title: Recovery of multipotent progenitors from the peripheral blood of patients requiring extracorporeal membrane oxygenation support.
abstract: BACKGROUND
  Studies have demonstrated that bone marrow-derived cells can be recruited to injured lungs through an unknown mechanism. We hypothesize that marrow progenitors are mobilized into the circulation of patients with cardiac and/or respiratory failure, and may then traffic to and incorporate into the sites of tissue injury.
  
  
  OBJECTIVE
  To determine whether progenitor populations are increased in the blood of patients with severe acute cardiorespiratory failure placed on extracorporeal membrane oxygenation (ECMO).
  
  
  METHODS
  Mononuclear cells from ECMO, umbilical cord, and control blood samples were evaluated in colony-forming assays for hematopoietic, mesenchymal, and epithelial cells. Progenitors were identified by proliferative and differentiative capacities, and confirmed by the expression of lineage-specific markers.
  
  
  RESULTS
  Significantly higher levels of hematopoietic progenitors were observed in ECMO (n = 41) samples than neonatal intensive care unit (n = 16) or pediatric intensive care unit controls (n = 14). Hematopoietic progenitor mobilization increased with time on ECMO support. Mesenchymal progenitors (MSC) were recovered from 18/58 ECMO samples with rapid sample processing (< 4 h) critical to their recovery. MSC were not recovered from normal controls. ECMO-derived MSC had osteogenic, chondrogenic, and adipogenic differentiation potential. The recovery of MSC did not influence survival outcome (61%). Epithelial progenitors were observed in eight ECMO samples but not in control samples. Their presence was associated with a lower survival trend (38%).
  
  
  CONCLUSIONS
  Hematopoietic, mesenchymal, and epithelial progenitors were mobilized into the circulation of patients on ECMO. This may reflect a response to severe cardiopulmonary injury, blood-foreign surface interactions with the ECMO circuit, and/or hemodilution.
authors.affiliation: Mattel Children's Hospital at UCLA Medical Center, David Geffen School of Medicine, Los Angeles, CA, USA.
authors.forename: Kim Chi T
authors.initials: KC
authors.lastname: Bui
authors.forename: Dinithi
authors.initials: D
authors.lastname: Senadheera
authors.forename: Xingchao
authors.initials: X
authors.lastname: Wang
authors.forename: Benjamin
authors.initials: B
authors.lastname: Hendrickson
authors.forename: Philippe
authors.initials: P
authors.lastname: Friedlich
authors.forename: Carolyn
authors.initials: C
authors.lastname: Lutzko
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001772:Blood Cell Count; D002454:Cell Differentiation; D002478:Cells, Cultured; D002648:Child; D002675:Child, Preschool; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods*; D005260:Female; D005434:Flow Cytometry; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D039902:Multipotent Stem Cells / Q000502:physiology*; D020127:Recovery of Function / Q000502:physiology*; D012131:Respiratory Insufficiency / Q000097:blood* / Q000628:therapy; D012189:Retrospective Studies; D055815:Young Adult