“…We recently discovered that GE itself, coupled with ex vivo culture, culminates into a p53mediated DNA damage response (DDR) activation leading to cell differentiation, loss of engraftment, and reduced graft clonality 16,[19][20][21] . Importantly, a set of data mainly obtained in mouse settings indicates that proliferating stem cells accumulate elevated levels of DNA replication stress, manifesting in the accumulation of DNA single-strand breaks (SSBs) [22][23][24] , spontaneous mutations or chromosomal abnormalities, and production of reactive oxidative species (ROS) and metabolic changes [25][26][27] , ultimately resulting in stem cell dysfunction. Similarly, it was reported that other stimuli, such as osmotic stress and pro-inflammatory cytokines, may trigger the stress kinase p38 mitogen-activated protein kinase (MAPK), resulting in differentiation and loss of HSC selfrenewal 26,28,29 .…”