결막 내 이식했던 양막을 이용한 난치성 각막 윤부결핍 질환 치료 1예
Amniotic Membrane Transplanted in Conjunctiva as a Mesenchymal Stem Cells Carrier for Limbal Stem Cell Deficiency
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목적: 양안 화학 화상 후 발생한 심한 윤부결핍 환자에서 기존 치료에 반응하지 않고 지속적으로 상태가 악화되어 결막 내 이식했던양막을 이용하여 성공적으로 치료하였기에 이를 보고하고자 한다. 증례요약: 43세 남자환자가 6년 전 발생한 양안 화학화상 이후 지속적으로 발생한 윤부결핍으로 자가결막피판이식, 양막이식, 전층각막이식, 동종윤부이식, 배양각막상피세포이식 등을 시행하였으나 각막상피세포결손이 악화되어 각막 천공이 발생하여 수술이 필요하였다. 과거력상 안압 조절을 위해 삽입한 방수유출장치의 실리콘 관이 결막 마찰로 노출되어 양막으로 실리콘 관을 감싸준 후 안정적으로 유지되어 결막 밑에 위치한 양막에 중배엽 줄기세포가 있을 것으로 가정하고, 이식된 양막 일부를 이용하여 각막천공부위에 이식하였다. 수술 후 6개월까지 각막 천공 재발 없이 외안부 상태는 안정적으로 유지되었다. 조직검사 및 면역조직화학염색상 이식한 양막에중배엽 줄기세포로 추정되는 세포를 확인할 수 있었다. 결과: 난치성 안구표면질환에 있어 중배엽 줄기세포를 골수에서 유도하여 직접적으로 창상 치유에 관여하는 세포를 유도하는 매개체로결막 내 이식한 양막이 유용할 수 있음을 확인하였다.
Abstract
Purpose: To report the use of amniotic membrane (AM) as a mesenchymal stem cell (MSC) carrier in cornea perforation with severe limbal stem cell deficiency due to a chemical burn on both eyes. Case summary: The patient in the present study is a 43-year-old man with a history of bilateral alkaline chemical injury six years previously. The patient suffered from total limbal stem cell deficiency (LSCD) in the injured eyes and underwent numerous operations including autologous conjunctival flap, AM graft, penetrating keratoplasty, keratolimbal autograft and ex vivo expanded limbal allogrft. However, the patient’s ocular condition deteriorated due to persistent LSCD, which led to corneal perforation resulting in the need for an urgent therapeutic operation. In the patient’s past ocular history,Ahmed valve implantation was performed for uncontrolled IOP. Revision of the Ahmed tube due to exposure and conjunctival erosion was performed again via placement of an AM over the exposed tube one year previous to presentation to our hospital. The authors performed a transplanted AM graft at the cornea perforation using sub-conjunctival AM believed to contain MSCs. Six months postoperatively, the ocular surface was well mainatained and the graft remained healthy. Transplanted AM showed morphological and immunohistochemical findings similar to those of MSCs. Conclusions: Results from the present study confirm that AM transplanted into the conjunctiva is a useful carrier of bone marrow-derived MSCs in severe ocular surface diseases.
참고문헌 (33)
- Zieske JD, "Enhancement of vinculin synthesis by migrating stratified squamous epithelium", J Cell Biology, 109, pp.571~576 (1989)
- Chung EH, "Synchronization of the G1", S transition in response to corneal debridement, 1999, pp.40, 1952~1958
- Hall PA, "Stem cells: the generation and maintenance of cellular diversity", Development, 106, pp.619~633 (1989)
- Thoft RA, "The X, Y, Z hypothesis of corneal epithelial maintenance", wInvest Ophthalmol Vis Sci, 24, pp.1442~1443 (1983)
- Sandvig KU, "Cell kinetics of conjunctival and corneal epithelium during regeneration of different- sized corneal epithelial defects", Acta Ophthalmol, 172, pp.43~48 (1994)
- Kotton DN, "Bone marrow-derived cells as progenitors of lung alveolar epithelium", Development, 128, pp.5181~5188 (2001)
- Ferrari G, "Muscle regeneration by bone marrow-derived myogenic progenitors", Science, 279, pp.1528~1530 (1998)
- Okamoto R, "Damaged epithelia regenerated by bone marrow-derived cells in the human gastrointestinal tract", Nat Med, 8, pp.1011~1017 (2002)
- Kenyon KR, "Limbal autograft transplantation for ocular surface disorders", Ophthalmology, 96, pp.709~723 (1989)
- Tsai RJ, "Human allograft limbal transplantation for corneal surface reconstruction", Cornea, 13, pp.389~400 (1994)
- Kwitko S, "Allograft conjunctival transplantation for bilateral ocular surface disorders", Ophthalmology, 102, pp.1020~1025 (1995)
- Shimazaki J, "Transplantation of human limbal epithelium cultivated on amniotic membrane for the treatment of severe ocular surface disorders", Ophthalmology, 109, pp.1285~1290 (2002)
- Ti SE, "Correlation of long term phenotypic and clinical outcomes following limbal epithelial transplantation cultivated on amniotic membrane in rabbits", Br J Ophthalmol, 88, pp.422~427 (2004)
- Park GS, "Stepwise surgical approach for in vivo expansion of epithelial stem cells to treating severe acute chemical burns with total limbal deficiency", Korean J Ophthalmol, 17, pp.75~82 (2003)
- Jenkins C, "Limbal transplantation in themanagement of chronic contact lens-associated epitheliopathy", Eye, 7, pp.629~633 (1993)
- Coster DJ, "Surgical management of ocular surface disorders using conjunctival and stem cell allografts", Br J Ophthalmol, 79, pp.977~982 (1995)
- Holland EJ, "The evolution of epithelial transplantation for severe ocular surface disease and a proposed classification system", Cornea, 15, pp.549~556 (1996)
- Henderson TR, "The long term outcome of limbal allografts: the search for surviving cells", Br J Ophthalmol, 85, pp.604~609 (2001)
- Pels E, "HLA-A,B,C, and HLA-DR antigens and dendritic cells in fresh and organ culture preserved corneas", Cornea, 3, pp.231~239 (1984)
- Pellegrini G, "Long-term restoration of damaged corneal surfaces with autologous cultivated human epithelium", Lancet, 349, pp.990~993 (1997)
- Koizumi N, "Amniotic membrane as a substrate for cultivating limbal corneal epithelial cells for autologous transplantation in rabbits", Cornea, 19, pp.65~71 (2000)
- Rama P, "Autologous fibrin-cultured limbal stem cells permanently restore the corneal surface of patients with total limbal stem cell deficiency", Transplantation, 72, pp.1478~1485 (2001)
- Prabhasawat P, "Single and multilayer amniotic membrane transplantation for persistent corneal epithelial defect with and without stromal thinning and perforation", Br J Ophthalmol, 85, pp.1455~1463 (2001)
- 신경선, "난치성 각막궤양 및 각막표면질환에서의 양막이식술의 효과", 대한안과학회지, 44(6), pp.10~1310 (2003), 대한안과학회
- Tseng SC, "Amniotic membrane transplantation for conjunctival surface reconstruction", Am J Ophthalmol, 124, pp.765~774 (1997)
- Tamhane A, "Evaluation of amniotic membrane transplantation as an adjunct to medical therapy as compared with medical therapy alone in acute ocular burns", Ophthalmology, 112, pp.1963~1969 (2005)
- Meller D, "Amniotic membrane transplantation for acute chemical or thermal burns", Ophthalmology, 107, pp.980~989 (2000)
- Tseng SC, "Amniotic membrane transplantation with or without limbal allografts for corneal surface reconstruction in patients with limbal stem cell deficiency", Arch Ophthalmol, 116, pp.431~441 (1998)
- Ucakhan OO, "Nonpreserved human amniotic membrane transplantation in acute and chronic chemical eye injuries", Cornea, 21, pp.169~172 (2002)
- Hanada K, "Multilayered amniotic membrane transplantation for severe ulceration of the cornea and sclera", Am J Ophthalmol, 131, pp.324~331 (2001)
- Kicic A, "The potential of marrow stromal cells in stem cell therapy", Eye, 15, pp.695~707 (2001)
- 신미선, "손상 받은 각막 상피세포가 중배엽 줄기세포의 분화에 미치는 영향", 대한안과학회지, 48(3), pp.423~430 (2007), 대한안과학회
- Ye J, "Mesenchymal stem cell transplantation in a rabbit corneal alkali burn model: engraftment and involvement in wound healing", Eye, 20, pp.482~490 (2006)