Saravana Kanagavelu1, Jennifer Johnson1, Hocine Rachid2, Chris Sakoda1, Liang Li1, Sharon Vaturi1, Mario Fournier3, Rachel Smith1, Linda Marban1, Reem Al-Daccak2, Luis Rodriguez-Borlado1

1 Capricor Therapeutics, 8700 Beverly Boulevard, Davis Building, Los Angeles, CA 90048; 2 HLA et Medicine, Hôpital Saint Louis, Paris, France; 3Cedars-Sinai Medical Center, Los Angeles, CA

CONCLUSIONS

REFERENCES1. Tseliou, E., Fouad, J., Reich, H., Slipczuk, L., de Couto, G., Aminzadeh, M., Middleton, R., Valle,

J., Weixin, L. and Marban, E. (2015). Fibroblasts Rendered Antifibrotic, Antiapoptotic, andAngiogenic by Priming With Cardiosphere-Derived Extracellular Membrane Vesicles. J. Am. Coll.66(6): 599-611.

2. Jefferies, J., Byrne, B., Taylor, M., Lima, J., Venkatesh, B., Ostovaneh, M., Ruckdeschel Smith,R., Malliaras, K., Fedor, B., Rudy, J., Pogoda, J., Marbán, L., Ascheim, D., Marbán, E., Victor, R.D. Cardiac and skeletal muscle improvements after cell therapy in the open-label Phase I/IIrandomized prospective Halt cardiOmyopathy ProgrEssion (HOPE) trial of Duchenne musculardystrophy. Manuscript submitted for publication. ActionDuchenneInternationalConference

Birmingham(UK),November10-12,2017

INTRODUCTION

Figure 2. CDC mechanism of action. CDCs secrete EVs containing bioactive moleculesable to regulate different responses involved in tissue regeneration.

Cardiosphere-Derived Cells(CAP-1002)

Immunomodulation

Macrophages

Anti-apoptoticProliferative

Cardiomyocytes

Angiogenic

Vessels

Antifibrotic

Fibroblasts

Regenerative

Progenitor cells

CAP-1002 is Immunomodulatory and Regenerative

Systemic Therapeutic Effects with IC Delivery in HOPE I

SUMMARY

-4 -2 0 2 4

10

20

30

40

y = -3.474x + 22.98R2 = 0.9996Efficiency = 94.02

Log (cells in qPCR)

Ct A

lu

Mouse model: C57BL/10 (8-12 weeks old)CDCs: human CDCs, 150,000 cells

Mouse model: SCID (8-12 weeks old)CDCs: human CDCs, 150,000 cells

CDCsshowastrongimmunomodulatoryactivityandimprovemusclephysiologywhensystemicallydelivered.

The immunomodulatory and regenerative properties of CDCs havebeen shown effective with in vitro and in vivo models.

Biodistribution of human CDCs was measured in mice using qPCR forhuman-specific Alu sequence. 10min and 24h after CDC injection,most cells were found in the lungs (Fig. 7b). Less than 5% of cellspresent in the lungs at 24h in SCID mice remained 1wk afteradministration. No significant amount of CDCs remained 3wk afterinjection (Fig. 7c).

Figure 7. A) DNA was isolated from CDCs and qPCR was run on serial dilutions.Standard curves of CDC DNA spiked into mouse tissue DNA were prepared for eachtissue to be tested for CDC biodistribution in mice. B) CDC biodistribution in WT mice10 minutes and 24 hours after injection of 150,000 human CDCs. C) CDCbiodistribution in SCID mice 24 hours, 1 week, and 3 weeks after CDC injection.

A B

C

B

Phenotypic analysis showed that CDCs have a low immunogenicexpression profile. CDCs limited the in vitro proliferation ofactivated human CD4 and CD8 T lymphocytes.Mdx mice (DMD mouse model) intravenously treated with CDCsshowed a dose dependent increase of exercise capability and animprovement in muscle physiology when compared with placebotreated mice. Histological analysis also showed a reduced fibrosis inmdx mice treated with CDCs when compared with control mice.CDCs accumulate preferentially in the lungs 10 min and 24h aftersystemic delivery. We also evaluated clearance of CDCs 1 and 3weeks after systemic delivery in SCID mice.

A

BIODISTRIBUTION AND CLEARANCE

CAP-1002 Manufacturing ProcessCAP-1002 is an allogeneic cell therapy product based on the isolationand expansion of Cardiosphere-Derived Cells (CDCs).

• CDCs have a low immunogenic profile and a strongimmunomodulation of T cells that can limit the inflammatoryprocess observed in DMD patients.

• 150,000 – 250,000 CDCs given intravenously are effective inincreasing exercise capacity and diaphragm muscle function ofmdx mice 3 – 6 weeks after injection.

• Most cells are initially trapped in the lungs, with smallredistribution of cells to the heart within 1 week of injection

• Cells are cleared within 3 weeks after injection.• These findings support clinical evaluation of systemic

administration and repeat dosing of CAP-1002 in patients withDMD.

Figure 1. A) Explant-derived cells (EDCs) are produced from donor heart tissue andexpanded to produce a master cell bank (MCB). B) Cardiospheres are formed from EDCs.C) CDCs are produced by culturing the cells obtained after seeding the cardiospheres.

Figure 3. Performance of the upper limb (PUL) test was used to measure the effects onskeletal muscle function in HOPE I. A) Test description showing shoulder, middle, anddistal level tests. B) Results from middle and distal levels in patients treated with CDCs(red) and placebo (blue).

AdaptedfromTseliou, E.etal.JAmColl Cardiol.2015;66(6):599–611.

Mediu

mPHA

CDC

5x10

9 EV/m

l

10x1

09 E

V/ml

20x1

09 E

V/ml

0

20

40

60

80

% p

rolif

erat

ing

cells

CD4+CD8+

**

*

****

* **

D

HLA I96%

HLA II3.6%

Human Leukocyte Antigens (HLA)

CD803.6%

CD8657.3%

Co-Stimulatory

CD274 (PD-L1)45.8%

CD275 (ICOS-L)9.4%

Co-Stimulatory/Regulatory

CD

4+ T

cells

CD

8+ T

cells

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11%

PHA + CDC

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55%

PHA

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0.1%

medium

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28%

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72%

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0.1%

CFSE

EFFICACY WITH IV ADMINISTRATION

Mouse model: mdx mice (8-10 months old)CDCs: C57BL/10 (syngeneic)

Figure 6. Efficacy of CDCs in mdx mice with IV administration. A) Study timeline.Mice received treatment in Week 0, exercise every week, and were sacrificed in week 6.B) Exercise capacity of mice given escalating doses of CDCs. C) Isolated diaphragmmuscle function. D) Masson’s Trichrome staining of heart tissue sections 6 weeks afterCDC injection.

A dose-dependent improvement in exercise capacity (Fig. 6b) andisolated diaphragm muscle function (Fig. 6c) was observed 6 weeksafter CDC treatment. Histological analysis of hearts reveal lowercollagen deposition (Fig. 6d).

PBS (n=10)

Study Groups

75K (n=4)

250K (n=4)150K (n=8)

A

Ex.Muscle

FunctionHistology

Time (Weeks)

-1 0 4 5 6

Ex. Echo Ex.

Ex.EchoEx.

1 2 3

Ex. Ex. Ex.

B C

CDC IMMUNOLOGY

Figure 5. Immune modulation of PHA- induced CD4+ and CD8+ T cells proliferationby CDC. Results are mean percentage values ± SEM from 2 different donors each donein triplicates.

Figure 4. Expression of immune molecules involved in T immune response

Dose Escalation Efficacy

D

CDCs show a low immunogenic phenotype with expression of class IHLA and CD86 co-stimulatory antigen and the immuno-regulatorymarker PD-L1 (Fig. 4). CDCs limit proliferation of in vitro activatedhuman T lymphocytes.

Donorheart MCBExplantcreation

Cardiospheres CDCs AllogeneicCDCproduct

EDCoutgrowth

CDCExpansionMCB

A

B C