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@article{Thompson:2015:10.1073/pnas.1413347112,
author = {Thompson, RB and Reffatto, V and Bundy, JG and Kortvely, E and Flinne, JM and Lanzirotti, A and Jones, EA and McPhail, DS and Fearn, S and Bold, K and Ueffing, M and Singh, SG and Pauleikhoff, L and Bird, AC and Lengyel, I},
doi = {10.1073/pnas.1413347112},
journal = {Proceedings of the National Academy of Sciences of the United States of America},
pages = {1565--1570},
title = {Identification of hydroxyapatite spherules provides new insight into subretinal pigment epithelial deposit formation in the aging eye},
url = {http://dx.doi.org/10.1073/pnas.1413347112},
volume = {112},
year = {2015}
}

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TY  - JOUR
AB  - Accumulation of protein- and lipid-containing deposits external to the retinal pigment epithelium (RPE) is common in the aging eye, and has long been viewed as the hallmark of age-related macular degeneration (AMD). The cause for the accumulation and retention of molecules in the sub-RPE space, however, remains an enigma. Here, we present fluorescence microscopy and X-ray diffraction evidence for the formation of small (0.5–20 μm in diameter), hollow, hydroxyapatite (HAP) spherules in Bruch’s membrane in human eyes. These spherules are distinct in form, placement, and staining from the well-known calcification of the elastin layer of the aging Bruch’s membrane. Secondary ion mass spectrometry (SIMS) imaging confirmed the presence of calcium phosphate in the spherules and identified cholesterol enrichment in their core. Using HAP-selective fluorescent dyes, we show that all types of sub-RPE deposits in the macula, as well as in the periphery, contain numerous HAP spherules. Immunohistochemical labeling for proteins characteristic of sub-RPE deposits, such as complement factor H, vitronectin, and amyloid beta, revealed that HAP spherules were coated with these proteins. HAP spherules were also found outside the sub-RPE deposits, ready to bind proteins at the RPE/choroid interface. Based on these results, we propose a novel mechanism for the growth, and possibly even the formation, of sub-RPE deposits, namely, that the deposit growth and formation begin with the deposition of insoluble HAP shells around naturally occurring, cholesterol-containing extracellular lipid droplets at the RPE/choroid interface; proteins and lipids then attach to these shells, initiating or supporting the growth of sub-RPE deposits.
AU  - Thompson,RB
AU  - Reffatto,V
AU  - Bundy,JG
AU  - Kortvely,E
AU  - Flinne,JM
AU  - Lanzirotti,A
AU  - Jones,EA
AU  - McPhail,DS
AU  - Fearn,S
AU  - Bold,K
AU  - Ueffing,M
AU  - Singh,SG
AU  - Pauleikhoff,L
AU  - Bird,AC
AU  - Lengyel,I
DO  - 10.1073/pnas.1413347112
EP  - 1570
PY  - 2015///
SN  - 1091-6490
SP  - 1565
TI  - Identification of hydroxyapatite spherules provides new insight into subretinal pigment epithelial deposit formation in the aging eye
T2  - Proceedings of the National Academy of Sciences of the United States of America
UR  - http://dx.doi.org/10.1073/pnas.1413347112
UR  - https://www.pnas.org/content/112/5/1565/
VL  - 112
ER  -

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