<p>The recent and dramatic rise in allergic disease, coupled with the manifestation of the disease within the first years of life, suggests that <em>in utero</em> events are likely critically important to the inception of allergy. Epidemiological and experimental evidence suggest that both genetic predisposition and prenatal environmental exposures (e.g., <em>in utero</em> microbial exposures) play a role in modulating neonatal immunity and subsequent development of allergy. Of relevance to the work in this thesis, reports suggest that bacterial agents can directly alter myelopoiesis and, in connection to allergy, we have previously shown that cord blood (CB) progenitors from high-atopic risk infants demonstrate altered hematopoietic responses. However, whether CB progenitor cell hematopoietic responses are directly altered by microbial stimulation, and what effect maternal atopy has on these responses are unclear. Therefore, this thesis examines the influences of bacterial lipopolysaccharide (LPS) stimulation (innate immunity), maternal atopy, and adaptive immune stimuli (representative of an atopic milieu) on CB progenitor cell eosinophilopoiesis. We show that CB progenitors from healthy, pregnant women respond to LPS through increased eosinophil-basophil (Eo/B) colony forming units (CFU) via the mitogen-activated protein kinase (MAPK) signalling pathway (Chapter 2), whereas the presence of maternal atopy (as defined by skin prick test positivity) is associated with reduced CB CD34⁺ cell LPS-induced Eo/B CFU formation (Chapter 3). To investigate the potential mechanism of reduced eosinophilopoiesis in high-atopic risk infants, CB progenitors stimulated with IL-4 (a surrogate <em>ex vivo</em> for maternal atopy), but not IL-13, demonstrate reduced LPS-induced MAPK activation and Eo/B CFU formation (Chapter 4). This novel work provides insight into mechanisms relating to the influence of maternal atopy and/or potential intrauterine exposures (e.g., prenatal cytokines) on the responsiveness of CB progenitor cells to LPS, which may be of key importance for the development of atopic illnesses. These observations may help in the generation of novel biomarkers and therapeutic targets for childhood atopy.</p> / Doctor of Philosophy (PhD)

Umbilical cord blood (UCB) is used as a source of haematopoietic stem cells (HSCs) for transplantation but shows defective homing to the bone marrow niche and delayed haematological reconstitution. Following transplantation, HSCs will home to the bone marrow in response to the CXCL12 chemokine, adhere to the bone marrow sinusoidal endothelial cells and then migrate into and lodge in bone marrow niches. In addition to CXCR4, a variety of molecules have been described as being important in these processes. In this laboratory, junctional adhesion molecule-A (JAM-A) was shown to be expressed on human UCB CD133⁺/CD34⁺ cells and regulated by hypoxia. In this thesis, further phenotypic studies show that this molecule is most highly expressed on human CD41a⁺ megakaryocytes and CD14⁺ monocytes/macrophages in UCB. JAM-A was also found to be expressed on all human UCB CD133⁺ cells, which have been shown by others to encompass the HSCs and early myeloid-lymphoid precursors and on the majority of CD34⁺ haematopoietic progenitor cells (HPCs). While it is also present on bone marrow sinusoidal endothelium (BMEC), JAM-A is not detected on cultured bone marrow mesenchymal stromal cells (MSCs). JAM-A blockade, silencing and overexpression experiments showed that JAM-A contributes to, but is not solely responsible for, the adhesion of CD34⁺ haematopoietic progenitor cells to IL-1β activated BMEC-60 cells and fibronectin. Lack of significance in cell migration suggested that JAM-A is more likely to act as an adhesion molecule or a regulator of adhesion rather than as a migratory molecule in such cells. Further functional studies using the proximity ligation assay highlight a potential association of JAM-A with CXCR4 and the adhesion molecules, tetraspanin CD82 and integrin β1. Mechanistic studies were commenced to establish if JAMA could modulate CXCR4 signalling following CXCL12 stimulation, but time constraints prevented these from being completed. These preliminary experiments which were carried out first in the Jurkat cell line lacking JAM-A or transduced to express JAM-A, however, suggest that JAM-A may modulate CXCL12-induced Rap1 phosphorylation and ERK1/2 phosphorylation. The former pathway is important for integrin function and the latter pathway is important in cell adhesion. The results described here, although requiring finalisation, support the hypothesis that JAM-A acts as an adhesion molecule and also may fine tune CXCR4 and integrin mediated functions on human CD34⁺ cells, thereby potentially regulating engraftment of these cells to the bone marrow niche.

The Master´s thesis gives an overview of cord blood, its use, processing and cryopreservation. The role of cord blood as an alternative resource for transplantation is being widely discussed. In the experimental part, 50 grafts of donor cord blood were processed and the effect of cryopreservation and demographic factors of mother and child were evaluated on the cellularity of cord blood. Based on the evaluation, a recommendation about the inclusion of additional tests in routine processing of cord blood were made.

隨著再生醫學研究的蓬勃發展，幹細胞也成為未來醫療的焦點，長生不老、青春永駐，將不再是夢想；慢性疾病、罕見疾病等的治癒都可預期。其中臍帶血幹細胞的移植已可取代骨髓移植治療惡性血液疾病、免疫疾病，成功率與預後狀況都比骨髓移植更好。所以將臍帶血保存下來的觀念，已普遍成為產前衛教的一課，台灣約有一成以內的父母會自費將寶寶的臍帶血保存下來。 活動理論是俄國心理學家Vygotsky（1978）所提出的，強調主體必須透過工具才能達成客體目標，並架構人類基本活動的六個元素：主體、中介工具、客體、規則、社群與分工。單一活動中各元素為動態的互動關係，會隨著時間軸改變。 本研究深入訪談六位臍帶血保存戶後，透過活動理論元素強度分析比較臍帶血保存戶的生活脈絡，了解其關鍵點，同時也將業界行銷做法與活動理論進行比對分析，再參酌人性中「理性」與「非理性」的心理反應，做為未來行銷策略的參考。 結果顯示，客戶的生活脈絡中「主體-工具-客體」之三角關係最強，其中工具扮演不可或缺的角色；「主體-客群-客體」之三角關係次之，社群仍是活動中互動最密切的一群；規則與分工對生活脈絡的影響較小，反映出臍帶血保存是一個新產業，法規與分工都還沒有深入發揮影響力。在訪談業代與分析業者行銷策略後，瞭解未來在行銷保存臍帶血時，需兼具產品與服務的特性，並加強研發的能力，強化在再生醫療中的角色，才能讓此產業更蓬勃發展。 活動理論可將思維結構化並進行盤點，使離散的概念統整，對整個活動有一個清楚的全貌。應用在例行思考上，不論是事前評估規劃，或是事後執行檢討，均可迅速而清晰的將藍圖完整呈現。 / The use of stem cells becomes a key area of research and therapy followed by the fast development in regenerative medicine. Because the existence of stem cells, immortality or staying young forever will no longer be just a dream, and serious diseases and rare disorder are expected to be cured. Umbilical cord blood transplants have higher success and recovery rates than Bone Marrow transplants in treating blood disorders and diseases of the immune system. The concept of ‘cord blood storage’ has become an instruction prenatally. There are about 10% of parent will keep their baby’s cord blood in private cord blood banks at present in Taiwan. ‘Activity Theory’ was initiated by Lev Vygotsky（1978）in the 1920s. He created the idea of mediation. Following to the activity theory, Leont’ev (1981) structured the general context model into six elements: Subject、Tool、Object、Rules、Community and Labor Division. The interaction among elements for each activity is dynamic and can be changed over time. Six customers stored the cord bloods of their babies were interviewed in this study. The life contexts were studied and the strength of the six elements was compared among these customers based on the activity theory to analyze the reason of storing their baby’s cord blood, and to build the activity theory model. In addition, the marketing methods in the industry were compared and analyzed with the activity theory, and the psychological responses of reasoning and nonreasoning in human nature were further referred to build the future marketing strategy. The relation among Subject-Tool-Object was found to be the most important part in the model, where tool played the key role. The relation among Subject-Community-Object was the second important, where community interacted closely with activity. Rules and Labor Division were the less effective elements. This result indicates that private Cord Blood Bank is a new business, which is not affected by Rules and Labor Division yet. In the future, product and service characters should be combined, and the significance of R&D of stem cells in cord blood should be enhanced in Regenerative Medicine to promote the development of this business. Activity theory was proved beneficial in seeing a whole picture of activity by structuralizing the thinking and integrating the diverse ideas. A clear blue print in routine thinking can be seen either in the beforehand evaluation or the post-implementation review.

Autism is a complex disorder with possible genetic, epigenetic and environmental components. As the etiology remains uncertain and an increase in incidence is suspected, the involvement of possible environmental risk factors has gained increasing attention. With this thesis, I aim to provide tools for assessing such risk factors. Firstly, I aim to construct a questionnaire for the analysis of an environmental component in the etiology of autism. Secondly, I aim to assess the importance of prenatal exposure to metals in certain diseases and thirdly I aim to construct a methodology enabling the analysis of the mitochondrial epigenome, which is especially interesting in relation to autism as mitochondrial diseases occur more frequently in an autistic population than in the general population. For the creation of the questionnaire the scientific literature was reviewed. The resulting questionnaire contains general, prenatal, neonatal and paternal risk factors. The metal analysis was conducted on the cord blood of patients who later developed autism, antinuclear antibodies positive rheumatoid arthritis or diabetes, which were then compared to healthy control subjects. My findings propose a link between elevated levels of cord blood cadmium or aluminum and rheumatic arthritis. In addition, elevated aluminum levels might be associated with autism. In regards to the analysis of the mitochondrial epigenome, to my knowledge, no standard protocol exists with frozen human whole blood as a source. In this thesis, I succeeded in creating the basis for such a protocol, however still needing several small modifications for an increased overall yield.

Les cellules souches suscitent de grands espoirs pour la thérapie cellulaire et l'ingénierie tissulaire. Les CSM du tissus foetaux (sang placentaire et gelée de Wharton du cordon ombilical), à l'origine d'épiblaste embryonnaire, sont considérées comme plus primitives que les CSM provenant de sources adultes. Les conditions de culture ayant un impact sur le comportement des cellules, dans notre étude, nous avons exploré l'effet de la concentration de l'oxygène sur l'expansion, l'immunophénotypage et la différenciation de ces cellules. L'objectif de ce travail est d'identifier la méthode optimale d'isolation des CSM issues de tissus foetaux. Compte tenu du faible taux de succès dans l'isolement des CSM extraites du sang placentaire, nous nous sommes dirigés vers les CSM-GW. Nous y avons déterminé in situ, les marqueurs spécifiques exprimés dans la gelée de Wharton et à la périphérie. Des études sur la morphologie, la cinétique de croissance, et sur l'expression phénotypique des marqueurs de surface, des CSM-GW, ont été effectuées sur une longue durée (7 passages) à différentes conditions de culture. Nous avons montré que la GW est composée d'une abondante matrice extracellulaire riche en collagènes et glycosaminoglycannes et que les cellules possèdent un phénotype variable selon leur localisation dans la gelée. Ce tissu est capable de fournir une quantité importante de CSM (6,7x105 Cs/cm de cordon) qui gardent une morphologie constante. Enfin, quel que soit le passage, la concentration de l'oxygène ne semble pas avoir d'effet sur le phénotype des cellules. En revanche, une faible teneur en oxygène durant l'expansion semble diminuer le temps de doublement des cellules, favoriser la chondrogénèse et inhiber la différenciation ostéogénique. Enfin, quelles que soient les conditions de culture, la différenciation adipogénique des CSM-GW semble difficile à obtenir / Stem cells are the hopes for cell therapy and tissue engineering. MSCs from fetal tissue (umbilical cord blood and WJ), which are a source of embryonic epiblast grow relatively faster comparing to other adult sources. The culture condition can affect cell behavior. In our study, we explored the effect of oxygen concentration on the expansion, immunophenotyping, and differentiation of these cells. The aim of this work is to identify the optimal method for isolation of MSCs derived from fetal tissue. Given the low rate of success in the isolation of MSCs from cord blood, we headed to WJ-MSCs. We have determined in siu, the specific markers expressed in the WJ and in the perivascular region. Studies on the morphology growth kinetics, and phenotypic expression of surface makers of MSCs isolated from WJ were made over a long period (7 passages) in different culture conditions. We have shown that WJ is composed of an abundant extracellular matrix rich in collagen and glycasominoglycans and have variable phenotype depending from their localization in the jelly. This tissue is able to provide a large amount of MSCs (6.7x105 Cs/cm of cord) that maintain a constant morphology. Finally, regardless of the passage, the oxygen concentration does not effect on the phenotype of the cells. In contrast, a low oxygen concentration during expansion appears to decrease the doubling time of MSCs, promote chondrogenesis and inhibit osteogenic differentiation. Finally, whatever the culture conditions, adipogenic differentiation of WJ-MSC seems difficult to obtain

Introdução: A célula NK possui uma importante função no sistema imune inato de defesa primária contra vírus e patógenos e também realiza a imunovigilâcia tumoral. Muitos estudos clínicos tem avaliado o uso dessas células na imunoterapia adotiva. A expansão e a ativação da célula NK requer sinais e estímulos para manter a sua sobrevivência. Atualmente existem muitos protocolos para a expansão e ativação da célula NK, porém não existe uma definição do melhor método para uso clínico. Objetivo: O estudo tem como objetivo avaliar a melhor forma para expansão das células NK isoladas de células mononucleares do sangue de cordão umbilical e placentário.Método: Foram avaliadas cinco diferentes condições para expansão de células NK de mononucleares isoladas do sangue do cordão umbilical e placentário. Foram testados protocolos utilizando as interleucinas (IL), IL-2, IL-3, IL-15; com ou sem a presença do co-cultivo com células-tronco mesenquimais do cordão umbilical (CTM-CU) e, também o co-cultivo com células apresentadoras de antígeno artificiais ligadas a IL-21 à membrana (mbIL21 APC). Resultados: Os protocolos utilizando co-cultivo com APC mbIL21 foram superiores aos demais quanto à capacidade de expansão de células NK (CD3-, CD56+, CD16+). O protocolo de co-cultura de APC, CTM-CU e estímulo com IL-2 apresentaram um aumento significativo de NK (CD3-, CD56+, CD16+) quando comparado ao protocolo de APC/IL-2 sem CTM-CU (p<0,05). Conclusão: A expansão ex vivo de células NK na presença das APC e CTM-CU apresentaram uma proporção estatisticamente superior de célula NK CD16+ quando comparada com condições de cultivo com apenas a APC, tendo essas células NK potencial para utilização na imunoterapia adotiva associada com anticorpos monoclonais ou anticorpos bi-específicos. / Background: Natural killer (NK) cells play a major role in innate immunity, especially against viral pathogens, and are also a part of the immune surveillance of tumors. Several clinical trials have evaluated the use of these cells for adoptive cell immunotherapy. Ex vivo expansion of NK cells, however, is a complex process which requires multiple cell signals to ensure cell survival, proliferation, and activation. There are many protocols used for NK cell expansion and activation, however, there is a lack of evidence regarding which method is the most effective for clinical grade NK cells expansion. Objective: The main purpose of this study is to evaluate an optimal protocol for the ex vivo expansion of NK cells isolated from umbilical cord blood mononuclear cells (CB-MNC). Methods: Five different conditions for the expansion of umbilical cord-derived NK cells were evaluated. Each protocol was a different combination of interleukins (IL-2, IL-3, and IL-15) with or without the presence of feeder cells or artificial antigen presenting cells (aAPCs). Feeder cells utilized were umbilical cord-derived mesenchymal stem cells (UC-MSC), and aAPCs were membrane-bound IL-21 artificial APCs (mbIL21 aAPCs). Results: Protocols employing mbIL21 aAPCs demonstrated greater expansion of natural killer cells (CD3- CD56+) than the other protocols. The protocol employing aAPCs, IL-2 and UC-MSC feeder cells had a statistically significant higher proportion of CD16+ NK cells when compared to the protocol without the MSC feeder cells, but there was no significant difference in the expansion of total natural killer cells concerning these two protocols. Conclusion: Ex vivo expansion of NK cells in the presence of aAPCs and UC-MSC feeder cells yielded a significant higher proportion of CD16+ NK when compared to the aAPCs only culture condition, and could be a better product for NK adoptive immunotherapy in conjunction with monoclonal or bi-specific antibodies.

Η λεπτίνη παράγεται από τα κύτταρα του λιπώδους ιστού, καθώς και από άλλους ιστούς συμπεριλαμβανομένων του πλακούντος και ρυθμίζει τη πρόσληψη τροφής, τη κατανάλωση ενέργειας, την αναπαραγωγική διαδικασία και τις ανοσολογικές λειτουργίες. Για τη διερεύνηση του ρόλου της λεπτίνης επί του νεογνικού ανοσολογικού συστήματος μετρήσαμε τα επίπεδα λεπτίνης και κυτταροκινών (INF-γ, TNF-α, IL-2, IL-4, IL-10 και IL-12) στον ορό αίματος ομφαλίου λώρου 481 φυσιολογικών νεογνών τα οποία γεννήθηκαν από υγιείς μητέρες. 317 ήταν νεογνά με ιδανικό βάρος γέννησης για την ηλικία κύησης (AGA) και 164 έφεραν αυξημένο βάρος για την ηλικία κύησης (LGA). Η ενδιάμεση συγκέντρωση λεπτίνης σε ολόκληρο το δείγμα ήταν 11.6 ng/ml. Στο 12% AGA νεογνών, τα επίπεδα λεπτίνης ήταν υψηλότερα του μέσου όρου (ενδιάμεση τιμή 34 ng/ml). Στο 33% των νεογνών αυτών (4% του ολικού δείγματος) τα επίπεδα λεπτίνης κυμαίνονταν μεταξύ 37.5-204 ng/ml, στην ομάδα αυτή βρέθηκαν επίσης υψηλά επίπεδα ιντερφερόνης-γ (μέση τιμή 27.11 pg/ml, διακύμανση 17.5-38.5 pg/ml). Κατόπιν μελετήσαμε εάν η λεπτίνη μπορεί να επηρεάσει τη γονιδιακή έκφραση κυτταροκινών στα Τ κύτταρα και μονοκύτταρα αίματος ομφαλίου λώρου. Η καλλιέργεια των κυττάρων ομφαλίου λώρου (Τ ή μονοκυττάρων) AGA νεογνών, τυχαία επιλεγμένων ή κυττάρων περιφερικού αίματος ενηλίκου, με λεπτίνη είχε σαν αποτέλεσμα τη γονιδιακή έκφραση IL-2, INF-γ και IL-4 από τα κύτταρα του ομφαλίου λώρου, καθώς και από τα Τ κύτταρα του ενηλίκου όπως και την έκφραση IL-10 κυρίως από τα μονοκύτταρα αίματος ομφαλίου λώρου. Σημαντικά υψηλότερη γονιδιακή έκφραση INF-γ παρατηρήθηκε σε Τ κύτταρα ομφαλίου λώρου θήλεος τα οποία καλλιεργήθηκαν με λεπτίνη συγκριτικά με τα Τ κύτταρα ομφαλίου λώρου άρρενος. Συμπερασματικά, η παρουσία υψηλών συγκεντρώσεων λεπτίνης και INF-γ στον ορό αίματος ομφαλίου λώρου φυσιολογικών AGA νεογνών, καθώς και το γεγονός ότι η λεπτίνη μπορεί άμεσα να διεγείρει τη γονιδιακή έκφραση κυτταροκινών σε κύτταρα ομφαλίου λώρου (Τ και μονοκύτταρα) δείχνει ότι τα υψηλά επίπεδα λεπτίνης μπορούν ανεξάρτητα να επηρεάσουν το ανοσολογικό σύστημα των φυσιολογικών νεογνών και να συμβάλλουν στη Th1 διαφοροποίηση της ανοσολογικής απόκρισης. / Leptin is a hormone synthesized by adipocytes and other tissues, including the placenta, and it regulates food intake and energy expenditure, reproductive and immune functions. To investigate the role of leptin in neonatal immunity, we measured serum leptin and cytokine (INF-γ, TNF-α, IL-2, IL-4, IL-10, IL-12) levels in cord blood (cb) of 481 healthy neonates, born to healthy mothers, of which 317 were appropriately grown for gestational age (AGA) and 164 were large for gestational age (LGA). The median serum leptin concentration in the whole sample was 11.6 ng/ml. In 12% AGA neonates, leptin levels were well above average, with a median of 34 ng/ml. In 33% of these neonates (4% of the total sample) leptin levels ranged between 37.5-204 ng/ml; in this group, significantly elevated levels of serum IFN- were also found (mean 27.11 pg/ml, range 17.5-38.5 pg/ml). We then investigated whether leptin can independently influence cytokine gene expression by cb T-cells and monocytes (Mc). Culture of cb T-cells or Mc, isolated from randomly selected AGA neonates or adult peripheral blood mononuclear cells (PBMC), with leptin, resulted in upregulation of IL-2, IFN- and IL-4 gene expression in cb and adult T-cells and IL-10 gene expression mainly in cb-Mc. Significantly higher expression of IFN- occurred in female cb-T-cells cultured with leptin, compared with male cb-T-cells. In conclusion, the concurrent presence of high concentrations in both leptin and INF- in cb of healthy AGA infants, together with the fact that leptin can directly upregulate cytokine gene expression in cb T and Mc cells, indicate that abnormally high leptin levels can independently influence the immune system of healthy newborns, and may mediate gender differences in the development of a Th1 polarized immune response.

Objetivo: Determinar a influência da presença de cafeína no sangue de cordão umbilical na ocorrência de apneia. Métodos: Estudo de coorte prospectivo de recém-nascidos pretermos com peso de nascimento menor de 2.000 g. Os critérios de exclusão foram: mães que receberam opióides , ventilação mecânica durante os primeiros 4 dias de vida, malformação congênita cerebral e cardíaca maiores, asfixia perinatal, hemorragia peri-intraventricular severa, exsanguíneotransfusão antes do quarto dia de vida e uso de metilxantina antes da extubação. Os recém-nascidos foram divididos em: com e sem cafeína detectável no sangue de cordão umbilical e acompanhados nos primeiros quatro dias de vida para a ocorrência de apneia. Resultados: 87 com e 40 sem cafeína detectável no sangue de cordão umbilical foram estudados. A mediana da concentração de cafeína dos 87 pacientes com cafeína detectável no sangue de cordão umbilical foi 2,3 µg/ml (0,2-9,4 µg/ml). Não houve associação entre a ocorrência de apneia e a presença de cafeína no sangue de cordão umbilical. Recém-nascidos com cafeína detectável no cordão umbilical tiveram apnéia mais tarde (66.3 horas) do que aqueles com níveis indetectáveis (54.2 horas). Conclusão: a detecção de níveis de cafeína no sangue de cordão umbilical não diminuiu a ocorrência de apneia da prematuridade. Nós sugerimos que novos estudos com a administração de altas doses de cafeína para mães antes do parto prematuro, como estratégia para prevenir a apneia da prematuridade, devam ser realizados. / Objective: To determine the influence of presence of caffeine in umbilical cord blood on apnea occurrence. Methods: A prospective cohort study with preterm newborns with birth weight less than 2,000 g was undertaken. Exclusion criteria were: mothers that received opioids, mechanical ventilation during the first 4 days of life, cerebral and major cardiac malformations, perinatal asphyxia, severe periintraventricular hemorrhage, exchange transfusion before the fourth day of life, and those that received methylxantine prior to extubation. Neonates were divided in: with detectable and undetectable caffeine in umbilical cord blood. Newborns were followed for the first 4 days for occurrence of apnea spells. Results: 87 with and 40 without detectable caffeine in umbilical cord blood were studied. The median caffeine concentration of the 87 patients with detectable caffeine in umbilical blood was 2.3 µg/ml (0.2-9.4 µg/ml). There was no association between occurrence of apnea spells and presence of caffeine in umbilical cord blood. Neonates with detectable caffeine in umbilical blood had apnea later (66.3 ± 4.14 hours) than those with undetectable levels (54.2 ± 6.26 hours). Conclusion: The detected levels of caffeine in umbilical cord blood did not decrease the occurrence of apnea of prematurity. We suggest that further studies on administration of high dose of caffeine to mothers prior to a preterm delivery as a preventive measure for apnea of prematurity deserve to be conducted.

Introdução: A célula NK possui uma importante função no sistema imune inato de defesa primária contra vírus e patógenos e também realiza a imunovigilâcia tumoral. Muitos estudos clínicos tem avaliado o uso dessas células na imunoterapia adotiva. A expansão e a ativação da célula NK requer sinais e estímulos para manter a sua sobrevivência. Atualmente existem muitos protocolos para a expansão e ativação da célula NK, porém não existe uma definição do melhor método para uso clínico. Objetivo: O estudo tem como objetivo avaliar a melhor forma para expansão das células NK isoladas de células mononucleares do sangue de cordão umbilical e placentário.Método: Foram avaliadas cinco diferentes condições para expansão de células NK de mononucleares isoladas do sangue do cordão umbilical e placentário. Foram testados protocolos utilizando as interleucinas (IL), IL-2, IL-3, IL-15; com ou sem a presença do co-cultivo com células-tronco mesenquimais do cordão umbilical (CTM-CU) e, também o co-cultivo com células apresentadoras de antígeno artificiais ligadas a IL-21 à membrana (mbIL21 APC). Resultados: Os protocolos utilizando co-cultivo com APC mbIL21 foram superiores aos demais quanto à capacidade de expansão de células NK (CD3-, CD56+, CD16+). O protocolo de co-cultura de APC, CTM-CU e estímulo com IL-2 apresentaram um aumento significativo de NK (CD3-, CD56+, CD16+) quando comparado ao protocolo de APC/IL-2 sem CTM-CU (p<0,05). Conclusão: A expansão ex vivo de células NK na presença das APC e CTM-CU apresentaram uma proporção estatisticamente superior de célula NK CD16+ quando comparada com condições de cultivo com apenas a APC, tendo essas células NK potencial para utilização na imunoterapia adotiva associada com anticorpos monoclonais ou anticorpos bi-específicos. / Background: Natural killer (NK) cells play a major role in innate immunity, especially against viral pathogens, and are also a part of the immune surveillance of tumors. Several clinical trials have evaluated the use of these cells for adoptive cell immunotherapy. Ex vivo expansion of NK cells, however, is a complex process which requires multiple cell signals to ensure cell survival, proliferation, and activation. There are many protocols used for NK cell expansion and activation, however, there is a lack of evidence regarding which method is the most effective for clinical grade NK cells expansion. Objective: The main purpose of this study is to evaluate an optimal protocol for the ex vivo expansion of NK cells isolated from umbilical cord blood mononuclear cells (CB-MNC). Methods: Five different conditions for the expansion of umbilical cord-derived NK cells were evaluated. Each protocol was a different combination of interleukins (IL-2, IL-3, and IL-15) with or without the presence of feeder cells or artificial antigen presenting cells (aAPCs). Feeder cells utilized were umbilical cord-derived mesenchymal stem cells (UC-MSC), and aAPCs were membrane-bound IL-21 artificial APCs (mbIL21 aAPCs). Results: Protocols employing mbIL21 aAPCs demonstrated greater expansion of natural killer cells (CD3- CD56+) than the other protocols. The protocol employing aAPCs, IL-2 and UC-MSC feeder cells had a statistically significant higher proportion of CD16+ NK cells when compared to the protocol without the MSC feeder cells, but there was no significant difference in the expansion of total natural killer cells concerning these two protocols. Conclusion: Ex vivo expansion of NK cells in the presence of aAPCs and UC-MSC feeder cells yielded a significant higher proportion of CD16+ NK when compared to the aAPCs only culture condition, and could be a better product for NK adoptive immunotherapy in conjunction with monoclonal or bi-specific antibodies.