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Definitions

• Insulin-dependent diabetes is a disease characterized by a loss of the insulin producing cells of the pancreas.
• the insulin producing cells also called “beta” cells, normally reside in small spherical structures termed “islets of Langerhans,” which are dispersed throughout the pancreas. It is proven in humans and animals that the transplant of replacement islets of Langerhans, containing functional beta cells, can cure insulin-dependent diabetes.
• islets are purified from the pancreata of one or more deceased organ donors and injected into one of various sites in the body. Some islets survive the procedure and establish residency in the body where they make and secrete insulin. This can suffice to cure the patient for a few years, until the end of the lifespan of the transplanted islets. See Shapiro (2011) and Robertson (2010).
• pluripotent stem cells are harvested from an embryo, or they can be created artificially by directing fully differentiated somatic cells to an embryonic- like state; that is, by "reprogramming" adult cells to resemble cells that are harvested from an embryo. Whether by harvesting or reprogramming, all pluripotent stem cells share three characteristics: • Expression of stem cell genes: They express genes typically expressed in the early mammalian embryo.
• Maturation into all lineages of the mammalian body All adult organs are derived from one of three tissue lineages of the early embryo. These are endoderm, from which the pancreas and other gut organs are formed, mesoderm, from which muscle and skeleton are formed, and ectoderm, from which brain and skin are formed.
• Protocols have been devised to manipulate pluripotent stem cells to form pancreatic cells. Some of these protocols are capable of driving the differentiation of pluripotent stem cells to a form resembling that of fetal progenitors of the islets of Langerhans. See Kroon (2008), and Rezania (2011). None yields pancreatic cells, however, that are capable of further maturation into functional, insulin-producing cells that could be used therapeutically, in the manner mentioned above.
• pancreatic progenitors are impure, being contaminated by non-pancreatic cells.
• Pluripotent stem cells are predisposed to form all three germ layers. Therefore, even the most efficient protocol produces populations of pancreatic cells intermixed with non-pancreatic cells.
• pancreatic progenitors are contaminated by immature cells.
• These cells have retained the property of immortality and can initiate a tumor after transplant to a patient.
• pancreatic progenitors fail to mature into fully functional insulin
• Islets originate during embryogenesis from progenitor cells that bud off from the developing pancreatic ducts. During the life of a healthy individual, beta cells are produced exclusively through replication of existing beta cells. See Dor (2004). The process of beta cell replication occurs more quickly during periods of weight gain, pregnancy, and recovery following pancreatic injury. Isolated beta cells have not replicated in culture heretofore without losing their mature properties. See Pagluca (2013).
• Pancreatic stem cells or progenitor cells have not been identified in mature tissue through lineage tracing experiments. Nevertheless, a number of publications have described cells, isolated from the mammalian pancreas, that are said to display some stem cell characteristics. These cells have been identified in the ductal tissue, in the exocrine tissue, and in the islets themselves. For instance, see Gong (2012), Noguchi (2010), and
• Ciba (2009). They are described as having limited replicative ability and being induced to express insulin.
• U.S. patent No. 8377689 speaks of pancreatic cells that are said to replicate in culture and to be induced to express insulin. As described, however, these cells had limited replicative ability and did not mature into fully functional beta cells or, at least, were incapable of reversing diabetes in rodent models. That is, the results actually obtained are said to show, in a "diabetic mouse" model, "a recovery from ... hyperglycemia (>400 mg/dl) to near normal ( ⁇ 300 mg/dl) within five weeks, while the non-transplanted diabetic mouse was hyperglycemic throughout the study period.” Column 45, after line 18 et seq. (emphasis added). In the diabetic mouse model, however, a "normal” is about 150 mg/dl, while a persistent reading above 250 mg/dl, as was reported, is considered proof of a stable diabetic state. See Dang (2013), for example.
• This body of work is distinct from the invention described here because it pertains to the isolation of a stem cell from a mammalian pancreas.
• This invention pertains to the isolation of a fully mature, non-stem cell from a pancreas or other source that is manipulated in culture to adopt stem cell characteristics.
• This method relies on harnessing the genetic diversity of mature cells within human organs to identify the subpopulation that can be manipulated to become a therapeutically useful stem cell.
• the genetic diversity of cells present in mature human tissues has been appreciated only recently, and conventional understanding is incomplete regarding cell heterogeneity within the mature pancreas.
• pancreatic cells do not yield effective surrogate pancreatic cells, i.e., cells that can be transplanted to a site in the mammalian body where they establish residency and perform a function of a native pancreatic cell.
• the present invention overcomes this shortcoming and other disadvantages by providing surrogate pancreatic cells and cell-containing compositions that are pharmaceutical-grade, i.e., that the U.S. Food and Drug Administration (FDA) and/or other such regulatory agencies deem acceptable for human use.
• FDA U.S. Food and Drug Administration
• a surrogate pancreatic cell-containing composition of the invention (1) does not contain non-therapeutic cells that decrease potency or perform unwanted functions, but its constituent therapeutic cells (2) are cultured using defined, non-animal- origin components, according to internationally accepted standards, and (3) are not genetically modified, transformed, karyotypically abnormal, or otherwise characterized by an unacceptably high risk of instability or tumorigenicity.
• a composition that comprises non-pluripotent progenitors of surrogate pancreatic cells.
• the progenitors (i) have no reprogramming genes integrated into their genomes, (ii) differentiate to the pancreatic lineage pursuant to a protocol that employs only defined reagents, and (iii) are substantially unable to differentiate to the mesodermal lineage.
• a method also is provided, according to another aspect of the invention, for generating a composition comprising such non-pluripotent progenitors of surrogate pancreatic cells that are suitable for treating insulin-dependent diabetes.
• the inventive method comprises:
• proliferate without losing the stem cell morphology, in minimal, defined culture conditions whereby proliferating reprogrammed cells are obtained; and then e. secondly selecting from among the proliferating reprogrammed cells for a cell
• Another aspect of the invention concerns a composition comprising surrogate pancreatic cells, suitable for treating insulin-dependent diabetes, where (A) the surrogate pancreatic cells are derived from the non-pluripotent progenitors described above and (B) more than about 90% of cells comprising the composition express the markers Pdxl, Nkx6.1, and NeuroDl .
• the invention further provides a method for generating such surrogate pancreatic cells, which method comprises:
• Figure 1 depicts harvesting of cells from a human organ. That is, a viable human pancreas is minced into fragments (A), which then are rinsed and sedimented in a conical tube (B). Adherent cells (C) are obtained after 72 hours in culture. In the defined culture conditions provided, the cell cultures respectively comprised a mixed population of cells, which exhibit epithelial and fibroblastic morphologies. There was no evidence of stem cell or mesenchymal cell morphologies
• FIG. 2 illustrates schematically the organization of genes on reprogramming episomal plasmids.
• CMV cytomegalovirus promoter
• 2A self cleaving peptide sequence
• WPRE woodchuck hepatitis virus posttranscriptional response element
• SV40 Poly A polyadenylation signal
• OriP origin of replication
• EBNA1 Epstein Ban- nuclear antigen 1
• p53shRNA small hairpin RNA targeting p53.
• Figure 3 presents a photomicrograph of reprogrammed cells.
• the phase contrast image shows that the cells exhibited stem cell morphology by 20 days after reprogramming.
• Figure 4 is a bar graph that illustrates the proliferation in culture of cell colonies selected for their display of stem cell morphology.
• Ten colonies of cells resembling the stem cells shown in Fig. 3 were transferred manually to individual culture vessels. When the growth surface became covered by a confluent layer of stem cells, the cells were passaged to new culture vessels. The proliferation of the transferred cells was tracked over time by counting the number of cells present at the beginning and the end of three consecutive passages. Cell number was counted manually, using a hemacytometer, and the doubling time for each clone was calculated. Six of the ten selected clones were shown able to proliferate in minimal defined medium.
• Figure 5 presents photomicrographs A through D, depicting the results of selection applied to the above-mentioned six clones that proliferated in minimal defined medium.
• Two of the six clones survived the differentiation procedure, which employed minimal, defined reagents. Only a fraction ( ⁇ 50%) of cells of Clone 9 survived the differentiation, producing small rafts of cells in otherwise empty tissue culture dishes (A, C). Immunocytofluorescence revealed that Pdxl was expressed in the nuclei of some of those cells (A), but appeared cytoplasmic in others (C). Nkx6.1 likewise appeared to be expressed in the nucleus (C). At least 80% of cells of Clone 10 survived the differentiation procedure, producing a confluent monolayer of cells (B, D) in the culture dishes. Pdxl (B,D) and Nkx6.1 (D) were expressed in the nucleus of >90% of the cells. Therefore, only Clones 9 and 10 survived the
• Figure 6 includes bar graphs that depict results from RT-qPCR analyses of gene expression. Embryoid bodies from clones 5-9 expressed genes that are representative of endoderm, mesoderm, and ectoderm at days three and ten of differentiation. Clone 10 did not express genes representative of mesoderm, however. Concurrent with differentiation, all embryoid bodies down-regulated expression of pluripotency-related genes at days three and ten. Results are normalized to beta-actin and are shown relative to day 0 cultures
• Figure 7 presents a bar graph showing experimental results that confirm that Clone 10 was incapable of differentiation towards the mesodermal lineage.
• Clones 5 and 10 were directed to differentiate towards the mesodermal cardiomyocyte lineage, following a protocol that generates highly pure population of cardiomyocytes from pluripotent stem cells. See Xu (2009).
• gene expression of cardiac specific growth factors (Gata4, Nkx2.5) and a structural protein (alpha MHC) were quantified by RT-qPCR.
• pancreatic stem cells or progenitor cells are not pancreatic stem cells or progenitor cells, but rather are members of a mature cell population of diverse genetic composition that harbor a specific genetic character rendering them amenable to the manipulations described in detail below.
• a key aspect of the invention is the harvesting of cells from an adult organ such that a diverse population is maintained, including the subpopulation identified by the present inventor. See Example 1, below.
• Another important aspect of the invention is the reprogramming to a stem cell state of the above-mentioned diverse population, each cell of which can be expanded for analysis and selection (see Examples 2 and 3).
• the reprogramming should be accomplished in a manner that does not cause integration of any reprogramming genes into the genome of the cells or that otherwise limits regulatory approval of the cells for human therapeutic use.
• a further important aspect of the invention is the selecting, from among the population of reprogrammed cells, the stem cells that have the unique property, first revealed by the inventor, of being a source for pharmaceutical grade surrogate pancreatic cells.
• the selection criteria differ from those for pluripotency, which is the goal of conventional methodology.
• cells are obtained, pursuant to the invention, that are not pluripotent and yet have improved clinical utility (see Example 4).
• the genotype of a colony of iPS cells can contain a specific genetic variation that is present in the parent cell population at only a very low frequency. Accordingly, the process of reprogramming may identify and select for genotypes represented by only a small minority of the starting cell population.
• Cell populations freshly harvested from human organs have a far greater range of cellular diversity than populations of cells cultured for an extended period of time.
• the inventor applied reprogramming genes to freshly harvested cell populations, in order to identify and select for a cell with a specific clinical utility, as mentioned above.
• a cell thus identified is not a pancreatic stem cell, as evidenced by the facts that identified cells (1) are not replicative and instead disappear in long-term culture, (2) do not exhibit stem cell morphology, and (3) can be isolated from tissues that do not contain putative pancreatic stem cells. (Putative pancreatic stem cells are hypothesized to exist in pancreatic ducts.) See Example 1, infra.
• fresh human pancreas tissue can be used as a source of cells whence to identify and select a non-stem cell population that is predisposed to being a source for surrogate pancreatic cells, capable of treating insulin-dependent diabetes.
• cells can be reprogrammed within one week of harvest from the organ to adopt stem cell state.
• the resulting stem cells were selected on the basis of an ability (1) to differentiate efficiently to pancreatic endocrine progenitor cells, themselves amenable to treatment of insulin-dependent diabetes as described above, and (2) to survive and differentiate in minimal culture conditions that are both scalable and generally acceptable by regulatory authorities. "Efficiently” in this regard connotes producing a cell population at the end of the
• Endocrine progenitor cells are cells that will mature into the hormone-producing cells of the islets of Langerhans. These cells are characterized, for instance, by the simultaneous expression of the genes Pdxl, Nkx6.1 and NeuroDl .
• survive denotes an ability of at least about 80% of the starting viable cell population, and preferably at least about 90%, to be viable at the end of the differentiation procedure.
• the approach of the present invention eliminates serum, whereby the resulting cells could be considered suitable for a human cell therapy.
• conventional protocols employ wnt, a growth factor that is expensive and extremely labile.
• the invention has eliminated the use of wnt, thereby to provide a process that is consistent and scalable.
• the inventive methodology is ineffective at driving efficient differentiation of a pluripotent stem cell.
• the cells of a composition according to the invention are selected to respond to and survive this novel approach.
• more than about 80% of cells selected in accordance with invention, preferably more than about 90% of cells survive the differentiation procedure.
• more than about 80%, and preferable more than about 90% simultaneously express Pdxl, Nkx6.1 and NeuroDl, markers of the pancreatic endocrine lineage (see Example 3, last paragraph).
• the selection criteria for pluripotent stem cells are ignored, and the cells created pursuant to the invention indeed are not pluripotent; that is, they lack the ability to differentiate substantially to a nonpancreatic lineage.
• “Substantially” in this context means at least about 5%, preferably at least about 10%, and more preferably at least about 20% of the population of differentiated cells demonstrates characteristics specific to a non-pancreatic lineage.
• cells produced per the invention were subjected to a protocol commonly used to derive a mixture of the three lineages, mesodermal, endodermal, and ectodermal.
• a protocol commonly used to derive a mixture of the three lineages mesodermal, endodermal, and ectodermal.
• a media that does not cause the differentiation of one lineage in favor of another, such as serum to a suspension of stem cell clusters, which enables spontaneous growth and differentiation.
• the stem cell clusters will differentiate according to their genetic programming, not specifically guided by provided culture conditions.
• the clusters thus formed are called "embryoid bodies" for their resemblance to an early mammalian embryo. See Rust (2006).
• Pluripotent cells will produce embryoid bodies that contain, after the fashion of a mammalian embryo, all three germ layers: the ectoderm, endoderm, and mesoderm. Unlike pluripotent stem cells, however, the mixture created from cells of the present invention did not include cells of the mesodermal lineage (see Example 4, e.g., in the fifth paragraph).
• Cells of the invention also were subjected to a protocol commonly employed to differentiate pluripotent stem cells to cardiomyocytes, which are cells of the mesodermal lineage. Again in contrast with pluripotent stem cells, the cells of the invention failed to express cardiomyocyte-related genes in response to the differentiation protocol. Visual examination revealed that none of the cells described by this invention displayed the typical beating morphology of cardiomyocytes. Thus, less than about 5% of cells responded to a protocol used in the field to derive cardiomyocytes from pluripotent stem cells (see
• Example 4 e.g. , in its sixth and seventh paragraphs.
• the surrogate pancreatic cells obtained pursuant to the invention also have properties that have not been described previously. These properties are:
• the present invention specifies that cells harvested from a mature organ cannot be cultured over a long term, preferably one week or less, with fewer than 5 population doublings. This prevents the cell population from adapting to the culture conditions and minimizes the opportunity for fast-growing cells to overtake the population and reduce overall population diversity.
• the present invention entails delivering reprogramming genes in plasmids that do not integrate the genes into the genome and, hence, that effects their expression only temporarily. While in the nucleus the genes carried by a plasmid can be transcribed by the host nuclear transcription complexes. See Takacs (2010).
• the genes are delivered in episomal plasmids.
• Episomal plasmids that can persist in the nucleus of a cell but that are not incorporated into any chromosome of the cell (Takacs, supra). Over time episomal plasmids are diluted from the cell population because they are not replicated and segregated during mitosis. Also, episomal plasmids can be expunged from the nucleus or can be degraded.
• a myc family member commonly used for reprogramming, C-myc is a known oncogene.
• the present invention employs L-myc, which is not an oncogene, in lieu of C-myc. See Nakagawa (2010).
• Cells that are reprogrammed are distinguishable from non-reprogrammed cells by displaying typical stem cell morphology. Typical stem cells are small and round, have a prominent nucleus and a small cytoplasm, and grow in tight clusters.
• a relatively small but discernable fraction of these reprogrammed cells are the source for pharmaceutical-grade surrogate pancreatic cells, pursuant to the present invention. This fraction is identified by virtue of satisfying the criteria detailed below.
• pancreatic cells i.e., a population comprised of at least about 80%, preferably at least about 90%, of cells that express genes characteristic of pancreatic endocrine progenitors and that can mature into hormone-producing cells of the islets of Langerhans
• the inventive protocol is designed to drive affected cells along a differentiation pathway that recapitulates the pathway that stem cells of the human body would follow in the development of the pancreas. Accordingly, the protocol mimics human development faithfully enough to produce a pancreatic cell that is indistinguishable from a pancreatic cell that can be isolated from a developing human fetus or neonate.
• the protocol according to the invention also uses only defined, non-animal origin components that can be part of a scalable pharmaceutical-grade manufacturing process. That is, the inventive protocol employs neither serum, used heretofore to enhance cell survival, nor a wnt family member, a growth factor that is extremely labile and expensive.
• survive denotes an ability of at least about 80% of the starting viable cell population, and preferably at least about 90%, to be viable at the end of the differentiation procedure.
• a human pancreas was rinsed thoroughly in DMEM supplemented with 5X antibiotic/antimycotic (Pennicilin, Streptomycin, Amphotericin. Life Technologies). A small portion of the tissue was minced into fragments no larger 2 mm in diameter. The minced tissue was transferred to a 50 ml conical tube and allowed to gravity sediment ( Figure 1 A,B).
• pancreas tissue purchased from Prodo Labs (Irvine, CA) was used in lieu of a whole human pancreas; that is, the pancreas tissue was fractionated into islet preparations and ductal preparations.
• a skin punch biopsy was used.
• collagenase was replaced with IX TrypLE Select (Life Technologies).
• CELLstart was replaced with dishes coated with IX VitronectinXF (Stem Cell Technologies). No substantial change occurred in relation to either variation.
• Reprogramming plasmids 1 and 2 are episomal, non-integrating plasmids.
• the genes used in the reprogramming plasmids have been described, for instance, by Takahashi (2006).
• L-myc was used in place of C-myc, a known oncogene. See Nakagawa (2010).
• the cuvette was inserted quickly into a Lonza Nucleofector and electroporated using program T-024.
• Reprogramming Culture Media was comprised of: DMEM/F12, L-ascorbic acid-2 -phosphate (64 mg/L), Na Selenium (14 ⁇ g/L), insulin (19.4 mg/L), NaHC0 3 (543 mg/L), transferrin (10.7 mg/L), TGF betal (2 ⁇ ), bFGF (10 ⁇ g/L), and heparin (50 ⁇ ). Media was adjusted to pH 7.4 and 340 mOSM.
• the electroporated cells were diluted in Essential 6 media (Life Technologies) supplemented with 100 ng/ml bFGF (Sigma), 100 ⁇ Sodium Butyrate (Sigma), and 100 nM Hydrocortisone (Sigma).
• the media was refreshed every 2 days.
• the media was supplemented with 2 mM valproic acid (Sigma) during days 4-10.
• Cells were passaged when they had reached confluence, using TrypLE. By day 20 colonies of cells with stem cell morphology had appeared ( Figure 3).
• Colonies of proliferating cells then were transferred to wells of six-well tissue culture dishes, pre-coated with CELLstart, and were allowed to grow to near confluence. At near-confluence the cells were subjected to a protocol to direct differentiation to the pancreatic lineage. Alternatively, cells were transferred to wells of a six -well tissue culture dishes pre-coated with Vitronectin XF (Stem Cell Technologies).
• Novel protocol to drive differentiation of stem cells to the pancreatic lineage The medium was replaced with DMEM/F-12 supplemented with 0.2% human serum albumin (HSA), 0.5XN2 (Life Technologies), 0.5XB27 (Life Technologies), 100 ng/ml Activin A, and ⁇ wortmannin (Sigma). The media was refreshed after 2 days. By day 4 the cells expressed genes characteristic of the endoderm lineage Sox 17, FiNF3p, and FiNF4a.
• HSA human serum albumin
• 0.5XN2 Life Technologies
• 0.5XB27 Life Technologies
• Activin A 100 ng/ml Activin A
• ⁇ wortmannin Sigma
• the medium was replaced with IMDM/F-12 supplemented with 0.5% HSA, 2 ⁇ retinoic acid (Sigma), 50 ng/ml Noggin, 10 ng/ml FGF7/KGF, and 0.5%> insulin-transferrin-selenium (BD Biosciences).
• the medium was refreshed on day 7.
• the medium was replaced with DMEM supplemented with 1% ITS, 1XN2, and 50 ng/ml EGF.
• the medium was refreshed on days 11 and 13.
• the cells simultaneously expressed genes characteristic of pancreatic cells from which the endocrine pancreas is derived, Pdxl, Nkx6.1, and NeuroD.
• Clones 5-10 were differentiated to the three primary germ layers to determine if these stem cells were pluripotent.
• the differentiation protocol commonly used by those practiced in the art, enables differentiation of stem cells into "embryoid bodies.” See [Rust 2006]. Differentiation was evaluated by RT-qPCR analysis of gene expression.
• M-MuLV Moloney murine leukemia virus
• clones 5 and 10 were subjected to a protocol designed to drive differentiation of pluripotent cells to mesodermal cardiomyocytes [Xu 2009]. In brief, clones were passaged onto low-attachment plates to form cell clusters as described above, except that Reprogramming Culture Media was used.
• media was replaced with media comprised of: DMEM, IX non-essential amino acids (Gibco), 2 mM L- glutamine (Gibco), 5.5 ⁇ g/ml transferrin (Sigma), 5 ng/ml sodium selenite (Sigma), 0.1 mM beta mercaptoethanol (Gibco), and IX penicillin/streptomycin (Gibco).
• Media was changed every 3 to 4 days.
• Cardiomyocyte genes were expressed robustly by Clone 5, i.e., at least 5-fold compared to undifferentiated cells (Figure 7). In contrast, spontaneously beating cell clusters were not present in the culture of Clone 10 at either day 12 or day 15 of differentiation. RT-PCR analysis of gene expression of cell clusters revealed that cardiomyocyte genes were not expressed above levels of undifferentiated stem cells.
• Clone 10 thus was incapable of substantially differentiating to cells of the mesodermal cardiac lineage. Because no spontaneously beating cell clusters were identified, and because cardiomyocyte genes were not expressed at levels above undifferentiated cell populations, it was concluded that less than about 5% of cells responded to a protocol commonly employed to differentiate pluripotent stem cells to cardiomyoctes.

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