Haemopoietic recovery after high dose chemotherapy (HOC) in the treatment of haematological disease may be slow and/or incomplete. This is generally attributed to progressive haemopoietic stem cell failure, however we hypothesize that HOC induced defective haemopoiesis may be in part due to poor stromal function. Although chemotherapy is known to damage mature bone marrow stromal cells in-vitro, the extent to which marrow mesenchymal stem cells (MSC) are damaged by HOC in-vivo and in-vitro is unknown. To firstly address this question the physical characteristics and functional properties of marrow MSC derived from patients who have received chemotherapeutic treatment for various haematological diseases were investigated. Subsequently a suitable in-vitro treatment culture model was developed and the effects of chemotherapy exposure in-vitro using cell culture and proteomic techniques were shown. Results of this study demonstrate proliferative and phenotypic changes to patient MSC caused by HOC regimens. In contrast, the differentiation capacity, and ability to form functional marrow stroma after exposure to HOC in-vivo was equal to that of patient MSC studied prior to HOC. Chemotherapeutic exposure to MSC cultures in-vitro have confirmed changes seen in-vivo, with abnormalities evident in MSC proliferation, differentiation and also in their ability to support haemopoietic stem cell migration and repopulation after treatment. A reduced C044 expression on MSC, after exposure to cyclophosphamide, was also observed and the importance of this molecule shown through con-focal microscopy demonstrating its interaction with C034+ haemopoietic stem cells. Using proteomic techniques differences in protein expression by MSC, relating to changes in their function after chemotherapy exposure, were also observed after treatment with cyclophosphamide or melphalan. Finally the role of keratinocyte growth factor as a potential cyto-protective agent to MSC against damage caused by chemotherapy exposure was tested. Results indicated there was significant evidence to indicate that KGF was able to preserve reductions in C044 expression levels after MSC exposure. It was concluded that marrow MSC sustain prolonged injury due to recurrent courses of HOC in-vivo and in-vitro. However, the clinical importance of the chemotherapy induced defects we have observed must be determined through the initiation of prospective randomized trials of the effects of MSC co-transplantation on haemopoietic recovery in the setting of HOC with and without haemopoietic stem cell rescue.
| Identifer | oai:union.ndltd.org:bl.uk/oai:ethos.bl.uk:495521 |
| Date | January 2008 |
| Creators | Kemp, Kevin Charles |
| Publisher | University of the West of England, Bristol |
| Source Sets | Ethos UK |
| Detected Language | English |
| Type | Electronic Thesis or Dissertation |
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