Recovery of Multipotent Progenitors from the Peripheral Blood of Patients Requiring Extracorporeal Membrane Oxygenation Support

• Published in: American journal of respiratory and critical care medicine 2010-02, Vol.181 (3), p.226-237
• Main Authors: Bui, Kim Chi T, Senadheera, Dinithi, Wang, Xingchao, Hendrickson, Benjamin, Friedlich, Philippe, Lutzko, Carolyn
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Blood Cell Count; Blood. Blood and plasma substitutes. Blood products. Blood cells. Blood typing. Plasmapheresis. Apheresis; Cell Differentiation; Cells, Cultured; Child; Child, Preschool; Extracorporeal Membrane Oxygenation - methods; Female; Flow Cytometry; Humans; Infant; Infant, Newborn; Intensive care medicine; Male; Medical sciences; Middle Aged; Multipotent Stem Cells - physiology; Recovery of Function - physiology; Respiratory Insufficiency - blood; Respiratory Insufficiency - therapy; Retrospective Studies; Transfusions. Complications. Transfusion reactions. Cell and gene therapy; Young Adult
• ISSN: 1073-449X; 1535-4970
• DOI: 10.1164/rccm.200812-1901OC

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. To determine whether progenitor populations are increased in the blood of patients with severe acute cardiorespiratory failure placed on extracorporeal membrane oxygenation (ECMO). 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. 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%). 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.