OF NEO-ISLETS OR EXOSOMES FROM STEM CELLS

5

FI ELD

[0001] This disclosure relates generally to the fields of cell biology and medicine. In particular this disclosure relates to the production of cells and exosomes for use in treating subjects and more particularly to the production of cells and exosomes that are useful in treating Diabetes mellitus

BACKGROUND

5 [0002] Mesenchymal Stem or Stromal Cells (MSC) from bone marrow, fat, umbilical cord, placenta, amniotic fluid, and other sources are non-embryonic, ^" 'adult" stem cells that possess potent anti-inflammatory, anti-apoptotic, mitogenic, angiogenic and vasculo-protective, immune modulating, a ti-fibrotic, anti-thrombotic and a ti-biotic paracrine activities that have been used for the promising treatment of various acute and0 chronic diseases and organ injuries. Most specifically, we have shown (We steni 'elder C.

Gooch A. et al. STEM CELLS Translational Medicine Volume 6, Issue 7, pages 1631- 1643, JULY 2017) that the co-aggregation of allogeneic MSCs and allogeneic, culture expanded pancreatic islet cells durably corrects TIDM in a mouse model of auto-immune TIDM that closely resembles human and canine TIDM (NOD mice). The MSC component5 of NIs provides robust protection against alio- and auto-immune attacks of insulin-producing endocrine islet cells in vivo, making the use of potentially toxic anti -rejection drags unnecessary, as these can cause serious infections, malignancies, damage of transplanted islets in the liver and kidney disease. In addition, the NI technology allows the generation of 80+ therapeutic doses from one pancreas donor, which is in striking contrast to pancreatic islet transplantation protocols, where a diabetic recipient needs 4 or more donors for one single treatment. MSCs in culture release beneficial cytokines and growth factors that mediate their pleiotropic effects. In addition, MSCs, like essentially all cells, release Exosomes (30-100 nm in diameter) into their microenvironment that are taken up by adjacent ceils, which, in turn, results in paracrine signaling in the target cells. Signaling occurs by the lateral transfer of rnRNAs, rniRNAs, proteins, and lipids, which together are known to exert beneficial effects that are essentially identical to those of intact MSCs.

[0Θ03] Described herein are a) mesenchymal and/or adipose stem cells; b) pancreatic islet cells: c) mesenchymal and/or adipose stem cell-derived exosomes; and d) exosomes derived from other cell types such as endothelial, muscle and other cultured ceils.

[0004] Further described are Neo-Islets (NIs), where NTs comprise mesenchymal and/or adipose stem cells; and pancreatic islet cells.

[0005] Disclosed herein is a method of generating exosomes (extracellular nano esicles). Such methods may include the expansion of mesenchymal or adipose stem cells or islets, or other cells in a Hollow-Fiber-based Cell Expansion (HFCE) System and collecting exosomes released by the culture expanded mesenchyme, adipose stem ceils, or other cells from the HFCE System.

[0006] in embodiments of the method, the cells are expanded to 70-95% confluency. In further embodiments, the culture medium perfused through the I U- ^' Cf system may be adjusted to enhance the release of exosomes into the lumens of the hollow fibers. [0007] Embodiments include exosomes produced by such methods as well as methods of treating subjects suffering from T1DM, T2DM, or associated microvascular disease by treating the subject with the exosomes produced by the above methods. In particular embodiments the exosomes have been cryopreserved for at least two years prior to treatment.

[0008] Provided are embodiments of a method for generating Neo Islets. Particular embodiments include culture expanding mesenchymal or adipose stem cells and pancreatic islet cells in HFCE System and collecting Neo Islets from the HFCE System. In embodiments of the method, the cells are expanded to 70-95% confluency.

[0009] In embodiments the Neo Istels may comprise a) dedifferentiated islet cells and mesenchymal or adipose stem cells and/or redifferentiated islet cells and mesenchymal or adipose stem cells. In particular embodiments wherein the islet cells and stem cells are present in the Neo Islets at an islet cell: stem cell ratio of about 1 : 100, 1 :75, 1:50, 1 :25, 1 : 10, 1 :9, 1 :8, 1 :7, 1 :6, 1 :5, 1 :4, 1 :3, 1 :2, 1 : 1, 2: 1, 3: 1, 4: 1, 5: 1, 6: 1, 7: 1, 8: 1, 9: 1, 10: 1, 25: 1, 50: 1, 75: 1, or 100: 1.

[0010] In certain embodiments the collected Neo Islets are placed in a hydrogel and/or are encapsulated.

[0011 [ Embodiments include neo-islets produced by such methods.

[0012] Embodiments include methods of treating a subject suffering from T1DM or T2DM, and associated microvascular disease with neo-islets produced by the above described methods.

[0013] Also described are methods of treating a subject with T1DM or T2DM, the methods comprising: administering to the subject NIs with or without exosomes derived from MSCs or other cultured cells.

[0014] The here disclosed NI technology harnesses the pleiotropic functions of MSCs, where appropriate, and of their Exosomes where needed i order to repair and protect the affected capillary system in the diseases and disorders listed above.

[0015] ^" Treating" or "treatment" does not require a complete cure. It means that the symptoms of the underlying disease are at least reduced, and/or that one or more of the underlying cellular, physiological, or biochemical causes or mechanisms causing the symptoms are reduced and/or eliminated, it is understood that reduced, as used in this context, means relative to the state of the disease, including the molecular state of tlie disease, not just the physiological state of the disease.

[0016] As used herein 'therapeutically effective amount" is an amount sufficient to act as a treatment as defined above. This may be determined by, e.g., standard techniques used to monitor and/or diagnose a particular disease state.

[0017] As used herein, "comprising," "including," "containing," "characterized by," and grammatical equivalents thereof are inclusive or open-ended terms that do not exclude additional, unrecited elements or method steps, but also includes the more restrictive terms "consisting of and "consisting essentially of.

[0018] in conclusion, the purpose of using a customized Hollow-Fiber-based Cell Culture system is to allow the scaled -up and highly efficient production of MSCs, islet cells and thus NIs for the treatment of diabetes. In addition, various cultured cell types in a Hollow-Fiber-based Cell Culture system can be programmed to generate large numbers of Exosomes in which therapeutically desired and unique therapeutic qualities are potentiated and used for the treatment of specific diseases in Personalized and Regenerative Medicine. It is also envisioned that the broad scale use of the developed, high efficiency Hollow-Fiber- based Cell Culture Technology will prove cost saving for the entire Health Care System . DETAILED DESCRIPTION

[0019] The illustrations presented in this disclosure are not meant to be actual views of any particular compositions, but are merely representations employed to describe illustrative embodiments. Thus, the figures are not necessarily to scale.

[ΘΘ20] In this disclosure, the term Mesenchymal Stem Cell means and includes mesenchymal and/or adipose stem cells; and b) mesenchymal and/or adipose stem cell- derived exosomes.

[0021] While certain illustrative embodiments have been described in connection with the figures, those of ordinary skill in the art will recognize and appreciate that the scope of this disclosure is not limited to those embodiments explicitly shown and described in this disclosure. Rather, many additions, deletions, and modifications to the embodiments described in this disclosure may be made to produce embodiments within the scope of this disclosure, such as those specifically claimed, including legal equivalents. In addition, features from one disclosed embodiment may be combined with features of another disclosed embodiment while still being within the scope of this disclosure, as contemplated herein.

[0022] This disclosure relates generally to the manufacturing of Neo-Islets for the treatment of Type 1 Diabetes mellitus in companion animals such as dogs and in human subjects. Neo-Islets (NIs) are co-aggregates of culture expanded pancreatic islet cells and cultured Mesenchymal Stem Cells (MSCs) obtained from bone marrow or adipose tissue. The Hollow-Fiber-based Cell Culture technology is a highly efficient, enclosed system, therefore not requiring a clean room that is currently used for the expansion of attached MSCs and other cells both for research and clinical use and for suspension culture of various types of blood cells.

[0023] Therapeutic targets for the here disclosed technology include both Type 1 and Type 2 Diabetes mellitus and their multiorgan complications (kidneys, eyes, heart, neurological and others), vasculitides, auto-immune diseases, sepsis, acute and chronic kidney diseases, cardiovascular and neurological diseases, solid organ transplantation, vascular rejection, wound healing, atherosclerosis, aging, and various degenerative retinal and neurological diseases. More specifically, disclosed embodiments relate to the therapeutic use of Mesenchymal Stem Cells from various sources as a critical component of NTs and their Exosomes, to repair and protect and stabilize the diseased microvasculature and thereby improve outcomes and survival both in canines and humans with T1DM.

[0024] It is envisioned that a Hollow-Fiber-based Cell Culture (HFCE) system can be used, with modifications, for the expansion of islet cells, the formation of therapeutic doses of NTs, and the generation of Exosomes from cultured MSCs and other cells that are programmed to impart specific therapeutic characteristics on released Exosomes for die treatment of various diseases, such as acute renal failure, chronic kidney disease, strokes, heart attacks, various auto-immune diseases, organ transplantation, and others

[0025] The use of an HFCE system to produce exosomes and NIs: (See also above paragraph). Such HFCE systems are in some aspects similar to the configuration of clinically used hemodialysis cartridges. These systems ahve the distinct advantage of providing a highly favorable surface area to culture medium ratio and flexibility regarding changes in culture conditions of both attached cells (e.g. Mesenchymal Stem, islet, and other cell types) and cells in suspension culture, a technique that is used for the manufacturing of Neo-Islets. In addition, various attached cell types that are expanded in a HFCE system can be programmed to release exosomes with optimized therapeutic characteristics such as immune-isolation, anti-inflammatory, cytoprotective, angiogenic, and others. Together, the efficacy and therefore costs of cell culturing, Neo-Islet and exosomes production in a suitable HFCE system., are expected to be substantially more favorable than in conventional culture systems. [0026] Production of Exosomes (extracellular nanovesicles) are spontaneously released from MSC, ASC and most other cell types when efficiently cultured in a suitable HFCE System (a bioreactor) or flask system. They can be continuously harvested, characterized (surface marker expression, miRNA, RNA, DNA, peptides, cytokines and lipid cargo), cryopreserved or freshly used. The utilized cell culture media in the HFCE System are standard media that are used by all experts in the field. However, modifications of the culture media can be employed to generate exosomes that possess desirable, therapeutic characteristics, such as augmented anti-inflammatory, immune-modulating and trophic effects (anti-apoptotic, mitogenic, angiogenic and others).

[0027] The production of NIs with a HFCE System, as described above, utilizes culture expanded pancreatic islet cells (insulin, glucagon, somatostatin, PPY producing cells and other non-endocrine cells) and culture expanded MSCs or ASCs. The suspension co- culture of islet cells and MSCs or ASCs in a suitably modified HFCE System results in the efficient generation of NIs that, after appropriate characterization (relevant gene expression profiles, glucose-sensitive insulin release test, etc.) can be used fresh for the treatment of T1DM or they can be cryopreserved for later use.

[0028] Regarding the treatment of subjects using NIs, the contents of US application 15/261,750 are incorporated herein in its entirety by this reference. EXAMPLES

[0029] The following examples are provided for illustration purposes only and are not to be construed as limiting the disclosure to the embodiments specifically disclosed therein.

[0030] Both type 1 and type 2 diabetes mellitus progressively result in wide-spread end organ damage, affecting the retina, coronaries, the nervous system, kidneys and other organs though microvascular disease that injures the capillary beds in these organs through endothelial and pericytes dysfunction, microvascular obstruction and inflammation, vasoconstriction, vascular leakage, coagulopathy, and fibrosis. This microvascular damage also affects the capillaries of the islets of Langerhans in the pancreas. This pathomechanisms, we hypothesized could accelerate the destruction of insulin producing cells and thereby hasten the complete loss of intrinsic insulin production, i.e., greatly aggravate the diabetic state in a patient. Accordingly, we tested whether the parenteral administration of mesenchymal and/or adipose-derived exosomes to db/db mice with advanced diabetic disease would improve glycemic control. This was observed, together with improvement in diabetic kidney disease.

[0031 ] In analogy to the microvascular disease of diabetes, which shares most pathologic features of various vasculitides, auto-immune diseases, sepsis, acute and chronic kidney diseases, cardiovascular and neurological diseases, solid organ transplantation, vascular rejection, wound healing, atherosclerosis, aging, and various degenerative retinal diseases, we expect that the treatment with Mesenchymal and/or Adipose Stem Cells alone or their exosomes alone or in combination with their parent stem cells will favorably affect outcomes in this large group of microvascular diseases.

[0032] A type 2 diabetic male subject presents with chronic kidney disease. MSCs are isolated from the subject and expanded in culture. The expanded MSCs are administered to the subject in an amount sufficient to improve the symptoms from which the subject is suffering that are related to microvasculature issues.

[0033] Detailed examples of using an HFCE System to produce exosomes and Ms:

[0034] It is envisioned that the HFCE System is used to produce exosomes from cultured MSCs, ASCs, and other cells of interest as shown in FIGURE 1. The cells of interest from which exosomes (MSCs or ASCs, other cells) or NIs (islet cells, MSCs or ASCs) are produced will be loaded, suspended in suitable culture media, into the top port (FIGURE 1), Defined culture media will perfuse the internal and external spaces of the hollow fibers that contain cells to be expanded or co-cultured (MSCs or ACSs with islet cells). Once the desired degree of cell expansion within the HFCE System is reached, cells are detached and harvested, at the bottom of the HFCE System. Once the desired degree of cell clustering is reached, NIs are harvested at the bottom of the HFCE System. Exosomes from cultured cells are collected without detaching the cultured ceils.

[0035] The treatment of diabetic (Type 1) subjects with the NIs consists of administering a body weight-based dose of this composition into the intraperitoneal space of such a subject, using ultrasound guidance and local anesthesia. The Exosome-based treatment of subjects with various diseases (autoimmune, transplantation-related complications, ischemic injury-, vasculitis, liver disease, neurodegenerative, retinal, cardiac, renai and other disorders) consists on the intravenous administration of a predetermined dose of functionally "customized" (see above) Exosomes.