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A primary limitation to cell-based insulin replacement therapies in type 1 diabetes is the paucity of human islets available for transplantation. The ability to regulate proliferation and differentiation of human pancreatic precursor cells into insulin-producing cells that meet the metabolic demands of an insulin-deficient state remains a critical building block for a cell-based therapy to treat type 1 diabetes.
Until the advent of hESC derived insulin-producing cells, human fetal pancreatic endocrine cells or their precursors were viewed as potential sources of cells for clinical transplantation. Although the scientific and regulatory landscape has changed in the past few years, there remains a vital need to understand how the human fetal pancreas develops. Many now view therapeutic use of human fetal cells as unlikely, however if effective and safe methods to expand the cells were established, therapeutic use of these cells could again be explored. A major hurdle that remains is that in vitro transformation of human fetal pancreatic cells aggregates (ICCs) into glucose responsive, insulin secreting endocrine cells is currently an inefficient process. Although much work over almost 30 years has elucidated and delineated the expression profile of transcription factors required for the development of endocrine pancreas, there remain gaps in our knowledge about how temporal expression of transcription factors is regulated and related to cell function.
Until the advent of hESC derived insulin-producing cells, human fetal pancreatic endocrine cells or their precursors were viewed as potential sources of cells for clinical transplantation. Although the scientific and regulatory landscape has changed in the past few years, there remains a vital need to understand how the human fetal pancreas develops. Many now view therapeutic use of human fetal cells as unlikely, however if effective and safe methods to expand the cells were established, therapeutic use of these cells could again be explored. A major hurdle that remains is that in vitro transformation of human fetal pancreatic cells aggregates (ICCs) into glucose responsive, insulin secreting endocrine cells is currently an inefficient process. Although much work over almost 30 years has elucidated and delineated the expression profile of transcription factors required for the development of endocrine pancreas, there remain gaps in our knowledge about how temporal expression of transcription factors is regulated and related to cell function.
Recently, the stem cell field has employed the accumulated knowledge about temporal transcription factor expression during islet development to drive the production of cells that express the markers of mature endocrine cells. Although genesis of insulin producing cells from hESC and induced pluripotent cells (iPSC) has made substantial and significant advances in the past few years, the most effective protocols require two distinct differentiation phases: 1) an early in vitro differentiation to generate cells expressing pancreatic precursor transcription factors, followed by 2) in vivo maturation after transplant — a so called “black box” period. To move forward, advances in understanding the biology underlying islet maturation in vivo, regardless of cell source, must be understood at a biochemical level. The similarity between the results obtained with ICCs and hESC suggests that a number of critical biochemical processes that regulate the transition of human pancreatic precursor cells into mature, glucose responsive, insulin secreting cells in vitro remain unknown. A central part of this understanding will be to develop novel methodologies to derive functional endocrine cell populations from pancreatic progenitor cells and hESC will require not only biochemical approaches that elucidate the maturation events, but methods to analyze the changes.
Why do we believe that imaging human fetal pancreatic cells is a critical aspect of identifying changes in islet maturation? The answer lies partially in the historical quest to generate insulin producing cells. Both model and tissue-culture systems for pancreatic precursors and islets have allowed researchers to explore the significant differences that exist between maturation of animal islets and human islets in vitro. A limitation to the exploration of human fetal pancreas development is that the gestational ages that can be legally used only give rise to heterogeneous cell aggregates. Although the isolated fetal human cells resemble islets, staining after in vitro culture from gestational ages 9-23 weeks reveals less than 15% contain markers for endocrine cells, with most cells not staining for islet hormones. However, after transplantation and in vivo maturation, a large majority of cells express endocrine markers 6,25. The results from these studies are being echoed today with hESC differentiation protocols that are only able to generate modest populations of single hormone positive endocrine cells after in vitro differentiation. In vitro methods to enhance populations of hormone positive cells will likely provide insight into in vivo islet maturation. Furthermore, understanding the molecular events that drive human fetal pancreatic development will likely improve efforts to derive insulin producing cells from hESC and further delineate the mechanisms that regulate β cell regeneration and pancreatic cell transdifferentiation.
The similarities between human fetal pancreatic cell and hESC maturation can be extended to cell function. Like murine cells, both human fetal cells and differentiated hESC are unable to release insulin in response to glucose after islet neoformation in vitro26,27. However, upon transplantation into nude mice and maturation, both human islet-like clusters and insulin producing cells derived from hESC exhibit an endocrine phenotype. Three months after grafting, almost 90% of the transplanted cells from either population are insulin positive, and function normally as determined by the release of C-peptide17,26. These results indicate that transplantation provides context and unidentified cues that promote islet maturation. Optimized imaging protocols, such as the one described here, for human fetal pancreatic cells will aid in the search to identify factors that modulate and accelerate maturation. Fundamental biochemical exploration of human fetal pancreatic cells and hESC differentiated towards an endocrine lineage at this stage of development is essential for measuring efficiency of maturation.
The following protocol, outlined in Figure 1, provides our current method for the isolation of human fetal pancreatic cells, called ICCs from whole human fetal pancreas and imaging of these cells. This protocol requires an initial preparation of cells from tissue, which can be subsequently grown as a monolayer or in suspension. Preparation of cells for imaging of commonly used markers of endocrine cell proliferation and maturation is described.
Generation and imaging of ICCs in the absence or presence of a variety of chemical modifying agents provides a rapid method, compared with transplantation models, to help identify culture conditions and compounds that accelerate maturation of human fetal pancreatic cells into fully functional exocrine, ductal, or hormone producing pancreatic cells.