Haverich, A. | Search bioRxiv

bioRxiv2024

Cell therapy with human iPSC-derived cardiomyocyte aggregates leads to efficient engraftment and functional recovery after myocardial infarction in non-human primates

BackgroundFunctionally coupled large myocardial grafts and a remarkable improvement of heart function in nonhuman primate models of myocardial infarction have been reported after transplantation of human embryonic stem cell-derived cardiomyocytes at relatively high numbers of up to 109 single cell cardiomyocytes - a dose equivalent to total cell loss after myocardial infarction in [~]10 times larger human hearts. To overcome apparent limitations associated with the application of single cells, this pre-clinical study investigated the injection of cardiomyocyte aggregates instead. MethodsHuman iPSC-derived cardiomyocyte aggregates were produced in scalable suspension culture. Intramyocardial injection of the aggregates into cynomolgus monkey hearts was conducted two weeks after myocardial infarction induced by permanent coronary artery ligation. Human cell engraftment was assessed after two weeks or three months; functional analyses included continuous telemetric ECG recording and repeated cardiac MRI assessment in comparison to sham treated animals. ResultsTreatment with cell numbers as low as 5 x 107 resulted in efficient structural engraftment. Notably, the degree of heart function recovery in vivo seemed to correlate with the contractility of the applied cardiomyocytes tested by parallel experiments in vitro. Graft-induced non-life-threatening arrhythmias were transient and decreased considerably during the three months follow-up. ConclusionsTransplantation of human iPSC-derived cardiomyocyte aggregates yielded comparable results to the reported application of higher numbers of single cell cardiomyocytes from human ESC, suggesting that the application of cardiomyocyte aggregates facilitates cell therapy development by reducing cell production costs and clinical risks associated with the administration of relatively high cell numbers. Clinical PerspectiveWhat is new? O_LIIn contrast to previously applied single cells, human iPSC-derived cardiomyocyte aggregates (hiCMAs) were transplanted in a non-human primate (NHP) model of MI, to reduce the required cell dose, promote myocardial retention of the graft, and limit the risks for adverse effects. Such low-dose treatment with almost pure ventricular cardiomyocytes produced under GMP-compliant conditions, resulted in the formation of relative large, structurally integrated human grafts in NHP hearts. C_LIO_LITransient non-life-threatening arrhythmias associated with intramyocardial cell transplantation decreased considerably during the three months follow-up. C_LIO_LIA remarkable recovery of left ventricular function was observed. This recovery notably correlated with the in vitro contractility of transplanted cardiomyocyte batches tested in bioartificial cardiac tissues (BCTs), underlining the relevance of a suitable potency assay. C_LI What are the clinical implications? O_LIIntra-myocardial injection of hiCMAs is a promising treatment modality for the recovery of contractile function after MI; their advanced production, storage and testing revealed in the study facilitate the clinical translation of hiPSC-based heart repair. C_LIO_LIThe need for relatively low numbers of cardiomyocytes produced through advanced protocols for scalable suspension culture reduces production costs of adequate cell batches, thereby increasing treatment availability. In vitro testing of the produced cell batches is required to ensure treatment efficacy. C_LIO_LIClinical hiCMA injection can be considered reasonably safe, however, pharmacological prevention and treatment of arrhythmias is required and temporary implantation of a cardioverter-defibrillator (ICD) could be considered. C_LI

cell biology↗

bioRxiv2023

Donor tissue-resident memory-like T and NK cells generate a transient peripheral chimerism in lung transplant recipients, potentially protective from chronic lung allograft dysfunction

Lung transplantation (LTx) is the only definite treatment option of patients suffering from end- stage lung disease. Long-term outcome is hampered by chronic allograft dysfunction resulting from poorly defined immune mechanisms. In this study of 97 lung recipients, we demonstrate dynamic changes of T, B and NK cell subsets early after lung transplantation with a selective decrease in memory CD4+ and CD8+ T cells accompanied by a relative increase in NK cells. Simultaneously, donor-derived T and NK cells were detected in recipient blood (n=44) immediately after LTx, persisting for three weeks. Donor T and NK cells displayed a CD69+ but CD103-CD49a- CD25- phenotype, which was shared by T and NK cells in lung perfusion solutions. In order to uncover the origin of these donor T and NK cells, the immune compartment of human lung explant tissue, i.e. trachea and parenchyma, was analyzed and it revealed three major subsets: classical circulating CD69-CD103-CD49a- T and NK cells, CD69+CD103+CD49a+ tissue-resident memory (TRM) T and NK cells and CD69+CD103-CD49a- TRM-like T and NK cells. Single-cell RNA sequencing confirmed the presence of TRM-like subsets with unique features, which reflected the phenotypes of donor T and NK cells and created a transient chimerism in recipient blood. Higher frequencies of donor T cells within the first three weeks showed a tendency for protection from chronic lung allograft dysfunction (CLAD) two years after transplantation although the correlation analyses did not reach statistical significance. To the best of our knowledge, we show for the first time that a transient chimerism is established within the first weeks after lung transplantation by donor TRM- like T and NK cells, which may contribute to protection from chronic lung allograft dysfunction (CLAD) development. Single Sentence SummaryDonor TRM-like T and NK cells cause a transient chimerism in lung recipients and potentially contribute to protection from CLAD.

immunology↗