The Intestinal Stem Cell
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Downloaded from genesdev.cshlp.org on September 29, 2021 - Published by Cold Spring Harbor Laboratory Press REVIEW The intestinal stem cell Nick Barker, Marc van de Wetering, and Hans Clevers1 Hubrecht Institute and University Medical Center Utrecht, Uppsalalaan 8, 3584CT Utrecht, the Netherlands The epithelium of the adult mammalian intestine is in a Claudinot et al. 2005). Of note, multipotency can only be constant dialog with its underlying mesenchyme to di- definitively demonstrated when transplantation can be rect progenitor proliferation, lineage commitment, ter- performed with a single cell, which is rarely possible. As minal differentiation, and, ultimately, cell death. The an alternative strategy, candidate stem cells are geneti- epithelium is shaped into spatially distinct compart- cally marked in situ, after which the introduced marker ments that are dedicated to each of these events. While allows the visualization of the modified stem cell and its the intestinal epithelium represents the most vigorously clonal offspring over time. As an example of the latter renewing adult tissue in mammals, the stem cells that approach, a progesterone-responsive version of the Cre fuel this self-renewal process have been identified only recombinase enzyme was specifically expressed in cells recently. The unique epithelial anatomy makes the in- residing in the bulge region of hair follicles using a trans- testinal crypt one of the most accessible models for the genic Keratin-15 promoter (Morris et al. 2004). Activa- study of adult stem cell biology. This review attempts to tion of the Cre enzyme by progesterone irreversibly ac- provide a comprehensive overview of four decades of re- tivated the genetic marker R26R-LacZ in the bulge cells. search on crypt stem cells. A simple blue stain for LacZ activity revealed that over time the entire hair follicle and its associated hair de- rived from the marked bulge stem cells, thus establish- Adult tissue stem cells can be defined by two essential ing that the bulge cells are endowed with longevity and features. First, a population of tissue stem cells should be pluripotency. maintained over long periods of time, often the entire Genetic marking is often technically challenging, as lifetime of the organism (“longevity”). And second, these one needs to be able to genetically modify individual long-lived stem cell populations should be able to gen- stem cells. Sometimes a combination of the two ap- erate the differentiated cell types of the tissue. Most proaches is applied, particularly when single cell trans- adult stem cells can generate multiple cell types (“mul- plantation is not feasible and in situ marking of indi- tipotency”), yet examples also exist in which they only vidual cells cannot be achieved. In such cases, one can generate offspring of a single lineage. Two experimental genetically mark individual cells in enriched stem cell strategies can unveil these combined features in candi- populations; for instance, by retroviral integration date stem cell populations. In this review, these are ar- (Jordan and Lemischka 1990) or by titration of individual bitrarily termed the transplantation strategy and the ge- putative stem cells into a stem cell suspension of a netic marking strategy. The transplantation strategy uti- different genetic background prior to transplantation lizes molecular markers to enrich putative stem cell (Smith et al. 1991). populations, followed by in vitro culture and/or trans- plantation into recipient animals. This approach has been highly successful in the identification of the hema- Quiescence and asymmetric cell division topoietic stem cell from bone marrow (Spangrude et al. In addition to longevity and multipotency, stem cells are 1988) and—more recently—of cancer stem cells in leu- often tacitly assumed to be endowed with two other kemias (Bonnet and Dick 1997) and in solid tumors characteristics. Stem cells are commonly believed to di- (Singh et al. 2004; Dalerba et al. 2007; O’Brien et al. 2007; vide very infrequently (“quiescence”), and when this oc- Prince et al. 2007). In an elegant example, Visvader and curs, to generate one rapidly cycling daughter cell, while colleagues regrew an entire mammary gland (Shackleton the other daughter replaces the parent stem cell (“asym- et al. 2006) from a single isolated stem cell. Similarly, metric cell division”). The rapidly cycling daughter cells, clonal analyses have shown that cells derived from a also called transit-amplifying (TA) cells, are responsible single follicle stem cell can give rise to epidermis, seba- for building tissue mass. TA cells typically undergo a ceous gland, and hair follicles (Blanpain et al. 2004; limited number of cell divisions, after which they termi- nally differentiate. While good examples exist of quiescent stem cells [Keywords: Crypt base columnar cell; intestine; stem cell] (e.g., in the bulge of the hair follicle) (Tumbar et al. 2004), 1Corresponding author. E-MAIL [email protected]; FAX 31-30-2121801. there is actually no a priori reason why stem cells should Article is online at http://www.genesdev.org/cgi/doi/10.1101/gad.1674008. be quiescent. The best studied animal stem cells, the 1856 GENES & DEVELOPMENT 22:1856–1864 © 2008 by Cold Spring Harbor Laboratory Press ISSN 0890-9369/08; www.genesdev.org Downloaded from genesdev.cshlp.org on September 29, 2021 - Published by Cold Spring Harbor Laboratory Press Identifying the intestinal stem cell germ cells of Drosophila, are actively cycling (Spradling structure. The outer layer consists of several sheets of et al. 2001). Furthermore, while the size of stem cell smooth muscle that, together with the intramural en- populations should be stable over time, there is no logi- teric nervous system, execute the rhythmic peristaltic cal reason why this should be accomplished at the single movements of the intestine. The space between the stem cell level, i.e., by obligatory asymmetric cell divi- outer muscle and the inner epithelial layer is filled by sion (Kiel et al. 2007, and refs therein). Physically defined connective tissue (“stroma”) that contains numerous stem cell niches could maintain stable stem cell popu- blood and lymph vessels, nerve fibers, and various cells lations, while allowing individual stem cells to take any of the immune system. On the inside, the luminal sur- of three courses in mitosis: the generation of two stem face consists of a simple epithelium; a single-cell layer cells, of two daughter cells, or of one of each. Of note, the termed the mucosa. The mucosa is responsible for the champion of all stem cells, the Embryonic Stem (ES) cell, processing and absorption of nutrients as well as for the is a very rapidly cycling cell that never undergoes asym- compaction of the stool (Sancho et al. 2003). metric cell divisions, at least when kept under appropri- The intestinal tract can be anatomically divided into ate culture conditions. two well-defined segments: the small intestine and the large intestine or colon. The small intestine is subdi- Surrogate markers for stemness: DNA label retention vided into three proximal-distal segments: the duode- num, jejunum, and ileum. The absorptive surface area of In many tissues, the technology is not available to iso- the small intestine is dramatically increased by numer- late/transplant or to genetically mark adult stem cells. In ous finger-like protrusions that point toward the lumen, such cases, markers known to identify stem cells in un- the so-called villi, and invaginations into the submucosa related tissues, such as CD34, cKit, or the Hoechst dye- known as the crypts of Lieberkühn. The mucosa of the defined Side Population may be used as surrogate stem large intestine lacks villi; crypts invaginate deep into the cell markers (Natarajan and FitzGerald 2007). It is im- submucosa. mediately apparent that this approach should be applied Four differentiated cell types mediate the functions of with great caution. Long-term retention of DNA repre- the intestinal epithelium (Sancho et al. 2003): absorp- sents another commonly used surrogate marker of tive, enteroendocrine, mucosecreting, and Paneth cells. “stemness” (Kiel et al. 2007). An elegant variation of this The relative abundance of each of these three cell types strategy involves the use of Histone-GFP marking (Tum- varies markedly within different segments of the intes- bar et al. 2004). Stem cells are commonly believed to be tine. Absorptive cells (also called enterocytes) are the unique in their ability to retain DNA labels such as BrdU more abundant cell type in the small intestine and are incorporated into their genome during periods of mitotic responsible for the absorption of nutrients from the food activity stimulated, for example, by severe tissue injury. and for the secretion of a cocktail of hydrolytic enzymes This is based on the assumption that stem cells tend to into the lumen. Numbers of mucosecreting cells (also be quiescent, while their direct descendants, the vigor- called goblet cells) increase from proximal (small intes- ously proliferating TA cells, rapidly dilute out any incor- tine) to distal (colon and rectum) as the stool becomes porated DNA label. increasingly compacted. Enteroendocrine cells represent As an alternative mechanism behind DNA label reten- a small proportion (<1%) of the cells in the epithelium. tion, John Cairns formulated the “immortal strand hy- They control gut physiology by secreting a variety of pothesis” 35 years ago (Cairns 1975). Stem cells may hormones including serotonine, substance P, and secre- selectively retain their old DNA strands, while donating tin. Multiple subtypes can be defined by the specific in- the newly synthesized DNA strands to their TA daugh- testinal hormones that are produced (Schonhoff et al. ters. To this day, the immortal strand hypothesis has 2004). Paneth cells reside at the bottom-most positions been the subject of controversy (Lansdorp 2007; Rando of the crypts of the small intestine. They secrete antimi- 2007). Few convincing examples have been reported, crobial agents such as cryptidins (termed defensins in while its molecular machinery remains unidentified.