角膜基质诱导胚胎干细胞定向分化的初步实验研究

目的:探索角膜基质接触诱导胚胎干细胞(embryonic stem cells,ES.细胞)定向分化的可能性。方法:分别在去上皮的新西兰白兔表层角膜缘基质上、晶状体上皮细胞饲养层上培养ES-D_3细胞,裸鼠皮下移植使其形成复层细胞,一段时间后,行扫描电镜和光镜观察。结果:I.ES细胞在新鲜表层角膜缘基质上增殖缓慢,2～3周形成较大细胞集落,光镜下细胞形态单一,体积较正常ES细胞大,电镜下细胞核已演变为细长形,移植到裸鼠皮下2周形成上皮样细胞复层,电镜下可见微绒毛,而角膜基质非上皮面的ES细胞仍保持其小细胞状态不变。2.晶状体上皮细胞与ES细胞共培养只能延缓其分化时间,不能诱导其定向分化。结论:表层角膜缘基质具有诱导ES细胞定向分化的潜能,体外培养条件下可能不发生晶状体诱导的第三级胚胎诱导。眼科学报1999;15:195-198。     

视黄酸联合视网膜细胞培养上清液对胚胎干细胞体外分化的诱导作用

目的：探讨经过初步诱导的拟胚体在视黄酸和视网膜细胞培养上清液作用下的分化特征。方法：将胚胎干细胞(embryonic stem cells,ESC)自液氮中复苏、培养，传1代后进行拟胚体(embry-onic bodies,EB)培养。3天半的EB离心重悬后不作消化，使用视黄酸、视黄酸加鼠视网膜胶质细胞和神经细胞培养上清液、视黄酸加人视网膜色素上皮培养上清液、视黄酸加人胎儿视网膜胶质细胞培养上清液(分别记为A、B、C、D组)等进行诱导。观察诱导过程中形态学改变，培养3周时使用免疫细胞化学检测Nestin、GFAP、cytokeratin、MAP-2、rhodopsin等在诱导后细胞中的表达情况。结果：(1)形态学改变：4种条件下的早期改变基本相同，均可见多种形态的细胞；3周后：拟胚体结构基本已散开，A组：见多种形态的细胞，细胞边界欠清，饱满度下降；B组：细胞以透明度较高的圆形细胞为主；C组：拟胚体及拟胚体周围的细胞中出现了含有明显色素的细胞；D组诱导：细胞胞体较大，形态结构较为单一；(2)免疫细胞化学：4种条件下均表现为大部分细胞MAP—2阳性，未见Nestin阳性细胞；此外，A组中，未见GFAP、Cytokeratin、Rhodopsin阳性细胞；B组中，可见GFAP、Cytokeratin、Rhodopsin阳性细胞；C组仅见Cytokeratin阳性细胞；D组仅见GFAP阳性细胞。结论：在KSC的次级诱导中，视黄酸可以诱导大部分细胞成为神经细胞，多种视网膜细胞的上清液在诱导中具有一定的作用，ESC能被诱导形成与上清液来源细胞相关的细胞。眼科学报2003；19：122-125     

Tissue engineered corneal epithelium derived from clinical-grade human embryonic stem cells

PurposeTo construct tissue engineered corneal epithelium from a clinical-grade human embryonic stem cells (hESCs) and investigate the dynamic gene profile and phenotypic transition in the process of differentiation.MethodsA stepwise protocol was applied to induce differentiation of clinical-grade hESCs Q-CTS-hESC-1 and construct tissue engineered corneal epithelium. Single cell RNA sequencing (scRNA-seq) analysis was performed to monitor gene expression and phenotypic changes at different differentiation stages. Immunostaining, real-time quantitative PCR and Western blot analysis were conducted to detect gene and protein expressions. After subcutaneous transplantation into nude mice to test the biosafety, the epithelial construct was transplanted in a rabbit corneal limbal stem cell deficiency (LSCD) model and followed up for eight weeks.ResultsThe hESCs were successfully induced into epithelial cells. scRNA-seq analysis revealed upregulation of ocular surface epithelial cell lineage related genes such as TP63, Pax6, KRT14, and activation of Wnt, Notch, Hippo, and Hedgehog signaling pathways during the differentiation process. Tissue engineered epithelial cell sheet derived from hESCs showed stratified structure and normal corneal epithelial phenotype with presence of clonogenic progenitor cells. Eight weeks after grafting the cell sheet onto the ocular surface of LSCD rabbit model, a full-thickness continuous corneal epithelium developed to fully cover the damaged areas with normal limbal and corneal epithelial phenotype.ConclusionThe tissue engineered corneal epithelium generated from a clinical-grade hESCs may be feasible in the treatment of limbal stem cell deficiency.     

人角膜及角膜缘上皮细胞分化标记的检测

目的检测分化标记在人角膜及角膜缘上皮细胞的表达,以了解角膜及角膜缘细胞分化状态,旨在发现新的角膜上皮干细胞的阴性标记。方法获取人角膜及角膜缘组织,对冰冻切片及整个角膜组织行免疫荧光染色检测分化标记钙粘连素E、角蛋白3(CK3)、角蛋白12(CK12)、缝隙连接蛋白43、巢蛋白(nestin)和包壳蛋白(involucrin)的表达,经荧光显微镜及激光扫描共焦电镜观察,并行半定量RT-PCR以检测其相关分化标记基因的表达。结果分化标记CK3、CK12、缝隙连接蛋白43、巢蛋白和包壳蛋白在角膜和角膜缘上皮的表层细胞表达,角膜缘基底细胞不表达。激光扫描共焦电镜观察及RT-PCR结果显示角膜缘基底上皮细胞不表达细胞CK3、连接蛋白43和巢蛋白,而角膜上皮细胞则明显表达。结论角膜及角膜缘表层上皮较为成熟分化,而角膜缘基底细胞具有未分化细胞的特征,很可能是干细胞的部位。     

干细胞移植修复眼表损伤的研究进展

角膜缘干细胞、口腔黏膜细胞、胚胎干细胞、骨髓问充质干细胞等多种来源干细胞在修复眼表损伤的研究中都取得了较大的进展.本文就角膜上皮的组织结构、功能特征及上皮细胞的生物学特点,对胚胎干细胞和多种成体干细胞向角膜上皮细胞的分化及其对眼表损伤修复过程的影响进行了阐述,并对其各自的临床应用前景和存在的问题进行了讨论.(中华眼科杂志,2009,45:658-662)     

Mesenchymal stem cells derived from human limbal niche cells

Purpose. We investigated whether human limbal niche cells generate mesenchymal stem cells. Methods. Limbal niche cells were isolated from the limbal stroma by collagenase alone or following dispase removal of the limbal epithelium (D/C), and cultured on plastic in Dulbecco's modified Eagle's medium (DMEM) with 10% fetal bovine serum (FBS), or coated or three-dimensional Matrigel in embryonic stem cell medium with leukemia inhibitory factor and basic fibroblast growth factor. Expression of cell markers, colony-forming units-fibroblast, tri-lineage differentiation, and ability of supporting limbal epithelial stem/progenitor cells were compared to limbal residual stromal cells. Results. Stromal cells expressing angiogenesis markers were found perivascularly, subjacent to limbal basal epithelial cells, and in D/C and limbal residual stromal cells. When seeded in three-dimensional Matrigel, D/C but not limbal residual stromal cells yielded spheres of angiogenesis progenitors that stabilized vascular networks. Similar to collagenase-isolated cells, D/C cells could be expanded on coated Matrigel for more than 12 passages, yielding spindle cells expressing angiogenesis and mesenchymal stem cells markers, and possessing significantly higher colony-forming units-fibroblast and more efficient tri-lineage differentiation than D/C and limbal residual stromal cells expanded on plastic in DMEM with 10% FBS, of which both lost the pericyte phenotype while limbal residual stromal cells turned into myofibroblasts. Upon reunion with limbal epithelial stem/progenitor cells to form spheres, D/C cells expanded on coated Matrigel maintained higher expression of p63α and lower expression of cytokeratin 12 than those expanded on plastic in DMEM with 10% FBS, while spheres formed with human corneal fibroblasts expressed cytokeratin 12 without p63α. Conclusions. In the limbal stroma, cells subjacent to limbal basal epithelial cells serve as niche cells, and generate progenitors with angiogenesis and mesenchymal stem cells potentials. They might partake in angiogenesis and regeneration during corneal wound healing.     

人角膜上皮干细胞的识别

目的 探讨人角膜上皮干细胞的分子标记。方法 对人角膜和角膜缘部位行组织学检查以分析角膜缘解剖结构。对人角膜切片和整个角膜组织行免疫组织化学染色以检测中央角膜和角膜缘部位未分化标记,如核蛋白p63、乳腺癌抵抗蛋白（ABCG2,BCRP1）、烯醇化酶α、整合素拍、胡及β1、表皮生长因子受体（EGFR）、细胞角蛋白19（CK19）、14（CK14）及转铁蛋白受体（CDT1）的表达,经荧光显微镜和激光扫描共焦显微镜观察。对角膜中部和角膜缘上皮细胞的mRNA进行半定量逆转录聚合酶链反应（RT—PCR）和原位杂交以检测其相关基因的表达。结果 角膜缘部位横向切片显示角膜缘上皮细胞为乳头放射状排列,对应于Vogt栅栏环境。未分化标记整合素β1、EGFR、烯醇化酶α及CK19在角膜缘基底细胞胞质染色较表层细胞更强;p63、ABCG2、整合素胡蛋白仅见于角膜缘基底部上皮细胞。激光扫描共焦显微镜观察和RT—PCR结果显示角膜缘表达p63、ABCG2、整合素胡蛋白及mRNA。原位杂交显示p63仅表达于角膜缘基底层细胞。结论 角膜缘上皮呈乳头放射状排列,角膜缘干细胞群具有复合标记：p63表达于细胞核、ABCG2表达于胞质、整合素胡表达于胞膜。采用这些标记复合体,可将角膜缘干细胞群与其他上皮细胞区分。     

深低温保存角膜缘干细胞自体移植实验研究

目的:评价深低温冷冻保存兔眼角膜缘干细胞活性及自体移植治疗角膜干细胞缺乏眼表疾病的疗效。方法:12只新西兰白兔用刀片制备带2mm周边角膜和2mm球结膜的环行浅层角膜缘植片,去除余下的角膜上皮,制成角膜干细胞缺乏眼表疾病模型。角膜缘植片通过程序降温仪程序降温后-196℃深低温保存。30天和60天后作自体移植行兔眼眼表重建术。结果:角膜干细胞缺乏导致角膜上皮愈合延迟,7眼在术后22～26天愈合,平均24±1天,4眼复发性上皮糜烂;基质混浊水肿;角膜血管化,平均5±1天出现新生血管。深低温保存角膜缘干细胞自体移植能促进角膜上皮愈合,平均10±2天愈合,基质混浊逐渐吸收,新生血管消退、变细,2眼消失。结论:深低温保存法能保存角膜缘干细胞活性;能随时按需为临床提供活性角膜缘材料;为临床深低温保存角膜缘干细胞移植治疗眼表疾病提供了实验依据。眼科学报1998;14:224～226。     

大鼠骨髓间充质干细胞体外可诱导分化为角膜上皮细胞

目的:探讨骨髓间充质干细胞 (mesenchymal stem cell,MSC) 分化为角膜上皮细胞的可塑性及其重建角膜上皮的可能性.方法:用密度梯度离心法结合贴壁培养法分离纯化大鼠骨髓MSC,经体外与角膜基质细胞共培养诱导分化,免疫荧光法检测角膜上皮细胞特异标志物K12的表达.结果:体外培养的大鼠骨髓MSC表现出很强的增殖潜能,原代培养的骨髓MSC CD29免疫荧光染色阳性,CD34和CD45为阴性,符合骨髓MSC的特征.MSC与角膜基质细胞共培养1wk后大部分细胞分化为间质细胞,少部分细胞形态上相对偏小,免疫荧光检测这部分细胞表达角膜上皮细胞特异性标志角蛋白K12.结论:体外培养的MSC在角膜基质细胞的诱导下可横向分化为角膜上皮细胞.     

去除型人皮肤成纤维饲细胞系的建立及其重建角膜表层的研究

目的　探讨去除型人皮肤成纤维饲细胞系的建立及其重建角膜表层的相关研究。方法　将增强型绿色荧光蛋白（EGFP）、端粒酶逆转录酶（hTERT）和单纯疱疹病毒胸苷激酶（HSV-TK）3种基因导入人皮肤成纤维细胞，建立荧光标记的永生化的可去除型TERT+TK-D人源饲细胞系。将创建的细胞系经丝裂霉素C处理后作为饲养细胞与人角膜缘干细胞共培养，并与3T3饲细胞的培养结果作比较。结果　TERT+TK-D细胞系在体外经过6个月的连续传代后仍然表达绿色荧光蛋白，保持旺盛的分裂能力，对更昔洛韦敏感。TERT+TK-D组的克隆形成率（colony forming efficiency,CFE）为（11.77±0.21)%，与3T3组CFE［（12.8±1.61)］%比较，差异无统计学意义（P=0.332）；经过共培养，两组都形成了4~5层复层上皮细胞片。角膜缘干细胞克隆和上皮细胞片的免疫荧光染色及Real-time PCR定量分析结果显示，TERT+TK-D组角蛋白K3表达低于3T3组；PCR结果证实TERT+TK-D饲细胞在更昔洛韦作用下凋亡、裂解，没有混入培养获得的角膜上皮细胞片中。结论　转基因荧光标记的永生化的去除型人皮肤成纤维饲细胞有望替代3T3细胞用于角膜再生医疗。     

Corneal epithelial stem cells at the limbus: looking at some old problems from a new angle

Corneal epithelium is traditionally thought to be a self-sufficient, self-renewing tissue implying that its stem cells are located in its basal cell layer. Recent studies indicate however that corneal epithelial stem cells reside in the basal layer of peripheral cornea in the limbal zone, and that corneal and conjunctival epithelia represent distinct cell lineages. These ideas are supported by the unique limbal/corneal expression pattern of the K3 keratin marker for corneal-type differentiation; the restriction of the slow-cycling (label-retaining) cells in the limbus; the distinct keratin expression patterns of corneal and conjunctival epithelial cells even when they are provided with identical in vivo and in vitro growth environments; and the limbal cells' superior ability as compared with central corneal epithelial cells in undergoing in vitro proliferation and in reconstituting in vivo an intact corneal epithelium. The realization that corneal epithelial stem cells reside in the limbal zone provides explanations for several paradoxical properties of corneal epithelium including its 'mature-looking' basal cells, the preponderance of tumor formation in the limbal zone, and the centripetal cellular migration. The limbal stem cell concept has led to a better understanding of the strategies of corneal epithelial repair, to a new classification of various anterior surface epithelial diseases, to the use of limbal stem cells for the reconstruction of corneal epithelium damaged or lost as a consequence of trauma or disease ('limbal stem cell transplantation'), and to the rejection of the traditional notion of 'conjunctival transdifferentiation'. The fact that corneal epithelial stem cells reside outside of the cornea proper suggests that studying corneal epithelium per se without taking into account its limbal zone will yield partial pictures. Future studies need to address the signals that constitute the limbal stem cell niche, the mechanism by which amniotic membrane facilitates limbal stem cell transplantation and ex vivo expansion, and the lineage flexibility of limbal stem cells.     

角膜缘niche细胞与基质细胞维持角膜缘干细胞功能的对比研究

目的　比较角膜缘niche细胞（limbal niche cells，LNCs）与角膜缘基质细胞（limbal stromal cells，LSCs）在维持角膜缘干细胞功能上的不同特性。方法　将LNCs和LSCs分别从6个角膜缘组织分离，并在相同的条件下培养、传代。LNCs与LSCs经丝裂霉素C（mitomycin C,MMC）处理后分为LNCs组与LSCs组作为饲养细胞分别与角膜缘干细胞共培养，比较两组角膜缘干细胞克隆形成率（colony-forming efficiency,CFE）、上皮细胞复层化以及细胞标志物和部分基因的表达。结果　LNCs组角膜缘干细胞CFE（6.57±1.54）%高于LSCs组（1.43±0.47）%。 LNCs组细胞复层上皮数（4~5层）多于LSCs组（2~3层）。角膜缘干细胞克隆与免疫荧光染色及mRNA半定量分析结果显示，LNCs组比LSCs组表达了更多干细胞标志物ΔNp63，能更有效地维持角膜缘干细胞的细胞特性。逆转录PCR分析结果显示，LNCs组与LSCs组都分泌了一些维持角膜缘干细胞生长的生长因子，但LNCs组比LSCs组高表达上皮型钙黏蛋白（E-cadherin），低表达营养神经素3（NT3），能更好地支持角膜上皮增殖。结论　LNCs比LSCs能更好地支持角膜缘干细胞的生长及维持其干细胞特性。     

角膜上皮干细胞定位特征的免疫组织化学研究

利用单克隆抗体ＡＥ５与分化型角膜上皮细胞中角蛋白Ｋ３特异性结合,研究缺乏分化标志特征的角膜上皮干细胞定位特点,应用免疫组织化学方法显示Ｋ３阳性表达的区域分布于除角膜缘上皮基底部以外的所有角膜上皮细胞中,角膜上皮干细胞存在于角膜缘基底部ＡＥ５抗体反应阴性细胞中,即角膜干细胞位于角膜缘上皮层基底部。     

胚胎干细胞定向诱导为结膜上皮样细胞的实验研究

目的：研究体外诱导小鼠胚胎干细胞(embryonic stem cell,ESC)分化为结膜上皮细胞的可能性及条件，为构建组织工程化结膜提供新型的种子细胞奠定基础。方法：以人结膜上皮细胞作为诱导条件，采用分层共培养的方法诱导小鼠ESC，倒置相差显微镜观察共培养后形态的改变；免疫组织化学法检测诱导后的细胞角蛋白3／12(CK3/K12)、角蛋白13(CKl3)、MUC4和MUC5AC的表达。结果：采用人结膜上皮细胞作为诱导条件，ESC在诱导72h后可见部分细胞显示典型上皮祥细胞形态，免疫组化检测CKl3、MUC4表达阳性，CK3/K12，MUC5AC表达阴性。结论：采用分层共培养的方法，用人结膜上皮细胞作诱导剂可以诱导小鼠ESC向结膜上皮样细胞分化。眼科学报2003；19：117-121     

Induction of epithelial progenitors in vitro from mouse embryonic stem cells and application for reconstruction of damaged cornea in mice

PURPOSE: Severe ocular surface diseases and injuries cause loss of the corneal limbal epithelium, leading to re-epithelialization by bulbar conjunctival cells, resulting in vascularization of the cornea, conjunctival scarring, and loss of visual acuity. In this study, the optimal culture condition for induction of differentiation of epithelial progenitor cells from embryonic stem (ES) cells was determined for use in transplantation to damaged cornea in mice. METHODS: Mouse ES cells were cultured on Petri dishes coated with several extracellular matrix proteins, and the markers for epithelial cells were analyzed with RT-PCR and Western blot analysis. The optimal condition for induction of epithelial progenitor cells was determined, and the progenitors were transplanted onto mouse eyes with corneal epithelia that had been damaged by exposure to n-heptanol. RESULTS: Epithelial progenitors were successfully induced by culturing mouse ES cells on type IV collagen for 8 days. These progenitors expressed keratin (K)12, which is specific to corneal epithelial cells, and cell surface CD44 and E-cadherin, both of which are essential in corneal epithelial wound healing. Complete re-epithelialization of the corneal surface occurred within 24 hours after transplantation. The resultant corneal epithelial cells expressed markers of the grafted cells, and no teratomata were observed during the follow-up period. CONCLUSIONS: Epithelial progenitors were successfully induced in vitro from ES cells and were applicable as grafts for treating corneal epithelial injury. ES cells may become an unlimited donor source of corneal epithelial cells for corneal transplantation and may restore useful vision in patients with a deficiency of limbal epithelial cells. This is an important first trial toward assessing the use of ES cells to reconstruct corneal epithelial cells.     

经角膜基质细胞诱导的大鼠骨髓间充质干细胞在人羊膜上构建角膜上皮移植片

目的:研究将骨髓间充质干细胞(mesenchymal stem cells,MSC)诱导分化后在羊膜表面培养构建角膜上皮移植片的可行性。方法:取SD大鼠骨髓间充质干细胞和角膜基质细胞,分别培养并传2代后进行共培养,取共培养7d后的MSC覆载于新鲜人羊膜,再培养7d。对MSC及诱导后MSC进行免疫荧光染色和扫描电镜检查;对覆载细胞的羊膜进行HE染色及免疫荧光染色。结果:MSC在体外培养条件下贴壁生长,免疫荧光染色CD29和CD44阳性,CK12阴性。经角膜基质细胞诱导分化后,MSC细胞CK12染色转为阳性。诱导后MSC接种到羊膜表面,迅速贴壁生长,组织学特性无明显改变,CK12染色仍为阳性。结论:经角膜基质细胞诱导的MSC表现出角膜上皮细胞特征,在羊膜上生长后保持不变。     

Induced pluripotent stem cells as a potential therapeutic source for corneal epithelial stem cells

Corneal blindness caused by limbal stem cell deficiency (LSCD) is one of the most common debilitating eye disorders. Thus far, the most effective treatment for LSCD is corneal transplantation, which is often hindered by the shortage of donors. Pluripotent stem cell technology including embryonic stem cells (ESCs) and induced pluripotent stem cells (iPSCs) have opened new avenues for treating this disease. iPSCs-derived corneal epithelial cells provide an autologous and unlimited source of cells for the treatment of LSCD. On the other hand, iPSCs of LSCD patients can be used for iPSCs-corneal disease model and new drug discovery. However, prior to clinical trial, the efficacy and safety of these cells in patients with LSCD should be proved. Here we focused on the current status of iPSCs-derived corneal epithelial cells used for cell therapy as well as for corneal disease modeling. The challenges and potential of iPSCs-derived corneal epithelial cells as a choice for clinical treatment in corneal disease were also discussed.     

Long-term effectiveness of autologous cultured limbal stem cell grafts in patients with limbal stem cell deficiency due to chemical burns

Background: Chemical burns cause depletion of limbal stem cells and eventually lead to corneal opacity and visual loss. We investigated the long‐term effectiveness of autologous cultured limbal stem cell grafts in patients with limbal stem cell deficiency. Design: Prospective, non‐comparative interventional case series. Participants: Sixteen eyes from 16 patients with severe, unilateral limbal stem cell deficiency caused by chemical burns. Methods: Autologous ex vivo cultured limbal stem cells were grafted onto the recipient eye after superficial keratectomy. Main Outcome Measures: Clinical parameters of limbal stem cell deficiency (stability/transparency of the corneal epithelium, superficial corneal vascularization and pain/photophobia), visual acuity, cytokeratin expression on impression cytology specimens and histology on excised corneal buttons. Results: At 12 months post‐surgery, evaluation of the 16 patients showed that 10 (62.6%) experienced complete restoration of a stable and clear epithelium and 3 (18.7%) had partially successful outcomes (re‐appearance of conjunctiva in some sectors of the cornea and instable corneal surface). Graft failure (no change in corneal surface conditions) was seen in three (18.7%) patients. Penetrating keratoplasty was performed in seven patients, with visual acuity improving up to 0.8 (best result). For two patients, regeneration of the corneal epithelium was confirmed by molecular marker (p63, cytokeratin 3, 12 and 19, mucin 1) analysis. Follow‐up times ranged from 12 to 50 months. Conclusions: Grafts of autologous limbal stem cells cultured onto fibrin glue discs can successfully regenerate the corneal epithelium in patients with limbal stem cell deficiency, allowing to perform successful cornea transplantation and restore vision.