Stem Cell Therapy in Autism

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Stem Cell Therapy in Autism Stem Cell Therapy in Autism Dario Dario Siniscalco Siniscalco, , ChemD ChemD, PhD , PhD Changing the Course of Autism Edinburgh, Scotland 12-13 June 2013 Dario Dario Siniscalco Siniscalco, , ChemD ChemD, PhD , PhD Department of Experimental Medicine Department of Experimental Medicine Second University of Naples, Italy Second University of Naples, Italy

Transcript of Stem Cell Therapy in Autism

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Stem Cell Therapy in AutismStem Cell Therapy in Autism

Dario Dario SiniscalcoSiniscalco, , ChemDChemD, PhD, PhD

Changing the Course of AutismEdinburgh, Scotland

12-13 June 2013

Dario Dario SiniscalcoSiniscalco, , ChemDChemD, PhD, PhD

Department of Experimental MedicineDepartment of Experimental Medicine

Second University of Naples, ItalySecond University of Naples, Italy

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Autism Autism ((ααὐὐτόςτός [[aw'tosaw'tos], ], selfself))

•• Unlike tuberculosis and polio, two infectious diseases that were Unlike tuberculosis and polio, two infectious diseases that were nearly eradicated in the twentieth century as a result of scientific nearly eradicated in the twentieth century as a result of scientific advances, many neurological disorders are actually on the rise. One advances, many neurological disorders are actually on the rise. One prominent example is prominent example is autismautism, , a disorder that results in a disorder that results in excessive fear and anxiety, extreme aloneness, and excessive fear and anxiety, extreme aloneness, and limited social communication skillslimited social communication skills. .

•• Frequency of these disorders, recognized as Frequency of these disorders, recognized as public public health problemhealth problem, is dramatically increasing: 23% reported , is dramatically increasing: 23% reported increase since 2009 and 78% increase since 2007; until increase since 2009 and 78% increase since 2007; until health problemhealth problem, is dramatically increasing: 23% reported , is dramatically increasing: 23% reported increase since 2009 and 78% increase since 2007; until increase since 2009 and 78% increase since 2007; until to present rates of 11.3 per 1,000 (to present rates of 11.3 per 1,000 (one in 88one in 88) children ) children aged 8 years in US, according to Center for Disease aged 8 years in US, according to Center for Disease Control Control ((SiniscalcoSiniscalco D., D., AntonucciAntonucci N. N. CurrCurr Prot Prot PeptPept SciSci, , 2013).2013).

•• This striking growth has renewed public dialogue about This striking growth has renewed public dialogue about the causes of autism and the subjectivity of its the causes of autism and the subjectivity of its diagnosis.diagnosis.

ScitableScitable Nature Nature EducationEducation

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AutismAutism diagnosisdiagnosis

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Autism pathogenesisAutism pathogenesis

+ =

Genetics Environment

+ =

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AutismAutism: : multifactorialmultifactorial disordersdisorders

•• Multiple Multiple interactinginteracting geneticgenetic factorsfactors couldcouldcontributecontribute toto autismautism;;

•• Environment factors, such as toxics, Environment factors, such as toxics, perinatalperinataltoxic stimuli, virus, bacteria, … toxic stimuli, virus, bacteria, …

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AutismAutism

•• MultigenicMultigenic pathologypathology withwith epigeneticepigeneticfactorsfactors!!

Brkanac, 2008

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Figure 1. Autism disease induced an over-expression of caspase-1, -2, -4,and -5, but not of caspase-8 in ASD-PBMCs. The measured mRNA levelswere normalized with respect to GAPDH (housekeeping gene) and geneexpression values were expressed as percentage of arbitrary units±S.E.M.

°P values<0.05 Siniscalco et al., JADD 2012

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Figure 2. Representative western blot analysis of Caspase-7 and Caspase-12 protein levels in the PBMCs obtained from the ASD patients respect to the healthy controls, respectively. The histograms indicate percentage variations in Caspase-7 and -12 protein levels normalized with respect to the signal obtained for β-actin housekeeping protein in the PBMCs of ASD patients respect to the healthy controls (CTL). °P<0.05.Siniscalco, JADD 2012

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Immunocytochemistry of active Caspase-3

Figure 3 . Representat ive f luorescent photomicrograph of PBMCs showingimmunocytochemistry for active Caspase-3. Arrows indicate active form Caspase-3 positivestaining (green fluorescent). Cell nuclei were counterstained with bisbenzimide (bluef l u o r e s c e n c e ) . ( A ) : c o n t r o l s u b j e c t s ; ( B ) : A S D p t s .

Siniscalco et al., JADD 2012

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Caspase-1 Caspase-2 Caspase-4,-5

Dario Siniscalco, Nicola Dario Siniscalco, Nicola AntonucciAntonucci, Sabatino , Sabatino MaioneMaione, Laura , Laura De De MagistrisMagistris

ReceptorReceptor//regulatoryregulatory moleculesmolecules pattern pattern changeschanges: a focus on : a focus on caspasescaspases in in autismautism spectrumspectrum disordersdisorders. In . In

A COMPREHENSIVE GUIDE TO AUTISM. BIOCHEMICAL A COMPREHENSIVE GUIDE TO AUTISM. BIOCHEMICAL ASPECTS IN AUTISM SPECTRUM DISORDERS. ASPECTS IN AUTISM SPECTRUM DISORDERS. SpringerSpringer, , 2013. in press.2013. in press.

Caspase-3,-7

Caspase-12

IL1b maturationInflammationImmune response changes

Oxidative stress Cellular damage

Altered immune responses

T cell activationInflammation

ER stress

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CONCLUSIONS-1• Caspases up-regulation in ASD children:

Inflammation

Immune imbalance

Grant: Autism Research Institute (ARI).Grant: Autism Research Institute (ARI).

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Three properties defining stem cells make them potential Three properties defining stem cells make them potential therapeutic agents for ASDs:therapeutic agents for ASDs:

--selfself--renewal ability with the capacity to generate more identical stem renewal ability with the capacity to generate more identical stem cellscells,

--capacity to give rise to more differentiated cells,capacity to give rise to more differentiated cells,

--paracrine regulatory functionsparacrine regulatory functions..

Dario Siniscalco, James Jeffrey Bradstreet, Nicola Antonucci. Cell Therapies for Autism Spectrum Disorders, 2012, (pp.129-142).

Neurodevelopmental Diseases - Laboratory and Clinical Research

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M1 proM1 pro--inflammatory inflammatory macrophagesmacrophages

Switching to M2 antiSwitching to M2 anti--inflammatory macrophagesinflammatory macrophages

hMSC systemic treatment

CD206 over-production

cellcell--toto--cell cell contact contact

activationactivation

IL-10 over-production

IL-1b and IL-17 down-production

Siniscalco Siniscalco etet al., al., FrontFront Int. Int.

NeurosciNeurosci, 2011 , 2011

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hMSC hMSC characterizationcharacterization

CD73 CD73 stainingstaining

Siniscalco, Siniscalco, MethodsMethodsMolMol BiolBiol, 2010, 2010

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Siniscalco et al., J Biomed Biotech, 2012

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Fetal stem cells (FSCs) have immune-regulatory functions found in mesenchymal stem cells, but in addition, exhibit a potent expansion capacity and plasticity, showing a great potential for clinical use.

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1. Fetal stem cells (FSC) have the highest proliferative potential (ability to multiply).2. Administration of these cells helps to avoid histocompatibility problems. HLA expression is either absent or minimal. Besides, immunological tolerance, total or selective, develops upon administration of these cells, thus immunosuppression is unnecessary and, as a rule, these cells engraft well in the recipient's body.3. Pluripotency is preserved until week 9.4. These cells are no longer capable of uncontrolled growth.

Neural crest cells in culture

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Rationale for the use of FSCs in ASD therapy Rationale for the use of FSCs in ASD therapy Rationale for the use of FSCs in ASD therapy Rationale for the use of FSCs in ASD therapy

FSCs are derived from ectodermal, mesodermal and endodermal layers, FSCs are derived from ectodermal, mesodermal and endodermal layers, and thereby retaining their regulatory instructions, unlike primitive ESCs. and thereby retaining their regulatory instructions, unlike primitive ESCs.

Cell or organ specific FSCs could restore the brain, gut and immune Cell or organ specific FSCs could restore the brain, gut and immune system, thereby increasing their appeal for use in ASDs. system, thereby increasing their appeal for use in ASDs.

Dario Siniscalco, James Jeffrey Bradstreet, Nicola Antonucci. Cell Therapies for Autism Spectrum Disorders, 2012, (pp.129-142).

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Fetal stem cell therapy in autism:18 autistic patients (9 males age: 7.11±4.40 , 9 females age: 6.78±3.31) diagnosed with

ASDs in according to Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) were enrolled.

Autism Treatment Evaluation Checklist scorespeech

CellCell TherapyTherapy Center Center EmCellEmCellKiev, Kiev, UkraineUkraine

speechsociabilitysensoryhealth

Aberrant Behaviour Checklist score

evaluated before cell treatment, after 1, 3, 6, 12 months (work in progress).

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FSC FSC MethodsMethodsOn day 1, we used liver stem cells harvested from tissues of 5-8 weeks old human fetuses. Suspension containing cryopreserved fetal liver stem cells was administered via drip-feed IV in the amount > 1.6 ml with nucleated cell count > 30.68x106/ml per transplantation.

On day 2, we administered ectodermal stem cells (nervous cell precursors) subcutaneously, in the amount >1.0 ml with nucleated cell count >8.7x106/ml per transplantation.

FSC were harvested from 5-8 weeks old legally aborted (for family planning reasons) normally developed and infection-free embryonic cadavers. Women were tested for viral and TORCH-developed and infection-free embryonic cadavers. Women were tested for viral and TORCH-infections before abortions. FSC were isolated by homogenization of fetal internal organs, then cryopreserved with cryoprotector in 3 stages with the initial speed of 1ºC/min and seeding point. After cryopreservation, the samples were stored in liquid nitrogen at -196ºC. Suspensions were screened for bacterial and viral safety and approved for clinical application. All patients signed the informed consent for treatment. This study is a scientific research registered (0113U004140) in the State Agency of Science, Innovations and Informatization of Ukraine of the Ukrainian Institute for Research and Development and Economic Information.

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Fetal stem cell therapy in autism

CellCell TherapyTherapy Center Center EmCellEmCellKiev, Kiev, UkraineUkraine

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Fetal stem cell therapy in autism

CellCell TherapyTherapy Center Center EmCellEmCellKiev, Kiev, UkraineUkraine

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ResultsResults

Children treated with FSCs observed no adverse effects. Children treated with FSCs observed no adverse effects.

There were no significant safety issues related to the treatment. There were no significant safety issues related to the treatment.

Statistically significant differences were shown on ATEC and ABStatistically significant differences were shown on ATEC and AB--C scores C scores evaluation in the treatment group compared to the control at several timeevaluation in the treatment group compared to the control at several time--points points postpost--treatment (p<0.05).treatment (p<0.05).postpost--treatment (p<0.05).treatment (p<0.05).

Transplantations of FSCs were effective in improve autistic syndrome, as Transplantations of FSCs were effective in improve autistic syndrome, as autistic children showed improved in autistic children showed improved in behaviourbehaviour, cognitive and , cognitive and communication deficits.communication deficits.

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Hematopoietic Stem Cells:

-Characterized by specific Cluster of Differentiation markers (CD34, -Characterized by specific Cluster of Differentiation markers (CD34, 59, 90, 117)

-Self-renewal, mobilization and multipotent differentiation capacities(including monocytes and macrophages)

-Paracrine activity

-Homing in the inflammation sites.

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Warnings: are HSCs pro-inflammatory?The proper cytokine signaling as deterministic of the end-

effect of stem cell responsesSiniscalco et al., Frontiers

Immunol 2013

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Siniscalco et al., J Regen Med 2012, 1:2

http://dx.doi.org/10.4172/jrgm.1000e104

Patient-specific somatic cell reprogramming could have a large impact on medicine by providing a source of cells for disease modelling and regenerative medicine

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iPSC patient specific therapy. From an autistic subject it is possible to obtain an examination on their behavior, brain structure and network, together with genetics for an attempt to identify the type of autism.

Beatriz C.G. Freitas , Cleber A. Trujillo , Cassiano Carromeu , Marianna Yusupova , Roberto H. Herai , Alysson R. ...

Stem cells and modeling of autism spectrum disorders

Experimental Neurology 2012

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AdiposeAdipose--Derived Mesenchymal Stem CellsDerived Mesenchymal Stem Cells

--abundant in adipose tissue in humans, and are easy to harvest abundant in adipose tissue in humans, and are easy to harvest with minimally invasive procedureswith minimally invasive procedures..--differentiation processes into cell lineages apart from adipocytes differentiation processes into cell lineages apart from adipocytes have not yet been conclusively demonstrated in human subjectshave not yet been conclusively demonstrated in human subjects

Umbilical Cord-Derived MSCs--placentas discarded after deliveryplacentas discarded after delivery--low immunogenicitylow immunogenicity

Neural Stem Cellsintegrate into the tissue, replace damaged cells, and reconstruct neural circuitryintegrate into the tissue, replace damaged cells, and reconstruct neural circuitry

1)1) reliable sources of sufficient autologous NPCs; reliable sources of sufficient autologous NPCs; 2)2) how to regulate neural plasticity; how to regulate neural plasticity;

3)3) the means to control differentiation of NSCs in the adult nervous systemthe means to control differentiation of NSCs in the adult nervous system

Dario Siniscalco, James Jeffrey Bradstreet, Nicola Antonucci. Cell Therapies for Autism Spectrum Disorders, 2012, (pp.129-142).

Neurodevelopmental Diseases - Laboratory and Clinical Research

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Clinical TrialsClinical Trials

Shenzhen Beike Bio-Technology Co., Ltd.

Collaborators:Shandong Jiaotong Hospital

Safety and Efficacy of Stem Cell Therapy in Patients With Autismhuman cord blood mononuclearhuman cord blood mononuclear cellscells and human umbilical cord mesenchymaland human umbilical cord mesenchymal stem cellsstem cells

Autologous Cord Blood Stem Cells for Autism

Sutter Health

Michael Chez, MD, Sutter Health

Autologous Bone Marrow Stem Cells for Children With ASDsAutologous Bone Marrow Stem Cells for Children With ASDsThe purpose of this study is to determine whether the plasticity of autologous intrathecal hematopoietic cells would

improve the neurologic and the social skills of pediatric patients with autism spectrum disorders.Hematology Service, Hospital UniversitarioMonterrey, Nuevo Leon, Mexico

Adipose Derived Stem Cell Therapy for AutismAgeless Regenerative Institute, Mexico

www.clinicaltrials.govwww.clinicaltrials.gov

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AutismAutism: : findingfinding a cure …a cure …

www.antonucci.eu

AutismAutism: : findingfinding a cure …a cure …

Dario Siniscalco Dario Siniscalco ((SecondSecond UniversityUniversity ofof NaplesNaples, Italy),, Italy),

NataliiaNataliia SychSych ((CellCell TherapyTherapy Center Center EmCellEmCell, Kiev , Kiev –– UkraineUkraine)),,

James Jeff James Jeff BradstreetBradstreet (International (International ChildChild DevelopmentDevelopment ResourceResource

Center, Center, CummingCumming, Georgia, USA),, Georgia, USA),

Nicola Nicola AntonucciAntonucci ((BiomedicalBiomedical CentreCentre forfor AutismAutism ResearchResearch and and

Treatment, Bari, Italy).Treatment, Bari, Italy).

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hMSC administration in neuropathic mice reduces mechanical allodynia and

thermal hyperalgesia until 90 days neuropathic pain

induction, without affecting neurological function

Siniscalco Siniscalco etet al., al., FrontFront Int. Int.

NeurosciNeurosci, 2011 , 2011

TransplantationTransplantation procedure: procedure: 2x102x1066cells/100µl in cells/100µl in tailtail veinvein