Mesenchymal Stromal Cells for personalized cell therapy of autoimmune disease.

Transcription

1 Mesenchymal Stromal Cells for personalized cell therapy of autoimmune disease. How mechanistic analysis of immune plasticity and cellular biochemistry can inform the design of clinical trials. Jacques Galipeau, MD FRCP(C) Professor of Hematology and Medical Oncology & Pediatrics Emory School of Medicine

2 Conflict of Interest Statement I have no financial relationships to disclose within the past 12 months relevant to my presentation Jacques Galipeau, MD FRCP(C) Professor of Hematology and Medical Oncology, Pediatrics & Medicine Emory School of Medicine jgalipe@emory.edu National Cancer Institute Designated Cancer Center

3 Isolation and Identification Niche of bone marrow derived MSC. Modidifed from Clin. Invest. (2006) 116(5):

4 Isolation and Identification Markers (mouse and human): Positive: CD105 (endoglin), CD73 (membrane-bound ecto-5 -nucleotidase) and CD44 (hyaluronate receptor) Negative: CD45 (hematopoietic marker) and CD31(endothelial marker) Morphology Human Mouse

5 Differentiation Osteocytes Adipocytes Chondrocytes Regenerative Med. (2006) 1(4),

6 MSCs are a source of adult stem cells for regenerative medicine and cell therapy applications. Cellular Biopharmaceutical - Regenerative Medicine; - Immune Modulation. Ex vivo expansion Cell # 1.00E E E E E E E+00 1 gram 1 kilo Doublings +/- genetic engineering

7

8 MSCs have been shown to display suppressive effect against allogeneic immune responses. The Lancet Volume 363, Issue 9419, 1 May 2004, Pages Treatment of severe acute graft-versus-host disease with third party haploidentical mesenchymal stem cells. Katarina Le Blanc, Ida Rasmusson, Berit Sundberg, Cecilia Götherström, Moustapha Hassan, Mehmet Uzunela and Olle Ringdéna. Figure 1. Clinical course and immunosuppression of the patient. =mesenchymal stem-cell transplantation. ASCT=allogeneic stem-cell transplantation. MSC=mesenchymal stem cells.

9 MSC for Graft-versus-Host Disease

10

11 Figure 2. Confidence Intervals and Meta-analysis of Adverse Events. Lalu MM, McIntyre L, Pugliese C, Fergusson D, et al. (2012) Safety of Cell Therapy with Mesenchymal Stromal Cells (SafeCell): A Systematic Review and Meta-Analysis of Clinical Trials. PLoS ONE 7(10): e doi: /journal.pone

12 How do MSC suppress?

13 IFN- Nauta A.J. and Fibbe W., Blood 2007

14

15 CD31 CD44 CD45 CD73 CD90 CD CD CD31 75 CD31 50 CD CD CD44 75 CD CD CD CD45 75 CD CD CD CD CD CD CD CD90 75 CD CD CD105 CD105 CD105 CD

16

17

18 Upregulation of MHC on human MSCs by IFNg and TNFa stimulation IFNg + TNFa 50ng/ml TNFa 50ng/ml IFNg 50ng/ml HLA ABC HLA DR No Stimulation Isotype control B7 1 B7 2 B7 H1 72 Hrs stimulation

19 MSC suppression intensity varies amongst subjects and is uniformly enhanced by IFN-γ

20 MSC Transcriptional induction by IFN-γ

21

22 IDO inhibition aborts suppression by MSC. COX2 and TGFβ blockade have no effect IL6 driven exuberance is unleashed

23

24

25 IFN alpha IFN gamma TNFalpha Variegation MHCI MHCII B7H CCL CCL CCL CCL IL1beta IL IL IDO MMP IL

26 Monocytes contained with a PBMC preparation play a meaningful role in T-cell suppression MSC instruct monocytes to adopt an M2 suppressor phenotype

27 Molecular Therapy Jan;20(1):

28 Are yours better than mine? Where Allo meets Auto

29

30 Universal Donor Strategy

31

32

33

34 Failure Analysis Hypothesis: non-self MSCs are of limited use when administered REPEATEDLY in subjects with intact immunity

35 H-2K b, H-2D b, I-A b H-2K d, H-2D d, I-A d

36 C57Bl/6 Collect Femurs & Tibias Isolate & Expand MSCs Retroviral Transfer of mepo Gene +/- Matrix Subcutaneous Injection ± Matrix C57Bl/6 Balb/c syngeneic allogeneic Blood Collection Hematocrit Determination Implant and Spleen Analysis

37 Hematocrit (%) Day Post-Implantation

38 Hematocrit (%) Day Post-Implantation

39 Hematocrit (%) Day Post-Implantation

40 . Slichter S J et al. Blood 2005;105: by American Society of Hematology

41

42 Failure Analysis Hypothesis: non-self MSCs are of limited use when administered REPEATEDLY in subjects with immune disease Remedy: Use your own MSCs as treatment What else???

43 MSC are like Sushi Fresh is best Cytotherapy Feb;14(2): Epub 2011 Oct 27.

44

45 Cryopreserved MSCs have a markedly impaired IFN response

46

47

48

49 What about homing in vivo? The Freezer burn effect

50 A Cryo Live B Cryo Live SSC-A SSC-A FSC-A 19.7 FSC-A 7.11 <PE-A>: PI 71.5 <PE-A>: PI 86.2 <FITC-A>: Annexin V 4.06 <FITC-A>: Annexin V 2.84 C

51 HUMAN MSCs Cryo Live SSC-A SSC-A FSC-A 19.7 FSC-A 7.11 <PE-A>: PI 71.5 <PE-A>: PI 86.2 <FITC-A>: Annexin V 4.06 <FITC-A>: Annexin V 2.84 Undetectable lung homing at 24 hours Lung homing at 24 hours

52 CPA: 10%DMSO 10% FBS Α-MEM

53 Personalized Cell Medicine

54 MSC clinical trials for Crohn s disease NCT TRIAL MSC Source AUTO/ALLO LOCATION Dosing Phase 2 Marrow Random donor Australia 2M/kg weekly x Phase 2 Marrow Random donor Belgium 2M/kg weekly x Phase 3 Marrow Random donor Prochymal 300M x 4 doses

55

56 Preparation of human MSCs. Bone Marrow Adapted from: Reinisch A. Regenerative Medicine 2007

57 Clinical PI: Subra Kugathasan, MD Co-PI: Tanvi Dhere, MD

58 Summary Auto/Allo Interferon licensing of MSC and link to monocytes Cryopreservation

59

60 EMORY TEAM Ian Copland, PhD Jiusheng Deng, PhD Raghavan Chinnadurai, PhD Pingxin Li, PhD Andrea Pennati, PhD Seema Patel, PhD Jeremy Hsieh, MD/PhD [in training] Spencer Ng, MD/PhD [in training] Shala Yuan, MSc Marco Garcia

61 Merci! Jacques Galipeau, MD FRCP(C) Professor of Hematology and Medical Oncology, Pediatrics & Medicine Emory School of Medicine