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Since 1989, umbilical cord blood has been used successfully to treat children with leukaemia, anaemias and other blood diseases. Researchers are now looking at ways of increasing the number of haematopoietic stem cells that can be obtained from cord blood, so that they can be used to treat adults routinely too.
If someone doesn’t have cord blood stored, they will have to rely on stem cells from another source. For that, we can go back to the history of cord blood, which really begins with bone marrow. Bone marrow contains similar although less effective and possibly tainted versions of the same stem cells abundant in cord blood. Scientists performed the first bone marrow stem cell transplant in 1956 between identical twins. It resulted in the complete remission of the one twin’s leukemia.
There are some hospitals that have dedicated collections staff who can process mothers at the last minute when they arrive to deliver the baby. However, in the United States that is the exception to the rule.
Pregnant women sometimes have questions or concerns regarding umbilical cord blood donation. Two common questions are: Can their infant’s cord blood be used to benefit MS research? Another question: Is it worthwhile to “bank” their infant’s umbilical cord blood for the benefit of a family member who might need the umbilical stem cells for future treatment of their MS?
Cord blood has an abundance of stem cells and immune system cells, and the medical uses of these cells has been expanding at a rapid pace. As these cells help the body re-generate tissues and systems, cord blood is often referred to as a regenerative medicine.
Dr. C. L. Cetrulo is thanked for critically reviewing the manuscript. Thanks to Dr. M. S. Rao and the members of the stem cell laboratory at NIA for their hospitality during my sabbatical leave and their continued assistance with this work. Thanks to my wife, Betti, and my children, Rita, Jonathan, Ellen, and James, for their patience and understanding. Dr. S. Bennet is thanked for assisting with umbilical cord collection. The anonymous donors are thanked for donating their umbilical cords. The Midwest Institute for Comparative Stem Cell Biology members who contributed to this work: M. Pyle, J. Hix, R. Rakasheklar, D. Davis, R. Carlin, D. Davis, S. Medicety, K. Seshareddy, C. Anderson, and M. Burton are thanked for their assistance. Thanks to our collaborators at ViaCell, Inc. (E. Abraham and A. Krivtsov, M. Kraus, S. Wnendt, and J. Visser) and at Athersys, Inc. (R. Deans and A. Ting) for their assistance and support. Drs. H. Klingemann (Tufts) and F. Marini (MD Anderson) are thanked for sharing the results of their ongoing work. This work was supported by National Institutes of Health (NIH) (salary support during sabbatical leave), Department of Anatomy and Physiology, College of Veterinary Medicine Dean’s office, Terry C. Johnson center for Basic Cancer Research and NIH NS034160. MLW is a paid consultant for RMI (Las Vegas, NV).
Umbilical cord blood contains haematopoietic (blood) stem cells. These cells are able to make the different types of cell in the blood – red blood cells, white blood cells and platelets. Haematopoietic stem cells, purified from bone marrow or blood, have long been used in stem cell treatments for leukaemia, blood and bone marrow disorders, cancer (when chemotherapy is used) and immune deficiencies.
Pro: It gives you that peace of mind that if anything did happen to your child, the doctors would have access to their blood. This could potentially be a great benefit, and you would have no idea what would have happened if it weren’t for this blood.
Carolinas Cord Blood Bank at Duke (CCBB) is headed by Dr. Joanne Kurtzberg. Expectant parents who have a child in need of therapy with cord blood, especially the new therapies in clinical trials at Duke, may be eligible for directed donation through CCBB.
Phone 1-888-932-6568 to connect with a CBR Cord Blood Education Specialist or submit an online request. International callers should phone 650-635-1420 to connect with a CBR Cord Blood Education Specialist.
Stem cells are injected into the veins during a peripheral blood transplant, and naturally work their way to the bone marrow. Once there, the new cells start increasing healthy blood count. Compared to bone marrow transplants, cells from peripheral blood are usually faster, creating new blood cells within two weeks.
Hematopoietic stem cells can be used to treat more than 70 types of diseases, including diseases of the immune system, genetic disorders, neurologic disorders, and some forms of cancer, including leukemia and lymphoma. For some of these diseases, stem cells are the primary treatment. For others, treatment with stem cells may be used when other treatments have not worked or in experimental research programs.
When an immediate family member has a disease that requires a stem cell transplant, cord blood from a newborn baby in the family may be the best option. There is a 25% chance, for example, that cord blood will be a perfect match for a sibling, because each child shares one of its two HLA genes with each parent. Occasionally cord blood will be a good match for a parent if, by chance, both parents share some of the six HLA antigens. The baby’s cord blood is less likely to be a good match for more distant relatives. The inventories of unrelated cord blood units in public cord blood banks are more likely to provide appropriate matches for parents and distant relatives, as well as for siblings that do not match.
Public cord blood banks store cord blood for allogenic transplants. They do not charge to store cord blood. The stem cells in the donated cord blood can be used by anyone who matches. Some public banks will store cord blood for directed donation if you have a family member who has a disease that could potentially be treated with stem cells.
The blood that remains in the umbilical cord and the placenta after birth is called “cord blood”. Umbilical cord blood, umbilical cord tissue, and the placenta are all very rich sources of newborn stem cells. The stem cells in the after birth are not embryonic. Most of the stem cells in cord blood are blood-forming or hematopoietic stem cells. Most of the stem cells in cord tissue and the placenta are mesenchymal stem cells.
While many diseases can be treated with a cord blood transplant, most require stem cells from another donor (allogeneic). Cord blood cells taken from the patient (autologous) typically contain the same defect or precancerous cells that caused the patient to need the transplant in the first place. Most medical professionals believe the chance that cord blood banking will be utilized by the patient or a close relative is relatively low. Estimates range from 1 out of 1,000 to 1 out of 200,000. From these estimates, privately stored cord blood is not likely to be utilized by the average family. The American Academy of Pediatrics has discouraged cord blood banking for self-use, since most diseases requiring stem cell transplants are already present in the cord blood stem cells. Additionally, a recent study published in Pediatrics indicates that few transplants have been performed using privately stored cord blood. From the responses of 93 transplant physicians, in only 50 cases was privately banked blood used. In 9 of these cases the cord blood was transplanted back into the donor patient (autologous transplant). One of the main selling points of private cord blood banks is the possibility of a future autologous transplant.
After your baby is born, the umbilical cord and placenta are usually thrown away. Because you are choosing to donate, the blood left in the umbilical cord and placenta will be collected and tested. Cord blood that meets standards for transplant will be stored at the public cord blood bank until needed by a patient. (It is not saved for your family.)
Cord blood donation doesn’t cost anything for parents. Public cord blood banks pay for everything which includes the collection, testing, and storing of umbilical cord blood. This means that cord blood donation is not possible in every hospital.
Sometimes, not enough cord blood can be collected. This problem can occur if the baby is preterm or if it is decided to delay clamping of the umbilical cord. It also can happen for no apparent reason. If an emergency occurs during delivery, priority is given to caring for you and your baby over collecting cord blood.
Once it arrives at the storage facility, the cord blood will be processed and placed in storage. The cord blood will either be completely immersed in liquid nitrogen or it will be stored in nitrogen vapor.
A limitation of cord blood is that it contains fewer HSCs than a bone marrow donation does, meaning adult patients often require two volumes of cord blood for treatments. Researchers are studying ways to expand the number of HSCs from cord blood in labs so that a single cord blood donation could supply enough cells for one or more HSC transplants.
As most parents would like to bank their babies’ cord blood to help safeguard their families, it is often the cost of cord blood banking that is the one reason why they do not. Most cord blood banks have an upfront fee for collecting, processing and cryo-preserving the cord blood that runs between $1,000 and $2,000. This upfront fee often also includes the price of the kit provided to collect and safely transport the cord blood, the medical courier service used to expedite the kit’s safe shipment, the testing of the mother’s blood for any infectious diseases, the testing of the baby’s blood for any contamination, and the cost of the first full year of storage. There is then often a yearly fee on the baby’s birthday for continued storage that runs around $100 to $200 a year.
The University of Texas Health Science Center at Houston is conducting a pioneering FDA-regulated phase I/II clinical trial to compare the safety and effectiveness of two forms of stem cell therapy in children diagnosed with cerebral palsy. The randomized, double-blinded, placebo-controlled study aims to compare the safety and efficacy of an intravenous infusion of autologous cord blood stem cells to bone marrow stem cells.
Complicating matters further, each public bank has its own registry, so transplant centers must search many different databases to find a match for a patient. Currently, a Caucasian patient has an 88 percent chance of finding a cord-blood match through a public-bank registry, and minorities have a 58 percent chance. (Collection hospitals tend to be in areas with higher rates of Caucasian births, and parents from certain ethnic groups are wary of donating for religious or cultural reasons.)
Next to hematopoeitic stem cells, the most widely studied stem cells in bone marrow are marrow-derived MSCs, also known as marrow stromal cells. In the adult, MSCs are found in highest concentration in the marrow cavity. MSCs are found at lower density in blood and in peripheral, adipose, and other tissues. MSC-like cells can be isolated from umbilical cord blood, placenta, perivascular areas, amniotic fluid, and from the tissue surrounding the umbilical cord vessels, i.e., Wharton’s jelly. The collection of MSC-like cells from tissues that are discarded at birth is easier and less expensive than collecting MSCs from a bone marrow aspirate. During the collection of these tissues, there is no health impact on either the mother or the newborn. At least in theory, these cells may be stored frozen and then thawed to provide stem cells for therapeutic use decades after cryogenic storage.
Bone marrow is tissue located in the center of your bones, making healthy blood cells that strengthen your immune system and fight off outside infections. A large amount of cells are located in bone marrow, and doctors frequently use hip bone marrow for most transplants, since the stem cells in this area are the most plentiful.
“One of the wonderful things about cord blood is that unlike bone marrow, you don’t always need a perfect match in order for it to work,” says Dr. Kurtzberg, who performed the first unrelated cord-blood transplant in the U.S. And it was a public donation that ultimately saved Anthony Dones. Within a week of starting a search, the National Cord Blood Program, a public bank operated by the New York Blood Center, found a “close enough” match. Had the now-3-year-old been forced to rely on a bone-marrow match, he might still be waiting.
^ Li, T; Xia, M; Gao, Y; Chen, Y; Xu, Y (2015). “Human umbilical cord mesenchymal stem cells: an overview of their potential in cell-based therapy”. Expert Opinion on Biological Therapy. 15 (9): 1293–306. doi:10.1517/14712598.2015.1051528. PMID 26067213.
Tracey said she felt lucky since she banked Anthony’s cord blood with a private company. And Osteopetrosis is one of 80 diseases listed by many cord blood companies in their marketing material as treatable with stem cells.
There are so many things to think about when you have a child. One of them is the blood from your baby’s umbilical cord (which connects the baby to the mother while in the womb). It used to be thrown away at birth, but now, many parents store the blood for the future health of their child. Should you do it?
A cord blood bank may be private (i.e. the blood is stored for and the costs paid by donor families) or public (i.e. stored and made available for use by unrelated donors). While public cord blood banking is widely supported, private cord banking is controversial in both the medical and parenting community. Although umbilical cord blood is well-recognized to be useful for treating hematopoietic and genetic disorders, some controversy surrounds the collection and storage of umbilical cord blood by private banks for the baby’s use. Only a small percentage of babies (estimated at between 1 in 1,000 to 1 in 200,000) ever use the umbilical cord blood that is stored. The American Academy of Pediatrics 2007 Policy Statement on Cord Blood Banking stated: “Physicians should be aware of the unsubstantiated claims of private cord blood banks made to future parents that promise to insure infants or family members against serious illnesses in the future by use of the stem cells contained in cord blood.” and “private storage of cord blood as ‘biological insurance’ is unwise” unless there is a family member with a current or potential need to undergo a stem cell transplantation. The American Academy of Pediatrics also notes that the odds of using a person’s own cord blood is 1 in 200,000 while the Institute of Medicine says that only 14 such procedures have ever been performed.
Osteopetrosis is a genetic disease, so this means that doctors could use a sibling’s cord blood cells to treat Anthony, but they cannot use his own cells because the disease is in every cell in his body. In fact, a majority of the diseases listed in private banking firms’ marketing material as treatable with stem cells are genetic diseases.
Certainly, there are plenty of doctors who have high hopes for stem-cell advances and advise patients to consider cord-blood banking. When private banks first started sending him informational packets, Jordan Perlow, MD, a maternal-fetal specialist in Phoenix, assumed they were just trying to profit from parents’ anxieties. But after attending medical conferences and scrutinizing studies about developments in stem-cell therapies, Dr. Perlow now encourages his patients to privately bank if they can afford it because he’s convinced that it might save their child’s life or the life of another family member. “If private banking had been available when my children were born, I would have done it,” he says.
Because the body’s immune system is designed to find and get rid of what it believes to be outside contaminants, stem cells and other cells of the immune system cannot be transfused into just anyone. For stem cell transfusions of any type, the body’s immune system can mistakenly start attacking the patient’s own body. This is known as graft-versus-host disease (GvHD) and is a big problem post-transplant. GvHD can be isolated and minimal, but it can also be acute, chronic and even deadly.