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Recent Advances in Stem Cell Therapy for Limbal Stem Cell Deficiency: A Narrative Review

Lookup NU author(s): Dr Ali Ghareeb, Professor Majlinda Lako, Professor Francisco Figueiredo

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This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).


Abstract

© 2020, The Author(s). Destruction of the limbus and depletion of limbal stem cells (LSCs), the adult progenitors of the corneal epithelium, leads to limbal stem cell deficiency (LSCD). LSCD is a rare, progressive ocular surface disorder which results in conjunctivalisation and neovascularisation of the corneal surface. Many strategies have been used in the treatment of LSCD, the common goal of which is to regenerate a self-renewing, transparent, and uniform epithelium on the corneal surface. The development of these techniques has frequently resulted from collaboration between stem cell translational scientists and ophthalmologists. Direct transplantation of autologous or allogeneic limbal tissue from a healthy donor eye is regarded by many as the technique of choice. Expansion of harvested LSCs in vitro allows smaller biopsies to be taken from the donor eye and is considered safer and more acceptable to patients. This technique may be utilised in unilateral cases (autologous) or bilateral cases (living related donor). Recently developed, simple limbal epithelial transplant (SLET) can be performed with equally small biopsies but does not require in vitro cell culture facilities. In the case of bilateral LSCD, where autologous limbal tissue is not available, autologous oral mucosa epithelium can be expanded in vitro and transplanted to the diseased eye. Data on long-term outcomes (over 5 years of follow-up) for many of these procedures is needed, and it remains unclear how they produce a self-renewing epithelium without recreating the vital stem cell niche. Bioengineering techniques offer the ability to re-create the physical characteristics of the stem cell niche, while induced pluripotent stem cells offer an unlimited supply of autologous LSCs. In vivo confocal microscopy and anterior segment OCT will complement impression cytology in the diagnosis, staging, and follow-up of LSCD. In this review we analyse recent advances in the pathology, diagnosis, and treatment of LSCD.


Publication metadata

Author(s): Ghareeb AE, Lako M, Figueiredo FC

Publication type: Review

Publication status: Published

Journal: Ophthalmology and Therapy

Year: 2020

Volume: 9

Pages: 809-831

Print publication date: 01/12/2020

Online publication date: 24/09/2020

Acceptance date: 15/09/2020

ISSN (print): 2193-8245

ISSN (electronic): 2193-6528

Publisher: Adis

URL: https://doi.org/10.1007/s40123-020-00305-2

DOI: 10.1007/s40123-020-00305-2


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