组织工程角膜内皮载体材料的研究进展

Recent advances in the carriers for tissue engineered corneal endothelium

学术背景:前房注射法移植角膜内皮细胞遭到失败,而采用载体法移植角膜内皮获得成功,提示了载体在组织工程角膜内皮体外构建与移植中的重要性。以各种材料为载体进行角膜内皮细胞体外培养与移植的实验研究广泛开展,获得了初步成功。但材料的免疫相容性、降解/溶解特性、亲细胞性、术后排斥反应、移植疾病传播等难题限制了角膜内皮体外构建与移植的发展,至今无法应用于临床实践。所以,寻找一种理想的载体材料一直是组织工程角膜内皮研究领域的重要课题和研究热点。目的:分析组织工程角膜内皮各种载体材料的优缺点,探索该领域还存在的难题和进一步发展方向。检索策略:应用计算机检索MEDLINE数据库和中国期刊全文数据库1973-01/2007-12的有关文献,检索词为"角膜内皮,组织工程,载体,材料,角膜移植,角膜构建",限定文章语言分别为英语和中文。共检索到986篇相关文献,其中中文文献645篇,英文文献341篇。根据本文文题和研究目的对文献进行筛选。纳入标准:①选取针对性强,相关度高的文献;②对同一领域的文献选择近期发表或权威杂志的文献;排除重复研究和Meta分析类文章。最后35篇论文被选用。文献评价:选用35篇文献,其中3篇为综述,其余均为临床与实验研究。资料综合:早期开始使用的材料主要有:异体角膜片、明胶薄膜、胶原凝胶、聚羟基乙酸和聚乳酸羟基乙酸、水凝胶膜等,而角膜基质/后弹力膜、羊膜基底膜、角膜基质片、复合生物膜是目前的研究热点。组织工程角膜内皮材料投入临床实践目前还存在许多难题。结论:组织工程角膜内皮载体材料各有优缺点,改善材料的亲细胞性、免疫原性和降解/溶解特性是今后的发展方向,并且应该加强对材料的人体效应和远期影响的研究。

BACKGROUND： It is a failure that corneal endothelial cells are transplanted by the injection into anterior chamber of the eyeball, while a carrier for tissue cultured corneal endothelial cells has achieved success. These results demonstrate many kinds of materials have been used as carriers for cultured corneal endothelial cells in the reconstruction of corneal endothelium in vitro, which has gained preliminary achievement, but there have been no reports of successfully reconstructed and developed human corneal endothelium due to the immuno-compatibility, degradation/resolution property, cytophile, post-operational rejection and transplantation disease, etc. Thus its clinical application is insufficient. Finding a kind of ideal carrier material is very urgent in field of tissue engineered corneal endothelium. OBJECTIVE： To investigate the advantages and disadvantages of carriers for tissue cultured corneal endothelial cells, and explore the existing problem and further development in the field of bioengineered corneal endothelium. RETRIEVAL STRATEGY： The relevant articles between January 1973 to December 2007 were recruited from MEDLINE and China Journal Full-text Database by using the key words of ＂cartier, materials, corneal endothelium, cornea transplantation, corneal reconstruction, tissue engineering＂ and the languages were limited to English and Chinese. The total number of enrolled articles was 986, 341 in English and 645 in Chinese. All the articles were screened according to the titles and objectives. Inclusive criteria： 1.articles with strong pertinence and close relationship.2.articles published in the recent years or on the authoritative journals were preferred in the same field. Exclusive criteria： repetitive articles and Meta analysis articles. At last, 35 articles were included. LITERATURE EVALUATION： Among 35 selected articles, three were reviews, while the others were clinical studies or experimental studies. DATA SYNTHESIS： Up to now, many kinds of materials have been used as carriers for cultured corneal endothelial cells, including heterologous cornea, collagen gel, gelatin membrane, hydrogel, polyglycolic acid and polylactic-co-glycolic acid, etc. while corneal stroma/Descemet＇s membrane, amniotic basal membrane, acellular corneal matrix, and poly-biomembrane are the popular carriers for cultured corneal endothelial cells. Many problems are still present in the clinical practice of tissue engineered corneal endothelium materials. CONCLUSION： Every carrier material for tissue engineered corneal endothelium has its advantages and disadvantages, the further development in this field is to improve the cytophile, immunogenicity and biodegradation/resolution of the materials. It is necessary to investigate the long-term effect on human body.