Abstract
In-utero stem cell transplantation (IUST) is an intriguing alternative to postnatal transplantation of hematopoietic stem cells. However, despite decades of research, both in animal models and in human fetuses, the clinical application of IUST is still not feasible. Thus far, more than 30 case reports on clinical experience with IUST in the human fetus, for various indications, have been published or described (Table 1). These cases were treated with cells from fetuses of various gestational ages and with different quantity and quality of stem cells. Only a few cases of IUST in severe combined immunodeficiency (SCID) showed some degree of engraftment. A potential cause of failure of IUST is lack of engraftment due to competition of the transplant with a vigorous hematopoietic compartment in the host. Not only differences in the characteristics of stem cells used can influence engraftment, but also characteristics of stem cells present in the host at each specific gestational age have to be taken into account. During embryonic and fetal life, the major hematopoietic sites of hematopoiesis change (Fig. 1). We have summarized the literature on the hematopoietic compartment of the first and second trimester fetus and discussed it in relation to IUST.
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Wilpshaar, J., Kanhai, H.H.H., Scherjon, S., Falkenburg, J.H.F. (2001). Fetal Hematopoiesis During First and Second Trimester of Pregnancy: Relevance for In Utero Stem Cell Transplantation. In: Holzgreve, W., Lessl, M. (eds) Stem Cells from Cord Blood, in Utero Stem Cell Development and Transplantation-Inclusive Gene Therapy. Ernst Schering Research Foundation Workshop, vol 33. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-04469-8_11
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