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Background

Hematopoietic Image of Bone Marrow

Cord blood stem cells or more officially known as umbilical cord blood stem cells are a very rich source of hematopoietic stem cells. Hematopoietic stem cells are a type of stem cell that can develop into all types of different blood cells whether its white blood cells, red blood cells, or platelets.

Stem cells have the ability to differentiate into tissues from three separate germ layers known as the ectoderm, endoderm, and mesoderm. This gives a stem cell the term "pluripotent" due to their ability to differentiate.

Due to their ability to proliferate at a higher rate while being especially convenient for treatment of some serious diseases, cord blood stem cells are a very suitable source and sought after piece of research. The cord blood stem cells, which could be found in the placenta and umbilical cord post childbirth, play a vital role in treatments for people of all ages, but primarily in younger aged patients. This is because younger patients have younger stem cells being able to proliferate, differentiate, and move at a faster and healthier rate.

The process of collecting the stem cells have been a trend on the rise as it gives parents essentially an "insurance policy" in the event that a family or relative's life may be at risk due to a blood disorder. This process is known as cord blood banking.

History

• 1985: Beginning in 1985, Dr. Hal Broxmeyer was the first scientist to find hematopoietic stem and progenitor cells in human cord blood cells.
• 1988: Then in 1988, the first ever successful cord blood transplant was completed in Paris, France for a young six-year-old patient suffering from a blood disorder called Fanconi's Anemia.
  • In the first ever transplant, a young 6 year old patient was given a successful Cord Blood transplantation to treat his Fanconi Anemia which is a rare disease with symptoms of multiple physical abnormalities, bone marrow failure as well as a much higher risk of cancer. They were able to save this young patient through the human leukocyte antigen that was matched with his sibling.

    

    Cord Blood Registry that began in 1992

• 1992: This was the year that the first public bank for umbilical cord blood was officially established in the city of New York by Dr. Pablo Rubinstein.
• 1998: The cord blood program was officially launched, being given the name National Marrow Donor Program (NMDP).
• 2005: Congress officially passed legislation for cord blood called, The Stem Cell Research and Therapeutic Act of 2005, to create a total inventory of 150,000 cord blood samples.
  • Present day estimations believe there are up to 5 million samples.
• 2012: By 2012, there were over 30,000 unrelated cord blood transplants that were performed.

Advantages

Stem cells taken from umbilical cord blood have some insane benefits that could only be found in the umbilical cord.

1. Readiness: Cord blood cells are able to be used relatively quickly when taken straight from the cord blood blank. The turnover time for a cord blood cell to be transfused into another human being patient is at a much faster rate then that of a bone marrow stem cell.
2. Higher chances of transplant success: One of the major arguments for the use of cord blood stem cells over any other types is because of their ability to create more new blood cells. In addition, there is a much lower incidence of GvhD otherwise known as Graft-versus-host-disease. Gvhd is a disease that often causes T cells that come from the donor's marrow to recognize the recipient's body tissues as foreign ultimately attacking the transplant recipient's own body.
3. Superior proliferation and engraftment: When comparing this to the proliferation and engraftments rates of bone marrow, it's capacity is at a much higher standard. Although it begins slow in the G0/G1 cell cycle state, these cells eventually respond rapidly to growth factors including the Granulocyte macrophage-colony simulating factor, M-CSF, G-CSF, IL-3, Erythropoietin, Stem Cell Factors, and Flt3 ligands. Through all these growth factors combined, they result in an increase proliferation rate.

Disadvantages

Although, cord blood cells could be helpful in multiple ways, there are also ways in which stem cells are a disadvantage.

1. Engraftment of neutrophils and platelets delayed: When given a cord blood stem cell, there is a possibility that the treatment of these cord blood stem cells may be delayed further due to the engraftment of neutrophils and platelets.
2. Limiting numbers of SCs in single CB collection: Since lower dosages and a smaller volume is collected, there sometimes may not be enough stem cells to make a huge impact. Current day treatments have been looking at various cytokines and small molecules to expand the umbilical cord blood hematopoietic stem cells ex vivo.
3. Price: The price of collecting cord blood stem cells are typically at a much higher range where most families wouldn't be able to afford.

Banking

Cord blood banking is a process used to collect stem cells that come from the umbilical cord and placenta. The main purpose for this collected stem cells would be for future use, come any unexpected diseases.

Cord blood can be collected directly after birth. The attending doctor would then clamp the umbilical cord in two separate places spanning approximately 10 inches apart then separating the baby and mother. A needle is then sent into the umbilical cord collecting a sample of at least 40 milliliters of blood. This sample is then collected and sent over quickly to the closest lab for testing and storage.

Cord Blood Processed

Price

The pricing to store a baby's cord blood varies on two factors typically including the price and the sector.

As per most things, the price of a service or item is always relative to its location. In areas where stem cell research is more defined, prices seem to be at a lower cost. However in states where they have not reached the ability of others', have been found to be more costly. According to the Texas Department of State Health Services, there is an initial collection fee that ranges from $900-$2000 and and annual storage fee of approximately $150 giving you a total price of $2150.

The biggest factor when determining where to store cord blood as well as its price would be whether to save it in a private or public cord blood bank. For private banks, they typically accept all types of samples regardless of its quality. However researchers have recently seen that these private companies are usually only in it for the profit rather than helping out families. The other type would be public cord blood banks. These centers are usually nonprofit and accept donations. This option is a lot more affordable and available to others who may really need it. However, the one downside would be the lack of these public centers as there are only 26 public cord blood banks in all o the U.S.

Treatment

Cord blood cells have the ability to cure a lot of different types of diseases. These conditions include:

Sickle Cell Anemia

• Leukemia
• Lymphomas
• Sickle cell anemia
• Krabbe's disease
• Other rare diseases

Research

Currently, cord blood stem cells are a hot topic amongst the stem cell community. There have recently possibly been breakthroughs for several problems. As addressed earlier, one of the major disadvantages is the lack of hematopoietic stem cells in a single unit of cord blood. However researchers in Korea have recently found that a combination of HIL-6, SR1, and UM171 onto the culture of the cord blood will result in the highest number of CD34+ cells. Through this specific combination, it shows a synergistic effect in the proliferation of the stem cells.

There has also been promising research on cord blood having the ability to cross the blood-brain barrier and being able to reduce inflammation. This is important as it increases the amount of diseases that it may be able to treat. With strokes being one of the most dangerous health issues in the country, this would be a huge breakthrough where human umbilical cord blood cells may finally be able to cross the blood brain barrier.

Future Hopes

Cryopreservation Example

The future hope of cord blood stem cells are truly still unknown. The possibilities that it holds seem to reach as far as the skies. However the hope for many researchers is that it may be used to treat other conditions such as Alzheimer's, diabetes, heart failure, spinal cord damage and more. This idea of cryopreservation is also a possibility where we preserve the cord blood stem cells in hopes of being able to use it in the future to treat more diseases. There is also enthusiasm for different forms of regenerative therapy as a possibility for the future.

References

1. National Cancer Institute
2. National Library of Medicine
3. Duke Marcus Center for Cellular Cures
4. Boston Children's Hospital
5. Healthy Moms Strong Babies
6. Midterm 3 Lecture
7. Pub Med
8. Texas Department of State Health Services
9. Forbes Health
10. WebMD
11. National Library of Medicine Article 2
12. PubMed