Co-grafting strategies uncover cell type–dependent regulation of dopamine neuron specification and functional maturation in a pre-clinical model of Parkinson’s Disease

Abstract Parkinson’s disease (PD), the second most common neurodegenerative disorder, is characterized by the progressive loss of A9 dopaminergic neurons in the substantia nigra, leading to dopamine (DA) depletion in the striatum and subsequent motor symptoms. Transplantation of ventral midbrain-patterned DA (vmDA) progenitors derived from human pluripotent stem cells, aimed at restoring DA neurotransmission in the striatum, is being developed and currently explored in ongoing clinical trials. One factor that may improve the maturation and fate determination of DA neurons in vivo is the intercellular communication within the graft environment, ultimately affecting the therapeutic outcome. In this study, we co-transplanted vmDA progenitors with either glial, ventral forebrain or striatal progenitors into a preclinical xenograft PD model to investigate how these interactions shape the development, maturation, and function of therapeutic DA neurons. Our findings show that co-grafts with ventral forebrain progenitors increase the yield of DA neurons and also promote their functional maturation. Furthermore, we demonstrated that co-grafts with striatal neurons promote functional maturation and the acquisition of DA subtype identity. From these data, we identified EBF3 and PBX3 as candidate transcription factors directing DA neuron maturation and subtype specification, and then functionally validated their role in brain organoids. Taken together, our data highlight that the cellular microenvironment, including specific interactions with neighbouring cells, guides in vivo DA neuron specification and maturation. These findings provide a foundation for developing more refined and effective cell preparations for replacement therapy in PD, and define a conceptual framework that could inform stem cell–based strategies for other neurodegenerative diseases. Competing Interest Statement M.P. is the owner of Parmar Cells AB, co-inventor of the following patents WO2016162747A2, WO2018206798A1, and WO2019016113A1, performs paid Consultancy and commissioned research for Novo Nordisk AS Cell Therapy Research and Development unit, and serves on the SAB for Arbor Bio. MP is a SAB member of Cell Stem Cell.