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First published online January 26, 2006
Stem Cells Vol. 24 No. 5 May 2006, pp. 1409 -1410
doi:10.1634/stemcells.2005-0654; www.StemCells.com
© 2006 AlphaMed Press

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LETTER TO THE EDITOR

Cell Culture Medium Composition and Translational Adult Bone Marrow-Derived Stem Cell Research

Panagiota A. Sotiropoulou, Sonia A. Perez, Maria Salagianni, Constantin N. Baxevanis, Michael Papamichail

Cancer Immunology and Immunotherapy Center, Saint Savas Hospital, Athens, Greece

Correspondence: Panagiota A. Sotiropoulou, Ph.D., Cancer Immunology and Immunotherapy Center, Saint Savas Cancer Hospital, 171, Alexandras Avenue, 115 22 Athens, Greece. Telephone: +30-210-6409462; Fax: +30-210-6409516; e-mail: sotiropoulou{at}ciic.gr

Received December 28, 2005; accepted for publication January 18, 2006.

    ABSTRACT
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 Abstract
 Introduction
 Disclosures
 References
 
The use of fetal calf serum (FCS) for the culture of cells to be used in clinical trials raises potential hazards that cannot be neglected, but this is a regulatory issue. However, as specifically regards the isolation and expansion of human mesenchymal stem cells (MSCs), unfortunately serum-free media have not yet been defined. The alternative of using autologous serum is feasible only for the minority of clinical protocols involving low numbers of MSCs, because a minimum concentration of 10% in the culture medium is required. Besides, because allogeneic serum results in MSC growth arrest and death, use of pooled human serum does not represent an alternative. Finally, vast numbers of MSCs cultured in FCS-containing media have already been used in many clinical trials targeting a variety of disorders, without any significant side effects, including ventricular arrhythmia.


    INTRODUCTION
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 Abstract
 Introduction
 Disclosures
 References
 
Drs. Dimarakis and Levicar have raised the interesting and well-known subject regarding the use of fetal calf serum (FCS) for the large-scale expansion of cells to be used in cellular therapy (although this use is of a regulatory nature). Unfortunately, serum-free media have not yet been defined for the isolation and expansion of human mesenchymal stem cells (MSCs), and studies using serum-free media refer only to differentiation studies in vitro [13]. The serum-free culture experiments of rat MSCs described by Lennon et al. and mentioned by Drs. Dimarakis and Levicar demonstrate their maintenance in culture only after two passages in FCS-supplemented medium [4]. Given that MSCs do exhibit species-specific differences in isolation, growth requirements, morphology, and time of senescence [5] even maintenance in serum-free conditions may still not be applicable in the human system.

Currently, interest is growing in the use of autologous serum for MSC isolation and expansion. One of the few relevant studies to date defining the optimal dosing conditions suggests that autologous serum is required at a minimum concentration of 10% in the culture medium [6]. For clinical protocols involving low numbers of MSCs, it is feasible to obtain the appropriate volume of peripheral blood. However, most types of cellular therapy require vast numbers of MSCs, which in turn necessitate large amounts of culture media and subsequently forbiddingly large volumes of peripheral blood. Besides, use of pooled human serum could not help to overcome this, because allogeneic serum results in MSC growth arrest and death [7].

To our knowledge, there are more than a dozen published clinical trials using MSCs for the treatment of various disorders, all of which use FCS for MSC culture (e.g., [813]). Infusion of large numbers of MSCs (even at 109 cells) at different sites (e.g., intravenously, intracoronary, in the middle cerebral artery, or at the surgically exposed spinal cord) has so far not been reported to cause any significant side effects [813]. In addition, recombinant proteins and monoclonal antibodies produced by mammalian cells in the presence of FCS indicated for human use have been approved by regulatory bodies in the U.S. and Europe and are in clinical practice. Although it has been reported that cellular cardiomyoplasty using FCS-cultivated myoblasts has demonstrated significant malignant ventricular arrhythmias [14], this was not the case when using MSCs expanded in FCS-containing media [12, 13]. In particular, in the study performed by our group [13], cardioverter defibrillators implanted in five of the patients undergoing MSC infusion failed to detect any ventricular arrhythmia (unpublished data).

In conclusion, the use of FCS does raise potential hazards (although reliable tests, such as for the detection of prion proteins, are now available), but until a suitable alternative arises, this remains the only choice in order to continue clinical trials for treating the variety of irreversible pathological disorders that do not respond to conventional therapies.


    DISCLOSURES
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 Disclosures
 References
 
The authors indicate no potential conflicts of interest.


    REFERENCES
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 Abstract
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 References
 

  1. Tao H, Rao R, Ma DD. Cytokine-induced stable neuronal differentiation of human bone marrow mesenchymal stem cells in a serum/feeder cell-free condition. Dev Growth Differ 2005;47:423–433.[Medline]

  2. Lee JW, Kim YH, Park KD et al. Importance of integrin ß-1-mediated cell adhesion on biodegradable polymers under serum depletion in mesenchymal stem cells and chondrocytes. Biomaterials 2004;25:1901–1909.[Medline]

  3. Schmitt B, Ringe J, Haupl T et al. BMP2 initiates chondrogenic lineage development of adult human mesenchymal stem cells in high-density culture. Differentiation 2003;71:567–577.[CrossRef][Medline]

  4. Lennon DP, Haynesworth SE, Young RG et al. A chemically defined medium supports in vitro proliferation and maintains the osteochondral potential of rat marrow-derived mesenchymal stem cells. Exp Cell Res 1995;219:211–222.[CrossRef][Medline]

  5. Javazon EH, Beggs KJ, Flake AW. Mesenchymal stem cells: Paradoxes of passaging. Exp Hem 2004;32:414–425.[CrossRef][Medline]

  6. Stute N, Holtz K, Bubenheim M et al. Autologous serum for isolation and expansion of human mesenchymal stem cells for clinical use. Exp Hematol 2004;32:1212–1225.[CrossRef][Medline]

  7. Shahdadfar A, Fronsdal K, Haug T et al. In vitro expansion of human mesenchymal stem cells: Choice of serum is a determinant of cell proliferation, differentiation, gene expression and transcriptome stability. STEM CELLS 2005;23:1357–1366.[Abstract/Free Full Text]

  8. Bang OY, Lee JS, Lee PH et al. Autologous mesenchymal stem cell transplantation in stroke patients. Ann Neurol 2005;57:874–882.[CrossRef][Medline]

  9. Mazzini L, Fagioli F, Boccaletti R et al. Stem cell therapy in amyotrophic lateral sclerosis: A methodological approach in human. ALS 2003;4: 158–161.

  10. Le Blanc K, Rasmusson I, Sundberg B et al. Treatment of severe acute graft-versus-host disease with third party haploidentical mesenchymal stem cells. Lancet 2004;363:1439–1441.[CrossRef][Medline]

  11. Koc ON, Gerson SL, Cooper BW et al. Rapid hematopoietic recovery after coinfusion of autologous-blood stem cells and culture-expanded marrow mesenchymal stem cells in advanced breast cancer patients receiving high-dose chemotherapy. J Clin Oncol 2000;18:307–316.[Abstract/Free Full Text]

  12. Chen SJ, Fang WW, Ye F et al. Effect on left ventricular function of intracoronary transplantation of autologous bone marrow mesenchymal stem cell in patients with acute myocardial infarction. Am J Cardiol 2004;94:92–95.[CrossRef][Medline]

  13. Katritsis DG, Sotiropoulou PA, Karvouni E et al. Transcoronary transplantation of autologous mesenchymal stem cells and endothelial progenitors into infarcted human myocardium. Catheter Cardiovasc Interv 2005;65:321–329.[CrossRef][Medline]

  14. Chachques JC, Herreros J, Trainini J et al. Autologous human serum for cell culture avoids the implantation of cardioverter-defibrillators in cellular cardiomyoplasty. Int J Cardiol 2004;95 (suppl 1):S29–S33.





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