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Sources of retinal pigment epithelium (RPE) for replacement therapy
  1. E Lee1,2,
  2. R E MacLaren1,2,3,4
  1. 1UCL Institute of Ophthalmology, London, UK
  2. 2Moorfields Eye Hospital Foundation Trust NIHR Ophthalmology Biomedical Research Centre, London, UK
  3. 3Nuffield Laboratory of Ophthalmology, University of Oxford, John Radcliffe Hospital, Oxford, UK
  4. 4Oxford Eye Hospital, John Radcliffe Hospital, Oxford, UK
  1. Correspondence to Professor Robert MacLaren, Nuffield Laboratory of Ophthalmology, University of Oxford, Level 6 John Radcliffe Hospital, Headley Way, Oxford OX3 9DU, UK; enquiries{at}eye.ox.ac.uk

Stem cells, with their capacity to regenerate and replace diseased tissues, have recently been proposed as having great potential in the treatment of age-related macular degeneration (AMD). A stem cell therapeutic approach could operate to replace either the retinal pigment epithelium (RPE), the neurosensory retina or a combination of both. From the scientific perspective, RPE replacement alone is likely to be far more straightforward than rebuilding the complex circuitry of the neurosensory retina. Furthermore, recent advances with induced pluripotent stem cells have raised the real possibility of transplanting healthy ‘young’ autologous RPE into patients with early signs of AMD. At this stage, however, it is useful to reconsider some of the earlier clinical studies that used suspensions of autologous RPE cells harvested from the peripheral retina. These showed that isolated RPE cell suspensions had little capacity to recreate a monolayer on the diseased Bruch's membrane of AMD. To counter this problem, researchers from Southampton in the UK report the use of a synthetic polymer alternative to Bruch's membrane, which could provide a scaffold for future RPE derived from stem cells or possibly reopen opportunities for autologous RPE cells harvested from the peripheral retina.

  • iPS
  • stem cell
  • AMD
  • cloning
  • Yamanaka
  • transplantation
  • retina
  • macula
  • genetics
  • degeneration
  • experimental
  • laboratory

https://doi.org/10.1136/bjo.2009.171918

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    Stem cells, with their capacity to regenerate and replace diseased tissues, have recently been proposed as having great potential in the treatment of age-related macular degeneration (AMD). A stem cell therapeutic approach could operate to replace either the retinal pigment epithelium (RPE), the neurosensory retina or a combination of both. From the scientific perspective, RPE replacement alone is likely to be far more straightforward than rebuilding the complex circuitry of the neurosensory retina. Furthermore, recent advances with induced pluripotent stem cells have raised the real possibility of transplanting healthy ‘young’ autologous RPE into patients with early signs of AMD. At this stage, however, it is useful to reconsider some of the earlier clinical studies that used suspensions of autologous RPE cells harvested from the peripheral retina. These showed that isolated RPE cell suspensions had little capacity to recreate a monolayer on the diseased Bruch's membrane of AMD. To counter this problem, researchers from Southampton in the UK report the use of a synthetic polymer alternative to Bruch's membrane, which could provide a scaffold for future RPE derived from stem cells or possibly reopen opportunities for autologous RPE cells harvested from the peripheral retina.

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    Footnotes

    • Linked articles 166728, 169953, 171926.

    • Funding EL is a Wellcome Trust Clinical Training Fellow; REM is a Health Foundation Clinician Scientist Fellow. This research is also supported by the Medical Research Council, the Royal College of Surgeons of Edinburgh, Fight for Sight, the John Fell Fund of Oxford University Press, the Special Trustees of Moorfields Eye Hospital and the NIHR Ophthalmology Biomedical Research Centre. Other Funders: Wellcome Trust; MRC, Health Foundation, NIHR.

    • Competing interests None.

    • Provenance and peer review Commissioned; externally peer reviewed.

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