How Stem Cell Therapy Protects Bone In Lupus

Systemic Lupus Erythematosis, otherwise known as lupus, is an autoimmune disease cause your own immune system attacking various cells and tissues in your body. Lupus patients can suffer from fatigue, joint pain and selling and show a marked increased risk or osteoporosis.

Clinical trials have established that infusions of mesenchymal stem cells (MSCs) can significantly improve the condition of lupus patients, but exactly why these cells help these patients is not completely clear. Certainly suppression of inflammation is probably part of the mechanism by which these cells help lupus patients, but how do these cells improve the bone health of lupus patients?

Songtao Shi and his team at the University of Pennsylvania have used an animal model of lupus to investigate this very question. In their hands, transplanted MSCs improve the function of bone marrow stem cells by providing a source of the FAS protein. FAS stimulates bone marrow stem cell function by means of a multi-step, epigenetic mechanism.

This work by Shi and his colleagues has implications for other cell-based treatment strategies for not only lupus, but other diseases as well.

“When we used transplanted stem cells for these diseases, we didn’t know exactly what they were doing, but saw that they were effective,” said Shi. “Now we’ve seen in a model of lupus that bone-forming mesenchymal stem cell function was rescued by a mechanism that was totally unexpected.”

In earlier work, Shi and his group showed that mesenchymal stem cell infusions can be used to treat various autoimmune diseases in particular animals models. While these were certainly highly desirable results, no one could fully understand why these cells worked as well as they did. Shi began to suspect that some sort of epigenetic mechanism was at work since the infused MSCs seemed to permanently recalibrate the gene expression patterns in cells.

In order to test this possibility, Shi and others found that lupus mice had a malfunctioning FAS protein that prevented their bone marrow MSCs from releasing pro-bone molecules that are integral for bone maintenance and deposition.

A deficiency for the FAS protein prevents bone marrow stem cells from releasing a microRNA called miR-29b.  The failure to release miR-29b causes its concentrations to increase inside the cells.  miR-29b can down-regulate an enzyme called DNA methyltransferase 1 (Dnmt1), and the buildup of miR-29b inhibits Dnmt1, which causes decreased methylation of the Notch1 promoter and activation of Notch signaling.  Methylation of the promoters of genes tends to shut down gene expression, and the lack of methylation of the Notch promoter increases Notch gene expression, activating Notch signaling.  Unfortunately, increased Notch signaling impaired the differentiation of bone marrow stem cells into bone-making cells.  Transplantation of MSCs brings FAS protein to the bone marrow stem cells by means of exosomes secreted by the MSCs.  The FAS protein in the MSC-provided exosomes reduce intracellular levels of miR-29b, which leads to higher levels of Dnmt1.  Dnmt1 methylates the Notch1 promoter, thus shutting down the expression of the Notch gene, and restoring bone-specific differentiation.

Shi and others are presently investigating if this FAS-dependent process is also at work in other autoimmune diseases.  If so, then stem cell treatments might convey similar bone-specific benefits.

MSC Transplantation Reduces Bone Loss via Epigenetic Regulation of Notch Signaling in Lupus

Mesenchymal stem cells from bone marrow, fat, and other tissues have been used in many clinical trials, experiments, and treatment regimens. While these cells are not magic bullets, they do have the ability to suppress unwanted inflammation, differentiate into bone, cartilage, tendon, smooth muscle, and fat, and can release a variety of healing molecules that help organs from hearts to kidneys heal themselves.

Mesenchymal stem cell transplantation (MSCT) is the main means by which mesenchymal stem cells are delivered to patients for therapeutic purposes. However, the precise mechanisms that underlie the success of these cells are not fully understood. In a paper by from the University Of Pennsylvania School Of Dental Medicine published in the journal Cell Metabolism, MSCT were able to re-establish the bone marrow function in MRL/lpr mice. The MRL/lpr mouse is a genetic model of a generalized autoimmune disease sharing many features and organ pathology with systemic lupus erythematosus (SLE). Such mice show bone loss and poor bone deposition, a condition known as “osteopenia.” Because mesenchymal stem cells are usually the cells in bone marrow that differentiate into osteoblasts (which make bone) a condition like osteopenia results from defective mesenchymal stem cell function.

In this paper, Shi and his coworkers and collaborators showed that the lack of the Fas protein in the mesenchymal stem cells from MRL/lpr mice prevents them from releasing a regulatory molecule called “miR-29b.” This regulatory molecule, mir-29b, is a small RNA molecule known as a microRNA. MicroRNAs regulate the expression of other genes, and the failure to release miR-29b increases the intracellular levels of miR-29b. This build-up in the levels of miR-29b causes the downregulation of an enzyme called “DNA methyltransferase 1” or Dnmt1. This is not surprising, since this is precisely what microRNAs do – they regulate genes. Dnmt1 attaches methyl groups (CH3 molecules) to the promoter or control regions of genes.

Decrease in the levels of Dnmt1 causes hypomethylation of the Notch1 promoter. When promoters are heavily methylated, genes are poorly expressed. When very methyl groups are attached to the promoters, then the gene has a greater chance of being highly expressed. Robust expression of the Notch1 genes activates Notch signaling. Increased Notch signaling leads to impaired bone production, since differentiation into bone-making cells requires mesenchymal stem cells to down-regulate Notch signaling.

When normal mesenchymal stem cells are transplanted into the bone marrow of MRL/lpr mice, they release small vesicles called exosomes that transfer the Fas protein to recipient MRL/lpr bone marrow mesenchymal stem cells. The presence of the Fas protein reduces intracellular levels of miR-29b, and this increases Dnmt1-mediated methylation of the Notch1 promoter. This decreases the expression of Notch1 and improves MRL/lpr BMMSC function.


These findings elucidate the means by which MSCT rescues MRL/lpr BMMSC function. Since MRL/lpr mice are a model system for lupus, it suggests that donor mesenchymal stem cell transplantation into lupus patients provides Fas protein to the defective, native mesenchymal stem cells, thereby regulating the miR-29b/Dnmt1/Notch epigenetic cascade that increases differentiation of mesenchymal stem cells into osteoblasts and bone deposition rates.

A Stem Cell Treatment for Stroke

A new clinical trial is enrolling people who are dealing with the disabling effects of stroke.

Every year approximately 800,000 Americans suffer a stroke. Strokes or TIAs for “trans-ischemic attacks” result from blockage of a blood vessel in the brain. The lack of blood flow to the brain results in the death of those cells that starve from oxygen, and the aftermath of a stroke is remarkably unpleasant; long-term disability, permanent brain damage, and even death. Stroke is the leading cause of adult disability and extracts an annual burden of $62 billion on the US economy. Physical therapy can improve the deficits caused by a stroke, but there are, to date, no good treatments to ameliorate the condition of a stroke patient.

In the hopes of creating new options for stroke patients, researchers at Northwestern Medicine are examining a new regenerative treatment for stroke that utilizes a novel stem cell line called SB623. This stem cell line might provide increased motor function to stroke victims.

Northwestern is only one of three sites in the nation enrolling patients in a clinical study to evaluate the efficacy and safety of adult stem cell therapy in stroke patients. Patient who have suffered from so-called “ischemic stroke” suffer from impaired bodily functions that includes such conditions as paralysis, weakness on one side, difficulty with speech and language, vision issues, and cognitive deficits.

Joshua Rosenow, the principal investigator of this clinical trial, is the director of Functional Neurosurgery at Northwestern Memorial Hospital. Rosenow had this to say of this clinical study: “Two million brain cells die each minute during a stroke making it critical to get treatment fast at the earliest sign of symptoms once brain damage occurs, there’s very little that can be done medically to reverse it. While this study is only a preliminary step towards understanding the healing potential of these cells, we are excited about what a successful trial could do for a patient population that hs very limited therapeutic options.”

The primary purpose of this study is to examine the safety of SB623 stem cells. However, there is an added motive behind this study, and that is to determine if SB623 cells are efficacious as a treatment for stroke patients. SB623 cells are genetically engineered mesenchymal stem cells from adult bone marrow.

Richard Bernstein, the director of Northwestern Memorial’s Stroke Center, weighed in: “Although not proven in humans, these stem cells (SB623) have been shown to promote healing and improve function when administered in animal models of stable stroke. The cells did not replace the neurons destroyed by stroke, but instead they appeared to encourage the brain to heal itself and promote the body’s natural regenerative process. Eventually, the implanted stem cells disappeared.”

Rosenow added, “In this study, the cells are transplanted into the brain using brain mapping technology and scans, allowing us to precisely deposit the cells in the brain adjacent to the area damaged by the stroke.”

The first participants have received injections of 25 million cells, but as the study progresses, the dose will escalate to 5 million and eventually 10 million cells. Since SB623 cells are allogeneic, which is to say that they come from someone other than the patient, a single donor’s cells can be used to treat as many other patients. All subjects in this study will be followed for up to two years with periodic evaluations for safety and effectiveness in improving motor function.

Bernstein explained, “Stroke can be a very disabling and life-changing event. Even just a slight improvement in function could make a huge difference for a person impacted [sic] by stroke. To potentially regain movement or speech is a very exciting prospect. In the animal models, the improvements appeared to remain even after the implanted stem cells disappeared.

Even at this early stage in this clinical trial, there is a great deal of excitement over the potential for stem cell therapy. Rosenow echoed this excitement when he said, “Of these cells are proven effective in improving, or even reversing brain damage, the implications of a successful outcome reach far beyond just stroke. Stem cell therapy may hold the key to treating a wide range of neurological disorders that do not have many available therapies. The Northwestern team is very excited to be a part of this groundbreaking trial.”

Participants for this trial must be between the ages of 18 and 75 years old, must have had an ischemic stroke in the last six to 36 months. They should have moderate to severe symptoms with impaired motor function. Full inclusion and exclusion criteria are available online. Full inclusion and exclusion criteria are available online. The FDA-approved phase 1-11 study is expected to enroll 18 subjects nationwide and this study is slated to last up to two years.

Other sites participating in the trial are the University of Pittsburgh Medical Center and Stanford University School of Medicine. The trial is funded by SanBio, Inc., a regenerative medicine company that developed the SB623 stem cell line.

SB623 papers:

1. Extracellular matrix produced by bone marrow stromal cells and by their derivative, SB623 cells, supports neural cell growth.  Aizman I, Tate CC, McGrogan M, Case CC.

  • J Neurosci Res. 2009, 87(14):3198-206.

2. Notch-induced rat and human bone marrow stromal cell grafts reduce ischemic cell loss and ameliorate behavioral deficits in chronic stroke animals. Yasuhara T, Matsukawa N, Hara K, Maki M, Ali MM, Yu SJ, Bae E, Yu G, Xu L, McGrogan M, Bankiewicz K, Case C, Borlongan CV.  Stem Cells Dev. 2009, 18(10):1501-14

3. Reversal of dopaminergic degeneration in a parkinsonian rat following micrografting of human bone marrow-derived neural progenitors. Glavaski-Joksimovic A, Virag T, Chang QA, West NC, Mangatu TA, McGrogan MP, Dugich-Djordjevic M, Bohn MC.  Cell Transplant. 2009, 18(7):801-14.


Tate CC, Fonck C, McGrogan M, Case CC. Cell Transplant. 2010,19(8):973-84.

5. Glial cell line-derived neurotrophic factor-secreting genetically modified human bone marrow-derived mesenchymal stem cells promote recovery in a rat model of Parkinson’s disease.  Glavaski-Joksimovic A, Virag T, Mangatu TA, McGrogan M, Wang XS, Bohn MC. J Neurosci Res. 2010, 88(12):2669-81.

6. Comparing the immunosuppressive potency of naive marrow stromal cells and Notch-transfected marrow stromal cells.

  • Dao MA, Tate CC, Aizman I, McGrogan M, Case CC.

J Neuroinflammation. 2011, 8(1):133.


Tate CC and Case CC.

  • Chapter in “Neurological Disorders”, InTech, 2012.