Murine corneal transplantation: a model to study the most common form of solid organ transplantation

Integrated environmental and health economic assessments of novel xeno-keratografts addressing a growing public health crisis

Tissue scarcity poses global challenges for corneal transplantation and public health. Xeno-keratoplasty using animal-derived tissues offers a potential solution, but its environmental and economic implications remain unclear. This study evaluated two xeno-keratoplasty procedures at a single institution: (1) native corneas (Option 1) and (2) tissue-engineered corneal scaffolds derived from slaughterhouse waste (Option 2). Life cycle assessment (LCA) quantified environmental impacts across 18 midpoint indicators, while cost-effectiveness analysis (CEA) incorporated cost and environmental impact using two approaches. Option 1 exhibited significantly lower environmental impact than Option 2 across most indicators, primarily due to the energy and equipment demands of cell culture in Option 2. Both CEA approaches (carbon offset pricing and utility decrement) demonstrated cost-effectiveness dominance for Option 1. Xeno-keratoplasty using native corneas (Option 1) appears more environmentally and economically favorable than tissue-engineered scaffolds (Option 2) in the current analysis. Future studies could explore diverse xeno-keratoplasty techniques for optimizing sustainability.

Role of NK T cells in transplantation with particular emphasis on corneal transplantation

Natural killer T cells (NKT cells) are a unique subset of the immune system that possess characteristics of both an innate and adaptive immune response. This study reviews the reported roles of NKT cells in different solid transplantations such as cardiac, skin, liver, and corneal grafts as well as investigates a novel role of NKT cells in steroid-resistant corneal rejections. It is unknown why there is late corneal graft rejection despite being treated with immunosuppression. Our experimental data suggests NKT cells are playing a crucial part in steroid-resistant late graft rejections. While the pathophysiology of acute rejection is better understood, the process of chronic graft rejection is much less clear. Our data suggests NKT cells as a potential therapeutic target to prevent chronic transplant rejection which needs further investigation.

Impact of co-blocking the costimulatory signals on immune-related genes after high-risk rabbit corneal allograft using 2nd-generation DNA sequencing technology

The aim of this study was to evaluate the impact and mechanism of co-blocking of costimulatory signals CD28-B7-CD40-CD40L during immune allograft rejection. Forty-eight recipient rabbits were prepared as a high-risk corneal allograft model. After surgery, the animals were randomly divided into: control group, MR1 group, anti-B7 group, and co-blocking group (n=12, each group). Subconjunctival injection was first performed on the allograft surgery day until post-surgery day five. Four weeks later, or when immune rejection occurred, the cornea was sampled to detect and analyze the gene spectrum. The survival time in the co-blocking group was significantly longer than that in the other three groups (p < 0.05). Gene expression analysis revealed that the expression of genes associated with immune rejection, interleukin (IL)-1α, IL-1β, intercellular cell adhesion molecule-1, and IL-2 was down-regulated in the co-blocking group, while IL-10 was up-regulated, but the changes in nuclear factor-κB and interferon-γ were not significant. In conclusion, the co-blocking of costimulatory signals can significantly reduce genes that promote corneal allograft rejection. The inhibition of corneal allograft rejection gene expression was significantly enhanced. These gene expression results can explain the conclusion of previous work at the genetic level.

Decellularization and recellularization of cornea: Progress towards a donor alternative

The global shortage of donor corneas for transplantation has led to corneal bioengineering being investigated as a method to generate transplantable tissues. Decellularized corneas are among the most promising materials for engineering corneal tissue since they replicate the complex structure and composition of real corneas. Decellularization is a process that aims to remove cells from organs or tissues resulting in a cell-free scaffold consisting of the tissues extracellular matrix. Here different decellularization techniques are described, including physical, chemical and biological methods. Analytical techniques to confirm decellularization efficiency are also discussed. Different cell sources for the recellularization of the three layers of the cornea, recellularization methods used in the literature and techniques used to assess the outcome of the implantation of such scaffolds are examined. Studies involving the application of decellularized corneas in animal models and human clinical studies are discussed. Finally, challenges for this technology are explored involving scalability, automatization and regulatory affairs.

Angiogenesis and lymphangiogenesis in corneal transplantation-A review

Corneal transplantation has been proven effective for returning the gift of sight to those affected by corneal disorders such as opacity, injury, and infections that are a leading cause of blindness. Immune privilege plays an important role in the success of corneal transplantation procedures; however, immune rejection reactions do occur, and they, in conjunction with a shortage of corneal donor tissue, continue to pose major challenges. Corneal immune privilege is important to the success of corneal transplantation and closely related to the avascular nature of the cornea. Corneal avascularity may be disrupted by the processes of angiogenesis and lymphangiogenesis, and for this reason, these phenomena have been a focus of research in recent years. Through this research, therapies addressing certain rejection reactions related to angiogenesis have been developed and implemented. Corneal donor tissue shortages also have been addressed by the development of new materials to replace the human donor cornea. These advancements, along with other improvements in the corneal transplantation procedure, have contributed to an improved success rate for corneal transplantation. We summarize recent developments and improvements in corneal transplantation, including the current understanding of angiogenesis mechanisms, the anti-angiogenic and anti-lymphangiogenic factors identified to date, and the new materials being used. Additionally, we discuss future directions for research in corneal transplantation.

Exposure Stress Induces Reversible Corneal Graft Opacity in Recipients With Herpes Simplex Virus-1 Infections

Purpose

Most of the inflammation in murine herpes simplex virus type 1 (HSV-1)-induced stromal keratitis (HSK) is due to exposure stress resulting from loss of corneal nerves and blink reflex. Corneal grafts often fail when placed on corneal beds with a history of HSK. We asked if corneal exposure contributes to the severe pathology of corneal grafts on HSV-1–infected corneal beds.

Methods

Herpes simplex virus type 1–infected corneas were tested for blink reflex. Opacity and vascularization were monitored in allogeneic and syngeneic corneal grafts that were transplanted to corneal beds with no blink reflex or to those that retained blink reflex in at least one quadrant following infection.

Results

Retention of any level of blink reflex significantly reduced inflammation in HSV-1–infected corneas. Corneal allografts placed on HSV-1–infected beds lacking corneal blink reflex developed opacity faster and more frequently than those placed on infected beds that partially or completely retained blink reflex. Corneal grafts placed on infected corneal beds with no blink reflex rapidly became opaque to a level that would be considered rejection. However, protecting these grafts from exposure by tarsorrhaphy prevented or reversed the opacity in both syngeneic and allogenic grafts.

Conclusions

Exposure due to HSV-1–engendered hypoesthesia causes rapid, severe, persistent, but reversible opacification of both allogeneic and syngeneic corneal grafts. This opacity should not be interpreted as immunologic rejection. Exposure stress may contribute to the high rate of corneal graft pathology in patients with recurrent HSK.