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Family cord blood: what you need to know.

Clinical dialogues with expectant parents often include a discussion about harvesting the newborn's umbilical cord blood and stem cells. Stem cell discussions and controversies are part of the medical landscape, as evidenced by the 2005 Stem Cell Therapeutic and Research Act, which expanded the bone marrow registry program to also include cord blood. (1) Currently, cord blood cells are used in the treatment of thalassemia, sickle cell and other hematologic disorders, immune deficiencies, and metabolic disorders; they are also used in oncology. Overall, results using cord blood stem cells are comparable to those achieved with bone marrow transplants, although cord blood stem cell use is associated with decreased graft-vs-host disease. (2)

We have to ask ourselves, however, what will medicine look like 10 or 20 years from now? Will advances in the field of regenerative medicine produce new and viable treatments for common diseases? If so, cord blood will likely play a vital role in many of these challenging areas.

New avenues of clinical investigation underscore the potential importance of umbilical cord stem cells and their efficacy in human subjects. (3) Recently, cord blood stem cells have shown potential to "transform" into specific differentiated cell types and develop into organ-specific tissue. (4) As a result, researchers are evaluating the usefulness of these cells in repair of damage caused by myocardial infarction, diabetes mellitus, stroke, traumatic brain injury, and spinal cord injury, among others. (5-17) At present, the likelihood of children needing their own cord blood stem cells for autologous transplant is controversial. Available estimates range from 1 in 1000 to 1 in 200,000, (18) but these estimates are premature, given the infancy of autologous banking.

Certainly, health care providers should inform prospective parents about public and private cord banking options. The authors of the American College of Obstetricians and Gynecologists "Committee Opinion: Routine Storage of Umbilical Cord Blood for Potential Future Transplantation" noted the encouraging results of cord blood stem cell transplants and discussed scientific, legal, and ethical issues associated with cord blood banking. The issues of public versus private banking were addressed, primarily regarding how to help patients realistically evaluate the potential future use of cord blood at that point in time. While many of the questions raised remain with us, considerable advances in the field and tantalizing results of small trials suggest that the uses of cord blood stem cells in humans will continue to expand.

A 2007 report from the National Guideline Clearing House (19) notes that physicians should be familiar with the rationale for cord blood banking, available options, and the potential costs of current storage options. Physicians should counsel prospective parents about the potential uses and contraindications of cord blood, and be able to educate patients about the pros and cons of public and private banks.

A recent report from the American Academy of Pediatrics (AAP) (20) supports the use of private cord blood storage when a full sibling has a medical condition (malignant or genetic) and could benefit from cord blood transplantation. Otherwise, the AAP recommends the use of public banking, but notes the importance of educating parents about the potential complications of banking, specifically that the cord blood banked with a public institution may not be available for private use. The report also specifically notes that underserved minorities (African American, Hispanic, American Indian/Alaska Native individuals) should be recruited to improve supplies of matches for these populations.

This publication seeks to provide a clear picture of the uses and contraindications of privately stored cord blood at this point in time and provide a resource with which clinicians can effectively counsel their patients.

References

(1.) The White House News Page. President signs "Stem Cell Therapeutic and Research Act of 2005." www.whitehouse.gov/news/releases/2005/12/20051220-1.html. Accessed September 27, 2007.

(2.) Moise KJ Jr. Umbilical cord stem cells. Obstet Gynecol. 2005; 106:1393-1407.

(3.) US National Institutes of Health. Safety of autologous stem cell treatment for traumatic brain injury in children. www.clinicaltrials.gov/ ct/show/NCT00254722?order=1. Accessed September 27, 2007.

(4.) McGuckin CP, Forraz N, Baradez MO, et al. Production of stem cells with embryonic characteristics from human umbilical cord blood. Cell Prolif. 2005;38:245-255.

(5.) Sanchez-Ramos JR, Neural cells derived from adult bone marrow and umbilical cord blood. J Neurosci Res. 2002;69:880-893.

(6.) Sunkomat JNE, Goldman S, Harris DT, et al. Cord blood-derived MNCs delivered intracoronary contribute differently to vascularization compared to CD34+ cells in the rat model of acute ischemia. Stem Cells. 2007. In press.

(7.) Amado LC, Saliares AP, Schuleri KH, et al. Cardiac repair with intramyocardial injection of allogeneic mesenchymal stem cells after myocardial infarction. Proc Natl Acad Sci USA. 2005;102:11474-11479.

(8.) Ende N, Chen R, Reddi AS. Effect of human umbilical cord blood celts on glycemia and insulitis in type 1 diabetic mice. Biochem Biophys Res Commun. 2004;325:665-669.

(9.) US National Institutes of Health. Umbilical cord blood infusion to treat type 1 diabetes, www.clinicaltrials.gov/ct/show/ NCT00305344? order=1. Accessed September 27, 2007.

(10.) Haller MJ, Cooper SC, Brusko T, et al. Autologous cord blood transfusion associated with prolonged honeymoon in a child with type 1 diabetes. Diabetes. 2005;54(suppl 1): Poster A485.

(11.) Chen J, Sanberg PR, Li Y, et al. Intravenous administration of human umbilical cord blood reduces behavioral deficits after stroke in rats. Stroke. 2001;32:2682-2688.

(12.) Di Campli C, Piscaglia AC, Pierelli L, et el. A human umbilical cord stem cells rescue therapy in a murine model of toxic liver injury. Dig Liver Dis. 2004;36:603-613.

(13.) Tang XP, Zhang M, Yang X, Chen LM, Zeng Y. Differentiation of human umbilical cord stem cells into hepatocytes in vivo and in vitro. World J Gastroenterol. 2006; 12:4014-4019.

(14.) Ende N, Chen R. Parkinson's disease mice and human umbilical cord blood. J Med. 2002;33:173-180.

(15.) Ende N, Chen R Ende-Harris D. Human umbilical cord blood cells ameliorate Alzheimer's disease in transgenic mice. J Med. 2001;32:241-247

(16.) Ende N, Chen N. Human umbilical cord blood cells ameliorate Huntington's disease in transgenic mice. J Med. 2001;32:231-240.

(17.) Chen R, Ende N. The potential for the use of mononuclear cells from human umbilical cord blood in the treatment of amyotrophic lateral sclerosis in SOD1 mice. J Med, 2000;31:21-30.

(18.) Barker JN, Weisdorf DJ, DeFor T, et al. Transplantation of 2 partially HLA-matched umbilical cord blood units to enhance engraftment in adults with hematologic malignancy. Blood. 2005;105:1343-1347.

(19.) National Guideline Clearing House. Cord blood banking for potential future transplantation, htt p://www.guidelines.gov/summary/ summary.aspx?doc_id=10389. Accessed: October 15, 2007.

(20.) American Academy of Pediatrics Section on Hematology/Oncology, American Academy of Pediatrics Section on Allergy/Immunology, Lubin BH, Shearer WT. Cord blood banking for potential future transplantation. Pediatrics. 2007;119;165-170.

Preface Joseph S. Sanfilippo, MD, MBA

PREPACE BY

Joseph S. Sanfilippo, MD, MBA Professor, Department of Obstretrics and Gynecology, University of Pittsburgh Vice Chairman, Reproductive Sciences Magee-Womens Hospital Pittsburgh, PA
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Author:Sanfilippo, Joseph S.
Publication:OBG Management
Geographic Code:1USA
Date:Nov 1, 2007
Words:1175
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