The clinical trials of myoblast transplantation in Duchenne Muscular Dystrophy (DMD) patients produced disappointing results. The main problems responsible for these poor results have since then been identified and partially resolved. One of them was related to the use of an inadequate immunosuppression and, since then, immunosuppression with FK506 has permitted successful myoblast transplantation not only in mice but also in monkeys. The requirement for a sustained immunosuppression may be eventually avoided by developing a state of tolerance to the allogeneic cells or by autologous transplantation of genetically corrected myoblasts or stem cells. The rapid death of 75-80% of the injected myoblasts during the first five days has also contributed to the limited success of the early trials. This death was due to an inflammatory reaction and has been compensated in animal experiments by the injection of a larger number of cells (30 millions per cc). Finally, the myoblasts migrated only 0.5 mm away from their site of injection. This problem is currently compensated in animal experiments by injecting the myoblasts at every mm. The number of injections required may eventually be reduced by transfecting myoblasts with one or several metalloproteinase genes. The very good results obtained during the last two years in primates permit us to undertake a new phase I clinical trial to verify that myoblast transplantation can lead to the formation of muscle fibers expressing normal dystrophin in muscles of DMD patients.

Murine embryonic stem (ES) cells are cell lines established from blastocyst which can contribute to all adult tissues, including the germ-cell lineage, after reincorporation into the normal embryo. ES cell pluripotentiality is preserved in culture in the presence of LIF. LIF withdrawal induces ES cell differentiation to nervous, myocardial, endothelial and hematopoietic tissues. The model of murine ES cell hematopoietic differentiation is of major interest because ES cells are non transformed cell lines and the consequences of genomic manipulations of these cells are directly measurable on a hierarchy of synchronized in vitro ES cell-derived hematopoietic cell populations. These include the putative hemangioblast (which represents the emergence of both hematopoietic and endothelial tissues during development), myeloid progenitors and mature stages of myeloid lineages. Human ES cell lines have been recently derived from human blastocyst in the USA. Their manipulation in vitro should be authorized in France in a near future with the possibility of developing a model of human hematopoietic differentiation. This allows to envisage in the future the use of ES cells as a source of human hematopoietic cells.

Transfusion medicine has the logic of a therapeutic chain applied to labile blood components and cell therapy products, within a coherent structure, such as the recently created Etablissement français du sang. Faced to the threat of emerging--sometimes hypothetical--transfusion risks, such as the possible transmission of BSE by blood transfusion, the precaution principle requires developing strategies to reduce labile blood components consumption, by strictly defining the framework of blood transfusion prescription and encouraging the search for red blood cell and platelet substitutes. In the field of alternatives to labile blood components, research has however yielded few results. The future of transfusion medicine lies in biotechnology: cell (and gene) therapy will become part of novel therapeutic strategies for the treatment of numerous pathologies in man. Transfusion medicine will have to consider the significant advances achieved over the last few years in the field of multipotent stem cells. Transfusion medicine will thus find its place in the promising field of innovating therapies.

The presence in normal adult man of stem cells sharing the properties of embryonic stem cells opens new avenues for basic and therapeutic research. We describe a stem cell present in normal adult human blood, probably able to give rise to the "reserve" stem cells in charge of repair, present in different organs. These monocytoid circulating cells are able to transdifferentiate into several cell types. In normal man, they are almost quiescent and are strictly controlled by a special subpopulation of T lymphocytes. In diseases such as fibrosis and chondrosarcoma, these cells proliferate and the differentiated cells escape T lymphocyte control. As a consequence, these cells accumulate, giving rise in vitro to a tissue which evoke the lesions characterizing the disorder of the patient, showing spontaneously their pluripotentiality. Neural cell markers are present in this migrating cell, suggesting that pluripotent stem cells present in adult man may derive from the neural crest. These circulating cells could offer a source of stem cells for cellular and gene therapy provided the normal cells could be expanded, their transdifferentiation directed and the control by T lymphocytes maintained.

To evaluate the biological effects of guided bone regeneration (GBR) barrier materials on osteoblastic cell migration, migration of mouse osteoprogenitor cells (MC3T3-E1) was examined, in vitro, on various membranes. Eight commercially available GBR membranes - bovine type I collagen (BioMend; BM), porcine type I collagen (BioGide; BG), bovine type I atelocollagen (Tissue Guide; TG), polylactic acid (Epi-Guide; EG), co-polymer of polylactic acid and polyglycolic acid (Resolute; RL, Resolut XT; RL-XT), expanded polytetrafluoroethylene (e-PTFE; Gore Tex; GT) and co-polymer of cellulose acetate and nitrocellulose (Millipore filter; MP) - were tested. A 3x5 mm section of the membrane was fixed to the bottom of a culture dish with double-sided adhesive tape, and half of the membrane was closely covered by PARAFILM (American National Can) to leave an unexposed area for cell migration. The border between exposed and unexposed areas was marked as a baseline of cell migration. Membranes were then plated with 3 ml of cell suspension at an initial density of 1x105 cells/ml in alpha-MEM culture medium with 10% fetal bovine serum and ascorbic acid. After a 5-hour incubation, non-attached cells were completely washed out with phosphate buffered saline and the PARAFILM cover was removed. After 3 days cultivation, specimens were fixed with 10% buffered formalin and stained briefly with hematoxylin. The area of cell migration on a membrane was analyzed using a LA 500 Image Analysis System and migration area per unit length of the baseline (mm2/mm) was compared among membranes. Results demonstrated that cell migration was greater in the order: RL>RL-XT, BM, TG, MP>EG, BG. Membranes except for BG, EG and GT showed the migration rate equal to or higher than a plastic culture cover slip (Celldesk) (P<0.01) on which cells generally grow favorably. Only a small number of the cells attached to GT, and the net cell migration for the membrane could not be determined. These results indicate that GBR barrier materials per se may influence the process of bone regeneration in vivo through the effects of their presence on cell migration.

Hepatitis C virus (HCV) induces chronic persistent infection that can lead to the development of hepatocellular carcinoma. We have searched for the presence of HCV genomic RNA in cells from hematopoietic origin and have, among others, documented such sequences in B cells as well as dendritic cells (DC) derived from monocytes. The allostimulatory capacity of these latter cells was found altered in chronic patients while it appeared restored in long term responders to therapy.

Cell therapy offers today important perspectives for the treatment of type 1 diabetes. The current utilization of primary human islets of Langerhans nevertheless forbids all hope of developing this treatment on a large scale. The recent description of the persistence of stem cells capable of proliferating and differentiating in the adult pancreas offers an attractive alternative for the production in vitro of homologous insulin-secreting cells. We first reproduced in vitro from human islet preparations the proliferation of ductal epithelial structures and their progressive organization. Thereafter, we focused on the description of a reproducible source of human ductal cells by the transdifferentiation of exocrine preparations. More recently we described in these exocrine derived ductal cells the the expression the of insulin promoter factor-1 (IPF-1/otherwise known as PDX-1), a transcription factor essential for the differentiation of ductal cells into endocrine cells during both development and pancreatic regeneration. If the proliferation and differentiation of these cells is confirmed, this approach could lead to the description of an abundant source of human pancreatic stem cells for the production ex vivo of human insulin secreting cells and may even allow autologous cell therapy, in the absence of immunosuppression.

The transcription factor MyoD, member of the myogenic regulators family, induces differentiation in precursor cells by its ability to arrest cell proliferation and to activate muscle specific genes. MyoD plays a key role in the antagonism between proliferation and differentiation. The withdrawal from the cell cycle and the activation of muscle differentiation are related to the level of MyoD protein. The cyclin E-cdk2 complex, one of the key regulators of the G1/S transition is directly implicated in the degradation of MyoD by the ubiquitin-proteasome pathway, leading the myoblasts to proliferate. The display of this control in normal myoblasts suggests that its deficiency in the muscle stem cells could lead to the formation of rhabdomyosarcomas which have lost both the control of cell proliferation and the transcriptional activity of MyoD.

Myelodysplastic syndromes are clonal hematologic disorders, expanded from myeloid stem cells. A primitive immunologic disorder is discussed. This hypothesis could explain a non-casual association with systemic diseases. The aim of our study is to test this hypothesis.

We report two cases of atypical defibrination syndromes in patients with respectively acute monoblastic leukemia (chronic myeloid leukemia initially) and acute lymphoblastic leukemia. Hemostasis studies show low fibrinogen level, elevated D-dimers, decreased alpha 2 antiplasmin and factor V, normal antithrombin III values. Plasminogen is below the normal range in one patient. Soluble complexes, which are an important argument for diagnosis of intravascular coagulation disease, are not detected in both patients. Primary or secondary hyperfibrinolysis seems also excluded since euglobulin clot lysis time was normal. Enzymatic proteolysis of fibrinogen (or fibrin) by the blast cells has been reported by some authors; this mechanism could account for the hemostasis abnormalities observed in these two patients.

Comprehension of cell cycle regulation mechanisms has progressed very quickly these past few years and regulators of the cell cycle have gained widespread importance in cancer. This review first summarizes major advances in the understanding of the control of cell cycle mechanisms. Examples of how this control is altered in tumoral cells are then described.

Neuroblastoma is a very common solid tumor which arises in childhood and shows an extreme heterogeneity at the clinical, histological and genetic levels. Besides age and stage, N-myc amplification and 1p deletion are prognostic factors of the disease: in Europe, these genetic markers are used to conduct therapy. In France, N-myc amplification is a factor of bad prognosis which leads, in all forms of the disease including localised forms and metastatic forms of children aged of less than 1 year, to a myeloablative treatment with autologous hematopoietic stem cells transplantation. By contrast, N-myc amplification has no impact on the survival of children aged of more than 1 year with a poor prognosis (30% overall survival, 5 years) but this genetic abnormality is taken into account to treat primary tumor of these patients. In an attempt to find out prognostic factors of these aggressive forms of the disease, various pathways (apoptosis, differentiation angiogenesis, detoxication, immune response) have been recently surveyed, but studies have been carried out on a limited number of genes. Moreover, experimental models of human metastatic neuroblastoma have been obtained in which variations of genes transcript levels involved in these pathways, are observed. The current break-through of cDNA microarrays allows to develop a dynamic transcriptomic scanning of these models as well as of tumors and bone marrows from patients upon conventional chemotherapy. This technology will enable: i) to define molecular entities of the metastatic disease; ii) to apply adapted treatment; iii) to develop new therapeutic strategies.

The manipulation of embryonic stem (ES) cells allows to generate mice with specific alteration in any gene. This is therefore an invaluable tool for studying gene function. A number of genes involved in the regulation of hematopoiesis have been inactivated, including genes that encode transcription factors, cytokines and their receptors as well as those encoding for intracellular signalling proteins. Alternatively, ES cells are able to differentiate towards myeloid, lymphoid and endothelial lineages under specific culture conditions. The role of master genes controlling hematopoiesis can be investigated by substituting the in vitro hematopoietic differentiation model of ES cells to mice fabrication. This method can be applied for studying effects of gene inactivation or overexpression of normal or abnormal gene. Interestingly, in vitro differentiation of ES cells recapitulates some aspects of embryonic development, including the emergence of the hemangioblast, the common precursor of hematopoietic and endothelial lineages. Thus, hematopoietic differentiation of ES cells constitutes a model for studying effects of gene manipulation on both hematopoiesis and emergence and commitment of the more hematopoietic primitive cell, the hemangioblast, during embryogenesis. In our studies, we used ES cells inactivated for the c-mpl gene, the thrombopoietin receptor, for dissecting the functions of various intracytoplasmic domain of c-mpl in the response of ES cell-derived hematopoietic cells to TPO.

The possible use of embryonic stem cells for therapeutic purposes raises once more the ethical question concerning the position of the embryo in relation to medical needs. Since this technology treats the embryo as a raw material, the debate must incorporate a semantic clarification, in order to identify the conceptual ambiguities that exist between popular thought, science, anthropology and the religious and philosophical convictions of the individual. The problem is knowing whether the end always justifies the means and whether the future may be sacrificed to the present.

Embryo definition is without any ambiguity: it consists in a stage of development able to give rise to an autonomous organism. In this sense, it is obvious that human embryos could be produced by cloning. If the therapeutic prospects of therapeutic cloning are confirmed, there will be a tension between two ethical logics: to respect human embryos as possible persons ... and to improve the condition of severely affected patients. Whatever the definitive solution, its moral significance should be denied. In contrast, it seems possible to use spare embryons for selected research without considering them only as things.

Hematopoietic stem cells, which share with other stem cells of adult tissues the ability to maintain constant the number and diversity of differentiated mature cells throughout adult life offer a fabulous system to analyze mechanisms controlling cell proliferation and differentiation. Cytokines controlling the differentiation of intermediate progenitors into mature cells of the various lineages have been characterized and have been widely used, in vitro as in vivo, to increase the output of differentiated cells. In contrast, despite significant technological advances, molecular events associated with the stem cell decisions first to either self-renew or differentiate, and then to irreversibly commit to one of the lymphoid or of the myeloid pathways are still very badly understood. This is partly explained by the lack of reliable assays, particularly in humans, to assess stem cell activity, and by the difficulty to dissect the composition of molecular complexes regulating gene expression in these very rare cells. Despite these limitations, recent evidence suggests that there is some flexibility in the initial decisions of stem cells, and that extracellular factors may influence stem cell fate. If this is confirmed, it may then become possible to propose new therapeutic strategies based on the manipulation of stem cell properties.

Since many years, the ability to harvest and then graft haematopoietic stem cells in man has allowed to treat with success several lethal diseases in haematology and oncology. Progress in cell biology recently made possible the obtention of human stem cells, particularly of embryonic origin which, theoretically, have all the potentialities of development. Therefore, in spite of other many obstacles still ahead, the perspective of using elements produced from such cells for therapeutic purpose seems closer.

It has been known for many years now that the vocal centers in the hyperstriatum (cortex) of birds with seasonal song behaviour are the site of neuronal generation and, thus, that stem cells capable of giving rise to real neurons exist in the adult. Since then, the notion that neuronal progenitors exist in the adult has been extended to mammals. It seems that the number of brain regions in which neuronal generation is taking place is limited. In addition to the olfactory epithelium where olfactory receptors are under constant renewal, the sites of neuronal regeneration are the olfactory bulb, the dentate gyrus of the hippocampus, the associative cortex--in the macaque--and the cerebellum. Although this represents only a limited number of regions and neuronal types (primarily GABAergic interneurons), the observation that new neurons can be created throughout life raises the possibility to use them in replacement therapy in the human.

Mammalian cells in culture can be modified by gene transfer and these procedures are routinely used in experimental biology. Yet, efficient approaches to modify certain complex cell populations, stem cells or cells organized within a tissue are still lacking. The hurdles to gene transfer can be listed by describing the pathway of a nucleic acid molecule, from the external medium towards the cell nucleus where its encoded information will be expressed. The requirements include the necessity to compact the size of the macromolecule, to overcome electrostatic repulsion, to cross a series of membranes and to establish itself permanently. Viruses have evolved to achieve these goals and understanding their strategies for cell invasion allows to design vectors for gene transfer. Chemicals or biochemicals able to bind DNA, as well as physical methods inducing changes in the structure of membranes can also be useful for gene transfer. The outcome of gene transfer technologies and their improvement pave the way to inovative medical applications and provide powerful tools for exploring the living world.

The birth of physiologically normal and fertile animal of several mammalian species following the transfer of somatic nuclei into recipient enucleated oocytes has stimulated researches on the functional plasticity of cells available from living organisms. This experimental approach, termed cloning, has up to a low efficiency. It however allows the study of mechanisms compatible with the reacquisition of an undifferentiated nuclear status and contributes to researches aimed at controlling the fate of stem cells for therapeutically applications.