The evolving treatment options for patients with stem cell deficiency.
Sajjad Ahmad | | Opinion
Stem cells are essential to the maintenance of a healthy corneal epithelium. Without a continuous supply; for example, in limbal stem cell deficiency (LSCD), the ocular surface becomes unstable, leading to ocular pain, corneal erosions and decreased vision from stromal scarring or epithelial irregularity. Stem cells are typically damaged in one of two ways: through trauma, such as chemical assault or burn, or as a result of genetic disease. Rare congenital conditions, such as aniridia or ectodermal dysplasia, Stevens Johnson’s syndrome and mucous membrane pemphigoid can all cause significant damage to the surface of the eye. But with the advent of new therapies, there is hope for patients with LSCD. We can now take cells from a patient’s healthy eye and grow them in the lab, amplifying the cells until there are enough to transplant into the deficient eye. In my practice, we outsource our cells to an Italian lab with EMA-approval and NHS England-authorization. In cases where both patient’s eyes are diseased, we rely on external sources. For this, we take stem cells from donor eye tissue and immune suppress the patient to reduce risk of rejection. We recently published the world’s first randomized control trial for allogeneic stem cell treatment and the results were extremely promising (1). Interestingly, treatment options are no longer dependent on the availability of donor tissue. If there are no ocular stem cells available, we can take cells from non-ocular sources, such as the mouth – a process known as cultivated oral mucosal epithelial transplantation, or COMET. In cases where the clinician cannot – or does not want to – immune suppress the patient, COMET is an option; however, the results are not as good as those derived from corneal stem cells.
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