The cornea, the avascular central outer most tissue of the eye, is one of the most important tissues involved in vision1. There are several types of cells that maintain the function of the cornea. The top outermost layer of the cornea comprises of epithelial cells which can be about 5-7 layers in thickness2. This layer prevents bacterial invasion into the cornea3 and allows entry of oxygen4. It has been reported that the stem cells of the corneal epithelium lie in niches or crypts (with sizes of 120-150 µm) at the peripheral region of the cornea known as the limbus5,6. As the stem cells divide, the daughter cells also known as transient amplifying cells travel out of the niches and as division continues the cells move centripetally inwards and upwards resulting in terminally differentiated cells at the central corneal region7,8. These cells are routinely wiped away with the blink of the eye exposing newer cells underneath9.
In addition to being the location of the epithelial stem cells, the limbus also plays a role in keeping the vascularized conjunctiva away from the cornea region10. Damage to the limbus could be caused by thermal/chemical burns, radiation and also genetic diseases10. When this happens, the limbus barrier is broken down allowing the conjunctival cells to move onto the cornea, vascularizing the region, causing pain and blindness in some cases. The condition is known as limbal stem cell deficiency (LSCD)10.
Different natural substrates have been reported as possible stem cell carriers for aiding in corneal regeneration. For example, collagen-based membranes were used by Dravida et al.11 and Rama and coworkers12 reported the use of fibrin in a study with 112 patients. At present however the most commonly used method of treatment is to use human amniotic membrane from a tissue bank and culture limbal epithelial cells on its surface13,14. Once a monolayer has formed, the amniotic membrane is glued cell-side up onto the damaged cornea which has all the conjunctival cells and scar tissue surgically removed from it prior to this cell transplantation14. The amniotic membrane degrades within weeks to months leaving the epithelial cells attached to the denuded area to regenerate the epithelium15,16. This technique has been successful in restoring vision however there are still a few practical issues which restrict its widespread uptake clinically. As the amniotic membrane is human tissue it needs to undergo screening using good tissue banking procedures before being used for cell transplantation on patients. This screening only lowers the risk of transmission of diseases but cannot completely eliminate it17. In addition to this there have been reports of variability in the performance of the amniotic membrane due to inter donor variation18,19 and different processing methods19,20. Alongside the small risk of disease transmission there is the requirement for surgical centers to have access to well-run tissue banks, not available to all.
Although the amniotic membrane is relatively successful, there is a need for the development of new synthetic biodegradable cell carrier alternatives for the treatment of corneal disease. Synthetic carriers would overcome the need for banking procedures as well as eliminating the small risk of disease transmission and inter-donor variability. In this sense, materials such as polyethylene glycol21,22 and PLGA23,24 have been studied.
In developing a synthetic alternative to the human amniotic membrane there is also the possibility to design into it desirable features to hopefully help the survival of the cultured cells. The inclusion of microfeatures within biomaterial devices for the specific control of cell behavior is an emerging area of interest. Many authors have reported work towards the development of artificial stem cells niches25-30. This group has recently reported the creation of a microfabricated PEGDA fibronectin-biofunctionalized artificial limbus for the delivery of limbal epithelial cells22 and a methodology for the fabrication of electrospun biodegradable membranes containing microfabricated pockets for the support of limbal epithelial cells31.
The aim of this work is to develop a new manufacturing technology for the development of biomaterial devices containing microfeatures which mimic to an extent the microenvironments in which stem cells reside in the body. We have developed a technique which combines microstereolithography and electrospinning that allows the fabrication of biodegradable microstructured membranes that show great potential for tissue regeneration applications.
It is important to notice that although in this work this technique has been applied to the fabrication of rings for corneal regeneration, the technology can be applied to the fabrication of devices for the regeneration of a broad range of epithelial tissues, e.g., skin, oral mucosa, intestine, respiratory, and bladder epithelia. Specifically, in this study we have developed a synthetic biodegradable membrane which functions in a similar manner to the amniotic membrane to deliver cells to the cornea. This membrane contains micropockets of around 300 µm (larger than the limbal crypts of the Pallisades of Vogt (around 150 µm)). Finally, we have established a packaging protocol which allows these membranes to be stored at -20 °C for more than 6 months without showing any signs of breakdown.