Patient-derived xenografts (PDX) are a powerful in vivo model for studying the production of normal and malignant hematopoietic cells in a 'native' mammalian environment. Most often, PDX are produced by injecting or transplanting human cells into immune deficient mice. The production of PDX using normal human hematopoietic stem cells allows in vivo studies of normal human blood and immune cell development. PDX produced from leukemia or other cancer cells make it possible to study oncogenic mechanisms and to identify effective therapies in context of the range of genetic landscapes and mutations present in the human population.1 Consequently, PDX are the current gold standard for translational biomedical research to identify effective therapies and an important tool for understanding mechanisms of cancer progression. PDX models are an essential tool to aid research into health disparities diseases due to specific genetic lesions, or any disease in which the variations of a patient's genetic landscape can substantially contribute to oncogenesis and treatment outcome.
Mouse-human PDX models are possible because many mouse cytokines adequately mimic their human analogs in activating the cytokine receptors of human cells while they are inside the mouse. For example, interleukin-7 (IL-7) provides a critical signal for human B cell development.2 In this case, mouse IL-7 has sufficient homology with human IL-7 that the mouse cytokine stimulates signaling pathways in human B cell precursors.2,3,4 However, this is not the case for thymic stromal lymphopoietin (TSLP),5,6 which among other cytokines (IL-3, granulocyte-macrophage colony stimulating factor (GM-CSF), stem cell factor (SCF),7 is important for the production of normal and malignant human hematopoietic cells. When mouse and human cytokines show low homology the mouse cytokines do not activate their respective receptors on human cells. To overcome this obstacle, a number of strategies have been used to engineer expression of human cytokines in PDX mice. These include injection of recombinant human cytokines, hydrodynamic injection of DNA, lentiviral expression, transgenic expression and knockin gene replacement.7 This report describes a method for engineering PDX to produce human cytokine via stromal-mediated cytokine delivery (Figure 1).
In the method demonstrated here, PDX mice are engineered to express the human cytokine, TSLP, or to serve as cytokine-negative controls. TSLP-expressing PDX are achieved by weekly intraperitoneal injections of stromal cells that have been transduced to express high levels of human TSLP. Cytokine-negative PDX "control" mice are similarly engineered; though control stroma are transduced with a control vector. This method achieves normal physiological levels of human TSLP in PDX mice injected with the TSLP+ stroma. No detectable TSLP is observed in PDX mice receiving the cytokine-negative stroma. We selected the human stromal cell line HS-27A for our studies because it grows robustly in culture and shows very low level of cytokine production that does not support proliferation of isolated progenitor cells in cocultures.8 For human TSLP expression, stroma were transduced with an advanced generation self-inactivating lentiviral vector derived from a previously described backbone,9 and includes the cPPT/cts element and the woodchuck hepatitis post-transcriptional regulatory element (WPRE) to increase transgene expression. The human TSLP gene was constructed into this vector under the control of the elongation factor-1 (EF-1) alpha promoter to achieve robust, constitutive, and long-term expression.
The engineering of this human-cytokine enhanced PDX model consists of 4 major steps. First, transduced stroma are expanded in vitro and assessed by enzyme-linked immunosorbent assay (ELISA) for stable, high level cytokine production. Second, the activity of human cytokine produced by the transduced stromal cells (and lack of cytokine activity from control stroma) is verified using phospho-flow cytometry. Cell lines known to be responsive to cytokine of interest (in this instance,TSLP) are incubated with stromal cell supernatant and assayed for cytokine-induced phosphorylation. Third, mice are injected with transduced human stroma and then mouse plasma is assessed by ELISA for levels of human cytokine on a weekly basis. Fourth, human hematopoietic cells are transplanted and the in vivo functional effects of the human cytokine is evaluated on a known target (e.g. cell population).

Figure 1: PDX Model Engineered to Produce Exogenous Human Cytokine in Mice. (1A) Design experiment and obtain transduced human stromal cells (1B) Obtain human cells (hematopoietic stem cells, leukemia cells, etc.) to generate PDX (patient-derived xenograft) mice. (2A) Inject engineered stroma and (2B) transplant human cells into immune deficient mice according experimental schedule. (3A-B) Monitor cytokine concentrations in the stroma supernatant and the mouse plasma by ELISA. (4) Harvest human cells and assess the in vivo functional effects of the human cytokine present in the PDX. Please click here to view a larger version of this figure.
Delivery of human cytokine via stromal cells offers both advantages and disadvantages when compared to other methods of delivering/producing human cytokines in PDX mice.7 Compared to injection of recombinant human cytokine, stroma-mediated delivery is generally less expensive (cost of stromal cell culture is less than cost of recombinant cytokine) and less labor intensive (one injection per week versus multiple injections per week). The issue of short cytokine half-life is also mitigated since stroma continually produce the exogenous cytokine. Delivery of cytokine via hydrodynamic injection of DNA may be less expensive than delivery via stroma. However, it is similarly transient and may require more technical skill than the simple weekly intraperitoneal injection required for stroma-mediated delivery. Lentiviral gene expression in the mouse may provide a less transient method of cytokine delivery; however, in our hands physiological TSLP levels were not achieved. Additionally, this method is labor intensive, requiring continuous production of lentiviral vector. Transgenic or knock-in mice offer stable long-term expression of cytokine and can be engineered for tissue specific expression, which can be an advantage. On the other hand, the transgenic expression of the human cytokine gene on the immune deficient mouse background required for PDX mice, necessitates an immense investment of resources before the value of the model has been established. Furthermore, transgenic models do not generally allow for the option of varying the timing of cytokine initiation or level of in vivo cytokine production. These can be achieved with stroma-mediated delivery by simply changing the time point for initiation of stromal cell injection or the dose of stromal cells injected.
The stromal-cell mediated cytokine delivery method detailed here was used to develop PDX for evaluating the role of TSLP in normal human B cell development4,6 and high risk B-cell acute lymphoblastic leukemia.6 This method provides an alternative cytokine delivery method for use in generating similar models with human cytokines other than TSLP. This model can also be useful for generating preliminary data that can help determine whether the value of a cytokine transgenic or cytokine knock-in PDX model would be worthy of the substantial time and money investment.