Single-cell RNA sequencing of iPSC-derived brain organoids reveals Treponema pallidum infection inhibiting neurodevelopment

Reviewer #1 (Public Review):

Summary:

This is an interesting study by Xu et al showing the effects of infection with the Treponema pallidum virus (which causes syphilis disease) on neuronal development using iPSC-derived human brain organoids as a model and single-cell RNA sequencing. This work provides an important insight into the impact of the virus on human development, bridging the gap between the phenomena observed in studies using animal models as well as non-invasive human studies showing developmental abnormalities in fetuses infected with the virus in utero through maternal vertical transmission.

Using single-cell RNAseq in combination with qPCR and immunofluorescence techniques, the authors show that T. pallidum infected organoids are smaller in size, in particular during later growth stages, contain a larger number of undifferentiated neuronal lineage cells, and exhibit decreased numbers of specific neuronal subcluster, which the authors have identified as undifferentiated hindbrain neurons.

The study is an important first step in understanding how T. pallidum affects human neuronal development and provides important insight into the potential mechanisms that underlie the neurodevelopmental abnormalities observed in infected human fetuses. Several important weaknesses have also been noted, which need to be addressed to strengthen the study's conclusions.

Strengths:

(1) The study is well written, and the data quality is good for the most part.

(2) The study provides an important first step in utilizing human brain organoids to study the impact of T. pallidum infection on neuronal development.

(3) The study's conclusions may provide important insight to other researchers focused on studying how viral infections impact neuronal development.

Weaknesses:

(1) It is unclear how T. pallidum infection was validated in the organoids. If not all cells are infected, this could have important implications for the study's conclusions, in particular the single-cell RNAseq experiments. Were only cells showing the presence of the virus selected for sequencing? A detailed description of how infection was validated and the process of selection of cells for RNAseq would strongly support the study's conclusions.

(2) The authors show that T. pallidum infection results in impaired development of hindbrain neurons. How does this finding compare to what has already been shown in animal studies? Is a similar deficit in this brain region observed with this specific virus? It would be useful to strengthen the study's conclusions if the authors added a discussion about the observed deficits in hindbrain neuronal development, and prior literature on similar studies conducted in animal models or human patients. Does T. pallidum preferentially target these neurons, or is this a limitation of the current organoid model system?

(3) The authors show that T. pallidum-infected organoids are smaller in size by measuring organoid diameter during later stages of organoid growth, with no change during early stages. Does that represent insufficient infection at the early stages? Is this due to increased cell death or lack of cell division in the infected organoids? Experiments using IHC to quantify levels of cleaved caspase and/or protein markers for cell proliferation would be able to address these questions.

1. In Figure 1D authors show differences in rosette-like structure in the infected organoids. The representative images do not appear to be different in any of the discussed components (e.g., the sox2 signal looks fairly similar between the two conditions). No quantification of these structures was presented. Authors should provide quantification or a more representative image to support their statement.

2. The IHC images shown in Figures 3E, G, and Figure 4E look very similar between the two conditions despite the discussed decrease in the text. A more suitable representative image should be presented, or the analysis should be amended to reflect the observed results.

Reviewer #2 (Public Review):

Summary:

This study provides an important overview of infectious etiology for neurodevelopment delay.

Strengths:

Strong RNA evaluation.

Weaknesses:

The study lacks an overview of other infectious agents. The study should address the epigenetic contributors (PMID: 36507115) and the role of supplements in improving outcomes (PMID: 27705610).
Addressing the above - with references included - is recommended.

Reviewer #3 (Public Review):

This article is the first report to study the effects of T. pallidum on the neural development of an iSPC-derived brain organoid model. The study indicates that T. pallidum inhibits the differentiation of subNPC1B neurons into hindbrain neurons, hence affecting brain organoid neurodevelopment. Additionally, the TCF3 and notch signaling pathways may be involved in the inhibition of the subNPC1B-hindbrain neuron differentiation axis. While the majority of the data in this study support the conclusions, there are still some questions that need to be addressed and data quality needs to be improved. The study provides valuable insights for future investigations into the mechanisms underlying congenital neurodevelopment disability.