Hematopoietic stem cell (HSC) transplantation (HSCT) for malignancy requires toxic preconditioning to maximize anti-tumor effects and donor-HSC engraftment. While this induces bone marrow (BM)-localized inflammation, how this BM environmental change affects transplanted HSCs in vivo remains largely unknown. We here report that, depending on interval between irradiation and HSCT, residence within lethally irradiated recipient BM compromises donor-HSC reconstitution ability. Both in vivo and in vitro we demonstrate that, among inflammatory cytokines, TNF-a plays a role in HSC damage: TNF-a stimulation leads to accumulation of reactive oxygen species (ROS) in highly purified hematopoietic stem/progenitor cells (HSCs/HSPCs). Transplantation of flow-cytometry-sorted murine HSCs reveals damaging effects of accumulated ROS on HSCs. Shortterm incubation either with an specific inhibitor of tumor necrosis factor receptor 1 signaling or an antioxidant N-acetyl-L-cysteine (NAC) prevents TNF-a-mediated ROS accumulation in HSCs. Importantly, pre-transplantation exposure to NAC successfully demonstrats protective effects in inflammatory BM on graft-HSCs, exhibiting better reconstitution capability than that of nonprotected control grafts. We thus suggest that in vivo protection of graft-HSCs from BM inflammation is a feasible and attractive approach, which may lead to improved hematopoietic reconstitution kinetics in transplantation with myeloablative conditioning that inevitably causes inflammation in recipient BM. STEM CELLS 2017;35:989-1002
SIGNIFICANCE STATEMENTThis study shows the following: (a) depending on interval between TBI and HSCT, residence within lethally irradiated recipient BM compromises donor-HSC reconstitution ability; (b) elevated levels of TNF-a in inflamed BM is responsible for the effect; (c) TNF-a induces formation of ROS through an NADPH oxidase in donor HSCs, leading to impaired reconstitution ability; (d) Pre-incubation with an antioxidant NAC that suppresses TNF-a-stimulated ROS production successfully protects transplanted HSCs from BM inflammation. We eventually came up with the proposal of "in vivo stem cell protection" as a novel therapeutic concept in HSCT. These findings have implications for the basic HSC biology and for the improvement of an HSCT outcome for patients.