Excretion of granulocyte colony-stimulating factor into human breast milk

Granulocyte-colony stimulating factor for hematopoietic stem cell donation from healthy female donors during pregnancy and lactation: what do we know?

BACKGROUND Hematopoietic growth factors (HGFs) are mostly used as supportive measures to reduce infectious complications associated with neutropenia. Over the past decade, the use of HGFs became a common method for mobilizing human CD34+ stem cells, either for autologous or allogeneic transplantation. However, since their introduction the long-term safety of the procedure has become a major focus of discussion and research. Most information refers to healthy normal donors and data concerning pregnant and lactating women are scarce. The clinical question, which is the core of this review, is whether stem cell donation, preceded by administration of granulocyte-colony stimulating factor (G-CSF) for mobilization, is a safe procedure for pregnant donors. METHODS Literature searches were performed in Pubmed for English language articles published before the end of May 2012, focusing on G-CSF administration during pregnancy, lactation and hematopoietic stem cell donation. Searches included animal and human studies. RESULTS Data from animals (n = 15 studies) and women (n = 46 studies) indicate that G-CSF crosses the placenta, stimulates fetal granulopoiesis, improves neonatal survival mostly for very immature infants, promotes trophoblast growth and placental metabolism and has an anti-abortive role. Granulocyte macrophage-CSF is a key cytokine in the maternal immune tolerance towards the implanted embryo and exerts protective long-term programming effects to preimplantation embryos. The available data suggest that probably CSFs should not be administered during the time of most active organogenesis (first trimester), except perhaps for the first week during which implantation takes place. Provided CSF is administered during the second and third trimesters, it appears to be safe, and pregnant women receiving the CSF treatment can become hematopoietic stem cell donors. There are also risks related to the anesthesia, which is required for the bone marrow aspiration. During lactation, there should be a period of at least 3 days to allow for clearance of CSF from milk before resuming breast feeding. With regard to teratogenicity or leukaemogenity, in non-pregnant or non-lactating women reports show that CSF administration is associated with a risk for leukemia; however, this risk is not higher compared with the control population. CONCLUSIONS The information available to date indicates that administration of CSF in general, and G-CSF in particular, is safe and healthy pregnant women can serve as donors of either bone marrow or peripheral blood stem cells. However, the clinical experience is rather limited and therefore until more data become available, G-CSF should not be used during pregnancy and lactation when other therapeutic options, instead of stem cell transplantation, are available.

Chemotherapy, targeted agents, antiemetics and growth-factors in human milk: how should we counsel cancer patients about breastfeeding?

An increasing number of women are diagnosed with cancer during pregnancy and lactation. Women are usually advised to interrupt breastfeeding during systemic anticancer treatment for fear of serious adverse effects to the nursed infant. However, the issue is poorly addressed in the literature and very few studies have evaluated the safety of breastfeeding during or after cytotoxic drugs or target agents administration. In this review we will analyze the available evidence that addresses the issue of anticancer drugs, targeted agents, antiemetics and growth-factors excretion in human milk. This could serve as a unique resource that may aid physicians in the management of breastfeeding cancer patients interested in maintaining lactation during treatment.

Transgene expression of biological active recombinant human granulocyte-colony stimulating factor (hG-CSF) into mouse urine

We have generated transgenic mice that expressed human granulocyte-colony stimulating factor (hG-CSF) in their urine. In particular, the expression plasmid DNA containing mouse uroplakin II promoter was used to direct the uroepithelium-specific transcription of the transgene. In this study, the hG-CSF transcript was detected only in bladder, as was determined by RT-PCR analysis. Furthermore, hG-CSF protein was detected in the suprabasal layer of the uroepithelium and ureter, as was demonstrated by immunohistochemistry. The hG-CSF was secreted into urine at a high level (approx. 500 pg/ml), and it was able to enhance the proliferation of DMSO treated HL-60 cells, suggesting that the transgenic urine-derived hG-CSF was bioactive. However, the recombinant hG-CSF was leaked to peripheral circulation system. To examine the relationship between hG-CSF in the blood stream and the proliferation of hematopoietic cells, we tested the transgenic mouse blood with hematocrit analysis. An increase of the total number of neutrophils in the transgenic mice peripheral blood was not observed; therefore, the leakage of human G-CSF can probably be expected to do no harm to the transgenic mouse. Our results demonstrate that bladder can be safely used as a bioreactor to produce biologically important substances such as recombinant G-CSF.