A Phase I Study to Evaluate Two Doses of Wharton's Jelly-Derived Mesenchymal Stromal Cells for the Treatment of De Novo High-Risk or Steroid-Refractory Acute Graft Versus Host Disease.

BACKGROUND: Because of their well-described immunosuppressive properties, allogeneic adult human mesenchymal stromal cells (MSC) derived from bone marrow have demonstrated safety and efficacy in steroid refractory acute graft versus host disease (SR aGVHD). Clinical trials have resulted in variable success and an optimal source of MSC has yet to be defined. Based on the importance of maternal-fetal interface immune tolerance, extraembryonic fetal tissues, such as the umbilical cord, may provide an superior tissue source of MSC to mediate immunomodulation in aGVHD. METHODS: A two-dose cohort trial allogeneic Wharton's Jelly-derived mesenchymal stromal cells (WJMSC, referred to as MSCTC-0010, here) were tested in 10 patients with de novo high risk (HR) or SR aGVHD post allogeneic hematopoietic stem cell transplantation (allo-HCT). Following Good Manufacturing Practices isolation, expansion and cryostorage, WJMSC were thawed and administered via intravenous infusions on days 0 and 7 at one of two doses (low dose cohort, 2 × 106/kg, n = 5; high dose cohort, 10 × 106/kg, n = 5). To evaluate safety, patients were monitored for infusion related toxicity, Treatment Related Adverse Events (TRAE) til day 42, or ectopic tissue formation at day 90. Clinical responses were monitored at time points up to 180 days post infusion. Serum biomarkers ST2 and REG3α were acquired 1 day prior to first MSCTC-0010 infusion and on day 14. RESULTS: Safety was indicated, e.g., no infusion-related toxicity, no development of TRAE, nor ectopic tissue formation in either low or high dose cohort was observed. Clinical response was suggested at day 28: the overall response rate (ORR) was 70%, 4 of 10 patients had a complete response (CR) and 3 had a partial response (PR). By study day 90, the addition of escalated immunosuppressive therapy was necessary in 2 of 9 surviving patients. Day 100 and 180 post infusion survival was 90% and 60%, respectively. Serum biomarker REG3α decreased, particularly in the high dose cohort, and with REG3α decrease correlated with clinical response. CONCLUSIONS: Treatment of patients with de novo HR or SR aGVHD with low or high dose MSCTC-0010 was safe: the infusion was well-tolerated, and no TRAEs or ectopic tissue formation was observed. A clinical improvement was seen in about 70% patients, with 4 of 10 showing a complete response that may have been attributable to MSCTC-0010 infusions. These observations indicate safety of two different doses of MSCTC-0010, and suggest that the 10 × 106 cells/ kg dose be tested in an expanded randomized, controlled Phase 2 trial. Graphical abstract.

Vibrational relaxation of NO (v = 1-16) with NO, N2O, NO2, He and Ar studied by time-resolved Fourier transform infrared emission.

Rates of vibrational quenching of NO (v = 1-16) in collisions with a series of quenching species NO, NO2, N2O, He and Ar have been measured at 295 K. NO (v) was formed both by the O(1D) + N2O reaction and the 193 nm photolysis of NO(2), and time-resolved FTIR emission was used to follow the behaviour of the vibrationally excited species. The trends in quenching rate constants can be explained in terms of V-T transfer, V-V transfer and by the effects of competing processes. He and Ar show trends expected from SSH theory, but with relaxation rates that are considerably higher than those expected from previous studies with closed shell molecules, and the influence of non-adiabatic pathways in the relaxation of the NO 2Pi state is discussed. Relaxation with NO2 shows the influence of resonant energy transfer to the nu3 mode, with rate constants peaking at v = 10. For N2O, relaxation rates show essentially a linear increase with v. A linear increase is expected for the change of the transition moment with v for the harmonic oscillator approximation, and when this is taken into account the "reduced probabilities" (defined as P/v, where P is probability of a gas kinetic collision changing the vibrational level from v to v-1) are approximately independent of the energy lost in the NO molecule. The influence of complex formation far from resonance is invoked in both this and for quenching of low vibrational levels by NO2. Finally, self-quenching shows rates which initially decrease with increasing v, but then show a marked increase, with a minimum value at v = 9. Both V-V and V-T processes are believed to occur. Where previously published data are available, general agreement is observed in this study.