Aktuelle und zukünftige Therapieoptionen bei Erkrankungen der Limbusstammzellen

Zusammenfassung

Die Limbusstammzelltransplantation stellt eine der größten Herausforderungen in der chirurgischen Therapie von Augenoberflächenerkrankungen dar. Während Patienten mit einseitiger oder partieller Limbusstammzellinsuffizienz (LSI) mit autologen lamellären Limbustransplantaten vom Partnerauge versorgt werden, kann bei fortgeschrittener beidseitiger, aber noch partieller LSI eine Ex-vivo-Expansion autologer Limbusstammzellen auf Amnionmembran durchgeführt werden. Diese Technik wurde in den letzten Jahren im Bereich der Substrate, auf denen die Zellen wachsen, weiterentwickelt. Dagegen kann die beidseitige komplette LSI nur durch Transplantation allogenen Limbusgewebes behandelt werden, was immunologische Risiken birgt, jedoch durch den Einsatz von Mitomycin C und Amnionmembran verbessert werden konnte. Ob dieses Verfahren in Zukunft durch die Transplantation ex vivo expandierter oraler Mukosa als Ersatz des kornealen Epithels abgelöst wird, müssen zukünftige Studien noch klären. Während rein experimentelle Ansätze zur Transdifferenzierung von Knochenmarksstammzellen zu epithelialen Zellen als nicht durchführbar verworfen wurden, könnte die Verwendung von transdifferenzierten Haarfollikelstammzellen als Ersatz für korneales Epithel vielversprechender sein. Diese Versuche reichen aktuell jedoch noch nicht über das In-vitro-Stadium hinaus.

Abstract

Therapy for limbal stem cell insufficiency (LSCI) is one of the most challenging tasks in ocular surface surgery. Partial and unilateral LSCI can be treated by fractionated abrasion or autologous limbal stem cell transplantation from the fellow eye. In cases of advanced bilateral and partial LSCI, transplantation of ex vivo expanded sheets of limbal stem cells on amniotic membrane or fibrin may be performed. All patients with complete bilateral LSCI must rely on allogenic limbal stem cell transplantation comprising higher immunological risks. Progress using this technique has been achieved by the application of mitomycin C and amniotic membrane. Alternatively, transplantation of ex vivo expanded oral mucosal sheets may be used in bilateral LSCI, but only few long-term data are available on this technique as yet. While experimental attempts to use transdifferentiated bone marrow stem cells as a substitute for corneal epithelial cells have been without success, transdifferentiation of hair follicle stem cells to corneal epithelial cells may be more promising due to the identical lineage. But these experiments have not gone beyond the in vitro stage yet.

Schlüsselwörter

Limbusstammzellinsuffizienz - Limbusstammzellnische - Transdifferenzierung - Limbus - Transplantation - Keratoplastik

Key words

limbal stem cells insufficiency - limbal stem cell niche - transdifferentiation - limbal stem cell - transplantation - keratoplasty

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