The retinal pigment epithelium (RPE) is a monolayer of hexagonal cells located between the sensory neuroretina and the choriocapillaris. It is an important element of the outer blood-retinal barrier and is critical for maintaining the visual cycle, photoreceptor outer segment phagocytosis, and transport of nutrients, ions, and fluid between the distal retina and the choriocapillaris.
1 In diseases such as proliferative vitreoretinopathy (PVR),
2 3 proliferative diabetic retinopathy (PDR),
4 and age-related macular degeneration (AMD),
5 RPE cells can reenter the cell cycle and initiate proliferation and migration and secrete extracellular matrix proteins. Breakdown of the blood-retinal barrier can alter the cytokine milieu in the subretinal space and in the vitreous
6 and trigger the activation of RPE cells. In PVR, RPE cells proliferate and migrate to the vitreous cavity along with other types of cells (e.g., glial cells, fibroblasts, macrophages) and form fibrocellular membranes on the retinal surface or in the vitreous. These newly formed membranes eventually contract, resulting in retinal detachment and, if untreated, eventual loss of vision.
7 PDR is another proliferative ocular disease correlated with the migration and proliferation of RPE cells.
8 In the back of the eye, choroidal neovascularization (CNV) is a clinical hallmark of the “wet” form of AMD, which is the leading cause of irreversible vision loss in the Western world among people older than 65.
9 These newly formed leaky blood vessels eventually penetrate the Bruch membrane and the RPE and lead to the accumulation of blood and serum in the subretinal space, causing detachment of the retina and the formation of disciform scars. In a protective response, the RPE cells proliferate and migrate to envelop the newly formed capillaries.