The molecular mechanisms by which mesenchymal stem cells (MSCs) suppress T-cell proliferation are poorly understood, and whether a soluble factor plays a major role remains controversial. Here we demonstrate that the T-cell-receptor complex is not a target for the suppression, suggesting that downstream signals mediate the suppression. We found that Stat5 phosphorylation in T cells is suppressed in the presence of MSCs and that nitric oxide (NO) is involved in the suppression of Stat5 phosphorylation and T-cell proliferation. The induction of inducible NO synthase (NOS) was readily detected in MSCs but not T cells, and a specific inhibitor of NOS reversed the suppression of Stat5 phosphorylation and T-cell proliferation. This production of NO in the presence of MSCs was mediated by CD4 or CD8 T cells but not by CD19 B cells. Furthermore, inhibitors of prostaglandin synthase or NOS restored the proliferation of T cells, whereas an inhibitor of indoleamine 2,3-dioxygenase and a transforming growth factor-␤-neutralizing antibody had no effect. Finally, MSCs from inducible NOS ؊/؊ mice had a reduced ability to suppress T-cell proliferation. Taken IntroductionBecause mesenchymal stem cells (MSCs) differentiate into osteocytes, chondrocytes, myotubes, and adipocytes, 1-3 they are expected to become a source of cells for regenerative therapy. Also, MSCs support hematopoietic stem cell engraftment 4-9 and modulate immunologic responses by unknown mechanisms. [9][10][11][12][13][14] Here, we investigated the molecular mechanisms by which MSCs suppress T-cell proliferation.Transforming growth factor-␤ (TGF-␤), hepatocyte growth factor, indoleamine 2,3-dioxygenase (IDO), and prostaglandin E2 (PGE 2 ) have been reported to mediate T-cell suppression by MSCs. [13][14][15] Specifically, neutralizing antibodies against TGF-␤ or hepatocyte growth factor, 13 an inhibitor of IDO,14 or an inhibitor of prostaglandin production reverse the inhibition of T-cell proliferation by MSCs. 15 In addition, some reports have shown that a soluble factor is the major mediator of suppression, [13][14][15][16][17] whereas some reports have demonstrated that T-cell-MSC contact is required for this suppression. [12][13][14]16,17 In the current study, we sought to resolve these conflicting results by using a mouse bone marrow-derived MSC system.One candidate soluble factor for T-cell suppression is nitric oxide (NO) because it is known to inhibit T-cell proliferation. [18][19][20][21][22][23][24][25] NO is produced by NO synthases (NOSs), of which there are 3 subtypes: inducible NOS (iNOS), endothelial NOS, and neuronal NOS. Like MSCs, it has been known that macrophages suppress T-cell proliferation. This suppression was reported to be mediated by NO inhibition of Stat5 phosphorylation. 18,19 Also, MSCs were reported to produce NO when they differentiate into chondrocytes. 26 We therefore investigated whether MSCs can produce NO and whether NO is involved in their ability to suppress T-cell proliferation. Materials and methods MaterialsN-nitro-L-a...

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Following a phase I/II study using mesenchymal stem cells (MSCs; JR-031) for steroid-refractory grade II or III acute graft-versus-host disease (aGVHD), a phase II/III study using the cells focused on steroid-refractory grade III or IV aGVHD was conducted. The number of infused MSCs and the number of MSC infusions were the same as the phase I/II study. No additional immunosuppressant was given for steroid-refractory aGVHD during the course of MSC infusions. Twenty-five patients (grade III, 22 patients and grade IV, 3 patients) were enrolled in this study. At 4 weeks after the first MSC infusions, six (24 %) and nine patients (36 %) achieved a complete response (CR) and partial response (PR), respectively. Durable CR by 24 weeks, which was the primary end-point, was obtained in 12 of 25 patients (48 %). At 52 weeks, 12 patients (48 %) treated with MSCs only (six patients) and MSCs plus additional treatments (six patients) were alive in CR. The survival was significantly better in patients showing overall response (OR; CR+PR) than in those showing no OR at 4 weeks. Adverse effects commonly associated with MSC infusions were not observed. Taken together, our two clinical trials suggest JR-031 to be effective for steroid-refractory aGVHD.

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Mesenchymal stromal cells (MSCs) have unique characteristics such immune suppression by inhibiting T cell proliferation, tissue-repair ability and acceleration of hemopoietic stem cell engraftment. The cells are rare in bone marrow, but easily cultured under standard culture conditions. Soluble factors and cells are implicated in the MSC-mediated T cell suppression and numerous clinical trials using MSCs to prevent and treat graft-versus-host disease (GVHD) have been reported. MSCs are suggested to suppress acute GVHD without impairing graft-versus-leukemia effects and increasing systemic infections. In this review, we focus on basic aspects of MSC-mediated T cell suppression and clinical trials using MSCs for GVHD and related conditions.