Stem Cells 2003;21:131-142
www.StemCells.com
© 2003 AlphaMed Press
Human Adult Marrow Cells Support Prolonged Expansion of Human Embryonic Stem Cells in Culture
Linzhao Cheng,
Holly Hammond,
Zhaohui Ye,
Xiangcan Zhan,
Gautam Dravid
The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
Key Words. Embryonic stem cells • Mesenchymal stem cells • Marrow stromal (stem) cells • Self-renewal • SSEA-4 • Oct-4
Correspondence:
Linzhao Cheng, Ph.D., The Johns Hopkins University School of Medicine, Bunting-Blaustein Cancer Research Building, Room 208, 1650 Orleans Street, Baltimore, Maryland 21231, USA. Phone: 410-614-6958; Fax: 410-614-7279; e-mail: lcheng{at}welch.jhu.edu
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ABSTRACT
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Prolonged propagation of human embryonic stem (hES) cells is currently achieved by coculture with primary mouse embryonic fibroblasts (MEFs) serving as feeder cells. Unlike mouse ES cells, adding growth factors such as leukemia inhibitory factor is insufficient to maintain undifferentiated hES cells without feeder cells. The presence of uncharacterized rodent cells or crude extracts imposes a risk to the clinical applications of hES cells. While others looked for a replacement of MEFs with human fetal cells, we attempted to use easily accessible postnatal human cells such as human marrow stromal cells (hMSCs). Culture-expanded hMSCs from multiple donors were used as feeder cells to support growth of the H1 hES cell line under a serum-free culture condition. Human ES cell colonies cultured on irradiated hMSCs amplified >100-fold during the 30-day continuous culture (in five passages). The longest continuous expansion of hES cells on hMSCs tested to date is 13 passages. The expanded hES cells displayed the unique morphology and molecular markers characteristic of undifferentiated hES cells as observed when they were cultured on MEFs. They expressed the transcription factor Oct-4, a membrane alkaline phosphatase, and the stage-specific embryonic antigen (SSEA)-4, but not the SSEA-1 marker. Expanded hES cells on hMSCs retained unique differentiation potentials in culture and a normal diploid karyotype. The well-studied hMSCs (and this animal cell- and serum-free system) may provide a clinically and ethically feasible method to expand hES cells for novel cell therapies. In addition, this system may help to identify cytokines and adhesion molecules that are required for the self-renewal of hES cells.
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INTRODUCTION
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Embryonic stem (ES) cells are continuous proliferating stem cell lines of embryonic origin first isolated from the inner cell mass (ICM) of mouse blastocysts 20 years ago. The distinguishing features of these ES cells (versus committed stem cells found in adults) are their capacity to be maintained in an undifferentiated state infinitely in culture and their potential to develop into every cell of the body. Based on previous methods developed for mouse ES cells, Dr. James Thomson and colleagues first reported a method to establish human (h)ES cell lines [1]. Like mouse ES cells, hES cells can proliferate in culture for years and maintain a normal karyotype. Both mouse and human ES cells express high levels of membrane alkaline phosphatase (APase) and Oct-4, a transcriptional factor critical to ICM and germline formation [15]. Unlike mouse ES cells, hES cells do not express the stage-specific embryonic antigen (SSEA)-1, but do express SSEA-4, which is another glycolipid cell-surface antigen recognized by a specific monoclonal antibody (mAb) [15]. The growth requirements of hES cells are also different. Prolonged propagation of hES cells is typically achieved by coculture with primary mouse embryonic fibroblasts (MEFs) serving as feeder cells. Unlike mouse ES cells, hES cell lines are not able to maintain their undifferentiated state in the absence of supporting feeder layer cells, even when exogenous cytokines such as leukemia inhibitory factor (LIF) and gelatin-coated plates are used [1,3,4]. Differentiated hES cell colonies (formed either in the absence of feeder cells or after extended culture without appropriate splitting) gradually lose the SSEA-4 and Oct-4 expression [2,5,6]. Xu and colleagues from Geron reported recently that hES cells could be maintained on extracellular matrix (ECM) if the conditioned medium from MEFs is provided [7]. The ECM used in this study was Matrigel, which is the trademark of crude extracts of basement membrane matrices from mouse sarcomas. It is unclear if the above feeder cell-free culture method can actually expand (net increase) or if it merely maintains undifferentiated hES cells after several passages. Nonetheless, the use of uncharacterized rodent cells such as MEFs or rodent tumor crude extracts makes the cultured hES cells xenogenic biologics and imposes an extra risk to the clinical utility of hES cell lines [4].
In adults, several distinct types of multipotent stem cells have been isolated from bone marrow (BM). Adult BM is the primary site of hematopoietic stem cells (HSCs), the common precursor of blood and immune cells. Beginning with pioneering work by Friedenstein et al. more than 30 years ago, it is well recognized that non-HSCs are also present in the BM of adult humans and animals [8,9]. The most characterized type is mesenchymal stem cells capable of generating mesenchymal cells and stromal cells that support hematopoiesis [1015]. It was also reported in recent years that certain freshly isolated or culture-expanded BM cells can differentiate into many other types of cells such as hepatocytes in the liver, neurons and glial cells in the brain, satellite cells in skeletal muscles, and cardiomyocytes in the heart [1624]. Thus, adult BM contains cells and microenvironments that are able to maintain stem cells in their undifferentiated states. These studies led us to investigate whether adult BM-derived cells can also support the growth of hES cells.
In recent years, several groups have developed improved methods to obtain large numbers of marrow stromal progenitor cells in culture from adult human BM aspirates, either by physical enrichment of precursor cells followed by culture expansion, or by direct culture selection and amplification. These marrow fibroblastic cells have been termed as either stromal progenitor cells reflecting their proliferation potential in culture [11], marrow stromal cells reflecting the source and method of the derivation [1214], or mesenchymal stem cells reflecting their proven potentials to generate multiple types of mesenchymal cells when exposed to appropriate stimuli in vivo or in vitro [10,25]. The latter two methods, which are very similar in practice, are widely used by many investigators including ourselves [26]. These marrow-derived (fibroblastic) stromal cells that function as nonhematopoietic multipotent stem cells are collectively called herein as MSCs. After two passages (approximately 14 cell divisions) in a selective medium supplemented with fetal bovine serum (FBS), culture-expanded human MSCs (hMSCs) are morphologically and phenotypically homogenous and essentially free of endothelial cells and macrophage or adipocyte contamination [25,26].
These culture-expanded and highly homogenous hMSCs enable us to perform detailed analyses that were previously impossible with mixed stromal cell populations. When used as adherent feeder cells with culture media optimized for hematopoietic cells, the culture-expanded hMSCs supported human CD34+ HSCs in long-term culture assays and their differentiation into erythroid, myeloid, megakaryocytic, osteoclastic, or B-cell lineages even in the absence of added cytokines [2631]. The activity is due to, at least in part, the production of various hematopoietic cytokines, including LIF, interleukin (IL)-6 and IL-11, as well as stem cell factor and Flt3/Flk2 ligand by hMSCs [2628,31]. Thus, our goal of the present study was to investigate whether culture-expanded hMSCs derived from human adult BM can also support the growth of hES cells in a culture medium that is known to favor their proliferation while retaining the undifferentiated state.
We report here that culture-expanded MSCs can replace MEFs and fully support prolonged expansion of hES cells in culture. Human ES cells cocultured on irradiated hMSCs expanded >100-fold during the 30-day continuous culture (in five passages). The expanded hES cells after nine passages maintained their normal karyotype. Moreover, the expanded hES cells retained the unique hES cell morphology and expression of APase and SSEA-4 that are characteristic of undifferentiated hES cells.
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MATERIALS AND METHODS
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Human MSC Isolation and Expansion
BM samples collected from healthy and consenting human donors were purchased from AllCells Company (Berkeley, CA; http://www.allcells.com). The use of anonymous primary human cells for laboratory research was approved by the Internal Review Board of the Johns Hopkins Medical Institutions. Mononuclear cells (MNCs) were isolated from heparinized BM aspirates (diluted with equal volume of phosphate-buffered saline [PBS]) by the standard density (1.077 g/ml) centrifugation using Ficoll (Pharmacia; Piscataway, NJ; http://www.pnu.com). As compared with a previous protocol [25,26] using Percoll (1.073 g/ml; Pharmacia), the Ficoll method yielded twofold more MNCs but generated the same total number of MSCs after culture expansion per unit volume of BM samples. MNCs at the interface were recovered, washed, and resuspended in the hMSC medium composed of Dulbeccos modified Eagles medium (DMEM) with low glucose, 10% FBS, and 1% antibiotic-antimycotic stock solution (all from Invitrogen; Carlsbad, CA; http://www.invitrogen.com) as previously described [25,26], in the absence or presence of 1 ng/ml basic fibroblast growth factor ([bFGF] Invitrogen or Peprotech; Rocky Hill, NJ; http://www.peprotech.com). The addition of bFGF to the "generic" hMSC medium gave consistent and optimal growth with different FBS batches from various suppliers (Invitrogen; Hyclone Laboratories; Logan, UT; http://www.hyclone.com; or Gemini Bio-Products; Calabasas, CA, http://www.gembio.com). For primary cultures, cells were plated into 175-cm2 flasks at a density of 6 x 107 MNCs/flask and the cultures were incubated at 37°C in 5% CO2 in air and 95% humidity. The medium was exchanged after 48 hours and every 3-4 days thereafter. When the cultures (the primary passage) reached approximately 90% of confluence (in approximately 2 weeks), hMSCs were recovered by digestion with 0.05% trypsin/0.53 mM EDTA solution (Invitrogen) and replated into passage culture at a density of 5,000-10,000 cells per cm2. Once confluent (10-14 days), harvested (passage 1) cells were similarly seeded to obtain passage two (p2) cells and so on. For the colony-formation assay, aliquots (up to 1.6 x 106 cells/well) of MNCs were plated into 6-well culture plates for 14 days with the complete hMSC medium. They were then washed, fixed with 4% formalin solution (Fisher Scientific; Fair Lawn, NJ; http://www.fishersci.com) and stained with 0.1% solution of crystal violet (Sigma; St. Louis, MO; http://www.sigmaaldrich.com) for 30 minutes [26]. Fibroblastic hMSC colonies (approximately 1 in 20,000 MNCs) were found in BM aspirates, but <1 in 6 x 107 MNCs were isolated from cord blood or peripheral blood (with or without G-CSF mobilization).
Human ES Cells
The H1 (also known as WA01 in the National Institutes of Health Embryonic Stem Cell Registry) hES cell line (p22) was obtained from the WiCell Research Institute (Madison, WI; http://www.wicell.org) and initially cultured on MEFs as instructed by the provider. MEFs (p3) purchased from Specialty Media, Inc. (Phillipsburg, NJ; http://www.specialtymedia.com) were used as feeder cells for the hES cells. MEFs or MSCs (200,000 cells) were plated per well (9.4 cm2) in 6-well plates after being irradiated (50 Gy, 1 Gy = 100 rads) using a 137Cs gamma-irradiator. The hES cell culture medium consisted of 80% (v/v) knockout (KO) DMEM, 20% (v/v) of the KO serum replacement, 2 mM L-glutamine, 10 mM nonessential amino acids (all from Invitrogen), 50 µM ß-mercaptoethanol (Sigma), and 4 ng/ml bFGF. Cell cultures were incubated at 37°C in 5% CO2 in air and 95% humidity. Once hES cell colonies grew to maximal size before the onset of visible differentiation, cells in the coculture (hES cells and irradiated MEFs) were digested and seeded onto newly prepared feeder cells. Initially, we used collagenase IV (1 mg/ml; Invitrogen) to split cells (1:1 to 1:3) as instructed and published previously [1,3]. Later, cells were harvested by digesting cells in cocultures with 0.05% trypsin/0.53 mM EDTA solution for 5 minutes. The digestion was stopped by adding soybean trypsin inhibitor (0.5 mg/ml; Sigma). After washing, the dissociated cells in the hES cell culture medium were split from 1:1 to 1:50 and seeded onto feeder cells or 6-well plates coated with diluted (1:20) Matrigel (Becton Dickinson Labware; Bedford, MA; http://www.bd.com) as described previously [7].
Immunofluorescence and APase Staining
Cocultures used for APase staining or immunofluorescence analysis were established in either 6-well or 24-well plates. Prior to analysis, adherent cell layers were fixed by the addition of 10% formalin (15 minutes). After wash with a Tris-based saline solution, APase staining was performed using a kit containing BCIP/NBT as the substrate (Sigma). The dark blue staining was visualized by light microscopy. The fixed cells in cocultures were also stained with mouse mAbs against either SSEA-4 (clone MC-813-70, isotype IgG3) or SSEA-1 (clone MC-480, isotype IgM). Hybridoma supernatants of both mAbs were obtained from Developmental Studies Hybridoma Bank (Iowa City, IA; http://www.uiowa.edu/
dshbwww). For the immunofluorescence staining, the fixed cells were incubated for 15 minutes with goat serum (2%) to block nonspecific binding. The cocultures were stained with diluted (1:100) hybridoma supernatants recognizing either SSEA-4 or SSEA-1 antigen. After incubation in the dark for 1 hour at 25°C or overnight at 4°C, fixed cells were washed extensively before the secondary staining reagent was added. Goat anti-mouse IgG conjugated to the fluorochrome Alexa 546 (Molecular Probes; Portland, OR; http://www.probes.com) was added for 45 minutes at 25°C. The nuclei of hES cells and hMSCs were counterstained by Hoechst 33358 (Molecular Probes). Immunofluorescence analysis was performed with a Nikon (TE300) microscope with separate filters for either Hoechst (blue) or red fluorescence, or a triple filter for blue, green, and red fluorescence simultaneously. The fluorescence and light images were recorded on Kodak film (ASA400). The scanned image was analyzed by Photoshop 4.0.
Cell Isolation by Magnetic Cell Sorting (MACS)
Cells were harvested from cocultures by gentle digestion with 0.25% trypsin/0.53 mM EDTA solution and washed once with PBS containing 2% bovine serum antigen (BSA) and 2 mM EDTA. Before incubating with the SSEA-4 mAb (1:100), cells were preincubated with human IgG (2 mg/ml) to block nonspecific IgG binding. The SSEA-4-labeled cells were incubated with magnetic beads conjugated with anti-mouse IgG antibodies (Miltenyi Biotec; Auburn, CA; http://www.miltenyibiotec.com). The labeled cells were isolated by the miniMACS magnet stand and the large cell isolation column as instructed (Miltenyi Biotec).
Flow Cytometric Analysis
Cells were harvested as described above and suspended in 100 µl staining buffer (2% BSA, 2 mM EDTA, and 0.1% sodium azide in PBS) containing human IgG to block nonspecific IgG binding. The diluted (1:100) SSEA-1 or SSEA-4 mAbs were added as primary antibodies. Fluorescein isothiocyanate (FITC)- or R-phycoerythrin (PE)-conjugated anti-mouse IgG antibodies were used to detect the binding of SSEA-4 mAb (mouse IgG3). For the SSEA-1 mAb (mouse IgM), anti-mouse IgM antibodies conjugated with PE were used. These secondary reagents were purchased from Caltag (Burlingame, CA; http://www.caltag.com) or Pharmingen (San Jose, CA; http://www.bdbiosciences.com/pharmingen). In addition, we also used PE-conjugated mAbs recognizing SH-2/endoglin/CD105 (clone SN6 or 266), HLA-ABC/ major histocompatibility complex (MHC) class I (clone TU149), HLA-DR/MHC class II (clone L233), CD133 (clone AC133-1), Thy-1/CD90 (clone F15-42-1-5), CD34 (clone HPCA-2), and platelet endothelial cell adhesion molecules (PECAM)-1/CD31 (MBC78.2), in conjunction with SSEA-4 and the FITC-conjugated anti-mouse IgG antibody (for hES cells). These PE-conjugated mAbs were purchased from Caltag, Miltenyi Biotec, Beckman Coulter (Miami, FL; http://www.beckman.com), and Pharmingen, and used as instructed by providers. A FACScan® flow cytometer (Becton Dickinson) was used for these analyses. Ten thousand events were acquired for each sample and analyzed using CellQuest software (Becton Dickinson).
Embryoid Body (EB) Formation and Differentiation In Vitro
Prior to differentiation, hES cells were collected and resuspended in the hES cell medium in the absence of bFGF. The hES cells were cultured in 6-well plates as aggregates in suspension. After 5 days, FBS (5% final) was added. Typically, aggregated hES cells formed EBs after 7-10 days in suspension culture, and mature (cystic) EBs emerged subsequently from 20%-80% of formed EBs.
All-trans-retinoic acid (RA) was purchased from Sigma and dissolved in dimethyl sulfoxide to make a 10-2 M stock solution. The RA induction of hES cell differentiation was carried out essentially the same as described previously [5]. Briefly, hES cells that had been cultured on hMSCs for eight passages were passaged onto Matrigel in the hES cell medium containing bFGF. RA (10-5 M final) was added the next day into half of samples. The culture medium was exchanged every 2 days. At day 9, cells were fixed and stained with APase, SSEA-4, and Hoechst dye as described above.
Karyotypic Analyses of hES Cells
Before and after cocultures on hMSCs, karyotyping analyses of hES cells were carried out by the Laboratory of Prenatal and Research Cytogenetics in the Department of Obstetrics and Gynecology at Johns Hopkins Hospital. The method used is essentially the same as previously described [32]. Briefly, cells were incubated with 0.1 µg/ml of colcemid for 3-4 hours, trypsinized, resuspended in 0.075 M KCl, incubated for 20 minutes at 37°C, and then fixed in 3:1 methanol/acetic acid. After staining, karyotypes of normal human chromosomes were examined by cytogenetics specialists at the 300-band level of resolution. For hES cells (the H1 line is from a male embryo) that had been cultured with male hMSCs (irradiated) for seven passages, we first passaged the coculture onto female hMSC feeder cells for two more passages followed by two additional passages on MEFs. Male hES cells could then be easily identified from irradiated mouse cells or fewer irradiated female hMSCs.
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RNA Preparation and Gene Expression Analysis
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Using the RNeasy kit (Qiagen; Valencia, CA; http://www.qiagen.com), we extracted total RNA from MACS-isolated hES cells that had been cultured on MEFs or hMSCs, or from control MEFs or hMSCs cultured in the same hES cell culture medium. The contaminating genomic DNA was further eliminated by DNase I digestion. The first strand cDNA synthesis was performed using the Superscript II reverse transcriptase (RT) and oligo(dT)12-18 as primers (Invitrogen). Aliquots (10%) of the RT product were used as a template for polymerase chain reaction (PCR) amplification with specific primer sets for either human Oct-4 or human/mouse ß-actin gene. The oligonucleotide primer pairs used for Oct-4 RT-PCR were based on a previous report [6]: Oct-4 sense, 5'-CGTGAAGCTGGAGAAGGAGAAGCTG-3'; and Oct-4 antisense, 5'-CAAGGGCCGCAGCTTACACATGTTC-3'. The two primers (nt. 862-886 and nt. 4527-4551 in the Oct-4 genomic DNA accession #Z11900) are located in two different exons. The detected cDNA fragment by RT-PCR was 247 bp long as predicted and verified by DNA sequencing. The primers for the ß-actin gene (accession #BC016045) are actin-sense (nt. 96-116): 5'-GCT CGTCGTCGACAACGGCTC-3'; and actin-antisense (nt. 424-448): 5'-CAAACATGATCTGGGTCATCTTCTC-3'. The RT-PCR product of human and mouse ß-actin cDNA is 353 bp long. After 40 cycles of PCR with an annealing temperature at 60°C, the RT-PCR products were visualized by ethidium bromide staining, following electrophoresis through a 1.5% agarose gel.
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RESULTS
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Origin and Growth of hES Cells
We obtained the H1 hES cell line from the WiCell Research Institute and expanded the stock in coculture on irradiated (mitotically inactive) MEFs as instructed by the provider, similar to previous publications [3,5,33]. We continuously cultured these ES cells for 3 months and split (using collagenase IV) approximately once a week. Consistent with the provided protocol, we observed ~2-3-fold expansion every passage (~7 days). Once enough cells were obtained, we attempted to improve new culture conditions and different passaging (splitting) methods. We observed consistently that splitting by trypsin/EDTA digestion (followed by the addition of trypsin inhibitors) resulted in more uniform and greater numbers of hES cell colonies in subsequent culture than the collagenase method. Thus, we chose to use the trypsin/EDTA digestion method to maintain and expand hES cells cocultured on either MEFs or hMSCs described below.
Improved Method to Derive and Expand hMSCs
The method used to derive and expand hMSCs from adult BM is similar to that previously described [25,26] with a few modifications. A major change is to add bFGF (1 ng/ml) to the culture medium containing 10% FBS. Consistent with a previous report [34], we found that adding a low concentration of bFGF provides a consistently optimal growth condition and essentially alleviates the need to screen favorable FBS lots. Using this improved method, we can efficiently and consistently derive and expand hMSCs from multiple male and female donors. After the primary and two subsequent passages in culture (a total of ~6 weeks), 75-200 million (p2) hMSCs can be obtained from ~100 x 106 MNCs in a 10-cc BM aspirate sample. Similar to the previous method, the expanded hMSCs were highly uniform in morphology and phenotype and essentially free of adipocytes, hematopoietic cells (CD45+), and endothelial cells (CD34+ or CD31+). As previously described [25,31], the expanded hMSCs in culture expressed unique markers such as CD105 (also known as SH-2 and endoglin) and CD90/Thy-1 (Table 1
).
Prolonged Expansion of hES Cells Cocultured on hMSCs
We observed that undifferentiated hES cell colonies also formed on hMSC feeders in the hES cell (serum-free) culture medium, despite an initially lower growth rate than that on MEFs. We continuously cultured hES cells on irradiated or nonirradiated hMSCs for an additional four passages (~4 weeks, with split ratios from 1:2 to 1:5 in each passage), and then characterized resulting hES cells in detail. Morphology of hES cell colonies expanded on hMSCs is shown in Figure 1
. In the absence of seeded hES cells (i.e., hMSCs alone), no hES cell-like colonies formed with or without irradiation (not shown). On nonirradiated hMSCs, hES cell colonies had a better growth rate and more compact morphology (Fig. 1A
). However, the proliferation of hMSCs in coculture imposed a practical difficulty, i.e., overgrowth of hMSC feeder cells that divided faster than hES cells. Subsequently, we discontinued the coculture of hES cells with proliferating MSCs and used exclusively irradiated MSCs as feeder cells. On irradiated hMSCs, hES cell colonies amplified >100-fold during the 30-day continuous culture (in five passages). In multiple experiments performed to date, the longest continuous coculture of hES cells with irradiated MSCs is 13 passages before the expanded hES cells were used for various assays.

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Figure 1. Morphology and APase staining of hES cell colonies cultured on hMSCs. hES cells were continuously cultured (for five to seven passages) on nonirradiated (A) or irradiated (B and C) hMSCs. Representative images of live hES cell colonies are shown on nonirradiated (A, 10 x) and irradiated (B, 20 x) hMSCs. Individual spindle-shaped fibroblastic hMSCs are also visible (A and B). After fixing, the coculture was stained for the APase activity that is primarily on the cell surface (C). Note that the hES cell colony is positive for APase activity, whereas the majority of hMSCs are negative. Bar scales: (A) 100 µm, (B) 10 µm, and (C) 5 µm.
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We attempted to compare directly the growth of hES cells on hMSCs with the growth on MEFs, as well as on different preparations of hMSCs from various donors. A 1:20 split of p6 hES cells on MSCs (#1) was seeded onto duplicate wells of irradiated MEFs or MSCs from two donors (#1 and #2). Six days later, numbers of hES cell colonies (consisting of ≥50 cells) with the undifferentiated morphology were counted (Fig. 2
). Both MSC feeders gave rise to similar numbers of hES cell colonies. We estimated that there was at least fivefold expansion in this passage. So far, different preparations (p2 to p5) of hMSCs from three donors (two males and one female) have been used, all with similar results (not shown). Under the same culture condition, Matrigel was insufficient to support hES cell growth, regardless of whether the conditioned medium from MSCs or MEFs was provided (not shown). The MEF feeder gave rise to fewer and smaller ES cell colonies (~twofold expansion). Therefore, we found that hES cells appeared to grow better on hMSCs than MEFs once they adapted on hMSCs (six passages in this experiment). This result suggests an "adaptation" hypothesis, which also explains the fact that hES cells grew poorer initially on hMSCs when passaged initially from the coculture with MEFs.

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Figure 2. Numbers of ES cell colonies after coculture with MEFs, hMSCs, and Matrigel as adhesion matrices. After expansion on hMSCs for six passages, hES cell aliquots (1:20 or 5%) were seeded in 6-well plates containing irradiated MEFs (n = 3), hMSCs #1 (n = 2), hMSCs #2 (n = 3), or coated with Matrigel (n = 3) as described in detail in Materials and Methods. Six days later, live ES cell colonies (≥50 cells, as shown in Fig. 1 ) were counted in each well. The mean and standard error of each sample are plotted.
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Expanded hES Cells Cocultured with hMSCs Retained Molecular Markers Unique to Undifferentiated hES Cells
After four or more passages on hMSCs, aliquots of the expanded hES cells were analyzed for the expression of cell-surface markers such as APase and SSEA-4. The APase isoform on ES cells is likely to be EC.3.1.3.1, which is also known as liver/kidney/bone APase or tissue nonspecific APase [5], and is sensitive to levamisole inhibition. By histochemical staining, hES cell colonies were strongly APase positive, while hMSCs as feeder cells were largely negative (Fig. 1C
). APase activities were preferentially expressed on the cell membrane of hES cells and sensitive to levamisole inhibition (not shown). Like irradiated MEFs, few singular MSCs with apoptotic morphology (broad and flat) displayed a weak APase activity (not shown). The absence or low level of APase activities on the viable MSCs is consistent with the report that undifferentiated hMSCs are APase negative until induced to differentiate to osteoblasts [35]. The expanded hES cells were also stained for SSEA-4, a glycolipid antigen expressed on hES cells but not on mouse ES cells. After fixation, the cocultures of hES cells with irradiated hMSCs (p4) were stained with or without a mouse mAb against the SSEA-4 antigen (Fig. 3
). A high level of SSEA-4 expression was found in expanded hES cells but was absent in the hMSC feeder cells (Fig. 3A and 3C
).

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Figure 3. hES cells expanded on hMSCs retained the SSEA-4 expression on cell surface. Six days after plating, hES cells/hMSC cocultures were fixed and then labeled with diluted hybridoma supernatants recognizing either SSEA-4 (A and B) or SSEA-1 (C and D). Goat anti-mouse IgG conjugated to Alexa 546 red fluorochrome was then added. The nuclei of both hES cells and hMSCs were counterstained by Hoechst 33358 (blue). Microphotographs of fluorescence (left, A and C) and bright field (right, B and D) images of the same colonies were taken with the same optical filter and recorded on Kodak film. The hES cell colonies in B and D are outlined with dotted lines.
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We also have employed the mAb against the SSEA-4 surface antigen to isolate live undifferentiated hES cells (expressing SSEA-4 or SSEA-4+) cultured on MSC or MEF feeder cells. Cells in cocultures were digested to single cell suspension and pooled for each group. The labeled SSEA-4+ cells were then isolated by the MACS system. Cells also were analyzed by flow cytometry before or after the MACS isolation (Fig. 4
). Flow cytometric analysis confirmed that the hES cell fraction (8.6% in Fig. 4A
) retained a high level of the SSEA-4 expression. After the MACS isolation, the purity of hES cells (SSEA-4+) was 93%-97% (94% in Fig. 4B
). The isolation method allowed us to obtain a pure hES cell population essentially free of feeder cells.

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Figure 4. Flow cytometric analysis of SSEA-4+ cells before and after cell isolation. The hES cells cocultured on hMSCs were harvested by trypsin/EDTA digestion. The single cell suspension was labeled with the SSEA-4 mAb. The labeled cells were then incubated with magnetic beads conjugated with anti-mouse IgG antibodies. Aliquots of input cells (A) and isolated cells after positive selection (B) were further incubated with anti-mouse IgG antibodies conjugated with PE (AM-PE). The histograms of the two samples are shown in dark open lines. The profile of a background control (omitting the SSEA-4 primary mAb) is shown as the filled gray line. The percentages of the gated positive cells in the marked region (M1) are also indicated.
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With these highly purified hES cells that had been cultured on either hMSCs or MEFs (as shown in Fig. 2
), we analyzed the gene expression of Oct-4, a critical transcription factor that is known to be preferentially expressed in undifferentiated hES cells [13]. By RT-PCR (Fig. 5
), a high level of the Oct-4 expression was detected in the hES cells cultured on MEFs (lane 1) as described previously [15]. We also found that hES cells that had been cultured on hMSCs for five passages also expressed the Oct-4 gene at a high level (lane 3). In contrast, hMSCs alone expressed a very low but detectable level of the Oct-4 gene (lane 4). The authenticity of the Oct-4 RT-PCR product was confirmed by DNA sequencing (not shown).

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Figure 5. RT-PCR analysis of the Oct-4 gene expression in hES cells cultured on MEFs and hMSCs. After coculture with hMSCs for five passages, hES cells were purified from hMSCs by MACS as shown in Figure 4 . Similarly hES cells cocultured on MEFs were also purified. Irradiated MEFs and hMSCs in the absence of hES cells were used as controls. After RT reactions, cDNA was amplified with the primer sets for either the human Oct-4 gene or for the ß-actin gene (human and mouse) as a control. Lane 1: hES cells cultured on MEFs; lane 2: MEFs alone; lane 3: hES cells cultured on MSCs; lane 4: MSCs alone.
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In addition, we analyzed the expression of other cell-surface markers on hES cells cultured on MSCs, or MSCs alone by flow cytometric analysis as in Figure 4
. The results are summarized in Table 1
. The expression pattern of these unique yet not definite markers is consistent with previous reports with H1 and several other hES cell lines [5,33,36]. Based on their morphology, the Oct-4 gene RT-PCR analysis, and the expression of 11 unique cell-surface markers including APase and SSEA-4, we conclude that the hES cells expanded by coculture on MSCs retained a unique morphology and phenotype characteristic of undifferentiated hES cells, as they did on MEFs.
Expanded hES Cells on MSCs Retain Unique Potential of Differentiation in Culture
We used aliquots of the expanded hES cells that had been cultured on hMSC for 8-12 passages in two culture assays to test whether they retained unique differentiation potentials. One such assay is to form EBs in suspension, a complex and organized structure resembling early embryos [25]. Figure 6A
shows a representative EB derived from aggregated hES cells that had been cultured on hMSCs for 12 passages and then in suspension culture for 15 days. When placed on tissue culture grade plates in FBS-containing medium, EBs adhered to the substrate and became flat cell masses that quickly proliferated and outgrew. A snapshot of outgrown differentiated cells 7 days in culture, which had morphology distinct from the undifferentiated ES cells, is shown in Figure 6B
. When hematopoietic cytokines were added into the differentiation medium, hematopoietic-like cells were observed (Fig. 6C
).

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Figure 6. hES cells expanded on hMSCs retained potential to form Ebs and differentiate in culture. hES cells expanded on irradiated hMSCs for 12 passages were harvested and placed in suspension culture. After 5-10 days, aggregated hES cells in suspension formed EBs. A cystic EB (arrow) and a disrupted EB (A) are shown. EBs were subsequently cultured in tissue culture grade plates, and whole EBs became adherent and continued producing progeny cells. Differentiated cells on the periphery of an outgrown EB are shown 7 days in adherent culture (B). When hematopoietic cytokines were added into culture medium, small rounded hematopoietic-like cells were detected at day 9 (C). They were loosely adherent on the top of other cell types as shown (B). Some of these hematopoietic cells were then released in suspension. Bar scales: (A) 100 µm, (B) 10 µm, and (C) 10 µm.
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The second differentiation assay is RA induction of ES cell differentiation [5]. Undifferentiated hES cells plated on Matrigel were treated with RA for 9 days (Fig. 7
). The RA-treated cells (Fig. 7A
) showed very different morphology (colonies with discrete cells) compared with the untreated hES cells (Fig. 7B
, more compact colonies). It is more evident after cell nuclei staining (Fig. 7C and 7D
). The RA-treated cells displayed a lower level of APase or SSEA-4 after the 9-day treatment, regardless of whether they had been originally cultured on hMSCs or MEFs (data not shown). Also consistent with the previous report [5], we found that hES cells appear to be less sensitive to the RA induction (or slower) as compared with mouse ES cells. Together with the previous data showing the undifferentiated morphology and phenotypes (Figs. 35

), the two in vitro differentiation assays further confirmed differentiation potentials of the expanded hES cells on hMSCs.

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Figure 7. Differentiation of hES cells expanded on hMSCs in response to RA induction. hES cells expanded on irradiated hMSCs were cultured on Matrigel to reduce number of feeder cells. RA was added the next day (A and C). No RA was added into B and D that served as undifferentiated controls. After 9 days in culture, cells were fixed and stained with Hoechst 33358 to label cell nuclei. The bright field image (upper panels) of hES cell morphology with or without RA induction is shown in A and B, respectively. The fluorescent staining (lower panels) of cell nuclei from the same colony is shown in C and D, respectively.
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Expanded hES Cells on MSCs Retain a Normal Chromosomal Karyotype
In one continuous coculture on irradiated hMSCs that lasted for nine passages, we attempted to examine chromosomal karyotypes of the expanded hES cells. Before the expansion, we had confirmed that the H1 ES cell line (which was derived from a male embryo) retained a normal 44+XY karyotype after continuous expansion on MEFs for 3 months in our laboratory (not shown). To easily identify hES cells and distinguish them from hMSCs that were also present in cocultures, we needed to reduce numbers of human feeder cells, particularly those of the male hMSCs that we used in the first seven passages. To this end, we seeded hES cells onto female hMSC feeder cells for two more passages followed by two additional passages on MEFs. Figure 8
shows a representative readout of such chromosomal karyotyping. Of the five samples examined, all of them displayed the same normal 44+XY chromosomal karyotype as the original. Thus, hES cells retained a stable and normal karyotype after prolonged expansion on hMSCs.

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Figure 8. A normal chromosomal karyotype of hES cells that have been expanded on hMSCs for nine passages.
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DISCUSSION
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|---|
Expanding hES cells efficiently under a clinically applicable culture condition is a prerequisite for their use in novel cell and gene therapies. We report here that we discovered a method to expand hES cells with the use of adult human cells. We developed an improved method to expand hMSCs and used them to support prolonged growth of hES cells. Irradiated MSCs from various donors at passage 2-10 supported the hES cell expansion in a serum-free medium at a rate similar to MEFs. The amplified hES cells on hMSCs displayed the same unique morphology and molecular marker characteristic of undifferentiated hES cells as MEFs, and retained differentiation potentials in culture and a normal chromosomal karyotype. The pluripotency of the expanded hES cells needs to be confirmed by other assays such as the teratoma formation assay in immunodeficient animals [13], which is currently the only in vivo pluripotency assay.
Currently, we do not know the identity of molecules that are made by hMSCs or MEFs and required by hES cells in culture. In Figure 2
, we showed that Matrigel alone (but with the conditioned medium from hMSCs or MEFs) was insufficient to support the growth of hES cells. Our result and a recent report [37] contradicted a previous report by Xu et al. [7] that hES cells could be maintained in an undifferentiated state if they were cultured on Matrigel as the ECM together with (undiluted) conditioned medium from MEFs. The apparent discrepancy may be due to varied levels of "carryover" MEFs in the Matrigel feeder cell-free culture. Xu et al. did not use purified hES cells free of MEFs that are also present in cocultures and did not address the level and importance of the carryover MEFs in their Matrigel feeder cell-free culture [7]. Since the majority of irradiated MEFs in hES cell coculture survived for at least 2 weeks, the carryover MEFs from the previous passage, although reduced in numbers, were also present in the Matrigel culture for several passages. For example, when an aliquot of hES cell cocultures (e.g., 1:3) was plated on Matrigel-coated plates, the equal fraction of MEFs (one-third of 200,000 cells) was also seeded simultaneously in the new culture.
Using the method described by Xu et al. [7], indeed we could also maintain or moderately (~twofold) expand hES cell colonies in the subsequent passage, if the splitting ratio of cocultures was between 1:1 and 1:3. However, we were unable to maintain the majority of hES cells in an undifferentiated state on Matrigel for four or five passages (~30-40 days, when numbers of remaining MEFs were negligible) and no expansion of ES cell colonies was observed after 1 month. Similarly, we failed to maintain (no net reduction in numbers of) undifferentiated hES cell colonies on Matrigel after one passage, if purified hES cells or significantly diluted cocultures (5% or 1:20, so that the carryover MEFs were negligible) were seeded (Fig. 2
). Our data are consistent with a recent publication reporting the similar difficulty in passaging and maintaining hES cell lines in an undifferentiated state using Matrigel supplemented with conditioned medium for >35-42 days [37]. Our data together with Richards et al. [37] acknowledged our current inability to separate the soluble and cell-associated components required for prolonged growth and expansion of hES cells in culture.
The culture-expanded and highly homogenous hMSCs will enable us to perform detailed analyses, which were previously impossible with mixed cell populations such as poorly characterized (p3) MEFs. A number of reports examined the production of cell adhesion molecules and growth factors/cytokines by hMSCs. For example, we have detected mRNA and protein for LIF, as well as IL-6 and IL-11 [27]. Indeed, hMSCs fully supported the proliferation of undifferentiated mouse ES cells in the absence of exogenous LIF, either in FBS-containing or the hES cell culture medium (unpublished data, August 2002). To this end, we will continue the investigation to separate soluble factors and ECM/cell adhesion molecules made by hMSCs. It is of interest to determine whether human feeder cells produce these required proteins only after they are cultured in the hES cell culture medium. It remains to be determined whether the ability of hMSCs to support the prolonged growth of hES cells is dependent on the MSC potential to generate various mesenchymal cell lineages.
Richards et al. also reported that fetal skin and muscle cells from 14-week-aborted fetuses can also support prolonged growth of hES cells [37]. Although it is an important breakthrough, "ethical concerns regarding the derivation of fetal cells from human abortuses" limit their uses, as noted by the authors [37]. They also used human feeder cells derived from adult fallopian tubal (AFT) tissues after hysterectomy. Unless the derived AFT cells can be immortalized and proliferate indefinitely in culture, the use of primary AFT cells to culture various ES cell lines for ES cell expansion will not be practical. In comparison, hMSCs can be readily derived from adult healthy donors or prospective patients, and can be expanded millionfold before being used in coculture for supporting hES cell expansion. Once hMSCs prove to support other ES cell lines and/or the derivation of new ES cell lines, this novel serum-free, animal cell-free culture system will provide a clinically and ethically feasible method to vastly expand hES cells on a clinical scale. Currently, hMSCs are established and expanded with media containing 10% FBS. Ideally, we will find a way to eliminate or replace FBS with human serum or purified factors.
We should also point out that hMSCs cultured with FBS have been used in several clinical trials for autologous and unrelated (allogeneic) transplantation and no adverse effects associated with the use of FBS have been reported [31,38]. An additional advantage of using hMSCs to expand hES cells is that unrelated MSCs do not generate alloreactive T lymphocytes in culture or in large animals [31,38]. In fact, recent data even revealed the remarkable ability of hMSCs to downregulate host alloimmune responses to the third party graft [38,39]. One can envision that the presence of hMSCs (derived from the patient or from a universal source) may help to induce immune tolerance and reduce the allogeneic rejection to the hES cell-derived progeny (a third party graft), when transplanted into a patient whose genotype is different from the hES cells.
Although hMSCs can proliferate in culture for a long time, we often observed that their proliferation rate was significantly reduced after six passages (>25 population doublings). Three groups recently reported on the immortalization of the proliferative and primitive potentials of hMSCs by overexpressing the TERT gene, the catalytic subunit of telomerase [4042]. Moreover, Dr. Verfaillies group reported that the adult BM-derived multipotent adult progenitor cells proliferate in culture for an extended time while maintaining their pluripotent differentiation potentials [2124]. It is of great interest to determine whether these immortalized adult marrow-derived cells can also support hES cell expansion as did the hMSCs used in this report.
 |
ACKNOWLEDGMENT
|
|---|
This work was supported in part by research grants from the W.W. Smith Charitable Trust and National Institutes of Health. We thank Gail Stetten, Sarah South, and Joseph McMichael in the Laboratory of Prenatal and Research Cytogenetics at the Johns Hopkins Hospital for their expert assistance with cell karyotyping analyses; Drs. Saul Sharkis, Michael Shamblott, and John Gearhart for critical reading of the manuscript, and the Developmental Studies Hybridoma Bank (Iowa City, IA) for SSEA-1 and SSEA-4 antibodies. Contents of this manuscript were included in an abstract and presented at the 44th Annual American Society of Hematology Meeting on December 9, 2002.
 |
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| EDITORS NOTE
For another important paper on human ES see:
"High-Level Sustained Transgene Expression in Human Embryonic Stem Cells Using Lentiviral Vectors," by
Yue Ma, Ali Ramezani, Rachel Lewis, Robert G. Hawley, and James A. Thomson. STEM CELLS 2003;21:111117[Abstract/Free Full Text]
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J. B. Lee, J. E. Lee, J. H. Park, S. J. Kim, M. K. Kim, S. I. Roh, and H. S. Yoon
Establishment and Maintenance of Human Embryonic Stem Cell Lines on Human Feeder Cells Derived from Uterine Endometrium under Serum-Free Condition
Biol Reprod,
January 1, 2005;
72(1):
42 - 49.
[Abstract]
[Full Text]
[PDF]
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J. B. Lee, J. M. Song, J. E. Lee, J. H. Park, S. J. Kim, S. M. Kang, J. N. Kwon, M. K. Kim, S. I. Roh, and H. S. Yoon
Available human feeder cells for the maintenance of human embryonic stem cells
Reproduction,
December 1, 2004;
128(6):
727 - 735.
[Abstract]
[Full Text]
[PDF]
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T. C. Schulz, S. A. Noggle, G. M. Palmarini, D. A. Weiler, I. G. Lyons, K. A. Pensa, A. C.B. Meedeniya, B. P. Davidson, N. A. Lambert, and B. G. Condie
Differentiation of Human Embryonic Stem Cells to Dopaminergic Neurons in Serum-Free Suspension Culture
Stem Cells,
December 1, 2004;
22(7):
1218 - 1238.
[Abstract]
[Full Text]
[PDF]
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C. Xu, J. Jiang, V. Sottile, J. McWhir, J. Lebkowski, and M. K. Carpenter
Immortalized Fibroblast-Like Cells Derived from Human Embryonic Stem Cells Support Undifferentiated Cell Growth
Stem Cells,
November 1, 2004;
22(6):
972 - 980.
[Abstract]
[Full Text]
[PDF]
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M. Stojkovic, M. Lako, T. Strachan, and A. Murdoch
Derivation, growth and applications of human embryonic stem cells
Reproduction,
September 1, 2004;
128(3):
259 - 267.
[Abstract]
[Full Text]
[PDF]
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M. Richards, C.-Y. Fong, S. Tan, W.-K. Chan, and A. Bongso
An Efficient and Safe Xeno-Free Cryopreservation Method for the Storage of Human Embryonic Stem Cells
Stem Cells,
September 1, 2004;
22(5):
779 - 789.
[Abstract]
[Full Text]
[PDF]
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K. Miyamoto, K. Hayashi, T. Suzuki, S. Ichihara, T. Yamada, Y. Kano, T. Yamabe, and Y. Ito
Human Placenta Feeder Layers Support Undifferentiated Growth of Primate Embryonic Stem Cells
Stem Cells,
July 1, 2004;
22(4):
433 - 440.
[Abstract]
[Full Text]
[PDF]
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J. H. Park, S. J. Kim, E. J. Oh, S. Y. Moon, S. I. Roh, C. G. Kim, and H. S. Yoon
Establishment and Maintenance of Human Embryonic Stem Cells on STO, a Permanently Growing Cell Line
Biol Reprod,
December 1, 2003;
69(6):
2007 - 2014.
[Abstract]
[Full Text]
[PDF]
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M. Mitalipova, J. Calhoun, S. Shin, D. Wininger, T. Schulz, S. Noggle, A. Venable, I. Lyons, A. Robins, and S. Stice
Human Embryonic Stem Cell Lines Derived from Discarded Embryos
Stem Cells,
September 1, 2003;
21(5):
521 - 526.
[Abstract]
[Full Text]
[PDF]
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