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Method Article
Here, we present a method to efficiently harness the cardiac differentiation potential of young sources of human mesenchymal stem cells in order to generate functional, contracting, cardiomyocyte-like cells in vitro.
Myocardial infarction and the subsequent ischemic cascade result in the extensive loss of cardiomyocytes, leading to congestive heart failure, the leading cause of mortality worldwide. Mesenchymal stem cells (MSCs) are a promising option for cell-based therapies to replace current, invasive techniques. MSCs can differentiate into mesenchymal lineages, including cardiac cell types, but complete differentiation into functional cells has not yet been achieved. Previous methods of differentiation were based on pharmacological agents or growth factors. However, more physiologically relevant strategies can also enable MSCs to undergo cardiomyogenic transformation. Here, we present a differentiation method using MSC aggregates on cardiomyocyte feeder layers to produce cardiomyocyte-like contracting cells.
Human umbilical cord perivascular cells (HUCPVCs) have been shown to have a greater differentiation potential than commonly investigated MSC types, such as bone marrow MSCs (BMSCs). As an ontogenetically younger source, we investigated the cardiomyogenic potential of first-trimester (FTM) HUCPVCs compared to older sources. FTM HUCPVCs are a novel, rich source of MSCs that retain their in utero immunoprivileged properties when cultured in vitro. Using this differentiation protocol, FTM and term HUCPVCs achieved significantly increased cardiomyogenic differentiation compared to BMSCs, as indicated by the increased expression of cardiomyocyte markers (i.e., myocyte enhancer factor 2C, cardiac troponin T, heavy chain cardiac myosin, signal regulatory protein α, and connexin 43). They also maintained significantly lower immunogenicity, as demonstrated by their lower HLA-A expression and higher HLA-G expression. Applying aggregate-based differentiation, FTM HUCPVCs showed increased aggregate formation potential and generated contracting cells clusters within 1 week of co-culture on cardiac feeder layers, becoming the first MSC type to do so.
Our results demonstrate that this differentiation strategy can effectively harness the cardiomyogenic potential of young MSCs, such as FTM HUCPVCs, and suggests that in vitro pre-differentiation could be a potential strategy to increase their regenerative efficacy in vivo.
Congestive heart failure (CHF) persists as a leading cause of morbidity and mortality worldwide. CHF often occurs following the massive loss of cardiomyocytes and the development of cell-free scar tissue as the pathological result of a myocardial infarction (MI)1. While the heart is a partially self-renewing organ, the resident stem and progenitor cell pool responsible for executing tissue regeneration significantly diminishes in abundance and function in aged patients, often becoming insufficient for optimal recovery after injury. Thus, there is great interest in developing experimental treatments that involve the transplantation of healthy donor cells into the damaged myocardium. It is imperative that the donor cells not only restore the structure of the tissue, but also achieve the functional recovery of the affected myocardium.
The native heart employs heart tissue-resident and endogenous bone marrow-originated stem cells for post-injury repair2,3,4. Regenerative cells- host- and donor-derived alike- must have the capacity to obtain the appropriate phenotype and function in the microenvironment of the remodeling myocardium, along with the ability to efficiently and safely replace the lost cells. In vitro differentiation methods have been used extensively to achieve high-efficiency, stem cell-based cardiomyocyte production5,6. The expression profile of cardiac lineage markers is used to define the process of stem cell differentiation towards the cardiac lineage7. Early differentiation markers, such as NKX2.5, myocyte enhancer factor 2C (Mef2c), and GATA48,9, can be an indication of the initiation of the cardiomyogenic process. Mature cardiomyocyte markers commonly used to assess differentiation efficacy are signal regulatory protein α (SIRPA)10, cardiac troponin T (cTnT)11, heavy chain cardiac myosin (MYH6)8,12,13, and connexin 43 (Cx43)14,15,16. The methods using embryonic stem cells (ESCs) and pluripotent stem cells (PSCs) have been thoroughly optimized and discussed regarding the details of inductive factors, oxygen and nutrient gradients, and the exact timing of action5,6,7,17,18. Nonetheless, ESC- and PSC-based technologies still present multiple ethical and safety concerns, along with suboptimal electrophysiological and immunological features19,20. Hosts transplanted with these cells often experience immunorejection and require permanent immunosuppression. This is mainly due to mismatching major histocompatibility complex (MHC) molecules in the host and donor and to the resulting T-cell response21. While individual MHC class I matching is a possible solution, a more accessible clinical practice would require a cell source that is universally immunoprivileged to overcome the concern of rejection.
As an alternative cell source for use in clinical applications, MSCs and in particular, BMSCs, have been investigated for use in tissue regeneration since their initial description in 199522. MSCs are believed to be resident regenerative cells that can be found in nearly any vascularized tissue23. Upon isolation from the desired source, MSCs can easily be expanded in culture, have extensive paracrine capacity, and often possess immunoprivileged or immunomodulatory properties24,25. Their safety and efficacy have already been shown in several pre-clinical studies, in particular for cardiac regeneration3,26.
Many MSC differentiation strategies utilize pharmacological agents, such as 5-azacytidine22 and DMSO27, and growth or morphogenic factors, like BMPs5,7,28,29 or angiotensin-II30, with variable efficiency. These strategies, however, are not based on the obstacles that a naïve regenerative cell is likely to encounter after homing or being delivered to the site of injury in vivo. More physiologically relevant strategies, while more difficult to define and manipulate, are based on the premise that MSC differentiation can be induced through signals from the tissue microenvironment itself. Previous studies have shown that exposure to the cardiac cell lysates31 or ventricular myocardium32,33, or direct contact with primary cardiomyocytes in vitro15,34, can increase the expression of cardiac markers in MSCs. Others have demonstrated spontaneous cardiomyogenesis after treating cardiac injuries with MSCs35,36,37,38, although in part, the fusion of BMSCs and cardiomyocytes39,40 generated the nascent myocardium. To our knowledge, functional, spontaneously contracting cardiomyocytes from human MSCs (hMSCs) of any tissue source have not yet been reported.
The current consensus is that all MSCs arise from perivascular cells23. Young MSCs with pericyte properties can be isolated from the perivascular region of human umbilical cord tissue41,42,43. In comparison to BMSCs, HUCPVCs possess increased differentiation potential and several other regenerative advantages, both in vitro41,44 and in vivo45,46,47. Notably, the source being the maternal-fetal interface, HUCPVCs have significantly lower immunogenicity compared to adult sources of MSCs. Our research focuses on the characterization and pre-clinical applications of FTM HUCPVCs, the youngest source of MSCs investigated, which we have previously shown to have increased proliferative and higher multilineage differentiation capacities, including in the cardiomyogenic lineage41.
Here, we present a protocol that combines aggregate formation and primary cardiac cell feeder layers as inductive forces to attain the complete cardiomyogenic differentiation of MSCs. Aggregates provide a 3D environment, which better models conditions in vivo compared to 2D adherent cultures. Utilizing cardiac feeder layers provides an environment that is representative of the ultimate transplantation site for the MSCs. We demonstrate that younger sources of MSCs isolated from pre- or post-natal umbilical cords have a higher capacity to form aggregates and to reach the cardiac phenotype compared to adult BMSCs, while still maintaining their immune-privilege. Besides the steep elevation of cardiac lineage marker genes and the induced expression of intracellular (i.e., cTnT and MYH6) and cell-surface proteins (i.e., SIRPA and Cx43) specific for cardiomyocytes, we show that the differentiation potential of FTM HUCPVCs can be harnessed with this method and that they can give rise to spontaneously contracting cardiomyocyte-like cells.
All studies involving animals were conducted and reported according to ARRIVE guidelines48. All studies were performed with institutional research ethics board approval (REB number 454-2011, Sunnybrook Research Institute; REB 29889, University of Toronto, Toronto, Canada). All animal procedures were approved by the Animal Care Committee of the University Health Network (Toronto, Canada), and all animals received humane care in compliance with the Guide for the Care and Use of Laboratory Animals, 8th edition (National Institutes of Health 2011).
1. Tissue Culture
2. Preparation of Primary Rat Cardiomyocyte-MSC Co-cultures
3. Preparation of Aggregate Co-cultures
4. Flow Cytometry (FC) and Fluorescence-activated Cell Sorting (FACS)
5. Immunocytochemistry (ICC) and Microscopy
6. RNA Isolation and Quantitative RT-PCR
HUCPVCs Display Higher Aggregate-formation Potential and CD49f Expression Levels Compared to BMSCs:
To induce the differentiation of hMSCs (i.e., FTM HUCPVCs, term HUCPVCs, and BMSCs), single-cell suspensions of undifferentiated MSCs or MSC-containing hanging drops (Table 1) were transferred onto rat primary cardiomyocyte monolayers to establish direct co-cultures or aggregate co-cultur...
The cardiac differentiation of stem cells has been under development for over 2 decades, with several different strategies being used to generate cardiomyocyte-like cells from MSC sources. Many of these strategies, however, are inefficient, and the conditions used are often not representative of the environment transplanted cells encounter in vivo.
In contrast to existing methods, the protocol presented here utilizes a combination of primary cardiac feeder layers and MSC aggregate for...
Dr. Clifford L. Librach is joint holder of the patent: Methods of isolation and use of cells derived from first trimester umbilical cord tissue, granted in Canada and Australia.
The authors thank the following staff members and research personnel for their contributions: Matthew Librach, Leila Maghen, Tanya A. Baretto, Shlomit Kenigsberg, and Andrée Gauthier-Fisher. This work was supported by the The Ontario Research Fund - Research Excellence (ORF-RE, Round #7) and CReATe Program Inc.
Name | Company | Catalog Number | Comments |
0.25% Trypsin/EDTA | Gibco | 25200056 | For cell dissociation |
Alpha-MEM | Gibco | 12571071 | For HUCPVC and BMSC culture media. |
PE-conjugated anti-human/mouse CD49f antibody | Biolegend | 313612 | Integrin marker for FC |
APC-conjugated human Cx43/GJA1 antibody | R&D Systems | FAB7737A | Connexin 43 marker for FC |
FITC-conjugated HLA-A2 antibody | Genway Biotech Inc. | GWB-66FBD2 | Immunogenicity marker for FC |
FITC-conjugated anti-HLA-G [MEM-G/9] antibody | Abcam | ab7904 | Immunogenicity marker for FC |
FITC-conjugated mouse anti-human SIRPA/CD172a antibody | AbD Serotec/Bio-Rad | MCA2518F | Cardiac marker for FC |
APC-conjugated human TRA-1-85/CD147 antibody | R&D Systems | FAB3195A | Human cell marker for FC and FACS |
FITC-conjugated human TRA-1-85/CD147 antibody | R&D Systems | FAB3195F | Human cell marker for FC and FACS |
Anti-connexin 43/GJA1 antibody | Abcam | ab11370 | Cx43. For ICC |
Goat anti-rabbit IgG (H+L) cross-absorbed secondary antibody, Alexa Fluor 555 | Life Technologies | A-21428 | For ICC |
Anti-sarcomeric alpha actinin [EA-53] antibody | Abcam | ab9465 | aSARC. For ICC |
Goat anti-mouse IgM heavy chain cross-absorbed secondary antibody, Alexa Fluor 555 | Life Technologies | A-21426 | For ICC |
Mef2C (D80C1) XP rabbit antibody | New England BioLabs Ltd. | 5030S | For ICC |
Donkey anti-rabbit IgG (H+L) secondary antibody, Alexa Fluor 488 | Life Technologies | A-21206 | For ICC |
Anti-nuclei (HuNu) (clone 235-1) antibody | EMD Millipore | MAB1281 | For ICC |
MZ9.5 Stereomicroscope | Leica | For imaging aggregates. | |
1.5 ml centrifuge microtubes | Axygen | MCT-150-C | For staining MSCs with fluorescent dye. |
ImageJ | Open source image processing software. | ||
Aria II | BD | UHN SickKids FC Facility. For cell sorting. | |
Bone marrow mesechymal stromal cells | Lonza | PT-2501 | BMSCs |
Bovine serum albumin | Sigma-Aldrich | A7030-100G | BSA. To prepare solutions for ICC |
BrdU | EMD Millipore | MAB3424 | Caution: BrdU is a strong teratogen and suspected mutagen. Please ensure proper training and refer to the SDS before use. |
Canto II | BD | UHN SickKids FC Facility. For flow cytometry. | |
cDNA EcoDry Premix | Clontech/Takara | 639570 | For preparation of cDNA for qPCR |
CellTracker Green CMFDA Dye | Life Technologies | C7025 | Fluorescent imaging of cell cytoplasm |
Countess automated cell counter | Invitrogen Inc. | C10227 | For cell counting |
DMEM-F12 | Sigma-Aldrich | D6421 | For rat primary cardiomyocyte culture medium. |
Dulbecco's Phosphate Buffered Saline | Gibco | 10010023 | D-PBS, without Ca2+, Mg2+ |
EVOS | Life Technologies | In-house fluorescent microscope | |
FACSCalibur | BD | In-house. For flow cytometry. | |
Fetal bovine serum (Hyclone) | GE Healthcare | SH3039603 | FBS. Component of cell culture medium. |
IDT Prime Time qPCR probes | Integrated Data Technologies | FAM fluorophore | http://www.idtdna.com/pages/products/gene-expression/primetime-qpcr-assays-and-primers |
Lab Vision PermaFluor Aqueous Mounting Medium | ThermoScientific | TA-030-FM | For storage of cells to undergo ICC |
LSR II | BD | UHN SickKids FC Facility. For flow cytometry. | |
MoFlo Astrios | Beckman Coulter | UHN SickKids FC Facility. For cell sorting. | |
Normal goat serum | Cell Signaling Technology | 5425S | NGS. Used in blocking solution for ICC |
Nunc Lab-Tek II Chamber Coverglass, 8-wells | Thermo Scientific Nunc | 155409 | To prepare samples for ICC |
OmniPur Triton X-100 Surfactant | EMD Millipore | 9410-OP | As a component of permeabilizing solution when preparing cells for ICC |
Paraformaldehyde, 16% Solution, EM Grade | Electron Microscopy Sciences | 15710 | For fixing cells for ICC. |
Penicillin/streptomycin | Gibco | 15140122 | Component of cell culture medium. |
Primers | Sigma | Custom Standard DNA Oligos, Desalted, 0.2 μmol | CTnT_F: GGC AGC GGA AGA GGA TGC TGA A; CTnT_R: GAG GCA CCA AGT TGG GCA TGA ACG A; MYH6 F: GCA AAG TAC TGG ATG ACA CGC T; MYH6 R: GTC ATT GCT GAA ACC GAG AAT G |
Quorum Spinning Disk Confocal | Zeiss | SickKids Imaging Facility | |
ReproCardio hiPS cell derived cardiomyocytes | ReproCell | RCD001N | Positive control for qPCR |
RNeasy mini kit | Qiagen | 74106 | To isolate RNA for qPCR |
Rotor-Gene SYBR Green PCR Kit | Qiagen | 204074 | For qPCR with master mix |
RPMI 1640 | Gibco | A1049101 | For MSC, monocyte coculture medium. |
TaqMan qPCR primer assays | Thermo Fisher Scientific | 4444556 | For qPCR |
Trypan Blue | Life Technologies | T10282 | Staining of cells for viability and counting |
Trypsin | Gibco | 272500108 | For cell dissociation |
Volocity | Perkin-Elmer | Volocity 6.3 | Imaging software |
0.2 μm pore filter | Thermo Fisher Scientific | 566-0020 | For sterilizing tissue culture media |
HERAcell 150i CO2 Incubator | Thermo Fisher Scientific | 51026410 | For incubating cells |
Dulbecco's phosphate buffered saline | Sigma-Aldrich | D8537 | PBS. 1X, Without calcium chloride and magnesium chloride |
Forceps | Almedic | 7727-A10-704 | For handing rat heart. Can use any similar forceps. |
Scissors | Fine Science Tools | 14059-11 | For mincing rat heart. Curved scissors recommended. |
50 mL tube | BD Falcon | 352070 | For collection during cardiomyocyte collection and general tissue culture procedures |
15 mL tube | BD Falcon | 352096 | For general tissue culture procedures |
6-well plates | Thermo Scientific Nunc | CA73520-906 | For tissue culture |
10 cm tissue culture dishes | Corning | 25382-428 | For aggregate formation |
Axiovert 40C Microscope | Zeiss | For bright-field imaging through out tissue culture and the rest of the protocol | |
70 μm cell strainer | Fisherbrand | 22363548 | To ensure a single cell suspension before flow cytometry or sorting |
Triton X-100 | EMD Millipore | 9410-1L | Used in permeabilization solution for ICC |
Hoechst 33342 | Thermo Fisher Scientific | H1399 | Stain used during visualization of Cx43 localization |
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