米托蒽醌、阿糖胞苷、粒细胞集落刺激因子的动员方案及大容量采集自体外周血干细胞

背景:外周血干细胞移植成功的首要条件是干细胞的有效动员和采集,选择高效低毒的动员方案,掌握动员和采集时机与动员效果密切相关。目的:探讨米托蒽醌-大剂量阿糖胞苷方案化疗后,单用粒细胞集落刺激因子或粒细胞集落刺激因子与粒-巨噬细胞集落刺激因子合用对恶性血液病和实体瘤患者自体外周血干细胞的动员效果。设计:观察对比实验。单位:徐州医学院附属医院血液科。对象:选择1998-09/2006-12在徐州医学院附属医院血液科收治的42例恶性血液病和实体瘤患者,诊断符合国际白血病分型及世界卫生组织新分类标准。男25例,女17例,年龄7～54岁,平均29岁,体质量(52±18)kg。其中急性髓细胞白血病12例,急性淋巴细胞白血病6例,慢性粒细胞白血病慢性期1例,非霍奇金淋巴瘤15例,霍奇金淋巴瘤4例,多发性骨髓瘤2例,晚期乳癌2例。患者均经常规化疗达到或接近完全缓解,骨髓细胞学检查无肿瘤细胞浸润。心、肺、肝、肾等主要脏器功能正常。动员前化疗疗程平均8次,所有患者均对治疗项目知情同意。方法:患者均采用米托蒽醌10mg/(m2·d)静脉滴注第2～3d后,阿糖胞苷2g/m2静脉滴注第1～2d,1次/12h。当白细胞计数下降至最低点开始回升时,20例患者使用粒细胞集落刺激因子5～7.5μg/(kg·d),连用3～5d,22例患者早6:00给予粒细胞集落刺激因子5～7.5μg/(kg·d),晚6:00给予粒-巨噬细胞集落刺激因子5～7μg/(kg·d)。白细胞计数>2.5×109 L-1,CD34 细胞≥1%时,用CS3000plus血细胞分离机连续2d采集自体外周血干细胞,检测CD34 细胞含量和T淋巴细胞亚群。①单个核细胞与FITC标记的CD34 、CD3和CD8单抗及与CD4PE标记的CD4单抗4℃混合30min,采用流式细胞仪检测CD34 细胞和T细胞亚群,分析5×105个细胞,得出CD3、CD34 细胞含量及CD4/CD8比值。用甲基纤维素法测定粒-巨噬细胞集落形成单位。②观察术后相关不良反应。③针对不同类型疾病给予相应预处理36～48h后回输自体外周血干细胞,并行单个核细胞计数及台盼蓝染色,解冻后检测粒-巨噬细胞集落形成单位和CD34 细胞。主要观察指标:①动员前后CD34 细胞和T细胞亚群变化。②术后相关不良反应。③自体外周血干细胞回输量(单个核细胞计数、粒-巨噬细胞集落形成单位和CD34 细胞数)。结果:纳入患者42例,均进入结果分析。①动员前后CD34 细胞和T细胞亚群变化:患者应用粒细胞集落刺激因子/粒-巨噬细胞集落刺激因子动员后外周血CD34 细胞明显增加[(0.054±0.032)%,(1.82±0.76)%,P<0.01]。22例联合应用粒细胞集落刺激因子和粒-巨噬细胞集落刺激因子动员患者CD34 细胞和粒-巨噬细胞集落形成单位分别为(8.76±3.39)×106/kg,(3.52±1.33)×105/kg,明显高于单用粒细胞集落刺激因子的20例患者[(6.12±2.11)×106/kg,(2.03±1.07)×105/kg,P<0.05]。单独应用粒细胞集落刺激因子及粒细胞集落刺激因子与粒-巨噬细胞集落刺激因子合用后随CD34 细胞增加,T淋巴细胞亚群变化不明显(P>0.05)。②外周血干细胞动员相关不良反应:全部病例出现Ⅱ～Ⅲ度脱发,血小板均有不同程度的下降,为(54.43±26.14)×109 L-1,21例患者出现感染性发热(37.8～41.0℃),经抗生素治疗感染均在短期内得到控制。13例患者在白细胞快速上升时出现骨骼疼痛(腰骶部为主)。③自体外周血干细胞回输量:自体外周血干细胞非程控冷冻-80℃保存2.0～6.5个月,细胞回收率(88.7±7.4)%,台盼蓝拒染率(92.1±5.5)%,回输的单个核细胞(5.21±2.44)×108/kg,CD34 细胞(6.89±3.55)×106/kg,粒-巨噬细胞集落形成单位(2.58±2.33)×105/kg。④循环血量每次10～16L(终点分血量均在3个TBV上)。无严重毒副反应。26例接受自体外周血干细胞移植者造血功能均获得满意重建。结论:米托蒽醌-大剂量阿糖胞苷方案化疗后单用粒细胞集落刺激因子及粒细胞集落刺激因子与粒-巨噬细胞集落刺激因子合用均能安全、有效动员自体外周血干细胞,但以合用更为有效。大容量采集是提高干细胞产率,减少采集次数的重要手段。     

CD271及CD133用于阳性分选富集骨髓间充质干细胞的比较

本研究旨在通过对CD271（低亲和性神经生长因子受体，low affinity nerve growth factor receptor，LNG—FR）及CD133免疫磁珠阳性分选富集骨髓间充质干细胞（mesenchymal stem cells，MSCs）的比较，选出一种相对理想的从骨髓中富集间充质干细胞的免疫磁珠分选方法。采用免疫磁珠的方法得到骨髓单个核细胞中的CD271^＋细胞及CD133^＋细胞；将得到的细胞分别进行培养，14天后计数成纤维细胞集落形成单位（colony forming unit—fibro—blast，CFU—F）；对每个传代细胞进行计数，绘制细胞增殖曲线；取两种方法得到的细胞培养至3代以后，流式细胞术检测细胞表面抗原，通过细胞形态及免疫化学染色鉴定比较成骨及成脂肪定向诱导分化。结果表明：CD271阳性分选纯度为（89．50±0．98）％，CD133阳性分选纯度为（88．03±3．06）％；1×10^4个CD271^＋细胞培养后产生的CFU—F数目是1×10^4个CD133^＋细胞培养后形成CFU—F数目的2倍，CD271^-细胞培养后无CFU—F形成，而CD133^-细胞培养后可形成少量的CFU—F；两种方法得到的细胞培养至第3代后表型基本一致，即CD34^-、CD14^-、CD45^-、CD90^＋、CD29^＋、CD44^＋、CD105^＋、CD73^＋；CD271^＋细胞的增殖能力比CD133^＋细胞的高出3倍，而且具有更强的成骨、成脂肪分化潜能。结论：虽然CD271及CD133阳性分选都可以得到间充质干细胞，但相比之下，CD271阳性分选得到的间充质干细胞有更强的增殖和分化能力，因而CD271阳性分选是一种相对理想的从骨髓中富集阃充质干细胞的免疫磁珠分选方法。     

脐血CD34+细胞与单个核细胞的体外扩增特性研究

目的　探讨CD34+ 富集细胞和单个核细胞 (MNC)的体外扩增特性。方法　利用Min iMACS系统富集CD34+ 细胞 ,在相同条件下与同批MNC进行对照培养 ;观察了再次富选和MNC培养上清 (MNC SN)对CD34+ 富集细胞扩增的影响 ;并尝试了MNCCD34- 细胞的培养。结果　虽然CD34+ 富集细胞具有很高的扩增潜力 ,但在培养过程中 ,其集落密度和CD34 + 细胞含量却始终呈下降趋势 ,而MNC在培养中却出现了一个上升的趋势 ,集落密度和CD34+ 细胞含量分别由第 0天的 (4 12± 16 7) 10 5细胞和 (1.12± 0 .4 2 ) %增至第 7天的 (116 2± 5 6 6 ) 10 5细胞和 (4 .17± 1.4 4 ) % ;再次富选可以使培养过的CD34+ 富集细胞的总细胞和CD34+ 细胞扩增能力大大提高 ;MNCCD34- 细胞具有集落形成和转化为CD34+ 细胞的能力 ;MNC SN对CD34+ 富集细胞的集落形成有促进作用 ,而同时又对CD34+ 细胞有促分化作用。结论　CD34+ 富集细胞在体外大量扩增的同时存在大量分化 ,其在培养过程中产生的CD34-细胞对CD34+ 细胞的扩增有抑制作用 ;脐血MNC中大量的CD34- 细胞含有造血干 祖细胞 ,其分泌的细胞因子有促进CD34+ 细胞向较为成熟的集落形成祖细胞分化的作用。     

影响外周血CD34+细胞纯化的相关因素

背景:造血干细胞具有良好的自我复制和更新的能力,CD34+细胞具备有造血干细胞的标志.目的:分析影响外周血CD34+细胞纯化的因素.方法:90例患者,经粒细胞集落刺激因子5 μg/(kg·d)动员1～3 d后,应用COBE血细胞分离机采集外周血单个核细胞液80～100 mL,经Clini MACS免疫磁珠分选技术纯化CD34+细胞.结果与结论:90例CD34+细胞平均数为(1.73±1.15)×107,经流式细胞仪分析,CD34+细胞阳性率大于80%.COBE血细胞分离机单次收集的循环血量在980～1 100 mL时,利于CD34+细胞收集(P=0.005);动员后白细胞浓度在(16～21)×109 L-1时,利于CD34+细胞收集(P < 0.05);中间细胞和淋巴细胞总比例超11%时,利于CD34+细胞收集(P < 0.05);单个核细胞液血小板小于2 100×109 L-1时,利于CD34+细胞的收集(P < 0.05);年龄小于16岁,CD34+细胞数高(P=0.003);CD34+细胞抗体的温度、磁性标记及细胞处理时离心力的大小,均有影响.结果提示,经Clini MACS免疫磁珠细胞分选技术纯化的CD34+细胞能满足临床需要,实验稳定性好,重复性好;注重相关因素的影响,可提高纯化的CD34+细胞数量.     

免疫磁珠法分选骨髓CD34+细胞:纯度影响因素的分析

背景:免疫磁珠分选技术已成为分选CD34+细胞的主要方法之一,在长期实验中发现诸多因素影响其分离纯度,包括磁珠与细胞孵育时干冰与碎冰的使用、磁珠与细胞孵育及分离时摇床的摇摆方向、红细胞裂解液裂解单个核细胞的使用等.目的:在免疫磁珠分选CD34+细胞过程中分别对上述影响因素进行分析改进,以提高分选CD34+细胞的纯度.设计、时间及地点:细胞学体外对照观察,于2008-07/2009-03在太原市中心医院皮肤科实验室完成.材料:骨髓象筛选正常的人骨髓29份,由太原市中心医院血液科提供,取材均经患者同意.CD34+免疫磁珠为Dynal公司产品.方法:采用淋巴细胞分离液密度梯度离心法分离培养人骨髓单个核细胞,用免疫磁珠法分选骨髓CD34+细胞,对其分选过程中的主要环节如冰块与碎冰、摇床的种类以及红细胞裂解液的使用进行方法改进.方法1:按试剂盒提供方法进行磁珠常规分选CD34+细胞.方法2:在方法1基础上,用碎冰替代冰块进行磁珠与单个核细胞孵育.方法3:在方法2基础上,用万向摇床替代水平摇床.方法4:在方法3基础上,向单个核细胞中预先加入红细胞裂解液裂解残留红细胞.主要观察指标:通过流式细胞仪检测不同方法分选出的CD34+细胞纯度.结果:随着不同环节的逐渐改进,CD34+细胞纯度由(32.7±6.6)%升至(84.5±512)%,方法1,2,3,4所分选出的CD34+细胞纯度逐渐升高,组间方差分析差异显著(F=76.209,P<0.01),Bonferroni法两两比较差异亦有非常显著性意义(P<0.01).结论:碎冰、万向摇床及红细胞裂解液的使用能有效提高免疫磁珠法分选人骨髓CD34+细胞的纯度.     

CD271和CD133果真能用于脐血间充质干细胞阳性分选吗?

众多研究表明,脐血中存在间充质干细胞(mesenchymal stem cells,MSC),且脐血获得过程简单,对供者没有损伤,因此可以作为MSC的另一个来源,但脐血间充质干细胞含量极少。本研究探讨CD271和CD133免疫磁珠阳性分选是否也能富集脐血中数量极少的MSC。采用免疫磁珠阳性分选方法从脐血单个核细胞(UCB-MNC)中分离得到CD271+、CD271-、CD133+和CD133-4种细胞;将得到的细胞分别进行培养,以未分选的UCB-MNC为对照,观察各组细胞成纤维细胞集落(CFU-F)形成能力;利用流式细胞术、成骨及成脂肪定向诱导分化对MSC进行鉴定。结果表明:CD271和CD133阳性细胞纯度均达85%,但是CD271+细胞中(99.76±0.08)%表达CD45,(6.24±0.03)%表达CD34,而CD133+细胞99%以上都表达CD34和CD45。阳性细胞培养可见单个成纤维样细胞贴壁生长,但不能形成集落并融合,两种阴性细胞中部分标本(约27%)可形成集落,并能融合传代,与对照组(UCB-MNC)培养成功率相似。将两种阴性细胞培养得到的MSC培养至第3代,表型测定基本一致,即CD34-、CD45-、CD14-、CD29+、CD44+、CD73+、CD90+、CD105+,而且具有成骨、成脂肪分化潜能。结论:CD271和CD133不是完全重合的一群细胞,但绝大多数为造血细胞,不能有效的用以扩增MSC。阴性细胞培养成功率与传统贴壁法相似,说明MSC多存在于CD271和CD133阴性细胞中。     

单抗CD71用于荧光激活细胞分选法富集分选母血中的胎儿细胞

目的:研究转铁蛋白受体(CD71)抗体对单个核细胞的标记情况,探讨该单克隆抗体识别胎儿细胞的有效性。方法:选用CD71抗体对92例正常孕妇外周血、15例未孕妇女外周血和15例胎儿脐血单个核细胞进行标记,并用于荧光激活细胞分选法富集分选母血中的胎儿有核红细胞。结果:孕10～35周的孕妇外周血中CD71阳性细胞的比例为(5.59±4.83)×10-2,与未孕妇女外周血及胎儿脐血中CD71阳性细胞的比例比较,均差异有极显著性(P<0.001)。结论:孕妇外周血中存在胎儿细胞,单抗CD71可以作为一种有效识别抗体用于母血中胎儿细胞的分选,从而为进一步的无创性产前诊断工作打下基础。     

磁珠双阳性分选法在阵发性睡眠性血红蛋白尿症患者骨髓CD34+CD59+细胞体外扩增的应用

应用磁珠双阳性分选法在体外扩增阵发性睡眠性血红蛋白尿症(PNH)患的CD34 CD59 细胞，为实现PNH患进行临床自体骨髓移植(ABMT)或自体外周血干细胞移植(APBSCT)奠定基础。流式细胞术分选虽然经常用于细胞纯化，但难于满足大规模临床细胞分选的需要。本研究利用免疫磁珠系统，应用隔夜孵育法去除第一次分选时CD34 细胞吸附的磁珠，经过两次磁珠双阳性分选，从PNH患骨髓中分离出足够数量的CD34 CD59 细胞，用于体外培养扩增。结果显示：磁珠双阳性法分选的CD34 CD59 细胞与磁珠—流式细胞术二步分选法比较，在细胞生存、增殖、扩增及形成造血集落形成单位(CFU)的能力上均无显性差异。结论：磁珠双阳性分选法可能推广应用于其它双阳性或多阳性细胞的分离纯化，尤其是造血干／祖细胞的分离纯化。     

免疫磁珠分离及流式细胞仪分选纯化外周血CD34+/CD90+干细胞

目的　建立人外周血CD34 细胞及其亚群的纯化分离方法。方法　用干细胞采集仪收集了 3例病人的外周血干细胞 ,应用免疫磁珠分离柱快速分离其中的CD34 细胞 ,随后采用分选型EPICSElite流式细胞仪进一步分选出CD34 /CD90 双阳性早期造血干细胞。结果　免疫磁珠分离纯化后CD34 干细胞的纯度可达 83%～ 95 % ,回收率 5 4 %～ 71% ,活细胞率 >95 %。流式细胞仪分选后的CD34 /CD90 细胞纯度可达 90 %以上 ,回收率在 4 0 %～ 5 0 % ,生存率 >95 %。起始标本中CD34 细胞含量越高 ,纯化所得到的干细胞纯度和回收率越高。两种纯化后的干细胞在形态学上有明显的不同。结论　联合应用免疫磁珠分离和流式细胞仪分选 ,可以较高的回收率快速纯化高纯度的CD34 细胞及其亚群     

造血干细胞移植中CD34^＋细胞最佳分选的应用效果评价

目的：探讨联合化疗加细胞因子动员自体外周血CD34^+细胞的采集及临床级磁性分选仪(CliniMACS)分选的最佳方法，评价分选后CD34^+细胞在造血干细胞移植中的应用效果。方法：2001-03／2002-01在南京市鼓楼医院血液科病房收治自身免疫性疾病患者9例。符合纳入标准患者9例，男3例，女6例。采用环磷酰胺[2～4g／(m^2&;#183;d)]+粒细胞集落刺激因子(G-CSF)[5～10μg／(kg&;#183;d)]作为动员剂，CS-3000Plus血细胞分离机采集外周血单个核样细胞，CliniMACS作CD34^+细胞分选，观察分选前后的细胞计数、纯度、细胞活力，流式细胞术进行细胞表型检测及粒巨细胞集落形成单位(CFU-GM)培养。计算CD34^+细胞的采集得率和分选回收率。观察CD34^+细胞移植后造血功能恢复的情况。结果：经环磷酰胺加G-CSF动员后，采集时机多以一次采集能够获得足够数量的CD34^+细胞(CliniMACS分选和冷冻保存的耗损计算在内)为原则，外周血白细胞总数&;gt;6&;#215;10^9+L^-1或CD34^+细胞&;gt;0．4％时开始采集，其中8例采集1次，1例采集2次。每例患者可获单个核样细胞(MNC)总数(0．924—5．360)&;#215;10^10，MNC(2．6～19．5)&;#215;10^8／k，CD34^+细胞(2．4～37．2)&;#215;10^6／kg，经CliniMACS系统分选后，CD34^+细胞回收率为51％～93％，平均回收率为87%，CUF-GM回收率为35%～62％。CD34^+细胞纯度为94．3％～98．4％，平均96．71％。CD3^+，CD19^+，CD56^+，CD14^+细胞去除2—4个对数级。经冰冻保存后的CD34^+细胞的回收率为78％～99％，CFU-GM回收率为82％～99％，实际回输CD34^+细胞为(2．0～8．3)&;#215;10^6／kg，移植后均获造血重建。结论：掌握最佳动员、采集及分选方法，CD34^+细胞可获较高产率，移植后造血功能恢复较快。     

Factors affecting purification of CD34(+) peripheral blood stem cells using the Baxter Isolex 300i

A total of 201 patients with breast cancer, ovarian cancer, or hematological malignancies underwent mobilization of peripheral blood stem cells (PBSC) using chemotherapy and granulocyte-colony stimulating factor (G-CSF). Stem cell products were collected using the Baxter CS3000 pheresis machine. The Baxter Isolex 300i was used to perform 240 CD34(+) cell separations on the apheresis products. Factors affecting yield and purity of the CD34(+) cells were analyzed. Overall yield was 55% and overall purity was 91.7%. T cell contamination was limited to 0.43% of total cells. Variables including red blood cells (RBC) concentration, platelet concentration, CD34(+) cell concentration, total WBCs selected, and time until processing had little effect on yields and purities. Installation of version 2.5 of the software in the Isolex 300i showed a modest improvement in yield and purity. Patients were reinfused with the cryopreserved CD34(+) selected cells following high-dose chemotherapy. No infusion-related side effects were noted. Analysis of engraftment data using the CD34(+)-selected cells revealed an increased risk of delayed or failed platelet engraftment when <5.0 x 10(6) CD34(+) cells per kilogram were transplanted. The Baxter Isolex 300i provides reproducible CD34(+) cell purification over a wide range of starting conditions. To provide prompt engraftment, >5.0 x 10(6) CD34(+) cells per kilogram should be infused for transplantation.     

Isolation of CD34+ progenitor cells from peripheral blood by use of an automated immunomagnetic selection system: factors affecting the results

BACKGROUND: The isolation of CD34+ cells from mobilized peripheral blood is being increasingly used in the setting of allogeneic or autologous hematopoietic cell transplantation. Investigation of variables that may influence the effectiveness of CD34+ cell selection is of interest. STUDY DESIGN AND METHODS: Fifty-one CD34+ cell selections from peripheral blood progenitor cells (PBPCs) (39 allogeneic and 12 autologous) were performed using a magnetic cell separator (Isolex 300i, Baxter), including version 2.0 software. The results obtained were analyzed for different processing variables. The feasibility of transplanting these isolated CD34+ cells was also analyzed. RESULTS: The isolated CD34+ cell fraction had a median purity of 88.9 percent (range, 47.8-98.3). The median recovery of CD34+ cells was 45.1 percent (13.8-76.2), and the median colony-forming unit- granulocyte-macrophage (CFU-GM) content was 17. 2 percent (0.8-58.6). Logarithms of T- and B-cell depletion had median values of 3.7 and 2.8, respectively. The version 2.0 software of the Isolex 300i gave a higher CD34+ cell recovery in the enriched cell fraction (median 57.8%) than did version 1.11 (39.4%) or 1.12 (44.4%) (p = 0.01). The use of recombinant human deoxyribonuclease I during cell processing yielded more CD34+ cells (53% vs. 41%, p = 0. 01) and higher purity (92.8% vs. 87%, p = 0.03). There was a correlation between the percentage of CD34+ cells labeled with the monoclonal antibody 8G12 clone and the percentage of CD34+ cells labeled with the monoclonal antibody used during the processing technique (9C5 clone) in the initial, enriched, and depleted CD34+ cell fractions (R(2) = 0.95; 0.92; 0.78, p< 0.005, respectively). Median times for recovering >0.5 x 10(9) per L of granulocytes and >20 x 10(9) per L of platelets were 13 and 16 days in the allograft patients and 13 and 14 days in the autograft patients. CONCLUSION: CD34+ cells can be highly and effectively isolated from allogeneic and autologous grafts by use of this automated technique, with a high grade of T- and B-cell depletion. These purified CD34+ cell components can engraft normally.     

A controlled comparison of two different clinical grade devices for CD34+ cell selection of autologous blood stem cell grafts

Six patients who were to undergo autologous PBSC transplantation with positively selected CD34+ cells were included in this study to compare the efficiency of two devices for clinical grade stem cell selection, the Isolex 300i (Baxter, Munich, Germany) and CEPRATE SC (CellPro, Bothell, WA). PBSC were mobilized by chemotherapy and G-CSF and were collected by leukapheresis on a CS3000 cell separator on 2 consecutive days. The two apheresis products were pooled for CD34 selection. The pooled apheresis products from each patient were divided into two equal portions to be separated on each of the two devices. Cell selection was performed according to the manufacturers' instructions. Enumeration of CD34+ cells was performed by flow cytometry using the HPCA-2 MAb. Purity and yield were significantly better with Isolex than with CEPRATE. Median purity was 93.0% (range 80%-98%) for Isolex and 61.5% (range 27%-72%) for CEPRATE (p = 0.03); median yields for Isolex and for CEPRATE were 48.0% (range 18%-73%) and 23.0% (range 17%-29%), respectively (p = 0.03). The number of CD34+ cells/kg body weight was also significantly higher with Isolex (median 3.8x10(6), range 1.7-5.2) compared with CEPRATE (median 2.35x10(6), range 0.7-4.3) (p = 0.03). Thus, the Isolex 300i device gave products of higher purity and recovered a higher proportion of the CD34+ cells in the harvest before separation. The yield was still poor with both devices, however, and further optimization of the technique for clinical grade stem cell selection is warranted.     

Ex vivo expansion of CD34+ umbilical cord blood cells in a defined serum-free medium (QBSF-60) with early effect cytokines

To investigate the clinically applicable conditions that support substantial expansion of both primitive and more mature hematopoietic cells of umbilical cord blood (UCB) for transplantation in adults, enriched CD34+ cells from 8 fresh UCB samples and 4 expanded UCB products were cultured in defined serum-free medium (QBSF-60) in the presence of a cytokine combination of SCF, Flt-3-ligand (FL), thrombopoietin (TPO), IL-3 for up to 2 weeks. Fresh medium with cytokines was supplemented or exchanged at day 4, day 7, and day 10. The proliferative response was assessed at day 7, day 10, and day 14 by evaluating the following parameters: nucleated cell (NC), clonogenic progenitors (colony-forming unit-granulocyte-macrophage [CFU-GM], burst-forming unit-erythrocyte [BFU-E], CFU-GEMM, and high-proliferative potential colony-forming cell [HPP-CFC]), immunophenotypes (CD34+ cells and CD34+ subpopulations), and LTCIC. Simultaneously numerical expansion of various stem/progenitor cells, including primitive CD34+CD38-HLA-DR- subpopulation and LTCIC, CD34+ cells, and clonogenic progenitors to mature nucleated cells, were continuously observed during the culture. An average 103.32 +/- 71.37 x 10(6) CD34+ cells (range 10.12 x 10(6)-317.9 x 10(6)) could be obtained from initial 1.72 +/- 1.13 x 10(6) UCB CD34+ cells after 10-14 days cultured under the described conditions. Sufficient CD34+ cells (>50.0 x 10(6)) for transplantation in adults would be available in all but one UCB collections after 10-14 days expansion. The expanded CD34+ cells sustained most of the in vitro characteristics of initial unmanipulated CD34+ cells, including clonogenic efficiency (of both primitive and committed progenitors), the proportion of CD34+CD38-HLA-DR- subpopulation, and the expansion potential. Initial addition of IL-3 to the cocktail of SCF + FL + TPO had positive effects on the expansion of both primitive and, especially, the more mature hematopoietic cells. It accelerated the expansion speed and shortened the optimal culture time from 14 days to 10 days. These results indicated that our proposed short-term culture system, consisting of QBSF-60 serum-free medium with a simple early acting cytokine combination of SCF + FL + TPO, could substantially support simultaneous expansion of various stem/progenitor cell populations involved in the different phases of engraftment. It would be a clinically applicable protocol for ex vivo expansion of CD34+ UCB cells.     

自体外周血干细胞动员中测定CD34^＋Thy—1＋细胞的意义

目的：确切评估动员后外周血干细胞（ＰＢＳＣ）水平的变化，及时指导临床选择最佳采血时机。方法：用流式细胞术测定化疗和粒细胞集落刺激因子（Ｇ－ＣＳＦ）联合动员时外周血ＣＤ３４＋Ｔｈｙ－１＋细胞含量的变化，同时用体外集落培养方法评价外周血祖细胞（ＰＢＰＣｓ）的克隆形成能力。结果：动员后循环血中ＣＤ３４＋Ｔｈｙ－１＋细胞、ＣＤ３４＋细胞和克隆形成细胞（ＣＦＣ）含量分别增高４８．６倍、５０．０倍和５３．１倍，高峰时间在化疗后第１２～１４天（注射Ｇ－ＣＳＦ的第６～８天）；外周血单个核细胞中ＣＤ３４＋Ｔｈｙ－１＋细胞、ＣＤ３４＋细胞的比例分别增高１３．８倍和１０．５倍；动员的早期阶段，ＣＤ３４＋细胞中Ｔｈｙ－１＋细胞比例最高。结论：联合应用化疗和Ｇ－ＣＳＦ对ＰＢＰＣｓ，尤其对早期干／祖细胞具有显著动员作用；用流式细胞术检测ＣＤ３４＋Ｔｈｙ－１＋细胞可及时指导临床准时采集ＰＢＳＣ。     

人重组粒细胞集落刺激因子动员后采集骨髓对健康供者外周血采集物成份的影响

本研究探讨健康供者体内应用人重组粒细胞集落刺激因子（G—CSF）后采集骨髓对外周血采集物成份的影响。62例健康供者皮下注射rhG—CSF5μg/（kg·d），连用5天，其中31例供者在第4、5天分别采集骨髓和外周血采集物（A组）；另31例供者于第4、5天均单采集外周血单个核细胞（B组）。应用流式细胞术检测两组供者外周血采集物中的淋巴细胞、CD3^＋、CD3^＋CD4^＋、CD3^＋CD8^＋、CD14^＋、CD34^＋细胞以及CD3^＋CD4^-CD8^-T细胞的数量。结果显示，A组供者每微升外周血采集物中单个核细胞中CD3^＋、CD3^＋CD4^＋、CD3^＋CD8^＋、CD14^＋、CD34^＋细胞以及CD3^＋CD4^-CD8^-T细胞的中位含量分别1．56×10^5μ1、8．56×10^4μl、6．12×10^4μl、3．38×10^4μl、2．27×10^4μl、3．83×10^4μl、744μl及3588μl，与B组的1．40×10^5μl、7．34×10^4μ1、5．32×10^4l、3．06×10^4μl、1．83×10^4μl、3．21×10^4μl、554μl及3120μl的差异无统计学意义（p〉0．05）；A组外周血采集物中CD4^＋细胞与CD8^＋细胞的比值[1．52（0．54—2．87）]、单核细胞与CD3^＋细胞的比值[0．57（0．15—1．64）]以及CD3^＋CD4^-CD8^-T细胞与CD3^＋细胞[0．064（0．018—0．673）]的比值与B组[1．68（0．31—3．35）]、[0．59（0．18—1．25）]、[0．063（0．021—0．136）]的差异均无统计学意义（P〉0．05）。结论：健康供者体内应用rhG—CSF后采集骨髓对外周血采集物成份无影响，对rhG—CSF动员的同一健康供者可单独采集骨髓、外周血采集物或同时采集两种采集物以满足临床移植的需要。     

人胎盘源贴壁细胞支持脐血CD34+细胞体外扩增

从胎盘中分离培养人胎盘源贴壁细胞 (humanplacentaderivedadherentcells,hPDAC) ,研究其对脐血CD34+细胞体外扩增作用。以酶消化法自人胎盘组织中分离培养hPDAC ,并以流式细胞术对其进行鉴定。进一步 ,采用免疫磁珠法分离人脐血CD34+细胞 ,建立以hPDAC为滋养层的CD34+细胞体外扩增培养体系 ,并与无滋养层的液体培养体系相比 ,观察不同培养体系对有核细胞总数、CFC及CD34+细胞百分率的影响。结果表明 ,人胎盘组织中可分离培养出hPDAC ,并证实其为混合性细胞群体 ,主要含有间充质细胞。以hPDAC为滋养层的共培养体系较无滋养层液体培养体系对有核细胞总数、CFC及CD34+细胞均具有明显的扩增效应 ,其中以SCF +IL 3+IL 6 +FL +hPDAC组扩增效果最强 ,分别扩增了 ( 12 6 .0± 6 .7)倍 ,( 4 9.8± 1.7)倍和 ( 8.3± 1.6 5 )倍。上述结果提示 ,hPDAC具有体外支持造血作用 ,并提供了一与脐血CD34+细胞体外扩增相适应的新滋养层。     

Immunomagnetic selection of CD34+ cells: factors influencing component purity and yield

BACKGROUND: In immunomagnetic selection of CD34+ cells from HPC transplants, not all factors that affect yield and purity of CD34+ cells are known. METHODS: Forty-three consecutive procedures of immunomagnetic selection of CD34+ cells from peripheral blood HPCs and bone marrow harvests (autologous harvests, n = 27; allogeneic harvests; n=16) were performed by use of a cell selection system (Isolex 300i, Baxter Immunotherapy). The composition of the starting component and the subsets of CD34+ cells were analyzed for correlation with the yield and purity of the final component. RESULTS: The mean purity of the final components was 84.3 percent (range, 27-99%), and the mean yield was 51.4 percent (range, 9.4-80. 4%). Partial regression analysis showed that, among the factors correlating with purity and/or yield, the RBC volume in the starting fraction had the highest predictive impact on the purity and yield of CD34+ cells, even after the exclusion of procedures using bone marrow harvests as an HPC source (beta coefficient, -0.704; p = 0. 001). CONCLUSION: The use of the Isolex 300i system allows efficient recovery of CD34+ cells in routine selection procedures. The volume of RBCs in the starting component should be minimized to ensure a high yield and purity of the final component.     

Notch配体δ-1对IL-6/sIL-6R融合蛋白诱导红系祖细胞分化成熟的影响

目的 探讨Notch配体δ-1在红系造血细胞分化过程中对可溶性IL-6受体（sIL-6R）生物效应的影响。方法 用CD34免疫磁珠和FACS Vantage流式细胞仪筛选脐血单个核细胞中的CD34^＋CD38^-细胞；将CD34^＋CD38^-细胞用含SCF、Flt3L、TPO和IL-3四种生长因子组合（4GFs）的培养基培养7d，然后用CD36免疫磁珠分离CD36^＋红系祖细胞，用流式细胞术检测IL-6R和血型糖蛋白（GPA）的表达，并分选CD36^＋GPA—IL-6R^＋和CD36^＋GPA—IL-6R^-细胞，将这两种表型的细胞分别进行集落分析；将CD36^＋GPA—IL-6R^-细胞用含有4GFs、4GFs＋IL-6或4GFs＋IL-6／sIL-6R融合蛋白（FP6）培养基并在加与不加Notch配体δ-1的情况下培养14d，并对CD36^＋GPA^high成熟红细胞进行计数。结果 CD36^＋GPA^＋细胞中IL-6R^-细胞占95％；CD36^＋GPA^-细胞可分为IL-6R^＋和IL-6R^-两部分，分别占46％和54％；IL-6R^＋细胞形成的粒-单核细胞集落形成单位（CFU—GM）数为2．1±1．8，IL-6R^-细胞形成的红系祖细胞爆式集落形成单位（BFU—E）数为58．2±18．1，明显高于IL-6R^＋细胞形成的CFU—GM数（P〈0．05）；在含有FP6的培养体系中，CD36^＋GPA^high细胞计数为（1．400±0．180）×10^6；在含FP6和Notch配体δ-1的培养体系中，CD36^＋GPA^high细胞计数为（2．460±0．190）×10^6，明显高于单独含有FP6的培养体系（P〈0．05）。结论 Notch配体δ-1可增强IL-6-红系细胞分化过程中sIL-6R所介导的生物学效应。     

脐血干细胞库的建立及其临床应用

目的建立无关供者脐血干细胞库,用于治疗骨髓衰竭、恶性及非恶性血液病、某些遗传病、重型免疫缺陷等疾病的干细胞移植.方法采集足月顺产或剖宫产的新生儿脐血,以羟乙基淀粉分离红细胞,DMSO/LMD冷冻保存.每份脐血常规检测细胞活率、有核细胞计数、祖细胞体外培养、CD34+细胞检测、HLA配型及病原学检测等.结果共采集2318份脐血,合格1240份,合格率为53.5%,合格脐血采集的平均体积(98.3±27.0)ml,分离后脐血有核细胞为(1.2±0.5)×109,回收率为(88.90±9.65)%.脐血细胞存活率为(97.00±2.61)%.CFU-GM数为(5.18±14.35)×105,BFU-E数为(10.35±11.55)×105,CFU-Mix数为(1.03±1.47)×105.脐血分离后CD34+细胞百分率为(0.5±0.32)%,细菌培养阳性4例,4例脐血CMV-IgM阳性.在广州脐血库的172例脐血移植登记患者中,HLA匹配4个位点以上的占91.12%.至2000年5月共提供9份应用于无关供者脐血移植,其中6例植入,植入成功率66.7%.结论脐血库的建立可使脐血能够较好地应用于造血干细胞移植治疗,建立脐血库有良好的应用前景.