U.S. patent application number 16/678929 was filed with the patent office on 2020-09-10 for methods to improve cell therapy.
The applicant listed for this patent is The Brigham and Women's Hospital, Inc.. Invention is credited to Robert SACKSTEIN.
Application Number | 20200281985 16/678929 |
Document ID | / |
Family ID | 1000004845342 |
Filed Date | 2020-09-10 |
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United States Patent
Application |
20200281985 |
Kind Code |
A1 |
SACKSTEIN; Robert |
September 10, 2020 |
METHODS TO IMPROVE CELL THERAPY
Abstract
Methods of treatment are provided herein, including
administration of a population cells modified to enforce expression
of an E-selectin and/or an L-selectin ligand, the modified cell
population having a cell viability of at least 70% after a
treatment to enforce such expression.
Inventors: |
SACKSTEIN; Robert; (Sudbury,
MA) |
|
Applicant: |
Name |
City |
State |
Country |
Type |
The Brigham and Women's Hospital, Inc. |
Boston |
MA |
US |
|
|
Family ID: |
1000004845342 |
Appl. No.: |
16/678929 |
Filed: |
November 8, 2019 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
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14982863 |
Dec 29, 2015 |
10471103 |
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16678929 |
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62098048 |
Dec 30, 2014 |
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62101863 |
Jan 9, 2015 |
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Current U.S.
Class: |
1/1 |
Current CPC
Class: |
A61K 35/14 20130101;
A61K 2035/124 20130101; A61K 35/407 20130101; C12N 5/0006 20130101;
A61K 35/34 20130101; A61K 35/42 20130101; A61K 35/33 20130101; A61K
35/37 20130101; A61K 35/28 20130101; A61K 35/35 20130101; C12N
2501/724 20130101; A61K 35/30 20130101; A61K 35/32 20130101 |
International
Class: |
A61K 35/30 20060101
A61K035/30; A61K 35/33 20060101 A61K035/33; A61K 35/34 20060101
A61K035/34; A61K 35/32 20060101 A61K035/32; A61K 35/42 20060101
A61K035/42; A61K 35/14 20060101 A61K035/14; C12N 5/00 20060101
C12N005/00; A61K 35/35 20060101 A61K035/35; A61K 35/37 20060101
A61K035/37; A61K 35/28 20060101 A61K035/28; A61K 35/407 20060101
A61K035/407 |
Goverment Interests
[0001] This disclosure was made with government support under
grants PO1 HL107146 (NHLBI Program of Excellence in Glycosciences),
RO1 HL73714, and RO1 HL60528, awarded by National Institutes of
Health. The government has certain rights in the disclosure.
Claims
1. (canceled)
2. A method of treating a disease, disorder or medical condition
manifesting as inflamed and/or damaged tissue in a subject, the
method comprising: administering to the subject a population of
cells that express an E-selectin ligand and/or an L-selectin
ligand, the population expressing the E-selectin ligand and/or
L-selectin ligand at a level that exceeds the level of expression
of a native population of the cells, wherein said cell
administration occurs coincident with E-selectin expression on
endothelial cells within the target tissue and/or coincident with
accumulation of leukocytes within the target tissue, and wherein
said population exhibits enhanced localization and/or colonization
within the inflamed and/or damaged tissue relative to a native
population of the administered cells.
3.-10. (canceled)
11. The method of claim 2, wherein said cell administration occurs
coincident with E-selectin expression on endothelial cells and
infiltrates of leukocytes bearing L-selectin within the target
tissue.
12.-13. (canceled)
14. The method of claim 2, wherein an immunomodulatory effect is
achieved by colonization of cells within an/the inflamed and/or
damaged tissue.
15. The method of claim 2, wherein a tissue reparative effect is
achieved by colonization of administered cells within an/the
inflamed and/or damaged tissue.
16. The method of claim 2, wherein an enhanced host defense/immune
response effect is achieved by delivery and colonization of
administered cells within an/the inflamed and/or damaged
tissue.
17. The method of claim 2, wherein an anti-malignancy effect is
achieved by colonization of administered cells within a/the
tumor/malignant tissue site.
18.-25. (canceled)
26. The method of claim 2, wherein the population of cells express
an E-selectin ligand and an L-selectin ligand.
27. The method of claim 2, wherein the E-selectin ligand and/or
L-selectin ligand is selected from one or more of Hematopoietic
Cell E-/L-selectin Ligand (HCELL), Neural Cell Adhesion Molecule
E-selectin Ligand (NCAM-E), CD43E, CLA, and ESL-1.
28. The method of claim 2, wherein the E-selectin ligand is
Hematopoietic Cell E-/L-selectin Ligand (HCELL) and/or Neural Cell
Adhesion Molecule E-selectin Ligand (NCAM-E).
29. The method of claim 2, wherein the E-selectin ligand is
HCELL.
30. The method of claim 2, wherein the E-selectin ligand is
NCAM-E.
31. The method of claim 2, wherein the L-selectin ligand is
HCELL.
32. The method of claim 2, wherein the cell population comprises
one or more of epithelial, endothelial, neuronal, adipose, cardiac,
skeletal muscle, fibroblast, and immune cells (for example,
dendritic cells, monocytes, macrophages, leukocytes (e.g., a
lymphocyte such as a NK cell, a B-lymphocyte, a T-lymphocyte, or a
subset of T-lymphocytes, such as regulatory lymphocyte
(CD4.sup.+/CD25.sup.+/FOXP3.sup.+)), a cytotoxic lymphocyte, etc.),
hepatic, splenic, lung, circulating blood cells, platelets,
reproductive cells, gastrointestinal, renal, bone marrow,
pancreatic cells, a stem cell (e.g., a mesenchymal stem cell, a
hematopoietic stem cell, a tissue stem/progenitor cell (for
example, a neural stem cell, myocyte stem cell or pulmonary stem
cell), an umbilical cord stem cell, or an embryonic stem cell, or
an induced pluripotent stem cell, or a differentiated progenitor
derived from an embryonic stem cell or from an induced pluripotent
stem cells, or a differentiated progenitor derived from an adult
stem cell, or a primary cell isolated from any tissue (e.g., brain,
liver, lung, gut, stomach, fat, muscle, testes, uterus, ovary,
skin, spleen, endocrine organ and bone), or a culture-expanded
progenitor cell population, or a culture-expanded stem cell
population, or a culture-expanded primary cell population.
33. The method of claim 2, wherein the cell population is a
mesenchymal stem cell, a hematopoietic stem cell, a tissue
stem/progenitor cell, an umbilical cord stem cell, or an embryonic
stem cell.
34. The method of claim 2, wherein the cell population is a
leukocyte (e.g., a lymphocyte such as an NK cell, B-lymphocyte, a
T-lymphocyte, or a subset of T-lymphocytes, such as regulatory
lymphocyte (CD4.sup.+/CD25.sup.+/FOXP3.sup.+)), a cytotoxic T cell,
etc.).
35. The method of claim 2, wherein the disease, disorder or medical
condition is one or more of direct tissue injury (e.g., burns,
trauma, decubitus ulcers, etc.), ischemic/vascular events (e.g.,
myocardial infarct, stroke, shock, hemorrhage, coagulopathy, etc.),
infections (e.g., cellulitis, pneumonia, meningitis, sepsis, SIRS,
etc.), neoplasia (e.g., breast cancer, lung cancer, prostate
cancer, lymphoma, leukemia, etc.), immunologic/autoimmune
conditions (e.g., graft vs. host disease, multiple sclerosis,
diabetes, inflammatory bowel disease, lupus erythematosus,
rheumatoid arthritis, psoriasis, etc.), degenerative diseases
(e.g., osteoporosis, osteoarthritis, Alzheimer's disease, etc.),
congenital/genetic diseases (e.g., epidermolysis bullosa,
osteogenesis imperfecta, muscular dystrophies, lysosomal storage
diseases, Huntington's disease, etc.), adverse drug effects (e.g.,
drug-induced hepatitis, drug-induced cardiac injury, etc.), toxic
injuries (e.g., radiation exposure(s), chemical exposure(s),
alcoholic hepatitis, alcoholic pancreatitis, alcoholic
cardiomyopathy, cocaine cardiomyopathy, etc.), metabolic
derangements (e.g., uremic pericarditis, metabolic acidosis, etc.),
iatrogenic conditions (e.g., radiation-induced tissue injury,
surgery-related complications, etc.), and/or idiopathic processes
(e.g., amyotrophic lateral sclerosis, Parsonnage-Turner Syndrome,
etc.).
36. The method of claim 2, wherein the disease, disorder or medical
condition is diabetes.
37. The method of claim 2, wherein the disease, disorder or medical
condition is multiple sclerosis.
38. The method of claim 2, wherein the subject is a human,
non-human primate, mouse, rat, dog, cat, horse, or cow.
39. The method of claim 2, wherein the subject is a human
patient.
40.-53. (canceled)
Description
[0002] This disclosure relates to compositions and methods for
modifying the cell surface and the improved efficiency and
applicability of such modified cells in cell-based treatment of
inflammatory conditions, tissue injury/damage, and cancer.
[0003] The success of cell-based therapeutics (also known as
"adoptive cellular therapeutics") depends on getting the relevant
cells to the site(s) where they are needed in sufficient amount(s)
to achieve intended biologic effect(s). Delivery of cells for
clinical indications can be achieved by direct (local) injection
into involved tissue(s), by intravascular administration (e.g.,
systemically or by catheter-based delivery to a particular vascular
bed), or by application/placement of cells directly onto the
affected area (e.g., for skin ulcers, burns, etc.). In all forms of
cell administration, it would be advantageous for administered
cells to possess membrane molecules that would promote lodgement of
the cell within the administered site precisely within tissue
microenvironments that are critical to achieve intended effect,
e.g., control of inflammation, tissue repair, elimination of
rejection, eradication of cancer, etc. One such microenvironmental
site are the "perivascular areas" present in and around
microvessels within the injured tissue, as it is well known that
integrity of the microvasculature, and production of new
microvessels (i.e., "angiogenesis"), is a critical prerequisite to
tissue regeneration/repair. Indeed, at all sites of tissue injury,
inflammation, and cancer, endothelial cells within the microvessels
of affected tissue(s) display a characteristic set of adhesion
molecules that serve a key role in recruitment of circulating
(blood-borne) cells to the target site. These endothelial molecules
are upregulated by inflammatory cytokines such as tumor necrosis
factor (TNF) and interleukin 1 (IL-1), and, in humans include the
molecule E-selectin, and, in mouse, the molecules E-selectin and
P-selectin, which are lectins belonging to a family of adhesion
molecules known as "selectins" (to be described in more detail
below). In addition, leukocytes that have been recruited to any
inflammatory site (including cancer) or to a site of tissue
injury/damage display L-selectin, the "leukocyte" selectin, and,
therefore, expression of ligands for L-selectin on administered
cells would promote lodgement of such cells to regions of leukocyte
infiltrates within the affected tissue(s).
[0004] At first glance, direct delivery might seem to be the most
efficient approach to cell administration. especially considering
that a concentrated bolus of cells could be applied to an affected
area. However, there are situations where local injection may
actually be counterproductive to intended therapeutic effects, and,
moreover, local injection is practical for only certain anatomic
locations: (1) By introducing pertinent cells in media suspension
under hydrostatic pressure, the injection procedure could harm the
delivered cells and, furthermore, could further compromise tissue
integrity and disrupt incipient tissue repair and/or host defense
processes, thereby exacerbating the inflammatory condition or
counteracting appropriate immune reactions in situ; (2) By virtue
of being an invasive method, the injection needle/device (and the
suspension solution) could induce target tissue damage and/or
instigate collateral tissue damage; (3) Direct injection is most
feasible for organs/tissues with well-defined anatomic boundaries
(e.g., the heart), and is impractical for tissues without extensive
connective tissue support (e.g., the lung); (4) The injection
procedure could be technologically demanding and labor-intensive,
requiring use of sophisticated delivery systems with substantial
imaging support, especially for relatively inaccessible and/or
fragile organs/tissues (e.g., the central nervous system); (5) Most
importantly, many degenerative and inflammatory conditions are
widely distributed and multifocal in nature (e.g., osteoporosis,
inflammatory bowel disease, multiple sclerosis, etc.), and thus
direct injection is neither practical nor effective. Thus, though
there are clinical conditions/situations in which local injection
is feasible, the vascular route of administration is mandated for
all generalized "systemic" disorders, as well as for any tissue
with problematic access and/or anatomy not amenable to local
injection (e.g., the pancreas in diabetes, the lung in chronic
obstructive pulmonary disease). The capacity to administer cells
repeatedly with minimal effort is another important practical
advantage of systemic infusion. Therefore, creation of
methodologies to optimize the expression/activity of molecular
effectors directing both the adhesion/lodgement of directly
injected cells within the inflammatory milieu and the physiologic
migration of intravascularly administered cells to the affected
site(s) is key to achieving the tremendous promise of all
cell-based therapeutics.
[0005] The capacity to direct migration of blood-borne cells to a
predetermined location ("homing") has profound implications for a
variety of physiologic and pathologic processes. Recruitment of
circulating cells to a specific anatomic site is initiated by
discrete adhesive interactions between cells in flow and vascular
endothelium at the target tissue(s). The molecules that mediate
these contacts are called "homing receptors," and, as defined
historically, these structures pilot tropism of cells in blood to
the respective target tissue. Historically, three "tissue-specific
homing receptors" were described: L-selectin for peripheral lymph
nodes, .alpha..sub.4.beta..sub.7 (LPAM-1) for intestines and
gut-associated lymphoid tissue, and a specialized glycoform of the
molecule P-selectin Glycoprotein Ligand-1 (PSGL-1) known,
specifically, as the "Cutaneous Lymphocyte Antigen" (CLA) that
promotes cell migration to skin (R. Sackstein, Curr Opin Hematol
12, 444 (2005)). Notably, apart from these tissues, it had been
recognized for several decades that circulating cells, especially
hematopoietic stem cells (HSCs), navigate effectively to bone
marrow (T. Lapidot, A. Dar, O. Kollet, Blood 106, 1901 (2005)), and
several studies pointed to a role for selectins, predominantly
E-selectin binding to HSC E-selectin ligands, in mediating
recruitment of HSCs to marrow.
[0006] From a biophysical perspective, a homing receptor functions
as a molecular brake, effecting initial tethering then sustained
rolling contacts of cells in blood flow onto the vascular
endothelium at velocities below that of the prevailing bloodstream
(Step 1) (R. Sackstein, Curr Opin Hematol 12, 444 (2005)).
Thereafter, a cascade of events ensue, typically potentiated by
chemokines, resulting in activation of integrin adhesiveness (Step
2), firm adherence (Step 3) and endothelial transmigration (Step 4)
(T. A. Springer, Cell 76, 301 (1994)). This "multi-step paradigm"
holds that tissue-specific migration is regulated by a discrete
combination of homing receptor and chemokine receptor expression on
a given circulating cell, allowing for recognition of a pertinent
"traffic signal" displayed by the relevant vascular adhesive
ligands and chemokines expressed within target endothelium in an
organ-specific manner. Following engagement of homing receptor(s)
directing trafficking of cells to bone marrow, several lines of
evidence indicate that one chemokine in particular, SDF-1 (CXCL12),
plays an essential role in Step 2-mediated recruitment of cells to
this site (T. Lapidot, A. Dar, O. Kollet, Blood 106, 1901 (2005);
A. Peled et al., Science 283, 845 (1999); D. A. Sipkins et al.,
Nature 435, 969 (2005)). However, expression of SDF-1 is not
limited to the marrow, and this chemokine is typically expressed at
all sites of tissue injury/inflammation (R. Sackstein, Immunol.
Rev. 230: 140-163 (2009)).
[0007] The most efficient effectors of Step 1 rolling interactions
are the selectins (E-, P- and L-selectin) and their ligands (R.
Sackstein, Curr Opin Hematol 12, 444 (2005)). As the name implies,
selectins are lectins that bind to specialized carbohydrate
determinants, consisting of sialofucosylations containing an
.alpha.(2,3)-linked sialic acid substitution(s) and an
.alpha.(1,3)-linked fucose modification(s) prototypically displayed
as the tetrasaccharide sialyl Lewis X (sLe.sup.x;
Neu5Ac.alpha.2-3Gal.beta.1-4[Fuc.alpha.1-3]GlcNAc.beta.1-)) (R.
Sackstein, Curr Opin Hematol 12, 444 (2005); M. J. Polley et al.,
Proc Natl Acad Sci USA 88, 6224 (1991)). The sLex glycan is
recognized by a variety of monoclonal antibodies (mAbs), including
the mAb known as "HECA452." E- and P-selectin are expressed on
vascular endothelium (P-selectin also on platelets), and L-selectin
is expressed on circulating leukocytes (R. Sackstein, Curr Opin
Hematol 12, 444 (2005)). E- and P-selectin are typically inducible
endothelial membrane molecules that are prominently expressed only
at sites of tissue injury and inflammation, where their expression
is generated in response to inflammatory cytokines. However, the
microvasculature of bone marrow and skin constitutively expresses
these selectins, and they play a key role in steady-state
recruitment of blood-borne cells to these sites (R Sackstein J
Invest. Dermatology, 122:1061-1069 (2004)). Importantly, within all
inflammatory sites and sites of tissue injury/damage in primates
(but not rodents), E-selectin is the principal vascular selectin
mediating cell recruitment, as the promoter element responsive to
the inflammatory cytokines TNF and IL-1 has been deleted from the
P-selectin gene. Thus, at all inflammatory sites of humans,
vascular E-selectin expression is more pronounced than that of
P-selectin (R. Sackstein, Immunol. Rev. 230: 140-163 (2009)).
[0008] Two principal ligands for E-selectin have been identified on
human hematopoietic stem/progenitor cells (HSPC), the highly
sialofucosylated CLA glycoform of PSGL-1 (Z. Laszik et al., Blood
88, 3010 (1996), R. Sackstein, Immunol. Rev. 230: 140-163 (2009))
and a specialized sialofucosylated CD44 glycoform known as
Hematopoietic Cell E-/L-selectin Ligand (HCELL) (C. J. Dimitroff,
J. Y. Lee, S. Rafii, R. C. Fuhlbrigge, R. Sackstein, J Cell Biol
153, 1277 (2001); C. J. Dimitroff, J. Y. Lee, R. C. Fuhlbrigge, R.
Sackstein, Proc Natl Acad Sci US A 97, 13841 (2000)). CD44 is a
rather ubiquitous cell membrane protein, but the HCELL phenotype is
found predominantly on human HSPCs. In contrast to HCELL's
restricted distribution, CLA/PSGL-1 is widely expressed among
hematopoietic progenitors and more mature myeloid and lymphoid
cells within the marrow (Z. Laszik et al., Blood 88, 3010 (1996),
R. Sackstein, Immunol. Rev. 230: 140-163 (2009)). HCELL is
operationally defined as CD44 that binds to E-selectin and
L-selectin under shear conditions, and is identified by Western
blot analysis of cell lysates as a CD44 glycoform reactive with
E-selectin-Ig chimera (E-Ig) and with mAb HECA452, which recognizes
sialyl Lewis X (and, in addition to sLex, HECA452 recognizes the
tetrasaccharide isomer of sLex known as a "sialylated Lewis a"
(sLea) in which fucose is attached in .alpha.(1,4)-linkage to
N-acetylglucosamine within a type 1 lactosamine backbone). In
addition to CLA and HCELL, human leukocytes and HSPCs can also
express a CD43 glycoform known as "CD43-E" which can serve as an
E-selectin ligand (Fuhlbrigge et al Blood 107:1421-1426 (2006),
Merzaban et al Blood 118:1774-1783 (2011)), and, in mouse
leukocytes, another E-selectin ligand known as E-selectin Ligand-1
(ESL-1) has been described (Merzaban et al Blood 118:1774-1783
(2011)). In all glycoprotein selectin ligands (e.g., CD43-E, CLA,
and HCELL) binding to E-selectin (and, also, to L-selectin and
P-selectin) is critically dependent on .alpha.(2,3)-sialic acid and
.alpha.(1,3)-fucose modifications (C. J. Dimitroff, J. Y. Lee, S.
Rafii, R. C. Fuhlbrigge, R. Sackstein, J Cell Biol 153, 1277
(2001); C. J. Dimitroff, J. Y. Lee, R. C. Fuhlbrigge, R. Sackstein,
Proc Natl Acad Sci US A 97, 13841 (2000); R. Sackstein, C. J.
Dimitroff, Blood 96, 2765 (2000); C. J. Dimitroff, J. Y. Lee, K. S.
Schor, B. M. Sandmaier, R. Sackstein, J Biol Chem 276, 47623
(2001)). On human HSPCs, HCELL displays the pertinent
sialofucosylated selectin binding determinants on N-glycans (C. J.
Dimitroff, J. Y. Lee, S. Rafii, R. C. Fuhlbrigge, R. Sackstein, J
Cell Biol 153, 1277 (2001); R. Sackstein, C. J. Dimitroff, Blood
96, 2765 (2000)). In vitro assays of E- and L-selectin binding
under hemodynamic shear stress indicate that HCELL is the most
potent ligand for these molecules expressed on any human cell (C.
J. Dimitroff, J. Y. Lee, S. Rafii, R. C. Fuhlbrigge, R. Sackstein,
J Cell Biol 153, 1277 (2001); C. J. Dimitroff, J. Y. Lee, K. S.
Schor, B. M. Sandmaier, R. Sackstein, J Biol Chem 276, 47623
(2001)). Importantly, though E-selectin is constitutively expressed
on microvascular endothelium of the marrow and skin, this molecule
is prominently expressed on endothelial beds at all sites of
inflammation--both acute and chronic types--regardless of whether
it is induced by direct tissue injury (e.g., burns, trauma,
decubitus ulcers, etc.), ischemic/vascular events (e.g., myocardial
infarct, stroke, shock, hemorrhage, coagulopathy, etc.), infections
(e.g., cellulitis, pneumonia, meningitis, SIRS, etc.), neoplasia
(e.g., breast cancer, lung cancer, lymphoma, etc.),
immunologic/autoimmune conditions (e.g., graft vs. host disease,
multiple sclerosis, diabetes, inflammatory bowel disease, lupus
erythematosus, rheumatoid arthritis, psoriasis, etc.), degenerative
diseases (e.g., osteoporosis, osteoarthritis, Alzheimer's disease,
etc.), congenital/genetic diseases (e.g., muscular dystrophies,
lysosomal storage diseases, Huntington's disease, etc.), adverse
drug effects (e.g., drug-induced hepatitis, drug-induced cardiac
injury, etc.), toxic injuries (e.g., radiation exposure(s),
chemical exposure(s), alcoholic hepatitis, alcoholic pancreatitis,
alcoholic cardiomyopathy, cocaine cardiomyopathy, etc.), metabolic
derangements (e.g., uremic pericarditis, metabolic acidosis, etc.),
iatrogenic conditions (e.g., radiation-induced tissue injury,
surgery-related complications, etc.), and/or idiopathic processes
(e.g., amyotrophic lateral sclerosis, Parsonnage-Turner Syndrome,
etc.).
[0009] Among the various aspects of the present disclosure is the
provision of methods for the treatment of a disease, disorder or
medical condition having E-selectin expression on vascular
endothelial cells and/or leukocyte infiltrates within affected
tissue(s). E-selectin binds to sialylated, fucosylated
carbohydrates (e.g., members of the sialylated Lewis X and Lewis A
families) present natively on the surface of certain leukocytes and
hematopoietic stem/progenitor cells, i.e., myeloid cells (e.g.,
neutrophils, monocytes, eosinophils, macrophages, etc.), dendritic
cells (both lymphoid- and myeloid-derived), lymphocytes (e.g.,
naive and memory T cells, naive and memory B cells, effector T
cells, regulatory T cells, natural killer cells (NK cells), etc.),
hematopoietic progenitor cells, and hematopoietic stem cells. These
cell types are thus found at acute and chronic inflammatory sites,
recruited by vascular E-selectin to such inflammatory sites.
Leukocytes and HSPCs characteristically display L-selectin.
L-selectin, itself, binds to sialylated, fucosylated carbohydrates
such as sLex. Thus, inflammatory sites have cells that express
E-selectin (on endothelial cells) and L-selectin (on infiltrating
leukocytes and HSPCs).
[0010] The ability to achieve intended outcome(s) of cell-based
therapeutics is critically dependent on delivery of administered
cells to sites where they are needed, and, also, to the
localization of the administered cells within specific tissue
microenvironments. Accordingly, there is a need in the art for
methods to enhance vascular delivery of administered cells to sites
of tissue injury/damage, to sites of inflammation, to sites of
cancer, and to sites of infection. There is also a need in the art
to enhance lodgement/colonization of the administered cells within
the affected tissue. Briefly, therefore, the present disclosure is
directed to methods of treating a disease, disorder or medical
condition manifesting as inflamed and/or damaged tissue and/or
cancer in a subject, the methods comprising administering to the
subject a cell population that expresses an E-selectin ligand
and/or an L-selectin ligand at a level that exceeds that of a
native population of the cells. The administration occurs
coincident with expression of E-selectin on endothelial cells
within the target tissue (e.g., inflamed and/or damaged tissue,
cancerous tissue) and/or coincident with accumulation of leukocytes
(e.g., leukocytic infiltrates) within the target tissue. The
administration may be by direct injection within the target tissue
and/or via the vasculature and/or via other means as described in
further detail below.
[0011] The present disclosure is further directed to a method for
the treatment of inflammation with a viable population of cells
that express an E-selectin and/or L-selectin ligand. The viable
cell population expresses an E-selectin ligand and/or an L-selectin
ligand at a level that exceeds the level of expression of a native
population of the cells. The administration occurs coincident with
expression of E-selectin on endothelial cells within the target
tissue (e.g., inflamed and/or damaged tissue, cancerous tissue)
and/or coincident with accumulation of leukocytes (e.g., leukocytic
infiltrates) within the target tissue. The administration may be by
direct injection into the target tissue and/or via the vasculature
(and/or via other means as described in further detail below) and
treatment of the disease, disorder or medical condition need not be
accompanied by long-term engraftment of the administered cells
(i.e., treatment could be achieved either with transient
colonization or with long-term persistence/longevity of
administered cells at the treatment site or with proliferation of
administered cells at the treatment site or with differentiation
and/or maturation of administered cells at the treatment site).
[0012] The present disclosure is further directed to a viable
population of cells that express an E-selectin and/or L-selectin
ligand for use in the manufacture of a medicament for treating
inflammation in a subject. The viable cell population expresses an
E-selectin ligand and/or an L-selectin ligand at a level that
exceeds the level of expression of a native population of the
cells. The administration occurs coincident with expression of
E-selectin on endothelial cells within the target tissue (e.g.,
inflamed and/or damaged tissue, cancerous tissue) and/or coincident
with accumulation of leukocytes (e.g., leukocytic infiltrates)
within the target tissue. The administration may be by direct
injection into the target tissue and/or via the vasculature and/or
via other means as described in further detail below.
[0013] The present disclosure is further directed to a viable
population of cells that express an E-selectin ligand and/or an
L-selectin ligand for use in the manufacture of a medicament for
the treatment of a tumor/malignant disease, the treatment
comprising administering to the subject the population of cells
that express an E-selectin ligand and/or an L-selectin ligand,
wherein the population expresses the E-selectin ligand and/or
L-selectin ligand at a level that exceeds the level of expression
of a native population of the cells, wherein said treatment
comprises administering the population coincident with E-selectin
expression on endothelial cells within the tumor/malignant tissue
and/or coincident with accumulation of leukocytes within the
tumor/malignant tissue.
[0014] The present disclosure is further directed to a viable
population of cells that express an E-selectin ligand and/or an
L-selectin ligand for use in the manufacture of a medicament for
the treatment of a diseased state manifesting inflammation, the
treatment comprising administering to the subject the population of
cells that express an E-selectin ligand and/or an L-selectin
ligand, wherein the population expresses the E-selectin ligand
and/or L-selectin ligand at a level that exceeds the level of
expression of a native population of the cells, wherein said
treatment comprises administering the population coincident with
the onset of E-selectin expression on endothelial cells within the
tumor/malignant tissue and/or coincident with accumulation of
leukocytes within the tumor/malignant tissue.
[0015] Other methods involving the administration (e.g., via the
vasculature and/or via direct injection into tissue and/or via
other means) described herein include, for example, method of
enhancing cell delivery and colonization in an inflamed and/or
damaged tissue or site of cancer in a subject (collectively, a
"target" tissue), methods of enhancing cell delivery into a target
tissue of a subject and/or enhancing tissue colonization in the
target tissue of the subject, methods of improving cellular
delivery to a target tissue in a subject, methods of enhancing cell
delivery and colonization into a target tissue of a subject, method
of enhancing homing and engraftment of a cell population within a
target tissue in a subject, methods of treating an inflammatory
condition in a subject, methods of enhancing tissue
repair/regeneration in a subject, and methods of treating
tumor/malignant disease in a subject.
[0016] In general, any of a variety of inflammatory conditions
(e.g., acute and/or chronic) and/or damaged tissue may be treated
in accordance with the methods described herein, including, but not
limited to those initiated by direct tissue injury (e.g., burns,
trauma, decubitus ulcers, etc.), ischemic/vascular events (e.g.,
myocardial infarct, stroke, shock, hemorrhage, coagulopathy, etc.),
infections (e.g., cellulitis, pneumonia, meningitis, SIRS, etc.),
neoplasia (e.g., breast cancer, lung cancer, lymphoma, etc.),
immunologic/autoimmune conditions (e.g., graft vs. host disease,
multiple sclerosis, diabetes, inflammatory bowel disease, lupus
erythematosus, rheumatoid arthritis, psoriasis, etc.), degenerative
diseases (e.g., osteoporosis, osteoarthritis, Alzheimer's disease,
etc.), congenital/genetic diseases (e.g., epidermolysis bullosa,
osteogenesis imperfecta, muscular dystrophies, lysosomal storage
diseases, Huntington's disease, etc.), adverse drug effects (e.g.,
drug-induced hepatitis, drug-induced cardiac injury, etc.), toxic
injuries (e.g., radiation exposure(s), chemical exposure(s),
alcoholic hepatitis, alcoholic pancreatitis, alcoholic
cardiomyopathy, cocaine cardiomyopathy, etc.), metabolic
derangements (e.g., uremic pericarditis, metabolic acidosis, etc.),
iatrogenic conditions (e.g., radiation-induced tissue injury,
surgery-related complications, etc.), and/or idiopathic processes
(e.g., amyotrophic lateral sclerosis, Parsonnage-Turner Syndrome,
etc.).
[0017] In certain embodiments, for example, the E-selectin ligand
and/or L-selectin ligand expressed by the cell population is
selected from one or more of Hematopoietic Cell E-/L-selectin
Ligand (HCELL), Neural Cell Adhesion Molecule E-selectin Ligand
(NCAM-E), CD43E, and CLA. In one embodiment, the E-selectin ligand
is Hematopoietic Cell E-/L-selectin Ligand (HCELL) and/or Neural
Cell Adhesion Molecule E-selectin Ligand (NCAM-E). In another
embodiment, the E-selectin ligand is HCELL. In another embodiment,
the E-selectin ligand is NCAM-E. In another embodiment, the
L-selectin ligand is HCELL. Notably, since E-selectin is expressed
within endothelial beds of the affected tissue and leukocytes
characteristically express L-selectin, expression of HCELL, a
potent E-selectin and L-selectin ligand, would serve to promote
tissue lodgement expressly within the microenvironments of most
intense immunoreactivity/tissue damage.
[0018] As discussed elsewhere herein in greater detail, a variety
of methods may be utilized to prepare the population of cells for
administration to the subject. In one embodiment, the population is
prepared by contacting the cell or a population of cells with
glycosyltransferase together with appropriate donor nucleotide
sugar. For example, glycan engineering may be used to
sialofucosylate CD44 to enforce the expression of Hematopoietic
Cell E-selectin Ligand (HCELL), by glycosyltransferase-enforced
expression of fucose residues (fucosylation), sialic acid residues
(sialylation), or both (sialofucosylation). Alternatively,
glycosyltransferases such as a fucosyltransferase may be used to
transfer intact glycan structures such as sialyl-Lewis.sup.X or
sialyl-Lewis.sup.a to cell surfaces. In addition, non-enzymatic
methods may be used to covalently or non-covalently bind E-selectin
and/or L-selectin ligands to cell surfaces. For example, aptamers,
sLex (sialyl-Lewis.sup.X), glycomimetics and/or peptidomimetics of
sLex glycans, sLea (sialyl-Lewis.sup.a), glycomimetics and/or
peptidomimetics of sLea glycans, and other moieties that bind
E-selectin and/or L-selectin may be non-covalently bound to cell
surfaces using biotin-streptavidin pairs or covalently bound to the
cell surfaces; whether covalent or non-covalent, the binding may be
direct or via a linker. By way of further example, phage display
particles or antibodies that bind E-selectin and/or L-selectin may
be covalently or non-covalently bound to the cell surface, in each
case mediating adherence of treated cells to E-selectin and/or
L-selectin.
[0019] In general, and independent of the manner of preparing the
cell population, the manner of preparation provides a modified cell
population having a viability of at least 70% at 24 hours from the
time of modification. In one such embodiment, the modified cell
population has a viability of at least 80% at 24 hours from the
time of the modification. In some embodiments, the modified cell
population has a viability of at least 85% at 24 hours from the
time of the modification. In some embodiments, the modified cell
population has a viability of at least 90% at 24 hours from the
time of the modification. Viability may be determined by methods
known in the art such as trypan blue exclusion, or by dual color
flow cytometry assessment for propidium iodide and Annexin V
staining. Preferably, the phenotype of the cells (other than the
cell surface modification) is preserved after treatment. By
preserved phenotype it is meant the cell maintains its native
function and/or activity. For example, if the cell is a stem cell
it retains its regenerative potency, e.g., its totipotency or its
pluripotency or its multipotency or its unipotency.
[0020] The modified cell populations are viable (i.e., have a
viability of at least 70% at 24 hours from the time of modification
as described above) and have enhanced binding to E-selectin and/or
L-selectin relative a native population of the cells. The
administration of cells may be via the vasculature and/or by direct
injection into the tissue (and/or by other means as described in
detail below). In one embodiment, the modified cell population is
administered at a time coincident with the onset of inflammation or
the infiltration of leukocytes into tissue. In another embodiment,
the modified cell population is administered just prior to the
onset of inflammation or the infiltration of leukocytes into the
tissue.
[0021] In cases where cells undergo glycan engineering to enforce
sLex expression or undergo decoration with sLex structures (e.g.,
via avidin-spreptavidin techniques), measurement of increased sLex
expression on treated cells can be performed by fluorescence
staining with mAb HECA452 or any other mAb which recognizes sLex
determinants, followed by flow cytometry to detect cell
fluorescence intensity. The predetermined fluorescence threshold of
the modified cell population is determined by first analyzing a
sample of native (untreated) cells. Increases in sLex of treated
cells is defined as increase percentage of marker-positive cells
(e.g., HECA452-reactive cells) of greater than 10% compared to
native population of cells and/or by a 10% increase in mean channel
fluorescence intensity over that of the baseline (untreated) cell
population. For detecting whether the treated cell population has
increased binding to E-selectin, binding to E-selectin can be
assessed using either parallel plate flow chamber studies under
shear stress conditions as described herein or via staining with
E-selectin-Ig chimera and assessment of fluorescence intensity by
flow cytometry. The control (baseline) sample of cells is assayed
using the functional E-selectin binding assay described elsewhere
herein, or by another generally accepted E-selectin fluorescence
binding assay known in the art. E-selectin binding fluorescence
levels are measured for the control (baseline) population sample.
Enhanced binding to E-selectin is defined as treated cells having
increased adherence to E-selectin in an E-selectin-specific binding
assay. In one embodiment, enhanced binding to E-selectin can be
defined by a fluorescence shift in an E-selectin binding assay
using fluorochrome-conjugated reagents, e.g., binding to
E-selectin-Ig chimera as assessed by flow cytometry, in which the
number of cells within the population that possess E-selectin
binding increases by at least 10% more than that of the base-line
binding (i.e., increase of 10% in marker-positive population)
and/or is at least 10% greater in mean channel fluorescence than a
predetermined fluorescence threshold (associated with the native
cell population). In another embodiment, the percentage of cells
that possess increased E-selectin reactivity is increased by 25%
and/or the modified population exceeds the predetermined
fluorescence threshold by 25%. In another embodiment, the modified
population exceeds the baseline reactivity and/or predetermined
fluorescence threshold by 50%. In another embodiment, the
percentage of cells that possess increased E-selectin reactivity is
increased by 75% over that of the baseline population of
E-selectin-binding cells and/or the modified population exceeds the
predetermined fluorescence threshold by 75%. In another embodiment,
at least 90% of the cells in the modified population exceed the
baseline E-selectin-binding population and/or the predetermined
fluorescence threshold. In another embodiment, at least 95% of the
cells in the modified population exceed the baseline
E-selectin-binding population and/or the the predetermined
fluorescence threshold.
[0022] Enhanced binding to L-selectin may be determined by an
increase in binding to L-selectin using a functional L-selectin
binding assay with high specificity such as a parallel plate flow
chamber under dynamic shear stress conditions or a Stamper-Woodruff
Assay, wherein the cell treatment increases the percentage of cells
supporting L-selectin-mediated adherence. In the case of parallel
plate assays, the treated cell population displays at least a 10%
increase in tethering/rolling adhesive interactions to L-selectin
(affixed and displayed on the chamber plastic or glass support
surface) compared to that of baseline (untreated cells). In the
case of the Stamper-Woodruff assay, increased L-selectin lymphocyte
adherence is defined by at least a 10% increase in treated cell
binding to L-selectin.sup.+ lymphocytes under a rotatory shear of
80 rpm; baseline cell binding is assessed on the untreated (control
population), and directly compared to that in the treated cell
population.
[0023] Unless otherwise defined, all technical and scientific terms
used herein have the same meaning as commonly understood by one of
ordinary skill in the art to which this disclosure belongs.
Although methods and materials similar or equivalent to those
described herein can be used in the practice or testing of the
present disclosure, suitable methods and materials are described
below. All publications, patent applications, patents, and other
references mentioned herein are incorporated by reference in their
entirety. In case of conflict, the present specification, including
definitions, will control. In addition, the materials, methods, and
examples are illustrative only and not intended to be limiting.
[0024] Other objects and features will be in part apparent and in
part pointed out hereinafter.
BRIEF DESCRIPTION OF THE DRAWINGS
[0025] The patent or application file contains at least on drawing
executed in color. Copies of this patent or patent application with
color drawings(s) will be provided by the Office upon request and
payment of the necessary fee.
[0026] FIGS. 1A-1D. Effects of Exofucosylation (FTVI treatment) on
E-selectin ligand expression by mouse mesenchymal stem cells
(MSCs). (FIG. 1A) MSCs derived from C57BL/6 marrow lack expression
of CD45 and express characteristic mouse MSC markers Sca-1, CD29,
CD44, CD73 and CD105. MSCs natively lack reactivity with mAb
HECA452 and with E-selectin-Ig chimera (mE-Ig) (istoype=red color
and antibody=blue color). (FIG. 1B) Fucosyltransferase VI
(FTVI)-modified MSC (solid line) stained positive for mAbs HECA452
and were reactive with mE-Ig. Digestion of FTVI-modified MSCs with
bromelain and proteinase K (shaded histogram) significantly reduced
murine E-selectin-Ig chimera (mE-Ig) reactivity, but not HECA452
staining, indicating that bromelain-sensitive glycoproteins serve
as the principal E-selectin ligand(s) on glycan-modified (i.e.,
FTVI-treated) MSCs. Dashed line represents staining controls
(isotype control for HECA452 staining and calcium chelation with
EDTA for mE-Ig staining). (FIG. 1C) Western blot analysis of
HECA452 (left) and mE-Ig (right) reactivity of cell lysates of
unmodified MSCs (-) and FTVI-modified MSCs (+). FTVI modification
induced HECA452- and mE-Ig-reactive moieties predominantly on a
doublet glycoprotein band of .about.100 kDa. (FIG. 1D) CD44 was
immunoprecipitated from equivalent amounts of cell lysate from
FTVI-modified (+) or unmodified (-) MSCs. Immunoprecipitates were
then electrophoresed and blotted with CD44 (mAbs KM114 and IM7;
left) and HECA452 (right).
[0027] FIG. 2. Parallel plate flow chamber assay of FTVI-modified
and unmodified wild type MSC adherence to TNF-.alpha. treated human
umbilical vein endothelial cells (HUVEC). FTVI modification
markedly improved MSC adhesion to HUVEC at 0.5 dynes/cm.sup.2, with
binding evident at shear stress in excess of 20 dynes/cm.sup.2
Treatment of HUVEC with anti-E-selectin (anti-CD62E)
function-blocking mAb reduced rolling adhesive interactions of
FTVI-modified MSCs to levels similar to that of unmodified MSCs.
Similarly, removal of sLex determinants by sialidase treatment of
FTVI-modified MSCs reduced adhesion to levels equivalent to
unmodified MSCs.
[0028] FIGS. 3A-3C. Effects of intravenous administration of
unmodified and FTVI-modified MSC on hyperglycemia in new onset
diabetic NOD mice. (FIG. 3A) Hyperglycemic NOD injected with PBS
(untreated control) showed no reversal of hyperglycemia (glucose
levels above 600 mg glucose/dL). As compared to infusion of
unmodified MSCs (FIG. 38), infusion of FTVI-modified MSCs (FIG. 3C)
resulted in a marked increase in number of mice with reversion to
normoglycemia and in the durability of diabetes reversal. Arrows in
X-axis denote days of MSC infusion.
[0029] FIGS. 4A-4H. Immunofluorescence staining of islets to assess
expression of E-selectin and localization of MSCs in the pancreas.
FIGS. 4A-48: Pancreatic islets of (FIG. 4A) diabetic-resistant
BALB/c mice and (FIG. 48) NOD mice were stained for expression of
insulin (green) and E-selectin (red). Islets are demarcated by
dashed line. Compared to BALB/c (FIG. 4A), NOD mice (FIG. 48) show
diminished insulin production due to insulitis. In FIGS. 4C-4G,
cryostat sections of pancreas from MSC-treated NOD mice stained
with DAPI (blue). FIGS. 4C-4D: Staining of sequential sections of
NOD pancreas demonstrates co-localization of endothelial marker
CD31 (FIG. 4C) and E-selectin (FIG. 4D), confirming the presence of
E-selectin on pen-islet endothelial cells. FIG. 4E: Co-staining of
NOD islet with DAPI (blue), T-cell marker CD3 (green) and insulin
(red) (FIG. 4E) reveals characteristic T-cell infiltration at the
margins of the islet. FIGS. 4F-4G: Immunofluorescence images of a
cryostat section stained for infiltrating MSC (visualized with
FITC-conjugated anti-sLex mAb HECA452; green), islet (FIG. 4F)
(visualized by APC-conjugated anti-insulin mAb; red) and
E-selectin-expressing microvessel (FIG. 4G) (visualized with
PE-conjugated anti-E-selectin mAb; red). Staining identifies
HECA452+ MSCs in zones of insulitis, in proximity to
E-selectin-expressing microvessels in the peri-islet area and
clustered within areas of lymphocytic infiltrates (i.e., cells
which characteristically express L-selectin). FIG. 4H: Pancreatic
infiltration of intravenously administered MSCs into NOD and BALB/c
hosts. Accumulation of FTVI-modified MSCs into pancreata of NOD
mice is 3-fold higher compared to that of unmodified MSCs
(p<0.01), whereas no difference in pancreatic infiltrates is
observed in BALB/c host (n=3 mice per group; minimum 30 fields
counted per group at 60.times. magnification).
[0030] FIGS. 5A-5B. FTVI-modification of MSCs does not affect cell
survival or immunosuppressive capacity. (FIG. 5A) Similar levels of
hGH was detected in the serum of NOD mice at different time points
following injection with pHRST-hGH-transduced FTVI-modified or
unmodified MSCs. (FIG. 58) FTVI-modified and unmodified MSCs
equally suppress proliferation of NOD CD4.sup.+ T cells stimulated
with CD3/CD28, indicating that glycan-modification does not
increase MSC capacity to suppress lymphocyte proliferation.
[0031] FIGS. 6A-6D. Lack of CD44 expression abrogates the
anti-diabetic effect of systemically administered FTVI-modified
MSC. (FIG. 6A) As compared to unmodified wild type MSC (FIG. 38),
administration of CD44-deficient MSCs shows modest anti-diabetic
effect. Only 1 NOD mouse (out of 7) receiving unmodified CD44 KO
MSCs showed reversal of hyperglycemia which was transient (diabetes
recurrence at .about.day 30), and 6 out of 7 diabetic NOD mice
remained hyperglycemic. (FIG. 68) As compared to results in mice
receiving FTVI-modified wild-type MSCs (FIG. 3C), administration of
FTVI-modified CD44 KO MSCs conferred minimal anti-diabetic effects,
with only 1 out of 6 NOD mice showing reversal of hyperglycemia.
(FIG. 6C) Accumulation of MSCs in NOD pancreata was no different in
mice receiving FTVI-modified CD44 KO MSCs (white bar) compared to
mice receiving unmodified CD44 KO MSCs (black bar) (p<0.01), and
in each case was similar to that receiving unmodified MSC (FIG.
4H). MSC infiltrates were quantified at .times.60 magnification.
(FIG. 6D) Both FTVI-modified and unmodified CD44 KO MSCs possess
immunosuppressive capacity, similarly dampening T cell
proliferation in the CD3/CD28 T cell stimulation assay.
[0032] FIG. 7. Characterization of mouse bone marrow derived MSCs.
MSCs were differentiated into osteocytes, adipocytes and
chondrocytes (.times.200 magnification).
[0033] FIG. 8. FTVI modification of CD44.sup.-/- MSCs results in
similar increase in HECA452 reactivity as wild-type (WT) MSCs.
Unmodified MSC (dotted line) show no reactivity with HECA452, while
FTVI-modified MSC (solid line) and FTVI-modified CD44 KO MSC
(filled grey) showed similar levels of staining with HECA452,
indicating that exofucosylation creates sialofucosylated epitopes
on alternative (i.e., non-CD44) scaffolds in CD44 KO MSC.
[0034] FIGS. 9A-9B: Neural stem cells (NSCs) lack E-selectin
ligands but express a number of other cell surface adhesion
molecules. (FIG. 9A) Flow cytometric analysis of HECA452, KM93,
CSLEX-1, E-selectin ligand (binding to E-selectin-Ig chimera
(E-Ig)), and P-selectin ligand (P-selectin-Ig chimera (P-Ig)
binding) expression on NSCs. The corresponding isotype controls
showed overlapping signals for each antibody surveyed i.e. RatlgM
(for HECA-452; MFI: 1.9), Mouse IgM (for KM93 and CSLEX-1; MFI:
2.7), and human IgG.sub.1 (for E-Ig and P-Ig; MFI: 3.5). A
histogram plot representing a typical E-Ig binding profile
illustrates that over 99% of the cells consistently express E-Ig
binding following glycosyltransferase-programmed stereosubstitution
(GPS) via cell surface treatment with Fucosyltransferase VI. (FIG.
9B) Flow cytometric analysis of CD43 (S7 and 1B11), PSGL-1 (2PH1,
4RA10), CD44 (IM7, KM114), NCAM, PSA, CD49d, CD49e, CD29, LPAM-1,
CD11a, CD18, and CXCR4. Dotted line is isotype control, black line
is specific antibody. All results displayed are representative of
n=5 flow cytometry experiments performed on NSCs.
[0035] FIGS. 10A-10C: GPS treatment (i.e.,
.alpha.(1,3)-exofucosylation via FTVI treatment) of NSCs generates
sialofucosylations mainly on glycoproteins, some of which are
glycophosphatidylinositol (GPI)-linked. (FIG. 10A) Flow cytometric
analysis of HECA452, CD15, KM93, CSLEX1, E-Ig and P-Ig reactivity
on BT-NSCs (black bars) and GPS-NSCs (grey bars). The corresponding
isotype controls for each antibody surveyed were: Rat IgM (for
HECA-452; MFI: 1.8), Mouse IgM (for CD15, KM93, and CSLEX-1; MFI:
1.9), and human IgG.sub.1 (for E-Ig and P-Ig; MFI: 3.2). Results
displayed are representative of five separate experiments. (FIG.
10B) Flow cytometric analysis of HECA452 reactivity of GPS-NSCs
undigested (black bars) or digested with bromelain (grey bars)
prior to GPS treatment. Values are means.+-.SEM. (n=3 for each
group). (FIG. 10C) Flow cytometric analysis of HECA452 reactivity
of GPS-NSCs undigested (black bars) or digested with phospholipase
C (PI-PLC) to cleave GPI anchors (grey bars). Values are
means.+-.SEM. (n=3 for each group).
[0036] FIGS. 11A-11C: GPS treatment of NSCs creates transient
E-selectin ligands at 100, 120 and 140-kDa which correspond to
HCELL and N-CAM-E. (FIG. 11A) CD44 was immunoprecipitated (with IM7
and KM114 mAb to CD44) from equivalent amounts of cell lysates from
GPS-treated (GPS) or buffer-treated (BT) NSCs. Western blot
analysis was performed on immunoprecipitates of NSCs and
supernatants (SN) from the immunoprecipitates, which were
electrophoresed and blotted with HECA452, E-Ig, and CD44. (FIG.
11B)N-CAM was immunoprecipitated (with N-CAM 13) from equivalent
amounts of cell lysates from GPS-treated (+) or buffer-treated (-)
NSCs lysates that had been either treated with PNGaseF (+) or not
(-) Immunoprecipitates were then electrophoresed and blotted with
E-Ig and N-CAM. Staining with E-Ig was performed in the presence of
Ca.sup.2+. (FIG. 11C) NSCs were treated with GPS on Day 0 and
cultured for another 3 days in normal growth media. Every 24 hours
aliquots of cells were removed and assayed for E-selectin ligand
activity by flow cytometry. See also FIGS. 11A-11C, 12A-12B,
13A-13F.
[0037] FIGS. 12A-12B: GPS-NSCs have markedly enhanced
shear-resistant adhesive interactions with endothelial E-selectin
under defined shear stress conditions. (FIG. 12A) BT-NSCs or
GPS-NSCs were perfused over IL-1.beta. and TNF-.alpha. stimulated
HUVECs at 1.0 dyn/cm.sup.2. NSC accumulation was then determined at
shear stresses of 1, 2, 4, 8, 16, 25 and 32 dyn/cm.sup.2. GPS-NSCs
show rolling adhesive interactions on HUVECs at a shear stress of
up to 32 dyn/cm.sup.2. To control for the specificity of binding of
GPS-NSCs, EDTA was added to the assay buffer (EDTA group), or
stimulated HUVECs were pretreated with a function blocking mAb to
E-selectin (anti-E-Sel group) before use in adhesion assays. Values
are means.+-.SEM. (n=4 for each group). P.ltoreq.0.001 for
comparisons of GPS-NSCs to all other groups at all shear stress
levels. (FIG. 12B) Adhesion bar graph for blot rolling assay
(rolling cells/mm.sup.2) for CHO-E cells perfused over SDS-PAGE
immunoblots of HECA-452-reactive membrane glycoproteins of NSCs at
0.6 dyne/cm.sup.2. Immunoprecipitates of CD44/HCELL and panNCAM
from both BT-NSC (black bars) and GPS-NSCs (grey bars) were
resolved by SDS-PAGE and blotted for HECA-452 prior to performing
the assay. To control for the specificity of CHO-E binding to
membrane glycoproteins, EDTA was added to the buffer containing the
CHO-E cells before use in adhesion assays; no cells bound under
this condition (data not shown). Results presented are
representative of multiple runs (n=4) on HECA-452 blots of multiple
(n=3) membrane preparations of NSCs.
[0038] FIGS. 13A-13F: GPS-NSCs exhibit improved homing in an EAE
model in vivo. (FIGS. 13A-13D) GPS-NSCs migrate to the CNS
parenchyma more efficiently than BT-NSCs. 1.times.10.sup.6 GPS-NSCs
or BT-NSCs were labeled with PKH26 dye and were injected
intravenously to MOG-induced EAE mice on day 9 and day 13
post-immunization (PI). (FIG. 13A) Analysis of the forebrain of EAE
mice (on day 17 PI) that either received BT-NSCs or GPS-NSCs,
revealed that lower numbers of PKH26-positive cells are seen in
animals injected with BT-NSCs compared to GPS-NSCs. The yellow
arrowheads indicate NSCs and the white arrows indicate infiltrates.
The white dashed line indicates Meningeal borders. FIGS. 20A-20B
show[[s]] further analysis of these sections to confirm that the
NSCs (PKH26; red) are located outside of Flk-1 vessels (green) and
that they are SOX-2 positive (green). (FIG. 13B) Lumbar-sacral
spinal cords (insert) were harvested on day 17 PI. At day 17 PI,
more GPS-NSCs migrated out of the blood vessels into the spinal
cord parenchyma than BT-NSCs. Blood vessels were visualized by
Flk-1 (VEGFR2; green) staining. The edge of the spinal cord
parenchyma is highlighted with a white dotted line. NSCs labeled
with PKH26 dye are shown in red and nuclei counterstained with
TO-PRO-3 are blue. WM, white matter. V, blood vessels. (FIG. 13C)
The insets show a 3-dimentional view of the migrated NSCs indicated
by the arrows in FIG. 13A. (FIG. 13D) Quantification of numbers of
BT-NSCs and GPS-NSCs per 200.times. migrating per spinal cord area
at day 17 PI were determined. A significant increase in the numbers
of migrating GPS-NSCs over BT-NSCs was evident, * p<0.05. (FIG.
13E) Quantification of biodistribution of NSCs. GPS-NSCs (grey
bars) or BT-NSCs (black bars) were labeled with CFDA-SE and
injected intravenously into MOG-treated C57BL6 mice on day 9 and
day 13 post-immunization. Brain, lymph nodes, spleen, liver and
lung were analyzed 16 hours after the last injection to determine
the percentage of CFSE positive cells present within a defined gate
representing NSCs. Non-EAE mice that received GPS-NSCs or BT-NSCs
were used to standardize the signals observed in each tissue
tested. Mice that did not receive cells were used to determine the
background signal. Error bars represent the standard error of the
mean. Data are representative of 2 separate experiments where 10
mice per group were tested. (FIG. 13F) In vivo confocal
demonstration that exofucosylated NSCs are found in close contact
with CD4 T cells in the spleen in vivo (NSCs are labeled pink and
CD4 T cells in green); this co-localization of NSCs and lymphocytes
would be engendered by NSC HCELL binding to lymphocyte
L-selectin.
[0039] FIGS. 14A-14I: GPS-NSCs contribute to significant
amelioration of EAE symptoms through enhanced neuroprotection.
(FIG. 14A) The EAE clinical scores in C57BL/6 mice immunized with
MOG 35-55 on Day 0 and subsequently injected with 1.times.10.sup.6
GFP-labeled buffer-treated NSCs (BT-NSC; filled red triangles;
n=30), GPS-treated NSCs (GPS-NSC; filled green circles; n=30) or
sham-treated mice (No NSC; filled black circles; n=30) on day 9 and
day 13 after immunization were determined. Mice that received
GPS-NSCs displayed a pronounced clinical improvement compared with
sham-treated mice (p=0.0001) and mice injected i.v. with BT-NSCs
(p=0.006). (FIG. 14B) The cumulative burden of disease was assessed
by performing a linear regression analysis comparing the slope of
the curves in (FIG. 14A). These data highlight GPS-NSCs (green
dotted line) significantly improve the clinical scores above that
of BT-NSCs (red line). Mice receiving either GPS-NSCs or BT-NSCs
displayed significantly improved clinical scores compared to mice
that did not receive NSCs (No NSCs; black line). These data also
suggest that BT-HSPCs (blue line) and GPS-HSPCs (purple line)
worsen disease (see FIG. 21C). (FIG. 14C) Neuropathology at day 30
PI of the brain from EAE mice injected with NSCs was analyzed by
staining with anti-CD11 b mAb (green) and the nuclear label To-Pro3
(blue). GPS-NSC injection leads to significantly less injury per
brain section as measured by numeration of CD11b
macrophage/microglia from 20 different sections of 3 different
spinal cords. Bar graphs depict the numeration of CD11b
macrophage/microglia in spinal cord sections per high power field
(HPF) from EAE mice that received No NSC, BT-NSC, or GPS-NSC and
also the numeration of infiltrates per HPF were calculated based on
To-Pro3 staining. White boxes correspond to higher magnification
images. Yellow arrowheads correspond to activated microglia and
white arrows correspond to infiltrates in the meninges (m). Note
that the microglia in the No NSC samples are more activated than
those found in the BT-NSC and GPS-NSC samples. Also the size of the
infiltrates in the meninges is larger in the No NSC samples than in
the BT-NSC samples. Scale bars, 100 .mu.m for top panels. Scale
bars, 50 .mu.m for bottom panels. (FIG. 14D) Neuropathology of the
brain from EAE mice injected with NSCs was analyzed by staining 20
different sections of 3 separate brains from mice that either
received no NSCs (EAE No NSCs), BT-NSC (EAE BT-NSCs), or GPS-NSC
(EAE GPS-NSCs) with CD4 (to measure T cell infiltrations), CNPase
(to quantify remyelinating cells), Olig-2 (to measure
oligodendroglial differentiation) or SOX-9 (to measure multipotency
of neural precursors) (green) and To-Pro3 (blue). GPS-NSC injection
lead to significantly less T cell infiltrations, enhanced
remyelination, higher numbers of oligodendroglia, and preservation
of progenitor numbers. (FIG. 14E) Bar graphs depict the numeration
of CD4 T, CNPase, Olig2, SOX-9 cells in brain sections per high
power field (HPF) from EAE mice that received No NSC, BT-NSC, or
GPS-NSC (as outlined in (FIG. 14D)), indicating that animals that
received GPS-NSCs display enhanced neuroprotection of progenitor
cells. (FIGS. 14F-14I) GPS-NSC and BT-NSC injection leads to
increased axonal regeneration and axonal protection compared to No
NSC control as measured by increased GAP-43 (green; p<0.001)
staining (FIG. 14F) and by decreased staining with the monoclonal
antibody SMI32 (red; p<0.001) (FIG. 14H) as assessed by
quantitative confocal imaging of GAP43 pixel intensity in more than
500 individual measurements. To-Pro3 staining dye was used to
detect cell nuclei (blue). (FIGS. 14G-14H) Based on quantitative
confocal imaging of more than 500 individual measurements of pixel
intensity (Imitola, J., Cote, D., et al. 2011) graphical
representation of GAP-43 (FIG. 14G) and SMI32 (FIG. 14I) was
determined; note that SMI32 patterns (FIG. 14I) demonstrated axonal
ovoids in animals with EAE but reduction in animals injected with
NSCs (FIG. 14I) and SMI32 pixel intensity showed a gradual
correction of axonal integrity in animals with GPS-NSCs. There is a
reduction of axonal ovoid and axonal fragments compared to controls
and BT-NSCs as depicted in the cartoon below (FIG. 14I) Scale bar,
100 .mu.m except for SMI32 staining where scale bar, 50 .mu.m.
[0040] FIG. 15: Inflammatory cytokine treatment does not induce
selectin ligand expression on mouse NSCs. NSCs were stimulated with
10 ng/ml of TNF.alpha., 10 ng/ml IL-1.beta., 10 ng/ml IFN.gamma.
independently or in combination (all at 10 ng/ml). At 24 h, NSCs
were harvested and analyzed by flow cytometry for E-selectin
binding. Controls included untreated NSCs and Kg1a cells (positive
control for E-selectin binding).
[0041] FIGS. 16A-16C: HCELL is the only E-selectin ligand created
by GPS treatment in one (exemplary) human NSC line (CC-2599). (FIG.
16A) Flow cytometric analysis of CD15, CSLEX-1, HECA452, and
E-selectin ligand (E-Ig binding), expression on human NSCs either
treated with GPS (grey bars) or buffer-treated (BT; black bars).
The mean fluorescence intensity is shown for each antibody
measured. (FIG. 16B) Flow cytometric analysis of CD44, PSGL-1,
NCAM, and CD43. (FIG. 16C) Western blot analysis of E-Ig reactivity
of NSC lysates from mouse and human sources. CD44 and NCAM were
immunoprecipitated from equivalent amounts of cell lysates from
GPS-treated (+) or buffer-treated (-) mouse NSCs or human NSCs.
Immunoprecipitates were then electrophoresed and blotted with E-Ig.
Staining of GPS-treated NSCs with E-Ig was performed in the
presence of Ca.sup.2+.
[0042] FIG. 17: GPS treatment does not affect of the ability of
NSCs to form neurospheres. 200 viable GFP.sup.+ NSCs were plated
per well in a 96 well plate immediately following GPS treatment for
7 days. The resulting neurospheres were counted and neurosphere
frequency was calculated as the number of neurospheres divided by
number of cells plated. There was no statistically significant
difference in the density of neurospheres or the number of
neurospheres formed between BT-NSCs and GPS-NSCs. A representative
image of the GFP.sup.+ neurospheres used for these experiments is
shown where the red fluorescence indicates Nestin expression and
the green fluorescence indicates GFP. Note that BT- and
GPS-GFP.sup.+ NSCs were both able to form neurospheres equally.
This figure is related to FIGS. 11A-11C.
[0043] FIGS. 18A-18D: GPS treatment does not affect the
differentiation capacity of NSCs into neurons (FIG. 18A),
astrocytes (FIGS. 18B, 18D) or oligodendrocyte precursors (FIGS.
18C, 18D). 1.times.10.sup.5 BT- and GPS-NSC were cultured in the
appropriate differentiation media and after 120 hours, numbers of
MAP-2.sup.+ neurons (FIG. 18A), GFAP.sup.+ astrocytes (FIGS. 188,
18D), and NG2.sup.+ oligodendrocytes (FIG. 18C) were counted per
20.times. vision field. There was no statistically significant
difference between the ability of BT and GPS-NSCs to differentiate
along these three lineages (p=0.1). (FIG. 18D) GFAP.sup.+
astrocytes and NG2.sup.+ oligodendrocytes are shown in red and
To-Pro3 is used to stain nuclei of neural stem cells treated in
vitro with control buffer (BT) or FTVI (GPS). Scale bar, 50 .mu.m.
These figures are related to FIGS. 11A-11C.
[0044] FIGS. 19A-19C: GPS treatment does not affect the
immunomodulation function of NSCs in vitro. Direct in vitro
suppressive effects of NSCs on lymph node cells (LNCs) were
measured by coculturing irradiated NSCs with LNCs isolated from
naive C57BL/6 mice. Both irradiated BT-NSC and GPS-NSC suppressed
.sup.3H-thymidine incorporation (FIG. 19A) into LNCs in response to
concanavalin A (ConA) in a dose-dependent manner and also suppress
inflammatory cytokine production (FIG. 198) as measured by ELISA to
an equal degree; the ratios correspond to numbers of NSCs to
numbers of LNCs (1:4, 1:2, 1:1, 2:1, and 4:1). Note that by
increasing the ratio of NSC:LNC compared to LNC alone (first bar),
the amount of .sup.3H-thymidine incorporation decreased
significantly (p=0.0005). Also note that there was no statistically
significant difference between the ability of BT-NSC and GPS-NSC to
inhibit proliferation (p=0.2). (FIG. 19C) 1.times.10.sup.6 BT-NSCs
or GPS-NSCs were treated for 24 h with or without inflammatory
cytokines (10 ng/mL IFN-.UPSILON. and 15 ng/mL TNF-.alpha.) and
with or without E-Ig (5 ng/mL) prior to RNA extraction and cDNA
synthesis. Real-time RT-PCR revealed the fold change in gene
expression (related to BT or GPS-NSCs alone) calculated using
2.sup.-.DELTA..DELTA.CT method and the relative expression of LIF
mRNA was assayed relative to GAPDH housekeeping gene. Values are
means.+-.SEM (n=4 experiments). These figures are related to FIGS.
11A-11C.
[0045] FIGS. 20A-20B: GPS-NSCs migrate to the CNS parenchyma more
efficiently than BT-NSCs. 1.times.10.sup.6 GPS-NSCs or BT-NSCs were
labeled with PKH26 dye and were injected intravenously to
MOG-induced EAE mice on day 9 and day 13 post-immunization (PI).
Brains were harvested on day 17 PI and snap-frozen before 20 .mu.m
sections were prepared and stained with antibodies: anti-Flk-1
(VEGFR2; green) or anti-SOX-2 (red) to reveal blood vessels and the
position of the NSCs respectively. (FIG. 20A) BT NSCs are primarily
localized with FLK-1.sup.+ endothelial cells whereas GPS-NSCs are
found in the parenchyma as they have crossed the endothelium. These
NSCs express sox-2, a marker for neural stem cells (FIG. 208).
These figures are related to FIGS. 13A-13F.
[0046] FIGS. 21A-21C: GPS treatment generates robust E-selectin
ligand activity on mouse HSPCs but this does not translate into
amelioration of EAE. (FIG. 21A) Flow cytometric analysis of E-Ig
reactivity on BT- and GPS-mouse hematopoietic stem/progenitor cells
(HSPC; Lineage.sup.negC-kit.sup.pos). The mean fluorescence
intensity is shown above each histogram for the hlgG.sub.1 isotype
control, E-Ig reactivity on BT-HSPC and E-Ig reactivity on
GPS-HSPC. These cells were used for in vivo EAE experiments as a
control. (FIG. 218) The EAE clinical scores in C57BL/6 mice
immunized with MOG 35-55 on Day 0 and subsequently injected with
1.times.10.sup.6 buffer-treated HSPC (BT-HSPC; open blue diamonds;
n=30), GPS-treated HSPC (GPS-HSPC; open purple diamonds; n=30) or
sham-treated mice (No NSC; filled black circles; n=30) on day 9 and
day 13 after immunization were determined. No significant
improvement in the clinical scores was evident in mice receiving
either BT- or GPS-HSPC. (FIG. 21C) The cumulative burden of disease
was assessed by performing a linear regression analysis comparing
the slope of the curves in (218). These figures are related to
FIGS. 14A-14H.
[0047] FIG. 22: No evidence of GFP signal was observed at Day 30 PI
from either BT- or GPS-NSCs injected into EAE mice. C57BL/6 Mice
were sacrificed 30 days after immunization with MOG 35-55 (on day
0) and subsequent injection with 1.times.10.sup.6 buffer-treated
NSCs (BT-NSC), GPS-treated NSCs (GPS-NSC) or sham-treated mice (No
NSC) on day 9 and day 13 and immunohistochemistry for GFP.sup.+
cells was performed. At 30 days PI GFP.sup.+ cells were not
identified in sections of relevant study groups, even when
antibodies against GFP (red) were compared to endogenous GFP signal
(EGFP; green). Cultured NSCs before injection were used as a
positive control (NSC-Pre Tx) and showed a robust GFP signal. Scale
bar, 50 .mu.m. This figure is related to FIGS. 14A-14H.
[0048] FIG. 23: Model of neurorestoration afforded by GPS treatment
of native-NSCs surface proteins, CD44 and NCAM, creating novel step
1 effectors, HCELL and NCAM-E, that efficiently bind endothelial
E-selectin in EAE mice. As a result of injury, endothelial cells
and glia may produce injury signals (e.g., SDF-1.alpha. and
E-selectin) that direct GPS-NSCs toward the injury-induced niches
in higher number than in control mice. Despite the increased number
of NSCs recruited, instead of cell replacement, NSCs offer local
modulation of immunity and endogenous regeneration of CNS by
increasing the number of SOX-9+/Olig-2+ oligodendroglia. This
subsequently leads to more mature oligodendroglial cells (CNPase+),
less axonal loss, and more axonal regeneration. Niche molecules
secreted by primitive neural stem cells may promote some of the
effects provided by their increased colonization.
[0049] FIG. 24. FTVII treatment of adipose-derived MSCs from lean
subjects and from obese subjects results in creation of sLex
structures on the cell surface. Bar graphs display flow cytometry
results (MFI, mean.+-.SEM) of sLex expression (HECA452-reactivity)
following .alpha.(1,3)-exofucosylation of adipose-derived MSCs (n=4
samples of MSCs derived from lean and obese subjects).
[0050] FIG. 25. Western blot analysis of cell lysates of
adipose-derived MSCs. Lysates of MSCs from bone marrow (BM-MSCs)
and from lean and obese adipose tissue (A-MSCs) were exofucosylated
with FTVII (+) or treated with buffer alone (-), then were
subjected to SDS-PAGE and blotted with HECA452 or with anti-human
CD44 mAb. Lysates of the hematopoietic cell line KG1a (control) and
the fibroblast cell line PIF were co-electrophoresed and blotted.
KG1a cells express HCELL (HECA-452-reactive CD44 at mw of .about.80
kDa). As shown in the figure, FTVII treatment results in enforced
expression of HCELL (HECA452-reactive CD44) on PIF cells and on
MSCs derived from adipose tissue of lean and obese subjects (upper
panel); staining for expression of CD44 in each lysate is shown
below the HECA452 blot. Expression of HCELL (.about.80 kDa
HECA452-reactive band) is abrogated following sialidase treatment
of cells (lower panel), consistent with sialidase sensitivity of
HCELL expression (i.e., elimination of sLex). Note that HCELL may
appear as a doublet at .about.80 kDa (see profile of FTVII-treated
A-MSC in lower panel), which reflects variable glycosylation of the
core CD44 glycoprotein that does not affect E-selectin or
L-selectin ligand activity of the HCELL molecule.
[0051] FIG. 26. Results of parallel plate flow chamber studies of
MSCs perfused over TNF-stimulated human umbilical vein endothelial
cells (HUVEC). As measured under defined hemodynamic shear
conditions (dynes/cm.sup.2, shown on x-axis),
.alpha.(1,3)-exofucosylation (FTVII treatment) of A-MSCs derived
from lean subjects (LA-MSCs) and from obese subjects (OA-MSCs)
confers potent E-selectin binding on E-selectin displayed on
TNF-stimulated HUVEC; the E-selectin ligand activity of
FTVII-treated (HCELL+) adipose-derived MSCs is equivalent to that
of FTVII-treated (HCELL+) bone marrow-derived MSCs (BM-MSCs; lower
panel). Untreated MSCs have no significant binding interactions on
HUVEC at any of the shear stress levels.
[0052] FIGS. 27A-27C. Analysis of effects of
.alpha.(1,3)-exofucosylation on E-selectin binding of various
leukocytes. (FIG. 27A) Parallel plate flow chamber analysis of
tethering and rolling interactions of native peripheral blood
leukocytes with endothelial E-selectin (expressed on TNF-stimulated
human umbilical vein endothelial cells (HUVEC)). Monocytes, CD4 T
cells, CD8 T cells and B cells were freshly isolated and then
perfused over TNF-simtulated HUVECs (i.e., TNF induces HUVEC to
express E-selectin) at a flow rate ranging from 0.5-16
dynes/cm.sup.2 and cell rolling was observed and recorded for video
analysis. Monocytes and CD4 T cells show rolling adhesive
interactions on TNF-activated HUVEC at a shear stress up to 16
dynes/cm.sup.2, whereas CD8 and B cells show minimal adhesive
shear-resistant adhesive interactions. Note that monocytes cell
rolling was 3-fold greater than CD4 T cells. Values are
means.+-.SEM for a minimum of 3 independent experiments. (FIG. 278)
Representative flow cytometric histograms of staining with
E-selectin-Ig chimera ("E-Ig", a probe for E-selectin ligands (from
R&D Systems)) (left) and mAb HECA452 (right) of monocytes, CD4
and CD8 T cells, and B cells. Filled curves represent isotype
control (or, for E-Ig staining, E-selectin binding in the absence
of input Ca.sup.2+) and open curves show specific reactivity (for
E-Ig, binding in presence of input Ca.sup.2+). (FIG. 27C) Untreated
(solid black line) or protease (bromelain) treated (dotted line)
cells were stained with HECA452 mAb and analyzed by flow cytometry.
Protease (bromelain) treatment (dotted line) markedly decreases
HECA452 staining of monocytes, CD4 T cells, CD8 T cells, and B
cells, showing that glycoproteins are the principal carriers of
sLex determinants on these cells.
[0053] FIGS. 28A-28C. Functional E-selectin ligand expression on
monocytes and lymphocytes is increased by
.alpha.(1,3)-exofucosylation treatment. (FIG. 28A) Human monocytes
were FTVII-treated or buffer treated (mock) and subjected to
immunoprecipitation with E-selectin-Ig chimera ("E-Ig", a probe for
E-selectin ligands (from R&D Systems)) followed by SDS-PAGE and
blotted with HECA-452, anti-CD43, anti-CD44 and anti-PSGL-1 mAbs,
respectively. Note increased immunoprecipitation with E-Ig
following FTVII treatment of monocytes, prominently on CD44 (i.e.,
creation of HCELL) and CD43 (creation of CD43-E-selectin ligand
("CD43-E"). (FIG. 288) Western blot analysis of sequential
immunoprecipitation of PSGL-1, CD43 and CD44 from lysates of CD4 T
cells, CD8 T cells and B cells, followed by staining with E-Ig.
(FIG. 28C) Parallel plate flow chamber analysis of tethering and
rolling interactions of untreated ("unt") and FTVII-treated (i.e.,
.alpha.(1,3)-exofucosylation; "FT7") of monocytes, CD4 and CD8T
cells, and B cells on TNF-.alpha. activated HUVEC (which express
E-selectin). FTVII treatment ("FT7") markedly augments
E-selectin-mediated adherence of flowing cells to HUVEC under all
shear stress levels tested.
[0054] FIGS. 29A-29C: CD44 expressed by monocyte-derived dendritic
cells (i.e., cultured following selection of monocytes by CD14
expression (CD14-S mo-DCs)) binds E-selectin. (FIG. 29A)
Representative flow cytometric histograms of HECA-452 mAb and E-Ig
reactivity staining of mo-DCs. Grey lines represent isotype control
or, for E-Ig, staining in the absence of Ca2+, whereas dotted black
line represents PA-S mo-DCs and solid black lines are CD14-S
mo-DCs. (FIG. 298) Western blot analysis of E-selectin staining of
CD14-S and PA-S mo-DC lysates. Whole cell lysates equivalent to
2.times.10.sup.6 mo-DCs were resolved on a SDS-PAGE gel and
immunoblotted. MW markers are along Y-axis (in kDa). Mo-DCs
cultured on CD14 beads (CD14-S Mo-DCs) have higher HCELL expression
(.about.80 kDa band) than those cultured on plastic (PA Mo-DCs).
(FIG. 29C) Western blot analysis of CD44 immunoprecipitated from
cell lysates of CD14-S and PA-S mo-DCs. CD44 immunoprecipitates
(CD44 IP) were then blotted and stained with E-Ig chimera or
anti-CD44 mAb. MW markers are as noted along Y-axis (in kDa). Note
pronounced HCELL expression on CD14-S mo-DCs.
[0055] FIGS. 30A-30E. .alpha.(1,3)-Exofucosylation of human mo-DCs
enforces higher E-selectin ligand activity and endothelial
E-selectin expression promotes transendothelial migration (TEM) of
exofucosylated DCs. (FIG. 30A) Western blot analysis comparing
E-selectin binding (E-Ig) of lysates of 2.times.10.sup.6 of KG1a
cells and of mo-DCs. (FIG. 30B) Western blot analysis of E-Ig
reactivity of mo-DC that were buffer treated (-) or FTVI-treated
(+). FTVI treatment induces E-Ig binding at .about.80 kDa,
indicating enforced expression of HCELL. (FIG. 30C)
Transendothelial migration (TEM) assay of buffer treated (BT) and
FTVI-treated mo-DCs under shear flow conditions (2 dynes/cm.sup.2)
on TNF-.alpha.-stimulated HUVEC. The TEM value is the fold-increase
in migration of cells on TNF-.alpha.-stimulated HUVEC compared with
cells transmigrated on untreated HUVECs (which was minimal). TEM
was analyzed under different conditions: HUVEC preincubated with
function blocking anti-E-selectin mAb clone 68-5H11, mo-DC
pre-incubated with function blocking anti-VLA-4 mAb HP2/1 or
isotype mAb, and mo-DC treated with sialidase or pertussis toxin
(PTX). As shown, exofucosylated DCs have higher TEM than untreated
cells; TEM is abrogated by function-blocking antibodies to
E-selectin and VLA-4, and by sialidase or PTX treatment of cells.
(FIG. 30D) Analysis of the number of tethering and rolling mo-DCs
(per cm.sup.2 of endothelial surface area) and number of firmly
adhering cells (per cm.sup.2 of endothelial surface area) in the
TEM assay. Note higher tethering/rolling interactions with
exofucosylated DCs. (FIG. 30E) Average rolling velocity of buffer
treated (BT) and FTVI-treated mo-DCs in the TEM assay. The cell
number was counted at 2.0 dyne/cm2 shear stress (i.e., perfused
over TNF-.alpha.-stimulated HUVEC, at 2.0 dyne/cm2 shear stress).
Values are means.+-.SD (n=3). Statistical significant differences
(p<0.05) are indicated by brackets and asterisks. The slower
rolling of FTVI-treated DCs is indicative of higher efficiency of
DC binding interactions to endothelial E-selectin under hemodynamic
shear conditions.
[0056] FIG. 31. Expression of FoxP3 on regulatory T cells generated
by ex vivo expansion of human CD4+ cells in presence of antibodies
to CD3 and CD28, and IL-2 supplementation. Dual color flow
cytometry histograms showing expression of CD4 and FoxP3 on
cultured CD4+/CD127-low T cells; high FoxP3 staining indicates that
all culture-expanded cells are Tregs.
[0057] FIG. 32. Flow cytometry profiles of sLex expression (HECA452
staining) of buffer treated (light grey fill) and exofucosylated
(FTVII-treated; black fill) Tregs. Note that buffer-treated Tregs
have no sLex expression (i.e., profile is similar to isotype
control staining (dashed line)), whereas FTVII-treated cells
display high levels of sLex.
[0058] FIG. 33. Western blot analysis of E-Ig staining of
FTVII-treated and buffer treated (BT) Tregs compared with the human
myeloid leukemia cell line KG1a. Buffer treated T regs have no
E-selectin ligands. .alpha.(1,3)-Exofucosylation induces expression
of several glycoprotein E-selectin ligands on Tregs, including
expression of HCELL (.about.80 kDa band). KG1a cells natively
express HCELL.
[0059] FIG. 34. Titration of regulatory T cell dosing in xenogenic
graft versus host disease (GVHD). Xenogeneic GVHD-associated weight
loss (measured at day 50 post-injection of PBMCs) is abrogated by
intravenous injection of 1.5.times.10.sup.5 T regs but not by
injection of similar dose of buffer treated Tregs (weight values
are mean of N=3 mice). However, injection of 5.times.10.sup.5 Tregs
prevents GVHD weight loss regardless of
.alpha.(1,3)-exofucosylation of administered Treg cells (mean of
N=3 mice). Thus, .alpha.(1,3)-exofucosylation of Tregs increases
potency in immunomodulation of GVHD by 3-fold.
EMBODIMENTS
[0060] The present disclosure is directed to methods of treating a
disease, disorder, or medical condition manifesting as inflamed
and/or damaged tissue or cancer in a subject. The methods involve
the administration, to a subject in need of tissue
repair/regeneration or cancer treatment, of a cell population that
expresses an E-selectin ligand and/or an L-selectin ligand at
levels that exceeds the level of E-selectin and/or L-selectin
binding of a native population of the cells. The composition of
cells is disposed in a pharmaceutically-acceptable solution,
suspension, carrier or vehicle for administration to a subject or
for storage (e.g., cryopreserved) prior to administration to a
subject.
[0061] Administration of cell populations described herein for
therapeutic indications can be achieved in a variety of ways, in
each case as clinically warranted/indicated, using a variety of
anatomic access devices, a variety of administration devices, and a
variety of anatomic approaches, with or without support of anatomic
imaging modalities (e.g., radiologic, MRI, ultrasound, etc.) or
mapping technologies (e.g., epiphysiologic mapping procedures,
electromyographic procedures, electrodiagnostic procedures, etc.).
Cells can be administered systemically, via either peripheral
vascular access (e.g., intravenous placement, peripheral venous
access devices, etc.) or central vascular access (e.g., central
venous catheter/devices, arterial access devices/approaches, etc.).
Cells can be delivered intravascularly into anatomic feeder vessels
of an intended tissue site using catheter-based approaches or other
vascular access devices (e.g., cardiac catheterization, etc.) that
will deliver a vascular bolus of cells to the intended site. Cells
can be introduced into the spinal canal and/or intraventricularly
(i.e., intrathecally, into the subarachnoid space to distribute
within cerebrospinal fluid and/or within the ventricles). Cells can
be administered directly into body cavities or anatomic
compartments by either catheter-based approaches or direct
injection (e.g., intraperitoneal, intrapleural, intrapericardial,
intravesicularly (e.g., into bladder, into gall bladder, into bone
marrow, into biliary system (including biliary duct and pancreatic
duct network), intraurethrally, via renal pelvis/intraureteral
approaches, intravaginally, etc.)). Cells can be introduced by
direct local tissue injection, using either intravascular
approaches (e.g., endomyocardial injection), or percutaneous
approaches, or via surgical exposure/approaches to the tissue, or
via laparoscopic/thoracoscopic/endoscopic/colonoscopic approaches,
or directly into anatomically accessible tissue sites and/or guided
by imaging techniques (e.g., intra-articular, into spinal discs and
other cartilage, into bones, into muscles, into skin, into
connective tissues, and into relevant tissues/organs such as
central nervous system, peripheral nervous system, heart, liver,
kidneys, spleen, etc.). Cells can also be placed directly onto
relevant tissue surfaces/sites (e.g., placement onto tissue
directly, onto ulcers, onto burn surfaces, onto serosal or mucosal
surfaces, onto epicardium, etc.). Cells can also administered into
tissue or structural support devices (e.g., tissue scaffold devices
and/or embedded within scaffolds placed into tissues, etc.), and/or
administered in gels, and/or administered together with enhancing
agents (e.g., admixed with supportive cells, cytokines, growth
factors, resolvins, anti-inflammatory agents, etc.).
[0062] The cell population is administered to the subject during a
period of (i.e., coincident with) induced expression (and,
preferably, coincident with the onset of induced expression) of
E-selectin on vascular endothelium within one or more tissues of
the subject. The enforced expression of E-selectin ligands on the
surface of administered cells will aid in revascularization, in
host defense (e.g., against infection or cancer) and/or in tissue
repair/regeneration and/or mediate immunomodulatory processes that
will dampen inflammation and/or prevent inflammation. The
expression of ligands for E-selectin guides delivery of
intravascularly administered cells to sites of inflammation by
mediating binding of blood-borne cells to vascular E-selectin
expressed on endothelial cells at sites of inflammation. Moreover,
whether cells are administered systemically, intravascularly, into
the spinal canal and/or intraventricularly (i.e., intrathecally,
into the subarachnoid space to distribute within cerebrospinal
fluid), directly into body cavities or compartments, by direct
local tissue injection, or by placement onto relevant tissue
surfaces/sites, the expression of ligands for E-selectin and/or
L-selectin on administered cells promotes lodgement of cells within
the affected tissue milieu, in apposition to cells bearing
E-selectin (i.e., endothelial cells) and/or L-selectin (i.e.,
leukocytes), respectively, within the target site. Thus, the
spatial distribution and localization of administered cells within
the target tissue is modulated by the expression of E-selectin
and/or L-selectin ligands on administered cells.
[0063] Particularly, the colonization of a desired cell type at a
site of inflammation occurs as a result of the enforced expression
of cell surface E-selectin ligands on the administered cells, such
that the administered cells have augmented binding to E-selectin,
thereby promoting the systemic delivery of the desired cells and/or
the lodgement of cells when injected directly into the affected
site. For example, the enforced expression of E-selectin ligands
(e.g., HCELL, CD43-E, CLA/PSLG-1, ESL-1, NCAM-E, etc.) is
advantageously capable of anchoring directly injected cells within
E-selectin-expressing vessels at sites of inflammation, tissue
injury, or cancer. Thus, the present methods augment efficiency in
the delivery of relevant cells at or to a site of inflammation,
tissue injury, or cancer, including, for example, the capacity to
deliver tissue-reparative stem cells, to deliver immunomodulatory
cells (e.g., mesenchymal stem cells, T-regulatory cells, NK-cells,
dendritic cells, etc.), and the capacity to deliver immune effector
cells to combat the inciting inflammatory process or cancer (e.g.,
in the case of infection or malignancy, delivery of
pathogen-specific immune effector T cells cells or cancer-specific
cytotoxic T cells or NK cells, respectively); such immunologic
cells (regulatory T-cells, NK cells, cytotoxic T-cells, dendritic
cells, etc.) may be antigen-pulsed, tumor cell pulsed,virus pulsed,
and other means to create antigen specificity. Similarly, the
enforced expression of L-selectin ligands (e.g., HCELL, PSGL-1,
etc.) is advantageously capable of anchoring directly injected
cells within L-selectin-expressing cells infiltrating sites of
inflammation, tissue injury, or cancer.
[0064] The enhanced expression of an E-selectin ligand on the cell
surface will drive vascular homing of cells to any site where
E-selectin is expressed. In various embodiments, the cell
population expresses Hematopoietic Cell E-/L-selectin Ligand
(HCELL) and/or Neural Cell Adhesion Molecule E-selectin Ligand
(NCAM-E). Other E-selectin ligands that may be expressed by cells
include, for example, CD43-E, ESL-1, PSGL-1 and the CLA glycoform
of PSGL-1. For example, since CD44 is a ubiquitously expressed cell
membrane protein and is displayed on stem/progenitor cell
populations of both "adult" and embryonic types, the capacity to
modify glycosylation of this protein by ex vivo glycan engineering
to create the HCELL (CD44 glycoform) phenotype will drive migration
of injected (e.g., intravascularly) (adoptively transferred) cells
in vivo to marrow or to any tissue/organ site where E-selectin is
expressed. Thus, the modified cells can be used in therapeutic
settings to achieve targeted cell migration in a variety of
physiologic and pathologic processes, including, for example, bone
diseases, immune diseases, infectious diseases, and cancer
therapeutics, to name just a few conditions.
[0065] It has also been discovered that the disease, disorder, or
medical condition having associated inflammation can be treated
using the instant methods even in the absence of differentiation of
the cell population in the subject. That is, there are trophic
effects of administered cells at the site of inflammation without
persistent engraftment and/or repopulation of the administered
cells, irrespective of the type of tissue involved. These trophic
effects include release of cytokines/growth factors that promote
revascularization (e.g., VEGF), that promote tissue repair (e.g.,
TGF-.beta.), that are immunomodulatory (e.g., IL-10), that
stimulate growth/proliferation of tissue-resident progenitors
(e.g., SCF, LIF, etc) and many other tissue-reparative processes
(e.g., mitochondria delivery to cells). In addition, administered
cells (e.g., Tregs, MSCs, dendritic cells, etc.) may have potent
immunomodulatory properties, including direct suppression of
activated lymphocytes (e.g., via expression of PDL-1).
[0066] As exemplified by FIGS. 4A-4H, and as described in greater
detail in the examples, cell populations modified to have enhanced
E-selectin and/or L-selectin binding activity relative to native
populations of the cell type have increased capacity to home,
infiltrate and colonize tissue in the vicinity of
E-selectin-expressing vasculature. Additionally, in one embodiment
such cells lodge into sites of inflammation via binding to
E-selectin on endothelial cells or lodge into sites of infiltrating
leukocytes within the inflammatory site (e.g., see FIGS. 4F-4G).
Further, beneficial effects (e.g., ameloriation of the disease) may
be realized by parenteral delivery or by direct injection into the
site of inflammation or the site of infiltrating leukocytes even in
the absence of differentiation of the cells (or long-term
engraftment) after administered cell lodgement within the site
(i.e., transient engraftment may be sufficient to deliver intended
biologic effect(s)).
[0067] In certain embodiments, the methods for glycan-engineering
described in U.S. Pat. No. 8,084,236 for the enforcement of HCELL
expression in viable cell populations, discussed in detail below,
can induce higher amounts of expression of E-selectin ligands on
such cells to promote their vascular delivery to sites of
inflammation, and can induce higher amounts of E-selectin ligands
and L-selectin ligands that can promote lodgement of cells within
the affected tissue milieu.
[0068] Treatment of the subject refers to reducing or eliminating
in an individual a clinical symptom of a disease, disorder, or
medical condition having associated inflammation or delaying or
preventing in an individual the onset of a clinical symptom of such
disease, disorder, or medical condition. For example, treating can
mean reducing a symptom of a condition characterized by an acute
and/or chronic inflammation by, e.g., at least 20%, at least 25%,
at least 30%, at least 35%, at least 40%, at least 45%, at least
50%, at least 55%, at least 60%, at least 65%, at least 70%, at
least 75%, at least 80%, at least 85%, at least 90% at least 95%,
or at least 100%. The actual symptoms associated with acute and
chronic inflammation are well known and can be determined by a
person of ordinary skill in the art by taking into account factors,
including, without limitation, the location of the acute and/or
chronic inflammation, the cause of the acute and/or chronic
inflammation, the severity of the acute and/or chronic
inflammation, and/or the tissue or organ affected by the acute
and/or chronic inflammation. Those of skill in the art will know
the appropriate symptoms or indicators associated with a specific
type of acute and/or chronic inflammation and will know how to
determine if an individual is a candidate for treatment as
disclosed herein.
[0069] Subjects that may be treated in accordance with the methods
described herein includes any mammal (e.g., a human), such as a
mammal that can be susceptible to a disease. Examples include, for
instance, a human, a non-human primate, a cow, a horse, a pig, a
sheep, a goat, a dog, a cat, or a rodent such as a mouse, a rat, a
hamster, or a guinea pig. A subject can be a subject diagnosed with
a disease, disorder, or medical condition having associated
inflammation or otherwise known to have a disease, disorder, or
medical condition the result or symptom of which is acute and/or
chronic inflammation. In some embodiments, a subject can be
diagnosed as, or known to be, at risk of developing a disease,
disorder, or medical condition having associated inflammation. In
certain embodiments, a subject can be selected for treatment on the
basis of a known disease, disorder, or medical condition in the
subject the result or symptom of which is an acute and/or chronic
inflammation. In some embodiments, a subject can be selected for
treatment on the basis of a suspected disease, disorder, or medical
condition having associated inflammation in the subject. In some
embodiments, the disease, disorder, or medical condition can be
diagnosed by detecting a mutation or other abnormality in a
biological sample (e.g., urine, sputum, whole blood, serum, stool,
etc., or any combination thereof. Accordingly, a modified cell
population can be administered to a subject based, at least in
part, on the fact that a mutation, symptom, or other abnormality is
detected in at least one sample (e.g., biopsy sample or any other
biological sample) obtained from the subject. In some embodiments,
diabetes, multiple sclerosis, or cancer (for example) cannot have
been detected or located in the subject, but the presence of a
mutation, symptom, or other abnormality associated with diabetes,
multiple sclerosis, or cancer in at least one biological sample can
be sufficient to administer modified cells to the subject in
accordance with the methods described herein. In some embodiments,
the composition can be administered to prevent the development of a
disease, disorder, or medical condition such as diabetes, multiple
sclerosis, or cancer. However, in some embodiments, the presence of
an existing disease, disorder, or medical condition can be
suspected, but not yet identified, and a composition of the
disclosure can be administered to prevent further growth or
development of the disease, disorder, or medical condition. The
administered cells can be derived from autologous sources (i.e.,
derived from the host itself), syngeneic sources (derived from an
identical twin), or allogeneic sources (derived from
non-genetically identical donor).
[0070] Timing of Administration
[0071] As noted above, the cell population is administered to the
subject coincident with induced expression (and preferably
coincident with the onset of induced expression) of E-selectin by
endothelial cells of the subject, or just prior to expected
increased E-selectin expression within an affected tissue (i.e., as
prophylaxis prior to or coincident with delivery of
E-selectin-inducing inflammatory stimulus (e.g., radiation
therapy)) or in anticipation of a reaction to a pathogen or disease
process with subsequent upregulation of vascular E-selectin
expression (e.g., following exposure to or endogenous reactivation
of an infectious agent, prior to overt flare of autoimmune disease,
prior to elaboration of graft-versus-host disease (GVHD), etc.)).
Accordingly, the treatment methods described herein may be
implemented, for example, when the subject (e.g., a human patient)
presents to his/her physician or healthcare provider with one or
more symptoms of inflammation or anticipated inflammatory flare.
For a subject with diabetes, for example, such initial symptoms may
include polyuria, nocturia, weight loss/gain, and/or lack of
satiety, at which time (and prior to the onset of diabetic
ketoacidosis) the subject may be administered the modified cells in
accordance with the disclosure. For a subject with multiple
sclerosis, for example, such initial symptoms may include transient
sensory perturbations (e.g., numbness, tingling) and/or
fasciculations (twitching) and/or muscular weakness episodes.
[0072] In general, the temporal aspects of the administration of
the modified cells may depend for example, on the particular
modified cells, or the nature of the disease, disorder, or medical
condition (and associated inflammation, tissue injury, or cancer)
being treated. Other considerations may include the severity of the
disease, disorder, or medical condition; activity of the specific
cells or cell fragments and modifications employed; the specific
composition employed; the age, body weight, general health, sex and
diet of the subject; the time of administration, route of
administration, and rate of excretion; the duration of the
treatment; drugs used in combination or coincidental with the
treatment regime; and like factors.
[0073] Accordingly, administration of the modified cells can occur
as a single event or over a time course of treatment. For example,
the modified cells can be administered hourly (e.g., every hour,
every two hours, every three hours, every four hours, every five
hours, every six hours, and so on), daily, weekly, bi-weekly,
bi-monthly or monthly. For treatment of acute conditions, for
example, the time course of treatment may be at least several
hours, days, or weeks. Certain conditions could extend treatment
from several days to several weeks, months, or years. For example,
treatment could extend over one week, two weeks, or three weeks, or
longer (e.g., one to several months). For more chronic conditions,
treatment could extend from several weeks to several months, a year
or more, or the lifetime of the patient in need of such treatment.
Alternatively, the compounds and agents can be administered hourly,
daily, weekly, bi-weekly, bi-monthly, or monthly, for a period of
several weeks, months, years, or over the lifetime of the patient
as a prophylactic or as a therapeutic measure.
[0074] It will also be understood that the frequency of doses may
be increased or decreased based upon the nature and severity of the
disease, disorder, or medical condition (and associated
inflammation) and/or the stage of the disease, disorder, or medical
condition in the subject. For example, depending on these and other
factors, less frequent administration may be desirable at the
beginning of the treatment and more frequent administration may be
desirable at or near end-stage, or vice versa. The various targets
and symptoms may also be tracked (e.g., insulin levels in a
diabetic subject) and the administration and dose amount may be
tailored accordingly.
[0075] If desired, the cells can be divided into multiple doses for
purposes of administration; consequently, single dose compositions
may contain such amounts or submultiples thereof to make up the
dose.
[0076] Indications
[0077] The present disclosure is directed to the treatment of a
disease, disorder, or medical condition wherein E-selectin is
expressed in endothelial beds of the affected tissue(s) and/or
L-selectin-expressing leukocytes have infiltrated/accumulated in
the affected tissue(s). As discussed above, E-selectin and
L-selectin each bind to sialylated, fucosylated carbohydrates, and
enforced expression of these sialofucosylated glycan structures on
the cell surface serves to program binding to these selectins.
Accordingly, the disclosure describes methods to enhance homing to
target tissue(s) by augmenting the expression of E-selectin ligands
on administered cells; additionally, in describing methods to
enhance expression of potent E-selectin and L-selectin ligands
(such as HCELL) on administered cells to promote adherence to
E-selectin on vascular endothelial cells and/or of L-selectin on
tissue-infiltrating leukocytes within affected tissue(s), the
disclosure provides a means to augment colonization/lodgement of
the cells within relevant tissue microenvironments where biologic
effects are intended. In general, the methods described herein have
utility in improving the outcome of any cell-based therapeutic
approach, be it in immunotherapy applications (e.g., administration
of culture-expanded antigen-specific T cells and/or culture
expanded NK cells for cancer or infectious disease applications,
administration of culture-expanded chimeric antigen receptor (CAR)
T cells, administration of antigen-pulsed dendritic cells, etc.),
immunomodulatory/immunosuppressive therapeutic applications (e.g.,
administration of culture-expanded regulatory T cells (Tregs),
administration of antigen-pulsed dendritic cells, administration of
mesenchymal stem cells, administration of culture-expanded NKT
cells, etc.), or tissue repair/regenerative medicine applications
(e.g., use of stem and/or progenitor cells or other
tissue-reparative cells for tissue regeneration/restoration; use of
culture-expanded stem cells and/or culture-expanded progenitor
cells for tissue regeneration/restoration). Within utility in
regenerative medicine applications, it is understood that
administered cells may themselves contribute to regenerate the
target tissue by way of long-term engraftment (with attendant
proliferation/differentiation) yielding tissue-specific cells
(e.g., such as in transplantation of hematopoietic stem cells for
blood cell production) and/or may deliver a tissue
restorative/reparative effect without long-term engraftment or
differentiation into tissue-resident cells (e.g., via delivery of
trophic effects that stimulate resident stem/progenitors to repair
the injured tissue(s) and/or by dampening inflammatory processes
that promote injury and impede repair). All applications for all
indications described herein can be used alone or in combination
with enhancing agents (e.g., growth factors, tissue scaffolds,
etc.).
[0078] Any and all diseases, disorders, or medical conditions
having associated inflammation (e.g., acute and/or chronic), tissue
injury/damage or neoplastic conditions may be treated in accordance
with the methods described herein, including, but not limited to
those initiated by direct tissue injury (e.g., burns, trauma, bone
fracture, bone deformities, decubitus ulcers, etc.),
ischemic/vascular events (e.g., myocardial infarct, stroke, shock,
hemorrhage, coagulopathy, etc.), infections (e.g., cellulitis,
pneumonia, meningitis, cystitis, sepsis, SIRS, etc.), neoplasia
(e.g., breast cancer, lung cancer, prostate cancer, renal cell
cancer, lymphoma, leukemia, etc.), immunologic/autoimmune
conditions (e.g., acute or chronic GVHD, multiple sclerosis,
diabetes, inflammatory bowel disease (e.g., Crohn's disease,
ulcerative colitis), rheumatoid arthritis, psoriasis, etc.),
degenerative diseases (e.g., osteoporosis, osteoarthritis, spinal
disc degeneration, Alzheimer's disease, atherosclerosis, etc.),
congenital/genetic diseases (e.g., epidermolysis bullosa,
osteogenesis imperfecta, muscular dystrophies, lysosomal storage
diseases, Huntington's disease, etc.), adverse drug effects (e.g.,
chemotherapy-induced tissue/organ toxicity, radiotherapy toxicity,
drug-induced hepatitis, drug-induced cardiac injury, etc.), toxic
injuries (e.g., radiation exposure(s), chemical exposure(s),
alcoholic hepatitis, alcoholic pancreatitis, alcoholic
cardiomyopathy, cocaine cardiomyopathy, etc.), metabolic
derangements (e.g., uremic pericarditis, metabolic acidosis, etc.),
iatrogenic conditions (e.g., radiation-induced tissue injury,
surgery-related complications, etc.), and/or idiopathic processes
(e.g., amyotrophic lateral sclerosis, Parsonnage-Turner Syndrome,
etc.).
[0079] Other general and specific diseases, disorders, or medical
condition that may be treated in accordance with the methods
described herein include, but are not limited to:
[0080] Acute Leukemias, e.g., Acute Biphenotypic Leukemia, Acute
Lymphocytic Leukemia (ALL), Acute Myelogenous Leukemia (AML), and
Acute Undifferentiated Leukemia;
[0081] Myelodysplastic Syndromes, e.g., Amyloidosis Chronic
Myelomonocytic Leukemia (CMML), Refractory Anemia (RA), Refractory
Anemia with Excess Blasts (RAEB), Refractory Anemia with Excess
Blasts in Transformation (RAEB-T), and Refractory Anemia with
Ringed Sideroblasts (RARS);
[0082] Myeloproliferative Disorders, e.g., Acute Myelofibrosis,
Agnogenic Myeloid Metaplasia (Myelofibrosis), Essential
Thrombocythemia, chronic myelogenous leukemia, and Polycythemia
Vera;
[0083] Phagocyte Disorders, e.g., Chediak-Higashi Syndrome, Chronic
Granulomatous Disease, Leukocyte adhesion deficiencies,
myeloperoxidase deficiency, Neutrophil Actin Deficiency, and
Reticular Dysgenesis;
[0084] Lysosomal Storage Diseases, e.g., Adrenoleukodystrophy,
Alpha Mannosidosis, Gaucher's Disease, Hunter's Syndrome (MPS-II),
Hurler's Syndrome (MPS-IH), Krabbe Disease, Maroteaux-Lamy Syndrome
(MPS-VI), Metachromatic Leukodystrophy, Morquio Syndrome (MPS-IV),
Mucolipidosis II (I-cell Disease), Mucopolysaccharidoses (MPS),
Niemann-Pick Disease, Sanfilippo Syndrome (MPS-III), Scheie
Syndrome (MPS-IS), Sly Syndrome, Beta-Glucuronidase Deficiency
(MPS-VII), and Wolman Disease;
[0085] Inherited Erythrocyte Abnormalities, e.g., Beta Thalassemia,
Blackfan-Diamond Anemia, Pure Red Cell Aplasia, and Sickle Cell
Disease;
[0086] Inherited Platelet Abnormalities, e.g.,
Amegakaryocytosis/Congenital Thrombocytopenia, Gray platelet
syndrome;
[0087] Solid organ malignancies, e.g., Brain Tumors, Ewing Sarcoma,
Neuroblastoma, Ovarian Cancer, Renal Cell Carcinoma, Lung Cancers,
Breast cancers, Gastric cancers, Esophageal cancers, Skin cancers,
Oral cancers, Endocrine cancers, Liver cancers, Biliary system
cancers, Pancreatic cancer, Prostate Cancer, and Testicular
Cancer;
[0088] Other Applications, e.g., Bone Marrow Transplants, Heart
Disease (myocardial infarction), Liver Disease, Muscular Dystrophy,
Alzheimer's Disease, Parkinson's Disease, Spinal Cord Injury,
Spinal disc disease/degeneration, Bone disease, Bone fracture,
Stroke, Peripheral Vascular Disease, Head trauma, Bullous diseases,
Mitochondrial diseases, Ex vivo and In vivo expanded stem and
progenitor cell populations, In vitro fertilization application and
enhancement, Hematopoietic Rescue Situations (Intense
Chemo/Radiation), Stem cells and progenitor cells derived from
various tissues sources, Application in humans and animals, and
Limb regeneration, reconstructive surgical procedures/indications,
alone or in combination with enhancing agents;
[0089] Chronic Leukemias, e.g., Chronic Lymphocytic Leukemia (CLL),
Chronic Myelogenous Leukemia (CML), Juvenile Chronic Myelogenous
Leukemia (JCML), and Juvenile Myelomonocytic Leukemia (JMML),
[0090] Stem Cell Disorders, e.g., Aplastic Anemia (Severe),
Congenital Cytopenia, Dyskeratosis Congenita, Fanconi Anemia, and
Paroxysmal Nocturnal Hemoglobinuria (PNH);
[0091] Lymphoproliferative Disorders, e.g., Hodgkin's Disease,
Non-Hodgkin's Lymphomas, and Prolymphocytic Leukemia;
[0092] Histiocytic Disorders, e.g., Familial Erythrophagocytic
Lymphohistiocytosis, Hemophagocytosis, Hemophagocytic
Lymphohistiocytosis, Histiocytosis-X, and Langerhans' Cell
Histiocytosis;
[0093] Congenital (Inherited) Immune System Disorders, e.g.,
Absence of T and B Cells, Absence of T Cells, Normal B Cell SCID,
Ataxia-Telangiectasia, Bare Lymphocyte Syndrome, Common Variable
Immunodeficiency, DiGeorge Syndrome, Kostmann Syndrome, Leukocyte
Adhesion Deficiency, Omenn's Syndrome, Severe Combined
Immunodeficiency (SCID), SCID with Adenosine Deaminase Deficiency,
Wiskott-Aldrich Syndrome, and X-Linked Lymphoproliferative
Disorder;
[0094] Other Inherited Disorders, e.g., Cartilage-Hair Hypoplasia,
Ceroid Lipofuscinosis, Congenital Erythropoietic Porphyria,
Familial Mediterranean Fever, Glanzmann Thrombasthenia, Lesch-Nyhan
Syndrome, Osteopetrosis, and Sandhoff Disease;
[0095] Plasma Cell Disorders, e.g., Multiple Myeloma, Plasma Cell
Leukemia, and Waldenstrom's Macroglobulinemia; and
[0096] Autoimmune Diseases, e.g., Multiple Sclerosis, Rheumatoid
Arthritis, Systemic Lupus Erythematosus, Scleroderma, Ankylosing
spondylitis, Diabetes Mellitus, and Inflammatory Bowel
Diseases.
[0097] Articular and skeletal diseases/conditions, e.g., disc
degeneration, synovial disease, cartilage degeneration, cartilage
trauma, cartilage tears, arthritis, bone fractures, bone
deformities, bone reconstruction, osteogenesis imperfecta,
congenital bone diseases/conditions, genetic bone
diseases/conditions, osteoporosis. Osteopetrosis, hypophosphatasia,
metabolic bone disease, etc.
[0098] Skin/soft tissue diseases and conditions such as bullous
diseases, psoriasis, eczema, epidermolysis bullosa, ulcerative skin
conditions, soft tissue deformities (including post-surgical skin
and soft tissue deformities), plastic surgery/reconstructive
surgery indications, etc.
[0099] In general, associated inflammation symptoms that include,
without limitation, fever, pain, edema, hyperemia, erythema,
bruising, tenderness, stiffness, swollenness, chills, respiratory
distress, hypotension, hypertension, stuffy nose, stuffy head,
breathing problems, fluid retention, blood clots, loss of appetite,
weight loss, polyuria, nocturia, anuria, dyspnea, dyspnea on
exertion, muscle weakness, sensory changes, increased heart rate,
decreased heart rate, arrythmias, polydipsia, formation of
granulomas, fibrinous, pus, non-viscous serous fluid, or ulcers.
The actual symptoms associated with an acute and/or chronic
inflammation are well known and can be determined by a person of
ordinary skill in the art by taking into account factors,
including, without limitation, the location of the inflammation,
the cause of the inflammation, the severity of the inflammation,
the tissue or organ affected, and the associated disorder.
[0100] Specific patterns of acute and/or chronic inflammation are
seen during particular situations that arise in the body, such as
when inflammation occurs on an epithelial surface, or pyogenic
bacteria are involved. For example, granulomatous inflammation is
an inflammation resulting from the formation of granulomas arising
from a limited but diverse number of diseases, include, without
limitation, tuberculosis, leprosy, sarcoidosis, and syphilis.
Purulent inflammation is an inflammation resulting in large amount
of pus, which consists of neutrophils, dead cells, and fluid.
Infection by pyogenic bacteria such as staphylococci is
characteristic of this kind of inflammation. Serous inflammation is
an inflammation resulting from copious effusion of non-viscous
serous fluid, commonly produced by mesothelial cells of serous
membranes, but may be derived from blood plasma. Skin blisters
exemplify this pattern of inflammation. Ulcerative inflammation is
an inflammation resulting from the necrotic loss of tissue from the
epithelial surface, exposing lower layers and forming an ulcer.
[0101] An acute and/or chronic inflammation symptom can be
associated with a large, unrelated group of disorders which
underlay a variety of diseases and disorders. The immune system is
often involved with acute and/or chronic inflammatory disorders,
demonstrated in both allergic reactions, arthritic conditions, and
some myopathies, with many immune system disorders resulting in
abnormal inflammation. Non-immune diseases with etiological origins
in acute and/or chronic inflammatory processes include cancer,
atherosclerosis, and ischaemic heart disease. Non-limiting examples
of disorders exhibiting acute and/or chronic inflammation as a
symptom include, without limitation, acne, acid reflux/heartburn,
age related macular degeneration (AMD), allergy, allergic rhinitis,
Alzheimer's disease, amyotrophic lateral sclerosis, anemia,
appendicitis, arteritis, arthritis, asthma, atherosclerosis,
autoimmune disorders, balanitis, blepharitis, bronchiolitis,
bronchitis, a bullous pemphigoid, burn, bursitis, cancer, cardiac
arrest, carditis, celiac disease, cellulitis, cervicitis,
cholangitis, cholecystitis, chorioamnionitis, chronic obstructive
pulmonary disease (COPD) (and/or acute exacerbations thereof),
cirrhosis, colitis, congestive heart failure, conjunctivitis,
drug-induced tissue injury (e.g., cyclophosphamide-induced
cystitis), cystic fibrosis, cystitis, common cold, dacryoadenitis,
decubitus ulcers, dementia, dermatitis, dermatomyositis, diabetes,
diabetic neuropathy, diabetic retinopathy, diabetic nephropathy,
diabetic ulcer, digestive system disease, eczema, emphysema,
encephalitis, endocarditis, endocrinopathies, endometritis,
enteritis, enterocolitis, epicondylitis, epididymitis, fasciitis,
fibromyalgia, fibrosis, fibrositis, gastritis, gastroenteritis,
gingivitis, glomerulonephritis, glossitis, heart disease, heart
valve dysfunction, hepatitis, hidradenitis suppurativa,
Huntington's disease, hyperlipidemic pancreatitis, hypertension,
ileitis, infection, inflammatory bowel disease, inflammatory
cardiomegaly, inflammatory neuropathy, insulin resistance,
interstitial cystitis, interstitial nephritis, iritis, ischemia,
ischemic heart disease, keratitis, keratoconjunctivitis,
laryngitis, lupus nephritis, macular degeneration, mastitis,
mastoiditis, meningitis, metabolic syndrome (syndrome X), a
migraine, mucositis, multiple sclerosis, myelitis, myocarditis,
myositis, nephritis, neuronitis, non-alcoholic steatohepatitis,
obesity, omphalitis, oophoritis, orchitis, osteochondritis,
osteopenia, osteomyelitis, osteoporosis, osteitis, otitis,
pancreatitis, Parkinson's disease, parotitis, pelvic inflammatory
disease, pemphigus vularis, pericarditis, peritonitis, pharyngitis,
phlebitis, pleuritis, pneumonitis, polycystic nephritis, proctitis,
prostatitis, psoriasis, pulpitis, pyelonephritis, pylephlebitis,
radiation-induced injury, renal failure, reperfusion injury,
retinitis, rheumatic fever, rhinitis, salpingitis, sarcoidosis,
sialadenitis, sinusitis, spastic colon, stasis dermatitis,
stenosis, stomatitis, stroke, surgical complication, synovitis,
tendonitis, tendinosis, tenosynovitis, thrombophlebitis,
thyroiditis, tonsillitis, trauma, traumatic brain injury,
transplant rejection, trigonitis, tuberculosis, tumor, ulcers,
urethritis, ursitis, uveitis, vaginitis, vasculitis, and
vulvitis.
[0102] General categories of diseases, disorders, and trauma that
can result in or otherwise cause acute and/or chronic inflammation
include, but are not limited to genetic diseases, neoplasias,
direct tissue injury, autoimmune diseases, infectious diseases,
vascular diseases/complications (e.g., ischemia/reperfusion
injury), iatrogenic causes (e.g. drug adverse effects, radiation
injury, etc.), and allergic manifestations.
[0103] In one embodiment, an acute and/or chronic inflammation
comprises a tissue inflammation. In general, tissue inflammation is
an acute and/or chronic inflammation that is confined to a
particular tissue or organ. Thus, for example, a tissue
inflammation may comprise a skin inflammation, a muscle
inflammation, a tendon inflammation, a ligament inflammation, a
bone inflammation, a cartilage/joint inflammation, a lung
inflammation, a heart inflammation, a liver inflammation, a gall
bladder inflammation, a pancreatic inflammation, a kidney
inflammation, a bladder inflammation, an gum inflammation, an
esophageal inflammation, a stomach inflammation, an intestinal
inflammation, an anal inflammation, a rectal inflammation, a vessel
inflammation, a vaginal inflammation, a uterine inflammation, a
testicular inflammation, a penile inflammation, a vulvar
inflammation, a neuron inflammation, an oral inflammation, an
ocular inflammation, an aural inflammation, a brain inflammation, a
ventricular/meningial inflammation and/or inflammation involving
central or peripheral nervous system cells/elements.
[0104] In another embodiment, an acute and/or chronic inflammation
comprises a systemic inflammation. Although the processes involved
are similar if not identical to tissue inflammation, systemic
inflammation is not confined to a particular tissue but rather
involves multiple sites within the body, involving the epithelium,
endothelium, nervous tissues, serosal surfaces and organ systems.
When it is due to infection, the term sepsis can be used, with
bacteremia being applied specifically for bacterial sepsis and
viremia specifically to viral sepsis. Vasodilation and organ
dysfunction are serious problems associated with widespread
infection that may lead to septic shock and death.
[0105] In another embodiment, an acute and/or chronic inflammation
is induced by an arthritis. Arthritis includes a group of
conditions involving damage to the joints of the body due to the
inflammation of the synovium including, for example,
osteoarthritis, rheumatoid arthritis, juvenile idiopathic
arthritis, spondyloarthropathies like ankylosing spondylitis,
reactive arthritis (Reiter's syndrome), psoriatic arthritis,
enteropathic arthritis associated with inflammatory bowel disease,
Whipple disease and Behcet disease, septic arthritis, gout (also
commonly referred to as gouty arthritis, crystal synovitis,
metabolic arthritis), pseudogout (calcium pyrophosphate deposition
disease), and Still's disease. Arthritis can affect a single joint
(monoarthritis), two to four joints (oligoarthritis) or five or
more joints (polyarthritis) and can be either an autoimmune disease
or a non-autoimmune disease.
[0106] In another embodiment, an acute and/or chronic inflammation
is induced by an autoimmune disorder. Autoimmune diseases can be
broadly divided into systemic and organ-specific autoimmune
disorders, depending on the principal clinico-pathologic features
of each disease. Systemic autoimmune diseases include, for example,
systemic lupus erythematosus (SLE), Sjogren's syndrome,
Scleroderma, rheumatoid arthritis and polymyositis. Local
autoimmune diseases may be endocrinologic (Diabetes Mellitus Type
1, Hashimoto's thyroiditis, Addison's disease, etc.), dermatologic
(pemphigus vulgaris), hematologic (autoimmune haemolytic anemia),
neural (multiple sclerosis) or can involve virtually any
circumscribed mass of body tissue. Types of autoimmune disorders
include, without limitation, acute disseminated encephalomyelitis
(ADEM), Addison's disease, an allergy or sensitivity, amyotrophic
lateral sclerosis (ALS), anti-phospholipid antibody syndrome (APS),
arthritis, autoimmune hemolytic anemia, autoimmune hepatitis,
autoimmune inner ear disease, autoimmune pancreatitis, bullous
pemphigoid, celiac disease, Chagas disease, chronic obstructive
pulmonary disease (COPD) (including acute exacerbations thereof),
diabetes mellitus type 1 (IDDM), endometriosis, fibromyalgia,
Goodpasture's syndrome, Graves' disease, Guillain-Barre syndrome
(GBS), Hashimoto's thyroiditis, hidradenitis suppurativa,
idiopathic thrombocytopenic purpura, inflammatory bowel disease
(IBD), interstitial cystitis, lupus (including discoid lupus
erythematosus, drug-induced lupus erythematosus. lupus nephritis,
neonatal lupus, subacute cutaneous lupus erythematosus and systemic
lupus erythematosus), morphea, multiple sclerosis (MS), myasthenia
gravis, myopathies, narcolepsy, neuromyotonia, pemphigus vulgaris,
pernicious anaemia, primary biliary cirrhosis, recurrent
disseminated encephalomyelitis (multiphasic disseminated
encephalomyelitis), rheumatic fever, schizophrenia, scleroderma,
Sjogren's syndrome, tenosynovitis, vasculitis, and vitiligo. In one
particular embodiment, the acute and/or chronic inflammation
results from or is otherwise caused by diabetes in the subject. In
another particular embodiment, the acute and/or chronic
inflammation results from or is otherwise caused by multiple
sclerosis in the subject.
[0107] In another embodiment, an acute and/or chronic inflammation
is induced by a myopathy. In general, myopathies are caused when
the immune system inappropriately attacks components of the muscle,
leading to inflammation in the muscle. A myopathy includes, for
example, an inflammatory myopathy and an autoimmune myopathy.
Myopathies include, for example, dermatomyositis, inclusion body
myositis, and polymyositis.
[0108] In another embodiment, an acute and/or chronic inflammation
is induced by a vasculitis. Vasculitis is a varied group of
disorders featuring inflammation of a vessel wall including
lymphatic vessels and blood vessels like veins (phlebitis),
arteries (arteritis) and capillaries due to leukocyte migration and
resultant damage. The inflammation may affect any size blood
vessel, anywhere in the body. It may affect either arteries and/or
veins. The inflammation may be focal, meaning that it affects a
single location within a vessel, or it may be widespread, with
areas of inflammation scattered throughout a particular organ or
tissue, or even affecting more than one organ system in the body.
Vasculitis include, without limitation, Buerger's disease
(thromboangiitis obliterans), cerebral vasculitis (central nervous
system vasculitis), ANCA-associated vasculitis, Churg-Strauss
arteritis, cryoglobulinemia, essential cryoglobulinemic vasculitis,
giant cell (temporal) arteritis, Golfer's vasculitis,
Henoch-Schonlein purpura, hypersensitivity vasculitis (allergic
vasculitis), Kawasaki disease, microscopic
polyarteritis/polyangiitis, polyarteritis nodosa, polymyalgia
rheumatica (PMR), rheumatoid vasculitis, Takayasu arteritis,
Wegener's granulomatosis, and vasculitis secondary to connective
tissue disorders like systemic lupus erythematosus (SLE),
rheumatoid arthritis (RA), relapsing polychondritis, Behcet's
disease, or other connective tissue disorders, vasculitis secondary
to viral infection.
[0109] In another embodiment, an acute and/or chronic inflammation
is induced by a skin disorder. Skin disorders include, for example,
an acne, including acne vulgaris, a bullous phemigoid, a
dermatitis, including atopic dermatitis and acute and/or chronic
actinic dermatitis, an eczema-like atopic eczema, contact eczema,
xerotic eczema, seborrhoeic dermatitis, dyshidrosis, discoid
eczema, venous eczema, dermatitis, dermatitis herpetiformis,
neurodermatitis, and autoeczematization, and stasis dermatitis,
diabetic skin complications, hidradenitis suppurativa, lichen
planus, psoriasis including plaqure psoriasis, nail psoriasis,
guttate psoriasis, scalp psoriasis, inverse psoriasis, pustular
psoriasis, erythrodermis psoriasis, and psoriatic arthritis,
rosacea and scleroderma including morphea, ulcers.
[0110] In another embodiment, an acute and/or chronic inflammation
is induced by a gastrointestinal disorder. A gastrointestinal
disorder includes, for example, irritable bowel disease (IBD), an
inflammatory bowel disease including Crohn's disease and an
ulcerative colitis like ulcerative proctitis, left-sided colitis,
pancolitis, and fulminant colitis.
[0111] In another embodiment, an acute and/or chronic inflammation
is induced by a cardiovascular disease. When LDL cholesterol
becomes embedded in arterial walls, it can invoke an immune
response. Acute and/or chronic inflammation eventually can damage
the arteries, which can cause them to burst. In general,
cardiovascular disease is any of a number of specific diseases that
affect the heart itself and/or the blood vessel system, especially
the veins and arteries leading to and from the heart. There are
over 60 types of cardiovascular disorders including, for example, a
hypertension, endocarditis, myocarditis, heart valve dysfunction,
congestive heart failure, myocardial infarction, a diabetic cardiac
conditions, blood vessel inflammation like arteritis, phlebitis,
vasculitis; arterial occlusive disease like arteriosclerosis and
stenosis, inflammatory cardiomegaly, a peripheral arterial disease;
an aneurysm; an embolism; a dissection; a pseudoaneurysm; a
vascular malformation; a vascular nevus; a thrombosis; a
thrombophlebitis; a varicose veins; a stroke. Symptoms of a
cardiovascular disorder affecting the heart include, without
limitation, chest pain or chest discomfort (angina), pain in one or
both arms, the left shoulder, neck, jaw, or back, shortness of
breath, dizziness, faster heartbeats, nausea, abnormal heartbeats,
feeling fatigued. Symptoms of a cardiovascular disorder affecting
the brain include, without limitation, sudden numbness or weakness
of the face, arm, or leg, especially on one side of the body,
sudden confusion or trouble speaking or understanding speech,
sudden trouble seeing in one or both eyes, sudden dizziness,
difficulty walking, or loss of balance or coordination, sudden
severe headache with no known cause. Symptoms of a cardiovascular
disorder affecting the legs, pelvis and/or arm include, without
limitation, claudication, which is a pain, ache, or cramp in the
muscles, and cold or numb feeling in the feet or toes, especially
at night.
[0112] In another embodiment, an acute and/or chronic inflammation
is induced by a cancer. In general, inflammation orchestrates the
microenvironment around tumors, contributing to proliferation,
survival and migration. For example, fibrinous inflammation results
from a large increase in vascular permeability which allows fibrin
to pass through the blood vessels. If an appropriate procoagulative
stimulus is present, such as cancer cells, a fibrinous exudate is
deposited. This is commonly seen in serous cavities, where the
conversion of fibrinous exudate into a scar can occur between
serous membranes, limiting their function. In another example, a
cancer is an inflammatory cancer like a NF-.kappa.B-driven
inflammatory cancer.
[0113] In another embodiment, an acute and/or chronic inflammation
is a pharmacologically-induced inflammation. Certain drugs or
exogenic chemical compounds, including deficiencies in key vitamins
and minerals, are known to effect inflammation. For example,
Vitamin A deficiency causes an increase in an inflammatory
response, Vitamin C deficiency causes connective tissue disease,
and Vitamin D deficiency leads to osteoporosis. Certain
pharmacologic agents can induce inflammatory complications, e.g.,
drug-induced hepatitis. Certain illicit drugs such as cocaine and
ecstasy may exert some of their detrimental effects by activating
transcription factors intimately involved with inflammation (e.g.,
NF-.kappa.B). Radiation therapy can induce pulmonary toxicity,
burns, myocarditis, mucositis, and other tissue injuries depending
on site of exposure and dose.
[0114] In another embodiment, an acute and/or chronic inflammation
is induced by an infection. An infectious organism can escape the
confines of the immediate tissue via the circulatory system or
lymphatic system, where it may spread to other parts of the body.
If an organism is not contained by the actions of acute
inflammation it may gain access to the lymphatic system via nearby
lymph vessels. An infection of the lymph vessels is known as
lymphangitis, and infection of a lymph node is known as
lymphadenitis. A pathogen can gain access to the bloodstream
through lymphatic drainage into the circulatory system. Infections
include, without limitation, bacterial cystitis, bacterial
encephalitis, pandemic influenza, viral encephalitis, and viral
hepatitis (A, B and C).
[0115] In another embodiment, an acute and/or chronic inflammation
is induced by a tissue or organ injury. Tissue or organ injuries
include, without limitation, a burn, a laceration, a wound, a
puncture, or a trauma.
[0116] In another embodiment, an acute and/or chronic inflammation
is induced by a transplant rejection. Transplant rejection occurs
when a transplanted organ or tissue is not accepted by the body of
the transplant recipient because the immune system of the recipient
attacks the transplanted organ or tissue. An adaptive immune
response, transplant rejection is mediated through both
T-cell-mediated and humoral immune (antibodies) mechanisms. A
transplant rejection can be classified as a hyperacute rejection,
an acute rejection, or a chronic rejection. Acute and/or chronic
rejection of a transplanted organ or tissue is where the rejection
is due to a poorly understood acute and/or chronic inflammatory and
immune response against the transplanted tissue. Also included as
transplant rejection is graft-versus-host disease (GVHD), either
acute or chronic GVHD. GVHD is a common complication of allogeneic
bone marrow transplantation in which functional immune cells in the
transplanted marrow recognize the recipient as "foreign" and mount
an immunologic attack. It can also take place in a blood
transfusion under certain circumstances. GVHD is divided into acute
and chronic forms. Acute and chronic GVHD appear to involve
different immune cell subsets, different cytokine profiles,
somewhat different host targets, and respond differently to
treatment. In another embodiment, an acute and/or chronic
inflammation is induced by a Th1-mediated inflammatory disease. In
a well-functioning immune system, an immune response should result
in a well-balanced pro-inflammatory Th1 response and
anti-inflammatory Th2 response that is suited to address the immune
challenge. Generally speaking, once a pro-inflammatory Th1 response
is initiated, the body relies on the anti-inflammatory response
invoked by a Th2 response to counteract this Th1 response. This
counteractive response includes the release of Th2 type cytokines
such as, e.g., IL-4, IL-5, and IL-13 which are associated with the
promotion of IgE and eosinophilic responses in atopy, and also
IL-10, which has an anti-inflammatory response. A Th1-mediated
inflammatory disease involves an excessive pro-inflammatory
response produced by Th1 cells that leads to acute and/or chronic
inflammation. The Th1-mediated disease may be virally, bacterially
or chemically (e.g., environmentally) induced. For example, a virus
causing the Th1-mediated disease may cause a chronic or acute
infection, which may cause a respiratory disorder or influenza.
[0117] In another embodiment, an acute and/or chronic inflammation
comprises an acute and/or chronic neurogenic inflammation. Acute
and/or chronic neurogenic inflammation refers to an inflammatory
response initiated and/or maintained through the release of
inflammatory molecules like SP or CGRP which released from
peripheral sensory nerve terminals (i.e., an efferent function, in
contrast to the normal afferent signaling to the spinal cord in
these nerves). Acute and/or chronic neurogenic inflammation
includes both primary inflammation and secondary neurogenic
inflammation. Primary neurogenic inflammation refers to tissue
inflammation (inflammatory symptoms) that is initiated by, or
results from, the release of substances from primary sensory nerve
terminals (such as C and A-delta fibers). Secondary neurogenic
inflammation refers to tissue inflammation initiated by
non-neuronal sources (e.g., extravasation from vascular bed or
tissue interstitium-derived, such as from mast cells or immune
cells) of inflammatory mediators, such as peptides or cytokines,
stimulating sensory nerve terminals and causing a release of
inflammatory mediators from the nerves. The net effect of both
forms (primary and secondary) of acute and/or chronic neurogenic
inflammation is to have an inflammatory state that is maintained by
the sensitization of the peripheral sensory nerve fibers. The
physiological consequence of the resulting acute and/or chronic
neurogenic inflammation depends on the tissue in question,
producing, such as, e.g., cutaneous pain (allodynia, hyperalgesia),
joint pain and/or arthritis, visceral pain and dysfunction,
pulmonary dysfunction (asthma, COPD), and bladder dysfunction
(pain, overactive bladder).
[0118] Routes of Administration
[0119] The cell population expressing an E-selectin and/or
L-selectin ligand can be administered to subjects in accordance
with a number of suitable routes of administration. Exemplary
methods can include vascular injection, for example intravenous
(i.v.) injection, or direct implantation of cells into a target
site in a subject.
[0120] Other methods of delivery can include intratracheal
delivery, intrathecal delivery, intraosseous delivery, pulmonary
delivery, buccal delivery, aerosol delivery, inhalational delivery,
and oral delivery. Still other methods can include intraarterial
delivery, intracerebral delivery, intraintestinal delivery,
intracardiac delivery, subcutaneous delivery, intramuscular
delivery, intraorbital delivery, intracapsular delivery,
intraspinal delivery, intraperitoneal delivery, intrasternal
delivery, intravesical delivery, intralymphatic delivery,
intracavital delivery, vaginal delivery, rectal delivery,
transurethral delivery, intradermal delivery, intraocular delivery,
aural delivery, intramammary delivery, orthotopic delivery,
intratracheal delivery, intralesional delivery, percutaneous
delivery, endoscopical delivery, transmucosal delivery, sublingual
delivery, and direct application on body surfaces (e.g., directly
onto skin surface).
[0121] Cells can be inserted into a delivery device which
facilitates introduction by injection or implantation into the
subjects. Such delivery devices can include tubes, e.g., catheters,
for injecting cells and fluids into the body of a recipient
subject. Such delivery devices may also include endoscopic delivery
devices and methods. Preferably, the tubes additionally have a
needle, e.g., a syringe, through which the cells of the disclosure
can be introduced into the subject at a desired location.
[0122] The cells can be delivered subsequent to
manipulations/procedures to enhance E-selectin and/or L-selectin
binding activity, or, in some embodiments, cryopreserved and then
thawed prior to administration to a subject. The cells can be
prepared for delivery in a variety of different forms. For example,
the cells can be suspended in a solution or gel or embedded in a
support matrix when contained in such a delivery device. Cells can
be mixed with a pharmaceutically acceptable carrier or diluent in
which the cells of the disclosure remain viable. Pharmaceutically
acceptable carriers and diluents include saline, aqueous buffer
solutions, solvents and/or dispersion media. The use of such
carriers and diluents is well known in the art. The solution is
preferably sterile and fluid. Preferably, the solution is stable
under the conditions of manufacture and storage and preserved
against the contaminating action of microorganisms such as bacteria
and fungi through the use of, for example, parabens, chlorobutanol,
phenol, ascorbic acid, thimerosal, and the like. Solutions can be
prepared by incorporating cells as described herein in a
pharmaceutically acceptable carrier or diluent and, as required,
other ingredients, followed by filtered sterilization.
[0123] Intravascular delivery via needles or vascular-assisted
devices (e.g., catheter-based) injection techniques for cell
administration can also be used to achieve distribution through the
entire vasculature, or to the vasculature of a particular organ,
such as for example liver, or kidney or any other organ. This
includes non-specific targeting of the vasculature. Alternatively,
any organ can be targeted by selecting a specific injection site,
such as e.g., a liver portal vein. Alternatively, the injection can
be performed systemically into any vein in the body. This method is
useful for enhancing stem cell numbers in aging patients. In
addition, the cells can function to populate vacant stem cell
niches or create new stem cells to replenish the organ, thus
improving organ function. For example, cells can take up pericyte
locations within the vasculature.
[0124] In some embodiments, the cells are introduced into the
subject as part of a cell aggregate (e.g., a pancreatic islet),
tissue, or organ, e.g., as part of an organ transplant method.
[0125] Delivery of cells can also be used to target sites of active
angiogenesis. For example, delivery of endothelial progenitor cells
or mesenchymal stem or progenitor cells can enhance the angiogenic
response at a wound site. Targeting of angiogenesis can also be
useful for using cells as a vehicle to target drugs to tumors.
[0126] Modified Cells and Methods for their Preparation
[0127] Due, at least in part, to their increased homing
capabilities, certain E-and/or L-selectin expressing cells are
useful in the methods described herein. By way of example, cells
can improve engraftment of stem cells such as HSPCs in clinical
transplantation, for use of MSC in cell-based therapy (e.g., for
bone diseases) or directing migration and infiltration of
progenitor/stem cells at injured/damaged tissue(s) for regenerative
therapeutics in accordance with the methods described herein.
[0128] Accordingly, the cells used in the methods described herein
express an E-selectin ligand and/or an L-selectin ligand. Thus, for
example, after modification, the cell binds E-selectin and/or
L-selectin. In various embodiments, the modified cell can bind
P-selectin. In one particular embodiment, after modification the
cells express the sialofucosylated CD44 glycoform known as
Hematopoietic Cell E-/L-selectin Ligand (HCELL). In another
particular embodiment, after modification the cells express Neural
Cell Adhesion Molecule E-selectin Ligand (NCAM-E). In certain
embodiments, after modification the cells express both HCELL and
NCAM-E. In certain embodiments the cells express HCELL and/or
CD43-E and/or CLA. After modification, the cell is capable of
homing in vivo to the bone marrow and or sites of inflammation.
[0129] In certain embodiments, the cells used in the methods
described herein express an L-selectin ligand. In one particular
embodiment, after modification the cells express the potent
L-selectin ligand known as Hematopoietic Cell E-/L-selectin Ligand
(HCELL), sialofucosylated CD44 glycoform. In another embodiment,
the cells express increased amounts of the L-selectin ligands HCELL
and/or PSGL-1, or the E-selectin ligands HCELL, CLA, CD43-E,
NCAM-E, or ESL-1. Such cells may lodge into sites of inflammation
via binding to E-selectin on endothelial cells or via binding to
L-selectin expressed on infiltrating leukocytes within the
inflammatory site.
[0130] For ex vivo custom engineering of live cell surface glycans
using glycosyltransferases, it is imperative that the treated cells
remain viable and phenotypically conserved following treatment(s).
Previously, divalent metal co-factors such as manganese had been
deemed critical for enzymatic activity for
.alpha.(1,3)-fucosyltransferases, with use of such co-factors at
levels that were overtly cytotoxic (e.g., 10 mM Mn.sup.++).
However, it is now known that these glycosyltransferases possess
enzymatic activity in the absence of, or in presence of, relatively
small amounts of, divalent metal co-factors (e.g., divalent cations
such as manganese, magnesium, calcium, zinc, cobalt or nickel).
Moreover, these enzymes can be stored in absence of stabilizers
such as glycerol which can themselves be toxic to cells. Certain
glycosyltransferase compositions described in U.S. Pat. No.
7,875,585 are particularly useful in modification of glycans on
live cells, which cells and/or particles or fragments thereof can
then be used in the treatment methods described herein. In
applications utilizing stem cells, it is also important to analyze
whether differentiation along characteristic lineages is affected
by enzymatic treatment.
[0131] Various methods can be utilized for preparing cells that
bind E-selectin and/or L-selectin.
[0132] For example, U.S. Pat. Nos. 7,875,585 and 8,084,236, provide
compositions and methods for ex vivo modification of cell surface
glycans on a viable cell, the latter of which may in turn be
utilized in methods of treatment of acute or chronic inflammation
as described herein. The compositions include a purified
glycosyltransferase polypeptide and a physiologically acceptable
solution, for use together with appropriate donor nucleotide sugars
in reaction buffers and reaction conditions specifically formulated
to retain cell viability. In certain preferred embodiments, the
physiologically acceptable solution is free or substantially free
of divalent metal co-factors, to such extent that cell viability is
not compromised. In these and other preferred embodiments, the
composition is also free or substantially free of stabilizer
compounds such as for example, glycerol. Glycosyltransferase
include for example, fucosyltransferase, galactosyltransferase,
sialytransferase and N-acetylglucosaminyltransferase. In one
embodiment, the fucosyltransferase is an alpha 1,3
fucosyltransferase such as an alpha 1,3 fucosyltransferase III,
alpha 1,3 fucosyltransferase IV, an alpha 1,3 fucosyltransferase V,
an alpha 1,3 fucosyltransferase VI, an alpha 1,3 fucosyltransferase
VII or an alpha 1,3 fucosyltransferase IX. The sialyltransferase
can be ST3GalII, ST3GalIV, or ST3GalVI.
[0133] Glycans are modified on the surface of a cell by contacting
a population of cells with one or more glycosyltransferase
compositions described above. The cells are contacted with the
glycosyltransferase composition together with appropriate
nucleotide sugar donor (e.g., GDP-fucose, CMP-sialic acid) under
conditions in which the glycosyltransferase has enzymatic activity.
Glycan modification according to this method results in cells that
have at least 70%, 75%, 80%, 85%, 90%, 95%, 96%, 97%, 98%, 99% A or
more viability at 24 hours or more after treatment. In one
embodiment, for example, the cells have at least 70% viability at
48 hours after treatment. In one such embodiment, for example, the
cells have at least 75% viability at 48 hours after treatment. In
one embodiment, for example, the cells have at least 80% viability
at 48 hours after treatment. In addition, the phenotype of the
cells (other than the glycan modification) is preferably preserved
after treatment. By preserved phenotype it is meant the cell
maintains its native function and/or activity. For example, if the
cell is a stem cell it retains its potency, i.e., its relevant
totipotency or pluripotency or multipotency or unipotency, as would
be characteristic of that particular stem cell type.
[0134] Another method of modifying cells for use in the treatment
methods described herein can be found in U.S. Patent Application
Pub. No. 2013/0040837. In accordance with the methods described
therein, nucleic acids (e.g., an aptamer) that specifically bind to
a non-nucleic acid target may be immobilized onto the cell
membrane. The aptamers can be selected for a specific target, such
as those capable of binding to particular proteins. Thus, for
example, aptamers that bind to cell surface receptors/cell adhesion
molecules (e.g., E-selectin, L-selectin) may be immobilized onto
the surface of the cell to improve cell targeting. The aptamers may
be conjugated to the cell surface using a three step modification
process that includes (i) treatment of cells (in a suspension after
trypsinization) with sulfonated biotinyl-N-hydroxy-succinimide
(NHS-biotin) to introduce biotin groups on the cell surface, (ii)
complexing with streptavidin, and (iii) coupling with biotinylated
aptamers. Using this approach, Karp et al. reported in US
2013/0040837 that typically 21,000 molecules were attached per cell
using this procedure and that the site density of aptamers on the
cell surface could be readily tuned by adjusting the aptamer
concentration used in the conjugation.
[0135] Expression of selectin binding may also be induced by
covalent addition of sLex or sLea moieties or other oligosaccharide
complexes that bind selectins. For example, as described more fully
and as exemplified by Karp et al. in US2011/0206740,
biotin-streptavidin conjugation was utilized to chemically
incorporate the sialyl-Lewis.sup.x moiety onto the cell surface.
More specifically, the free amine groups present on the surface of
the cells were allowed to react with N-hydroxy-succinimide group of
biotinyl-N-hydroxy-succinimide to biotinylate the cell surface.
This step was subsequently followed by reacting the biotin moiety
of the cell surface with a streptavidin molecule. The strong
interaction between biotin and streptavidin allows the streptavidin
molecule to be immobilized on the cell surface. The streptavidin is
then reacted with biotinylated SLeX (Sialyl-Lex-PAA-Biotin) to
introduce SLeX on the cell surface.
[0136] In an alternative approach to glycan engineering of cell
surfaces, a fucosyltransferase is used incorporate an en bloc
assembly of an sLex or sLea glycan onto a cell surface as
described, for example, by Srivastava et al., J. Biol. Chem. 1992,
267:22356-22361. More specifically, Srivastava et al. reported that
a partially purified Le-FucT from human milk, which normally used
GDP-fucose as the donor for the transfer of a single fucose residue
will also transfer a fucose residue substituted on C-6 by a very
large sterically demanding structure. Accordingly, the
fucosyltransferase could be used to transfer a glycan such as such
as sialyl-Lewis.sup.x to increase the level of expression of
E-selectin ligand and/or an L-selectin ligand on the surface of of
a population cells that is greater than the level of expression for
a native population of such cells.
[0137] In another embodiment, a variety of bifunctional chemical
linkers can be used to covalently attach sLex or sLea glycans, or
glycomimetics of sLex or sLea, or peptidomimetics of sLex or sLea
(e.g., as could be generated by phage display technology).
Similarly, mAb or mAb fragments thereof that bind to E-selectin
and/or L-selectin could be conjugated to the cell surface to
enhance binding to E-selectin and/or L-selectin, respectively.
[0138] In addition to the foregoing, any other methods of modifying
a cell or cells to express an E-selectin ligand and/or an
L-selectin ligand may be utilized. This includes, for example, the
promotion of covalent and/or non-covalent interactions, hydrogen
bonding, and/or van der Wals forces between the cell surface and
the ligand, phage display product, and the like.
[0139] In general, any type of cell can modified and used in the
treatment methods described herein. For animal use it is preferable
that the cell is of animal origin, while for human use it is
preferably that the cell is a human cell; in each case, an
autologous cell source could be used, a syngeniec source cell could
be used, an allogeneic source cell could be used (including a
combination of allogenic donor cells in a given cell product), or a
xenogeneic cell source can be utilized. The cell can be a primary
cell, e.g., a primary hepatocyte, a primary neuronal cell, a
primary myoblast, a primary mesenchymal stem cell, primary
progenitor cell, or it can be a cell of an established cell line or
of a culture expanded cell (e.g., T cells, dendritic cells, etc).
It is not necessary that the cell be capable of undergoing cell
division; a terminally differentiated cell can be used in the
methods described herein. In this context, the cell can be of any
cell type including, but not limited to embryonic stem cells, adult
stem cells, induced pluripotent stem cells, blood progenitor cells,
tissue progenitor cells, epithelial, endothelial, neuronal,
adipose, cardiac, skeletal muscle, fibroblast, immune cells (for
example, dendritic cells, monocytes, macrophages, leukocytes (e.g.,
a lymphocyte such as a B-lymphocyte, a T-lymphocyte, or a subset of
T-lymphocytes, such as regulatory lymphocyte
(CD4.sup.+/CD25.sup.+/FOXP3.sup.+)), a naive T cell, a central
memory T cell, an effector memory T cell, an effector T cell, NK
cells, etc.), hepatic, splenic, lung, circulating blood cells,
platelets, reproductive cells, gastrointestinal cells, renal cells,
bone marrow cells, cardiac cells, endothelial cells, endocrine
cells, skin cells, muscle cells, neuronal cells, and pancreatic
cells. The cell can be a cell line, a stem cell (e.g., a
mesenchymal stem cell, a hematopoietic stem cell, a tissue
stem/progenitor cell (for example, a neural stem cell,
gastrointestinal stem cell, myocyte stem cell, cardiomyocyte
progenitor/stem cell, endothelial progenitor cell, or pulmonary
stem cell), an umbilical cord stem cell, or an embryonic stem cell,
or a primary cell isolated from any tissue including, but not
limited to brain, liver, lung, gut, stomach, fat, muscle, testes,
uterus, ovary, skin, spleen, endocrine organ and bone, and the
like.
[0140] Where the cell is maintained under in vitro conditions,
conventional tissue culture conditions and methods can be used, and
are known to those of skill in the art. Isolation and culture
methods for various cells are well within the knowledge of one
skilled in the art.
[0141] In addition, both heterogeneous and homogeneous cell
populations are contemplated for use with the methods and
compositions described herein. In addition, aggregates of cells,
cells attached to or encapsulated within particles, cells within
injectable delivery vehicles such as hydrogels, and cells attached
to transplantable substrates (including scaffolds) or applied into
tissue(s) that harbors scaffolds/transplantable substrates are
contemplated for use with the methods and compositions described
herein. Moreover, cells may be used in combination with tissue
proliferative/enhancing agents and/or anti-inflammatory agents
(e.g., growth factors, cytokines, prostaglandins, trophic agents,
Resolvins, NSAIDS, steroids, etc.)
[0142] The present disclosure further includes the following
enumerated embodiments.
Embodiment 1
[0143] A method of enhancing cell delivery into a target tissue of
a subject and/or enhancing tissue colonization in the target tissue
of the subject, the method comprising: administering to the subject
a population of cells that express an E selectin ligand and/or an
L-selectin ligand, the population expressing the E selectin ligand
and/or L-selectin ligand at a level that exceeds the level of
expression of a native population of the cells, wherein said cell
administration occurs coincident with E selectin expression on
endothelial cells within the target tissue and/or coincident with
accumulation of leukocytes within the target tissue.
Embodiment 2
[0144] A method of treating a disease, disorder or medical
condition manifesting as inflamed and/or damaged tissue in a
subject, the method comprising: administering to the subject a
population of cells that express an E selectin ligand and/or an
L-selectin ligand, the population expressing the E selectin ligand
and/or L-selectin ligand at a level that exceeds the level of
expression of a native population of the cells, wherein said cell
administration occurs coincident with E selectin expression on
endothelial cells within the target tissue and/or coincident with
accumulation of leukocytes within the target tissue, and wherein
said population exhibits enhanced localization and/or colonization
within the inflamed and/or damaged tissue relative to a native
population of the administered cells.
Embodiment 3
[0145] A method of improving cellular delivery to a target tissue
in a subject, the method comprising: administering to the subject,
via vascular delivery and/or via direct tissue injection (i.e.,
directly into affected tissue site(s)) and/or intrethecally and/or
intracavitary and/or intravesically and/or within anatomic conduits
(biliary system, urinary system, etc.) and/or onto tissue (i.e.,
placement onto affected tissue), a population of cells that express
an E selectin ligand and/or an L-selectin ligand, the population
expressing the E selectin ligand and/or L-selectin ligand at a
level that exceeds the level of expression of a native population
of the cells, wherein said cell administration occurs coincident
with E selectin expression on endothelial cells within the target
tissue and/or coincident with accumulation of leukocytes within the
target tissue, and wherein said administered cell population
achieves one or more of enhanced homing, colonization, and
engraftment relative to a native population of cells.
Embodiment 4
[0146] A method of enhancing cell delivery and colonization in an
inflamed and/or damaged tissue of a subject, the method comprising:
directly injecting into or placing onto/within said inflamed and/or
damaged tissue a population of cells that express an E selectin
ligand and/or an L-selectin ligand, the population expressing the E
selectin ligand and/or L-selectin ligand at a level that exceeds
the level of expression of a native population of the cells,
wherein said injection/placement occurs coincident with E selectin
expression on endothelial cells within the target tissue and/or
coincident with accumulation of leukocytes within the target
tissue.
Embodiment 5
[0147] A method of enhancing cell delivery, colonization and/or
engraftment into a target tissue of a subject, the method
comprising: administering via the vasculature of the subject a
population of cells that express an E selectin ligand and/or an
L-selectin ligand, the population expressing the E selectin ligand
and/or L-selectin ligand at a level that exceeds the level of
expression of a native population of the cells, wherein said
administration occurs coincident with E selectin expression on
endothelial cells within the target tissue and/or coincident with
accumulation of leukocytes within the target tissue.
Embodiment 6
[0148] A method of enhancing lodgement, colonization and/or
engraftment of a cell population within a target tissue in a
subject, the method comprising: directly injecting into the target
tissue or placement onto the target tissue a population of cells
that express an E selectin ligand and/or an L-selectin ligand, the
population expressing the E selectin ligand and/or L-selectin
ligand at a level that exceeds the level of expression of a native
population of the cells, wherein said injection occurs coincident
with E selectin expression on endothelial cells within the target
tissue and/or coincident with accumulation of leukocytes within the
target tissue, and wherein said population achieves enhanced target
tissue colonization relative to a native population of the
cells.
Embodiment 7
[0149] A method of treating a disease, disorder or medical
condition manifesting as inflamed and/or damaged tissue in a
subject, the method comprising: administering to the subject a
population of cells that express an E selectin ligand and/or an
L-selectin ligand, the population expressing the E selectin ligand
and/or L-selectin ligand at a level that exceeds the level of
expression of a native population of the cells, and wherein said
injection occurs coincident with E selectin expression on
endothelial cells within the inflamed and/or damaged tissue and/or
coincident with accumulation of leukocytes within the inflamed
and/or damaged tissue.
Embodiment 8
[0150] A method of treating a tumor/malignant disease in a subject,
the method comprising: administering to the subject a population of
cells that express an E selectin ligand and/or an L-selectin
ligand, the population expressing the E selectin ligand and/or
L-selectin ligand at a level that exceeds the level of expression
of a native population of the cells, wherein said administration
occurs coincident with E selectin expression on endothelial cells
within tissue(s) harboring tumor/malignant cells and/or coincident
with accumulation of leukocytes within the tissue(s) harboring
tumor/malignant cells.
Embodiment 9
[0151] A population of cells that express an E selectin ligand
and/or an L-selectin ligand for use in the manufacture of a
medicament for the treatment of a disease, disorder or medical
condition manifesting as inflamed and/or damaged tissue in a
subject, the treatment comprising administering to the subject the
population of cells that express an E selectin ligand and/or an
L-selectin ligand, wherein the population expresses the E selectin
ligand and/or L-selectin ligand at a level that exceeds the level
of expression of a native population of the cells, wherein said
treatment comprises administering the population coincident with E
selectin expression on endothelial cells within the inflamed and/or
damaged tissue and/or coincident with accumulation of leukocytes
within the inflamed and/or damaged tissue.
Embodiment 10
[0152] A population of cells that express an E selectin ligand
and/or an L-selectin ligand for use in the manufacture of a
medicament for the treatment of a tumor/malignant disease, the
treatment comprising administering to the subject the population of
cells that express an E selectin ligand and/or an L-selectin
ligand, wherein the population expresses the E selectin ligand
and/or L-selectin ligand at a level that exceeds the level of
expression of a native population of the cells, wherein said
treatment comprises administering the population coincident with E
selectin expression on endothelial cells within the tumor/malignant
tissue and/or coincident with accumulation of leukocytes within the
tumor/malignant tissue.
Embodiment 11
[0153] The method or population of any one of Embodiments 1-10,
wherein said cell administration occurs coincident with E selectin
expression on endothelial cells and infiltrates of leukocytes
bearing L-selectin within the target tissue.
Embodiment 12
[0154] The method or population of any one of Embodiments 1-11,
wherein said administration/injection occurs during infiltration of
leukocytes to an/the inflamed and/or damaged tissue.
Embodiment 13
[0155] The method or population of any one of Embodiments 1-12,
further comprising engraftment of the administered population of
cells in a milieu of an/the inflamed and/or damaged tissue.
Embodiment 14
[0156] The method or population of any one of Embodiments 1-13,
wherein an immunomodulatory effect is achieved by colonization of
cells within an/the inflamed and/or damaged tissue.
Embodiment 15
[0157] The method or population of any one of Embodiments 1-14,
wherein a tissue reparative effect is achieved by colonization of
administered cells within an/the inflamed and/or damaged
tissue.
Embodiment 16
[0158] The method or population of any one of Embodiments 1-15,
wherein an enhanced host defense/immune response effect is achieved
by delivery and colonization of administered cells within an/the
inflamed and/or damaged tissue.
Embodiment 17
[0159] The method or population of any one of Embodiments 1-16,
wherein an anti-malignancy effect is achieved by colonization of
administered cells within a/the tumor/malignant tissue site.
Embodiment 18
[0160] The method or population of any one of Embodiments 1-17,
wherein said administration/injection comprises one or a series of
injections of the cell population.
Embodiment 19
[0161] The method or population of cells of any one of Embodiments
1-18, wherein said administration/injection comprises daily,
weekly, bi-weekly, monthly, or yearly injections of the cell
population.
Embodiment 20
[0162] The method or population of cells of any one of Embodiments
1-9, further comprising one or more additional
administrations/injection of the cell population upon a decrease in
the subject of an immunomodulatory effect of a prior
administration/injection.
Embodiment 21
[0163] The method or population of cells of any one of Embodiments
1-20, wherein the cell population is administered/injected
intravenously.
Embodiment 22
[0164] The method or population of cells of any one of Embodiments
1-21, wherein the cell population is administered by direct
injection to the inflamed and/or injured tissue.
Embodiment 23
[0165] The method or population of cells of any one of Embodiments
1-21, wherein the cell population is placed onto the inflamed
tissue and/or injured tissue.
Embodiment 24
[0166] The method or population of cells of any one of Embodiments
1-21, wherein the cell population is placed onto an/the inflamed
tissue and/or injured tissue.
Embodiment 25
[0167] The method or population of cells of any one of Embodiments
1-21, wherein the cell population is utilized in combination with
other enhancing agents, anti-inflammatory agents, or with tissue
scaffolds/transplantable devices/gels.
Embodiment 26
[0168] The method or population of any one of Embodiments 1-25,
wherein the population of cells express an E selectin ligand and an
L-selectin ligand.
Embodiment 27
[0169] The method or population of any one of Embodiments 1-26
wherein the E-selectin ligand and/or L-selectin ligand is selected
from one or more of Hematopoietic Cell E-/L-selectin Ligand
(HCELL), Neural Cell Adhesion Molecule E-selectin Ligand (NCAM-E),
CD43E, CLA, and ESL-1.
Embodiment 28
[0170] The method or population of any one of Embodiments 1-27,
wherein the E-selectin ligand is Hematopoietic Cell E-/L-selectin
Ligand (HCELL) and/or Neural Cell Adhesion Molecule E-selectin
Ligand (NCAM-E).
Embodiment 29
[0171] The method or population of any one of Embodiments 1-28,
wherein the E-selectin ligand is HCELL.
Embodiment 30
[0172] The method or population of any one of Embodiments 1-29,
wherein the E-selectin ligand is NCAM-E.
Embodiment 31
[0173] The method or population of any one of Embodiments 1-30,
wherein the L-selectin ligand is HCELL.
Embodiment 32
[0174] The method or population of any one of Embodiments 1-31,
wherein the cell population comprises one or more of epithelial,
endothelial, neuronal, adipose, cardiac, skeletal muscle,
fibroblast, and immune cells (for example, dendritic cells,
monocytes, macrophages, leukocytes (e.g., a lymphocyte such as a NK
cell, a B-lymphocyte, a T-lymphocyte, or a subset of T-lymphocytes,
such as regulatory lymphocyte (CD4+/CD25+/FOXP3+)), a cytotoxic
lymphocyte, etc.), hepatic, splenic, lung, circulating blood cells,
platelets, reproductive cells, gastrointestinal, renal, bone
marrow, pancreatic cells, a stem cell (e.g., a mesenchymal stem
cell, a hematopoietic stem cell, a tissue stem/progenitor cell (for
example, a neural stem cell, myocyte stem cell or pulmonary stem
cell), an umbilical cord stem cell, or an embryonic stem cell, or
an induced pluripotent stem cell, or a differentiated progenitor
derived from an embryonic stem cell or from an induced pluripotent
stem cells, or a differentiated progenitor derived from an adult
stem cell, or a primary cell isolated from any tissue (e.g., brain,
liver, lung, gut, stomach, fat, muscle, testes, uterus, ovary,
skin, spleen, endocrine organ and bone), or a culture-expanded
progenitor cell population, or a culture-expanded stem cell
population, or a culture-expanded primary cell population.
Embodiment 33
[0175] The method or population of any one of Embodiments 1-32,
wherein the cell population is a mesenchymal stem cell, a
hematopoietic stem cell, a tissue stem/progenitor cell, an
umbilical cord stem cell, or an embryonic stem cell.
Embodiment 34
[0176] The method or population of any one of Embodiments 1-33,
wherein the cell population is a leukocyte (e.g., a lymphocyte such
as an NK cell, B-lymphocyte, a T-lymphocyte, or a subset of
T-lymphocytes, such as regulatory lymphocyte (CD4+/CD25+/FOXP3+)),
a cytotoxic T cell, etc.).
Embodiment 35
[0177] The method or population of any one of Embodiments 1-34,
wherein the disease, disorder or medical condition is one or more
of direct tissue injury (e.g., burns, trauma, decubitus ulcers,
etc.), ischemic/vascular events (e.g., myocardial infarct, stroke,
shock, hemorrhage, coagulopathy, etc.), infections (e.g.,
cellulitis, pneumonia, meningitis, sepsis, SIRS, etc.), neoplasia
(e.g., breast cancer, lung cancer, prostate cancer, lymphoma,
leukemia, etc.), immunologic/autoimmune conditions (e.g., graft vs.
host disease, multiple sclerosis, diabetes, inflammatory bowel
disease, lupus erythematosus, rheumatoid arthritis, psoriasis,
etc.), degenerative diseases (e.g., osteoporosis, osteoarthritis,
Alzheimer's disease, etc.), congenital/genetic diseases (e.g.,
epidermolysis bullosa, osteogenesis imperfecta, muscular
dystrophies, lysosomal storage diseases, Huntington's disease,
etc.), adverse drug effects (e.g., drug-induced hepatitis,
drug-induced cardiac injury, etc.), toxic injuries (e.g., radiation
exposure(s), chemical exposure(s), alcoholic hepatitis, alcoholic
pancreatitis, alcoholic cardiomyopathy, cocaine cardiomyopathy,
etc.), metabolic derangements (e.g., uremic pericarditis, metabolic
acidosis, etc.), iatrogenic conditions (e.g., radiation-induced
tissue injury, surgery-related complications, etc.), and/or
idiopathic processes (e.g., amyotrophic lateral sclerosis,
Parsonnage-Turner Syndrome, etc.).
Embodiment 36
[0178] The method or population of any one of Embodiments 1-35,
wherein the disease, disorder or medical condition is diabetes.
Embodiment 37
[0179] The method or population of any one of Embodiments 1-36,
wherein the disease, disorder or medical condition is multiple
sclerosis.
Embodiment 38
[0180] The method or population of any one of Embodiments 1-37,
wherein the subject is a human, non-human primate, mouse, rat, dog,
cat, horse, or cow.
Embodiment 39
[0181] The method or population of any one of Embodiments 1-38,
wherein the subject is a human patient.
Embodiment 40
[0182] The method or population of any one of Embodiments 1-39
wherein the cell population is treated to form a modified cell
population having an enforced expression of an E-selectin and/or an
L-selectin ligand, and the cell population has a viability of at
least 70% at 24 hours after the treatment.
Embodiment 41
[0183] The method or population of any one of Embodiments 1-40
wherein the cell population has a viability of at least 80% at 24
hours after the treatment.
Embodiment 42
[0184] The method or population of any one of Embodiments 1-40
wherein the cell population has a viability of at least 70% at 48
hours after the treatment.
Embodiment 43
[0185] The method or population of any one of Embodiments 1-42
wherein, upon administration to the cell population to a subject,
the cell population lodges within a tissue comprising infiltrating
leukocytes.
Embodiment 44
[0186] The method or population of Embodiment 43 wherein the
administration is a direct injection into the tissue or placement
onto the tissue.
Embodiment 45
[0187] The method or population of Embodiment 43 wherein the
administration is vascular.
Embodiment 46
[0188] The method or population of any of Embodiments 1-21 or 25-42
wherein the population is administered systemically, via either
peripheral vascular access or central vascular access.
Embodiment 47
[0189] The method or population of any of Embodiments 1-21 or 25-42
wherein the population is administered intravascularly into
anatomic feeder vessels of an intended tissue site using
catheter-based approaches or other vascular access devices that
will deliver a vascular bolus of cells to the intended site.
Embodiment 48
[0190] The method or population of any of Embodiments 1-21 or 25-42
wherein the population is administered by introduction into the
spinal canal and/or intraventricularly.
Embodiment 49
[0191] The method or population of any of Embodiments 1-21 or 25-42
wherein the population is administered directly into body cavities
by either catheter-based approaches or direct injection.
Embodiment 50
[0192] The method or population of any of Embodiments 1-21 or 25-42
wherein the population is administered by direct local tissue
injection, using either intravascular approaches, or percutaneous
approaches, or directly into anatomically accessible tissue sites
and/or guided by imaging techniques.
Embodiment 51
[0193] The method or population of any of Embodiments 1-21 or 25-42
wherein the population is administered by placement directly onto
relevant tissue surfaces/sites.
Embodiment 52
[0194] The method or population of any of Embodiments 1-21 or 25-42
wherein the population is administered into scaffolds or embedded
within scaffolds placed into tissues, and/or administered in gels,
and/or administered together with enhancing agents.
Embodiment 53
[0195] The method or population of any of Embodiments 1-21 or 25-42
wherein the population is administered into the cerebrospinal
fluid.
[0196] Having described the disclosure in detail, it will be
apparent that modifications and variations are possible without
departing the scope of the disclosure defined in the appended
claims. Furthermore, it should be appreciated that all examples in
the present disclosure are provided as non-limiting examples.
EXAMPLES
[0197] The following non-limiting examples are provided to further
illustrate the present disclosure. It should be appreciated by
those of skill in the art that the techniques disclosed in the
examples that follow represent approaches the inventors have found
function well in the practice of the disclosure, and thus can be
considered to constitute examples of modes for its practice.
However, those of skill in the art should, in light of the present
disclosure, appreciate that many changes can be made in the
specific embodiments that are disclosed and still obtain a like or
similar result without departing from the spirit and scope of the
disclosure.
Example 1: Alpha(1,3)-Fucosyltransferase Treatment of
Adipose-Derived Mesenchymal Stem Cells Enforces Expression of
HCELL
[0198] Prior studies indicated that bone marrow-derived mesenchymal
stem cells (MSCs) can be glycan engineered by
.alpha.(1,3)-fucosyltransferases to create the potent E- and
L-selectin ligand HCELL (R Sackstein et al, Nature Medicine
14:181-187 (2008)). To determine whether HCELL expression can be
enforced on MSC derived from non-bone marrow sources, we analyzed
the effects of .alpha.(1,3)-exofucosylation on adipose-derived
mesenchymal stem cells. To this end, adipose tissue was obtained
from liposuction material from both lean and obese subjects and
mesenchymal stem cells were cultured as described (R Sackstein et
al, Nature Medicine 14:181-187 (2008)). Cells were grown at low
density (confluence <60%) under both normoxic (21% O.sub.2) and
hypoxic (<5% O.sub.2) conditions in MSC medium supplemented with
either FBS (DMEM with 20% FBS and 1% penicillin/streptomycin) or
with human platelet lysate (DMEM with 5% human platelet lysate and
1% penicillin/streptomycin). MSCs were passaged when confluence
approached 60%, and MSCs were harvested at passages 3-6. MSCs
(20.times.10.sup.6/ml) were then treated with Fucosyltransferase
VII (FTVII; prepared by R&D Systems in suspension without
divalent cations) at 20 ug/ml or with Fucosyltransferase VI (60
mU/ml (R Sackstein et al, Nature Medicine 14:181-187 (2008))) in
each case in Hank's balanced salt solution (HBSS) without divalent
cations containing 10 mM HEPES, 0.1% human serum albumin and 1 mM
GDP-fucose (Sigma) for 60 min at 37.degree. C., whereas control
cells (buffer-treated) were treated in the same buffer without
FTVII or without FTVI. Cell viability was assessed routinely by
dual laser flow cytometry using propidium iodide and annexin V
staining. Cell viability was consistently greater than 80% at 24
hours following .alpha.(1,3)-exofucosylation with either FTVI or
FTVII. See FIGS. 24-26.
Example 2: Alpha(1,3)-Fucosyltransferase Treatment of Human Blood
Leukocytes Induces High Level E-Selectin Ligand Activity on the
Cells and Enforces Expression of HCELL
[0199] The enforced expression of E selectin ligands (i.e., HCELL
and other E-selectin ligands) on surfaces of desired cells (e.g.
stem cells, progenitor cells, leukocytes, etc.) would confer
heightened capacity of those cells to traffic intravascularly to
sites of tissue inflammation/damage and to sites of tumor/cancer
infiltrates on the basis of vascular E-selectin expression on
endothelial cells within the affected tissue(s). Additionally, once
extravasated, the expression of HCELL (or other enforced
E-selectin/L-selectin ligands) on the relevant administered cell
surface would serve to promote colonization of the administered
cells within the target tissue, as administered cells would collect
within perivascular areas via E-selectin ligand adherence to
E-selectin expressed at endothelial cells, and, additionally,
administered cells would also anchor via L-selectin ligand
adherence to L-selectin displayed on the surfaces of infiltrating
leukocytes within the inflamed/damaged or cancer tissue milieu. As
such, enforcing the expression of HCELL and of other E-selectin
ligands and/or L-selectin ligands on stem cells/progenitor cells
and on specific leukocyte subsets (including, for example, NK
cells, CD4 T cells, CD8 T cells, Tregs, monocytes, dendritic cells
and granulocytes, as well as relevant leukocytes expanded in
culture for therapeutic purposes (e.g., antigen-specific T cells,
expanded NK cells, chimeric antigen receptor T cells (CAR T cells),
etc.)) could be harnessed in adoptive cell therapeutics (for tissue
regeneration/repair and/or for immunotherapy to either augment
immunity or to dampen immunity). Thus, critically, enforced
expression of HCELL would enable efficient trafficking of
intravascularly administered cells to target sites by
E-selectin-dependent endothelial interactions yielding recruitment
of blood-borne cells, thereafter followed by E-selectin-mediated
and L-selectin-mediated lodgement of the extravasated cells with
discrete tissue microenvironments. Moreover, similarly, if such
cells were injected directly into the affected site(s) of tissue
injury/damage or at sites of cancer, enforced expression of HCELL
and other E-selectin/L-selectin ligands would promote
E-selectin-mediated and L-selectin-mediated lodgement/colonization
of the cells within the tissue milieu.
[0200] To analyze the molecular targets of cell surface
.alpha.(1,3)-exofucosylation and the effects of exofucosylation on
leukocyte E-selectin and L-selectin ligand activity, studies were
performed on primary human peripheral blood leukocytes obtained
from citrated whole blood. Leukocytes were separated by
immunomagnetic bead sorting (Miltenyi) into monocytes (CD14+
cells), CD4+ lymphocytes, CD8+ lymphocytes, and B cells (CD19+
cells). Cells were treated with Fucosyltransferase VII (FTVII;
prepared by R&D Systems in suspension without divalent cations)
at 20 ug/ml or with Fucosyltransferase VI (at 60 mU/ml (R Sackstein
et al, Nature Medicine 14:181-187 (2008))) in each case in Hank's
balanced salt solution (HBSS) without divalent cations containing
10 mM HEPES, 0.1% human serum albumin and 1 mM GDP-fucose (Sigma)
for 60 min at 37.degree. C., whereas control cells (buffer-treated)
were treated in the same buffer without FTVII or without FTVI. Cell
viability was assessed routinely by dual laser flow cytometry using
propidium iodide and annexin V staining. Cell viability was
consistently greater than 80% at 24 hours following exofucosylation
with either FTVI or FTVII. See FIGS. 27A-27C and FIGS. 28A-28C.
Example 3: Alpha(1,3)-Fucosyltransferase Treatment of Primary
Cultures of Human Dendritic Cells Induces High Level E-Selectin
Ligand Activity on the Cells and Enforces Expression of HCELL
[0201] To assess the capacity of .alpha.(1,3)-exofucosylation to
modulate E-selectin and L-selectin ligand activity of human
dendritic cells, monocytes were isolated from human peripheral
blood mononuclear cells using anti-CD14 coated magnetic beads
(Miltenyi Biotech) (CD14-S) or by plastic adherence (PA-S), and
then cultured per standard protocols with cytokines IL-4 and GM-CSF
for 6 days to induce differentiation into monocyte-derived
dendritic cells (mo-DCs). Monocyte purity was evaluated by flow
cytometry for expression of CD14, and differentiation and
maturation of mo-DCs was evaluated by staining for expression of
BDCA-1, HLA-DR, CD80, and CD86 (each from BD Biosciences). Mo-DCs
were then treated with Fucosyltransferase VII (FTVII; prepared by
R&D Systems in suspension without divalent cations) at 20 ug/ml
or with Fucosyltransferase VI (60 mU/ml (R Sackstein et al, Nature
Medicine 14:181-187 (2008))) in each case in Hank's balanced salt
solution (HBSS) without divalent cations containing 10 mM HEPES,
0.1% human serum albumin and 1 mM GDP-fucose (Sigma) for 60 min at
371 C, whereas control cells (buffer-treated) were treated in the
same buffer without FTVII or without FTVI. Cell viability was
assessed routinely by dual laser flow cytometry using propidium
iodide and annexin V staining. Cell viability was consistently
greater than 80% at 24 hours following exofucosylation with either
FTVI or FTVII. See FIGS. 29A-29C and FIGS. 30A-30E.
Example 4: Alpha(1,3)-Fucosyltransferase Treatment of Primary
Cultures of Human Regulatory T Cells (Tregs) Induces High Level
E-Selectin Ligand Activity on the Cells and Enforces Expression of
HCELL; Administration HCELL+ Tregs Suppresses Xenogeneic GVHD
Induced by Autologous Cells
[0202] The ability to enhance delivery of immunomodulatory cells
(such as MSCs and Tregs) to sites of inflammation would serve to
improve the potential of adoptive cell therapeutics to dampen
tissue damage in immunologic diseases (e.g., GVHD, rheumatoid
arthritis, etc.) and in exuberant inflammatory responses to
infections (e.g., sepsis, fulminant viral hepatitis, etc.). To this
end, we investigated the effects of .alpha.(1,3)-exofucosylation on
the capacity of intravascularly administered primary human Tregs to
treat xenogeneic graft-versus-host disease in a human-mouse GVHD
model. We sought to assess the capacity of Tregs derived from the
autologous lymphocyte source that induced GVHD, as this strategy
would be relevant to clinical hematopoietic stem cells
transplantation (i.e., Tregs would be expanded from donor
hematopoietic/immune cell inoculum, and, therefore, donor Tregs
would be used to treat GVHD induced by donor immune cells). To this
end, peripheral blood mononuclear cells (PBMCs) were obtained by
Ficoll gradient centrifugation of whole blood of a healthy human
donor. CD4-high/CD127-low T cells were isolated using a negative
selection magnetic immunobead system (Miltenyi) and expanded in
culture in the presence of anti-CD3/anti-CD28 mAb supplemented with
IL-2 to produce CD4+/FoxP3+/CD25+ cells (Tregs). Unfractionated
PBMCs from the same donor subject were injected IP (10.sup.7
cells/mouse) into NSG host mice intraperitoneally. Fourteen days
after injection (accordingly, day 14 of Treg expansion) the
expanded Treg cells were collected and then treated with
Fucosyltransferase VII (FTVII; prepared by R&D Systems in
suspension without divalent cations) at 20 ug/ml or with
Fucosyltransferase VI (60 mU/ml (R Sackstein et al, Nature Medicine
14:181-187 (2008))) in each case in Hank's balanced salt solution
(HBSS) without divalent cations containing 10 mM HEPES, 0.1% human
serum albumin and 1 mM GDP-fucose (Sigma) for 60 min at 37.degree.
C., whereas control cells (buffer-treated) were treated in the same
buffer without FTVII or without FTVI (cell viability was assessed
routinely by dual laser flow cytometry using propidium iodide and
annexin V staining; cell viability was consistently greater than
80% at 24 hours following exofucosylation with either FTVI or
FTVII). Mice were then injected intravascularly with either
buffer-treated (BT) Tregs or with exofucosylated Tregs at a dose of
2.5.times.10.sup.5 cells/mouse. Mice were then followed clinically
and mouse weights were monitored for 50 days post-initial PBMC
injection. Data as shown in Figures reveal that FTVII treatment of
human Tregs induces expression of E-selectin ligands, including
HCELL. Injection of exofucosylated autologously-derived Tregs into
mice with xenogeneic GVHD (induced by prior administration of
autologous PBMCs) results in dampening of GVHD, as evidenced by
reversal of weight loss; exofucosylated Tregs are 3-fold more
potent in reversing GVHD than are unfucosylated Tregs. See FIGS.
31-34.
Example 5: Alpha(1,3)-Fucosyltransferase Treatment of MSC and of
Human Blood Leukocytes Induces L-Selectin Ligand Activity on the
Cells as Assessed by Stamper-Woodruff Lymphocyte Adherence
Assay
[0203] The Stamper Woodruff lymphocyte adherence assay is the
conventional tool to assess L-selectin ligand activity (R.
Sackstein, Immunol. Rev. 230: 140-163 (2009)). This assay, which
was devised in the mid-1970s to evaluate the molecular basis of
lymphocyte binding to lymph node high endothelial venules, measures
the capacity of L-selectin--as natively expressed on the surface of
a live lymphocyte --to attach to its cognate ligand(s) expressed on
the surface of a relevant cell. The assay is performed under
rotatory shear conditions, thereby placing a discrete biophysical
restriction on the binding interaction: only the most potent
L-selectin ligands (presented on the surface of cells attached to
glass) will support adherence of L-selectin displayed on the
rotating suspension of lymphocytes. Indeed, the only L-selectin
ligands that are robust enough to support L-selectin-mediated
binding of lymphocytes in this assay are HCELL and the
"endothelial" L-selectin ligands displayed on lymph node high
endothelial venules (collectively, these L-selectin ligands are
called "addressins") (R. Sackstein, Immunol. Rev. 230: 140-163
(2009)).
[0204] To assess the expression of L-selectin ligand activity
induced by .alpha.(1,3)-exofucosylation, the Stamper-Woodruff was
performed on cytospin preparations of native cells, buffer-treated
cells, and .alpha.(1,3)-exofucosylated cells. Briefly, lymphocyte
suspensions prepared fresh from human blood (10.sup.7/ml
lymphocytes in RPMI 1640 medium) were overlaid onto glass slides
containing preparations of relevant cells placed on the slides by
cytocentrifugation. Slides were placed on a rotating platform for
incubation under shear (80 rpm) at 4.degree. C. for 30 minutes.
Slides were then rinsed in PBS to remove nonadherent lymphocytes,
fixed in 3% glutaraldehyde, and stained with methyl green-thionin.
Slides were examined for lymphocyte adherence to cytocentrifuged
cells by light microscopy. L-selectin ligand activity was measured
by counting the number of lymphocytes adherent to a confluent area
of cytocentrifuged cells, using an ocular grid under 250.times.
magnification. The cytocentrifuged cells that have adherent
lymphcytes are scored, and the percentage of such cells within the
total lawn of cytocentrifuged cells is quantified (as shown on Key
in Table 1).
TABLE-US-00001 TABLE 1 Results of Stamper-Woodruff Assay (L-
selectin binding activity of cells) L-SELECTIN LIGAND ACTIVITY
Buffer- .alpha.(1,3)- Type of Native treated exofucosylated Cell
cells cells cells Human MSC 0 0 ++++ Human CD4 + + ++++ T cell
Human CD8 0 0 ++ T cell Human B 0 0 + cell Human Treg 0 0 +++ cell
Human + + ++++ Monocyte Human + + ++++ Dendritic Cell KEY: 0
<10% of cells bind L-selectin.sup.+lymphocytes + 10-30% of cells
bind L-selectin.sup.+lymphocytes ++ 30-50% of cells bind
L-selectin.sup.+lymphocytes +++ 50-70% of cells bind
L-selectin.sup.+lymphocytes ++++ >70% of cells bind
L-selectin.sup.+lymphocytes
[0205] As shown in Table 1, native MSCs have no L-selectin binding
activity, but .alpha.(1,3)-exofucosylation of MSCs induces profound
L-selectin binding activity, with L-selectin-mediated lymphocyte
binding observed on essentially all exofucosylated cells. Human CD4
T cells, human monocytes, and human dendritic cells each display
modest L-selectin binding activity, but these cells support robust
L-mediated lymphocyte adherence following
.alpha.(1,3)-exofucosylation. Human Tregs, B cells and CD8 cells do
not natively possess L-selectin ligand activity, but each cell type
can be induced to bind L-selectin by .alpha.(1,3)-exofucosylation,
with exofucosylated Tregs showing marked increases in L-selectin
adherence. Thus, L-selectin binding is enhanced on essentially all
human leukocytes following .alpha.(1,3)-exofucosylation, and, in
particular, L-selectin ligand activity can be profoundly induced on
human MSC, CD4 T cells, monocytes, dendritic cells and Tregs by
.alpha.(1,3)-exofucosylation. In each case, this L-selectin binding
activity is a reflection of enforced HCELL expression, and is
commensurate with results of HCELL expression on these cells as
exhibited by western blot data staining for sLex/E-Ig as displayed
in FIGS. 25, 28A-28C, 30A-30E, and 33.
Example 6--Hcell Expression on Murine Msc Licenses Pancreatotropism
and Confers Durable Reversal of Autoimmune Diabetes in Nod Mice
Introduction
[0206] Despite significant advances in the pharmacotherapy of
glycemia control, type 1 diabetes (T1D) is still associated with
significant morbidity and mortality, and it continues to pose a
major public health burden demanding innovative treatment
strategies[1, 2]. Cell-based immunomodulatory therapy has emerged
as a promising approach in the treatment of T1D[3]. Because of
their immunomodulatory properties, safety profile, easy
acquisition, and robust ex vivo expansion, mesenchymal stem cells
(MSCs) have become the most rapidly growing cell therapy for the
treatment of various refractory immune-mediated diseases including
T1D[4-7]. In preclinical models using NOD mice, we and others have
recently reported that systemically-administered MSCs have utility
in dampening autoimmune diabetes[8-13]. However, the benefits of
MSC therapy in reversal of hyperglycemia were temporary,
highlighting a pressing need to develop strategies to improve the
effectiveness of MSC-based therapy for T1D[6].
[0207] The efficacy of immunomodulatory cell therapy is closely
related to the ability of the infused cells to traffic to the
inflamed tissue[14, 15]. For some organs (e.g., the heart), direct
(local) injection of cells into the affected site can achieve
requisite colonization for physiologic benefit[16]. However, for
treatment of T1D, the vascular route of cell delivery is mandated,
as direct injection of cells into the pancreatic parenchyma would
trigger release of proteases and other enzymes that could induce
profound, life-threatening pancreatic inflammation. The migration
of blood-borne cells into tissues is initiated by tethering/rolling
adhesive interactions on target tissue endothelium. The most potent
mediators of these binding interactions are the selectins, a family
of three Ca.sup.++-dependent lectins (E-, P- and L-selectin, also
known as CD62E, CD62P, and CD62L, respectively) that bind to
sialofucosylated glycan determinants expressed on their respective
ligands[17]. Importantly, within the microvasculature at all
inflammatory sites, the endothelial selectin, E-selectin, is
inducibly expressed in response to inflammatory cytokines such as
TNF-.alpha.[17,18]. E-selectin binds to membrane glycoproteins
and/or glycolipids on circulating cells that prototypically display
the sialofucosylated tetrasaccharide known as "sialylated Lewis X"
(sLex). However, MSCs do not natively express E-selectin
ligands[19]. This deficit in trafficking limits the engraftment of
MSCs in inflamed peripheral tissues following intravenous
administration[17,20], constraining the utility of MSC-based
therapeutics. Accordingly, we sought to investigate whether MSC
trafficking to inflamed pancreas could be licensed via cell surface
glycan modification to enforce E-selectin ligand expression, and
whether this would impact MSC therapeutic effect(s) in new onset
autoimmune diabetes in NOD mice. Our findings provide new insights
on the biology of MSC effects in diabetes, highlighting a unique
and prominent role for enforced expression of the E-selectin ligand
HCELL in enhancing the capacity of murine MSCs to reverse
hyperglycemia in diabetic NOD mice.
[0208] Materials and Methods
[0209] Mice
[0210] C57BL/6, B6.129(Cg)-Cd4.sup.tm1Hbg/J (CD44.sup.-/- on
CD57BL/6 genetic background; CD44-knock out ("CD44-KO")), BALB/c,
and NOD mice were purchased from Jackson Laboratories and were
housed and/or bred in a pathogen-free environment at the Harvard
Medical School Facilities for Animal Care and Housing. Experiments
requiring the use of mice were approved by the Institutional Animal
Care and Use Committee.
[0211] MSC Culture
[0212] Bone marrow MSCs were derived as described previously [9,
10]. In brief, isolated marrow cells from C57BL/6 (wild-type) or
from CD44-KO mice were flask-seeded in culture medium consisting of
Dulbecco's Modified Eagle Medium with 10% fetal bovine serum
(Lonza), 10 ng/ml fibroblast growth factor (PeproTech), 100 U/ml
penicillin and 100 ug/ml streptomycin (Gibco). MSCs in culture
passage 4 to 6 were used for experiments.
[0213] MSC Characterization and Differentiation
[0214] MSCs were characterized by flow cytometry using anti-mouse
antibodies (all from eBioscience) directed to cell surface markers
Sca1, CD44, CD73, CD45, CD29, and CD105, together with relevant
isotype controls. Recombinant mouse E-selectin (CD62E)-human Fc
chimera was purchased from R&D Systems. MSCs were tested for
their differentiation capacity into various mesodermal lineages as
previously described[21, 22]. Briefly, chondrogenic differentiation
of MSCs was induced with ascorbic acid (50 .mu.g/ml) and TGF.beta.1
(1 ng/ml) in culture medium. After 3 weeks of culture, plates were
washed with PBS, fixed with 4% paraformaldehyde, and stained with
0.05% alcian blue for light microscopic visualization of cartilage.
Osteogenic differentiation was induced with ascorbic acid (50
.mu.g/ml), sodium .beta.-glycerophosphate (10 mM), and
dexamethasone (10 nM) in culture medium. Two weeks later, plates
were washed, fixed with 4% paraformaldehyde, and stained with 2%
alizarin red for visualization of characteristic calcium deposits.
Adipogenic differentiation was induced by the addition of
dexamethasone (100 nM) and insulin (6 ng/ml) in F12 medium
supplemented with 1% fetal calf serum, 1% glutamine, 1%
penicillin-streptomycin. Cells were fixed in 4% parafomaldehyde and
stained with 0.3% Oil Red solution in 60% isopropanol to assess
lipid-laden vacuoles.
[0215] MSC Exofucosylation
[0216] MSCs in suspension (10.times.10.sup.6 per 200 ul reaction)
were treated for 90 min at 37.degree. C. with 60 mU/mL
fucosyltransferase VI (FTVI) in reaction buffer consisting of
Ca.sup.2+- and Mg.sup.2+-free Hanks Balanced Salt Solution (HBSS)
containing 20 mM HEPES, 0.1% human serum albumin and 1 mM
GDP-fucose ("FTVI-modified MSC"), or with reaction buffer alone
(unmodified MSC). Following treatment, MSCs were washed with HBSS
containing 0.2% HSA and 20 mM HEPES. Cell viability was assessed by
trypan blue exclusion and propidium iodide staining (consistently
>85% viability 24 hours post-detachment and treatment). FTVI
modification was assessed by flow cytometry. FTVI enzyme was
provided by Dr. Roland Wohlgemuth (Sigma Chemical Corporation).
[0217] Western Blot Analysis
[0218] FTVI-modified and unmodified MSC lysates were prepared by
incubation with 2% Nonidet P-40 (NP-40) in Buffer A (150 mM NaCl,
50 mM Tris-HCl, pH 7.4, 20 mg/mL phenylmethylsulfonyl fluoride,
0.02% sodium azide, and protease inhibitor cocktail tablet (Roche
Molecular Biochemicals). All Western blots of whole cell lysates or
of immunoprecipitated protein were performed under reducing
conditions on 7.5% SDS-PAGE gels as described previously[19]. The
amount of lysate in each lane was normalized to cell number for
each Western blot performed. Blots were visualized with
chemiluminescence using Lumi-Light Western Blotting Substrate
(Roche).
[0219] Flow Cytometry and Immunoprecipitation Studies
[0220] Flow cytometry was performed as described previously[19].
For more details please refer to the Supplementary Methods
section.
[0221] Parallel Plate Flow Chamber Adhesion Assay
[0222] A dynamic flow adhesion assay was performed using a parallel
plate flow chamber (250 .mu.m channel depth.times.5.0 mm channel
width), to assess E-selectin mediated MSC binding over stimulated
human umbilical vein endothelial cells (HUVEC) as previously
described [19]. For more details, please refer to the Supplementary
Methods section.
[0223] Transduction of MSCs with hGH Viral Vector
[0224] MSCs were transduced with the lentivirus containing hGH
plasmid construct as described previously[21]. Levels of hGH were
measured by enzyme-linked immunosorbent assay (Roche Diagnostics)
in MSC supernatants and in serum of injected animals.
[0225] Transduction of MSCs with GFP Viral Vector
[0226] MSCs were transduced with a retrovirus plasmid containing
GFP (GFP-MSC) as described previously[21]. Transduced MSC were
assessed for perinuclear expression of GFP by fluorescent
microscopy. In a complementary approach to the use of GFP-MSCs to
assess homing, MSCs (non-GFP-transduced) were labeled with the
fluorescent dye CFSE.
[0227] Immunofluorescence
[0228] Pancreata were embedded in Tissue Tek OCT, frozen and
sectioned in a cryomicrotome. Immunofluorescence images were
acquired using a Nikon E-1000 epifluorescence microscope
(.times.400 total magnification). For more details on specific
staining, please refer to the Supplementary Methods section.
[0229] Mitogen-Stimulation CD3/CD28 T Cell Proliferation Assay
[0230] T cell proliferation assay using anti-CD3 and anti-CD28
stimulation was used to assess effects of FTVI modification on
immunomodulatory capacity of MSCs. Briefly, 1.times.10.sup.5 NOD
splenocytes were stimulated with purified mouse anti-CD3e and
anti-CD28 (each at 1 .mu.g per well; eBioscience) for 72 hours in
RPMI media (Lonza), supplemented with 10% fetal bovine serum
(Gemini Bio-Products), 1% penicillin streptomycin (Lonza) and 1%
glutamine (Lonza), in the presence of a titrating concentration
(5.times.10.sup.2-5.times.10.sup.4) of irradiated (3000 rad)
unmodified and FTVI-modified MSCs. In the last 12 hours of the 72
hour incubation period, cells were pulsed with 1 .mu.Ci of
tritiated thymidine, and lymphocyte proliferation
(.sup.3H-thymidine incorporation) was measured by scintillation
counting. Results are reported as an average of triplicate samples
(mean cpm.+-.SEM).
[0231] Reversal of New-Onset Hyperglycemia Studies in NOD Mice
[0232] Unmodified and FTVI-modified MSCs (0.5.times.10.sup.6 cells
in 200 ul) were injected intravenously via tail vein without
anesthesia into female NOD mice on the second day of hyperglycemia
(>250 mg glucose/dL), and at 7 days and 30 days following onset
of hyperglycemia. To assess effect of MSC administration on
hyperglycemia, blood was obtained via tail vein and glucose
measured as described previously[9, 10].
[0233] Statistics
[0234] Data from experimental assays and immunohistological
experiments were analyzed using student t-test and Mann Whitney
tests. Survival data were assessed using Kaplan-Meyer analysis. To
perform the analysis and to generate graphs, Prism software was
used (GraphPad Software, Inc., San Diego, Calif.). P value <0.05
was considered significant. Data represent mean.+-.SEM.
[0235] Supplementary Methods
[0236] Flow Cytometry and Immunoprecipitation Studies
[0237] Flow cytometry was performed as described previously.sup.19
using biotinylated mAb HECA452 (anti-human cutaneous lymphocyte
antigen, which recognizes sLex; Rat IgM (BioLegend)), and
anti-mouse CD44 mAb (KM114; Rat IgG1), purified anti-mouse CD44 mAb
(IM7; Rat IgG2b), and phycoerythrin (PE)-labeled streptavidin (all
obtained from BD Pharmingen). For western blotting, MSC lysates
were incubated with anti-CD44 immunoprecipitating antibodies
(KM114/IM7) or with appropriate isotype controls and then collected
with Protein G-agarose (Invitrogen). Immunoprecipitates were washed
extensively using Buffer A containing 2% NP-40, 1% SDS, and then
subjected to SDS-PAGE, transferred to polyvinylidene difluoride
membrane, and immunostained with HECA452 or anti-mouse CD44
antibodies (KM114/IM7), followed by incubation with appropriate
HRP-conjugated secondary antibodies for visualization by
chemiluminescence using Lumi-Light Western Blotting Substrate
(Roche).
[0238] Parallel Plate Flow Chamber Adhesion Assay
[0239] Confluent HUVECs were stimulated for 6 h with TNF-.alpha.
(40 ng/ml) to up-regulate E-selectin expression. Wild-type (WT) and
CD44KO MSC were harvested with 0.005% Trypsin/EDTA, and were either
FTVI modified or treated with buffer alone (control) for 90 minutes
at 37.degree. C. MSC were then resuspended at 10.sup.6 cells/ml in
Hanks' Balanced Salt Solution supplemented with 1 mM calcium
chloride, 1 mM magnesium chloride, 5 mM HEPES, and 1 mg/ml BSA. MSC
were perfused over the HUVEC monolayer at 0.5 dynes/cm.sup.2, and
then subjected to shear stress levels of 1.0, 2.0, 5.0, 10.0, 20.0,
and 30.0 dynes/cm.sup.2 at 3-minute intervals. MSC that interacted
with HUVEC (cells that rolled in the field of view or rolled into
it within a 10 second time frame) were viewed at the center of the
chamber, minimum of 6 fields of view at each shear stress level. As
controls to assess specificity of E-selectin binding to stimulated
HUVEC, FTVI-modified MSC were treated with sialidase from Vibrio
cholerae (0.1 U/ml; Roche) to cleave terminal sialic acid from
sLex, and adherence was also assessed in presence of
function-blocking anti-human E-selectin mAb (10 ug/ml) (BD
Pharmingen).
[0240] Immunofluorescence
[0241] Tissues were cryostat-sectioned at 10 um thickness and fixed
on slides in cold acetone for 5 min. After drying, sections were
blocked with 1% BSA and incubated in primary antibody overnight.
Sections were washed 3.times. in Tris-buffered Saline (TBS) and
incubated with secondary antibody for one hour. E-selectin (CD62E)
staining was performed using primary rat anti-mouse CD62E (R&D
Systems, 1:100), and secondary PE-conjugated goat anti-rat IgG
(Southern Biotech, 1:500). Isotype-matched rat mAb was used as a
staining control. CD31 staining was performed using rat anti-mouse
CD31 (Biocare, 1:200) and secondary PE-conjugated goat anti-rat IgG
(Southern Biotech, 1:500). Assessment of CD31 and E-selectin
co-localization was performed on sequential sections. Insulin
staining was undertaken using purified guinea pig anti-insulin
(Dako, 1:5) and APC conjugated donkey anti-guinea Pig IgG (H+L)
(Jackson Immunoresearch, 1:200). HECA452 mAb (Rat anti-CLA IgM mAb
(Biolegend, 1:200)) and FITC conjugated mouse anti-rat IgM
(Biolegend, 1:500) were used to detect FTVI-modified MSC within
tissue sections. Sections were overlaid with mounting media alone
or, when indicated, with mounting media containing DAPI (Vector
Labs), cover-slipped, and then visualized by immunofluorescence
microscopy.
[0242] Results
[0243] Expression and Functional Analysis of FTVI-Modified MSC
[0244] Bone marrow-derived MSCs from C57BL/6 mice, ("wild-type"), a
diabetes-resistant strain, and from CD44-KO mice (CD44.sup.-/- on
C57BL/6 background) showed characteristic small spindle
fibroblast-like pattern and could be differentiated into mesodermal
cell types (FIG. 7). MSCs expressed cell surface markers
characteristics of MSCs (FIG. 1A). MSCs did not natively express
E-selectin ligands, as shown by absence of reactivity with mAb HECA
452 (which recognizes canonical sialofucosylated E-selectin binding
determinants (such as sialylated Lewis X (sLe.sup.x)) and by
absence of binding to E-selectin-Ig chimera (E-Ig) that serves as a
probe for E-selectin ligand activity (FIG. 1B).
[0245] A prior study of human MSCs showed that cell surface
glycoengineering (i.e., Glycosyltransferase-Programmed
Stereosubstitution (GPS)) using the
.alpha.-(1,3)-fucosyltransferase VI (FTVI) induces E-selectin
adherence via conversion of native membrane CD44 into the molecule
known as Hematopoietic Cell E-/L-selectin Ligand (HCELL), a
fucosylated sialyllactosaminyl glycovariant of CD44 that potently
binds E-selectin[19]. To determine whether cell surface
exofucosylation could program E-selectin ligand activity on murine
MSCs, cells were treated with FTVI using reaction conditions that
were optimized to preserve cell viability. FTVI modification of
MSCs markedly induced staining with mAb HECA452, as well as binding
with a murine E-selectin-Ig chimera (mE-Ig) (FIG. 1B). Notably,
protease digestions of MSCs prior to FTVI modification markedly
reduced mE-Ig reactivity, indicating that glycoproteins, not
glycolipids, were predominant carriers of E-selectin binding
determinants (FIG. 1B). Following exofucosylation of mouse MSC,
western blot of whole cell lysates (FIG. 1C) and of
immunoprecipitated CD44 (FIG. 1D) revealed that the principal
membrane glycoprotein decorated with the sialofucosylations
recognized by E-Ig and HECA-452 was the "standard" (i.e.,
containing no splice variant exons) form of CD44 (.about.100 kDa).
These data indicate that FTVI modification converts murine MSC
surface CD44 into HCELL.
[0246] FTVI-Modified Mouse MSCs have Increased Binding to
E-Selectin Under Physiologic Shear Stress Conditions
[0247] To assess the capacity of FTVI-modified mouse MSCs to bind
E-selectin under physiologic shear stress conditions, we performed
parallel plate flow chamber assays of both unmodified and
FTVI-modified MSCs. To this end, HUVEC monolayers were first
stimulated with TNF-.alpha. to upregulate E-selectin expression. As
shown in FIG. 2, FTVI-modification enabled MSC adhesion to HUVEC at
shear stress levels of 0.5 dynes/cm.sup.2 to as much as 20
dynes/cm.sup.2. In flow chamber studies, MSC adherence to
stimulated HUVEC was strictly dependent on E-selectin
receptor/ligand interactions as incubation of HUVEC with
function-blocking E-selectin mAb and sialidase treatment of MSCs
(to eliminate sLe.sup.x display) each profoundly reduced adhesion
of FTVI-modified MSCs, to levels similar to that of unmodified MSCs
(FIG. 2). Altogether, these findings indicate that FTVI
modification of murine MSC induces potent E-selectin binding
activity, capable of sustaining E-selectin adherence at hemodynamic
shear stress levels well beyond those typical of post-capillary
venules[17].
[0248] Systemically-Administered FTVI-Modified MSCs Potently
Reverse New Onset Hyperglycemia in NOD Mice
[0249] To assess whether FTVI-modification affected the capacity of
MSCs to modulate diabetes in NOD mice, new onset diabetic NOD mice
either received no cells (untreated control), or received
5.times.10.sup.5 FTVI-modified or 5.times.10.sup.5 unmodified
C57BL/6 MSCs intravenously (via tail vein) on day 2 of
hyperglycemia (glucose >250 mg/dL), followed by intravenous
injections at days 7 and 30 after onset of hyperglycemia. As shown
in FIG. 3A, untreated NOD mice showed a rapid increase in their
blood glucose levels and, with exception of one animal, died within
a few weeks of the onset of hyperglycemia. As compared to the
administration of unmodified MSCs (FIG. 3B), which resulted in a
temporary reversal of autoimmune diabetes (i.e., 3 of 9 mice were
normoglycemic at 3 weeks, 2 of 9 animals were normoglycemic at 6
weeks, and all animals were hyperglycemic by 12 weeks), the
infusion of FTVI-modified MSCs robustly and durably reversed
hyperglycemia (FIG. 3C). Strikingly, 7 out of 8 mice were
normoglycemic for 3 weeks, 6 of 8 mice remained normoglycemic for 6
weeks, and 5 of 8 mice were free of diabetes for upwards of 12
weeks following initial treatment (FIG. 3C). While the majority of
the mice in the unmodified and FTVI-modified MSC group which had
blood glucose levels above 600 mg/dl survived up to 90 days, only
one (out of 7 mice) in the untreated group (i.e., receiving no
MSCs) survived 90 days.
[0250] E-Selectin Expression and MSC Localization in the Pancreas
of NOD Mice
[0251] To examine the effect of FTVI-modification on MSC
trafficking to the pancreas, we first assessed the expression of
E-selectin within microvasculature of the pancreas of 14-week-old
NOD mice using immunofluorescence microscopy. Peri-islet
microvessels are reported to be the primary site of inflammatory
cell trafficking which results in insulitis [23, 24]. There was no
E-selectin expression in pancreata of diabetic-resistant mice (FIG.
4A), whereas peri-islet microvessels of the pancreas of NOD mice
expressed E-selectin (FIG. 4B), which co-localized with CD31
staining in sequential sections (FIGS. 4C-4D). Infiltration of
T-cells into the diabetic islet margins was confirmed by CD3
staining of NOD pancreata during diabetic onset (FIG. 4E). To
assess pancreatic infiltration of systemically administered
FTVI-modified MSCs in NOD mice, we stained frozen sections of
pancreata with antibody HECA452. As shown in FIGS. 4F-4G,
HECA452.sup.+ MSCs were observed in the peri-islet area within the
vicinity of E-selectin-expressing microvasculature 1 day after
transplantation, colonizing (E-selectin-expressing) perivascular
regions and (L-selectin-expressing) areas of T cell infiltrates. To
assess the extent of homing of FTVI-modified and unmodified MSCs
after systemic administration, GFP-transduced FTVI-modified and
unmodified MSCs were intravenously injected into NOD mice, and
their pancreata, pancreatic and mesenteric lymph nodes and spleen
were harvested at day 4 post-injection, sectioned, and assessed for
presence of MSCs by fluorescence microscopy. FTVI-modified MSCs
showed 3-fold higher infiltration of pancreas as compared to
unmodified MSCs, whereas no difference in pancreatic infiltrates of
infused FTVI-modified and unmodified MSC were seen in
diabetes-resistant BALB/c mice (FIG. 4H). However, no difference
was noted in the extent of homing of FTVI-modified and unmodified
MSCs into lymphoid tissues of treated NOD mice.
[0252] Exofucosylation has No Effect on MSC Immunosuppressive
Capacity or on In Vivo Survival
[0253] We have previously reported that measuring human growth
hormone (hGH) produced by hGH-transduced MSCs is a sensitive method
to ascertain longevity of administered MSCs[21]. To assess if the
enhanced reversal of hyperglycemia of administered FTVI-modified
MSCs was consequent to a survival advantage, 5.times.10.sup.5 of
hGH-transduced FTVI-modified and unmodified MSCs were injected into
NOD mice at day 2 and 7 following onset of hyperglycemia, and serum
hGH was measured at various time-points post-injection. As shown in
FIG. 5A, there was no difference in the pattern of hGH production,
indicating that FTVI modification did not affect MSC persistence in
vivo. To evaluate whether exofucosylation modifies MSC
immunomodulatory capabilities, we performed co-culture T cell
suppression assays. T cell proliferation was equally dampened by
FTVI-modified and unmodified MSCs (FIG. 5B), indicating that
exofucosylation does not impart additional immunomodulation
properties on MSCs.
[0254] Absence of MSC CD44 Expression Abrogates the Anti-Diabetic
Effect of FTVI-Modified MSC
[0255] To examine whether CD44 expression is requisite for the
enhanced anti-diabetic potency of FTVI-modified MSCs, we generated
MSCs from CD44 KO mice (CD44.sup.-/- on C57BL/6 genetic
background). With exception of CD44, MSCs generated from marrow of
CD44 KO mice showed identical levels of cell surface adhesion
molecules. By flow cytometry, exofucosylated CD44 KO MSCs showed
HECA452-reactivity equivalent to that of exofucosylated wild-type
MSCs (FIG. 8), indicating that sialofucosylated determinants were
created on alternative (i.e., non-CD44) scaffolds. To assess
whether administration of CD44 KO MSCs conferred anti-diabetic
activity, 5.times.10.sup.5 cells each of FTVI-modified and
unmodified CD44 KO and of C57BL/6 wild-type MSCs were injected into
new-onset diabetic NOD mice at days 2, 7 and 30 post-hyperglycemia
onset. Compared to wild-type MSCs, CD44 deficiency of MSCs resulted
in a significant impairment in their anti-diabetic effect, as
demonstrated by failure in reversing autoimmune diabetes in 5 out 6
mice receiving unmodified CD44 KO MSCs, and in 6 out 7 mice
receiving FTVI-modified CD44 KO MSCs (FIG. 6A and FIG. 6B,
respectively). Following injection in NOD mice, CFSE-labeled
FTVI-modified and unmodified CD44 KO MSCs showed no difference in
trafficking to pancreata (FIG. 6C), with levels similar to that
observed for wild-type MSCs (FIG. 4H). MSC suppressive capacity in
vitro was not abrogated by lack of MSC CD44 expression nor by
exofucosylation of CD44 KO MSCs (FIG. 6D), suggesting that the
absence of euglycemic effect(s) of administered FTVI-treated
CD44.sup.-/- MSCs is not attributable to inherent deficits in
immunoregulation. Notably, the finding that exofucosylation renders
expression of cell surface sialofucosylations recognizable by
HECA452 on CD44 KO MSCs yet such cells do not realize intended
biologic outcomes in diabetic NOD mice clearly highlights the
importance of biochemical studies (e.g., western blot analysis)
--beyond just simple flow cytometry studies to evaluate induced
E-Ig and HECA452 immunoreactivity--in defining/predicting the
biologic impact of enforced selectin binding engendered by cell
surface glycan engineering.
DISCUSSION
[0256] Because of their immunomodulatory properties, safety
profile, and robust expansion ex vivo, MSCs have become the focus
of several human trials to treat various refractory immune-mediated
diseases including T1D[6]. MSCs have been found to suppress
insulitis and autoimmune diabetes via multifaceted immunomodulatory
effects on pathogenic components critical to elaboration of T1D[25,
26]. These effects include the capacity to modulate expression of
inflammatory vs. regulatory cytokines thereby promoting expansion
of regulatory DC and T cells, and MSC expression of negative
costimulatory molecules (e.g., PDL-1) which can directly inhibit
autoreactive T cells[8-10,13]. Hence, MSC therapy has great
potential to be an exciting and unique strategy for T1D treatment.
Nevertheless, there is a pressing need for studies to improve the
efficacy MSC-based therapy in T1D[6].
[0257] In prior studies, we observed that intravenous
administration of fully allogenic MSCs was associated with a
transient reversal of hyperglycemia in diabetic NOD mice[9]. We
hypothesized that a proximate hurdle in realizing a more robust
anti-diabetic effect might be the relative paucity of MSC homing to
inflamed pancreas. Here, we sought to assess whether systemic
administration of MSCs with enhanced homing capacity via enforced
HCELL expression would influence reversal of diabetes in the NOD
model. To this end, we utilized the C57BL/6 strain as the allogenic
source of MSCs since the CD44 KO phenotype was available on this
genetic background. We focused on metabolic control as the primary
end-point for assessing the efficacy of MSC therapy, as we had
previously examined the immune mechanisms mediating anti-diabetic
effects of MSC[9, 10].
[0258] In contrast to other studies which characteristically assess
the effects of anti-diabetic interventions for relatively short
time periods (typically <30 days), in this study the effects of
MSC on reversal of autoimmune diabetes were assessed over a
prolonged observation period (90 days). Our data here indicate that
conversion of native membrane CD44 into HCELL by cell surface
.alpha.-(1,3)-exofucosylation ("FTVI-modification") confers high
efficiency mouse MSC binding to E-selectin. We observed E-selectin
expression in the peri-islet area of pancreata of NOD mice with
insulitis, but not in pancreata of diabetic-resistant mice.
Consistent with these findings, we did not observe differences in
the level of homing of injected allogenic C57BL/6 FTVI-modified and
unmodified MSCs into pancreata of diabetic-resistant mice (BALB/c
hosts), but, compared with unmodified MSCs, there was heightened
pancreatic infiltration of systemically administered C57BL/6
(allogenic) FTVI-modified MSCs in diabetic NOD mice, with
concomitant durable reversal of diabetes. Notably, we did not
observe differences in infiltration of lymphoid tissues between
animals receiving FTVI-modified and unmodified MSCs, but there was
marked increase in lodgement/engraftment of cells within the
perivascular regions of E-selectin-expressing microvessels and
within clusters of leukocytes. Collectively, these data draw
attention to a primary role of MSC pancreatic colonization in
suppressing autoimmune diabetes, but do not exclude the potential
contribution of extrapancreatic effects of MSCs.
[0259] Compared to the anti-diabetic effects observed using
intravenously administered fully allogenic unmodified MSCs in this
study and in prior studies [9], the marked improvement in T1D
reversal using fully allogeneic FTVI-modified (HCELL) MSCs observed
here does not appear to be attributable to an enhanced
immunosuppressive capacity of the glycoengineered MSC itself or to
in vivo survival advantage endowed by glycoengineering of MSCs. In
a prior study, we observed improved anti-diabetic effects in NOD
mice following intravenous administration of semi-allogeneic MSCs
obtained from NOR mice [10], likely a reflection of decreased
rejection of the semi-allogeneic MSCs yielding improved in vivo
tissue colonization/persistence of cells. However, in clinical
applications, it would be advantageous to employ strategies to
augment potency of fully allogeneic-source MSCs, especially as
manufacturing and regulatory issues support the use of
"off-the-shelf" (i.e., culture-expanded, pooled) allogeneic MSC
products. The finding that exofucosylated CD44 KO MSCs lack the
capacity to induce durable reversal of hyperglycemia, despite
evident creation of FTVI-dependent surface sialofucosylated
determinants detectable by HEC452 reactivity, indicates that
E-selectin binding determinants displayed expressly on the CD44
scaffold (i.e., elaboration of HCELL) are required to achieve
potent anti-diabetic effects. This may be related to a key role for
HCELL expression to attain requisite tissue homing and
extravasation[27] and/or could reflect a requirement for HCELL/CD44
expression to achieve appropriate lodgment in relevant
microenvironmental sites[28]. A role for in situ tissue lodgment to
achieve MSC effect(s) has been highlighted by studies of MSC
co-transplantation with islet allografts engendering
immunoprivileged zones[29-31]. In this regard, the observed
localization of HCELL.sup.+ MSCs within islet perivascular areas
and within islet leukocyte infiltrates highlights an operative role
for HCELL in licensing immunomodulation: since E-selectin is
expressed within endothelial beds of the affected tissue and
leukocytes characteristically express L-selectin, expression of
HCELL, a potent E-selectin and L-selectin ligand, serves to promote
tissue lodgement expressly within the microenvironments of most
intense immunoreactivity. While further studies of the
immunomodulatory effects of MSC in vivo are warranted, the data
here highlight the potential of enhanced pancreatotropism via
systemic administration of HCELL.sup.+ MSCs in the therapy of T1D.
More broadly, the fact that E-selectin is upregulated by cytokines
such as TNF and IL-1 within endothelial beds at all inflammatory
sites[17,18] offers the opportunity to exploit enforced MSC HCELL
expression to improve the efficacy of MSC-based therapy for a wide
variety of inflammatory conditions.
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Example 7--Cell Surface Glycan Engineering of Neural Stem Cells
Augments Neurotropism and Improves Recovery in a Murine Model of
Multiple Sclerosis
Introduction
[0291] Nature has developed an extremely efficient mechanism to
deliver circulating cells to sites of inflammation and injury. This
process is controlled by a highly ordered cascade of molecular
interactions (Butcher, E. C. 1991; Sackstein, R. 2005; Springer, T.
A. 1994). The first essential event in cell recruitment involves
shear-resistant adhesion of flowing cells on the endothelial
surface, a process most efficiently mediated by selectins, a family
of three Ca.sup.2+ dependent lectins (comprised of E-, P-, and
L-selectin), binding to their respective counter-receptors. These
interactions initially tether the cell to the vessel wall and, in
the context of vascular shear flow, cause the cell to roll along
the endothelial surface at velocities below that of the prevailing
hemodynamic stream (Step 1). This process facilitates engagement of
specific cell-borne chemokine receptors to pertinent chemokines
present in the perivascular areas, thereby triggering inside-out
signal transduction events leading to increased adhesiveness of
integrin family members (Step 2). Adhesive interactions between the
activated cell integrins and their cognate endothelial cell
counter-receptors then leads to arrest of rolling and firm adhesion
of the cell to the vessel wall (Step 3), and, ultimately,
transendothelial migration (extravasation, Step 4).
[0292] In multiple sclerosis (MS), and in its animal model,
experimental autoimmune encephalomyelitis (EAE), recruitment of
immunologic effectors is mediated by the upregulation of the
vascular selectins, E- and P-selectin. E- and P-selectin are
expressed on brain endothelium after in vivo activation with LPS or
TN F-.alpha., however, in murine EAE, P-selectin is expressed only
transiently (Piccio, L., Rossi, B., et al. 2002). Notably,
E-selectin is expressed throughout the inflammatory period with a
patchy distribution at sites where vessels branch, suggesting the
existence of preferential recruitment areas (Piccio, L., Rossi, B.,
et al. 2002). E-selectin is also characteristically found in
vessels from acute plaques in MS patients (Lee, S. J. and
Benveniste, E. N. 1999; Washington, R., Burton, J., et al. 1994).
These findings suggest that E-selectin plays a dominant role in the
recruitment of circulating cells to the brain in inflammatory
diseases.
[0293] All three selectins bind to specialized carbohydrate
determinants, comprised of sialofucosylations containing an
.alpha.(2,3)-linked sialic acid substitution on galactose, and an
.alpha.(1,3)-linked fucose modification on N-acetylglucosamine,
prototypically displayed as the terminal tetrasaccharide sialyl
Lewis X (sLe.sup.x) (Polley, M. J., Phillips, M. L., et al. 1991;
Sackstein, R. 2005). This structure, also known as "CD15s", may be
displayed on either a protein scaffold (i.e., a glycoprotein) or a
lipid scaffold (i.e., a glycolipid), and is recognized by mAb such
as CSLEX-1 and HECA-452 (Alon, R., Feizi, T., et al. 1995;
Dimitroff, C. J., Lee, J. Y., et al. 2001; Fuhlbrigge, R. C.,
Kieffer, J. D., et al. 1997; Gadhoum, S. Z. and Sackstein, R. 2008;
Merzaban, J. S., Burdick, M. M., et al. 2011). Although additional
structural modifications principally involving sulfation increase
binding affinity of P- and L-selectin to sLe.sup.x, no such
modifications are needed for optimal binding of E-selectin
(Leppanen, A., White, S. P., et al. 2000; Rosen, S. D. 2004).
[0294] Neural stem cell (NSC)-based therapy has generated great
hope for halting and/or reversing disease progression in CNS
inflammatory and/or degenerative diseases (Ben-Hur, T., Einstein,
O., et al. 2003; Einstein, O., Fainstein, N., et al. 2007;
Einstein, O., Grigoriadis, N., et al. 2006; Imitola, J., Raddassi,
K., et al. 2004; Lee, S. T., Chu, K., et al. 2008; Pluchino, S.,
Quattrini, A., et al. 2003; Pluchino, S., Zanotti, L., et al. 2005;
Ziv, Y., Avidan, H., et al. 2006). It is well known that NSCs
express Step 2 and Step 3/4 effectors, such as CXCR4 (Bezzi, P.,
Domercq, M., et al. 2001; Flax, J. D., Aurora, S., et al. 1998;
Imitola, J., Raddassi, K., et al. 2004) and VLA-4 (Pluchino, S.,
Zanotti, L., et al. 2005; Rampon, C., Weiss, N., et al. 2008),
respectively, but there are no data on whether NSCs natively
express Step 1 effectors. Accordingly, we examined expression of
Step 1 effectors on mouse NSCs, and found that these cells are
conspicuously devoid of Step 1 effectors, in particular, E-selectin
ligands. Using the EAE model, we analyzed whether enforced
E-selectin ligand activity via cell surface glycan engineering
would impact migration of administered NSCs and, more importantly,
the therapeutic effect(s) of administered cells. To this end, we
utilized a technology called glycosyltransferase-programmed
stereosubstitution (GPS) to create relevant selectin-binding glycan
determinants on the cell surface (Sackstein, R., Merzaban, J. S.,
et al. 2008). We report here that GPS enforces expression of
E-selectin ligands on NSCs by modifying glycans of two neural stem
cell membrane glycoproteins, CD44 and of NCAM, creating the
E-selectin ligands HCELL (Hematopoietic Cell E-/L-selectin Ligand)
and NCAM-E, respectively. Glycoengineering of NSC E-selectin ligand
activity resulted in increased neurotropism and yielded improved
clinical outcome in EAE in absence of detectable long-term
engraftment, indicating that these tissue-specific stem cells
engendered a restorative effect, not a direct regenerative effect.
Importantly, this neurorestorative effect is not a universal
property of adult stem cells, as administration of GPS-engineered
mouse hematopoietic stem/progenitor cells (HSPC) did not improve
EAE clinical course. These findings have profound clinical
implications in providing the first direct evidence that cell
surface glycoengineering to create effectors of cell migration can
improve the efficacy of stem cell-based therapeutics, and also
provide new perspectives on the use of NSCs in the treatment of
neuroinflammatory diseases.
[0295] Results
[0296] Expression of Molecular Effectors of Cell Migration on
Neural Stem Cells
[0297] To analyze expression of molecular effectors of Step 1, Step
2 and Step 3/4 of cell migration, flow cytometry was performed on
primary cultures of mouse NSCs. NSCs were devoid of reactivity with
E-selectin-Ig chimera (E-Ig) and P-selectin-Ig chimera (P-Ig),
indicating absence of E- and P-selectin ligands (FIG. 9A) even in
the presence of inflammatory mediators (FIG. 15); they also did not
stain with mAb CSLEX1, KM93, or HECA452 (each of which identify
sLe.sup.x). NSCs expressed CD44 and the integrins VLA-4
(CD49d/CD29) and VLA-5 (CD49e/CD29), as well as the chemokine
receptor CXCR4; this pattern of NSC marker expression has been
observed by others (Back, S. A., Tuohy, T. M., et al. 2005; Campos,
L. S., Decker, L., et al. 2006; Campos, L. S., Leone, D. P., et al.
2004; Imitola, J., Raddassi, K., et al. 2004; Ji, J. F., He, B. P.,
et al. 2004; Leone, D. P., Relvas, J. B., et al. 2005; Pluchino,
S., Quattrini, A., et al. 2003; Pluchino, S., Zanotti, L., et al.
2005) (FIG. 9B). The NSCs also characteristically expressed Neural
Cell Adhesion Molecule (NCAM) in addition to the well-described
polysialic acid (PSA) (Vitry, S., Avellana-Adalid, V., et al. 2001)
(FIG. 9B). NSCs did not express PSGL-1, CD43, LFA-1 (lacking both
CD11a (.alpha..sub.1) and CD18 (.beta..sub.2) chains), and LPAM-1
(.alpha..sub.4.beta..sub.7) (FIG. 9B). These results indicate that
NSCs are deficient in expression of Step 1 effectors of the
multistep cascade of cell transmigration, yet express chemokine
receptors and relevant integrin effectors that mediate Steps 2-4 in
extravasation and that are also involved in their mobilization in
the developing brain via radial migration (Imitola, J., Comabella,
M., et al. 2004).
[0298] GPS Enforces E-Selectin Ligand Activity on Neural Stem
Cells
[0299] CD44, a molecule involved in migration of NSCs (Deboux, C.,
Ladraa, S., et al. 2013) and brain cancer stem cells (Fu, J., Yang,
Q. Y., et al. 2013), is strongly expressed among NSCs in culture
(FIG. 9B). However, the finding that NSC lack E-selectin binding
(FIG. 9A) indicates that these cells do not natively express the
E-selectin binding glycoform of CD44 known as HCELL (Dimitroff, C.
J., Lee, J. Y., et al. 2000; Dimitroff, C. J., Lee, J. Y., et al.
2001; Sackstein, R. 2004). We thus sought to determine whether a
non-genetic manipulation using glycosyltransferase-programmed
stereosubstitution (GPS) of CD44 glycans would enforce HCELL
expression (Sackstein, R., Merzaban, J. S., et al. 2008). To this
end, we treated NSCs with the .alpha.(1,3)-linkage-specific
fucosyltransferase, fucosyltransferase VI (FTVI). This enzyme
specifically places a fucose onto a terminal type 2-lactosamine
unit; if that lactosamine is capped with an .alpha.(2,3)-linked
sialic acid, sLe.sup.x is created. Following FTVI treatment of NSCs
(GPS-NSC), reactivity with mAbs CSLEX1, KM93 and HECA452 was
induced, consistent with strong expression of sLex epitopes (FIG.
10A), with associated E-Ig binding (FIG. 10A) but without induction
of P-Ig binding (FIG. 10A). Notably, expression of CD15 (also known
as SSEA-1 or Le.sup.x) is high in NSCs (FIG. 10A), and although
FTVI can fucosylate unsialylated terminal lactosamines thereby
yielding CD15 (SSEA-1), the expression of CD15 was unchanged
following enforced fucosylation (FIG. 10A). Altogether, these data
indicate that .alpha.(1,3)-exofucosylation only occurred on
sialylated lactosaminyl glycans. Bromelain digestion of NSCs prior
to GPS treatment markedly reduced HECA452 reactivity (FIG. 10B),
demonstrating that glycoproteins, not glycolipids, were the
predominant carriers of sialofucosylated determinants. Treatment of
GPS-NSCs with phosphatidylinositol phospholipase C (PI-PLC)
resulted in a modest but significant decrease in the HECA452 signal
by FACS (FIG. 10C), indicating that a minor population of
sLe.sup.x-decorated glycoproteins are glycophosphatidyl
(GPI)-linked.
[0300] Western blot of cell lysates and of immunoprecipitated CD44
from GPS-NSCs revealed that one of the glycoproteins decorated with
the essential sialofucosylations recognized by HECA452 was the
standard, unspliced, form of CD44 (.about.100 kDa; FIG. 11A), and
CD44 also reacted with E-Ig (FIG. 11A). However, following
exhaustive immunoprecipitation of CD44, other candidate
glycoprotein E-selectin ligand(s) were identified by evidence of
reactivity with E-Ig and HECA452 in the residual supernatant
fraction. Two bands were apparent at .about.120 and .about.140 kDa.
Based on the molecular weight profile of these bands (FIG. 11A) and
the partial PI-PLC sensitivity of E-selectin binding (FIG. 10C), a
characteristic of the 120 kDa form of NCAM (Gascon, E., Vutskits,
L., et al. 2007; Maness, P. F. and Schachner, M. 2007; Rutishauser,
U. 2008), we speculated that NCAM could be serving as an additional
E-selectin ligand. We thus performed immunoprecipitation with a
pan-NCAM mAb, and observed that the residual bands persisting after
exhaustive immunoprecipitation of CD44 were indeed those of NCAM
(FIG. 11B). To determine if the relevant sialofucosylations on NCAM
were displayed on N-glycans, we tested E-Ig reactivity on western
blot of lysates of GPS-NSCs following digestion with N-glycosidase
F (FIG. 11A); no evident staining with E-Ig following digestion was
observed, indicBing that the relevant E-selectin binding
determinant(s) are displayed on N-glycans. The contribution of the
GPI-anchored form of NCAM-E to overall sLe.sup.x expression after
enforced fucosylation of NSC is modest, as shown by a small
decrease in HECA452 signal (and E-Ig signal --data not shown)
following PI-PLC treatment (FIG. 10C). Therefore, enforced
.alpha.(1,3)-fucosylation of murine NSCs created HCELL as well as a
unique E-selectin ligand reactive form of the neural precursor
molecule NCAM, which we named "NCAM-E". Interestingly, human NSCs
(CC-2599) only express HCELL and not NCAM-E following GPS treatment
(FIGS. 16A-16C).
[0301] To assess the stability of GPS-engineered E-selectin ligand
activity on NSCs, we measured E-Ig reactivity by flow cytometry at
24 h intervals following enforced exofucosylation. E-selectin
ligand activity was stable for up to 24 h, subsequently declining
to undetectable levels by 72 h, presumably due to turnover of
surface protein (FIG. 11C). NSC viability (FIG. 17) was unaffected
by enforced exofucosylation and there were no differences in the
number or proliferation of neurospheres in clonogenic assays or in
differentiation of NSCs (FIGS. 18A-18D). Thus, there were no
evident phenotypic differences induced by GPS treatment of NSCs,
except for creation of E-selectin ligands.
[0302] NSCs have been shown to inhibit the proliferation T cells in
vitro (Einstein, O., Fainstein, N., et al. 2007; Einstein, O.,
Grigoriadis, N., et al. 2006; Martino, G. and Pluchino, S. 2006),
and, in particular, to dampen mitogenic responses of T cells in
vitro. To assess whether this immunoregulatory function of NSCs is
affected by enforced E-selectin ligand activity, we examined the
ability of GPS-NSCs and control buffer-treated NSCs (BT-NSCs) to
suppress the proliferation of lymph node cells in response to Con A
activation. As displayed in FIGS. 19A-19C, both GPS- and BT-NSCs
were able to decrease T cell proliferation as well as suppress the
level of inflammatory cytokine production equally, suggesting that
there is no immunomodulatory advantage or disadvantage provided by
the GPS treatment itself on NSCs. Interestingly, we also observed
equal release of leukemia inhibitory factor (LIF) from NSCs upon
inflammatory cytokine treatment for both BT- and GPS-NSCs that was
enhanced upon binding of GPS-treated cells to E-Ig (FIG. 19C).
Thus, enforced exofucosylation of NSCs induced transient E-selectin
ligand activity without undesirable effects on NSC phenotype or
function as determined by in vitro studies.
[0303] GPS-NSCs Display Robust Physiological Rolling Interactions
with E-Selectin
[0304] To analyze the potency of E-selectin ligand activity of
GPS-NSCs under physiologic blood flow conditions, parallel plate
flow chamber studies were performed using human umbilical vein
endothelial cells (HUVEC) stimulated by cytokines (IL-1.beta. and
TNF-.alpha.) to express E-selectin. As shown in FIG. 12A, GPS-NSCs
exhibited prominent E-selectin ligand activity that was completely
abrogated in the presence of EDTA or by the use of a blocking
anti-E-selectin mAb. Significant shear-resistant rolling
interactions were observed within usual post-capillary venular
shear levels (1-4 dynes/cm.sup.2), and persisted over 20
dynes/cm.sup.2 (FIG. 12A). To analyze which of the
glycan-engineered E-selectin ligands, HCELL or NCAM-E, is the more
potent E-selectin ligand on NSCs, we used the blot-rolling assay.
(Fuhlbrigge, R. C., King, S. L., et al. 2002) This technique
permits the detection of shear-dependent selectin ligand
interactions on membrane proteins resolved by SDS-PAGE, thus
allowing the evaluation of the individual contribution of HCELL and
NCAM-E to the E-selectin ligand activity of GPS-NSC. Accordingly,
to evaluate the respective E-selectin binding properties,
E-selectin transfected CHO cells (CHO-E) were perfused over
HECA-452 immunostained blots of GPS-NSC lysates. As illustrated in
FIG. 12B, more CHO-E cells interacted and adhered to HCELL compared
to either the 120 kD or the 140 kD forms of NCAM-E. CHO-E cells
suspended in flow medium containing 5 mM EDTA had negligible
adhesion to any regions of the blot, confirming Ca.sup.2+-dependent
binding consistent with selectin ligand activity.
[0305] GPS-NSCs Exhibit Increased Homing and Tissue Infiltration In
Vivo in EAE
[0306] To assess whether injected NSCs infiltrated the CNS
parenchyma, we performed confocal microscopy studies. To this end,
GPS-NSCs and BT-NSCs were labeled with PKH26 dye and were injected
intravenously into MOG-induced chronic EAE mice in two separate
i.v. injections: before disease onset (day 9 post-immunization
(PI)) and at the onset of the disease (day 13 PI). These days were
chosen based on prior studies of E-selectin expression on brain
endothelium in EAE (Piccio, L., Rossi, B., et al. 2002).
Lumbar-sacral spinal cords and brains were harvested 4 days (day 17
PI) after the second NSC injection. Confocal analysis of the brain
demonstrated both higher amounts of GPS-NSCs (FIG. 13A) and
localization outside of Flk-1.sup.+ vessels in the brain (FIGS.
20A-20B). Further, parallel analysis of the spinal cord (FIGS.
13B-13D), where the majority of pathology occurs in EAE,
demonstrated two-fold greater numbers of extravascular GPS-NSCs
infiltrates over BT-NSCs infiltrates by day 17 PI (FIG. 13D). These
data indicate that GPS-NSCs infiltrate the CNS parenchyma
significantly more effectively than BT-NSCs in both the brain and
the spinal cord. To further confirm our confocal data, we studied
the effect of GPS-engineered E-selectin ligand activity on
short-term homing of NSCs in vivo. NSCs were stained using a
fluorochrome tracking dye, CFSA-SE (carboxyfluorescein diacetate
succinimidyl ester) and adoptively transferred into C57BL/6 mice on
day 9 and day 13 PI with MOG as described in Materials and Methods.
Within 16 h after the second cell injection, we observed that
GPS-NSCs accumulated in the brain, spleen and liver three- to
five-fold more efficiently than BT-NSCs (FIG. 13E). The relative
advantage of GPS-NSCs in infiltrating the brain, spleen and liver
reflected a true difference in trafficking, and not simply the
preferential expansion of these cells in situ, as their average
CFDA-SE fluorescence was not reduced relative to BT-NSCs (data not
shown). Indeed of those cells that migrated to the spleen, it is
evident that there are close interactions of NSCs with CD4.sup.+ T
cells (FIG. 13F). Injected cells also accumulated in lungs, but
without difference between GPS- and BT-NSC, likely a reflection of
steric trapping in pulmonary microvessels (FIG. 13E). Thus, the
sLe.sup.x structure formed on NSCs following GPS-treatment licenses
migration of these cells into these organs, and highlights the
critical role of the E-selectin ligand activity in driving
tissue-specific migration of NSCs in vivo.
[0307] GPS-NSCs Increased Homing Translates into Amelioration of
Neuropathology by Enhanced Endogenous Indirect Neuroregeneration in
EAE
[0308] To address whether improved tissue homing of NSC had an
enhanced therapeutic effect, we monitored the neurologic status of
C57BL/6 mice receiving NSC injections following MOG-induced chronic
EAE and analyzed clinical parameters as well as tissue restoration
and pathology. Neural precursors were administered in two separate
i.v. injections on day 9 PI and on day 13 PI. Five groups of EAE
mice were tested: (1) GPS-NSCs; (2) BT-NSCs; (3) HBSS (sham; i.e.
no cells); (4) BT-HSPC; and (5) GPS-HSPC. The clinical score was
evaluated daily in individual mice in a blind fashion (FIG. 14A),
and the linear regression of cumulative burden of disease was
calculated (FIG. 14B and Table 2).
TABLE-US-00002 TABLE 2 EAE features in C57BL/6 mice treated i.v.
GPS treated NSCs. Disease Maximum Cumulative Cumulative Route of
cell No. of onset clinical disease score disease score Treatment
administration mice (days p.i) score (0-20 p.i) (21-30 p.i) No NSC
-- 30 13.22 .+-. 0.6 2.2 .+-. 0.4 15.75 .+-. 0.6 14.9 .+-. 2.4 NSCs
BT i.v 30 12 .+-. 0.6 2.1 .+-. 0.3 12.3 .+-. 0.9 10.9 .+-. 2.sup.
NSCs-GPS i.v 30 12.2 .+-. 0.5 1.8 .+-. 0.1 .sup.ns 10.8 .+-. 1.4
.sup.ns 7.1 .+-. 1.5* *p < 0.05 ANOVA multiple comparisons.
The injection of control NSCs (BT-NSC) attenuated the clinical
severity of EAE compared to HSPC and sham treated animals
(p=0.006). However, i.v. injection of GPS-NSCs (n=30) showed a more
significantly improved clinical score compared to BT-NSCs (n=30;
p=0.006), GPS-HSPC (n=30; p<0.0001), BT-HSPC (n=30;
p<0.0001), and sham (n=30; p<0.0001) treated animals. It is
important to note that this amelioration of disease severity is
specific to NSCs, since neither the injection of GPS-HSPC (which
display markedly increased E-selectin ligand activity, see FIG. 21A
(Merzaban, J. S., Burdick, M. M., et al. 2011)) or the injection of
BT-HSPC showed an improvement in the clinical score of MOG-induced
animals compared to control animals (FIGS. 21B-21C and Table
3).
TABLE-US-00003 TABLE 3 EAE clinical features in C57BL/6 mice
injected with i.v. GPS treated HSPCs. Disease Maximum Cumulative
Cumulative Route of cell No. of onset clinical disease score
disease score Treatment administration mice (days p.i) score (0-20
p.i) (21-30 p.i) No Cells -- 30 13.22 .+-. 0.6 2.2 .+-. 0.4 15.75
.+-. 0.6 14.9 .+-. 2.4 BT-HSPC i.v 30 10 .+-. 0.7 2.1 .+-. 0.2 17.2
.+-. 1* 16.7 .+-. 1*.sup. GPS-HSPC i.v 30 9.5 .+-. 0.4 2.5 .+-. 0.6
18.3 .+-. 2.2** 16.8 .+-. 1.7* *p < 0.05 ANOVA multiple
comparisons.
Indeed, injection of either GPS- or BT-HSPCs showed a trend towards
worsened clinical outcomes indicating that the observed salutary
effects of NSC infusion are not a general property of adult stem
cells.
[0309] Notably, examination of the neuropathology at day 30 after
EAE induction showed statistically significant differences in
several parameters of inflammation and neuroregeneration in mice
that received GPS-NSC compared to BT-NSC and sham treated animals
(FIG. 14C). To determine the impact of NSC injections on the
neuropathology of EAE, we evaluated a number of different markers.
First, to assess the extent of inflammation, we stained sections of
spinal cord from each study group of mice for CD11b, a marker that
identifies infiltrating macrophages and microglia. Animals with EAE
that received HBSS buffer alone displayed high levels of staining
for CD11 b, with cells exhibiting increased numbers of membrane
processes, morphologic evidence of an activated phenotype (FIG.
14C). The numbers of CD11 b-stained cells were significantly
decreased in mice that received BT-NSCs (p<0.0001), and notably,
these levels were even further decreased in animals injected with
GPS-NSCs (p.sub.<0.005 compared to BT-NSCs). Importantly, the
macrophage/microglia displayed decreased CD11 b staining and more
discrete membrane processes indicative of decreased activation
(FIG. 14C). In addition, quantification of brain CD4+ T cells in
the different treatment groups revealed a significant decrease of
infiltrating T cells in animals given GPS-NSCs (FIGS. 14D-14E). To
assess neuroregeneration, we stained sections of spinal cord for
the markers GAP-43 and SMI-32 (FIGS. 14F-14I). In animals injected
with GPS-NSCs, there was increased expression of GAP-43, a molecule
associated with axon integrity and regeneration, compared to that
in mice that received either BT-NSCs or HBSS buffer alone (FIGS.
14F-14G). Conversely, a specific reduction in the expression of
SMI-32, a marker of axonal degeneration, was observed in animals
that received GPS-NSCs compared to mice receiving either BT-NSCs or
HBSS buffer (FIGS. 14H-14I). These data support the notion that the
improved clinical effects afforded by GPS-NSCs over BT-NSCs are
secondary to increased lesional migration of tissue-specific NSC
yielding enhanced neuroprotection.
[0310] To further assess whether observed effects of GPS-NSCs
reflect increased neuroregeneration, we stained for markers
associated with oligodendrogenesis and mature oligodendrocytes,
including CNPase, Olig-2, and SOX9. We observed a statistically
significant enhancement in the number of Olig-2, SOX9 and CNPase
cells in animals that received GPS-NSCs compared to BT-NSCs or sham
control (FIGS. 14D-14E). Although there was evidence of injected
NSCs at day 17 PI (SOX-2.sup.+ cells; FIGS. 20A-20B), we did not
observe persistent colonization by NSC (tagged with GFP) at 30 days
PI (FIG. 22) in any of the injection groups, suggesting that the
mechanism of NSC neuroprotection associated with improved homing
does not necessitate the continued presence, nor differentiation
towards neural lineage cells, of administered NSCs. Altogether,
these data indicate that the treatment of mice with GPS-NSCs
enhanced the delivery of NSCs to the CNS and provided
neurorestoration via an indirect neuroregenerative effect, not
through direct neuroregeneration (i.e., cell replacement).
DISCUSSION
[0311] MS is a chronic, demyelinating disease of the CNS
characterized by multifocal inflammatory lesions yielding gradual
destruction of the myelin sheath, leading to axonal injury and loss
(Imitola, J., Chitnis, T., et al. 2006). Stem cell-based
therapeutics offers the promise of repair of damaged/inflamed
tissue by replacing affected cells (direct regeneration) and/or by
production of supportive/trophic factors in the milieu that evoke
tissue restoration by endogenous cells (indirect regeneration). In
the case of disseminated neurologic diseases like MS, use of
tissue-specific NSCs could prove clinically useful in achieving CNS
recovery, but a proximate hurdle to accomplishing this goal is to
deliver adequate numbers of cells to sites of neural injury. Prior
studies have shown a benefit of transplanted NSCs in experimental
models of stroke, spinal cord trauma and MS (Ben-Hur, T., Einstein,
O., et al. 2003; Einstein, O., Fainstein, N., et al. 2007;
Einstein, O., Grigoriadis, N., et al. 2006; Imitola, J., Raddassi,
K., et al. 2004; Lee, S. T., Chu, K., et al. 2008; Pluchino, S.,
Quattrini, A., et al. 2003; Pluchino, S., Zanotti, L., et al. 2005;
Ziv, Y., Avidan, H., et al. 2006). Direct injection into the
affected site was used as route of delivery in these studies,
however, in order to attain appropriate colonization of NSC within
affected tissue(s) in multifocal CNS diseases, the vascular route
of delivery is required as local administration (i.e., in situ
injection) is impractical given the diffuse nature of disease and
associated anatomic constraints. To date, there have been no
studies to evaluate the expression of molecular effectors of cell
migration on NSCs, and, more importantly, no studies to address how
optimizing expression of such effectors could enhance NSC
neurotropism.
[0312] Our studies reveal that NSCs express relevant Step 2-4
effectors, but are conspicuously deficient in Step 1 effectors: (1)
they do not natively express ligands for E-selectin or P-selectin
(even when grown in the presence of inflammatory cytokines (FIG.
15)); (2) they lack expression of the glycan sLe.sup.x, which is
the canonical selectin binding determinant; and (3) they do not
express the glycoprotein PSGL-1, a selectin ligand on
myelin-specific Th1 cells that has been reported to mediate
trafficking to the brain (Piccio, L., Rossi, B., et al. 2005;
Piccio, L., Rossi, B., et al. 2002). Importantly, expression of
endothelial selectins, especially E-selectin, has been implicated
in recruitment of immunologic effectors in MS and EAE (Lee, S. J.
and Benveniste, E. N. 1999; Piccio, L., Rossi, B., et al. 2002).
Thus, we sought here to assess whether glycan engineering of NSC to
enforce expression of E-selectin ligands would enhance systemic
delivery of the cells and, in consequence, have biologic effects in
an MS model.
[0313] The dataset here show that cultured NSC express two
well-characterized neural cell surface molecules, CD44 and NCAM
(Back, S. A., Tuohy, T. M., et al. 2005; Pluchino, S., Quattrini,
A., et al. 2003). Strikingly, exofucosylation of mouse NSCs yielded
high expression of sLe.sup.x determinants prominently on these
glycoproteins, programming conversion of CD44 into the potent
E-selectin ligand HCELL (Dimitroff, C. J., Lee, J. Y., et al. 2000;
Dimitroff, C. J., Lee, J. Y., et al. 2001) and also inducing
expression of two sialofucosylated glycoforms of NCAM of .about.120
kDa and .about.140 kDa, which we designate "NCAM-E". Blot rolling
assays revealed that HCELL is the principal E-selectin ligand
expressed on GPS-NSCs (FIG. 12B). These findings are corroborated
by results of flow cytometry following the removal of NCAM-E by
PI-PLC digestion, showing considerable retention of NSC sLe.sup.x
expression and E-Ig reactivity (FIG. 10C).
[0314] NCAM, a member of the immunoglobulin superfamily, is
expressed on both neurons and glia, and is conventionally viewed as
a mediator of cell-cell interactions establishing a physical
anchorage of cells to their environment. Post-translational glycan
modifications consisting of .alpha.-2,8-linked polysialic acid
(PSA) on the NCAM protein core provides unique properties in neural
migration (Gascon, E., Vutskits, L., et al. 2007; Maness, P. F. and
Schachner, M. 2007; Rutishauser, U. 2008) and PSA-NCAM appears to
play a crucial role in mediating precursor cell migration in the
brain (Glaser, T., Brose, C., et al. 2007; Lavdas, A. A.,
Franceschini, I., et al. 2006; Zhang, H., Vutskits, L., et al.
2004). Our data now provide the first evidence that NCAM displays
relevant terminal .alpha.-(2,3)-sialyllactosaminyl glycans that can
serve as acceptors for exofucosylation to create sLe.sup.x
determinants. Following cell surface glycoengineering of NSCs, PSA
expression levels did not change and the induced E-selectin ligand
activity is not permanent, as there was complete loss of sLe.sup.x
expression within 72 hours of enforced fucosylation (FIGS.
11A-11C). Thus, subsequent to extravasation, temporal reversion to
native NCAM should occur, and infiltrating NSCs would then be
capable of undergoing endogenous NCAM-mediated intraparenchymal CNS
migration. Notably, though murine NSC express NCAM bearing
.alpha.-(2,3)-sialyllactosaminyl glycans, our studies of human NSCs
(CC-2599) indicate that these cells only express HCELL and not
NCAM-E following exofucosylation (FIG. 15); thus, human NSC may
express relevant sialolactosaminyl glycans that serve as acceptors
for enforced fucosylation only on CD44. These species differences
should be considered when interpreting xenograft studies where
human NSCs are used in rodent systems (Goncharova, V., Das, S., et
al. 2014).
[0315] The induction of E-selectin ligand activity has profound
implications for cell trafficking, serving to direct cell migration
to endothelial beds that express E-selectin. As shown by others, we
observed that NSCs display the chemokine receptor CXCR4 and the
integrin VLA-4 (see FIGS. 9A-9B). It has been shown that expression
of CXCR4 on human NSCs (Bezzi, P., Domercq, M., et al. 2001; Flax,
J. D., Aurora, S., et al. 1998; Imitola, J., Raddassi, K., et al.
2004) promotes migration in vivo toward CNS injury wherein local
astrocytes and endothelium up-regulate the cognate ligand stromal
cell-derived factor 1.alpha. (SDF-1.alpha., also known as CXCL12)
(Imitola, J., Raddassi, K., et al. 2004). These observations define
CXCR4 as a prominent Step 2 effector in promoting NSC homing to CNS
injury. The corresponding endothelial receptor for VLA-4, VCAM-1,
is also upregulated in the inflammatory response of the brain to
injury (Justicia, C., Martin, A., et al. 2006). The VLA-4/VCAM-1
axis has similarly been shown to play a critical role in migration
of NSC, in that only NSCs that constitutively express VLA-4, in
addition to CXCR4, were able to accumulate around inflamed CNS
microvessels in affected lesions in EAE (Pluchino, S., Zanotti, L.,
et al. 2005). A recent xenograft study suggests that integrins may
play a role as step 1 mediators of migration on human NSCs in a rat
stroke model suggesting that selectin interactions are not
necessary in this model system (Goncharova, V., Das, S., et al.
2014). Although further work is warranted, the varying role(s) of
integrins as mediators of Step 1 interactions could reflect
differences in the inflammatory model used, the host animal system,
the permeability of vessels, the expression of endothelial adhesion
molecules at that site of inflammation, the presence of soluble
adhesion molecules at the site, and the physical properties of the
vessel that dictate the flow rate (i.e. diameter of vessel)
(Berlin, C., Bargatze, R. F., et al. 1995; Ding, Z. M., Babensee,
J. E., et al. 1999; Zarbock, A., Kempf, T., et al. 2012; Zarbock,
A., Lowell, C. A., et al. 2007). In any case, expression of
E-selectin ligands as Step 1 effectors on NSCs would serve to
complement the constitutive expression of CXCR4 and VLA-4, thereby
optimizing the recruitment of NSC to inflammatory sites.
Accordingly, though we observed that intravenously administered
(non-modified) BT-NSCs can infiltrate the brain of EAE mice (FIG.
13E), enforced E-selectin ligand expression by glycoengineering
yielded markedly increased migration of NSCs to the brain. This
increased neurotropism was associated with markedly diminished CNS
inflammation (FIGS. 14A-14I). Moreover, as shown in FIGS. 13A-13F,
NSC accumulation in the CNS parenchyma was two-fold higher among
GPS-NSCs than BT-NSCs by day 17 post-injection, indicating that
enforced expression of Step 1 effectors promotes extravasation.
[0316] In addition to enhanced neurotropism, short-term homing data
also revealed a significantly higher accumulation of GPS-NSCs in
the spleen and liver than in BT-NSCs (FIG. 13E). These findings are
consistent with results of a study reporting that systemically
administered NSCs tend to accumulate in the brains of mice with
EAE, and also in the spleen and the liver (Politi, L. S.,
Bacigaluppi, M., et al. 2007). E-selectin expression in the spleen
has been described in humans, non-human primates and rodents (Alam,
H. B., Sun, L., et al. 2000; Drake, T. A., Cheng, J., et al. 1993;
Redl, H., Dinges, H. P., et al. 1991; Schweitzer, K. M., Drager, A.
M., et al. 1996), and is upregulated by pro-inflammatory cytokines
that are characteristically expressed in CNS inflammatory
conditions (Emamgholipour, S., Eshaghi, S. M., et al. 2013;
Weishaupt, A., Jander, S., et al. 2000); indeed, conjugation of
sLe.sup.x to polymers has been shown to markedly enhance the
accumulation of such polymers within the spleen (Hone, K.,
Sakagami, M., et al. 2000; Horie, K., Sakagami, M., et al. 2004),
providing direct evidence that sLe.sup.x expression promotes
splenic delivery. It has been reported that infiltration of the
spleen by NSCs dampens production of inflammatory cytokines by
resident spleen cells (e.g., macrophages) resulting in
anti-inflammatory effects (Lee, S. T., Chu, K., et al. 2008). Other
studies have reported that intravascularly administered NSCs
provide peripheral immunosuppression (Einstein, O., Fainstein, N.,
et al. 2007; Einstein, O., Grigoriadis, N., et al. 2006) or local
immunomodulation that restrains CNS injury, rather than by
enhancing neuroregeneration (Martino, G. and Pluchino, S. 2006;
Pluchino, S., Zanotti, L., et al. 2009; Wang, L., Shi, J., et al.
2009). Thus, the observed increased splenic homing by enforced
expression of E-selectin ligand activity on NSCs could be
contributory to neuroprotection via immunomodulation by virtue of
increased tissue ratio of NSCs to immune cells. This notion is
supported by our in vitro data showing that although GPS-NSCs did
not confer an immunomodulatory advantage compared to that observed
with control NSCs, as the ratio of input NSCs to splenocytes is
increased, T cell proliferation decreases (FIG. 19A).
[0317] Previous studies of cell surface exoglycosylation had
utilized human mesenchymal stem cells in a xenotransplant model and
did not address the therapeutic impact on tissue injury, i.e.,
whether glycoengineered stem cells would home to a site of
inflammation and whether such cells would have desired regenerative
and/or tissue-protective effect(s). Though enhanced recruitment of
NSCs to the CNS was observed following infusion of GPS-NSCs, there
was no commensurate increase in long-term engraftment of NSCs.
Thus, though enhanced CNS infiltration was achieved by exploiting
physiologic cell migration (i.e., in a non-invasive fashion that
would preserve CNS tissue microenvironmental architecture), we did
not observe that administered NSCs differentiated into progeny that
regenerate functional CNS tissue in situ (i.e., through direct
regeneration). In fact, we observed that administration of GPS-NSCs
improved the ability of endogenous neuronal progenitors to become
oligodendroglia (FIGS. 14D-14E). Our findings thus do not support
the paradigm of direct neuroregeneration, but instead suggest that
the predominant role of NSCs in CNS tissue repair is via trophic
effects that support repair by endogenous cells (Caplan, A. I.
2009; Hess, D. C. and Borlongan, C. V. 2008; Laterza, C., Merlini,
A., et al. 2013; Phinney, D. G. and Prockop, D. J. 2007), thus
yielding neurorestoration (i.e., through indirect
neuroregeneration). Consistent with this notion, undifferentiated
NSCs have been reported to significantly reduce scar formation and
increase survival and function of endogenous glial and neuronal
progenitors through the secretion of neurotrophins such as LIF
(Laterza, C., Merlini, A., et al. 2013). In addition, NSCs support
the formation of injury-induced growth niches through the
expression of molecules such as BMP-4 and Noggin (Imitola, J.,
Raddassi, K., et al. 2004; Pluchino, S., Zanotti, L., et al. 2005)
that trigger indirect neuroregeneration by endogenous cells.
[0318] Collectively, our data support a mechanism in which glycan
engineering of NSC to enforce expression of E-selectin ligands
heightens tissue colonization, mediating immunomodulation and
tissue repair without necessitating persistent/long-term
engraftment of administered NSCs. Notably, despite enhanced
E-selectin ligand activity, infusion of GPS-HSPC did not improve
the course of EAE (indeed, injection of HSPC worsens disease, see
FIGS. 21A-21B and Table 3), indicating that the observed
neuroprotective effects of GPS-NSCs are not a general property of
adult stem cells and are due to neurorestorative effects inherent
to NSC. Consistent with this finding of adult stem cell-specific
biologic effect(s), human HSPCs have been found to elicit strong
host immune rejection in a mouse model of congenital corneal
disease while other adult stem cells such as mesenchymal stem cells
suppress the host immune response (Liu, H., Zhang, J., et al.
2010). Though further studies on the molecular mechanism(s)
mediating the observed neuroprotection by NSCs are warranted, our
results indicate that cell surface glycan engineering did not
change the self-renewal capacity, differentiation potential or
alter the innate immunomodulatory capacity of neural stem cells.
Collectively, the data presented here lead us to propose a model
(FIG. 23) whereby enforced E-selectin ligand expression via
exofucosylation of the surface of NSCs yields increased tissue
recruitment at CNS inflammatory sites, thereby enhancing payload
delivery of NSC trophic factors where they are needed. Because
E-selectin expression is markedly upregulated at endothelial beds
at all sites of inflammation in humans, our findings have profound
translational implications for future clinical trials exploiting
cell surface glycan engineering to improve the efficacy of stem
cell therapeutics for MS as well as other devastating multifocal
inflammatory diseases.
[0319] Materials and Methods
[0320] Ethics Statement:
[0321] All mouse experiments were performed in accordance with the
NIH guidelines for the care and use of animals and under approval
of the Institutional Animal Care and Use Committees of Harvard
Medical School. The following are the specifics related to using
mice these experiments. Justification for use: EAE is a valuable
model for the human disease multiple sclerosis. There are no
mathematical models, computer simulations or in vitro systems that
can substitute for the in vivo disease. Many of the treatments
available for MS and other autoimmune diseases were first tested
and their mechanisms investigated in EAE. MOG induced EAE in
C57/BL6 mice is valuable because of the availability of many
knockout and transgenic mice on that background. Veterinary care:
Mice are handled and cared for according to federal, institutional,
and AAALAC guidelines. Procedures to minimize adverse effects:
After immunization, animals are examined daily. Those affected by
EAE develop a floppy tail (grade1), partial hind limbs (grade2),
complete hind limb paralysis (grade 3), quadriparesis (grade 4),
moribund or animal death (grade 5). Most animals have a grade 0 to
3, and, rarely, animals reach grade 4 and in such cases euthanasia
is performed. When animals are affected by EAE, they are provided
with gel packs to ensure access to fluids and are provided with
access to food within the cage. Euthanasia is performed by CO2
inhalation administered according to institutional guidelines.
[0322] Reagents:
[0323] The following antibodies were purchased from BD Pharmingen:
function blocking mouse anti-human E-selectin (68-5H11; IgG1), rat
anti-human CLA (HECA-452; IgM), mouse anti-human sLe.sup.x
(CSLEX-1; IgM), mouse anti-human CD15 (IgM), rat anti-mouse PSGL-1
(2PH1 and 4RA10; IgG1), mouse anti-human PSGL-1 (KPL-1; IgG1), rat
anti-mouse CD44 (KM114 and IM7; IgG1), mouse anti-human CD44 (515;
IgG1), rat anti-mouse CD43 (S7; IgG2a), mouse anti-human CD43
(1G10; IgG1), mouse anti-(mouse anti-adult and embryonic pan N-Cam)
CD56 (NCAM13; IgG2b), mouse anti-human CD56 (NCAM16.2; IgG2b), rat
anti-human CXCR4 (2B11; IgG2b), mouse anti-human CXCR4 (12G5;
IgG2a), rat anti-mouse CD18 (GAME-46; IgG1), rat anti-mouse CD29
(KM16; IgG2a), rat anti-mouse CD49d (9C10; IgG2b), rat anti-mouse
CD11a (2D7; IgG2a), rat anti-mouse CD11b (M1/70; IgG2b), rat
anti-mouse CD49e (MFRS; IgG2a), mouse IgG1,.kappa. isotype, mouse
IgG2a isotype, mouse IgM isotype, rat IgG isotype, rat IgM isotype,
and human IgG.sub.1 isotype. The following secondary antibodies
were also purchased from BD Pharmingen: PE Streptavidin, biotin
anti-rat IgM, and goat anti-mouse Ig-HRP. The following secondary
antibodies were purchased from Southern Biotech.: rabbit anti-human
IgG-biotin, goat anti-mouse IgM-PE, goat anti-rat IgG-PE, goat
anti-mouse Ig-biotin, goat anti-rat Ig-HRP, and goat anti-human
Ig-HRP. Recombinant mouse E-selectin/human Ig chimera (E-Ig) and
recombinant mouse P-selectin/human Ig chimera (P-Ig) were from
R&D. Mouse anti-human sLe.sup.x (KM93; IgM) was purchased from
Calbiochem. Rat anti-mouse CD43 (1B11; IgG2a) was purchased from
Biolegend. Rat anti-mouse LPAM-1 (DATK32; IgG2a) and mouse
anti-SMI32 (SMI-32; IgG1) were purchased from Abcam. Mouse
anti-human CD15 (80H5; IgM) was purchased from Coulter-Immunotech.
PNGase F was purchased from New England Biolabs. PI-PLC, Bromelain,
Soybean Trypsin Inhibitor, DNase, mouse anti-Map2 (HM-2; IgG1) were
purchased from Sigma. Mouse-anti GFP (B2, IgG.sub.2a) was purchased
from Santa Cruz Biotechnology, Inc (Santa Cruz, Calif.). To-pro3
was purchased from Invitrogen. Mouse anti-human polysialic acid
(PSA; IgG2a) was a kind gift from Dr. Nicholas Stamatos.
Fucosyltransferase VI (FTVI) enzyme was a gift of Dr. Roland
Wohlgemuth (Sigma-Aldrich).
[0324] Cells:
[0325] Mouse NSCs were isolated and cultured as described (Imitola,
J., Comabella, M., et al. 2004; Imitola, J., Raddassi, K., et al.
2004) previously. Briefly, a suspension of dissociated NSCs
(5.times.10.sup.5 cells per ml), isolated from the telencephalic VZ
of murine embryonic day 12, were cultured in 98% DMEM/F12 (GIBCO),
1% N2 supplement (GIBCO), 1% penicillin/streptomycin (GIBCO) 8
mg/ml heparin (Sigma), 10 ng/ml leukemia inhibiting factor (LIF,
Chemicon), 20 ng/ml bFGF (Calbiochem) in uncoated 25-cm.sup.2
flasks (Falcon) at 37.degree. C. in 5% CO.sub.2. NSCs were used
after second passage for most experiments. Single cell suspension
of neural stem cells was achieved by mechanical dissociation of the
neurospheres in Versene (Life Technologies).
[0326] For isolation of mouse HSPC, bone marrow was harvested from
the femur and tibia of C57BL/6 mice and single cell suspensions
were made. Red blood cells were lysed using red blood cell lysing
buffer (Sigma). Cells were then washed and filtered through a 100
.mu.m cell strainer (BD Falcon) prior to lineage depletion using
the Lineage Cell Depletion Kit from Miltenyi Biotec. Cell
preparations were depleted using the autoMACS.TM. Separator
(Miltenyi Biotec.). Following depletion, the cells were then
positively selected for c-kit using CD117 MicroBeads (Miltenyi
Biotec.). The resulting Lineage.sup.negC-kit.sup.pos population
(referred to as HSPC) was used for in vivo EAE mouse studies.
[0327] Chinese hamster ovary cells transfected with full-length
E-selectin (CHO-E) and were maintained as described previously
(Dimitroff, C. J., Lee, J. Y., et al. 2001). The human
.beta.FGF-dependent NSC cell line, CC-2599, was cultured as
previously described (Imitola, J., Raddassi, K., et al. 2004) and
used for data presented in FIGS. 16A-16C.
[0328] GPS-Treatment, PI-PLC and Bromelain Reactions:
[0329] The procedure for GPS treatment of murine NSCs was as
previously described for MSCs (Sackstein, R., Merzaban, J. S., et
al. 2008). Briefly, neurospheres were first harvested and
dissociated into single cells by incubating with PBS/EDTA (0.02%)
for 15 min at 37.degree. C. Cells were then washed with HBSS,
counted, and resuspended in 60 mU/ml FTVI in HBSS (without
Ca.sup.2+ or Mg.sup.2+) containing 20 mM HEPES, 0.1% human serum
albumin and 1 mM GDP-fucose for 40 min at 37.degree. C. PI-PLC
reactions were performed at 37.degree. C. using 0.1 U/ml for 1 hr.
Bromelain reactions were performed at 37.degree. C. in HBSS+2%
BSA+0.1% bromelain for 1 hr.
[0330] Flow Cytometry:
[0331] Aliquots of cells (2.times.10.sup.5 cells) were washed with
PBS/2% FBS and incubated with primary mAbs or with isotype control
mAbs (either unconjugated or fluorochrome conjugated). The cells
were washed in PBS/2% FBS and, for indirect immunofluorescence,
incubated with appropriate secondary fluorochrome-conjugated
anti-isotype antibodies. After washing cells, FITC or PE
fluorescence intensity was determined using a Cytomics FC 500 MPL
flow cytometer (Beckman Coulter Inc., Fullerton, Calif.).
[0332] Immunoprecipitation Studies:
[0333] Cell lysates of BT-NSC or GPS-NSC were incubated with
immunoprecipitating antibodies or with appropriate isotype controls
and then incubated with Protein G-agarose. Immunoprecipitates were
washed extensively using Buffer A containing 2% NP-40, 1% SDS. In
some experiments, immunoprecipitates were treated with
N-glycosidase F (New England Biolabs) as previously described
(Dimitroff, C. J., Lee, J. Y., et al. 2001). For Western blot
analysis, all immunoprecipitates were diluted in reducing sample
buffer, boiled, then subjected to SDS-PAGE, transferred to PVDF
membrane, and immunostained with HECA-452 or E-lg.
[0334] Western Blot Analysis:
[0335] BT- and GPS-NSCs were lysed using 2% NP-40 in Buffer A (150
mM NaCl, 50 mM Tris-HCl, pH 7.4, 1 mM EDTA, 20 .mu.g/ml PMSF, 0.02%
sodium azide; and protease inhibitor cocktail tablet (Roche
Molecular Biochemicals)). Western blots of quantified protein
lysates or of immunoprecipitated protein were performed under
reducing conditions as described previously (Dimitroff, C. J., Lee,
J. Y., et al. 2001). Blots were visualized with chemiluminescence
using Lumi-Light Western Blotting Substrate (Roche).
[0336] Parallel Plate Flow Chamber Adhesion Assays:
[0337] E-selectin binding capacity of BT-NSCs and GPS-NSCs was
compared using the parallel plate flow chamber assay (Glycotech;
Gaithersburg, Md.). NSCs (0.5.times.10.sup.6 cells/ml, suspended in
HBSS/10 mM HEPES/2 mM CaCl.sub.2 solution) were drawn over
confluent HUVEC monolayers. Initially, the NSCs were allowed to
contact the HUVEC monolayer at a shear stress of 0.5 dyne/cm.sup.2,
subsequently the flow rate was adjusted to exert shear stress
ranging from 0.5 to 30 dynes/cm.sup.2. The number of BT- or
GPS-NSCs adherent to the HUVEC monolayer were quantified in the
final 15 sec interval at shear stress of 0.5, 1, 2, 5, 10, 20 and
30 dyne/cm.sup.2. Each assay was performed at least 3 times and the
values averaged. Control assays were performed by adding 5 mM EDTA
to the assay buffer to chelate Ca.sup.2+ required for selectin
binding or treating HUVEC with function-blocking anti-human
E-selectin mAb at 37.degree. C. for 15 min. prior to use in
adhesion assays.
[0338] Blot Rolling Assay:
[0339] The blot rolling assay has been described previously
(Dimitroff, C. J., Lee, J. Y., et al. 2000; Fuhlbrigge, R. C.,
King, S. L., et al. 2002; Sackstein, R. and Fuhlbrigge, R. 2006)
and here was used to detect selectin-binding activity of NSC
membrane proteins resolved by SDS-PAGE. Western blots of NSC
membrane preparations were stained with anti-CLA (HECA-452) and
rendered translucent by immersion in DMEM with 10% glycerol. CHO-E
cells were resuspended (5.times.10.sup.6/mL) in DMEM containing 2
mM CaCl.sub.2 and 10% glycerol. The blots were placed under a
parallel plate flow chamber, and CHO-E cells were perfused at a
physiologically relevant shear stress of 1.0 dyne/cm.sup.2, an
adjustment in the volumetric flow rate was made to account for the
increase in viscosity due to the presence of 10% glycerol in the
flow medium. Molecular weight markers were used as guides to aid
placement of the flow chamber over stained bands of interest. The
number of interacting cells per square millimeter was tabulated as
a function of the molecular weight region and compiled into an
adhesion histogram. Nonspecific adhesion was assessed by perfusing
CHO-E cell suspensions containing 5 mM EDTA in the flow medium.
[0340] Immunization for EAE-Induction and Neural Stem Cells
Injection:
[0341] NSCs or bone marrow HSPC (Lineage.sup.negC-kit.sup.pos) were
either treated with GPS or not and 1.times.10.sup.6 cells were
injected into the tail vein of C57BL/6 mice on day 9 and day 13
after immunization (PI) with MOG 35-55 (subcutaneously in the
flanks; see details in Supplementary Material). EAE was scored in a
blinded fashion; the investigator was not involved in the
injections and was not aware of the composition of the groups.
Details of the grading scale used are outlined in the Supplementary
Material. BT-NSC, GPS-NSCs, BT-HSPCs or GPS-HSPCs were injected as
a cell suspension into the tail-vein of EAE mice in a volume of 0.2
ml of HBSS. Sham treated mice (No NSCs) injected with HBSS alone
were used as a negative control.
[0342] Short-Term Homing Studies:
[0343] BT-NSCs and GPS-NSCs were labelled with 5 mM CFDA-SE
(Invitrogen) for 5 min at room temperature in RPMI containing 10%
FBS and injected intravenously into MOG-treated C57BL6 mice on day
9 and day 13 post-immunization (PI). Two million NSCs in a volume
of 0.2 mL of HBSS were injected into each mouse on each day. HBSS
buffer alone was used to determine background signals. BT-NSCs and
GPS-NSCs were also injected into animals that were not immunized
with MOG and used to standardize the signals observed in each
tissue assayed. Sixteen hours after the second NSC transfer, mice
were sacrificed and perfused with 1.times.PBS without Ca.sup.2+ and
Mg.sup.2+. The brain, spinal cord, lymph nodes, spleen, liver and
lung were isolated. The brain and spinal cord were homogenized.
Resulting pellets were resuspended in 0.25% Trypsin-EDTA
(Invitrogen) and incubated at 37.degree. C. for 10 minutes. The
digestion process was stopped using DMEM containing 0.01% SBTI,
0.001% DNase and 0.075% BSA. The lymph nodes, spleen and liver were
mechanically dissociated and the resulting single-cell suspensions
were assessed for frequencies of CFDA-SE positive cells by flow
cytometry in the FL1 channel. Flow cytometric data was analyzed and
expressed as percent of CFDA-SE-positive events detected in 200,000
cells scanned within a narrow gate that is set to include NSC. This
gate was determined based on mixing cultured NSCs with suspensions
of cells isolated from each tissue tested (brain, spinal cord,
lymph node, spleen, liver and lung).
[0344] Analysis of NSC Migration to CNS:
[0345] BT-NSCs, GPS-NSCs were labelled with PKH26 dye (Invitrogen)
and injected intravenously into MOG-treated C57BL6 mice on day 9
and day 13 post-immunization (PI). One million NSCs in a volume of
0.2 mL of HBSS were injected into each mouse on each day. HBSS
buffer alone was used to determine background signals. Four days
after the second NSC transfer, mice were sacrificed and perfused
with 1.times.PBS without Ca.sup.2+ and Mg.sup.2+ and lumbar-sacral
spinal cords were harvested. The spinal cord was chosen because in
the B6 model, the CNS lesions in the forebrain are very variable in
size and location compared with the spinal cords, which possess a
more predictable location (lumbosacral region) and also more
exuberant pathology (Chitnis, T., Najafian, N., et al. 2001;
Rasmussen, S., Wang, Y., et al. 2007; Wang, Y., Imitola, J., et al.
2008). For FACS analysis, the spinal cords were then homogenized
and the resulting pellets were resuspended in 0.25% Trypsin-EDTA
(Invitrogen) and incubated at 37.degree. C. for 10 minutes. The
digestion process was stopped using DMEM containing 0.01% SBTI,
0.001% DNase and 0.075% BSA. For histology analysis, the brain and
spinal cord were snap-frozen in liquid nitrogen and stored in
-80.degree. C. until sectioning. The cryostat sections (20 .mu.m)
of lumbar-sacral spinal cord or anterior, middle and posterior
brain were fixed with 4% paraformaldehyde for 15 minutes and then
stained with antibodies of interest, Blood vessels were visualized
by anti-Flk-1 (VEGFR2, Sigma) and NSCs were stained with either
anti-sox-2 (Millipore) or visualized by PKH26 dye in red. The
spinal cords were then homogenized and the resulting pellets were
resuspended in 0.25% Trypsin-EDTA (Invitrogen) and incubated at
37.degree. C. for 10 minutes. The digestion process was stopped
using DMEM containing 0.01% SBTI, 0.001% DNase and 0.075% BSA.
Blood vessels were visualized by Flk-1 (VEGFR2) staining.
[0346] Immunization for EAE-Induction and NSC/HSPC Injection:
[0347] NSCs or HSPC (Lineage.sup.negC-kit.sup.pos) were either
treated with GPS or not and 1.times.10.sup.6 cells were injected
into the tail vein of C57BL/6 mice on day 9 and day 13 after
immunized (PI) with MOG 35-55. MOG 35-55
(M-E-V-G-W-Y-R-S-P-F-S-R-O-V-H-L-Y-R-N-G-K) corresponding to mouse
sequence is synthesized by QCB Inc. Division of BioSource
International (Hopkinton, Mass.), and purified to >99% by HPLC.
Mice are immunized subcutaneously in the flanks with 150-200 .mu.g
of MOG peptide in 0.1 ml PBS and 0.1 ml CFA containing 0.4 mg
Mycobacterium Tuberculosis (H37Ra, Difco, Detroit, Mich.) and
injected intraperitoneally with 200 ng Pertussis toxin (List
Laboratories, Campbell, Calif.) on the day of immunization and 2
days later. EAE was scored in a blinded fashion; the investigator
was not involved in the injections and was not aware of the
composition of the groups. The following grade was used: grade 1,
limp tail or isolated weakness of gait without limp tail; grade 2,
partial hind leg paralysis; grade 3, total hind leg or partial hind
and front leg paralysis; grade 4, total hind leg and partial front
leg paralysis; grade 5, moribund or dead animal. BT-NSC, GPS-NSCs,
BT-HSPCs, GPS-HSPCs were injected as a cell suspension into the
tail-vein of EAE mice in a volume of 0.2 ml of HBSS. Sham treated
mice (No NSCs) injected with HBSS alone were used as a negative
control.
[0348] Immunohistologic Staining:
[0349] Mice were perfused with 50 ml normal saline before
sacrificing to remove any intravascular PBMCs. For confocal imaging
animals were perfused intracardially with 10 ml of 4%
paraformaldehyde in PBS. The brain and spinal cord were removed and
embedded in O. C. T., quick frozen in liquid nitrogen and kept at
-70.degree. C. until sectioning. Cryostat sections (10 .mu.m) of
spinal cords were fixed with acetone or 4% paraformaldehyde and
then labelled with the antibody of interest. Isotype-matched Ig and
omission of the primary antibody served as negative controls. Each
specimen was evaluated at a minimum of three different levels of
sectioning. The entire tissue section (a longitudinal spinal cord
section) was evaluated for a given cellular marker at 40.times.
magnification. The number of cells staining positive for the given
markers were counted in ten 40.times. (high power fields) fields
per section. The results for one section were totalled, and the
results between sections were averaged.
[0350] Staining for confocal microscopy:
[0351] Paraformaldehyde fixed sections (40 .mu.m) were washed in
PBS, blocked in PBS containing 4% goat serum, 0.3% BSA, and 0.3%
triton and subsequently incubated with primary antibodies overnight
and secondary antibodies for 2 h in blocking solution. We used
highly cross-adsorbed secondary antibodies to avoid
cross-reactivity (Alexa 488 and Alexa 594). Confocal microscopy was
performed using a Zeiss Laser Scanning Microscope 3D analysis
software (Zeiss, Thornwood, N Y) with a multitrack acquisition
protocol to avoid potential overlapping of the two
fluorochromes.
[0352] Effects of GPS Treatment on NSC Differentiation,
Self-Renewal Capacity and Immunosuppressive Effects In Vitro:
[0353] The procedure for GPS treatment of murine NSCs was as
previously described for MSCs (Sackstein, R., Merzaban, J. S., et
al. 2008). BT- and GPS-NSCs were compared in vitro for their
capacity to self-renew, form neurospheres, differentiate into
MAP2.sup.+ neurons, and inhibit the proliferation of ConA activated
lymph node cells. NSC differentiation and self-renewal capacity:
Neurospheres initially cultured in FGF/EGF containing media were
plated on poly-D-lysine (PDL)-coated glass coverslips allowed to
proliferate then harvested and treated for an hour with buffer
(control) or enzymatic treatment with FTVI (60 mU/mL), subsequently
the resulting BT-NSCs and GPS-NSCs were plated at clonal density of
20 cells per .mu.l and allowed to proliferate as neurospheres for
96 hours to 5 days. Neurosphere imaging was captured with an
Axiovision microscope (NY). For neuronal, astrocyte, and
oligodendrocyte differentiation, dissociated neurospheres were
plated on PL-coated glass coverslips in a 24 well plate and
cultured without FGF/EGF but in the presence of neurobasal medium
containing 1% Glutamax, 1% Antibiotic/Antimycotic and 2%
B27-Supplement. Fresh media was added every other day until day 5,
and the cells were then subjected to immunofluorescence staining
with MAP2 (neurons), GFAP (astrocytes), and NG2 (oligodendrocyte
precursors). MAP2.sup.+, GFAP.sup.+, and NG2.sup.+ cells were
counted using standard stereological technique by an investigator
blinded to the treatments. Cocultures of Neural Stem Cells and
Lymph Node Cells: Lymph nodes were isolated from naive C57BL/6
mice. Lymph node cells (LNC) were cultured as single-cell
suspensions in a 96 well plate at 2.times.10.sup.5 cells per well,
as previously described (Einstein, O., Fainstein, N., et al. 2007).
Culture medium consisted of RPMI-1640 supplemented with 10% fetal
bovine serum, L-glutamine, sodium pyruvate, non-essential amino
acid, 2-mercaptoethanol, HEPES and antibiotics (BioWhittaker) with
2.5 .mu.g/ml concanavalin A (ConA, Sigma) or without. Neurospheres
were dissociated and were first either treated with GPS or not (BT)
and subsequently irradiated with 3,000 Rad. Following irradiation
the dissociated NSCs were then added directly to the LNC culture
medium at different ratios with ConA stimulated LNCs. The ratios
tested of numbers of NSCs to numbers of LNCs were: 1:4, 1:2, 1:1,
2:1, and 4:1. The cells were then cultured for 48 hours before
adding thymidine. Thymidine incorporation assays were performed 16
hours later.
[0354] Assessment of E-Selectin Ligands Following Treatment of NSCs
with Inflammatory Cytokines:
[0355] 1.5.times.10.sup.6 cells/well were seeded in a 6 well plate
containing 3 ml proliferation medium per well and stimulated with
either 10 ng/ml of TNF.alpha. (R&D; 410-TRNC), 10 ng/ml IL-18
(R&D; 401-ML), 10 ng/ml IFN.gamma. (R&D; 485-MI)
independently or in combination (all three at 10 ng/ml). After 24 h
and 48 h, the neurospheres were harvested by centrifugation and
stained with E-Ig for flow cytometric analysis.
[0356] Measurement of LIF mRNA:
[0357] 1.times.10.sup.6 mouse embryonic NSCs were treated for 24
hours with or without inflammatory cytokines (IFN-.UPSILON. at 10
ng/ml and TNF-.alpha. at 15 ng/ml). Total RNA was then extracted
using Trizol reagent and the quality of the extracted RNA was
measured using Agilent 2200 Tab station system. cDNA synthesis was
done using high capacity cDNA reverse transcription kit (Applied
Biosystems) and a Random Hexamer. mRNA level was measured using
RT-PCR and the fold change in gene expression was calculated using
2.sup.-.DELTA.CT method. The forward primer sequence for the LIF
gene was CCTACCTGCGTCTTACTCCATCA and the reverse primer was
CCCCAAAGGCTCAATGGTT (Sigma). The relative expression of LIF mRNA
was assayed relative to GAPDH housekeeping gene in which
TGCACCACCAACTGCTTAGC was used as a forward primer and
GGCATGGACTGTGGTCATGAG as reverse primer.
[0358] Analysis of NSC Migration to CNS:
[0359] BT-NSCs, GPS-NSCs were labeled with PKH26 dye (Invitrogen)
and injected intravenously into MOG-treated C57BL6 mice on day 9
and day 13 post-immunization (PI). One million NSCs were injected
into each mouse on each day. HBSS buffer alone was used to
determine background signals. Either 24 hours or 4 days after the
second NSC transfer, mice were sacrificed, perfused, and
lumbar-sacral spinal cords were harvested. The spinal cord was
chosen because in the B6 model, the CNS lesions in the forebrain
are very variable in size and location compared with the spinal
cords, which possess a more predictable location (lumbosacral
region) and also more exuberant pathology (Chitnis, T., Najafian,
N., et al. 2001; Rasmussen, S., Wang, Y., et al. 2007; Wang, Y.,
Imitola, J., et al. 2008). For flow cytometric analysis, the spinal
cords were then homogenized and the resulting pellets were
resuspended in 0.25% Trypsin-EDTA and incubated at 37.degree. C.
for 10 minutes. The digestion process was stopped using DMEM
containing 0.01% SBTI, 0.001% DNase and 0.075% BSA. For histology
analysis, the brain and spinal cord were snap-frozen in liquid
nitrogen and stored in -80.degree. C. until sectioning. The
cryostat sections (20 .mu.m) of lumbar-sacral spinal cord or
anterior, middle and posterior brain were fixed and then stained
with antibodies of interest. Blood vessels were visualized by
anti-Flk-1 (VEGFR2) and NSCs were stained with either anti-SOX-2 or
visualized by PKH26 dye in red. For neuropathology analysis, cell
quantification was performed by stereological analysis of animals
in different groups. Spinal cords and brain were sectioned and
every third section of the cervical and lumbosacral region was
stained, cell quantification was performed in high power
magnification of 3-5 sections. LSM 510 Confocal microscope with
motorized stage was used to stereologically calculate the intensity
of staining, and total cell numbers/per high power
magnification.
[0360] Statistical Analysis--
[0361] Data are expressed as the mean.+-.SEM. Statistical
significance of differences between means was determined by two-way
ANOVA. If means were shown to be significantly different, multiple
comparisons were performed post-hoc by the Turkey t-test.
Statistical significance was defined as p<0.05.
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