Organoids induced from human embryonic stem cells (ESCs)/iPSCs represent promising disease models for rare intractable diseases, whereas the generation of brain organoids typically requires extended culture periods lasting several months10 and the use of expensive equipment, such as an engineered container that continuously stirs the culture medium and maintains stable conditions for long-term 3D cell culture. In this study, we established brain organoids within a short timeframe using standard cell culture equipment. Using iPSCs derived from a patient with MELAS carrying the m.3243A>G mitochondrial DNA variant, we successfully identified disease-cell-specific phenotypes.
We followed a previously published protocol reported by Nakamura et al. in 2019 with minor modifications. In their original study, V-shaped, 96-well low attachment plates were used to aggregate iPSCs on Day 0. However, in this study, we adopted U-shaped 96-well low attachment plates for cells to naturally aggregate at the center of the well. We believe the use of high-quality low-attachment plates is crucial for successful outcomes. In addition, organoids were cultured on a shaker during differentiation in a previous study9. However, we omitted the use of shakers in our method because organoids tend to aggregate during agitation. Shaking culture plates may be necessary to improve nutrient and oxygen diffusion and waste removal during long-term culture. However, using our short-term culture method, we successfully generated brain organoids without shaking. With these modifications, we generated brain organoids containing FOXG1-positive neurons on Day 30, which showed little variation in size (Figure 2A,B). Neurons dissociated from brain organoids derived from healthy iPSCs were plated onto coated dishes, where they extended neurites and formed visible neuronal networks (Figure 3A). These neurons also expressed synaptic markers such as synaptophysin and PSD-95 (data not shown).
In addition to healthy control iPSCs, we used two iPSC lines from a MELAS patient8 harboring the m.3243A>G mitochondrial variant. Patient-derived iPSCs and their differentiated derivatives, neurons, and organoids offer powerful tools for pathophysiological analyses and drug screening for intractable diseases as they can recapitulate aspects of a patient's pathology in vitro. For disorders caused by nuclear gene variants, genome editing can be used to generate isogenic control cell lines by repairing the causative variant, thereby isolating the effects of the variant, while keeping other genomic factors constant. However, such genomic editing approaches are not yet generally applicable to mitochondrial DNA variants7.To address this challenge, we utilized two iPSC lines derived from the same MELAS patient, which share an identical nuclear genetic background but differ in their heteroplasmy levels for the m.3243A>G mitochondrial DNA variant. This approach enabled us to examine the specific effects of mitochondrial gene variants while minimizing the confounding influence of nuclear genomic variations. Although heteroplasmy levels are typically quantified using next-generation sequencing, which can be costly and technically demanding, the m.3243A>G variant can be reliably analyzed using conventional qPCR methods11,12. This would allow for a more accessible and cost-effective high-throughput screening method. The heteroplasmy levels observed in our study are consistent with those previously reported8 (Figure 4). iPSCs with LH levels generated brain organoids comparable to those derived from healthy controls, whereas iPSCs with HH levels exhibited impaired organoid development, including reduced size and abnormal morphology (Figure 2). These findings suggest that the m.3243A>G variant affects neural development and differentiation in MELAS to a certain extent.
Our results highlight the value of using multiple iPSC lines with varying heteroplasmy levels derived from the same patient to model the pathophysiology of mitochondrial disease. A limitation of our study is that the differentiation protocol we employed was relatively simple and short-term and did not result in multiple-layered neuronal structures, as seen in the human brain in vivo. Thus, although informative, the phenotypes observed in our organoids may not fully reflect authentic patient pathology. However, it is possible that high-heteroplasmy lines with low viability are inadequate for long-term culture. Even in such cases, the short-term protocol described in this study can still be used to investigate disease phenotypes. Nonetheless, considering the current challenges in generating genetically modified animal models of mitochondrial disorders, patient-derived brain organoids and neurons provide a valuable and accessible platform for studying the mechanisms involved in MELAS and for drug screening.
When used as drug screening platforms in the future, cell lines with either low or high heteroplasmy can be selected depending on the research question. For studies requiring 2D culture to examine neurite extension or branching, we recommend using low-heteroplasmy lines, since high-heteroplasmy lines are unsuitable for 2D culture due to their poor differentiation efficiency into neurons. Using low-heteroplasmy lines in combination with drugs that induce cellular stress can represent useful disease models. In contrast, for studies of neurogenesis, high-heteroplasmy lines are valuable for evaluating the therapeutic potential of drugs by assessing phenotypic improvements. Nevertheless, if neurons can be differentiated and maintained in 2D culture using alternative induction methods from high-heteroplasmy lines, they may also be employed for analyses of neurite extension and branching.
In summary, we used a robust and accessible method to evaluate heteroplasmy levels of the m.3243A>G variant and generated brain organoids. Our conventional methods, with the short culture time and cost-effectiveness, offer advantages over others. These techniques offer practical tools for investigating the pathophysiology of mitochondrial diseases and may serve as useful platforms for therapeutic drug screening in MELAS.