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Definitions

• CD34 + CD41 DIM MEGAKARYOCYTES PROGENITORS AND USES THEREOF FOR PRODUCING PROPLATELET-BEARING MKs AND/OR PLATELETS
• the invention relates to a method of producing CD34 + CD41 dim megakaryocyte (MK) progenitor cells, and substantially pure cell population of megakaryocyte precursor cells obtained by said method.
• the invention also relates to a method of producing proplatelet- bearing MKs and/or platelets using the CD34 + CD41 dim cells.
• Platelets play crucial roles in both physiology and pathology and it is therefore of major importance to understand the mechanisms controlling their production.
• MKs bone marrow megakaryocytes
• In vitro production of platelets for transfusion has been the subject of many studies in recent years. Continuous improvements in the culture conditions make this an attainable goal, like the recent generation of transfusable human red cells. Nevertheless, we are still unable to efficiently reproduce the native process which can generate over 1000 platelets per MK (Reems JA et al., Transfusion medicine reviews. 2010;24:33-43).
• MK progenitors In the accepted hierarchical map of hematopoiesis, MKs diverge from a common bipotent MK/erythroid progenitor (MEP) (Chen L et al., Science. 2014;345:1251033). Although the existence of a separate MK progenitor has been suggested, no such univocal progenitor has yet been clearly identified or expanded from human adult hematopoietic cells.
• MEP bipotent MK/erythroid progenitor
• CD41 positive cells have been described among human CD34 + cells isolated directly from bone marrow or after culture under MK promoting conditions (Debili N. et al., Blood. 1992;80:3022-3035; Dercksen MW et al., Blood. 1995;86:3771 -3782).
• CD34 + CD41 + cells have also been observed after co-culture of bone marrow-derived CD34 + cells on hMSCs without TPO, but no evidence was provided for a distinct CD41 dim subpopulation (Cheng L. et al., Journal of cellular physiology. 2000;184:58-69).
• 0W phenotype representing a very minor population were recently reported in cultures derived from peripheral blood but were not characterized further (Debili et al., Blood, 2001 , 97(7), 2023-2030.
• SR1 aryl hydrocarbon receptor 1
• HPCs hematopoietic progenitor cells
• WO 2012/129109 discloses an ex vivo three-step method for producing platelets which comprises a first step of generating megakaryocyte progenitor cell population by culturing stem cells in the presence of a plurality of growth factors selected from a group of 29 growth factors or families of growth factors, including SR1 and co-culture with mesenchymal stem cells.
• the method further comprises maturing the expanded megakaryocyte progenitor cells under conditions of increased oxygen concentration and in the presence of a plurality of growth factors, and culturing the matured megakaryocytes in a three-dimensional matrix, under conditions of increased oxygen concentration and in the presence of a plurality of growth factors, to produce platelets.
• WO 2014/028749 discloses a method of making a megakaryocyte-erythroid progenitor cell (MEP), comprising differentiating a MEP precursor cells into a MEP in culture in the presence of an AhR modulator.
• the method comprises in particular culturing MEP precursor cells in the presence of an AhR antagonist and then culturing MEP precursor cells in the presence of an AhR agonist.
• WO 2014/138485 discloses an ex vivo two-step method which comprises a first step of generating megakaryocytes by directed differentiation of hematopoietic stem cells and progenitor cell (HSPC) using platelet-derived growth factor receptor (PDGFR) antagonist and a combination of cytokines TPO, IL-6, Flt3-L and SCF, and a second step which promotes platelet biogenesis from the megakaryocytes using an AhR antagonist and TPO, IL-6, Flt3-L and SCF, or an AhR antagonist and TPO, and optionally further a matrix metalloproteinase (MMP) inhibitor.
• MMP matrix metalloproteinase
• the invention relates to an ex vivo method of producing proplatelet-bearing megakaryocytes (MKs) and/or platelets comprising:
• TPO thrombopoietin
• AhMSCs aryl hydrocarbon receptor
• hMSCs human mesenchymal stromal cells
• the invention further provides for a method of producing megakaryocyte (MK) progenitor cells comprising:
• HSC haematopoietic stem cells
• LDL low-density lipoprotein
• SCF stem cell factor
• TPO TPO
• IL-6 IL-9
• AhR aryl hydrocarbon receptor
• hMSCs human mesenchymal stromal cells
• the invention in another aspect relates to a substantially pure cell population of megakaryocyte (MK) progenitors wherein at least 80% of the cells in the population are CD34 + CD41 dim cells.
• MK megakaryocyte
• composition comprising a cell population of proplatelet-bearing megakaryocytes (MKs) and/or platelets and an infusion buffer for use for transfusion, wherein said use comprises preparing proplatelet-bearing megakaryocytes (MKs) and/or platelets by a method according to the invention.
• MKs proplatelet-bearing megakaryocytes
• infusion buffer for use for transfusion
• SR1 a AhR antagonist
• HSC peripheral blood haematopoietic stem cells
• MK megakaryocyte progenitor cells
• the invention provides for a method of producing megakaryocyte (MK) progenitor cells comprising:
• HSC haematopoietic stem cells
• LDL low-density lipoprotein
• SCF stem cell factor
• TPO TPO
• IL-6 IL-9
• AhR aryl hydrocarbon receptor
• hMSCs human mesenchymal stromal cells
• HSCs Hematopoietic stem cells
• HSCs are immature blood cells having the capacity to self-renew and to differentiate into more mature blood cells comprising granulocytes, erythrocytes, platelets, and monocytes. HSCs are interchangeably described as stem cells throughout the specification. In an embodiment HSC are CD34+ cells. CD34+ cells are believed to include a subpopulation of cells with the stem cell properties defined above. It is well known in the art that HSCs include pluripotent stem cells, multipotent stem cells (e.g., a lymphoid stem cell), and/or stem cells committed to specific hematopoietic lineages.
• Sources for HSC include unfractionated bone marrow, umbilical cord, and peripheral blood.
• normal peripheral blood cells can be mobilized with G-CSF [leukapheresis (LK) cells], and CD34+ cells are isolated from LK cells by cell selection.
• HSC also include induced-pluripotent stem (iPS) cells committed to the hematopoietic lineage.
• iPS cells are well-known to one of skill in the art. By way of example, iPS cells can be obtained following the teachings of Takahashi & Yamanaka (2006) Cell 126:663-676 and Yamanaka et al. (2007) Nature 448:313-317.
• the HSC are human cells.
• the starting HSC population may preferably contain at least 60% CD34+ cells, in some embodiments, more than 80% of CD34+ cells, or even more than 90% of CD34+ cells.
• the starting HSC population may comprise between 10 5 and 10 9 nucleated cells
• HSC are typically seeded at a cell density of 1 -10 ⁇ 1 0 4 per ml_ of culture medium, for instance 2-6x 10 4 per ml_.
• a “culture medium” denotes a “basal medium” which is supplemented with a mixture of cytokines, growth factors, and AhR antagonist which is specified at each step of the method.
• the basal medium is not supplemented with, i.e. the culture medium does not comprise, any additional component beside the mixtures of cytokines, growth factors, and AhR antagonist which is specified at each step.
• human cytokines and growth factors are used in the frame of the invention.
• a “basal medium” is a synthetic serum free medium which typically comprises amino acids, carbon sources, vitamins, serum proteins (e.g. albumin), inorganic salts, divalent cations, buffers and any other element suitable for use in culturing of cells, and HSC in particular.
• the basal medium may typically contain or be supplemented with antibiotics to prevent contamination during cell culture, and glutamine. Growth factors and cytokines are typically not present into a basal medium.
• SFEM StemSpanTM Serum-Free Expansion Medium
• StemSpan® H3000 -Defined Medium StemCell Technologies, Vancouver, Canada
• CellGro® SCGM CellGro® SCGM.
• StemSpanTM Serum-Free Expansion Medium (SFEM) has been developed for the in vitro culture and expansion of human hematopoietic cells. This medium contains pretested bovine serum albumin, insulin and transferrin, and supplements in Iscove's MDM. Recombinant hematopoietic growth factors, required for the optimal growth and expansion of hematopoietic cells, are not present into StemSpanTM SFEM.
• the basal medium is supplemented with low-density lipoprotein (LDL), stem cell factor (SCF), TPO, IL-6 and IL-9.
• LDL low-density lipoprotein
• SCF stem cell factor
• TPO TPO
• IL-6 IL-9
• the culture medium comprises SCF, TPO, IL-6 and IL-9 each present in a concentration of 1 -100 ng/mL, such as 25-100 ng/mL, in particular 10-50 ng/mL, 40-50 ng/mL, or 20-30 ng/mL.
• the basal medium is preferably supplemented with LDL 1 -40 ⁇ g/mL for instance 10- 30 ⁇ g/mL, or 15-25 jjg/mL
• the culture medium may comprise 10-30 ⁇ g/mL LDL, 25-100 ng/mL SCF, 40-50 ng/mL TPO, 20-30 ng/mL IL-6, and 20-30 ng/mL IL-9.
• SCF, TPO, IL-6 and IL-9 are added to the basal medium by addition of the StemSpanTM Megakaryocyte Expansion Supplement (formerly known as CC220) (StemCell Technologies, Vancouver, Canada).
• StemSpanTM Megakaryocyte Expansion Supplement is supplied as a 100X concentrate and it contains a combination of recombinant human cytokines (SCF, IL-6, IL-9 and TPO) formulated to selectively promote the expansion and differentiation of human megakaryocyte progenitor cells in liquid cultures initiated with CD34+ cord blood (CB) or bone marrow (BM) cells.
• CB CD34+ cord blood
• BM bone marrow
• HSC human mesenchymal stromal cells
• the AhR antagonist is a synthetic compound added to the basal medium which has formula (I)
• L is selected from -NR 5a (CH 2 ) 2 - 3 -, -NR 5a (CH 2 ) 2 NR 5b -, -NR 5a (CH 2 ) 2 S-, - NR 5a CH 2 CH(OH)- and -NR 5a CH(CH 3 )CH 2 -; wherein R 5a and R 5b are independently selected from hydrogen and d- 4 alkyl;
• Ri is selected thiophenyl, furanyl, benzoimidazolyl, isoquinolinyl, imidazopyridinyl, benzothiophenyl, pyrimidinyl, pyrazolyl, pyridinyl, imidazolyl, pyrrolidinyl, pyrazinyl, pyridazinyl, pyrrolyl and thiazolyl; wherein said thiophenyl, furanyl, benzoimidazolyl, isoquinolinyl, imidazopyridinyl, benzothiophenyl, pyrimidinyl, pyrazolyl, pyridinyl, imidazolyl, pyrrolidinyl, pyrazinyl, pyridazinyl, pyrrolyl and thiazolyl of Ri
• S optionally substituted by 1 to 3 radicals independently selected from halo, cyano, Ci- 4 alkyl, halo-
• R 6a , Re b and R 6c are independently selected from hydrogen and d- 4 alkyl
• said phenyl, pyrrolopyridinyl, indolyl, thiophenyl, pyridinyl, triazolyl, oxoimidazolidinyl, pyrazolyl, or indazolyl of R 2 is optionally substituted with 1 to 3 radicals independently selected from hydroxy, halo, methyl, methoxy, amino, - 0(CH 2 )nNR 7 aR7b, -OS(0) 2 NR 7a R 7b and -NR 7a S(0) 2 R 7b ; wherein R 7a and R 7b are independently selected from hydrogen and C 1-4 alkyl;
• R 3 is selected from hydrogen, C 1-4 alkyl and biphenyl
• R 4 is selected from C 1-10 alkyl, C 1-4 alkenyl, oxetanyl, tetrahydrofuranyl, cyclohexyl, (oxopyrrolidinyl)ethyl, tetrahydropyranyl, phenyl, and benzyl, wherein said C 1-10 alkyl, d.
• R 4 alkenyl, oxetanyl, tetrahydrofuranyl, cyclohexyl, (oxopyrrolidinyl)ethyl, tetrahydropyranyl, phenyl, and benzyl of R 4 can be optionally substituted with 1 to 3 radicals independently selected from hydroxy, C _ 4 alkyl and halo-substituted- C 1-4 alkyl.
• the AhR antagonist of formula (I) is StemRegenin 1 (SR1 ), i.e. 4- (2-(2-(benzo[b]thiophen-3-yl)-9-isopropyl-9H-purin-6-ylamino)ethyl)phenol.
• the AhR antagonist is typically present in the culture medium at a concentration of 10 nM to 10 ⁇ , for instance 100 nM to 7.5 ⁇ , in particular 1 to 5 ⁇ .
• the HSC are co-cultured with human mesenchymal stromal cells (hMSCs) in the culture medium comprising LDL, SCF, TPO, IL-6 and IL-9.
• hMSCs human mesenchymal stromal cells
• the effect of co-culture with hMSCs is reversed by addition of the AhR agonist FICZ, and co-culture with hMSCs drastically decreases transcription of CYP1 B1 , a downstream target of AhR.
• said hMSCs are obtained by a method comprising: i) Isolating bone marrow mononuclear cells (BM-MNCs) from a healthy human subject by Ficoll density gradient;
• BM-MNCs seeding isolated BM-MNCs in culture medium comprising 5-15% fetal bovine serum and 0.5-5 ng/mL fibroblast growth factor 2 (FGF-2), for instance 1 ng/mL FGF-2;
• FGF-2 fibroblast growth factor 2
• BM-MNCs are seeded for instance at a cell density of 10 4 cells/cm 2 .
• hMSCs Harvesting hMSCs is typically performed using trypsin. Cells are then typically seeded at a cell density of 500 cells/cm 2 and cultured until confluence (first passage, P1 ). hMSCs display a lack of CD45, CD14, CD34, and CD31 expression, together with a strong expression of CD73, CD90, and CD105.
• hMSCs can be maintained in culture medium comprising 10% fetal bovine serum and 0.5-5 ng/mL FGF-2, for instance 2 ng/mL FGF2.
• hMSCs are used in a confluent layer and CD34 + cells are typically added at the above specified cell density.
• the culture medium used for producing and maintaining the hMSCs is any culture medium suitable for the culture of mesenchymal cells, such as a-MEM.
• a-MEM mesenchymal cells
• the cultures are typically incubated at 37°C, under normoxic conditions (i.e. 20-21 % 0 2 ), and 5% C0 2 .
• the culture comprises CD34 + CD41 dim cells which are isolated from the cell culture by any suitable method known to the skilled person.
• cells in suspension are harvested and washed with a suitable buffer such as PBS.
• Methods for isolating the CD34 + CD41 dim cell population based on CD34 and CD41 markers uses flow cytometry, more specifically fluorescent activated cell sorting (FACS) technology. To that end, cells in suspension harvested from the cell culture are incubated with a mixture of labeled anti-CD34 and anti-CD41 antibodies. Incubation can be typically performed for 20-40 minutes at 4°C. Cells are then washed before cell sorting by FACS.
• FACS fluorescent activated cell sorting
• CD34 + CD41 dim cells are selected from the harvested cell population.
• washed cells are further incubated with a fluorescent marker of cell viability, such as 7-aminoactinomycine D (7-AAD) or Hoechst which are a marker of DNA. Incubation is performed typically for 20-40 minutes at 4°C. Cells are then washed before cell sorting by FACS.
• a fluorescent marker of cell viability such as 7-aminoactinomycine D (7-AAD) or Hoechst which are a marker of DNA. Incubation is performed typically for 20-40 minutes at 4°C. Cells are then washed before cell sorting by FACS.
• the FACS morphologic and sorting gates are typically positioned as follows :
• the CD34 + CD41 dim cell population can be readily identified as culture in presence of AhR antagonist, such as SR1 , gives rise to a CD34+CD41 + cell population displaying a mean fluorescence intensity lower compared to control condition and which may be identified as shown on Figure 10.
• AhR antagonist such as SR1
• CD34 + CD41 dim cells selected are characterized by any one of the following features, or the combination thereof:
• FSC 200-400
• SSC 200;
• CD34 + CD41 dim cell can generate 2-3 MKs.
• the method described therein produces at least 150,000 CD34 + CD41 dim cells per seeded HSC, in particular CD34+ cell.
• the invention further relates to a substantially pure cell population of MK progenitors, wherein at least 80%, preferably, at least 85%, 90%, 95%, of the cells in the population are CD34 + CD41 dim cells.
• said substantially pure cell population of MK progenitors comprises at least 150,000 CD34 + CD41 dim cells.
• Said substantially pure cell population of MK progenitors is obtainable, or obtained, by the method of producing megakaryocyte (MK) progenitor cells.
• MK megakaryocyte
• the inventors further isolated a subpopulation of CD34 + CD41 dim cells using CD9 " sorting, which subpopulation is called CD34 + CD9 " CD41 + .
• This subpopulation CD34 + CD9 " CD41 + was obtained from peripheral blood CD34 + cells cultured in the presence of SR1 for 10 days from which CD34 + CD9 " progenitors cells were gated by cell sorting.
• the population of CD34 + CD9 " progenitor cells was then fractionated into MK progenitors according to the FSC/CD41 + expression as further explained in example 2. The resulting subpopulation was thus identified as a CD34 + CD9 " CD41 + cell population.
• CD34 + CD9 " CD41 + cell population as identified by the inventors, can also be called a CD34 + CD9 " CD41 dim cell population.
• CD34 + CD9 " CD41 + subpopulation can be indifferently referred to as CD34 + CD9 CD41 dim .
• CD34 + CD9 dim cells allows to further increase by 1 .8 fold the platelet release compared to the use of CD34 + CD41 dim cells.
• step aO) of the method of producing megakaryocyte (MK) progenitor cells the cell population comprising CD34 + CD41 dim cells is a cell population comprising CD34 + CD9 CD41 dim and in step a1 ) said CD34 + CD9 CD41 dim cell population is isolated.
• the invention refers to a method of producing megakaryocyte (MK) progenitor cells comprising:
• HSC haematopoietic stem cells
• SCF stem cell factor
• TPO TPO
• IL-6 TPO
• IL-9 aryl hydrocarbon receptor
• hMSCs human mesenchymal stromal cells
• CD34 + CD9 CD41 dim cells are characterized by any one of the following features, or the combination thereof:
• FSC 200-400
• SSC 200;
• CD34+CD41 dim cell can generate 2-3 MKs.
• Methods for isolating the CD34 + CD9 " CD41 dim cell population based on CD34 and CD41 markers uses flow cytometry, more specifically fluorescent activated cell sorting (FACS) technology. To that end, cells in suspension harvested from the cell culture are incubated with a mixture of labeled anti-CD34 and anti-CD9 antibodies. Incubation can be typically performed for 20-40 minutes at 4°C. Cells are then washed before cell sorting by FACS.
• FACS fluorescent activated cell sorting
• CD34 + CD9 Only viable CD34 + CD9 " cells are selected from the harvested cell population. According to this embodiment washed cells are further incubated with a fluorescent marker of cell viability, such as 7-aminoactinomycine D (7-AAD) or Hoechst which are a marker of DNA. Incubation is performed typically for 20-40 minutes at 4°C. Cells are then washed before cell sorting by FACS. Using the CD9 " cell surface marker for sorting excludes CD41 high cells. The resulting viable CD34 + CD9 " are then further sorted into MK progenitors according to the FSC/CD41 + expression allowing obtaining a population of CD34 + CD9 CD41 dim cells.
• a fluorescent marker of cell viability such as 7-aminoactinomycine D (7-AAD) or Hoechst which are a marker of DNA. Incubation is performed typically for 20-40 minutes at 4°C. Cells are then washed before cell sorting by FACS. Using the CD9 " cell surface
• the CD34 + CD9 " CD41 dim cell population represents 40 to 80% of the CD34 + CD41 dim cell population, preferably 45 to 75%, such as 50 to 70%, 55 to 65%, more preferably 60%.
• the invention further relates to a substantially pure cell population of MK progenitors, wherein at least 50%, preferably, at least 55%, 60%, more preferably 80% such as 85%, 90%, 95%, of the cells in the population are CD34 + CD9 " CD41 dim cells.
• said substantially pure cell population of MK progenitors comprises at least 150,000 CD34 + CD9 CD41 dim cells.
• Said substantially pure cell population of MK progenitors is obtainable, or obtained, by the method of producing megakaryocyte (MK) progenitor cells.
• MK megakaryocyte
• the invention further provides for a method of producing proplatelet-bearing megakaryocytes (MKs) and/or platelets comprising:
• TPO thrombopoietin
• AhR aryl hydrocarbon receptor
• hMSCs human mesenchymal stromal cells
• CD34 + CD41 dim cells are typically seeded at a cell density of 1 -10 10 4 per ml_ of serum-free culture medium, for instance 2-6x 10 4 per ml_.
• the basal medium is supplemented with TPO and the culture is conducted in presence of AhR antagonist.
• serum-free culture medium "basal medium” and “aryl hydrocarbon receptor (AhR) antagonist” are as defined previously.
• the culture medium comprises 20-100 ng/ml TPO, preferably 25- 65 ng/ml, still preferably 40-60 ng/ml.
• an AhR antagonist in particular a compound of formula (I) -Fi
• a co-culture with hMSCs is used independently from the AhR antagonist or co- culture with hMSCs used in step aO) for producing CD34 + CD41 dim cells.
• an AhR antagonist is used, in particular a compound of formula (I), or a co-culture with hMSCs is performed;
• an AhR antagonist in particular a compound of formula (I), is used, while in step a) a co-culture with hMSCs is performed;
• step aO a co-culture with hMSCs is performed, and in step a), an AhR antagonist, and in particular a compound of formula (I), is used.
• the cultures are typically incubated at 37°C, under normoxic conditions (i.e. 20-21 % 0 2 ), and 5% C0 2 .
• the step a) of culturing is conducted for 5 to 9 days, preferably for 6-8 days, still preferably for about 7 days.
• cells in suspension are harvested from the culture, thereby collecting proplatelet-bearing MKs and/or platelets present in the cell culture.
• Proplatelet-bearing MKs can be identified by phase-contrast microscopy by detecting round and pro-platelet bearing cells.
• the CD34 + CD41 dim cell population of MK progenitors is a CD34 + CD9 " CD41 dim cell population of MK progenitors.
• the invention relates to an ex vivo method of producing proplatelet-bearing megakaryocytes (MKs) and/or platelets comprising:
• the method further comprises selecting CD41/CD61 + and CD42c+ cells from the collected cell population comprising proplatelet-bearing MKs and/or platelets.
• Platelets or platelet-like particles are identified as CD41 and CD42c double positive events, having the same scattering properties as human blood platelets.
• the cell population comprising proplatelet-bearing MKs and/or platelets typically comprises at least 75%, preferably 80%, 85%; 90%, 92% or 95% proplatelet-bearing MKs and/or platelets.
• the cell population comprising proplatelet-bearing MKs and/or platelets comprises at least 50,000 CD41 +CD42c+ cells, obtained from 20,000 CD34 + CD41 dim seeded cells.
• the method described herein thus produces at least 2, preferably at least 2.5, such as 2.7 proplatelet-bearing MKs per seeded CD34 + CD41 dim cell.
• About 1 .10 6 platelets are obtained from 20,000 CD34 + CD41 dim seeded cells, hence about 50 platelets per CD34 + CD41 dim seeded cell.
• the method described herein produces at least 3.6, preferably at least 4.5, such as 4.8 MKs per seeded CD34 + CD9 " CD41 dim cell.
• About 1 .8x10 6 platelets are obtained from 20,000 CD34 + CD9 " CD41 dim seeded cells, hence about 90 platelets per CD34 + CD9 CD41 dim seeded cell.
• the method of producing proplatelet-bearing MKs and/or platelets can further comprise washing the collected proplatelet-bearing MKs and/or platelets and suspending the washed cells in an infusion buffer.
• infusion buffer e.g., a 5% HSA (Baxter) at a concentration of between 10 7 to 10 10 proplatelet-bearing MKs and/or platelets /ml.
• the method of the invention can produce platelets in a patient specific manner by using HLA-matched CD34+ cells.
• compositions and therapeutic treatments are provided.
• the invention further relates to a composition
• a composition comprising a cell population of proplatelet-bearing megakaryocytes (MKs) and/or platelets, in particular CD41 and CD42c+ cells, and an infusion buffer obtainable or obtained by the method of the invention.
• MKs proplatelet-bearing megakaryocytes
• CD41 and CD42c+ cells in particular CD41 and CD42c+ cells
• the invention also relates to said composition for its use for allogeneic or autologous transfusion.
• said use comprises preparing proplatelet-bearing megakaryocytes (MKs) and/or platelets by a method according to the invention.
• MKs proplatelet-bearing megakaryocytes
• MKs proplatelet-bearing megakaryocytes
• the subject according to the invention is a mammal, such as a rodent, a canine, a feline or a primate.
• a mammal such as a rodent, a canine, a feline or a primate.
• the subject is a human.
• the number of cells transfused typically takes into consideration factors such as sex, age, weight, the types of disease or disorder, stage of the disorder, the percentage of the desired cells in the cell population and the amount of cells needed to produce a therapeutic benefit.
• the composition is administered by intravenous infusion and comprises at least 10 8 platelets/kg, from 10 9 to 10 10 platelets/kg or more if needed.
• a transfusion dose is typical about 3 to 5 x 10 11 platelets.
• Figure 1 Preservation of CD34 expression in MKs cultured in the presence of
• SR1 MK differentiation protocol. Peripheral blood CD34 + cells were cultured in the absence (Ctrl) or presence of SR1 (1 ⁇ ) in a serum-free medium containing CC220 cytokine cocktail from day 0 to day 7 and with TPO (30 ng/mL) from day 7 to day 14.
• B Level of proliferation. Viable cells were counted on days 7 and 10 of culture using an automatic cell counter and the fold increase over the input of CD34 + cells on day 0 was calculated.
• C Proportion of CD34 + cells. The proportion of CD34 + cells was determined on the indicated days by flow cytometry after labeling with an R-PE-Cy5-conjugated anti- CD34 mAb. Experiments were performed at least three times (mean ⁇ SEM; two-way ANOVA and a Bonferroni post-test, n.s. P > 0.05, *** P ⁇ 0.001 ).
• Figure 2 Increased production of proplatelets and platelet-like elements in the presence of SR1.
• CD34 + cells were cultured as in Fig. 1 A and analyses were performed on day 14.
• A Quantification of the percentage of MKs extending proplatelets (34.6 ⁇ 2.1 % with SR1 versus 1 1 .5 ⁇ 4.5 % for the control; mean ⁇ SEM in 3 experiments; Student's t-test * P ⁇ 0.05).
• B Release of platelets. The cell suspension was subjected to multiple pipetting and platelet-like elements were detected and counted by flow cytometry.
• Upper panel Representative gating strategy based on the forward and side scattering properties and CD41 /CD42 expression of the cells.
• Figure 3 Emergence of a CD34 + CD41 dim population in the presence of SR1.
• CD34 + cells were cultured as in Fig. 1 A and analyses were performed on days 7 and 10.
• CD34 + cells amounted to 51 .6 ⁇ 4.9 % of the cells in the control versus 26.7 ⁇ 4.5 % in the presence of SR1 .
• the CD34 + CD41 + population (red) was more abundant in SR1 -treated cultures (55.1 ⁇ 4.9 %) than under control conditions (32.1 ⁇ 0.7 %).
• a CD34 + CD41 + subpopulation (region R2) with an intermediate level of CD41 expression, defined as CD34 + CD41 dim was predominant in SR1 cultures.
• Figure 4 Ploidy distribution of the CD34+CD41 dim and CD34-CD41 + cells from an SR1 -treated culture on day 10 (Student's t-test, * P ⁇ 0.05, ** P ⁇ 0.005).
• FIG. 5 High capacity of CD34 + CD41 dim cells to produce proplatelets and platelet-like elements.
• A CD34 + cells cultured for 10 days in the presence of SR1 as in Fig. 1 A were sorted according to their CD34 + CD41 dim and CD34 " CD41 + expression using a FACS Aria II flow cytometer and then cultured for 7 days in a medium containing TPO with or without SR1 (5 ⁇ ).
• B Quantification of the percentage of MKs extending proplatelets 7 days after seeding CD34 + CD41 dim cells (91 .0 ⁇ 2.4 % with SR1 versus 10.0 ⁇ 6.6 % for the control; mean ⁇ SEM in 5 experiments; Student's t-test, *** P ⁇ 0.001 ).
• FIG. 6 Co-culture of CD34 + cells with hMSCs promotes platelet production and the emergence of a CD34 + CD41 dim population.
• A CD34 + cells were cultured as in Fig. 1 A in the absence (Ctrl) or presence of a monolayer of hMSCs for up to 14 days.
• B Level of proliferation. Viable cells were counted on days 7 and 10 of culture using an automatic cell counter and the fold increase over the input of CD34 + cells was calculated (mean ⁇ SEM in 3 experiments; Student's t-test, n.s. P > 0.05).
• C Quantification of culture-derived platelets. The cell suspension was subjected to multiple pipetting on day 14 of culture and platelet-like elements were detected and counted by flow cytometry (mean ⁇ SEM in 3 experiments; Student's t-test, * P ⁇ 0.05).
• FIG. 7 Effect of FICZ on platelet production.
• CD34 + cells were co-cultured on MSCs as in Fig. 5A in the presence or absence of the AhR agonist FICZ (0.2 ⁇ ).
• platelet-like elements were counted by flow cytometry (20.6 ⁇ 1 .3 vs 4.5 ⁇ 1 .9 per cell seeded on day 7, with or without FICZ, respectively; mean ⁇ SEM in 3 experiments; Student's t-test, *** P ⁇ 0.001 ?
• B CYP1B1 expression. qPCR analysis of CYP1 B1 mRNA on day 10 in MKs co-cultured or not with MSCs or SR1 and with or without FICZ. Data are the mean values ⁇ SEM of 3 experiments.
• FIG. 8 (A) Evolution of CD34 and CD41 expression. Representative flow cytometric dot plots of CD34 and CD41 expression in the cell suspension on day 10 revealing a CD34 + CD41 dim population in MSC co-cultures. (B) Proportion of CD34 + CD41 dim cells. Bar graph representing the proportion of cells in the CD34 + CD41 dim region (mean ⁇ SEM in 3 experiments; Student's t-test, * P ⁇ 0.05). (C) Ploidy distribution of the CD34 + CD41 dim cells from an MSC co-culture on day 10.
• Figure 9 Comparable properties of CD34 + CD41 dim cells obtained after treatment with MSCs or SR1.
• CD34 + cells were cultured for 10 days as in Fig. 1 A in the presence of a monolayer of MSCs.
• CD34 + CD41 dim cells were sorted on day 10 and cultured for a further 7 days with TPO, TPO+5 ⁇ SR1 , or TPO+MSC.
• Panel i Quantification of the percentage of MKs extending proplatelets.
• Panel ii Quantification of culture-derived platelets.
• B CD34 + cells were cultured for 10 days as in Fig. 1 A in the presence of 5 ⁇ SR1 .
• CD34 + CD41 dim cells were sorted on day 10 and cultured for a further 7 days with TPO, TPO+5 ⁇ SR1 , or TPO+MSC.
• Panel i Quantification of the percentage of MKs extending proplatelets.
• Panel ii Quantification of culture-derived platelets. Mean ⁇ SEM in 3-4 experiments.
• Figure 10. Density plot allowing visualizing the cell population CD34 + CD41 dim .
• the region in the right lower inlet represents the CD34 + CD9 " cell population that is gated in Example 2.
• the region in the right lower inlet of A) representing the CD34 + CD9 " cell population corresponds in the lower inlet of the CD41/CD9 dot plot which is CD9 " CD41 dim . It can be concluded that the CD9 " cell population is identical with the CD9 " CD41 dim cell population.
• FIG. 12 Visualisation of the CD34 + CD9 CD41 dim cell population in comparison to the CD34 + CD41 dim cell population
• the CD34 + CD9 " CD41 + cell population can thus be called a CD34 + CD9 " CD41 dim cell population.
• CD34 + cells were seeded in 48-well plates at a density of 4x 10 4 per ml_ in StemSpan SFEM medium supplemented with 20 ng/mL human LDL and CC220 (1 X), a cocktail of cytokines containing SCF, TPO, IL-6 and IL-9 (all from Stemcell Technologies), with or without addition of 1 ⁇ SR1 (Cellagen Technology, San Diego, CA) (Fig. 1 A).
• the cells were harvested, washed and seeded at 5x 10 4 /mL in StemSpan SFEM medium containing 30 ng/mL TPO with or without 1 ⁇ SR1 for an additional 7 days.
• SR1 was replaced by the AhR agonist FICZ (Enzo life sciences, Villeurbane, France) added at 0.2 ⁇ .
• CD34 + cells were cultured in the presence of mesenchymal stromal cells (MSCs) isolated from human bone marrow (Guilloton F et al., Blood. 2012;1 19:2556-2567). MSCs were maintained in a-MEM medium supplemented with 10% fetal bovine serum (Invitrogen, Cergy Pontoise, France) and 2 ng/mL recombinant human (rh) FGF2 (Peprotech, Rocky Hill, NJ).
• MSCs mesenchymal stromal cells isolated from human bone marrow
• CD34 + cells were added to a confluent layer of MSCs at a density of 4x 10 4 /mL in 48-well plates in StemSpan SFEM medium supplemented with 20 ng/mL human LDL and CC220. On day 7, the cells in suspension were harvested, washed and co-cultured at 5x 10 4 /mL on a new layer of confluent MSCs in StemSpan SFEM medium containing 30 ng/mL TPO for an additional 7 days (Fig. 5A).
• the cells recovered on day 10 were incubated with a mixture of Alexa-488- conjugated anti-CD41 (ALMA.17) and PE-Cy7-conjugated anti-CD34 mAbs (BD Biosciences) for 30 min at 4°C. They were then washed in PBS-EDTA and incubated for 30 min in PBS containing 7-AAD (1/50) to select viable cells.
• AMA.17 Alexa-488- conjugated anti-CD41
• PE-Cy7-conjugated anti-CD34 mAbs BD Biosciences
• the morphologic and sorting gates were determined by FMO (fluorescence minus one) analysis and megakaryocytic precursors were sorted at 500 cells/s according to their CD34/CD41 expression using a FACS Aria II flow cytometer (Becton Dickinson, Mountain View, CA) equipped with a 50 ⁇ nozzle and two argon lasers operating at 500 mW and tuned to 488 and 360 nm, respectively (Coherent Radiation, Palo Alto, CA).
• the sorted CD34 + CD41 dim and CD34 " CD41 + cells were then counted and seeded at 4x 10 4 /mL in 48-well plates in StemSpan medium containing TPO with or without SR1 for 7 days (Fig. 4A). Analysis of MK maturation
• Cells were analyzed by flow cytometry (Gallios, Beckman Coulter, France) after labeling with anti-CD34-PE-Cy7 (Beckman Coulter, Fullerton, CA), anti- CD41 -Alexa-488 (ALMA.17), anti-CD42c-PE (RAM.1 ) and anti-CD42d-Alexa-647 (V.1 ) mAbs for 30 min at 4°C. The cells were then washed and resuspended in PBS containing 7-AAD (1/50). The acquired data were analyzed with Kaluza software.
• the percentage of MKs extending proplatelets was determined in the culture wells by phase-contrast microscopy. In each culture, at least 100 MKs were analyzed and images were acquired using a Zeiss Axio Vert.AI microscope with a 20x objective (Marly- le-Roi, France).
• CD34 + cells cultured for 7 days in the presence of CC220 (Figs. 1 A and 5A) or CD34/CD41 sorted cells (Figs. 4A and 6A) were seeded in a medium containing TPO.
• 1 ⁇ PGEi and 0.02 U/mL apyrase were added to the culture medium and the cells were gently passed 5 times through a P1000 pipet tip.
• the resulting suspension (200 ⁇ ) was incubated with anti-CD41 -Alexa-647 and anti-CD42c-Alexa-488 mAbs for 15 min at room temperature before analysis in a Gallios flow cytometer.
• CD41 /CD42c double positive events, having the same scattering properties as washed blood platelets, were counted as platelet-like particles and the number of particles per seeded cell, at day 7 or 10 following experiments, was determined.
• CD41/61 cells were obtained on day 7 or 10 of culture using the antibody ALMA.17 and magnetic beads (EasySep® "Do-It- Yourself" Selection Kit, StemCell Technologies).
• Total RNA were extracted using an RNeasy® Mini kit (QIAGEN) following manufacturer's instructions. Quantity and quality of total RNA for all samples were evaluated by measuring OD at 260nm and concentration was adjusted at 50 ng/ml. The RNA samples were stored at -80°C until use. qRT-PCR was applied under standard conditions using the SYBR Green Master Mix kit on the ABI Prism 7900 Sequence Detection System (PerkinElmer-Cetus, Courtaboeuf, France).
• SR1 sustains CD34 expression in MKs differentiated from peripheral blood CD34 + cells
• SR1 (50 ⁇ ) was added on days 0 and 7 in a two-step culture protocol where peripheral blood CD34 + cells (Peytour Y et al., Transfusion. 2010;50:2152-2157) were first expanded for 7 days in the presence of CC220, an optimized mix of SCF, TPO, IL-6 and IL-9, and then differentiated for a further 7 days in the presence of TPO alone (Fig. 1 A).
• SR1 promotes the expansion of a CD34 + CD41 dim population
• CD41 dim phenotype region R2
• the CD41 dim population (R2) comprised cells of decreased size as compared to those with a higher level of CD41 (R1 ), as evidenced by their FSC properties (Fig. 3C), indicating a lower degree of MK differentiation. This was confirmed by the ploidy analysis since CD34 + CD41 dim cells were mostly 2n-4n (Fig. 4).
• CD34 + CD41 dim cells have a high capacity to produce proplatelets and platelet-like particles Addition of SR1 in the two-step culture protocol resulted in an increased production of proplatelet-bearing MKs and platelet-like elements (Fig. 2A-B). We therefore investigated whether this was related to the expansion and particular properties of the CD34 + CD41 dim population.
• CD34 + CD41 dim cells from a day 10 culture with SR1 were sorted by flow cytometry and cultured for 7 days in a TPO-containing medium supplemented or not with SR1 (Fig. 5A).
• An unprecedented high proportion of MKs reached the proplatelet stage (91 .0 ⁇ 2.4 %) when CD34 + CD41 dim cells were grown in the presence of SR1 (Fig 4B).
• Bone marrow-derived stromal cells can maintain hematopoietic sternness, secrete cytokines and favor MK maturation (Pallotta I et al., PloSone. 2009;4:e8359; Cheng L et al., Journal of cellular physiology. 2000;184:58-69) and could provide a favorable milieu for the emergence of an MK precursor.
• CD34+ cells were cultured in a two-step protocol on preformed monolayers of human mesenchymal stromal cells (hMSCs) isolated from human bone marrow (Fig. 6A). Co-culture with hMSCs did not significantly modify cell proliferation (Fig.
• CD34 + cells were cultured with SR1 or on MSCs and the corresponding CD34 + CD41 dim cells were sorted on day 10 (Fig. 9). These cells were then subcultured for 7 days with TPO, with TPO and SR1 or with TPO and MSCs. The results showed that MSC-derived CD34 + CD41 dim cells exhibited an increased capacity to produce proplatelet-bearing MKs when cultured in the presence of SR1 (Fig.
• CD34 + CD41 dim population identified here in the human system, such as the small size and low ploidy of the cells and their high capacity to mature into pure MKs able to efficiently extend proplatelets, appear to correspond to the definition of a platelet-biased progenitor. Its distinctive phenotype combines a CD34 + progenitor signature with intermediate or dim expression of the CD41 megakaryocytic marker.
• CD41 positive cells have been described among human CD34 + cells isolated directly from bone marrow or after culture under MK promoting conditions (Debili N. et al., Blood. 1992;80:3022-3035; Dercksen MW et al., Blood. 1995;86:3771 -3782).
• CD34 + CD41 dim phenotype did not fully recapitulate the CD34 + CD41 dim phenotype since they appeared to express higher levels of CD41 and were highly polyploid and unable to proliferate (Dercksen MW et al., Blood. 1995;86:3771 -3782).
• CD34 + CD41 + cells have also been observed after co-culture of bone marrow-derived CD34 + cells on hMSCs without TPO, but no evidence was provided for a distinct CD41 dim subpopulation(Cheng L. et al., Journal of cellular physiology. 2000;184:58-69). Cells with a CD34 + CD41
• CD34 + CD41 dim population was similarly of low frequency in our standard cultures (Fig. 3A) and only became apparent upon addition of SR1 or co-culture with MSCs.
• a CD31 + CD34 + CD41 + megakaryoblastic population resembling the cells described here was recently observed in reprogrammed iPS cells cultured in a three-step serum-free system. This population appeared to express low levels of CD41 and was negative for CD42.
• Peripheral blood CD34+ cells were isolated as described above in the section “Isolation of CD34+ cells” and cultured in the presence of SR1 (1 ⁇ ) as described above in the section “MK differentiation in culture” of example 1 .
• the cells recovered on day 10 were incubated with a mixture of Alexa-488- conjugated anti-CD41 (ALMA.17), phycoerythrin (PE)-Cy7-conjugated anti-CD34 monoclonal antibodies and phycoerythrin (PE)-CD9 (mAbs; BD Biosciences) for 30 minutes at 4°C. They were then incubated for 2 minutes in phosphate-buffered saline containing 7-aminoactinomycin D (2.5 ⁇ g/mL) to select viable cells.
• the cells were first subdivided into CD34 + CD9 " progenitors. Cell sorting using CD9 " excludes CD41 high cells because only CD9 + cells are CD41 high as shown in Figure 1 1 .
• the population of CD34 + CD9 " progenitor cells (which thus does not comprise CD41 hlQh cells) was then fractionated into MK progenitors according to the FSC/CD41 + expression. The only CD41 + present in the cell population are CD41 dim therefore allowing to gate on the population of interest of CD34 + CD9 " CD41 dim cells.
• CD34 + CD41 dim The population previously described as being CD34 + CD41 dim can be also characterized as CD34 + CD9 " CD41 dim .
• CD34 + CD9 " CD41 dim represents a subpopulation of CD34 + CD41 dim , wherein the population CD34 + CD9 " CD41 dim represents 60% of the total population of CD34 + CD41 dim cells.
• the differentiation potential of CD34 + CD41 dim cells compared to CD34 + CD9 " CD41 dim cells was functionally examined.
• CD34 + CD9 " CD41 dim cells have a platelet release that is increased by 1 .8 fold compared to CD34 + CD41 dim cells.

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