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Corneal stromal regeneration—keratoconus cell therapy: a review

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Abstract

Background

Keratoconus is a corneal ectatic disease caused by stromal thinning leading to astigmatism and progressive loss of vision. Loss of the keratocytes and excessive degradation of collagen fibres by matrix metalloproteinases are the molecular signatures of the disease. Despite several limitations, corneal collagen cross-linking and keratoplasty are the most widely used treatment options for keratoconus. In the pursuit of alternative treatment modalities, clinician scientists have explored cell therapy paradigms for treating the condition.

Methods

Articles pertaining to keratoconus cell therapy with relevant key words were used to search in PubMed, Researchgate, and Google Scholar. The articles were selected based on their relevance, reliability, publication year, published journal, and accessibility.

Results

Various cellular abnormalities have been reported in keratoconus. Diverse cell types such as mesenchymal stromal cells, dental pulp cells, bone marrow stem cells, haematopoietic stem cells, adipose-derived stem cells apart from embryonic and induced pluripotent stem cells can be used for keratoconus cell therapy. The results obtained show that there is a potential for these cells from various sources as a viable treatment option.

Conclusion

There is a need for consensus with respect to the source of cells, mode of delivery, stage of disease, and duration of follow-up, to establish a standard operating protocol. This would eventually widen the cell therapy options for corneal ectatic diseases beyond keratoconus.

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Acknowledgements

The authors would also like to thank Dr Arkasubhra Ghosh, Dr P Narendra, and Dr K Bhujang Shetty for their administrative support needed for this work.

Funding

This study was funded by Narayana Nethralaya Foundation, India, and Velux Stiftung, Switzerland (Grant NO. 1695).

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Authors and Affiliations

  1. Department of Cornea and Refractive Surgery, Narayana Nethralaya Eye Hospital, Bangalore, India

    Rohit Shetty

  2. Stem Cell Research Lab, GROW Lab, Narayana Nethralaya Foundation, Narayana Nethralaya, Bangalore, India

    Krithikaa Mahendran, Parth D. Joshi & Debashish Das

  3. GROW Lab, Narayana Nethralaya Foundation, Narayana Nethralaya, Bangalore, India

    Nallathambi Jeyabalan

  4. Department of Vitreo-Retina, Narayana Nethralaya Eye Hospital, Bangalore, India

    Chaitra Jayadev

  5. Stem Cell Lab, GROW Lab, Narayana Nethralaya Foundation, Narayana Nethralaya Eye Hospital, Narayana Health City, 258/A Bommasandra Industrial Area, Bangalore, 560099, Karnataka, India

    Debashish Das

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Shetty, R., Mahendran, K., Joshi, P.D. et al. Corneal stromal regeneration—keratoconus cell therapy: a review. Graefes Arch Clin Exp Ophthalmol 261, 3051–3065 (2023). https://doi.org/10.1007/s00417-023-06064-7

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