Improved Lipofuscin Models and Quantification of Outer Segment Phagocytosis Capacity in Highly Polarized Human Retinal Pigment Epithelial Cultures

Summary

This protocol describes a lipofuscin accumulation model in highly differentiated and polarized human retinal pigment epithelial (RPE) cultures and an improved outer segment (OS) phagocytosis assay to detect the total OS consumption/degradation capacity of the RPE. These methods overcome the limitations of previous lipofuscin models and classical pulse-chase outer segment phagocytosis assays.

Abstract

The daily phagocytosis of photoreceptor outer segments by the retinal pigment epithelium (RPE) contributes to the accumulation of an intracellular aging pigment termed lipofuscin. The toxicity of lipofuscin is well established in Stargardt’s disease, the most common inherited retinal degeneration, but is more controversial in age-related macular degeneration (AMD), the leading cause of irreversible blindness in the developed world. Determining lipofuscin toxicity in humans has been difficult, and animal models of Stargardt’s have limited toxicity. Thus, in vitro models that mimic human RPE in vivo are needed to better understand lipofuscin generation, clearance, and toxicity. The majority of cell culture lipofuscin models to date have been in cell lines or have involved feeding RPE a single component of the complex lipofuscin mixture rather than fragments/tips of the entire photoreceptor outer segment, which generates a more complete and physiologic lipofuscin model. Described here is a method to induce the accumulation of lipofuscin-like material (termed undigestible autofluorescence material, or UAM) in highly differentiated primary human pre-natal RPE (hfRPE) and induced pluripotent stem cell (iPSC) derived RPE. UAM accumulated in cultures by repeated feedings of ultraviolet light-treated OS fragments taken up by the RPE via phagocytosis. The key ways that UAM approximates and differs from lipofuscin in vivo are also discussed. Accompanying this model of lipofuscin-like accumulation, imaging methods to distinguish the broad autofluorescence spectrum of UAM granules from concurrent antibody staining are introduced. Finally, to assess the impact of UAM on RPE phagocytosis capacity, a new method for quantifying outer segment fragment/tips uptake and breakdown has been introduced. Termed “Total Consumptive Capacity”, this method overcomes potential misinterpretations of RPE phagocytosis capacity inherent in classic outer segment “pulse-chase” assays. The models and techniques introduced here can be used to study lipofuscin generation and clearance pathways and putative toxicity.

Introduction

The retinal pigment epithelium (RPE) provides critical support for overlying photoreceptors, including the daily uptake and degradation of photoreceptor outer segment tips or fragments (throughout this protocol, the abbreviation OS stands for OS tips or fragments rather than whole outer segments). This daily uptake in the post-mitotic RPE eventually overloads phagolysosomal capacity and leads to the buildup of undigestible, autofluorescent intracellular material, termed lipofuscin. Interestingly, several studies have also demonstrated that RPE lipofuscin can accumulate without OS phagocytosis^1,2. Lipofuscin has many components, including cross-linked adducts derived from visual cycle retinoids, and can occupy nearly 20% of RPE cell volume for those over the age of 80³.

Whether lipofuscin is toxic has been hotly debated. Stargardt's disease is an autosomal recessive degeneration of the photoreceptors and RPE in which a mutation in ABCA4 triggers improper processing of visual cycle retinoids contained within photoreceptor outer segments. Improper retinoid processing leads to aberrant cross-linking and formation of bis-retinoid species, including the bis-retinoid N-retinylidene-N-retinylethanolamine (A2E). Studies have demonstrated multiple mechanisms for A2E toxicity^4,5. Lipofuscin contributes to fundus autofluorescence signals during clinical imaging, and both Stargardt's patients and animal models display increased fundus autofluorescence prior to retinal degeneration, suggesting a correlation between lipofuscin levels and toxicity^6,7. However, with age, lipofuscin accumulates in all humans without triggering an RPE degeneration. Further, in age-related macular degeneration (AMD), where RPE degeneration occurs only in elderly patients, those with early and intermediate forms of the disease have less fundus autofluorescence signals than age-matched non-diseased humans⁸. These clinical findings have been verified at the histologic level as well^9,10.

Animal models of RPE lipofuscin accumulation have also left some ambiguity about lipofuscin toxicity. The ABCA4 knockout mouse does not display retinal degeneration on a pigmented background, whereas it does on an albino background or when exposed to blue light^11,12. Further, the toxicity of lipofuscin derived via ABCA4 knockout likely differs from the more slowly accumulating lipofuscin that occurs with natural aging, as seen in AMD¹³.

In vitro models of lipofuscin accumulation provide an alternative to studying the effects of lipofuscin accumulation on RPE health. Such models allow for manipulating lipofuscin components, from feeding single retinoid components to feeding OS, and allow study in human rather than animal RPE. In the last couple of decades, multiple methods have been developed to model RPE lipofuscin in culture. Along with other groups, Dr. Boulton's group fed bovine OS daily for up to three months on passage 4 to 7 human primary RPE cells from donors aged 4 to 85 years old¹⁴. Alternatively, inhibition of autophagy has also led to lipofuscin accumulation in passages 3 to 7 primary human RPE cultures¹⁵. However, sub-lethal lysosomal inhibition in highly differentiated, passage 1, primary human pre-natal RPE (hfRPE) cultures failed to induce lipofuscin, even with the repeated addition of OS on a daily basis¹⁶.

As a more reductionist approach, others have fed single lipofuscin components to cultures, especially the bis-retinoid A2E^4,17. Such studies are valuable in that they define potential direct mechanisms of toxicity for individual lipofuscin components, implicating, for example, lysosomal cholesterol and ceramide homeostasis¹⁸. At the same time, there is debate about the toxicity of A2E¹⁹, and feeding it directly to cells circumvents the typical pathway for lipofuscin accumulation, which involves phagocytosis of photoreceptor OS. In an attempt to deliver all components of lipofuscin to RPE cultures, Boulton and Marshall purified lipofuscin from human eyes and fed this to passage 4 to 7 human primary RPE cultures derived from both fetal and elderly human donors²⁰. While innovative, this method represents a limited lipofuscin source for repeated experiments.

While repeated feedings of OS to RPE cultures produce lipofuscin in many systems, it fails to do so in highly differentiated primary RPE cultures¹⁶. Photo-oxidizing OS induces cross-linking reactions like bis-retinoid formation that naturally occurs during lipofuscin formation in vivo. This can accelerate lipofuscin-like granule formation in RPE culture systems, even those that are highly differentiated and resistant to lipofuscin accumulation¹⁶. Here, a method to induce lipofuscin-like granule accumulation in highly differentiated hfRPE and human iPSC-RPE is introduced, modified from Wihlmark's published protocol²¹. This method has the advantage of inducing lipofuscin-like granules employing the same source (photoreceptor OS) and pathway (phagolysosomal OS uptake) as occurs for lipofuscinogenesis in vivo. Further, it is done on human RPE cultures that are highly differentiated and validated in multiple studies to replicate human RPE in vivo^22,23,24. These lipofuscin-like granules are termed undigestible autofluorescent material (UAM), and provide data and discussion in this protocol comparing UAM to in vivo lipofuscin. Along with methods for building and evaluating UAM-laden cultures in highly differentiated human RPE, an updated method to assess RPE OS phagocytosis is also introduced. Multiple excellent pulse-chase methods for quantifying OS phagocytosis have been introduced, including Western blotting, immunocytochemistry, and FACS^25,26,27. However, early in the OS pulse-chase, conditions that lead to poor OS uptake can be conflated with conditions that promote rapid degradation of internalized OS. The method presented here measures the total amount of introduced OS that is fully consumed/degraded by the RPE ("Total Consumptive Capacity"), helping eliminate this ambiguity. It is anticipated that insights about lipofuscin toxicity utilizing these protocols, including effects on OS phagocytosis rates utilizing the "Total Consumptive Capacity" method, will be used to shed light on the toxicity of lipofuscin in vivo.

Protocol

The present protocol involving the acquisition and use of human tissue was reviewed and approved by the University of Michigan Institutional Review Board (HUM00105486). 1. Preparation of photo-oxidized outer segment tips and fragments NOTE: Dark-adapted bovine retinas were purchased and shipped on ice (see Table of Materials). From these retinas, OS were purified following a previously published protocol23. Outer …

Representative Results

The set-up for photo-oxidation of OS is demonstrated in Figure 1Ai. The polytetrafluoroethylene-coated slides allow for a large volume of OS in solution to be loaded per open rectangle without spreading across the rest of the slide. The slide with OS is contained within a sterile Petri dish with the lid off, and a UV lamp is placed over the slide as shown in Figure 1Aii. Alternatively, the slide can be placed in a UV Crosslinker device, as shown in <strong class…

Discussion

While RPE lipofuscin has been studied for decades, its toxicity is debated^2,9,16,42. Given ambiguity about the toxicity of lipofuscin from animal models¹¹, in vitro models using human RPE are valuable. A range of in vitro lipofuscin accumulation models have been described, but none have utilized both OS feeding and highly mature and differentiated human…

Materials

100 mm cell culture dish	Corning	#353003	Others also work
24-well Transwells	Corning	#3470
Anti-LC3 antibody	Cell Signaling Technology	#4801S	1:1000 dilution
Anti-rhodopsin antibody 1D4	Abcam	#5417	1:1000 dilution. Epitope is C-terminal.
Anti-rhodopsin antibody 4D2	EnCor Biotech	MCA-B630	1:5000 dilution for western blot, 1:1000 dilution for immunostaining. Epitope is N-terminal.
Autofluorescence quencher	Biotium	#23007	TrueBlack Lipofuscin Autofluorescence Quencher
Autofluorescence quencher	Vector Laboratories	SP-8400	Vector TrueVIEW Autofluorescence Quenching Kit
Bodipy 493/503	Life Technologies	D3922
Cholesterol esterase	Life Technologies	From A12216 kit
Confocal microscope	Leica	Leica Stellaris SP8 with FALCON module
Dark-adapted bovine retinas	W. L. Lawson Company	Dark-adapted bovine retinas (pre-dissected)	Contact information: https://wllawsoncompany.com/ (402) 499-3161 stacy@wllawsoncompany.com
Filipin	Sigma-Aldrich	F4767
Flow cytometer	Thermo Fisher	Attune NxT
Flow cytometer analysis software	BD	FlowJo
Handheld UV light	Analytik Jena US	UVGL-55
Human MFG-E8	Sino Biological	10853-H08B
Human purified Protein S	Enzyme Research Laboratories	HPS
Laemmli sample buffer	Thermo Fisher	J60015-AD
LDH assay	Promega	J2380	LDH-Glo Cytotoxicity Assay
Mounting media	Invitrogen	P36930	Prolong Gold antifade reagent
Nile red	Sigma-Aldrich	#72485
Polytetrafluoroethylene-coated slides	Tekdon	Customized	Customized specifications: PTFE mask with the following "cut-outs" -  3 glass rectangles, each measuring 17 mm x 9 mm, oriented so that the 17 mm side is 4 mm from the top of the slide and 4 mm from the bottom of the slide, assuming a standard microscope slide of 25 mm x 75 mm. Each rectangle is spaced at least 6 mm away from other rectangles and the edges of the slide. Print PTFE mask on a slide with frosted glass on one side to allow for labeling of the slide.
Protease inhibitors	Cell Signaling Technology	#5872
Protein assay	Bio-Rad	#5000122 RC DC protein assay
TEER electrode	World Precision Instruments	STX3
Trans-epithelial electrical resistance (TEER) meter	World Precision Instruments	EVOM3
Ultraviolet crosslinker device	Analytik Jena US	UVP CL-1000