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Improved differentiation of umbilical cord blood-derivedmesenchymal stem cells into insulin-producing cells by PDX-1 mRNA transfection Anh Nguyen-Tu Bui, Loan Thi-Tung Dang, Khue Gia Ngu

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Improved differentiation of umbilical cord blood-derived

mesenchymal stem cells into insulin-producing cells

by PDX-1 mRNA transfection

Anh Nguyen-Tu Bui, Loan Thi-Tung Dang, Khue Gia Nguyen, Ngoc Kim Phan

Laboratory of Stem Cell Research and Application, University of Science, Vietnam National University, Ho Chi Minh City, Viet Nam

a r t i c l e i n f o

Article history:

Received 29 April 2014

Received in revised form

4 August 2014

Accepted 18 August 2014

Keywords:

Mesenchymal stem cells

UCB-MSCs

Insulin producing cells

PDX-1

mRNA transfection

a b s t r a c t

Numerous studies have sought to identify diabetes mellitus treatment strategies with fewer side effects Mesenchymal stem cell (MSC) therapy was previously considered as a promising therapy; however, it requires the cells to be trans-differentiated into cells of the pancreatic-endocrine lineage before transplantation Previous studies have shown that PDX-1 expression can facilitate MSC differentiation into insulin-producing cells (IPCs), but the methods employed to date use viral or DNA-based tools to express PDX-1, with the associated risks of insertional mutation and immunogenicity Thus, this study aimed to establish a new method to induce PDX-1 expression in MSCs by mRNA transfection MSCs were isolated from human umbilical cord blood and expanded in vitro, with stemness confirmed by surface markers and multipotentiality MSCs were transfected with PDX-1 mRNA by nucleofection and chemically induced to differentiate into IPCs (combinatorial group) This IPC differentiation was then compared with that of untransfected chemically induced cells (inducer group) and uninduced cells (control group) We found that PDX-1 mRNA transfection significantly improved the differentiation of MSCs into IPCs, with 8.372.5% IPCs in the combinatorial group, 3.2172.11% in the inducer group and 0%

in the control Cells in the combinatorial group also strongly expressed several genes related to beta cells (Pdx-1, Ngn3, Nkx6.1 and insulin) and could produce C-peptide in the cytoplasm and insulin in the supernatant, which was dependent on the extracellular glucose concentration These results indicate that PDX-1 mRNA may offer a promising approach to produce safe IPCs for clinical diabetes mellitus treatment

& 2014 International Society of Differentiation Published by Elsevier B.V All rights reserved

1 Introduction

Diabetes mellitus is a highly prevalent disease estimated by the

World Health Organization to affect approximately 500 million

people worldwide However, to date, there is still no cure All of

the current methods used to treat diabetes mellitus aim to restore

glucose homeostasis Cellular therapy has long been considered as

a potential approach to cure this disease However, beta cell numbers are limited, and thus not ideal for replacement therapy Insulin-producing cells (IPCs), on the other hand, can be differ-entiated from stem cells and offer a potential source of cells in lieu

of beta cells For this reason, numerous studies have been conducted to establish protocols to differentiate stem cells into IPCs

Various sources of stem cells have been successfully differen-tiated into IPCs, including embryonic stem cells (Hua et al., 2014; Jiang et al., 2007), induced-pluripotent stem cells (Alipio et al., 2010; Jeon et al., 2012; Zhu et al., 2011), pancreatic stem cells (Noguchi et al., 2010), mesenchymal stem cells from human umbilical cord blood (UCB) (Parekh et al., 2009; Phuc et al.,

2011), placenta (Kadam et al., 2010), bone marrow (Phadnis

et al., 2011), and adipose tissue (Chandra et al., 2009) Of these, UCB-derived MSCs offer several advantages, particularly because

of the increased banking of UCB samples in recent years

Contents lists available atScienceDirect

journal homepage:www.elsevier.com/locate/diff

Differentiation

http://dx.doi.org/10.1016/j.diff.2014.08.001

Join the International Society for Differentiation (www.isdifferentiation.org)

0301-4681/& 2014 International Society of Differentiation Published by Elsevier B.V All rights reserved.

Abbreviations: DMEM, Dulbecco’s modified eagle medium; GFP, green fluorescent

protein; MNC, mononuclear cell; mRNA, messenger RNA; MSC, mesenchymal stem

cell; IMDM, Iscove’s modified Dulbecco’s media; IPC, insulin producing cell; PBS,

phosphate buffered saline

n Corresponding author.

E-mail addresses: pvphuc@hcmuns.edu.vn (P Van Pham),

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Consequently, UCB-MSCs have been extensively studied for IPC

differentiation Until now, the most successful methods to induce

UCB-MSC differentiation into IPCs used nicotinamide and/or

exendin-4 inducers (Phuc et al., 2011; Prabakar et al., 2012; Tsai

et al., 2012) Other studies have also successfully differentiated

UCB-MSCs into IPCs by up-regulating some of the master genes

that cause IPC differentiation (mainly PDX-1) (He et al., 2011;

Wang et al., 2011) These studies have demonstrated that PDX-1 is

an important factor regulating pancreatic-endocrine

differentia-tion, particularly for beta cell formation and function

Further-more, PDX-1-differentiated IPCs can regulate the glucose

concentration of diabetic mice

The chemical induction of IPCs from MSCs, however, is

gen-erally poor and, although PDX-1 up-regulation can significantly

increase IPC production, the use of vector viruses, such as an

adenovirus or a lentivirus, harbors the risk of insertional

muta-genesis and immunogenicity (Dave et al., 2009; Hacein-Bey-Abina

et al., 2008; Howe et al., 2008) As such, the differentiated IPCs

from these protocols cannot be used to treat humans in clinical

applications Therefore, this study aimed to develop a novel and

safe method to improve the differentiation efficiency of UCB-MSCs

into IPCs We show improved chemical differentiation of MSCs

following transfection of PDX-1 mRNA

2 Materials and methods

2.1 Isolation of UCB-MSCs

Human UCB was obtained from hospital samples with informed

consent obtained from the mother after delivery of her child All

procedures and manipulations were approved by our Institutional

Ethical Committee (Laboratory of Stem Cell Research and Application,

University of Science, Vietnam National University, Ho Chi Minh City,

Vietnam) and the Hospital Ethical Committee (Nhan Dan 115

Hospital, Ho Chi Minh City, Vietnam) A bag system containing

17 mL of anticoagulant (citrate, phosphate, and dextrose) was used

All UCB units were processed within 3 h after delivery To isolate

mononuclear cells (MNCs), each UCB unit was diluted 1:1 with

phosphate-buffered saline (PBS) and carefully loaded onto

Ficoll-Hypaque (1.077 g/mL, Sigma-Aldrich, St Louis, MO) After density

gradient centrifugation at 3000 rpm for 20 min at room temperature,

MNCs were removed from the interphase, washed twice with PBS,

and resuspended in Iscove’s modified Dulbecco’s media (IMDM)

with 15% fetal bovine serum (FBS) and 1% antibiotic-antimycotic

(Sigma-Aldrich) MNCs were seeded in T-75 cm2 flasks at 1  105

cells/cm2and incubated at 371C, 5% CO2 The medium was replaced

every 3 days When cells reached 70–80% confluence, they were

sub-cultured at a ratio of 1:3 using the same medium as primary culture

2.2 UCB-MSC characterization

UCB-MSCs were characterized according the MSC standard set

by Dominici et al (2006) UCB-MSCs were confirmed by flow

cytometry using surface marker expressions of CD14, CD34, CD45,

HLA-DR, CD73, CD90 and CD105 Flow cytometry was performed

on a FACSCalibur flow cytometer (BD Bioscience, San Jose, CA)

UCB-MSCs were stained with anti-CD14-FITC, anti-CD34-FITC,

anti-CD45-FITC, anti-HLA-DR-FTIC, anti-CD73-PE, anti-CD90-FITC

and anti-CD105-FITC monoclonal antibodies A total of 10,000 cells

were analyzed by CellQuest Pro software Isotype controls were

used in all analyses

UCB-MSCs were also confirmed by their potential to

differenti-ate along multiple lineages Adipogenic differentiation of MSCs

was performed as described previously (Lee et al., 2004b) Briefly,

UCB-MSCs at passage 5 were plated at a density of 1 104

cells/well in 24-well plates At 70% confluence, the cells were switched to IMDM supplemented with 0.5 mM 3-isobutyl-1-methyl-xanthine, 1 nM dexamethasone, 0.1 mM indomethacin and 10% FBS (all from Sigma-Aldrich) and cultured for 21 days Adipogenic differentiation was evaluated by observing the produc-tion of lipid vesicles within cells via microscopy

For osteogenic differentiation, UCB-MSCs were plated at 1 104

cells/well in 24-well plates At 70% confluence, the cells were switched to IMDM supplemented with 10% FBS, 107M dexametha-sone, 50μM ascorbic acid-2 phosphate and 10 mM β-glycerol phosphate (all from Sigma-Aldrich), and cultured for 21 days, as described elsewhere (Lee et al., 2004b) Osteogenic differentiation (calcium accumulation) was confirmed by Alizarin red staining For chondrogenic differentiation, UCB-MSCs were induced using a commercial medium for chondrogenesis (StemPro Chon-drogenesis Differentiation Kit, A10071-01, Life Technologies) UCB-MSCs were differentiated in pellet form, according to manufac-turer’s guidelines After 21 days growth, cell pellets were stained with an anti-aggrecan monoclonal antibody (BD Bioscience) 2.3 In vitro mRNA PDX-1 production

pcDNA3.1-hPDX-1 was amplified by PCR with 50-T7 primer (50-TAATACGACTCACTATAGGG-30) and 30-specific primer for PDX-1 (50-GTCCTCCTCCTTTTTCCAC-30) pcDNA3.1-hPDX-1 was prepared in the previous study by cutting hPDX-1 from vector pWPT-PDX1 with NotI and BamHI (Plasmid 12256, Addgene, Cambridge, MA) and inserting to vector pcDNATM 3.1 (Invitrogen, Carlsbad, CA) (Nguyen

et al., 2014)

The PCR products for hPDX-1 were purified using the GenElute PCR Clean-up Kit, Sigma-Aldrich, St Louis, MO) The purified PCR product was employed for an in vitro transcription reaction using the T7 mScript Standard mRNA Production System (Epicentre Biotechnologies, Madison, WI) The mRNA concentration was measured using a Nanophotometer (Eppendorf, Germany) 2.4 mRNA PDX-1 transfection

UCB-MSCs were transfected according to a previously pub-lished protocol (Arnold et al., 2012) UCB-MSCs were transfected with 3μg of mRNA by nucleofection (NHDF-VPD-1001, Lonza) After transfection, these cells were plated into T-25 flasks and cultured in the medium At 72 h, 144 h, and 216 h after nucleofec-tion, the adherent cells were transfected with “FuGENE HD” (Roche, Basel, Switzerland) according to the manufacturer’s instructions, which was replaced with culture medium 4 h later The ratio of“FuGENE HD” reagent and mRNA was 8μL per 3μg of mRNA Transfected samples of UCB-MSCs were evaluated for changes in Pdx-1 expression at both transcriptional and transla-tional levels

2.5 RNA extraction and reverse transcript real-time RT PCR RNA was extracted from cell cultures using a Trizol extraction kit (Intron Biotechnology, Korea) mRNA was reversed trans-cribed into cDNA using an AMV reverse transcription kit (Agilent Technologies, Santa Clara, CA) The real-time RT-PCR reactions were carried out using Brilliant II SYBRsGreen QPCR Master Mix (Agilent Technologies) The primer sequences were as follows: GAPDH, forward, 50-AGAAGGCTGGGGCTCATTTG-30, and reverse,

50-AGGGGCCATCCACAGTCTTC-30; PDX-1, forward, 50-GGATGAAGTC TACCAAAGCTCACGC-30, and reverse, 50-CCAGATCTTGATGTGTCTC TCGGTC-30; INSULIN, forward, 50-AACCAACACCTGTGCGGCT CA-30; reverse, 50-TGCCTGCGGGCTGCGTCTA-30; NGN3, forward,

50-CGCCGGTAGAAAGGATGAC-30, reverse: 50 -GAGTTGAGGTTGTG-CATTCG-30; NKX6.1, forward: 50-CTGGAGAAGACTTTCGAACAA-30,

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reverse, 50-AGAGGCTTATTGTAGTCGTCG-30 GAPDH was used as an

internal control for the normalization of gene expression

Real-time RT-PCR was performed as per the following cycling

condi-tions: 951C for 30 s; 60 1C for 30 s; and 72 1C for 60 s for 40 cycles

The Ct values were used to calculate gene expression according to

the 2ΔCCtmethod.

2.6 IPC differentiation

In this study, UCB-MSCs were treated under three conditions:

combinatorial group (PDX-1-transfected and chemically induced);

inducer group (chemically induced only); and control group

(no induction or transfection) At the start of the assay (herein

referred to as day-9 of the time line), undifferentiated UCB-MSCs in

the combinatorial group were transfected with PDX-1 mRNA Nine

days later at‘day 0’, UCB-MSCs in the combinatorial and inducer

groups were induced to differentiate into IPCs in IMDM

supple-mented with 2% FBS, 100 ng/mL epidermal growth factor and 2%

B27 for 3 days From days 4 to 21, cells were incubated in IMDM

supplemented with 10 nM nicotinamide, 2% B27, 10 ng/mL

betacel-lulin and 0.1 mM beta-mercaptoethanol, with fresh media replaced

every 3 days UCB-MSCs in the control group only were cultured

in basic medium (IMDM plus 15% FBS, 1% antibiotic-antimycotic)

At days 7, 14, and 21, the gene expression levels of PDX-1, NGN3,

NKX6.1 and INSULIN were evaluated At day 21, the supernatant

from all three groups was collected to analyze the amount of

insulin production and cell extracts were used to measure

C-peptide production

2.7 Flow cytometry analysis

PDX-1-transfected cells were analyzed byflow cytometry About

5 106 cells were fixed in PFA 4% and permeabilized with 0.03%

Triton X-100 (Sigma-Aldrich, St Louis, MO) diluted in PBS with 0.1%

bovine serum albumin (BSA) (Sigma-Aldrich, St Louis, MO) for 1 h

Non-specific sites were blocked using 10% BSA for an additional 1 h

Cells were then incubated with anti-Pdx1 monoclonal antibody (BD

Bioscience) for 4 h Stained cells were washed three times with PBS

plus 0.1% BSA and then incubated with an anti-mouse secondary

IgG1-FITC for 1 h Finally, the cells were washed three times with PBS

plus 0.1% BSA and re-suspended in FACSfluid sheath for analysis and

sorting on a FACSJazzflow cytometer (BD Bioscience) Isotypes were

used for this analysis

2.8 Immunohistochemistry

For immunohistochemistry, cells werefixed with 4%

paraformal-dehyde and then permeabilized by 0.03% Triton X-100 diluted in PBS

with 0.1% BSA for 1 h Non-specific sites were blocked using 10% BSA

for an additional 1 h Cells were then stained with primary

mono-clonal antibodies against Pdx-1 (sc-390792, Santa Cruz

Biotechnol-ogy, Canada) insulin (sc-52035, Santa Cruz BiotechnolBiotechnol-ogy, Canada)

Following washing with PBS, cells were then stained with

anti-mouse secondary IgG1-FITC (sc-2010, Santa Cruz Biotechnology,

Canada) for 30 min, washed again and then counterstained with

Hoechst 33342 for 10 min (Sigma-Aldrich, St Louis, MO) Staining was

observed under afluorescent microscope (Cell Observer, Carl-Zeiss,

Germany)

2.9 Insulin and C-peptide measurement

After 21 days of differentiation, cells were washed with PBS and

then incubated for 3 h in DMEM-LG (low glucose; 5 mM glucose)

The supernatant was collected and stored at 20 1C for insulin

measurement and the differentiated cells were harvested and the

cellular extract used for C-peptide measurement The Insulin ELISA

kit (ab100578, Abcam, Cambridge, MA) and C-peptide ELISA kit (ab178641, Abcam, Cambridge, MA) were used according to the manufacturer’s instructions The assays were read at 450 nm in a DTX Multimode plate reader (Beckman Coulter, Fullerton, CA) 2.10 Glucose response assay

At day 21 of differentiation, cells were washed with PBS and then incubated for 1 h in DMEM-LG The supernatant was col-lected and stored at 20 1C The cells were washed with PBS and incubated for an additional 1 h in DMEM-HG (high glucose;

25 mM glucose) and this supernatant was also collected and stored at20 1C The insulin concentration was determined using the Insulin ELISA kit, as described above

2.11 Statistical analysis Significance of differences between mean values was assessed

by t test and ANOVA A P value o0.05 was considered to be significant All data were analyzed by Prism 6 software (GraphPad Software, La Jolla, CA)

3 Results 3.1 UCB-MSCs fully exhibited the MSC characteristics

We successfully isolated MSCs from five samples of human UCBs All potential isolates of MSCs were confirmed according to the guidelines set out by Dominici et al (2006) The results showed that isolated MSCs exhibited afibroblast-like shape when cultured under adherent conditions (Fig 1A) These cells were positive for CD44, CD73, and CD90 and negative for CD14 (a marker of monocytes), CD34 (a marker of hematopoietic stem cells), CD45 (a marker of leukocytes) and HLA-DR (Fig 1E–L) The MSCs could also be successfully differentiated along three different mesenchymal lineages, including adipocyte, osteocyte and chon-drocyte lineages For adipogenic differentiation, MSCs demon-strated a change in shape and the presence of lipid droplets within the cytoplasm of cells following growth in adipocyte-inducing medium These lipid droplets were stained red by Oil Red dye (Fig 1B) For osteogenic differentiation, MSCs also demon-strated a change in shape as well as an accumulation in cytoplas-mic calcium, as determined by Alizarin red staining (Fig 1C) Finally, MSCs were also successfully differentiated into chondro-cytes, with pellets staining positively for aggrecan, a specific marker of chondrocytes (Fig 1D)

3.2 PDX-1 mRNA transfection and PDX-1 expression in MSCs

In this experiment, we transfected UCB-MSCs with PDX-1 mRNA according to a published protocol (Arnold et al., 2012)

We found that, compared with un-transfected control cultures (Fig 2A–E), some of the transfected cells showed positive PDX-1 expression, as determined using immunochemistry staining (Fig 2F–K) Using flow cytometry, we determined the PDX-1-positive cell population as 12.5575.32% of the total number of cells (Fig 2L and M)

3.3 Differentiation of UCB-MSCs into IPCs by chemical induction with or without PDX-1 mRNA transfection

To evaluate the efficacy of PDX-1 mRNA transfection on IPC differentiation of UCB-MSCs, we set up two experimental groups and a control group herein referred to as the combinatorial group (Pdx-1-transfected and chemically induced), inducer group

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(chemically induced only), and control group (no induction or

transfection) In both experimental groups, UCB-MSCs started to

form cell clusters that resembled islets after 14 days of culture

(Fig 3B and E), with no cluster formation observed in the control

group (Fig 3A and D) However, different condensation patterns

were noted between the inducer and combinatorial groups, with

UCB-MSCs in the combinatorial group triggering earlier cell cluster

formation (Fig 3E and F vs.Fig 3B and C) By counting the number

of cell clusters formed in the same time frame between inducer

and combinatorial groups, we found that the number of cell

clusters formed in the combinatorial group (89725 clusters) was significantly higher than that in the inducer group (53731 clusters)

We next assessed the expression of pancreatic cell-related genes

at days 7, 14 and 21 for all three groups Our results showed differences in the expression of Pdx-1, Ngn3, Nkx6.1 and insulin between the groups and between the successive timepoints (Fig 3G and H) After day 7, in comparison with the control group, cells in the inducer group showed 2.4770.9, 1.4370.31, 15.374.9 times higher expression of Pdx-1, Ngn3, Nkx6.1, respectively In the combinatorial

Fig 2 Mesenchymal stem cells (MSCs) expressed PDX-1 after transfection with PDX-1 mRNA MSCs transfected with Pdx-1 mRNA showed expression of PDX-1 protein as detected by immunocytochemistry ((F)–(K)) as compared with untransfected control cells ((A)–(E)) PDX-1-positive cells were analyzed by flow cytometry in the experimental group (M) and the control (L) (Magnification: 100  ).

Fig 1 Mesenchymal stem cells (MSCs) isolated from umbilical cord blood (UCB) Isolated cells complied with the minimal standards for defining MSCs: they were adherent with a fibroblast-like shape (A); they were successfully differentiated into adipocytes stained with Oil Red (B), osteoblasts stained with Alizarin Red (C), and chondrocytes stained with anti-aggrecan-PE and Hoechst 33342 (D); they expressed CD44 (H), CD73 (I), CD90 (K); and lacked CD14 (E), CD34 (F), CD45 (G) and HLA-DR (L) (For interpretation of the references to color in this figure legend, the reader is referred to the web version of this article.)

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group, Pdx-1, Ngn3, Nkx6.1 expression was significantly higher than

that in the inducer group (5.9371.5 vs 2.4770.9, 2.7770.70

vs 1.4370.31, 33.0772.76 vs 15.374.9, respectively) At this time

point, insulin was not expressed in UCB-MSCs in the inducer group,

but was present in cells in the combinatorial group (Fig 3G)

After 14 days of induction, UCB-MSCs in both experimental

groups increased the gene expression of Pdx-1, Ngn3, Nkx6.1 and

Insulin, again with higher gene expression observed in the

combi-natorial group as compared with the inducer group (8.6771.86 vs

3.5770.65 for PDX-1; 10.771.31 vs 4.5770.70 for Ngn3;

50.579.8 vs 30.379.8 for Nkx6.1; and 3.8771.5 vs 0.8370.25

for insulin) (Fig 3H) At day 14, insulin expression was now also

detected in the inducer group

After 21 days of induction, there was a reduction in almost all

of the genes, with the exception of insulin, especially in the

combinatorial group Pdx-1, Ngn3, Nkx6.1 expression for the

combinatorial and inducer groups, respectively, were 3.970.1

and 2.2270.99; 2.070.36 and 0.8370.15; and 3.771.1 and

1.5370.7 Insulin expression increased from 3.8771.50 at day

14 to 8.4770.81 at day 21 for the combinatorial group and from

0.8370.25 at day 14 to 2.8770.55 at day 21 for inducer group

(Fig 3I) At this time point, cell cultures were also stained with

anti-insulin monoclonal antibody to determine the translational

expression level of insulin The results showed that cells in

islet-like cell clusters expressed protein insulin whereas cells outside the cell clusters did not (Fig 4)

To determine the differentiation efficiency, we counted the percentage of insulin-positive cells in the experimental and con-trol groups The results showed that there were 8.372.5% (Fig 5E and F) insulin-positive cells in the combinatorial group versus 3.2172.11% in the inducer group (Fig 5C and D) and 0% in the control group (Fig 5A and B)

Differentiated cells at day 21 were induced with two different concentrations of glucose (5 mM and 25 mM) At both concentra-tions of glucose, induced cells in the two experimental groups produced insulin in the supernatant and C-peptide in the cell extract However, the insulin and C-peptide concentrations expressed by cells

in the combinatorial group were higher than those for cells in the inducer group (Fig 5G) With 5 mM glucose, insulin was recorded as 6.76771.747μg/L in the combinatorial group as compared with 2.971.217μg/L in the inducer group and 0.46770.252μg/L in the control group Similarly, the C-peptide concentration reached 30.533711.804 ng/L in the combinatorial group as compared with 12.03373.424 ng/L in the inducer group and 0 ng/L in the control group With 25 mM glucose, the induced cells produced significantly higher amounts of insulin and C-peptide; for example, in the combinatorial group, cells produced 13.8071.389μg/L insulin and 55.900711.758 ng/L C-peptide in 25 mM glucose as compared with

Fig 3 Changes in cell shape and gene expression during differentiation Cells in both inducer (chemical induction only) (B) and combinatorial (Pdx-1 mRNA transfection and chemical induction) (E) groups formed cell clusters after 7 days of induction as compared with cells at Day 0 ((A) and (D), respectively in chemical induction and combinatorial group) These cell clusters were more condensed after 21 days and formed structures that resembled islets ((C) and (F), respectively in chemical induction and combinatorial group) Some of the genes related to beta cells were expressed after 7 days (G), 14 days (H) and 21 days (I) in both experimental groups as compared with the control.

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6.76771.747μg/L and 30.533711.804 ng/L in 5 mM glucose In the

inducer group, cells also increased the amount of insulin and

C-peptide at 25 mM glucose, with 6.56772.723μg/L insulin and

20.56776.100 ng/L C-peptide However, the concentration of insulin

in the supernatant of the control sample was not significantly

affected by glucose (0.43370.153μg/L), and the cells in this group

also showed a complete absence of C-peptide production (Fig 5G

and H)

4 Discussion

An improvement in the differentiation efficiency of UCB-MSCs

into IPCs is an important step if UCB-MSCs are to be used for the

treatment of diabetic mellitus in the clinical setting Most of the

current methods use chemical induction to cause IPC

differentia-tion but with limited success Although previous studies have

successfully reprogrammed UCB-MSCs into pancreatic endocrine

lineage cells, the results held other limitations, including the use of

virus transfection vectors to induce Pdx-1 expression Numerous

previous reports have successfully reprogrammed pluripotent

stem cells using mRNA transfection Thus, we took advantage of

this knowledge to induce UCB-MSC differentiation into IPCs in

combination with chemicals

In thefirst step, we successfully isolated UCB-MSCs that complied

with the suggested guidelines for MSC identification (Dominici et al.,

2006) These cells were positive for CD44, CD73, and CD90 markers

and negative for CD14, CD34, CD45 and HLA-DR, similar to previous

studies (Lee et al., 2004a, 2004b) These cells also were successfully

differentiated into adipocytes, osteoblasts, and chondrocytes and

thus determined to be MSCs for the subsequent experiments

We next applied PDX-1 mRNA transfection system to improve

differentiation of MSCs into IPCs in combination with traditional

inducers such as nicotinamide, among others Pdx-1, also known as

insulin promoter factor 1, is a transcription factor for pancreatic

development and beta cell maturation PDX-1 has been used

previously as a reprogramming factor to trigger the differentiation

of MSCs from various sources– bone marrow (Guo et al., 2012; Li

et al., 2007; Limbert et al., 2011; Sun et al., 2006; Zaldumbide et al.,

2012), UCB (He et al., 2011; Wang et al., 2011), and adipose tissue

(Boroujeni and Aleyasin, 2013) – into endocrine pancreatic cells

Pdx-1 was thus confirmed as an important factor for MSC

differ-entiation However, in most of the previous studies, Pdx1 is delivered

to the target cells via virus-based vectors, such as adenoviruses (Guo

et al., 2012; He et al., 2011; Li et al., 2007; Zaldumbide et al., 2012) or

retroviruses (Boroujeni and Aleyasin, 2013; Limbert et al., 2011;

Rahmati et al., 2013; Talebi et al., 2012) These viral vectors hold

some inherent risks such as insertional mutagenesis and/or vector mobilization following viral infection (Dave et al., 2009; Hacein-Bey-Abina et al., 2008; Howe et al., 2008), which limit their use in the clinical setting The recent study byBoroujeni and Aleyasin (2013) used a non-integrated lentiviral vector carrying Pdx-1 to induce the adipose derived stem cells (ADSCs) into IPCs, which provided a new safe method for transient transfection However, the procedure for using a non-integrated lentiviral vector is complex, difficult and time consuming

RNA-based reprogramming tools are considered to better instigate cellular reprogramming for clinical applications (Bernal,

2013) mRNA is one of best RNA-based tools that has been proven

to be safe, particularly in terms of its lack of immunogenicity (Bernal, 2013) Moreover, mRNA transfection can be used to

efficiently reprogram some cells Indeed, some authors have successfully activated the pluripotency of fibroblasts by mRNA (Mandal and Rossi, 2013; Plews et al., 2010; Tavernier et al., 2012; Warren et al., 2010) In an earlier study, Wiehe et al (2007) demonstrated that mRNA could efficiently promote protein expression of DeltaLNGFR in human hematopoietic stem cells and MSCs by nucleofection with DeltaLNGFR mRNA (Wiehe

et al., 2007) Immature dendritic cells (DCs) can also be forced to mature into antigen-presenting cells by electroporation of mRNAs encoding a tumor antigen, CD40 ligand, CD70 and constitutively active (caTLR4) (Van Nuffel et al., 2010) In this way, DC vaccines are used safely in cancer treatment, for instance, to induce antigen-specific T-cell responses in melanoma patients (Aarntzen

et al., 2012; Bonehill et al., 2009; Van Nuffel et al., 2012; Wilgenhof

et al., 2011), ovarian carcinoma and carcinosarcoma patients and (Coosemans et al., 2013), leukemia patients (Overes et al.,

2009) mRNA has also been used to re-direct stem cell fate In a recent study, the authors directly injected VEGF mRNA into a myocardial site, and found a marked improvement in heart function because of the mobilization of epicardial progenitor cells and their redirection toward to cardiovascular cells (Zangi et al.,

2013) Lui et al (2013)were also able to drive the multipotent Isl1þ heart progenitors into endothelial cells by VEGF mRNA (Lui

et al., 2013)

Thus, it is with this supportive literature that we chose to use the mRNA-based tool to express the transcription factor PDX-1 in UCB-MSCs in this study Because the transgenic system is based on mRNA, this technique is a safe approach for generating clinically relevant IPCs We were uncertain, however, whether PDX-1 mRNA would be able to cross the phospholipid membrane to the cyto-plasm Indeed, ourfindings indicate that PDX-1 mRNA can cross the membrane, even though the ratio of PDX-1-positive cells detected

byflow cytometry and immunocytochemistry were low Taking into

Fig 4 Insulin synthesis from islet-like cell clusters after differentiation Cell clusters were positive with anti-insulin monoclonal antibody (FITC, green) Cells in the cell cluster expressed insulin in both combinatorial (Pdx-1 mRNA transfection and chemical induction) ((A)–(E)) and inducer (chemical induction only) ((F)–(K)) groups, whereas cells outside the islets were negative for insulin Cells were counterstained with Hoechst 33342 (blue color) (Magnification: 100  ) (For interpretation of the references to color in this figure legend, the reader is referred to the web version of this article.)

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consideration that different mRNAs have different capacities to

cross the cell membrane, we believe that a higher number of cells

received the mRNA than expressed the protein, with only some cells

receiving sufficient PDX-1 mRNA to express PDX-1 protein in high

enough concentrations for detection by the naked eye as compared

withflow cytometry and immunocytochemistry Indeed, all tools

that are not based on DNA integration can only be effective when

proteins are translated These proteins are active components that

trigger cell fate, and our findings show that PDX-1 expression triggering the differentiation of UCB-MSCs into endocrine pancrea-tic cells Pdx-1 has been shown to regulate a number of important genes that dictate pancreas formation and differentiation as well as beta cell function: insulin (Ohlsson et al., 1993), glucose transporter

2 (Glut2) (Waeber et al., 1996), glucokinase (Watada et al., 1996) and islet amyloid polypeptide (Bretherton-Watt et al., 1996; Carty et al., 1997; Serup et al., 1996)

Fig 5 Differentiated cell cultures contained insulin-positive cell populations and exhibited glucose-dependent responses Flow cytometry showed that the percentage

of insulin-positive cells in the combinatorial (Pdx-1 mRNA transfection and chemical induction) group ((E) and (F)) was higher than that in the inducer (chemical induction only) group ((C) and (D)) There were 0% insulin-positive cells in the control group ((A) and (B)) Concentrations of insulin (from supernatant) and C-peptide (from cell extract) in the combinatorial group were higher than those in the inducer group with both 5 mM and 25 mM glucose (G).

Trang 8

We showed that the combinatorial group was able to signi

fi-cantly increase the expression of genes related to beta cells over

cells subjected to chemical induction alone, demonstrating the

utility of PDX-1 mRNA transfection The results illustrate that

although the chemical inducers have a positive effect on

pancrea-tic differentiation, the active expression of PDX-1 helps to facilitate

and accelerate this process The results from the gene analysis

showed that PDX-1 expression initiated this process In the control

group, UCB-MSCs expressed extremely low levels of PDX-1 and

thus were unable to differentiate into IPCs In contrast, UCB-MSCs

expressed Pdx-1 mRNA at the transcriptional level in both

experi-mental groups By quantitative analysis, PDX-1 mRNA expression

in the combinatorial group was higher than the endogenous

expression of PDX-1 identified in cells in the inducer group This

difference in the expression level of PDX-1 between these two

groups subsequently caused a difference in the gene expression

levels of Ngn3, Nkx6.1, and insulin In addition, the difference in

insulin transcription because of these levels of PDX-1 affected the

C-peptide concentration These results were similar to those of

another previously published study (Yuan et al., 2012).Yuan et al

(2012)showed that the expression of Pdx-1 correlated with the

level of insulin at both the transcriptional and translational levels

(Yuan et al., 2012) Our results from the analysis of insulin-positive

cells after 21 days of induction also indicated that the percentage

of insulin-positive cells (8.372.5%) was higher than cultures

subjected to chemical induction only Thisfinding was similar to

that reported for human embryonic stem cell differentiation into

IPCs (Jiang et al., 2007) Interestingly, our insulin production levels

were higher than those achieved by transfecting bone

marrow-derived mesenchymal stem cells with plasmid vectors containing

Pdx-1 and Betacellulin, with only5% insulin-positive cells in that

study (Li et al., 2008); this was similar to the transduction of PDX-1

in UCB-MSCs with an adenovirus vector (11.6174.83%

insulin-positive cells) (Wang et al., 2011) However, all of these results,

including our own study, showed a lower expression of insulin as

compared with PDX-1 transduction by lentiviral vector (28.23%

insulin-positive cells) (Sun et al., 2006)

Although we also detected some insulin in the control group,

we did not detect C-peptide in this group It is thus possible that

the insulin detected in this group could be from cross-reaction

between bovine insulin in the FBS This study showed that PDX-1

mRNA transfection could not only increase the percentage of IPCs

but also produce functional IPCs IPCs in both experimental groups

could produce insulin in a glucose-dependent manner Thus,

PDX-1 mRNA transfection increased the differentiation efficiency

with-out interfering with the normal pancreatic differentiation process

However, the level of C-peptide as well as insulin produced from

IPCs had not been compared to them in islets of Langerhans

Another limitation was insulin production of IPCs had not been

evaluated for a long time Quality of IPCs needs to be evaluated

before they can be used in preclinical and clinical trials

5 Conclusions

The establishment of an efficient and safe protocol for

UCB-MSC differentiation into IPCs is a crucial step for the utility of UCB-MSCs

in the treatment of clinical diabetes mellitus This study showed

that PDX-1 mRNA transfection in combination with chemical

inducers is a safe and efficient method to improve UCB-MSC

differentiation into IPCs PDX-1 mRNA transfection significantly

increased the percentage of IPCs in the differentiated cell

popula-tion as compared with the use of chemical inducpopula-tion alone These

differentiated cells strongly expressed some of the genes related to

beta cell function and produced insulin and C-peptide in a

glucose-dependent manner These results provide a new method for the potential clinical application of IPCs from UCB-MSCs

Authors’ contributions PVP carried out studies including primary culture of MSCs, MSC transfection, flow cytometry analysis, gene analysis PTMN and ATQN collected umbilical cord blood; prepared and isolation of plasmid containing Pdx-1 gene; PCR product purification VMP, ANTB, LTTD, KGN take care MSCs before and after transfection, ELISA analysis, PCR preparation NKP revised the manuscript, spelling and grammaticalfixation

Competing interests The authors declare that they have no competing interests

Acknowledgements This work was funded by grants from Vietnam National Uni-versity, Ho Chi Minh city, Vietnam (B2010-18-02TD), and Ministry

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