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A schematic of the differentiation protocol is shown in Figure 1A. On day 1 of the protocol, hiPSCs should be compact and forming small colonies with total confluence approximately 50-60%. 24 hours following induction of differentiation towards DE cells begin to migrate away from the stem cell colonies to form a monolayer of cells. This continues over the following 3 days and should form a complete monolayer on D3 of DE differentiation (Figure 1). Gene expression should be monitored over the course of differentiation with pluripotency markers (OCT4, NANOG, SOX2) highly expressed on D0 and rapidly downregulated during DE differentiation. During DE differentiation T expression should peak on D1, followed by EOMES and MIXL on D2. On D2 DE genes (SOX17, FOXA2, GATA4, CXCR4) should begin to be expressed and peak at D3 (Figure 2 and Figure 3). Cells should be a monolayer by DE D3 and can then be posteriorized into hindgut endoderm. During the posteriorization event 3D structures will start to form as early as D2. However, sometimes they will only start to appear at D4 or not at all; this is not always indicative of whether or not the cells will proceed and form intestinal organoids (Figure 1). During HG specification CDX2 and HNF4a expression should be induced and increase over time (Figure 3).
Following transfer of 2D sheets of cells into extracellular matrix, clumps of 2D cells will be observed for the first 24 h. After 48 h sheets of cells should begin to auto organize into more compacted 3D spheroid structures that are initially small (Figure 4A) then gradually increase in size and complexity over 7-10 days of culture (Figure 4B & Figure 4C). Organoids should not be passaged until they have achieved a clear organoid/spheroid morphology with obvious epithelium with the lumen facing towards the center of the organoid/spheroid (Figure 4D). At this stage immunocytochemistry can be used to confirm expression of intestinal markers such as villin and CDX2 (Figure 5). Not all clumps of 2D cells will develop into organoids and there will be some contaminating dead cells within the extracellular matrix. These dead sheets of cells should be ignored until the surviving cells have formed large organoids and are ready for passaging.
To model inflammation, TNFα can be added to the tissue culture medium for 24-48 h. Following incubation with proinflammatory molecules, organoids are harvested using the same technique used for their isolation and passaging and then lysed using a cell buffer compatible application such as QPCR or western blotting. If shorter exposures are required, organoids should first be removed from the extracellular matrix and exposed to TNFα in suspension using a 1.5 mL tube. Treatment of intestinal organoids with TNFα for 48 h typically induces expression of pro-inflammatory markers (TNFα, IL1B, IL8, IL23) while negatively affecting expression of intestinal epithelial markers (LGR5, VIL) (Figure 6).
| Endoderm basal media | 50 mL |
| RPMI 1640 | 48.5 mL |
| B27 Supplement | 1 mL |
| 1% NEAA | 0.5 mL |
Table 1: Composition of endodermal basal media for endoderm differentiation.
| Intestinal Basal Media | 50 mL |
| Advanced DMEM/F12 | 46.5 mL |
| HEPES Buffer | 0.5 mL |
| GlutaMAX | 0.5 mL |
| Nicotinamide | 0.5 mL |
| N2 Supplement | 0.5 mL |
| B27 Supplement | 1.0 mL |
| Pen/Strep | 0.5 mL |
Table 2: Composition of intestinal basal media for culture of intestinal organoids

Figure 1: Morphological changes during differentiation of hiPSC via definitive endoderm to the hindgut lineage.
(A) Schematic overview of intestinal differentiation protocol. This cell line of hiPSC forms loose colonies of small cells with a high nucleus to cytoplasm ratio. As the differentiation proceeds, the cells undergo changes consistent with transition from the epithelial to the mesenchymal phenotype and by DE D3 form a uniform monolayer. Once appropriate signals are delivered, DE cells elongate and form a more densely packed monolayer with 3D spheroids appearing as soon as HD D3 but this is dependent upon cell line used and is not a requirement for transition to 3D culture (B). Scale bar: 100 µm. Please click here to view a larger version of this figure.

Figure 2: Differentiation of hiPSCs to HG endoderm induces expression of endodermal genes.
Immunostaining of hiPSC differentiating to definitive endoderm shows changes in expression of TFs at protein level. Pluripotency markers (NANOG and OCT4) are downregulated by DE D3 (A). Expression of mesendoderm marker BRA(T) is present at D1 of the protocol (B) and DE specific TFs SOX17 and FOXA2 appear on D2 (B & C). Scale bar: 200 mm. Please click here to view a larger version of this figure.

Figure 3: Gene expression changes by qPCR during hiPSC differentiation to hindgut endoderm (HG).
Genes associated with pluripotency are downregulated (OCT4, NANOG, SOX2) followed by transient expression of mesendoderm genes (T, EOMES, MIXL1), and finally expression of DE genes (SOX17, FOXA2, CXCR4) and hindgut genes (CDX2, GATA4, HNF4a). Data presented as mean ±SD. Please click here to view a larger version of this figure.

Figure 4: HG endoderm self-assembles to form 3D intestinal organoids in 3D extracellular matrix culture.
HG endoderm is transferred into a suitable 3D extracellular matrix culture and initially forms small solid clumps of cells (A). Clumps of HG endoderm expand over 7-10 days of culture (B) and then become asymmetrical and begin to form a more complex epithelium (C) eventually giving rise to organoids with clear epithelial morphology and a luminal surface facing towards the centre of the organoid (D). Scale bars = 50 µm Please click here to view a larger version of this figure.

Figure 5: Established hiPSC-derived intestinal organoids express intestinal markers.
Immunocytochemistry showing expression of CDX2 and Villin. Scale bars = 100 µm Please click here to view a larger version of this figure.

Figure 6: Effect of TNFα on the inflammatory profile & intestinal cell expression of healthy intestinal organoids.
Inflammatory profile of healthy colonic organoids following 48 hour treatment with TNFα (40 ng/mL). Expression of pro-inflammatory markers (TNFα, IL-8 & IL-23) increases following exposure to TNFα, while at the same time expression of intestinal epithelial markers (LGR5, VIL) are downregulated. Statistical analyses were performed by two-sided student’s t-test. Data are expressed as mean ± SD of each group. *P < .01; **P < .001; ***P < .0001. (n=3). Please click here to view a larger version of this figure.