Duchez P, Chevaleyre J, Dazey B, Vlaski M, Ivanovic Z.

Transcription

1 EX-VIVO EXPANSION OF CORD BLOOD HEMATOPOIETIC STEM AND PROGENITOR CELLS FOR TRANSPLANTATION USING AN ANTIOXYDANT-SUPPLIED MEDIUM AND A CYTOKINE COCKTAIL INDUCING HYPOXIC-LIKE CELLULAR RESPONSE Duchez P, Chevaleyre J, Dazey B, Vlaski M, Ivanovic Z

2 Cord Blood Transplantation Ex vivo amplification (expansion) Conditioning

3 A. Committed progenitors Graft composed 8000 of: B. Stem cells

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5 Concentration in O2: balance stem cells/progenitors 0,1% O 2 Hermitte i sar, % O 2 Ivanović i sar, 2000, 2002 Kovačević i sar, % O 2 Ivanović i sar, 2004

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9 A DELETERIOUS EFFECT OF O2: 20% O2 REPRESENTS AN HYPEROXIA How can we limit the effects of a hyperoxygenation? 1. «Free Radicals» or «ROS» issue; 2. The Cytokines presenting des effects hypoxia like Tpo (MGDF) stabilize HIF; SCF

10 DEVELOPMENT OF THE NEW GENERATION OF CULTURE MEDIA ANTIOXIDANTS: The new medium «HP0-1» of MACOPHARMA has been conceived and developed on the basis of these fundamental knowledge; once produced at clinical grade we continued our clinical essay concerning the expansion and engraftment of CD34+ cells mobilized in peripheral blood.

11 CFC

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14 Thawing of banked cord blood unit VueLife Culture bags Selection of CD34+ cells (Isolex) Initiation of cultures: a) Serum-free clinical-grade medium (Macopharma HP01); b) clinical-grade cytokines: SCF, FLT3 ligand, MGDF (100ng/ml each one) and G-GSF (10 ng/ml) «Cobary coctail» 14 days of culture (dilution 1:4 at day 6 with the same cytokinesupplemented medium)

15 EXSPANSION FOLD Total cells CD34+ cells Fold expansion CFC Day 6 Day 10 Day 14

16 PHENOTYPE CD34 CD13 CD14 CD33 CD41 CD61 0 CD34 CD13 CD14 CD33 CD41 CD61 0 CD34 CD13 CD14 CD33 CD41 CD61 Day 10 Day 10 Day 14 In course of expansion an increase in the percentage of cells expressing the markers of megakaryocytic line (CD41, CD61) was observed.

17 Very primitive stem cells Primitive stem cells Les primitive stem cells Progenitors Pre-SRC CFC Pre-SRC CD SRC CFC SRC CD Pre-CFC, LTC-IC CFC Engraftment to the secondary recipient immunodeficient mice; analysis of progenitors of human origin on the basis of «colony forming cells» Engraftment to the secondary recipient immunodeficient mice; analysis of human antigens after 6-9 weeks Engraftment to the immunodefficient mice (NOD/SCID, NOG); analysis after 6-10 weeks of progenitors of human origin on the basis of colony forming capacity Engraftment to the immunodefficient mice (NOD/SCID, NOG); analysis of cells of human origin after 6-10 weeks on the basis of human-specific antigens (usually CD45, CD33, CD19 ). Enables to evaluate the differentiation potential of stem cells

18 SERIAL TRANSPLANTATION (NOD/SCID MICE) 1ry recipients Engraftment (i.v. injection) to NOD/SCID mice treated by antibody anti-cd122 and conditioned by total body irradiation (2 Gy) 2ary recipients Engraftment (intrafemoral injection) to NOD/SCID mice treated by antibody anti-cd122 and conditioned by total body irradiation (2Gy) Injected femur Non-injected (contralateral) femur Detection of human cells in femoral bone marrow of mice 6 weeks after transplantation by means of flow-cytometry (human CD45, CD33 and CD19 antigens) (SRC CD ), and by functional test of colony-formation (CFC) (SRC CFC ). Detection of human cells in femoral bone marrow of mice 6 weeks after transplantation by means of flow-cytometry (human CD45, CD33 and CD19 antigens) (pre-src CD ), and by functional test of colony-formation (CFC) (pre-src CFC ).

19 Very primitive stem cells are maintained after expansion Primary recipient mice Secondary recipient mice 1000 SRC CFC 1000 Pre-SRC CFC No of CFC of human origin per femur of engrafted mice (x 10-3) (52+29) (115+30***) (65+24) Day 0 Day 14 w/o IL-3 Day 14 w IL-3 No of CFC of human origin per femur of engrafted mice (x 10-3) Day 0 Day 14 w/o IL-3 Day 14 w IL-3

20 STEM CELL SUBPOPULATIONS AFTER EXPANSION Expansion Steady state SC(preSRC CFC ) SC(SRC CFC ) SC(SRC CD45 ) Committed progenitors (2 nd transpl.)

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22 Expansion as shown with addition of Tpo (Peprotec) instead of MGDF; 12 days instead of 14 days; Expanded cells engraftment plus cryopreserved negative CD34 fraction, freezed and non-manipulated, without cord blood CD34+ cells.

23 «GRAPA» CLINICAL TRIAL A clinical trial was elaborated was elaborated by Professor Noel Milpied (CHU de Bordeaux) with the above mentioned technique, Adult patients suffering myelo proliferative and lympho proliferative disorders (indication of allogeneic transplantation); «PHRC» Accepted en 2008; Authorization from French Health Authority (AFSSaPS) obtained in October 2009; 14 patients transplanted

24 Expansion d USP pour allogreffe de cellules souches adultes Freezed CBU Thawing Control CD34+ cells selection CD34+ Fraction Controls Fraction CD34- F Controls Culture with CD34 cells/ml Of HP01medium SCF 100 ng/ml (Peprotech Inc USA) Flt3l 100ng/ml (Peprotech Inc USA) G-CSF 10ng/ml (Amgen France) TPO 20ng/ml (Peprotech Inc USA) 12 days 37 C, 5 %CO 2, 95% H 2 O Controls Concentration and wash of cells (cytometer) Cells are resuspended in HSA 4% Thawing for an engraftment 3 h later Controls Engraftment Engraftment

25 WBC (/mm3) 500 PMN (/mm3) D-7 D-4 D-1 D0 d0 D2 D5 D8 D11 D14 D17 D20 D23 D26 D29 D32 D35 D38 D41 Lym (/mm3)

26 De Lima et al: De lima et al, Whole blood cells amplification 12 fold 240 fold We CD34+ Amplification 30,1 fold 39,4 fold CFC amplification 17,7 fold 97 fold Neutrophil recovery (neutrophils>500/µl) 15 days 7 days Platelet reconstitution 49 days 28 days

27 Research Laboratory EFS-AQLI Duchez P. Chevaleyre J. Lafarge X. Hammoud M. Bijou F. Volkmann E. Cord Blood bank EFS-AQLI Dazey B. EFS-AQLI Regional Director (At the time of project development) Boiron J-M. EFS-AL Scientific Director and Head of Research Laboratory, Ivanovic Z.

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29 RIC: Flu (40 mg/m2/d x 5d) Cyclophosphamide (50 mg/kgx1d) ICT 2 Gy GVHD PREVENTION: MMF (d-3 to d28) CSA from d-3

30 DESCRIPTIF DES PATIENTS INCLUS Sexe N=12 H 9 F 3 Age médian (années) 51 (26-64) Diagnostic LAM 3 LA biphénotypique 1 LA à cellules dendritiques 1 LAL 1 LMMC 2 MDS 2 MDH 2 Nombre de lignes de traitement avant la greffe (Médiane) 2 (1-3)

31 Greffe (1) Médiane des CD34 amplifiées injectée (10 6 /Kg)) 1.55 ( ) Médiane de la fraction négative injectée (10 6 /Kg)) 3.24 (1.2-5) Prise de greffe 1 non prise de greffe avant J42 1 rejet de la greffe à J120 Nombre de jours médian ou les PNN< 500/mm 3 8 (6-30) Nombre de jours médian ou les plaquettes < /mm 3 28 (14-39)

32 Chimerism Blue: WBC no donor < 50% D 51-98% D 99% D Black: CD3 < 50% D 51-98% D 99% D Pt 1 Pt 2 Pt 3* Pt 4 Pt 5 Pt 6 Pt 7 Pt 8 AW 31 m Rel 12 m Rescue AW 28 m AW 28 m AW 27 m No take died 9 m Died 6 m GVHD A W 12 m days

33 Chimerism Blue: WBC no donor < 50% D 51-98% D 99% D Black: CD3 < 50% D 51-98% D 99% D Pt 9 Pt 10 Pt 11 Pt 12 Died WD 7 m Rescue (rej) AW 4 m Died 4 m TRM AW 1.6 m days