title: Advances in umbilical cord blood manipulation-from niche to bedside.
abstract: The use of umbilical cord blood (UCB) as an alternative haematopoietic cell source in lieu of bone marrow for haematopoietic reconstitution is increasingly becoming a mainstay treatment for both malignant and nonmalignant diseases, as most individuals will have at least one available, suitably HLA-matched unit of blood. The principal limitation of UCB is the low and finite number of haematopoietic stem and progenitor cells (HSPC) relative to the number found in a typical bone marrow or mobilized peripheral blood allograft, which leads to prolonged engraftment times. In an attempt to overcome this obstacle, strategies that are often based on native processes occurring in the bone marrow microenvironment or 'niche' have been developed with the goal of accelerating UCB engraftment. In broad terms, the two main approaches have been either to expand UCB HSPC ex vivo before transplantation, or to modulate HSPC functionality to increase the efficiency of HSPC homing to the bone marrow niche after transplant both of which enhance the biological activities of the engrafted HSPC. Several early phase clinical trials of these approaches have reported promising results.
authors.affiliation: Division of Pediatric Blood and Marrow Transplant, University of Minnesota, MMC 366, 420 Delaware Street SE, Minneapolis, MN 55445, USA.
authors.forename: Troy C
authors.initials: TC
authors.lastname: Lund
authors.affiliation: Genomics Institute of the Novartis Research Foundation, 10675 John Jay Hopkins Drive, San Diego, CA 92121, USA.
authors.forename: Anthony E
authors.initials: AE
authors.lastname: Boitano
authors.affiliation: Fred Hutchinson Cancer Research Center, University of Washington, D2-100, 1100 Fairview Avenue North, Seattle, WA 98109, USA.
authors.forename: Colleen S
authors.initials: CS
authors.lastname: Delaney
authors.affiliation: The University of Texas, MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit Number 423, Houston, TX 77030, USA.
authors.forename: Elizabeth J
authors.initials: EJ
authors.lastname: Shpall
authors.affiliation: Division of Pediatric Blood and Marrow Transplant, University of Minnesota, MMC 366, 420 Delaware Street SE, Minneapolis, MN 55445, USA.
authors.forename: John E
authors.initials: JE
authors.lastname: Wagner
mesh_terms: D018929:Cell Culture Techniques; D036101:Cord Blood Stem Cell Transplantation / Q000379:methods; D005312:Fetal Blood / Q000166:cytology*; D006085:Graft Survival; D006412:Hematopoietic Stem Cells / Q000166:cytology / Q000378:metabolism; D006801:Humans; D011379:Prognosis; D057170:Translational Research, Biomedical; D014184:Transplantation, Homologous; D016896:Treatment Outcome