Corneal endothelial wound healing: understanding the regenerative capacity of the innermost layer of the cornea

Currently, there are very few well-established treatments to stimulate corneal endothe-lial cell regeneration in vivo as a cure for corneal endothelial dysfunctions. The most frequently performed intervention for a damaged or dysfunctional corneal endothe-lium nowadays is corneal endothelial keratoplasty, also known as lamellar corneal transplantation surgery. Newer medical therapies are emerging and are targeting the regeneration of the corneal endothelium, helping the patients regain their vision with-out the need for donor tissue. Alternatives to donor tissues are needed as the aging population requiring transplants, has further exacerbated the pressure on the corneal eye banking system. Significant ongoing research efforts in the field of corneal regen-erative medicine have been made to elucidate the underlying pathways and effector proteins involved in corneal endothelial regeneration. However, the literature offers little guidance and selective attention to the question of how to fully exploit these pathways. The purpose of this paper is to provide an overview of wound healing characteristics from a biochemical level in the lab to the regenerative features seen in the clinic. Studying the pathways involved in corneal wound healing together with their key effector proteins, can help explain the effect on the proliferation and migration capac-ity of the corneal endothelial cells. (Translational Research 2022; 248:111-127)

Automated summary

Currently, there are limited treatments available for corneal endothelial cell regeneration in vivo. Corneal endothelial keratoplasty, or lamellar corneal transplantation surgery, is the most commonly performed intervention for damaged or dysfunctional corneal endothelium. New medical therapies are emerging to target the regeneration of the corneal endothelium and reduce the need for donor tissue. However, there is limited research on the underlying pathways and effector proteins involved in corneal endothelial regeneration. The purpose of this paper is to provide an overview of wound healing characteristics and regenerative features, as well as study the pathways and effector proteins involved in corneal wound healing to explain their impact on corneal endothelial cells.