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Longitudinal adaptive optics fluorescence microscopy reveals cellular mosaicism in patients
HaeWon Jung, Jianfei Liu, Tao Liu, Aman George, Margery G. Smelkinson, Sarah Cohen, Ruchi Sharma, Owen Schwartz, Arvydas Maminishkis, Kapil Bharti, Catherine Cukras, Laryssa A. Huryn, Brian P. Brooks, Robert Fariss, Johnny Tam
HaeWon Jung, Jianfei Liu, Tao Liu, Aman George, Margery G. Smelkinson, Sarah Cohen, Ruchi Sharma, Owen Schwartz, Arvydas Maminishkis, Kapil Bharti, Catherine Cukras, Laryssa A. Huryn, Brian P. Brooks, Robert Fariss, Johnny Tam
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Resource and Technical Advance Ophthalmology

Longitudinal adaptive optics fluorescence microscopy reveals cellular mosaicism in patients

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Abstract

The heterogeneity of individual cells in a tissue has been well characterized, largely using ex vivo approaches that do not permit longitudinal assessments of the same tissue over long periods of time. We demonstrate a potentially novel application of adaptive optics fluorescence microscopy to visualize and track the in situ mosaicism of retinal pigment epithelial (RPE) cells directly in the human eye. After a short, dynamic period during which RPE cells take up i.v.-administered indocyanine green (ICG) dye, we observed a remarkably stable heterogeneity in the fluorescent pattern that gradually disappeared over a period of days. This pattern could be robustly reproduced with a new injection and follow-up imaging in the same eye out to at least 12 months, which enabled longitudinal tracking of RPE cells. Investigation of ICG uptake in primary human RPE cells and in a mouse model of ICG uptake alongside human imaging corroborated our findings that the observed mosaicism is an intrinsic property of the RPE tissue. We demonstrate a potentially novel application of fluorescence microscopy to detect subclinical changes to the RPE, a technical advance that has direct implications for improving our understanding of diseases such as oculocutaneous albinism, late-onset retinal degeneration, and Bietti crystalline dystrophy.

Authors

HaeWon Jung, Jianfei Liu, Tao Liu, Aman George, Margery G. Smelkinson, Sarah Cohen, Ruchi Sharma, Owen Schwartz, Arvydas Maminishkis, Kapil Bharti, Catherine Cukras, Laryssa A. Huryn, Brian P. Brooks, Robert Fariss, Johnny Tam

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Figure 6

Evaluation of the degree of progressive RPE changes in patients.

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Evaluation of the degree of progressive RPE changes in patients.
Clinica...
Clinical applications of AO-ICG in (A–C) a healthy eye and in patients with (D–F) late-onset retinal degeneration (L-ORD) and (G–I) Bietti Crystalline Dystrophy (BCD). (A, D, and G) Color fundus photographs. White boxes indicate a 500 μm × 500 μm ROI in which overlapping AO-ICG images were acquired. Scale bar: 500 μm. (B, C, E, F, H, and I) Longitudinal AO-ICG images of foveal cells acquired in a healthy eye and diseased eyes. AO-ICG images on the second visit were generated with a new injection of ICG. Small green hexagons indicate the RPE spacing measured from within the 100 μm × 100 μm ROIs (white boxes). The RPE mosaic in the patient with L-ORD was similar to that of healthy eyes (98.7% stability across 2 visits; cell spacing z-score, 0.76). There was 1 hypofluorescent spot spanning several cell widths across that appeared in the second visit (arrows in E and F). In contrast, in the patient with BCD, RPE cells are markedly enlarged (84.5% stability across 2 visits; cell spacing z-score: –8.7), and many RPE nuclei can be visible even in the foveal region (arrows). There are larger RPE cells present outside of the ROI in (H and I). Scale bar for AO-ICG images: 100 μm. (J and K) Foveal RPE fluorescence distribution in the patients, averaged across both visits counts indicated on left axis. The overall distributions were significantly different compared with normal, dashed lines (P6L, n = 128 RPE cells, P < 0.001; P5R, n = 288 RPE cells, P < 0.001, Kruskal-Wallis one-way ANOVA). Solid line, fit to Weibull distribution. The expected fluorescence distribution from normal data presented in this manuscript is overlaid in the gray dashed lines (counts indicated by axis on right side).

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