Abstract
The diverse immunomodulatory properties of mesenchymal stem/stromal cells (MSCs) may be exploited for treatment of a multitude of inflammatory conditions. MSCs have long been reported to be hypoimmunogenic or 'immune privileged'; this property is thought to enable MSC transplantation across major histocompatibility barriers and the creation of off-the-shelf therapies consisting of MSCs grown in culture. However, recent studies describing generation of antibodies against and immune rejection of allogeneic donor MSCs suggest that MSCs may not actually be immune privileged. Nevertheless, whether rejection of donor MSCs influences the efficacy of allogeneic MSC therapies is not known, and no definitive clinical advantage of autologous MSCs over allogeneic MSCs has been demonstrated to date. Although MSCs may exert therapeutic function through a brief 'hit and run' mechanism, protecting MSCs from immune detection and prolonging their persistence in vivo may improve clinical outcomes and prevent patient sensitization toward donor antigens.
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References
Friedenstein, A.J., Piatetzky-Shapiro, I.I. & Petrakova, K.V. Osteogenesis in transplants of bone marrow cells. J. Embryol. Exp. Morphol. 16, 381–390 (1966).
Friedenstein, A., Gorskaja, J. & Kulagina, N. Fibroblast precursors in normal and irradiated mouse hematopoietic organs. Exp. Hematol. 4, 267–274 (1976).
Friedenstein, A.J., Chailakhyan, R.K. & Gerasimov, U.V. Bone marrow osteogenic stem cells: in vitro cultivation and transplantation in diffusion chambers. Cell Tissue Kinet. 20, 263–272 (1987).
Caplan, A.I. Mesenchymal stem cells. J. Orthop. Res. 9, 641–650 (1991).
James, A.W. et al. An abundant perivascular source of stem cells for bone tissue engineering. Stem Cells Transl. Med. 1, 673–684 (2012).
Crisan, M., Corselli, M., Chen, W.C.W. & Péault, B. Perivascular cells for regenerative medicine. J. Cell. Mol. Med. 16, 2851–2860 (2012).
Chan, C.K.F. et al. Clonal precursor of bone, cartilage, and hematopoietic niche stromal cells. Proc. Natl. Acad. Sci. USA 110, 12643–12648 (2013).
Park, D. et al. Endogenous bone marrow MSCs are dynamic, fate-restricted participants in bone maintenance and regeneration. Cell Stem Cell 10, 259–272 (2012).
Dominici, M. et al. Minimal criteria for defining multipotent mesenchymal stromal cells. The International Society for Cellular Therapy position statement. Cytotherapy 8, 315–317 (2006).
Copley, M.R., Beer, P.A. & Eaves, C.J. Hematopoietic stem cell heterogeneity takes center stage. Cell Stem Cell 10, 690–697 (2012).
Verovskaya, E. et al. Heterogeneity of young and aged murine hematopoietic stem cells revealed by quantitative clonal analysis using cellular barcoding. Blood 122, 523–532 (2013).
Bernardo, M.E. & Fibbe, W.E. Mesenchymal stromal cells: sensors and switchers of inflammation. Cell Stem Cell 13, 392–402 (2013).
Nauta, A.J. & Fibbe, W.E. Immunomodulatory properties of mesenchymal stromal cells. Blood 110, 3499–3506 (2007).
François, M., Romieu-Mourez, R., Li, M. & Galipeau, J. Human MSC suppression correlates with cytokine induction of indoleamine 2,3-dioxygenase and bystander M2 macrophage differentiation. Mol. Ther. 20, 187–195 (2012).
Prockop, D.J. Concise review: two negative feedback loops place mesenchymal stem/stromal cells at the center of early regulators of inflammation. Stem Cells 31, 2042–2046 (2013).
Bianco, P . et al. The meaning, the sense and the significance: translating the science of mesenchymal stem cells into medicine. Nat. Med. 19, 35–42 (2013).
Shen, H. Stricter standards sought to curb stem-cell confusion. Nature 499, 389 (2013).
Keating, A. Mesenchymal stromal cells: new directions. Cell Stem Cell 10, 709–716 (2012).
Caplan, A.I. & Correa, D. The MSC: an injury drugstore. Cell Stem Cell 9, 11–15 (2011).
Phinney, D.G. et al. MSCs: science and trials. Nat. Med. 19, 812 (2013).
Fibbe, W.E., Dazzi, F. & LeBlanc, K. MSCs: science and trials. Nat. Med. 19, 812–813 (2013).
Pittenger, M.F. MSCs: science and trials. Nat. Med. 19, 811 (2013).
Ankrum, J. & Karp, J. Mesenchymal stem cell therapy: two steps forward, one step back. Trends Mol. Med. 16, 203–209 (2010).
Haynesworth, S.E., Baber, M.A. & Caplan, A.I. Cytokine expression by human marrow-derived mesenchymal progenitor cells in vitro: effects of dexamethasone and IL-1 alpha. J. Cell. Physiol. 166, 585–592 (1996).
Devine, S.M. & Hoffman, R. Role of mesenchymal stem cells in hematopoietic stem cell transplantation. Curr. Opin. Hematol. 7, 358–363 (2000).
Lazarus, H., Curtin, P., Devine, S., McCarthy, P. & Holland, K. Role of mesenchymal stem cells (MSC) in allogeneic transplantation: early phase I clinical results. Blood 96, 392a (2000).
Klyushnenkova, E., Mosca, J.D., McIntosh, K.R. & Thiede, M.A. Human mesenchymal stem cells suppress allogeneic T cell responses in vitro: implications for allogeneic transplantation. Blood 92, 2652 (1998).
Tse, W.T., Beyer, W., Pendleton, J.D. & D'Andrea, A. Bone marrow derived mesenchymal stem cells suppress T cell activation without inducing allogeneic anergy. Blood 96, 1034a (2000).
Tse, W.T., Pendleton, J.D., Beyer, W.M., Egalka, M.C. & Guinan, E.C. Suppression of allogeneic T-cell proliferation by human marrow stromal cells: implications in transplantation. Transplantation 75, 389–397 (2003).
Klyushnenkova, E. et al. T cell responses to allogeneic human mesenchymal stem cells: immunogenicity, tolerance, and suppression. J. Biomed. Sci. 12, 47–57 (2005).
Bartholomew, A. et al. Mesenchymal stem cells suppress lymphocyte proliferation in vitro and prolong skin graft survival in vivo. Exp. Hematol. 30, 42–48 (2002).
Le Blanc, K., Tammik, L., Sundberg, B., Haynesworth, S.E. & Ringden, O. Mesenchymal stem cells inhibit and stimulate mixed lymphocyte cultures and mitogenic responses independently of the major histocompatibility complex. Scand. J. Immunol. 57, 11–20 (2003).
Di Nicola, M. et al. Human bone marrow stromal cells suppress T-lymphocyte proliferation induced by cellular or nonspecific mitogenic stimuli. Blood 99, 3838–3843 (2002).
Krampera, M. et al. Bone marrow mesenchymal stem cells inhibit the response of naive and memory antigen-specific T cells to their cognate peptide. Blood 101, 3722–3729 (2003).
Liechty, K.W. et al. Human mesenchymal stem cells engraft and demonstrate site-specific differentiation after in utero transplantation in sheep. Nat. Med. 6, 1282–1286 (2000).
Ito, T. et al. Mesenchymal stem cell and islet co-transplantation promotes graft revascularization and function. Transplantation 89, 1438–1445 (2010).
Casiraghi, F. et al. Pretransplant infusion of mesenchymal stem cells prolongs the survival of a semiallogeneic heart transplant through the generation of regulatory T cells. J. Immunol. 181, 3933–3946 (2008).
Waterman, R.S., Tomchuck, S.L., Henkle, S.L. & Betancourt, A.M. A new mesenchymal stem cell (MSC) paradigm: polarization into a pro-inflammatory MSC1 or an immunosuppressive MSC2 phenotype. PLoS ONE 5, e10088 (2010).
Ranganath, S.H., Levy, O., Inamdar, M.S. & Karp, J.M. Harnessing the mesenchymal stem cell secretome for the treatment of cardiovascular disease. Cell Stem Cells 10, 244–258 (2012).
Le Blanc, K., Tammik, C., Rosendahl, K., Zetterberg, E. & Ringdén, O. HLA expression and immunologic properties of differentiated and undifferentiated mesenchymal stem cells. Exp. Hematol. 31, 890–896 (2003).
Hemeda, H. et al. Interferon-γ and tumor necrosis factor-α differentially affect cytokine expression and migration properties of mesenchymal stem cells. Stem Cells Dev. 19, 693–706 (2010).
Mastri, M. et al. Activation of Toll-like receptor 3 (TLR3) amplifies mesenchymal stem cell trophic factors and enhances therapeutic potency. Am. J. Physiol. Cell Physiol. 303, C1021–C1033 (2012).
Delarosa, O., Dalemans, W. & Lombardo, E. Toll-like receptors as modulators of mesenchymal stem cells. Front. Immunol. 3, 182 (2012).
Shi, Y. et al. How mesenchymal stem cells interact with tissue immune responses. Trends Immunol. 33, 136–143 (2012).
Le Blanc, K. et al. Treatment of severe acute graft-versus-host disease with third party haploidentical mesenchymal stem cells. Lancet 363, 1439–1441 (2004).
von Bahr, L. et al. Long-term complications, immunologic effects, and role of passage for outcome in mesenchymal stromal cell therapy. Biol. Blood Marrow Transplant. 18, 557–564 (2012).
Lalu, M.M. et al. Safety of cell therapy with mesenchymal stromal cells (SafeCell): a systematic review and meta-analysis of clinical trials. PLoS ONE 7, e47559 (2012).
Penn, M.S. et al. Adventitial delivery of an allogeneic bone marrow-derived adherent stem cell in acute myocardial infarction: phase I clinical study. Circ. Res. 110, 304–311 (2012).
Yang, H. South Korea's stem cell approval. Nat. Biotechnol. 29, 857 (2011).
Cyranoski, D. Canada approves stem cell product. Nat. Biotechnol. 30, 571 (2012).
Kurtzberg, J. et al. Allogeneic human mesenchymal stem cell therapy (Remestemcel-L, Prochymal) as a rescue agent for severe refractory acute graft-versus-host disease in pediatric patients. Biol. Blood Marrow Transplant. 10.1016/j.bbmt.2013.11.001 (2013).
Le Blanc, K. et al. Mesenchymal stem cells for treatment of steroid-resistant, severe, acute graft-versus-host disease: a phase II study. Lancet 371, 1579–1586 (2008).
Bernardo, M.E. et al. Co-infusion of ex vivo-expanded, parental MSCs prevents life-threatening acute GVHD, but does not reduce the risk of graft failure in pediatric patients undergoing allogeneic umbilical cord blood transplantation. Bone Marrow Transplant. 46, 200–207 (2011).
Ball, L.M. et al. Multiple infusions of mesenchymal stromal cells induce sustained remission in children with steroid-refractory, grade III–IV acute graft-versus-host disease. Br. J. Haematol. 163, 501–509 (2013).
Riordan, N.H. et al. Non-expanded adipose stromal vascular fraction cell therapy for multiple sclerosis. J. Transl. Med. 7, 29 (2009).
Toma, C., Wagner, W.R., Bowry, S., Schwartz, A. & Villanueva, F. Fate of culture-expanded mesenchymal stem cells in the microvasculature: in vivo observations of cell kinetics. Circ. Res. 104, 398–402 (2009).
Lee, R.H. et al. Intravenous hMSCs improve myocardial infarction in mice because cells embolized in lung are activated to secrete the anti-inflammatory protein TSG-6. Cell Stem Cell 5, 54–63 (2009).
Kidd, S. et al. Direct evidence of mesenchymal stem cell tropism for tumor and wounding microenvironments using in vivo bioluminescent imaging. Stem Cells 27, 2614–2623 (2009).
von Bahr, L. et al. Analysis of tissues following mesenchymal stromal cell therapy in humans indicates limited long-term engraftment and no ectopic tissue formation. Stem Cells 30, 1575–1578 (2012).
Muschler, G.F., Nakamoto, C. & Griffith, L.G. Engineering principles of clinical cell-based tissue engineering. J. Bone Joint Surg. Am. 86-A, 1541–1558 (2004).
Eliopoulos, N., Stagg, J., Lejeune, L., Pommey, S. & Galipeau, J. Allogeneic marrow stromal cells are immune rejected by MHC class I- and class II-mismatched recipient mice. Blood 106, 4057–4065 (2005).
Campeau, P.M. et al. Mesenchymal stromal cells engineered to express erythropoietin induce anti-erythropoietin antibodies and anemia in allorecipients. Mol. Ther. 17, 369–372 (2009).
Zangi, L. et al. Direct imaging of immune rejection and memory induction by allogeneic mesenchymal stromal cells. Stem Cells 27, 2865–2874 (2009).
Nauta, A.J. et al. Donor-derived mesenchymal stem cells are immunogenic in an allogeneic host and stimulate donor graft rejection in a nonmyeloablative setting. Blood 108, 2114–2120 (2006).
Badillo, A.T., Beggs, K.J., Javazon, E.H., Tebbets, J.C. & Flake, A.W. Murine bone marrow stromal progenitor cells elicit an in vivo cellular and humoral alloimmune response. Biol. Blood Marrow Transplant. 13, 412–422 (2007).
Griffin, M.D. et al. Anti-donor immune responses elicited by allogeneic mesenchymal stem cells: what have we learned so far? Immunol. Cell Biol. 91, 40–51 (2013).
Camp, D.M., Loeffler, D.A., Farrah, D.M., Borneman, J.N. & LeWitt, P.A. Cellular immune response to intrastriatally implanted allogeneic bone marrow stromal cells in a rat model of Parkinson's disease. J. Neuroinflammation 6, 17 (2009).
Schu, S. et al. Immunogenicity of allogeneic mesenchymal stem cells. J. Cell. Mol. Med. 16, 2094–2103 (2012).
Beggs, K.J. et al. Immunologic consequences of multiple, high-dose administration of allogeneic mesenchymal stem cells to baboons. Cell Transplant. 15, 711–721 (2006).
Isakova, I.A., Dufour, J., Lanclos, C., Bruhn, J. & Phinney, D.G. Cell-dose-dependent increases in circulating levels of immune effector cells in rhesus macaques following intracranial injection of allogeneic MSCs. Exp. Hematol. 38, 957–967 (2010).
Poncelet, A.J., Vercruysse, J., Saliez, A. & Gianello, P. Although pig allogeneic mesenchymal stem cells are not immunogenic in vitro, intracardiac injection elicits an immune response in vivo. Transplantation 83, 783–790 (2007).
Grinnemo, K.H. et al. Xenoreactivity and engraftment of human mesenchymal stem cells transplanted into infarcted rat myocardium. J. Thorac. Cardiovasc. Surg. 127, 1293–1300 (2004).
Xia, Z. et al. Macrophagic response to human mesenchymal stem cell and poly(epsilon-caprolactone) implantation in nonobese diabetic/severe combined immunodeficient mice. J. Biomed. Mater. Res. A 71, 538–548 (2004).
Moll, G. et al. Are therapeutic human mesenchymal stromal cells compatible with human blood? Stem Cells 30, 1565–1574 (2012).
Moll, G. et al. Mesenchymal stromal cells engage complement and complement receptor bearing innate effector cells to modulate immune responses. PLoS ONE 6, e21703 (2011).
Li, Y. & Lin, F. Mesenchymal stem cells are injured by complement after their contact with serum. Blood 120, 3436–3443 (2012).
Le Blanc, K. & Mougiakakos, D. Multipotent mesenchymal stromal cells and the innate immune system. Nat. Rev. Immunol. 12, 383–396 (2012).
Chan, J.L. et al. Antigen-presenting property of mesenchymal stem cells occurs during a narrow window at low levels of interferon-gamma. Blood 107, 4817–4824 (2006).
Stagg, J., Pommey, S., Eliopoulos, N. & Galipeau, J. Interferon-gamma-stimulated marrow stromal cells: a new type of nonhematopoietic antigen-presenting cell. Blood 107, 2570–2577 (2006).
François, M. et al. Mesenchymal stromal cells cross-present soluble exogenous antigens as part of their antigen-presenting cell properties. Blood 114, 2632–2638 (2009).
Dembinski, J.L. et al. Tumor stroma engraftment of gene-modified mesenchymal stem cells as anti-tumor therapy against ovarian cancer. Cytotherapy 15, 20–32 (2013).
Ren, G. et al. Species variation in the mechanisms of mesenchymal stem cell-mediated immunosuppression. Stem Cells 27, 1954–1962 (2009).
Voll, R.E. et al. Immunosuppressive effects of apoptotic cells. Nature 390, 350–351 (1997).
Leonard, D.A., Cetrulo, C.L. Jr., McGrouther, D.A. & Sachs, D.H. Induction of tolerance of vascularized composite allografts. Transplantation 95, 403–409 (2013).
Zanotti, L. et al. Encapsulated mesenchymal stem cells for in vivo immunomodulation. Leukemia 27, 500–503 (2013).
Maccario, R. et al. Human mesenchymal stem cells and cyclosporin a exert a synergistic suppressive effect on in vitro activation of alloantigen-specific cytotoxic lymphocytes. Biol. Blood Marrow Transplant. 11, 1031–1032 (2005).
Buron, F. et al. Human mesenchymal stem cells and immunosuppressive drug interactions in allogeneic responses: an in vitro study using human cells. Transplant. Proc. 41, 3347–3352 (2009).
Ge, W. et al. Infusion of mesenchymal stem cells and rapamycin synergize to attenuate alloimmune responses and promote cardiac allograft tolerance. Am. J. Transplant. 9, 1760–1772 (2009).
Luznik, L. et al. High-dose cyclophosphamide as single-agent, short-course prophylaxis of graft-versus-host disease. Blood 115, 3224–3230 (2010).
Huang, W.H., Yan, Y., De Boer, B., Bishop, G.A. & House, A.K. A short course of cyclosporine immunosuppression inhibits rejection but not tolerance of rat liver allografts. Transplantation 75, 368–374 (2003).
Huang, W.H. et al. A short course of mycophenolate immunosuppression inhibits rejection, but not tolerance, of rat liver allografts in association with inhibition of interleukin-4 and alloantibody responses. Transplantation 76, 1159–1165 (2003).
Forslöw, U. et al. Treatment with mesenchymal stromal cells is a risk factor for pneumonia-related death after allogeneic hematopoietic stem cell transplantation. Eur. J. Haematol. 89, 220–227 (2012).
de la Garza-Rodea, A.S. et al. Exploitation of herpesvirus immune evasion strategies to modify the immunogenicity of human mesenchymal stem cell transplants. PLoS ONE 6, e14493 (2011).
Soland, M.A. et al. Modulation of human mesenchymal stem cell immunogenicity through forced expression of human cytomegalovirus US proteins. PLoS ONE 7, e36163 (2012).
Levy, O. et al. mRNA-engineered mesenchymal stem cells for targeted delivery of interleukin-10 to sites of inflammation. Blood 122, e23–e32 (2013).
Ko, I.K., Kean, T.J. & Dennis, J.E. Targeting mesenchymal stem cells to activated endothelial cells. Biomaterials 30, 3702–3710 (2009).
Sarkar, D. et al. Chemical engineering of mesenchymal stem cells to induce a cell rolling response. Bioconjug. Chem. 19, 2105–2109 (2008).
Sarkar, D. et al. Engineered mesenchymal stem cells with self-assembled vesicles for systemic cell targeting. Biomaterials 31, 5266–5274 (2010).
Sarkar, D., Ankrum, J., Teo, G.S.L., Carman, C.V. & Karp, J.M. Cellular and extracellular programming of cell fate through engineered intracrine-, paracrine-, and endocrine-like mechanisms. Biomaterials 32, 3053–3061 (2011).
Ankrum, J. et al. Engineering cells with intracellular agent-loaded microparticles to control cell phenotype. Nat. Protoc. 9, 233–245 (2014).
Brandenberger, R. et al. Cell therapy bioprocessing. Bioprocess Int. 9, 30–37 (2011).
Melief, S.M., Zwaginga, J.J., Fibbe, W.E. & Roelofs, H. Adipose tissue-derived multipotent stromal cells have a higher immunomodulatory capacity than their bone marrow-derived counterparts. Stem Cells Transl. Med 2, 455–463 (2013).
Bravery, C.A. . et al. Potency assay development for cellular therapy products: an ISCT review of the requirements and experiences in the industry. Cytotherapy 15, 9–19 (2013).
Hare, J.M. et al. Comparison of allogeneic vs autologous bone marrow–derived mesenchymal stem cells delivered by transendocardial injection in patients with ischemic cardiomyopathy: the POSEIDON randomized trial. J. Am. Med. Assoc. 308, 2369–2379 (2012).
Jung, Y., Bauer, G. & Nolta, J.A. Concise review: induced pluripotent stem cell-derived mesenchymal stem cells: progress toward safe clinical products. Stem Cells 30, 42–47 (2012).
Krampera, M. et al. Immunological characterization of multipotent mesenchymal stromal cells-The International Society for Cellular Therapy (ISCT) working proposal. Cytotherapy 15, 1054–1061 (2013).
Zhukareva, V., Obrocka, M., Houle, J.D., Fischer, I. & Neuhuber, B. Secretion profile of human bone marrow stromal cells: donor variability and response to inflammatory stimuli. Cytokine 50, 317–321 (2010).
Strioga, M., Viswanathan, S., Darinskas, A., Slaby, O. & Michalek, J. Same or not the same? Comparison of adipose tissue-derived versus bone marrow-derived mesenchymal stem and stromal cells. Stem Cells Dev. 21, 2724–2752 (2012).
Zhao, W. et al. Cell-surface sensors for real-time probing of cellular environments. Nat. Nanotechnol. 6, 524–531 (2011).
Saxon, E. & Bertozzi, C.R. Cell surface engineering by a modified Staudinger reaction. Science 287, 2007–2010 (2000).
Acknowledgements
This work was supported by National Institutes of Health grant HL095722, Department of Defense grant no. W81XWH-13-1-0305 and by a Movember–Prostate Cancer Foundation Challenge Award to J.M.K. J.A.A. was supported by the Hugh Hampton Young Memorial Fellowship.
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J.M.K. is a paid consultant of Sanofi and Stempeutics in the area of regenerative medicine and mesenchymal stem cells.
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Ankrum, J., Ong, J. & Karp, J. Mesenchymal stem cells: immune evasive, not immune privileged. Nat Biotechnol 32, 252–260 (2014). https://doi.org/10.1038/nbt.2816
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DOI: https://doi.org/10.1038/nbt.2816
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