Concise review: hematopoietic stem cells and tissue stem cells: current concepts and unanswered questions

The term hematopoietic stem cells has at times been used to include a miscellany of precursor cells ranging from multipotential self-generating cells to lineage-restricted progenitors with little capacity for self-generation. It is probable that the stem cells of other tissues also vary widely in their multipotentiality and proliferative capacity. This review questions several dogmas regarding the self-generative capacity of various hematopoietic cells, the single episodic origin of hematopoietic cells, and the irreversible nature of progressive mature cell formation in individual hematopoietic lineages. Disclosure of potential conflicts of interest is found at the end of this article.     

Alternative donor hematopoietic stem cell transplantation: current concepts

Hematopoietic stem cell transplantation (HSCT) is a curative therapy for many diseases such as hematological malignancies, bone marrow failure, immunodeficiency and other disorders. Unrelated donor and haploidentical family member are important alternative donors for the patients who need HSCT for otherwise incurable disease but without identical sibling donor. Since the first unrelated HSCT in 1974, the number and the clinical outcomes of unrelated transplant have been progressed significantly over time. More than 16 million adult unrelated donors have been registered worldwide. Near half of the donations from unrelated donors are international in recent years. HLA disparity between donor and recipient and disease status before transplant are key factors on survival after unrelated HSCT. In experienced centers, unrelated transplant has achieved comparable results with identical sibling HSCT. In addition, transplant from unrelated donor has advantage to cure some inherited disorders such as severe combined immunodeficiency disease, thalassaemia, Fanconi anemia, Familial Hemophagocytic Lymphohistiocytosis and so on. Haploidentical HSCT (haplo-HSCT) was initiated in 1981. The early results were poor mainly due to severe graft-versus-host disease (GVHD) and infections post-transplant. To reduce GVHD, T-cell depletion and mega dose CD34 + cells have been employed with certain success. Reduced intensity conditioning has further decreased early transplant-related mortality (TRM), but relapse rate is relatively high. Haplo-HSCT in our group with GIAC regimen has achieved comparable outcomes in terms of severe acute GVHD, chronic GVHD, relapse, TRM, disease-free survival (DFS), and overall survival (OS) with HLA-identical sibling transplant. New strategies have been applied in order to better manage complications post HSCT. As the third party cells, cord blood co-infusion has reduced severe acute GVHD and early TRM significantly. The majority of refractory cytomegalovirus, Epstein–Barr virus and aspergillus infections can be controlled with adoptive cellular therapy. Our clinical results from a large series of transplants have demonstrated that haplo-HSCT in sex-matched donor–recipient pair has survival advantage. Early disease stage before HSCT and high CD34 + cell infused but not age and HLA disparity have positive influence on DFS and OS. Therefore, it is better to consider haplo-HSCT for the patients who need urgent transplant to cure the diseases at earlier disease stage, when matched siblings or unrelated donors are not available. Among all haploidentical family members, sex-matched one should be the first choice as a donor for HSCT.     

Hematopoietic stem cells: concepts, assays, and controversies.

Mature cells of the hematopoietic system, including B and T lymphocytes, have a limited life span and must be continuously replenished by differentiation from immature precursors. The stability of the hematopoietic system depends on the maintenance of a pool of pluripotent hematopoietic stem cells. During the past 30 years, the development of quantitative assays for stem cells and their progeny has led to an explosion of information concerning the stages of differentiation, regulatory factors and receptors, and characterization of surface markers. Nevertheless, there remain many controversies about the properties of cells in the stem cell compartment. The degree of heterogeneity within the stem cell compartment is unknown. The detailed mechanisms for regulation of stem cells are uncertain. Finally, the factors which control the recruitment of quiescent stem cells are unknown and controversial.     

脐血CD34+CD19-造血干/祖细胞体外B细胞分化条件研究

目的:研究体外脐血造血干/祖细胞向B细胞分化的条件.方法:体外免疫磁珠分离纯化脐血CD34+CD19-造血干/祖细胞;在小鼠S-17基质细胞支持下,脐血CD34+CD19-造血干/祖细胞、T3、各种细胞因子共培养建立体外B细胞分化发育培养体系,诱导脐血CD34+CD19-造血干/祖细胞向B细胞分化;用流式细胞仪检测培养的B细胞.结果:T3、IL-7与小鼠S-17基质细胞共培养诱导CD34+CD19-造血干/祖细胞28天时,分化形成的B细胞数可达初始培养细胞的198倍,诱导细胞大部分表达CD10、CD19.结论:在选用的实验条件下,T3、IL-7与小鼠S-17基质细胞体外能诱导脐血造血干/祖细胞的B细胞分化.     

Skeletal muscle-derived CD34+/45- and CD34-/45- stem cells are situated hierarchically upstream of Pax7+ cells

The hierarchical relationship of skeletal muscle-derived multipotent stem cells sorted as CD34(+)/CD45(-) (Sk-34) and CD34(-)/CD45(-) (Sk-DN) cells, which have synchronized reconstitution capacities for blood vessels, peripheral nerves, and muscle fibers, was examined. Expression of Sca-1 and CD34 (typical state of freshly isolated Sk-34 cells) in Sk-DN cells was examined using in vitro culture and in vivo cell implantation. Sk-DN cells sequentially expressed Sca-1 and CD34 during cell culture showing self-maintenance and/or self-renewal-like behavior, and are thus considered hierarchically upstream of Sk-34 cells in the same lineage. Sk-34 and Sk-DN cells were further divided into small and large cell fractions by cell sorting. Immunocytochemistry using anti-Pax7 was performed at the time of isolation (before culture) and revealed that only 1% of cells in the large Sk-DN cell fraction were positive for Pax7, while Sk-34 cells and 99% of Sk-DN cells were negative for Pax7. Therefore, putative satellite cells were possibly present in the large Sk-DN cell fraction. However, serial analysis of Pax7 expression by RT-PCR and immunocytochemistry for single and 2 to >40 clonally proliferated Sk-34 and Sk-DN cells revealed that both cell types expressed Pax7 after several asymmetric cellular divisions during clonal-cell culture. In addition, production of satellite cells was seen after muscle fiber formation following Sk-34 or Sk-DN cell transplantation into damaged muscle, and even in the nonmuscle tissue environment (beneath the renal capsule). Thus, Sk-DN cells are situated upstream of Sk-34 cells and both cells can produce Pax7+ cells (putative satellite cells) after cellular division.     

Role of the CD34+ 38- cells in posttransplant hematopoietic recovery

Using three different statistical tests in parallel, we showed in a preliminary study that neither mononuclear cells, CD34+ 33+ or 33- cells, nor CD34+ 38+ cells significantly correlated with engraftment kinetics following autologous blood cell transplantation (ABCT). We additionally demonstrated here, in a series of patients suffering from malignant diseases, that the graft content in CD34+ 38- cells is individually a more sensitive indicator of the earliest, as well as the latest post-ABCT trilineage hematopoietic recovery than the colony-forming units-granulocyte-macrophage and even the total CD34+ cell content. This suggests that the CD34+ 38- cell population is itself subdivided into two more subsets, one being already lineage-committed and responsible for short-term engraftment, the other containing only very primitive hematopoietic cells responsible for sustained engraftment. Strong arguments favor the probability that these subsets correspond to HLA-DR+ and DR cells, respectively. We also defined an optimal threshold value of 0.05 x 10(6) CD34+ 38- cells/kg of the patient's body weight (b.w.) above which a rapid and sustained trilineage engraftment safely occurs. In fact, infusion of lower numbers of cells seems to have a more significant impact on long-term compared to short-term neutrophil recovery and on platelet kinetics engraftment. We additionally looked for the eventual influence on engraftment time of the type of disease, and of post-ABCT administration of hematopoietic growth factors (HGF). When the type of disease appeared to have no influence on the engraftment time, posttransplant HGF administration significantly reduced the time to trilineage engraftment in patients transplanted with < 0.05 x 10(6) CD34+ 38- cells, thus justifying it in case of reinfusion of low numbers of CD34+ 38- cells. On the other hand, the administration of HGF after infusion of more than 0.05 x 10(6) CD34+ 38- cells/kg b.w. did not hasten more, or only very little, the engraftment time, thus becoming not only unprofitable for the patients but costly as well.     

Lobular carcinoma in situ: current concepts and controversies.

Clinical and clinicopathologic studies performed over the last 50 years have elucidated many of the important features of lobular carcinoma in situ. However, certain aspects of the natural history, treatment, and diagnosis of these lesions remain controversial. The purpose of this article is to review the current understanding of lobular carcinoma in situ and to highlight some of the controversies surrounding this entity.     

Analysis of primitive CD34- and CD34+ hematopoietic cells from adults: gain and loss of CD34 antigen by undifferentiated cells are closely linked to proliferative status in culture

There is limited understanding of CD34- hematopoietic cells and the linkage between CD34 antigen expression and cell proliferation. In this study, early CD34- CD38- LIN- (CD34-) cells were purified from mobilized adult peripheral blood and carefully analyzed in vitro for growth and modulation of CD34. Mobilized CD34+CD38- LIN- (CD34+) cells were used for comparison. Expression of CD34, CD38, and LIN antigens was determined, and proliferative responses were assessed with PKH tracking dye, expression of Ki67 antigen, and uptake of pyronin Y. Suspension cultures of adult CD34- cells generated CD34+ cells and progenitors for >8 weeks. Stromal cultures demonstrated the presence of long-term culture-initiating cells within the CD34- fraction. While CD34- cells were slower to initiate growth than the CD34+ cells were, no significant difference in hematopoietic cell output was found. Upon cultivation of CD34- cells, CD34 antigen appeared within 48 hours but was restricted to those cells that had initiated growth. Surprisingly, CD34+ precursors lost CD34 expression in culture if they remained in G0 for more than 2 days. Those cells later regained expression of CD34 antigen upon initiation of growth. Comparison of cells that did or did not rapidly modulate CD34 antigen revealed no differences in long-term growth potential. In conclusion, in vitro expression of CD34 by CD34- and CD34+ populations is tightly linked to cellular proliferation. In this culture system, expression of CD34 antigen by LIN- cells constitutes an early hallmark of growth. Measurement of CD34 expression by LIN- cells in expansion culture underestimates the total content of hematopoietic cells.     

Chemotherapy and hematopoietic stem cell transplantation for adult T-cell lymphoblastic lymphoma: current status and controversies.

Adult T-cell lymphoblastic lymphoma is a relatively rare aggressive type of non-Hodgkin lymphoma with frequent involvement of extranodal sites. Because of the rarity of this malignancy, it is treated variably and often suboptimally, using approaches similar to those used for other types of aggressive non-Hodgkin lymphomas, with the consequence that outcome is often suboptimal. The collective experience in the management of adult T-cell lymphoblastic lymphoma suggests a good outcome for patients with no adverse prognostic factors who are treated with an acute lymphocytic leukemia-like treatment strategy. Patients with adverse prognostic features should be considered for more aggressive therapy-specifically, high-dose chemotherapy and hematopoietic stem cell transplantation. This article will attempt to review the current status of chemotherapy treatment programs and the relative merits of the different hematopoietic stem cell transplantation programs in this disease, particularly in relation to the pathologic and clinical features that correlate with disease prognosis.     

Human hematopoietic (CD34+) stem cells possess high-affinity receptors for adenovirus type 11p

Gene transfer into human hematopoietic stem cells using Ad5 is inefficient due to lack of the primary receptor CAR and the secondary receptors alphavbeta3 integrin and alphavbeta5 integrin, and due to the high seroprevalence of Ad5 antibodies in most adults, resulting in diminished gene transduction. In the present study, we screened six species (species A-F) of adenovirus, displaying different tropisms for interaction with CD34+ cells, at the level of virus attachment and expression. Virus particles were biotinylated and their binding capacity was determined by FACS analysis using streptavidin-FITC. Ad11p, Ad35, and Ad3 (species B) showed high binding affinity, while Ad7, Ad11a (species B), and Ad37 (species D) displayed intermediate affinity. Virions of Ad4 (species E), Ad5 (species C), Ad31 (species A), and Ad41 (species F) hardly bound to hematopoietic progenitor cells. Using a double-labeling system, we demonstrated that adenoviruses bind to quiescent CD34+ cells. Ad11p virions showed the highest affinity among the adenoviruses detected. We further confirmed that virus fiber-specific receptors were present on the hematopoietic progenitor cell surface, because both recombinant fiber of Ad11p and specific antiserum against rfiber could block virus attachment. The ability of the adenoviruses to infect hematopoietic cells was studied by immunofluorescence staining. The adenoviruses from species B and Ad37 showed higher infectivity than Ad31, Ad5, Ad4, and Ad41. Among the studied species B adenoviruses, Ad11p manifested a superior infectivity. Thus, we have confirmed that these cells have high-affinity receptors for species B:2 human adenovirus, Ad11p, and this virus may be used as candidate vector to target therapeutic genes to hematopoietic stem cells.     

Microencapsulated feeder cells as a source of soluble factors for expansion of CD34(+) hematopoietic stem cells

Expansion of hematopoietic stem cells (HSCs) from cord blood is highly desired for treatment and transplantation of adult patients for hematologic diseases. For efficient proliferation of HSCs, CD34(+) cells from cord blood were co-cultured with microencapsulated murine stromal cells (HESS-5) or immortalized human mesenchymal stem cells (MSCs) in their conditioned media (CM). Bioactive substances for HSC proliferation in CM at the onset of culture are likely consumed by HSCs with time, and co-culturing with microencapsulated feeder cells ensures a continuous supply. The cell number of CD34(+) cell progeny efficiently increased under these culture conditions, and progeny were analyzed by flow cytometry, the colony assay and the cobblestone area-forming cell (CAFC) assay. Total nucleated cells and CD34(+) cell number increased 194- and 7.4-fold, respectively, in the presence of microencapsulated HESS-5 in CM. Colony forming cells and CAFCs were well maintained. The effective expansion of total cells and maintenance of primitive progenitor cells suggest that transfusion of the progeny obtained from CD34(+) cell culture with microencapsulated HESS-5 in CM could shorten the time to engraftment by bridging the pancytopenic period and support functional hematopoietic repopulation.     

Down-regulation of CXCR4 expression by SDF-KDEL in CD34 hematopoietic stem cells: An anti-human immunodeficiency virus strategy

CXCR4 plays an essential role as the first discovered coreceptor for the entry of T cell tropic isolates of HIV-1. Blocking the surface expression of this receptor may be a potential strategy to prevent HIV-1 infection. A lentiviral vector, pLenti6/V5-S-K, expressing a SDF-KDEL fusion protein was constructed and a replication-incompetent lentiviral stock was produced. The lentiviral stock was transduced into CD34⁺ hHSC and the transient expression of the recombinant protein, SDF-1, was assayed using indirect immunofluorescence. The surface expression of CXCR4 in CD34⁺ hHSC pretreated with different amounts of recombinant lentiviral vectors was detected by flow cytometric analysis. A marked down-regulation of CXCR4 expression in the cells transduced with recombinant lentiviral vectors pLenti6/V5-S-K was observed by flow cytometry with PE-conjugated anti-human CXCR4 monoclonal antibodies which showed the percentages of the inhibition effects of CXCR4-SDF-1 mediated syncytium formation are presented by concentration. P24 antigen levels of cell culture supernatants were detected on the 4th, 7th, and 10th day, with 10³ TCID50 HIV-1 infected CD34⁺ hHSC to evaluate the inhibitory effect of pLenti6/V5-S-K transduction on HIV-1 infection. The cells transfected with pLenti6/V5-S-K had a significant reduction of HIV-1 DP27 infection compared to controls (P < 0.05).     

脐血CD34+造血干/祖细胞基因表达图谱的研究

目的：通过脐血CD34^＋造血干／祖细胞的基因表达分析，理解造血干／祖细胞生物学特性。方法：利用MiniMACS免疫磁珠法从脐血细胞中分离CD34^＋造血干／祖细胞，提取总RNA，用SMART-PCR技术从微量RNA中扩增产生足够量的cDNA用于高密度点阵膜分析检测CD34^＋造血干／祖细胞表达的基因。结果：在所检测的588个基因中，发现63个基因具有显著的表达水平，其中18个基因强表达。这些基因主要涉及造血干细胞增殖、分化、应激响应、凋亡、转录调节以及细胞周期等。结论：对理解脐血干／祖细胞生物学性质以及指导造血干细胞体外培养提供了分子生物学基础。     

Immunophenotype and functional characteristics of human primitive CD34-negative hematopoietic stem cells: the significance of the intra-bone marrow injection

The biology of hematopoietic stem cell (HSC) is a current topic of interest which has important implications for clinical HSC transplantation as well as for the basic research of HSC. The most primitive HSCs in mammals, including mice and humans, have long been believed to be CD34 antigen (Ag)-positive (CD34(+)) cells. In fact, bone marrow (BM), peripheral blood (PB), and cord blood (CB) stem cell transplantation studies indicate that a CD34(+) subpopulation in the BM, PB, or CB can provide durable long-term donor-derived lymphohematopoietic reconstitution. Therefore, CD34 Ag was used to identify/purify immature HSCs. However, Osawa et al. reported that murine long-term lymphohematopoietic reconstituting HSCs are lineage marker-negative (Lin(-)) c-kit(+)Sca-1(+)CD34-low/negative (CD34(low/-)), which are called CD34(low/-) KSL cells. Recently, human CB-derived CD34(-) HSCs, a counterpart of murine CD34(low/-) KSL cells, were successfully identified using an intra-bone marrow injection (IBMI) method. This review will update the concept of the immunophenotype and the functional characteristics of human primitive CD34(-) HSCs. In addition, the significance of the application of the IBMI technique in clinical HSC transplantation is also discussed. Recent rapid advances in understanding the biological nature of HSCs may make it possible to fully characterize the most primitive class of human HSCs in the near future.     

CD34 modulates the trafficking behavior of hematopoietic cells in vivo

The CD34 surface antigen has been recognized as a marker of hematopoietic stem cells (HSCs) and is widely used for HSC selection as well as for quality control in HSC transplantation. CD34 has been implicated in cytoadhesion signaling, and its expression has been suggested to reflect the activation state of hematopoietic progenitor cells. However, the function of CD34 remains essentially unknown. Here we analyzed the effects of ectopic CD34 expression in vivo in a bone marrow transplantation model. We transduced murine bone marrow stem cells with retroviral vectors encoding either murine full-length or the alternative splice product truncated CD34. Transduced cells were transplanted into syngeneic, marrow ablated hosts. For comparison, "control" animals received either enhanced green fluorescent protein (eGFP)-transduced or mock-transduced cells. Six months post-transplantation, transduced differentiated blood cells ectopically expressing murine CD34 showed decreased migration from peripheral blood to both bone marrow and thymus, an effect that was more pronounced with full-length CD34 than with the truncated variant. In contrast, no influence of transgene expression on trafficking of differentiated blood cells was seen in the eGFP control group. Our data indicate that CD34 expression in mature blood cells has a suppressive effect on cellular trafficking to hematopoietic stroma organs, thereby supporting a modulating role of the CD34 molecule in cytoadhesion.     

Evidence of peripheral blood-derived, plastic-adherent CD34(-/low) hematopoietic stem cell clones with mesenchymal stem cell characteristics

The hematopoietic system of vertebrates can be completely reconstituted with hematopoietic stem cells derived from the bone marrow, fetal liver, or cord blood, or even from peripheral-blood-derived cells. A cellular marker to identify those cells is the proteoglycan CD34, although we have shown that the earliest identifiable hematopoietic stem cell is a CD34(-) fibroblast-like cell which can differentiate into CD34(+) hematopoietic precursors. Peripheral blood mononuclear cells were isolated from the heparinized blood of a dog and incubated in tissue culture in the presence of interleukin 6. After 10-14 days, an adherent layer of fibroblast-like cells had developed and cells were immortalized using the SV-40 large T antigen. Cells were cloned and subcloned by measures of limiting dilution, and various fibroblast-like clones were established. These fibroblast-like cells either do not express the CD34 antigen or express CD34 on a low level, although transcribing CD34. The CD34(-/low) cells express osteocalcin as a mesenchymal cell marker. The fibroblast-like cells eventually differentiate spontaneously in vitro into CD34(+) precursors and show colony formation. Prior to autologous stem cell transplantation, one clone of choice (IIIG7) was transfected with a retroviral construct containing the green-fluorescence protein (GFP). The recipient dog was totally irradiated with 300 cGy and received a stem cell transplant with GFP-containing, immortalized, fibroblast-like monoclonal autologous stem cells (0.5 x 10(8)/kg dog). No additional growth factors were applied. The peripheral blood counts recovered after 23 days (WBC >500; platelets >10,000). A peripheral blood smear showed some dim but definite, although timely, limited expression of the GFP protein in nucleated peripheral blood cells just five weeks after transplantation. A bone marrow biopsy showed GFP-positive cells in the marrow cavity predominantly as "bone-lining cells."