Theglobal bone marrow aspirate concentrates marketwas valued around US$ 130.0 Mn in 2016 is anticipated to register a stable CAGR of over 5.0% during forecast period of 2017 to 2025, according to a new report published by Transparency Market Research (TMR)titled Bone Marrow Aspirate Concentrates Market Global Industry Analysis, Size, Share, Growth, Trends, and Forecast, 20172025. Growth of the global bone marrow aspirate concentrates market is driven by increased prevalence of and incidences of orthopedic diseases, and sports injuries, along with high growth of the cosmetic surgery industry and increasing applications of the BMAC products in the cosmetic and orthopedic surgeries. The bone marrow aspirate concentrates market in Asia Pacific is expanding with a high potential to grow registering a CAGR above 6.0% on the backdrop of unmet clinical needs, rising geriatric population, large patient pool, favorable government regulations, development in health care sector, and increased focus on research and developmental activities.

Increase in incidences of Osteoarthritis on the backdrop of rising geriatric population to drive market growth

According to a collaborative survey conducted by the United Nations and the World Health Organization, 1.2 billion people in China are suffering from OA, of which more than 55% are aged 60 years or above. On the backdrop of such a huge patient base, there has been several developments in the field orthopedic surgery. Bone marrow-derived stem cell treatment is considered a promising and advanced therapy. It reduces the injury healing time in orthopedic diseases to five to six weeks from four to six months in case of surgery. Reduction in the healing time is a factor likely to propel theBone Marrow Aspirate Concentrates marketduring the forecast period. However, pain associated with the treatment, lack of product approval, and preference for alternative treatments are negatively affecting the market growth. Moreover, high investments in R&D and clinical trials, slow approval processes entailing sunken costs, and marginal returns on investment (RoI) for stakeholders are primary concerns faced by manufacturer further hampering growth of the market.

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Rise in the Number of BMAC Assisted Procedures to Boost Growth of Bone Marrow Aspirate Concentrates Accessories Segment

The product type segment is fragmented into bone marrow aspirate concentrates systems and bone marrow aspirate concentrates accessories. The bone marrow aspirate concentrates accessories segment is anticipated to carry major share of the market on the backdrop of rise in number of BMAC assisted procedures. Cell therapies have been used extensively over the past decade for a variety of medical applications to restore cellular function and enhance quality of life. Owing to the differentiation property, stem cells are being used for repair and regeneration of bone. Moreover, increase in awareness about hygiene and risk of cross-contamination in developing countries such as Brazil, China and India are expected to increase the use of single-use Jamshidi needles for bone marrow stem cell procedures. This is likely to fuel the growth of the accessories segment in the near future.

Orthopedic Surgery Application to Dominate the GlobalBone Marrow Aspirate Concentrates Market

The application segment of global bone marrow aspirate concentrates market is divided into orthopedic surgery, wound healing, chronic pain, peripheral vascular disease, dermatology, and others applications. Of which, orthopedic surgery segment is anticipated to dominate the market owing to rising geriatric population, and surge in incidences of osteoarthritis around the globe. The dermatology segment is anticipated to expand at the highest CAGR of over 6.0% during forecast period of 2017 to 2025 owing to current boom in the industry, increase in disposable income, and technological advancements in the market. The utilization of the regenerative ability of fibroblasts and keratinocytes from human skin has formed new ways to develop cell-based therapies for patients. Moreover, capacity of bone marrow derived extra-cutaneous cells is being researched for its plasticity in regenerating skin; it is likely to lead to the future growth of cell therapies in dermatology.

Rise in Healthcare Expenditure to Fuel Growth ofHospitals & Clinics End-user Segment

In terms of end-users, market is divided into hospitals & clinics, pharmaceutical & biotechnology companies, Contract Research Organizations (CROs) & Contract Manufacturing Organizations (CMOs), and academic & research institutes. The hospitals & clinics segment dominated the bone marrow aspirate concentrates market in 2016. The trend is expected to continue during the forecast period. The hospitals & clinics segment is likely to be followed by the biotechnology & biopharmaceutical companies segment in terms of market share during the forecast period. The segment is anticipated to hold more than 8.0% of market share in 2016. Growth of the segment is attributed to increasing number of biotechnology companies and rising partnerships among the market players to expand global presence.

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Large Patient Pool in Developing Countries Like China, India, Brazil, and Taiwan to Create More Opportunities in the Market

Geographically, global bone marrow aspirate concentrates market is divided into major five geographical regions, including North America, Europe, Asia-Pacific, Latin America and Middle East and Africa. North America is anticipated to hold major share of the market owing to technological advancements and regulatory approval for new devices, awareness about stem cell therapy, and rise in number of cosmetic surgical procedures. While, Asia Pacific orthopedic market is at a pivotal point today, which was valued around US$ 19 Million in 2016 and anticipated to derive massive and augmented growth. The orthopedic market in Asia, including bone graft, spine, and bone substitute, is anticipated to grow more than twice as fast as the overall orthopedic market which will further boost growth of BMAC market in the region.

Semi-consolidated Market with 3-4 key Players Operating in the BMAC Systems Market Segment

Key players covered in this report are Terumo Corporation (Terumo BCT), Ranfac Corp., Arthrex, Inc., Globus Medical, Inc., Cesca Therapeutics Inc., MK Alliance Inc. (TotipotentSC), and Zimmer Biomet Holdings, Inc. Companies operating in the global market for bone marrow aspirate concentrates are focusing on in-licensing and collaboration agreements to put new products in the developing markets like Asia Pacific, and Latin America. For instance, in August 2017, Cesca Therapeutics Inc. announced a distribution agreement with Boyalife WSN Ltd., a China based company. Through this agreement, Boyalife WSN Ltd. will distribute Cescas innovative biobanking and point-of-care solutions in China, India, Singapore, and the Philippines. As India and China represent two of the fastest growing economies in the world, successful penetration of these regions can generate more market opportunity to the companies.

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The global bone marrow aspirate concentrates market is segmented as follows:

Global bone marrow aspirate concentrates market, by product

Global bone marrow aspirate concentrates market, by application

Global bone marrow aspirate concentrates market, by end-user

Global Bone Marrow Aspirate Concentrates Market, by Geography

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Bone Marrow Aspirate Concentrates Market Valuable Growth Prospects and Upcoming Trends Till 2025 - Science Examiner

Bone Marrow Stem Cells Comments Off on Bone Marrow Aspirate Concentrates Market Valuable Growth Prospects and Upcoming Trends Till 2025 – Science Examiner | September 11th, 2020

Bone marrowaspiration and trephine biopsy are usually performed on the back of the hipbone, or posterior iliac crest. An aspirate can also be obtained from the sternum (breastbone). For the sternal aspirate, the patient lies on their back, with a pillow under the shoulder to raise the chest. A trephine biopsy should never be performed on the sternum, due to the risk of injury to blood vessels, lungs or the heart.

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The need to selectively isolate and concentrate selective cells, such as mononuclear cells, allogeneic cancer cells, T cells and others, is driving the market. Over 30,000 bone marrow transplants occur every year. The explosive growth of stem cells therapies represents the largest growth opportunity for bone marrow processing systems.Europe and North America spearheaded the market as of 2016, by contributing over 74.0% to the overall revenue. Majority of stem cell transplants are conducted in Europe, and it is one of the major factors contributing to the lucrative share in the cell harvesting system market.

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In 2016, North America dominated the research landscape as more than 54.0% of stem cell clinical trials were conducted in this region. The region also accounts for the second largest number of stem cell transplantation, which is further driving the demand for harvesting in the region.Asia Pacific is anticipated to witness lucrative growth over the forecast period, owing to rising incidence of chronic diseases and increasing demand for stem cell transplantation along with stem cell-based therapy.

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Japan and China are the biggest markets for harvesting systems in Asia Pacific. Emerging countries such as Mexico, South Korea, and South Africa are also expected to report lucrative growth over the forecast period. Growing investment by government bodies on stem cell-based research and increase in aging population can be attributed to the increasing demand for these therapies in these countries.

Major players operating in the global bone marrow processing systems market are ThermoGenesis (Cesca Therapeutics inc.), RegenMed Systems Inc., MK Alliance Inc., Fresenius Kabi AG, Harvest Technologies (Terumo BCT), Arthrex, Inc. and others

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Bone Marrow Processing System Market Insights Research Forecast By Upstream And Downstream Manufacturers Analysis 2018 2025 - Scientect

Bone Marrow Stem Cells Comments Off on Bone Marrow Processing System Market Insights Research Forecast By Upstream And Downstream Manufacturers Analysis 2018 2025 – Scientect | September 11th, 2020

Global Coronavirus pandemic has impacted all industries across the globe, Human Mesenchymal Stem Cells (hMSC) market being no exception. As Global economy heads towards major recession post 2009 crisis, Cognitive Market Research has published a recent study which meticulously studies impact of this crisis on Global Human Mesenchymal Stem Cells (hMSC) market and suggests possible measures to curtail them. This press release is a snapshot of research study and further information can be gathered by accessing complete report. To Contact Research Advisor Mail us @ [emailprotected] or call us on +1-312-376-8303.

The research report on global Human Mesenchymal Stem Cells (hMSC) market as well as industry is a detailed study that provides detailed information of major key players, product types & applications/end-users; historical figures, region analysis, market drivers/opportunities & restraints forecast scenarios, strategic planning, and a precise section for the effect of Covid-19 on the market. Our research analysts intensively determine the significant outlook of the global Human Mesenchymal Stem Cells (hMSC) market study with regard to primary & secondary data and they have represented it in the form of graphs, pie charts, tables & other pictorial representations for better understanding.

Umbilical Cord Matrix hMSC, Bone Marrow hMSC, Adipose Tissue hMSC, Other are some of the key types of market. All the type segments have been analyzed based on present and future trends and the market is estimated from 2020 to 2027. Based on the application segment, the global market can be classified into Medical Application, Research, Other Applications . The analysis of application segment will help to analyze the demand for market across different end-use industries.

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Amid the COVID-19 pandemic, the industry is witnessing a major change in operations.Some of the key players include PromoCell, ThermoFisher, KURABO, Lifeline Cell Technology, Merck . key players are changing their recruitment practices to comply with the social distancing norms enforced across several regions to mitigate the risk of infection. Additionally, companies are emphasizing on using advanced recruiting solutions and digital assets to avoid in-person meetings. Advanced technologies and manufacturing process are expected to play a decisive role in influencing the competitiveness of the market players.

Regional Analysis for Human Mesenchymal Stem Cells (hMSC) Market:North America (United States, Canada)Europe (Germany, Spain, France, UK, Russia, and Italy)Asia-Pacific (China, Japan, India, Australia, and South Korea)Latin America (Brazil, Mexico, etc.)The Middle East and Africa (GCC and South Africa)

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NOTE: Whole world is experiencing the impact of Covid-19 pandemic due to its increasing spread hence, the report comprises of an up to date scenario of the Human Mesenchymal Stem Cells (hMSC) market report. Research analyst team of our company is understanding & reviewing the Covid19 Impact on Market and all the necessary areas of the market that have been altered due to the change caused by Covid19 impact. Get in touch with us for more precise/in-depth information of the Human Mesenchymal Stem Cells (hMSC) market.

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At the end of May, many states began lifting lockdown restrictions and reopening in order to revive their economies, despite warnings that it was still too early. As a result, by mid-July, around 33 states were reporting higher rates of new cases compared to the previous week with only three states reporting declining rates. Due to this Covid-19 pandemic, there has been disruptions in the supply chain which have made end-use businesses realize destructive in the manufacturing and business process. During this lockdown period, the plastic packaging helps the products to have longer shelf life as the public would not be able to buy new replacements for the expired products because most of the production units are closed.

About Us:Cognitive Market Research is one of the finest and most efficient Market Research and Consulting firm. The company strives to provide research studies which include syndicate research, customized research, round the clock assistance service, monthly subscription services, and consulting services to our clients. We focus on making sure that based on our reports, our clients are enabled to make most vital business decisions in easiest and yet effective way. Hence, we are committed to delivering them outcomes from market intelligence studies which are based on relevant and fact-based research across the global market.Contact Us: +1-312-376-8303Email: [emailprotected]Web: https://www.cognitivemarketresearch.com/

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Reasons Industries to Thrive Post-Pandemic! Human Mesenchymal Stem Cells (hMSC) Market Report xyz Answers it Analysis by Key Companies PromoCell,...

Bone Marrow Stem Cells Comments Off on Reasons Industries to Thrive Post-Pandemic! Human Mesenchymal Stem Cells (hMSC) Market Report xyz Answers it Analysis by Key Companies PromoCell,… | September 11th, 2020

Arteries and veins are the blood vessels that help transport blood and nutrients in the body. Each type of blood vessel has its own specific structure and set of features that enable the functioning of blood vessels at an optimal level.

For example, arteries, which are the vessels responsible for carrying oxygenated blood from the heart to the rest of the body are generally thick and more elastic than their counterpart, veins. Veins carry the deoxygenated blood from the body back to the heart and are generally thinner than arteries.

It is important to note that the thickness or thinness of the blood vessel refers to the wall size and the diameter of the vessel.

Read Also: Senolytic Agents: The Potential Forerunners in the Fight Against Aging

The blood vessels over time become less elastic and can be calcified over time. This is referred to as an age-related change, something everyone goes through. The entire body undergoes these types of changes as one ages. Most of the changes are associated with the general weakness of body physiology. Over time, these changes, after being affected by comorbidities can be severely detrimental to an individuals health.

As people age, the blood vessels in the body become weak and less elastic. This weakness presents in the form of leakiness. Furthermore, the loss of elasticity results in rigid and hardened vessels. All of this can result in serious consequences to ones health.

Hence, making blood vessels an important topic of research, However, this research topic comes riddled with limitations as the study of blood vessels requires a sample which can only be obtained in an invasive manner. This is not a suitable method for long term research and study of blood vessels and the effect of age on them has been performed using pluripotent stem cells.

Read Also: Anti-Aging: HGH Can Reduce Biological Age by One Year and a Half Study Shows

The use of stem cells by researchers leads to the second limitation in this field of research. Stem cells are the undifferentiated cells in the embryonic stage that can differentiate into any other type of cells. These are the cells that all humans start off as. However, differentiating them into cells of the blood vessels to study them further doesnt provide the results scientists hoped for.

Martin Hetzer, Salks vice president and chief science officer is the head of the new research in which he and his team claim to have found a solution to this problem. However, in 2015, Hetzer was in the team that initially used stem cells to form cells of the blood vessels. The limitation of this study was that the blood vessel formed had no age-markers and was brand new and couldnt be studied for the effects of aging on blood vessels.

A recent study published in the eLife Journal in September 2020, performed by a team of scientists from Salk headed by Hetzer found that using fibroblasts may be more useful than pluripotent stem cells. Fibroblasts, a type of cells in the connective tissue, were derived from skin cells and used in this study to form induced vascular endothelial cells (iVECs) and induced smooth muscle cells (iSMCs)

Read Also: Is NAD+ The Anti Aging Substance Mankind Has Been Searching For?

For this study, researchers used skin cells from three groups of subjects; young subjects between the ages of 19 and 30 years, older subjects between the ages of 62 and 87 years, and patients suffering from Hutchinson-Gilford progeria syndrome (HGPS), an accelerated aging disorder.

Three samples from young subjects, three from older subjects, and 8 from patients affected by Hutchinson-Gilford Progeria Syndrome were taken and stimulated to develop into iVECs and iSMCs.

Hetzer and his team found that these iVECs and iSMCs had all the age-markers and showed different genetic expression dependant on age. This helped the researchers find genes and proteins associated with aging and age-related effects on blood vessels.

One such protein, namely BMP4, was found in higher amounts in the samples from older individuals and the iSMCs from the HGPS patients. Researchers assumed that this protein might be the reason for the accelerated aging seen in HGPS.

Read Also: HGH and Anti Diabetic drugs, an Anti-Aging Cocktail According to Study

To test their hypothesis, they used antibodies against BMP4 in volunteers with vascular disease. Hetzer and the team found that blocking BMP4 in these volunteers resulted in lesser vascular leaking, a feature of vascular disease. This finding is being recommended by the researchers as the new target for the treatment of HGPS or progeria.

Hetzer and his team aim to continue working on this to isolate the genes associated with aging and the exact mechanism of them, especially at the molecular level.

Direct reprogramming of human smooth muscle and vascular endothelial cells reveals defects associated with aging and Hutchinson-Gilford progeria syndrome

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Scientists at the Salk Institute Came Across a Possible Way to Slow Down Aging - Gilmore Health News

Skin Stem Cells Comments Off on Scientists at the Salk Institute Came Across a Possible Way to Slow Down Aging – Gilmore Health News | September 11th, 2020

Sept. 11, 2020 05:00 UTC

SOUTH SAN FRANCISCO, Calif.--(BUSINESS WIRE)-- Genentech, a member of the Roche Group (SIX: RO, ROG; OTCQX: RHHBY), today announced new data that show Ocrevus (ocrelizumab) is a highly effective treatment option for people with relapsing-remitting multiple sclerosis (RRMS) who experienced a suboptimal response to their prior disease modifying therapy (DMT). Subgroup analysis from the two-year open-label Phase IIIb CASTING study also demonstrates that patients benefit across a wide range of disease related and demographic subgroups, regardless of prior treatment background. Findings will be presented at MSVirtual2020, the 8th Joint Meeting of the Americas Committee for Treatment and Research in Multiple Sclerosis (ACTRIMS) and the European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS).

For a wide range of people with MS who experienced a suboptimal response to prior treatment, we continue to see evidence that Ocrevus provides significant benefit in slowing disease progression, said Levi Garraway, M.D., Ph.D., chief medical officer and head of Global Product Development. New real-world Ocrevus data show high persistence and adherence to the only B-cell therapy with a twice-yearly dosing schedule, which we know can be very important to both people with MS and their physicians.

Phase IIIb open-label CASTING study

Approximately 75% of RRMS patients (492/658) had no evidence of disease activity (NEDA; brain lesions, relapses and worsening of disability) two years after switching to twice-yearly Ocrevus treatment (with prespecified MRI re-baselining at 8 weeks) in the primary analysis of the CASTING study. Patients enrolled in the study had prior suboptimal response to at least six months of treatment with up to two DMTs. The analysis also showed the proportion of patients achieving NEDA remained consistently high across all measured patient subgroups, including baseline MRI activity, relapse activity, disability level, age and the number of prior DMTs. Further, 78% of patients treated with only one prior DMT compared with 70% of patients treated with two prior DMTs achieved NEDA.

Additionally, patients treated with Ocrevus experienced an improvement in the majority of symptoms measured by SymptoMScreen after two years. SymptoMScreen is a patient-reported outcome tool to assess symptom severity across twelve domains. The most pronounced significant improvements (p<0.001) were seen in sensory symptoms, fatigue and vision, which are important for daily living.

CONFIDENCE real-world safety study

A 97% treatment persistence for Ocrevus patients at 18 months, and strong adherence to infusions every six months, was seen in an interim analysis of more than 1,600 patients in the ongoing German CONFIDENCE study. Separate data from a U.S. commercial claims database that support high persistence and sustained adherence to Ocrevus treatment will also be presented.

Ocrevus longer-term safety data

New safety data as of January 2020 will be presented, representing 5,680 patients with RMS and PPMS and 18,218 patient-years of exposure to Ocrevus, across all Ocrevus clinical trials. These findings further demonstrate the consistently favorable benefit:risk profile of Ocrevus over seven years.

With rapidly growing real-world experience and more than 170,000 people treated globally, Ocrevus has twice-yearly (six-monthly) dosing and is the first and only therapy approved for RMS (including relapsing-remitting MS [RRMS] and active, or relapsing, secondary progressive MS [SPMS], in addition to clinically isolated syndrome [CIS] in the U.S.) and primary progressive MS (PPMS). Ocrevus is approved in 92 countries across North America, South America, the Middle East, Eastern Europe, as well as in Australia, Switzerland and the European Union.

About multiple sclerosis

Multiple sclerosis (MS) is a chronic disease that affects nearly one million people in the United States, for which there is currently no cure. MS occurs when the immune system abnormally attacks the insulation and support around nerve cells (myelin sheath) in the brain, spinal cord and optic nerves, causing inflammation and consequent damage. This damage can cause a wide range of symptoms, including muscle weakness, fatigue and difficulty seeing, and may eventually lead to disability. Most people with MS experience their first symptom between 20 and 40 years of age, making the disease the leading cause of non-traumatic disability in younger adults.

Relapsing-remitting MS (RRMS) is the most common form of the disease and is characterized by episodes of new or worsening signs or symptoms (relapses) followed by periods of recovery. Approximately 85 percent of people with MS are initially diagnosed with RRMS. The majority of people who are diagnosed with RRMS will eventually transition to secondary progressive MS (SPMS), in which they experience steadily worsening disability over time. Relapsing forms of MS (RMS) include people with RRMS and people with SPMS who continue to experience relapses. Primary progressive MS (PPMS) is a debilitating form of the disease marked by steadily worsening symptoms but typically without distinct relapses or periods of remission. Approximately 15 percent of people with MS are diagnosed with the primary progressive form of the disease. Until the FDA approval of Ocrevus, there had been no FDA approved treatments for PPMS.

People with all forms of MS experience disease activity inflammation in the nervous system and permanent loss of nerve cells in the brain even when their clinical symptoms arent apparent or dont appear to be getting worse. An important goal of treating MS is to reduce disease activity as soon as possible to slow how quickly a persons disability progresses. Despite available disease-modifying treatments (DMTs), some people with RMS continue to experience disease activity and disability progression.

About Ocrevus (ocrelizumab)

Ocrevus is the first and only therapy approved for both RMS (including clinically isolated syndrome, RRMS and active, or relapsing, SPMS) and PPMS, with dosing every six months. Ocrevus is a humanized monoclonal antibody designed to target CD20-positive B cells, a specific type of immune cell thought to be a key contributor to myelin (nerve cell insulation and support) and axonal (nerve cell) damage. This nerve cell damage can lead to disability in people with MS. Based on preclinical studies, Ocrevus binds to CD20 cell surface proteins expressed on certain B cells, but not on stem cells or plasma cells, suggesting that important functions of the immune system may be preserved.

Ocrevus is administered by intravenous infusion every six months. The initial dose is given as two 300 mg infusions given two weeks apart. Subsequent doses are given as single 600 mg infusions.

Important Safety Information

What is Ocrevus?

Ocrevus is a prescription medicine used to treat:

It is not known if Ocrevus is safe or effective in children.

Who should not receive Ocrevus?

Do not receive Ocrevus if you have an active hepatitis B virus (HBV) infection.

Do not receive Ocrevus if you have had a life threatening allergic reaction to Ocrevus. Tell your healthcare provider if you have had an allergic reaction to Ocrevus or any of its ingredients in the past.

What is the most important information I should know about Ocrevus?

Ocrevus can cause serious side effects, including:

These infusion reactions can happen for up to 24 hours after your infusion. It is important that you call your healthcare provider right away if you get any of the signs or symptoms listed above after each infusion.

If you get infusion reactions, your healthcare provider may need to stop or slow down the rate of your infusion.

Before receiving Ocrevus, tell your healthcare provider about all of your medical conditions, including if you:

Tell your healthcare provider about all the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements.

What are the possible side effects of Ocrevus?

Ocrevus may cause serious side effects, including:

Most common side effects include infusion reactions and infections.

These are not all the possible side effects of Ocrevus.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

For more information, go to http://www.Ocrevus.com or call 1-844-627-3887.

For additional safety information, please see the full Prescribing Information and Medication Guide.

About Genentech in neuroscience

Neuroscience is a major focus of research and development at Genentech and Roche. Our goal is to pursue groundbreaking science to develop new treatments that help improve the lives of people with chronic and potentially devastating diseases.

Genentech and Roche are investigating more than a dozen medicines for neurological disorders, including multiple sclerosis, stroke, Alzheimers disease, Huntingtons disease, Parkinsons disease, Duchenne muscular dystrophy and autism spectrum disorder. Together with our partners, we are committed to pushing the boundaries of scientific understanding to solve some of the most difficult challenges in neuroscience today.

About Genentech

Founded more than 40 years ago, Genentech is a leading biotechnology company that discovers, develops, manufactures and commercializes medicines to treat patients with serious and life-threatening medical conditions. The company, a member of the Roche Group, has headquarters in South San Francisco, California. For additional information about the company, please visit http://www.gene.com.

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New Data Further Reinforce Genentech's Ocrevus (ocrelizumab) as a Highly Effective Treatment for People With Multiple Sclerosis - BioSpace

Skin Stem Cells Comments Off on New Data Further Reinforce Genentech’s Ocrevus (ocrelizumab) as a Highly Effective Treatment for People With Multiple Sclerosis – BioSpace | September 11th, 2020

Shelby Hedgecock contracted the coronavirus in April and thought she had fought through the worst of it the intense headaches, severe gastrointestinal distress and debilitating fatigue but early last month she started experiencing chest pain and a pounding heartbeat. Her doctor put her on a cardiac monitor and ordered blood tests, which indicated that the previously healthy 29-year-old had sustained heart damage, likely from her bout with COVID-19.

I never thought I would have to worry about a heart attack at 29 years old, Hedgecock told Yahoo News in an interview. I didnt have any complications before COVID-19 no preexisting conditions, no heart issues. I can deal with my taste and smell being dull, I can fight through the debilitating fatigue, but your heart has to last you a really long time.

Hedgecocks primary-care physician has referred her to a cardiologist she will see this week; the heart monitor revealed that Hedgecocks pulse rate is wildly irregular, ranging from 49 to 189 beats per minute, and she has elevated inflammatory markers and platelet counts. She was told to go to the emergency room if her chest pain intensifies before she can see the specialist. A former personal trainer who is now out of breath just from walking around the room, Hedgecock is worried about what the future holds.

She is far from alone in her struggle. Dr. Ossama Samuel is a cardiologist at New Yorks Mount Sinai Hospital, where he routinely sees coronavirus survivors who are contending with cardiac complications. Samuel said his team has treated three young and otherwise healthy coronavirus patients who have developed myocarditis an inflammation of the heart muscle weeks to months after recovering from the virus.

Shelby Hedgecock in a hospital bed. (Shelby Hedgecock)

Myocarditis can affect how the heart pumps blood and trigger rapid or abnormal heart rhythms. It is particularly dangerous for athletes, doctors say, because it can go undetected and can result in a heart attack during strenuous exercise. In recent weeks, some collegiate athletes have reported cardiac complications from the coronavirus, underscoring the seriousness of the condition.

Last month, former Florida State basketball center Michael Ojo died from a heart attack in Serbia; Ojo had recovered from the coronavirus before he collapsed on the basketball court. An Ohio State University cardiologist found that between 10 and 13 percent of university athletes who had recovered from COVID-19 had myocarditis.When the Big Ten athletic conference announced the cancellation of its season last month, Commissioner Kevin Warren cited the risk of heart failure in athletes. Researchers have estimated that up to 20 percent of people who get the coronavirus sustain heart damage.

Samuel said he feels an obligation to warn people, particularly since some of the patients he and Mount Sinai colleagues have seen with myocarditis had only mild cases of the coronavirus months ago.

We are now seeing people three months after COVID who have pericarditis [inflammation of the sac around the heart] or myocarditis, Samuel said. He said he believes a small fraction of coronavirus survivors are sustaining heart damage, but when a disease is so widespread it is concerning that a tiny fraction is still sizable.

Samuel said he worries particularly about athletes participating in team sports, since many live together and spend time in close quarters. Teammates may all get the coronavirus and recover together, Samuel said, but the one who really gets that crazy myocarditis could be at risk of dying through exercise or training.

Story continues

Its a concern about what do you do: Should we do sports in general, should we do it in schools, should we do it in college, should we just do it for professionals who understand the risk and they're getting paid? Samuel asked. I hope we dont scare the public, but we should make people aware.

Samuel is recommending that patients recovering from COVID-19 with myocarditis avoid workouts for three to six months.

Todd McDevitt, who runs a stem-cell lab at Gladstone Institutes, which is affiliated with the University of California at San Francisco, recently published images that show how the coronavirus can directly invade the heart muscle. McDevitt said he was so alarmed when he saw a sample of heart muscle cells in a petri dish get diced by the coronavirus that he had trouble sleeping for nights afterward.

Todd McDevitt. (Facebook)

McDevitt said his teams research was spurred by their desire to understand if the coronavirus is entering heart cells and how it is affecting them. He was surprised to see the heart muscle samples he was studying react to a very small amount of the coronavirus, usually within 24 to 48 hours. He said the virus decimated the heart cells in his petri dishes.

Cell nuclei the hubs of all the genetic information, all of the nuclear DNA in many of the cells were gone, McDevitt said. There was a black hole literally where we would normally see the nuclear DNA. Thats also pretty bizarre.

While McDevitts study has not yet been peer-reviewed it is still in pre-print he said he felt compelled to share the findings as soon as possible. He said his team also sampled tissues from three COVID-19 patient autopsies and found similar damage in the heart muscles of those patients, none of whom had been flagged for myocarditis or heart problems while they were alive.

This is probably not the whole story yet, but we think we have insights into the beginning of when the virus would get into some of these people and what it might be doing that is concerning enough that we should probably let people know, because clinicians need to be thinking about this, McDevitt said in an interview. We dont have any means of bringing heart muscle back. ... This virus is [causing] a very different type of injury, and one we haven't seen before.

McDevitt said the chopped-up heart muscles he and his colleagues saw are so concerning because when the microfibers in the muscle are damaged, the heart cant properly contract.

If heart muscle cells are damaged and they cant regenerate themselves, then what youre looking at is someone who could prematurely have heart failure or heart disease due to the virus, McDevitt said. This could be a warning sign for a potential wave of heart disease that we could see in the future, and its in the survivors thats the concern.

McDevitt said he believes the risk of heart disease is serious and one people should consider as they assess their own risk of getting the coronavirus.

I am more scared today of contracting the virus, by far, than I was four months ago, he said.

In lab experiments, infection of heart muscle cells with SARS-CoV-2 caused long fibers to break apart into small pieces, shown above. (Gladstone)

The medical journal the Lancet recently reported that an 11-year-old child had died of myocarditis and heart failure after a bout of COVID-induced multisystem inflammatory syndrome (MIS-C). An autopsy showed coronavirus embedded in the childs cardiac tissue.

A recent study from Germany found that 78 percent of patients who had recovered from the coronavirus and who had only mild to moderate symptoms while ill with the disease had indications of cardiac involvement on MRIs conducted more than two months after their initial infection.Lead investigator Eike Nagel said it is concerning to see such widespread cardiac impact; six in 10 of the patients Nagels team studied experienced ongoing myocardial inflammation.

We found an astonishingly high level of cardiac involvement approximately two months after COVID infection, Nagel said in an email. These changes are much milder than observed in patients with severe acute myocarditis.

The scale of the cardiac impact on relatively healthy, young patients surprised many doctors. Nagel said the findings are significant on a population basis, and that the impact of COVID-19 on the heart must be studied more.

Dr. Gregg Fonarow. (UCLA)

Dr. Gregg Fonarow, chief of UCLAs Division of Cardiology and director of the Ahmanson-UCLA Cardiomyopathy Center, said the picture is evolving, but the new studies showing cardiac impact in even young people with mild cases of COVID-19 have raised troubling new questions.

We really do need to take seriously individuals that have had the infection and are having continued symptoms, [and] not just dismiss those symptoms, Fonarow said. There could be, in those who had milder or even asymptomatic cases, the potential for cardiac risk.

Fonarow said it is important to understand whether a more proactive screening and treatment approach is needed to better address the needs of patients who have recovered from the coronavirus and who may still have weakened heart function. Fonarow said he found McDevitts research to be potentially significant because it proves from a mechanistic standpoint that there can be direct cardiac injury from the virus itself.

Even if it were going to impact, say, 2 percent of the people that had COVID-19, when you think of the millions that have been infected, that ends up in absolute terms being a very large number of individuals, Fonarow said in an interview. You dont want people to be unduly alarmed, but on the other hand you dont want individuals to be complacent about, Oh, the mortality rate is so low with COVID-19, I dont really care if Im infected because the chances that it will immediately or in the next few weeks kill me is small enough, I dont need to be concerned. There are other consequences.

_____

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Post-COVID heart damage alarms researchers: 'There was a black hole' in infected cells - Yahoo Sports

Cardiac Stem Cells Comments Off on Post-COVID heart damage alarms researchers: ‘There was a black hole’ in infected cells – Yahoo Sports | September 11th, 2020

The aim of this detailed market research report on Progenitor Cell Product market is to offer readers, with ample competitive edge in the context of market dynamics such as challenges, barriers, threats and opportunities that orchestrate high end growth amidst stringent competition in global Progenitor Cell Product market.

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The aforementioned Progenitor Cell Product market has been evaluated to register a thumping growth of xx million USD in 2020 and is anticipated to further attain a growth valuation of xx million USD through the forecast tenure till 2027, growing at a CAGR of xx% throughout the forecast span.For utmost reader convenience this elaborate research report on global Progenitor Cell Product market identifies 2019 as the base year and 2020-27 constitutes the overall forecast tenure, allowing precise market estimation about growth probabilities in the Progenitor Cell Product market.

Major Company Profiles operating in the Progenitor Cell Product Market:

NeuroNova ABR&D SystemsAsterias BiotherapeuticsStemCellsAxol BioReNeuron LimitedATCCSTEMCELL TechnologiesThermo Fisher ScientificLonzaIrvine ScientificCDI

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1. A thorough and detailed analytical review of the Progenitor Cell Product market2. Brief about evident changes and market developments affecting market dynamics3. A clear understanding of market segmentation related to Progenitor Cell Product market4. A critical synopsis of all historical, real time as well as forecast developments likely to impact growth5. A systematic review of the diverse market developments and potent alterations that steer growth in the global Progenitor Cell Product market6. A reference of all the successful growth rendering developments

By the product type, the market is primarily split into:

Pancreatic progenitor cellsCardiac Progenitor CellsIntermediate progenitor cellsNeural progenitor cells (NPCs)Endothelial progenitor cells (EPC)Others

By the application, this report covers the following segments:

Medical careHospitalLaboratory

Owing to the sudden onset of global pandemic with the COVID-19 outrage in place, Orbis Pharma Reports analysts and dedicated research personnel have assigned a specific section evaluating the various implications and explaining the aftermath of the pandemic affecting diverse trends, developments as well as also categorically focusing on various opportunities emerging during the pandemic. The section is aimed at allowing market players to devise winning growth plans to secure profit even amidst the pandemic in Progenitor Cell Product market.

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Covid-19 Impact on Global Progenitor Cell Product Market 2020 Industry Opportunities And Development Analysis 2026: NeuroNova AB,R&D Systems,Asterias...

Cardiac Stem Cells Comments Off on Covid-19 Impact on Global Progenitor Cell Product Market 2020 Industry Opportunities And Development Analysis 2026: NeuroNova AB,R&D Systems,Asterias… | September 11th, 2020

A study which appeared in the journal Oncotarget sheds light on why people with Down syndrome are at higher risk of Leukemia. Researchers pinpointed a new set of genes overexpressed in endothelial cells of individuals with Down syndrome, thus creating an environment conducive for leukemia.

Down syndrome occurs in approximately in one in 700 babies, and individuals with the syndrome not only development physical impairments, they have a greatly augmented risk of developing leukemia. Specifically, people with Down syndrome have a 500-fold risk of developing acute megakaryoblastic leukemia (AMKL) and a 20-fold risk of being diagnosed with acute lymphoblastic leukemia (ALL).

In this study, researchers used skin samples from patients with Down syndrome to create induced pluripotent stem cells (iPSC). They subsequently differentiated the iPSC cells into that were then endothelial cells. The researchers observed that the endothelial cell genetic expression produced altered endothelial function throughout cell maturation. We found that Down syndrome, or Trisomy 21, has genome-wide implications that place these individuals at higher risk for leukemia, says co-lead author Mariana Perepitchka, BA, Research Associate at the Manne Research Institute at Lurie Childrens via a press release. We discovered an increased expression of leukemia-promoting genes and decreased expression of genes involved in reducing inflammation. These genes were not located on chromosome 21, which makes them potential therapeutic targets for leukemia even for people without Down syndrome.

Our discovery of leukemia-conducive gene expression in endothelial cells could open new avenues for cancer research, said co-lead author Yekaterina Galat, BS, Research Associate at the Manne Research Institute at Lurie Childrens.

Fortunately, advances in iPSC technology have provided us with an opportunity to study cell types, such as endothelial cells, that are not easily attainable from patients, stated senior author Vasil Galat, PhD, Director of Human iPS and Stem Cell Core at Manne Research Institute at Lurie Childrens and Research Assistant Professor of Pathology at Northwestern University Feinberg School of Medicine. If our results are confirmed, we may have new gene targets for developing novel leukemia treatments and prevention.

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Study Identifies New Set of Genes That May Explain Why People with Down Syndrome Have a Higher Risk of Leukemia - DocWire News

Skin Stem Cells Comments Off on Study Identifies New Set of Genes That May Explain Why People with Down Syndrome Have a Higher Risk of Leukemia – DocWire News | September 9th, 2020

Yes, even your metabolism has a memory and it can hold a grudge for years. In people with diabetes, periods of high blood sugar can negatively impact their health years later, even if they get their blood sugar under control. While this metabolic memory phenomenon has been known for years, why it happens is poorly understood.

Rama Natarajan, Ph.D., Professor and Chair of the Department of Diabetes Complications & Metabolism at City of Hope, turned to our epigenome for the answer.

Weve shown the first link between DNA methylation in blood and stems cells, blood sugar history, and future development of complications, said Natarajan. This highlights the importance of good glycemic control to prevent long-term complications.

The history of metabolic memory

We now know high blood sugar can lead to a variety of complications, including eye disease, kidney disease, nerve problems, heart disease, and stroke. But the relationship between strict blood sugar control and complication risk wasnt well understood before the 1980s.

Back in 1983, the Diabetes Control and Complications Trial (DCCT) began tracking complications in 1,441 participants with type 1 diabetes. Researchers compared the occurrence of long-term complications between participants who tightly regulated their blood glucose levels to those who followed less strict standard regulation.

After 10 years, the difference was striking the risk of diabetic complications was reduced in participants who tightly regulated their blood sugar but not in those following standard regulation. In other words, a person with higher blood sugar had a higher risk of complications.

To continue following the DCCT patients, the Epidemiology of Diabetes Interventions and Complications (EDIC) follow-up trial began at the end of DCCT in 1993 and is ongoing. At the end of DCCT, all participants were encouraged to adopt strict blood sugar regulation; many in the standard regulation group did.

Despite blood sugar regulation being very similar in all the patients (as measured by hemoglobin A1c, called HbA1c), differences persisted between the two original intervention groups. The phenomenon of long-term effects from high or variable blood sugar control is called metabolic memory (or the legacy effect in type 2 diabetes).

Complications resulted from total high blood sugar exposure it didnt matter whether the person was exposed to slightly elevated levels over a long time or high levels over a short time.

So, what caused the sweet sugar molecule to become so destructive?

Sugary destruction

Extra sugar in your blood can interact with your cells, DNA, and proteins, adding itself onto things it shouldnt be on through a process called glycation. In fact, HbA1c can be thought of as sugar-coated red blood cells.

The sugar-coated molecules cant function as well, if at all, and the damage begins a self-perpetuating cycle. Not only do these damaged molecules stop working, they can also accumulate in the skin, eyes, and other organs, causing damage. Build-up of sugar-coated molecules can trigger the creation of harmful free radicals, causing oxidative stress and feeding a destructive cycle.

Although sugar can directly modify molecules, it can also trigger other epigenetic modifications. These modifications can control how genes are expressed, changing protein levels in cells.

There hasnt been a strong genetic association with diabetic complications very few genetic mutations have been strongly linked to complications, Natarajan explained. But we knew the epigenome is what makes identical twins different and can have implications into why one gets diabetes or cancer and the other doesnt. So, we turned our focus to epigenetics.

Epigenetics and diabetes

Natarajan sought to explain the long-term sugary destruction wrought by high blood sugar by searching the epigenome. Her lab specifically looks for one type of modification called DNA methylation, where a tiny molecule called a methyl group is added onto DNA.

Epigenetics is the coating on top of genetics that can be altered by environmental influences, Natarajan said. We started focusing on the role of epigenetics in developing diabetes and its complications because we know that lifestyles, improper diet, lack of exercise, and even viruses can affect epigenetics.

Natarajans lab began collaborating with the DCCT trial group, analyzing data collected through the trial for epigenetic clues to explain the metabolic memory of complications. They found more modifications associated with active genes on proteins called histones that are wrapped by DNA in participants with regular blood sugar control compared to the strict controllers. Even more interesting was that many epigenetic DNA methylation variations between the two groups persisted through at least 17 years of follow-up in the EDIC study.

These changes were in important genes related to complications, showing something about persistent epigenetic programming in peripheral blood cells, commented Natarajan. Previous high blood sugar episodes could be a key factor in why these genes were continually misbehaving.

Now, Natarajans lab illuminated even more links between epigenetic changes, blood sugar history, and metabolic memory in their recent Nature Metabolism paper. Persistent epigenetic modifications of a few key genes were detected in participants with previously less regulated blood sugar who developed either retinopathy or nephropathy. They showed that DNA methylation is a key link between a patients HbA1c history, metabolic memory, and development of future complications.

Many HbA1c-associated modifications were in stem cells and the blood cells they create. Even though blood cells are turned over relatively quickly, stem cells stick around for a long-time, so changes in stem cells can have long-term consequences.

The important thing we found was the connection to stem cells, explained Natarajan. Were asking how these changes alter inflammatory gene expression and how we can interrupt those pathways.

Sugar-modified genes arent so sweet

Natarajans lab sorted through all the modified genes to find the most common modifications in participants with less strict blood sugar control. The most commonly modified gene coded for thioredoxin-interacting protein (TxNIP).

TxNIP is not a new protein, but the discovery that its DNA methylation is altered by different glycemic control is new, Natarajan added.

Thioredoxin-interacting protein is known to be highly regulated in certain pancreas cells, called beta cells, that release insulin. The plot thickened when high blood sugar was found to increase TxNIP protein production. Even more interesting, high TxNIP protein levels make beta-cells dysfunctional, ultimately leading to their untimely death. So, high blood sugar triggers more TxNIP to be produced, possibly through epigenetic modifications of the TxNIP gene, which ultimately leads to the death of insulin-producing beta cells.

Showing that the TxNIP gene can be epigenetically modified for years and years suggests that it could be one of the culprits causing long-term problems in diabetes, Natarajan said.

The proteins that TxNIP interacts with, called thioredoxins, protect against oxidative stress. TxNIP can bind to and inactivate thioredoxin to increase oxidative stress by increasing reactive oxygen species (ROS). In mouse cells in a dish, high glucose exposure triggered increased ROS levels mediated by TxNIP, leading to oxidative stress. Oxidative stress can trigger cell and organ damage, so this could be one mechanism explaining diabetes-induced damage.

Her lab also found epigenetic changes in other genes related to inflammation and inflammation-related processes.

Next steps and clinical implications

Natarajans lab is continuing to study the link between blood sugar history, epigenetics, and other complications of diabetes. They are also expanding their scope, searching the entire genome for more epigenetic modifications linked with past blood sugar maintenance.

This study also lays the groundwork for further studies with meaningful clinical implications, including developing epigenetic biomarkers for diabetic complications. In the future, Natarajan says a simple blood test looking at key epigenetic modifications, along with HbA1c history, could be used to predict future risk of retinopathy, nephropathy, and neuropathy. This would allow the doctor to figure out who should have early and more aggressive treatment to mitigate complication risk.

While these studies were done in type 1 diabetes patients, other studies in type 2 diabetes patients have shown similar epigenetic modifications after history of higher blood sugar levels.

Turning knowledge into potential drugs

What about doing something about the epigenetic modifications can we remove them? As a matter of fact, yes!

There is an interesting new type of experimental drug on the horizon called epigenetic editing. The hot new technology CRISPR isnt just for cutting out chunks of DNA or controlling genes it can also be used to insert or remove epigenetic modifications. While this technology is still experimental and in early preclinical animal studies, the potential is very exciting.

A CRISPR/enzyme pair can be used the CRISPR genetic material can hunt down the genetic spot you want to change; and the attached enzyme can snip or add certain molecules to the DNA, effectively removing or creating an epigenetic modification, thereby activating or silencing the targeted gene.

Enzymes such as methyltransferase or demethylase can add or remove methyl groups from genes. Because they just change what is on the gene or histone wrapped around it (not the genetic sequence itself), the gene itself isnt tampered with, meaning there could be less genetic complications associated with CRISPR epigenetic editing.

This is a futuristic thing, Natarajan concluded. The combination of genetics and epigenetics is going to be the future of personalized medicine.

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Can High Blood Sugar Haunt People with Diabetes Even After it is Under Control? - BioSpace

Skin Stem Cells Comments Off on Can High Blood Sugar Haunt People with Diabetes Even After it is Under Control? – BioSpace | September 9th, 2020

Dr. Shavelle, a Millikan High School (Long Beach, Calif.) graduate, is returning to Long Beach with more than 20 years of cardiology practice, research leadership, and teaching experience. He joins Long Beach Medical Center from Keck Medical Center at the University of Southern California, where he served as the Director of Interventional Cardiology while leading a multitude of clinical research trials, including several focused on implanted devices for heart failure. He plans on increasing the availability of clinical research trials for cardiology patients at Long Beach Medical Center.

"The MemorialCare Heart & Vascular Institute has a rich history of research and pioneering new treatment techniques," says Ike Mmeje, chief operating officer, Long Beach Medical Center.

"Dr. Shavelle's passion for research makes him a perfect fit to continue that legacy and find the next cutting-edge treatment for our cardiology patients."

MemorialCare Heart & Vascular Institute facilities are among the most comprehensive centers for diagnosis, treatment and rehabilitation of cardiac disease, providing groundbreaking care for complex heart conditions, including myocardial infarction, heart failure, arrhythmias and peripheral vascular disease. In addition to his hopes to expand research opportunities, Dr. Shavelle plans on expanding the programs for heart failure and structural heart disease.

"I am excited to join the MemorialCare Heart & Vascular Institute at Long Beach Medical Center," says Dr. Shavelle. "My dad was a physician here, and many of my mentors and fellows are at Long Beach Medical Center. I'm looking forward to creating more collaboration among cardiologists, surgeons, residents and the entire team to expand the already comprehensive cardiology care available to the community."

After earning his medical degree from the University of California, Los Angeles (UCLA), Dr. Shavelle completed his internal medicine internship and residency at Harbor-UCLA Medical Center. He completed General Cardiology Fellowship at the University of Washington and Interventional Cardiology Fellowship at Harbor-UCLA Medical Center/Good Samaritan Hospital. Dr. Shavelle served as Associate Professor at both the David Geffen School of Medicine at UCLA and the Keck School of Medicine at the University of Southern California. He alsoserveson the editorial boards for the Journal of Cardiovascular Pharmacology and Therapeutics, Current Medical Research and Opinion and Cardiology Clinics.

The MemorialCare Heart & Vascular Institute delivering nearly 20,000 cardiovascular diagnostic tests and treatments last year continues to push the boundaries of discovery with many "firsts." These began 70 years ago when world-renowned cardiologist, researcher and educator, the late Mervyn Ellestad, M.D., co-invented at Long Beach Medical Center the modern-day maximum stress test to detect heart disease. Today, millions of exercise stress tests performed annually save hundreds of thousands of lives globally.

"It is amazing how the field of cardiology has grown and how many treatment options are available through minimally invasive techniques," says Dr. Shavelle. "Many of these new treatment options have come from research trials, and I'm looking forward to expanding the opportunities for patients in the Long Beach area. The studies we have in the pipeline include trials with stem cells and heart failure devices."

About MemorialCare Long Beach Medical Center:MemorialCare Long Beach Medical Center has been providing the community with compassionate, quality health care for more than 100 years. While leading in specialized care, research and education, Long Beach Medical Center uses the most advanced health care technologies it is the only hospital in L.A. County with the innovative ExactechGPS and ExcelsiusGPS surgical systems. Long Beach Medical Center is ranked no. 7 in the Los Angeles Metro Area by U.S. News & World Report and has earned Magnet recognition for nursing excellence. With leading centers for cancer, heart, rehabilitation, orthopedics, neurology and trauma, physicians and surrounding hospitals continually refer to its accredited programs. For more information, visit memorialcare.org/LongBeach.

SOURCE MemorialCare Long Beach Medical Center

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David Shavelle, MD, Named Medical Director of Adult Cardiology for the MemorialCare Heart & Vascular Institute at Long Beach Medical Center -...

Cardiac Stem Cells Comments Off on David Shavelle, MD, Named Medical Director of Adult Cardiology for the MemorialCare Heart & Vascular Institute at Long Beach Medical Center -… | September 9th, 2020

Targeted Oncology was joined by Kami J. Maddocks, MD, associate professor of clinical internal medicine, Division of Hematology, The Ohio State University Comprehensive Cancer CenterJames, for the discussion of a 76-year-old man with relapsed/refractory diffuse large B-cell lymphoma (DLBCL) in a recent tweet chat. In this case scenario, the patient presented with stage IV high-risk disease and received R-CHOP (Rituximab [Rituxan], cyclophosphamide, doxorubicin, vincristine, prednisone), and radiotherapy.

Although the treatment appeared well-tolerated, the patient presented with similar symptoms as at diagnosis after completing 6 cycles with complete response to the therapy. According to the work-up, the patient is ineligible for transplant.

The patient was ineligible for stem cell transplantation (SCT), which Maddocks speculates may be due to the patients age, although other considerations could include comorbidities or intolerance to R-CHOP. Eligibility is the first thing she considers for her patients as it is currently the standard of care and the only curative approach for patients to receive salvage chemotherapy followed by consolidation with autologous SCT.

Maddocks told Targeted Oncology, In some patient cases, [the reason for ineligibility] is age even though there's no specific age cutoff, but we know that it's harder on the marrow as patients get older to collect stem cells and get that aggressive salvage chemotherapy. Patient comorbidities [can also impact eligibility], so heart conditions, lung conditions, renal insufficiency can be a problem. Performance status and then lastly, just if the patient had trouble getting to their initial chemotherapy with R-CHOP or had a lot of complications, then it's probably going to be harder for them to tolerate even more aggressive or intensive therapy.

In a twitter poll ahead of the chat, Targeted Oncology asked what the next best line of therapy for this patient might be, with 4 potential different treatment options. The option that drew the most attention, however, was the recently approved regimen of tafasitamab (Monjuvi) and lenalidomide (Revlimid).

Maddocks tweeted, All these options are potential therapeutic choices for this patient, but the combination of tafasitamab/lenalidomide is the only option approved in this setting. The treatment has a promising ORR [overall response rate], and CR [complete response], and the remissions for patients who respond are durable!

During the tweet chat, Maddocks reviewed each of the different treatment options in the poll, and why she selected this combination regimen as the next best line of therapy for this particular patient. Following the chat, she spoke with Targeted Oncology to share further insights on each of these therapeutic approaches and the importance of the FDAs approval of tafasitamab plus lenalidomide in this setting.

The combination of tafasitamab plus lenalidomide held the majority vote, which Maddocks agreed would be the next best line of therapy for this patient.

For patients who are not candidates or considered eligible for a salvage chemotherapy followed by autologous SCT, the tafasitamab/lenalidomide combination was recently approved in the setting of first relapse, and it's the only approved therapy in this setting, Maddocks said. Historically, we would give some sort of palliative chemotherapy approach if patients were candidates and interested in pursuing therapy, or consideration of clinical trial, but this is the only therapy approved in this setting.

The approval of tafasitamab in combination with lenalidomide includes an indication for patients who are not eligible for autologous SCT, as describes the patient in our case. This regimen was approved on the basis of the phase 2 L-MIND (NCT02399085) clinical trial, which explored this use of this regimen in 81 patients with relapsed/refractory DLBCL. Two-year follow-up demonstrated an ORR of 58.5%, which included CRs in 41.3% of patients and partial responses (PRs) in 17.5% of patients. In addition, 15.0% achieved stable disease, and the median duration of response was 34.6 months (95% CI, 26.1-34.6).1

I think this patient case is the perfect example of where this can fit into the treatment landscape, Maddocks explained. For patients who first relapse from the standard R-CHOP therapy, the toxicities were generally manageable, and with the response rate, this is a great option for patients at first relapse who are not going to be candidates for a transplant. I think maybe patients who go on to get palliative chemotherapy or maybe patients who get treatment with plans to go to transplant but just don't tolerate it and dont look like they're going to [undergo] aggressive therapy, this may be an option for those patients too, understanding that there is some role for CAR T in a set of those patients.

This study, which was presented during the 25th Congress of the European Hematology Association (EHA), demonstrated that the majority of toxicities were hematologic, and most were reversible. The most common grade 3 hematologic treatment-emergent adverse events (TEAEs) were neutropenia in 49.4% of patients, thrombocytopenia in 17.3%, and febrile neutropenia in 13.2%.1

These were able to be managed by holding the dose growth factor, and there was a population of patients who had to be dose-reduced on the lenalidomide. The starting dose was 25 mg, so the majority were able to maintain 20 mg if they were dose-reduced, although a few had to be reduced more than once, Maddocks said. The most common grade 3/4 or serious AEs were infection, probably not surprisingly, and overall, that's probably similar to what you see with other options in this setting. There was a small number of infusion reactions, but these were all grade 1 in the trial and were easily managed.

Non-hematologic TEAEs of grade 3 included pneumonia in 8.6% of patients and hypokalemia in 6.2%. Serious AEs reported included pneumonia in 8.6%, febrile neutropenia in 6.2%, and pulmonary embolism in 3.7%, as well as bronchitis, lower respiratory tract infection, atrial fibrillation, and congestive cardiac failure in 2.5% each.1

Given the safety profile of this combination of tafasitamab plus lenalidomide, this regimen is particularly suitable for a large proportion of patients with DLBCL, Gilles Salles, MD, PhD, lead author of L-MIND, toldTargeted Oncology. We do know that the median age of occurrence of DLBCL is in the late 60s, and there are many, many patients that are over 70 and that are not usually transplant eligible. Clearly this is a great opportunity for patients to receive this non-cytotoxic regimen.

Although this regimen is an exciting opportunity for patients with DLBCL and relapsed/refractory disease, 1 challenge that needs to be addressed is the potential use of tafasitamab plus lenalidomide in sequence with CAR T-cell therapy. There is very little experience, if any, of patients receiving the combination regimen after receiving CAR T-cell therapy. The combination and CAR T cells both target the same antigen, CD19, which can be problematic. As its known that some patients will lose CD19 expression on CAR T-cell therapy, the regimen may no longer be an effective treatment option.

For those patients that had failed CAR T-cell therapy, substantial proportions, about 30% of them, may have lost CD19 expression and then may not be eligible anymore for this regimen. There is, however, a substantial proportion of patients that retains CD19 and in whom tafasitamab/lenalidomide can be used as a treatment option, Salles commented.

A large proportion of patients will maintain CD19 expression following CAR T-cell therapy, so tafasitamab plus lenalidomide may still be effective in a percentage of patients.

Its hard to say because we dont have a lot of data, but we do know there are other CD19-directed therapies outside of CAR T cell development, Maddocks told Targeted Oncology. I think in the next few years, were going to see patients treated both pre- and post-CAR T with other CD19-directed therapies, and well have more information on this.

The combination of polatuzumab vedotin (Polivy) plus bendamustine (Bendeka) and rituximab (BR) was approved by the FDA as treatment of patients with relapsed/refractory DLBCL after 2 prior lines of therapy in June 2019 based on the findings from the phase 1b/2 GO29365 (NCT02257567) clinical trial. Although this option is also not FDA-approved for the treatment of patients after first relapse, Maddocks noted that this was the only treatment evaluated in a randomized trial. The study had included patients who were ineligible for transplant.

Significant improvements were observed with polatuzumab vedotin plus BR compared with BR alone in an international, multicenter, open-label study, particularly in regard to the ORR, CRs, progression-free survival (PFS), and overall survival (OS). CRs were observed in 40.0% of the patients with the combination versus 17.5% with BR alone. Survival rates favored the combination as well, with a median PFS of 9.5 months with the combination versus 3.7 months with BR alone (HR, 0.36; 95% CI, 0.21-0.63; P <.001) and a median OS of 12.4 months versus 4.7 months (HR, 0.42; 95% CI, 0.24-0.75; P =.002), respectively.2

The addition of polatuzumab did increase toxicity from the standpoint of cytopenias, but that didn't really translate to increased serious infections. It did add neuropathy as a side effect, but most of that was reversible, so I think this was a regimen that, by the addition of polatuzumab, was something that you could offer patients that did give them somewhat of a better overall response and was more durable than just giving them a palliative chemotherapy alone, Maddocks added. This is also a regimen that's been used in patients who were not able to achieve a remission to bridge them to CAR T or in some patients after CAR T, and so I can understand why this was definitely one of the more favorable choices.

In the study, grade 3/4 neutropenia was observed more frequently in the combination arm (42.6%) compared with the BR alone arm (33.3%), but the occurrence of grade 3/4 infections was comparable between the 2 groups (23.1% vs. 20.5%, respectively). In addition, the study authors noted that although many of the fatal AEs occurred after disease progression, 11 patients in the BR arm experienced fatal AEs compared with 9 in the combination arm, infection being the most common, which was the cause in 4 patients in each arm.2

Although the regimen appeared tolerable in this setting, Maddocks tweeted, it is more attractive than chemotherapy alone and understandable why it was chosen [as the second-best option in the Twitter poll].

Among the treatment options considered in our twitter poll ahead of the tweet chat, selinexor (Xpovio) only caught the attention of 16.7% of voters, similar to CAR T-cell therapy. However, both of these options are currently only approved in patients who have received at least 2 prior lines of therapy, which this case did not.

In regard to selinexor in particular, Maddocks tweeted, Looking at the single arm phase 2 data, it also has the lowest overall response rates of all the options listed with an ORR of 28%.

Selinexor received its approval from the FDA in June 2020, which is indicated for the treatment of adult patients with relapsed/refractory DLBCL, not otherwise specified, who have received at least 2 prior systemic therapies. This is the only oral single-agent therapy approved in this setting, and it is also the only nuclear export inhibitor approved by the FDA for use in hematologic malignancies.

The agent was approved on the basis of the phase 2b SADAL clinical trial, which demonstrated an ORR of 29% with 13% CRs and 16% PRs. The responses achieved in the study were durable, which led to a median duration of response of 9.2 months in the overall population (95% CI, 4.8-23.0) and 13.5 months in those who had achieved a CR (95% CI, 9.3-23.0).3

The most common treatment-related AEs were cytopenias and gastrointestinal/constitutional symptoms, which were generally reversible and manageable with dose modifications and/or standard supportive care approaches. The most common on-hematologic AEs, which were mostly grade 1/2, were nausea (52.8%), fatigue (37.8%), and anorexia (34.6%). The most common grade 3/4 AEs included thrombocytopenia (39.4%), neutropenia (20.5%), and anemia (13.4%). No treatment-related grade 5 AEs were observed.

CAR T-cell therapy, on the other hand, offers a unique option to this patient case even though it is still only approved in patients who have progressed or relapsed after 2 prior therapies or SCT. The TRANSCEND-PILOT-017006 (NCT03483103) study is evaluating the potential for CAR T-cell therapy lisocabtagene maraleucel (liso-cel) as treatment of patients with relapsed/refractory aggressive B-cell non-Hodgkin lymphoma who have received at least 1 prior therapy and are ineligible for SCT. While this does appear promising for introducing CAR T-cell therapy earlier on for patients with DLBCL, the treatment is not available off trial and is not a standard approach.

Maddocks told Targeted Oncology, It's very clear who's eligible for autologous transplant by age and comorbidities, but with CAR T, it's not so clear all the time who is going to be a candidate. There's not as great of data or information on who is going to be a candidate for that or not. Probably more patients are going to be a candidate for transplant, but there is still going to be patients that are comorbidities that they're not going to be a candidate for CAR T cells, and while they're approved in this setting and they can be very effective, there's also logistical issues, including that right now there's only certain centers, most often transplant centers, that are able to administer CAR T cells, so the patient has to have access to a center, they have to be able to get through the time that their leukapheresis cells are sent out and then sent back, and there's still barriers to cost and insurance in some patients, too.

This particular patient case does represent a challenge, Maddocks said. Historically, this is not a patient that's going to be a candidate for an autologous SCT, and that's going to be the only curative approach. CAR T is not approved in this setting, which is the other curative approach we know outside of patients who are unable to get to autologous STC, or at least appears to be likely curative for a percentage of patients.

Overall, CAR T-cell therapy is not a viable treatment option for the patient depicted in our tweet chat discussion, although it can still offer curative opportunities to a select group of patients with DLBCL who are ineligible for transplant.

In conclusion, tafasitamab plus lenalidomide helps fulfill the unmet need of patients who are in first relapse but are ineligible for transplant, which is the only curative option for patients with relapsed/refractory DLBCL. Although CAR T cells appear hopeful in this space, more research needs to be done to further determine their role in the treatment paradigm.

When you look at relapsed DLBCL, in general, and have these options, it's exciting for our patients to be able to have these. All of these have come up in the last 1 to 2 years, CAR T being a little bit longer than the other 3 regimens, but they all have offered patients tolerable therapy in the setting of previously not having these options.

Reference

1. Salles G, Duell J, Gonzlez-Barca E, et al. Long-term outcomes from the phase II L-MIND study of Tafasitamab (MOR208) plus lenalidomide in patients with relapsed or refractory diffuse large B-cell lymphoma. Presented at: Presented at: EHA25 Virtual; June 11-21, 2020. Abstract EP1201.

2. Sehn LH, Herrera AF, Flowers CR, et al. Polatuzumab Vedotin in Relapsed or Refractory Diffuse Large B-Cell Lymphoma.J Clin Oncol. 2019;38(2):155-165. doi: 10.1200/JCO.19.00172

3. Kalakonda N, Cavallo F, Follows G, et al. A phase 2b study of selinexor in patients with relapsed/refractory (r/r) diffuse large B-cell lymphoma (DLBCL).Hematol Oncol. 2019;37(S2). doi: 10.1002/hon.31_2629

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Tweet Chat Recap: Evaluating Treatment Approaches for Relapsed/Refractory DLBCL - Targeted Oncology

Cardiac Stem Cells Comments Off on Tweet Chat Recap: Evaluating Treatment Approaches for Relapsed/Refractory DLBCL – Targeted Oncology | September 9th, 2020

Sept. 9, 2020 12:00 UTC

ALAMEDA, Calif. & CARLSBAD, Calif.--(BUSINESS WIRE)-- AgeX Therapeutics, Inc.(AgeX: NYSE American: AGE), a company focused on developing and commercializing innovative therapeutics for human aging, and Lineage Cell Therapeutics, Inc.. (Lineage: NYSE American and TASE: LCTX), a clinical-stage biotechnology company developing novel cell therapies for unmet medical needs, and ES Cell International Pte Ltd. (ESI), a subsidiary of Lineage, today announced the broadening of their collaborative relationship with regard to ESI stem cell lines. ESI cell lines are current Good Manufacturing Practice (cGMP)-compatible, registered with the National Institutes of Health (NIH), and widely studied as a potential source for the industrial-scale manufacture of any cell type in the human body. Neither party made or received any cash payments in connection with this arrangement.

Both Lineage and AgeX are pioneering important aspects of regenerative medicine. Working together, we have amended our agreement regarding ESI cell lines derived under cGMP to be optimal for the business needs of each company, stated Brian M. Culley, Lineages CEO. In particular, Lineage has acquired exclusivity for the use of ESI cell lines in spinal cord injury and certain oncology indications. On the other hand, AgeX has gained greater flexibility and independence to support its efforts toward licensing certain technologies and cell lines to third parties. With this step complete, we next intend to explore additional opportunities to collaborate with AgeX on promising tissue regenerating projects.

The ESI cell lines are recognized for being the first clinical-grade human pluripotent stem cell lines created under cGMP as described in the publication Cell Stem Cell (2007;1:490-4). It may become possible to generate potentially limitless quantities of all the cell types of the human body from these master cell banks with a wide array of potential therapeutic applications. These cell lines are listed on the NIH Stem Cell Registry and are among the best characterized and documented stem cell lines available globally. Importantly, ESI cells are among only a few pluripotent stem cell lines from which a derived cell therapy product candidate has been granted FDA investigational new drug (IND) clearance to commence human studies.

Key to the creation of shareholder value is the placement of these important assets in the hands of collaborators to advance the development of a vast number of regenerative therapies, said Michael West, Ph.D., AgeXs CEO. Our collaborative relationship with Lineage led to this streamlined process that may facilitate the commercialization of these applications to the benefit of shareholders of each company. Since the beginning of the year, AgeX has entered into new research and commercial arrangements utilizing an array of its technology platforms, such as UniverCyteTM for the engineering of universally transplantable cells, PureStem for the manufacture and derivation of cells, and an ESI cell line as source material for deriving cellular therapeutics.

About AgeX Therapeutics, Inc

AgeX Therapeutics, Inc. (NYSE American: AGE) is focused on developing and commercializing innovative therapeutics for human aging. Its PureStem and UniverCyte manufacturing and immunotolerance technologies are designed to work together to generate highly defined, universal, allogeneic, off-the-shelf pluripotent stem cell-derived young cells of any type for application in a variety of diseases with a high unmet medical need. AgeX has two preclinical cell therapy programs: AGEX-VASC1 (vascular progenitor cells) for tissue ischemia and AGEX-BAT1 (brown fat cells) for Type II diabetes. AgeXs revolutionary longevity platform induced Tissue Regeneration (iTR) aims to unlock cellular immortality and regenerative capacity to reverse age-related changes within tissues. AGEX-iTR1547 is an iTR-based formulation in preclinical development. HyStem is AgeXs delivery technology to stably engraft PureStem cell therapies in the body. AgeXs core product pipeline is intended to extend human healthspan. AgeX is seeking opportunities to establish licensing and collaboration arrangements around its broad IP estate and proprietary technology platforms and therapy product candidates. For more information, please visit http://www.agexinc.com or connect with the company on Twitter, LinkedIn, Facebook, and YouTube.

About Lineage Cell Therapeutics, Inc.

Lineage Cell Therapeutics is a clinical-stage biotechnology company developing novel cell therapies for unmet medical needs. Lineages programs are based on its robust proprietary cell-based therapy platform and associated in-house development and manufacturing capabilities. With this platform Lineage develops and manufactures specialized, terminally differentiated human cells from its pluripotent and progenitor cell starting materials. These differentiated cells are developed to either replace or support cells that are dysfunctional or absent due to degenerative disease or traumatic injury or administered as a means of helping the body mount an effective immune response to cancer. Lineages clinical programs are in markets with billion dollar opportunities and include three allogeneic (off-the-shelf) product candidates: (i) OpRegen, a retinal pigment epithelium transplant therapy in Phase 1/2a development for the treatment of dry age-related macular degeneration, a leading cause of blindness in the developed world; (ii) OPC1, an oligodendrocyte progenitor cell therapy in Phase 1/2a development for the treatment of acute spinal cord injuries; and (iii) VAC, an allogeneic dendritic cell therapy platform for immuno-oncology and infectious disease, currently in clinical development for the treatment of non-small cell lung cancer and in preclinical development for additional cancers and as a vaccine against infectious diseases, including SARS-CoV-2, the virus which causes COVID-19. For more information, please visit http://www.lineagecell.com or follow the Company on Twitter @LineageCell.

About ESI

ES Cell International Pte Ltd (ESI). Established in 2000, ESI, a wholly owned subsidiary of Lineage Cell Therapeutics, Inc., developed ESI hESC lines in compliance with the principles of current Good Manufacturing Practices and has made them available to various biopharmaceutical companies, universities and other research institutions, including AgeX. These ESI cell lines are extensively characterized and most of the lines have documented and publicly available genomic sequences.

Forward-Looking Statements for AgeX

Certain statements contained in this release are forward-looking statements within the meaning of the Private Securities Litigation Reform Act of 1995. Any statements that are not historical fact including, but not limited to statements that contain words such as will, believes, plans, anticipates, expects, estimates should also be considered forward-looking statements. Forward-looking statements involve risks and uncertainties. Without limitation, such risks include those associated with the use of human pluripotent stem cell lines in the research, development, and use of therapies for the treatment of human diseases, disorders, and injuries, and risks associated with commercializing the pluripotent stem cell lines. Actual results may differ materially from the results anticipated in these forward-looking statements and as such should be evaluated together with the many uncertainties that affect the business of AgeX Therapeutics, Inc. and its respective subsidiaries, particularly those mentioned in the cautionary statements found in more detail in the Risk Factors section of its most recent Annual Reports on Form 10-K and Quarterly Reports on Form 10-Q filed with the Securities and Exchange Commissions (copies of which may be obtained at http://www.sec.gov). Subsequent events and developments may cause these forward-looking statements to change. Undue reliance should not be placed on forward-looking statements, which speak only as of the date on which they were made. AgeX specifically disclaims any obligation or intention to update or revise these forward-looking statements as a result of changed events or circumstances that occur after the date of this release, except as required by applicable law.

Forward-Looking Statements for Lineage

Lineage cautions you that all statements, other than statements of historical facts, contained in this press release, are forward-looking statements. Forward-looking statements, in some cases, can be identified by terms such as believe, may, will, estimate, continue, anticipate, design, intend, expect, could, plan, potential, predict, seek, should, would, contemplate, project, target, tend to, or the negative version of these words and similar expressions. Such statements include, but are not limited to, statements relating to the potential commercialization of ESI cell lines. Forward-looking statements involve known and unknown risks, uncertainties and other factors that may cause Lineages actual results, performance or achievements to be materially different from future results, performance or achievements expressed or implied by the forward-looking statements in this press release, including risks and uncertainties inherent in Lineages business and other risks in Lineages filings with the Securities and Exchange Commission (the SEC). Lineages forward-looking statements are based upon its current expectations and involve assumptions that may never materialize or may prove to be incorrect. All forward-looking statements are expressly qualified in their entirety by these cautionary statements. Further information regarding these and other risks is included under the heading Risk Factors in Lineages periodic reports with the SEC, including Lineages Annual Report on Form 10-K filed with the SEC on March 12, 2020 and its other reports, which are available from the SECs website. You are cautioned not to place undue reliance on forward-looking statements, which speak only as of the date on which they were made. Lineage undertakes no obligation to update such statements to reflect events that occur or circumstances that exist after the date on which they were made, except as required by law.

View source version on businesswire.com: https://www.businesswire.com/news/home/20200909005398/en/

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AgeX Therapeutics and Lineage Cell Therapeutics Announce Expansion of Agreement Related to ESI Clinical-grade Pluripotent Stem Cell Lines for...

Spinal Cord Stem Cells Comments Off on AgeX Therapeutics and Lineage Cell Therapeutics Announce Expansion of Agreement Related to ESI Clinical-grade Pluripotent Stem Cell Lines for… | September 9th, 2020

AgeX Therapeutics, Inc. (AgeX: NYSE American: AGE), a company focused on developing and commercializing innovative therapeutics for human aging, and Lineage Cell Therapeutics, Inc. (Lineage: NYSE American and TASE: LCTX), a clinical-stage biotechnology company developing novel cell therapies for unmet medical needs, and ES Cell International Pte Ltd. (ESI), a subsidiary of Lineage, today announced the broadening of their collaborative relationship with regard to ESI stem cell lines. ESI cell lines are current Good Manufacturing Practice (cGMP)-compatible, registered with the National Institutes of Health (NIH), and widely studied as a potential source for the industrial-scale manufacture of any cell type in the human body. Neither party made or received any cash payments in connection with this arrangement.

Both Lineage and AgeX are pioneering important aspects of regenerative medicine. Working together, we have amended our agreement regarding ESI cell lines derived under cGMP to be optimal for the business needs of each company, stated Brian M. Culley, Lineages CEO. In particular, Lineage has acquired exclusivity for the use of ESI cell lines in spinal cord injury and certain oncology indications. On the other hand, AgeX has gained greater flexibility and independence to support its efforts toward licensing certain technologies and cell lines to third parties. With this step complete, we next intend to explore additional opportunities to collaborate with AgeX on promising tissue regenerating projects.

The ESI cell lines are recognized for being the first clinical-grade human pluripotent stem cell lines created under cGMP as described in the publication Cell Stem Cell (2007;1:490-4). It may become possible to generate potentially limitless quantities of all the cell types of the human body from these master cell banks with a wide array of potential therapeutic applications. These cell lines are listed on the NIH Stem Cell Registry and are among the best characterized and documented stem cell lines available globally. Importantly, ESI cells are among only a few pluripotent stem cell lines from which a derived cell therapy product candidate has been granted FDA investigational new drug (IND) clearance to commence human studies.

Key to the creation of shareholder value is the placement of these important assets in the hands of collaborators to advance the development of a vast number of regenerative therapies, said Michael West, Ph.D., AgeXs CEO. Our collaborative relationship with Lineage led to this streamlined process that may facilitate the commercialization of these applications to the benefit of shareholders of each company. Since the beginning of the year, AgeX has entered into new research and commercial arrangements utilizing an array of its technology platforms, such as UniverCyteTM for the engineering of universally transplantable cells, PureStem for the manufacture and derivation of cells, and an ESI cell line as source material for deriving cellular therapeutics.

About AgeX Therapeutics, Inc

AgeX Therapeutics, Inc. (NYSE American: AGE) is focused on developing and commercializing innovative therapeutics for human aging. Its PureStem and UniverCyte manufacturing and immunotolerance technologies are designed to work together to generate highly defined, universal, allogeneic, off-the-shelf pluripotent stem cell-derived young cells of any type for application in a variety of diseases with a high unmet medical need. AgeX has two preclinical cell therapy programs: AGEX-VASC1 (vascular progenitor cells) for tissue ischemia and AGEX-BAT1 (brown fat cells) for Type II diabetes. AgeXs revolutionary longevity platform induced Tissue Regeneration (iTR) aims to unlock cellular immortality and regenerative capacity to reverse age-related changes within tissues. AGEX-iTR1547 is an iTR-based formulation in preclinical development. HyStem is AgeXs delivery technology to stably engraft PureStem cell therapies in the body. AgeXs core product pipeline is intended to extend human healthspan. AgeX is seeking opportunities to establish licensing and collaboration arrangements around its broad IP estate and proprietary technology platforms and therapy product candidates. For more information, please visit http://www.agexinc.com or connect with the company on Twitter, LinkedIn, Facebook, and YouTube.

About Lineage Cell Therapeutics, Inc.

Lineage Cell Therapeutics is a clinical-stage biotechnology company developing novel cell therapies for unmet medical needs. Lineages programs are based on its robust proprietary cell-based therapy platform and associated in-house development and manufacturing capabilities. With this platform Lineage develops and manufactures specialized, terminally differentiated human cells from its pluripotent and progenitor cell starting materials. These differentiated cells are developed to either replace or support cells that are dysfunctional or absent due to degenerative disease or traumatic injury or administered as a means of helping the body mount an effective immune response to cancer. Lineages clinical programs are in markets with billion dollar opportunities and include three allogeneic (off-the-shelf) product candidates: (i) OpRegen, a retinal pigment epithelium transplant therapy in Phase 1/2a development for the treatment of dry age-related macular degeneration, a leading cause of blindness in the developed world; (ii) OPC1, an oligodendrocyte progenitor cell therapy in Phase 1/2a development for the treatment of acute spinal cord injuries; and (iii) VAC, an allogeneic dendritic cell therapy platform for immuno-oncology and infectious disease, currently in clinical development for the treatment of non-small cell lung cancer and in preclinical development for additional cancers and as a vaccine against infectious diseases, including SARS-CoV-2, the virus which causes COVID-19. For more information, please visit http://www.lineagecell.com or follow the Company on Twitter @LineageCell.

About ESI

ES Cell International Pte Ltd (ESI). Established in 2000, ESI, a wholly owned subsidiary of Lineage Cell Therapeutics, Inc., developed ESI hESC lines in compliance with the principles of current Good Manufacturing Practices and has made them available to various biopharmaceutical companies, universities and other research institutions, including AgeX. These ESI cell lines are extensively characterized and most of the lines have documented and publicly available genomic sequences.

Forward-Looking Statements for AgeX

Certain statements contained in this release are forward-looking statements within the meaning of the Private Securities Litigation Reform Act of 1995. Any statements that are not historical fact including, but not limited to statements that contain words such as will, believes, plans, anticipates, expects, estimates should also be considered forward-looking statements. Forward-looking statements involve risks and uncertainties. Without limitation, such risks include those associated with the use of human pluripotent stem cell lines in the research, development, and use of therapies for the treatment of human diseases, disorders, and injuries, and risks associated with commercializing the pluripotent stem cell lines. Actual results may differ materially from the results anticipated in these forward-looking statements and as such should be evaluated together with the many uncertainties that affect the business of AgeX Therapeutics, Inc. and its respective subsidiaries, particularly those mentioned in the cautionary statements found in more detail in the Risk Factors section of its most recent Annual Reports on Form 10-K and Quarterly Reports on Form 10-Q filed with the Securities and Exchange Commissions (copies of which may be obtained at http://www.sec.gov). Subsequent events and developments may cause these forward-looking statements to change. Undue reliance should not be placed on forward-looking statements, which speak only as of the date on which they were made. AgeX specifically disclaims any obligation or intention to update or revise these forward-looking statements as a result of changed events or circumstances that occur after the date of this release, except as required by applicable law.

Forward-Looking Statements for Lineage

Lineage cautions you that all statements, other than statements of historical facts, contained in this press release, are forward-looking statements. Forward-looking statements, in some cases, can be identified by terms such as believe, may, will, estimate, continue, anticipate, design, intend, expect, could, plan, potential, predict, seek, should, would, contemplate, project, target, tend to, or the negative version of these words and similar expressions. Such statements include, but are not limited to, statements relating to the potential commercialization of ESI cell lines. Forward-looking statements involve known and unknown risks, uncertainties and other factors that may cause Lineages actual results, performance or achievements to be materially different from future results, performance or achievements expressed or implied by the forward-looking statements in this press release, including risks and uncertainties inherent in Lineages business and other risks in Lineages filings with the Securities and Exchange Commission (the SEC). Lineages forward-looking statements are based upon its current expectations and involve assumptions that may never materialize or may prove to be incorrect. All forward-looking statements are expressly qualified in their entirety by these cautionary statements. Further information regarding these and other risks is included under the heading Risk Factors in Lineages periodic reports with the SEC, including Lineages Annual Report on Form 10-K filed with the SEC on March 12, 2020 and its other reports, which are available from the SECs website. You are cautioned not to place undue reliance on forward-looking statements, which speak only as of the date on which they were made. Lineage undertakes no obligation to update such statements to reflect events that occur or circumstances that exist after the date on which they were made, except as required by law.

View source version on businesswire.com: https://www.businesswire.com/news/home/20200909005398/en/

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Lineage Cell Therapeutics : AgeX Therapeutics and Lineage Cell Therapeutics Announce Expansion of Agreement Related to ESI Clinical-grade Pluripotent...

Spinal Cord Stem Cells Comments Off on Lineage Cell Therapeutics : AgeX Therapeutics and Lineage Cell Therapeutics Announce Expansion of Agreement Related to ESI Clinical-grade Pluripotent… | September 9th, 2020

I signed up to be a bone marrow donor in 2016, after an anonymous strangers marrow saved my father. It started out easy enough: The registry mailed me a kit to swab my cheeks, I mailed it back, and then I heard nothing for years. This wasnt unusual. Marrow transplantation requires finding complex and rare genetic matches; according to Be The Match, only about one out of every 430 people who sign up will ever go on to donate. I expected it would be a while before I got to pay my dads transplant forward. It did not occur to me that my opportunity might arise at the height of a global coronavirus pandemic.

The coronavirus created a tangle of moral dilemmas that most Americans never expected to face. At the extremes, weve resolved these dilemmas easily. Weve designated whole categories of labormostly underpaid, perennially underappreciatedessential because we accept that even with a plague lurking, people must eat and medicate and have working showers in which to cry. On the opposite end of the spectrum, weve trained our online shaming apparatus on the most reckless and selfish offendersthe wealthy New Yorkers who fled to the Hamptons, the house parties posted to Instagram with weak defensive captions (we only took our masks off for the body shots).

The longer we live in the shadow of an uncontained virus, the more agonizing the in-between dilemmas become. How long should people be expected to remain isolated from their loved ones? Is there a point at which the negative effects of physical distancing begin to outweigh the toll of the disease itself? On the one hand, we should do everything in our power to protect the most vulnerable in our communities. On the other hand, what should we tell the vulnerable seniors who feel they dont have endless spare months to let pass without embracing their grandchildren? Are our individual mitigation responsibilities lessened by the fact that we all made sacrifices to buy an incompetent president time to get this under control, and he squandered it? Are we that much more obligated to pick up the slack?

In some sort of sick philosophical joke, the moral waters get even murkier when you throw altruism into the mix. For all of the guidance reminding us of the impact of our selfish choices on strangersyou might not kill your own grandmother by going to that dive bar, but think of the bartenders roommates grandmothermoral experts have had far less to say about the boundaries around charitable acts. How should we think about helping strangers when doing so requires a dangerous level of social interaction? How should we measure the suffering of the people we want to help against the harm we risk causing to unseen others in the process? That quandary leads to another awful question that most people should never have to confront: When does human life become too risky to save?

Be The Match first notified me that it had identified me as a potential match in June, when coronavirus cases in Los Angeles, where I live, had just begun to spike. By the time I was confirmed as the patients best match and asked to proceed with a donation several weeks later, the city had become a full-blown hotspot. The idea of navigating the whole process in plague conditions made me nervous, but underneath the anxiety was a distinct whiff of relief. Like a lot of people, Id spent the last few months in a horrified daze, helpless to do anything but stay home, donate money, and cyberbully the mayor. Here, finally, was a task that felt equal to the urgency of the moment. Here was somethingsomeonereal. I just wasnt allowed to know who.

Be The Match will put donor and recipient in contact one year after the transplant, if both have consented; until then, everything is completely anonymous. I was told that my recipient was a man in the United States, along with his age (surprisingly young), and diagnosis (a type of blood cancer). Because matches are typically found within shared ancestries, I assume that he is, like me, an Ashkenazi Jew, and because he needed a bone marrow transplant, his situation must have been dire.

Fortunately, helping people like him has become simpler. When most people think of donating for a bone marrow transplant, they imagine general anesthesia; a very big needle; a painful recovery. This is one of the two ways to donate, but its grown much less common. Ninety percent of donors (including me) are instead asked to donate peripheral blood stem cells (PBSC), through a process called apheresis. While a donor is awake and watching Party Down, their blood flows through a tube attached to one arm, gets spun around in a centrifuge that separates out the extra blood-forming stem cells, and is returned through a tube into the other arm. This can take several hours, but its painless, and neednt even happen at a hospital. Usually.

(Sarah Lazarus)

On August 13, two nurses met me at the San Bernardino blood bank where I was scheduled to donate later that month. We were all there for an assessment, to make sure my arm veins could handle the apheresis needles. It was a weird little ritual. The two women bent on either side of me, intently tapping along my upturned arms in total silence as if waiting for something to tap back. They then switched sides, tapped the opposite arm, and issued their verdict: Too small. I would need to donate through a central line placed in one of my larger veins, and that could only happen at a hospital. I would probably be sent to a medical center two hours south in La Jolla, they told me.

This was a complication, but not necessarily a big deal. Be The Match footed the bill for all of my donation-related expenses, including the fancy car service that seemed safer, COVID-wise, than using Lyft. (I am a genius who moved to Los Angeles without a drivers license. A worse essay for another time.) Donating at the La Jolla hospital would mean a longer commute, maybe even one night in a hotel, but that was about it.

Later that morning I was waiting for my next appointment at an urgent care center when Heather, my donor coordinator, called to tell me that La Jolla didnt have an opening on the right day. Neither did the next-closest option, she told me as I paced around the parking lot, and the patients team couldnt shift his treatment schedule.

So my question for you is, would you feel comfortable flying to Boise, Idaho?

I went back inside to the busy waiting room and reclaimed my seat. Across the room, a man in a UPS uniform freed his nose to rest obscenely on top of his mask. I hunched over my phone and googled, Boise coronavirus. My phone informed me that it was dying. The UPS man coughed. On a TV in the corner, the president admitted he was sabotaging the post office to steal the election. I googled, airports coronavirus. At last, a nurse called me back and started checking my vitals.

Your heart rate is really elevated, she said, frowning at the reading. Any idea why?

As of this writing, Be The Matchs COVID-19 FAQ page was last updated on April 6. Heres part of the section on air travel:

Q: Are there alternatives to donors traveling for donation?A: Possibly. If you feel uncomfortable traveling, we respect your decision. However, it is extremely important that you tell us right away so we can look for alternatives. Donation is time-sensitive, and any delay can have a negative impact on the recipients wellbeing. It may be possible to arrange for donation to occur somewhere within driving distance.

There was an alternative to Boise, it turned out, if I felt uncomfortable. I could donate at the La Jolla hospital a day later than originally planned. My cells would be cryogenically frozen and given to the patient a week or two later, instead of immediately. Heather told me that the patients team preferred me to stick with the original date, that a delayed transplant would be riskier for him, but, for confidentiality reasons, they couldnt tell me how much riskier.

We dont want you to feel pressured, Heather emphasized. You should only agree to travel if you feel comfortable.

Did I feel comfortable? It depended on the circumstances, which I wasnt allowed to know. The window of risks were willing to take expands as the stakes get higher; anyone who showed up to a Black Lives Matter protest this summer or signed up to be a poll worker this fall can attest to that. I wouldnt feel at all comfortable flying for the heck of it, but I would certainly do it to save a life. This fell somewhere on the vast spectrum in between, but I had no idea where.

How do you make a call about your personal risk tolerance when its also a choice about the course of a strangers cancer treatment? If the pandemic had taught us all a valuable lesson about the interconnectedness of our fates, I was now being beaten over the head with it. Stuck without enough facts to make an informed decision, I thought about my dads old hospital room in Baltimore, the airlock separating his ward from the rest of the building because any mundane microbe could kill the patients on the other side. I imagined a somber-looking doctor walking through those doors to give my vulnerable recipient the news.

Im afraid theres been a change of plans, he would say, removing his glasses. It seems your donor is a pussy-ass bitch.

I called Heather back and told her to arrange my donation in Boise.

In most respects, my pre-donation medical screening was extremely, almost ludicrously thorough. I submitted vials and vials of blood to check for a host of diseases and disorders. I peed in a cup to make sure I wasnt pregnant. I had more blood drawn, to make sure I really wasnt pregnant. After the second pregnancy test confirmed the results of the first pregnancy test, I got the following email from Heather:

The result of your repeat pregnancy test on 8/13 was negative, but we are still required to complete our pregnancy assessment with you today. The assessment consists of a single question Is there any chance you could be pregnant? Please respond via email when convenient.

I have not touched another person in five months, I wrote back.

Thank you for completing the pregnancy assessment, Heather replied.

In one respect, my pre-donation medical screening seemed oddly lax. I wasnt tested for coronavirus until the day before my flight, and only then because I panicked.

(Sarah Lazarus)

The PBSC donation process begins in earnest a few days before the stem cells are actually collected, with five rounds of filgrastim injections. Its a drug normally given to cancer patients to bring up low white-blood cell counts after chemo or radiation. In my case, it would send my healthy bone marrow into overdrive, to produce enough cells for the donation. The injections have a few side effects: bone pain, fatigue, headaches, nausea. Essentially, filgrastim makes you feel like you have the flua particularly special feeling in the year of our lord 2020. My side effects were mild and I knew to expect them, and I was managing them fine until an extra one showed up.

The night after receiving my second round of shots, I went for a walk around my neighborhood. It was a hot night, and I was tired and achy from the medication; this was not a fast walk. And yet within a few blocks I noticed that my breathing was quick and shallow, and my heart was pounding as if Id just run a sprint. When I tried to take a deep breath, it felt like there was an elastic band cinched around my chest.

Shortness of breath was not on my list of filgrastim side effects. Neither were the heart palpitations, which continued long after I went home and collapsed on my bed.

I put an empty Gatorade bottle on my stomach and watched it pulse up and down as I considered how fucked I was. I had assumed my fatigue and body aches were side effects; what if those were symptoms, too? I mentally tallied up my appointments from over the past week. I had been to five different medical facilities, been a passenger in three different cars. Of course I had caught it. How stupid to think I wouldnt catch it.

The timing was a nightmare. At some point while I was receiving the filgrastim injections, the patient began a course of high-dose chemo to kill off his own blood-forming stem cells in preparation for the transplant. If I had to back out of donating after that treatment began, the patient would die quickly.

For a few desperate minutes, I thought about keeping these symptoms to myself. I didnt have a fever. As long as I didnt develop one, maybe I could get to Boise and finish the donation leaving no one the wiser. What was the moral math, I wondered, of proceeding with travel plans that might seed multiple new outbreaks (but also might not) and lead to numerous deaths (but maybe none), knowing that if I didnt, one person would certainly die? Had anyone solved that particular trolley problem? My heart palpitations got worse. This was insane. I texted Heather everything and asked if she could arrange for a rapid coronavirus test the next day.

It was nearly 11 p.m. by this point, later in Heathers time zone. She made sure my shortness of breath wasnt an emergency, then said shed see how I was feeling in the morning to assess whether a test was necessary.

I went to bed and thought about what they would tell the patient. Would his doctors be allowed to explain why I couldnt donate? Would he think I had just bailed? Would he and his family hate me? What did it say about my motivations that I was fixated on this? Probably nothing good. I drifted off into a stress dream, and then it was dawn.

My breathing was still labored in the morning, and now, compounding my dread, I had a definite tickle in my throat that verged on a cough. Heather and the medical team decided this did indeed warrant a coronavirus test, and went about setting one up. In the meantime, Heather told me, I should proceed with my third day of filgrastim.

When my home nurse Maria arrived at 8 a.m. to do the honors, I stopped her outside to inform her that I might be a vector of death. She was unimpressed. (Ok, sweetie. Can I come in and wash my hands?) Soon afterwards, Heather called to let me know she had found a doctors office that would send someone to test me at my apartment, and deliver results within 24 hoursjust fast enough that I could still make my flight if I tested negative. Be The Match picked up the tab for this, too, but the receipt came to my email. The cost of a rapid PCR test, antibody test, and home visit came out to a cool $900.

The unaffordable testing nurse arrived an hour later cloaked in full PPE. She coached me on how to swab my own mouth and throat for the diagnostic test, then we made small talk while waiting for the little white antibody tray, which looked for all the world like yet another pregnancy test, to reveal either one or two lines. She had been doing these home visits for two weeks, she told me, and none of her patients had yet tested positive for an infection. For no good reason at all, this made me feel better. The antibody test came up negative. The nurse wished me luck with my other results and headed off to her next appointment, leaving me alone with my wonderful thoughts.

I had nothing to do for the rest of the day but wait. By late afternoon my throat felt better, and my breathing had become less conspicuous. At one point I started to pack a bag, wondered if I was jinxing it, and unpacked the bag. At 10 p.m., less than 12 hours after my throat swab, the results arrived in my inbox. NOT DETECTED. I texted Heather a screenshot and lay down on the floor, awash with relief.

(Sarah Lazarus)

The travel and donation themselves were mercifully uneventful. My parents, who were very pleased that I was donating and terrified that I was flying, had shipped me a steady stream of hand sanitizer, KN95 masks, surgical masks, disinfectant wipes, face shields, safety glasses, and gloves. I wore only some of this to the airport, unless you are my parents, in which case I wore all of it. In any event, I felt protected. My terminal at LAX was deserted, and Heather had booked me a first class seat on Delta, which limits capacity to 50 percent. After barely leaving my immediate neighborhood for half a year, the feeling of takeoff, even for a two-day trip to Boise, was sensational.

The next day I arrived at the hospital at 7:15 a.m. By 8:30 Id had a central line inserted above my collarbone, in a painless 15-minute procedure under local anesthesia. The song We Are Young was playing, and the doctors threading a tube into my neck were chatting quietly about a patient whod given them trouble over the weekend. (Im just saying, if youre cussing people out and trying to beat me up, you probably didnt have too bad of a stroke.) Ive had much less pleasant mornings.

By 9:30 I was in bed and hooked up to the apheresis machine, where I would remain for the next seven hours. At one point my calcium levels dropped too low and I threw up; this was the excitement peak of the day. I spent the rest of the time comfortably reading or watching Netflix, keeping an eye on the stem cells slowly collecting in the bag above my head, and carefully avoiding any RNC coverage that might cause the nausea to recur. At around 4:30 I was loosed from the machine, and after waiting a couple more hours while the lab made sure I had forked over enough cells, the nurse removed my central line and I was officially done.

I was exhausted that evening, but the next day felt well enough to go for a walk along the Boise River, where I took 50 terrible photos of a great blue heron. My shortness of breath, whatever it had been, was gone. The day after that I was just a little more fatigued than usual, and by day three I was back to my 2020-adjusted tiredness baseline.

Coronavirus complications aside, the actual donation process was remarkably easy; shockingly easy, when you consider the scale of what it means for the recipient. It was a time commitment for a few weeksIm lucky to have employers who were happy to give me the necessary leaveand involved some mild discomfort, but as a baby about both pain and scheduling, I would not hesitate to do this again.

I also came away with a clearer sense of how to approach the kind of altruistic acts that standard social-distancing guidelines say we shouldnt engage in. The people and organizations that facilitate charity, particularly sensitive medical charity, have existing support systems that theyve retrofitted to help mitigate the extra risks. Those systems may be imperfect and require some self-advocacy, but when combined with ones own diligence and added layers of protection (and, if one is lucky, a concerned Jewish mother), its possible to get help to the people who need it with risk levels not much higher than we tolerate in normal times. There is a way to be selfless without being self-sacrificing, or worse, becoming an inadvertent menace.

Even so, pandemic experiences like this one wont be universally feasible. One might live with immunosuppressed family members or roommates, or have care-taking responsibilities, or lack the spare emotional bandwidth, or have any number of circumstances more complex than my own. And thats finethere will still be people in need of a lifeline on the other side of this crisis, and that lifeline will be no less appreciated.

I asked my dad, Mitchell Lazarus, what he thought potential donors should know about the recipient experience. He sent me this:

The diagnosis is, literally, a death sentence: you will soon die. Word of a matching donor who has agreed to participate is a reprieve the only possible reprieve. I have felt relief many times in my life, but except possibly for the safe birth of my children, nothing like that. I was in a chemo chair when they came by and told me. I called my wife and said, I have a donor, and I started to cry.

Patients in the transplant ward talk a lot about our donors, despite not knowing who they are. Everybody everybody! tears up when talking about their donors.

True story: I was in the hallway on the transplant floor, talking with the woman in the room next to mine. A nurse walking by stopped and said, Mr. Lazarus, are you having trouble with allergies? (which would require attention). I said no, I was talking about my donor. No other explanation needed. She patted my arm and walked on.

I am a chimera. The rest of me has my own DNA, but my blood cells carry my donors DNA, not mine. Somebody elses blood pumps through my body, keeping me alive, not just through treatment, but every second of every day for the rest of my life. How can you not be grateful to someone who literally gave you the rest of your life?

At some point during the 24 hours after I was unhooked from the machine, a volunteer courier arrived at the hospital in Boise. He or she or they retrieved the bag of my donated cells, flew with it to wherever the recipient is located, and hand-delivered it to his hospital. The patient almost certainly received the transplant before I made it back to Los Angeles. If all goes well, my stem cells will navigate their way into his bone marrow, where theyll settle in, multiply, and start producing healthy blood cells. If all goes well, this perfect stranger will eventually have my blood type, and potentially even my childhood immunitieshe might soon, in other words, have my immune system. If all goes well, may that sucker protect us both.

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Coronavirus, Charity, and the Trolley Problem - Crooked

Bone Marrow Stem Cells Comments Off on Coronavirus, Charity, and the Trolley Problem – Crooked | September 9th, 2020

New Jersey, United States, The Stem Cell Therapy Market report 2020 provides a detailed impression, describe the product industry scope and the market expanded insights and forecasts up to 2027. It shows market data according to industry drivers, restraints and opportunities, analyzes the market status, the industry share, size, future Trends and growth rate of the market. The Stem Cell Therapy Market report is categorized by application, end user, technology, product / service types, and other, as well as by region. In addition, the report includes the calculated expected CAGR of chitosan acetate-market derivative from the earlier records of the Stem Cell Therapy Market, and current market trends, which are organized with future developments.

Global Stem Cell Therapy Market was valued at USD 117.66 million in 2019 and is projected to reach USD 255.37 million by 2027, growing at a CAGR of 10.97% from 2020 to 2027.

1.Stem Cell Therapy Market, By Cell Source:

Adipose Tissue-Derived Mesenchymal Stem Cells Bone Marrow-Derived Mesenchymal Stem Cells Cord Blood/Embryonic Stem Cells Other Cell Sources

2.Stem Cell Therapy Market, By Therapeutic Application:

Musculoskeletal Disorders Wounds and Injuries Cardiovascular Diseases Surgeries Gastrointestinal Diseases Other Applications

3.Stem Cell Therapy Market, By Type:

Allogeneic Stem Cell Therapy Market, By Application Musculoskeletal Disorders Wounds and Injuries Surgeries Acute Graft-Versus-Host Disease (AGVHD) Other Applications Autologous Stem Cell Therapy Market, By Application Cardiovascular Diseases Wounds and Injuries Gastrointestinal Diseases Other Applications

The report provides detailed coverage of the Stem Cell Therapy Market, including structure, definitions, applications, and Industry Chain classifications. The Stem Cell Therapy Market analysis is provided for the international markets including development trends, competitive landscape analysis, investment plan, business strategy, opportunities and development status of key regions. Development policies and plans are discussed and manufacturing processes and cost structures analyzed. This report also includes information on import / export consumption, supply and demand, costs, industry share, policy, Price, Sales and gross margins.

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Stem Cell Therapy Market forecast up to 2027, with information such as company profiles, product picture and specification, capacity production, price, cost, revenue, and contact information. Upstream raw materials and equipment as well as downstream demand analyses are also carried out. The Stem Cell Therapy Market size, development trends and marketing channels are analyzed. Finally, the feasibility of new investment projects is assessed and general research results are offered.

The Stem Cell Therapy Market was created on the basis of an in-depth market analysis with contributions from industry experts. The report covers the growth prospects in the coming years and the discussion of the main providers.

To understand how the effects of COVID-19 are addressed in this report. A sample copy of the report is available at https://www.verifiedmarketresearch.com/product/Stem-Cell-Therapy-Market/?utm_source=TDC&utm_medium=001

Verified Market Researchis a leading Global Research and Consulting firm servicing over 5000+ customers. Verified Market Research provides advanced analytical research solutions while offering information enriched research studies. We offer insight into strategic and growth analyses, Data necessary to achieve corporate goals, and critical revenue decisions.

Our 250 Analysts and SMEs offer a high level of expertise in data collection and governance use industrial techniques to collect and analyze data on more than 15,000 high impact and niche markets. Our analysts are trained to combine modern data collection techniques, superior research methodology, expertise, and years of collective experience to produce informative and accurate research.

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Stem Cell Therapy Market is Thriving Worldwide 2020 | Trends, Growth and Profit Analysis, Forecast by 2027 - The Daily Chronicle

Bone Marrow Stem Cells Comments Off on Stem Cell Therapy Market is Thriving Worldwide 2020 | Trends, Growth and Profit Analysis, Forecast by 2027 – The Daily Chronicle | September 9th, 2020

Rich Hill is trying different ways to make hitters uncomfortable while contributing to a team that has high expectations this season.

That part hasn't been perfect, but the 40-year-old Twins lefthander is coming off an outing on Sunday against Detroit during which he held the Tigers to two runs over five innings and left the game leading 5-2 before the bullpen had a rare multiplayer meltdown.

The fact that the oldest pitcher is baseball is even able take the mound this season is an achievement. Faced with Tommy John elbow surgery last October that threatened to knock him out for all of 2020, Hill ended up being a candidate for different type of elbow surgery that got him back on a mound in nine months.

"Absolutely pleased with my elbow," Hill said. "Feeling zero issues the entire time through rehab, through the throwing program, through any outing this season. The elbow has been great.

"Continue to keep moving in that upward fashion, and again, it's the four days in between, making sure that I'm getting in the work that I need to get in. The training staff has done a great job.

Instead of having Tommy John surgery, in which the ulnar collateral ligament is reconstructed using a ligament from a patient's forearm or hamstring and can knock a pitcher out of action for up to 16 months, a procedure called primary repair was used to strengthen the ligament instead of replacing it. A piece of tape that is coated with collagen is attached to the ligament and bone to assist in the repair and strengthening of the area. It is a less invasive surgery than the one named after John, the pitcher who was the first to have such a surgery in 1974. Therefore, the recovery time is shorter.

Making the call

Given his age and desire to chase a World Series, Hill was all ears once he learned of the possibility of the surgery. He spent nearly three months on the Los Angeles Dodgers' injured list last season because of a left forearm strain and still had trouble upon his return.

But the primary repair surgery is still relatively new, going back to 2011, in comparison to hundreds of Tommy John surgeries being performed since 1974. Only a handful of baseball players, including pitchers Seth Maness and Jesse Hahn and outfielder Brandon Guyer, have had the procedure. Hill consulted with several of the nation's top orthopedic surgeons including James Andrews, Neal El-Attrache and Timothy Kremchek to learn as much as he could about the procedure. He also spoke with Maness and Guyer.

"I gathered as much information as I could talked to maybe every major orthopedic surgeon in baseball," Hill said. "I think I talked to everyone across the country as far as orthos go. Understanding this has been a very successful surgery and I wanted to make sure the percentages were going in the right direction as far coming back as possible and making sure I would not be looking back and having something."

Unique case

Still, he had to be the right candidate for the procedure. Each UCL tear is different. If the tear is in the middle of the ligament, the tape might not be effective. A tear off the bone is considered the perfect candidate for primary repair.

And a surgeon will not know if a ligament can be treated with primary repair until after he or she can open up the damaged area and inspect the ligament. A Magnetic Resonance Imaging exam isn't enough.

"You can't look at it and say 'I want that one,'" said Dr. Jeffrey Dugas of the Andrews Sports and Orthopedic Center in Birmingham, Ala. "You've got to fit the mold for it. You have to have the right tissue, the right injury and that doesn't occur all the time. There are lots of people who still are better off with reconstruction."

Tissue issues

Dugas who performed the surgery on Hill, who previously had Tommy John surgery in 2011. Dugas took a look at the damage and determined primary repair was the way to go.

"Rich had previous reconstruction, so he had already had Tommy John surgery," Dugas said. "So he had more tissue than the average person who had never torn it before. He had his own tissue plus the graft. He had a ton of tissue to deal with.

"He had double or triple the amount of tissue."

On top of it all, Hill also underwent a stem cell injection, with the stem cells coming from his own bone marrow, to assist in the healing process. Hill stopped at nothing to get back on the mound this season.

Ups and downs

On New Year's Eve, he signed with the Twins, getting a contract worth $3 million with bonuses for games started and innings pitched, with both sides understanding he wouldn't be ready until July. As it turned out, that's when the truncated season started, cutting Hill's base salary to $1.1 million in a 60-game season.

After his first start, he missed three weeks because of shoulder fatigue, working at St. Paul to get back in the Twins' rotation. In five starts, he is 1-1 with a 3.86 ERA. He's been knocked out in the third and fourth innings in two of his outings, and opponents' line drive percentage of .290 is the highest against Hill in his career.

But Hill has spent his 16-year career adapting, being used as a starter with the Cubs, to being a reliever with the Red Sox, to being a starter again with the Dodgers and now with the Twins. And there was a stop in independent ball when things weren't working out for him.

Adding a pitch

Everyone knows Hill throws plenty of curveballs, a pitch he can change the shape of and speed. But he's broken out a cut fastball lately, throwing 18 over his last three starts. It's something else for hitters to think about and a pitch that could help him down the stretch in the heat of a pennant race.

Because that's what it was all about for Hill, getting healthy as fast as possible and getting another chance at the postseason while he still can.

"The last five years have just been an incredible experience of just being able to use that knowledge to now, where my body is strong and healthy again, to be able to continue to use that knowledge," Hill said, "and to ultimately it is to win a World Series and that's the biggest thing.

"Am I chasing a World Series? Yeah I am, and everyone here is chasing a World Series."

About Rich Hill

Age: 40

Size: 6-5, 220

Position: lefthanded starting pitcher

Hometown: Milton, Mass.

College: Michigan

Drafted: Reds, 36th round, 1999; Angels, seventh round, 2001; Cubs, fourth round, 2002 (signed).

Major league teams: Cubs (2005-08), Orioles (2009), Red Sox (2010-12, 2015), Indians (2013), Angels (2014), Yankees (2014), Oakland (2016), Dodgers (2016-2019), Twins (2020).

Career stats: 16 seasons, 289 games, 161 starts, 66-43, 3.82 ERA. In 10 postseason series, 13 games, 1-2, 3.06 ERA.

Oh, no! Hill had a no-hitter going in the 10th inning of a 2017 game that was ruined by a walk-off home run by Pittsburgh's Josh Harrison.

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Complicated elbow repair has Twins' Rich Hill back on the mound - Minneapolis Star Tribune

Bone Marrow Stem Cells Comments Off on Complicated elbow repair has Twins’ Rich Hill back on the mound – Minneapolis Star Tribune | September 9th, 2020

Three years after retiring from the BC Forest Service in 2013,Bob Trudeau of Kamloops began experiencing extreme pain in his torso while out on his regular trail runs and backpacking treks in the area around his hometown

A fit, avid outdoorsman who followed a healthy and active lifestyle, Trudeau was concerned and decided to see his doctor. After a series of tests, he was dumbfounded to learn that the pain was the result of 11 fractured vertebrae a common symptom of the disease with which he would soon be diagnosed.

A few weeks later, on Jan. 3, 2017, Trudeau, then 59, was even more stunned when he received the diagnosis of multiple myeloma, a little-known and incurable cancer of the plasma cells.

It was like, Happy New Year, youve got myeloma, Trudeau said. To suddenly find out that I had an incurable cancer that Id never heard of was unbelievable. Ive always led a very active and healthy life. I just couldnt understand it. I was shocked.

Shortly after his diagnosis, Trudeau underwent intense chemotherapy in preparation for a stem cell transplant in August 2017 The transplant was a success he was in remission. Unfortunately, 18 months later, the myeloma resurfaced and he had to find another treatment regimen to keep the cancer in check.

Today, Trudeaus condition is stable and he is on a maintenance program consisting of a combination of immunotherapy and chemotherapy drugs.

Trudeau, who has returned to running, is co-leading the Kamloops Myeloma Support Group.

My wife, Jennifer and I have been wanting grandchildren for years and now it's happening! he said. We're very much enjoying little Jacob and being able to help our daughter.

Trudeau and his family will be raising funds for myeloma research and awareness of the disease when they take part in the fourthannual Kamloops Multiple Myeloma March, which will take place on Sunday, Sept. 13, at 9 a.m.

This years event has been modified to help stop the spread of COVID-19. In compliance with physical-distancing measures, participants are encouraged to hold their own walk in their neighbourhood at the same time as the regularly scheduled march onSept. 13. Trudeau plans to run and walk 50 kilometres on a trail he has mapped out around Kamloops.

Local participants have set their fundraising goal at $10,000. The national fundraising goal is set at $650,000.

The Multiple Myeloma March is now in its 12thyear. The annual five-kilometre event brings Canadian communities together to raise funds for research and to help improve the lives of those impacted by myeloma. Kamloops is one of a record 33 communities across the country to be included in this years event. Information can be found by clicking here.

Multiple myeloma, also known as myeloma, is thesecond-most common form of blood cancer. Myeloma affects a type of immune cell called the plasma cell, found in the bone marrow. Every day, nine Canadians are diagnosed, yet in spite of its growing prevalence, the disease remains relatively unknown.

While there is no cure, people with myeloma are living longer and better lives, thanks to recent breakthroughs in treatment. To learn more, or to donate, visitwww.myeloma.ca.

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Annual Kamloops Multiple Myeloma March to be held on Sept. 13 - Kamloops This Week

Bone Marrow Stem Cells Comments Off on Annual Kamloops Multiple Myeloma March to be held on Sept. 13 – Kamloops This Week | September 9th, 2020

INTRODUCTION

Articular cartilage is an elastic connective tissue in the joint (1). Cartilage injury is extremely common, yet cartilage has limited self-healing capacity because of its low cellularity and avascular nature. Because damage to cartilage leads to knee joint dysfunction, resulting in substantial pain and disability in the arthritic joint, cartilage or joint reconstruction remains a considerable challenge.(1). Arthritic joints in clinical practice are replaced by total joint arthroplasty using metallic and synthetic prosthesis (2, 3). Existing joint prostheses do not remodel with host joint tissue and can lead to long-term failure by aseptic loosening or infection (4), which could only be addressed by biological regeneration of the joint. Recently, using mesenchymal stem cell (MSC) transplants and then stimulating the directional differentiation into chondrocytes is becoming the method of choice for cartilage repair (5, 6). Clinical studies have shown that joint cartilage damage always extends deeply into the subchondral bone and, thus, causes osteochondral defects in the knee joint, which can alter the joints biomechanical properties and influence the long-term performance of the cartilage tissue (7), indicating the significance of simultaneous repair of whole-layer anisotropic articular cartilage in successful knee repair. As articular cartilage transitions from the superficial zone to the deep zone, the extracellular matrix (ECM) of the cartilage is characterized by increased oxygen tension and nutrient availability, lower amounts of ECM constituents such as glycosaminoglycans (GAG), and increased presence of a different phenotype of chondrocyte population with hypertrophic and ossification markers such as RUNX2 (Runt-related transcription factor 2) and type X collagen (8, 9). The gradient and anisotropic structure in ECM deposition and cell type provides excellent permeability in deep zone (vessel ingrowth) as well as desired mechanical support (10). However, developing biomimetic constructs mimicking the gradient anisotropic structure and the signaling approaches in different layers to induce zonal-dependent chondrogenic differentiation and ECM deposition is very challenging in cartilage repair. Previous studies showed that scaffolds with small pore size (100 to 200 m) could better promote chondrogenesis in osteochondral regeneration (11). However, osteogenesis and angiogenesis were inhibited in these scaffolds with small pore sizes, showing less nutrient diffusion and worse tissue integration by decreased microvessel ingrowth in these scaffolds (12). Hydrogel has been reported for cartilage regeneration in many studies (13, 14), yet it is still difficult to construct large-scale tissue structures with hydrogel owing to inadequate structural integrity, mechanical stability, and printability (12). Here, we report developing three-dimensional (3D) bioprinted dual-factor releasing and gradient-structured MSC-laden constructs ready to implant for whole-layer cartilage regeneration.

Different joint tissue constructs for joint reconstruction were fabricated using 3D bioprinting as previously reported with organ printing united system (OPUS; Novaprint) (15). To better mimic the native cartilage, we incorporated biochemical stimulus (BCS) with different growth factor releasing, and biomechanical stimulus (BMS) with small pore sizes to induce better chondrogenesis to create the dual-factor releasing and gradient-structured cartilage construct in the double stimulus (DS) group. We chose to test the combination of bone morphogenetic protein 4 (BMP4) and transforming growth factor3 (TGF3) in the cartilage construct in an established knee cartilage defect model given its potential generalizability in the regeneration of complex, inhomogeneous joint tissues. Poly(lactic-co-glycolic acid) (PLGA) (50:50 PLA/PGA) microspheres (S) were used to deliver TGF3 and BMP4 in hydrogel (Fig. 1, A and B). Briefly, poly(-caprolactone) (PCL) was molten to fabricate the physically gradient supporting structure for the scaffold, while MSC-laden hydrogel encapsulating PLGA microparticles carrying TGF3 or BMP4 in different layers was bioprinted into the microchannels between PCL fibers from different syringes (fig. S1). During plotting, the needle diameter, layer thickness, and speed for PCL printing were kept constant at 200 m, 200 m, and 180 mm/min, respectively. The fiber spacing was kept constant at 150 m (BMS group) or 750 m (BCS group) for nongradient (NG) scaffolds and varied gradually from 150 to 750 m throughout the gradient scaffolds (DS group) (fig. S1). The gradient microchannels between PCL range gradually from 150 m wide from the superficial zone of the cartilage, providing enough mechanical properties and smaller compartments favoring articular chondrocyte differentiation (11, 16), to 750 m wide in the deepest zone of the cartilage construct, maximizing diffusion of nutrients with better microvessel ingrowth and offering higher oxygen stress in the deep zone (Fig. 1B) (12). The fiber spacing was changed by 200 m every millimeter. The scaffolds were plotted in blocks of 4 4 4 mm for rabbit cartilage construct and 14 14 14 mm for human cartilage construct (Fig. 2A and movie S1).

(A) Schematic Illustration of the study design with 3D bioprinted dual-factor releasing and gradient-structured MSC-laden constructs for articular cartilage regeneration in rabbits. Schematic diagram of construction of the anisotropic cartilage scaffold and study design. (B) A computer-aided design (CAD) model was used to design the four-layer gradient PCL scaffolding structure to offer BMS for anisotropic chondrogenic differentiation and nutrient supply in deep layers (left). Gradient anisotropic cartilage scaffold was constructed by one-step 3D bioprinting gradient polymeric scaffolding structure and dual protein-releasing composite hydrogels with bioinks encapsulating BMSCs with BMP4 or TGF3 S as BCS for chondrogenesis (middle). The anisotropic cartilage construct provides structural support and sustained release of BMSCs and differentiative proteins for biomimetic regeneration of the anisotropic articular cartilage when transplanted in the animal model (right). Different components in the diagram are depicted at the bottom. HA, hyaluronic acid.

(A) Gross appearance of (a) human-scale and (b and c) rabbit-scale cartilage scaffold (b, NG with 150-m spacing; c, NG with 750-m spacing). Top view of the rabbit cartilage scaffold is also shown (d, NG with 150-m spacing; e, NG with 750-m spacing; f, gradient scaffold with 150- to 750-m spacing) atop of the SEM images (g, horizontal section; h, vertical section) taken for the 150-m NG scaffold to demonstrate the precise alignment of the PCL fibers in the printed scaffold. (B) Deconstruction of the gradient scaffold. The structure of the gradient scaffold was deconstructed into four layers. Microscopic appearance of the hydrogel-PCL composite structure in each layer demonstrated good interconnectivity and delicate, orderly aligned structure for each layer. (C and D) Good cell viability is shown respectively for superficial and deep layers after printing with live/dead assay (green, live cells; red, dead cells) (C) under a microscope and (D) under a confocal microscope. DAPI, 4,6-diamidino-2-phenylindole. (E) Cell spreading in superficial and deep layers with cytoskeleton staining. (F) Immunostaining for cartilage markers in superficial and deep layers. Expression of COL2A1 and PRG4, the lubrication markers, was significantly higher in the superficial layers with small pore size (a and b), while the chondrogenic cells in the deep layers (c and d) mostly presented with hypertrophic phenotype (COL10A1 expression). Photo credit: Ye Sun, First Affiliated Hospital of Nanjing Medical University.

Recombinant human TGF3 (rhTGF3) and rhBMP4 were microencapsulated in PLGA S (fig. S1) (17). TGF3 and BMP4 S were mixed in the cell-laden hydrogel (table S1), respectively, and printed into the microchannels between PCL fibers with different syringes (Fig. 2B and fig. S1). To chemically simulate the hypertrophic layer in native cartilage, we used PLGABMP4-encapsulated MSC-laden hydrogel in the deepest layer with a 750-m PCL fiber spacing, while PLGATGF3 was used for the other three layers of the cartilage construct. Scanning electron microscopy (SEM) images of PLGA S were taken, showing a less than 2-m diameter for most of the PLGA S. The PLGA-encapsulated MSC-laden hydrogel also showed nice printability as demonstrated (Fig. 2B and fig. S1A).

The final product of the human and rabbit cartilage construct demonstrated good interconnectivity and delicate, orderly aligned structure under the microscope, SEM, and in gross appearance for both PCL fibers and the printed hydrogel in between (Fig. 2, B to D). To validate S distribution in MSC-laden hydrogel, fluorophore-conjugated rhodamine was encapsulated into PLGA S and delivered to the hydrogel. At day 7, PLGArhodamine S showed well-proportioned distribution and minimal cell toxicity in the hydrogel printed between the PCL fibers under a confocal microscope (Fig. 2, C and D, and fig. S1B). Immunostaining for cartilage markers in the gradient scaffold was performed (Fig. 2, E and F). Resembling the native cartilage, the expression of COL2A1 (Collagen Type II Alpha 1 Chain) and PRG4 (Proteoglycan 4), the lubrication marker, was significantly higher in the superficial layers with small pore size, while the chondrogenic cells in the deep layers mostly presented with hypertrophic phenotype (COL10A1 expression) (Fig. 2F and fig. S2). Moreover, the compressive Youngs modulus of the NG-150 scaffold and the gradient scaffold were similar to that of the native cartilage and significantly higher than that of the NG-750 scaffold (fig. S3), demonstrating that smaller PCL fiber spacing plays an important role in enhancing the mechanical properties of the PCL-hydrogel composite scaffolds. In biomimetic regeneration of native articular cartilage, the gradient scaffold could provide anisotropic chondrogenesis in different layers and structural support for the newly formed cartilage tissue in compression, and allow nutrient supply and vessel ingrowth in the deep layers.

To examine the effects of BMP4, TGF3, and their S on bone marrow stromal cell (BMSC) viability and proliferation, we cultured BMSCs in the composite hydrogel for 7 days (fig. S4). Spheres showed controlled release of TGF3 first, followed by BMP4. Relatively rapid TGF3 release in the three layers with smaller PCL fiber spacing and slower release of BMP4 in the deepest layer were sustained over 60 days in vitro (fig. S5). Similar viability and proliferation rate of BMSCs were demonstrated for BMP4 and TGF3 compared with control through 7 days in the hydrogel (fig. S4, A, C, and D). Compared with empty S, S encapsulating BMP4 and TGF3 also showed minimal toxicity to BMSC viability and proliferation in the hydrogel (fig. S4, B, E, and F). Cell viability and proliferation were further examined in the printed scaffolds (Fig. 3, A to E). Scaffold fabrication with gradient structure (Fig. 3A, left) and delicate alignment of hydrogel printing (Fig. 3A, right) were separately conducted. Printed cell-laden hydrogel causes cell alignment in a longitudinal direction of the printed paths, forming a reticular network with cell interaction (Fig. 3B). The PCL pillar structure in the final construct further stabilized the 3D printed BMSC organization, inducing a compaction phenomenon of the patterns of cell alignment in the cell-laden hydrogel (Fig. 3C). Survival of BMSCs throughout the final cartilage construct with gradient structure was examined at 60 min (day 0), 1 day, 7 days, and 21 days after printing (Fig. 3, I to K). Live/dead cell assays showed 95% cell viability on day 0, which was maintained over 75% through days 3 to 21 (Fig. 3D). Cell proliferation, assessed using the alamarBlue assay system, increased over a 21-day period, similar to the proliferation of control cells encapsulated in a fibrin construct (Fig. 3E). Immunostaining of cytoskeleton showed cell spreading, both in the hydrogel and the PCL fibers throughout the four layers of the construct (Fig. 3C). At day 21, good 3D anchoring to the PCL fiber cylinder was observed for the BMSCs released from the hydrogel (Fig. 3F). These data indicate that the one-step 3D bioprinted dual-factor releasing and gradient-structurally optimized cartilage scaffold preserved cell viability during the printing process and provided a favorable microenvironment for BMSC proliferation, spreading, and condensation for differentiation into chondrocytes in vitro.

(A) Schematic of anisotropic cartilage scaffold construction with fabrication of gradient scaffolding structure (left) and large-scale printing of aligned protein-releasing BMSC-laden hydrogel (right). Scale bar, 1 mm. (B) Gross appearance of PLGA Sencapsulated BMSC-laden hydrogel under a microscope (top). Printed cell-laden hydrogel causes cell alignment in a longitudinal direction of the printed paths, forming a reticular network with cell interaction (bottom). (C) Live/dead cell assays showed 95% cell viability maintained through day 1 to 21 for all four layers with gradient spacing (4th row, 150-m spacing; 3rd row, 350-m spacing; 2nd row, 550-m spacing; 1st row, 750-m spacing). Immunostaining of cytoskeleton (rightmost column) showed cell spreading both in the hydrogel and on the PCL fibers throughout the four layers of the construct. Scale bar, 500 m. (D and E) Quantified cell viability and proliferation in the printed scaffolds. (F) Cell anchoring in the scaffolds. (a to c) At day 21, good 3D anchoring to the PCL fiber cylinder was observed for the MSC cells released from the hydrogel. (d to f) Similar cell anchoring was observed for PCL fibers in adjacent layers. (b), (c), (e), and (f) are 3D demonstration of cell anchoring in (a) and (d), respectively. Scale bars, 100 m. Photo credit: Ye Sun, First Affiliated Hospital of Nanjing Medical University.

Before in vivo application of the scaffold, we ascertained whether spatiotemporal delivery of rhTGF3 and rhBMP4 induced layer-specific BMSC differentiation into chondrocytes that present with hyaline articular and hypertrophic phenotype. Articular chondrocytes with hyaline and hypertrophic phenotype were first derived from rabbit BMSCs in vitro. Hyaline chondrocytes concurrently produced both aggrecan and type II collagens, while hypertrophic chondrocytes produced type I collagen and type X collagen. Sequential application of rhTGF3 for 2 weeks in culture, followed by rhTGF3 for another 4 weeks (TGF3 group), induced differentiation of BMSCs into chondrocytes that synthesized aggrecan and type II collagens, suggesting hyaline articular chondrocyte-like cells. BMSCs sequentially treated with rhTGF3 and rhBMP4 demonstrated significantly higher type I collagen, type X collagen, and aggrecan protein expressions than the control (Fig. 4A and fig. S6). Moreover, cells in the TGF3-induced tissue were fibroblastic, whereas those induced with BMP4 were larger and arranged in a cobblestone pattern (Fig. 4A), similar to hypertrophic chondrocytes previously generated in culture (5). Condensation of BMSCs that indicated differentiation was observed at 4 weeks (fig. S6B). Both treatments induced BMSC differentiation and yielded a cartilaginous matrix that stained positively for toluidine blue and alcian blue in condensed BMSCs, indicative of a proteoglycan-rich, cartilage-like ECM.

(A) Chondrogenic differentiation of condensed rMSCs with toluidine blue (TB) and alcian blue (AB) staining. (B) Scaffolds were transplanted subcutaneously for 12 weeks. (C) To validate the cartilage-generating capability, scaffolds were incubated and observed for 12 weeks in vitro, indicating better cartilage-generating potential for the physically gradient protein-releasing scaffold (movie S2). (D) Youngs modulus of the scaffolds compared with native cartilage after 12 weeks. Data are presented as averages SD (n = 6). *P < 0.05 between the NG-750 group and other groups; #P < 0.05 between the native cartilage group and other groups. (E) In the generated cartilage tissues, spatiotemporally released dual-factors induced zone-specific expression of PRG4, aggrecan, and collagens II and X and showed resemblance with native joint cartilage. (F) (a to c) Toluidine blue staining of the 3D printed cartilage constructs (a, top view; b, side view; c, bottom view) after culture in chondrogenic medium for 6 weeks in vitro. (d to g) Toluidine blue and (h to k) alcian blue staining was applied for each layer of the gradient scaffold. (l to p) Safranin O (SO) and (q to t) toluidine blue staining of cartilage tissue between PCL fibers (green curved line) in different layers of the 3D printed cartilage constructs after subcutaneous implantation. Photo credit: Ye Sun, First Affiliated Hospital of Nanjing Medical University.

Cartilage scaffolds incorporating rhTGF3 and rhBMP4 for spatiotemporally controlled release were also examined in different groups of scaffolds transplanted in vivo subcutaneously for 12 weeks (Fig. 4, B to F). To validate the cartilage-generating capability of the composite scaffold, the protein-carrying scaffolds were incubated and observed for 12 weeks in vitro (Fig. 4C). All scaffolds, physically gradient or NG, showed cartilage-like tissue development surrounding the scaffolds, whereas the BCS and BMS scaffolds developed 1/4 to 1/3 thickness cartilage tissue, while the DS scaffold showed almost full-thickness coverage of cartilage-like tissue around the construct (movie S2), indicating a significantly better cartilage-generating potential in vitro and a better prospect of its cartilage matrix integration in vivo for the physically gradient protein-releasing scaffold (Fig. 4C). The compressive Youngs modulus of the BMS scaffold and the DS scaffold were similar to that of the native cartilage and significantly higher than that of the BCS scaffold with large pore sizes (Fig. 4D), demonstrating that smaller PCL fiber spacing plays an important role in enhancing the mechanical properties of the PCL-hydrogel composite scaffolds. The enhanced mechanical properties are promising for biomimetic regeneration of native articular cartilage and provide structural support for the newly formed cartilage tissue.

After 12 weeks in vivo, spatiotemporally released rhTGF3 and rhBMP4 in the DS scaffold induced zone-specific expression of PRG4, aggrecan, and collagen II and X assayed with immunofluorescence, showing resemblance with native joint cartilage (Fig. 4E). Superficial zone marker PRG4, with a gradient manner throughout the four layers, was presented mainly in the superficial layer with the smallest PCL compartments (Fig. 4E, first column, 150 m 150 m). Abundant cartilaginous matrix with collagen type II and aggrecan was present in a gradient manner primarily in the superficial layers with TGF3 delivery, whereas hypertrophic marker collagen type X was primarily expressed in the deepest zone (Fig. 4E, second to fourth columns). Cartilaginous matrix was demonstrated and stained positive for toluidine blue for the scaffold (Fig. 4F, a to c). To determine the production of GAG in each layer of the gradient scaffold, we applied toluidine blue staining (Fig. 4F, d to g) and alcian blue staining (Fig. 4F, h to k). The whole gradient scaffold body stained positive (Fig. 4F, a to c), with a gradient staining intensity from the superficial layer to the deepest layer (Fig. 4F, d to k), indicating a gradient cartilaginous matrix formation resembling the native cartilage matrix. Safranin O staining and toluidine blue staining of the generated cartilage tissue sections showed the production of a cartilaginous matrix between PCL fibers in different layers of the 3D printed cartilage constructs after subcutaneous implantation in vivo (Fig. 4F, j to s). The chondrocytes in the newly formed tissue demonstrated similar morphological characteristics to those in native cartilage. A large fraction of generated chondrocytes in the TGF3-induced tissue were fibroblastic, whereas those induced with BMP4 in the deepest layers were larger and arranged in a cobblestone pattern, similar to hypertrophic chondrocytes generated in the culture plate (Fig. 4F, l to t). All cells located within typical chondrocyte lacunae, surrounded by cartilaginous matrix.

Rabbits were used as animal models to evaluate the knee repair capacity of the cartilage scaffolds. Cartilage scaffolds were constructed by one-step 3D bioprinting gradient polymeric supporting structure and different protein-releasing composite hydrogels with bioinks encapsulating BMSCs with BMP4 or TGF3, providing structural support and sustained release of BMSCs and differentiative proteins for biomimetic regeneration of the native articular cartilage (Fig. 5). As shown in Fig. 5A (first row), a full-thickness cartilage defect was created in the knee joint. The scaffold was implanted into the defect to test for cartilage tissue regeneration. Cartilage repair with the DS scaffold showed much better gross appearance at 8, 12, and 24 weeks compared with the BCS and BMS scaffolds (Fig. 5A, second to fourth rows). During the 24-week posttransplantation period, magnetic resonance imaging (MRI) was made for the operated knee joint, demonstrating significantly better resolution of subchondral edema and healing of the articular surface after 24 weeks for the DS group (Fig. 5A, fifth row). In addition, the chondroprotective effects of the scaffolds were compared (18). The gradient scaffold group showed better chondroprotective effects with a significantly higher histological grading compared with the NG groups over the 24 weeks in vivo (Fig. 5, B to E). Better repairing effects were demonstrated with gradient scaffolds compared with NG groups over 24 weeks (Fig. 5, B to E). Compared with the control group, the gradient group also showed better cartilage regeneration capabilities (fig. S7) and chondroprotection with significantly minor damage to the femoral condyle and tibial plateau (Fig. 5, D and E). Examination of intra-articular inflammatory response showed no significant difference in interleukin-1 and tumor necrosis factor level among different groups, maintaining at a relatively low level during the 24-week cartilage healing (fig. S8, A and B, and table S2). After the 24-week healing, histomorphological analysis was conducted for the generated cartilage. As shown in Fig. 5B, the DS scaffold regenerated fully hyaline-like cartilage in the defect site as evidenced by intense staining for GAGs and better cell filling in hematoxylin and eosin (H&E) staining (Fig. 5B). Type 1 and III collagens were also demonstrated in the regenerated cartilage with picrosirius red staining and compared with the native cartilage (Fig. 5B). Immunohistochemical staining of markers (PRG4 and type II and X collagens) for chondrocyte phenotype was conducted in the generated cartilage tissue sections in different groups compared with the native cartilage (fig. S8C). In the superficial zone, only the DS scaffolds showed PRG4 staining in the superficial chondrocytes in the generated cartilage tissue. Meanwhile, gradient expression of type II and X collagens, resembling the native cartilage, was also demonstrated from the superficial zone to the deep zone of the newly formed cartilage in the DS group, indicating successful construction of the anisotropic layered cartilage with different chondrocyte phenotypes and gradient ECM deposition by the 3D bioprinted dual-factor releasing and gradient-structured MSC-laden scaffold. Furthermore, neocartilage in the DS group showed more similar appearance to normal cartilage than other groups (Fig. 5B and fig. S8C). The above results indicated that the DS anisotropic scaffold had a better cartilage-repairing effect than the BCS or BMS groups and maintained better joint function after transplantation.

(A) Scaffold implantation process and gross appearance of the repair cartilage at 8, 12, and 24 weeks. MRI was made for the operated knee joint (fifth row), demonstrating significant better resolution of subchondral edema and healing of the articular surface (white arrowheads) for joint transplanted with DS scaffolds. (B to F) Chondroprotective effects of the scaffolds were compared by (B) histological scoring evaluation of the repaired cartilage tissue during in vivo implantation. (C) Mankin score and (D) ICRS (International Cartilage Repair Society) histological score of articular cartilage in the femoral condyle (FC) and tibial plateau (TP) in both groups with scaffold implantation. *P < 0.05 between the native group and other groups. #P < 0.05 between the BCS group and the DS group. Data are presented as averages SD (N = 6). (A) Histomorphological analysis of the neocartilage tissue at 24 weeks. PR, picrosirius red. The left bottom panels are higher-resolution pictures of the formed neocartilage outline in the colored square boxes. (a to e) Sections were stained with (a) H&E, (b) Safranin O, (c) TB, and (d) AB staining to indicate the presence of proteoglycans in different groups compared with native cartilage. (e) Picrosirius red was used to stain collagens I and III. The brown irregular area at the interface under the formed neocartilage was undegraded PCL material as supporting structure for the scaffolds. Photo credit: Ye Sun, First Affiliated Hospital of Nanjing Medical University.

As native articular cartilage transitions from the superficial zone to the deep zone, different phenotypes of chondrocyte population were presented with higher lubrication and GAGs (PRG4, ACAN expression) in the superficial layers and ossification (RUNX2, COL10A1 expression) in the deep layers. In the present study, we further tested the anisotropic properties of the generated cartilage and compared it with the native cartilage. In the superficial layer, immunostaining demonstrated greater PRG4 and ACAN expression in the DS group and the native cartilage compared with other two groups (Fig. 6, A to C). Meanwhile, higher expression of ossification markers (RUNX2 and COL10A1) were also observed for the group with implanted dual-factor releasing and gradient-structured scaffold (Fig. 6, D to F). These results indicate that the dual-factor releasing and gradient-structured scaffold could better restore the anisotropic properties of the native cartilage with different chondrogenic and ossification markers in specific layers. Moreover, resembling the ingrown microvessels in the deep layers of the native cartilage, the DS scaffold could better promote microvessel ingrowth compared with the group with small pore sizes, indicating better nutrient supply and tissue integration with large pore sizes in the deep zone (Fig. 6, G and H).

(A to C) In the superficial layer, immunostaining demonstrated greater PRG4 and ACAN expression in the DS group and the native cartilage compared with other two groups. (D to F) Meanwhile, higher expression of ossification markers (RUNX2 and COL10A1) were also observed for the group with implanted dual-factor releasing and gradient-structured scaffold in deep layers. (G and H) Moreover, the DS scaffold could better promote microvessel ingrowth compared with the group with small pore sizes, indicating better nutrient supply and tissue integration with large pore sizes in the deep zone. *P < 0.05 between the native group and other groups. #P < 0.05 between the DS group and other groups. BC, biochemical stimulus; BS, biomechanical stimulus. **P < 0.01; ##P < 0.01.

In conclusion, we have generated 3D bioprinted anisotropic constructs with structural integrity for joint reconstruction and articular cartilage regeneration and further tested the functional knee articular cartilage construct in a rabbit cartilage defect model with 6-month follow-up. Human-scale cartilage constructs with the structural integrity needed and that are ready for surgical implantation were created by sequentially printing protein-releasing and MSC-laden hydrogels with synthetic PCL polymer with gradient structures, a technique that could also be applied to the regeneration of the whole joint. In previous studies, relative nonuniformity was possible when hydrogel was printed alone without PCL as scaffolding support. Although hydrogel could serve as a carrier of cells and growth factors, it alone was quite not suitable for construction of complex biomimetic tissues with required mechanical properties. The combined printing with PCL scaffolding offered the uniformity for the hydrogel and the mechanical properties needed for in vivo study. In the present study, the cell-laden hydrogel allows well-proportioned distribution of MSCs and the protein-encapsulated S and thus protects cell viability and promotes its differentiation and expansion in the scaffold (17). Meanwhile, the adjacent PCL scaffolding provides adequate mechanical support and architectural integrity, offering a stable microenvironment for the 3D anchored MSC cells within the hydrogel to differentiate and form the tissue with their secreted cartilage matrix that replaces the hydrogel as it slowly degrades (15).

However, the release of the growth factors from the embedded S was not tracked in vivo after the scaffold transplantation. The intra-articular environment in vivo would definitely lead to faster disintegration of the S in the hydrogel. In this case, the PCL scaffolding would offer a much more stable microenvironment for cell and growth factor release than hydrogel alone. Lineage tracing studies have provided compelling evidence that articular chondrocytes derive from interzone cells in regions of condensing chondrogenic mesenchyme (19), similar to our observations that the MSCs, in the presence of TGF3 and BMP4, condense in the small compartments with surrounding PCL fibers as supporting structure and develop into articular chondrocytes that express genes expressed in cartilage layers. The MSC-derived articular chondrocytes were able to generate and maintain stable cartilage phenotype in vivo when transplanted into the knee defect site. The ECM composition of TGF3- or BMP4-induced cartilage tissues in the bioprinted scaffold shared many characteristics of native articular cartilage, including the gradient expression of type II collagen, superficial localization of PRG4, and abundant presence of type X collagen in the deep zone, indicative of regenerated superficial zone articular cartilage and deep zone hypertrophic cartilage in the constructs. In summary, we have generated 3D bioprinted constructs with structural integrity for joint reconstruction and articular cartilage regeneration and further tested the functional knee articular cartilage construct in a rabbit cartilage defect model with 6-month follow-up. Generating 3D bioprinted functional constructs as prosthesis for joint replacement or cartilage repair provides an opportunity to integrate the feasibility of MSC- and 3D bioprintingbased therapy for injured or degenerative joints. Evaluation will be needed to assess the function of the joint constructs in animal experiments and whether the functional cartilage phenotypes could be sustained in daily function. For translation, we envision the surgeons could incorporate surgery and 3D bioprinting by performing a mini-invasive arthroscopy procedure to replace the damaged or degenerated articular cartilage with 3D bioprinted cartilage scaffold or by performing joint replacement surgery using 3D bioprinted joint scaffolds.

BMSCs were isolated from rabbit bone marrow aspirates. Briefly, marrow aspirates (20-ml volume) were harvested and immediately transferred into plastic tubes. Isolated rMSCs were expanded in minimum essential medium containing fetal bovine serum (10%), d-glucose (4.5 mg/ml), nonessential amino acids (0.1 mM), sodium pyruvate (1 mM), Hepes buffer (100 mM), penicillin (100 Ul/ml), streptomycin (100 g/ml), and l-glutamate (0.29 mg/ml). Medium was changed twice a week, and rMSCs were used at passage 2 for the following experiments. TGF3 (10 ng/ml) was added in the medium for 2 weeks, and then TGF3 was replaced with BMP4 (50 ng/ml) in some of the cultures for another 4 weeks. Medium was also changed twice a week. Immunofluorescence staining of chondrogenic markers (Col1A1, Col2A1, Aggrecan, and Col10A1) was conducted to compare the generated chondrocyte phenotype and observed under confocal microscopy (Leica, Japan). The expression of chondrogenesis markers (SOX9, Col1A1, and Col2A1), superficial zone chondrocyte markers (ACAN, PRG4, CILP2, GDF5, and Col22A1), and deep zone chondrocyte markers(Col10A1, RUNX2, and ALP) after TGF3 or BMP4 incubation for 6 weeks was analyzed by real-time polymerase chain reaction (RT-PCR) using an ABI 7300 RT-PCR system (Applied Biosystems, USA). Six-week-old tissues generated under both conditions were stained with toluidine blue and alcian blue for proteoglycan production. The stained images were taken using a light microscope (Leica Microsystems, Germany).

Different joint tissue constructs for joint reconstruction were fabricated using 3D bioprinting with OPUS (Novaprint). 3D bioprinting cell-laden hydrogels together with biodegradable polymers was conducted for specific articular joint. The motion program and alignment of cell-laden hydrogel and PCL fibers were demonstrated in the printing process of anisotropic cartilage tissues in movie S1. Bioprinting rabbit-derived MSC-laden hydrogels together with physically and chemically gradient biodegradable polymers was conducted for knee cartilage repair using OPUS. The rMSCs suspension (a total of 1 107 cells) was loaded into the composite hydrogel (table S1). The printing chamber was kept at a constant 17C. The native cartilage structure inspired us to produce four-layer 3D structures by placing together cell-laden hydrogel and PCL (~100-m diameter for hydrogel and ~200-m diameter for PCL) to construct a composite cartilage scaffold (17). Needle sizes for the hydrogel and PCL were 100 and 200 m, respectively. Briefly, PCL was molten (~60C) to fabricate the physically gradient supporting structure for the scaffold, while MSC-laden hydrogel (~37C) encapsulating PLGA microparticles carrying TGF3 or BMP4 in different layers was bioprinted into the microchannels between PCL fibers from different syringes (movie S1). During plotting, the needle diameter, layer thickness, and speed for PCL printing were kept constant at 200 m, 200 m, and 180 mm/min, respectively, as previously reported (15). The extrusion pressure for PCL and hydrogel was 1.2 to 1.8 kPa and 0.5 to 0.8 kPa, respectively. The fiber spacing was kept constant at 150 or 750 m for NG scaffolds and varied gradually from 150 to 750 m throughout the gradient scaffolds. The gradient microchannels between PCL range gradually from 150 m wide from the superficial zone of the cartilage to 750 m wide in the deep zone of the cartilage construct. The fiber spacing was changed every millimeter. The scaffolds were plotted in blocks of 4 4 4 mm for rabbit cartilage construct and 14 14 14 mm for human cartilage construct.

rhTGF3 and rhBMP4 were microencapsulated in PLGA (50:50 PLA/PGA) S to deliver TGF3 (20 ng/ml) and BMP4 (100 ng/ml) in hydrogel as previously described (15, 17). TGF3 and BMP4 S were mixed in the cell-laden hydrogel (table S1), respectively, and printed into the microchannels between PCL fibers with different syringes. To chemically simulate the deep layer in native cartilage, PLGABMP4-encapsulated MSC-laden hydrogel was used in the deepest layer with a 750-m PCL fiber spacing, while PLGATGF3 was used for the other three layers of the cartilage construct. Generated PLGA S was shown with SEM. Printability was also shown with a test run for the PLGA-encapsulated MSC-laden hydrogel. Release kinetics of TGF3 and BMP4 from PLGA S were measured by incubating S (10 mg/ml) encapsulating TGF3 (0.1% bovine serum albumin) or BMP4 [in phosphate-buffered saline (PBS)] at 37C with mild agitation for up to 60 days. Upon centrifugation at 2500 revolutions per minute for 5 min, supernatant of the PLGA S incubation solution was collected. Released TGF3 and BMP4 concentration was measured using enzyme-linked immunosorbent assay kits following the manufacturers protocols (15). To validate S distribution in MSC-laden hydrogel, fluorophore-conjugated rhodamine was encapsulated into PLGA S and delivered to the hydrogel. At day 7, PLGA rhodamine S and cell viability (live/dead assay) in the hydrogel was observed under a confocal microscope.

To validate the cartilage-generating capability of the composite scaffold, the protein-carrying scaffolds were incubated and observed for 12 weeks in vitro. Photographs of cartilage-like tissue development surrounding the scaffolds were taken to show the cartilage-generating potential in vitro of the scaffolds. Mechanical measurements on scaffolds and native cartilage were carried out with a single-column static instrument (Instron 5843, USA) equipped with two flat compression stages and a 10-N load cell.

To see the differences within the rMSCs cultured in the different areas of the gradient scaffolds, after 6 weeks under differentiation conditions, the constructs were collected, washed three times with PBS, and cut in four portions of 1 mm in height. The images of each layer were taken using a light microscope. The viability of the BMSCs on the scaffolds were analyzed with live/dead assay and observed under confocal microscopy for 3, 7, and 21 days, while the morphology of cells was observed under confocal microscopy at end point (21 days). Briefly, The MSCs in the scaffold were fixed with 4% paraformaldehyde and treated with rhodamine phalloidin (Thermo Fisher Scientific, USA) to stain the F-actin for 1 hour and incubated with DAPI (Thermo Fisher Scientific, USA) to stain the nucleus for 5 min in turn. Cell proliferation in the constructs was assessed with alamarBlue assay kit (DAL1100; Life Technologies) according to the manufacturers instruction as previously described (12).

Biochemical studies were performed to the full and partitioned scaffolds. Toluidine blue and alcian blue staining were applied to determine the production of GAGs in each layer of the gradient scaffold. The sections for the different layers were prepared and then treated with Safranin O and toluidine blue staining to identify GAG formation in each layer. Immunofluorescence staining of chondrocyte markers (PRG4, Col2A1, aggrecan, and Col10A1) was conducted for layer-specific chondrogenesis and observed under confocal microscopy.

Different groups of scaffolds were transplanted under the dorsal skin of nude mice in vivo subcutaneously for 12 weeks. The cartilage scaffolds were retrieved after 12 weeks in vivo, and zone-specific expressions of PRG4, aggrecan, and type II and X collagens were assayed with immunofluorescence. GAG production was determined with toluidine blue and alcian blue staining.

Adult male New Zealand white rabbits weighing 3.0 to 3.5 kg were used for the study in vivo. Rabbits were randomized into three groups (two knees of each rabbit were used): NG-750 (BCS group), NG-150 scaffold (BMS group), and the gradient scaffold (DS group). After anesthesia, the knee joint of the rabbits was exposed after dislocating the patella. A cylindrical defect (4-mm diameter, 4-mm depth) on the trochlear groove of the distal femur was created using corneal trephine. Then, suited 3D bioprinted BCS, BMS, or DS scaffolds were implanted matching with the defect. Forced flexion and extension were conducted for the operated knee to confirm the localization of the implanted scaffolds in the defect. Last, the operated knee joint was closed with suture (4-0 thread), and antibiotics were given intramuscularly for prophylactic infection. After the operation, rabbits were allowed to move freely in their single cages and fed with standard food and water. Eight, 12, and 24 weeks later, rabbits were euthanized for further study. The protocol was approved by the local Institutional Animal Care and Use Committee and complied with the Guide for the Care and Use of Laboratory Animals, revised in 2010 and published by the National Academy of Sciences.

Serial sections (4 mm thick) were cut sagittally through the center of the operative site and stained with H&E, toluidine blue, Safranin O and fast green, toluidine blue, alcian blue, and picrosirius red according to standard protocols. Immunohistochemical staining of markers (PRG4, RUNX2, and collagens II and X) for chondrocyte phenotype and microvessel ingrowth (CD31 and smooth muscle actin) was conducted according to standard protocols in the generated cartilage tissue sections in different groups compared with the native cartilage. The stained images were taken, and regenerated cartilage thickness (n = 6 for each) was calculated for different bioprinted scaffolds using a light microscope. A modified method was used to evaluate the histological repair of articular cartilage defects (18).

Acknowledgments: Funding: This work was funded by the National Key R&D Program of China (nos. 2018YFB1105600 and 2018YFA0703000), the China National Natural Science Funds (nos. 51631009 and 81802122), the Chinese postdoctoral funding (no. 2019M661559), and the Funds from Shanghai Jiao Tong University for the Clinical and Translational Research Center for 3D Printing Technology. Author contributions: Y.S. and Y.Y. contributed equally to conceiving the study and designing the experiments. W.J. helped design the 3D bioprinted scaffolds. B.W. helped synthesize the growth factorencapsulated microspheres. Y.S. and Q.W. conducted the animal experiment. Y.S. and Y.Y. analyzed the data and wrote the manuscript. K.D. helped edit the manuscript and provided oversight. All authors read and approved the final manuscript. Competing interests: The authors declare that they have no competing interests. Data materials and availability: All data needed to evaluate the conclusions in the paper are present in the paper and/or the Supplementary Materials. Additional data related to this paper may be requested from the authors.

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3D bioprinting dual-factor releasing and gradient-structured constructs ready to implant for anisotropic cartilage regeneration - Science Advances

Bone Marrow Stem Cells Comments Off on 3D bioprinting dual-factor releasing and gradient-structured constructs ready to implant for anisotropic cartilage regeneration – Science Advances | September 9th, 2020

Concerning heart failure (HF), the current COVID-19 pandemic is having a dramatic effect on the daily life of each individual, ranging from social distancing measures applied in most countries to getting severely diseased due to the virus. Cardiovascular Disease (CVD) is among the most common conditions in people that die of the infection. The burden of CVD accounts for over 60 million people in the EU alone, therefore, it is the leading cause of death in the world.

Although COVID-19 shows us the direct impact of a potential treatment for peoples health, CVD is a stealthy pandemic killer. HF is a chronic disease condition in which the heart is not able to fill properly or efficiently pump blood throughout your body, caused by different stress conditions including myocardial infarction, atherosclerosis, diabetes and high blood pressure. Several measures are commonly used to treat heart disease, such as lifestyle changes and medications like beta-blockers and ACE inhibitors, yet these typically only slow down the progression of the disease.

Biomedical research is exploring new avenues by combining scientific insights with new technologies to overcome chronic diseases like HF. Among the most appealing and promising technologies are the use of cardiac tissue engineering and extracellular vesicles-mediated repair strategies.

Upon an initial cell loss post-infarction, it is appealing to replace this massive loss in contractile cells for new cells and thereby not treating patients symptoms, but repairing the cause of the disease. Cardiac cell therapy has been pursued for many years with variable results in small initial trials upon injection into patients. Different cell types have been used to help the myocardium in need, but the most promising approaches aim to use induced pluripotent cells (iPS) from reprogrammed cells from the patient themselves that can be directed towards contractile myocardial cells. These cells in combination with natural materials, in which the cells are embedded in the heart, can be used for tissue engineering strategies (1). Together with different international partners, Sluijters team are trying to develop strategies to use these iPS-derived contractile cells for myocardial repair via direct myocardial injection (H2020-Technobeat-66724) or to make a scaffold that can be used as a personalised biological ventricular assist device (H2020-BRAV-874827). A combination of engineering and biology to mimic the native myocardium aims to replace the chronically ill tissue for healthy and well-coupled heart tissue that can enhance the contractile performance of the heart.

Recently, a Dutch national programme started, called RegMedXB, in which the reparative treatment of the heart is aimed to be performed outside the patients body. During the time the heart is outside the body; the patient is connected to the heart-lung machine, and after restoring function, it will be re-implanted. The so-called Cardiovascular Moonshot aims to create a therapy that best suits the individual patient, by having their heart beating in a bioreactor, outside the body. Although it sounds very futuristic, many small lessons will be learned to feet novel therapeutic insights.

The initial injection of stem cells did result in a nice improvement of myocardial performance. We have now learned that rather than these delivered cells helping the heart themselves, the release of small lipid carriers called extracellular vesicles (EVs) (2) from these cells occur. These EVs carry different biological molecules, including nucleotides, proteins and lipids, and are considered to be the bodies nanosized messengers for communication. The use of stem cell-derived EVs are now being explored as a powerful means to change the course of the disease. Via these small messengers, natural biologics are delivered to diseased cells and thereby help them to overcome the stressful circumstances. EVs carry reparative signals that can be transferred to the diseased heart and thereby change the course of heart disease in some patients.

Within the EVICARE program (3) (H2020-ERC-725229), Sluijters team are using stem cell-derived EVs to change the response of the heart to injury. Also, to understand which heart cells and processes are being affected, they use materials to facilitate a slow release of biomaterials over an extended period rather than a single dose, which is probably essential for a chronic disease like HF. For now, improved blood flow is the main aim but the team have seen other effects as well, such as cardiovascular cell proliferation (4) by which the heart cells themselves start to repair the organ.

The use of EVs basically aims to enhance the endogenous repair mechanisms of the heart. These natural carriers can be mimicked with synthetic materials, or used as a hybrid of the two, thereby creating an engineered nanoparticle, that is superior in the intracellular delivery of genetic materials. The possibility of loading different biological materials allows a further tuning of its effectiveness and use in different disease conditions, creating a new off-the-shelf delivery system for nanomedicine to treat cancer and CVD (H2020-Expert-825828).

As is true of the current COVID-19 pandemic, HF is also a growing chronic disease that affects millions of people worldwide. The chronic damaged myocardium needs reparative strategies in the future to lower the social burden for patients, but also to keep the economic consequences affordable. New scientific insights with cutting edge technological developments will help to address these needs of CVD patients and their families.

References

(1) Madonna R, Van Laake LW, Botker HE, Davidson SM, De Caterina R, Engel FB, Eschenhagen T, Fernandez-Aviles F, Hausenloy DJ, Hulot JS, Lecour S, Leor J, Menasch P, Pesce M, Perrino C, Prunier F, Van Linthout S, Ytrehus K, Zimmermann WH, Ferdinandy P, Sluijter JPG. ESC Working Group on Cellular Biology of the Heart: position paper for Cardiovascular Research: tissue engineering strategies combined with cell therapies for cardiac repair in ischaemic heart disease and heart failure. Cardiovasc Res. 2019 Mar 1;115(3):488-500.

(2) Sluijter JPG, Davidson SM, Boulanger, CM, Buzs EI, de Kleijn DPV, Engel FB, Giricz Z, Hausenloy DJ, Kishore R, Lecour S, Leor J, Madonna R, Perrino C, Prunier F, Sahoo S, Schiffelers RM, Schulz R, Van Laake LW, Ytrehus K, Ferdinandy P. Extracellular vesicles in diagnostics and therapy of the ischaemic heart: Position Paper from the Working Group on Cellular Biology of the Heart of the European Society of Cardiology. Cardiovasc Res. 2018 Jan 1;114(1):19-34.

(3) https://www.sluijterlab.com/extracellular-vesicle-inspired-ther

(4) Maring JA, Lodder K, Mol E, Verhage V, Wiesmeijer KC, Dingenouts CKE, Moerkamp AT, Deddens JC, Vader P, Smits, AM, Sluijter JPG, Goumans MJ. Cardiac Progenitor Cell-Derived Extracellular Vesicles Reduce Infarct Size and Associate with Increased Cardiovascular Cell Proliferation. J Cardiovasc Transl Res. 2019 Feb;12(1):5-17.

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Innovative treatments for heart failure - Open Access Government

IPS Cell Therapy Comments Off on Innovative treatments for heart failure – Open Access Government | September 9th, 2020

Skin fibroblasts were successfully reprogrammed into the smooth muscle cells (red) and endothelial cells (white) which surround blood vessels. The cells nuclei are shown in blue. Credit: Bersini, Schulte et al. CC by 4.0

Salk study is the first to reveal ways cells from the human circulatory system change with age and age-related diseases.

Salk scientists have used skin cells called fibroblasts from young and old patients to successfully create blood vessels cells that retain their molecular markers of age. The teams approach, described in the journal eLife on September 8, 2020, revealed clues as to why blood vessels tend to become leaky and hardened with aging, and lets researchers identify new molecular targets to potentially slow aging in vascular cells.

The vasculature is extremely important for aging but its impact has been underestimated because it has been difficult to study how these cells age, says Martin Hetzer, the papers senior author and Salks vice president and chief science officer.

Research into aging vasculature has been hampered by the fact that collecting blood vessel cells from patients is invasive, but when blood vessel cells are created from special stem cells called induced pluripotent stem cells, age-related molecular changes are wiped clean. So, most knowledge about how blood vessel cells age comes from observations of how the blood vessels themselves change over time: veins and arteries become less elastic, thickening and stiffening. These changes can contribute to blood pressure increases and a heightened risk of heart disease with age.

From left: Martin Hetzer and Simone Bersini. Credit: Salk Institute

In 2015, Hetzer was part of the team led by Salk President Rusty Gage to show that fibroblasts could be directly reprogrammed into neurons, skipping the induced pluripotent stem cell stage that erased the cells aging signatures. The resulting brain cells retained their markers of age, letting researchers study how neurons change with age.

In the new work, Hetzer and his colleagues applied the same direct-conversion approach to create two types of vasculature cells: vascular endothelial cells, which make up the inner lining of blood vessels, and the smooth muscle cells that surround these endothelial cells.

We are among the first to use this technique to study the aging of the vascular system, says Roberta Schulte, the Hetzer lab coordinator and co-first author of the paper. The idea of developing both of these cell types from fibroblasts was out there, but we tweaked the techniques to suit our needs.

The researchers used skin cells collected from three young donors, aged 19 to 30 years old, three older donors, 62 to 87 years old, and 8 patients with Hutchinson-Gilford progeria syndrome (HGPS), a disorder of accelerated, premature aging often used to study aging.

The resulting induced vascular endothelial cells (iVECs) and induced smooth muscle cells (iSMCs) showed clear signatures of age. 21 genes were expressed at different levels in the iSMCs from old and young people, including genes related to the calcification of blood vessels. 9 genes were expressed differently according to age in the iVECs, including genes related to inflammation. In patients with HGPS, some genes reflected the same expression patterns usually seen in older people, while other patterns were unique. In particular, levels of BMP-4 protein, which is known to play a role in the calcification of blood vessel, were slightly higher in aged cells compared to younger cells, but more significantly higher in smooth muscle cells from progeria patients. This suggests that the protein is particularly important in accelerated aging.

The results not only hinted at how and why blood vessels change with age, but confirmed that the direct-conversion method of creating vascular endothelial and smooth muscle cells from patient fibroblasts allowed the cells to retain any age-related changes.

One of the biggest theoretical implications of this study is that we now know we can longitudinally study a single patient during aging or during the course of a treatment and study how their vasculature is changing and how we might be able to target that, says Simone Bersini, a Salk postdoctoral fellow and co-first author of the paper.

To test the utility of the new observations, the researchers tested whether blocking BMP4 which had been present at higher levels in smooth muscle cells developed from people with HGPS could help treat aging blood vessels. In smooth muscle cells from donors with vascular disease, antibodies blocking BMP4 lowered levels of vascular leakiness one of the changes that occurs in vessels with aging.

The findings point toward new therapeutic targets for treating both progeria and the normal age-related changes that can occur in the human vascular system. They also illustrate that the direct conversion of fibroblasts to other mature cell types previously successful in neurons and, now, in vascular cells is likely useful for studying a wide range of aging processes in the body.

By repeating what was done with neurons, weve demonstrated that this direct reprogramming is a powerful tool that can likely be applied to many cell types to study aging mechanisms in all sorts of other human tissues, says Hetzer, holder of the Jesse and Caryl Philips Foundation Chair.

The team is planning future studies to probe the exact molecular mechanisms by which some of the genes they found to change with age control the changes seen in the vasculature.

Reference: Direct reprogramming of human smooth muscle and vascular endothelial cells reveals defects associated with aging and Hutchinson-Gilford progeria syndrome by Simone Bersini, Roberta Schulte, Ling Huang, Hannah Tsai and Martin W Hetzer, 8 September 2020, eLife.DOI: 10.7554/eLife.54383

Other researchers on the study were Ling Huang and Hannah Tsai of Salk. The work was supported by grants from the National Institutes of Health, the NOMIS Foundation and an AHA-Allen Initiative in Brain Health and Cognitive Impairment award made jointly through the American Heart Association and the Paul G. Allen Frontiers Group. Simone Bersini was supported by the Paul F. Glenn Center for Biology of Aging Research at the Salk Institute.

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Scientists May Have Discovered a Way to to Slow Aging by Direct Reprogramming of Human Cells - SciTechDaily

Skin Stem Cells Comments Off on Scientists May Have Discovered a Way to to Slow Aging by Direct Reprogramming of Human Cells – SciTechDaily | September 8th, 2020