Methods of Using Human Mesenchymal Stem Cells to Effect Cellular and

Humoral Immunity

FIELD OF THE INVENTION

[0001] The present invention relates to methods of administering therapeutically effective amounts of isolated populations of allogeneic mesenchymal stem cells to effect cellular and humoral immunity in subjects suffering from non-ischemic dilated cardiomyopathy. The present invention also relates to methods of administering therapeutically effective amounts of isolated populations of allogeneic mesenchymal stem cells to effect cellular and humoral immunity in subjects suffering from symptoms of aging frailty.

BACKGROUND OF THE INVENTION

Aging Frailty and Inflammaging

[0002] Aging frailty poses a very concerning problem for the overall health and well- being of individuals and is characterized as a syndrome of multisystem physiological dysregulation. Aging frailty is a geriatric syndrome characterized by weakness, low physical activity, slowed motor performance, exhaustion, and unintentional weight loss. See Yao, X. et al, Clinics in Geriatric Medicine 27(7^:79-87 (2011). Furthermore, there are many studies showing a direct correlation between aging frailty and inflammation. See Hubbard, R E. et al, Biogerontoiogy 11 (5):6i5-(A\ (2010).

[0003] Immunosenescence is characterized by a low grade, chronic systemic inflammatory state known as inflammaging. See Franceshi, C. et al, Annals of the New York Academy of Sciences 908:244-254 (2000). This heightened inflammatory state or chronic inflammation found in aging and aging frailty leads to immune dy sregulation and a complex remodeling of both innate and adaptive immunity. In immunosenescence, the T cell and B cell repertoire is skewed resulting in an increase in CD8 ⁺ T effector memory cells re- expressing CD45ra (TEMRA) and in the CD19 ⁺ late/exhausted memory B cells, and a decrease in the CD8 ¹ Naive T cells, and in the switched memory B cells (CD27 ⁺ ). See Blomberg, B.B. et al, Immunologic Research 57(1 -3) :354-360 (2013); Colonna-Romano, G. et al, Mechanisms of Ageing and Development 130(10):6M-690 (2009); and Koch S. et al, Immunity & Ageing: 5:6 (2008). This shift in the T cell and B cell repertoire results in a refractoiy or less efficient immune status. It is well known that age-associated increase in systemic inflammation (TNF-ot, IL-6, IL-8, INFy and CRP) induces impaired B cell function.

[0004] Inflammaging has received considerable attention because it proposes a link between immune changes and a number of diseases and conditions (such as aging frailty) common in old age. Circulating inflammatory mediators such as cytokines and acute phase proteins are markers of the low-grade inflammation observed to increase with aging. These pro-inflammatory cytokines (e.g., TNF-α, IL-6) impair the capacity of B cells to make protective antibodies to exogenous antigens and vaccines. This impaired B cell response is measured by reduced class switch recombination (CSR) which is the ability of immunoglobulins to switch isotype from IgM to a secondary isotype (IgG, IgA, or IgE). Immunoglobulin isotype switching is crucial for a proper immune response as the effector functions differ in each isotype. A key player in CSR and somatic hypermutation (SHM) is the enzyme, activation-induced cytidine deaminase (AID), encoded by the Aicda gene. AID's basic function in CSR and SHM is to initiate breaks in the DNA by converting cytosines to uracils in the switch and variable regions of immunoglobulins. E47, encoded by the Tcfe2a (E2A) gene, is a transcription factor belonging to the class I basic helix loop helix (bHLH) proteins, also known as E proteins. Without E47 expression, the B cell specific transcription factors EBF1 (early B cell factor) and Pax-5 (paired box protein) are not expressed. Both E47 and Pax-5 are key transcription factors in early development for the B cell lineage and mature B cell function. See Hagman J. el al., Immunity 27(1):%-\ Q (2007); Horcher M. et al, Immunity 14(6) J79-790 (2001); Riley R.L. et al, Seminars in Immunology 17(5).330-336 (2005). The Pax-5 gene encodes the B cell lineage specific activator protein (BSAP) that is expressed at all stages of B cell differentiation, but not in terminally differentiated B cells. Pax-5 controls B cell commitment by repressing B lineage inappropriate genes and activating B cell specific genes making Pax-5 the B cell gatekeeper and is exclusively expressed in the B lymphoid lineage from the committed pro-B cell to the mature B cell stage. The B cell specific transcription factor, Pax-5, is not only highly important in early B cell development and B cell lineage commitment, it is also involved in CSR.

[0005] It has also been shown in humans that the amount of TNF-a made: (1) depends on the amount of system inflammation and (2) impairs the ability of the same B cells to be stimulated with mitogens or antigens. See Frasca, D. et al., Journal of Immunology 188(1):Π9-2&6 (2012). Thus, the immune response in subjects suffering from aging frailty is impaired for a number of reasons.

Non-Ischemic Dilated Cardiomyopathy (NIDCM)

[0006] Non-ischemic dilated cardiomyopathy (NIDCM) is a progressive disorder with no current cure, often culminating in heart transplantation. See Felker, G.M. et al, The New England Journal of Medicine 342:1077-84 (2000) and Kirklin, J.K. et al, J. Heart Lung Transplant. 35:407-412 (2016). NIDCM is a disorder with a major component of immune dysregulation as an underlying etiology. See Efthimiadis, I. et al, Hippokratia 75:335-342 (2011) and Meng, X. etal, Nature Reviews Cardiology 75:167-79 (2016). Cell-based therapy for heart disease is a promising new treatment strategy undergoing evaluation, with a major challenge and opportunity in developing allogeneic therapy. See Patel, A.N. et al, Lancet 557:2412-21 (2016); Assmus, B. el al, The New England Journal of Medicine 555:1222-32 (2006); Hare, J.M. et al, J Am. Coll. Cardiol. 54:2277-86 (2009); Heldman, A.W. et al, JAMA 577:62-73 (2014); Perin, EC. et al, JAMA 307:1717-26 (2012); Golpanian, S. et al, Physiol Rev. 96: 1127-68 (2016); and Hare, J.M. etal, JAMA 505:2369-79 (2012).

Mesenchymal Stem Cells

[0007] Mesenchymal stem cells are multipotent cells able to migrate to sites of injury, while also being immunoprivileged by not detectably expressing major histocompatibility complex class II (MHC-II) molecules, and expressing MHC-I molecules at low levels. See Le Blanc, K. et al, Ixmcet 577(962^:1579-1586 (2008) and Klyushnenkova E el al, J. Biomed. Sci. 12(1)Ά7-57 (2005). As such, allogeneic mesenchymal stem cells hold great promise for therapeutic and regenerative medicine, and have been repeatedly shown to have a high safety and efficacy profile in clinical trials for multiple disease processes. See Hare, J.M. et al, Journal of the American College of Cardiology 54(24):2277-22%β (2009); Hare, J.M. et al, Tex. Heart Inst. J. 56^:145-147 (2009); and Lalu, M.M. et al, PloS One 7(10):o47559 (2012). They have also been shown to not undergo malignant transformation after transplantation into patients. See Togel F. et al, American Journal of Physiology Renal Physiology 289(1):¥31-F42 (2005). Treatment with mesenchymal stem cells has been shown to ameliorate severe graft-versus-host disease, protect against ischemic acute renal failure, contribute to pancreatic islet and renal glomerular repair in diabetes, reverse fulimant hepatic failure, regenerate damaged lung tissue, attenuate sepsis, and reverse remodeling and improve cardiac function after myocardial infarction. See Le Blanc K. et al, Lancet 371(9624):1579- 1586 (2008); Hare, J.M. et al, Journal of the American College of Cardiology 54(24):2277- 2286 (2009); Togel F. et al, American Journal of Physiology Renal Physiology 289(1):Έ3\- F42 (2005); Lee R.H. et al, PNAS 103(46): 17438-17442 (2006); Parekkadan, B. et al, PloS One 2(9):Q94\ (2007); Ishizawa K. et al., FEBS Letters 556(7-5/249-252 (2004); Nemeth K. et al., Nature Medicine 75(7/42-49 (2009); Iso Y. et al., Biochem. Biophys. Res. Comm. 354(3):700-706 (2007); Schuleri K.H. et al., Eur. Hearth J. 50^22/2722-2732 (2009); and Heldman AW. et al., JAMA 577(7/62-73 (2014). Furthermore, mesenchymal stem cells are also a potential source of multiple cell types for use in tissue engineering. See Gong Z. et al. Methods in Mol. Bio. 698:279-294 (2011); Price, A.P. et al, Tissue Engineering Part A 76(8/2581-2591 (2010); and Togel F. etal, Organogenesis 7(2/96-100 (2011).

[0008] Mesenchymal stem cells have immuno-modulatory capacity. They control inflammation and the cytokine production of lymphocytes and myeloid-derived immune cells without evidence of immunosuppressive toxicity' and are hypo-immunogenic. See Bernardo M.E. etal, Cell Stem Cell 75(^/392-402 (2013).

[0009] Mesenchymal stem cells also have the capacity to differentiate not only into cells of mesodermal origin, but into cells of endodermal and ectodermal origin. See Le Blanc K. et al, Exp. Hematol. 37(70/890-896 (2003). For example, in vitro, mesenchymal stem cells cultured in airway growth media differentiate to express lung-specific epithelial markers, e.g., surfactant protein-C, Clara cell secretory protein, and thyroid transcription factor-1. See Jiang Y. et al. Nature 418(6893)A\-49 (2002) and Kotton D.N. et al, Development 728(24/5181-5188 (2001).

[00010] In vivo studies have shown mat human mesenchymal stem cells undergo site- specific differentiation into various cell types, including myocytes and cardiomyocytes, when transplanted into fetal sheep. See Airey J.A. et al, Circulation 109(1!); ] 401-1407 (2004). These mesenchymal stem cells can persist for as long as 13 months in multiple tissues after transplantation in non-immunosuppressed immunocompetent hosts. Other in vivo studies using rodents, dogs, goats, and baboons similarly demonstrate that human mesenchymal stem cells xenografts do not evoke lymphocyte proliferation or systemic allo-antibody production in the recipient. See Klyushnenkova E. et al., J. Biomed. Sci. 12(l):47-57 (2005); Aggarwal S. et al, Blood 705(4/1815-22 (2005); Augello A. et al, Arthritis and Rheumatism 56(4): \ 175-86 (2007); Bartholomew A. et al. Exp Hematol. 30(7/42-48. (2002); Dokic J. el al, European Journal of Immunology 43(7):\%62-72 (2013); Gerdoni E. et al, Annals of Neurology 61(3)219-227 (2007); Lee S.H. et al, Respiratory Research 77:16 (2010); Urban V.S. et al, Stem Cells 26(7/244-253 (2008); Yang H. et al, PloS One 8(7/e69129 (2013); Zappia E. et al. Blood 106(5): 1755-1761 (2005); Bonfield T.L. et al, American Journal of Physiology Lung Cellular and Molecular Physiology 299(6)±760-70 (2010); Glenn J.D. ei al, World Journal of Stem Cells. 6(5):526-39 (2014); Guo K. et al, Frontiers in Cell and Developmental Biology 2:8 (2014); Puissant B. et al, British Journal of Haematology 129(1): 118-129 (2005); and Sun L. et al, Stem Cells 27^:1421-32 (2009). Taken as a whole, these repeated finding of allogeneic safety and efficacy solidify the notion for using mesenchymal stem cells as an allograft for successful tissue regeneration.

[00011] However, despite being a safe therapeutic agent, mesenchymal stem cells are reported in the literature to exert a suppressive effect on antibody production as well as proliferation and maturation of B cells. See Uccelli, A. et al. Trends in Immunology 28(5):2\9-226 (2007). Mesenchymal stem cells are also reported to inhibit the generation and function of antigen presenting cells. See Hoogduijn M.J. et al, Int. Immunopharmacology I0(12):1496-1500 (2010). Finally, mesenchymal stem cells are reported to suppress CD4 ⁺ and CD8 ⁺ T cell proliferation. See Ghannam S. et al, Stem Cell Res. & Ther. 1:2 (2010). Finally, some preclinical data indicates a higher risk of immunological clearance with administration of allogeneic mesenchymal stem cells as compared to the administration of autologous mesenchymal stem cells. See, e.g., Huang, X.P. etal, Circulation 722:2419-29 (2010).

SUMMARY

[00012] Surprisingly, despite the reports of mesenchymal stem cells having a suppressive effect on aspects of the immune system, the present inventors discovered a method of treating non-ischemic dilated cardiomyopathy in a subject, comprising administering a therapeutically effective amount of a population of isolated allogeneic human mesenchymal stem cells to a subject in need thereof. The present inventors also discovered a method of treating symptoms of aging frailty in a subject, comprising administering a therapeutically effective amount of a population of isolated allogeneic human mesenchymal stem cells to a subject in need thereof. The present inventors identified several biomarkers specific for non-ischemic dilated cardiomyopathy and aging frailty including, but not limited to, the levels of exhausted B cells (CD19 ⁺ , CD27 ^" , lgD ^" ), the levels of switched memory B cells (CD19 ⁺ , CD27 ^high , IgD-), the levels of B-cells expressing intracellular TNF-α, the levels of early activated T-cells (CD3 ⁺ , CD69 ⁴ ), the levels of chronic activated T-cells (CD3 ⁺ , CD25 ⁺ ), the levels of Temra cells (CD45RA ⁺ , CCR7 ^" ), the CD4 ⁺ :CD8 ⁺ T cell ratio, and the TNF-a concentration in serum.

[00013] One aspect of the invention relates to a method of treating non-ischemic dilated cardiomyopathy in a subject, comprising administering a therapeutically effective amount of a population of isolated allogeneic human mesenchymal stem cells to a subject in need thereof, wherein the number of exhausted B cells (CD19 ⁺ , CD27 ^" , IgD ^" ) in a sample of the subject' serum decreases by at least 25% as compared to the number of exhausted B cells in a sample of the subject's serum prior to administration of the population of isolated allogeneic human mesenchymal stem cells, thereby treating the non-ischemic dilated cardiomyopathy.

[00014] Another aspect of the invention relates to a method of treating non-ischemic dilated cardiomyopathy in a subject, comprising administering a therapeutically effective amount of a population of isolated allogeneic human mesenchymal stem cells to a subject in need thereof, wherein the number of switched memory B cells (CD19 ⁺ , CD27 ^high , IgD ^" ) in a sample of the subject's serum increases by at least 100% as compared to the number of switched memory B cells in a sample of the subject's serum prior to administration of the population of isolated allogeneic human mesenchymal stem cells, thereby treating the nonischemic dilated cardiomyopathy.

[00015] Another aspect of the invention relates to a method of treating non-ischemic dilated cardiomyopathy in a subject, comprising administering a therapeutically effective amount of a population of isolated allogeneic human mesenchymal stem cells to a subject in need thereof, wherein the number of B-cells expressing intracellular TNF-a in a sample of the subject's serum decreases by at least 30% as compared to the number of B-cells expressing intracellular TNF-a in a sample of the subject's serum prior to administration of the population of isolated allogeneic human mesenchymal stem cells, thereby treating the nonischemic dilated cardiomyopathy.

[00016] Another aspect of the invention relates to a method of treating non-ischemic dilated cardiomyopathy in a subject, comprising administering a therapeutically effective amount of a population of isolated allogeneic human mesenchymal stem cells to a subject in need thereof, wherein the number of early activated T-cells (CD3 ⁺ , CD69 ⁺ ) in a sample of the subject's serum decreases by at least 30% as compared to the number of early activated T- cells in a sample of the subject's serum prior to administration of the population of isolated allogeneic human mesenchymal stem cells, thereby treating the non-ischemic dilated cardiomyopathy. [00017] Another aspect of the invention relates to a method of treating non-ischemic dilated cardiomyopathy in a subject, comprising administering a therapeutically effective amount of a population of isolated allogeneic human mesenchymal stem cells to a subject in need thereof, wherein the number of chronic activated T-cells (CD3 ⁺ , CD25 ⁺ ) in a sample of the subject's serum decreases by at least 70% as compared to the number of chronic activated T-Cells in a sample of the subject's serum prior to administration of the population of isolated allogeneic human mesenchymal stem cells, thereby treating the non-ischemic dilated cardiomyopathy.

[00018] Another aspect of the invention relates to a method of treating non-ischemic dilated cardiomyopathy in a subject, comprising administering a therapeutically effective amount of a population of isolated allogeneic human mesenchymal stem cells to a subject in need thereof, wherein the number of Temra cells (CD45RA ^f , CCR7 ^' ) in a sample of the subject's serum decreases by at least 40% as compared to the number of Temra cells in a sample of the subject's serum prior to administration of the population of isolated allogeneic human mesenchymal stem cells, thereby treating the non-ischemic dilated cardiomyopathy.

[00019] Another aspect of the invention relates to a method of treating non-ischemic dilated cardiomyopathy in a subject, comprising administering a therapeutically effective amount of a population of isolated allogeneic human mesenchymal stem cells to a subject in need thereof, wherein the TNF-a concentration in a sample of the subject's serum decreases by at least 80% as compared to the TNF-a concentration in a sample of the subject's serum prior to administration of the population of isolated allogeneic human mesenchymal stem cells, thereby treating the non-ischemic dilated cardiomyopathy.

[00020] Another aspect of the invention relates to a method of treating symptoms of aging frailty in a subject, comprising administering a therapeutically effective amount of a population of isolated allogeneic human mesenchymal stem cells to a subject in need thereof, wherein the number of exhausted B cells (CD19 ⁺ , CD27 ^" , IgD ^" ) in a sample of the subject' serum decreases by at least 10% as compared to the number of exhausted B cells in a sample of the subject's serum prior to administration of the population of isolated allogeneic human mesenchymal stem cells, thereby treating the symptoms of aging frailty.

[00021] Another aspect of the invention relates to a method of treating symptoms of aging frailty in a subject, comprising administering a therapeutically effective amount of a population of isolated allogeneic human mesenchymal stem cells to a subject in need thereof, wherein the number of switched memory in a sample of the subject's serum increases by at least 75% as compared to the number of switched memory B cells in a sample of the subject's serum prior to administration of the population of isolated allogeneic human mesenchymal stem cells, thereby treating the symptoms of aging frailty.

[00022] Another aspect of the invention relates to a method of treating symptoms of aging frailty in a subject, comprising administering a therapeutically effective amount of a population of isolated allogeneic human mesenchymal stem cells to a subject in need thereof, wherein the number of B-cells expressing intracellular TNF-a in a sample of the subject's serum decreases by at least 60% as compared to the number of B-cells expressing intracellular TNF-a in a sample of the subject's serum prior to administration of the population of isolated allogeneic human mesenchymal stem cells, thereby treating the symptoms of aging frailty.

[00023] Another aspect of the invention relates to a method of treating symptoms of aging frailty in a subject, comprising administering a therapeutically effective amount of a population of isolated allogeneic human mesenchymal stem cells to a subject in need thereof, wherein the number of early activated T-cells (CD3 ⁺ , CD69 ⁺ ) in a sample of the subject's serum decreases by at least 30% as compared to the number of early activated T-cells in a sample of the subject's serum prior to administration of the population of isolated allogeneic human mesenchymal stem cells, thereby treating the symptoms of aging frailty.

[00024] Another aspect of the invention relates to a method of treating symptoms of aging frailty in a subject, comprising administering a therapeutically effective amount of a population of isolated allogeneic human mesenchymal stem cells to a subject in need thereof, wherein the number of chronic activated T-cells (CD3 ⁺ , CD25 ⁺ ) in a sample of the subject's serum decreases by at least 75% as compared to the number of chronic activated T-Cells in a sample of the subject's serum prior to administration of the population of isolated allogeneic human mesenchymal stem cells, thereby treating the symptoms of aging frailty.

[00025] Another aspect of the invention relates to a method of treating symptoms of aging frailty in a subject, comprising administering a therapeutically effective amount of a population of isolated allogeneic human mesenchymal stem cells to a subject in need thereof, wherein the number of Temra cells (CD45RA ⁺ , CCR7 ^" ) in a sample of the subject's serum decreases by at least 20% as compared to the number of Temra cells in a sample of the subject's serum prior to administration of the population of isolated allogeneic human mesenchymal stem cells, thereby treating the symptoms of aging frailty. [00026] Another aspect of the invention relates to a method of treating symptoms of aging frailty in a subject, comprising administering a therapeutically effective amount of a population of isolated allogeneic human mesenchymal stem cells to a subject in need thereof, wherein the TNF-a concentration in a sample of the subject's serum decreases by at least 50% as compared to the TNF-a concentration in a sample of the subject's serum prior to administration of the population of isolated allogeneic human mesenchymal stem cells, thereby treating the symptoms of aging frailty.

[00027] Another aspect of the invention relates to a method of treating symptoms of aging frailty in a subject, comprising administering a therapeutically effective amount of a population of isolated allogeneic human mesenchymal stem cells to a subject in need thereof, wherein the CD4 ⁺ :CD8 ⁺ T cell ratio in a sample of the subject's serum increases by at least 100% as compared to the CD4 ⁺ :CD8 ⁺ T cell ratio in a sample of the subject's serum prior to administration of the population of isolated allogeneic human mesenchymal stem cells, thereby treating the symptoms of aging frailty

[00028] In one embodiment of the invention, the subject is a human. In another embodiment of the invention, the subject is a human who exhibits infiammaging.

[00029] In one embodiment of the invention, the mesenchymal stem cells are bone marrow-derived mesenchymal stem cells. In one embodiment of the invention, the mesenchymal stem cells do not express STRO-1. In another embodiment of the invention, the mesenchymal stem cells do not express CD45. In another embodiment of the invention, the mesenchymal stem cells do not express fibroblast surface markers or have a fibroblast morphology. In another embodiment of the invention, the mesenchymal stem cells are not genetically manipulated.

[00030] In another embodiment of the invention, the isolated population of allogeneic mesenchymal stem cells is administered in a single dose. In another embodiment of the invention, the isolated population of allogeneic mesenchymal stem cells is administered in multiple doses, e.g., two or more doses. In another embodiment of the invention, the isolated population of allogeneic mesenchymal stem cells is administered at least yearly.

[00031] In one embodiment, the isolated population of allogeneic mesenchymal stem cells is administered systemically. In one embodiment of the invention, the isolated population of allogeneic mesenchymal stem cells is administered by infusion or direct injection. In one embodiment of the invention, the isolated population of allogeneic mesenchymal stem cells is administered intravenously, intraarterially, intramuscularly, intraperitoneally, subcutaneously, intradermally, orally, transendocardially, or intranasally. In a further embodiment, the isolated population of allogeneic mesenchymal stem cells is administered intravenously. In a further embodiment, the isolated population of allogeneic mesenchymal stem cells is administered intramuscularly.

[00032] In one embodiment of the invention, the isolated population of allogeneic mesenchymal stem cells is administered at a dose of about 20x10 ⁶ mesenchymal stem cells. In another embodiment of the invention, the isolated population of allogeneic mesenchymal stem cells is administered at a dose of about lOOxlO ⁶ mesenchymal stem cells. In another embodiment of the invention, the isolated population of allogeneic mesenchymal stem cells is administered at a dose of about 200x10 ⁶ mesenchymal stem cells.

[00033] In one embodiment of the invention, the isolated population of allogeneic mesenchymal stem cells are obtained from a human donor and wherein a step of MHC matching of the human donor to the subject is not employed prior to the administration of the isolated population of allogeneic mesenchymal stem cells to the subject.

[00034] Another aspect of the invention relates to a method of evaluating cellular and humoral immunity status in a subject, comprising:

(1) obtaining a serum sample from a subject selected for evaluation based on a determination that the subject was previously in need of treatment of non-ischemic dilated cardiomyopathy and the subject had been administered an initial dose of an isolated population of allogeneic human mesenchymal stem cells;

(2) performing one or more assays configured to detect a non-ischemic dilated cardiomyopathy marker selected from the group of exhausted B cells (CD19 ⁺ , CD27 ^" , IgD ^" ), switched memory B cells expressing intracellular TNF-a, early activated T-cells (CD3 ⁺ , CD69 ⁺ ), chronic activated T-cells (CD3 ⁺ , CD25 ⁺ ), Temra cells and serum TNF-a by introducing the serum sample obtained from the subject into an assay instrument which (i) contacts the serum sample with one or more antibodies which specifically bind for detection the biomarker(s) which are assayed, and (ii) generates one or more assay results indicating of binding of each biomarker which is assayed to a respective antibody to provide one or more assay results;

(3) correlating the assay result(s) generated by the assay instrument to the immunity status of the subject, wherein the correlating step comprises assigning a likelihood of one or more future changes in immune status to the subject based on the assay result(s); and (4) treating the subject based on the predetermined subpopulation of individuals to which the subject is assigned, wherein the treatment comprises administration of one or more additional doses of an isolated population of allogeneic human mesenchymal stem cells.

[00035] Another aspect of the invention relates to a method of evaluating cellular and humoral immunity status in a subject, comprising:

(1) obtaining a serum sample from a subject selected for evaluation based on a determination that the subject was previously in need of treatment of symptoms of aging frailty and the subject had been administered an initial dose of an isolated population of allogeneic human mesenchymal stem cells;

(2) performing one or more assays configured to detect aging frailty marker selected from the group of exhausted B cells (CD19 ⁺ , CD27 ^" , IgD ^" ), switched memory B cells B-cells expressing intracellular TNF-α, early activated T-cells

(CD3 ⁺ , CD69 ⁺ ), chronic activated T-cells (CD3 ⁺ , CD25 ⁺ ), Temra cells (CD45RA ⁺ , CCR7 ^" ), the CD4 ⁺ :CD8 ⁺ T cell ratio, and serum TNF-a by introducing the serum sample obtained from the subject into an assay instrument which (i) contacts the serum sample with one or more antibodies which specifically bind for detection the biomarker(s) which are assayed, and (ii) generates one or more assay results indicating of binding of each biomarker which is assayed to a respective antibody to provide one or more assay results;

(3) correlating the assay result(s) generated by the assay instrument to the immunity status of the subject, wherein the correlating step comprises assigning a likelihood of one or more future changes in immune status to the subject based on the assay result(s); and

(4) treating the subject based on the predetermined subpopulation of individuals to which the subject is assigned, wherein the treatment comprises administration of one or more additional doses of an isolated population of allogeneic human mesenchymal stem cells.

[00036] In one embodiment of the invention, one or more future changes in immune status comprise one or more of an increase in the number of exhausted B cells (CD 19* CD27 ^" , IgD ^" ), a decrease in the number of switched memory B cells

an increase in the number of B-cells expressing intracellular TNF-a, an increase in the number of early activated T-cells (CD3 ⁺ , CD69*), an increase in the number of chronic activated T-cells (CD3 ⁺ , CD25 ¹ ), an increase in the number of Temra cells (CD45RA , CCR7 ^" ), a decrease in the CD4 ⁺ :CD8 ⁺ T cell ratio, and an increase in serum TNF-a.

[00037] Another aspect of the invention relates to an in vitro method of determining efficacy of treatment of non-ischemic dilated cardiomyopathy in a subject comprising: detennining the levels of one or more biomarkers selected from the group consisting of exhausted B cells (CD19 ⁺ , CD27 ^" , IgD ), switched memory B cells (CD19 ⁺ , CD27 ^high , IgD ), B-cells expressing intracellular TNF-a, early activated T-cells (CD3 ⁺ , CD69*), chronic activated T-cells (CD3 ⁺ , CD25 ⁺ ), Temra cells (CD45RA ⁺ , CCR7 ^" ), and the TNF-a concentration in serum obtained from the subject before and after administration of a population of isolated allogeneic human mesenchymal stem cells to the subject, and comparing the levels of the one or more biomarkers in the serum obtained before and after administration of the population of isolated human mesenchymal stem cells, wherein treatment is efficacious if

(1) the number of exhausted B cells (CD19 ⁺ , CD27 ^" , IgD ^" ) decreases by at least 25% as compared to the number of exhausted B cells prior to administration of the population of isolated allogeneic human mesenchymal stem cells,

(2) the number of switched memory B ( , , g ) increases by at least 100% as compared to the number of switched memory B cells prior to administration of the population of isolated allogeneic human mesenchymal stem cells,

(3) the number of B-cells expressing intracellular TNF-a decreases by at least 30% as compared to the number of B-cells expressing intracellular TNF-a prior to administration of the population of isolated allogeneic human mesenchymal stem cells,

(4) the number of early activated T-cells (CD3 ⁺ , CD69 ⁺ ) decreases by at least 30% as compared to the number of early activated T-cells prior to administration of the population of isolated allogeneic human mesenchymal stem cells,

(5) the number of chronic activated T-cells (CD3 ⁺ , CD25 ⁺ ) decreases by at least 70% as compared to the number of chronic activated T-Cells prior to administration of the population of isolated allogeneic human mesenchymal stem cells,

(6) the number of Temra cells (CD45RA ⁺ , CCR7 ^" ) decreases by at least 40% as compared to the number of Temra cells prior to administration of the population of isolated allogeneic human mesenchymal stem cells, and/or

(7) the TNF-a concentration in a sample of the subject's serum decreases by at least 80% as compared to the TNF-a concentration in a sample of the subject's serum prior to administration of the population of isolated allogeneic human mesenchymal stem cells.

[00038] Another aspect of the invention relates to an in vitro method of determining efficacy of treatment of symptoms of aging frailty in a subject comprising: determining the levels of one or more biomarkers selected from the group consisting of exhausted B cells (CD19 ⁺ , CD27\ IgD ), switched memory B cells (CD19 ⁺ , CD27 ^high , IgD ^* ), B-cells expressing intracellular TNF-a, early activated T-cells (CD3 ⁺ , CD69 ⁺ ), chronic activated T-cells (CD3 ⁺ , CD25 ⁺ ), Temra cells (CD45RA ⁺ , CCR7 ^" ), the CD4 ⁺ :CD8 ⁺ T cell ratio, and the TNF-a concentration in serum obtained from the subject before and after administration of a population of isolated allogeneic human mesenchymal stem cells to the subject, and comparing the levels of the one or more biomarkers in the serum obtained before and after administration of the population of isolated human mesenchymal stem cells, wherein treatment is efficacious if

(1) the number of exhausted B cells (CD19 ⁺ , CD27 ^" , IgD ^" ) decreases by at least 10% as compared to the number of exhausted B cells prior to administration of the population of isolated allogeneic human mesenchymal stem cells,

(2) the number of switched memory B cells increases by at least 75% as compared to the number of switched memory B cells prior to administration of the population of isolated allogeneic human mesenchymal stem cells,

(3) the number of B-cells expressing intracellular TNF-a decreases by at least 60% as compared to the number of B-cells expressing intracellular TNF-a prior to administration of the population of isolated allogeneic human mesenchymal stem cells,

(4) the number of early activated T-cells (CD3 ⁺ , CD69 ⁺ ) decreases by at least 30% as compared to the number of early activated T-cells prior to administration of the population of isolated allogeneic human mesenchymal stem cells,

(5) the number of chronic activated T-cells (CD3 ⁺ , CD25 ⁺ ) decreases by at least 75% as compared to the number of chronic activated T-Cells prior to administration of the population of isolated allogeneic human mesenchymal stem cells,

(6) the number of Temra cells (CD45RA ⁺ , CCR7 ^" ) decreases by at least 20% as compared to the number of Temra cells prior to administration of the population of isolated allogeneic human mesenchymal stem cells,

(7) the TNF-a concentration in a sample of the subject's serum decreases by at least 50% as compared to the TNF-a concentration in a sample of the subject's serum prior to administration of the population of isolated allogeneic human mesenchymal stem cells, and/or

(8) the CD4+:CD8+ T cell ratio in a sample of the subject's serum increases by at least 100% as compared to the CD4+:CD8+ T cell ratio in a sample of the subject's serum prior to administration of the population of isolated allogeneic human mesenchymal stem cells.

[00039] Another aspect of the invention relates to the use in vitro of the levels of exhausted B cells (CD19 ⁺ , CD27 ^" , IgD ^" ), the levels of switched memory B cells (CD19 ⁺ , CD27 ^hi8h , IgD ^" ), the levels of B-cells expressing intracellular TNF-α, the levels of early activated T-cells , the levels of chronic activated T-cells ( the levels of Temra cells and the TNF-a concentration in serum for determining whether treatment for non-ischemic dilated cardiomyopathy is efficacious.

[00040] Another aspect of the invention relates to the use in vitro of the levels of exhausted B cells the levels of switched memory B cells the ievels of B-cells expressing intracellular TNF-α, the levels of early activated T-cells the levels of chronic activated T-cells (CD3 ⁺ , CD25 ¹ ), the levels of Temra cells (CD45RA ⁺ , CCR7 ^" ), the CD4 ⁺ :CD8 ⁺ T cell ratio, and the TNF-a concentration in serum for determining whether treatment for aging frailty is efficacious.

BRIEF DESCRIPTION OF THE FIGURES

[00041] FIG. 1 is a Consort Diagram for a randomized, double-blinded, placebo- controlled study investigating the use of allogeneic mesenchymal stem cells for the treatment of older individuals with frailty.

[00042] FIG. 2 provides baseline patient characteristics for subjects enrolled in the randomized, double-blinded, placebo-controlled study investigating the use of allogeneic mesenchymal stem cells for the treatment of older individuals with frailty.

[00043] FIG. 3 shows a decrease in TNF-a in older subjects administered allogeneic human mesenchymal stem cells.

[00044] FIG. 4 shows a decrease in early activated T cells expressing CD69 in older subjects administered allogeneic human mesenchymal stem cells.

[00045] FIG. 5 shows a decrease in the numbers of chronic/late activated T cells expressing CD2S in older subjects administered allogeneic human mesenchymal stem cells.

[00046] FIG. 6 shows measurements of CD8+ T cells in older subjects administered allogeneic human mesenchymal stem cells.

[00047] FIG. 7 shows an increase in the ratio of CD47CD8 ¹ T cells in older subjects administered allogeneic human mesenchymal stem cells.

[00048] FIG. 8 shows an increased immunosenescence score in patients with aging frailty who received two infusions of human mesenchymal stem cells. [00049] FIG. 9 shows a correlation between baseline serum TNF-a and baseline B cells expressing IC TNF-a .

[00050] FIG. 10 provides the % of B cells expressing IC TNF-a in Young Control BL, Low TNF:IC TNF BL, and High TNF:IC TNF BL.

[00051] FIG. 11 provides the % of Switch Memory B cells in Young Control BL, Low TNF:SwMem B cells BL, and High TNF:SwMem B cells BL.

[00052] FIG. 12 provides the % of Exhausted B cells in Young Control BL, Low TNF:Exh B cells BL, and High TNF:Exh B cells BL.

[00053] FIG. 13 provides the % of Temra cells in Young Control BL, Low TNFiTemra cells BL, and High TNF:Temra cells BL.

[00054] FIG. 14 provides the CD4 ⁺ /CD8 ⁺ T cell ratio in Young Control BL, Low TNF:CD4:CD8 BL, and High TNF:CD4:CD8 BL.

[00055] FIG. 15 provides the absolute change of serum TNF-a in pg/ml in Placebo Control, Low TNF-a, and High TNF-a.

[00056] FIG. 16 shows a correlation between baseline serum TNF-a and the change in serum TNF-a.

[00057] FIG. 17 shows the absolute change of B cells expressing IC TNF-a in Placebo Control, Low TNF-a, and High TNF-a.

[00058] FIG. 18 shows a correlation between serum TNF-a and change in B cells expressing IC TNF-a.

[00059] FIG. 19 shows the absolute change of % of Switch Memory B cells in Placebo Control, Low TNF-a, and High TNF-a.

[00060] FIG. 20 shows the absolute change of % of Exhausted B cells in Placebo Control, Low TNF-a, and High TNF-a.

[00061] FIG. 21 shows the absolute change of % of Temra T cells in Placebo Control, Low TNF-a, and High TNF-a

[00062] FIG. 22 shows a correlation between the change in serum TNF-a and the change in Temra T cells.

[00063] FIG. 23 shows the absolute change in the CD4 ⁺ /CD8 ⁺ T cell ratio in Placebo Control, Low TNF-α, and High TNF-a.

[00064] FIG. 24 shows a correlation between the change in CD4 ⁺ /CD8 ⁺ T cell ratio and the change in Temra T cells. DET AILED DESCRIPTION

[00065] In certain embodiments, the present invention is directed to methods of treating non-ischemic dilated cardiomyopathy in a subject, comprising administering a therapeutically effective amount of a population of isolated allogeneic human mesenchymal stem cells to a subject in need thereof. The examples demonstrate that in vivo administration of isolated populations of allogeneic human mesenchymal stem cells result in an increase in the percentage of switched memory B cells and a decrease in exhausted B cells in subjects. The examples also demonstrate that in vivo administration of isolated allogeneic human mesenchymal stem cells results in an improvement in the CD4 ⁺ :CD8 ⁺ T cell ratio in subjects. Also, as shown in the examples, the levels of B-cells expressing intracellular TNF-a, the levels of early activated T-cells (CD3 ⁺ , CD69*), the levels of chronic activated T-cells (CD3 ⁴ , CD25 ⁺ ), the levels of Temra cells (CD45RA ⁴ , CCR7 ), and the TNF-a concentration in serum is reduced in subjects having received infusions of allogeneic human mesenchymal stem cells. From these unexpected results, the present inventors determined that isolated allogeneic human mesenchymal stem cells favorably altered several immunologic markers typically elevated in chronic inflammation. Restoration of immune competence has clinical relevant in subject who are of higher risk for co-morbid infectious disease.

[00066] In other embodiments, the present invention is directed to methods of treating symptoms of aging frailty in a subject, comprising administering a therapeutically effective amount of a population of isolated allogeneic human mesenchymal stem cells to a subject in need thereof. The examples demonstrate that in vivo administration of isolated populations of allogeneic human mesenchymal stem cells result in an increase in the percentage of switched memory B cells and a decrease in exhausted B cells in subjects. The examples also demonstrate that in vivo administration of isolated allogeneic human mesenchymal stem cells results in an improvement in the CD4 ⁺ :CD8 ⁺ T cell ratio in subjects. Also, as shown in the examples, the levels of B-cells expressing intracellular TNF-a, the levels of early activated T- cells (CD3 ⁺ , CD69 ⁺ ), the levels of chronic activated T-cells (CD3 ⁺ , CD25 ⁺ ), the levels of Temra cells (CD45RA ⁺ , CCR7 ^" ), and the TNF-a concentration in serum is reduced in subjects having received infusions of allogeneic human mesenchymal stem cells. From these unexpected results, the present inventors determined that isolated allogeneic human mesenchymal stem cells are effective at reducing inflammaging, a prevalent feature in aging frailty.

Definitions [00067] Embodiments may be practiced without the theoretical aspects presented. Moreover, the theoretical aspects are presented with the understanding that the embodiments are not bound by any theory presented.

[00068] Unless otherwise defined, all terms (including technical and scientific terms) used herein have the same meaning as commonly understood by one of ordinary skill in the art. It will be further understood that terms, such as those defined in commonly used dictionaries, should be interpreted as having a meaning that is consistent with their meaning in the context of the relevant art and will not be interpreted in an idealized or overly formal sense unless expressly so defined herein.

[00069] The terminology used herein is for the purpose of describing particular embodiments only and is not intended to be limiting. As used herein, the singular forms "a", "an" and "the" are intended to include the plural forms as well, unless the context clearly indicates otherwise. Furthermore, to the extent that the terms "including", "includes", ^c ¾aving", "has", "with", or variants thereof are used in either the detailed description and/or the claims, such terms are intended to be inclusive in a manner similar to the term "comprising."

[00070] Recitation of ranges of values herein are merely intended to serve as a shorthand method of referring individually to each separate value falling within the range, unless otherwise indicated herein, and each separate value is incorporated into the specification as if it were individually recited herein. The use of any and all examples, or exemplary language (e.g., "such as") provided herein, is intended merely to better illuminate the invention and does not pose a limitation on the scope of the invention unless otherwise claimed. No language in the specification should be construed as indicating any non-claimed element as essential to the practice of the invention.

[00071] The term "about" or "approximately" means within an acceptable error range for the particular value as determined by one of ordinary skill in the art, which will depend in part on how the value is measured or determined, i.e., the limitations of the measurement system For example, "about" can mean within 1 or more than 1 standard deviation, per the practice in the art. Alternatively, "about" can mean a range of ±10% of the referenced value.

Dosage, Duration and Subjects

[00072] "A therapeutically effective amount" means an amount that stimulates a B- or T- cell dependent immune response. Such a response is characterized by the ability to elicit significant levels of IgG and opsonic activity. The dosage and number of doses (e.g., single or multiple dose) administered to the subject will vary depending upon a variety of factors, including the route of administration, patient conditions and characteristics (sex, age, body weight, health, size), extent of symptoms, concurrent treatments, frequency of treatment and the effect desired, and the like.

[00073] In one embodiment of the invention, the isolated population of allogeneic mesenchymal stem cells is administered as a single dose. In another embodiment, the isolated population of allogeneic mesenchymal stem cells is administered in multiple doses, e.g., two or more doses. In other embodiments, the isolated population of allogeneic mesenchymal stem cells is administered at least yearly.

[00074] In another embodiment of the invention, the administration of the isolated population of allogeneic mesenchymal stem cells is repeated, such as at least 1, 2, 3, 4, 5, 6, 8 months after the first administration of the isolated population of allogeneic mesenchymal stem cells, or repeated between 2-4, 2-6, 2-8, months after the first administration of the isolated population of allogeneic mesenchymal stem cells.

[00075] In one embodiment of the invention, the isolated population of allogeneic mesenchymal stem cells is administered at a dose of about l

mesenchymal stem cells. In a further embodiment, the isolated population of allogeneic mesenchymal stem cells is administered at a dose of about 20x10 ⁶ mesenchymal stem cells. In a further embodiment, the isolated population of allogeneic mesenchymal stem cells is administered at a dose of about lOOxlO ⁶ mesenchymal stem cells. In yet a further embodiment, the isolated population of allogeneic mesenchymal stem cells is administered at a dose of about 200x10 ⁶ mesenchymal stem cells. In further embodiments, the isolated population of allogeneic mesenchymal stem cells is administered

mesenchymal stem cells.

[00076] In some embodiments, the therapeutically effective amount of the isolated population of allogeneic mesenchymal stem cells is sufficient to increase the ratio of CD4 ⁺ :CD8 ⁺ T cells in a subject, such as to increase the ratio of CD4 ⁺ :CD8 ⁺ T cells by at least two-, three, four-, five-, or six-fold as compared to the ratio prior to administration of the isolated population of allogeneic mesenchymal stem cells, i.e., an increase in the ratio of CD4 ⁺ :CD8 ⁺ T cells by at least 100%, 200%, 300%, 400%, or 500%.

[00077] In some embodiments, the therapeutically effective amount of the isolated population of allogeneic mesenchymal stem cells is sufficient to increase the number of switched memory B cells (CD19 ⁺ , CD27 ^high , IgD ^" ) in a subject, such as to increase the number of switched memory B cells by at least two-, three-, four-, or five-fold as compared to the number prior to administration of the isolated population of allogeneic mesenchymal stem cells, i.e., an increase in the number of switched memory B cells (CD19 ⁺ , CD27 ^high ,, IgD ^" ) by at least 100%, 200%, 300%, or 400%. In other embodiments, the number of switched memory B cells as compared to the number of such B cells prior to administration of the isolated population of allogeneic mesenchymal stem cells increases by at least 10%, 15%, 20%, 25%, 30%, 35%, 40%, 45%, 50%, 55%, 60%, 65%, 70%, 75%, 80%, 85%, 90%, or 95%.

[00078] In some embodiments, the therapeutically effective amount of the isolated population of allogeneic mesenchymal stem cells is sufficient to decrease the number of B cells expressing intracellular TNF-a in a subject, such as to decrease the number by at least two-, three-, four-, five-, or six-fold as compared to the number of such B cells prior to administration of the isolated population of allogeneic mesenchymal stem cells. In other embodiments, the number of B cells expressing intracellular TNF-a as compared to the number of such B cells prior to administration of the isolated population of allogeneic mesenchymal stem cells decreases by at least 10%, 20%, 30%, 40%, 50%, or 60%.

[00079] In some embodiments, the therapeutically effective amount of the isolated population of allogeneic mesenchymal stem cells is sufficient to decrease the number of exhausted B cells (CD19 ⁺ , CD27 ^" , IgD ^" ) in a subject, such as to decrease the number of exhausted B cells by at least two- or three-fold as compared to the number prior to administration of the isolated population of allogeneic mesenchymal stem cells. In other embodiments, the number of exhausted B cells as compared to the number of such B cells prior to administration of the isolated population of allogeneic mesenchymal stem cells decreases by at least 10%, 15%, 20%, 25%, 30%, 35%, 40%, 45%, or 50%.

[00080] In some embodiments, the therapeutically effective amount of the isolated population of allogeneic mesenchymal stem cells is sufficient to decrease the number of early activated T-cells (CD3 ⁺ , CD69 ⁺ ) in a subject, such as to decrease the number of early activated T-cells by at least two- or three-fold as compared to the number prior to administration of the isolated population of allogeneic mesenchymal stem cells. In other embodiments, the number of early activated T-cells as compared to die number of such T cells prior to administration of the isolated population of allogeneic mesenchymal stem cells decreases by at least 10%, 20%, 30%, 40%, or 50%.

[00081] In some embodiments, the therapeutically effective amount of the isolated population of allogeneic mesenchymal stem cells is sufficient to decrease the number of chronic activated T-cells (CD3 ⁺ , CD25 ⁺ ) in a subject, such as to decrease the number of chronic activated T-cells by at least two- or three-fold as compared to the number prior to administration of the isolated population of allogeneic mesenchymal stem cells. In other embodiments, the number of chronic activated T-cells as compared to the number of such T cells prior to administration of the isolated population of allogeneic mesenchymal stem cells decreases by at least 10%, 15%, 20%, 25%, 30%, 35%, 40%, 45%, 50%, 55%, 60%, 65%, 70%, 75%, 80%, 85%, 90%, or 95%.

[00082] In some embodiments, the therapeutically effective amount of the isolated population of allogeneic mesenchymal stem cells is sufficient to decrease the number of Temra cells (CD45RA ⁺ , CCR7 ^" ) in a subject, such as to decrease the number of Temra cells by at least two- or three-fold as compared to the number prior to administration of the isolated population of allogeneic mesenchymal stem cells. In other embodiments, the number of Temra cells as compared to the number of such Temra cells prior to administration of the isolated population of allogeneic mesenchymal stem cells decreases by at least 10%, 20%, 30%, 40%, or 50%.

[00083] In some embodiments, the therapeutically effective amount of the isolated population of allogeneic mesenchymal stem cells is sufficient to decrease the TNF-a concentration in a sample of the subject's serum, such as to decrease the TNF-a concentration by at least two- or three-fold as compared to the TNF-a concentration prior to administration of the isolated population of allogeneic mesenchymal stem cells. In other embodiments, the concentration of TNF-a decreases by at least 10%, 20%, 30%, 40%, 50%, 60%, 70%, 80%, or 90%, as compared to the concentration of TNF-a prior to administration of the isolated population of allogeneic mesenchymal stem cells.

[00084] Other aspects of the invention include methods for evaluating the cellular and humoral immunity status in subjects to determine if the subjects would benefit from the administration of an isolated population of allogeneic mesenchymal stem cells and treating a predetermined subpopulation of subjects based on biomarker data For example, one or more assays could be performed to detect a non-ischemic dilated cardiomyopathy marker selected from the group of exhausted B cells (CD19 ⁺ , CD27 ^" , IgD ^" ), switched memory B cells (CD19 ⁺ , IgD ^" ), B-cells expressing intracellular TNF-a, early activated T-cells (CD3 ⁴ , CD69 ⁺ ), chronic activated T-cells (CD3 ^f , CD25 ⁴ ), Temra cells (CD45RA ⁴ , CCR7 ), and serum TNF-a. Similarly, one or more assays could be performed to detect an aging frailty marker selected from the group of exhausted B cells (CD19 ⁺ , CD27 ^" , IgD ^" ), switched memory B cells (CD19 ⁺ , IgD ^" ), B-cells expressing intracellular TNF-α, early activated T-cells (CD3 ⁺ , CD69 ⁺ ), chronic activated T-cells (CD3 ⁺ , CD25 ⁺ ), Temra cells (CD45RA ⁺ , CCR7 ^" ), the CD4 ⁺ :CD8 ⁺ T cell ratio, and serum TNF-a.

[00085] In some embodiments, treatment is demonstrated to be efficacious when the isolated population of allogeneic mesenchymal stem cells is sufficient to increase the ratio of CD4 ⁺ :CD8 ⁺ T cells in a subject, such as to increase the ratio of CD4 ⁺ :CD8 ⁺ T cells by at least two-, three, four-, five-, or six-fold as compared to the ratio prior to administration of the isolated population of allogeneic mesenchymal stem cells, i.e.. an increase in the ratio of CD4 ⁺ :CD8 ⁺ T cells by at least 100%, 200%, 300%, 400%, or 500%.

[00086] In some embodiments, treatment is demonstrated to be efficacious when the isolated population of allogeneic mesenchymal stem cells is sufficient to increase the number of switched memory B cells (CD19 ⁺ , CD27 ^high , IgD ^" ) in a subject, such as to increase the number of switched memory B cells by at least two-, three-, four-, or five-fold as compared to the number prior to administration of the isolated population of allogeneic mesenchymal stem cells, i.e., an increase in the number of switched memory B cells (CD19 ⁺ , C

IgD ^" ) by at least 100%, 200%, 300%, or 400%. In other embodiments, the number of switched memory B cells as compared to the number of such B cells prior to administration of the isolated population of allogeneic mesenchymal stem cells increases by at least 10%, 15%, 20%, 25%, 30%, 35%, 40%, 45%, 50%, 55%, 60%, 65%, 70%, 75%, 80%, 85%, 90%, or 95%.

[00087] In some embodiments, treatment is demonstrated to be efficacious when the isolated population of allogeneic mesenchymal stem cells is sufficient to decrease the number of B cells expressing intracellular TNF-a in a subject, such as to decrease the number by at least two-, three-, four-, five-, or six-fold as compared to the number of such B cells prior to administration of the isolated population of allogeneic mesenchymal stem cells. In other embodiments, the number of B cells expressing intracellular TNF-a as compared to the number of such B cells prior to administration of the isolated population of allogeneic mesenchymal stem cells decreases by at least 10%, 20%, 30%, 40%, 50%, or 60%.

[00088] In some embodiments, treatment is demonstrated to be efficacious when the isolated population of allogeneic mesenchymal stem cells is sufficient to decrease the number of exhausted B cells (CD19 ⁺ , CD27 ^" , IgD ^" ) in a subject, such as to decrease the number of exhausted B cells by at least two- or three-fold as compared to the number prior to administration of the isolated population of allogeneic mesenchymal stem cells. In other embodiments, the number of exhausted B cells as compared to the number of such B cells prior to administration of the isolated population of allogeneic mesenchymal stem cells decreases by at least 10%, 15%, 20%, 25%, 30%, 35%, 40%, 45%, or 50%.

[00089] In some embodiments, treatment is demonstrated to be efficacious when the isolated population of allogeneic mesenchymal stem cells is sufficient to decrease the number of early activated T-cells (CD3 ⁺ , CD69*) in a subject, such as to decrease the number of early activated T-cells by at least two- or three-fold as compared to the number prior to administration of the isolated population of allogeneic mesenchymal stem cells. In other embodiments, the number of early activated T-cells as compared to the number of such T cells prior to administration of the isolated population of allogeneic mesenchymal stem cells decreases by at least 10%, 20%, 30%, 40%, or 50%.

[00090] In some embodiments, treatment is demonstrated to be efficacious when the isolated population of allogeneic mesenchymal stem cells is sufficient to decrease the number of chronic activated T-cells (CD3 ⁺ , CD25 ⁴ ) in a subject, such as to decrease the number of chronic activated T-cells by at least two- or three-fold as compared to the number prior to administration of the isolated population of allogeneic mesenchymal stem cells. In other embodiments, the number of chronic activated T-cells as compared to the number of such T cells prior to administration of the isolated population of allogeneic mesenchymal stem cells decreases by at least 10%, 15%, 20%, 25%, 30%, 35%, 40%, 45%, 50%, 55%, 60%, 65%, 70%, 75%, 80%, 85%, 90%, or 95%.

[00091] In some embodiments, treatment is demonstrated to be efficacious when the isolated population of allogeneic mesenchymal stem cells is sufficient to decrease the number of Temra cells (CD45RA ¹ , CCR7 ^" ) in a subject, such as to decrease the number of Temra cells by at least two- or three-fold as compared to the number prior to administration of the isolated population of allogeneic mesenchymal stem cells. In other embodiments, the number of Temra cells as compared to the number of such Temra cells prior to administration of the isolated population of allogeneic mesenchymal stem cells decreases by at least 10%, 20%, 30%, 40%, or 50%.

[00092] In some embodiments, treatment is demonstrated to be efficacious when the isolated population of allogeneic mesenchymal stem cells is sufficient to decrease the TNF-a concentration in a sample of the subject's serum, such as to decrease the TNF-a concentration by at least two- or three-fold as compared to the TNF-a concentration prior to administration of the isolated population of allogeneic mesenchymal stem cells. In other embodiments, the concentration of TNF-a decreases by at least 10%, 20%, 30%, 40%, 50%, 60%, 70%, 80%, or 90%, as compared to the concentration of TNF-a prior to administration of the isolated population of allogeneic mesenchymal stem cells.

[00093] "Administering" a composition may be accomplished by oral administration, injection, infusion, parenteral, intravenous, mucosal, sublingual, intramuscular, intradermal, intranasal, intraperitoneal, intraarterial, subcutaneous absorption or by any method in combination with other known techniques. In one embodiment of the invention, the isolated population of allogeneic mesenchymal stem cells is administered systemically. In another embodiment of the invention, the isolated population of allogeneic mesenchymal stem cells is administered by infusion or direct injection. In one embodiment of the invention, the isolated population of allogeneic mesenchymal stem cells is administered intramuscularly, intravenously, intraarteerially, intraperitoneally, subcutaneously, intradermally, orally, transendocardially, or intranasally. In a further embodiment, the isolated population of allogeneic mesenchymal stem cells is administered intramuscularly. In a further embodiment, the isolated population of allogeneic mesenchymal stem cells is administered intravenously.

[00094] The term "subject" as used herein includes, but is not limited to, humans and non-human vertebrates such as wild, domestic, and farm animals. In some embodiments, the term refers to humans, such as elderly humans >65 years of age, or elderly humans 60-95 years of age. In some embodiments, the human subject exhibits symptoms of aging frailty. In some embodiments, the human subject exhibits inflammaging.

[00095] The term "allogeneic" refers to a cell that is of the same animal species but genetically different in one or more genetic loci as the animal that becomes the "recipient host." This usually applies to cells transplanted from one animal to another non-identical animal of the same species. [00096] As used herein, the phrase "in need thereof means that the subject has been identified as having a need for the particular method or treatment. In some embodiments, the identification can be by any means of diagnosis. In any of the methods and treatments described herein, the subject can be in need thereof. In some embodiments, the subject is in an environment or will be traveling to an environment in which a particular disease, disorder, or condition is prevalent.

[00097] Cells are referred to herein as being positive or negative for certain markers. For example, a cell can be negative for CD45, which can also be referred to as CD45 ^" . The superscript notation " ^" " refers to a cell that is negative for the marker linked to the superscript. In contrast a marker with the " ⁺ " refers to a cell that is positive for that marker. For example, a cell that is referenced as "CD8 ⁺ " is positive for CDS. A "+" can also be used to reference the marker as positive. A "-" can also be used to reference the marker as negative.

[00098] As used herein, the term "stem cell" refers to a cell from the embryo, fetus, or adult that has, under certain conditions, the ability to reproduce itself for long periods or, in the case of adult stem cells, throughout the life of the organism. It also can give rise to specialized cells that make up the tissues and organs of the body.

[00099] Mesenchymal stem cells are the formative pluripotent blast cells found inter alia in bone marrow, blood, dermis, and periosteum that are capable of differentiating into any kind of the specific types of mesenchymal or connective tissues {i.e., the tissues of the body that support the specialized elements; particularly adipose, osseous, cartilaginous, elastic, and fibrous connective tissues) depending upon various influences from bioactive factors, such as cytokines.

[000100] Certain methods of isolating and/or purifying mesenchymal stem cells have been described herein and are known in the art. In some embodiments, mesenchymal stem cells are isolated from bone marrow of adult humans. In some embodiments, the cells are passed through a density gradient to eliminate undesired cell types. The cells can be plated and cultured in appropriate media. In some embodiments, the cells are cultured for at least one day or about three to about seven days, and removing non-adherent cells. The adherent cells can then be plated and expanded.

[000101] Other methods for isolating and culturing stem cells are also known. Placenta is an excellent readily available source for mesenchymal stem cells. Moreover, mesenchymal stem cells can be derivable from adipose tissue and bone marrow stromal cells are speculated to be present in other tissues. While there are dramatic qualitative and quantitative differences in the organs from which adult stem cells can be derived, the initial differences between the cells may be relatively superficial and balanced by the similar range of plasticity thej' exhibit.

[000102] Homogeneous human mesenchymal stem cell compositions are provided which serve as the progenitors for all mesenchymal cell lineages. Mesenchymal stem cells are identified by specific cell surface markers which are identified with unique monoclonal antibodies. The homogeneous mesenchymal stem cell compositions are obtained by positive selection of adherent marrow or periosteal cells which are free of markers associated with either hematopoietic or differentiated mesenchymal cells. These isolated mesenchymal cell populations display epitopic characteristics associated with only mesenchymal stem cells, have the ability to regenerate in culture without differentiating, and have the ability to differentiate into specific mesenchymal lineages when either induced in vitro or placed in vivo at a site of inflammation.

[000103] In order to obtain the human mesenchymal stem cells for the compositions, methods, and kits disclosed herein, pluri potent mesenchymal stem cells are separated from other cells in the bone marrow or other mesenchymal stem cell source. Bone marrow cells may be obtained from iliac crest, femora, tibiae, spine, rib, or other medullary spaces. Other spaces of human mesenchymal stem cells include embryonic yolk sac, placenta, umbilical cord, fetal and adolescent skin, and blood.

[000104] In some embodiments, the human mesenchymal stem cells are identified by the absence of markers. For example, human mesenchymal stem cells useful in the invention include those that are negative for STRO-1 and/or negative for CD45. Similarly, human mesenchymal stem cells useful in the invention include those that do not express fibroblast surface markers or have a fibroblast morphology.

Methods of Enhancing Immune Responses

[0001 OS] As discussed above, the present invention is directed to a method of enhancing a subject's cellular or humoral immune response, comprising administering to the subject therapeutically effective amounts of an isolated population of human mesenchymal stem cells. In some embodiments of the invention, the mesenchymal stem cells are not genetically manipulated. In some embodiments of the invention, the mesenchymal stem cells are obtained from a human donor and wherein a step of MHC matching of the human donor to the subject is not employed prior to the administration of the isolated population of human mesenchymal stem cells.

[000106] Compositions for use in the invention may be formulated using any suitable method. Formulation of cells with standard pharmaceutically acceptable carriers and/or excipients may be carried out using routine methods in the pharmaceutical art. The exact nature of a formulation will depend upon several factors including the cells to be administered and the desired route of administration. Suitable types of formulation are fully described in Remington's Pharmaceutical Sciences, 19 ^th Edition, Mack Publishing Company, Eastern Pennsylvania, USA.

[000107] Compositions may be prepared together with a physiologically acceptable carrier or diluent. Typically, such compositions are prepared as liquid suspensions of cells. The cells may be mixed with an excipient which is pharmaceutically acceptable and compatible with the active ingredient. Suitable excipients are, for example, water, saline, dextrose, glycerol, of the like and combinations thereof

[000108] In addition, if desired, the pharmaceutical compositions of the invention may contain minor amounts of auxiliary substances such as wetting or emulsifying agents, pH buffering agents, and/or adjuvants which enhance effectiveness. In one embodiment of the invention, the adjuvant comprises human serum albumin (HSA).

[000109] One suitable carrier or diluent is PlasmaLyte A™. This is a sterile, nonpyrogenic isotonic solution for intravenous administration. Each 100 mL contains 526 mg of Sodium Chloride, USP (NaCl); 502 mg of Sodium Gluconate (CeHnNaO?); 368 mg of Sodium Acetate Trihydrate, USP 37 mg of Potassium Chloride, USP (KG); and 30 mg of Magnesium Chloride, USP It contains no antimicrobial agents. The pH is adjusted with sodium hydroxide. The pH is 7.4 (6.5 to 8.0).

[000110] In one embodiment of the invention the mesenchymal stem cells are not genetically manipulated. In another embodiment of the invention, the mesenchymal stem cells are cryopreserved. For example, the mesenchymal stem cells can be suspended in cryoprotectant consisting of Hespan® (6% hetastarch in 0.9% sodium chloride) supplemented with 2% HSA and 5% DMSO and then aliquoted into cryopreservation containers for placement in vapor phase nitrogen freezers. In another embodiment, the mesenchymal stem cells may be provided in PlasmaLyte A™ supplemented with 1% HSA.

EXAMPLES Example 1

Treatment of Chronic Non-Ischemic Dilated Cardiomyopathy

[000111] Briefly, thirty-seven patients were randomized to receive either allogeneic or autologous human mesenchymal stem cells in a 1:1 ratio. Patients were recruited between December 2011 and July 2015 at the University of Miami Hospital. Patients (age: 55.8 ± 11.2; 32% female) received human mesenchymal stem cells (100 million) by trans endocardial stem cell injection (TESI) in ten left ventricular sites by NOGA Catheter. Treated patients were evaluated at baseline, 30 days, 3-, 6- and 12-months for immune biomarkers.

Patient Population

[000112] Patient eligibility was determined after confirmation of diagnosis of NIDCM with an EF of less than 40% and either a left ventricular end diastolic diameter greater than 5.9 cm in male subjects and greater than 5.6 cm in female subjects or a left ventricular end diastolic volume index > 125 mL/m ² . Thirty-seven patients were randomized to either autologous human mesenchyme stem cells (hMSCs) or allogeneic hMSCs in a ratio of 1:1. Thirty-four patients received study injection; 16 and 18 patients in the auto- and allo-hMSC, respectively. Three patients did not receive the study injection. One patient withdrew consent before treatment. Another patient was recruited but did not receive treatment due to automatic implantable cardioverter-defibrillator placement (n=l), and one patient died before treatment (n=l). The mean age of injected participants was 55.8 ± 11.2, 29% were female, and 35% were Hispanic. The mean years of NIDCM diagnosis before the TESI was 6.1 ± 6.2 years for alio and 6.9 ± 7.3 years for auto patients (p=0.5 between groups). Fifty percent of patients had NYHA class II symptoms, mean baseline global EF was 26.5 ± 9.64%, mean 6MWT was 422 ± 86.8 M, and median baseline MLHFQ scores were 36 (IQR 18.0, 64.0). Study Procedures and Timeline

[000113] Baseline assessments included chemistry and hematology laboratories, echocardiography, and chest, abdominal and pelvic computed tomography scans.

Human Mesenchymal Stem Cells (hMSCs) for Cell Therapy

[000114] All allogeneic and autologous human mesenchymal stem cells were manufactured at the University of Miami ISO. See, e.g., Golpanian, S. et al, Physiol. Rev. 96:1127-68 (2016) and Mushtaq, M. et al, J. Cardio. Trans. Res. 7:769-80 (2014). Allogeneic human mesenchymal stem cells were derived from Caucasian male donors mean age 25.4 ± 3.3 years and were between 80 to 90% viable at the time of TESI. The auto- hMSCs were from 11 males with a mean age of 58.0 ± 9.9 and six females with a mean age of 55.0 ± 12.4 years.

Transendocardial Stem Cell Injection

[000115] Injection sites were selected to prioritize safety of the TESI procedure and to distribute sites throughout the accessible myocardial territories. Considerations for site selection included avoidance of the ventricular apex, and optimization of catheter stability prior to needle extension.

Immune Monitoring

[000116] Calculated panel reactive antibodies (cPRA) were measured at baseline and at six-months using Luminex 200. Serum TNF-a was measured using human TNF-a ELISA high sensitivity kit (eBiosciences). Lymphocytes were stained for T-cell markers of activation. Late/exhausted T-cells, B-cell subsets (Switched memory and Late/Exhausted B- cells) and TNF-a by B-cells. All samples were acquired using the LSR-Fortessa-HTS analyzer (BD Pharmigen) and analyzed with the FlowJo V10 software, i.e., all lymphocyte populations were assessed by flow cytometry and expressed as a percent from gated (B-cell parameters gated on CD 19* and T-cell parameters gated on CD3 ⁺ ).

[000117] cPRA results showed that 67% of alio and 92% of auto recipients had no reaction to low cPRA (0-20% cPRA). Twenty-seven % of alio and 8% of auto had a moderate cPRA (21-79% cPRA), and one subject (7%) receiving alio MSCs had a high cPRA response (+80% cPRA).

[000118] Elevated baseline levels of TNF-a decreased from baseline to 6-months in both groups (alio: -10.6 ± 1.6 pg/ml, pO.0001, auto: -6.8 ± 1.4 pg/ml, pO.0001, Table 1; between group, p=0.05). Temra T-cells (exhausted T-cell phenotype) were reduced in both groups with a greater decrease in alio (alio: -15.9±5.4%, pO.0001, auto: -9.3±3.3%, pO.0001, Table 1; between group, p=0.0111; Table 1). Suppressed %Switch Memory B- cells (predictive biomarker for antibody response) at baseline were significantly increased at six-months in both groups with a greater improvement in alio (alio: +10.2±4.9%, pO.0001 vs. auto: +4.3±3.9%, p=0.0014, between group, pO.0001; Table 1). Finally, intracellular TNF-a expression in B23 cells was also decreased at 6-months relative to baseline in both groups (alio: -11.2±3.3%, p<0.0001, auto: -8.5±3.0%, p<0.0001; between group, p=0.174; Table 1). In contrast, Late/exhausted B-cells decreased significantly in both groups (alio: - 5.4±1.03%, pO.0001, auto: -5.9±2.5%, p=0.003; between group difference, p=0.57; Table 1). Early T-cell activation (alio: -5.57±1.03%, pO.0001, auto: -2.92±1.5%, p=O.02; between group, p=0.08; Table 1) decreased to similar degrees in both group. Whereas late/chronic T- cell activation did not significantly decrease in either group (alio: -2.3±1.3%, p=0.4, and auto: -3.4±2.7%, p=0.7).

Table 1. Effects of Human Mesenchymal Stem Cells on Cellular and Humoral Immunity at 6-months.

group p < 0.5; indicates between group p < 0.001.

Example 2

Treatment of Symptoms of Aging Frailty - Study 1 [000119] Thirty subjects aged 60 years of age or older who met the study inclusion/exclusion criteria for frailty by the Canadian Study of Health and Aging (CSHA) were randomized. Ten subjects received 100 million MSCs, ten subjects received 200 million MSCs, and ten subjects received placebo. Subjects were followed for one year for safety and efficacy. Assessments included at least the following: a study of inflammatory biomarkers and a review of immunologic effects. FIG. 1 is a Consort Diagram. FIG. 2 provides baseline patient characteristics. FIGs. 3-7 illustrate the impact of allogeneic human MSCs on immune biomarkers.

[000120] Figure 3 shows a decrease TNF-a in subjects administered human MSCs. Both early and late/chronic T cell activation decreases after allogeneic MSC treatment. FIG. 4 shows a decrease in early activated T cells expressing CD69 in subjects administered human MSCs. FIG. 5 shows a decrease in the numbers of chronic/late activated T cells expressing CD25 in subjects administered human MSCs. FIG. 7 shows an increase in the ratio of CD4 ⁺ /CD8 ⁺ T cells in subjects administered human MSCs.

Example 3

Treatment of Symptoms of Aging Frailty' - Study 2

[000121] Fifteen aged subjects were included in an open-label study and administered human mesenchymal stem cells in two separate infusions. Subjects were evaluated for changes in various immune biomarkers to determine a response to the injected human mesenchymal stem cells. These immune biomarkers included the levels of exhausted B cells (CD19 ⁺ , CD27\ IgD ^" ), the levels of switched memory the

levels of B-cells expressing intracellular TNF-α, the levels of early activated T-cells (CD3 ⁺ , CD69 ^f ), the levels of chronic activated T-cells (CD3 ⁺ , CD25 ⁺ ), the levels of Temra cells (CD45RA ⁺ , CCR7 ^" ), the CD4 ⁺ :CD8 ⁺ T cell ratio, and the TNF-a concentration in serum. Subjects were evaluated 6 months after the first injection and 1, 3, and 6 months after the second injection. Provided in Tables 2-9 are the measured values for each of the immune biomarkers discussed above. Also provided in Tables 2-9 are Scores assigned to each of the immune biomarkers assessed in each patient at different time-points that indicate whether an increase or decrease was observed in the immune biomarker measured. Finally, in Table 10 are the total Scores for each patient that includes different time-points as well as averages among the patients. As can be observed in the last row of Table 10 and in FIG. 8, the immunosenescence Score improves in subjects with aging frailty after the first injection of human mesenchymal stem cells and continues to stay in an improved state after a second injection of human mesenchymal stem cells.

Table 2. Effects of Human Mesenchymal Stem Cells on Switched Memory B Cells

Improvement Scale: No Change=0; Improved XKl fold=l; Improved >1<2 fold=2; Improved >2<3 fold=3; Improved >3 fold=4; Worsened X)<1 fold— 1; Worsened >1<2 fold=-2; Worsened >2<3 fold =-3; and Worsened >3 fold=-4.

Table 3. Effects of Human Mesenchymal Stem Cells on %B-Cells Expressing Intracellular TNF-o

Table 6. Effects of Human Mesenchymal Stem Cells on Early Activation of T Cells (CD69)

Table 7. Effects of Human Mesenchymal Stem Cells on Late/Chronic Activation of T Cells (CD25)

Table 8. Effects of Human Mesenchymal Stem Cells on Ratio of CD4 :CD8 ⁺ T Cells

Table 9. Effects of Human Mesenchymal Stem Cells on Serum TNF-a Concentration

Table 10. Total Immunosenescence Scores of Patients