In haploidentical hematopoietic cell transplantation (Haplo-HCT), in vivo or ex vivo T-cell depletion (TCD) can prevent graft-versus-host disease (GVHD) but increase risk of infection and relapse. We hypothesized that TCRαβ-depleted allograft together with upfront infusion with CD45RA-depleted memory T cells (αβTCD + TMDLI) may result in favourable GVHD-free and relapse-free survival (GRFS). Between January 2017 and July 2023, 145 adult patients with various haematological malignancies received αβTCD + TMDLI. All except 2 patients had robust engraftment at a median of 12 days for neutrophil and 11 days for platelet. The cumulative incidence (CI) of CMV, EBV, HHV6 or ADV infection was only 43% (n = 63) at day+120. CI of grade II-IV and III-IV acute GVHD at 180 days was 31% and 8% respectively. Chronic GVHD was seen in only 5 patients with a 2-year CI of 4%. CI of non-relapse mortality and relapse at 2 years were 17% and 22% respectively. At a median follow up of 28 months, 3-year overall (OS), event-free (EFS), and GRFS were 67%, 62%, and 59%, respectively. This was significantly improved over a propensity score-matched contemporary cohort (n = 53) who received PTCy as GVHD prophylaxis. This first multi-center study demonstrated the potential benefits of the αβTCD + TMDLI approach for Haplo-HCT.

Thinning hair affects the quality of life of affected men and women but has limited treatment options. A novel technology refines exosomes from stem cells to create a concentrated complex that is quickly absorbed into the scalp to deliver growth factors, peptides, coenzymes, minerals, amino acids, and vitamins (Exosome Regenerative Complex+®. BENEV, Inc.; Mission Viejo, CA). This study assessed the efficacy and safety of the Exosome Regenerative Complex applied following microneedling on the scalp of subjects with self-perceived thinning hair. Enrolled subjects were male (n=15) and female (n=15) with a mean (SD) age of 50.2 (10.9) years (range, 26-65 years). Subjects were treated on days 0, 30, 60, and 90, with a final assessment on day 120. Trichoscopy assessments showed this treatment significantly increased terminal and vellus hair counts (P<0.0001) and decreased hair shedding on day 120 (P<0.01), increased mean follicular units per cm² (P<0.0001), and decreased inter-follicular distance (P<0.0001). On day 120, the investigator rating for improved hair quality was 97% and improved hair growth was 83%. Subject satisfaction with treatment results was high with no reported adverse events. The combined use of an Exosome Regenerative Complex combined with RF microneedling appears to be an effective and well-tolerated treatment for hair loss in men and women. ClinicalTrials.gov NCT06571799.

Anterior cruciate ligament (ACL) reconstruction (ACLR) surgery remains the prevailing standard of care for complete ACL ruptures but is not without risk. The aim of this study was to compare non-surgical, autologous bone marrow concentrate (BMC) with platelet products compared to exercise therapy for partial and complete, non-retracted ACL tears without meniscus injuries.

Oncogenic KRAS is amongst the key genetic drivers for initiation and maintenance of pancreatic ductal adenocarcinoma (PDAC). Here, we show that engineered exosomes with KrasG12D specific siRNA (iExoKrasG12D) reveal a biodistribution in pancreas with negligible toxicity in preclinical studies in mice and Rhesus macaques. Clinical testing of iExoKrasG12D in the iEXPLORE (iExoKrasG12D in Pancreatic Cancer) Phase I study employed a non-randomized single-arm classical 3 + 3 dose escalation design (Phase Ia), followed by an accelerated titration design (Phase Ib) (NCT03608631). The primary outcomes included safety, tolerability and target engagement, and the secondary outcomes aimed to assess disease control. Patients with advanced metastatic disease were enrolled after failure of multiple lines of therapy. iExoKrasG12D therapy was well-tolerated: the primary outcomes were met with iExoKrasG12D showing no dose-limiting toxicity. The maximum tolerated dose was not reached even at the highest dose. In some cases, iExoKrasG12D therapy was associated with stable disease response (secondary outcome). Downregulation of KRASG12D DNA and suppression of phospho-Erk was documented together with an increase in intratumoral CD8+ T cells following treatment. The CD8+ T cell recruitment priming by iExoKrasG12D informed on potential efficacy of immune checkpoint therapy and lead to validation testing in preclinical PDAC models. Combination therapy of iExoKrasG12D and anti-CTLA-4 antibodies, but not anti-PD1, revealed robust pre-clinical anti-tumor efficacy via FAS mediated CD8+ T cell anti-tumor activity. This first-in-human, precision medicine clinical trial and supporting preclinical functional studies offer new insights into priming of immunotherapy by oncogenic Kras inhibitor for future opportunistic combination therapy for PDAC patients.

Large number of decompensated liver cirrhosis patients in China have been diagnosed with hepatitis B virus (HBV). Human umbilical cord-derived mesenchymal stem cells (hUC-MSCs) can possibly cure decompensated liver cirrhosis because of their self-renewal and multidirectional differentiation potential.

This is a phase I trial, assessing the feasibility, safety, and potential efficacy of intradiscal injection of allogeneic bone marrow-derived clonal mesenchymal stromal cells (BM-cMSCs) in patients suffering from discogenic low back pain (DLBP).

Patients with mucopolysaccharidosis type I Hurler (MPSIH) experience multisystem clinical manifestations, which are only partially addressed by allogeneic hematopoietic stem cell transplantation (allo-HSCT). This study evaluated outcomes from a lentiviral vector-mediated hematopoietic stem and progenitor cell-gene therapy (HSPC-GT) trial (NCT03488394) in eight MPSIH patients followed up to 4 years post-treatment. Key findings included corneal clouding, hearing loss (HL), carpal tunnel syndrome (CTS), and cardiac evaluations. A retrospective comparison with an external cohort of nine MPSIH patients undergoing allo-HSCT was performed. All patients are alive at last follow-up, show stable engraftment without graft failure, insertional oncogenesis, or immune responses to the transgene. Notably, at last follow-up 3/8 HSPC-GT patients experienced corneal clouding resolution, while all allo-HSCT patients maintained moderate corneal clouding; 4/8 HSPC-GT patients showed normal hearing function at last follow-up due to improvement (n = 3) or stabilization (n = 1); 7/9 allo-HSCT patients had mild or moderate HL at baseline, while 2/9 showed moderate HL at last follow-up. No HSPC-GT patients required surgery for CTS developed after HSPC-GT, while 7/9 patients needed such surgery after allo-HSCT. No HSPC-GT patients developed severe cardiomyopathy or valvular disease, while in the HSCT cohort 4/9 patients experienced progression of valvular insufficiency although not requiring valve replacement. Our results indicate a favorable effect of HSPC-GT on MPSIH multisystemic manifestations up to 4 years after treatment; long-term, prospective comparative studies are warranted for definitive conclusions.

Kidney function declines with age, largely due to chronic low-grade inflammation. Mesenchymal stem cells (MSCs) have demonstrated immunomodulatory effects in certain immune-mediated kidney diseases, but their role in preserving renal function in aging individuals without chronic kidney disease (CKD) remains unclear. This study presents secondary outcome findings from a randomized clinical trial in Parkinson's disease (PD), evaluating the impact of allogeneic human bone marrow-derived MSCs (allo-hMSCs) on kidney function in an aging population with PD with preserved renal function.

Systemic lupus erythematosus (SLE) remains refractory to conventional immunosuppression in a subset of patients. In treatment-refractory SLE, we show that peripheral CD19⁺ B cells and bone marrow CD19⁻BCMA⁺ long-lived plasma cells are dominant autoantibody sources, motivating dual CD19 and BCMA targeting. Here we report results from a cohort of patients (14 female, one male) in an ongoing phase 1 dose-escalation trial of co-infused autologous anti-CD19 and anti-BCMA chimeric antigen receptor (CAR) T cells after fludarabine/cyclophosphamide lymphodepletion. Primary endpoints were dose-limiting toxicities (DLTs) within 28 days and adverse events within 12 weeks; key secondary endpoints comprised attainment of Lupus Low Disease Activity State (LLDAS) and DORIS remission within 12 weeks and in vivo CAR-T persistence within 24 weeks. Exploratory endpoints were the duration of post-infusion B cell depletion and time to recovery, the kinetics of immune reconstitution and longitudinal changes in autoantibody titers and serum immunoglobulin concentrations after CAR-T therapy. Over a median 712-day follow-up (range, 613-1,134), no DLTs occurred. Grade 1 cytokine release syndrome developed in 86.7% of patients, with no neurotoxicity or treatment-related deaths. The most common grade 3 or higher adverse events were neutropenia (100%), thrombocytopenia (40%) and anemia (13.3%), all of which were reversible with supportive care. By week 12, 12 of 15 patients (80%) fulfilled both the LLDAS and DORIS remission criteria. Multiomic analyses confirmed elimination of autoreactive CD19⁺BCMA⁺ clones, reconstitution of naive IgM/IgD B cells and durable downregulation of interferon-stimulated and BAFF-dependent signatures, indicating improved immune homeostasis. Longitudinal monitoring of three patients for 1 year demonstrated sustained eradication of pathogenic clones, suggesting potential cure. Dual anti-CD19/anti-BCMA CAR-T cell therapy demonstrates good safety and promising clinical efficacy in treatment-refractory SLE. This study supports the further development of this treatment approach for patients with rSLE. ClinicalTrials.gov identifier: NCT05030779 .

Patients with significant T-cell dysfunction from chemotherapy or hematopoietic stem cell transplant are at significant risk for complications of viral infections. Off-the-shelf third-party virus-specific T cells (TP VSTs) are an effective and well-tolerated treatment for the management of infection with adenovirus, BK polyomavirus, cytomegalovirus, and Epstein-Barr virus. TP VST product selection for any particular patient incorporates maximizing the number of HLA matches between the product and the patient, along with consideration of the antiviral activity of the product. We have previously shown that single-antigen cell lines (SALs), cell lines expressing a single HLA molecule, can be used in a flow cytometric-based assay to determine sites of HLA restriction for TP VST products. We hypothesized that incorporating match at sites of HLA restriction into TP VST product selection would improve response rates. Here we report on 25 patients who received TP VSTs for the treatment of 26 viral infections with at least 1 match at an HLA-restricted site. In this cohort, the overall response rate was 96.2%, with a complete response rate of 69.2%. These data suggest the annotation of VST banks to include SAL-derived HLA restriction could lead to improved product selection and efficacy. This trial was registered at www.clinicaltrials.gov as #NCT02532452.

Clinical application of mesenchymal stem cells for endometrial repair has been hampered by variability in cell quality, large-scale production, and uncertainty regarding the optimal delivery route. In this study, we investigated the therapeutic potential of clinical-grade human embryonic stem cell-derived immunity-and-matrix-regulatory cells (IMRCs) for treating refractory moderate-to-severe intrauterine adhesion (IUA). In a rabbit IUA model, sub-endometrial injection of IMRCs significantly reduced fibrosis and enhanced endometrial angiogenesis, outperforming uterine perfusion. Transcriptomic analysis revealed distinct pro-angiogenic gene expression profiles between the two delivery routes. In vitro, IMRCs co-cultured with endometrial stromal cells (ESCs) markedly enhanced angiogenic potential compared to either cell type alone. Protein array analysis of the co-culture supernatant showed elevated levels of angiogenic factors, with functional assays confirming that inhibition of ANGPTL4, a non-canonical pro-angiogenic mediator, impaired angiogenesis. In a first-in-human, single-center, phase 1 dose-escalation trial involving 18 patients with refractory IUA, high-dose sub-endometrial IMRC injection promoted angiogenesis, reduced uterine scarring, and improved pregnancy outcomes, with no safety concerns observed over 3 years of follow-up. These findings highlight the translational promise of IMRCs as a novel therapeutic strategy for endometrial regeneration in severe IUA.

Talquetamab, a G protein-coupled receptor class C group 5 member D-targeting bispecific antibody for relapsed/refractory multiple myeloma (R/R MM), plus daratumumab, may lead to deeper and more durable responses than either therapy alone. In the phase 1b TRIMM-2 study, patients with R/R MM (at least 3 previous lines of therapy or double refractory to a proteasome inhibitor and an immunomodulatory drug) received subcutaneous talquetamab 0.4 mg/kg weekly (QW; "QW cohort") or 0.8 mg/kg every other week (Q2W cohort) plus daratumumab 1800 mg per the approved schedule. The primary end point was safety. Secondary end points included overall response and duration of response. Progression-free survival was an exploratory end point. Sixty-five patients (median 5 previous lines of therapy; 61.5% triple-class refractory; 24.6% bispecific antibody exposed) received talquetamab plus daratumumab (QW, n = 14; Q2W, n = 51; median follow-up of 18.6 months). Most common adverse events were oral events, skin events, cytokine release syndrome, and infections. Grade 3 or 4 events occurred in 81.5%. Two patients had dose-limiting toxicities, both in the Q2W cohort (grade 3 stomatitis/oral mucositis, and grade 3 maculopapular rash). Responses occurred in 71.4% (QW cohort) and 82.4% (Q2W cohort) of patients. Median progression-free survival was 23.3 and 21.2 months, respectively, in each cohort. Pharmacodynamic results suggest the immunomodulatory action of daratumumab contributes to a conducive environment for talquetamab by reducing immunosuppressive cells. Talquetamab plus daratumumab demonstrated promising efficacy outcomes in patients with heavily pretreated disease, with a safety profile consistent with each agent as monotherapy. This trial was registered at www.clinicaltrials.gov as #NCT04108195.

Retinal pigment epithelium (RPE) cell atrophy in dry age-related macular degeneration (AMD) compromises photoreceptor cell function, leading to vision loss. Stem cell-based RPE replacement therapy aims to reverse disease progression and restore vision. RPESC-RPE-4W, a post-mitotic adult RPE stem cell-derived RPE (RPESC-RPE) progenitor cell product, exhibits consistent safety and efficacy in preclinical studies. The first-in-human clinical trial of RPESC-RPE-4W completed low-dose cohort 1 interventions (NCT04627428). Six subjects received a subretinal suspension of 50,000 RPESC-RPE-4W cells. No significant inflammation, tumor, or product-related serious adverse events were observed. Best-corrected visual acuity in the three worse-seeing group A subjects improved by an average of +21.67 letters from baseline at 12 months. Three better-seeing group B subjects improved by an average of +3.0 letters at 6 months. The positive safety and tolerability outcomes for low-dose cohort 1 enabled dose escalation to mid-dose RPESC-RPE-4W therapy for dry AMD.

Early-stage knee osteoarthritis (knee OA) lacks effective regenerative therapies. This study aimed to compare the cartilage regenerative effects, clinical efficacy, and safety of intra-articular injections of autologous adipose-derived mesenchymal stem cells (ADSCs) versus hyaluronic acid (HA). Forty-eight patients with early knee OA were enrolled in a prospective open-blinded multi-center study at Suranaree University of Technology Hospital and Phramongkutklao Hospital. Participants were randomized into either the ADSC or HA group. Primary outcomes included MRI-based cartilage lesion volume, synovial thickness via ultrasound, and WOMAC scores over 6 months. MRI results revealed significant and progressive cartilage regeneration in the ADSC group. In particular, medial femoral cartilage lesion volume decreased by 50.06 mm3, whereas the HA group showed an increase of 36.44 mm3. Synovial thickness also declined significantly in the ADSC group at 3 and 6 months. Both groups demonstrated reduced symptoms, but the ADSC group achieved superior and sustained improvements in WOMAC pain, stiffness, and function scores throughout the 6-month follow-up. The clinical benefits were consistent and more pronounced compared with HA. No serious adverse events occurred. In conclusion, intra-articular ADSC injections show superior cartilage restoration on MRI and better clinical outcomes than HA injection, making them a promising treatment for early-stage knee OA.

Refractory cytomegalovirus (CMV) infection is a severe complication following umbilical cord blood transplantation (UCBT). Antiviral agents, the standard first-line therapy, are limited by toxicity and resistance without robust T-cell immunity. We evaluated third-party donor (TPD)-derived CMV-specific T cells (CMVSTs) as a treatment option. In a prospective phase I trial, UCBT recipients under 60 years with refractory CMV infection were enrolled. CMV-seropositive TPDs, matched for at least one human leucocyte antigen (HLA) class I allele at high resolution, were selected from family members. CMVSTs were manufactured for two infusions within 1 month. Safety and feasibility were primary end-points while efficacy and immune reconstitution were secondary end-points. Ten patients (median age: 15.5 years, range: 3-46 years) received CMVSTs (median doses: 2.2 × 107/m2 and 4.2 × 107/m2). Products showed high CD3+ T-cell purity and memory T-cell dominance. Infusions caused mild adverse events, with no severe toxicities. At 6 months post-first infusion, 80% (8/10) achieved durable virological clearance; 60% (6/10) survived at 2 years with sustained CMV control. TPD-derived CMVST infusions are safe and feasible for refractory CMV infection post-UCBT, offering durable virological control while larger studies are needed to confirm efficacy. This trial was registered at www.chictr.org.cn as # ChiCTR2000034951.

Although Kasai surgery has saved many patients with biliary atresia, the long-term survival rate remains low. Recently, cell therapy has been explored as a potential strategy to improve post-surgical survival. This study aims to evaluate the safety and outcomes of allogeneic umbilical cord mesenchymal stem cell (UC-MSC) infusion in management of liver cirrhosis due to Biliary Atresia after Kasai operation.

The potential of the phytoconstituent, curcumin, as an adjuvant to chemoradiotherapy has been investigated because of its ameliorating effects, including the sensitization of cancer and cancer stem cells. Curcumin, a strong antioxidant with pharmacologically non-toxic effects, can be used as an adjuvant with enhanced bioavailability and administered along with chemotherapy to achieve better treatment outcomes. The present study was carried out with a total of 120 women with locally advanced/metastatic breast cancer, who were randomized to receive standard chemotherapy alone or chemotherapy with oral curcumin, a 500 mg capsule (1 g/day) containing 95% curcuminoid and 1% piperine given for 12 to 24 weeks. Primary outcomes were determined using the Response Evaluation Criteria in Solid Tumors (RECIST) to determine the objective response rate (ORR), progression-free survival (PFS), and time to tumor progression (TTP), including safety and adverse events, while the quality of life (QoL) and physical activity were secondary outcomes. ORR was significantly higher in the curcumin group than in those who received standard chemotherapy (38.33% vs. 8.33%, p < 0.01) at 4 weeks follow-up post-treatment, which further improved (43.40% vs. 10.64%, p < 0.0031) upon completion of 12 weeks post-treatment. Curcumin-treated women displayed higher physical performance, better prognosis and QoL, better tolerance to chemotherapy, fewer adverse effects, and better PFS. The study suggests that curcumin can be used as a safe adjuvant along with chemotherapeutic drugs for a better treatment outcome in breast cancer and also in other cancers.

Neuroinflammation contributes to Parkinson's disease (PD) progression and motor dysfunction. Allogeneic human mesenchymal stem cells (allo-hMSCs) may reduce neuroinflammation and improve motor symptoms.

Glucagon-like peptide-1 receptor agonists (GLP-1RAs) reduce major atherosclerotic cardiovascular events in individuals living with either diabetes or obesity. Since the turnover of vascular regenerative (VR) stem and progenitor cells has been demonstrated to modulate vessel repair and atherothrombotic risk, this study aimed to determine the effect of the GLP-1RA semaglutide on the levels of circulating VR cells.

This study aims to evaluate the efficacy of intra-articular autologous adipose-derived ex vivo expanded mesenchymal stromal cells (ADSC) on patient-reported outcome (pain and function) in symptomatic mild-to-moderate tibiofemoral knee osteoarthritis (OA).