Effect of ginsenoside Rg1 on hematopoietic stem cells in treating aplastic anemia in mice via MAPK pathway

BACKGROUND Aplastic anemia(AA)presents a significant clinical challenge as a life-threatening condition due to failure to produce essential blood cells,with the current the-rapeutic options being notably limited.AIM To assess the therapeutic potential of ginsenoside Rg1 on AA,specifically its protective effects,while elucidating the mechanism at play.METHODS We employed a model of myelosuppression induced by cyclophosphamide(CTX)in C57 mice,followed by administration of ginsenoside Rg1 over 13 d.The invest-igation included examining the bone marrow,thymus and spleen for pathological changes via hematoxylin-eosin staining.Moreover,orbital blood of mice was collected for blood routine examinations.Flow cytometry was employed to identify the impact of ginsenoside Rg1 on cell apoptosis and cycle in the bone marrow of AA mice.Additionally,the study further evaluated cytokine levels with enzyme-linked immunosorbent assay and analyzed the expression of key proteins in the MAPK signaling pathway via western blot.RESULTS Administration of CTX led to significant damage to the bone marrow’s structural integrity and a reduction in hematopoietic cells,establishing a model of AA.Ginsenoside Rg1 successfully reversed hematopoietic dysfunction in AA mice.In comparison to the AA group,ginsenoside Rg1 provided relief by reducing the induction of cell apoptosis and inflammation factors caused by CTX.Furthermore,it helped alleviate the blockade in the cell cycle.Treatment with ginsenoside Rg1 significantly alleviated myelosuppression in mice by inhibiting the MAPK signaling pathway.CONCLUSION This study suggested that ginsenoside Rg1 addresses AA by alleviating myelosuppression,primarily through modulating the MAPK signaling pathway,which paves the way for a novel therapeutic strategy in treating AA,highlighting the potential of ginsenoside Rg1 as a beneficial intervention.

The related effects of astragalus polysaccharides on the improvement of bone marrow suppression and hematopoietic stem cells during chemotherapy in elderly patients with lung cancer

Objective:To investigate the effects of astragalus polysaccharides(APS)on bone marrow suppression and hematopoietic stem cells during chemotherapy in elderly patients with lung cancer.Methods:120 elderly patients with lung cancer treated in the first hospital of Xingtai city from January 2019 to early December 2019 were divided into the treatment group and the control group by the random number table method,all of whom received pemetrexed+carboplatin chemotherapy,and the treatment group was treated with APS at the same time.The efficacy was evaluated after 2 cycles of chemotherapy,bone marrow suppression was observed,and levels of TCM symptoms score,peripheral blood T lymphocyte subgroup index,L-selectin(CD62L)and macrophage differentiation antigen-1(Mac-1)were measured before and after 2 cycles of chemotherapy.Results:The response rate(RR)was 56.67%in the treatment group and 45.00%in the control group,with no statistically significant difference(P>0.05);The disease control rate(DCR)in the treatment group was 81.67%,which was significantly higher than 65.00%in the control group(P<0.05);The reduction degree of leukopenia in the treatment group was significantly lower than that in the control group(P<0.05);The treatment group had a platelet reduction of grade 1+2 at a rate of 40.00%,and hemoglobin reduction of grade 1+2 at a rate of 28.33%,which were significantly lower than the control group at 65.00%and 58.33%(P<0.05);Compared with those before chemotherapy,the total score of TCM symptoms,serum CD62L and Mac-1 levels in the two groups all decreased significantly after chemotherapy,and they were significantly lower in the treatment group than in the control group(P<0.05);After chemotherapy,CD3+,CD4+and CD4+/CD8+in the treatment group increased significantly and they were all higher in the treatment group than in the control group,while CD8+decreased significantly and was lower in the treatment group than in the control group(P<0.05).There was no statistically significant difference in T lymphocyte subsets before and after chemotherapy in the control group(P>0.05).Conclusion:Astragalus polysaccharide can improve the chemotherapy effect and improve the bone marrow suppression in elderly patients with lung cancer,which may be related to its obvious enhancement of immune function and decrease of CD62L and Mac-1 levels.

Local signals in stem cell-based bone marrow regeneration

The cellular basis of bone marrow （BM） tissue development and regeneration is mediated through hematopoietic stem cells （HSCs） and mesenchymal stem cells （MSCs）. Local interplays between hematopoietic cells and BM stromal cells （BMSCs） determine the reconstitution of hematopoiesis after myelosuppression. Here we review the BM local signals in control of BM regeneration after insults. Hematopoietic growth factors （HGFs） and cytokines produced by BMSCs are primary factors in regulation ofBM hematopoiesis. Morphogens which are critical to early embryo development in multiple species have been added to the family of HSCs regulators, including families of Wnt proteins, Notch ligands, BMPs, and Hedgehogs. Global gene expression analysis of HSCs and BMSCs has begun to reveal signature groups of genes for both cell types. More importantly, analysis of global gene expression coupled with biochemical and biological studies of local signals during BM regeneration have strongly suggested that HGFs and cytokines may not be the primary local regulators for BM recovery, rather chemokines （SDF- 1, FGF-4） and angiogenic growth factors （VEGF-A, Ang- 1） play instructive roles in BM reconstitution after myelosuppression. A new direction of management of BM toxicity is emerging from the identification of BM regenerative regulators.

Growing and aging of hematopoietic stem cells

In the hematopoietic system, a small number of stem cells produce a progeny ofseveral distinct lineages. During ontogeny, they arise in the aorta-gonadmesonephrosregion of the embryo and the placenta, afterwards colonise the liverand finally the bone marrow. After this fetal phase of rapid expansion, thenumber of hematopoietic stem cells continues to grow, in order to sustain theincreasing blood volume of the developing newborn, and eventually reaches asteady-state. The kinetics of this growth are mirrored by the rates of telomereshortening in leukocytes. During adulthood, hematopoietic stem cells undergo avery small number of cell divisions. Nonetheless, they are subjected to aging,eventually reducing their potential to produce differentiated progeny. The causalrelationships between telomere shortening, DNA damage, epigenetic changes,and aging have still to be elucidated.

Bone marrow cell death and proliferation: Controlling mechanisms in normal and leukemic state

Bone marrow cell death and proliferation are regulated by multiple factors including genetic and epigenetic alterations of hematopoietic cells, crosstalk of hematopoietic cells with bone marrow mesenchymal cells through direct cell-cell interaction or cytokine/chemokine production, vascularity of the bone marrow, and interactions of sympathetic nerve system with hematopoiesis. Cell proliferation usually predominates over cell death in neoplastic processes such as leukemia and myeloproliferative neoplasms, while apoptotic processes also have a significant role in the pathogenesis of myelodysplastic syndromes. Recently, hematopoietic stem cells(HSCs) and leukemia stem cells(LSCs) have been identif ied and their characters on self renewal process, differentiation, cell dynamics and drug resistance have been implicated. Although most leukemia cells are initially sensitive to chemo- or radiotherapy, LSCs are resistant and considered to be the basis for disease relapse after initial response. HSCs and LSCs may use similar interactions with bone marrow microenvironment. However, bone marrow microenvironment called niche should inf luence the normal as well as malignant hematopoiesis in different manners. Recent studies have expanded the number of cell types constituting bone marrow niche and made the issue more complex. Since the majority of excellent and contributing studies on bone marrow niches have been performed in animal models, niches in human tissues are beginning to be localized and characterized. In this article, we summarize the relation of hematopoietic cells with niches and hope to point a hint to the novel strategy for treatment of malignant proliferation of hematopoietic cells.

Impact of T cells on hematopoietic stem and progenitor cell function:Good guys or bad guys?

When hematopoietic stem and progenitor cells(HSPC)are harvested for transplantation, either from the bone marrow or from mobilized blood, the graft contains a significant number of T cells. It is these T cells that are the major drivers of graft-vs-host disease(Gv HD). The risk for Gv HD can simply be reduced by the removal of these T cells from the graft. However, this is not always desirable, as this procedure also decreases the engraftment of the transplanted HSPCs and, if applicable, a graft-vs-tumor effect. This poses an important conundrum in the field: T cells act as a double-edged sword upon allogeneic HSPC transplantation, as they support engraftment of HSPCs and provide anti-tumor activity, but can also cause Gv HD. It has recently been suggested that T cells also enhance the engraftment of autologous HSPCs, thus supporting the notion that T cells and HSPCs have an important functional interaction that is highly beneficial, in particular during transplantation. The underlying reason on why and how T cells contribute to HSPC engraftment is still poorly understood. Therefore, we evaluate in this review the studies that have examined the role of T cells during HSPC transplantation and the possible mechanisms involved in their supporting function. Understanding the underlying cellular and molecular mechanisms can provide new insight into improving HSPC engraftment and thus lower the number of HSPCs required during transplantation. Moreover, it could provide new avenues to limit the development of severe Gv HD, thus making HSPC transplantations more efficient and ultimately safer.

How mesenchymal stem cell cotransplantation with hematopoietic stem cells can improve engraftment in animal models

BACKGROUND Bone marrow transplantation(BMT)can be applied to both hematopoietic and nonhematopoietic diseases;nonetheless,it still comes with a number of challenges and limitations that contribute to treatment failure.Bearing this in mind,a possible way to increase the success rate of BMT would be cotransplantation of mesenchymal stem cells(MSCs)and hematopoietic stem cells(HSCs)to improve the bone marrow niche and secrete molecules that enhance the hematopoietic engraftment.AIM To analyze HSC and MSC characteristics and their interactions through cotransplantation in murine models.METHODS We searched for original articles indexed in PubMed and Scopus during the last decade that used HSC and MSC cotransplantation and in vivo BMT in animal models while evaluating cell engraftment.We excluded in vitro studies or studies that involved graft versus host disease or other hematological diseases and publications in languages other than English.In PubMed,we initially identified 555 articles and after selection,only 12 were chosen.In Scopus,2010 were identified,and six were left after the screening and eligibility process.RESULTS Of the 2565 articles found in the databases,only 18 original studies met the eligibility criteria.HSC distribution by source showed similar ratios,with human umbilical cord blood or animal bone marrow being administered mainly with a dose of 1×10^(7) cells by intravenous or intrabone routes.However,MSCs had a high prevalence of human donors with a variety of sources(umbilical cord blood,bone marrow,tonsil,adipose tissue or fetal lung),using a lower dose,mainly 106 cells and ranging 104 to 1.5×107 cells,utilizing the same routes.MSCs were characterized prior to administration in almost every experiment.The recipient used was mostly immunodeficient mice submitted to low-dose irradiation or chemotherapy.The main technique of engraftment for HSC and MSC cotransplantation evaluation was chimerism,followed by hematopoietic reconstitution and survival analysis.Besides the engraftment,homing and cellularity were also evaluated in some studies.CONCLUSION The preclinical findings validate the potential of MSCs to enable HSC engraftment in vivo in both xenogeneic and allogeneic hematopoietic cell transplantation animal models,in the absence of toxicity.

Hematopoietic cell transplantation for Crohn’s disease;is it time?

AIM： To review all studies in the literature that have assessed Hematopoietic cell transplantation （HCT） and Crohn＇s disease （CD） with the ultimate aims of determining if this is a viable treatment option for those with CD. A secondary aim was to review the above literature and determine if the studies shed further light on the mechanisms involved in the pathogenesis of CD. METHODS： An extensive Medline search was performed on all articles from 1970 to 2005 using the keywords; bone marrow transplant, stem cell, hematopoietic cell, Crohn＇s disease and inflammatory bowel disease. RESULTS： We identified one case in which a patient developed CD following an allogeneic HCT from a sibling suffering with CD. Evidence for transfer of the genetic predisposition to develop CD was also identified with report of a patient that developed severe CD following an allogeneic HCT. Following HCT it was found that the donor （that had no signs or symptoms of CD） and the recipient had several haplotype mismatches in HLA class 111 genes in the IBD3 locus including a polymorphism of NOD2/CARD15 that has been associated with CD. Thirty three published cases of patients with CD who underwent either autologous or allogeneic HCT were identified. At the time of publication 29 of these 33 patients were considered to be in remission. The median follow-up time was seven years, and twenty months for allogeneic and autologous HCT respectively. For patients who underwent HCT primarily for treatment of their CD there have been no mortalities related to transplant complications. CONCLUSION： Overall these preliminary data suggest that both allogeneic and autologous HCT may be effective in inducing remission in refractory CD. This supports the hypothesis that the hematolymphatic cells play a key role in CD and that resetting of the immune system may be a critical approach in the management or cure of CD.

Regulatory role of sphingosine kinase and sphingosine-1-phosphate receptor signaling in progenitor/stem cells

Balanced sphingolipid signaling is important for the maintenance of homeostasis. Sphingolipids were demonstrated to function as structural components, second messengers, and regulators of cell growth and survival in normal and disease-affected tissues. Particularly, sphingosine kinase 1 (SphK1) and its product sphingosine-1-phosphate (S1P) operate as mediators and facilitators of proliferation-linked signaling. Unlimited proliferation (selfrenewal) within the regulated environment is a hallmark of progenitor/stem cells that was recently associated with the S1P signaling network in vasculature, nervous,muscular, and immune systems. S1P was shown to regulate progenitor-related characteristics in normal and cancerstemcells(CSCs) viaG-protein coupled receptorsS1Pn(n=1 to 5). The SphK/S1P axis is crucially involved in the regulation of embryonic development of vasculature and the nervous system, hematopoietic stem cell migration, regeneration of skeletal muscle, and development of multiple sclerosis. The ratio of the S1P receptor expression, localization, and specific S1P receptoractivated downstream effectors influenced the rate of selfrenewal and should be further explored as regeneration related targets. Considering malignant transformation,it is essential to control the level of self-renewal capacity.Proliferation of the progenitor cell should be synchronized with differentiation to provide healthy lifelong function of blood, immune systems, and replacement of damaged ordead cells. The differentiation-related role of SphK/S1P remains poorly assessed. A few pioneering investigations exploredpharmacologicaltoolsthattargetsphingolipid signaling and can potentially confine and direct self-renewal towards normal differentiation. Further investigation is required to test the role of the SphK/S1P axis in regulation of self-renewal and differentiation.

Mechanisms of action of neuropeptide Y on stem cells and its potential applications in orthopaedic disorders

Musculoskeletal disorders are the leading causes of disability and result in reduced quality of life.The neuro-osteogenic network is one of the most promising fields in orthopaedic research.Neuropeptide Y(NPY)system has been reported to be involved in the regulations of bone metabolism and homeostasis,which also provide feedback to the central NPY system via NPY receptors.Currently,potential roles of peripheral NPY in bone metabolism remain unclear.Growing evidence suggests that NPY can regulate biological actions of bone marrow mesenchymal stem cells,hematopoietic stem cells,endothelial cells,and chondrocytes via a local autocrine or paracrine manner by different NPY receptors.The regulative activities of NPY may be achieved through the plasticity of NPY receptors,and interactions among the targeted cells as well.In general,NPY can influence proliferation,apoptosis,differentiation,migration,mobilization,and cytokine secretion of different types of cells,and play crucial roles in the development of bone delayed/non-union,osteoporosis,and osteoarthritis.Further basic research should clarify detailed mechanisms of action of NPY on stem cells,and clinical investigations are also necessary to comprehensively evaluate potential applications of NPY and its receptor-targeted drugs in management of musculoskeletal disorders.

Optimal stem cell source for allogeneic stem cell transplantation for hematological malignancies

Hematopoietic stem cell transplant(HSCT) is a standard treatment for many hematological malignancies.Three different sources of stem cells, namely bone marrow(BM), peripheral blood stem cells(PBSC) and cord blood(CB) can be used for HSCT, and each has its own advantages and disadvantages. Randomized controlled trials(RCTs) suggest that there is no significant survival advantage of PBSC over BM in Human Leukocyte Antigen-matched sibling transplant for adult patients with hematological malignancies. PBSC transplant probably results in lower risk of relapse and hence better disease-free survival, especially in patients with high risk disease at the expense of higher risks of both severe acute and chronic graft-versus-host disease(GVHD).In the unrelated donor setting, the only RCT available suggests that PBSC and BM result in comparable overall and disease-free survivals in patients with hematological malignancies; and PBSC transplant results in lower risk of graft failure and higher risk of chronic GVHD.High level evidence is not available for CB in comparison to BM or PBSC. The risks and benefits of different sources of stem cells likely change with different conditioning regimen, strategies for prophylaxis and treatment of GVHD and manipulation of grafts. The recent success and rapid advance of double CB transplant and haploidentical BM and PBSC transplants further complicate the selection of stem cell source. Optimal selection requires careful weighing of the risks and benefits of different stem cell source for each individual recipient and donor. Detailed counseling of patient and donor regarding risks and benefits in the specific context of the patient and transplant method is essential for informed decision making.

Stem cells of the reproductive tract of women

Research in stem cells is one of the most rapidly evolving fields of investigation in medicine today. Stem cells are defined as cells that have the capacity to both generate daughter cells identical to the cell of origin (self-renewal) and to produce progeny with more restricted, specialized potential (differentiated cells). This dual ability to self-renew and differentiate offers great promise for expanding our understanding of organ systems, elucidating disease pathophysiology, and creating therapeutic approaches to difficult diseases. The goal of this review is to offer an overview of the different types of stem cells and to provide an introduction to the applications of stem cells to the field of obstetrics and gynecology.

Guilu Erxian Glue(龟鹿二仙胶)Inhibits Chemotherapy-Induced Bone Marrow Hematopoietic Stem Cell Senescence in Mice May via p16INK4a-Rb Signaling Pathway

Objective To evaluate the effect of Guilu Erxian Glue(龟鹿二仙胶,GEG)on cyclophosphamide(CTX)-induced bone marrow hematopoietic stem cells(HSCs)senescence in mice and explore the underlying mechanism.Methods The H22 liver cancer ascites lump model was established in male Kunming mice by injecting intraperitoneally(i.p.)with 5×10^6/mL H22 cells per mouse.Fifty tumor-bearing mice were divided into the control,model,pifithrin-α,GEG,and GEG+pifithrin-αgroups using a random number table,10 mice in each group.CTX(100 mg/kg i.p.)was administrated to mice from day 1 to day 3(d1–d3)continuously except for the control group.The mice in the pifithrin-α,GEG and GEG+pifithrin-αgroups were treated with pifithrin-α(2.2 mg/(kg·d)i.p.)for 6 consecutive days(d4–d9),GEG(9.5 g/(kg·d)i.p.)for 9 consecutive days(d1–d9),and GEG plus pifithrin-α,respectively.HSCs were collected after 9-d drug treatment.The anti-aging effect of GEG was studied by cell viability,cell cycle,andβ-galactosidase(β-gal)assays.The mRNA and protein expressions of cyclin-dependent kinase 2(CDK2),CDK4,inhibitor of cyclin-dependent kinase 4a encoding the tumor suppressor protein p16^(p16^INK4a),p21^Cip1/Waf1,p53,and phosphorylated retinoblastoma(pRb)were evaluated by quantitative real-time reverse transcription-polymerase chain reaction and semi-quantitative Western blot,respectively.Results Compared with the model group,GEG increased cell viability as well as proliferation(P<0.05 or P<0.01)and reducedβ-gal expression.Furthermore,GEG significantly decreased the expressions of p16^INK4a,p53 and p21^Cip1/Waf1 proteins,and increased the expressions of CDK2,CDK4 and pRb proteins compared with the model group(P<0.05 or P<0.01).Conclusion GEG can alleviate CTX-induced HSCs senescence in mice,and the p16^INK4a-Rb signaling pathway might be the underlying mechanism.

Influence of the degree of donor bone marrow hyperplasia on patient clinical outcomes after allogeneic hematopoietic stem cell transplantation

This study evaluated the influence of the degree of donor bone marrow(BM)hyperplasia on patient clinical outcomes after allogeneic hematopoietic stem cell transplantation(allo-HSCT).Twelve patients received allo-HSCT from hypoplastic BM donors between January 2010 and December 2017.Forty-eight patients whose donors demonstrated BM hyperplasia were selected using a propensity score matching method(1:4).Primary graft failure including poor graft function and graft rejection did not occur in two groups.In BM hypoplasia and hyperplasia groups,the cumulative incidence(CI)of neutrophil engraftment at day 28(91.7%vs.93.8%,P=0.75),platelet engraftment at day 150(83.3%vs.93.8%,P=0.48),the median time to myeloid engraftment(14 days vs.14 days,P=0.85)and platelet engraftment(14 days vs.14 days,P=0.85)were comparable.The 3-year progression-free survival,overall survival,CI of non-relapse mortality and relapse were 67.8%vs.71.7%(P=0.98),69.8%vs.77.8%(P=0.69),18.5%vs.13.6%(P=0.66),and 10.2%vs.10.4%(P=0.82),respectively.In multivariate analysis,donor BM hypoplasia did not affect patient clinical outcomes after allo-HSCT.If patients have no other suitable donor,a donor with BM hypoplasia can be used for patients receiving allo-HSCT if the donor Complete Blood Count and other examinations are normal.

小剂量骨髓联合外周血造血干细胞移植治疗重型再生障碍性贫血18例临床研究

目的:探讨小剂量骨髓联合外周血造血干细胞(PBSC)移植治疗重型再生障碍性贫血(SAA)的疗效及安全性。方法:纳入以小剂量骨髓(中位体积200 mL)联合PBSC移植治疗的18例SAA患者的临床资料,回顾分析其造血重建情况、移植物抗宿主病(GVHD)发生率、感染发生率及生存率等指标。结果:18例患者的中位年龄27(13~52)岁,男11例,女7例;SAA-Ⅰ型15例,SAA-Ⅱ型3例;单倍体相合供者15例,同胞全相合供者3例;预处理:氟达拉滨+环磷酰胺+抗人胸腺球蛋白方案2例,氟达拉滨+环磷酰胺+移植后环磷酰胺方案8例,氟达拉滨+环磷酰胺+抗人胸腺球蛋白+移植后环磷酰胺方案8例;采用环孢素或他克莫司+短疗程甲氨蝶呤联合吗替麦考酚酯预防GVHD。所有患者均获得造血重建,仅1例患者出现继发性移植物功能不良;10例(55.6%)出现总计19例次移植后感染,其中10例次为巨细胞病毒(CMV)或EB病毒(EBV)血症,6例次细菌感染;急性GVHD发生率为16.7%,其中Ⅰ度1例,Ⅱ度2例;慢性GVHD发生率为16.7%,均为轻度;中位随访26(2~64)个月,移植后2年总生存率为72.2%(95%CI:51.4~93.0)。5例患者死亡,4例死于肺部感染,1例死于颅内感染。结论:采用小剂量骨髓联合PBSC是SAA患者进行造血干细胞移植的有效且可行的移植物选择策略。

父供女HLA半相合造血干细胞移植后供者DC-CIK细胞输注治疗儿童难治复发性急性髓细胞白血病1例并文献复习

目的探索儿童难治复发性急性髓细胞白血病的治疗方法。方法对1例难治复发性急性髓细胞白血病M1患儿,行父供女人类白细胞抗原(HLA)半相合造血干细胞移植,移植前骨髓原始粒细胞16%,原幼单核细胞44.5%,未缓解。供者为其父亲,HLA半相合;预处理方案采用洛莫司汀+阿糖胞苷+白消安+环磷酰胺+抗胸腺细胞球蛋白(ATG);用骁悉、环孢素、甲氨蝶呤及ATG预防移植物抗宿主病(GVHD)。结果患儿移植后14 d造血功能重建,移植后21 d复查骨髓完全缓解,骨髓染色体检查完全转为供者型,移植后23 d开始每周输注供者树突状细胞-细胞因子诱导为杀伤细胞(DC-CIK)共5次,细胞数按梯度递增。患者定期监测血常规各项指标均基本正常,移植后130 d复查骨髓示完全缓解,现继续随访中。结论供者DC-CIK细胞过继性治疗降低了异基因造血干细胞移植后白血病的复发概率,是有效且值得探索的新手段。

吉林骨髓库汉族造血干细胞捐献者HLA-A、B、DRB1基因分布和单体型分析

目的了解中国造血干细胞捐献者资料库吉林分库HLA基因及单体型分布特征。方法采用PCR-SSP、PCR-SSO和PCR-SBT法对吉林分库内10 120份吉林籍汉族捐献者HLA-A、B、DRB1基因低分辨分型,用Excel软件计算HLA基因频率、单倍型频率及其连锁不平衡参数。结果吉林分库内汉族捐献者的HLA-A、B、DRB1基因(含血清学特异性)分别有21、45、13种,频率高的基因是:A*02、A*24、A*11、A*30,B*13、B*60、B*61、B*62、B*35、B*46、B*51,DR*01、DR*03、DR*04、DR*07、DR*09、DR*12、DR*15。HLA单体型分布,两座位连锁频率较高的有:A30-B13、A02-B46、A02-B61、A02-B58,B13-DR07、B13-DR12、B46-DR09、B61-DR09,A2-DR09、A30-DR07、A02-DR12、A02-DR15;三座位连锁频率较高的是:A30-B13-DR07、A02-B46-DR09、A02-B13-DR12、A02-B61-DR09。结论为临床造血干细胞移植寻找合适匹配的供受对,以及吉林地区汉族人群HLA基因多态性与HLA相关疾病的研究提供了有意义的参照数据。

HLA不全相合造血干细胞联合脐血移植治疗急性白血病的临床观察

目的观察HLA不全相合造血干细胞联合脐血移植治疗急性白血病的有效性及安全性。方法 2008年6月～2010年12月本科20名急性白血病患者接受HLA不全相合造血干细胞联合脐血移植,和同期进行的HLA不全相合造血干细胞移植的51名急性白血病患者,进行造血重建、植入,移植相关并发症和疗效方面的比较。结果联合移植组平均输入脐血有核细胞数2.96×107/kg,CD34+细胞2.99×105/kg;1名患者未植入,ANC≥0.5×109/L的平均时间为12.6±2.50 d,Plt≥20×109/L的平均时间为17.2±3.70 d和对照组均无显著差异(P>0.05);植入检查均为完全供者型;联合移植组Ⅲ～Ⅳ度的严重aGVHD的发生率为5.0%显著低于对照组的11.7%(P<0.05);1年OS联合移植组为80%优于对照组的72.5%(P<0.05);两组间cGVHD发生率、复发率和感染并发症的比较无统计学意义(P>0.05)。结论 HLA不全相合造血干细胞联合脐血移植降低严重aGVHD的发生率,提高长期生存率,是对HLA不全相合造血干细胞移植方法的改良,临床应用安全有效。

HLA半相合外周血造血干细胞移植治疗急性白血病的临床观察

目的:探讨HLA半相合外周血造血干细胞移植(peripheral blood stem cell transplantation,PBSCT)治疗急性白血病的效果及安全性。方法:4例急性白血病行HLA半相合PBSCT,其中急性淋巴细胞白血病2例,急性非淋巴细胞白血病2例,移植时均处于完全缓解状态。HLA配型1、2个位点不合各1例,3个位点不合2例。预处理方案由全身照射或白消安、阿糖胞苷、环磷酰胺、甲基洛莫司汀组成。移植物抗宿主病(graft versus host disease,GVHD)的预防采用环胞素、甲氨蝶呤、麦考酚吗乙酯、抗胸腺细胞球蛋白四联方案。结果:4例均获得造血功能重建。2例出现Ⅰ度急性GVHD,2例出现Ⅱ度急性GVHD。1例并发巨细胞病毒间质性肺炎,2例并发真菌肺炎。至今3例无病存活29、15和2个月,1例死亡。结论:HLA半相合PBSCT疗效较好、安全可行,为无HLA完全相合供者的白血病患者提供了新的治疗手段,但要特别注意移植后病毒和真菌感染的防治。

辐照小鼠骨髓移植后造血和免疫系统重建的动态过程

目的研究小鼠骨髓移植后造血和免疫系统重建的动态过程,为优化造血干细胞移植治疗方案和药物研究提供支持。方法60只CD45.2^(+)雄性C57BL/6小鼠作为受体鼠,随机均分为正常对照组和移植组,移植组经致死剂量钴60射线全身照射后,经尾静脉输注移植CD45.1^(+)雄性C57BL/6小鼠骨髓细胞,正常对照组尾静脉注射等体积PBS。移植后1,2,4,8和16周取2组受体鼠外周血、脾、淋巴结、胸腺和骨髓,外周血进行血常规检测,其他样本制备细胞悬液后利用自动细胞计数仪测定细胞总数,用荧光抗体染色,用流式细胞术分析髓系白细胞和红细胞祖细胞比例、巨核细胞及其祖细胞比例及造血干细胞比例。结果骨髓移植后4周,移植组小鼠外周血白细胞和红细胞数量恢复至正常对照组同等或更高水平(P<0.05);血小板数量虽有明显恢复,但直至16周仍低于正常对照组(P<0.05)。骨髓移植后4周,移植组小鼠外周血、脾、淋巴结和骨髓中髓系白细胞和B细胞及骨髓中巨核细胞和红细胞祖细胞的比例恢复至正常对照组同等水平,且髓系白细胞和B细胞均由自供体的CD45.1^(+)细胞占据主导地位。骨髓移植后8周,移植组受体小鼠外周血、脾、淋巴结、胸腺和骨髓中T细胞的比例恢复至正常对照组相同水平,并以CD45.1^(+)T细胞占据主导地位。结论骨髓移植后8周,受体小鼠的造血和免疫系统重建基本完成,但不同细胞的重建速度及同种细胞在不同部位的重建动态过程具有较大差异。