Die rheumatoide Arthritis ist eine chronisch entzündliche Gelenkentzündung, deren Ursachen bis dato ungeklärt bleibt. Der Verlauf der Erkrankung führt zu irreversiblem Zerstörung von Knorpel, Knochen und umgebenden Geweben in den betroffenen Gelenken. Es scheint jedoch klar, dass Synovialzellen, Knorpelzellen und Zytokine eine entscheidende Rolle im Fortschreiten der Erkrankung spielen. IL17 ist ein kürzlich entdecktes Zytokine, welches im besonderen Maßen mit der rheumatoiden Arthritis in Verbindung gebracht wird. Es liegt in der Synovialflüssigkeit und im Serum von Patienten mit rheumatoider Arthritis in deutlich höherer Konzentration vor als in anderen Gelenks-zerstörenden Erkrankungen wie z.B. der Osteoarthritis. Eine kürzlich entdeckte Zellpopulation konnte als chondrogene Vorläuferzellen charakterisiert werden. Da sie einen IL17-Rezeptorkomplex exprimieren, ist anzunehmen, dass eine IL17 Stimulation der chondrogenen Vorläuferzellen zu Veränderungen in deren Synthesemustern führt. Methode: Chondrogenen Vorläuferzellen konnten aus menschlichem Knorpel von Patientin mit rheumatoider Arthritis gewonnen und in Kultur gehalten werden. Die Zellen wurden mit IL17 inkubiert und deren Reaktion durch Zellkulturstudien, real-time-PCR, Immunfluoreszenz und western blot untersucht. Ergebnisse: Die IL17 Stimulation der chondrogenen Vorläuferzellen führte zu einer Suppression des Zellwachstums in den ersten Tagen der Zellkultur. Folgende mRNA Moleküle konnten erstmals in den chondrogenen Vorläuferzellen nachgewiesen werden: IL6, IL1,MMP3, MMP14,MMP15, MMP17 NFkB, , MAPK1, IL1, Aggrecan, ADAMTS-5 und TIMP3. Die IL17 Stimulation führte zu einer Erhöhung der Expression von MMP3, MMP17, IL6 und NFkB in den chondrogenen Vorläuferzellen. MMP14 und MMP15 zeigten sich nicht beeinflusst in ihrem Expressionsmuster. Anschließend konnten die Proteine MMP3 und IL6 stellvertretend in den chondrogenen Vorläuferzellen nachgewiesen werden. Ein IL17 Antikörper konnte den zuvor gezeigten Effekt von IL17 auf die IL6 Expression erfolgreich blocken. Schlussvolgerung: chondrogenen Vorläuferzellen scheinen in einem bestimmten Expressionsmuster auf die IL17 Stimulation zu reagieren. Gerade diese Reaktion scheint zum weiteren Fortschreiten der rheumatoiden Arthritis zu führen. Aufgrund der vielen bereits gezeigten Effekte von IL17 auf Gewebe in der rheumatoiden Arthritis scheint IL17 ein vielversprechendes Ziel in der zukünftigen Therapie der Erkrankung darzustellen.

Regenerative medicine is a rapidly developing field, merging engineering and biological life sciences to create biological replacements for damaged tissue and organ function. Development of cellular based therapies has the potential of curing present untreatable diseases and conditions, such as diabetes. The identification of protein expression patterns, that guide undifferentiated cells to different lineages, can provide important information about the progression of cellular differentiation at various stages. This research project utilizes proteomics and in vitro live-cell microscopy to investigate two distinct cellular systems: (1) the signaling pathways of calmodulin (CaM) in the differentiation of a human glioblastoma cell line; and (2) the effect of islet neogenesis associated protein (INGAP) on human islet-derived progenitor cells (hIPCs). Using a proteomic readout with a long term live-cell imagining approach, it was hypothesized that highly specific binding proteins of a CaM-mutant, and proteins in hIPCs perturbed by INGAP, could be identified and studied in vitro, characterizing specific signaling pathways which control the function of CaM in brain tumour cells and the mechanism(s) of INGAP in islet-derived progenitor cells. This thesis presents the utility of a proteomics and an in vitro cell microscopy approach to investigate therapeutic proteins, such as INGAP, on cell culture systems. The results have established the limitations and the utility of DIGE, differential binding of a CaM-mutant versus calcium-CaM, and the cell specific uptake feasibility of using the TAT-binding domain. In the hIPC system, proteomic, phenotypic, motility, proliferation and nuclear effects of INGAP were determined. Specifically, hIPCs exposed to INGAP had 50% decrease in average nuclear speed, the translocation of two identified proteins caldesmon and tropomyosin and INGAP was found to bind specifically to hIPCs. However, hIPCs had no changes in insulin specific hormone expression.

Les données cliniques supportent le concept et offrent l’espoir que la thérapie cellulaire trouvera sa place parmi les stratégies thérapeutiques des pathologies hépatiques. Cependant deux obstacles majeurs limitent l'étendue de son application clinique: la faible disponibilité d’hépatocytes humains de qualité et en quantité importante, et une faible efficacité de greffe conduisant à une survie et une fonctionnalité seulement à court terme. L’objectif de ce travail était de développer des modèles animaux d’insuffisance hépatique après hépatectomie et d’analyser la réponse régénérative après transplantation de progéniteurs hépatiques humains isolés et caractérisés dans 2 laboratoires de recherche (INSERM U1040 Montpellier et laboratoire PEDI UCL Bruxelles), en comparaison à des hépatocytes fraichement isolés.Le premier modèle consistait à réaliser une hépatectomie de 30% chez des souris NOD SCID, associée à l’injection préalable de rétrorsine (blocage de la prolifération cellulaire endogène) et d’injecter dans le même temps directement dans le parenchyme 1 million de cellules progénitrices exprimant constitutivement le gène rapporteur Luciférase. Les résultats ont montré la bonne implantation des cellules jusqu’à 1 mois après l’injection avec une différenciation fonctionnelle des cellules mise en évidence par la sécrétion d’albumine humaine dans le sang circulant des animaux.Le deuxième modèle consistait à réaliser une hépatectomie large de 70% chez des souris immunodéprimées RAG 2-/- γ-/- pour augmenter la souffrance hépatocellulaire et à comparer deux timing d’injection (voie intrasplénique) des cellules progénitrices génétiquement marquées avec la Green Fluorescent Protein. Les résultats ont montré une meilleure tolérance clinique (moins de mortalité) et une plus grande quantité de cellules implantées lorsque l’injection était réalisée 48h après l’hépatectomie. La régénération hépatique endogène était plus importante et plus rapide chez les souris injectées avec les progéniteurs qu’avec les hépatocytes primaires, suggérant un effet paracrine bénéfique de ces cellules.Ces travaux ont mis en évidence la possibilité d’utiliser ces cellules progénitrices comme alternative aux hépatocytes avec des propriétés régénératrices certaines mais soulèvent les problèmes d’implantation de ces cellules qui reste faible dans des foies hépatectomisés remaniés. Définir le meilleur environnement pour favoriser la survie, la fonctionnalité et éventuellement l’intégration effective des cellules transplantées reste une question clé pour avancer dans cette voie.En parallèle de ces travaux de recherche, un projet de recherche clinique de biothérapie a été développé et accepté pour transplanter des hépatocytes frais humains en intrahépatique chez des patients ayant une insuffisance hépatocellulaire terminale (hépatite alcoolique aigue, cirrhose grave, après résection hépatique large). Il devrait débuter fin 2013. / Clinical data support the concept and offer the hope that cell therapy will find its place among the therapeutic strategies in liver diseases. However, two major obstacles limit the scope of its clinical application: the limited availability of human hepatocytes quality and in large quantities, and low efficiency leading to graft survival and only a short-term functionality. The objective of this work was to develop animal models of liver failure after hepatectomy and analyze the regenerative response after transplantation of human hepatic progenitors isolated and characterized in two research laboratories (INSERM U1040 Montpellier laboratory PEDI UCL Brussels) compared to freshly isolated hepatocytes.The first model was to achieve a 30% hepatectomy in mice NOD SCID associated with prior injection retrorsine (blocking of endogenous cellular proliferation) and injected at the same time directly into the parenchyma 1 million progenitor cells constitutively expressing the luciferase reporter gene. The results showed good cell implantation until 1 month after injection with a functional differentiation as evidenced by secretion of human albumin in the circulating blood cells of animals.The second model was to achieve a wide 70% hepatectomy in mice immunocompromised RAG 2 - / - γ-/ - to increase the suffering hepatocellular comparing two injection timing (channel intrasplenically) progenitor cells genetically marked with the Green Fluorescent Protein. The results showed better clinical tolerance (less mortality) and a greater amount of implanted when the injection was performed 48 hours after hepatectomy cells. Endogenous hepatic regeneration was greater and faster in mice injected with the progenitors with primary hepatocytes, suggesting a beneficial paracrine effect of these cells.These studies have highlighted the possibility of using these progenitor cells as an alternative to hepatocytes with regenerative properties but raise some problems implementing these cells remains low in hepatectomized livers reworked. Define the Define the best environment to promote the survival, function and possibly the effective integration of transplanted cells remains a key issue for progress in this direction.In parallel with this research, a clinical research project biotherapy was developed and agreed to transplant human hepatocytes in intrahepatic costs in patients with terminal liver failure (acute alcoholic hepatitis, severe cirrhosis, after extensive liver resection). It should begin in late 2013.

A hematopoese tem sido bem descrita em modelos murinos nas últimas décadas, contudo, trabalhos demonstrando os mecanismos da hematopoese em humanos ainda são escassos. A derivação da primeira linhagem de células-tronco embrionárias humanas (CTEhs) em 1998, gerou novas perspectivas tanto para o estudo da hematopoese na tentativa de mimetizar o que ocorre naturalmente durante o desenvolvimento embrionário, quanto para a aplicação clínica das células hematopoéticas obtidas a partir da diferenciação dessas células. Contudo, apesar de inúmeros trabalhos terem demonstradoa obtenção de células hematopoéticas a partir de CTEhs, os protocolos têm gerado quantidades variáveis de células, com baixa eficiência e com propriedades funcionais de células primitivas. Desse modo, este trabalho procurou estabelecer um modelo próprio de diferenciação de CTEhs-H1 em células progenitoras hematopoéticas para que estas pudessem ser melhor caracterizadas e obtidas de forma mais eficiente. Para isto, foi desenvolvido um sistema de diferenciação baseado no co-cultivo da linhagem de CTEh-H1 com fibroblastos de embrião de camundongo (MEFs), em meio de diferenciação suplementado soro fetal bovino (SFB) e citocinas e fatores de crescimento hematopoéticos em baixas concentrações. Como resultado, o desenvolvimento do presente trabalho permitiu o estabelecimento de um método para geração de populações mistas de células enriquecidas em CPHs positivas para o marcador CD45, o qual mostrou ser coexpresso com outros marcadores hematopoéticos (CD31, CD43, CD71 e CD38), e células hematopoéticas maduras positivas para marcadores mielóide-específicos (235a, CD14, CD15, CD16) e com características morfológicas típicas. Foi demonstrado que as células obtidas expressavam genes relativos ao sistema hematopoético (CD45, CD31, runx1, tal1, lmo2, prom1, CD34 e notch1), e possuíam potencial clonogênico in vitro da ordem de 1/574 células plaqueadas. Em adição, corroboramos os achados de que as células hematopoéticas apresentam duas origens distintas: a partir do endotelio hemogênico e a partir de células com propriedades hemangioblásticas independentes do endotélio hemogênico. / Hematopoiesis has been well described in murine models in recent decades, however, studies demonstrating the mechanisms of hematopoiesis in humans are still scarce. The first human embryonic stem cells line (hESCs) derived in 1998, has generated new perspectives about the study of hematopoiesis as in attempting to mimic what naturally occurs during embryonic development, as for clinical application of hematopoietic cells obtained from the differentiation of these cells. However, although numerous studies have shown the production of hematopoietic cells derived from hESCs, the protocols have generated varying quantities of cells with low efficiency and functional properties of primitive stem cells. Thus, this study sought to establish our own model for hESC-H1 differentiation in hematopoietic progenitor cells so that they could be better characterized and obtained more efficiently. For this way, we developed a differentiation system based on co-culture of hESC-H1 line with inactivated mouse embryonic fibroblasts (MEFs) in differentiation medium supplemented with fetal calf serum (FCS) and cytokines and hematopoietic growth factors in low concentrations. As a result, the development of this study allowed the establishment of a method for generation of mixed population of cells enriched in hematopoietic progenitor cells positive for the marker CD45, which proved to be co-expressed with other hematopoietic markers (CD31, CD43, CD71 and CD38), and mature hematopoietic cells positive for myeloid-specific markers (235a, CD14, CD15, CD16) and morphological characteristics typical. It was shown that these cells expressed genes related to the hematopoietic system (CD45, CD31, runx1, TAL1, LMO2, prom1, CD34 and NOTCH1), and had clonogenic potential in vitro of 1/574 plated cells. In addition, we corroborate the findings that hematopoietic cells have two distinct origins: they can arise as from an hemogenic endothelium as from cells with hemangioblastic properties by an hemogenic endothelium-independent way.

O saco vitelino é o único anexo embrionário presente em todas as espécies dos embriões vertebrados, répteis, aves e mamíferos. Em mamíferos domésticos o saco vitelino é inicialmente grande, pois nestas espécies ele é transitório. Após a implantação, surge no mesênquima lateral à notocorda agrupamentos de células, denominados ilhotas sanguíneas, que representam os progenitores dos sistemas vascular e hematopoético: os hemangioblastos. Os hemangioblastos centrais das ilhas sanguíneas formam as primeiras células-tronco hematopoéticas, enquanto os hemangioblastos periféricos se diferenciam em angioblastos, os precursores dos vasos sanguíneos. O desenvolvimento inicial da atividade hematopoética no saco vitelino conduz a hipótese de que esse tecido é o local primário de desenvolvimento hematopoético e que as células-tronco derivadas dele semeiam os outros sítios intraembriônicos. Foi possível observar nas análises microscópicas que realmente existe uma relação entre ambas linhagens. Nas análises de expressão gênica, alguns genes expressos pelo hemangioblasto apresentaram alta expressão nas análises D+0 e outros genes também específicos do hemangioblasto, porém em estágios secundários de diferenciação como os encontrados na região aórtica, a nível de endotélio hemogênico apresentaram altos níveis de expressão após 3 dias em cultivo. Concluímos portanto, que o saco vitelino por ser o local primário de formação das células sanguíneas e endoteliais nos estágios iniciais da embriogênese, por serem primitivas e, portanto não expressarem marcadores de células maduras na sua superfície, tornam estas células uma importante fonte de células-tronco relevante para a Terapia Celular para hemofilia e muitas outras doenças humanas. / The yolk sac is the single attachment embryo present in all species of vertebrate embryos, reptiles, birds and mammals. In domestic mammals the yolk sac is initially large, since these species it is transient. After implantation, appears in the lateral mesenchyme to the notochord cell clusters, called \"blood islands\" that represent the progenitors of vascular and hematopoietic systems: the hemangioblasts. The central islands hemangioblasts form the first blood hematopoietic stem cells, while peripheral hemangioblasts, the angioblastic differentiate into the precursors of blood vessels. The initial development of the yolk sac hematopoietic activity leads to the hypothesis that this tissue is the primary site of development and that hematopoietic stem cells derived from them sow other intraembryos sites. It was observed in the microscopic analysis that there is indeed a relationship between the two lineages. In the analysis of gene expression, some genes expressed by hemangioblasts showed high expression in D+0 and other specific genes also hemangioblasts, but in secondary stages of differentiation as found in the aortic region, the level of hemogenic endothelium showed high levels of expression after 3 days in culture. We therefore conclude that the yolk sac to be the primary site of formation of blood and endothelial cells in the early stages of embryogenesis, for its cells be primitive and therefore do not express markers of mature cells on the surface, these cells become an important source of cells relevant to stem cell therapy for hemophilia and many other human diseases.

Les cellules progénitrices endothéliales formant des colonies (EFCFs) sont issues decellules CD34+ de la moelle osseuse humaine. Peu de données concernent l’expression dufacteur tissulaire (FT) lors de cette différenciation endothéliale. Outre son rôle dansl’initiation de la génération de thrombine, le FT est impliqué dans l’angiogenèse.Nous montrons que les cellules CD34+ expriment le FT mais non ses isoformes. LesECFCs expriment peu de FT à l’état basal. En revanche, leur stimulation par le TNF-α induitune augmentation de l’expression de FT, et la génération de microparticules pro-coagulantes.Nous avons analysé les modifications fonctionnelles induites par cette stimulation. Nosrésultats montrent que l’expression de FT par les ECFCs est responsable d’une activité procoagulante majeure, alors que les propriétés angiogéniques ne semblent pas affectées.L’expression du tissue factor pathway inhibitor (TFPI) a été évaluée, ainsi que la capacité desmicroparticules issues de ECFCs à générer des métalloprotéinases (MMP2-, MMP-9).Une évaluation de la stabilité chromosomique des cb-ECFCs durant leur expansion aété réalisée, mettant en évidence des anomalies de nombre, mais pas d’anomalies destructures. Les conséquences de ces résultats en termes de thérapie cellulaire appliquées auxpathologies cardio-vasculaires sont discutées. Enfin, nous évoquons la possibilité deconsidérer l’expression de FT comme un marqueur de différenciation cellulaire. / Endothelial colony-forming cells (ECFCs) can be obtained from human bone marrowCD34+ cells. In spite of the essential role of the tissue factor (TF) in coagulation triggeringand angiogenesis, its expression during endothelial differentiation is not established. We showthat CD34+ cells express TF, but not TF splicing forms. ECFCs express a small amount of TFat baseline level. In contrast, ECFCs express TF high levels of TF on response to TNF-α andcan generated highly pro-coagulant microparticles. We have examined the functionalproperties induced by TNF-α stimulation. TF expression confers to ECFCs a strong thrombingeneration capacity without influencing their non-coagulant properties. We have examinedthe co-expression of the tissue factor pathway inhibitor (TFPI) and the ability of ECFCs togenerate microparticles producing metalloproteins (MMP-2, MMP-9).We have performed an evaluation of cb-ECFCs chromosomal stability during theirexpansion. We found quantitative but no structural chromosomal abnormalities. Theconsequences of our observations in the use of cell therapy in cardiovascular diseases arediscussed. We conclude that TF expression may be considered as cell differentiation marker

Tissue regeneration is a complex and highly orchestrated process dependent on cells with the potential to restore structures and functions and on controlling factors from the tissue microenvironment. Hematopoietic tissue has a high ability to regenerate, which is attributed to the presence of stem cells, but the regeneration of severely damaged adult tissue is still only partially understood. Hematopoietic tissue provides a unique opportunity to study tissue regeneration due to its well-established steady- state structure and function, easy accessibility, advanced research methods, and well-defined embryonic, fetal, and adult stages of development. Embryonic/fetal liver hematopoiesis and adult hematopoiesis recovering from damage share the needto expand populations of progenitors and stem cells in parallel with increasing production of mature blood cells. We analyzed adult hematopoiesis in mice subjected to a submyeloablative dose (6 Gy) of gamma radiation, in which only a few cells with reconstituting capacity survived. We targeted the period of regeneration characterized by the renewed massive production of mature blood cells and the ongoing expansion of immature hematopoietic cells. Cells from the top of the hematopoietic hierarchy, hematopoietic stem cells, and multipotent progenitors are almost missing...

South Africa is in dire need of a public umbilical cord blood stem cell bank (UCB SCB). A severe shortage of genetically compatible samples for BM transplantation precludes the majority of South Africans from receiving the relevant medical care. UCB is a viable alternative to BM but is currently disposed of post-delivery. UCB could furthermore serve as a resource of genetically compatible haematopoietic progenitor cells (HPCs) that could be used in gene therapy approaches directed towards a cure for HIV-1. Knowing whether HIV-1 affects or infects primitive HPCs is vital to determine the course of action for transplantation of UCB-derived genetically resistant HPCs. Collecting and storing UCB in a public UCB bank could thus serve as a vital resource of genetically compatible samples for BM transplantation. It was thought that the high incidence of HIV-1 in South African patients and the persistent stigma surrounding HIV-1 would be problematic for collecting sustainable numbers of UCB units and subjecting units to compulsory screening for infectious diseases. This was however, not the case. In the South African context, we are faced with unique and rich challenges relating to cultural and religious differences that are further augmented by linguistic constraints and educational insufficiencies. Nevertheless, the majority of patients within the interviewed patient cohort were supportive of the idea of establishing a public UCB SCB in SA and were willing to undergo additional HIV-1 screening. The Ultrio-Plus® assay was verified in this study for screening UCB units for HIV-1 and could be used in routine analyses of UCB units prior to banking. Conflicting results in the literature exist with regard to HIV-1’s ability to infect or affect haematopoietic progenitor cells. Results from this study revealed that HIV-1 was not only able to affect HPCs’ ability to form colonies in vitro, but was also capable of infecting CD34+ HPCs in some individuals. These results substantiate the theory that some CD34+ HPCs serve as viral reservoirs which could account for residual viraemia in patients on antiretroviral therapy. Results suggest that allogeneic transplantation of HIV-1 infected individuals with UCB-derived, genetically modified HPCs, should be pursued. / Thesis (PhD)--University of Pretoria, 2012. / Immunology / unrestricted

Haematopoietic stem and progenitor cells (HSPCs) are crucial for lifelong blood cell production. We analysed the cell cycle and cell production rate in HSPCs in murine haematopoiesis. The labelling of DNA-synthesizing cells by two thymidine analogues, optimized for in-vivo use, enabled the determination of the cell cycle flow rate into the G2-phase, the duration of the S-phase and the average cell cycle time in Sca-1+ and Sca-1- HSPCs. The determination of cells with 2n DNA content and labelled during the preceding S-phase was used to establish the cell flow rates in the G1-phase. Our measurements revealed a significant difference in how Sca-1+ and Sca-1- HSPCs self-renew and differentiate. The division of Sca-1+ progenitors led to the loss of the Sca-1 marker in about half of newly produced cells, corresponding to asymmetric cell division. In contrast both Sca-1- progenitors, arising from mitotic cell division, entered a new round of the cell cycle. This corresponds to symmetric self-renewing cell division. The novel data also enabled us to estimate the cell production rates in the Sca-1+ and in three subtypes of Sca-1- HSPCs. We focused on adult murine erythroid differentiation in the next part of our study. We introduced an original flow cytometry approach for identifying and studying erythroid...

The regenerative potential of adult stem cell populations within the human body bears great promises for their use in regenerative medicine. The bone marrow (BM) harbours two different types of adult stem cells, haematopoietic stem and progneitor cells (HSPCs) and multipotent mesenchymal stromal cells (MSCs), which are tightly regulated in their distinct anatomically defined niches by multiple cues such as cytokines, cell-cell contacts, the extracellular matrix (ECM) and the physical microenvironment. The ex vivo expansion of these cells for applications in regenerative therapies is of great interest and several biomaterial approaches attempt to mimic the natural BM niche and its components to control stem cell maintenance and differentiation. However, as of now the complexity of such stem cell niches is hard to recapitulate. Towards this goal, this work was focussing on the ECM environment of BM stem cells and was set out to engineer improved in vitro culture systems. MSC themselves are one of the most important cell types within the BM that secrete and construct ECM-networks and thereby shape the microenvironment of the residing cells. The potential of primary human BM-MSC to secrete ECM in vitro has been exploited to generate niche-like ECM surrogates in a robust and versatile format. Application of decellularisation regimes allowed the fabrication of complex matrices which demonstrated suprastructural, compositional and physicochemical properties compareable to those of the native BM-ECM environment. Reliable stability and reproduciblity was achieved by a dedicated procedure of maleic anhydride co-polymer-mediated covalent binding of fibronectin and subsequent anchorage of cell-secreted ECM molecules. As a result of the high reproducibility, a complete proteomic register of ECM molecules was obtained in combination with determining the complex fibrillar and soft gel-like characteristics of MSC-derived matrices. Based on the established BM niche-like substrate, the impact of extracellular matrices on MSC and HSPC ex vivo behavior has been explored. Both cell types demonstrated strong adhesion to ECM substrates and depicted a changed cellular morphology upon contact with native ECM structures compared to standard culture substrates or simple ECM protein coatings, indicating an intense interplay between the cell and the microenvironment. MSC that re-grew into their own matrices have shown advantageous proliferation and cytokine secretion levels as well as enhanced differentiation intensity (upon differentiation induction) compared to MSC that were cultured on less complex substrates. Similarly, HSPC were also instructed for enhanced expansion on MSC-derived matrices without exhaustion of stem cell-marker expressing progenitor cells. The efficiency of these matrices was related to their ability to mimic the native composite suprastructure, ligand nano-topography, molecular composition and physical properties of natural BM ECM environments. The data obtained within this thesis set the ground for a more rational design of artificial stem cell niches with defined and distinct properties, offering exciting options for the in-depth analysis and understanding of stem cell regulation by exogenous cues.