Abstract
Blood derived products have become a valuable source of tissue for the treatment of ocular surface diseases that are refractory to conventional treatments. These can be obtained from autologous or allogeneic sources (patient’s own blood or from healthy adult donors/umbilical cord blood, respectively). Allogeneic cord blood demonstrates practical advantages over alternatives and these advantages will be discussed herein. Umbilical cord blood (UCB) can be divided, generally speaking, into two distinct products: first, mononuclear cells, which can be used in regenerative ophthalmology, and second, the plasma/serum (an acellular fraction), which may be used in the form of eyedrops administered directly to the damaged ocular surface. The rationale for using umbilical cord serum (UCS) to treat ocular surface diseases such as severe dry eye syndrome (DES), persistent epithelial defects (PED), recurrent epithelial erosions, ocular chemical burns, graft versus host disease (GVHD), among others, is the considerably high concentration of growth factors and cytokines, mimicking the natural healing properties of human tears. Allogeneic serum also offers the opportunity for therapeutic treatment to patients who, due to poor heath, cannot provide autologous serum. The mechanism of action involves the stimulation of endogenous cellular proliferation, differentiation and maturation, which is highly efficient in promoting and enhancing corneal epithelial healing where other therapies have previously failed.
Highlights
The authors measured levels of epidermal growth factor (EGF), fibroblast growth factor (FGF), platelet-derived growth factor (PDGF), insulin-like growth factor (IGF), transforming growth factor (TGF)-α, TGF-β 1-2-3, VEGF, nerve growth factor (NGF), IL-1β, IL-4, IL-6, IL-10 and IL-13, and found that EGF, TGF-α, TGF-β2, FGF, PDGF, VEGF, NGF, IL-1B, IL-4, IL-6, IL-10, and IL-13 were expressed at significantly higher levels in umbilical cord serum (UCS) compared to peripheral blood serum (PBS), while the levels of IGF-1, IGF-2, and TGF-β1 were significantly higher in PBS compared to UCS (Table 1)
UCS clinical applications in ophthalmology include a wide variety of pathologic ocular surface conditions, such as dry eye syndrome (DES) due to Sjögren’s syndrome, persistent epithelial defects (PED), recurrent corneal erosions, neurotrophic keratopathy (NK), graft versus host disease (GVHD), chemical burns causing limbal stem cell deficiency (LCSD), after keratorefractive surgery and in ocular complications associated with SJS, such as ocular surface keratinization and ocular cicatricial pemphigoid [9] (Table 2)
The above studies support the idea that blood-derived products, UCS eye drops, are a safe and efficient option for the treatment of a wide array of ocular surface disease
Summary
The idea of using blood derived products in ophthalmology has become increasingly popular in the past few decades. Starting in 1975, when Ralph et al created a mobile ocular perfusion pump for continuous delivery of autologous serum (AS) to treat various ocular surface diseases such as keratoconjunctivitis sicca (KCS), persistent epithelial defects, Stevens Johnson syndrome, ocular pemphigoid, chemical burns, or following penetrating keratoplasty [1]. In. 1984 Fox, et al treated KCS patients with the first generation of such blood derived products, AS tears [2]. Other than the patient’s own peripheral blood (autologous), additional sources were used to obtain serum products from healthy donors (allogeneic). These sources include allogeneic adult donor’s blood and umbilical cord blood (UCB)
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