Intestinal Subepithelial Myofibroblasts Support in vitro
and in vivo Growth of Human Small Intestinal Epithelium
Nicholas Lahar1, Nan Ye Lei1,2, Jiafang Wang3, Ziyad Jabaji1, Stephaine C. Tung1,3, Vaidehi Joshi2,
Michael Lewis4, Matthias Stelzner1, Martı ´n G. Martı ´n3, James C. Y. Dunn1,2*
1Division of Gastroenterology and Nutrition, Department of Surgery, David Geffen School of Medicine, University of California, Los Angeles, California, United States of
America, 2Division of Gastroenterology and Nutrition, Department of Bioengineering, David Geffen School of Medicine, University of California, Los Angeles, California,
United States of America, 3Division of Gastroenterology and Nutrition, Department of Pediatrics, David Geffen School of Medicine, University of California, Los Angeles,
California, United States of America, 4Department of Pathology, Veterans Affairs Greater Los Angeles Healthcare System, University of California, Los Angeles, California,
United States of America
The intestinal crypt-niche interaction is thought to be essential to the function, maintenance, and proliferation of progenitor
stem cells found at the bases of intestinal crypts. These stem cells are constantly renewing the intestinal epithelium by
sending differentiated cells from the base of the crypts of Lieberku ¨hn to the villus tips where they slough off into the
intestinal lumen. The intestinal niche consists of various cell types, extracellular matrix, and growth factors and surrounds
the intestinal progenitor cells. There have recently been advances in the understanding of the interactions that regulate the
behavior of the intestinal epithelium and there is great interest in methods for isolating and expanding viable intestinal
epithelium. However, there is no method to maintain primary human small intestinal epithelium in culture over a prolonged
period of time. Similarly no method has been published that describes isolation and support of human intestinal epithelium
in an in vivo model. We describe a technique to isolate and maintain human small intestinal epithelium in vitro from surgical
specimens. We also describe a novel method to maintain human intestinal epithelium subcutaneously in a mouse model for
a prolonged period of time. Our methods require various growth factors and the intimate interaction between intestinal
sub-epithelial myofibroblasts (ISEMFs) and the intestinal epithelial cells to support the epithelial in vitro and in vivo growth.
Absence of these myofibroblasts precluded successful maintenance of epithelial cell formation and proliferation beyond
just a few days, even in the presence of supportive growth factors. We believe that the methods described here can be used
to explore the molecular basis of human intestinal stem cell support, maintenance, and growth.
Citation: Lahar N, Lei NY, Wang J, Jabaji Z, Tung SC, et al. (2011) Intestinal Subepithelial Myofibroblasts Support in vitro and in vivo Growth of Human Small
Intestinal Epithelium. PLoS ONE 6(11): e26898. doi:10.1371/journal.pone.0026898
Editor: Dean G. Tang, The University of Texas M.D Anderson Cancer Center, United States of America
Received June 1, 2011; Accepted October 6, 2011; Published November 17, 2011
This is an open-access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for
any lawful purpose. The work is made available under the Creative Commons CC0 public domain dedication.
Funding: This work was supported by grants from the National Institute of Diabetes and Digestive and Kidney Diseases U01 Intestinal Stem Cell Consortium
(DK085535-01 and DK085535-02S2), DK083762, DK083319 and the California Institute for Regenerative Medicine (CIRM) (Grant Number RT2-01985). The contents
of this publication are solely the responsibility of the authors and do not necessarily represent the official views of CIRM or any other agency of the State of
California. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Competing Interests: The authors have declared that no competing interests exist.
* E-mail: firstname.lastname@example.org
The intestinal epithelium is composed of a perpetually dividing
epithelium composed of five primary cell types: the common
absorptive enterocyte, the enteroendocrine cell, the mucous
secreting goblet cell, the tuft cell, and the Paneth cell[1,2]. These
cells are continuously being renewed at the base of the crypts of
Lieberku ¨hn where the intestinal stem cells reside . These
progenitors differentiate on their journey up the crypt to the villus
tip, and these crypt-villus units comprise the functional element of
the intestinal epithelium[1,4].
Intestinal stem cells are of great interest for their potential
clinical applications. Significant advances have recently been
made in the understanding of the intimate interaction between
these stem cells, which are found at the base of intestinal crypts,
and the surrounding milieu[5,6].
Of particular interest among the factors that play a role in the
stem cell niche are the intestinal subepithelial myofibroblasts
(ISEMFs). These cells are located in the lamina propria in close
proximity to the crypt cells. ISEMFs have qualities of both
smooth muscle cells and fibroblasts. They interact via various
conserved intracellular pathways such as Wnt, Bmp, and Notch to
regulate stem cell behavior, likely via both direct contact and
paracrine modalities [2,8,9,10]. However, ISEMFs are not the
only cells that have been shown to have supportive and regulatory
effects upon crypt stem cells. Recently, Paneth cells have been
implicated in the maintenance of intestinal stem cells and likely
interact via pathways similar to ISEMFs. The alternating
pattern of Paneth cell and crypt stem cells at the crypt base speak
to the intimate contact of these cell types, much like that between
the ISEMFs and the crypt stem cells . Indeed, Lgr5+ stem cells
grown in vitro in the presence of Paneth cells were shown to form
intestinal epithelial cell structures in a significantly higher number
than for stem cells cultured alone . Additionally, myofibro-
blasts are just one of a variety of mesenchymal cells found in the
crypt-villus niche. Recent studies show that there are several
different variably smooth muscle actin positive mesenchymal cells
in the lamina propria with a variety of other cell surface markers
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that may also contribute to the functionality of the intestinal
epithelium . Although ISEMFs have been frequently associ-
ated with regulation of intestinal epithelium, clearly multiple
factors and cell types play a role in intestinal stem cell regulation.
ISEMFs likely play other supportive roles; subepithelial myofibro-
blast migration may promote epithelial regrowth and enhance
barrier function during times of injury or stress . Electron
microscopy has demonstrated migration of myofibroblast through
basement membrane pores following the loss of overlying
In this study we demonstrate the ability of both mouse and
human ISEMFs to support the growth, differentiation, and
expansion of human intestinal epithelium from previously isolated
human crypts. We demonstrate that myofibroblasts are required to
maintain human epithelial cells on a long-term basis in a culture
environment. We also demonstrate that mouse myofibroblasts can
maintain human epithelial cell clusters subcutaneously in vivo.
These cultured human epithelial cells exhibit immunohistochem-
ical markers for complete, mature intestinal epithelium.
Evaluation of murine ISEMFs
In order to identify the ISEMFs obtained from C57BL/6 mouse
small intestine, immunofluorescence was used to confirm charac-
teristic specific markers for myofibroblasts. Cells stained positive
for a smooth muscle actin (SMA) and vimentin and negative for
desmin (Fig. 1A). Quantitative real-time PCR was used to examine
the mRNA expression of SMA, vimentin, and desmin (Fig. 1D).
Adult and infant human small intestinal samples were stained and
demonstrated characteristic myofibroblast staining. However, the
SMA staining was not as uniformly strong as that found in the
murine myofibroblasts (Figs. 1B and 1C). Quantitative real-time
PCR of mRNA from human myofibroblasts yielded a similar
pattern of SMA, vimentin, and desmin expression as the murine
Human Intestinal Crypts in vitro with Respect to Time
Human crypts were isolated from small intestinal surgical
samples, suspended in Matrigel and placed into 24-well plates
without a myofibroblast feeder layer (n=16). Intestinal spheroids
were observed until culture day 2 but by day 3 their distinct
epithelial borders broke down and the spheroids rendered non-
viable (Fig 2A). However, when human crypts were placed upon a
murine myofibroblasts feeder layer, the epithelial cells were
sustained for at least 56 days in vitro, maintaining their distinct
borders (n=16). Such cultures were observed on a daily basis
during the first week, and on a weekly basis subsequently. Their
morphology remained essentially that of a simple cyst without
complex structures throughout their growth period (Fig. 2B). Such
cystic structures were observed approximately 80% of the time
when grown on murine myofibroblasts.
Figure 1. Characterization of Mouse and Human Myofibroblasts. (A) C57 BL/6 murine myofibroblasts plated in plastic culture dishes for four
days. Using immunofluorescence, cells stained characteristically for intestinal myofibroblasts with positive SMA and vimentin staining and negative
desmin staining. The blue pseudocolor is DAPI counterstaining for cell nuclei. (B) Myofibroblasts were isolated from adult human ileostomy surgical
samples and plated for four days prior to immunofluorescence staining. Similar to murine myofibroblasts, SMA and vimentin stains were positive
while the desmin stain was negative. (C) Myofibroblasts were isolated from a human infant ileostomy and plated for four days prior to
immunofluorescence staining. Like the adult human sample, SMA was positive but faint. Vimentin stains were positive while the desmin stain was
negative. (D) PCR results performed on the C57 BL/6 murine myofibroblasts consistent with the immunofluorescence results of positive SMA and
vimentin staining and negative desmin staining.
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The effect of growth factors Wnt and FGF on epithelial
development was evaluated using human crypts grown on murine
myofibroblasts. Serial images were obtained of the cultured
intestinal crypts over time for 8 days. Isolated crypts quickly
developed into simple spheroids with well-defined borders (Fig. 2C,
day 1). Over the next day these spheroids filled with debris from
the epithelial lining that was eventually extruded from the lumen
of the enterospheres (Fig. 2C, day 3). Over the next several days
(Fig. 2C, to day 8), there was additional growth of the
enterospheres and their morphology became more complex with
increasing folding of the cyst wall, which will be called ‘enteroids.’
Most of the viable enteroids were found in the periphery of the
culture wells, a common finding with murine enteroids culture
models (data not shown, ).
Adult human myofibroblasts were isolated from small intestinal
surgical samples, plated, and used to assess their ability to support
isolated human intestinal crypts. These enterospheres that were
cultured in the presence of these adult human ISEMFs remained
viable for 2–3 days (n=9). They then promptly lost their distinct
edge and became non-viable (Fig. 2D, and data not shown).
However, we were able to grow adult human enteroids for longer
time periods on myofibroblasts isolated from a human infant
(n=8, Fig. 2E). Such enteroids formed every time, and they
remained viable for more than 56 days (Figure 3). Interestingly,
the enteroids grown on human infant ISEMFs did not require the
presence of FGF10, Wnt3a or even R-spondin to sustain growth.
Enteroids grown in these cultures demonstrated a variety of
different morphologies. These morphologies included simple cyst-
like structures with thin epithelial walls, cyst-like structures with
budding outgrowths, and elongated thin-walled formations
(Fig 2E). The size of the cyst-like structures continued to expand,
increasing from the 0.2 mm in diameter initially to over 2 mm in
the linear dimension (Figure 3D). When the cyst-like structures
were small, we were able to transfer them into a new culture with
myofibroblasts, and these structures will continue to expand in
Figure 2. Supportive Effect of Wnt, FGF Growth Factors and Myofibroblasts on Human Epithelial Growth. (A) Human small intestinal
crypts cultured without myofibroblasts (MFs) or growth factors (GFs) will live for approximately two days before dying off. (B) Human small intestinal
crypts cultured in the presence of murine myofibroblast but without growth factors maintain their cystic shape indefinitely but without significant
growth. (C) Human small intestinal crypts cultured with Wnt3a and FGF10 growth factors in the presence of mouse myofibroblasts began as simple
cysts that fill and extruded their contents and became more complex in morphology over time. (D) Human epithelial clusters grown on adult human
myofibroblasts in the presence of growth factors organize into simple cysts but cannot be maintained for longer than 3 days. (E) Infant human
myofibroblasts are capable of supporting human intestinal epithelial growth into complex cystic structures through 9 days post-explantation. For A
and B, scale bar is 200 mm. For C, D, and E, scale bar is 100 mm.
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Human Epithelium Expanded in Culture
Some of the human enteroid preparations on murine ISEMFs
were allowed to grow until day 18 when they were removed from
culture mechanically and processed. Surface markers character-
istic for the various cell types of the small intestinal epithelium
were used to examine the sections. Phase contrast microscopy of
the human epithelial enteroids demonstrated significantly in-
creased complexity of the structures at day 18 as compared to days
1–8 (Fig. 4A). Hematoxylin and Eosin (H&E) staining demon-
strated a polarity to the organization of the formed epithelium
(Fig. 4B). Goblet cells and enterocytes were found at the apical
pole while nuclear staining was found in the basal region of the
enteroid. Immunohistochemical stains on the cultures with E-
cadherin and CDX-2 corroborated the intestinal epithelial nature
of the cultured cells (Fig. 4C, D). CDX-2 is typically expressed
more intensely in the crypt base of the intestinal epithelium. The
intensity of the nuclear staining by CDX-2 was irregular,
suggestive of separate crypt and villus domains within the enteroid.
Myofibroblasts were positive for SMA and were found in
abundance at the basal side of the enteroid (Fig. 4E). Goblet cells
were evaluated using Periodic-acid Schiff staining. Periodic-acid
Schiff positive cells were present in the epithelium with extruded
mucoid material present in the adjacent overlying region (Fig. 4F).
Typically Paneth cells are morphologically pyramidal shaped and
lysozyme-positive and are located in the crypt bases between crypt
base columnar cells . We demonstrated alternating dark
lysozyme positive staining of pyramidal cells in culture (Fig. 4G).
Enteroendocrine cells are rare cells in the intestinal epithelium and
stain positively with Synaptophysin and Chromogranin A .
Here we demonstrate the presence of enteroendocrine cells using
Synaptophysin immunohistochemical staining (Fig. 4H). When
human epithelial crypts were grown on murine ISEMFs for 58
days, H&E staining demonstrated a polarized epithelial layer
(Fig 5A). These epithelial cells were CDX-2 and E-cadherin
positive (Fig 5B & C, respectively). In contrast, the adjacent
myofibroblasts were positive for SMA (Fig 5D).
Human Intestinal Epithelium Implanted Subcutaneously
in Immunocompromised Mice
Human epithelial enteroids and associated murine ISEMF were
cultured for 11 days before being placed upon polyglycolic acid
(PGA) scaffolds that were implanted subcutaneously in NOD-
SCID-IL2Rc null (NSG) mice (n=2). The time span of 11 days
was selected due to the ISEMFs and their epithelial contents
detaching from the culture well at that point, and thereby
facilitating placement on the polyglycolic scaffold. The scaffolds
were harvested after 28 days to ascertain their contents’ viability
and intestinal marker expression. The implantation period of 28
days was chosen because no epithelial culture could be maintained
without growth factor support for this length of time in our
previous experience. Once excised, the implants were 10%
formalin fixed and stained. H&E demonstrated epithelial cysts
with eosinophilic luminal contents and with at least three
morphologically different cell types (Fig. 6A). Similar to the
epithelial cultures, E-cadherin and CDX-2 were positive in the cell
lining in the cyst wall, indicating the presence of intestinal
epithelium (Fig. 6B, C). The CDX-2 stain again demonstrated
domains of irregular staining suggestive of crypt and villus
Figure 3. Long-Term Culture of Human Small Intestinal Enteroids Grown on Human Infant Myofibroblasts. Micrographs of human
small intestinal crypts that were cultured on human infant myofibroblasts for (A) 2 days, (B) 8 days, (C) 23 days, and (D) 56 days in culture. Small cysts
get larger with time and sometimes fuse with each other to form larger structures.
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Figure 4. In vitro Human Small Intestinal Enteroids Grown on Murine Myofibroblasts Demonstrate Characteristic Intestinal
Epithelial Markers. Human crypts cultured on murine myofibroblasts in the presence of Wnt3a and FGF10 were processed after 18 days in vitro.
(A) Phase contrast microscopy of culture. (B) Hematoxylin and Eosin stain. Note cellular polarity with epithelial nuclei at the basal region and goblet
cells at the apical region. (C) E-cadherin, an epithelial cell marker. (D) CDX-2, stains intestinal epithelium. Of note, while the E-cadherin staining is
relatively even, the CDX-2 staining demonstrates uneven staining suggestive of alternating crypt-villus domains. (E) Smooth Muscle Actin, marker for
myofibroblasts. (F) PAS, stains for goblet cells. Note the extruded mucinous material at the apical side of the epithelium culture. (G) Lysozyme, a
Paneth cell marker. (H) Synaptophysin, marker for enteroendocrine cells. For all images, scale bars are 100 mm.
Figure 5. Long-term In vitro Human Small Intestinal Enteroids Grown on Murine Myofibroblasts. Human small intestinal crypts cultured
on murine myofibroblasts in the presence of Wnt3a and FGF10 were processed after 58 days in vitro. (A) Hematoxylin and Eosin stain. (B) CDX-2,
stains intestinal epithelium. (C) E-cadherin, an epithelial cell marker. (D) a Smooth Muscle Actin, marker for myofibroblasts.
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domains along the epithelial cyst. SMA-positive cells suggestive of
myofibroblasts were seen in close association with the cyst,
surrounding the lining cells of the cyst (Fig. 6D). PAS staining
again demonstrated the presence of mucin-producing cells
consistent with goblet cells (Fig. 6E). The lumen of the cyst also
stained strongly for mucin. Like synaptophysin, chromogranin A
also stains enteroendocrine cells. Consistently, multiple stains of
the intestinal clusters demonstrated isolated chromogranin A
staining. This particular epithelial cyst demonstrated a single cell
positive for chromogranin A (Fig. 6F). When human epithelial
enteroids cultured with human infant ISEMF were implanted in
the same animal model, cysts analogous to those cultured with
murine ISEMF also formed (Figure 7). Immunohistochemical
staining confirmed the expression of CDX-2 and E-cadherin in the
epithelial cells, as well as the expression of SMA in cells
surrounding the cysts. Mucin and lysozyme were also present in
some of the cells, indicating the presence of goblet and Paneth
cells, respectively. Attempts to implant epithelial cells without first
establishing this culture with ISEMF led to no growth of
epithelium in this model.
The intimate contact between the small intestinal epithelium
and the associated sub-epithelial myofibroblasts in both mouse and
humans is generally thought to facilitate cross talk between the cell
types and help to promote the growth and differentiation of the
overlying epithelium [5,10]. Here we showed that mouse and
human ISEMFs would support the growth of isolated intestinal
epithelial`cells. In the presence of mouse ISEMFs, human
epithelial cell cultures are maintained for at least 60 days. On
the other hand, epithelial cultures lacking an ISEMF feeder layer
died after only 2–3 days. Isolated mouse ISEMFs maintained
ectopically placed human intestinal epithelium in vivo, allowing
them to survive for 28 days subcutaneously in an immunodeficient
mouse model without additional external growth factor support.
While there have been descriptions of long-term human intestinal
epithelial culture systems previously, all have required transformed
cells. This is the first report of maintaining non-neoplastic
human intestinal epithelium in vivo in an immunocompromised
mouse for a prolonged period of time. The intestinal enteroids
were suspended in Matrigel, a proprietary proteinacious mixture
that contains many of the elements and factors in the extracellular
environment. Without support from ISEMFs, these suspended
epithelial cells in Matrigel only survive approximately 2 days. As
we demonstrated, the human epithelial cells were maintained for
longer periods of time in the presence of ISEMFs. These findings
are consistent with multiple animal studies concluding that
apoptosis is prevented with immediate interaction of the
epithelium with some matrix element while longer term culture
of epithelium in vitro requires some mesenchymal element for
Another interesting finding was our observation that enteroids
develop apparent villus and crypt domains in formations of
otherwise morphologically similar cells, both in the culture and in
vivo specimens. This phenomenon was seen most clearly with the
Figure 6. In vivo Human Small Intestinal Enteroids Can Be Maintained with Murine ISEMFs. Human small intestinal crypts on murine
myofibroblasts were grown in culture for 11 days in the presence of Wnt3a and FGF10, and then placed on a PGA felt scaffold and implanted
subcutaneously into an immunocompromised NOD-SCID-IL2Rc null mice. After 28 days, the implant was harvested and evaluated with intestinal
epithelial markers. (A) H&E demonstrates at least three cell morphologies, and eosinophilic material in the cyst lumen. (B) E-cadherin and (C) CDX-2,
are intestinal epithelial cell markers. Again note the variable staining intensity by the CDX-2 suggestive of crypt and villus domains (D) a Smooth
Muscle Actin staining for myofibroblast adjacent to epithelial cells. (E) PAS staining for mucin and mucin producing goblet cells (F) Chromogranin A,
marker for enteroendocrine cells. For all images, scale bar is 100 mm.
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CDX-2 staining variability. The finding is suggestive that even
within a week of epithelial growth, there is organizational behavior
at the cellular level. FGF4 and Wnt3a have been implicated
previously in determining the cellular fate of human pluripotent
stem cells into hindgut specific domains . It was not until Wnt
and FGF were added to our culture systems that the human
epithelial cysts became more complex in morphology and
dramatically expanded in size. Further understanding the role
that other growth factors have will hopefully increase yields of
surviving epithelium and improve their growth.
The cues that allow human ISEMFs to support human
intestinal enteroids remain to be determined. We were able to
support human epithelial growth in vitro for at least 60 days using
human myofibroblasts. This supportive interaction proved signif-
icantly more difficult to demonstrate experimentally than had
been the case with the mouse myofibroblasts. We had tested the
ability of adult human myofibroblasts’ to support the intestinal
epithelium but were unsuccessful. In contrast, ISEMF cells isolated
from infant human small intestine supported the long-term growth
of the epithelial cell cultures. The ‘classic’ myofibroblasts markers
in the cells were similar and consistent with those of the mouse.
Clearly other age-dependent factors contribute to the long-term
support of the human epithelium. These remain to be elucidated.
Myofibroblasts are likely one of a number of heterogeneous
mesenchymal cells in the lamina propria that have various roles in
supporting intestinal epithelium. Likely some of the roles
attributed to the ISEMFs may actually be due to other SMA-
positive cells. Further assessments of the subtle factors that
make the various myofibroblast lines different are certainly
Our findings lend themselves to further experiments aimed at
clarifying the specific factors by which the ISEMFs support the
epithelium. By understanding these interactions, it may, for
example, be possible to expand single intestinal stem cells into
viable human intestinal epithelium using human ISEMF cells as a
supportive cell layer. Additionally, the relationship between the
crypt stem cells, Paneth cells, and ISEMFs will also need to be
investigated to further delineate the molecular interaction between
these cell types. Maintenance of these cultures in an in vivo
environment opens possibilities of long-term cell viability without
continuous external supplementation of cytokines and growth
Materials and Methods
For human tissues, fresh tissues were obtained with appropriate
IRB approval from the UCLA Department of Pathology
Translational Pathology Core Laboratory.
All animal studies were approved by the animal research
committee at UCLA, IRB #2005-169. The UCLA facility is an
AALAC-accredited facility. This study was carried out in strict
accordance with the recommendations in the Guide for the Care
and Use of Laboratory Animals of the National Institutes of
Health. All efforts were made to minimize suffering.
Myofibroblasts were isolated from 5-day-old C57BL/6 wild
type mice from our own breeding colony. Six-week-old immuno-
compromised NOD-SCID-IL2Rcnull (NSG) mice (Jackson Lab-
oratory, Bar Harbor, Maine) were used for human epithelial
implantation studies. Both strains of mouse were housed in the
UCLA animal facility. The mouse pups were sacrificed per UCLA
Division of Laboratory Animal Medicine (DLAM) protocol using
an isoflurane overdose followed by decapitation. NSG mice were
placed into a CO2 chamber and gas added per DLAM protocol.
The UCLA facility is an AALAC-accredited facility. This study
was carried out in strict accordance with the recommendations in
Figure 7. In vivo Human Small Intestinal Enteroids Can Be Maintained with Human Infant ISEMFs. Human small intestinal crypts were
grown on human myofibroblasts for 8 days, and then placed on a PGA felt scaffold and implanted subcutaneously into an immunocompromised
NOD-SCID-IL2Rc null mice. After 28 days, the implant was harvested and evaluated with intestinal epithelial markers. (A) H&E staining showing
epithelial organization. (B) E-cadherin and (C) CDX-2 are intestinal epithelial cell markers. (D) a Smooth Muscle Actin staining for myofibroblast
surrounding epithelial cells. (E) PAS staining for mucin and mucin producing goblet cells. (F) Lysozyme, marker for Paneth cells.
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the Guide for the Care and Use of Laboratory Animals of the
National Institutes of Health. All efforts were made to minimize
Human Intestinal Tissue
Non-diseased small intestinal samples were obtained fresh from
intestinal specimens excised for Roux-en-Y gastric bypass
procedures and uncomplicated ileostomy takedown procedures.
Samples were obtained from the Surgical Pathology Department
within 45 minutes of resection and placed into ice-cold Dulbecco’s
Phosphate Buffered Solution (PBS). Fresh tissues obtained with
appropriate IRB approval from the UCLA Department of
Pathology Translational Pathology Core Laboratory.
Isolation of intestinal crypts
Tissue was removed from PBS solution and washed multiple
times with ice-cold PBS washes until the solution remained clear.
The specimen was then placed in a Petri dish containing PBS on
ice with the mucosal surface facing upward. Using a razor blade,
excess mucoid material was scrapped from the epithelial surface.
The specimen was then divided into approximately 0.5 cm2
pieces. These pieces were placed into a 2.5 mmol/L EDTA
solution in PBS for 30 minutes of incubation with gentle shaking at
4uC. After this incubation period, the fragments were allowed to
settle and the supernatant was discarded. 10 ml of cold PBS was
added to the sample, and subsequently vortexed for 10 seconds
with 1-second bursts. The fragments were allowed to settle, and
the supernatant was removed and saved on ice. Again 10 ml of
PBS were added and the process was repeated eight times.
Samples were spun down at 100 g for 2 minutes. The supernatant
was discarded. The contents of the pellets were examined under
light microscopy using a Nikon TMS microscope to assess purity
of crypt fractions. Typically, all fractions were pooled together to
increase yield of epithelial crypts. The pooled fractions were then
purified using a 100-mm pore filter (BD Biosciences, Bedford, MA).
Fetal Bovine Serum at 10% per volume was then used to suspend
the contents of the filtrate. These clusters were examined under
light microscopy and counted. 500 crypt clusters were suspended
in 50 mL Matrigel (BD Biosciences) as previously described in
Sato’s 3-D Matrigel culture system developed for murine
intestines. The crypt cell/Matrigel suspension was placed
directly upon previously plated mouse/human myofibroblasts.
Matrigel was allowed to polymerize on the myofibroblasts. Crypt
culture medium was then added to the wells. The media consisted
of Advanced DMEM/F12 (Invitrogen, Carlsbad, CA) with
penicillin-streptomycin (Invitrogen), GlutaMax supplement (Invi-
trogen, 2 mmol/L), HEPES buffer (Invitrogen, 10 mmol/L), N-2
supplement (Invitrogen), B-27 supplement (Invitrogen), EGF
(PeproTech, Rocky Hill, NJ, 50 mg/mL), Murine noggin (Pepro-
Tech, 100 mg/mL) and R-spondin (R&D Systems, Minneapolis,
MN, 1 mg/mL). Subsets of studies utilized various doses of
Wnt3a (R&D Systems, 100 ng/mL), and FGF10 (R&D Systems,
100 ng/mL). The medium was replaced every two days with the
Myofibroblast isolation and culture
Small intestine was excised from 7 day-old mice. The tissue was
placed into a Petri dish containing calcium and magnesium free
Hank’s Buffered Salt Solution (Invitrogen) with D-Glucose (Sigma,
20 mg/mL), penicillin-streptomycin (Invitrogen), and L-glutamine
(Invitrogen, 4 mmol/L) (HBSS* solution). The intestines were
washed out and rinsed. The intestinal tissue was diced into 0.3–
0.5 mm2pieces. The diced material was transferred into a T25
flask. 30 mL of cold HBSS* solution was added to the flask after
which the flask was shaken for 2 minutes at room temperature.
The flask was then allowed to settle and the supernatant discarded.
This process was repeated until the solution was clear.
Once the last supernatant was discarded, a 20 mL dispase
(Invitrogen, 0.31 mg/mL)/collagenase Type XI (Sigma, St. Louis,
MO, 0.25 mg/mL) solution was added to the tissue. The flask was
gently rocked moderately for 30 minutes at room temperature.
The flask contents were then transferred to a 50 mL conical
tube and vigorously shaken for 30 seconds. 10 mL cold HBSS*
was added to the solution and entire contents allowed to settle.
The supernatant was transferred to a new 50 mL conical tube.
This was repeated 6 times in 50 ml conical tubes.
The samples were then suspended in 25 mL of high glucose
Dulbecco’s Modified Eagle Medium with fetal bovine serum
(Invitrogen, 5% v/v), L-glutamine (Invitrogen, 4 mmol/L), D-
Sorbitol (Sigma, 20 mg/mL), and penicillin-streptomycin (Invitro-
gen) (DMEM-S solution). The solution was inverted until well
mixed and then centrifuged at 100 g at 4uC for two minutes. The
tube was then placed back on ice and the supernatant discarded.
The pellet was transferred to a 5 mL centrifuge tube. The contents
were allowed to settle and any supernatant was discarded. The
pellet was resuspended in HBSS with magnesium and calcium
supplemented with penicillin-streptomycin (Invitrogen) and L-
glutamine (Invitrogen, 4 mmol/L). The entire contents were spun
at high speed for 10 seconds. The supernatant was discarded and
the pellet was suspended in Basic Growth Media for myofibro-
blasts. Basic Growth Media consisted of DMEM (Invitrogen), with
Antibiotic-Antimycotic (Invitrogen), fetal bovine serum (Invitro-
gen, 10% v/v), EGF (PeproTech, Rocky Hill, NJ, 50 mg/mL),
transferrin (Sigma, St. Louis, MO, 10 mg/mL), and insulin (Sigma,
St. Louis, MO, 0.25 U/mL) added.
Immunohistochemical studies were undertaken using paraffin-
embedded culture samples that were prepared as follows: culture
samples were washed once with PBS. The samples were then fixed
for ,12 hours with 10% buffered formalin solution. The formalin
solution was then removed and 80% ethanol solution added for 10
minutes then removed. A 95% ethanol solution was added for 15
minutes twice. Finally, 100% ethanol was then added for 10
minutes. The culture contents were then carefully removed
mechanically from the culture dish. The samples were then
paraffin embedded. Serial 8 mm cuts of the tissue were obtained
for microscopic evaluation and staining. Immunohistochemical
staining was performed using the DAKO (Carpinteria, CA)
automated Flex system. Primary antibodies CDX-2, E-cadherin,
SMA, Synaptophysin were obtained from DAKO and were at
manufacturer concentrations. Antibody to lysozyme (DAKO) was
diluted 1:1500 in Antibody Diluent (DAKO). Antibody to
Chromogranin A (Immunostar, Hudson, WI) was diluted 1:200
in Antibody Diluent (DAKO).
7–11 days old culture samples were allowed to elevate and
partially detach from the culture plate as part of their natural
growth process. These samples were placed on non-woven 5 mm
polyglycolic acid (PGA) felt disks (Synthecon, Houston, TX).
Immunocompromised NOD-SCID-IL2Rc null (NSG) mice were
anesthetized in a manner consistent with protocols establish by the
UCLA DLAM group (http://www.ncbi.nlm.nih.gov/pubmed/
19052619). A subcutaneous pocket was created in the anterior
abdominal wall. The PGA felt with the cultured cells was placed
into the pocket and 6–0 Prolene suture (Ethicon, Somerville, NJ)
was used to suture the scaffold to underlying muscle. The
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PLoS ONE | www.plosone.org8November 2011 | Volume 6 | Issue 11 | e26898
overlying incision was closed without tension using 3–0 silk Download full-text
(Ethicon, Somerville, NJ) suture. The mouse was sacrificed after 28
days and the implantation was excised and fixed in buffered 10%
formalin solution. The sample was embedded, sectioned, and
stained for microscopic evaluation.
Quantitative real-time PCR
mRNA was isolated from the samples with the RNeasy RNA
Isolation Kit (Qiagen, Valencia, CA) following the manufacturer’s
protocol. The mRNA samples were then prepared for the RT-
PCR reaction with the Quantitect Probe RT-PCR Kit (Qiagen)
and the TaqMan Gene Expression Assay (Applied Biosystems,
(Mm00449208_m1), and GAPDH (Mm99999915_g1). GAPDH
was used as the house keeping gene to normalize RNA quantities.
The samples were analyzed with the LightCycler 480 Real-Time
PCR System (Roche, Indianapolis, IN) with settings described in
the Quantitect Probe Kit. The comparative CTmethod was used
to calculate the relative gene expression.
Human intestinal tissues were obtained with appropriate institutional
approval from the UCLA Department of Pathology Translational
Pathology Core Laboratory. We thank Dr. Sarah Dry for coordinating
this effort as well as the laboratory staff for implementing the procurement
Immunohistochemical staining and processing were performed in the
Surgical Pathology laboratories. Renee Bowers and Nazlin Sharif gave
expert advice and generous technical assistance.
Conceived and designed the experiments: MS MGM JCYD. Performed
the experiments: NL NYL JW ZJ SCT VJ. Analyzed the data: NL NYL
JW ML ZJ MS MGM JCYD. Contributed reagents/materials/analysis
tools: ML MS MGM JCYD. Wrote the paper: NL ML MS MGM JCYD.
1. Cheng H, Leblond CP (1974) Origin, differentiation and renewal of the four
main epithelial cell types in the mouse small intestine. V. Unitarian Theory of
the origin of the four epithelial cell types. The American journal of anatomy 141:
2. Gerbe F, van Es JH, Makrini L, Brulin B, Mellitzer G, et al. (2011) Distinct
ATOH1 and Neurog3 requirements define tuft cells as a new secretory cell type
in the intestinal epithelium. The Journal of cell biology 192: 767–780.
3. Li L, Clevers H (2010) Coexistence of quiescent and active adult stem cells in
mammals. Science 327: 542–545.
4. Garrison AP, Helmrath MA, Dekaney CM (2009) Intestinal stem cells. Journal
of pediatric gastroenterology and nutrition 49: 2–7.
5. Yen TH, Wright NA (2006) The gastrointestinal tract stem cell niche. Stem cell
reviews 2: 203–212.
6. Samuel S, Walsh R, Webb J, Robins A, Potten C, et al. (2009) Characterization
of putative stem cells in isolated human colonic crypt epithelial cells and their
interactions with myofibroblasts. American journal of physiology Cell physiology
7. Pinchuk IV, Mifflin RC, Saada JI, Powell DW (2010) Intestinal mesenchymal
cells. Current gastroenterology reports 12: 310–318.
8. Katoh M (2008) WNT signaling in stem cell biology and regenerative medicine.
Current drug targets 9: 565–570.
9. Ishizuya-Oka A, Hasebe T (2008) Sonic hedgehog and bone morphogenetic
protein-4 signaling pathway involved in epithelial cell renewal along the radial
axis of the intestine. Digestion 77 Suppl 1: 42–47.
10. Yeung TM, Chia LA, Kosinski CM, Kuo CJ (2011) Regulation of self-renewal
and differentiation by the intestinal stem cell niche. Cellular and molecular life
11. Sato T, van Es JH, Snippert HJ, Stange DE, Vries RG, et al. (2011) Paneth cells
constitute the niche for Lgr5 stem cells in intestinal crypts. Nature 469: 415–418.
12. Mifflin RC, Pinchuk IV, Saada JI, Powell DW (2011) Intestinal myofibroblasts:
targets for stem cell therapy. American journal of physiology Gastrointestinal
and liver physiology 300: G684–696.
13. McKaig BC, Makh SS, Hawkey CJ, Podolsky DK, Mahida YR (1999) Normal
human colonic subepithelial myofibroblasts enhance epithelial migration
(restitution) via TGF-beta3. The American journal of physiology 276:
14. Mahida YR, Beltinger J, Makh S, Goke M, Gray T, et al. (1997) Adult human
colonic subepithelial myofibroblasts express extracellular matrix proteins and
cyclooxygenase-1 and -2. The American journal of physiology 273:
15. Sato T, Vries RG, Snippert HJ, van de Wetering M, Barker N, et al. (2009)
Single Lgr5 stem cells build crypt-villus structures in vitro without a
mesenchymal niche. Nature 459: 262–265.
16. Schonhoff SE, Giel-Moloney M, Leiter AB (2004) Minireview: Development
and differentiation of gut endocrine cells. Endocrinology 145: 2639–2644.
17. Roig AI, Eskiocak U, Hight SK, Kim SB, Delgado O, et al. (2010) Immortalized
epithelial cells derived from human colon biopsies express stem cell markers and
differentiate in vitro. Gastroenterology 138: 1012-1021 e1011-1015.
18. Spence JR, Mayhew CN, Rankin SA, Kuhar MF, Vallance JE, et al. (2011)
Directed differentiation of human pluripotent stem cells into intestinal tissue in
vitro. Nature 470: 105–109.
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