Rapamycin reduces VEGF expression in retinal pigment epithelium (RPE) and inhibits RPE-induced sprouting angiogenesis in vitro

Anti-VEGF treatment has become accepted first-line treatment for choroidal neovascularisation (CNV) in age-related macular degeneration. However, VEGF-inhibition does not always lead to sustained CNV-reduction. In this study, the effect of rapamycin was superior to VEGF-inhibition in a co-culture assay of endothelial cells (ECs) and retinal pigment epithelium (RPE). Rapamycin reduced EC sprouting in groups that did not respond to anti-VEGF treatment. Rapamycin did not induce EC apoptosis, but reduced both VEGF-production in RPE and the responsiveness of ECs to stimulation. Rapamycin might therefore be a therapeutic option for CNV patients that do not respond sufficiently to the established anti-VEGF treatments.

Mutations in TOPORS cause autosomal dominant retinitis pigmentosa with perivascular retinal pigment epithelium atrophy

We report mutations in the gene for topoisomerase I-binding RS protein (TOPORS) in patients with autosomal dominant retinitis pigmentosa (adRP) linked to chromosome 9p21.1 (locus RP31). A positional-cloning approach, together with the use of bioinformatics, identified TOPORS (comprising three exons and encoding a protein of 1,045 aa) as the gene responsible for adRP. Mutations that include an insertion and a deletion have been identified in two adRP-affected families--one French Canadian and one German family, respectively. Interestingly, a distinct phenotype is noted at the earlier stages of the disease, with an unusual perivascular cuff of retinal pigment epithelium atrophy, which was found surrounding the superior and inferior arcades in the retina. TOPORS is a RING domain-containing E3 ubiquitin ligase and localizes in the nucleus in speckled loci that are associated with promyelocytic leukemia bodies. The ubiquitous nature of TOPORS expression and a lack of mutant protein in patients are highly suggestive of haploinsufficiency, rather than a dominant negative effect, as the molecular mechanism of the disease and make rescue of the clinical phenotype amenable to somatic gene therapy.

Histological evidence for revascularisation of an autologous retinal pigment epithelium--choroid graft in the pig

BACKGROUND

Translocation of a free autologous graft consisting of retinal pigment epithelium (RPE), Bruch's membrane, choriocapillaris and choroid in patients with exudative age-related macular degeneration is currently being evaluated in clinical practice. Angiographic studies in these patients suggest that their grafts become revascularised.

AIM

To investigate the histological evidence of revascularisation of the graft in a porcine model.

METHODS

In 11 pigs (11 eyes), an RPE-choroid graft was translocated from the mid-periphery to an intact or an intentionally damaged RPE and Bruch's membrane at the recipient site. The eyes were enucleated 1 week or 3 months after surgery. Tissue sections were evaluated using immunohistochemistry.

RESULTS

Bridging vessels between recipient layer and graft were identified from 1 week to 3 months after surgery. This reconnection occurred regardless of whether the Bruch's membrane of the recipient site was left intact or intentionally damaged at the time of transplantation. The vasculature of the graft appeared open and perfused. Vessels with transcapillary pillars and conglomerates of small new vessels were present in the graft.

CONCLUSIONS

This study showed histological evidence for revascularisation by angiogenesis of a free autologous RPE-choroid graft.

Autologous translocation of the choroid and retinal pigment epithelium in patients with geographic atrophy

PURPOSE

To evaluate the functional and anatomical outcomes of autologous translocation of peripheral choroid and retinal pigment epithelium (RPE) in patients with geographic atrophy.

DESIGN

Prospective nonrandomized study.

PARTICIPANTS

Twelve consecutive patients with geographic atrophy secondary to age-related macular degeneration presenting with recent loss of reading vision.

METHODS

An autologous peripheral full-thickness graft of RPE, Bruch's membrane, and choroid was positioned under the macula in patients with geographic atrophy.

MAIN OUTCOME MEASURES

Functional tests included Early Treatment Diabetic Retinopathy Study distant vision, reading (Radner Test, measured as logarithm of the reading acuity determination [logRAD]), threshold static perimetry, and determination of the point of fixation. Fluorescein and indocyanine green angiography, autofluorescence, and optical coherence tomography served to evaluate the anatomical outcome in a 6-month follow-up (12 months in 7 patients).

RESULTS

Preoperative visual acuity (VA) ranged from 20/800 to 20/40 (mean, 0.6+/-0.4 logarithm of the minimum angle of resolution), and reading vision from 1.1 to 0.5 logRAD (mean, 0.8+/-0.2). Three patients were unable to read. Six months after surgery, VA ranged from hand movements to 20/32, with an increase of > or =5 letters in 2 eyes. Two patients without reading ability preoperatively were able to read after surgery. Reading was possible in a total of 8 patients after 6 months (1.3-0.4 logRAD). In 7 patients who were observed for 1 year, VA remained stable (+/-1 line) in 5 eyes and decreased in 2 eyes between 6 months' and 1 year's follow-up. In all eyes but 2, revascularization was visible on indocyanine green angiography as early as 3 weeks after surgery. Autofluorescence of the RPE was independent of revascularization of the graft and persisted throughout follow-up. Four eyes had unstable fixation and/or extrafoveal fixation before surgery. Two of these eyes stabilized during follow-up. Areas overlying atrophic areas demonstrated low threshold sensitivities that persisted after translocation of a free graft with only limited recovery. Revisional surgery due to proliferative vitreoretinopathy was required in 5 eyes.

CONCLUSIONS

The translocation of a full-thickness graft usually results in a vascularized and functioning graft in patients with geographic atrophy, although is associated with a high risk of complications and visual loss. Longer follow-up is necessary to learn about the long-term survival and functionality of the graft.

RPE-rip after intravitreal bevacizumab (Avastin) treatment for vascularised PED secondary to AMD

BACKGROUND

Retinal pigment epithelial (RPE)-rips in age-related macular degeneration (AMD)-associated pigment epithelial detachment (PED) occur in the natural course of the disease but also after therapy (e.g. laser photocoagulation, photodynamic therapy), possibly triggered by the specific therapy. We report here on four patients that received intravitreal bevacizumab (Avastin) for AMD-associated vascularised PED and developed RPE-rips during the follow-up.

METHODS

The case reports of four consecutive patients that developed RPE-rips after intravitreal injection of bevacizumab at 1 mg/0.1 ml were reviewed.

RESULTS

The RPE-rips occurred in all patients between 1 week and 1 month following intravitreal injection. Two of the four patients improved in vision despite the rip, but 3 months after the initial intervention, three patients suffered deterioration in visual acuity and had to be re-injected.

CONCLUSION

Improvement in visual acuity may occur following intravitreal bevacizumab despite RPE-rips, but the patients need close follow-up and eventual re-treatment in the case of deterioration.

Inhibitive effect of genistein on hypoxia-induced basic fibroblast growth factor expression in human retinal pigment epithelium cells

AIM

The time course changes of basic fibroblast growth factor (bFGF) expression induced by hypoxia and the effects of genistein on hypoxia-induced bFGF expression in the human retinal pigment epithelium (RPE) cells were studied.

METHODS

The bFGF mRNA expression was examined by reverse transcription polymerase chain reaction. The bFGF protein expression was detected by Western blot.

RESULTS

Hypoxia significantly increased bFGF mRNA expression. The maximal level detected at 24 h was approximately two times that at the start of treatment. With pretreatment of genistein (10, 20, 50, 100, and 200 microM) for 30 min, the elevated expression of bFGF mRNA was suppressed in a concentration-dependent manner. bFGF mRNA expression was reduced to 30.4% by 200 microM of genistein when compared with that untreated with genistein. Hypoxia treatment also remarkably increased the expression of bFGF protein. At 24 h after hypoxia, when the highest expression of bFGF protein was observed, it was approximately two times as much as that at the start of treatment. Genistein (10, 20, 50, 100, and 200 microM) could also suppress bFGF protein expression in a concentration-dependent manner. The highest suppression was observed when exposed to 200 microM of genistein, which was 43% of control.

CONCLUSIONS

These results suggested that suppression of bFGF expression in RPE cells might partly account for the inhibitive effect of genistein on retinal neovascularization in vivo.

Triamcinolone acetonide suppresses early proangiogenic response in retinal pigment epithelial cells after photodynamic therapy in vitro

OBJECTIVE

To investigate the expression of proangiogenic and antiangiogenic factors, vascular endothelial growth factor (VEGF) and pigment epithelium-derived factor (PEDF) in retinal pigment epithelial (RPE) cells after photodynamic therapy (PDT), especially focusing on their change in the presence of triamcinolone acetonide.

METHODS

Firstly, the cellular uptake of verteporfin was quantified after confluent ARPE-19 (human retinal pigment epithelial) cells were exposed to 5 microg/ml verteporfin combined with or without 1 microg/ml triamcinolone acetonide for 1 h. Secondly, ARPE-19 cells exposed to various doses of verteporfin were irradiated with 120 mJ/cm(2) light. After incubation with or without 1 microg/ml triamcinolone acetonide for 2 days, cell viability and expressions of VEGF and PEDF were assessed.

RESULTS

Cellular uptake of verteporfin was not significantly changed by the presence of 1 microg/ml triamcinolone acetonide. In addition, 0.01-0.1 microg/ml of verteporfin showed a dose-dependent toxicity on the ARPE-19 cells 2 days after the light exposure. The presence of verteporfin at a concentration of 0.01 microg/ml did not affect the cell viability but significantly increased VEGF (p<0.001) and reduced PEDF (p = 0.03) expression. Administration of triamcinolone acetonide significantly suppressed both this increase in VEGF (p<0.001) and decrease in PEDF (p = 0.001).

CONCLUSIONS

VEGF was increased and PEDF reduced in cultured RPE cells shortly after PDT even at a sublethal dose. Triamcinolone acetonide suppressed this proangiogenic response.

Photodynamic Therapy for Focal Retinal Pigment Epithelial Leaks Secondary to Central Serous Chorioretinopathy

PURPOSE

To report the use of photodynamic therapy with verteporfin as a treatment for patients with focal retinal pigment epithelial leaks secondary to central serous chorioretinopathy (CSC).

DESIGN

Noncomparative, nonrandomized, retrospective interventional case series.

PARTICIPANTS

Nine eyes of 9 symptomatic patients with acute focal retinal pigment epithelial leaks secondary to CSC, confirmed with fluorescein angiography, evaluated at 1 of 3 referral retina practices.

METHODS

Patients were treated with photodynamic therapy using verteporfin. Best-corrected visual acuity (VA) was recorded at presentation and follow-up visits.

MAIN OUTCOME MEASURES

Resolution of neurosensory detachment, status of fluorescein leakage, and VA.

RESULTS

Neurosensory detachment and fluorescein leakage resolved in all patients within 1 month. Visual acuity improved from 1 to 6 lines in 7 eyes and remained unchanged in 2. At 6 months, there was a statistically significant improvement in mean VA (P = 0.012, Wilcoxon signed ranks test), and mean VA improved from 20/80 to 20/40. No patient lost vision or suffered any treatment-related complications.

CONCLUSION

The treatment of acute CSC with photodynamic therapy may result in prompt resolution of neurosensory detachment and fluorescein leakage, which can be associated with rapidly improved vision. Although this case series is limited in follow-up and number of patients, the encouraging results and lack of visually significant complications suggest that further investigation is warranted.

[Optical coherence tomography in Malattia Leventinese]

BACKGROUND

Malattia Leventinese (ML) is a genetically homogeneous macular dystrophy with an autosomal dominant mode of inheritance. Ophthalmoscopically it is recognisable by a radial pattern of drusen-like deposits in the macula and by parapapillary deposits, named Forni's verrucosities. The aim of this study is to describe optical coherence tomographic (OCT) findings and to compare them with histological data.

PATIENTS AND METHODS

Six patients underwent ophthalmological examination, angiography and OCT. Diagnosis was confirmed by genetic analysis of the R345W mutation. A histopathological study of an ML donor eye was performed.

RESULTS

OCT revealed a diffuse RPE-choriocapillaris thickening with nodular features in the macular and parapapillary areas. The protrusions reached as far as the outer nuclear layer.

CONCLUSIONS

OCT is a non-invasive technique that provides a cross-sectional picture of the retina comparable to a histological section. In ML, OCT revealed a diffuse alteration of the RPE-Bruch's membrane complex. The macular and parapapillary nodular lesions are the tomographic equivalents of drusen and Forni's verrucosities.

Automated analysis of digital fundus autofluorescence images of geographic atrophy in advanced age-related macular degeneration using confocal scanning laser ophthalmoscopy (cSLO)

Background

Fundus autofluorescence (AF) imaging using confocal scanning laser ophthalmoscopy (cSLO) provides an accurate delineation of areas of geographic atrophy (GA).

Automated computer-assisted methods for detecting and removing interfering vessels are needed to support the GA quantification process in longitudinal studies and in reading centres.

Methods

A test tool was implemented that uses region-growing techniques to segment GA areas. An algorithm for illuminating shadows can be used to process low-quality images. Agreement between observers and between three different methods was evaluated by two independent readers in a pilot study. Agreement and objectivity were assessed using the Bland-Altman approach.

Results

The new method (C) identifies vascular structures that interfere with the delineation of GA. Results are comparable to those of two commonly used procedures (A, B), with a mean difference between C and A of -0.67 mm² (95% CI [-0.99, -0.36]), between B and A of -0.81 mm², (95% CI [-1.08, -0.53]), and between C and B of 0.15 mm² (95% CI [-0.12, 0.41]). Objectivity of a method is quantified by the mean difference between observers: A 0.30 mm² (95% CI [0.02, 0.57]), B -0.11 mm² (95% CI [-0.28, 0.10]), and C 0.12 mm² (95% CI [0.02, 0.22]).

Conclusion

The novel procedure is comparable with regard to objectivity and inter-reader agreement to established methods of quantifying GA. It considerably speeds up the lengthy measurement process in AF with well defined GA zones.

In vitro model of the outer blood–retina barrier

The outer blood-retina barrier (BRB) is formed by the retinal pigment epithelium (rpe) and functions similarly to the blood-brain barrier (BBB). In contrast to the BBB, which is composed of a myriad of capillaries, the rpe can in principle be prepared as an intact planar tissue sheet without disruption of its barrier and carrier functions. Both a rapid and gentle procedure to isolate porcine rpe and a method to implement the harvested rpe in drug penetration testing are presented. Enucleated eyes were flat-mounted and the RPE/choroid tissue sheets with or without the retina were isolated. Fluorescence microscopy based on double-labeling with propidium iodide/calcein and scanning electron microscopy revealed well-preserved cell and tissue architecture. For drug evaluation, specimens were immobilized as the interface between test compartments in a dual-chamber device. Ten different test agents were added to one chamber at defined concentrations. After an incubation time of 30 min at 37 degrees C permeated drug levels in both compartments were quantified by HPLC-tandem mass spectrometry or HPLC with fluorescence detection. Sodium fluorescein used as a barrier marker indicated that the rpe model had excellent seal integrity. The use of a representative subset of pharmaceuticals with known BBB permeability characteristics demonstrated that the rpe model had a large permeability dynamic range (factor >350). These findings showed that the model represents a valuable tool for the investigation of the blood barrier penetration of test compounds.

Regional differences and post-mortem stability of enzymatic activities in the retinal pigment epithelium

BACKGROUND

The retinal pigment epithelium (RPE) is essential for the metabolism of the neural retina. As a result of dysfunction of the RPE, retinal degeneration occurs. A potential treatment for certain forms of retinal degenerations is transplantation of RPE cells. To determine optimal conditions for treatment of donor eyes before transplantation, activities of key proteases (aminopeptidase M, dipeptidylpeptidase II and IV and gamma-glutamyltranspeptidase) as indicators of RPE cell quality (viability and functional state) were measured.

METHODS

Protease activities were quantified in bovine RPE cells from different regions of the eyecup, after different times of storage of the bulbi, cryopreservation of the RPE cells and in RPE cell cultures. The distribution of the activities was compared to the pigmentation of the RPE cells, the thickness of the choroid and photoreceptor density.

RESULTS

Most proteases showed regional maxima. Prolonged storage of the bulbi decreased gamma-glutamyltranspeptidase and aminopeptidase M activities. Cryopreservation of the RPE cells for up to 6 weeks caused no loss in the enzymatic activities. Culture of RPE cells caused pronounced decreases in the activities of gamma-glutamyltranspeptidase and dipeptidylpeptidase IV. Storage of the bulbi at 4 degrees C for more than 50 h causes marked loss of enzymatic activities in RPE cells.

CONCLUSION

The decrease in gamma-glutamyltranspeptidase activity may be especially important because the RPE is exposed to high concentrations of reactive oxygen species. Whole bulbi should be stored for less than 50 h, but isolated RPE cells may be stored at -80 degrees C for weeks. Propagation of RPE cells by culture increases cell number; this effect may be counteracted by a decrease in the function of these cells.

Vascular endothelial growth factor upregulates pigment epithelium-derived factor expression via VEGFR-1 in human retinal pigment epithelial cells

We previously demonstrated that differentiated retinal pigment epithelial (RPE) cells express high levels of vascular endothelial growth factor (VEGF) and pigment epithelium-derived factor (PEDF), and a critical balance between VEGF and PEDF is important to prevent the development of choroidal neovascularization. We report here that VEGF secreted by RPE cells upregulates PEDF expression via VEGFR-1 in an autocrine manner. PEDF mRNA and protein expression was downregulated by neutralizing antibody against VEGF in differentiated human RPE cells. VEGFR-1 neutralization decreased PEDF mRNA and protein expression whereas anti-VEGFR-2 antibody had no effect. Addition of placenta growth factor (PlGF) restored PEDF expression in the presence of anti-VEGF antibody. These results demonstrate a regulatory interaction between angiogenesis stimulators and inhibitors to maintain homeostasis in normal human retina.

In vivo use of oligonucleotides to inhibit choroidal neovascularisation in the eye

BACKGROUND

We have previously demonstrated the in vivo uptake of oligonucleotides in the rat eye and have continued with experiments to look at the effectiveness of targeted oligonucleotide sequences. Vascular endothelial growth factor (VEGF) is correlated with new blood vessel formation and has been implicated in numerous eye diseases characterised by abnormal blood vessel proliferation. An oligonucleotide targeted to the VEGF sequence was examined for its effect on VEGF production in vitro and the development of choroidal neovascularisation in vivo in the eye.

METHODS

A series of sequences were assessed in an in vitro screening system using retinal pigment epithelial (RPE) cells to demonstrate a reduction in VEGF. A targeted sequence was further investigated using an animal model of choroidal neovascularisation where a krypton laser was used to produce a wound healing response in the choroid and retina. The oligonucleotide was injected into the vitreous and the development of choroidal neovascularisation assessed using fluorescein angiography.

RESULTS

The targeted sequence was shown in vitro to downregulate the VEGF produced by RPE cells grown under hypoxic conditions and when injected into laser treated eyes was shown to be preferentially taken up in the laser lesion. Fluorescein angiography demonstrated that the test oligonucleotide was successful in reducing laser-mediated choroidal neovascularisation.

CONCLUSIONS

A sequence corresponding to the 5'UTR of the VEGF gene has provided encouraging results for the treatment of neovascularisation.

Clinical application of digital indocyanine green angiography in choroidal neurofibromatosis

Indocyanine green angiography (ICGA) was used to investigate 2 cases of type 1 systemic neurofibromatosis that had appeared at birth with café-au-lait skin spots, gradually developing into multiple cutaneous neurofibromas. Patients underwent periodical visual acuity examinations, the fundus was checked and fluorescein angiography (FA) was done; all findings appeared extremely stable. In 1995 these 2 patients underwent ICGA to check for pathological choroidal involvement. In both cases the initial examination stages showed multiple extensive areas of hypofluorescence, their morphology and extension coinciding with the retinal pigment epithelium (RPE) lesions shown by FA and by ophthalmoscopic examination. In later stages the hypofluorescent areas became smaller, generally shrinking to small isolated dots in the middle of the original areas. These initially hypofluorescent areas appeared to be due to slow focal choroidal filling caused by deep alterations to the walls of the choroidal arterioles induced by the disease. Chronic hypoperfusion of the choriocapillaris results in impairment of the overlying RPE, causing it to atrophy. The late hypofluorescent areas could be either persistent nonperfused lobules of choriocapillaris or neurofibromatose choroidal nodules. ICGA examination showed that the FA lesions described in the literature as choroidal nodules are in fact alterations to the RPE secondary to areas of hypoperfusion in the choriocapillaris.

Recurrent RPE microrips in a case of vascularised pigment epithelial detachment

Microrips of the RPE are an infrequent finding in vascularised pigment epithelial detachments (PEDs). Fluorescein angiography revealed that they are identical to the leaks seen in central serous chorioretinopathy (CSC); it has been hypothesised that both may be caused by hydrostatic forces generating a mechanical disruption of the RPE. We report a case of vascularised PED that was complicated by repeated subretinal haemorrhages and presented recurrent microrips of the RPE, which is a finding never described before according to our knowledge. In this case, a very high protein concentration in the subretinal space, due to prolonged bleeding from the neovascular membrane, might have damaged the RPE and reduced the choroidal suction, as believed for CSC. It might also have increased the intraluminal pressure in the PED, finally determining the passage of fluid through the microrips, which have been hypothesised to be RPE defects. These observations represent further speculation about the pathogenesis and the unique angiographic pattern of the leaks in CSC and of RPE microrips.

Regulation of glucose transporters during development of the retinal pigment epithelium

The retinal pigment epithelium (RPE) separates the outer retina from its blood supply. To satisfy the retina's large requirement for glucose, the RPE expresses high levels of glucose transporters. In most rat cells, the transporter GLUT3 provides a basal level of transport, but the expression of GLUT1 can be regulated. The opposite is true in chicken (P. Wagstaff, H.Y. Kang, D. Mylott, P.J. Robbins, M.K. White, Characterization of the avian GLUT1 glucose transporter: differential regulation of GLUT1 and GLUT3 in chicken embryo fibroblasts, Mol. Biol. Cell 6 (1995) 1575-1589). We examined chick RPE to determine which isoform is regulated during development, and if the neural retina regulates GLUT expression. By RT-PCR, RPE expressed GLUT1 and GLUT3, but not GLUT2. Only the level of GLUT1 increased between E5 and E18. A corresponding increase in GLUT1 protein was observed by immunoblotting. Most of the increase occurred between E14 and E18, which corresponds to the late stage of tight junction development. A culture model of development was used to examine the intermediate phase, which extends from E7 to E14. While medium conditioned by the neural retina decreased paracellular diffusion across the tight junctions, it increased diffusion through the glucose transporters. Unlike mammals, chick upregulates different isoforms in quiescent RPE and proliferating fibroblasts. Further, the upregulation of glucose transport is coordinated with the development of tight junctions in the blood-retinal barrier.

The role of vascular endothelial growth factor (VEGF) in abnormal vascular changes in the adult rat eye

The aim of this project was to determine if the subretinal delivery of a recombinant adenovirus encoding vascular endothelial growth factor (VEGF) was sufficient to induce changes resembling choroidal neovascularisation (CNV) in a rat model. A recombinant adenovirus was produced encoding vegf164 cDNA (Ad.RSV.VEGF). Transduction of cultured RPE cells confirmed VEGF expression and ensured the absence of Ad.RSV.VEGF-related toxicity. Following subretinal injection into rat eyes, fluorescein angiography indicated that the in vivo delivery of Ad.RSV.VEGF was associated with vascular leakage. Histological analysis demonstrated that changes resembling the early signs of CNV development were also present in the Ad.RSV.VEGF injected eyes. These results suggest that while a transient VEGF expression in the RPE layer is able to induce CNV-related changes, it may be insufficient for the development of a full neovascular membrane. This study demonstrates that virus-mediated gene delivery, in addition to its clinical applications, is a potentially efficient research tool for investigating gene expression-related physiological changes in vitro and in vivo.

Changes in choriocapillaris and retinal pigment epithelium in age-related macular degeneration

Retinal pigment epithelial cells (RPE) and the choriocapillaris are on opposite sides of Bruch's membrane and control transport in and out of the retina. In age-related macular degeneration (AMD), they may also be responsible for deposition of material in and on Bruch's membrane and the formation or regression of choroidal neovascularization (CNV). Indocyanine green (ICG) angiography can be used to visualize the choroidal vasculature and CNV. Filling of the choriocapillaris with ICG was delayed in subjects older than 50 years of age, and areas of hypofluorescence were observed in maculas of AMD subjects, often associated with CNV. Laser Doppler flowmetry of the choriocapillaris in the macula demonstrated that choroidal blood flow and volume are reduced in subjects older than 46 years of age and further decreased in subjects with AMD. The human choriocapillaris can be histologically studied in two dimensions by incubating the tissue for alkaline phosphatase activity, flat-embedding it in transparent polymer and sectioning it. Using this technique, choriocapillaris dropout was found to be associated with deposition of material in Bruch's membrane in diabetic subjects. When RPE are removed from Bruch's membrane, the choriocapillaris degenerates; the regeneration of choriocapillaris can be blocked by Genistein, a tyrosine kinase inhibitor. Finally, RPE cells may produce substances that both stimulate the formation and regression of CNV in animal models. These studies suggest that there may be a reduction in choriocapillaris flow in AMD, and this loss of choriocapillaris can be associated with the Bruch's membrane deposits that are hallmarks of AMD. Furthermore, RPE may stimulate the formation and regression of CNV and RPE loss can result in loss of choriocapillaris.

Neovascularization of the RPE: temporal differences in mice with rod photoreceptor gene defects

Neovascularization (NV) of the retinal pigment epitheium (RPE) by retinal capillaries following degeneration and loss of photoreceptor cells is a widely recognized phenomenon in rodents. NV of the RPE usually occurs several weeks to months after the loss of photoreceptor cells. We have observed that NV of the RPE occurs much earlier in a line of P23H mutant rhodopsin transgenic mice than in most other mice and rats that have been previously examined. To compare the temporal course of RPE NV in P23H mice with that of two other retinal degeneration mutants with the same time course of photoreceptor cell loss, we have quantified the number of retinal capillaries in the RPE of P23H and Q344ter mutant rhodopsin transgenic mice and retinal degeneration (rd/rd) mice at ages ranging from postnatal day (P) 20-400. Retinal capillary profiles located within the RPE were already present as early as P20 in the P23H retinas, and although these usually were located where most photoreceptor nuclei were missing, they occasionally were found where 1-2 rows of photoreceptor nuclei were still present. The maximal incidence was found in P23H retinas at P100. By contrast, NV of the RPE in rd/rd and Q344ter mice occurred much later. In rd/rd, a significant number of capillary profiles was not seen in the RPE until about P130, and not until about P180 in Q344ter. Both showed maximal incidence at about P240. In all three mutants, an apparent regression of the capillaries occurred following the peak, with that in the P23H mice preceeding the other two mutants. The findings suggest that the P23H mutant rhodopsin transgenic mouse may be a useful model for studying the regulation of NV in the outer retina.

[A pathohistological study of newly formed subpigment epithelial tissue in patients with senile macular dystrophy]

Efficacy and possibility of direct operations on the macular area of the retina in humid (exudative) maculopathies (senile maculodystrophy) is validated theoretically, morphologically, and clinically. A hypothesis on the mechanism of exudative process development in the macular area in degenerative diseases is formulated on the basis of pathohistological analysis of removed subpigmental material. Indications for such operations are defined.

Choroidal melanoma-associated retinal and retinal pigment epithelial changes

Many clinical findings associated with choroidal melanoma are the result of secondary changes in the adjacent tissues. There may be alterations in the choriocapillaris, the RPE, the Bruch's membrane, and the sensory retina. Proper identification of these changes is essential for diagnosis and management.

Increased expression of angiogenic growth factors in age-related maculopathy

AIMS/BACKGROUND

The late stages of age-related maculopathy (ARM), especially neovascular macular degeneration (ARMD), can severely affect central vision and are the main cause of blindness in the elderly in the Western world. It has been shown that angiogenic growth factors are present in neovascular membranes in ARMD. However, it is not known if angiogenic growth factors play a role in the onset of neovascularisation.

METHODS

In order to elucidate the involvement of angiogenic growth factors in the initiation of neovascularisation in early stages of ARM, the expression patterns of VEGF, TGF-beta, b-FGF, and PDGF-AA on 18 human maculae with ARM, and on 11 control specimens were investigated immunohistochemically.

RESULTS

A significantly increased expression of VEGF (p = 0.00001) and TGF-beta (p = 0.019) was found in the retinal pigment epithelium (RPE) of maculae with ARM compared with control maculae. Furthermore, an increased expression of VEGF and PDGF was found in the outer nuclear layer of maculae with ARM.

CONCLUSION

These results demonstrate an increased expression of VEGF in the RPE, and in the outer nuclear layer in maculae with ARM, that could be involved in the pathogenesis of neovascular macular degeneration. Furthermore, enhanced TGF-beta expression in the RPE cells of maculae with early stages of ARM was shown.

Lymphocyte migration across the anterior and posterior blood-retinal barrier in vitro

The migration of lymphocytes through monolayers of rat retinal pigment epithelium (RPE) and retinal vascular endothelium, which form the posterior and anterior blood-retinal barrier (BRB) respectively, was investigated in vitro. After a 4-hr assay the migration of untreated peripheral lymph node (PLN) cells through RPE monolayers was negligible (<1%) with only a small increase found after activation of the PLN cells with concanavalin A or by cross-linking CD3. Activation of the RPE with IFN-gamma augmented migration with maximal PLN cell migration being achieved with a combination of CD3 cross-linking and IFN-gamma activation (17% migration). The highest level of lymphocyte migration was observed with three CD4+ antigen-specific T cell lines specific for purified protein derivative (PPD; 33% migration), ovalbumin (OA; 31%), and S-antigen (S-Ag; 57%). Migration of both untreated and Con A-activated PLN cells through retinal endothelial cells (EC) from PVG rats was negligible, whereas the migration of the antigen-specific T cell lines was 23, 29 and 23% for PPD, OA, and S-Ag lines, respectively. Migration of these cell lines through retinal endothelium derived from Lewis rats was significantly greater (44% for PPD, 39% for OA, and 39% for S-Ag) which corresponded with a greater expression of ICAM-1 on the EC.

Blood-aqueous barrier in pseudoexfoliation syndrome: evaluation by immunohistochemical staining of endogenous albumin

BACKGROUND

Alterations of the integrity of the blood-aqueous barrier (BAB) are frequent findings in eyes with pseudoexfoliation syndrome (PSX).

METHODS

Immunohistochemical staining for the demonstration of albumin was used to analyze the BAB in 10 eyes with PSX without previous intraocular surgery and in 10 age-matched normal control eyes.

RESULTS

In eyes with PSX, small amounts of albumin were detected along the anterior surface of the iris in 7, in the anterior chamber in 1, along the ciliary epithelium in 4, and in the trabecular meshwork in 9 of 10 eyes. PSX material was also immunoreactive. In the 10 normal control eyes, albumin was detected anterior to the iris stroma in 1 eye, in the anterior chamber in 2 eyes, in the trabecular meshwork in 1 eye, but not internal to the ciliary epithelium.

CONCLUSIONS

Our findings indicate that impairment of the BAB in PSX can be localized at the level of the iris and, less frequently or to a lesser extent, at the level of the ciliary body.

Human microvascular endothelial cell-extracellular matrix interaction in cellular growth state determination

We introduce two methods, both of which are based on cellular-extracellular matrix interaction, which will facilitate the study of human microvascular endothelial cells. One method describes the means to obtain a G1 population baseline in human microvascular endothelial cells. Because of the contribution of the extracellular matrix in endothelial cell growth, synchronization in G1 was possible only after the incorporation of angiostatic levels of heparin and hydrocortisone into the extracellular matrix. In the second method, we demonstrate that selective perturbation of human microvascular endothelial cell-extracellular matrix interactions results in the induction of a transitional growth state, between proliferative and differentiated growth states, in human microvascular endothelial cells. In the functional, microtubule formation assays, transitional growth state endothelial cells display rates that are indermediate between those obtained from differentiated and proliferative endothelial cells. Our results demonstrate the importance of the human microvascular endothelial cell-extracellular matrix interaction in the determination of cellular growth state. Our findings also imply that responsiveness of microvascular endothelial cells to their cellular-extracellular matrix environs is highest during the differentiated growth state.

Assessment of blood-retinal barrier integrity

The blood-retinal barrier consists of two components which are comprised of the retinal vascular endothelium and the retinal pigment epithelium, respectively. Its functional integrity can be recognized by tight junctions between these cells with a paucity of endocytic vesicles within them and the presence of the molecules that regulate the ionic and metabolic gradients that constitute the barrier. The barrier is compromised in several disease processes and by a variety of agents, but in most cases the location and mechanism for barrier failure is not understood. Perfusion with a variety of radiolabeled tracer molecules, vitreous fluorophotometry, or magnetic resonance imaging can be used to quantitate blood-retinal barrier leakage. Fluorescein angiography or magnetic resonance imaging can localize sites of leakage in vivo with limited resolution. Evans blue dye can be used to visualize blood-retinal barrier failure in gross pathological specimens and immuno-histochemical labeling of serum proteins such as albumin or fibrinogen can be used to localize sites of blood-retinal barrier breakdown by light microscopy. Tracers such as horseradish peroxidase, microperoxidase, or lanthanum, or the immunocytochemical demonstration of albumin can be used to reveal blood-retinal barrier breakdown at the ultrastructural level and provide insights into the mechanisms involved. This review discusses the advantages and limitations of each of these methods to aid in selection of the appropriate techniques to derive the desired information.

Retinal pigment epithelial fine structure in the American crow (Corvus brachyrhynchos)

The fine structure of the retinal epithelial (RPE) region has been investigated by light and electron microscopy in the American crow (Corvus brachyrhynchos). In this species the RPE consists of a single layer of cuboidal cells which display numerous deep basal (scleral) infoldings and plentiful apical (vitreal) microvillar processes which surround photoreceptor inner and outer segments. The RPE cells are joined laterally by a series of tight junctions (Verhoeff's membrane) located in the mid to basal region. Within the epithelial cells, smooth endoplasmic reticulum is very abundant while rough endoplasmic reticulum (RER) is scarce. Mitochondria of various shapes are abundant basally while polysomes are plentiful and widespread. In the light-adapted state RPE nuclei are large and vesicular and basally located while the melanosomes of these cells are predominantly located with the apical processes indicating photomechanical movements. Myeloid bodies are large and numerous and often have ribosomes on their outer surface. Bruch's membrane (complexus basalis) is typical of avian species in that it is pentalaminate and the lamina densa is displaced near the choriocapillaris. The endothelium of the choriocapillaris is thin facing Bruch's membrane but is only moderately fenestrated. Some of these fenestrations display a double-layered diaphragm while the majority show the more typical single-layered diaphragm noted in most species.

Biomicroscopic and histopathologic considerations regarding the feasibility of surgical excision of subfoveal neovascular membranes

Surgical excision of subfoveal neovascular membranes may result in recovery of excellent visual acuity in patients with presumed ocular histoplasmosis but not in patients with age-related macular degeneration. To provide an explanation for this discrepancy, I analyzed the clinical and histopathologic findings in five patients with presumed ocular histoplasmosis. These findings provide evidence that the new vessels arising in the choroid in these patients usually grow within the subsensory retinal space and not in the subpigment epithelial space, as occurs in patients with age-related macular degeneration. In presumed ocular histoplasmosis, the new vessels are partly engulfed by a monolayer of proliferating retinal pigment epithelium. Surgical excision of this membrane permits reapproximation of the retinal receptors and native pigment epithelium and may be associated with remarkable return of visual acuity.

Pontine infarction in acute posterior multifocal placoid pigment epitheliopathy

In a patient with acute posterior multifocal placoid pigment epitheliopathy (APMPPE), a pontine infarction occurred about 6 months after the ophthalmological manifestation. We report the first case with histopathologically proven vasculitis shown by muscle biopsy and the first positron emission tomographic documentation in APMPPE. The ophthalmological and cerebral symptoms responded well to steroid treatment. Long-term immunosuppression (e.g. azathioprine 1-2 mg/kg) seems to decrease the risk of recurrent systemic vasculitis.

The retinal pigment epithelium induces fenestration of endothelial cells in vivo

Rodent photoreceptor dystrophies are characterized by late stage ingrowth of retinal blood vessels into the retinal pigment epithelium (RPE) where they proliferate. Some of these vessels develop the fenestrated phenotype of the choriocapillaris (CC). To determine if development of fenestrae in these endothelial cells is a function of the duration of time the endothelial cell had been encapsulated by the RPE, we did an ultrastructural morphometric study of these vessels in urethane induced photoreceptor degeneration in Long-Evans rats. Retinas of animals aged 20, 24, 40 and 56 weeks were studied. The fraction of vessel profiles within the RPE that had fenestrated endothelial cells increased from 10% to 90% between 20 to 56 weeks. The average number of fenestrae per vessel increased approximately 25 fold between 20 and 24 weeks but stabilized after that, despite a decrease in the number of vessels present at 56 weeks. A large number of degenerated retinal vessel profiles were seen in the RPE at 40 weeks. These facts support the idea that the presence of the RPE induces endothelial cell fenestrae, and also show that a complex process of remodelling including proliferation and degeneration is occurring in these vessels. Analogies between the basic cell biology of neovascularization occurring in these rodent models and that of proliferative diabetic retinopathy and age-related macular degeneration are discussed.

Retinal pigment epithelial fine structure in the red-backed salamander (Plethodon cinereus)

The retinal pigment epithelium (RPE) of the red-backed salamander (Plethodon cinerus) consists of a single layer of large squamous shaped cells. The RPE cells are but minimally infolded basally (sclerally) but show many large apical (vitreal) processes interdigitating with the rod outer segments. These epithelial cells are joined laterally by prominent tight junctions located in the mid region of the cells. Internally smooth endoplasmic reticulum is very plentiful while rough endoplasmic reticulum is not. Polysomes, small dense mitochondria and small round to oval melanosomes are plentiful. Golgi zones and lysosome-like bodies are also present as are phagosomes of outer segment material and myeloid bodies. The RPE cell nucleus is large and vesicular. It is felt that the melanosomes undergo retinomotor movements but as only light-adapted specimens were examined it is not known how extensive are these movements. Bruch's membrane or complexus basalis shows the typical pentalaminate structure noted for most vertebrates. The choriocapillaris is a single layer of large anastomosing capillaries which are minimally fenestrated facing Bruch's membrane.

Detection of subpigment epithelial neovascularisation in cases of retinal pigment epithelial detachments: a review of the Moorfields treatment trial

The entry angiograms of 42 eyes with detachment of the retinal pigment epithelium in a treatment trial of laser photocoagulation were reviewed in a masked fashion by three observers in order to assess the possible presence of subpigment epithelial neovascularisation. Vascularity or avascularity was designated with reference to a list of clues believed to imply the presence of subpigment epithelial neovascularisation. As a predictor of outcome the initial assessment achieved a sensitivity and specificity of 77% and 82% respectively. Despite notable parity of the degree of sensitivity and specificity among the three observers, full agreement on the initial assessments was reached in only 23 eyes (55%), 10 with vascular and 13 with avascular outcome. Of these, only one eye which developed new vessels after 4 years had an outcome which differed from that predicted by classification of the entry angiograms.

Pigment epithelial cell changes precede vascular transformations in the dystrophic rat retina

In the Royal College of Surgeons rat with inherited retinal dystrophy, vascularization of the retinal pigment epithelium (RPE) is preceded by migration and proliferation of Müller cell processes in the subretinal space where they contact the RPE. Later, RPE cells envelope subretinal vessels which have lost their perivascular Müller cell sheath. To characterize RPE cell changes and interactions in relation to glial and vascular transformations in retinal dystrophy, we used immunocytochemical techniques and antibodies against cytokeratin (CK) and glial fibrillary acidic protein (GFAP). Prior to the proliferation of Müller cell processes in the dystrophic retina, CK filaments in RPE cells formed a circumferential meshwork with intense cytoplasmic and perinuclear labeling as in control RPE cells. Following entry of Müller cell processes into the membranous debris zone and formation of RPE-Müller cell contact, RPE cells became pleomorphic and extended prominent apical processes in the debris zone. Some CK-reactive RPE cells detached from Bruch's membrane and migrated into the debris zone. Electron microscopic study showed extensive areas of close RPE-Müller cell contact at this time. Obvious junctional specializations of the plasma membranes were not seen but prominent tubulo-vesicular profiles occupied the cytoplasm of altered RPE and Müller cell processes. Following RPE vascularization, hypertrophic CK-positive cells surrounded blood vessels and accompanied them into the inner retina. Electron microscopic analysis showed that RPE-associated vessels were fenestrated and devoid of their perivascular glial sheath. Apparent proliferation of RPE cells and redistribution of CK filaments were observed. Our study shows that RPE cell alterations accompany Müller cell and vascular changes which result in altered RPE-Müller cell and RPE-endothelial cell relationships in the dystrophic rat retina. The altered relationships among RPE, Müller and endothelial cells may result in increased cellular interaction and promote proliferation and transformation of all three cells types in diseased retinas.

Choroidal vasculitis in acute posterior multifocal placoid pigment epitheliopathy

A 24-year-old Caucasian female presented with acute posterior multifocal placoid pigment epitheliopathy (APMPPE) and associated infiltration round some of the larger choroidal blood vessels. This infiltration dissipated as the patient's clinical condition improved and did not induce any permanent alteration of the overlying retinal pigment epithelium. We suggest that the infiltration round the choroidal vessels was due to a choroidal vasculitis. The finding of choroidal inflammation in this case lends support to the hypothesis that choroidal vasculitis is an underlying pathological process in APMPPE.

Selective neovascularization of the retinal pigment epithelium in rat photoreceptor degeneration in vivo

Photoreceptor cell degeneration in rodents from a variety of causes results in neovascularization of the retinal pigment epithelium as a late stage phenomenon. Even though the vessels within the pigment epithelium arise from the retinal circulation, they can manifest the choroidal endothelial cell phenotype of fenestrated endothelial cells. In order to study the detailed cellular events which result in incorporation of retinal vessels within the retinal pigment epithelium, a morphological and morphometric analysis of the RPE and vasculature was performed in rats. Urethane, given subcutaneously to newborn rats, results in a photoreceptor degeneration but does not affect the RPE, choroid or inner retinal layers. Retinas were studied from rats of 8 to 24 weeks of age, the time period when vascularization of the RPE occurs. Loss of retinal vessels is first seen at 12 weeks, primarily in substantial dropout of vessel profiles in the outer plexiform layer (OPL) vessel bed. There is a gradient of loss from the OPL bed to the nerve fiber layer (NFL) bed and from the central to peripheral region. Total vessel density of the experimental retinas is greater than controls at 8 and 12 weeks. This occurs because there is marked loss of retinal thickness, due to photoreceptor degeneration, without a comparable loss of vessel profiles. The total retinal vessel density decreases from 8 to 20 weeks, and appears to stabilize at 20 and 24 weeks. Analysis of the separate vessel beds shows that this apparent stabilization is due to continued loss of vessels within the sensory retina, and increased presence of vascular profiles within the RPE. Total absence of the photoreceptor cell is necessary for incorporation of vessels within the RPE. Since new vessel profiles develop in the RPE but not the adjacent sensory retina, we speculate that the RPE may stimulate neovascularization of the RPE. A model of the cellular events leading to RPE neovascularization is proposed.

Development of the choroid and related structures

The development of the choriocapillaris and the choroid is described using light and electron microscopy. Up to the seventh week after conception, the endothelium of the choriocapillaris is thick and contains many cytoplasmic vesicles. By the ninth week the endothelium flattens and becomes vesiculated. Fenestrations are found as early as the seventh week, whereas the continuous basement membrane is only observed at the ninth week. The first choroidal arterioles and venules can be seen during the fifteenth week and the arteries and veins become distinguishable at the twenty-second week. Haller's and Sattler's layers are both venous and arterial at the time of their first appearance.

Müller cell changes precede vascularization of the pigment epithelium in the dystrophic rat retina

In the Royal College of Surgeons rat with inherited retinal dystrophy, photoreceptor cell degeneration is accompanied by retinal pigment epithelial (RPE) cell alterations and Müller cell changes such as increased expression of glial fibrillary acidic protein (GFAP). Vascular changes such as vascularization of the RPE, vascular proliferation, and formation of vitreoretinal membranes (VRMs) are observed later. To study the relationship of Müller cell changes to the vascular alterations in the dystrophic retina, we used immunoperoxidase techniques and antibodies against GFAP and vimentin. Our study showed that during photoreceptor degeneration, Müller cells expressed small amounts of GFAP. As degeneration progressed, GFAP expression increased and morphological alterations occurred in Müller cells. Müller cell apical processes extended and proliferated in the subretinal space and contacted the apical surface of duplicated RPE cells. Later, GFAP reactive fibers surrounded retinal vessels apposed to the RPE. As the vessels became enmeshed within the RPE, the GFAP-positive perivascular processes disappeared. Eventually, the RPE-associated vessels became displaced into the inner retina where VRMs were sometimes observed. Immunoblots showed increased GFAP in dystrophic as compared with control retinas. Studies of vimentin distribution in the dystrophic retina showed results similar to the GFAP study. Moreover, the vimentin study suggested increased number of Müller cell processes in the dystrophic as compared with control retinas. The close temporal and anatomical relationships among Müller cell, RPE, and vascular changes in the dystrophic rat suggest a role for Müller cells in retinal neovascularization and proliferative retinopathy.

Increased vascular density and vitreo-retinal membranes accompany vascularization of the pigment epithelium in the dystrophic rat retina

Observations of vascularization of the retinal pigment epithelium (RPE) and formation of vitreo-retinal membranes (VRMs) in Royal College of Surgeons (RCS) rats with inherited retinal dystrophy suggest that vascular proliferation occurs in this model. To test this hypothesis, we studied the progression of vascular changes in RCS and age-matched control rats using quantitative light microscope morphometry and electron microscopy. At 2 weeks, prior to photoreceptor degeneration, the dystrophic retina is comparable with the control. By 2 months, extensive degeneration of photoreceptor cells results in significant thinning of the dystrophic retina as compared with the control. Signs of vascular degeneration are evident at the electron microscope level--"ghost" vessels consisting of acellular basal lamina surrounded by amorphous electron-dense material; degenerating endothelial cells and pericytes; and abnormal deposits of extracellular matrix (ECM) material around blood vessels. Vascular degeneration is accompanied by glial changes in the form of necrotic perivascular glial processes and abnormal ECM deposits among the altered Muller cell processes. At 2-4 months in the dystrophic retina, numbers of vessel profiles in dystrophic retinas are decreased as compared with controls. However, vascular degeneration is overshadowed by the formation of numerous capillary tufts within the RPE layer, which together with retinal thinning results in increased vessel density. Between 4-12 months, the retinal thickness diminishes further, vascularization of the RPE increases, vitreo-retinal membranes are formed, and vascular density increases. In summary, following an initial period of vascular degeneration, vascularization of the RPE is accompanied by an increase in retinal vessel density and by the formation of vitreo-retinal membranes.

Extracellular matrix alterations precede vascularization of the retinal pigment epithelium in dystrophic rats

In Royal College of Surgeons (RCS) rats, the defective retinal pigment epithelium (RPE) fails to phagocytose the shed outer segment membranes, and the photoreceptors degenerate. Following degeneration of the photoreceptors, neovascularization and vitreo-retinal membranes (VRMs) develop. Blood-retinal barrier abnormalities at the level of the RPE suggested that Bruch's membrane extracellular matrix filtration barriers might also be abnormal. To study the progression of RPE cell, extracellular matrix and vascular alterations in the dystrophic retina, we used the cationic tracer polyethyleneimine and electron microscope morphometric techniques. At two weeks in the RCS retina, the RPE and retinal vessels, and their basal laminae, appeared normal. By two months, the RPE was hypertrophic and duplicated in some areas, and flattened in others. The RPE basal lamina was thickened (171% of the control, p less than .01), and there were more anionic sites along the RPE basal surface (158% of the control, p less than .01). Patches of displaced basal lamina material appeared within the RPE basal infoldings. By four months and later numerous retinal vessels were present within the RPE layer. In addition, cords of migrating RPE cells surrounded presumptive new vessels branching from the RPE layer towards the inner limiting membrane. The RPE-associated vessels exhibited diaphragmed fenestrae and channels, unlike normal retinal vessels, and their basal laminae were marked by anionic sites. These observations of RPE and extracellular matrix changes prior to vascular proliferation, and VRM formation in the dystrophic retina suggest that the RPE-associated extracellular matrix changes may contribute to vascular alterations in the dystrophic retina. A preliminary report of these findings has been presented previously.

Choriocapillaris regeneration in the rabbit. Ultrastructure of new endothelial tube formation

After experimental destruction of the retinal pigment epithelium (RPE) by intravenous injection of sodium iodate, the rabbit choriocapillaris (CC) atrophies. This report studies the subsequent regeneration of the CC with the goal of identifying sources of new CC and mechanisms by which new endothelial tube is formed. Light and transmission electron microscopic methods were used. The CC appeared to regenerate from three sources: choroidal venules, remnant CC and newly produced cells. Whatever the source, new endothelial tube was formed by extensions of the endothelium that sealed off new lumenal space by junctional complexes. This process was always confined to the tissue space within remnant sleeves of basement membrane left behind by initial atrophy, and which served as a substrate for endothelial movement. The endothelium of new endothelial tube was initially thick and unfenestrated. It became thinner and fenestrated by a process of cavitation, in which cavities continuous with the lumen pushed into the thick endothelial cytoplasm towards its abluminal side. At this site new fenestrae were formed. Fenestrae were initially scattered about the endothelial tube, but with its maturation became localized on the side facing the regenerated RPE.

Choriocapillaris regeneration in the rabbit: a study with vascular casts

Vascular casts were made of the choriocapillaris (CC) of rabbits that received sodium iodate intravenously 6-28 days prior to examination, in order to augment studies of CC regeneration in sectioned material. Regeneration of CC was evident 6 days after administration of iodate where zones of spared CC bordered zones of atrophic CC. Venular as well as capillary sprouts created foci of regenerating CC at this border. These foci to create an extended capillary plexus similar to mature CC. The observations corroborate those obtained in sectioned material as regards the geography of the CC response and the origins of new CC during the sodium iodate retinopathy, and provide new information on the way in which CC regenerates.

Remodelling of the retinal pigment epithelium in response to intraepithelial capillaries: evidence that capillaries influence the polarity of epithelium

Light- and urethane-induced retinopathies in rats are characterized by loss of photoreceptors. Retinal capillaries subsequently become incorporated into the normally avascular retinal pigment epithelium. These models provided an opportunity to study the response of epithelial cells to closely apposed capillaries, in order to determine if capillaries contribute to the polar organization of epithelial cells. Pigment epithelial cells reorganized their lateral plasma membrane where the latter faced intraepithelial capillaries. This normally flat, undifferentiated membrane developed attachment sites, folds and intracytoplasmic tubules, and exhibited endocytosis and putative basal lamina secretion. These structural and functional specializations are normally restricted to the basal plasma membrane - the normal vascular front of the cell facing the dense meshwork of capillaries constituting the choriocapillaris. We conclude that RPE cells, and perhaps epithelia in general, polarize in response to an adjacent capillary bed.

Pathogenesis of tears of the retinal pigment epithelium

This report confirms a previous report that elderly patients with serous detachments of the pigment epithelium prior to and after developing a pigment epithelial tear at one border present a characteristic ophthalmoscopic and fluorescein angiographic appearance. Evidence is presented that subpigment epithelial choroidal neovascularisation and not irregular separation of the basement membrane from its pigment epithelium is the primary cause of the detachment and tear in the pigment epithelium.

Ultrastructure of blood-retinal barrier permeability in rat phototoxic retinopathy

It has been shown previously that the blood-retinal barrier (BRB) of rats with phototoxic retinopathy is permeable to sodium fluorescein and to fluoresceinated dextrans as large as 32A ESR (Einstein-Stokes radius). The leakage presumably occurs from retinal capillaries that have invaded the retinal pigment epithelium (RPE) and become fenestrated. In this report, the ultrastructural tracers horseradish peroxidase and catalase were used to further localize the leakage site, and to evaluate the size limit of molecules penetrating the phototoxic BRB. Horseradish peroxidase (HRP: 30A ESR) freely penetrates the BRB of phototoxic rats, since it is present in the retinal extracellular space 10 min after intravenous injection. HRP penetrates the fenestrae of capillaries which invade the RPE from the retina. It then diffuses along the pericapillary space of the intraepithelial capillaries, which is confluent with that of their parent retinal capillaries, and into the retinal extracellular space. HRP thus circumvents the tight junctions between RPE cells and between capillary endothelial cells, which appear intact in thin sections. Catalase (52A ESR) does not freely penetrate the BRB of phototoxic rats. As long as 40 min after intravenous injection, catalase is still confined to the lumen of fenestrated capillaries in the RPE, retinal capillaries, and the choriocapillaris. Although present in intraendothelial vesicles, no evidence of deposition in the pericapillary space is observed. It is concluded fenestrated capillaries in the RPE are a major site where blood-borne tracers penetrate the BRB in phototoxic retinopathy.

Observations on the permeability of the choriocapillaris of the eye

The choriocapillaris is a fenestrated capillary bed located posterior to the retinal pigment epithelium. It serves as the main source of supply to the photoreceptors, retinal pigment epithelium, and other cells of the outer retina. The permeability of these capillaries to intravenously injected ferritin (MW - approx. 480,000; mol. diam. 11 nm) was examined in the mouse, rabbit, and guinea pig, each of which is characterized by a different type of retinal vascularization. In all three species, the bulk of the ferritin remained in the capillary lumina, where it appeared to be blocked at the level of the diaphragmed fenestrae. Some ferritin was present in endothelial cell vacuoles. The results confirm previous work on the rat choriocapillaris and indicate that the barrier function of the choriocapillary endothelium is present even among species in which the retinal circulation differs significantly.