摘要视网膜色素上皮(RPE)细胞替代治疗是治疗老年性黄斑变性的发展趋势.已完成临床试验或即将进入临床试验的细胞种类包括自体RPE细胞、虹膜色素上皮细胞(IPE)、人胎儿RPE细胞(fRPE)、人类胚胎干细胞来源的RPE细胞(hESC-RPE)、诱导多潜能干细胞来源的RPE细胞(iPSC-RPE).自体RPE细胞和IPE由于其固有的缺陷相关临床试验已逐渐停止;iPSC-RPE和hESC-RPE在致肿瘤性和基因突变的风险难以规避,临床应用前应对细胞进行基因水平的筛选;fRPE具有免疫原性低、易于同宿主视网膜整合、完全的RPE功能等特点,是优于hESC-RPE的最佳选择.移植方式主要有RPE单层或RPE-脉络膜复合物移植、RPE细胞悬液移植、支架上形成的RPE片层移植.其中首选的和较为成熟的移植方式仍为细胞悬液的注射治疗.注射所导致的细胞逆流,以及细胞逆流所带来的一系列并发症亟待得到解决.

abstractsBased on the pathogenic mechanisms of age-related macular degeneration (AMD),tremendous preclinical and clinical trials have demonstrated that cell transplantation which aim to replace impaired retinal pigment epithelium (RPE) with healthy RPE cells is a promising approach to treat AMD.So far,choices of cell sources mainly are autologous RPE,iris pigment epithelium,fetal RPE,human embryonic stem cell-derived RPE and human induced pluripotent stem cell-derived RPE,and some of them are undergoing clinical researches.Grafting manners in cell-based therapies are various including RPE sheet or RPE-choroid complex transplantation,RPE cell suspension injection,and RPE sheet transplantation with scaffolds.This review is limited to cell-based therapies for RPE that damaged first in the progress of AMD and focus on recent advances in cell sources,transplantation methods,preclinical and clinical trials,and the obstacles that must be overcome.