Umbilical Cord Blood banking and its Therapeutic uses: A Review
Ambika Nand Jha1*, Dhaval M. Patel2, Jignesh S Patel3, Upama N. Trivedi4, Akshay H. Shah4
1Doctor of Pharmacy, Department of Pharmacy Practice, Indubhai Patel College of Pharmacy and Research Centre, Dharmaj Anand Gujarat. 388430.
2Department of Pharmacology, SAL Institute of Pharmacy, Ahmedabad, Gujarat 380060.
3Department of Pharmaceutics Indubhai Patel College of Pharmacy and Research Centre,
Dharmaj Anand Gujarat. 388430.
4Department of Pharmacology, Indubhai Patel College of Pharmacy and Research Centre,
Dharmaj Anand Gujarat. 388430.
*Corresponding Author E-mail: nandjha99@gmail.com
ABSTRACT:
The Cord blood is the blood from the baby that is left in the umbilical cord and placenta postpartum. Cord blood contains all the normal elements of blood-red blood cells, white blood cells, platelets and plasma. But it is also rich in haematopoietic stem cells, similar to those found in the bone marrow. Haematopoietic stem cell cells that can be used to treat some types of diseases. The first successful transplantation using haematopoietic stem cells from cord blood was performed in 1988 by a team lead by Dr E. Gluckman to treat a five-year-old boy suffering from Fanconi’s anaemia. It has been estimated that more than 35,500 transplants have been performed in children and adults for the correction of inborn errors of metabolism, hematopoietic malignancies, and genetic disorders of the blood and immune system. The umbilical cord is a narrow tube-like structure that connects the growing baby to the placenta. The cord is sometimes called the baby's “supply line” because it carries the baby's blood back and forth, between the baby and the placenta. It delivers nutrients and oxygen to the baby and excretes the baby's waste products. Three cord blood banking options are available public, private and direct donation banks. The protocols and standards for screening collections and storage of cord blood have now been established worldwide for both public and private cord blood banks. The use of cord blood provides viable options for paediatric patients with malignant conditions, hemoglobinopathies, metabolic disorders, immune deficiencies and regenerative applications.
KEYWORDS: Umbilical cord blood, Hematopoietic stem cell, Transplantation, Human Leukocyte Antigen, Cord Blood Bank.
INTRODUCTION:
Recommendations4
The American College of Obstetricians and Gynecologists makes the following recommendations regarding umbilical cord blood banking:
1. Umbilical cord blood collected from a neonate cannot be used to treat a genetic disease or malignancy in that same individual because stored cord blood contains the same genetic variant or premalignant cells that led to the condition being treated.
2. The routine collection and storage of umbilical cord blood with a private cord blood bank is not supported by the available evidence.
3. The current indications for umbilical cord blood transplantation are limited to select genetic, hematologic, and malignant disorders.
4. Private umbilical cord blood banking may be considered when there is knowledge of a family member with a medical condition who could potentially benefit from cord blood transplantation.
5. Public umbilical cord blood banking is the recommended method of obtaining umbilical cord blood for use in transplantation, immune therapies, or other medically validated indications.
6. Families of all ethnicities and races should consider the societal benefit of public umbilical cord blood donation to increase the availability of matched cord blood units for people of all backgrounds.
7. Obstetrician–gynecologists and other obstetric care providers should be aware of state and local laws regarding umbilical cord blood banking, including the law in some states that requires physicians to inform patients about umbilical cord blood banking options.
8. Health care providers with a financial interest in private umbilical cord blood banking should disclose these interests, incentives, or other potential conflicts of interest.
9. If a patient requests information about umbilical cord blood banking, balanced and accurate information regarding the advantages and disadvantages of public and private umbilical cord blood banking should be provided.
10. A variety of circumstances may arise during the process of labor and delivery that may preclude adequate collection.
11. Umbilical cord blood collection should not compromise obstetric or neonatal care or alter routine practice of delayed umbilical cord clamping with the rare exception of medical indications for directed donation.
12. It is important to inform patients that the medical condition of the woman or neonate may prevent adequate umbilical cord blood collection.
What are the advantages of using cord blood to treat disease?5,6
Using the stem cells in cord blood to treat a disease has the following benefits compared with using those in bone marrow:
· Stem cells from cord blood can be given to more people than those from bone marrow. More matches are possible when a cord blood transplant is used than when a bone marrow transplant is used. In addition, the stem cells in cord blood are less likely to cause rejection than those in bone marrow.
· It is harder to collect bone marrow than it is to collect cord blood. Collecting bone marrow poses some risks and can be painful for the donor.
· Cord blood can be frozen and stored. It is ready for anyone who needs it. Bone marrow must be used soon after it is collected.
· Stem cells in cord blood can be used to strengthen the immune system during cancer treatments. Bone marrow stem cells do not have this capability.
What are the disadvantages of using cord blood to treat disease?6,7
a) The volume of cord blood collected is relatively small therefore the quality stem cells that are used for transplantation much less than that in peripheral blood or bone marrow.
b) If the average total nucleated cell dose in a cord blood is less than about 1/10th of the average bone marrow then as a consequence, the engraftment to the patient’s blood is slower with cord blood than with bone marrow transplants. This is a major problem for adults and adolescents because they need more quantity of stem cells for transplantation.
c) Cord blood transplantation can expose the patient to one of the rarest genetic disorders of the immune system or blood. This disorder is not detectable while testing the cord blood sample.
d) The donor cord blood stem cells that are donated by a newborn baby are unavailable for an extra donation of cord blood. Therefore, if by any chance the first cord blood unit fails, then a second unit should be obtained from a different donor.
Cord blood banking protocols and standards:
The donor of umbilical cord in blood banks following protocols and standards:-
· Family history is collected to minimize the potential risk of transmitting unrecognized hereditary disorders that could impact on the recipient.
· Cord blood should avoid if there are any hereditary diseases specifically involving hematopoiesis in the family or if severe disabilities8
· These factors would impact on the quality and quantity of cord blood collected. The mother must consent before thorough testing for infectious diseases, recording of medical or clinical information to be added to the dataset and for HLA typing to be completed before the collection and storage of cord blood in the public bank for future transplantation purposes.
· The collection of cord blood, in general, must not affect the delivery of the baby and should only be performed by trained staffs who are knowledgeable about cord blood collection, processing and handling for screening, transportation and storage. To address issues related to cord blood banking.9,10,11
Public versus private cord blood banking:
The first publicly funded cord blood bank was established in New York in 199312. Cord blood units stored in public banks are available for the patients in need worldwide. A patient anywhere from the world can access the cord blood units in a public bank through search performed by various registries worldwide, if they get HLA-matched. The donors are not charged for the storage process. The recipients who will be using the cord blood units for their treatment will be charged. The list ofpublic cord blood banks in India is provided (Table 1).13
Table 1: List of Cord Blood Banks
|
Cord blood bank |
Contact details |
Email ID URL |
|
1. Reliance Dhirubhai Ambani Life Sciences Center.
|
Thane-Belapur Road, Navi Mumbai. html |
info@relbio.com http://www.rellife.com/cord_blood. |
|
2. School of Tropical |
108, Chittaranjan Avenue, Kolkata, –– |
http://www.stmkolkata.org/rmts/ |
|
3. StemCyte India |
Apollo Hospital Campus, Bhat GIDC Estate, Ahmedabad Rd,
Gandhinagar, Gujarat. |
info@stemcyteindia.com. http://www.stemcyteindia.com |
|
4. Jeevan |
22, Wheatcrofts Rd, Seetha Nagar, |
stemcell@jeevan.org http://www.jeevan.org/stem-cell |
Table 2: Examples of Conditions Treated with Stem cell Transplants
|
Cancers |
Blood disorders |
Congenital metabolicdisorders |
Immunodeficiencie |
|
Acute lymphocyticleukemia |
Sickle-cell anemia |
Adrenoleukodystrophy |
Adenosine deaminasedeficiency |
|
Acute myelogenous leukemia |
Fanconi’s anemia |
Gunther’s disease |
Wiskott-Aldrich’s |
|
Chronic myelogenous leukemia |
Thalassemia |
Gaucher’s disease |
Duncan’s disease |
Therapeutic uses of umbilical cord blood:
Umbilical cord blood of human is source of hematopoietic stem cells, totipotent cells. These cells provide outstanding health treatments in medical industries. The stem cells in the cord blood has the ability to develop into several types of cells that develop organ specific tissue in special conditions, so cord blood is termed as regenerative medicine14. UCB is a good hematopoietic source and perhaps one of the most important cells that could be derived from UCB is Natural Killer cells. These cells can kill different targets such as cancer or virally-infected cells without any prior activation15,16 it is also used for developing the therapies for incurable condition. Some of the diseases cured are cancers and blood disorders which are considered to be fatal diseases17. Umbilical cord blood solves many problems in the medical field as there are no counter effects after treatment. It also helps to recover from the harmful diseases which are not cured over generations as when these genetic disorders are cured then they do not pass on to next generation. Diseases such as Alzheimer’s, Arthritis, Asthma, Cancer, Diabetes, Heart diseases and Strokes can be treated by UCB.18
Examples of Conditions Treated with Stem cell
Transplants are indicated in Table 2. The table provides a brief understanding about different types of cancers, blood disorder, congenital metabolic disorders and immunodeficiency which can be treated using stem cell transplants.19
CONCLUSION:
Policymakers should promote public cord blood banking. The myths and lack of awareness regarding cord blood banking among health care professionals and the public is a big threat leading to exploitation by private banking. The umbilical cord blood was discarded as a waste material but today it is considered to be a regenerative medicine in order to produce the organ tissues. The cord blood has a small chance to be used by the donor so it is better to store it in a public bank as it can save a life. In addition, many legal and ethical aspects must be considered in private cord blood banking.
ACKNOWLEDGEMENT:
We would like to express our sincere gratitude to Dr. Dhaval M. Patel, Professor and HOD, Department of Pharmacology, SAL Institute of Pharmacy, Ahmedabad.
CONFLICT OF INTEREST:
The authors declare that they have no competing interest.
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Received on 29.12.2020 Modified on 19.01.2021
Accepted on 08.02.2021 ©AandV Publications All right reserved
Res. J. Pharmacology and Pharmacodynamics.2021; 13(2):55-58.
DOI: 10.52711/2321-5836.2021.00012