Abstract
ABSTRACTIntroduction: The transparency of human cornea is critical for normal vision. It is maintained by a small population of stem cells present in the corneal limbus. Corneal diseases are a major cause of global blindness, second only to cataract in overall importance. They are usually treated by medications and surgical modalities that sometimes include expensive and potentially toxic medications with long-term side effects, particularly to prevent rejection of the corneal allograft. Therefore, cell based therapies may provide a promising alternative to overcome these limitations for the treatment of corneal diseases.Areas covered: This review article covers major sources, properties, and applications of mesenchymal stem cells in corneal reconstruction. This also includes a brief description of the structure, function, and immune privilege of the cornea; corneal stem cells, corneal diseases, available treatments, and potential of MSC-based cell therapy for corneal diseases.Expert opinion: Technical advancements in corneal transplantation and development of explant culture techniques like cultivated limbal epithelial transplantation, cultivated oral mucosal epithelial transplantation, and simple limbal epithelial transplantation have resulted in improved outcomes for treating corneal diseases; however, the treatment for bilateral corneal diseases still remains elusive. The increased risk of allograft rejection and long term side-effects of immunosuppressive medications, calls for alternative cell based therapies. Mesenchymal stem cells, with their unique dual property of multipotency and immunomodulation, offer a promising approach towards treatment of bilateral corneal disorders. However, the parameters including mechanism of homing, transdifferentiation, immunomodulation, and the risk of rejection, the cell source and the number of cells, the time of injection, and the mode of delivery must be studied before translating the possible benefits of MSCs in corneal transplants to clinical practice.
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