenergic antagonists were ranked as the most preferred choice by 59 (66.3%) of the respondents. For graft rejection after corneal transplantation, topical steroids (79.8%) were the initial treatment of choice with hourly administration being the most common frequency prescribed (87.4%). Most surgeons either agreed or strongly agreed (78.4%) that a randomized clinical trial evaluating the safety and efficacy of different steroid regimens after corneal transplantation would influence their clinical decision making. CONCLUSIONS Prednisolone remains the predominantly used steroid across different keratoplasties. Steroid regimens are similar for non-high-risk penetrating keratoplasty, Descemet membrane endothelial keratoplasty, Descemet stripping endothelial keratoplasty, and deep anterior lamellar keratoplasty. To treat graft rejection, surgeons tend to initially add a glaucoma medication than to reduce the potency or frequency of the steroid.
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Affiliation(s)
- Nikolay Boychev
- Harvard Medical School Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Schepens Eye Research Institute, Boston, MA
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27
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Wang X, Elbahrawi RT, Abdukadir AM, Ali ZM, Chan V, Corridon PR. A proposed model of xeno-keratoplasty using 3D printing and decellularization. Front Pharmacol 2023; 14:1193606. [PMID: 37799970 PMCID: PMC10548234 DOI: 10.3389/fphar.2023.1193606] [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: 03/25/2023] [Accepted: 09/06/2023] [Indexed: 10/07/2023] Open
Abstract
Corneal opacity is a leading cause of vision impairment and suffering worldwide. Transplantation can effectively restore vision and reduce chronic discomfort. However, there is a considerable shortage of viable corneal graft tissues. Tissue engineering may address this issue by advancing xeno-keratoplasty as a viable alternative to conventional keratoplasty. In particular, livestock decellularization strategies offer the potential to generate bioartificial ocular prosthetics in sufficient supply to match existing and projected needs. To this end, we have examined the best practices and characterizations that have supported the current state-of-the-art driving preclinical and clinical applications. Identifying the challenges that delimit activities to supplement the donor corneal pool derived from acellular scaffolds allowed us to hypothesize a model for keratoprosthesis applications derived from livestock combining 3D printing and decellularization.
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Affiliation(s)
- Xinyu Wang
- Biomedical Engineering and Healthcare Engineering Innovation Center, Khalifa University, Abu Dhabi, United Arab Emirates
- Department of Immunology and Physiology, College of Medicine and Health Sciences, Khalifa University, Abu Dhabi, United Arab Emirates
| | - Rawdah Taha Elbahrawi
- Department of Immunology and Physiology, College of Medicine and Health Sciences, Khalifa University, Abu Dhabi, United Arab Emirates
| | - Azhar Mohamud Abdukadir
- Department of Immunology and Physiology, College of Medicine and Health Sciences, Khalifa University, Abu Dhabi, United Arab Emirates
| | - Zehara Mohammed Ali
- Department of Immunology and Physiology, College of Medicine and Health Sciences, Khalifa University, Abu Dhabi, United Arab Emirates
| | - Vincent Chan
- Biomedical Engineering and Healthcare Engineering Innovation Center, Khalifa University, Abu Dhabi, United Arab Emirates
| | - Peter R. Corridon
- Biomedical Engineering and Healthcare Engineering Innovation Center, Khalifa University, Abu Dhabi, United Arab Emirates
- Department of Immunology and Physiology, College of Medicine and Health Sciences, Khalifa University, Abu Dhabi, United Arab Emirates
- Center for Biotechnology, Khalifa University, Abu Dhabi, United Arab Emirates
- Hleathcare, Engineering and Innovation Center, Khalifa University, Abu Dhabi, United Arab Emirates
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Mandal S, Maharana PK, Kaweri L, Asif MI, Nagpal R, Sharma N. Management and prevention of corneal graft rejection. Indian J Ophthalmol 2023; 71:3149-3159. [PMID: 37602601 PMCID: PMC10565940 DOI: 10.4103/ijo.ijo_228_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 03/03/2023] [Accepted: 04/04/2023] [Indexed: 08/22/2023] Open
Abstract
The management of an episode of corneal graft rejection (CGR) is primarily by corticosteroids. Immunomodulators are useful for long-term immunosuppression and in dealing with cases of high-risk (HR) corneal grafts. The classical signs of CGR following penetrating keratoplasty (PKP) include rejection line, anterior chamber (AC) reaction, and graft edema. However, these signs may be absent or subtle in cases of endothelial keratoplasty (EK). Prevention of an episode of graft rejection is of utmost importance as it can reduce the need for donor cornea significantly. In our previous article (IJO_2866_22), we had discussed about the immunopathogenesis of CGR. In this review article, we aim to discuss the various clinical aspects and management of CGR.
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Affiliation(s)
- Sohini Mandal
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Prafulla K Maharana
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Luci Kaweri
- Consultant, Narayana Nethralaya, Bengaluru, Karnataka, India
| | | | - Ritu Nagpal
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Namrata Sharma
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
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Roberts PK, Keane M, Yang G, Chan E, Harkin DG, McKirdy N, Daniell M. Comparison of penetrating and endothelial keratoplasty in patients with iridocorneal endothelial syndrome: A registry study. Clin Exp Ophthalmol 2023; 51:663-672. [PMID: 37608637 DOI: 10.1111/ceo.14283] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 06/27/2023] [Accepted: 07/16/2023] [Indexed: 08/24/2023]
Abstract
BACKGROUND To compare graft survival of endothelial keratoplasty (EK) versus penetrating keratoplasty (PK) in patients with iridocorneal endothelial (ICE) syndrome and identify ocular features associated with graft survival. METHODS Observational, prospective, cohort study. A total of 30 806 first grafts performed between 1985 and 2020 were identified through the Australian Corneal Graft Registry and included in this observational, prospective cohort study. A total of 196 eyes underwent a primary corneal graft for ICE syndrome. Kaplan-Meier graft survival plots and Chi-squared tests were performed to identify graft survival rates for EK and PK. A history of raised intraocular pressure (IOP) was also recorded and analysed. Graft survival of eyes with ICE syndrome were compared to that of other indications. RESULTS Grafts performed for ICE syndrome increased to 0.8% of all cases during the 2005 to 2020 period compared with 0.5% between 1985 to 2004 (χ2 =9.35, p = 0.002). From 2010, EK surpassed PK as the preferred graft type. Survival of primary grafts in eyes with ICE syndrome was lower than for other indications (log-rank = 56.62, p < 0.001). Graft survival was higher following PK than Descemet stripping (automated) endothelial keratoplasty (DS(A)EK) (log-rank = 10.56, p = 0.001). Graft survival was higher in eyes without a history of raised IOP compared to those with a reported history of raised IOP (log-rank = 13.06, p < 0.001). CONCLUSIONS ICE syndrome carries a poor prognosis for graft survival. DS(A)EK had a poorer prognosis than PK. A history of raised IOP is associated with higher risk of graft failure.
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Affiliation(s)
- Philipp K Roberts
- Corneal Unit, Department of Ophthalmology, Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia
- Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
| | - Miriam Keane
- Australian Corneal Graft Registry, Department of Ophthalmology, Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Gink Yang
- Centre for Eye Research Australia, University of Melbourne, Melbourne, Victoria, Australia
| | - Elsie Chan
- Corneal Unit, Department of Ophthalmology, Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia
- Centre for Eye Research Australia, University of Melbourne, Melbourne, Victoria, Australia
| | - Damien G Harkin
- School of Biomedical Sciences, Centre for Vision and Eye Research, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Natalie McKirdy
- School of Biomedical Sciences, Centre for Vision and Eye Research, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Mark Daniell
- Corneal Unit, Department of Ophthalmology, Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia
- Centre for Eye Research Australia, University of Melbourne, Melbourne, Victoria, Australia
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Sakowska J, Glasner P, Dukat-Mazurek A, Rydz A, Zieliński M, Pellowska I, Biernat W, Glasner L, Michalska-Małecka K, Trzonkowski P. Local T cell infiltrates are predominantly associated with corneal allograft rejection. Transpl Immunol 2023; 79:101852. [PMID: 37196866 DOI: 10.1016/j.trim.2023.101852] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 05/11/2023] [Accepted: 05/13/2023] [Indexed: 05/19/2023]
Abstract
BACKGROUND Corneal transplantations (CTXs) are a vision-saving procedure. Routinely, while CTXs' survival rates remain high, the risk of graft failure increases significantly for repeated CTXs. The reason is an alloimmunization following previous CTXs and development of memory T (Tm) and B (Bm) cells. METHODS We characterized populations of cells present in explanted human corneas from patients receiving the first CTX and marked as a primary CTX (PCTX) or the second or more CTXs and marked as a repeated CTX (RCTX). Cells extracted from resected corneas and from peripheral blood mononuclear cells (PBMCs) were analyzed by the flow cytometry method using multiple surface and intracellular markers. RESULTS Overall, the number of cells was similar in PCTX and RCTX patients. Extracted infiltrates from PCTXs and RCTXs contained similar numbers of T cell subsets, namely CD4+, CD8+, CD4+ Tm, CD8+ Tm, CD4+Foxp3+ T regulatory (Tregs), CD8+ Treg cells, while very few B cells (all p = NS). However, when compared to peripheral blood, PCTX and RCTX corneas contained significantly higher percentages of effector memory CD4+ and CD8+ T cells (both p < 0,05). In comparison to PCTX, RCTX group had the highest levels of Foxp3 in T CD4+ Tregs (p = 0,04) but decreased percentage of Helios-positive CD4+ Tregs. CONCLUSION PCTXs and especially RCTXs are rejected mainly by local T cells. The accumulation of effector CD4+ and CD8+ T cells, as well as CD4+ and CD8+ Tm cells is associated with the final rejection. Furthermore, local CD4+ and CD8+ Tregs expressing Foxp3 and Helios are probably insufficient to impose the acceptance of CTX.
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Affiliation(s)
- Justyna Sakowska
- Department of Medical Immunology, Medical University of Gdańsk, Dębinki Street 7, Building 27, Gdańsk, Poland.
| | - Paulina Glasner
- Department of Ophthalmology, Medical University of Gdańsk, Smoluchowskiego Street 17, Gdańsk, Poland
| | - Anna Dukat-Mazurek
- Department of Medical Immunology, Medical University of Gdańsk, Dębinki Street 7, Building 27, Gdańsk, Poland
| | - Anna Rydz
- Department of Ophthalmology, Medical University of Gdańsk, Smoluchowskiego Street 17, Gdańsk, Poland
| | - Maciej Zieliński
- Department of Medical Immunology, Medical University of Gdańsk, Dębinki Street 7, Building 27, Gdańsk, Poland
| | - Irena Pellowska
- Department of Clinical Pathomorphology, University Clinical Centre in Gdańsk, Smoluchowskiego Street 17, Gdańsk, Poland
| | - Wojciech Biernat
- Department of Pathomorphology, Medical University of Gdańsk, Smoluchowskiego Street 17, Gdańsk, Poland
| | - Leopold Glasner
- Department of Ophthalmology, Medical University of Gdańsk, Smoluchowskiego Street 17, Gdańsk, Poland
| | | | - Piotr Trzonkowski
- Department of Medical Immunology, Medical University of Gdańsk, Dębinki Street 7, Building 27, Gdańsk, Poland
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Malhotra K, Buznyk O, Islam MM, Edin E, Basu S, Groleau M, Dégué DS, Fagerholm P, Fois A, Lesage S, Jangamreddy JR, Šimoliūnas E, Liszka A, Patra HK, Griffith M. Phosphorylcholine and KR12-Containing Corneal Implants in HSV-1-Infected Rabbit Corneas. Pharmaceutics 2023; 15:1658. [PMID: 37376106 DOI: 10.3390/pharmaceutics15061658] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 05/29/2023] [Accepted: 05/29/2023] [Indexed: 06/29/2023] Open
Abstract
Severe HSV-1 infection can cause blindness due to tissue damage from severe inflammation. Due to the high risk of graft failure in HSV-1-infected individuals, cornea transplantation to restore vision is often contraindicated. We tested the capacity for cell-free biosynthetic implants made from recombinant human collagen type III and 2-methacryloyloxyethyl phosphorylcholine (RHCIII-MPC) to suppress inflammation and promote tissue regeneration in the damaged corneas. To block viral reactivation, we incorporated silica dioxide nanoparticles releasing KR12, the small bioactive core fragment of LL37, an innate cationic host defense peptide produced by corneal cells. KR12 is more reactive and smaller than LL37, so more KR12 molecules can be incorporated into nanoparticles for delivery. Unlike LL37, which was cytotoxic, KR12 was cell-friendly and showed little cytotoxicity at doses that blocked HSV-1 activity in vitro, instead enabling rapid wound closure in cultures of human epithelial cells. Composite implants released KR12 for up to 3 weeks in vitro. The implant was also tested in vivo on HSV-1-infected rabbit corneas where it was grafted by anterior lamellar keratoplasty. Adding KR12 to RHCIII-MPC did not reduce HSV-1 viral loads or the inflammation resulting in neovascularization. Nevertheless, the composite implants reduced viral spread sufficiently to allow stable corneal epithelium, stroma, and nerve regeneration over a 6-month observation period.
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Affiliation(s)
- Kamal Malhotra
- Department of Ophthalmology, Université de Montréal, Montreal, QC H3C 3J7, Canada
- Maisonneuve-Rosemont Hospital Research Centre, Montreal, QC H1T 2M4, Canada
| | - Oleksiy Buznyk
- Department of Clinical and Experimental Medicine, Linköping University, 58183 Linköping, Sweden
- Filatov Institute of Eye Diseases and Tissue Therapy of the NAMS of Ukraine, 65061 Odessa, Ukraine
| | - Mohammad Mirazul Islam
- Department of Clinical and Experimental Medicine, Linköping University, 58183 Linköping, Sweden
| | - Elle Edin
- Department of Ophthalmology, Université de Montréal, Montreal, QC H3C 3J7, Canada
- Maisonneuve-Rosemont Hospital Research Centre, Montreal, QC H1T 2M4, Canada
- Department of Clinical and Experimental Medicine, Linköping University, 58183 Linköping, Sweden
- Institute of Biomedical Engineering, Université de Montréal, Montreal, QC H3T 1J4, Canada
| | - Sankar Basu
- Department of Microbiology, Asutosh College, Affiliated with University of Calcutta, Kolkata 700026, India
| | - Marc Groleau
- Department of Ophthalmology, Université de Montréal, Montreal, QC H3C 3J7, Canada
- Maisonneuve-Rosemont Hospital Research Centre, Montreal, QC H1T 2M4, Canada
- Département de Microbiologie, Infectiologie et Immunologie, Université de Montréal, Montreal, QC H3T 1J4, Canada
| | - Delali Shana Dégué
- Department of Ophthalmology, Université de Montréal, Montreal, QC H3C 3J7, Canada
- Maisonneuve-Rosemont Hospital Research Centre, Montreal, QC H1T 2M4, Canada
- Institute of Biomedical Engineering, Université de Montréal, Montreal, QC H3T 1J4, Canada
| | - Per Fagerholm
- Department of Clinical and Experimental Medicine, Linköping University, 58183 Linköping, Sweden
| | - Adrien Fois
- Maisonneuve-Rosemont Hospital Research Centre, Montreal, QC H1T 2M4, Canada
- Département de Microbiologie, Infectiologie et Immunologie, Université de Montréal, Montreal, QC H3T 1J4, Canada
| | - Sylvie Lesage
- Maisonneuve-Rosemont Hospital Research Centre, Montreal, QC H1T 2M4, Canada
- Département de Microbiologie, Infectiologie et Immunologie, Université de Montréal, Montreal, QC H3T 1J4, Canada
| | | | - Egidijus Šimoliūnas
- Department of Biological Models, Institute of Biochemistry, Life Sciences Center, Vilnius University, 01513 Vilnius, Lithuania
| | - Aneta Liszka
- Department of Clinical and Experimental Medicine, Linköping University, 58183 Linköping, Sweden
| | - Hirak K Patra
- Department of Clinical and Experimental Medicine, Linköping University, 58183 Linköping, Sweden
- Department of Surgical Biotechnology, UCL Division of Surgery and Interventional Science, University College London, London WC1E 6BT, UK
| | - May Griffith
- Department of Ophthalmology, Université de Montréal, Montreal, QC H3C 3J7, Canada
- Maisonneuve-Rosemont Hospital Research Centre, Montreal, QC H1T 2M4, Canada
- Department of Clinical and Experimental Medicine, Linköping University, 58183 Linköping, Sweden
- Institute of Biomedical Engineering, Université de Montréal, Montreal, QC H3T 1J4, Canada
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32
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Lee JY, Knight RJ, Deng SX. Future regenerative therapies for corneal disease. Curr Opin Ophthalmol 2023; 34:267-272. [PMID: 36602407 DOI: 10.1097/icu.0000000000000938] [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: 01/06/2023]
Abstract
PURPOSE OF REVIEW To highlight the progress and future direction of stem-cell based regenerative therapies for the treatment of corneal disease. RECENT FINDINGS Corneal stem cell-based therapies, such as limbal stem cell transplantation, corneal stromal stem cell transplantation, endothelial stem cell transplantation, and stem cell-derived extracellular vesicles have demonstrated promising results in the laboratory. Although most are still in preclinical development or early phase clinical trials, these stem cell-based therapies hold potential to facilitate tissue regeneration, restore native function, and inhibit pathologic disease processes such as fibrosis, inflammation, and neovascularization. SUMMARY Stem cell-based therapy offers a promising therapeutic option that can circumvent several of the challenges and limitations of traditional surgical treatment. This concise review summarizes the progress in stem-cell based therapies for corneal diseases along with their history, underlying mechanisms, limitations, and future areas for development.
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Affiliation(s)
- John Y Lee
- Stein Eye Institute, Department of Ophthalmology, David Geffen School of Medicine
| | - Robert J Knight
- Stein Eye Institute, Department of Ophthalmology, David Geffen School of Medicine
| | - Sophie X Deng
- Stein Eye Institute, Department of Ophthalmology, David Geffen School of Medicine
- Molecular Biology Institute, University of California, Los Angeles, California, USA
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33
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Dutta A, Panigrahi SP, Mohamed A, Das S. Lost-to-follow-up: A study on corneal transplantation from Eastern India. Indian J Ophthalmol 2023; 71:1877-1881. [PMID: 37203048 PMCID: PMC10391456 DOI: 10.4103/ijo.ijo_3136_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2023] Open
Abstract
Purpose This study aims to analyze the pattern of follow-ups and the reasons for follow-up loss in keratoplasty cases in a tertiary eye care center. Methods This is a single-center retrospective cross-sectional study. During the study period, 165 eyes underwent corneal transplantation. The data on the demographic features of the recipients and the indications of keratoplasty, including visual acuity before and after surgery, duration of follow-up, and the condition of the graft at the last follow-up, were collected. The primary outcome was to determine the factors causing lost-to-follow-up (LTFU) among graft recipients. LTFU was defined when a patient failed to adhere to any of the following seven follow-up visits since the surgery: 4 ± 2 weeks, 3 ± 1 months, 6 ± 1 months, 12 ± 2 months, 18 ± 2 months, 24 ± 3 months, and 36 ± 6 months. The secondary outcome was to analyze the best-corrected visual acuity (BCVA) among patients available for the final follow-up. Results The recipient follow-up rates at 6, 12, 18, 24, and 36 months were 68.5%, 57.6%, 47.9%, 42.4%, and 35.2%, respectively. Old age and distance to the center were significant factors for lost-to-follow-up. A failed graft as an indication for transplantation and those undergoing penetrating keratoplasty for optical purposes were significant factors for completing follow-up. Conclusion The inability to follow-up after corneal transplantation is a common challenge. Elderly patients and those living in remote areas must be prioritized for follow-ups.
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Affiliation(s)
- Anirban Dutta
- Cornea and Anterior Segment Service, L. V. Prasad Eye Institute, Bhubaneswar, Odisha, India
| | | | - Ashik Mohamed
- Ophthalmic Biophysics Department, L. V. Prasad Eye Institute, Hyderabad, Telangana, India
| | - Sujata Das
- Cornea and Anterior Segment Service, L. V. Prasad Eye Institute, Bhubaneswar, Odisha, India
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34
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Abraham AR, Maghsoudlou P, Copland DA, Nicholson LB, Dick AD. CAR-Treg cell therapies and their future potential in treating ocular autoimmune conditions. FRONTIERS IN OPHTHALMOLOGY 2023; 3:1184937. [PMID: 38983082 PMCID: PMC11182176 DOI: 10.3389/fopht.2023.1184937] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Accepted: 04/03/2023] [Indexed: 07/11/2024]
Abstract
Ophthalmic autoimmune and autoinflammatory conditions cause significant visual morbidity and require complex medical treatment complicated by significant side effects and lack of specificity. Regulatory T cells (Tregs) have key roles in immune homeostasis and in the resolution of immune responses. Polyclonal Treg therapy has shown efficacy in treating autoimmune disease. Genetic engineering approaches to produce antigen-specific Treg therapy has the potential for enhanced treatment responses and fewer systemic side effects. Cell therapy using chimeric antigen receptor modified T cell (CAR-T) therapy, has had significant success in treating haematological malignancies. By modifying Tregs specifically, a CAR-Treg approach has been efficacious in preclinical models of autoimmune conditions leading to current phase 1-2 clinical trials. This review summarises CAR structure and design, Treg cellular biology, developments in CAR-Treg therapies, and discusses future strategies to apply CAR-Treg therapy in the treatment of ophthalmic conditions.
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Affiliation(s)
- Alan R. Abraham
- Ophthalmology Research Group, Academic Unit of Ophthalmology, Translational Health Sciences, University of Bristol, Bristol, United Kingdom
| | - Panayiotis Maghsoudlou
- Ophthalmology Research Group, Academic Unit of Ophthalmology, Translational Health Sciences, University of Bristol, Bristol, United Kingdom
- University of Bath, Bath, United Kingdom
| | - David A. Copland
- Ophthalmology Research Group, Academic Unit of Ophthalmology, Translational Health Sciences, University of Bristol, Bristol, United Kingdom
| | - Lindsay B. Nicholson
- Ophthalmology Research Group, Academic Unit of Ophthalmology, Translational Health Sciences, University of Bristol, Bristol, United Kingdom
| | - Andrew D. Dick
- Ophthalmology Research Group, Academic Unit of Ophthalmology, Translational Health Sciences, University of Bristol, Bristol, United Kingdom
- UCL-Institute of Ophthalmology, University College London, London, United Kingdom
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35
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Akoto T, Cai J, Nicholas S, McCord H, Estes AJ, Xu H, Karamichos D, Liu Y. Unravelling the Impact of Cyclic Mechanical Stretch in Keratoconus-A Transcriptomic Profiling Study. Int J Mol Sci 2023; 24:7437. [PMID: 37108600 PMCID: PMC10139219 DOI: 10.3390/ijms24087437] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 04/04/2023] [Accepted: 04/16/2023] [Indexed: 04/29/2023] Open
Abstract
Biomechanical and molecular stresses may contribute to the pathogenesis of keratoconus (KC). We aimed to profile the transcriptomic changes in healthy primary human corneal (HCF) and KC-derived cells (HKC) combined with TGFβ1 treatment and cyclic mechanical stretch (CMS), mimicking the pathophysiological condition in KC. HCFs (n = 4) and HKCs (n = 4) were cultured in flexible-bottom collagen-coated 6-well plates treated with 0, 5, and 10 ng/mL of TGFβ1 with or without 15% CMS (1 cycle/s, 24 h) using a computer-controlled Flexcell FX-6000T Tension system. We used stranded total RNA-Seq to profile expression changes in 48 HCF/HKC samples (100 bp PE, 70-90 million reads per sample), followed by bioinformatics analysis using an established pipeline with Partek Flow software. A multi-factor ANOVA model, including KC, TGFβ1 treatment, and CMS, was used to identify differentially expressed genes (DEGs, |fold change| ≥ 1.5, FDR ≤ 0.1, CPM ≥ 10 in ≥1 sample) in HKCs (n = 24) vs. HCFs (n = 24) and those responsive to TGFβ1 and/or CMS. PANTHER classification system and the DAVID bioinformatics resources were used to identify significantly enriched pathways (FDR ≤ 0.05). Using multi-factorial ANOVA analyses, 479 DEGs were identified in HKCs vs. HCFs including TGFβ1 treatment and CMS as cofactors. Among these DEGs, 199 KC-altered genes were responsive to TGFβ1, thirteen were responsive to CMS, and six were responsive to TGFβ1 and CMS. Pathway analyses using PANTHER and DAVID indicated the enrichment of genes involved in numerous KC-relevant functions, including but not limited to degradation of extracellular matrix, inflammatory response, apoptotic processes, WNT signaling, collagen fibril organization, and cytoskeletal structure organization. TGFβ1-responsive KC DEGs were also enriched in these. CMS-responsive KC-altered genes such as OBSCN, CLU, HDAC5, AK4, ITGA10, and F2RL1 were identified. Some KC-altered genes, such as CLU and F2RL1, were identified to be responsive to both TGFβ1 and CMS. For the first time, our multi-factorial RNA-Seq study has identified many KC-relevant genes and pathways in HKCs with TGFβ1 treatment under CMS, suggesting a potential role of TGFβ1 and biomechanical stretch in KC development.
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Affiliation(s)
- Theresa Akoto
- Department of Cellular Biology & Anatomy, Medical College of Georgia, Augusta University, Augusta, GA 30912, USA
| | - Jingwen Cai
- Department of Cellular Biology & Anatomy, Medical College of Georgia, Augusta University, Augusta, GA 30912, USA
| | - Sarah Nicholas
- North Texas Eye Research Institute, University of North Texas Health Science Center, Fort Worth, TX 76107, USA
- Department of Pharmaceutical Sciences, University of North Texas Health Science Center, Fort Worth, TX 76107, USA
| | - Hayden McCord
- Department of Cellular Biology & Anatomy, Medical College of Georgia, Augusta University, Augusta, GA 30912, USA
| | - Amy J. Estes
- Department of Ophthalmology, Augusta University, Augusta, GA 30912, USA
- James & Jean Culver Vision Discovery Institute, Medical College of Georgia, Augusta University, Augusta, GA 30912, USA
| | - Hongyan Xu
- Department of Population Health Sciences, Medical College of Georgia, Augusta University, Augusta, GA 30912, USA
| | - Dimitrios Karamichos
- North Texas Eye Research Institute, University of North Texas Health Science Center, Fort Worth, TX 76107, USA
- Department of Pharmaceutical Sciences, University of North Texas Health Science Center, Fort Worth, TX 76107, USA
- Department of Pharmacology and Neuroscience, University of North Texas Health Science Center, Fort Worth, TX 76107, USA
| | - Yutao Liu
- Department of Cellular Biology & Anatomy, Medical College of Georgia, Augusta University, Augusta, GA 30912, USA
- James & Jean Culver Vision Discovery Institute, Medical College of Georgia, Augusta University, Augusta, GA 30912, USA
- Center for Biotechnology and Genomic Medicine, Medical College of Georgia, Augusta University, Augusta, GA 30912, USA
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He Y, Ma BS, Zeng JH, Ma DJ. Corneal optical density: Structural basis, measurements, influencing factors, and roles in refractive surgery. Front Bioeng Biotechnol 2023; 11:1144455. [PMID: 37091331 PMCID: PMC10117965 DOI: 10.3389/fbioe.2023.1144455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Accepted: 03/29/2023] [Indexed: 04/08/2023] Open
Abstract
The cornea is the main refractive medium of the human eye, and its clarity is critical to visual acuity. Corneal optical density (COD) is an important index to describe corneal transparency. Intact corneal epithelial and endothelial cells, regular arrangement of collagen fibers in the stroma, and normal substance metabolism are all integral for the cornea to maintain its transparency. In the last two decades, the Pentacam Scheimpflug imaging system has emerged as a breakthrough for the measurement of COD (also called corneal densitometry). It has been found that a wide variety of factors such as age, refractive status, and corneal diseases can affect COD. Different corneal refractive surgery methods also change COD in different corneal regions and layers and affect visual acuity following the surgery. Thus, COD has gradually become a significant indicator to evaluate corneal health, one on which the attention of clinicians has been increasingly focused.
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Affiliation(s)
- Ye He
- Changsha Aier Eye Hospital, Changsha, China
| | - Bo-Sheng Ma
- Department of Ophthalmology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Jun-Hao Zeng
- Xiangya School of Medicine, Central South University, Changsha, China
| | - Dai-Jin Ma
- Changsha Aier Eye Hospital, Changsha, China
- *Correspondence: Dai-Jin Ma,
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Dong Q, Qi B, Zhang B, Zhuang X, Chen S, Zhou Q, Zhang BN, Li S. Overactivation of Norepinephrine-β2-Adrenergic Receptor Axis Promotes Corneal Neovascularization. Invest Ophthalmol Vis Sci 2023; 64:20. [PMID: 36897151 PMCID: PMC10010442 DOI: 10.1167/iovs.64.3.20] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/11/2023] Open
Abstract
Purpose To investigate the role of the sympathetic nervous system in corneal neovascularization (CNV) and to identify the downstream pathway involved in this regulation. Methods Three types of CNV models were constructed with C57BL/6J mice, including the alkali burn model, suture model, and basic fibroblast growth factor (bFGF) corneal micropocket model. Subconjunctival injection of the sympathetic neurotransmitter norepinephrine (NE) was administered in these three models. Control mice received injections of water of the same volume. The corneal CNV was detected using slit-lamp microscopy and immunostaining with CD31, and the results were quantified by ImageJ. The expression of β2-adrenergic receptor (β2-AR) was stained with mouse corneas and human umbilical vein endothelial cells (HUVECs). Furthermore, the anti-CNV effects of β2-AR antagonist ICI-118,551 (ICI) were examined with HUVEC tube formation assay and with a bFGF micropocket model. Additionally, partial β2-AR knockdown mice (Adrb2+/-) were used to establish the bFGF micropocket model, and the corneal CNV size was quantified based on the slit-lamp images and vessel staining. Results Sympathetic nerves invaded the cornea in the suture CNV model. The NE receptor β2-AR was highly expressed in corneal epithelium and blood vessels. The addition of NE significantly promoted corneal angiogenesis, whereas ICI effectively inhibited CNV invasion and HUVEC tube formation. Adrb2 knockdown significantly reduced the cornea area occupied by CNV. Conclusions Our study found that sympathetic nerves grow into the cornea in conjunction with newly formed vessels. The addition of the sympathetic neurotransmitter NE and activation of its downstream receptor β2-AR promoted CNV. Targeting β2-AR could potentially be used as an anti-CNV strategy.
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Affiliation(s)
- Qiaoqiao Dong
- Eye Institute of Shandong First Medical University, Eye Hospital of Shandong First Medical University (Shandong Eye Hospital), Jinan, China.,School of Ophthalmology, Shandong First Medical University, Qingdao, China.,Aier Eye Hospital of Wuhan University (Wuhan Aier Eye Hospital), Wuhan, China
| | - Benxiang Qi
- School of Ophthalmology, Shandong First Medical University, Qingdao, China.,Eye Institute of Shandong First Medical University, Qingdao Eye Hospital of Shandong First Medical University, Qingdao, China.,State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Qingdao, China
| | - Bin Zhang
- School of Ophthalmology, Shandong First Medical University, Qingdao, China.,Eye Institute of Shandong First Medical University, Qingdao Eye Hospital of Shandong First Medical University, Qingdao, China.,State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Qingdao, China
| | - Xiaoyun Zhuang
- Eye Institute of Shandong First Medical University, Eye Hospital of Shandong First Medical University (Shandong Eye Hospital), Jinan, China.,School of Ophthalmology, Shandong First Medical University, Qingdao, China.,Department of Ophthalmology, School of Clinical Medicine, Weifang Medical University, Weifang, China
| | - Shijiu Chen
- Eye Institute of Shandong First Medical University, Eye Hospital of Shandong First Medical University (Shandong Eye Hospital), Jinan, China.,School of Ophthalmology, Shandong First Medical University, Qingdao, China.,Department of Medicine, Qingdao University, Qingdao, China
| | - Qingjun Zhou
- School of Ophthalmology, Shandong First Medical University, Qingdao, China.,Eye Institute of Shandong First Medical University, Qingdao Eye Hospital of Shandong First Medical University, Qingdao, China.,State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Qingdao, China
| | - Bi Ning Zhang
- School of Ophthalmology, Shandong First Medical University, Qingdao, China.,Eye Institute of Shandong First Medical University, Qingdao Eye Hospital of Shandong First Medical University, Qingdao, China.,State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Qingdao, China
| | - Suxia Li
- Eye Institute of Shandong First Medical University, Eye Hospital of Shandong First Medical University (Shandong Eye Hospital), Jinan, China.,School of Ophthalmology, Shandong First Medical University, Qingdao, China.,State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Qingdao, China
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Musa M, Zeppieri M, Enaholo ES, Chukwuyem E, Salati C. An Overview of Corneal Transplantation in the Past Decade. Clin Pract 2023; 13:264-279. [PMID: 36826166 PMCID: PMC9955122 DOI: 10.3390/clinpract13010024] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 02/07/2023] [Accepted: 02/10/2023] [Indexed: 02/16/2023] Open
Abstract
The cornea is a transparent avascular structure located in the front of the eye that refracts light entering the eyes and also serves as a barrier between the outside world and the internal contents of the eye. Like every other body part, the cornea may suffer insult from trauma, infection, and inflammation. In the case of trauma, a prior infection that left a scar, or conditions such as keratoconus that warrant the removal of all or part of the cornea (keratoplasty), it is important to use healthy donor corneal tissues and cells that can replace the damaged cornea. The types of cornea transplant techniques employed currently include: penetrating keratoplasty, endothelial keratoplasty (EK), and artificial cornea transplant. Postoperative failure acutely or after years can result after a cornea transplant and may require a repeat transplant. This minireview briefly examines the various types of corneal transplant methodologies, indications, contraindications, presurgical protocols, sources of cornea transplant material, wound healing after surgery complications, co-morbidities, and the effect of COVID-19 in corneal transplant surgery.
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Affiliation(s)
- Mutali Musa
- Department of Optometry, University of Benin, Benin City 300238, Nigeria
| | - Marco Zeppieri
- Department of Ophthalmology, University Hospital of Udine, 33100 Udine, Italy
- Correspondence:
| | - Ehimare S. Enaholo
- Centre for Sight Africa, Nkpor, Onitsha 434112, Nigeria
- Africa Eye Laser Centre, Benin 300001, Nigeria
| | - Ekele Chukwuyem
- Centre for Sight Africa, Nkpor, Onitsha 434112, Nigeria
- Africa Eye Laser Centre, Benin 300001, Nigeria
| | - Carlo Salati
- Department of Ophthalmology, University Hospital of Udine, 33100 Udine, Italy
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Khan RL, Khraibi AA, Dumée LF, Corridon PR. From waste to wealth: Repurposing slaughterhouse waste for xenotransplantation. Front Bioeng Biotechnol 2023; 11:1091554. [PMID: 36815880 PMCID: PMC9935833 DOI: 10.3389/fbioe.2023.1091554] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 01/23/2023] [Indexed: 02/05/2023] Open
Abstract
Slaughterhouses produce large quantities of biological waste, and most of these materials are underutilized. In many published reports, the possibility of repurposing this form of waste to create biomaterials, fertilizers, biogas, and feeds has been discussed. However, the employment of particular offal wastes in xenotransplantation has yet to be extensively uncovered. Overall, viable transplantable tissues and organs are scarce, and developing bioartificial components using such discarded materials may help increase their supply. This perspective manuscript explores the viability and sustainability of readily available and easily sourced slaughterhouse waste, such as blood vessels, eyes, kidneys, and tracheas, as starting materials in xenotransplantation derived from decellularization technologies. The manuscript also examines the innovative use of animal stem cells derived from the excreta to create a bioartificial tissue/organ platform that can be translated to humans. Institutional and governmental regulatory approaches will also be outlined to support this endeavor.
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Affiliation(s)
- Raheema L. Khan
- Department of Immunology and Physiology, College of Medicine and Health Sciences, Khalifa University of Science and Technology, Abu Dhabi, United Arab Emirates
| | - Ali A. Khraibi
- Department of Immunology and Physiology, College of Medicine and Health Sciences, Khalifa University of Science and Technology, Abu Dhabi, United Arab Emirates
- Center for Biotechnology, Khalifa University of Science and Technology, Abu Dhabi, United Arab Emirates
| | - Ludovic F. Dumée
- Department of Chemical Engineering, College of Engineering, Khalifa University of Science and Technology, Abu Dhabi, United Arab Emirates
- Research and Innovation Center on CO2 and Hydrogen (RICH), Khalifa University of Science and Technology, Abu Dhabi, United Arab Emirates
| | - Peter R. Corridon
- Department of Immunology and Physiology, College of Medicine and Health Sciences, Khalifa University of Science and Technology, Abu Dhabi, United Arab Emirates
- Center for Biotechnology, Khalifa University of Science and Technology, Abu Dhabi, United Arab Emirates
- Healthcare Engineering Innovation Center, Khalifa University of Science and Technology, Abu Dhabi, United Arab Emirates
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40
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TIGIT-Fc Prolongs Corneal Allograft Survival in Mice by Upregulating TIGIT/CD226 Expression and the Proportion of Helios + Foxp3 + Treg Cells. Transplantation 2023; 107:372-381. [PMID: 35876368 DOI: 10.1097/tp.0000000000004257] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND Reduction of graft rejection remains key issue for supporting long-term graft retention after corneal transplantation. The relevance of Treg in reduction of corneal allografts rejection has been demonstrated. It has been recently reported that in addition to Foxp3, Helios is also considered to be a marker of activated Treg. Helios + Foxp3 + Treg are considered to be the true immunosuppressive Treg. TIGIT is an immunosuppressive costimulatory molecule that was found to be highly expressed on the surface of Helios + Foxp3 + Treg. METHODS In this study, we aimed to explore whether supplementing TIGIT would result in an expansion and activation of Helios + Foxp3 + Treg thus to mediate an immune tolerance following corneal transplantation by administering topically and systemically TIGIT-Fc treatment in murine models. RESULTS TIGIT-Fc treatment significantly improved the survival of corneal allograft compared with the control group. TIGIT-Fc treatment increased TIGIT/CD226 expression, the proportion of Helios + Foxp3 + Treg cells and an enhanced ex vivo suppressive effect from peripheral lymph nodes isolated Treg cells. Furthermore, the expression of Helios in corneal grafts was upregulated, whereas expression of CD226 and production of aqueous interferon-γ and VEGF were reduced by TIGIT-Fc treatment. CONCLUSIONS TIGIT-Fc treatment could specifically upregulate Helios + Foxp3 + Treg-mediated immune response after allogeneic corneal transplantation via TIGIT/CD226-CD155 pathway which improves the survival of allografts.
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Trone MC, Poinard S, Crouzet E, Garcin T, Mentek M, Forest F, Matray M, Thuret G, Gain P. Dropless penetrating keratoplasty using a subconjunctival dexamethasone implant: safety pilot study. Br J Ophthalmol 2023; 107:181-186. [PMID: 34426402 DOI: 10.1136/bjophthalmol-2021-319376] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 08/08/2021] [Indexed: 01/27/2023]
Abstract
BACKGROUND/AIM Rejection is the main cause of graft failure after penetrating keratoplasty (PK). Its prevention by repeated instillation of steroid eye-drops has not evolved in decades. Poor adherence and discontinuous nature of eye-drop treatment may explain some PK failures. In a rabbit model, we previously demonstrated that a subconjunctival dexamethasone implant was well tolerated and prevented rejection efficiently in the first 5-6 weeks. This clinical trial investigates its tolerance and safety after PK. METHODS Single-centre, phase II non-randomised tolerance and safety pilot study (NCT02834260). Designed to analyse the risk of elevated intraocular pressure (IOP), discomfort and resorption time. Fourteen patients with a low rejection risk indication of PK were enrolled between January 2017 and August 2018. The implant was injected in the 12 o'clock position, 5 mm from the limbus, at the end of PK. A steroid eye-drop treatment was planned when implant resorption was complete. Patients were monitored regularly for 12 months: IOP (main outcome measure at 1 month), discomfort and redness scores, implant status, rejection episode and central corneal thickness by optical coherence tomography. An independent data safety monitoring committee verified safety aspects. RESULTS No increase in IOP or other adverse event related to the implant was observed. Average resorption time was 6 weeks. The switch to steroid eye-drops was uneventful. One patient, included despite preoperative corneal neovascularisation (unintended protocol deviation) experienced a rejection. CONCLUSIONS This is the first proof of concept that dropless immunosuppression is possible after low rejection risk PK. TRIAL REGISTRATION NUMBER NCT02834260.
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Affiliation(s)
- Marie Caroline Trone
- Corneal Graft Biology, Engineering and Imaging Laboratory, BiiGC, EA2521, Faculty of Medecine, Jean Monnet University, Saint-Etienne, France.,Ophthalmology Department, University Hospital, Saint-Etienne, France
| | - Sylvain Poinard
- Corneal Graft Biology, Engineering and Imaging Laboratory, BiiGC, EA2521, Faculty of Medecine, Jean Monnet University, Saint-Etienne, France.,Ophthalmology Department, University Hospital, Saint-Etienne, France
| | - Emmanuel Crouzet
- Corneal Graft Biology, Engineering and Imaging Laboratory, BiiGC, EA2521, Faculty of Medecine, Jean Monnet University, Saint-Etienne, France
| | - Thibaud Garcin
- Corneal Graft Biology, Engineering and Imaging Laboratory, BiiGC, EA2521, Faculty of Medecine, Jean Monnet University, Saint-Etienne, France.,Ophthalmology Department, University Hospital, Saint-Etienne, France
| | - Marielle Mentek
- Corneal Graft Biology, Engineering and Imaging Laboratory, BiiGC, EA2521, Faculty of Medecine, Jean Monnet University, Saint-Etienne, France
| | - Fabien Forest
- Pathology department, University Hospital, Saint-Etienne, France
| | - Marie Matray
- Ophthalmology Department, University Hospital, Saint-Etienne, France
| | - Gilles Thuret
- Corneal Graft Biology, Engineering and Imaging Laboratory, BiiGC, EA2521, Faculty of Medecine, Jean Monnet University, Saint-Etienne, France .,Ophthalmology Department, University Hospital, Saint-Etienne, France
| | - Philippe Gain
- Corneal Graft Biology, Engineering and Imaging Laboratory, BiiGC, EA2521, Faculty of Medecine, Jean Monnet University, Saint-Etienne, France.,Ophthalmology Department, University Hospital, Saint-Etienne, France
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Overview of Corneal Transplantation for the Nonophthalmologist. Transplant Direct 2023; 9:e1434. [PMID: 36700069 PMCID: PMC9835895 DOI: 10.1097/txd.0000000000001434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 11/03/2022] [Accepted: 11/27/2022] [Indexed: 01/27/2023] Open
Abstract
Corneal transplant is a procedure that aims to replace dysfunctional corneal tissue with a transparent graft and is one of the most widely performed transplant surgeries, but its public and professional awareness is low outside of ophthalmology. Corneal tissue consists of 5 major layers that serve to maintain its structural integrity and refractive shape: the epithelium, Bowman's layer, the stroma, Descemet's membrane, and the endothelium. Failure or irreversible damage to any layer of the cornea may be an indication for corneal transplant, and variants of this procedure may be full thickness or selectively lamellar. Complications related to corneal transplantation may occur anywhere from during surgery to years afterward, including rejection, dehiscence, cataract, and glaucoma. Complications should be managed by an ophthalmologist, but other physicians should be aware of prophylactic medications. Topical immunosuppressants and steroids are effective for preventing and treating rejection episodes, whereas there is little evidence to support the use of systemic immunosuppression. Eye protection is recommended for any corneal transplant recipient. Physicians should counsel patients on corneal donation, especially if outside the United States, where donor tissue is in short supply.
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43
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Jia S, Bu Y, Lau DSA, Lin Z, Sun T, Lu WW, Lu S, Ruan C, Chan CHJ. Advances in 3D bioprinting technology for functional corneal reconstruction and regeneration. Front Bioeng Biotechnol 2023; 10:1065460. [PMID: 36686254 PMCID: PMC9852906 DOI: 10.3389/fbioe.2022.1065460] [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: 10/09/2022] [Accepted: 12/19/2022] [Indexed: 01/09/2023] Open
Abstract
Corneal transplantation constitutes one of the major treatments in severe cases of corneal diseases. The lack of cornea donors as well as other limitations of corneal transplantation necessitate the development of artificial corneal substitutes. Biosynthetic cornea model using 3D printing technique is promising to generate artificial corneal structure that can resemble the structure of the native human cornea and is applicable for regenerative medicine. Research on bioprinting artificial cornea has raised interest into the wide range of materials and cells that can be utilized as bioinks for optimal clarity, biocompatibility, and tectonic strength. With continued advances in biomaterials science and printing technology, it is believed that bioprinted cornea will eventually achieve a level of clinical functionality and practicality as to replace donated corneal tissues, with their associated limitations such as limited or unsteady supply, and possible infectious disease transmission. Here, we review the literature on bioprinting strategies, 3D corneal modelling, material options, and cellularization strategies in relation to keratoprosthesis design. The progress, limitations and expectations of recent cases of 3D bioprinting of artifial cornea are discussed. An outlook on the rise of 3D bioprinting in corneal reconstruction and regeneration is provided.
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Affiliation(s)
- Shuo Jia
- Department of Ophthalmology, LKS Faculty of Medicine, University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Yashan Bu
- Department of Ophthalmology, LKS Faculty of Medicine, University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Dzi-Shing Aaron Lau
- Department of Orthopedic and Traumatology, LKS Faculty of Medicine, University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Zhizhen Lin
- Department of Ophthalmology, LKS Faculty of Medicine, University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Tianhao Sun
- Department of Orthopedic and Traumatology, LKS Faculty of Medicine, University of Hong Kong, Hong Kong, Hong Kong SAR, China
- Shenzhen Gangqing Biomedical Technology Co. Ltd, Shenzhen, China
| | - Weijia William Lu
- Department of Orthopedic and Traumatology, LKS Faculty of Medicine, University of Hong Kong, Hong Kong, Hong Kong SAR, China
- Research Center for Human Tissues and Organs Degeneration, Institute of Biomedicine and Biotechnology, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Sheng Lu
- Department of Orthopedic Surgery, The First People’s Hospital of Yunnan Province, Kunming, China
| | - Changshun Ruan
- Research Center for Human Tissues and Organs Degeneration, Institute of Biomedicine and Biotechnology, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Cheuk-Hung Jonathan Chan
- Department of Ophthalmology, LKS Faculty of Medicine, University of Hong Kong, Hong Kong, Hong Kong SAR, China
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44
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Immunosuppressive Therapy for High-Risk Corneal Transplant. CURRENT OPHTHALMOLOGY REPORTS 2022. [DOI: 10.1007/s40135-022-00298-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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45
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Muacevic A, Adler JR. Classic and Current Opinions in Human Organ and Tissue Transplantation. Cureus 2022; 14:e30982. [PMID: 36337306 PMCID: PMC9624478 DOI: 10.7759/cureus.30982] [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] [Accepted: 11/01/2022] [Indexed: 11/30/2022] Open
Abstract
Graft tolerance is a pathophysiological condition heavily reliant on the dynamic interaction of the innate and adaptive immune systems. Genetic polymorphism determines immune responses to tissue/organ transplantation, and intricate humoral and cell-mediated mechanisms control these responses. In transplantation, the clinician's goal is to achieve a delicate equilibrium between the allogeneic immune response, undesired effects of the immunosuppressive drugs, and the existing morbidities that are potentially life-threatening. Transplant immunopathology involves sensitization, effector, and apoptosis phases which recruit and engages immunological cells like natural killer cells, lymphocytes, neutrophils, and monocytes. Similarly, these cells are involved in the transfer of normal or genetically engineered T cells. Advances in tissue transplantation would involve a profound knowledge of the molecular mechanisms that underpin the respective immunopathology involved and the design of precision medicines that are safe and effective.
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46
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Hjortdal J, Griffin MD, Cadoux M, Armitage WJ, Bylesjo M, Gabhann PM, Murphy CC, Pleyer U, Tole D, Vabres B, Walkinshaw MD, Gourraud P, Karakachoff M, Brouard S, Degauque N. Peripheral blood immune cell profiling of acute corneal transplant rejection. Am J Transplant 2022; 22:2337-2347. [PMID: 35704290 PMCID: PMC9796948 DOI: 10.1111/ajt.17119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 05/17/2022] [Accepted: 06/09/2022] [Indexed: 01/25/2023]
Abstract
Acute rejection (AR) of corneal transplants (CT) has a profound effect on subsequent graft survival but detailed immunological studies in human CT recipients are lacking. In this multi-site, cross-sectional study, clinical details and blood samples were collected from adults with clinically diagnosed AR of full-thickness (FT)-CT (n = 35) and posterior lamellar (PL)-CT (n = 21) along with Stable CT recipients (n = 177) and adults with non-transplanted corneal disease (n = 40). For those with AR, additional samples were collected 3 months later. Immune cell analysis was performed by whole-genome microarrays (whole blood) and high-dimensional multi-color flow cytometry (peripheral blood mononuclear cells). For both, no activation signature was identified within the B cell and T cell repertoire at the time of AR diagnosis. Nonetheless, in FT- but not PL-CT recipients, AR was associated with differences in B cell maturity and regulatory CD4+ T cell frequency compared to stable allografts. These data suggest that circulating B cell and T cell subpopulations may provide insights into the regulation of anti-donor immune response in human CT recipients with differing AR risk. Our results suggest that, in contrast to solid organ transplants, genetic or cellular assays of peripheral blood are unlikely to be clinically exploitable for prediction or diagnosis of AR.
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Affiliation(s)
- Jesper Hjortdal
- Department of OphthalmologyAarhus University HospitalAarhusDenmark,Department of Clinical MedicineAarhus UniversityAarhusDenmark
| | - Matthew D. Griffin
- Regenerative Medicine Institute (REMEDI) at CÚRAM SFI Centre for Research in Medical DevicesSchool of Medicine, National University of Ireland GalwayGalwayIreland
| | - Marion Cadoux
- Nantes Université, INSERM, Center for Research in Transplantation and Translational Immunology, UMR 1064NantesFrance,CHU Nantes, Institut De Transplantation Urologie Néphrologie (ITUN)NantesFrance
| | - W. John Armitage
- Translational Health SciencesUniversity of BristolBristolUK,Tissue and Eye ServicesNHS Blood and TransplantBristolUK
| | - Max Bylesjo
- Fios Genomics Ltd, Nine Edinburgh BioquarterEdinburghUK
| | | | - Conor C. Murphy
- Royal Victoria Eye and Ear HospitalDublinIreland,Royal College of Surgeons in Ireland University of Medicine and Health SciencesDublinIreland
| | - Uwe Pleyer
- Department of OphthalmologyCharité University HospitalBerlinGermany
| | - Derek Tole
- University Hospitals Bristol NHS Foundations TrustBristol Eye HospitalBristolUK
| | - Bertrand Vabres
- Nantes Université, CHU Nantes, Service OphtalmologieNantesFrance
| | - Malcolm D. Walkinshaw
- Wellcome Centre for Cell Biology, School of Biological SciencesUniversity of EdinburghEdinburghUK
| | - Pierre‐Antoine Gourraud
- Nantes Université, INSERM, Center for Research in Transplantation and Translational Immunology, UMR 1064NantesFrance,CHU Nantes, Institut De Transplantation Urologie Néphrologie (ITUN)NantesFrance,CHU de Nantes, INSERM, CIC 1413, Pôle Hospitalo‐Universitaire 11: Santé Publique, Clinique des donnéesNantesFrance
| | - Matilde Karakachoff
- CHU de Nantes, INSERM, CIC 1413, Pôle Hospitalo‐Universitaire 11: Santé Publique, Clinique des donnéesNantesFrance
| | - Sophie Brouard
- Nantes Université, INSERM, Center for Research in Transplantation and Translational Immunology, UMR 1064NantesFrance,CHU Nantes, Institut De Transplantation Urologie Néphrologie (ITUN)NantesFrance
| | - Nicolas Degauque
- Nantes Université, INSERM, Center for Research in Transplantation and Translational Immunology, UMR 1064NantesFrance,CHU Nantes, Institut De Transplantation Urologie Néphrologie (ITUN)NantesFrance
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Urbańska K, Woźniak M, Więsyk P, Konarska N, Bartos W, Biszewski M, Bielak M, Chorągiewicz T, Rejdak R. Management and Treatment Outcomes of High-Risk Corneal Transplantations. J Clin Med 2022; 11:jcm11195511. [PMID: 36233379 PMCID: PMC9572799 DOI: 10.3390/jcm11195511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 09/14/2022] [Accepted: 09/16/2022] [Indexed: 12/01/2022] Open
Abstract
Corneal transplantation is the most effective treatment for corneal blindness. Standard planned keratoplasties have a high success rate. Conditions such as active inflammation at the time of surgery, the presence of ocular surface disease, previous graft disease, or neovascularization make them more susceptible to rejection. These are so-called high-risk corneal transplantations. In our study, we selected 52 patients with a higher risk of graft rejection. A total of 78 procedures were performed. The main indications for the first keratoplasty were infections (59.6%) and traumas (21.2%). Visual acuity (VA) significantly improved from 2.05 logMAR on the day of keratoplasty to 1.66 logMAR in the latest examination (p = 0.003). An analysis of the graft survival showed a 1-year survival of 54% and a 5-year survival of 19.8% of grafts. The mean observation time without complications after the first, second, and third surgery was 23, 13, and 14 months, respectively. The best results were noted among patients with infectious indications for keratoplasty (p = 0.001). Among them, those with bacterial infection had the best visual outcomes (p = 0.047).
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48
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Ocular Drug Delivery: Advancements and Innovations. Pharmaceutics 2022; 14:pharmaceutics14091931. [PMID: 36145679 PMCID: PMC9506479 DOI: 10.3390/pharmaceutics14091931] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 08/24/2022] [Accepted: 09/06/2022] [Indexed: 11/16/2022] Open
Abstract
Ocular drug delivery has been significantly advanced for not only pharmaceutical compounds, such as steroids, nonsteroidal anti-inflammatory drugs, immune modulators, antibiotics, and so forth, but also for the rapidly progressed gene therapy products. For conventional non-gene therapy drugs, appropriate surgical approaches and releasing systems are the main deliberation to achieve adequate treatment outcomes, whereas the scope of “drug delivery” for gene therapy drugs further expands to transgene construct optimization, vector selection, and vector engineering. The eye is the particularly well-suited organ as the gene therapy target, owing to multiple advantages. In this review, we will delve into three main aspects of ocular drug delivery for both conventional drugs and adeno-associated virus (AAV)-based gene therapy products: (1) the development of AAV vector systems for ocular gene therapy, (2) the innovative carriers of medication, and (3) administration routes progression.
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49
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Kaluzny BJ, Mlyniuk P, Liberski S, Jimenez-Villar A, Machalińska A, Grulkowski I. Swept-source OCT for corneal graft quantitative evaluation in the eye bank and the correlation of the measurements to pre-excision values. Sci Rep 2022; 12:14834. [PMID: 36050445 PMCID: PMC9437096 DOI: 10.1038/s41598-022-19225-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 08/25/2022] [Indexed: 11/15/2022] Open
Abstract
Quantitative evaluation of the human corneal grafts stored in the tissue banks is usually limited to endothelial cell density and central thickness. Swept-source OCT (SS-OCT) is capable of measuring the central curvatures of the corneal tissue prepared for transplantation without loss of sterileness, providing insights on its refractive state. The aim of the paper is to compare in vitro SS-OCT measurements with pre-excision values. Hand-held keratometry and ultrasound pachymetry was performed on 22 corneas before excision of corneoscleral button and insertion in the vial with Eusol-C solution (AlchimiaS.r.l, Nicolò, Italy). After 12 to 36 h of hypothermic storage the corneas were examined within the vials with custom built SS-OCT system maintaining a sterile environment. The anterior and posterior central curvatures, and central corneal thickness (CCT) were measured. Rotation of the corneoscleral button was controlled by making a 6-o'clock mark during excision. Mean pre-excision CCT was 626.45 ± 28.71 µm and 468.05 ± 52.96 µm when measured with SS OCT (r = 0.55; p < 0.001). Respective values for average keratometry were 7.74 ± 0.39 mm and 7.92 ± 0.57 mm (r = 0.6; p = 0.22). Although high differences were observed in corneal thickness, keratometric radius of curvature at the flat (r = 0.42; p < 0.001) and steep (r = 0.62; p = 0.014) meridian of the anterior corneal surface, as well as corneal anterior astigmatism (r = 0.3; p < 0.001), showed good correlation with pre-excision values. SS-OCT is capable of providing quantitative evaluation of the human corneal grafts in hypothermic storage. Good correlation between curvature measurements before excision and during banking in the vial indicates its clinical utility.
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Affiliation(s)
- Bartlomiej J Kaluzny
- Division of Ophthalmology and Optometry, Department of Ophthalmology, Collegium Medicum, Nicolaus Copernicus University, Ul. K. Ujejskiego 75, 85-168, Bydgoszcz, Poland.,Oftalmika Eye Hospital, Bydgoszcz, Poland
| | - Patryk Mlyniuk
- Division of Ophthalmology and Optometry, Department of Ophthalmology, Collegium Medicum, Nicolaus Copernicus University, Ul. K. Ujejskiego 75, 85-168, Bydgoszcz, Poland.,Oftalmika Eye Hospital, Bydgoszcz, Poland
| | - Slawomir Liberski
- Department of Ophthalmology, Poznan University of Medical Sciences, Ul. A. Szamarzewskiego 84, 61-848, Poznań, Poland.
| | - Alfonso Jimenez-Villar
- Institute of Physics, Faculty of Physics, Astronomy and Informatics, Nicolaus Copernicus University, Ul. Grudziądzka 5, 87-100, Toruń, Poland
| | - Anna Machalińska
- First Department of Ophthalmology, Pomeranian Medical University, Al. Powstańców Wielkopolskich 72, 70-111, Szczecin, Poland
| | - Ireneusz Grulkowski
- Institute of Physics, Faculty of Physics, Astronomy and Informatics, Nicolaus Copernicus University, Ul. Grudziądzka 5, 87-100, Toruń, Poland
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Ocular emergencies visits after corneal transplantation at a tertiary eye care hospital in Saudi Arabia. Int Ophthalmol 2022; 42:3897-3904. [PMID: 35941409 DOI: 10.1007/s10792-022-02410-6] [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: 01/03/2022] [Accepted: 06/13/2022] [Indexed: 10/15/2022]
Abstract
PURPOSE To evaluate the characteristics of patients with post-keratoplasty complications and their presentation at an emergency center. DESIGN Retrospective one-armed cohort study. METHODS Data were evaluated on patients who underwent corneal grafts in 2019 and presented to an emergency unit. Data were collected on patient demographics, presenting symptoms, clinical details, diagnosis at emergency visit, final diagnosis, best-corrected visual acuity (BCVA) at presentation and at the last follow-up after management. Severe visual impairment (SVI) and graft rejection were tested for correlations to other factors. RESULTS The study sample was comprised of 149 eyes of 124 patients with a mean age of 27.5 years. Keratoconus was the indication for keratoplasty in 94 (75.8%) patients. The main presenting symptoms were pain 57 (38.3%) and red eye in 52 (34.9%) patients. The median interval between emergency visit and keratoplasty was 1.6 years. There were 63 (42.3%) patients who had emergency visits due to suture-related problems. The rates of SVI and graft rejection at the time of discharge after managing emergencies in eyes with previous keratoplasty were 14.1% (95% CI 8.5; 19.7) and 13.4 (95% CI 7.9; 18.9), respectively. Keratoconus (OR = 22.8) and young age (P < 0.001) were negatively associated with SVI after management. CONCLUSION Patients with keratoplasty are at high risk for severe vision loss and should be counseled to seek urgent eye care for early detection and management of sight-threatening complications to improve graft survival and vision.
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