A device that revives eyeballs from dead donors could make eye transplants possible
A device that revives eyeballs from dead donors could make eye transplants possible
一种能让捐赠者眼球“复活”的装置，或将使眼球移植成为可能
EXECUTIVE SUMMARY It’s not easy to transplant a whole human eye. The surgery is difficult. And the eyes themselves start to degenerate as soon as they’ve left the body. When surgeons attempted it a few years ago, the newly-transplanted eye wasn’t able to see. But researchers believe they might have a solution: a device that maintains and revives freshly removed eyeballs using a technique called perfusion.
执行摘要 移植完整的人类眼球并非易事。手术难度极大，且眼球一旦离开人体就会迅速退化。几年前，当外科医生尝试进行此类手术时，移植后的眼球并无法恢复视力。但研究人员认为他们可能找到了解决方案：一种利用“灌注”（perfusion）技术来维持并复活新鲜摘除眼球的装置。
Perfusion works by providing surgically-removed organs with some of the oxygen and nutrients they typically get when they’re inside a body. Treated eyes don’t degrade as quickly, and appear to retain the ability to transmit electrical signals, and potentially see. The device could one day make eye transplantations a viable possibility. “It’s really cool,” says Shannon Tessier at Massachusetts General Hospital, who was not involved in the research but studies perfusion of other organs. “It could be a new frontier for retina preservation.”
灌注技术的工作原理是为手术摘除的器官提供其在体内时通常获得的氧气和营养物质。经过处理的眼球退化速度较慢，且似乎保留了传输电信号的能力，甚至可能具备视觉功能。该装置未来有望使眼球移植成为一种可行的医疗手段。“这真的很酷，”马萨诸塞州总医院的香农·泰西尔（Shannon Tessier）表示。她并未参与这项研究，但一直在研究其他器官的灌注技术，“这可能是视网膜保存领域的一个新前沿。”
Pia Cosma at the Centre for Genomic Regulation at the Barcelona Institute of Science and Technology in Spain and her colleagues have spent years developing their device. The Eye-in-a-Care-Box (ECaBox), as they call it, delivers an oxygen-rich supply of fluid through the artery that normally supplies the eye with blood. The eye itself sits on a “bed,” and excess fluids are drained away. And while the device itself is sealed to maintain a specific temperature and pressure, a clear window on its side allows researchers to study and image the eye while it’s inside.
西班牙巴塞罗那科学技术学院基因组调控中心的皮娅·科斯马（Pia Cosma）及其同事花费数年时间开发了这种装置。他们将其命名为“眼球护理箱”（Eye-in-a-Care-Box，简称 ECaBox），该装置通过原本为眼球供血的动脉输送富含氧气的液体。眼球被放置在一个“底座”上，多余的液体会被排出。虽然该装置是密封的以维持特定的温度和压力，但其侧面的透明窗口允许研究人员在眼球处于箱内时对其进行研究和成像。
Cosma and her colleagues started experimenting with pig eyes, which are anatomically similar to human eyes but easier to get hold of (the team got theirs from a local slaughterhouse). Pig eyes that are kept at room temperature outside of the device start to degenerate pretty quickly. The team found that cells in the eye shrank, and the eyes started to lose their structure. Cooling the organs didn’t help preserve them, either—the eyes degenerated within 24 hours even when they were kept at 4°C (39°F).
科斯马和她的同事们首先用猪眼进行了实验，猪眼在解剖结构上与人眼相似，且更容易获取（研究团队的实验材料来自当地屠宰场）。在室温下离开该装置的猪眼会迅速退化。研究小组发现，眼部细胞会萎缩，眼球开始失去结构。冷却器官也无法起到保护作用——即使在 4°C (39°F) 的环境下，眼球也会在 24 小时内退化。
But eyes kept in the EcABox fared much better. 24 hours later, tests suggested the perfused eyes were “significantly more viable” than eyes that hadn’t been maintained in the device. The perfused eyes also seemed to be able to respond to light, suggesting they might technically be able to see if they were transplanted. Untreated pig eyes lost this ability as soon as they were removed from the animal. But it came back after about 15 minutes of perfusion, according to the scientists behind the work. A few of the treated eyes kept going for 10 hours or more.
但保存在 ECaBox 中的眼球状况要好得多。24 小时后，测试表明，经过灌注的眼球比未经过该装置维护的眼球“活力显著更高”。这些经过灌注的眼球似乎还能对光线做出反应，这意味着如果进行移植，它们在技术上可能具备视觉功能。未经处理的猪眼在离开动物身体后会立即丧失这种能力。但据研究人员称，在灌注约 15 分钟后，这种能力又恢复了。一些经过处理的眼球甚至能持续保持这种状态 10 小时或更久。
Cosma and her colleagues described the work in a preprint article that has not yet been peer reviewed, and did not want to comment on the work. After success with the pig eyes, the team members then tested their device on human eyes. They first collected 12 eyes from six people who had died. In each case, one of each pair of eyes was put in the device, while the other was not. Again, the perfused eyes did better—and their retinas were preserved.
科斯马及其同事在一篇尚未经过同行评审的预印本文章中描述了这项工作，并拒绝就此发表评论。在猪眼实验取得成功后，团队成员随后在人眼上测试了该装置。他们首先收集了 6 名已故者的 12 只眼球。在每一对眼球中，其中一只放入装置，另一只则不放入。结果再次证明，经过灌注的眼球表现更好，且其视网膜得到了保存。
Cosma and her colleagues hope that their device could offer scientists a new way to study eye treatments—one that doesn’t involve experimenting on living animals. They also hope that, with some improvements, the ECaBox might provide a way to maintain and revive donated human eyes for whole-eye transplantation. Whole-eye transplants have been attempted in the past, mostly in research animals, with limited success.
科斯马和她的同事们希望，他们的装置能为科学家提供一种研究眼科治疗的新方法——一种无需在活体动物身上进行实验的方法。他们还希望，通过进一步改进，ECaBox 或许能为维护和复活捐赠的人类眼球提供途径，从而实现全眼移植。过去曾有过全眼移植的尝试，主要是在实验动物身上，但成功率有限。
In May 2023, a team at NYU Langone transplanted an eye along with part of a face to a man who had survived a high-voltage electrical accident that resulted in the loss of much of the left side of his face, including his left eye, two years earlier. Although the man recovered well, he wasn’t able to see out of the transplanted eye. We won’t know whether eyes treated in the ECaBox could do any better until they have been transplanted, says Tessier. In the meantime, Cosma and her colleagues plan to use a newer version of their device to collect more human eyes for research. “We are planning to develop a portable, surgery-room ECaBox to minimize [degradation] in heart-beating donor eyes, when they become available,” they write.
2023 年 5 月，纽约大学朗格尼医学中心（NYU Langone）的一个团队为一名男子移植了一只眼球和部分面部组织。该男子两年前曾遭遇高压电事故，导致其左脸大部分区域（包括左眼）受损。尽管该男子恢复良好，但他无法通过移植的眼球看到东西。泰西尔表示，在经过 ECaBox 处理的眼球被移植之前，我们无法确定它们是否会有更好的表现。与此同时，科斯马和她的同事计划使用该装置的更新版本收集更多人眼用于研究。他们写道：“我们正计划开发一种便携式手术室版 ECaBox，以便在心脏仍在跳动的捐赠者眼球可用时，最大限度地减少其退化。”