Cord blood monocytes as a source of cell therapy products for treatment of brain injuries ISCT/CBA 2015 Cord Blood Workshop Wednesday, May 27, 2015

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Cord blood monocytes as a source of cell therapy products for treatment of brain injuries ISCT/CBA 2015 Cord Blood Workshop Wednesday, May 27, 2015 Andrew E. Balber, PhD Senior Scientific Advisor CT 2, Duke University Translational Medicine Institute

Two potential CB monocyte derived products to treat acquired brain injury CB CD14+ cells Protect and/or effect repair of brain neurons tissue subjected to hypoxic/ischemic damage OGD model: Early effects of HI injury Treatment time may be critical Manufactured by selection, but not manipulated DUOC-01 Potentiates remyelination of damaged CNS neurons Removed from initial insult Cuprizone model: Repair of established injury Manufactured by cultivation for 3 weeks

More details J. Kurtzberg et al, 2015. Cytotherapy 17, 803-815. DUOC-01 5:30PM Friday, May 29 ISCT poster session Saha, A. et al Poster #189 DUOC-01 Storms, R.A. et al Poster #191 DUOC-01 Patel, S. et al Poster #195 CB CD14+

Hypoxic/Ischemic injury model: Brain slice cultures deprived of oxygen & glucose (OGD) 11 days 45 minutes of OGD Assess impact of OGD/cells on brain tissue structure 3 days Restore to normal conditions +/- cell therapy population

OGD kills brain neurons & activates astrocytes 72h Control- No OGD 72-hr post OGD Patel, S. et al, ISCT Poster #195. GFAP, NeuN, Iba1

OGD kills brain neurons 400 350 300 250 Average # cells /hpf 200 150 Control 72h post-ogd 100 50 0

CB-MNC protect brain slices from OGD No OGD OGD OGD + CB MNC PI = cell death DAPI = nuclei

% Dead cells compared to OGD Identification of CB populations that protect brain neurons from OGD in slice cultures Slice cultures exposed to OGD added CB cells +PB MNC -CD3 -CD14 -CD19 MNC CB MNC are neuroprotective PB MNC are not neuroprotective Protective activity of CB MNCs is in CD14+ monocytes

Effects of CB CD14+ monocytes on OGD in brain slice cultures 72h Control- No OGD 72-hr post OGD 72h post OGD CB CD14 (+) Patel, S. et al, ISCT Poster #195. GFAP, NeuN, Iba1

CB CD14+ monocytes protect neurons from OGD

Hypoxic/Ischemic injury model: Brain slice cultures deprived of oxygen & glucose (OGD) 11 days 45 minutes of OGD Assess impact of OGD/cells on brain tissue structure 3 days Restore to normal conditions +/- cell therapy population

Cell death as % of OGD control Neuroprotective effect of CB cells OGD is largely mediated by soluble factors 120 100 80 60 40 20 0 no cell normoxic control no cell OGD control OGD -direct MNC OGD -indirect MNC Activity can be concentrated from CD14+ monocyte supernatants

What neuroprotective mediators? Whole genome expression analysis of active CB population vs inactive PB CD14+ populations CANDIDATE EFFECTOR MOLECULES Test for importance in protection from OGD model

Gene expression analysis of CB and PB CD14+ monocytes p<0.05 2-fold difference

Expression of candidate effector genes by CD14+ CB and PB cells Fold expression increase CB/PB Experiment CTH THBS1 INHBA MMP9 IL10 CHI3L1 GAPDH 1 168.3 35.0 15.9 7.8 4.6 141.4 1.0 2 141.7 2.7 34.6 11.6 6.0 3.1 1.0 3 62.4 4.4 11.6 9.0 3.7 2.4 1.0 4 78.7 19.3 12.2 32.5 0.8 4.8 1.0 5 81.8 1.4 14.1 16.9 6.6 0.7 1.0 6 73.0 2.9 8.3 14.1 4.8 7.3 1.0 Q-PCR confirmation of microarray data.

Western blot analysis of candidate effector molecules CB MMP9 CD14+ PB CB CD14- PB TSP1 CTH IL10 GAPDH CHI3L1 GAPDH CB PB CB PB INHBA GAPDH

CB monocytes as potential early intervention for HI injury Account for most of neuroprotective activity of CB MNCs in the OGD model Are more neuroprotective than PB monocytes Secrete soluble neuroprotective factors Express many different transcripts than PB monocytes Identifying mediators appears tractable Suitable for rapid translation to clinic [Panel]

DUOC-01 -- Background Kurtzberg, J. et al (2015) Cytotherapy, 17: 803-815. Manufactured by culturing cryopreserved CB unit for 21 days Express CD45, M1, and M2 macrophage markers Secrete IL-10, IL-6 and TGF-beta Actively phagocytic Change morphology reversibly, resembling macrophage/microglia Cultures contain many proliferating cells Actively promote myelination of damaged CNS nerves Saha, A. et al, ISCT Poster # 189.

Reversible demyelination of corpus callosum of NSG mice following feeding: Protocol Milled chow 0.2% CPZ Remove CPZ Harvest brain tissues Demyelination Repair WEEK -1 0 5 6 DUOC-01 or Ringer s into CC region 1 day after switch

Normal chow + 0.2% Cuprizone DUOC-01 treatment accelerates myelination after cuprizone treatment: Luxol fast blue Normal chow Ringer s DUOC-01 Myelination score 3 2.5 2 1.5 1 0.5 0 ** p < 3.25 x 10E-14 100X 400X

DUOC-01 Ringers DUOC-01 treatment accelerates formation of myelinated nerve fibers after cuprizone treatment MBP and NFH i iii MBP Normal control Cuprizone treated ii Ringer s Control CZ iv vi Ringers DUOC-1 cells v CZ/DUOC-01 CZ/Ringer s DUOC-01

Electron microscopic analysis of remyelination status one week after DUOC-01 treatment Ringers DUOC-01 Blue arrows indicate un-myelinated axons. Red arrow-heads indicate mitochondria. Scale bar =1.0 micrometer

DUOC-01 treatment reverses cuprizone induced changes in axonal myelination Ringer s DUOC-01 Higher proportion of myelinated axons More turns per axon Higher g ratio Reverses giant mitochondrial formation One week after cell treatment. Magnification= 35000x.

% area covered by Iba1 % area covered by GFAP DUOC-1 Ringers control DUOC-01 treatment reduces astrogliosis and microglial infiltration 3 2.5 2 1.5 1 0.5 0 Cellularity score 60 40 20 0 60 40 20 0 R D R D Iba1(blue), GFAP (pink), MBP(green), CC region, 40x

DUOC-01 Ringer s DUOC-01 promotes oligodendrocyte lineage cell proliferation Olig2 Ki67 Merge 100 p 0.02 80 60 40 20 0 Olig2+ cells/hpf Ringer s (left) DUOC-01 (right) 15 p 0.01 10 5 0 Olig2+ Ki67+cells/HPF Ringer s (left) DUOC-01 (right)

DUOC-01 repairs LPC demyelinated mouse cerebellar axons in vitro NFSMi312 MAP2 MBP MBP Control LPC treated LPC, then DUOC

On-going studies CD14+ CB monocytes are not active in CPZ model DUOC-01 is not active in the OGD model

DUOC-01 arises from CD14+ cord blood cells CD14+ MNC CD34+ CD14- CD14 + selected DUOC-01 Products made from CB MNC & CD14+ monocytes differ (p<0.05, 2- fold) in only 22 genes on expression analysis CD14 depleted

DUOC-01 and CB CD14+ monocytes differ in gene expression >2-fold p<0.05

Potential mechanisms of DUOC-01 action Clean up Cytokine secretion: Modulate inflammation [IL10, IL6, TGF-beta] Drive oligodendrocyte development & myelination Gene name Fold change Mean ±SEM P-value PDGF-α 32.3±8.3 0.01 IGF-1 799±294 0.05 SCF-1 26.7±4.8 0.033 MMP9 632±109 0.002 MMP12 2057±460 0.006 TREM2 1634±368 0.011 Fold increase DUOC-01 relative to CB CD14+ by RTqPCR. N>3

Understanding monocyte biology to make cellular therapeutics Adult PB CD14 + cells Not active in OGD? Birth?? Post natal life DUOC-01 Not active in OGD model Active in Cz model Manufacturing CB CD14 + cells Active in OGD model Not active in Cz model

CT2 Specialized Cell Team Arjun Saha Sachit Patel Susan Buntz Paula Scotland Li Xu Robert Storms Marcia Bentz Aruni Gunaratne Joanne Kurtzberg Robertson Foundation Marcus Foundation Tracy Gentry Pamela Noeldner Benjamin Rusche April Ozamiz CCBB staff Neil Medvitz Zhengzheng Wei Mike Cook Glenn Matsushima

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