The pupillary light response: assessment of function mediated by intracranial retinal transplants

Ectopic eyes outside the head in Xenopus tadpoles provide sensory data for light-mediated learning

A major roadblock in the biomedical treatment of human sensory disorders, including blindness, has been an incomplete understanding of the nervous system and its ability to adapt to changes in sensory modality. Likewise, fundamental insight into the evolvability of complex functional anatomies requires understanding brain plasticity and the interaction between the nervous system and body architecture. While advances have been made in the generation of artificial and biological replacement components, the brain's ability to interpret sensory information arising from ectopic locations is not well understood. We report the use of eye primordia grafts to create ectopic eyes along the body axis of Xenopus tadpoles. These eyes are morphologically identical to native eyes and can be induced at caudal locations. Cell labeling studies reveal that eyes created in the tail send projections to the stomach and trunk. To assess function we performed light-mediated learning assays using an automated machine vision and environmental control system. The results demonstrate that ectopic eyes in the tail of Xenopus tadpoles could confer vision to the host. Thus ectopic visual organs were functional even when present at posterior locations. These data and protocols demonstrate the ability of vertebrate brains to interpret sensory input from ectopic structures and incorporate them into adaptive behavioral programs. This tractable new model for understanding the robust plasticity of the central nervous system has significant implications for regenerative medicine and sensory augmentation technology.

Reversal of end-stage retinal degeneration and restoration of visual function by photoreceptor transplantation

One strategy to restore vision in retinitis pigmentosa and age-related macular degeneration is cell replacement. Typically, patients lose vision when the outer retinal photoreceptor layer is lost, and so the therapeutic goal would be to restore vision at this stage of disease. It is not currently known if a degenerate retina lacking the outer nuclear layer of photoreceptor cells would allow the survival, maturation, and reconnection of replacement photoreceptors, as prior studies used hosts with a preexisting outer nuclear layer at the time of treatment. Here, using a murine model of severe human retinitis pigmentosa at a stage when no host rod cells remain, we show that transplanted rod precursors can reform an anatomically distinct and appropriately polarized outer nuclear layer. A trilaminar organization was returned to rd1 hosts that had only two retinal layers before treatment. The newly introduced precursors were able to resume their developmental program in the degenerate host niche to become mature rods with light-sensitive outer segments, reconnecting with host neurons downstream. Visual function, assayed in the same animals before and after transplantation, was restored in animals with zero rod function at baseline. These observations suggest that a cell therapy approach may reconstitute a light-sensitive cell layer de novo and hence repair a structurally damaged visual circuit. Rather than placing discrete photoreceptors among preexisting host outer retinal cells, total photoreceptor layer reconstruction may provide a clinically relevant model to investigate cell-based strategies for retinal repair.

Cell replacement and visual restoration by retinal sheet transplants

Retinal diseases such as age-related macular degeneration (ARMD) and retinitis pigmentosa (RP) affect millions of people. Replacing lost cells with new cells that connect with the still functional part of the host retina might repair a degenerating retina and restore eyesight to an unknown extent. A unique model, subretinal transplantation of freshly dissected sheets of fetal-derived retinal progenitor cells, combined with its retinal pigment epithelium (RPE), has demonstrated successful results in both animals and humans. Most other approaches are restricted to rescue endogenous retinal cells of the recipient in earlier disease stages by a 'nursing' role of the implanted cells and are not aimed at neural retinal cell replacement. Sheet transplants restore lost visual responses in several retinal degeneration models in the superior colliculus (SC) corresponding to the location of the transplant in the retina. They do not simply preserve visual performance - they increase visual responsiveness to light. Restoration of visual responses in the SC can be directly traced to neural cells in the transplant, demonstrating that synaptic connections between transplant and host contribute to the visual improvement. Transplant processes invade the inner plexiform layer of the host retina and form synapses with presumable host cells. In a Phase II trial of RP and ARMD patients, transplants of retina together with its RPE improved visual acuity. In summary, retinal progenitor sheet transplantation provides an excellent model to answer questions about how to repair and restore function of a degenerating retina. Supply of fetal donor tissue will always be limited but the model can set a standard and provide an informative base for optimal cell replacement therapies such as embryonic stem cell (ESC)-derived therapy.

Stem cell therapy and the retina

Retinal degeneration culminating in photoreceptor loss is the leading cause of untreatable blindness in the developed world. In this review, we consider how photoreceptors might be replaced by transplantation and how stem cells might be optimised for use as donor cells in future clinical strategies for retinal repair. We discuss the current advances in human and animal models of retinal cell transplantation, focussing on stem cell and reproductive cloning biology, in relation to the practical issues of retinal transplantation surgery. Stem and progenitor cells can be isolated from a number of sources including embryonic tissue, adult brain and even the retina, prompting many researchers to investigate the potential for using these cells to generate photoreceptors for transplantation. Nevertheless, several obstacles need to be overcome before these techniques can be applied in a clinical setting. Embryonic or stem cells have so far shown little ability to differentiate into retinal phenotypes when transplanted into the adult retina. We have recently noted, however, that donor cells harvested much later, at the photoreceptor precursor developmental stage, can be transplanted successfully and restore visual function. The current challenge is to understand the developmental processes that guide embryonic or adult stem cells towards photoreceptor differentiation, so that large numbers of these cells might be transplanted at the optimal stage. Future advances in reproductive cloning technology could lead to the successful generation of stem cells from adult somatic cells, thereby facilitating auto-transplantation of genetically identical cells in patients requiring photoreceptor replacement.

Cell transplantation as a treatment for retinal disease

It has been shown that photoreceptor degeneration can be limited in experimental animals by transplantation of fresh RPE to the subretinal space. There is also evidence that retinal cell transplants can be used to reconstruct retinal circuitry in dystrophic animals. Here we describe and review recent developments that highlight the necessary steps that should be taken prior to embarking on clinical trials in humans.

Graft location affects functional rescue following RPE cell transplantation in the RCS rat

Photoreceptor (PRC) rescue in the dystrophic Royal College of Surgeons (RCS) rat has been well documented following a variety of interventions. Although the dystrophic process is asymmetric with respect to the horizontal meridian, little attention has been paid to the effect of topographic position on treatment outcome. In this study, RPE cells from adult congenic nondystrophic animals were injected into the subretinal space of 1-month-old dystrophic RCS rats in either the dorsal or the ventral equatorial region. Animals were followed longitudinally during the degenerative process using the pupillary light reflex (PLR). The parameter of the PLR most sensitive to PRC rescue is latency at low light levels. At 3 months of age this parameter showed statistically better performance (ANOVA, P = 0.016) for eyes with grafts placed dorsally compared to those placed ventrally or untreated controls. There was no treatment effect on amplitude. By 6 months of age the dorsal/ventral disparity in latency was less apparent and amplitude remained equivalent across groups. Late analysis of retinal whole-mounts using RT-97 fluorescent labeling showed extensive irregularities in ventral axonal morphology in all treatment groups. These results indicate that functional rescue of the RCS retina is significantly influenced by the local degenerative timetable. The role of initial local conditions on treatment outcome is worthy of consideration in other models of neuroprotection.

Partial rescue of the ocular retardation phenotype by genetic modifiers

The or(J) allele of the murine ocular retardation mutation is caused by a premature stop codon in the homeodomain of the Chx10 gene. When expressed on an inbred 129/Sv strain, the or(J) phenotype is characterized by microphthalmia and a thin, poorly differentiated retina in which the peripheral portion is affected to a greater extent than the central portion. Such mutant retinae lack differentiated bipolar cells and the optic nerve typically fails to form, leading to blindness. Here, we show that progeny from an outcrossed backcross between 129/Sv-or(J) /or(J) and Mus musculus castaneus produce animals that are homozygous for the or(J) mutation and exhibit a much ameliorated eye phenotype. Although not of normal size, such modified or(J) eyes are significantly larger than those in 129/Sv-or(J) /or(J) mice, and contain a better organized retina which includes bipolar cells. Furthermore, optic nerves are frequently present, and the eyes show a degree of function as reflected by electroretinogram and pupillary response. As in 129/Sv-or(J) /or(J) mice, however, modified or(J) eyes show incomplete growth and a lack of cell differentiation in the periphery of the retina. The selective, and apparently nonmodifiable, effect of the ocular retardation phenotype on the periphery of the retina indicates that Chx10 plays an important role in the central-to-peripheral gradient of retinal development. These findings demonstrate that the ocular retardation phenotype can be greatly modified by the genetic background, and help to define a role for Chx10 in ocular development.

Extent and duration of recovered pupillary light reflex following retinal ganglion cell axon regeneration through peripheral nerve grafts directed to the pretectum in adult rats

The functional reinnervation of the olivary pretectal nucleus (OPN) was studied in adult rats with peripheral nerve (PN) grafts bridging the interrupted retinopretectal pathway. Functional recovery was assessed quantitatively using established pupillometry techniques. The effect of intravitreal tuftsin fragment 1-3 (tuftsin 1-3) injections during the grafting procedure was also studied. A total of 53 adult rats received autologous PN grafts connecting the ocular stump of the transected optic nerve to the ipsilateral OPN. The contralateral eye was enucleated to remove the input from that eye to the OPN. A pupillary light reflex was elicited from 35 of the 53 PN-grafted animals and in the best cases, a response was obtained which compared closely to that recorded from control animals. Tuftsin 1-3 was found to increase the rate of recovery of the response. The response amplitude of PN-grafted rats was generally found to diminish with repeated stimulus presentation and also appeared to deteriorate with age. This was in contrast to control animals' responses. However, a PLR could still be elicited in 3 of the 6 animals studied 15 months after PN-grafting. These findings indicate that a near-normal PLR function can be restored using a peripheral nerve graft, but there are a number of factors that are likely to compromise optimal outcome.

Retinal degeneration and transplantation in the Royal College of Surgeons rat

The Royal College of Surgeons rat provides a valuable animal model for examining the ontogeny of inherited or acquired photoreceptor degeneration and for assessing various treatment paradigms. Here we describe a sequence of events in which photoreceptor loss induces secondary changes that ultimately result in a progressive loss of retinal ganglion cells. The functional consequences of photoreceptor loss are described and compared with those observed in dystrophic animals that received grafts of pigment epithelial cells at an early stage in the degenerative process. The results of this work suggest that transplantation might slow or halt the progress of photoreceptor loss in certain human retinal degenerative conditions, provided suitable safeguards have been put in place.

Restoration of circadian behavior by anterior hypothalamic grafts containing the suprachiasmatic nucleus: graft/host interconnections

Destruction of the hypothalamic suprachiasmatic nucleus (SCN) disrupts circadian behavior. Transplanting SCN tissue from fetal donors into SCN-lesioned recipients can restore circadian behavior to the arrhythmic hosts. In the transplantation model employing fetal hamster donors and SCN-lesioned hamsters as hosts, the period of the restored circadian behavior is hamster-typical. However, when fetal rat anterior hypothalamic tissue containing the SCN is implanted into SCN-lesioned rats, the period of the restored circadian rhythm is only rarely typical of that of the intact rat. The use of an anterior hypothalamic heterograft model provides new approaches to donor specificity of restored circadian behavior and with the aid of species-specific markers, provides a means for assessing connectivity between the graft and the host. Using an antibody that stains rat and mouse neuronal tissue but not hamster neurons, it has been demonstrated that rat and mouse anterior hypothalamic heterografts containing the SCN send numerous processes into the host (hamster) neuropil surrounding the graft, consistent with graft efferents reported in other hypothalamic transplantation models in which graft and host tissue can be differentiated (i.e., Brattleboro rat and hypogonadal mouse). Moreover, SCN neurons within anterior hypothalamic grafts send an appropriately restricted set of efferent projections to the host brain which may participate in the functional recovery of circadian locomotor activity.

Changes in the pupillary light reflex of pigmented royal college of surgeons rats with Age

We studied the latency and amplitude of the pupillary light reflex response of the Royal College of Surgeons rat from 10 to 52 weeks of age. The responses of these dystrophic rats were diminished compared to those of normal, non-dystrophic rats at all ages examined. This was most marked at the dimmest light intensity studied here and for the latency of dystrophic animals' responses. The latency deteriorated over the course of 52 weeks, although there was some evidence of improvement beyond 36 weeks of age. The amplitude of the dystrophic animals' responses also suggested some deterioration occurring up to 36 weeks of age, but with a substantial improvement beyond this time. In addition to these parameters, we also observed a break in the constriction phase of the pupillary light reflex that was unique to the dystrophic animals' responses. The frequency with which the anomaly occurred decreased in a light-dependent manner with age. The improvement of the pupillary light reflex at older ages, even when very few photoreceptors remain, may reflect compensatory events occurring in the inner retinal layers and/or in the central connections of the pupillary light reflex pathway. We suggest that the break in the constriction phase is a reflection of dual inputs driving the response, one of which is affected more by the degenerative events. This study provides baseline data on the effect of degeneration on function over time which can be used to evaluate the efficacy of repair strategies such as transplantation.

The pupillary light response: functional and anatomical interaction among inputs to the pretectum from transplanted retinae and host eyes

Pupilloconstriction to light can be mediated in rats through direct illumination of retinae previously transplanted to intracranial locations. Transplant-driven and normal pupillary light responses are stable under optimal testing conditions, and parameters describing the response can be quantified precisely. The present study demonstrates the interaction between transplant-driven and normal pupillary response patterns. When stimuli are presented concurrently to a transplanted retina and to the remaining eye in host rats, a greater degree of pupilloconstriction occurs than when either the transplanted or the host eye is illuminated independently. This suggests that transplant and host retinal inputs act in concert to determine pupil diameter. The second portion of this study investigates the pattern of retinal input to the pretectum to determine if a structural basis for such functional interactions may exist. Crossed and uncrossed retinal projections to the olivary pretectal nucleus occupy non-overlapping regions of this bilaterally represented nucleus in normal rats, with a greater number of optic axons directed to the contralateral olivary pretectal nucleus. Retinae transplanted to the midbrain of neonatal rats, from whom the contralateral eye had been removed, also project to the olivary pretectal nucleus at maturity. By contrast with the normal pattern of segregated retinal inputs, however, the terminal fields of transplant axons were found to overlap extensively with the retinal projection from the remaining host eye. In addition, the relative proportion of transplant axons directed to the ipsilateral and contralateral olivary pretectal nucleus varied among animals. The lack of spatial segregation between inputs from transplant and host sources and the relative proportion of ipsilateral and contralateral transplant axons together may represent a structural basis for the observed functional interactoin of these inputs to the neural circuit subserving pupilloconstriction to light. These features may also relate to the marked improvements in transplant-mediated responses that frequently occur when optic input from the remaining host eye is eliminated. The results presented here, together with our previous transplant studies, show that this preparation can be used to provide insight into more general questions as to the dynamic interactions that occur between converging sensory inputs in the generation of integrated output responses.