Abstract

The stem cells (SCs) of the corneal epithelium located in the limbal basal layer are the ultimate source to maintain corneal epithelial homeostasis. Like other adult tissue-specfic SCs, self renewal and fate decision of limbal SCs are regulated by a specialized in vivo microenvironment, termed “niche”. Loss of limbal SCs or dysfunction of the limbal niche renders corneas with a unique clinical disease labeled limbal stem cell deficiency (LSCD). Besides transplantation of autologous or allogeneic limbal SCs or amniotic membrane, a new strategy of treating LSCD is to transplant a bio-engineered graft by expanding limbal SCs ex vivo. Herein, we conduct a critical appraisal of six protocols that have successfully been practiced in treating human patients with LSCD, and identify issues whether niche regulation has been disrupted or maintained during isolation and expansion. Consequently, we propose a future direction that may circumvent the potential pitfalls existing in these conventional protocols by preserving the interaction between limbal SCs and their native niche cells during isolation and expansion. Such an approach may one day help realize considerable promise held by adult SCs in treating a number of diseases.

Keywords: Epithelium, ex vivo expansion, limbal stem cell deficiency, limbus, ocular surface, reconstruction, stem cells, niche cells, cytokeratin, transit amplifying cells, Vimentin-expressing, homeostasis, conjunctivalization, vascularization, inflammation, corneal transplantation, amniotic membrane, LSCD, trypsin/EDTA, Dispase, fibroblasts, xenogenic cells, single progenitor, fluorescent-activated cell, FACS, 3T3 fibroblast feeder layers, clonogenicity, stratification