Cord Blood, storage and costs

Umbilical cord blood is human blood from the placenta and umbilical cord that is rich in hematopoietic stem cells. Cord blood is collected after the umbilical cord has been detached from the newborn, and utilized as a source of stem cells for transplantation. 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 for-profit organizations that store cord blood for the exclusive use of the donor or donor's relatives.

Public cord blood banking is strongly supported by the medical community. However, private cord blood banking is generally not recommended unless there is a family history of specific genetic diseases. Private banking is unlawful in France and Italy, and opposed by the European Group on Ethics in Science and New Technologies. See cord blood bank.

Properties
Cord blood stem cells are more proliferative and have a higher chance of matching family members than stem cells from bone marrow. Fathers have a 25% chance of matching their child's cord blood stem cells. Siblings have a 25% chance of being a perfect cord blood match.

Collection, storage and costs

There are 2 main methods in cord blood collection from the umbilical vein; before the placenta is delivered (in utero) or after (ex utero.)

With ex utero collection method, the cord blood is collected after the placenta is delivered and the umbilical cord is clamped off from the newborn. The placenta is placed in a sterile supporting structure with the umbilical cord hanging through the support. The cord blood is collected by gravity drainage yielding between 40-150 mL.

A similar collection method is done for in utero except that the cord blood is collected after the baby has been delivered but before the delivery of the placenta.

After collection the cord blood units must be immediately shipped to a cord blood bank facility. At public cord blood banks, this blood is then analyzed for infectious agents and the tissue-type is determined. Cord blood is processed and depleted of red blood cells before being stored in liquid nitrogen for later use.

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 2006. The donation of cord blood may not be available in all areas, however the opportunity to donate is becoming more available. 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, but the OB/GYN may still charge a collection fee of $100-$250, which is usually not covered by insurance. However, many OB/GYNs choose to donate their time.

"According to research in the Journal of Pediatric Hematology/Oncology (1997, 19:3, 183-187), the odds that a child will need to use his or her own stem cells by age twenty-one for current treatments are about 1:2,700, and the odds that a family member would need to use those cells are about 1:1,400."

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.

Source: http://www.answers.com/topic/cord-blood

What are the facilities used for the collection and storage of cord blood?

Both commercial and non-profit facilities (cord blood banks) collect and store cord blood. Cord blood banks that operate for the general public collect and store cord blood that is donated for use by anyone who might need it in the future (unrelated allogeneic use). Some commercial facilities charge fees to collect and store cord blood for a family's own private use, in the event it is needed by the donor infant (autologous use) or an HLA-matched family member (related allogeneic use) at a later time.

Storage for private use is controversial when it is purely "speculative" and no specific family member has been identified as needing a transplant. The American Academy of Pediatrics does not recommend private storage for purely speculative purposes. Cord blood cannot be used autologously, for example, for children with genetic diseases because the same disease would be returned with the transplant. Moreover, most transplant physicians do not recommend autologous cord blood transplants for children with leukemia. Most will have cells with the leukemic mutations in their blood at birth. Moreover, a child who develops leukemia has evidence that his or her own immune system already failed to prevent the leukemia. Thus, physicians fear that an autologous cord blood transplant would have little if any graft versus leukemia effect. It also should be noted that only 25% of any two siblings are fully-matched for their HLA tissue type.

A family's choosing to store their baby's cord blood for their own private use must make arrangements in advance with a storage company. Usually the family will sign a contract with the company, pay an initial fee, obtain the company's special cord blood collection kit and get their obstetrician's agreement to do the collection. Initial and annual storage fees vary and may be covered by health insurance.

Non-profit cord blood banks do not charge for collecting and storing donated cord blood. They do require the mother to complete a thorough health history and to be tested for viruses such as hepatitis and HIV (also free of charge). The process may be initiated during pregnancy or before or immediately after the delivery, but is completed in the hospital.

Source: http://l3.leukemia-lymphoma.org/all_mat_toc.adp?item_id=9622

Cord Blood yields 'ethical' embryonic Stem Cells

Hopes for treating disease with stem cells from umbilical cord blood has received a major boost, following the discovery of primitive cells with clinical potential matching that of the far more controversial embryonic stem cells (ESCs). The latter are originally derived from human fetuses, which are then destroyed, and have become a major ethical issue, especially in the US.

Furthermore, the same team is applying new microgravity technology - originally developed by NASA for the International Space Station - to make large enough quantities of the stem cells to repair tissue damage in patients.

The newly discovered human cells, named “cord-blood-derived embryonic-like stem cells” or CBEs, are not quite as primitive as embryonic stem cells, which can give rise to any tissue type of the body. But they appear to be much more versatile than “adult stem cells” such as those found in bone marrow which repair damaged tissue during life.

“We have found a unique group of cells that bring together the essential qualities of both types of stem cells for the first time,” says Colin McGuckin of Kingston University in Surrey, UK, who co-led the team with colleague Nico Forraz.

In laboratory experiments, the team successfully coaxed CBEs into becoming liver cells. They also showed that the cells have most of the surface “markers” considered as identifiers of embryonic stem cells and form “embryoid bodies” – characteristic clumps of cells formed by ESCs.

Ethically acceptable

But the factor that may make the discovery very significant is that umbilical cord blood can be saved, stored and multiplied without any of the ethical dilemmas facing embryonic stem cell use, which are derived from human fetuses.

And with more and more “banks” around the world for saving cord blood, the potential for finding tissue matches for every patient becomes more and more realistic. “There are now eight banks in the UK alone,” says McGuckin.

Stephen Minger, director of the Stem Cell Biology Laboratory at King's College London, UK, says he is "intrigued" by the claims but would like to see more proof of the cells' embryonic character. Can they, for example, differentiate into the three fundamental cell types that go on to form all adult tissues, he asks. McGuckin says his team has already shown this, and that the work is awaiting publication.

Free-floating production

The technology used by the team to start multiplying the CBEs was originally developed for NASA by Synthecon Incorporated in Houston, Texas, US, for isolating proteins with clinical potential from cells grown aboard the International Space Station.

The spinning devices used essentially put "the cells in a constant state of freefall in a liquid", McGuckin explains. He says that in these free-floating “three-dimensional” conditions, the cells grow faster than if grown in “two dimensions” in a lab dish.

Nor do they need to be nourished from underneath by “feeder layers” of animal cells which have been shown to contaminate human cells grown, making them unsuitable for use in medical treatments.

“We’re now developing a new bioreactor to make considerably more, which means we can make thousands and thousands more stem cells than are available from embryonic sources,” says McGuckin.

Journal reference: Cell Proliferation (vol 38, p 245)

Source: http://www.newscientist.com/article.ns?id=dn7864

Stem Cells and Cord Blood... The future

What are the potential uses of human stem cells and the obstacles that must be overcome before these potential uses will be realized?

There are many ways in which human stem cells and cord blood can be used in basic research and in clinical research. However, there are many technical hurdles between the promise of stem cells and the realization of these uses, which will only be overcome by continued intensive stem cell research.

Studies of human embryonic stem cells may yield information about the complex events that occur during human development. A primary goal of this work is to identify how undifferentiated stem cells become differentiated. Scientists know that turning genes on and off is central to this process. Some of the most serious medical conditions, such as cancer and birth defects, are due to abnormal cell division and differentiation. A better understanding of the genetic and molecular controls of these processes may yield information about how such diseases arise and suggest new strategies for therapy. A significant hurdle to this use and most uses of stem cells is that scientists do not yet fully understand the signals that turn specific genes on and off to influence the differentiation of the stem cell.

Human stem cells could also be used to test new drugs. For example, new medications could be tested for safety on differentiated cells generated from human pluripotent cell lines. Other kinds of cell lines are already used in this way. Cancer cell lines, for example, are used to screen potential anti-tumor drugs. But, the availability of pluripotent stem cells would allow drug testing in a wider range of cell types. However, to screen drugs effectively, the conditions must be identical when comparing different drugs. Therefore, scientists will have to be able to precisely control the differentiation of stem cells into the specific cell type on which drugs will be tested. Current knowledge of the signals controlling differentiation fall well short of being able to mimic these conditions precisely to consistently have identical differentiated cells for each drug being tested.

Perhaps the most important potential application of human stem cells is the generation of cells and tissues that could be used for cell-based therapies. Today, donated organs and tissues are often used to replace ailing or destroyed tissue, but the need for transplantable tissues and organs far outweighs the available supply. Stem cells, directed to differentiate into specific cell types, offer the possibility of a renewable source of replacement cells and tissues to treat diseases including Parkinson's and Alzheimer's diseases, spinal cord injury, stroke, burns, heart disease, diabetes, osteoarthritis, and rheumatoid arthritis.

For example, it may become possible to generate healthy heart muscle cells in the laboratory and then transplant those cells into patients with chronic heart disease. Preliminary research in mice and other animals indicates that bone marrow stem cells, transplanted into a damaged heart, can generate heart muscle cells and successfully repopulate the heart tissue. Other recent studies in cell culture systems indicate that it may be possible to direct the differentiation of embryonic stem cells or adult bone marrow cells into heart muscle cells (Figure 4).

In people who suffer from type I diabetes, the cells of the pancreas that normally produce insulin are destroyed by the patient's own immune system. New studies indicate that it may be possible to direct the differentiation of human embryonic stem cells in cell culture to form insulin-producing cells that eventually could be used in transplantation therapy for diabetics.

To realize the promise of novel cell-based therapies for such pervasive and debilitating diseases, scientists must be able to easily and reproducibly manipulate stem cells so that they possess the necessary characteristics for successful differentiation, transplantation and engraftment. The following is a list of steps in successful cell-based treatments that scientists will have to learn to precisely control to bring such treatments to the clinic. To be useful for transplant purposes, stem cells must be reproducibly made to:

- Proliferate extensively and generate sufficient quantities of tissue.
- Differentiate into the desired cell type(s).
- Survive in the recipient after transplant.
- Integrate into the surrounding tissue after transplant.
- Function appropriately for the duration of the recipient's life.
- Avoid harming the recipient in any way.
- Also, to avoid the problem of immune rejection, scientists are experimenting with different research strategies to generate tissues that will not be rejected.

To summarize, the promise of stem cell therapies is an exciting one, but significant technical hurdles remain that will only be overcome through years of intensive research.

The NIH has a wide array of new scientific programs designed to support research that uses embryonic stem cell lines.

Source: http://stemcells.nih.gov/info/basics/basics6.asp

Cord blood usage in infant medicine

Cord blood is the name given to the human blood of the placenta, together with the umbilical cord, which is resulted after giving birth to a child. The recent medical innovations and discoveries include saving and using this cord blood for potential further medical operations, as its stern cells are of high importance and appropriation in various medical cases.

After collecting the cord blood in maximum 15 minutes after the baby is born, processing it is the following faze in order to be viable for further medical operations. The processing of cord blood includes specific steps, such as RBC depletion, shipping and the actual freezing. The freezing or, scientifically said, the cryopreservation is applied within 1 day after the actual collection and can be successfully preserved for indefinite years.

There are various pediatric solutions that include using the cord blood. The most major ones are the children cancers and blood diseases, including infant leukemia (juvenile chronic myelogenous leukemia and juvenile myelomonocytic leukemia) or immune system disorders. All these are usually treated with chemotherapy, which, besides its benefic effects, also negatively affects some good cells. A significant cord blood usage in infant medicine is the marrow transplant. This procedure has the result of providing new and healthy blood cells, which leads to a safer immune system of the child. Besides these, there are some rare genetic diseases that require cord blood stem cells. Among these rare disorders, there is the fatal Krabbe Disease, which is characterized by causing severe degeneration of mental and motor skills of the child.

If receiving the stem cells from the umbilical cord before the actual manifestation of the symptoms, the brain development can be successfully preserved. Hurler Syndrome, Adrenoleukodystrophy, Metachromatic Leukodystrophy, Tay-Sachs disease, Sandhoff disease are also other rare and severe conditions that affect the infants and can be successfully treated if using the cord blood stems. Hurler’s Syndrome is a genetic and progressive disorder that results from the body’s incapacity to make a significant enzyme. The disease damages many organs and most importantly, it affects the heart and causes death in the early teens. The Sandoff disorder has a result the progressive deterioration of the central nervous system and, like the Krabble disease, it is fatal before the age of 3.

Cord blood is not used as a temporary solution in serious medical cases of infants. Cord blood actually provides a new and healthy blood structure that increases the safety of the immune system and prevents further imbalances.

Author: Michael Rad