Cord Blood Stem Cells

1. How long can stem cells be stored?
   Based on current developments, cryogenic preservation of tissue under liquid nitrogen conditions can last indefinitely (1). According to guidelines by the New York State Department of Health, there is no evidence at present that cord blood stem cells stored at -150 degrees Celsius in an undisturbed manner will lose either in vitro-determined viability or biological activity.
   Studies on the cryopreservation of other types of cells (like sperm cells and eggs) have indicated that these cells can be stored up to 50 years. Records also show that umbilical cord blood stem cells currently stored for almost 30 years remained viable and retained their ability to engraft (2 & 3).
2. What will happen to the stem cells after 21 years of storage?
   After 21 years, a letter will be sent to the grown-up child to give him/her the choice of whether to continue with the stem cell storage.
3. Should I bank my baby's cord blood stem cells with public or private cord blood banks? If I store cord blood stem cells with a public cord blood bank, can I retrieve them when I need them?
   It is entirely the parents' decision to opt for private or public cord blood banking. Private cord blood banking provides guaranteed availability when the cord blood is needed; while availability is not guaranteed if the cord blood is stored in a public cord blood bank. Do note that not all samples donated are eligible for storage in public cord blood banks.
4. Why perform the maternal blood test when I already have a medical report from the doctor?
   An antenatal check-up may have been performed, but the mother may still acquire an infection prior to delivery. A maternal blood test, performed in compliance with AABB standards, ensures that the cord blood is free of any infectious diseases. Maternal blood testing is essential to confirm the cord blood is virus-free. This is because not all detectable antibodies may be present in the cord blood.
5. Is it sufficient to bank just one child's cord blood stem cells?
   Each child's genetic composition is unique and hence siblings may have different HLA typing. For best results during stem cell transplantation, a perfect (100%) HLA typing match is preferred over a partial HLA matched sample. By storing each child's cord blood stem cells, the likelihood of using the stored cord blood will be higher when a cord blood transplant is needed. Storing each child's cord blood may also increase the chances of finding a good HLA match among family members.
6. When must I decide to save my baby's cord blood?
   We encourage parents to enroll as early as possible during their pregnancy. Nevertheless, it is never too late in your pregnancy to enroll.
   Simply call us at +603-4050 5509 for more information.
7. What happens if the number of cord blood stem cells collected is insufficient or less than the acceptable volume?
   Should the number of nucleated cells collected be less than the acceptable minimum of 200 million cells or more, the client will be informed and their decision requested on whether or not to proceed with storing their child's cord blood.
8. Will my baby ever need it, as the odds of needing to use the cord blood stem cells seem very low?
   Multiple sources have shown that the odds of one needing to use its own cord blood unit range from 1:1000 to 1:200,000. According to the Journal of Pediatric Hematology/Oncology (5), the odds of a child using his or her own cord blood stem cells by age 21 for existing treatments is 1:2700. Notwithstanding, taking into consideration that the causes of most cancers remain unknown and the rapid development of stem cell therapies, these odds can never be estimated accurately. Moreover, it has recently been established that cord blood units may also be used in treatments for adults too. As such, parents should not discount the importance of storing their newborns' cord blood units based on these odds. In fact, parents should take into account that research being carried out may widen the scope of treatment by stem cells, making stem cells a seriously vital treatment option (6).
9. What is graft vs. host disease (GvHD)?
   Graft vs. host disease (GvHD) is a common complication following an allogeneic tissue transplant. It is commonly associated with stem cell or bone marrow transplant but the term also applies to other forms of tissue graft. Immune cells (white blood cells) in the tissue (the graft) recognize the recipient (the host) as "foreign" and will then attack the host’s body cells. GvHD can also occur after a blood transfusion if the blood products used have not been irradiated.
10. What is HLA matching?
    Human leukocyte antigen (HLA) is the maker protein on the tissue surface indicating the immunological properties of a tissue. It is used as an identification agent for the immune system to distinguish the body’s own cells from foreign agents.

Mesenchymal Stem Cells

1. Why save Cord Blood Stem Cells and Mesenchymal Stem Cells (MSCs)?
   Cord blood remains in the umbilical cord and placenta following a baby’s birth. Cord blood is a rich source of stem cells, currently used to treat about 80 blood- and bone-related diseases.
   
   Fats and umbilical cord Wharton’s Jelly contain Mesenchymal Stem Cells (MSCs), which can transform into many different kinds of cells, including organ, muscle, bone, and cartilage cells. MSCs are not currently being used for treatment, but they’re being investigated in over fifty clinical trials worldwide because it is thought that someday they will be able treat a huge array of diseases.
2. What are Mesenchymal Stem Cells?
   The two most common types of adult stem cells are Hematopoietic Stem Cells, which form all types of blood cells and Mesenchymal Stem Cells. These cells give rise to a variety of other cell types, including bone cells (osteocytes), cartilage cells (chondrocytes), fat cells (adipocytes), and other kinds of connective tissue cells, such as those in tendons.
3. Are Mesenchymal Stem cells (MSCs) used in therapeutic treatments?
   Mesenchymal stem cells (MSCs) from many different tissues are being tested in clinical trials for efficacy. In addition, cells specifically derived from cord tissue are currently being used in several clinical trials, for example, treating Cardiomyopathy, Ulcerative Colitis, Diabetes, Anemia, Autism and Cirrhosis of the Liver.
4. What is the difference between Cord Blood Stem Cells and Mesenchymal Stem Cells (MSCs)?
   The physical tissue of the umbilical cord, (not to be confused with the cord blood that is drained from the umbilical cord), contains Mesenchymal Stem Cells (MSCs). MSCs are a different type of stem cell than those that are collected from cord blood in the umbilical cord because they are tissue-based and can proliferate into skin, connective tissue, bones, cartilage, and even organs. The types of stem cells that exist in great numbers in cord blood are called hematopoietic stem cells (HSCs) and they are blood-based stem cells.
5. What is the process for storing Mesenchymal Stem Cells (MSCs)?
   The same freezing process is used for both cord blood stem cells and Mesenchymal Stem Cells (MSCs). Cellsafe, in a unique way, the stem cells are extracted prior to cryopreservation. This step is to extract the cells beforehand, to provide families with a treatment-ready source of stem cells if they are ever needed.
6. What about other sources of mesenchymal stem cells; are they better?
   Adipose (fat) derived MSC come out as the sample that can be acquired latest in life to purpose, are easier to harvest, and have the greatest number of potential therapeutic uses in comparison to those obtained from peripheral blood and bone marrow.
   Very few humans have cryopreserved their umbilical cord from birth, so generally these MSC are not accessible. This leaves autologous adipose (fat) derived and Wharton’s Jelly MSC for adult MSC banking purposes.

Reference

1. Guidelines for Collection, Processing and Storage of Cord Blood Stem Cells (2nd Ed. Mar 2003), New York State Department of Health;
2. Broxmeyer, H.E. et al. (2003), “High-efficiency recovery of functional hematopoietic progenitor and stem cells from human cord blood cryopreserved for 15 years”, Proceedings of the National Academy of Sciences, USA, Volume 100. Issue 2, pp. 645-650;
3. Kobylka, P., Ivanyi, P., Breur-Vriesendorp, B.S., et al. (1998),”Preservation of Immunological and Colony-Forming Capacities of Long-Term (15 years) Cryopreserved Cord Blood Stem Cells”. Transplantation. Volume 65. Issue 2, pp. 1275-1278;
4. Marco, F., Bureo, E., et al. (2000),”high Survival Rate in Infant Acute Leukaimia Treated with Early High-Dose Chemotherapy and Stem-Cell Support”. Journal of Clinical Oncology, Volume 18, pp. 3256-3261;
5. Johnson, F., (1997),”Placental Blood Transplantation and Autologous Banking”. Journal of Paediatic Haematology/Oncology Volume 19. Issue 3, pp. 183-187;
6. Laughilin, M., Barker, J., et al., (2001),”Hematopoeitic Engraftment and Survival in Adult Recipients of Umbilical-Cord Blood from Unrelated Donor”. New England Journal of Medicine Volume 344. Issue 24, pp. 1815-1822.