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Umbilical Cord Blood: Current Status and Future Role in Medicine

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Umbilical Cord Blood: Current Status and Future Role in Medicine

The latest issue of Cytotherapy focuses on the recent advances with regard to umbilical cord blood. With around 30,000 cord blood transplants already done, research is centred on removing the disadvantages associated with the procedure and expanding the application to several diseases.

The umbilical cord is more than a connection between the mother and baby that is discarded following birth. The umbilical cord and the blood vessels of the placenta contain immature blood cells called hematopoietic stem cells, just like the bone marrow. These cells can differentiate into blood cells like red blood cells, white blood cells and platelets. Thus, they can be used in patients instead of a fully donor matched bone marrow for a bone marrow transplant.

Advantages of Cord Blood in Comparison to Bone Marrow for a Transplant

The use of umbilical cord blood instead of a bone marrow in transplants has several advantages and these include,
  • Stored cord blood is easier and quicker to obtain than a bone marrow for transplant since one does not have to search for a matching donor.
  • Cord blood is usually free of infections since the mother is tested for infections during pregnancy (Cord blood is tested before it is stored. If found to be infected, it is discarded).
  • Unrelated cord blood does not require very stringent HLA matching and therefore donor cord blood may be easier to find for individuals who do not have a matched donor. HLA matching is required to prevent rejection of the graft by the host.
Recent studies indicate that a more precise HLA matching may produce a better response in the recipient. In addition, matching of certain other factors will improve outcomes in transplantation patients.

Storing of Cord Blood in Private Bank vs Public Bank

Several umbilical cord banks are now available where people can store the umbilical cord. Unfortunately, the private cord banks are beyond the reach of most people. Private banks, which preserve cord blood for use by the family, are extremely expensive. Public banks accept donation of cord blood, but do not charge for the storage and do not reserve it for any specific individual.

Thus, if you store your baby's umbilical cord in the private cord bank, if your child or his/her sibling suffers from a condition that requires a bone marrow transplant in the future, the blood will be available, which can safely be used. You can also donate the blood to a public bank; it will make no difference to you as your child will have access and in addition someone else may benefit too.

However, if you are planning to store the cord in a private bank for your own family, think twice. There are some facts that you should know before you decide to store the blood.

Should You Store Cord Blood of Your baby in Private Bank?

The chances that your same child will need the cord blood are very remote. The more likely use will be for a sibling if he/she suffers from disease condition for which stem cells are useful. Also, the cord blood may not last for more than 15-20 years. Thus, you may spend trying to store the blood for 15 years, and if your child needs it at an older age, it may be useless. Thus, given the enormous cost associated with storing cord blood, it is advised to store it in a private bank only if a sibling suffers from a condition where stem cells are currently being used.

Extending the Horizon for Cord Blood Usage

Current research is widening the scope of using umbilical cord blood. The stem cells have a potential for use not only for cancer but also for a number of other conditions like immunodeficiency conditions, bone marrow failure, inborn errors of metabolism and haemoglobin abnormalities. Even brain injury may be treated with stem cells. People with genetic disorders cannot use their own cord blood since the cord blood also has the same disease.

One of the potential uses of cord blood is in immunotherapy - to produce specific types of immune cells like virus-specific T-cells and regulatory T-cells. It may also be used in the future to produce anti-tumor cells that can fight cancers.

A current problem with cord blood transplant is early mortality. However, newer studies are addressing this issue, which will hopefully not be a significant problem in the future. Umbilical cord blood is also associated with delayed engraftment (delay in functioning of the graft) and increased chances of infection. However, newer methods can help to overcome these problems.

The number of available cells from cord blood may be low. Procedures to increase the number of cells before transplantation are producing better results. The cells may also be exposed to chemicals that could increase the chances of the graft procedure being successful.

Further progress in the field of umbilical cord blood will hopefully address the problems associated with the procedure and result in the routine use of cord blood instead of donor bone marrow for transplants and in the treatment of malignancy as well as non-malignant conditions.

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