Genetic basis of inherited macular dystrophies and implications for stem cell therapy

LRRTM4-C538Y novel gene mutation is associated with hereditary macular degeneration with novel dysfunction of ON-type bipolar cells

The macula is a unique structure in higher primates, where cone and rod photoreceptors show highest density in the fovea and the surrounding area, respectively. The hereditary macular dystrophies represent a heterozygous group of rare disorders characterized by central visual loss and atrophy of the macula and surrounding retina. Here we report an atypical absence of ON-type bipolar cell response in a Japanese patient with autosomal dominant macular dystrophy (adMD). To identify a causal genetic mutation for the adMD, we performed whole-exome sequencing (WES) on four affected and four-non affected members of the family for three generations, and identified a novel p.C538Y mutation in a post-synaptic gene, LRRTM4. WES analysis revealed seven rare genetic variations in patients. We further referred to our in-house WES data from 1360 families with inherited retinal diseases, and found that only p.C538Y mutation in LRRTM4 was associated with adMD-affected patients. Combinatorial filtration using public database of single-nucleotide polymorphism frequency and genotype-phenotype annotated database identified novel mutation in atypical adMD.

Cellular regeneration strategies for macular degeneration: past, present and future

Despite considerable effort and significant therapeutic advances, age-related macular degeneration (AMD) remains the commonest cause of blindness in the developed world. Progressive late-stage AMD with outer retinal degeneration currently has no proven treatment. There has been significant interest in the possibility that cellular treatments may slow or reverse visual loss in AMD. A number of modes of action have been suggested, including cell replacement and rescue, as well as immune modulation to delay the neurodegenerative process. Their appeal in this enigmatic disease relate to their generic, non-pathway-specific effects. The outer retina in particular has been at the forefront of developments in cellular regenerative therapies being surgically accessible, easily observable, as well as having a relatively simple architecture. Both the retinal pigment epithelium (RPE) and photoreceptors have been considered for replacement therapies as both sheets and cell suspensions. Studies using autologous RPE, and to a lesser extent, foetal retina, have shown proof of principle. A wide variety of cell sources have been proposed with pluripotent stem cell-derived cells currently holding the centre stage. Recent early-phase trials using these cells for RPE replacement have met safety endpoints and hinted at possible efficacy. Animal studies have confirmed the promise that photoreceptor replacement, even in a completely degenerated outer retina may restore some vision. Many challenges, however, remain, not least of which include avoiding immune rejection, ensuring long-term cellular survival and maximising effect. This review provides an overview of progress made, ongoing studies and challenges ahead.

Recent Advances in Retinal Stem Cell Therapy

Purpose of review

Progress in stem cell research for blinding diseases over the past decade is now being applied to patients with retinal degenerative diseases and soon perhaps, glaucoma. However, the field still has much to learn about the conversion of stem cells into various retinal cell types, and the potential delivery methods that will be required to optimize the clinical efficacy of stem cells delivered into the eye.

Recent findings

Recent groundbreaking human clinical trials have demonstrated both the opportunities and current limitations of stem cell transplantation for retinal diseases. New progress in developing in vitro retinal organoids, coupled with the maturation of bio-printing technology, and non-invasive high-resolution imaging have created new possibilities for repairing and regenerating the diseased retina and rigorously validating its clinical impact in vivo.

Summary

While promising progress is being made, meticulous clinical trials with cells derived using good manufacturing practice, novel surgical methods, and improved methods to derive all of the neuronal cell types present in the retina will be indispensable for developing stem cell transplantation as a paradigm shift for the treatment of blinding diseases.

Generation of a foveomacular transcriptome

PURPOSE

Organizing molecular biologic data is a growing challenge since the rate of data accumulation is steadily increasing. Information relevant to a particular biologic query can be difficult to extract from the comprehensive databases currently available. We present a data collection and organization model designed to ameliorate these problems and applied it to generate an expressed sequence tag (EST)-based foveomacular transcriptome.

METHODS

Using Perl, MySQL, EST libraries, screening, and human foveomacular gene expression as a model system, we generated a foveomacular transcriptome database enriched for molecularly relevant data.

RESULTS

Using foveomacula as a gene expression model tissue, we identified and organized 6,056 genes expressed in that tissue. Of those identified genes, 3,480 had not been previously described as expressed in the foveomacula. Internal experimental controls as well as comparison of our data set to published data sets suggest we do not yet have a complete description of the foveomacula transcriptome.

CONCLUSIONS

We present an organizational method designed to amplify the utility of data pertinent to a specific research interest. Our method is generic enough to be applicable to a variety of conditions yet focused enough to allow for specialized study.

Lab generated retina: realizing the dream

Blindness represents an increasing global problem with significant social and economic impact upon affected patients and society as a whole. In Europe, approximately one in 30 individuals experience sight loss and 75% of those are unemployed, a social burden which is very likely to increase as the population of Europe ages. Diseases affecting the retina account for approximately 26% of blindness globally and 70% of blindness in the United Kingdom. To date, there are no treatments to restore lost retinal cells and improve visual function, highlighting an urgent need for new therapeutic approaches. A pioneering breakthrough has demonstrated the ability to generate synthetic retina from pluripotent stem cells under laboratory conditions, a finding with immense relevance for basic research, in vitro disease modeling, drug discovery, and cell replacement therapies. This review summarizes the current achievements in pluripotent stem cell differentiation toward retinal cells and highlights the steps that need to be completed in order to generate human synthetic retinae with high efficiency and reproducibly from patient-specific pluripotent stem cells.

Hope and major strides for genetic diseases of the eye

There have been dramatic advances in the elucidation of the genetic etiology of inherited eye diseases and their underlying pathophysiology in the last two to three decades. This was made possible by the exponential development of powerful molecular biology instrumentation and techniques, the completion of the human genome project, an increasing interest in the study of these diseases worldwide, and a push by the lay public to find cures for these rare but devastating conditions. The genes for a wide range of eye diseases have been identified and have led to a rethinking and a reclassification of disorders that is based not only on classical clinical signs, but also on underlying genetic etiology. Examples of these include the corneal dystrophies, rare forms of strabismus now designated as the cranial dysinnervation disorders, ocular malformations that result from mutations in transcription factors, cataracts that result from mutations in crystallins and other structural lens components, and finally retinal dystrophies that result from defects in phototransduction or visual cycle defects. This article is a perspective on recent advances in the field of ophthalmic genetics.