Mayani Hector, Wagner John E, Broxmeyer Hal E
Oncology Research Unit, Oncology Hospital, National Medical Center, IMSS, Mexico City, Mexico.
Blood and Marrow Transplantation Program, Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA.
Bone Marrow Transplant. 2020 Jan;55(1):48-61. doi: 10.1038/s41409-019-0546-9. Epub 2019 May 14.
The first hematopoietic transplant in which umbilical cord blood (UCB) was used as the source of hematopoietic cells was performed in October 1988. Since then, significant achievements have been reported in terms of our understanding of the biology of UCB-derived hematopoietic stem (HSCs) and progenitor (HPCs) cells. Over 40,000 UCB transplants (UCBTs) have been performed, in both children and adults, for the treatment of many different diseases, including hematologic, metabolic, immunologic, neoplastic, and neurologic disorders. In addition, cord blood banking has been developed to the point that around 800,000 units are being stored in public banks and more than 4 million units in private banks worldwide. During these 30 years, research in the UCB field has transformed the hematopoietic transplantation arena. Today, scientific and clinical teams are still working on different ways to improve and expand the use of UCB cells. A major effort has been focused on enhancing engraftment to potentially reduce risk of infection and cost. To that end, we have to understand in detail the molecular mechanisms controlling stem cell self-renewal that may lead to the development of ex vivo systems for HSCs expansion, characterize the mechanisms regulating the homing of HSCs and HPCs, and determine the relative place of UCBTs, as compared to other sources. These challenges will be met by encouraging innovative research on the basic biology of HSCs and HPCs, developing novel clinical trials, and improving UCB banking both in the public and private arenas.
1988年10月进行了首例使用脐带血（UCB）作为造血细胞来源的造血移植。从那时起，在我们对源自脐带血的造血干细胞（HSCs）和祖细胞（HPCs）生物学的理解方面取得了重大进展。已经进行了40000多例脐带血移植（UCBTs），用于治疗儿童和成人的多种不同疾病，包括血液学、代谢、免疫、肿瘤和神经系统疾病。此外，脐带血库已经发展到全球公共库中储存了约80万个单位，私人库中储存了400多万个单位。在这30年里，脐带血领域的研究改变了造血移植领域。如今，科研和临床团队仍在致力于以不同方式改进和扩大脐带血细胞的应用。一项主要工作集中在提高植入率以潜在降低感染风险和成本。为此，我们必须详细了解控制干细胞自我更新的分子机制，这可能会促成用于造血干细胞扩增的体外系统的开发，表征调节造血干细胞和祖细胞归巢的机制，并确定与其他来源相比脐带血移植的相对地位。通过鼓励对造血干细胞和祖细胞基础生物学的创新性研究、开展新的临床试验以及改善公共和私人领域的脐带血库，这些挑战将得到应对。
