Neural stem/precursor cells can self-renew and maintain their potential to generate differentiated progenies such as neurons, astrocytes and oligodendrocytes (
Seaberg and van der Kooy 2003). Thus, they represent both an excellent tool to study neural cells
in vitro and a potential source of unlimited cells for cell replacement therapy of neurodegenerative diseases. In order to use these differentiated neural cells therapeutically, however, they must be separated from the undifferentiated cell population to prevent teratoma formation. Efforts to purify neural stem/precursor cells from embryonic or adult brain, using cell surface markers or transgene expression driven by NP-specific promoters, have been reported (
Keyoung et al. 2001;
Rietze et al. 2001;
Capela and Temple 2002;
Murayama et al. 2002;
Tamaki et al. 2002;
Nagato et al. 2005). Of the markers that have been investigated, sox1 has shown the most specific expression pattern for NP populations during development (
Pevny et al. 1998;
Aubert et al. 2003;
Pevny and Placzek 2005). Aubert and co-workers generated a sox1-GFP knock-in mouse and demonstrated that GFP expression overlaps well with endogenous sox1 expression, thus providing a good handle for purification of NPs using FACS. In addition to the embryonic or adult brain, ES cells represent another source of NP cells due to their unlimited proliferation capacity and their potential to generate most cell types
in vitro (
Lang et al. 2004a). Ying
et al., using sox1-GFP knock-in ES cells, demonstrated that differentiated ES cells expressing sox1-GFP acquired neuroepithelial morphology (
Ying et al. 2003).
Lang et al. (2004b) generated sox knock-in ES cells harboring the neomycin resistance gene, allowing enrichment of NPs by drug selection. These drug-selected ES cell-derived NP cells generated electrophysiologically functional neurons
in vitro.
In this study, we used florescence-activated cell sorting (FACS) to purify ES cell-derived NPs using sox1-GFP knock-in reporter expression (
Ying et al. 2003) and characterized them
in vitro and
in vivo. FACS purification of sox1-GFP
+ cells efficiently yielded an enriched neural cell population while effectively removing teratoma-causing pluripotent cells. The resulting neural cell population can generate multiple subtypes of neural cells ( and ), demonstrating the value of these purified NPs as a tool for studying various neural cells
in vitro and as a possible cell source for cell replacement therapy of various neurodegenerative diseases. In addition, we demonstrated that purifying NP prior to transplantation efficiently reduced tumor formation in the host brain. The heterogeneous nature of
in vitro differentiated ES cell preparations may raise concerns about their safe usage for therapeutic application and thus, it is essential to establish their safety before applying them to human diseases (
Odorico et al. 2001). One way to prevent teratoma formation is to remove possible tumor-forming cells from the ES cell-derived neural cell preparation. We achieved this by using FACS purification of genetically marked ES cells.
The therapeutic use of ES cell-derived neural populations in animal models of various neurodegenerative diseases, such as intracerebral hemorrhage, Parkinson’s disease, Huntington’s disease, ischemia and myelin disease, has been reported (
Dinsmore et al. 1996;
Brustle et al. 1999;
Kim et al. 2002;
Barberi et al. 2003;
Nonaka et al. 2004;
Wei et al. 2005). Since the NPs purified in this study can be used to generate the various neural cells that are dying in these diseases, such as dopaminergic neurons, glutamatergic neurons and GABAergic neurons (;
Lang et al. 2004b), the procedure described in this paper can be applied to these fields with a high degree of confidence that potentially tumor-forming pluripotent stem cells can be removed prior to transplantation.
Another way to purify and prepare cells for transplantation is to isolate specific neuronal cell types from
in vitro-differentiated ES cells rather than NPs. Zhao
et al. generated Pitx3 knock-in ES cells and purified midbrain dopaminergic neurons (
Zhao et al. 2004). Transplantation of these cells has not been reported and thus, no evaluation of their safety and efficacy is available. Another group used the TH promoter to drive GFP expression, and transplanted the purified GFP
+ cells into rat brain (
Yoshizaki et al. 2004), but they reported very low graft survival. Unlike the NP population that we purified, mature neurons are more vulnerable to manipulations such as trypsination and FACS. When we transplanted FACS-sorted cells that had reached post-neuronal differentiation stages, we similarly observed lower graft survival compared with cells at the NP stage (data not shown). Thus, purification of specific types of neurons offers the advantage of a unique cell population for transplantation, whereas transplanting NPs has the advantage that these cells have better survival over the course of the manipulations. Additionally, in some cases, co-transplantation with astrocytes enhances neuronal differentiation and/or survival (
Song et al. 2002;
Dhandapani et al. 2003). By transplanting NPs that can generate both neurons and astrocytes (;
Lang et al. 2004b), we may be able to achieve such a neuroprotective effect. Eventually, it will be even better if marker gene expression specific for each cell type can be used, and then single cell types can be purified and used alone or in combination for complete control of the phenotype of the cell being transplanted.
Using the five-stage procedure (
Lee et al. 2000;
Chung et al. 2002) to differentiate sox1-GFP ES cells, we have shown that some of the sox1-GFP
+ cells express the early midbrain marker Engrailed-1 and could generate DA neurons. We observed a rather low proportion of DA neurons being generated from sox1-GFP
+ cells compared with the number generated from unsorted cells ( and ). Interestingly, even though the GFP
− population generated far fewer neurons (), a majority of these neurons was dopaminergic (; data not shown). We have postulated two explanations for this. First, it is possible that some NP cells that can generate DA neurons are not expressing sox1 and thus, are sox1-GFP
−. Secondly, it is possible that there are DA-inducing, factor-releasing cells in the GFP
− populations. Our mixing experiment () supports the possibility that at least some of the DA precursors may be GFP
−. Further studies will be needed to understand clearly this unexpected observation.
While we were preparing this manuscript, Fukuda
et al. also reported reduction of teratoma formation by purification of ES-derived NPs using FACS (
Fukuda et al. 2005). Using different methods of
in vitro differentiation (PA6 co-culture procedure), they also showed enrichment of NPs and removal of pluripotent cells by FACS. Taken together, using two different
in vitro differentiation methods, both studies demonstrate that NP cells derived from FACS purification of the sox1-GFP
+ population can prevent tumor formation even 8 weeks post-transplantation. The PA6 co-culture procedure is less time-consuming and more efficient for DA differentiation than the five-stage method. However, the reason we used the five-stage procedure was so that we could compare the GFP
+ versus GFP
− population without contaminating feeder cells. By using the five-stage procedure instead of the PA6 method, we could compare differentiation and proliferative potentials of GFP
+ and GFP
− populations more clearly, which could not be done in the study of Fukuda
et al. Thus, even though there are many advantages to using the PA6 system, we believe that the five-stage procedure is more beneficial for comparative studies of different cell populations. Furthermore, our study demonstrates that these purified NP cells can differentiate into various subtypes of neurons and glial cells and thus, can potentially be applied to various disease models. One striking difference in these two studies is the extremely small graft size generated by sox-GFP
+ cells and the small number of DA neurons in the Fukuda
et al. study, possibly because these cells were transplanted immediately after FACS. In contrast, we incorporated a recovery/expansion stage after FACS and before transplantation, resulting in increased graft size and more than 15-fold total DA neurons compared with their study. Taken together, whereas it can be a powerful method of removing unwanted cell types before transplantation, FACS could, at the same time, lower cell survival by imposing stress on the cells sorted. Our studies demonstrate that this pitfall can be largely resolved by providing for a recovery/expansion stage after FACS purification of the desired cell type.