Source Of Hematopoietic Stem Cells Research Articles

Abstract 12 Evaluating the Properties of the Donor to Determine the Quality of Cord Blood

Abstract Introduction Cord blood is a valuable source of hematopoietic stem cells (HSCs) that offer advantages over other sources, but the volume and the absolute number of stem cells in cord blood are limited. Objectives The study aimed to analyze the influence of the factors relating to mothers, babies, and collection on the quality of cord blood units before cryopreservation in Vinmec Tissue Bank, Vietnam. This provides a thorough insight into available predictors that can inform the potential recipients. Methods This study, conducted at Vinmec Tissue Bank in Vietnam between January 2019 and December 2021, collected, processed, and analyzed 2,668 cord blood samples. The study evaluated the impact of donor and collection factors, including maternal age, delivery mode, gestational age, infant weight, gender, blood group, geography, season, collection volume, viability, TNC, and CD34+ cell components on cord blood characteristics. Results Results showed that maternal age, gestational age, delivery mode, and infant weight significantly affected TNC and CD34+ cells, while infant gender only has a significant impact on TNC. Additionally, the collection features such as cord blood volume, geography, the season of delivery, and waiting time associated with cord blood outcomes. Discussion In virtue of its superior matching probability, lower incidence of GVHD, and reduced recurrence rates, cord blood is considered a favorable option for HSC transplantation. However, the limited number of HSCs available from cord blood for bigger patients can be addressed through global cooperation. The possibility of using multiple cord blood units for hematologic cancers has been made feasible through inter-unit HLA matching 29,30. As global cooperation between cord blood banks expands, there is a growing opportunity to find matching samples for recipients. Our large-scale analysis of cord blood throughout Vietnam has highlighted the significance of baby weight and volume in determining cord blood quality. This report represents the first-ever study in Asia to investigate the impact of geography and demography on cord blood. Further evaluation is necessary for a comprehensive understanding of these factors, which would enable more appropriate counseling for patients. Figure 1. Elements that impact the quality of hematopoietic stem cells in cord blood.

Accessory-cell-free differentiation of hematopoietic stem and progenitor cells into mature red blood cells

Background aimsThe culture and ex vivo engineering of red blood cells (RBCs) can help characterize genetic variants, model diseases, and may eventually spur the development of applications in transfusion medicine. In the last decade, improvements to the in vitro production of RBCs have enabled efficient erythroid progenitor proliferation and high enucleation levels from several sources of hematopoietic stem and progenitor cells (HSPCs). Despite these advances, there remains a need for refining the terminal step of in vitro human erythropoiesis, i.e., the terminal maturation of reticulocytes into erythrocytes, so that it can occur without feeder or accessory cells and animal-derived components. MethodsHere, we describe the near-complete erythroid differentiation of cultured RBCs (cRBCs) from adult HSPCs in accessory-cell-free and xeno-free conditions. ResultsThe approach improves post-enucleation cell integrity and cell survival, and it enables subsequent storage of cRBCs for up to 42 days in classical additive solution conditions without any specialized equipment. ConclusionsWe foresee that these improvements will facilitate the characterization of RBCs derived from gene-edited HSPCs.

Hematopoietic cell transplantation for telomere biology diseases: A retrospective single-center cohort study.

Telomere biology diseases (TBD) result from defective telomere maintenance, leading to bone marrow failure. The only curative treatment for aplastic anemia related to TBD is a hematopoietic cell transplant (HCT). Although reduced-intensity conditioning (RIC) regimens decrease transplant-related mortality, non-hematological phenotypes represent a major challenge and are associated with poor long-term follow-up outcomes. To describe the outcome of TBD patients transplanted for marrow failure. This is a retrospective, single-center study describing the outcomes of 32 consecutive transplants on 29 patients between 1993 and 2019. The median age at transplantation was 14 years (range, 3-30 years). Most patients received a RIC regimen (n = 28) and bone marrow (BM) from an unrelated donor (n = 16). Four patients received a haploidentical transplant. Chimerism was available for 27 patients with a median time to neutrophil recovery of 20 days (13-36 days). Primary graft failure occurred in one patient, whereas second graft failure occurred in two. Acute GVHD grade II-IV and moderate to severe chronic GVHD occurred in 22% of patients at risk. Fourteen patients were alive after HCT at the last follow-up (median, 6 years; 1.4-19 years). The 5-year overall survival was better after matched sibling donor (MSD) transplantation compared to other hematopoietic stem cell sources (88.9% vs. 47.7%; p = .05; CI = 95%). Overall, 15 patients died after HCT, most of them (n = 11) after the first year of transplant, due to non-hematological disease progression or complication of chronic GVHD. Hematopoietic cell transplantation is a potentially curative treatment option for TBD, nonetheless the poor outcome reflects the progression of non-hematologic disease manifestations, which should be considered when transplantation is indicated.

STEM CELL THERAPY IN STROKE

Stem cells are emerging as an attractive option because of their intrinsic ability as vectors for drug delivery to diseased tissues. The term stem cells or stem cells was first introduced by a Russian histologist, Alexander Maksimov (1874-1928). The purpose of this study is to describe the research and development of stem cell applications for stroke. This study is a literature study (review article) regarding stem cells (stem cells) in stroke which has been discussed in several scientific journals. From several articles that have been collected in giving stem cells to people with stroke, namely in bone marrow. MSC (Mesenchymal Stem Cell) is a multipotent stem cell from bone marrow and Adult SPM and because of its high applicability. Bone marrow is a rich source of hematopoietic stem cells so it can be applied to stroke patients.

Pre-transplant Medical Evaluation: A Multidisciplinary Approach

Conventional autologous and allogenic hematopoietic stem cell transplants (HSCT) are lifesaving or life extending medical procedures but associated with significant risk for non-infectious and infectious complications. The center for international blood and marrow transplant research estimates that worldwide about 100000 transplants are performed yearly. The frequency of transplantation is varied widely from country to country, with a close association of transplant rates with gross national income (GNI) per-capita. Appropriate indication for transplant is mandatory for these rigorous procedures. Hematological malignancies, bone marrow failure syndromes, inherited immune deficiencies, hemoglobinopathies and inherited metabolic disorders are usual indications for BMT. Sources of hematopoietic stem cells are crucial. Patient evaluation includes psychosocial and systems evaluation. Foundation for the Accreditation of cellular therapy (FACT) is required. General guidelines for patient eligibility are chemo sensitive, adequate performance status, adequate nonhematopoietic organ function, ability to provide informed consent and adequately matched available donor or adequate collection of autologous stem cells. Exclusion criteria include chemo refractory, life expectancy severely limited by other illness, inability to tolerate preparative regimen and pregnancy. Relative contraindications are major medical comorbidities, major psychiatric illness and lack of insurance/financial resources. Comorbidities are cardiac arrhythmia, EF d” 50%, body mass index e” 35 kg/m2, serum creatinine > 2 mg/dl and EFV1 d” 65%. Allogeneic donor evaluation is also vital and includes HLA typing for HLA-A, -B, -DRBI; screening of transmissible diseases, laboratories, consents and notifications. J Medicine 2023; Vol. 34, No. 2(1) Supplement: 212

An analysis of the efficacy of graft-versus-host disease prophylaxis with post-transplant cyclophosphamide in children with acute myeloid leukemia following allogeneic hematopoietic stem cell transplantation from HLA-matched and partially-matched unrelated donors

An analysis of the efficacy of graft-versus-host disease prophylaxis with post-transplant cyclophosphamide in children with acute myeloid leukemia following allogeneic hematopoietic stem cell transplantation from HLA-matched and partially-matched unrelated donors

Results of hematopoietic stem cell transplantation in children with acute leukemia: a single-center experience

Currently, allogeneic hematopoietic stem cell transplantation (allo-HSCT) is an effective treatment option for relapsed / refractory (R / R) acute leukemia (AL) and high-risk AL. In this article, we present our own experience of allo-HSCT in children with R / R AL. The study was approved by the Independent Ethics Committee and the Scientific Council of the N. N. Blokhin National Medical Research Center of Oncology. Fifty-one patients with R / R AL were included in the study: 32 patients had acute lymphoblastic leukemia (ALL), 17 patients had acute myeloid leukemia (AML) and 2 patients had biphenotypic leukemia (BL). All patients underwent allo-HSCT from January 2021 to October 2022. The median age was 8.7 years (5 months – 17 years). At the time of allo-HSCT, 26 patients were in the second (and further) remission, the rest were in the first clinical and hematologic remission (high-risk AML and refractory ALL). Twenty-one (41.2 %) patients received allo-HSCT from a haploidentical donor, 19 (37.2 %) patients underwent allo-HSCT from an HLA-matched related donor and 11 (21.6 %) patients – from an HLA-matched unrelated donor. Pre-transplant conditioning in ALL: 27 patients received regimens based on total body irradiation at a dose of 12 Gy, 4 patients received busulfan-based conditioning regimens, and in 1 patient we used treosulfan. In AML and BL, we used conditioning regimens based on treosulfan/thiotepa (n = 10), treosulfan/melphalan (n = 8) or busulfan / melphalan (n = 1). Bone marrow (in 14 patients) and peripheral blood stem cells (in 37 patients) were used as a source of hematopoietic stem cells. In haploidentical allo-HSCTs in order to prevent graft-versus-host disease (GVHD) we performed TCRab/CD19 depletion followed by additional administration of abatacept / tocilizumab / rituximab on day –1 in 15 patients, 6 patients received post-transplant cyclophosphamide. In transplantations from HLA-matched related and unrelated donors, patients received combined immunosuppressive therapy with abatacept and rituximab on day –1, and calcineurin inhibitors were used as basic immunosuppressive therapy. All patients engrafted with a median time to engraftment of 13 (range, 9 to 24) days after allo-HSCT. Eight (15.7 %) patients developed a relapse of AL at different times after HSCT (five of them are alive). At the median follow-up of 9 (5–25) months, the overall and disease-free survival survival rates were 76.4 % and 68.8 %, respectively, for patients with AL. Acute GVHD was observed in 72.5 % of children, grade 3–4 GVHD was observed in 5.3 % of patients, and 13.7 % of children developed chronic GVHD. Most patients developed infectious complications in the early post-transplant period: febrile neutropenia (96.0 %), reactivation of viremia (47.3 %,) oropharyngeal mucositis (78.4 %), acute cystitis (12.3 %). The overall mortality rate was 17.6 %. Late mortality was associated with a relapse of AL.

Expanding the Abu Dhabi Bone Marrow Transplant Program (AD-BMT<sup>®</sup>) Scope with the Collection and Cryopreservation of Cord Blood Stem Cells

<i>Introduction:</i> The umbilical cord blood (UCB) is the blood from the placenta's blood vessels and the portion of the umbilical cord that remains attached to the newborn after the delivery when the cord is clamped and cut. UCB is rich in hematopoietic stem cells (HSC) and other stem cells (SC). Between 1974 and 1988, scientific knowledge and UCB application possibilities for human therapy opened a new significative era in cell therapy, using UCB HSC as an alternative source of SC for bone marrow transplant and the cure of patients with malignant hematological diseases. <i>Objective:</i> The possibility of having a UCB bank (UCB-B) in Abu Dhabi encouraged us to make this analysis. <i>Method:</i> A literature review from Google Scholar, PubMed, SciELO, Scopus, and other sources, about the increasing application of UCB-SC and storage in UCB-B was done to update about all the possibilities for translational medicine. <i>Results:</i> We prepared a UCB overview, including the pioneering use of UCB-SC for HSC transplantation, their biological composition, characteristics, and the UC-associated tissues like Wharton-Jelly and the human term placenta, UCB advantages, and disadvantages in HSC transplantation, the number of clinical trials applying UCB donation samples, and promising possibilities for regenerative medicine. The existence of different types of UCB-Bs, and the development of new specific cellular manipulation techniques. The UCB-B regulatory framework and some ethical issues were also included in the review. <i>Conclusions:</i> After 30 years of UCB-B, more than 100 public UCB-Bs worldwide, with millions of UCB units donated altruistically, more than 800,000 clinical-grade products are now available: a great source of transplantable SC and other cellular material for the development of new therapies. Even though the UCB as a source of HSC for transplantation has been recently statistical ranked in third place, after HSC apheresis collected and bone marrow aspirates, until now, more than 50,000 UCB HSC allogeneic transplants (HSC-Allo-T) have been performed worldwide in both children and adults to treat many different diseases, including hematologic, metabolic, immunologic, neoplastic, and neurologic disorders. A significant effort has been focused on enhancing engraftment to reduce the risk of infection and cost. <i>Recommendations:</i> To that end, we must understand in detail the molecular mechanisms controlling SC self-renewal that may lead to the development of ex-vivo systems for HSCs expansion, characterize the mechanisms regulating the homing of HSC and determine the relative place of UCB HSC-Allo-T, as compared to other sources.

Pediatric Autologous Hematopoietic Stem Cell Transplantation: Safety, Efficacy, and Patient Outcomes. Literature Review.

Autologous stem cell transplantation (auto-HSCT) is a part of the therapeutic strategy for various oncohematological diseases. The auto-HSCT procedure enables hematological recovery after high-dose chemotherapy, otherwise not tolerable, by the infusion of autologous hematopoietic stem cells. Unlike allogeneic transplant (allo-HSCT), auto-HSCT has the advantage of lacking acute-graft-versus-host disease (GVHD) and prolonged immunosuppression, however, these advantages are counterbalanced by the absence of graft-versus-leukemia. Moreover, in hematological malignancies, the autologous hematopoietic stem cell source may be contaminated by neoplastic cells, leading to disease reappearance. In recent years, allogeneic transplant-related mortality (TRM) has progressively decreased, almost approaching auto-TRM, and many alternative donor sources are available for the majority of patients eligible for transplant procedures. In adults, the role of auto-HSCT compared to conventional chemotherapy (CT) in hematological malignancies has been well defined in many extended randomized trials; however, such trials are lacking in pediatric cohorts. Therefore, the role of auto-HSCT in pediatric oncohematology is limited, in both first- and second-line therapies and still remains to be defined. Nowadays, the accurate stratification in risk groups, according to the biological characteristics of the tumors and therapy response, and the introduction of new biological therapies, have to be taken into account in order to assign auto-HSCT a precise role in the therapeutic strategies, also considering that in the developmental age, auto-HSCT has a clear advantage over allo-HSCT, in terms of late sequelae, such as organ damage and second neoplasms. The purpose of this review is to report the results obtained with auto-HSCT in the different pediatric oncohematological diseases, focusing on the most significant literature data in the context of the various diseases and discussing this data in the light of the current therapeutic landscape.

In vitro erythrocyte production using human-induced pluripotent stem cells: determining the best hematopoietic stem cell sources

BackgroundBlood transfusion is an essential part of medicine. However, many countries have been facing a national blood crisis. To address this ongoing blood shortage issue, there have been efforts to generate red blood cells (RBCs) in vitro, especially from human-induced pluripotent stem cells (hiPSCs). However, the best source of hiPSCs for this purpose is yet to be determined.MethodsIn this study, hiPSCs were established from three different hematopoietic stem cell sources—peripheral blood (PB), cord blood (CB) and bone marrow (BM) aspirates (n = 3 for each source)—using episomal reprogramming vectors and differentiated into functional RBCs. Various time-course studies including immunofluorescence assay, quantitative real-time PCR, flow cytometry, karyotyping, morphological analysis, oxygen binding capacity analysis, and RNA sequencing were performed to examine and compare the characteristics of hiPSCs and hiPSC-differentiated erythroid cells.ResultshiPSC lines were established from each of the three sources and were found to be pluripotent and have comparable characteristics. All hiPSCs differentiated into erythroid cells, but there were discrepancies in differentiation and maturation efficiencies: CB-derived hiPSCs matured into erythroid cells the fastest while PB-derived hiPSCs required a longer time for maturation but showed the highest degree of reproducibility. BM-derived hiPSCs gave rise to diverse types of cells and exhibited poor differentiation efficiency. Nonetheless, erythroid cells differentiated from all hiPSC lines mainly expressed fetal and/or embryonic hemoglobin, indicating that primitive erythropoiesis occurred. Their oxygen equilibrium curves were all left-shifted.ConclusionsCollectively, both PB- and CB-derived hiPSCs were favorably reliable sources for the clinical production of RBCs in vitro, despite several challenges that need to be overcome. However, owing to the limited availability and the large amount of CB required to produce hiPSCs, and the results of this study, the advantages of using PB-derived hiPSCs for RBC production in vitro may outweigh those of using CB-derived hiPSCs. We believe that our findings will facilitate the selection of optimal hiPSC lines for RBC production in vitro in the near future.

Clinical characteristics and correlative factors of dry eye disease associated with graft-versus-host disease

Objective: To investigate the clinical features of dry eye disease in patients with graft-versus-host disease (GVHD) and to identify the correlative factors that contribute to its severity. Methods: It was a retrospective case series study. A total of 62 patients with dry eye disease caused by GVHD after allogeneic hematopoietic stem cell transplantation (HSCT) were recruited from the First Affiliated Hospital of Soochow University between 2012 and 2020. The study population comprised 38 males (61%) and 24 females (39%), with an average age of (35.29±11.75) years. Only the right eye of each patient was evaluated. The patients were divided into two groups based on the severity of corneal epitheliopathy: a mild group (15 eyes) and a severe group (47 eyes). Demographic information, including gender, age, primary disease, type of allogeneic HSCT, donor-to-recipient information, source of hematopoietic stem cells, systemic GVHD, and the time from HSCT to the first visit, was collected. Ophthalmologic assessments, including the Schirmer Ⅰ test, tear breakup time, corneal epithelial staining, and eye margin assessment, were performed during the first visit to the ophthalmology department and compared between the two groups. Results: The average time from HSCT to the first visit to the ophthalmology department among the 62 patients was (20.26±13.09) months. The median corneal fluorescein staining score was 4.5 points. In the mild group, the main characteristic of corneal staining was scattered punctate staining in the peripheral region in 80% of cases, while in the severe group, corneal staining fused into clumps in both the peripheral region (64%) and the pupillary zone (28%). Results of the Schirmer Ⅰ test were significantly lower in the severe group compared to the mild group (P<0.05). The median total eyelid margin score in the severe group was higher than that in the mild group [9 (7, 12) points vs. 6 (5, 8) points] (P<0.05). The median eyelid congestion score in the severe group was, also higher than that in the mild group [2 (1, 3) points vs. 1 (0, 2) points] (P<0.05). The compatibility between the blood types of the donor and recipient was found to be statistically significant (P<0.05). There was no significant difference in gender, age, family relationship, human leukocyte antigen matching, gender consistency, source of hematopoietic stem cells, or the occurrence of systemic GVHD between the two groups (P>0.05). Conclusions: Patients in the mild group had scattered punctate corneal staining in the peripheral region, while those in the severe group showed fusion of corneal staining into clumps in both the peripheral and pupillary zones. The severity of dry eye disease caused by GVHD was strongly correlated with eyelid margin lesions. A higher degree of eyelid margin lesions indicated more severe dry eye disease caused by GVHD. Additionally, compatibility between the blood types of the donor and recipient may play a role in the development of GVHD-associated dry eye.

Impact of the source of hematopoietic stem cells on immune reconstitution after transplantation: A systematic review.

Hematopoietic stem cell (HSC) transplantation's success lies in its ability to induce immune reconstitution. To date, there is no review published to compare the immune reconstitution among the three sources of HSC: umbilical cord blood (UCB), bone marrow (BM), and peripheral blood (PB). The review aims to analyze the kinetic of immune reconstitution among UCB, PB, and BM in HSC transplant patients by focusing on natural killer (NK) cells, B and T lymphocytes, and neutrophils. A systematic review was conducted through five databases, searching for clinical trials and randomized control trials (RCTs) which analyze the kinetics of immune reconstitution in at least two sources. Selected studies were assessed with Cochrane RoB 2.0. This review included 14 studies, with a total of 2539 subjects. The PB group achieved the fastest time to neutrophil recovery, while the B-cell count was the highest in the UCB group. The T-cell count is the lowest in the BM group, and the NK-cell count does not differ significantly among the three HSC sources. Among the three sources of HSC, there is no superior HSC source for any immune reconstitution parameter. More studies must be conducted to compare the immune reconstitution and clinical outcomes of all HSC sources in specific diseases.

In vitro expansion of hematopoietic stem cells in a porous hydrogel-based 3D culture system.

Hematopoietic stem cell (HSC) transplantation remains the most effective therapy for hematologic and lymphoid disorders. However, as the primary therapeutic cells, the source of HSCs has been limited due to the scarcity of matched donors and difficulties in ex vivo expansion. Here, we described a facile method to attempt the expansion of HSCs in vitro through a porous alginate hydrogel-based 3D culture system. We used gelatin powders as the porogen to create submillimeter-scaled pores in alginate gel bulk while pre-embedding naïve HSCs in the gel phase. The results indicated that this porous hydrogel system performed significantly better than those cultured via conventional suspension or encapsulation in non-porous alginate hydrogels in maintaining the phenotype and renewability of HSCs. Only the porous hydrogel system achieved a two-fold growth of CD34+ cells within seven days of culture, while the number of CD34+ cells in the suspension system and nonporous hydrogel showed different degrees of attenuation. The expansion efficiency of the porous hydrogel for CD34+CD38- cells was more than 2.2 times that of the other two systems. Mechanistic study via biophysical analysis revealed that the porous alginate system was competent to reduce the electron capture caused by biomaterials, decrease cellular oxygen stress, avoid oxidative protection, thus maintaining the cellular phenotype of the CD34+ cells. The transcriptomic analysis further suggested that the porous alginate system also upregulated the TNF signaling pathway and activated the NF-κB signaling pathway to promote the CD34+ cells' survival and maintain cellular homeostasis so that renewability was substantially favoured. STATEMENT OF SIGNIFICANCE: • The reported porous hydrogel system performs significantly better in terms of maintaining the phenotype and renewability of HSCs than those cultured via conventional suspension or encapsulation in non-porous alginate hydrogel. • The reported porous alginate system is competent to reduce the electron capture caused by biomaterials, decrease cellular oxygen stress, avoid oxidative protection, and therefore maintain the cellular phenotype of the CD34+ cells. • The reported porous alginate system can also upregulate the TNF signaling pathway and activate the NF-κB signaling pathway to promote the CD34+ cells' survival and maintain cellular homeostasis so that the renewability is substantially favored..

Umbilical Cord Blood Transplantation: Connecting Its Origin to Its Future.

Transplantation of umbilical cord blood (UCB) is an attractive alternative source of hematopoietic stem cells (HSCs). The unique properties of cord blood and its distinct immune tolerance and engraftment kinetics compared to bone marrow (BM) and peripheral blood progenitor cells, permit a wider disparity in human leukocyte antigen levels between a cord blood donor and recipient after an unrelated umbilical cord blood transplant (UCBT). In addition, it is readily available and has a lowered risk of graft-versus-host disease (GvHD), with similar long-term clinical outcomes, compared to BM transplants. However, the relatively low number of cells administered by UCB units, as well as the associated delayed engraftment and immune reconstitution, pose limitations to the wide application of UCBT. Research into several aspects of UCBT has been evaluated, including the ex vivo expansion of cord blood HSCs and the process of fucosylation to enhance engraftment. Additionally, UCB has also been used in the treatment of several neurodegenerative and cardiovascular disorders with varying degrees of success. In this article, we will discuss the biology, clinical indications, and benefits of UCBT in pediatric and adult populations. We will also discuss future directions for the use of cord blood.

Unrelated Donor Cord Blood Transplantation in Children: Lessons Learned Over 3 Decades

Four decades ago, Broxmeyer et al. demonstrated that umbilical cord blood (CB) contained hematopoietic stem cells (HSC) and hypothesized that CB could be used as a source of donor HSC for rescue of myeloablated bone marrow. In 1988, Gluckman et al. reported the first successful matched sibling cord blood transplant (CBT) in a child with Fanconi Anemia. In 1991, Rubinstein et al. established an unrelated donor CB bank, and in 1993, the first unrelated CBT used a unit from this bank. Since that time, >40 000 CBTs have been performed worldwide. Early outcomes of CBT were mixed and demonstrated the importance of cell dose from the CB donor. We hypothesized that improvements in CB banking and transplantation favorably impacted outcomes of CBT today and performed a retrospective study combining data from Eurocord and Duke University in 4834 children transplanted with a single unrelated CB unit (CBU) from 1993 to 2019. Changes in standard transplant outcomes (overall survival [OS], disease free survival [DFS], acute and chronic graft-versus-host disease [GvHD], treatment related mortality [TRM], and relapse) over 3 time periods (1: <2005; 2: 2005 to <2010; and 3: >2010 to 2019) were studied. Increased cell dose and degree of HLA matching were observed over time. OS, times to engraftment, and DFS improved over time. The incidence of TRM and GvHD decreased while the incidence of relapse remained unchanged. Relative contributions of cell dose and HLA matching to transplant outcomes were also assessed and showed that HLA matching was more important than cell dose in this pediatric cohort.

Ex Vivo Expansion and Homing of Human Cord Blood Hematopoietic Stem Cells.

Cord blood (CB) has been proven to be an alternative source of haematopoietic stem cells (HSCs) for clinical transplantation and has multiple advantages, including but not limited to greater HLA compatibility, lower incidence of graft-versus-host disease (GvHD), higher survival rates and lower relapse rates among patients with minimal residual disease. However, the limited number of HSCs in a single CB unit limits the wider use of CB in clinical treatment. Many efforts have been made to enhance the efficacy of CB HSC transplantation, particularly by ex vivo expansion or enhancing the homing efficiency of HSCs. In this chapter, we will document the major advances regarding human HSC ex vivo expansion and homing and will also discuss the possibility of clinical translation of such laboratory work.

Invasive aspergillosis caused by &lt;i&gt;Aspergillus non-fumigatus&lt;/i&gt; after allogeneic hematopoietic stem cell transplantation

Objective. To study the features of invasive aspergillosis (IA) due to A. non-fumigatus versus A. fumigatus in adult (≥ 18 years) recipients of allogeneic hematopoietic stem cell transplantation (allo-HSCT) in 2016-2021. Materials and methods. The study included 33 patients with IA caused by A. non-fumigatus (n = 20) and A. fumigatus (n = 13). A comparative analysis of cases of IA, the results of therapy and outcomes in patients after allo-HSCT in the RM Gorbacheva Research Institute was performed. Diagnostic criteria EORTC / MSGERC 2020 were used. Results. Invasive aspergillosis caused by A. non-fumigatus made up the majority (60.6 %) of IA cases with an identified pathogen registered in patients after allo-HSCT in the period from 2016 to 2021. The main etiological agents in the A. non-fumigatus group were A. niger in 13 (65 %) patients, A. flavus – in 4 (20 %). The median day of diagnosis of A. non-fumigatus IAwas + 110 days (17–2093), for A. fumigatus it was + 46 days (2–866) (p = 0.171). Overall 12-week survival was 55 % and 59.2 % in the A. non-fumigatus and A. fumigatus groups, respectively (p = 0.617). The majority of patients in both the A. fumigatus (n = 10, 77 %) and A. non-fumigatus (n = 16, 80 %) groups received voriconazole as initial antifungal therapy. Second-linetherapy was required in 2 (10 %) patients with A. non-fumigatus IA: liposomal amphotericin B and echinocandins with or with-out posaconazole, and 2 (15 %) patients in the A. fumigatus group: liposomal amphotericin B and voriconazole in combination with echinocandins. A comparative analysis showed that in patients from the two groups, none of the assessed signs (gender, age, underlying disease, disease status at the time of transplantation, time from diagnosis to allo-HSCT, source of hematopoietic stem cells, conditioning regimen, donor type, antifungal prophylaxis, cytomegalovirus reactivation, severe acute and chronic graft-versus-host disease) did not differ significantly. Conclusions. A. niger is the main causative agent of IA caused by A. non-fumigatus. Patients characteristics, their treatment and outcomes did not differ significantly between the A. non-fumigatus and A. fumigatus groups.

Factors Associated with Opting Out of Donation among Registered Young Unrelated Hematopoietic Stem Cell Donors

Young adults enrolled in hematopoietic stem cell (HSC) donation registries, including the Be The Match registry in the United States, often opt out of the registry when a potential recipient is identified. This results in a limited supply from the most desirable allogeneic source of HSCs used in transplantation to treat serious health conditions. The differences in demographic, psychosocial, registry-related, and donation-related characteristics between those who continue to donation and those who opt out may elucidate the modifiable risk factors for attrition, but these characteristics have not been extensively studied in young donors up to age 30 years. Our goal was to study demographic, psychosocial, registry-related, and donation-related characteristics in a group of young HSC donor registry members who had recently been contacted about a potential recipient, to determine the key characteristics that differ between those who continued toward donation and those who opted out and to examine the extent of these differences. We conducted a cross-sectional survey in a random sample of young (age 18 to 30 years) current and former registry members, stratified by race/ethnicity and sex. Demographic, psychosocial (eg, life goals, HSC allocation mistrust), registry-related (eg context and motive for joining the registry), and donation-related (eg, ambivalence, religious objections to donation, knowledge about donation) characteristics were assessed. Chi-square and 2-sample t tests were used to examine differences between those who continued (CT-C group) and those who opted out (CT-NI group). Hierarchical logistic regression was used to estimate adjusted covariate effects on the odds of opting out. A total of 935 participants were surveyed. Donation-related knowledge was higher in the CT-C group than in the CT-NI group. HSC allocation mistrust, religious objections, and concerns about donation were higher in the CT-NI group. After adjusting for covariates in a logistic regression model, we found that having more intrinsic life goals, having more ambivalence, and talking with registry staff only once/twice were significantly associated with opting out of the registry. Ambivalence had the strongest association with opting out. In contrast, remembering joining the registry, believing that parents would support donation, and having medical concerns were significantly associated with continuing toward donation. This effect of medical concerns on donation was discovered only after adjusting for the related but distinct ambivalence variable, with the remaining effect of medical concerns relating to engagement with the donation process and information-seeking. The model had strong discriminative ability (area under the receiver operating characteristic curve=.92) and classification accuracy (86.6%). Our data indicate that among young adult members of a national HSC donor registry, ambivalence and limited contact with registry staff were more strongly associated with opting out of donation. Medical concerns were associated with continuing toward donation. Further studies are needed to confirm a causal link between medical concerns and continuing to donation among young donors. Our study suggests that these concerns might not be directly related to attrition, whereas other factors (eg, ambivalence, low donation-related knowledge) are associated with attrition and thus should be targeted for attrition reduction strategies.

Recovery of Highly Functional Human Hematopoietic Stem and Progenitor Cells from 27-Year Old Cryopreserved Umbilical Cord Blood

Umbilical cord blood (CB) is a promising source of hematopoietic stem cells (HSCs) and progenitor cells (HPCs) for hematopoietic cell transplantation (HCT). CB is cryopreserved following collection, allowing for the amassment of nearly 800,000 CB units in public banks and an estimated 4 million in private banks. Cryopreservation of CB is essential for successful CB transplantation, and it is critical to understand how long CB can be stored with efficient recovery of engraftable HSCs. Prior work demonstrated efficient recovery of engraftable HSCs from 10-, 15-, and 21-year old cryopreserved CB. Here, we demonstrate efficient recovery of highly engraftable HSCs from 27-year old cryopreserved CB units. 3 CB units cryopreserved for >27 years were thawed with clinical protocols, and total nucleated cells were recovered with 76-87% viability. 3-6 fresh CB units were used as a comparison for cryopreserved units. Immunophenotyping assays to determine numbers of HSCs/HPCs showed that cryopreserved CB units had on average 4.25x103 CD34+ cells per 1x106 nucleated low density CB cells (LDCB), similar to fresh CB with 4.55x103CD34+ per 1x106 LDCB. Within the CD34+ population, cryopreserved CB when compared to fresh CB had on average equal or greater numbers of stringently immunophenotypically defined HSCs (9.1x103 vs 6.2x103), multipotent progenitors (MPPs) (2.1x105 vs 8.6x104), and multilymphoid progenitors (MLPs) (1.9x104 vs 1.0x104) per 1x106 CD34+ cells. Conversely, there were fewer numbers of common myeloid progenitors (CMPs) (2.9x104 vs 1.1x105), megakaryocyte-erythroid progenitors (MEPs) (4.5x104 vs 1.0x105), and granulocyte macrophage progenitors (GMPs) (4.8x104 vs 1.4x105). Colony forming unit (CFU) assays demonstrated that cryopreserved CB units exhibited lower functional HPC numbers per 1x106 CD34+ enriched cells including CFU-GM (1.9x104 vs 8.3x104), BFU-E (1.2x104 vs 3.4x104), and CFU-GEMM (1.1x104 vs 5.8x104). In ex vivo analysis of HSC/HPC proliferative capacity, cryopreserved CB units showed similar or greater capacity for expansion in growth stimulating media compared to fresh CB, including HSCs (7.7-fold vs 6.2-fold increase), MPPs (3.5-fold vs 4-fold increase), MLPs (44-fold vs 1.7-fold increase), CFU-GM (29-fold vs 13.3-fold increase), and CFU-GEMM (28.6-fold vs 4-fold increase). For in vivo functional HSC analysis, 10,000 CD34+ enriched cells were transplanted to sublethally irradiated NSG mice. Cryopreserved CB units exhibited early and late human engraftment in peripheral blood (PB) at months 1, 2, 4, and 5. Bone marrow (BM) human chimerism at month 5 ranged from low (0.5%) to robust levels of engraftment (52.7%). Limiting dilution analysis revealed that 2 cryopreserved CB units had similar SCID repopulating cell (SRC) frequency, ranging from 314 to 1392 SRCs per 1x106 CD34+ cells while the third had a much lower 65 to 393 SRCs per 1x106 CD34+ cells. The third CB unit also exhibited lower average human chimerism in the BM (0.55%) than the other 2 units (15% and 16.2%). However, the SRC frequencies in all 3 CB units are similar to those in fresh CB units published by our group and others (range 51 to 929 SRCs per 1x106 CD34+ cells). Secondary transplants showed that all 3 CB units have secondary repopulation capacity demonstrated by human chimerism in PB. These data suggest functional HSCs with short- and long-term engrafting and sustained self-renewal capacity can be cryopreserved for at least 27 years. We show that different cryopreserved CB units contain variable functional HSC frequency. Similar results in ex vivo characterization suggest cryopreservation is not the cause of these functional differences, but rather there were functional differences in the CB units prior to cryopreservation. This underscores the need to have reliable measures of CB functionality prior to cryopreservation for more efficient selection of donor units and to test potential effects of cryopreservation on individual units. Transcriptomic studies are ongoing to determine molecular programs that may contribute to differences in SRC frequency. These data will provide insight into mechanistic explanations for differences in HSC function in different CB units. Authors’ note: This project was conceived by the authors prior to the death of Hal E. Broxmeyer. Dr. Broxmeyer initiated the study as a continuation of his life's work demonstrating the utility of CB for HCT. This work is dedicated to Hal.

Extracellular DEK Activates NRF2 Antioxidant Targets and Drives Expansion of Functional and ROS-Low Human Hematopoietic Stem Cells

Umbilical cord blood (CB) is a promising source of hematopoietic stem cells (HSCs) for hematopoietic cell transplantation (HCT), a life-saving treatment, due to lower incidence of graft versus host disease and its availability. CB HCT is limited by low numbers of HSCs, thus there is a strong need to increase numbers of engraftable HSCs, for instance by expanding functionally competent HSCs ex vivo. We have shown that extracellular DEK protein, an epigenetic regulator that is secreted in response to stress and inflammation, is a novel hematopoietic regulatory chemokine. Treatment with extracellular DEK in growth stimulating media significantly enhances the expansion of engraftable HSCs in mouse bone marrow (BM) and human CB (Capitano, et al. JCI 2019; 129(6):2555-2570). To examine mechanisms driving enhanced expansion of functional HSCs after DEK treatment, we performed RNA-sequencing on CB HSCs, multipotent progenitor cells (MPPs), common myeloid progenitors (CMPs), and granulocyte macrophage progenitors (GMPs) after overnight DEK treatment in expansion media. All cell populations upregulated gene programs related to antioxidant responses upon DEK treatment. Indeed, 7/10 genes upregulated by DEK in all HSC/HPC populations (NMRAL2P, PIR, NQO1, SELENOW, FTL, RIT1, and QPCT) promote antioxidant activity. Overnight DEK treatment significantly reduced mean fluorescence of the activated reactive oxygen species (ROS) indicator CM-H2DCFDA in HSCs, MPPs, CMPs, and GMPs. Thus, DEK may induce antioxidant activity. We next found that all 10 genes commonly upregulated in HSCs/HPCs are either direct transcriptional targets of NRF2 (NMRAL2P, LUCAT1,PIR, NQO1, FTL, and QPCT) or are directly affected by changes in NRF2 activation (SELENOW, EBI3, TNFRSF9, and RIT1). Further, several genes highly upregulated by DEK treatment in HSCs (i.e., CCL2, KYNU, and CXCL8) are NRF2 targets. To examine if DEK activates NRF2 transcriptional activity, we utilized a transgene reporter assay where expression of red fluorescent protein (RFP) is driven by activation of promoter antioxidant response elements (ARE), to which active NRF2 binds. DEK treatment of hematopoietic derived cell lines (mouse MLL-AF9 AML and human HL-60 APL) expressing the transgene significantly increased RFP signal, indicating that DEK could activate NRF2. We further examined whether DEK treatment affects mitochondrial metabolism, a source of ROS and tightly regulated process in hematopoiesis. Seahorse XFe analysis, which measures metabolic flux, showed DEK treatment of MLL-AF9 cells significantly reduced mitochondrial oxygen consumption rate, suggesting a reduced reliance on oxidative phosphorylation as an energy source in DEK treated cells. These data suggest that DEK treatment during expansion of primitive hematopoietic cells drives activation of NRF2 transcription, upregulation of antioxidant response genes, reduction of intracellular ROS levels, and may reduce the mitochondrial metabolic rate. These effects in a sense "mimic” the in vivo niche of HSCs, where they reside in low oxygen tensions, have low intracellular ROS, and exhibit low levels of oxidative phosphorylation. To test this hypothesis, we examined if DEK treatment has similar effects to maintaining HSCs in physiologic oxygen tensions (3%) compared to HSCs exposed to extraphysiologic ambient air (21%), which drives oxidative stress (Mantel, et al. Cell 2015; 161(7):1553-65). Isolating and maintaining mouse BM in physiologic oxygen tensions or treating mice in vivo with recombinant DEK preserved HSC numbers compared to exposing the BM cells to ambient air or treating with vehicle. However, combining in vivo DEK treatment with physiologic isolation of HSCs/HPCs had no additive or synergistic effect, suggesting that the overall effects of DEK treatment and maintaining low oxygen tensions may be similar. Thus, extracellular DEK treatment leads to expansion of functionally competent HSCs and reduction of oxidative stress. These data have important implications for the regulation of HSCs/HPCs in stress conditions, where DEK is most likely to be secreted. Further, DEK may present a novel way to mimic physiologic oxygen conditions for enhancement of functional HSC expansion, and the elucidated mechanisms may be exploited for more efficient targeting of molecular programs critical for functional HSC competency, potentially providing new ways to enhance HCT.