(Investigative Ophthalmology and Visual Science. 2000;41:1210-1216.)
© 2000
by The Association for Research in Vision and Ophthalmology, Inc.
IL-10 and Antibodies to TGF-ß2 and PDGF Inhibit RPE-Mediated Retinal Contraction
Louise Carrington1,
David McLeod2 and
Mike Boulton1
1 From the Cell and Molecular Biology Unit, Department of Optometry and Vision Sciences, University of Cardiff, United Kingdom; and the
2 Department of Ophthalmology, Manchester Royal Eye Hospital, United Kingdom.
 |
Abstract
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PURPOSE. Retinal pigment epithelial (RPE) cells are believed to play a pivotal
role in the formation and contraction of epiretinal membranes in
proliferative vitreoretinopathy (PVR). In the present study, an organ
culture method was used that mimics the contractile stage of PVR, to
investigate the contribution of a variety of growth factors in human
RPE cellmediated contraction of the retina.
METHODS. Cultured human RPE cells were seeded onto bovine retinal explants.
After attachment, cultures received one of the following exogenous
growth factors: platelet-derived growth factor (PDGF)-AB, PDGF-BB,
basic fibroblast growth factor (bFGF), transforming growth factor
(TGF)-ß1, TGF-ß2, or interleukin (IL)-10;
or a neutralizing antibody to PDGF and/or TGF-ß2. Control
explants were either untreated or received a null antibody. Contraction
was assessed by image analysis and expressed as percentage reduction in
retinal area.
RESULTS. RPE cells produced a more than 50% contraction of the retina after 7
days in untreated samples. PDGF and TGF-ß2 stimulated
RPE-mediated contraction by a further 20% at 100 ng/ml. IL-10
decreased contraction by 63%, whereas the other growth factors gave
rise to similar contraction to untreated controls. Neutralizing
antibodies against PDGF and TGF-ß2 reduced RPE-mediated
contraction by up to 70% in comparison with untreated controls. The
neutralizing antibodies also inhibited the effects of exogenous PDGF
and TGF-ß2 on RPE-mediated contraction of the retina
(P < 0.01).
CONCLUSIONS. These findings confirm a role for both PDGF and TGF-ß2 in
RPE cellmediated contraction of the retina. Such contraction can be
inhibited by neutralizing antibodies against PDGF and
TGF-ß2, which, together with IL-10, are putative
candidates for therapeutic intervention in
PVR.
 |
Introduction
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Proliferative vitreoretinopathy (PVR) is a common sequel to
rhegmatogenous retinal detachment and is the leading cause of failure
of surgery to correct it. Characterized by the formation of contractile
membranes in the vitreal cavity and on both surfaces of the
retina,1
the disease has been compared with an
inappropriate wound-healing response. This comparison, coupled with
immunohistochemical analysis of excised membranes, has focused interest
on the contribution of specific growth factors/cytokines to the
progression of the disease. Retinal pigment epithelial (RPE) cells are
thought to play a pivotal role in both the formation and the
contraction of these membranes and are known to secrete, and to be
modulated by, a wide range of growth factors, including transforming
growth factor (TGF)-ß, platelet-derived growth factor (PDGF), and
fibroblast growth factor (FGF).2
TGF-ß isoforms 1, 2, and 3 have been identified in the posterior
segment of the eye by both molecular and immunohistochemical
techniques.3
4
5
RPE cells, fibroblasts, platelets, and
macrophages (all epiretinal membrane components) are known to secrete
TGF-ß and are considered to be the major source of exogenous TGF-ß
in the eye.4
6
Although not definitively proven in man,
TGF-ß2 is considered to be the predominant
TGF-ß isoform in the posterior segment; studies in primates have
shown that the ß2:ß1
ratios are 6:1 for the neural retina and 425:1 for
vitreous.5
TGF-ß is hypothesized to play a major role in
PVR, because levels in the vitreous of patients with PVR are increased
fourfold over vitreous extracted from patients without such
disease,7
and TGF-ß has been localized to excised
epiretinal membranes (Mike Boulton, unpublished data, 1997).
Furthermore, when RPE cells in culture are exposed to TGF-ß, they are
stimulated to increase fibronectin synthesis and
secretion8
and collagen gel contraction,9
10
11
both features associated with the pathobiology of PVR.2
TGF-ß can be modulated by a variety of growth factors-cytokines of
which interleukin (IL)-10 is a potent antagonist of TGF-ß
production.12
13
The presence of PDGF in membranes excised from patients with PVR
has been confirmed immunohistochemically14
;PDGF
concentration is also elevated in the vitreous of patients with the
disease.14
Fibroblasts, macrophages, platelets, and RPE
cells have all been shown to secrete PDGF isoforms.6
15
16
In response to PDGF, RPE cells proliferate and upregulate secretion of
PDGF in an autocrine feedback loop.16
PDGF has been shown
to be chemotactic for both fibroblasts and RPE
cells6
17
18
and enhances the contraction of RPE cells and
fibroblasts in collagen gels.9
19
Basic FGF (bFGF) has been localized to PVR membranes20
and
is known to be secreted by a number of cell types, including RPE cells,
involved in the pathologic course of PVR.21
The purpose of this study was to investigate the contribution of a
variety of growth factors to human RPE cellmediated contraction of
the retina, using a novel organ culture model in which the formation of
contractile cellular epiretinal membranes represents the early
pathobiology of PVR22
and to assess the efficacy of a
neutralizing antibody against those growth factors that affect
contraction.
 |
Materials and Methods
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Materials
Growth factors were purchased as follows: PDGF-AB, PDGF-BB from
Sigma (Poole, UK); bFGF, TGF-ß1,
TGF-ß2 from R&D (Oxon, UK); IL-10 from Genzyme
(Kent, UK). TGF-ß was prepared in phosphate-buffered saline
(PBS) supplemented with 0.1% bovine serum albumin and 4 mM HCl, and
the other growth factors were prepared in PBS according to the
manufacturers instructions. A neutralizing polyclonal antibody to
PDGF was obtained from R&D. Three to 5 µg/ml of this antibody
neutralizes 50% of the bioactivity due to 10 ng/ml of human PDGF; the
antibody is effective against all isoforms of PDGF. A neutralizing
monoclonal antibody to active human TGF-ß2
(IgG4 6B1) and a null isotype matching monoclonal antibody (2G6) with
no cross reactivity with TGF-ß were kindly donated by Cambridge
Antibody Technology, Melbourn, UK. The anti
TGF-ß2 antibody had a 50% inhibitory
concentration (IC50) of 1.2 nM when assayed in
the TF1 proliferation assay.
RPE CellMediated Retinal Contraction
Retinal contraction studies were undertaken as previously
described.22
In brief, retinas isolated from bovine eyes
obtained from a local abattoir within 4 hours of death were mounted
on cellulose ester membranes (Supor; Gelman Sciences, Northampton, UK).
Explants approximately 5 x 5 mm2 were cut
from the equatorial retina, producing a preparation with an identical
area of retina and support and allowing nontraumatic preparation of the
tissue. The explants were transferred to organ culture dishes where
they rested on a stainless steel mesh (16 explants per dish). Medium
(Trowels T8; Gibco, Paisley, UK) supplemented with 10% fetal calf
serum, 20 mM HEPES buffer, 200 mg/l streptomycin, 200 mg/l kanamycin,
120 mg/l benzyl penicillin, and 70 mg/l glutamine was added to the
level of the meshthat is, in contact with the support membrane
beneath the explant. The dishes were then incubated at 37°C in a
humidified atmosphere of air and 5% CO2.
Retinal explants and their underlying membrane supports were cultured
for 2 days before transfer to a 96-well dish. Human RPE cells (passages
59), isolated and cultured as previously described,23
were seeded into each attachment well at a cell density of 4 x
104 (i.e., the number of cells added to each
attachment well suspended in 100 µl T8 medium plus 10% fetal calf
serum). The cells were allowed to attach to the explant surface for 2
hours before the explants were transferred back to the organ culture
dish; this was referred to as time 0, after which 10 µl of test
substance was pipetted on top of each explant. The underlying medium
was changed every 2 days. For individual experiments, RPE cells of the
same passage and from the same donor were always used.
Addition of Growth Factors
Growth factors (PDGF-AB, PDGF-BB, bFGF,
TGF-ß1, TGF-ß2, and
IL-10) were prepared in serum-free T8 medium at concentrations of 1,
10, and 100 ng/ml. At time 0, retinal explants were placed in separate
organ culture dishes (six explants per dish), and 10 µl of growth
factor solution was pipetted on top of each explant, once only or three
times daily for 7 days. Controls were replacement of growth factor
solution with growth factor diluent, explants plus RPE cells with no
additions, and explants without RPE cells but addition of growth
factors or diluent. Contraction was assessed by image analysis (Seescan
Imaging, Cambridge, UK) of photographs taken at 0, 3, 5, and 7 days by
measuring the area of the explant viewed from above, expressed as a
percentage of the area of the support membrane.22
Addition of Neutralizing Antibodies to TGF-ß and PDGF-AB
Neutralizing antibodies to PDGF and
TGF-ß2, and control null antibodies, were
prepared in serum-free T8 medium at concentrations of 0.01, 0.1, and 1
mg/ml. In initial experiments, 10 µl of antibody solution was
pipetted on top of each explant three times daily for 7 days but in
subsequent experiments, antibodies were added every 4 hours for the
first 24 hours and then three times daily for the remaining 6 days.
Controls were replacement of antibody solution with diluent, explants
plus RPE cells with no additions, explants without RPE cells but
addition of antibodies or diluent, and 100 ng/ml growth factor and 1
mg/ml neutralizing antibody to confirm the neutralizing effect of the
antibodies in the organ culture model. Contraction was assessed at days
0, 3, 5, and 7, as described.
Statistics
Replicates of six explants were created for each experiment and
each experiment was repeated at least twice. Data were analyzed by
Students t-test and analysis of variance, using commercial
software (Simfit, Manchester, UK).24
 |
Results
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Human RPE cells were consistently able to contract bovine retinal
explants at all passages used (passages 59). However, the degree of
contraction was passage dependent with contraction increasing with
higher passage number (Fig. 1)
and varying between different cell lines (this was independent of
donor age).

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Figure 1. Effect of increasing passage number (passages 59) on the RPE-mediated
contraction of bovine retinal explants seeded with 4 x
104 human RPE cells and maintained for 7 days. Explants
were cultured in T8 with 10% fetal calf serum. Each point represents
mean of nine explants ± SEM.
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Effect of TGF-ß and Neutralizing Antibodies to TGF-ß on Retinal
Contraction
Repeated addition of TGF-ß1 did not
statistically affect the RPE cell-induced contraction of retinal
explants even at the highest concentration of 100 ng/ml (data not
shown). By contrast, repeated addition of
TGF-ß2 modulated the RPE-mediated contraction
of retinal explants in a dose dependent manner (Fig. 2) . Although there was variation between experiments, the same trend was
always observed. The highest concentration of
TGF-ß2 (100 ng/ml) significantly stimulated
RPE-mediated retinal contraction by 40% more than that observed in the
absence of added growth factor at day 7 (P < 0.01).
Addition of 10 ng/ml TGF-ß2 did not produce a
statistically significant effect on contraction, whereas at 1 ng/ml
TGF-ß2 the degree of retinal contraction was
significantly decreased by greater than 30% at day 7 compared with
contraction in the absence of growth factor (P <
0.01). A single addition of 100 ng/ml TGF-ß2 at
time 0 produced a contraction pattern comparable to that seen with
repeated additions, whereas a single addition of 1 or 10 ng/ml
TGF-ß2 produced no additional RPE-mediated
retinal contraction compared with controls in the absence of growth
factor (data not shown). In all experiments growth factor diluent had
no effect on baseline RPE-mediated contraction, and no retinal
contraction was observed in retinas that had not been seeded with RPE
cells (either in the presence or absence of growth factor).

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Figure 2. The contraction of bovine retinal explants seeded with 4 x
104 RPE cells (passage 6) over a time course of 7 days,
comparing the effects of adding 10 µl of 1 ng/ml, 10 ng/ml, or 100
ng/ml human recombinant TGF-ß2 every 8 hours. Controls
are either with no additions or the addition of growth factor diluent.
Each data point represents the mean value of six replicates ±
SEM. *Significant difference from control levels at the 1% level
(Students t-test).
|
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Addition of neutralizing antibody at 1 mg/ml every 4 hours for 24 hours
followed by every 8 hours for 6 days significantly reduced RPE-mediated
retinal contraction compared with controls (P < 0.001;
Fig. 3
); RPE cellmediated contraction was reduced by up to 50% in the
presence of neutralizing antibody. Potency of the antibody was
confirmed by demonstrating that 1 mg/ml of
anti-TGF-ß2 antibody was sufficient to
neutralize the stimulatory action of repeated additions of 100 ng/ml of
human recombinant TGF-ß2 on RPE-mediated
contraction of the retina (Fig. 3)
. No effect was observed with lower
concentrations (10 and 100 µg/ml) of antibody or lower frequency
regimen. Addition of the neutralizing monoclonal antibody directed
against active human recombinant TGF-ß2, even
at a concentration of 1 mg/ml, every 8 hours for 7 days had no
significant effect on the RPE-mediated contraction compared with
untreated controls (data not shown). The contraction of explants was
not significantly affected by addition of either null antibody (1 mg/ml
human IgG4) or the antibody diluent.

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Figure 3. The contraction of bovine retinal explants seeded with 4 x
104 RPE cells (passage 9) over a time course of 7 days,
comparing the effects of adding 10 µl of 100 ng/ml human recombinant
TGF-ß2, 0.1 or 1 mg/ml 6B1 (human monoclonal antibody
against active human TGF-ß2), or a combination of 1 mg/ml
6B1 and 100 ng/ml TGF-ß2, every 4 hours for 24 hours,
then every 8 hours. Controls were untreated or treated with antibody
diluent or 1 mg/ml of a null antibody. Each data point represents the
mean value of six replicates ± SEM. *Significant difference from
control levels at the 1% level (Students t-test).
|
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Effect of PDGF and a Neutralizing Antibody to PDGF on
Retinal Contraction
RPE-mediated contraction of retinal explants was significantly
enhanced in a dose-dependent manner by the addition of PDGF-AB
(P < 0.01; Fig. 4
); stimulation was greatest at 100 ng/ml and least at 1 ng/ml being,
respectively, 40% and 18% greater than in the untreated controls.
PDGF-AB had no effect on retinal explants that had not been seeded with
RPE cells. By contrast, none of the concentrations of PDGF-BB tested in
this experiment produced any statistically significant effect on
retinal contraction by day 7 in culture (data not shown).

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Figure 4. The contraction of bovine retinal explants seeded with 4 x
104 RPE cells (passage 7) over a time-course of 7 days,
comparing the effects of adding 10 µl of 1 ng/ml, 10 ng/ml, or 100
ng/ml human recombinant PDGF-AB every 8 hours. Controls were untreated.
Each data point represents the mean value of three replicates + SEM.
*Significant difference from control levels at the 1% level
(Students t-test).
|
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Addition of all three concentrations of neutralizing antibody (0.01,
0.1, and 1 mg/ml) to PDGF every 4 hours for 24 hours, followed by every
8 hours for 6 days, significantly reduced RPE-mediated retinal
contraction in the absence of antibody or added growth factor
(P < 0.001; Fig. 5
). RPE-mediated contraction was reduced by up to 50% in the presence of
neutralizing antibody. Potency of the antibody was confirmed by
demonstrating that 1 mg/ml of anti-PDGF antibody was sufficient to
neutralize the stimulatory action of 100 ng/ml of PDGF-AB on
RPE-mediated contraction of the retina (Fig. 5)
. The contraction of
explants was not significantly affected by addition of either null
antibody (1 mg/ml) or the antibody diluent.

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Figure 5. The contraction of bovine retinal explants seeded with 4 x
104 RPE cells (passage 6) over a time course of 7 days,
comparing the effects of adding 10 µl of 100 ng/ml of PDGF-AB, 0.1 or
1 mg/ml of a neutralizing antibody against PDGF, or a combination of 1
mg/ml of neutralizing antibody and 100 ng/ml PDGF-AB every 4 hours for
24 hours, then every 8 hours. Controls were untreated or were treated
with antibody diluent or 1 mg/ml of a null antibody. Each data point
represents the mean value of six replicates ± SEM. *Significant
difference from control levels at the 1% level (Students
t-test).
|
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Effect of a Combination of Neutralizing Antibodies to PDGF and
TGF-ß2 on Retinal Contraction
A combination of neutralizing antibodies to PDGF and TGF-ß
tended to produced a greater inhibition of RPE cellmediated retinal
contraction compared with either antibody on its own; however, this
effect was not significant (Table 1)
.
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Table 1. Comparison of the Effects of Neutralizing Antibody Alone or in
Combination on RPE-Induced Contraction of the Retina after 7 Days in
Organ Culture
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Effect of bFGF and IL-10 on Retinal Contraction
None of the concentrations of bFGF produced any statistically
significant change in RPE-mediated retinal contraction compared with
that seen in the absence of growth factor by day 7 in culture (data not
shown). However, at the highest concentration of IL-10 tested (100
ng/ml) repeated addition of IL-10 resulted in an inhibition of
RPE-mediated contraction of the retina; contraction was decreased by
63% compared with untreated controls (Fig. 6)
. Addition of IL-10 had no significant effect on contraction at the
lower doses tested (1 and 10 ng/ml).

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Figure 6. Graph showing the contraction of bovine retinal explants seeded with
4 x 104 RPE cells (passage 7) over a time course of 5
days, comparing the effects of adding 10 µl of either 1 ng/ml, 10
ng/ml, or 100 ng/ml of human recombinant IL-10 every 8 hours. Controls
were untreated. Each data point represents the mean value of five
replicates ± SEM. *Significant difference from control levels at
the 1% level (Students t-test).
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 |
Discussion
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In this study we have demonstrated the importance of both
TGF-ß2 and PDGF in RPE-mediated contraction of
the retina. Furthermore, we have demonstrated that RPE-mediated
contraction of the retina can be inhibited by IL-10 and by neutralizing
antibodies to TGF-ß and PDGF.
Both TGF-ß and PDGF have been implicated in promoting contraction
using a variety of cell types including RPE cells.9
25
26
27
However, the potency of this effect appears to be isoform specific.
Exogenous TGF-ß2 significantly stimulated
RPE-mediated retinal contraction in this study, whereas
TGF-ß1 had no effect. The timing of application
may well be critical, because TGF-ß2 is
reported to have most effect on contraction in the first 24 hours after
application.28
Furthermore, our results show that a single
addition of TGF-ß2 at the beginning of an
experiment is enough to enhance contraction significantly. The potency
of TGF-ß2 is in agreement with that reported in
other studies.26
29
However, the role of
TGF-ß1 is equivocal. In contrast to our
findings, it has previously been shown to enhance contraction by
fibroblasts25
30
and RPE cells in collagen
gels.6
10
This apparent discrepancy may reflect the
difference in substrate between these studies and our model; the nature
of the extracellular matrix is also known to regulate the cellular
response to growth factors.31
PDGF also demonstrated isoform-specific RPE mediated contraction;
PDGF-AB stimulated contraction, whereas PBGF-BB had no effect at the
concentrations used. This suggests that the A chain of PDGF is
essential for RPE-mediated contraction. Choudary et al.9
have demonstrated that PDGF stimulates RPE-mediated collagen gel
contraction but did not assess isoform differences. Studies using
fibroblasts have reported that both PDGF-AB and PDGF-BB, but not
PDGF-AA, stimulate the contraction of type 1 collagen and fibrin
gels.19
27
32
This may reflect differences in
extracellular matrix or cell type specificity. Interestingly, bFGF had
no effect on RPE-mediated contraction of the retina, despite its
ability to promote contraction in other cell types.33
34
The results from this study suggest that RPE cellmediated contraction
is induced by at least two growth factors and is almost certainly
dependent on the nature of the extracellular matrix. However, the
induction of the contractile response may be more complicated than
this. Choudary et al.9
have demonstrated that RPE-induced
contraction of collagen gels by TGF-ß and IL-1ß was due, not to the
direct effect of these growth factors, but to the production of another
growth factor or factors by the target cells. Analysis of the
conditioned medium revealed a peptide similar to PDGF which, when
inhibited, prevented contraction. The observation from our study that
RPE cells did not require repeated application of exogenous
TGF-ß2 to increase their contraction and that
neutralizing antibodies to TGF-ß2 did not
result in total inhibition of contraction supports a role for a second
growth factor, probably PDGF. The mechanism by which TGF-ß and PDGF
promote RPE-mediated contraction is unclear but is likely to involve
adhesion receptors. TGF-ß is known to increase
2ß1 integrin
expression, and neutralizing antibodies to the
2ß1 integrin dimer
can inhibit collagen matrix contraction.35
The ß1
integrin is also known to be regulated by PDGF.9
36
The observation that the contractile ability of cultured human RPE
cells increases with passage number is not unexpected. Grisanti and
Guidry37
have previously demonstrated that RPE cells take
on a fibroblastic morphology with increased passage and that this is
associated with an increased ability to contract silicone membranes.
RPE cells have been proposed as one of the possible sources of the
fibroblasts seen in epiretinal membranes, and this enhanced contractile
ability could come about either through expression of
-smooth muscle
actin, differences in the ability to manipulate surrounding
extracellular matrix, or changes in the effect of soluble factors on
these cells. The phenotypic change did not affect their response to
either TGF-ß isoforms, bFGF, PDGF-BB, or IL-10, in that a similar
effect was observed at both high and low passage.
A role for PDGF and TGF-ß in PVR is supported by the observations
that RPE cells have receptors for both TGF-ß and PDGF,16
that TGF-ß and PDGF promote RPE-induced contraction, that both
TGF-ß (Mike Boulton, unpublished data, 1997) and PDGF have
been localized to epiretinal membranes,14
and that
intravitreal levels of TGF-ß and PDGF are increased in
PVR.38
39
40
The source of these growth factors is unclear,
but there is evidence for paracrine-autocrine actions, in that a
variety of retinal cells, including RPE cells, are capable of
synthesizing both TGF-ß and PDGF.2
3
4
Thus, a feasible
approach to the modulation of PVR is the inhibition of these growth
factors, either by neutralizing their activity or through the action of
known antagonists. We have clearly demonstrated in this study that
neutralizing antibodies to both TGF-ß and PDGF inhibit RPE-mediated
contraction of the retina. Neutralizing antibodies to TGF-ß have
previously been shown to inhibit contraction in fibroblast-seeded
collagen matrices,11
but to our knowledge similar studies
have not been undertaken on human RPE cells. However, application of
neutralizing antibodies against PDGF have previously been shown to
inhibit RPE contraction in the collagen gel assay.9
41
It
is difficult to determine whether the neutralizing antibodies were
acting against endogenous growth factor levels in the fetal calf serum
used in these experiments (it is not possible to maintain retinas in
the absence of serum) or whether they were neutralizing growth factor
produced by the RPE or retina. Given that serum is reported to contain
negligible TGF-ß242
and
approximately 100 ng/ml PDGF,43
we estimate that our
cultures were exposed to no and 10 ng/ml of TGF-ß and PDGF,
respectively. These levels are sufficiently low to suggest that the
neutralizing antibodies are also acting against locally produced growth
factors.
Exogenous IL-10 produced a dose-dependent inhibition of RPE-mediated
contraction in our organ culture model. This is perhaps not surprising,
because IL-10 is reported to reduce collagen synthesis, induce matrix
metalloproteinase production at the posttranslational level, and
suppress TGF-ß production in bone marrow cells.13
44
Because the addition of IL-10 produced the same effect as neutralizing
antibodies to TGF-ß, it is tempting to speculate that, in our model,
IL-10 not only suppressed the synthesis of
TGF-ß2 by RPE cells but also acted as an
antagonist. The reported ability of IL-10 to inhibit collagen
production and upregulate matrix metalloproteinase secretion is
directly antagonistic to some TGF-ß2-induced
actions. Further studies might investigate the interrelationship
between TGF-ß2 and IL-10 on modulating RPE
behavior.
It is clear from these studies that both TGF-ß and PDGF play an
important role in RPE-mediated contraction of the retina. As previously
discussed, our combined cellorgan culture system provides a model
with reproducibility of histologic features and contractile responses
representing the early events of PVR.22
Therefore, our
observations that neutralizing antibodies and certain peptides can
inhibit this contractile response suggest that these agents should be
considered for use in clinical trials. The efficacy of neutralizing
antibodies to TGF-ß in preventing fibrosis in the eye has recently
been confirmed by Cordeiro et al.45
who demonstrated that
application of neutralizing monoclonal antibodies to active TGF-ß can
prevent bleb failure in a recent model of glaucoma filtration surgery.
However, our study suggests that it may be necessary to inhibit more
than one factor simultaneously to obtain a maximal effect. Further
study is necessary to identify new, and more successful, means of
therapeutic intervention in PVR.
 |
Footnotes
|
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Presented at the annual meeting of the Association for Research in Vision and Ophthalmology, Fort Lauderdale, Florida, May, 1998.
Supported by the Wellcome Trust; The Guide Dogs for the Blind Association, Reading, UK; and the Manchester Royal Eye Hospital Endowments, UK.
Submitted for publication July 2, 1999; revised November 10, 1999; accepted December 1, 1999.
Commercial relationships policy: C5(LC, MB).
Corresponding author: Mike Boulton, Cell and Molecular Biology Unit, Department of Optometry and Vision Sciences, Redwood Building, University of Cardiff, PO Box 905, Cardiff CF1 3XF, UK. boultonm{at}cardiff.ac.uk
 |
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