Biomimetic Corneal Stroma for Scarless Corneal Wound Healing via Structural Restoration and Microenvironment Modulation

Corneal injury-induced stromal scarring causes the most common subtype of corneal blindness, and there is an unmet need to promote scarless corneal wound healing. Herein, a biomimetic corneal stroma with immunomodulatory properties is bioengineered for scarless corneal defect repair. First, a fully defined serum-free system is established to derive stromal keratocytes (hAESC-SKs) from a current Good Manufacturing Practice (cGMP)-grade human amniotic epithelial stem cells (hAESCs), and RNA-seq is used to validate the phenotypic transition. Moreover, hAESC-SKs are shown to possess robust immunomodulatory properties in addition to the keratocyte phenotype. Inspired by the corneal stromal extracellular matrix (ECM), a photocurable gelatin-based hydrogel is fabricated to serve as a scaffold for hAESC-SKs for bioengineering of a biomimetic corneal stroma. The rabbit corneal defect model is used to confirm that this biomimetic corneal stroma rapidly restores the corneal structure, and effectively reshapes the tissue microenvironment via proteoglycan secretion to promote transparency and inhibition of the inflammatory cascade to alleviate fibrosis, which synergistically reduces scar formation by approximate to 75% in addition to promoting wound healing. Overall, the strategy proposed here provides a promising solution for scarless corneal defect repair. Herein, the biomimetic corneal stroma with induced keratocytes and extracellular matrix-based hydrogel can promptly restore the corneal defect without sutures or fibrin glue. Moreover, it dramatically reshapes the tissue microenvironment by proteoglycan secretion to promote transparency and inflammation inhibition to alleviate stromal scarring. It presents a promising strategy to improve the prognosis of corneal injuries and reduce corneal blindness.image