Tendon regeneration is difficult because detailed knowledge about tendon progenitor cells (TPCs), which produce tenocytes to repair tendon tissue, has not been revealed. Mohawk homeobox (MKX) is a marker of TPCs or tenocytes, but a human pluripotent stem cell (hPSC)-based reporter system that visualizes MKX+ cells has not been developed. Here, we established an hPSC-derived MKX-tdTomato reporter cell line and tested the induction ratio of MKX-tdTomato+ cells using our stepwise/xeno-free differentiation protocol. MKX-tdTomato+ cells were generated with high efficiency and expressed tendon-specific markers, including MKX, SCX, TNMD, and COL1A1. Our MKX-tdTomato hPSC line would be a useful tool for studying the development or regeneration of tendon tissue.
Keywords: Tendon; Human pluripotent stem cells; Tenocytes; Tendon regeneration
Yuki Fujisawa and Lu Ming contributed equally to this work
Tendons are fibrous connective structures composed of collagen fibers that connect muscles to bones. Tendons are easily damaged by injury, overuse, or age-related degeneration, and tendinopathy is common and hard to recover from due to the poor regenerative potential of tendons [[
During embryogenesis, paraxial mesoderm is considered to differentiate into several cell types, including skeletal muscle cells, chondrocytes, osteocytes, dermal fibroblasts, and tenocytes [[
Mohawk homeobox (MKX) is an essential transcription factor that is persistently expressed during tendon development and plays a crucial role in tendon maturation and maintenance [[
Human ESC cell line SEES4 (donated by RIKEN BRC. Japan) was cultured and maintained using StemFit (AK02N, Ajinomoto). Before reaching subconfluency, the cells were dissociated with TrypLE Select (Thermo Fisher)/0.25 mM EDTA and suspended in StemFit containing 10 µM Y-27632. The cells (1 × 10
Table 1 Oligos for PX459-MKX gRNA
Purpose Name Sequence MKX 3'UTR knock-in hMKX-CRPs2 caccGGCTAATAAGCATATGGCGT hMKX-CRPa2 aaacACGCCATATGCTTATTAGCC
Figure 1A depicts the targeting strategy for the knock-in of the IRRS-tdTomato-PGK-Neo cassette at the MKX 3' untranslated region (UTR) to achieve MKX and tdTomato coexpression. To construct the targeting vector (pEXA2J2-hMKX HA-IRES-tdTomato-PGK-Neo), primers listed in Table 2. were used and IRES-tdTomato-PGK-Neo fragments were inserted into the pEXA2J2-hMKX homology arm (pEXA2J2-hMKX HA; artificially synthesized by Eurofins) using an In-Fusion HD cloning kit (Takara).
Graph: Fig. 1 Establishment of a MKX-tdTomato reporter hPSC line. a The targeting cassette of the MKX-tdTomato knock-in allele. PAM sequence (CCA) is highlighted in red. b Generation of the MKX-tdTomato reporter hPSC line. The targeting and gRNA-Cas9 expression vector were electroporated into the hESC line SEES4. After selection with G418, single colonies were selected, expanded, and screened to identify the integration of the knock-in reporter cassette. c. Agarose gel electrophoresis of PCR products using forward and reverse primers that recognize sequences outside the targeting cassette. Genomic DNAs were purified from SEES4 wild type and MKX-tdTomato reporter hPSCs. WT, wild type allele; KI, knock-in allele. Full-length blot is presented in Additional file 1: Fig. S1
Table 2 Oligos for pEXA2J2-3´MKX HA-IRES-tdTomato-PGK-Neo
Purpose Name Sequence MKX 3'UTR Homology arm F1_FW for MKX HA CCTCAAAATGCCAACGGTACCGAGCTCGGATCC F1_RV for MKX HA TAATAAGCATATGGCGGTCTAGACTCGAGGCGG IRES-tdTomato-PGKNeo (In-fusion) 15 bp + IresTomato_PX459 GTTCCTCCTCCCTCTGGTACCGAGCTCGGATCCGCCCC IresTomato + 15bp_ PX459 TGGTGGTGGTATCCCGGTCTAGACTCGAGGCGGCCGC pEXA2J2- 3'MKX HA (In-fusion) Vec_FW for MKX HA GCCATATGCTTATTAGCCTG Vec_RV for MKX HA GTTGGCATTTTGAGGCATAGC
Guide RNAs (gRNA) were designed to target the protospacer adjacent motif (PAM) sequence-located MKX locus (CCAACGCCATATGCTTATTAGCC; the PAM sequence is indicated in bold font). The number of potential target sites in the human genome are 1 site (20 mer + PAM), 1 site (12 mer + PAM) and 389 sites (8 mer + PAM). gRNA oligos (Table 1) were designed and subcloned into the PX459 vector (Addgene, #62988) harboring a Cas9 expression cassette (PX459-MKX gRNA). To generate the MKX-tdTomato reporter line, 1 × 10
Table 3 Genotyping primers for MKX-tdTomato reporter
Purpose Name Sequence Knock-in check(WT: 2130 bp, KI: 3037 bp) MKXreporter_OUT(F) CCCTGACATTGTGGGAGGTC MKXreporter_OUT(R) ACTGGCTGCACTATTGACCC Cloning primers for 5′ boundary out-F(1) TGCAATTACAGAAACCCACCA ires-R(1) CACACCGGCCTTATTCCAAG Cloning primers for 3′ boundary PGK-F(2) CCAGACTGCCTTGGGAAAAG out-R(2) ACCAGAGCTCAGGCTCCAAA
The hPSCs suspension (3 × 10
Cultured cells were washed with PBS, fixed with 4% paraformaldehyde (PFA) for 20 min at room temperature, and incubated with blocking solution (3% normal goat serum and 0.1% Triton X-100 in PBS) for 1 h at room temperature. Next, the cells were incubated with primary antibodies (1:200 dilution) at 4 ˚C overnight. The secondary antibodies (1:500 dilution) were subsequently added to the cells for 1 h at room temperature. After incubation, 0.1 µg/ml DAPI (Thermo Fisher) in PBS was used to counterstain the nuclei. The samples were then observed using a BZ-X710 fluorescence microscope (Keyence). The antibodies used are listed in Table 4.
Table 4 Antibodies used for immunocytochemistry
Name Company Catalog Number Clone Dilution SOX2 Cell Signaling Technology 4900 L1D6A2 1:200 CDX2 Cell Signaling Technology 12306 D11D10 1:200 SOX9 MERK AB5535 1:200 MKX Atlas antibodies A83377 1:200 anti-rabbit Alexa Fluor 488 Fab2 Cell Signaling Technology 4412 1:200 anti-rabbit Alexa Fluor 647 Fab2 Cell Signaling Technology 4414 1:200 anti-mouse Alexa Fluor 647 Fab2 Cell Signaling Technology 4410 1:200
RNA was extracted using an RNeasy kit (Qiagen), and complementary DNA was synthesized using M-MLV reverse transcriptase (Thermo Fisher) and random primers (Thermo Fisher). The expression of specific genes was analyzed by qPCR using an ArialMX real-time PCR system (Agilent). The cycle parameters include denaturation at 95 °C for 30 s, annealing at 62 °C for 30 s, and elongation at 72 ˚C for 30 s. The mRNA expression levels of each gene were normalized to β -Actin (ACTB) and quantified using the 2
Table 5 qRT-PCR primers
Gene Forward primer sequence Reverse primer sequence AGAAAATCTGGCACCACACC AGAGGCGTACAGGGATAGCA GGGCTCTCTGAGAGGCAGGT CCTTTGCTCTGCGGTTCTG AAGCTCTGGAGACTTCTGAACGA CGCCTTGAAGATGGCGTTGG CTCGCAGATGACGCTAGTGC TGGCTGTCGAACGGTATTCTT GAGAAAGTTGAGCAAGGACCG CCAGCTCAGGTCCAAGGTG TGGCCGGAGGTACCCAAAAA AAGTAGATGCCAGTGTATCCGTTT GACTGGTGAGACCTGCGTGT GCCGCCATACTCGAACTGGA CTGTTCCTGGGGCATGGCA CGGCCATGTTGTTGTCCTCG AGATTATATCAGGTTGTACGGGATCA ACACAGCGGAAACACTCGAT CCCACAACACAACCTACAGC GCGAGACTGACGCCTATGTA TGCTAGAGCAGCCCTCACTC TGGGTTTGGAGCAGTGGAACTTA
Dissociated cells were suspended in 100 μl of 2% FBS/PBS containing 10 ng/ml DAPI. Furthermore, tdTomato expression was detected and analyzed using a CytoFLEX S flow cytometer (Beckman Coulter) and FlowJo software (FlowJo LLC), respectively.
To visualize MKX
To test the differentiation capacity of our MKX-tdTomato reporter hPSCs, we performed stepwise differentiation to induce SCL that generates syndetome (SYN) or tendon progenitor cells (TPCs). During mesoderm development, pluripotent epiblast cells differentiate into the primitive streak and paraxial mesoderm (PM), subsequently producing somites. Somites are divided into two compartments, namely dermomyotome dorsally and SCL/TPCs ventrally [[
Graph: Fig. 2 Directed differentiation of hPSCs toward PM and SCL. a Schematic representation of sclerotome (SCL) induction and differentiation protocol mimicking embryonic development. hPSCs were differentiated toward paraxial mesoderm (PM), somites (SM), and SCL. b The expression of markers for pluripotency (SOX2), PM (CDX2), and SCL (SOX9) in wild type (upper) and MKX-tdTomato reporter (lower) cells was assessed by immunocytochemistry. The nuclei were costained with DAPI. c qRT-PCR analysis of each marker gene on day 0, 1, 2, 3, and 5. Total RNA was extracted at each indicated time point from wild type (white column) or MKX-tdTomato reporter (gray column)-derived cells. All expression values are normalized to those of ACTB mRNA (n = 3, three independent experiments).
FGF8 signaling is required for SYN differentiation in the early phase, and BMP and TGFβ signaling pathways are involved in the development and maintenance of tendons and ligaments [[
Graph: Fig. 3 Induction of MKX+ tenocytes from hPSCs. a Schematic representation of the tenogenic differentiation protocol. hPSCs were differentiated toward PM, SM, SCL, and subsequently into tenocytes derived from syndetome (SYN), a precursor of tendon progenitor cells. b Morphological characteristics and MKX-tdTomato expression of wild type (upper) and MKX-tdTomato reporter (lower) cells after 26 days of tenogenic induction. c Flow cytometry of MKX-tdTomato expression of wild type and MKX-tdTomato reporter cells on day 26. d qRT-PCR analysis of tendon-specific markers. Total RNA was extracted on day 0, 1, 2, 3, 5, 8, 11, and 26 from wild type (white column) or MKX-tdTomato reporter (gray column)-derived cells. All expression values are normalized to those of ACTB mRNA (n = 3, three independent experiments). e Immunostaining of MKX in wild type (upper) and MKX-tdTomato reporter (lower)-derived cells on day 26. All MKX-tdTomato reporter cells coexpressed MKX and tdTomato
Herein, we utilized a CRISPR/Cas9-mediated homologous recombination system to establish an hPSC-derived reporter hPSC line that allows us to visualize MKX
The authors thank the National Research Institute for Child Health and Development (Tokyo, Japan) for providing the hESC line SEES4.
YF and LM performed the experiments, analyzed the data, and wrote the manuscript. DY and ToT discussed the data and provided critical advice. TaT supervised the project and wrote the manuscript. All authors read and approved the final manuscript.
This work was mainly supported by Projects for Grants-in-aid for Scientific Research from the Japan Society for the Promotion of Science (Grant No. 21H02643 to TaT) and AMED (Grant No. 18bm0704024h0001 to TaT). However, these funders played no role in the study design, data collection and analysis, publication decision, or manuscript preparation.
All data generated and/or analyzed during this study are included in this published article and its supplementary information.
The Ethics Committee of Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, approved the experimental protocols for studies of human subjects. Written informed consent was provided by each donor.
Not applicable.
The authors declare no competing interests.
Graph: Additional file 1. Supplemental Fig. S1 Full-lenght blot related to Fig. 1c.
• TPCs
- Tendon progenitor cells
• MKX
- Mohawk homeobox
• hPSCs
- Human pluripotent stem cells
• MSCs
- Mesenchymal stem cells
• TSPCs
- Tendon stem/progenitor cells
• iPSCs
- Induced pluripotent stem cells
• ESCs
- Embryonic stem cells
• PSCs
- Pluripotent stem cells
• gRNA
- Guide RNA
• WT
- Wild type
• SCL
- Sclerotome
• SYN
- Syndetome
• PM
- Paraxial mesoderm
• SM
• Somite
• SOX
- Sry-related HMG box
• HMG
- High-mobility group
• TGF
- Transforming growth factor
• BMP
- Bone morphogenetic protein
• SCX
- Scleraxis
• TNMD
- Tenomodulin
• COL
- Collagen
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By Yuki Fujisawa; Lu Ming; Daisuke Yamada; Tomoka Takao and Takeshi Takarada
Reported by Author; Author; Author; Author; Author