Patent Description:
The present disclosure relates to the fields of cell and tissue biology. More particularly, the present disclosure relates to lineage-specific differentiation of pluripotent stem cells into mesoderm cells and/or endothelial colony forming cell-like cells (ECFC-like cells) that can form blood vessels in vivo.

Endothelial colony forming cells (ECFCs) are rare circulating endothelial cells, particularly abundant in umbilical cord blood, with clonal proliferative potential and intrinsic in vivo vessel forming ability (<NPL>); <NPL>); <NPL>); <NPL>); <NPL>); <NPL>). It is not understood what type of cell within umbilicial cord blood or donor marrow gives rise to ECFCs. When cultured primary ECFCs are injected intravenously into rodent vascular injury models, they are recruited the site of vascular injury or tissue ischemia to orchestrate initiation of a vasculogenic response (<NPL>); <NPL>); <NPL>). Human ECFCs have been reported to enhance vascular repair and improve blood flow following myocardial infarction (<NPL>); <NPL>). , stroke (Moubarik, C. <NUM>), ischemic retinopathy (<NPL>); <NPL>), ischemic limb injury (Schwartz et al. <NUM>; Saif et al. <NUM>; <NPL>); <NPL>), and to engraft and re-endothelialize denuded vascular segments or implanted grafts; (<NPL>). In subjects with peripheral arterial disease (PAD) and critical limb ischemia (CLI), circulating or resident ECFCs may become prone to replicative senescence (i.e., ECFCs may lack proliferative potential), thus rendering them impotent for autologous vascular repair. At least for these reasons, it is desirable to find alternate sources of ECFCs or other cell types that may be used for vascular repair.

Human pluripotent stem cells (hPSCs) display virtually unlimited self-renewal capacity and ability to differentiate into any cell type in the animal body (<NPL>); <NPL>); <NPL>). The present inventors have previously determined a method for in vitro derivation of ECFC-like cells from hPSCs, in which the ECFC- like cells can form blood vessels in vivo (<CIT>; <NPL>)). This method described the use of the growth factors Activin-A, BMP-<NUM>, FGF-<NUM>, and VEGF to direct hPSCs to mesodermal cells that subsequently led to the emergence of ECFC-like cells with high clonal proliferative potential that was greater than or equal to that of ECFCs isolated from human cord blood. The ECFC-like cells displayed a stable endothelial phenotype with the capacity to form human vessels in mice and to repair the ischemic mouse retina and limb. Furthermore, the method of generating mesodermal cells and ECFC-like cells does not require embryoid body formation, TGF-β inhibition or co-culture with supportive cells. This is in contrast to the method of <NPL>) which describes plating of hPSCs onto supportive OP9 stromal cells to induce the formation of mesodermal cells that were characterized by the expression of apelin receptor (APLNR), platelet-derived growth factor receptor alpha (PDGRFα), and the endothelial marker VEGF receptor <NUM> (KDR), a phenotype the authors referred to as A+P+ cells.

It is desirable to mitigate and/or obviate one or more of the above deficiencies.

The present disclosure is broadly summarized as relating to methods for generating lineage-specific mesoderm cells and/or endothelial colony forming cell-like cells (ECFC-like cells) from hPSCs. Protocols for reproducibly differentiating hPSCs into populations of lineage- specific mesoderm and/or ECFC-like cells having in vivo blood vessel formation capacity are provided. The disclosure is set out in the appended set of claims.

In an aspect, the present disclosure provides a method for generating an isolated population of human KDR+NCAM+APLNR+ mesoderm cells from human pluripotent stem cells. The method comprises providing pluripotent stem cells (PSCs); (a) inducing the pluripotent stem cells to undergo mesodermal differentiation, wherein the mesodermal induction is carried out in the absence of co-cultured supportive cells, and further comprises: i) culturing the pluripotent stem cells for about <NUM> hours in a mesoderm differentiation medium comprising Activin A, BMP-<NUM>, VEGF and FGF-<NUM>; and ii) replacing the medium of step i) with a mesoderm differentiation medium comprising BMP-<NUM>, VEGF and FGF-<NUM> about every <NUM>-<NUM> hours thereafter for about <NUM> hours, and comprising contacting the cells with one or more of a miRNA inhibitor selected from the group consisting of miR-<NUM>-3p, miR-<NUM>-5p, miR-<NUM>, miR-<NUM>, miR-<NUM>-3p, miR-30d-5p, miR-<NUM>-3p and miR-<NUM>-5p, and/or one or more of a miRNA mimic selected from the group consisting of miR-<NUM>-5p, miR-<NUM>-5p, miR-<NUM>, and miR-<NUM>-5p; and (b) isolating from the cells induced to undergo differentiation the mesoderm cells, wherein the isolation of mesoderm cells comprises: iii) sorting the mesoderm cells to select for KDR+NCAM+APLNR+ cells.

In an embodiment, the sorting further comprises selection of SSEA5- KDR+NCAM+APLNR+ cells.

In an embodiment, the mesodermal induction further comprises contacting the cells undergoing mesodermal induction with Fc-NRP-<NUM>. In an embodiment, the mesoderm differentiation medium of step (b) ii).

In an embodiment, the mesodermal induction further comprises contacting the cells undergoing mesodermal induction with one or more miRNA inhibitor, wherein the one or more miRNA inhibitor inhibits an miRNA selected from the group consisting of: miR-<NUM>-3p, miR-<NUM>-5p, miR-<NUM>, miR543, miR-<NUM>-3p, miR-30d-5p, miR-<NUM>-3p and miR-<NUM>-5p. In an embodiment, the cells undergoing mesodermal induction are contacting with one or more of an miRNA inhibitor of miR-<NUM>-3p, miR-<NUM>-5p and miR-<NUM>, preferably miR-<NUM>-3p.

In an embodiment, the mesodermal induction further comprises contacting the cells undergoing mesodermal induction with one or more miRNA mimic, wherein the one or more miRNA mimic mimics an miRNA selected from the group consisting of: miR-<NUM>-5p, miR-<NUM>-5p, miR-<NUM>-3p and miR-<NUM>-5p. In an embodiment, the cells undergoing mesodermal induction are cultured with one or more of an miRNA mimic of miR-<NUM>-Sp, miR-<NUM>-5p and miR-<NUM>-3p, preferably miR-<NUM>-5p. In an embodiment, the mesodermal induction further comprises contacting the cells undergoing mesodermal induction with a miR-<NUM> mimic.

In an embodiment, the isolated mesoderm cells have a capacity to form blood vessels when implanted into a mammal.

Another aspect of the present disclosure provides a method for generating a population of human endothelial colony forming-like (ECFC-like) cells from human pluripotent stem cells, the method comprising:
inducing the isolated human KDR+NCAM+APLNR+ mesoderm cells to undergo endothelial differentiation, wherein the endothelial induction comprises: culturing the isolated mesoderm cells in an endothelial differentiation medium comprising BMP- <NUM>, VEGF and FGF-<NUM> for about <NUM>-<NUM> days; and isolating from the cells induced to undergo endothelial differentiation endothelial colony forming-like (ECFC-like) cells, wherein the ECFC- like cells are CD31+NRP-<NUM>+ and exhibit a cobblestone morphology.

In an embodiment, the isolated ECFC-like cells are further characterized by one or more of CD144+, KDR+ and a-SMA- expression.

In an embodiment, the endothelial inducing step is carried out in the absence of one or more of: co-culture cells, embryoid body formation and exogenous TGF-β inhibition.

In an embodiment, the isolated ECFC-like cells have a capacity to form blood vessels when implanted into a mammal in the absence of co-implanted cells.

The patent or application file contains at least one drawing in color. Copies of this patent or patent application publication with color drawings will be provided by the Office upon request and payment of the necessary fee.

The features of the disclosure will become more apparent in the following detailed description in which reference is made to the appended drawings wherein:.

The present disclosure generally relates to methods for in vitro differentiation of pluripotent cells, such as, for example, human embryonic stem cells (hESCs; disclosed for reference only) or induced pluripotent stem cells (iPSCs) (collectively, human pluripotent stem cells (hPSCs)), into lineage- specific mesoderm cells and, additionally, further differentiating the lineage-specific mesoderm cells into endothelial colony forming cell-like cells (ECFC-like cells). Surprisingly, the inventors have found that the mesoderm cells generated and isolated using the method provided herein can generate blood vessels in vivo. In various embodiments of the method provided herein, the resulting ECFC-like cells may be further grown into blood vessels in vivo in the absence of co- culture and/or co-implantation cells.

The definitions of certain terms as used in this specification are provided below. Unless defined otherwise, all technical and scientific terms used herein generally have the same meaning as commonly understood by one of ordinary skill in the art to which this disclosure belongs.

As used herein, "pluripotent cell" refers to a cell that has the potential to differentiate into any cell type, for example, cells of any one of the three germ layers: endoderm, mesoderm, or ectoderm.

As used herein, "embryonic stem cells", "ES cells" or "ESCs" refer to pluripotent stem cells derived from early embryos.

As used herein, "induced pluripotent stem cells," "iPS cells" or "iPSCs" refer to a type of pluripotent stem cell that has been prepared from a non-pluripotent cell, such as, for example, an adult somatic cell, or a terminally differentiated cell, such as, for example, a fibroblast, a hematopoietic cell, a myocyte, a neuron, an epidermal cell, or the like, by introducing into the non-pluripotent cell or contacting the non-pluripotent cell with one or more reprogramming factors.

As used herein, "mesodermal differentiation medium" refers to any nutrient medium that supports and/or enhances differentiation of pluripotent cells into cells of the mesoderm lineage.

As used herein, "mesoderm" refers to the middle of three primary germ layers in an early embryo (the other two layers being ectoderm and endoderm). There are four components or classes of mesoderm, including axial mesoderm, paraxial mesoderm, intermediate mesoderm and lateral plate/extra-embryonic mesoderm. Mesoderm comprises "mesoderm cells", also referred to as "mesodermal cells".

As used herein, miRNA mimic" refers to double-stranded RNA oligonucleotides designed to "mimic" native/endogenous miRNA activity. miRNA mimics supplement endogenous microRNA activity to discover the functional roles of individual microRNAs.

As used herein, miRNA inhibitor" refers to single-stranded RNA oligonucleotides designed to "inhibit" native/endogenous miRNA activity. miRNA inhibitors suppress the function of endogenous miRNAs, increase the expression of the target gene, and attenuate the presentation of the phenotype.

As used herein, "endothelial differentiation medium" refers to any nutrient medium that supports and/or enhances differentiation of pluripotent cells into cells of the endothelial lineage.

As used herein, "endothelial growth medium" refers to any medium that is suitable for maintaining cells of the endothelial lineage.

As used herein, "endothelial colony forming cell" and "ECFC" refer to primary endothelial cells found in the blood that display the potential to proliferate and form an endothelial colony from a single cell and have a capacity to form blood vessels in vivo in the absence of co-implanted or co-cultured cells.

As used herein, "cord blood ECFC" and "CB-ECFC" refer to primary ECFCs that are derived from umbilical cord blood.

As used herein, "endothelial colony forming cell-like cell" and "ECFC-like cell" refer to non-primary endothelial cells that are generated in vitro from human pluripotent stem cells (hPSCs). ECFC-like cells have various characteristics of ECFCs, at least including the potential to proliferate and form an endothelial colony from a single cell and have a capacity to form blood vessels in vivo in the absence of co-implanted or co-cultured cells.

As used herein, the terms "proliferation potential" and "proliferative potential" refer to the capacity of a cell to divide when provided appropriate growth promoting signals.

As used herein, the terms "high proliferation potential", "high proliferative potential" and "HPP" refer to the capacity of a single cell to divide into more than about <NUM> cells in a <NUM> day cell culture. Preferably, HPP cells have a capacity to self-replenish. For example, the HPP- ECFC-like cells provided herein have a capacity to self-replenish, meaning that an HPP-ECFC- like cell can give rise to one or more HPP-ECFC-like cells within a secondary HPP-ECFC-like colony when replated in vitro. In some embodiments, HPP-ECFC-like cells may also have the ability to give rise to one or more of LPP-ECFC-like cells and ECFC-like cell clusters within a secondary HPP-ECFC-like colony when replated in vitro.

As used herein, the terms "low proliferation potential" "low proliferative potential" and "LPP" refer to the capacity of a single cell to divide into about <NUM>-<NUM> cells in a <NUM> day cell culture. In some embodiments, LPP-ECFC-like cells may also have the ability to give rise to ECFC-like cell clusters. However, LPP-ECFC-like cells do not have a capacity to give rise to secondary LPP-ECFC-like cells or HPP-ECFC-like cells.

In an aspect, the method provided herein involves at least three steps:.

wherein the isolation of mesoderm cells comprises: i) sorting the mesoderm cells to select for KDR+NCAM+APLNR+ cells.

In various embodiments, the method includes one or more of the following further steps:.

Each step in the aforementioned method is described further herein below.

In one aspect, a method for generating an isolated population of mesoderm and/or ECFC-like cells in vitro from pluripotent cells is provided. Pluripotent cells that are suitable for use in the methods of the present disclosure can be obtained from a variety of sources. For example, one type of suitable pluripotent cell can be an embryonic stem (ES) cell derived from the inner cell mass of a blastocyst. Methods for obtaining various types of ES cells, such as mouse, rhesus monkey, and common marmoset, are well known. The source of ES cells used in the method may be, for example, one or more established non-human ES cell lines. Various non-human ES cell lines are known and the conditions for their growth and propagation have been defined. It is contemplated herein that virtually any non-human ES cell or ES cell line may be used with the methods disclosed herein. In one embodiment, the pluripotent cell is an induced pluripotent stem (iPS) cell derived by reprogramming somatic cells. Induced pluripotent stem cells have been obtained by various known methods. It is contemplated herein that virtually any iPS cell or cell line may be used with the methods disclosed herein.

In one embodiment, pluripotent cells are cultured under conditions suitable for maintaining pluripotent cells in an undifferentiated state. Methods for maintaining pluripotent cells in vitro, i.e., in an undifferentiated state, are well known. In one embodiment, pluripotent cells are cultured for about two days under conditions suitable for maintaining pluripotent cells in an undifferentiated state. For example, in the Examples below, hES and hiPS cells were maintained in mTeSR1 complete medium on Matrigel™ in <NUM><NUM> tissue culture dishes at <NUM> and <NUM> % CO<NUM> for about two days.

Additional and/or alternative methods for culturing and/or maintaining pluripotent cells may be used. For example, as the basal culture medium, any of TeSR, mTeSR1 alpha. MEM, BME, BGJb, CMRL <NUM>, DMEM, Eagle MEM, Fischer's media, Glasgow MEM, Ham, IMDM, Improved MEM Zinc Option, Medium <NUM> and RPMI <NUM>, or combinations thereof, may be used for culturing and or maintaining pluripotent cells.

The pluripotent cell culture medium used may contain serum or it may be serum-free. Serum-free refers to a medium comprising no unprocessed or unpurified serum. Serum-free media can include purified blood-derived components or animal tissue-derived components, such as, for example, growth factors. The pluripotent cell medium used may contain one or more alternatives to serum, such as, for example, knockout Serum Replacement (KSR), chemically-defined lipid concentrated (Gibco) or glutamax (Gibco).

Methods for splitting or passaging pluripotent cells are well known. For example, in the Examples below, after pluripotent cells were plated, medium was changed on days <NUM>, <NUM>, and <NUM> and cells were passaged on day <NUM>. Generally, once a culture container is full (i.e., <NUM>-<NUM>% confluence), the cell mass in the container is split into aggregated cells or single cells by any method suitable for dissociation and the aggregated or single cells are transferred into new culture containers for passaging. Cell "passaging" or "splitting" is a well-known technique for keeping cells alive and growing cells in vitro for extended periods of time.

In one aspect of the method disclosed, in vitro pluripotent cells are induced to undergo mesodermal differentiation, also referred to as a step of "mesodermal induction". Various methods, including culture conditions, for inducing differentiation of pluripotent cells into cells of the mesodermal lineage are known in the art. In the protocol provided herein it is preferable to induce differentiation of pluripotent cells in a chemically defined medium. For example, Stemline II serum-free hematopoietic expansion medium can be used as a basal mesodermal differentiation medium. In the protocol provided herein various growth factors are used to promote differentiation of pluripotent cells into cells of the mesodermal lineage. For example, Activin A, vascular endothelial growth factor (VEGF), basic fibroblast growth factor (FGF-<NUM>) and bone morphogenetic protein <NUM> (BMP-<NUM>) are included in a chemically defined differentiation medium to induce differentiation of pluripotent cells into cells of the mesodermal lineage.

In one embodiment of the protocol provided herein, after <NUM> days (-D2) of culture in a basal culture medium (e.g., mTeSR1), differentiation of pluripotent cells was directed toward the mesodermal lineage by contacting the cells for <NUM> hours with an endothelial differentiation medium comprising an effective amount of Activin A, BMP-<NUM>, VEGF and FGF-<NUM>. Following <NUM> hours of differentiation, Activin A was removed from the culture by replacing the mesodermal differentiation medium with an mesodermal differentiation medium comprising an effective amount of BMP-<NUM>, VEGF and FGF-<NUM>. By "effective amount", we mean an amount effective to promote differentiation of pluripotent cells into cells of the mesodermal lineage. Further replacement of the mesodermal differentiation medium comprising an effective amount of BMP- <NUM>, VEGF and FGF-<NUM> may be done every <NUM>-<NUM> days for about <NUM> days (i.e., to D4).

Activin A is a member of the TGF-β superfamily that is known to activate cell differentiation via multiple pathways. Activin-A facilitates activation of mesodermal specification but is not critical for endothelial specification and subsequent endothelial amplification. In one embodiment, the mesodermal differentiation medium comprises Activin A in a concentration of about <NUM>-<NUM> ng/ml. In one preferred embodiment, the mesodermal differentiation medium comprises Activin A in a concentration of about 10ng/ml.

Bone morphogenetic protein-<NUM> (BMP-<NUM>) is a ventral mesoderm inducer that is expressed in adult human bone marrow (BM) and is involved in modulating proliferative and differentiative potential of hematopoietic progenitor cells. Additionally, BMP-<NUM> can modulate early hematopoietic cell development in human fetal, neonatal, and adult hematopoietic progenitor cells. In one embodiment, the mesodermal differentiation medium comprises BMP-<NUM> in a concentration of about <NUM>-<NUM> ng/ml. In one preferred embodiment, the mesodermal differentiation medium comprises BMP-<NUM> in a concentration of about 10ng/ml.

Vascular endothelial growth factor (VEGF) is a signaling protein involved in embryonic circulatory system formation and angiogenesis. In vitro, VEGF can stimulate endothelial cell mitogenesis and cell migration. In one embodiment, the mesodermal differentiation medium comprises VEGF in a concentration of about <NUM>-<NUM> ng/ml. In one preferred embodiment, the mesodermal differentiation medium comprises VEGF in a concentration of about 10ng/ml. In one particularly preferred embodiment, the mesodermal differentiation medium comprises VEGF<NUM> in a concentration of about 10ng/ml.

Basic fibroblast growth factor, also referred to as bFGF or FGF-<NUM>, has been implicated in diverse biological processes, including limb and nervous system development, wound healing, and tumor growth. bFGF has been used to support feeder-independent growth of human embryonic stem cells. In one embodiment, the mesodermal differentiation medium comprises FGF-<NUM> in a concentration of about <NUM>-<NUM> ng/ml. In one preferred embodiment, the mesodermal differentiation medium comprises FGF-<NUM> in a concentration of about 10ng/ml.

The method disclosed herein does not require co-culture with supportive cells, such as, for example, OP9 stromal cells, does not require embryoid body (EB) formation and does not require exogenous TGF-β inhibition.

In an aspect, KDR+NCAM+APLNR+ cells are selected and isolated from the population of cells induced to undergo mesodermal differentiation. Methods for selecting cells having one or more specific molecular markers are known in the art. For example, cells may be selected based on expression of various transcripts by flow cytometry, including fluorescence-activated cell sorting, or magnetic-activated cell sorting.

In one embodiment, KDR+NCAM+APLNR+ cells are selected from a population of cells undergoing mesodermal differentiation, as described herein, on day <NUM> of differentiation. In one preferred embodiment, KDR+ cells are selected from a population of cells undergoing mesodermal differentiation and then from the selected KDR+ cells, NCAM+APLNR+ cells are selected, thereby yielding a population of KDR+NCAM+APLNR+ cells.

In the Examples below, mesoderm cells were harvested after day <NUM> of differentiation and made into a single cell suspension. Cells were counted and prepared for antibody staining with anti-human antibodies to KDR, NCAM and APLNR. KDR+NCAM+APLNR+ cells were gated/selected and sorted using flow cytometry.

The mesoderm subsets identified herein display gene products consistent with known subsets of human mesoderm. These specific mesoderm subsets have not previously been noted to give rise to human ECFCs.

In one embodiment, the selected cells have a capacity for in vivo vessel formation. This result was unexpected. Specific types of mesoderm are expressed in early human development, and those cells that give rise to angioblast cells (the first mesoderm-derived cells that further differentiate into endothelial cells) are predicted to be derived from extra- embryonic/lateral plate mesoderm. Accordingly, a skilled person would predict that mesoderm cells would differentiate at specific times in specific places to form the first blood vessels via vasculogenesis. A skilled person would not predict that mesoderm cells would display the ability to give rise to ECFCs and form human blood vessels in an adult immunodeficient mouse, at least because there are no mesoderm cells that exist in adult mice (they have already committed to lineage fates during embryogenesis and are now only represented by their specified lineage progeny).

In one embodiment, SSEA5-KDR+NCAM+APLNR+ cells are selected from a population of cells undergoing mesodermal differentiation, as described herein, on day <NUM> of differentiation. In one preferred embodiment, SSEA5-KDR+ cells are selected from a population of cells undergoing mesodermal differentiation and then from the selected SSEA5-KDR+ cells, NCAM+APLNR+ cells are selected, thereby yielding a population of SSEA5-KDR+NCAM+APLNR+ cells.

The inventors found that negative selection of Day <NUM> differentiated cells with an SSEA5 antibody allowed identification and subsequent removal of an undifferentiated or partially differentiated hiPSCs mixture from day <NUM> differentiated cells. This was achieved by performing in vivo implantation of SSEA5-KDR+NCAM+APLNR+ cells and KDR+NCAM+APLNR+ cells (without negative selection for SSEA5) in the same animal. One abdominal side received SSEA5-KDR+NCAM+APLNR+ cells and other abdominal side of the same animal received KDR+NCAM+APLNR+ cells. Implanted KDR+NCAM+APLNR+ cells formed blood vessels and endoderm derivatives, whereas implanted SSEA5-KDR+NCAM+APLNR+ cells formed blood vessels, and did not form endoderm and/or teratomas. Accordingly, one advantage of the SSEA5-KDR+NCAM+APLNR+ mesoderm cells provided herein is that they can be used to achieve selective ECFC blood vessel formation in vivo without formation of endodermal derivatives.

The inventors contemplated that stimulating KDR signalling in the cells undergoing mesoderm induction might increase mesoderm production. In one embodiment of the protocol provided herein, following <NUM> hours of differentiation in Activin-A containing medium, the mesodermal differentiation medium was replaced with a mesodermal differentiation medium comprising an effective amount of Fc-NRP-<NUM>, BMP-<NUM>, VEGF and FGF-<NUM>. By "effective amount", we mean an amount effective to promote differentiation of pluripotent cells into cells of the mesodermal lineage. Further replacement of the mesodermal differentiation medium comprising an effective amount of Fc-NRP-<NUM>, BMP-<NUM>, VEGF and FGF-<NUM> may be done, for example, every <NUM>-<NUM> days for about <NUM> days (i.e., to D4). The inventors found that addition of Fc- NRP-<NUM> to the mesoderm induction protocol improved mesoderm generation. This result is surprising, at least because NRP-<NUM> (the Fc-NRP-<NUM> acts as a surrogate for NRP-<NUM>) and VEGF<NUM> (the ligand that binds to Fc-NRP1 or endogenous NRP-<NUM>), are not expressed in the cells undergoing mesoderm induction. The other molecules that are known to activate KDR signaling are VEGF<NUM> and NRP-<NUM>. However, the inventors' studies show that neither of these molecules are endogenously expressed in the cells undergoing day <NUM> mesoderm differentiation. The inventors' identification of a soluble molecule (which could be used to supplement culture media) that can activate KDR signaling, thereby enhancing mesoderm formation, is advantageous for augmenting production of ECFC mesoderm cells.

In one embodiment of the protocol provided herein, cells being induced to undergo mesodermal differentiation are exposed to one or more miRNA inhibitors, mimics, or a combination thereof. The inventors have identified a set of miRNAs that are downregulated in SSEA5-KDR+NCAM+APLNR+ cells (miR-<NUM>-3p, miR-<NUM>-Sp, miR-<NUM>, miR-<NUM>, miR-<NUM>-3p, miR-30d-5p, miR-<NUM>-3p and miR-<NUM>-Sp) and a set of miRNAs that were identified as being upregulated in SSEA5-KDR+NCAM+APLNR+ cells (miR-<NUM>-Sp, miR-<NUM>-Sp, miR-<NUM>-3p and miR-<NUM>-Sp). The inventors have found that transfecting the cells undergoing mesoderm induction with one or more agents that mimic specific miRNAs that are upregulated in SSEA5- KDR+NCAM+ APLNR+ cells increases the frequency of SSEA5-KDR+NCAM+APLNR+ cells generated from PSCs. The inventors have found that transfecting the cells undergoing mesoderm induction with one or more agents that inhibit specific miRNAs that were identified as being downregulated in SSEA5-KDR+NCAM+APLNR+ cells increases the frequency of SSEA5-KDR+NCAM+APLNR+ cells generated from PSCs. The inventors have also found that transfecting the cells undergoing mesoderm induction with a combination of specific miRNA mimics and inhibitors increases the frequency of SSEA5-KDR+NCAM+APLNR+ cells generated from PSCs.

In one embodiment of the protocol provided herein, after <NUM> days (-D2) of culture in a basal culture medium, differentiation of pluripotent cells was directed toward the mesodermal lineage by contacting the cells for <NUM> hours with an endothelial differentiation medium comprising an effective amount of Activin A, BMP-<NUM>, VEGF and FGF-<NUM>. During this first <NUM> hours (i.e., on D0), the cells were transfected with one of <NUM> treatments: i) <NUM> miRNA mimics; ii) <NUM> miRNA inhibitors; iii) <NUM> miRNA mimics and <NUM> miRNA inhibitors; or iv) a control. Following <NUM> hours of differentiation, Activin A was removed from the culture by replacing the mesodermal differentiation medium with an mesodermal differentiation medium comprising an effective amount of BMP-<NUM>, VEGF and FGF-<NUM>. The cells were transfected again, with the same treatment, on day <NUM> of mesodermal induction. Further replacement of the mesodermal differentiation medium comprising an effective amount of BMP-<NUM>, VEGF and FGF-<NUM> may be done every <NUM>-<NUM> days for about <NUM> days (i.e., to D4). On day <NUM>, cells were sorted and isolated, as described above.

In one aspect of the method disclosed, the isolated mesoderm cells are induced to undergo endothelial differentiation. Various methods, including culture conditions, for inducing differentiation of mesoderm cells into cells of the endothelial lineage are known in the art. In the ECFC-like cell protocol provided herein it is preferable to induce differentiation of endothelial cells in a chemically defined medium. For example, Stemline II serum-free hematopoietic expansion medium can be used as a basal endothelial differentiation medium. In the ECFC-like cell protocol provided herein various growth factors are used to promote differentiation of pluripotent cells into cells of the endothelial lineage, including ECFC-like cells. For example, VEGF, FGF-<NUM> and BMP-<NUM> are included in a chemically defined differentiation medium to induce differentiation of isolated mesoderm cells into cells of the endothelial lineage, including ECFC- like cells.

In one embodiment of the ECFC-like cell protocol provided herein, isolated mesoderm cells are cultured with an endothelial differentiation medium comprising an effective amount of BMP-<NUM>, VEGF and FGF-<NUM>. By "effective amount", we mean an amount effective to promote differentiation of isolated mesoderm cells into cells of the endothelial lineage, including ECFC-like cells. Further replacement of the endothelial differentiation medium comprising an effective amount of BMP-<NUM>, VEGF and FGF-<NUM> may be done every <NUM>-<NUM> days.

The method disclosed herein does not require co-culture with supportive cells, such as, for example, OP9 stromal cells, does not require embryoid body (EB) formation, and does not require exogenous TGF-β inhibition.

In one embodiment of the method disclosed herein, CD31+NRP-<NUM>+ cells are selected and isolated from the population of cells undergoing endothelial differentiation. For example, in one embodiment, CD31+NRP-<NUM>+ cells are selected from a population of cells undergoing endothelial differentiation, as described herein, on day <NUM>, <NUM> or <NUM> of differentiation. In one preferred embodiment, CD31+NRP-<NUM>+ cells are selected from the population of cells undergoing endothelial differentiation on day <NUM> of differentiation. The inventors have found that the day <NUM> population of cells undergoing endothelial differentiation contains a higher percentage of NRP-<NUM>+ cells relative to cell populations that are present on other days of differentiation.

In the Examples below, adherent ECs were harvested after day <NUM> of differentiation and made into a single cell suspension. Cells were counted and prepared for antibody staining with anti-human CD31, CD144 and NRP-<NUM>. CD31+CD144+NRP-<NUM>+ cells were sorted and selected using flow cytometry.

In one embodiment, the selected cells exhibit a cobblestone morphology, which is typical of ECs, including ECFCs.

In one embodiment, the selected cells have a capacity for in vivo vessel formation in the absence of co-culture and/or co-implanted cells, which is typical of ECFCs.

In one embodiment, an isolated population of human KDR+NCAM+APLNR+ mesoderm cells is provided. In one embodiment, the purified human cell population of KDR+NCAM+APLNR+ mesoderm cells provided is generated using the in vitro method for generating mesoderm cells from hPSCs disclosed herein. The isolated KDR+NCAM+APLNR+ mesoderm cells of the population have a capacity to give rise to ECFCs and the capacity for blood vessel formation in vivo. In one embodiment, the KDR+NCAM+APLNR+ mesoderm cells of the population are further characterized by increased expression of one or more lateral plate- extra-embryonic mesoderm markers (e.g., BMP4, WNTSA, NKX2-<NUM> and/or HAND1) relative to PSCs. In one embodiment, the KDR+NCAM+APLNR+ mesoderm cells of the population are further characterized by a lack of increased expression of one or more axial mesoderm markers (e.g., CHIRD and/or SHH), paraxial mesoderm markers (e.g., PAX1, MEOX1, and TCF15) and/or intermediate mesoderm markers (e.g., GOSR1, PAX2 and PAX8), relative to PSCs.

In one embodiment, an isolated population of human SSEA5-KDR+NCAM+APLNR+ mesoderm cells is provided. In one embodiment, the purified human cell population of SSEA5- KDR+NCAM+ APLNR+ mesoderm cells provided is generated using the in vitro method for generating mesoderm cells from hPSCs disclosed herein. The isolated SSEA5-KDR+NCAM+APLNR+ mesoderm cells of the population have a capacity for ECFC formation and blood vessel formation in vivo. In one embodiment, the SSEA5-KDR+NCAM+APLNR+ mesoderm cells of the population are further characterized by increased expression of one or more lateral plate-extra-embryonic mesoderm markers (e.g., BMP4, WNTSA, NKX2-<NUM> and/or HAND1) relative to PSCs. In one embodiment, the SSEA5-KDR+NCAM+APLNR+ mesoderm cells of the population are further characterized by a lack of increased expression of one or more axial mesoderm markers (e.g., CHIRD and/or SHH), paraxial mesoderm markers (e.g., PAX1, MEOX1, and TCF15) and/or intermediate mesoderm markers (e.g., GOSR1, PAX2 and PAX8), relative to PSCs.

In one preferred embodiment, the isolated mesoderm cell population is substantially pure. In one embodiment, <NUM>% of total live cells at day <NUM> of mesoderm differentiation are KDR+NCAM+APLNR+. In one embodiment, <NUM>% of total live cells at day <NUM> of mesoderm differentiation are SSEA5-KDR+NCAM+APLNR+.

In one embodiment, an isolated population of human NRP-<NUM>+/CD31+ ECFC-like cells is provided. In one embodiment, the purified human cell population of NRP-<NUM>+/CD31+ ECFC-like cells provided is generated using the in vitro method for generating ECFC-like cells from hPSCs disclosed herein.

In the Examples below, the method disclosed herein is used to generate a purified human cell population of NRP-<NUM>+ and CD31+ ECFC-like cells, from an isolated subset of mesoderm cells. The isolated ECFC-like cells of the population exhibit cobblestone morphology and have a capacity for blood vessel formation in vivo without co-culture and/or co-implanted cells. In one embodiment, the ECFC-like cells of the population are further characterized by one or more of CD144+, KDR+ and a-SMA-.

In one embodiment, at least some of the ECFC-like cells in the population generated from the isolated mesoderm cells have a high proliferation potential that is similar to the proliferation potential of ECFC's generated in vitro using the inventor's previous hPSC-ECFC- lice cell protocol.

In one preferred embodiment, the isolated ECFC-like cell population is substantially pure.

In the Examples herein, cells in the ECFC-like cell populations generated from the disclosed mesoderm cells can form blood vessels when implanted in vivo in a mammal, even in the absence of supportive cells.

Various techniques for measuring in vivo vessel formation are known and can be used.

The capacity to form blood vessels in vivo in the absence of exogenous supportive cells is one indicator that the cells produced using the methods disclosed herein are ECFCs.

In contrast to known mesoderm cell lines and other known isolated mesoderm cells described previously, the mesoderm cells generated using the method disclosed herein can be generated in vitro and used to form blood vessel tissue in vivo for various clinical applications, as described below.

In contrast to ECFCs, which are primary cells, the ECFC-like cells generated using the method disclosed herein can be generated in vitro in a volume that can be useful for various clinical applications, as described below.

The disclosure will be more fully understood upon consideration of the following non- limiting Examples.

Culturing of hPSCs: Human Embryonic stem cell (hES) cell line H9; disclosed for reference only (<NPL>) and fibroblast-derived human iPS cell line (DF19-<NUM>-11T) (<NPL>) were purchased from WiCell Research institute (Madison, Wisconsin). Both hES and hiPSCs were maintained in mTeSR1 complete media (Stem Cell Technologies) on Matrigel in <NUM><NUM> tissue culture dishes at <NUM> and <NUM> % CO<NUM>. After the plating of cells, media was changed on days <NUM>, <NUM>, and <NUM>. Cells were passaged on Day <NUM>. Media was aspirated and <NUM>-<NUM> of dispase (<NUM>/ml, Gibco) containing media was added to the plate and incubated at <NUM> for <NUM>-<NUM> minutes or until the edges of the colonies had lifted from the plate. Dispase containing media was aspirated from the plate and cells were gently washed with DMEM-F12 (Gibco) <NUM> times to remove any residual amount of enzyme. Fresh media was then used to collect colonies from the plate using a forceful wash and scraping with a <NUM> disposable pipette taking care to avoid bubbles. Collected colonies were then centrifuged at <NUM> x g for <NUM> minutes. The supernatant was aspirated and pellet was resuspended in mTeSR1 complete media. Prior to passaging, <NUM><NUM> tissue culture dishes were coated with Matrigel for <NUM> minutes. Unattached Matrigel was removed from the tissue culture dishes and <NUM> of mTeSR1 complete medium was added to dishes. Colonies evenly distributed in mTeSR1 media were added to each plate. Cells were then spread out within the dish using multiple side to side shaking motions while avoiding any swirling. Cultures were checked for growth quality and morphology, and by performing teratoma formation assay as previously described (<NPL>).

Directed differentiation of hPSCs into mesoderm cells: After <NUM> days (-D2) of culture in mTeSR1 media, cultures were directed toward the mesodermal lineage with addition of activin A (<NUM> ng/ml) in the presence of FGF-<NUM>, VEGF<NUM>, and BMP4 (<NUM> ng/ml) for <NUM> hrs. The following day (D1), activin-A containing media was removed and replaced with <NUM> of Stemline II complete media (Sigma) containing FGF-<NUM> (Stemgent), VEGF<NUM> (R&D) and BMP4 (R&D). Media was replaced with <NUM> of fresh Stemline II differentiation media on day <NUM>. On day <NUM> the cells were collected for sorting by flow cytometry for KNA+ mesoderm cells or SSEA5-KNA+ mesoderm cells.

Directed differentiation of KNA+ mesoderm cells or SSEA5-KNA+ mesoderm cells into the EC lineage, including ECFC-like cells: Day <NUM> sorted mesoderm cells (KDR+NCAM+APLNR+ or SSEA5-KDR+NCAM+APLNR+) were further cultured with <NUM> of Stemline II complete media (Sigma) containing FGF-<NUM> (Stemgent), VEGF<NUM> (R&D) and BMP4 (R&D), which was replaced on days <NUM>, <NUM>, <NUM> and <NUM>. On day <NUM> and thereafter media was changed with <NUM> of Stemline II differentiation media.

Flow cytometry: At day <NUM> after differentiation, adherent cells were harvested using TrypleE and made into a single cell suspension in EGM-<NUM> medium. Cells were counted and aliquots of the cell suspension were prepared for antibody staining. FcR blocking reagent (Miltyni Biotech) was added to prevent the non-specific binding of antibodies. Anti-human CD31 (CD31-FITC, clone WM59 from BO Pharmingen), CD144 (CD144-PE, clone 16B1 from ebioscience) and NRP-<NUM> (NRP-<NUM>-APC, clone AD5-<NUM> from Miltenyi Biotech) antibodies were used at concentrations that were titrated prior to use. Propidium Iodide (PI, Sigma) was added to the cell suspension for dead cell staining. Flow cytometric detection of the cell surface antigens and cells sorting were performed on an ISR II and FACS Aria (Becton Dickinson) respectively. Compensation was set by single positive controls using cord blood derived ECFCs. A gating of targeted cell population was determined based on fluorescent minus one (FMO) controls for each fluorescent color.

Cell culture of sorted cells: CD31\ CD144+ or KDR+ and NRP-<NUM>+ sorted cells were centrifuged at <NUM> X g for <NUM> minutes then resuspended in <NUM>% EGM-<NUM> and <NUM>% complete Stemline II differentiation media. To generate ECFCs from the sorted population, <NUM> cells per well were seeded on rat tail type I collagen coated <NUM> well plates. After <NUM> days, the media was aspirated and three parts of EGM-<NUM> and one part of differentiation media was added to the cultures. ECFC colonies appeared as tightly adherent cells and exhibited cobblestone morphology on day <NUM>. On occasion, cloning cylinders were used to isolate ECFC colonies from heterogeneous cell populations. Cloning of endothelial cell clusters was performed to isolate pure populations of highly proliferative endothelial cells as described previously (Yoder et al. , <NUM>; Ingram et al. Confluent ECFCS were passage by plating <NUM>,<NUM> cells per cm<NUM> as a seeding density and maintain ECFCs in complete endothelial growth media (collagen coated plates and cEGM-<NUM> media) with media change every other day as described previously (Yoder et al. , <NUM>; Ingram et al.

Immunochemistry: ECFCs were fixed with <NUM>% (w/v) paraformaldehyde for <NUM> minutes and permeabilized with <NUM>% (v/v) TritonX-<NUM> in PBS for <NUM> minutes. After blocking with <NUM>% (v/v) goat serum for <NUM>, cells were incubated with primary following antibodies; anti- CD31 (Santa Cruz), anti-CD144 (ebioscience), anti-NRP-<NUM> (Santa Cruz) and anti-a-SMA, (Chemicon) overnight at <NUM>. Cells were washed with PBS, then incubated with secondary antibodies conjugated with Alexa-<NUM> or Alexa-<NUM> (Molecular Probe) and visualized by confocal microscopy after counterstaining with <NUM>/ml DAPI (Sigma-Aldrich). The confocal images were obtained with an Olympus FV1000 mpE confocal microscope using as an Olympus uplanSApo 60xW/<NUM>. 2NA/eus objective. All the images were taken as Z-stacks with individual <NUM>µ thick sections at room temperature and images were analyzed using FV10-ASW <NUM> Viewer.

Mice: All animal procedures were carried in accordance with the Guidelines for the Care and Use of Laboratory Animals and were approved by the Institutional Animal Care and Use Committees (IACUCs) at Indiana University School of Medicine (IACUC protocol# <NUM>). Both male and female <NUM>-<NUM> week old NOD/SCID mice (T- and B-cell deficient, impaired complement) were used for all animal studies. NOD-SCID mice were maintained under specific- pathogen-free conditions at the Indiana University Laboratory Animal Resource Center (LARC). Previous work with this animal model was used to determine the minimum number of animals needed to obtain statistically significant results (Yoder et al. Previous studies have shown that <NUM> out of <NUM> matrices (one animal received two matrices) implanted inosculate with the host vasculature and that <NUM> matrices (<NUM> animals) with functional vessels are needed for each group for statistical significance (Yoder et al. Method of randomization was not used while allocating samples and animals to each experimental group. Also, investigator was not blinded to the group allocation both during the experiment and when accessing the outcomes.

In vivo implantation/vessel formation assay (including functional assay): Pig skin type I collagen was used to generate three-dimensional (3D) cellularized collagen matrices as previously described (Critser et al. Briefly, type <NUM> collagen gel mixture was prepared by mixing together ice-cold porcine skin collagen solution, <NUM>% v/v human platelet lysate in <NUM>. 01N HCL, and neutralized with phosphate buffered saline and <NUM>. 1N NaOH to achieve neutral pH (<NUM>). Neutralized gel mixtures (~<NUM>/ml) were kept on ice before induction of polymerization by warming at <NUM>, in <NUM>% CO<NUM>. KNA+ mesoderm cells or SSEA-KNA+ mesoderm cells or SSEA-KNA+-derived NRP-<NUM>+CD31+ ECFCs were added to the collagen mixture to a final concentration of four million cells/ml collagen. The collagen mixture (<NUM>µL) containing the cell suspension was added to <NUM>-well tissue culture dishes and was allowed to polymerize to form gels by incubation in a CO<NUM> incubator at <NUM> for <NUM> minutes. The gels were then overlaid with <NUM>µl of culture medium for <NUM> at <NUM>, in <NUM>% CO<NUM>. After <NUM> hour of ex vivo 3D culture, cellularized gels were implanted into the flanks (a bluntly dissected subcutaneous pouch of anterior abdominal wall with close proximity of host vasculature) of <NUM>- to <NUM>-week-old NOD/SCID mice as previously described{Yoder, <NUM> #<NUM>}. Surgical procedures to implant collagen gels were conducted under anesthesia and constant supply of oxygen. Incisions were sutured and mice monitored for recovery. Various days after implantation, gels were recovered by excising engrafts in animals that had been humanely sacrificed per approved IACUC protocol. Confocal fluoresce imaging and immunohistochemistry was performed as described previously using H&E and anti-human CD31 (and NRP-<NUM>) staining to examine the gels for human endothelial- lined vessels perfused with mouse red blood cells. hCD31+ blood vessels were imaged from each explant using a Leica OM 4000B microscope (Leica Microsystems) with attached Spot-KE digital camera (Diagnostic Instruments). Functional vessels were counted only if they contained at least <NUM> mouse erythrocyte. Olympus-FV-<NUM> MPE inverted confocal/2P system was utilized to examine NRP-<NUM>+CD31+ vessels.

Gene and miRNA expression analysis: Reverse transcriptase (RT) reactions were performed in a GeneAmp PCR <NUM> Thermocycler (Applied Biosystems). mRNA RT reactions were performed using Transcriptor Univessal cDNA Master (Roche). Specific miRNA primers were used for specific miRNA of interest for generating cDNA. RT reactions without templates or primer were used as controls. Gene and miRNA expression levels were quantified using the ABI <NUM> RT-PCR System (Applied Biosytems). Quantitative PCR for mRNA was performed using FastStart Universal SYBR green master (Rox) (Roche). Comparative real-time PCR with or without specific primers for miRNAs and mRNAs was performed in triplicates. mRNA reactions were performed at <NUM> for 1O min, followed by <NUM> cycles of <NUM> for <NUM> and <NUM> for <NUM>. miRNA reactions were performed by <NUM> cycles of <NUM> for <NUM> sand <NUM> for <NUM>. Relative expression levels were calculated using the comparative Ct method (Lee et al.

ECFC single cell proliferation assays: KNA+ or SSEA5-KNA+ mesoderm cell-derived ECFCs were subjected to a single cell assay to evaluate clonogenic proliferative potential.

Briefly, endothelial cells were treated with trypLE Express (Invitrogen) to obtain a single cell suspension. Cell counts and serial dilutions were performed to obtain a concentration of <NUM> cells per well in individual wells of <NUM>-well culture plates. Wells were examined the day after plating to ensure the presence of a single cell per well. Culture media was changed on days <NUM>, <NUM>, and <NUM>. On day <NUM> of culture, cells were stained with Sytox reagent (Invitrogen), and each well was examined to quantitate the number of cells using a fluorescent microscope. Those wells containing two or more cells were identified as positive for proliferation under a fluorescent microscope at 1Ox magnification using a Zeiss Axiovert <NUM> CFL inverted microscope with a 1Ox CP-ACHROMAT/<NUM> NA objective. Wells with endothelial cell counts of <NUM>-<NUM>, <NUM>-<NUM>, <NUM>- <NUM> and ≥<NUM> were labeled as endothelial cell clusters (ECCs), low proliferative potential ECFCs (LPP) and high proliferative potential ECFCs (HPP) as previously described (Yoder et al. , <NUM>; Ingram et al.

Western blot analysis: Cell lysates were prepared by resuspending cells in lysis buffer (<NUM> Tris-HCl pH <NUM>, <NUM> NaCl, <NUM>% glycerol, <NUM>% Triton X-<NUM>, <NUM> EDTA, <NUM> Na<NUM>VO<NUM>, <NUM>µg/ml each of aprotinin and leupeptin) followed by incubation on ice for <NUM>. Insoluble components were removed by centrifugation at <NUM>,000Xg for <NUM>. Protein concentrations were determined with a protein assay kit (Bio-rad). Proteins were separated by electrophoresis on <NUM>-<NUM>%Tris-glycine minigels and then transferred onto immobilon-FL PVDF membrane (Millipore). Nonspecific binding was blocked with blocking buffer for <NUM> hr at room temperature and incubated overnight at <NUM> with primary antibodies against phospho-PYK2 (<NUM>:<NUM>,<NUM>; Cell Signaling) and phospho-p130cas (<NUM>:<NUM>,<NUM>; Cell Signaling) in Odyssey blocking buffer. Blots were washed with PBS containing <NUM>% Tween20, followed by incubation for <NUM> hour at room temperature with anti-rabbit antibody (<NUM>:<NUM>,<NUM>; LI-COR). Immunoreactive bands were detected using the Odyssey Infrared Imager (LI-COR).

Fc-NRP-<NUM> treatment assay: After <NUM> days (-D2) of culture of hiPSC clumps in mTeSR1 media, cultures were directed toward the mesodermal lineage with addition of activin A (<NUM> ng/ml) in the presence of FGF-<NUM>, VEGF<NUM>, and BMP4 (<NUM> ng/ml) for <NUM> hrs. The following day (D1), activin-A containing media was removed and replaced with <NUM> of Stemline II complete media (Sigma) containing FGF-<NUM> (Stemgent), VEGF<NUM> (R&D) and BMP4 (R&D) and <NUM> ng/ml of Fc-NRP-<NUM> (R&D). Media was replaced with <NUM> of fresh Stemline II differentiation media containing FGF-<NUM> (Stemgent), VEGF<NUM> (R&D) and BMP4 (R&D) and <NUM> ng/ml of Fc-NRP-<NUM> (R&D) on day <NUM>. On day <NUM> the cells were collected for sorting by flow cytometry for SSEA5-KNA+ mesoderm cells.

miRNA microarray and RNA sequence analysis: Total RNA was isolated from the samples using Trizol reagent (Invitrogen) and the RNA quality was examined as previously described (<NPL>). For miRNA microarray, miRNome miRNA PCR Array plates, miScript <NUM> Reverse Transcription reaction kits, and miScript SYBR Green PCR Kits (all from Qiagen) were used to examine the expression profiles of the <NUM> most abundantly expressed and best characterized miRNA sequences in the human miRNA genome (miRNome) as annotated in miRBase Release <NUM>. For, RNA-seq analysis, RNA sequence library was generated using <NUM>µg of high quality total RNA and sequencing was performed using Illumina HiSeq2000 sequencer as previously described (Ginsberg et al. The resulting sequence reads were mapped to the human genome (hg18) using TopHat with default parameters, and the RefSeq (June <NUM>) transcript levels (FPKMs) were quantified using Cufflinks.

miRNA mimic/inhibitor treatment assay: After <NUM> day (-D1) of culture of single cell suspension of hiPSCs in mTeSR1 media, cultures were directed toward the mesodermal lineage with addition of activin A (<NUM> ng/ml) in the presence of FGF-<NUM>, VEGF<NUM>, and BMP4 (<NUM> ng/ml) and <NUM>µg mimic or inhibitor/<NUM>,<NUM> seeded cells/well of <NUM> well plate (GE Dharacon) for <NUM> hrs. The following day (D1), activin-A and miRNA mimic or inhibitor containing media was removed and replaced with <NUM> of Stemline II complete media (Sigma) containing FGF-<NUM> (Stemgent), VEGF<NUM> (R&D) and BMP4 (R&D). Media was replaced with <NUM> of fresh Stemline II differentiation media containing FGF-<NUM> (Stemgent), VEGF<NUM> (R&D) and BMP4 (R&D) and <NUM>µg mimic or inhibitor on day <NUM>. Media was replaced with <NUM> of fresh Stemline II differentiation media containing FGF-<NUM> (Stemgent), VEGF<NUM> (R&D) and BMP4 (R&D) on day <NUM>. On day <NUM> the cells were collected for sorting by flow cytometry for SSEA5-KNA+ mesoderm cells.

Statistical analysis: All experiments were performed ≥<NUM> times in triplicate and data are represented as mean value± SD for statistical comparison. A power of analysis with a <NUM>% confidence interval was used to calculate sample size required to obtain statistically significant results. The sampling number we used gave a normal distribution. Significance of differences was assessed by a two tailed student's t-test or one way ANOVA-Tukey post-hoc test Multiple Comparison Test.

Referring now to <FIG>, NCAM and APLNR co-expressing cells within day <NUM> (D4) KDR+ mesoderm cells (KNA+ mesoderm) gave rise to NRP-<NUM>+CD31+ endothelial cells with ECFC competence.

Human PSCs cultured in mTeSR1 were induced to differentiate into mesoderm cells under 2D, serum and feeder-free conditions. PSCs were cultured in Stemline-ll medium with FGF-<NUM> (10ng/ml), BMP4 (<NUM> ng/ml), VEGF165 (<NUM> ng/ml) and Activin-A (<NUM> ng/ml) for <NUM> hours (i.e., from D0-D1) (<FIG>). On D1, the cell culture medium was replaced with Stemline- II medium with FGF-<NUM> (10ng/ml), BMP4 (<NUM> ng/ml), VEGF<NUM> (<NUM> ng/ml). This replacement medium was used to culture the cells undergoing mesodermal induction for <NUM> days (i.e., from D1-D4).

On Day <NUM>, the cells induced to differentiate into mesoderm cells were sorted (<FIG>). KDR+ cells were gated for NCAM and APLNR expression. KDR+NCAM+APLNR+ (K+N+A+, also referred to herein as KNA+) and KDR+NCAM+APLNR- (K+N+A) KDR+NCAM-APLNR- (K+N-A ) cells were sorted for further differentiation and examination for the emergence of NRP- <NUM>+CD31+ ECFC-like cells (<FIG>). Sorted K+N+A+, K+N+A and K+N-A mesoderm sub-sets that were further differentiated into ECFC lineage for another <NUM> days (<NUM> plus <NUM>, total of <NUM> days) to examine for the emergence of NRP-<NUM>+CD31+ cells at various days of differentiation (<FIG>). At day <NUM>, the K+N+A+ mesoderm fraction gave rise to NRP1+CD31+ cells that formed a homogenous cobblestone endothelial monolayer, displayed uniform co-expression for CD31 and CD144 endothelial markers and completely lacked a-SMA expression (top panels of <FIG>), suggesting a stable ECFC-like phenotype. However, cells isolated from the other two subsets (i.e., K+N+A (center panels of <FIG>) and K+N-A (lower panels of <FIG>)) lacked adequate NRP-<NUM> expression, formed heterogeneous cell monolayers, displayed expression for CD144 but lacked uniform co-expression for CD31 and CD144 endothelial markers and exhibited expression for the non-endothelial marker a-SMA, suggesting a complete lack of a stable ECFC phenotype. The K+N+A+ mesoderm-derived NRP-<NUM>+CD31+ cells exhibited high clonal proliferative potential with a hierarchy of colonies ranging from clusters of <NUM>-<NUM> cells up to colonies of ><NUM> similar to that of hiPSC-ECFC-like cells (<FIG>). However, cells isolated from the other two subsets (i.e., K+N+A and K+N-A) failed to exhibit high clonal proliferative potential. K+N+A+ mesoderm-derived NRP-<NUM>+CD31+ cells produced robust in vivo human blood vessels filled with host murine red blood cells (<FIG>, top right panel; arrows point to blood vessels) similar to those produced by hiPSC-ECFC-like cells (<FIG>, top left panel). However, cells isolated from the other two subsets (i.e., K+N+A and K+N-A) failed to produce robust in vivo human blood vessels filled with host murine red blood cells (<FIG>, bottom left and right panels, respectfully; arrows point to hCD31+ functional blood vessels. Similarly, functional hCD31+ blood vessels were generated by K+N+A+ mesoderm-derived NRP-<NUM>+CD31+ cells hiPSC-ECFC-like cells, but not by K+N+A or K+N-A mesoderm cells (<FIG>).

Referring now to <FIG>, human iPS cells after <NUM>-<NUM> days of differentiation using the above culture protocol generate cells expressing mesoderm markers and lacking typical endothelial surface expression. APLNR+ cells were found only in the KDR+NCAM+ mesoderm sub-set and were absent in KDR-NCAM- sub-set (<FIG>) and KDR+ cells were found at highest levels at day <NUM> and <NUM> and decreased over time (<FIG>). Typical endothelial marker (CD31, NRP-<NUM> and CD144) expression was not found in any day <NUM> differentiated cells (<FIG>).

Referring now to <FIG>, direct in vivo differentiation of day <NUM> KNA+ mesoderm cells that were isolated without selecting against SSEA5+ cells formed robust human blood vessels, but also produced endoderm-derived cell-like derivatives.

KDR+ cells were gated for NCAM and APLNR expression. APLNR+ and APLNR- mesoderm cells were sorted for further direct in vivo implantation and examination (<FIG>). Sorted APLNR- mesoderm cells produced teratomas after <NUM> months of in vivo implantation (<FIG>, left panel). The APLNR+ mesoderm sub-set (<FIG>, right panel) formed robust in vivo human blood vessels filled with host murine red blood cells (blue open arrows) with accompanying endoderm-derived cell like derivatives (pink closed arrows).

Referring now to <FIG>, direct in vivo differentiation of D4 SSEA5 depleted KNA+ mesoderm cells (i.e., SSEA5-KDR+NCAM+APLNR+, also referred to as SSEA5-KNA+) formed robust human blood vessels without giving rise to teratoma or endoderm-derived cell- like derivatives.

Day <NUM> differentiated hiPSCs were first gated for SSEA5 and KDR expression (<FIG>, left). The SSEA5-KDR+ cells were gated for NCAM and APLNR expression (<FIG>, right). SSEA5-KDR+NCAM+APLNR+ (SSEA5-KNA+) and SSEA5-KDR+NCAM+APLNR- (SSEA5-KNA) cells were sorted for further analysis. SSEA5-KNA+ cells formed robust functional in vivo vessels (<FIG>, blue arrows, left panel), SSEA5-KNA cells failed to form robust in vivo vessels (<FIG>, white arrows, right panel). Similarly, functional hCD31+ blood vessels were generated by SSEA5-KNA+ cells, but not by SSEA5-KNA cells (<FIG>). When implanted in vivo, SSEA5- KNA+ cells formed NRP-<NUM>+CD31+ ECFC vessels as early as <NUM> days after implantation (<FIG>).

Referring now to <FIG>, day <NUM> SSEA5 depleted KNA+ mesoderm cells displayed transcripts typically enriched in lateral plate/extra-embryonic mesoderm cells, and exhibited enhanced formation of NRP-<NUM>+CD31+ cells with ECFC competence upon in vitro ECFC differentiation.

Gene expression analysis revealed that SSEA5-KNA+ cells over-expressed lateral plate-extra-embryonic mesoderm markers, relative to hiPSCs, and lacked expression of axial, paraxial and intermediate mesoderm markers (<FIG>). Sorted SSEA5-KNA+ cells were further differentiated into the ECFC-like lineage for another <NUM> days (<NUM> plus <NUM>, total of <NUM> days). At day <NUM>, SSEA5-KNA+ cells produced ≥ <NUM> fold more NRP-<NUM>+CD31+ cells compared to NRP-<NUM>+CD31+ cells produced from hiPSCs induced to differentiate into an ECFC-like lineage (i.e., <NUM> days differentiation without isolating a SSEA5-KNA+ mesoderm sub-set at day <NUM> of differentiation) (<FIG>; left panel, bar graph). NRP1+CD31+ cells derived from the SSEA5-KNA+ mesoderm cells formed a homogenous cobblestone endothelial monolayer (<FIG>, left middle panel), displayed uniform co-expression for CD31 and CD144 endothelial markers (<FIG>, right panel) and completely lacked a-SMA expression (<FIG>, right middle panel), suggesting that the SSEA5-KNA+ mesoderm cells were able to differentiate into a stable ECFC-like phenotype. SSEA5-KNA+ mesoderm-derived NRP-<NUM>+CD31+ cells exhibited high clonal proliferative potential with a hierarchy of colonies ranging from clusters of <NUM>-<NUM> cells up to colonies of ><NUM> similar to that of hiPSC-ECFCs (<FIG>). However, cells isolated from SSEA5-KNA mesoderm sub-set failed to exhibit high clonal proliferative potential (<FIG>).

Referring now to <FIG>, the inventors found that Fc-NRP-<NUM> mediates VEGF- KDR signaling through p130cas/Pyk2 activation and enhances formation of SSEA5-KNA+ mesoderm cells from hiPSCs.

NRP-<NUM>, KDR, Fc-NRP-<NUM>, NRP-<NUM>-B and VEGF<NUM> functions in endothelial cells are shown in <FIG>. Briefly, NRP-<NUM> functions as a VEGF<NUM> co-receptor and brings VEGF<NUM> to its receptor (KDR). Fc-NRP-<NUM> acts as surrogate for membrane NRP-<NUM> and binds and brings VEGF<NUM> to KDR. In contrast, NRP-<NUM>-B blocking antibody selectively binds to the VEGF<NUM> binding site of NRP-<NUM>, thereby specifically blocking binding of VEGF<NUM> to NRP-<NUM>.

Examination of KDR and p130cas/Pyk2 phosphorylation was carried out by Western blotting (<FIG>). KDR phosphorylation was observed in VEGF stimulated groups and Fc-NRP-<NUM> dimer treatment increased phosphorylation of KDR compared to control treated cells. However, decreased phosphorylation was observed in NRP-<NUM>-B treated cells. Similarly, increased p130cas/Pyk2 phosphorylation was observed in Fc-NRP-<NUM> dimer treated cells compared to NRP-<NUM>-B treated cells.

Gene expression of VEGF-A isoforms in hiPSCs and SSEA5-KNA+ mesoderm cells was investigated. VEGF-A isoforms were not up-regulated in SSEA5-KNA+ mesoderm cells compared to hiPSCs (<FIG>).

A mesoderm lineage differentiation protocol that involves culturing the cells undergoing mesoderm induction in the presence of Fc-NRP-<NUM> dimer and growth factors is shown in <FIG>. Dimeric Fc-NRP-<NUM> treatment to differentiating hiPSCs caused more than a <NUM>- fold increase in the production of SSEA5-KNA+ mesoderm cells compared to Fc-NRP-<NUM>- untreated cells (<FIG>).

Referring now to <FIG>, specific miRNA mimics miRNA inhibitors and combinations thereof enhance SSEA5-KNA+ mesoderm formation from hiPSCs.

In order to identify miRNAs and their putative transcription factor targets relevant to SSEA5-KNA+ mesoderm formation, we performed miRNA micro-array and RNA-seq analysis of Day O undifferentiated hiPSCs and Day <NUM> SSEA5-KNA+ mesoderm cells (<FIG>). Our analysis of expression of miRNA and mRNA transcripts revealed <NUM> miRs (miR-<NUM>-3p, miR-<NUM>-Sp, miR-<NUM>, miR-<NUM>, miR-<NUM>-3p, miR-30d-5p, miR-<NUM>-3p, miR-<NUM>-Sp, miR-<NUM>-Sp, miR-<NUM>-Sp, miR-<NUM>-3p and miR-<NUM>-Sp) with published and validated targets that potentially regulate transcription factors relevant to SSEA5-KNA+ mesoderm formation from hiPSCs. Among these <NUM> candidate miRNAs, we found <NUM> miRNAs (miR-<NUM>-3p, miR-<NUM>-Sp, miR-<NUM>, miR-<NUM>, miR-<NUM>-3p, miR-30d-5p, miR-<NUM>-3p and miR-<NUM>-Sp) were expressed at lower levels in Day <NUM> SSEA5-KNA+ mesoderm cells compared to Day O undifferentiated hiPSCs, and four miRNAs (miR-<NUM>-Sp, miR-<NUM>-Sp, miR-<NUM>-3p and miR-<NUM>-Sp) were expressed at higher levels in Day <NUM> SSEA5-KNA+ mesoderm cells compared to Day O undifferentiated hiPSCs.

To determine the effect of mimicking and/or inhibiting the identified miRNAs on mesoderm lineage differentiation, we developed a protocol for inducing mesoderm generation from hiPSCs in the presence of specific miRNA mimics, miRNA inhibitors, both mimics and inhibitors (3m3i), or mimic/inhibitor controls (<FIG>). Addition of specific mimics for <NUM> miRNAs (miR-<NUM>-Sp, miR-<NUM>-Sp and miR-<NUM>-3p), specific inhibitors for <NUM> miRNAs (miR-<NUM>-3p, miR- <NUM>-Sp, miR-<NUM>) or <NUM> mimics and <NUM> inhibitors combined increased the frequency of SSEA5- KNA+ mesoderm cells compared to the control (<FIG>). Addition of these specific mimics, inhibitors, or 3m3i decreased the expression of most of the miRNAs that were identified (in our miRNA array analysis) to be expressed at lower levels in Day <NUM> SSEA5-KNA+ mesoderm cells (<FIG>). Addition of these specific mimics, inhibitors or 3m3i increased the expression of some of the miRNAs that were identified (in our miRNA array analysis) to be expressed at higher levels in Day <NUM> SSEA5-KNA+ mesoderm cells (<FIG>).

Referring now to <FIG>, miR-<NUM>-3p targets CLDN6 in differentiating hiPSC and enhances formation of SSEA5-KNA+ mesoderm cells.

Expression of miR-<NUM> and its putative target CLDN6 was analyzed in hiPSCs and SSEA5-KNA+ mesoderm cells. We found that miR-<NUM> and CLDN6 exhibit an inverse expression correlation in hiPSCs and SSEA5-KNA+ mesoderm cells, respectively (<FIG>). miR-<NUM> is highly expressed in SSEA5-KNA+ cells compared to hiPSCs (<FIG>, left bar) and CLDN6 is expressed at lower levels in SSEA5-KNA+ cells compared to hiPSCs (<FIG>, right bar). Over-expression of miR-<NUM> in differentiating hiPSCs caused more than a <NUM>-fold increase in the production of SSEA5-KNA+ mesoderm cells compared to a GFP reporter control vector (<FIG>). A luciferase reporter assay confirmed that miR-<NUM> directly regulates expression of wild type (WT) CLND6 (<FIG>). Differential gene expression analysis between hiPSC and SSEA5-KNA+ mesoderm cells revealed that CLND6 is one of the most down-regulated genes among the <NUM> validated miR-<NUM> targets that decreased in the SSEA5-KNA+ mesoderm (<FIG>). For example, CLDN6 is only expressed at only <NUM>% in the SSEA5-KNA+ mesoderm cells compared to the level measured in the hiPSCs.

Claim 1:
A method for generating an isolated population of human KDR+NCAM+APLNR+ mesoderm cells from human pluripotent stem cells, the method comprising:
(a) inducing pluripotent stem cells (PSCs) to undergo mesodermal differentiation,
wherein the inducing step is carried out in the absence of co-cultured supportive cells, and further comprises:
i) culturing the pluripotent stem cells for about <NUM> hours in a mesoderm differentiation medium comprising Activin A, BMP-<NUM>, VEGF, and FGF-<NUM>;
ii) replacing the medium of step i) with a mesoderm differentiation medium comprising BMP-<NUM>, VEGF, and FGF-<NUM> about every <NUM>-<NUM> hours thereafter for about <NUM> hours;
and comprising contacting the cells undergoing mesodermal induction with one or more of a miRNA inhibitor(s) selected from the group consisting of miR-<NUM>-3p, miR-<NUM>-5p, miR-<NUM>, miR-<NUM>, miR-<NUM>-3p, miR-30d-5p, miR-<NUM>-3p and miR-<NUM>-5p, and/or one or more of a miRNA mimic selected from the group consisting of miR-<NUM>-5p, miR-<NUM>-5p, miR-<NUM>, and miR-<NUM>-5p; and
(b) isolating from the cells induced to undergo differentiation the mesoderm cells, wherein the isolation of mesoderm cells comprises:
iii) sorting the mesoderm cells to select for KDR+NCAM+APLNR+ cells.