Retinal Pigment Epithelium Transplantation Research Articles

Investigation of the effectiveness of gelatin hydrolysate in human iPS-RPE cell suspension transplantation

IntroductionThe retinal pigment epithelium (RPE) plays essential roles in maintaining retinal functions as well as choroidal capillaries and can lead to visual disorders if dysfunctional. Transplantation of human-induced pluripotent stem cell-derived RPE (hiPSC-RPE) is a promising therapy for such RPE impaired conditions including age-related macular degeneration. The challenge with cell suspension transplantation is targeted delivery of graft cells and undesired cell reflux. Gelatin hydrolysate, a soluble variant with specific molecular weight distribution, is examined in this study for its potential use in hiPSC-RPE suspension transplantation, particularly in reducing cell reflux and enhancing RPE engraftment. MethodsA retinal bleb model was created using polydimethylsiloxane (PDMS) soft lithography to quantify cellular reflux. We examined the effects of gelatin hydrolysate on the hiPSC-RPE of various aspects of cell behavior and performance such as cell viability, hypoxia reaction, morphology, induction of inflammation and immune responses. ResultsGelatin hydrolysate at 5 % concentration effectively mitigated cell reflux in vitro mimic, improved cell viability, reduced cell aggregation, and had an inhibitory effect on hypoxic reactions due to cell deposition with hiPSC-RPE. Additionally, gelatin hydrolysate did not affect cell adhesion and morphology, and decreased the expression of major histocompatibility complex class II molecules, which suggests reduced immunogenicity of hiPSC-RPE. ConclusionGelatin hydrolysate is considered a valuable and useful candidate for future regenerative therapies in hiPSC-RPE suspension transplantation.

Immune privilege in the subretinal space and prospects of retinal pigment epithelium transplantation in degenerative diseases of the retina

Damage of the retinal pigment epithelium (RPE) underlies the pathogenesis of degenerative-dystrophic diseases of the retina, in particular, age-related macular degeneration (AMD) — one of the leading causes of irreversible loss of central vision, blindness and elderly population disability. Advanced AMD treatment options are limited to angiogenesis inhibitors in the wet form of the disease; there is no effective treatment for geographic atrophy, since RPE cells are unable to regenerate. The advances of biomedicine and the progress of vitreoretinal surgery gave rise to searching new high-technology methods of degenerative retinal disease treatment, aimed at restoring RPE. Replacement transplantation with induced pluripotent stem cells (iPSCs) specifically oriented at RPE seems to be the most promising approach for replacing damaged retinal elements and improving visual acuity, while, as some researchers believe, the fact that the eye is an immune-privileged organ ensures relatively safe conditions for subretinal administration of iPSC-RPE. The review systematizes the literature data on immune privilege in the posterior eye segment, as well as the results of studies in the field of subretinal stem cells transplantation. The conditions and possible mechanisms that trigger graft rejection, methods aimed at preventing tissue incompatibility reactions are also discussed.

Invited Session II: Retinal remodeling and regeneration: Insights into retinal cell replacement: Optimising photoreceptor and RPE transplantation.

Retinal degenerative diseases, such as age-related macular degeneration and inherited retinal degenerations, are characterized by the dysfunction and ultimately loss of photoreceptors and retinal pigment epithelium (RPE). Retinal cell replacement has emerged as a potential therapeutic strategy. This is enabled by the availability of desired donor cells differentiated in large numbers from human embryonic or induced pluripotent stem cells. With many differentiation protocols around, detailed comparison of donor cell and host characteristics allowing improved transplantations outcomes are however still sparse. Here, I will present our work on a more detailed assessment of photoreceptor and RPE single cell suspension transplantations. Human photoreceptors incorporate extensively into a cone-degeneration mouse host, interact with host Müller glia and bipolar cells and polarize to form inner and outer segments as well as synapses. Importantly, increased donor-host interactions correlate with improved graft polarization and maturation, with donor cell age greatly influencing this process. Similarly, RPE transplantations into an acute RPE depletion mouse model showed that monolayer formation strongly depends on RPE differentiation times, with further improvement by enrichment of an RPE subpopulation by cell surface markers. Overall, our work highlights the need for careful selection of appropriate donor cells for structural integration into recipient tissue after transplantation.

A Novel Surgical Approach for Big Sheet Allogenic Retinal Pigment Epithelium-Bruch Membrane Complex Transplantation Into the Subretinal Space.

Allogenic transplantation of retinal pigmented epithelium monolayer sheet has experienced bottlenecks due to imperfect surgical techniques. In this study, we developed a novel approach for allogenic transplantation of big sheets of retinal pigment epithelium (RPE)-Bruch membrane complex. RPE-Bruch membrane complex sheets of 5 × 6 mm2 to 10 × 10 mm2 were taken from donated eyes. Through a novel approach, the sheets of RPE-Bruch membrane complex were transplanted into the subretinal space of eight eyes (8 patients) with late-stage retinitis pigmentosa. The patients were followed up for 5 ± 2 months. All RPE-Bruch membrane complexes were successfully inserted into the subretinal space during the surgery. Follow-up examinations also showed that the grafts attached well to the transplantation site. No rejection or retinal detachment was found. Through our technique, big sheets of allogenic RPE-Bruch membrane complexes could be implanted into the subretinal space smoothly. This novel approach may be useful for big sheet of allogenic RPE-derived or stem cells-derived RPE transplantation in the treatment of RP and other retinal dystrophic diseases.

Vitreoretinal surgery in age-related macular degeneration

The structure of the vitreous body, its interaction with the retinal surface and tractive alterations of the vitreoretinal interface may play arole in the pathogenesis and the development of age-related macular degeneration (AMD). From clinical trials it can be concluded that posterior vitreous detachment (PVD) or vitreous removal may protect against the development of neovascular AMD. Vitreomacular adhesions may promote neovascular AMD and may have an impact on the efficacy and frequency of intravitreal vascular endothelial growth factor (VEGF) inhibition. Therefore, vitreomacular surgery may be considered as atreatment option in selected cases. Peeling of epimacular membranes and the internal limiting membrane (ILM) may contribute to stabilizing visual acuity and reducing the treatment burden of current intravitreal pharmacotherapy. At present, surgical interventions in AMD are mainly performed in cases of submacular hemorrhage involving the fovea. The treatment is not standardized and consists of liquefaction of the blood using recombinant tissue plasminogen activator (rTPA) and its pneumatic displacement, potentially combined with VEGF inhibition. Other submacular surgical strategies, such as choroidal neovascularization (CNV) extraction, macular translocation or transplantation of retinal pigment epithelium (RPE) are currently limited to selected cases as asalvage treatment; however, the development of these submacular surgical interventions has formed the basis for new approaches in the treatment of dry and neovascular AMD including submacular or intravitreal gene and stem cell therapy.

Single-cell transcriptomics reveals maturation of transplanted stem cell–derived retinal pigment epithelial cells toward native state

Transplantation of stem cell-derived retinal pigment epithelial (RPE) cells is considered a viable therapeutic option for age-related macular degeneration (AMD). Several landmark Phase I/II clinical trials have demonstrated safety and tolerability of RPE transplants in AMD patients, albeit with limited efficacy. Currently, there is limited understanding of how the recipient retina regulates the survival, maturation, and fate specification of transplanted RPE cells. To address this, we transplanted stem cell-derived RPE into the subretinal space of immunocompetent rabbits for 1 mo and conducted single-cell RNA sequencing analyses on the explanted RPE monolayers, compared to their age-matched invitro counterparts. We observed an unequivocal retention of RPE identity, and a trajectory-inferred survival of all invitro RPE populations after transplantation. Furthermore, there was a unidirectional maturation toward the native adult human RPE state in all transplanted RPE, regardless of stem cell resource. Gene regulatory network analysis suggests that tripartite transcription factors (FOS, JUND, and MAFF) may be specifically activated in posttransplanted RPE cells, to regulate canonical RPE signature gene expression crucial for supporting host photoreceptor function, and to regulate prosurvival genes required for transplanted RPE's adaptation to the host subretinal microenvironment. These findings shed insights into the transcriptional landscape of RPE cells after subretinal transplantation, with important implications for cell-based therapy for AMD.

Electrospun mini-MiSp spidroin/poly(L-lactide-co-ε-caprolactone) nanofibrous scaffolds for ARPE-19 cells

Age-related macular degeneration, a type of retinal degenerative disease, is the primary cause of severe visual impairment and irreversible blindness in people older than 50, due to age-related deterioration of the photoreceptors and the retinal pigment epithelium (RPE), which could be restored by cell therapy. However, the success of cell therapy depends on biocompatible scaffolds, which serve as carriers for the growth of RPE cells for repairing damaged or diseased retinas. In this study, the plasmid pET-SUMO-R2C for expressing a mini-spidroin, fusing the second repetitive region to the C-terminal domain of the minor ampullate spidroin gene from the spider Araneus ventricosus, was constructed and named R2C. The spidroin R2C was expressed, purified and wet spun into silk-like fibers, possessing a Young’s modulus of 3.51 ± 0.92 GPa and toughness of 24.67 ± 9.51 MPa. The spidroin R2C, mixed with poly(L-lactide-co-ε-caprolactone) (PLCL) at a ratio of 3:1, was electrospun into nanofibrous scaffolds, composed of nanometric fibers with a diameter of 751.70 ± 19.48 nm. After co-culturing with the R2C/PLCL scaffolds, the transcriptomic differences of the ARPE-19 cells were analyzed, showing that fourteen genes that are mainly related to inflammation, tumors and keratinization were upregulated more than three times, while seven genes that are mostly related to substance transport and homeostasis were downregulated more than three times. The R2C/PLCL scaffolds have the potential to be further studied to serve as a suitable carrier for RPE transplantation in the future.

Surgical methods of retinal pigment epithelium transplantation in rabbits in experiment

The article is devoted to the study of surgical methods of retinal pigment epithelium transplantation in experiment on rabbits. The history of retinal pigment epithelium transplantation is briefly characterized in the study. Characteristics of the methods used are presented, their limitations, possibilities, and requirements for implementation in practice are highlighted. The results of transplantation of suspension of retinal pigment epithelium cells differentiated from human induced pluripotent stem cells (IPSC-RPE) without and with the use of platelet-rich blood plasma (PRP) are also considered. According to the results of the analysis we have developed modified methods of IPSC-RPE cells transplantation in the experiment on rabbits, which allow to reduce the number of postoperative complications, which provides the best therapeutic effect. Prospects for further studies are associated with a comparative analysis of the proposed techniques in terms of cell survival at different terms, anatomical integration and functional efficiency in the dynamics.

Stem cell-derived retinal pigment epithelium cell therapy: Past and future directions.

The eyes are relatively immune privileged organs, making them ideal targets for stem cell therapy. Researchers have recently developed and described straightforward protocols for differentiating embryonic and induced pluripotent stem cells into retinal pigment epithelium (RPE), making diseases affecting the RPE, such as age-related macular degeneration (AMD), viable targets for stem cell therapy. With the advent of optical coherence tomography, microperimetry, and various other diagnostic technologies, the ability to document disease progression and monitor response to treatments such as stem cell therapy has been significantly enhanced in recent years. Previous phase I/II clinical trials have employed various cell origins, transplant methods, and surgical techniques to identify safe and efficacious methods of RPE transplantation, and many more are currently underway. Indeed, findings from these studies have been promising and future carefully devised clinical trials will continue to enhance our understanding of the most effective methods of RPE-based stem cell therapy, with the hope to eventually identify treatments for disabling and currently incurable retinal diseases. The purpose of this review is to briefly outline existing outcomes from initial clinical trials, review recent developments, and discuss future directions of clinical research involving stem-cell derived RPE cell transplantation for retinal disease.

Retinal Pigment Epithelium Cell Development: Extrapolating Basic Biology to Stem Cell Research

The retinal pigment epithelium (RPE) forms an important cellular monolayer, which contributes to the normal physiology of the eye. Damage to the RPE leads to the development of degenerative diseases, such as age-related macular degeneration (AMD). Apart from acting as a physical barrier between the retina and choroidal blood vessels, the RPE is crucial in maintaining photoreceptor (PR) and visual functions. Current clinical intervention to treat early stages of AMD includes stem cell-derived RPE transplantation, which is still in its early stages of evolution. Therefore, it becomes essential to derive RPEs which are functional and exhibit features as observed in native human RPE cells. The conventional strategy is to use the knowledge obtained from developmental studies using various animal models and stem cell-based exploratory studies to understand RPE biogenies and developmental trajectory. This article emphasises such studies and aims to present a comprehensive understanding of the basic biology, including the genetics and molecular pathways of RPE development. It encompasses basic developmental biology and stem cell-based developmental studies to uncover RPE differentiation. Knowledge of the in utero developmental cues provides an inclusive methodology required for deriving RPEs using stem cells.

Progress of iPS cell-based transplantation therapy for retinal diseases.

The discovery of induced Pluripotent Stem) (iPS) cells has instigated innovation in various fields, including ophthalmology. Cell therapy has shown tremendous progress in translational research on retinal diseases, including the first-in-human transplantation of autologous iPS cell-derived retinal pigment epithelium (RPE) cells for patients with age-related macular degeneration (AMD). Cell therapy for retinitis pigmentosa (RP) has also been developed. Retinal organoid and photoreceptor cell transplantation has been shown to incorporate into the degenerated host retina, forming synapses with host neurons and resulting in functional recovery. Based on preclinical data, first-in-human transplantation of iPS cell-derived retinal sheets has been conducted. In this review, we summarize the current progress in iPS cell-based retinal cell transplantation research for retinal diseases, addressing some remaining challenges and future prospects.

From biomimetic in vitro culture towards functional transplantation of hPSC‐RPE

AbstractHuman pluripotent stem cell‐derived retinal pigment epithelium (hPSC‐RPE) transplantation is currently under evaluation as treatment for macular degeneration. In our studies, we have shown that the culture substrate affects hPSC‐RPE properties in vitro, and our results also suggest that the choice of coating proteins may have implications to the functional properties of these cells also after important cryostorage cell banking. Importantly, transplanted cells must tolerate cellular stress caused by various sources such as retinal inflammation and regain their functions rapidly after the transplantation. In our studies, we have shown that the maturation level of the cultured hPSC‐RPE cells influence for example their calcium signalling properties and for the ability to tolerate cellular stress. With our collaborators, we have also studied the role of ion channels and their involvement in diverse physiological functions of hPSC‐RPEs. Last but not least, we have transplanted hPSC‐RPE as cell sheets in a novel immunosuppressed non‐human primate (NHP) model with a disrupted ocular immune privilege to study safety and submacular graft integration. In transplantations, microscope‐integrated intraoperative optical coherence tomography (miOCT)‐guided surgery, postoperative follow‐up incorporated scanning laser ophthalmoscopy, spectral domain (SD‐) OCT, and full‐field electroretinography (ERG) were used as outcome measures in addition to the histology performed after a 28‐day follow‐up. As a result, miOCT revealed foveal disruption and ERG showed amplitude and peak time preservation in cases with favourable surgical outcomes. Histology confirmed photoreceptor preservation above the grafts and in vivo phagocytosis by hPSC‐RPE, albeit evidence of cytoplasmic redistribution of opsin in photoreceptors and glia hypertrophy. The established immunosuppression protocol efficiently suppressed retinal T cell infiltration and microglia activation. As a conclusion, our results suggest the important role of biomimetic in vitro culture for the hPSC‐RPE maturation and for the functional transplantation outcome.

Hydrogels to Support Transplantation of Human Embryonic Stem Cell-Derived Retinal Pigment Epithelial Cells.

Retinal pigment epithelial (RPE) cells are highly specialized neural cells with several functions essential for vision. Progressive deterioration of RPE cells in elderly individuals can result in visual impairment and, ultimately, blinding disease. While human embryonic stem cell-derived RPE cell (hESC-RPE) growth conditions are generally harsher than those of cell lines, the subretinal transplantation of hESC-RPE is being clinically explored as a strategy to recover the damaged retina and improve vision. The cell-adhesion ability of the support is required for RPE transplantation, where pre-polarized cells can maintain specific functions on the scaffold. This work examined four typical biodegradable hydrogels as supports for hESC-RPE growth. Four biodegradable hydrogels were examined: gelatin methacryloyl (GelMA), hyaluronic acid methacryloyl (HAMA), alginate, and fibrin hydrogels. ARPE-19 and hESC-RPE cells were seeded onto the hydrogels separately, and the ability of these supports to facilitate adherence, proliferation, and homogeneous distribution of differentiated hESC-RPE cells was investigated. Furthermore, the hydrogel's subretinal bio-compatibility was assessed in vivo. We showed that ARPE-19 and hESC-RPE cells adhered and proliferated only on the fibrin support. The monolayer formed when cells reached confluency, demonstrating the polygonal semblance, and revealing actin filaments that moved along the cytoplasm. The expression of tight junction proteins at cell interfaces on the 14th day of seeding demonstrated the barrier function of epithelial cells on polymeric surfaces and the interaction between cells. Moreover, the expression of proteins crucial for retinal functions and matrix production was positively affected by fibrin, with an increment of PEDF. Our in vivo investigation with fibrin hydrogels revealed high short-term subretinal biocompatibility. The research of stem cell-based cell therapy for retinal degenerative diseases is more complicated than that of cell lines. Our results showed that fibrin is a suitable scaffold for hESC-RPE transplantation, which could be a new grafting material for tissue engineering RPE cells.

Retinal Pigment Epithelium Transplantation: Past, Present, and Future.

Retinal pigment epithelium (RPE) is a monolayer of cells situated between photoreceptors and the underlying choroid. It is essential for normal retinal function. Damaged RPE is associated with diseases such as age-related macular degeneration, Stargardt's macular dystrophy, and retinitis pigmentosa. RPE cells can easily be visualized in vivo, sustainable in vitro, and differentiated from stem cells with a relatively straightforward protocol. Due to these properties and the clinical significance of this epithelium in various retinal diseases, RPE transplantation as a treatment modality has gained considerable interest in the last decade. This paper presents the main techniques for RPE transplantation and discusses recent clinically relevant publications.

Comparison of human amniotic membrane decellularisation approaches for hESC-derived RPE cells culture

ObjectiveRecent clinical studies have shown that the transplantation of functional retinal pigment epithelium (RPE) cells can prevent the onset of RPE degeneration in age-related macular degeneration. This study aimed to...

New Prospects for Retinal Pigment Epithelium Transplantation.

Retinal pigment epithelium (RPE) transplants rescue photoreceptors in selected animal models of retinal degenerative disease. Early clinical studies of RPE transplants as treatment for age-related macular degeneration (AMD) included autologous and allogeneic transplants of RPE suspensions and RPE sheets for atrophic and neovascular complications of AMD. Subsequent studies explored autologous RPE-Bruch membrane-choroid transplants in patients with neovascular AMD with occasional marked visual benefit, which establishes a rationale for RPE transplants in late-stage AMD. More recent work has involved transplantation of autologous and allogeneic stem cell-derived RPE for patients with AMD and those with Stargardt disease. These early-stage clinical trials have employed RPE suspensions and RPE monolayers on biocompatible scaffolds. Safety has been well documented, but evidence of efficacy is variable. Current research involves development of better scaffolds, improved modulation of immune surveillance, and modification of the extracellular milieu to improve RPE survival and integration with host retina.

Regenerative and restorative medicine for eye disease.

Causes of blindness differ across the globe; in higher-income countries, most blindness results from the degeneration of specific classes of cells in the retina, including retinal pigment epithelium (RPE), photoreceptors, and retinal ganglion cells. Advances over the past decade in retinal regenerative medicine have allowed each of these cell types to be produced ex vivo from progenitor stem cells. Here, we review progress in applying these technologies to cell replacement - with the goal of vision restoration in degenerative disease. We discuss the landscape of human clinical trials for RPE transplantation and advanced preclinical studies for other cell types. We also review progress toward in situ repair of retinal degeneration using endogenous progenitor cells. Finally, we provide a high-level overview of progress toward prosthetic ocular vision restoration, including advanced photovoltaic devices, opsin-based gene therapy, and small-molecule photoswitches. Progress in each of these domains is at or near the human clinical-trial stage, bringing the audacious goal of vision restoration within sight.

Heterogeneity of Potassium Channels in Human Embryonic Stem Cell-Derived Retinal Pigment Epithelium

Human pluripotent stem cell (hPSC)-derived retinal pigment epithelium (RPE) is extensively used in RPE research, disease modeling, and transplantation therapies. For successful outcomes, a thorough evaluation of their physiological authenticity is a necessity. Essential determinants of this are the different ion channels of the RPE, yet studies evaluating this machinery in hPSC-RPE are scarce. We examined the functionality and localization of potassium (K+) channels in the human embryonic stem cell (hESC)-derived RPE. We observed a heterogeneous pattern of voltage-gated K+ (KV) and inwardly rectifying K+ (Kir) channels. Delayed rectifier currents were recorded from most of the cells, and immunostainings showed the presence of KV1.3 channel. Sustained M-currents were also present in the hESC-RPE, and based on immunostaining, these currents were carried by KCNQ1-KCNQ5 channel types. Some cells expressed transient A-type currents characteristic of native human fetal RPE (hfRPE) and cultured primary RPE and carried by KV1.4 and KV4.2 channels. Of the highly important Kir channels, we found that Kir7.1 is present both at the apical and basolateral membranes of the hESC- and fresh native mouse RPE. Kir currents, however, were recorded only from 14% of the hESC-RPE cells with relatively low amplitudes. Compared to previous studies, our data suggest that in the hESC-RPE, the characteristics of the delayed rectifier and M-currents resemble native adult RPE, while A-type and Kir currents resemble native hfRPE or cultured primary RPE. Overall, the channelome of the RPE is a sensitive indicator of maturity and functionality affecting its therapeutic utility.

Strategies of pluripotent stem cell-based therapy for retinal degeneration: update and challenges.

Stem cell-based therapy for retinal degeneration is transitioning from the research stage to the clinical stage and is being developed as a treatment across the globe. In clinical studies on induced pluripotent stem cell (iPSC)-derived retinal pigment epithelium (RPE) transplantation, the safety of the technique has started to clarify, and clinical study on further advances such as the long-desired transplantation of iPSC-derived retina to treat retinitis pigmentosa (RP) has begun. Ophthalmologists are now working closely with basic researchers to incorporate new technology areas with a synergy that is anticipated to realize the practical application of stem cell-based therapy for retinal degeneration.

HUMAN EMBRYONIC STEM CELL DERIVATIVE SUBRETINAL PIGMENT EPITHELIAL TRANSPLANTATION AS A TREATMENT FOR DRY-TYPE MACULAR

Age-related Macular Degeneration (AMD), is the fourth disease which causes blindness in the world, will potentially increase in 2020. Therefore, alternative treatment is needed to be developed, such as Human Embryonic Stem Cell-derived Retinal Pigment Epithelium (hESC-RPE) transplantation in a subretinal layer. The purpose of this literature review is to identify AMD pathogenesis, especially dry type, to know the impact of hESC-RPE transplantation towards acuity of vision, and to understand its therapeutic effect, safety, also tolerability based on the literature cited. Articles were collected by google search engine through Pubmed, Sciencedirect, Proquest, and Springer link. Inclusion criteria are literature that was published between 2010-2020, clinical trial study, systematic review, and meta-analysis. the topic of these sources is focused on regenerative therapy in AMD patients. Whereas exclusion criteria are literature that published under 2010. According to our research, hESC-RPE transplantation in a subretinal layer can increase the acuity of vision in dry-type AMD patients by improving RPE pigmentation, which protects its photoreceptor cells. Safety and tolerability are proof that there are no abnormalities in proliferation and immunity. In conclusion, these findings are beneficial in the improvement quality life of AMD patients. Therefore, in the future, subretinal hESC-RPE can be effective in the alternative treatment of dry-typed AMD patients.