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Umbilical Cord Blood: An Alternate Source of Stem Cells

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... concerns surrounding umbilical cord blood use. Stem Cell Transplants ... Collecting cord blood has variable results due to technique and delivery complications ... – PowerPoint PPT presentation

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Title: Umbilical Cord Blood: An Alternate Source of Stem Cells


1
Umbilical Cord Blood An Alternate Source of
Stem Cells
  • Susan Parker
  • Advisor David Fahringer PA-C
  • University of Kentucky
  • College of Health Sciences
  • Physician Assistant Program

2
(No Transcript)
3
Objectives
  • Understand the process of stem cell transplants
  • Discuss methods of retrieval of stem cells
  • Learn benefits and disadvantages of using
    umbilical cord stem cells
  • Discuss ethical concerns surrounding umbilical
    cord blood use

4
Stem Cell Transplants
  • Stem cell transplants are indicated for
    hematopoietic malignancies, bone marrow failure
    syndromes, and genetic immunodifiecient
    disorders.
  • When a patient needs a stem cell transplant, a
    suitable donor must be found.
  • Immune ablation, to reduce GVHD risk, is
    administered under intense medical supervision in
    a sterile environment.
  • The patients recovery begins with an extremely
    weak and vulnerable immune system with a wide
    range of complications and opportunistic
    infection risk.

5
Stem Cell Transplants (contd)
  • 6 human leukocyte antigens (HLAs) need to be
    matched between donor and recipient to improve
    post-transplant prognosis
  • Only 30 of patients will have the ideal
    situation related donor with all six HLA matches
  • If no suitable related donor, the process of
    searching the National Marrow Donor Program
    (NMDP) begins.
  • Currently, there are two sources of stem cells
    available to patients, bone marrow derived and
    umbilical cord derived stem cells.

6
Your Chances of Finding a Donor
  • 10 million registered BM donors worldwide
  • Caucasion has a 50 chance of finding a donor
  • Minorities are lower, donor programs targeting
    subpopulations to increase diversity of donor
    pool.
  • Basically, any circumstance.

7
Bone Marrow Stem Cells
  • Standard stem cell source for over 40 years
  • Obtained by bone marrow aspiration of the pelvis
    of donor
  • Relatively no risk to donor other than pain (no
    anesthetics used)
  • From beginning search to actual transplant takes
    3-5 months

8
Umbilical Cord Stem Cells
  • First successful transplant in 1988
  • Relatively low risk to mother and baby
  • Beginning search to transplant in as few as 21
    days

9
Umbilical Cord Collection
  • Collected after delivery of baby, before delivery
    of placenta
  • Contraindicated in moderate-high risk births
  • Collected under aseptic techniques and stored at
    -80?F

10
Umbilical Cord Retrieval
11
Benefits of UCSC over BMSC
  • Decreased transplant time
  • No chance of donor having acquired disease,
    infection, nor the possibility of donor declining
    procedure
  • Increased diversity of donor pool, much higher
    rates of minority donation
  • UCSC have acceptable mortality rates with 4/6 HLA
    matches
  • Faster neutrophil engraftment (lower chance of
    engraftment)
  • Best prognoses seen in pediatric patients
  • Non-myeloblative immune destruction has better
    outcome with UCSC transplant

12
Drawbacks of UCSC
  • Longer time to immune system recovery due to
    immaturity of cells
  • Leads to increased GVHD and infection risk (but
    diseases less severe than with BM)
  • Less effective for adults
  • Cell dose of one sample usually inadequate for
    patients with increased body mass
  • Possible unknown genetic conditions of newborn
    donor

13
The Bottom Line
  • Chance of engraftment similar between BM and UC
  • Decreased severity of complications with UC
  • Pooling of two or more UC samples has promising
    results, ex-vivo expansion of cells being
    researched
  • Collecting cord blood has variable results due to
    technique and delivery complications
  • Best outcome is still with 6/6 HLA matched
    related bone marrow donor
  • UC contains mesenchymal stem cells that have
    shown promise in becoming various types of
    tissues neural, cardiac, hepatic, renal, etc.

14
Ethics of Using UCSC
  • Alturistic donation no cost to donor, increased
    attention to minorities, LOTS of paperwork and
    stipulations
  • Private donation - 1500 150/month with no
    guarantee of successful collection or storage
  • Recommendations for families with known genetic
    and inherited disorders
  • Pressure on families during an already stressful
    life event
  • Targeting middle and upper class mothers and
    obstetricians in wealthy areas
  • Not available to all women in all areas

15
Private Cord Banking Advertisement
  • http//www.cryo-cell.com/video_center/angelvision/
    index.asp

16
References
  • Armson, 2005, B. Umbilical Cord Banking
    Implications for Perinatal Providers. J Obstet
    Gynaecol Can. 2005 March 27(3)263-90.
  • Ballen, 2005, K. New trends in umbilical cord
    blood transplantation. Blood. 2005 May 105(10)
    3786-91
  • Barker, 2003, J., Weisdorf, D., et al. Rapid and
    complete donor chimerism in adult recipients of
    unrelated donor umbilical cord blood
    transplantation after reduced-intensity
    conditioning. Blood. 2003 September 102(5)
    1915-19.
  • Bieback, 2004, K., Kern, S., Kluter, H., Eichler,
    H. Critical parameters for the isolation of
    mesenchymal stem cells from umbilical cord
    blood. Stem Cells. 2004 22 625-634.
  • Fisk, 2005, N., Roberts, I., Markwald, R.,
    Mironov, V. Can Routine Commercial Cord Blood
    Banking Be Scientifically and Ethically
    Justified? PloS Medicine. 2005 February 2(2)
    44- 47.
  • Laughlin, 2005, M., Giralt, S., Spitzer, T.
    Umbilical Cord Blood Transplantation A New
    Alternative Option. Hematology. 2005 377-383.
  • Lu, L., Yang, S., et al. Isolation and
    characterization of human umbilical cord
    mesenchymal stem cells with Hematopoiesis-support
    ive function and other potentials. The
    Hematology Journ. 2006 91(8)1017-26.
  • OBrien, 2006, T., Tiedemann, K., Vowels, M. No
    longer a biological waste product umbilical cord
    blood. MJA. 2006 April 184(8) 407-410.
  • Tuch, 2006, B. Stem Cells A Clinical Update.
    Family Physician. 2006 35 719-721.
  • Wang, 2005, F., Huang, X., Zhang, Y., Chen, Y.,
    Lu, D. Successful transplantation of double unit
    umbilical-cord blood from unrelated donors in
    high risk leukemia with a long follow-up.
    Chinese Medical Journal. 2005 188(9) 772-6.
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