helmholtzeyeinstituteРоссийский офтальмологический журналRussian Ophthalmological Journal2072-00762587-5760Real time Publishers10.21516/2072-0076-2023-16-4-152-158helmholtzeyeinstitute-1370Research ArticleОБЗОРЫ ЛИТЕРАТУРЫREVIEWSИммунная привилегия в субретинальном пространстве и перспективы трансплантации ретинального пигментного эпителия при дегенеративных заболеваниях сетчаткиImmune privilege in the subretinal space and prospects of retinal pigment epithelium transplantation in degenerative diseases of the retinaНероеваН. В.NeroevaN. V.

Наталия Владимировна Нероева — канд. мед. наук, врач-офтальмолог отдела патологии сетчатки и зрительного нерва

ул. Садовая-Черногрязская, д. 14/19, Москва, 105062, Россия

Natalia V. Neroeva — Cand. of Med. Sci., ophthalmologist, department of retinal and optic nerve pathology

14/19, Sadovaya-Chernogryazskaya St., Moscow, 105062, Russia

БалацкаяН. В.BalatskayaN. V.

Наталья Владимировна Балацкая — канд. биол. наук, начальник отдела иммунологии и вирусологии

ул. Садовая-Черногрязская, д. 14/19, Москва, 105062, Россия

Natalya V. Balatskaya — Cand. of Biol. Sci., head of the department of the immunology and virology

14/19, Sadovaya-Chernogryazskaya St., Moscow, 105062, Russia

КатаргинаЛ. А.KatarginaL. A.

Людмила Анатольевна Катаргина — д-р мед. наук, профессор, заместитель директора по науке

ул. Садовая-Черногрязская, д. 14/19, Москва, 105062, Россия

Ludmila A. Katargina — Dr. of Med. Sci., professor, deputy director

14/19, Sadovaya-Chernogryazskaya St., Moscow, 105062, Russia

БриллиантоваА. Г.BrilliantovaA. G.

Ангелина Грантовна Бриллиантова — аспирант отдела патологии сетчатки и зрительного нерва

ул. Садовая-Черногрязская, д. 14/19, Москва, 105062, Россия

Angelina G. Brilliantova — PhD student, department of retinal and optic nerve pathology

14/19, Sadovaya-Chernogryazskaya St., Moscow, 105062, Russia

angelinabrilliantova@gmail.comФГБУ «НМИЦ глазных болезней им. Гельмгольца» Минздрава РоссииРоссияHelmholtz National Medical Research Center of Eye DiseasesRussian Federation202329122023164152158Copyright © Нероева Н.В., Балацкая Н.В., Катаргина Л.А., Бриллиантова А.Г., 20232023Нероева Н.В., Балацкая Н.В., Катаргина Л.А., Бриллиантова А.Г.Neroeva N.V., Balatskaya N.V., Katargina L.A., Brilliantova A.G.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://roj.igb.ru/jour/article/view/1370

Поражение ретинального пигментного эпителия (РПЭ) лежит в основе патогенеза дегенеративно-дистрофических заболеваний сетчатки, в частности возрастной макулярной дегенерации (ВМД) — одной из ведущих причин необратимого снижения центрального зрения, слепоты и инвалидизации среди пожилого населения. Варианты терапии поздних стадий ВМД ограниченны и представлены ингибиторами ангиогенеза при влажной форме заболевания; эффективного лечения географической атрофии не существует, так как клетки РПЭ не способны к регенерации. Развитие биомедицинских наук, прогресс витреоретинальной хирургии инициировали поиск новых, высокотехнологичных способов лечения дегенеративных заболеваний сетчатки, направленных на восстановление РПЭ. Заместительная трансплантация индуцированными плюрипотентными стволовыми клетками (ИПСК), дифференцированными в РПЭ, представляется наиболее перспективным подходом для замены поврежденных элементов сетчатки и улучшения остроты зрения, а особенности глаза как иммунопривилегированного органа создают, по мнению ряда исследователей, относительно безопасные условия для субретинального введения ИПСК РПЭ. В обзоре систематизированы данные литературы, посвященной изучению иммунной привилегии в заднем отрезке глаза, а также результаты исследований в области субретинальной трансплантации СК; обсуждаются условия и возможные механизмы, запускающие отторжение трансплантата, методы, направленные на предотвращение реакции тканевой несовместимости.

Damage of the retinal pigment epithelium (RPE) underlies the pathogenesis of degenerative-dystrophic diseases of the retina, in particular, age-related macular degeneration (AMD) — one of the leading causes of irreversible loss of central vision, blindness and elderly population disability. Advanced AMD treatment options are limited to angiogenesis inhibitors in the wet form of the disease; there is no effective treatment for geographic atrophy, since RPE cells are unable to regenerate. The advances of biomedicine and the progress of vitreoretinal surgery gave rise to searching new high-technology methods of degenerative retinal disease treatment, aimed at restoring RPE. Replacement transplantation with induced pluripotent stem cells (iPSCs) specifically oriented at RPE seems to be the most promising approach for replacing damaged retinal elements and improving visual acuity, while, as some researchers believe, the fact that the eye is an immune-privileged organ ensures relatively safe conditions for subretinal administration of iPSC-RPE. The review systematizes the literature data on immune privilege in the posterior eye segment, as well as the results of studies in the field of subretinal stem cells transplantation. The conditions and possible mechanisms that trigger graft rejection, methods aimed at preventing tissue incompatibility reactions are also discussed.

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The authors declare that there are no conflicts of interest present.