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The differentiation protocol described here provides a robust in vitro method to obtain enteric neurons from hPSCs within 30-40 days (Figure 1E) and enteric glia expressing glial fibrillary acidic protein, GFAP, and SOX10 in older cultures (> day 55)13,14,19,22. These neurons and glia are induced by stepwise differentiation of hPSCs into vagal and enteric neural crest cells followed by enteric neuron and glia progenitors13,14. The neural crest cells express neural crest markers, transcription factor AP-2 alpha and beta, TFAP2A and TFAP2B, respectively21. We previously showed that CD49 can be used as a marker to indicate the efficiency of hPSC-derived neural crest cells14. The efficiency and success of this method depends on a combination of factors. First, it is critical to perform all steps under sterile conditions. Testing hPSC cultures for mycoplasma contamination is important as it can adversely affect stem cell growth and is not detectable visually. Second, use of evenly and properly coated plates reduces the chance of patchy hPSC culture growth and detachment of NC cultures and older neurons from the surface of the wells. Third, for high efficiency in differentiation it is essential to start with pluripotent and fully undifferentiated hPSC cells. hPSC colonies should have minimal differentiating cells at the colony borders. hPSCs should be passaged or plated for differentiation when colonies are large, or the center of the colony starts to thicken/darken in color as observed through a phase contrast microscope. Undesired differentiated cells (usually mesenchymal cells), not only drop the overall differentiation efficiency, but they can result in detachment of neurons from the surface of the well as the cultures get older. It is therefore recommended to monitor the ENC cultures in the first 15 days carefully. Under efficient differentiation conditions dark disks appear on the surface of the culture ~day 6 which indicates efficient spheroid formation on days 12-15. In addition, in the spheroid phase (day 12-15) free-floating spheres should have smooth surfaces (Figure 1D). Maintaining the 3D spheroid phase on days 12-15 is generally sufficient to improve the purity of ENCs for the downstream differentiation of cultures into ENS lineages. However, for studies that require early and pure ENC progenitor cells populations, FACS using CD49D is recommended. CD49D is a specific surface marker for SOX10:hPSC-derived NC lineages and has been used successfully across cell lines13,14. For more information on isolating CD49D+ cells using FACS and recommendations on gating strategy readers are referred to the paper by Barber et al, Figure 2D, Box1 and Supplementary Figure 614. Fourth, to maximize efficiency, differentiation should start when hPSC cultures are monolayer and ~80% confluent. This means having a fully confluent culture on day 2. Lower confluency negatively affects the efficiency and very dense cultures tend to have a higher rate of cell death and can potentially lead to emergence of unwanted differentiated cells.
Re-plating cells on day 15 marks an important step in this protocol. This is the last cell transfer step for a monolayer neuronal culture and hence the plate layout should be chosen according to the assays planned. The number of cells transferred to each well can considerably affect the neuronal diversity and older neurons remaining attached to the surface of the wells. Generally, a cell density in the range of 250,000-350,000 cells per cm2 (about 75,000-100,000 cells per well of a 96-well plate or 500,000-700,000 per well of a 24-well plate) is desirable. Starting at day 30-40, one might consider adding fibronectin and laminin to the feeding medium (not more than once a week) to prospectively prevent detachment of neurons especially for cells planned for longer neuron cultures. At this point it is recommended to reduce the feeding frequency to once in every 5-7 days and leaving some medium in each well before adding extra fresh medium. This reduces the chance of applying unnecessary physical stress on the neuronal projections. Considering evaporation of medium (especially for wells in the border of the plate) one can remove 75 µL and add 100 µL of fresh medium to each well. Based on experience, cultures grown on polymer coverslip bottom imaging plates tend to live and stay attached to the surface of the well for a longer time. Therefore, considering the polymer coverslip bottom imaging plates for experiments requiring very old neuronal cultures such as co-cultures with other cell types is recommended. Although air-dried PO/FN/laminin coated plates might still yield in efficient differentiation, this has not been tested systematically for the purpose of this protocol. Hence, the use of freshly coated plates is recommended.
The protocol described here is based on a previously published protocol by Barber et al14. Compared to older ENC induction methods that use media containing serum-replacement factors (e.g., KSR)13,14, the current protocol media conditions are chemically defined. This is advantageous towards more consistent differentiations and allows more precise developmental studies by manipulating the culture conditions. This robust protocol reproducibly generates cultures of enteric neurons from independent induced and embryonic stem cell lines that have been tested, such as H9, UCSF4 and WTC11. A powerful aspect of the presented protocol is its capacity to generate a variety of ENS neuronal subtypes resembling those found in the human ENS. For example, expression of specific markers for different ENS neurochemical identities can be checked by flow cytometry and fluorescence imaging (Figure 1F,G). The typical range of hPSC-derived enteric neuronal populations positive for nitric oxide synthase 1 (NOS1) is 5%-20%; choline O-acetyltransferase (CHAT) is 40%-60%; gamma-aminobutyric acid (GABA) is 15%-30% and serotonin (5-HT) is 15%-30%. However, the extent to which the in vitro structural and functional connectivity between these subtypes accurately models the in vivo cellular networks requires further studies. In addition, single cell analyses to expand the transcriptional profiling of individual subtypes would not only help to better compare the in vivo and in vitro cellular identities but would also benefit developmental and molecular studies as well as future protocol optimizations towards enriching specific subtypes for drug discovery and regenerative medicine.
Despite the cultures containing different neuronal, and in older cultures glial cells, this protocol does not generate the other cell types naturally found in the in vivo niche of the ENS, such as muscle cells, epithelial cells, and immune cells. Studying the ENS interaction with these cell types in the context of health and disease requires investment in optimizing co-culture and intestinal organoids systems. Overall, a powerful method to generate different subtypes of the ENS in from hPSCs in vitro is described here. The scalable cultures are suitable for developmental studies of the human ENS, toxicology testing and disease modeling experiments aimed at developing drug therapies and providing transplantable cells for treating enteric neuropathies.