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角膜基质替代物替代眼部原生组织 Alternatives to eye bank native tissue for corneal stromal replacement

Brunette I, Roberts CJ, Vidal F, Harissi-Dagher M, Lachaine J, Sheardown H, Durr GM, Proulx S, Griffith M

期刊名称:Progress in Retinal and Eye Research

卷期:2017年第59卷

摘要

摘要:角膜盲是全球主要致盲原因,角膜移植是恢复视力的唯一广泛接受的治疗方法。然而,眼库越来越难以满足不断增长的对可移植组织的需求,部分原因是人口老龄化。因此,供体组织短缺受到了全球越来越多的关注,需要人类供体角膜的替代品。与天然角膜相比,生物合成角膜替代物具有几个显着的优点:大规模生产为全球人类供体角膜严重短缺提供了强大的潜在解决方案;良好的制造方法确保了无菌和质量控制;去细胞角膜替代物减少了由于同种异体细胞诱导免疫排斥反应;植入物的光学和生物力学性质可以适应临床需要;最后这些角膜替代物可以从生物材料科学的新进展中受益,如表面涂层,功能化和纳米粒子。本综述重点介绍了角膜基质替代品实验室的重要贡献。它重点研究了合成惰性假体(角膜假体),具有和不具有内源性再生强化的无细胞支架和基于细胞的替代物。重点放在这些生物材料的物理性质和生物相容性上,一旦在动物或人眼中移植后体内的功能和临床预后,以及角膜基质替代物的主要挑战。还讨论了监管和经济方面的问题。所有这些观点突出了角膜基质替代物临床应用的基本原则,这一概念已经成为现实。

 

Corneal blindness is a major cause of blindness in the world and corneal transplantation is the only widely accepted treatment to restore sight in these eyes. However, it is becoming increasingly difficult for eye banks to meet the increasing demand for transplantable tissue, which is in part due to population aging. Donor tissue shortage is therefore a growing concern globally and there is a need for alternatives to human donor corneas. Biosynthetic corneal substitutes offer several significant advantages over native corneas: Large-scale production offers a powerful potential solution to the severe shortage of human donor corneas worldwide; Good manufacturing practices ensure sterility and quality control; Acellular corneal substitutes circumvent immune rejection induced by allogeneic cells; Optical and biomechanical properties of the implants can be adapted to the clinical need; and finally these corneal substitutes could benefit from new advances in biomaterials science, such as surface coating, functionalization and nanoparticles. This review highlights critical contributions from laboratories working on corneal stromal substitutes. It focuses on synthetic inert prostheses (keratoprostheses), acellular scaffolds with and without enhancement of endogenous regeneration, and cell-based replacements. Accent is put on the physical properties and biocompatibility of these biomaterials, on the functional and clinical outcome once transplanted invivo in animal or human eyes, as well as on the main challenges of corneal stromal replacement. Regulatory and economic aspects are also discussed. All of these perspectives combined highlight the founding principles of the clinical application of corneal stromal replacement, a concept that has now become reality.


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