Versatile stem cells, young and old. A review.

Both embryonic and somatic stem cells have been studied in recent years with particular regard to their differentiation potential. In vitro studies allow a considerable amplification of such cells in culture as well as the induction of commitment in different directions under proper stimulating factors. Moreover, a surprising versatility has been discovered,which makes possible a ;reprogramming' of stem cells into a lineage pathway which may be completely different from the expected direction: for instance, a production of brain cells from blood progenitors has been obtained. It is thus possible to envisage methods of producing in culture sufficient amounts of stem cells, committed to a certain pathway, which can be transplanted in vivo to replace damaged tissues and organs.

Cytokine effect on ex vivo expansion of haemopoietic stem cells from different human sources.

Human pluripotential stem cells (PSC) are currently the target for transplantation attempts and genetic manipulation. We have therefore investigated the frequency and the expansion potential of PSC's in different types of blood samples. CD 34+ cells were thus obtained from human bone marrow (BM), as well as from peripheral blood (PB) and cord blood (CB) samples. After immuno-magnetic separation the highest yields of CD 34+ cells were from BM (1.08-2.25%) and CB (0.42-1.32%) while PB samples gave much lower values. Suspension cultures of PSC's from the three sources were then set up, in the presence of combinations of haemopoietic growth factors. A remarkable amplification of the nucleated cell pool was observed reaching a maximum between 10 and 15 days of culture; earliest and maximum expansion (up to 220-fold) was achieved when Erythropoietin (Epo) was added to the culture medium, but this resulted in reduction of colony-forming cells and differentiation into erythroid progenitors. Clonogenic tests for BFU-E's derived colonies showed a peak value at 5 days of liquid culture. Further studies are advisable to establish the best cytokine combination for a valuable ex vivo expansion, coupled with preservation of stem cell properties.

Cytokine effect on ex vivo expansion of haemopoietic stem cells from different human sources.

Human pluripotential stem cells (PSC) are currently the target for transplantation attempts and genetic manipulation. We have therefore investigated the frequency and the expansion potential of PSC's in different types of blood samples. CD 34+ cells were thus obtained from human bone marrow (BM), as well as from peripheral blood (PB) and cord blood (CB) samples. After immuno-magnetic separation the highest yields of CD 34+ cells were from BM (1.08-2.25%) and CB (0.42-1.32%) while PB samples gave much lower values. Suspension cultures of PSC's from the three sources were then set up, in the presence of combinations of haemopoietic growth factors. A remarkable amplification of the nucleated cell pool was observed reaching a maximum between 10 and 15 days of culture; earliest and maximum expansion (up to 220-fold) was achieved when Erythropoietin (Epo) was added to the culture medium, but this resulted in reduction of colony-forming cells and differentiation into erythroid progenitors. Clonogenic tests for BFU-E's derived colonies showed a peak value at 5 days of liquid culture. Further studies are advisable to establish the best cytokine combination for a valuable ex vivo expansion, coupled with preservation of stem cell properties.

Mammalian artificial chromosomes: A review.

A mammalian artificial chromosome (MAC) may be assembled through the juxtapposition of three kinds of DNA elements: a centromere, several DNA replication origins, and two telomeric repeats. The resulting structure should be able to carry and express one or more selected genes (transgenes), introduced for specific purposes. The minimal length is unknown, but may be of several Mb.Of its basic elements, the telomeres may present lesser problems, in view of their simple composition and organization. Centromeres could be an issue, given their many unknowns. Mammalian DNA replication origins are at present poorly characterized, but it is expected that at least one may be contained within the MAC components, especially the transgene. Their overall assembly may require a combination of in vivo and in vitro approaches.A promising strategy aims at constructing two telomeric arms of a MAC, one of which may include the transgene. The two novel arms could acquire a functional centromere through recombination with the two arms of a resident chromosome. Alternatively, if the two telomeric constructs are also endowed with properly placed and oriented centromeric sequences, a centromere may be rescued in vivo by homologous recombination with the external parts of the centromere of the resident chromosome. Positive selection for the artificial arms and counterselection against the resident arms should facilitate the assembly process.The assembly of such construct would not change the ploidy number of the host cell. After loading of a transgene, however, the resulting MAC may be isolated and transferred into an expression cell, where it may represent a novel chromosomal element. In this case untoward effects to the host cell may derive from an ensuing dosage effect for the transgene(s) rather than from the presence of a MAC per se.A MAC may contribute to a deeper understanding of the structural requirements for chromosomal function and evolution as well as the mechanism of chromatin formation. It should also help in the development of second generation vectors for transfer of Mb-long DNA sequences, as required for properly regulated mammalian gene function as well as, possibly, for therapy.

In vitro sensitivity of human erythroid progenitors to hemopoietic growth factors: studies on primary and secondary polycythemia.

BACKGROUND: Primary proliferative polycythemia is a clonal disease characterized by excessive hemopoiesis and associated with a lower than normal erythropoietin plasma level; in vitro colony studies may reveal increased sensitivity of the abnormal clone to hemopoietic growth factors. MATERIALS AND METHODS: We studied the in vitro formation of erythroid colonies (BFU-E derived clone) in cultures set up with a serum-free medium and containing Epo, interleukin 3 (IL-3) and stem cell factor (SCF), in various combinations. The clonogenic test was performed by plating non adherent mononuclear cells from the peripheral blood of normal subjects and from patients with PPP and secondary polycythemia (SP). RESULTS: SCF is a major amplifier of erythroid colony growth, in the presence of Epo; in cultures from PPP patients, however, the presence of SCF, in addition to Epo, enhances colony formation at about the same rate as in cultures from normal subjects. When SCF is omitted, the presence of even modest amounts of Epo and IL-3 is sufficient to obtain a statistically significant difference between colony formation from PPP patients on the one side, and SP patients and normal subjects on the other. CONCLUSIONS: Our results show that in vitro culture studies may contribute an additional diagnostic criterion for distinguishing between PPP and SP in uncertain cases. It is also possible that hypersensitivity to erythropoietic factors may play a role in the pathogenetic mechanism of primary proliferative polycythemia.

Polycythemia: from clones to clinic.

Increasing evidence for pathological erythroid clones and availability of additional diagnostic criteria suggest to reconsider the classification of polycythemia, with particular regard to the separation between primary proliferative polycythemia (PPP) or polycythemia vera, and other conditions in which the excessive red cell mass is not due to a myeloproliferative disorder. The characteristics of the abnormal erythropoietic clone in PPP are reviewed, with special reference to the in vitro growth of Epo-independent clones and the response to Epo and other growth factors. Traditional PPP diagnostic criteria are thus integrated with more recent parameters and the clinical features are considered; the main features of idiopathic erythrocytosis (IE) are also reviewed, as well as those of other forms, like familial, secondary and apparent polycythemia. It is pointed out that previously obscure forms are now being elucidated, with the decisive help from molecular biology investigations, allowing the discovery of genetic defects. It is thus becoming apparent that basic science acquisitions, as in the field of erythropoietic initiators (Epo receptor, GATA-1 transcription factor and so on) are eventually helping our understanding of clinical problems in this area, with relevant consequences on diagnosis and treatment of various forms of polycythemia.

Erythropoietin gene expression in haemopoietic cell lines.

Erythropoietin (Epo) gene expression was studied in a number of different haemopoietic cell lines by in situ hybridization and Northern Blot analysis using a radioisotope-labelled monkey Epo DNA probe. A positive message was expressed by a human cell line, CM-S, derived from a patient with congenital hypoplastic anemia, and by a murine erythro-leukaemic cell line, clone 707, derived from the spleen of Friend virus-infected mice. No message was detected in two megakaryoblastic cell lines, and in a monocytic cell line, derived from a patient with acute monocytic leukaemia. These data may fit with the hypothesis of expression of Epo and other growth factors by haemopoietic cells through a mechanism of so-called autocrine secretion.

Rearrangement of T-cell Receptor (Delta, Gamma and Beta) Genes and its Significance in T-cell Chronic Leukaemias.

The configuration of the delta, gamma and beta TCR genes and IgH genes was studied using appropriate DNA probes in 12 patients previously diagnosed as having T-cell chronic leukaemia. One or more TCR genes showed rearrangement and/or deletion in 11 patients, whereas rearrangement of IgH genes were seen in 3 patients only. TCR genes showed four distinct patterns: (a) rearrangement and/or deletion of each of the three TCR genes (7 patients), (b) re-arrangement of two TCR genes (3 patients), (c) rearrangement/deletion of one TCR gene only (1 patient), (d) germ-line state of all TCR genes (1 patient). These patterns had no demonstrable relationship with the clinical status either at the time of diagnosis or during the subsequent course of the disease. The findings provided unequivocal evidence of T-cell lineage of the leukaemic cells in 10 out of 12 patients. In one patient the lineage of leukaemic cells remained indeterminate. In the last patient the germ-line state of all TCR genes and rearrangement of both IgH alleles genes indicated that the leukaemia was of B-cell origin, even though the leukaemic cells had other features regarded as characteristic of T-lymphocytes. The different patterns of TCR genes, seen in the context of the hierarchical nature of the rearrangement process, suggest that the leukaemic transformation occurred at different stages of T-cell ontogeny and was followed by arrest of subsequent TCR gene rearrangement.

In vitro colony culture and chromosomal studies in hepatic and portal vein thrombosis--possible evidence of an occult myeloproliferative state.

We have studied the prevalence of an underlying myeloproliferative state in 20 patients with either hepatic or portal vein thrombosis. Using conventional clinical and laboratory criteria, an underlying myeloproliferative state was identified as the cause of the thrombosis in five patients (25%). A further 10 of the remaining 15 cases were found to have characteristic in vitro bone marrow culture studies and cytogenetic abnormalities suggestive of an underlying myeloproliferative disorder. Although none of these 10 cases have developed overt clinical and laboratory features of such a myeloproliferative disorder after a median observation period of two years, the presence of clonal karyotypic abnormalities in three cases, increased megakaryocyte colony growth in three cases and endogenous erythropoietin independent colony growth of the marrow erythroid progenitors in seven cases, argues strongly in favour of a primary haematological disorder. This has important therapeutic implications, particularly in cases being considered for orthotopic liver transplantation.

Primary polycythaemia: positive diagnosis using the differential response of primitive and mature erythroid progenitors to erythropoietin, interleukin 3 and alpha-interferon.

Forty adult subjects were studied with the aim of establishing positive diagnostic criteria in primary proliferative polycythaemia (polycythaemia vera, PPP). These comprised 14 patients with PPP, eight secondary polycythaemia (SP), five idiopathic erythrocytosis, and 13 normal subjects, classified under standard criteria following comprehensive investigation for causes of SP. Erythroid colony formation from peripheral blood in a serum-free system was assayed with the addition of recombinant human erythropoietin (Epo), interleukin 3 (IL3), or alpha-interferon (alpha-IFN). The differential sensitivity of primitive and mature progenitors (BFU-E) was assessed by counting the number of clusters ('sub-colonies') comprising each erythroid burst. 'Endogenous' erythroid colonies were found in both PPP (56%) and controls (17%). In Epo containing cultures, the mean number of clusters per burst was lower in PPP than controls, and the percentage of small (less than or equal to 8 clusters) bursts was higher. In PPP primitive BFU-E demonstrated greater dependence on IL3 than controls, and mature BFU-E greater inhibition by alpha-IFN. These findings suggest an abnormal response to several growth factors, rather than dysfunction of a single growth factor receptor. Regression analysis of these data defined a discriminant of high diagnostic sensitivity and specificity. This discriminant accurately predicted diagnosis in a further nine polycythaemic patients.

Sensitivity of erythroid progenitors to recombinant growth factors in the diagnosis of myeloproliferative disorders.

Sixty-six adults were studied with the aim of establishing positive diagnostic criteria for myeloproliferative disease. Erythroid colony formation from peripheral blood progenitors was assayed in a serum-free culture system with the addition of recombinant human growth factors. Endogenous colonies were more frequent in myeloproliferative disease than controls. The mean number of clusters per erythroid burst (BFU-e) in cultures with erythropoietin only was lower in primary proliferative polycythemia (polycythemia vera, PPP) than controls. In PPP, primitive BFU-e demonstrated greater dependence on interleukin 3 than controls, and mature BFU-e more susceptibility to inhibition by alpha-interferon. The findings indicate an abnormal response to several different cellular messengers in PPP, and permit an effective diagnostic discrimination from non-clonal polycythemias.

Primary thrombocythaemia: diagnostic criteria and a simple scoring system for positive diagnosis.

Forty new patients with elevated platelet counts (greater than 600 x 10(9)/l) and without palpable splenomegaly were assigned to diagnostic groups defined by essentially conventional criteria after 3 months follow up: Proliferative (17), reactive (17) or unclassified (six). Mean platelet volume (MPV), platelet distribution width (PDW), platelet nucleotide ratio (ATP:ADP), unstimulated BFU-E derived colony formation from peripheral blood, spleen scan and clinical ischaemia were assessed at the outset, with a view to defining diagnostic criteria for distinguishing primary thrombocythaemia from reactive thrombocytosis. All except the first variable were significantly associated with diagnostic group (P less than 0.05). A simple scoring system was devised: enlarged spleen on scan, or presence of BFU-E, each scored 2; elevated PDW (greater than 2 SD from mean), elevated ATP:ADP (greater than 4 SD from mean) or presence of clinical ischaemia, each scored 1. Score totals greater than or equal to 3 predicted primary thrombocythaemia, and totals less than 3 suggested reactive thrombocytosis (predictive value 89%). The system correctly predicted diagnosis in four out of four (probably six out of six) patients whose diagnosis was not apparent initially, and thus whose results were not used in constructing the scoring system. Exclusion of BFU-E from the system resulted in only one incorrect prediction in this group.

Erythropoietic colonies in a serum-free system: results in primary proliferative polycythaemia and thrombocythaemia.

The formation of erythropoietic colonies from the peripheral blood of normal subjects, patients with primary proliferative polycythaemia (PPP) and primary thrombocythaemia (PT) was studied, using a chemically defined serum-free (S-) medium. Colony formation was markedly more prominent in the presence of burst-promoting activity (BPA) and erythropoietin (Ep) than with medium alone (P less than 0.001). In cultures using medium alone, significantly more PPP patients formed colonies than the control group (P less than 0.05). In the PT group this difference did not achieve statistical significance, but the mean BFU-E yield was significantly greater than in controls (P less than 0.05). In a separate series of experiments, parallel cultures in serum-containing (S+) and serum-free (S-) systems, in the presence of BPA and Ep did not show any significant difference in colony yield. The growth of 'endogenous' colonies in cultures with serum-free medium alone could be due to a peculiar sensitivity of erythropoietic progenitors to growth factors other than Ep.

Patterns of in vitro BFU-E proliferation in different forms of polycythaemia and in thrombocythaemia.

To investigate erythroid colony formation in polycythaemia of different types and in thrombocythaemia, a study was performed in 121 subjects, including 13 normal volunteers (N), 30 patients with Primary Proliferative Polycythaemia (PPP), 35 with Idiopathic Erythrocytosis (IE), 19 with Secondary Polycythaemia (SP), 10 with Primary Thrombocythaemia (PT) and 14 with Secondary Thrombocytosis (ST); BFU-E colony formation from peripheral blood samples was studied in the presence of medium only, medium plus a source of burst-promoting activity (BPA) and medium BPA, plus erythropoietin (Ep). In the presence of medium only, practically no colonies were seen in cultures from N and SP, while a variable number was observed in cultures from PPP, IE and PT. Significant differences between groups were as follows: N v PPP; IE v PPP; SP v PPP; N v PT; ST v PT. Such differences persisted in the presence of BPA, but disappeared when Ep was added to the cultures. Further experiments, plating non-adherent mononuclear cells in a chemically defined serum-free medium, confirmed the growth of tiny erythropoietic colonies from circulating stem cells of patients with PPP and PT, in the absence of BPA and EP. These results provide a useful criterion to differentiate PPP, as a group, from other types of polycythaemia; individual cases of IE may need further characterization.

A novel abl protein expressed in Philadelphia chromosome positive acute lymphoblastic leukaemia.

The Philadelphia (Ph) chromosome breakpoints in chronic myelocytic leukaemia are clustered on chromosome 22 band q11 in a 5.8-kilobase (kb) region designated bcr. The c-abl protooncogene is translocated from chromosome 9 band q34 into bcr and the biochemical consequence of this molecular rearrangement is the production of an abnormal fusion protein bcr-abl p210 with enhanced protein-tyrosine kinase activity compared to the normal p145 c-abl protein. The Ph chromosome translocation is also seen in some acute lymphoblastic leukaemias with B-cell precursor phenotypes some of which have bcr rearrangement (bcr+) and some do not (bcr-). We present evidence that the Ph+, bcr- leukaemias are associated with a novel p190 abl kinase. We propose that acute lymphoblastic leukaemias that are bcr+, p210+ are probably lymphoid blast crises following a clinically silent chronic phase of chronic myelocytic leukaemia arising in multipotential stem cells whereas bcr-, p190+ cases are de novo acute lymphoblastic leukaemias arising in more restricted precursors.