MRI can provide anatomical, functional, and physiological images at relatively high spatial resolution and is non-invasive and does not have depth limitation. However, the application of MRI to study the retina is difficult due to the very small size of the retina. This thesis details the development of MRI methods to image blood flow (BF), anatomy, and function of the retina and choroid, and their application to two diseases of the retina: diabetic retinopathy and retinal degeneration. A unique continuous arterial spin labeling technique was developed to image BF in mice and tested by imaging cerebral BF. This method was then applied to image layer-specific BF of the retina and choroid in mice, and to acquire BF functional MRI of the retina and choroid in response to hypoxic challenge. Additionally blood oxygen level dependent functional MRI of the mouse retina and choroid in response to hypoxic challenge was obtained using a balanced steady state free precession sequence which provides fast acquisition, has high signal to noise ratio, and does not have geometric distortion or signal dropout artifacts. In a mouse model of diabetic retinopathy, MRI detected reduced retinal BF in diabetic animals. Visual function in the diabetic mice, as determined by psychophysical tests, was also reduced. Finally, in a mouse model of retinal degeneration, BF and anatomical MRI detected reductions of retinal BF and the thickness of the retina. The studies detailed in this thesis demonstrate the feasibility of layer-specific MRI to study BF, anatomy, and function, in the mouse retina. Further, these methods were shown to provide a novel means of studying animal models of retinal disease in vivo.

Current approaches to treat neurodegenerative disease provide only mild symptomatic relief but do not modify the natural history of these conditions. A large body of evidence suggests that mitochondrial dysfunction is a key event in the pathophysiology of neurodegeneration. Supporting and improving mitochondrial function has a big potential as a strategy for neuroprotection. The goal of this dissertation was to test whether interventions that target mitochondrial function are effective at preventing neurodegeneration induced by mitochondrial failure in vivo. A rodent model of optic neuropathy induced by the mitochondrial toxin rotenone was used to test the neuroprotective effects of methylene blue (MB) and near-infrared light (NIL), two interventions with mechanisms of action localized to mitochondria. This work also tested the effects of memantine, an NMDA receptor blocker, to further characterize the relationship between excitotoxicity and mitochondrial dysfunction. Neuroprotective effects were evaluated via behavioral testing of visual function and histopathological analysis of the retina. The neurochemical effects of MB, NIL and memantine were analyzed in vitro and in vivo with indicators of oxidative stress, cell respiration and catalytic activity of respiratory enzymes, including NADH dehydrogenase and cytochrome oxidase. MB, a diaminophenothiazine with potent antioxidant and unique redox properties, prevented the changes in visual function and the retinal histopathology induced by rotenone. In vitro, MB increased oxygen consumption and prevented the increases in oxidative stress in brain tissue induced by rotenone. NIL prevented the behavioral impairment and the decrease in retinal and visual pathway metabolic activity, retinal nerve fiber layer thickness and ganglion cell layer cell density induced by rotenone in a dose-dependent manner. Whole-brain cytochrome oxidase and superoxide dismutase activities were also increased in NIL-treated subjects in a dose-dependent manner, suggesting an in vivo transcranial effect of NIL. Finally, uncompetitive NMDA receptor blockade with memantine displayed neuroprotection against rotenone-induced neurodegeneration in a dose-response manner, and this effect was associated with a decrease in retinal oxidative stress and a long-term increase in neuronal energy metabolism capacity. These data constitute a proof-of-principle that interventions that target the mitochondria and support the function of the respiratory chain are effective at preventing neurodegeneration in vivo. / text

A high frequency of retinitis pigmentosa (RP) is found in Northern Sweden. In an inventory of autosomal recessive RP patients in Västerbotten County, a great number of cases with a unique phenotype was noticed, denoted Bothnia Dystrophy (BD). The aim of the study was to describe the phenotype, to determine the chromosomal location, and to identify the gene. Patients typically show night blindness from early childhood. Symptoms of defect macular function with a decrease of visual acuity can appear in early adulthood. The retinal fundus shows irregular white spots in a central, and parafoveal pattern along the arcades. Centrally areolar maculopathy develops and round circular atrophies are observed in the periphery. The disease was shown to be associated with a missense mutation in the RLBP1 gene resulting in an amino acid substitution (R234W) in the cellular retinaldehyde-binding protein (CRALBP). The R234W mutation was found in a homozygous state in 61 patients affected with BD. Ten patients were heterozygous for the R234W mutation, and presented a similar phenotype. No additional mutations in the coding sequence or exon-intron junctions were found. CRALBP is localised in retinal pigment epithelium (RPE), and Müller cells of the retina. In the RPE, CRALBP functions as a carrier protein for endogenous retinoids. Dark adaptometry and electrophysiologic testing showed an initial loss of rod function followed by a progressive reduction of the cone responses in older ages. A compromised rod function, dysfunction of the Müller cells, and indications of a disturbed function of the inner retina were found. With prolonged dark adaptation, a gradual increase in retinal sensitivity to light and an improvement of the ERG components occurred. The findings indicate a prolonged synthesis of photopigments, retardation of the visual process in the retinal pigment epithelium and a loss of retinal cells probably starting at a relative early age in BD. To evaluate the subjective visual function in BD patients, a battery of objective tests of visual function and composite score of the 25-item NEI-Visual Function Questionnaire (VFQ-25) were analyzed. We found that weighted distance logMAR visual acuity (WVA), had the strongest association with subjective visual function, and that there was a considerable loss of subjective and objective visual function with increasing age in BD patients. The prevalence of BD is as high as 1:3600 in Västerbotten County. The possibility that recycling of retinoids localized in the RPE might be impaired in BD might give future therapeutic possibilities. Due to the large and clinically well-characterized set of patients with this disease, they constitute a suitable study group.

Thesis (Ph. D.)--University of Tennessee, Memphis, 2006. / The electronic version of this thesis is available at http://d.utmem.edu/CAMPUS-ACCESS-ONLY/2006-001-chona.pdf Includes bibliographical references (leaves 128-136).

京都大学 / 0048 / 新制・課程博士 / 博士(医学) / 甲第18850号 / 医博第3961号 / 新制||医||1007(附属図書館) / 31801 / 京都大学大学院医学研究科医学専攻 / (主査)教授 山下 潤, 教授 吉村 長久, 教授 中畑 龍俊 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

京都大学 / 0048 / 新制・課程博士 / 博士(医学) / 甲第19561号 / 医博第4068号 / 新制||医||1013(附属図書館) / 32597 / 京都大学大学院医学研究科医学専攻 / (主査)教授 吉村 長久, 教授 戸口田 淳也, 教授 高橋 淳 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

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Photoreceptors are highly specialized neurons within the eye and the key retinal cells sensing light. They are indispensable for our visual perception and loss of photoreceptors consequently leads to loss of vision, a sense that alone is responsible for more than 30% of the input to our brain. Vision impairment and blindness is a leading cause of disability in the industrialized world and is in many cases ultimately due to a degeneration of the photoreceptors, which cannot be halted or reversed. Retinal degenerative diseases encompass a heterogeneous group of etiologies, mainly caused by various mutations in a plethora of proteins involved in the visual process. Currently, several therapeutic options are being explored, with so far one gene therapy for a rare inherited blinding condition being clinically approved. However, the gene therapy approach requires not only the presence of remaining photoreceptors but the tailoring of the therapy to each individual mutation. An alternative, more generally applicable approach is to restore vision through photoreceptor replacement therapy. As such, research on mouse-to-mouse photoreceptor transplantations has been carried out for many years, though with mixed results. In the last decade, it has however also become possible to generate large quantities of human photoreceptors through retinal organoid technology, allowing to instead transplant human cells. While promising, this field is still in development and principal conditions for successful photoreceptor transplantation have yet to be defined. Here, human-to-mouse photoreceptor transplantations were performed and assessed with the aim to receive insights into retinal cell replacement technology with specific focus on photoreceptor maturation, polarization and functional integration. Using a cone-degeneration host line, large-scale incorporation of human photoreceptor grafts into the murine retina was shown for the first time. It was found that for human photoreceptors, the choice of developmental stage strongly affects incorporation and maturation capacity. Furthermore, the results demonstrate the necessity of adequate graft-host interaction for successful transplant maturation and function, suggesting that photoreceptor replacement strategies might benefit from transplantation in earlier rather than late stages of retinal degeneration. Taken together, this thesis lays important groundwork for the further development of human photoreceptor replacement strategies to treat retinal degenerative disease.:ACKNOWLEDGEMENTS I ABSTRACT III ZUSAMMENFASSUNG V PUBLICATIONS VII TABLE OF CONTENTS IX LIST OF FIGURES XIII LIST OF TABLES XIV GENERAL ABBREVIATIONS XV GENE AND PROTEIN ABBREVIATIONS XVII 1 INTRODUCTION 1 1.1 THE RETINA AND LIGHT PERCEPTION 1 1.1.1 General structure of the eye 1 1.1.2 General structure of the retina 1 1.1.3 General photoreceptor structure 3 1.1.4 Phototransduction 4 1.1.5 Signal transmission to the brain 6 1.1.6 Major differences between rods and cones 7 1.1.7 The role of Müller glia in photoreceptor support and light perception 9 1.2 RETINAL DEGENERATION DISEASES AND TREATMENT OPTIONS 11 1.2.1 Retinal degeneration diseases 11 1.2.2 Therapeutic approaches to treat retinal degeneration diseases 12 1.3 CELL REPLACEMENT AS TREATMENT APPROACH FOR RETINOPATHIES 14 1.3.1 Transplantations of rodent retinal tissue and cells 14 1.3.2 Transplantations of human retinal tissue and cells 17 1.4 AIM OF THIS THESIS 22 2 CHARACTERIZATION OF CRX-MCHERRY HUMAN RETINAL ORGANOIDS AS PHOTORECEPTOR CELL SOURCE 23 2.1 AIMS 23 2.2 CHARACTERIZATION OF CRX-MCHERRY REPORTER-EXPRESSING CELLS 23 2.2.1 Crx-mCherry expression overlaps with endogenous CRX expression and increases over time 23 2.2.2 Crx-mCherry organoids contain an outer and an inner nuclear layer 24 2.2.3 Crx-mCherry+ cells express early and mature rod and cone markers 25 2.2.4 Crx-mCherry+ cells do not express proliferation markers 27 2.3 ENRICHMENT AND CHARACTERIZATION OF CRX-MCHERRY+ DONOR CELLS 28 2.3.1 Enrichment of Crx-mCherry+ cells by FACS 28 2.3.2 Characterization of Crx-mCherry enriched cells by single cell sequencing 29 2.3.3 Characterization of D200 Crx-mCherry-enriched cells by immunocytochemistry 30 2.4 SUMMARY 31 3 TRANSPLANTATION OF HUMAN CRX-MCHERRY+ GRAFTS AGED D100, D200 AND D300 INTO CPFL1 MICE 33 3.1 AIMS 33 3.2 CRX-MCHERRY+ CELLS OF ALL AGES CAN BE TRANSPLANTED AND SURVIVE IN THE MURINE RETINA 33 3.2.1 Human grafts can be identified by RCVRN staining 34 3.2.2 D100 Crx-mCherry+ transplants are larger than D200 and D300 grafts 34 3.2.3 Graft volume increase over time is not due to in vivo proliferation 36 3.3 GRAFT MORPHOLOGY DIFFERS WITH DONOR AGES 37 3.3.1 Human grafts can adopt an intraretinal position 37 3.3.2 Graft positioning changes over time 37 3.3.3 Qualitative differences in graft morphology between donor ages 38 3.4 GRAFT MATURATION 41 3.4.1 D200 but not D100 or D300 grafts develop large quantities of inner segments 41 3.4.2 Inner segment development is associated with close proximity to the host retina 42 3.5 HUMAN IDENTITY OF INTRARETINAL GRAFTS 43 3.5.1 Intraretinal Crx-mCherry+ grafts are largely a result of true morphological incorporation 43 3.5.2 Rare indications of potential human-to-mouse material transfer 45 3.6 SUMMARY 47 4 IN DEPTH CHARACTERIZATION OF TRANSPLANTED D200 CRX-MCHERRY+ CELLS 49 4.1 AIMS 49 4.2 EARLY POST TRANSPLANTATION DYNAMICS IN GRAFT POSITIONING AND GRAFT-HOST INTERACTIONS 49 4.2.1 Intraretinal and proximal D200 grafts interact with the host retina while isolated and distal clusters show only little interaction 49 4.2.2 Incorporation of D200 grafts is first evident at 8 weeks post transplantation 50 4.2.3 Host Müller glia extend processes into the graft before host bipolar cells 51 4.2.4 MG staining in D200 grafts originates from host MG 51 4.3 INCORPORATING D200 GRAFTS POLARIZE AND FORM STRUCTURES OF MATURE PHOTORECEPTORS 53 4.3.1 Grafts and host form an outer limiting membrane (OLM)-like structure 53 4.3.2 Inner segment formation occurs where an OLM is formed 54 4.3.3 Incorporating grafts form outer segment-like structures 55 4.3.4 Incorporating grafts form synaptic structures 57 4.3.5 Transplanted Crx-mCherry+ cells become enriched for cones 58 4.3.6 Higher levels of mature photoreceptor markers in ex vivo compared to in vitro cones 60 4.4 INCORPORATION AND MATURATION CAPACITY DEPEND ON THE HOST ENVIRONMENT 63 4.4.1 Graft morphology and maturation in C57BL/6JRj recipients resembles that in Cpfl1 hosts 63 4.4.2 Graft morphology and maturation in highly degenerated rd1 and tgCR host lines differs strongly from the outcome in models with an ONL 63 4.5 SUMMARY 67 5 FUNCTIONAL ASSESSMENT OF TRANSPLANTED CRX-MCHERRY+ CELLS 69 5.1 AIMS 69 5.2 HIGH-LEVEL FUNCTION 69 5.2.1 Light-Dark Box 69 5.3 TISSUE-LEVEL FUNCTION 71 5.3.1 Multi-electrode array assessment of D200+26w grafts in Cpfl1 mice 71 5.3.2 Isolation of cone-mediated RGC response through photopic light stimulation and L-AP4 addition 71 5.3.3 Graft-containing retinal portions exhibit cone-mediated light responses 72 5.4 SUMMARY 74 6 DISCUSSION AND FUTURE PERSPECTIVES 75 6.1 HUMAN GRAFTS CAN MORPHOLOGICALLY INCORPORATE INTO THE MODERATELY DEGENERATED MOUSE RETINA 75 6.2 INTRARETINAL GRAFTS MOSTLY REPRESENT TRUE INCORPORATION EVENTS, NOT MATERIAL TRANSFER 76 6.3 GRAFT MATURATION DEPENDS ON GRAFT-HOST INTERACTION 77 6.4 ESTABLISHMENT OF GRAFT-HOST INTERACTION AND GRAFT INCORPORATION 78 6.5 D200 CRX-MCHERRY+ CELLS ARE THE PREFERABLE DONOR POPULATION COMPARED TO D100 AND D300 80 6.6 CONES SHOW PREFERENTIAL SURVIVAL POST GRAFTING 81 6.7 FUNCTIONAL ANALYSES OF TRANSPLANTED ANIMALS 82 6.8 FUTURE CLINICAL TRANSLATION 85 6.9 MAJOR CONTRIBUTION TO OTHER WORK 88 7 FINAL CONCLUSION 89 8 MATERIALS AND METHODS 91 8.1 STUDY APPROVAL 91 8.2 MATERIALS 91 8.2.1 Materials and Chemicals 91 8.2.2 Cell Line 92 8.2.3 Mouse Lines 92 8.2.4 Antibodies 93 8.3 METHODS 95 8.3.1 Cell culture 95 8.3.2 Transplantations 96 8.3.3 Functional analyses 98 8.3.4 Immunohistochemistry and Immunocytochemistry 100 8.3.5 Imaging and image processing 103 8.3.6 Statistics 106 8.3.7 Single cell sequencing 107 8.3.8 Bioinformatic analysis 108 9 BIBLIOGRAPHY 111 10 APPENDIX 128 10.1 APPENDIX 1: ERKLÄRUNGEN ZUR ERÖFFNUNG DES PROMOTIONSVERFAHRENS 128 10.2 APPENDIX 2: BESTÄTIGUNG ÜBER EINHALTUNG DER AKTUELLEN GESETZLICHEN VORGABEN 129

One strategy to restore vision in retinitis pigmentosa and related retinal degenerations is by cell replacement. Typically, patients lose vision when the outer retinal photoreceptor layer is lost, and so the therapeutic ideal 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 pre-existing 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, transplanted rod precursors are shown to reform an anatomically distinct and appropriately polarised outer nuclear layer. A trilaminar nuclear organisation is returned to the rd1 hosts that had only two retinal layers before treatment. The newly introduced rod precursor cells were able to resume their developmental programme in the degenerate host niche to become mature rods with light- sensitive outer segments, and reconnected 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 amongst pre-existing host outer retinal cells, total photoreceptor layer reconstruction may provide a clinically relevant model to investigate cell-based strategies for retinal repair.

A Degeneração da Mácula Relacionada a Idade (DMRI) acomete pessoas com mais de 50 anos, comprometendo gravemente a visão. Desde 2005, têm-se sugerido uma correlação entre DMRI e o polimorfismo Y402H do Fator H (FH). Os mecanismos pelos quais a proteína FH participa da etiopatogenia dessa doença têm sido alvo de muitos estudos, desde então. Neste trabalho, investigamos a correlação entre esse polimorfismo e a expressão de proteínas da via alternativa e parâmetros do perfil lipídico de pacientes com DMRI. As concentrações de FH, Fator B, C3 e Proteína C-reativa foram semelhantes entre os grupos controle e paciente. As concentrações de Fator D e os autoanticorpos encontravam-se reduzidos nos pacientes; enquanto Fator I e os demais parâmetros do perfil lipídico estavam aumentados nesses pacientes. A variante Y402 aparentemente aderiu melhor à superfície das leptospiras (superfície ativadora da via alternativa) em relação à variante H402, mas não houve diferença entre as variantes em relação à ligação a células endoteliais (superfície não ativadora). / Age-related Macular Degeneration (AMD) affects people over 50 years, and severely prejudice the vision. Since 2005, it has been suggested a correlation between AMD and the Y402H polymorphism of Factor H (FH). After this, the mechanisms by which FH protein participates in the pathogenesis of this disease have been extensively studied. In this study, we investigated the correlation between this polymorphism and expression of proteins of the alternative pathway and lipid profile of patients with AMD. The concentrations of FH, Factor B, C3 and C-reactive protein were similar between the control and patient groups.Factor D concentrations and autoantibodies levels were reduced in patients, while Factor I concentrations and the levels of the other parameters of lipid profile were increased in these patients.Apparently, Y402 variant displays better adhesion to the surface of Leptospira (alternative pathway activating surface) than the H402 variant, but no difference between the variants of the linkage to endothelial cells (non-alternative pathway activating surface).