In vitro RBC production from stem cells could represent an alternative to classic transfusion products. Until now the clinical feasibility of this concept has not been demonstrated. We addressed the question of the capacity of cultured RBCs (cRBCs) to survive in humans. By using a culture protocol permitting erythroid differentiation from peripheral CD34 ؉ HSC, we generated a homogeneous population of cRBC functional in terms of their deformability, enzyme content, capacity of their hemoglobin to fix/release oxygen, and expression of blood group antigens. We then demonstrated in the nonobese diabetes/severe combined immunodeficiency mouse that cRBC encountered in vivo the conditions necessary for their complete maturation. These data provided the rationale for injecting into one human a homogeneous sample of 10 10 cRBCs generated under good manufacturing practice conditions and labeled with 51

IntroductionMesenchymal stromal cells (MSCs) are multipotent stem cells able to differentiate into mesoderm-derived cells, 1 and exhibit immunoregulatory properties. 2 MSCs have been used in the context of allogeneic hematopoietic stem cell transplantation to improve hematopoietic engraftment, to prevent graft failure, and to reduce the incidence or severity of acute graft-versus-host disease (GVHD). [3][4][5] MSCs obtained from bone marrow (BM) can undergo in vitro expansion in medium containing either fetal calf serum (FCS), with or without fibroblast growth factor (FGF-2), or platelet lysate (PL). 6 However, little is known about the effect of donor selection or culture conditions on the functional properties and therapeutic potential of clinical-grade MSCs.Recent studies have suggested that MSCs can contribute to tumor growth and metastasis. 7 A related concern is the capacity of MSCs for oncogenic transformation. Mouse MSCs show chromosomal abnormalities and are highly susceptible to transformation associated with an increased telomerase activity and myc expression, and a loss of p53 and p16. [8][9][10] In contrast, human MSCs are more resistant to transformation in vitro with no genomic instability detected and no tumor induced after long-term in vivo transfer. [11][12][13][14][15] After 20 to 50 population doublings (PDs), human MSCs undergo replicative senescence, with telomere shortening and increased p16 expression. 16 They require the same steps to achieve transformation as for differentiated cells, suggesting that they are not prone to spontaneous transformation. 17 Nevertheless, one recent study described the transformation of human adipose tissue-derived MSCs with up-regulation of myc, repression of p16, acquisition of telomerase activity, 18 and generation of carcinoma in mice. 19 We investigated the immune properties and resistance to transformation of MSCs produced in 4 cell therapy facilities during 2 multicenter clinical trials designed to evaluate the capacity of BM-MSCs to prevent acute GVHD or to treat irradiationinduced lesions. MethodsDetails regarding methods are provided in the supplemental data (available on the Blood website; see the Supplemental Materials link at the top of the online article). For personal use only. on March 28, 2019. by guest www.bloodjournal.org From (1A to 11A) were done for the GVHD prevention clinical trial, and 4 (12A, 13A2) to treat accidentally irradiated patients. For irradiated patients, 5 supplemental MSC productions (12B to 16B) were done using human PL. 6 MSC production Growth kinetics and MSC characterizationGrowth kinetics was assessed by studying total fold increase, total number of PDs, and colony-forming unit-fibroblast. MSCs were screened for the expression of CD45, CD73, CD105, CD90, and human leukocyte antigen-DR (HLA-DR) and were also checked for their capacity to stimulate the growth of allogeneic peripheral blood mononuclear cells (PBMCs) and to inhibit alloantigen-driven proliferation of PBMCs. Cytogenetic analysisAt the end of the first (P ...

This study showed that significant improvement in healing outcomes could be achieved by the use of BMC containing MSC as an adjunct therapy in standard of care rotator cuff repair. Furthermore, our study showed a substantial improvement in the level of tendon integrity present at the ten-year milestone between the MSC-treated group and the control patients. These results support the use of bone marrow-derived MSC augmentation in rotator cuff repair, especially due to the enhanced rate of healing and the reduced number of re-tears observed over time in the MSC-treated patients.

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Background:One of the reasons for bone remodeling leading to an insufficient creeping substitution after osteonecrosis in the femoral head may be the small number of progenitor cells in the proximal femur and the trochanteric region. Because of this lack of progenitor cells, treatment modalities should stimulate and guide bone remodeling to sufficient creeping substitution to preserve the integrity of the femoral head. Core decompression with bone graft is used frequently in the treatment of osteonecrosis of the femoral head. In the current series, grafting was done with autologous bone marrow obtained from the iliac crest of patients operated on for early stages of osteonecrosis of the hip before collapse with the hypothesis that before stage of subchondral collapse, increasing the number of progenitor cells in the proximal femur will stimulate bone remodeling and creeping substitution and thereby improve functional outcome.Materials and Methods:Between 1990 and 2000, 342 patients (534 hips) with avascular osteonecrosis at early stages (Stages I and II) were treated with core decompression and autologous bone marrow grafting obtained from the iliac crest of patients operated on for osteonecrosis of the hip. The percentage of hips affected by osteonecrosis in this series of 534 hips was 19% in patients taking corticosteroids, 28% in patients with excessive alcohol intake, and 31% in patients with sickle cell disease. The mean age of the patients at the time of decompression and autologous bone marrow grafting was 39 years (range: 16–61 years). The aspirated marrow was reduced in volume by concentration and injected into the femoral head after core decompression with a small trocar. To measure the number of progenitor cells transplanted, the fibroblast colony forming unit was used as an indicator of the stroma cell activity.Results:Patients were followed up from 8 to 18 years. The outcome was determined by the changes in the Harris hip score, progression in radiographic stages, change in volume determined by digitizing area of the necrosis on the different cuts obtained on MRI, and by the need for hip replacement. Total hip replacement was necessary in 94 hips (evolution to collapse) among the 534 hips operated before collapse (Stages I and II). Sixty-nine hips with stage I osteonecrosis of the femoral head at the time of surgery demonstrated total resolution of osteonecrosis based on preoperative and postoperative MRI studies; these hips did not show any changes on plain radiographs. Before treatment, these 69 osteonecrosis had only a marginal band like pattern as abnormal signal and a volume less than 20 cubic centimeters. The intralesional area had kept a normal signal as regards the signal of the femoral head outside the osteonecrosis area. For the 371 other hips without collapse at the most recent follow up (average 12 years), the mean preoperative volume of the osteonecrosis was 26 cm3 (minimum 12, maximum 30 cm3). The mean volume of the abnormal signal measured on MRI at the most recent follow up (mean 12 y...