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From the Departments of Internal Medicine* and Biological and Clinical Sciences,
Research Center for Experimental Medicine, and the Department of Anatomy, Pharmacology, and Forensic Medicine,
University of Torino, Torino, Italy
| Abstract |
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It has been recently demonstrated that the embryonic rat metanephric mesenchymes possess organ-specific progenitor cells capable of differentiating into epithelia, myofibroblasts, and smooth muscle cells, indicating the presence of embryonic renal stem cells.4 It is currently unknown whether these stem cells are also present in the adult human kidney. Data are also unclear regarding the possible origin of renal endothelial cells. Contradictory evidences suggest either a possible colonization of kidney by exogenous angioblasts or a common origin of renal endothelial cells with other renal cell types.5,6
The aim of the present study was to isolate and characterize a population of renal progenitor cells. As a selection marker we chose the human CD133 stem cell antigen. This pentaspan molecule, discovered for its expression on hematopoietic stem and progenitor cells,7 was shown to be also expressed by undifferentiated human intestine-derived epithelial cells in culture and by embryonic kidney.8 We therefore aimed to evaluate whether renal CD133+ cells derived from human adult kidney were capable of expansion and self-renewal and whether they could differentiate into epithelial and endothelial cells in vitro and in vivo and participate in renal tissue repair.
| Materials and Methods |
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Renal progenitor cells were obtained from the normal portion of cortex obtained from surgically removed kidneys. After dissection and passage through a graded series of meshes, CD133+ cells were isolated from the tubular fraction by magnetic cell sorting, using the MACS system (Miltenyi Biotec, Auburn, CA).9
CD133+ cells were plated onto fibronectin in the presence of an expansion medium, consisting of 60% DMEM LG (Invitrogen, Paisley, UK), 40% MCDB-201, with 1x insulin-transferrin-selenium, 1x linoleic acid 2-phosphate, 109 mol/L dexamethasone, 104 ascorbic acid 2-phosphate, 100 U penicillin, 1000 U streptomycin, 10 ng/ml epidermal growth factor, and 10 ng/ml platelet-derived growth factor-BB (all from Sigma-Aldrich, St. Louis, MO) and 2% fetal calf serum (EuroClone, Wetherby, UK).10
For cell cloning, single cells were deposited in 96-well plates in the presence of the expansion medium. Epithelial differentiation was obtained in the presence of fibroblast growth factor-4 (10 ng/ml) and hepatocyte growth factor (20 ng/ml, Sigma).10
Endothelial differentiations were obtained by culturing the cells in EBM medium (Cambrex Bio Science, Baltimore, MD) with vascular endothelial growth factor (10 ng/ml, Sigma) and 10% fetal calf serum on endothelial cell attachment factor (Sigma).11
CD133+ cells were also isolated from the blood of granulocyte-colony stimulating factor mobilized patients using the MACS system (Miltenyi Biotec). Mesenchymal cells were obtained from the bone marrow of healthy donors and cultured in
-minimal essential medium supplemented with 10% fetal calf serum and 10% horse serum (all from Invitrogen), as described.12
The nonadherent cells were removed by medium change at 48 hours and every 4 days thereafter. Tube formation on Matrigel was performed as described.9
Immunofluorescence and Immunocytochemistry
Cytofluorimetric analysis was performed as described9 using the following antibodies, all fluorescein isothiocyanate or phycoerythrin conjugated: anti-CD1331 monoclonal Ab (mAb) (Miltenyi Biotec); anti-CD44 and anti-human HLA class I mAbs (Sigma); anti-CD31 and anti-CD105 mAbs (Serotec Inc., Oxford, UK); anti-KDR mAb (R&D Systems, Minneapolis, MN); anti-Muc-18 mAb (Chemicon Int., Temecula, CA); and anti-CD29, -CD33, -CD34, -CD45, -CD73, -CD90, and -CD117 mAbs (Becton Dickinson, San Jose, CA). Anti-VE cadherin mAb was kindly provided by Guido Tarone (University of Torino). Fluorescein isothiocyanate or phycoerythrin mouse nonimmune isotypic IgG (DAKO, Copenhagen, Denmark) were used as controls. Indirect immunofluorescence was performed on cells cultured on chamber slides, fixed in 4% paraformaldehyde containing 2% sucrose and, when needed, permeabilized with Hepes-Triton X-100 buffer.13 Immunofluorescence was also performed on human or mouse tissues rapidly frozen in liquid nitrogen, cut in 3-µm sections, and fixed in 3.5% paraformaldehyde containing 2% sucrose. The following antibodies were used: anti-NaCl co-transporter, anti-aminopeptidase A, and anti-alkaline phosphatase polyclonal goat Abs (Santa Cruz Biotechnology, Santa Cruz, CA), rabbit anti-zonula occludens (ZO)-1 polyclonal Ab (Santa Cruz Biotechnology), goat anti-von Willebrand factor (vWF) and rabbit anti-pan-cytokeratin Abs (Sigma), anti-vimentin, and anti-E cadherin mAbs (DAKO), anti-EMA mAb (Chemicon Int.), polyclonal rabbit anti-PAX-2 Ab (Covance, Princeton, NJ) phycoerythrin-conjugated anti-CD133 (Miltenyi Biotec), and anti-proliferating cell nuclear antigen, fluorescein isothiocyanate-conjugated anti-HLA I and anti-calbindin D-28K mAbs (Sigma). Control mouse, rabbit, or goat nonimmune immunoglobulins were used as controls. Fluorescein isothiocyanate-conjugated anti-mouse, -rabbit, or -goat IgGs (Sigma) were used as secondary antibodies when needed. Immunocytochemistry was performed as described14 on tissue fixed in 10% buffered formalin and embedded in paraffin. Confocal microscopy was performed using a Leica TCS SP2 model confocal microscope (Heidelberg, Germany). Hoechst 33258 dye (Sigma) was added for nuclear staining.
Quantitative Real-Time Polymerase Chain Reaction (PCR)
Quantitative real-time PCR were performed as previously described.15 Briefly first-strand cDNA was produced from 2 mg of random hexamer-primed total RNA using reverse transcription reactions (20 µl). Relative quantitation by real-time PCR was performed using SYBR-green detection of PCR products in real time using the iCycler from Bio-Rad (Cambridge, MA). In each experiment, the human b2 microglobulin (B2M) housekeeping gene was amplified as a reference standard. Primers for B2M were B2MF, 5'-AGATGAGTATGCCTGCCGTGT-3' and B2MR, 5'-GCTTACATGTCTCGATCCCACTTA-3'. In all real-time PCR experiments, cloned Pax-2 DNA were included as positive control. RNA from human umbilical vein endothelial cells were used as negative control.14 Template RNAs were treated with DNase I before amplification. Each real-time PCR reaction (50 µl) contained 2.5 µl of cDNA were amplified using the Platinum Taq polymerase amplification system from Invitrogen (Carlsbad, CA) and primers at a final concentration of 20 µmol/L. Primers were as follows: PAX2F, 5'-CCCAGCGTCTCTTCCATCA-3'; PAX2R, 5'-GGCGTTGGGTGGAAAGG-3'. Reactions were prepared in duplicate and heated to 95°C for 10 minutes followed by 40 cycles at 95°C for 15 seconds and 58°C for 60 seconds, with a final incubation at 95°C for 15 minutes. To detect the log phase of amplification, the fluorescence level (quantification of product) was determined at each cycle. The cycle at which the fluorescence reached threshold was recorded, averaged between duplicates, and normalized to the averaged cycle of threshold value for B2M. The relative expression level for PAX-2 gene was then calculated according to the manufacturers instructions.
Electron Microscopy
Immunogold labeling was performed on 2.5% paraformaldehyde-fixed cells16 using a primary specific antibody or an isotype-matched immunoglobulin (DAKO) and, as secondary antibody, the 5-nm gold-conjugated rabbit anti-goat Ab (BBInternational, Cardiff, UK) followed by silver enhancement (Silver enhancing kit, BBInternational). Samples were postfixed in 2.5% glutaraldehyde, dehydrated in alcohol, dried, and coated with gold by sputter coating. The specimens were examined in a scanning Jeol T300 electron microscope. Images were obtained via secondary electron at a working distance of 15 to 25 mm and at an accelerating voltage of 20 to 25 kV. Transmission electron microscopy was performed on Karnovskys-fixed, osmium tetraoxide-postfixed tissues and embedded in epoxy resin according to standard procedures.16 Ultra-thin sections were stained with uranyl acetate and lead citrate and were examined with a Jeol JEM 1010 electron microscope.
Transepithelial Electrical Resistance
Transepithelial electrical resistance was used as an indicator of epithelial differentiation.17 CD133+ cells undifferentiated or differentiated into epithelial cells were plated in transwells on collagen-coated polycarbonate membrane (Corning Costar Corp., Cambridge, MA) and allowed to reach confluency. An epithelial volt-ohm meter (EVOM; World Precision Instruments, Inc., Sarasota, FL) was used to determine the transepithelial electrical resistance value. All values were normalized for the area of the membrane. As a control we used an immortalized tubular epithelial cell line, previously characterized.18 All experiments were done in triplicate.
Xenograft in SCID Mice
CD133+ cells (undifferentiated or endothelial committed) were implanted subcutaneously into SCID mice (Charles River, Jackson Laboratories, Bar Harbor, ME) within Matrigel (Becton Dickinson), as described.9 Cells were harvested using trypsin-ethylenediaminetetraacetic acid, washed with phosphate-buffered saline, counted in a microcytometer chamber, and resuspended in Dulbeccos modified Eagles medium (1 x 106 in 250 µl of Dulbeccos modified Eagles medium). Cells were chilled on ice, added to 250 µl of Matrigel at 4°C, and injected subcutaneously into the left back of SCID mice via a 26-gauge needle using a 1-ml syringe. At day 10, mice were sacrificed and Matrigel plugs recovered and analyzed. To evaluate the ability of CD133+ cells to localize in the injured kidney, we induced acute tubular injury by intramuscle injection of glycerol in SCID mice.19,20 The peak of tubular injury was observed 3 days after glycerol injection (8 µl/g body weight of 50% glycerol solution). At this time, 106 CD133+ cells (passage III to IV) labeled with PHK2 green fluorescent dye (Sigma) were intravenously injected in treated and untreated animals, and mice were sacrificed after 3 days.
| Results |
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Immunostaining showed the presence of rare CD133+ cells within the cortex of normal renal tissue. Scattered cells were observed within the interstitium (Figure 1, a and b)
. Glomeruli were negative. The specimens we obtained did not include the medullary part of the kidney. We isolated the CD133+ cells from adult renal cortical tissue by immunomagnetic sorting. CD133-based fluorescence-activated cell sorting gated an average of 0.8 to 1.2% of the cells (Figure 1, c and d)
. The percentage of cells we sorted from renal tissue was 0.8 ± 0.15% of total cells extracted from the renal cell population deprived of glomeruli (n = 8). Cells were plated onto fibronectin and grown in serum-free medium with epidermal growth factor and platelet-derived growth factor-BB (expansion medium), a medium used by Jiang and colleagues10
to maintain undifferentiated multipotent adult progenitor cells.
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Cell Cloning and Differentiation into Epithelial and Endothelial Cells
To assess the capacity of a single CD133+ cell to give rise to both an epithelial and an endothelial population, we generated clones using a limiting dilution technique. Clones were expanded in expansion medium and then cells from the same clone were plated in differentiating medium to obtain endothelial or epithelial differentiation. To obtain epithelial differentiation, cells were grown in the presence of hepatocyte growth factor and fibroblast growth factor-4. After 10 days of culture, cells lost CD133 expression but maintained CD44 expression (Figure 2, a and b)
Cytokeratin expression, undetectable on undifferentiated cells, became detectable on >50% of cells after 5 days and was present on 100% of cells after 10 days of culture (Figure 2c)
. They also express the mesenchymal marker vimentin (Figure 2d)
, which is frequently co-expressed with cytokeratin in embryonic or dedifferentiated tubular cells.23
In addition, cells expressed the epithelial antigens E-cadherin (Figure 2e)
and ZO-1 (Figure 2f)
, as well as markers characteristic of fully differentiated renal epithelia, such as alkaline phosphatase (Figure 2g)
, amino peptidase A (Figure 2j)
, mainly expressed by proximal tubular epithelial cells24,25
and the thiazide-sensitive NaCl co-transporter (Figure 2k)
, mainly expressed by distal tubular epithelial cells.26
Approximately 1% of the cells expressed also calbindin-D, a distal tubular marker (not shown).27
-Smooth muscle actin was negative (Figure 2h)
. In vitro epithelial differentiation was also supported by polarization of the cell layer evaluated by trans epithelial electrical resistance (Figure 3a)
. Trans epithelial electrical resistance has been considered a marker of cell polarization and of stem cell differentiation into epithelial cells.17
Differentiated cells exhibited high trans epithelial electrical resistance in respect to undifferentiated CD133+ cells and comparable to renal proximal tubular epithelial cells used as control (Figure 3a)
. Moreover, epithelial differentiated cells cultured in Transwell on collagen-coated semipermeable membrane (Figure 3b)
showed by transmission electron microscopy morphological aspects of cell polarization such as apical microvilli and junctional complexes (Figure 3c)
. To induce endothelial differentiation, cells were plated onto endothelial cell attachment factor and grown in the presence of vascular endothelial growth factor. Expression of CD133 was down-regulated after three culture passages (8 days) and undetectable thereafter (Figure 4a)
. In contrast, CD44, already present in undifferentiated cells, remained unaltered (Figure 4b)
. After 3 days of culture, cells started to express the endothelial markers Muc-18, KDR, CD105, VE-cadherin, and vWF, and the expression was maximal at day 10 (Figure 4; c to g)
and persisted thereafter. In contrast, CD31 expression remained very low (not shown). When plated onto Matrigel, endothelial differentiated but not CD133-positive undifferentiated cells rapidly (4 hours) aligned to form, as mature endothelial cells, ring-like structures (Figure 4; h to j)
also defined as capillary-like.28
These cords of endothelial cells expressed vWF (Figure 4k)
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Renal CD133+ cells, at variance of circulating CD133+ cells, did not differentiate in hematopoietic cells (CD33+/CD45+) after culturing in Iscove with 10% fetal calf serum, interleukin-3, and granulocyte-colony stimulating factor, nor did they differentiate in adipocytes (positive for neutral lipid vacuoles that stain with red oil) after culturing in adipocyte differentiating medium,12 at variance of bone marrow-derived mesenchymal cells (not shown).
In Vivo Implantation
Renal progenitor CD133+ cells were subcutaneously injected into Matrigel in nonimmunocompetent SCID mice to assess their differentiation in vivo. After 10 days, plugs were recovered and processed for histological and immunohistochemical analysis. Undifferentiated cells (passage III) injected into mice showed a spontaneous differentiation into epithelial tubular structures. Cells organized in tubular-like structures with morphological aspects of cell polarization and a virtual lumen containing proteinaceous material (Figure 5a)
. Immunohistochemical evaluation indicated that these structures were human, as they expressed HLA class I antigen (Figure 5a
, inset), were positive for epithelial markers, such as cytokeratin and the EMA (Figure 5, b and d)
, and for the mesenchymal marker vimentin (Figure 5c)
, commonly expressed by regenerating renal epithelium. Moreover, tubular structures were positive for the distal tubular marker thiazide-sensitive NaCl co-transporter but not for the proximal tubular marker amino peptidase A (Figure 5, e and f)
. Some tubules were also positive for the alkaline phosphatase, a marker of proximal tubules (Figure 5g)
, and only some cells of the tubular structures expressed calbindin-D, a marker of distal tubules (Figure 5h)
. In addition, by immunohistochemistry cells expressed nuclear staining for Pax-2 protein (Figure 5i)
but were negative for endothelial markers, such as vWF (not shown). When isotypic controls were used instead of the specific primary antibody no staining was observed (not shown). By electron microscopy, the arrangement of cells around a virtual lumen filled with dense material and the presence of short microvilli and tight junctions indicate the polarization of epithelial cells forming the tubular-like structures (Figure 6; a to c)
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| Discussion |
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Adult stem cells have been isolated from several tissue sources, including the central nervous system,29 bone marrow,12 retina,30 skeletal muscle,31 and skin.32 Isolation and characterization of human adult renal stem cells has not been so far described. We identified the presence of small clusters of CD133+ cells within the interstitium of normal human kidney by immunohistochemistry and we immunomagnetically sorted and characterized these cells. CD133 antigen has been previously used to isolate stem cells from hematopoietic and nervous tissues.7,33 In hematopoietic tissues CD133 is expressed solely on CD34 bright stem and progenitor cells.34 In addition, CD133 was found on a subset of cells within both skeletal muscle and human neural tissue, the majority of which was also devoid of the hematopoietic marker CD45.35 Moreover, the discovery of alternative tissue-specific promoters may suggest the presence of different isoforms of CD133.36 We found that renal CD133+ cells were uniformly negative for the hematopoietic stem cell markers CD34 or CD45 and that they expressed PAX-2, a developmental renal marker,22 suggesting their renal origin. Alternatively, these cells may represent a bone marrow-derived population that has homed to the kidney through the circulation and has been resident long enough to have lost blood cell lineage markers. The expression of CD44, CD29, and CD73 may suggest a mesenchymal origin.12,21 The existence of mesenchymal stem cells in adult tissues was proposed by Caplan and Bruder.37 However, the cells isolated from kidney were strongly and persistently positive for CD133, a marker that is usually lacking in mesenchymal stem cells.38-40 Moreover, at variance of mesenchymal stem cells, renal CD133+ cells have limited differentiation capability.
Tissue stem cells preferentially generate differentiated cells of the same lineage as their tissue of origin: neural stem cells are biased to generate neurons and glia; bone marrow mesenchymal stem cells to generate mesodermal cell types; and hematopoietic stem cells to generate blood cells. However, several recent transplant studies indicate that at least a fraction of stem cells in these populations can generate cells of different embryonic lineages.10 We tested the capability of renal-derived CD133+ cells and of clones of individual cells to generate endothelial cells, epithelial cells, blood cells, and adipocytes. The results obtained indicate that these cells may differentiate into endothelial or epithelial cells, but not in blood cells or adipocytes. This observation suggests a partial commitment of renal CD133+ cells. The potential of kidney-derived stem cells to be highly proliferative and to generate cells with the phenotypic and functional features of endothelial and epithelial cells suggesting that these cells may be the source of the regenerative capability of the human kidney. Some acute and progressive renal diseases are characterized by a loss of the microvasculature that correlates with the development of glomerular and tubulointerstitial scarring.2 The maintenance of the microvasculature would thus seem to be critical for the recovery of acute glomerular injury41 and the prevention of progressive renal disease.2 We show that renal-derived CD133+ cells were able to differentiate in vitro in endothelial cells and to generate in vivo functional vessels. This observation suggests a potential involvement of these cells in the repair of vascular injury and in antagonizing the endothelial loss and the progression to renal failure.
At variance with the low regenerative potential of the endothelial compartment, tubular epithelial cell regeneration frequently occurs after tubulonecrotic injury.1 In this context, stem cells may participate to the epithelial cell regeneration. Several studies indicate a contribution of bone marrow-derived stem cells in tubular repair.42,43 Based on our results, we can speculate that resident CD133+ stem cells, being located in the interstitium in the proximity of tubules, may also contribute to renal repair. Indeed, renal-derived CD133+ cells and clones of individual cells differentiated in vitro into epithelial cells expressing some markers of renal proximal and distal epithelium, such as aminopeptidase A and the NaCl co-transporter. In addition, when injected subcutaneously in SCID mice these cells spontaneously formed epithelial tubular-like structures in Matrigel. These tubular structures expressed both cytokeratin and vimentin, markers of immature or regenerating tubular epithelial cells.23 In vivo, these cells expressed some markers of both distal tubules such as the NaCl co-transporter and calbindin-D and of proximal tubules such as alkaline phosphatase. However, the nonhomogeneous or focal expression of these markers probably reflects an immature phenotype. Moreover, the morphological aspects of the tubules developed subcutaneously in Matrigel are reminiscent of the renal structures because epithelial cells appeared polarized with apical microvilli and tight junctions. Finally, when renal-derived CD133+ cells were injected intravenously in SCID mice that developed glycerol-induced acute tubulonecrosis, we observed their renal homing and integration into some proximal and distal tubules. One can speculate that renal-derived CD133+ cells may contribute to the repair of renal injury either by regeneration of tissue structures or by a paracrine release of growth factors able to stimulate cell proliferation, survival, and differentiation of parenchymal cells, as described for the heart.44 The cell location and the expression of cytokeratin suggested their differentiation into tubular epithelial cells. Recent studies have also suggested the possibility that stem cells fuse with adult differentiated cells to repair damaged organs.45
In conclusion, the results of the present study demonstrate the presence in adult normal human kidney of a resident population of stem cells expressing CD133 marker and capable of expansion and potential self-renewal. These cells may respond to local environmental stimulation, with differentiation into endothelial or epithelial tubular cells, both in vitro and in vivo.
| Acknowledgements |
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| Footnotes |
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Supported by the Associazione Italiana per la Ricerca sul Cancro, the Italian Ministry of University and Research FIRB project (RBNE01HRS5-001) and COFIN, the Italian Ministry of Health (Ricerca Finalizzata 02), the Progetto S. Paolo (to G. C), and Italian Ministry of University and Research (MIUR) (ex60% to B.B.).
B.B. and S.B. contributed equally to this work.
Accepted for publication October 5, 2004.
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C. Sagrinati, G. S. Netti, B. Mazzinghi, E. Lazzeri, F. Liotta, F. Frosali, E. Ronconi, C. Meini, M. Gacci, R. Squecco, et al. Isolation and Characterization of Multipotent Progenitor Cells from the Bowman's Capsule of Adult Human Kidneys J. Am. Soc. Nephrol., September 1, 2006; 17(9): 2443 - 2456. [Abstract] [Full Text] [PDF] |
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B. M. Christensen, Y.-H. Kim, T.-H. Kwon, and S. Nielsen Lithium treatment induces a marked proliferation of primarily principal cells in rat kidney inner medullary collecting duct Am J Physiol Renal Physiol, July 1, 2006; 291(1): F39 - F48. [Abstract] [Full Text] [PDF] |
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G. Zerbini, L. Piemonti, A. Maestroni, G. Dell'Antonio, and G. Bianchi Stem Cells and the Kidney: A New Therapeutic Tool? J. Am. Soc. Nephrol., April 1, 2006; 17(4_suppl_2): S123 - S126. [Abstract] [Full Text] [PDF] |
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J. D. Raman, N. P. Mongan, L. Liu, S. K. Tickoo, D. M. Nanus, D. S. Scherr, and L. J. Gudas Decreased expression of the human stem cell marker, Rex-1 (zfp-42), in renal cell carcinoma Carcinogenesis, March 1, 2006; 27(3): 499 - 507. [Abstract] [Full Text] [PDF] |
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J.-K. Guo, A. Schedl, and D. S. Krause Bone Marrow Transplantation Can Attenuate the Progression of Mesangial Sclerosis Stem Cells, February 1, 2006; 24(2): 406 - 415. [Abstract] [Full Text] [PDF] |
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