METHOD FOR XENO-FREE GENERATION OF A POPULATION OF HMPC

Abstract

The present invention concerns a method of generating a population of skeletal muscle derived human muscle precursor cells. For this purpose, a specialized FBS-free cell growth medium is used. The invention further concerns a composition comprising such a population of hMPCs for use as a medicament, especially in the treatment of skeletal muscle dysfunction.

Claims

1. A method of generating a population of human muscle precursor cells derived from skeletal muscle, comprising at least the following steps: surgically removing fat-, and/or tendon-, and/or connective tissue from a human tissue sample from a skeletal muscle biopsy of a human patient; mincing and enzymatic digestion of the human tissue sample; reducing a number of fibroblast cells, thereby yielding a population of human muscle precursor cells; allowing the human muscle precursor cells to settle in a collagen coated dish; and expansion of the human muscle precursor cells in a cell growth medium for at least one passage.

2. The method according to claim 1, wherein the skeletal muscle biopsy is taken from a tissue selected from the group consisting of: musculus soleus, rectus abdominis, quadriceps femoris, and vastus lateralis.

3. The method according to claim 1, wherein the human muscle precursor cells are cultured for at least 2 passages.

4. The method according to claim 1, wherein the human muscle precursor cells are expanded using a cell growth medium which is free of fetal bovine serum.

5. The method according to claim 4, wherein the human muscle precursor cells are expanded using a cell growth medium comprising human platelet lysate, and wherein the human platelet lysate is present in the cell growth medium at a final concentration of 5-20%.

6. The method according to claim 5, wherein the cell growth medium used for expansion of the human muscle precursor cells further comprises an anti-coagulation factor, and wherein the cell growth medium additionally comprises at least one of the following ingredients: a nutrient solution, preferably DMEM; hEGF, hbFGF, insulin; and dexamethasone.

7. A population of skeletal muscle derived human muscle precursor cells, expressing Pax7, Desmin, and alpha-actinin, said population having been generated in a method according to claim 1.

8. A population of skeletal muscle derived human muscle precursor cells generated in a method according to claim 1 for use: as a medicament; in the treatment of skeletal muscle dysfunction; or in the treatment of stress urinary incontinence.

9. (canceled)

10. (canceled)

11. A cell growth medium for the production of a population of human muscle precursor cells for the treatment of skeletal muscle dysfunction, wherein the cell growth medium is free of fetal bovine serum.

12. The cell growth medium according to claim 11, wherein the cell growth medium contains human platelet lysate.

13. The cell growth medium according to claim 12, wherein the cell growth medium comprises the following composition: a nutrient solution; hEGF; hbFGF; insulin; dexamethasone; heparin; and filtrated human platelet lysate.

14. The cell growth medium according to claim 11, wherein for use in at least one passage, the cell growth medium further comprises a solution containing an antibiotic agent.

15. A method for the production of a cell growth medium according to claim 13, comprising the following steps: provision of a nutrient solution; addition of hEGF; addition of hbFGF; addition of insulin; preparation of a mixture of human platelet lysate with an anti-coagulation factor, before adding the mixture to the nutrient solution, and addition of the mixture of human platelet lysate and heparin to the nutrient solution; and addition of dexamethasone.

16. A method for the production of a composition comprising a population of skeletal muscle derived human muscle precursor cells, said method comprising: preparing a population of skeletal muscle according to claim 1, and suspending the population of human muscle precursor cells derived from skeletal muscle origin in a collagen solution, preferably at

17. (canceled)

18. A composition comprising a population of skeletal muscle derived human muscle precursor cells suspended in a collagen solution, wherein the collagen solution contains type I of porcine, bovine or human origin, and wherein the concentration of collagen in the composition is 1-4 mg/ml.

19. The composition according to claim 18 for use as a medicament.

20. (canceled)

21. A method for treating a skeletal muscle dysfunction in a human patient, and/or for regenerating skeletal muscle tissue in a human patient, the method comprising the steps of: providing a composition comprising a population of skeletal muscle derived human muscle precursor cells suspended in a collagen solution, wherein the composition is prepared according to the following steps: surgically removing fat-, and/or tendon-, and/or connective tissue from a human tissue sample from a skeletal muscle biopsy of a human patient; mincing and enzymatic digestion of the human tissue sample; reducing a number of fibroblast cells, thereby yielding a population of skeletal muscle derived human muscle precursor cells; allowing the human muscle precursor cells to settle in a collagen coated dish; expansion of the skeletal muscle derived human muscle precursor cells in a cell growth medium for at least one passage; and suspending of the skeletal muscle derived human muscle precursor cells at a concentration of 10-30 million cells/ml with at least 80% viability in a low percentage collagen solution, thereby yielding a composition comprising the population of skeletal muscle derived human muscle precursor cells suspended in a collagen solution; and injecting the composition into a skeletal muscle of a human patient.

22. The method according to claim 21, wherein the composition is injected into a skeletal muscle of the same human patient who's human tissue sample was used for preparing the composition.

23. The method according to claim 21, wherein the collagen solution contains type I collagen of porcine, bovine or human origin, and wherein the concentration of collagen in the composition is 1-4 mg/ml.

24. The method according to claim 21, wherein after the injection of the composition, the human patient is subjected to neuro-muscular electromagnetic stimulation (MMES) following the injection of the composition.

25. A method for treating a defect of the external urethral sphincter muscle in a human patient, the method comprising: providing a composition comprising a population of skeletal muscle derived human muscle precursor cells suspended in a collagen solution, wherein the composition is prepared according to the following steps: surgically removing fat-, and/or tendon-, and/or connective tissue from a human tissue sample from a skeletal muscle biopsy of a human patient; mincing and enzymatic digestion of the human tissue sample; reducing a number of fibroblast cells, thereby yielding a population of skeletal muscle derived human muscle precursor cells; allowing the human muscle precursor cells to settle in a collagen coated dish; expansion of the skeletal muscle derived human muscle precursor cells in a cell growth medium for at least one passage; and suspending of the skeletal muscle derived human muscle precursor cells at a concentration of 10-30 million cells/ml with at least 80% viability in a low percentage collagen solution, thereby yielding a composition comprising the population of skeletal muscle derived human muscle precursor cells suspended in a collagen solution; and injecting the composition into the external urethral sphincter muscle of a human patient.

26. A combination therapy for the treatment of at least one of: a skeletal muscle dysfunction in a human patient, and/or for regenerating skeletal muscle tissue in a human patient, an external urethral sphincter muscle in a human patient; and stress urinary incontinence in a human patient, comprising injection of a composition comprising a population of skeletal muscle derived human muscle precursor cells according to claim 7 suspended in a collagen solution into the human patient, followed by neuro-muscular electromagnetic stimulation (NMES) of the human patient.

27. The combination therapy according to claim 26, wherein the population of skeletal muscle derived human muscle precursor cells are autologous.

Description

BRIEF DESCRIPTION OF THE DRAWINGS

[0064] Preferred embodiments of the invention are described in the following with reference to the drawings, which are for the purpose of illustrating the present preferred embodiments of the invention and not for the purpose of limiting the same. In the drawings,

[0065] FIG. 1 shows, in a schematic way, the differentiation of hMPC in culture;

[0066] FIG. 2 shows a comparison of morphology of cultured hMPC in different growth media;

[0067] FIG. 3 shows a comparison of growth potential of cultured hMPCs in different growth media;

[0068] FIG. 4 shows a comparison of flow cytometry analysis of cultured hMPCs in different growth media;

[0069] FIGS. 5a-5c show a comparison of hMPCs cultured in two different conditions for myogenic characterization, wherein in FIG. 5a, flow cytometry analysis is shown of hMPCs for passage 1, in FIG. 5b for passage 2, and in FIG. 5c for passage 3;

[0070] FIG. 6 shows a fiber formation assay for hMPCs cultured in differentiation medium containing either FBS or 10% phPL;

[0071] FIG. 7 shows a fiber formation analysis comparing hMPCs cultured in differentiation medium containing FBS with hMPCs cultured in differentiation medium containing 10% phPL;

[0072] FIGS. 8a-8b show fiber formation in tissue-engineered muscle generated from subcutaneously injected hMPCs cultured with differentiation medium containing either FBS (FIG. 8a) or 10% phPL (FIG. 8b);

[0073] FIG. 9 shows an organ bath analysis performed at two levels of stimulation;

[0074] FIG. 10 shows a characterization of fiber formation in the tissue engineered skeletal muscle after subcutaneous injection of hMPCs in nude mice by H&E staining;

[0075] FIG. 11 shows the tracking of transplanted hMPCs by MRI;

[0076] FIG. 12 shows the signal decay curves for the tracking of transplanted hMPCs by T2*MRI (MRI-images not depicted);

[0077] FIGS. 13a-13b show a functional assessment of sphincter function in a canine model, wherein in A, representative urethra profiles are shown, and in B, a graph showing sphincter pressures over time are shown;

[0078] FIG. 14 shows a radiogram of the dog sphincter area at 6 months, wherein in A, the image for a normal animal sphincter, in B for a damaged sphincter, and in C for a damaged sphincter treated with MPC is shown;

[0079] FIG. 15 shows the sequence of steps from biopsy over cell culture to treatment.

DESCRIPTION OF PREFERRED EMBODIMENTS

[0080] In FIG. 15, a summary is shown of the steps contributing to the present invention. First, a skeletal muscle biopsy is taken from the patient to be treated for skeletal muscle dysfunction. Next, the biopsy is processed and autologous hMPCs are isolated and expanded in cell culture, using an inventive cell growth medium. Following harvesting, the hMPCs are used for the preparation of a composition for use as a medicament, which is then injected into the patient, followed by NMES (not pictured).

Example 1

[0081] For the purpose of identifying an alternative to fetal bovine serum (FBS) that grants the proliferation of hMPCs and the efficient formation of contracting tissue engineered muscles, FBS in culture/growth medium of hMPCs was replaced by either human serum (HS) or pooled human platelet lysate (phPL).

[0082] Human biopsies from the rectus abdominis muscle were collected during abdominal surgeries. All samples were processed according to established protocols or by applying variations to this method (Eberli et al., Optimization of human skeletal muscle precursor cell culture and myofiber formation in vitro, Methods 47, 98, 2009). Briefly, each sample was minced and digested for 1 hour (37° C., 5% CO.sub.2) in DMEM/F12 (Gibco, Invitrogen) enriched with 0.2% collagenase type I (Worthington Biochemical) and 0.4% dispase (Gibco). The digestion was stopped with growth medium supplemented with either FBS (FBS-GM), HS (HS-GM) or phPL (phPL-GM).

[0083] After centrifugation, the samples were resuspended in the respective growth medium and plated on collagen-coated 6 well dishes. In order to reduce the number of fast adhering fibroblasts, the suspension containing hMPCs was re-plated after 24 hours on new collagen-coated 6 well dishes. hMPCs were expanded at 37° C. in 5% CO.sub.2 with growth medium supplemented either with FBS, with HS or with phPL. For experimental purposes, concentrations of phPL of 5%, 10% and 20% were tested.

[0084] The following composition of the growth medium was used: DMEM/F12 (Gibco, Invitrogen) supplemented with either 18% FBS (Gibco, Invitrogen), 10% HS (Invitrogen), or 5/10/20% phPL (following the protocol in Schallmoser et al., 2007, obtained from Universitätsinstitut für Transfusionsmedizin, Salzburger Landeskliniken und Paracelsus Medizinische Privatuniversität, Salzburg, Austria). Additional supplements were similar for all growth medium variations: 1% penicillin/streptomycin (Gibco, Invitrogen) (for passage 0 only), 10 μg/ml human epidermal growth factor (hEGF) (Sigma), 1 μg/ml human basic fibroblast growth factor (hbFGF) (Sigma), 10 μg/ml human insulin (Sigma) and 0.4 μg/ml dexamethasone (0.5 μM, Sigma).

[0085] All experiments were done in triplicates for each sample from passage 1 to 3.

[0086] Following the expansion phase, the cells were transplanted subcutaneously into nude mice and after 4 weeks the formed tissue was harvested. hMPCs were characterized at different time points applying several criteria for identity, purity, and function. In vitro analysis was done by growth analysis, flow cytometry analysis, immunofluorescence staining and fiber formation assay. In vivo tests were done by immunohistochemistry, Western blot and myography. For the in vitro tests, the experiments were performed with at least 4 biopsies of patients in triplicate.

[0087] HS was chosen as an alternative to FBS for culturing hMPCs because of its successful application with other cell types such as chondrocytes, mesenchymal stem cells, corneal epithelial cells, and dental pulp stem cells. However, the growth medium supplemented with HS was not capable of sustaining the proliferation of hMPCs, the cells did not adhere to the culture dishes, even after 2 weeks and in cell cultures of biopsies originating from 4 different patients (data not shown). Even higher concentrations of 20% or higher of HS did not yield promising results despite speculations.

[0088] Morphological structures of growing cells were similar among the cells grown in FBS-supplemented growth medium (FBS-GM) and cells grown in phPL-supplemented growth medium (phPL-GM) at early and late passages (1 and 3), though less confluent for the xeno-free medium (FIG. 2). No differences were observed among the different concentrations of phPL in all passages.

[0089] For the analysis of the growth potential of the hMPC cultured in different growth media, following the primary culture after biopsy, hMPCs were seeded at 5000 cells/cm.sup.2 at each passage, cultured until 90-95% confluency and counted. The proliferation of hMPCs in either FBS-GM or phPL-GM was efficient and the same growth potential was observed during the first three passages (FIG. 3). However, the conditions with growth medium containing 10% and 20% phPL appeared to offer the best conditions for hMPCs to expand in vitro, resulting in more cells at the end of passage 3. Cells cultured in 10% phPL-GM were growing better in small dishes than in growth medium supplemented with 5% and 20% phPL-GM. Furthermore, after passage 3, the hMPCs cultured in 20% phPL-GM were growing and a proliferation arrest was witnessed. The 10% phPL-GM seemed to promote the proliferation of hMPC even more than the standard growth medium using FBS.

[0090] Obviously, media composition and -adjustment are cell-specific and critical for successful cell expansion and myogenic differentiation and explain why Kramer et al. (2005) were not able to optimally replace FBS by phPL. The missing supplements of growth factors such as hEGF, bFGF and insulin, and the use of a 20% concentration of phPL which is not the optimal concentration as discussed above, might be the reason.

[0091] hMPCs were cultured until they were 80-90% confluent prior to flow cytometry analysis. The effect of phPL on the myogenic profile of hMPCs was studied by immunofluorescence and flow cytometry analysis. phPL maintains the myogenic cell markers and phenotypes of hMPCs and differentiation potential that is well expressed in vivo.

[0092] The flow cytometry analysis of hMPCs cultured in different conditions (FBS or phPL) showed the expression of muscle specific markers at passage 3 (n=4 biopsies). The 10% phPL culture condition seems to promote the proliferation of hMPC even more than the standard condition (FBS-GM). However, the differences among the xeno-free conditions, as well as between phPL-GM and FBS-GM were not significant. In the growing cell populations, myogenic differentiation markers Alpha-actinin, Desmin, MyHC (myosin heavy chain), MyoD and Pax7 were expressed at about 80% for alpha-actinin, about 78% for Desmin, about 40% for MyHC, about 35% for MyoD, and about 65% for Pax 7, respectively (FIG. 4). The 10% phPL condition was chosen for further studies and comparison with FBS-GM condition.

[0093] The expression of the skeletal muscle markers was comparable among FBS and phPL conditions over all passages, except for MyHC (FIGS. 5a-c). The latter was 2-fold higher in the phPL alternative in passage 1 and 2.5 times higher in passage 2, while there was no difference in passage 3. Both conditions represented ideal settings and favored the proliferation of hMPCs (rather than fibroblasts). CD34 detection stayed low and stable over all passages. Noteworthy is the slight decrease in the percentage of muscle markers expressed by MPCs from passage 1 to 3, in both FBS- and phPL-GM. This did not prevent the fusing of cells or the formation of myotubes in both environments (FIG. 6). Triggering the differentiation of skeletal cells, fiber formation of hMPCs could be observed by Giemsa staining. However, the fiber counting illustrated a different capacity of hMPCs grown in FBS-GM or phPL-GM in constructing muscle-like structures. It appears that hMPCs cultured for two weeks in FBS-GM fused and formed fibers more easily (11.4 fibers/slide (±2.4)) than hMPCs expanded in phPL (7.56 fibers/slide (±1.9)) (FIG. 7). The expression of skeletal muscle markers in both cell culture conditions was confirmed by immunocytofluorescence (not shown). Staining of the cultured hMPCs at passage 3 of hMPCs cultured with FBS-GM or 10% phPL-GM in vitro showed expression of the specific skeletal muscle markers Alpha-actinin, Desmin, MyHC and MyoD. The growth medium used for the fiber formation assays, i.e. differentiation medium, contained no growth factors (such as EGF, FGF, etc.).

[0094] Following the in-vitro experiments, hMPCs cultured in FBS-GM and in 10% phPL-GM were injected subcutaneously into the back of nude mice. After four weeks, the animals were sacrificed and the engineered muscle tissues were extracted. The engineered tissues were visible in the transplantation area of all conditions. In addition, H&E staining demonstrated muscle-like structures in engineered muscle tissues (FIGS. 8a, b). The 40× magnification details and highlights the muscle formation with myotube structures. Western blot performed on samples 4 weeks post-injection confirmed the expression of the muscle specific markers Alpha-actinin, Desmin, MyHC and MyoD in both culture conditions (not shown). Immunohistochemical analysis confirmed the muscular characterization of the in vivo samples. Transplanted hMPCs were labeled with PKH67 before injection. The engineered tissues of both conditions were detected with this label. The muscle specific markers Alpha-actinin, Desmin, MyHC and Pax7 were expressed in the engineered tissues originating of both, hMPCs cultured in FBS-GM and 10% phPL-GM (not shown). Finally, these tissue-engineered harvests were contracting when stimulated at 40V/40 Hz and 80V/80 Hz (FIG. 9). Although the phPL-GM condition seemed to provide a better contractility compared to the standard condition, the observed difference was not statistically significant.

[0095] To summarize, hMPCs were able to proliferate in FBS-based growth medium and growth medium supplemented with all tested concentrations of phPL (5-20%). phPL has shown to sustain the expansion of hMPCs capable of fusing and forming contracting tissue-engineered muscle in vivo in a manner similar to FBS. Therefore, phPL can be used as a substrate for FBS in cell culture, preserving the characteristics of hMPCs to proliferate and the expression of myogenic cell surface markers. Although subtle differences between FBS and phPL expanded hMPCs have been identified, the differentiation potential of the cells to form myotubes in vivo remains constant. This finding can promote the clinical application of a cell-therapy with hMPCs isolated from muscle biopsies to treat patients suffering from SUI.

Example 2

Biopsy:

[0096] Provided that the patient did not meet any of the exclusion criteria and met all inclusion criteria, the biopsy was taken under general or spinal anesthesia. The biopsy was taken from the musculus soleus (a skeletal muscle which is very similar in composition to the sphincter muscle) of the left or right leg. For this purpose, an incision (approx. 2-4 cm) a few centimeters below the popliteal fossa on the back side of the lower limb was performed. The musculus soleus was then identified and a piece of the muscle (about 1 cm.sup.3) was surgically removed. The sterile muscle biopsy was transferred immediately after harvesting to a closed 50 ml tube containing transport medium (PBS with 1% Penicillin/Streptomycin) and processed within 24 hours, preferably within 6 hours, more preferably immediately after biopsy in a GMP laboratory. The fascia, subcutaneous tissue and skin were sutured in routine fashion. Wound control and removal of the skin sutures were performed one week after biopsy.

Preparation of a hMPC-population and cell-culture:

[0097] In the laboratory, fat- and tendon tissue were surgically removed under laminar flow, followed by rinsing in PBS and disinfection in a 1:1 solution containing a disinfectant and PBS. The remaining tissue was cut into small tissue pieces of about 1×1 mm using scissors and a forceps, then placed into 5 ml of a solution of 0.2% collagenase and 0.4% dispase and incubated for at least 1 hour at 37° C. for enzymatic digestion. After incubation the tissue pieces were aspirated with a 25 ml pipette and placed in a 50 ml tube, where they were washed with growth medium as listed below to block the enzymatic reaction. Subsequently, the sample was centrifuged for 5 minutes at 1500 rpm, after which the supernatant was removed. 15 ml of growth medium composed according to the recipe listed below were added to the cell pellet and the mixture was homogenized by pipetting up and down at least 10 times. Then, a cell strainer with a pore size of 100 μm was placed on the tube and the sample was filtered.

[0098] Meanwhile, a 6-well dish was pre-coated with a collagen solution. After 1 h, the collagen solution was aspirated and the wells were washed 3 times with PBS to remove the acidic environment.

[0099] After removing the PBS from the collagen-coated wells, the cells suspended in growth medium were split into the first two wells of a collagen-coated 6-well dish. Two other wells were filled with PBS, which is removed prior to adding cells in a subsequent step. The presence of single fibers was confirmed by phase microscopy and all dishes were incubated over night at 37° C. and humidified atmosphere containing 5% CO.sub.2.

[0100] In order to increase the purity of the hMPCs, the cells were submitted to a fibroblast reduction step: As fibroblasts tend to adhere to the plate first, the supernatant containing non adhered hMPCs was transferred after 20-28 hours to the next collagen type I coated well on the same plate after removing the PBS. The growth medium was changed at day 4 and 7. If the hMPCs were not yet adherent, medium was not changed on day 4. Instead, some fresh growth medium war carefully added on top. For the medium change, around 80% of the old medium was carefully removed and fresh medium was slowly added. The primary cultured cells reached 80% confluency within 8-10 days post-plating in the 6-well plate. Splitting was done respecting the final concentration of 3000-7000 cells/cm.sup.2, optimally about 5000 cells/cm.sup.2. After the transfer from the 6-well plate to large culture plates, a growth medium was used which was not supplemented with antibiotics any more. Cell morphology, cell numbers and fiber formation were evaluated at every passage.

[0101] The following protocol was used for the production of the hMPC-growth medium for the expansion of hMPCs:

[0102] The following materials were used: [0103] a 500 ml bottle of DMEM/F12 nutrient mix (1:1, Gibco) stored at 4° C.; [0104] 500 μl of hbFGF (Sigma, 500 ng in 500 μl at −80° C.) (final concentration of 1 ng/ml); [0105] 1 ml of hEGF (5 μg/ml at −80° C.) (final concentration of 10 ng/ml); [0106] 500 μl of human insulin (Sigma, 5 mg in 500 μl at −20° C.) (final concentration of 10 μg/ml); [0107] 1.2 ml of dexamethasone (Sigma, 200 μg in 1.2 ml at −20° C.) (final concentration of 0.4 μg/ml); [0108] 50 ml filtrated human platelet lysate (hPL) (BG 0 (platelets)/AB (plasma)) (final concentration of 10%); [0109] 600 μl Heparin-Na (Braun, 3511014) (25′000 IU/5 ml), added to the filtrated hPL before adding to the DMEM (final concentration of Heparin-Na of 6 IU per ml of growth medium); [0110] Pen/Strep (6 ml of 10′000 units/ml of penicillin and 10′000 μg/ml of streptomycin at −20° C.) only for medium used for passage 0 (final concentration of 1%).

[0111] Thereby, a culture technique was established that uses only collagen-coated dishes and defined media for expansion and differentiation of hMPCs. Cell characterization demonstrated that the hMPC phenotype can be maintained under these conditions and that the cells have the ability to form myofibers in vitro and in vivo. Sufficient numbers of cells for tissue engineering applications can be grown in 3-4 weeks using this method.

Preparation of cell composition:

[0112] Before injection, a sample of the cells is analyzed by flow cytometry, and viability tests are performed to investigate quality and purity. To deliver a minimum of 80 million mMPCs with at least 80% viability, i.e. about 64 million viable cells, in a final concentration of 20 million cells/ml, the cultured cells (about 80 million) are suspended in 4 ml of a low percentage collagen solution, i.e. 3-4 mg/ml, leading to a final concentration of about 2 mg/ml collagen in the final product. For the carrier matrix, only a low concentration of collagen is necessary. This compares to previous studies using higher collagen concentrations, which only lead to good short-term results.

[0113] As for the preparation of the collagen solution, the collagen was mixed in 0.01 M HCl. Then MEM was added as a pH indicator, until the solution turned yellow. Then NaHCO.sub.3 was added dropwise until the solution turned pink, i.e. reaches a physiological pH-value of pH 6-8. The collagen solution was then transferred unto the final cell pellet (harvested after passage 2), homogenized by pipetting up and down, transferred into a 50 ml tube and cooled in a cooler device.

[0114] The optimal maximal shelf-life of the finalized composition of hMPCs in a collagen solution is limited. The stability of the final composition is up to 24 hours at 2-8° C. Therefore, the finalized composition should be administered as fast as possible, preferably within 4 hours, at the latest within 24 hours after preparation, to maintain at least 80% cell viability.

[0115] The final product in the 10 ml syringe is transported in a box at 5° C. (+/−3° C.) controlled by temperature measuring device to the study site. In the surgery room, the final product is mixed gently before injection.

Injection of hMPC-composition:

[0116] The treatment of SUI with hMPCs is restricted to a damaged sphincter muscle of low-risk adult female patients (according to specific exclusion criteria) with a history of SUI.

[0117] To allow standardized injections into the pelvic floor of female patients, the cells are injected under ultrasound guidance.

[0118] An ultrasound probe is positioned transvaginally and a guidance tool comprising a tube and one-way syringes, is placed into the urethra. 8-12 aliquots of the hMPC-collagen composition are injected into the pelvic floor, not exceeding a total amount of 4 ml of the composition.

[0119] A sample of cells to be injected may be cultured for fiber formation assay and flow cytometry assays to check their capability in forming fibers and in expressing myogenic markers.

[0120] For comparative purposes, different injection options (transurethral and transvaginal) were evaluated, as well as transvaginal ultrasound (BK 8848, BK Medical, Denmark)-guided injections of fluid polymer compounds (liquid polymer which hardens after application) into urinary sphincter muscles of Thiel fixated human cadavers. The sphincter was then analyzed by MRI and histology of whole mount sections. Both methods showed good and comparable accuracy in hitting the rhabdosphincter.

[0121] However, the transurethral approach seems to be superior in means of simplicity primarily due to handling and shorter learning curve.

Electromagnetic Stimulation:

[0122] Physiotherapy for pelvic floor exercises was performed by electromagnetic chair stimulation (BioCon-2000). The strength of the induced electric field at maximum output was 120 V/m at the surface of the stimulation coil. At 5 cm above the stimulation coil, the field measured 22 V/m.

Analysis of muscular differentiation and function in animal models:

[0123] For studying the effect of MPCs on skeletal muscle regeneration, several animal models were used: mouse (subcutaneous cell injection for ectopic muscle formation (FIG. 10) and crush injury models of quadriceps and tibialis hindlimb muscles (not shown)); rat (bladder outlet obstruction model); dog (urethral sphincter insufficiency model by microsurgical incision of the external sphincter) (FIGS. 13 and 14).

[0124] For the characterization of fiber formation in the tissue engineered skeletal muscle after injection of hMPCs in nude mice, cultured primary hMPCs were injected subcutaneously in nude mice. 3, 7, 14 and 28 days after injection, the formed tissue was harvested and analyzed by H&E staining. Increasing fiber formation capacity by the injected hMPCs was observed within four weeks with histologically mature muscle tissue at day 14, as shown in FIG. 10. Immunohistofluorescence staining confirmed the expression of skeletal muscle markers Alpha-actinin, MyHC, and Desmin (not shown).

[0125] As an example for non-invasive visualization of the cells' differentiation by MRI, hMPCs were tracked by MRI and the developing muscle tissue by T2*MRI (FIGS. 11 and 12). FIG. 11 shows the tracking of transplanted MPCs by MRI. Unlabelled (control) and MPCs labelled with 400 μg/ml superparamagnetic iron oxide (SPIO) were injected subcutaneously on the back of nude mice. Mice were scanned by MRI 4 days, and 1, 2, and 4 weeks after injection. T2-weighted MRI images of the area of interest are shown. Injected cells are marked with an arrow. In FIG. 12, the T2* signal decay curves for all measurement time points are shown. The maturation of muscle precursor cells into skeletal muscle fibers was observed, correlating with a decrease in relaxation and diffusion parameters (measured by MRI). Importantly, during differentiation, the relaxation and diffusion parameters decreased, approaching the values for mature skeletal muscle tissue, suggesting that MRI relaxation and diffusion measurements provide adequate biomarkers for the in-vivo monitoring of muscular differentiation and function.

[0126] FIG. 13 shows a functional assessment of sphincter function in a canine model. Canine muscle progenitor cells were successfully and reproducibly isolated, grown and expanded. In A, representative urethra profiles show the increase of sphincter pressure in the sphincter area after cell treatment. N shows the normal control, D6 shows the “damage only” control at 6 months, and M6 shows the MPC treated animal at 6 months. In B, the graph shows sphincter pressures over time. The animals injected with cells showed a significant functional recovery of their sphincter function with sphincter pressures approximately 80% of normal, while the pressures in the control animals (“damage only”) dropped and remained at 20% (p<0.025). Histologically, the implanted cells survived and formed tissue within the injected region of the sphincter and formed new innervated muscle fibers (see also Eberli, D., et al., Muscle Precursor Cells for the Restoration of Irreversibly Damaged Sphincter Function. Cell Transplant, 2012).

[0127] In FIG. 14, a radiogram of the dog sphincter area at 6 months is shown. Animals treated with MPC injection were able to regain a normal anatomical sphincter structure (arrows in C) and bladder neck region while animals without treatment showed a widening of the sphincter area (arrows in B), indicating a loss of anatomic integrity. A shows a representation of a normal, undamaged sphincter, B of a damaged sphincter, and C of a damaged sphincter treated with MPC.

[0128] The results in dogs showed that autologous MPCs are able to restore otherwise irreversibly damaged sphincter function. The injected cells were able to survive and formed mature tissue within the damaged sphincter function. This large animal study demonstrated the feasibility of using autologous muscle precursor cells for functional restoration of urinary sphincter muscle in patients with sphincter insufficiency.

[0129] For successful application of MPCs in muscle cell therapy in humans, a non-invasive in-vivo monitoring tool of the differentiation process is crucial. MRI relaxation and diffusion measurements provide adequate biomarkers for the in-vivo monitoring of muscular precursor differentiation.