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  • 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
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  • 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
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  • A61K31/00—Medicinal preparations containing organic active ingredients
  • A61K31/33—Heterocyclic compounds
  • A61K31/395—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
  • A61K31/435—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with one nitrogen as the only ring hetero atom
  • A61K31/44—Non condensed pyridines; Hydrogenated derivatives thereof
  • A61K31/4418—Non condensed pyridines; Hydrogenated derivatives thereof having a carbocyclic group directly attached to the heterocyclic ring, e.g. cyproheptadine
• • A—HUMAN NECESSITIES
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  • A61K31/00—Medicinal preparations containing organic active ingredients
  • A61K31/33—Heterocyclic compounds
  • A61K31/395—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
  • A61K31/495—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with two or more nitrogen atoms as the only ring heteroatoms, e.g. piperazine or tetrazines
  • A61K31/496—Non-condensed piperazines containing further heterocyclic rings, e.g. rifampin, thiothixene or sparfloxacin
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  • 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
  • A61K35/48—Reproductive organs
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  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K40/00—Cellular immunotherapy
  • A61K40/10—Cellular immunotherapy characterised by the cell type used
  • A61K40/17—Monocytes; Macrophages
• • A—HUMAN NECESSITIES
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  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K40/00—Cellular immunotherapy
  • A61K40/20—Cellular immunotherapy characterised by the effect or the function of the cells
  • A61K40/24—Antigen-presenting cells [APC]
• • A—HUMAN NECESSITIES
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  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K40/00—Cellular immunotherapy
  • A61K40/40—Cellular immunotherapy characterised by antigens that are targeted or presented by cells of the immune 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
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P29/00—Non-central analgesic, antipyretic or antiinflammatory agents, e.g. antirheumatic agents; Non-steroidal antiinflammatory drugs [NSAID]
• • 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
• • 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
  • C12N5/0634—Cells from the blood or the immune system
  • C12N5/0645—Macrophages, e.g. Kuepfer cells in the liver; Monocytes
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K2239/00—Indexing codes associated with cellular immunotherapy of group A61K40/00
  • A61K2239/31—Indexing codes associated with cellular immunotherapy of group A61K40/00 characterized by the route of administration
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K2239/00—Indexing codes associated with cellular immunotherapy of group A61K40/00
  • A61K2239/38—Indexing codes associated with cellular immunotherapy of group A61K40/00 characterised by the dose, timing or administration schedule
• • 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
  • C12N2502/00—Coculture with; Conditioned medium produced by
  • C12N2502/13—Coculture with; Conditioned medium produced by connective tissue cells; generic mesenchyme cells, e.g. so-called "embryonic fibroblasts"
  • C12N2502/1352—Mesenchymal stem cells
  • C12N2502/1358—Bone marrow mesenchymal stem cells (BM-MSC)

Definitions

• Idiopathic pulmonary fibrosis is a chronic progressive respiratory disease with a prevalence of 0.5 to 27.9 per 100,000 person years. The lack of complete understanding of the underlying mechanism of this disease, may have contributed to the paucity of successful therapies. Despite two newly approved drugs, IPF remains fatal with a five-year survival rate of less than 10%.
• a single intravenous (IV) dose of mesenchymal stem cell (MSC) exosomes reverts bleomycin-induced pulmonary fibrosis, at least partly through the modulation of monocyte phenotypes in the bone marrow and reduction of alveolar epithelial cell (AEC) apoptosis.
• monocytes treated with MSC exosomes when administered to a subject having pulmonary fibrosis, were therapeutically effective against the disease.
• a monocyte phenotype comprising contacting a monocyte with an isolated mesenchymal stem cell (MSC) exosome.
• MSC mesenchymal stem cell
• the monocyte is from bone marrow.
• the isolated MSC exosome is isolated from MSC -conditioned media.
• the MSC is from Wharton’s Jelly, bone marrow, or adipose tissue.
• the isolated MSC exosome is substantially free of protein contaminants. In some embodiments, the isolated MSC exosome has a diameter of about 50-150 nm.
• the contacting is in vitro. In some embodiments, the contacting is ex vivo. In some embodiments, the contacting is in vivo. In some embodiments, the contacting is for at least 2 hours. In some embodiments, the monocyte is pro-inflammatory prior to being contacted with the isolated MSC exosome, and is regulatory after being contacted with the isolated MSC exosome.
• aspects of the present disclosure provide methods of treating a fibrotic disease or an autoimmune disease, the method comprising administering to a subject in need thereof an effective amount of a monocyte, wherein the monocyte is treated with an isolated mesenchymal stem cell (MSC) exosome prior to being administered.
• MSC mesenchymal stem cell
• the method further comprises isolating the monocyte prior to treating the monocyte with the MSC exosome.
• the monocyte is isolated from the subject. In some embodiments, the monocyte is isolated from the bone marrow of the subject.
• the monocyte is treated with the MSC exosome for at least 2 hours prior to being administered to the subject. In some embodiments, the monocyte is administered systemically. In some embodiments, the monocyte is administered via intravenous infusion. In some embodiments, the monocyte is administered intratracheally or intranasally. In some embodiments, the monocyte is administered once to the subject. In some embodiments, the monocyte is administered multiple times to the subject.
• the method further comprises administering to the subject an effective amount of a second agent.
• the second agent is an isolated MCS exosome.
• the second agent is nintedanib, Pirfenidone, an anti-fibrotic agent, an immunosuppressant, and/or an anti-inflammatory agent.
• the fibrotic disease is selected from the group consisting of:
• the fibrotic disease is pulmonary fibrosis.
• the pulmonary fibrosis is idiopathic pulmonary fibrosis (IPF).
• the monocyte reduces inflammation associated with the fibrotic disease. In some embodiments, the monocyte reduces apoptosis associated with the fibrotic disease.
• the subject is a mammal. In some embodiments, the subject is a human subject. In some embodiments, the human 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. In some embodiments, 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 subject is a rodent.
• the rodent is a mouse or a rat.
• the monocyte is pro-inflammatory prior to being treated with the isolated MSC exosome, and is regulatory after being treated with the isolated MSC exosome.
• monocytes treated with an isolated mesenchymal stem cell (MSC) exosome are provided.
• the monocyte is from bone marrow.
• the isolated MSC exosome is isolated from MSC-conditioned media.
• the MSC is from Wharton’s Jelly, bone marrow, or adipose tissue.
• the monocyte is pro-inflammatory prior to being treated with the isolated MSC exosome, and is regulatory after being treated with the isolated MSC exosome.
• compositions comprising the monocytes described herein are also provided.
• the composition further comprises a second agent.
• the composition is a pharmaceutical composition.
• the composition further comprises a pharmaceutically acceptable carrier.
• the monocyte or the composition comprising the monocytes described herein may also be used use in the manufacturing of a medicament for treating a fibrotic disease or an autoimmune disease.
• FIGS. 1A to ID show that MEx treatment at the beginning of inflammation prevents fibrosis.
• FIG. 1A Ten to fourteen-week old C57BL/6 mice received endotracheal bleomycin (60 pg) or 0.9% normal saline (NS) on day 0 followed by a bolus dose of IV MEx (Bleo+MEx), NS (bleo+NS), FEx (Bleo+FEx), or iodixanol (IDX 1:9 dilution, bleo+IDX). Results were compared to control group who received either NS (vehicle, control) or NS followed by a dose of MEx (control+MEx). Mice were sacrificed on day 14. (FIG.
• FIG. 1C Administration of MEx to bleomycin-treated mice substantially reduced fibrosis and alveolar distortion. Findings were similar to control or Control+Mex group. Lung fibrosis was measured at day 14 by Ashcroft score.
• FIGS. 2A to 2E show that MEx modulates alveolar macrophage phenotypes and blunt inflammation.
• Whole lung RT-qPCR shows an increase in the expression of macrophage Ccl-2 and Arginase-l (Argl) markers at day 7 (FIG. 2A) and day 14 (FIG. 2B), while their level was similar to control with MEx treatment.
• FIGS. 3A to 3F show that MEx modulates monocyte and macrophage phenotype at a systemic level MEx restore alveolar macrophage and inflammatory monocyte populations in the lung.
• FIGS. 3A to 3F show that MEx modulates monocyte and macrophage phenotype at a systemic level MEx restore alveolar macrophage and inflammatory monocyte populations in the lung.
• FIGS. 3A to 3F show that MEx modulates monocyte and macrophage phenotype at a systemic level MEx restore alveolar macrophage and inflammatory monocyte populations in the lung.
• FIGS. 3A to 3F show that MEx modulates monocyte and macrophage phenotype at a systemic level MEx restore alveolar macrophage and inflammatory monocyte populations in the lung.
• AM number (represented as CD45 +ve CDllb ve CDl lc +ve cells).
• FIG. 3B This was associated with an increase in Ly6Chi infiltrating or classical monocytes (Ly6ChiCCR-2 +ve ).
• FIG. 3C On day 14 AM number increased and (FIG. 3D) classical monocytes number decrease to
• MEx therapy led to a decrease in inflammatory monocytes and a shift from inflammatory to regulatory (Ly6ClowCCR-2-ve) phenotype, similar to levels observed in control mice (Mean difference: 10.25% ⁇ 4.2, p ⁇ 0.05 and 13.39% ⁇ 5.76, p ⁇ 0.05 vs. bleomycin-exposed mice).
• n 4-7 per group, *p ⁇ 0.05; ** p ⁇ 0.01; ***p ⁇ 0.001 vs. bleomycin-exposed mice.
• FIGS. 4A to 4F show that adoptive transfer of MEx-pretreated bone marrow derived monocytes protects mice from pulmonary fibrosis.
• FIG. 4A BMDMo were isolated from 6-8-wks-old FVB mice, cultured ex vivo for 3 days and treated with MEx
• FIG. 4B Flow cytometric analysis of BMDMo after 3 days of culture showed more than 90% CD45+veCDl lb+ve cells.
• FIG. 4C Dil-labeled BMDMo were detected in the lung 14 days after injection. Images obtained at x20 magnification.
• BMDMo+MEx compared to NS (Bleomycin).
• Arrow marks the Dil-labeled monocytes. Between group comparison: *p ⁇ 0.05, ** r ⁇ 0.01, ***r ⁇ 0.001, ****p ⁇ 0.00l. Scale bar 100 pm.
• FIGS. 5A to 5D shows that MEx therapy decreases apoptosis.
• FIGS. 5A and 5B Tunel staining in whole lung sections shows increase in apoptosis (green) in the bleomycin-exposed group of mice compared to control (NS) and bleomycin+MEx. Nuclei were stained with Dapi. Images obtained at x20 magnification. MFI quantified using image J software and normalized for Dapi. *p ⁇ 0.05, ** p ⁇ 0.0l vs bleomycin-exposed mice (FIG.
• Annexin V/PI staining in whole lungs shows an increase in apoptosis (Annexin V+ PI-) in bleomycin-exposed mice compared to control and bleomycin+MEx mice.
• FIG. 5D In vitro apoptosis was measured using Caspase- Glo® 3/7 Assay. More apoptosis is noted in Bleomycin-exposed human alveolar epithelial cells. This effect is abrogated with MEx therapy. Relative luminescence unit was used as a
• Y axis represents luminescence relative to control.
• n 8 per group, ** p ⁇ 0.0l; ****P ⁇ 0.000l vs bleomycin- exposed mice.
• FIGS. 6A to 6C show the purification, isolation and characterization of exosomes.
• CM Conditioned media
• BMSCs or HDFs were differentially centrifuged and concentrated through tangential flow filtration.
• Concentrated (50x) CM was floated on an iodixanol (OptiPrepTM, IDX) cushion gradient.
• Purified EV population in fraction 9 was used for analysis. (FIG. 6A)
• NTA Nanoparticle tracking analysis
• FIGS. 7A to 7D show that MEx treatment at the end of inflammation reverts fibrosis.
• FIG. 7A MEx were administered 7 days after the administration of bleomycin and mice were sacrificed on day 14.
• FIG. 8 shows the representative in vivo gating strategy of lung macrophage, monocyte and bone marrow derived monocytes.
• Cells were isolated from whole lung after enzymatic digestion. Lung aggregates and cell debris were excluded based on forward and side scatter parameters.
• Immune cells were identified by CD45 staining.
• Alveolar macrophages (AM) were identified using a sequential gating strategy to identify CD45 +ve CDl lb ve CDl lc +ve population. Subsequent gating was performed on CD206 +ve AMs. In order to identify monocyte subpopulation, sequential gating strategy was performed on non-alveolar macrophage subset of CD45 +ve cells (CD l 1 b int
• CD1 lC ⁇ ow CD1 lC ⁇ ow
• CD2 +ve Ly6C ⁇ and CCR-2 ⁇ vc Ly6C' ow population CD1 lC ⁇ ow
• CD206 markers of AMs
• FIG. 9 shows that labeled-MEx can be detected in the bone marrow.
• Membrane dye- labeled EVs were IV injected into mice, and the animals were sacrificed 2 hours after injection. MEx were detected in the BM cy to spins (Labeled-MEx). Injected free dye and dye- stained EV free supernatant were used as controls. Counterstaining performed with Dapi. Images were obtained at x60 magnification.
• mesenchymal stromal cell also termed herein interchangeably as“mesenchymal stem cell” or“MSC” exosomes (also termed“Mex” herein)
• MSC mesenchymal stem cell
• MSC mesenchymal stem cell
• monocytes e.g., bone marrow -derived monocytes
• monocytes treated with MSC exosomes in vitro, when administered to subjects having pulmonary fibrosis, have therapeutic effects on fibrotic lungs.
• monocytes treated with isolated mesenchymal stem cell (MSC) exosomes are provided.
• A“monocyte” is a type of leukocyte (also called“white blood cell”) that can differentiate into macrophages and myeloid lineage dendritic cells. In vertebrates, monocytes are part of the innate immune system but can also influence the process of adaptive immunity.
• Monocytes compose 2% to 10% of all leukocytes in the human body and serve multiple roles in immune function, e.g., without limitation, replenishing resident macrophages under normal conditions; migration in response to inflammation signals from sites of infection in the tissues; and differentiation into macrophages or dendritic cells to effect an immune response.
• Monocytes are heterogeneous populations of cells, and can be divided into subpopulations with different phenotypes and functions.
• human monocytes are subdivided into phenotypically and functionally distinct subpopulations based on the expression of the lipopoly saccharide (LPS) receptor (CD14) and the CD16 (Fcgamma receptor III) (e.g., as described in Ziegler-Heitbrock et ah, Blood, vol. 116, no. 16, pp. e74-e80, 2010 and Gordon et ah, Nature Reviews Immunology, vol. 5, no. 12, pp. 953-964, 2005, incorporated herein by reference).
• LPS lipopoly saccharide
• CD16 Fegamma receptor III
• CDl4 ++ CDl6 _ In healthy individuals, approximately 80-90% of monocytes are highly CD14 positive and CD16 negative (CDl4 ++ CDl6 _ ).
• the CDl4 ++ CDl6 _ monocytes are termed“classical monocytes” or “regulatory monocytes” herein.
• CD 16 positive monocytes express higher levels of major histocompatibility complex (MHC) class II antigens, adhesion molecules, chemokine receptors, and proinflammatory cytokines such as TNF-a, but lower levels of the anti-inflammatory cytokine (e.g., IL-10) (e.g., as described in Kawanaka et ah, Arthritis & Rheumatism, vol.
• Proinflammatory monocytes are elevated in various pathologic conditions, including inflammatory and infectious diseases, cancer, and in coronary heart disease. In mice, monocytes can also be divided in two subpopulations: proinflammatory monocytes (Cx3CRl low , CCR2 + , Ly6C hlgh ), which are equivalent to human proinflammatory monocytes; and regulatory monocytes (Cx3CRl hlgh , CCR2 , Ly6C low ), which are equivalent to human CDl4 ++ CDl6 _ monocytes.
• proinflammatory monocytes Cx3CRl low , CCR2 + , Ly6C hlgh
• regulatory monocytes Cx3CRl hlgh , CCR2 , Ly6C low
• Monocytes are produced by the bone marrow from precursors called monoblasts, bipotent cells that differentiated from hematopoietic stem cells. Monocytes circulate in the bloodstream for about one to three days and then typically move into tissues throughout the body where they differentiate into macrophages and dendritic cells.
• the monocytes treated with MSC exosomes described herein are from bone marrow (e.g., isolated from bone marrow).
• the monocytes treated with MSC exosomes described herein are from a specific tissue (e.g., isolated from a specific tissue such as lungs).
• 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.
• These cells have been characterized to express (and thus be positive for) one or more of CD13, CD29, CD44, CD49a, b, c, e, f, CD51, CD54, CD58, CD71, CD73, CD90, CD102, CD105, CD106, CDwl l9, CDl20a, CDl20b, CD123, CD124, CD126, CD127, CDl40a, CD166, P75, TGF-bIR, TGF-bllR, HLA-A, B, C, SSEA-3, SSEA-4, D7 and PD-L1.
• 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, adipose tissue, blood, periosteum, dermis, umbilical cord blood and/or matrix (e.g., Wharton’s Jelly), and placenta.
• 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). Methods for harvesting MSCs are described in the art, e.g., in US Patent No. 5486359, incorporated herein by reference.
• FACS fluorescence-activated cell sorting
• Such media include but are not limited to Dulbecco’s modified Eagle’s medium
• DMEM 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.
• 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., L-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, chlortetra
• the MSC exosomes used to treat the monocytes are isolated.
• 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 (e.g., MSCs).
• the isolated MSC exosomes are isolated from the culturing media of MSCs from human bone marrow, umbilical cord Wharton’s Jelly, or adipose tissue. 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 un-manipulated conditioned media.
• the isolated MSC exosome described herein comprises one or more (e.g., 1, 2, 3, 4, 5, or more) known exosome markers.
• the known exosome markers are selected from the group consisting of: FLOT1 (Flotillin-l, Uniprot ID: 075955), CD9 (CD9 antigen, Uniprot ID: P21926), and CD63 (CD63 antigen, Uniprot ID: P08962).
• the isolated MSC exosome is substantially free of contaminants (e.g., protein contaminants).
• the isolated MSC exosome is“substantially free of contaminants” when the preparation of the isolated MSC exosome contains fewer than 20%, 15%, 10%, 5%, 2%, 1%, or less than 1%, of any other substances (e.g., proteins).
• 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 isolated MSC exosome used in accordance with the present disclosure has a diameter of about 30-150 nm.
• the isolated MSC exosome may have a diameter of 30-150 nm, 30-140 nm, 30-130 nm, 30-120 nm, 30-110 nm, 30-100 nm, 30-90 nm, 30-80 nm, 30-70 nm, 30-60 nm, 30-50 nm, 30-40 nm, 40-150 nm, 40-140 nm, 40-130 nm, 40-120 nm, 40-110 nm, 40-100 nm, 40-90 nm, 40-80 nm, 40-70 nm, 40-60 nm, 40-50 nm, 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, 40-60
• the isolated 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 isolated MSC exosomes exhibit a biconcave morphology.
• the isolated MSC exosomes can be used to treat the monocytes to modulate the monocyte phenotype (e.g., both in vitro and in vivo such as in the bone marrow).
• “Treat a monocyte with an isolated MSC exosome” means contacting the monocyte with a MSC exosome (e.g., for a period of time).
• the treating i.e., contacting
• monocytes may be cultured in vitro and isolated MSC exosomes may be added to the culture such that the monocytes contact the isolated MSC exosomes.
• the treating i.e., contacting
• the treating is carried out ex vivo.
• monocytes may be isolated from the bone marrow of a subject and isolated MSC exosomes may be added to the monocytes such that the monocytes contact the isolated MSC exosomes.
• the treating i.e., contacting
• the isolated MSC exosomes may be administered to a subject (e.g., via intravenous injection), reach the one marrow, and contact the monocytes in the bone marrow.
• the monocyte is treated (i.e., contacted) with the MSC exosome for at least 1 hour (e.g., at least 1, at least 2, at least 3, at least 4, at least 5, at least 6, a least 7, at least 8, at least 9, at least 10, at least 15, at least 20, at least 25, at least 30, at least 35, at least 40, at least 45, at least 50, at least 55, at least 60, at least 65, at least 70, at least 75, at least 80, at least 85, at least 90, at least 95, at least 100 hours, or longer).
• the monocyte is treated (i.e., contacted) with the MSC exosome for 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15,
• the monocyte has been polarized to a pro-inflammatory state as a result of environmentally or developmentally-precipitated injury, and its polarity is modulated to a regulatory phenotype upon contact with the isolated MSC exosome.
• the monocyte is a pro-inflammatory monocyte prior to being treated (i.e., contacted) with the isolated MSC exosome, and is a regulatory monocyte after being treated (i.e., contacted) with the isolated MSC exosome.
• a mixture of pro-inflammatory monocytes and regulatory monocytes are contacted with isolated MSC exosomes and the treating results in a higher ratio (e.g., at least 10% higher) of regulatory monocytes in the mixture, being treated with isolated MSC exosomes.
• the ratio of regulatory monocytes may be at least 10%, 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 100-fold, or higher after being treated with MSC exosomes, compared to before being treated with isolated MSC exosomes.
• the ratio of regulatory monocytes is 10%, 20%, 30%, 40%, 50%, 60%, 70%, 80%, 90%, 100%, 2-fold, 5-fold, lO-fold, lOO-fold, or higher after being treated with MSC exosomes, compared to before being treated with isolated MSC exosomes.
• the monocytes treated with isolated MSC exosomes for treating a disease (e.g., a fibrotic disease such as pulmonary fibrosis or an autoimmune disease).
• a disease e.g., a fibrotic disease such as pulmonary fibrosis or an autoimmune disease.
• the monocytes treated with isolated MSC exosomes are used in the manufacturing of a medicament for treating a disease (e.g., a fibrotic disease or an autoimmune disease).
• Compositions comprising monocytes treated with isolated MSC exosomes are also provided.
• the monocytes treated with isolated MSC exosomes are formulated in a composition for the treatment of a disease (e.g., a fibrotic disease or an fibrotic disease).
• the composition comprising monocytes treated with isolated MSC exosomes further comprises a second agent.
• the second agent is a therapeutic agent effective against the diseases being treated by the monocytes.
• the second agent may be any agent that can be used in the prevention, treatment and/or management of a fibrotic disease or an autoimmune disease such as those described herein.
• the second agent is an isolated MSC exosome.
• the second agent is an agent that is known to have therapeutic effects against fibrotic diseases.
• Exemplary second agents that may be used to treat fibrotic diseases include, without limitation: nintedanib (a tyrosine kinase inhibitor), pirfenidone, an anti-fibrotic agent, and/or an anti-inflammatory agent.
• nintedanib a tyrosine kinase inhibitor
• pirfenidone an anti-fibrotic agent
• an anti-fibrotic agent and/or an anti-inflammatory agent.
• other types of therapies e.g., oxygen supplement, may be used in conjunction with the therapeutic agents described herein.
• the second agent is an agent that is known to have therapeutic effects against autoimmune diseases.
• agents include, without limitation, non-steroidal anti inflammatory drugs, glucocorticoids, metrotrexate, leflunomide, anti-TNF biologicals (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 Li et ah, Front Pharmacol. 2017;
• the monocytes treated with isolated MSC exosomes and the second agent are formulated in the same composition. In some embodiments, the monocytes treated with isolated MSC exosomes and the second agent are formulated in separate compositions. In some embodiments, the monocytes treated with isolated MSC exosomes and the second agent are administered to the subject simultaneously. In some embodiments, the monocytes treated with isolated MSC exosomes and the second agent are administered separately. In some embodiments, the monocytes treated with isolated MSC exosomes are administered before the second agent. In some embodiments, the monocytes treated with isolated MSC exosomes are administered after the second agent.
• the composition comprising the monocytes treated with isolated MSC exosomes is a pharmaceutical composition.
• the composition further comprises pharmaceutically acceptable concentrations of salt, buffering agents, preservatives, or compatible carriers.
• a pharmaceutically acceptable carrier is a pharmaceutically acceptable material, composition or vehicle, such as a liquid or solid filler, diluent, excipient, solvent or encapsulating material, involved in carrying or transporting a prophylactically or therapeutically active agent.
• a pharmaceutically acceptable material, composition or vehicle such as a liquid or solid filler, diluent, excipient, solvent or encapsulating material, involved in carrying or transporting a prophylactically or therapeutically active agent.
• Each carrier must be “acceptable” in the sense of being compatible with the other ingredients of the formulation and not injurious to the subject.
• 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;
• 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.
• a disease e.g., a fibrotic disease or an autoimmune disease
• the method comprising administering to a subject in need thereof an effective amount of a monocyte, wherein the monocyte is treated with an isolated mesenchymal stem cell (MSC) exosome (e.g., for at least 2 hours) prior to being administered using the methods described herein.
• the method further comprises isolating the monocytes from the subject (e.g., from the bone marrow of the subject) such that the monocytes can be treated with isolated MSC exosomes prior to administration to the subject.
• MSC mesenchymal stem cell
• Treat” or“treatment” of a disease includes, but is not limited to, preventing, reducing, or halting the development of a fibrotic disease or an autoimmune disease, reducing or eliminating the symptoms of a fibrotic disease or an autoimmune disease, or preventing a fibrotic disease or an autoimmune disease.
• 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).
• 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.
• the subjects may be those that have a disease described herein amenable to treatment using the monocytes 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 bom at low gestational age.
• a human neonate refers to a 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 born 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,
• 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 fibrotic disease), and those subjects may also be treated according to the disclosure.
• the disclosure contemplates administration of the monocytes treated with isolated MSC exosomes or the composition comprising such 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,
• the monocytes treated with isolated MSC exosomes or the composition comprising such 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 monocytes treated with isolated MSC exosomes or the composition comprising such monocytes is administered to the subject immediately after birth.
• the present disclosure further contemplates administration of the monocytes treated with isolated MSC exosomes or the composition comprising such even in the absence of symptoms indicative of a disease or disorder as described herein.
• the monocytes treated with isolated MSC exosomes or the composition comprising such monocytes are administered to a subject (e.g., a human subject) once.
• a subject e.g., a human subject
• repeated administration of the monocytes treated with isolated MSC exosomes or the composition comprising such monocytes including two, three, four, five or more administrations of the monocytes treated with isolated MSC exosomes or the composition comprising such monocytes, is contemplated.
• the monocytes treated with isolated MSC exosomes or the composition comprising such 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.
• the monocytes treated with isolated MSC exosomes or the composition comprising such monocytes 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 monocytes treated with isolated MSC exosomes or the composition comprising such monocytes are administered at least once within 1 hour of birth and then at least once more within 3-4 days of birth.
• the monocytes treated with isolated MSC exosomes or the composition comprising such monocytes may be administered by any route that effects delivery to the fibrotic organ and/or the bone marrow.
• Systemic administration routes such as intravenous injection or continuous infusion are suitable.
• Other administration routes that are also suitable include oral administration, intranasal administration, intratracheal administration, inhalation, intravenous administration, etc. Those of ordinary skill in the art will know the customary routes of administration.
• the monocytes treated with isolated MSC exosomes or the composition comprising such monocytes 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.
• the method described herein further comprises administering an effective amount of the second agent (e.g., agents for treating a fibrotic disease or an autoimmune disease).
• the second agent may also be administered by any suitable route including systemic administration (e.g., intravenous infusion or injection), oral administration, intranasal administration, intratracheal administration, inhalation, etc. Those of ordinary skill in the art will know the customary routes of administration for such second agents.
• A“fibrotic disease” or“fibrosis” refers to a condition manifested by the formation of excess fibrous connective tissue in an organ or tissue in a reparative or reactive process.
• fibrotic diseases include: systemic sclerosis (Scleroderma), pulmonary fibrosis (e.g., cystic fibrosis or idiopathic pulmonary fibrosis), liver fibrosis (cirrhosis or biliary atresia, heart fibrosis (e.g., atrial fibrosis, endomyocardial fibrosis, or old myocardial infarction), brain fibrosis (e.g., glial scar), kidney fibrosis, and myelofibrosis.
• systemic sclerosis Scleroderma
• pulmonary fibrosis e.g., cystic fibrosis or idiopathic pulmonary fibrosis
• liver fibrosis cirrhosis or biliary atresia
• fibrotic diseases include, without limitation: arterial stiffness, arthrofibrosis (knee, shoulder, other joints), crohn's disease (intestine), dupuytren's contracture (hands, fingers), keloid (skin), mediastinal fibrosis (soft tissue of the mediastinum), myelofibrosis (bone marrow), peyronie's disease (penis), nephrogenic systemic fibrosis (skin), progressive massive fibrosis (lungs); a complication of coal workers' pneumoconiosis, retroperitoneal fibrosis (soft tissue of the retroperitoneum),
• scleroderma/systemic sclerosis skin, lungs
• adhesive capsulitis shoulder
• the fibrotic disease is pulmonary fibrosis.
• Pulmonary fibrosis refers to a condition where lung tissue becomes damaged and scarred, causing thickening and stiffing of the lung tissue and reduced lung function. Pulmonary fibrosis can have a variety of cause. Pulmonary fibrosis is typically seen in subjects with bronchopulmonary dysplasia (BPD).
• BPD bronchopulmonary dysplasia
• the pulmonary fibrosis is idiopathic pulmonary fibrosis (IPF). Idiopathic pulmonary fibrosis is characterized by scarring or thickening of the lungs without a known cause. It occurs most often in persons 50-70 years of age.
• fibrotic diseases e.g., pulmonary fibrosis
• administration of the monocytes treated with isolated MSC exosomes at the beginning or late stage of inflammation associated with the fibrosis are shown herein to both be therapeutically effective against the diseases.
• the monocyte treated with isolated MSC exosomes reduces inflammation associated with the fibrotic disease.
• inflammation may be assessed by measuring the levels of biomarkers of inflammation in the fibrotic organ or in the blood.
• inflammations in the fibrotic organ is reduced by at least 20%, in subjects that have been administered the monocytes treated with isolated MSC exosomes, compared to in subjects that have not been administered the monocytes treated with isolated MSC exosomes.
• inflammation may be 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 monocytes treated with isolated MSC exosomes, compared to in subjects that have not been administered the monocytes treated with isolated MSC exosomes.
• inflammation is reduced by 20%, 30%, 40%, 50%, 60%, 70%, 80%, 90%, 95%, 99%, or 100%, in subjects that have been administered the monocytes treated with isolated MSC exosomes, compared to in subjects that have not been administered the monocytes treated with isolated MSC exosomes.
• the monocytes treated with isolated MSC exosomes reduces apoptosis of epithelial cells in the fibrotic organ (e.g., alveolar epithelial cells in the lung).
• Apoptosis refers to the death of cells that occurs as a normal and controlled part of an organism's growth or development.
• apoptosis of epithelial cells in the fibrotic organ e.g., alveolar epithelial cells in the lung
• apoptosis of epithelial cells in the fibrotic organ may be considered“reduced” when the number of alveolar epithelial cells 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 monocytes treated with isolated MSC exosomes, compared to in subjects that have not been administered the monocytes treated with isolated MSC exosomes.
• apoptosis of epithelial cells in the fibrotic organ is considered“reduced” when the number of alveolar epithelial cells undergoing apoptosis is reduced by 20%, 30%, 40%, 50%, 60%, 70%, 80%, 90%, 95%, 99%, or 100%, in subjects that have been administered the monocytes treated with isolated MSC exosomes, compared to in subjects that have not been administered the monocytes treated with the MSC exosomes.
• the monocytes treated with isolated MSC exosomes reduces pulmonary fibrosis.
• Pulmonary fibrosis is considered“reduced” when the degree of pulmonary fibrosis (e.g., as indicated by collagen deposition on lung tissues) is reduced by at least 20%, in subjects that have been administered the monocytes treated with the MSC exosomes, compared to in subjects that have not been administered the monocytes treated with the MSC exosomes.
• pulmonary fibrosis may be considered reduced when the degree of pulmonary fibrosis (e.g., as indicated by collagen deposition on lung tissues) 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 monocytes treated with the MSC exosomes, compared to in subjects that have not been administered the monocytes treated with the MSC exosomes.
• the degree of pulmonary fibrosis e.g., as indicated by collagen deposition on lung tissues
• pulmonary fibrosis is considered reduced when the degree of pulmonary fibrosis (e.g., as indicated by collagen deposition on lung tissues) is reduced by 20%, 30%, 40%, 50%, 60%, 70%, 80%, 90%, 95%, 99%, or 100%, in subjects that have been administered the monocytes treated with the MSC exosomes, compared to in subjects that have not been administered the monocytes treated with the MSC exosomes.
• degree of pulmonary fibrosis e.g., as indicated by collagen deposition on lung tissues
• An“autoimmune disease” is a condition in which your immune system mistakenly attacks your body. Normally, the immune system can tell the difference between foreign cells and your own cells. In an autoimmune disease, the immune system mistakes part of your body (e.g., joint or skin) as foreign. It releases proteins called autoantibodies that attack healthy cells. Some autoimmune diseases target only one organ. Type 1 diabetes damages the pancreas. Other diseases, like lupus, affect the whole body. Non-limiting examples of autoimmune diseases include:
• Achalasia Addison’s disease, Adult Still's disease, Agammaglobulinemia, Alopecia areata, Amyloidosis, Ankylosing spondylitis, Anti-GBM/Anti-TBM nephritis, Antiphospholipid syndrome, Autoimmune angioedema, Autoimmune dysautonomia, Autoimmune
• Autoimmune retinopathy Autoimmune urticaria, Axonal & neuronal neuropathy (AMAN), Balo disease, Behcet’s disease, Benign mucosal pemphigoid, Bullous pemphigoid, Castleman disease (CD), Celiac disease, Chagas disease, Chronic inflammatory demyelinating polyneuropathy (CIDP), Chronic recurrent multifocal osteomyelitis (CRMO), Churg-Strauss Syndrome (CSS) or Eosinophilic Granulomatosis (EGPA), Cicatricial pemphigoid, Cogan’s syndrome, Cold agglutinin disease, Congenital heart block, Coxsackie myocarditis, CREST syndrome, Crohn’s disease, Dermatitis herpetiformis, Dermatomyositis, Devic’s disease (neuromyelitis optica), Discoid lupus, Dressler’s syndrome, Endometriosis, Eosinophilic e
• GGR thrombocytopenic purpura
• IBM Inclusion body myositis
• IC Interstitial cystitis
• Juvenile arthritis Juvenile diabetes (Type 1 diabetes)
• Juvenile myositis Juvenile myositis (JM)
• Kawasaki disease Lambert- Eaton syndrome
• Leukocytoclastic vasculitis Lichen planus, Lichen sclerosus, Ligneous conjunctivitis, Linear IgA disease (LAD), Lupus, Lyme disease chronic, Meniere’s disease
• MPA Mixed connective tissue disease
• Mooren’s ulcer Mucha-Habermann disease
• Multifocal Motor Neuropathy (MMN) or MMNCB Multiple sclerosis, Myasthenia gravis, Myositis, Narcolepsy, Neonatal Lupus, Neuromyelitis optica, Neutropenia, Ocular cicatricial pemphigoid, Optic neuritis, Palindromic rheumatism (PR),
• PCD Paraneoplastic cerebellar degeneration
• PNH Paroxysmal nocturnal hemoglobinuria
• Parry Romberg syndrome Pars planitis (peripheral uveitis)
• Parsonnage-Tumer syndrome Pemphigus
• Peripheral neuropathy Perivenous encephalomyelitis
• Pernicious anemia PA
• POEMS syndrome Polyarteritis nodosa
• Polyglandular syndromes type I, II, III Polymyalgia rheumatica
• Polymyositis Postmyocardial infarction syndrome, Postpericardiotomy syndrome, Primary biliary cirrhosis, Primary sclerosing cholangitis, Progesterone dermatitis, Psoriasis, Psoriatic arthritis, Pure red cell aplasia (PRCA), Pyoderma gangrenosum, Raynaud’s phenomenon, Reactive Arthritis, Reflex sympathetic dystrophy, Relapsing polychondritis, Restless legs syndrome (RLS),
• Retroperitoneal fibrosis Retroperitoneal fibrosis, Rheumatic fever, Rheumatoid arthritis, Sarcoidosis, Schmidt syndrome, Scleritis, Scleroderma, Sjogren’s syndrome, Sperm & testicular autoimmunity, Stiff person syndrome (SPS), Subacute bacterial endocarditis (SBE), Susac’s syndrome, Sympathetic ophthalmia (SO), Takayasu’s arteritis, Temporal arteritis/Giant cell arteritis, Thrombocytopenic purpura (TTP), Tolosa-Hunt syndrome (THS), Transverse myelitis, Type 1 diabetes, Ulcerative colitis (UC), Undifferentiated connective tissue disease (UCTD), Uveitis, Vasculitis, Vitiligo, Vogt-Koyanagi-Harada Disease, Wegener’s granulomatosis (or Granulomatosis with Polyangiitis (GPA)).
• the autoimmune disease is selected from the group consisting of: 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, experimental autoimmune encephalomyelitis, immune neutropenia, and immune responses associated with delayed hypersensitivity mediated by cytokines, T-lymphocytes typically found in tuberculosis, sarcoidosis, and polymyositis, polyart
• Idiopathic pulmonary fibrosis is a chronic progressive respiratory disease whose underlying mechanism is incompletely understood and which currently lacks effective treatments.
• MSC mesenchymal stromal cell
• MSC-extracellular vesicles EVs
• MEx exosomes isolated from MSC secretome
• Exosomes isolated from human bone marrow MSCs were injected into adult C57BL/6 mice 0 or 7 days following instillation of endotracheal bleomycin.
• Lungs and bone marrow-derived monocytes were harvested on day 7 and 14 for histologic, gene expression or cytometric analysis.
• MEx treatment concurrent with or 7 days after bleomycin exposure substantially prevented lung fibrosis and collagen deposition.
• MEx prevented alveolar epithelial cell apoptosis.
• Idiopathic pulmonary fibrosis is a chronic progressive respiratory disease with a prevalence of 0.5 to 27.9 per 100,000 person years (1, 2). The lack of complete understanding of the underlying mechanism of this disease, may have contributed to the paucity of successful therapies. Despite two newly approved drugs, IPF remains fatal with a five-year survival rate of less than 10% (3-6).
• cell-based therapies such as mesenchymal stromal cells (MSCs) have also been explored (7-9).
• MSCs mesenchymal stromal cells
• MSCs vascular endometrial sarcoma
• secretome which is composed of a heterogeneous pool of bioactive molecules, often enclosed in extracellular vesicles (EVs).
• EVs extracellular vesicles
• EVs or more specifically exosomes (MEx) isolated from MSC secretome have been shown to act as the therapeutic vector (7, 11-19).
• MEx monocyte-derived alveolar macrophages
• mice All mice were housed and cared for in a pathogen-free facility. All animal experiments were approved by the Boston Children’s Hospital Animal Core and Use Committee. Ten to fourteen-week-old C57BL/6 mice (Charles Laboratories) were anaesthetized with isoflurane and endotracheally injected with a dose of 3 U/kg of bleomycin sulfate in 50 pl of 0.9% normal saline (NS) or NS alone on day 0.
• NS normal saline
• mice received 200 m ⁇ of bolus dose of MEx, (EVs produced by 5 x 10 6 MSCs, treatment group), human dermal fibroblast- derived exosomes (FEx); (EVs produced by 5 x 10 6 human dermal fibroblasts cells, first control group) or OptiPrepTM (iodixanol, IDX, 1:9 dilution); (vehicle, second control group) or NS via tail vein injection on days 0 and 7.
• MEx EVs produced by 5 x 10 6 MSCs, treatment group
• FEx human dermal fibroblast- derived exosomes
• OptiPrepTM iodixanol, IDX, 1:9 dilution
• NS via tail vein injection on days 0 and 7.
• mice were euthanized with
• trachea was cannulated and lungs were inflated with 4% paraformaldehyde.
• Right lung was embedded in paraffin and sectioned for hematoxylin and eosin or Masson’s trichrome staining.
• the left lung was either snap frozen in liquid nitrogen and used for RNA and protein isolation or used fresh for collagen quantification or cytometric analysis. Randomly selected areas (10-15 fields) from 5 pm thick lung sections were acquired at xlOO and x200 magnification using a Nikon Eclipse 80i microscope (Nikon, Tokyo, Japan). Large airways and vessels were not imaged.
• the Ashcroft score was used in a blinded fashion. Scores of 0-1 represented no fibrosis, scores of 2-3 represented minimal fibrosis, scores of 4-5 were considered as moderate fibrosis, and scores of 6-8 indicated severe fibrosis (23).
• BMDMo BMDMo were isolated as described previously (11). Cell suspension was used for cytometric analysis and cultured adherent cells after 3 days were used for adoptive transfer experiments (further details can be found in online supplementary material).
• concentrated conditioned media from bone marrow MSCs or human dermal fibroblasts was floated on top of IDX cushion and centrifuged for 3.5 hours at 100,000 xg at 4°C.
• a well-established bleomycin lung injury model was used for pulmonary fibrosis characterized by an inflammatory (day 0 to 8) followed by a fibrotic stage (day 9 to 32) (24).
• mice received endotracheal bleomycin (3 U/kg) or NS (vehicle, control) on day 0 followed by a bolus dose of intravenous (IV) MEx via tail vein.
• IV intravenous
• Mice were sacrificed at day 14 and lungs were assessed for fibrosis quantification and collagen content (FIG. 1A).
• Bleomycin increased the Ashcroft score more than threefold compared to control mice.
• mice were injected with MEx 7 days after bleomycin administration (FIG. 7A). Similar to what was observed in the preventive therapy experiment (MEx injection on day 0), administration of MEx during the inflammatory stage led to an improvement in fibrosis scores and a statistically significant reduction in collagen deposition (FIG. 7B, 7C and 7D). Therefore, MEx therapy ameliorates fibrosis even if administered at the end of inflammation. MEx modulate alveolar macrophage phenotypes and blunt inflammation
• Monocyte-derived macrophages participate in the development and progression of fibrosis (20, 21), thus, the role of MEx was assessed in the modulation of inflammation through regulation of inflammatory and profibrotic macrophage phenotype.
• Interleukin-6 mRNA levels showed a similar trend to that of Ccl-2 and Argl, though the difference did not reach statistical significance between groups.
• TGF-B expression was similar at both time points in all three experimental groups (FIGS. 2A and 2B).
• IF Immunofluorescence staining of lung tissue sections with CD206 and Argl antibodies which are macrophage markers of M2-like activation, showed an increase in IF intensity in mice that received bleomycin but remained similar to control levels when mice were treated with MEx (FIGS. 2C and 2D).
• Flow cytometric analysis of whole lungs also showed an increase in CD206 expressing alveolar macrophages (AM) (CD45+veCDl lb-veCDl lc+veCD 206+ve cells) in bleomycin mice.
• AM alveolar macrophages
• FIG. 2E The above results reveal that MEx exert anti-inflammatory effects through the modulation of AM phenotype in the lung.
• MEx can modulate monocyte phenotypes in the bone marrow
• MEx may exert immunomodulatory effects by modifying the monocyte phenotypes in the BM.
• BM bone marrow
• BMDMo+MEx media alone
• BMDMo+Media media alone
• FIG. 4A On day 3 it was confirmed that more than 90% of the bone marrow cells were CD45+veCDl lb+ve (myeloid subset, FIG. 4B).
• Monocytes were then labeled with Dil (fluorescent lipophilic dye) and adoptively-transferred intravenously to C57BL/6 mice at day 0 and 3 after instillation of bleomycin. Mice were sacrificed at day 14 and lungs were assessed for histology and collagen content. Results were compared to mice that received bleomycin with NS injection (bleomycin).
• the Dil- labeled monocytes were identified in the lungs 14 days after the administration of bleomycin (FIG. 4C). Interestingly, less fibrosis was detected both with histologic quantification and collagen assay in mice that received BMDMo+MEx compared to bleomycin and
• BMDMo+Media-receiving mice Surprisingly, minimal amelioration of fibrosis score on histology and statistically non- significant collagen deposition in the BMDMo+Media -treated group compared to bleomycin-exposed mice (FIGS. 4D, 4E, and 4F) were detected.
• MEx-treated AMs AM+MEx
• Any amelioration of fibrosis was not detected in mice who received pretreated AMs compared to the bleomycin group (FIG. 4E).
• Alveolar epithelial cell apoptosis has been described as a trigger for a pro-fibrotic signal in damaged lungs (26, 27).
• AEC Alveolar epithelial cell apoptosis
• the degree of lung apoptosis was assessed using tunel staining on lung sections from control, bleomycin, and MEx-treated mice. There was an increase in apoptosis noted in the bleomycin-exposed group, while apoptosis levels were similar in Bleo+MEx and control mice (FIG. 5A, 5B). Additionally, Annexin V/PI staining in whole lungs at day 14 was performed. There was again an increase in apoptosis (Annexin V+/PI-) present in bleomycin compared to control and MEx-treated mice (FIG. 5C).
• A549 human alveolar epithelial cells
• AEC human alveolar epithelial cells
• An in vitro assay was designed where epithelial cell apoptosis was induced by treating A549 cells with bleomycin.
• a group of bleomycin-exposed AECs were treated with MEx for 24 hours and changes in apoptosis were determined by caspase 3 and 7 activity using Caspase-Glo® 3/7 luminescence assay.
• An increase in apoptosis in the bleomycin group was noted which was abrogated in MEx-treated cells (FIG. 5D).
• MSC-EVs can repopulate Sca-l positive and c-kit low-positive stem cells in the BM of irradiated mice (32). They have also been shown to modulate monocytes trafficking in a model of myocarditis (33). In the presence of organ injury, MSC-EVs may reprogram myeloid stem cells to differentiate into a regulatory phenotype. Accordingly, there was an increase in regulatory monocytes in the BM and a reduction in inflammatory monocytes in the lung, and therefore, less differentiation to profibrotic macrophages.
• MEx could also potentially prevent fibrosis through the reduction of apoptosis. Furthermore, the in vitro assay described herein suggests that this effect is produced by targeting the alveolar epithelial cells.
• MSC exosomes are believed to be a promising cell-free therapy for the treatment of fibrotic lung diseases if administered early in the course of disease.
• BMSCs Human bone marrow mesenchymal stem cells
• BMSCs Human bone marrow mesenchymal stem cells
• HDFs Human foreskin (dermal) fibroblast cells
• ATCC A549 Alveolar epithelial cells (ATCC) were cultured in F-12K medium (Thermo Fisher Scientific, Inc., Waltham, MA).
• NTA NanoSight LM10 system, Malvern instruments, MA, US
• Proteins in exosome preparations were separated on a 4-20% polyacrylamide gel (Bio- Rad, Hercules, CA), followed by transfer to 0.45 pm PVDF membrane (Millipore, MA, US).
• Rabbit polyclonal anti-flotillin- 1 and anti-CD63 antibodies (Santa Cruz Biotech, CA, US), and mouse monoclonal anti-Alix antibody (Santa Cruz Biotech, CA, US) were used based on recommended dilutions by the manufacturer.
• EV preparations were diluted on PBS to correspond to 5 x 10 6 cell equivalent. This dose was estimated based on previous dose calculation in newborn mice with corresponding NTA and protein concentrations (37).
• Lung tissue sections were de-paraffinized in xylene and rehydrated. Tissue slides were treated with lOmM citrate buffer and blocked with serum and BSA for 20 min. Samples were then incubated at 40 C overnight with indicated primary antibody, Arginase 1 (Santa Cruz Biotech, CA, US); CD206 (Santa Cruz Biotech, CA, US), then further incubated with secondary antibody (Life technologies, MA, US) for 20 minutes followed by nuclear staining with DAPI for 10 minutes.
• Arginase 1 and CD206 positive cells were imaged using a Nikon Eclipse 80i microscope (Nikon, Tokyo, Japan). 10-15 random images were analyzed using image J software.
• MLI Mean Lluorescence Intensity
• the left lung was used for collagen quantification per manufacturer protocol (Biocolor, Life Science Assays). Briefly, left lung homogenate were shaken overnight at 4° in 5ml of 0.5 M acetic acid with 0.6% pepsin. One ml of dye reagent was added to 100 pl of transparent supernatant and the samples were vortexed for 30 minutes. The residual pellet was washed by acid-salt wash buffer to eliminate unbound collagen and pH was normalized with alkalization buffer. Absorbance was measured at a wavelength of 550 nm in a microplate reader. Measured collagen content was compared to a standard curve and represented as mg/ml of left lung homogenate.
• Lung macrophage populations were assessed by flow cytometry as previously described (38). Lungs were harvested on days 7 and 14. Left lung was cut into small pieces and digested in 5ml of digestion buffer consisting of RPMI-1640 (Invitrogen, CA, US), Collagenase IV (1.6 mg/ml); and DNAsel (50 unit/ml), both from Worthington Biochemical Corp, NJ, US. Lung were shaken at 37°C for 30 minutes and red blood cells (RBC) were lysed using RBC lysis buffer (Roche, IN, US). Homogenized lung was passed through a 40pm cell strainer (Coming, MA, US) to obtain a single-cell suspension.
• the cell suspension was stained with antibodies; PE/Cy7 -conjugated anti-mouse CD45, FITC- conjugated anti-mouse CDl lb, PerCP Cy 5.5-conjugated anti-mouse CDl lc, BV 421 -conjugated anti-mouse CD206, BV 605-conjugated anti-mouse MHC II, BV 510- conjugated anti-mouse Ly6C and Alexa 647- conjugated anti-mouse CCR-2.
• BMDMo bone marrow derived monocytes
• TaqMan® primers used in the PCR reactions including Ccl2, 116, TGF-b, and Arginase 1 were obtained from Invitrogen.
• Nuclear pore protein 133 served as an internal control. Analysis of the fold change was performed as previously described compared to control mice (39).
• Annexin V staining kit (Sigma- Aldrich, MO, US) was used to assess apoptosis in the whole lung. Single cell suspension was obtained from left lung as described above. Cells were then floated in lx binding buffer and stained with FITC conjugated-Annexin V and PI antibody for 10 minutes and immediately assessed by flow cytometry.
• Apoptosis was assessed in paraffin-embedded lung tissue using TACS® TdT in situ - Fluorescein tunnel assay (R&D systems, MN, US) per manufacturer protocol. Briefly, deparaffinized lung sections were permeabilized using Cytonin for 1 hour and labeled with a combination of
• TdT dNTP Mix Mangenese cation, TdT dNTP Mix, and TdT enzyme followed by incubation with Strep-Fluor solution for 20 minutes. Fluorescent imaging and quantification was performed as described above.
• Caspase 3/7 assays were performed according to the manufacturer's instructions. Briefly, 2 x 10 4 A549 alveolar epithelial cells were plated overnight in a 96-well plate. Cells were treated with 0.1 pg/well of bleomycin sulfate or media alone for 24 hours (8 wells per group). This was followed by treatment of the bleomycin-treated cells with lpl/well of MEx (equivalent to EVs produced by approximately 2 x 10 4 MSCs) for 24 hours. Bleomycin- treated cells treated with media only were used as control. All the experiments were performed in serum free medium. On day 3, cells were washed with PBS and 50pl of fresh media was added to each well.
• caspase 3/7 activity 50pL of caspase Glo 3/7 reagent was added to each well for 2h at room temperature and the plate was left on a plate shaker. Luminescence was measured using VICTOR Multilabel plate reader. The background luminescence (measured in cell-free well) was subtracted from each read-out.
• BMDMo were isolated from 6-8 wk-old FVB by flushing the femur and tibia and culturing cells for 3 days in Dulbecco’s Modified Eagle Medium (DMEM) supplemented with 10% FBS, containing 30% v/v L929-conditioned medium (as a source of macrophage colony-stimulating factor; M-CSF). Each plate was treated with MEx generated from lxlO 6 MSCs or media only on days 1 and 2. Cells were harvested on day 3 and after two washes with PBS, stained with Dil as per the manufacturer protocol (Life technologies). BMDMo were then administered via tail vein injection at a 1:1 ratio (BMDMo isolated from one mice were injected into the experiment mouse) on day 0 and day 3 after endotracheal instillation of bleomycin.
• DMEM Modified Eagle Medium
• Bronchoalveolar lavage fluid was collected with 5 flushes of 0.6 ml of sterile HBSS (supplemented with 0.5 mM EDTA and lmM HEPES) using a 1 ml syringe. BALF was centrifuged at 400 xg for 5 min and the supernatant was aspirated. Murine AMs were resuspended in fresh RPMI media supplemented with 1% penicillin/streptomycin and 10% FBS and were seeded in a 35mm plate at a seeding density of lxlO 6 per plate. Each plate was treated overnight with MEx generated from lxlO 6 cells.
• the cells were harvested after 24 hours, washed twice with PBS, stained with Dil and re-suspended in 50 pl of PBS.
• AMs were administered endotracheally at a one-to-one (AMs isolated from one mouse were administered to the experiment mouse) ratio on day 0 and 3 following instillation of bleomycin.
• EVs were pelleted for 70 minutes at 100,000 g from concentrated conditioned media of bone marrow MSCs. EV protein concentration was determined using micro BCA protein assay kit (Thermo Fisher Scientific, Inc., Waltham, MA). EVs were labeled by ExoGlow-MembraneTM EV Labeling Kit (System biosciences, CA, USA) per manufacture protocol. Briefly, 50-100 pg of EVs were added to the mixture of reaction buffer and labeling dye and incubated at room temperature for 30 minutes. Free unlabeled dye was removed following a second ultracentrifugation at 100,000 g for 70 minutes. The EVs produced by equivalent of 1 x 10 6 MSCs were diluted in 200 pl of PBS and injected into C57BL/6 mice using tail vein injection. 200 m ⁇ of stained EV-free SN, or diluted free dye were used as controls.
• mice were sacrificed at 2, 4, 8 and 24 hours following injections.
• the femur bones were flushed with PBS and cell suspension was cytocentrifuged at 300 g for 5 min using the Shandon Cytospin 4 (Thermo Fisher Scientific, Inc., Waltham, MA). Slides were air-dried, fixed with 4% paraformaldehyde and counterstained with Dapi. Images were obtained using a Nikon Eclipse 80i microscope (Nikon, Tokyo, Japan).
• Cottin V The role of pirfenidone in the treatment of idiopathic pulmonary fibrosis.
• Pirfenidone in patients with idiopathic pulmonary fibrosis (CAPACITY): two randomised trials. Lancet. 2011;377(9779): 1760-9.
• Phinney DG Di Giuseppe M, Njah J, Sala E, Shiva S, St Croix CM, et al.
• Mesenchymal stem cells use extracellular vesicles to outsource mitophagy and shuttle microRNAs. Nat Commun. 20l5;6:8472.
• 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
• 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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