Improving RPE adhesion to Bruch's membrane

Age-related macular degeneration is the leading cause of blindness in the developing world. Retinal pigmented epithelium (RPE) transplantation in subretinal space, has been assessed in various animal models of age-related macular degeneration and in humans as a potential technique to preserve the visual function. However, the RPE cell survival posttransplantation is limited because of lack of attachment of the transplanted cells to the pathological Bruch's membrane and also partly because of iatrogenic removal of adhesive elements in the membrane during the removal of choroidal new vessels before transplantation procedure. Although pathological Bruch's membrane is well studied, there is still much debate as to why and how changes in the structure and components of this membrane leads to loss of RPE cells and disruption of their function and subsequent death of photoreceptors leading to visual loss. Integrins on RPE cells have been characterized and shown to be important for attachment of cells to Bruch's membrane. Considering the essential role of integrins in functions such as cell migration and adhesion, it is plausible that lack of attachment of RPE cells posttransplantation can be overcome by improving integrin function. Here, we have focused on some of the recent findings on the use of integrins and modulation of their function to improve the adhesion of RPE cells to normal and pathological Bruch's membrane. This work also aims at elucidating a potential mechanism by which accumulating inhibitory molecules in the Bruch's membrane in the pathological state, interferes with integrin function. Eye (2009) 23, 1890-1893; doi:10.1038/eye.2008.411; published online 16 January 2009