AU2014202292A1 - Stem cell preparations and methods of use - Google Patents

Abstract

The present invention relates to a method of preparing cells and in particular to a method of preparing breastmilk stem cells (BSCs) by isolation from breastmilk and subsequent culture. The invention further relates to BSCs prepared by the methods of the invention 5 and to methods and uses thereof. The invention has been developed primarily as a method for preparing and culturing BSC.

Description

1 STEM CELL PREPARATIONS AND METHODS OF USE The present application is a divisional application of Australian patent application No. 2012202353, which is incorporated in its entirety herein by reference. FIELD OF THE INVENTION [0001] The present invention relates to a method of preparing cells and in particular to a method of preparing breastmilk stem cells (BSCs) by isolation from breastmilk and subsequent culture. The invention further relates to BSCs prepared by the methods of the invention and to methods and uses thereof. The invention has been developed primarily as a method for preparing and culturing BSCs and will be described hereinafter with reference to this application. However, it will be appreciated that the invention is not limited to this particular field of use. BACKGROUND [0002] Any discussion of the background art throughout the specification should in no way be considered as an admission that such art is widely known or forms part of common general knowledge in the field. [0003] Stem cells derived from the inner mass of mammalian blastocysts (embryonic stem cells, ESCs) have the ability to self-renew and differentiate into all body cell types (Evans and Kaufman, 1981). These properties have led to expectations that human embryonic stem cells (hESCs) might be useful to treat patients with various diseases and injuries, thereby revolutionizing regenerative medicine. [0004] Cell transplantation therapy using stem cells may offer a viable treatment strategy for patients with disease or injury by (a) providing new cells to replace those lost through disease or injury, or (b) by replacing malfunctioning cells. However, the clinical application of hESCs faces difficulties regarding ethical concerns relating to the use of embryos, as well as instances of tissue rejection after implantation due to immunological incompatibility between patient and donor cells. [0005] One way to circumvent these issues is to artificially derive an embryonic stem cell-like (pluripotent) cell from a mature somatic cell by inducing a "forced" expression of certain genes. These artificially derived embryonic stem cell-like cells are known as 2 induced pluripotent stem (iPS) cells and are believed to be very similar to embryonic stem cells in many respects (Hochedlinger and Plath, 2009). The generation of iPS cells from mature somatic cells, such as fibroblast cells obtained directly from the patient, prevents therapeutic concerns regarding ethics, and may potentially provide the optimal cell source for regenerative medicine. Although immune rejection of autologous iPS cells (i.e. iPS cells derived from the patient) was not considered problematic, recent work suggests that immune rejection of autologous iPS cells may occur (Lister et al., 2011). At the same time, the tumorigenic properties of iPS cells (Ghosh et al., 2011) may prohibit their usage in clinical applications. Moreover, more recent work indicates that iPS cells appear to retain a memory of their somatic program (Ohi et al., 2011) and are characterised by genomic instability (Bar-Nur et al., 2011; Pasi et al., 2011) - another hurdle for the clinical application of such cells. [0006] iPS cells were first generated by Yamanaka and colleagues in 2006 from mouse fibroblast cells (Cell 126, 663-676). The method of deriving iPS cells traditionally involves the transfection of certain embryonic stem cell-associated genes into non-pluripotent cells, such as mature fibroblasts. Transfection is usually achieved through viral vectors, such as retroviruses. Yamanaka and colleagues initially identified 4 key genes essential for the production of pluripotent stem cells: Oct-3/4, Sox2, c-Myc and Klf4. Additional studies demonstrated the requirement of Nanog as another major determinant of cellular pluripotency (Okita et al., 2007; Wernig et al., 2007; and Maherali et al., 2007). In 2007, two independent research groups generated iPS cells from human cells (Takahashi et al., 2007; and Yu et al., 2007). Applying the same principles used earlier in mouse cells, Yamanaka and colleagues (Takahashi et al., 2007) successfully transformed human fibroblasts into pluripotent stem cells using the same 4 pivotal genes Oct-3/4, Sox2, c-Myc and Klf4 in a retroviral transfection system. Thomson and colleagues (Yu et al., 2007) used Oct4, Sox2, Nanog and Lin28 using a lentiviral transfection system. The exclusion of c-Myc in these experiments was based on evidence that c-Myc is oncogenic and is not necessary to promote cellular pluripotency. [0007] Alternatively, and as self-renewing stem cells also exist in adult tissues buffered within specialised niches, a further approach would be to identify a pluripotent stem cell population which can conveniently be harvested without detriment to a donor. Stem cells have been isolated from a wide range of adult tissues, from those that have a high rate of ongoing cellular turnover, such as blood, cord blood, bone marrow, skin, intestine, and 3 breast tissue, to those with a low turnover such as brain, skeletal muscle, and juvenile teeth. [0008] However, most adult self-renewing stem cells only escape their quiescent state in response to developmental and physical cues in order to maintain homeostasis during tissue turnover or injury (Bjornson et al., 1999) and, as such, are generally only found in populations of very limited numbers. Further, it was thought that adult stem cells have limited differentiation potential restricted to the tissue/organ of origin. However, recent evidence has suggested that certain cell subpopulations within adult stem cell compartments are capable of in vitro and in vivo differentiation into cell types unrelated to their developmental origin (Clarke et al., 2000; Krause et al., 2001; Jiang et al., 2002; Hoffman, 2007). Notwithstanding, so far only a few such cell populations have been identified and the pluripotent cells obtained are often very limited in number rarely allowing direct therapeutic application of the cells. Great research efforts are now being directed at establishing methods of expansion of such cell populations without compromising the cells' pluripotent properties and therefore their differentiation potential. [0009] In light of the above, it is noteworthy that bi-potent stem cells (Mammary gland stem cells; MaSCs) have been identified in the mammary gland and are known to exist in the basal epithelial layer in the resting breast. Interestingly, these cells have been shown to be capable of differentiation, however, only towards the two main mammary cell lineages, the myoepithelial and luminal cell lineages (Dontu et al., 2003; Shackleton et al., 2006; Villadsen et al., 2007; Visvader, 2009). [0010] The mammary gland undergoes significant remodelling during pregnancy and lactation, which is fuelled by controlled mammary stem cell (MaSCs) proliferation. Briefly, while rudimentary mammary glands exist in males and females, hormonal changes during puberty lead to further development in females mainly through the influence of oestrogen and progesterone leading to the establishment of a rudimentary duct structure with terminal end bud formation. While, influenced by progesterone and prolactin levels, the duct structure of the mammary gland is further refined following puberty, secretory alveoli only develop during pregnancy. The gland finally develops into a secretory, milk producing organ during late pregnancy and/or in the first few days after birth with the secretion of colostrum. Colostrum production is followed by a short period of production of the so called "transition milk" leading to the production of mature milk throughout the lactation period. After weaning, the mammary gland undergoes involution during which the 4 developmental stages seen during gestation are reversed such that the mammary gland reverts to a near resting state. From the above, it will be appreciated that the mammary gland is a highly plastic organ capable of intense remodelling during repeated pregnancies during the life of a female. [0011] The lactating breast in its fully mature state displays the complete cellular hierarchy and contains a larger number of stem cells than found in the resting breast. It is therefore thought that the lactating breast provides the best model for studying the properties of MaSCs. However, due to the scarcity of human lactating breast tissue specimens the human lactating breast has not been extensively studied in this context. As such, the scarcity of human lactating breast tissue specimens and the low number and quiescent state of MaSCs in available resting breast tissue specimens have hindered understanding of the normal MaSC biology and the molecular determinants that drive their aberrant self-renewal in breast cancer. [0012] The existence of stem cells in the breast was first postulated based on the capacity of the mammary epithelium to significantly expand and regress in a repeated fashion throughout adult life (Taylor-Papadimitriou et al., 1977). In accordance with this hypothesis, and as known for other adult stem cell populations, MaSCs exist in a quiescent state and in scarce numbers in the resting breast. Yet, due to the physiological changes linked to mammary remodelling during pregnancy and lactation, MaSCs appear to undergo a controlled program of proliferation, differentiation, and apoptosis stimulated by hormonally-driven cues (Pang and Hartmann, 2007; Asselin-Labat et al., 2010; Joshi et al., 2010). [0013] However, in addition to their important physiological role during pregnancy and lactation, increasing evidence also implicates MaSCs in the onset and progression of invasive breast carcinomas having metastatic features with a propensity towards both mesodermal (bone) and endodermal (lung) organs. It would therefore appear that the mammary gland harbours a stem cell population with unique self-renewal capabilities and a potential plasticity reflected both in normal development and in aberrant conditions of the breast. To date, and despite ongoing research in this field, our understanding of normal MaSC biology is limited and the molecular determinants and regulators of MaSC self-renewal and plasticity (normal or aberrant) are largely unknown.

5 [0014] Currently a lack of suitable cell culture model systems for propagation and characterisation of MaSCs exists and progress has been hindered twofold, (a) by the scarcity and quiescent state of MaSCs obtainable from the resting breast, and (b) by the extremely limited availability of human lactating breast tissue, which contains activated MaSCs in greater numbers. [0015] Interestingly, it has also been shown that breastmilk contains a mixture of different cell types such as, for example, epithelial cells (lactocytes). It would appear that these cells are sloughing off the basement membrane of the breast as a consequence of the pressure and shear forces associated with the continued filling and emptying of the breast and, as a result infiltrate the milk. It has been stipulated that lactocytes account for approximately 10-20% of the total cell population (varying significantly between individual breastmilk samples). While it has long been thought that the majority of the remainder of cells found in human milk are immune cells (such as lymphocytes, macrophages, monocytes, natural killer cells, basophils, eosinophils, and neutrophils) more recent data suggests that human breastmilk from healthy subjects only contains a small percentage of immune cells. [0016] In addition to lactocytes and immune cells, it has previously been demonstrated that breastmilk also contains an activated MaSC population derived from the lactating breast and that this cell population can be accessed non-invasively via expressed breastmilk (Cregan et al., 2007; Thomas et al., Cell Cycle, 2011; Thomas et al., Cell Death Dis., 2011). MaSCs as well as the differentiated cells from the lactating epithelium mentioned above enter breastmilk either through cell migration and turnover and/or as a consequence of the mechanical shear forces of breastfeeding. Culture of CD49f', human breastmilk-derived multipotent cells expressing the epithelial stem cell marker p63 in epithelial-specific two-dimensional (2D) monolayer culture over a twenty-one day period showed that a non-adherent, multipotent p63* epithelial cell population expands in the floating cell population within the first five days of growth. However, these cells are depleted reciprocally with attachment and expansion of adherent cells homogenously expressing pan-epithelial markers. In the proceeding sixteen days of growth sub populations of adherent cells expressing myoepithelial and luminal epithelial markers in mutually exclusive colonies have been identified, indicating that lineage commitment has already occurred in the floating cell population prior to adherence. Furthermore, when the adherent cells are subsequently cultivated in a three-dimensional (3D) biomatrix, these cells have been shown to form differentiated spherical, milk protein-secreting structures 6 (mammospheres) resembling the in vivo secretory alveoli. Based on these results, it would appear that the p63*/CD49f* cell population in breastmilk shares properties of MaSCs (Thomas et al., Cell Cycle, 2011; Thomas et al., Cell Death Dis., 2011). As such, these results indicate that breastmilk contains MaSCs capable of differentiation towards the myoepithelial and luminal mammary lineages. [0017] As indicated above, it has long been known that breastmilk contains a mixture of different cell types. However, a comprehensive analysis and characterisation of human milk identifying all different cell types found in breastmilk is still needed. [0018] In light of the above, it will be appreciated that there is a need in the art for improved methods of isolating embryonic stem cell-like (pluripotent) cell populations from adult tissues/organs as well as for improved methods of propagation and expansion of any such cells with a view to producing cell numbers suitable for therapeutic application. SUMMARY OF THE INVENTION [0019] The present invention overcomes or ameliorates at least one of the disadvantages of the prior art, or to provide a useful alternative. The studies underlying the present invention were aimed to examine whether breastmilk contains stem cell populations with a wide ranging differentiation potential allowing for differentiation towards cell types outside the mammary lineage. [0020] In a first aspect the present invention relates to a method of preparing a spheroid comprising or consisting of breastmilk stem cells (BSCs), the method comprising the steps of: a) separating cells from non-cellular portions of breastmilk obtained from a subject, wherein said cells comprise a mixture of cell types; b) growing the cells in suspension culture to form one or more spheroids; c) harvesting at least one of said one or more spheroids, wherein said one or more spheroids comprise or consist of said BSCs; and d) optionally, isolating at least one BSC from said one or more spheroids.

7 [0021] Generally, the step of growing said cells comprises the proliferation of cells of at least one cell type. The step of growing said cells typically comprises selective proliferation of said BSCs. [0022] In some embodiments, the at least one spheroid is harvested after growing in suspension culture for up to 12-14 days. Typically, the at least one spheroid is harvested after growing in suspension culture for 9 days. [0023] In some embodiments, the method of the first aspect further comprising the step of passaging the one or more spheroids in suspension culture after step (b) and before step (c). The passaging comprises dissociation of the one or more spheroids. [0024] In some embodiments, the one or more spheroids are grown in a low-binding cell culture vessel. Typically, the one or more spheroids are grown in a feeder-free culture. [0025] In some embodiments, the step of growing the cells in suspension culture comprises growing the cell types in the presence of any one or more of the following, or a combination thereof: a growth factor, insulin, transferrin, selenium, nicotinamide, dexamethasone, fetal bovine serum or a non-essential amino acid (NNEA). The growth factor is selected from epidermal growth factor and fibroblast growth factor. [0026] In some embodiments, the BSCs are pluripotent stem cells. [0027] In some embodiments, the breastmilk is human breastmilk and the BSCs are human pluripotent stem cells (hBSCs). The hBSCs express Oct4, Sox2, Nanog and/or Klf4. [0028] In a second aspect the present invention relates to a method of preparing a spheroid comprising or consisting of breastmilk stem cells (BSCs), the method comprising the steps of: a) separating cells from non-cellular portions of breastmilk obtained from a subject after initiation of feeding, wherein said cells comprise a mixture of cell types; b) growing the cells in suspension culture to form one or more spheroids; 8 c) harvesting at least one of said one or more spheroids, wherein said one or more spheroids comprise or consist of said BSCs; and d) optionally, isolating at least one BSC from said one or more spheroids. [0029] In some embodiments, the breastmilk is obtained after or at the end of said feeding. Typically, the breastmilk is obtained from about 0 minutes to about one hour after said feeding. Alternatively, the breastmilk is obtained about 25-30 minutes after said feeding. [0030] In one or more embodiments, the at least one isolated BSC is differentiated to become a myoepithelial cell, a luminal cell, a lactocyte, a neural cell, a stromal cell, an osteoblast, a chondrocyte, an adipocyte, a cardiomyocyte, a hepatocyte, or a beta islet cell. [0031] In a third aspect the present invention relates to an isolated breastmilk stem cell (BSC) or a spheroid comprising or consisting of BSCs prepared according to the methods of the first or second aspect. [0032] In some embodiments, the BSC is a pluripotent stem cell. [0033] In a fourth aspect the present invention relates to an isolated breastmilk stem cell (BSC) or a spheroid comprising or consisting of BSCs prepared according to the methods of the first or second aspect, wherein said cell has low tumorigenicity and does not form teratomas. [0034] In a fifth aspect the present invention relates to an isolated breastmilk stem cell (BSC), wherein said BSC is a pluripotent stem cell or a progenitor or a more committed cell. [0035] In some embodiments, the BSC is capable of differentiating or has differentiated to become a myoepithelial cell, a luminal cell, a lactocyte, a neural cell, a stromal cell, an osteoblast, a chondrocyte, an adipocyte, a cardiomyocyte, a hepatocyte, or a beta islet cell.

9 [0036] In a sixth aspect the present invention relates to a composition comprising the cell or the spheroid of the third, fourth or fifth aspect. [0037] In a seventh aspect the present invention relates to method of cell treatment in a patient in need thereof comprising administering to said patient an effective amount of the cell or the spheroid of the third, fourth or fifth aspect or the composition of the sixth aspect. [0038] Typically, the cell or the spheroid is positive for the PD-1 receptor / PD-L1 ligand complex. In some embodiments, cell is capable of integrating into a tissue of the patient. The cell is allogeneic to the patient. In some instances, the patient is an infant and the cell is obtained from the breastmilk of the infant's mother. In other embodiments, the cell is autologous to the patient. [0039] In an eighth aspect the present invention relates to a method of treating milk production deficiency in a lactating female in need thereof comprising administering to said female the cell or the spheroid comprising or consisting of the BSC of the third, fourth or fifth aspect or the composition of the sixth aspect in an amount effective to treat said milk production deficiency. [0040] In some embodiments, the cell administered in the methods of the sixth or seventh aspect is autologous to the patient. Alternatively, the patient is an infant and the cell is obtained from the breastmilk of the infant's mother. [0041] In a ninth aspect the present invention relates to a method of treating a disease condition in a patient in need thereof comprising the step of administering to the patient an effective amount of the cell or the spheroid of the third, fourth or fifth aspect or the composition of the sixth aspect, wherein the disease condition is a cardiovascular disease, diabetes, inborn errors in metabolism, cancer, a neurological disease, a chronic disease, a liver disease, a fatal infant disease, or any organ/tissue disease for which administration of said cell is beneficial. [0042] Typically, the cell or the spheroid is positive for the PD-1 receptor / PD-L1 ligand complex. In some embodiments, cell is capable of integrating into a tissue of the patient. The cell is allogeneic to the patient. In some instances, the patient is an infant and the cell is obtained from the breastmilk of the infant's mother. In other embodiments, the cell is autologous to the patient.

10 [0043] In another aspect the present invention relates to a method of integrating a cell or spheroid of the third, fourth or fifth aspect into a tissue of a recipient, wherein said method comprises administering said cell or spheroid to said recipient. [0044] Typically, the cell or the spheroid is positive for the PD-1 receptor / PD-L1 ligand complex. In some embodiments, cell is capable of integrating into a tissue of the patient. The cell is allogeneic to the patient. In some instances, the patient is an infant and the cell is obtained from the breastmilk of the infant's mother. In other embodiments, the cell is autologous to the patient. [0045] Reference throughout this specification to "one embodiment", "some embodiments" or "an embodiment" means that a particular feature, structure or characteristic described in connection with the embodiment is included in at least one embodiment of the present invention. Thus, appearances of the phrases "in one embodiment", "in some embodiments" or "in an embodiment" in various places throughout this specification are not necessarily all referring to the same embodiment, but may. Furthermore, the particular features, structures or characteristics may be combined in any suitable manner, as would be apparent to one of ordinary skill in the art from this disclosure, in one or more embodiments. [0046] In the context of this specification the following terms are defined as follows: [0047] "comprising"- Unless the context clearly requires otherwise, throughout the description and the claims, the words "comprise", "comprising", and the like are to be construed in an inclusive sense as opposed to an exclusive or exhaustive sense; that is to say, in the sense of "including, but not limited to". [0048] "lineage"- In so far as this term refers to cell lineages, a lineage is a genealogic pedigree of cells related through mitotic division. [0049] "lineage-specific" - In so far as this term refers to cells, it refers to the differentiation state to which a cell has become committed. [0050] "progenitor/precursor cell" - Please note that these terms can be used interchangeably and, in so far as the terms refer to cells, they refer to a cell capable of differentiating into a number of cell and/or tissue types of a cell lineage.

11 [0051] "pluripotent" - In so far as this term refers to cells, it refers to a cell capable of differentiating into cell and/or tissue types of all cell lineages, excluding extra embryonic cell and/or tissue types. [0052] "multi-potent" - In so far as this term refers to cells, it refers to a cell capable of differentiating into of cell and/or tissue types of multiple but not all cell lineages. [0053] "milk production deficiency"- In so far as this term refers to a condition suffered by lactating female, it relates to females who cannot produce breastmilk at all as well as to females-who have insufficient breastmilk supply. [0054] Also, the terms 'a', 'an' and 'the' mean 'one or more', unless expressly specified otherwise. The terms 'an embodiment', 'embodiment', 'embodiments', 'the embodiment', 'the embodiments', 'some embodiments', 'an example embodiment', 'at least one embodiment', 'one or more embodiments' and 'one embodiment' mean 'one or more (but not necessarily all) embodiments of the present invention(s)' unless expressly specified otherwise. For example, reference to "a cell" includes a single cell as well a mixture or combination of two or more cells. Similarly, reference to "a growth factor" includes mixtures of two or more growth factors as well as a single growth factor, and the like.

12 BRIEF DESCRIPTION OF THE DRAWINGS [0055] Embodiments of the invention will now be described, by way of example only, with reference to the accompanying drawings in which: [0056] Figs. 1A and Fig. 1B illustrate the total amount of cells found in breastmilk over a time course following feeding. Fig. 1C shows the fat concentration of breastmilk over a similar time course. [0057] Fig. 2A shows that expression of the mesenchymal stem cell marker STRO-1 decreases after feeding. Fig. 2B provides representative flow cytometry profiles and positively-labeled fluorescent cell images for a number of cell markers in breastmilk, including CD24, CD90, CD45, CD49f, STRO-1, Nestin, CK5, CD71, CD271, p63, CD34, CD117, CD44, CD133 and CD309. Cell nuclei were stained with 4',6-diamidino-2 phenylindole (DAPI) in all images showing nuclear staining. Additional information on the antibodies used to detect the cell markers can be found in Table 1. Flow cytometry profiles are shown in comparison to a respective negative isotype control (human fibroblasts). Fig. 2C shows the presence of the selected cell markers in breast tissue using immunofluorescent staining. [0058] Fig. 3 shows representative cells for comparative cell marker immunofluorescence staining for lactating as well as resting breast tissue. Positive staining for cytokeratin 5, CD29 as well as CD49f (mammary stem cell markers)(see Table 1) was observed in tissue from lactating breasts whereas only a minimal signal for these markers was obtained in resting breast tissue. Cell nuclei were stained with DAPI. [0059] Fig. 4A depicts representative images of the embryonic stem cell marker expression detected in the luminal and basal epithelial layers in the alveoli and ducts of the mammary tissues. Normal resting and lactating human breast tissue biopsies were examined using immunostaining for expression of genes that affect self-renewal in embryonic stem cells, including Oct4, Sox2, Nanog, SSEA4 and Tra-1-60/Tra-1-81. (See Table 1). Fig. 4B depicts the detection of the Oct4, Sox2, Nanog, SSEA4 and Tra-1 60/Tra-1-81 in isolated cells from freshly expressed breastmilk samples. Proteins were detected using immunofluorescence staining using the cell marker antibody listed in Table 1. Cell nuclei were stained with DAPI. Fluorescence-Activated Cell Sorting (FACS) was also used. An analytic gating strategy was developed for the quantification of protein 13 expression by FACS, which excluded interference by dead cells and/or fat globules. Expression levels obtained with FACS were analyzed as the percentage of positive cells and as the standardized difference in mean fluorescence intensity (MFI) between the control cells (human fibroblasts) and the test. Representative counts are shown in Fig. 4B. Fig. 4C shows Oct4 protein expression in several breastmilk samples (noted as S1, S2, S3, etc.) using western blot. Human fibroblasts were used as a negative control, while hESCs were used as a positive control. Fig. 4D shows the quantity of mRNA for Oct4, Sox2, Nanog, and KLF4 in several breastmilk samples using quantitative RT-PCR, as further detailed below. Figs. 4A through 4D illustrate the presence of cells expressing embryonic stem cell (ESC) markers in hBSC preparations. [0060] Fig. 5A illustrates the morphology of hBSCs and the expression profile of typical ESC markers Oct4, Sox2, Nanog, SSEA4, SSEA3, and Tra-1-60/Tra-1-81 in embryonic stem cell-like colonies derived and specifically expanded in spheroid culture. Cells from breastmilk-derived colonies that did not show ES-like morphology showed reduced ESC marker fluorescence. Positive control cells (ES H7 line) are shown. Additional information on the cell marker detection can be found in Table 1. Fig. 5B shows breastmilk-derived spheroids as observed by cell morphology and immunofluorescence for ESC markers. Co-expression of several ESC marker genes were observed, and cell nuclei were stained with DAPI. Fig. 5C shows RT-PCR quantification of mRNA levels for Oct4, Sox2, and Nanog at various time points during spheroid formation. Negative controls (fibroblasts) and positive controls (hESC) are also shown. [0061] Fig. 6A depicts immunofluorescent detection of various markers of differentiated cells after growing hBSCs under particular culture conditions, and illustrates the differentiation potential of spheroid-expanded hBSCs. Example markers for myoepithelial cells (CK14+, SMA+), neurological cells (nestin, p-Ill-tubulin), glial cell markers (glial fibrillary acidic protein (GFAP), S100 protein), osteoblasts (Runx2, OSX), chondrocytes (Runx2+/Sox-6+), adipose cells (Oil Red 0+, PPAR-y), endodermal cells (OV-6), hepatocytes (albumin, a-fetoprotein (AFP), M2 isoenzyme of pyruvate kinase (M2PK)), pancreatic cells (PDX1, insulin). Further details on the detection of these and other markers can be found in Table 1. Cell nuclei were stained with DAPI if applicable. Fig. 6B depicts a Western blot showing luminal cells (CK18+/CD49f-) that spontaneously synthesised several milk proteins including p-casein, lactoferrin, and a-lactalbumin at week 3. Fig. 6C shows the results of RT-PCR indicating that hBSC cells cultured under 14 pancreatic conditions produce significantly higher amounts of insulin mRNA than freshly isolated hBSC cells and control cells. [0062] Fig. 7 depicts representative immunological fluorescent staining of cell-type specific markers in hBSCs subjected to directed differentiation in spheroid culture. When hBSCs were cultured in the respective differentiation media, mammospheres producing milk proteins (p-casein), pancreatospheres expressing insulin, and cardiospheres expressing cardiac T troponin were all obtained within 3-4 weeks of first culturing. Cell nuclei were stained with DAPI. [0063] Fig. 8 shows representative images of mesenchymal cell marker expression detected in the luminal and basal epithelial layers in the alveoli and ducts of lactating breast tissue. Vimentin, a protein typically expressed in mesenchymal cells and encoded by the VIM gene, was detected in lactating human breast tissue biopsies using a Vimentin specific antibody (see Table 1 for further details regarding the antibody). Cell nuclei were stained with DAPI. [0064] Fig. 9 is a graph illustrating the total amount of cells per millilitre of human breastmilk as determined in a large number of distinct breastmilk samples taken at various stages of lactation ranging from shortly after birth up to about 180 weeks of lactation. The total cell number per millilitre of human breastmilk ranges from about 10,000 to 13,500,000 cells per millilitre. [0065] Fig. 10 depicts images obtained from wild type mice (mothers) as well as from transgenic mice (mothers) ubiquitously expressing a modified DsRed fluorescent protein, td Tomato (TdT). The mice were photographed either under normal light conditions or under light conditions exciting the TdT protein. Fluorescence of the TdT in the transgenic mice illustrates the ubiquitous TdT expression as well as ease of detectability of TdT expressing cells. [0066] Fig. 11 shows the presence of TdT positive cells within the stomach of mouse pups cross-fostered by a transgenic TdT mouse. The images were obtained from the stomaches of two individual pups (P8 and P19, respectively). Following sacrifice of the pups, the stomachs were imaged using a small animal imaging fluorescent microscope. Individual TdT fluorescent cells are shown in the lumen of each stomach imaged. Two 15 representative cells have been encircled for illustration in both images. The insert shows a magnified view of the two encircled, TdT positive cells of pup P8. [0067] Fig. 12A depicts representative images of a stomach tissue section illustrating the presence of breastmilk-derived stem cells within the stomach lumen of a pup cross fostered by a transgenic TdT mouse. The tissue section shown was examined using immunostaining for the NANOG protein, a protein encoded by the above-mentioned Nanog gene known to be involved in self-renewal in embryonic stem cells, i.e. as a marker for pluripotency. The arrows indicate cells within the stomach lumen which were positive for both NANOG as well as for TdT, indicating that the cells are breastmilk-derived stem cells from the cross-fostering TdT mother which have been ingested by the pup during feeding. Cell nuclei were stained with DAPI. Fig. 12B, similarly, depicts representative images of a stomach tissue section illustrating the presence of breastmilk-derived stem cells within the stomach lining of pups cross-fostered by a transgenic TdT mouse. The tissue section shown was examined using immunostaining for the OCT4 protein, a protein also known to be involved in self-renewal in embryonic stem cells, i.e. as a marker for pluripotency. The arrows indicate cells within the stomach lining positive for both OCT4 as well as for TdT, indicating that the breastmilk-derived stem cells ingested by the pup during feeding attach to the stomach lining. Cell nuclei were stained with DAPI. [0068] Fig. 13A depicts a representative image of a liver tissue section obtained from a pup cross-fostered by a transgenic TdT mouse. The tissue section shown was examined using immunostaining for the OCT4 protein, The highlighted cell cluster at the centre of the image illustrates the presence of cells within the liver positive for both OCT4 as well as for TdT, indicating that the breastmilk-derived stem cells ingested by the pup during feeding have been incorporated into the liver tissue of the cross-fostered pup. Cell nuclei were stained with DAPI. Similarly, Fig. 13B shows another representative image of a liver tissue section obtained from a pup cross-fostered by a transgenic TdT mouse. Again, the highlighted cluster of cells at the centre of the image shows cells within the liver tissue positive for both OCT4 as well as for TdT. Cell nuclei were stained with DAPI. [0069] Fig. 14A depicts a representative image of a thymus tissue section obtained from a pup cross-fostered by a transgenic TdT mouse. The tissue section shown was examined using immunostaining for the OCT4 protein. Cells staining positively for OCT4 as well as expressing the TdT protein can be seen throughout the section. Cell nuclei were stained with DAPI. Fig. 14B shows a large cluster of breastmilk-derived cells (i.e.

16 cells positive for TdT) some of which also express the stem cell marker OCT4. Without being bound by theory, the large cluster of TdT positive cells seen within the pup's thymus might indicate the clonal expansion within the thymus of breastmilk-derived stem cells initially ingested by the cross-fostered pup. The presence of TdT positive cells that do not stain positively for OCT4 but are seen within the cluster might indicate that the breastmilk derived cells have started to differentiate, i.e. have "turned off' the expression of genes that affect the self-renewal of stem cells such as OCT4. Breastmilk-derived stem cells are indicated by the left arrow, while the right arrow illustrates OCT4 positive cells seen throughout the thymus, which are negative for TdT (i.e. are not derived from the cross fostering mother but from the pup itself). Cell nuclei were stained with DAPI. Fig. 14C depicts the same image as depicted in Fig. 14B, only showing the fluorescence of TdT positive cells. The cluster of TdT-positive cells is clearly visible. Fig. 14D again depicts the same image as shown in Fig. 14B and Fig. 14C, only showing the fluorescence of OCT4 positive cells. When combining Fig. 14D with 14B, it can be seen that not all TdT positive cells are also positive for OCT4. Cells that are only positive for OCT4 and not for TdT are stem cells derived from the pup itself, i.e. not derived from the cross-fostering mother (indicated by the right arrow in Fig. 14B). Cell nuclei were stained with DAPI. [0070] Fig. 15A depicts the detection of TdT in cells isolated from the blood of a mouse pup cross-fostered by a transgenic TdT mouse for 10 days. The blood was obtained and analysed on day 10 after birth. Fluorescence-Activated Cell Sorting (FACS) was used to detect the TdT-positive cells within the blood sample. Fig. 15B, similarly to Fig. 15A shows the detection of TdT in cells isolated from the blood of a mouse pup cross-fostered by a transgenic TdT mouse for 26 days. The blood was obtained and analysed on day 26 after birth. Again, Fluorescence-Activated Cell Sorting (FACS) was used to detect the TdT positive cells within the blood sample.. [0071] Figure 16A provides a representative flow cytometry profile of a breastmilk sample (whole milk) for a cell marker typically expressed in immune cells, the protein tyrosine phosphatase, receptor type, C (CD45). The percentage of CD45 positive cells present in human breastmilk as determined by flow cytometry was 63.8%. Fig. 16B provides a representative flow cytometry profile of a breastmilk sample (whole milk) for a cell marker typically expressed in epithelial cells, the epithelial cell adhesion molecule (EPCAM). The percentage of EPCAM positive cells present in human breastmilk as determined by flow cytometry was 7.6%. Fig. 16C provides a representative flow cytometry profile of a breastmilk sample (whole milk) for a cell marker typically expressed 17 in stem cells, integrin beta-1 (CD29). The percentage of CD29 positive cells present in human breastmilk as determined by flow cytometry was 10.5%. Additional information on the antibodies used to detect the cell markers can be found in Table 1. [0072] Figure 17A provides a representative flow cytometry profile of a breastmilk sample (whole milk) for a cell marker associated with the suppression of an immune response, programmed cell death 1 (PD-1). The percentage of PD-1 positive cells present in human breastmilk as determined by flow cytometry was 65.3%. Fig. 17B provides a representative flow cytometry profile of a breastmilk sample (whole milk) for a ligand of PD-1, programmed death-ligand 1 (PD-L1). The percentage of PD-L1 positive cells present in human breastmilk as determined by flow cytometry was 63.4%. [0073] Fig. 18A shows a FACS plot of a breastmilk sample (whole milk). CD45-positive cells are represented through fluorescein isothiocyanate (FITC)-mediated fluorescence in channel 1 (FL1-H::FITC) and PD-L1 (CD274)-positive cells are represented through phycoerythrin (PE)-mediated fluorescence in channel 2 (FL2-H::PE). While the analytical gating strategy employed may still require refinement, the plot shows that a proportion of CD45-positive cells are also CD274-positive. Fig. 18B shows a FACS plot of a breastmilk sample (whole milk). CD45-positive cells are represented through fluorescein isothiocyanate (FITC)-mediated fluorescence in channel 1 (FL1-H::FITC) and PD-1 (CD279)-positive cells are represented through phycoerythrin (PE)-mediated fluorescence in channel 2 (FL2-H::PE). While the analytical gating strategy employed may still require refinement, the plot shows that a proportion of CD45-positive cells are also CD279 positive. [0074] Fig. 19A shows a FACS plot of a breastmilk sample (whole milk). Cells positive for a T-lymphocyte marker, cluster of differentiation 8 (CD8), i.e. CD8-positive cells are represented through allophycocyanin (APC)-mediated fluorescence in channel 4 (FL4 H::APC) and PD-L1 (CD274)-positive cells are represented through phycoerythrin (PE) mediated fluorescence in channel 2 (FL2-H::PE). While the analytical gating strategy employed may still require refinement, the plot shows that a proportion of CD8-positive cells are also CD274-positive. Fig. 19B shows a FACS plot of a breastmilk sample (whole milk). CD8-positive cells are represented through allophycocyanin (APC)-mediated fluorescence in channel 4 (FL4-H::APC) and PD-1 (CD279)-positive cells are represented through phycoerythrin (PE)-mediated fluorescence in channel 2 (FL2-H::PE). While the 18 analytical gating strategy employed may still require refinement, the plot shows that a proportion of CD8-positive cells are also CD279-positive. [0075] Fig. 20A shows a FACS plot of a breastmilk sample (whole milk). EPCAM positive cells are represented through fluorescein isothiocyanate (FITC)-mediated fluorescence in channel 1 (FL1-H::FITC) and PD-L1 (CD274)-positive cells are represented through phycoerythrin (PE)-mediated fluorescence in channel 2 (FL2-H::PE). While the analytical gating strategy employed may still require refinement, the plot shows that a proportion of EPCAM-positive cells are also CD274-positive. Fig. 20B shows a FACS plot of a breastmilk sample (whole milk). EPCAM-positive cells are represented through fluorescein isothiocyanate (FITC)-mediated fluorescence in channel 1 (FL1 H::FITC) and PD-1 (CD279)-positive cells are represented through phycoerythrin (PE) mediated fluorescence in channel 2 (FL2-H::PE). While the analytical gating strategy employed may still require refinement, the plot shows that a proportion of EPCAM-positive cells are also CD279-positive. [0076] Fig. 21A shows a FACS plot of a breastmilk sample (whole milk). CD29-positive cells are represented through allophycocyanin (APC)-mediated fluorescence in channel 4 (FL4-H::APC) and PD-L1 (CD274)-positive cells are represented through phycoerythrin (PE)-mediated fluorescence in channel 2 (FL2-H::PE). While the analytical gating strategy employed may still require refinement, the plot shows that a proportion of EPCAM-positive cells are also CD274-positive. Fig. 21 B shows a FACS plot of a breastmilk sample (whole milk). CD29-positive cells are represented through allophycocyanin (APC)-mediated fluorescence in channel 4 (FL4-H::APC) and PD-1 (CD279)-positive cells are represented through phycoerythrin (PE)-mediated fluorescence in channel 2 (FL2-H::PE). While the analytical gating strategy employed may still require refinement, the plot shows that a proportion of CD29-positive cells are also CD279-positive. DESCRIPTION OF THE INVENTION [0077] Surprisingly, it was found that a stem cell population exists in breastmilk (breastmilk stem cells; BSCs), which expresses an array of genes responsible for the regulation of pluripotency in embryonic stem cells (ESCs or ES cells) such as, for example, the genes for the transcription factors (TFs) Oct4, Sox2, Nanog and Klf4.

19 [0078] In situ histological examination of rare human lactating breast tissue specimens revealed the origin and localisation in the lactating breast epithelium of this hBSC population. By contrast, this cell population was scarce in normal resting breast tissue biopsies. Upon expansion in feeder cultures in ESC growth conditions, hBSCs exhibited the encapsulated ESC-like colony morphology and phenotype. These colonies could be passaged in secondary feeder cultures, demonstrating clonogeneicity and self-renewal. [0079] Propagation of hBSCs in 3D culture conditions resulted in the formation of spheroids with a dramatic up-regulation of ESC TFs. Furthermore, hBSCs differentiated in vitro into cell types from all three germ layers, they did not form tumors when injected in mice and show expression of cellular markers linked to the suppression of an immune response. [0080] Furthermore, a corresponding stem cell population has been identified in mouse breastmilk and cross-fostering experiments have revealed that breastmilk-derived cells migrate to, and integrate into, the developing organs of the cross-fostered pups. [0081] These findings demonstrate that breastmilk is a novel and non-invasive resource of patient-specific stem cells with ESC-like properties. This cell population is easily accessible and may be used in regenerative medicine and to study molecular determinants of cancer. Materials & Methods Breastmilk sample collection [0082] The study was approved by the Human and Animal Research Ethics Committees of The University of Western Australia and the University of North Carolina, and all participants provided informed written consent. Healthy breastfeeding women (>70) were recruited in Australia and USA, covering a wide range of lactation stages, from month 1 to year 5 and beyond. Pump-expressed mature breastmilk was obtained from each participant and was transported to the laboratory immediately upon expression under aseptic conditions. Breastmilk cell isolation [0083] Breastmilk was diluted with equal volume of sterile PBS (pH 7.4, Gibco, USA) and centrifuged at 805 g for 20 min at 20 0 C. The fat layer and liquid part were removed with a pipette and the cell pellet was washed three times in PBS and was resuspended in 20 7% Fetal Bovine Serum (FBS, Certified, Invitrogen, USA) in PBS (blocking buffer). The total cell concentration and viability of each sample were determined with a Neubauer hemocytometer by Trypan Blue exclusion. Cell culture [0084] The human embryonic stem cell line H7 was maintained at 370C and 5% CO2 in hESC medium containing DMEM/F12 (Gibco), 20% knock-out serum replacement (Invitrogen), 5 ng/ml human basic fibroblast growth factor (bFGF, Sigma-Aldrich), 100 pM non-essential amino acids (NEAA, Invitrogen), 100 pM p-mercaptoethanol (Sigma Aldrich), and 5% antibiotic/antimycotic (Invitrogen), and 2 pl/ml fungizone (Invitrogen). Immortalized mammary epithelial cells from resting breast mammoplasties were maintained in HuMEC complete medium (Invitrogen). Primary neonatal human fibroblasts were cultured in DMEM (Gibco) supplemented with 10% fetal bovine serum (FBS, Invitrogen) and 1% antibiotic/antimycotic (Invitrogen). For feeder culture of breastmilk cells, plates were coated with 0.01% gelatine at 370C for 40 min. Unbound gelatine was aspirated off and washed out with PBS prior to seeding of MEFs. MEFs were maintained in DMEM (Gibco) containing 10% FBS (Invitrogen) and 1% antibiotic/antimycotic (Invitrogen). Two hours prior to plating of breastmilk cells, the MEF medium was aspirated off, the plate was washed with PBS and fresh hESC medium was added. Breastmilk cells were seeded in feeders in MEF-conditioned hESC medium at densities ranging 5x1 05 5x10 6 per 35 mm dish and incubated at 370C and 5% CO2. On days 2 and 4 after plating, fresh hESC medium was added on top of the existing medium. On day 5-6, the medium was changed, and since then medium change was done daily. For secondary feeder culture, single colonies were individually picked and transferred to new plates in appropriate volume of fresh medium in a split ratio of 1:2. For feeder-free culture, breastmilk cells were seeded in gelatine-coated or uncoated adherence plates in hESCs medium at densities ranging 5 x 10 5 -5 x 106 per 35 mm dish, and incubated at 370C and 5% CO2. Media changes were done as above. For passaging of the adherent colonies, the cells were washed once with PBS and then incubated with trypsin medium (Gibco) for 5 min at 370C. Detached cells were collected after addition of trypsin inhibitor (Invitrogen), washed with PBS once, resuspended in fresh medium and transferred to a new plate in a split ratio of 1:3. For spheroid culture, breastmilk cells were seeded in ultra-low binding plates (Co-Star) at densities ranging 5 x 10 5 -5 x 106 per 35 mm dish, in MammoCult medium (Stem Cell Technologies) supplemented with 3% antibiotic/antimycotic and 2 pl/ml fungizone (Invitrogen). Spheroids were maintained for up to 2 weeks at 37 0 C and 5% CO 2 with addition of fresh MammoCult medium on top of the existing medium every 3 21 days. For spheroid passaging, spheroids were washed once with PBS and then incubated with trypsin medium (Gibco) for 5 min at 370C. Dissociated cells were collected after addition of trypsin inhibitor (Invitrogen), washed with PBS once, resuspended in fresh medium and transferred to a new plate in a split ratio of 1:3. Flow Cytometry [0085] Antibodies against cell markers were standardised using human fibroblasts as negative control (e.g. see Fig. 4) and were shown to recognize their target proteins by FACS (Stemgent, USA Santa Cruz Biotechnology, USA). Freshly isolated breastmilk cells were incubated in unconjugated or fluorophore-conjugated primary antibody (see Table 1 below) for 30 min at 40C, followed by washes and secondary antibody incubation (for unconjugated primaries) for 30 min at 40C (AlexaFluor, Invitrogen, USA), and finally washed and resuspended in fixative (1% paraformaldehyde/0.7% sucrose in PBS). For surface markers, all incubations and washes were done in blocking buffer, while for intracellular markers in 0.05% Tween-20 in PBS after initial cell fixation. Cells were also incubated with live/dead fixable cell stain (Invitrogen, USA) according to the manufacturer's instructions and only the live cells were included in data analyses. Appropriate negative and isotype controls were used. Data acquisition was done with a FACS Calibur Flow Cytometer (Becton Dickinson, New Jersey, USA) and data analysis with FlowJo. Cell debris were excluded from the analyses, via propidium iodide staining (Sigma-Aldrich) at 1 pg/ml. Quantitative real-time polymerase chain reaction [0086] Total RNA from freshly isolated breastmilk cells, harvested hBSC-derived spheroids, hESC H7 cell line, mammary immortalised cells derived from resting tissue mammoplasties, and human primary neonatal fibroblasts was extracted with an RNeasy extraction kit (Qiagen, Valencia, CA, USA) following the instructions of the manufacturer. Total RNA was reverse-transcribed using the high-capacity cDNA archive kit (Applied Biosystems, Carlsbad, CA, USA) plus RNase inhibitor (Applied Biosystems). Gene transcription was quantified by qRT-PCR using hydrolytic probes (Taqman; Applied Biosystems) with the 7500 Fast RT-PCR system (Applied Biosystems). Fold change in gene expression for each sample and experimental condition was calculated as 2 Ct(controi) - Ct(sample) ± standard deviation.

22 Western Blotting [0087] Freshly isolated breastmilk cells, hBSC-derived spheroids, hESCs (positive control) and primary neonatal human fibroblasts (negative control) were lysed in RIPA buffer for 30 min on ice. Protein was quantified using the Micro BCA protein kit (Thermo Scientific). Protein denaturation was done for 5 min at 950C. 50 pg of protein were loaded into Biorad TGX stain-free gels, which were run at 300 V for 30 min. Protein was transferred onto membranes using a Trans-Blot Turbo System (Biorad). Membranes were washed in 0.05% TBS-T, stained with Ponceau red for 5 min, destained with dH20, and washed in 0.05% TBS-T. Membranes were blocked using 5% non-fat cow's skim milk for 1 hour, incubated with primary antibodies (Table 1) overnight at 40C, washed in 0.05% TBS-T, and incubated with secondary antibodies with 1:10,000 Streptoactin for 1 hour at room temperature. Subsequently, membranes were washed in 0.05% TBS-T before incubation in Chemiluminescence Crescendo (Millipore) for 5 min. Imaging was done using a Chemi-Doc MP (Biorad). Culture supernatants from breastmilk cells cultured under mammary differentiation conditions were harvested on weeks 2-4 of culture and examined for the presence of a-lactalbumin and lactoferrin. Fresh medium and human breastmilk/purified proteins were used as negative and positive controls, respectively. 200 pg of total protein from the culture supernatants was loaded per well of a 10% polyacrylamide gel and run under SDS/PAGE denaturing conditions. Antibodies were applied at the concentrations listed in Table 1. Proteins were transferred to a nitrocellulose membrane and blocked for 1 hour in 5% cow's skim milk. Membranes were then developed (ECL-Plus, GE Healthcare, Piscataway, NJ, USA) and visualized by autoradiography. In vitro differentiation [0088] To examine the ability of hBSCs to spontaneously differentiate, breastmilk cells were initially grown as spheroids (see above). By day 4-7, some cells had attached. The remaining spheroids were then transferred into new wells where adherent cells appeared in 1-2 days. Both the initial and subsequent attached cells were cultured for another 2-3 weeks, with media changes every 5 days. For directed differentiation, primary and first- to third-passage breastmilk cell cultures were incubated in corresponding differentiation media for 3-4 weeks. For mammary differentiation, cells were incubated at 37 0 C and 5%

CO

2 in medium containing RPMI 1640 with L-glutamine (Invitrogen) supplemented with 20% FBS (Certified, heat-inactivated, Invitrogen), 4 pg/ml insulin (Invitrogen), 20 ng/ml EGF (Invitrogen), 0.5 pg/ml hydrocortisone (Sigma-Aldrich), 60 ng/ml cholera toxin (Sigma-Aldrich), 5% antibiotic-antimycotic (Invitrogen), and 2 pl/ml fungizone (Invitrogen).

23 For osteoblastic and adipogenic differentiation, cells were incubated for 3-4 weeks in NH OsteoDiff or NH Adipodiff medium, respectively, (Miltenyi Biotec), with 5% antibiotic antimycotic and 2 pl/ml fungizone. For chondrocyte differentiation, cells were incubated for 3-4 weeks in StemPro Chondrogenesis Differentiation medium (Life Technologies). For neuronal differentiation, cells were incubated in RPMI 1640 with L-glutamine, supplemented with 20% FBS, 4 pg/ml insulin, 20 ng/ml EGF, 0.5 pg/ml hydrocortisone, 5% antibiotic-antimycotic, 2 pl/ml fungizone, 20 ng/ml prolactin (Peprotech), and MACS Supplement B27 (Miltenyi Biotec). For hepatocyte differentiation, cells were cultured in Williams' E basic medium supplemented with 10% FBS, 2.5 pg/ml fungizone, 5% antibiotic/antimycotic (Invitrogen), 2 mM glutamine (Sigma-Aldrich), 6.25 pg/ml ITS (growth supplement comprising insulin, transferring and selenium; Invitrogen), 20 ng/ml EGF (BD Biosciences), 10 mM nicotinamide, and 10- 7 M dexamethasone for 2-4 weeks. For pancreatic differentiation, cells were first incubated for 2 days in high-glucose DMEM supplemented with 10% FBS, 2.5 pg/ml fungizone, 5% antibiotic/antimycotic (Invitrogen), 2 mM glutamine (Sigma-Aldrich), 6.25 pg/ml ITS (Invitrogen), 20 ng/ml EGF (BD Biosciences), 50 ng/ml activin A (Sigma-Aldrich), and 10-6 mol/1 retinoic acid (Sigma Aldrich). Subsequently, for the next 9-12 days cells were incubated in DMEM/F12 supplemented with 10% FBS, 2.5 pg/ml fungizone, 5% antibiotic/antimycotic (Invitrogen), 2 mM glutamine (Sigma-Aldrich), 6.25 pg/ml ITS (Invitrogen), 20 ng/ml EGF (BD Biosciences), 10 mM nicotinamide, 10-7 M dexamethasone, and 300 nmol/1 indolactam V (Sigma-Aldrich). For the final 2-4 days of differentiation, the above medium was used supplemented with 50 ng/ml activin A. For cardiomyocyte differentiation, cells were cultured in DMEM/F12 supplemented with 20% FBS, 5% horse serum (Invitrogen), 2 mM L-glutamine, 0.1 M NEAA, 3 mM sodium pyruvate (Invitrogen), 1 pg/ml insulin, 2.5 pg/ml fungizone, and 5% antibiotic/antimycotic. Mammary tissue sections [0089] Lactating and resting mammary tissue sections (5 pm-thick) were prepared from normal human biopsied formalin-fixed and paraffin-embedded tissue currently available in the tissue archive of the School of Anatomy and Human Biology, The University of Western Australia (n=6). Immunohistochemistry [0090] Antibodies for ESC markers were standardised using human fibroblasts as negative control cells (Fig. 4). All antibodies used were shown to recognize their target proteins by immunocytochemistry (Table 1). Part of the breastmilk cell suspensions was 24 immediately fixed for immunofluorescence staining in 1.5% paraformaldehyde/0.7% sucrose in PBS and cytospins of the cell suspensions on glass slides were generated using a Shandon Cytospin 3 centrifuge at 40.7 g for 4 min. Primary antibodies (Table 1) were applied in blocking buffer for 1 hour at room temperature in a humid chamber, after a 5-min permeabilisation with 0.05% Tween20 in PBS for intracellular markers. Appropriate controls were used. The cytospins were washed in PBS and incubated with secondary antibody (AlexaFluor 488, 546 or 555 nm, Invitrogen) in blocking buffer at 1:300 and DAPI (1:100, Roche) for 30 min. After a final wash, they were mounted in DakoCytomation fluorescent mounting medium. Fixed adherent cells grown on plastic plates were stained after 10-25 days of growth. Adherent cells grown on plastic plates were fixed as above, permeabilised in 0.1% TritonX in PBS for 30 min, washed in PBS, incubated with primary and secondary antibodies as above, washed and resuspended in fixative. Mammary tissue sections were rehydrated in deionised water overnight at 40C, followed by a 10-min incubation in PBS, permeabilisation in 0.1% PBS-TritonX 100 for 15 min under humid conditions, and a wash in PBS prior to overnight incubation in at room temperature with primary antibody (Table 1) in blocking buffer. Negative control sections were also prepared. The sections were then washed in PBS and incubated with secondary antibody (as above) for 2 hours, followed by a final wash and mounting. Appropriate negative controls (with no primary antibody incubation) were used to standardise imaging, which was done using a Nikon AlSi Confocal microscope, an Olympus TH4-200 inverted optical microscope, a Nikon Eclipse Ti inverted optical microscope and a Leica DMIRB Inverted Fluorescence/DIC microscope. Teratoma formation assay [0091] Freshly isolated breastmilk cells (3 x 106 - 32 x 106) or spheroid-derived breastmilk cells (2 x 10 5 - 107) were suspended in 30% Matrigel (BD Biosciences, USA) in PBS and injected subcutaneously into dorsal flanks of 15 immunodeficient (SCID) mice. Nine weeks after injection, mice were examined for tumor formation. p86-OTBC-L1 (OCT4-tranduced breast cells) (Beltran et al., 2011) were used as positive control. Statistical analysis [0092] All statistical analyses, including descriptive statistics, graphical exploration of the data, and Student's t tests for statistical significance were performed in Microsoft Excel and in R 2.9.01 (R Development Core, 2009). The results are presented as mean ± SEM as indicated in figure legends, and P values are shown in the figures. Mouse cross-fostering 25 [0093] Wild type mouse pups were removed from their biological mother shortly after birth and were placed in a cage with a transgenic, lactating mouse, which ubiquitously expressed a modified DsRed fluorescent protein, tdTomato (TdT). The pups were exclusively fed via cross-fostering by the TdT-mothers and developed normally when compared to control animals. Pups were sacrificed after varying periods of cross-fostering for organ analysis.

26 Table 1. Markers tested and corresponding antibodies used. Marker Company Cat. No Applications used Oct4 Miltenyi (Stemgent) 130-095-635 FACS (1:100), IF (1:100), IHC (1:100) Oct4A Santa Cruz Biotech. sc-5279 FACS (1:50), IF (1:100), IHC (1:100) Oct4 Abcam ab1 8976 IF (1:100) Oct4A Cell Signalling Tech. 2840 WB (1:1000) Sox2 Miltenyi (Stemgent) 130-095-636 FACS (1:50), IF (1:50), IHC (1:50) Sox2 Cell Signalling Tech. 3579 IF (1:100), WB (1:1000) Nanog Santa Cruz Biotech. sc-33759 FACS (1:100), IF (1:100), IHC (1:100) Nanog Abcam ab80892 IF (1:100) Nanog R&D Systems AF1997 IF (1:50) Nanog Cell Signalling Tech. 3580 WB (1:1000) SSEA4 Miltenyi (Stemgent) 130-095-622 FACS (1:100), IF (1:100), IHC (1:100) SSEA4 Hybridoma cell line* MC-813-70 IF (1:30) Tra-1-60 Miltenyi (Stemgent) 130-095-625 FACS (1:300), IF (1:300), IHC (1:300) Tra-1-60 ABCAM ab16288 IF (1:100) Tra-1-81 Miltenyi (Stemgent) 130-095-626 FACS (1:300), IF (1:300), IHC (1:300) Tra-1-81 ABCAM ab16289 IF (1:100) p-actin Sigma-Aldrich A5441 WB (1:1000) CK14 AbD Serotec SEMCA890HT IF (1:100) a-SMA Sigma-Aldrich A2547-0.2ML IHC (1:100) CK18 Abcam ab32118 IF (1:100) p-casein AbD Serotec SE18602655 IF (1:20) p-casein Santa Cruz Biotech. sc-53189 IF (1:100) a-lactalbumin Dako A057901 WB (1:500) lactoferrin MP Biomedicals 670581 WB (1:500) p-III-tubulin Covance PRB-435P IF (1:1000) Nestin Miltenyi (Stemgent) 130-095-648 IF (1:100) OV6 R&D Systems MAB2020 IF (1:200) M2PK Cell Signalling Tech. 3198 IF (1:200) a-Fetoprotein (AFP) ZYMED Laboratories 18-0055 IF (1:200) Albumin Sigma-Aldrich A-3293 IF (1:200) PDX1 Santa Cruz Biotech. sc-14662 IF (1:100) PDX1 Cell Signalling Tech. 2437S IF (1:100) Insulin Santa Cruz Biotech. sc-52040 IF (1:100) Insulin Cell Signalling Tech. 4590S IF (1:100) RUNX2 Santa Cruz Biotech. sc-1 01145 IF (1:100) OSX Santa Cruz Biotech. sc-133871 IF (1:100) Sox6 Santa Cruz Biotech. sc-20092 IF (1:100) PPAR-y Santa Cruz Biotech. sc-1 984 IF (1:100) Vimentin Sigma-Aldrich V5255 IF (1:100) STRO-1 Hybridoma cell line** IF (Culture supernatant) Desmin Sigma-Aldrich D1033-0.2ML IF (1:100) Cardiac T troponin Abcam ab45932 IF (1:100) FACS: Fluorescence Activated Cell Sorting; IF: Immunofluorescence staining; IHC: Immunohistochemistry; WB: Western Blotting. *Culture supernatant was purchased from the Development Studies Hybridoma Bank. **The hybridoma cell line was purchased from the Development Studies Hybridoma Bank.

27 Results Breastmilk contains different number of cells at different times [0094] It has been found that the number of cells contained in breastmilk varies significantly. Specifically, and referring to Figures 1A and B, the amount of total cells in breastmilk samples sharply increases shortly after a feed, with a peak (maximum concentration at about 25 to 30 minutes following a feed and then gradually decreases back to the concentration of cells found just before feeding is initiated. Accordingly, most efficient sampling of breastmilk for cell collection should occur after feeding, more preferably within 1.5 hours following feeding and most preferably at about 25 to 30 minutes following feeding. [0095] Interestingly, and as shown in Figure 1C, it has also been found that the overall fat concentration of breastmilk follows the pattern described above with respect to cell concentration. Accordingly, the fat concentration also sharply increases shortly after a feed, with a peak (maximum concentration at about 25 to 30 minutes following a feed). Again, and as seen for the number of cells found in breastmilk, the fat concentration then gradually decreases to the concentration found just before feeding is initiated. Characterisation of breastmilk cells [0096] Further, characterisation of breastmilk cells by flow cytometry indicates that a change in cell composition also occurs after feeding. Figure 2A shows that expression of the mesenchymal stem cell marker STRO-1 decreases following feeding with a minimum of STRO-1 positive cells seen at about 1 hour following feeding. In Figure 2B an array of cells from breastmilk staining positive for a number of further cell markers, including CD24, CD90, CD45, CD49f, STRO-1, Nestin, CK5, CD71, CD271, p63, CD34, CD117, CD44, CD133 and CD309, together with a respective flow cytometry profile indicating the prevalence of such cells in comparison to a respective negative isotype control are shown. Further, as seen in Figure 2C the presence of these markers could also be shown by immunohistochemistry staining of breastmilk cells. Analysis of differentiation potential of the lactating breast [0097] As indicated above, when analysing tissue samples from resting as well as lactating breasts a clear difference was observed. For example, and referring to Figure 3, positive in situ staining for Cytokeratin 5, CD29 as well as CD49f (mammary stem cell markers) was observed in tissue from lactating breasts whereas only a minimal signal for these markers was obtained in resting breast tissue.

28 [0098] Further, and referring to Figure 8, it has been shown that the mesenchymal cell marker Vimentin (encoded by the VIM gene) is expressed in the luminal and basal epithelial layers of the alveoli and ducts of lactating breast tissue. Without being bound by theory, and considering the observation by Patki et al. 2010 that human breastmilk is a rich source of multipotent mesenchymal stem cells, we note that the expression of a well established mesenchymal marker in the epithelial cells of the lactating breast may indicate that the BSCs of the present invention may be of epithelial origin, i.e. are derived from epithelial cells having undergone epithelial-mesenchymal transition (EMT). While EMT may have an effect on the development of the mammary gland during lactation, it is also envisioned that EMT may facilitate the migration of cells from the epithelium into the lumen of the alveoli and ducts, i.e. into the milk. Human breastmilk stem cells express hESC markers [0099] When examining the molecular determinants of self-renewal and indicators of plasticity in MaSCs in the human, normal human resting and lactating breast tissue biopsies were also examined immunohistochemically for expression of genes that constitute the core circuitry of self-renewal in hESCs. No or minimal expression of Oct4, Sox2, Nanog, SSEA4 and Tra-1-60/Tra-1-81 were observed in resting mammary tissues (Fig. 4A). By contrast, a clear upregulation of ESC genes was observed in normal lactating mammary tissues, where distinct patterns of gene expression were recorded (Fig. 4A). The transcription factors (TFs) Oct4, Sox2 and Nanog were expressed both in the luminal and the basal epithelial layers in the alveoli and ducts of the lactating epithelium (Fig. 4A). Differences were observed in the distribution and level of ESC gene expression between different ducts and alveolar batches, confirming a previously reported developmental heterogeneicity between different epithelial compartments within the same tissue (Molenaar et al. 1992). Moreover, even within a duct or alveolus expression differences were evident, ranging from absence of expression, minimal cytoplasmic expression, clear nuclear expression, and mixed cytoplasmic and nuclear expression within a cell (Fig. 4A). For all three TFs, the highest expression level was observed in the myoepithelial layer compared to the luminal layer both in ducts and alveoli. SSEA4 was more irregularly expressed in both ducts and alveoli (Fig. 4A). Tra-1-60 and Tra-1-81 were restricted to the luminal cell surface in alveoli, but were more irregularly expressed in ducts. Co-expression of these markers was observed in cell subpopulations in the ductal and alveolar zones. Positive cells were also captured in the lumen of ducts and alveoli (Fig. 4A), suggesting their presence in breastmilk.

29 [00100] To non-invasively access this enriched ES-marker+ cell population from the lactating breast, freshly expressed breastmilk donated from women from various lactating stages (month 1 to year 5 and beyond, n>70) was used. Total cells were isolated from the freshly expressed breastmilk samples and examined for ex vivo expression of ESC markers at the protein and mRNA levels, using immunofluorescence staining (IF) (Fig. 4B), Fluorescence-Activated Cell Sorting (FACS) (Fig. 4B), Western Blotting (WB) (Fig. 4C) and RT-PCR (Fig. 4D). All antibodies and probes were first standardized using human fibroblasts as negative control. A clear nuclear, and sometimes perinuclear localization of Oct4, Sox2 and Nanog was observed using IF in breastmilk cell subpopulations, whereas SSEA4 and Tra-1-60/Tra-1-81 were localized on the cell surface (Fig. 4B). An analytic gating strategy was developed for the quantification of protein expression by FACS, which excluded interference by dead cells and/or fat globules. Expression levels obtained with FACS were analyzed as the percentage of positive cells and as the standardized difference in mean fluorescence intensity (MFI) between the control and the test. A wide variation in FACS expression levels was observed among the breastmilk cell preparations examined, ranging from 4-96% of total cells for Oct4, Sox2 and Nanog, and 0.1-93% for the surface antigens SSEA4 and Tra-1-60/Tra-1-81. Among these genes, Nanog and Tra-1-60/Tra-1-81 were the most highly expressed, followed by OCT4. Co-expression of these genes by single cells was demonstrated both with IF and FACS. WB confirmed ESC gene expression at the protein level (Fig. 4C). Similar to protein expression, a wide variation was observed in mRNA expression levels among samples from different women (Fig. 4D). Oct4, Sox2 and Nanog mRNA expressions were lower in hBSCs compared to the hESC line H7, but significantly higher than that of human fibroblasts and cells derived from resting breast mammoplasties (p=<0.0001; Fig. 4D). Among the breastmilk samples analysed, the highest level of ESC gene mRNA expression was observed in a participant who was breastfeeding and was concurrently pregnant with her next child. hBSCs expressed Nanog mRNA at higher levels compared to Oct4 and Sox2, which was consistent with the results obtained using IF and FACS for protein expression. Interestingly, Klf4 expression by hBSCs was significantly higher than that of hESCs (p=<0.0001; Fig. 4D). In addition to the above ESC markers, hBSCs expressed Rex1, hTERT and GDF3. The above findings established expression of ESC genes at the protein and mRNA levels by hBSCs. Clonogeneicity and self-renewal of breastmilk stem cells [00101] A distinguishing property of hESCs is the formation of flat, compact and encapsulated colonies in feeder culture conditions in hESC medium. These colonies 30 typically express the pluripotency genes Oct4, Sox2, Nanog, SSEA4 and Tra-1-60/Tra-1 81 (Fig. 5A). To examine the clonogeneicity, morphology and phenotype of hBSCs in the presence of feeders and compare it with that of hESCs, cells isolated from freshly expressed breastmilk were cultured in the presence of feeders in hESC medium. A rapid cellular proliferation was first observed in suspension, during which individual cells divided and formed spherical structures. Although expansion in suspension continued, within 4-7 days of plating adherent individual cells and colonies appeared. The suspension cells were removed with the first media change and the adherent colonies were allowed to expand. Two distinct types of adherent colonies were observed: ES-like flat, compact encapsulated colonies with high nucleus:cytoplasm ratio, and non-ES-like colonies (Fig. 5A). The non-ES-like colonies had various morphologies, from a mesenchymal-like to an epithelial-like or mixed morphology (Fig. 5A). The formation frequency of the two colony types differed between different breastmilk samples, with 68-100% (mean 90±3%, n=1 1) of all colonies displaying the ES-like morphology. In the breastmilk samples tested, the frequency of ES-like colony forming cells ranged from 1 in 15,000 to 1 in 1,750,000 (n= 11). [00102] All ES-like hBSC colonies expressed Oct4, Sox2, Nanog, SSEA4, SSEA3, and Tra-1-60/Tra-1-81, with the TFs being localised primarily in the nucleus (Fig. 5A). Similarly to hESCs, spontaneous differentiation in the centre of the ES-like colonies was occasionally observed, particularly when they were allowed to expand for more than 2 weeks. Most non-ES-like colonies expressed these genes at very low levels, if at all. Based on TF gene expression, three distinct cell types were observed within the non-ES like colonies: negative cells, dimly positive cells with TF expression primarily in the cytoplasm, and few smaller round weakly attached cells that were clearly positive in the nucleus (Fig. 5A). SSEA4 and Tra-1-60/Tra-1-81 were expressed at higher levels than the TFs in the non-ES-like colonies, but at lower levels than in the ES-like colonies. It must be noted that in addition to colonies obtained, single attached cells that failed to expand in 2D were also observed. Many of these cells expressed ESC genes at high levels. The nature and properties of these cells remains to be established. [00103] ES-like colonies were passaged in secondary feeder cultures, where they generated identical colonies with ES-like morphology and phenotype. Similar colony formation characteristics were observed when breastmilk cells were cultured in the absence of feeders in gelatine-coated or uncoated adhesion plates, although attachment and colony formation success was higher in the presence of feeders. These data suggest 31 that a subpopulation of hBSCs possesses ES-like features, clonogeneicity and self renewal properties. 3D culture enriches for hESC gene expression in breastmilk stem cells [00104] As a propensity for initial expansion of hBSCs in suspension via spheroid formation (even in adhesion plates) was observed, the characteristics of breastmilk cells when cultured in 3D in ultra-low binding plates were examined. With or without the presence of extracellular matrix (Matrigel), breastmilk cells rapidly formed spheroids, which could be successfully maintained through several passages (Fig. 5B). Typically, the most rapid increase in spheroid size was observed within the first 1-4 days (Fig. 5B). The ability of spheroid formation, spheroid sizes and size increase in the course of culture varied between different breastmilk samples, with smaller magnitude variations observed also between spheroids of the same sample. ESC gene expression in breastmilk-derived spheroids was confirmed by IF (Fig. 5B), which revealed co-expression of these genes, and RT-PCR (Fig. 5B). [00105] Interestingly, a significant upregulation of ESC genes was observed during spheroid formation that equalled or sometimes exceeded the expression levels of hESCs. A time-course analysis of Oct4, Sox2 and Nanog mRNA expression from day 1 to day 12 of spheroid formation revealed a stable upregulation of these genes, which typically peaked after day 7, such as day 9, and reached or exceeded the expression levels of hESCs (Fig. 5B). Of note, variations in the extent of upregulation of ESC genes and the day which expression levels peaked were observed among different breastmilk samples. Therefore, culture of breastmilk cells in suspension provides a rapid method for expansion of the hBSC population with ES-like features. Determination of the differentiation potential of BSCs - Spontaneous and directed differentiation of breastmilk stem cells into cells originating from all three germ layers [00106] To determine the differentiation potential of the identified ESC-like hBSCs spontaneous as well as directed differentiation was assessed. In hESCs and hiPSCs (human induced pluripotent stem cells), an initial 3D embryoid body formation and subsequent cultivation of the embryoid bodies in adherent conditions results in spontaneous differentiation into cells from all three germ layers (Itskovitz-Eldor et al., 2000; Takahashi et al., 2007). Therefore, breastmilk cells were allowed to form 3D spheroids. By day 4-7, some cells had attached. The remaining spheroids were then transferred into new wells where adherent cells appeared in 1-2 days. Both the initial and 32 subsequent adherent cells were cultured for another 2-3 weeks. The resultant cultures contained a mixture of adherent cells/ cell colonies with various morphologies, including those of epithelial cells, mesenchymal cells, neural cells, and cobblestone-like cells (which stained positive for corresponding markers), indicating that spontaneous differentiation had occurred. [00107] Further, lineage-directed differentiation of hBSCs under 2D culture conditions, i.e. in specific growth media using methods previously reported for hESCs, was examined. Initially, the potential of differentiation into the two mammary lineages was confirmed. Within the first 2 weeks of culture in mammary differentiation conditions, myoepithelial cells (CK14*, SMA*) were observed in the attached colonies (Fig. 6A). On week 3, luminal cells (CK18*/CD49f) were detected, some of which spontaneously synthesised milk proteins (p-casein, lactoferrin, a-lactalbumin; Fig. 6B) and breastmilk characteristic oligosaccharides, which were secreted and detected in the culture supernatant. Under neurogenic conditions, cells with neuronal morphology and expression of nestin and P-Ill tubulin were detected within 2-3 weeks of culture (Fig. 6A) as well as cells expressing glial cell markers such as glial fibrillary acidic protein (GFAP) and S100 protein. Under osteoblastic conditions, cells with nuclear expression of Runx2, a transcription factor essential for osteoblastic differentiation (Fig. 6A) was detected. Some Runx2* cells co expressed OSX, an osteoblast-specific transcription factor required for bone formation. Under chondrogenic conditions, cells with the chondrocyte marker profile (Runx2*/Sox-6*) were identified after 2-3 weeks of culture (Fig. 6A). Under conditions promoting adipogenic differentiation, cells with lipid droplets (Oil Red O) positive for the adipogenic transcription factor PPAR-y were observed (Fig. 6A). Differentiation towards endodermal cells was examined. Breastmilk cells cultured in hepatocyte differentiation conditions initially upregulated the endodermal progenitor marker OV-6, which was subsequently downregulated with concurrent upregulation of the mature hepatocyte markers a fetoprotein and M2 isoenzyme of pyruvate kinase, and the functional hepatocyte marker albumin (Fig. 6A). Under pancreatic differentiation conditions, upregulation of the mature beta cell marker PDX1 was observed, and expression of insulin in the resulting cells was confirmed by IF (Fig. 6B) and RT-PCR (Fig. 6C). Directed differentiation in 3D conditions was also examined by growing breastmilk-derived spheroids in differentiation media for a longer period. Indeed, in corresponding media, mammospheres producing milk proteins (p-casein), pancreatospheres expressing insulin, and cardiospheres expressing cardiac T troponin were obtained within 3-4 weeks of culture (Fig. 7). In all differentiation inductions, 33 upregulation of the differentiation genes was accompanied by downregulation of ESC genes. Teratoma assay of breastmilk-derived MaSCs [00108] One assay to establish the in vivo pluripotency of a cell population is to test whether the cells have the ability to induce teratoma formation. However, at the same time, tumorigenicity, i.e. the potential of cells to form a teratoma/tumor, is a key concern in the practical application of stem cell therapies. For example, the formation of tumors, such as teratomas, following transplantation of hESC-derived precursor cells has been observed in a number studies (Roy et al., 2006; Erdo et al., 2003; Hedlund et al., 2007; Pruszak et al., 2007; Bj6rklund et al., 2002; Riess et al., 2007; and Aubry et al., 2008;) and was also noted by Wernig et al., 2009 in a recent study in which iPS cell-derived neural precursors were transplanted into a 6-OHDA lesion model of Parkinson's disease. The formation of teratomas is thought to result from a proportion of the transplanted cells retaining an undifferentiated state and having tumorigenic potential. Accordingly, teratoma formation following transplantation of hESC- or iPS cell-derived precursor cells presents a major obstacle for the clinical application of stem cell therapy, as tumor formation as a clinical result of cell transplantation therapy in human patients is unacceptable. [00109] To establish whether hBSCs are capable of forming teratomas when injected subcutaneously into dorsal flanks of immunodeficient (SCID) mice, 15 mice were injected with freshly isolated total breastmilk cells (3 x 106 - 32 x 106) or with spheroid-derived breastmilk cells (2 x 10 5 - 107). Nine weeks after injection, mice were examined and no tumor formation was observed, suggesting that hBSCs do not form tumors under the conditions employed. By contrast, positive control animals injected with as few as 50 cells of p86-OTBC-L1 (OCT4-tranduced breast cancer cells) showed formation of poorly differentiated tumors (Beltran et al., 2011). Cross-fostering [00110] As established above, human breastmilk contains stem cells that express pluripotency genes which have the potential to differentiate into cells of all three germ layers when cultured in vitro. It is noteworthy that, in humans, the amount of total cells per millilitre breastmilk may vary between 10,000 and 13,500,000 and that a baby may consume between 470 and 1350 millilitres of breastmilk per day. Considering that between 1 and 30% of these cells display the ESC marker profile of being 34 OCT4/SOX2/NANOG-positive, we investigated the role breastmilk stem cells play in the neonate. To this end, we used a cross-fostering mouse model to test distribution and latency of milk stem cells within the cross-fostered pups. [00111] Specifically, and as indicated above, wild type mouse pups were cross-fostered by mothers that ubiquitously express td Tomato (TdT; also see Figure 10). Imaging of organs from TdT-foster pups at varying times of cross-fostering revealed the presence of breastmilk-derived TdT-positive cells in the stomach (Figure 11) and thymus (Figures 14A to 14D) of the cross-fostered pups but not in wild-type controls nursed by their biological mothers. Confocal imaging of immunostained organs of the TdT-fostered pups revealed TdT-positive cells in stomach (Figures 12A and 12B) and liver (Figures 13A and 13B). TdT-positive cells in the gastric lumen adhered to and penetrated the stomach wall (Figures 12A and 121B). Some of these TdT-positive cells expressed stem cell markers OCT4, NANOG and CD49f. The thymus of cross-fostered pups harboured TdT-positive, i.e. breastmilk-derived, cells expressing stem cell markers and apparently having undergone clonal expansion within the thymus, thereby contributing to the developing organ (Figures 14B to 14D). In close proximity to breastmilk-derived stem cells identified in the thymus of the cross-fostered pup, we observed TdT-positive, i.e. breastmilk-derived, cells with low or no expression of stem cell markers. This observation suggests differentiation and assimilation of the breastmilk-derived cells within the tissue of the cross-fostered pups and/or homing of other types of TdT-positive breastmilk-derived cells in the thymus (Figures 14B to 14D). FACS analysis of blood from cross-fostered pups [00112] In light of the above results indicating that breastmilk stem cells not only migrate/infiltrate the organs of the newborn but also integrate and functionally contribute to the organs of the breastfed newborn, we further investigated how the breastmilk derived cells may migrate to the organs into which they integrate. To this end, flow cytometry analysis was performed on blood samples obtained from cross-fostered mouse pups at various times during cross-fostering (Figures 15A and 15B). It was found that breastmilk-derived cells were present in the circulation of the pups, i.e. that breastmilk derived cells were being distributed/transferred to the pups' organs via the circulation.

35 Analysis of PD-L 1/PD-I expression in BSCs [00113] With a view to establishing why breastmilk-derived cells that infiltrate the organs of the newborn do not elicit an immune response but rather appear to integrate into and contribute to the organs to which they are transferred, we investigated whether breastmilk derived cells may interact with the newborn's immune system such that an immune response is suppressed. [00114] Surprisingly, it was found that a substantial number of human BSCs express a transmembrane protein that has been implicated in suppressing the immune system during particular events such as pregnancy, tissue allografts, and autoimmune disease programmed death-ligand 1 (PD-L1). Fig. 17B provides a representative flow cytometry profile of a breastmilk sample (whole milk) for a ligand of PD-1, programmed death-ligand 1 (PD-L1). The percentage of PD-L1 positive cells present in human breastmilk as determined by flow cytometry was 63.4%. Similarly, the percentage of PD-1 positive cells present in human breastmilk as determined by flow cytometry was 65.3% (Figure 17A). [00115] Under normal circumstances, the immune system reacts to foreign antigens via proliferation of antigen-specific CD8-positive T immune cells. However, it has been suggested that the formation of PD-1 receptor / PD-L1 ligand complex transmits an inhibitory signal which reduces the proliferation of such CD8-positive T cells. As shown in Figures 16A, 16B and 16C, and as indicated above, human breastmilk contains cells expressing immune cell markers (CD45), epithelial markers (EPCAM) and stem cell markers (CD29). [00116] Simultaneous detection of the immune cell marker CD45 and markers for the PD-1 receptor / PD-L1 ligand complex illustrates that at least a proportion of CD45 positive cells are also positive for PD-L1 (as determined by the detection of the CD274 antigen) and for PD-1 (as determined by the detection of the CD279 antigen). In particular, Figure 18A shows a FACS plot of a breastmilk sample (whole milk). CD45 positive cells are represented through fluorescein isothiocyanate (FITC)-mediated fluorescence in channel 1 (FL1-H::FITC) and PD-L1 (CD274)-positive cells are represented through phycoerythrin (PE)-mediated fluorescence in channel 2 (FL2-H::PE). Figure 18B shows a FACS plot of a breastmilk sample (whole milk). CD45-positive cells are represented through fluorescein isothiocyanate (FITC)-mediated fluorescence in channel 1 (FL1-H::FITC) and PD-1 (CD279)-positive cells are represented through phycoerythrin (PE)-mediated fluorescence in channel 2 (FL2-H::PE). While the analytical 36 gating strategy employed may still require refinement, the plot shows that a proportion of CD45-positive cells are also CD274 and/or CD279-positive. [00117] Simultaneous detection of the T-lymphocyte marker CD8 and markers for the PD-1 receptor / PD-L1 ligand complex illustrates that at least a proportion of CD8-positive cells are also positive for PD-L1 (as determined by the detection of the CD274 antigen) and for PD-1 (as determined by the detection of the CD279 antigen). In particular, Figure 19A shows a FACS plot of a breastmilk sample (whole milk). Cells positive for a T lymphocyte marker, cluster of differentiation 8 (CD8), i.e. CD8-positive cells are represented through allophycocyanin (APC)-mediated fluorescence in channel 4 (FL4 H::APC) and PD-L1 (CD274)-positive cells are represented through phycoerythrin (PE) mediated fluorescence in channel 2 (FL2-H::PE). Figure 19B shows a FACS plot of a breastmilk sample (whole milk). CD8-positive cells are represented through allophycocyanin (APC)-mediated fluorescence in channel 4 (FL4-H::APC) and PD-1 (CD279)-positive cells are represented through phycoerythrin (PE)-mediated fluorescence in channel 2 (FL2-H::PE). The plot shows that a proportion of CD8-positive cells are also CD274 and/or CD279-positive. [00118] Simultaneous detection of the epithelial cell marker EPCAM and markers for the PD-1 receptor / PD-L1 ligand complex illustrates that at least a proportion of EPCAM positive cells are also positive for PD-L1 (as determined by the detection of the CD274 antigen) and for PD-1 (as determined by the detection of the CD279 antigen). In particular, Figure 20A shows a FACS plot of a breastmilk sample (whole milk). EPCAM positive cells are represented through fluorescein isothiocyanate (FITC)-mediated fluorescence in channel 1 (FL1-H::FITC) and PD-L1 (CD274)-positive cells are represented through phycoerythrin (PE)-mediated fluorescence in channel 2 (FL2-H::PE). Figure 20B shows a FACS plot of a breastmilk sample (whole milk). EPCAM-positive cells are represented through fluorescein isothiocyanate (FITC)-mediated fluorescence in channel 1 (FL1-H::FITC) and PD-1 (CD279)-positive cells are represented through phycoerythrin (PE)-mediated fluorescence in channel 2 (FL2-H::PE). The plot shows that a proportion of EPCAM-positive cells are also CD274 and/or CD279-positive. [00119] Simultaneous detection of the stem cell marker CD29 and markers for the PD-1 receptor / PD-L1 ligand complex illustrates that at least a proportion of EPCAM-positive cells are also positive for PD-L1 (as determined by the detection of the CD274 antigen) and for PD-1 (as determined by the detection of the CD279 antigen). In particular, Figure 37 21A shows a FACS plot of a breastmilk sample (whole milk). CD29-positive cells are represented through allophycocyanin (APC)-mediated fluorescence in channel 4 (FL4 H::APC) and PD-L1 (CD274)-positive cells are represented through phycoerythrin (PE) mediated fluorescence in channel 2 (FL2-H::PE). Figure 21 B shows a FACS plot of a breastmilk sample (whole milk). CD29-positive cells are represented through allophycocyanin (APC)-mediated fluorescence in channel 4 (FL4-H::APC) and PD-1 (CD279)-positive cells are represented through phycoerythrin (PE)-mediated fluorescence in channel 2 (FL2-H::PE). The plot shows that a proportion of CD29-positive cells are also CD274 and/or CD279-positive. Discussion [00120] A stem cell population with ES-like properties and multi-lineage differentiation potential has been identified in the human lactating breast and breastmilk. This cell population is scarce in the normal resting breast tissue, suggesting (a) that at least some of these cells may be mobilised from other tissues during lactation, and/or (b) that it is remnant from embryonic development in the resting breast, where it is scarce and in a quiescent state. Pregnancy- and lactation-associated hormonal cues activate this cell population via stimulation of a self-renewal program mediated by a marked upregulation of embryonic stem (ES) cell genes. This newly described cell population was non-invasively accessed via freshly expressed breastmilk and ex vivo, in situ and in vitro characterisation of these cells was performed. [00121] Breastmilk contains a heterogeneous cell population, which reflects the cellular hierarchy of the lactating mammary epithelium. Both in lactating breast tissues and breastmilk samples examined a high, yet variable, percentage of cells expressing the ESC pluripotency transcription factors Oct4, Sox2, Nanog, Klf4, SSEA4, Tra-1-60/Tra-1-81 was observed. Nevertheless, the differing subcellular localisation (from cytoplasmic to nuclear) and levels of expression between different cells further reinforce the presence of a cellular hierarchy, from early-stage stem cells to committed progenitors, and stages in between. Although all these cells express pluripotency genes at some level, it is proposed that not all are at the same developmental stage and not all have the same self-renewal and differentiation potential. For example, a much lower frequency of ES-like colony formation by breastmilk-derived cells in feeder culture was observed and, moreover, in these cultures a large number of single, attached cells was observed, which did not proliferate, yet expressed ESC genes at high levels. This is in accordance with the initial high ESC 38 gene expression levels seen pre-plating in the freshly isolated breastmilk cell population. In addition to the single attached cells and ES-like colonies, non-ES-like colonies were observed in feeder cultures, which retained some expression of ESC genes, but at much lower levels compared to ES-like colonies. The non-ES-like colonies displayed varying morphologies, from epithelial to mesenchymal to mixed. Based on the above, it is hypothesized that the non-ES-like colonies originate from the expansion of more committed luminal or myoepithelial or common progenitors present in breastmilk, suggesting that ESC genes are not completely downregulated in the more committed mammary progenitor cells. [00122] It therefore becomes clear that a wide spectrum of developmental stages and functionalities is represented in breastmilk. Amongst the more committed progenitor and differentiated cells, breastmilk contains a stem cell population, which is similar to hESCs, yet not identical. Freshly isolated breastmilk cells expressed the core TF network governing pluripotency in hESCs (Young, 2011). Interestingly, of the three TFs (Oct4, Sox2 and Nanog), Nanog was expressed at higher levels among the breastmilk samples tested. Nanog is the key self-renewal regulator essential for early development and for maintaining the ground-state pluripotency of ESCs (Ding et al., 2012). Expression levels of ESC genes in freshly isolated breastmilk cell preparations were lower than in hESCs, likely due to the cellular heterogeneicity of breastmilk. However, 3D culture conditions enriched for the ES-like hBSCs in a time-dependent manner, with expression levels of ESC genes that equalled or exceeded those of hESCs. Since spheroid formation conditions are thought to better represent the in vivo environment (Lee et al., 2007), it is postulated that ESC gene expression levels in the breastmilk-derived spheroids may reflect those of the ES-like cell population present in the lactating breast epithelium. The propensity of breastmilk cells to grow in suspension rather than as adherent cells is indicative of a migratory character, another similarity with hESCs cells. Furthermore, the findings are in accordance with previous studies reporting increased expression of OCT4 during spheroid culture of breast cancer cell lines (Wang et al., 2010) and of epithelial cells derived from resting breast tissue mammoplasties (Blancafort, unpublished data). However, the increase in OCT4 expression during spheroid culture in both breast cancer cell lines and normal epithelial cells from resting breast tissue is in the order of 3-5 times, whereas in hBSCs in the order of hundreds to thousands of times, often reaching or exceeding the expression levels of hESCs (Fig. 5C). These findings support the pre existence in the resting breast of a quiescent stem cell population which expands during pregnancy and lactation. As such, these findings provide a useful method for expansion of 39 the ES-like hBSC population for future purposes. In addition, it suggests the possibility that some of these cells may have been mobilised from other tissues. [00123] In addition to ESC gene expression, hBSCs formed ES-like colonies in feeders in hESC culture conditions, with morphology and phenotype that closely resembled that of hESCs. These hBSC-derived colonies could be serially passaged in secondary feeders and in 3D culture, demonstrating clonogeneicity and self-renewal. Furthermore, similarly to hESCs, hBSCs demonstrated spontaneous differentiation towards various cell types in vitro, and were capable of directed differentiation into cell types of mammary, neuroectodermal, mesodermal and endodermal origins. The resultant differentiation progressed to functional cells, including milk-secreting lactocytes, albumin-producing hepatocytes, and insulin-producing beta islet cells. [00124] Furthermore, it was established that, as in humans, mouse milk contains cells that express a corresponding profile of stem cell markers. Mouse cross-fostering experiments aimed at investigating the fate of breastmilk-derived cells after having been ingested by the newborn provide the first evidence of migration and integration of breastmilk stem cells into organs of the newborn. Specifically, it has been shown that BSCs are present within the circulation of cross-fostered pups which may allow their distribution within the newborn. [00125] Breastmilk cells injected subcutaneously in immunodeficient mice did not form tumors. hESCs and hiPCSs form teratoma-like masses when injected in immunodeficient mice, an assay that is used as an indicator of in vivo pluripotency (Lensch et al., 2007; Takahashi et al., 2007). Nevertheless, adult cells with pluripotent features and low tumorigenicity, i.e. that do not form teratomas when injected subcutaneously in mice, have been previously described, such as the very small ES-like cells (VSELs) isolated from the bone marrow and other adult tissues in mice (Ratajczak et al., 2011). Similarly to what has been previously suggested for the nature of VSELs, in the normal breast epigenetic modifications of the ES-like stem cells identified here may be responsible for maintaining them at a controlled state of self-renewal, prohibiting uncontrolled proliferation and tumor formation. It is proposed that the ESC TF network upregulated in the normal breast during lactation plays a fundamental role in the remodelling of the breast necessary to support its development towards a milk-secretory organ. Due to inherent expression of ESC TFs, these cells accessed via breastmilk are capable of multi-lineage differentiation in vitro. Importantly, disruption of this transcriptional network during pregnancy and lactation, 40 failure to silence these genes during involution, or their aberrant upregulation in the resting breast may be at the core of malignant transformation in the breast. In accordance with this, it has been shown that forced ectopic expression of Oct4 in cells from the resting epithelium results in aberrant expansion of MaSCs possessing multi-lineage potential and displaying tumor-initiating features (Beltran et al., 2011). Future work will utilise hBSCs as a model to study molecular determinants of breast cancer associated with deregulation of their self-renewal machinery. [00126] Furthermore, it has been shown that BSCs express a transmembrane protein that is known to play a major role in suppressing the immune system during particular events such as pregnancy, tissue allografts, and autoimmune disease - programmed death-ligand 1 (PD-L1). Figure 17B provides a representative flow cytometry profile of a breastmilk sample (whole milk) for a ligand of PD-1, programmed death-ligand 1 (PD-L1). The percentage of PD-L1 positive cells present in human breastmilk as determined by flow cytometry was 63.4%. Similarly, the percentage of PD-1 positive cells present in human breastmilk as determined by flow cytometry was 65.3% (Figure 17A). [00127] Under normal circumstances, the immune system reacts to foreign antigens via proliferation of antigen-specific CD8-positive T immune cells. However, it has been suggested that the formation of PD-1 receptor / PD-L1 ligand complex transmits an inhibitory signal which reduces the proliferation of such CD8-positive T cells. As shown in Figures 16A, 16B and 16C, and as indicated above, human breastmilk contains cells expressing immune cell markers (CD45), epithelial markers (EPCAM) and stem cell markers (CD29). As such, the expression of the PD-1 receptor/ PD-L1 ligand complex may convey reduced immunogenicity to BSCs and allow for their infiltration into the tissues of the breastfed infant without eliciting a potentially detrimental immune response. The expression of the PD-1 receptor / PD-L1 ligand complex shown for breastmilk immune cells on the other hand may convey increased tolerance of such immune cells towards infant-derived tissue/cells, generally establishing an environment more permissive to integration of allogeneic cells into the infant's tissue. [00128] As such, the in vitro multi-lineage differentiation potential of breastmilk-derived stem cells together with the lack of tumor formation in recipient animals and the reduced immunogenicity due to the expression of the PD-1 receptor / PD-L1 ligand complex support the potential benefits of using hBSCs as a therapeutic alternative to hESCs and hiPSCs, the use of which is hindered by the ethical and safety issues discussed above 41 (Takahashi et al., 2007; Miura et al., 2009; Ghosh et al., 2011). Because of its ethical, non-invasive and plentiful nature, breastmilk offers a novel resource of patient-specific stem cells for applications in regenerative medicine. [00129] In light of the above, it will be appreciated that in accordance with the present invention, BSCs can be isolated, expanded and enriched. Conveniently, the BSCs may be expanded as spheroids. As indicated above, such BSCs or spheroids may be used for autologous cell therapies of the breastmilk donor or of individuals having a matching immunogenicity profile. Advantageously, the BSCs of the present invention may also be used in heterologous, therapeutical applications. [00130] It will further be appreciated that the cell therapy can consist of therapy comprising the administration of the pluripotent BSCs or of the spheroids comprising or consisting of the BSCs of the invention or of therapy comprising the administration of more committed/differentiated cells which are directly derived from the BSCs or from the spheroids comprising or consisting of the BSCs. [00131] Furthermore, the skilled addressee will understand that compositions comprising the BSCs or the spheroids comprising or consisting of the BSCs of the present invention or more committed/differentiated cells directly derived from the BSCs or the spheroids comprising or consisting of the BSCs of the invention may be prepared. Such compositions may be formulated to allow storage or transport of viable cells - either in the form of individual BSCs or in the form of spheroids comprising or consisting of the BSCs. Alternatively, the compositions may be pharmaceutical compositions for therapeutical administration comprising the BSCs or the spheroids comprising or consisting of the BSCs of the present invention or more committed/differentiated cells directly derived from the BSCs or the spheroids comprising or consisting of the BSCs of the invention. [00132] As indicated above, in a further embodiment, the present invention relates to methods of expanding the BSC population such that large cell numbers can be obtained either as individual cells or as a plurality of spheroids comprising or consisting of the BSCs. These cells or spheroids can then be banked in cell banks such that they can be made available at a later stage. With a clear trend towards personalised medicine, banked cells according to the present invention provide a valuable source of therapeutic cells.

42 [00133] In light of the above, it will also be appreciated that breastmilk and the BSCs or the spheroids comprising or consisting of the BSCs of the present invention can serve as a valuable resource for breast cancer research. Specifically, it is proposed that cells of different degrees of differentiation of the mammary gland may serve as model systems for aberrant cell growth and proliferation in breast cancer. As such, the BSCs or the spheroids comprising or consisting of the BSCs of the present invention can provide new cell culture model systems for breast cancer research. [00134] Thus, while there has been described what are believed to be the preferred embodiments of the invention, those skilled in the art will recognize that other and further modifications may be made thereto without departing from the spirit of the invention, and it is intended to claim all such changes and modifications as falling within the scope of the invention.

Claims (39)

1. A method of preparing a spheroid comprising or consisting of breastmilk stem cells (BSCs), said method comprising the steps of: a) separating cells from non-cellular portions of breastmilk obtained from a subject, wherein said cells comprise a mixture of cell types; b) growing said cells in suspension culture to form one or more spheroids; c) harvesting at least one of said one or more spheroids, wherein said one or more spheroids comprise or consist of said BSCs; and d) optionally, isolating at least one BSC from said one or more spheroids.

2. The method of claim 1 wherein the step of growing said cells comprises the proliferation of cells of at least one cell type.

3. The method of claim 1 or claim 2 wherein the step of growing said cells comprises selective proliferation of said BSCs.

4. The method of any one of claims 1 to 3 wherein said at least one spheroid is harvested after growing in suspension culture for up to 12-14 days.

5. The method of any one of claims 1 to 3 wherein said at least one spheroid is harvested after growing in suspension culture for 9 days.

6. The method of any one of claims 1 to 5, further comprising the step of passaging said one or more spheroids in suspension culture after step (b) and before step (c).

7. The method of claim 6 wherein said passaging comprises dissociating said one or more spheroids.

8. The method of any one of claims 1 to 7 wherein said one or more spheroids are grown in a low-binding cell culture vessel. 44

9. The method of any one of claims 1 to 8 wherein said one or more spheroids are grown in a feeder-free culture.

10. The method of any one of claims 1 to 9 wherein the step of growing said cells in suspension culture comprises growing said cells in the presence of any one or more of the following, or a combination thereof: a growth factor, insulin, transferrin, selenium, nicotinamide, dexamethasone, fetal bovine serum or a non-essential amino acid (NNEA).

11. The method of claim 10, wherein said growth factor is selected from epidermal growth factor and fibroblast growth factor.

12. The method of any one of claims 1 to 11 wherein said BSCs are pluripotent stem cells.

13. The method of any one of claims 1 to 12 wherein the breastmilk is human breastmilk and wherein said BSCs are human pluripotent stem cells (hBSCs).

14. The method of claim 13 wherein said (hBSCs) express Oct4, Sox2, Nanog and/or Klf4.

15. The method of claim 13 wherein said (hBSCs) express Oct4, Sox2, Nanog, SSEA4 and TRA-1-60/81.

16. The method of any one of the preceding claims wherein said breastmilk is obtained from a subject after initiation of feeding.

17. The method of claim 16 wherein said breastmilk is obtained after or at the end of said feeding.

18. The method of claim 17 wherein said breastmilk is obtained from about 0 minutes to about one hour after said feeding.

19. The method of claim 17 wherein the breastmilk is obtained about 25-30 minutes after said feeding. 45

20. The method of any one of the preceding claims further comprising the step of differentiating said BSCs.

21. The method of claim 20 wherein said at least one isolated BSC is differentiated to become a myoepithelial cell, a luminal cell, a lactocyte, a neural cell, a stromal cell, an osteoblast, a chondrocyte, an adipocyte, a cardiomyocyte, a hepatocyte, or a beta islet cell.

22. An isolated breastmilk stem cell (BSC) or a spheroid comprising or consisting of BSCs prepared according to the method of any one of claims 1 to 11.

23. The BSC of claim 22 wherein said cell is a pluripotent stem cell.

24. The BSC of claim 22 or claim 23 wherein said cell has low tumorigenicity and does not form teratomas.

25. An isolated breastmilk stem cell (BSC), wherein said BSC is a pluripotent stem cell or a progenitor or a more committed cell.

26. The isolated BSC of claim 25, wherein said BSC is capable of differentiating or has differentiated to become a myoepithelial cell, a luminal cell, a lactocyte, a neural cell, a stromal cell, an osteoblast, a chondrocyte, an adipocyte, a cardiomyocyte, a hepatocyte, or a beta islet cell.

27. A method of cell treatment in a patient in need thereof comprising administering to said patient an effective amount of the cell or the spheroid of claim 22.

28. A method of treating a disease condition in a patient in need thereof comprising the step of administering to the patient an effective amount of the cell or the spheroid of claim 22, wherein the disease condition is a cardiovascular disease, diabetes, inborn errors in metabolism, cancer, a neurological disease, a chronic disease, a liver disease, a fatal infant disease, or any organ/tissue disease for which administration of said cell is beneficial.

29. The method of claim 27 or claim 28, wherein the cell or the spheroid is positive for the PD-1 receptor / PD-L1 ligand complex. 46

30. The method of claim 29, wherein the cell is capable of integrating into a tissue of the patient.

31. The method of claim 30 wherein the cell is allogeneic to the patient.

32. The method of claim 31, wherein the patient is an infant and the cell is obtained from the breastmilk of the infant's mother.

33. The method of claim 32, wherein the cell is autologous to the patient.

34. A method of integrating a cell or spheroid of claim 22 into a tissue of a recipient, wherein said method comprises administering said cell or spheroid to said recipient.

35. The method of claim 34, wherein the cell or the spheroid is positive for the PD-1 receptor / PD-L1 ligand complex.

36. The method of claim 35, wherein the cell is capable of integrating into a tissue of the recipient.

37. The method of claim 36 wherein the cell is allogeneic to the recipient.

38. The method of claim 37, wherein the recipient is an infant and the cell is obtained from the breastmilk of the infant's mother.

39. The method of claim 38, wherein the cell is autologous to the patient.