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To examine whether bone marrow mesenchymal stem cells (MSCs) could be differentiated into corneal epithelial cells in vivo and ex vivo.
In vivo, BrdU labeled rabbit MSCs (Rb-MSCs) were suspended in the fibrin gels and transplanted onto the surface of the damaged rabbit corneas. Histology and molecular phenotype were studied on postoperative day 28. In vitro, labeled Rb-MSCs were cultured for three days in two different systems: (1) Group A: Rb-MSCs were co-cultured with rabbit limbal stem cells (Rb-LSCs) by the Transwell culture system. A suspension of Rb-LSCs was added to the upper membrane surface, and the inserts were positioned in the culture wells, which were incubated with Rb-MSCs; (2) Group B: Supernatant medium that had first been used to culture Rb-LSCs and then filtered with a 0.45 μm filter was used to culture Rb-MSCs. For both groups, immunofluorescence and flow cytometric analysis were used to examine the expression of cytokeratin 3 (CK3) in differentiated Rb-MSCs.
In vivo, the data showed that following transplantation of Rb-MSCs, the rabbit’s damaged corneal surface was successfully reconstructed and that some Rb-MSCs participated in the healing of the injured corneal epithelium and expressed CK3. In vitro, the data showed that Rb-MSCs rapidly differentiated into cells with a morphological and molecular phenotype of corneal epithelial-like cells. For both groups, the differentiated Rb-MSCs were positive for corneal epithelial-specific marker CK3. In Group A, flow cytometry analysis showed that at day one, only 3.46±1.9% of cells expressed CK3. This increased to 7.24±3.80% at day two and decreased slightly (5.50±3.33%) at day three. The proportion of CK3 in Group B was 4.09±1.84% at day one, rising to 9.31±5.92% after 24 h, but falling (4.37±2.61%) at day three. The mean differences are significant between each group and the negative control, but was not significant between Group A and Group B.
MSCs could differentiate into corneal epithelial-like cells in vivo and ex vivo.
The corneal epithelium is a rapidly regenerating stratified epithelium which plays a critical role in maintaining corneal transparency and integrity of the ocular surface. The maintenance of the corneal epithelial cell mass is achieved by limbal stem cells (LSCs) located in the basal epithelium of the limbus [
Due to their great expansion and differentiation potential, particular attention has been focused on mesenchymal stem cells (MSCs). MSCs are a self-renewing, multipotent stem cell group that mainly present in bone marrow (BM) [
Adult New Zealand white rabbits (1.5–2 kg) were purchased from Peking University Animals Science Research Center. All animals were housed and treated in accordance with the ARVO Statement for the Use of Animals in Ophthalmic and Vision Research.
Dulbecco’s modified Eagle’s medium (DMEM), Dulbecco’s modified Eagle’s medium/Ham’s F-12 nutrient mixture (1:1; DMEM/F-12), and Dispase II were purchased from
New Zealand white rabbits (n=20) were subjected to corneal damage in the right eye as previously described [
Rb-LSCs used for cell-suspension culture were isolated from New Zealand white rabbit limbal tissues by modification of a method previously described [
Rb-MSCs were obtained from the femurs of adult New Zealand white rabbits as previously described [
For adipogenic differentiation assays, Rb-MSCs were plated to a 6 well plate (5,000/cm2) and grown to 80% confluence. The adipogenic differentiation was induced by using Dulbecco’s modified Eagle medium (DMEM) supplemented with 10% FBS, 0.5 mM isobutylmethylxanthine, 10 μM insulin, 1 μM dexamethasone, and 200 μM indomethacin for 2 weeks with full medium changes performed every 3 days. To detect fat deposition in the cells, cells were fixed with 4% paraformaldehyde for 30 min at room temperature and stained with oil red O.
To obtain cells for later identification expressing 5-bromo-20-deoxyuridine (BrdU), media containing 10 μmol/l BrdU was added to 70% confluent cultures for 24 h. To investigate its efficiency for cell labeling, at the completion of the incubation period, the cells were stained with antibodies against BrdU. Cultured cells on chamber slides were fixed with ice-cold acetone/methanol (1:1) at 20 °C for 30 min. After incubating with 2 N of HCl at 20 °C for 30 min and washed three times in PBS, the slides were incubated overnight with primary antibodies against BrdU at a 1:500 dilution at 4 °C. Negative control samples were incubated in PBS without the primary antibodies. After incubation with the proper secondary antibody at 37 °C for 45 min, slides were mounted with anti-fading mounting medium and examined using fluorescence microscope equipment (Olympus BX51, Olympus Co., Ltd., Tokyo, Japan).
Twenty eight days after the corneal injury, fibrin gels were transplanted onto the rabbit cornea. For the transplantation, the rabbits with damaged cornea were divided into two random groups. Group 1 underwent a graft of fibrin gel with labeled Rb-MSCs (the labeled Rb-MSCs were suspended in a fibrin gel). For Group 2, the transplanted to fibrin gel did not contain Rb-MSCs. For all the rabbits, the damaged corneal surface was carefully keratectomized under anesthesia. The surgery procedures were the same in both groups. A 360° limbal peritomy was performed with Vanass scissors and Bonn forceps. The corneal epithelium that remained was scraped off from the central cornea with a number 15 scalpel blade. The fibrin gel with (or without) Rb-MSCs was placed on the cornea with the conjunctiva covering the edges. The grafts were secured in place by four interrupted cardinal sutures of 10–0 nylon. To protect the fresh graft, a complete central tarsorrhaphy was achieved with a single 5–0 mattress suture. Seven days after surgery, the eyelid was opened. After the eyelid was opened, antibiotic drops were applied to the operated eye three times a day throughout 21 day.
Rabbit corneas were observed with a slit lamp microscope (SL-1600; Nidek Co., Ltd., Aithi, Japan) every day to evaluate reepithelialization, neovascularization, and transparency. On postoperative day 28, rabbits were euthanized with a 10% overdose of trichloroacetaldehyde monohydrate solution for histology and immunofluorescence study.
To induce differentiation in vitro, BrdU labeled Rb-MSCs were divided into two groups: (1) Group A: Rb-MSCs were established using 0.45 μm MILLICELL-HA membrane Transwell culture system. A suspension of Rb-LSCs was added to the upper membrane surface and inserts were positioned in the culture wells, which had been incubated with Rb-MSCs. (2) Group B: Rb-MSCs were cultured with supernatant medium. The supernatant medium used to culture Rb-MSCs had first been used to culture Rb-LSCs and were then filtered with a 0.45 μm filter. After induced treatment, the expression of cytokeratin 3 (CK3) was observed by immunofluorescence and flow cytometric analysis. The process was repeated three times in all groups. Pure Rb-MSCs were used as negative controls.
At the end of the experiment, rabbit corneas from the in vivo experiments were collected, fixed in 4% paraformaldehyde, and embedded in Tissue Tek OCT compound for sectioning. The cells grown in glass chamber slides were fixed with ice-cold acetone/methanol (1:1) for 30 min at room temperature. For hematoxylin and eosin (H&E) staining, consecutive sections (6 μm) were routinely washed, stained, and observed with a light microscope (Olympus BX51; Olympus Co., Ltd., Tokyo, Japan). For immunofluorescence, the cells and the sections were incubated with 3% BSA/0.1% Triton X-100/PBS for 30 min at room temperature to block unspecific binding sites. The cells were incubated with primary antibody (CK3 1:100, p63 1:50, integrinß1 1:50), and the sections were incubated overnight with anti-CK3 (1:100) antibody at 4 °C. After washing three times in PBS, the slides were incubated with proper secondary antibody at 37 °C for 45 min. Isotype-matched primary antibodies served as controls. Specimens were mounted with anti-fading mounting medium and examined using fluorescence microscope equipment (Olympus BX51; Olympus Co., Ltd.).
Double staining with CK3 and BrdU was performed on cells grown on coverslips and on the sections. After incubation with antibody directed against CK3 (1:100) and Cy3-conjugated secondary antibody, the slides were subjected to anti-BrdU (1:100) antibody and FITC-conjugated secondary antibody. After covering with anti-fading mounting medium, the specimens were examined by confocal microscopy (Zeiss 510 META; Carl Zeiss Co, Ltd, Jena , Germany).
Cells were harvested by trypsinization, and nonspecific binding was prevented by incubating the cells in 3% BSA for 30 min. Approximately 5x105 cells were suspended in a final volume of 100 μl of flow cytometric (FC) buffer and incubated with the primary antibody (CK3 1:100, CD34 1:100, and CD29 1:100) or isotype contro1 at 4 °C for 30 min. After being washed twice, the cells were incubated with proper secondary antibody in FC buffer for 30 min at 4 °C. The cells were washed twice with cold FC buffer and suspended in a final volume of 500 μl for flow cytometric analysis. Fluorescent cell analysis was performed with FACSC alibur cytometer (Becton Dickinson Immunocytometry System, San Jose, CA) and data analyzed by FlowJo software (Tree Star, Inc., Ashland, OR).
Results are expressed as the mean±SD% from three replicate experiments. Where appropriate, differences were analyzed by ANOVA. A p<0.05 was regarded as statistically significant.
Within 24 h after seeding, most Rb-LSCs attached to plastic and started spreading. Small colonies, including approximately 8–10 cells, were formed day 3–4 after inoculation and extended very quickly thereafter. The cell morphology appeared to be compact, uniform, and small polygon in shape. By day 10–14, colonies began to fuse and formed a monolayer on confluence (
Characterization of Rb-LSCs and Rb-MSCs in vitro. A light photomicrograph of cultured Rb-LSCs is seen in panel
Flow cytometric analysis of the Rb-MSCs. The data showed that 97.5% of cells were positive for CD29 (
The fibrin gel was semi-transparent. Transverse sectioning of Group 1 revealed that labeled Rb-MSCs penetrated into the pores of fibrin gel by H&E staining (
Characterization of the fibrin gel and the rabbit corneas after transplantation. Hematoxylin and eosin staining of Group 1 (
Limbal stem cell deficiency was achieved at day 28. Analysis by slit lamp photography showed thickened corneas, stromal scarring, and subepithelial neovascularization (
Analysis by slit lamp photography showed that the appearance of the lids, cornea, and conjunctiva improved with time. Corneal epithelium was epithelialized completely in both groups at day 28 after surgery, but neovascularization and corneal opacification presented in both groups within the four-week period after surgery (
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|
|
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|---|---|---|
|
|
|
|
| Completely transparent |
0 (0%) |
0 (0%) |
| Iris was clear (partially obscure) |
3 (30%) |
2 (20%) |
| Iris was not clear (completely obscure) |
7 (70%) |
8 (80%) |
|
|
|
|
| No neovascularization |
0 (0%) |
0 (0%) |
| Detected within 3 mm from the limbus |
2 (20%) |
0 (0%) |
| Detected over 3 mm from the limbus | 8 (80%) | 10 (10%) |
Data was evaluated based on the transparency (χ2=0.267, p=0.606) and neovascularization (χ2=2.222, p=0.136).
In vitro, to further test the hypothesis that Rb-MSCs are capable of differentiation into corneal epithelial cells, we cultured Rb-MSCs with two different induction methods. In all groups we found that a subset of the adherent Rb-MSCs rapidly lose their characteristic fibroblast morphology, becoming broad and flattened with an epithelial shape. To determine the molecular phenotype of differentiated Rb-MSCs, the expression of CK3 (special proteins of corneal epithelial cells) was examined by confocal microscopy. CK3 positive Rb-MSCs were first observed within 2 h and there was little difference between different groups. Multinucleated Rb-MSCs were not found. The morphological and phenotypic differentiated Rb-MSCs remained unchanged in both groups as of day three (
Morphological and phenotypic of differentiated Rb-MSCs in vitro. Double staining showed expression of CK3 and BrdU both in Group A (
To determine the extent of differentiation, flow cytometry analyses (FCAS) were used to assay the total population of differentiated Rb-MSCs. In Group A, FCAS showed that only 3.46±1.90% of cells expressed CK3 at day one, increasing to 7.24±3.80% at day two, and slightly decreasing (5.50±3.33%) at day three. In Group B, the proportion of CK3 was 4.09±1.84% at day one, rising to 9.31±5.92% after 24 h, but falling significantly (4.37±2.61%) at day three. The proportion of CK3+ cells remained steady in the negative group (0.78±0.1% at day 1, 0.66±0.15% at day 2, and 0.55±0.11% at day 3). The mean difference is significant between each group and negative control (p<0.05), but is not significant between Group A and Group B (p>0.05;
Flow cytometry analysis of the ratio of CK3+ cells in all groups. Data represent the mean±SE% of results in three replicate experiments (The asterisk indicated a p
Bone marrow contains hematopoietic stem cells (HSCs) which produce all the blood cells and mesenchymal stem cells (MSCs) differentiate into mesenchymal lineages. It has been observed that MSCs express several surface markers, such as CD29, CD90, and CD105, but do not express the hematopoietic markers CD34 and CD45 [
MSCs are pluripotent precursor cells, which can differentiate into mesenchymal cells and also into cell tissue types other than their own lineage in vivo and ex vivo [
To confirm the characterization of these epithelial cells, we investigated the expression of CK3 and found positive CK3 staining presented in both groups. In Group 1, the expression of CK3 was continuous throughout the entire corneal epithelium, but was irregular in Group 2. This signifies that there are epithelial-like cells covering the damaged rabbit cornea. To examine the nature of these cells, we studied the expression of BrdU and CK3 by double staining. The results revealed the co-expression of BrdU and CK3 in Group 1. This means that in Group 1, some Rb-MSCs participated in the healing of injured corneal epithelium and might differentiate into corneal epithelial-like cells in vivo. However, CK3+ cells were also found in Group 2. We believe this result can be explained by the works of Kurpakus et al. [
To examine whether Rb-MSCs can differentiate into corneal epithelial cells in vitro, we co-cultured BrdU labeled Rb-MSCs with Rb-LSCs in a Transwell culture system, which permits only chemical factors to diffuse but not cells (Group A). The results showed a subset of Rb-MSCs rapidly differentiated into corneal epithelial cells and expressed CK3 as of day three. As a Transwell culture system does not allow direct cell-to-cell contact, soluble chemical factors in the culture may be a cause of Rb-MSCs’ differentiation. We hypothesized that factors secreted by Rb-LSCs may play an important role in Rb-MSCs corneal differentiation. To test this hypothesis, we cultured Rb-MSCs in conditioned medium which had been used to culture Rb-LSCs and filtered with 0.45 um filter (Group B). Double staining showed the expression of CK3 to be the same as Group A. FACS analyses showed expression of CK3 in differentiated Rb-MSCs was similar in both groups. Statistical Analysis showed the mean difference is significant between each group and negative control (p<0.05), but is not significant between Group A and Group B (p>0.05). In Group A, Rb-MSCs were cultured in a microenvironment which permits only secreted chemical factors to diffuse. In Group B, cells cultured in conditioned medium were affected by some chemical factors, which had already been secreted from Rb-LSCs. For both groups, we did not co-culture Rb-MSCs with Rb-LSCs in direct cell-to-cell contact, which demonstrated that Rb-MSCs could differentiate into corneal epithelial cells in vitro and indicated that some chemical factors secreted by Rb-LSCs may play an important role in this process.
In vitro, with immunofluorescent staining and FACS analyses, we noted that as of day three, the morphology and phenotype of differentiated Rb-MSCs remained unchanged in both groups. We considered that this was due to not enough time having yet elapsed to observe an obvious change. At the same time, FACS analyses showed that the level of CK3 decreased in day three for all in vitro groups. We believed cell apoptosis might be the reason for this decrease. The factors which induced differentiation might also have participated in the cell apoptosis.
Although it was observed that Rb-MSCs differentiated into corneal epithelial-like cells, it should be noted that this study only demonstrated short-term results. Moreover, Rb-MSCs are multipotent stem cells whereas corneal epithelial cells are terminal differentiated cells and do not belong to the same germ layer. The precise process of this differentiated reprogramming remains to be determined. Future studies will be needed to determine if a key switch contributes to this process, and the key transcription signals which regulate this process. Despite its preliminary character, our study demonstrated that Rb-MSCs participated in the healing of injured corneal epithelium and could be induced into corneal epithelial-like cells in vivo and ex vivo, providing a new source of cells for the treatment of corneal disorders.
The authors thank Lizhong Chen for her help. Supported by: the National Natural Science Fund of P.R. China (Numbers: 30670816, 30471865) and Shenyang Science Technology Fund (Number: 1053111–3-07).