Expansion of human stem cells before cell therapy is typically performed at 20% O 2 . Growth in these pro-oxidative conditions can lead to oxidative stress and genetic instability. Here, we demonstrate that culture of human mesenchymal stem cells at lower, physiological O 2 concentrations significantly increases lifespan, limiting oxidative stress, DNA damage, telomere shortening and chromosomal aberrations. Our gene expression and bioenergetic data strongly suggest that growth at reduced oxygen tensions favors a natural metabolic state of increased glycolysis and reduced oxidative phosphorylation. We propose that this balance is disturbed at 20% O 2 , resulting in abnormally increased levels of oxidative stress. These observations indicate that bioenergetic pathways are intertwined with the control of lifespan and decisively influence the genetic stability of human primary stem cells. We conclude that stem cells for human therapy should be grown under low oxygen conditions to increase biosafety. Cell Death and Differentiation (2012) 19, 743-755; doi:10.1038/cdd.2011; published online 2 December 2011Human mesenchymal stem cells (hMSC) are being evaluated for the treatment of a large variety of pathologies, including traumatic lesions and cardiovascular and autoimmune diseases. 1,2 Although hMSC can be obtained from several tissues, they are scarce and their quantity and quality depends on a patient's clinical history, age, gender and genetic background. Most cell therapy protocols use 10-50 million hMSC per treatment, requiring expansion of extracted stem cells ex vivo for about 8 weeks before implantation. This expansion is typically performed under 'standard' non-physiological culture conditions, which among other factors expose cells to 20% O 2 , roughly 10 times the oxygen concentration encountered in their natural niches. 3,4 Previous studies have shown that exposure of mammalian cells to 20% O 2 concentrations induces DNA damage, thereby contributing decisively to cell senescence and loss of viability. [5][6][7] Conversely, culture of human stem cells over a physiological range of oxygen tensions (1-5%) improves cell growth, alters differentiation processes and extends lifespan. 8 Low oxygen tensions have also been shown to reduce the levels of double-strand breaks (DSB) and chromosomal abnormalities in several types of stem cells. 9,10 This evidence suggests that the poorly defined 'cell culture stress' can be a cause of genetic instability and therefore constitute a biological risk for cell therapy protocols. In agreement with this notion, we have found that short-term growth of hMSC at 20% O 2 significantly increases oxidative stress and DNA damage markers, DSB, chromosomal aberrations, aneuploidy and telomere shortening rates compared with cells grown at 3% O 2 . Despite these clear correlations, the mechanisms underlying the generation of genetic instability at high O 2 tension are mostly unknown.Mammalian cells have developed oxygen-sensing mechanisms to maintain cell and tissue homeostasis (reviewed...