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Umbilical cord blood is blood that remains in the placenta and in the attached umbilical cord after childbirth. Cord blood is obtained from the umbilical cord at the time of childbirth, after the cord has been detached from the newborn.[1] Cord blood is collected because it contains stem cells, including hematopoietic cells, which can be used to treat hematopoietic and genetic disorders.[2] Some placental blood may be returned to the neonatal circulation if the umbilical cord is not prematurely clamped.[3] If the umbilical cord is not clamped, such as in an extended-delayed cord clamping protocol, a physiological postnatal occlusion occurs upon interaction with cold air, when the internal gelatinous substance, called Wharton's jelly, swells around the umbilical artery and veins.

In the United States, the Food and Drug Administration regulates cord blood under the category of “Human Cells, Tissues, and Cellular and Tissue Based-Products.” The Code of Federal Regulations under which the FDA regulates public and private cord blood banks is Title 21 Section 1271. Both public and private cord blood banks are eligible for voluntary accreditation with either the American Association of Blood Banks AABB or the Foundation for the Accreditation of Cellular Therapy FACT. Potential clients can check the current accreditation status of banks from the AABB list of accredited cord blood banks or the FACT search engine of accredited cord blood banks. Other countries also have regulations pertaining to cord blood.

Contents

Cord blood and Regenerative Medicine

Regenerative medicine is a field of medical research developing treatments to repair or re-grow specific tissue in the body. Because a person’s own (autologous) cord blood stem cells can be safely infused back into that individual without being rejected by the body’s immune system - and because they have unique characteristics compared to other sources of stem cells - they are an increasing focus of regenerative medicine research.

Research in this area that has the potential to revolutionize medicine is advancing rapidly and it is difficult for professional medical societies, and other resources that expectant parents turn to for information, to keep pace.

Physicians and researchers are making significant progress evaluating the safety and efficacy of umbilical cord blood stem cells for therapeutic uses far beyond cancers and blood disorders.

The use of cord blood stem cells in treating conditions such as brain injury [4] and Type 1 Diabetes [5] is already being studied in humans, and earlier stage research is being conducted for treatments of stroke [6] [7], and hearing loss. [8]

Current estimates indicate that approximately 1 in 3 Americans could benefit from regenerative medicine, [9] and children whose cord blood stem cells are available for their own potential use could be among the first to benefit from new therapies as they become available. With autologous (the person’s own) cells, there is no risk of the immune system rejecting the cells, so physicians and researchers are only performing these potential cord blood therapies on children who have their own stem cells available.

Researchers are exploring the use of cord blood stem cells in the following regenerative medicine applications:

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Type 1 Diabetes

A clinical trial underway at the University of Florida is examining how an infusion of autologous cord blood stem cells into children with Type 1 diabetes will impact metabolic control over time, as compared to standard insulin treatments. Preliminary results demonstrate that an infusion of cord blood stem cells is safe and may provide some slowing of the loss of insulin production in children with type 1 diabetes.[10]

Cardiovascular

The stem cells found in a newborn’s umbilical cord blood are holding great promise in cardiovascular repair. Researchers are noting several positive observations in pre-clinical animal studies. Thus far, in animal models of myocardial infarction, cord blood stem cells have shown the ability to selectively migrate to injured cardiac tissue, improve vascular function and blood flow at the site of injury, and improve overall heart function.[11]

Central Nervous System

Research has demonstrated convincing evidence in animal models that cord blood stem cells injected intravenously have the ability to migrate to the area of brain injury, alleviating mobility related symptoms. [12] [13] Also, administration of human cord blood stem cells into animals with stroke was shown to significantly improve behavior by stimulating the creation of new blood vessels and neurons in the brain.[14]

This research also lends support for the pioneering clinical work at Duke University, focused on evaluating the impact of autologous cord blood infusions in children diagnosed with cerebral palsy and other forms of brain injury. This study is examining if an infusion of the child’s own cord blood stem cells facilitates repair of damaged brain tissue, including many with cerebral palsy. To date, more than 100 children have participated in the experimental treatment – many whose parents are reporting good progress.

As these clinical and pre-clinical studies demonstrate, cord blood stem cells will likely be an important resource as medicine advances toward harnessing the body’s own cells for treatment. The field of regenerative medicine can be expected to benefit greatly as additional cord blood stem cell applications are researched and more people have access to their own preserved cord blood.

Cord blood harvesting

Umbilical cord blood is the blood left over in the placenta and in the umbilical cord after the birth of the baby. The cord blood contains stem cells, including hematopoietic cells. Umbilical cord blood is well-recognized to be useful for treating hematopoietic and genetic disorders.[15] Removing the umbilical cord blood is not harmful to the baby and the blood would normally be thrown away as medical waste.

There are several methods for collecting cord blood. The method most commonly used in clinical practice is the “closed technique”, which is similar to standard blood collection techniques. With this method, the technician cannulates the vein of the severed umbilical cord using a needle that is connected to a blood bag, and cord blood flows through the needle into the bag. On average, the closed technique enables collection of about 75 ml cord blood.[16].

Collected cord blood is cryopreserved and then stored in a cord blood bank for future transplantation. 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[17]) ever use the umbilical cord blood that is stored. The American Academy of Pediatrics 2007 Policy Statement on Cord Blood Banking states that:

"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;"[17]

Cord blood is stored by both public and private cord blood banks. Public cord blood banks store cord blood for the benefit of the general public, and most U.S. banks coordinate matching cord blood to patients through the National Marrow Donor Program (NMDP). Private cord blood banks are usually for-profit organizations that store cord blood for the exclusive use of the donor or donor's relatives.

Public cord blood banking is supported by the medical community. However, private cord blood banking is generally not recommended unless there is a family history of specific genetic diseases.

New parents have the option of storing their newborn's cord blood at a private cord blood bank or donating it to a public cord blood bank. The cost of private cord blood banking is approximately $2000 for collection and approximately $125 per year for storage, as of 2007. Donation to a public cord blood bank is not possible everywhere, but availability is increasing. Several local cord blood banks across the United States are now accepting donations from within their own states. The cord blood bank will not charge the donor for the donation; the OB/GYN may still charge a collection fee, although many OB/GYNs choose to donate their time.

After the first sibling-donor cord blood transplant was performed in 1988, the National Institute of Health (NIH) awarded a grant to Dr. Pablo Rubinstein to develop the world's first cord blood program at the New York Blood Center (NYBC),[18] in order to establish the inventory of non embryonal stem cell units necessary to provide unrelated, matched grafts for patients.

In 2005, University of Toronto researcher Peter Zandstra developed a method to increase the yield of cord blood stem cells to enable their use in treating adults as well as children.[19]

Medical Guidelines & Legislation

While the American Academy of Pediatrics discourages private banking except in the case of existing medical need, it also believes that information about the potential benefits and limitations of cord blood banking and transplantation should be provided so that parents can make an informed decision. In addition, the American College of Obstetricians and Gynecologists recommends that if a patient requests information on umbilical cord blood banking, balanced information should be given.

Cord blood education is also supported by legislators at the federal and state levels. In 2005, the National Academy of Sciences published an Institute of Medicine (IoM) report titled, "Establishing a National Cord Blood Stem Cell Bank Program". The IoM report recommended that expectant parents be given a balanced perspective on their options for cord blood banking. In response to their constituents, state legislators across the country are introducing legislation intended to help inform physicians and expectant parents on the options for donating, discarding or banking lifesaving newborn stem cells. Currently 17 states, covering two-thirds of U.S. births, have enacted legislation recommended by the IoM guidelines.

Controversy

While there is general support in the medical community for public banking of cord blood, the question of private banking has raised objections from many governments and nonprofit organizations. The controversy centers on varying assessments of the current and future likelihood of successful uses of the stored blood. In March 2008, a paper was published by Nietfeld et al.[20] in the journal Biology of Blood and Marrow Transplantation which computed the lifetime probability (up to age 70) that an individual in the US would undergo a stem cell transplant. The likelihood of an autologous transplant using your own stem cells is 1 in 435, the likelihood of an allogeneic transplant from a matched donor (such as a sibling) is 1 in 400, and the net likelihood of any type of stem cell transplant is 1 in 217 [21].

The National Marrow Donor Program estimates that by the year 2015, there will be 10,000 cord blood transplants world-wide per year using publicly banked cord blood. It is therefore vitally important to build public repositories of cord blood donations throughout the world. In the United States, the Health Resources and Services Administration (HRSA) of the US Dept. of Health and Human Services is responsible for funding national programs to register marrow donors and bank cord blood donations.[22]

The European Union Group on Ethics (EGE) has issued Opinion No.19 [23] titled Ethical Aspects of Umbilical Cord Blood Banking. The EGE concluded that "[t]he legitimacy of commercial cord blood banks for autologous use should be questioned as they sell a service, which has presently, no real use regarding therapeutic options. Thus they promise more than they can deliver. The activities of such banks raise serious ethical criticisms."[23] However, in the final section 1.27 of their Opinion, the EGE admits that: "if in the future regenerative medicine developed in such a way that using autologous stem cells became possible, then the fact to have one's own cord blood being stored at birth could increase the chance of having access to new therapies."[23]

In May 2006, The World Marrow Donor Association (WMDA) Policy Statement for the Utility of Autologous or Family Cord Blood Unit Storage[24 ] stated that:

  1. The use of autologous cord blood cells for the treatment of childhood leukemia is contra-indicated because pre-leukemic cells are present at birth. Autologous cord blood carries the same genetic defects as the donor and should not be used to treat genetic diseases.
  2. There is at present no known protocol where autologous cord blood stem cells are used in therapy.
  3. If autologous stem cell therapies should become reality in the future, these protocols will probably rely on easily accessible stem cells.

Emerging Stem Cell ApplicationsBrain Injury Cerebral Palsy Type 1 Diabetes Heart Disease

As of spring 2008, there are several known instances where autologous use of cord blood is indicated:

  1. Whereas the WMDA cautioned against autologous transplant for diseases with a genetic signature, there are pediatric cancers (ex: neuroblastoma) and acquired conditions (ex: aplastic anemia) which can be treated by autologous transplant. There has even been one autologous transplant for leukemia[25]
  2. Type 1 Diabetes, also known as Juvenile Diabetes, has been shown to improve if treated shortly after onset with an infusion of autologous cord blood.[26] The American Diabetes Association reports that 1 in 7000 children is diagnosed each year with Type 1 diabetes, and 1 in 600 children are living with it.
  3. A Phase I clinical trial is underway at Duke University to investigate whether cerebral palsy and other forms of pediatric brain injury may respond to infusions of autologous cord blood.[27] The Brain Injury Association of America[28] estimates that the prevalence of Cerebral Palsy is about 1 in 300 among children up to age 10.

See also

References

  1. ^ Cord Blood Banking: Donating Umbilical Cord Blood, Buzzle.com
  2. ^ Cairo MS, Wagner JE (1997). "Placental and/or umbilical cord blood: an alternative source of hematopoietic stem cells for transplantation.". Blood 90 (12): 4665-4678. PMID 9389681.  
  3. ^ Umbilical Cord Issues/Delayed Cord Clamping, gentlebirth.org
  4. ^ Cord Blood for Neonatal Hypoxic-Ischemic Encephalopathy, Autologous Cord Blood Cells for Hypoxic Ischemic Encephalopathy Study 1. Phase I Study of Feasibility and Safety
  5. ^ Haller MJ, etal. (2008). "Autologous umbilical cord blood infusion for type 1 diabetes.". Exp. Hematol. 36 (6): 710-715. PMID 18358588.  
  6. ^ Vendrame M, et al. (2006). "Cord blood rescues stroke-induced changes in splenocyte phenotype and function.". Exp. Neurol. 199 (1): 191-200. PMID 16713598.  
  7. ^ Vendrame M, et al. (2005). "Anti-inflammatory effects of human cord blood cells in a rat model of stroke.". Stem Cells Dev. 14 (5): 595-604. PMID 16305344.  
  8. ^ Revoltella RP, et al. (2008). "Cochlear repair by transplantation of human cord blood CD133+ cells to nod-scid mice made deaf with kanamycin and noise.". Cell Transplant. 17 (6): 665-678. PMID 18819255.  
  9. ^ Harris DT, et al. (2007). "The potential of cord blood stem cells for use in regenerative medicine.". Expert Opin. Biol. Ther. 7 (9): 1311-1322. PMID 17727322.  
  10. ^ Haller MJ, et al. (2008). "Autologous umbilical cord blood infusion for type 1 diabetes.". Exp. Hematol. 36 (6): 710-715. PMID 18358588.  
  11. ^ Harris DT, et al. (2007). "The potential of cord blood stem cells for use in regenerative medicine.". Expert Opin. Biol. Ther. 7 (9): 1311-1322. PMID 17727322.  
  12. ^ Lu D, et al. (2002). "Intravenous administration of human umbilical cord blood reduces neurological deficit in the rat after traumatic brain injury.". Cell Transplant. 11 (3): 275-281. PMID 12075993.  
  13. ^ Meier C, etal. (2006). "Spastic paresis after perinatal brain damage in rats is reduced by human cord blood mononuclear cells.". Pediatr. Res. 59 (2): 244-249. PMID 116439586.  
  14. ^ Taguchi A, et al. (2004). "Administration of CD34+ cells after stroke enhances neurogenesis via angiogenesis in a mouse model.". J. Clin. Invest. 114 (3): 330-338. PMID 15286799.  
  15. ^ Cairo MS, Wagner JE (1997). "Placental and/or umbilical cord blood: an alternative source of hematopoietic stem cells for transplantation.". Blood 90 (12): 4665-4678. PMID 9389681.  
  16. ^ Christopher D. Hillyer, Ronald G. Strauss & Naomi L. C. Luban. (2004). Handbook of Pediatric Transfusion Medicine. Academic Press. pp. 295,296. ISBN 012-348-776-5.  
  17. ^ a b "119/1/165 2007 Policy Statement on Cord Blood Banking". The American Academy of Pediatrics. http://aappolicy.aappublications.org/cgi/content/full/pediatrics.  
  18. ^ NIH data
  19. ^ Raymer, Elizabeth (2005-10-14). "New strategy will boost cord blood stem cells". University of Toronto. http://www.news.utoronto.ca/bin6/051014-1723.asp. Retrieved September 20 2006.  
  20. ^ Nietfield J, et al. Lifetime probabilities of hematopoietic stem cell transplantation in the U.S. Biology of Blood and Marrow Transplantation. 2008;14:316-322
  21. ^ citation needed
  22. ^ Health Resources and Services Administration
  23. ^ a b c Opinion N° 19, European Union Group on Ethics
  24. ^ World Marrow Donor Association (2006). "Policy Statement for the Utility of Autologous or Family Cord Blood Unit Storage" (PDF). World Marrow Donor Association. http://www.worldmarrow.org/fileadmin/WorkingGroups_Subcommittees/DRWG/Cord_Blood_Registries/WMDA_Policy_Statement_Final_02062006.pdf. Retrieved June 2 2006.  
  25. ^ Hayani A, et al. First report of autologous cord blood transplantation in the treatment of a child with leukemia. Pediatrics. 2007;119:296-300
  26. ^ Haller, M.J. et al. Autologous umbilical cord blood infusion for type 1 diabetes. Exp. Hematol. 36, 710-715 (2008)
  27. ^ Duke University, Neonatal Hypoxic-Ischemic Encephalopathy; Phase I clinical trial NCT00593242, [1]
  28. ^ Brain Injury Association of America

External links

General information

Free, public donation information

Diseases treated with cord blood


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