Rethinking immunological privilege: implications for corneal and limbal stem cell transplantation

Immunological privilege operates within the normal eye by multiple passive and active mechanisms, including antigen sequestration, maintenance of an immunosuppressive local environment and induction of apoptotic death in infiltrating cells of the immune system. Ocular privilege might have developed to protect the eye from the collateral damage associated with an inflammatory response to invading pathogens. Nevertheless, corneal grafts do undergo irreversible immunological rejection and, furthermore, corneal graft rejection is very similar at a histological level to the rejection processes that operate in vascularized organ grafts. Ocular privilege is thus relative. The question arises as to how corneal grafts are rejected in the face of so many mechanisms designed to prevent immune responses from operating inside the eye--a question that is still essentially unanswered.