Enteric Neural Cells From Hirschsprung Disease Patients Form Ganglia in Autologous Aneuronal Colon.
OBJECTIVE
Hirschsprung disease (HSCR) is caused by failure of cells derived from the neural crest (NC) to colonize the distal bowel in early embryogenesis, resulting in absence of the enteric nervous system (ENS) and failure of intestinal transit postnatally. Treatment is by distal bowel resection, but neural cell replacement may be an alternative. We tested whether aneuronal (aganglionic) colon tissue from patients may be colonized by autologous ENS-derived cells.


METHODS
Cells were obtained and cryopreserved from 31 HSCR patients from the proximal resection margin of colon, and ENS cells were isolated using flow cytometry for the NC marker p75 (nine patients). Aneuronal colon tissue was obtained from the distal resection margin (23 patients). ENS cells were assessed for NC markers immunohistologically and by quantitative reverse-transcription polymerase chain reaction, and mitosis was detected by ethynyl-2'-deoxyuridine labeling. The ability of human HSCR postnatal ENS-derived cells to colonize the embryonic intestine was demonstrated by organ coculture with avian embryo gut, and the ability of human postnatal HSCR aneuronal colon muscle to support ENS formation was tested by organ coculture with embryonic mouse ENS cells. Finally, the ability of HSCR patient ENS cells to colonize autologous aneuronal colon muscle tissue was assessed.


RESULTS
ENS-derived p75-sorted cells from patients expressed multiple NC progenitor and differentiation markers and proliferated in culture under conditions simulating Wnt signaling. In organ culture, patient ENS cells migrated appropriately in aneural quail embryo gut, and mouse embryo ENS cells rapidly spread, differentiated, and extended axons in patient aneuronal colon muscle tissue. Postnatal ENS cells derived from HSCR patients colonized autologous aneuronal colon tissue in cocultures, proliferating and differentiating as neurons and glia.


CONCLUSIONS
NC-lineage cells can be obtained from HSCR patient colon and can form ENS-like structures in aneuronal colonic muscle from the same patient.
Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Victoria, Australia.
Benjamin N
BN
Rollo
Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Victoria, Australia.
Dongcheng
D
Zhang
Department of Anatomy and Neuroscience, University of Melbourne, Parkville, Victoria, Australia.
Lincon A
LA
Stamp
Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Victoria, Australia; Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia.
Trevelyan R
TR
Menheniott
Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Victoria, Australia.
Lefteris
L
Stathopoulos
Stem Cell Laboratory, Department of Biomedicine, Danish Research Institute of Translational Neuroscience, Aarhus University, Aarhus, Denmark.
Mark
M
Denham
Centre for Neural Engineering, NICTA, University of Melbourne, Australia.
Mirella
M
Dottori
Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Victoria, Australia; Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia; Royal Children's Hospital, Parkville, Victoria, Australia.
Sebastian K
SK
King
Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Victoria, Australia; Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia; Royal Children's Hospital, Parkville, Victoria, Australia.
John M
JM
Hutson
Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Victoria, Australia.
Donald F
DF
Newgreen
Aganglionosis; CHIR-99021, 6-[2-[[4-(2,4-dichlorophenyl)-5-(5-methyl-1H-imidazol-2-yl)pyrimidin-2-yl]amino]ethylamino]pyridine-3-carbonitrile; Cell Therapy; ENC, enteric neural crest; ENS, enteric nervous system; EdU, ethynyl-2′-deoxyuridine; Enteric Nervous System; FBS, fetal bovine serum; GFAP, glial fibrillary acidic protein; GSK3, glycogen synthase kinase 3; HNK1, human natural killer-1; HSCR, Hirschsprung disease; Hirschsprung Disease; MTR, MitoTracker Red; Megacolon; NC, neural crest; PBS, phosphate-buffered saline; PFA, paraformaldehyde; RCH, Royal Children’s Hospital; SMA, smooth muscle actin; SOX10, sex-determining region Y–box 10; TUJ1, neuron-specific class III β-tubulin; eGFP, enhanced green fluorescent protein; nNOS, neuronal nitric oxide synthase; nTCM, neural tissue culture medium; qRT-PCR, quantitative reverse transcription and polymerase chain reaction