Keratin, Kollagen oder doch Spendergewebe – wo liegt die Zukunft in der Entwicklung neuer Biomaterialien zur Hornhautrekonstruktion?

Zusammenfassung

Für den Ersatz von Hornhautgewebe werden seit Langem standardmäßig Hornhauttransplantate bzw. Amnionmembran verwendet. Da es sich hierbei um biologisches Gewebe handelt, besteht nur eine eingeschränkte Standardisierung, was die Herstellung, Beschaffenheit und die Eigenschaften nach Transplantation betrifft. Darüber hinaus gibt es ein Risiko der Krankheitsübertragung vom Spender und die Verfügbarkeit sowohl von menschlichen Hornhäuten als auch von Amnionmembran ist in vielen Regionen der Erde ungenügend. Aus diesem Grund werden seit vielen Jahren alternative Biomaterialien für den Hornhautersatz beforscht. Unter den natürlichen Biomaterialien bieten Materialien auf Kollagen- oder Keratinbasis Eigenschaften, die sie zu aussichtsreichen Kandidaten für den Hornhautstromaersatz machen. Aktuell bestehen aber noch viele ungelöste Probleme, insbesondere was die Degradation nach Implantation und die Nahtfestigkeit der Materialien angeht. Erste klinische Untersuchungen mit unterschiedlichen Biomaterialien auf Kollagenbasis belegen jedoch ihre insgesamt recht gute Biokompatibilität hinsichtlich ihrer Integrationsfähigkeit bzw. hinsichtlich ihrer geringen Immunogenität. Aktuell gibt es kein Biomaterial, das den Anforderungen in jeder Situation gerecht wird. Es ist zu vermuten, dass zukünftig unterschiedliche Biomaterialen zur Verfügung stehen, die in Abhängigkeit von der zugrunde liegenden Hornhauterkrankung unterschiedliche Funktionen erfüllen und so eine patienten- und krankheitsindividuelle Versorgung möglich machen.

Abstract

For the replacement of corneal tissue, corneal grafts or amniotic membrane are still used as a standard material. Since this is biological tissue, there is only a limited standardization regarding preparation, tissue properties and behaviour after transplantation. In addition, there is a risk of disease transmission, and the availability of both human corneas and amniotic membrane is insufficient in many regions of the world, which is why alternative biomaterials have been explored for many years now. Among the natural biomaterials, materials based on collagen or keratin provide characteristics that make them good candidates for corneal tissue replacement. However, there are still many unsolved problems, particularly regarding the degradation after implantation and the seam strength of the materials. Initial clinical studies with different biomaterials based on collagen prove their good biocompatibility to integrate and their low immunogenicity. Currently, there is no biomaterial that meets the requirements in every situation. It can be assumed that different biomaterials will be available in the future, which, depending on the underlying corneal disease, will fulfill different functions and thus make a patient- and disease-specific care possible.

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