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Preconditioning of mesenchymal stem cells for improved transplantation efficacy in recessive dystrophic epidermolysis bullosa.
[dystrophic epidermolysis bullosa]
The
use
of
hematopoietic
cell
transplantation
(
HCT
)
has
previously
been
shown
to
ameliorate
cutaneous
blistering
in
pediatric
patients
with
recessive
dystrophic
epidermolysis
bullosa
(
RDEB
)
,
an
inherited
skin
disorder
that
results
from
loss
-of-function
mutations
in
COL
7
A
1
and
manifests
as
deficient
or
absent
type
VII
collagen
protein
(
C
7
)
within
the
epidermal
basement
membrane
.
Mesenchymal
stem
cells
(
MSCs
)
found
within
the
HCT
graft
are
believed
to
be
partially
responsible
for
this
amelioration
,
in
part
due
to
their
intrinsic
immunomodulatory
and
trophic
properties
and
also
because
they
have
been
shown
to
restore
C
7
protein
following
intradermal
injections
in
models
of
RDEB
.
However
,
MSCs
have
not
yet
been
demonstrated
to
improve
disease
severity
as
a
stand-alone
systemic
infusion
therapy
.
Improving
the
efficacy
and
functional
utility
of
MSCs
via
a
pre-transplant
conditioning
regimen
may
bring
systemic
MSC
infusions
closer
to
clinical
practice
.
M
SCs
were
isolated
from
2
-
to
4
-
week
-old
mice
and
treated
with
varying
concentrations
of
transforming
growth
factor
-
beta
(
TGF-
beta
;
5
-
20
ng
/
mL
)
,
tumor
necrosis
factor
-
alpha
(
TNF
-alpha
;
10
-
40
ng
/
mL
)
,
and
stromal
cell-derived
factor
1
-
alpha
(
SDF-
1
alpha
;
30
ng
/
mL
)
for
24
-
72
hours
.
We
demonstrate
that
treating
murine
MSCs
with
exogenous
TGF-
beta
(
15
ng
/
mL
)
and
TNF
-alpha
(
30
ng
/
mL
)
for
48
hours
induces
an
8
-
fold
increase
in
Col
7
a
1
expression
and
a
significant
increase
in
secretion
of
C
7
protein
,
and
that
the
effects
of
these
cytokines
are
both
time
and
concentration
dependent
.
This
cytokine
treatment
also
promotes
a
4
-
fold
increase
in
Tsg-
6
expression
,
a
gene
whose
product
is
associated
with
improved
wound-healing
and
immunosuppressive
features
.
Finally
,
the
addition
of
exogenous
SDF-
1
alpha
to
this
regimen
induces
a
simultaneous
upregulation
of
Col
7
a
1
,
Tsg-
6
,
and
Cxcr
4
expression
.
These
data
suggest
that
preconditioning
represents
a
feasible
method
for
improving
the
functional
utility
of
MSCs
in
the
context
of
RDEB
stem
cell
transplantation
,
and
also
highlight
the
applicability
of
preconditioning
principles
toward
other
cell-based
therapies
aimed
at
treating
RDEB
patients
.
Diseases
Validation
Diseases presenting
"inherited skin disorder that results from loss-of-function mutations"
symptom
dystrophic epidermolysis bullosa
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