Patrick Au

Tissue engineering: creation of long-lasting blood vessels.

The construction of stable blood vessels is a fundamental challenge for tissue engineering in regenerative medicine. Although certain genes can be introduced into vascular cells to enhance their survival and proliferation, these manipulations may be oncogenic. We show here that a network of long-lasting blood vessels can be formed in mice by co-implantation of vascular endothelial cells and mesenchymal precursor cells, by-passing the need for risky genetic manipulations. These networks are stable and functional for one year in vivo.

Engineering vascularized tissue

The creation in vitro of vascularized skeletal muscle represents a first step to the engineering of more complex tissue architectures.

Bone marrow-derived mesenchymal stem cells facilitate engineering of long-lasting functional vasculature

Vascular tissue engineering requires a ready source of endothelial cells and perivascular cells. Here, we evaluated human bone marrow-derived mesenchymal stem cells (hMSCs) for use as vascular progenitor cells in tissue engineering and regenerative medicine. hMSCs expressed a panel of smooth muscle markers in vitro including the cardiac/smooth muscle-specific transcription coactivator, myocardin. Cell-cell contact between endothelial cells and hMSCs up-regulated the transcription of myocardin. hMSCs efficiently stabilized nascent blood vessels in vivo by functioning as perivascular precursor cells. The engineered blood vessels derived from human umbilical cord vein endothelial cells and hMSCs remained stable and functional for more than 130 days in vivo. On the other hand, we could not detect differentiation of hMSCs to endothelial cells in vitro, and hMSCs by themselves could not form conduit for blood flow in vivo. Similar to normal perivascular cells, hMSC-derived perivascular cells contracted in response to endothelin-1 in vivo. In conclusion, hMSCs are perivascular cell precursors and may serve as an attractive source of cells for use in vascular tissue engineering and for the study of perivascular cell differentiation.

Endothelial cells derived from human embryonic stem cells form durable blood vessels in vivo

We describe the differentiation of human embryonic stem (hES) cells into endothelial cells using a scalable two-dimensional method that avoids an embryoid-body intermediate. After transplantation into severe combined immunodeficient (SCID) mice, the differentiated cells contributed to arborized blood vessels that integrated into the host circulatory system and served as blood conduits for 150 d.

Differential CD146 expression on circulating versus tissue endothelial cells in rectal cancer patients: implications for circulating endothelial and progenitor cells as biomarkers for antiangiogenic therapy.

PURPOSE Circulating endothelial cells (CECs) and progenitor cells are currently evaluated as potential biomarkers of antiangiogenic therapy. CD146 is considered a panendothelial-specific marker, but its utility as a CEC marker in cancer patients remains unclear. PATIENTS AND METHODS We analyzed the expression of CD146 on mononuclear blood cells, primary tissue endothelial cells, and malignant and normal tissues by flow cytometric and immunohistochemical analyses. Furthermore, we measured the circulation kinetics of CD146+ cells before, and then 3 and 12 days after vascular endothelial growth factor (VEGF) antibody blockade by bevacizumab infusion in rectal cancer patients enrolled in a phase I trial. RESULTS In the peripheral blood of these cancer patients, over 90% of the CD146+ cells were CD45+ hematopoietic cells. CD146 expression was primarily detected on a subset of CD3+CD4+ lymphocytes, and was undetectable on CD34+CD133+CD45(dim) progenitor cells or CD31(bright)CD45- viable CECs. In contradistinction, CD146 was detectable in tissues on both cellular components of tumor vessel wall: CD31(bright)CD45- endothelial cells and alpha-SMA+ pericytes. Unlike viable CECs and progenitor cells, CD146+ cell concentration in the peripheral blood of cancer patients did not decrease during VEGF blockade. CONCLUSION CD146 is fairly homogeneously expressed on vascular endothelium but not on viable CECs or progenitor cells. The vast majority of CD146+ blood cells are lymphocytes, and VEGF blockade by bevacizumab did not significantly change their number in rectal cancer patients. These results underscore the need for further characterization and identification of new markers for CEC subpopulations for their development as biomarkers of antiangiogenic therapy.

Generation of functionally competent and durable engineered blood vessels from human induced pluripotent stem cells

Efficient generation of competent vasculogenic cells is a critical challenge of human induced pluripotent stem (hiPS) cell-based regenerative medicine. Biologically relevant systems to assess functionality of the engineered vessels in vivo are equally important for such development. Here, we report a unique approach for the derivation of endothelial precursor cells from hiPS cells using a triple combination of selection markers—CD34, neuropilin 1, and human kinase insert domain-containing receptor—and an efficient 2D culture system for hiPS cell-derived endothelial precursor cell expansion. With these methods, we successfully generated endothelial cells (ECs) from hiPS cells obtained from healthy donors and formed stable functional blood vessels in vivo, lasting for 280 d in mice. In addition, we developed an approach to generate mesenchymal precursor cells (MPCs) from hiPS cells in parallel. Moreover, we successfully generated functional blood vessels in vivo using these ECs and MPCs derived from the same hiPS cell line. These data provide proof of the principle that autologous hiPS cell-derived vascular precursors can be used for in vivo applications, once safety and immunological issues of hiPS-based cellular therapy have been resolved. Additionally, the durability of hiPS-derived blood vessels in vivo demonstrates a potential translation of this approach in long-term vascularization for tissue engineering and treatment of vascular diseases. Of note, we have also successfully generated ECs and MPCs from type 1 diabetic patient-derived hiPS cell lines and use them to generate blood vessels in vivo, which is an important milestone toward clinical translation of this approach.

Secreted Gaussia Luciferase as a Biomarker for Monitoring Tumor Progression and Treatment Response of Systemic Metastases

Background Currently, only few techniques are available for quantifying systemic metastases in preclinical model. Thus techniques that can sensitively detect metastatic colonization and assess treatment response in real-time are urgently needed. To this end, we engineered tumor cells to express a naturally secreted Gaussia luciferase (Gluc), and investigated its use as a circulating biomarker for monitoring viable metastatic or primary tumor growth and their treatment responses. Methodology/Principal Findings We first developed orthotopic primary and metastatic breast tumors with derivative of MDA-MB-231 cells expressing Gluc. We then correlated tumor burden with Gluc activity in the blood and urine along with bioluminescent imaging (BLI). Second, we utilized blood Gluc assay to monitor treatment response to lapatinib in an experimental model of systemic metastasis. We observed good correlation between the primary tumor volume and Gluc concentration in blood (R2 = 0.84) and urine (R2 = 0.55) in the breast tumor model. The correlation deviated as a primary tumor grew due to a reduction in viable tumor fraction. This was also supported by our mathematical models for tumor growth to compare the total and viable tumor burden in our model. In the experimental metastasis model, we found numerous brain metastases as well as systemic metastases including bone and lungs. Importantly, blood Gluc assay revealed early growth of metastatic tumors before BLI could visualize their presence. Using secreted Gluc, we localized systemic metastases by BLI and quantitatively monitored the total viable metastatic tumor burden by blood Gluc assay during the course of treatment with lapatinib, a dual tyrosine kinase inhibitor of EGFR and HER2. Conclusion/Significance We demonstrated secreted Gluc assay accurately reflects the amount of viable cancer cells in primary and metastatic tumors. Blood Gluc activity not only tracks metastatic tumor progression but also serves as a longitudinal biomarker for tumor response to treatments.

An FDA perspective on preclinical development of cell-based regenerative medicine products

721 regenerative medicine products, as they comprise diverse and heterogeneous products with varying biological and technological complexity. For example, they often incorporate cell types with varied phenotypes isolated from diverse tissue sources (e.g., bone marrow, adipose tissue, placenta and fetal tissue2); manufacturing processes vary among product developers (e.g., during cellular expansion; Fig. 1b); and many products have multiple purported mechanisms of action (MOA) (e.g., through secretion of growth factors, immunomodulation or direct structural and functional substitution) that may not be well-understood. These products are also delivered via varied and often invasive routes of administration (ROA; Fig. 1c), and the incorporation of an investigational delivery device or other noncellular component often adds complexity. Such heterogeneity and complexity are evident even in subsets The clinical testing of investigational regenerative medicine products is generally underpinned by preclinical testing programs that span discovery-phase and proofof-concept (POC) studies to definitive safety studies. The design and conduct of preclinical studies are critical to justifying testing in humans1. Specifically, they help to: first, establish the scientific rationale of the proposed approach; second, identify, characterize and minimize potential local and systemic toxicities; third, select a safe initial clinical starting dose, dose-escalation scheme and dosing regimen; and fourth, inform subject eligibility and clinical monitoring strategies. Preclinical testing programs that are designed early in product development to address these objectives are well positioned to advance from the bench to clinical investigation. This is particularly true for To the Editor: Owing to the complexity and novelty of cell-based regenerative medicine products, regulatory recommendations and requirements associated with preclinical testing may not be familiar to researchers. To facilitate translation of these products from the bench to clinical investigation, in November 2013 the US Food and Drug Administration (FDA; Rockville, MD) released its finalized guidance on their preclinical assessment: “Guidance for Industry: Preclinical Assessment of Investigational Cellular and Gene Therapy Products” (the ‘P/T guidance’; http://www.fda.gov/BiologicsBloodVaccines/ GuidanceComplianceRegulatoryInformation/ Guidances/CellularandGeneTherapy/ ucm376136.htm). Here we provide a highlevel overview of the guidance and outline preclinical development strategies to support the initiation of human clinical trials for regenerative medicine products. We define regenerative medicine products as those that incorporate a viable cellular component and are intended to repair, replace or restore diseased, damaged or missing tissues (for the analyses presented here, we exclude genetically modified and oncology products). These products are being developed for a wide range of indications (Fig. 1a). Several have been approved for commercial use (for a list, see: http:// www.fda.gov/BiologicsBloodVaccines/ CellularGeneTherapyProducts/ ApprovedProducts/default.htm), and many have advanced to later-phase clinical testing. According to our analysis of 163 Investigational New Drug (IND) submissions for regenerative medicine products to the FDA Center for Biologics Evaluation and Research (CBER)/Office of Cellular, Tissue and Gene Therapies (OCTGT) between 2006 and 2013, ~69% of new clinical trials were phase 1 investigations, whereas 31% were phase 2 or phase 3 investigations (clinical trials that had been initiated before 2006 were not included, regardless of whether they were active at the time of analysis). An FDA perspective on preclinical development of cell-based regenerative medicine products

Paradoxical Effects of PDGF-BB Overexpression in Endothelial Cells on Engineered Blood Vessels In Vivo

Therapeutic revascularization with either exogenous angiogenic growth factors or vascular cells has yet to demonstrate efficacy in the clinic. Injection of angiogenic growth factors often produces unstable and abnormal blood vessels. Blood vascular networks derived from implanted endothelial cells persist only transiently due to the insufficient recruitment of perivascular cells. We hypothesize that a combination of the two approaches may act synergistically to yield a better result. To enhance the recruitment of perivascular cells, human umbilical vein endothelial cells were genetically modified to overexpress platelet-derived growth factor (PDGF)-BB. PDGF-BB overexpression promoted both proliferation and migration of perivascular precursor cells (10T1/2 cells) in vitro. When mock-infected endothelial cells were implanted alone in vivo, they formed transient blood vascular networks that regressed by day 30. PDGF-BB overexpression enhanced the survival of endothelial cells in vivo. However, the PDGF-BB-expressing vessel network failed to establish patent blood flow. Co-implantation of PDGF-BB-overexpressing endothelial cells with 10T1/2 cells paradoxically resulted in the rapid regression of the vascular networks in vivo. PDGF-BB stimulated the expression of both chemokine (C-C motif) ligand 2 (CCL2) and CCL7 in 10T1/2 cells and led to the increased accumulation of macrophages in vivo. These results suggest a potential negative interaction between angiogenic growth factors and vascular cells; their use in combination should be carefully tested in vivo for such opposing effects.

Small blood vessel engineering.

Tissue engineering has attracted wide interest as a potential method to alleviate the shortage of transplantable organs (1). To date, almost all of the successfully engineered tissues/organs have relatively thin and/or avascular structures [e.g., skin (2), cartilage (3), and bladder (4)], where postimplantation vascularization from the host (angiogenesis) is sufficient to meet the implants demand for oxygen and nutrients. Vascularization remains a critical obstacle impeding attempts to engineer thicker, metabolically demanding organs, such as heart and liver. One approach in vascularizing an engineered tissue is to add the cellular components of blood vessels (endothelial and perivascular cells) directly to the tissue-engineered construct. We have shown that coimplanting endothelial cells and perivascular cells in a scaffold in vivo can lead to the formation of a vascular network that anastomoses to the host circulatory system. The engineered vessels are stable and functional, and they persist for more than 1 year in vivo. This approach may potentially lead to the creation of a well-vascularized-engineered tissue.