During the first year of this project we have made substantial progress toward achieving the ultimate goal of developing a stem cell (SC) therapy for treating patients with recurrent glioblastoma (GBM). At the outset, we began investigating three SC candidates as the cellular vehicle to carry a therapeutic payload and disperse within the tumor of GBM patients: mesenchymal stem cells (MSCs); fetal neural stem cells (fNSCs); and adult neural stem cells (aNSCs). In addition, we were considering two therapeutic genes as the payload, cytosine deaminase (CD) and tumor necrosis factor related apoptosis-inducing ligand (TRAIL), and two routes of therapeutic SC administration for treating brain tumor patients, intravascular and direct intratumoral. Thus, at the start of the project, there were twelve possibilities (3 stem cell vehicles x 2 therapeutic genes x 2 routes of administration) to investigate and compare prior to determining the best combination to develop for a GBM clinical trial. From this starting point we have been able to rapidly eliminate the aNSCs from consideration due to their slow rate of proliferation that would limit their expansion to sufficient number for use in a clinical product for patients. Next we determined that SC access to intracranial tumor through intravascular injection was negligible, and that it is highly unlikely that SC administration by this route would result in a sufficient number of SCs reaching intracranial tumor for achieving therapeutic benefit in treating patients with recurrent GBM. Thus, our work to date has resulted in the narrowing options for SC + therapeutic gene + route of delivery to four: two cellular vehicle candidates (fNSCs and MSCs) and two therapeutic gene payloads (CD and TRAIL). During the first year of this project, each of the four combinations has been tested and have demonstrated anti-tumor activity. During early year 2 research we will determine the most effective combination based on preclinical testing results using multiple human GBM models. The decision regarding most effective therapeutic gene + stem cell vehicle will be achieved within six months, and from that point, in going forward, project emphasis will focus on the development of a specific product candidate, including manufacturing process and assay development, GLP/GMP product manufacturing, further preclinical animal studies to demonstrate efficacy and safety, and development of a clinical protocol. In association with the research accomplished to date we have developed and applied several approaches that will prove useful for SC research and clinical application in general. Foremost among these is the use of micron-sized particles of iron oxide (MPIOs) for labeling SCs prior to their injection into animal subjects, and then monitoring the movement of labeled SCs using magnetic resonance imaging (MRI). This is a powerful technique with implications for understanding the distribution and persistence of SCs in patients receiving SC therapies. For our project, this method is informing us about the distribution of labeled SCs within and around brain tumors, as well as with regard to how long the SCs remain in animal subjects. In addition to the MRI detection of iron particle labeled SCs, we have developed and refined a technique for determining the amount of human SC DNA in animal subject tissues, which has a sensitivity of detecting one human cell among more than a million host cells. Similar to the MRI detection of labeled SCs, the DNA detection method provides us a very sensitive approach for monitoring SC biodistribution and persistence in animal subjects, and it is broadly applicable to all SC research in which rodent models are used for pre-clinical investigation of SCs for treating disease. We are also developing novel approaches for the use of optical imaging to visualize stem cells labeled with fluorescent reporters, and for monitoring the anti-tumor activity of therapeutic stem cells administered to animal subjects. These novel approaches are contributing to the repertoire of techniques available to expedite the identification and application of therapeutic SCs in clinical settings. This project is a collaboration among outstanding scientists and clinicians at five of California’s leading medical research institutions: the Sanford-Burnham and Salk Institutes in La Jolla, and the San Francisco, Los Angeles, and San Diego campuses of the University of California (including Ludwig Institute at UCSD). By leveraging complementary expertise of these investigators, we have made rapid progress in the preclinical animal studies, design of the clinical trial protocol, and the product development studies that will lead to preparation of a gene-modified SC product for the clinical trial. These activities will culminate in an IND application to FDA that will allow us to test the safety and efficacy of our SC product in patients with this devastating illness.