Иммунная привилегия в субретинальном пространстве и перспективы трансплантации ретинального пигментного эпителия при дегенеративных заболеваниях сетчатки

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.

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