Growing Use of Newborn Umbilical Cord Blood in Regenerative Medicine

Newborn umbilical cord blood, once considered a biological waste product, has proved to be a valuable medical resource, with nearly 80 conditions now being treated with cord blood stem cells.¹ Umbilical cord blood is increasingly being used in medicine, in traditional transplant applications and in regenerative medicine to heal injury and regrow tissue.

Reproductive nurses are on the front line as providers of the education necessary for parents to make an informed decision on whether to donate or privately bank their child’s cord blood stem cells.

Cord Blood in Transplant Medicine
Cord blood was first used as a source of hematopoietic stem cells in transplantation in 1988 for a young patient with Fanconi anemia, who received cord blood collected from his sister. More than 20 years later, the patient is disease free, and cord blood is now considered the standard of care in the pediatric transplantation setting.² In addition to hematologic disorders, cord blood is also used for malignant, metabolic, and immune conditions.

Inpatient stem-cell transplant care begins with a conditioning regimen to eradicate the underlying disease using high-dose chemotherapy and potentially radiation therapy. This regimen also serves to suppress the patient’s immune system and create space within the bone marrow to allow the stem cells to proliferate. The patient then undergoes a painless cord blood transplant via intravenous (IV) infusion to regenerate a healthy blood and immune system. After that, the patient is closely monitored for signs of infection or other complications.

For conditions such as sickle-cell anemia, cord blood transplants can be completely curative. One such example is Joseph Davis, Jr., of Cedar Hill, Texas, who had a severe form of sicklecell anemia. Joseph’s father said, “Our doctors told us that unless he had a stem-cell transplant, he might not make it to his teens—and at that time he was barely 2 years old.” An unexpected pregnancy yielded joyful results: Joseph received cord blood stem cells harvested from his brother’s umbilical cord that were a genetic match. Today, his health completely restored, Joseph is a typical, rambunctious 9 years old, according to his mother. The family has become passionate advocates for cord blood storage, testifying in front of legislatures across the country.

Regenerative Medicine
More recently, advancements in regenerative medicine have led to therapies using cord blood stem cells to repair tissues once believed to be irreversibly damaged. The characteristics of cord blood that make it ideal for use in regenerative medicine include the stem cells’ ability to secrete cellular reparative factors and differentiate into many tissue types.³ Regenerative medicine research has shown great promise for brain injury, type 1 diabetes, and vascular disease, as well as exciting preclinical data for congenital heart disease.^4-8

Researchers are studying the most effective treatment protocols for regenerative medicine, which will likely depend on the indication. The treatment protocol may involve a simple IV infusion, in which the stem cells will migrate to the damaged tissue (eg, brain injury, cerebral palsy, type 1 diabetes). For other indications, stem cells may be delivered directly to the damaged tissue by injection or coupled with standard therapy (eg, vascular disease). The treatment may also involve tissue-engineering techniques to generate replacement tissue grafts using autologous cord blood stem cells (eg, congenital heart disease).

The Future: Educate Your Patients
The use of cord blood in medicine has grown considerably. More than 15,000 cord blood transplants have been performed worldwide, and approximately 3000 patients are treated with cord blood annually.⁹ This number is likely to grow with expected breakthroughs in regenerative medicine research.

As the use of cord blood in medicine continues to grow, so does the importance of educating expecting parents on their cord blood storage options: to donate the cord blood to a public bank for use by an unrelated patient in need, or to store with a family bank to preserve the valuable stem cells for use by the newborn or by a family member.

Parents and their children depend on the knowledge and expertise of those who care for them during pregnancy. An estimated 90% to 95% of cord blood is still routinely discarded after birth—an alarming statistic given the enormous potential of umbilical cord blood stem cells. The more you know, the more valuable information you can pass on about this underutilized medical resource. 

References

1. McGuckin CP, Forraz N. Umbilical cord blood stem cells—an ethical source for regenerative medicine. Med Law. 2008;27:147-165.
2. Brunstein CG, Setubal DC, Wagner JE. Expanding the role of umbilical cord blood transplantation. Br J Haematol. 2007;137:20-35.
3. Harris DT, Badowski M, Ahmad N, Gaballa MA. The potential of cord blood stem cells for use in regenerative medicine. Expert Opin Biol Ther. 2007;7:1311-1322.
4. Cord Blood for Neonatal Hypoxic-Ischemic Encephalopathy. ClinicalTrials.gov. http://clinicaltrials. gov/ct2/show/NCT00593242?term=nct00593242&ran k=1. Accessed September 24, 2009.
5. Haller MJ, Viener HL, Wasserfall C, et al. Autologous umbilical cord blood infusion for type 1 diabetes. Exp Hematol. 2008;36:710-715.
6. Sodian R, Schaefermeier P, Abegg-Zips S, et al. Abstract 3087: human tissue-engineered heart valves based on umbilical cord blood derived progenitor cells as single cell source. Circulation. 2008;118:S812.
7. Henning RJ, Burgos JD, Vasko M, et al. Human cord blood cells and myocardial infarction: effect of dose and route of administration on infarct size. Cell Transplant. 2007;16:907-917.
8. Meier C, Middelanis J, Wasielewski B, et al. Spastic paresis after perinatal brain damage in rats is reduced by human cord blood mononuclear cells. Pediatr Res. 2006;59:244-249.
9. Frey MA, Guess C, Allison J, Kurtzberg J. Umbilical cord stem cell transplantation. Semin Oncol Nurs. 2009; 25:115-119.