Retinal pigment epithelium transplantation: concepts, challenges, and future prospects.

The retinal pigment epithelium (RPE) is a single layer of cells that supports the light-sensitive photoreceptor cells that are essential for retinal function. Age-related macular degeneration (AMD) is a leading cause of visual impairment, and the primary pathogenic mechanism is thought to arise in the RPE layer. RPE cell structure and function are well understood, the cells are readily sustainable in laboratory culture and, unlike other cell types within the retina, RPE cells do not require synaptic connections to perform their role. These factors, together with the relative ease of outer retinal imaging, make RPE cells an attractive target for cell transplantation compared with other cell types in the retina or central nervous system. Seminal experiments in rats with an inherited RPE dystrophy have demonstrated that RPE transplantation can prevent photoreceptor loss and maintain visual function. This review provides an update on the progress made so far on RPE transplantation in human eyes, outlines potential sources of donor cells, and describes the technical and surgical challenges faced by the transplanting surgeon. Recent advances in the understanding of pluripotent stem cells, combined with novel surgical instrumentation, hold considerable promise, and support the concept of RPE transplantation as a regenerative strategy in AMD.

Aptamer BAX 499 mediates inhibition of tissue factor pathway inhibitor via interaction with multiple domains of the protein.

BACKGROUND: Tissue factor pathway inhibitor (TFPI) is a multidomain protein that negatively regulates the coagulation cascade. TFPI inhibits the tissue factor (TF)-activated factor VII-activated FX (FXa) complex during TF-mediated coagulation initiation. The aptamer BAX 499 binds specifically to TFPI and inhibits its function, mediating a procoagulant effect in both in vitro and in vivo models of hemophilia. OBJECTIVES: This study sought to identify the regions of TFPI that are critical for BAX 499 binding, and to determine how binding mediates aptamer inhibition of TFPI. METHODS AND RESULTS: In vitro biochemical methods were used to evaluate the BAX 499 interaction with and inhibition of TFPI. Binding experiments indicated that the full-length TFPI protein is required for tight aptamer binding. Binding-competition experiments implicated the Kunitz 1, Kunitz 3 and C-terminal domains of TFPI in aptamer binding, a finding that is supported by hydrogen-deuterium exchange experiments, and indicated that aptamer and FXa can bind simultaneously to TFPI. In enzymatic assays, BAX 499 inhibited TFPI in a manner that is distinct from domain-specific antibodies, and aptamer inhibitory activity is reduced in the presence of the TFPI cofactor protein S. CONCLUSIONS: These studies demonstrate that BAX 499 binds to TFPI via multiple domains of the protein in a manner that is distinct from other TFPI inhibitors, mediating a mechanism of inhibition that does not involve direct competition with FXa. With this unique inhibitory mechanism, BAX 499 provides a useful tool for studying TFPI biology in health and disease.

Biodegradable poly(α-hydroxy ester) blended microspheres as suitable carriers for retinal pigment epithelium cell transplantation.

Five blends of poly(L-lactic acid) (PLLA) with poly(D,L-lactic-co-glycolic acid) (PLGA) were used to prepare microcarriers by a solvent evaporation technique. Microcarriers were evaluated as suitable scaffolds to facilitate retinal pigment epithelium (RPE) cell transplantation. The blend ratios were 90:10, 75:25, 50:50, 25:75, 10:90 (PLLA:PLGA). Samples of each microcarrier blend were coated with an extracellular matrix protein. Coated and uncoated microcarriers were seeded with a human RPE cell line. As the lactide unit content increased the size of microcarriers generally became larger and the surface more irregular. Cells remained proliferative and retained phenotype as confirmed by immunocytochemistry. Blends rich in PLLA were superior for maintenance of RPE cell viability. This study demonstrates for the first time the feasibility of using microcarriers as a vehicle for retinal cell transplantation for ocular disease.

Successful change programs begin with results.

Most corporate improvement programs have a negligible impact on operational and financial performance because management focuses on the activities, not the results. By initiating activities-centered programs, such as seven-step problem solving, statistical process control, and total quality management training, managers falsely assume that one day results will materialize. But because there is no explicit connection between action and outcome, improvements seldom do materialize. The authors argue for an alternative approach: results-driven improvement programs that focus on achieving specific, measurable operational improvements within a few months. While both activity-centered and results-driven programs aim to strengthen fundamental corporate competitiveness, the approaches differ dramatically. Activity-centered programs rely on broad-based policies and are more concerned with time-consuming preparations than with measurable gains. Results-driven programs, on the other hand, rely on an incremental approach to change, building on what works and discarding what doesn't. As a result, successes come quickly, and managers build their skills and gain the support of their employees for future changes. Because results-driven improvements require minimal investment, there is no excuse for postponing action. Indeed, there is always an abundance of underexploited capability and dissipated resources within the organization that management can tap into to get the program off the ground. The authors give a few pointers for how to get started: translate the long-term vision into doable but ambitious short-term goals; periodically review strategy, learning from both successes and failures; and institutionalize the changes that work and get rid of the rest.