Muscular Dystrophy

Coding Dimension ID: 
302
Coding Dimension path name: 
Muscular Dystrophy

Combination therapy to Enhance Antisense Mediated Exon Skipping for Duchenne Muscular Dystrophy

Funding Type: 
Early Translational from Disease Team Conversion
Grant Number: 
TRX-05426
ICOC Funds Committed: 
$0
Disease Focus: 
Muscular Dystrophy
Pediatrics
Stem Cell Use: 
Adult Stem Cell
oldStatus: 
Active
Public Abstract: 
Duchenne muscular dystrophy (DMD) affects 1 in every 3,500 boys worldwide. DMD is caused by mutations in the gene encoding dystrophin, a protein key to muscle health. DMD patients are typically weaker than normal by age 3, and with progressive muscle weakness most loose the ability to walk by age 11. DMD progresses to complete paralysis, respiratory insufficiency heart failure, and death, usually before the age of 25. No therapies exist that address the primary defect or dramatically alter the debilitating disease. Exon-skipping is an emerging therapy in which anti-sense oligonucleotide (AO) guided-RNA splicing rescues expression of a partially functional dystrophin; but it is unclear if efficacy will be optimal for clinical gain. We identified a combination therapy that improves the efficacy of exon-skipping in mouse muscle and human DMD patient-stem-cell-derived muscle cells. The DMD mouse model will be used to establish dosing and efficacy. To determine if combination therapy promotes exon skipping in human DMD patient cells with different DMD mutations, DMD patient derived stem cells converted into muscle-like cells in culture and screened for efficacy of combination drug relative to AO alone. The proposed research program will complete studies to identify a single drug/AO combination as a developmental candidate anticipated to treat up to 13% of DMD patients; although the strategy is likely generalizable to enable treatment of 70% of DMD patients.
Statement of Benefit to California: 
Duchenne muscular dystrophy (DMD) is a fatal genetic disorder, caused by a defect in the gene that produces dystrophin, a protein critical for normal skeletal muscle function. DMD affects more than 1,000 boys in California. Muscle weakness first appears in boys in the hips and legs and progressively extends to every muscle in the body such that most affected individuals require a wheelchair by age 11, have trouble feeding themselves by their late teens and ultimately loose most muscle function. Patients usually die by age 25 from respiratory or cardiac insufficiency. In addition to the human suffering, DMD places a large economic burden on patients, their families and society. Patients require intensive medical care because they cannot perform the simplest activities of daily living. Eventually, each individual requires ventilation and 24/7 care. The proposed combination therapy is predicted to cause skeletal muscle cells to skip DMD exon 51 and express a partially functional dystrophin protein, lessening the severity of DMD. A therapy that effectively slows or reverses disease will allow patients to lead longer, more productive lives and reduce costly supportive services—progress that will benefit patients, their families and society. Our proposal stands to specifically benefit Californians in another way: Because the University of California owns the intellectual property to the combined therapy, our success could ultimately lead to revenue for a state institution.
Progress Report: 
  • Duchenne muscular dystrophy (DMD) is the most common muscular dystrophies and the most common fatal genetic disorder of childhood. Approximately one in every 5,000 boys worldwide is affected with DMD often caused by spontaneous mutations. Extrapolating from population based studies, there are over 15,000 people currently living with DMD in the US alone. DMD is a devastating and incurable muscle-wasting disease caused by genetic mutations in the gene that codes for dystrophin, a protein that plays a key role in muscle cell health. Children with DMD are typically weaker than normal by age three, and progressive muscle weakness of the legs, pelvis, arms, neck and other areas result in most patients requiring full-time use of a wheelchair by age 11. Eventually, the disease progresses to complete paralysis and increasing difficulty in breathing due to respiratory muscle dysfunction and heart failure, with death usually occuring before the age of 25. While corticosteroids can slow disease progression and supportive care can extend lifespan and improve quality of life, no therapies exist that address the primary defect or dramatically alter the debilitating disease course.
  • Exon-skipping is a promising therapy that aims to repair the expression of the dystrophin protein by repairing the RNA. We have identified a combination therapy that improves the effectiveness of exon-skipping therapy in mouse muscle and in human DMD patient stem cell derived muscle cells in culture. In exon skipping the genetic defect is directly repaired inside of each muscle cell. Thus, this therapy is predicted to lessen the disease severity.
  • Early research on this combination therapy for Duchenne used human DMD patient stem cells including: reprogrammed patient fibroblasts converted into muscle-like cells in culture or when transplanted in mice. We have made a panel of these cells with different mutations to assess efficacy in a range of DMD mutations. These cells are necessary because each patient’s mutation in the dystrophin gene is different. In order to know who will or will not benefit from the exon-skipping therapy, individualized cell culture and mouse transplant models from a number of DMD patients must be created to effectively characterize the combination therapy. At 12 months of the CIRM-funded research program, we have established optimal oral dosing of dantrolene that is compatible with 6 month long-term testing in dystrophic mice and optimal dosing of morpholino antisense oligo. The combination therapy is well tolerated by mice, and dystrophin rescue is increased in short term experiments. 6 month treatment experiments are being initiated that will test if the induction of dystrophin can reduce the severity of the disease in the dystrophic mice. Since exon-skipping therapy relies on knowing individual patients exact DNA mutation, this is a form of personalized genetic medicine. While the specific combination therapy being developed here will treat up to 13% of DMD patients, the strategy is likely to be generalized to be able to treat up to 70% of DMD patients.

Engineered iPSC for therapy of limb girdle muscular dystrophy type 2B

Funding Type: 
Early Translational IV
Grant Number: 
TR4-06711
ICOC Funds Committed: 
$1 876 253
Disease Focus: 
Muscular Dystrophy
Pediatrics
Stem Cell Use: 
iPS Cell
Cell Line Generation: 
iPS Cell
oldStatus: 
Active
Public Abstract: 
Limb girdle muscular dystrophy type 2B (LGMD 2B) is a form of muscular dystrophy that leads to muscle degeneration and disability. In LGMD 2B, a vital muscle protein is mutated, and its absence leads to progressive degeneration of muscles in the body that are needed for mobility. To create a therapy, we will provide a new supply of stem cells that carry the missing protein that is lacking. These cells will be delivered to the body in such a way that they will engraft into the muscles and produce new, healthy muscle tissue on an ongoing basis. We now possess methods to create stem cells that can become muscle cells out of adult skin cells by a process known as “reprogramming”. By reprogramming adult cells, together with addition to them of a correct copy of the gene that is mutated in LGMD 2B, we will create stem cells that have the ability to create new, healthy muscle cells in the body of a patient. This is the type of strategy that we are developing in this proposal. The corrected muscle stem cells will be transplanted into mice with LGMD 2B, and the ability of the cells to generate healthy new muscle tissue and increased muscle strength will be evaluated. This project could lead to a new stem cell therapy that could improve the clinical condition of LGMD 2B patients. If we are successful with this disease, similar methods could be used to treat other degenerative disorders, and perhaps even some of the degeneration that occurs during muscle injury and normal aging.
Statement of Benefit to California: 
The proposed research could lead to a stem cell therapy for limb girdle muscular dystrophy type 2B (LGMD 2B). This outcome would deliver a variety of benefits to the state of California. There would be a profound personal benefit to the Californians affected directly or indirectly by LGMD 2B. Progress toward a cure for LGMD 2B is also likely to accelerate the development of treatments for other degenerative disorders. The most obvious targets would be other forms of muscular dystrophy and neuromuscular disorders. Muscle injury, and even some of the normal processes of muscle aging, may be treatable by a similar strategy. An effective stem cell therapy for LGMD 2B would also bring economic benefits to the state by reducing the huge burden of costs associated with the care of patients with long-term degenerative disorders. Many of these patients would be more able to contribute to the workforce and pay taxes. Another benefit is the effect of novel, cutting-edge technologies developed in California on the business economy of the state. Such technologies can have a profound effect on the competitiveness of California through the formation of new manufacturing and health care delivery facilities that would employ California citizens and bring new sources of revenue to the state. Therefore, this project has the potential to bring health and economic benefits to California that are highly desirable for the state.

Combination therapy to Enhance Antisense Mediated Exon Skipping for Duchenne Muscular Dystrophy

Funding Type: 
Disease Team Therapy Planning I
Grant Number: 
DR2-05426
ICOC Funds Committed: 
$86 414
Disease Focus: 
Muscular Dystrophy
oldStatus: 
Closed
Public Abstract: 
A drug was identified through the use of muscle stem cells that can enhance the effectiveness of exon skipping by antisense oligonucleotides to the DMD gene to restore dystrophin expression and at least partially correct the defect responsible for loss of muscle function in Duchenne. We propose to test the effectiveness of this drug in combination with antisense oligonucleotides as a novel therapeutic strategy for Duchenne muscular dystrophy (DMD). DMD is the most common muscular dystrophy and leads to progressive muscle loss in boys resulting in severe weakness, and is caused by mutations in the DMD gene. DMD generally leads to death in the teens or early 20’s, making Duchenne one of the most severe disorders in humans. Further, Duchenne occurs in 1/3500 boys, making it one of the most common genetic disorders. There are no highly effective therapies. Thus, there is an urgent need to develop new and highly effective therapies. We propose to perform the necessary studies using DMD patient-derived iPS and animal models to perform safety studies that will permit regulatory approval to test the safety and efficacy of the combination therapy in Duchenne muscular dystrophy. The goal of the treatment is to make a functional dystrophin protein the patient’s body by altering the RNA in each muscle cell. Preliminary results indicate that the process is relevant to about 70% of those afflicted by Duchenne.
Statement of Benefit to California: 
Since Duchenne muscular dystrophy is the most common lethal genetic disorder, there are over 1,000 patients affected in the state of California alone, 15,000 nationwide, and 300,000 worldwide. Duchenne muscular dystrophy has a large direct economic impact with intensive medical care with substantial disability. There is an obvious huge impact on the family as well. More effective therapies will directly benefit these families, lead to increased productivity. Further, a California based company will have developed a key therapy for an otherwise lethal genetic disorder further demonstrating California’s leadership in medical science, and generating novel business opportunities within the Biotechnology industry in California.
Progress Report: 
  • Duchenne muscular dystrophy (DMD) is the most common muscular dystrophy and one of the most common fatal genetic disorders. Approximately one in every 3,500 boys worldwide is affected with DMD. Extrapolating from population based studies, there are over 15,000 people currently living with DMD in the US. DMD is a devastating and incurable muscle-wasting disease caused by genetic mutations in the gene that codes for dystrophin, a protein that plays a key role in muscle cell health. Children are typically weaker than typical by age three, and progressive muscle weakness of the legs, pelvis, arms, neck and other areas result in most patients requiring full-time use of a wheelchair by age 11. Eventually, the disease progresses to complete paralysis and increasing difficulty in breathing due to respiratory muscle dysfunction and heart failure. The condition is terminal, and death usually occurs before the age of 25. While corticosteroids can slow disease progression and supportive care can extend lifespan and improve quality of life, no therapies exist that address the primary defect or dramatically alter the debilitating disease course.
  • The Planning Award funded the organization of the scientific and clinical team to apply for a well-defined CIRM Disease Team Therapy Development Award. The PI and project manager travelled to San Francisco to a CIRM sponsored workshop to gain training and insight in developing a Target Product Profile, to meet with other CIRM disease team grantees and aid in developing the most effective grant application. During that trip, we also met with investigators at the California based CRO, SRI, toured the SRI facilities, and planned for the assembly of the team that would us develop appropriate toxicology package for the proposed drug development. Several face-to-face meetings and conference calls with leaders in Duchenne advocacy, DMD clinic directors and industry partners were orchestrated to assess enthusiasm for the proposed project, which was across the board very high. A day long planning grant meeting was held on Dec 9th, 2011 in Santa Monica with participation of over 30 national and local academic, CRO, and industry experts in exon skipping, Duchenne Muscular Dystrophy, clinical trials planning, FDA regulatory practices and drug development. We identified and secured a leading industry partner necessary for streamlining the proposed work. Following the meeting, a series of weekly/daily conference calls between team members from UCLA, SRI and the industry partner enabled us to develop details of the proposal. During the planning grant period we were awarded a provisional patent for the combination therapeutic that is being moved forward in this proposal. Through discussions with leaders in the clinical care of Duchenne Muscular Dystrophy, leaders in antisense mediated exon skipping, and leaders in pre-IND drug development, we built a strong team to propose all IND enabling work to bring a proposed combination therapy for exon skipping as a novel Duchenne muscular dystrophy therapy.
  • Exon-skipping is a promising therapy that aims to repair the expression of the dystrophin protein by altering the RNA, but it is unclear whether it will be effective enough to lead to clinical improvements. We have identified a combination therapy that improves the effectiveness of exon-skipping therapy in mouse muscle and in human DMD patient stem cell derived muscle cells in culture. Because the genetic defect is being directly repaired inside of each muscle cell, this therapy is predicted to lessen the disease severity. The early research and further development of the proposed combination therapy require screening for drug efficacy and toxicity using human DMD patient stem cells including: reprogrammed patient fibroblasts converted into muscle-like cells in culture or when transplanted in mice. These cells are necessary because each patient’s mutation in the dystrophin gene is different. In order to know who will or will not benefit from the exon-skipping therapy, individualized cell culture and mouse transplant models from a number of DMD patients must be created to effectively characterize the combination therapy. The proposed research program will complete necessary efficacy and toxicity studies to allow submission of appropriate material to the FDA to allow testing of this novel combined therapeutic in children with DMD. It will also involve a team of clinical trialists who will incorporate findings in planning optimal trial design and ensure clinical trial readiness by the grants end. Since exon-skipping therapy relies on knowing individual patients exact DNA mutation, this is a form of personalized genetic medicine. While the specific combination therapy being developed here will treat up to 13% of DMD patients, the strategy is likely to be generalized to be able to treat up to 70% of DMD patients.

Phenotypic Analysis of Human ES Cell-Derived Muscle Stem Cells

Funding Type: 
Basic Biology III
Grant Number: 
RB3-05041
ICOC Funds Committed: 
$1 381 296
Disease Focus: 
Muscular Dystrophy
Stem Cell Use: 
Embryonic Stem Cell
oldStatus: 
Active
Public Abstract: 
We study human muscle development, and are actively investigating potential cell-based therapies for the treatment of degenerative muscle diseases, such as muscle dystrophy. This project will define the pathway that muscle stem cells follow as they form new muscle, and identify which muscle stem cells are most useful for therapy. Our approach will be to examine human embryonic stem cells as they become muscle stem cells and mature muscle in culture, to define the stages of normal muscle development. We will then transplant these stem cells at various stages of development into the leg muscles of mice with muscular dystrophy, and study how these cells become new muscle tissue, how this impacts the animals’ ability to exercise, and the strength of the treated muscles. Our goal for this research is to fully understand the normal process of human muscle stem cell development, and to identify specific stem cells that provide therapeutic benefit when transplanted into dystrophic muscle.
Statement of Benefit to California: 
Muscular dystrophies are profoundly debilitating disorders that affect more than 1 in 3,500 male births. They comprise a group of genetic diseases that cause progressive weakness and damage to skeletal muscle resulting from abnormal proteins critical to muscle health. These abnormal proteins are thought to predispose muscle to damage from normal activity, leading to premature depletion of normal muscle stem cells that maintain muscle health during normal use. This research will identify human embryonic stem cells that are able to repair damaged muscle, thereby providing a new approach to therapy for patients with muscle disease. The medical treatments developed as a result of these studies will not only benefit the health of Californians with muscular dystrophy and other degenerative muscle diseases, but also should result in significant savings in health care costs. This research will push the field of muscle regenerative medicine forward despite the paucity of federal funds for embryonic stem cell research, and better prepare us to utilize these funds when they become available in the future.
Progress Report: 
  • The overall goal of this project was to use hESCs to define the cellular and functional phenotypes of human muscle stem cells as they differentiate along the muscle lineage, and specifically evaluate their ability to augment tissue and function of dystrophic muscle. Toward this goal, we have evaluated one muscle-specific reporter hESC line, generated a second line using another muscle-specific promoter, developed three alternative methods for directing myoblast differentiation from hESCs in culture, and piloted injections of hESC-derived myogenic precursor cells into hind limb muscle of immunodeficient mice.
  • Muscle cells derived from human embryonic stem cell (hESC) can be potential source for cell therapy to regenerate muscular diseases. The focus of this grant has been to develop efficient methods for isolating muscle stem cells from hESCs that avoid animal products so that we can use these to both understand how muscle cells form, and determine which of these may be best for treating muscular dystrophy.
  • Our progress over the past year has significantly advanced the aims of this work: 1) Determine the cellular phenotypes of human muscle stem cells as they differentiate into myoblasts, and 2) Determine the ability of human muscle stem cells at different stages of development to engraft, proliferate and differentiate into muscle in a mouse model of muscular dystrophy, and determine their functional and myo-mechanical effects on dystrophic muscle. We now have a working system to derive early progenitor muscle cells from human embryonic stem cells. The differentiation protocol has been developed sufficiently such that skeletal muscle cells can be generated from human ES cells. We have identified points along the differentiation process at which muscle cells that are less mature and possibly more stem-like are prevalent. The data suggests that based on the genes the cells express at early stages, isolation and transplantation of cells at that stage but not further along will be most beneficial for transplantation and clinical application. This brings us a step closer to obtaining useful muscle cells that can be transplanted to treat muscle disorders. The current plan is to test these cells in muscle injury preclinical models to evaluate their capacity to regenerate injured muscle.

Stem Cell Therapy for Duchenne Muscular Dystrophy

Funding Type: 
Early Translational II
Grant Number: 
TR2-01756
ICOC Funds Committed: 
$2 325 933
Disease Focus: 
Muscular Dystrophy
Pediatrics
Stem Cell Use: 
iPS Cell
Cell Line Generation: 
iPS Cell
oldStatus: 
Active
Public Abstract: 
Duchenne muscular dystrophy (DMD) is the most common and serious form of muscular dystrophy. One out of every 3500 boys is born with the disorder, and it is invariably fatal. Until recently, there was little hope that the widespread muscle degeneration that accompanies this disease could be combated. However, stem cell therapy now offers that hope. Like other degenerative disorders, DMD is the result of loss of cells that are needed for correct functioning of the body. In the case of DMD, a vital muscle protein is mutated, and its absence leads to progressive degeneration of essentially all the muscles in the body. To begin to approach a therapy for this condition, we must provide a new supply of stem cells that carry the missing protein that is lacking in DMD. These cells must be delivered to the body in such a way that they will engraft in the muscles and produce new, healthy muscle tissue on an ongoing basis. We now possess methods whereby we can generate stem cells that can become muscle cells out of adult cells from skin or fat by a process known as “reprogramming”. Reprogramming is the addition of genes to a cell that can dial the cell back to becoming a stem cell. By reprogramming adult cells, together with addition to them of a correct copy of the gene that is missing in DMD, we can potentially create stem cells that have the ability to create new, healthy muscle cells in the body of a DMD patient. This is essentially the strategy that we are developing in this proposal. We start with mice that have a mutation in the same gene that is affected in DMD, so they have a disease similar to DMD. We reprogram some of their adult cells, add the correct gene, and grow the cells in incubators in a manner that will produce muscle stem cells. The muscle stem cells can be identified and purified by using an instrument that detects characteristic proteins that muscles make. The corrected muscle stem cells are transplanted into mice with DMD, and the ability of the cells to generate healthy new muscle tissue is evaluated. Using the mouse results as a guide, a similar strategy will then be pursued with human cells, utilizing cells from patients with DMD. The cells will be reprogrammed, the correct gene added, and the cells grown into muscle stem cells. The ability of these cells to make healthy muscle will be tested by injection into mice with DMD that are immune-deficient, so they will accept a graft of human cells. In order to make this process into something that could be used in the clinic, we will develop standard procedures for making and testing the cells, to ensure that they are effective and safe. In this way, this project could lead to a new stem cell therapy that could improve the clinical condition of DMD patients. If we have success with DMD, similar methods could be used to treat other degenerative disorders, and perhaps even some of the degeneration that occurs during normal aging
Statement of Benefit to California: 
The proposed research could lead to a stem cell therapy for Duchenne muscular dystrophy (DMD). This outcome would deliver a variety of benefits to the state of California. First, there would be a profound personal impact on patients and their families if the current inevitable decline of DMD patients could be halted or reversed. This would bring great happiness and satisfaction to the thousands of Californians affected directly or indirectly by DMD. Progress toward a cure for DMD is also likely to accelerate the development of treatments for other degenerative disorders. The most obvious targets would be other forms of muscular dystrophy and neuromuscular disorders. However, the impact would likely also stimulate medical progress on a variety of conditions in which a stem cell therapy could be beneficial. These conditions may even extend to some of the normal processes of aging, which can be traced to depletion of stem cells. An effective stem cell therapy for DMD would also bring economic benefits to the state. Currently, there is a huge burden of costs associated with the care of patients with long-term degenerative disorders like DMD, which afflict thousands of patients statewide. If the clinical condition of these patients could be improved, the cost of maintenance would be reduced, saving billions in medical costs. Many of these patients would be more able to contribute to the workforce and pay taxes. Another benefit is the effect of novel, cutting-edge technologies developed in California on the business economy of the state. Such technologies can have a profound effect on the competitiveness of California through the formation of new manufacturing and health care delivery facilities that would employ California citizens and bring new sources of revenue to the state. Therefore, this project has the potential to bring health and economic benefits to California that are highly desirable for the state.
Progress Report: 
  • The goal of this project is to develop a new approach for therapy of Duchenne muscular dystrophy (DMD). In our strategy, we use skin cells from patients as the starting material and convert these cells into stem cells by adding “reprogramming” genes. We then add the therapeutic dystrophin gene to the stem cells to correct the mutation that causes DMD. The corrected stem cells are grown in a manner so that they will become muscle precursor cells. This process is called differentiation. The differentiated muscle precursor cells are injected into diseased muscles to restore healthy muscle fibers. The overall goal of the project is to demonstrate the entire strategy in a mouse model of DMD, using both mouse and human cells.
  • The milestones for the first year of the project were 1A) to demonstrate the complete strategy for making stem cells from the mouse model and adding a correct dystrophin gene at a precise location in the chromosomes, and 1B) to demonstrate differentiation of mouse and human stem cells into muscle precursor cells that will later be used for engraftment. We achieved both of these milestones.
  • Milestone 1A. Our project takes advantage of the recent discovery that ordinary skin cells can be “reprogrammed” into stem cells that are similar in their properties to embryonic cells. The reprogramming process is carried out by introducing four genes into skin cells that can change the pattern of expression of genes in the cells to that of embryonic cells. The reprogramming genes are usually introduced into cells by putting them into viruses that can incorporate, or integrate, themselves into the chromosomes. This process is effective, but leaves behind viruses embedded in the chromosomes, which can activate genes that cause cancer. My laboratory has developed a safer method for reprogramming, in which no viruses are used. Instead, we utilize an enzyme that can place a single copy of the reprogramming genes into a safe place in the chromosomes.
  • In our method, the reprogramming genes are present on small circles of DNA that are easily made from bacteria grown in the laboratory. The circles of DNA, along with DNA that codes for the integration enzyme, are introduced into patient skin cells. The enzyme causes the reprogramming genes to incorporate into a chromosome at a single, safe location. After the cells are reprogrammed, the reprogramming genes, which are no longer needed, are precisely removed from the chromosomes by using another enzyme. These cells appear to be safe to use in the clinic.
  • In addition, we developed a method to add the therapeutic dystrophin gene to the reprogrammed cells at a precise location. By adding a correct copy of the dystrophin gene, the stem cells now have the potential to make healthy muscle. These corrected stem cells were used to create muscle precursor cells in Milestone 1B.
  • Milestone 1B. In these experiments, we demonstrated that cells reprogrammed and corrected by our methods can be grown in such a way that they differentiate into muscle precursor cells that have the capacity to become healthy muscle fibers. This process of differentiation takes place over a period of about two to three weeks, while the stem cells are grown in plastic dishes in an incubator. The cells are grown in culture medium that contains substances that allow the cells to differentiate from generalized stem cells into cells that are committed to produce muscle.
  • We followed two procedures published in the literature for differentiation of the cells. We analyzed the cells at different time points to see if they had the characteristics of muscle precursor cells. First, we observed the cells under the microscope and saw that they fused together into long fibers, which is characteristic of muscle cells. Moreover, the fibers began to contract and twitch, which is typical of muscle fibers.
  • To analyze the cells at the molecular level, we stained them with antibodies that recognize proteins that are made in muscle precursor cells. We were able to detect staining in some of the cells in the culture, indicating that they were becoming muscle precursor cells. This was demonstrated for both human and mouse stem cells.
  • To measure what fraction of the cells had become muscle precursors, we mixed the culture containing differentiated mouse stem cells with an antibody that binds to the surface of muscle precursor cells. The cells were analyzed with an instrument that can measure how many cells in the culture bind the antibody. We found that 5 – 10% of the cells stained with the antibody. This result indicated that a significant fraction of the cells had become muscle precursors cells, with the potential to be engrafted.
  • In the coming year, these corrected and differentiated mouse stem cells will be introduced into DMD mice to repair muscle damage. We will also apply our reprogramming and correction methods to human cells from DMD patients.
  • The goal of this project is to develop a new approach for therapy of Duchenne muscular dystrophy (DMD). In our strategy, we use skin cells from patients as the starting material and convert these cells into stem cells by adding “reprogramming” genes. We then add the therapeutic dystrophin gene to the stem cells to correct the mutation that causes DMD. The corrected stem cells are grown in a manner so that they will develop into muscle precursor cells. This process is called differentiation. The differentiated muscle precursor cells are injected into diseased muscles to restore healthy muscle fibers. The overall goal of the project is to demonstrate the entire strategy in a mouse model of DMD, using both mouse and human cells as starting material.
  • The first milestones for the project were 1A) to demonstrate the complete strategy for making stem cells from the mouse model and adding a correct dystrophin gene at a precise location in the chromosomes, and to do the same for human cells (2B).
  • Our project took advantage of the recent discovery that ordinary skin cells can be “reprogrammed” into stem cells that are similar in their properties to embryonic cells. The reprogramming process is carried out by introducing four genes into skin cells that can change the pattern of expression of genes in the cells to that of embryonic cells. The reprogramming genes are usually introduced into cells by putting them into viruses that can incorporate, or integrate, themselves into the chromosomes. This process is effective, but leaves behind viruses embedded in the chromosomes, which can activate genes that cause cancer. Our laboratory developed a safer method for reprogramming, in which no viruses are used. Instead, we utilize an enzyme that can place a single copy of the reprogramming genes into a safe place in the chromosomes.
  • In our method, the reprogramming genes are present on small circles of DNA that are easily made from bacteria grown in the laboratory. The circles of DNA, along with DNA that codes for the integration enzyme, are introduced into skin cells. The enzyme causes the reprogramming genes to incorporate into a chromosome at a single, safe location. After the cells are reprogrammed, the reprogramming genes, which are no longer needed, are precisely removed from the chromosomes by using another enzyme. In addition, we developed a method to add the therapeutic dystrophin gene to the reprogrammed cells at a precise location. By adding a correct copy of the dystrophin gene, the stem cells now have the potential to make healthy muscle. These corrected stem cells were used to create muscle precursor cells in Milestone 1B.
  • In the Milestone 1B experiments, we demonstrated that cells reprogrammed and corrected by our methods can be grown in such a way that they differentiate into muscle precursor cells that have the capacity to become healthy muscle fibers. This process of differentiation takes place over a period of several weeks, while the stem cells are grown in plastic dishes in an incubator. The cells are grown in culture fluids that contain substances that allow the cells to differentiate from generalized stem cells into cells that are committed to produce muscle. We analyzed the cells at different time points to see if they had the characteristics of muscle precursor cells. We observed the cells under the microscope and saw that they fused together into long fibers, which is characteristic of muscle cells. Moreover, the fibers began to contract and twitch, which is typical of muscle fibers.
  • To analyze the cells at the molecular level, we stained them with antibodies that recognize proteins that are made in muscle precursor cells and also demonstrated that they contained messenger RNA that encoded muscle proteins. We also verified that the cells expressed the dystrophin gene that we inserted into them and produced normal dystrophin protein. To measure what fraction of the cells had become muscle precursors, we mixed the culture containing differentiated mouse stem cells with an antibody that binds to the surface of muscle precursor cells. The cells were analyzed with an instrument that can measure how many cells in the culture bind the antibody. We found that 20 - 50% of the cells stained with the antibody. This result indicated that a significant fraction of the cells had become muscle precursors cells, with the potential to be engrafted.
  • In Milestone 2A, we introduced these corrected and differentiated mouse stem cells into DMD-model mice to repair muscle damage. We injected the cells into a leg muscle, and three weeks later, we detected engrafted cells by staining for dystrophin. In the coming year, we will carry out the final experiments, Milestone 3, in which human cells that have been reprogrammed and corrected are engrafted into disease model mice.
  • This project has led to great progress in the development of a stem cell therapy for Duchenne muscular dystrophy. During the project period, we went from a conceptual strategy to making all parts of the strategy work, while at the same time discovering improvements in all aspects. The studies began with developing a new and potentially safer way to reprogram mouse cells. We started with skin cells from mdx disease model mice and introduced a plasmid, or circle of DNA, that encoded four genes that could reprogram the skin cells back into embryonic-like cells. We used an enzyme from bacteria called a “recombinase” to paste the reprogramming genes into a safe place in the mouse chromosomes. The next step was to use a second recombinase enzyme to place a correct copy of the dystrophin gene, the gene that is mutated in this form of muscular dystrophy, into a precise position next to the reprogramming genes. Once this was accomplished, we used a third recombinase to delete the portions of inserted DNA that were no longer needed, including the reprogramming genes. These steps left us with “induced pluripotent stem cells”, or iPSC, that were corrected for the disease-causing mutation. In the next step, we used methods to grow the iPSC that induced them to become muscle precursor cells. We measured these changes by monitoring several proteins that are typical of muscle cells. These muscle proteins began to appear in the iPSC as they were undergoing the differentiation process. Once the cells were differentiated, we injected them into the leg muscles of living mice that had muscular dystrophy. We showed that the cells we injected were able to engraft into the muscle, where they could repair and replace damaged muscle fibers. Having successfully carried out the complete stem cell strategy using mouse cells, we published our findings in a scientific journal and sought to develop a similar strategy using human cells. We found that the reprogramming strategy that we had used in mouse cells did not work well in human cells. Therefore, we turned to a reprogramming method that was recently reported by two labs, in which plasmids based on Epstein-Barr virus are used to carry the reprogramming genes into human cells. The long-lasting plasmids provided a sufficient dose of the reprogramming genes, such that the human cells became iPSC. In order to supply a correct copy of the mutated gene, we developed a new method of genome engineering called DICE, for dual integrase cassette exchange. In this method, a short DNA sequence called a “landing pad” was positioned in a special place in the chromosomes called H11. This location has features that make it favorable as a spot to place introduced genes. The landing pad contains recognition sequences for two different recombinase enzymes. When a piece of DNA carrying the genes we want to insert is flanked by recognition sequences for the two enzymes, the landing pad is replaced by the gene we would like to insert. By using this method, we generated iPSC that had a new gene inserted precisely at the H11 location. The next step is to differentiate the cells into muscle precursor cells. The procedure that had worked in mouse cells was not effective for the human cells. We tried two new methods, and both generated human muscle precursor cells at good efficiency. We transplanted the differentiated muscle precursor cells into leg muscles of immune-deficient mice. The mice needed to be immune-deficient in order to accept grafts of human cells without rejecting the cells. We obtained evidence that the human cells successfully engrafted into the muscle. Until now, we had been introducing the stem cells by injecting them directly into a muscle with a needle. This procedure works well in the small muscles of a mouse, but would not work well in the much larger muscles of a human. Therefore, we also began developing a new stem cell delivery method in which the stem cells are introduced into an artery, where they can access muscle tissue by passing through the blood vessel wall and into the muscle tissue. We generated preliminary results suggesting that this arterial delivery system might be a successful means to distribute healthy stem cells to diseased muscles throughout the body. We intend to continue developing this stem cell strategy so that it can be used to help repair the muscles in patients with muscular dystrophy.

Identification of hESC-mediated molecular mechanism that positively regulates the regenerative capacity of post-natal tissues

Funding Type: 
New Faculty I
Grant Number: 
RN1-00532
ICOC Funds Committed: 
$2 246 020
Disease Focus: 
Aging
Muscular Dystrophy
Pediatrics
Trauma
Stem Cell Use: 
Embryonic Stem Cell
oldStatus: 
Active
Public Abstract: 
Statement of Benefit to California: 
Progress Report: 
  • In 2009 beginning of 2010 we have focused on investigating what factors human embryonic stem cells (hESCs) may produce that enhance regeneration and if those factors have any effects by themselves on regeneration. We have published three papers and four book chapters funded at least in part by this award. One patent application has been filed with our University. We have used a proteomic antibody array to examine over 500 common signaling proteins at once to see if any are produced in much higher or lower levels by hESCs. We found that hESCs produce both positive growth factors and negative regulators of the TGF-beta family. We confirmed that typical growth factor signaling was in fact occurring in muscle cells exposed to hESC produced factors, and that hESCs produce a TGF-beta antagonist. This fits with our recently published work showing that young muscle regenerates well from strong growth factor signaling and low TGF-beta signals while old muscle regenerated poorly due to weak growth factor signaling and high TGF-beta signaling. Our current running hypothesis is that the positive growth factors produced by hESCs trigger injured muscle to initiate and maintain regeneration, the TGF-beta inhibitors produced by hESCs reduce the TGF-beta signaling, and the combination assures the robust regeneration of muscle. We also found a surprising increase in insulin production by hESCs and are integrating that result with ongoing regeneration experiments. In the next reporting period we will re-confirm that the levels of candidate proteins from the 500 antibody array actually are very highly produced by hESCs and that the signals from these proteins are perceived by regenerating muscle cells. For Aim 4 we have examined the effects on live regenerating muscle of administering the TGF-beta inhibitors that we found in Aim 2. Preliminary data indicates the effects on regeneration of old muscle look very promising. What was surprising is that administering these inhibitors to the whole animal appears to reduce TGF-beta levels in the whole animal, suggesting some kind of feed-back and perhaps effects on other tissues as well as muscle. For the next reporting period we will confirm these results. In addition we will analyze the effect on regeneration of administering the growth factors that we found in Aim 2, both alone and in combination with the inhibitors of TGF-beta.
  • In 2010 beginning of 2011, we have approached the identification and characterization of the proteins that are produced by hESCs and have the rejuvenating and pro-regenerative activity on adult muscle. Specifically, our data suggest that several other ligands of MAPK pathway secreted by hESCs are likely to enhance and rejuvenate the regeneration of old muscle tissue. Our work is at the stage of understanding the molecular mechanisms by which the aging of the regenerative potential of organ stem cells can be reversed by particular human embryonic factors that are capable of neutralizing the affects of aged niches on tissue regenerative capacity. We have submitted the several manuscripts on topics of enhanced tissue regeneration and we are preparing the manuscript that identifies hESC-based novel strategies for restoring high regenerative capacity to old muscle. Additionally, our data in progress suggest that muscle and brain age by similar molecular mechanisms and thus, therapeutic strategies for rejuvenating muscle repair might be applicable to the restoration of neurogenesis in aged brain. Finally, our data suggest that muscle stem cells either do not accumulate DNA damage with age or can efficiently repair such damage, when activated for tissue regeneration. Thus, the use of hESC-produced pro-regenerative factors for boosting the regenerative capacity of organ stem cells is likely to yield healthy, young tissue. Our plan is to develop further these projects that cross-fertilize each other and have a main theme of enhancing and rejuvenating tissue regeneration. In the next funding period we also plan to accomplish transition from mouse model to human cells and studies.
  • Although functional organ stem cells persist in the old, tissue damage invariably overwhelms tissue repair, ultimately causing the demise of an organism. The poor performance of stem cells in an aged organ, such as skeletal muscle, is caused by the changes in regulatory pathways such as Notch, MAPK and TGF‐β, where old differentiated tissues and blood circulation inhibit the regenerative performance of organ stem cells. While responses of adult stem cells are regulated extrinsically and age‐specifically,
  • our work recently published puts forward experimental evidence suggesting that embryonic cells have an intrinsic youthful barrier to aging and produce soluble pro‐regenerative proteins that signal the MAPK pathway for rejuvenating myogenesis. Future identification of this activity will improve our understanding of embryonic versus adult regulation of tissue regeneration suggesting novel strategies for organ rejuvenation. Comprehensively, our progress of the last year indicates that if the age‐imposed decline in the regenerative capacity of stem cells was understood, the debilitating lack of organ maintenance in the old could be ameliorated and perhaps, even reversed.The same understanding is also required for successful transplantation of stem and progenitor cells into older individuals and for combatting many tissue degenerative disorders: namely, productive performance of transplanted cells is dependent on the niche into which they are placed and the inhibitory factors of the aged and pathological niches need to be identified and neutralized. Additional recently published work was focused on developing new strategies for providing new source of regenerative cells to people who suffer from genetic myopaties (where their own muscle stem cells become exhausted due to the progression of the disease). Muscle regeneration declines with aging and myopathies, and reprogramming of differentiated muscle cells to their progenitors can serve as a robust source of therapeutic cells. We utilized small molecule inhibitors to dedifferentiate muscle into dividing myogenic cells, without gene over expression, which is clinically adaptable. The reprogrammed muscle precursor cells contributed to muscle regeneration in vitro and in vivo and were unequivocally distinguished because of the lineage marking method. These findings enhance understanding of cell-fate determination and create novel therapeutic approaches for improved muscle repair. Moreover, one more of our recently published papers has identified new ways of making muscle progenitor cells to fuse more robustly into muscle fibers, hence enabling deliberate control of muscle tissue formation. We are at the latest stages in our work on the design of novel biomimetic stem cell niches, which based on our current results make easy to expand in culture progenitor cells (e.g. derived from paints) akin to muscle stem cells and enhancing the efficiency of cell transplantation to such an extent that progressive muscle loss in genetic myopathies is predicted to be averted. We have also deciphered some of the fundamental properties of embryonic stem cells, which would enable deliberate control of their self-renewal and tissue specific differentiation and the manuscript describing these findings has been submitted to Cell.
  • Since the last progress report we have confirmed and extrapolated our studies and, as proposed last year, we have identified specific proteins that are secreted by human embryonic stem cells and that enhance muscle regeneration. We have extrapolated the mouse findings and see that these therapeutic embryonic proteins have the pro-regenerative activity on human muscle cells, and excitingly, show that these factors also enhance proliferation of neuronal stem cells and even combat the Alzheimer’s disease (modeled in human cortical neurons derived from embryonic stem cells). We are starting to understand how these pro-regenerative proteins act (which will help to optimally harness their therapeutic potential). We are also in the process of attempting rejuvenation of tissue repair in live aged animals and the preliminary results are encouraging. Notably, the manuscripts, which were listed in the last progress report as in preparation or submitted have been published.
  • The work on the hESC-secreted pro-regenerative factors has been published in two papers and the third manuscript is under review. Additionally, an invention disclosure has been filed with UC Berkeley on the enrichment of the pro-regenerative activity in proteins with heparin-containing domains and thus, our ability to enrich these therapeutic factors by heparin-coated beads.

Skeletal muscle development from hESC and its in vivo applications in animal models of muscular dystrophy

Funding Type: 
New Faculty I
Grant Number: 
RN1-00525
ICOC Funds Committed: 
$1 623 064
Disease Focus: 
Muscular Dystrophy
Stem Cell Use: 
Embryonic Stem Cell
Cell Line Generation: 
Embryonic Stem Cell
oldStatus: 
Closed
Public Abstract: 
Statement of Benefit to California: 

Purified allogeneic hematopoietic stem cells as a platform for tolerance induction

Funding Type: 
Transplantation Immunology
Grant Number: 
RM1-01733
ICOC Funds Committed: 
$1 403 557
Disease Focus: 
Blood Disorders
Immune Disease
Muscular Dystrophy
Stem Cell Use: 
Adult Stem Cell
oldStatus: 
Active
Public Abstract: 
Blood and immune cells originate and mature in the bone marrow. Bone marrow cells are mixtures of blood cells at different stages of development, and include rare populations of blood-forming stem cells. These stem cells are the only cells capable of generating the blood system for the life of an individual. Bone marrow transplants (BMT) have been performed > 50 years, to replace a diseased patient’s blood system with that of a donor. Unfortunately, BMT have associated dangers which make the procedure high risk. Major risks include a syndrome called graft-versus-host disease (GvHD) which results when the donor’s mature blood cells attack the organs of the host, and toxicity from the treatments (radiation and chemotherapy) required to permit the donor cells to take in the recipient. These risk factor limit the use of BMT to only immediate life-threatening diseases. If made safer, BMT could cure many other debilitating diseases. In addition to being curative of blood cancers and non-malignant blood diseases (such as sickle-cell anemia), these transplants can cure autoimmune diseases, such as juvenile (type I) diabetes and multiple sclerosis. In addition, simultaneous BMT with organ transplants induces “tolerance” to the new organ, meaning the recipient will not reject the graft because the new blood system provides continuous proteins to re-train the recipient immune system not to attack it. This establishment of tolerance eliminates the need for drugs that suppress the immune system. In efforts to make BMT safer, our research has focused on isolating the blood stem cells away from the other bone marrow cells because transplants of pure stem cells do not cause GvHD. We developed the methods to purify the blood stem cells from mouse and human blood forming sources and showed in mice that transplants of blood stem cells can cure autoimmune disease and induce tolerance to solid organ transplants. However, this technology has not been tested in human clinical trials because safer methods must be developed that permit the stem cells to engraft in recipients. Our studies in mice show that we can replace the toxic drugs and radiation used to prepare recipients for BMT with non-toxic proteins that target the cells responsible for rejection of blood stem cells. The goal of this study is to translate this technology from mice to patient clinical trials. If successful, the studies will open the door to the use of blood stem cell transplants to the many thousands of patients who could benefit from this approach. The science behind achieving blood stem cell engraftment by the methods we propose look toward the future when blood stem cells and other tissues will be developed from pluripotent stem cells (ES, NT and iPS). We envision that the blood stem cells will induce tolerance to tissues derived from the same pluripotent stem cell line, in the same way that adult blood stem cells induce tolerance to organs from the same living donor.
Statement of Benefit to California: 
The science and the preclinical pathway to induce human immune tolerance in patients with degenerative diseases so that new blood and tissue stem cells can regenerate their lost tissues: For stem cell biology to launch the era of regenerative medicine, stem cells capable of robust and specific regeneration upon transplantation must be found, and methods for safe patient administration must be developed. In the cases where cell donation cannot come from the host, immune responses will reject the donor stem cells. Successful transplants of blood-forming stem cells (HSC) leads to elimination immune cells that reject organ grafts from donors. While bone marrow or cord blood transplants contain immune cells called T cells that will attack the host in a potentially lethal graft against host immune reaction, purified HSC do not do this. Pluripotent stem cells (ES, NT, iPS) can make all cell types in the body and provide a shortcut to find tissue and organ stem cells. Just as co-transplants of adult HSC prevent rejection of organs from the same donor, co-transplants of HSC derived from pluripotent cells should protect tissues derived from the same pluripotent line. Attack by a patient's blood system against one’s own organs cause the syndromes of autoimmune disease including juvenile diabetes, multiple sclerosis, and lupus. Transplanted HSC from donor mice genetically resistant to these diseases end the autoimmune attack permanently. We have in mice, substituted minimally toxic antibodies for toxic chemoradiotherapy to prepare the host for HSC transplants. Now it is time to take these advances to humans, with human immune cell and HSC-targeting antibodies. Long-term potential benefits to the state of California and its residents: The justification for Proposition 71 was to establish in California centers of research not funded adequately in the areas of stem cell biology and regenerative medicine. This research, if successful, is the platform for the application of stem cell biology to regenerative medicine. The costs for long-term immune suppression to patients who receive organ transplants are enormous, both in terms of quality of life, even survival, and healthcare resources. Add to that the lifetime costs of insulin to treat juvenile diabetes, with the inevitable premature diseases of compromised blood vessels and organs, and the shortened lifespan of patients. Add to that the costs to lives and the healthcare system of lupus, of multiple sclerosis, of other autoimmune diseases like juvenile and adult rheumatoid arthritis and scleroderma, and of muscular dystrophy, to mention a few, and the value to Californians and people everywhere is obvious. If our studies are successful, and if the clinical trials were first done in California, our citizens will have the first chance at successful treatment. Further, if these studies are successful - new antibodies, if produced by CIRM funds, will generate royalties which eventually will return to the state.
Progress Report: 
  • The successful transplantation of blood forming stem cells from one person to another can alter the recipient immune system in profound ways. The transplanted blood forming cells can condition the recipient to accept organs from the original stem cell donor without the need for drugs to suppress their immune system; and such transplantations can be curative of autoimmune diseases such as childhood diabetes and multiple sclerosis. Modification of the immune system in these ways is called immune tolerance induction.
  • Unfortunately, the current practice of blood stem cell transplantation is associated with serious risks, including risk of death in 10-20% of recipients. It has been a long-standing goal of investigators in this field to make transplantations safer so that patients that must undergo this procedure have better outcomes, and so that patients who need an organ graft or that suffer from an autoimmune disorder can be effectively treated by this powerful form of cellular therapy. The major objectives of our proposal are to achieve this goal by developing methods to prepare patients to accept blood forming stem cell grafts with reagents that specifically target cell populations in recipients that constitute the barriers to engraftment, and to transplant only purified blood forming stem cells thereby avoiding the potentially lethal complication call graft-vs-host disease.
  • The proposal has four Specific Aims. Aims 1 and 2 focus on development of biologic agents that specifically target recipient barrier cells. Aims 3 and 4 propose to test the reagents and approaches developed in the first two aims in mouse models to induce tolerance to co-transplanted tissues and to cure animals with Type 1 diabetes mellitus or multiple sclerosis. These aims have not changed in this reporting period.
  • One parameter of success in this project is the development of one or more biologic reagents that can replace toxic radiation and chemotherapy that can be used in human clinical trials by the end of the third year of funding (Aim 2). In this regard, significant progress has been made in the last year. A reagent critical to the success of donor blood forming stem cell engraftment is one that targets and eliminates the stem cells that already reside in the recipients. Recipient blood stem cells block the ability of donor stem cells to take. In our prior mouse studies we determined that a protein (antibody) that specifically targets a molecule on the surface of blood forming stem cells called CD117 is capable of eliminating recipient blood stem cells thus opening up special niches and allowing donor stem cells to engraft. This antibody was highly effective in permitting engraftment of purified donor blood stem cells in mice that lack a functional immune system. In this application we proposed to develop and test reagents that could target and eliminate human blood forming stem cells by targeting human CD117. This year we have identified and tested such an antibody which is manufactured by a third party. This anti-CD117 antibody has been evaluated in early clinical trials for an indication separate from our proposed use and appears to be non-toxic. In mice that we generated to house a human blood system, the antibody was capable eliminating the human blood forming stem cells. We plan to pursue the use of this reagent in a clinical trial as a non-toxic way to prepare children with a disease called severe combined immunodeficiency (SCID) for transplantation. Without a transplant children with SCID will die. The use of the anti-CD117 antibody and transplantation of purified blood forming stem cells has the potential to significantly reduce the complications of such transplants and improve the outcomes for these patients. The trial will be the first step to using this form of targeted therapy and serve as a pioneering study for all indications for which a blood forming stem cell transplant is needed, including the induction of immune tolerance.
  • The transplantation of blood forming stem cells from one individual to another can alter the recipient immune system in profound ways. Transplanted blood forming cells can condition the recipient to accept organs from the original stem cell donor without the need for drugs to suppress their immune system. Such transplantations can also be curative of autoimmune diseases such as childhood diabetes and multiple sclerosis. Modification of the immune system in these ways is called immune tolerance induction.
  • The major goal of this project is to enable the use of blood forming stem cell transplantation for the purpose of immune tolerance induction without unwanted side effects. The current practice of blood stem cell transplantation is associated with serious risks, including risk of death in 10-20% of recipients due to complications of transplant conditioning and graft-versus-host disease. We aim to abolish or reduce the risks of these transplantations so that this curative form of stem cell therapy can safely treat patients who need an organ graft or who suffer from an autoimmune disorder. To achieve our goals, we proposed the development of methods to prepare patients to accept blood forming stem cell grafts with reagents that specifically target recipient cell populations that constitute the barriers to engraftment, and to transplant only purified blood forming stem cells, thereby avoiding graft-versus-host disease.
  • The proposal has four Specific Aims. Aims 1 and 2 focus on development of biologic agents that specifically target recipient barrier cells. Aims 3 and 4 propose testing the reagents and approaches developed in the first two aims in mouse models to induce tolerance to co-transplanted tissues and to cure animals with muscular dystrophy, Type 1 diabetes mellitus and multiple sclerosis. These aims have not changed in this reporting period.
  • In this reporting period, significant progress has been made in the first three aims. In prior years we identified a biologic reagent that has the potential to replace toxic radiation and chemotherapy. Radiation and chemotherapy are used in transplantation to eliminate the blood forming stem cells of recipients because recipient stem cells block the ability of donor cells to take. The novel reagent we have studied is a protein, called a monoclonal antibody, which differs from radiation and chemotherapy because it specifically targets and eliminates recipient blood stem cells. This antibody reagent recognizes a molecule on the surface of blood stem cells called CD117. In years 1 and 2 we began testing of an anti-human CD117 (anti-hCD117) antibody in mice. Mice were engrafted with human blood cells and we showed that this antibody safely and specifically eliminated the human blood forming cells. These studies were proof-of-concept that the antibody is appropriate for use in human clinical trials.
  • This last year we were awarded a CIRM Disease Team grant to move the testing of this anti-hCD117 from the experimental phase in mice to a clinical trial for the treatment of children with a disease call severe combined immunodeficiency (SCID), also known as the “bubble boy” disease. Children with SCID are missing certain types of white blood cells (lymphocytes) so they cannot defend themselves from infections. Without a transplant, children with SCID will die. The use of the anti-CD117 antibody and transplantation of purified blood forming stem cells has the potential to significantly reduce the complications of such transplants and improve the outcomes for these patients. The use of the anti-CD117 antibody and transplantation of purified blood forming stem cells has the potential to significantly reduce the complications of such transplants and improve the outcomes for these patients. The trial will be the first step to using this form of targeted therapy and serve as a pioneering study for all indications for which a blood forming stem cell transplant is needed, including the induction of immune tolerance.
  • In the last year we have moved forward with the purification of skeletal muscle stem cells based upon labeling and sorting of primitive muscle cells that express an array of molecules on the cell surface. We have also transplanted a special strain of mice (mdx) that are a model for muscular dystrophy with blood forming stem cells from normal mouse donors. In the coming year we will perform simultaneous transplants of blood forming stem cells and skeletal muscle stem cells from normal donor mice into the mdx mice. We will determine if the blood stem cells permit the long-term survival of the muscle stem cells in recipients transplanted across histocompatibility barriers. Our ultimate goal is to achieve long-term recovery of muscle cell function in the recipients of these co-transplantations.
  • The transplantation of blood forming stem cells from one individual to another is widely used to treat patients with otherwise incurable cancers. Because such transplantations alter the recipient immune system in profound ways there are many other applications for this powerful form of therapy. The studies proposed in this grant focused on the use of blood stem cell transplantation for the purpose of immune tolerance induction. Tolerance induction in this setting means that transplantation of blood stem cells trains the body of a recipient to accept organs from same stem cell donor without the need for drugs to suppress their immune system. Blood stem transplantations can also reverse aberrant immune responses in individuals with autoimmune diseases such as childhood diabetes and multiple sclerosis.
  • In this project we sought to develop new ways to perform blood stem cell transplants to make the procedure safer and therefore more widely useable for a broad spectrum of patients. Transplants can be dangerous and sometimes fatal. Serious complications are caused by the toxic chemotherapy or radiation which are used to permit stem cells to engraft, and by a syndrome called graft-versus-host disease. Our research has aimed to replace the toxic treatments by testing novel reagents that more specifically target and eliminate the cells in recipients that constitute the barriers to stem cell engraftment. Furthermore, we perform transplantations of purified blood forming stem cells, and thus are able to avoid the problem of graft-versus-host disease which is caused by non-stem cell “passenger” immune cells in the donor grafts.
  • The proposal has four Specific Aims. Aims 1 and 2 focus on development of biologic agents that specifically target recipient barrier cells. Aims 3 and 4 propose testing the reagents and approaches developed in the first two aims in mouse models to induce tolerance to co-transplanted tissues and to cure animals with muscular dystrophy, Type 1 diabetes mellitus and multiple sclerosis. These aims have not changed in this reporting period.
  • Our prior reports highlighted our progress in Aim 2, which is now complete. Aim 2 focused on the identification and testing of an antibody directed against a molecule called CD117 present on surface of human blood stem cells. We demonstrated that this antibody can safely target and eliminate human blood stem cells in mice that had been previously engrafted with human cells. Based upon these studies we were awarded a CIRM Disease Team Grant, which will test this anti-human CD117 antibody in a clinical trial for the treatment of children with severe combined immune deficiency (SCID), also known as the “bubble boy” disease. Children with SCID are missing certain types of white blood cells (lymphocytes) so they cannot defend themselves from infections. Without a transplant, SCID patients usually die before the age of two. Our proposed clinical study has the potential to significantly improve the success of transplants for these patients. This clinical trial will be a first to test a reagent that specifically targets recipient stem cells to clear niche space and allow replacement therapy by healthy donor stem cells.
  • In the last year we have continued to make significant progress on Aims 1, 3 and 4. Aim 1 proposed to study how to improve blood stem cell engraftment using novel agents in mice that have intact immune systems. The anti-CD117 antibody discussed above works well in recipients that lack lymphocytes but not recipients with normal immune function. We have tested the anti-CD117 antibody in mice that lack more defined lymphocyte subsets to narrow down which lymphocyte type must be neutralized or eliminated. We have also tested novel reagents that inhibit the activity of specific immune cells and observed a stronger effect of the anti-CD117 antibody when co-administered with these reagents. For Aims 3 and 4, we have successfully achieved our goal of performing blood stem cell transplants that result in the stable mixing of blood cells between donor and recipients (called partial chimerism). For Aim 3, recipients are from a specialized mouse strain that models muscular dystrophy (MDX mice). We have transplanted purified skeletal muscle stem cells (SMSC) and observed engraftment of SMSC in MDX mice injected with genetically-matched SMSC. The next step is to test if co-transplants of blood stem cells plus SMSC from genetically mismatched donors will permanently engraft and expand in MDX recipients. For Aim 4, two mouse models are studied: (1) NOD mice which model childhood diabetes, and (2) mice that develop multiple sclerosis. We can successfully block the progression of disease in these animals with blood stem cell transplants. Our next steps are to apply the therapies developed in Aim 1 to these disease models. In the post-award period we will continue to carry out studies testing the novel approaches developed here in models of tolerance induction.

A Novel Microenvironment-Mediated Functional Skeletal Muscle from Human Embryonic Stem Cells and their In Vivo Engraftment

Funding Type: 
New Faculty II
Grant Number: 
RN2-00945
ICOC Funds Committed: 
$2 300 569
Disease Focus: 
Muscular Dystrophy
Stem Cell Use: 
Embryonic Stem Cell
oldStatus: 
Active
Public Abstract: 
Statement of Benefit to California: 
Progress Report: 
  • The overarching goal of this proposal is to develop robust clinically viable stem cell based therapeutics for muscle wasting focusing on Duchenne Muscular Dystrophy. Three specific aims were proposed to achieve this goal, and during the past year we have made significant progress towards this goal. The focus of aim one is to optimize the microenvironment factors comprising of cell-matrix interaction, cytokines, and cell-secreted morphogens on differentiation of stem cells into muscle cells. Stem cells require complex signals for differentiation and many of which are unknown, making it a challenge to direct tissue specific differentiation. We have adopted a stepwise differentiation strategy to promote myogenic differentiation of pluripotent stem cells (embryonic stem cells, ESCs and induced pluripotent stem cells, iPSCs). This involves differentiating the pluripotent stem cells into mesoderm progenitor cells followed by differentiating them into muscle cells. Our experimental findings show that our approach promotes efficient mesoderm differentiation of pluripotent stem cells. These extensively expandable ESC/iPSC-derived mesoderm progenitor cells are now being subjected to myogenic differentiation. We have also identified and optimized the combination of soluble factors that promote myogenic differentiation of muscle progenitor cells and stem cells. These soluble factors were found to promote myotube formation of muscle progenitor cells, in addition to promoting myogenic differentiation of stem cells. In an effort to understand the role of cell-matrix interactions, we have developed a novel method to decellularize the native skeletal muscle while maintaining their structural, biochemical composition, and mechanical properties unaltered. This approach has much more implications than supporting myogenic differentiation because it can be used as a model system to examine the changes ECM undergoes with pathological changes and how these changes affect stem cell myogenic differentiation and engraftment.
  • The second aim of the proposed study is to test the hypothesis that a bioengineered niche exhibiting “excitation-contraction” dynamics encoded with biochemical cues can be used as a 3D microenvironment to promote myogenic differentiation of stem cells. The first goal of this aim is to develop a bioengineered synthetic niche recapitulating the biophysical cues of native skeletal muscle. To this end, we have developed synthetic hydrogel based biocompatible electro-mechanical matrices, which not only provide three-dimensional structural support to the embedded cells but also can simultaneously provide dynamic mechanical and electrical cues to the cells. A unique aspect of these matrices is that they can undergo reversible, anisotropic bending dynamics in an electric field and functions like multi-functional mechanical actuators. The direction and magnitude of this bending can be tuned through the hydrogel crosslink density while maintaining the same electric potential gradient, allowing precise control over the mechanical strain imparted to the cells in a three-dimensional environment. Our results showed that these bioengineered electro-mechanical niches not only support stem cell culture but also promotes their proliferation and differentiation. The third aim of the proposed study is on evaluating the engraftment and differentiation of in vitro conditioned stem cells using animal models. Based on the progress made in aims 1 and 2, we are certain that we will be able to initiate the animal studies soon.
  • In sum, we have made significant progress in aims 1 and 2 of the proposed study. We have submitted one manuscript and three more manuscripts are under preparation. Another important achievement is training the researchers in stem cells. In addition to the postdoctoral and graduate fellows, we also trained undergraduate and high school students; Jomkuan Theprungsirikul from United World College, Montezuma, NM, had spent the summer in our lab to learn more about regenerative medicine and its potential in irradiating the public health problems. The PI visited Francis Parker School and gave a talk on stem cells on September 23 (Stem Cell Awareness Day). The PI also gave an invited talk on stem cell and regenerative medicine at the 3rd International Congress of NanoBiotechnology & Nanomedicine NanoBio 2009 held in San Francisco, CA.
  • N/A
  • During the reporting period, we successfully developed a protocol for deriving progenitor cells from human embryonic stem cells, which is being written up for a publication. The ESC-derived progenitor cells were found to undergo both myogenesis in vitro and in vivo. We were able to significantly expand these cells in vitro and the in vitro cultured cells expressed a number of muscle markers Pax3, Myf5, desmin, and MyoG. A muscle injury model was then used to investigate the in vivo viability and engraftment efficiency of these cells. A significant fraction of the transplanted cells were found to be engrafted. Additionally, we observed localization of a large number of transplanted cells in the centers of muscle fibers indicating the contribution of the transplanted cells towards the muscle regeneration. We have also developed a muscle-like synthetic material (termed as electromechanical material) that simultaneously provides mechanical and electrical cues to the embedded cells. A manuscript based on these results is published in Advanced Functional Materials, a highly regarded journal in interdisciplinary materials science. This work also received significant press coverage. The above-developed system will allow us determine the effect of various physicochemical cues of the matrix on myogenic commitment and maturation of progenitor cells.
  • During the reporting period, we successfully developed a protocol for deriving progenitor cells from human embryonic stem cells, which is being written up for a publication. The ESC-derived progenitor cells were found to undergo both myogenesis in vitro and in vivo. We were able to significantly expand these cells in vitro and the in vitro cultured cells expressed a number of muscle markers Pax3, Myf5, desmin, and MyoG. A muscle injury model was then used to investigate the in vivo viability and engraftment efficiency of these cells. A significant fraction of the transplanted cells were found to be engrafted. Additionally, we observed localization of a large number of transplanted cells in the centers of muscle fibers indicating the contribution of the transplanted cells towards the muscle regeneration. We have also developed a muscle-like synthetic material (termed as electromechanical material) that simultaneously provides mechanical and electrical cues to the embedded cells. A manuscript based on these results is published in Advanced Functional Materials, a highly regarded journal in interdisciplinary materials science. This work also received significant press coverage. The above-developed system will allow us determine the effect of various physicochemical cues of the matrix on myogenic commitment and maturation of progenitor cells.
  • We have developed a protocol devoid of genetic manipulations to derived progenitor cells with myogenic differentiation potential from human embryonic stem cells (hESCs). These hESC-derived cells underwent myogenic differentiation in vitro both in the presence and absence of serum in culture medium. When transplanted in vivo into an injured muscle, these pre-myogenically committed cells were viable in tibialis anterior muscles 14 days post-implantation. A manuscript describing these results have been published (Hwang Y, Suk S,Lin S, Tierney M, Du B, Seo T, Mitchell A, Sacco A, Varghese S. Directed in vitro myogenesis of human embryonic stem cells and their in vivo engraftment. PLoS One, 8, e72023 (2013). We have further modified the culture conditions to improve myogenic differentiation. When transplanted into injured muscles of immune-deficient NOD/SCID mice, a significant portion of fraction of the transplanted cells were found to be engrafted. Additionally, we observed localization of a large number of transplanted cells in the centers of muscle fibers indicating the contribution of the transplanted cells towards the muscle regeneration. Additionally, we also observed contribution of the transplanted donor cells towards the satellite compartment. The high proliferative capacity of hESCs along with their ability to differentiate into functional skeletal myogenic progenitor cells and engraft in vivo without teratoma formation highlights their potential therapeutic applications to ameliorate skeletal muscle defects and injuries.

Generation of clinical grade human iPS cells

Funding Type: 
New Cell Lines
Grant Number: 
RL1-00681
ICOC Funds Committed: 
$1 382 400
Disease Focus: 
Amyotrophic Lateral Sclerosis
Neurological Disorders
Melanoma
Cancer
Muscular Dystrophy
Neurological Disorders
Stem Cell Use: 
iPS Cell
Cell Line Generation: 
iPS Cell
oldStatus: 
Closed
Public Abstract: 
Statement of Benefit to California: 
Progress Report: 
  • The goal of this project is to develop and bank safe, well-characterized pluripotent stem cell lines that can be used to study and potentially ameliorate human diseases, and that are not limited by technical, ethical or immunological considerations. To that end, we proposed to establish protocols for generation of human induced pluripotent stem cells (hiPSC) that would not involve viral vector integration, and that would be compatible with Good Manufacturing Processes (GMP) standards. To establish baseline characteristics of hiPSCs, we performed a complete molecular characterization of all existing hiPSCs in comparison to human embryonic stem cells (hESCs). We found that all hiPSC lines created to date, regardless of the method by which they were reprogrammed, shared a common gene expression signature, distinct from that of hESCs. The functional role of this gene expression signature is still unclear, but any lines that are generated under the guise of this grant will be subjected to a similar analysis to set the framework by which these new lines are functionally characterized. Our efforts to develop new strategies for the production of safe iPS cells have yielded many new cell lines generated by various techniques, all of which are safer than the standard retroviral protocol. We are currently expanding many of the hiPSCs lines generated and will soon demonstrate whether their gene expression profile, differentiation capability, and genomic stability make them suitable for banking in our iPSC core facility. Once fully characterized, these cells will be available from our bank for other investigators.
  • For hiPSC technology to be useful clinically, the procedures to derive these cells must be robust enough that iPSC can be obtained from the majority of donors. To determine the versatility of generation of iPS cells, we have now derived hiPSCs from commercially obtained fibroblasts derived from people of different ages (newborn through 66 years old) as well as from different races (Caucasian and mixed race). We are currently evaluating medium preparations that will be suitable for GMP-level use. Future work will ascertain the best current system for obtaining hiPSC, and establish GMP-compliant methodologies.
  • The goal of this project is to develop and bank safe, well-characterized pluripotent stem cell lines that can be used to study and potentially ameliorate human diseases. To speed this process, we are taking approaches that are not limited by technical, ethical or immunological considerations. We are establishing protocols for generation of human induced pluripotent stem cells (hiPSCs) that would not involve viral vector integration, and that are compatible with Good Manufacturing Practices (GMP) standards. Our efforts to develop new strategies for the production of safe hiPSC have yielded many new cell lines generated by various techniques. We are characterizing these lines molecularly, and have found hiPSCs can be made that are nearly indistinguishable from human embryonic stem cells (hESC). We have also recently found in all the hiPSCs generated from female fibroblasts, none reactivated the X chromosome. This finding has opened a new frontier in the study and potential treatment of X-linked diseases. We are currently optimizing protocols to generate hiPSC lines that are derived, reprogrammed and differentiated in the absence of animal cell products, and preparing detailed standard operating procedures that will ready this technology for clinical utility.
  • This project was designed to generate protocols whereby human induced pluripotent stem cells could be generated in a manner consistent with use in clinical trials. This required optimization of protocols and generation of standard operating procedures such that animal products were not involved in generation and growth of the cells. We have successfully identified such a protocol as a resource to facilitate widespread adoption of these practices.

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