Cell therapy may be new treatment pathway for regeneration of corneal stroma
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MILAN — Cellular therapy with adipose-derived mesenchymal stem cells implanted in the corneal stroma may be an alternative to corneal transplantation, according to a study presented here.
“We have performed the first-in-human trial in patients with advanced keratoconus using human autologous adipose-derived adult stem cells (ADASCs), and results at 3 years are encouraging,” Jorge Alió del Barrio, MD, said at the European Society of Cataract and Refractive Surgeons meeting.
Elective liposuction was performed in the abdomen or hips to extract and isolate the cells. A femtosecond laser-assisted intrastromal pocket was then performed in the mid stroma, and the cells were transplanted.
“We obtained a small improvement in all visual parameters, which is stable at 3 years. A mild mean improvement of 16.5 µm in the central corneal thickness was detected by anterior segment OCT at 6 months, correlating with the demonstration of newly formed collagen in the majority of the patients,” Alió del Barrio said.
ADASC survival was confirmed by confocal biomicroscopy. The shape of the cells changed from round to fusiform after 6 months, and 1 year later, they were not distinguishable from regular keratocytes.
“This was a possible sign that ADASCs have become adult cells,” Alió del Barrio said.
Anterior corneal densitometry decreased over 3 years, suggesting stromal remodeling leading to increased transparency. No complications and no inflammatory responses were observed.
These results are encouraging but should be considered carefully, according to Alió del Barrio.
“Two main questions remain,” he said. “Since we are using autologous cells of a patient who has a disease, are they potentially going to reproduce the same problem? Could allogenic cells be used instead? In addition, could collagen renewal be insufficient to rehabilitate a pathological thin cornea?”
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Alió del Barrio J. Corneal stromal enhancement with advanced cell therapy. Presented at: European Society of Cataract and Refractive Surgeons meeting; Sept. 16-20, 2022; Milan.
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