Neurological Disorders

Coding Dimension ID: 
303
Coding Dimension path name: 
Neurological Disorders

Developing a therapeutic candidate for Canavan disease using induced pluripotent stem cell

Funding Type: 
Early Translational II
Grant Number: 
TR2-01832
ICOC Funds Committed: 
$1 835 983
Disease Focus: 
Genetic Disorder
Neurological Disorders
Pediatrics
Collaborative Funder: 
Germany
Stem Cell Use: 
iPS Cell
Cell Line Generation: 
iPS Cell
oldStatus: 
Active
Public Abstract: 
Canavan disease is a devastating disease of infants which affects their neural development and leads to mental retardation and early death. It occurs in 1 in 6,400 persons in the U.S. and there is no treatment so far. We propose to generate genetically-repaired and patient-specific stem cells (called iPSCs) from patients’ skin cells, and then coax these stem cells into specific types of corrective neural precursors using methods established in our laboratories in order to develop a therapeutic candidate for this disease. By use of a mouse model of Canavan disease, we will determine the ability of these genetically corrected cells to successfully treat the disease. These results will form the basis for an eventual clinical trial in humans, and if successful, would be the first treatment for this terrible disease. There are many families affected by this disease, and other diseases similar to it. Results from this work could have applications to this and other similar genetic diseases. Through the proposed research, maybe no parents will have to watch their child suffer and die as a result of these dreadful diseases in one day. What a wonderful day that would be!
Statement of Benefit to California: 
It is estimated that California has ~12% of all cases of Canavan disease in the U.S. Besides the tremendous emotional and physical pain that this disease inflicts on families, it produces in California a medical and fiscal burden that is larger than any other states. Thus, there is a real need to develop a strategy of treatment for this disease. Stem cells provide great hope for the treatment of a variety of human diseases that affect the citizens of California. Combination of gene therapy and iPSC technology will enable the development of therapeutic candidates of human genetic diseases via the creation of genetically-corrected patient-specific iPSCs. Our proposal aims to establish a therapeutic development candidate for Canavan disease, a devastating neurodegenerative disease that leads to mental retardation and early death. The generation of genetically-repaired and patient-specific iPSC lines will represent great potential not only for California health care patients but also for pharmaceutical and biotechnology industries in California. Moreover, California is a strong leader in pre-clinical and clinical research developments. To maintain this position, we need to create patient-specific stem cells as autologous therapeutic candidates, in order to overcome the challenges of immune rejection faced by today’s cell therapy field. This proposal addresses the very issue by generating “disease-corrected” and patient-specific iPSCs as a therapeutic candidate with the potential to create safer and more effective cell replacement therapies.
Progress Report: 
  • Canavan disease is a devastating disease of infants which affects their neural development and leads to mental retardation and early death. It occurs in 1 in 6,400 persons in the U.S. and there is no treatment so far. We propose to generate genetically-repaired and patient-specific stem cells (called iPSCs) from patients’ skin cells, and then coax these stem cells into specific types of corrective neural precursors using methods established in our laboratories in order to develop a therapeutic candidate for this disease.
  • For the reporting period, we have obtained primary dermal fibroblasts from clinically affected Canavan disease patients and have derived Canavan disease patient iPSCs. We have demonstrated that these iPSCs exhibited typical human embryonic stem cell (ESC) like morphology, expressed human ESC cell surface markers and hold pluripotency potential. We are also optimizing methods to coax these cells into specific types of neural precursors. Either the patient iPSCs or their neural precursor derivatives will be genetically corrected in the following years to develop a therapeutic tool for Canavan disease patients.
  • There are many families affected by this disease, and other diseases similar to it. Results from this work could have applications to this and other similar genetic diseases. Through the proposed research, maybe no parents will have to watch their child suffer and die as a result of these dreadful diseases in one day.
  • Canavan disease is a devastating disease of infants which affects their neural development and leads to mental retardation and early death. It occurs in 1 in 6,400 persons in the U.S. and there is no treatment so far. We propose to generate genetically-repaired and patient-specific stem cells (called iPSCs) from patients’ skin cells, and then coax these stem cells into specific types of corrective neural precursors using methods established in our laboratories in order to develop a therapeutic candidate for this disease.
  • For the reporting period, we have demonstrated that the Canavan disease patient iPSCs hold pluripotency potential. We also genetically corrected the patient iPSCs and demonstrated that these genetically-corrected cells maintained human embryonic stem cell-like features. We coaxed these cells into specific types of neural precursors and showed that the genetically-corrected patient cells restored their cellular function. These genetically corrected cells will be tested for their therapeutic effect in the next year, in order to develop a therapeutic tool for Canavan disease patients.
  • There are many families affected by this disease, and other diseases similar to it. Results from this work could have applications to this and other similar genetic diseases. Through the proposed research, maybe no parents will have to watch their child suffer and die as a result of these dreadful diseases in one day.
  • Canavan disease is a devastating disease of infants which affects their neural development and leads to mental retardation and early death. It occurs in 1 in 6,400 persons in the U.S. and there is no treatment so far. We propose to generate genetically-repaired and patient-specific stem cells (called iPSCs) from patients’ skin cells, and then coax these stem cells into specific types of corrective neural precursors using methods established in our laboratories in order to develop a therapeutic candidate for this disease.
  • We have demonstrated that the Canavan disease patient iPSCs hold pluripotency potential. We also genetically corrected the patient iPSCs and demonstrated that these genetically-corrected cells maintained human embryonic stem cell-like features. We coaxed these cells into specific types of neural precursors and showed that the genetically-corrected patient cells restored their cellular function.
  • For the reporting period, we provided evidence that the genetically-corrected patient iPSC-derived neural precursors were able to produce myelin binding protein in an animal model. We also characterized the Canavan disease mice to show that they exhibited the characteristic Canavan disease patient phenotypes. The genetically corrected cells will be tested in Canavan disease mice for their therapeutic effect in the next funding period, in order to develop a therapeutic tool for Canavan disease patients.
  • There are many families affected by this disease, and other diseases similar to it. Results from this work could have applications to this and other similar genetic diseases. Through the proposed research, maybe no parents will have to watch their child suffer and die as a result of these dreadful diseases in one day.

Repair of Conus Medullaris/Cauda Equina Injury using Human ES Cell-Derived Motor Neurons

Funding Type: 
Early Translational II
Grant Number: 
TR2-01785
ICOC Funds Committed: 
$1 614 441
Disease Focus: 
Spinal Cord Injury
Neurological Disorders
Stem Cell Use: 
Embryonic Stem Cell
oldStatus: 
Active
Public Abstract: 
Injuries to the spinal cord commonly result from motor vehicle accidents, traumatic falls, diving, surfing, skiing, and snowboarding accidents, other forms of sports injuries, as well as from gunshot injuries in victims of violent crimes. Injuries to the anatomically lowest part of the spinal cord, the lumbosacral portion and its associated nerve roots commonly cause paralysis, loss of sensation, severe pain, as well as loss of bladder, bowel, and sexual function. Lumbosacral injuries represent approximately one-fifth of all traumatic lesions to the human spinal cord. As a result of the direct injury to the lumbosacral portion of the spinal cord, there is degeneration and death of spinal cord nerve cells, which control muscles in the legs as well as bladder, bowel, and sexual function. No treatments are presently available in clinical practice to reverse the effects of these devastating injuries. In order to reverse the loss of function after lumbosacral spinal cord injury, replacement of the lost nerve cells is required. Recent research studies have identified some properties that are shared by spinal cord neurons responsible for muscle and bladder control. Human embryonic stem cells can now be prepared in research laboratories to develop properties that are shared between nerve cells controlling muscle and bladder function. Such nerve cells are particularly at risk of degeneration and death as a result of injuries to the lumbosacral spinal cord. Human embryonic stem cells, which have undergone treatment to obtain properties of muscle and bladder controlling nerve cells, are now very attractive development candidates for new cell replacement therapies after lumbosacral spinal cord injuries. The proposed feasibility studies will study the properties of such cells in a clinically relevant rat model for lumbosacral spinal cord injuries. In Specific Aim 1, we will determine whether ACUTE transplantation of human embryonic stem cells, which have been treated to develop properties of specific lumbosacral spinal cord neurons, may replace lost nerve cells and result in a return of bladder function in a rat model of lumbosacral spinal cord injury and repair. In Specific Aim 2, we will determine whether DELAYED transplantation of human embryonic stem cells, which have been treated to develop properties of specific lumbosacral spinal cord neurons, may replace lost nerve cells and result in a return of bladder function in a rat model of lumbosacral spinal cord injury and repair. A variety of functional studies will determine the effect of the cell transplantation on bladder function, walking, and pain. We will also use detailed anatomical studies to determine in microscopes whether the transplanted cells have grown processes to connect with pelvic target tissues, including the lower urinary tract. If successful, the proposed experiments may lead to a new treatment strategy for patients with lumbosacral spinal cord injuries.
Statement of Benefit to California: 
There are presently about 250,000 patients living with neurological impairments from spinal cord injuries (SCIs) in the United States, and approximately 11,000 new cases present every year. SCIs typically result in paralysis, loss of sensation, pain as well as bladder, bowel, and sexual dysfunction. No successful treatments are available to reverse the neurological deficits that result from SCI. Common causes for SCIs include car and motorcycle accidents, skiing, diving, surfing, and snow boarding injuries, traumatic falls, sports injuries, and acts of violence. California medical centers encounter a large proportion of the overall cases in the U.S. because of our large population, extensive network of freeways, and an active life style with recreational activities taking place both along the Californian coastline and in the mountains. The proposed development candidate feasibility project will capitalize on recent progress in human stem cell science and surgical repair of conus medullaris/cauda equina (CM/CE) forms of SCI. Human embryonic stem cell-derived neurons and neuronal progenitors, which express the transcription factor Hb9, will be transplanted into the conus medullaris in attempts to replace lost motor and autonomic neurons after a lumbosacral ventral root avulsion injury in rats. Surgical replantation of avulsed lumbosacral ventral roots into the spinal cord will also be performed in this clinically relevant model for CM/CE injury and repair. If successful, our development candidate may reinnervate muscles and pelvic organs, including the lower urinary tract after CM/CE forms of SCI. Return of functional bladder control represents one of the absolute top priorities among the spinal cord injured population (Anderson, J Neurotrauma, 2004; 21, 1371-83). Successful recovery of bladder function after SCI is expected to have very significant impact on the quality of life of spinal cord injured subjects and markedly reduce health care costs. Recovery of bladder function in spinal cord injured subjects would markedly reduce or eliminate the need for intermittent bladder catheterizations and indwelling bladder catheters. The number of visits in physicians’ offices and already over-crowded California emergency rooms for bladder infections and other complications would be markedly reduced, thereby significantly reducing health care costs for both patients and our state. Improved neurological function among the SCI population is also expected to reduce care giver needs, thereby further reducing health care costs. The increased independence that will result from improved bladder control and concomitant possible recovery of other neurological functions, for instance in transfers and locomotion, will promote return to and participation in the work force for many individuals with SCI. These effects are also expected to bring a very positive effect to the California economy and increased quality of life for those living with an SCI.
Progress Report: 
  • Injuries to the lowest portion of the spine and the spinal cord commonly results in paralysis and impairment of bladder , bowel, and sexual functions. These injuries are usually referred to as conus medullaris and cauda equina forms of spinal cord injuries. Presently, no treatments are available to reverse the neurological deficits that result from these injuries.
  • In this project, we aim to reverse neurological deficits, including bladder function, in a rat model of spinal cord injury, which affects the lowermost portion of the spinal cord. This part of the spinal cord and the associated nerve roots are called the conus medullaris and cauda equina. In our experimental model, nerve roots carrying fibers that control muscle function and pelvic organs, such as the bladder and bowel, are injured at the surface of the spinal cord. This injury mimics many of the neurological deficits encountered in human cases.
  • For treatment purposes, we transplant human derived embryonic stem cells, which have been prepared to acquire properties of motor neurons, into the lowermost portion of the rat spinal cord after injury and surgical repair of nerve roots carrying motor fibers. The studies will evaluate both acute and delayed transplantation of human embryonoic
  • During the first year of the studies, we have developed improved protocols to increase our ability to produce large number of motor neurons from human embryonic stem cells. We have also developed improved methods to detect motor neurons during the neuron production process by using fluorescent reporters inside of the cells. The latter development is of great help when sorting and preparing cells with desired properties for transplantation studies. In addition, we have refined our surgical methods to make it less invasive, using a one-sided injury model instead of lesions on both sides of the spinal cord in rats. Specifically, bladder dysfunction can be assess after a one sided injury of nerve roots and be evaluated using a combination of bladder pressure recorings and electrical recordings referred to as electromyography (EMG) from muscles along the urethra. The revised procedure is well tolerated by the rats and is a suitable approach for studies of chronic injury and cell-based long-term treatments. A research manuscript describing this improved experimental method and refinement has been submitted to a scientific journal and reviewed, and the manuscript is currently undergoing our revisions before being considered for publication. The experimental refinement will greatly assist with our long-term studies on the effects of transplanted motor neurons derived from human embryonic stem cells. We have also begun experiments using our refined model and cells, which now can be produced in high numbers and be identifiable during both the cell culture steps and during the animal studies. Initial tissues have been harvested and are being processed for morphological analyses.
  • Injuries to the lowest portion of the spine and the spinal cord commonly results in paralysis and impairment of bladder , bowel, and sexual functions. These injuries are usually referred to as conus medullaris and cauda equina forms of spinal cord injuries. Presently, no treatments are available to reverse the neurological deficits that result from these injuries.
  • In this project, we aim to reverse neurological deficits, including bladder function, in a rat model of spinal cord injury, which affects the lowermost portion of the spinal cord. This part of the spinal cord and the associated nerve roots are called the conus medullaris and cauda equina. In our experimental model, nerve roots carrying fibers that control muscle function and pelvic organs, such as the bladder and bowel, are injured at the surface of the spinal cord. This injury mimics many of the neurological deficits encountered in human cases.
  • For treatment purposes, we transplant human derived embryonic stem cells, which have been prepared to acquire properties of motor neurons, into the lowermost portion of the rat spinal cord after injury and surgical repair of nerve roots carrying motor fibers. The studies will evaluate both acute and delayed transplantation of human embryonic stem cells, which have acquired properties of motor neurons.
  • During the second year of the studies, we have developed improved protocols to increase our ability to produce large number of motor neurons from human embryonic stem cells. We have also developed improved methods to detect motor neurons during the neuron production process by using fluorescent reporters inside of the cells. The latter development is of great help when sorting and preparing cells with desired properties for transplantation studies. In addition, we have refined our surgical methods to make it less invasive, using a one-sided injury model instead of lesions on both sides of the spinal cord in rats. Specifically, bladder dysfunction can be assessed after a one sided injury of nerve roots and be evaluated using a combination of bladder pressure recordings and electrical recordings referred to as electromyography (EMG) from muscles along the urethra. The revised procedure is well tolerated by the rats and is a suitable approach for studies of chronic injury and cell-based long-term treatments. A research manuscript describing this improved experimental method and refinement has been published. The experimental refinement will greatly assist with our long-term studies on the effects of transplanted motor neurons derived from human embryonic stem cells. We have also performed transplantations of embryonic human stem cell derived motor neurons into the rat spinal cord and demonstrated surgical feasibility as well as survival of large numbers of neurons in the rat spinal cord. Some of the transplanted cells also demonstrate anatomical markers for motor neurons after transplantation.
  • During the reporting period, we have contined to demonstrate that human embryonic stem cell derived motor neurons and motor neuron progenitors can be produced in vitro. These motor neurons and motor neuron progenitors are transplanted into the rat spinal cord after a lumbosacral ventral root avulsion injury and repair of injured roots in the form of surgical re-attachment of the roots to the spinal cord surface. The lumbosacral ventral root avulsion injury mimics cauda equina and conus medullaris forms of spinal cord injury, an underserved patient population with paralysis of the legs and loss of bladder and bowel funcion. In this clinically relevant injury and repair model in rats, we have during the past several months demonstrated that transplanted human embryonic stem cell-derived motor neurons and motor neuron progenitors are able to survive in the spinal cord of rats over extended periods of time with large numbers of neurons being detectable in the spinal cord grey matter at 1, 2, and 10 weeks after the injury, surgical root repair, and transplantation of the cells. The long term viability of translanted cells suggests integration of the transplanted cells in the host tissues. Some of the cells show expression of motor neuron markers, such as the transcription factor Hb9, as demonstrated by immunohistochemistry and light microscopy.
  • Additional studies have been performed during this reporting period to address whether the transplanted cells may extend axons into the replanted lumbosacral ventral roots. Interestingly, many human axons were detected in the replanted ventral roots using immunohistochemitry and light microscopy for the detection of human processes. Additional immunohistochemistry demonstrated that these processes contained neurofilaments, which are characteristic for axons. In control experiments, we showed that avulsed roots, which had not been replanted into the spinal cord, did not exhibit any human axons. As expected, surgical reconnection of lesioned ventral roots to the spinal cord is needed in order for the axons of the transplanted human embryonic stem cell derived motor neurons and motor neuron progenitors to be extended into avulsed ventral roots. Furthermore, in a series of sham operated animals without ventral root lesions, human motor neurons and motor neuron progenitors were also transplanted into the rat spinal cord. Interestingly, the transplanted human motor neurons and motor neuron progenitors were here also able to extend axons into ventral roots, even though the ventral roots had never been lesions. We conclude that transplanted human embryonic stem cell derived motor neurons are capable of extending axons into both intact ventrl roots and into ventral roots, which had been avulsed and surgically reattached to the spinal cord using a replantation procedure.
  • In functional studies, we have performed urodynamic studies and voiding behavioral studies in rats after the transplantation of human embryonic stem cell derived motor neurons and motor neuron progenitors. These studies are still ongoing with additional experiments being performed. However, preliminary studies suggest that the combination of acute repair of avulsed ventral roots and cell transplantation results in a gradual improvement of voiding reflexes. Ongoing studies are addressing the relative contribution that may be provided by the replantation of avulsed ventral roots and by the transplantation of human motor neurons and motor neuron progenitors into the rat spinal cord.

Inhibitory Nerve Cell Precursors: Dosing, Safety and Efficacy

Funding Type: 
Early Translational II
Grant Number: 
TR2-01749
ICOC Funds Committed: 
$1 752 058
Disease Focus: 
Neurological Disorders
Epilepsy
Pediatrics
Stem Cell Use: 
Embryonic Stem Cell
oldStatus: 
Active
Public Abstract: 
Many neurological disorders are characterized by an imbalance between excitation and inhibition. Our ultimate goal: to develop a cell-based therapy to modulate aberrant brain activity in the treatment of these disorders. Our initial focus is on epilepsy. In 20-30% of these patients, seizures are unresponsive to drugs, requiring invasive surgical resection of brain regions with aberrant activity. The candidate cells we propose to develop can inhibit hyperactive neural circuits after implantation into the damaged brain. As such, these cells could provide an effective treatment not just for epilepsy, but also for a variety of other neurological conditions like Parkinson's, traumatic brain injury, and spasticity after spinal cord injury. We propose to bring a development candidate, a neuronal cell therapy, to the point of preclinical development. The neurons that normally inhibit brain circuits originate from a region of the developing brain called the medial ganglionic eminence (MGE). When MGE cells are grafted into the postnatal or adult brain, they disperse seamlessly and form inhibitory neurons that modulate local circuits. This property of MGE cells has not been shown for any other type of neural precursor. Our recent studies demonstrate that MGE cells grafted into an animal model of epilepsy can significantly decrease the number and severity of seizures. Other "proof-of-principle" studies suggest that these progenitor cells can be effective treatments in Parkinson's. In a separate effort, we are developing methods to differentiate large numbers of human MGE (H-MGE) cells from embryonic stem (ES) cells. To translate this therapy to humans, we need to determine how many MGE cells are required to increase inhibition after grafting and establish that this transplantation does not have unwanted side-effects. In addition, we need simple assays and reagents to test preparations of H-MGE cells to determine that they have the desired migratory properties and differentiate into nerve cells with the expected inhibitory properties. At present, these issues hinder development of this cell-based therapy in California and worldwide. We propose: (1) to perform "dose-response" experiments using different graft sizes of MGE cells and determine the minimal amount needed to increase inhibition; (2) to test whether MGE transplantation affects the survival of host neurons or has unexpected side-effects on the behavior of the grafted animals; (3) to develop simple in vitro assays (and identify reagents) to test H-MGE cells before transplantation. Our application takes advantage of an established multi-lab collaboration between basic scientists and clinicians. We also have the advice of neurosurgeons, epilepsy neurologists and a laboratory with expertise in animal behavior. If a safe cell-based therapy to replace lost inhibitory interneurons can be developed and validated, then clinical trials in patients destined for invasive neurosurgical resections could proceed.
Statement of Benefit to California: 
This proposal is designed to accelerate progress toward development of a novel cell-based therapy with potentially broad benefit for the treatment of multiple neurological diseases. The potential to translate our basic science findings into a treatment that could benefit patients is our primary focus and our initial target disease is epilepsy. This work will provide benefits to the State of California in the following areas: * California epilepsy patients and patients with other neurological diseases will benefit from improved therapies. The number of patients refractory to available medications is significant: a recent report from the Center for Disease Control and Prevention [www.cdc.gov/epilepsy/] estimates that 1 out of 100 adults have epilepsy and up to one-third of these patients are not receiving adequate treatment. In California, it is one of the most common disabling neurological conditions. In most states, including California, epileptic patients whose seizures aren't well-controlled cannot obtain a driver's license or work certain jobs -- truck driving, air traffic control, firefighting, law enforcement, and piloting. The annual cost estimates to treat epilepsy range from $12 to $16 billion in the U.S. Current therapies curb seizures through pharmacological management but are not designed to modify brain circuits that are damaged or dysfunctional. The goals of our research program is to develop a novel cell-based therapy with the potential to eliminate seizures and improve the quality of life for this patient population, as well as decrease the financial burden to the patients' families, private insurers, and state agencies. Since MGE cells can mediate inhibition in other neurological and psychiatric diseases, the neural based therapy we are proposing is likely to have a therapeutic and financial impact that is much broader. * Technology transfer in California. Historically, California institutions have developed and implemented a steady flow of technology transfer. Based on these precedents and the translational potential of our research goals, both to provide bioassays and potentially useful markers to follow the differentiation of MGE cells, this program is likely to result in licensing of further technology to the corporate sector. This will have an impact on the overall competitiveness of our state's technology sector and the resulting potential for creation of new jobs. * Stem cell scientists training and recruitment in California. As part of this proposal we will train a student, technicians, and associated postdocs in MGE progenitor derivation, transplantation, and cell-based therapy for brain repair. Moreover, the translational nature of the disease-oriented proposal will result in new technology which we expect to be transferable to industry partners for facilitate development into new clinical alternatives.
Progress Report: 
  • Advances in stem cell research and regenerative medicine have led to the potential use of stem cell therapies for neurodegenerative, developmental and acquired brain disease. The Alvarez-Buylla lab at UCSF is part of a collaboration that is pioneering the investigation of therapeutic interneuron replacement for the correction of neurological disorders arising from defects in neural excitation/inhibition. Our preliminary data suggests that grafting interneuron precursors into the postnatal rodent brain allows for up to a 35% increase in the number of cortical interneurons. Interneuron replacement has been used in animal models to modify plasticity, prevent spontaneous epileptic seizures, ameliorate hemiparkinsonian motor symptoms, and prevent PCP-induced cognitive deficits. Transplantation of interneuron precursors therefore holds therapeutic potential for treatment of human neurological diseases involving an imbalance in circuit inhibition/excitation.
  • The goal of the research in progress here is to ultimately prepare human interneuron precursors for clinical trials. Towards the therapeutic development of inhibitory neuron precursor transplantation for human neurological disorders, we have made significant progress in the differentiation of these cells from human ESCs and will complete optimization of this protocol. We will continue our investigation of rodent-derived interneuron transplantation to obtain relevant preclinical data for dose response, safety and efficacy in animal models. These dosing and safety data will then serve as the baseline for comparison with human interneuron precursors and inform design of preclinical studies of these cells in immunosuppressed mice. Together, these data will provide essential information for developing a plan for clinical trials using human interneuron precursors.
  • During this first year, we have made considerable headway in the optimization of the human interneuron precursor differentiation protocol, verified functional engraftment of these cells in mice, and begun to collect dose, safety and efficacy data for rodent-derived interneuron transplantation. Importantly, we have achieved the development of a protocol that robustly generates interneuron-like progenitor cells from human ES cells and demonstrated that these progenitors mature in vitro and in vivo into GABAergic inhibitory interneurons with functional potential. We have also compared the behavior of primary fetal cells to these human interneuron precursor-like cells both in vivo and in vitro. As we continue to optimize our ES cell differentiation protocol, these primary interneuron precursors will enable initial human cell dose response and behavior experiments and, along with rodent-derived cells, will provide important baseline measures.
  • In sum, this work will provide essential knowledge for the therapeutic development of inhibitory neuron transplantation. The experiments underway will yield insights that will be critical to the development of a clinical trial using human interneuron precursors.
  • During the reporting period, we have developed methods to enable the optimization of inhibitory nerve precursor cell, or MGE cell, derivation from human pluripotent stem cells (hPSCs). Optimization encompassed increasing MGE cell motility, enhancing MGE cell maturation into inhibitory nerve subtypes, and elimination of tumors post-transplantation into the rodent brain. Furthermore, we demonstrated that the injected hPSC-MGE cells functionally matured into inhibitory nerves with advanced physiological properties that integrated into the rodent brain. In addition, we determined an optimum dose of injected mouse MGE cells in rodent. Moreover, following injection of either the optimum dose or a 10-fold higher dose of mouse MGE cells, we found no detectable behavioral side effects from MGE cell transplantation.
  • In this reporting period, we continued to improve the acquisition of migratory medial ganglionic eminence (MGE)-type interneurons from human embryonic stem cells (hESC). We compared alternative procedures by testing MGE marker expression, and we developed additional tests to measure cell division and migration of MGE cell made from hESCs. We also extended our methods to clinical-grade hESC lines. With these optimized procedures, both research and clinical grade lines were transplanted into the rodent brain. In addition, we completed an evaluation of human fetal MGE transplants after-injection into the rodent brain. Finally, we report safety, survival, and neuronal differentiation of both hESC-MGE and human Fetal-MGE grafts at three months post-injection into the brain of the non-human primate rhesus macaque. A manuscript is in preparation concerning this work. Our work has continued to show the viability of using a cell therapy technique in the potential treatment of brain-related disease.

Embryonic-Derived Neural Stem Cells for Treatment of Motor Sequelae following Sub-cortical Stroke

Funding Type: 
Disease Team Research I
Grant Number: 
DR1-01480
ICOC Funds Committed: 
$20 000 000
Disease Focus: 
Stroke
Neurological Disorders
Collaborative Funder: 
Germany
Stem Cell Use: 
Embryonic Stem Cell
Cell Line Generation: 
Embryonic Stem Cell
oldStatus: 
Active
Public Abstract: 
A stroke kills brain cells by interrupting blood flow. The most common “ischemic stroke” is due to blockage in blood flow from a clot or narrowing in an artery. Brain cells deprived of oxygen can die within minutes. The loss of physical and mental functions after stroke is often permanent and includes loss of movement, or motor, control. Stroke is the number one cause of disability, the second leading cause of dementia, and the third leading cause of death in adults. Lack of movement or motor control leads to job loss and withdrawal from pre-stroke community interactions in most patients and institutionalization in up to one-third of stroke victims. The most effective treatment for stroke, thrombolytics or “clot-busters”, can be administered only within 4.5 hours of the onset of stroke. This narrow time window severely limits the number of stroke victims that may benefit from this treatment. This proposal develops a new therapy for stroke based on embryonic stem cells. Because our (and others’) laboratory research has shown that stem cells can augment the brain’s natural repair processes after stroke, these cells widen the stroke treatment opportunity by targeting the restorative or recovery phase (weeks or months after stroke instead of several hours). Embryonic stem cells can grow in a culture dish, but have the ability to produce any tissue in the body. We have developed a technique that allows us to restrict the potential of embryonic stem cells to producing cell types that are found in the brain, making them “neural stem cells”. These are more appropriate for treating stroke and may have lower potential for forming tumors. When these neural stem cells are transplanted into the brains of mice or rats one week after a stroke, the animals are able to regain strength in their limbs. Based on these findings, we propose in this grant to further develop these neural stem cells into a clinical development program for stroke in humans at the end of this grant period. This proposal develops a multidisciplinary team that will rigorously test the effectiveness of stem cell delivery in several models of stroke, while simultaneously developing processes for the precise manufacture, testing and regulatory approval of a stem cell therapy intended for human use. Each step in this process consists of definite milestones that must be achieved, and provides measurable assessment of progress toward therapy development. To accomplish this task, the team consists of stroke physician/scientists, pharmacologists, toxicologists, experts in FDA regulatory approval and key collaborations with biotechnology firms active in this area. This California-based team has a track record of close interactions and brings prior stroke clinical trial and basic science experience to the proposed translation of a stem cell therapy for stroke.
Statement of Benefit to California: 
The State of California has made a historic investment in harnessing the potential of stem cells for regenerative therapy. While initially focused on developing new stem cell technologies, CIRM has recognized that translational progress from laboratory to clinic must also be fostered, for this is ultimately how Californians will benefit from their investment. Our focus on developing a neuro-restorative therapy for treatment of motor sequelae following sub-cortical stroke contains several benefits to California. The foremost benefit will be the development of a novel form of therapy for a major medical burden: The estimated economic burden for stroke exceeds $56.8 billion per year in the US, with 55% of this amount supporting chronic care of stroke survivors (1). While the stroke incidence markedly increases in the next half-century, death rates from stroke have declined. These statistics translate into an expected large increase in disabled stroke survivors (1) that will have a significant impact on many aspects of life for the average Californian. Stroke is the third greatest cause of death, and a leading cause of disability, among Californians. Compared to the nation, California has slightly above average rates for stroke (2). Treatments that improve repair and recovery in stroke will reduce this clinical burden. The team that has been recruited for this grant is made of uniquely qualified members, some of whom were involved in the development, manufacturing and regulatory aspects of the first clinical trial for safety of neural stem cells for stroke. Thus not only is the proposed work addressing a need that affects most Californians, it will result in the ability to initiate clinical studies of stem cells for stroke recovery from a consortium of academic and biotechnology groups in California. 1. Carmichael, ST. (2008) Themes and strategies for studying the biology of stroke recovery in the poststroke epoch. Stroke 39(4):1380-8. 2. Reynen DJ, Kamigaki AS, Pheatt N, Chaput LA. The Burden of Cardiovascular Disease in California: A Report of the California Heart Disease and Stroke Prevention Program. Sacramento, CA: California Department of Public Health, 2007.
Progress Report: 
  • A stroke kills brain cells by interrupting blood flow. The most common “ischemic stroke” is due to blockage in blood flow from a clot or narrowing in an artery. Brain cells deprived of oxygen can die within minutes. The loss of physical and mental functions after stroke is often permanent and includes loss of movement, or motor, control. Stroke is the number one cause of disability, the second leading cause of dementia, and the third leading cause of death in adults. Lack of movement or motor control leads to job loss and withdrawal from pre-stroke community interactions in most patients and institutionalization in up to one-third of stroke victims. The most effective treatment for stroke, thrombolytics or “clot-busters”, can be administered only within 4.5 hours of the onset of stroke. This narrow time window severely limits the number of stroke victims that may benefit from this treatment. This proposal develops a new therapy for stroke based on embryonic stem cells. Because our (and others’) laboratory research has shown that stem cells can augment the brain’s natural repair processes after stroke, these cells widen the stroke treatment opportunity by targeting the restorative or recovery phase (weeks or months after stroke instead of several hours).
  • Embryonic stem cells can grow in a culture dish, but have the ability to produce any tissue in the body. We have developed a technique that allows us to restrict the potential of embryonic stem cells to producing cell types that are found in the brain, making them “neural stem cells”. These are more appropriate for treating stroke and may have lower potential for forming tumors. When these neural stem cells are transplanted into the brains of mice or rats one week after a stroke, the animals are able to regain strength in their limbs. Based on these findings, we propose in this grant to further develop these neural stem cells into a clinical development program for stroke in humans at the end of this grant period.
  • A multidisciplinary team is working rigorously to test the effectiveness of stem cell delivery in several models of stroke, while simultaneously developing processes for the precise manufacture, testing and regulatory approval of a stem cell therapy intended for human use. Each step in this process consists of definite milestones that are being achieved, providing measurable assessment of progress toward therapy development. To accomplish this task, the team consists of stroke physician/scientists, pharmacologists, toxicologists, experts in FDA regulatory approval and key collaborations with a biotechnology manufacturer active in this area. This California-based team has a track record of close interactions and brings prior stroke clinical trial and basic science experience to the proposed translation of a stem cell therapy for stroke.
  • In the first year of this program, the cells have been translated from an encouraging research level to a product which can be manufactured under conditions suitable for human administration. This has included optimization of the production process, development of reliable tests to confirm cell identity and function, and characterization of the cells utilizing these tests. In animal models in two additional laboratories , improvement in motor function following stroke has been confirmed. The method of administration has also been carefully studied. It has been determined that the cells will be administered around the area of stroke injury rather than directly into the middle of the stroke area. These results encourage the translation of this product from research into clinical trials for the treatment of motor deficit following stroke.
  • A stroke kills brain cells by interrupting blood flow. The most common “ischemic stroke” is due to blockage in blood flow from a clot or narrowing in an artery. Brain cells deprived of oxygen can die within minutes. The loss of physical and mental functions after stroke is often permanent and includes loss of movement, or motor, control. Stroke is the number one cause of disability, the second leading cause of dementia, and the third leading cause of death in adults. Lack of movement or motor control leads to job loss and withdrawal from pre-stroke community interactions in most patients and institutionalization in up to one-third of stroke victims. The most effective treatment for stroke, thrombolytics or “clot-busters”, can be administered only within 4.5 hours of the onset of stroke. This narrow time window severely limits the number of stroke victims that may benefit from this treatment. This proposal develops a new therapy for stroke based on embryonic stem cells. Because our (and others’) laboratory research has shown that stem cells can augment the brain’s natural repair processes after stroke, these cells widen the stroke treatment opportunity by targeting the restorative or recovery phase (weeks or months after stroke instead of several hours).
  • Embryonic stem cells can grow in a culture dish, but have the ability to produce any tissue in the body. We have developed a technique that allows us to restrict the potential of embryonic stem cells to producing cell types that are found in the brain, making them “neural stem cells”. These are more appropriate for treating stroke and may have lower potential for forming tumors. When these neural stem cells are transplanted into the brains of mice or rats one week after a stroke, the animals are able to regain strength in their limbs. Based on these findings, we propose in this grant to further develop these neural stem cells into a clinical development program for stroke in humans at the end
  • of this grant period.
  • A multidisciplinary team is working rigorously to test the effectiveness of stem cell delivery in several models of stroke, while simultaneously developing processes for the precise manufacture, testing and regulatory approval of a stem cell therapy intended for human use. Each step in this process consists
  • of definite milestones that are being achieved, providing measurable assessment of progress toward therapy development. To accomplish this task, the team consists of stroke physician/scientists, pharmacologists, toxicologists, experts in FDA regulatory approval and key collaborations with a biotechnology manufacturer active in this area. This California-based team has a track record of close interactions and brings prior stroke clinical trial and basic science experience to the proposed translation of a stem cell therapy for stroke.
  • A stroke kills brain cells by interrupting blood flow. The most common “ischemic stroke” is due to blockage in blood flow from a clot or narrowing in an artery. Brain cells deprived of oxygen can die within minutes. The loss of physical and mental functions after stroke is often permanent and includes loss of movement, or motor control. Stroke is the number one cause of disability, the second leading cause of dementia, and the third leading cause of death in adults. Lack of movement or motor control leads to job loss and withdrawal from pre-stroke community interactions in most patients and institutionalization in up to one-third of stroke victims. The most effective treatment for stroke, thrombolytics or “clot-busters”, can be administered only within 4.5 hours of the onset of stroke. This narrow time window severely limits the number of stroke victims that may benefit from this treatment. This proposal develops a new therapy for stroke based on embryonic stem cells. Because our (and others’) laboratory research has shown that stem cells can augment the brain’s natural repair processes after stroke, these cells widen the stroke treatment opportunity by targeting the restorative or recovery phase (weeks or months after stroke instead of several hours).
  • Embryonic stem cells can grow in a culture dish, but have the ability to produce any tissue in the body. We have developed a technique that allows us to restrict the potential of embryonic stem cells to producing cell types that are found in the brain, making them “neural stem cells”. These are more appropriate for treating stroke and may have lower potential for forming tumors. When these neural stem cells are transplanted into the brains of mice or rats one week after a stroke, the animals are able to regain strength in their limbs. Based on these findings this grant is supporting conduct of IND-enabling work to initiate a clinical development program for stroke in humans by the end of this grant period.
  • A multidisciplinary team is working rigorously to test the effectiveness of stem cell delivery in several models of stroke, while enabling precise manufacture, testing and regulatory clearance of a first in human clinical trial. Defined milestones are being achieved, providing measurable assessment of progress toward therapy development. Definitive manufacturing and pharmacology studies are underway and regulatory filings are in progress. The team consists of stroke physician/scientists, pharmacologists, toxicologists, experts in FDA regulatory and key collaborations with a biotechnology manufacturer active in this area. This California-based team has a track record of close interactions and brings prior stroke clinical trial and basic science experience to the proposed translation of a stem cell therapy for stroke.
  • A stroke kills brain cells by interrupting blood flow. The most common 'ischemic stroke' is due to blockage in blood flow from a clot or narrowing in an artery. Brain cells deprived of oxygen can die within minutes. The loss of physical and mental functions after stroke is often permanent and includes loss of movement, or motor, control. Stroke is the number one cause of disability, the second leading cause of dementia, and the third leading cause of death in adults. Lack of movement or motor control leads to job loss and withdrawal from pre-stroke community interactions in most patients and institutionalization in up to one-third of stroke victims. The most effective treatment for stroke, thrombolytics or 'clot-busters', can be administered only within 4.5 hours of the onset of stroke. This narrow time window severely limits the number of stroke victims that may benefit from this treatment. This proposal develops a new therapy for stroke based on embryonic stem cells. Because our (and others') laboratory research has shown that stem cells can augment the brain's natural repair processes after stroke, these cells widen the stroke treatment opportunity by targeting the restorative or recovery phase (weeks or months after stroke instead of several hours).
  • Embryonic stem cells can grow in a culture dish, but have the ability to produce any tissue in the body. We have developed a technique that allows us to restrict the potential of embryonic stem cells to producing cell types that are found in the brain, making them 'neural stem cells'. These are more appropriate for treating stroke and may have lower potential for forming tumors. When these neural stem cells are transplanted into the brains of mice or rats one week after a stroke, the animals are able to regain strength in their limbs. Based on these findings this grant is supporting conduct of IND-enabling work to initiate a clinical development program for stroke in humans by the end of this grant period.
  • A multidisciplinary team is working to test the effectiveness of stem cell delivery in several models of stroke, while enabling precise manufacture, testing and regulatory clearance of a first in human clinical trial. Defined milestones are being achieved, providing measurable assessment of progress toward therapy development. Definitive manufacturing and pharmacology studies are underway and regulatory filings are in progress. The team consists of stroke physicians/scientists, pharmacologists, toxicologists, experts in FDA regulatory and key collaborations with a biotechnology manufacturer active in this area. This California-based team has a track record of close interactions and brings prior stroke clinical trial and basic science experience to the proposed translation of a stem cell therapy for stroke.

Use of iPS cells (iPSCs) to develop novels tools for the treatment of spinal muscular atrophy.

Funding Type: 
Tools and Technologies II
Grant Number: 
RT2-02040
ICOC Funds Committed: 
$1 933 022
Disease Focus: 
Spinal Muscular Atrophy
Neurological Disorders
Pediatrics
Stem Cell Use: 
iPS Cell
Cell Line Generation: 
Adult Stem Cell
oldStatus: 
Active
Public Abstract: 
Spinal Muscular Atrophy (SMA) is one of the most common lethal genetic diseases in children. One in thirty five people carry a mutation in a gene called survival of motor neurons 1 (SMN1) which is responsible for this disease. If two carriers have children together they have a one in four chance of having a child with SMA. Children with Type I SMA seem fine until around 6 months of age, at which time they begin to show lack of muscular development and slowly develop a "floppy" syndrome over the next 6 months. Following this period, SMA children become less able to move and are eventually paralyzed by the disease by 3 years of age or earlier. We know that this mutation causes the death of motor neurons - which are important for making muscle cells work. Interestingly, there is a second gene which can lessen the severity of the disease process (SMN2). Children with more copies of this modifying gene have less severe symptoms and can live for longer periods of time (designated Type II, III and IV and living longer periods respectively). There is no therapy for SMA at the current time. One of the roadblocks is that there are no human models for this disorder as it is very difficult to make the motor neurons that die in the disease in the laboratory. The researchers in the current proposal have recently created pluripotent stem cells from a patient with Type I SMA (the most severe) and shown that motor neurons grown out from the pluripotent stem cells also die in the culture dish just like they do in children. This is an important model for SMA. The proposed research takes this model of SMA and extends it to Type II and Type III children in order to have a wider range of disease severity in the culture dish (Type IV is very rare and difficult to get samples from). It then develops new technologies to produce very large numbers of motor neurons and perform large scale analysis of their survival profiles. Finally, it will explore whether novel compounds can slow down the degeneration of motor neurons in this model which should lead to the discovery of dew drugs that then may be used to treat the disease.
Statement of Benefit to California: 
The aim of this research is to develop novel drugs to treat a lethal childhood disease - SMA. There would be three immediate benefits to the state of California and its citizens. 1. Children in California would have access to novel drugs to slow or prevent their disease. 2. SMA is a world wide disease. The institutions involved with the research would be able to generate income from any new drugs developed and the profit from this would come back to California. 3. The project will employ a number of research staff in Californian institutions
Progress Report: 
  • This year we have created a large number of new SMA lines, developed ways to differentiate them into motor neurons using high content dishes, and begun to analyze the health of the motor neurons over time. We have also submitted a new paper showing that much of the cell death seen in the dying motor neurons is due to apoptosis - a form of cell death that is treatable with specific types of drug. We are now using these new lines to begin setting up screening runs with drug libraries and should be able to start these in the new year of funding.
  • In this year we have made more induced pluripotent stem (iPSC) cell lines from Spinal Muscular Atrophy patients also using blood cells in addition to skin cells. Blood cells from patients are usually more readi;y accessible. As such, this technique can be used to make larger bank of similar cell lines. We have also rigorously tested all the iPSCs them for their quality. These lines are now available for distribution to other California researchers along with a certificate of analysis.
  • Motor neurons are a type of neuron that control muscle movement and are markedly destroyed in SMA patients. In order for these powerful iPS cells form patients to be useful for discovering new drugs for SMA it is very important that we can make motor neurons from iPSCs in large quantities of millions to billions in number. Only then will testing of thousands to millions of new drugs would be feasible in neurons from SMA patients. To this end, we have created a method for making a predecessor cell type to human motor neurons from human iPSCs in a petri dish. These predecessor cells, known as motor neuron precursor spheres (iMNPS), are grown as clumps of floating spherical balls, each containing thousands such cells that are grown in large numbers repeatedly for long periods of time. We have made these iMNPS now from many SMA patients as well as healthy humans. These spheres can be preserved for long period of time by freezing them at very low temperatures. They are then awoken at a later time making it convenient for testing large numbers of drugs.
  • Since iPSCs have the power to make any cell type in the human body, they can also be contaminated with other unwanted types of cells. Typically such a technique is very difficult to accomplish in pluripotent stem cells such as embryonic and iPSCs. Therefore, we have designed a more efficient scheme to generate iPSC lines from SMA patients that will become fluorescent color (green, red or blue) when then motor neurons are made from iPSCs. These types of cells are known as reporter cell lines. This will aid in picking out the desired cell type from patient iPSCs, in this case a motor neuron, and discard any unwanted cell types. This will enormously simplify testing of new drugs in SMA patient motor neurons.
  • Deficiency of an important protein in SMA patients is one of the key causes to the course of the disease. We have also designed an automated method for identifying new drugs in patient motor neurons that will test for correction of SMN protein levels in motor neurons.
  • In Year 3 we completed making all iPSC lines from Spinal Muscular Atrophy patients. We rigorously tested all the iPSCs for quality. These lines are now available for distribution to other California researchers along with a quality control certificate.
  • Motor neurons are a type of neuron that control muscle movement and are markedly destroyed in SMA patients. In order for these powerful iPS cells form patients to be useful for discovering new drugs for SMA it is very important that we can make motor neurons from iPSCs in billions and repeatedly. Only then will testing of thousands to millions of new drugs would be feasible in neurons from SMA patients.
  • To this end, we have created a method for making a predecessor cell type to human motor neurons from human iPSCs in a petri dish. These predecessor cells, known as motor neuron precursor spheres (iMPS), are grown as clumps of floating spherical balls, each containing thousands such cells that are grown in large numbers repeatedly for long periods of time. We have now tested our method in multiple patient cells and characterized these spheres. The iMPS have now been produced from many SMA patients as well as healthy humans. The next step we have developed is to take the iMPS to make motor neurons that are similar to those that are affected in SMA children. We have then discovered a method for creating them quickly. These aggregate spheres and spinal cord motor neurons from them can be preserved for long period of time by freezing them at very low temperatures. They are then awoken at a later time making it convenient for testing large numbers of drugs.
  • Since iPSCs have the power to make any cell type in the human body, they can also be contaminated with other unwanted types of cells. Typically such a technique is very difficult to accomplish in pluripotent stem cells such as embryonic and iPSCs. Therefore, we have designed a more efficient scheme to generate iPSC lines from SMA patients that will become fluorescent color (green, red or blue) when then motor neurons are made from iPSCs. These types of cells are known as reporter cell lines. This will aid in picking out the desired cell type from patient iPSCs, in this case a motor neuron, and discard any unwanted cell types. This will enormously simplify testing of new drugs in SMA patient motor neurons. Using new technologies that can edit, cut, copy, and paste new DNA in the stem cell genome, we are also developing ways to engineer iPS cell lines that will tag the motor neurons when they are made. This will allow us another method for making pure motor neurons and tracking them in a dish among other types of cells while they are alive.
  • Deficiency of an important SMN protein in SMA patients is one of the key causes to the course of the disease. An automated method has been developed for identifying what causes the SMA neurons to become sick and test new drugs in motor neurons. We are now gearing up to test some ~1400 known compounds on patient motor neurons to determine whether we can raise SMN protein levels in motor neurons.

Development and preclinical testing of new devices for cell transplantation to the brain.

Funding Type: 
Tools and Technologies II
Grant Number: 
RT2-01975
ICOC Funds Committed: 
$1 831 723
Disease Focus: 
Neurological Disorders
Parkinson's Disease
oldStatus: 
Active
Public Abstract: 
The surgical tools currently available to transplant cells to the human brain are crude and underdeveloped. In current clinical trials, a syringe and needle device has been used to inject living cells into the brain. Because cells do not spread through the brain tissue after implantation, multiple brain penetrations (more than ten separate needle insertions in some patients) have been required to distribute cells in the diseased brain region. Every separate brain penetration carries a significant risk of bleeding and brain injury. Furthermore, this approach does not result in effective distribution of cells. Thus, our lack of appropriate surgical tools and techniques for clinical cell transplantation represents a significant roadblock to the treatment of brain diseases with stem cell based therapies. A more ideal device would be one that can distribute cells to large brain areas through a single initial brain penetration. In rodents, cell transplantation has successfully treated a great number of different brain disorders such as Parkinson’s disease, epilepsy, traumatic brain injury, multiple sclerosis, and stroke. However, the human brain is about 500 times larger than the mouse brain. While the syringe and needle transplantation technique works well in mice and rats, using this approach may not succeed in the much larger human brain, and this may result in failure of clinical trials for technical reasons. We believe that the poor design of current surgical tools used for cell delivery is from inadequate interactions between basic stem cell scientists, medical device engineers, and neurosurgeons. Using a multidisciplinary approach, we will first use standard engineering principles to design, fabricate, refine, and validate an innovative cell delivery device that can transplant cells to a large region of the human brain through a single brain penetration. We will then test this new prototype in a large animal brain to ensure that the device is safe and effective. Furthermore, we will create a document containing engineering drawings, manufacturing instructions, surgical details, and preclinical data to ensure that this device is readily available for inclusion in future clinical trials. By improving the safety and efficacy of cell delivery to the brain, the development of a superior device for cell transplantation may be a crucial step on the road to stem cell therapies for a wide range of brain diseases. In addition, devices and surgical techniques developed here may also be advantageous for use in other diseased organs.
Statement of Benefit to California: 
The citizens of California have invested generously into stem cell research for the treatment of human diseases. While significant progress has been made in our ability to produce appropriate cell types in clinically relevant numbers for transplantation to the brain, these efforts to cure disease may fail because of our inability to effectively deliver the cells. Our proposed development of a superior device for cell transplantation may thus be a crucial step on the road to stem cell therapies for a wide range of brain disorders, such as Parkinson’s disease, stroke, brain tumors, epilepsy, multiple sclerosis, and traumatic brain injury. Furthermore, devices and surgical techniques developed in our work may also be advantageous for use in other diseased organs. Thus, with successful completion of our proposal, the broad community of stem cell researchers and physician-scientists will gain access to superior surgical tools with which to better leverage our investment into stem cell therapy.
Progress Report: 
  • The surgical tools currently available to transplant cells to the human brain are crude and underdeveloped. In current clinical trials, a syringe and needle device has been used to inject living cells into the brain. Because cells do not spread through the brain tissue after implantation, multiple brain penetrations (more than ten separate needle insertions in some patients) have been required to distribute cells in the diseased brain region. Every separate brain penetration carries a significant risk of bleeding and brain injury. Furthermore, this approach does not result in effective distribution of cells. Thus, our lack of appropriate surgical tools and techniques for clinical cell transplantation represents a significant roadblock to the treatment of brain diseases with stem cell based therapies. A more ideal device would be one that can distribute cells to large brain areas through a single initial brain penetration.
  • In this first year of progress, we have designed, prototyped, and tested a stereotactic neurosurgical device capable of delivering cells to a volumetrically large target region through a single cortical brain penetration. We compared the performance of our device to a currently used cell transplantation implement – a 20G cannula with dual side ports. Through a single initial penetration, our device could transplant materials to a region greater than 4 cubic centimeters. Modeling with neurosurgical planning software indicated that our device could distribute cells within the entire human putamen – a target used in Parkinson’s disease trials – via a single transcortical penetration. While reflux of material along the penetration tract was problematic with the 20G cannula, resulting in nearly 80% loss of cell delivery, our device was resistant to reflux. We also innovated an additional system that facilitates small and precise volumes of injection. Both dilute and highly concentrated neural precursor cell populations tolerated transit through the device with high viability and unaffected developmental potential. Our device design is compatible with currently employed frame-based, frameless, and intraoperative MRI stereotactic neurosurgical targeting systems.
  • The surgical tools currently available to transplant cells to the human brain are crude and underdeveloped. In current clinical trials, a syringe and needle device has been used to inject living cells into the brain. Because cells do not spread through the brain tissue after implantation, multiple brain penetrations (more than ten separate needle insertions in some patients) have been required to distribute cells in the diseased brain region. Every separate brain penetration carries a significant risk of bleeding and brain injury. Furthermore, this approach does not result in effective distribution of cells. Thus, our lack of appropriate surgical tools and techniques for clinical cell transplantation represents a significant roadblock to the treatment of brain diseases with stem cell based therapies. A more ideal device would be one that can distribute cells to large and anatomically complex brain areas through a single initial brain penetration.
  • In the first year of progress, we designed, prototyped, and tested a stereotactic neurosurgical device capable of delivering cells to a volumetrically large target region through a single cortical brain penetration. We compared the performance of our device to a currently used cell transplantation implement – a 20G cannula with dual side ports. Through a single initial penetration, our device could transplant materials to a region greater than 4 cubic centimeters. Modeling with neurosurgical planning software indicated that our device could distribute cells within the entire human putamen – a target used in Parkinson’s disease trials – via a single transcortical penetration. While reflux of material along the penetration tract was problematic with the 20G cannula, resulting in nearly 80% loss of cell delivery, our device was resistant to reflux. We also innovated an additional system that facilitates small and precise volumes of injection. Both dilute and highly concentrated neural precursor cell populations tolerated transit through the device with high viability and unaffected developmental potential. Our device design is compatible with currently employed frame-based, frameless, and intraoperative MRI stereotactic (iMRI) neurosurgical targeting systems.
  • In this second year of progress, we have produced and tested the iMRI compatible version of our cell delivery device. The device components are fabricated from materials that are FDA-approved for use in medical devices, and we have assembled the device under Good Manufacturing Practice (GMP) conditions. Our device functions seamlessly with an FDA-approved stereotactic iMRI neurosurgical platform and computer-aided targeting system, and we have demonstrated that this iMRI-compatible system can deliver to the volume and shape of the human putamen through a single initial brain penetration. Thus, by using modern materials and manufacturing techniques, we have produced a neurosurgical device and technique that enables clinicians to “tailor” cell delivery to individual patient anatomical characteristics and specific disease states. This modern and “easy to use” platform technology furthermore allows “real-time” monitoring of cell delivery and unprecedented complication avoidance, increasing patient safety.
  • In this third year of progress, we have made final design refinements to the Radially Branched Deployment (RBD) cell transplantation device, which is fully compatible with currently employed interventional MRI stereotactic (iMRI) neurosurgical targeting systems. These design changes increase the "usability" of the device and enhance patient safety. The iMRI-guided RBD technology advances our ability to properly “tailor” the distribution of cell delivery to larger brain target volumes that vary in size and shape due to individual patient anatomy and different disease states. Furthermore, iMRI-guided RBD may increase patient safety by enabling intraoperative MRI monitoring. Importantly, this platform technology is easy-to-use and has a low barrier to implementation, as it can be performed “inside” essentially any typical diagnostic 1.5T MRI scanner found in most hospitals. We believe that this ease of access to the technology will facilitate the conduct of multi-site clinical trials and the future adoption of successful cellular therapies for patient care worldwide. In summary, by improving intracerebral cell delivery to the human brain, iMRI-guided RBD may have a transformative impact on the safety and efficacy of cellular therapeutics for a wide range of neurological disorders, helping ensure that basic science results are not lost in clinical translation.
  • Working with a California-based medical device manufacturer, we have developed manufacturing and testing procedures that are now being compiled into a design history file, which is a document required for eventual commercial use of the device. We are also working with an FDA regulatory consultant to prepare a 510K application to seek marketing clearance from the FDA.

Stem Cell Mechanisms Governing Discrete Waves of Gliogenesis in the Childhood Brain

Funding Type: 
Basic Biology IV
Grant Number: 
RB4-06093
ICOC Funds Committed: 
$1 264 248
Disease Focus: 
Neurological Disorders
Pediatrics
Stem Cell Use: 
Adult Stem Cell
oldStatus: 
Active
Public Abstract: 
White matter is the infrastructure of the brain, providing conduits for communication between neural regions. White matter continues to mature from birth until early adulthood, particularly in regions of brain critical for higher cognitive functions. However, the precise timing of white matter maturation in the various neural circuits is not well described, and the mechanisms controlling white matter developmental/maturation are poorly understood. White matter is conceptually like wires and their insulating sheath is a substance called myelin. It is clear that neural stem and precursor cells contribute significantly to white matter maturation by forming the cells that generate myelin. In the proposed experiments, we will map the precise timing of myelination in the human brain and changes in the populations of neural precursor cells that generate myelin from birth to adulthood and define mechanisms that govern the process of white matter maturation. The resulting findings about how white matter develops may provide insights for white matter regeneration to aid in therapy for diseases such as cerebral palsy, multiple sclerosis and chemotherapy-induced cognitive dysfunction.
Statement of Benefit to California: 
Diseases of white matter account for significant neurological morbidity in both children and adults in California. Understanding the cellular and molecular mechanisms that govern white matter development the may unlock clues to the regenerative potential of endogeneous stem and precursor cells in the childhood and adult brain. Although the brain continues robust white matter development throughout childhood, adolescence and young adulthood, relatively little is known about the mechanisms that orchestrate proliferation, differentiation and functional maturation of neural stem and precursor cells to generate myelin-forming oligodendrocytes during postnatal brain development. In the present proposal, we will define how white matter precursor cell populations vary with age throughout the brain and determine if and how neuronal activity instructs neural stem and precursor cell contributions to human white matter myelin maturation. Disruption of white matter myelination is implicated in a range of neurological diseases, including cerebral palsy, multiple sclerosis, cognitive dysfunction from chemotherapy exposure, attention deficit and hyperactivity disorder (ADHD) and even psychiatric diseases such as schizophrenia. The results of these studies have the potential to elucidate clues to white matter regeneration that may benefit hundreds of thousands of Californians.
Progress Report: 
  • Formation of the insulated fiber infrastructure of the human brain (called "myelin") depends upon the function of a precursor cell type called "oligodendrocyte precursor cells (OPC)". The first Aim of this study seeks to determine how OPCs differ from each other in different regions of the brain, and over different ages. Understanding this heterogeneity is important as we explore the regenerative capacity of this class of precursor cells. We have, in the past year, isolated OPCs from various regions of the human brain from individuals at various ages and are studying the molecular characteristics of these precursor cells at the single cell level in order to define distinct OPC subpopulations. We have also begun to study the functional capabilities of OPCs isolated from different brain regions. The second Aim of this study seeks to understand how interactions between electrically active neurons and OPCs affect OPC function and myelin formation. We have found that when mouse motor cortex neurons "fire" signals in such a way as to elicit a complex motor behavior, much as would happen when one practices a motor task, OPCs within that circuit respond and myelination increases. This affects the function of that circuit in a lasting way. These results indicate that neurons and OPCs interact in important ways to modulate myelination and supports the hypothesis that OPC function may play a role in learning.

Modeling disease in human embryonic stem cells using new genetic tools

Funding Type: 
Basic Biology IV
Grant Number: 
RB4-05855
ICOC Funds Committed: 
$1 387 800
Disease Focus: 
Neuropathy
Neurological Disorders
Stem Cell Use: 
Embryonic Stem Cell
oldStatus: 
Active
Public Abstract: 
The use of stem cells or stem cell-derived cells to treat disease is one important goal of stem cell research. A second, important use for stem cells is the creation of cellular models of human development and disease, critical for uncovering the molecular roots of illness and testing new drugs. However, a major limitation in achieving these goals is the difficulty in manipulating human stem cells. Existing means of generating genetically modified stem cells are not ideal, as they do not preserve the normal gene regulation, are inefficient, and do not permit removal of foreign genes. We have developed a method of genetically modifying mouse embryonic stem cells that is more efficient than traditional methods. We are adapting this approach for use with human embryonic stem cells, so that these cells can be better understood and harnessed for modeling, or even treating, human diseases. We will use this approach to create a human stem cell model of Charcot-Marie-Tooth (CMT) disease, an inherited neuropathy. How gene dysfunction leads to nerve defects in CMT is not clear, and there is no cure or specific therapy for this neurological disease. Thus, we will use our genetic tools to investigate how gene function is disrupted to cause CMT. By developing these tools and using them to gain understanding of CMT, we will illustrate how this system can be used to gain insight into other important diseases.
Statement of Benefit to California: 
Although human stem cells hold the potential to generate new understanding about human biology and new approaches to important diseases, the inability to efficiently and specifically modify stem cells currently limits the pace of research. Also, there is presently no safe means of changing genes compatible with the use of the stem cells in therapies. We are developing new genetic tools to allow for the tractable manipulation of human stem cells. By accelerating diverse other stem cell research projects, these tools will enhance the scientific and economic development of California. We will use these tools to create cellular models of Charcot-Marie-Tooth (CMT), a neurological disease with no cure that affects about 15,000 Californians. This model will facilitate understanding of the etiology of CMT, and may lead to insights that can be used to develop specific therapies. Beyond gaining insight into CMT, the ability to engineer specific genetic changes in human stem cells will be useful for many applications, including the creation of replacement cells for personalized therapies, reporter lines for stem cell-based drug screens, and models of other diseases. Thus, our research will assist the endeavors of the stem cell community in both the public and private arenas, contributing to economic growth and new product development. This project will also train students and postdoctoral scholars in human stem cell biology, who will contribute to the economic capacity of California.
Progress Report: 
  • An important use for stem cells is the creation of cellular models of human development and disease, critical for uncovering the molecular roots of illness and testing new drugs. However, a major limitation in achieving these goals is the difficulty in manipulating human stem cells. We have developed a method of genetically modifying mouse embryonic stem cells that is more efficient than traditional methods. During the first year of this project, we adapted this approach for use with human embryonic stem cells. We have also created gene trap mutations in a diversity of human embryonic stem cell genes that can be used to better harness human embryonic stem cells for modeling, or even treating, human diseases.

Stem cell models to analyze the role of mutated C9ORF72 in neurodegeneration

Funding Type: 
Basic Biology IV
Grant Number: 
RB4-06045
ICOC Funds Committed: 
$1 393 200
Disease Focus: 
Amyotrophic Lateral Sclerosis
Neurological Disorders
Dementia
Neurological Disorders
Stem Cell Use: 
iPS Cell
Cell Line Generation: 
iPS Cell
oldStatus: 
Active
Public Abstract: 
Amyotrophic lateral sclerosis (ALS) is an idiopathic adult-onset degenerative disease characterized by progressive weakness from loss of upper and lower motor neurons. Onset is insidious, progression is essentially linear, and death occurs within 3-5 years in 90% of patients. In the US, 5,000 deaths occur per year and in the world, 100,000. In October, 2011, the causative gene defect in a long sought after locus on chromosome 9 for ALS, frontotemporal dementia (FTD) and overlap ALS-FTD was identified to be a expansion of a hexanucleotide repeat in the uncharacterized C9ORF72 gene. The goal of the proposed research is to generate human stem cell models from cells derived from ALS patients with the C9ORF72 expanded repeats and relevant control cells using genome-editing technology. We will also generate a stem cell model expressing the repeat independent of the C9ORF72 gene to study if the repeat alone is causing neural defects. Using advanced genome technologies, biochemical and cellular approaches, we will study the molecular pathways affected in motor neurons derived from these stem cell models. Finally, we will use innovative technologies to rescue the abnormal phenotypes that arise from the expanded repeat in human motor neurons. Completion of the proposed research is expected to transform our understanding of the regulatory and pathogenetic mechanisms underlying ALS and FTD, and establish therapeutic options for these debilitating diseases.
Statement of Benefit to California: 
Our research provides the foundation for decoding the mechanisms that underlie the single most frequent genetic mutation found to contribute to both ALS and FTD, debilitating neurological diseases that impact many Californians. In California, the expected prevalence of ALS (the number of total existing cases) is 2,200 to 3,000 cases at any one time, and the incidence is 750-1,100 new cases each year. The number of FTD cases is five times as many. Our research has and will continue to serve as a basis for understanding deviations from normal and disease patient neuronal cells, enabling us to make inroards to understanding neurological disease modeling using neurons differentiated from reprogammed patient-specific lines. Such disease modeling will have great potential for California health care patients, pharmaceutical and biotechnology industries in terms of improved human models for drug discovery and toxicology testing. Our improved knowledge base will support our efforts as well as other Californian researchers to study stem cell models of neurological disease and design new diagnostics and treatments, thereby maintaining California's position as a leader in clinical research.
Progress Report: 
  • Expanded hexanucleotide repeats in the C9ORF72 gene were identified in Oct 2011 as a cause of amyotrophic lateral sclerosis (ALS) and frontotemporal dementia (FTD), thus identifying the single most frequent genetic cause of each and connecting them to repeat expansion disease. We are developing stem cell disease models to enable key hypotheses of pathogenesis and new interventions to be tested. We have successfully engineered stem cell models to analyze the effects of C9ORF72 mutations, and have differentiated these stem cell models into motor neurons which enabled us to conduct transcriptomic and biochemical studies. In addition, we have utilized antisense-oligonucleotides (ASOs) from ISIS Pharmaceuticals to deplete mutant C9ORF72 in motor neurons. We expect our efforts to provide mechanistic insights and a potential therapy in human cells.

Mechanism and Utility of Direct Neuronal Conversion with a MicroRNA-Chromatin Switch

Funding Type: 
Basic Biology IV
Grant Number: 
RB4-05886
ICOC Funds Committed: 
$1 392 426
Disease Focus: 
Neurological Disorders
Stem Cell Use: 
Directly Reprogrammed Cell
oldStatus: 
Active
Public Abstract: 
Many human diseases and injuries that affect the brain and nervous system could potentially be treated by either introducing healthy neurons or persuading the cells that normally provide supporting functions to become functioning neurons. A number of barriers must be traversed to bring these goals to practical therapies. Recently our laboratory and others have found ways of converting different human cell types to functioning neurons. Surprisingly, two routes for the production of neurons have been discovered. Our preliminary evidence indicates that these two routes are likely to work together and therefore more effective ways of producing neurons can likely be provided by understanding these two routes, which is one aim of this application. Another barrier to effective treatment of human neurologic diseases has been the inability to develop good models of human neurologic disease due to inability to sample tissues from patients with these diseases. Hence we will understand ways of making neurons from blood cells and other cells, which can be easily obtained from patients with little or no risk. Our third goal will be to understand how different types of neurons can be produced from patient cells. We would also like to understand the barriers and check points that keep one type of cell from becoming another another type of cell. Understanding these mysterious processes could help provide new sources of human cells for replacement therapies and disease models.
Statement of Benefit to California: 
The state of California and its citizens are likely to benefit from the work described in this proposal by the development of more accurate models for the testing of drugs and new means of treatment of human neurologic diseases. Presently these diseases are among the most common afflicting Californians, as well as others and will become more common in an aging population. Common and devastating diseases such as Alzheimer’s, Schizophrenia, Parkinson's Disease, and others lack facile cell culture models that allow one to probe the basis of the disease and to test therapies safely and without risk to the patient. Our work is already providing these models, but we hope to make even better ones by understanding the fundamental processes that allow one cell type (such as a skin cell or blood cell) to be converted to human neurons, where the disease process can be investigated. In the past the inability to make neurons from patients with specific diseases has been a major roadblock to treatment. In the future the studies described here might be able to provide healthy neurons to replace ones loss through disease or injury.
Progress Report: 
  • During the past year, our laboratory has investigated the way that human skin cells can be changed to neurons. To do this, we have used a natural switch that occurs as embryonic cells decide to become neurons. We have found that this process proceeds in a highly ordered series of stages that involve first a resetting of fundamental cell biologic processes characteristic of neurons. This is followed by activation of genes encoding proteins that allow different types of neurons to interact and develop communication between one another. This finding surprised us since we expected to find changes in transcription factors, which instruct the formation of neurons. Instead, we find that the natural switching mechanism in neurons first regulates cell-to-cell communication.

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