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| courtesy: Gazetteunion.com |
The first successful cord blood transplant in the world was performed, by Dr.
Eliane Gluckman of St. Louis Hospital, Paris, France on a five-year-old boy
named Matthew
Farrow, suffering from Fanconi’s Anemia (a blood disorder) in 1988. The
cord blood donor was Matthew’s sister at birth and it was stored by Dr.
Broxmeyer. Matthew’s U.S.
physician was Dr.
Joanne Kurtzberg.
Since than the field of UCB banking and transplantation has
grown exponentially with over 600 000
UCB units been stored for transplantation worldwide, and >30 000 UCBTs have been
performed.
UCB serves as an alternative stem cell source; because in a
multiethnic society only 30% of
patients who require an allograft will have a human leukocyte antigen
(HLA)-matched sibling donor.
The successful first transplant opened a new field in
allogeneic hematopoietic stem cell (HSC) transplant. Now UCBT is done for
correction of inborn errors of metabolism, hematopoietic malignancies, and
genetic disorders of the blood and immune system
The main practical advantages of using UCB is the relative
ease with which it can be obtained, no ethical issues, the absence of risk for mothers and donors,
the reduced likelihood of transmitting infections, and the ability to store
fully tested and HLA-typed UCB in the frozen state for atleast 20 years,
available for immediate use. It also seems to be less likely than bone marrow
to cause immune rejection or complications such as Graft versus Host Disease.
Following this first successful transplant, UCB banks were
established in order to collect and cryopreserve UCB for related and unrelated
use.
UCB can be stored cryopreserved for >20 years with
efficient recovery of HSCs and HPCs
Initially, umbilical cord blood transplantation was only limited
to children, given the low cell dose infused and was only used for blood
disorders and malignancies. Both related
and unrelated cord blood transplants have been performed with high rates of
success for a variety of hematologic disorders and metabolic storage diseases
in the pediatric setting.
After promising results in children, the initial UCBT
experience with adults was poor, with 40% of patients dying before day 100.With
time, more studies and improved technique it was realized that higher infused
cell dose was associated with superior survival and the common indications were
myelodysplasia and early-stage hematologic malignancies.
Given the current estimation of more than 130 million annual
births, UCB is considered the most plentiful reservoir of regenerative cells
for a large number of clinical applications.
Public versus Private Umbilical Cord Blood Banking
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| courtesy: Life cell |
Two types of banks work for the collection and storage of
umbilical cord blood:
1) Public banks
2) Private banks.
According to ACOG “Collection can be performed before or after removing the placenta. In either case, thorough cleansing of a section of umbilical cord is performed, and blood is obtained from the umbilical vein by venipuncture and allowed to drain by gravity into a bag supplied by the bank. Blood should be collected as soon as feasible after birth to minimize coagulation and maximize volume .If the specimen is not sterile or is not of sufficient quantity, it will be discarded by the bank”.
Umbilical cord blood collection is not part of routine obstetric care and is not medically indicated. Initial human leukocyte antigen typing of these units allows them to be entered into computerized registries so that when the need arises, a specific unit can be rapidly located for a patient.
Private for-profit banks were initially developed to store
stem cells from umbilical cord blood for autologous use (taken from an
individual for subsequent use by the same individual) if the child develops
disease later in life or for use by other family members. Private banks
advertise directly to consumers often encouraging parents to bank their
infants’ cord blood as a form of “biological insurance.” The routine storage of
umbilical cord blood as biological insurance against future disease is not
recommended by the American
Academy of Pediatrics.
Currently, Although
UCB is used mainly for hematopoietic progenitor cells (HPC) transplantation to
treat blood disorders, the spectrum of diseases for which it is effective has
been expanded to non-hematopoietic conditions, and UCBT is also employed as a
form of regenerative cell therapy or immune modulation. Multiple Clinical Trial
are underway to test the non-hematopoietic use of UCB namely Alzheimer disease,
Autism, Bronchopulmonary dysplasi, Diabetes mellitus type 1, Orthopedic
cartilage repair, Spinal cord injury, Inborn error of metabolism.
The limitations of UCB transplants is slow engraftment,
delayed immune reconstitution, and increased opportunistic infections, which
may be a consequences of lower cell
dose. Scientists all over are working on strategies to improve on these
limitations.
As embryo-destructive transplantation medicine continues to
evoke prejudices and criticism, UCB will probably continue to grow in future
with abundant UCB supply, digitalized UCB selection, multiple new indications,
and significantly improved clinical outcomes.
References:
Umbilical Cord Blood Banking Market Analysis Opportunities and Feature Demand in the world with Forecast 2024 Download free sample report of Umbilical Cord Blood Banking Market The regulatory body checks for the standardization of recruitment, collection, donor screening, transport, testing, processing, storage, freezing, and distribution and further checks on the thresholds of quality.
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