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Jenseits von Ästhetik – Regenerative Medizin bei schweren Erkrankungen der okulären Adnexe

Beyond esthetics—Regenerative medicine for severe diseases of the adnexa oculi

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An Erratum to this article was published on 04 August 2022

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Zusammenfassung

Hintergrund

Die Wiederherstellung der Lid- und Tränenfunktion sind wichtige Schritte auf dem Weg zu einer intakten Augenoberfläche. Für die Lidrekonstruktion und Tränendrüsenregeneration klinisch zur Verfügung stehende Ersatzgewebe bzw. Therapiemöglichkeiten stoßen bei Patienten mit schweren Erkrankungen der okulären Adnexe oft an ihre Grenzen. Mehrere Ansätze der regenerativen Medizin sind in den letzten Jahren intensiv erforscht und teilweise klinisch erprobt worden. Sie umfassen rekonstruktive Ansätze mit neuartigen Gewebematrices im Bereich der Lidchirurgie sowie Stammzelltherapien zur Wiederherstellung der Tränendrüsenfunktion.

Material und Methoden

Die aktuelle Literatur wird vorgestellt und ein Überblick über klinische angewandte sowie derzeit erforschte Gewebe zur Lidrekonstruktion gegeben. Weiterhin werden Ansätze zur Stammzelltherapie der Tränendrüse und eigene Ergebnisse vorgestellt.

Ergebnisse

Azelluläre Dermis wurde bereits mehrfach erfolgreich zur Lidrekonstruktion eingesetzt und stellt v. a. bei eingeschränkter Verfügbarkeit von autologem Gewebe eine mögliche Option dar. In vitro gezüchtete, zelluläre Konstrukte oder Gewebe mit gentechnisch veränderten Zellen wurden bereits in der Dermatologie zur Behandlung von Verbrennungen oder schweren Genodermatosen erfolgreich angewandt. Erste Studien zur Stammzelltherapie von schwerem trockenem Auge bei Sjögren-Syndrom zeigen eine sichere und effektive Anwendung von mesenchymalen Stammzellen nach Injektion in die Tränendrüse.

Schlussfolgerungen

Aufgrund der Limitationen von derzeit zur Verfügung stehenden Ersatzgeweben besteht klinisch ein Bedarf für die Entwicklung neuer Materialien für die Rekonstruktion der okulären Adnexe. In vitro gezüchtete Konstrukte mit allogenen und/oder gentechnisch veränderten Zellen finden langsam ihren Weg in die Klinik. Die Effektivität und Wirkungsweise von Stammzellen bei schwerem trockenem Auge werden aktuell klinisch erprobt.

Abstract

Background

Restoration of eyelid and lacrimal functions are important steps on the way to an intact ocular surface. Clinically available substitute tissues or therapeutic options for eyelid reconstruction and lacrimal gland regeneration often reach their limits in patients with severe diseases of the adnexa oculi. Several approaches in regenerative medicine have been intensively researched and clinically tested in recent years. These range from reconstructive approaches with novel tissue matrices in the field of eyelid surgery to stem cell therapies to regenerate lacrimal gland function.

Material and methods

The state of the art in the current literature is presented and an overview of clinically applied or currently researched tissues for eyelid reconstruction is given. Furthermore, approaches in stem cell therapy of the lacrimal gland as well as own results are presented.

Results

Acellular dermis has been successfully used for eyelid reconstruction and represents a viable option in cases of limited availability of autologous tissue. In vitro grown cellular constructs or tissues with genetically modified cells have already been successfully applied in dermatology for the treatment of burns or severe genodermatoses. First studies on stem cell therapy for severe dry eye in Sjögren syndrome showed a safe and effective application of mesenchymal stem cells by injection into the lacrimal gland.

Conclusion

Due to the limitations of currently available replacement tissues, there is a clinical need for the development of new materials for adnexa oculi reconstruction. Constructs grown in vitro with allogeneic and/or genetically engineered cells are slowly making their way into clinical practice. The efficacy and mode of action of stem cells in severe dry eye are subject matters of current clinical trials.

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Authors and Affiliations

  1. Klinik für Augenheilkunde, Universitätsklinikum Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Deutschland

    J. Witt,  M. Borrelli,  C. Holtmann &  G. Geerling

  2. Klinik für Augenheilkunde, Rigshospitalet-Glostrup, Universität Kopenhagen, Valdemar Hansens Vej 13, 2600, Glostrup, Dänemark

    M. Møller-Hansen &  S. Heegaard

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  1. J. Witt
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Correspondence to J. Witt.

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Interessenkonflikt

J. Witt, M. Møller-Hansen, M. Borrelli, C. Holtmann, S. Heegaard und G. Geerling geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien. Für Bildmaterial oder anderweitige Angaben innerhalb des Manuskripts, über die Patienten zu identifizieren sind, liegt von ihnen und/oder ihren gesetzlichen Vertretern eine schriftliche Einwilligung vor.

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In dem Originalbeitrag wurde der Name des Autors S. Heegaard fälschlicherweise als S. Heegard angegeben.

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Witt, J., Møller-Hansen, M., Borrelli, M. et al. Jenseits von Ästhetik – Regenerative Medizin bei schweren Erkrankungen der okulären Adnexe. Ophthalmologie 119, 878–890 (2022). https://doi.org/10.1007/s00347-022-01643-1

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