Raymond D. Lund

Long‐Term Safety and Function of RPE from Human Embryonic Stem Cells in Preclinical Models of Macular Degeneration

Assessments of safety and efficacy are crucial before human ESC (hESC) therapies can move into the clinic. Two important early potential hESC applications are the use of retinal pigment epithelium (RPE) for the treatment of age‐related macular degeneration and Stargardt disease, an untreatable form of macular dystrophy that leads to early‐onset blindness. Here we show long‐term functional rescue using hESC‐derived RPE in both the RCS rat and Elov14 mouse, which are animal models of retinal degeneration and Stargardt, respectively. Good Manufacturing Practice‐compliant hESC‐RPE survived subretinal transplantation in RCS rats for prolonged periods (>220 days). The cells sustained visual function and photoreceptor integrity in a dose‐dependent fashion without teratoma formation or untoward pathological reactions. Near‐normal functional measurements were recorded at >60 days survival in RCS rats. To further address safety concerns, a Good Laboratory Practice‐compliant study was carried out in the NIH III immune‐deficient mouse model. Long‐term data (spanning the life of the animals) showed no gross or microscopic evidence of teratoma/tumor formation after subretinal hESC‐RPE transplantation. These results suggest that hESCs could serve as a potentially safe and inexhaustible source of RPE for the efficacious treatment of a range of retinal degenerative diseases. STEM CELLS 2009;27:2126–2135

Prenatal development of the optic projection in albino and hooded rats

The development of retinofugal projections has been examined in albino and hooded rat embryos from embryonic day 16 to birth (E21.5). Horseradish peroxidase (HRP) was injected intraocularly through the uterine wall and its anterograde transport revealed with TMB and DAB. The retrograde transport of HRP or the fluorescent dyes Nuclear yellow, Fast blue and propidium iodide from optic tract, superior colliculus (SC) or lateral geniculate body (LG) injections was used to demonstrate the origin of the projections. Superficial projections to the contralateral SC were first identified at E16. A light projection to the entire medio-lateral extent of the ipsilateral SC could be detected a day later. The optic axons grow over the surface of the diencephalon at E16 and it was only at later stages that the fibers were observed to invade successively deeper parts of the LG. A superficial projection to the ipsilateral LG could first be detected at E17. Both the ipsilateral and contralateral projections grew through the entire dorso-ventral extent of the lateral geniculate body: some restriction of the axons to their normal adult termination zones could be detected by E21. No difference in the distribution of projections could be detected between the albino and pigmented rats although the projections were lighter, and possibly because of this were detected later, in the albino rats. At all the ages examined in this study labeled retinal ganglion cells were observed in the non-injected eyes after injection of label into the contralateral eye. The use of persistent fluorescent dyes showed that these retinal ganglion cells did not survive for more than 5 days postnatally. The projection to the uninjected eye came preferentially from ganglion cells in the lower nasal retina while the ipsilateral central projections came predominantly but not exclusively from the lower temporal retina of the injected eye. It appears, therefore, that the initial projections of optic axons in the rat are not limited to their normal termination zones and that the choice of pathway at the chiasm appears to be only loosely controlled.

Cells Isolated from Umbilical Cord Tissue Rescue Photoreceptors and Visual Functions in a Rodent Model of Retinal Disease

Progressive photoreceptor degeneration resulting from genetic and other factors is a leading and largely untreatable cause of blindness worldwide. The object of this study was to find a cell type that is effective in slowing the progress of such degeneration in an animal model of human retinal disease, is safe, and could be generated in sufficient numbers for clinical application. We have compared efficacy of four human‐derived cell types in preserving photoreceptor integrity and visual functions after injection into the subretinal space of the Royal College of Surgeons rat early in the progress of degeneration. Umbilical tissue‐derived cells, placenta‐derived cells, and mesenchymal stem cells were studied; dermal fibroblasts served as cell controls. At various ages up to 100 days, electroretinogram responses, spatial acuity, and luminance threshold were measured. Both umbilical‐derived and mesenchymal cells significantly reduced the degree of functional deterioration in each test. The effect of placental cells was not much better than controls. Umbilical tissue‐derived cells gave large areas of photoreceptor rescue; mesenchymal stem cells gave only localized rescue. Fibroblasts gave sham levels of rescue. Donor cells were confined to the subretinal space. There was no evidence of cell differentiation into neurons, of tumor formation or other untoward pathology. Since the umbilical tissue‐derived cells demonstrated the best photoreceptor rescue and, unlike mesenchymal stem cells, were capable of sustained population doublings without karyotypic changes, it is proposed that they may provide utility as a cell source for the treatment of retinal degenerative diseases such as retinitis pigmentosa.

Subretinal transplantation of genetically modified human cell lines attenuates loss of visual function in dystrophic rats

Royal College of Surgeons rats are genetically predisposed to undergo significant visual loss caused by a primary dysfunction of retinal pigment epithelial (RPE) cells. By using this model, we have examined the efficacy of subretinal transplantation of two independent human RPE cell lines each exhibiting genetic modifications that confer long-term stability in vitro. The two cell lines, a spontaneously derived cell line (ARPE19) and an extensively characterized genetically engineered human RPE cell line (h1RPE7), which expresses SV40 large T (tumor) antigen, were evaluated separately. Both lines result in a significant preservation of visual function as assessed by either behavioral or physiological techniques. This attenuation of visual loss correlates with photoreceptor survival and the presence of donor cells in the areas of rescued photoreceptors at 5 months postgrafting (6 months of age). These results demonstrate the potential of genetically modified human RPE cells for ultimate application in therapeutic transplantation strategies for retinal degenerative diseases caused by RPE dysfunction.

Long-term preservation of cortically dependent visual function in RCS rats by transplantation.

Cell transplantation is one way of limiting the progress of retinal degeneration in animal models of blinding diseases such as retinitis pigmentosa (RP) and age-related macular degeneration (AMD). Here we transplanted a human retinal pigment epithelial (RPE) cell line into the subretinal space of one such model, the Royal College of Surgeons (RCS) rat, and showed, using head tracking to moving stripes and pattern discrimination in conjunction with single-unit cortical physiology, that cortically mediated vision can be preserved with this treatment.

Retrograde axonal transport of horseradish peroxidase by ganglion cells of the albino rat retina

Abstract After introduction of small amounts of horseradish peroxidase (HRP) into known visual centers of the brain, retinal ganglion cells projecting to these regions were detected by the accumulation of HRP-positive granules in their somata. Control experiments indicated that the HRP-positive granules had reached the ganglion cell somata by retrograde axonal transport, and did not represent blood-borne or endogenous peroxidase. Using this technique, it has been determined that axons of both large and medium-sized neurons in the ganglion cell layer of adult and immature rat retinae terminate in the superior colliculus and lateral geniculate body, and that characteristic displaced ganglion cells with axonal connections to these visual centers occur regularly in these retinae. In addition, certain small cells in the retinal ganglion cell layer are described which may represent glia or interneurons, or ganglion cells which lack the ability to transport peroxidase or which lack central connections to these visual centers of the brain.

Cell transplantation as a treatment for retinal disease.

It has been shown that photoreceptor degeneration can be limited in experimental animals by transplantation of fresh RPE to the subretinal space. There is also evidence that retinal cell transplants can be used to reconstruct retinal circuitry in dystrophic animals. Here we describe and review recent developments that highlight the necessary steps that should be taken prior to embarking on clinical trials in humans.

Ganglion cell loss in RCS rat retina: A result of compression of axons by contracting intraretinal vessels linked to the pigment epithelium

In the dystrophic Royal College of Surgeons (RCS) rat retina, there is a progressive loss of photoreceptors. As a result, the retinal circulation becomes apposed to the retinal pigment epithelium (RPE) and neovascular formations develop. RPE and inner nuclear layer cells migrate along these vessels towards the retinal ganglion cell (RGC) layer. The retinal layers gradually become disrupted, and some of the RGC axon bundles involute into the retina. These bundles are always associated with blood vessels, and there is evidence of axon damage where they juxtapose.

Specific projections of retina transplanted to rat brain.

SummaryRetinae were taken from fetal rats and transplanted adjacent to the superior colliculus of neonatal rats. After 1 month survival, the transplants were surgically removed from the hosts, locally damaged or injected with horseradish peroxidase (HRP) to determine the distribution of the transplant efferents in the host brains. Histological examination of the transplants revealed cell and plexiform layers characteristic of normal retinae. Since the retinae were undifferentiated at the time of transplantation, this layering developed within the host. The only obvious differences from normal retina were that the layers were organized in rosettes or folded sheets and lacked well developed photoreceptor outer segments. In animals which had lesions or HRP injections confined to the retinal transplant, proper staining of sections of the host brain revealed transplant projections. These projections were confined to the optic tract and nuclei which are normally retinorecipient such as the superior colliculus and dorsal lateral geniculate nucleus. Projections were found along the border of non-retinorecipient nuclei such as the lateral posterior nucleus, but did not appear to enter these nuclei. It was observed that within the superior colliculus the host retinal input had an effect on the distribution of the transplant projection. In one-eyed hosts the transplant projection was distributed throughout the stratum (s.) zonale, s. griseum superficiale, and s. opticum; whereas in the two-eyed hosts, the transplant projection was confined to the s. zonale and the border between s. griseum superficiale and s. opticum.We suggest that a special affinity exists between the axons of the retinal transplants and host visual structures. Furthermore, factors, such as competition and timing may be important in determining the distribution of the transplant axons within the specific target nuclei. Transplantation appears to be a useful technique for further studies on the mechanisms underlying the development of specific neuronal connections.

Regressive and reactive changes in the connectivity patterns of rod and cone pathways of P23H transgenic rat retina

We have used the P23H line 1 homozygous albino rat to study how progressive photoreceptor degeneration affects rod and cone relay pathways. We examined P23H retinas at different stages of degeneration by confocal microscopy of immunostained sections and electroretinogram (ERG) recordings. By 21 days of age in the P23H rat retina, there is already substantial loss of rods and reduction in rod bipolar dendrites along with reduction of metabotropic glutamate receptor 6 (mGluR6) and rod-associated bassoon staining. The cone pathway is relatively unaffected. By 150 days, when rods are absent from much of the retina, some rod bipolars remain and dendrites of rod and cone bipolar cells form synaptic complexes associated with cones and horizontal cell processes. These complexes include foci of mGluR6 and bassoon staining; they develop further by 270 days of age. Over the course of degeneration, beginning at 21 days, bipolar axon terminals atrophy and the inner retina undergoes further changes including a reduced and disorganized AII amacrine cell population and thinning of the inner plexiform layer. Electroretinogram (ERG) results at 23 days show reductions in a-wave amplitude, in rod and cone-associated b-waves (using a double flash paradigm) and in the amplitude of oscillatory potentials (OPs). By 38 days, rod scotopic a-wave responses and OPs are lost. B-wave amplitudes decline until 150 days, at which point they are purely cone-driven and remain stable up to 250 days. The results show that during the course of photoreceptor loss in the P23H rat, there are progressive degenerative changes, particularly in the rod relay pathway, and these are reflected in the changing ERG response patterns. Later reactive changes involving condensation of cone terminals and neurotransmitter receptors associated with rod and cone bipolar dendrites and with horizontal cell processes suggest that at this stage, there are likely to be complex changes in the relay of sensory information through the retina.