Classifications

• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K35/00—Medicinal preparations containing materials or reaction products thereof with undetermined constitution
  • A61K35/12—Materials from mammals; Compositions comprising non-specified tissues or cells; Compositions comprising non-embryonic stem cells; Genetically modified cells
  • A61K35/30—Nerves; Brain; Eyes; Corneal cells; Cerebrospinal fluid; Neuronal stem cells; Neuronal precursor cells; Glial cells; Oligodendrocytes; Schwann cells; Astroglia; Astrocytes; Choroid plexus; Spinal cord tissue
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K45/00—Medicinal preparations containing active ingredients not provided for in groups A61K31/00 - A61K41/00
  • A61K45/06—Mixtures of active ingredients without chemical characterisation, e.g. antiphlogistics and cardiaca
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K9/00—Medicinal preparations characterised by special physical form
  • A61K9/0012—Galenical forms characterised by the site of application
  • A61K9/0019—Injectable compositions; Intramuscular, intravenous, arterial, subcutaneous administration; Compositions to be administered through the skin in an invasive manner
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P25/00—Drugs for disorders of the nervous system
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P37/00—Drugs for immunological or allergic disorders
  • A61P37/02—Immunomodulators
  • A61P37/06—Immunosuppressants, e.g. drugs for graft rejection
• • C—CHEMISTRY; METALLURGY
  • C12—BIOCHEMISTRY; BEER; SPIRITS; WINE; VINEGAR; MICROBIOLOGY; ENZYMOLOGY; MUTATION OR GENETIC ENGINEERING
  • C12N—MICROORGANISMS OR ENZYMES; COMPOSITIONS THEREOF; PROPAGATING, PRESERVING, OR MAINTAINING MICROORGANISMS; MUTATION OR GENETIC ENGINEERING; CULTURE MEDIA
  • C12N5/00—Undifferentiated human, animal or plant cells, e.g. cell lines; Tissues; Cultivation or maintenance thereof; Culture media therefor
  • C12N5/06—Animal cells or tissues; Human cells or tissues
  • C12N5/0602—Vertebrate cells
  • C12N5/0603—Embryonic cells ; Embryoid bodies
  • C12N5/0606—Pluripotent embryonic cells, e.g. embryonic stem cells [ES]
• • C—CHEMISTRY; METALLURGY
  • C12—BIOCHEMISTRY; BEER; SPIRITS; WINE; VINEGAR; MICROBIOLOGY; ENZYMOLOGY; MUTATION OR GENETIC ENGINEERING
  • C12N—MICROORGANISMS OR ENZYMES; COMPOSITIONS THEREOF; PROPAGATING, PRESERVING, OR MAINTAINING MICROORGANISMS; MUTATION OR GENETIC ENGINEERING; CULTURE MEDIA
  • C12N5/00—Undifferentiated human, animal or plant cells, e.g. cell lines; Tissues; Cultivation or maintenance thereof; Culture media therefor
  • C12N5/06—Animal cells or tissues; Human cells or tissues
  • C12N5/0602—Vertebrate cells
  • C12N5/0618—Cells of the nervous system
  • C12N5/0622—Glial cells, e.g. astrocytes, oligodendrocytes; Schwann cells

Definitions

• the present disclosure relates to the field of stem cell biology and oligodendrocyte progenitor cells. More specifically, the present disclosure relates to oligodendrocyte progenitor cell compositions and methods of using the same.
• SCI spinal cord injury
• Traumatic SCI most commonly impacts individuals in their 20s and 30s, resulting in a high-level of permanent disability in young and previously healthy individuals.
• Individuals with SCI not only have impaired limb function, but suffer from impaired bowel and bladder function, reduced sensation, spasticity, autonomic dysreflexia, thromboses, sexual dysfunction, increased infections, decubitus ulcers and chronic pain, which can each significantly impact quality of life, and can even be life threatening in some instances.
• the life expectancy of an individual suffering a cervical spinal cord injury at age 20 is 20-25 years lower than that of a similarly aged individual with no SCI (NSCISC Spinal Cord Injury Facts and Figures 2013).
• spinal motoneurons can become spontaneously hyperactive, producing debilitating stiffness and uncontrolled muscle spasms or spasticity. This hyperactivity can also cause sensory systems to produce chronic neurogenic pain and paresthesias, unpleasant sensations including numbness, tingling, aches, and burning.
• recovery of ambulatory function was not the highest ranked function that these patients desired to regain, but in many cases, relief from the spontaneous hyperactivity sequelae was paramount (Anderson KD, Friden J, Lieber RL. Acceptable benefits and risks associated with surgically improving arm function in individuals living with cervical spinal cord injury. Spinal Cord. 2009 Apr;47(4):334-38).
• Oligodendrocytes which provide both neurotrophic factor and myelination support for axons are susceptible to cell death following SCI and therefore are an important therapeutic target (Almad A, Sahinkaya FR, Mctigue DM. Oligodendrocyte fate after spinal cord injury. Neur other apics 2011 8(2): 262-73). Replacement of the oligodendrocyte population could both support the remaining and damaged axons and also remyelinate axons to promote electrical conduction (Cao Q, He Q, Wang Yet et al. Transplantation of ciliary neurotrophic factor-expressing adult oligodendrocyte precursor cells promotes remyelination and functional recovery after spinal cord injury. . Neurosci. 2010 30(8): 2989-3001).
• AST-OPC1 is a population of oligodendrocyte progenitor cells (OPCs) that are produced from human embryonic stem cells (hESCs) using a specific differentiation protocol (Nistor GI, Totoiu MO, Haque N, Carpenter MK, Keirstead HS. Human embryonic stem cells differentiate into oligodendrocytes in high purity and myelinate after spinal cord transplantation. Glia. 2005 Feb;49(3):385-96). AST-OPC1 has been characterized by the expression of several molecules that are associated with oligodendrocyte precursors, including Nestin and NG2.
• the cells are further characterized by their minimal or lack of expression of markers known to be present in other cell types, such as neurons, astrocytes, endoderm, mesoderm, and hESCs (Keirstead HS, Nistor G, Bernal G, Totoiu M, Cloutier F, Sharp K, Steward O. Human embryonic stem cell-derived oligodendrocyte progenitor cell transplants remyelinate and restore locomotion after spinal cord injury. Neurosci. 2005 May l l;25(19):4694-705; Zhang YW, Denham J, Thies RS. Oligodendrocyte progenitor cells derived from human embryonic stem cells express neurotrophic factors. Stem Cells Dev.
• AST-OPC1 also produces diffusible factors that support neurite extension from sensory neurons (Zhang YW, Denham J, Thies RS. Oligodendrocyte progenitor cells derived from human embryonic stem cells express neurotrophic factors. Stem Cells Dev. 2006 Dec;15(6):943-52J.
• Pluripotent stem cell-derived neural cells have been used by researchers to treat CNS injuries and disorders in animal models.
• therapies for clinical applications in humans.
• the present disclosure provides, inter alia, a population of oligodendrocyte progenitor cells (OPCs) derived from pluripotent stem cells and methods of use of the same in the treatment of spinal cord injury.
• OPCs oligodendrocyte progenitor cells
• the present disclosure provides a method of improving upper extremity motor function in a human subject with a spinal cord injury, comprising administering to said subject a composition that comprises a population of allogeneic human oligodendrocyte progenitor cells (OPCs).
• OPCs oligodendrocyte progenitor cells
• the allogeneic human OPCs are capable of engrafting at a spinal cord injury site.
• administering the composition comprises injecting the composition into the spinal cord injury site.
• the composition is injected approximately 2-10 mm caudal of the spinal cord injury epicenter.
• the composition is injected approximately 5 mm caudal of the spinal cord injury epicenter.
• the subject has a cervical spinal cord injury.
• the subject has a thoracic spinal cord injury.
• the composition is administered after the subject has suffered a traumatic spinal cord injury.
• the composition is administered between 14-60 days after the spinal cord injury, such as between 14-30 days after the injury, such as between 20-40 days after the injury, such as between 40-60 days after injury.
• the composition is administered about 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39 or 40 days after the injury.
• the improvement in the subject's upper extremity motor function may be measured as an increase or change over baseline in the subject's upper extremity motor score (UEMS) following the administration of the composition comprising allogeneic human OPCs.
• the subject's UEMS detectably increases within 30-400 days from the administration of the composition.
• the increase in the subject's UEMS is both detectable and significant over any potential increase in the UEMS of control subjects that were not administered a population of allogeneic human OPCs.
• the subject's UEMS detectably increases within 30 days from the administration of the composition.
• the subject's UEMS detectably increases within 60 days from the administration of the composition.
• the subject's UEMS detectably increases within 90 days from the administration of the composition. In some embodiments, the subject's UEMS detectably increases within 180 days from the administration of the composition. In some embodiments, the subject's UEMS score detectably increases within 270 days from the administration of the composition. In some embodiments, the subject's UEMS score detectably increases within 360 days from the administration of the composition.
• the subject's UEMS score continues to improve from the initial UEMS baseline measurement for a period of about 1-24 months post- administration of the composition comprising allogeneic human OPCs. In some embodiments, the subject's UEMS score improves over time following administration of allogeneic human OPC
• the subject's UEMS score continues to improve up to or beyond 18 months post administration of the allogeneic human OPC composition. In certain embodiments, the subject's UEMS score continues to improve up to or beyond 24 months post administration of the allogeneic human OPC composition.
• the subject's UEMS improvement over the course of 1- 24 months post administration of allogeneic human OPCs can range from about 1 to about 30 points, such as about 2 points, such as about 4 points, such as about 6 points, such as about 8 points, such as about 10 points, such as about 12 points, such as about 14 points, such as about 16 points, such as about 18 points, such as about 20 points, such as about 22 points, such as about 24 points, such as about 26 points, such as about 28 points, such as about 30 points.
• the subject's UEMS score improvement over the course of 1-18 months post administration of allogeneic human OPCs can be over 20 points.
• the improvement in the subject's upper extremity motor function may be measured as improved motor level recovery (motor levels defined based on International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI).
• the subject's motor level improvement is significant over any potential motor level improvement in control subjects that were not administered a population of allogenic human OPCs.
• the subject's motor level improvement may be about one level at about 1-12 months post-administration of the allogeneic human OPC composition.
• the subject's motor level improvement may be about two levels at about 1- 12 months post-administration of the allogeneic human OPC composition.
• the subject's motor level improvement may be more than two levels at about 1-12 months post-administration of the allogeneic human OPC composition. In some embodiments, the subject's measured motor level continues to improve from the initial baseline measurement for a period of about 1- 24 months post- administration of the allogeneic human OPC
• the subject's measured motor level continues to improve from the initial baseline measurement for a period of about 12 months post-administration of the allogeneic human OPC composition.
• the motor level improvement may be unilateral. In other embodiments, the motor level improvement may be bilateral.
• the improvement in the subject's upper extremity motor function may be measured or assessed using means other than the UEMS or motor level recovery, including, but not limited to, various neurological exams and clinical impairment measurements such as GRASSP (the Graded Redefined Assessment of Strength, Sensibility and Prehension).
• GRASSP the Graded Redefined Assessment of Strength, Sensibility and Prehension
• the improvement in the subject's upper extremity motor function may be measured indirectly, such as by using MRI or by assessing the subject's functional independence using, for example, SCIM (spinal cord independence measure). Any means known in the art for detecting or assessing motor function improvement may be used.
• the method further comprises administering to the subject a low dose immunosuppressant regimen.
• the method further comprises administering to the subject a low dose immunosuppressant regimen.
• immunosuppressant regimen comprises a dose of tacrolimus at about 0.03 mg/kg/day per os, adjusted to maintain a trough blood concentration of about 3-7 ng/mL through about day 46 following the administering of the composition, followed by tapering off and discontinuing the immunosuppressant at about day 60 following the administering of the composition comprising a population of allogeneically derived OPCs.
• method comprises administering a composition comprising a population of allogeneic oligodendrocyte progenitor cells (OPCs), wherein the dose of the composition comprises between about 2 x 10 6 and about 50 x 10 6 AST-OPC1. In some embodiments, the dose of the composition comprises about 50 x 10 6 AST-OPC1. In some embodiments, the dose of the composition comprises about 40 x 10 6 AST-OPC1. In some embodiments, the dose of the composition comprises about 30 x 10 6 AST-OPC1. In some embodiments, the dose of the composition comprises about 20 x 10 6 AST-OPC1. In some embodiments, the dose of the composition comprises about 10 x 10 6 AST-OPC1. In some embodiments, the dose of the composition comprises about 5 x 10 6 AST-OPC1. In some embodiments, the dose of the composition comprises about 2 x 10 6 AST-OPC1.
• OPCs allogeneic oligodendrocyte progenitor cells
• the OPCs are capable of remaining within the spinal cord injury site of said subject for a period of about 90 days or longer following the
• the OPCs are capable of remaining within the spinal cord injury site of said subject for a period of about 1 year or longer following the administration of the composition to the spinal cord injury site. In further embodiments, the OPCs are capable of remaining within the spinal cord injury site of said subject for a period of about 2 years or longer following the administration of the composition to the spinal cord injury site. In further embodiments, the OPCs are capable of remaining within the spinal cord injury site of said subject for a period of about 3 years or longer following the administration of the composition to the spinal cord injury site. In further embodiments, the OPCs are capable of remaining within the spinal cord injury site of said subject for a period of about 4 years or longer. In yet further embodiments, the OPCs are capable of remaining within the spinal cord injury site of said subject for a period of about 5 years or longer.
• the present disclosure provides a container comprising a composition comprising a population of allogeneic human oligodendrocyte progenitor cells (OPCs) that are capable of improving upper extremity motor function in a human subject with a spinal cord injury when administered to said subject.
• OPCs of the present disclosure may be derived from any type of human pluripotent stem cell.
• the population of OPCs are the in vitro differentiated progeny of human embryonic stem cells (hESC).
• the OPCs are the in vitro differentiated progeny of pluripotent stem cells other than human embryonic stem cells, such as induced pluripotent stem cells (iPSC).
• the subject has a cervical spinal cord injury.
• the subject has a thoracic spinal cord injury.
• FIG. 1 depicts a study design and timeline for a Phase l/2a dose escalation study of AST-OPC1 in subjects with traumatic spinal cord injury.
• FIG. 2 depicts study design with respect to subject cohorts and AST-OPC1 dosing.
• 2M cohort subjects receive an injection of 2 x 10 6 AST-OPC1;
• 10M cohort subjects receive an injection of 10 x 10 6 AST-OPC1;
• 20M cohort subjects receive an injection of 20 x 10 6 AST-OPC1.
• AIS A American Spinal Injury Association (ASIA) Impairment Scale (AIS) grade A spinal cord injury, sensorimotor complete.
• AIS B American Spinal Injury Association (ASIA) Impairment Scale (AIS) grade B spinal cord injury, motor complete, sensory incomplete. See, e.g. American Spinal Injury Association: International Standards for Neurological
• FIG. 3 depicts AST-OPCl injection procedure. Injections were performed using a table-mounted syringe -positioning device (SPD). Subjects in Cohorts 1 and 2 received a single intra-parenchymal injection into the spinal cord lesion, with an injection volume of 50 ⁇ .
• SPD table-mounted syringe -positioning device
• FIG. 4A and FIG. 4B show upper extremity motor function recovery data in Cohorts 1 and 2 as available in September 2016.
• FIG. 4 B At 90 days post-injection, 50 % (2 out of 4) of subjects in Cohort 2 had improved one motor level and 50 % (2 out of 4) of subjects had improved two motor levels at least on one side.
• AIS-A Acute/Subacute Cervical Sensorimotor Complete
• FIG. 5 depicts matching criteria used to generate the closely matched historical controls from the EMSCI database.
• FIG. 7 shows motor function recovery measured as a percent of subjects improved by two or more motor levels in Cohort 2 subjects through 12-month follow-up visit. Cohort 2 subjects were compared to the closely matched historical controls from the EMSCI database.
• Methods disclosed herein can comprise one or more steps or actions for achieving the described method.
• the method steps and/or actions may be interchanged with one another without departing from the scope of the present invention.
• the order and/or use of specific steps and/or actions may be modified without departing from the scope of the present invention.
• phrases such as "between X and Y” and “between about X and Y” should be interpreted to include X and Y.
• phrases such as “between about X and Y” mean “between about X and about Y” and phrases such as “from about X to Y” mean “from about X to about Y.”
• AST-OPC1 refers to a specific, characterized, in vitro differentiated cell population containing a mixture of oligodendrocyte progenitor cells (OPCs) and other characterized cell types obtained from undifferentiated human embryonic stem cells (uhESCs) according to specific differentiation protocols disclosed herein.
• Compositional analysis of AST-OPC1 by immunocytochemistry (ICC), flow cytometry, and quantitative polymerase chain reaction (qPCR) demonstrates that the cell population is comprised primarily of neural lineage cells of the oligodendrocyte phenotype. Other neural lineage cells, namely astrocytes and neurons, are present at low frequencies. The only non-neural cells detected in the population are epithelial cells. Mesodermal, endodermal lineage cells and uhESCs are routinely below quantitation or detection of the assays.
• oligodendrocyte progenitor cells refers to cells of neuroectoderm/glial lineage that are committed to form progeny comprising mature oligodendrocytes. These cells typically express the characteristic markers NG2 and PDGF-Ra.
• terapéuticaally effective amount refers to a dosage, dosage regimen, or amount sufficient to produce a desired result.
• treatment can refer to both therapeutic treatment or prophylactic or preventative measures, wherein the object is to prevent or slow down (lessen) an undesired physiological condition, symptom, disorder or disease, or to obtain beneficial or desired clinical results.
• the term may refer to both treating and preventing.
• beneficial or desired clinical results may include, but are not limited to one or more of the following: alleviation of symptoms; diminishment of the extent of the condition, disorder or disease; stabilization (i.e., not worsening) of the state of the condition, disorder or disease; delay in onset or slowing of the progression of the condition, disorder or disease; amelioration of the condition, disorder or disease state; and remission (whether partial or total), whether detectable or undetectable, or enhancement or improvement of the condition, disorder or disease.
• Treatment includes eliciting a clinically significant response. Treatment also includes prolonging survival as compared to expected survival if not receiving treatment.
• subject refers to a human or an animal. In some embodiments, the term “subject,” refers to a male. In some embodiments, the term “subject,” refers to a female.
• implantation or “transplantation” refers to the administration of a cell population into a target tissue using a suitable delivery technique, (e.g., using an injection device).
• engraftment and “engrafting” refer to incorporation of implanted tissue or cells (i.e. "graft tissue” or “graft cells”) into the body of a subject.
• graft tissue or “graft cells”
• imaging techniques can be used to detect the presence of graft tissue.
• allogeneic and allogeneically derived refer to cell populations derived from a source other than the subject and hence genetically non-identical to the subject.
• allogeneic cell populations are derived from cultured pluripotent stem cells. In certain embodiments, allogeneic cell populations are derived from hESCs. In other embodiments, allogeneic cell populations are derived from induced pluripotent stem (iPS) cells. In yet other embodiments, allogeneic cell populations are derived from primate pluripotent (pPS) cells.
• iPS induced pluripotent stem
• pPS primate pluripotent
• central nervous system and “CNS” as used interchangeably herein refer to the complex of nerve tissues that control one or more activities of the body, which include but are not limited to, the brain and the spinal cord in vertebrates.
• a method can be carried out on a pluripotent stem cell line. In other embodiments, a method can be carried out on an embryonic stem cell line. In an embodiment, a method can be carried out on a plurality of undifferentiated stem cells that are derived from an HI, H7, H9, H13, or H14 cell line. In another embodiment, undifferentiated stem cells can be derived from an induced pluripotent stem cell (iPS) line. In another embodiment, a method can be carried out on a primate pluripotent stem (pPS) cell line. In yet another embodiment, undifferentiated stem cells can be derived from parthenotes, which are embryos stimulated to produce hESCs without fertilization.
• iPS induced pluripotent stem cell
• pPS primate pluripotent stem
• undifferentiated pluripotent stem cells can be maintained in an undifferentiated state without added feeder cells ⁇ see, e.g., (2004) Rosier et al., Dev. Dynam. 229:259).
• Feeder-free cultures are typically supported by a nutrient medium containing factors that promote proliferation of the cells without differentiation (see, e.g., U.S. Pat. No. 6,800,480).
• conditioned media containing such factors can be used.
• Conditioned media can be obtained by culturing the media with cells secreting such factors.
• Suitable cells include, but are not limited to, irradiated (-4,000 Rad) primary mouse embryonic fibroblasts, telomerized mouse fibroblasts, or fibroblast- like cells derived from pPS cells (U.S. Pat. No. 6,642,048).
• Medium can be conditioned by plating the feeders in a serum free medium, such as knock-out DMEM supplemented with 20% serum replacement and 4 ng/mL bFGF.
• a serum free medium such as knock-out DMEM supplemented with 20% serum replacement and 4 ng/mL bFGF.
• Medium that has been conditioned for 1-2 days can be supplemented with further bFGF, and used to support pPS cell culture for 1-2 days (see. e.g., WO 01/51616; Xu et al., (2001) Nat. Biotechnol. 19:971).
• fresh or non-conditioned medium can be used, which has been supplemented with added factors (such as, e.g., a fibroblast growth factor or forskolin) that promote proliferation of the cells in an undifferentiated form.
• factors such as, e.g., a fibroblast growth factor or forskolin
• Non-limiting examples include a base medium like X-VIVOTM 10 (Lonza, Walkersville, Md.) or QBSFTM-60 (Quality Biological Inc. Gaithersburg, Md.), supplemented with bFGF at 40-80 ng/mL, and optionally containing SCF (15 ng/mL), or Flt3 ligand (75 ng/mL) (see, e.g., Xu et al., (2005) Stem Cells 23(3):315).
• undifferentiated pluripotent cells such as hESCs
• a media comprising bFGF and TGFp.
• concentrations of bFGF include about 80 ng/ml.
• concentrations of TGFP include about 0.5 ng/ml.
• undifferentiated pluripotent cells can be cultured on a layer of feeder cells, typically fibroblasts derived from embryonic or fetal tissue (Thomson et al. (1998) Science 282: 1145).
• Feeder cells can be derived, inter alia, from a human or a murine source.
• Human feeder cells can be isolated from various human tissues, or can be derived via differentiation of human embryonic stem cells into fibroblast cells (see, e.g., WO 01/51616).
• human feeder cells that can be used include, but are not limited to, placental fibroblasts (see, e.g., Genbacev et al. (2005) Fertil. Steril.
• fallopian tube epithelial cells see, e.g., Richards et al. (2002) Nat. Biotechnol., 20:933
• foreskin fibroblasts see, e.g., Amit et al. (2003) Biol. Reprod.6S:2l50
• uterine endometrial cells see, e.g., Lee et al. (2005) Biol. Reprod. 72(1):42).
• Solid surfaces suitable for growing undifferentiated pluripotent cells can be made of a variety of substances including, but not limited to, glass or plastic such as polystyrene, polyvinylchloride, polycarbonate, polytetrafluorethylene, melinex, thermanox, or combinations thereof.
• suitable surfaces can comprise one or more polymers, such as, e.g., one or more acrylates.
• a solid surface can be three-dimensional in shape. Non-limiting examples of three- dimensional solid surfaces are described, e.g., in U.S. Patent Pub. No. 2005/0031598.
• undifferentiated stem cells can be grown under feeder-free conditions on a growth substrate.
• a growth substrate can be Matrigel ® (e.g., Matrigel ® or Matrigel ® GFR), recombinant Laminin, or Vitronectin.
• undifferentiated stem cells can be subcultured using various methods such as using collagenase, or such as manual scraping.
• undifferentiated stem cells can be subcultured using non-enzymatic means, such as 0.5 mM EDTA in PBS, or such as using ReLeSRTM.
• a plurality of undifferentiated stem cells are seeded or subcultured at a seeding density that allows the cells to reach confluence in about three to about ten days.
• the seeding density can range from about 6.0 x 10 3 cells/cm 2 to about 5.0 x 10 5 cells/cm 2 , such as about 1.0 x 104 cells/cm 2 , such as about 5.0 x 104 cells/cm 2 , such as about 1.0 x 10 5 cells/cm 2 , or such as about 3.0 x 105 cells/cm 2 of growth surface.
• the seeding density can range from about 6.0 x 10 3 cells/cm 2 to about 1.0 x
• 10 4 cells/cm 2 of growth surface such as about 6.0 x 103 cells/cm 2 to about 9.0 x 103 cells/cm 2 , such as about 7.0 x 10 3 cells/cm 2 to about 1.0 x 104 cells/cm 2 , such as about 7.0 x 103 cells/cm 2 to about 9.0 x 10 3 cells/cm 2 , or such as about 7.0 x 103 cells/cm 2 to about 8.0 x 103 cells/cm 2 of growth surface.
• the seeding density can range from about 1.0 x 10 4 cells/cm 2 to about 1.0 x 105 cells/cm 2 of growth surface, such as about 2.0 x 104 cells/cm 2 to about 9.0 x 10 4 cells/cm 2 , such as about 3.0 x 104 cells/cm 2 to about 8.0 x 104 cells/cm 2 , such as about 4.0 x 10 4 cells/cm 2 to about 7.0 x 104 cells/cm 2 , or such as about 5.0 x 104 cells/cm 2 to about 6.0 x 104 cells/cm 2 of growth surface.
• the seeding density can range from about 1.0 x 10 5 cells/cm 2 to about 5.0 x 105 cells/cm 2 of growth surface, such as about 1.0 x
• a culture medium can be exchanged at a suitable time interval.
• a culture medium can be completely exchanged daily, initiating about 2 days after sub-culturing of the cells.
• a surrogate flask can be sacrificed and enumerated using one or more suitable reagents, such as, e.g., CoUagenase IV and 0.05% Trypsin-EDTA in series to achieve a single cell suspension for quantification.
• a plurality undifferentiated stem cells can then be sub- cultured before seeding the cells on a suitable growth substrate (e.g., Matrigel ® GFR) at a seeding density that allows the cells to reach confluence over a suitable period of time, such as, e.g., in about three to ten days.
• a suitable growth substrate e.g., Matrigel ® GFR
• undifferentiated stem cells can be subcultured using CoUagenase IV and expanded on a recombinant laminin matrix.
• undifferentiated stem cells can be subcultured using CoUagenase IV and expanded on a Matrigel ® matrix.
• undifferentiated stem cells can be subcultured using ReLeSRTM and expanded on a Vitronectin matrix.
• the seeding density can range from about 6.0 x 10 cells/cm 2 to about 5.0 x 105 cells/cm 2 , such as about 1.0 x 104 cells/cm 2 , such as about 5.0 x 104 cells/cm 2 , such as about 1.0 x 105 cells/cm 2 , or such as about 3.0 x 105 cells/cm 2 of growth surface.
• the seeding density can range from about 6.0 x 10 3 cells/cm 2 to about 1.0 x 10 4 cells/cm 2 of growth surface, such as about 6.0 x 103 cells/cm 2 to about 9.0 x 103 cells/cm 2 , such as about 7.0 x 103 cells/cm 2 to about 1.0 x 104 cells/cm 2 , such as about 7.0 x 103 cells/cm 2 to about 9.0 x 103 cells/cm 2 , or such as about 7.0 x 103 cells/cm 2 to about 8.0 x 103 cells/cm of growth surface.
• the seeding density can range from about 1.0 x 10 4 cells/cm 2 to about 1.0 x 105 cells/cm 2 of growth surface, such as about 2.0 x 104 cells/cm 2 to about 9.0 x 104 cells/cm 2 , such as about 3.0 x 104 cells/cm 2 to about 8.0 x 104 cells/cm 2 , such as about 4.0 x 104 cells/cm 2 to about 7.0 x 104 cells/cm 2 , or such as about 5.0 x 104 cells/cm 2 to about 6.0 x 104 cells/cm 2 of growth surface.
• the seeding density can range from about 1.0 x 10 5 cells/cm 2 to about 5.0 x 105 cells/cm 2 of growth surface, such as about 1.0 x 10 5 cells/cm 2 to about 4.5 x 105 cells/cm 2 , such as about 1.5 x 105 cells/cm 2 to about 4.0 x 10 5 cells/cm 2 , such as about 2.0 x 105 cells/cm 2 to about 3.5 x 105 cells/cm 2 , or such as about 2.5 x 10 5 cells/cm 2 to about 3.0 x 105 cells/cm 2 of growth surface.
• oligodendrocyte progenitor cells have been previously described, for example, in U.S. Patent Application No. 15/156,316 and provisional patent application No. 62/315,454.
• OPCs oligodendrocyte progenitor cells
• the methods of producing highly pure populations of oligodendrocyte progenitor cells from pluripotent stem cells may comprise a pretreatment step during which the cells are incubated with one or more modulators of stem cell differentiation, for example, as described in U.S. provisional patent application No. 62/315,454, filed March 30, 2016, and International patent application PCT/US2017/024986, filed March 30, 2017.
• a cell population can have a common genetic background.
• a cell population may be derived from one host.
• a cell population can be derived from a pluripotent stem cell line.
• a cell population can be derived from an embryonic stem cell line.
• a cell population can be derived from a hESC line.
• a hESC line can be an HI, H7, H9, H13, or H14 cell line.
• a cell population can be derived from an induced pluripotent stem cell (iPS) line.
• iPS induced pluripotent stem cell
• a cell population can be derived from a subject in need thereof (e.g., a cell population can be derived from a subject that is in need to treatment).
• a hESC line can be derived from parthenotes, which are embryos stimulated to produce hESCs without fertilization.
• the OPCs of the present disclosure express one or more markers chosen from Nestin, NG2, Oligl and PDGF-Ra. In certain embodiments, the OPCs of the present disclosure express all of the markers Nestin, NG2, Oligl and PDGF-Ra. In some embodiments, at least 70% of AST-OPC1 are positive for Nestin expression. In some embodiments, at least 30% of AST-OPC1 are positive for NG2 expression. In some embodiments, at least 70% of AST-OPC1 are positive for Oligl expression. In some embodiments, at least 70% of AST-OPC1 are positive for PDGF-Ra expression.
• the specific markers and combinations of various markers expressed by the cell populations of the present disclosure can be determined and quantified, for example, by flow cytometry.
• the OPCs can be administered to a subject in need of therapy per se.
• the cells of the present disclosure can be administered to the subject in need of therapy in a pharmaceutical composition mixed with a suitable carrier and/or using a delivery system.
• composition refers to a preparation comprising a therapeutic agent or therapeutic agents in combination with other components, such as physiologically suitable carriers and excipients.
• the term "therapeutic agent” can refer to the cells of the present disclosure accountable for a biological effect in the subject. Depending on the embodiment of the disclosure, “therapeutic agent” can refer to the oligodendrocyte progenitor cells of the disclosure. Alternatively, “therapeutic agent” can refer to one or more factors secreted by the oligodendrocyte progenitor cells of the disclosure.
• a pharmaceutically acceptable carrier can comprise dimethyl sulfoxide (DMSO).
• DMSO dimethyl sulfoxide
• excipient refers to an inert substance added to a pharmaceutical composition to further facilitate administration of the therapeutic agent.
• compositions in accordance with the present disclosure can be formulated for parenteral administration by injection, e.g., by bolus injection or continuous infusion.
• Formulations for injection can be presented in unit dosage form, e.g., in ampoules or in multi- dose containers, with an added preservative.
• the compositions can contain formulatory agents such as suspending, stabilizing and/or dispersing agents.
• the compositions can be formulated to be adapted for cryopreservation.
• compositions in accordance with the present disclosure can be formulated for administration via a direct injection to the spinal cord of a subject.
• a composition in accordance with the present disclosure can be formulated for intracerebral, intraventricular, intrathecal, intranasal, or intracisternal administration to a subject.
• a composition in accordance with the present disclosure can be formulated for administration via an injection directly into or immediately adjacent to an infarct cavity in the brain of a subject.
• a composition in accordance with the present disclosure can be formulated for administration through implantation.
• a composition in accordance with the present disclosure can be formulated as a solution.
• a composition in accordance with the present disclosure can comprise from about 1 x 10 6 to about 5 x 10 s cells per milliliter, such as about 1 x 10 6 cells per milliliter, such as about 2 x 10 6 cells per milliliter, such as about 3 x 10 6 cells per milliliter, such as about 4 x 10 6 cells per milliliter, such as about 5 x 10 6 cells per milliliter, such as about 6 x 10 6 cells per milliliter, such as about 7 x 10 6 cells per milliliter, such as about 8 x 10 6 cells per milliliter, such as about 9 x 10 6 cells per milliliter, such as about 1 x 10 7 cells per milliliter, such as about 2 x 10 7 cells per milliliter, such as about 3 x 107 cells per milliliter, such as about 4 x
• 10 7' cells per milliliter such as about 5 x 107 cells per milliliter, such as about 6 x 107 cells per milliliter, such as about 7 x 10 7 cells per milliliter, such as about 8 x 107 cells per milliliter, such as about 9 x 10 7 cells per milliliter, such as about 1 x 108 cells per milliliter, such as about 2 x
• a composition in accordance with the present disclosure can comprise from about 1 x 10 8 to about 5 x 108 cells per milliliter, such as about 1 x 10 8 to about 4 x 108 cells per milliliter, such as about 2 x 108 to about
• a composition in accordance with the present disclosure can comprise from about 1 x 10 7 to about 1 x 108 cells per milliliter, such as about 2 x 107 to about 9 x 10 7 cells per milliliter, such as about 3 x 107 to about 8 x 107 cells per milliliter, such as about 4 x 10 7 to about 7 x 107 cells per milliliter, or such as about 5 x 107 to about 6 x 107 cells per milliliter.
• a composition in accordance with the present disclosure can comprise from about 1 x 10 6 to about 1 x 10 7 cells per milliliter, such as about 2 x 10 6 to about 9 x 10 6 cells per milliliter, such as about 3 x 10 6 to about 8 x 10 6 cells per milliliter, such as about 4 x 10 6 to about 7 x 10 6 cells per milliliter, or such as about 5 x 10 6 to about 6 x 10 6 cells per milliliter.
• a composition in accordance with the present disclosure can comprise at least about 1 x 10 6 cells per milliliter, such as at least about 2 x 10 6 cells per milliliter, such as at least about 3 x 10 6 cells per milliliter, such as at least about 4 x 10 6 cells per milliliter, such as at least about 5 x 10 6 cells per milliliter, such as at least about 6 x 10 6 cells per milliliter, such as at least about 7 x 10 6 cells per milliliter, such as at least about 8 x 10 6 cells per milliliter, such as at least about 9 x 10 6 cells per milliliter, such as at least about 1 x 10 7 cells per milliliter, such as at least about 2 x 10 7 cells per milliliter, such as at least about 3 x 107 cells per milliliter, such as at least about 4 x 10 7 cells per milliliter, or such as at least about 5 x 107 cells per milliliter.
• a composition in accordance with the present disclosure can comprise up to about 1 x 10 8 cells or more, such as up to about 2 x 108 cells per milliliter or more, such as up to about 3 x 10 8 cells per milliliter or more, such as up to about 4 x 108 cells per milliliter or more, such as up to about 5 x 10 cells per milliliter or more, or such as up to about 6 x 10° cells per milliliter.
• a composition in accordance with the present disclosure can comprise from about 4 x 10 7 to about 2 x 108 cells per milliliter.
• a composition in accordance with the present disclosure can have a volume ranging from about 10 microliters to about 5 milliliters, such as about 20 microliters, such as about 30 microliters, such as about 40 microliters, such as about 50 microliters, such as about 60 microliters, such as about 70 microliters, such as about 80 microliters, such as about 90 microliters, such as about 100 microliters, such as about 200 microliters, such as about 300 microliters, such as about 400 microliters, such as about 500 microliters, such as about 600 microliters, such as about 700 microliters, such as about 800 microliters, such as about 900 microliters, such as about 1 milliliter, such as about 1.5 milliliters, such as about 2 milliliters, such as about 2.5 milliliters, such as about 3 milliliters, such as about 3.5 milliliters, such as about 4 milliliters, or such as about 4.5 milliliters.
• a composition in accordance with the present disclosure can have a volume ranging from about 10 microliters to about 100 microliters, such as about 20 microliters to about 90 microliters, such as about 30 microliters to about 80 microliters, such as about 40 microliters to about 70 microliters, or such as about 50 microliters to about 60 microliters.
• a composition in accordance with the present disclosure can have a volume ranging from about 100 microliters to about 1 milliliter, such as about 200 microliters to about 900 microliters, such as about 300 microliters to about 800 microliters, such as about 400 microliters to about 700 microliters, or such as about 500 microliters to about 600 microliters.
• a composition in accordance with the present disclosure can have a volume ranging from about 1 milliliter to about 5 milliliters, such as about 2 milliliter to about 5 milliliters, such as about 1 milliliter to about 4 milliliters, such as about 1 milliliter to about 3 milliliters, such as about 2 milliliter to about 4 milliliters, or such as about 3 milliliter to about 5 milliliters.
• a composition in accordance with the present disclosure can have a volume of about 20 microliters to about 500 microliters.
• a composition in accordance with the present disclosure can have a volume of about 50 microliters to about 100 microliters.
• a composition in accordance with the present disclosure can have a volume of about 50 microliters to about 200 microliters. In another embodiment, a composition in accordance with the present disclosure can have a volume of about 20 microliters to about 400 microliters.
• the present disclosure provides a container comprising a composition comprising a population of OPCs derived in accordance with one or more methods of the present disclosure.
• a container can be configured for cryopreservation.
• a container can be configured for administration to a subject in need thereof.
• a container can be a prefilled syringe.
• composition can also comprise or be accompanied by one or more other ingredients that facilitate the engraftment or functional mobilization of the enriched target cells. Suitable ingredients can include matrix proteins that support or promote adhesion of the target cell type or that promote vascularization of the implanted tissue.
• the present disclosure provides methods of using a cell population that comprises pluripotent stem cell-derived OPCs for improving one or more neurological functions in a subject in need of therapy.
• methods for using pluripotent stem-cell derived OPCs in the treatment of traumatic spinal cord injury are provided.
• methods for using pluripotent stem-cell derived OPCs in the treatment of other traumatic CNS injuries are provided.
• methods for using pluripotent stem-cell derived OPCs in the treatment of nontraumatic CNS disorders or conditions are provided.
• a cell population in accordance with the present disclosure can be injected or implanted into a subject in need thereof.
• methods for using pluripotent stem-cell derived OPCs in the treatment of conditions requiring myelin repair or remyelination are provided.
• the following are non-limiting examples of conditions, diseases and pathologies requiring myelin repair or remyelination: multiple sclerosis, the leukodystrophies, the Guillain-Barre Syndrome, the Charcot-Marie-Tooth neuropathy, Tay-Sachs disease, Niemann-Pick disease, Gaucher disease and Hurler syndrome.
• Other conditions that result in demyelination include but are not limited to inflammation, stroke, immune disorders, metabolic disorders and nutritional deficiencies (such as lack of vitamin B 12).
• the OPCs of the present disclosure can also be used for myelin repair or remyelination in traumatic injuries resulting in loss of myelination, such as acute spinal cord injury.
• the OPCs are administered in a manner that permits them to graft or migrate to the intended tissue site and reconstitute or regenerate the functionally deficient area.
• Administration of the cells can be achieved by any method known in the art.
• the cells can be administered surgically directly to the organ or tissue in need of a cellular transplant.
• non-invasive procedures can be used to administer the cells to the subject.
• Non- limiting examples of non-invasive delivery methods include the use of syringes and/or catheters to deliver the cells into the organ or tissue in need of cellular therapy.
• the subject receiving the OPCs of the present disclosure may be treated to reduce immune rejection of the transplanted cells.
• Methods contemplated include the administration of traditional immunosuppressive drugs such as, e.g., tacrolimus, cyclosporin A (Dunn et al., Drugs 61: 1957, 2001), or inducing immunotolerance using a matched population of pluripotent stem cell-derived cells (WO 02/44343; U.S. Patent No. 6,280,718; WO 03/050251).
• a combination of anti-inflammatory (such as prednisone) and immunosuppressive drugs can be used.
• the OPCs of the invention can be supplied in the form of a pharmaceutical composition, comprising an isotonic excipient prepared under sufficiently sterile conditions for human administration.
• a cell population in accordance with the present disclosure can be capable of engrafting at a spinal cord injury site following implantation of a composition comprising the cell population into the spinal cord injury site.
• a cell population in accordance with the present disclosure is capable of remaining within the spinal cord injury site of the subject for a period of about 90 days or longer following implantation of a dose of the composition into the spinal cord injury site. In other embodiments, a cell population in accordance with the present disclosure is capable of remaining within the spinal cord injury site of the subject for a period of about 1 year or longer following implantation of a dose of the composition into the spinal cord injury site. In further embodiments, a cell population in accordance with the present disclosure is capable of remaining within the spinal cord injury site of the subject for a period of about 2 years or longer following implantation of a dose of the composition into the spinal cord injury site.
• a cell population in accordance with the present disclosure is capable of remaining within the spinal cord injury site of the subject for a period of about 3 years or longer following implantation of a dose of the composition into the spinal cord injury site. In further embodiments, a cell population in accordance with the present disclosure is capable of remaining within the spinal cord injury site of the subject for a period of about 4 years or longer following implantation of a dose of the composition into the spinal cord injury site. In yet further embodiments, a cell population in accordance with the present disclosure is capable of remaining within the spinal cord injury site of the subject for a period of about 5 years or longer following implantation of a dose of the composition into the spinal cord injury site.
• a cell composition in accordance with the present disclosure is capable of improving upper extremity motor function in a human subject with a spinal cord injury when administered to said subject.
• the subject has a cervical spinal cord injury.
• the subject has a thoracic spinal cord injury.
• the present disclosure provides a method of improving upper extremity motor function in a human subject with a spinal cord injury, comprising administering to said subject a composition that comprises a population of allogeneic human oligodendrocyte cells that are capable of engrafting at a spinal cord injury site.
• administering the composition comprises injecting the composition into the spinal cord injury site.
• the composition is injected approximately 2-10 mm caudal of the spinal cord injury epicenter.
• the composition is injected approximately 5 mm caudal of the spinal cord injury epicenter.
• the subject has a cervical spinal cord injury.
• the subject has a thoracic spinal cord injury.
• the subject to whom a composition comprising a population of allogeneic human oligodendrocyte cells is administered to according to the methods of the present disclosure gains an improvement in upper extremity motor function equal to at least one motor level (as defined based on International Standards for Neurological Classification of Spinal Cord Injury [ISNCSCI]).
• the improvement in function may be unilateral or bilateral.
• the subject to whom a composition comprising a population of allogeneic human oligodendrocyte cells is administered to according to the methods of the present disclosure gains an improvement in upper extremity motor function equal to at least two motor levels either unilaterally or bilaterally.
• the subject gains an improvement in upper extremity motor function equal to at least one motor level on one side and equal to at least two motor levels on the other side.
• the subject exhibits an improved upper extremity motor score (UEMS) relative to the subject baseline score prior to administration of a population of allogeneic human oligodendrocyte cells according to the methods of the present disclosure.
• UEMS upper extremity motor score
• Additional embodiments include the following:
• a method of improving upper extremity motor function in a human subject with a traumatic spinal cord injury comprising administering to said subject a therapeutically effective amount of a composition that comprises a population of allogeneic human oligodendrocyte progenitor cells.
• administering the composition comprises injecting the composition into a spinal cord injury site.
• composition comprises between about 2 x 10 6 and 50 x 10 6 AST-OPC1 cells.
• composition comprises about 10 x 10 6 AST-OPC1 cells.
• composition comprises about 20 x 10 6 AST-OPC1 cells.
• pluripotent stem cells are human embryonic stem cells.
• a pharmaceutical composition for use in improving upper extremity motor function in a human subject with a traumatic spinal cord injury comprising a population of allogeneic human oligodendrocyte progenitor cells.
• composition according to 20 further comprising a biologically acceptable carrier.
• compositions for use in treatment of traumatic spinal cord injury in a human subject comprising a population of allogeneic human oligodendrocyte progenitor cells.
• EXAMPLE 1 PHASE l/2a ESCALATION DOSE TRIAL OF AST-OPCl IN PATIENTS WITH MOTOR COMPLETE C4-C7 CERVICAL SCI
• AST-OPCl cells were generated by differentiation of WA01 (HI) hESCs from a master cell bank (MCB) as described in the U.S. Patent Application No. 15/136,316.
• AST-OPCl The initial clinical safety of AST-OPCl was previously evaluated in a phase 1 clinical trial that enrolled patients with neurologically complete T3-T11 thoracic spinal cord injury (SCI). Based on favorable 5-year safety data from the phase 1 trial, a phase l/2a trial was initiated to evaluate the safety and activity of escalating doses of AST-OPCl in patients with sensorimotor complete C5-C7 cervical spinal injury.
• phase 1 trial Five subjects received a dose of 2 x 10 6 AST-OPCl between 7 and 14 days following their injury.
• the phase l/2a trial has enrolled and will continue to enroll subjects to sequential dose cohorts receiving 2 x 10 6 , 10 x 10 6 or 20 x 10 6 AST-OPCl between 14 and 40 days post-SCI.
• Study design of phase l/2a trial is depicted in FIG. 1; cohort designs are depicted in FIG. 2. Subjects are followed for one year under the main study protocol and will be followed for an additional 14 years under a long term follow-up protocol.
• EXAMPLE 2 COMPARISON OF IMROVEMENT IN UPPER EXTREMITY MOTOR FUNCTION IN PATIENTS IN COHORTS 1 AND 2 RELATIVE TO
• FIG. 6A The motor function recovery in Cohort 2 subjects (10 x 10 6 AST- OPCl) as measured by a change in UEMS over time compared favorably with the closely matched historical controls, with a significant improvement by 3 months, and continued increase through 12 months.
• FIG. 6B As expected, the motor function recovery (UEMS) in Cohort 1 subjects (2 x 10 6 AST-OPCl, same dose as used in the phase 1 safety trial) was similar to the matched historical controls, further supporting safety of AST-OPCl. Comparison of the improvement in motor scores between Cohorts 1 and 2 relative to the EMSCI historical control group supports an AST-OPCl dose-dependent effect on the recovery of motor score.
• FIG. 6A The motor function recovery in Cohort 2 subjects (10 x 10 6 AST- OPCl) as measured by a change in UEMS over time compared favorably with the closely matched historical controls, with a significant improvement by 3 months, and continued increase through 12 months.
• FIG. 6B As expected, the motor function recovery (UEMS)

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