Simple oral mucosal epithelial transplantation in a rabbit model

Abstract

This study investigated a rabbit model of autologous simple oral mucosal epithelium transplantation (SOMET) for limbal stem cell deficiency (LSCD). LSCD was created in the SOMET group and the Control group. In the SOMET group, oral mucosa harvested from the buccal region was treated with dispase, cut into small pieces, and placed on the exposed corneal stroma without using graft sutures, amniotic membrane, and/or glue. A soft contact lens was positioned and tarsorrhaphy was performed in both groups. Postoperative corneal neovascularization and fluorescein staining scores were evaluated by slit lamp microscopy in both groups. At 2 weeks postoperatively, eyes were excised and subjected to immunohistochemical staining for CK3, CK13, CK15, and p63. In the SOMET group, transplantation of oral mucosa led to complete recovery of LSCD, as indicated by low neovascularization scores, low fluorescein staining scores, and detection of stratified K3/K13-positive cells on the stroma at 2 weeks after surgery. In contrast, corneal epithelial defects persisted in the Control group at 2 weeks. SOMET achieved re-epithelialization of the corneal surface in this rabbit LSCD model. It is a simple technique that does not require culture and could be a promising option for ocular surface reconstruction in bilateral LSCD.

Successful Ocular Surface Reconstruction in Complete Ankyloblepharon With the Simple Oral Mucosal Epithelial Transplantation Technique: A Case Report

“…Our case demonstrated that the epithelium grew in a centrifugal pattern from the chopped pieces of the oral mucosa, consistent with the findings in patients who underwent simple limbal epithelial transplantation. 11,12 In addition, in vivo confocal microscopy and ICIF showed that the newly formed cornea-like epithelium had similar characteristics with patients who had COMET in previous reports. We speculate that the transplanted oral mucosal stem cells transdifferentiate into corneal epithelial cells in response to the signals of corneal niche.…”

“…10 However, to the best of our knowledge, it has not been executed in a clinical setting. The only reported success of applying SOMET technique was by Inamochi et al 11 in a rabbit model with an addition of dispase to separate the mucosal epithelium from the submucosal tissue.…”

The clinical efficacy of a new surgical technique of oral mucosal epithelial transplantation for severe ocular surface disorders

“…Several researchers had reported that ex vivo cultivated oral mucosal stem cells could be induced to differentiate into a new cell type, which was similar to the normal cornea epithelia (31-33, 35, 36). One research on animal showed that after two weeks of oral mucosal graft transplantation, a K3 positive and K13 negative strati ed epithelium was covered on the cornea surface (37). Whether in vivo transplantation would induce the stem cells of the oral epithelial graft to change in human was unknown.…”

“…To avoid such kind of disadvantages, a direct transplantation of oral mucosal graft was performed in total limbal stem cell de ciency eyes to reconstruct the limbus and had demonstrate good clinical e cacy (22,23). A study for single oral mucosal epithelial transplantation in rabbits also showed complete success in restore the limbus (24). There were no further studies and clinical application reports for this ever since.…”

Effects of corneal epithelial superficial keratectomy in patients with focal limbal stem cell disease

“…Some severe cases with total LSC deficiency may require stem-cell transplantation of autologous 6 , 7 , 8 , 9 and cultured sheet 10 , 11 using limbal epithelium, conjunctivae, 12 and oral mucosal epithelium. 13 , 14 , 15 , 16 In partial LSC deficiency corneas, which are covered with vascular and conjunctival fibroblasts, the combination therapy with superficial keratectomy and amniotic membrane transplantation has been recommended to rebuild the ocular surface conditions. 17 , 18 , 19 , 20 In contrast, some mild cases of LSC diseases 5 can be treated simply with medicated eyedrops 5 , 21 , 22 , 23 or autologous serum eyedrops 24 to rebuild the microenvironment of the improve the dysfunction of the LSCs niche.…”