Department of Ophthalmology and Visual Neurosciences, University of Minnesota, Minneapolis, Minnesota, USA.
Curr Opin Ophthalmol. 2023 Jul 1;34(4):311-323. doi: 10.1097/ICU.0000000000000961. Epub 2023 Apr 25.
To discuss bioengineered tissue-cellular products for treatment of corneal diseases that are currently in clinical use. These include tissue-cellular products that have received regulatory approval, are being used off-label in clinical practice, or are in active use in clinical trials.
Due to the global shortage of donor corneal tissue, significant efforts have been made to develop bioengineering tissue-cellular products that can replace or augment the use of cadaveric tissue for corneal transplantation. The development of carrier substrates to support transplantation of cultivated limbal epithelial transplantation (CLET) has been a growing area of research. CLET offers a promising therapeutic alternative to conventional simple limbal epithelial transplantation and keratolimbal allografts for treatment of limbal stem cell deficiency. Engineered tissue matrices and porcine-derived corneas are potential alternatives to human donor tissue in anterior lamellar keratoplasty for corneal ulcers and scars, as well as intrastromal transplants for advanced keratoconus. For endothelial disease, substrate supported cultured endothelial cell grafts, and synthetic barrier devices are promising alternative to traditional endothelial keratoplasties.
There has been increasing interest in cellular and acellular bioengineered tissue-cellular and synthetic products for treatment of corneal diseases, and many of these products have already seen clinical use. Industry and academia have important roles in advancing these products to later phase clinical trials and comparing them to conventional allograft approaches. Future development of full thickness donor corneas with cultivated epithelium, endothelium, and stromal keratocytes in a biosynthetic matrix will likely be an important next step in tissue alternatives. Continued progress in this field will be critical for addressing the global disease burden from corneal blindness.
讨论目前临床应用的用于治疗角膜疾病的生物工程组织细胞产品。这些产品包括已获得监管部门批准、在临床实践中被超适应证使用或正在临床试验中积极使用的组织细胞产品。
由于全球供体角膜组织短缺，人们做出了巨大努力来开发生物工程组织细胞产品，以替代或补充用于角膜移植的尸体组织。为了支持培养的角膜缘上皮移植（CLET）的移植，载体基质的开发已经成为一个不断发展的研究领域。CLET 为治疗角膜缘干细胞缺陷提供了一种很有前途的治疗选择，可替代传统的单纯角膜缘上皮移植和角膜缘同种异体移植物。工程组织基质和猪源性角膜可能是前板层角膜移植治疗角膜溃疡和瘢痕以及用于治疗晚期圆锥角膜的基质内移植的人供体组织的替代物。对于内皮疾病，基质支持的培养内皮细胞移植物和合成屏障装置是传统内皮角膜移植术的一种有前途的替代方法。
人们对用于治疗角膜疾病的细胞和去细胞生物工程组织细胞及合成产品越来越感兴趣，其中许多产品已经在临床上得到应用。工业界和学术界在将这些产品推进到后期临床试验并与传统同种异体移植方法进行比较方面发挥着重要作用。在生物合成基质中培养的具有上皮、内皮和基质角膜细胞的全厚供体角膜的进一步发展可能是组织替代物的重要下一步。该领域的持续进展对于解决全球角膜盲疾病负担至关重要。
