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Personalized Medicine in Ophthalmology: Treatment of Total Limbal Stem Cell Deficiency with Autologous Ex Vivo Cultivated Limbal Epithelial Stem Cell Graft

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Personalized Medicine in Healthcare Systems

Part of the book series: Europeanization and Globalization ((EAG,volume 5))

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Abstract

Most of the blinding corneal diseases are treatable by corneal transplantation in which a corneal allograft is used. However, in severe corneal burns that often result in total limbal epithelial stem cell (LECS) deficiency, corneal transplantation alone is not feasible, as corneal graft in eyes without stem cells cannot survive. Total LESC deficiency is clinically characterized by growth of conjunctival tissue over the cornea, corneal neovascularization and opacification. It unfortunately affects mostly younger population. Two decades ago, it has been shown that a successful corneal graft in patients with corneal burns can only be performed as a second surgical act; namely only after transplantation of limbal stem cells cultivated ex vivo have restored a healthy anterior ocular surface. Cultivation of LESC ex vivo has been adopted as treatment of choice for such cases. Various carriers of LESC in vitro has been tested and clinically applied, such as fibrin, amniotic membrane and contact lens. LESC samples for cultivation in vitro can be autologous grafts harvested from the contralateral healthy eye (if only one eye has corneal burn), or allografts retrieved from a healthy relative or donor corneo-scleral rim. The most effective way of treatment is collection of healthy LESC from patient’s healthy eye, their multiplication ex vivo on certain carrier and final grafting of cultivated epithelial sheet on the diseased eye of the same patient. Transplantation of such LESC becomes a personalized ocular treatment as epithelial sheet of cells must be cultivated for each particular patient. Other sources of LESC for ex vivo cultures, such as allografts, are significantly less successful and has disadvantage that the patient must receive systemic immunosuppressive treatment with unwanted side-effects.

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Notes

  1. 1.

    Pellegrini et al. (1997).

  2. 2.

    Schwab et al. (2000), Rama et al. (2001) and Grueterich et al. (2003).

  3. 3.

    Rama et al. (2010) and Sangwan et al. (2011).

  4. 4.

    Pellegrini et al. (2001).

  5. 5.

    Di Iorio et al. (2005) and Schlötzer-Schrehardt and Kruse (2005).

  6. 6.

    Dhamodaran et al. (2015).

  7. 7.

    Chen and Tseng (1991) and Dua et al. (2003).

  8. 8.

    Kenyon and Tseng (1989) and Puangsricharern and Tseng (1995).

  9. 9.

    Kenyon and Tseng (1989) and Tsai et al. (2000).

  10. 10.

    Schwab (1999), Schwab et al. (2000) and James et al. (2001).

  11. 11.

    Lindberg et al. (1993), Koizumi et al. (2000) and Meller et al. (2002).

  12. 12.

    Pellegrini et al. (1997).

  13. 13.

    Sidney et al. (2015) and López-Paniagua et al.(2016).

  14. 14.

    Shimazaki et al. (2002), Zakaria et al. (2010), González et al. (2016) and Bobba et al. (2015).

  15. 15.

    Pathak et al. (2013) and O’Callaghan et al. (2016).

  16. 16.

    Dobrowolski et al. (2015) and Utheim (2015).

  17. 17.

    Priya et al. (2011).

  18. 18.

    Ahmadet al. (2007), Ho et al. (2011), Holan et al. (2015) and Brzeszczynska et al. (2014).

  19. 19.

    Dekaris and Gabrić (2009).

  20. 20.

    Tominac Trcin et al. (2016).

  21. 21.

    Tominac Trcin et al. (2016).

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Author information

Authors and Affiliations

  1. Specialty Eye Hospital ‘Svjetlost’, Department of Ophthalmology, University of Rijeka, Zagreb, Croatia

    Iva Dekaris, Nikica Gabrić & Adi Pašalić

  2. Tissue Bank, University Department of Traumatology, University Hospital “Sestre Milosrdnice”, Zagreb, Croatia

    Mirna Tominac-Trcin

  3. Department of Basic Natural and Technical Sciences, Faculty of Textile Technology, University of Zagreb, Zagreb, Croatia

    Budimir Mijović

Authors
  1. Iva Dekaris
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  2. Mirna Tominac-Trcin
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  3. Nikica Gabrić
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  4. Budimir Mijović
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  5. Adi Pašalić
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Editor information

Editors and Affiliations

  1. Faculty of Law, University of Rijeka, Rijeka, Croatia

    Nada Bodiroga-Vukobrat

  2. Croatian Academy of Sciences and Arts, Rijeka, Croatia

    Daniel Rukavina

  3. Juraj Dobrila University of Pula, Faculty of Medicine, Pula, Croatia

    Krešimir Pavelić

  4. Department of Biotechnology, Centre for High-Throughput Technologies, University of Rijeka, Rijeka, Croatia

    Krešimir Pavelić

  5. University of Applied Sciences, Ludwigsburg, Germany

    Gerald G. Sander

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Dekaris, I., Tominac-Trcin, M., Gabrić, N., Mijović, B., Pašalić, A. (2019). Personalized Medicine in Ophthalmology: Treatment of Total Limbal Stem Cell Deficiency with Autologous Ex Vivo Cultivated Limbal Epithelial Stem Cell Graft. In: Bodiroga-Vukobrat, N., Rukavina, D., Pavelić, K., Sander, G.G. (eds) Personalized Medicine in Healthcare Systems. Europeanization and Globalization, vol 5. Springer, Cham. https://doi.org/10.1007/978-3-030-16465-2_24

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  • DOI: https://doi.org/10.1007/978-3-030-16465-2_24

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