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Jackson CJ, Myklebust Ernø IT, Ringstad H, Tønseth KA, Dartt DA, Utheim TP. Simple limbal epithelial transplantation: Current status and future perspectives. Stem Cells Transl Med 2019; 9:316-327. [PMID: 31802651 PMCID: PMC7031634 DOI: 10.1002/sctm.19-0203] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 11/01/2019] [Indexed: 12/15/2022] Open
Abstract
Damage to limbal stem cells as a result of injury or disease can lead to limbal stem cell deficiency (LSCD). This disease is characterized by decreased vision that is often painful and may progress to blindness. Clinical features include inflammation, neovascularization, and persistent cornea epithelial defects. Successful strategies for treatment involve transplantation of grafts harvested from the limbus of the alternate healthy eye, called conjunctival‐limbal autograft (CLAU) and transplantation of limbal cell sheets cultured from limbal biopsies, termed cultured limbal epithelial transplantation (CLET). In 2012, Sangwan and colleagues presented simple limbal epithelial transplantation (SLET), a novel transplantation technique that combines the benefits of CLAU and CLET and avoids the challenges associated with both. In SLET a small biopsy from the limbus of the healthy eye is divided and distributed over human amniotic membrane, which is placed on the affected cornea. Outgrowth occurs from each small explant and a complete corneal epithelium is typically formed within 2 weeks. Advantages of SLET include reduced risk of iatrogenic LSCD occurring in the healthy cornea at harvest; direct transfer circumventing the need for cell culture; and the opportunity to perform biopsy harvest and transplantation in one operation. Success so far using SLET is comparable with CLAU and CLET. Of note, 336 of 404 (83%) operations using SLET resulted in restoration of the corneal epithelium, whereas visual acuity improved in 258 of the 373 (69%) reported cases. This review summarizes the results of 31 studies published on SLET since 2012. Progress, advantages, challenges, and suggestions for future studies are presented.
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Affiliation(s)
- Catherine J Jackson
- Department of Plastic and Reconstructive Surgery and Institute for Surgical Research, Oslo University Hospital, Oslo, Norway.,Institute of Oral Biology, Faculty of Dentistry, University of Oslo, Oslo, Norway.,Department of Medical Biochemistry, Oslo University Hospital, Oslo, Norway
| | | | - Håkon Ringstad
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway
| | - Kim A Tønseth
- Department of Plastic and Reconstructive Surgery and Institute for Surgical Research, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway
| | - Darlene A Dartt
- Schepens Eye Research Institute, Massachusetts Eye and Ear Infirmary, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
| | - Tor P Utheim
- Department of Plastic and Reconstructive Surgery and Institute for Surgical Research, Oslo University Hospital, Oslo, Norway.,Institute of Oral Biology, Faculty of Dentistry, University of Oslo, Oslo, Norway.,Department of Medical Biochemistry, Oslo University Hospital, Oslo, Norway.,Department of Ophthalmology, Oslo University Hospital, Oslo, Norway.,Department of Ophthalmology, Vestre Viken Hospital Trust, Drammen, Norway.,Department of Ophthalmology, Stavanger University Hospital, Stavanger, Norway.,Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Bergen, Norway.,Department of Ophthalmology, Sørlandet Hospital, Arendal, Norway
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Fernandez-Buenaga R, Aiello F, Zaher SS, Grixti A, Ahmad S. Twenty years of limbal epithelial therapy: an update on managing limbal stem cell deficiency. BMJ Open Ophthalmol 2018; 3:e000164. [PMID: 30123847 PMCID: PMC6093197 DOI: 10.1136/bmjophth-2018-000164] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 07/06/2018] [Accepted: 07/20/2018] [Indexed: 01/19/2023] Open
Abstract
Limbal stem cell damage after chemical injury, autoimmune disorders or iatrogenic trauma leads to corneal conjunctivalisation with new vessel formation, epithelium instability and visual loss. Limbal stem cell transplantation includes reconstructive surgical procedures to restore a corneal epithelium. The recognised options are: conjunctival limbal autograft, in which stem cells are taken from the patient's healthy eye; conjunctival limbal allograft, in which stem cells are taken from a living, related or dead donor and the keratolimbal allograft. Each of these procedures has some drawbacks; in particular, the conjunctival limbal autograft needs a relatively healthy fellow eye and needs a relatively large amount of donor tissue from the healthy eye (about one-third of the healthy limbal stem cell tissue) with potential risks to the donor eye. In the case of keratolimbal allograft transplants, the recipient needs an immunosuppressive treatment to reduce the risk of rejection with the associate possible side effects. More modern treatment options are reviewed. Cultivated oral mucosa epithelial transplantation success rate can vary between 50% and 70% at 3-4 years of follow-up. Simple limbal epithelial transplantation results show a success rate from 75.2% to 83.8% after 1 year of follow-up. Inclusion criteria for autologous cultivated limbal epithelial transplantation as approved by the National Institute of Health and Care Excellence are also shown in this paper. On the basis of these more contemporary treatment options, a stepladder approach to evaluate which procedure is most appropriate and personalised to the patient's conditions is proposed.
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Affiliation(s)
- Roberto Fernandez-Buenaga
- Department of Cornea and External Diseases, Moorfields Eye Hospital-NHS Foundation Trust, London, UK
| | - Francesco Aiello
- Department of Cornea and External Diseases, Moorfields Eye Hospital-NHS Foundation Trust, London, UK
- Department of Experimental Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Sarah S Zaher
- Department of Cornea and External Diseases, Moorfields Eye Hospital-NHS Foundation Trust, London, UK
| | - Andre Grixti
- Department of Cornea and External Diseases, Moorfields Eye Hospital-NHS Foundation Trust, London, UK
| | - Sajjad Ahmad
- Department of Cornea and External Diseases, Moorfields Eye Hospital-NHS Foundation Trust, London, UK
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Borroni D, Wowra B, Romano V, Boyadzhieva M, Ponzin D, Ferrari S, Ahmad S, Parekh M. Simple limbal epithelial transplantation: a review on current approach and future directions. Surv Ophthalmol 2018; 63:869-874. [PMID: 29800578 DOI: 10.1016/j.survophthal.2018.05.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Revised: 05/02/2018] [Accepted: 05/07/2018] [Indexed: 10/16/2022]
Abstract
Simple limbal epithelial transplantation is a recently developed technique for treating limbal stem cell deficiency caused by ocular burns. A small limbal biopsy from the donor eye, usually from the patient's healthy eye, is excised and dissected into multiple pieces. An amniotic membrane is atttached using fibrin glue on the diseased eye after removing the conjunctivalized pannus from the corneal surface. The limbal biopsy pieces are placed onto the amniotic membrane, fixed with fibrin glue, followed by bandaging of the ocular surface with a contact lens. This technique (auto simple limbal epithelial transplantation) offers easier surgical manipulations and economic advantages over other techniques for the treatment of limbal stem cell deficiency. We therefore review simple limbal epithelial transplantation along with recent modifications in the technique and case studies, including challenges and failures.
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Affiliation(s)
- Davide Borroni
- Department of Ophthalmology, Riga Stradins University, Riga, Latvia; Department of Genetics, Riga Stradins University, Riga, Latvia
| | - Bogumil Wowra
- Department of Ophthalmology, Medical University of Silesia, Katowice, Poland
| | - Vito Romano
- Department of Corneal and External Eye Diseases, St Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, UK; Department of Eye and Vision Science, University of Liverpool, Liverpool, UK
| | - Maria Boyadzhieva
- Department of Ophthalmology, Medical University of Varna, Varna, Bulgaria
| | - Diego Ponzin
- International Center for Ocular Physiopathology, The Veneto Eye Bank Foundation, Venice, Italy
| | - Stefano Ferrari
- International Center for Ocular Physiopathology, The Veneto Eye Bank Foundation, Venice, Italy
| | - Sajjad Ahmad
- Moorfields Eye Hospital NHS Foundation Trust, London, UK; University College London Institute of Ophthalmology, London, UK
| | - Mohit Parekh
- International Center for Ocular Physiopathology, The Veneto Eye Bank Foundation, Venice, Italy.
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Baradaran-Rafii A, Asl NS, Ebrahimi M, Jabbehdari S, Bamdad S, Roshandel D, Eslani M, Momeni M. The role of amniotic membrane extract eye drop (AMEED) in in vivo cultivation of limbal stem cells. Ocul Surf 2018; 16:146-153. [DOI: 10.1016/j.jtos.2017.11.001] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2017] [Revised: 09/10/2017] [Accepted: 11/01/2017] [Indexed: 12/28/2022]
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Kethiri AR, Basu S, Shukla S, Sangwan VS, Singh V. Optimizing the role of limbal explant size and source in determining the outcomes of limbal transplantation: An in vitro study. PLoS One 2017; 12:e0185623. [PMID: 28957444 PMCID: PMC5619808 DOI: 10.1371/journal.pone.0185623] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Accepted: 09/15/2017] [Indexed: 12/11/2022] Open
Abstract
Purpose Simple limbal epithelial transplantation (SLET) and cultivated limbal epithelial transplantation (CLET) are proven clinical techniques for treating limbal stem cell deficiency (LSCD). However, the ideal size and number of the limbal explants required for transplantation has not been clearly elucidated. This in vitro study aimed to determine the optimal limbal explant size required for complete corneal epithelialization by characterizing the cell expansion. Methods Limbal explants obtained from both live and cadaveric biopsies were cultured on the denuded amniotic membrane. Explant size and the explant cell outgrowth (expansion) were measured using ImageJ software with respect to days. Cultures were characterized by assessing the rate of proliferation of cells with 5-bromo-2’-deoxyuridine (BrdU) assay along with the expression of different stem cell markers (ABCG2, p63α), corneal epithelial (CK3+12) and adherens junction molecules (E-Cadherin) by immunofluorescence. Results Explants from live biopsies had 80% growth potential in vitro whereas 40% of the cadaveric tissue failed to grow. Minimum explant sizes of 0.3 mm2 for live and ≥0.5 mm2 for cadaveric tissue had a mean expansion areas of 182.39±17.06 mm2 and 217.59±16.91 mm2 respectively suggesting adequate growth potential of the explants. Mean total percentage of proliferative cells was 31.80±3.81 in live and 33.49±4.25 in cadaveric tissue expansion. The expression was noted to be similar in cells cultured from cadaveric compared to cells cultured from live limbal tissue with respect to ABCG2, p63α, CK(3+12) and E-cadherin. Conclusion Our findings show that a minimal amount of 0.3 mm2 live tissue would be sufficient for ample limbal cell expansion in vitro. Cadaveric explants <0.5 mm2 had poor growth potential. However, larger explants (≥ 0.5 mm2) had growth rate and proliferative potential similar to the live tissue. These findings could prove to be critical for clinical success especially while attempting cadaveric limbal transplantation. This study provides a novel clinical strategy for enhancing efficacy of the limbal transplantation surgery and opens the probability of even using the cadaveric tissue by considering the size of explant.
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Affiliation(s)
- Abhinav Reddy Kethiri
- SSR- Stem Cell Biology Laboratory and Center for Ocular Regeneration, L V Prasad Eye Institute, Hyderabad, Telangana, India
- Tej Kohli Cornea Institute, L V Prasad Eye Institute, Hyderabad, Telangana, India
- Research Scholar, Manipal University, Manipal, Karnataka, India
| | - Sayan Basu
- SSR- Stem Cell Biology Laboratory and Center for Ocular Regeneration, L V Prasad Eye Institute, Hyderabad, Telangana, India
- Tej Kohli Cornea Institute, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Sachin Shukla
- SSR- Stem Cell Biology Laboratory and Center for Ocular Regeneration, L V Prasad Eye Institute, Hyderabad, Telangana, India
- Tej Kohli Cornea Institute, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Virender Singh Sangwan
- SSR- Stem Cell Biology Laboratory and Center for Ocular Regeneration, L V Prasad Eye Institute, Hyderabad, Telangana, India
- Tej Kohli Cornea Institute, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Vivek Singh
- SSR- Stem Cell Biology Laboratory and Center for Ocular Regeneration, L V Prasad Eye Institute, Hyderabad, Telangana, India
- Tej Kohli Cornea Institute, L V Prasad Eye Institute, Hyderabad, Telangana, India
- * E-mail:
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Vazirani J, Mariappan I, Ramamurthy S, Fatima S, Basu S, Sangwan VS. Surgical Management of Bilateral Limbal Stem Cell Deficiency. Ocul Surf 2016; 14:350-64. [DOI: 10.1016/j.jtos.2016.02.006] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2015] [Revised: 01/10/2016] [Accepted: 02/01/2016] [Indexed: 01/01/2023]
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Arya SK, Bhatti A, Raj A, Bamotra RK. Simple Limbal Epithelial Transplantation in Acid Injury and Severe Dry Eye. J Clin Diagn Res 2016; 10:ND06-7. [PMID: 27504323 DOI: 10.7860/jcdr/2016/19306.7997] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Accepted: 04/07/2016] [Indexed: 12/15/2022]
Abstract
The epithelial cells of cornea constantly undergo renewal and regeneration and the stem cells responsible for renewal resides within basal epithelium at the limbus in palisades of Vogt. Simple limbal epithelial transplantation (SLET) is a simplified technique for limbal stem cell deficiency and it combines the benefits of both conjunctival limbal autografting and cultivated limbal epithelial transplantation by being single-stage and utilizing minimal donor tissue. We will be discussing two cases of ocular surface disorder which were managed successfully by new technique simple limbal epithelial transplantation. Two patients one with unilateral Limbal Stem Cell Deficiency (LSCD) following acid injury and other with bilateral LSCD due to severe dry eye underwent limbal epithelial transplantation using the SLET method after taking prior consent for the procedure. Success was termed complete when a completely epithelialized, avascular and stable corneal surface was seen. The follow up examinations were done on first day, at 1 week, 2 weeks, 4 weeks and at 3 months after the surgery. A completely epithelialised, avascular and stable corneal surface was achieved by 4 weeks in both patients. Simple limbal epithelial transplantation is a new technique which is simple, cheap and easily affordable and it has decreased the dependence on stem cell laboratory.
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Affiliation(s)
- Sudesh Kumar Arya
- Professor, Department of Ophthalmology, Government Medical College and Hospital , Chandigarh, Punjab, India
| | - Anubha Bhatti
- Assistant Professor, Department of Ophthalmology, Shri Guru Ram Das Institute of Medical Sciences & Research , Amritsar, Punjab, India
| | - Amit Raj
- Assistant Professor, Department of Ophthalmology, Government Medical College and Hospital , Chandigarh, Punjab, India
| | - Ravi Kant Bamotra
- Senior Resident, Department of Ophthalmology, Government Medical College and Hospital , Chandigarh, Punjab, India
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Vazirani J, Ali MH, Sharma N, Gupta N, Mittal V, Atallah M, Amescua G, Chowdhury T, Abdala-Figuerola A, Ramirez-Miranda A, Navas A, Graue-Hernández EO, Chodosh J. Autologous simple limbal epithelial transplantation for unilateral limbal stem cell deficiency: multicentre results. Br J Ophthalmol 2016; 100:1416-20. [DOI: 10.1136/bjophthalmol-2015-307348] [Citation(s) in RCA: 79] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Accepted: 01/03/2016] [Indexed: 11/03/2022]
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Basu S, Hertsenberg AJ, Funderburgh ML, Burrow MK, Mann MM, Du Y, Lathrop KL, Syed-Picard FN, Adams SM, Birk DE, Funderburgh JL. Human limbal biopsy-derived stromal stem cells prevent corneal scarring. Sci Transl Med 2015; 6:266ra172. [PMID: 25504883 DOI: 10.1126/scitranslmed.3009644] [Citation(s) in RCA: 173] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Conventional allograft therapy for corneal scarring is widespread and successful, but donor tissue is not universally available, and some grafts fail owing to rejection and complications such as endothelial failure. We investigated direct treatment of corneal scarring using autologous stem cells, a therapy that, if successful, could reduce the need for corneal grafts. Mesenchymal cells were expanded from small superficial, clinically replicable limbal biopsies of human cadaveric corneo-scleral rims. Limbal biopsy-derived stromal cells (LBSCs) expanded rapidly in media containing human serum, were highly clonogenic, and could generate spheres expressing stem cell genes (ABCG2, Nestin, NGFR, Oct4, PAX6, and Sox2). Human LBSCs differentiated into keratocytes expressing characteristic marker genes (ALDH3A1, AQP1, KERA, and PTGDS) and organized a thick lamellar stroma-like tissue containing aligned collagen and keratan sulfate proteoglycans when cultured on aligned nanofiber substrata. When engrafted into mouse corneal wounds, LBSCs prevented formation of light-scattering scar tissue containing fibrotic matrix components. The presence of LBSCs induced regeneration of ablated stroma with tissue exhibiting lamellar structure and collagen organization indistinguishable from that of native tissue. Because the limbus can be easily biopsied from either eye of an affected individual and LBSCs capable of corneal stromal remodeling can be expanded under xeno-free autologous conditions, these cells present a potential for autologous stem cell-based treatment of corneal stromal blindness.
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Affiliation(s)
- Sayan Basu
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA. L V Prasad Eye Institute, Hyderabad 500034, India
| | - Andrew J Hertsenberg
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
| | - Martha L Funderburgh
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
| | - Michael K Burrow
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
| | - Mary M Mann
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
| | - Yiqin Du
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
| | - Kira L Lathrop
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
| | - Fatima N Syed-Picard
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
| | - Sheila M Adams
- Department of Molecular Pharmacology and Physiology, Morsani College of Medicine, University of South Florida, Tampa, FL 33612, USA
| | - David E Birk
- Department of Molecular Pharmacology and Physiology, Morsani College of Medicine, University of South Florida, Tampa, FL 33612, USA
| | - James L Funderburgh
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA.
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Das S, Basu S, Sangwan V. Molten metal ocular burn: long-term outcome using simple limbal epithelial transplantation. BMJ Case Rep 2015; 2015:bcr-2014-209272. [PMID: 26150624 DOI: 10.1136/bcr-2014-209272] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
One day after molten aluminium had fallen into his right eye, a young man presented to our clinic with a vision of counting fingers at 1 m, conjunctival and corneal epithelial defects, and limbal involvement. He was diagnosed with grade 4 thermal burn and managed medically. Subsequently, the inflammation resolved, however, he developed pannus with conjunctivalisation and scarring of cornea suggestive of partial unilateral limbal stem cell deficiency. He was treated surgically with autologous simple limbal epithelial transplantation (SLET). Postoperatively, his vision improved along with corneal clarity. He achieved a best corrected vision of 20/50 at the last follow-up 27 months postsurgery, with maintenance of a healthy corneal epithelium. This case describes the different management strategies employed in two different stages of an ocular burn. It highlights the long-term success of SLET in a case of ocular surface thermal burn.
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Affiliation(s)
- Shilpa Das
- Department of Cornea, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Sayan Basu
- Cornea and Anterior Segment Services, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Virender Sangwan
- Cornea and Anterior Segment Services, L V Prasad Eye Institute, Hyderabad, Telangana, India
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Science and Art of Cell-Based Ocular Surface Regeneration. INTERNATIONAL REVIEW OF CELL AND MOLECULAR BIOLOGY 2015; 319:45-106. [DOI: 10.1016/bs.ircmb.2015.07.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Sangwan VS, Jain R, Basu S, Bagadi AB, Sureka S, Mariappan I, Macneil S. Transforming ocular surface stem cell research into successful clinical practice. Indian J Ophthalmol 2014; 62:29-40. [PMID: 24492499 PMCID: PMC3955067 DOI: 10.4103/0301-4738.126173] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
It has only been a quarter of a century since the discovery of adult stem cells at the human corneo-scleral limbus. These limbal stem cells are responsible for generating a constant and unending supply of corneal epithelial cells throughout life, thus maintaining a stable and uniformly refractive corneal surface. Establishing this hitherto unknown association between ocular surface disease and limbal dysfunction helped usher in therapeutic approaches that successfully addressed blinding conditions such as ocular burns, which were previously considered incurable. Subsequent advances in ocular surface biology through basic science research have translated into innovations that have made the surgical technique of limbal stem cell transplantation simpler and more predictable. This review recapitulates the basic biology of the limbus and the rationale and principles of limbal stem cell transplantation in ocular surface disease. An evidence-based algorithm is presented, which is tailored to clinical considerations such as laterality of affliction, severity of limbal damage and concurrent need for other procedures. Additionally, novel findings in the form of factors influencing the survival and function of limbal stem cells after transplantation and the possibility of substituting limbal cells with epithelial stem cells of other lineages is also discussed. Finally this review focuses on the future directions in which both basic science and clinical research in this field is headed.
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Affiliation(s)
- Virender S Sangwan
- Clinical Trial Center, Dr. Paul Dubord Chair in Cornea, L V Prasad Eye Institute, Hyderabad, Andhra Pradesh, India
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Zhou Q, Liu XY, Ruan YX, Wang L, Jiang MM, Wu J, Chen J. Construction of corneal epithelium with human amniotic epithelial cells and repair of limbal deficiency in rabbit models. Hum Cell 2014; 28:22-36. [PMID: 25134797 DOI: 10.1007/s13577-014-0099-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2014] [Accepted: 07/31/2014] [Indexed: 12/13/2022]
Abstract
This study aims to evaluate the effect of a human amniotic epithelial cell (HAEC)-rabbit corneal stroma tissue-engineered cornea on ocular reconstruction in three different animal models. HAECs were isolated from human placenta, seeded onto rabbit corneal stroma. HAECs-rabbit corneal stroma tissue engineering cornea transplantation was examined in three distinct rabbit models: transplantation of cornea constructed (1) with lamellar corneal HAECs and rabbit corneal stroma, (2) with central corneal HAECs and rabbit corneal stroma, or (3) with full-thickness corneal HAECs and rabbit corneal stroma. In the tissue engineering corneal transplantation groups in all three models, the mean number of days to corneal epithelial healing was significantly shorter than that in the control group and the mean number of days to corneal neovascularization was significantly greater than in the control group. In addition, in the tissue engineering corneal transplantation groups in the central lamellar cornea model and the full-thickness corneal transplantation model neovascularization, corneal turbidity, and epithelial fluorescence were significantly less than in the control groups. HAECs can be induced to differentiate into corneal epithelial cells, which may be suitable for the reconstruction of the corneal epithelium in cases of limbal stem cell deficiency.
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Affiliation(s)
- Qing Zhou
- Department of Ophthalmology, The First Affiliated Hospital of Jinan University, Guangzhou, 510630, Guangdong, People's Republic of China
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Pınarlı FA, Okten G, Beden U, Fışgın T, Kefeli M, Kara N, Duru F, Tomak L. Keratinocyte growth factor-2 and autologous serum potentiate the regenerative effect of mesenchymal stem cells in cornea damage in rats. Int J Ophthalmol 2014; 7:211-9. [PMID: 24790860 DOI: 10.3980/j.issn.2222-3959.2014.02.05] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2013] [Accepted: 11/25/2013] [Indexed: 01/07/2023] Open
Abstract
AIM To investigate the healing process after severe corneal epithelial damage in rats treated with mesenchymal stem cells (MSCs) cultured with or without keratinocyte growth factor (KGF-2) and autologous serum (AS) on amniotic membrane (AM). Many patients are blind and devastated by severe ocular surface diseases due to limbal stem cell deficiency. Bone marrow-derived MSCs are potential sources for cell-based tissue engineering to repair or replace the corneal tissue, having the potential to differentiate to epithelial cells. METHODS The study included 5 groups each including 10 female "Sprague Dawley" rats in addition to 20 male rats used as bone marrow donors. Group I rats received AM+MSCs, Group II rats AM+MSCs cultured with KGF-2, Group III rats AM+MSCs cultured with KGF-2+AS, Group IV rats only AM and Group V rats, none. AS was derived from blood drawn from male rats and bone marrow was obtained from the femur and tibia bones of the same animals. Therapeutic effect was evaluated with clinical, histopathological and immunohistochemical assessment. MSC engraftment was demonstrated via detection of donor genotype (Y+) in the recipient tissue (X) with polymerase chain reaction. RESULTS Corneal healing was significantly better in Groups I-III rats treated with MSC transplantation compared to Group IV and Group V rats with supportive treatment only. The best results were obtained in Group III rats with 90% transparency, 70% lack of neovascularization, and 100% epithelium damage limited to less than 1/4 of cornea. CONCLUSION We suggest that culture of MSCs with KGF-2 and AS on AM is effective in corneal repair in case of irreversible damage to limbal stem cells.
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Affiliation(s)
- Ferda Alpaslan Pınarlı
- Department of Medical Biology and Genetics, Faculty of Medicine, Ondokuz Mayis University, Samsun 55270, Turkey
| | - Gülsen Okten
- Department of Medical Biology and Genetics, Faculty of Medicine, Ondokuz Mayis University, Samsun 55270, Turkey
| | - Umit Beden
- Department of Ophthalmology, Faculty of Medicine, Ondokuz Mayis University, Samsun 55270, Turkey
| | - Tunç Fışgın
- Department of Pediatric Hematology, Faculty of Medicine, Ondokuz Mayis University, Samsun 55270, Turkey
| | - Mehmet Kefeli
- Department of Pathology, Faculty of Medicine, Ondokuz Mayis University, Samsun 55270, Turkey
| | - Nurten Kara
- Department of Medical Biology and Genetics, Faculty of Medicine, Ondokuz Mayis University, Samsun 55270, Turkey
| | - Feride Duru
- Department of Pediatric Hematology, Faculty of Medicine, Ondokuz Mayis University, Samsun 55270, Turkey
| | - Leman Tomak
- Department of Medical Biostatistics, Faculty of Medicine, Ondokuz Mayis University, Samsun 55270, Turkey
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