Anna & Anna

Transcription

1 Teaser: Promising results of experimental cell therapy did not translate into equivalent clinical benefit yet. Feasibility and safety of endothelial and mesenchymal progenitor cell transplantation have been verified in multiple clinical trials over the past decade. For conventional 'bone marrow transplantation' it took 20 years from early steps until the first proof of cure. Lessons learned from one million patients who received lifesaving blood stem cell transplantations since will be discussed and compared to our still limited mechanistic insight into cardiovascular regenerative cell therapy. Anna & Anna 1

2 LECTURE OUTLOOK 1.Strunk Lab.: Cell Tx & Reg. Med. ( Why ECFC & MSPC?) 2.Cell Tx. in Cardiology / CV Surgery (hematopoietic > CM; endoth. & mesench. cells) 3.Learning from HSCT (new strategies / next steps ) Re generative S tem Cell T herapy Adult stem cells can improve organ regeneration after ischemic / metabolic / toxic injury. BM-DERIVED CANDIDATE REGENERATIVE CELLS HSPC (< 1%) MSPC (< 0.01%) (incl.mapc; USSC; RS1; BMSC; MIAMI < ) EPC (< %) OPERATIVE MECHANISMS vascular REPAIR cellular BYSTANDER EFFECT somatic REPAIR humoral 2

3 LATE OUTGROWTH COLONIES = ECFC Lin, Hebbel et al Ingram, Yoder et al. 2004, 2005 Rohde, Strunk et al Rohde, Strunk et al Reinisch, Strunk et al Define EPC Hirschi et al, ATVB 2008 MAKE ECFC A CLINICAL PRODUCT Blood 113(26): (2009) ISOLATION >1x10 8 somatic ECFCs EXPANSION 3

4 Karlsruhe, Germany with: Clemens Diwoky, Rudolf Stollberger TU Graz Bruker WB Tesla Bruker WB ,7 Tesla 78µm slice thickness, 2h10min aquisition C Darkfield Microscopy Bi SLICE THICKNESS 78µm Bii Biii Biv Bv Bvi Bvii Bviii 2.5mm MAXIMUM INTENSITY PROJECTION ECFC FUNCTION IN VIVO hu. CD31 4

5 biology and function cord blood Reinisch et al., Blood 113(26): (2009) see also: Koike, Nature 428:138-9 (2004) ECFC Au, Blood 111: (2008) Melero-Martin, Circ Res 103: (2008) 1 2 mio. 1 : 4 Matrix 300µL immunecompromised mice A MSPC B Vimentin C Vimentin D CD31 Matrigel plug + Human cells s.c. implantation Mouse tissue E vwf F mter119 G mter119 H migg Isolation & Large Scale Expansion Protocols MSPC s Regen Med : Blood : ECFC s MNC remove non adherent cells (day 3) density gradient centrifugation a-mem / 10% phpl wash (2-3x) a-mem / 10% FBS MSC HPL vs. MSC FBS primary culture 2-3 colonies / flask (15-25 days) ISOLATION MSC HPL vs. MSC FBS MSC HPL vs. MSC FBS clinical scale expansion 4 x CF-4; 30/cm 2 ; 14 days 1 st passage (14 days) >1x10 8 somatic ECFCs EXPANSION PMU ExCT Experimental & Clinical Cell Therapy Institute Prof. Dr. D. STRUNK 5

6 SALZBURG Patient Center Sex Age Diagnosis Indication Donor Infusions MSC/kg D.F. U.K. H.E. N.S. T.T. K.J. W.TJ. R.K. L.S. S.EM. E.A. F.J. Hematology Graz m 33 AML agvhd Third party x10 7 Orthop. Graz m 35 Critical size bone defect Tissue repair Autologous 2 local 2+6 x 10 8 Hematology Graz f 65 AML agvhd Third party 1 2x10 6 St. Anna Vienna f 8 JMML Graft failure Third party 1 1.5x10 7 PHO Graz m 11 Cycl. Neutropenia agvhd Sibling 3 1-2x10 7 St. Anna Vienna f 15 SAA Graft failure Third party 1 5x10 6 PHO Graz f 8 AML agvhd Parent 3 1-2x10 6 PHO Graz f 15 AML agvhd Third party 5 1x10 7 PHO Graz f 15 Neuroblastoma agvhd Third party 3 1.8x10 6 Ped Hem Geneva f 10 SAA agvhd Third party 2 2x10 6 Hematology Graz m 31 AML GvHD Third party 3 2-4x10 6 Hematology Innsbruck m 33 AML GvHD Third party 2 1.8x10 6 D.A. PMU, Salzburg m 27 Critical size bone defect Tissue repair Autologous 2 local 2 + 6x10 8 E.W. PMU, Salzburg f 48 Non-union fracture Tissue repair Autologous 1 local 4x10 8 O.R. Hematology Vienna m 57 CLL GvHD Third party x10 6 Los Angeles Vancouver Our Contribution: phpl Contact: Ottawa Indianapolis Washington Bethesda (NIH) Tucson Houston (MDACC +TX Heart) Cantanhede London Zürich, Genf Oslo k.schallmoser@salk.at Göttingen, Mannheim, Ulm, Hannover Tübingen, Bergisch Gladbach, Berlin Wien Langenfeld Innsbruck, Graz / Salzburg Padua Maskat (Oman) Commercially available since: IV / 2012 Standard pooled Human Platelet Lysate (phpl; 3-5L): Production / Testing / Cryopreservation in Salzburg. Distribution on dry ice to partner institutions and reference laboratories. see also: Human Alternatives to FBS Stem Cells 27: (2009) 12 6

7 Bone Score H/E Movats 5C Reinisch / Strunk Blood N. Etchart-Liechtenstein (manuscript in preparation) Donor N HPL x All BM-MSPCs + Bone culture µl Matrigel + + medium + 17/17 Marrow /17 NSG mouse Bone - n.t. - - FBS n.t. - n.t. - - n.t. n.t. - n.t. 2/11 Marrow - n.t. - culture n.t. - n.t. - - n.t. n.t. - n.t. 1/11 medium HPL-derived MSPC FBS-derived MSPC Near-Infrared fluorenscence, Maestro in vivo imaging HPL-cultured FBS-cultured 4 weeks Donor A knee matrigel implant 24 hrs OsteoSense 750 i.v., 150 µl fixation in newly formed Hydroxyapatite, emission 750 nm Donor B A Score = 0 Score = 1 Score : a = 2; b = 2 a b Score : a = 3; b = 5 a b Score : a = 4; b = 5 a b B D * * * Matrigel, non-inductive TCP/HA, osteo-inductive BM WAT UC Fib. no cells C OsteoSense Fluorescence Bone Scoring System 0 = None 1 = Weak signal 2 = Clear signal, weaker than knee 3 = Clear signal, as intense as knee 4 = Signal more intense than knee 5 = Signal more than twice as intense as knee HUMAN BONE + MOUSE MARROW BM WAT UC Fib. 7

8 PMU ExCT Experimental & Clinical Cell Therapy Institute Prof. Dr. D. STRUNK PMU Experimental & Clinical Cell Therapy Institute Dr. D. STRUNK 8

9 September 12, 1957 Vol. 257 No st intra-myocardial HSPC Tx Stamm Steinhoff, (CD133 + BMNC ~ CABG) Lancet 2003 ~ 30 years 1 st clinical MSC Tx Lazarus HM et al, Bone Marrow Transplantation st intra-myocardial MYOBLAST Tx Menasché et al, (5-Aza+skel. Myobl. ~ CABG) Lancet st intra-coronary BM Tx Hamano K et al, (BMNC ~ CABG) Jpn Circ J

10 IMBALANCE EFFECT BENEFIT FOR PATIENTS NUMBER OF CLINICAL TRIALS IMMUNE SYSTEM &ORGAN REGENERATION Circ Res. 2015; 116:

11 Circ Res. 2015;116: hematopoietic 11

12 Circ Res. 2015;116: PMU ExCT Experimental & Clinical Cell Therapy Institute Prof. Dr. D. STRUNK 12

13 There are 3 possible strategies to utilize stem cells (SC) for regeneration: 1.) Local recruitment of resident SC towards an injury. 2.) Mobilization of SC from bone marrow or other distant sites via BLOOD circulation. 3.) Transplantation of SC to the injury site vs. systemic delivery. invasive SC harvest ipscs non - invasive SC harvest 3rd party SC (living or cadaveric donor) BM WAT Heart Blood Apheresis UC UCB Placenta Urine Mictionation PMU Exp. & Clin. Cell Therapy Institute D. STRUNK, MD USCs 007 p % 99.99% 98.64% 99.56% 40.53% CD90 CD73 CD105 CD29 NG % 1.86% 2.56% 2.09% 1.42% CD45 CD34 HLA-DR CD14 CD19 p2 PMU Exp. & Clin. Cell Therapy Institute D. STRUNK, MD 13

14 SSC Endothelial cell BONE MARROW Endothelial colony forming progenitor cell (ECFC) Pericyte Osteoblast Osteocyte Adipocyte HSCs Osteoclast Multipotent mesenchymal stromal cell (MSC) Osteoclast Hematopoietic stem cell (HSC) Hematopoietic progenitor cell (HPC) Adipocyte Hematopoietic cluster VASCULAR RBC Osteoclasts Pericyte NICHE ENDOSTEAL NICHE Osteoblasts CAR/MSPC Hematopoietic Cluster Osteocyte HSPC from: REINISCH, STRUNK. Concepts to facilitate UCB-Tx. in: Regenerative Therapy using Blood- Derived Stem Cells Springer, NY (2012) NON-MOBILIZED PB 63.0% CD % CD3(2) 3.4% CD56 6.7% CD14 2.4% CD19 1.2% CD41 0.7% GpA TRANSFUSION 54:315 (2005) Fluorescence 2 14

15 BONE MARROW TRANSPLANTATION (HSCT = Hematopoietic SC Tx) >99% CD45+ WBC (BM; MPB) <1% SC CD34 + Hematopoietic Stem / Progenitor Cells Human LT-HSC: CD34 + /Lin NEG /CD38 - /CD90 + /CD45RA - Human MSC: CD34 - /Lin NEG /CD38 - /CD90 + /CD45RA - Human EPC: CD34 + /Lin NEG /CD38 - /CD90 - /CD45RA - Highlights The number of cardiomyocytes remains constant during the human lifespan Endothelial and mesenchymal cells increase into adulthood and show high turnover Cardiomyocyte turnover decreases exponentially with age and is <1% per year in adults The cardiomyocyte turnover rate is equal in the main subdivisions of the human heart 15

16 What is the mechanism? Hematopoietic stem / progenitor cells 2 = FIX FOR BROKEN HEARTS C Templin / A Reinisch / D Strunk / U Martin et al.; Circulation 2012 PMU ExCT Experimental & Clinical Cell Therapy Institute Prof. Dr. D. STRUNK 16

17 What is the best model? syngeneic dog; minipig multicenter prospective randomized in vitro Rodent large Mammal non-human Primate clinical Trial humanized AVATAR horse mechanistic side studies 100% predict/reflect in vivo pathology / mechanism 17

18 What is the mechanism? 18