Classifications

• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61L—METHODS OR APPARATUS FOR STERILISING MATERIALS OR OBJECTS IN GENERAL; DISINFECTION, STERILISATION OR DEODORISATION OF AIR; CHEMICAL ASPECTS OF BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES; MATERIALS FOR BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES
  • A61L27/00—Materials for grafts or prostheses or for coating grafts or prostheses
  • A61L27/36—Materials for grafts or prostheses or for coating grafts or prostheses containing ingredients of undetermined constitution or reaction products thereof, e.g. transplant tissue, natural bone, extracellular matrix
  • A61L27/3604—Materials for grafts or prostheses or for coating grafts or prostheses containing ingredients of undetermined constitution or reaction products thereof, e.g. transplant tissue, natural bone, extracellular matrix characterised by the human or animal origin of the biological material, e.g. hair, fascia, fish scales, silk, shellac, pericardium, pleura, renal tissue, amniotic membrane, parenchymal tissue, fetal tissue, muscle tissue, fat tissue, enamel
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
  • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
  • A61F2/02—Prostheses implantable into the body
  • A61F2/14—Eye parts, e.g. lenses or corneal implants; Artificial eyes
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
  • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
  • A61F2/02—Prostheses implantable into the body
  • A61F2/14—Eye parts, e.g. lenses or corneal implants; Artificial eyes
  • A61F2/142—Cornea, e.g. artificial corneae, keratoprostheses or corneal implants for repair of defective corneal tissue
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K35/00—Medicinal preparations containing materials or reaction products thereof with undetermined constitution
  • A61K35/12—Materials from mammals; Compositions comprising non-specified tissues or cells; Compositions comprising non-embryonic stem cells; Genetically modified cells
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61L—METHODS OR APPARATUS FOR STERILISING MATERIALS OR OBJECTS IN GENERAL; DISINFECTION, STERILISATION OR DEODORISATION OF AIR; CHEMICAL ASPECTS OF BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES; MATERIALS FOR BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES
  • A61L27/00—Materials for grafts or prostheses or for coating grafts or prostheses
  • A61L27/36—Materials for grafts or prostheses or for coating grafts or prostheses containing ingredients of undetermined constitution or reaction products thereof, e.g. transplant tissue, natural bone, extracellular matrix
  • A61L27/38—Materials for grafts or prostheses or for coating grafts or prostheses containing ingredients of undetermined constitution or reaction products thereof, e.g. transplant tissue, natural bone, extracellular matrix containing added animal cells
  • A61L27/3804—Materials for grafts or prostheses or for coating grafts or prostheses containing ingredients of undetermined constitution or reaction products thereof, e.g. transplant tissue, natural bone, extracellular matrix containing added animal cells characterised by specific cells or progenitors thereof, e.g. fibroblasts, connective tissue cells, kidney cells
  • A61L27/3813—Epithelial cells, e.g. keratinocytes, urothelial cells
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61L—METHODS OR APPARATUS FOR STERILISING MATERIALS OR OBJECTS IN GENERAL; DISINFECTION, STERILISATION OR DEODORISATION OF AIR; CHEMICAL ASPECTS OF BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES; MATERIALS FOR BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES
  • A61L27/00—Materials for grafts or prostheses or for coating grafts or prostheses
  • A61L27/36—Materials for grafts or prostheses or for coating grafts or prostheses containing ingredients of undetermined constitution or reaction products thereof, e.g. transplant tissue, natural bone, extracellular matrix
  • A61L27/38—Materials for grafts or prostheses or for coating grafts or prostheses containing ingredients of undetermined constitution or reaction products thereof, e.g. transplant tissue, natural bone, extracellular matrix containing added animal cells
  • A61L27/3839—Materials for grafts or prostheses or for coating grafts or prostheses containing ingredients of undetermined constitution or reaction products thereof, e.g. transplant tissue, natural bone, extracellular matrix containing added animal cells characterised by the site of application in the body
• • C—CHEMISTRY; METALLURGY
  • C12—BIOCHEMISTRY; BEER; SPIRITS; WINE; VINEGAR; MICROBIOLOGY; ENZYMOLOGY; MUTATION OR GENETIC ENGINEERING
  • C12N—MICROORGANISMS OR ENZYMES; COMPOSITIONS THEREOF; PROPAGATING, PRESERVING, OR MAINTAINING MICROORGANISMS; MUTATION OR GENETIC ENGINEERING; CULTURE MEDIA
  • C12N5/00—Undifferentiated human, animal or plant cells, e.g. cell lines; Tissues; Cultivation or maintenance thereof; Culture media therefor
  • C12N5/0068—General culture methods using substrates
• • C—CHEMISTRY; METALLURGY
  • C12—BIOCHEMISTRY; BEER; SPIRITS; WINE; VINEGAR; MICROBIOLOGY; ENZYMOLOGY; MUTATION OR GENETIC ENGINEERING
  • C12N—MICROORGANISMS OR ENZYMES; COMPOSITIONS THEREOF; PROPAGATING, PRESERVING, OR MAINTAINING MICROORGANISMS; MUTATION OR GENETIC ENGINEERING; CULTURE MEDIA
  • C12N2533/00—Supports or coatings for cell culture, characterised by material
  • C12N2533/90—Substrates of biological origin, e.g. extracellular matrix, decellularised tissue
  • C12N2533/92—Amnion; Decellularised dermis or mucosa

Definitions

• This invention concerns epithelial stem cell and limbal stem cell deficiency and, more specifically, a method and graft for treating this problem of epithelial stem cell deficiency in, for example, the reconstruction of corneal surface.
• the normal ocular surface is covered by corneal, limbal and conjunctival epithelia.
• Severe limbal epithelial damage due to: chemical or thermal burns, Stevens- Johnson syndrome, ocular cicatricial pemphigoid, multiple surgeries and cryotherapies at the limbal region, contact lens wears and severe microbial infection can lead to limbal and epithelial stem cell deficiency.
• Limbal epithelial stem cell deficiency usually is manifested with conjuctivalization, vascularization, chronic inflammation and fibrous ingrowth onto the corneal surface and corneal opacification.
• limbal stem cells and epitheleal cells from a small limbal biopsy taken from a healthy eye, and in culture are expanded on a specially treated amniotic membrane.
• Employing such amniotic membrane as a substrate helps restore a non-inflamed limbal stroma and expand the limbal stem and epitheleal stem cell populations.
• the resulting X ⁇ product" can be transplanted, as a graft, to a denuded corneal surface, following superficial heretectomy to remove fibrovascular ingrowth.
• a biopsy of healthy epithelial cells is from an adjacent tissue area, having the same or similar biologic/histologic characteristics, i.e. histocompatible with the damaged area.
• a PREFERRED EMBODIMENT Limbal biopsy is performed on a healthy eye, which can be a fellow eye of a patient or from another living individual.
• the eye lid is sterilized with Betadine® (prvidone-iodine) .
• Betadine® porvidone-iodine
• 1 to 2 mm 2 of the limbal tissue, containing epithelial cells and part of the corneal stroma tissue is separated from the limbal margin and excised from superficial corneal stroma by lamellar keratectomy, with No. 66 Beaver® blade (Becton Dickinson, Franklin Lakes, NJ) .
• the tissue is placed in a 35 mm dish containing 1.5 ml of culture medium, having per ml: DMEM (Dulbecco's modified Eagle's medium) and Ham's F12 (1:1 ratio), supplemented with 0.5% DMSO (dimethyl sulfoxide) , 2 ug mouse EGF (epidermal growth factor), 1 ug bovine insulin, 0.1 ug cholera toxin and 5% fetal bovine serum and it is sent immediately to the laboratory for culture in a sterile, laminar flow hood.
• DMEM Dynamic fetal
• Ham's F12 1: 1 ratio
• Amniotic membrane (obtained from Bio Tissue, Miami, FI . ) is used as a culture system and is obtained, processed and preserved as reported by Tseng SCG in Am. J. Opthalmol 1997; 124:765-774 and Tseng U.S. Patent 6,452,142, the teaching of which is incorporated herein.
• the amniotic membrane, with basement membrane side up, is affixed smoothly onto a culture
• the limbal explant with the epithelial stem cells is planted/transferred onto the basement membrane side of the amniotic membrane in a 35 mm dish containing 1 ml of the above described culture medium.
• the medium is changed every two days, and the culture is maintained for 2 to 3 weeks, by which time the epithelial stem cells have grown and spread to form a cell layer covering an area of about 2 to 3 cm in diameter, for corneal surface reconstruction.
• epithelial stem cell layer area can be employed, as needed.
• corneal repair following periotomy at the limbus, the perilimbal subconjunctival scar and inflamed tissues are removed to the bare sclera.
• the fibrovascular tissue of cornea is removed by lamellar keratectomy, with No. 57 and 66 Beaver blades, in a manner similar to that described for allograft limbal transplantation (Tsai and Tseng Cornea 1994; 13:389-400).
• the cultivated limbal epithelial stem cells with the amniotic membrane is used as a sectorial limbal corneal graft, or a limbal equivalent, fashioned according to the size of the recipient eye, and transplanted to the corresponding
• the novel graft is used as a whole lamellar corneal tissue, or a limbal corneal equivalent, and transplanted as lamellar keratoplasty to cover the entire area.
• a properly sized, cultured, epithelial stem cell sheet on the treated amniotic membrane substrate is affixed to cover the entire defect with the epithelial side up, which can be readily identified by fluorescent staining or by the presence of loosely attached original explant.
• the graft then is secured to the damaged site.
• securing can be by interrupted 10-0 nylon sutures on the corneal side, and interrupted 8-0 Vicryl® sutures to the surrounding conjunctival edge with episcleral anchorage.
• the cultured epithelium stem cell layer is protected from exposure, drying and abrasion by a coating of sodium hyaluronic (hyaluronate) acid Healon® (Pharmacia & Upjohn AB, Uppsala, Sweden) .
• the original explant tissue can be removed from the amniotic membrane at the end of surgery.
• a therapeutic contact lens is placed the next day, for one week; and topical prednisolone acetate 1% solution is administered four times a day for the first week, twice a day for the next two weeks, and followed by 0.1% fluorometholone twice a day for 2 to 3 months, depending on the severity of conjunctival inflammation around the surgical area.
• the explant is cultured onto the basement membrane side of the specially treated amniotic membrane.
• the epithelial stem cells grow to form a sheet approximately 2 to 3 cm 2 in size on the amniotic membrane.
• Flat-mount preparation shows the epithelial stem cell layer is negative to PAS and Alcian blue staining; and the bare amniotic membrane is stained purple.
• Histological examinations show that epithelial sheet is composed of 4 to 5 stem cell layers at the margin of the sheet and from 1 to 4 cell layers in the area between the margin and original explant tissue.
• Ultrastructural examinations reveal the presence of loose and wide intercellular spaces and basement membrane structure, with focal condensation of electron-dense ground substance at the basal cell-amniotic membrane junction.
• a mean ( ⁇ SD) follow-up period of 14.8+1.9 months shows varying degrees of visual improvement based on the Snellen visual acuity scale. All eyes show complete re- epithelialization in 2 to 4 days with a mean ( ⁇ SD) period of 2.7 ⁇ 0.8 days. The reconstructed corneal surfaces show reduced inflammation and regression of vascularization within 1 to 2 weeks. One month after operation, the corneal clarity is improved and the surface smooth and wettable.
• the cultured epithelial stem cells expanded on a specially prepared amniotic membrane substrate, can be used as a limbal equivalent or a limbal-corneal equivalent.
• amniotic membrane based autologous epithelial stem cells for transplantation also provides all the beneficial effects inherent in amniotic membrane transplantation, including facilitating epithelization, reducing inflammation and scarring, and substrate replacement when the underlying stromal tissue is destroyed.
• amniotic membrane, pre-treated according to Tseng provides a natural substrate for epithelial stem cells to be preserved and expand, forming the autologous cell mass necessary for corneal reconstruction.
• immunosuppression is not required after transplantation.
• the rejection rate may be lessened, since only epithelial stem cells, without other cell types, are transplanted.
• this unique graft and the method of its forming, by use of specially treated amniotic membrane, upon which epithelial stem cells from an explant are expanded have uses beyond that of eye surgery, for example, repair of burned skin areas; especially when the donor site of the explant needs to be small.
• the biopsy from which the small explant is obtained, need not be of limbal tissue.
• the explant is to have healthy tissue, contain epithelial stem cells and be histocompatible with the recipient site for the graft. If the biopsy cannot be from the same body part as the recipient site, a corresponding similar body part can be chosen for the explant; just as in the preferred example of a damaged eye being the recipient site and the other eye — the healthy eye — providing donor explant.

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• 2001
  • 2001-04-25 WO PCT/US2001/013321 patent/WO2001080760A1/en not_active Ceased
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  • 2001-04-25 CN CNB018081649A patent/CN1296102C/zh not_active Expired - Fee Related
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