Name: generation of human nasal epithelial cell spheroids for individualized cystic fibrosis transmembrane conductance regulator study
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Description: Watch this Scientific Journal Video about Generation of Human Nasal Epithelial Cell Spheroids for Individualized Cystic Fibrosis Transmembrane Conductance Regulator Study at JoVE.com

This work was supported by Cystic Fibrosis Foundation Therapeutics, grant number CLANCY14XX0, and through Cystic Fibrosis Foundation, grant number CLANCY15R0. The authors wish to thank Kristina Ray for her assistance in patient recruitment and regulatory oversight. The authors also wish to thank the HNE working group, supported by the Cystic Fibrosis Foundation, who assisted in generation of HNE culture capabilities: Preston Bratcher, Calvin Cotton, Martina Gentzsch, Elizabeth Joseloff, Michael Myerburg, Dave Nichols, Scott Randell, Steve Rowe, G. Marty Solomon, and Katherine Tuggle.

HNE samples were procured from subjects recruited through the Cincinnati Children&#39;s Hospital Medical Center CF Research Center. All methods described here have been approved by the Institutional Review Board (IRB) of Cincinnati Children&#39;s Hospital Medical Center. Written consent was obtained from all subjects prior to testing.
1. Prepare Expansion Media and Antibiotic Media
<ol>
	<li>Gather media components listed in Table 1. Thaw frozen materials at room temperature...

<ol>
	<li>Rowe, S. M., Miller, S., Sorscher, E. J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Cystic+fibrosis.">Cystic fibrosis.</a> N Engl J Med. 352 (19), 1992-2001 (2005).</li><li>Rommens, J. M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Identification+of+the+cystic+fibrosis+gene:+chromosome+walking+and+jumping.">Identification of the cystic fibrosis gene: chromosome walking and jumping.</a> Science. 245 (4922), 1059-1065 (1989).</li><li>Anderson, M. P., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Nucleoside+triphosphates+are+required+to+open+the+CFTR+chloride+channel.">Nucleoside triphosphates are required to open the CFTR chloride channel.</a> Cell. 67 (4), 775-784 (1991).</li><li>Boucher, R. C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Human+airway+ion+transport.+Part+one.">Human airway ion transport. Part one.</a> Am J Respir Crit Care Med. 150 (1), 271-281 (1994).</li><li>Ehre, C., Ridley, C., Thornton, D. J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Cystic+fibrosis:+an+inherited+disease+affecting+mucin-producing+organs.">Cystic fibrosis: an inherited disease affecting mucin-producing organs.</a> Int J Biochem Cell Biol. 52, 136-145 (2014).</li><li>Accurso, F. J., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Effect+of+VX-770+in+persons+with+cystic+fibrosis+and+the+G551D-CFTR+mutation.">Effect of VX-770 in persons with cystic fibrosis and the G551D-CFTR mutation.</a> N Engl J Med. 363 (21), 1991-2003 (2010).</li><li>De Boeck, K., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Efficacy+and+safety+of+ivacaftor+in+patients+with+cystic+fibrosis+and+a+non-G551D+gating+mutation.">Efficacy and safety of ivacaftor in patients with cystic fibrosis and a non-G551D gating mutation.</a> J Cyst Fibros. 13 (6), 674-680 (2014).</li><li>Moss, R. B., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Efficacy+and+safety+of+ivacaftor+in+patients+with+cystic+fibrosis+who+have+an+Arg117His-CFTR+mutation:+a+double-blind,+randomised+controlled+trial.">Efficacy and safety of ivacaftor in patients with cystic fibrosis who have an Arg117His-CFTR mutation: a double-blind, randomised controlled trial.</a> Lancet Respir Med. 3 (7), 524-533 (2015).</li><li>Wainwright, C. E., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Lumacaftor-Ivacaftor+in+Patients+with+Cystic+Fibrosis+Homozygous+for+Phe508del+CFTR.">Lumacaftor-Ivacaftor in Patients with Cystic Fibrosis Homozygous for Phe508del CFTR.</a> N Engl J Med. , (2015).</li><li>Brewington, J. J., McPhail, G. L., Clancy, J. P. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Lumacaftor+alone+and+combined+with+ivacaftor:+preclinical+and+clinical+trial+experience+of+F508del+CFTR+correction.">Lumacaftor alone and combined with ivacaftor: preclinical and clinical trial experience of F508del CFTR correction.</a> Expert Rev Respir Med. 10 (1), 5-17 (2016).</li><li>. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=.">.</a> CFTR2 Database. , (2017).</li><li>Mou, H., Brazauskas, K., Rajagopal, J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Personalized+medicine+for+cystic+fibrosis:+establishing+human+model+systems.">Personalized medicine for cystic fibrosis: establishing human model systems.</a> Pediatr Pulmonol. 50 Suppl 40, S14-S23 (2015).</li><li>Randell, S. H., Fulcher, M. L., O'Neal, W., Olsen, J. C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Primary+epithelial+cell+models+for+cystic+fibrosis+research.">Primary epithelial cell models for cystic fibrosis research.</a> Methods Mol Biol. 742, 285-310 (2011).</li><li>Whitcutt, M. J., Adler, K. B., Wu, R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+biphasic+chamber+system+for+maintaining+polarity+of+differentiation+of+cultured+respiratory+tract+epithelial+cells.">A biphasic chamber system for maintaining polarity of differentiation of cultured respiratory tract epithelial cells.</a> In Vitro Cell Dev Biol. 24 (5), 420-428 (1988).</li><li>Worthington, E. N., Tarran, R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Methods+for+ASL+measurements+and+mucus+transport+rates+in+cell+cultures.">Methods for ASL measurements and mucus transport rates in cell cultures.</a> Methods Mol Biol. 742, 77-92 (2011).</li><li>Van Goor, F., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Correction+of+the+F508del-CFTR+protein+processing+defect+in+vitro+by+the+investigational+drug+VX-809.">Correction of the F508del-CFTR protein processing defect in vitro by the investigational drug VX-809.</a> Proc Natl Acad Sci U S A. 108 (46), 18843-18848 (2011).</li><li>Hug, M. J., Tummler, B. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Intestinal+current+measurements+to+diagnose+cystic+fibrosis.">Intestinal current measurements to diagnose cystic fibrosis.</a> J Cyst Fibros. 3 Suppl 2, 157-158 (2004).</li><li>van Barneveld, A., Stanke, F., Ballmann, M., Naim, H. Y., Tummler, B. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Ex+vivo+biochemical+analysis+of+CFTR+in+human+rectal+biopsies.">Ex vivo biochemical analysis of CFTR in human rectal biopsies.</a> Biochim Biophys Acta. 1762 (4), 393-397 (2006).</li><li>Dekkers, J. F., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+functional+CFTR+assay+using+primary+cystic+fibrosis+intestinal+organoids.">A functional CFTR assay using primary cystic fibrosis intestinal organoids.</a> Nat Med. 19 (7), 939-945 (2013).</li><li>Dekkers, J. F., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Optimal+correction+of+distinct+CFTR+folding+mutants+in+rectal+cystic+fibrosis+organoids.">Optimal correction of distinct CFTR folding mutants in rectal cystic fibrosis organoids.</a> Eur Respir J. 48 (2), 451-458 (2016).</li><li>Dekkers, R., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+bioassay+using+intestinal+organoids+to+measure+CFTR+modulators+in+human+plasma.">A bioassay using intestinal organoids to measure CFTR modulators in human plasma.</a> J Cyst Fibros. 14 (2), 178-181 (2015).</li><li>Zomer-van Ommen, D. D., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Limited+premature+termination+codon+suppression+by+read-through+agents+in+cystic+fibrosis+intestinal+organoids.">Limited premature termination codon suppression by read-through agents in cystic fibrosis intestinal organoids.</a> J Cyst Fibros. , (2015).</li><li>Bridges, M. A., Walker, D. C., Davidson, A. G. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Cystic+fibrosis+and+control+nasal+epithelial+cells+harvested+by+a+brushing+procedure.">Cystic fibrosis and control nasal epithelial cells harvested by a brushing procedure.</a> In Vitro Cell Dev Biol. 27a (9), 684-686 (1991).</li><li>Di Lullo, A. M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=An+&amp;#34;ex+vivo+model&amp;#34;+contributing+to+the+diagnosis+and+evaluation+of+new+drugs+in+cystic+fibrosis.">An &amp;#34;ex vivo model&amp;#34; contributing to the diagnosis and evaluation of new drugs in cystic fibrosis.</a> Acta Otorhinolaryngol Ital. 37 (3), 207-213 (2017).</li><li>Pranke, I. M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Correction+of+CFTR+function+in+nasal+epithelial+cells+from+cystic+fibrosis+patients+predicts+improvement+of+respiratory+function+by+CFTR+modulators.">Correction of CFTR function in nasal epithelial cells from cystic fibrosis patients predicts improvement of respiratory function by CFTR modulators.</a> Sci Rep. 7 (1), 7375 (2017).</li><li>Devalia, J. L., Davies, R. J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Human+nasal+and+bronchial+epithelial+cells+in+culture:+an+overview+of+their+characteristics+and+function.">Human nasal and bronchial epithelial cells in culture: an overview of their characteristics and function.</a> Allergy Proc. 12 (2), 71-79 (1991).</li><li>Devalia, J. L., Sapsford, R. J., Wells, C. W., Richman, P., Davies, R. J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Culture+and+comparison+of+human+bronchial+and+nasal+epithelial+cells+in+vitro.">Culture and comparison of human bronchial and nasal epithelial cells in vitro.</a> Respir Med. 84 (4), 303-312 (1990).</li><li>Thavagnanam, S., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Nasal+epithelial+cells+can+act+as+a+physiological+surrogate+for+paediatric+asthma+studies.">Nasal epithelial cells can act as a physiological surrogate for paediatric asthma studies.</a> PLoS One. 9 (1), e85802 (2014).</li><li>Jorissen, M., Van der Schueren, B., Van den Berghe, H., Cassiman, J. J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+preservation+and+regeneration+of+cilia+on+human+nasal+epithelial+cells+cultured+in+vitro.">The preservation and regeneration of cilia on human nasal epithelial cells cultured in vitro.</a> Arch Otorhinolaryngol. 246 (5), 308-314 (1989).</li><li>Brewington, J. J., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Detection+of+CFTR+function+and+modulation+in+primary+human+nasal+cell+spheroids.">Detection of CFTR function and modulation in primary human nasal cell spheroids.</a> J Cyst Fibros. , (2017).</li><li>Sun, H., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Tgf-beta+downregulation+of+distinct+chloride+channels+in+cystic+fibrosis-affected+epithelia.">Tgf-beta downregulation of distinct chloride channels in cystic fibrosis-affected epithelia.</a> PLoS One. 9 (9), e106842 (2014).</li><li>Boucher, R. 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This protocol describes the generation of patient-derived nasal cell spheroid cultures able to produce an individualized, specific model of CFTR function. There are several key steps in the process that should be closely attended to avoid difficulty. First is a good sample acquisition from the patient's nose. A good sample should have &gt;50,000 cells, limited mucus/debris, and be ready for processing within 4 h (though success is also easily achievable with overnight shipping on ice). Practice acquiring samples with cur...

Cystic Fibrosis (CF) is a fatal, autosomal recessive disease affecting over 70,000 people worldwide1. This life-shortening genetic disease is caused by mutations in the Cystic Fibrosis Transmembrane conductance Regulator protein (CFTR)2. CFTR is a member of the adenosine triphosphate-binding cassette family, and functions as an ion channel allowing movement of chloride and bicarbonate across the apical membranes of multiple polarized epithelia including the gastrointestinal tract, sweat gland, and respiratory tree, among others3,4. As such, dysfunctional CFTR leads to multisystem epithelial dysfunction, with most mortality stemming from the respiratory disease1. In the CF lung, loss of CFTR-driven airway surface liquid (ASL) regulation and mucus release leads to thickened mucus, airway obstruction, chronic infection, and progressive airway remodeling and loss of lung function1,5.
Despite the identification of CFTR dysfunction as the cause of disease, therapies in CF traditionally focused on mitigation of symptoms (e.g., pancreatic enzyme replacement therapy, airway clearance therapies)1. This approach was recently revolutionized by the advent of novel therapeutics, termed &#34;CFTR modulators,&#34; that directly target dysfunctional CFTR. This approach has shifted the clinical landscape from symptom management to disease-modifying care but carries several limitations6,7,8,9,10. Modulator activity is specific to the protein defect accompanying each CFTR mutation and limited to select genetic populations11. This limitation is driven by the heterogeneous nature of protein defects, but also by the impracticality of clinical trials in rare mutation groups. In addition, among subjects with well-studied genotypes (e.g., F508del/F508del CFTR, the most common CFTR mutation), there is wide variability in disease burden and modulator response6,7,8,9,11.
To overcome both of these issues, investigators have proposed the use of personalized models for preclinical testing12. This concept utilizes patient-specific tissue to generate an individualized ex vivo model system for compound testing, predicting in vivo subject response to therapies in a personalized fashion. Once validated, such a model could be used by clinicians to drive precision therapy regardless of the patient&#39;s underlying CFTR genotype.
Human bronchial epithelial (HBE) cells obtained from explant tissue at the time of lung transplant established the possibility of such a model for CF13,14. HBEs grown at an air-liquid interface (ALI) allow for functional CFTR quantification directly through electrophysiologic testing or indirectly through measures of ASL homeostasis13,15. This model has been critical to understanding CFTR biology and was a key driver in the development of CFTR modulators16. Unfortunately, HBE models are not tenable as a personalized model due to the invasive nature of acquisition (lung transplant or bronchial brushing) and lack of samples for those with rare mutations or mild disease. Conversely, intestinal tissue, obtained from rectal or duodenal biopsy specimens, can be used for intestinal current measurement (ICM) or a swelling-based organoid assay to study individualized CFTR function17,18,19. Organoid assays, in particular, are very sensitive models of CFTR activity20,21,22. Both models are limited by the tissue source (intestinal tissue, while most disease pathology is respiratory) and the semi-invasive method of acquisition. Alternatively, several investigators have studied human nasal epithelial (HNE) cells to model CFTR restoration23,24,25. HNEs can be safely harvested by brush or curettage in subjects of any age and, when cultured in ALI, recapitulate many characteristics of HBEs25,26,27,28. HNE monolayer cultures have traditionally been limited by squamous transformation and a long time to maturity29. Moreover, reported short-circuit current measurements in HNEs are smaller than those in HBEs, suggesting a smaller window to detect therapeutic efficacy25.
Given the need for a personalized, non-invasive, respiratory tissue culture model of CFTR function, we sought to merge the sensitivity of a swelling-based, organoid assay with the non-invasive and respiratory nature of HNEs. Here, we describe our method of generating 3-dimensional &#34;spheroid&#34; cultures of HNEs for individualized CFTR study in a swelling-based assay30. HNE spheroids polarize reliably with the epithelial apex towards the sphere center, or lumen. This model recapitulates numerous characteristics of a lower respiratory epithelium and matures more quickly than ALI cultures. As a functional assay, HNE spheroids reliably quantify a range of CFTR function, as well as modulation in well-studied mutation groups (e.g., F508del CFTR). This swelling-based assay capitalizes on the ion/salt transport properties of CFTR, indirectly measuring fluid influx into the spheroid as water follows apical salt efflux. In this fashion, stimulated spheroids with fully functional CFTR swell robustly, while those with dysfunctional CFTR swell less or shrink. This is quantified through image analysis of pre- and 1 h post-stimulation spheroids, measuring luminal area and determining the percent change. This measure can then be compared across experimental groups to screen for drug bioactivity in a patient-specific fashion.

<table border="0" cellpadding="0" cellspacing="0" width="633">
	<tbody>
		<tr height="20">
			<td height="20" style="height:20px;width:180px;">1.5 mL Eppendorf Tube</td>
			<td style="width:149px;">USA Scientific&#160;</td>
			<td style="width:131px;">4036-3204</td>
			<td style="width:173px;"></td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;width:180px;">150 mL Filter Flask</td>
			<td style="width:149px;">Midsci&#160;</td>
			<td style="width:131px;">TP99150</td>
			<td style="width:173px;">To filter Media</td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;width:180px;">15 mL Conical Tube</td>
			<td style="width:149px;">Midsci&#160;</td>
			<td style="width:131px;">TP91015</td>
			<td style="width:173px;"></td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;width:180px;">1 L Filter Flask</td>
			<td style="width:149px;">Midsci&#160;</td>
			<td style="width:131px;">TP99950</td>
			<td style="width:173px;">To filter Media</td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;width:180px;">35 mm Glass-Bottom Dish</td>
			<td style="width:149px;">MatTek Corporation</td>
			<td style="width:131px;">P35G-0-20-C</td>
			<td style="width:173px;">Optional</td>
		</tr>
		<tr height="60">
			<td height="60" style="height:60px;width:180px;">3-Isobutyl-1-Methylxanthine (IBMX)</td>
			<td style="width:149px;">Fisher Scientific&#160;</td>
			<td style="width:131px;">AC228420010&#160;</td>
			<td style="width:173px;">Prepare a 100 mM stock solution of 22.0 mg in 1 mL of DMSO</td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;width:180px;">50 mL Conical Tube</td>
			<td style="width:149px;">Midsci&#160;</td>
			<td style="width:131px;">&#160;TP91050</td>
			<td style="width:173px;"></td>
		</tr>
		<tr height="40">
			<td height="40" style="height:40px;width:180px;">Accutase</td>
			<td style="width:149px;">Innovative Cell Technologies, Inc.</td>
			<td style="width:131px;">AT-104</td>
			<td style="width:173px;">Cell detachment solution</td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;width:180px;">Adenine</td>
			<td style="width:149px;">Sigma-Aldrich</td>
			<td style="width:131px;">A2786-25G</td>
			<td style="width:173px;">See Table 1</td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;width:180px;">Amphotericin B</td>
			<td style="width:149px;">Sigma-Aldrich</td>
			<td style="width:131px;">A9528-100MG</td>
			<td style="width:173px;">See Table 1</td>
		</tr>
		<tr height="40">
			<td height="40" style="height:40px;width:180px;">Bovine Brain Extract (9mg/mL)</td>
			<td style="width:149px;">Lonza&#160;</td>
			<td style="width:131px;">CC-4098</td>
			<td style="width:173px;">See Table 2</td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;width:180px;">Ceftazidime hydrate</td>
			<td style="width:149px;">Sigma-Aldrich</td>
			<td style="width:131px;">C3809-1G</td>
			<td style="width:173px;">See Table 1</td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;width:180px;">Cell Scrapers 20 cm&#160;</td>
			<td style="width:149px;">Midsci&#160;</td>
			<td style="width:131px;">TP99010</td>
			<td style="width:173px;"></td>
		</tr>
		<tr height="60">
			<td height="60" style="height:60px;width:180px;">CFTR Inh172</td>
			<td style="width:149px;">Tocris Bioscience</td>
			<td style="width:131px;">3430</td>
			<td style="width:173px;">Prepare a 10 mM stock solution of 4.0 mg in 1 mL of DMSO</td>
		</tr>
		<tr height="40">
			<td height="40" style="height:40px;width:180px;">Cholera Toxin B (From Vibrio cholerae)</td>
			<td style="width:149px;">Sigma-Aldrich</td>
			<td style="width:131px;">C8052-.5MG</td>
			<td style="width:173px;">See Table 1</td>
		</tr>
		<tr height="40">
			<td height="40" style="height:40px;width:180px;">CYB-1</td>
			<td style="width:149px;">Medical Packaging Corporation</td>
			<td style="width:131px;">CYB-1</td>
			<td style="width:173px;">Cytology brush</td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;width:180px;">Dimethyl sulfoxide (DMSO)</td>
			<td style="width:149px;">Sigma-Aldrich</td>
			<td style="width:131px;">D5879-500ML</td>
			<td style="width:173px;"></td>
		</tr>
		<tr height="40">
			<td height="40" style="height:40px;width:180px;">Dulbecco&#39;s Modified Eagle Media (DMEM)/F12 Hepes&#160;</td>
			<td style="width:149px;">Life Technologies&#160;</td>
			<td style="width:131px;">11330-057</td>
			<td style="width:173px;">Base Medium; See Tables 1 and 2</td>
		</tr>
		<tr height="80">
			<td height="80" style="height:80px;width:180px;">Epidermal Growth Factor (Recombinant Human Protein, Animal-Origin Free)</td>
			<td style="width:149px;">Thermo Fisher Scientific</td>
			<td style="width:131px;">PHG6045</td>
			<td style="width:173px;">See Table 1</td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;width:180px;">Epinephrine</td>
			<td style="width:149px;">Sigma-Aldrich</td>
			<td style="width:131px;">E4250-1G</td>
			<td style="width:173px;">See Table 2</td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;width:180px;">Ethanol</td>
			<td style="width:149px;">Fisher Scientific&#160;</td>
			<td style="width:131px;">2701</td>
			<td style="width:173px;"></td>
		</tr>
		<tr height="40">
			<td height="40" style="height:40px;width:180px;">Ethanolamine</td>
			<td style="width:149px;">Sigma-Aldrich</td>
			<td style="width:131px;">E0135-500ML</td>
			<td style="width:173px;">16.6 mM solution; See Table 2</td>
		</tr>
		<tr height="40">
			<td height="40" style="height:40px;width:180px;">Ethylenediaminetetraacetic Acid (EDTA)</td>
			<td style="width:149px;">TCI America&#160;</td>
			<td style="width:131px;">E0084</td>
			<td style="width:173px;"></td>
		</tr>
		<tr height="40">
			<td height="40" style="height:40px;width:180px;">Fetal Bovine Serum (high performance FBS)</td>
			<td style="width:149px;">Invitrogen&#160;</td>
			<td style="width:131px;">10082147</td>
			<td style="width:173px;">See Table 1</td>
		</tr>
		<tr height="60">
			<td height="60" style="height:60px;width:180px;">Forskolin</td>
			<td style="width:149px;">Sigma-Aldrich</td>
			<td style="width:131px;">F6886-50</td>
			<td style="width:173px;">Prepare a 10 mM stock solution of 4.1 mg in 1 mL of DMSO</td>
		</tr>
		<tr height="101">
			<td height="101" style="height:101px;width:180px;">Growth Factor-Reduced Matrigel</td>
			<td style="width:149px;">Corning, Inc.</td>
			<td style="width:131px;">356231</td>
			<td style="width:173px;">Corning Matrigel Growth Factor Reduced (GFR) Basement Membrane Matrix, Phenol Red-Free, LDEV-Free, 10 mL.</td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;width:180px;">Hemacytometer</td>
			<td style="width:149px;">Hausser Scientific</td>
			<td style="width:131px;">1483</td>
			<td style="width:173px;"></td>
		</tr>
		<tr height="40">
			<td height="40" style="height:40px;width:180px;">Human Collagen Solution, Type I (VitroCol; 3 mg/mL)</td>
			<td style="width:149px;">Advanced BioMatrix</td>
			<td style="width:131px;">5007-A</td>
			<td style="width:173px;">Collagen solution</td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;width:180px;">HyClone (aka FetalClone II)&#160;</td>
			<td style="width:149px;">GE Healthcare&#160;</td>
			<td style="width:131px;">SH30066.03HI</td>
			<td style="width:173px;">See Table 2</td>
		</tr>
		<tr height="40">
			<td height="40" style="height:40px;width:180px;">Hydrocortisone</td>
			<td style="width:149px;">StemCell Technologies</td>
			<td style="width:131px;">07904</td>
			<td style="width:173px;">See Tables 1 and 2</td>
		</tr>
		<tr height="40">
			<td height="40" style="height:40px;width:180px;">Insulin, human recombinant, zinc solution</td>
			<td style="width:149px;">Life Technologies&#160;</td>
			<td style="width:131px;">12585014</td>
			<td style="width:173px;">4 mg/mL solution; see Table 2</td>
		</tr>
		<tr height="60">
			<td height="60" style="height:60px;width:180px;">IVF 4-Well Dish, Non-treated</td>
			<td style="width:149px;">NUNC (via Fisher Scientific)</td>
			<td style="width:131px;">12566350</td>
			<td style="width:173px;">4-well plate for spheroids; similar well size to a 24-well plate</td>
		</tr>
		<tr height="40">
			<td height="40" style="height:40px;width:180px;">MEF-CF1-IRR</td>
			<td style="width:149px;">Globalstem</td>
			<td style="width:131px;">GSC-6001G</td>
			<td style="width:173px;">Irradiated murine embryonic fibroblasts</td>
		</tr>
		<tr height="160">
			<td height="160" style="height:160px;width:180px;">Metamorph 7.7</td>
			<td style="width:149px;">Molecular Devices</td>
			<td style="width:131px;"></td>
			<td style="width:173px;">Analysis Software; https://www.moleculardevices.com/systems/metamorph-research-imaging/metamorph-microscopy-automation-and-image-analysis-software for a quote</td>
		</tr>
		<tr height="140">
			<td height="140" style="height:140px;width:180px;">Olympus IX51 Inverted Microscope</td>
			<td style="width:149px;">Olympus Corporation</td>
			<td style="width:131px;">Discontinued</td>
			<td style="width:173px;">Imaging Microscope. Replacment: Olympus IX53, https://www.olympus-lifescience.com/pt/microscopes/inverted/ix53/&#160; for a quote</td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;width:180px;">Pen Strep</td>
			<td style="width:149px;">Life Technologies&#160;</td>
			<td style="width:131px;">15140122</td>
			<td style="width:173px;">See Table 2</td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;width:180px;">Phsophoryletheanolamine</td>
			<td style="width:149px;">Sigma-Aldrich</td>
			<td style="width:131px;">P0503-5G</td>
			<td style="width:173px;">See Table 2</td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;width:180px;">Retinoic Acid</td>
			<td style="width:149px;">Sigma-Aldrich</td>
			<td style="width:131px;">R2625-50MG</td>
			<td style="width:173px;">See Table 2</td>
		</tr>
		<tr height="40">
			<td height="40" style="height:40px;width:180px;">Rhinoprobe</td>
			<td style="width:149px;">Arlington Scientific, Inc.</td>
			<td style="width:131px;">96-0905</td>
			<td style="width:173px;">Nasal curette</td>
		</tr>
		<tr height="101">
			<td height="101" style="height:101px;width:180px;">Slidebook 5.5</td>
			<td style="width:149px;">3i, Intelligent Imaging Innovations</td>
			<td style="width:131px;">Discontinued</td>
			<td style="width:173px;">Imaging Software. Replacement: Slidebook 6, https://www.intelligent-imaging.com/slidebook for a quote</td>
		</tr>
		<tr height="40">
			<td height="40" style="height:40px;width:180px;">Sterile Phosphate Buffered Saline (PBS)</td>
			<td style="width:149px;">Thermo Fisher Scientific</td>
			<td style="width:131px;">20012050</td>
			<td style="width:173px;"></td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;width:180px;">Sterile Water</td>
			<td style="width:149px;">Sigma-Aldrich</td>
			<td style="width:131px;">W3500-6X500ML</td>
			<td style="width:173px;"></td>
		</tr>
		<tr height="40">
			<td height="40" style="height:40px;width:180px;">Tissue Culture Dish 100</td>
			<td style="width:149px;">Techno Plastic Products</td>
			<td style="width:131px;">93100</td>
			<td style="width:173px;">Tissue culture dish for expansion</td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;width:180px;">Tobramycin</td>
			<td style="width:149px;">Sigma-Aldrich</td>
			<td style="width:131px;">T4014-100MG</td>
			<td style="width:173px;">See Table 1</td>
		</tr>
		<tr height="40">
			<td height="40" style="height:40px;width:180px;">Transferrin (Human Transferrin 0.5 mL)</td>
			<td style="width:149px;">Lonza&#160;</td>
			<td style="width:131px;">CC-4205</td>
			<td style="width:173px;">See Table 2</td>
		</tr>
		<tr height="60">
			<td height="60" style="height:60px;width:180px;">Triiodothryonine</td>
			<td style="width:149px;">Sigma-Aldrich</td>
			<td style="width:131px;">T6397-1G</td>
			<td style="width:173px;">3,3&#8242;,5-Triiodo-L-thyronine sodium salt&#160; [T3]; See Table 2</td>
		</tr>
		<tr height="40">
			<td height="40" style="height:40px;width:180px;">Trypsin from Porcine Pancreas</td>
			<td style="width:149px;">Sigma-Aldrich</td>
			<td style="width:131px;">T4799-10G</td>
			<td style="width:173px;"></td>
		</tr>
		<tr height="40">
			<td height="40" style="height:40px;width:180px;">Ultroser-G</td>
			<td style="width:149px;">Crescent Chemical (via Fisher Scientific)</td>
			<td style="width:131px;">NC0393024</td>
			<td style="width:173px;">20 mL lypophilized powder; See Table 2</td>
		</tr>
		<tr height="60">
			<td height="60" style="height:60px;width:180px;">Vancomycin hydrochloride from Streptomyces orientalis</td>
			<td style="width:149px;">Sigma-Aldrich</td>
			<td style="width:131px;">V2002-5G</td>
			<td style="width:173px;">See Table 1</td>
		</tr>
		<tr height="60">
			<td height="60" style="height:60px;width:180px;">VX770</td>
			<td style="width:149px;">Selleck Chemicals</td>
			<td style="width:131px;">S1144</td>
			<td style="width:173px;">Prepare a 1 mM stock solution of 0.4 mg in 1 mL of DMSO</td>
		</tr>
		<tr height="60">
			<td height="60" style="height:60px;width:180px;">VX809</td>
			<td style="width:149px;">Selleck Chemicals</td>
			<td style="width:131px;">S1565</td>
			<td style="width:173px;">Purchase or prepare a 10 mM stock solution of 4.5 mg in 1 mL of DMSO</td>
		</tr>
		<tr height="41">
			<td height="41" style="height:41px;width:180px;">Y-27632 Dihydrochloride&#160; ROCK inhibitor&#160;</td>
			<td style="width:149px;">Enzo LifeSciences&#160;</td>
			<td style="width:131px;">ALX-270-333-M025&#160;</td>
			<td style="width:173px;">See Table 1</td>
		</tr>
	</tbody>
</table>

generation of human nasal epithelial cell spheroids for individualized cystic fibrosis transmembrane conductance regulator study

While the introduction of Cystic Fibrosis Transmembrane Conductance Regulator (CFTR) modulator drugs has revolutionized care in Cystic Fibrosis (CF), the genotype-directed therapy model currently in use has several limitations. First, rare or understudied mutation groups are excluded from definitive clinical trials. Moreover, as additional modulator drugs enter the market, it will become difficult to optimize the modulator choices for an individual subject. Both of these issues are addressed with the use of patient-derived, individualized preclinical model systems of CFTR function and modulation. Human nasal epithelial cells (HNEs) are an easily accessible source of respiratory tissue for such a model. Herein, we describe the generation of a three-dimensional spheroid model of CFTR function and modulation using primary HNEs. HNEs are isolated from subjects in a minimally invasive fashion, expanded in conditional reprogramming conditions, and seeded into the spheroid culture. Within 2 weeks of seeding, spheroid cultures generate HNE spheroids that can be stimulated with 3',5'-cyclic adenosine monophosphate (cAMP)-generating agonists to activate CFTR function. Spheroid swelling is then quantified as a proxy of CFTR activity. HNE spheroids capitalize on the minimally invasive, yet respiratory origin of nasal cells to generate an accessible, personalized model relevant to an epithelium reflecting disease morbidity and mortality. Compared to the air-liquid interface HNE cultures, spheroids are relatively quick to mature, which reduces the overall contamination rate. In its current form, the model is limited by low throughput, though this is offset by the relative ease of tissue acquisition. HNE spheroids can be used to reliably quantify and characterize CFTR activity at the individual level. An ongoing study to tie this quantification to in vivo drug response will determine if HNE spheroids are a true preclinical predictor of patient response to CFTR modulation.

HNEs should attach to the culture dish and form small islands of cells within 72 h of seeding; examples of good and poor island formation at one week are shown in Figure 1A and 1B, respectively. These islands should expand to cover the dish over the course of 15-30 days. Small or suboptimal samples may take longer, and often will not yield useful spheroids. Contamination with infectious agents is evidenced by deep yellow/cloudy media, failure...

Watch this Scientific Journal Video about Generation of Human Nasal Epithelial Cell Spheroids for Individualized Cystic Fibrosis Transmembrane Conductance Regulator Study at JoVE.com

Generation of Human Nasal Epithelial Cell Spheroids for Individualized Cystic Fibrosis Transmembrane Conductance Regulator Study

Here we describe a method to generate three-dimensional spheroid cultures of human nasal epithelial cells. Spheroids are then stimulated to drive Cystic Fibrosis Transmembrane Conductance Regulator (CFTR)-dependent ion and fluid secretion, quantifying the change in the spheroid luminal size as a proxy for CFTR function.

While the introduction of Cystic Fibrosis Transmembrane Conductance Regulator (CFTR) modulator drugs has revolutionized care in Cystic Fibrosis (CF), the ...

The overall of this procedure is to generate human nasal cell spheroids which can ultimately be used as an assay for functional CFTR studies. This method can help answer key questions in the cystic fibrosis field such as assessing an individual subject's response to CFTR altering drugs in an ex vivo model system. The main advantage of this technique is that a large number of spheroids are generated in a relatively fast timeframe from a small nasal cell sample allowing for extensive testing.Demonstrating the procedure will be Lauren Strecker and Jessica Moncivaiz, technicians from my laboratory. After processing and expanding Human Nasal Epithelial or HNE cells on feeder fibroblasts according to the text protocol, bring previously prepared expansion medium, differentiation medium, 0.1%Trypsin EDTA solution, and sterile PBS to room temperature over 30 minutes. Then use 70%ethanol to clean the containers and transfer them to a clean biosafety cabinet.In the biosafety cabinet, use a Pasteur pipette attached to a vacuum line to aspirate and discard the medium from HNE culture. Then with a clean serological pipette, use five milliliters of PBS to wash the dish by adding, swirling, and aspirating the buffer. Add five milliliters of 0.1%Trypsin EDTA solution to the culture and return it to the incubator at 37 degrees Celsius and 5%carbon dioxide for five minutes.Then under an inverted microscope at four to 10X, check that the cells detach from the dish, become round and float. Gently tap the side of the culture dish to dislodge the cells and if necessary, re-incubate the dish for an additional five minutes until most cells are detached. Next, using a 10 milliliter serological pipette, add five milliliters of expansion medium to the dish and collect all the liquid into a labeled sterile 50 milliliter conical tube.If cells remain adherent to the culture dish after three rounds of trypsinization, use a sterile cell scraper to gently release the remaining cells and with five milliliters of expansion medium, wash the scraper and dish and collect the contents into the same labeled conical tube. Centrifuge the tube at 360 times g in four degrees Celsius for five minutes. Aspirate the supernatant and use one milliliter of expansion medium to resuspend the cell pellet.Then use a hemocytometer to count the cells. Thaw the basement membrane matrix on ice per the manufacturer's instructions. Separate an appropriate number of differentially trypsinized passage cells for a final concentration of 500, 000 cells per milliliter of the matrix.For a four-well plate use 200, 000 cells and collect them into a 1.5 milliliter tube. Next, centrifuge the cell mixture at no more than 360 times g for five minutes. Then using a one milliliter pipette, completely and carefully aspirate and discard the medium, taking care not to disturb the cell pellet.Keep the tube of cells on ice when not actively handling it. Use a one milliliter pipette tip to add 100 microliters of the basement membrane matrix per planned well to the cells. While not completely emptying the pipette tip to avoid the introduction of air bubbles, pipette up and down to carefully and thoroughly resuspend the cells.Move quickly to avoid solidification of the matrix. To seed 100 milliliter matrix aliquots into each well of a four-well IVF culture plate, use a clean pair of scissors to trim off the distal three to four millimeters from a 200 microliter pipette tip. Carefully and slowly pipette a 100 microliter drop of cell matrix mixture into the center of each well, ensuring that the drop remains spherical and does not touch the sides of the well.Incubate the plate at 37 degrees Celsius and 5%carbon dioxide for 30 minutes until solid. Then carefully pipette 500 microliters of differentiation medium into each well, taking care not to disturb the matrix drop. Ensure that the medium just covers the drop and add more if necessary.To culture HNE spheroids, using a one milliliter pipette tip, gently aspirate all medium from the well while avoiding the matrix which will destroy spheroids. Then with a fresh one milliliter pipette tip and while avoiding touching or disturbing the matrix, gently add 500 microliters of differentiation medium to the well around the matrix. Continue to incubate the spheroids, replacing the differentiation medium three times weekly as just demonstrated.Under an inverted microscope at 20X magnification, evaluate spheroid morphology daily. Spheroids should form within three to five days of plating and reach maturity within approximately 10 days. HNEs should attach to the culture dish and form small islands within 72 hours of seeding.Examples of good and poor island formation at one week are shown here. Islands should expand to cover the dish over the course of 15 to 30 days. Within the first three to four days of culture, small cystic structures should begin to form in the matrix and mature over approximately 10 days.If plated at the described density, successful cultures will contain 50 to 100 spheroids per matrix drop. The lumens may be relatively clear as with wild-type CFTR or filled with cellular debris and mucus as in CF spheroids. Masking to delineate the luminal area of the spheroids is demonstrated in these two panels.Shown here are examples of poorly formed unsuccessful spheroid cultures. As illustrated in these graphs from functional assays, spheroids from subjects with wild-type CFTR should swell over an hour when stimulated and should swell less or shrink if stimulated in the presence of the CFTR inhibitor inh-172. Spheroids from a subject homozygous for F508del-CFTR should either shrink or swell very slightly with increased swelling or less shrinking when pharmacologically corrected with the CFTR modulators VX809 and VX770.Once mastered, seeding nasal cell spheroids can be done in 15 to 20 minutes if it's performed properly. While attempting this procedure, it's important to remember to maintain clean operating procedures within the biosafety cabinet to minimize the sample contamination risk and to avoid any risks to your own health. Following this procedure, other methods like fixation, staining, and microscopy can be performed in order to answer additional questions about cell morphology and composition.After watching this video, you should have a good understanding of how to generate primary human nasal cell spheroids which can be utilized as a personalized assay of CFTR function. Don't forget that working with primary human tissues can be hazardous and precautions such as proper personal protective equipment use should always be taken when performing this procedure.

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