Therapeutic effects of hypoimmunogenic universal human iPSC-derived endothelial cells in a humanized mouse model of peripheral artery disease

Abstract Background Peripheral arterial disease (PAD) is a leading cause of limb disability due to ischemia caused by atherosclerotic plaques. Cell-based therapies using endothelial cells (ECs) have shown promise in promoting angiogenesis for PAD, but challenges remain in obtaining sufficient ECs fr...

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Main Authors: Jungju Choi, Nam Gyo Kim, Dasom Kong, Min-Ji Kim, Byeong-Cheol Kang, Daekee Kwon, Da-Hyun Kim, Kyung-Sun Kang
Format: Article
Language:English
Published: BMC 2025-08-01
Series:Stem Cell Research & Therapy
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Online Access:https://doi.org/10.1186/s13287-025-04554-5
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author Jungju Choi
Nam Gyo Kim
Dasom Kong
Min-Ji Kim
Byeong-Cheol Kang
Daekee Kwon
Da-Hyun Kim
Kyung-Sun Kang
author_facet Jungju Choi
Nam Gyo Kim
Dasom Kong
Min-Ji Kim
Byeong-Cheol Kang
Daekee Kwon
Da-Hyun Kim
Kyung-Sun Kang
author_sort Jungju Choi
collection DOAJ
description Abstract Background Peripheral arterial disease (PAD) is a leading cause of limb disability due to ischemia caused by atherosclerotic plaques. Cell-based therapies using endothelial cells (ECs) have shown promise in promoting angiogenesis for PAD, but challenges remain in obtaining sufficient ECs from human tissues. Induced pluripotent stem cells (iPSCs) provide a potential solution, though immune rejection issues arise due to human leukocyte antigen (HLA) mismatches. The depletion of HLA class I and II through gene editing aims to broadly avoid lymphocyte recognition and can be achieved by inactivating β2-microglobulin (B2M) and class II transactivator (CIITA). However, B2M inactivation can lead to a ‘missing self’ killing response by NK cells and macrophages. To overcome this, we proposed universal iPSCs by knocking out B2M and CIITA and over-expressing CD24 to reduce immune rejection. Methods Universal iPSCs were tested for their pluripotency and ability to differentiate into ECs. The stimulation of universal iPSC-derived endothelial cells (U-ECs) to T and NK cells was evaluated by activation marker using flow cytometry. We generated a humanized mouse model by intravenously injecting CD34+ hematopoietic stem cells isolated from umbilical cord blood into NSG mice. Finally, we induced a humanized PAD mouse model by removing the femoral artery of the left hindlimb. Then we injected U-ECs, demonstrating the therapeutic efficacy of U-ECs. Results We generated hypoimmunogenic universal iPSC by knocking out B2M and CIITA, along with over-expressing CD24, and confirmed that their pluripotency was maintained. We demonstrated that U-ECs exhibit functional endothelial properties and reduced immunogenicity, effectively mitigating immune recognition from both adaptive and innate immune responses. U-ECs survived in significantly greater numbers after transplantation and elicited a weaker immune response in humanized mice. Then we induced hindlimb ischemia in humanized mice to establish a humanized PAD model. U-ECs induced effective angiogenic capabilities, leading to significant blood flow restoration in ischemic limbs. Conclusions This study demonstrates the feasibility of creating hypoimmunogenic iPSCs and their derivatives that can reduce immune response and function effectively in vivo.
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spelling doaj-art-67090c20b3194fd8ac7db964aa13c0db2025-08-20T03:42:20ZengBMCStem Cell Research & Therapy1757-65122025-08-0116112310.1186/s13287-025-04554-5Therapeutic effects of hypoimmunogenic universal human iPSC-derived endothelial cells in a humanized mouse model of peripheral artery diseaseJungju Choi0Nam Gyo Kim1Dasom Kong2Min-Ji Kim3Byeong-Cheol Kang4Daekee Kwon5Da-Hyun Kim6Kyung-Sun Kang7Adult Stem Cell Research Center and Research Institute for Veterinary Medicine, College of Veterinary Medicine, Seoul National UniversityAdult Stem Cell Research Center and Research Institute for Veterinary Medicine, College of Veterinary Medicine, Seoul National UniversityAdult Stem Cell Research Center and Research Institute for Veterinary Medicine, College of Veterinary Medicine, Seoul National UniversityAdult Stem Cell Research Center and Research Institute for Veterinary Medicine, College of Veterinary Medicine, Seoul National UniversityDepartment of Experimental Animal Research, Biomedical Research Institute, Seoul National University HospitalResearch Institute in Maru TherapeuticsAdult Stem Cell Research Center and Research Institute for Veterinary Medicine, College of Veterinary Medicine, Seoul National UniversityAdult Stem Cell Research Center and Research Institute for Veterinary Medicine, College of Veterinary Medicine, Seoul National UniversityAbstract Background Peripheral arterial disease (PAD) is a leading cause of limb disability due to ischemia caused by atherosclerotic plaques. Cell-based therapies using endothelial cells (ECs) have shown promise in promoting angiogenesis for PAD, but challenges remain in obtaining sufficient ECs from human tissues. Induced pluripotent stem cells (iPSCs) provide a potential solution, though immune rejection issues arise due to human leukocyte antigen (HLA) mismatches. The depletion of HLA class I and II through gene editing aims to broadly avoid lymphocyte recognition and can be achieved by inactivating β2-microglobulin (B2M) and class II transactivator (CIITA). However, B2M inactivation can lead to a ‘missing self’ killing response by NK cells and macrophages. To overcome this, we proposed universal iPSCs by knocking out B2M and CIITA and over-expressing CD24 to reduce immune rejection. Methods Universal iPSCs were tested for their pluripotency and ability to differentiate into ECs. The stimulation of universal iPSC-derived endothelial cells (U-ECs) to T and NK cells was evaluated by activation marker using flow cytometry. We generated a humanized mouse model by intravenously injecting CD34+ hematopoietic stem cells isolated from umbilical cord blood into NSG mice. Finally, we induced a humanized PAD mouse model by removing the femoral artery of the left hindlimb. Then we injected U-ECs, demonstrating the therapeutic efficacy of U-ECs. Results We generated hypoimmunogenic universal iPSC by knocking out B2M and CIITA, along with over-expressing CD24, and confirmed that their pluripotency was maintained. We demonstrated that U-ECs exhibit functional endothelial properties and reduced immunogenicity, effectively mitigating immune recognition from both adaptive and innate immune responses. U-ECs survived in significantly greater numbers after transplantation and elicited a weaker immune response in humanized mice. Then we induced hindlimb ischemia in humanized mice to establish a humanized PAD model. U-ECs induced effective angiogenic capabilities, leading to significant blood flow restoration in ischemic limbs. Conclusions This study demonstrates the feasibility of creating hypoimmunogenic iPSCs and their derivatives that can reduce immune response and function effectively in vivo.https://doi.org/10.1186/s13287-025-04554-5Hypoimmunogenic iPSCsEndothelial cellsAngiogenesisHumanized mouseHindlimb ischemiaImmune response
spellingShingle Jungju Choi
Nam Gyo Kim
Dasom Kong
Min-Ji Kim
Byeong-Cheol Kang
Daekee Kwon
Da-Hyun Kim
Kyung-Sun Kang
Therapeutic effects of hypoimmunogenic universal human iPSC-derived endothelial cells in a humanized mouse model of peripheral artery disease
Stem Cell Research & Therapy
Hypoimmunogenic iPSCs
Endothelial cells
Angiogenesis
Humanized mouse
Hindlimb ischemia
Immune response
title Therapeutic effects of hypoimmunogenic universal human iPSC-derived endothelial cells in a humanized mouse model of peripheral artery disease
title_full Therapeutic effects of hypoimmunogenic universal human iPSC-derived endothelial cells in a humanized mouse model of peripheral artery disease
title_fullStr Therapeutic effects of hypoimmunogenic universal human iPSC-derived endothelial cells in a humanized mouse model of peripheral artery disease
title_full_unstemmed Therapeutic effects of hypoimmunogenic universal human iPSC-derived endothelial cells in a humanized mouse model of peripheral artery disease
title_short Therapeutic effects of hypoimmunogenic universal human iPSC-derived endothelial cells in a humanized mouse model of peripheral artery disease
title_sort therapeutic effects of hypoimmunogenic universal human ipsc derived endothelial cells in a humanized mouse model of peripheral artery disease
topic Hypoimmunogenic iPSCs
Endothelial cells
Angiogenesis
Humanized mouse
Hindlimb ischemia
Immune response
url https://doi.org/10.1186/s13287-025-04554-5
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