Офтальмохирургия. 2020; : 77-85
Клинические результаты трансплантации аутологичного культивированного эпителия полости рта при дисфункции стволовых клеток лимба роговицы
https://doi.org/10.25276/0235-4160-2020-4-77-85Аннотация
В обзоре представлен анализ результатов клинических исследований трансплантации аутологичного культивированного эпителия полости рта у пациентов с синдромом лимбальной недостаточности (СЛН) роговицы за последние 15 лет. Приведены подробная характеристика и оценка клинических исходов, динамики остроты зрения и частоты осложнений. Полученные в ходе анализа результаты подтверждают состоятельность концепции реэпителизации роговицы с помощью данной технологии. Трансплантация аутологичного культивированного эпителия полости рта способствует образованию стойкого эпителиального покрова в 81,5% случаев и увеличению остроты зрения в 78,8% у пациентов с СЛН. Технология не требует системной иммуносупрессивной терапии, а в сравнении с кератопротезированием сопровождается меньшим числом и тяжестью осложнений. У порядка 15% пациентов регистрируется развитие поверхностной периферической неоваскуляризации роговицы, спонтанно регрессирующей к 12 мес. наблюдений. Опираясь на результаты клинических исследований, тактика ведения пациентов с двусторонним СЛН требует дальнейшей оптимизации с учетом патогенеза основного заболевания. Таким образом, трансплантация аутологичного культивированного эпителия полости рта представляется перспективным научно-практическим направлением офтальмотрансплантологии, требующим дальнейшего углубленного изучения и широкого внедрения в клиническую практику.
Список литературы
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38. Dobrowolski D, Orzechowska-Wylegala B, Wowra B, et al. Cultivated oral mucosa epithelium in ocular surface reconstruction in aniridia patients. Biomed Res Int. 2015;2015: 281870. doi: 10.1155/2015/281870
39. Prabhasawat P, Ekpo P, Uiprasertkul M, et al. Long-term result of autologous cultivated oral mucosal epithelial transplantation for severe ocular surface disease. Cell Tissue Bank. 2016;17(3): 491–503. doi: 10.1007/s10561-016-9575-4
40. Baradaran-Rafii A, Delfazayebaher S, Aghdami N, et al. Midterm outcomes of penetrating keratoplasty after cultivated oral mucosal epithelial transplantation in chemical burn. Ocul Surf. 2017;15(4): 789–794. doi: 10.1016/j.jtos.2017.08.006
41. Kim YJ, Lee HJ, Ryu JS, et al. Prospective clinical trial of corneal reconstruction with biomaterial-free cultured oral mucosal epithelial cell sheets. Cornea. 2018;37(1): 76–83. doi: 10.1097/ICO.0000000000001409
42. Gopakumar V, Agarwal S, Srinivasan B, et al. Clinical outcome of autologous cultivated oral mucosal epithelial transplantation in ocular surface reconstruction. Cornea. 2019;38(10): 1273–1279. doi: 10.1097/ICO.0000000000002082
43. Всемирная организация здравоохранения. Нарушения зрения и слепота. Доступно по: https://www.who.int/ru/news-room/fact-sheets/detail/blindness-and-visual-impairment [Ссылка активна на 14.06.2020]. [World Health Organization. Blindness and vision impairment. Available from: https://www.who.int/news-room/fact-sheets/detail/blindness-and-visualimpairment [Accessed 14 June 2020].
44. Liu CY, Kao WW. Corneal epithelial wound healing. Prog Mol Biol Transl Sci. 2015;134: 61–71. doi: 10.1016/bs.pmbts.2015.05.002
Fyodorov Journal of Ophthalmic Surgery. 2020; : 77-85
Clinical outcomes of autologous cultured oral mucosal epithelium transplantation for treatment of limbal stem cell deficiency
https://doi.org/10.25276/0235-4160-2020-4-77-85Abstract
The review presents an analysis of clinical trials results for autologous cultured oral mucosal epithelium transplantation (COMET) in patients with bilateral corneal limbal stem cell deficiency (LSCD) over the past 15 years. Detailed characteristics and evaluation are given for anatomical outcomes, visual acuity changes, and complication rates. The results obtained during the analysis confirm the consistency of the concept of corneal re-epithelization by means of COMET. COMET promoted persistent corneal re-epithelization in 81.5% of cases, and visual acuity improvement in 78.8% of patients with LSCD. COMET does not require systemic immunosuppression, and it is accompanied by much smaller numbers and significantly lower grades of complications compared with keratoprosthesis. About 15% of patients experienced developing superficial peripheral corneal neovascularization regressed spontaneously by 12 months of observation. Based on the COMET clinical trials results, the management of patients with bilateral LSCD is under optimization by reference to the pathogenesis of the underlying disease. Thus, autologous cultured oral mucosal epithelium transplantation seems promising for further studies and introduction into routine clinical practice.
References
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24. Satake Y, Dogru M, Yamane GY, et al. Barrier function and cytologic features of the ocular surface epithelium after autologous cultivated oral mucosal epithelial transplantation. Arch Ophthalmol. 2008;126:23–28. doi: 10.1001/archopht.126.1.23
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26. Ma DH, Kuo MT, Tsai YJ, et al. Transplantation of cultivated oral mucosal epithelial cells for severe corneal burn. Eye. 2009;23: 1442–1450. doi: 10.1038/eye.2009.60
27. Nakamura T, Takeda K, Inatomi T, Sotozono C, Kinoshita S. Long-term results of autologous cultivated oral mucosal epithelial transplantation in the scar phase of severe ocular surface disorders. Br J Ophthalmol. 2011;95: 942–946. doi: 10.1136/bjo.2010.188714
28. Satake Y, Higa K, Tsubota K, Shimazaki J. Longterm outcome of cultivated oral mucosal epithelial sheet transplantation in treatment of total limbal stem cell deficiency. Ophthalmology. 2011;118: 1524–1530. doi: 10.1016/j.ophtha.2011.01.039
29. Priya CG, Arpitha P, Vaishali S, et al. Adult human buccal epithelial stem cells: Identification, ex vivo expansion, and transplantation for corneal surface reconstruction. Eye. 2011;25: 1641–1649. doi: 10.1038/eye.2011.230
30. Takeda K, Nakamura T, Inatomi T, et al. Ocular surface reconstruction using the combination of autologous cultivated oral mucosal epithelial transplantation and eyelid surgery for severe ocular surface disease. Am J Ophthalmol. 2011;152: 195–201. doi: 10.1016/j.ajo.2011.01.046
31. Burillon C, Huot L, Justin V, et al. Cultured autologous oral mucosal epithelial cell sheet (CAOMECS) transplantation for the treatment of corneal limbal epithelial stem cell deficiency. Investig Ophthalmol Vis Sci. 2012;53: 1325–1331. doi: 10.1167/iovs.11-7744
32. Chen HC, Yeh LK, Tsai YJ, et al. Expression of angiogenesis-related factors in human corneas after cultivated oral mucosal epithelial transplantation. Investig Ophthalmol Vis Sci. 2012;53: 5615–5623. doi: 10.1167/iovs.11-9293
33. Hirayama M, Satake Y, Higa K, Yamaguchi T, Shimazaki J. Transplantation of cultivated oral mucosal epithelium prepared in fibrin-coated culture dishes. Investig Ophthalmol Vis Sci. 2012;53: 1602–1609. doi: 10.1167/iovs.11-7847
34. Sotozono C, Inatomi T, Nakamura T, et al. Visual improvement after cultivated oral mucosal epithelial transplantation. Ophthalmology. 2013;120: 193–200. doi: 10.1016/j.ophtha.2012.07.053
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36. Sotozono C, Inatomi T, Nakamura T, et al. Cultivated oral mucosal epithelial transplantation for persistent epithelial defect in severe ocular surface diseases with acute inflammatory activity. Acta Ophthalmol. 2014;92: e447–e453. doi: 10.1111/aos.12397
37. Kolli S, Ahmad S, Mudhar HS, et al. Successful application of ex vivo expanded human autologous oral mucosal epithelium for the treatment of total bilateral limbal stem cell deficiency. Stem Cells. 2014;32: 2135–2146. doi: 10.1002/stem.1694
38. Dobrowolski D, Orzechowska-Wylegala B, Wowra B, et al. Cultivated oral mucosa epithelium in ocular surface reconstruction in aniridia patients. Biomed Res Int. 2015;2015: 281870. doi: 10.1155/2015/281870
39. Prabhasawat P, Ekpo P, Uiprasertkul M, et al. Long-term result of autologous cultivated oral mucosal epithelial transplantation for severe ocular surface disease. Cell Tissue Bank. 2016;17(3): 491–503. doi: 10.1007/s10561-016-9575-4
40. Baradaran-Rafii A, Delfazayebaher S, Aghdami N, et al. Midterm outcomes of penetrating keratoplasty after cultivated oral mucosal epithelial transplantation in chemical burn. Ocul Surf. 2017;15(4): 789–794. doi: 10.1016/j.jtos.2017.08.006
41. Kim YJ, Lee HJ, Ryu JS, et al. Prospective clinical trial of corneal reconstruction with biomaterial-free cultured oral mucosal epithelial cell sheets. Cornea. 2018;37(1): 76–83. doi: 10.1097/ICO.0000000000001409
42. Gopakumar V, Agarwal S, Srinivasan B, et al. Clinical outcome of autologous cultivated oral mucosal epithelial transplantation in ocular surface reconstruction. Cornea. 2019;38(10): 1273–1279. doi: 10.1097/ICO.0000000000002082
43. Vsemirnaya organizatsiya zdravookhraneniya. Narusheniya zreniya i slepota. Dostupno po: https://www.who.int/ru/news-room/fact-sheets/detail/blindness-and-visual-impairment [Ssylka aktivna na 14.06.2020]. [World Health Organization. Blindness and vision impairment. Available from: https://www.who.int/news-room/fact-sheets/detail/blindness-and-visualimpairment [Accessed 14 June 2020].
44. Liu CY, Kao WW. Corneal epithelial wound healing. Prog Mol Biol Transl Sci. 2015;134: 61–71. doi: 10.1016/bs.pmbts.2015.05.002
