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Hematopoietic stem cell transplantation (HSCT) is the therapeutic concept to cure the blood/immune system of patients suffering from malignancies, immunodeficiencies, red blood cell disorders, and inherited bone marrow failure syndromes. Yet, allogeneic HSCT bear considerable risks for the patient such as non-engraftment, or graft-versus host disease. Transplanting gene modified autologous HSCs is a promising approach not only for inherited blood/immune cell diseases, but also for the acquired immunodeficiency syndrome. However, there is emerging evidence for substantial heterogeneity of HSCs in situ as well as ex vivo that is also observed after HSCT. Thus, HSC gene modification concepts are suggested to consider that different blood disorders affect specific hematopoietic cell types. We will discuss the relevance of HSC heterogeneity for the development and manufacture of gene therapies and in exemplary diseases with a specific emphasis on the key target HSC types myeloid-biased, lymphoid-biased, and balanced HSCs.
Acute myeloid leukemia (AML) is characterized by the accumulation of a large number of abnormal, immature blast cells. Recently, histone deacetylase inhibitors (HDIs) received considerable interest on the ground of their ability to overcome the differentiation block in these leukemic blasts regardless of the primary genetic alteration, an effect achieved either alone or in combination with differentiating agents, such as all-trans retinoic acid (t-RA). Valproic acid (VPA), a potent HDI, is now under clinical evaluation owing to its potent differentiation effect on transformed hematopoietic progenitor cells and leukemic blasts from AML patients. Conversely, in a clinical study by Bug et al., the favorable effects of the combination treatment with t-RA/VPA in advanced acute myeloid leukemia patients were reported to be most likely due to an enhancement of nonleukemic myelopoiesis and the suppression of malignant hematopoiesis rather than enforced differentiation of the leukemic cells. Based on the hypothesis that VPA influences normal hematopoiesis, the effect of chromatin modeling through VPA on HSCs was investigated with respect to differentiation, proliferation as well as self-renewal in the present study. It has been shown that valproic acid increases both proliferation and self-renewal of HSC. It accelerates cell cycle progression of HSC accompanied by a down-regulation of p21cip-1/waf-1. Furthermore, valproic acid inhibits GSK3B by phosphorylation on Ser9 accompanied by an activation of the Wnt signaling pathway as well as by an up-regulation of HoxB4, a target gene of Wnt signaling. Both are known to directly stimulate the proliferation of HSC and to expand the HSC pool. To sum up, valproic acid, a potent histone deacetylase inhibitor known to induce differentiation and/or apoptosis in leukemic blasts, stimulates the proliferation and self-renewal of hematopoietic stem cells. Therefore, the data reported in this study suggest to reconsider the role of histone deacetylase inhibitors from a differentiation inducer to a coadjuvant factor for increasing the response to conventional therapy in acute myeloid leukemia.