In Vivo Differentiation of hESC-Derived Neural Crest Cells into Trabecular Meshwork Cells.

Primary open-angle glaucoma is a prevalent type of degenerative eye disease that results in lifelong blindness, and its critical pathogenic cause is trabecular meshwork (TM) dysfunction or decreased TM cellularity. Considering that TM develops from neural crest cells (NCCs), we investigate the potential of human embryonic stem cell (hESC)-derived NCCs transplantation for TM regeneration. We used a chemically defined method to induce the differentiation of NCCs and injected 1.0 × 10⁶ hESC-derived NCCs combined with 100 μmol/L Y-27632 into the anterior chamber of rabbit. Intraocular pressure (IOP), TM, and corneal changes of rabbits with cell transplantation were examined with TonoPEN AVIA, slit lamp microscope, dual-immunofluorescence staining, and optical coherence tomography. The hESC-derived NCCs underwent homogenous differentiation over the course of 5 days' induction, which expressed the typical neural crest markers HNK-1, P75, SOX10, and AP-2α. NOD/SCID mice received injections of hESC-derived NCCs in the groin or axilla. There was no teratoma formation. When intracamerally injected, hESC-derived NCCs integrated into the TM tissue and expressed mature TM cell markers Aqp1, Chi3l1, and Timp3 after 7 days transplantation in rabbit eyes. The IOP and central corneal thickness basically maintained at normal levels within 2 weeks. No significant adverse effects in rabbits with hESC-derived NCC injection were observed after 5 weeks of cell transplantation. Our findings indicate that hESC-derived NCCs could integrate into the TM tissue and differentiate into mature TM cells after being injected intracamerally, showing a potential therapeutic approach to addressing TM dysfunction in the treatment of glaucoma. Impact Statement Glaucoma is the leading cause of irreversible blindness that poses a substantial burden on public health and the quality of life of affected individuals. We found human embryonic stem cell (hESC)-derived NCCs integrated into the trabecular meshwork (TM) tissue, and expressed mature TM cell markers Aqp1, Chi3l1, and Timp3 after intracameral injection. The results also highlighted hESC-derived NCC treatment's safety, with no treatment-related serious adverse events during the long-term follow-up. These findings suggest that hESC-derived NCCs offer potential for new interventions for the therapy of glaucoma.