Adrenal cortical cell transplantation

Future directions for adrenal insufficiency: cellular transplantation and genetic therapies

Primary adrenal insufficiency occurs in 1 in 5-7000 adults. Leading aetiologies are autoimmune adrenalitis in adults and congenital adrenal hyperplasia (CAH) in children. Oral replacement of cortisol is lifesaving, but poor quality of life, repeated adrenal crises and dosing uncertainty related to lack of a validated biomarker for glucocorticoid sufficiency, persists. Adrenocortical cell therapy and gene therapy may obviate many of the shortcomings of adrenal hormone replacement. Physiological cortisol secretion regulated by pituitary adrenocorticotropin, could be achieved through allogeneic adrenocortical cell transplantation, production of adrenal-like steroidogenic cells from either stem cells or lineage conversion of differentiated cells, or for CAH, gene therapy to replace or repair a defective gene. The adrenal cortex is a high turnover organ and thus failure to incorporate progenitor cells within a transplant will ultimately result in graft exhaustion. Identification of adrenocortical progenitor cells is equally important in gene therapy where new genetic material must be specifically integrated into the genome of progenitors to ensure a durable effect. Delivery of gene editing machinery and a donor template, allowing targeted correction of the 21-hydroxylase gene, has the potential to achieve this. This review describes advances in adrenal cell transplants and gene therapy that may allow physiological cortisol production for children and adults with primary adrenal insufficiency.

[Gene and cell therapy of adrenal pathology: achievements and prospects]

Our current understanding of the molecular and cellular mechanisms in tissues and organs during normal and pathological conditions opens up substantial prospects for the development of novel approaches to treatment of various diseases. For instance, lifelong replacement therapy is no longer mandatory for the management of some monogenic hereditary diseases. Genome editing techniques that have emerged in the last decade are being actively investigated as tools for correcting mutations in affected organs. Furthermore, new protocols for obtaining various types of human and animal cells and cellular systems are evolving, increasingly reflecting the real structures in vivo. These methods, together with the accompanying gene and cell therapy, are being actively developed and several approaches are already undergoing clinical trials. Adrenal insufficiency caused by a variety of factors can potentially be the target of such therapeutic strategies. The adrenal gland is a highly organized organ, with multiple structural components interacting with each other via a complex network of endocrine and paracrine signals. This review summarizes the findings of studies in the field of structural organization and functioning of the adrenal gland at the molecular level, as well as the modern approaches to the treatment of adrenal pathologies.

Towards novel treatments for adrenal diseases: Cell- and gene therapy-based approaches

Adrenal insufficiency, the inability to produce adequate levels of corticosteroids, is a multi-causal disease that requires lifelong daily hormone replacement. Nevertheless, this cannot replace the physiological demand for steroids which are secreted following a circadian rhythm and vary in periods of stress; the consequences of under- or over-replacement include adrenal crisis and metabolic disturbances, respectively. Although clinical research has focused on enhancing the effectiveness/reducing side effects of current treatment modalities, only small improvements are deemed possible; thus, alternative solutions are urgently needed. Gene and cell therapy strategies have opened new possibilities for the cure of many diseases in a way that has never been possible before and could offer a viable option for the cure of adrenal diseases. The current state of cell- and gene-based approaches to restore adrenocortical function is discussed in this review.

In Vivo Verification of the Pathophysiology of Lipoid Congenital Adrenal Hyperplasia in the Adrenal Cortex

A two-hit hypothesis has been proposed to describe the pathophysiology of lipoid congenital adrenal hyperplasia. In previous studies using conventional steroidogenic acute regulatory protein (Star) gene knockout (KO) mice, adrenocortical lipid accumulation was already prominent at birth. Thus, the two-hit hypothesis was verified in the gonads of Star KO mice but not in the adrenal cortices. We generated time-dependent conditional Star KO mice induced by tamoxifen (TAM) injections and analyzed the adrenal cortices of the mice histologically and endocrinologically before, 24 hours after, and 8 weeks after TAM. We performed RNA sequencing analyses of the adrenal glands before and 8 weeks after TAM and histologically analyzed autologous adrenal cortices of TAM-induced Star KO mice with transplantation of wild-type adrenal gland. Lipid accumulation was scattered 24 hours after TAM and was prominent 8 weeks after TAM. Steroidogenic capacity decreased sequentially after TAM. Gene expression related to steroid biosynthesis significantly decreased 8 weeks after TAM compared with that before TAM. TAM-induced Star KO mice with adrenal transplantation showed normal ACTH levels and mild lipid accumulation. These results showed that the steroidogenic capacity decreased without histological change (the first hit) and declined with histological change (the second hit). Thus, we visualized the two-hit hypothesis in the adrenal cortex. The key feature of the secondary decline of steroidogenic capacity might be the decreased gene expression related to steroid biosynthesis after lipid accumulation exacerbated by ACTH hypersecretion.

Label-free enrichment of adrenal cortical progenitor cells using inertial microfluidics

Passive and label-free isolation of viable target cells based on intrinsic biophysical cellular properties would allow for cost savings in applications where molecular biomarkers are known as well as potentially enable the separation of cells with little-to-no known molecular biomarkers. We have demonstrated the purification of adrenal cortical progenitor cells from digestions of murine adrenal glands utilizing hydrodynamic inertial lift forces that single cells and multicellular clusters differentially experience as they flow through a microchannel. Fluorescence staining, along with gene expression measurements, confirmed that populations of cells collected in different outlets were distinct from one another. Furthermore, primary murine cells processed through the device remained highly viable and could be cultured for 10 days in vitro. The proposed target cell isolation technique can provide a practical means to collect significant quantities of viable intact cells required to translate stem cell biology to regenerative medicine in a simple label-free manner.

Outcome of adrenal tissue fragments allotransplantation: the impact of cryopreservation

Cryopreservation is thought to have the potential to preserve tissue for transplantation. In addition, it can also be used for decreasing tissue immunogenicity, which might be important for prolonging allograft survival. In the present study we examined the impact of cryopreservation at various cooling rates on the outcome of allotransplantation of murine adrenal tissue fragments (ATFr). ATFr were cryopreserved with a cooling rate at 1; 10; 40 and more than 100 °C/min. After thawing it was found that the number of the cells expressing markers of dendritic cells (CD11c) and macrophages (CD11b) in the suspension obtained from ATFr decreased with increasing cooling rate. After allotransplantation the survival rates of adrenalectomized mice and the blood serum levels of corticosterone were higher in recipients of cryopreserved ATFr. By immunohistochemistry, cryopreserved allografts displayed a decreased infiltration by CD4+ and CD8+ T-lymphocytes as compared to fresh grafts. These findings suggest that cryopreserved allografts cause a less severe rejection by decreasing graft immunogenicity.

Moving toward personalized cell-based interventions for adrenal cortical disorders: part 2--Human diseases and tissue engineering

Transdifferentiation of an individual's own cells into functional differentiated cells to replace an organ's lost function would be a personalized approach to therapeutics. In this two part series, we will describe the progress toward establishing functional transdifferentiated adrenal cortical cells. In this article (Part 2), we describe the disorders of the adrenal cortex, therefore establishing why there is the need for personalized cell-based therapy for individuals with these disorders. We then present our pilot studies of cell transdifferentiation toward an adrenal cortical fate using genes described in the first article of this pair (Part 1).

Adrenocortical cell transplantation reverses a murine model of adrenal failure

PURPOSE

Although adrenal insufficiency can be managed with steroid replacement, transplantation of adrenocortical cells may represent a more definitive therapy.

METHODS

An adrenal failure model was created by adding stress to mice that underwent staged bilateral adrenalectomy. Murine adrenocortical cells were seeded onto collagen sponges. The grafts were implanted under the renal capsule during the first adrenalectomy. Some mice had an additional graft placed next to the kidney. A contralateral adrenalectomy and a laparotomy were performed 1 week after the first adrenalectomy. Two weeks later, blood was collected for corticosterone measurement; and implants were retrieved for adrenal-specific messenger RNA analysis and histology. Mice that underwent the same procedures but received a graft without cells served as controls.

RESULTS

Control group mortality was 100%. Mice that had only one cell-seeded implant had 42% survival, whereas mice that had 2 cell-seeded implants had 100% survival. Retrieved implants demonstrated viable cells and expression of adrenocortical genes. The plasma corticosterone concentration in animals that survived was similar to that in normal mice.

CONCLUSION

Cells transplantation restored the adrenocortical function in these mice. Further optimization of this technique could bring a curative therapy to patients with adrenal insufficiency.

Adrenal extracellular matrix scaffolds support adrenocortical cell proliferation and function in vitro

Transplantation of functional adrenal cortex cells could reduce morbidity and increase the quality of life of patients with adrenal insufficiency. Our aim was to determine whether adrenal extracellular matrix (ECM) scaffolds promote adrenocortical cell endocrine function and proliferation in vitro. We seeded decellularized porcine adrenal ECM with primary human fetal adrenocortical (HFA) cells. Adrenocortical function was quantified by cortisol secretion of HFA-ECM constructs after stimulation with adrenocorticotropic hormone. Proliferation was assessed by adenosine triphosphate assay. HFA-ECM construct morphology was evaluated by immunofluorescence microscopy and scanning electron microscopy. Adrenal HFA-ECM constructs coated with laminin were compared to uncoated constructs. Laminin coating did not significantly affect HFA morphology, proliferation, or function. We demonstrated HFA cell attachment to adrenal ECM scaffolds. Cortisol production and HFA cell proliferation were significantly increased in HFA-ECM constructs compared to controls (p < 0.05), and cortisol secretion rate per cell is comparable to that of human adult and fetal explants. We conclude that adrenal ECM supports endocrine function and proliferation of adrenocortical cells in vitro. Adrenal ECM scaffolds may form the basis for biocompatible tissue-engineered adrenal replacements.

Basic fibroblast growth factor delivery enhances adrenal cortical cellular regeneration

The effective delivery of angiogenic factors is a useful strategy for the engineering of vascularized tissues. When adrenal cortical cells were implanted in mice under the renal capsule, the size of the implant was reduced to about 100 microm in thickness after 8 weeks. Either low (approximately 2 microg) levels of basic fibroblast growth factor (bFGF) or high (approximately12 microg) levels of bFGF were encapsulated into poly-lactic-co-glycolic acid microspheres, and these bFGF-encapsulated microspheres were coimplanted with adrenal cortical cells. After 56 days, the implants with low and high levels of bFGF weighed five and eight times more, respectively, than the implants without bFGF delivery. The implants with bFGF-encapsulated microspheres also contained significantly more cells than the implants without bFGF delivery. The levels of adrenal cortical gene expression were not significantly changed with bFGF delivery. The implants with high levels of bFGF also had a more uniform distribution of anti-CD31 immunofluorescence. Based on the increased number of cells that expressed adrenal cortical genes, the delivery of bFGF enhanced adrenal cortical cellular regeneration, possibly through an angiogenic response.

Transplantation of adrenal cortical progenitor cells enriched by Nile red

BACKGROUND

The adrenal cortex may contain progenitor cells useful for tissue regeneration. Currently there are no established methods to isolate these cells.

MATERIAL AND METHODS

Murine adrenal cells were sorted into a Nile-red-bright (NR(bright)) and a Nile-red-dim (NR(dim)) population of cells according to their degree of cholesterol content revealed by Nile red fluorescence. The cells were transplanted under the renal capsule to determine their ability for regeneration.

RESULTS

The NR(bright) cells contained an abundance of lipid droplets, whereas the NR(dim) cells contained little. The NR(bright) cells expressed Sf1 and the more differentiated adrenal cortical genes, including Cyp11a1, Cyp11b1, and Cyp11b2, whereas the NR(dim) cells expressed Sf1 but not the more differentiated adrenal cortical genes. After 56 d of implantation in unilateral adrenalectomized mice, the NR(dim) cells expressed Sf1 and the more differentiated adrenal cortical genes, whereas the NR(bright) cells ceased to express Sf1 as well as the more differentiated adrenal cortical genes. NR(dim) cells also proliferated in the presence of basic fibroblast growth factor.

CONCLUSIONS

The population of NR(dim) cells contained adrenal cortical progenitor cells that can proliferate and give rise to differentiated daughter cells. These cells may be useful for adrenal cortical regeneration.

Increased expression of insulin-like growth factor in intestinal lengthening by mechanical force in rats

INTRODUCTION

A segment of the jejunum could double its length by the application of an axial mechanical force. We hypothesize that this growth is correlated with an increased expression of insulin-like growth factor (IGF-I) in the jejunum.

METHODS

Adult Sprague-Dawley rats underwent the isolation of a 1.5-cm segment of the jejunum. The isolated jejunal segment was either lengthened using mechanical force or left alone for 3 weeks. The jejunal segments were analyzed by quantitative polymerase chain reaction and immunofluorescence for the expression of IGF-I.

RESULTS

Whereas jejunal segments that underwent isolation alone did not change their length, isolated jejunal segments that were stretched by applying a gradual mechanical force doubled their initial length. Both groups increased their muscular thickness 5 folds as compared to the normal jejunum. The mRNA level of IGF-I in the lengthened jejunum was 6 folds higher than that in the normal jejunum, but the IGF-I mRNA level in the isolated jejunum without mechanical lengthening was unchanged. By immunofluorescence, the increased IGF-I expression in the lengthened jejunum was localized to the intestinal smooth muscle cells.

CONCLUSIONS

Insulin-like growth factor I may be an important signal induced by the applied axial force that mediates longitudinal intestinal growth.

Serum-free cultures of murine adrenal cortical cells

PURPOSE

The feasibility of culturing murine adrenal cortical cells before transplantation was investigated in this study.

METHOD

Primary murine adrenal cortical cells were maintained in either fetal bovine and horse sera-containing media or serum-free media. Real-time polymerase chain reaction was used to quantify the levels of adrenal cortical gene expression in the cultured cells.

RESULTS

The use of sera-containing media led to the growth of many cells in the culture, but the expression of Sf-1, Dax-1, and Cyp11b1 in such cultures declined rapidly. In contrast, there was no significant cell growth in the serum-free culture medium. Culturing murine adrenal cortical cells in the serum-free medium resulted in higher levels of Sf-1, Dax-1, and Cyp11b1 gene expression. In the serum-free medium, adrenal cortical cells also responded to adrenocorticotropic hormone by increasing the expression of Cyp11b1 and suppressing the expression of Dax-1 in a dose-dependent manner. The addition of basic fibroblast growth factor to the serum-free medium maintained the expression of Sf-1, Dax-1, and Cyp11b1 for 4 weeks.

CONCLUSION

Adrenal cortical cells isolated from adult mice were successfully maintained in a serum-free culture medium with basic fibroblast growth factor. This culture system may be suitable for further manipulation of adrenal cortical cells in vitro before transplantation.