Treatment of macular hole (MH) through a combination of vitrectomy and
autologous blood preparations has been very successful (success
rates > 90%) and is becoming generalized throughout Europe.
There are currently no data available on success rates of adjuvant
therapy in different forms of MH, but given the high success rate in
treatment of simple MH by surgery alone,
3 4 5 6 such
approaches would be particularly interesting in cases of recurrent MH
or failed surgery. Except for histopathologic observations in
humans
18 29 and in experimental rabbit
models,
19 20 the possible cellular and molecular pathways
through which PS exerts its effects are largely unknown. The original
reason for testing PS was based on its known rich content in TGF-β,
since TGF-β
2 had been shown to be effective in
earlier in vivo studies,
5 6 although recombinant
TGF-β
2 later proved to be
ineffective.
7 In turn, the justification for testing
TGF-β came from its published effects on stimulating extracellular
matrix synthesis and trophic effects for many cells.
30 In
the in vitro trials used here, TGF-β is unlikely to contribute
significantly to glial responses for several reasons.
TGF-β
2 concentrations in PS would probably have
been too low (∼10 pg:
Ref. 12) to induce any cellular division.
Neutralizing pan-TGF-β antibody was unable to inhibit PS-stimulated
migration, which is important in light of the presence in PS of high
levels of thrombospondin, a known activator of latent
TGF-β.
31 Furthermore, heating is known to convert the
latent precursors of TGF-β into active forms,
32 whereas
in our studies heating destroyed PS effects. Finally,
TGF-β
1 even when used at high concentrations
was ineffective in stimulating glial proliferation or migration.
TGF-β
1 is known to stimulate glycosaminoglycan
synthesis in cells
33 and in cultured Müller glia
(unpublished results) and so may still be involved in wound repair by
stimulating synthesis of matrix components. In the present study we did
not examine the possible effects of PS or identified proteins on other
cell types thought to be present in MH plugs, such as retinal pigment
epithelium and fibroblasts, which may produce additional trophic
factors.