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By
From Progenesys Program, Systemix Inc, Palo Alto, CA; and the City of Hope National Medical Center, Duarte, CA.
The potential of hematopoietic stem cells (HSCs) from human immunodeficiency virus type-1 (HIV-1)-infected individuals, eg, self-renewal and multilineage differentiative capacity, might be perturbed due to the underlying disease. In this study, we assessed the HSC activity in the CD34+Thy-1+ cell population of peripheral blood stem cells (PBSCs) of three asymptomatic HIV-1-infected individuals after granulocyte colony-stimulating factor (G-CSF; 10 µg/kg/d) mobilization. On day 4 of G-CSF treatment, 0.8% to 1% of the total blood mononuclear cells were CD34+. Leukapheresis followed by a two-step cell isolation process yielded a CD34+Thy-1+ cell population of high purity (76% to 92% CD34+Thy-1+ cells). This cell population showed no evidence of HIV-1-containing cells based on a semiquantitative HIV-1 DNA polymerase chain reaction. Furthermore, the purified cells showed normal hematopoietic potential in in vitro clonogenic assays. Successful gene transfer into committed progenitor cells (colony-forming units-cells) and more primitive stem/progenitor cells (long-term culture colony-forming cells) could be shown after amphotropic retroviral transduction. These data provide evidence that the CD34+Thy-1+ stem cell compartment can be mobilized and enriched in early stage HIV-1-infected patients. Furthermore, successful transduction of this cell population as a prerequisite for stem cell-based clinical gene therapy protocols was demonstrated.
PERIPHERAL BLOOD stem cells (PBSCs) are currently being used for both autologous and allogeneic long-term hematopoietic reconstitution of cancer patients after myeloablation or chemoradiotherapy.1-4 The administration of chemotherapeutic agents and/or hematopoietic growth factors, such as granulocyte colony-stimulating factor (G-CSF ) mobilizes hematopoietic stem/progenitor cells in normal donors,5 cancer patients,6,7 and human immunodeficiency virus type-1 (HIV-1)-infected individuals.8 After G-CSF mobilization, PBSCs can then be procured by leukapheresis. Furthermore, transplantation of mobilized PBSCs is associated with shortened hematologic recovery times compared with bone marrow (BM) transplants.9,10 Within human blood mononuclear cells, a subpopulation of cells expresses the CD34 surface antigen (CD34+) exhibiting hematopoietic stem cell (HSC) characteristics.11-13 However, a more primitive HSC subset (CD34+Thy-1+Lin-) has been identified using long-term in vitro clonogenic assays and in vivo studies.14 This cell population is enriched in HSC activity capable of self-renewal and long-term multilineage differentiation15,16 and represents a subpopulation for autologous transplantation of PBSCs.
Gene therapy is a new treatment modality for a variety of genetic, neoplastic, or infectious diseases and has the potential to correct defects in all mature cells derived from gene-modified HSCs. In the case of HIV-1 infection, introduction of anti-HIV-1 gene constructs into HSCs might prevent acquired immunodeficiency syndrome (AIDS) pathogenesis17 in differentiated T lymphocytes, monocytes/macrophages, and dendritic and microglial cells. Several reports have described that BM CD34+ stem/progenitor cells are infected with HIV-1 at low frequencies in some patients.18-22 In contrast, one study concluded that, in individuals with advanced HIV-1 infection, up to 1 in 500 CD34+ cells is infected with HIV.23 Thus, hematopoietic stem/progenitor cells might be infected with HIV-1 and/or affected by the concurrent infection of BM stromal cells,24,25 resulting in the observed hematosuppression.26
The purpose of this study was to assess the in vitro clonogenic potential of mobilized PBSCs isolated from asymptomatic HIV-1-infected individuals and to assess retroviral-mediated gene transfer. Mobilization of PBSCs was achieved by G-CSF administration and the CD34+Thy-1+ subpopulation of HSCs was isolated after leukapheresis to high purity in a two-step isolation process. Our data support the notion that the CD34+Thy-1+ primitive hematopoietic cell population can be mobilized and enriched and is not adversely affected in early stage, asymptomatic HIV-1-infected patients. Furthermore, this cell population can be transduced with recombinant retroviral vectors supporting their clinical utility as autologous target cells for HSC-based gene therapies in HIV-1 disease.
Patients.
Written informed consent was obtained from all study participants as approved by the institutional review board of the City of Hope National Medical Center. Study participants were HIV-1 seropositive with CD4 counts of Purification of CD34+ and CD34+Thy-1+ cells from asymptomatic HIV-1 patients.
Details on study participants are given in Table 1. Leukapheresis was performed on day 5 of G-CSF treatment (10 µg/kg/d). Figure 1 shows a flowchart depicting the purification steps, analyses, and assays performed with the apheresis products. The average number of viable cells in the leukapheresis samples received (n = 3) was 6.5 × 109 (range, 3.7 × 109 to 8.3 × 109) and the mean percentage of CD34+ cells in the apheresis product was 1.3% (range, 1.11% to 1.64%) compared with levels of CD34+ cells below the detection limit before G-CSF administration. The CD34+ cells were enriched using a positive immunomagnetic selection device27 and the mean percentage of CD34+ cells was 78.9% (range, 77.5% to 83.6%) after enrichment. The CD34+Thy-1+ subpopulation was 42.2% (range, 26.6% to 51.5%) of CD34+ cells. The CD34+Thy-1+ cell population was further enriched using an HSCS.29 After this step, the percentage of CD34+ cells was 90.6%, 94%, and 98.2% and the percentage of CD34+Thy-1+ cells was 76.2%, 90.1%, and 91.6% for tissue CoH-1, CoH-2, and CoH-3, respectively. The relative cell recovery after the CD34+ and CD34+Thy-1+ cell enrichment processes was 60% to 80% and 20% to 40%, respectively (data not shown). The cell viability was on average 71.6% (range, 38% to 93%) after HSCS. One tissue (CoH-1) showed low cell viability, which was most likely due to the storage and transportation conditions used. Figure 2 shows a representative FACS analysis of samples from each purification step of one tissue (CoH-3).
In this study, we showed for the first time purification of a primitive CD34+Thy-1+ HSC-enriched cell population15 from cytokine-mobilized PBSCs of early stage, asymptomatic HIV-1-infected individuals. We did not detect HIV-1 proviral DNA sequences in any of the CD34+Thy-1+ cell samples using a DNA PCR assay with a sensitivity of detecting one proviral copy in the background of 1 × 104 or 1 × 105 uninfected cells. These results suggest that these cells are not infected in vivo or the infection rate is below the detection limit. Our results are in agreement with previous reports that used BM or G-CSF-mobilized CD34+ cells from HIV-1-seropositive patients at different disease stages and showed low levels of infection of CD34+ cells.8,18-22 Further evidence that only few CD34+ cells are infected by HIV-1 stems from in vitro experiments in which BM CD34+ cells were exposed to HIV-1. In this study, reselected CD34+ cells tested negative for HIV-1 infection and expression.36 CD34+Thy-1+ cells are more primitive than CD34+ cells and are highly enriched for lineage-negative cells and a better defined stem cell population. For these reasons, it is possible that this cell population is less susceptible to HIV-1 infection than CD34+ cells. Whether this also applies to HIV-1 patients with advanced disease awaits further investigation.
Submitted November 22, 1996;
accepted January 28, 1997.
The publication costs of this article were defrayed in part by page
charge payment. This article must therefore be hearly marked
``advertisment'' in accordance with 18 U.S.C. section 1734 solely to
indicate this fact. We thank the staff at the Donor/Apheresis Center at City of Hope National Medical Center, in particular Dr James I. Ito for subject recruitment and Priscilla Yam for providing apheresis samples. We also thank our Systemix colleagues: Dave Adams for cell sorting, Charles Dowding for his advice with cell enrichment, Sean Forestell for providing vector supernatant, Robin Hastings for operational assistance with the FACS Vantage, Susan Nicholas for organizing sample shipments, Linda Osborne for maintenance of Sys1 cells, Ivan Plavec and Robert Tushinski for access to unpublished data, and Ben Chen and Richard J. Rigg for critical review of the manuscript. We are indebted to the patients who participated in this study. The Progenesys Program at Systemix is a Research and Development Collaboration jointly sponsored by Novartis and Systemix.
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