Hospital Universitari Vall d'Hebron. Institut de Recerca

En los transplantes de progenitores hematopoyéticos, la sangre de cordón umbilical es una fuente establecida de células madre hematopoyéticas que presenta como mayor ventaja una menor incidencia de enfermedades de injerto contra el huésped. Sin embargo, el bajo número de células madre obtenidas de una sola unidad limita su utilización a un número reducido de pacientes. Las células madre hematopoyéticas se definen por su capacidad de automantenimiento y reconstitución de todo el sistema hematopoyético de un huésped trasplantado. En ratón, la combinación de los marcadores de superficie Lin- LSK junto con los marcadores de la familia SLAM, ha permitido establecer una jerarquía en las poblaciones de células madre y progenitores hematopoyéticos. Sin embargo, la población de células madre hematopoyéticas humanas CD34+CD38- es heterogénea y las subpoblaciones de progenitores y células madre no están bien establecidas. Uno de los objetivos de este trabajo es determinar si los marcadores de la familia SLAM podrían redefinir la población de células madre hematopoyéticas humanas CD34+CD38- de forma similar a lo sucedido en ratón. En este trabajo se describe una nueva población de progenitores hematopoyéticos en sangre de cordón umbilical caracterizada por el fenotipo CD34+CD38-CD150+CD135-. Lon ensayos realizados tanto in vitro como in vivo han demostrado que esta población esta formada por células con capacidad de autorrenovación, de diferenciación a todos los linajes hematopoyéticos, y de reconstitución a corto y largo plazo de un modelo murino inmunodeficiente irradiado. Por otro lado, con la finalidad de obtener un número suficiente de progenitores hematopoyéticos para ser trasplantados, se han estudiado diferentes sistemas de expansión in vitro. Se ha observado que el ácido valproico (un inhibidor de las histona deacetilasas) y la activación de la vía de Notch, promueven el mantenimiento y expansión de los progenitores hematopoyéticos reduciendo los procesos de diferenciación.

Generation of induced pluripotent stem cells from human cord blood cells with only two factors:OCT4 and SOX2

Induced pluripotent stem cells (iPSC ) provide an invaluable resource for regenerative medicine as they allow the generationof patient-specific progenitors with potential value for cell therapy. However, in many instances, an off-the-shelf approach isdesirable, such as for cell therapy of acute conditions or when the patient’s somatic cells are altered as a consequence of a chronicdisease or aging. Cord blood (CB) stem cells appear ideally suited for this purpose as they are young cells expected to carryminimal somatic mutations and possess the immunological immaturity of newborn cells; additionally, several hundred thousandimmunotyped CB units are readily available through a worldwide network of CB banks. Here we present a detailed protocol for thederivation of CB stem cells and how they can be reprogrammed to pluripotency by retroviral transduction with only two factors(OCT 4 and SO X2) in 2 weeks and without the need for additional chemical compounds.

Long-term expansion of transplantable human fetal liver hematopoietic stem cells

Hematopoietic stem cells (HSCs), with their dual ability for self-renewal and multilineage differentiation, constitute an essential component of hematopoietic transplantations. Human fetal liver (FL) represents a promising alternative HSC source, and we previously reported simple culture conditions allowing long-term expansion of FL hematopoietic progenitors. In the present study, we used the nonobese diabetic/severe combined immunodeficiency (NOD/SCID) mouse xenotransplantation assay to confirm that human FL is rich in NOD/SCID-repopulating cells (SRCs) and to show that these culture conditions repeatedly maintained short- and long-term SRCs from various FL samples for at least 28 days. Quantitative limited dilution analysis in NOD/SCID mice demonstrated for the first time that a 10- to over a 100-fold net expansion of FL SRCs could be achieved after 28 days of culture. The efficiency of this culture system may lead to an increase in the use of FL as a source of HSCs for transplantation in adult patients, as previously demonstrated with umbilical cord blood under different culture conditions.

Intrauterine growth restriction is associated with structural alterations in human umbilical cord and decreased nitric oxide-induced relaxation of umbilical vein.

INTRODUCTION: Intrauterine growth restriction (IUGR) affects ∼8% of all pregnancies and is associated with major perinatal mortality and morbidity, and with an increased risk to develop cardiovascular diseases in adulthood. Despite identification of several risk factors, the mechanisms implicated in the development of IUGR remain poorly understood. In case of placental insufficiency, reduced delivery of oxygen and/or nutrients to the fetus could be associated with alterations in the umbilical circulation, contributing further to the impairment of maternal-fetal exchanges. We compared the structural and functional properties of umbilical cords from growth-restricted and appropriate for gestational age (AGA) term newborns, with particular attention to the umbilical vein (UV). METHODS: Human umbilical cords were collected at delivery. Morphological changes were investigated by histomorphometry, and UV's reactivity by pharmacological studies. RESULTS: Growth-restricted newborns displayed significantly lower growth parameters, placental weight and umbilical cord diameter than AGA controls. Total cross-section and smooth muscle areas were significantly smaller in UV of growth-restricted neonates than in controls. Maximal vasoconstriction achieved in isolated UV was lower in growth-restricted boys than in controls, whereas nitric oxide-induced relaxation was significantly reduced in UV of growth-restricted girls compared to controls. CONCLUSION: IUGR is associated with structural alterations of the UV in both genders, and with a decreased nitric oxide-induced relaxation in UV of newborn girls, whereas boys display impaired vasoconstriction. Further investigations will allow to better understand the regulation of umbilical circulation in growth-restricted neonates, which could contribute to devise potential novel therapeutic strategies to prevent or limit the development of IUGR.

Valproate treatment of human cord blood CD4-positive effector T cells confers on them the molecular profile (microRNA signature and FOXP3 expression) of natural regulatory CD4-positive cells through inhibition of histone deacetylase.

Regulatory T cells (Tregs) play a key role in immune system homeostasis and tolerance to antigens, thereby preventing autoimmunity, and may be partly responsible for the lack of an appropriate immune response against tumor cells. Although not sufficient, a high expression of forkhead box P3 (FOXP3) is necessary for their suppressive function. Recent reports have shown that histones deacetylase inhibitors increased FOXP3 expression in T cells. We therefore decided to investigate in non-Tregs CD4-positive cells, the mechanisms by which an aspecific opening of the chromatin could lead to an increased FOXP3 expression. We focused on binding of potentially activating transcription factors to the promoter region of FOXP3 and on modifications in the five miRs constituting the Tregs signature. Valproate treatment induced binding of Ets-1 and Ets-2 to the FOXP3 promoter and acted positively on its expression, by increasing the acetylation of histone H4 lysines. Valproate treatment also induced the acquisition of the miRs Tregs signature. To elucidate whether the changes in the miRs expression could be due to the increased FOXP3 expression, we transduced these non-Tregs with a FOXP3 lentiviral expression vector, and found no changes in miRs expression. Therefore, the modification in their miRs expression profile is not due to an increased expression of FOXP3 but directly results from histones deacetylase inhibition. Rather, the increased FOXP3 expression results from the additive effects of Ets factors binding and the change in expression level of miR-21 and miR-31. We conclude that valproate treatment of human non-Tregs confers on them a molecular profile similar to that of their regulatory counterpart.

Phenotypic and functional analysis of human fetal liver hematopoietic stem cells in culture.

Steady-state hematopoiesis and hematopoietic transplantation rely on the unique potential of stem cells to undergo both self-renewal and multilineage differentiation. Fetal liver (FL) represents a promising alternative source of hematopoietic stem cells (HSCs), but limited by the total cell number obtained in a typical harvest. We reported that human FL nonobese diabetic/severe combined immunodeficient (NOD/SCID) repopulating cells (SRCs) could be expanded under simple stroma-free culture conditions. Here, we sought to further characterize FL HSC/SRCs phenotypically and functionally before and following culture. Unexpanded or cultured FL cell suspensions were separated into various subpopulations. These were tested for long-term culture potential and for in vivo repopulating function following transplantation into NOD/SCID mice. We found that upon culture of human FL cells, a tight association between classical stem cell phenotypes, such as CD34(+) /CD38(-) and/or side population, and NOD/SCID repopulating function was lost, as observed with other sources. Although SRC activity before and following culture consistently correlated with the presence of a CD34(+) cell population, we provide evidence that, contrary to umbilical cord blood and adult sources, stem cells present in both CD34(+) and CD34(-) FL populations can sustain long-term hematopoietic cultures. Furthermore, upon additional culture, CD34-depleted cell suspensions, devoid of SRCs, regenerated a population of CD34(+) cells possessing SRC function. Our studies suggest that compared to neonatal and adult sources, the phenotypical characteristics of putative human FL HSCs may be less strictly defined, and reinforce the accumulated evidence that human FL represents a unique, valuable alternative and highly proliferative source of HSCs for clinical applications.

Morphological aspects of buffaloes (Bubalus bubalis) umbilical cord

Buffalo is an important livestock resource, with a great participation in agricultural systems, providing milk, meat, and work power. Umbilical cord is responsible for maternal-fetal nutrients exchange during pregnancy, and its alterations can compromise the fetal development. We investigated ten pregnant uteruses collected from cross-bread buffaloes in different stages of gestation. Pregnancy and fetal age was determined by measuring the apex sacral length and development period was calculated by previously published formula. Umbilical cords were measured for length determination. Umbilical cord vascular net and anastomosis were observed by injection of Neoprene latex. Histological sections of the umbilical cord were studied after stain with HE, picrossirius, toluidine blue, orceine, and PAS reaction. Buffaloes' umbilical cord was formed by two central arteries, an allantois duct and two peripheral veins. The artery wall was composed by large quantity of collagen, elastic fibers, fibroblasts and large number of vasa vasorum. The allantois duct was located between the arteries and presented a great number of small nourishing vessels. Small nourishing vessels should be carefully considered to avoid to be mistaken to the arterials and veins vasa vasorum. Medium length of umbilical cord from buffalos was 11.8cm (minimum of 6.8cm and maximum of 17.4cm).

Secondary prevention of type 1 diabetes mellitus: stopping immune destruction and promoting ß-cell regeneration

Type 1 diabetes mellitus results from a cell-mediated autoimmune attack against pancreatic ß-cells. Traditional treatments involve numerous daily insulin dosages/injections and rigorous glucose control. Many efforts toward the identification of ß-cell precursors have been made not only with the aim of understanding the physiology of islet regeneration, but also as an alternative way to produce ß-cells to be used in protocols of islet transplantation. In this review, we summarize the most recent studies related to precursor cells implicated in the regeneration process. These include embryonic stem cells, pancreas-derived multipotent precursors, pancreatic ductal cells, hematopoietic stem cells, mesenchymal stem cells, hepatic oval cells, and mature ß-cells. There is controversial evidence of the potential of these cell sources to regenerate ß-cell mass in diabetic patients. However, clinical trials using embryonic stem cells, umbilical cord blood or adult bone marrow stem cells are under way. The results of various immunosuppressive regimens aiming at blocking autoimmunity against pancreatic ß-cells and promoting ß-cell preservation are also analyzed. Most of these regimens provide transient and partial effect on insulin requirements, but new regimens are beginning to be tested. Our own clinical trial combines a high dose immunosuppression with mobilized peripheral blood hematopoietic stem cell transplantation in early-onset type 1 diabetes mellitus.

Amniotic fluid and umbilical cord plasma corticotropin-releasing factor (CRF), CRF-binding protein, adrenocorticotropin, and cortisol concentrations in intraamniotic infection and inflammation at term

Context: Pregnant tissues express corticotropin-releasing factor (CRF), a peptide modulating fetal and placental ACTH and cortisol secretion. These actions are modulated by the locally expressed CRF-binding protein (CRF-BP). Objective: The objective of the study was to determine whether CRF, CRF-BP, ACTH, and cortisol concentrations change in amniotic fluid and umbilical cord plasma in the presence of intraamniotic infection/inflammation (IAI) in women with spontaneous labor at term. Design: This was a cross-sectional study. Setting: The study was conducted at a tertiary referral center for obstetric care. Patients: Patients included women in active labor at term with (n = 39) and without (controls; n = 78) IAI. Main Outcome Measures: Amniotic fluid and umbilical cord plasma concentrations of CRF, CRF-BP, ACTH, and cortisol measured by RIA and immunoradiometric assays were measured. Results: In patients with IAI, amniotic fluid CRF (0.97 +/- 0.18 ng/ml) and CRF-BP (33.06 +/- 5.54 nmol/liter) concentrations were significantly (P < 0.001) higher than in controls (CRF: 0.32 +/- 0.04 ng/ml; CRF-BP: 14.69 +/- 2.79 ml). The umbilical cord plasma CRF and CRF-BP concentrations were significantly (P < 0.001 for all) higher in women with IAI than in controls (CRF: 2.96 +/- 0.35 ng/ml vs. 0.38 +/- 0.18 ng/ml; CRF-BP: 152.12 +/- 5.94 nmol/liter vs. 106.9 +/- 5.97 nmol/liter). In contrast, amniotic fluid and umbilical cord plasma ACTH and cortisol concentrations did not differ between groups. Conclusions: Amniotic fluid and umbilical cord plasma CRF and CRF-BP concentrations are increased in women with spontaneous labor at term and IAI. CRF-BP may modulate CRF actions on ACTH and cortisol secretion, playing a pivotal role in limiting the inflammatory process and thus avoiding an overactivation of the fetal/placental hypothalamus-pituitary-adrenal axis at birth.

Human Multipotent Mesenchymal Stromal Cells from Distinct Sources Show Different In Vivo Potential to Differentiate into Muscle Cells When Injected in Dystrophic Mice

Limb-girdle muscular dystrophies are a heterogeneous group of disorders characterized by progressive degeneration of skeletal muscle caused by the absence or deficiency of muscle proteins. The murine model of Limb-Girdle Muscular Dystrophy 2B, the SJL mice, carries a deletion in the dysferlin gene. Functionally, this mouse model shows discrete muscle weakness, starting at the age of 4-6 weeks. The possibility to restore the expression of the defective protein and improve muscular performance by cell therapy is a promising approach for the future treatment of progressive muscular dystrophies (PMD). We and others have recently shown that human adipose multipotent mesenchymal stromal cells (hASCs) can differentiate into skeletal muscle when in contact with dystrophic muscle cells in vitro and in vivo. Umbilical cord tissue and adipose tissue are known rich sources of multipotent mesenchymal stromal cells (MSCs), widely used for cell-based therapy studies. The main objective of the present study is to evaluate if MSCs from these two different sources have the same potential to reach and differentiate in muscle cells in vivo or if this capability is influenced by the niche from where they were obtained. In order to address this question we injected human derived umbilical cord tissue MSCs (hUCT MSCs) into the caudal vein of SJL mice with the same protocol previously used for hASCs; we evaluated the ability of these cells to engraft into recipient dystrophic muscle after systemic delivery, to express human muscle proteins in the dystrophic host and their effect in functional performance. These results are of great interest for future therapeutic application.

Detailed molecular characterization of cord blood-derived endothelial progenitors

Objective. Given their involvement in pathological and physiological angiogenesis, there has been growing interest in understanding and manipulating endothellial progenitor cells (EPC) for therapeutic purposes. However, detailed molecular analysis of EPC before and during endothelial differentiation is lacking and is the subject of the present study. Materials and Methods. We report a detailed microarray gene-expression profile of freshly isolated (day 0) human cord blood (CB)-derived EPC (CD133(+)KDR(+) or CD34(+)KDR(+)), and at different time points during in vitro differentiation (early: day 13; late: day 27). Results. Data obtained reflect an EPC transcriptome enriched in genes related to stem/progenitor cells properties (chromatin remodeling, self-renewal, signaling, cytoskeleton organization and biogenesis, recruitment, and adhesion). Using a complementary DNA microarray enriched in intronic transcribed sequences, we observed, as well, that naturally transcribed intronic noncoding RNAs were specifically expressed at the EPC stage. Conclusion. Taken together, we have defined the global gene-expression profile of CB-derived EPC during the process of endothelial differentiation, which can be used to identify genes involved in different vascular pathologies. (C) 2008 ISEH - Society for Hematology and Stem Cells. Published by Elsevier Inc.

Análise clínica e epidemiológica do transplante de medula óssea no Serviço de Oncologia Pediátrica do Hospital de Clínicas de Porto Alegre

Objetivos: Descrever o perfil e as complicações agudas mais importantes das crianças que receberam transplante de medula óssea (TMO) em nosso Serviço. Casuística e métodos: Análise retrospectiva de 41 pacientes menores de 21 anos transplantados entre Agosto de 1997 até Junho de 2002. Deste total 20 receberam transplante alogênico e 21 receberam transplante autogênico. Resultados: No TMO alogênico a média de idade foi de 8,9 + 5,4 anos, sendo 12 pacientes do sexo masculino. As fontes de células foram: medula óssea (MO) 12, sangue periférico (SP) 5, sangue de cordão umbilical não aparentado (SCU) 3. As doenças tratadas foram leucemia linfóide aguda (LLA) 7 pacientes, leucemia linfóide crônica (LMC) 2; leucemia mielóide aguda (LMA) 4; Síndrome mielodisplásica 2; Linfoma de Burkitt 1, Anemia aplástica grave 1; Anemia de Fanconi 1; Síndrome Chediak Higashi 1; Imunodeficiência congênita combinada grave 1. Um paciente desenvolveu doença do enxerto contra hospedeiro (DECH) aguda grau 2 e três DECH grau 4. Três pacientes desenvolveram DECH crônica. Todos haviam recebido SP como fonte de células. A sobrevida global foi de 70,0 + 10,3%. A principal causa do óbito foi DECH em 3 pacientes e sépse em outros 3. Todos os óbitos ocorreram antes do dia 100. Um dos pacientes que recebeu SCU está vivo em bom estado e sem uso de medicações 3 anos e 6 meses pós TMO. No TMO autogênico, a média de idade foi de 8,7 + 4,3 anos, sendo 11 pacientes do sexo masculino. As fontes de células foram SP 16, MO 3, SP + MO 2. As doenças tratadas foram: tumor de Wilms 5; tumores da família do sarcoma de Ewing 4; neuroblastomas 3; linfomas de Hodgkin 3; rabdomiossarcomas 2, tumor neuroectodérmico primitivo do SNC 2; Linfoma não Hodgkin 1; LMA 1. A sobrevida global está em 59,4 + 11,7 %. Cinco óbitos tiveram como causa a progressão da doença de base, um óbito ocorreu devido à infecção 20 meses pós TMO e dois óbitos foram precoces por sépse. As toxicidades mais comuns em ambos os grupos foram vômitos, mucosite, diarréia e dor abdominal. Infecções foram documentadas em 58,5% dos pacientes e 46,9% tiveram no mínimo um agente isolado na hemocultura. Os tempos de enxertia de neutrófilos e plaquetas correlacionaram-se com o número de células progenitoras infundidas. Conclusão: A sobrevida de nossos pacientes é semelhante à encontrada na literatura de outros serviços nacionais e internacionais. Não encontramos diferença entre os dois tipos de transplante com relação às toxicidades agudas e ás infecções.

Quantificação de subpopulações linfocitárias no sangue do cordão umbilical de eqüinos

Este estudo visou a determinar os valores eritroleucométricos e quantificar as subpopulações linfocitárias no sangue do cordão umbilical (SCU) e no sangue jugular de eqüinos neonatos. Foi realizada a colheita de SCU e do sangue jugular de 20 potros ao nascimento. As amostras foram submetidas às determinações dos valores eritroleucométricos e à quantificação de subpopulações de linfócitos-T, pela técnica citofluorométrica. Não foram verificadas diferenças significativas (P<0,05) entre os valores médios de tais parâmetros, entre o sangue jugular de neonatos e o SCU eqüino. O valor total para neutrófilos segmentados, no SCU e na jugular dos neonatos, foi inferior ao reportado para eqüinos ao nascimento. As contagens de linfócitos CD5+ e CD4+ no SCU e jugular de neonatos eqüinos foram inferiores àquelas admitidas para o sangue periférico de eqüinos adultos, indicando um componente imunológico imaturo. No entanto, a contagem de linfócitos CD8+ foi semelhante à descrita em sangue periférico de eqüinos adultos. A proporção CD4:CD8 obtida nesse ensaio, tanto para o SCU (2,64±0,91), como no sangue jugular de eqüinos neonatos (2,41±0,81), demonstrou uma dominância das células T CD4+ sobre os linfócitos T CD8+.