As the lack of homogeneity in the size of spheroids is one of the main drawbacks of currently available 3D spheroid culture systems13, the aim of this work was to set up a reliable and reproducible protocol to obtain homogenous spheroids. First, to establish ideal working conditions, different numbers of Caco2 cells were tested, ranging from 50 to 2,000 cells per microwell/spheroid using dedicated plates (Table 1). In effect, each well in these plates contains 1,200 microwells, enabling the formation of the same number of spheroids per well, and more importantly, the formation of one spheroid per microwell21. After two days of culture, the wells containing 2,000 cells per spheroid grew as a monolayer, and 50 cells per spheroid gave rise to small and non-homogenous spheroids (Figure 1A). These two conditions were therefore excluded from further analyses. To establish long-term cultures, spheroids were harvested from the microwells and seeded under non-adherent conditions in freshly prepared agarose-coated plates. Spheroid growth was then monitored throughout the experimental time-course by measuring the change in volume. To take into account the non-spherical shape, three different diameters of each spheroid were measured, and the volume formula was applied27 (Figure 1B). Spheroids generated from 100 and 200 cells maintained their initial size over the entire course of the experiment, whereas those containing 1,000 cells disintegrated during harvesting due to their large size and, consequently, presented more variability in their volume. Therefore, as spheroids arising from 500 cells showed the most homogenous increase in size over the experimental time-course, this number of cells was used for spheroid formation.
Second, besides 500 cells per spheroid, additional cell numbers ranging from 300 to 800 cells were studied. Moreover, to improve the non-adherent conditions, the original protocol was modified by pretreating the wells twice instead of applying only one wash. An improvement in spheroid homogeneity and compaction was observed with these changes (Figure 2A). The size of the spheroids in each condition was measured at the time of harvest (Figure 2B), and their long-term growth was monitored throughout the days in culture in agarose-coated dishes (Figure 2C). Based on the results, 500 and 600 cells/spheroid were confirmed as the optimal conditions yielding good growth and low variability. Owing to the more homogenous growth profile throughout the experimental time-course and the compact structures formed, 600 cells per spheroid was selected as the cell number for subsequent experiments. Finally, to further improve the protocol, DMEM complete medium was supplemented with 2.5% of basement membrane matrix, which contains additional growth factors and a large panel of extracellular matrix proteins28. Indeed, the multilobular shape of the spheroids could be due to the lack of signals from the microenvironment that may have affected cell polarization29,30. The addition of basement membrane matrix enhanced spheroid growth and improved their homogeneity (Figure 2D). An example of this improvement can be seen for 500 cells per spheroid. In the absence of the basement membrane matrix (Figure 1B), the size of the spheroids was more heterogeneous, doubling from D3 to D7 and then reaching a plateau. However, in the presence of the basement membrane matrix (Figure 2C), the size of the spheroids at each time-point was more homogeneous, increasing proportionally over time.
To analyze long-term features of the spheroids, they were recovered at different time-points after culture in agarose-coated dishes for detailed histological and IF analyses on paraffin sections. H&E staining showed that cells within the spheroids underwent changes in their organization and shape over time. Indeed, cells were densely arranged in multilayers at D3, while flattened cells arranged in monolayers were clearly visible at D10. Interestingly, as indicated by the black dotted lines in the images, a lumen appeared within the spheroids from D5 onwards (Figure 3). In parallel, cell proliferation and apoptosis were analyzed by IF using the proliferation marker, proliferating cell nuclear antigen (PCNA), and the cell death marker, activated caspase 3. Labeling for PCNA revealed that proliferating cells were often present at the outer surface of the spheroids, sometimes in crypt-like or bud-like structures reminiscent of organoid cultures15. In addition, a clear increase in PCNA-positive cells at D5 and D7 was observed that declined by D10 (Figure 4, left panels). Surprisingly, activated caspase 3 was observed in very few cells in the spheroids at both D3 and D5 (Figure 4, left panels) and over longer periods of time (data not shown). The expression pattern of β-catenin was also evaluated in paraffin sections. Interestingly, high levels of β-catenin expression were observed at each time-point with clear membrane-bound and cytoplasmic staining (Figure 4, right panels). It is worth noting that membrane-bound β-catenin participates in cell-cell adhesion by binding to E-cadherin31. A high level of ß-catenin labeling was noted in clusters of cells at all time-points. In some cases, cells also displayed clear nuclear ß-catenin localization (Figure 4, right panels). Caco2 cells are known to differentiate in vitro in 2D mainly into enterocytes19,32. However, the expression of differentiation markers, such as chromogranin A (enteroendocrine cells), lysozyme (Paneth cells) or mucin 2 (MUC 2, goblet cells), was undetectable in these spheroids by IF (data not shown). However, the potential to differentiate into enterocytes was confirmed, given that the spheroids expressed ALPI (alkaline phosphatase) and solute carrier family 2, transcript variant 2 (SLC2A5)/glucose transporter 5 (GLUT5) mRNAs (Figure 5). These mRNA levels increased at D5 and D7, but the difference was either not significant (ALPI) or only marginally significant (SLC2A5) compared to the levels at D3.
With the final aim of defining whether the spheroids generated and cultured based on this new method are a reliable tool to study CSCs, the expression of CSC markers was analyzed by IF and qRT-PCR. CD133 and CD44 characterize cancer cell populations including CSCs7,33,34 and are also expressed by SCs in the normal intestine and colon33,34,35. Clusters of CD133-positive cells were mainly localized on the external surface of the spheroids at each time-point (Figure 6A, left panels). CD44-positive cells were less frequent, but were always associated with CD133-positive cells (Figure 6A, right panels), indicating the existence of a population of CD133/CD44 double-positive CSC-like cells and a population expressing only CD133. Olfactomedin 4 (OLFM4) and Musashi 1 (MSI1) were examined as SC/CSC markers; these markers are expressed in a very limited manner in colon crypts36,37 and also in distinct cell populations35,38. Only a few MSI1-positive cells were observed at each time-point (Figure 7), whereas OLFM4 remained undetectable (data not shown). Nevertheless, as observed for CD44 and CD133, MSI1-labeled cells were located on the external surface of the spheroids in crypt-like or bud-like structures. The same markers were also analyzed at the mRNA level at the same time-points after culture in agarose-coated dishes. Aldehyde dehydrogenase 1 (ALDH1a1), a well-characterized marker of CSCs39,40, was also included in the study (Figure 8). The analysis of prominin-1 (PROM1 encoding for CD133) and CD44 mRNAs confirmed the expression of both markers in spheroids at all time-points analyzed. Of note, however, while PROM1 mRNA levels were quite similar over time in culture, CD44 levels decreased from D3 onwards. The difference, however, was only marginally significant when comparing the mRNA levels of D10 and D3.
The analysis of MSI1 mRNA confirmed its expression in spheroids at each time-point, with significantly higher levels at D3 and D5 compared with those at D7 or D10 (Figure 8), whereas OLFM4 mRNA was not detectable (not shown). Finally, ALDH1a1 mRNA was expressed in spheroids at each time-point and showed an expression profile that declined at D10, the levels being only marginally significant compared to those at D3 (Figure 8). To validate the appropriateness of the new model to study cancer cell biology, the response to chemotherapy was analyzed in spheroids treated with FOLFOX or FOLFIRI, combination therapies routinely administered to CRC patients22,23,24,25. First, the efficacy of the treatments in inducing cell death was examined by incubating the spheroids with a fluorescent nucleic acid stain that specifically enters into dead cells26. Compared to the control NT condition, the treatment with each of the drugs induced significant cell death measured by the accumulation of fluorescence (Figure 9A). This observation was also confirmed at the morphological level using live microscopy, which showed that the treatments strongly affected the size and the appearance of the spheroids (Figure 9B). Finally, the expression of SC/CSC markers was analyzed by qRT-PCR in spheroids under the same conditions (Figure 9C). Intriguingly, a significant decrease in PROM1 mRNA levels under both FOLFOX and FOLFIRI conditions was observed in comparison to the levels for the control, whereas MSI1 levels were not affected by the treatments. Furthermore, whereas FOLFOX had no effect on ALDH1a1 mRNA expression compared to the control, treatment with FOLFIRI significantly increased its levels. OLFM4 mRNA was not detected, and CD44 mRNA levels were extremely low (data not shown).

Figure 1: Setup of spheroid cultures. (A) Spheroid formation initiated from the indicated concentrations of Caco2 cells per spheroid/microwell. The top panel shows a representative image of a whole culture plate after two days of culture. The bottom panel shows images of selected microwells per condition. Images were taken at 4x magnification (microwell size: 400 μm). Scale bars: low magnification, 100 μm; high magnification, 30 μm. (B) Growth characteristics of the spheroids generated from different number of cells per microwell and analyzed at different time-points. Note that the indicated days include the first two days of culture in the microwells and the subsequent culture of the harvested spheroids in agarose-coated plates. Histograms show mean ± standard deviation, n = 4–6. Black circles show the values for individual spheroids. The formula for the estimated volume is shown in the upper part of the panel, where d1, d2, and d3 indicate the three diameters measured for each spheroid. Please click here to view a larger version of this figure.

Figure 2: Optimization of the conditions for spheroid formation and culture. (A) Representative images of spheroids at D7 after their recovery from the microwells (2 days) and culture in agarose-coated dishes (5 days), using new well preparation and culture medium conditions. Scale bar: 30 μm. (B) Estimated volume of the freshly harvested spheroids two days after the start of cell culture in the microwells. Histograms show mean ± standard deviation (SD), n = 4–6. Black circles indicate the size of the individual spheroids. (C) Estimated volume of the spheroids in long-term culture based on the newly selected conditions. Graphs show the growth characteristics of the spheroids generated from different number of cells per spheroid and analyzed at different time-points after their harvesting, as indicated. Histograms show mean ± SD, n = 6–10. Black circles indicate the size of the individual spheroids. (D) Representative images of the chosen 600 cells per spheroid condition over the experimental time-course (right panels) and within the microwells (left panel). Images were taken at 4x magnification. Scale bars: low magnification, 100 μm; high magnification, 30 μm. Please click here to view a larger version of this figure.

Figure 3: Histological characterization of the spheroids. Histological hematoxylin and eosin (H&E) staining of paraffin sections. Representative images of spheroids at the indicated time-points after harvesting, as indicated. Black dotted lines in each high magnification inset delimit the lumen within the spheroids. Scale bars: low magnification, 30 μm; high magnification, 10 μm. Please click here to view a larger version of this figure.

Figure 4: Caco2 spheroid characterization by immunolabeling. Immunostaining of spheroids for proliferation marker, proliferating cell nuclear antigen (PCNA, red), and cell death marker, activated caspase 3 (green) (left panels) and for β-catenin (red) (right panels) at the indicated times. Images show merged labeling of PCNA (red), activated caspase 3 (green), and nuclei (blue) or of β-catenin (red) and nuclei (blue). White arrows point to cells or groups of cells expressing high levels of β-catenin. Images were taken with a 20x objective. Scale bar: 5 μm. Please click here to view a larger version of this figure.

Figure 5: Analysis of enterocyte differentiation markers by qRT-PCR. Analysis of ALPI and SLC2A5 encoding alkaline phosphatase and GLUT5 proteins, respectively. Histograms show mean ± standard deviation, n = 3, after normalization against ACTB. Data are represented as fold change relative to normal colon mucosa (red line = 1). NS: not significant; MS: marginally significant compared with D3 by unpaired Student’s t-test. Abbreviations: qRT-PCR = quantitative reverse transcription-polymerase chain reaction; GLUT5 = glucose transporter 5; SLC2A5 = solute carrier family 2, transcript variant 2; ACTB = β-actin. Please click here to view a larger version of this figure.

Figure 6: Heterogeneous expression of stem cell markers,CD44 and CD133, in the spheroids. Immunostaining for the stem cell markers, CD133 and CD44, at the indicated times. Images in the left panels show merged labeling of CD133 (green) and nuclei (blue); the same images in the right panels show merged labeling of CD44 (red) and nuclei (blue). Green arrows in the left panels point to CD133-expressing cells, and white arrows in both panels point to cells or groups of cells expressing CD44 and CD133. Images were acquired with a 20x objective. Scale bar: 5 μm. Please click here to view a larger version of this figure.

Figure 7: Heterogeneous expression of stem cell marker, MSI1, in the spheroids. Immunostaining for the stem cell marker MSI1 (red) at the indicated times. Images show merged labeling of MSI1 (red) and nuclei (blue). White dotted lines underline some crypt-like structures where cells are positive for MSI1 immunolabeling. Images were taken at 20x magnification. Scale bar: 5 μm. Abbreviation = MSI1 = Musashi 1. Please click here to view a larger version of this figure.

Figure 8: Analysis of stem cell markers by qRT-PCR. Quantification of PROM1, CD44, MSI1, and ALDH1a1 levels was performed on mRNA from spheroids at the indicated times. Histograms show mean ± standard deviation, n = 3, after normalization against ACTB. Data are represented as fold change relative to normal colon mucosa (red line = 1). NS: not significant; MS: marginally significant compared with D3, using unpaired Student’s t-test. *: P < 0.05 compared with D3 or D5, using unpaired Student’s t-test. Abbreviations: qRT-PCR = quantitative reverse transcription-polymerase chain reaction; PROM1 = prominin-1; MSI1 = Musashi 1; ALDH1α1 = aldehyde dehydrogenase 1 alpha; ACTB = β-actin. Please click here to view a larger version of this figure.

Figure 9: Effect of chemotherapy on spheroids. After harvesting from the microwells, spheroids were cultured in agarose-coated plates and treated for 3 days with FOLFOX or FOLFIRI or were maintained in (control) non-treated (NT) condition. (A) Analysis of fluorescence due to labeling of nucleic acid in dead cells. Histograms show mean ± standard deviation (SD), n = 4. (B) Morphological features of the spheroids maintained in the different culture conditions. Images were taken with a 4x objective. Scale bar: 400 μm. (C) Quantification of PROM1, MSI1, and ALDH1a1 mRNAs by qRT-PCR. Histograms show mean ± SD, n = 4, after normalization against ACTB. *: NS: not significant; P < 0.05; **: P < 0.01; ***: P < 0.001 compared to the control (NT) condition, using unpaired Student’s t-test. Abbreviations: FOLFOX = 5-Fluorouracil, 50 µg/mL; Oxaliplatin, 10 µg/mL; Leucovorin, 25 µg/mL ; FOLFIRI = 5-Fluorouracil, 50 µg/mL; Irinotecan, 100 µg/mL; Leucovorin, 25 µg/mL; qRT-PCR = quantitative reverse transcription-polymerase chain reaction; PROM1 = prominin-1; MSI1 = Musashi 1; ALDH1α1 = aldehyde dehydrogenase 1 alpha; ACTB = β-actin. Please click here to view a larger version of this figure.
| Desired number of cells per spheroid | Required number of cells per well |
| 50 | 6 x 104 |
| 100 | 1.2 x 105 |
| 200 | 2.4 x 105 |
| 300 | 3.6 x 105 |
| 400 | 4.8 x 105 |
| 500 | 6 x 105 |
| 600 | 7.2 x 105 |
| 700 | 8.4 x 105 |
| 800 | 9.6 x 105 |
| 1000 | 1.2 x 106 |
| 2000 | 2.4 x 106 |
Table 1: Summary of spheroid formation and cell seeding.
| 10 mm dishes | 6-well plates | 12-well plates | 24-well plates | 96-well plates |
| Coating Volume | 4 mL | 300 µL | 250 µL | 150 µL | 50 µL (Down & Up) |
Table 2: Volumes of agarose solution for coating of different plates/dishes.
| Genes | Primers | Sequence | Product Length |
| Differentiation markers | ALPI | Forward | CTG GTA CTC AGA TGC TGA CA | 81 |
| Reverse | ATG TTG GAG ATG AGC TGA GT |
| SLC2A5 | Forward | TAC CCA TAC TGG AAG GAT GA | 94 |
| Reverse | AAC AGG ATC AGA GCA TGA AG |
| Stem cell markers | ALDH1a1 | Forward | GCC TTC ACA GGA TCA ACA GAG | 147 |
| Reverse | TGC AAA TTC AAC AGC ATT GTC |
| MSI1 | Forward | AGT TGG CAG ACT ACG CAG GA | 131 |
| Reverse | TGG TCC ATG AAA GTG ACG AAG |
| PROM1 | Forward | GTA AGA ACC CGG ATC AAA AGG | 131 |
| Reverse | GCC TTG TCC TTG GTA GTG TTG |
| CD44 | Forward | TGC CTT TGA TGG ACC AAT TAC | 160 |
| Reverse | TGA AGT GCT GCT CCT TTC ACT |
| OLFM4 | Forward | TCT GTG TCC CAG TTG TTT TCC | 118 |
| Reverse | ATT CCA AGC GTT CCA CTC TGT |
| Housekeeping genes | ACTB | Forward | CAC CAT TGG CAA TGA GCG GTT C | 134 |
| Reverse | AGG TCT TTG CGG ATG TCC ACG T |
| PPIB | Forward | ATG ATC CAG GGC GGA GAC TT | 100 |
| Reverse | GCC CGT AGT GCT TCA GTT TG |
Table 3: Primers used for quantitative reverse transcription-polymerase chain reaction.