Subducted and melanotic cells in advanced age-related macular degeneration are derived from retinal pigment epithelium
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PURPOSE: To describe, illustrate, and account for two cell types plausibly derived from RPE in geographic atrophy (GA) and choroidal neovascularization (CNV) of AMD, using melanosomes, lipofuscin, and basal laminar deposit (BLamD) as anatomical markers. METHODS: Human donor eyes with GA (n = 13) or CNV (n = 39) were histologically processed, photodocumented, and analyzed for frequencies of occurrence. We defined RPE as cells containing spindle-shaped melanosomes and RPE lipofuscin, internal to basal lamina or BLamD, if present, or Bruch's membrane if not, and RPE-derived cells as those plausibly derived from RPE and not attached to basal lamina or BLamD. RESULTS: 'Subducted' cells contain RPE melanosomes and localize to the sub-RPE space, on Bruch's membrane. Credible transitional forms from RPE cells were seen. Grades of RPE overlying 'Subducted' cells were 'Atrophic with BLamD' (32.2% vs. 37.0% of 'Subducted,' for GA and CNV eyes, respectively), 'Dissociated' (22.0% vs. 21.7%), 'Nonuniform' (22.0% vs. 23.9%), and 'Sloughed' RPE (10.2% vs. 4.3%). Found exclusively in CNV scars, 'Melanotic' cells containing spherical melanosomes were adjacent to 'Entombed' RPE with spindle-shaped and spherical melanosomes. Of subretinal 'Melanotic' cells, 40.0% associated with 'Atrophy with BLamD,' 36.8% with 'Atrophy without BLamD,' and 20.6% with 'Entombed.' CONCLUSIONS: 'Dissociated' RPE within atrophic areas may be the source of 'Subducted' cells. 'Entombed' RPE within fibrovascular and fibrocellular scars may be the source of 'Melanotic' cells. An imaging correlate for 'Subducted' cells awaits discovery; 'Melanotic' cells appear gray-black in the CNV fundus. Results provide a basis for future molecular phenotyping studies.
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RPE trans-differentiation from epithelial to mesenchymal phenotype may make these cells adhere to and pull on the extracellular matrix, possibly contributing to clinical atrophy progression.
“This trans-differentiation of retinal pigment epithelial cells from epithelial to mesenchymal phenotype can cause the RPE cells to adhere to and exert traction forces on the extracellular matrix and could be one of the factors contributing to the evolution of atrophy clinically.41-43”
From Development and Course of Scars in the Comparison of Age-Related Macular Degeneration Treatments Trials (2018) · cites this paper as [42]
The section ‘Does RPE Undergo Transdifferentiation in AMD?’ discusses epithelial-to-mesenchymal transition as a possible RPE process and notes contractile behavior in cultured RPE, while emphasizing that whether this transition occurs in AMD remains unresolved. The Conclusions mention prognostic significance for one RPE-cell pattern in atrophy progression. Neither section says that RPE cells adhere to and exert traction on the extracellular matrix or that such forces contribute to clinical atrophy progression. (LLM, conf=0.84)
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- Authors
- Zanzottera, E. C., Messinger, J. D., Ach, T., Smith, R. T., & Curcio, C. A.
- Affiliations
- University of Alabama (US)
- New York University (US)
- Corresponding author
- Curcio, Christine A.
- Venue
- Investigative Opthalmology & Visual Science
- Published
- 2015-05-21
- Volume
- 56
- Issue
- 5
- Pages
- 3269
- ISSN
- 0146-0404 (ISSN-L)
- 1552-5783
- PMC
- PMC4453434
- OpenAlex
- W2419123448
- Cited by
- 110
- References
- 55
- Citations by year
- 2026: 5 · 2025: 12 · 2024: 11 · 2023: 5 · 2022: 12 · 2021: 7 · 2020: 7 · 2019: 11 · 2018: 11 · 2017: 12 · 2016: 12 · 2015: 5
- FWCI
- 12.80
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- public-domain
- Locations
- Investigative Ophthalmology & Visual Science (publishedVersion, public-domain)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- EyeSight Foundation of Alabama (EY06109)
- International Retinal Research Foundation (EY06109)
- Research to Prevent Blindness (EY06109, EY015520)
- Edward N. and Della L. Thome Memorial Foundation
- Arnold and Mabel Beckman Initiative for Macular Research
- Università degli Studi di Milano
- Deutsche Forschungsgemeinschaft (AC265/1-1, EY06109)
- National Eye Institute (R01EY015520, R01EY021470, R01EY006109, EY06109, P30EY003039)
- 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
- age-related macular degeneration, geographic atrophy, choroidal neovascularization, retinal pigment epithelium, melanosomes, lipofuscin, basal laminar deposits, Bruch's membrane, retinal pigment epithelium atrophy
- MeSH terms
- Aged, Aged, 80 and over, Basement Membrane, Female, Humans, Lipofuscin, Macular Degeneration, Male, Biomarkers, Bruch Membrane, Choroidal Neovascularization, Melanosomes, Retinal Pigment Epithelium, Geographic Atrophy
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