Transplantation, limbal stem cell

Stoiber, J., Muss, W.H., Pohla-Gubo, G., Ruckhofer, J., Grabner, G. Histopathology of human corneas after amniotic membrane and limbal stem cell transplantation for severe chemical burn. Cornea 21, 482-489 (2002)... 

Fogla, R., Padmanabhan, R Deep anterior lamellar keratoplasty combined with autologous limbal stem cell transplantation in unilateral severe chemical injury. Cornea 24, 421-425 (2005)... 

More severe burns typically require extensive medical and surgical treatment. Ascorbate and citrate have been shown to reduce the risk of corneal ulceration and perforation.The use of topical sodium citrate 10% and topical sodium ascorbate 10% every 2 hours and oral vitamin C (500 mg) every 6 hours has been recommended fc>r grades n, HI, and IV burns. Oral tetracyclines have also been shown to reduce collagenase activity, decreasing corneal ulceration after chemical burns. Doxycycline 100 mg twice daily is recommended for grades n, HI, and IV chemical burns. Surgical options include conjimctival transplantation, amniotic membrane transplantation, limbal stem cell transplantation, and lamellar keratoplasty. 

It has been well known for a long time that the renewal of the comeal epithelium depends on the lim-bal stem cells. At first considered as a simple theory [7], supported by several publications [8, 14], the lim-bal stem cells are now coimnonly used in transplantation as a treatment to numerous pathologies including bums. This transplantation of limbal stem cells is one of the rare successful cases of therapeutic use of stem cells for human patients [7]. 

Gomes, J.A., Dos Santos, M.S., Cunha, M.C., Mascaro, V.L., Barros, J.N., De Sousa, L.B. Amniotic membrane transplantation for partial and total limbal stem cell deficiency secondary to chemical bum. Ophthalmology 110, 466-473 (2003)... 

A successful clinical study was conducted by using limbal-derived cell sheets for the treatment of patients suffering from unilateral total corneal stem-cell deficiencies [18], which resulted from alkali burns or Stevens-Johnson syndrome. In the case of bilateral total comeal stem-cell deficiencies, an autologous oral mucosal epithelial cell sheet was transplanted onto the ocular surface [19]. A clinical trial in France for the treatment of a bilateral limbal stem-cell deficiency had been conducted by using autologous oral mucosal epithelial cell sheets [20]. Through this clinical trial, the treatment was safe and effective in 25 cases with a 1-year follow-up, although two patients experienced serious adverse events, which were not related to the transplantation of the cell sheets. 

D. Amniotic membrane transplantation with or without lim-bal allografts for comeal surface reconstmction in patients with limbal stem cell deficiency. Arch Ophthalmol 116(4), 431-441 (1998)... 

Last, the surgical procedures such as keratoprosthe-sis [24] surgery and comeal and limbal transplantations are on the way to be developed. Yet, the transfer of cultured stem cells is a problem due to the need of mouse-derived feeder cells these might introduce new risks of disease transfer. Until those problems are not solved, these techniques are not applicable on humans, but these problems are likely to be solved in the near future [25]. 

Burillon, C., Huot, L., Justin, V., Nataf, S., Chapuis, R, DecuUier, E., et al. (2012). Cultured autologous oral mucosal epithelial cell sheet (CAOMECS) transplantation for the treatment of comeal limbal epithelial stem cell deficiency. Investigative Ophthalmology and Visual Science, 53, 1325-1331. 

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