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Background and AimMacrophages regulate metabolic homeostasis in health and disease. Macrophage colony-stimulating factor (CSF1)-dependent macrophages contribute to homeostatic control of the size of the liver. This study aimed to determine the systemic metabolic consequences of elevating circulating CSF1.Methods and ResultsAcute administration of a CSF1-Fc fusion protein led to monocytosis, increased resident tissue macrophages in the liver and all major organs, and liver growth. These effects were associated with increased hepatic glucose uptake and extensive mobilisation of body fat. The impacts of CSF1 on macrophage abundance, liver size and body composition were rapidly reversed to restore homeostasis. CSF1’s effects on metabolism were independent of several known endocrine regulators and did not impact the physiological fasting response. Analysis using implantable telemetry in metabolic cages revealed progressively reduced body temperature and physical activity with no change in diurnal food intake.ConclusionThese results demonstrate the existence of a dynamic equilibrium between CSF1, the mononuclear phagocyte system, metabolic regulation and homeostatic control of liver:body weight ratio.

Purpose of ReviewThe purpose of the review is to summarize the expression and function of CSF1R and its ligands in bone homeostasis and constraints on therapeutic targeting of this axis.Recent FindingsBone development and homeostasis depends upon interactions between mesenchymal cells and cells of the mononuclear phagocyte lineage (MPS), macrophages, and osteoclasts (OCL). The homeostatic interaction is mediated in part by the systemic and local production of growth factors, macrophage colony-stimulating factor (CSF1), and interleukin 34 (IL34) that interact with a receptor (CSF1R) expressed exclusively by MPS cells and their progenitors. Loss-of-function mutations in CSF1 or CSF1R lead to loss of OCL and macrophages and dysregulation of postnatal bone development. MPS cells continuously degrade CSF1R ligands via receptor-mediated endocytosis. As a consequence, any local or systemic increase or decrease in macrophage or OCL abundance is rapidly reversible.SummaryIn principle, both CSF1R agonists and antagonists have potential in bone regenerative medicine but their evaluation in disease models and therapeutic application needs to carefully consider the intrinsic feedback control of MPS biology.

Background Prior chemotherapy and/or underlying morbidity commonly leads to poor mobilisation of hematopoietic stem cells (HSC) for transplantation in cancer patients. Increasing the number of available HSC prior to mobilisation is a potential strategy to overcome this deficiency. Resident bone marrow (BM) macrophages are essential for maintenance of niches that support HSC and enable engraftment in transplant recipients. Here we examined potential of donor treatment with modified recombinant colony-stimulating factor 1 (CSF1) to influence the HSC niche and expand the HSC pool for autologous transplantation. Methods We administered an acute treatment regimen of CSF1 Fc fusion protein (CSF1-Fc, daily injection for 4 consecutive days) to naive C57Bl/6 mice. Treatment impacts on macrophage and HSC number, HSC function and overall hematopoiesis were assessed at both the predicted peak drug action and during post-treatment recovery. A serial treatment strategy using CSF1-Fc followed by granulocyte colony-stimulating factor (G-CSF) was used to interrogate HSC mobilisation impacts. Outcomes were assessed by in situ imaging and ex vivo standard and imaging flow cytometry with functional validation by colony formation and competitive transplantation assay. Results CSF1-Fc treatment caused a transient expansion of monocyte-macrophage cells within BM and spleen at the expense of BM B lymphopoiesis and hematopoietic stem and progenitor cell (HSPC) homeostasis. During the recovery phase after cessation of CSF1-Fc treatment, normalisation of hematopoiesis was accompanied by an increase in the total available HSPC pool. Multiple approaches confirmed that CD48−CD150+ HSC do not express the CSF1 receptor, ruling out direct action of CSF1-Fc on these cells. In the spleen, increased HSC was associated with expression of the BM HSC niche macrophage marker CD169 in red pulp macrophages, suggesting elevated spleen engraftment with CD48−CD150+ HSC was secondary to CSF1-Fc macrophage impacts. Competitive transplant assays demonstrated that pre-treatment of donors with CSF1-Fc increased the number and reconstitution potential of HSPC in blood following a HSC mobilising regimen of G-CSF treatment. Conclusion These results indicate that CSF1-Fc conditioning could represent a therapeutic strategy to overcome poor HSC mobilisation and subsequently improve HSC transplantation outcomes.

Osteal macrophages (osteomacs) support osteoblast function and promote bone anabolism, but their contribution to osteoporosis has not been explored. Although mouse ovariectomy (OVX) models have been repeatedly used, variation in strain, experimental design and assessment modalities have contributed to no single model being confirmed as comprehensively replicating the full gamut of osteoporosis pathological manifestations. We validated an OVX model in adult C3H/HeJ mice and demonstrated that it presents with human postmenopausal osteoporosis features with reduced bone volume in axial and appendicular bone and bone loss in both trabecular and cortical bone including increased cortical porosity. Bone loss was associated with increased osteoclasts on trabecular and endocortical bone and decreased osteoblasts on trabecular bone. Importantly, this OVX model was characterized by delayed fracture healing. Using this validated model, we demonstrated that osteomacs are increased post-OVX on both trabecular and endocortical bone. Dual F4/80 (pan-macrophage marker) and tartrate-resistant acid phosphatase (TRAP) staining revealed osteomacs frequently located near TRAP+ osteoclasts and contained TRAP+ intracellular vesicles. Using an in vivo inducible macrophage depletion model that does not simultaneously deplete osteoclasts, we observed that osteomac loss was associated with elevated extracellular TRAP in bone marrow interstitium and increased serum TRAP. Using in vitro high-resolution confocal imaging of mixed osteoclast-macrophage cultures on bone substrate, we observed macrophages juxtaposed to osteoclast basolateral functional secretory domains scavenging degraded bone byproducts. These data demonstrate a role for osteomacs in supporting osteoclastic bone resorption through phagocytosis and sequestration of resorption byproducts. Overall, our data expose a novel role for osteomacs in supporting osteoclast function and provide the first evidence of their involvement in osteoporosis pathogenesis. © 2021 American Society for Bone and Mineral Research (ASBMR).

Osteoporotic fracture results in disability, increased morbidity and even mortality. There is currently no broadly applicable pro-regenerative therapy for osteoporotic fractures. A growing body of evidence implicates osteal tissue macrophages (osteomacs) as key contributors to physiological bone dynamics particularly through their support of osteoblast-mediated bone anabolism. This new paradigm exposed the possibility that osteomacs could be therapeutically targeted to enhance bone regeneration. To investigate this, it is imperative to improve understanding regarding osteomac function in bone growth, turnover, repair and pathology. Macrophage contribution to postnatal bone development was further elucidated in this thesis using Csf1r knockout (Csf1rko) rats. Mapping of skeletal changes postnatally through immunohistochemistry and micro-computed tomography (micro-CT) revealed contribution of osteomacs/macrophages to formation of secondary ossification centres and ossification of cranial vault and suture. However, while this rat model was informative, it did not fully delineate macrophage and osteoclast contributions given both cells are Csf1r-dependent. The inability of experimental approaches to specifically target macrophages without undesired impacts on osteoclasts has been a major limitation in studies investigating macrophage contributions to bone dynamics. This limitation was next addressed. Flow cytometry of enriched periosteal and endosteal cell suspensions revealed that CD169 (Siglec 1) is expressed by both periosteal and endosteal osteomacs. Targeted depletion using CD169-diphtheria toxin receptor (DTR) knock-in mouse model demonstrated significant loss of endosteal osteomacs and concomitant loss of osteoblasts but had no effect on osteoclasts. Preclinical bone injury and fracture models were employed to assess CD169+ osteomac function during intramembranous- and endochondral-mediated bone healing respectively. CD169+ osteomac/macrophage depletion during the early healing phase of intramembranous ossification resulted in significant reduction in new collagen type I+ woven bone deposited within the injury site. Similarly, CD169+ osteomac/macrophage depletion during the early inflammatory phase of fracture healing decreased callus size, representing a delayed healing response. These findings provide compelling evidence that CD169+ macrophages/osteomacs, independent of osteoclasts, have vital pro-anabolic contributions during bone repair mechanisms.Based on this new knowledge, whether CD169 expression by macrophages influenced bone homeostasis was next investigated. Micro-CT assessment of CD169-knockout mice showed that loss of CD169 resulted in a low bone mass phenotype. This was the first demonstration that loss of expression of a single macrophage-specific molecule was sufficient to cause osteopenia. This led to the hypothesis that macrophage dysfunction could have a role in osteoporosis-induced bone loss. To investigate this, an ovariectomy (OVX)-induced model of post-menopausal osteoporosis in C3H/HeJ mice, which recapitulated features of human post-menopausal osteoporosis, was validated. Interestingly, osteomac frequency was increased on both trabecular and endocortical bone post-OVX. Dual F4/80 antigen (pan-murine macrophage marker) and tartrate resistant acid phosphatase (TRAP) activity staining demonstrated TRAP+ vesicles present within F4/80+ osteomacs, suggesting a role for osteomacs in phagocytosing extracellular TRAP. Additionally, CD169+ osteomac/macrophage depletion in vivo using CD169-DTR mice was associated with elevated TRAP+ deposits in the bone marrow and serum TRAP, suggesting that in the absence of bone-associated macrophages, combined with unchanged osteoclast function (static measure of TRAP+ osteoclasts/bone surface, TRAP staining area and trabecular bone area), TRAP liberated into the bone marrow interstitium during bone resorption was leaching into the serum. These data demonstrate a role for osteomacs in supporting bone resorption through sequestering resorption by-products and the observed increase in osteomacs post-OVX was likely a compensatory mechanism associated with elevated bone resorption.The observations generated thus far provided justification for assessing whether enhancing osteomacs/macrophages function is a valid strategy for improving fracture healing in healthy and osteoporotic bones. Osteomacs/macrophages can be increased in vivo using macrophage colony stimulating factor 1 (CSF1). Therefore, the utility of CSF1 in promoting pro-regenerative responses was investigated using the chimeric CSF1 molecule, CSF1-Fc, which was previously engineered to achieve improved pharmacokinetics in vivo. Bone catabolic actions of CSF1 particularly in osteoporotic bone is a potential contraindication of CSF1-Fc use for promoting fracture repair. Here, an intermittent CSF1-Fc treatment regimen for 4 weeks that avoided potential dose-limiting indications was optimised. This regimen also enhanced regenerative mechanisms in an internally plated mid-diaphyseal fracture model in healthy bones, culminating in increased fracture strength. To determine whether this treatment strategy can also improve osteoporotic fracture healing, the OVX-operated C3H/HeJ osteoporosis model validated herein was used, and fracture was generated by blunt trauma and stabilised using the MouseScrew intramedullary screw fixation system. Micro-CT assessment of fracture sites showed a reduction in cortical bridging at 5 weeks post-fracture in OVX mice compared to SHAM operated controls, indicative of delayed bone repair. Importantly, weekly CSF1-Fc treatment of OVX mice post-fracture corrected this delayed healing phenotype by significantly improving fracture bridging and strength. Overall, this study considerably advanced understanding on the role of osteomacs during postnatal bone growth, homeostasis, repair and pathology. Notably, this study reveals that targeting macrophages using CSF1-Fc is a promising fracture therapeutic to promote regeneration in both healthy and osteoporotic fracture patients.

SummaryMouse hematopoietic tissues contain abundant and heterogeneous populations of tissue-resident macrophages attributed trophic functions in control of immunity, hematopoiesis and bone homeostasis. A systematic strategy to characterise macrophage subsets in mouse bone marrow (BM), spleen and lymph node, unexpectedly revealed macrophage surface marker staining typically emanated from membrane-bound subcellular remnants associated with unrelated cell types. Remnant-restricted macrophage-specific membrane markers, cytoplasmic fluorescent reporters and mRNA were all detected in non-macrophage cell populations including isolated stem and progenitor cells. The profile of macrophage remnant association reflects adhesive interactions between macrophages and other cell types in vivo. Applying this knowledge, reduced macrophage remnant attachment to BM granulocytes in Siglec1 deficient mice was associated with compromised emergency granulocytosis, revealing a function for Siglec1-dependent granulocyte-macrophage interactions. Analysis of published RNA-seq data for purified macrophage and non-macrophage populations indicates that macrophage fragmentation is a general phenomenon that confounds bulk and single cell analysis of disaggregated tissues.

Mouse hematopoietic tissues contain abundant tissue-resident macrophages that support immunity, hematopoiesis, and bone homeostasis. A systematic strategy to characterize macrophage subsets in mouse bone marrow (BM), spleen, and lymph node unexpectedly reveals that macrophage surface marker staining emanates from membrane-bound subcellular remnants associated with unrelated cells. Intact macrophages are not present within these cell preparations. The macrophage remnant binding profile reflects interactions between macrophages and other cell types in vivo. Depletion of CD169+ macrophages in vivo eliminates F4/80+ remnant attachment. Remnant-restricted macrophage-specific membrane markers, cytoplasmic fluorescent reporters, and mRNA are all detected in non-macrophage cells including isolated stem and progenitor cells. Analysis of RNA sequencing (RNA-seq) data, including publicly available datasets, indicates that macrophage fragmentation is a general phenomenon that confounds bulk and single-cell analysis of disaggregated hematopoietic tissues. Hematopoietic tissue macrophage fragmentation undermines the accuracy of macrophage ex vivo molecular profiling and creates opportunity for misattribution of macrophage-expressed genes to non-macrophage cells.

Vincristine is an important component of many regimens used for pediatric and adult malignancies, but it causes a dose-limiting sensorimotor neuropathy for which there is no effective treatment. This study aimed to delineate the neuro-inflammatory mechanisms contributing to the development of mechanical allodynia and gait disturbances in a murine model of vincristine-induced neuropathy, as well as to identify novel treatment approaches. Here, we show that vincristine-induced peripheral neuropathy is driven by activation of the NLRP3 inflammasome and subsequent release of interleukin-1β from macrophages, with mechanical allodynia and gait disturbances significantly reduced in knockout mice lacking NLRP3 signaling pathway components, or after treatment with the NLRP3 inhibitor MCC950. Moreover, treatment with the IL-1 receptor antagonist anakinra prevented the development of vincristine-induced neuropathy without adversely affecting chemotherapy efficacy or tumor progression in patient-derived medulloblastoma xenograph models. These results detail the neuro-inflammatory mechanisms leading to vincristine-induced peripheral neuropathy and suggest that repurposing anakinra may be an effective co-treatment strategy to prevent vincristine-induced peripheral neuropathy.

Osteal macrophages (osteomacs) support osteoblast function and promote bone anabolism, but their contribution to osteoporosis has not been explored. While mouse ovariectomy models have been repeatedly used, variation in strain, experimental design and assessment modalities, have contributed to no single model being confirmed as comprehensively replicating the full gamut of osteoporosis pathological manifestations. We validated an ovariectomy model in adult C3H/HeJ mice and demonstrated that it presents with human post-menopausal osteoporosis features, including reduced bone volume in axial and appendicular bone and bone loss in both trabecular and cortical bone including increased cortical porosity. Bone loss was associated with increased osteoclasts on trabecular and endocortical bone and decreased osteoblasts on trabecular bone. Importantly, this OVX model was characterised by delayed fracture healing. Using this validated model, we demonstrated that osteomacs are increased post-ovariectomy on both trabecular and endocortical bone. Dual F4/80 (pan-macrophage marker) and TRAP staining revealed osteomacs frequently located near TRAP+ osteoclasts and containing TRAP+ intracellular vesicles. Using an in vivo inducible macrophage depletion model that does not simultaneously deplete osteoclasts, we observed that osteomac loss was associated with elevated extracellular TRAP in bone marrow interstitium and increased serum TRAP. Using in vitro high-resolution confocal imaging of mixed osteoclast-macrophage cultures on bone substrate, we observed macrophages juxtaposed to osteoclast basolateral functional secretory domains scavenging degraded bone by-products. These data demonstrate a role for osteomacs in supporting osteoclastic bone resorption through phagocytosis and sequestration of resorption by-products. Finally, using Siglec1 knockout mice, we demonstrated that loss of the macrophage-restricted molecule Siglec-1/CD169 is sufficient to cause age-associated low bone mass, emphasizing the macrophages, independent of osteoclasts, contribute to optimal skeletal health. Overall, our data expose a novel role for osteomacs in supporting osteoclast function and provide the first evidence of their involvement in osteoporosis pathogenesis.

Macrophage-targeted therapies, including macrophage colony-stimulating factor 1 (CSF1), have been shown to have pro-repair impacts post-fracture. Preclinical/clinical applications of CSF1 have been expedited by development of chimeric CSF1-Fc which has extended circulating half-life. Here, we used mouse models to investigate the bone regenerative potential of CSF1-Fc in healthy and osteoporotic fracture. We also explored whether combination of CSF1-Fc with interleukin (IL)-4 provided additional fracture healing benefit in osteopenic bone. Micro-computed tomography, in situ histomorphometry, and bone mechanical parameters were used to assess systemic impacts of CSF1-Fc therapy in naive mice (male and female young, adult and geriatric). An intermittent CSF1-Fc regimen was optimized to mitigate undesirable impacts on bone resorption and hepatosplenomegaly, irrespective of age or gender. The intermittent CSF1-Fc regimen was tested in a mid-diaphyseal femoral fracture model in healthy bones with treatment initiated 1-day post-fracture. Weekly CSF1-Fc did not impact osteoclasts but increased osteal macrophages and improved fracture strength. Importantly, this treatment regimen also improved fracture union and strength in an ovariectomy-model of delayed fracture repair. Combining CSF1-Fc with IL-4 initiated 1-week post-fracture reduced the efficacy of CSF1-Fc. This study describes a novel strategy to specifically achieve bone regenerative actions of CSF1-Fc that has the potential to alleviate fragility fracture morbidity and mortality.

Prior chemotherapy and/or underlying morbidity commonly leads to poor mobilisation of hematopoietic stem cells (HSC) for transplantation in cancer patients. Increasing the number of available HSC prior to mobilisation is a potential strategy to overcome this deficiency. Resident bone marrow (BM) macrophages are essential for maintenance of niches that support HSC and enable engraftment in transplant recipients. Here we examined potential of donor treatment with colony stimulating factor-1 (CSF1) to modify the BM niche and expand the potential HSC pool for autologous transplantation. We administrated CSF1 Fc fusion protein (CSF1-Fc) to naive C57Bl/6 mice and assessed the impacts on HSC number and function and overall haematopoiesis. Outcomes were assessed by in situ imaging and ex vivo flow cytometry with functional validation by colony formation and competitive transplantation assay. CSF1-Fc treatment caused a transient expansion of monocyte-macrophage cells within BM and spleen at the expense of BM B lymphopoiesis and hematopoietic stem and progenitor cell (HSPC) homeostasis. During the recovery phase after cessation of CSF1-Fc treatment, normalisation of haematopoiesis was accompanied by an increase in the total available HSPC pool. In the spleen, increased HSC was associated with expression of the BM niche marker CD169 in red pulp macrophages. Pre-treatment with CSF1-Fc increased the number and reconstitution potential of HSPC in blood following a HSC mobilising regimen of granulocyte colony stimulating factor (G-CSF) treatment. These results indicate that CSF1-Fc conditioning could represent a therapeutic strategy to overcome poor HSC mobilisation and subsequently improve autologous or heterologous HSC transplantation outcomes.Key points1) Recovery from Fc-modified colony stimulating factor-1 (CSF1-Fc) treatment was accompanied by an increase in total haematopoietic stem cells. 2) Pre-conditioning with CSF1-Fc increased the reconstitution potential of blood after haematopoietic stem cell mobilisation.

Better understanding of bone growth and regeneration mechanisms within periosteal tissues will improve understanding of bone physiology and pathology. Macrophage contributions to bone biology and repair have been established but specific investigation of periosteal macrophages has not been undertaken. We used an immunohistochemistry approach to characterise macrophages in growing murine bone and within activated periosteum induced in a mouse model of bone injury. Osteal tissue macrophages (osteomacs) and resident macrophages were distributed throughout resting periosteum. Tissues were collected from 4 week old mice and osteomacs were observed intimately associated with sites of periosteal diaphyseal and metaphyseal bonedynamics associated with normal growth. This included F4/80+Mac-2-/low osteomac association with extended tracks of bone formation (modeling) on diphyseal periosteal surfaces. While this recapitulated endosteal osteomac characteristics, there was subtle variance in the morphology and spatial organization of modelling-associated osteomacs, which likely reflects the greater structural complexity of periosteum. We also demonstrated that osteomacs, resident macrophages and inflammatory macrophages (F4/80+Mac-2hi) were associated with the complex bone dynamics occurring within the periosteum at the metaphyseal corticalization zone. These 3 macrophage subsets were also present within activated native periosteum after bone injury across a 9 day time course that spanned the inflammatory through remodeling bone healing phases. This included osteomac association with foci of endochondral ossification within the activated native periosteum. These observations confirm that osteomacs are key components of both ostealtissues, in spite of salient differences between endosteal and periosteal structure and that multiple macrophage subsets are involved in periosteal bone dynamics.

Prior chemotherapy and/or underlying morbidity commonly leads to poor mobilization of hematopoietic stem cells (HSC) for autologous transplantation in cancer patients. Increasing the number of available HSC prior to mobilization is a potential strategy to overcome this deficiency. Bone marrow (BM) macrophages regulate HSC niches and promote engraftment of donor HSC post-transplant. In this study, we examined if manipulating macrophages using a modified long-acting Fc fusion protein of CSF1 could influence HSC niches to expand the HSC pool. Acute CSF1-Fc treatment (4 x daily injection) in C57Bl/6 mice induced a robust systemic myeloproliferative response that peaked 1 week post the initial injection. BM and spleen homeostasis were disrupted during peak myelopoiesis, including supressed lymphopoiesis and temporary engraftment of BM hematopoietic stem and progenitor cell (HSPC) in liver. CSF1-Fc effects were transient as by 2 weeks post first CSF1-Fc injection, overall haematopoiesis had normalized, but the number of HSC in BM (1.6 fold), and particularly in spleen (5.9 fold), were significantly elevated compared to controls. This was not due to direct CSF1-Fc actions on HSC as multiple experimental approaches confirmed that HSC and multipotent progenitors do not express CSF1-receptor. The increase in splenic HSC corresponded with a sustained phenotype shift in red pulp macrophages characterized by expression of the BM HSC niche macrophage marker CD169. We observed minimal evidence of in situ macrophage proliferation, indicating specialised adaptation of monocyte-derived macrophages to the CSF1-Fc altered splenic environment. Importantly, CSF1-Fc pre-treatment enhanced HSC mobilization (2.5 fold) into blood after G-CSF treatment when compared to controls. Competitive transplantation demonstrated the CSF1-Fc + G-CSF mobilized blood graft had improved reconstitution potential with no leukocyte lineage bias. Overall, the data suggest that CSF1-Fc treatment resulted in sustained adaptation of resident macrophages with improved capability to support extramedullary HSC niches resulting in a systemic increase in the absolute number of HSC. Therefore, conditioning patients with CSF1 could be a potential therapeutic strategy to overcome poor mobilization and subsequently improve autologous transplantation outcomes.

Osteal macrophages (osteomacs) contribute to bone homeostasis and regeneration. To further distinguish their functions from osteoclasts, which share many markers and growth factor requirements, we developed a rapid, enzyme-free osteomac enrichment protocol that permitted characterization of minimally manipulated osteomacs by flow cytometry. Osteomacs differ from osteoclasts in expression of Siglec1 (CD169). This distinction was confirmed using the CD169-diphtheria toxin (DT) receptor (DTR) knock-in model. DT treatment of naïve CD169-DTR mice resulted in selective and striking loss of osteomacs, whilst osteoclasts and trabecular bone area were unaffected. Consistent with a previously-reported trophic interaction, osteomac loss was accompanied by a concomitant and proportionately striking reduction in osteoblasts. The impact of CD169(+) macrophage depletion was assessed in two models of bone injury that heal via either intramembranous (tibial injury) or endochondral (internally-plated femoral fracture model) ossification. In both models, CD169(+) macrophage, including osteomac depletion compromised bone repair. Importantly, DT treatment in CD169-DTR mice did not affect osteoclast frequency in either model. In the femoral fracture model, the magnitude of callus formation correlated with the number of F4/80(+) macrophages that persisted within the callus. Overall these observations provide compelling support that CD169(+) osteomacs, independent of osteoclasts, provide vital pro-anabolic support to osteoblasts during both bone homeostasis and repair.

Mounting evidence supporting the critical contribution of macrophages, in particular osteal macrophages, to bone regeneration is reviewed. We specifically examine the potential role of macrophages in the basic multicellular units coordinating lifelong bone regeneration via remodelling and bone regeneration in response to injury. We review and discuss the distinctions between macrophage and osteoclast contributions to bone homeostasis, particularly the dichotomous role of the colony-stimulating factor 1—colony-stimulating factor 1 receptor axis. The impact of inflammation associated with aging and other hallmarks of aging, including senescence, on macrophage function is addressed in the context of osteoporosis and delayed fracture repair. Resident macrophages versus recruited macrophage contributions to fracture healing are also discussed. We identify some of the remaining knowledge gaps that will need to be closed in order to maximise benefits from therapeutically modulating or mimicking the function of macrophages to improve bone health and regeneration over a lifetime.

Osteal macrophages (osteomacs) contribute to bone homeostasis and regeneration. To further distinguish their functions from osteoclasts, which share many markers and growth factor requirements, we developed a rapid, enzyme-free osteomac enrichment protocol that permitted characterization of minimally manipulated osteomacs by flow cytometry. Osteomacs differ from osteoclasts in expression of Siglec1 (CD169). This distinction was confirmed using the CD169-diphtheria toxin (DT) receptor (DTR) knock-in model. DT treatment of naïve CD169-DTR mice resulted in selective and striking loss of osteomacs, whilst osteoclasts and trabecular bone area were unaffected. Consistent with a previously-reported trophic interaction, osteomac loss was accompanied by a concomitant and proportionately striking reduction in osteoblasts. The impact of CD169

Autologous HSC transplant is a common therapeutic strategy for some haematological malignancies but is unachievable in up to 40% of cases due to insufficient mobilisation of HSCs for successful transplantation. The monocyte-macrophage colony stimulating factor-1 (CSF1) improves HSC transplantation outcomes in preclinical models and clinical trials, but the underlying mechanism of CSF1 induced benefit is unclear. BM macrophages are a key component of the HSC niches and a primary target of granulocyte colony-stimulating factor (G-CSF) induced HSC mobilisation. We examined CSF1 impacts on HSC frequency using a modified CSF1-Fc molecule that has improved drug qualities. Haematopoietic progenitor cells (HPC), but not HSCs or multipotent progenitors (MPP), expressed the CSF1 receptor. Acute CSF1-Fc treatment (4 x daily injection) induced a robust myeloproliferative response that was evident 1 week post the initial injection. At this time, BM HSCs (17 fold) and MPP (19 fold), but not HPC, were significantly reduced. However, at 2 weeks post the first CSF1-Fc injection, after the myeloproliferative event had resolved, the overall pool of HSCs in BM (1.6 fold), and unexpectedly spleen (9.2 fold), was significantly elevated compared to controls. A mobilising regimen of G-CSF started at 2 weeks post CSF1-Fc treatment enhanced HSC mobilisation (2.5 fold) into blood when compared to mice treated with G-CSF only. This increase in mobilised HSCs was verified via competitive secondary transplantation. The data suggest that CSF1 has complex indirect effects on HSCs to increase HSC frequency and promote formation of extramedullary HSC niches. CSF1-induced increased in the total HSC pool may contribute to the reported improvement in transplantation outcomes associated with CSF1 therapy and reveals a novel strategy to increase HSCs prior to mobilisation.

Interaction between the chemokine receptor CXCR4 and its chief ligand CXCL12 plays a critical role in the retention and migration of hematopoietic stem and progenitor cells (HSPCs) in the bone marrow (BM) microenvironment. In this study, qualitative and quantitative effects of long-term pharmacologic inhibition of the CXCR4/CXCL12 axis on the HSPC compartment were investigated by using 3 structurally unrelated small molecule CXCR4 antagonists. A >10-fold increase in mobilization efficiency was achieved by administering the antagonists as a subcutaneous continuous infusion for 2 weeks compared to a single bolus injection. A concurrent increase in self-renewing proliferation leading to a twofold to fourfold expansion of the HSPC pool in the BM was observed. The expanded BM showed a distinct repopulating advantage when tested in serial competitive transplantation experiments. Furthermore, major changes within the HSPC niche associated with previously described HSPC expansion strategies were not detected in bones treated with a CXCR4 antagonist infusion. Our data suggest that prolonged but reversible pharmacologic blockade of the CXCR4/CXCL12 axis represents an approach that releases HSPC with efficiency superior to any other known mobilization strategy and may also serve as an effective method to expand the BM HSPC pool.

Macrophages, named for their phagocytic ability, participate in homeostasis, tissue regeneration and inflammatory responses. Bone and adjacent marrow contain multiple functionally unique resident tissue macrophage subsets which maintain and regulate anatomically distinct niche environments within these interconnected tissues. Three subsets of bone-bone marrow resident tissue macrophages have been characterised; erythroblastic island macrophages, haematopoietic stem cell niche macrophages and osteal macrophages. The role of these macrophages in controlling homeostasis and repair in bone and bone marrow niches is reviewed in detail.

For decades it has been assumed that lethal irradiation in bone marrow transplantation experiments ablates the entire host hematopoietic system but preserves the host non-hematopoietic bone marrow stroma. This postulate is at the basis of transplantation chimera experiments in mice to test involvement of hematopoietic cells versus non-hematopoietic stroma. As BM-Macs support HSC niche homeostasis, we examined whether host-derived BM-Macs persist lethal irradiation and play a role in HSC engraftment. Recipient MacGreen mice (expressing GFP in myeloid cells under the control of Csf1r promoter) were lethally irradiated (11.5Gy) and transplanted with sorted syngeneic B6.SJL CD45.1+ Lin-Kit+Sca1+ sorted cells. Flow cytometry analyses of BM 2-30 weeks (wk) post-transplant confirmed more than 99% donor chimerism of monocytes and granulocytes validating ablation of recipient HSC. In contrast, GFP+CD11b+F4/80+CD169+VCAM-1+ERHR3+Ly6Gneg recipient BM-Macs were detected throughout the time-course. A 5.9 fold expansion of these recipient BM-Macs occurred between wk 2 and 5 ( from 45,000 to 270,000 cells/femur) post-transplant which coincided with increased number of phenotypic donor HSC (GFP-Lin-Kit+Sca1+CD48-CD150+). Host BM-Mac proliferation was cell autonomous in the absence of host HSC and granulocytes. Recipient Macs in spleen displayed different frequency and longevity kinetics that correlated with transient post-Tx splenic extramedullary haematopoiesis. In situ, GFP+F480+ recipient BM-Macs were enriched in perivascular microenvironments within both central BM and endosteal regions. These GFP+ host-derived macrophages persisted long-term forming 8.4% of BM macrophages 7months post-transplant. To evaluate the importance of these host-derived radiation-resistant macrophages, we selectively depleted recipient BM-Macs using CD169-DTR mice transplanted with syngeneic ubiquitous GFP+ HSC. Depletion of recipient CD169+ Macs abated engraftment of donor phenotypic HSC by 70% at 5 wk post-transplant and reduced BM reconstitution potential in competitive secondary transplants. In conclusion BM contains a myeloablation-resistant self-repopulating Mac subset that is necessary for efficient and/or sustained HSC BM engraftment following transplantation. Therefore interpretation of transplantation chimera experiments must take into account the persistence of this subset of host macrophages that support donor HSC engraftment.