Cord Blood Banking A new horizon

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1 Cord Blood Banking A new horizon Dr. Sushma Sharma Professor Obst. & Gyn., MIMER Medical College, Talegaon Dabhade, Pune.

2 Abstract : Background : Umbilical cord blood is a potential vast source of primitive hematopoietc stem & progenitor cells. This is a ready available source for clinical application to reconstitute the hematopoetic system and/or restore immunological function in affected individuals requiring treatment. These cells have been successfully used as an alternative to bone marrow or peripheral blood progenitor cells in various diseases and are increasingly being explored as treatment option in several others in various trials the world over. Umbilical cord blood being such a precious source of stem cells, needs to be collected and stored under specified conditions leading to the concept of cord blood banking. There are several established & upcoming cord blood banks are over the world including India. Key words: cord blood, stem cell banking Introduction : Cord blood i.e. the blood that remains in the umbilical cord after a baby is born represents a relatively new and potentially the richest source of primitive hematopoetic stem & progenitor cells.- these cells form the basic origin of the body s haemotological & immunological system. With rising interest in stem cell based therapy, the scope of cord blood bank is becoming more of a cell pharmacy!! This source of pluripotent progenitor cells has been used successfully as an alternative to bone marrow or peripheral blood progenitor cells for transplantation. The emerging trend, importance & potential of Cord Blood Banking needs to be understood with a basic knowledge of the application of stem cells. Stem cells are basically the primal / pluripotent progenitor cells found in multicellular organisms. Being pluripotent, they have the remarkable ability to

3 differentiate & develop into many different cell types in the body, simply almost serving as a patchwork repair system in the body! Simply put, they serve as master cells which have the ability to give rise to all tissues & organ systems in the body. This ability holds tremendous potential for treating & curing several disease conditions. Stem cell therapy in the coming decades may provide solutions to presently incurable ailments & severe injuries. Some of the current & emerging applications of cord blood based stem cells have been listed below: Current applications of Stem Cells / Cord blood Acute leukemias Chronic Leukemias Thalassemia Fanconi s anemia Sickle Cell Anemia Hodgkin s Lymphoma Non Hodgkin s Lymphoma Multiple myeloma Others Emerging applications of stem cells / cord blood Cardiac Diseases Diabetes Multiple sclerosis Muscular Dystrophy Parkinson s Disease Spinal Cord injury Stroke Alzheimer s disease Cerebral palsy Source : Wikipedia.org. blood. There are basically 3 sources of stem cells: bone marrow, embryonic cells & cord

4 A bone marrow based treatment requires accurate HLA matching which is tedious & difficult. Treatment based on embryonic cells involves a lot of controversies as it requires the culture of embryo or waste fetus. Weiss et al [7] report that umbilical cord contains an inexhaustible, non controversial source of stem cells therapy. Stem cells derived from human umbilical cord Wharton s Jelly are called umbilical cord matrix stem (UCMS) cells. They can be isolated in large numbers and are negative for CD 34 and CD 45. The grow profusely & can be cryopreserved. UCMS cells have surface markers of mesenchymal stem cells and appear to be stable in terms of their surface marker expression. Kang et al [4] have reported in 2005 the use of cord blood stem cells to restore some function to a Paraplegic female (secondary to spinal cord injury). The injury was 19 years old. Forty one days after the stem cell transplantation, there was proof of regeneration of the spinal cord at the injury site and also below it. Borlongan et al [2] in 2004 report the use of peripheral i/v injection of cord blood stem cells in stroke patients resulting in reduction of stroke size and therefore resultant neuro deficit. Paediatric and adult patients with haematological disorders & malignancies are treated at present with bone marrow transplantations. Not only is this difficult to find, it also runs the risk of chronic graft versus host disease. UCMS cells mitigate cell dose limitations as well as serve the added advantage of decreased chronic graft versus host disease. The first treatment using umbilical cells derived from cor blood was that of Fanconi s anemia by Dr. Elaine Gluckman[3] in 1998, in Paris. This was done for a patient

5 of Fanconi s anemia using an identical HLA matched sibling. More than 25,000 allogenic cord blood transplantations have been performed worldwide since then. The clinical results, to date are encouraging and appear at least comparable to bone marrow or peripheral blood progenitor cells as the donor source for transplants. With the realization of cord blood being such a precious resource came the realization for the need of cord blood banking. Umbilical cord blood has been approved for use by the FDA and other authorities since the late 1980 s. The concept of banking cord blood was pioneered by Dr. Pablo Rubinstein [5], who was awarded grant by the NIH to set up the first National Cord Blood Banking programme at the New York Blood Centre. In India, umbilical cord cell research was initiated at the Cancer Research Institute, Tata Memorial Center, Mumbai in 1990 with the NCCS, Pune as the co investigator. The technology of umbilical cord blood collection, enrichment of stem cells and their cryopreservation was transferred to AFMC, Pune & Tata Memorial Hospital in Mumbai. However, these institutions did not get any support from the government of India to set up a stem cell bank. [1] CORD BLOOD BANKING: A cord blood bank is a place that stores umbilical cord blood for future use. There are two options for cord blood banking: private (or family) and public. Approved public cord blood banks are available for all donors & receive umbilical cord blood following informed parental consent. The inventory is registered & later searched by the public & healthcare providers to access information for transplantation sources.

6 On the contrary, private cord blood banks obtain blood samples & store the cord blood for individual use by families & become the property of the child under the guardianship of parents. The samples stored in private banks for either autologous infant donor or related family members are not searchable or available to the public. Cord Blood banking protocols & Standards: The donor selection process for umbilical cord blood banks is carefully conducted & a through family history is attained to minimize the potential risk of transmitting unrecognized hereditary disorders that could impact on the recipient. Cord blood is not collected if there are known hereditary diseases especially involving hematopoiesis in the family or if severe disabilities or diseases are identified in the donor s fetus before birth. Additional exclusion either include infectious diseases ( e.g. HIV, hepatitis) in the mother, severe pregnancy complications, or premature delivery with birth weight less than 1,500gm or if perinatal asphyxia is present in the fetus. The collection of cord blood in general, must not affect the delivery of the early & should be performed by trained staff. The recommended protocol for umbilical cord blood collection, after the birth of the infant and before the placenta is delivered, is to clamp the cord and thoroughly clean and disinfect to prevent contamination with maternal blood or by infections agents. A specialized blood bag containing anticoagulants is then bar coded for collection of cord blood. The cord is punctured such that the needle of the collecting bag blood is allowed to flow freely assisted by gravity. The storage & transport temperature should be maintained at 22 +/- 4 C. The cord blood is then labeled, weighed & the volume recorded. The blood cell counts for nucleated, mononucleated and CD 34 + cells are recorded before the blood units are stored in liquid nitrogen or in the vapour phase of liquid nitrogen ( < 150 C). Cord blood can effectively be frozen in glycerol, but 10% or less dimethyl sulfoxide is more commonly used today as the cryopreservative of choice & can rest in liquid for decades if not for a lifeline without significant degradation or loss of potency. Over 400,000 cord blood units are now stored for use in more than 100 qualities controlled public international cord blood banks. Standards & protocols for collection, processing and handling of stored cord blood have been established & this has culminated in establishing registries for accreditation practises. In 1998, the foundation NETCORD ( was developed to establish an international registry for cord blood banks & procedures with standards for the safe exchange & clinical use of banked cord blood.

7 Approximately 50% of United States cord blood banks have been certified following standards & accreditation procedures by the AABB (American Association of Blood Banks) Furthermore, the Net- Cord Foundation for the Accreditation of Cellular Therapy (FACT) was established & led to international standards for accreditation in 2000 of cord blood collection, processing testing, banking, selection & later published in There are now two international registries: NETCORD, which lists cord blood units only & Bone marrow Donors Worldwide which lists both bone marrow & cord blood donors. Eurocord & the Center for International Blood & Marrow Transplant Research (CIBMTR) provide extensive analytical expertise in evaluating efficacy and outcome. Where the Indian scenario is concerned the institutes which carried out the pioneering research work i.e. AFMC, Pune & TMH, Mumbai did not get any support from the Indian Government to set up a stem cell bank, The first private cord stem cell bank was established in As of now, there are around 6 main cord bank companies. Most of the established cord bloods banking companies in India have an overseas parent Company responsible for the initial investment. The leading private companies are Reliance Life Sciences, Lifecell International, Cryobanks International India, Cryostemcell Karnataka, Cordlife Sciences and Cryo-Save India. In the public sector Jeevan Stem Cell blood bank exists as a not for- profit stem cell bank, making its nominal presence felt. The Ministry of Health has approved a grant of Rs. 5 crores to upgrade its stem cell research at the Mumbai based National Institute for Research in Reproductive Health under the ICMR. The Ministry of Health has also working on a More with an offshore private company Histostem. The company said that they would be obliged to only conduct research at the 2 leading institutes AIIMS, Delhi & PGI, Chandigarh. They are also in talks with the Apollo group of Hospitals to set up a Histostem therapy Centre. This new area of therapy holds immense promise and an exciting future in the medical field. Some may object to the present high cost of this modality of investment for their child s future. However, comparing the cost with the benefits of the child s & ones own future will helps one put things in perspective. References: 1) A.Dastur Umblical Cord Blood Banking J Obstet Gynecol India Vol. 55, no.6:nov/dec2005 Pg ) Borlongan CV, Hadman M, Sanberg CD et al. Central nervous system Entry of peripherally injected umbilical cord blood cells is not required for neuroprotection in stroke. Stroke 2004; 35: )Gluckman E, Broxmeyer HA, Auerbach AD, Friedman HS, Douglas GW, Devergie A, et al. Hematopoietic reconstitution in a patient with Fanconi s anemia by means of umbilical cord blood from an HLA-identical sibling. N Engl J Med.1989; 321:

8 4) Kang K S, Kim S, Oh Y et al. A 37- year old spinal cord injured female patient, Transplanted of multipotent stem cells from human UC blood, with improved sensory perception and mobility, both functionally and morphologically: a case study. Cytotherapy 2005; 7: ) Laughlin MJ, Eapen M, Rubinstein P et al. Outcomes after transplantation of cord blood or bone marrow from unrelated donors in adults with leukemia. N Engl J Med 2004;351: ) Merlin G,Butler et al Umblical cord Blood banking: an update. J of Asst Reproductive Genetics (2011),Vol 28, ) Weiss ML S, Bledsoe AR et al. Human umbilical cord matrix stem cells: Preliminary characterization and effect of transplantation in a rodent model of Parkinson s disease. Stem Cells 2005;Oct 13;