Procedury umożliwiające szersze zastosowanie komórek macierzystych z krwi pępowinowej

Dominika Gładysz¹, Katarzyna Pawelec^{1, 2}, *Dariusz Boruczkowski²

Summary
Nearly nine thousands patients worldwide have been transplanted with cord blood stem cells and that number continues to increase. The intense interest in cord blood usage can be explained by its advantages: prompt availability of HLA-typed stem cells, acceptable HLA disparity up to two antigen mismatches, no adverse effects on stem cell donor, decreased risk of infection transmission and lower incidence of graft versus host disease. Nevertheless, the limitations still exist. The number of stem cells collected is lower in comparison with bone marrow or mobilized peripheral blood. This results in poorer homing and engraftment, which puts patients at risk of prolonged neutropenia and life-threatening infections. With a remarkable growth of science in medicine, many methods have appeared with the object to overcome those limitations. That can be archived by increasing numbers of infused stem cells through double umbilical cord blood stem cell transplantation or enhanced homing using complement C3a and dipeptidyl peptidase IV inhibitors either stem cells ex vivo expansion with cytokines and growth factors. The bone marrow microenvironment can be influenced by mesenchymal stem cells co-transplantation or intrabone infusion in place of intravenous one. Other possibilities include maintaining of undifferentiated state of progenitors by co-culture with Notch ligand, nicotinamide, copper chelators or aryl hydrocarbon receptor antagonists. Prostaglandin E₂ or α1,3-fucosyltransferase VI has been used in manipulation of stem cells as well. Up to date, there are many clinical trials conducted to establish safety and efficacy of above-mentioned procedures.

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