Abstract
Death is defined as the irreversible cessation of circulatory, respiratory or brain activity. Many peripheral human organs can be transplanted from deceased donors using protocols to optimize viability. However, tissues from the central nervous system rapidly lose viability after circulation ceases1,2, impeding their potential for transplantation. The time course and mechanisms causing neuronal death and the potential for revival remain poorly defined. Here, using the retina as a model of the central nervous system, we systemically examine the kinetics of death and neuronal revival. We demonstrate the swift decline of neuronal signalling and identify conditions for reviving synchronous in vivo-like trans-synaptic transmission in postmortem mouse and human retina. We measure light-evoked responses in human macular photoreceptors in eyes removed up to 5 h after death and identify modifiable factors that drive reversible and irreversible loss of light signalling after death. Finally, we quantify the rate-limiting deactivation reaction of phototransduction, a model G protein signalling cascade, in peripheral and macular human and macaque retina. Our approach will have broad applications and impact by enabling transformative studies in the human central nervous system, raising questions about the irreversibility of neuronal cell death, and providing new avenues for visual rehabilitation.
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Data availability
The data that support the findings of this study are available from G-Node at https://doi.org/10.12751/g-node.sayvud. Source data are provided with this paper.
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Acknowledgements
This work was supported by National Institutes of Health (P30 EY014800), and an Unrestricted Grant from Research to Prevent Blindness to the Department of Ophthalmology and Visual Sciences, University of Utah. A.H. is supported by NIH/NCATS grant UL1 TR002550, NIH EY031706, the Daro Foundation, the A. C. Israel Foundation, the Warren Family Foundation, the Renaissance Charitable Foundation, The Rancho Santa Fe Foundation, the Money Arenz Foundation, the Considine Foundation, the Fonseca Foundation, the Pfeiffer Foundation, the Mericos Eye Institute, the Thomas and Audrey Pine Foundation and additional philanthropic funding. F.V. is supported by NIH grant EY031706, Research to Prevent Blindness/Dr. H. James and Carole Free Career Development Award, Diabetes Research Connection, and International Retinal Research Foundation. S.B. is supported by ARVO Foundation for Eye Research EyeFind research grant. B.W.J. is supported by the National Institutes of Health (R01 EY015128, R01 EY028927) and the National Science Foundation (2014862). S.P. is supported by the National Institutes of Health (R01s: CA236352, DK115214, DK118278), Department of Defense (W81XWH1810645), and Wu-Tsai Human Performance Alliance and the Joe and Clara Tsai Foundation. L.S.M. is supported by Velux Stiftung. Figure schematics were made with resources from Biorender.com. We thank J. Dessert for producing the surgical donation and transportation illustrations in Fig. 3a; J. R. Allen for the fusion 360 model of the ex vivo ERG specimen holder in Extended Data Fig. 3; T. Neikirk, a member of the Hanneken laboratory, for providing technical support and assistance; H. Calligaro, a member of the Panda laboratory, for useful discussions of some of the most recent human retina experiments; C. Faulkner and J. Perlmutter for providing non-human primate eyes; the Utah Lions Eye Bank, Lifesharing and the San Diego Eye bank for providing human donor eyes. Finally, we are deeply grateful to those who donated their eyes, and their legal representatives who accommodated the surgical team’s effort to procure the eyes.
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A.H. and F.V. conceived, organized and supervised the project. S.B. carried out and analysed mouse in vivo ERG and low-oxygen ex vivo ERG experiments. F.A. collected and analysed death-to-enucleation delay and low pH mouse ex vivo ERG data and carried out mouse immunohistochemistry staining and imaging. B.W.J. carried out and analysed CMP staining. F.A. and F.V. collected and analysed human research donor data. A.H. recovered the organ donor eyes. F.A., F.V. and L.S.M. acquired and analysed human organ donor data. F.V. acquired and analysed macaque data. F.A. and F.V. prepared the figures. F.A., A.H., S.P. and F.V. wrote the manuscript. All authors discussed and commented on the data.
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Extended data figures and tables
Extended Data Fig. 1 Changes after 45 min death-to-enucleation delay to metabolites related to cell health and synaptic signaling.
Example RGB maps of CMP staining of metabolites in the immediately fixed vs. 45-minute postmortem wild-type retina (a). τQE (Taurine, Glutamine, Glutamate) → RGB for both immediate and 45 min PM retinas. The density maps for each metabolite are also shown (greyscale). Scale bar represents 50 μm. Histograms of the mean levels of Taurine, Glutamine and Glutamate measured in retinas either after immediate enucleation (black) or 45 min enucleation delay (red, b), according to masked cell populations (n = 3 retinas from 3 animals). Data are presented as averages (lines) ± SEM (shaded areas).
Extended Data Fig. 2 Phototransduction sensitivity and kinetics in relation to enucleation delay.
Example plot showing how dim flash response sensitivity is calculated (a). Responses normalized to maximal response of retina plotted against the intensity of light stimulus, curve fits Naka-Rushton function (Eq. 2) to amplitude data, dim flash sensitivity is defined as response amplitude divided by Rmax at constant intensity producing ~20% of the maximal response amplitude. Dim flash sensitivities of retinas from wild-type mouse retinas with different enucleation delays (b), and I1/2 values from retinas of wild-type mice with different enucleation delays (c). Example response plot showing how I1/2 was obtained (d), responses of retina to each intensity presented is plotted and a Naka-Rushton fit applied to the plot. I1/2 is the intensity required to produce half the maximal response size. Amplification constant plotted against enucleation delay for each retina (e). Time-to-peak (tp) and integral (Ti, inset) of dim responses for each retina plotted against the enucleation delay (f, *** indicates p < 0.001 compared to 0min). Exact p values: tp: 0 vs 90 min p = 0.0002, 0 vs 120 min p = 0.002, 0 vs 180 min p = 0.001, Ti: 0 vs 90 min p = 0.002, 0 vs 120 min p = 0.0007, 0 vs 180 min p = 0.01). Example dim flash response showing how time-to-peak (tp) and integration time (Ti) was calculated (g). Time-to-peak is the time from light stimulus onset to the peak of the dim flash response. Integral (Ti) is the area under the dim flash response curve (orange shaded area), divided by the response amplitude. Light stimulus is indicated with a shaded yellow area. For all plots, bar height indicates mean, error bars represent ± SEM. All comparisons are one-way ANOVA with Holm-Bonferroni means comparisons. (DF: 35 for all comparisons, F values: Ti = 8.4, tp = 5.8, Dim flash sensitivity = 2.0, Amplification constant = 1.6, I1/2 : 2.2).
Extended Data Fig. 3 Drawings of ex vivo ERG specimen holder for CNC machining from polycarbonate.
(exported from Fusion 360, Autodesk, used to design the specimen holder for CNC machining). Retina samples are placed on the dome (shaded in blue in b). The dome has electrode channel with ∅0.5–2 mm diameter that determines the recording area. O-ring (a, black shading; b, pink shading) minimizes shunt currents to improve signal-to-noise ratio (SNR).
Extended Data Fig. 4 Comparison of freshly enucleated Macaque retina, and human organ and research donor maculas with longer enucleation delays.
Light responses of macular cones from freshly enucleated macaque (a, hatched squares, n = 5 maculae, from 3 animals) human DCD donor (b, filled triangles, top trace, n = 5 maculae from 3 donors) and research donor eyes (b, crosses lower trace, n = 23 maculae from 17 donors). (c) The maximal response obtained from maculae from each tissue type plotted against enucleation delay. Inset shows Ln of Rmax from each macula, and linear fit in red with decay (τ = 74 min). (d) Example of how sensitivity, S (1/I½), is calculated. Macular responses to different light intensities were plotted and a Hill curve fitted (see Eq. 3 in Methods) to determine the intensity required to produce a half-maximal response size. (e) Sensitivities of each macula plotted against enucleation delay, linear fit in red (no significant correlation between delay and S, ANOVA, DF =24, F value = 3.9, p = 0.06).
Extended Data Fig. 5 Contributing factors to the quality of light-evoked responses from human postmortem research donor retinas.
(a) Histogram of research donor ages, with numbers of donors represented within the bars. (b) Histogram of the primary cause of death of donors as noted on tissue donor forms. (c) The maximal response obtained from each donor eye plotted against donor age, with linear fit showing a positive correlation (n = 23 maculae, Pearson’s r = 0.61, adjusted R2 = 0.37) (d) Average maximal amplitude obtained from each research donor according to the primary cause of death (Stroke: squares, n = 2 donors, ACE: circles, n = 4 donors, Sepsis: triangles, n = 7 donors), data are averages of responses obtained from each individual donor, with mean presented as a solid line. Maculae that did not produce any detectable responses were included as a response size of 0 µV. Donor information (e) for a single donor (donor #8) in which ex vivo ERG ON-bipolar cell responses were recorded to flash intensities of 29–32,500 photons µm−2(f). Yellow bar indicates the onset of flash stimuli.
Extended Data Fig. 6 Decay of cone photoreceptor and bipolar cell function in relation to the enucleation delay in Gnat1−/− mice.
(a) The Rmax of mouse cone photoreceptors (black circle) and bipolar cells (red circle) plotted as a function of enucleation delay, normalized to maximal response obtained with 0 min enucleation delay. Smooth traces plot exponential decay function fitted to mean data. Inset plots natural log amplitude data for individual retinas (τ = 53 min for photoreceptors, τ = 35 min for bipolar cells), and linear fit (Photoreceptor fit: Pearson’s r = −0.851 with adj. R2 = 0.704, Bipolar cell fit: Pearson’s r = 0.905 with adj R2 = 0.819). Sensitivity of retinas at different enucleation delays (b, 1/I1/2), Pearson’s r = 0.52 with adj. R2 = 0.27. For all plots, n (retinas, animals) is 0min = 7, 45 min = 5, 120 min = 3, responses from individual retinas are plotted as hollow circles.
Extended Data Fig. 7 Double-flash responses allow the isolation of cone responses from rod in both human macula (a) and periphery (b).
Representative responses from human donor macular (a, black) and peripheral (b, red) punches to double-flash light stimuli to isolate cone responses. Light flashes are indicated with yellow shading, rod saturating flash intensity was ~25,000, cone stimulating intensities used were 2800–147,000 photons (560 nm) µm−2.
Extended Data Fig. 8 Comparison of Human Macular and Peripheral Cone sensitivity and kinetics.
Dim flash response time-to-peak (at intensity producing response size 15–20% of maximal retina response in ms) recorded from human macular and peripheral cone responses (c), individual responses are shown as diamonds, with line indicating mean. The average dim flash photoreceptor response normalized to maximal response recorded from each retina, plotted against time (d). Graph line shows average response with shaded area showing ± SEM.
Extended Data Fig. 9 Determination of dominant time constant (τD) for macaque cones.
Representative responses to flashes of light ranging from 220 to 183,000 photons (500 nm) µm−2 from a macular (a) and peripheral (c) sample recorded using ex vivo ERG. A rod-saturating pre-flash (15,000 photons µm−2 at 500 nm) was used to isolate cones in peripheral samples. Saturation times (Tsat) measured at 50% recovery (example red dashed line in a, c) plotted as a function of logarithmic light flash intensity (in photons µm−2) for induvial macular (b) and peripheral samples (d). e. Log response amplitudes plotted against light intensities in macaque maculae (black) and peripheral retina punches (red) with Hill function fits (Eq. 3 in Methods) . n = 5 macular and n = 7 peripheral punches from 3 animals. (f) Table of statistics for slopes in (b, d), i.e. τD, mean ± SEM.
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Abbas, F., Becker, S., Jones, B.W. et al. Revival of light signalling in the postmortem mouse and human retina. Nature 606, 351–357 (2022). https://doi.org/10.1038/s41586-022-04709-x
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DOI: https://doi.org/10.1038/s41586-022-04709-x
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