Touraine J L, Raudrant D, Vullo C, Frappaz D, Freycon F, Rebaud A, Barbier F, Roncarolo M G, Gebuhrer L, Bétuel H
Department of Transplantation and Clinical Immunology, Claude Bernard University, Lyon, France.
Bone Marrow Transplant. 1991;7 Suppl 3:92-7.
Based on the experience acquired in post-natal liver transplantation since 1974, we recently initiated pre-natal, in utero stem cell transplantation from the human fetal liver. The first two fetuses that we treated had immunodeficiencies, the third one had thalassemia major. Donors and recipients were not matched. The fetal cells were infused in the umbilical vein of the first two patients and injected intraperitoneally into the third one, under ultrasonic visualization. The first patient, born in 1988, has both engraftment of donor cells and reconstitution of cell-mediated immunity. This child, who had bare lymphocyte syndrome, has no clinical manifestation of the disease and he lives normally at home. The second child, born in 1989, has not yet developed a significant reconstitution of immunity although donor cell engraftment has been proven (Y chromosome in this female patient). The third patient has also evidence of donor cell take (Y chromosome in a female patient) but the effect on thalassemia has not yet been fully analyzed (donor hemoglobin present in small quantity). In all 3 cases, no side-effect of any kind developed in the mother nor in the fetus. Several advantages appear to be associated with in utero FLT: increased probability of graft take, ideal isolation of patient (in the uterus), optimal environment for fetal cell development (in the fetal host).
基于1974年以来在产后肝移植中积累的经验，我们最近开展了产前经子宫内的人胎肝干细胞移植。我们治疗的前两个胎儿患有免疫缺陷，第三个患有重型地中海贫血。供体和受体不匹配。在超声可视化下，将胎儿细胞注入前两名患者的脐静脉，并注入第三名患者的腹腔。第一名患者于1988年出生，供体细胞已植入，细胞介导的免疫功能得到重建。这名患有裸淋巴细胞综合征的儿童没有该疾病的临床表现，在家中正常生活。第二名儿童于1989年出生，尽管已证实供体细胞植入，但尚未出现明显的免疫重建（该女性患者体内有Y染色体）。第三名患者也有供体细胞植入的证据（女性患者体内有Y染色体），但对地中海贫血的影响尚未完全分析（存在少量供体血红蛋白）。在所有3例病例中，母亲和胎儿均未出现任何副作用。子宫内胎肝移植似乎具有几个优点：移植成功的可能性增加、患者（子宫内）的理想隔离、胎儿细胞发育的最佳环境（胎儿宿主内）。
