Human Pluripotent Stem Cells Derived Endothelial Cells Repair Choroidal Ischemia

Abstract Choroidal atrophy is a common fundus pathological change closely related to the development of age‐related macular degeneration (AMD), retinitis pigmentosa, and pathological myopia. Studies suggest that choroidal endothelial cells (CECs) that form the choriocapillaris vessels are the first cells lost in choroidal atrophy. It is found that endothelial cells derived from human pluripotent stem cells (hPSC‐ECs) through the MESP1+ mesodermal progenitor stage express CECs‐specific markers and can integrate into choriocapillaris. Single‐cell RNA‐seq (scRNA‐seq) studies show that hPSC‐ECs upregulate angiogenesis and immune‐modulatory and neural protective genes after interacting with ex vivo ischemic choroid. In a rat model of choroidal ischemia (CI), transplantation of hPSC‐ECs into the suprachoroidal space increases choroid thickness and vasculature density. Close‐up examination shows that engrafted hPSC‐ECs integrate with all layers of rat choroidal vessels and last 90 days. Remarkably, EC transplantation improves the visual function of CI rats. The work demonstrates that hPSC‐ECs can be used to repair choroidal ischemia in the animal model, which may lead to a new therapy to alleviate choroidal atrophy implicated in dry AMD, pathological myopia, and other ocular diseases.