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Regenerative Medicine pp 755–774Cite as

Regenerative Therapies for the Ocular Surface

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Abstract

Integrity of ocular surface depends on adequate tear film and stability of the surface epithelium consisting of two specialized phenotypically different epithelial cells – the central transparent corneal epithelium and the peripheral conjunctival cells, separated by a more specialized transition zone, called the limbus. Similar to the epithelial regeneration in other parts of the body, the corneal epithelium is regenerated from the stem cells located in limbus. Severe chemical burns and other diseases can cause damage to the limbus, resulting in a condition called Limbal Stem Cell Deficiency (LSCD). Effective therapeutic modalities for this vision-threatening condition include use of human amniotic membrane, replenishing the stores of limbal stem cells by limbal transplantation. However last decade has witnessed the use of ex-vivo expanded sheet of limbal epithelial cells for ocular surface reconstruction in such cases. Our group has established a simple, feeder-cell free, cost-effective way of culturing the corneal epithelium from limbal tissues within 2 weeks, using human amniotic membrane as a carrier. The interim results of a clinical trial involving 700 patients with severe unilateral and bilateral LSCD revealed 70 and 50% success at the end of 3 and 5 years respectively. For patients affected by bilateral condition, options include use of allogenic tissues with immunosuppressive therapy or use of autologous alternative sources of epithelium like oral mucosal epithelium, both of which show limited success. The pre-requisites for cell therapy are that the desired cells should be grown in sufficient amounts, should survive, integrate and network with the host tissues and cause no harm to the recipient. All these criteria are fulfilled when limbal epithelial cell therapy is used for ocular surface reconstruction thus making it a successful model in the emerging field of regenerative medicine.

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Acknowledgements

The authors wish to acknowledge all the patients of limbal stem cell deficiency who participated in the study. We wish to profusely thank Dr. G Chandra Sekhar, Director, LV Prasad Eye Institute, Dr. Gullapalli N Rao, Chairman, LV Prasad Eye Institute for their constant support and guidance. We also thank Karthik for assisting in figure designing.

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Authors and Affiliations

  1. School of Medical Sciences, University of Hyderabad, Prof C R Rao Road, Gachibowli, Hyderabad, 500 046, Andhra Pradesh, India

    Geeta K. Vemuganti M.D., DNB, FAMS, FICP

  2. Cornea and Anterior Segment, Ocular Immunology and Uveitis Services, Prof Brien Holden Eye Research Centre, L.V Prasad Eye Institute, Banjara Hills, Hyderabad, 500 034, Andhra Pradesh, India

    Virender S. Sangwan M.D.

  3. Sudhakar and Sreekanth Ravi Stem Cell Biology Laboratory, Prof Brien Holden Eye Research Centre, L.V. Prasad Eye Institute, Banjara Hills, Hyderabad, 500 034, Andhra Pradesh, India

    Indumathi Mariappan Ph.D.

  4. Prof Brien Holden Eye Research Centre, L.V Prasad Eye Institute, Banjara Hills, Hyderabad, 500 034, Andhra Pradesh, India

    Dorairajan Balasubramanian Ph.D.

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  1. Geeta K. Vemuganti M.D., DNB, FAMS, FICP
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  2. Virender S. Sangwan M.D.
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  3. Indumathi Mariappan Ph.D.
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  4. Dorairajan Balasubramanian Ph.D.
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Correspondence to Geeta K. Vemuganti M.D., DNB, FAMS, FICP .

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  1. Klinik und Poliklinik für Herzchirurgie, Universitätsklinikum Rostock, Schillingallee 35, Rostock, 18057, Germany

    Gustav Steinhoff

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Vemuganti, G.K., Sangwan, V.S., Mariappan, I., Balasubramanian, D. (2013). Regenerative Therapies for the Ocular Surface. In: Steinhoff, G. (eds) Regenerative Medicine. Springer, Dordrecht. https://doi.org/10.1007/978-94-007-5690-8_29

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