Transplantation of RPE in age-related macular degeneration: observations in disciform lesions and dry RPE atrophy
Abstract
Unlabelled A study was carried out to investigate whether human RPE allografts are tolerated or rejected in the subretinal space and to determine the feasibility of RPE transplantation in subjects with age-related macular degeneration (AMD).Methods Patches of human fetal RPE (13-20 weeks of gestational age) were transplanted into the subretinal space of five patients after surgical removal of subfoveal fibrovascular membranes, and to four subjects with dry geographic atrophy. Suspensions of RPE cells were transplanted to four other patients with nonexudative AMD. Results were evaluated with clinical ophthalmological examination, SLO microperimetry and fluorescein angiography over 8-20 months.Results In disciform lesions, RPE transplants developed macular edema and fluorescein leakage concomitant with gradual reduction of visual acuity, implying host-graft rejection, over 1-6 months. In geographic atrophy, three of four transplants showed little change in shape and size after 12 months (one transplant was slowly rejected). In non-exudative AMD, RPE suspension transplants showed no evidence of rejection and were associated with the disappearance of drusen; visual acuity remained stable and SLO microperimetry confirmed retinal function over the transplanted area.Conclusion Human RPE allografts are not invariably rejected in the subretinal space without immunosuppression. The rejection rate is lower in nonexudative than in neovascular AMD. An intact blood-retinal barrier is likely to protect against rejection. It is technically feasible to transplant human RPE into the submacular space without adversely affecting visual function in nonexudative AMD over relatively long periods of time.
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Clinical trials using allogenic RPE cells for the treatment of AMD two decades ago were all met with graft rejection.
“clinical trials conducted using allogenic RPE cells for the treatment of AMD, 2 decades ago, were all met with graft rejection (38–42).”
From Subretinal therapy: technological solutions to surgical and immunological challenges (2022) · cites this paper as [39]
Previous allogeneic RPE cell transplantations in dry AMD resulted in graft rejections in some cases, although rejection started later and was seen less frequently than in patients with wet AMD.
“Previous allogeneic RPE cell transplantations in dry AMD resulted in graft rejections in some cases, although it started later in the treatment course and was seen less frequently than in patients with wet AMD (Algvere et al., 1997, Algvere et al., 1999).”
From Treatment of macular degeneration using embryonic stem cell-derived retinal pigment epithelium: Preliminary results in Asian patients (2015) · cites this paper as Algvere et al., 1997
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Age-related macular degeneration: etiology, pathogenesis, and therapeutic strategies
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- Authors
- Algvere, P. V., Berglin, L., Gouras, P., Sheng, Y., & Kopp, E. D.
- Affiliations
- Karolinska Institutet (SE)
- Columbia University (US)
- ORCID
- Gouras, Peter
- Venue
- Graefe's Archive for Clinical and Experimental Ophthalmology
- Published
- 1997-03
- Volume
- 235
- Issue
- 3
- Pages
- 149-158
- ISSN
- 0721-832X (ISSN-L)
- 1435-702X
- OpenAlex
- W2049342495
- Cited by
- 264
- References
- 31
- Citations by year
- 2026: 1 · 2025: 4 · 2024: 6 · 2023: 3 · 2022: 10 · 2021: 7 · 2020: 7 · 2019: 6 · 2018: 2 · 2017: 6 · 2016: 4 · 2015: 10 · 2014: 6 · 2013: 8 · 2012: 7
- FWCI
- 21.97
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Graefe s Archive for Clinical and Experimental Ophthalmology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Ophthalmology › Retinal Diseases and Treatments
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Retinal Development and Disorders
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Retinal and Macular Surgery
- Keywords
- retinal pigment epithelium transplantation, age-related macular degeneration, dry age-related macular degeneration, geographic atrophy, subretinal transplantation, graft rejection, blood-retinal barrier, immunosuppression, drusen, macular edema, visual acuity
- MeSH terms
- Aging, Atrophy, Body Water, Feasibility Studies, Fetus, Fluorescein Angiography, Follow-Up Studies, Humans, Macular Degeneration, Pigment Epithelium of Eye, Postoperative Period, Visual Acuity, Fetal Tissue Transplantation, Cell Transplantation
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