Clinical Considerations for RPE Cell Transplantation

Purpose of Review: Transplantation of retinal pigment epithelium (RPE) derived from either induced pluripotent stem cells (iPSCs) or embryonic stem cells (ESCs) is steadily progressing toward a clinical reality. This review explores various aspects of transplantation that will be relevant to clinical settings, including cellular composition, delivery techniques, and complications resulting from the surgical procedure. Recent Findings: Animal model research and clinical trials are refining the methodology, surgical techniques, and minimization of complications for RPE transplantation. Cellular composition of RPE for delivery has evolved from cell suspensions to sheets of cells grown on synthetic substrates. Surgical techniques are evolving as well, where trans-retinal delivery of cells to the sub-retinal space can have complications such as retinal detachment, whereas trans-scleral techniques may minimize some of the issues. Finally, immune-based rejection of transplanted tissue is a potential problem where precision medicine has the potential to tailor an immunosuppressive regimen that is specific to the individual to provide the best outcome. Summary: The optimization of cell transplantation to the eye is ongoing. From a clinical standpoint, many of the observed complications are readily treatable, but others require careful monitoring.