Treatment with placenta-derived mesenchymal stem cells mitigates development of bronchiolitis obliterans in a murine model Yunge Zhao, MD, PhD, Jacob.

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Treatment with placenta-derived mesenchymal stem cells mitigates development of bronchiolitis obliterans in a murine model Yunge Zhao, MD, PhD, Jacob R. Gillen, MD, David A. Harris, BS, Irving L. Kron, MD, Michael P. Murphy, MD, FACS, Christine L. Lau, MD, MBA The Journal of Thoracic and Cardiovascular Surgery Volume 147, Issue 5, Pages 1668-1677.e5 (May 2014) DOI: 10.1016/j.jtcvs.2013.09.041 Copyright © 2014 Terms and Conditions

Figure 1 Intratracheal injection of PMSCs and PMSCCM attenuated the development of BO on day 28 after tracheal transplantation. A, Representative images of H&E staining of the allograft 28 days after transplantation. The magnification of all images is 4×. +PMSCs, Treated with PMSCs (1 × 106); +PBS, treated with 1× PBS as the control; +PMSCCM, treated with PMSCCM; +CONM, treated with blank medium as the control. B, Bar graph of luminal obliteration of the allografts with PMSC (n = 13) and PMSCCM (n = 8) on day 28. Data shown are the mean ± standard error of mean. PMSC, Placenta-derived human mesenchymal stem cells; PBS, phosphate-buffered saline; PMSCCM, PMSC-conditioned medium; CONM, control media. The Journal of Thoracic and Cardiovascular Surgery 2014 147, 1668-1677.e5DOI: (10.1016/j.jtcvs.2013.09.041) Copyright © 2014 Terms and Conditions

Figure 2 Loss of epithelial cells in allografts after intratracheal injection of PMSCs or PMSCCM on day 14 after transplantation. A, Representative images of H&E-stained histopathologic sections of allografts at 14 days after transplantation. All images are 40× magnification. +PMSCs, Treated with PMSCs (1 × 106); +PBS, treated with 1× PBS as control; +PMSCCM, treated with PMSCCM; +CONM, treated with blank medium as the control. B, Bar graph depicting percentage allograft luminal epithelial loss with each type of injection (n = 7-13). Data shown are the mean ± standard error of mean. PMSC, Placenta-derived human mesenchymal stem cells; PBS, phosphate-buffered saline; PMSCCM, PMSC-conditioned medium; CONM, control media. The Journal of Thoracic and Cardiovascular Surgery 2014 147, 1668-1677.e5DOI: (10.1016/j.jtcvs.2013.09.041) Copyright © 2014 Terms and Conditions

Figure 3 Immunofluorescent staining and densitometric analysis of macrophage and neutrophil infiltration in the allografts treated with PMSCs and PBS controls on day 14. A, Representative images of immunofluorescent staining of the allograft 14 days after transplantation. Red color indicates positive-staining signals. Blue color indicates nuclei stained with DAPI. The magnification of all images is 20×. B, Bar graph of macrophage and neutrophil infiltration in the allografts treated with PMSCs and PBS on day 14. Data shown are the mean ± standard error of mean. n = 8. +PMSCs, Treated with PMSCs (1 × 106); +PBS, treated with 1× PBS as control; HPF, high-power field; PMSC, placenta-derived human mesenchymal stem cells; PBS, phosphate-buffered saline. The Journal of Thoracic and Cardiovascular Surgery 2014 147, 1668-1677.e5DOI: (10.1016/j.jtcvs.2013.09.041) Copyright © 2014 Terms and Conditions

Figure 4 PMSCs failed to integrate into the airway epithelial layer on day 14 after transplantation after intratracheal delivery. A, Representative images of immunofluorescent staining of human HLA-ABC within in vitro PMSCs. The images were taken at 20× magnification. Red color indicates positive staining of human HLA-ABC, blue color indicates nuclei stained with DAPI. B, Representative images of immunofluorescent staining of human HLA-ABC and CK14 within tracheas treated with PMSCs. The images were taken at 40× magnification. Red color indicates positive staining of human HLA-ABC molecules (left panel) and CK14 molecules (right panel); blue color indicates nuclei stained with DAPI. Right, The location of epithelial cells is seen by the area of strong CK14 signal. Left, There is essentially no HLA-ABC signal in this same location. HLA-ABC, Human leukocyte antigens-A, -B, and -C. The Journal of Thoracic and Cardiovascular Surgery 2014 147, 1668-1677.e5DOI: (10.1016/j.jtcvs.2013.09.041) Copyright © 2014 Terms and Conditions

Figure 5 Double immunofluorescent staining of P63 and CK14 in the tracheal allografts treated intratracheally with PMSCs or PBS on day 14 after transplantation. Red color indicates positive staining of CK14; green color shows positive staining of P63; blue color indicates nuclei stained with DAPI. The magnification of all images is 40×. The merged images are indicated on the side. +PMSCs, Intratracheally treated with PMSCs (1 × 106); +PBS, treated with 1× PBS as control. PMSC, Placenta-derived human mesenchymal stem cells; PBS, phosphate-buffered saline; DAPI, 4,6-diamidine-2-phenylindole dihydrochloride. The Journal of Thoracic and Cardiovascular Surgery 2014 147, 1668-1677.e5DOI: (10.1016/j.jtcvs.2013.09.041) Copyright © 2014 Terms and Conditions

Figure E1 Local injection of PMSCs reduced the development of BO on day 28 after tracheal transplantation. A, Representative images of H&E-stained tracheal allografts 28 days after transplantation. The magnification of the images is indicated on the left. B, Comparison of luminal obliteration of the allografts with and without PMSC injection on day 28. Data shown are the mean ± standard deviation. n = 8. +PMSCs, Treated with PMSCs (1 × 106); +PBS, treated with 1× PBS as control. PMSC, Placenta-derived human mesenchymal stem cells; PBS, phosphate-buffered saline. The Journal of Thoracic and Cardiovascular Surgery 2014 147, 1668-1677.e5DOI: (10.1016/j.jtcvs.2013.09.041) Copyright © 2014 Terms and Conditions

Figure E2 Loss of epithelial cells in allografts with and without local PMSC injection on day 14 after transplantation. A, Representative images of H&E-stained histopathologic sections of tracheas treated with PMSCs (left column) and PBS (right column) at 14 days after transplantation. B, Bar graph of epithelial cell loss in allografts with and without PMSC injection on day 14. Data shown are the mean ± standard deviation. n = 8. +PMSCs, Intratracheally treated with PMSCs (1 × 106); +PBS, treated with 1× PBS as control. PMSC, Placenta–derived human mesenchymal stem cells; PBS, phosphate-buffered saline. The Journal of Thoracic and Cardiovascular Surgery 2014 147, 1668-1677.e5DOI: (10.1016/j.jtcvs.2013.09.041) Copyright © 2014 Terms and Conditions

Figure E3 Immunohistochemical staining of CD3+ T cells (A) and CD4+ CD25+ Foxp3+ regulatory T cells (B) in the allografts treated with PMSCs and PBS controls on day 14. Data shown are the mean ± standard error of the mean. n = 8. HPF, High-power field; PMSC, placenta–derived human mesenchymal stem cells. The Journal of Thoracic and Cardiovascular Surgery 2014 147, 1668-1677.e5DOI: (10.1016/j.jtcvs.2013.09.041) Copyright © 2014 Terms and Conditions

Figure E4 Double immunofluorescent staining of P63 and CK14 in the tracheal allografts after intratracheal treatment with PMSCCM or blank medium on day 14 after transplantation. Red color indicates positive staining of CK14; green color shows positive staining of P63; blue color indicates nuclei stained with DAPI. The magnification of all images is 40×. The merged images are indicated on the side. +PMSCCM, Treated with PMSCCM; +CONM, treated with blank medium as control. DAPI, 4,6-diamidine-2-phenylindole dihydrochloride; PMSCCM, PMSC-conditioned medium; CONM, control media. The Journal of Thoracic and Cardiovascular Surgery 2014 147, 1668-1677.e5DOI: (10.1016/j.jtcvs.2013.09.041) Copyright © 2014 Terms and Conditions

Figure E5 Immunohistochemical staining of Foxp3+ regulatory T cells in allografts treated intratracheally with PMSCs and PBS controls on day 7 after transplantation. A, Representative images of immunohistochemical staining of Foxp3+ regulatory T cells in allografts at 7 days after transplantation. Images are at 40× magnification. +PMSCs, Treated with PMSCs (1 × 106); +PBS, treated with 1× PBS as control. B, Bar graph of Foxp3+ regulatory T cells in the allografts. Data shown are the mean ± standard error of the mean. n = 8-12. Lu, Lumen; EP, epithelial layer; HPF, high-power field; PMSC, placenta–derived human mesenchymal stem cells; PBS, phosphate-buffered saline. The Journal of Thoracic and Cardiovascular Surgery 2014 147, 1668-1677.e5DOI: (10.1016/j.jtcvs.2013.09.041) Copyright © 2014 Terms and Conditions