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Ozaki A, Sakai D, Mandai M. hPSC-based treatment of retinal diseases - Current progress and challenges. Adv Drug Deliv Rev 2025; 221:115587. [PMID: 40228605 DOI: 10.1016/j.addr.2025.115587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2024] [Revised: 03/26/2025] [Accepted: 04/11/2025] [Indexed: 04/16/2025]
Abstract
Degenerative retinal diseases, such as age-related macular degeneration (AMD) and inherited retinal diseases (IRDs), cause visual impairment due to irreversible damage to the retinal pigment epithelium (RPE) and photoreceptor cells (PRCs). Currently, no definitive treatment exists. However, cell-based therapies using induced pluripotent stem cells (iPSCs) or embryonic stem cells (ESCs) offer potential solutions for restoring damaged retinal cells. This review summarizes recent advances in RPE and PRC transplantation, highlighting the benefits of each approach. For RPE transplantation, we focus on the outcomes of clinical studies involving three formulations: RPE sheets, RPE suspensions, and RPE strips. In the context of PRC transplantation, we trace the progress from fetal retinal transplantation to the latest studies. Additionally, we discuss our recent clinical work with retinal sheet transplantation and genome-edited retinal organoid sheets, which aim to improve functional integration by reducing bipolar cells in grafts. Finally, with the overall safety of the regenerative cell-based therapies demonstrated in past clinical applications, we explore future prospects for these therapies.
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Affiliation(s)
- Atsuta Ozaki
- Research Center, Kobe City Eye Hospital, 2-1-8 Minatojima Minaminachi, Chuo-ku, Kobe-shi, Hyogo 650-0047, Japan; Department of Ophthalmology, Mie University Graduate school of Medicine, 2-174 Edobashi, Tsu-shi, Mie 514-8507, Japan
| | - Daiki Sakai
- Research Center, Kobe City Eye Hospital, 2-1-8 Minatojima Minaminachi, Chuo-ku, Kobe-shi, Hyogo 650-0047, Japan; Department of Ophthalmology, Kobe City Medical Center General Hospital, Kobe, Japan, 2-1-1 Minatojima Minaminachi, Chuo-ku, Kobe-shi, Hyogo 650-0047, Japan; Division of Ophthalmology, Department of Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki, Chuo-ku, Kobe-shi, Hyogo 650-0017 Japan
| | - Michiko Mandai
- Research Center, Kobe City Eye Hospital, 2-1-8 Minatojima Minaminachi, Chuo-ku, Kobe-shi, Hyogo 650-0047, Japan; Department of Ophthalmology, Kobe City Medical Center General Hospital, Kobe, Japan, 2-1-1 Minatojima Minaminachi, Chuo-ku, Kobe-shi, Hyogo 650-0047, Japan.
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Ishida M, Masuda T, Sakai N, Nakai-Futatsugi Y, Kamao H, Shiina T, Takahashi M, Sugita S. Graft survival of major histocompatibility complex deficient stem cell-derived retinal cells. COMMUNICATIONS MEDICINE 2024; 4:187. [PMID: 39349587 PMCID: PMC11442691 DOI: 10.1038/s43856-024-00617-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 09/18/2024] [Indexed: 10/04/2024] Open
Abstract
BACKGROUND Gene editing of immunomodulating molecules is a potential transplantation strategy to control immune rejection. As we noticed the successful transplantation of retinal pigment epithelium (RPE) derived from embryonic stem cells of a cynomolgus monkey that accidentally lacked MHC class II (MHC-II) molecules, we hypothesized immune rejection could be evaded by suppressing MHC-II. METHODS Gene editing by the Crispr/Cas9 system was performed in induced pluripotent stem cells derived from a cynomolgus monkey (miPSCs) for targeted deletion of the gene coding class II MHC trans-activator (CIITA). Then the CIITA-knocked out miPSCs were differentiated into RPE cells to generate miPSC-derived MHC-II knockout RPE. The MHC-II knockout or wild-type RPEs were transplanted into the eyes of healthy cynomolgus monkeys. All monkeys used in this study were male. RESULTS Here we show when MHC-II knockout RPE are transplanted into monkey eyes, they show suppressed immunogenicity with no infiltration of inflammatory cells, leading to successful engraftment. CONCLUSIONS Our results reasonably evidence the efficacy of MHC-II knockout iPSC-RPE transplants for clinical application.
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Affiliation(s)
- Masaaki Ishida
- Laboratory for Retinal Regeneration, Center for Developmental Biology, RIKEN, Kobe, Japan
- Department of Ophthalmology, Toyama University, Toyama, Japan
| | - Tomohiro Masuda
- Laboratory for Retinal Regeneration, Center for Developmental Biology, RIKEN, Kobe, Japan
- VC Cell Therapy Inc, Kobe, Japan
- Ritsumeikan University, Research Organization of Science and Technology, Kusatsu, Japan
| | - Noriko Sakai
- Laboratory for Retinal Regeneration, Center for Developmental Biology, RIKEN, Kobe, Japan
- VC Cell Therapy Inc, Kobe, Japan
| | - Yoko Nakai-Futatsugi
- Laboratory for Retinal Regeneration, Center for Developmental Biology, RIKEN, Kobe, Japan.
- VC Cell Therapy Inc, Kobe, Japan.
- Ritsumeikan University, Research Organization of Science and Technology, Kusatsu, Japan.
| | - Hiroyuki Kamao
- Department of Ophthalmology, Kawasaki Medical School, Okayama, Japan
| | - Takashi Shiina
- Department of Molecular Life Science, Tokai University, School of Medicine, Kanagawa, Isehara, Japan
| | - Masayo Takahashi
- Laboratory for Retinal Regeneration, Center for Developmental Biology, RIKEN, Kobe, Japan
- Ritsumeikan University, Research Organization of Science and Technology, Kusatsu, Japan
- Kobe City Eye Hospital, Department of Ophthalmology, Kobe, Japan
- Vision Care Inc, Kobe, Japan
| | - Sunao Sugita
- Laboratory for Retinal Regeneration, Center for Developmental Biology, RIKEN, Kobe, Japan.
- Kobe City Eye Hospital, Department of Ophthalmology, Kobe, Japan.
- Vision Care Inc, Kobe, Japan.
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Uyama H, Mandai M, Takahashi M. Stem-cell-based therapies for retinal degenerative diseases: Current challenges in the establishment of new treatment strategies. Dev Growth Differ 2021; 63:59-71. [PMID: 33315237 PMCID: PMC7986097 DOI: 10.1111/dgd.12704] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 11/13/2020] [Accepted: 12/04/2020] [Indexed: 12/17/2022]
Abstract
Various advances have been made in the treatment of retinal diseases, including new treatment strategies and innovations in surgical devices. However, the treatment of degenerative retinal diseases, such as retinitis pigmentosa (RP) and age-related macular degeneration (AMD), continues to pose a significant challenge. In this review, we focus on the use of embryonic stem cells (ESCs) and induced pluripotent stem cells (iPSCs) to treat retinal diseases by harnessing the ability of stem cells to differentiate into different body tissues. The retina is a tissue specialized for light sensing, and its degradation leads to vision loss. As part of the central nervous system, the retina has very low regenerative capability, and therefore, treatment options are limited once it degenerates. Nevertheless, innovations in methods to induce the generation of retinal cells and tissues from ESCs/iPSCs enable the development of novel approaches for these irreversible diseases. Here we review some historical background and current clinical trials involving the use of stem-cell-derived retinal pigment epithelial cells for AMD treatment and stem cell-derived retinal cells/tissues for RP therapy. Finally, we discuss our future vision of regenerative treatment for retinal diseases with a partial focus on our studies and introduce other interesting approaches for restoring vision.
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Affiliation(s)
- Hirofumi Uyama
- Laboratory for Retinal Regeneration, RIKEN Center for Biosystems Dynamics Research, Kobe, Japan.,Department of Ophthalmology, Kobe City Eye Hospital, Kobe, Japan
| | - Michiko Mandai
- Laboratory for Retinal Regeneration, RIKEN Center for Biosystems Dynamics Research, Kobe, Japan.,Department of Ophthalmology, Kobe City Eye Hospital, Kobe, Japan
| | - Masayo Takahashi
- Laboratory for Retinal Regeneration, RIKEN Center for Biosystems Dynamics Research, Kobe, Japan.,Department of Ophthalmology, Kobe City Eye Hospital, Kobe, Japan
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Sugita S, Mandai M, Hirami Y, Takagi S, Maeda T, Fujihara M, Matsuzaki M, Yamamoto M, Iseki K, Hayashi N, Hono A, Fujino S, Koide N, Sakai N, Shibata Y, Terada M, Nishida M, Dohi H, Nomura M, Amano N, Sakaguchi H, Hara C, Maruyama K, Daimon T, Igeta M, Oda T, Shirono U, Tozaki M, Totani K, Sugiyama S, Nishida K, Kurimoto Y, Takahashi M. HLA-Matched Allogeneic iPS Cells-Derived RPE Transplantation for Macular Degeneration. J Clin Med 2020; 9:jcm9072217. [PMID: 32668747 PMCID: PMC7408794 DOI: 10.3390/jcm9072217] [Citation(s) in RCA: 110] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 07/07/2020] [Accepted: 07/07/2020] [Indexed: 01/01/2023] Open
Abstract
Immune attacks are key issues for cell transplantation. To assess the safety and the immune reactions after iPS cells-derived retinal pigment epithelium (iPS-RPE) transplantation, we transplanted HLA homozygote iPS-RPE cells established at an iPS bank in HLA-matched patients with exudative age-related macular degeneration. In addition, local steroids without immunosuppressive medications were administered. We monitored immune rejections by routine ocular examinations as well as by lymphocytes-graft cells immune reaction (LGIR) tests using graft RPE and the patient's blood cells. In all five of the cases that underwent iPS-RPE transplantation, the presence of graft cells was indicated by clumps or an area of increased pigmentation at 6 months, which became stable with no further abnormal growth in the graft during the 1-year observation period. Adverse events observed included corneal erosion, epiretinal membrane, retinal edema due to epiretinal membrane, elevated intraocular pressure, endophthalmitis, and mild immune rejection in the eye. In the one case exhibiting positive LGIR tests along with a slight fluid recurrence, we administrated local steroid therapy that subsequently resolved the suspected immune attacks. Although the cell delivery strategy must be further optimized, the present results suggest that it is possible to achieve stable survival and safety of iPS-RPE cell transplantation for a year.
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Affiliation(s)
- Sunao Sugita
- Department of Ophthalmology and Kobe City Eye Hospital, Kobe 650-0047, Japan; (S.S.); (M.M.); (Y.H.); (S.T.); (T.M.); (M.F.); (M.M.); (M.Y.); (N.K.); (Y.K.)
- Department of Ophthalmology, Kobe City Medical Center General Hospital Kobe 650-0047, Japan
- Laboratory for Retinal Regeneration, RIKEN Center for Biosystems Dynamics Research, Kobe 650-0047, Japan; (K.I.); (N.H.); (A.H.); (S.F.); (N.S.); (Y.S.); (M.T.); (M.N.)
| | - Michiko Mandai
- Department of Ophthalmology and Kobe City Eye Hospital, Kobe 650-0047, Japan; (S.S.); (M.M.); (Y.H.); (S.T.); (T.M.); (M.F.); (M.M.); (M.Y.); (N.K.); (Y.K.)
- Department of Ophthalmology, Kobe City Medical Center General Hospital Kobe 650-0047, Japan
- Laboratory for Retinal Regeneration, RIKEN Center for Biosystems Dynamics Research, Kobe 650-0047, Japan; (K.I.); (N.H.); (A.H.); (S.F.); (N.S.); (Y.S.); (M.T.); (M.N.)
| | - Yasuhiko Hirami
- Department of Ophthalmology and Kobe City Eye Hospital, Kobe 650-0047, Japan; (S.S.); (M.M.); (Y.H.); (S.T.); (T.M.); (M.F.); (M.M.); (M.Y.); (N.K.); (Y.K.)
- Department of Ophthalmology, Kobe City Medical Center General Hospital Kobe 650-0047, Japan
| | - Seiji Takagi
- Department of Ophthalmology and Kobe City Eye Hospital, Kobe 650-0047, Japan; (S.S.); (M.M.); (Y.H.); (S.T.); (T.M.); (M.F.); (M.M.); (M.Y.); (N.K.); (Y.K.)
- Department of Ophthalmology, Kobe City Medical Center General Hospital Kobe 650-0047, Japan
- Department of Ophthalmology, School of Medicine, Toho University, Tokyo 153-8515, Japan
| | - Tadao Maeda
- Department of Ophthalmology and Kobe City Eye Hospital, Kobe 650-0047, Japan; (S.S.); (M.M.); (Y.H.); (S.T.); (T.M.); (M.F.); (M.M.); (M.Y.); (N.K.); (Y.K.)
- Laboratory for Retinal Regeneration, RIKEN Center for Biosystems Dynamics Research, Kobe 650-0047, Japan; (K.I.); (N.H.); (A.H.); (S.F.); (N.S.); (Y.S.); (M.T.); (M.N.)
| | - Masashi Fujihara
- Department of Ophthalmology and Kobe City Eye Hospital, Kobe 650-0047, Japan; (S.S.); (M.M.); (Y.H.); (S.T.); (T.M.); (M.F.); (M.M.); (M.Y.); (N.K.); (Y.K.)
- Department of Ophthalmology, Kobe City Medical Center General Hospital Kobe 650-0047, Japan
| | - Mitsuhiro Matsuzaki
- Department of Ophthalmology and Kobe City Eye Hospital, Kobe 650-0047, Japan; (S.S.); (M.M.); (Y.H.); (S.T.); (T.M.); (M.F.); (M.M.); (M.Y.); (N.K.); (Y.K.)
- Department of Ophthalmology, Kobe City Medical Center General Hospital Kobe 650-0047, Japan
| | - Midori Yamamoto
- Department of Ophthalmology and Kobe City Eye Hospital, Kobe 650-0047, Japan; (S.S.); (M.M.); (Y.H.); (S.T.); (T.M.); (M.F.); (M.M.); (M.Y.); (N.K.); (Y.K.)
- Department of Ophthalmology, Kobe City Medical Center General Hospital Kobe 650-0047, Japan
| | - Kyoko Iseki
- Laboratory for Retinal Regeneration, RIKEN Center for Biosystems Dynamics Research, Kobe 650-0047, Japan; (K.I.); (N.H.); (A.H.); (S.F.); (N.S.); (Y.S.); (M.T.); (M.N.)
| | - Naoko Hayashi
- Laboratory for Retinal Regeneration, RIKEN Center for Biosystems Dynamics Research, Kobe 650-0047, Japan; (K.I.); (N.H.); (A.H.); (S.F.); (N.S.); (Y.S.); (M.T.); (M.N.)
| | - Ayumi Hono
- Laboratory for Retinal Regeneration, RIKEN Center for Biosystems Dynamics Research, Kobe 650-0047, Japan; (K.I.); (N.H.); (A.H.); (S.F.); (N.S.); (Y.S.); (M.T.); (M.N.)
| | - Shoko Fujino
- Laboratory for Retinal Regeneration, RIKEN Center for Biosystems Dynamics Research, Kobe 650-0047, Japan; (K.I.); (N.H.); (A.H.); (S.F.); (N.S.); (Y.S.); (M.T.); (M.N.)
| | - Naoshi Koide
- Department of Ophthalmology and Kobe City Eye Hospital, Kobe 650-0047, Japan; (S.S.); (M.M.); (Y.H.); (S.T.); (T.M.); (M.F.); (M.M.); (M.Y.); (N.K.); (Y.K.)
- Department of Ophthalmology, Kobe City Medical Center General Hospital Kobe 650-0047, Japan
- Laboratory for Retinal Regeneration, RIKEN Center for Biosystems Dynamics Research, Kobe 650-0047, Japan; (K.I.); (N.H.); (A.H.); (S.F.); (N.S.); (Y.S.); (M.T.); (M.N.)
| | - Noriko Sakai
- Laboratory for Retinal Regeneration, RIKEN Center for Biosystems Dynamics Research, Kobe 650-0047, Japan; (K.I.); (N.H.); (A.H.); (S.F.); (N.S.); (Y.S.); (M.T.); (M.N.)
| | - Yumiko Shibata
- Laboratory for Retinal Regeneration, RIKEN Center for Biosystems Dynamics Research, Kobe 650-0047, Japan; (K.I.); (N.H.); (A.H.); (S.F.); (N.S.); (Y.S.); (M.T.); (M.N.)
| | - Motoki Terada
- Laboratory for Retinal Regeneration, RIKEN Center for Biosystems Dynamics Research, Kobe 650-0047, Japan; (K.I.); (N.H.); (A.H.); (S.F.); (N.S.); (Y.S.); (M.T.); (M.N.)
| | - Mitsuhiro Nishida
- Laboratory for Retinal Regeneration, RIKEN Center for Biosystems Dynamics Research, Kobe 650-0047, Japan; (K.I.); (N.H.); (A.H.); (S.F.); (N.S.); (Y.S.); (M.T.); (M.N.)
| | - Hiromi Dohi
- Center for iPS Cell Research and Application, Kyoto University, Kyoto 606-8567, Japan; (H.D.); (M.N.); (N.A.)
| | - Masaki Nomura
- Center for iPS Cell Research and Application, Kyoto University, Kyoto 606-8567, Japan; (H.D.); (M.N.); (N.A.)
| | - Naoki Amano
- Center for iPS Cell Research and Application, Kyoto University, Kyoto 606-8567, Japan; (H.D.); (M.N.); (N.A.)
| | - Hirokazu Sakaguchi
- Department of Advanced Device Medicine, Graduate School of Medicine, Osaka University, Osaka 565-0871, Japan; (H.S.); (C.H.)
| | - Chikako Hara
- Department of Advanced Device Medicine, Graduate School of Medicine, Osaka University, Osaka 565-0871, Japan; (H.S.); (C.H.)
| | - Kazuichi Maruyama
- Department of Innovative Visual Science, Graduate School of Medicine, Osaka University, Osaka 565-0871, Japan;
| | - Takashi Daimon
- Department of Biostatistics, Hyogo College of Medicine, Nishinomiya 663-8501, Japan; (T.D.); (M.I.)
| | - Masataka Igeta
- Department of Biostatistics, Hyogo College of Medicine, Nishinomiya 663-8501, Japan; (T.D.); (M.I.)
| | - Toshihiko Oda
- Center for Clinical Research and Innovation, Kobe City Medical Center General Hospital, Kobe 650-0047, Japan; (T.O.); (U.S.); (M.T.)
| | - Utako Shirono
- Center for Clinical Research and Innovation, Kobe City Medical Center General Hospital, Kobe 650-0047, Japan; (T.O.); (U.S.); (M.T.)
| | - Misato Tozaki
- Center for Clinical Research and Innovation, Kobe City Medical Center General Hospital, Kobe 650-0047, Japan; (T.O.); (U.S.); (M.T.)
| | - Kota Totani
- Tomey Corporation, Nagoya 451-0051, Japan; (K.T.); (S.S.)
| | | | - Kohji Nishida
- Department of Ophthalmology, Graduate School of Medicine, Osaka University, Osaka 565-0871, Japan;
| | - Yasuo Kurimoto
- Department of Ophthalmology and Kobe City Eye Hospital, Kobe 650-0047, Japan; (S.S.); (M.M.); (Y.H.); (S.T.); (T.M.); (M.F.); (M.M.); (M.Y.); (N.K.); (Y.K.)
- Department of Ophthalmology, Kobe City Medical Center General Hospital Kobe 650-0047, Japan
| | - Masayo Takahashi
- Department of Ophthalmology and Kobe City Eye Hospital, Kobe 650-0047, Japan; (S.S.); (M.M.); (Y.H.); (S.T.); (T.M.); (M.F.); (M.M.); (M.Y.); (N.K.); (Y.K.)
- Department of Ophthalmology, Kobe City Medical Center General Hospital Kobe 650-0047, Japan
- Laboratory for Retinal Regeneration, RIKEN Center for Biosystems Dynamics Research, Kobe 650-0047, Japan; (K.I.); (N.H.); (A.H.); (S.F.); (N.S.); (Y.S.); (M.T.); (M.N.)
- Correspondence: ; Tel.: +81-78-306-3305; Fax: +81-78-306-3303
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Singh MS, Park SS, Albini TA, Canto-Soler MV, Klassen H, MacLaren RE, Takahashi M, Nagiel A, Schwartz SD, Bharti K. Retinal stem cell transplantation: Balancing safety and potential. Prog Retin Eye Res 2020; 75:100779. [PMID: 31494256 PMCID: PMC7056514 DOI: 10.1016/j.preteyeres.2019.100779] [Citation(s) in RCA: 138] [Impact Index Per Article: 27.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 08/29/2019] [Accepted: 09/02/2019] [Indexed: 12/14/2022]
Abstract
Stem cell transplantation holds great promise as a potential treatment for currently incurable retinal degenerative diseases that cause poor vision and blindness. Recently, safety data have emerged from several Phase I/II clinical trials of retinal stem cell transplantation. These clinical trials, usually run in partnership with academic institutions, are based on sound preclinical studies and are focused on patient safety. However, reports of serious adverse events arising from cell therapy in other poorly regulated centers have now emerged in the lay and scientific press. While progress in stem cell research for blindness has been greeted with great enthusiasm by patients, scientists, doctors and industry alike, these adverse events have raised concerns about the safety of retinal stem cell transplantation and whether patients are truly protected from undue harm. The aim of this review is to summarize and appraise the safety of human retinal stem cell transplantation in the context of its potential to be developed into an effective treatment for retinal degenerative diseases.
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Affiliation(s)
- Mandeep S Singh
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA.
| | - Susanna S Park
- Department of Ophthalmology & Vision Science, University of California-Davis Eye Center, Sacramento, CA, 95817, USA
| | - Thomas A Albini
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, 33136, USA
| | - M Valeria Canto-Soler
- CellSight Ocular Stem Cell and Regeneration Research Program, Department of Ophthalmology, Sue Anschutz-Rodgers Eye Center, University of Colorado School of Medicine, Aurora, CO, 80045, USA
| | - Henry Klassen
- Gavin Herbert Eye Institute and Stem Cell Research Center, Irvine, CA, 92697, USA
| | - Robert E MacLaren
- Nuffield Laboratory of Ophthalmology, Department of Clinical Neurosciences, University of Oxford and Oxford University Eye Hospital, NHS Foundation Trust, NIHR Biomedical Research Centre, Oxford, OX3 9DU, UK
| | - Masayo Takahashi
- Laboratory for Retinal Regeneration, Center for Biosystems Dynamics Research, RIKEN, Kobe, Hyogo, 650-0047, Japan
| | - Aaron Nagiel
- The Vision Center, Department of Surgery, Children's Hospital Los Angeles, Los Angeles, CA, 90027, USA; USC Roski Eye Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA, 90007, USA
| | - Steven D Schwartz
- Stein Eye Institute, University of California Los Angeles Geffen School of Medicine, Los Angeles, CA, 90095, USA; Edythe and Eli Broad Stem Cell Institute, University of California Los Angeles, Los Angeles, CA, 90095, USA
| | - Kapil Bharti
- National Eye Institute, National Institutes of Health, Bethesda, MD, 90892, USA
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