Clinical Commentary: Tawbi Assesses Toxicities of Therapies in … – Targeted Oncology

We have randomized phase 3 data for pembrolizumab [Keytruda], nivolumab, andnivolumab plus ipilimumab [Yervoy], so I completely agree that all of these [agents are considered] category 1 treatments by the NCCN [National Comprehensive Cancer Network] because all have shown improvements over single-agent ipilimumab.1 That is kind of where the category 1 comes from when including overall survival [OS] benefit. I consider NCCN guidelines to bevery safe. They dont include options just because they exist.

However, [combination] pembrolizumab and low-dose ipilimumab has been tried in 1 large single-arm study called KEYNOTE-29 [NCT02089685] and [found to be]safer than the combination of ipilimumab and nivolumab or high-dose ipilumumab.2 Yet, most of[the] relevant data are from a second-line study that showed about a 25% response rate in the second line low dose of ipilimumab or pembrolizumab. So, personally, I dont necessarily agree with this recommendation as a first-line regimen for low-dose ipilimumab/ pembrolizumab, but obviously this is up for discussion.

Relatlimab is a novel antibody that blocks LAG3. Its one of those interesting receptors and is quite different than PD-1. Its expressed on activated T cells and exhausted T cells. Initially, people were thinking that it has an association with MHC class II, the primary ligand, but more and more data are arising to show that its directly associated with the TCR CD3, basically signaling cascade.3 It actually modulates TCR signaling, so it makes a bigger impact in a place where theres a lot more TCR signaling happening, and thats probably why it works better in the first line than in the second line.

We just published in Nature [results of a] neoadjuvant study where the response rate in our neoadjuvant patients was 57%, so the earlier you use it, the more signaling happens through TCR, and the more you can modulate anti-LAG3.4 Now, the RELATIVITY-047 study [NCT03470922] was a phase 3 trial followed by the FDA approval of nivolumab plus relatlimab [for patients 12 years and older with unresectable/metastatic melanoma].5,6

With ipilimumab/nivolumab in any setting, you get grade 3 to 4 toxicity of at least 50%, and the highest discontinuation rate because of an adverse event [AE] was 36% in the CheckMate 067 [NCT01844505] study.7 [The rate of any grade 3/4 AEs with] nivolumab and relatlimab was 21%, and this is why I do feel like its slightly more toxicbut the pattern oftoxicity is similar [Table7]. With [this combination] every toxicity Ive encountered feels the same as when you encounter a singleagent toxicity. It doesnt feel a lot more recalcitrant and its not a lot harder, and you get 1 toxicity per patient, just like you would get it with the single-agent PD-1 inhibitor. The other factor that I share with [patients] is that Ive run 2 trialswith it. Both are randomized, double-blind studies vs nivolumab as a single agent. I had a fellow in my clinic who was seeing a patient on the adjuvant trial,[and I challenged him to find out which treatment the patient was on based on toxicity presentation]. He told me he wasnt sure he could do that and thats the point. If we were treating the patient with ipilimumab/nivolumab, you would know which arm. If it was blinded and [using] ipilimumab/nivolumab, you would know which arm, but because its nivolumab/relatlimab, it was impossible to tell.

The phase 1 [portion of the] study had about 25 patients treated with [relatlimab as a] single agent in the second line, and it had no activity, but we only use it in combination because of the way it works; it has a lot more potential for working only in combination because it potentiates the TCR signaling. So once you use a PD-1 [inhibitor], you increase the TCR signaling, and then the LAG3 amplifies that signal and makes it better.

If you have an immune-suppressed individual who is already [being treated in the] second line and [is] resistant to immunotherapy, the TCR signaling is going to be so much more limited, and youll not [be] able to reverse the exhaustion with either single agent, whereas with a combination, you get about a 13% response in the second line [From the Data5]. Now, 13% [is a smaller response] and 1 out of 7 patients responded, so Im not surprised that some patients feel like it never works. Every time Ive used it in the metastatic [setting] in the second or third line, Im just candid with patients [and I discuss how much of a response] I expect. I dont do 3 months in that situation. I just repeat their scans in 2 months because if they are going to progress I may want to do something different.

The data that we have [show] that if the patient is requiring steroids at the time of initiation, when youre starting ipilimumab and nivolumab, their chances of a response are only 18%, so its limited. If you have already treated them with ipilimumab and nivolumab, and now youre treating the toxicity with steroidsI would focus on finishing the steroids completely tapering them off if you canand thenconsider rechallenging.

In CheckMate 067, the study that I ran in that population, if you had a grade 3 to 4 toxicity, they basically never rechallenged you with immunotherapy. They just took you off. We allowed [rechallenging] on the study after they taper off steroidsand we got away with it about half the time. The other halfwould get hepatitis back or other things back, but you can get away with a rechallenge about half the time.

KEYNOTE-006 [NCT01866319], which compared 2 doses of pembrolizumab with single agent ipilimumab,is interesting because we used to dose [patients] so high, [at about] 10 mg/kg every 2 weeks.8 The 200 mg that you currently use every 3 weeks is equivalent to 3 mg/kg every 3 weeks, so imagine how much more of a dose that was. And it didnt matter, so theres not a lot of dose-response relationship with pembrolizumab. By even decreasing the dose by almost twothirds, you still get the same outcome.

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Clinical Commentary: Tawbi Assesses Toxicities of Therapies in ... - Targeted Oncology

American Association for Cancer Research Recognizes 2022-2023 … – American Association for Cancer Research (AACR)

PHILADELPHIA TheAmerican Association for Cancer Research(AACR) is proud to announce its newest class of grant recipients.

Since 1993, the AACR has allocated $133 million and awarded 880 research grants to support hundreds of scientists devoted to advancing the understanding, prevention, diagnosis, and treatment of cancer. Our grants support researchers domestically and abroad at every stage of their careers, representing a global commitment to cancer prevention, early detection, interception, and cure.

Fellowships

2021 AACR-Bristol Myers Squibb Immuno-oncology Research Fellowship

2022 AACR-Amgen Fellowship in Clinical/Translational Cancer Research

2022 AACR-Day One Biopharmaceuticals Pediatric Cancer Research Fellowship

2022 AACR-Exelixis Renal Cell Carcinoma Research Fellowship

2022 AACR-Genmab Non-Hodgkin B-Cell Lymphoma Research Fellowship

2022 AACR-Merck Cancer Disparities Research Fellowship

2022 AACR-Merck Immuno-oncology Research Fellowship

2022 AACR-Mirati Cancer Chemical Biology Research Fellowship

2022 AACR-QuadW Foundation Sarcoma Research Fellowship, in Memory of Willie Tichenor

2023 AACR Fellowship to Further Diversity, Equity, and Inclusion in Cancer Research

2023 AACR-Bristol Myers Squibb Immuno-Oncology Research Fellowship

2023 AACR-D-Team Sarcoma Research Fellowship

2023 AACR-D-Team Sarcoma Research Fellowship

2023 AACR-Incyte Immuno-oncology Research Fellowship

2023 AACR-John and Elizabeth Leonard Family Foundation Basic Cancer Research Fellowship

2023 AACR-QuadW Foundation Sarcoma Research Fellowship, in Memory of Willie Tichenor

Career Development Awards

2022 AACR Career Development Award to Further Diversity, Equity, and Inclusion in Cancer Research

2022 AACR Career Development Award to Further Diversity, Equity, and Inclusion in Cancer Research

2022 AACR Career Development Award to Further Diversity, Equity, and Inclusion in Cancer Research

2022 AACR Career Development Award to Further Diversity, Equity, and Inclusion in Cancer Research

2022 AACR Career Development Award to Further Diversity, Equity, and Inclusion in Cancer Research

2022 AACR Career Development Award to Further Diversity, Equity, and Inclusion in Clinical Cancer Research

2022 AACR Career Development Award to Further Diversity, Equity, and Inclusion in Clinical Cancer Research

2022 AACR Career Development Award to Further Diversity, Equity, and Inclusion in Clinical Cancer Research

2022 AACR-MPM Oncology Charitable Foundation Transformative Cancer Research Grant

2022 AACR-MPM Oncology Charitable Foundation Transformative Cancer Research Grant

2022 AACR-Novocure Career Development Award for Tumor Treating Fields Research

2022 Victorias Secret Global Fund for Womens Cancers Career Development Award, in Partnership with Pelotonia & AACR

2022 Victorias Secret Global Fund for Womens Cancers Career Development Award, in Partnership with Pelotonia & AACR

2022 Victorias Secret Global Fund for Womens Cancers Career Development Award, in Partnership with Pelotonia & AACR

2022 Victorias Secret Global Fund for Womens Cancers Career Development Award, in Partnership with Pelotonia & AACR

2022 Victorias Secret Global Fund for Womens Cancers Career Development Award, in Partnership with Pelotonia & AACR

2023 Lustgarten Foundation-AACR Pancreatic Cancer Career Development Award, in Honor of John Robert Lewis

2023 Lustgarten Foundation-AACR Pancreatic Cancer Career Development Award, in Honor of Ruth Bader Ginsburg

Independent Investigator Awards

2021 AACR-Bayer Innovation and Discovery Grant

2021 AACR-Bristol Myers Squibb Midcareer Female Investigator Grant

2021 AACR-Novocure Tumor Treating Fields Research Grant

2022 Friends of the AACR Foundation Early Career Investigator Award

2023 Lustgarten Foundation-Swim Across America-AACR Pancreatic Cancer Early Detection Research Grant

2023 Victorias Secret Global Fund for Womens Cancers Rising Innovator Research Grant, in Partnership with Pelotonia & AACR

2023 Victorias Secret Global Fund for Womens Cancers Rising Innovator Research Grant, in Partnership with Pelotonia & AACR

2023 Victorias Secret Global Fund for Womens Cancers Rising Innovator Research Grant, in Partnership with Pelotonia & AACR

2023 Victorias Secret Global Fund for Womens Cancers Rising Innovator Research Grant, in Partnership with Pelotonia & AACR

2023 Victorias Secret Global Fund for Womens Cancers Rising Innovator Research Grant, in Partnership with Pelotonia & AACR

Grants Supporting Researchers in Africa

2022 Beginning Investigator Grant for Catalytic Research (BIG Cat)

2022 Beginning Investigator Grant for Catalytic Research (BIG Cat)

2022 Beginning Investigator Grant for Catalytic Research (BIG Cat)

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American Association for Cancer Research Recognizes 2022-2023 ... - American Association for Cancer Research (AACR)

2023 drug discovery forecast: emerging trends and disruptors … – Drug Target Review

With advancements in artificial intelligence, precision medicine and gene editing, the field of drug discovery is undergoing a rapid transformation. In this article, Drug Target Reviews Izzy Wood gets the insider knowledge from industry leaders at SLAS 2023, who are experiencing these changes first hand.

AI has seen quite a boom in the last couple of years, overcoming challenges such as limited and low-quality data. Researchers can avoid numerous delays by employing AI for drug discovery, often using computational approaches in combination with their own techniques, for a faster and smoother path to the clinic.1

Getting to grips with what AI can do and how best to acquire and utilise its skills.

According to Cyrill Brunner, Application Specialist at Bruker Daltonics, effective AI calls for good data because you can predict a lot of things, but if your data is not good, your results will lack quality. Its therefore vital to invest in high quality instruments that have the ability to deliver quality data in a short time.

Yet, even with the positive advances in AI, it does not come without its challenges. Brunner continued to explain that one of the biggest changes in the pharmaceutical industry is that AI has moved over from just making data predictions to also analysing data.

For instance, if we look at mass spectrometry, the data is increasingly being analysed by computational methods, so it can be faster to keep up with all of the other screening technologies. Given the increasing amounts of generated data, manual analysis becomes unfeasible from a timescale perspective.

Michael A Norman, Lab Automation GM & VP of Sales at Flow Robotics, concurred that advancements in AI and machine learning were disrupting the drug discovery landscape.

Norman reflected that AI and machine learning will usher in an era of quicker, cheaper and more effective drug discovery. But whether this remains a good or bad thing remains sceptical.2

Most experts do expect these tools to become increasingly important. This shift presents both challenges and opportunities for scientists, especially when the techniques are combined with automation.2 Yet it is this combination of tying in automation and equipment that will create the lab of the future.

As emphasised by the experts, it is a case of getting to grips with what AI can do and how best to acquire and utilise its skills.

According to the National Health Service (NHS), the basis for personalised medicine is understanding the role DNA plays in ones health, transforming healthcare by delivering the four Ps:

Analysing the genome allows patterns to be identified that can help determine individual risk of developing diseases.

Jovi Jenkins, VP of Business Development at SPT Lab Tech, explained: Scientifically, what we are seeing is a lot more interest in genomic applications within the drug discovery process. Using genomics is becoming routine, such as CRISPR screening.

Norman echoed these predictions, suggesting that there will be advancements in individualised personal medicine, like gene therapy and CRISPR, on a much larger level.

The use of automation in drug discoveryprovides more consistent data that allows labs to make better decisions, faster. It also facilitates the testing of hundreds of thousands of compounds and samples.

Automation involves a verybroad range of technologiesincluding robotics and expert systems.4

Nick Ritzo, Genie Life Sciences, suggested that a big trend in drug discovery is going to be how modular lab spaces can gain the ability to quickly pivot from the discovery of one molecule to another. In this space, that is going to be really important to bring more drugs into the market.

Following on, Steven Watters, North America Sales Manager at HighRes Biosolutions, explained how automation is all about how we get more connected data into scientists hands. He emphasised the importance of the enablement of scientists to review their work, make predictions, and then drive forwards.

References:

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2023 drug discovery forecast: emerging trends and disruptors ... - Drug Target Review

Roundtable Discussion: Kishtagari Reviews Treatment and … – Targeted Oncology

KISHTAGARI: The challenge as treating clinicians these days in the clinic is that almost 34% of the patients present with severe thrombocytopenia of less than 50 109/L platelets at the time of initial diagnosis of myelofibrosis. Most patients, 66%, presented with thrombocytopenia of over 50 109/L.1,2 This is a significant challenge when treating patients, especially with ruxolitinib [Jakafi], the medication that has had FDA approval for the longest time. The medication itself can cause [decreased] blood counts as well. A lot of patients do have anemia at baseline, and that gets worse with the disease evolution as well. So both thrombocytopenia and anemia are huge challenges for us. I think this is important in the sense that we need to monitor these patients frequently while they are on treatment. I think one [issue] is how frequently to monitor them. We should monitor them frequently initially, but once theyve stabilized, we can probably monitor them every 6 weeks to 2 months. Its been my practice to do 6 weeks to 2 months once they have

stability in their platelet counts, based on their treatment. Of course, if any drop in the platelet counts or hemoglobin happens, I tend to monitor them more frequently and include dose reduction of the treatment they are on.

ZAMAN: Recently I had a couple of patients who had hemolytic anemia, so they didnt take the prednisone. I gave rituximab [Rituxan] to a patient and she did not respond. I stopped it after 4 cycles with no response. Suddenly, 3 or 4 months later, she was not requiring as many transfusions. How often do you see hemolytic anemia?

KISHTAGARI: In my practice, I have seen 1 patient with hemolytic anemia with myelofibrosis. Its not that common, if you look at the literature as well. I keep thinking about management for this patient. Fortunately, my patient responded very well to high-dose steroids. But, like you said, its a challenge. That is something [that reminds us] when we see a drop in hemoglobin, we should always think broadly, not [only] of the disease but of the adverse effects [AEs] of the medication. We need to think broadly and keep our differentials broad. Look for hemolysis as a cause as well. But its rare, and it is reported in less than 5% [of patients], based on the literature.

BHANDARI: In my opinion, [the goals are] improvement of the symptoms and improved quality of life. The platelet count of 43 109/L is less concerning. I think the symptoms are more important.

KISHTAGARI: I think thats a good [approach]. A lot of these patients come with such a huge symptom burden, and I think thats the most important thing to address while we are thinking about the long term for this patient.

MAHAJAN: This is a 68-year-old patient. [Although] his ECOG performance status is 2, will a stem cell transplant [SCT] be a possibility for him? He is relatively young.

KISHTAGARI: Absolutely. I think a lot of times I give these patients the benefit of the doubt. I always refer for SCT, just for an evaluation. It doesnt mean that they will go for SCT. I think they need to at least be evaluated by a transplant physician to see if they can be considered for SCT. The oldest I have sent for transplant [was a 79-year-old patient], and this was a patient who was very active with an ECOG performance status of 0 to 1. This patients ECOG performance status of 2 is likely from the severe symptom burden he has been experiencing secondary to myelofibrosis. Given that, it is always good to initiate treatment and send them for transplant evaluation because we all know that the ultimate treatment or cure, especially for high-risk myelofibrosis, is SCT.

ZAMAN: If they are symptomatic, we start them on ruxolitinib. We look for the risk assessment, and Johns Hopkins [Sidney Kimmel Comprehensive Cancer Center] is approximately 100 miles from here, so I call them for an evaluation to see what they think. I try to cover both things, unless they are frail and cannot travel, which also is sometimes an issue.

MENDOZA: I have a similar approach. I sit down with them, and tell them that they need pharmacologic intervention, and we look at the performance status. We say that if they have some comorbid conditions, and they are highly symptomatic andhigh-risk, typically by guidelines, they would be candidates for transplant. But if the performance status is 2 and we start treatment and that improves their symptoms, then thats when I say we are 50 miles away from [a transplant center in] Baltimore, Maryland. So we also do something different, and typically the response is quick. Now in this case, discussing the specific pharmacologic agent is a little bit tough because of the platelet count. I would be careful with the choice. I would probably phone the transplant [specialist], go over the case, and say this is what I want to do. I want to see if they improve on pacritinib [Vonjo] or some other type of agent, and if it is indicated, Ill start that, and 2 to 4 weeks later I will see them and they have improved. The patients can tell when the spleen gets smaller. That by itself improves their symptom burden, and if thats the case, then the next thing we do is send them to Baltimore [for transplant evaluation].

KISHTAGARI: Thats fantastic. I like that approach a lot.

KALRA: Most of us who are in the community dont have open trials for patients with myelofibrosis, but at least I am in Baltimore and have access to 2 large academic centers, and if this is a patient who would qualify for a trial, and its open at one of those centers, then [I would refer for clinical trials].

LANG: If a patient has high-risk myelofibrosis but does not have clinical symptoms and is a candidate for transplant, do they still benefit from bridging therapy with a JAK [Janus kinase] inhibitor?

KISHTAGARI: If they have splenomegaly, I would consider JAK inhibitor therapy prior to proceeding to allogeneic SCT because if you can control the spleen size as much as possible before going for transplant, [data from] multiple studies have shown that it has a good outcome post transplant.3,4 So at least for the spleen reduction, I recommend initiating a JAK inhibitor.

ISLAS-OHLMAYER: Would you continue the JAK inhibitor during SCT?

KISHTAGARI: That is something a lot of centers have been doing. We have also been doing it after SCT, not during SCT. After SCT we have been initiating JAK inhibitor therapy because the symptom burden sometimes comes back, and we continue them on ruxolitinib. [N]ot all of them, [however,] only a few patients. This is being done as a part of a clinical trial, not as a standard of care.

KISHTAGARI: Getting a donor is something we all face whenever we refer the patient for allogeneic SCT evaluation. I have a lot of patients in my clinic right now who do not have a donor, and thats a significant challenge. Access is also something we all face for transplant evaluation, and even the cost is something we dont talk about often, which we should. They need to be very close to the transplant center, at least for the 90 to 100 days when they are undergoing allogeneic SCT evaluation. Do you always refer for transplant if they have high-risk myelofibrosis?

MAITI: Yes, the high-risk patients. I am at a regional oncology center close to the Cleveland Clinic main campus [in Ohio], so if I see a patient with high-risk myelofibrosis, I would refer them to a [transplant physician] on the main campus and work on the bridging therapy.

KISHTAGARI: OK, good.

MISBAH: Usually [the transplant physician] will tell us the bridging therapy they want us to use.

KISHTAGARI: Do they have any preference for the bridging therapy that they recommend?

MISBAH: I havent referred anyone recently, so I wouldnt be able to speak to that. But usually they will guide us very well on what we should use or what their preference is.

KISHTAGARI: Do you have any experience? [For] how long do you use bridging therapy? I know that very few patients subsequently undergo transplant.

LANG: In the past couple of years, I referred 3 patients for transplant. I was thinking they continue the bridging therapy until you find a transplant donor.

KISHTAGARI: So until the transplant donor is identified, and then until they go to transplant, the bridging therapy is continued.

LANG: Right.

KALRA: I think its the patient population. Myelofibrosis is not a disease of young people. Its the comorbidities. Its obviously the availability of donors. Its a lot of those factors, and then, eventually, whether they can even tolerate a transplant.

KISHTAGARI: Good. I think those are the challenges we face as clinicians on getting these patients [to transplant] with their advanced age, as well as donor availability and their performance status. Other factors such as cost and access are at play. Lately we have been seeing debulking of the disease before going for transplant. I think thats less of a challenge compared with other diseases such as AML [acute myeloid leukemia] or MDS [myelodysplastic syndrome] where they prefer the [myeloablative conditioning] before going for SCT. I dont think we have that challenge here. We have other challenges with myelofibrosis.

BHANDARI: I think its promising. I have used it in 1 of my patients.

MAITI: I have not used pacritinib yet. I have only used ruxolitinib as first-line therapy. But with the data,5 I think especially in patients with a platelet count of less than 50 109/L, I would consider pacritinib.

KISHTAGARI: In patients with a platelet count greater than 50 109/L, also, one can consider pacritinib, especially in the second-line setting.

KNAPP: Patients had platelet counts of less than 100 109/L on the trial, but they only approved it for those with less than 50 109/L. Is there a reason for that?

KISHTAGARI: In the [PERSIST-2] clinical trial [NCT02055781], they looked at both groups, but patients with platelet counts below 50 109/L derived maximal benefit [From the Data5], and so the FDA only approved it for that.6

MENDOZA: If I have a patient who is on dose-adjusted ruxolitinib, hes borderline, he had initial counts greater than 50 109/L, but he developed a platelet count of less than 50 109/L, do you recommend switching to pacritinib at that point? Or would you rather hold the dose, wait, and then adjust ruxolitinib again?

KISHTAGARI: It all depends. If the patient is getting benefit from ruxolitinib and you only noticed significant thrombocytopenia, dose reduce first before switching to pacritinib. If with the dose reductions you do not see any improvement in blood counts, then definitely switch to pacritinib.

MAHAJAN: What about pacritinibs effect on anemia? Is it like ruxolitinib, or other than that do you have to wait for momelotinib [GS-0387] to be approved?

KISHTAGARI: What we have seen is pacritinib also inhibits a protein called ACVR1 more than momelotinib.7 We also see this in the clinic as well, where there is a significant improvement in hemoglobin. But you need to treat the patient longer, and there are some retrospective data where they are noticing an improvement in hemoglobin along with a stabilizing platelet count.8 So there might be a role for pacritinib in the future for patients with myelofibrosis and anemia.

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Roundtable Discussion: Kishtagari Reviews Treatment and ... - Targeted Oncology

Getting Creative To Combat Foodborne Norovirus – Technology Networks

Every year, norovirus causes hundreds of millions of cases of food poisoning and the deaths of at least 50,000 children yet there exists no real way to control it. The virus has proven exceptionally difficult to study in the lab, and scientists have struggled to develop effective vaccines and drugs.

A new study at Washington University School of Medicine in St. Louis describes a creative way to make a vaccine against norovirus by piggybacking on the highly effective vaccines for rotavirus, an unrelated virus that also causes diarrhea.

The researchers created an experimental rotavirus-norovirus combo vaccine by adding a key protein from norovirus to a harmless strain of rotavirus. Mice that received the experimental vaccine produced neutralizing antibodies against both rotavirus and norovirus. The study, available online in Proceedings of the National Academy of Sciences, outlines an innovative approach to preventing one of the most common and intractable viral infections.

Pretty much everyone has had norovirus at some point, said senior author Siyuan Ding, PhD, an assistant professor of molecular microbiology. You go out to eat, and the next thing you know youre vomiting and having diarrhea. You will recover, but its going to be a rough three days or so. For kids in the developing world who dont have access to clean water, though, it can be deadly. The rotavirus vaccines work really well, and there are already global distribution systems set up for them, so based on that, we saw an opportunity to finally make some headway against norovirus.

Before the first rotavirus vaccines were rolled out in 2006, half a million children around the world died every year of diarrhea caused by rotavirus infection. Now, the number is estimated to be about 200,000 still high but a huge improvement. Four rotavirus vaccines are in use around the world. All are live-virus vaccines, meaning they are based on weakened forms of rotavirus capable of triggering an immune response but not of making people sick.

Human norovirus, on the other hand, has stymied scientific investigation for decades. It doesnt infect mice or rats or any other ordinary lab animals, so the kinds of experiments that led to the development of rotavirus vaccines have been impossible to replicate with norovirus.

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Ding and colleagues including first author Takahiro Kawagishi, PhD, a staff scientist in Dings lab, and co-corresponding author Harry B. Greenberg, MD, a professor emeritus of medicine at Stanford University came up with the idea of using rotavirus to bypass the technical difficulties of working with norovirus. They worked with a laboratory strain of rotavirus as a stand-in for one of the approved rotavirus vaccines, which are proprietary.

The researchers inserted the gene for the protein that forms the outer surface of human norovirus into the genome of the rotavirus lab strain. Then, they administered the modified rotavirus to immunocompromised infant mice by mouth, the same way rotavirus vaccines are given to children. They took blood and fecal samples four, six and eight weeks later. Nine weeks after the initial immunization, the researchers gave the mice a booster by injection and took samples again a week later.

A strong antibody response was evident in the blood of nine of 11 mice tested, and in the intestines of all 11 mice. Even better, some of the antibodies from the blood and the intestines were able to neutralize both viruses in human mini-gut cultures in a dish. Such cultures, also known as organoids, are grown from human stem cells and replicate the surface of the human gut.

Traditionally, vaccine studies have focused on the antibody response in the blood, because we understand that part of the immune response the best, Ding said. But norovirus and rotavirus are gut viruses, so antibodies in the blood are less important than the ones in the intestines in terms of fighting off these viruses. The fact that we saw a strong antibody response in the intestines is a good sign.

The next step is to show that animals immunized with the experimental vaccine are less likely to get sick or die from norovirus. Ding has such experiments underway.

The power of this study is that it outlines a novel approach that could accelerate vaccine development for a variety of troublesome organisms that cause diarrhea, especially in resource-limited countries where many of these infections occur.

There are a lot of intestinal pathogens out there for which we dont have good treatments or vaccines, Ding said. In principle, we could put a gene from any organism that infects the intestinal tract into the rotavirus vaccine to create a bivalent vaccine. Wed have to find the right targets to produce a good immune response, of course, but the principle is simple.

As basic scientists, we rarely get the chance to actually move something forward into the clinic, Ding continued. We study what the virus does and how the host responds at a basic level. This is a rare opportunity for our work to affect human health directly and make peoples lives better.

Reference:Kawagishi T, Snchez-Tacuba L, Feng N, et al. Mucosal and systemic neutralizing antibodies to norovirus induced in infant mice orally inoculated with recombinant rotaviruses. PNAS. 2023;120(9):e2214421120. doi:10.1073/pnas.2214421120

This article has been republished from the following materials. Note: material may have been edited for length and content. For further information, please contact the cited source.

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Getting Creative To Combat Foodborne Norovirus - Technology Networks

The bared external anal sphincter (BEAS), a new technique for high … – Nature.com

Study design and population

The study was a retrospective analysis of prospectively collected data from a cohort from the tertiary referral center (Shuguang Hospital). Consecutive adult patients diagnosed with HHAF undergoing BEAS technique between June 2020 and January 2021 were included. Ethical approval was obtained from the ethics committee of Shuguang Hospital Affiliated with Shanghai University of Traditional Chinese Medicine (Approval No. 2020-823-30-01). Written informed consent was obtained from each participant. All methods were carried out in accordance with relevant guidelines and regulations.

Magnetic resonance imaging (MRI) was performed on every patient, which helped to determine the extent of the HHAF lesion and its relationship with surrounding tissues. The diagnosis of HHAF was made and confirmed by at least two senior imaging specialists.

The inclusion criteria were the following: (1) male or female patients aged 18 to 65years; and (2) patients diagnosed with high cryptoglandular fistula-in-ano (involving more than one-third of the sphincter complex as assessed on MRI and intraoperative examination under anesthesia). Both primary and recurrent horseshoe fistulas were included. Patients with Crohn's disease, cancer, tuberculosis, diabetes, autoimmune diseases or patients receiving long-term steroids or corticosteroid therapy were excluded.

Patient demographics, clinical information, and short-term clinical outcome data were collected through outpatient follow-up, a WeChat questionnaire and telephone follow-up. Forty-one patients were followed-up by WeChat questionnaire and seven patients were followed-up by phone. There is no difference between these methods. The main outcomes included the 6-month cure rate, Visual Analog Scale pain score (VAS-PS) and Cleveland Clinic Florida incontinence score (CCF-IS). The secondary outcomes included the Quality of Life in Patients with Anal Fistula Questionnaire score (QoLAF-QS), Bristol stool chart and postoperative complications. Postoperative pain was measured using an 11-point Visual Analog Scale pain score (VAS-PS)14. The severity of fecal incontinence symptoms was evaluated using the Cleveland Clinic Florida incontinence score (CCF-IS)15. The Quality of Life in Patients with Anal Fistula Questionnaire score (QoLAF-QS) was used to assess the quality of life of patients with anal fistula16. Stool consistency was assessed using the 7-point Bristol stool scale17. Disease recurrence, as was reported by Mei et al., was defined as persistence or recurrence of symptoms or the relapse of the perianal sepsis within or more than 6months following surgical intervention18,19.

SPSS Statistics 25.0 (IBM Inc., IL, USA) software was used for ststistical analysis. Continuous variables are presented as the meanstandard deviation (SD) or median with interquartile range (IQR) based on distribution. The independent t test was used to compare normally distributed continuous variables, and the MannWhitney U test was used to compare nonnormally distributed continuous variables. Categorical data are expressed as the number of cases and percentages. P<0.05 was considered to indicate a ststistically significant difference.

Preparation for surgery begins with a careful evaluation of preoperative MRI to assess the location of the internal opening and the extent of inflammation as well as the relationship between the fistula and the muscles. The imaging also informs about the anatomical structure of anal canal, aiding in operative planning (Fig.1).

The diagrams of preoperative MRI. (a) The cross section of the perianal structure showing the relationship between IAS, EAS and HHAF. (b) The coronal section of the pelvis showing layers of anal sphincter, especially the levator ani muscle, and HHAF. IAS=internal anal sphincter; EAS=external anal sphincter; HHAF=high horseshoe anal fistula.

The patient is given spinal anesthesia and then placed in prone jackknife position. After preparing and draping, the operating table is placed in a 10 to 15 head-side-down position. This allows the muscles and spaces exposed more clearly in posterior aspect of anal canal during the operation. The internal opening, the external opening and the fistula of HHAF is then identified again to begin dissection (Fig.2).

Anatomic Structure of HHAF. (a) View of the outside appearance. The dotted line represents the scope HHAF. (b) Sagittal section of the pelvis. (c) Schematic diagram of posture for surgical exposure. (d) Preoperative visual field. The green shaded part represents HHAF. HHAF=high horseshoe anal fistula.

The dissection is initiated with a curvilinear incision (IS approach) along the intersphincteric groove to identify the internal anal sphincter (IAS) and external anal sphincter (EAS). This incision is directly behind the anal canal, which is approximately 1/41/3 of a quadrant of the anus. Then, the dissection is performed along the plane of the intersphincteric groove to separate the IAS from EAS with an electrical scalpel. The internal opening should be concerned during the dissections. Through both the anal canal and intersphincteric plane, the internal opening can be identified easily. There is barely no blood supply in the intersphincteric plane, therefore it is a safe dissection plane. However, care should be taken to observe the muscle contraction of EAS during this dissection. Because dissection is close to the IAS and EAS, the surgeon should take care during the dissection to avoid inadvertent injury. To avoid complications of incontinence or bleeding, the surgeon should dissect the IAS and EAS strictly along the plane (Fig.3).

The operation diagram of IS approach and LES approach. (a) View of the outside appearance. (b) Sagittal section of the pelvis. The dissection of IS approach is along the intersphincteric plane to separate the IAS from EAS. (c) IS approach. (d) LES approach. The dissection of LES approach is along the outer edge of the EAS to bare the EAS. IS=Intersphincteric; IAS=internal anal sphincter; EAS=external anal sphincter; LES=Lateral-external-sphincteric.

The next step involves the dissection of the EAS, which is initiated with a curvilinear incision (LES approach) along the outer edge of the EAS on one side behind the anal canal. The dissection is performed along the outer edge of the EAS until above the level of the deep EAS so as to bare the EAS. The lateral part of the EAS in the corresponding quadrant is exposed with the traction of a self-retaining retractor (Lone Star, Cooper Surgical, Trumbull, CT). The highest risk for incontinence, which is the most common postoperative complication, may be due to the injury of EAS. The bareness of EAS can completely expose the infection focus of HHAF. In this process, the surgeon should also be mindful of avoiding the anterior displacement of anal canal caused by the injury of anococcygeal ligament (Fig.3).

Once the IAS and EAS are separated, medial to lateral dissection of the muscles are continued along the intersphincteric plane to both sides. Then, the IAS is separated from EAS by a combination of sharp and blunt dissection. Through the IS approach, the suprasphincter anal fistula can be detected above the level of the deep EAS easily. Cephalad dissection is continued above or beneath the levator ani muscle so that the DPIS and the inner part of the EAS could be completely exposed (Fig.4).

The operation diagram of exposure of DPIS and DPAS. (a) View of the outside appearance. (b) Sagittal section of the pelvis. (c) Exposure of DPIS. (d) Exposure of DPAS. Expose DPIS and DPAS to reach the fistula through IS approach and LES approach, respectively. DPIS=deep intersphincteric space; DPAS=deep postanal space.

Continuing the dissection cephalad with the assist of self-retaining retractor along the LES approach reveals the DPAS, which can then be handled at the top of the infection. Both two approaches communicate at the top of the EAS (or at the top point of the pus cavity of the HHAF). Typically, the visualization of these approaches reveals the pus cavity under direct vision. The aim of these dissections is to utilize both the IS approach and the LES approach as a landmark to ensure a complete preservation of the EAS (Fig.4).

After the DPIS, the DPAS, and the pus cavity are irrigated repeatedly with povidone and hydrogen peroxide, the bare EAS is pushed proximally to confirm that the internal opening on the musculomucosal flap could reach the inferior edge of the EAS without tension. After the musculomucosal flap and the EAS advancement are performed, they are sutured and fixed with 20 Polyglactin suture (Coated VICRYL, 20, ETHICON Inc, China) to close the intersphincteric incision in an interrupted manner. At last, the LES approach is kept open and indwelled with povidone gauze to facilitate postoperative drainage (Fig.5).

The operation diagram of musculomucosal flap and EAS advancement. (a) View of the outside appearance. (b) Sagittal section of the pelvis. (c) Musculomucosal Flap and EAS Advancement. (d) Visual field after suture. Perform advancement of the musculomucosal flap and the EAS to confirm the internal opening could reach the inferior edge of the EAS without tension. Then close the intersphincteric incision (IS approach) in an interrupted manner and keep LES approach. EAS=external anal sphincter; IS=Intersphincteric; LES=Lateral-external-sphincteric.

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The bared external anal sphincter (BEAS), a new technique for high ... - Nature.com

QurAlis Announces First Patient Dosed With QRL-201, a First-in … – PR Newswire

First patient dosed in Canada in Phase 1 ANQUR study the first-ever clinical trial to evaluate a therapy that rescues STATHMIN-2 expression in ALS patients

STATHMIN-2 is a well-validated protein important for neural repair and axonal stability, the expression of which is significantly decreased in nearly all ALS patients

CAMBRIDGE, Mass., April 6, 2023 /PRNewswire/ -- QurAlis Corporation, a clinical-stage biotechnology company developing breakthrough precision medicines for amyotrophic lateral sclerosis (ALS) and other neurodegenerative diseases with genetically validated targets, today announced that the first patient has been dosed in its Phase 1 clinical trial of QRL-201 for the treatment of ALS (ANQUR).QRL-201 is a first-in-class therapeutic product candidate aiming to restore STATHMIN-2 (STMN2) expression in ALS patients. ANQUR is the first-ever study to evaluate a therapy that rescues STMN2 expression in ALS patients.

"STATHMIN-2 is a well-validated protein important for neural repair and axonal stability and is the most significantly regulated gene by TDP-43 exclusively in humans. Its expression is significantly decreased in nearly all ALS patients and it is the most consistently decreased gene over all sporadic ALS patient data sets. QRL-201 rescues STMN2 loss of function in QurAlis ALS patient-derived motor neuron disease models in the presence of TDP-43 pathology," said Angela Genge, M.D., FRCP(C), chief medical officer of QurAlis. "QRL-201 recently entered the clinic in Canada and we are pleased to dose our first patient. We look forward to advancing the ANQUR clinical trial of QRL-201 for the treatment of ALS so that we can make a meaningful difference in patients' lives."

The first participant in the ANQUR study was dosed at University of Montral Hospital Centre (CHUM) by Genevive Matte, M.D.C.M., FRCP(C), assistant clinical professor, Department of Neurosciences, University of Montral; ALS clinic director, CHUM; principal investigator, University of Montral Hospital Research Centre (CRCHUM); and an ANQUR study investigator.

"ALS is a serious neurodegenerative disease with limited treatment options. There is great need for therapies that could slow disease progression and improve outcomes. This study has the potential to show QRL-201 could be such a therapy that could potentially benefit ALS patients who have a loss of STMN2 due to TDP-43 pathology," said Merit Cudkowicz, M.D., M.Sc., director of the Sean M. Healey & AMG Center for ALS, chief of neurology at Massachusetts General Hospital, director and the Julieanne Dorn Professor of Neurology at Harvard Medical School, and member of QurAlis' Clinical Advisory Board.

ANQUR (NCT05633459) is a first-in-human global, multi-center, randomized, double-blind, placebo-controlled multiple-ascending dose Phase 1 clinical trial designed to evaluate the safety, tolerability, and pharmacokinetics of QRL-201 versus placebo in patients with ALS. The primary objective of the study is to determine the safety and tolerability of multiple doses of QRL-201 in people living with ALS. The ANQUR clinical trial is expected to include 64 study participants with ALS across sites in Canada, the U.S., the United Kingdom, Belgium, the Netherlands, Italy, Germany, and Ireland.

Visit http://www.clinicaltrials.gov for more information about the ANQUR study.

About STATHMIN-2 and TDP-43STATHMIN-2 (STMN2) is a well-validated protein important for neural repair and axonal stability, the expression of which is significantly decreased in nearly all ALS patients. Also known as SCG-10, STMN2 is a protein essential for the stabilization of microtubules which form an important component of the cytoskeleton of cells and axons. STATHMIN-2 is highly expressed in human motor neurons, the cells that primarily degenerate in patients suffering from ALS. In animal models, STMN2 deletion was found to cause axonal degeneration and loss of muscle innervation, which is the primary functional deficit that leads to paralysis in ALS patients.

Using human neuronal stem cell models from ALS patients, QurAlis co-founder and former Harvard professor Kevin Eggan, Ph.D.,discovered in 2019 that the expression of STMN2 is regulated by TDP-43. The Eggan Lab showed that loss of normal TDP-43 function leads to a highly significant decrease in expression of STMN2 and an impairment in neuronal repair which could be rescued by restoring STMN2 levels. These results were published in Nature Neuroscience.

In addition to nearly all ALS patients, TDP-43 pathology is also associated with approximately 50 percent of patients with frontotemporal degeneration (FTD), the second most common form of dementia; about a third of Alzheimer's Disease patients; and up to seven percent of Parkinson's disease patients.

There are currently no cures for ALS or FTD. Limited therapeutic options are available for ALS and FTD patients who are in desperate need for effective therapies.

About QurAlis CorporationQurAlis is trailblazing the path to conquering amyotrophic lateral sclerosis (ALS) and other neurodegenerative diseases with genetically validated targets with next-generation precision medicines. QurAlis' proprietary platforms and unique biomarkers enable the design and development of drugs that act directly on disease-causing genetic alterations. Founded by an internationally recognized team of neurodegenerative biologists from Harvard Medical School and Harvard University, QurAlis is advancing a deep pipeline of antisense oligonucleotides and small molecule programs including addressing sub-forms of ALS that account for the majority of ALS patients. For more information, please visit http://www.quralis.com or follow us on Twitter @QurAlisCo.

SOURCE QurAlis

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QurAlis Announces First Patient Dosed With QRL-201, a First-in ... - PR Newswire

Laser Pigmentation Treatment and Skin Rejuvenation Review – Expat Living Singapore

Heres our tried-and-tested lowdown on the fabulous new MOXI laser treatment we discover how it works with BBL Hero for effective pigmentation removal, skin rejuvenation and even pre-juvenation!

MOXI is a 30-45 minute clinical laser treatment thats perfect for working professionals. You could even do it in your lunchtime.

Like other light and laser-based technologies, it works by creating numerous microscopic areas of controlled injury.

This triggers a rejuvenating, wound-healing process that causes the skin to generate new collagen and shed unwanted pigment. The result? A smoother, brighter and firmer complexion.

By delivering energy to water in the skin layer, this remarkably versatile laser treats a wide range of skin concerns:

Unlike other light-based skin rejuvenation, says Bay Aesthetic Clinics Dr Bernard Tan, MOXI laser treatment is safe for all skin types in Singapore. Whats more, it can be used year-round, and you can have it done even after recent sun exposure. Now, thats unusual!

Its three settings make it unusually versatile, adds Dr Tan. For younger people, aged say 30 to 40, Level 1 works as an effective prejuvenation treatment that can delay early signs of ageing and reverse signs of sun damage. Level 2 is moderately intense, aiming at revitalisation and maintenance: youll probably want numbing cream and should expect downtime of three to five days. Level 3 promises to transform and renew your skin, requiring numbing cream and a longer downtime of up to a week.

Dr Bernard typically uses MOXI on the face, neck and dcolletage but it can also be used on the body and arms.

I had always avoided beauty treatments with downtime, my colleague Danielle told me. I wrongly associated them with pain and the potential for skin damage.

Then she tried BBL Hero, another popular laser treatment in Singapore, and loved what it did for pore size, fine lines and pigmentation removal. Dr Bernard assured her that MOXI was the next logical step. He explained that the two treatments in fact paired very well together and could be done one after the other.

I was glad that my treatment would include the neck and dcolletage areas, said Danielle. Though Ive been careful to use sunscreen on my face, I havent always protected my neck and chest properly and the neglect neck-lect? was starting to show. From now on, I promise to do better!

Before we started, Dr Bernard assured me I would be red for only a couple of days. Then the top layer of skin would flake off over the course of five to seven days. One of his clinic nurses showed me her skin, which just looked a little scaly three days after her treatment. This was reassuring, because I had multiple events and activities lined up.

The whole treatment took around two hours. First up was BBL Hero, which takes half-an-hour and is totally painless. Then they applied numbing cream and left it to take effect.

During the 30-minute MOXI treatment that followed, I felt a little tingling around the forehead. I assumed this was where the skin was thinner, holding less water. Generally, though, it was pretty painless. I think the worst part of laser treatments is the sound effects, ranging from a distant jackhammer to the immediate crackle of burning hairs!

After the laser, I enjoyed 30 relaxing minutes of LED light treatment aimed at accelerating healing. Finally, they applied a healing stem cell serum, gave me some to take home and told me to continue using it twice a day for the next week.

I was also reminded to stay strictly out of the sun and avoid outdoor activities for at least a week, avoid skin products containing AHA or Vitamin C, and use lots of moisturiser.

The next day, it just looked just like a sunburn. I had a couple of client meetings, where I explained the colour of my face: not raging red, but not normal, either. On Day 3, I wore light makeup to a lunch and dinner event, and the redness was hardly noticeable at all.

By Day 4, I was starting to get a little scaly and dry. From Days 5 to 7, the pigmentation started to flake off. The neck and dcolletage areas lagged a couple of days behind the face, so I ended up using a gentle exfoliating cleanser around Day 7 to remove the dry skin.

The pigmentation marks on my neck have almost totally gone, and my skin is smoother, firmer and more even in tone. People are commenting that I am glowing! And strangely, though my skin tone is normally a little red, it looks less so now.

MOXI is a 1927nm thulium fractional non-ablative laser that targets the water in the skin layer.

For best skin rejuvenation results, Dr Bernard recommends monthly treatment for three to five months. How much will this cost?

Considering that the combined treatment is a two-hour procedure for both laser pigmentation removal and rejuvenation that includes face, neck and dcolletage, plus the LED healing treatment, we feel its a worthwhile investment depending on budget, of course. What do you think?

Bay Aesthetics ClinicB2-12 Marina Bay Link Mall, Marina Bay Financial Centre8A Marina Boulevard8428 7811 | FB: @bayclinicsg | IG: @bay.clinic

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Laser Pigmentation Treatment and Skin Rejuvenation Review - Expat Living Singapore

Reprogramming of human peripheral blood mononuclear cells into … – Nature.com

OCT4 alone was insufficient to reprogram PBMCs into iMSCs directly

Previously, we reported that lentivirally expressed OCT4 could directly reprogram human cord blood CD34+ hematopoietic progenitor cells into iMSCs with very high efficiency11. Therefore, we first tried to convert human PBMCs into iMSCs by overexpressing OCT4 alone using a clinically relevant vector system. Isolated human PBMCs were cultured in a Stemline-based erythroid medium for six days to expand erythroid progenitors. Using the nucleofection method, 2106 expanded PBMCs were transfected with our modified oriP/EBNA1-based episomal vector, which expressed OCT4 under a strong SFFV promoter (Fig.1a), as we previously described11. Cells were then cultured in MSC medium11 supplemented with small molecules that promote reprogramming (3M CHIR99021, 10M forskolin, 10M ALK inhibitor (SB431542), and 5M tranylcypromine hydrochloride)15. However, there was no MSC-like colony formation 2 weeks later, indicating that OCT4 alone was insufficient to convert human PBMCs into iMSCs directly (Fig.1b).

a Schematic diagram of the episomal vector plasmids. SFFV is the spleen focus-forming virus U3 promoter; WPRE, posttranscriptional regulatory element; SV40PolyA, polyadenylation signal from SV40 virus; OriP, EBV (EpsteinBarr virus) origin of replication; EBNA1, EpsteinBarr nuclear antigen 1. b Colony formation at day 14 after nucleofection with 2106 PBMCs and maintenance in MSC culture conditions. c Reprogramming efficiency with different combinations of reprogramming factors. Error bars indicate standard deviation. n=3 biologically independent samples for each group. d Fluorescence-activated cell sorting (FACS) analysis of iMSCs 8 days after reprogramming with different factor combinations. SOX2 induced iPSCs generation (TRA-1-60+ cells). However, SOX9 did not induce detectable TRA-1-60+ cells. e Colony formation at day 14 after nucleofection with 1106 PBMCs (control) or CD34+-depleted PBMCs followed by maintenance in MSC culture conditions.

Our previous studies showed that BCL-XL is a critical reprogramming factor in blood cell reprogramming9,16, which increased the reprogramming efficiency by 10-fold when converting PBMCs into iPSCs using Yamanaka factors16. Here, we observed that transfection of PBMCs with OCT4, BCL-XL, and MYC (OBM) led to the formation of MSC-like colonies 2 weeks later (Fig.1b), albeit at low efficiency. The combination of any two of the OBM factors failed to generate iMSC colonies (Fig.1b). To improve the reprogramming efficiency further, we examined OBM with different combinations of other factors for generating iPSCs, including KLF4 and SOX2. KLF4 moderately improved iMSC generation, whereas SOX2 increased reprogramming efficiency by ~5-fold (Fig.1c and Supplementary Data1). However, the presence of SOX2 in the reprogramming cocktail resulted in ~12% of reprogrammed cells expressing iPSC markers, e.g., TRA-1-60 (Fig.1d) and NANOG (Supplementary Fig.1), even in MSC expansion culture conditions. Since iPSCs may induce teratomas, the SOX2-containing approach is not clinically prudent.

We decided to replace SOX2 with SOX9 because SOX9 plays an important role in skeletal development and chondrogenesis17,18. Surprisingly, SOX9 showed greater potency than SOX2 in iMSC reprogramming (Fig.1c). As expected, SOX9 virtually abolished the generation of TRA-1-60-expressing cells (Fig.1d). To ensure the absence of undetectable levels of iPSCs after reprogramming with SOX9, we cultured iMSCs in iPSC medium for 1 week. Phenotyping analysis of cultured cells showed no expression of iPSC markers. These data suggested that SOX9 restricted cell fate to iMSCs, whereas SOX2 would overshoot the reprogramming of a proportion of PBMCs beyond the stage of iMSCs. Moreover, after reprogramming with SOX9, PBMCs transformed morphologically to spindle-like cells resembling MSCs within 46 days, whereas SOX2-reprogrammed cells did not display spindle-like morphology (Supplementary Fig.2a).

Although PBMCs are composed of many different cell types, based on our previous studies3,16,19, we hypothesized that the CD34+ cell subset in peripheral blood was the most amenable to reprogramming to iMSCs. After six days of culture in hematopoietic stem cell expansion medium, the percentage of CD34+ cells in PBMCs increased from <1% to ~45%. When we depleted CD34+ cells from PBMCs before inducing reprogramming, no MSC-like colonies were observed (Fig.1e). These results suggested that the five reprogramming factors converted the CD34+ hematopoietic stem cells and progenitors but not the matureblood cells into iMSCs.

Having observed that the combination of OCT4, BCL-XL, MYC, KLF4, and SOX9 (named as 5F) induced the highest levels of PBMC conversion without overshooting the iMSC reprogramming process, we used the five factors (5F) for reprogramming in subsequent experiments. In all, 57 days after nucleofection of PBMCs with 5F, dozens of MSC-like colonies were observed. At approximately 2 weeks, reprogrammed cells resembled MSCs with typical spindle-like morphology (Fig.2a). The expression of MSC markers such as CD90 and CD73 increased from ~5% of reprogrammed cells by ~1 week to ~15% and 40% of the cells, respectively, by week 2 and >75% by week 3 (Fig.2b and Supplementary Data2). Four weeks after reprogramming with 5F, almost all cells expressed typical MSC markers: CD29 (99.7%), CD73 (95.3%), CD90 (96%), and CD166 (80%) (Fig.2c, d). The expression of hematopoietic markers such as CD45 and CD34 was negligible (Fig.2e). In addition, OCT4+ cells were not detectable (Supplementary Fig.3). Next, we evaluated the immunomodulatory potential of the iMSCs. We found that our 5F iMSCs were able to significantly suppress T-cell proliferation (CD4+ and CD8+ T-cell subsets) after 3 or 6 days (Fig.2f, Supplementary Fig.4a, and Supplementary Data3) co-culture with PBMCs. To further determine if the reprogramming to iMSCs or their expansion in culture may cause any chromosomal abnormalities, we performed digital karyotyping using SNP arrays. We did not identify any chromosomal abnormalities after either 1 week or 4 weeks of in vitro culture (Supplementary Figs.57). These data demonstrated that human PBMCs can be efficiently reprogrammed into iMSCs using our nonintegrating episomal vector system.

a Representative images of human PBMCs and iMSCs 14 days after reprogramming with five factors (5F). Scale bar represents 100m. b Changes in the percentage of cells expressing the MSC markers CD73 and CD90 as measured by flow cytometry of 5F-transfected PBMCs over time.c,d Flow cytometry plots of typical MSC marker expression (CD29, CD73, CD90, CD166)at 4 weeks after reprogramming. n=3 biologically independent samples for time point. eBlood cell markers (CD45 and CD34) were assessed 4 weeks after transfection of reprogramming factors. f iMSCs significantly inhibited T-cell proliferation after 3 days of co-culture with PBMCs. **P=0.0007. Error bars indicate standard deviation. n=3 biologically independent samples for each group.

To assess the essentiality of the five factors, we performed reprogramming by omitting a single factor in separate experiments. PBMCs from various donors were used. Surprisingly, we found that skipping OCT4, a critical factor for blood cell reprogramming, still allowed the generation of a considerable number of MSC-like colonies (Fig.3a and Supplementary Data4). In addition, PBMCs could be converted to iMSCs without KLF4, although at a ~35% decreased efficiency (Fig.3a). Omitting SOX9 not only significantly reduced the number of colonies formed but the reprogrammed cells were round in shape instead of spindle-like MSCs suggesting that SOX9 played a pivotal role in determining the MSC fate (Supplementary Fig.2b). By comparison, hardly any colonies were formed in the absence of BCL-XL or MYC. Taken together, SOX9, BCL-XL, and MYC were indispensable for reprogramming PBMCs into iMSCs.

a Reprogramming efficiency with the five-factor combination and removing one of the five factors. One-way ANOVA and Dunnetts multiple comparisons test, *P<0.05 vs. 5F group, ***P<0.001 vs. 5F group. ns: not significant. Error bars indicate standard deviation. n=5 for each group from biological independent donors. b Flow cytometry analysis of the MSC marker CD73 4 weeks after transfection with 5F, 4FnoO (no OCT4), and 4FnoK (no KLF4). c Flow cytometry analysis of the MSC markers CD73 and CD90 at 2, 3, and 4 weeks after transfection with 5F, 4FnoO (no OCT4), or 4FnoK (no KLF4). df RTqPCR analysis of osteogenesis-, adipogenesis-, and chondrogenesis-related genes in iMSCs reprogrammed with 5F, 4FnoO, and 4FnoK 2 weeks after multilineage differentiation. Tukeys multiple comparisons test, *P<0.05, 4FnoO vs. 5F and 4FnoK group. #P<0.05, 4FnoO vs. 4FnoK group. n=4 biologically independent samples for each group. Error bars indicate standard deviation (SD). g Multilineage differentiation of iMSCs reprogrammed with 5F, 4FnoO, or 4FnoK. Cells were cultured in osteogenic, adipogenic, or chondrogenic induction medium for 24 weeks and stained with Alizarin Red (osteogenesis), Oil Red O (adipogenesis), or Alcian blue (chondrogenesis), respectively. Scale bars represent 200m.

The iMSCs generated with the three different combinations of reprogramming factors, 5F, 4FnoO (5F minus OCT4), and 4FnoK (5F minus KLF4), were morphologically similar: they were all spindle-shaped, resembling MSCs (Supplementary Fig.2b). We evaluated the proliferation of the iMSCs generated from different conditions and compared it with primary human bone marrow MSCs (BMMSCs) (Supplementary Fig.2c). Primary human BMMSCs showed slowed proliferation after ~1 month in culture. The iMSCs reprogrammed from PBMCs displayed an enhanced in vitro proliferative capacity compared with BMMSCs. While the 5F iMSCs and 4FnoK iMSCs have similar proliferation ability, the 4FnoO iMSCs showed slower proliferation compared with the other two types of iMSCs (5F iMSCs and 4FnoK iMSCs). More than 100-fold more 5F iMSCs were generated than the human primary BMMSCs after ~1 month culture. In addition, >90% of the reprogrammed cells expressed the MSC marker CD73 (Fig.3b) 4 weeks after vector transfection. To monitor the reprogramming process in more detail, we evaluated the expression of the MSC markers CD73 and CD90 at 2-, 3-, and 4-week post-transfection (Fig.3c). We found that more than 60% of cells reprogrammed from either 5F or 4FnoK conditions became CD90+ by week 2, whereas only ~6% of cells from 4FnoO were CD90+, suggesting that OCT4 promoted the formation of CD90+ cells.

A characteristic feature of MSCs is the potential for trilineage differentiation into osteoblasts, adipocytes, and chondrocytes20. To assess the functionality of iMSCs reprogrammed with 5F, 4FnoO, or 4FnoK, we cultured iMSCs in three lineage-specific induction media, followed by RTqPCR analysis on the marker genes of osteogenesis, adipogenesis, and chondrogenesis.

The expression levels of runt-related transcription factor 2 (RUNX2), an early marker of osteogenic commitment, as well as the later osteogenic markers SP7 and alkaline phosphatase (ALP), were significantly decreased in the 4FnoO-reprogrammed iMSCs compared with 5F- or 4FnoK-reprogrammed iMSCs (P=0.01 and 0.03, respectively; Tukeys multiple comparisons test, Fig.3d and Supplementary Data5). To confirm the osteogenic commitment, we assessed calcium deposits by Alizarin Red S staining. Mineralization was observed in iMSCs reprogrammed with either 5F or 4FnoK but not in 4FnoO-reprogrammed iMSCs (Fig.3g).

Regarding chondrogenic differentiation, there was no significant difference in the expression of chondrogenic marker genes such as ACAN among the three groups (Fig.3e and Supplementary Data5). Alcian blue staining, which stains for aggrecans associated with MSC chondrogenic potential, also showed no significant difference among the three groups (Fig.3g). However, SOX9 expression was significantly reduced in 4FnoO iMSCs (4FnoO vs. 4FnoK, P=0.005). These data suggested that omitting OCT4 also impaired the chondrogenic differentiation potential of iMSCs. Taken together, these five factors were necessary for the generation of iMSCs with unbiased differentiation potential. Conversely, reprogramming without OCT4 led to the formation of dysfunctional iMSCs.

After the induction of adipogenic differentiation, lipoprotein lipase (LPL) and fatty acid-binding protein 4 (FADP4) were expressed at substantially lower levels in 4FnoO iMSCs than in either 5F or 4FnoK iMSCs (Fig.3f and Supplementary Data5). We used Oil Red O staining to visualize lipid droplets in functional adipocytes. Consistent with the adipogenic gene expression data, iMSCs reprogrammed without OCT4 failed to differentiate into functional adipocytes (Fig.3g). Of interest, omitting KLF4 led to the expression of higher levels of adipocyte markers and the formation of larger oil droplets, suggesting that KLF4 played a role in restricting adipogenic-biased MSCs.

To evaluate the immunomodulatory potentials of iMSCs reprogrammed with 5F, 4FnoO, or 4FnoK, we compared a list of major immunoregulatory cytokines, chemokines, and soluble factors secreted by MSCs21,22 using the normalized gene counts from the RNA-seq data (Supplementary Fig.4b and Supplementary Data6). We found that compared with 5F iMSCs, in addition to impaired trilineage differentiation potential, the 4FnoO iMSCs showed significantly reduced gene expression on many immunoregulatory cytokines/chemokines, such as IL-10, HGF, VCAM1, CCL2, CXCL14 (Supplementary Fig.4b). Both 5F and 4FnoK iMSCs showed comparable levels of immunoregulatory cytokines/chemokines gene expression compared to the primary human bone marrow-derived MSCs23.

To investigate the mechanisms underlying the distinct features of iMSCs reprogrammed with different factors (i.e., 5F, 4FnoO, and 4FnoK), we conducted transcriptome analysis 4 weeks after reprogramming factor transfection. We chose 4 weeks because >90% of the reprogrammed cells expressed MSC markers at this time point, and the nonintegrating episomal viral vectors were cleared from the reprogrammed cells7. First, we investigated the differentially expressed genes (DEGs) between the 5F, 4FnoO, or 4FnoK iMSCs. DEG analysis identified 827 significantly down- and 538 significantly upregulated genes in 4FnoO iMSCs compared to 5F iMSCs (FDR<0.05 and fold change (FC)>2, Fig.4a and Supplementary Data7). Of note, 5F and 4FnoK iMSCs showed similar transcriptomes with only 24 DEGs, consistent with their seemingly identical differentiation potentials (Supplementary Fig.8). Hierarchical clustering analysis identified a set of genes highly enriched in 5F and 4FnoK iMSCs, some of which were reported as MSC lineage signature genes, such as SRPX, S1PR3, ROBO2, NCAM1, COL5A1, and COL4A1 etc24,25,26 (Fig.4b and Supplementary Data7). Furthermore, the 4FnoO iMSCs displayed a significant decrease in the expression of mesoderm-regulating genes, including SOX4, SALL4, and TWIST1 (Supplementary Data7). We speculated that these downregulated genes might be associated with the impaired functionality of 4FnoO iMSCs. We then performed Gene Ontology (GO) enrichment analyses to explore the pathways associated with genes expressed at low levels in 4FnoO iMSCs. We found that 1365 DEGs were enriched in the biological processes of axonogenesis, extracellular structure organization, ossification, and cartilage development (Fig.4c). The top identified Kyoto Encyclopedia of Genes and Genomes (KEGG) pathways were the PI3K-Akt signaling and calcium signaling pathways (Fig.4d). These data helped explain the functional defects in osteogenesis of 4FnoO iMSCs and further understanding of the role of OCT4 in reprogramming PBMCs into iMSCs.

a Volcano plot showing differentially expressed genes identified in 4FnoO iMSCs compared with 5F iMSCs. Each dot represents a gene. The red dots are genes significantly upregulated (right) or downregulated (left) in 4FnoO iMSCs (Cutoff: P<10e6, fold change>2). b Heatmap showing the top 30 differentially expressed genes between 5F iMSCs and 4FnoO iMSCs (ranked by p-value). c, d Dot plots showing the top Gene Ontology (GO) biological process (BP) terms (c) and KEGG pathways (d) enriched from DEGs in 4FnoO iMSCs compared to 5F iMSCs. e PCA of RNA-seq from iMSCs 4 weeks after reprogramming with 5F, 4FnoO, or 4FnoK, primary human bone marrow-derived MSCs (BMMSC) and primary adipose-derived MSCs (AdMSC). For each condition, iMSCs were reprogrammed from PBMCs derived from three biologically independent donors. f Pearson correlation analysis of iMSCs and primary MSCs. g Comparison of twenty-four genes previously determined to be specific to the MSC lineage between primary MSCs and iMSCs.

To compare the iMSCs reprogrammed from PBMCs with primary human MSCs, we downloaded RNA-seq data generated from primary human bone marrow-derived MSCs (BMMSC)23 and primary human adipose-derived MSCs (AdMSC). First, we analyzed the transcriptional similarity of the iMSCs in our study to the primary human MSCs using principal component analysis (PCA) (Fig.4e). The reduction of the multi-dimensional dataset into two principal component (PC) dimensions enables the unbiased comparison and visualization of the transcriptomes between samples. As expected, the results showed that 4FnoO iMSCs were distinct from the other two iMSC groups (Fig.4e), consistent with the impaired differentiation potential of 4FnoO iMSCs when compared with 5F and 4FnoK iMSCs. The transcriptomes of human BMMSC and AdMSC were very similar to each other. Furthermore, the variation captured in PC1 demonstrated closer similarity of 5F and 4FnoK iMSCs with the primary MSCs compared to 4FnoO iMSCs, which tended to cluster further away from BMMSC and AdMSC (Fig.4e). Pearson correlation analysis confirmed that the 4FnoK and 5F iMSCs retained strong transcriptome correlation with the primary MSCs, while the 4FnoO iMSCs had less correlation with the primary MSCs (Fig.4f). A panel of 24 MSC lineage genes25,26 were compared between the primary MSCs and our iMSCs (Fig.4g). The 4FnoO iMSCs showed distinct expression patterns of these MSC signature genes that contrasted strongly with other groups. Noteworthy is that COL4A1, COL5A1, LOX, NNMT, which are known to be upregulated in MSCs versus fibroblasts24,27, were downregulated in 4FnoO iMSCs.

Genome-wide chromatin accessibility can provide mechanistic insights at the molecular level into cell fate decisions, especially during the reprogramming process. Thus, we performed ATAC-seq28 analysis on iMSCs 4 weeks after reprogramming PBMCs with 5F, 4FnoO, or 4FnoK. Open chromatin regions were identified as peaks in the ATAC-seq dataset. Furthermore, after peak calling, the relative genomic distribution of ATAC peaks showed reduced peaks within promoter regions in iMSCs generated without OCT4 (Fig.5a). In contrast, these cells had more open chromatin at intron regions. These results suggested that OCT4 may preferentially bind promoter regions to promote chromatin accessibility during reprogramming.

a Genomic location of ATAC-seq peaks from 5F, 4FnoO, and 4FnoK iMSCs. b PCA using normalized ATAC-seq counts from 5F, 4FnoO, and 4FnoK iMSCs, and two datasets from bone marrow-derived CD34+ cells (SRR2920489 and SRR2920490). For each condition, the chromatin accessibility was profiled from iMSCs that were reprogrammed from two biologically independent donors. c Heatmap showing ATAC-seq signals with the top 200 most different peaks (ranked by padj). Red represents chromatin regions with more mapped reads, suggesting possible chromatin openness. Gray represents chromatin regions with fewer mapped reads, suggesting closed chromatin. d Selected genomic views of the ATAC-seq data using IGV (2.8) for the indicated groups. For each gene, all genome views are on the same vertical scale. e The bar plot showing RNA-seq gene expression values for the respective genes shown above in the genome view. RNA-seq gene expression levels are shown as log2() normalized read counts. n=3 biologically independent samples for each group. *P0.05; error bars indicate standard deviation.

Similar to what was observed in the RNA-seq transcriptomic data, PCA of normalized ATAC-seq read counts showed that chromatin accessibility of three groups of iMSCs (5F, 4FnoO, and 4FnoK) were well-separated from each other, in which the accessible chromatin regions were mainly different in 4FnoO cells (PC1=52% variance, Supplementary Fig.9). However, in contrast to the similar transcriptomes between 5F and 4FnoK iMSCs (Supplementary Fig.8 and Fig.4a), ATAC-seq analysis showed that therewas aclear separation between 5F and 4FnoK iMSCs (PC2=19%, Supplementary Fig.9). These data suggested that both OCT4 and KLF4 facilitate chromatin remodeling during reprogramming. To compare the changes in chromatin accessibility during reprogramming, we downloaded the ATAC-seq data of primary CD34+ cells from bone marrow (SRR2920489, SRR2920490)29, which are similar to our reprogramming-initiating cells in this study. The datasets were processed using the same analysis pipeline. PCA revealed that CD34+ hematopoietic progenitor cells clustered separately from the three groups of reprogrammed iMSCs (Fig.5b), whereas 5F iMSCs and 4FnoK iMSCs were clustered closely with each other.

We also noticed that some chromatin regions remained closed in both CD34+ and 4FnoO iMSCs, whereas the same regions were in an open configuration in the 5F and 4FnoK iMSCs (Fig.5c). These data suggested that OCT4, but not KLF4, played a critical role in opening chromatin during the reprogramming process. More specifically, OCT4 opened the chromatin of the stemness-associated gene SALL4, Wnt signaling-related genes such as SFRP4, microtubule-binding and glutamate receptor binding-related genes JAKMIP2 and SYNDIG1, and MSC lineage signature gene NNMT (Fig.5d). These genes with reduced ATAC-seq peaks in 4FnoO iMSCs also showed significantly reduced mRNA expression, indicating a consistency between transcriptome and chromatin accessibility data (Fig.5e and Supplementary Data8).

DNA methylation is the most common epigenetic modification of the genome to control gene expression in mammalian cells30 and the differentiation or self-renewal of MSCs13. To determine the effects of reprogramming factors on methylation levels and patterns in iMSCs, we assessed genome-wide CpG methylation profiles in 5F, 4FnoO, and 4FnoK iMSCs at week four using RRBS. First, we profiled CpG methylation patterns on five different genomic features (all sites, promoters, exons, introns, and transcription start sites (TSSs) (Fig.6a, b and Supplementary Data9). We found that iMSCs reprogrammed without OCT4 showed a globally hypermethylated CpGs compared to iMSCs reprogrammed with OCT4 (Fig.6a, b). Specifically, when reprogramming in the absence of OCT4, we identified 10,760 differentially methylated cytosines (DMCs) (20%, q=0.1, Supplementary Data10), of which 9004 DMCs were hypermethylated and 1756 DMCs were hypomethylated (4FnoO vs. 5F). Among these sites, 7.7% were within promoter regions, and 7.9% werewithin exon regions (Fig.6c). In contrast, there was no significant difference in CpG methylation within all five genomics features in the iMSCs when reprogrammed in the absence of KLF4 (Fig.6a, b). Of the 3849 CpG sites significantly different (20%, q=0.1) between the 5F and 4FnoK groups, 3698 CpG sites were hypermethylated, and 151 sites were hypomethylated. When measuring the average methylation against the distance to the TSS, there was a global hypermethylation pattern in the iMSCs reprogrammed without OCT4 (Fig.6d, p<0.0001), suggesting that OCT4 was critical for global demethylation during reprogramming of PBMCs to iMSCs.

a The bar graph showing the methylation levels of all sites, promoters, exons, and intron regions from 5F, 4FnoO, and 4FnoK iMSCs. n=2 biologically independent samples for each group. b The methylation levels of the TSS region. n=2 biologically independent samples for each group. c The percentage of differentially methylated CpGs (DMCs) between 5F and 4FnoO iMSCs annotated within the promoter, exon, intron, and intergenic regions shown in the pie chart. d The average methylation levels surrounding the TSSs (5000 to +5000bp) in 5F, 4FnoO, and 4FnoK iMSCs. e Hierarchical clustering and heatmap analysis of 13,974 DMCs. f The bar plot showing the log2() normalized read counts from RNA-seq. n=3 biologically independent samples for each group. *P<0.05; error bars indicate standard deviation.

We performed hierarchical clustering on six RRBS datasets and generated a heatmap using the beta value of all common CpG sites. As expected, two datasets from 4FnoO clustered together, enriched a set of hypermethylated DMCs that were not observed in the 5F and 4FnoK datasets (Fig.6e). Since the cells reprogrammed from 5F and 4FnoK were very similar in their transcriptomes, chromatin openness, and methylation levels, we focused on our comparisons in the iMSCs programmed using 5F vs. 4FnoO. We annotated 10,760 DMCs and identified 665 differentially methylated genes (DMGs) between 5F and 4FnoO iMSCs (Supplementary Data10) which were subject to GO enrichment analysis (Supplementary Fig.10). Similar to the GO enrichment analysis based on RNA-seq data, DMGs were enriched in axonal guidance signaling and mesenchyme development. Of note, POU5F1, SALL4, NCAM1, HDAC4, and MSC lineage signature gene COL5A1 were significantly hypermethylated in iMSCs reprogrammed using 4FnoO compared with the iMSCs programmed using 5F (Supplementary Data10), suggesting that these genes might be associated with the impaired functionality in the 4FnoO iMSCs.

Demethylation may occur passively. DNMT1 is the most abundant DNA methyltransferase in mammalian cells and is considered the key methyltransferase responsible for DNA methylation maintenance, and its inhibition will result in passive demethylation. We found that the expression levels of DNMT1 in iMSCs reprogrammed with or without OCT4 were similar (Fig.6f and Supplementary Data8), suggesting minimal role of DNMT1 in OCT4-mediated demethylation. We then suspected that active DNA demethylation might have contributed to the global hypomethylation. Active DNA demethylation is mainly regulated by ten-eleven translocation (TET) enzymes31. We observed that the expression of TET1, but not TET2, was significantly reduced when reprogramming without OCT4 (Fig.6f), suggesting that TET1 might have contributed to OCT4-induced global demethylation. Meanwhile, the expression level of DNMT3B was significantly increased when reprogramming without KLF4, suggesting a role of KLF4 in regulating DNA methylation homeostasis via de novo DNA methyltransferase DNMT3B (Fig.6f).

To assess the influence of methylation on gene expression, we performed integration analysis of DMGs and DEGs datasets. We found the co-occurrence of 67 genes between 5F and 4FnoO iMSCs (Fig.7a and Supplementary Table1). Hypergeometric test was applied to show that the overlap is significant. Our analysis suggested that the observed difference in functionality between 5F and 4FnoO iMSCs might be a consequence of the difference in the methylation status of these 67 genes. Among these genes, ZFHX4, SLC8A2, NCAM1, TFPI2, and SALL4 were the most differentially expressed (Fig.7b). When PBMCs were reprogrammed without OCT4, not only were these genes significantly hypermethylated on either promoters or exons compared to PBMCs reprogrammed with OCT4 (Supplementary Data10), but some chromatin regions of these genes also remained inaccessible/closed (Fig.7c). Consistent with the hypermethylation of the four genes, their transcription levels were close to zero (Fig.7d and Supplementary Data8).

a Venn diagram illustrating the overlap between the differentially expressed genes (DEGs) and differentially methylated genes (DMGs) between 5F iMSCs and 4FnoO iMSCs. A total of 1365 DEGs and 665 DMGs were identified; 67 of these were both differentially expressed and differentially methylated. b Volcano plot showing 67 overlapping genes between the DEG and DMG. pCutoff=10e6, log2 FC>1). c Selected genomic views of the ATAC-seq data using IGV (2.8) for the indicated groups. For each gene, all genome views are on the same vertical scale. d The bar plot showing the RNA-seq gene expression values for the respective genes, which are shown above in the genome view. RNA-seq gene expression levels are shown as log2() normalized read counts. *, P<0.05; error bars indicate standard deviation. n=3 biologically independent samples for each group. e Heatmap showing the normalized gene read count after log2() transformation from RNA-seq.

ZFHX4, a transcription-related zinc finger protein involved in the mesodermal commitment pathway, is upregulated in both embryonic stem cell-derived and bone marrow (BM)-derived MSCs32,33. These reports, together with our findings, indicate that ZFHX4 may serve as an MSC marker. In addition, neural cell adhesion molecule (NCAM), also called CD56, is expressed on human MSCs and was proposed as a marker for human MSC isolation34,35. Also, CD56+ cells showed increased colony formation ability, suggesting CD56 expression enriches MSCs with self-renewal potency36. On the other hand, BM-MSCs from NCAM-deficient mice exhibited defective migratory ability and significantly impaired adipogenic and osteogenic differentiation potential37.

Many genes have been proposed as MSC surface marker genes, but no consensus has been reached yet. To screen possible trilineage differentiation function associated MSC markers, we compared ten well-established MSC surface markers between primary MSCs and our iMSCs (Fig.7e and Supplementary Fig.11). We found that other than NCAM1, four additional MSC surface markers (CD90, PDGFRB, CD82, and FZD5) were highly expressed in both primary MSCs and 5F/4FnoK iMSCs but downregulated in 4FnoO iMSCs (Fig.7e). Taken together, integrated analysis of multiomics data lead to the identification of putative functional MSC markers, and our dataset enables the mining for additional MSC surface markers that co-associate with functional potential.

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Novel microelectrode array system enables long-term cultivation and analyses of brain organoid – Medical Xpress

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A human brain organoid (colored red) grew on the hammock-like mesh structure of a Mesh-MEA (green) for one year. The scanning electron micrograph shows how the brain organoid has grown around the mesh filaments and microelectrodes. Credit: Max Planck Institute for Molecular Biomedicine

Brain organoids are self-organizing tissue cultures grown from patient cell-derived induced pluripotent stem cells. They form tissue structures that resemble the brain in vivo in many ways. This makes brain organoids interesting for studying both normal brain development and for the development of neurological diseases. However, organoids have been poorly studied in terms of neuronal activity, as measured by electrical signals from the cells.

A team of scientists led by Dr. Thomas Rauen from the Max Planck Institute for Molecular Biomedicine in Mnster, Germany, in collaboration with Dr. Peter Jones' group at the NMI (Natural and Medical Sciences Institute at the University of Tbingen, Germany), has now developed a novel microelectrode array system (Mesh-MEA) that not only provides optimal growth conditions for human brain organoids, but also allows non-invasive electrophysiological measurements throughout the entire growth period. This opens up new perspectives for the study of various brain diseases and the development of new therapeutic approaches.

The study is published in the journal Biosensors and Bioelectronics.

Nerve cells communicate through chemical signals (neurotransmitters), which are converted into electrical signals that pass information from one nerve cell to the next. This is also the way in which the neurons in the brain organoids communicate with each other.

"To find the causes of various brain diseases and new therapeutic approaches, it is not enough to simply look at nerve cells under the microscope. You also need to know how the nerve cells workhow they communicate with each other," says Thomas Rauen.

However, current systems for recording the communication between nerve cells in brain organoids have their limitations. In the relatively large brain organoids, the sensors either do not get close enough to the nerve cells or they destroy parts of the organoid tissue when they penetrate it.

Now, Dr. Thomas Rauen's team, in collaboration with Dr. Peter Jones' team, has developed a novel microelectrode array system (Mesh-MEA) that not only provides optimal growth conditions for human brain organoids, but also enables non-invasive electrophysiological measurements throughout the growth period of the brain organoids.

The scientists designed a kind of hammock for the brain organoids. "The hammock-like mesh structure provides 61 microelectrodes for electrophysiological measurements of neuronal network activity," explains Dr. Peter Jones.

The current study shows that brain organoids can not only be cultured on the newly developed Mesh MEA for up to one year but can also be continuously electrophysiologically analyzed during this period. "This is a great achievement because it allows us to study brain organoids for much longer than before. Normal human brain development takes a very long time, and neurodegenerative diseases also develop slowly," says Rauen.

The key to the current success is that the brain organoids enveloped the filaments and continued to grow on the spider web-like Mesh-MEA scaffold. Dr. Katherina Psathaki from CellNanOs at the University of Osnabrck was able to show this using an electron microscope. She analyzed brain organoids in their Mesh-MEA hammock one year after the start of cultivation.

"The images clearly confirm that the brain organoids develop in the suspended Mesh-MEA net structure. The microelectrodes are located in the center of the brain organoid tissue," adds Thomas Rauen.

The scientists observed spontaneous neuronal activity recorded by the microelectrodes in the brain organoids. "There was continuously recurring, synchronized neuronal activity throughout the recording phase, suggesting the formation of neuronal networks as seen in vivo," says Thomas Rauen.

Although brain organoids cannot represent all the functions of the human brain, Peter Jones and Thomas Rauen are convinced that the electrophysiological analysis of brain organoids using their newly developed Mesh-MEA system will open up the possibility of simulating specific functional aspects of human brain development and its diseases in the laboratory, which has not been possible until now.

More information: Matthew McDonald et al, A mesh microelectrode array for non-invasive electrophysiology within neural organoids, Biosensors and Bioelectronics (2023). DOI: 10.1016/j.bios.2023.115223

Journal information: Biosensors and Bioelectronics

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