The transparent cornea at the ocular surface allows light to enter the retina and provides the majority of the eye's refractive power. The outermost layer, the stratified corneal epithelium, is continuously regenerated by limbal epithelial stem cells (LESCs). The LESCs reside in the basal layer of the limbal niches at the corneoscleral junction1,2. LESCs lack specific and unique markers, so their identification requires a more extensive analysis of a set of putative markers. Epithelial transcription factor p63, and especially N-terminally truncated transcript of the alpha isoform of p63 (ΔNp63α), has been proposed as a relevant positive LESC marker3,4. Asymmetric division of LESCs allows them to self-renew, but also produce progeny that migrate centripetally and anteriorly. As the cells progress toward the corneal surface they gradually lose their stemness and finally terminally differentiate to superficial squamous cells that are continuously lost from the corneal surface.
Damage to any of the corneal layers can lead to severe visual impairment, and corneal defects are thus one of the leading causes of vision loss worldwide. In limbal stem cell deficiency (LSCD), the limbus is destroyed by disease or trauma which leads to conjunctivalization and opacification of the corneal surface and subsequent loss of vision5,6. Cell replacement therapy using autologous or allogeneic limbal grafts offers a treatment strategy for patients with LSCD4,7,8,9. However, harvesting autologous grafts bears a risk of complications to the healthy eye, and donor tissue is in short supply. Human pluripotent stem cells (hPSCs), specifically human embryonic stem cells (hESCs) and human induced pluripotent stem cells (hiPSCs), can serve as an unlimited source of clinically relevant cell types, including corneal epithelial cells. Therefore, hPSC-derived LESCs (hPSC-LESCs) represent an attractive new cell source for ocular cell replacement therapy.
Traditionally, both the undifferentiated hPSC culture methods and their differentiation protocols to LESCs have relied on the use of undefined feeder cells, animal sera, conditioned media, or amniotic membranes10,11,12,13,14,15. Recently, efforts toward safer cell therapy products have prompted the search for more standardized and xeno-free culture and differentiation protocols. As a result, several defined and xeno-free methods for long-term culture of undifferentiated hPSCs are now commercially available16,17,18. As a continuum, directed differentiation protocols relying on molecular cues to guide hPSCs to corneal epithelial fate have been recently introduced19,20,21,22,23. Yet many of these protocols used either undefined, feeder based hPSCs as starting material, or complex, xenogeneic growth factor cocktails for differentiation.
The purpose of this protocol is to provide a robust, optimized, xeno-and feeder-free hPSC culture method and subsequent differentiation to corneal LESCs. Monolayer culture of pluripotent hPSCs on laminin-521 (LN-521) matrix in defined, albumin-free hPSC medium (specifically Essential 8 Flex) allows rapid production of homogeneous starting material for differentiations. Thereafter a simple, two-step differentiation strategy guides hPSCs toward surface ectodermal fate in suspension, followed by adherent differentiation to LESCs. A cell population where > 65% express ΔNp63α is obtained within 24 days. The xeno- and feeder-free protocol has been tested with several hPSC lines (both hESCs and hiPSCs), without any requirement for cell line specific optimization. The protocols for weekend-free maintenance, passaging, cryostoring and hPSC-LESC phenotyping described here enable production of large batches of high-quality LESCs for clinical or research purposes.