WO2009154770A2

WO2009154770A2 - Mesenchymal stem cells, compositions, and methods for treatment of cardiac tissue damage

Info

Publication number: WO2009154770A2
Application number: PCT/US2009/003657
Authority: WO
Inventors: Darwin J. Prockop; Ryang Hwa Lee
Original assignee: The Texas A & M University System
Priority date: 2008-06-18
Filing date: 2009-06-18
Publication date: 2009-12-23
Also published as: JP2015199755A; EP3029061B1; EP3029061A1; WO2009154770A3; US20100278790A1; JP5866601B2; EP2294183A4; JP2011525355A; US10035834B2; EP2294183B1; EP2294183A2

Abstract

The present invention provides compositions comprising mesenchymal stem cells (MSCs), and methods for their novel use in the repair of cardiac damage and treatment of inflammatory diseases. The invention also provides methods for using TSG-6 protein that is secreted by MSCs under certain conditions, for repair of cardiac damage and inflammatory disease. The compositions of the invention may be particularly useful in restoring cardiac function following cardiac damage, including, but not limited to, myocardial infarction, as well as in reducing symptoms of inflammatory disease.

Description

MESENCHYMAL STEM CELLS, COMPOSITIONS, AND METHODS FOR TREATMENT OF CARDIAC TISSUE DAMAGE

This application claims priority to co-pending U.S. Provisional Application Serial No. 61/073,739, filed June 18, 2008, herein incorporated by reference in its entirety for all purposes.

The invention was made with U.S. Government support under grant numbers HL073252, P40 RR 17447, POl HL 075161 and 1R01HL080682-01A2 awarded by the National Heart, Lung, and Blood Institute of the National Institutes of Health. The United States Government has certain rights in the invention.

FIELD OF THE INVENTION

The present invention relates to compositions comprising mesenchymal stem cells (also called mesenchymal stromal cells, or MSCs), and to their novel uses for repair of cardiac damage and treatment of inflammatory diseases. The invention also relates to a protein (TSG- 6) secreted by MSCs under certain conditions, and its novel use for repair of cardiac damage and treatment of inflammatory disease. The compositions of the invention may be particularly useful in restoring cardiac function following cardiac damage, including, but not limited to, myocardial infarction, as well as in reducing symptoms of inflammatory disease.

BACKGROUND OF THE INVENTION

There is currently tremendous optimism and enthusiasm for cell-based therapies for heart disease. However, cell therapy is in its early stages, and various questions remain. For example, the identification of those patients who benefit most from cell therapy, the optimal cell type and number for patient with acute and chronic diseases, the best time and way of cell delivery, and the mechanisms of action by which cells exhibit beneficial effects, need to be further evaluated."

As summarized in a recent review (Segers and Lee, 2008), there were 31 reports of clinical trials involving cell therapies in patients with MI. Of these, 14 reported statistically significant improvement in left ventricular ejection fraction, one noted decreased mortality, two did not provide sufficient data to evaluate, and 14 reported no significant improvement in ejection fraction. It is clear, however, that the significance of these results is extremely difficult to evaluate because a variety of different cells were used, including: bone marrow nucleated cells; circulating progenitor cells; CDl 33 hematopoietic stem cells; CD34 hematopoietic stem cells; skeletal myoblasts; MSCs; a combination of MSCs and endothelial progenitor cells; and unspecified bone marrow cells. The different studies also used significantly different criteria for selecting and evaluating patients, the nature of their controls, the number of patients enrolled, mean follow-up times, the number of cells administered, and the routes of administration. Therefore, the best that one can conclude at the moment is that cell-based therapies offer promise for patients with cardiac disease, but many aspects of the potential therapies require further study (see Segers and Lee, 2008; Dimmeler & Leri, 2008; Charwat et al., 2008; Burt et al., 2008). There is a need to better define the optimal cells, routes of administration and the mechanism by which MSCs can repair the heart. The technical problem underlying the present invention was therefore to overcome these prior art difficulties by identifying a suitable cell type for cell-based therapies for heart disease, and by identifying at least one cell-based factor responsible for improved outcomes in heart disease. The solution to this technical problem is provided by the embodiments characterized in the claims.

SUMMARY OF THE INVENTION

As indicated herein, the inventors have made considerable progress on several of the aforementioned goals as they relate to cell therapy with the stem/progenitors cells from bone marrow, referred to as mesenchymal stem cells or multipotent mesenchymal stromal cells (in either case, "MSCs"). In particular, the inventors have discovered surface epitopes that define a sub-population of MSCs (defined as RS-MSCs) that demonstrate decreased propensity to generate lethal pulmonary emboli, increased engraftment into infarcted hearts of mice, and more efficient differentiation than preparations of MSCs currently employed by most investigators in the field. The inventors demonstrate herein that after intravenous (IV) infusion of human MSCs into mice, MSCs entrapped in the lungs are activated to express extremely high levels of a pluripotent anti-inflammatory gene known as "TNFα stimulated gene 6" (TSG-6). TSG-6 is also known as "tumor necrosis factor-alpha-induced protein 6," or TNFAIP6, and its expression is also induced by interleukin-1 (ILl) and lipopolysaccharide (LPS). The expression of TSG-6 by MSCs inhibits deleterious inflammatory responses to infarction, and the functional improvements in mice with myocardial infarction (MI) are due in large part to the activation of MSCs and their expression of TSG-6. Thus, the inventors provide an explanation for the paradoxical observations reported by many others, wherein IV infusions of MSCs improve the function after myocardial infarction (MI) even though most of the infused cells are trapped in the lungs. Moreover the data suggest that at least some of the beneficial effects of cell-based therapies for MI can be obtained via: 1) infusions comprising MSCs activated by pre-incubation with TNFα, ILl, and/or LPS to express elevated levels of TSG-6; 2) infusions comprising MSCs engineered to express elevated levels of TSG-6 (e.g., transfected MSCs over-expressing TSG-6); and 3) infusions comprising recombinant TSG-6 (e.g., recombinant human TSG-6). As used herein, "infusion" contemplates both intravenous and intracardiac infusion, unless specifically modified.

Thus, in one embodiment, the invention provides a method of treating cardiac damage comprising administering to a mammal in need thereof a plurality of MSCs, wherein said MSCs are pre-activated MSCs, and further wherein said pre-activated MSCs express elevated levels of TSG-6. The invention also provides a method of treating cardiac damage comprising administering to a mammal in need thereof a plurality of MSCs, wherein said MSCs over- express TSG-6. Also provided is a method of treating cardiac damage comprising administering to a mammal in need thereof recombinant human TSG-6. The inention additionally provides an MSC, wherein said MSC has been transfected to over-express TSG- 6. The invention further provides a pharmaceutically-acceptable preparation of MSCs, wherein said MSCs have been pre-activated with one or more of the following: TNFα; ILl , or LPS.

More specifically, the invention contemplates selecting and isolating TSG-6 positive cells from the population of MSCs pre-activated with one or more cytokines (e.g. so as to isolate an enriched population, i.e. a population with a reduced number of TSG-6 negative cells). In one embodiment, positive selection is achieved with an antibody to TSG-6 (e.g. an immobilized antibody for cell capture, a fluorescent antibody for cell sorting, etc.).

The invention further provides a purified population of mesenchymal stem cells (MSCs) that has been contacted with one or more ligands under conditions to express increased levels of TSG-6 protein. In a preferred embodiment, the contacting comprises in vitro treatment. In a further embodiment, the ligand comprises a cytokine, chemokine, and/or LPS.

The invention also provides a purified population of mesenchymal stem cells (MSCs) that has been contacted with one or more of TNF-alpha, ILl, and LPS under conditions to express increased levels of TSG-6 protein. In a more preferred embodiment, the purified population comprises purified rapidly self-renewing mesenchymal stem cells (RS-MSCs).

The invention also provides a purified population of rapidly self-renewing mesenchymal stem cells (RS-MSCs) that has been contacted with one or more of TNF-alpha, ILl, and LPS under conditions to express increased levels of TSG-6 protein. The irivention further provides a population of.transgenic mesenchymal stem cells

(MSCs) that (a) comprises a heterologous nucleotide sequence encoding TSG-6 protein, and (b) expresses the TSG-6 protein. In one preferred embodiment, the population is purified. In an alternative embodiment, the population of transgenic mesenchymal stem cells (MSCs) comprises transgenic rapidly self-renewing mesenchymal stem cells (RS-MSCs) that (a) comprise a heterologous nucleotide sequence encoding TSG-6 protein, and (b) express the TSG-6 protein. In yet a further embodiment, the transgenic rapidly self-renewing mesenchymal stem cells (RS-MSCs) are purified.

Also provided herein is a population of transgenic rapidly self-renewing mesenchymal stem cells (RS-MSCs) that (a) comprises a heterologous nucleotide sequence encoding TSG-6 protein, and (b) expresses the TSG-6 protein.

The invention additional provides a pharmaceutical composition comprising a population of any of the cells described herein.

The invention further provides a method for purifying rapidly self-renewing mesenchymal stem cells (RS-MSCs), comprising a) providing a first population of cells comprising RS-MSCs, b) contacting the population of cells with one or both of (i) an antibody that specifically binds to PODXL and (ii) an antibody that specifically binds to CD49f, and c) isolating cells that bind to the one or both of the antibodies, thereby producing a population of purified RS-MSCs. In one embodiment, the method further comprises d) contacting the population of purified RS-MSCs with one or more of TNF-alpha, ILl, and LPS under conditions to produce a contacted population of cells that expresses increased levels of TSG-6 protein compared to TSG-6 protein levels expressed by the population of purified RS-MSCs. In yet another embodiment, the increased levels of TSG-6 protein are from 10 fold to 500 fold. In a further embodiment, the method further comprises d) transfecting the population of purified RS-MSCs with a nucleotide sequence that encodes TSG-6 protein. The invention further contemplates a purified population of rapidly self-renewing mesenchymal stem cells (RS-MSCs) produced by any of the methods described in this paragraph..

The invention also provides a method for reducing one or more symptoms of cardiac muscle cell necrosis in a mammalian subject comprising a) providing i) a mammalian subject in need of reducing one or more symptoms of cardiac muscle cell necrosis, and ii) a composition comprising purified tumor necrosis facto-alpha stimulated gene 6 (TSG-6) protein, and b) administering a therapeutically effective amount of the composition to the mammalian subject, thereby reducing one or more symptoms of the cardiac muscle cell necrosis. Without limiting the route of administration, in one embodiment, administering is selected from the group consisting of intramuscular administration into cardiac muscle and intravenous administration. In a further embodiment, the TSG-6 protein is purified from a transgenic cell that (a) comprises a heterologous nucleotide sequence encoding TSG-6 protein, and (b) expresses the TSG-6 protein.

The invention also provides a method for reducing one or more symptoms of cardiac muscle cell necrosis in a mammalian subject comprising a) providing i) a mammalian subject in need of reducing one or more symptoms of cardiac muscle cell necrosis, and ii) a population of purified mesenchymal stem cells (MSCs) that has been contacted with one or more chemokine, cytokine and LPS under conditions to express increased levels of TSG-6 protein, and b) administering a therapeutically effective amount of the population of purified mesenchymal stem cells (MSCs) to the mammalian subject, thereby reducing one or more symptoms of the cardiac muscle cell necrosis. In a particular embodiment, the population of purified mesenchymal stem cells (MSCs) comprises purified rapidly self-renewing mesenchymal stem cells (RS-MSCs). In a further embodiment, the step of administering is selected from the group consisting of intramuscular administration into cardiac muscle and intravenous administration.

In addition, the invention provides a method for reducing one or more symptoms of cardiac muscle cell necrosis in a mammalian subject comprising a) providing i)a mammalian subject in need of reducing one or more symptoms of cardiac muscle cell necrosis, ii) a population of transgenic mesenchymal stem cells (MSCs) that (a) comprises a heterologous nucleotide sequence encoding TSG-6 protein, and (b) expresses the TSG-6 protein, and coadministering a therapeutically effective amount of the population of transgenic mesenchymal stem cells (MSCs) to the mammalian subject, thereby reducing one or more symptoms of the cardiac muscle cell necrosis. In one embodiment, the population of transgenic mesenchymal stem cells (MSCs) comprises purified rapidly self-renewing mesenchymal stem cells (RS-MSCs). In a further embodiment, the step of administering is selected from the group consisting of intramuscular administration into cardiac muscle and intravenous administration. The invention also provides a method for reducing one or more symptoms of sterile inflammation in a mammalian subject comprising a) providing i) a mammalian subject in need of reducing one or more symptoms of sterile inflammation in a tissue, and ii) a population of purified mesenchymal stem cells (MSCs) that has been contacted with one or more of TNF-alpha, ILl, and LPS under conditions to express increased levels of TSG-6 protein, and b) administering a therapeutically effective amount of the population of purified mesenchymal stem cells (MSCs) to the mammalian subject, thereby reducing one or more symptoms of. the sterile inflammation in the tissue. In one embodiment, the population of purified mesenchymal stem cells (MSCs) comprises purified rapidly self-renewing mesenchymal stem cells (RS-MSCs). In a further embodiment, the step of administering is selected from the group consisting of intramuscular administration into cardiac muscle and intravenous administration. In another embodiment, the tissue comprises cardiac muscle tissue, and administering is selected from the group consisting of intramuscular administration into the cardiac muscle tissue and intravenous administration. In another embodiment, the subject has, or is at risk of having, a^'sterile inflammatory disease. Also provided is a method for reducing one or more symptoms of sterile inflammation in a mammalian subject comprising a) providing i) a mammalian subject in need of reducing one or more symptoms of sterile inflammation in a tissue, ii) a population of transgenic mesenchymal stem cells (MSCs) that (a) comprises a heterologous nucleotide sequence encoding TSG-6 protein, and (b) expresses the TSG-6 protein, and b) administering a therapeutically effective amount of the population of transgenic mesenchymal stem cells (MSCs) to the mammalian subject, thereby reducing one or more symptoms of the sterile inflammation in the tissue. In one embodiment, the population of transgenic mesenchymal stem cells (MSCs) comprises purified rapidly self-renewing mesenchymal stem cells (RS- MSCs). In another embodiment the tissue comprises cardiac muscle tissue, and administering is selected from the group consisting of intramuscular administration into the cardiac muscle tissue and intravenous administration. In an alternative embodiment, the subject has, or is at risk of having, a sterile inflammatory disease.

The invention also provides a method for reducing one or more symptoms of sterile inflammation in a mammalian subject comprising a) providing i) a mammalian subject in need of reducing one or more symptoms of sterile inflammation in a tissue, and ii) a composition comprising purified tumor necrosis facto-alpha stimulated gene 6 (TSG-6) protein, and b) administering a therapeutically effective amount of the composition to the mammalian subject, thereby reducing one or more symptoms of the sterile inflammation in the tissue. In one embodiment, the tissue comprises cardiac muscle tissue, and administering is selected from the group consisting of intramuscular administration into the cardiac muscle tissue and intravenous administration. In an alternative embodiment, the subject has, or is at risk of having, a sterile inflammatory disease. In a further embodiment, the TSG-6 protein is purified from a transgenic cell that comprises a heterologous nucleotide sequence encoding TSG-6 protein, and that expresses the TSG-6 protein.

The invention additionally provides a method for detecting sterile inflammation in a tissue in a mammalian subject comprising a) providing a mammalian subject in need of reducing one or more symptoms of sterile inflammation in a tissue, and b) detecting an increase in serum level of two or more (including three, four, five and six) of plasmin activity, macrophage chemoattractant protein -1 (MCP-I), macrophage inflammatory protein- 1 alpha (MIP-I alpha), beta thromboglobulin, soluble ST2 receptor, C-reactive protein (CRP), and natriuretic peptide compared to a control mammalian subject lacking the sterile inflammation in the tissue. In one embodiment^ the tissue comprises cardiac muscle tissue. In another embodiment, the method further comprises c) administering to the subject a therapeutically effective amount of one or more of i) a composition comprising purified tumor necrosis factor-alpha stimulated gene 6 (TSG-6) protein, ii) a population of purified mesenchymal stem cells (MSCs) that has been contacted with one or more of TNF-alpha, ILl, and LPS under conditions to express increased levels of TSG-6 protein, and ii) a population of transgenic mesenchymal stem cells (MSCs) that comprises a heterologous nucleotide sequence encoding TSG-6 protein and expresses the TSG-6 protein, wherein the administering produces a treated subject, and d) detecting, in the treated subject, a reduction in serum level of two or more of the plasmin activity, MCP-I, MIP-I alpha, beta thromboglobulin, soluble ST2 receptor, CRP, and natriuretic peptide, compared to the serum level that is detected in step b).

BRIEF DESCRIPTION OF THE DRAWINGS

For a further understanding of the nature, objects, and advantages of the present invention, reference should be had to the following detailed description, read in conjunction with the following drawings, wherein like reference numerals denote like elements.

FIG. 1 shows the use of micfoarrays as a preliminary screen for useful surface epitopes. FIG. IA is a schematic of two protocols used to prepare human MSCs. High density cultures are employed by many investigators; low density cultures are designed to retain RS-MSCs. FIG. IB shows phase-contrast photomicrographs of viable MSCs from

Passage 1/ donor 1 plated at 100 cells/cm2 and incubated for 5 or 9 days to generate Passage 2 MSCs. FIG. 1C shows an assay by forward and side scatter of light of MSCs from FIG. IB. Vertical and horizontal lines were generated with microbeads to standardize the assay. The inventors previously used the assay to distinguish RS-MSCs from SM-MSCs but it was not highly reproducible (Smith et al., 2004). FIG. ID shows microarray assays of mRNAs from viable hMSCs from Passage 1 /donor 6 plated at 100 cells/cm2 and incubated for 5 days to about 50 % confluency, 10 days to 100% confluency and 15 days to over-confluency. The values were normalized to mRNA signals on day 15 (left panel) or on day 5 (right panel).

FIG. 2 shows assays of cultures of viable MSCs Passage 1 /donor 5 that were plated at 100 cells/cm² and incubated for 5 days or 9 days to generate Passage 2 MSCs. To prepare

Passage 3 MSCs, 9-day cultures were lifted with trypsin/EDTA and re-plated at 100 cells/cm² for incubation for 5 or 9 days. FIG. 2A shows RT-PCR assays. FIG. 2B shows Western blot assays. (C) shows assays by immunbcytochemistry. Bar = 200 μm. Nuclei were labeled with DAPI (9-day columns, Passages 2 and 3). FIG. 3 shows FACScans of changes in the epitopes in MSCs with expansion in culture. FIG. 3 A shows Viable Passage 1 /donor 4 MSCs plated at 100 cells/cm² and incubated for 5, 6, 7, 8, or 9 days. Cells were lifted with trypsin/EDTA. FIG. 3B shows data obtained with MSCs from 5 donors under conditions as in FIG. 3A. Values expressed either as mean fluorescence intensity (X-means) or % positive cells. FIG. 3 C shows X-mean values from FIG. 3B normalized to values for day 5. FIG. 3D shows FACScan from Passage 1/donor 1 MSCs incubated as in FIG. 3A and assayed for STRO-I and GD2. FIG. 3E shows X-means values from Passage 1/donor 1 and donor 7 MSCs.

FIG. 4 shows tissue distributions (expressed as % injected cells) of intravenously infused MSCs. One million Passage 2 MSCs (donor 1 and donor 8) that were either PODXL^hi/CD49f^hi or PODXL^l7CD49f^!o were infused intravenously into control mice or mice with myocardial infarctions (MI). Tissues were recovered one day after the MSC infusions. Values from real-time PCR assays for human AIu sequences are expressed either as % of infused human cells or as human cell numbers. Error bars: range of values; n = 4 to 6. Asterisk: p < 0.05 versus PODXL^hi/CD49f^hl in control mice and p < 0.05 versus PODXL^l7CD49f^)o in MI mice by nohparametric Mann- Whitney test; the Kolmogorov- Smirnov test indicated the data were not normally distributed. Double asterisk: p < 0.05 versus PODXL^hi/CD49f^hl in control mice and p < 0.05 verse PODXL¹7CD49f^l° in MI mice by two-tailed Student's t-test. Cross: p< 0.05 versus PODXL^l7CD49f^!o in MI mice by two- tailed Student's t-test.

FIG. 5 shows the tissue distribution of infused hMSCs, cancer cells, and human WBCs. FIG. 5, Top Left: Intravenously infused hMSCs were cleared from blood in less than 5 minutes (min). Total recovery of AIu sequences for seven other tissues are indicated by lower curve and numbers inserted. FIG. 5, Top Right: hMSCs infused into the left ventricle of the heart were also cleared in less than 5 min. FIG. 5, Bottom Left: Tissue distribution of human AIu sequences 15 min after IV infusion of hMSCs, a breast cancer cell line (MDAMB- 231), and human WBCs. FIG. 5, Bottom Right: Distribution 15 min after IC infusion of hMSCs and the cancer cell line.

FIG. 6 shows the tissue distribution (expressed as % of infused cells) of IV infused hMSCs (2 x 10⁶). FIG. 6A: Assays for AIu sequences and human mGAPDH demonstrating that over 80% of infused cells are trapped in lung and then gradually disappear over about 50 hr. FIG. 6B: Immunohistochemistry results demonstrating presence of human cells in lung (human β2-microglobulin +) 15 rrϊih after IV infusion of hMSCs. FIG. 6C: Tissue distribution of human AIu sequences 15 min after IV administration of hMSCs (10⁶) without and with prior administration of a vasodilator, or with prior incubation of the cells with antibodies to CD49f or CD49d, or infusion together with human WBCs (10⁶). FIG. 6D: Delayed appearance of hMSCs infused IV one day after MI. FIG. 7 shows results from real-time RT-PCR assays for human-specific mRNAs.

Symbols: "In vitro MSC" refers to RNA for hMSCs before IV infusion to mice; "In vivo MSC 1" and "In vivo MSC 2" refer to RNA from lungs of two separate mice (mouse one and mouse two) 10 hr after IV infusion of hMSCs (10⁶). Values are fold increases over levels observed in in vitro MSCs (set to value = 1). FIG. 8 shows expression of TSG-6. FIG. 8, Top Left: Real time RT-PCR assays of hMSCs (Passage 2 and 3) and fibroblasts incubated in serum-free medium withlO ng/ml TNFα. FIG. 8, Top Right: Western' blots of cell lysate's. Some of the TSG-6 was recovered in larger molecular forms apparently because of its tight binding to hyaluronan and other proteins. FIG. 8, Middle Left: ELISA assays of medium from hMSCs and fibroblasts (Fibros). FIG. 8, Middle Right: Western blots of conditioned medium (first four lanes) and loading control (second four lanes, Coomassie stained). FIG. 8, Bottom Left: Real-time RT- PCR assays of TSG-6 of hMSCs after transduction with siRNA to TSG-6. FIG. 8, Bottom Right: ELISA assays for TSG-6 in medium from samples in FIG. 8, Bottom Left.

FIG. 9 FIG. 9 shows the effects of IV hMSCs in mice with MI. Permanent MI was induced in mice and 2 x 10⁶ hMSCs or 100 micrograms recombinant TSG- 6 were infused into a tail vein after 1 hour. Serum or hearts were collected 48 hr later. FIG. 9A shows serum plasmin activity by chromozym PL (Roche Applied Science). Values are ± SD; ** p < 0.01 with n = 3. FIG. 9B shows the results of hearts assayed for tissue plasminogen activator (tPA) and urokinase (uPA) on a casein zymogen gel (Invitrogen). FIG. 9C shows the results of hearts assayed for pro- and active-matrix metalloprotease on a gelatin zymogen gel (Invitrogen).

FIG. 10. Circulating hMSCs after Intravenous Administration. CFU-f assay from mouse blood 15 min after intravenous administration of hMSCs. Colonies were labeled with anti-human nuclei, β2-microglobulin and DAPI. FIG. 11. Circulating hMSCs and Tissues Distribution after Intracardiac

Administration. A. Clearance of human AIu sequences from blood after intracardiac infusion of about 2 X 10⁶ hMSCs into mice. Values are means +/-S.D; n = 6. B. Tissues distribution of human AIu sequences 15 min after intracardiac infusion of about 2 X 10⁶ hMSCs into mice. Values are means +/-S.D; n = 6.

FIG. 12. Histology Sections from Heart 3 wk after MI. The heart was cut from the apex through base into 5 μm sections and stained with Masson Trichrome. Every 20^th section covering the infarct is shown. Symbols as in FIG. 16 B; n=3 or 4 hearts.

FIG. 13. Assays for Fate of hMSCs Infused into Mice. A. Clearance of human AIu sequences from blood after IV infusion of about 2 X 10⁶ hMSCs into mice. Values are means +/-S.D; n = 6. B. Standard curves for real time PCR assays of human AIu sequences in 7 organs. Values indicate ΔΔC_t for primers for mouse/human GAPDH genes and AIu sequences on same samples. C. Tissue distribution of human AIu sequences 15 min after IV infusion of about 2 X 10⁶ hMSCs into mice. Values are means +/-S.D; n = 6. D. Standard curves for real time RT-PCR assays of human mRNA for GAPDH. Values indicate ΔΔQ for primers for mouse/human GAPDH genes and cDNA for human specific GAPDH on same samples. E. Kinetics of hMSCs in lung and 6 other tissues after IV infusion of about 2 X 10⁶ hMSCs. Values are means +/-S.D; n = 6. F. Appearance of hMSCs in heart after IV infusion of about IX 10⁶ hMSCs 1 day after permanent ligation of the left anterior descending coronary artery.

FIG. 14. Heat Map of Microarray Assays of Mouse Lungs after IV Infusion of hMSCs. About 2 X 10⁶ hMSCs were infused IV and lung RNA was recovered 10 hr later for assays on both mouse-specific and human-specific microarrays (Affymetrix, Santa Clara, CA). Data were filtered for cross-hybridization (CV>0.5 and call > 33%), analyzed with the Microarray Suite 5.0 program, and normalized to a value of 1 and variance of 3 SD (+ 3, red; 3, blue). Gene ontology categories of genes are indicated. The number of genes with expression differences is indicated in the boxes. A. Assay on mouse specific chip. B. Assay of same RNA on human specific chip. Symbols: con, lung from control mouse; hMSCs con, sample of hMSCs added to lung from control mouse before extraction of RNA; hMSCs IV, sample from mouse lung 10 hr after IV infusion of hMSCs.

FIG. 15. Activation of hMSCs to Express TSG-6. A. Real-time RT-PCR assays for human-specific mRNAs in lung 10 hr after IV infusion of 2 X 10⁶ hMSCs. Values are fold increase over values for cultured hMSCs, normalized by ΔΔQ for hGAPDH. Symbols: hMSCs con, sample of hMSCs added to lung from control mouse before extraction of RNA; hMSCs IV 1 and 2, samples from lungs of 2 mice 10 hr after IV infusion of hMSCs. B. Realtime RT-PCR assays for human TSG-6 in mouse lung. About 2 X 10⁶ hMSCs were infused IV into naive mice (IV-nor) or mice at 1 h after MI (IV-MI) and lungs were recovered 0.25 hr to 24 hr after the infusions. Values are +/- SD; n=2 or, 3 for normal mice; n=6 for MI mice. C. Real-time RT-PCR assays for TSG-6 in hMSCs and human fibroblasts from the same donor incubated in serum-free medium withlO ng/ml TNF-α for 24 or 48 hr. Results with two passages of the same cells are shown. Values are +/- SD; n=3. D. ELISA assays for TSG-6 in medium from hMSCs and human fibroblasts incubated in serum-free medium with 10 ng/ml TNF-α for 48 hr. Values are +/- SD; n=3. E. Real-time RT-PCR assays TSG-6 of control hMSCs (Con), hMSCs treated with transfection reagents only (no siRNA), hMSCs transfected with a scrambled siRNA (scr siRNA) or hMSCs transduced with TSG-6 siRNA (TSG-6 siRNA). Cells were incubated with or without 10 ng/ml TNF-α for 6 hr. Values are +/- SD; n=3. F. ELISA assays for TSG-6 in medium after incubation of cells with or without TNF-α for 48 hr. Symbols: as in E. Values are +/- SD; n=3.

FIG. 16. Assays of Serum and Heart. A. Assay for cardiac troponin I in serum 48 hr after MI. Values are +/- SD; ** p < 0.01 with n = 3 (Normal) or 6 mice (MI) per group. B. Plasmin activity in serum 48 hr after MI. Symbols: Normal, naive mice; -, MI only; hMSCs, 2 X 10⁶ hMSCs infused IV 1 hr after MI; scr siRNA, 2 X 10⁶ hMSCs transduced with scrambled siRNA infused IV 1 hr after MI; TSG-6 siRNA, 2 X 10⁶ hMSCs transduced with TSG-6 siRNA infused IV 1 hr after MI; rhTSG-6, 30 μg rhTSG-6 protein infused IV 1 hr and again 24 hr after MI. Values are +/- SD; ** p < 0.01 with n = 3 mice per group. N.S.= not significant. C. Hearts assayed for pro- and active-matrix MMP9 on a gelatin zymogen gel 48 hr after MI. Image is reversed. Symbols: as in B. D and E. Granulocyte and monocyte infiltration in the heart 48 hr after MI. Sections stained with anti-Ly-6G and Ly-6C. Symbols: as in B except 100 μg rhTSG-6 protein was infused IV 1 hr and again 24 hr after MI. Magnification X 4. Scale bars, 250 μm. Values are ^■+/- SD; n = 3 or 4 for each group. ** p < 0.001; N.S.=not significant.

FIG. 17. Assays of Infarct Size. Each heart was cut from the apex through base into over 400 sequential 5 um sections and stained with Masson Trichrome. Every 20^th section is shown. Additional heart samples shown in FIG. 12. A. to E. Symbols as in FIG. 16 B except 100 μg rhTSG-6 protein was infused IV 1 hr and again 24 hr after MI. F. Infarct size measurements (%) obtained by midline length measurement from 10^th section of the infarct area for a total of 20 sections per heart (Takagawa et al., 2007). Values are +/- SD; n = 3 or 4 mice in each group; ***p < 0.0001 compared to MI controls; N.S.=not significant compared to MI controls; * p < 0.05 for MI + MSCs versus MI + rhTSG-6.

FIG. 18. Echocardiographic Assays 3 Wk after MI. A. Representative M-mode echocardiograms. Symbols: as in FIG. 16 B. B. Left ventricular fractional shortening (LVFS) and left ventricular ejection fraction (LVEF) from echocardiographic data. Values are +/- SD; n = 5 or 6 for each group; *p < 0.05 versus MI; N.S.=not significant. FIG. 19 shows (A) the TSG-6amino acid sequence and (B) nucleotide sequence encoding Homo sapiens tumor necrosis factor, alpha-induced protein 6 (TS G-6) (TNFAIP6) (GenBank No. NM_007115).

DEFINITIONS To facilitate understanding of the invention, a number of terms are defined below.

In this specification and the appended claims, the singular forms "a," "an," and "the" include plural reference unless the context clearly dictates otherwise. Unless defined otherwise, all technical and scientific terms used herein have the same meaning as commonly understood to one of ordinary skill in the art to which this invention belongs. The terms "cells" and "population of cells" interchangeably refer to a plurality of cells, i.e., more than one cell. The population may be a pure population comprising one cell type. Alternatively, the population may comprise more than one cell type. In the present invention, there is no limit on the number of cell types that a cell population may comprise. "Mesenchymal stem cell," "MSC," "bone marrow stromal cells" and "multipotent stromal cell," are interchangeably used to refer to a cell derived from bone marrow (reviewed in Prockop, 1997), peripheral blood (Kuznetsov et al., 2001), adipose tissue (Guilak et al., 2004), umbilical cord blood (Rosada et al., 2003), synovial membranes (De Bari et al., 2001), and periodontal ligament (Seo et al., 2005). MSCs are characterized by their ability to adhere to plastic tissue culture surfaces (Friedenstein et al.; reviewed in Owen & Friedenstein, 1988), and by being an effective feeder layers for hematopoietic stem cells (Eaves et al., 2001). In addition, MSCs can be differentiated both in culture and in vivo into osteoblasts and chondrocytes, into adipocytes, muscle cells (Wakitani et al., 1995) and cardiomyocytes (Fukuda and Yuasa, 2006), into neural precursors (Woodbury et al., 2000; Deng et al., 2001, Kim et al., 2006; Mareschi et al., 2006; Krampera et al., 2007). Mesenchymal stem cells (MSCs) may be purified using methods known in the art (Wakitani et al., 1995; Fukuda and Yuasa, 2006;, Woodbury et al., 2000; Deng et al., 2001 ; Kim.et al., 2006; Mareschi et al., 2006; Krampera et al., 2007).

"Rapidly self-renewing mesenchymal stem cell," "RS-MSC" and "type I mesenchymal stem cell" are interchangeably used to refer to an early progenitor cell. They are typically spindle shaped and are present in early-passage MSCs plated at low density. Rapidly self-renewing mesenchymal stem cells (RS-MSCs) may be purified from bone marrow cells and/or from a purified population of mesenchymal stem cells (MSCs) using methods described herein (e.g., binding to one or more of antibody that specifically binds to PODXL, and antibody that specifically binds to CD49f).)

"Slowly replicating mesenchymal stem cell," "type II mesenchymal stem cell" and "SR-MSC" are interchangeably used to refer to an early progenitor cell. The cells are larger in size than RS-MSC, and are present in early-passage MSCs plated at low density. Typically, SR-MSCs arise from RS-MSCs as the cultures expand to confluency.

The tqrms "reduce," "inhibit/¹ "diminish," "suppress,? "decrease," and grammatical equivalents (including "lower," "smaller," etc.) when in reference to the level of any molecule (e.g., amino acid sequence such as PODXL protein, CD49f protein, TSG-6 protein, MCP-I, MIP-I alpha, beta thromboglobulin, soluble ST2 receptor, CRP, natriuretic peptide, antibody that specifically binds to PODXL, antibody that specifically binds to CD49f protein, antibody that specifically binds to TSG-6 protein, etc., and nucleic acid sequence such as those encoding any of the polypeptides described herein), cell (e.g., bone marrow cell, mesenchymal stem cell (MSC), rapidly self-renewing mesenchymal stem cell (RS-MSC), slowly replicating mesenchymal stem cell (SR-MSC), etc.), and/or phenomenon (e.g., plasmin activity, symptom of a disease, cell proliferation, cell differentiation, cell engraftment, cell death, cell apoptosis, cell viability, cell survival, binding to a molecule, affinity of binding, expression of a nucleic acid sequence, transcription of a nucleic acid sequence, enzyme activity, etc.) in a first sample (or patient) relative to a second sample (or in a treated patient), mean that the, quantity of molecule, cell, and/or phenomenon, in the first sample (or patient) is lower than in the second sample (or in a treated patient) by any amount that is statistically significant using any art-accepted statistical method of analysis. In one embodiment, the reduction may be determined subjectively, for example when a patient refers to their subjective perception of disease symptoms, such as pain, fatigue, difficulty in breathing, clarity of vision, nausea, etc. In another embodiment, the quantity of molecule, cell, and/or phenomenon in the first sample is lower by any numerical percentage from 5% to 100%, such as, but not limited to, from 10% to 100%, from 20% to 100%, from 30% to 100%, from 40% to 100%, from 50% to 100%, from 60% to 100%, from 70% to 100%, from 80% to 100%, and from 90% to 100% lower than the quantity of the same molecule, cell and/or phenomenon in a second sample.

The terms "increase," "elevate," "raise," and grammatical equivalents (including "higher," "greater," etc.) when in reference to the level of any molecule {e.g., amino acid sequence such as PODXL protein, CD49f protein, TSG-6 protein, MCP-I, MIP-I alpha, beta thromboglobulin, soluble ST2 receptor, CRP, natriuretic peptide, antibody that specifically binds to PODXL, antibody that specifically binds to CD49f protein, antibody that specifically binds to TSG-6 protein, etc., and nucleic acid sequence such as those encoding any of the polypeptides described herein), cell (e.g., bone marrow cell, mesenchymal stem cell (MSC), rapidly self-renewing mesenchymal stem cell (RS-MSC), slowly replicating mesenchymal stem cell (SR-MSC), etc.), and/or phenomenon {e.g., plasmin activity, symptom of a disease, cell proliferation, cell differentiation, cell engraftment, cell death, cell apoptosis, cell viability, cell survival, binding to a molecule, affinity of binding, expression of a nucleic acid sequence, transcription of a nucleic acid sequence, enzyme activity, etc.) in a first sample (or patient) relative to a second sample (or treated patient), mean that the quantity of the molecule, cell and/or phenomenon in the first sample (or patient) is higher than in the second sample (or in a treated patient) by any amount that is statistically significant using any art-accepted statistical method of analysis. In one embodiment, the increase may be determined subjectively, for example when a patient refers to their subjective perception of disease symptoms, such as pain, fatigue, difficulty in breathing,' clarity of vision, nausea, etc. In another embodiment, the quantity of molecule, cell, and/or phenomenon in the first sample is higher by any numerical percentage, such as at least 10% greater than, at least 25% greater than, at least 50% greater than, at least 75% greater than, and/or at least 90% greater than the quantity of the same molecule, cell and/or phenomenon in a second sample. In yet a further embodiment, the quantity of molecule, cell, and/or phenomenon in the first sample is higher by any numerical amount from 5 fold to 1000 fold, including from 5 fold to 500 fold, 10 fold to 400 fold, from 20 fold to 300 fold, from 30 fold to 200 fold, from 40 fold to 200 fold, from 50 fold to 200 fold.

"Cardiac infarction," "myocardial infarction," "MI," "acute myocardial infarction," and "AMI" are commonly known as a heart attack, which occurs when the blood supply to part of the heart is interrupted causing myocardial muscle cell necrosis. This is most commonly due to occlusion (blockage) of a coronary artery following the rupture of a vulnerable atherosclerotic plaque. The resulting ischemia (restriction in blood supply) and oxygen shortage, if left untreated for a sufficient period of time, can cause damage and/or death (infarction) of heart muscle tissue (myocardium).

The terms "treating," "treatment" and grammatical equivalents when in reference to a disease (e.g., cardiac infarction, cardiac muscle cell necrosis, inflammation, etc.) encompasses delaying and/or reducing the level of one or more objective symptoms and/or one or more subjective symptoms.

"Tumor necrosis factor-alpha stimulated gene 6 protein," "TSG-6 protein," "TNF-α stimulated gene 6 protein," and "TNFAIP6 protein" are used interchangeably to refer to a secretory protein that contains a hyaluronan-binding domain, and thus is a member of the hyaluronan-binding protein family. The hyaluronan-binding domain is known to be involved in extracellular matrix stability and cell migration. This protein has been shown to form a stable complex with inter-alpha-inhibitor (I alpha I), and thus enhance the serine protease inhibitory activity of I alpha I, which is important in the protease network associated with inflammation. The expression of this gene can be induced by tumor necrosis factor alpha and interleukin-1. The expression can also be induced by mechanical stimuli in vascular smooth muscle cells, and is found to be correlated with proteoglycan synthesis and aggregation. TSG-6 protein is exemplified by the homo sapiens amino acid sequence of Figure 19 A, which is encoded by the nucleotide sequence of Figure 19 B (GenBank No. NM_007115). Recombinant purified human TSG-6 protein is commercially available (R&D Systems, Inc., Minneapolis, Catalog # 2104-TS-050 ). Antibodies that specifically bind to TSG-6 are commercially available (ELISA, monoclonal antibody specific for TSG-6 (clone A38.1.20; Santa Cruz Biotechnology, Inc., Catalog # BAF2104; biotinylated anti-human TSG-6 (TSG-6 Biotinylated PAb Detection Antibody; R&D Systems, Inc., Minneapolis).

"PODXL," "podocalyxin-like 2," "endoglycan," "PODLX2," "Podocalyxin-like protein 2 precursor," and "UNQ1861/PRO3742" are interchangeably used, and are exemplified by GenBank Accession no. NM Ol 5720, encoded by mRNA (GenBank)

AF219137. Antibodies that specifically bind to PODXL are known in the art, including FITC Labeled anti-Human PCLPl (Cat.# M084-4, MBL International Corporation, Woburn, Massachusetts).

"CD49f ' "alphaό-integrin" "integrin, alpha 6" and "ITGA6" protein product is the integrin alpha" chain alpha 6. Integrins are integral cell-surfade proteins composed of an alpha chain and a beta chain. A given chain may combine with multiple partners resulting in different integrins. For example, alpha 6 may combine^' with beta 4 in the integrin referred to as TSP 180, or with beta 1 in the integrin VLA-6. Integrins are known to participate in cell adhesion as well as cell-surface mediated signaling. Two transcript variants encoding different isoforms have been found for this gene. The amino acid sequence and nucleotide sequence of the exemplary homo sapiens integrin, alpha 6 (ITGA6), transcript variant 2, are described in GenBank Accession No. NM_000210. Homo sapiens chromosome 2, reference assembly, complete sequence is described in GenBank Accession No. NC_000002.11. Antibodies that specifically bind to CD49f are known in the art including PE-Cy5 Rat anti- Human CD49f (Cat.# 551129, BD PharMingen/BD Biosciences.

DETAILED DESCRIPTION OF THE INVENTION

The pfesent invention provides compositions comprising mesenchymal stem cells (MSCs), and methods for their novel use in the repair of cardiac damage and treatment of inflammatory diseases. The invention also provides methods for using TSG-6 protein, that is secreted by MSCs under certain conditions, for repair of cardiac damage and treatment of inflammatory disease. The compositions of the invention may be particularly useful in restoring cardiac function following cardiac damage, including, but not limited, to myocardial infarction, as well as in reducing symptoms of inflammatory disease. The inventors disclose herein: (i) the identification of new epitopes that can — for the first time — provide quantitative data on the RS-MSC content of preparations of MSCs; (ii) that RS-MSCs are more clonogenic, have a greater potential to differentiate in culture, and more effective engraft into MI heart and other tissues in mice than the confluent cultures of MSCs (SR- MSCs) employed by most other investigators; (iii) that heart function in MI mice improves after IV infusions of hMSCs because the cells trapped in the lung are activated to secrete large amounts of the multifunctional anti-inflammatory protein TSG-6 that inhibits serine proteinases in the injured heart; and (iv) that some of the protective effects of hMSCs in MI can be reproduced by systemic infusion of rhTSG-6.

The invention is further described under (A) Mesenchymal stromal cells (MSCs), (B) Intravenous hMSCs improve myocardial infarction in mice because cells embolized in the lung are activated to secrete the anti-inflammatory protein TSG-6, (C) Preactivated mesenchymal stem cells (MSCs), and/or preactivated rapidly self-renewing mesenchymal stem cells (RS-MSCs), that overxpress TSG-6 protein, (D) Transgenic mesenchymal stem cells (MSCs), and/or transgenic rapidly self-renewing mesenchymal stem cells (RS-MSCs), that overxpress TSG-6 protein, (E) Pharmaceutical Compositions, (F) Methods for purifying RS-MSCs, (G) Methods for treating cardiac muscle damage by administering preactivated MSCs and/or preactivated RS-MSCs, (H) Methods for treating cardiac muscle damage by administering transgenic MSCs and/or transgenic RS-MSCs, (I) Methods for treating cardiac muscle damage by administering TSG-6 protein, (J) Methods for treating sterile inflammation using preactivated MSCs and/or preactivated RS-MSCs, (K) Methods for treating sterile inflammation using transgenic MSCs and/or transgenic RS-MSCs, (L) Methods for treating sterile inflammation by administering TSG-6 protein, and (M) Methods for detecting inflammation using biomarkers.

A. Mesenchymal stromal cells (MSCs) Initial experiments carried out over a century ago suggested that blood-borne cells from bone marrow of mammals may participate in tissue repair and regeneration (reviewed in Prockop, 1997). Some of the first direct evidence for bone marrow cells that might contribute to the repair of multiple tissues were published over 40 years ago by Friedenstein et al. (reviewed in Owen & Friedenstein, 1988) who demonstrated that a small fraction of cells from bone marrow that adhere to tissue culture surfaces can be differentiated both in culture and in vivo into osteoblasts and chondrocytes. Later, the same plastic adherent cells from bone marrow were found to be effective feeder layers for hematopoietic stem cells (see Eaves et al., 2001). The initial observations by Friedenstein et al. were confirmed and extended by a large number of subsequent investigators (Castro-Malaspina et al., 1980; Mets and Verdonk, 1981; Piersma et al., 1983; Owen and Friedenstein, 1988; Caplan, 1990; Prockop, 1997). The further work demonstrated that the cells can also differentiate in culture into adipocytes, muscle cells (Wakitani et al., 1995) and cardiomyocytes (Fukuda and Yuasa, 2006). Initial reports by the inventors that MSCs can differentiate into neural precursors (Woodbury et al., 2000; Deng et al., 2001) were criticized as inconclusive, but there have been persistent reports by other laboratories that MSCs can differentiate in culture to cells that display the electrophysiological properties of neural cells (Kim et al., 2006; Mareschi et al., 2006;

Krampera et al., 2007). In addition, cells with properties very similar to bone marrow MSCs were identified in a large number of tissues, including peripheral blood (Kuznetsov et al., 2001), adipose tissue (Guilak et al., 2004), umbilical cord blood (Rosada et al., 2003), synovial membranes (De Bari et al., 2001), and periodontal ligament (Seo et al., 2005). The results suggested the presence of an extensive network of MSC-like stem/progenitor cells in many tissues. This network probably comprises the first responders to injury but then can be replenished by MSCs from the bone marrow in time of need.

Bone marrow MSCs have attracted attention in efforts to develop cell therapies (Caplan, 1990;Prockop, 1997; Prockop et al., 2003; Caplan, 2005), because they are readily obtained from patients and expanded in culture. The first clinical trial with MSCs was in patients with severe osteogenesis imperfecta (Horwitz et al., 1999; 2002), a disease of brittle bones caused by mutations in the genes for type I collagen (Prockop, 1985; Prockop & Kivirrikko, 1995). The trial was designed on the basis of data from experiments in a transgenic mouse model developed in our laboratory (Pereira et al., 1998). Subsequent trials were in patients with mucopolysaccharidoses (Koc et al., 2002), and then in patients with graft- versus-host disease (GVHD), which capitalized on the ability of the cells to suppress immune reactions (Aggarwal & Pittenger, 2005; Ringden et al., 2006). The recent explosion of new clinical trials with MSCs is prompted largely by three biotech companies that successfully launched initial public offerings (IPOs) within the last year and a half. The first of these companies, Osiris Therapeutics (Baltimore, Maryland), has announced clinical trials in arthritis, heart disease, Crohn's disease (Phase III), and type 1 diabetes (Phase II) and graft- versus-host- disease (Phase III). Other groups have announced trials a broader range of diseases including stroke.

Although MSCs originally attracted interest because of their stem-like properties to differentiate into multiple cellular phenotypes, more recent observations presented a paradox: the cells frequently repair injured tissues without much evidence of either engraftment or differentiation. For example, in the first clinical trial in which MSCs were used to treat children with severe osteogenesis imperfecta (Horwitz et al., 1999, 2002), children improved in growth rates and other symptoms. However, assays of tissues from the children revealed that less than 1% of the donor MSCs had engrafted. Similar observations of functional improvement were made subsequently in a series of animal models for diseases, including parkinsonism, spinal cord injury, stroke, and myocardial infarction (reviewed in Prockop et al., 2003; Prockop, 2007; Caplan & Dennis, 2006). In myocardial infarction, for example, some investigators have observed differentiation of MSCs into cardiomyocytes following MI (Fukuda & Yuasa, 2006). Most, though, reported improved function with little long term engraftment of MSCs into infarcted heart (see Mishra, 2008), an observation the inventors confirmed after IV infusion of human MSCs into immunodeficient mice with MI (Iso et al., 2007). Therefore, there has been a paradigm shift in the explanations as to how MSCs can repair injured tissues. There is now renewed interest in the early observations that MSCs provide effective feeder layers for hematopoietic cells (see Eaves et al., 2001), because they secrete a variety of cytokines and chemokines (see Zacharek et al., 2007; Schinkothe et al. 2008; Penolazzi et al., 2007).

The paradigm shift has been supported by recent evidence that MSCs respond to cross-talk with injured tissues to enhance repair via a number of different mechanisms, including: 1) enhanced proliferation and differentiation of tissue-endogenous stem/progenitor cells; 2) rescue of ischemic cells by transfer of mitochondria or mitochondrial DNA; 30 suppression of excessive inflammatory responses; and 4) suppression of excessive immune reactions.

The inventors observed that injection of human MSCs into the dentate gyrus of the hippocampus of mice enhanced proliferation, migration and neural differentiation of the endogenous neural stem cells of the mouse (Munoz et al, 2005). Without limiting the invention to a particular mechanism, such stimulation of tissue-endogenous stem/progenitor cells may in part explain the inventors' subsequent observations that intracardiac infusions of hMSCs lowered plasma sugar and increased mouse insulin in immunodeficient mice in which diabetes was induced with streptozotocin (Lee et al., 2006a).

The inventors also observed that after human MSCs were cocultured with a line of pulmonary epithelial cells with non-functional mitochondria (A549 p⁰ cells), rescued clones of the A549 p⁰ cells with full mitochondrial function were recovered (Spees et al., 2006). Genetic assays indicated that the rescued clones had received mitochondrial DNA from the MSCs without any transfer of genomic DNA or other evidence of cell fusion. Without limiting the invention to a particular mechanism, since loss of functional mitochondria is an early consequence of ischemia, MSCs may in part rescue ischemic injury to myocardium or other tissues since one of the earliest events in ischemic injury is loss of mitochondrial function.

Persistent chronic inflammation is now recognized as a contributing factor in a wide variety of diseases ranging from parkinsonism (Tansey et al., 2007; McGeer and McGeer 2007) to diabetes (Theuma and Fonseca 2004; Shoelson et al., 2007). A series of recent reports have emphasized that inflammatory responses to tissue injury in mammals are frequently excessive, and require cell mediators to actively suppress the responses and thereby improve tissue repair (Schwab et al., 2007; Serhan et al., 2008). One class of inflammation suppressors comprises the lipids referred to as lipoxins, resolvins and protectins (Sehran et al., 2008). A series of recent reports, though, indicate that MSCe provide another mechanism for suppressing inflammation because they can be activated to secrete peptides and proteins that modulate both inflammation and immune responses. Secretion by MSCs of the interleukin 1 (ILl) receptor antagonist apparently explained the improvements observed with administration of MSCs in a lung model of fibrosis induced by bleomycin (Ortiz et al., 2007). Intra-tracheal administration of MSCs suppressed inflammation and prolonged survival of mice by expression of MIP-I and other cytokines after acute lung inflammation was induced with LPS (Gupta et al., 2007). As indicated in below, the inventors have observed that when human MSCs are infused intravenously into mice, most of the cells are trapped in the lungs and activated to secrete the pluripotent anti-inflammatory protein TSG-6 (Getting et al. 2002; Wisniewski and Vilcek 2004; Forteza et al., 2007; Milner et al., 2006). A series of reports demonstrated that MSCs suppressed mixed lymphocyte reactions in culture, produced improvements in an animal model for multiple sclerosis (Gerdoni et al., 2007), and improved patients with graft versus host disease (Aggarwal & Pittenger, 2005; Le Blanc & Ringden, 2007). Recently, the mechanisms of immune suppression by MSCs were defined (Ren et al., 2008): MSCs are activated by IFNγ, together with one of three other proinflammatory cytokines to attract T lymphocytes. The MSCs then secrete nitrous oxide to suppress the T lymphocytes. The inventors recently observed that human MSCs injected into the hippocampus of mice after transient global ischemia are activated to reduce neurological deficits and neuron death by suppressing both inflammatory and immune reactions (Ohtaki et al., 2008).

A number of investigators have independently observed that MSCs can produce beneficial effects by IV administration both in animal models (Pereira et al., 1998; Akiyama et al., 2002; Chen et al., 2003; Nomura et al., 2005; Wu et al., 2008), and in patients (Horwitz et al., 1999, 2002; Koc et al., 2002; Ringden et al., 2006). The results are surprising, since it has been convincingly demonstrated that most MSCs that are infused IV are rapidly trapped in the lung (Gao et al., 2001; Schrepfer et al., 2007). Trapping of MSCs in the lung is not in itself unexpected, since it also occurs with polymorphonuclear (PMN)cells (Hogg et al., 1994), metastatic tumors (MacDonald et al., 2002), and probably hematopoietic stem cells (Dooner et al., 2004). However, it was not clear how MSCs trapped in the lung could enhance repair of the heart, brain and other tissues. Hence, the present inventors' observations on the effects of IV infusions into mice with MI (as presented below) represent a significant advance.

B. Intravenous hMSCs improve myocardial infarction in mice because cells embolized in lung are activated to secrete the anti-inflammatory protein TSG-6

Data herein show data obtained using quantitative assays for human DNA and mRNA, which were used to examine the paradox that intravenously (IV) infused human multipotent stromal cells (hMSCs) can enhance tissue repair without significant engraftment. After 2 X 10⁶ hMSCs were IV infused into mice, most of the cells were trapped as emboli in lung. The cells in lung disappeared with a half-life of about 24 hr but < 1,000 cells appeared in 6 other tissues. The hMSCs in lung up-regulated expression of multiple genes with a large increase in the anti-inflammatory protein TSG-6. After myocardial infarction, IV hMSCs but not hMSCs transduced with TSG-6 siRNA decreased inflammatory responses, reduced infarct size, and improved cardiac function. IV administration of recombinant TSG-6 also reduced inflammatory responses and reduced infarct size. The results suggest improvements in animal models and patients after IV infusions of MSCs are at least in part explained by activation of MSCs to secrete TSG-6.

The inventors first developed assays to provide quantitative data on the fate of human cells infused into mice. The inventors then demonstrated that IV infused human MSCs (hMSCs) produced functional improvement in mice with myocardial infarction (MI) at least in part because the cells trapped as emboli in lung are activated to express the anti- inflammatory factor TNF-α induced protein 6 (TNAIP6 or TSG-6).

The hMSCs trapped in mouse lung after IV infusion underwent major changes in their patterns of gene expression in response to the injury to the lung produced by micro- embolization of the cells in the pulmonary vasculature (Furlani et al., 2009; Lee et al., 2009). The up-regulation of the human TSG-6 was of special interest because of the anti- inflammatory effects of the protein (Milner et al., 2006; Wisniewski and Vilcek, 2004), and because excessive inflammatory responses contribute to the pathological changes produced by MI (Ovechkin et al., 2005; Paolocci et al., 2006; Carvalho et al., 2006; Fang et al., 2007; Moshal et al., 2008). Therefore the results suggested a possible explanation for the observations that IV infusions of MSCs improved cardiac function in models for MI (Halkos et al., 2008; Iso et al., 2007; Krause et al., 2007; Wolf et al., 2007). In the mouse model for MI, knock down of TSG-6 expression in hMSCs largely negated the improvements in inflammatory responses, infarct size and cardiac function produced by IV fusions of hMSCs. In addition, IV infusions of rhTSG-6 largely duplicated the therapeutic effects of the hMSCs on inflammatory responses and infarct size. Therefore the results indicated that the hMSCs that were trapped in the lung were activated to secrete TSG-6, and the TSG-6 suppressed the excessive inflammatory response to LAD so as to decrease the proteolytic damage to the heart and the subsequent fibrotic scarring and decrease in cardiac function. The 1,500 or so of hMSCs transiently appeared in the infracted heart after infusion of 10⁶ hMSCs may also have contributed to the anti-inflammatory effects. The up-regulation of TSG-6 was detected by the cross-species strategy of infusing hMSCs into NOD/scid mice. Similar strategies of using hMSCs in animal models previously proved useful, because the hMSCs provided numerous endogenous markers for the cells and no obvious cross-species artifacts were encountered (Hwang et al., 2008; Lu et al., 2009; Bai et al., 2009; Gonzalez-Rey et al., 2009; Sasportas et al., 2009), apparently because of the immune modulatory effects of the cells (Uccelli et al., 2008). Also, the strategy of using hMSCs avoids the technical difficulties of isolating mouse MSCs (Baddoo et al., 2003; Gnecchi and MeIo, 2009; Peister et al., 2004; Sung et al., 2008), and the marked tendency of mouse MSCs to develop genomic instability and become tumorgenic as they are expanded in culture (Sung et al., 2008; Tolar et al., 2007). Permanent LAD ligation in mice does not mimic human MI as closely as ischemia and reperfusion models in larger animals. However, permanent LAD ligation in NOD/scid mice provided a useful model for testing the effects on hMSCs because the mice retained the excessive inflammatory responses to MI (Iso et al., 2007). TSG-6 is a 30 kDa glycoprotein (Heng et al., 2008; Milner et al., 2006) that was shown to produce three distinct anti-inflammatory effects (Milner et al., 2006; Wisniewski and Vilcek, 2004). (a) It inhibits the inflammatory network of proteases primarily by increasing the inhibitory activity of inter-α-inhibitor; (b) it binds to fragments of hyaluronan and thereby blunt their pro-inflammatory effects; (c) it inhibits neutrophil infiltration into sites of inflammation. In transgenic mice, inactivation of the gene increased inflammatory responses (Szanto et al., 2004) and over-expression of the gene decreased inflammatory responses (Mindrescu et al., 2002). Also, administration of the recombinant protein improved arthritis in several murine models (Bardos et al., 2001; Mindrescu et al., 2000). Although TSG-6 was originally discovered by screening cDNA libraries from fibroblasts incubated with TNF-α (Lee et al., 1992), the results here demonstrated that hMSCs produced far more TSG-6 in response to TNF-α than dermal fibroblasts.

The hMSCs trapped in lung secreted additional cardioprotective factors in addition to TSG-6. The effects of rhTSG-6 on infarct size in the mice were slightly less than the effects of IV infusions of hMSCs. MSCs in culture and in response to chemokines or injured cells secrete large amounts of therapeutic factors such as TGF-β, HGF, IL-4, IL-10, PGE2 and stanniocalcin-1 (Caplan, 2009; Gnecchi et al., 2008; Block et al., 2009; Ohtaki et al., 2008). TSG-6 may however play a key role in many beneficial effects of MSCs. Inflammatory responses to sterile tissue injury are frequently excessive and require active suppression (Schwab et al., 2007). Also, chronic inflammation plays a key role in diseases such as diabetes, stroke, Alzheimer's disease and parkinsonism (Bergsbaken et al., 2009; McCombe and Read, 2008; Shoelson et al., 2006; Theuma and Fonseca, 2004). Therefore secretion of TSG-6 by MSCs trapped as emboli in lung may in part explain the therapeutic effects observed after IV infusions of MSCs in animal models for these and other diseases (Uccelli et al., 2008; Ezquer et al., 2008; Parr et al., 2007). Secretion of TSG-6 may also play a role in therapies for heart disease with other cells such as skeletal myoblasts, fetal myoblasts and ES cells ( Jolicoeur et al . , 2007) .

C. Preactivated mesenchymal stem cells (MSCs), and/or preactivated rapidly self- renewing mesenchymal stem cells (RS-MSCs), that over-express TSG-6 protein

In one embodiment, the invention provides a purified population of mesenchymal stem cells (MSCs) that has been contacted with one or more ligand selected from the group consisting of pro-inflammatory chemokine, pro-inflammatory cytokine (e.g., TNF-alpha and ILl), and LPS, under conditions to express increased levels of TSG-6 protein. In a particular embodiment, the purified population of mesenchymal stem cells (MSCs) comprises purified rapidly self-renewing mesenchymal stem cells (RS-MSCs). Each of these cell populations is useful in the below described methods for reducing one or more symptoms of cardiac muscle cell necrosis and/or sterile inflammation in a tissue.

The terms "purified," "isolated," and grammatical equivalents thereof as used herein, refer to the reduction in the amount of at least one undesirable component (such as cell type, protein, and/or nucleic acid sequence) from a sample, including a reduction by any numerical percentage of from 5% to 100%, such as, but not limited to, from 10% to 100%, from 20% to 100%, from 30% to 100%, from 40% to 100%, from 50% to 100%, from 60% to 100%, from 70% to 100%, from 80% to 100%, and from 90% to 100%. Thus purification results in an "enrichment," i.e., an increase in the amount of a desirable cell type, protein and/or nucleic acid sequence in the sample. For example, mesenchymal stem cells (MSCs) may be purified from bone marrow cells using methods known in the art (Wakitani et al., 1995; Fukuda and Yuasa, 2006; Woodbury et al., 2000; Deng et al., 2001; Kim et al., 2006; Mareschi et al., 2006; Krampera et al., 2007). In another example, rapidly self-renewing mesenchymal stem cells (RS-MSCs) may be purified from bone marrow-cells and/or from a purified population of mesenchymal stem cells (MSCs) using methods described herein (e.g., binding to one or more of antibody that specifically binds to PODXL, and/or antibody that specifically binds to CD49f).

"Cytokine" is a category of signaling molecule (protein, peptide, glycoprotein) that is involved in cellular communication. "Pro-inflammatory cytokine" refers to a cytokine produced predominantly by activated immune cells, such as microglia, and is involved in the amplification of inflammatory reactions. Pro-inflammatory cytokines are exemplified by IL- 1 alpha, IL-I beta, IL-6, TNF-alpha, and TGF-beta. Other pro-inflammatory mediators include LIF, IFN-gamma, OSM, CNTF, TGF-beta, GM-CSF, ILI l, IL12, IL17, IL18, and IL8.

"Chemokine" and "pro-inflammatory chemokine" interchangeably refer to a molecule that chemoattracts inflammatory cells, and that contains a polypeptide comprising at least two (preferably at least three) cysteine residues that are involved in forming the molecule's 3- dimensional shape. Chemokines include CC chemokines, CXC chemokines, C chemokines, and CX3C chemokines. "CC chemokines" (also referred to as "β-chemokines") have two adjacent cysteines near their amino terminus, and include those that have four cysteines (C4- CC chemokines), and six cysteines (C6-CC chemokines). CC-chemokine are exemplified by RANTES, AOP-RANTES, CAP-RANTES, HEY-GIy¹ -RANTES, HEA-GIy '-RANTES, NNY-RANTES, NNA-RANTES, DDY-RANTES, PSC-RANTES, Pl-RANTES, P2-

RANTES, C1,C5-RANTES, L-RANTES, Met-RANTES, MIP-Ia, MIP-IaP, AOP-MIP-lα, MIP- IB, vMIP-II. In "CXC chemokines" (also referred to as "α-chemokines") the two N- terminal cysteines are separated by one amino acid ("X"). CXC chemokines include chmokines with the motif glutamic acid-Leucine-Arginine (ELR) immediately before the first cysteine of the CXC motif (ELR-positive) (exemplified by CXCLl, CXCL2, CXCL3,

CXCL5, CXCL6, CXCL8), and those without an ELR motif (ELR-negative). Chemokines with an ELR sequence motif have been found to chemoattract and activate primarily neutrophils. Chemokines without the ELR sequence motif appear to chemoattract and activate monocytes, dendritic cells, T-cells, NK-cells, B-lymphocytes, basophils, and eosinophils. "C chemokines" (also known as "γ chemokines") have only two cysteines; one N-terminal cysteine and one cysteine downstream. "CX₃C chemokines" (also known as "δ-chemokines") have three amino acids between the two cysteines.

The inventors have demonstrated that isolated preparations of RS-MSCs are far more clonogenic and have greater potential to differentiate in culture than more mature MSCs from more confluent cultures that the inventors have defined as "SM-MSCs" (Smith et al., 2004) and that are currently employed by most investigators. The inventors have demonstrated that the sub-population of MSCs obtained by serum-starvation of cultures (pre-RS-MSCs) are very early progenitor cells with enhanced expression of Oct-4 and other embryonic genes (Pochampally et al., 2004). The inventors have defined Dkk-1 derived synthetic peptides that inhibit Wnt signaling and therefore provide a means of recovery and manipulation in culture of early precursor sub-populations of MSCs (Gregory et al., 2005). The inventors have established that the sub-population of MSCs defined as RS-MSCs are engrafted preferentially after IV infusion into immunodefiCient mice, and that they migrate more efficiently to cytokines that attract stem cells because of their expression of CXCR4 and CX3R1, the receptors for SDF-I and fractalkine (Lee et al., 2006).

The inventors used ex vivo co-culture experiments to demonstrate that both cell fusion and differentiation without evidence of cell fusion occurred when MSCs were co-cultured with heat-shocked pulmonary epithelial cells or cardiac endothelial cells (Spees et al., 2003). The inventors used ex vivo co-culture experiments to demonstrate the surprising finding that MSCs could rescue cells with non- functional mitochondria by transfer of either intact mitochondria or mitochondrial DNA (Spees et al., 2003). The inventors used experiments with chick embryos to demonstrate that rat MSCs can differentiate into early cardiomyocytes without evidence of cell fusion (Pochampally et al., 2004).

Friedenstein et al. (Owen and Friedenstein, 1998) originally identified MSCs by their ready adherence to tissue culture surfaces, an isolation technique subsequently followed by most investigators. Numerous attempts were made to develop more specific procedures for isolation and characterization of the cells by preparing antibodies to surface epitopes on MSCs (see Simmons and Torok-Storb, 1991; Haynesworth et al., 1992; Gronthos et al., 2003; Anjos-Afonso Bonnet 2007; Gang et al., 2007; Battula et al., 2007; Martinez et al., 2007). Although the published antibodies to MSCs are useful, none distinguish two major sub- populations that are present in early-passage human MSCs plated at low density: (a) spindle- shaped and rapidly self-renewing cells referred to as type I cells (Mets and Verdunk, 1982) or "RS-MSCs" (Colter et al., 2002) , and (b) larger, slowly replicating type II cells or "SR- MSCs" that arise from type I or RS-MSCs as the cultures expand to confluency.

Thus, in one embodiment, the invention provides a purified population of rapidly self- renewing mesenchymal stem cells (RS-MSCs) that has been contacted with one or more of ligands, such as TNF-alpha, ILl, and LPS under conditions to express increased levels of TSG-6 protein. These cells are useful in the below described methods for reducing one or more symptoms of cardiac muscle cell necrosis and/or sterile inflammation in a tissue.

D. . Transgenic mesenchymal stem cells (MSCs), and/or transgenic rapidly self- renewing mesenchymal stem cells (RS-MSCs), that over-express TSG-6 protein

In a further embodiment, the invention provides a population of transgenic mesenchymal stem cells (MSCs) that (a) comprises a heterologous nucleotide sequence encoding TSG-6 protein, and (b) expresses the TSG-6 protein. In a particular embodiment, the population of transgenic mesenchymal stem cells (MSCs) is purified. In a further embodiment, the population of transgenic mesenchymal stem cells (MSCs) comprises transgenic rapidly self-renewing mesenchymal stem cells (RS-MSCs) that (a) comprise a heterologous nucleotide sequence encoding TSG-6 protein, and (b) express the TSG-6 protein. Each of these cell populations is useful in the below described methods for reducing one or more symptoms of cardiac muscle cell necrosis and/or sterile inflammation in a tissue.

The invention also provides a population of transgenic rapidly self-renewing mesenchymal stem cells (RS-MSCs) that (a) comprises a heterologous nucleotide sequence encoding TSG-6 protein, and (b) expresses the TSG-6 protein. These cells are useful in the below described methods for reducing one or more symptoms of cardiac muscle cell necrosis and/or sterile inflammation in a tissue.

The term "transgenic" when used in reference to a cell refers to a cell which contains a transgene, or whose genome has been altered by the introduction of a "transgene." Transgenic cells may be produced by several methods including the introduction of a "transgene" comprising nucleic acid (usually DNA) into a target cell or integration of the transgene into a chromosome of a target cell by way of human intervention, using methods known in the art such as vectors (e.g., plasmids, linear DNA, encapsidated virus, etc.) The term "transgene" as used herein refers to any nucleic acid sequence that is introduced into the cell by experimental manipulations. A transgene may be an "endogenous DNA sequence" or a "heterologous DNA sequence." The term "endogenous DNA sequence" refers to a nucleotide sequence that is naturally found in the cell into which it is introduced so long as it does not contain some modification (e.g., a point mutation, the presence of a selectable marker gene, etc.) relative to the naturally occurring sequence. The terms "heterologous DNA sequence" and "foreign DNA sequence " interchangeably refer to a nucleotide sequence that is ligated to, or is manipulated to become ligated to, a nucleic acid sequence to which it is not ligated in nature, or to which it is ligated at a different location in nature. Heterologous DNA is not endogenous to the cell into which it is introduced, but has been obtained from another cell. Heterologous DNA also includes an endogenous DNA sequence that contains some modification. Generally, although not necessarily, heterologous DNA encodes RNA and proteins that are not normally produced by the cell into which it is expressed. Examples of heterologous DNA include reporter genes, transcriptional and translational regulatory sequences, selectable marker proteins (e.g., proteins which confer drug resistance), etc.

Vectors (i.e., plasmids, linear DNA, encapsidated virus, etc.) may be introduced into cells using techniques well known in the art. The term "introducing" a nucleic acid sequence into a cell refers to the introduction of the nucleic acid sequence into a target cell to produce a "transformed" or "transgenic" cell. Methods of introducing nucleic acid sequences into cells are well known in the art. For example, where the nucleic acid sequence is a plasmid or naked piece of linear DNA, the sequence may be "transfected" into the cell using, for example, calcium phosphate-DNA co-precipitation, DEAE-dextran-mediated transfection, polybrene-mediated transfection, electroporation, microinjection, liposome fusion, lipofection, protoplast fusion, and biolistics. Alternatively, where the nucleic acid sequence is encapsidated into a viral particle, the sequence may be introduced into a cell by "infecting" the cell with the virus.

Transformation of a cell may be stable or transient. The terms "transient transformation" and "transiently transformed" refer to the introduction of one or more nucleotide sequences of interest into a cell in the absence of integration of the nucleotide sequence of interest into the host cell's genome. Transient transformation may be detected by, for example, enzyme-linked immunosorbent assay (ELISA) that detects the presence of a polypeptide encoded by one or more of the nucleotide sequences of interest. Alternatively, transient transformation may be detected by detecting the activity of the protein encoded by the nucleotide sequence of interest. The term "transient transformant" refer to a cell that has transiently incorporated one or more nucleotide sequences of interest.

In contrast, the terms "stable transformation" and "stably transformed" refer to the introduction and integration of one or more nucleotide sequence of interest into the genome of a cell. Thus, a "stable transformant" is distinguished from a transient transformant in that, whereas genomic DNA from the stable transformant contains one or more heterologous nucleotide sequences of interest, genomic DNA from the transient transformant does not contain the heterologous nucleotide sequence of interest. Stable transformation of a cell may be detected by Southern blot hybridization of genomic DNA of the cell with nucleic acid sequences that are capable of binding to one or more of the nucleotide sequences of interest. Alternatively, stable transformation of a cell may also be detected by the polymerase chain reaction of genomic DNA of the cell to amplify the nucleotide sequence of interest.

"Gene expression" refers to the process of converting genetic information encoded in a gene into RNA (e.g., mRNA, rRNA, tRNA, or snRNA) through "transcription" of the gene (i.e., via the enzymatic action of an RNA polymerase), and for protein encoding genes, into protein through "translation" of mRNA. Gene expression can be regulated at many stages in the process. "Up-regulation" or "activation" refers to regulation that increases the production of gene expression products (i.e., RNA or protein), while "down-regulation" or "repression" refers to regulation that decrease production. Molecules (e.g., transcription factors) that are involved in up-regulation or down-regulation are often called "activators" and "repressors," respectively.

E. Pharmaceutical Compositions

The invention additionally provides a pharmaceutical composition comprising the purified MSCs, and/or purified RS-MSCs, and/or transgenic MSCs that express TSG-6, and/or transgenic RS-MSCs that express TSG-6, and/or purified TSG-6. The terms "pharmaceutical" and "physiologically tolerable" composition interchangeably refer to a composition that contains pharmaceutically acceptable molecules, i.e., molecules that are capable of administration to or upon a subject and that do not substantially produce an undesirable effect such as, for example, adverse or allergic reactions, dizziness, gastric upset, toxicity and the like, when administered to a subject. Preferably also, the pharmaceutically acceptable molecule does not substantially reduce the activity of the invention's compositions. Pharmaceutical molecules include, but are not limited to, excipients and diluents.

An "excipient" is an inactive substance used as a carrier for the invention's compositions that may be useful for delivery, absorption, bulking up to allow for convenient and accurate dosage of the invention's compositions. Excipients include, without limitation, antiadherents, binders (e.g., starches, sugars, cellulose, modified cellulose such as hydroxyethyl.cellulose, hydroxypropyl cellulose and methly,cellulose, lactose, sugar alcohols such as xylitol, sorbital and maltitol, gelatin, polyvinyl pyrrolidone, polyethylene glycol), coatings (e.g., shellac, corn protein zein, polysaccharides), disintegrants (e.g., starch, cellulose, crosslinked polyvinyl pyrrolidone, sodium starch glycolate, sodium carboxymethl cellulosemethycellulose), fillers (e.g., cellulose, gelatin, calcium phsophate, vegetable fats and oils, and sugars, such as lactose), diluents, flavors, colors, glidants (e.g., silicon dioxide, talc), lubriants (e.g., talc, silica, fats, stearin, magnesium strearate, steaic acid), preservatives (e.g., antioxidants such as vitamins A, E, C, selenium, cystein, methionine, citric acids, sodium citrate, methyl papaben, propyl paraben), sorbents, sweetners (e.g., syrup). In a particular embodiment, the excipient comprises HEC (hydroxyethylcellulose), which is a nonionic, water-soluble polymer that can thicken, suspend, bind, emulsify, form films, stabilize, disperse, retain water, and provide protective colloid action.

Exemplary "diluents" include water, saline solution, human serum albumin, oils, polyethylene glycols, aqueous dextrose, glycerin, propylene glycol or other synthetic solvents.

F. Methods for purifying RS-MSCs

The invention provides a method for purifying rapidly self-renewing mesenchymal stem cells (RS-MSCs), comprising a) providing a first population of cells comprising RS- MSCs, b) contacting the population of cells with one or both of (i) an antibody that specifically binds to PODXL and (ii) an antibody that specifically binds to CD49f, and c) isolating cells that bind to the one or both of the antibodies, thereby producing a population of purified RS-MSCs.

For example, Fig 3. shows the changes in the epitopes in MSCs with expansion in culture, and that cell populations enriched for PODXL 7CD49F^hl cells demonstrate increased clonogenicity and differentiation potential compared to the MSC cells population from which they are isolated.

The term "antibody" encompasses any immunoglobulin (e.g., IgG, IgM, IgA, IgE, IgD, etc.) obtained from any source (e.g., humans, rodents, non-human primates, caprines, bovines, equines, ovines, etc.). Included within this definition are polyclonal antibody, monoclonal antibody, and chimeric antibody. Methods for making monoclonal antibodies are known (See e.g., Harlow and Lane, Antibodies: A Laboratory Manual, Cold Spring Harbor Laboratory Press, Cold Spring Harbor, NY; Kδhler and Milstein, Nature, 256:495-497 (1975); PCT/US90/02545, Kozbor et al., Immunol. Today, 4:72 (1983), Cole et al., in Monoclonal Antibodies and Cancer Therapy, Alan R. Liss, Inc., pp. 77-96 (1985). Methods for making a "chimeric antibody" that contains portions of two different antibodies, typically of two different species are also standard in the art. See, e.g. : U.S. Pat. No. 4,816,567 to Cabilly et al.; U.S. Pat. No. 4,978,745 to Shoemaker et al.; U.S. Pat. No. 4,975,369 to Beavers et al.; and U.S. Pat. No. 4,816,397 to Boss et al.

The terms "specific binding," "binding specificity," and grammatical equivalents thereof when made in reference to the binding of a first molecule (such as a polypeptide, glycoprotein, nucleic acid sequence, etc.) to a second molecule (such as a polypeptide, glycoprotein, nucleic acid sequence, etc.) refer to the preferential interaction between the first molecule with the second molecule as compared to the interaction between the second molecule with a third molecule. Specific binding is a relative term that does not require absolute specificity of binding; in other words, the term "specific binding" does not require that the second molecule interact with the first molecule in the absence of an interaction between the second molecule and the third molecule. Rather, it is sufficient that the level of interaction between the first molecule and the second molecule is higher than the level of interaction between the second molecule with the third molecule. "Specific binding" of a first molecule with a second molecule also means that the interaction between the first molecule and the second molecule is dependent upon the presence of a particular structure on or within the first molecule. For example, if a second molecule is specific for structure "A" that is on or within a first molecule, the presence of a third nucleic acid sequence containing structure A will reduce the amount of the second molecule which is bound to the first molecule.

Antibodies that specifically bind to PODXL are known in the art, including FITC Labeled anti-Human PCLPl (Cat.# M084-4, MBL International Corporation, Woburn, Massachusetts). Antibodies that specifically bind to CD49f are known in the art including PE-Cy5 Rat anti-Human CD49f (Cat.# 551129, BD PharMingen/BD Biosciences.

In a particular embodiment, the methods further include step d) contacting the population of purified RS-MSCs with one or more of TNF-alpha, ILl, and LPS under conditions to produce a contacted population of cells that expresses increased levels of TSG-6 protein compared to TSG-6 protein levels expressed by the population of purified RS-MSCs. In a more preferred embodiment, the increased levels of TSG-6 protein are from 10 fold to 500 fold. In yet a further embodiment, the increased levels of TSG-6 protein is higher by any numerical amount from 5 fold to 1000 fold, including from 5 fold to 500 fold, 10 fold to 400 fold, from 20 fold to 300 fold, from 30 fold to 200 fold, from 40 fold to 200 fold, from 50 fold to 200 fold. For example, Fig. 8 shows increased expression of 60-fold to 120-fold. In an alternative embodiment, the methods comprise step d) transfecting the population of purified RS-MSCs with a nucleotide sequence that encodes TSG-6 protein (e.g., sequences of Figure 19). The invention further contemplates a purified population of rapidly self-renewing mesenchymal stem cells (RS-MSCs) produced by the methods described herein.

G. Methods for treating cardiac muscle damage by administering preactivated MSCs and/or preactivated RS-MSCs In a particular embodiment, the invention provides a method for reducing one or more symptoms of cardiac muscle cell necrosis in a mammalian subject comprising a) providing i) a mammalian subject in need of reducing one or more symptoms of cardiac muscle cell necrosis, and ii) a population of purified mesenchymal stem cells (MSCs) that has been contacted with one or more of TNF-alpha, ILl, and LPS under conditions to express increased levels of TSG-6 protein, and b) administering a therapeutically effective amount of the population of purified mesenchymal stem cells (MSCs) to the mammalian subject, thereby reducing one or more symptoms of the cardiac muscle cell necrosis. In a particular embodiment, the population of purified mesenchymal stem cells (MSCs) comprises purified rapidly self-renewing mesenchymal stem cells (RS-MSCs).

"Subject" "and "animal" interchangeably refer to any multicellular animal, preferably a mammal, e.g., humans, non-human primates, murines, ovines, bovines, ruminants, lagomorphs, porcines, caprines, equines, canines, felines, aves, etc.). Thus, mammalian subjects include mouse, rat, guinea pig, hamster, ferret and chinchilla.

"Subject in need of reducing one or more symptoms of a disease, e.g., cardiac muscle cell necrosis, inflammation, etc., includes a subject that exhibits and/or is at risk of exhibiting one or more symptoms of the disease. For Example, subjects may be at risk based on family history, genetic factors, environmental factors, etc. This term includes animal models of the disease, such as the mouse models described herein.

As used herein the terms "therapeutically effective amount" and "protective amount" of a composition (e.g.,, cells, nucleotide sequence, protein sequences, etc.) with respect to cardiac muscle cell necrosis and/or myocardial infarction, interchangeably refer to, in one embodiment, an amount of the composition that delays, reduces, palliates, ameliorates, stabilizes, prevents and/or reverses one or more symptoms of the disease compared to in the absence of the composition of interest. It is not necessary that all symptoms be completely eliminated. The term "delaying" symptoms refers to increasing the time period during which symptoms are detectable. The term "eliminating" symptoms refers to 100% reduction of one or more symptoms. A pharmaceutically effective amount may be determined using in vitro and in vivo assays known in the art and disclosed herein, as well as clinical trials. The amount depends, for example, on the route of administration, patient weight (e.g. milligrams of drug per kg body weight). These factors and their relationship to determining this amount are well known to skilled practitioners in the medical, veterinary, and other related arts. This amount and the method of administration can be tailored to achieve optimal efficacy but will depend on such factors as weight, diet, concurrent medication and other factors that those skilled in the art will recognize. The dosage amount and frequency are selected to create an effective level of the composition without substantially harmful effects. When administered orally or intravenously, the dosage of the polypeptides will generally range from 0.001 to 1000 mg/Kg/day, more preferably from 0.01 to 100 mg/Kg/day, and most preferably from 0.1 to 10 mg/Kg/day.

"Symptoms of myocardial muscle cell necrosis" and "symptoms of cardiac infarction" are used to refer to objective and/or subjective symptoms. Objective symptoms are exemplified by increased plasmin activity in serum (Fig. 9A), increased cardiac tissue levels of one or more of plasminogen activator (tPA), urokinase (uPA), pro-matrix metalloproteinase 9 (pro-MMP9), active MMP9 (Figs. 9B and 9C), and cardiac muscle cell death. Symptoms may also include subjective symptoms such as chest pain, shortness of breath, nausea, vomiting, palpitations, sweating, anxiety, feeling of indigestion, fatigue, etc. "Necrosis" refers to the premature death of cells and living tissue. Necrosis is typically caused by external factors, such as infection, toxins, trauma, reduced blood supply, etc. This is in contrast to apoptosis, which is a naturally occurring cause of cellular death.

The term "administering" refers to introducing a polypeptide, introducing a nucleic acid sequence encoding a polypeptide, and/or introducing a host cell that expresses a polypeptide. Polypeptides may be administered to a subject using methods known in the art (e.g., Erickson et al., U.S. Patent 6,632,979; Furuta et al., U.S. Patent 6,905,839; Jackobsen et al., U.S. Patent 6,238,878; Simon et al., U.S. Patent 5,851,789), including those for administering bacteria (Bellinger et al., U.S. Patent 6,964,856) and for administering antisense (de Ia Monte et al., U.S. Patent7,291,454; Smith et al., WO 90/09180; Squinto et al., WO 93/00909), and oligonucleotides (Inoyue et al., U.S. Patent 5,272,065). The polypeptides, nucleic acid sequences and/or cells may be administered prophylactically (i.e., before the observation of disease symptoms) and/or therapeutically (i.e., after the observation of disease symptoms). Administration also may be concomitant with (i.e., at the same time as, or during) manifestation of one or more disease symptoms. Also, the invention's compositions may be administered before, concomitantly with, and/or after administration of another type of drug or therapeutic procedure (e.g., surgery). Methods of administering the invention's compositions include, without limitation, administration in parenteral, oral, intraperitoneal, intranasal, topical (e.g., rectal, and vaginal), and sublingual forms. Parenteral routes of administration include, for example, subcutaneous, intravenous, intramuscular, intrastemal injection, and infusion routes. In a particular embodiment, the route of administration is selected from the group consisting of intramuscular administration into cardiac muscle and intravenous administration.

H. Methods for treating cardiac muscle damage by administering transgenic MSCs and/or transgenic RS-MSCs

The invention provides a method for reducing one or more symptoms of cardiac muscle cell necrosis in a mammalian subject comprising a) providing i) a mammalian subject in need of reducing one or more symptoms of cardiac muscle cell necrosis, ii) a population of transgenic mesenchymal stem cells (MSCs) that (a) comprises a heterologous nucleotide sequence encoding TSG-6 protein, and (b) expresses the TSG-6 protein, and b) administering a therapeutically effective amount of the population of transgenic mesenchymal stem cells (MSCs) to the mammalian subject, thereby reducing one or more symptoms of the cardiac muscle cell nόcrosis. In one embodiment, the population of transgenic mesenchymal stem cells (MSCs) comprises purified rapidly self-renewing mesenchymal stem cells (RS-MSCs).

Without intending to limit the route of administration to any particular route, in one embodiment, the route of administration is selected from the group consisting of intramuscular administration into cardiac muscle and intravenous administration.

I. Methods for treating cardiac muscle damage by administering TSG-6 protein

The invention also provides a method for reducing one or more symptoms of cardiac muscle cell necrosis in a mammalian subject comprising a) providing i) a mammalian subject in need of reducing one or more symptoms of cardiac muscle cell necrosis, and ii) a composition comprising purified tumor necrosis factor-alpha stimulated gene 6 (TSG-6) protein, and b) administering a therapeutically effective amount of the composition to the mammalian subject, thereby reducing one or more symptoms of the cardiac muscle cell necrosis.

Purified recombinant TSG-6 protein, is commercially available (R&D Systems, Inc., MinneapoliSjCatalog # 2104-TS-050 ). In another embodiment, TSG-6 protein may be purified from a transgenic cell that (a) comprises a heterologous nucleotide sequence encoding TSG-6 protein, and (b) expresses the TSG-6 protein.

Any cell that may be transformed to express a heterologous nucleotide sequence may be used to express TSG-6 protein. Such cells include human and non-human eukaryotic animal cells. In one embodiment, the cell is a human eukaryotic animal cell as exemplified by U937 cells (macrophage), ATCC# crl 1593.2; A-375 cells (melanoma/melanocyte), ATCC# crl-1619; KLE cells (uterine endometrium), ATCC# crl- 1622; T98G cells (glioblastoma), ATCC# crl- 1690; CCF-STTGl cells (astrocytoma), ATCC# crl-1718; HUV-EC-C cells (vascular endothelium), ATCC# CRL- 1730; UM-UC-3 cells (bladder), ATCC# crl-1749; CCD841-CoN cells (colon, ATCC# crl-1790; SNU-423 cells

(hepatocellular carcinoma), ATCC# crl-2238; WI38 cells (lung, normal), ATCC# crl-75; Raji cells (lymphoblastoid), ATCC# ccl-86; BeWo cells (placenta, choriocarcinoma), ATCC# ccl-98; HT1080 cells (fibrosarcoma), ATCC# ccl-121 ; MIA PaCa2 cells (pancreas), ATCC# crl-1420; CCD-25SK cells (skin fibroblast), ATCC# crl-1474; ZR75-30 cells (mammary gland), ATCC# crl-1504; HOS cells (bone osteosarcoma), ATCC# crl-1543; 293-SF cells (kidney), ATCC# crl-1573; LL47 (MaDo) cells (normal lymphoblast), ATCC# ccl-135; and HeLa cells (cervical carcinoma), ATCC# ccl-2.

In another embodiment, the cell is a non-human eukaryotic animal cell exemplified by, but not limited to, yeast cells (AH109), LM cells (mouse fibroblast), ATCC# ccl-1.2; NCTC 3526 cells (rhesus monkey kidney), ATCC# ccl-7.2; BHK-21 cells (golden hamster kidney), ATCC# ccl-10 ; MDBK cells (bovine kidney), ATCC# ccl-22; PK 15 cells (pig kidney), ATCC# ccl-33; MDCK cells (dog kidney), ATCC# ccl-34; PtKl cells (kangaroo rat kidney), ATCC# ccl-35; Rk 13 cells (rabbit kidney), ATCC# ccl-37; Dede cells (Chinese hamster lung fibroblast), ATCC# ccl-39; Bu (IMR31) cells (bison lung fibroblast), ATCC# ccl-40; FHM cells (minnow epithelial), ATCC# ccl-42; LC-540 cells (rat Leydig cell tumor), ATCC# ccl-43; TH-I cells (turtle heart epithelial), ATCC# ccl-50; E. Derm (NBL-6) cells (horse fibroblast), ATCC# ccl-57; MvLn cells (mink epithelial), ATCC# ccl-64; ChI Es cells (goat fibroblast), ATCC# ccl-73; Pl I Nt cells (raccoon fibroblast), ATCC# ccl-74; Sp I k cells (dolphin epithelial), ATCC# ccl-78; CRFK cells (cat epithelial ), ATCC# ccl-94; Gekko Lung 1 cells (lizard-gekko epithelial), ATCC# ccl-111; Aedes Aegypti cells (mosquito epithelial), ATCC# ccl-125; ICR 134 cells (frog epithelial), ATCC# ccl-128; Duck embryo cells (duck fibroblast), ATCC# ccl-141; DBS FcI-I cells (monkey lung fibroblast), ATCC# ccl-161.

J. Methods for treating sterile inflammation using preactivated MSCs and/or preactivated RS-MSCs

The invention also provides a method for reducing one or more symptoms of inflammation, including, but not limited to, sterile inflammation in a mammalian subject comprising a) providing i) a mammalian subject in need of reducing one or more symptoms of sterile inflammation in a tissue, and ii) a population of purified mesenchymal stem cells (MSCs) that has been contacted with one or more of TNF-alpha, ILl, and LPS under conditions to express increased levels of TSG-6 protein, and b) administering a therapeutically effective amount of the population of purified mesenchymal stem cells (MSCs) to the mammalian subject, thereby reducing one or more symptoms of the sterile inflammation in the tissue. In one embodiment, the population of purified mesenchymal stem cells (MSCs) comprises purified rapidly self-renewing mesenchymal stem cells (RS-MSCs). In another embodiment, the subject has, or is at risk of having, a sterile inflammatory disease. Inflammation can also be due to an autoimmune response.

"Inflammation" "inflammatory" and grammatical equivalents when in reference to a disease refer to the complex biological response of vascular tissues to harmful stimuli, such as pathogens, damaged cells, or irritants. It is a protective attempt by the organism to remove the injurious stimuli as well as initiate the healing process for the tissue.

Inflammation can be acute or chronic. Acute inflammation is the initial response of the body to harmful stimuli and is achieved by the increased movement of plasma and leukocytes from the blood into the injured tissues. A cascade of biochemical events propagates and matures the inflammatory response, involving the local vascular system, the immune system, and various cells within the injured tissue. Prolonged inflammation, known as chronic inflammation, leads to a progressive shift in the type of cells which are present at the site of inflammation and is characterized by simultaneous destruction and healing of the tissue from the inflammatory process. Inflammation is not a synonym for infection by a pathogen. Thus, "sterile inflammation" refers to inflammation that is not caused by a pathogen (e.g., bacteria, virus, etc.), but which is caused in response to an injury or abnormal stimulation caused by a physical, chemical, or biologic molecule (protein, DNA, etc.); these reactions include the local reactions and resulting morphologic changes, destruction or removal of the injurious material, and responses that lead to repair and healing. One underlying theme in inflammatory, disease is a perturbation of the cellular immune response that results in recognition of proteins, such as host proteins (antigens), as foreign. Thus the inflammatory response becomes misdirected at host tissues with effector cells targeting specific organs or tissues often resulting in irreversible damage. The self-recognition aspect of auto-immune disease is often reflected by the clonal expansion of T-cell subsets characterized by a particular T-cell receptor (TCR) subtype in the disease state. Often, inflammatory disease is also characterized by an imbalance in the levels of T-helper (Th) subsets (i.e., ThI cells versus Th2 cells).

Sterile inflammatory disease and conditions may be systemic (e.g., lupus) or localized to particular tissues or organs. Examples of sterile inflammatory diseases include, without limitation, myocardial infarction (MI), diabetes, stroke, Alzheimer's disease, multiple sclerosis, parkinsonism, nephritis, cancer, inflammatory diseases involving acute or chronic inflammation of bone and/or cartilage in a joint, anaphylactic reaction, asthma, conjunctivitis, systemic lupus erythematosus, pulmonary sarcoidosis, ocular inflammation, allergy, emphysema, ischemia-reperfusion injury, fibromyalgia, and inflammatory cutaneous disease selected from psoriasis and dermatitis, or an arthritis selected from rheumatoid arthritis, gouty arthritis, juvenile rheumatoid arthritis, and osteoarthritis.

"Symptoms of inflammation" and "symptoms of sterile inflammation" are interchangeably used to refers to objective and/or subjective symptoms. Objective symptoms are exemplified by increased serum levels of one or more (including two, three, four, five, six, and seven) of plasmin activity (Example 11, Figs. 9 and 16), macrophage chemoattractant protein -1 (MCP-I), macrophage inflammatory protein- 1 alpha (MIP-I alpha), beta thromboglobulin, soluble ST2 receptor, C-reactive protein (CRP), and natriuretic peptide compared to a control mammalian subject lacking inflammation in the tissue. Subjective symptoms include pain. In one embodiment, where inflammation is in cardiac muscle tissue, the route of administration is selected from the group consisting of intramuscular administration into cardiac muscle and intravenous administration.

K. Methods for treating sterile inflammation using transgenic MSCs and/or transgenic RS-MSCs

The invention also provides a method for reducing one or more symptoms of sterile inflammation in a mammalian subject comprising a) providing i) a mammalian subject in need of reducing one or more symptoms of sterile inflammation in a tissue, ii) a population of transgenic mesenchymal stem cells (MSCs) that (a) comprises a heterologous nucleotide sequence encoding TSG-6 protein, and (b) expresses the TSG-6 protein, and b)administering a therapeutically effective amount of the population of transgenic mesenchymal stem cells (MSCs) to the mammalian subject, thereby reducing one or more symptoms of the sterile inflammation in the tissue. In one embodiment, the population of transgenic mesenchymal stem cells (MSCs) comprises purified rapidly self-renewing mesenchymal stem cells (RS-MSCs). In another embodiment, the tissue comprises cardiac muscle tissue and the route of administration is selected from the group consisting of intramuscular administration into the cardiac muscle tissue and intravenous administration. In a further embodiment, the subject has, or is at risk of having, a sterile inflammatory disease.

L. Methods for treating sterile inflammation by administering TSG-6 protein

The invention further provides a method for reducing one or more symptoms of sterile inflammation^* in a mammalian subject comprising a) providing i) a mammalian subject in need of reducing one or more symptoms of sterile inflammation in a tissue, and ii) a composition comprising purified tumor necrosis factor-alpha stimulated gene 6 (TSG-6) protein, and b) administering a therapeutically effective amount of the composition to the mammalian subject, thereby reducing one or more symptoms of the sterile inflammation in the tissue. In another embodiment, the tissue comprises cardiac muscle tissue and the route of administration is selected from the group consisting of intramuscular administration into the cardiac muscle tissue and intravenous administration. In a further embodiment, the subject has, or is at risk of having, a sterile inflammatory disease. In a further embodiment, the TSG- 6 protein is purified from a transgenic cell that comprises a heterologous nucleotide sequence encoding TSG-6 protein, and that expresses the TSG-6 protein.

M. Methods for detecting inflammation using biomarkers

The invention additionally provides methods for detecting sterile inflammation in a tissue in a mammalian subject comprising a) providing a mammalian subject in need of reducing one or more symptoms of sterile inflammation in a tissue, and b) detecting an increase in serum level of one or more (including two, three, four, five, six and seven) of plasmin activity, macrophage chemoattractant protein -1 (MCP-I), macrophage inflammatory protein- 1 alpha (MIP-I alpha), beta thromboglobulin, soluble ST2 receptor, C-reactive protein (CRP), , and natriuretic peptide compared to a control mammalian subject lacking the sterile inflammation in the tissue. In one embodiment, the tissue comprises cardiac muscle tissue.

The levels of the biomarkers used in the invention's methods may be determined using standard techniques. For example, methods for detection of plasmin activity are described herein (Example 11, Figs. 9 and 16); MCP-I and MIP-I alpha may be assayed using a commercial ELISA kit from Leinco Technologies, Inc., St. Louis, Missouri; Beta thromboglobulin may be assayed using the commercial ELISA kit (ASSERACHROM B-TG) from DIAGNOSTICA STAGO, Inc., Parsippany, NJ; ST2 may be assayed using the commercial ELISA kit from MBL, Woburn, MA, and CRP may be assayed by Quest Diagnostics. Additional methods for detecting the levels of the biomarkers are known in the art: Macrophage chemoattractant protein -1 (MCP-I) (Aukrust et al. (1998) Circulation 97: 1136-1143); macrophage inflammatory protein-1 alpha (MIP-lalpha) (Aukrust et al.

(1998)); beta thromboglobulin: (Riza et al. (2004) Coron Artery Dis.;15:265-8); soluble ST2 receptor (Weinberg et al. (2002) Circulation 106:2961-2966), C-reactive protein (CRP) (Pye et al. (1990) Br Heart J 63:228-230);' and natriuretic peptide ((Weinberg et al. (2002).

In a further embodiment, the method further comprises c) administering to the subject a therapeutically effective amount of one or more of i)a composition comprising purified tumor necrosis factor-alpha stimulated gene 6 (TSG-6) protein, ii) a population of purified mesenchymal stem cells (MSCs) of Claim 1, and ii) a population of transgenic mesenchymal stem cells (MSCs) of Claim 4, wherein the administering produces a treated subject, and d)detecting, in the treated subject, a reduction in serum level of two or more of the plasmin activity, MCP-I, MIP-I alpha, beta thromboglobulin, soluble ST2 receptor, CRP, and natriuretic peptide compared to the serum level that is detected in step b).

EXPERIMENTAL

The following examples serve to illustrate certain preferred embodiments and aspects of the present invention and are not to be construed as limiting the scope thereof.

EXAMPLE 1

Isolation of RS-MSCs using PODXL and CD49f epitope expression

Recently, the inventors searched for antibodies to surface proteins that identify early progenitors in cultures of MSCs (FIGS. IA and IB). As an initial strategy, the inventors queried microarray data for changes in transcripts for surface proteins as hMSCs plated at low density and the cultures expanded. The results demonstrated that the steady-state levels of over 10 transcripts decreased (> 2-fold) and an almost equal number increased (FIG. 2D). The two of the transcripts with the largest decreases coded for proteins previously shown to be linked to cell motility and tumor progression: PODXL (Furness and McNagny, 2006); and α6-integrin (CD49f) (Lipscomb and Mercurio 2005). The inventors then used commercial antibodies to follow expression of PODXL, α6- integrin (CD49f), and several other epitopes related to cell trafficking and motility as cultures of MSCs were expanded (FIGS. 2 and 3). By the variety of assays indicated, antibodies to PODXL and α6-integrin (CD49f) most consistently distinguished early progenitor RS-MSCs from later stage SR-MSCs. Of special interest was that although the epitopes disappeared as the cultures of Passage 2 cells approached confluency after culture for 9 days, they were again expressed if the cells were re-plated at low density and incubated for 5 days to generate Passage 3 cells. A similar pattern was observed with several other epitopes (α6-integrin, c- Met, CXCR4, and CX3CR1), but these proved less reliable either because they were cleaved and internalized by the trypsinization required to lift the cells from cultures (not shown), or because the results were not as consistent among different preparations of MSCs (FIG. 3). Also of interest was the observation that there was an increase instead of a decrease with expansion of two epitopes previously used to identify MSCs (FIGS. 3D and 3E): STRO-I (Simmons and Torok-Storb, 1991) and GD2 (Martinez et al.| 2007).

To demonstrate the increased clonogenicity and differentiation potential of PODXL^hi/CD49f^hi MSCs, MSCs were plated at 100 cells/cm². The cultures were expanded for 5 days to obtain MSCs that were PODXL^hi/CD49f^hi and for 9 days to obtain MSCs that were PODXL^l7CD49f^!o. Two sub-populations were then re-plated at 1 cell/cm² to assay colony forming units (CFU-Fs). The PODXL^hl/CD49f^hi cells were more highly clonogenic with CFU-F values of 90 % ± 6.0 SD versus 48 % ± 5 SD for PODXL^l7CD49f^)o cells (n = 4 ; p < 0.1). In addition, the PODXL^hi/CD49f^hl cells more efficiently differentiated into mineralizing cells and adipocytes: absorbance of extracted Alizarin Red S after incubation in osteogenic medium 0.16 OD units ± 0.05 SD versus 0.65 ± 0.029 (n = 4; p < 0.01) and extracted Oil Red O after incubation in adipogenic medium 0.70 OD units ± 0.14 SD versus 0.06 OD units ± 0.012 SD (n = 4; p< 0.01).

EXAMPLE 2

More efficient engraftment of RS-MSCs into the hearts of mice following MI

The inventors employed an improved PCR assay (see below) for human AIu to compare the engraftment of RS-MSCs (PODXL^hi/CD49f^hi) into mice with MIs. As indicated in FIG. 4, the RS-MSCs engrafted more efficiently into the hearts with MI. The cells also engrafted more efficiently into kidney, apparently as a result of secondary damage to the kidney, as reflected by an increase in serum creatinine levels (0.53 mg/dcl ± 0.08 SD vs 1.08

± 0.14 SD; n = 4).

As demonstrated in FIG. 3D, cultures of MSCs from some donors remained

PODXL^hi/CD49f^hi when plated at 100 cells/cm² and expanded for up to 7 days. In order to conveniently obtain adequate numbers of cells, 7 day cultures enriched for RS-MSCs from such selected donors were used for subsequent experiments. Unless otherwise noted, they are referred to simply as MSCs.

EXAMPLE 3 Tissue distribution of infused hMSCs, cancer cells, and human WBCs After IV infusion into mice, hMSCs were cleared from the blood in less than 5 min (FIG. 5, Top Left). In confirmation of previous reports (Barbash et al., 2003; Gao et al., 2001b; Schrepfer et al., 2007), most of the infused cells were trapped in the lung (FIG. 5, Bottom Left). Similar observations were made with a human breast cancer cell line (MDA- MB-231) and with human WBCs, except a fraction of the human WBCs escaped trapping in the lung and were recovered in liver. hMSCs infused into the left ventricle of the heart (IC infused) were also cleared from the blood in less than 5 min (FIG. 5, Top Right), but compared to IV infusions larger numbers of hMSCs appeared in brain, heart, lung, liver, pancreas, spleen, kidney and bone marrow (FIG. 5, Bottom Right). AIu sequences were assayed in blood, lung and seven tissues of mice for up to 4 days

(100 hr) after IV infusions (FIG. 6, Top). There was no increase in human cells circulating in blood in the first 60 min, suggesting that few of the trapped cells were leaving the lung. Also, the recovery of the infused human DNA in the seven other tissues was less than a total of 0.2%, or fewer than 2,000 cells. The assays for AIu sequences in lung reflected live MSCs, since essentially same values were obtained by assays for human GAPDH mRNA (FIG. 6, Top Left). The number of MSCs trapped was decreased by immediate pretreatment of the mice with a vasodilator (sodium nitroprusside) (FIG. 6, Lower Left). There was no effect from pre-treatment of the cells with antibodies to α4-integrin or α6-integrin, or incubation with WBCs, all procedures reported to inhibit homing of hematopoietic stem cells to bone marrow (Qian et al. 2006; Chute, 2006). In addition, the proportion of hMSCs trapped in the lung was not decreased by reducing the number of cells infused to as little as 10⁴ (not shown). In mice with permanent MI produced one day before the IV infusions of hMSCs, there was a delayed appearance of a small number of hMSCs (<2,000) in heart (FIG. 6, Bottom, Lower Right).

EXAMPLE 4

The transcriptomes of both mouse lung cells and hMSCs change after hMSCs are trapped in the lung

To examine the effects of hMSCs being trapped in the lung, RNA was extracted from mouse lungs 10 hr after MSCs were IV infused and the RNA assayed on both mouse-specific and human-specific microarrays. As expected, there were major changes in the mouse transcriptome: 755 genes were up-regulated, and 347 genes were down-regulated two-fold or more (not shown). In addition, there were also major changes in the transcriptome of the hMSCs: 451 genes were up-regulated, and 1,001 genes were down-regulated two-fold or more. The results, therefore, indicated that the hMSCs responded to cross-talk with the mouse lung containing emboli of hMSCs.

Subjective analysis of the several hundred human genes that were up-regulated twofold or more in the hMSCs provided an interesting list of candidates for confirming the data by human-specific real-time RT-PCR assays (FIG. 7). The largest increase was a 30- fold or more increase in the transcript for TNF-α stimulated gene 6 (TNFAIP6 or TSG-6). The increase in TSG-6 was of particular interest because the protein was previously shown to be a powerful anti-inflammatory factor (Getting et al. 2002; Wisniewski and Vilcek 2004; Forteza et al., 2007; Milner et al., 2006). The 30 kDa protein was demonstrated to reduce inflammation by several actions: (i) it binds to and blocks th,e pro-inflammatory effects of fragments of hyaluronan; (ii) it forms a stable complex with inter-α-inhibitor and thus produces a 100-fold increase in the inhibition of serine proteases that are essential components of most inflammatory responses; (iii) it inhibits neutrophil chemotaxis; and (iv) in animal models of arthritis, it protects joint cartilage from degradation.

EXAMPLE 5 hMSCs can be activated to express high levels of TSG-6

To examine TSG-6 synthesis by hMSCs, hMSCs were incubated with the proinflammatory cytokine TNF-α. The hMSCs were activated to express 60- to 120-fold levels of the TSG-6 transcript (FIG. 8, Top Left). Unstimulated hMSCs did not secrete measurable amounts of the protein but hMSCs activated by TNF-α secreted large amounts (FIG. 8, Middle Panels). Knock down of the gene with siRNAs decreased both the level of the transcript and the secretion of the protein (FIG. 8, Bottom Panels). Surprisingly, the response of hMSCs to TNF-α far exceeded the response of human fibroblasts, even though TSG-6 was first discovered in fibroblasts incubated with TNF-α (Wisniewski and Vilcek 2004).

EXAMPLE 6 Both IV MSCs and recombinant TSG-6 decrease pro-inflammatory proteases in serum and heart in mice with MI

Permanent MI was produced in immunodeficient mice, and hMSCs were then infused into a tail vein under conditions that the inventors previously observed to improve left ventricular ejection fraction (Iso et al., 2007). Assays of serum demonstrated that plasmin activity was increased in mice with MI and that IV administcation of hMSCs one hour later decreased the activity (FIG. 9A). Also, the effect of hMSCs was reproduced by a singe IV infusion of human recombinant TSG-6. Assays of heart demonstrated that levels of tissue plasminogen activator (tPA), urokinase (uPA), pro-matrix metalloproteinase 9 (pro-MMP9) and active MMP9 were increased in mice with MI (FIGS. 9B and 9C).

The results are of special interest because of the known anti-inflammatory effects of TSG-6 and the evidence that activation of proteinases, including MMP9 (Moshal et al., 2007), contributes to the inflammatory responses and deleterious effects of cardiac disesases (Ovechkin et al., 2005; Paolocci et al., 2006; Carvalho et al., 2006).

EXAMPLE 7

Supplemental Methods

Data obtained using the following methods are described below.

A. , Preparations of MSCs: The hMSCs were obtained from the Center for Preparation and Distribution of Adult Stem Cells. The cells consistently differentiated into three lineages in culture, were negative for hematopoietic markers (CD34, CD36, CDl 17 and CD45), and positive for CD29 (95%), CD44 (>93%), CD49c (99%), CD49f (>70%), CD59 (>99%), CD90 (>99%), CD 105 (>99%) and CD 166 (>99%). Vials of about 1 million cells (passage 1 or 2) were thawed, plated on a 174 cm² dish (Nunc) in 25 ml of complete culture medium (CCM), and incubated at 37 ⁰C in 5 % CO₂. The CCM was α-MEM (GIBCO/BRL) containing 17% FBS (lot-selected for rapid growth of hMSCs; Atlanta Biologicals, Lawrenceville, GA); 100 units/ml of penicillin; 100 μg/ml of streptomycin; and 2 mM L- glutamine (GIBCO/BRL). After 1 day, the medium was replaced, the cultures were washed with PBS to remove non-adherent cells, and then they were incubated with 0.25 % trypsin/1 mM EDTA (GIBCO/BRL) for 5 min at 37°C to recover viable cells. The cells were concentrated by centrifugation at 800 x g for 10 min, suspended in CCM, replated at 100 cells/cm² in a 174 cm² dish, and incubated for 6 to 7 days until 70% confluent so that about 50 % of the cells were positive for the anti-cell adhesion protein PODOXL (Lee et al., 2009). Mouse (C57/B16) MSCs from bone marrow were also obtained from the Center and expanded to passage 5 as described (Peister et al., 2004). Human breast carcinoma cells (MDA-MB 231; American Type Culture Collection) from frozen vials were plated at 10,000 cells / cm² and expanded to 80 % confluency through two passages. Culture medium for MDA-MB 231 cells contained high glucose DMEM (GIBCO/BRL) supplemented with 10% FBS (Atlanta Biologicals); 100 units/ml of penicillin; 100 μg/ml of streptomycin; and 2 mM L-glutamine (GIBCO/BRL). Human skin fibroblasts (gift from Dr. Carl Gregory, Institute for Regenerative Medicine) from the same donor who provided the hMSCs were expanded under the same conditions. Human white blood cells (h WBCs) wefe prepared from fresh samples of heparinized peripheral blood, isolated by density gradient centrifugation (Ficoll Hypaque; Pharmacia Biotechnology), and washed with PBS. The carcinoma cells and hWBCs were infused into mice under the same conditions as the hMSCs.

B. Detection of hMSCs in Blood: For detection of hMSCs in mouse blood 15 min after IV infusion, 50 μl of blood was plated on a 10 cm dish in CCM. After 1 day, cells were washed with PBS, covered with 10 ml CCM and incubated 14 days with changes of medium every 3 to 4 days. Colonies (Figure 10) were fixed with 4 % paraformaldehyde for 20 min, labeled with anti-human nuclei antigen (1 :200; clone 235-1 ; Chemicon) and anti-human β2-microglubulin (1 :200; Roche) and mounted with DAPI (VECTASHIELD^® Mounting Medium with DAPI; Vector Laboratories).

C. Incubations of hMSCs and Fibroblasts: hMSCs, mouse MSCs and fibroblasts were plated at 50,000 cells/well in CCM in 6-well plates and incubated for 18 hours. The medium was removed without washing to retain 'some FBS on the cells and replaced with serum-free CCM containing 10 ng/ml of recombinant humanTNF-α (R&D Systems). After incubation for 0 to 48 hours, total RNA was extracted (RNeasy Mini Kit; QIAGEN) for RT-PCR assays and medium was recovered for ELISAs.

D. Cardiac troponin - ELISA: Cardiac troponin I concentrations were determined on serum from mice on 2 days after LAD ligation using the murine troponin I ELISA kit (Life Diagnostics Inc.) according to the directions of the manufacturer. E. Plasmin Activity: Two million of Passage 2 MSCs were infused IV into mice 1 hr after MI and serum and hearts were collected after 48 hr. Plasmin activity from mice serum was assayed using a chromozym PL (Roche Applied Science) as a chromogenic substrate in 50 mM Tris, pH 7.4 and 0.9 % NaCl. Reaction mixtures were incubated at 37 ⁰C and assayed spectrophotometrically at 405 nm every 2 min for 30 min. The values were expressed as average change in absorbance per min.

F. Zymograms: Heart tissue was homogenized on ice in lysis buffer (1% Triton X-100, 0.1 % of SDS, 0.1 % sodium azide in IX PBS pH 7.2) and incubated with rotation for 1 hr at 4 ⁰C. Lysates were cleared by centrigugation at 12,000 g for 10 min at 4 °C. Five- microliter aliquots of heart extracts were analyzed by zymography using precast gelatin gels (10% Zymogram Gelatin Gels; Invitrogen/Novex). With constant gentle agitation, gels were renatured for 30 minutes at room temperature, developed overnight at 37 °C, stained with Colloidal Blue (Novex technical bulletin IM-6025), and extensively washed (>20 hours) to yield uniform background signal. Digital images of stained wet gels were captured using a scanner.

G. Assays of mRNAs in Lung by Microarrays: RNA was isolated from lungs of control mice, lungs of mice 10 hr after IV infusion of about 2 million hMSCs and lungs to which 1 million hMSCs were added just before homogenizafion. About 8 μg of total RNA was used for assay on either the mouse (MG-430 2.0) or human (HG-Ul 33 Plus 2.0) microarrays (Affymetrix). The data analyzed using Microarray Suite 5.0 (MASS 5.0;

Affymetrix) and dChip 1.3+ programs (Schadt et al., 2001). Values were expressed as fold- changes relative to the signal intensities on either control mouse lung, control mouse lung with hMSCs added before homogenization or mouse lung after IV infusion of hMSCs. The data were filtered for cross-hybridization (CV>0.5 and call > 33%), analyzed with the Microarray Suite 5.0 program, and normalized to a value of 1 and variance of 3 SD (+ 3, red; 3, blue) as described (Ohtaki et al., 2008).

EXAMPLE 8

Upregulated and downregulated transcripts of hMSCs up-regulated in lung after IV infusion Table 1. The top 100 transcripts of hMSCs up-regulated in lung after IV infusion versus control hMSCs.

Table 2. The top 100 transcripts of hMSCs down-regulated in lung after IV infusion versus control hMSCs.

EXAMPLE 9

Echocardiographic Data 3 wk after MI.

Table 3. Echocardiographic Data 3 wk after MI.

EXAMPLE 10

PCR Primer Sequences

Table 4. PCR Primer Sequences.

EXAMPLE 11 Supplemental Methods

Data obtained using the following methods are shown in Figures 13-18.

A. Preparations: hMSCs and mouse MSCs from bone marrow were obtained from the Center for the Preparation and Distribution of Adult Stem Cells. The Center has supplied standardized preparations of MSCs enriched for early progenitor cells to over 250 laboratories under the auspices of an NIH/NCRR grant (P40 RR 17447-06). The hMSCs were expanded to passage 3 and 70 % confluency and the mouse MSCs cultures as indicated in Example 7-10. Source and conditions for culture of human breast carcinoma cells and fibroblasts are also presented in Examples 7-10. B. IV Infusion of hMSCs: Mice were anesthetized, and 150 μl of a suspension of about 1 or 2 X 10⁶ hMSCs was infused with a 28 gauge needle either through a tail vein or through the chest wall into the left ventricle. Successful IV infusion was monitored by lack of extravasation at the site and recoveries of about 80 % of the AIu sequences in lung within the first hour of infusion (Figure 13 C). Prior to infusion, the cells were maintained at 4°C and they were gently re-suspended with a pipette to ensure they were not aggregated before infusion.

C. Isolations of DNA and RNA: Blood samples of 50 μl were withdrawn with a needle and syringe from the left ventricle of the heart and adjusted to 2 mM EDTA. The mice were then perfused through the left ventricle with 20 ml of PBS and then through the right ventricle with 5 ml of PBS. Brain, heart, lung, liver, pancreas, spleen, kidney tissues and bone marrow'were isolated by dissection and stored at -80 °C. To extract DNA, the samples were thawed and added to in 5 ml buffer (10 mM Tris HCl, (pH 8.0) containing 20 μl proteinase K (10 mg/ml), 0.1 mM EDTA (pH 8.0),' 0.5% SDS and 20 ug/ml RNase A] was added to each sample. The samples were homogenized (PowerGen Model 125 Homogenizer; Fisher Scientific) and incubated in a shaker at 200 rpm and 50 ⁰C overnight. DNA was extracted by mixing 0.5 ml of sample with 0.5 ml phenol/chloroform solution (pH 6.7) and centrifugation at 15,300 g for 5 min in 2 ml phase lock gel tubes (Phase Lock Gel; Eppendorf/Brinkmann Instruments, Inc). DNA was precipitated with half volume of 2.5 M ammonium acetate and same volume of 100 % ethanol overnight at 4 ⁰C. The precipitates were washed with ice cold 75 % ethanol and re-suspended in sterile water. RNA was isolated from the same mouse tissues and from cell cultures using a Trizol (Invitrogen) and cleaned by RNeasy Mini Kit (Qiagen).

D. Real-time PCR Assays for AIu Sequences: Because assays by UV absorbance of DNA extracts from several tissues did not proVide values accurate enough for the PCR assays, DNA concentration was measured by diphenylamine reaction (BURTON, 1956). Samples of 40 μl were digested for 1 h at 37 ⁰C with 3 μl DNase I (Fisher Scientific) in 5 μl DNase buffer and 2 μl of sterile water. Each sample was diluted with 50 μl of sterile water and 200 μl of a stock solution of diphenylamine reagent was added (1 g diphenylamine (Fisher Scientific) in 100 ml glacial acetic acid (Fisher Scientific) and 2.75 ml H₂SO₄ (Sigma)]. The samples were incubated for 21 min at 100 ⁰C and absorbance was measured at 595 nm. Standard curves were prepared with 0.039 to 1.25 mg/ml calf thymus DNA (Sigma).

Real-time PCR assays for AIu sequences (McBride et al., 2003) were performed in a volume of 50 μl that contained 25 μl Taqman Universal PCR Master Mix (Applied Biosystems), 900 nM each of the forward and reverse primers, 250 nM TaqMan probe, and 200 ng target template (See Example 10 for sequences of primers and probes). Reactions were incubated at 50 ⁰C for 2 min and at 95 °C for 10 min followed by 40 cycles at 95 ⁰C for 15 sec and 60 °C for 1 min. Standard curves were generated by adding serial dilutions of hMSCs into mouse tissue samples just prior to homogenization. Real-time PCR assays for human and mouse genes for GAPDH were performed in a volume of 50 μl that contained 25 μl SYBR Green Master Mix (Applied Biosystems), 200 nM each of the forward and reverse primers and 200 ng target template. All real-time PCR assays were performed in duplicate or triplicate and average values are presented. The final value for total DNA in the sample was corrected by parallel real-time PCR assays with primers that amplified both the human and mouse gene for GAPDH (NCBI home page; Examples 7-10).

E. Real-Time RT-PCR Assays for mRNA for Human GAPDH: Standard curves were generated by adding serial dilutions of hMSCs to mouse tissue samples just prior to homogeniz'ation. About 200 ng of total RNA was used to synthesize double-stranded cDNA by reverse transcription (Superscript III; Invitrogen). cDNA was analyzed by real time PCR (ABI 7900 Sequence Detector, Applied Biosystems) with human specific GAPDH primers and probe (TaqMan® Gene Expression Assays ID, Hs00266705_gl) using Taqman Universal PCR Master Mix (Applied Biosystems). The final value for total cDNA in the sample was corrected by parallel real-time PCR assays with primers that amplified both the human and mouse gene for GAPDH (see Examples 7-10). F. Assays of mRNAs in Lung by Microarrays: RNA was isolated from lungs of mice, assayed on both mouse (MG-430 2.0) and human (HG-Ul 33 Plus 2.0) microarrays (Affymetrix, Santa Clara, CA), and the data filtered as described in Examples 7-10.

G. Real Time RT-PCR Analysis for Selected mRNAs: About 200 ng of total RNA was used to synthesize double-stranded cDNA by reverse transcription (Superscript III; Invitrogen). cDNA was analyzed by real time PCR using Taqman Universal PCR Master Mix (Applied Biosystems). For the assays, reactions were incubated at 50 °C for 2 min, 95°C for 10 min, and then 40 cycles at 95 ⁰C for 15 s followed by 60 °C for 1 min. For relative quantitation of gene expression, human specific GAPDH primers and probe (TaqMan® Gene Expression Assays ID, Hs00266705_gl) were used. All other PCR primer and probe sequences were listed in Example 10. H. Transfections with TSG-6 siRNA: Target hMSCs for the transfections were prepared with viable passage 1 hMSCs that were plated at 50,000 cells/well in CCM in 6-well plates. After incubation for 1 day, cells were transfected with 10 nM or 20 nM siRNA for TSG-6 (sc-39819; Santa Cruz Biotechnology, Santa Cruz, CA) or RNAi negative control (Stealth™ RNAi negative Control; Invitrogen) using a commercial kit (Lipofectamine™ RNAiMAX reagent; Invitrogen). Six hrs later, the medium was replaced with 3 ml per well of CCM lacking antibiotics and hMSCs were incubated for 1*6 to 20 hrs.

I. TSG-6 ELISA: TSG-6 protein levels in medium from TNF-α treated MSCs were determined by ELISA. A 96-well plate (Maxisorp™; Nunc) was coated overnight at 4 ⁰C with 50 μl of 10 μg/ml monoclonal antibody specific for TSG-6 (clone A38.1.20; Santa Cruz Biotechnology, Inc.) in 0.2 M sodium bicarbonate buffer (pH 9.2). The plate were washed with PBS and blocked with 0.25% (wt/vol) BSA and 0.05% (vol/vol) Tween-20 in PBS for 30 min at room temperature. Plates were again washed with PBS. Samples of 50 μl or standards of recombinant human TSG-6 protein (R&D Systems) in blocking buffer were added. After 2 hr at room temperature, wells were washed with PBS followed by 50 μl/well of 0.5 μg/ml biotinylated anti-human TSG-6 (TSG-6 Biotinylated PAb Detection Antibody; R&D Systems). After 2 hr, plates were washed with PBS. Fifty μL streptavidin-HRP (R&D Systems) was added to each well. The plate was covered and incubated for 20 min at room temperature. One hundred μL substrate solution (R&D Systems) was added and the sample was incubated for 10 min at room temperature. Absorbance was read at 450 run (Fluostar Optima; BMG Labtechnologies).

J. Permanent Ligation of the Anterior Descending Coronary Artery (LAD): Male immunodeficient NOO/scid mice (NOO.CB17-Prkdc^scιd/J; The Jackson Laboratory) 7 to 8 weeks of age were ventilated mechanically under anesthesia with isoflourine, the chest was opened, the left anterior descending" coronary artery was ligated, and the chest was closed. The effectiveness of the LAD was established in preliminary experiments by the demonstration that serum cardiac troponin I levels were elevated in 7 mice 48 hr after the surgery (Figure 16A).

K. Other Assays: As indicated in Examples 7-10, commercial kits were used to assay mouse cardiac troponin I in serum (ELISA kit; Life Diagnostics, Inc.), plasmin activity in serum (Roche Applied Science) and MMPs in heart.by zymography (10% Zymogram Gelatin Gels; Invitrogen/Novex).

L. Leukocyte Infiltration Assay in Heart: Frozen heart sections of 5 μm from Mi-induced mice were stained with anti-Ly-6G and Ly-6C (RB6-8C5, BD Biosciences) and Ly-6G and Ly-6C positive cells were counted with a software program (ImageJ, NIH Image). M. Microscopic Examination of the Myocardium: Paraffin-embedded heart samples at 21 days after MI were cut into over 400 sequential 5 μm sections and stained with Masson Trichrome. Quantitative assays for infarct size were performed as described by (Takagawa et al., 2007). In brief, images of every 10^th section covering the region of infarct (total of 20 sections per heart) were examined with a spinning disc microscopy (Olympus) using a X4 objective and captured with Stereo Investigator software (Stereo Investigator ver7; MBF Bioscience). Stereological quantification software was used to measure midline infarct length of heart.

N. Echocardiography: Echocardiography (Acuson Sequoia C512 echocardiography system, Siemens Medical Solutions USA, Inc.) was performed 21 days after MI.

O. Statistical Analyses: Comparisons between two groups were made with the use of unpaired and two-tailed Student's /-tests. P < 0.05 was considered significant.

EXAMPLE 12 Clearance from Blood and Trapping of Systemically Infused hMSCs

To follow the fate of hMSCs infused IV into mice, the inventors used real time PCR assays for human-specific AIu sequences (McBride et al., 2003). After IV infusion of 2 X 10⁶ human MSCs, the AIu assay indicated that 99 % +/- 1.07 SD of the cells were cleared from the circulation within 5 min (Figure 13A). From 2 to ^'3 % of the cells (4 to 6 X 10⁴) re- appeared in the circulation after a lag period of about 10 min, apparently after release from the lung. To verify that the small number of AIu sequences detected in blood reflected hMSCs, 50 μl of peripheral blood recovered after 15 min was plated on plastic culture dishes in hMSCs medium and incubated for 14 days. The cultures generated typical colonies of spindle-shaped hMSCs that were labeled with antibodies to both human nuclei antigen and human β2-microglobulin (Supplemental Figure 13). To follow the distribution of the cells in tissues, individual standard curves were developed for each tissue by adding varying numbers of hMSCs to the tissues from naive mice just before homogenization (Figure 13 B). The use of tissue-specific standard curves minimized variations introduced by differences in yields of extracted DNA, cell numbers of the organs, or efficiencies of the PCR reactions. The sensitivity of the assay was about 100 human cells per mouse organ assayed. To facilitate the assay, a quantitative colorimetric assay for DNA in extracts (BURTON, 1956) was used instead of UV absorbance to select appropriate aliquots for the PCR reactions. As expected (Gao et al., 2001; Schrepfer et al., 2007; Lee et al., 2009), most of the cells cleared from the circulation were trapped in the lung: In mice sacrificed after 15 min, 83 % +/- 6.3 SD of the human DNA was recovered in lung and only trace amounts were recovered in other tissues (Figure 13 C). Similar results were obtained in control experiments with IV infusions of a line of metastatic breast carcinoma cells (MDA-MB-231 in Figure 13 C). After infusion IV of human white blood cells, a smaller fraction was recovered in lung after 15 min and larger numbers both remained in circulation and appeared in liver (Figure 13 C). The fraction of hMSCs trapped in the lung was not significantly reduced by decreasing the number of infused MSCs to a little as 10,000 in the same volume of vehicle (150 μl), pre-treating the cells with antibodies to integrin-α4 or integrin-α6 (Qian et al., 2006), or pre-incubating the cells with rat white blood cells (Chute, 2006). To examine effects of arterial infusion, 2 X 10⁶ hMSCs were infused into the left ventricle of the heart. Most of the cells were again cleared from the blood in 5 min (Supplementary Figure 14 A) but there again was a small re-circulation of about 1.72 % +/- 1.81 SD of the infused cells for 15 to 60 min (Supplemental Figure 14 A). Also, in comparison to IV infusions, larger numbers of the cells were recovered in organs such as brain, heart, lung, liver and kidney 15 min after the infusions (Supplemental Figure 14B). Control experiments with breast metastatic cancer cells produced a similar pattern of tissue distribution (Supplemental Figure 14B). For a semi-quantitative assay for viable cells (Nishida et al., 2006), a similar strategy was used to develop a quantitative RT-PCR assay specific for human GAPDH mRNA (Figure 13D). The assay had about the same sensitivity as the AIu assay but required more manipulation of the samples. Data developed with the assay indicated that the distribution of AIu sequences largely reflected live cells (Figure 13E and F).

EXAMPLE 13

Kinetics and Redistribution of hMSCs Trapped in Lung

To examine the redistribution with time of the cells from lung, 2 X 10⁶ hMSCs were infused IV and 7 tissues of mice were assayed for up to 4 days (Figure 13 E). Assays for AIu sequences indicated that the cells initially trapped in lung disappeared with a half-life of about 24 hr. Similar values were obtained by assays for viable human cells by the levels of human mRNA for GAPDH (Figure 13 E). Histological sections of lung demonstrated that the human MSCs trapped in lung formed emboli in afferent blood vessels (Lee et al., 2009) with many of the cells undergoing apoptosis (not shown). The cells that disappeared from lung did not appear in any significant numbers in the 6 other tissues: a total of 0.04 % of the infused AIu sequences (equivalent to about 4,000 cells) were recovered in the 6 tissues after 48 hr and 0.01 % after 96 hr (Figure 13 E).

EXAMPLE 14

Trapping of hMSCs in Infarcted Heart To determine whether larger numbers of IV infused hMSCs appeared in the heart after

MI, hMSCs were infused into the tail veins for NOD/scid mice 1 day after MIs were produced by permanent ligation of the anterior descending coronary artery (LAD). Assays for AIu sequences indicated that 0.04 % +/- 0.03 SD of the infused cells (400 cells +/- 300 SD; n = 5) were recovered in the infracted hearts 15 min after the infusion (Figure 13F). One day after IV infusions, the AIu sequences in heart increased about 5-fold to 0.148 % +/- 0.053 SD, equivalent to about 1,480 cells +/- 530 SD (n = 5). Similar values were obtained by assays for human GAPDH mRNA (792 cells +/- 140 SD; n = 5) 1 day after the infusions.

EXAMPLE 15 Changes in the Mouse and Human Transcriptome Produced by Embolization To assay both transcriptomes, about 2 X 10⁶ hMSCs were infused into the tail veins of mice and RNA was extracted from lung 10 hr later, a time at which assays for human GAPDH mRNA indicated there were adequate amounts of human mRNA for assays (Figure 13 E). After filtering for cross-hybridization with human mRNA (see Supplemental Materials), the data indicated that embolization with the hMSCs up-regulated expression of 755 mouse transcripts and down-regulated expression of 347 mouse transcripts 2-fold or more (Figure 14 A). Also, the data indicated that after embolization in lung, 451 human transcripts were up-regulated and 1,009 transcripts were down-regulated (Figure 14 B).

The up-regulated 451 human transcripts were subjectively examined for candidate genes of interest and human-specific real-time RT-PCR assays were used to confirm the microarray data (Figure 15A). The results confirmed 2-fold or greater increases in the transcripts for SMAD6, CSFl, VCAM-I and TNFAIP6 (TSG-6). The increases in TSG-6 were 28-fold and 47-fold or considerably larger than the 7.5-fold increase detected by the microarrays (Supplemental Table 1). As recently reported (Ylostalo et al., 2008), real-time RT-PCR assays frequently demonstrated larger changes in transcripts than microarray assays with the system employed here.

EXAMPLE 16

MSCs in Vitro Are Activated to Secret TSG-6 The increase in TSG-6 was of particular interest because the protein was previously shown to be a powerful anti-inflammatory factor (Forteza et al., 2007; Getting et al., 2002; Wisniewski and Vilcek, 2004; Milner et al., 2006). Real-time RT-PCR assays demonstrated that human TSG-6 mRNA in lung was increased at 10 hr and further increased at 24 hr after IV infusions of hMSCs (Figure 15B). There was no difference in expression of TSG-6 in lungs from naive mice and mice with MIs (Figure 15B). TSG-6 was discovered by analysis of cDNA clones from skin fibroblasts that were incubated with TNF-α (Lee et al., 1992). Therefore, hMSCs and fibroblasts from same donor were incubated with TNF-α and the mRNAs were assayed by real-time RT-PCR. The transcript for TSG-6 in hMSCs was increased about 120-fold after incubation with 10 ng/ml TNF-α for 48 hr and increased about 80-fold with a further passage of the hMSCs (Figure 15C). ELISAs indicated that incubation with TNF-α for 48 hr increased the secretion of TSG-6 protein from undetectable levels to over 2,000 pg/ml/ 10⁵ cells/ 48 hr (Figure 15 D). Surprisingly, the response of hMSCs to TNF-α far exceeded the response of human fibroblasts. In parallel experiments, mouse MSCs incubated with TNF-α under the same conditions up-regulated expression of the transcript for TSG-6 3.94-fold (+/- 0.49 SD; n = 4). Transient transduction of hMSCs with TSG-6 siRNA abrogated the effects of TNF-α on TSG-6 transcription (Figure 15 E) and secretion (Figure 3 F). Expression of TSG-6 was partially reduced by a mock transduction or transduction with a scrambled siRNA.

EXAMPLE 17 Both IV MSCs and rhTSG-6 Decrease Pro-Inflammatory Proteases in Mice with MI

Acute MI produces an acute inflammatory response in which infiltrating neutrophils generate MMPs that degrade the myocardium (Fang et al., 2007; Lindsey et al., 2001). The permanent LAD increased serum levels of both cardiac troponin I (Figure 16A), a biomarker for myocardial injury (Chapelle, 1998; Pervaiz et al., 1997), and plasmin activity (Figure 16B), a marker for inflammatory responses (Heymans et al., 1999; Griffin et al., 2005). The plasmin activity was decreased by two infusions of rhTSG-6; an observation consistent with its known inhibitory effects (Bardos et al., 2001; Milner et al., 2006). The plasmin activity was also decreased by IV infusion of hMSCs and hMSCs with a scrambled siRNA but not hMSCs transduced with siRNA for TSG-6. As expected (Fang et al., 2007), the enzymic activities of both pro-MMP9 and active

MMP9 were increased in heart 2 days after MI (Figure 16C). IV infusion of hMSCs or hMSCs transduced with a scrambled siRNA decreased both activities (Figure 16C). The effects of hMSCs were partially negated by knock down of the TSG-6 gene prior to infusion of the cells. Also, the effects of hMSCs were partially duplicated by the two infusions of human recombinant TSG-6. The decreases in pro-MMP activities were reflected in decreases in granulocyte and monocyte infiltration in the heart (Figure 16 D and E).

EXAMPLE 18

Effects of TSG-6 on Infarct Size and Heart Function in MI As reported previously (Iso et al., 2007), IV infusion of hMSCs decreased infarct size examined 3 wk after MI (Figure 17 A, B and F and Figure 12). hMSCs with an siRNA knock down of the TSG-6 gene had no effect on infarct size (Figure 17D and F). hMSCs transduced with the scrambled siRNA produced an intermediate effect on infarct size (Figure 17 C and F), apparently because the scrambled siRNA had a partial effect on TSG-6 secretion (Figure 15 E and F). In addition, IV infusion of 100 μg of rhTSG-6 immediately following the surgery and at 24 hr also decreased infarct size (Figure 17 E and F and Figure 12). However, the effect the rhTSG-6 was somewhat less than the decrease in infarct size following administration of the hMSCs (p < 0.05).

Assays by echocardiography demonstrated comparable effects on heart function. IV infusions of 2 X 10⁶ hMSCs or hMSCs with a scrambled siRNA 1 hr after MI produced significant improvements in % left ventricular fractional shortening and left ventricular ejection fraction in hearts assayed 3 wk later (Figure 18 and Table 3). Infusions of hMSCs with a knock-down of TSG-6 had no effect.

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All references, patents and patent publications cited in this specification are herein incorporated by reference as though each reference was specifically and individually indicated to be incorporated by reference. The citation of any reference is for its disclosure prior to the filing date and should not be construed as an admission that the present invention is not entitled to antedate such reference by virtue of prior invention.

It is to be understood that the invention is not limited to the particular embodiments of the invention described herein, as variations of the particular embodiments may be made and still fall within the scope of the appended claims. It is also to be understood that the terminology employed is for the purpose of describing particular embodiments, and is not intended to be limiting. Instead, the scope of the present invention will be established by the appended claims.

It will be further understood that each of the elements described above, or two or more together may also find a useful application in other types of methods differing from the type described above. Without further analysis, the foregoing will so fully reveal the gist of the present invention that others can, by applying current knowledge, readily adapt it for various applications without omitting features that, from the standpoint of prior art, fairly constitute essential characteristics of the generic or specific aspects of this invention set forth in the appended claims. The foregoing embodiments are presented by way of example only.

Each and every publication and patent mentioned in the above specification is herein incorporated by reference in its entirety for all purposes.

Claims

CLAIMSWe Claim:

1. A purified population of mesenchymal stem cells (MSCs) that has been contacted with one or more of TNF-alpha, ILl, and LPS under conditions to express increased levels of TSG-

6 protein.

2. The purified population of MSCs of Claim 1, wherein said purified population comprises purified rapidly self-renewing mesenchymal stem cells (RS-MSCs).

3. A pharmaceutical composition comprising the population of cells of Claim 1.

4. A population of transgenic mesenchymal stem cells (MSCs) that (a) comprises a heterologous nucleotide sequence encoding TS G-6 protein, and (b) expresses said TSG-6 protein.

5. The population of transgenic MSCs of Claim 4, wherein said population is purified.

6. A pharmaceutical composition comprising the population of cells of Claim 4.

7. A method for purifying rapidly self-renewing mesenchymal stem cells (RS-MSCs), comprising: a) providing a first population of cells comprising RS-MSCs, b) contacting said population of cells with one or both of (i) an antibody that specifically binds to PODXL and (ii) an antibody that specifically binds to CD49f, and c) isolating cells that bind to said one or both of said antibodies, thereby producing a population of purified RS-MSCs.

8. A purified population of rapidly self-renewing mesenchymal stem cells (RS-MSCs) produced by the method of Claim 7.

9. A method for reducing one or more symptoms of cardiac muscle cell necrosis in a mammalian subject comprising a) providing i) a mammalian subject in need of reducing one or more symptoms of cardiac muscle cell necrosis, and ii) a composition comprising purified tumor necrosis factor-alpha stimulated gene 6 (TSG-6) protein, and b) administering a therapeutically effective amount of said composition to said mammalian subject, thereby reducing one or more symptoms of said cardiac muscle cell necrosis.

10. The method of Claim 9, wherein said administering is selected from the group consisting of intramuscular administration into cardiac muscle and intravenous administration.

11. A method for reducing one or more symptoms of cardiac muscle cell necrosis in a mammalian subject comprising a) providing i) a mammalian subject in need of reducing one or more symptoms of cardiac muscle cell necrosis, and ii) a population of purified mesenchymal stem cells (MSCs) of Claim 1 , and b) administering a therapeutically effective amount of said population of purified mesenchymal stem cells (MSCs) to said mammalian subject, thereby reducing one or more symptoms of said cardiac muscle cell necrosis.

12. The method of Claim 11, wherein said administering is selected from the group consisting of intramuscular administration into cardiac muscle and intravenous administration.

13. A method for reducing one or more symptoms of cardiac muscle cell necrosis in a mammalian subject comprising a) providing i) a mammalian subject in need of reducing one or more symptoms of cardiac muscle cell necrosis,. ii) a population of transgenic mesenchymal stem cells (MSCs) of Claim 4, and b) administering a therapeutically effective amount of said population of transgenic mesenchymal stem cells (MSCs) to said mammalian subject, thereby reducing one or more symptoms of said cardiac muscle cell necrosis.

14. The method of Claim 13, wherein said administering is selected from the group consisting of intramuscular administration into cardiac muscle and intravenous administration.

15. A method for reducing one or more symptoms of sterile inflammation in a mammalian subject comprising a) providing i) a mammalian subject in need of reducing one or more symptoms of sterile inflammation in a tissue, and ii) a population of purified mesenchymal stem cells (MSCs) of Claim 1 , and b) administering a therapeutically effective amount of said population of purified mesenchymal stem cells (MSCs) to said mammalian subject, thereby reducing one or more symptoms of said sterile inflammation in said tissue.

16. The method of Claim 15, wherein said administering is selected from the group consisting of intramuscular administration into cardiac muscle and intravenous administration.

17. The method of Claim 15, wherein said tissue comprises cardiac muscle tissue.

18. The method of Claim 17, wherein said administering is selected from the group consisting of intramuscular administration into said cardiac muscle tissue and intravenous administration.

19. A method for reducing one or more symptoms of sterile inflammation in a mammalian subject comprising a) providing i) a mammalian subject in need of reducing one or more symptoms of sterile inflammation in a tissue, ii) a population of transgenic mesenchymal stem cells (MSCs) of Claim 4, and b) administering a therapeutically effective amount of said population of transgenic mesenchymal stem cells (MSCs) to said mammalian subject, thereby reducing one or more symptoms of said sterile inflammation in said tissue.

20. The method of Claim 19, wherein said tissue comprises cardiac muscle tissue.

21. The method of Claim 20, wherein said administering is selected from the group consisting of intramuscular administration into said cardiac muscle tissue and intravenous administration.

22. A method for reducing one or more symptoms of sterile inflammation in a mammalian subject comprising a) providing i) a mammalian subject in need of reducing one or more symptoms of sterile inflammation in a tissue, and ii) a composition comprising purified tumor necrosis factor-alpha stimulated gene 6 (TSG-6) protein, and b) administering a therapeutically effective amount of said composition to said mammalian subject, thereby reducing one or more symptoms of said sterile inflammation in said tissue.

23. A method for detecting sterile inflammation in a tissue in a mammalian subject comprising a) providing a mammalian subject in need of reducing one or more symptoms of sterile inflammation in a tissue, and b) detecting an increase in serum level of two or more of plasmin activity, macrophage chemoattractant protein -1 (MCP-I), macrophage inflammatory protein- 1 alpha (MIP-I alpha), beta thromboglobulin, soluble ST2 receptor, C-reactive protein (CRP), and natriuretic peptide, compared to a control mammalian subject lacking said sterile inflammation in said tissue.

24. The method of Claim 23, wherein said method further comprises c) administering to said subject a therapeutically effective amount of one or more of

_" i) a composition comprising purified tumor necrosis factor-alpha stimulated gene 6 (TSG-6) protein, ii) a population of purified mesenchymal stem cells (MSCs) of Claim 1, and iii) a population of transgenic mesenchymal stem cells (MSCs) of Claim 4, wherein said administering produces a treated subject, and d) detecting, in said treated subject, a reduction in serum level of two or more of said plasmin activity, MCP-I, MIP-I alpha, beta thromboglobulin, soluble ST2 receptor, CRP and natriuretic peptide, compared to said serum level that is detected in step b).