Corneal epithelial stem cells for corneal injury

ABSTRACT

Introduction: Ocular surface diseases with limbal insufficiency represent a therapeutic challenge for restoring vision. This corneal deficiency includes both classical ocular diseases (as chemical burns) and rare ocular diseases (as congenital aniridia and ocular cicatricial pemphigoid).

Areas covered: Our understanding of limbal epithelial stem cells (LESCs) has increased the potential for treatment options. Pharmacological treatment strategies (as regenerating agent ophthalmic solutions) and especially surgical treatment strategies are available. Isolated LESCs can be produced by limbal primary cultures obtained from explants or cell suspensions. We review the latest cornea surgery techniques.

Expert opinion: The adjunction of human limbal mesenchymal cells as a support for limbal stem cell primary cultures appears to be of great interest. Recently, human-induced pluripotent stem cells have allowed the generation of minicorneal organoids. This potential means of creating a three-dimensional cornea with in vitro maturation opens up important research areas for corneal regeneration therapy.

KEYWORDS:

• Cornea
• induced pluripotent stem cells (iPSCs)
• limbal primary cultures
• limbal stem cell deficiency
• limbal stem cells (LSCs)
• simple limbal epithelial transplantation (SLET)
• limbal autograft transplantation
• corneal epithelial transplantation
• aniridia
• corneal chemical burns

Article highlights

Corneal epithelium is maintained by a distinct population of unipotent stem cells located in the basal epithelium of the corneoscleral limbus in limbal niches named ‘palisades of Vogt’. We review innovative therapies, medical or surgical, for limbal stem cells deficiency.

• New ophthalmic solutions for treating severe corneal dystrophies and treatment-resistant corneal ulcers can be of great interest.

• An innovative research method for generating complex 3D corneal organoids from human pluripotent stem cells, defined as minicorneas, may have an application in bilateral limbal defects.

• There are two main methods for producing limbal primary cultures mostly fresh: explant culture technique and suspension culture technique. Limbal autograft transplantation is a useful surgical procedure for treating unilateral limbal stem cells deficiency.

• Concerning limbal stem cells deficiency, challenges remain such as improving regeneration of the ocular surface.

This box summarizes key points contained in the article.

Declaration of Interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial relationships or otherwise to disclose.

Additional information

Funding

This paper is not funded.