Ex vivo expansion of umbilical cord blood stem cells for transplantation : growing knowledge from the hematopoietic niche

• Published in: Bone marrow transplantation (Basingstoke) Vol. 39; no. 1; pp. 11 - 23
• Main Authors: HOFMEISTER, C. C, ZHANG, J, KNIGHT, K. L, LE, P, STIFF, P. J
• Format: Journal Article
• Language: English
• Published: Basingstoke Nature Publishing Group 01.01.2007
• Subjects: Adult; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Apoptosis - immunology; Biological and medical sciences; Bone marrow; Bone marrow, stem cells transplantation. Graft versus host reaction; Care and treatment; Cell Culture Techniques; Cell Differentiation - physiology; Cell Proliferation; Cell Separation; Cord Blood Stem Cell Transplantation; Fetal blood; Graft Survival - physiology; Hematopoiesis - immunology; Hematopoietic stem cell disorders; Hematopoietic Stem Cells - cytology; Hematopoietic Stem Cells - physiology; Humans; Medical sciences; Recovery of Function - immunology; Risk factors; Signal Transduction - physiology; Stem cell transplantation; Time Factors; Transfusions. Complications. Transfusion reactions. Cell and gene therapy; Transplantation; Transplantation, Homologous; United States; Hematology; Stem cell; Hematopoietic cell; Homograft; Blood; Blood cell; Ex vivo; hematopoietic stem cell transplantation; Graft; Umbilical cord; hematopoietic stem cells; Expansion; cord blood stem cell transplantation
• ISSN: 0268-3369; 1476-5365
• DOI: 10.1038/sj.bmt.1705538

Umbilical cord blood transplantation (UCBT) in adults is limited by the small number of primitive hematopoietic stem cells (HSC) in each graft, resulting in delayed engraftment post transplant, and both short- and long-term infectious complications. Initial efforts to expand UCB progenitors ex vivo have resulted in expansion of mature rather than immature HSC, confounded by the inability to accurately and reliably measure long-term reconstituting cells. Ex vivo expansion of UCB HSC has failed to improve engraftment because of resulting defects that promote apoptosis, disrupt marrow homing and initiate cell cycling. Here we discuss the future of ex vivo expansion, which we suggest will include the isolation of immature hematopoietic progenitors on the basis of function rather than surface phenotype and will employ both cytokines and stroma to maintain and expand the stem cell niche. We suggest that ex vivo expansion could be enhanced by manipulating newly discovered signaling pathways (Notch, Wnt, bone morphogenetic protein 4 and Tie2/angiopoietin-1) and intracellular mediators (phosphatase and tensin homolog and glycogen synthase kinase-3) in a manner that promotes HSC expansion with less differentiation. Improved methods for ex vivo expansion will make UCBT available to more patients, decrease engraftment times and allow more rapid immune reconstitution post transplant.