Gene transfer for ocular neovascularization and macular edema.

Diseases complicated by abnormal growth of vessels or excessive leakage are the most prevalent cause of moderate or severe vision loss in developed countries. Recent progress unraveling the molecular pathogenesis of several of these disease processes has led to new drug therapies that have provided major benefits to patients. However, those treatments often require frequent intraocular injections, and despite monthly injections, some patients have a suboptimal response. Gene transfer of antiangiogenic proteins is an alternative approach that has the potential to provide long-term suppression of neovascularization (NV) and/or excessive vascular leakage in the eye. Studies in animal models of ocular NV have demonstrated impressive results with a number of transgenes, and a clinical trial in patients with advanced neovascular age-related macular degeneration has provided proof-of-concept. Two ongoing clinical trials, one using an adeno-associated viral (AAV) vector to express a vascular endothelial growth factor-binding protein and another using a lentiviral vector to express endostatin and angiostatin, will provide valuable information that should help to inform future trials and provide a foundation on which to build.

Sequence and expression analysis of bovine pigment epithelium-derived factor.

PEDF, a member of the serpin superfamily of proteins related through their highly conserved folded conformation, has neurotrophic properties, including promotion of neurite-outgrowth and neuronal survival. Previously, we have purified and characterized PEDF protein from extracellular matrixes of bovine eyes. Here, we show the cDNA sequence and expression analysis of bovine PEDF. Northern analysis of RNA from bovine retinal pigment epithelium (RPE) and neural retina using a human PEDF cDNA fragment reveals expression of the PEDF gene only for RPE. Sequence analysis of a cDNA clone isolated from bovine RPE predicts a polypeptide of 416 amino acid residues that shares 88.6% and 85% amino acid identity with human and mouse PEDF, respectively. It has an N-terminal signal peptide, a consensus glycosylation site and homology with serpins including the conserved residues required for maintaining the serpin tertiary structure. Cell-free expression of the bovine PEDF cDNA by in vitro transcription and translation yields a precursor polypeptide of 45,000-Mr that immunoprecipitates with an antibody to human PEDF. Expression analysis in stably transfected baby hamster kidney cells shows that the recombinant bovine protein is secreted to the culture media as a mature 50,000-Mr protein, which induces neurite-outgrowth on retinoblastoma cells, like the naturally-occurring PEDF protein. Thus, the bovine PEDF cDNA isolated here codes for a functional soluble secreted PEDF glycoprotein.

Aldose reductase expression in human diabetic retina and retinal pigment epithelium.

The conversion of glucose to sorbitol by aldose reductase (AR) and its subsequent intracellular accumulation have been implicated in the pathogenesis of diabetic cataracts. There is also evidence linking AR activity with retinal capillary basement membrane thickening in galactosemic rats, suggesting a possible role in diabetic retinopathy. In this study, we explored one feature of this issue by examining diabetic and nondiabetic eyes for immunoreactive AR. AR was immunohistochemically undetectable in the retinal pigment epithelia (RPE) and neural retinas of nondiabetic human eyes. Weak, focal staining for AR was present unilaterally in the RPE of 1 of 11 diabetic patients without pathologic ocular findings and in 43% of diabetic patients with mild ocular findings. Retinal positivity was found (unilaterally) in only 2 of 19 individuals from either of these mildly affected groups. Fifty-five percent of patients with background retinopathy demonstrated AR positivity in the RPE, and half of these expressed AR in the RPE of both eyes. Of the individuals with proliferative diabetic retinopathy, 87.5% showed bilateral staining in the RPE. Retinal positivity was present in 36% of background retinopathy and 75% of proliferative retinopathy cases, demonstrating a positive correlation between AR expression and the severity of the disorder. In weakly staining retinas, only the ganglion cell bodies, nerve fibers, and Müller cells were positive, whereas in intensely staining cases, virtually the entire retina, except for the rod outer segments, was positive. Eyes from patients who had had diabetes less than or equal to 6 yr were negative for AR, but those from long- term-diabetic patients (14-45 yr) manifested positively.(ABSTRACT TRUNCATED AT 250 WORDS)

Month-6 primary outcomes of the READ-3 study (Ranibizumab for Edema of the mAcula in Diabetes-Protocol 3 with high dose).

PURPOSE: To compare 2.0 mg ranibizumab (RBZ) injections with 0.5 mg RBZ for eyes with center-involved diabetic macular edema (DME) and a central subfield thickness (CFT) of ≥250 µm on time-domain optical coherence tomography.DesignRandomized, controlled, multicenter clinical trial. METHODS: Eligible eyes were randomized in a 1:1 ratio to 0.5 mg (n=77) or 2.0 mg (n=75) RBZ. Study eyes received 6-monthly injections.Main outcome measuresThe primary outcome measure was the mean change in best corrected visual acuity (BCVA) at month 6. Secondary outcomes included the incidence and severity of systemic and ocular adverse events and the mean change in CFT from baseline. RESULTS: In all, 152 eyes (152 patients) were randomized in the study. At month 6, the mean improvement from baseline BCVA was +9.43 letters in the 0.5 mg RBZ group and +7.01 letters in the 2.0 mg RBZ group (P=0.161). At month 6, one death occurred in the 0.5 mg RBZ group and three deaths in the 2.0 mg RBZ group, all due to myocardial infarction in subjects with a prior history of heart disease. Mean CFT was reduced by 168.58 µm in the 0.5 mg RBZ group and by 159.70 µm in the 2.0 mg RBZ group (P=0.708). CONCLUSIONS: There was no statistically significant difference in the mean number of letters gained between the 0.5 and 2.0 mg RBZ groups through month 6. In this DME study population, high-dose RBZ does not appear to provide additional benefit over 0.5 mg RBZ.

Clinical protocol. An open-label, phase I, single administration, dose-escalation study of ADGVPEDF.11D (ADPEDF) in neovascular age-related macular degeneration (AMD).

Age-Related Macular Degeneration (AMD) is, together with Diabetic Retinopathy, the most common cause of vision loss among adults in the U.S. and other developed countries. In the U.S., at least 1.7 million people have impaired vision due to AMD. Every year, more than 165,000 people contract AMD and 16,000 go blind from it, predominantly from a rapidly progressing form of the disease called "wet" AMD. Wet AMD is characterized by serious or hemorrhagic detachment of the retinal pigment epithelium and choroidal neovascularization. The macula has the highest concentration of photoreceptors facilitating central vision and permitting high-resolution visual acuity. The damage caused by the leakage and fibrovascular scarring in wet AMD leads to profound loss of central vision and severe loss of visual acuity (usually 20/200 or worse). People with wet AMD have several limitations, including inability to read, inability to recognize faces or drive, and the disease often leads to blindness. The onset of severe visual changes in wet AMD can occur suddenly. More than 400,000 Americans are currently affected by this form of the disease, and the incidence is rising rapidly with the aging of the population. Therefore, the serious consequences of this disease along with the limited treatment options and their effectiveness make this a very good candidate for a gene transfer treatment approach. The investigational agent, Ad(GV)PEDF.11D, is an E1-, partial E3-, E4- deleted replication-deficient, adenovirus serotype 5, gene transfer vector. The transgene in this vector is the cDNA for human pigment epithelium-derived factor (PEDF). PEDF is one of the most potent known antiangiogenic proteins found in humans. While Ad(GV)PEDF.11D is able to transduce many somatic cell types, the natural barrier to other tissues created by the retina limits the ability of Ad(GV)PEDF.11D to affect tissues other than in the eye. Intravitreal administration of Ad(GV)PEDF.11D provides a convenient means of delivering PEDF to the relevant cells within the eye likely to result in a more prolonged duration of effect versus administration of the PEDF protein alone. In three murine disease models (the laser-induced choroidal neovascularization model, the VEGF transgenic model, and the retinopathy of prematurity model) significant inhibition of neovascularization (up to 85%) was demonstrated with doses of Ad(GV)PEDF vectors ranging from 1 x 10(8) to 1 x 10(9) pu. In toxicology studies performed in Cynomolgus monkeys, a dose-related inflammatory response was observed. A dose of 1 x 10(8) pu caused no adverse effects, while the inflammatory response observed at 1 x 10(9) pu was minimal and fully reversible. The observed inflammatory response at doses of 1 x 10(10) and 5 x 10(10) pu were increasingly severe. The proposed clinical trial is an open-label, dose-escalation, phase I study to investigate the safety, tolerability and potential activity of intravitreal injection of Ad(GV)PEDF.11D in patients with wet AMD. Ad(GV)PEDF.11D will be injected once via intravitreal injection into the eye with the most advanced AMD based on visual acuity. Subjects will be age 50 or over and have severe wet AMD in at least one eye defined by a best-corrected vision of 20/200 or worse. The primary objectives of this investigation are: (1) to assess the safety, tolerability and feasibility of intravitreal injection of Ad(GV)PEDF.11D in patients with severe, neovascular AMD, (2) to identify the maximum tolerated dose (MTD) of Ad(GV)PEDF.11D, and (3) to get some indication of potential activity of Ad(GV)PEDF.11D.

Increased vascular endothelial growth factor (VEGF) and transforming growth factor beta (TGFbeta) in experimental autoimmune uveoretinitis: upregulation of VEGF without neovascularization.

Experimental autoimmune uveoretinitis (EAU) was induced in Lewis rats and B10.A mice by immunization with S-antigen (S-Ag) to study the potential roles of vascular endothelial growth factor (VEGF) and the beta1 and beta2 isoforms of transforming growth factor (TGFbeta1 and TGFbeta2) during the progression of the disease. VEGF has been implicated as an angiogenic factor in ischemic retinopathies; however, Lewis rats developing EAU have high levels of VEGF in the retina, but no neovascularization. In the present study, immunohistochemical staining for VEGF, TGFbeta1 and TGFbeta2 was performed on the retinas of Lewis rats developing EAU or with oxygen-induced ischemic retinopathy. In rats immunized with S-antigen, a marked upregulation of VEGF was immunohistochemically visualized from the inner nuclear layer to the inner limiting membrane prior to blood-retinal barrier (BRB) failure and lymphocytic infiltration. VEGF is normally induced by hypoxia and its induction leads to neovascularization. Coincident with the increase in VEGF, there was increased immunoreactivity for TGFbeta1 and TGFbeta2 within the same layers of the retina. In contrast, rats with ischemic retinopathy and retinal neovascularization showed only a modest increase in VEGF immunoreactivity, which is largely confined to retinal ganglion cells and inner retinal vessels, and little or no increase in TGFbeta1 or TGFbeta2. In addition, in mice developing EAU, which does not have an abrupt onset as it does in rats and may involve neovascularization, a comparable upregulation of VEGF in the inner retina to that seen in rats developing EAU occurs with no increase in TGFbeta1 or TGFbeta2. Since TGFbeta can inhibit endothelial cell proliferation, it is likely that an increase in TGFbeta may prevent VEGF from exerting its endothelial growth activity in the rat EAU model, but VEGF may be operative in inducing BRB failure. These data suggest that there is a complex interaction among growth factors in the retina and that retinal neovascularization may require an imbalance between stimulatory and inhibitory factors.

Ultrastructural localization of blood-retinal barrier breakdown in diabetic and galactosemic rats.

Breakdown of the blood-retinal barrier (BRB) is an early event in diabetic and galactosemic rats, but the location and nature of the specific defect(s) are controversial. Using an electron microscopic immunocytochemical technique, the retinas of normal, diabetic, and galactosemic rats were immunostained for endogenous albumin. Normal rats showed little evidence of BRB breakdown at either the inner barrier (retinal vasculature) or the outer barrier (retinal pigment epithelium) (RPE). In diabetic and galactosemic rats, as was true in human diabetics, BRB breakdown occurred predominantly at the inner BRB, but in some cases at the outer barrier as well. Treatment with the aldose reductase inhibitor sorbinil largely prevented BRB failure in galactosemic rats. In the inner retina of diabetic and galactosemic rats, albumin was frequently demonstrated on the abluminal side of the retinal capillary endothelium (RCE) in intercellular spaces, basal laminae, pericytes, ganglion cells, astrocytes, and the perinuclear cytoplasm of cells in the inner nuclear layer. Albumin did not appear to cross RCE cell junctions; however, it was occasionally seen in RCE cytoplasm of galactosemic rats. In the outer retina, albumin was frequently detected in the subretinal space, in the intercellular space between photoreceptors, and in the perinuclear cytoplasm of photoreceptor cells, but was only infrequently found in the RPE cells constituting the barrier. Albumin derived from the choroidal vasculature did not appear to cross the tight junctions of the RPE. These findings suggest that specific sites of BRB compromise are infrequent but that once albumin has crossed the RCE or RPE it freely permeates the retinal tissue by filling intercellular spaces and permeating the membranes of cells not implicated in BRB formation. The diffuse cytoplasmic staining of some RCE and RPE cells suggests that the predominant means of BRB breakdown in diabetes and galactosemia involves increased focal permeability of the surface membranes of the RCE and RPE cells rather than defective tight junctions or vesicular transport.

Stimulation of cyclic adenosine monophosphate accumulation causes breakdown of the blood-retinal barrier.

Pigmented rabbits were given an intravitreous injection of 0.1 ml of various concentrations of test drug, and vitreous fluorophotometry was done 6 and 24 hr after injection. Dibutyryl cyclic adenosine monophosphate (AMP) and 8-bromo-cyclic AMP caused reversible intravitreous fluorescein leakage only at relatively high concentrations. Adrenergic agents that are effective stimulators of adenylate cyclase (epinephrine, isoproterenol, and norepinephrine) caused transient intravitreous fluorescein leakage (2.3-3.1-fold above baseline) that was significantly greater than that caused by phenylephrine (1.1-fold above baseline), an adrenergic agent that is a poor stimulator of adenylate cyclase. Prostaglandins E1 and E2, which are good stimulators of adenylate cyclase, caused striking disruption of the blood-ocular barriers, and prostaglandins that are not good stimulators of adenylate cyclase had little or no effect on these barriers. The magnitude of the prostaglandin E1 effect (9.3-fold above baseline) was similar to that of N-ethylcarboxamidoadenosine (NECA), the most potent adenosine agonist, and was greater than one would predict based on its effect on adenylate cyclase in vitro. Prostaglandin E1, like NECA, also caused retinal vasodilation and hemorrhages. These data suggest that stimulation of intracellular cyclic AMP accumulation may be a common feature of mediators that cause breakdown of the blood-retinal barrier, but there may be another as yet unexplained feature shared by PGE1 and NECA that makes them particularly effective and capable of causing retinal vasodilation and hemorrhages.

Modulation of plasminogen activator inhibitor-1 and urokinase in retinal pigmented epithelial cells.

PURPOSE: To examine the effect of several agents that either stimulate or inhibit neovascularization on plasminogen activator inhibitor-1 and urokinase in retinal pigmented epithelial cells and vascular endothelial cells. METHODS: Steady-state levels of messenger RNA were assessed by Northern blots and dot blots and protein levels were assessed by immunoprecipitation. RESULTS: Data indicate that messenger RNA levels for plasminogen activator inhibitor-1 are modulated in similar fashion in both cells types, being increased by incubation with transforming growth factor-beta, dexamethasone, tumor necrosis factor, phorbol myristate acetate, and thrombin. Levels of urokinase messenger RNA in retinal pigmented epithelial cells are significantly increased only by phorbol myristate acetate and are decreased by dexamethasone and transforming growth factor-beta, whereas in endothelial cells plasminogen activator urokinase messenger RNA is increased by each of the stimuli except dexamethasone, which causes a decrease. Immunoprecipitation experiments demonstrate similar modulation of inhibitor-1 proteins secreted by retinal pigmented epithelial cells, whereas urokinase is difficult to detect. CONCLUSIONS: These data suggest that retinal pigmented epithelial cells may help to alter proteolytic activity in the subretinal space and thereby participate, along with endothelial cells, in the regulation of choroidal neovascularization.

An adenosine agonist and prostaglandin E1 cause breakdown of the blood-retinal barrier by opening tight junctions between vascular endothelial cells.

Macular edema occurs in several disease processes, but little is known about the mechanisms by which it occurs in any disease process. Previously, the authors showed that intravitreous injection of adenosine agonists, prostaglandin E1 (PGE1), or epinephrine in rabbits, causes breakdown of the blood-retinal barrier (BRB) measured by vitreous fluorophotometry. N-ethylcarboxamidoadenosine (NECA), a nonspecific adenosine agonist, and PGE1, cause much greater breakdown of the BRB than the other agents tested. In this study, rabbit eyes were examined ultrastructurally and electron immunocytochemically for extravascular albumin as an indicator of BRB failure after intravitreous injection of these agents or vehicle alone to investigate potential mechanisms involved in BRB compromise. Six hours after injection, there were significantly more open tight junctions between retinal vascular endothelial cells in NECA-, PGE1-, and adenosine-injected eyes than in vehicle-injected eyes. Immunocytochemical staining for serum albumin showed that many of the junctions that appeared open were functionally open. Forty-eight hours after injection of PGE1 (10(-4) mol/l), the percentage of open vascular endothelial cell tight junctions had returned to that of the control specimens, but the opening of tight junctions by NECA (10(-3) mol/l) did not appear to be reversed after 48 hr. Pinocytotic vesicular transport was prominent in all eyes, and no difference was found between vehicle- and drug-injected eyes. These data suggest that NECA and PGE1 cause breakdown of the BRB, at least in part, by opening tight junctions between retinal vascular endothelial cells.

The extracellular matrix of human retinal pigment epithelial cells in vivo and its synthesis in vitro.

The production of extracellular matrix material by retinal pigment epithelium (RPE) may influence or mediate some of the many important functions of this tissue. Using immunohistochemical staining techniques, the extracellular matrix surrounding the RPE in vivo and the components produced by RPE in vitro have been investigated. Frozen sections of eye bank eyes showed antigen specific staining for collagen types I, III, and IV, and for fibronectin and laminin in Bruch's membrane and surrounding the RPE. Only very slight staining of the membrane was seen with antiserum against type II collagen, and there was no staining for type V collagen. Specific staining was demonstrated for the four collagens and glycoproteins in the extracellular matrix of RPE cells grown in culture. Once again, there was no staining for type V collagen. This study demonstrates that the RPE is capable of producing many of the components of the extracellular matrix found in Bruch's membrane and surrounding the RPE in vivo. This function may be important in the maintenance of a physical barrier to subretinal neovascularization, and may also play a role in such pathologic states as proliferative vitreoretinopathy.

Ultrastructural and electron-immunocytochemical characterization of cells in epiretinal membranes.

Electron-immunocytochemical staining for three intermediate filament (IF) proteins, keratin (K), glial fibrillary acidic protein (GFAP), and vimentin (V), and for the macrophage marker, EBM/11 (E), was performed on epiretinal membranes obtained during vitrectomies performed for proliferative vitreoretinopathy (PVR), postdetachment macular puckers (PDMPs), idiopathic macular puckers (IMPs), or macular puckers associated with other disease processes. The ultrastructural and immunocytochemical characteristics of the cells were compared. Unstained cells outnumbered stained cells for each of the markers in almost all membranes. Six cell types, based on ultrastructure, were found in the majority of epiretinal membranes: 1) polarized cells with microvilli on the free border and foot processes anchoring them to extracellular matrix that consistently stained negative for all of the immunocytochemical markers; 2) spindle-shaped fibroblastlike cells that were generally negative for all markers, but rarely positive for V; 3) large undifferentiated cells with large, lightly stained nuclei and little cytoplasm that frequently expressed one of the intermediate filament (IF) proteins; 4) poorly differentiated cells that contained numerous mitochondria and frequently expressed one of the IF proteins; 5) undifferentiated, pigment-laden cells that rarely stained for any of the above IF proteins, but occasionally showed K or V positivity in a portion of the cell, suggesting that they may be losing or acquiring these proteins, and that rarely expressed GFAP; and 6) small, round, mononuclear cells with short processes that were sometimes, but not always, positive for E and that were consistently negative for K, V, and GFAP. In addition to these morphologic types, transitional cells demonstrating features of two or more of the above cell types were seen, suggesting that phenotypic changes between the various cell types can occur. The amount of extracellular matrix in epiretinal membranes showed a correlation with disease process (PVR greater than PDMP greater than IMP), and a negative correlation with the percentage of cells expressing a highly differentiated polarized morphology and with the percentage of cells staining for IF proteins. These data suggest that both cell morphology and IF protein expression may be dependent in part on microenvironment and that neither alone can be used to identify unequivocally the derivation of particular cells found in epiretinal membranes. The integration of ultrastructural and immunocytochemical data may provide a more accurate determination of the cell of origin and of phenotypic changes that have occurred. In some cases, however, both ultrastructural and IF protein composition taken together are insufficient for the precise identification of all cells.(ABSTRACT TRUNCATED AT 250 WORDS)

Retinoic acid promotes density-dependent growth arrest in human retinal pigment epithelial cells.

After retinal detachment the retinal pigment epithelium (RPE) undergoes a striking phenotypic change. It becomes dedifferentiated, proliferates to form multilayered colonies, and migrates into the subretinal space. These processes are important because they have been implicated in proliferative vitreoretinopathy and poor visual recovery after retinal reattachment; however the mechanisms by which they occur are unknown. In this study, the effect of retinoic acid on RPE cell morphology and growth in culture was examined. Cells grown in the presence of 1 microM retinoic acid do not exhibit cellular overgrowth and maintain characteristics associated with the morphologic appearance of mature RPE cells in vivo. Growth curves and 3H-thymidine incorporation suggest that retinoic acid inhibits RPE cell growth primarily after the cells have reached confluence. It may act by promoting density-dependent growth arrest. Dibutryl cyclic adenosine monophosphate also inhibits RPE cell growth and 3H-thymidine incorporation, but has little effect on cell morphology. However, in combination with retinoic acid it appears to have an additive effect on inhibition of cell growth and maintenance of a morphology like RPE in vivo. Retinoids have been demonstrated to modulate the growth and differentiation of several cell types. They are usually present in high levels in RPE cells. They become depleted in RPE in culture and such depletion may also occur in vivo after retinal detachment. This could play a role in the phenotypic alteration of RPE that occurs in association with retinal detachment.

VEGF is major stimulator in model of choroidal neovascularization.

PURPOSE: Vascular endothelial growth factor (VEGF) is upregulated by hypoxia and is a major stimulatory factor for retinal neovascularization in ischemic retinopathies such as diabetic retinopathy. This study sought to determine if VEGF is a stimulatory factor in a murine model of choroidal neovascularization (CNV). METHODS: Mice with laser-induced ruptures in Bruch's membrane were treated with vehicle alone; a drug that inhibits both VEGF and platelet-derived growth factor (PDGF) receptor kinases; a drug that inhibits PDGF, but not VEGF receptor kinase; or genistein, a nonspecific kinase inhibitor. After two weeks, CNV was quantified and compared. RESULTS: Blockade of phosphorylation by VEGF and PDGF receptors caused dramatic, almost complete inhibition of CNV. Genistein also had an inhibitory effect, but less so than the VEGF/PDGF receptor blocker. Blockade of phosphorylation by PDGF receptors, but not VEGF receptors, had no significant effect on CNV. CONCLUSIONS: These data and our previous study, which demonstrated that a kinase inhibitor that blocks VEGF and PDGF receptors and several isoforms of protein kinase C causing dramatic inhibition of CNV, suggest that VEGF signaling plays a critical role in the development of CNV in this model. If safety is established, the effect of inhibiting VEGF receptor kinase activity should be investigated in patients with CNV.

Neurotrophic factors cause activation of intracellular signaling pathways in Müller cells and other cells of the inner retina, but not photoreceptors.

PURPOSE: Intravitreal injection of brain-derived neurotrophic factor (BDNF), ciliary neurotrophic factor (CNTF), or basic fibroblast growth factor (FGF2) promotes survival of photoreceptors exposed to various types of insults, but it is not known if these survival-promoting effects occur by direct action of the factors on photoreceptors or indirectly through the activation of other cells. In this study, the authors have sought to address this issue by determining which cells in the retina show evidence of activated intracellular signaling pathways acutely and at longer time points after intravitreal injection of these agents. METHODS: Retinas were removed from C57BL/6J mice at 1, 6, or 24 hours after intravitreal injection of 1 microg of human BDNF, rat CNTF, human FGF2, or human transforming growth factor-alpha (TGFalpha), and immunohistochemically stained for phosphorylated extracellular signal-regulated kinase (pERK), phosphorylated cAMP responsive element binding protein (pCREB), or c-fos. Retinal organ cultures were incubated with 10 ng/ml of BDNF, CNTF, FGF2, or TGFalpha for 10 or 30 minutes or 1, 3, or 6 hours and then immunohistochemically stained for pERK, pCREB, or c-fos. RESULTS: Intravitreal injection of BDNF, CNTF, or FGF2 resulted in a rapid increase in pERK immunoreactivity in Müller cells and a rapid increase in c-fos immunoreactivity in Müller, amacrine, and ganglion cells. Immunoreactivity for pERK and c-fos returned to baseline in all retinal cells at 6 or 24 hours after injection, but there was increased staining for glial fibrillary acidic protein (GFAP) in Müller cells at these time points. At no time after injection was there any staining for pERK or c-fos in photoreceptors. Similarly, retinal explants treated with FGF2, BDNF, or CNTF showed increased staining for pCREB, pERK, and c-fos in cells of the inner retina, but not photoreceptors. CONCLUSIONS: These data support the hypothesis that BDNF, CNTF, and FGF2 exert their effects on photoreceptors by acting indirectly through activation of Müller cells and perhaps other nonphotoreceptor cells.

Localization of TIMP-3 mRNA expression to the retinal pigment epithelium.

PURPOSE: To evaluate ocular sites of expression of the tissue inhibitor of metalloproteinases-3 gene (TIMP-3). METHODS: In situ hybridization was performed on frozen sections of albino mouse eyes using riboprobes generated to the 3' untranslated region of TIMP-3. RESULTS: TIMP-3 mRNA expression was detected strongly in the retinal pigment epithelium (RPE) and to a minor extent in the ciliary epithelium, but not at any other site within the eye. CONCLUSIONS: Expression of TIMP-3 in the RPE is consistent with the recent demonstration of TIMP-3 mutations in patients with Sorsby's fundus dystrophy, a condition marked by the early onset of choroidal neovascularization in the macula. Unlike many of the recently described genes that cause human retinal disease, TIMP-3 is preferentially expressed in the RPE of the normal eye, as opposed to the photoreceptors.

Growth factor responsiveness of human retinal pigment epithelial cells.

Growth factor effects on DNA synthesis in density-arrested human retinal pigment epithelial cells were assessed by [3H]-thymidine incorporation. Acidic and basic fibroblast growth factor and epidermal growth factor were potent stimulators, whereas platelet-derived growth factor, insulinlike growth factor-1, and insulin were weak or modest stimulators when used alone. When used in combination, each of the above growth factors caused a significant enhancement of [3H]-thymidine incorporation regardless of its effect when used alone. The combination of all four growth factors was significantly more effective than all other combinations, demonstrating synergism in their action. Similar results were found in cell proliferation assays. In contrast to this, transforming growth factor-beta inhibited the ability of each of the other growth factors and serum-containing media to stimulate [3H]-thymidine incorporation. These data suggest that DNA synthesis in human retinal pigment epithelial cells can be modulated by several growth factors, some in a stimulatory or synergistic manner and at least one in an inhibitory manner. A better understanding of these complex interactions may provide insights relevant to normal and abnormal ocular wound healing.

Ultrastructural and immunocytochemical changes in retinal pigment epithelium, retinal glia, and fibroblasts in vitreous culture.

Retinal pigment epithelial (RPE) cells, retinal glial, and fibroblasts, three cell types believed to play a role in the pathogenesis of epiretinal membrane formation, were maintained in vitreous culture to determine the influence of vitreous on their ultrastructure and expression of cytokeratin, glial fibrillary acidic protein (GFAP), vimentin, and glutamine synthetase (GS). Using a highly sensitive, preembedding technique for the immunolocalization of these antigens at the ultrastructural level, most RPE cells were found to lose cytokeratin and vimentin within 1 day after seeding on irradiated vitreous. The percentage of keratin-positive cells then increased with time in culture. If the vitreous was placed on RPE cells cultured in monolayer instead of placing the cells on the vitreous, keratin and vimentin were expressed these intermediate filament proteins diminished with time. Glutamine synthetase was found in RPE cells grown in monolayer with or without a vitreous overlay, but not in RPE cells grown on the surface of vitreous. Retinal glial grown on vitreous showed a time-dependent decrease in the number of cells expressing GFAP and a corresponding increase in cells expressing vimentin or GS. Some fibroblasts in vitreous culture expressed vimentin but not the other antigens evaluated. A substantial number of cells in each culture did not stain positively for cytokeratin, GFAP, vimentin, or GS. All three cell types showed phenotypic diversity at the ultrastructural level with each cell type being capable of assuming the same morphologic appearance under certain conditions. These results demonstrate the phenotypic plasticity of RPE cells, retinal glia, and fibroblasts when grown in contact with vitreous and provide further evidence that neither ultrastructure, intermediate filament protein expression, nor the presence of GS is sufficient to determine the cell type of origin of cells in epiretinal membranes.

Inhibition of growth factor effects in retinal pigment epithelial cells.

Several agents were examined for their effect on growth factor-stimulated processes in retinal pigment epithelial (RPE) cells. DNA synthesis was assessed by 3H-thymidine incorporation in density-arrested cells using previously determined maximally effective concentrations of various growth factors with and without test substances. Cell migration was assessed in Boyden chamber assays. For each test substance, trypan blue exclusion was used to determine noncytotoxic concentrations, and the effect of several concentrations were assessed on selected growth factors. The most effective, nontoxic concentration was then used for comparisons. Two cationic proteins, protamine and histone type II B, caused inhibition of RPE chemotaxis and 3H-thymidine incorporation induced by several growth factors, but a cationic polypeptide, polylysine, did not. Protamine and histone, were particularly effective inhibitors of acidic and basic fibroblast growth factors (FGF) but not if they were exposed to cells and then removed before growth factor addition. They had no effect on serum-stimulated chemotaxis or 3H-thymidine incorporation even when used in the presence of serum. Three anionic substances, heparin, pentosan polysulfate, and suramin, also inhibited RPE chemotaxis and 3H-thymidine incorporation induced by several different growth factors. They were less effective inhibitors of the FGFs than protamine and histone but were better inhibitors of serum-induced effects. Also unlike protamine and histone, the anionic substances maintained their inhibitory effect even when removed before growth factor addition. Since migration and proliferation of RPE cells are important processes in the pathogenesis of proliferative vitreoretinopathy, these agents and their mechanism of action deserve further study for potential therapeutic applications.

Simultaneous expression of keratin and glial fibrillary acidic protein by the same cells in epiretinal membranes.

The identification of cells comprising epiretinal membranes is difficult because of the phenotypic changes that occur. Examination of intermediate filament protein content by immunocytochemical analysis can help to identify some cells with altered ultrastructure but is not always definitive because altered expression of intermediate filament proteins can also occur. To examine this issue further, the authors utilized a postembedding immunocytochemical technique with epiretinal membranes in which they were able to double label for keratin, a useful marker for identifying retinal pigment epithelial cells, and glial fibrillary acidic protein (GFAP), a useful marker for identifying glial cells. Nine of ten idiopathic epiretinal membranes contained cells that labeled for GFAP and not keratin. Two of these membranes also contained cells that labeled only for keratin and one membrane contained cells that simultaneously labeled for both GFAP and keratin. Other types of epiretinal membranes had an equal participation by cells that expressed only GFAP or keratin (12 of 17 membranes contained cells positive for keratin; 13 of 17 contained cells positive for GFAP). Ten of 17 nonidiopathic membranes contained cells simultaneously expressing GFAP and keratin, although they comprised only a minor subpopulation of the total number of cells present. These findings demonstrate that keratin and GFAP are not mutually exclusive intermediate filament proteins in cells of epiretinal membranes and that, although each may provide a helpful adjunct for cell type identification, neither is an absolutely specific marker.