We wish to thank Alison Dorsey for helping to develop the subretinal injection technique. We also acknowledge the National Eye Institute (NEI grants EY11254 and EY021416), California Institute for Regenerative Medicine (CIRM grant TR1-01219), and the Lowy Medical Research Institute (LMRI) for very generous funding for this project.

注：すべての動物は、スクリップス研究所によって確立倫理指針に従って処理した。 注射用材料の作製（〜20分） <ol style="margin-left: 40px;"><li>前加温細胞解離溶液（好ましくは血清を、希釈によって不活性化されているもの）、滅菌PBS、および培養培地（ 表1）。 </li><li>それを分解し、15分間水で部品を沸騰させることによりブラントニードル付きシリンジを殺菌する。 </li></ol>注射用RPE細胞の調製（1時間に約30分） <ol style="margin-left: 40px;"><li> 37℃で5-8分間予め温め細胞解離溶液を使用してRPE細胞を切り離す。 </li><li>まだ接続されているものを解放するために静かに細胞をこすり。 </li><li>解離溶液を不活性化し、それらをカウントする（15mlチューブを埋める）培地の大容量で細胞を希釈する。 </li><li>細胞をペレットに5分間800×gで遠心分離する。 </li><li>無菌予め温めPBSに（0.5μlのボリュームに100,000細胞を提供するために）/μL200,000細胞で細胞を​​再懸濁し、1.5 mlのマイクロ遠心チューブにそれらを転送する。 </li><li>必要に応じて、生細胞一過性の蛍光マーカーを追加し、30〜45分間37℃でインキュベートする。 </li><li>細胞の0.5μlの鈍針で注射器をロードします。できるだけ早く細胞を注入する。 </li></ol> 3.網膜下注射（注射当たり〜5分） 注：可能であれば、輪部の血管が視覚化する方がはるかに簡単であるため、大人のアルビノラットとテクニックを学ぶ。より簡単に注射部位の視覚化を容易にするために、（細胞を注入しようとする前に）学習するときにファストグリーンソリューションを注入。 <ol style="margin-left: 40px;"><li>齧歯類を麻酔。 100 mg / mlのケタミンおよび10mg / mlのキシラジンの腹腔内注射（20μL/ 10グラムボディWを使用して、イソフルラン吸入以上8個）が、げっ歯類を操縦し、吸入器で鼻と眼の中に注入することが困難であるため。 <ol><li>動物が深く、その足の1をつまんで麻酔をかけていることを確認します。それはフリンチ行動する場合は、さらに数分待ってから網膜下注射を開始する前に、再試行してください。 </li></ol></li><li>注入されます目を天井に直面しているように、その側に齧歯類を配置します。 </li><li>目がソケット（一時的な眼球突出）からわずかに浮き上がるとちょうど耳の上とその顎によると優しくまぶたに皮膚と平行に伸びる2本の指で頭を保持することで、よりアクセス可能になるように解剖顕微鏡下で優しく肌を伸ばす目が（ 図1Cを参照してください）わずかにソケットから飛び出して外れるようにします。喉に近すぎる齧歯類を把握しないでください。 </li><li> 30 Gシャープ使い捨て滅菌済み注射針を使用すると、血管がヒットしている場合は、出血をbします（すぐに輪部の下に穴を作る重要なメールと、後で穴を見つけることは困難である）との角度で針（ 図1D）でレンズに触れないように。発生するシャープ（または鈍い）針または即時白内障形成のレンズに触れないようにしてください。 注：注射は2人とのより良い仕事。このように1人は、彼らが穴がどこに焦点を維持するために、鋭利な使い捨て針で最初の穴を作成した後に注入を行う人に鈍い針で注射器を渡すことができます。 </li><li>頭の上にグリップを維持しながら、眼から使い捨て鋭い針を撤回。穴がある場所を正確に覚えておいてください。 </li><li>マイクロマニピュレータに鈍い針で事前にロードされた注射器を取り付けたり、手でそれを保持しているいずれかの後、穴を介して鈍針で注射器の先端を挿入し、レンズに触れないように再び注意しながら、静かに目を通してそれをプッシュするとても優しく感じ抵抗（ 図1D）まで、。 </li><li> K最小限にすべての動きをeeping、慎重にゆっくりと網膜下腔へのRPE細胞を注入する。 注：RPE /網膜剥離が誘発されます。これは避けられない。しかし、クリーナー注入は剥離を最小限に抑え、大幅に再付着（ 図1E）の可能性を向上させます。任意の誇張された動きが戻って網膜に針を移動させることができる、と横の動きが網膜を損傷することがあります。噴射ポンプの使用は任意であるが、非常に正確な送達を可能にする。 </li><li>ゆっくりと注射器を撤回。目の保湿を適用することは、水和目を維持するためにドロップされます。 </li><li>それは胸骨横臥位を取り戻すまで、動物を監視し続ける。それは胸骨横臥位を取り戻すまで、無人の動物を残したり、他の警報動物とケージに戻らないでください。 </li></ol>

None of the authors have any commercial disclosures to declare.

この記事では、ラットおよびマウス中に懸濁したRPE細胞の網膜下注射を実行するための比較的簡単な方法を記載する。プロトコルは、学習が容易で技術に多くの経験が（ 図3;これは、より良い注射のうちの1つを表す）より少ない外傷に翻訳し、マイクロマニピュレーターが（ 図1A）を使用している場合は特に。任意の外傷CSLOおよびOCTシステム（ 図2）利...

The sensory retina is organized in functional tiers of neurons, glia, and endothelial cells. Photoreceptors at the back of the retina are activated by light; through phototransduction they convert photons into electrical signals that are refined by interneurons and transmitted to the visual cortex in the brain. Phototransduction cannot occur without the coordinated efforts of Mueller glia and retinal pigment epithelium (RPE) cells. RPE are organized in a monolayer directly behind the photoreceptors and perform multiple and diverse functions integral to photoreceptor function and homeostasis. In fact, RPE and photoreceptors are so co-dependent that they are considered to be one functional unit. Death or dysfunction of RPE results in devastating secondary effects on photoreceptors and is associated with age-related macular degeneration (AMD), the leading cause of blindness in the elderly1,2.
While no cure has been discovered for AMD, several clinical studies have shown that RPE cell replacement may be a promising therapeutic option3-13. With the advent of stem cell technology, it is now possible to generate large numbers of RPE cells in vitro from embryonic and induced pluripotent stem cells (hES and hiPS) that strongly resemble their somatic counterparts functionally and anatomically14-26. Stem cell-derived RPE have also been shown to function in vivo by multiple independent groups, including our own, to significantly slow retinal degeneration in rat and mouse lines with spontaneous retinal degeneration16,18,21,22,25,28,29. This combination of clinical and preclinical supporting evidence is so compelling that several clinical trials to prevent retinal degeneration using stem cell-derived RPE cells are now ongoing30,31. 
RPE can be readily derived from hES and/or hiPS and implanted in the subretinal space of rodents using various derivation and injection techniques32,33. (See Westenskow et al. for a methods paper in multimedia format demonstrating the directed differentiation protocol we employ)34. There are critical remaining questions regarding the safety, survival, and functional capacity of exogenously delivered RPE cells upon implantation, therefore the ability to perform subretinal injections in rodents is a critical skill16,18,21,29,36,37. The delivery of RPE is not trivial, and the field is divided on the most effective injection technique. The protocol we describe here is a simple and effective way to deliver of bolus of RPE cells subretinally, and was used in the first clinical trial for stem cell-derived RPE transplantation31. (The reader may also refer to another JoVE article by Eberle et al. for an alternative depiction of subretinal injections in rodents.38) 
The technique outlined in this manuscript cannot be visualized and trauma is unavoidable (as with any subretinal injection technique). It is performed by making a hole just under the limbus vessels and inserting a blunt needle along a transscleral route to inject a bolus of cells under the diametrically opposed retina. The person doing the injection will feel resistance as the blunt needle touches the retina. The cells may be directly visualized after the injection, however, and the degree of the induced retinal detachment can be determined by labeling the RPE cells with a transient fluorescent marker and detecting them with a confocal scanning ophthalmoscope (cSLO). An optical coherence tomography (OCT) system can also be used to monitor the trauma and easily identify the injection site.

<table><tbody><tr><td>2-Mercaptoethanol (55 mM)</td><td>Gibco&amp;nbsp;</td><td>21985-023</td><td>50 ml x 1&amp;nbsp;</td></tr><tr><td>Cell Scapers</td><td>VWR</td><td>89260-222</td><td>Case x 1</td></tr><tr><td>CellTracker Green CMFDA</td><td>Molecular Probes</td><td>C34552</td><td>50 &amp;micro;g x 20</td></tr><tr><td>DPBS, no calcium, no magnesium</td><td>Gibco</td><td>14190-144</td><td>500 ml x 1&amp;nbsp;</td></tr><tr><td>Fast Green</td><td>Sigma-Aldrich</td><td>F7258</td><td>25 g x 1&amp;nbsp;</td></tr><tr><td>Genteal Geldrops Moderate to Severe Lubricant Eye Drops&amp;nbsp;</td><td>Walmart</td><td>4060941</td><td>25 ml x 1</td></tr><tr><td>Hamilton Model 62 RN SYR</td><td>Hamilton</td><td>87942</td><td>Syringe x 1&amp;nbsp;</td></tr><tr><td>Hamilton Needle 33 G, 0.5&quot;, point 3 (304 stainless steel)</td><td>Hamilton</td><td>7803-05</td><td>Needles x 6</td></tr><tr><td>Knockout DMEM</td><td>Gibco</td><td>10829-018</td><td>500 ml x 1&amp;nbsp;</td></tr><tr><td>KnockOut Serum Replacement</td><td>Gibco</td><td>10828-028</td><td>500 ml x 1&amp;nbsp;</td></tr><tr><td>L-Glutamine 200 mM</td><td>Gibco</td><td>25030-081</td><td>100 ml x 1</td></tr><tr><td>Magnetic Stand</td><td>Leica Biosystems</td><td>39430216</td><td>Stand x 1</td></tr><tr><td>MEM Non-Essential Amino Acids Solution 100X&amp;nbsp;</td><td>Gibco</td><td>11140-050</td><td>100 ml x 1</td></tr><tr><td>Micromanipulator</td><td>Leica Biosystems</td><td>3943001</td><td>Manipulator x 1</td></tr><tr><td>Penicillin-Streptomycin (10,000 U/ml)</td><td>Gibco</td><td>15140-122</td><td>100 ml x 1</td></tr><tr><td>Slip Tip Syringes without Needles BD&amp;nbsp; (3 ml)&amp;nbsp;&amp;nbsp;</td><td>VWR</td><td>BD309656</td><td>Pack x 1</td></tr><tr><td>Specialty-Use Needles BD&amp;nbsp; (30 G, 1&quot;)</td><td>VWR</td><td>BD305128</td><td>Box x 1</td></tr><tr><td>TrypLE Express Enzyme (1X), no phenol red</td><td>Gibco</td><td>12604013</td><td>100 ml x 1</td></tr></tbody></table>

performing subretinal injections in rodents to deliver retinal pigment epithelium cells in suspension

電気インパルスへの光の変換は、網膜の外側で発生し、桿体および錐体光受容体および網膜色素上皮（RPE）細胞によって主に達成される。 RPEは、光受容体と死亡またはRPE細胞の機能障害、加齢黄斑変性症（AMD）、人々の年齢55歳以上で永久的な失明の主要な原因の特徴であるための重要なサポートを提供します。 AMDの治療法は同定されていないが、罹患した眼における健康RPEの移植が有効な治療であることを証明することができ、RPE細胞の多数は容易に多能性幹細胞から生成することができる。 RPE細胞送達の安全性および有効性に関するいくつかの興味深い問題は、依然として動物モデルにおいて試験することができ、RPEを注入するために使用される広く受け入れられたプロトコルが開発されている。ここに記載された技術は、様々な研究に複数のグループによって使用されており、最初の鋭い針で目に穴を作成することを含む。ブルーレイとシリンジ細胞を装填した針が穴を通って挿入され、それは穏やかにRPEに接触するまで、硝子体を通過するのnt。比較的単純であり、最小限の設備を必要とするこの注入法を用いて、動物モデルにおける光受容体変性のかなりの量を防止するホストRPEとの間に幹細胞由来のRPE細胞の一貫性のある効率的な統合を達成する。実際のプロトコルの一部ではないが、我々はまた、注射によって誘導外傷の程度を決定する方法について説明し、どのように細胞は、生体内の画像診断法で使用して網膜下腔に注入したことを確認します。最後に、このプロトコルの使用は、RPE細胞に限定されるものではない。それが網膜下腔への任意の化合物又は細胞を注入するために使用することができる。

我々は、この原稿に記載された技術を使用して迅速かつ一貫してげっ歯類の網膜下腔へのRPE細胞の懸濁液を提供することができます。必須ではありませんが、外傷が大幅に図1A＆Bでマイクロマニピュレーターで示した設定を使用して最小限に抑えることができます。一時的な眼球突出については、図1（c）に示すように齧歯類を持ってください。マイクロマニピュレ?...

Watch this Scientific Journal Video about Performing Subretinal Injections in Rodents to Deliver Retinal Pigment Epithelium Cells in Suspension at JoVE.com

Performing Subretinal Injections in Rodents to Deliver Retinal Pigment Epithelium Cells in Suspension

Here we present a community accepted protocol in multimedia format for subretinally injecting a bolus of RPE cells in rats and mice. This approach can be used for determining rescue potentials, safety profiles, and survival capacities of grafted RPE cells upon implantation in animal models of retinal degeneration.

懸濁液中の網膜色素上皮細胞を送達するげっ歯類における網膜下注射の実行

The conversion of light into electrical impulses occurs in the outer retina and is accomplished largely by rod and cone photoreceptors and retinal pigment ...

performing-subretinal-injections-rodents-to-deliver-retinal-pigment

Research

JoVE Journal

Medicine

17.3K ビュー.  The Scripps Research Institute. Here we present a community accepted protocol in multimedia format for subretinally injecting a bolus of RPE cells in rats and mice. This approach can be used for determining rescue potentials, safety profiles, and survival capacities of grafted RPE cells upon implantation in animal models of retinal degeneration.

ビデオ: Performing Subretinal Injections in Rodents to Deliver Retinal Pigment Epithelium Cells in Suspension

Subretinal Injection of Gene Therapy Vectors and Stem Cells in the Perinatal Mouse Eye

The loss of sight affects approximately 3.4 million people in the United States and is expected to increase in the upcoming years.1 Recently, gene therapy and stem cell transplantations have become key therapeutic tools for treating blindness resulting from retinal degenerative diseases. Several forms of autologous transplantation for age-related macular degeneration (AMD), such as iris pigment epithelial cell transplantation, have generated encouraging results, and human clinical trials have begun for other forms of gene and stem cell therapies.2 These include RPE65 gene replacement therapy in patients with Leber's congenital amaurosis and an RPE cell transplantation using human embryonic stem (ES) cells in Stargardt's disease.3-4 Now that there are gene therapy vectors and stem cells available for treating patients with retinal diseases, it is important to verify these potential therapies in animal models before applying them in human studies. The mouse has become an important scientific model for testing the therapeutic efficacy of gene therapy vectors and stem cell transplantation in the eye.5-8 In this video article, we present a technique to inject gene therapy vectors or stem cells into the subretinal space of the mouse eye while minimizing damage to the surrounding tissue.

This surgical technique illustrates the injection of gene therapy vectors and stem cells into the subretinal space of the mouse eye.

マウスの眼の中に遺伝子治療ベクターと幹細胞の網膜下注入

The loss of sight affects approximately 3.4 million people in the United States and is expected to increase in the upcoming years.1 Recently, gene therapy ...

医学

Retinal Detachment Model in Rodents by Subretinal Injection of Sodium Hyaluronate

Subretinal injection of sodium hyaluronate is a widely accepted method of inducing retinal detachment (RD). However, the height and duration of RD or the occurrence of subretinal hemorrhage can affect photoreceptor cell death in the detached retina. Hence, it is advantageous to create reproducible RDs without subretinal hemorrhage for evaluating photoreceptor cell death. We modified a previously reported method to create bullous and persistent RDs in a reproducible location with rare occurrence of subretinal hemorrhage. The critical step of this modified method is the creation of a self-sealing scleral incision, which can prevent leakage of sodium hyaluronate after injection into the subretinal space. To make the self-sealing scleral incision, a scleral tunnel is created, followed by scleral penetration into the choroid with a 30 G needle. Although choroidal hemorrhage may occur during this step, astriction with a surgical spear reduces the rate of choroidal hemorrhage. This method allows a more reproducible and reliable model of photoreceptor death in diseases that involve RD such as rhegmatogenous RD, retinopathy of prematurity, diabetic retinopathy, central serous chorioretinopathy, and age-related macular degeneration (AMD).

Creating experimental retinal detachments with a reproducible and sustained height of detachment, and without subretinal hemorrhage, is important for studying the pathophysiology of photoreceptor cell loss in retinal disease and evaluating potential therapeutic interventions. Here, we report such a method in detail.

ヒアルロン酸ナトリウムの網膜下注入によるげっ歯類における網膜剥離モデル

Subretinal injection of sodium hyaluronate is a widely accepted method of inducing retinal detachment (RD). However, the height and duration of RD or the ...

Limbal Approach-Subretinal Injection of Viral Vectors for Gene Therapy in Mice Retinal Pigment Epithelium

The eye is a small and enclosed organ which makes it an ideal target for gene therapy. Recently various strategies have been applied to gene therapy in retinopathies using non-viral and viral gene delivery to the retina and retinal pigment epithelium (RPE). Subretinal injection is the best approach to deliver viral vectors directly to RPE cells. Before the clinical trial of a gene therapy, it is inevitable to validate the efficacy of the therapy in animal models of various retinopathies. Thus, subretinal injection in mice becomes a fundamental technique for an ocular gene therapy. In this protocol, we provide the easy and replicable technique for subretinal injection of viral vectors to experimental mice. This technique is modified from the intravitreal injection, which is widely used technique in ophthalmology clinics. The representative results of RPE/choroid/scleral complex flat-mount will help to understand the efficacy of this technique and adjust the volume and titer of viral vectors for the extent of gene transduction.

Subretinal injection is a surgical technique for effective gene delivery to retinal pigment epithelium in the mouse eye. Here we describe an easy and replicable method for subretinal injection of viral vectors to retinal pigment epithelium in experimental mice.

マウス網膜色素上皮における遺伝子治療用ウイルスベクターの縁アプローチ、網膜下注射

The eye is a small and enclosed organ which makes it an ideal target for gene therapy. Recently various strategies have been applied to gene therapy in ...

神経科学

An Alternative and Validated Injection Method for Accessing the Subretinal Space via a Transcleral Posterior Approach

Subretinal injections have been successfully used in both humans and rodents to deliver therapeutic interventions of proteins, viral agents, and cells to the interphotoreceptor/subretinal compartment that has direct exposure to photoreceptors and the retinal pigment epithelium (RPE). Subretinal injections of plasminogen as well as recent preclinical and clinical trials have demonstrated safety and/or efficacy of delivering viral vectors and stem cells to individuals with advanced retinal disease. Mouse models of retinal disease, particularly hereditary retinal dystrophies, are essential for testing these therapies. The most common injection procedure in rodents is to use small transcorneal or transcleral incisions with an anterior approach to the retina. With this approach, the injection needle penetrates the neurosensory retina disrupting the underlying RPE and on insertion can easily nick the lens, causing lens opacification and impairment of noninvasive imaging. Accessing the subretinal space via a transcleral, posterior approach avoids these problems: the needle crosses the sclera approximately 0.5 mm from the optic nerve, without retinal penetration and avoids disrupting the vitreous. Collateral damage is limited to that associated with the focal sclerotomy and the effects of a transient, serous retinal detachment. The simplicity of the method minimizes ocular injury, ensures rapid retinal reattachment and recovery, and has a low failure rate. The minimal damage to the retina and RPE allows for clear assessment of the efficacy and direct effects of the therapeutic agents themselves. This manuscript describes a novel subretinal injection technique that can be used to target viral vectors, pharmacological agents, stem cells or induced pluripotent stem (iPS) cells to the subretinal space in mice with high efficacy, minimal damage, and fast recovery.

An Alternative and Validated Injection Method for Accessing the Subretinal Space via a Transcleral Posterior Approach

Subretinal injections are the most common technique for delivering large therapeutic agents such as proteins and viral vectors to photoreceptors and the retinal pigment epithelium. An alternative method in mice that successfully targets the subretinal space with minimal collateral damage and fast recovery times is described here.

網膜下腔にアクセスするための代替と検証済みの注入方法<i&gt;経由で</i&gt;経強後方アプローチ

Subretinal injections have been successfully used in both humans and rodents to deliver therapeutic interventions of proteins, viral agents, and cells to ...

Development of a Refined Protocol for Trans-scleral Subretinal Transplantation of Human Retinal Pigment Epithelial Cells into Rat Eyes

Degenerative retinal diseases such as age-related macular degeneration (AMD) are the leading cause of irreversible vision loss worldwide. AMD is characterized by the degeneration of retinal pigment epithelial (RPE) cells, which are a monolayer of cells functionally supporting and anatomically wrapping around the neural retina. Current pharmacological treatments for the non-neovascular AMD (dry AMD) only slow down the disease progression but cannot restore vision, necessitating studies aimed at identifying novel therapeutic strategies. Replacing the degenerative RPE cells with healthy cells holds promise to treat dry AMD in the future. Extensive preclinical studies of stem cell replacement therapies for AMD involve the transplantation of stem cell-derived RPE cells into the subretinal space of animal models, in which the subretinal injection technique is applied. The approach most frequently used in these preclinical animal studies is through the trans-scleral route, which is made difficult by the lack of direct visualization of the needle end and can often result in retinal damage. An alternative approach through the vitreous allows for direct observation of the needle end position, but it carries a high risk of surgical traumas as more eye tissues are disturbed. We have developed a less risky and reproducible modified trans-scleral injection method that uses defined needle angles and depths to successfully and consistently deliver RPE cells into the rat subretinal space and avoid excessive retinal damage. Cells delivered in this manner have been previously demonstrated to be efficacious in the Royal College of Surgeons (RCS) rat for at least 2 months. This technique can be used not only for cell transplantation but also for delivery of small molecules or gene therapies.

Subretinal injection has been widely applied in preclinical studies of stem cell replacement therapy for age-related macular degeneration. In this visualized article, we describe a less risky, reproducible and precisely modified subretinal injection technique via the trans-scleral approach to deliver cells into rat eyes.

強膜網膜移植ひと網膜色素上皮細胞のラットの目の洗練されたプロトコルの開発

Degenerative retinal diseases such as age-related macular degeneration (AMD) are the leading cause of irreversible vision loss worldwide. AMD is ...

Ultrahigh Resolution Mouse Optical Coherence Tomography to Aid Intraocular Injection in Retinal Gene Therapy Research

HR-SD-OCT is utilized to monitor the progression of photoreceptor degeneration in live mouse models, assess the delivery of therapeutic agents into the subretinal space, and to evaluate toxicity and efficacy in vivo. HR-SD-OCT uses near infrared light (800-880 nm) and has optics specifically designed for the unique optics of the mouse eye with sub-2-micron axial resolution. Transgenic mouse models of outer retinal (photoreceptor) degeneration and controls were imaged to assess the disease progression. Pulled glass microneedles were used to deliver sub retinal injections of adeno-associated virus (AAV) or nanoparticles (NP) via a trans-scleral and trans-choroidal approach. Careful positioning of the needle into the subretinal space was required prior to a calibrated pressure injection, which delivers fluid into the sub retinal space. Real time subretinal surgery was conducted on our retinal imaging system (RIS). HR-SD-OCT demonstrated progressive uniform retinal degeneration due to expression of a toxic mutant human mutant rhodopsin (P347S) (RHOP347S) transgene in mice. HR-SD-OCT allows rigorous quantification of all the retinal layers. Outer nuclear layer (ONL) thickness and photoreceptor outer segment length (OSL) measurements correlate with photoreceptor vitality, degeneration, or rescue. The RIS delivery system allows real-time visualization of subretinal injections in neonatal (~P10-14) or adult mice, and HR-SD-OCT immediately determines success of delivery and maps areal extent. HR-SD-OCT is a powerful tool that can evaluate the success of subretinal surgery in mice, in addition to measuring vitality of photoreceptors in vivo. HR-SD-OCT can also be used to identify uniform animal cohorts to evaluate the extent of retinal degeneration, toxicity, and therapeutic rescue in preclinical gene therapy research studies.

Here we demonstrate a novel approach to using high resolution spectral-domain optical coherence tomography (HR-SD-OCT) to assist delivery of gene therapy agents into the subretinal space, assess its areal coverage, and characterize photoreceptor vitality.

超高解像度マウス光コヒーレンストモグラフィー網膜遺伝子治療研究における眼内注入を支援するために

HR-SD-OCT is utilized to monitor the progression of photoreceptor degeneration in live mouse models, assess the delivery of therapeutic agents into the ...

Subretinal Implantation of RPE on a Carrier in Minipigs: Guidelines for Preoperative Preparations, Surgical Techniques, and Postoperative Care

Degenerative disorders of the retina (including age-related macular degeneration), which originate primarily at or within the retinal pigmented epithelial (RPE) layer, lead to a progressive disorganization of the retinal anatomy and the deterioration of visual function. The substitution of damaged RPE cells (RPEs) with in vitro cultured RPE cells using a subretinal cell carrier has shown potential for re-establishing the anatomical structure of the outer retinal layers and is, therefore, being further studied. Here, we present the principles of a surgical technique that allows for the effective subretinal transplantation of a cell carrier with cultivated RPEs into minipigs. The surgeries were performed under general anesthesia and included a standard lens-sparing three-port pars plana vitrectomy (PPV), subretinal application of a balanced salt solution (BSS), a 2.7 mm retinotomy, implantation of a nanofibrous cell carrier into the subretinal space through an additional 3.0 mm sclerotomy, fluid-air exchange (FAX), silicone oil tamponade, and closure of all the sclerotomies. This surgical approach was used in 29 surgeries (18 animals) over the past 8 years with a success rate of 93.1%. Anatomic verification of the surgical placement was carried out using in vivo fundus imaging (fundus photography and optical coherence tomography). The recommended surgical steps for the subretinal implantation of RPEs on a carrier in minipig eyes can be used in future preclinical studies using large-eye animal models.

The subretinal implantation of retinal pigmented epithelium (RPE) is one of the most promising approaches for the treatment of degenerative retinal diseases. However, the performance of preclinical studies on large-eye animal models remains challenging. This report presents guidelines for the subretinal transplantation of RPE on a cell carrier into minipigs.

ミニブタのキャリアへのRPEの網膜下移植:術前準備、手術手技、および術後ケアのガイドライン

Degenerative disorders of the retina (including age-related macular degeneration), which originate primarily at or within the retinal pigmented epithelial ...

生物工学

Transpupillary-Guided Trans-Scleral Transplantation of Subretinal Grafts in a Retinal Degeneration Mouse Model

Transplantation of photoreceptor cells and retinal pigment&#160;epithelial (RPE) cells provide a potential therapy for retinal degeneration diseases. Subretinal transplantation of therapeutic donor cells into mouse recipients is challenging due to the limited surgical space allowed by the small volume of the mouse eye. We developed a trans-scleral surgical transplantation platform with direct transpupillary vision guidance to facilitate the subretinal delivery of exogenous cells in mouse recipients. The platform was tested using retinal cell suspensions and three-dimensional retinal sheets collected from rod-rich Rho::EGFP mice and cone-rich OPN1LW-EGFP;NRL-/- mice, respectively. Live/dead assay showed low cell mortality for both forms of donor cells. Retinal grafts were successfully delivered into the subretinal space of a mouse model of retinal degeneration, Rd1/NS, with minimum surgical complications as detected by multimodal confocal scanning laser ophthalmoscope (cSLO) imaging. Two months post-transplantation, histological staining demonstrated evidence of advanced maturation of the retinal grafts into &#39;adult&#39; rods and cones (by robust Rho::EGFP, S-opsin, and OPN1LW:EGFP expression, respectively) in the subretinal space. Here, we provide a surgical platform that can enable highly accurate subretinal delivery with a low rate of complications in mouse recipients. This technique offers precision and relative ease of skill acquisition. Furthermore, the technique could be used not only for studies of subretinal cell transplantation but also for other intraocular therapeutic studies including gene therapies.

This protocol presents a transpupillary vision-guided trans-scleral approach to safely and precisely deliver subretinal cellular grafts, with a low rate of surgical complications, in mouse recipients with or without retinal degeneration.

網膜変性マウスモデルにおける網膜下移植片の経瞳孔ガイド下経強膜移植

Transplantation of photoreceptor cells and retinal pigment&#160;epithelial (RPE) cells provide a potential therapy for retinal degeneration diseases. ...

Subretinal Transplantation of Human Embryonic Stem Cell Derived-retinal Pigment Epithelial Cells into a Large-eyed Model of Geographic Atrophy

Geographic atrophy (GA), the late stage of dry age-related macular degeneration is characterized by loss of the retinal pigment epithelial (RPE) layer, which leads to subsequent degeneration of vital retinal structures (e.g., photoreceptors) causing severe vision impairment. Similarly, RPE-loss and decrease in visual acuity is seen in long-term follow up of patients with advanced wet age-related macular degeneration (AMD) receiving intravitreal anti-vascular endothelial growth factor (VEGF) treatment. Therefore, on the one hand, it is fundamental to efficiently derive RPE cells from an unlimited source that could serve as replacement therapy. On the other hand, it is important to assess the behavior and integration of the derived cells in a model of the disease entailing surgical and imaging methods as close as possible to those applied in humans. Here, we provide a detailed protocol based on our previous publications that describes the generation of a preclinical model of GA using the albino rabbit eye, for evaluation of the human embryonic stem cell derived retinal pigment epithelial cells (hESC-RPE) in a clinically relevant setting. Differentiated hESC-RPE are transplanted into naive eyes or eyes with NaIO3-induced GA-like retinal degeneration using a 25 G transvitreal pars plana technique. Evaluation of degenerated and transplanted areas is performed by multimodal high-resolution non-invasive real-time imaging.

Retinal pigment epithelial cells could serve as a cell-replacement therapy for the advanced form of dry age-related macular degeneration. This protocol describes the generation of a large-eyed model of geographic atrophy and the subretinal transplantation of human embryonic stem cell-derived retinal pigment epithelial cells into this model of disease.

地図状委縮の目の大きいモデルにヒト胚性幹細胞由来網膜色素上皮細胞の網膜下移植

Geographic atrophy (GA), the late stage of dry age-related macular degeneration is characterized by loss of the retinal pigment epithelial (RPE) layer, ...

生物学

視力の活性化:網膜変性症に対する幹細胞治療

Sub-Retinal Delivery of Human Embryonic Stem Cell Derived Photoreceptor Progenitors in rd10 Mice

Regeneration of photoreceptor cells using human pluripotent stem cells is a promising therapy for the treatment of both hereditary and aging retinal diseases at advanced stages. We have shown human recombinant retina-specific laminin isoform matrix is able to support the differentiation of human embryonic stem cells (hESCs) to photoreceptor progenitors. In addition, sub-retinal injection of these cells has also shown partial restoration in the rd10 rodent and rabbit models. Sub-retinal injection is known to be an established method that has been used to deliver pharmaceutical compounds to the photoreceptor cells and retinal pigmented epithelial (RPE) layer of the eye due to its proximity to the target space. It has also been used to deliver adeno-associated viral vectors into the sub-retinal space to treat retinal diseases. The sub-retinal delivery of pharmaceutical compounds and cells in the murine model is challenging due to the constraint in the size of the murine eyeball. This protocol describes the detailed procedure for the preparation of hESC-derived photoreceptor progenitor cells for injection and the sub-retinal delivery technique of these cells in genetic retinitis pigmentosa mutant, rd10 mice. This approach allows cell therapy to the targeted area, in particular the outer nuclear layer of the retina, where diseases leading to photoreceptor degeneration occur.

著者スポットライト:視力回復の進歩-網膜疾患に対する幹細胞ベースの治療 

We describe a detailed protocol for the preparation of post-cryopreserved hESC-derived photoreceptor progenitor cells and the sub-retinal delivery of these cells in rd10 mice.

rd10マウスにおけるヒト胚性幹細胞由来光受容体前駆細胞の網膜下送達

Regeneration of photoreceptor cells using human pluripotent stem cells is a promising therapy for the treatment of both hereditary and aging retinal ...