Utheim Tor Paaske, Aass Utheim Øygunn, Salvanos Panagiotis, Jackson Catherine J, Schrader Stefan, Geerling Gerd, Sehic Amer
Department of Medical Biochemistry, Oslo University Hospital, Norway.
Department of Ophthalmology, Drammen Hospital, Vestre Viken Hospital Trust, Norway.
Stem Cells Transl Med. 2018 May;7(5):415-427. doi: 10.1002/sctm.17-0257. Epub 2018 Mar 23.
Limbal stem cell deficiency (LSCD) can result from a variety of corneal disorders, including chemical and thermal burns, infections, and autoimmune diseases. The symptoms of LSCD may include irritation, epiphora, blepharospasms, photophobia, pain, and decreased vision. There are a number of treatment options, ranging from nonsurgical treatments for mild LSCD to various forms of surgery that involve different cell types cultured on various substrates. Ex vivo expansion of limbal epithelial cells (LEC) involves the culture of LEC harvested either from the patient, a living relative, or a cadaver on a substrate in the laboratory. Following the transfer of the cultured cell sheet onto the cornea of patients suffering from LSCD, a successful outcome can be expected in approximately three out of four patients. The phenotype of the cultured cells has proven to be a key predictor of success. The choice of culture substrate is known to affect the phenotype. Several studies have shown that amniotic membrane (AM) can be used as a substrate for expansion of LEC for subsequent transplantation in the treatment of LSCD. There is currently a debate over whether AM should be denuded (i.e., de-epithelialized) prior to LEC culture, or whether this substrate should remain intact. In addition, crosslinking of the AM has been used to increase the thermal and mechanical stability, optical transparency, and resistance to collagenase digestion of AM. In the present review, we discuss the rationale for using altered versus unaltered AM as a culture substrate for LEC. Stem Cells Translational Medicine 2018;7:415-427.
角膜缘干细胞缺乏症（LSCD）可由多种角膜疾病引起，包括化学和热烧伤、感染以及自身免疫性疾病。LSCD的症状可能包括眼刺激感、溢泪、眼睑痉挛、畏光、疼痛和视力下降。有多种治疗选择，从针对轻度LSCD的非手术治疗到涉及在各种基质上培养不同细胞类型的各种手术形式。角膜缘上皮细胞（LEC）的体外扩增涉及在实验室中在基质上培养从患者、活体亲属或尸体获取的LEC。将培养的细胞片转移到患有LSCD的患者角膜上后，大约四分之三的患者有望获得成功结果。已证明培养细胞的表型是成功的关键预测指标。已知培养基质的选择会影响表型。多项研究表明，羊膜（AM）可作为LEC扩增的基质，用于后续移植治疗LSCD。目前对于在LEC培养之前AM是否应去上皮（即剥除上皮），或者该基质是否应保持完整存在争议。此外，AM的交联已被用于提高AM的热稳定性和机械稳定性、光学透明度以及对胶原酶消化的抵抗力。在本综述中，我们讨论使用改变的和未改变的AM作为LEC培养基质的理论依据。《干细胞转化医学》2018年；7：415 - 427。
