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Augmenting canonical Wnt signalling in therapeutically inert cells converts them into therapeutically potent exosome factories


Cardiosphere-derived cells are therapeutic candidates with disease-modifying bioactivity, but their variable potency has complicated their clinical translation. Transcriptomic analyses of cardiosphere-derived cells from human donors have revealed that their therapeutic potency correlates with Wnt/β-catenin signalling and with β-catenin protein levels. Here, we show that skin fibroblasts engineered to overexpress β-catenin and the transcription factor Gata4 become immortal and therapeutically potent. Transplantation of the engineered fibroblasts into a mouse model of acute myocardial infarction led to improved cardiac function and mouse survival, and in the mdx mouse model of Duchenne muscular dystrophy, exosomes secreted by the engineered fibroblasts improved exercise capacity and reduced skeletal-muscle fibrosis. We also demonstrate that exosomes from high-potency cardiosphere-derived cells exhibit enhanced levels of miR-92a (a known potentiator of the Wnt/β-catenin pathway), and that they activate cardioprotective bone-morphogenetic-protein signalling in cardiomyocytes. Our findings show that the modulation of canonical Wnt signalling can turn therapeutically inert mammalian cells into immortal exosome factories for cell-free therapies.

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Fig. 1: Sequencing summary of high- and low-potency donors.
Fig. 2: β-catenin is necessary for CDC potency.
Fig. 3: Mest regulates β-catenin in CDCs.
Fig. 4: Mest inhibition in immortalized CDCs.
Fig. 5: NHDF immortalization with β-catenin or β-catenin/gata4.
Fig. 6: Bioactivity of ASTEX in an mdx mouse model of Duchenne muscular dystrophy.
Fig. 7: β-catenin-activation leads to downstream activation of bmp2 in target cells via miR-92a.

Data availability

The authors declare that all data supporting the results in this study are available within the paper and its Supplementary Information.


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We thank the Cedars-Sinai Genomics Core for RNA sequencing, the Cedars Sinai Biobank and Translational Research Core for tissue processing, R. Benhaghnazar for technical assistance and A. Burtnick for help with Fig. 7. Work in the Marbán lab was supported by NIH R01124074; work at Capricor Therapeutics was supported by DOD PRMRP PR150618.

Author information




A.I. conceived the idea, designed the experiments, performed the experiments, analysed the data and wrote the manuscript. C.L., R.R., M.F., T.A. and R.R.S. performed the experiments and provided technical and design input. L.L., S.D.V., J.J.M., B.T., A.A. and L.S. performed the experiments and analysed the data. L.R.-B. assisted with project design, L.M. supervised the study and E.M. conceived the idea, wrote the manuscript and supervised the study.

Corresponding authors

Correspondence to Ahmed G. E. Ibrahim or Eduardo Marbán.

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Competing interests

E.M. owns founder’s stock in Capricor Therapeutics. L.L., S.D.V., J.J.M., L.R.-B., R.R.S. and L.M. are employees of the company.

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Ibrahim, A.G.E., Li, C., Rogers, R. et al. Augmenting canonical Wnt signalling in therapeutically inert cells converts them into therapeutically potent exosome factories. Nat Biomed Eng 3, 695–705 (2019).

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