Proceedings of the Society for Experimental Biology and Medicine 223:149-155 (2000)
© 2000 Society for Experimental Biology and Medicine
Review Article
Pluripotent Hemopoietic Stem Cells in Mice and Humans
Susumu Ikehara1,
First Department of Pathology, Transplantation Center, Kansai Medical University, Moriguchi, Osaka 5708506, Japan
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Abstract
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Although it has been reported previously that pluripotent hemopoietic stem cells (P-HSCs) express c-kit, the receptor for stem cell factor (steel factor), we and other groups have recently shown that P-HSCs do not express c-kit. In this review, we provide evidence that c-kit<low P-HSCs in mice have long-term-reconstituting activity (LTRA > 2 years) and the capacity to form colony-forming units in spleen (CFU-S) on Day 16, although c-kitlow HSCs or c-kit+ HSCs have LTRA less than 1.5 years and the capacity to form CFU-S on Day 14 or on Day 10, respectively. In addition, we have found that there is a major histocompatibility complex (MHC) restriction between P-HSCs and stromal cells; normal P-HSCs can proliferate and differentiate efficiently in collaboration with MHC class I-compatible (but not MHC class I-incompatible) stromal cells. In humans, we also show that c-kit<low P-HSCs can differentiate into c-kitlow cells, then c-kit+ cells in vitro.
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Introduction
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Pluripotent hemopoietic stem cells (P-HSCs) are defined as cells with the capacity to self-renew and differentiate eternally into all hemopoietic lineage cells. Purification of P-HSCs has been carried out on the basis of the retention of rhodamine 123 (1, 2) and/or the expression of Sca-1 (3-6), Thy-1 (3-6), CD4 (7), Mac-1 (7), and CD34 (8).The expression of c-kit molecules (the receptor for stem cell factor) has also been a marker to purify P-HSCs. In earlier studies, P-HSCs in the mouse bone marrow (9-12) and in the adult liver (13) have been reported to be c-kit+. However, recent mouse and human studies have provided evidence that P-HSCs are c-kitlow; mouse hemopoietic progenitors (in the dormant stage) and human CD34+ primitive progenitors are enriched in c-kitlow cells when assayed by colony formation and long-term culture-initiating cells (14, 15). We have very recently shown that P-HSCs are c-kit<low (phenotypically c-kit-, but the c-kit message is only detectable by reverse-transcriptase-polymerase chain reaction [RT-PCR]) by assessing LTRA activity after serial bone marrow transplantation (BMT). This was very recently confirmed by Oritz et al. (16). This minireview provides evidence that P-HSCs are c-kit<low in mice and also humans.
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Mouse P-HSCs
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LTRA.
The first step was to examine which cells (c-kitlow or c-kit<low cells) have LTRA. HSCs (Lin-/CD71-/class Ihigh cells) were fractionated on the basis of the expression of c-kit. Figure 1a
shows the flow cytometric profile of Lin-/CD71- cells stained with anti-H-2Kb and anti-c-kit mAbs. H-2Kb high cells were gated, and two cell populationsc-kitlow and c-kit<low (which are comparable to the negative control level)were fractionated by sorting on the basis of c-kit expression. Sorting gates and histogram are shown in Figures 1a and 1b
; the sorting gate of c-kit<low cells was set not to overlap that of c-kitlow cells. The FACS profile is very similar to that reported by Katayama et al. (15); the c-kitlow and c-kit<low populations were identified as shown in Figures 1a and 1b
. Purified Lin-/CD71-/class Ihigh/c-kitlow cells or Lin-/CD71-/class Ihigh/c-kit<low cells were
0.006% or 0.008% of the 5-FU-treated whole BMCs, respectively.

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Figure 1. (a, b) Staining profiles and (c) RT-PCR analyses of Lin-/CD71-/class Ihigh/c-kit<low cells. Lin-/CD71- cells were stained with anti-H-2Kb and antic-kit mAbs, and cells with a high expression of MHC class I were collected (represented in a). These cells were further divided into two populations based on the expression of c-kit [a and b (histogram)], and (A) c-kit<low and (B) c-kitlow cells were sorted by a FACStar. The dotted line in b represents a negative control stained by isotype-matched rat mAb. (c) RT-PCR-amplified products from (upper) a c-kit gene and (lower) a glyceraldehyde 3-phosphate dehydrogenase (G3PDH) gene as an internal standard were electrophoresed, transferred to a nylon membrane, and probed with internal oligonucleotides. Lanes: 1, Lin-/CD71-/class Ihigh/c-kit<low cells; 2, Lin-/CD71-/class Ihigh/c-kitlow cells; and 3, Lin-/CD71- unsorted BMCs.
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The next step was to examine the expression of c-kit transcripts in these cells. The c-kit transcripts in Lin-/CD71- cells, Lin-/CD71-/class Ihigh/c-kitlow cells, and Lin-/CD71-/class Ihigh/c-kit<low cells were therefore compared by RT-PCR analyses. As shown in Figure 1c
, substantial expression of c-kit mRNA was detected even in the class Ihigh/c-kit<low cells, although the level in these cells was much lower than that in class Ihigh/c-kitlow cells. Based on these findings, we defined the cells as "c-kit<low" instead of "c-kit-," although the cells appeared to be "c-kit-" in FACS analyses, as shown in Figures 1a and 1b
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Five hundred cells of each fraction from 5-FU-treated B6 Ly5.1 mice were intravenously (iv) injected into irradiated B6 Ly5.2 recipients along with B6 Ly5.2 compromized cells. Six months after the transplantation, cells from several organs were double-stained with a panel of mAbs against mature myeloid/lymphoid cells and anti-Ly5.1 mAb to check for donor-derived cells. Ly5.1+ donor-derived mature cells (B cells, T cells, granulocytes, and macrophages) were detected in both recipients that received either Lin-/CD71-/class Ihigh/c-kitlow cells or Lin-/CD71-/class Ihigh/c-kit<low cells, in all organs tested such as the bone marrow, thymus, spleen, lymph nodes, peripheral blood, and peritoneal cavity (data not shown).
To examine the LTRA of these two cell populations, 1 x 106 BMCs either from recipients of Lin-/CD71-/class Ihigh/c-kitlow cells or Lin-/CD71-/class Ihigh/c-kit<low cells were re-transplanted into irradiated B6 Ly5.2 mice. Six months later, several organs were again examined to check for original donor-derived Ly5.1+ cells. In contrast to the results observed in the primary recipients, original donor-derived Ly5.1+ cells could be detected only in secondary recipients originally reconstituted with Lin-/CD71-/class Ihigh/c-kit<low cells; Ly5.1+ cells were observed in the myeloid and lymphoid cells in all organs tested (Fig. 2a)
. However, in the secondary recipients of BMCs from the mice that originally received Lin-/CD71-/class Ihigh/c-kitlow cells, no Ly5.1+ donor-derived cells were detected at all (Fig. 2b)
. These findings clearly show that P-HSCs with LTRA are Lin-/CD71-/class Ihigh/c-kit<low cells, but not Lin-/CD71-/class Ihigh/c-kitlow cells.

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Figure 2. Detection of donor-derived cells in the secondary recipients. Six months after the primary transplantation, BMCs from the primary recipients were transferred to the irradiated secondary B6 Ly5.2 recipients. Six months later, cells from various organs were stained with a panel of mAbs and donor-specific anti-Ly5.1 mAb to determine whether the original donor-derived cells could be detected among the multilineage cells.
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Tertiary transplantation was carried out to confirm the LTRA of the original Lin-/CD71-/class Ihigh/c-kit<low cells. Six months after the secondary transplantation, BMCs (1 x 106) from the secondary recipients were again transplanted into irradiated B6 Ly5.2 tertiary recipients. All the tertiary recipients of BMCs from secondary recipients originally reconstituted with Lin-/CD71-/class Ihigh/c-kitlow cells died within 10 days. However, all the tertiary recipients of BMCs from secondary recipients originally reconstituted with Lin-/CD71-/class Ihigh/c-kit<low cells showed donor (Ly5.1+)-derived cells in their peripheral blood; cells expressing Ly5.1 phenotype were detected in the bone marrow, spleen, lymph nodes, thymus, and peritoneal cavity 6 months after the tertiary BMT (17). We are now carrying out fifth BMT to examine how long c-kit<low cells have LTRA. Although all c-kit<low cells have the capacity to self-renew for 2 years, the self-renewal capacity diminishes after 2 years (Fig. 3)
. However, it should be noted that some (but not all) c-kit<low cells have the capacity to self-renew even after 3 years (Inaba M et al., unpublished data).
CFU-S.
We next carried out CFU-S assays using c-kitlow or c-kit<low cells. c-kitlow or c-kit<low cells (1 x 103) from male B6 Ly5.1 mice were transplanted into allotype-disparate female B6 Ly5.2 mice, and CFU-S counts were measured 820 days later. As shown in Figure 4
, the recipients of c-kitlow cells formed visible CFU-S on Day 12. CFU-S counts (and also spleen weight) gradually increased and became uncountable as a result of fusion on Days 16 and 20. In contrast, no CFU-S was detected in the recipients of c-kit<low cells on Days 12 and 14, but first appeared on Day 16. The numbers had increased on Day 20, though each colony was small. Thus, c-kit<low cells can form CFU-S, although colony formation is delayed. However, c-kit+ cells (Lin-/Thy-llow/Sca-1+ cells) formed CFU-S on Day 10 (Fig. 4)
. In contrast, all the irradiated mice died within 14 days without the transplantation of HSCs (c-kit+, c-kitlow, or c-kit<low cells), and no CFU-S was detected during these days after the fractionated irradiation (5.5 Gy x 2 = 11 Gy). This indicates that CFU-S in the recipients are actually donor-derived, and are not derived from the radioresistant progenitors of the recipients (18).

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Figure 4. CFU-S assays using c-kit<low, c-kitlow, or c-kit+ cells. The female C57BL/6 Ly 5.2 mice that received 103 c-kit<low, c-kitlow, or c-kit+ cells were killed on Days 820; c-kit<low and c-kitlow cells were obtained from the BMCs of 5-FU-treated male Ly 5.1 mice, and c-kit+ cells were obtained from the BMCs of male Ly 5.1 mice without 5-FU treatment. The spleens were removed and fixed with Bouin's fixing fluid before the spleen colonies were counted.
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Using counter-current centrifugal elutriation (CCE), Oritz et al. (16) have very recently shown that P-HSCs are c-kit- (no c-kit RNA expression even by RT-PCR), and that they do not form CFU-S on Day 12. However, as shown in the above, our P-HSCs (Lin-/CD71-/class I high/c-kit<low cells) form CFU-S on Day 16. The difference between the data from Oritz et al. and ours may be due to different populations, since their cell population contains a moderate number of CD4+ or Thy-1+ (not Thy-1low) cells, whereas our cell population does not contain CD4+ or Thy-1+ cells.
Peripheral Blood Stem Cells in Mice.
The next step was to examine whether peripheral blood stem cells (PBSCs) are true P-HSCs or not. PBSCs were mobilized in mice by treatment with cytosine-arabinoside on Day 0, followed by the administration of granulocyte colony-stimulating factor for 4 days. There were remarkable increases in the numbers of cells with Lin-/c-kit+ markers, cells with colony-forming unit-cell (CFU-C) and CFU-S activities, and cells with marrow-repopulating ability (MRA) in the extramedullary sites (the spleen, peripheral blood, and liver) on Day 5, whereas the number of these immature hemopoietic cells decreased in the bone marrow (BM) on Day 5. This finding suggests the mobilization of immature hematopoietic cells from the BM to the extramedullary sites. Three-color flow cytometric analyses showed that CD4 antigen was not expressed on the Lin-/Sca-1+ cells in the mobilized PB cells (PBCs), although CD71- CD4low cells were found in those of normal BM cells. Lin-/c-kit+ cells in the mobilized PBCs contained more cells with immature phenotypes (Sca-1+/Thy1.2low/CD71-/Rh123dull) than in normal BMCs, indicating an alteration of the hierarchical composition of the Lin-/c-kit+ cells. We could find neither Lin-/Sca-1+/c-kitlow cells nor Lin-/Sca+/c-kit<low cells in the PBCs. Electron microscopic studies of these cells in the mobilized PBCs showed that only 10% to 20% of these cells had a thin rim of cytoplasm with poorly developed organelles (Fig. 5a)
. In contrast, P-HSCs present in the bone marrow had a large nucleus with narrow cytoplasm. Their chromatin pattern was dispersed, but small aggregates appeared at nuclear margins. There were few cytoplasmic organelles but abundant free ribosomes (Fig. 5b)
. It should be noted that P-HSCs possess microvilli; they show active movement like neutrophils when observed on video tape. Thus, PBSCs seem to be more mature than P-HSCs in the bone marrow (19).

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Figure 5. Electron microscopic (EM) findings in (a) PBSCs (Lin-/Sca-1+/c-kit+ cells) and (b) P-HSCs in the bone marrow. P-HSCs show large nuclei with narrow cytoplasm and microvilli, whereas PBSCs show a more spacious cytoplasm with more abundant mitochondrias than P-HSCs.
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The next step was to examine by allogeneic PBSC transplantation (PBSCT) whether PBSCs have LTRA. Allogeneic PBSCT [B6
C3H] showed long-term reconstituting activity across the MHC barrier within 1 year of transplantation. However, all the [B6
C3H] mice with PBSCT died 60 weeks after PBSCT, although the [B6
C3H] mice with allogeneic BMT showed a 70% survival rate (Fig. 6)
. These findings suggest that PBSCs are not true P-HSCs (Yamamoto Y et al., unpublished data).

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Figure 6. Survival rate in [B6 C3H] chimeric mice reconstituted with normal BMCs (1.5 x 107 cells) or PBSCs (7 x 106 cells).
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Human P-HSCs
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In humans, HSCs have been characterized as CD34+cells; they possess colony-forming activity when bone marrow (BM), cord blood (CB), and mobilized peripheral blood are cultured (20-23). Other immunophenotypes defining primitive HSCs have been reported to be CD34+/CD38, CD34+/Thy-1low+, CD34+/Lin-/CD41a, and CD34+/HLA-DR+, based on the assays for high proliferative potential colony-forming cells (HPP-CFCs) or long-term culture-initiating cells (LTC-ICs). CD34+/CD38 cells can generate colony-forming unit-culture (CFU-C) in LTC-IC assay (24). Most LTC-IC, cobblestone areaforming cells, and cells capable of reconstituting human hemopoiesis in severe combined immunodeficiency mice are contained in the CD34+/Thy-1low population (25-27).
Another functionally and phenotypically important molecule is c-kit, which plays an important role in the early stage of hemopoiesis (28-31). In previous studies, it was found that the CD34+/c-kitlow population contained the majority of cycle-dormant progenitors, multilineage colony-forming cells, colony-forming unit granulocyte-erythroid-macrophage-megakaryocyte (CFU-GEMM) and LTC-ICs (14, 32, 33). In addition, LTRA was found to be enriched in the CD34+/c-kitlow population using an in utero transplantation system (34). In contrast, CD34+/c-kit- cells were rejected because of their low proliferative responses or the absence of such responses to several stimuli (30, 32-35), in spite of the existence of these cells in the human BM and CB. However, it has also been shown that the expression of c-kit molecules on HSCs is dependent on the differentiation steps (30, 35, 36). Therefore, there is a possibility that the induction of c-kit molecules is a first step in the differentiation of P-HSCs, being accompanied by the acquirement of reactivity to SCF. Furthermore, taking the dormancy of HSCs into consideration, it would be logical for HSCs not to express c-kit on their surface and so protect them from stimuli that would induce them to enter the cell cycle. In this sense, CD34+/c-kitlow cells could be more primitive HSCs.
These findings prompted us to examine whether human P-HSCs are c-kit<low, c-kitlow, or c-kit+. We purified CD34+/c-kit<low cells (phenotypically c-kit-negative but only detectable at the message level) from the human cord blood and examined their maturational steps in relation to the expression of c-kit molecules. When the CD34+/c-kit<low cells were cultured with cytokines (flt3-ligand, IL-6, and IL-7) plus immobilized anti-CD34 monoclonal antibody (mAb) (to cross-link CD34 molecules), c-kit molecules were clearly induced within 24 hr (Fig. 7)
. The c-kit expression gradually increased until Day 8. Although the colony-forming ability of sorted CD34+/c-kit<low cells is less than that of the other two populations (CD34+/c-kit+ and CD34+/c-kitlow), when CD34+/c-kitlow or CD34+/c-kit+ cells that had been induced from CD34+/c-kit<low cells were re-sorted and re-cultured using a methylcellulose culture system, they showed the same colony-forming ability as the freshly isolated CD34+/c-kitlow or CD34+/c-kit+ cells, respectively. These data indicate that the changes in the expression of c-kit molecules reflect the changes not only in their immunophenotypes but also in the functional maturation of the CD34+/c-kit<low cells. This is in accordance with the report by Gunji et al. (14) where: (i) CD34+/c-kithigh cells were induced from CD34+/c-kitlow cells after four-week culture with stromal cells and (ii) LTC-ICs were enriched in the CD34+/c-kitlow population, but not in differentiated CD34+/c-kithigh cells with the ability to form CFU-GM. However, they only reported the induction of differentiation from c-kitlow to c-kithigh. Our purified CD34+/c-kit<low or low and CD34+/c-kit+ cells may correspond to CD34+/c-kit- and CD34+/c-kitlow cells, respectively, in the previous reports, based on FCM pattern and colony-forming ability (32, 34). Therefore, our results clearly show that the changes in the intensity of c-kit molecules are closely related to the earliest maturational phase of hematopoiesis. Furthermore, CD34+/c-kit<low cells have a similar hemopoietic potential to CD34+/c-kitlow cells in assays for LTC-IC and CFU-C generated from long-term cultures. These findings suggest that CD34+/c-kit<low cells differentiate into CD34+/c-kitlow and CD34+/c-kit+ cells and acquire the reactivity to various humoral hemopoietic stimuli. Moreover, CD34+/c-kit<low cells showed a low level of rhodamine 123 (Rh123) retention, suggesting that these cells have multidrug resistance. Electron microscopic studies revealed the presence of P-HSCs, similar to those seen in the mouse bone marrow (Fig. 5b)
(37) in the cord blood (Fig. 8)
. Therefore, we conclude that human cord blood contains CD34+/c-kit<low cells that correspond to mouse P-HSCs (38).

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Figure 8. Electron microscopic findings in human P-HSCs (CD34+/c-kit<low). A human P-HSC shows a large nucleus with narrow cytoplasm and microvilli, as seen in mouse P-HSCs (see Fig. 5 ).
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MHC Restriction Exists Between Normal P-HSCS and Stromal Cells
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In vitro studies revealed that P-HSCs cannot proliferate in the presence of putative cytokines such as GM-CSF, stem cell factor (SCF), and IL-3, whereas they can do so by direct interaction with stromal cells without adding any cytokines (Fig. 9)
. This finding indicates that the direct interaction of P-HSCs with stromal cells is essential for P-HSCs to proliferate.

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Figure 9. Necessity of stromal cells for P-HSCs to proliferate. When P-HSCs were cocultured with stromal cells, the P-HSCs proliferated without the addition of cytokines, whereas they did not without stromal cells.
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We have found previously that donor-derived stromal cells play a crucial role in successful BMT across MHC barriers (39, 40). This finding prompted us to examine whether there is MHC restriction between P-HSCs and stromal cells. Hemopoiesis was observed only in the bone marrow engrafted with the BALB/c bone when BALB/c BMCs (T cell-depleted and adherent cell-depleted) were i.v. injected into irradiated C3H/HeN mice that had been engrafted with bones of C3H/HeN, B6, and BALB/c mice or with a Teflon tube as a control. This was confirmed in in vitro experiments; when B10 (H-2b) P-HSCs were cocultured with B10 stromal cells, the P-HSCs proliferated, whereas when B10 P-HSCs were cocultured with B10D2 (H-2d) stromal cells, the P-HSCs showed poor proliferative responses (Fig. 10)
(41). These findings indicate that an MHC restriction exists between P-HSCs and stromal cells not only in vivo but also in vitro. Recently, we have found that there is an MHC class I (D and S loci) restriction between them (42).

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Figure 10. In vitro MHC restriction between P-HSCs and stromal cells. When B10 (H-2b) P-HSCs (300 or 100 cells) are cocultured with B10 stromal cells, the P-HSCs proliferate. In contrast, when B10 P-HSCs are cocultured with B10D2 (H-2d) stromal cells, the P-HSCs (10300 cells) show poor proliferative responses.
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Abstract
P-HSCs in mice are c-kit<low cells, which have LTRA (>2 years) and the capacity to form CFU-S on Day 16, whereas c-kitlow and c-kit+ cells have LTRA (<1.5 years) and the capacity to form CFU-S on Day 12 or Day 10, respectively. MHC class I-compatible stromal cells are essential for P-HSCs to proliferate and differentiate. In humans, CD34+/c-kit<low are also found to differentiate into c-kitlow cells, then c-kit+ cells in vitro. Based on these findings, we believe that c-kit<low cells are P-HSCs in both mice and humans. From mouse experiments, we recommend the recruitment of donor-derived stromal cells for allogeneic BMT across MHC barriers to succeed.
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Acknowledgments
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These experiments were carried out in collaboration with researchers who appear in the references of this paper. I would like to express my deep appreciation to them. I would also like thank Mr. Hilary Eastwick-Field and Ms. Keiko Ando for preparing this manuscript.
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Footnotes
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This work was supported by a grant from the Japanese Ministry of Health and Welfare; a grant from "Haiteku Research Center" of the Ministry of Education, Science and Culture, Japan, and the Science Research Promotion Fund of the Japan Private School Promotion Foundation.
1 To whom requests for reprints should be addressed at First Department of Pathology, Kansai Medical University, 1015 Fumizono-cho, Moriguchi City, Osaka 5708506, Japan. E-mail: ikehara{at}takii.kmu.ac.jp 
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