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
  • A61K35/28—Bone marrow; Haematopoietic stem cells; Mesenchymal stem cells of any origin, e.g. adipose-derived stem cells
• • 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
  • A61P11/00—Drugs for disorders of the respiratory system
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P11/00—Drugs for disorders of the respiratory system
  • A61P11/06—Antiasthmatics
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P13/00—Drugs for disorders of the urinary system
  • A61P13/12—Drugs for disorders of the urinary system of the kidneys
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P31/00—Antiinfectives, i.e. antibiotics, antiseptics, chemotherapeutics
• • 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
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P9/00—Drugs for disorders of the cardiovascular system
  • A61P9/10—Drugs for disorders of the cardiovascular system for treating ischaemic or atherosclerotic diseases, e.g. antianginal drugs, coronary vasodilators, drugs for myocardial infarction, retinopathy, cerebrovascula insufficiency, renal arteriosclerosis
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P9/00—Drugs for disorders of the cardiovascular system
  • A61P9/12—Antihypertensives
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P9/00—Drugs for disorders of the cardiovascular system
  • A61P9/14—Vasoprotectives; Antihaemorrhoidals; Drugs for varicose therapy; Capillary stabilisers

Definitions

• MSCs mesenchymal stem/stromal cells
• the present disclosure in some aspects, describe the therapeutic effects of MSC exosomes in treating thymic dysfunction.
• the subject is an infant or a neonate (e.g., human infant or neonate).
• Methods of treating diseases associated with thymus dysfunction are also provided.
• Some aspects of the present disclosure provide methods of treating a disease associated with thymic dysfunction, the method comprising administering to a subject in need thereof an effective amount of a mesenchymal stem cell (MSC) exosome.
• MSC mesenchymal stem cell
• the isolated MSC exosome is isolated from MSC -conditioned media.
• the MSC is from Warton’s Jelly or bone marrow.
• the subject is a human subject. In some embodiments, the human subject is a neonate, an infant, or an adult. In some embodiments, the human subject is less than four weeks of age. In some embodiments, the human subject is four weeks to 3 years of age. In some embodiments, the human subject is 3-18 years of age. In some embodiments, the human subject is an adult.
• the human subject is born prematurely. In some embodiments, the human subject was born before 37 weeks of gestation. In some embodiments, the human subject was bom before 26 weeks of gestation.
• the human subject was stressed at birth.
• the subject has been administered oxygen or has been on a ventilator.
• the subject has oxygen-induced thymic involution.
• the subject has impaired innate and/or adaptive immunity.
• the MSC exosome is administered immediately after birth. In some embodiments, the MSC exosome is administered within an hour of birth. In some embodiments, the isolated MSC exosome is administered within one month of birth. In some embodiments, the isolated MSC exosome is administered intravenously.
• the MSC exosome restores thymic architecture. In some embodiments, the MCS exosomes increases thymocyte counts. In some embodiments, the MSC exosome reduces thymocyte apoptosis. In some embodiments, the MSC exosome promotes maturation of medullary thymic epithelial cells. In some embodiments, the MSC exosome restores thymocyte progenitor population in the thymus.
• the disease associated with thymic dysfunction is an immune disorder.
• the immune disorder is selected from the group consisting of: autoimmune disease, neonatal lupus, rheumatoid arthritis, and type I diabetes.
• the disease associated with thymic dysfunction is infection, congenital heart disease especially in the setting of DiGeorge’s syndrome, post cardiac surgery where thymectomy is performed to access the heart for surgical repair, birth trauma, or hypoxic- ischemic encephalopathy (HIE).
• HIE hypoxic- ischemic encephalopathy
• the subject is a rodent.
• the rodent is a mouse or rat.
• the subject is a companion animal.
• MSC mesenchymal stem cell
• FIGs. 1A to ID MSC-Exosomes restored thymic architecture and thymocyte counts to control levels.
• FIG. 1A Newborn FVB mice were exposed to HYRX (75% 02) for 7 days.
• HYRX-exposed mice were treated with MSC-exosomes intravenously (IV) at PN4.
• Outcomes of treated and non-treated HYRX-mice were compared to mice that remained at NRMX (room air).
• FIG. 1B Thymic architecture of mice subjected to NRMX (left), HYRX (middle) and HYRX+MSC-exo (right) was assessed by measurements of whole cortical and medullary areas (micrographs with magnification 4x).
• FIG. 1C Thymic architecture of HYRX group displayed an involution of the medullary area of the thymus, which translates into an increased cortico-medullary ratio, compared to NRMX controls.
• MSC-exosome treatment restored thymic architecture, as evidenced by cortico-medullary ratios similar to NRMX control levels.
• FIG. 1D Thymocytes number was determined by flow cytometric analysis using Countbright Beads.
• HYRX group exhibits a loss of thymocytes compared to NRMX levels. The number of thymocytes was restored to NRMX levels with MSC-exosome treatment.
• FIGs. 2A-2D MSC-exosome treatment reduces oxygen-induced thymocyte apoptosis and promoted normal maturation of medullary TECs. Thymi from the three study groups were mechanically disrupted into single cell suspensions of thymocytes.
• Thymocytes were labelled with Annexin V and PI and analyses for apoptosis levels. Apoptotic cells were determined as AnnV+PI- cells.
• FIG. 2A Representative graphs of thymocytes from mice subjected to NRMX (left), HYRX (middle) and HYRX+MSC-exosomes (right) display the differences in the overall percentage of apoptotic cells in each group at PN14.
• FIG. 2B HYRX thymocytes displayed higher apoptotic levels compared to NRMX-derived thymocytes (50.74% ⁇ 1.74 vs 27.24% ⁇ 1.64, respectively).
• FIG. 2C Representative micrographs of AIRE (autoimmune regulator transcription factor) expression in thymic medulla of NRMX, HYRX and HYRX ⁇ MSC-Exo groups.
• AIRE autoimmune regulator transcription factor
• FIGs. 3A-3D MSC-exosome treatment restores the thymocyte progenitor population in the thymus.
• FIG. 3A Schematic representation of the phenotype of the T cell developmental stages in the thymus.
• Migratory thymocyte progenitors that migrate from the Bone Marrow are CD44 + CD25 and negative for the expression of CD4 and CD8 T cell markers.
• the progenitors lose the expression of CD44 and gain the expression of CD25 (DN stages 1-3).
• DN stages 1-3 DN stages 1-3.
• thymocytes undergo positive selection in the thymic cortical area and start expressing CD4 and CD8 (DP).
• thymocytes migrate to the medullary area of the thymus where they interact with antigen presenting cells (monocytes, dendritic cells, macrophages and AIRE expressing TECs) where they undergo negative selection (eradication of autoreactive T cells) into either naive CD4 + (SP4) and CD8 + (SP8) T cells, which will then migrate out of the thymus.
• antigen presenting cells monocytes, dendritic cells, macrophages and AIRE expressing TECs
• SP4 + and SP8 + (SP8) T cells which will then migrate out of the thymus.
• FIG. 3B Flow cytometric analysis of thymocytes at PN7 shows a decrease in the proportion of double negative progenitors in the HYRX thymi, compared to NRMX (9.14% ⁇ 0.97 vs 11.7% ⁇ 1.06, respectively).
• MSC-exosome restored the proportion of double negative progenitors to control levels (13.8% ⁇ 1.03).
• Results represent the sum of the proportions of DN1, DN2 and DN3 as acquired by flow cytometry.
• FIG. 3C No differences were in the proportion of double negative progenitors at PN14.
• FIGs. 4A-4G MSC-Exosome treatment promotes the development of CD4 + T cells in the thymus but inhibits the development of CD8 + T cells.
• Thymocytes were analyzed for the expression of CD4 and CD8. No differences were detected in the proportion of the double positive populations (not shown).
• FIGs. 5A-5C MEx prevents cellular apoptosis in the thymus of mice exposed to hyperoxia.
• the thymus of mice harvested at postnatal day 14 were assessed for overall thymocyte counts using countbright beads by flow cytometry and thymus slides of normoxia and hyperoxia-exposed mice ( ⁇ MEx) were stained for TUNEF for detection of apoptotic cells
• FIG. 5A shows that the thymus of hyperoxia-exposed mice present lower thymocyte counts compared to the normoxia group and MEx-treated groups.
• FIG. 5B shows representative TUNEL staining micrographs and FIG.
• 5C illustrates the number of apoptotic cells/mm 2 , which shows that mice exposed to hyperoxia exhibit increased levels of TUNEL + cells which are restored to normoxic levels upon MEx treatment. Representative micrographs were taken at a magnification of 600x and scale bar represents 20 mih. Data are shown as mean ⁇ SEM of n>6. *P ⁇ 0.05, ****p ⁇ 0.000l.
• FIGs. 6A-6C MEx restores the phenotype of medullary antigen presenting cells after hyperoxic injury.
• FIG. 6A is a schematic showing the role of thymic medullary area. After undergoing positive selection in the cortical area of the thymus, T cell progenitors expressing either CD4 or CD8 (SPs) migrate to the medullary area where they interact with medullary thymic epithelial cells (mTECs) and dendritic cells (CDl lc + DC). In the medulla, mTECs express the autoimmune regulator (AIRE) which leads to the expression of a plethora of tissue restricted self-antigens (TRAs).
• AIRE autoimmune regulator
• AIRE + mTECs directly interact with SPs or tightly collaborate with CD1 lc + DCs to delete autoreactive T cells and induce the generation of naive regulatory T cells.
• MEx treatment restores AIRE expression in mTECs (FIG. 6B) and restore the CD1 lc + DC phenotype (FIG. 6C) in the medullary area of mice exposed to hyperoxia.
• FIGs. 7A-7D MEx restores the regulatory T cell phenotype at multi-organ level.
• MEx treatment had an effect on the generation of regulatory T cells, cell suspensions of thymi, lungs and spleens of mice harvested at postnatal day 14 were stained with regulatory T cell markers, i.e., CD4, CD25 and FoxP3 (thymi) or CD3, CD4, CD25 and FoxP3 (lungs and spleen) and assessed by cytometric analysis.
• FIGs. 7A-7B show
• FIG. 7A representative graphs (FIG. 7A) and cumulative data (FIG. 7B) of CD25 and FoxP3 expression within the thymic CD4 + CD25 + single positive T cell population indicate that MEx treatment in mice exposed to hyperoxia restores the regulatory T cell phenotype to levels akin to normoxia.
• FIGs. 7C-7D show representative graphs (FIG. 7C) and cumulative data (FIG. 7D) of CD25 and FoxP3 expression within the CD3 + CD4 + T cell gate show that MEx induces a regulatory phenotype in CD4 T cells in the spleen and lungs of mice exposed to hyperoxia. Data are shown as mean ⁇ SEM of n > 5. *P ⁇ 0.05, **R ⁇ 0.01, ***P ⁇ 0.00l. DETAILED DESCRIPTION OF CERTAIN EMBODIMENTS
• Oxygen induced injuries can cause a wide range of diseases. In newborns (e.g., infants or neonates) requiring oxygen supplementation, oxygen injury causes restricted lung growth and alveolar and blood vessel development, resulting in impaired pulmonary function. It has been previously shown that mesenchymal stem cell (MSC) exosomes can be used to treat lung diseases, including impairment of lung function induced by hyperoxia (e.g., as described in Willis et al., American journal of respiratory and critical care medicine,
• MSC exosomes can significantly improve lung morphology, reduced lung fibrosis and promoted vascular remodeling in an experimental model of neonatal hyperoxia. These effects were mainly via inhibition of hyperoxia-induced inflammation, through modulation of macrophage phenotype in the lung 1 .
• the present disclosure assesses the effect of hyperoxia on thymic architecture and function, especially in neonates, whose adaptive immune system is relatively underdeveloped.
• the thymic microenvironment is a three-dimensional cellular architecture composed of a set thymic epithelial cells (TECs), which guide the development and repertoire of T cells 2 .
• TECs thymic epithelial cells
• Oxygen-induced thymic involution was shown to be due to increased thymocyte apoptosis which induced a significant reduction in count and proliferation of double positive and double negative thymocytes 3,4 . Further provided herein are the therapeutic effects of MSC exosomes on the dysfunctional thymus, which has not been previously explored. The MSC exosomes restored thymic architecture and function, reduced apoptosis of thymocytes, and promoted normal maturation of medullary TECs.
• some aspects of the present disclosure provide methods of treating a disease associated with thymic dysfunction, the method comprising administering to a subject in need thereof an effective amount of a mesenchymal stem cell (MSC) exosome.
• MSC mesenchymal stem cell
• the thymus is a specialized primary lymphoid organ of the immune system. T cells mature within the thymus. T cells are critical to the adaptive immune system, where the body adapts specifically to foreign invaders.
• the thymus is composed of two identical lobes and is located anatomically in the anterior superior mediastinum, in front of the heart and behind the sternum. Histologically, each lobe of the thymus can be divided into a central medulla and a peripheral cortex which is surrounded by an outer capsule. The cortex and medulla play different roles in the development of T cells.
• thymic stromal cells derived from bone marrow resident hematopoietic stem cells. Developing T cells are referred to as thymocytes and are of hematopoietic origin.
• Stromal cells include epithelial cells of the thymic cortex and medulla, and dendritic cells.
• the thymus provides an inductive environment for development of T cells from hematopoietic progenitor cells.
• thymic stromal cells allow for the selection of a functional and self-tolerant T cell repertoire. Therefore, one of the most important roles of the thymus is the induction of central tolerance.
• the thymus is largest and most active during the neonatal and pre-adolescent periods. By the early teens, the thymus begins to atrophy and thymic stroma is mostly replaced by adipose (fat) tissue. Nevertheless, residual T
• lymphopoiesis continues throughout adult life.
• Thymic dysfunction refers to the impairment in thymus architecture and function in the subject to be treated.
• thymic dysfunction is a dysfunction in thymic microenvironment, including but not limited to defects of thymic epithelial cells (TECs) and dendritic cells, defects in T cell development, and thymic involution.
• TECs thymic epithelial cells
• TECs thymic epithelial cells
• dendritic cells defects in T cell development
• thymic involution thymic epithelial cells
• one of the major biological functions of the thymus is generating diverse repertoire of T cells for the development of adaptive immunity and keep balance between host immunity and self-tolerance.
• thymic dysfunction encompasses dysfunction in a subject’s adaptive immune system and/or self-tolerance establishment.
• Thymic dysfunction may be caused by various reasons.
• the subject having thymic dysfunction was stressed at birth.
• Factors that cause a subject to be stressed at birth include, without limitation: premature birth, intrauterine growth restriction (IUGR), chorioamnionitis, infection, respiratory distress, cardiac disease, hypoxic ischemic encephalopathy (HIE), placental blood loss or any neonatal conditions requiring intensive care treatment and separation from the mother.
• IUGR intrauterine growth restriction
• HIE hypoxic ischemic encephalopathy
• placental blood loss or any neonatal conditions requiring intensive care treatment and separation from the mother.
• the subject may be born prematurely.
• the subject has been administered oxygen or has been on a ventilator (e.g., as required by the treatment of any condition the subject may have).
• a ventilator e.g., as required by the treatment of any condition the subject may have.
• the subject has oxygen-induced thymic involution.
• Exposure to hyperoxia condition can cause oxygen-induced thymic involution, which is the progressive shrinking of the thymus.
• Thymic involution is typically associated with the decline of the development of T cells (e.g., naive T cells), the impairment of immunological tolerance and the decline of the immune system.
• a subject that has thymic dysfunction has a thymus of reduced size, compared to a subject that does not have thymic dysfunction (e.g., a healthy subject).
• a subject that has thymic dysfunction may have a thymus whose size is reduced by at least 20%, at least 30%, at least 40%, at least 50%, at least 60%, at least 70%, at least 80%, at least 90%, or 100%, compared to a subject that does not have thymic dysfunction (e.g., a healthy subject).
• a subject that has thymic dysfunction has a thymus whose size is reduced by 20%, 30%, 40%, 50%, 60%, 70%, 80%, 90%, or 100%, compared to a subject that does not have thymic dysfunction (e.g., a healthy subject).
• a subject that has thymic dysfunction has a reduced number (e.g., by at least 20%) of thymocytes, compared to a subject that does not have thymic dysfunction (e.g., a healthy subject).
• a subject that has thymic dysfunction may have a number of thymocytes that is reduced by at least 20%, at least 30%, at least 40%, at least 50%, at least 60%, at least 70%, at least 80%, at least 90%, or 100%, compared to a subject that does not have thymic dysfunction (e.g., a healthy subject).
• a subject that has thymic dysfunction has a number of thymocytes that is reduced by 20%,
• A“thymocyte” is a hematopoietic progenitor cells present in the thymus. The primary function of a thymocytes is the generation of T
• Thymocytes are classified into a number of distinct maturational stages based on the expression of cell surface markers.
• the earliest thymocyte stage is the double negative stage (negative for both CD4 and CD8, also termed“thymocyte progenitor cells” herein), which more recently has been better described as Lineage-negative, and which can be divided into four sub stages.
• the next major stage is the double positive stage (positive for both CD4 and CD8).
• the final stage in maturation is the single positive stage (positive for either CD4 or CD8).
• a subject that has thymic dysfunction has a reduced number (e.g., by at least 20%) of thymocyte progenitor cells, compared to a subject that does not have thymic dysfunction (e.g., a healthy subject).
• a subject that has thymic dysfunction may have a number of thymocyte progenitor cells that is reduced by at least 20%, at least 30%, at least 40%, at least 50%, at least 60%, at least 70%, at least 80%, at least 90%, or 100%, compared to a subject that does not have thymic dysfunction (e.g., a healthy subject).
• a subject that has thymic dysfunction has a number of thymocyte progenitor cells that is reduced by 20%, 30%, 40%, 50%, 60%, 70%, 80%, 90%, or 100%, compared to a subject that does not have thymic dysfunction (e.g., a healthy subject).
• a subject that has thymic dysfunction develops a reduced number (e.g., by at least 20%) of CD4 and/or CD8 positive T cells, compared to a subject that does not have thymic dysfunction (e.g., a healthy subject).
• a subject that has thymic dysfunction may develop a number of CD4 and/or CD8 positive T cells that is reduced by at least 20%, at least 30%, at least 40%, at least 50%, at least 60%, at least 70%, at least 80%, at least 90%, or 100%, compared to a subject that does not have thymic dysfunction (e.g., a healthy subject).
• a subject that has thymic dysfunction develops a number of CD4 and/or CD8 positive T cells that is reduced by 20%, 30%, 40%, 50%, 60%, 70%, 80%, 90%, or 100%, compared to a subject that does not have thymic dysfunction (e.g., a healthy subject).
• the subject who has thymic dysfunction has an abnormal ratio of CD4/CD8 T cells, compared to a subject that does not have thymic dysfunction (e.g., a healthy subject).
• the subject who has thymic dysfunction has an impaired innate and/or adaptive immune system.
• the subject who has thymic dysfunction may have an adaptive immune system that has reduced activity against invading pathogens (e.g., causing infection) or increased activity against self (e.g., causing autoimmune diseases).
• a subject that has thymic dysfunction has a reduced number (e.g., by at least 20%) of mature medullary thymic epithelial cells, compared to a subject that does not have thymic dysfunction (e.g., a healthy subject).
• a subject that has thymic dysfunction may have a number of mature medullary thymic epithelial cells that is reduced by at least 20%, at least 30%, at least 40%, at least 50%, at least 60%, at least 70%, at least 80%, at least 90%, or 100%, compared to a subject that does not have thymic dysfunction (e.g., a healthy subject).
• a subject that has thymic dysfunction has a number of mature medullary thymic epithelial cells that is reduced by 20%, 30%, 40%, 50%, 60%, 70%, 80%, 90%, or 100%, compared to a subject that does not have thymic dysfunction (e.g., a healthy subject).
• a subject that has thymic dysfunction has an increased (e.g., by at least 20%) thymocyte apoptosis, compared to a subject that does not have thymic
• the thymocyte apoptosis in a subject that has thymic dysfunction may be increased by at least 20%, at least 30%, at least 40%, at least 50%, at least 60%, at least 70%, at least 80%, at least 90%, at least 100%, at least 2-fold, at least 5-fold, at least 10 fold, at least lOO-fold, at least 1000-fold, or more, compared to a subject that does not have thymic dysfunction (e.g., a healthy subject).
• the thymocyte apoptosis in a subject that has thymic dysfunction is increased by 20%, 30%, 40%, 50%, 60%, 70%, 80%, 90%, 100%, 2-fold, 5-fold, lO-fold, lOO-fold, lOOO-fold, or more, compared to a subject that does not have thymic dysfunction (e.g., a healthy subject).
• Thymic dysfunction is associated with many diseases including thymic tumors, infectious diseases, and immune disorders (e.g., as described in Sun et al., Biomed Res Int. 2014; 2014: 206929, incorporated herein by reference).
• a subject has thymic dysfunction has or is at risk of developing diseases associated with thymic dysfunction.
• a subject that has thymic dysfunction has impaired innate and/or adaptive immunity, compared to a subject that does not have thymic dysfunction (e.g., a healthy subject).
• the disease associated with thymic dysfunction is an immune disorder.
• An“immune disorder” refers to a disorder that causes abnormally low activity of over activity of the immune system. In cases of immune system over activity, the body attacks and damages its own tissues (autoimmune diseases). Immune deficiency diseases decrease the body's ability to fight invaders, causing vulnerability to infections.
• the immune disorder is selected from the group consisting of: autoimmune disease, neonatal lupus, rheumatoid arthritis, and type I diabetes. In some embodiments, the immune disorder is an autoimmune disease.
• Non-limiting examples of autoimmune diseases include: rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), Myasthenia Gravis (MG), Graves Disease, Idiopathic Thrombocytopenia Purpura (ITP), Guillain-Barre Syndrome, autoimmune myocarditis, Membrane Glomerulonephritis, Type I or Type II diabetes, juvenile onset diabetes, multiple sclerosis, Reynaud's syndrome, autoimmune thyroiditis, gastritis, Celiac Disease, Vitiligo, Hepatitis, primary biliary cirrhosis, inflammatory bowel disease,
• spondyloarthropathies e.g., spondyloarthropathies, experimental autoimmune encephalomyelitis, immune neutropenia, and immune responses associated with delayed hypersensitivity mediated by cytokines, T- lymphocytes typically found in tuberculosis, sarcoidosis, and polymyositis, polyarteritis, cutaneous vasculitis, pemphigus (e.g., pemphigus vulgaris, pemphigus foliaceus or
• the disease associated with thymic dysfunction is infection (e.g., infection caused by pathogens such as bacteria, viruses, fungi, and other microorganisms).
• the infection is caused by a bacterium.
• Exemplary, non-limiting bacterial taxa, species, and strains, suitable for use in some embodiments of this disclosure include: Escherichia spp., Enterobacter spp. (e.g., Enterobacter cloacae), Salmonella spp. (e.g., Salmonella enteritidis, Salmonella typhi), Shigella spp., Pseudomonas spp.
• Moraxella spp. e.g., Moraxella catarrhalis
• Neisseria spp. e.g., Neisseria gonorrhoeae, Neisseria meningitidis
• Helicobacter spp. e.g., Helicobacter pylori
• Stenotrophomonas spp. Vibrio spp. (e.g., Vibrio cholerae), Legionella spp. (Legionella pneumophila), Hemophilus spp.
• Brucella spp. e.g., Brucella abortus, Brucella canis, Brucella melitensis, Brucella suis
• Campylobacter spp. e.g., Campylobacter jejuni
• Chlamydophila spp. e.g., Chlamydia pneumoniae, Chlamydia trachomatis, Chlamydophila psittaci
• Clostridium spp. e.g., Clostridium botulinum, Clostridium difficile, Clostridium perfringens, Clostridium tetani
• Corynebacterium spp. e.g., Corynebacterium diphtheriae
• Enterococcus spp. e.g., Enterococcus faecalis , Enterococcus faeciumf, Escherichia spp.
• E. coli 0157.H7 e.g., Escherichia coli, Enterotoxic E. coli, enteropathogenic E. coli; E. coli 0157.H7
• Francisella spp. e.g., Francisella tularensis
• Haemophilus spp. e.g., Haemophilus influenzae
• Helicobacter spp. e.g., Helicobacter pylori
• Legionella spp. e.g., Legionella pneumophila
• Leptospira spp. e.g., Leptospira interrogans
• Listeria spp. e.g., Listeria monocytogenes
• Mycobacterium spp. e.g., Mycobacterium leprae, Mycobacterium tuberculosis
• Mycobacterium ulcerans Mycoplasma spp. (e.g., Mycoplasma pneumoniae), Neisseria spp. (e.g., Neisseria gonorrhoeae, Neisseria meningitidis), Pseudomonas spp. (e.g., Pseudomonas aeruginosa), Rickettsia spp. (e.g., Rickettsia rickettsii), Salmonella spp. (e.g., Salmonella typhi, Salmonella typhimurium); Shigella spp. (e.g., Shigella sonnei); Staphylococcus spp. (e.g., Staphylococcus aureus, Staphylococcus epidermidis, Staphylococcus saprophyticus);
• Staphylococcus spp. e.g., Staphylococcus aureus,
• Streptococcus spp. e.g., Streptococcus agalactiae, Streptococcus pneumoniae, Streptococcus pyogenes
• Treponema spp. e.g., Treponema pallidum
• Marinobacter spp. e.g., Marinobacter hydrocarbonoclasticus, Marinobacter vinifirmus
• Alcanivorax spp. e.g., alcanivorax dieselolei
• Acetinobacter spp. e.g., A.
• Halomonas spp. e.g., H. shengliensis
• Eabrenzia spp. e.g., Eabrenzia spp.
• Microbulifer spp. e.g.,
• M. schleiferi Shewanella spp. (e.g., S. algae); Vibrio spp. (e.g., Vibrio cholerae, Vibrio alginolyticus, Vibrio hepatarius), and Yersinia spp. (e.g., Yersinia pestis).
• the bacterium is Bacillus anthracis (causing anthrax),
• Bordetella pertussis (causing whooping cough), Corynebacterium diphtheriae (causing diphtheria), Clostridium tetani (causing tetanus), Haemophilus influenzae type b,
• pneumococcus causing pneumococcal infections
• Staphylococci spp. including Group A or B streptococci
• Mycobacterium tuberculosis Neiserria meningitidis (causing meningococcal disease)
• Salmonella typhi causing typhoid
• Vibrio cholerae causing Cholera
• Yersinia pestis causing plague.
• the bacterium is a Gram-negative bacterium.
• Gram-negative bacterial species include: Neisseria species including Neisseria gonorrhoeae and Neisseria meningitidis, Branhamella species including Branhamella catarrhalis, Escherichia species including Escherichia coli,
• Enterobacter species Proteus species including Proteus mirabilis, Pseudomonas species including Pseudomonas aeruginosa, Pseudomonas mallei, and Pseudomonas pseudomallei, Klebsiella species including Klebsiella pneumoniae,
• Salmonella species Shigella species, Serratia species , Acineiobacter species; Haemophilus spe cies including Haemophilus influenzae and Haemophilus ducreyi;
• Brucella species Yersinia species including Yersinia pestis and Yersinia enterocolitica, Francisella species including Francisella tularensis, Pasturella species including Pasteurella multocida, Vibrio cholerae, Flavobacterium species, meningosepticum, Campylobacter species including Campylobacter jejuni, Bacteroides species (oral, pharyngeal ) incl uding Bacteroides fragilis, Fusobacterium species including Fusobacterium nucleatum, Calymmatobacterium granulornatis, Streptobacillus species including Streptobacillus moniliformis,
• Legionella species including Legionella pneumophila.
• the bacteriu is a Gram-positive bacterium.
• Exemplary Gram positive bacteria include, but are not limited to. Staphylococcus spp., Streptococcus spp., Micrococcus spp., Peptococcus spp., Peptostreptococcus spp., Enterococcus spp., Bacillus spp., Clostridium spp., Lactobacillus spp.. Listeria spp., Erysipelothrix spp.,
• the Gram-positive bacteria is a bacteria of the phylum Firmicutes. In some embodiments, the Gram-positive bacteria is Streptococcus.
• acid-fast bacilli examples include Mycobacterium species including Mycobacterium tuberculosis and Mycobacterium leprae.
• spirochetes examples include Treponema species including Treponema pallidum.
• actinomycetes include:
• Actinomyces species including Actinomyces israelii
• Nocardia species including Nocardia aster oides.
• the infection is caused by a virus.
• viruses include but are not limited to: Retroviruses, human immunodeficiency viruses including HIV-l, HDTV-III, LAVE, HTLV-III/LAV, HIV-III, HIV-LP, Cytomegaloviruses (CMV),
• Picomaviruses polio viruses, hepatitis A virus, enteroviruses, human Coxsackie viruses, rhinoviruses, echoviruses, Calciviruses, Togaviruses, equine encephalitis viruses, rubella viruses, Flaviruses, dengue viruses, encephalitis viruses, yellow fever viruses, Coronaviruses, Rhabdoviruses, vesicular stomatitis viruses, rabies viruses, Filoviruses, ebola virus,
• Paramyxoviruses parainfluenza viruses, mumps virus, measles virus, respiratory syncytial virus (RSV), Orthomyxoviruses, influenza viruses, Bungaviruses, Hantaan viruses,
• phleboviruses and Nairo viruses Arena viruses, hemorrhagic fever viruses, reoviruses, orbiviruses, rotaviruses, Birnaviruses, Hepadnaviruses, Hepatitis B virus, parvoviruses, Papovaviridae, papilloma viruses, polyoma viruses, Adenoviruses, Herpesviruses including herpes simplex virus 1 and 2, varicella zoster virus, Poxviruses, variola viruses, vaccinia viruses, Irido viruses, African swine fever virus, delta hepatitis virus, non-A, non-B hepatitis virus, Hepatitis C, Norwalk viruses, astroviruses, and unclassified viruses.
• Arena viruses hemorrhagic fever viruses
• reoviruses orbiviruses
• rotaviruses Birnaviruses
• Hepadnaviruses Hepati
• the virus is adenovirus, enterovirus such as poliomyelitis (polio), Ebola virus, herpes viruses such as herpes simplex virus, cytomegalovirus and varicella- zoster (chickenpox and shingles), measles, mumps, rubella, hepatitis-A, -B, or-C, human papilloma virus, Influenza virus, rabies, Japanese encephalitis, rotavirus, human immunodeficiency virus (HIV), respiratory syncytial virus (RSV), smallpox, yellow fever, Zika Virus, or Dengue virus.
• enterovirus such as poliomyelitis (polio), Ebola virus
• herpes viruses such as herpes simplex virus, cytomegalovirus and varicella- zoster (chickenpox and shingles), measles, mumps, rubella, hepatitis-A, -B, or-C
• the infection is caused by a fungus.
• fungi include, but are not limited to: Cryptococcus species including Crytococcus neoformans, Histoplasma species including Histoplasma capsulatum, Coccidioides species including Coccidiodes immitis, Paracoccidioides species including Paracoccidioides brasiliensis, Blastomyces species including Blastomyces dermatitidis, Chlamydia species including Chlamydia trachomatis, Candida species including Candida albicans, Sporothrix species including Sporothrix schenckii, Aspergillus species, and fungi of mucormycosis.
• the fungus is Candida spp., Aspergillus spp., Cryptococcus spp., Mucormycete, Blastomyces dermatitidis (causing blastomycosis), or endemic mycosis causing fungus such as Histoplasma capsulatum (causing histoplasmosis), or Sporothrix schenckii (causing sporotrichosis).
• Parasites include Plasmodium species, such as Plasmodium species including Plasmodium falciparum, Plasmodium malarias, Plasmodium ovale , and Plasmodium vivax and Toxoplasma gondii.
• Blood-borne and/or tissues parasites include Plasmodium species, Babesia species including Babesia microti and Babesia divergens, Leishmania species including Leishmania tropica, Leishmania species, Leishniania braziliensis, Leishmania donovani, Trypanosoma species including Trypanosoma gambiense, Trypanosoma rhodesiense (African sleeping sickness), and Trypanosoma cruzi (Chagas' disease).
• the parasite is Plasmodium spp., Leishmania, or a helminth.
• the disease associated with thymic dysfunction is cancer.
• Types of cancer that may be treated using the methods disclosed herein include, without limitation, neoplasms, malignant tumors, metastases, or any disease or disorder characterized by uncontrolled cell growth such that it would be considered cancerous.
• the cancer may be a primary or metastatic cancer. Cancers include, but are not limited to, biliary tract cancer;
• bladder cancer brain cancer including glioblastomas and medulloblastomas; breast cancer; cervical cancer; choriocarcinoma; colon cancer; endometrial cancer; esophageal cancer; gastric cancer; hematological neoplasms including acute lymphocytic and myelogenous leukemia; multiple myeloma; AIDS-associated leukemias and adult T-cell leukemia lymphoma;
• intraepithelial neoplasms including Bowen’s disease and Paget’s disease
• liver cancer lung cancer
• lymphomas including Hodgkin’s disease and lymphocytic lymphomas
• neuroblastomas oral cancer including squamous cell carcinoma; ovarian cancer including those arising from epithelial cells, stromal cells, germ cells and mesenchymal cells; pancreatic cancer; prostate cancer; rectal cancer; sarcomas including leiomyosarcoma,
• rhabdomyosarcoma liposarcoma, fibrosarcoma, and osteosarcoma
• skin cancer including melanoma, Kaposi’s sarcoma basoceilular cancer, and squamous cell cancer
• testicular cancer including germinal tumors such as seminoma, non-seminoma, teratomas, choriocarcinomas; stromal tumors and germ cell tumors; thyroid cancer including thyroid adenocarcinoma and medullar carcinoma; and renal cancer including adenocarcinoma and Wilms’ tumor.
• Commonly encountered cancers include breast, prostate, lung, ovarian, colorectal, and brain cancer. In some embodiments, the cancer is metastatic.
• MSC exosomes are found herein to have therapeutic effects against diseases associated with thymic dysfunction.
• An“exosome” is a membrane (e.g., lipid bilayer) vesicle that is released from a cell (e.g., any eukaryotic cell). Exosomes are present in eukaryotic fluids, including blood, urine, and cultured medium of cell cultures. The exosomes of the present disclosure are released from mesenchymal stem cells (MSCs) and are interchangeably termed “mesenchymal stem cell exosomes” or“MSC exosomes.”
• MSCs mesenchymal stem cells
• A“mesenchymal stem cell (MSC)” is a progenitor cell having the capacity to differentiate into neuronal cells, adipocytes, chondrocytes, osteoblasts, myocytes, cardiac tissue, and other endothelial or epithelial cells. (See for example Wang, Stem Cells
• CD13 CD29, CD44, CD49a, b, c, e, f, CD51, CD54, CD58, CD71, CD73, CD90, CD102, CD105, CD106, CDwl l9, CDl20a, CDl20b, CD123,
• These cells have also been characterized as not expressing (and thus being negative for) CD3, CD5, CD6, CD9, CD10, CDl la, CD14, CD15, CD18, CD21, CD25, CD31, CD34, CD36, CD38, CD45, CD49d, CD50, CD62E, L, S, CD80, CD86, CD95,
• MSCs may be characterized phenotypically and/or functionally according to their differentiation potential.
• MSCs may be harvested from a number of sources including but not limited to bone marrow, blood, periosteum, dermis, umbilical cord blood and/or matrix (e.g., Wharton’s Jelly), and placenta. Methods for harvesting MSCs are described in the art, e.g., in US Patent No. 5486359, incorporated herein by reference.
• MSCs can be isolated from multiple sources, e.g., bone marrow mononuclear cells, umbilical cord blood, adipose tissue, placental tissue, based on their adherence to tissue culture plastic.
• sources e.g., bone marrow mononuclear cells, umbilical cord blood, adipose tissue, placental tissue, based on their adherence to tissue culture plastic.
• MSCs can be isolated from commercially available bone marrow aspirates. Enrichment of MSCs within a population of cells can be achieved using methods known in the art including but not limited to fluorescence-activated cell sorting (FACS).
• FACS fluorescence-activated cell sorting
• MSCs Commercially available media may be used for the growth, culture and maintenance of MSCs.
• Such media include but are not limited to Dulbecco’s modified Eagle’s medium (DMEM).
• Components in such media that are useful for the growth, culture and maintenance of MSCs, fibroblasts, and macrophages include but are not limited to amino acids, vitamins, a carbon source (natural and non-natural), salts, sugars, plant derived hydrolysates, sodium pyruvate, surfactants, ammonia, lipids, hormones or growth factors, buffers, non-natural amino acids, sugar precursors, indicators, nucleosides and/or nucleotides, butyrate or organics, DMSO, animal derived products, gene inducers, non-natural sugars, regulators of intracellular pH, betaine or osmoprotectant, trace elements, minerals, non-natural vitamins.
• DMEM Dulbecco’s modified Eagle’s medium
• tissue culture medium e.g., animal serum (e.g., fetal bovine serum (FBS), fetal calf serum (FCS), horse serum (HS)), antibiotics (e.g., including but not limited to, penicillin, streptomycin, neomycin sulfate, amphotericin B, blasticidin, chloramphenicol, amoxicillin, bacitracin, bleomycin, cephalosporin, chlortetracycline, zeocin, and puromycin), and glutamine (e.g., F- glutamine).
• FBS fetal bovine serum
• FCS fetal calf serum
• HS horse serum
• antibiotics e.g., including but not limited to, penicillin, streptomycin, neomycin sulfate, amphotericin B, blasticidin, chloramphenicol, amoxicillin, bacitracin, bleomycin, cephalosporin, chlortetracycl
• the MSC exosomes used to treat diseases associated with thymic dysfunction are isolated exosomes.
• an“isolated exosome” is an exosome that is physically separated from its natural environment.
• An isolated exosome may be physically separated, in whole or in part, from tissue or cells with which it naturally exists, including MSCs, fibroblasts, and macrophages.
• the isolated exosomes are MSC exosomes.
• the MSC exosomes are isolated from the culturing media of MSCs from human bone marrow, or umbilical cord Wharton’s Jelly. Such culturing media is termed“MSC-conditioned media” herein.
• isolated exosomes may be free of cells such as MSCs, or it may be free or substantially free of conditioned media, or it may be free of any biological contaminants such as proteins.
• the isolated exosomes are provided at a higher concentration than exosomes present in
• the isolated MSC exosome is substantially free of contaminants (e.g., protein contaminants).
• the isolated MSC exosome is“substantially free of
• the isolated MSC is“substantially free of contaminants” when the preparation of the isolated MSC exosome is at least 80%, at least 85%, at least 90%, at least 95%, at least 98%, at least 99%, at least 99.9% pure, with respect to contaminants (e.g., proteins).
• Protein contaminants refer to proteins that are not associated with the isolated exosome and do not contribute to the biological activity of the exosome.
• the protein contaminants are also referred to herein as“non-exosomal protein contaminants.”
• the MSC exosome described herein has a diameter of about 30-150 nm.
• the MSC exosome may have a diameter of 30-150, 30-140, 30-130, 30-120, 30-110, 30-100, 30-90, 30-80, 30-70, 30-60, 30-50, 30-40, 40-150, 40-140, 40-130, 40-120, 40-110, 40-100, 40-90, 40-80, 40-70, 40-60, 40-50, 50-150 nm, 50-140 nm, 50-130 nm, 50-120 nm, 50-110 nm, 50-100 nm, 50-90 nm, 50-80 nm, 50-70 nm, 50-60 nm, 60-150 nm, 60-140 nm, 60-130 nm, 60-120 nm, 60-110 nm, 60-100 nm, 60-90 nm, 60-80 nm, 60-70 nm, 70-150 nm, 60-
• the MSC exosome may have a diameter of about 50 nm, 60 nm, 70 nm, 80 nm, 90 nm, 100 nm, 110 nm, 120 nm, 130 nm, 140 nm, or 150 nm. In some embodiments, the MSC exosomes exhibit a biconcave morphology.
• the MSC exosomes may be used for treating the diseases associated with thymic dysfunction.
• the MSC exosomes e.g., isolated MSC exosomes
• the composition further comprises pharmaceutically acceptable concentrations of salt, buffering agents, preservatives, compatible carriers, and and/or other (i.e., secondary) therapeutic agents.
• a pharmaceutically acceptable carrier is a pharmaceutically acceptable material, composition or vehicle, such as a liquid or solid filler, diluent, excipient, solvent or
• materials which can serve as pharmaceutically acceptable carriers include sugars, such as lactose, glucose and sucrose; glycols, such as propylene glycol; polyols, such as glycerin, sorbitol, mannitol and polyethylene glycol; esters, such as ethyl oleate and ethyl laurate; buffering agents, such as magnesium hydroxide and aluminum hydroxide; pyrogen- free water; isotonic saline; Ringer's solution; ethyl alcohol; phosphate buffer solutions; and other non-toxic compatible substances employed in pharmaceutical formulations.
• sugars such as lactose, glucose and sucrose
• glycols such as propylene glycol
• polyols such as glycerin, sorbitol, mannitol and polyethylene glycol
• esters such as ethyl oleate and ethyl laurate
• buffering agents such as magnesium hydroxide and aluminum hydroxide
• an effective amount of the MSC exosomes or the composition comprising the MSC exosomes is administered to a subject having thymic dysfunction.
• An“effective amount” is the amount of an agent that achieves the desired outcome. The absolute amount will depend upon a variety of factors, including the material selected for administration, whether the administration is in single or multiple doses, and individual patient parameters including age, physical condition, size, weight, and the stage of the disease. These factors are well known to those of ordinary skill in the art and can be addressed with no more than routine experimentation.
• the effective amount is a dosage of an agent that causes no toxicity to the subject. In some embodiments, the effective amount is a dosage of an agent that causes reduced toxicity to the subject.
• Methods for measuring toxicity are well known in the art (e.g., biopsy/histology of the liver, spleen, and/or kidney; alanine transferase, alkaline phosphatase and bilirubin assays for liver toxicity; and creatinine levels for kidney toxicity).
• Treatment includes, but is not limited to, preventing, reducing, or halting the development of a lung disease, reducing or eliminating the symptoms of lung disease, or preventing lung disease.
• a subject shall mean a human or vertebrate animal or mammal including but not limited to a rodent, e.g., a rodent such as a rat or a mouse, dog, cat, horse, cow, pig, sheep, goat, turkey, chicken, and primate, e.g., monkey.
• the subject is human.
• the subject is a companion animal.
• “A companion animal,” as used herein, refers to pets and other domestic animals. Non-limiting examples of companion animals include dogs and cats; livestock such as horses, cattle, pigs, sheep, goats, and chickens; and other animals such as mice, rats, guinea pigs, and hamsters.
• the methods of the present disclosure are useful for treating a subject in need thereof.
• a subject in need thereof can be a subject who has or is has a risk of developing a disease associated with thymic dysfunction.
• the subjects may be those that have a disease described herein amenable to treatment using the exosomes described in this disclosure, or they may be those that are at risk of developing such a disease.
• the subject is a human subject.
• the subject is a human infant.
• the subject may be a neonate and particularly neonates born at low gestational age.
• a human neonate refers to an human from the time of birth to about 4 weeks of age.
• a human infant refers to a human from about the age of 4 weeks of age to about 3 years of age.
• low gestational age refers to birth (or delivery) that occurs before a normal gestational term for a given species.
• a full gestational term is about 40 weeks and may range from 37 weeks to more than 40 weeks.
• Low gestational age in humans, akin to a premature birth is defined as birth that occurs before 37 weeks of gestation.
• the disclosure therefore contemplates prevention and/or treatment of subjects bom before 37 weeks of gestation, including those bom at even shorter gestational terms (e.g., before 36, before 35, before 34, before 33, before 32, before 31, before 30, before 29, before 28, before 27, before 26, or before 25 weeks of gestation).
• the present disclosure contemplates their treatment even beyond the neonate stage and into childhood and/or adulthood.
• the subject treated using the methods of the present disclosure is 3-18 years of age.
• the subject treated using the methods of the present disclosure may be 3-18, 3-17, 3-16, 3-15, 3-14, 3-13, 3-12, 3-11, 3-10, 3-9, 3-8, 3-7, 3-6, 3-5, 3-4, 4-18, 4-17, 4-16, 4-15, 4-14, 4-13, 4-12, 4-11, 4-10, 4-9, 4-8, 4-7, 4-6, 4-5, 5-18, 5-17, 5-16, 5-15, 5- 14, 5-13, 5-12, 5-11, 5-10, 5-9, 5-8, 5-7, 5-6, 6-18, 6-17, 6-16, 6-15, 6-14, 6-13, 6-12, 6-11, 6- 10, 6-9, 6-8, 6-7, 7-18, 7-17, 7-16, 7-15, 7-14, 7-13, 7-12, 7-11, 7-11, 7-11, 7-11, 7-11, 7-11
• the subject is an adult, e.g., 18 or more than 18 years of age.
• Certain subjects may have a genetic predisposition to certain forms of the diseases (or conditions) described herein (for example, autoimmune diseases or cancer), and those subjects may also be treated according to the disclosure.
• the disclosure contemplates administration of the isolated MSC exosomes within 1 year, 11 months, 10 months, 9 months, 8 months, 7 months, 6 months, 5 months, 4 months, 3 months, 2 months, 1 month, 4 weeks, 3 weeks, 2 weeks, 1 week, 6 days, 5 days, 4 days, 3 days, 2 days, 1 day, 12 hours, 6 hours, 3 hours, or 1 hour of birth.
• the isolated MSC exosomes are administered within 1 hour of birth (e.g., within 1 hour, within 55 minutes, within 50 minutes, within 45 minutes, within 40 minutes, within 35 minutes, within 30 minutes, within 25 minutes, within 20 minutes, within 15 minutes, within 10 minutes, within 5 minutes, or within 1 minute).
• the MSC exosome is administered to the subject immediately after birth.
• the present disclosure further contemplates administration of the MSC exosomes even in the absence of symptoms indicative of a disease or disorder as described herein.
• the MSC exosome or the composition comprising the isolated exosome is administered to a subject (e.g., a neonate) once.
• a subject e.g., a neonate
• repeated administration of the MSC exosomes including two, three, four, five or more administrations of the MSC exosomes, is contemplated.
• the MSC exosomes may be administered continuously.
• Repeated or continuous administration may occur over a period of several hours (e.g., 1-2, 1-3, 1-6, 1-12, 1-18, or 1-24 hours), several days (e.g., 1-2, 1-3, 1-4, 1- 5, 1-6 days, or 1-7 days) or several weeks (e.g., 1-2 weeks, 1-3 weeks, or 1-4 weeks) depending on the severity of the condition being treated.
• the time in between administrations may be hours (e.g., 4 hours, 6 hours, or 12 hours), days (e.g., 1 day, 2 days, 3 days, 4 days, 5 days, or 6 days), or weeks (e.g., 1 week, 2 weeks, 3 weeks, or 4 weeks).
• the time between administrations may be the same or they may differ. As an example, if the symptoms of the disease appear to be worsening the a-type exosomes may be administered more frequently, and then once the symptoms are stabilized or diminishing the a-type exosomes may be administered less frequently.
• the MSC exosomes are administered at least once within 24 hours of birth and then at least once more within 1 week of birth. In some embodiments, the MSC exosomes are administered at least once within 1 hour of birth and then at least once more within 3-4 days of birth.
• the MSC exosomes may be administered by any route that effects delivery to the thymus.
• Systemic administration routes such as intravenous injection or continuous infusion are suitable.
• the MSC exosomes may be formulated for parenteral administration by injection, including for example by bolus injection or continuous infusion.
• Formulations for injection may be presented in unit dosage form, e.g., in ampoules or in multi-dose containers, with or without an added preservative.
• the compositions may take such forms as water-soluble suspensions, solutions or emulsions in oily or aqueous vehicles, and may contain formulatory agents such as suspending, stabilizing and/or dispersing agents.
• Suitable lipophilic solvents or vehicles include fatty oils such as sesame oil, or synthetic fatty acid esters, such as ethyl oleate or triglycerides.
• Aqueous injection suspensions may contain substances which increase the viscosity of the suspension, such as sodium carboxymethyl cellulose, sorbitol, or dextran.
• the suspension may also contain suitable stabilizers or agents which increase solubility.
• the exosomes may be in lyophilized or other powder or solid form for constitution with a suitable vehicle, e.g., sterile pyrogen-free water, before use.
• agents to be administered to subjects being treated according to the disclosure may be administered by any suitable route including oral administration, intranasal administration, intratracheal administration, inhalation, intravenous administration, etc.
• suitable route including oral administration, intranasal administration, intratracheal administration, inhalation, intravenous administration, etc.
• Those of ordinary skill in the art will know the customary routes of administration for such secondary agents.
• the MSC exosomes, or the composition comprising the MSC exosomes when administered to a subject, improves thymus function.
• thymus function is considered to be“improved” when the functionality of the thymus, e.g., as measured by any methods known to the skilled artisan, is improved by at least 20% in subjects that have been administered the MSC exosomes, compared to in subjects that have not been administered the MSC exosomes.
• thymus function may be considered improved when the functionality of the thymus, e.g., as measured by any methods known to the skilled artisan, is improved by at least 20%, at least 30%, at least 40%, at least 50%, at least 70%, at least 80%, at least 90%, at least 100%, at least 2-fold, at least 5-fold, at least 10-fold, at least 50-fold, at least lOO-fold or more, in subjects that have been administered the MSC exosomes, compared to in subjects that have not been administered the MSC exosomes.
• thymus function is considered to be improved when the functionality of the thymus, e.g., as measured by any methods known to the skilled artisan, is improved by 20%, 30%, 40%, 50%, 70%, 80%, 90%, 100%, 2-fold, 5-fold, lO-fold, 50-fold, lOO-fold or more, in subjects that have been administered the MSC exosomes, compared to in subjects that have not been administered the MSC exosomes.
• Methods of evaluating thymus function are known to those skilled in the art. Non limiting examples of such methods include measuring the size and/or the cortico-medullary ratio, imaging of the thymus, assessing the ability of T cell production by the thymus, and/or evaluating the subject’s immune competence (e.g., against infection). Methods of evaluating thymus function are also described in the art, e.g., as described in Lorenzi et ah, J Immunol Methods. 2008 Dec 31; 339(2): 185-194; Harris et ah, Clin Immunol. 2005 May;l l5(2):l38- 46; Saidakova et ah, Klin Lab Diagn.
• thymic function is by analysis of T cell receptor excision circles (TRECs) in peripheral blood, which are present in the thymocytes that exit the thymus (e.g., as described in Lorenzi et al, J Immunol Methods. 2008 Dec 31; 339(2), incorporated herein by reference).
• T cell receptor excision circles T cell receptor excision circles
• the MSC exosomes, or the composition comprising the MSC exosomes when administered to a subject, restores thymic architecture.
• thymic architecture is considered to be“restored” when the architecture of the thymus, e.g., as indicated by the cortico-medullary ratio of the thymus (see FIG. 1E), is increased by at least 20% in subjects that have been administered the MSC exosomes, compared to in subjects that have not been administered the MSC exosomes.
• thymic architecture may be considered“restored” when the architecture of the thymus, e.g., as indicated by the cortico-medullary ratio of the thymus (see FIG.
• thymic architecture is considered“restored” when the architecture of the thymus, e.g., as indicated by the cortico- medullary ratio of the thymus (see FIG.
• 1E is increased by 20%, 30%, 40%, 50%, 70%, 80%, 90%, 100%, 2-fold, 5-fold, lO-fold, 50-fold, lOO-fold or more, in subjects that have been administered the MSC exosomes, compared to in subjects that have not been administered the MSC exosomes.
• the MSC exosomes, or the composition comprising the MSC exosomes when administered to a subject, restores thymic development. In some embodiments, the MSC exosomes, or the composition comprising the MSC exosomes, when administered to a subject, restores thymic development. In some embodiments, the MSC exosomes, or the composition comprising the MSC exosomes, when administered to a subject, restores thymic development.
• thymic development is considered to be“restored” when the number of thymocytes (also termed“thymocyte counts”) is increased by at least 20% in subjects that have been administered the MSC exosomes, compared to in subjects that have not been
• thymic development may be considered “restored” when the number of thymocytes is increased by at least 20%, at least 30%, at least 40%, at least 50%, at least 70%, at least 80%, at least 90%, at least 100%, at least 2-fold, at least 5-fold, at least lO-fold, at least 50-fold, at least lOO-fold or more, in subjects that have been administered the MSC exosomes, compared to in subjects that have not been
• thymic development is considered “restored” when the number of thymocytes is increased by 20%, 30%, 40%, 50%, 70%, 80%, 90%, 100%, 2-fold, 5-fold, lO-fold, 50-fold, lOO-fold or more, in subjects that have been administered the MSC exosomes, compared to in subjects that have not been administered the MSC exosomes.
• the MSC exosomes, or the composition comprising the MSC exosomes when administered to a subject, restores thymocyte progenitor population in the thymus.
• thymocyte progenitor population in the thymus is considered to be“restored” when the number of thymocyte progenitor cells is increased by at least 20% in subjects that have been administered the MSC exosomes, compared to in subjects that have not been administered the MSC exosomes.
• thymocyte progenitor population in the thymus is considered to be“restored” when the number of thymocyte progenitor cells is increased by at least 20%, at least 30%, at least 40%, at least 50%, at least 70%, at least 80%, at least 90%, at least 100%, at least 2-fold, at least 5-fold, at least lO-fold, at least 50-fold, at least lOO-fold or more, in subjects that have been administered the MSC exosomes, compared to in subjects that have not been administered the MSC exosomes.
• thymocyte progenitor population in the thymus is considered to be“restored” when the number of thymocyte progenitor cells is increased by 20%, 30%, 40%, 50%, 70%, 80%, 90%, 100%, 2-fold, 5-fold, lO-fold, 50-fold, lOO-fold or more, in subjects that have been administered the MSC exosomes, compared to in subjects that have not been administered the MSC exosomes.
• the MSC exosomes, or the composition comprising the MSC exosomes when administered to a subject, reduces thymocyte apoptosis (e.g., induced by exposure to hyperoxia).“Apoptosis” refers to the death of cells that occurs as a normal and controlled part of an organism's growth or development. In some embodiments, thymocyte apoptosis is considered“reduced” when the number of thymocytes undergoing apoptosis is reduced by at least 20%, in subjects that have been administered the MSC exosomes, compared to in subjects that have not been administered the MSC exosomes.
• thymocyte apoptosis e.g., induced by exposure to hyperoxia.
• thymocyte apoptosis may be considered“reduced” when the number of thymocytes undergoing apoptosis is reduced by at least 20%, at least 30%, at least 40%, at least 50%, at least 60%, at least 70%, at least 80%, at least 90%, at least 95%, at least 99%, or 100%, in subjects that have been administered the MSC exosomes, compared to in subjects that have not been administered the MSC exosomes.
• thymocyte apoptosis is considered“reduced” when the number of thymocytes undergoing apoptosis is reduced by 20%, 30%, 40%, 50%, 60%, 70%, 80%, 90%, 95%, 99%, or 100%, in subjects that have been administered the MSC exosomes, compared to in subjects that have not been administered the MSC exosomes.
• the MSC exosomes, or the composition comprising the MSC exosomes when administered to a subject, restores maturation of medullary thymic epithelial cells.
• “Medullary thymic epithelial cell” represent unique stromal cell population of the thymus which plays essential role in the establishment of central tolerance and are relevant for the development of functional mammal immune system.
• maturation of medullary thymic epithelial cells is considered to be“restored” when the number of medullary thymic epithelial cells, e.g., as indicated by evaluating the expression level of the autoimmune regulator (AIRE, e.g., see FIG.
• medullary thymic epithelial cells may be considered to be“restored” when the number of medullary thymic epithelial cells, e.g., as indicated by evaluating the expression level of the autoimmune regulator (AIRE, e.g., see FIG.
• medullary thymic epithelial cells is increased by at least 20%, at least 30%, at least 40%, at least 50%, at least 70%, at least 80%, at least 90%, at least 100%, at least 2-fold, at least 5-fold, at least lO-fold, at least 50- fold, at least lOO-fold or more, in subjects that have been administered the MSC exosomes, compared to in subjects that have not been administered the MSC exosomes.
• maturation of medullary thymic epithelial cells is considered to be“restored” when the number of medullary thymic epithelial cells, e.g., as indicated by evaluating the expression level of the autoimmune regulator (AIRE, e.g., see FIG.
• 2E is increased by 20%, 30%, 40%, 50%, 70%, 80%, 90%, 100%, 2-fold, 5-fold, lO-fold, 50-fold, lOO-fold or more, in subjects that have been administered the MSC exosomes, compared to in subjects that have not been administered the MSC exosomes.
• the MSC exosomes, or compositions comprising the MSC exosomes are used together with other agents for treating any of the diseases described herein.
• the MSC exosomes and the other agents are formulated in the same composition.
• the MSC exosomes and the other agents are formulated in separate compositions.
• the MSC exosomes and the other agents are administered to the subject simultaneously.
• the MSC exosomes and the other agents are administered separately.
• the MSC exosomes are administered before the other agents.
• the MSC exosomes are administered after the other agents.
• the MSC exosomes may be used together with agents that are known to have therapeutic effects against autoimmune diseases.
• agents include, without limitation, non-steroidal anti-inflammatory drugs,
• glucocorticoids e.g., antibodies such as infliximab, adalimumab, golinumab, or certolizumab pegol.
• Drugs for treating autoimmune diseases are known in the art, e.g., as described in Fi et ah, Front Pharmacol. 2017; 8: 460, incorporated herein by reference.
• the MSC exosomes are administered with other anti-infection agents.
• anti-infection agents include anti bacterial agents (e.g., antibiotics), anti-viral agents, anti-fungal agents, anti-parasitic agents.
• the MSC exosomes are administered with other anti-cancer agents.
• the anti-cancer agent is selected from the group consisting of: small molecules, oligonucleotides, polypeptides, and combinations thereof.
• the anti-cancer agent is a chemotherapeutic agent.
• the chemotherapeutic agent is selected from the group consisting of:
• Bronchopulmonary dysplasia is a multifactorial chronic lung disease which affects preterm newborns requiring oxygen supplementation. It is characterized by restricted lung growth and alveolar and blood vessel development which results in impaired pulmonary function. Up to date, BPD lacks effective therapeutic approaches for preventing or treating the oxygen-induced injuries. Previous work demonstrated that a single dose of MSC-exosomes significantly improved lung morphology, reduced lung fibrosis and promoted vascular remodeling in an experimental model of neonatal hyperoxia. These effects were mainly via inhibition of hyperoxia- induced inflammation, through modulation of macrophage phenotype in the lung 1 .
• the thymic microenvironment is a three-dimensional cellular architecture composed of a set thymic epithelial cells (TECs) which guide the development and repertoire of T cells 2 .
• TECs thymic epithelial cells
• Oxygen-induced thymic involution was shown to be due to increased thymocyte apoptosis which induced a significant reduction in count and proliferation of double positive and double negative thymocytes 3,4 .
• Exosomes were purified from the conditioned media of human Wharton’s Jelly derived MSCs. New-bom mice were exposed to hyperoxia (75% 0 2 ), treated with MSC-exosomes on postnatal day 4 (PN4) and returned to room air on PN7. Treated animals and appropriate controls were harvested on PN7 and PN14. Thymic structure was analysed by histopathology of thymic architecture. Medullary epithelial cells were analysed for the expression of AIRE, a transcription factor that functions as an‘Autoimmune REgulator’ to prevent the immune system from attacking self.
• AIRE a transcription factor that functions as an‘Autoimmune REgulator’ to prevent the immune system from attacking self.
• AIRE protein levels were detected by immunofluorescence and thymocyte count by flow cytometry analysis using the following antibodies: CD44-PE, CD25- FITC, CD3-BV510, CD4-PECy7 and CD8-PerCPCy5.5.
• MSC-Exosomes restored thymic architecture and thymocyte counts to control levels (FIGs. 1A-1D). MSC-exosome treatment also reduced oxygen-induced thymocyte apoptosis and promoted normal maturation of medullary TECs (FIG. 2A-2D).
• MSC-exosome treatment restored the thymocyte progenitor population in the thymus (FIGs. 3A-3D).
• MSC-Exosome treatment promoted the development of CD4+ T cells in the thymus but inhibited the development of CD8+ T cells (FIGs. 4A-4G).
• the data further shows that the MSC-exosomes prevented cellular apoptosis in the thymus of mice exposed to hyperoxia (FIGs. 5A-5C), restored the phenotype of medullary antigen presenting cells after hyperoxic injury (FIGs. 6A-6C), and restores the regulatory T cell phenotype at multi-organ level (7A-7D).
• Articles such as“a,”“an,” and“the” may mean one or more than one unless indicated to the contrary or otherwise evident from the context. Claims or descriptions that include“or” between two or more members of a group are considered satisfied if one, more than one, or all of the group members are present, unless indicated to the contrary or otherwise evident from the context.
• the disclosure of a group that includes“or” between two or more group members provides embodiments in which exactly one member of the group is present, embodiments in which more than one members of the group are present, and embodiments in which all of the group members are present. For purposes of brevity those embodiments have not been individually spelled out herein, but it will be understood that each of these embodiments is provided herein and may be specifically claimed or disclaimed.
• URL addresses are provided as non-browser-executable codes, with periods of the respective web address in parentheses.
• the actual web addresses do not contain the parentheses.
• any particular embodiment of the present disclosure may be explicitly excluded from any one or more of the claims. Where ranges are given, any value within the range may explicitly be excluded from any one or more of the claims. Any embodiment, element, feature, application, or aspect of the compositions and/or methods of the disclosure, can be excluded from any one or more claims. For purposes of brevity, all of the embodiments in which one or more elements, features, purposes, or aspects is excluded are not set forth explicitly herein.

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