Blocking apoptosis promotes survival and alters developmental dynamics of human retinal ganglion cells in retinal organoids

Retinal ganglion cells (RGCs) are the projection neurons that transmit visual information from the retina to the brain. In many species, a substantial proportion of RGCs are eliminated by programmed cell death during development to regulate their final number, but how cell death impacts human RGC development remains poorly understood. Here, we characterized the timing and cell-type-specificity of cell death in human fetal retinas and retinal organoids. Both retinas and organoids exhibited two waves of apoptosis: an early wave targeting neurogenic retinal progenitor cells and neuronal precursors, and a late wave affecting RGCs and other neurons. Additionally, organoids displayed a distinct wave of necrosis. To investigate how the apoptotic waves affect retinal development, we differentiated human BAX/BAK double mutant organoids deficient in apoptosis. In these mutants, RGC lifespan and survival increased, while RGC neurogenesis and maturation were delayed. Thus, developmental apoptosis controls not only the quantity of RGCs but also their developmental dynamics. Together, our results highlight the roles of apoptosis in human RGC development and the challenges in retinal organoid design. Addressing these limitations will improve the utility of organoids for studying human retinal development and modeling optic neuropathies like glaucoma.