Hematopoietic Stem And Progenitor Cells Transplantation Research Articles

CCR2 cooperativity promotes hematopoietic stem cell homing to the bone marrow.

Cross-talk between hematopoietic stem and progenitor cells (HSPCs) and bone marrow (BM) cells is critical for homing and sustained engraftment after transplantation. In particular, molecular and physical adaptation of sinusoidal endothelial cells (ECs) promote HSPC BM occupancy; however, signals that govern these events are not well understood. Extracellular vesicles (EVs) are mediators of cell-cell communication crucial in shaping tissue microenvironments. Here, we demonstrate that integrin α4β7 on murine HSPC EVs targets uptake into ECs. In BM ECs, HSPC EVs induce up-regulation of C-C motif chemokine receptor 2 (CCR2) ligands that synergize with CXCL12-CXCR4 signaling to promote BM homing. In nonirradiated murine models, marrow preconditioning with HSPC EVs or recombinant CCR2 ligands improves homing and early graft occupancy after transplantation. These findings identify a role for HSPC EVs in remodeling ECs, newly define CCR2-dependent graft homing, and inform novel translational conditioning strategies to improve HSPC transplantation.

Silencing endomucin in bone marrow sinusoids improves hematopoietic stem and progenitor cell homing during transplantation.

Efficient homing of infused hematopoietic stem and progenitor cells (HSPCs) into the bone marrow (BM) is the prerequisite for successful hematopoietic stem cell transplantation. However, only a small part of infused HSPCs find their way to the BM niche. A better understanding of the mechanisms that facilitate HSPC homing will help to develop strategies to improve the initial HSPC engraftment and subsequent hematopoietic regeneration. Here, we show that irradiation upregulates the endomucin expression of endothelial cells in vivo and in vitro. Furthermore, depletion of endomucin in irradiated endothelial cells with short-interfering RNA (siRNA) increases the HSPC-endothelial cell adhesion in vitro. To abrogate the endomucin of BM sinusoidal endothelial cells (BM-SECs) in vivo, we develop a siRNA-loaded bovine serum albumin nanoparticle for targeted delivery. Nanoparticle-mediated siRNA delivery successfully silences endomucin expression in BM-SECs and improves HSPC homing during transplantation. These results reveal that endomucin plays a critical role in HSPC homing during transplantation and that gene-based manipulation of BM-SEC endomucin in vivo can be exploited to improve the efficacy of HSPC transplantation.

Exagamglogene Autotemcel for Transfusion-Dependent β-Thalassemia

BackgroundExagamglogene autotemcel (exa-cel) is a nonviral cell therapy designed to reactivate fetal hemoglobin synthesis through ex vivo clustered regularly interspaced short palindromic repeats (CRISPR)–Cas9 gene editing of the erythroid-specific enhancer region of BCL11A in autologous CD34+ hematopoietic stem and progenitor cells (HSPCs).MethodsWe conducted an open-label, single-group, phase 3 study of exa-cel in patients 12 to 35 years of age with transfusion-dependent β-thalassemia and a β0/β0, β0/β0-like, or non–β0/β0-like genotype. CD34+ HSPCs were edited by means of CRISPR-Cas9 with a guide mRNA. Before the exa-cel infusion, patients underwent myeloablative conditioning with pharmacokinetically dose-adjusted busulfan. The primary end point was transfusion independence, defined as a weighted average hemoglobin level of 9 g per deciliter or higher without red-cell transfusion for at least 12 consecutive months. Total and fetal hemoglobin concentrations and safety were also assessed.ResultsA total of 52 patients with transfusion-dependent β-thalassemia received exa-cel and were included in this prespecified interim analysis; the median follow-up was 20.4 months (range, 2.1 to 48.1). Neutrophils and platelets engrafted in each patient. Among the 35 patients with sufficient follow-up data for evaluation, transfusion independence occurred in 32 (91%; 95% confidence interval, 77 to 98; P<0.001 against the null hypothesis of a 50% response). During transfusion independence, the mean total hemoglobin level was 13.1 g per deciliter and the mean fetal hemoglobin level was 11.9 g per deciliter, and fetal hemoglobin had a pancellular distribution (≥94% of red cells). The safety profile of exa-cel was generally consistent with that of myeloablative busulfan conditioning and autologous HSPC transplantation. No deaths or cancers occurred.ConclusionsTreatment with exa-cel, preceded by myeloablation, resulted in transfusion independence in 91% of patients with transfusion-dependent β-thalassemia. (Supported by Vertex Pharmaceuticals and CRISPR Therapeutics; CLIMB THAL-111 ClinicalTrials.gov number, NCT03655678.)

Exagamglogene Autotemcel for Severe Sickle Cell Disease

BackgroundExagamglogene autotemcel (exa-cel) is a nonviral cell therapy designed to reactivate fetal hemoglobin synthesis by means of ex vivo clustered regularly interspaced short palindromic repeats (CRISPR)–Cas9 gene editing of autologous CD34+ hematopoietic stem and progenitor cells (HSPCs) at the erythroid-specific enhancer region of BCL11A.MethodsWe conducted a phase 3, single-group, open-label study of exa-cel in patients 12 to 35 years of age with sickle cell disease who had had at least two severe vaso-occlusive crises in each of the 2 years before screening. CD34+ HSPCs were edited with the use of CRISPR-Cas9. Before the exa-cel infusion, patients underwent myeloablative conditioning with pharmacokinetically dose-adjusted busulfan. The primary end point was freedom from severe vaso-occlusive crises for at least 12 consecutive months. A key secondary end point was freedom from inpatient hospitalization for severe vaso-occlusive crises for at least 12 consecutive months. The safety of exa-cel was also assessed.ResultsA total of 44 patients received exa-cel, and the median follow-up was 19.3 months (range, 0.8 to 48.1). Neutrophils and platelets engrafted in each patient. Of the 30 patients who had sufficient follow-up to be evaluated, 29 (97%; 95% confidence interval [CI], 83 to 100) were free from vaso-occlusive crises for at least 12 consecutive months, and all 30 (100%; 95% CI, 88 to 100) were free from hospitalizations for vaso-occlusive crises for at least 12 consecutive months (P<0.001 for both comparisons against the null hypothesis of a 50% response). The safety profile of exa-cel was generally consistent with that of myeloablative busulfan conditioning and autologous HSPC transplantation. No cancers occurred.ConclusionsTreatment with exa-cel eliminated vaso-occlusive crises in 97% of patients with sickle cell disease for a period of 12 months or more. (CLIMB SCD-121; ClinicalTrials.gov number, NCT03745287.)

Efficient Combinatorial Adaptor-Mediated Targeting of Acute Myeloid Leukemia with CAR T-Cells

Introduction: Chimeric Antigen Receptor (CAR) T-cell therapies are remarkably efficient in treating B- and plasma-cell malignancies by targeting cell-of-origin antigens, eradicating both tumor cells as well as healthy B- and plasma-cell counterparts. Their loss can be compensated by immunoglobulin substitution until they regenerate from hematopoietic stem and progenitor cells (HSPCs). However, similar on-target, off-tumor cell-of-origin elimination would be detrimental in the context of HSPC-derived malignancies, such as acute myeloid leukemia (AML) or myelodysplastic neoplasia (MDS), as the CAR T-cell activity might lead to terminal ablation of hematopoiesis. In principle, CAR T-cells could be used to abrogate both, AML cells as well as HSPCs, followed by HSPC transplantation, ensuring hematopoietic recovery after termination of CAR T-cell activity and possibly without genotoxic preconditioning. This approach could be particularly beneficial for patients unable to tolerate radiation and high-dose chemotherapy. In order to address this challenge, we developed adaptor-mediated CAR T-cells displaying the single-chain variable fragment E2, AdFITC(E2), that binds to fluorescein conjugated to antigen-binding adaptors in diabody format (Db-FM). Such tagged adaptors, used as single linkers or in combination, would then act as safety switch, modulating CAR T-cell activation, proliferation, and lytic activity. Results: We generated second-generation AdFITC(E2)-CAR T-cells and multiple diabody-based adaptors against selected AML antigens. We then tested the diabodies targeting CD33 and CD117 with respect to their ability to mediate CAR T-cell biocidal activity as single adaptors or in combination. Combinatorial staining with CD117 Db-FM and CD33 Db-FM, each added at saturating concentration for the cognate antigen, resulted in higher fluorescein decoration of target cells, with more than two-fold increased fluorescence intensity detected by flow cytometry upon combined staining, thus enhancing AdFITC(E2)-CAR T-cell target density. In vitro cytotoxicity assays of healthy-donor-derived AdFITC(E2)-CAR T-cells, both against cell lines (MOLM14-CD117 +GFP +Luc +) as well as patient-derived AML blasts, revealed that dual adaptor use significantly improved tumor cell lysis compared to equimolar concentration of single adaptors. To further investigate the basis for increased killing by dual targeting, we performed live-cell imaging of effector-target cell interactions in microwells. The addition of both CD117 and CD33 Db-FM to the co-culture of MOLM14-CD117 +GFP +Luc + and AdFITC(E2)-CAR T-cells resulted in faster tumor cell lysis (measured by influx of PI) which correlated with a more rapid, durable engagement time of CAR T-cells with target cells. We next tested CAR T-cell biocidal activity in therapeutic xenogeneic mouse models engrafted with MOLM14-CD117 +GFP +Luc + where AdFITC(E2)-CAR T-cells in combination with CD117 or CD33 Db-FM administered as single adaptors were as efficient as direct CAR T-cells against the same antigens. Injection of AdFITC(E2)-CAR T-cells and both CD117 and CD33 Db-FM effectively inhibited tumor growth, outperforming monotherapies, and leading in some cases to full AML elimination in bone marrow and blood as shown by bioluminescence and terminal flow cytometry analysis (Figure 1). Conclusions: We here tested an adaptor CAR T-cell approach using multiple adaptors to on-off modulate and enhance CAR T-cell activity, focusing on AML as a relevant disease model with high clinical need for therapeutic improvement. The high heterogeneity in antigen expression on AML cells supports a combinatorial targeting strategy, individualized based on the respective AML immunophenotype. Due to their relatively small molecular weight (~55kDa), diabody-based adaptors are rapidly cleared from the body via the kidneys allowing for rapid control over AdFITC-CAR T-cell on-off activity prior to HSPC transplantation. We envision that this approach has the clinical potential to improve CAR T-cell safety profiles by enhancing the specificity towards target cells, while ameliorating the side-effects against healthy tissues expressing only one antigen of the combination.

Modeling Cell Population Dynamics in Early Hematopoiesis Reveals Mechanisms of Myeloid Bias Mediated By NFκB-Dysregulation

Alterations in hematopoiesis are associated with immune dysregulation and perturbations in NFκB signaling. Aging, for example, is correlated with increased myeloid and decreased lymphoid cell output, as well as elevated levels of NFκB activity in hematopoietic stem and progenitor cells (HSPC) and inflammatory cytokines in the bone marrow. Further, patients with myelodysplastic syndrome (MDS) show increased expression of components of the NFκB signaling pathway in HSPC and mesenchymal cells, in addition to increased production of inflammatory cytokines. Despite being implicated in these contexts, it remains unknown how elevated NFκB signaling might affect the production and abundance of certain HSPC subsets. Here we interrogate how increased NFκB activity may alter the developmental dynamics within the HSPC compartment to give rise to a biased progenitor population. To investigate how myeloid cell overproduction arises in the bone marrow, we developed mathematical models to recapitulate HSPC population dynamics. To address the role of NFκB in the process, we leveraged data from the IκB - mouse model ( Nfkbia +/- Nfkbib -/- Nfkbie -/-), which has constitutively elevated NFκB activity. Cell counts of HSPC subpopulations demonstrated a myeloid biased alteration in multipotent progenitor (MPP) abundances in the IκB -mouse, reminiscent of what occurs with aging. Fitting the cell population dynamics model to these data suggested that accelerated differentiation of Short-Term HSC (STHSC) with skewing in their fate commitment is insufficient to account for the increase in MPP2 and MPP3 cells. To explore additional mechanisms contributing to myeloid bias, we utilized single-cell RNA sequencing (scRNAseq) data from IκB - versuscontrol HSPC. We first used pseudotime reconstruction to position cells along a continuous differentiation trajectory from HSCs to erythrocyte-megakaryocyte- (MPP2), myeloid- (MPP3), and lymphoid- (MPP4) primed progenitors and then fit these data to a partial differential equation (PDE) model of population dynamics. This analysis suggested not only a loss of lymphoid fate specification amongst HSC but also an increase in the expansion of early myeloid primed cells to produce more MPP3 cells. Transplantation of wildtype HSPC into a lethally irradiated IκB - mouse additionally showed that an inflamed microenvironment is sufficient to drive myeloid bias. Utilizing the same mathematical models to describe these data revealed similar perturbations in population dynamics of the transplanted HSPC. Finally, the scRNAseq pseudotime analysis identified differentially expressed genes along the differentiating lineages that indicated decreased HSC commitment towards the lymphoid fate and increased proliferation of early myeloid primed cells, supporting the model predictions. We next leveraged scRNAseq datasets from HSPC isolated from MDS patients and healthy aged-matched controls to explore if these features of NFκB-mediated immune dysregulation are clinically relevant. These data demonstrated myeloid bias in progenitors at the transcriptional level and suggested elevated NFκB signaling amongst the HSPC from MDS patients. Finally, applying the same mathematical modeling and gene expression analyses developed for the murine datasets revealed common perturbations in developmental dynamics of MDS HPSC as the IκB - mouse models. These analyses motivate further study of the downstream consequences of immune dysregulation on hematopoiesis and the identification of perturbations in NFκB signaling in pathological contexts.

N-3 Polyunsaturated Fatty Acid (N-3 PUFA) Derived Lipid Mediators Increase Hematopoiesis during Zebrafish Embryogenesis

Polyunsaturated fatty acids (PUFAs), which include n-3 PUFAs and n-6 PUFAs, are essential fatty acids that we can only get from diet. The richest source of PUFAs is fish oil. N-3 PUFAs have been used in the prevention and treatment of coronary artery disease, diabetes, hypertension, arthritis, cancer, and other inflammatory and autoimmune disorders in humans. Lipid mediators derived from n-3 PUFAs are implicated in mediating the resolution of inflammation. However, their effect on hematopoietic stem and progenitor cell (HSPC) proliferation and differentiation and on hematopoiesis has not been studied. Therefore, in this project, we investigated the pro-hematopoietic effects of n-3 PUFA-derived lipid mediators. We exposed wild-type zebrafish embryos to different n-3 PUFA-derived lipid mediators. After fixation, we performed whole mount in situ hybridization (WISH) using antisense RNA probes such as c-myb (hematopoietic stem cell marker), gata1 (erythroid progenitor cell marker), hbbe1 (erythrocyte marker), l-plastin (macrophage and neutrophil cell marker ), mpx (neutrophil cell marker), lyz (neutrophil cell marker), and rag1 (immature lymphocyte marker); reverse transcription-quantitative polymerase chain reaction (RT-qPCR); and fluorescence-activated cell sorting (FACS) to understand the effect of lipid mediator exposure on the proliferation of HSPCs, erythroid progenitor cells, erythrocytes, granulocytic cells, neutrophils, macrophages, and T lymphocytes in different development stages during vertebrate hematopoiesis. In addition, we also used o-dianisidine staining to study red blood cell (RBC) formation and transgenic zebrafish to observe different blood lineages including HSPCs, neutrophils, macrophages, erythroid progenitors, and erythrocytes with fluorescent microscopy. We identified two novel lipid mediators which promote HSPC proliferation, enhance erythroid progenitor cell and erythrocyte production, and increase neutrophil cell number. These two molecules could be applied as novel therapeutics for blood disorders and blood cancers such as anemia and leukemia in humans. These two compounds can be intensely investigated to become candidate supplements to enhance HSPC amplification before HSPC transplantation for leukemia patients.

Autologous MPO Knock-out Hematopoietic Stem and Progenitor Cells for Pulmonary Arterial Hypertension

Pulmonary Arterial Hypertension (PAH) is a progressive condition for which there is no cure. Even with substantial pharmacologic advances in the modern treatment era, existing treatments provide only symptomatic relief and survival remains unacceptably poor. Patients who fail to respond to medications usually have the worst prognosis and patients with persistently elevated pulmonary pressure and right heart failure usually die within 5 years. PAH is a severe complication of Systemic sclerosis (SSc) affecting approximately 8%-12% of patients. SSc affects 13.5-44.3 per 100,000 individuals and is complex and diverse, with limited treatment options. SSc-associated PAH is the second largest group of patients with PAH. Once diagnosed, it becomes the leading cause of mortality among this patient population, with a 50% mortality rate within 3 years of PAH diagnosis. Inflammation and endothelial injury being the main components of the syndrome, investigation regarding the underlying mechanisms of this immune response may lead to the development of a new efficient therapy. There is extensive evidence for a pathogenic role for neutrophil myeloperoxidase (MPO) in PAH disease. PAH patients with higher levels of MPO have a poorer outcome. Studies in murine models of PAH demonstrate significant disease amelioration by elimination of neutrophil MPO by hematopoietic stem cell (HSC) transplantation with HSC lacking MPO from germline MPO gene knock-out. We developed a gene therapy approach to PAH in which autologous HSCs will undergo gene editing using CRISPR/Cas9 to achieve bi-allelic disruption of the MPO gene. These MPO-knock-out HSCs will then be autologous transplanted. That autologous transplantation of HSPC in which the MPO gene is disrupted is expected to prevent progression of PAH due to the essential role of neutrophil MPO activity on disease development. We identified a sgRNA that leads to high frequency disruption of MPO in primary human CD34+ hematopoietic stem and progenitor cells (HSPC), leading to efficient elimination of MPO protein in the resultant neutrophils. That sequence was assessed for genome-wide off-target and showed no detectable locus, validating it as a lead candidate for safe gene editing strategy. We validated in an in vitro neutrophil differentiation model the functional efficiency of the knock-out. MPO KO differentiated cells exhibit reduced neutrophil extracellular traps formation (NETosis) and absence of MPO protein. An optimized gene editing protocol for HSC was optimized and showed consistent allelic disruption over 80%. The edited cells retain hematopoietic potential and showed no skewing in the generated lineages in an in vitro colony forming assay. We developed a surrogate gene editing protocol for murine cells and optimized electroporation to achieve high allelic disruption of the murine MPO gene in lineage negative murine hematopoietic cells. The protocol will be tested in a hypoxia-induced PAH murine model. The presented work can represent a major improvement for PAH patient. The limited therapeutic options and severity of the disease urges to develop new approaches. The gene therapy protocol developed showed promising result in vitro and rely on clinical evidences for the implication of MPO in the disease. Results will be tested in a pre-clinical murine model

Trafficking Kinetics of Steady State Versus Mobilized Hematopoietic Stem and Progenitor Cells in Non-Human Primates

The safety and efficacy of hematopoietic stem and progenitor cell (HSPC) allogeneic transplantation and autologous gene therapies are dependent on mobilization of HSPCs out of bone marrow (BM) niches into peripheral blood (PB) and homing of infused HSPCs into open niches. However, the disposition of HSPCs exiting the marrow in steady state and following mobilization are not well understood. We characterized short-term (≤ 48 hours (h)) HSPC dynamics during steady state and following mobilization (single dose AMD3100 (plerixafor), 1mg/kg) in rhesus macaques (RMs), a model with direct preclinical relevance. We used serial intravascular staining (SIVS) (Potter et al., 2021; Morlock et al., 2021), based on timed intravenous infusions of multiple fluorescently labeled anti-CD45 antibodies (Ab) (half-life ~8.5 min), to specifically and instantaneously label all blood leukocytes at the time of each infusion, providing a window into blood residence time and tissue entry and egress. SIVS Abs are stably retained on the surface of leukocytes for up to one week and persist with migration into tissues, allowing determination of the passage of cells in and out of circulation. SIVS Abs were administered at multiple time points over 48 h, and PB was collected 5 (minutes (min)) before and 5 min, 2 h, and 4 h after each infusion. PB and BM were collected 5 min after the final Ab infusion, which was used to designate cells as intravascular (-5 min +/IVas +) or tissue-homed (-5 min -/IVas -). HSPC subsets and SIVS Abs were analyzed via flow cytometry. Additionally, trafficking to extramedullary HSPC tissue reservoirs (spleen, thymus, lymph nodes) was studied in a RM euthanized immediately following the final Ab infusion. Under steady state (n=3 RMs), we documented rapid (≤ 2 h) homing of ~55-95% of blood HSPCs out of the circulation to alternate tissue reservoirs. Of the circulating HSPC subsets, no significant differences were observed between the trafficking of HSC-enriched (CD34 +CD45RA -CD90 +), lympho-myeloid progenitor-enriched (CD34 +CD45RA +CD90-), and multipotent and erythro-myeloid progenitor-enriched (CD34 +CD45RA -CD90 -) HSPCs (Radtke et al., 2020). Following 48 h, minimal (≤ 10%) circulating HSPCs from all earlier times were found in BM, suggesting that steady state circulating HSPCs rarely “rehome,” at least within 48 h (Figure 1). Of the extramedullary reservoirs studied, minimal HSPCs trafficked to the thymus or lymph nodes; however, the spleen had a population (&amp;lt; 14 %) of HSPCs moving in and out over a 24 h period. To investigate the impact of AMD3100 on HSPC trafficking (n=1 RM), four SIVS Abs were administered 5 min prior to mobilization (baseline), at peak of mobilization (4 h post-AMD3100), and 10 h and 12 h post-AMD3100, as the concentration of blood HSPCs decreased. PB was collected 5 min before and 5 min, 0.5 h, and 2 h post each SIVS Ab infusion to monitor HSPC kinetics; PB and BM were collected at 12 h post-AMD3100, and final PB was collected at 24 h post-AMD3100. Compared to steady state HSPC dynamics described above, mobilized HSPCs labeled at the peak of mobilization exhibited prolonged circulation (Figure 2), with a higher portion of the mobilized cells remaining in the blood at the 2 h time window compared to steady state. However, there was no increase in the fraction of the HSPCs rehoming to the BM (Figure 1), suggesting that mobilized HSPCs do not exhibit a greater propensity for rehoming compared to steady state and that BM niches are still open 12 h after mobilization. The extended availability of these niches holds potential relevance for the use of potent mobilizing regimens to facilitate engraftment of transplanted autologous gene-modified or allogeneic HSPCs. In summary, under both steady-state and mobilization conditions, HSPCs exhibit minimal rehoming to bone marrow niches, and mobilized HSPCs linger in circulation for up to 24 h post-mobilization. Further studies in progress aim to investigate longer term BM rehoming and better define extramedullary sites of HSPC egress at steady state or following mobilization. Harnessing knowledge of HSPC dynamics holds potential to improve mobilization approaches and provide key insights into developing efficient mobilization-based conditioning for safer HSPC transplantation.

Regulation of Metabolic Homeostasis By TRAF6 Contributes to the Leukemia Progression

TNF receptor associated factor 6 (TRAF6) is an E3 ubiquitin ligase that mediates innate immune signaling that converges on key mediators of Toll-like receptor and interleukin-1 signaling. Dysregulated TRAF6 expression and innate immune pathway activation is implicated in the pathogenesis of various myeloid malignancies. For instance, increased TRAF6-mediated signaling in hematopoietic stem and progenitor cells (HSPCs) results in myelodysplastic syndrome-like cellular features, such as the functional impairment of HSPCs. On the other hand, our previous study indicated that loss of TRAF6 induces the leukemic transformation of pre-leukemic cells ( Muto et al. Cell Stem Cell). These paradoxical observations suggests that TRAF6 acts as both an oncogene and tumor suppressor gene in hematopoietic cells in a disease type- and context-dependent manner. However, the direct consequence of TRAF6 loss in AML cells, rather than in pre-leukemic cells, has not yet been explored. Therefore, the role of TRAF6 in the pathogenesis of AML remains obscure. In this study, we found elevated level of TRAF6 expression in AML cells, and determined the effect of TRAF6 loss on the cellular and molecular features of AML cells. We proposed a novel role of TRAF6 as a regulator of metabolic homeostasis, which is important for the progression of AML. To determine the requirement of TRAF6 in AML, we first evaluated cell the effect of TRAF6 loss in AML cell lines on proliferative capacities. Multiple types of human AML cell lines showed significant growth impairment upon TRAF6-knockdown. Furthermore, transplantation of TRAF6-deficient HSPCs expressing the leukemic oncogene MLL-AF9 to the recipient mice resulted in suppression of overt leukemia. These findings confirm that loss of TRAF6 suppresses leukemic cell function in vitro and in vivo. To assess the molecular mechanism of inhibitory effect of TRAF6 loss in AML, we next performed gene expression analysis using human AML database and TRAF6-knockdown AML cell lines. Interestingly, we found that reduced levels of TRAF6 in AML is associated with changes in the expression of genes involved in mitochondria-related processes. Our extensive in vitro validation experiments including extracellular flux assay and metabolome analysis confirmed that TRAF6 loss in AML cells induces dynamic changes in metabolites and the impairment of mitochondrial function. To identify the mechanism of metabolic alterations by TRAF6 loss in leukemia, we compared the upregulated genes in TRAF6-knockdown AML cells with the 130 previously identified essential genes for AML cell survival in vitro and in vivo ( Yamauchi et al. Cancer Cell). We focused on O-GlcNAc transferase ( OGT) as a gene associated in mitochondrial function and AML cell survival. Importantly, TRAF6 gene expression in human AML patient samples was positively correlated with the expression of OGT. To confirm the importance of OGT in the regulation of mitochondrial function mediated by TRAF6 in leukemia, we utilized the inhibitor of O-GlcNAcase (OGA), a remover of O-GlcNAc from its substrates. The treatment with MK8719 (OGA inhibitor) mildly, but significantly, restored the number of TRAF6 knockdown AML cells, which was correlated with the changes in mitochondrial function, indicating that O-GlcNAc modification regulated by TRAF6 is important for AML progression. In summary, We provide evidence for the oncogenic function of TRAF6 in leukemia, and shed light on the novel TRAF6/OGT/O-GlcNAc axis that regulates the metabolic reprogramming required for leukemogenesis.

Using Human Genetics to Develop Strategies to Increase Erythropoietic Output from Genome-Edited Hematopoietic Stem and Progenitor Cells

Genome editing is a powerful tool that enables precise changes in the genetic code of a cell. Genome-edited hematopoietic stem and progenitor cells (HSPCs) yield genome-corrected cells of all lineages, yet the only cell type of clinical relevance in red blood cell (RBC) disorders is the RBC. Most applications of genome editing have sought to correct disease-causing mutations of monogenic diseases. However, human genetic variation reveals variants that confer positive health benefits as well. In this study we took advantage of a naturally occurring human variant to increase erythropoietic output from genome-edited HSPCs. The variant leads to a condition termed congenital erythrocytosis (CE), a rare phenotype in which people have higher than normal levels of RBCs and consequently elevated hemoglobin. It is caused by truncations in the erythropoietin receptor (tEPOR) in which the intracellular inhibitory domain to erythropoietin (EPO) signaling is eliminated. The genetic cause of this phenotype was identified in a family of a Finnish Olympic gold medal-winning cross-country skier who was found to have levels of hemoglobin &amp;gt;50% higher than normal. One of the challenges in gene therapy is to achieve sufficient engraftment of genetically engineered cells to have a clinical effect. Here we sought to give edited cells a selective advantage such that low levels of engraftment might still result in a clinical benefit through use of genome editing to recreate the CE phenotype by engineering tEPOR into HSPCs in different ways. We hypothesized we could recapitulate the CE variant using CRISPR/Cas9 genome editing of HSPCs to create insertions/deletions (indels) at the EPOR locus near the site of the mutation ( EPOR c.1316G&amp;gt;A) and then transfer the cells into culture media that promotes erythroid differentiation (Fig. 1). We demonstrated increased erythropoietic output from cells containing truncating mutations in EPOR, measured by an increase in indel formation throughout erythroid differentiation (1.3-3.8-fold increase). Because not all indels created cause truncations in EPOR, we explored if we could amplify this effect by integrating an AAV6 repair template that introduces a stop codon into EPOR followed by a BGH-polyA tail and GFP marker driven by a constitutive UbC promoter. This strategy enriched for GFP + cells with the truncation even more dramatically as they developed during erythroid differentiation (2.5-4.6-fold increase). We also found a substantial increase in the total number of cells produced from the tEPOR edited condition at the end of differentiation (3.3 times greater fold increase compared to mock edited cells). Importantly, we observed no enrichment in cells kept in HSPC media or cultured in RBC media without EPO, indicating this effect is EPO-dependent (Fig. 2). Next, we investigated whether a tEPOR cDNA could be targeted to the CCR5 safe harbor locus under ubiquitous expression or to the HBA1 RBC-specific safe harbor site imparting high levels of erythroid specific expression. Integration of the tEPOR cDNA at both loci yielded strong enrichment of edited alleles in an EPO-dependent manner when put through erythroid differentiation (6.2-8.6-fold increase at CCR5 and 2.9-5.2 at HBA1). Lastly, we sought to pair the tEPOR cDNA with a clinical edit for β-thalassemia to boost production of disease-corrected RBCs. We showed that through use of bi-cistronic cassettes we were able to drive a &amp;gt;2-fold enrichment of edited alleles over the course of differentiation. Additionally, we were able to pair the tEPOR cDNA and clinical edit for β-thalassemia through multiplexed gene editing at EPOR and HBA1, respectively, and again demonstrated enrichment of edited alleles. Ultimately, we believe this work has the potential to amplify the efficacy of gene and cell therapies for blood disorders currently in the clinic. Expression of tEPOR could be integrated into any treatment for blood disorders that involve transplantation of HSPCs, including both allogeneic and autologous bone marrow transplants. Further, as low chimerism in the bone marrow could produce high levels of peripheral RBCs using our strategy, it has the potential to reduce the morbidity of myeloablation regimens currently required for cure of blood disorders. This work, in effect, has the potential to improve the safety and accessibility to currently available treatments for the millions of patients affected by RBC disorders worldwide.

Heme-deficient primitive red blood cells induce HSPC ferroptosis by altering iron homeostasis during zebrafish embryogenesis.

The crosstalk between hematopoietic lineages is important for developmental hematopoiesis. However, the role of primitive red blood cells (RBCs) in the formation of definitive hematopoietic stem and progenitor cells (HSPCs) is largely unknown. Primitive RBC deficiencies in mammals always lead to early embryonic lethality, but zebrafish lines with RBC deficiencies can survive to larval stage. By taking advantage of a zebrafish model, we find that the survival of nascent HSPCs is impaired in alas2- or alad-deficient embryos with aberrant heme biosynthesis in RBCs. Heme-deficient primitive RBCs induce ferroptosis of HSPCs through the disruption of iron homeostasis. Mechanistically, heme-deficient primitive RBCs cause blood iron-overload via Slc40a1, and an HSPC iron sensor, Tfr1b, mediates excessive iron absorption. Thus, iron-induced oxidative stress stimulates the lipid peroxidation, which directly leads to HSPC ferroptosis. Anti-ferroptotic treatments efficiently reverse HSPC defects in alas2 or alad mutants. HSPC transplantation assay reveals that the attenuated erythroid reconstitution efficiency may result from the ferroptosis of erythrocyte-biased HSPCs. Together, these results illustrate that heme-deficient primitive RBCs are detrimental to HSPC production and may provide potential implications for iron dysregulation-induced hematological malignancies.

An innovative hematopoietic stem cell gene therapy approach benefits CLN1 disease in the mouse model

Hematopoietic stem and progenitor cells (HSPCs) can establish a long‐lasting microglia‐like progeny in the central nervous system of properly myeloablated hosts. We exploited this approach to treat the severe CLN1 neurodegenerative disorder, which is the most aggressive form of neuronal ceroid lipofuscinoses due to palmitoyl‐protein thioesterase‐1 (PPT1) deficiency. We here provide the first evidence that (i) transplantation of wild‐type HSPCs exerts partial but long‐lasting mitigation of CLN1 symptoms; (ii) transplantation of HSPCs over‐expressing hPPT1 by lentiviral gene transfer enhances the therapeutic benefit of HSPCs transplant, with first demonstration of such a dose–effect benefit for a purely neurodegenerative condition like CLN1 disease; (iii) transplantation of hPPT1 over‐expressing HSPCs by a novel intracerebroventricular (ICV) approach is sufficient to transiently ameliorate CLN1‐symptoms in the absence of hematopoietic tissue engraftment of the transduced cells; and (iv) combinatorial transplantation of transduced HSPCs intravenously and ICV results in a robust therapeutic benefit, particularly on symptomatic animals. Overall, these findings provide first evidence of efficacy and feasibility of this novel approach to treat CLN1 disease and possibly other neurodegenerative conditions, paving the way for its future clinical application.

A Link between Blood Flow and the Inflammatory Networks That Govern Hematopoietic Stem Cell Specification

Hematopoietic stem and progenitor cells (HSPCs) are multipotent, self-renewing cells that maintain the blood-forming system throughout the life of all individuals. The unique properties of these cells make HSPC transplantation an effective therapy for treatment of many blood disorders. The advent of induced-pluripotent stem cells (iPSCs) led to great optimism in the field as a potentially limitless source of immunologically-matched, clinical-grade hematopoietic cells. Despite success in producing in vitro hematopoietic progenitors and cells that are capable of limited in vivo reconstitution, there are no robust, reproducible protocols that can generate long-term reconstituting HSPCs. Having a more complete understanding of the signals and molecular pathways required to develop HSPCs in their native environment will move the field forward, leading to more robust protocols and the development of novel HSPC-based therapeutics. Years of investigation have revealed that HSPCs require multiple molecular inputs for proper specification, including activity of the Notch, Wnt, FGF, and BMP signaling pathways. In addition, we have reported inflammatory signaling (Tnfa and NF-kB) as a novel group of HSPC fate modulators. However, the spatial temporal requirement of NF-kB activity has been enigmatic due to: (1) lack of tools that faithfully report the dynamic activation of NF-kB; (2) difficulty on assessing NF-kB dynamics in vivo in a mammalian system during embryonic development due to artifactual inflammatory conditions triggered by invasive techniques required for in utero experimentation. Addressing this knowledge gap will be critical for optimizing in vitro protocols for the generation of patient-specific HSPCs. To date, all existing zebrafish NF-kB reporter lines fail to report dynamic cellular activation of NF-kB in real time due to the long half-life of their fluorescent reporter proteins. To overcome this limitation, we have generated a novel NF-kB reporter zebrafish line driving a destabilized version of eGFP (D2eGFP) containing a PEST domain. This modified eGFP has a short half-life of two hours, enabling us to pinpoint the precise developmental window these signals are required. Time-lapse confocal imaging, in conjunction with flow cytometry, of double transgenic kdrl:mCherry, NF-kB:D2eGFP embryos revealed that NF-kB was activated in vivo within the hemogenic endothelium (HE) just prior to the establishment of circulation (18-24 hpf) and was deactivated soon after its initiation (26 hpf). When this window of NF-kB activity was disrupted by inhibiting the translocation of the NF-kB p65 subunit to the nucleus using Caffeic acid phenethyl ester (CAPE), HSPCs failed to specify. qPCR analysis from FACS-isolated HE with activated NF-kB kdrl:mCherry+ ,NF-kB:D2eGFP+ and the surrounding endothelium kdrl:mCherry+ ,NF-kB:D2eGFP- showed a significant enrichment of the early HSPC markers gfi1 and runx1 in the NF-kB+ endothelial population at 22 hpf. In addition, mRNAseq of kdrl:mCherry+ HE of NF-kB+ showed hematopoietic GO terms enriched, demonstrating that NF-kB is a contributing activator of the endothelial to hematopoietic transition. Blood flow is a well-known conserved regulator of HSPC formation. To investigate the correlation between NF-kB deactivation and circulation, blood flow was inhibited by morpholino knockdown of tnnt2a in Tg(kdrl:mCherry, NF-kB:D2eGFP) embryos and assessed by confocal microscopy and flow cytometry for NF-kB activity. In the absence of circulation, NF-kB displayed sustained activity throughout the HE. To determine if this prolonged NF-kB activity was contributing to the loss of HSPCs observed in tnnt2a morphants, we blocked NF-kB at the developmental time circulation would normally occur using CAPE and observed a significant rescue of HSPC numbers. These data provide evidence of a link between the extrinsic biomechanical forces of blood flow and the intrinsic molecular regulation of the inflammatory networks that govern HSPC specification. Altogether, our NF-kB reporter line provides one of the earliest markers that can be utilized to isolate HE in vivo. These data pinpoint the early NF-kB requirement to form HSPCs and could be applied in vitro to improve current protocols of hematopoietic differentiation from human PSCs.

Comparing the Impact of NHEJ-CRISPR/Cas9 and Base Gene Editing on Rhesus Macaque Hematopoietic Stem Cell Clonal Behavior and Integrity

Despite recent transformative advancements in gene editing tools and hematopoietic stem and progenitor cell (HSPC) gene therapies, there are still unanswered questions about the impact of CRISPR/Cas9 and base editing technologies on HSPC clonal behavior, function, and integrity in vivo. Better understanding of the impact of available gene therapy modalities on HSCs in a relevant animal model should help safely move these therapies forward for clinical use and provide information regarding their relative advantages and risks. CRISPR/Cas9 editing generates double strand DNA breaks (DSBs) at targeted genomic locations and potentially at off-target sites, resulting in potential HSC genotoxicity and loss. To counter DSB-related consequences, base editors (BEs) have been developed with the ability to produce single-nucleotide conversion without DSBs, avoiding potentially deleterious DNA damage repair pathways. CD33 is expressed on all myeloid cells downstream of the common myeloid progenitor and is used as both a diagnostic marker and a therapeutic target for acute myeloid leukemia. Our past work demonstrated successful Cas9/NHEJ-mediated CD33 KO in rhesus macaque (RM) HSPCs with no functional impact (Kim et al, Cell, 2018). In the current study, we first genetically barcoded RM HSPCs, and then knocked out the CD33 locus with the intent of comparing the clonal impact of CRISPR/Cas9 editing via non-homologous end joining (NHEJ) to base editing in RM HSPCs in vitro by myeloid differentiation assays and in vivo following autologous HSPC transplantation. Highly diverse DNA barcodes were introduced into RM HSPCs via transduction with a lentiviral vector also expressing GFP. 24 hours later, the cells were electroporated with either Cas9/NHEJ or BE complexes targeted to disrupt CD33. Cells were further cultured in myeloid differentiation media for 8 days in vitro for differentiation assays (IVD). Cell viability and proliferation were analyzed over time during IVD. DNA was collected on day 8 for editing efficiency and barcode clonal analysis. In addition, GFP and CD33 expression were analyzed by flow cytometry to assess CD33 KO efficiency and examine whether the addition of gene editors impacted the clonality of the HSPCs as assessed by barcode retrieval, and whether the initial lentiviral transduction impacted editing efficiency. HSPC colony-forming unit (CFU) assays were carried out to assess differentiation potential of the transduced and/or edited HSPCs and check for biallelic versus monoallelic editing status at a clonal level. Throughout the 8 days of IVD, cell numbers increased overtime and maintained high cell viability (80-95%) in all test groups, which indicates barcoded lentiviral transduction and gene editing procedures had minimal impact on cell proliferation and viability. Base editing resulted in 80-85% CD33 KO efficiency, regardless of barcode lentivirus transduction prior to gene editing. However, Cas9/NHEJ was significantly less efficient, with CD33 KO efficiency of 10-20%, requiring additional optimization (Figure 1A). Variant allele frequency analysis confirmed the relative levels of CD33 locus editing by both editing methods. CFU assays indicated the lentiviral transduction and gene editing methods do not alter the HSPC differentiation potential as assessed in vitro. Barcode clonal analysis revealed both NHEJ and BE test groups demonstrated retention of high clonal diversity as assessed by Shannon Diversity Index, all > 8 regardless of gene editing methods (Figure 1B). In summary, lentiviral barcode transduction and editing procedures had no negative impact on cell viability and proliferation. Base editing allowed very high gene editing efficiency in HSPCs and can serve as a powerful editing tool. Importantly, both editing methods resulted highly diverse polyclonal clonal patterns in vitro long term, with no significant differences compared to the non-edited group. Combining genetic barcode technology and the BE or Cas9/NHEJ editing in an in vivo RM autologous HSPC transplantation model to track the hematopoietic clonal reconstitution of the edited HSPCs over time and compare the impact of BE or Cas9/NHEJ editing on engrafting HSPCs clonal behavior is ongoing. Therefore, these clinically relevant findings can determine which gene editing method is more suitable for developing human HSPC gene therapies. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Injectable bone marrow microniches by co-culture of HSPCs with MSCs in 3D microscaffolds promote hematopoietic reconstitution from acute lethal radiation.

Hematopoietic syndrome of acute radiation syndrome (h-ARS) is an acute illness resulted from the damage of bone marrow (BM) microenvironment after exposure to radiation. Currently, the clinical management of h-ARS is limited to medication-assisted treatment, while there is still no specific therapy for the hematopoietic injury from high-dose radiation exposure. Our study aimed to assemble biomimetic three-dimensional (3D) BM microniches by co-culture of hematopoietic stem and progenitor cells (HSPCs) and mesenchymal stem cells (MSCs) in porous, injectable and viscoelastic microscaffolds in vitro. The biodegradable BM microniches were then transplanted in vivo into the BM cavity for the treatment of h-ARS. We demonstrated that the maintenance of HSPCs was prolonged by co-culture with MSCs in the porous 3D microscaffolds with 84 μm in pore diameter and 11.2 kPa in Young's modulus compared with 2D co-culture system. Besides, the minimal effective dose and therapeutic effects of the BM microniches were investigated on a murine model of h-ARS, which showed that the intramedullary cavity-injected BM microniches could adequately promote hematopoietic reconstitution and mitigate death from acute lethal radiation with a dose as low as 1000 HSPCs. Furthermore, the mRNA expression of Notch1 and its downstream target gene Hes1 of HSPCs were increased when co-cultured with MSCs, while the Jagged1 expression of the co-cultured MSCs was upregulated, indicating the significance of Notch signaling pathway in maintenance of HSPCs. Collectively, our findings provide evidence that biomimetic and injectable 3D BM microniches could maintain HSPCs, promote hematopoiesis regeneration and alleviate post-radiation injury, which provides a promising approach to renovate conventional HSPCs transplantation for clinical treatment of blood and immune disorders.

Living Biomaterials to Engineer Hematopoietic Stem Cell Niches.

Living biointerfaces are a new class of biomaterials combining living cells and polymeric matrices that can act as biologically active and instructive materials that host and provide signals to surrounding cells. Here, living biomaterials based on Lactococcus lactis to control hematopoietic stem cells in 2D surfaces and 3D hydrogels are introduced. L. lactis is modified to express C-X-C motif chemokine ligand 12 (CXCL12), thrombopoietin (TPO), vascular cell adhesion protein 1 (VCAM1), and the 7th-10th type III domains of human plasma fibronectin (FN III7-10 ), in an attempt to mimic ex vivo the conditions of the human bone marrow. These results suggest that living biomaterials that incorporate bacteria expressing recombinant CXCL12, TPO, VCAM1, and FN in both 2D systems direct hematopoietic stem and progenitor cells (HSPCs)-bacteria interaction, and in 3D using hydrogels functionalized with full-length human plasma fibronectin allow for a notable expansion of the CD34+ /CD38- /CD90+ HSPC population compared to the initial population. These results provide a strong evidence based on data that suggest the possibility of using living materials based on genetically engineered bacteria for the ex-vivo expansion of HSPC with eventual practical clinical applications in HSPCs transplantation for hematological disorders.

Differential CXCR4 expression on hematopoietic progenitor cells versus stem cells directs homing and engraftment.

Gene therapy involves a substantial loss of hematopoietic stem and progenitor cells (HSPC) during processing and homing. Intra-BM (i.b.m.) transplantation can reduce homing losses, but prior studies have not yielded promising results. We studied the mechanisms involved in homing and engraftment of i.b.m. transplanted and i.v. transplanted genetically modified (GM) human HSPC. We found that i.b.m. HSPC transplantation improved engraftment of hematopoietic progenitor cells (HPC) but not of long-term repopulating hematopoietic stem cells (HSC). Mechanistically, HPC expressed higher functional levels of CXCR4 than HSC, conferring them a retention and homing advantage when transplanted i.b.m. Removing HPC and transplanting an HSC-enriched population i.b.m. significantly increased long-term engraftment over i.v. transplantation. Transient upregulation of CXCR4 on GM HSC-enriched cells, using a noncytotoxic portion of viral protein R (VPR) fused to CXCR4 delivered as a protein in lentiviral particles, resulted in higher homing and long-term engraftment of GM HSC transplanted either i.v. or i.b.m. compared with standard i.v. transplants. Overall, we show a mechanism for why i.b.m. transplants do not significantly improve long-term engraftment over i.v. transplants. I.b.m. transplantation becomes relevant when an HSC-enriched population is delivered. Alternatively, CXCR4 expression on HSC, when transiently increased using a protein delivery method, improves homing and engraftment specifically of GM HSC.

Hemgn Protects Hematopoietic Stem and Progenitor Cells Against Transplantation Stress Through Negatively Regulating IFN-γ Signaling.

Hematopoietic stem and progenitor cells (HSPCs) possess the remarkable ability to regenerate the whole blood system in response to ablated stress demands. Delineating the mechanisms that maintain HSPCs during regenerative stresses is increasingly important. Here, it is shown that Hemgn is significantly induced by hematopoietic stresses including irradiation and bone marrow transplantation (BMT). Hemgn deficiency does not disturb steady‐state hematopoiesis in young mice. Hemgn −/‐ HSPCs display defective engraftment activity during BMT with reduced homing and survival and increased apoptosis. Transcriptome profiling analysis reveals that upregulated genes in transplanted Hemgn −/− HSPCs are enriched for gene sets related to interferon gamma (IFN‐γ) signaling. Hemgn −/− HSPCs show enhanced responses to IFN‐γ treatment and increased aging over time. Blocking IFN‐γ signaling in irradiated recipients either pharmacologically or genetically rescues Hemgn −/‐ HSPCs engraftment defect. Mechanistical studies reveal that Hemgn deficiency sustain nuclear Stat1 tyrosine phosphorylation via suppressing T‐cell protein tyrosine phosphatase TC45 activity. Spermidine, a selective activator of TC45, rescues exacerbated phenotype of HSPCs in IFN‐γ‐treated Hemgn −/− mice. Collectively, these results identify that Hemgn is a critical regulator for successful engraftment and reconstitution of HSPCs in mice through negatively regulating IFN‐γ signaling. Targeted Hemgn may be used to improve conditioning regimens and engraftment during HSPCs transplantation.

Hematopoietic Stem Cell Gene Therapy for Cystinosis: From Bench-to-Bedside.

Cystinosis is an autosomal recessive metabolic disease that belongs to the family of lysosomal storage disorders. The gene involved is the CTNS gene that encodes cystinosin, a seven-transmembrane domain lysosomal protein, which is a proton-driven cystine transporter. Cystinosis is characterized by the lysosomal accumulation of cystine, a dimer of cysteine, in all the cells of the body leading to multi-organ failure, including the failure of the kidney, eye, thyroid, muscle, and pancreas, and eventually causing premature death in early adulthood. The current treatment is the drug cysteamine, which is onerous and expensive, and only delays the progression of the disease. Employing the mouse model of cystinosis, using Ctns−/− mice, we first showed that the transplantation of syngeneic wild-type murine hematopoietic stem and progenitor cells (HSPCs) led to abundant tissue integration of bone marrow-derived cells, a significant decrease in tissue cystine accumulation, and long-term kidney, eye and thyroid preservation. To translate this result to a potential human therapeutic treatment, given the risks of mortality and morbidity associated with allogeneic HSPC transplantation, we developed an autologous transplantation approach of HSPCs modified ex vivo using a self-inactivated lentiviral vector to introduce a functional version of the CTNS cDNA, pCCL-CTNS, and showed its efficacy in Ctns−/− mice. Based on these promising results, we held a pre-IND meeting with the Food and Drug Administration (FDA) to carry out the FDA agreed-upon pharmacological and toxicological studies for our therapeutic candidate, manufacturing development, production of the GMP lentiviral vector, design Phase 1/2 of the clinical trial, and filing of an IND application. Our IND was cleared by the FDA on 19 December 2018, to proceed to the clinical trial using CD34+ HSPCs from the G-CSF/plerixafor-mobilized peripheral blood stem cells of patients with cystinosis, modified by ex vivo transduction using the pCCL-CTNS vector (investigational product name: CTNS-RD-04). The clinical trial evaluated the safety and efficacy of CTNS-RD-04 and takes place at the University of California, San Diego (UCSD) and will include up to six patients affected with cystinosis. Following leukapheresis and cell manufacturing, the subjects undergo myeloablation before HSPC infusion. Patients also undergo comprehensive assessments before and after treatment to evaluate the impact of CTNS-RD-04 on the clinical outcomes and cystine and cystine crystal levels in the blood and tissues for 2 years. If successful, this treatment could be a one-time therapy that may eliminate or reduce renal deterioration as well as the long-term complications associated with cystinosis. In this review, we will describe the long path from bench-to-bedside for autologous HSPC gene therapy used to treat cystinosis.