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The present protocol describes a robust, fast, simple, and widely accessible methodology to generate hdIN precursors in vitro and its use as early interventional cell therapy in preclinical models of neurodevelopmental disorders.
Even though some of the characteristic phenotypes of neurodevelopmental disorders arise during adolescence or adulthood, pathophysiological alterations are already present during early development. For this reason, early intervention would be highly warranted for achieving beneficial effects by acting in critical brain developmental periods before symptomatology or clinical manifestation. In the future, genetic screening and the development of biomarkers will afford prophylactic or pre-symptomatic treatment, representing a game changer for those patients. Therefore, hdIN precursors were transplanted early after birth in the Cntnap2 KO mouse model when epileptogenic changes in the neuronal network might be ongoing28 and at a timepoint at which cellular alterations have been described in this animal model29. It is important, however, to consider the potential pitfalls of age extrapolation and the timing of certain processes in the mouse versus the human brain.
Focusing on the procedure itself, the differentiation protocol presented here is based on the use of transcription factors, which allow for fast and highly efficient programming of stem cells compared with other protocols elsewhere based on small molecules10,30. A potential drawback of this approach could be the requirement for lentiviral vectors, which carries a risk of insertional mutagenesis. Two critical steps in the protocol are the addition of the antibiotics and the anti-mitotic agent to the medium to select for cells expressing the transcription factors and eliminate proliferative cells, avoiding the risk of teratoma formation, respectively. Although only hdIN precursors were tested in this study, the procedure is expected to be feasible with other cell sources and programming/differentiation protocols. Nevertheless, other neuronal subtypes and/or models should be validated.
The hdIN precursor's age for transplantation, 7 DIV, was decided based on (i) the absence of proliferative cells, assessed by immunoreactivity against Ki67, (ii) together with the previously reported observation of decreases in the expression of pluripotency genes such as POU5F1 and the appearance of the neuronal marker MAP2 and the interneuron marker GAD1 at that timepoint8. However, the original work describing this protocol performed transplantations at 14 DIV after DOX withdrawal9. This raises questions about whether DOX in the mother's drinking water can reach cells grafted into the brains of nursing pups via the milk, or if 7 DIV of DOX induction is enough to establish the GABAergic fate. Although Yang et al. identified 14 days of DOX as sufficient to generate stable neuronal cells in vitro9, Gonzalez-Ramos et al.8 detected GAD1 gene expression already at 7 DIV, indicating that the downstream activation of GAD67 by Ascl1 and Dlx2 has already occurred at this time point. Hence, patterning has begun at 7 DIV and might be less dependent on the DOX treatment. Moreover, evidence in rodents and humans indicates the presence of DOX in breast milk31,32, and the results presented here show that grafted hdINs were immunoreactive for Ascl1 at 2 weeks and 2 months PT and interneuron markers later on at 9 months PT. Within the grafted population, besides PV and SST positive neurons, other markers for subpopulations of interneurons were also found in lower amounts, such as calretinin (CR) and calbindin (CB).
A challenging aspect of this procedure is the coordination of the timings for both differentiation and the age of the pups. Usually, mouse gestation takes 21 days after setting up the mating cage, albeit this can vary sometimes. This scenario does not occur when performing cell transplantations in adult rodents when everything can be carefully planned and arranged. Nevertheless, this can be easily mitigated by setting up two to three mating cages with a 2 day interval or two to three differentiation batches with a 2 day time-lapse from each other.
Although the mice used in this study were neither immunodeficient nor immunosuppressed, the transplanted cells survived up to 9 months in vivo, and markers of immune reaction against xenogeneic cells or local inflammation were not observed at either P14 or 2 months PT. Immune rejection of grafted xenogeneic cells is triggered against MHC/peptides, and the key cellular mediators of graft rejection are T lymphocytes and microglial cells33,34. Therefore, immunoreactivity to markers of T cells, as well as reactive microglia, was explored. No signs of immune rejection of the grafted cells in the host tissue were detected either by levels of reactive microglia or by the presence of T lymphocytes in WT mice at P14 or 2 months. Moreover, no local inflammation was observed based on the assessed levels of astrogliosis and inflammatory cytokines. This outcome could partly be dependent on neonatal immune tolerance35,36,37, observed by other cell identities, locations, and animal models35,38. Englund et al. identified regional differences in the outcome of the grafted cells in terms of migration and maturation, including the observation of grafted cells in the adjacent white matter35.
Finally, a greater dispersion of the grafted cells within the hippocampus was observed compared to other studies transplanting into adult rodents, where hdINs remained as a grafted core25. This dispersion also differed from results observed previously by Yang et al.9, which could be explained in this case by the age of the cells at the time of transplantation.