We have applied the protocol described above to dissociate and culture 125 fresh surgical glioblastoma specimens (Figure 1), 88 newly diagnosed, and 37 recurrent tumors (Table 2), with approved patient consent and under institutional guidelines. The efficiency of the protocol for establishing long term neurosphere cultures was 41.6%, and similar for newly diagnosed tumors and recurrent tumors (Table 2). For some GBM samples, neurospheres form in the first few days (Figures 1B and 1C), while for others longer culturing time is required (Figures 1D and 1E).
Efficiency of neurosphere formation was not exclusively dependent on the level of necrosis in the tissue, as exemplified by the results from a newly diagnosed tumor with high cell density (GBM1) and a recurrent and necrotic tumor (GBM2) processed according to Protocols 1 and 2, both yielding neurosphere cultures (Figure 2).
Testing the tumorigenic potential of each neurosphere culture in immunocompromised mice is the crucial validation of this approach for enrichment of CSCs. Using a protocol similar to previously described18, GBM1 and GBM2 neurospheres were implanted into the brains of immunocompromised mice, under institutional and IACUC animal care guidelines. The xenograft tumors present morphological characteristics of GBMs, such as invasion into the brain parenchyma and necrosis (Figure 2).
GBM3 was dissociated (Figure 1A) and cultured in neurosphere medium (Figures 1D and 1E), and in 2% FBS/NMGF (Figures 1D, 1G, and 1H). Monolayer cells cultured in 2% FBS/NMGF and neurosphere cells cultured in NMGF were dissociated and the same number of cells were implanted in nude mouse, using the same procedure as in Figure 2. No differences in survival, tumor growth dynamics, or morphology were observed between the two preimplant culture methods (Figures 3A-C). Tumor growth characteristics do not change up to the latest passage tested, P20 for neurospheres, and P10 for 2% FBS/NMGF. While neural stem cell markers, including Sox2, are downregulated in most primary GBM cells cultured in 10% FBS 3,4,11, NMGF supplemented with 2% FBS allows for the retention of Sox2 expression (Figure 3D).
Neurospheres were processed according to Protocol 4, and labeled with H&E (Figure 4A), anti-Sox2 antibody, showing nuclear localization (Figure 4B), and EGFR antibody, cell membrane localization (Figure 4C). This protocol has been applied to access stimuli-dependent alterations in the expression of nestin, GFAP, and the proliferation marker Ki6711.
Table 2. Efficiency of deriving long term self-renewing neurosphere cultures from GBMs.
| Pathology | n | Percentage of samples yielding long term self-renewing neurospheres (n) |
| Glioblastoma - untreated, first surgery | 88 | 42.0% (37) |
| Glioblastoma - recurrent | 37 | 40.5% (15) |
| TOTAL | 125 | 41.6% (52) |

Figure 1. Cell culture from fresh glioblastoma surgical specimens. Fresh tumors are enzymatically dissociated into single cells. Nucleated cell interface from density separation medium is then plated in NMGF. Dissociated neurospheres are plated in NMGF, and typically 1 day after plating there are dead cells, debris, attached single cells, and occasional dividing cells in suspension (A). Neurosphere formation is faster for some cases (B,C), and slower for others (D,E). All neurospheres are dissociated and replated for at least 10 passages, 41.6% GBMs yield long term self-renewing neurospheres. Viable GBM dissociated cells that fail to grow as neurospheres (F) can be transferred to alternative culture conditions, for example 2% FBS/NMGF (G,H). Bar (A), 100 μm, applies to all images. Click here to view larger image.

Figure 2. Neurosphere generation and orthotopic mouse xenografts from GBM tumors. A tumor sample presenting high cell density (GBM1) and a tumor with high necrotic content (GBM2) were dissociated and neurospheres cultured for 10 passages according to Protocols 1 and 2. Immunocompromised mice were implanted with 3 x 105 dissociated neurosphere cells and sacrificed when moribund. Mouse brains were formalin fixed and paraffin embedded for H&E staining and immunohistochemistry detection of human markers, human mitochondria (hMit) or major histocompatibility class I subunit HLA-A (MHC-I). Click here to view larger image.

Figure 3. Similar tumor growth in mice implanted intracranially with GBM3 cells cultured as neurospheres in NMGF or as monolayers in 2% FBS/NMGF. (A) Kaplan-Meier survival curves for GBM3 cultured as either neurospheres in NMGF or monolayers in 2%FBS/NMGF (both passage <10) show no difference in survival (n=10, p=0.7174, log-rank test). (B) Tumor growth monitored by live bioluminescence imaging (BLI) show no significant difference in tumor growth dynamics between the two groups. (C) Tumor morphology is indistinguishable for 4 GBM3 xenografts, 2 cultured in NMGF and 2 cultured in 2% FBS/NMGF. MHC-I stain as described for Figure 2. Scale, 600 μm. (D) Western blot showing the stem cell maker Sox2 expression retained in 2% FBS/NMGF cultures used to initiate the xenograft tumors (A-C). Click here to view larger image.

Figure 4. Analysis of protein expression in neurosphere sections by immunohistochemistry. Neurosphere cultures were formalin-fixed and paraffin embedded as described in Procedure 4, and stained with H&E (A), anti-Sox2 antibody (B), and anti-EGFR antibody (C). DAB substrate was used to visualize (B,C). Bar, 20 μm. Click here to view larger image.