In Brief: Umbilical cord stem cells provide alternatives in the treatment of several degenerative conditions. The importance of stem cell preservation for therapeutic use is recognized by many thought leaders in the medical field. Sibling-directed donation has been implemented in numerous successful cord blood transplantations, and families should be advised of the many benefits associated with preserving each of their children’s umbilical stem cells.
Umbilical cord blood and cord tissue are rich in hematopoietic (HSCs), endothelial (EPCs), and mesenchymal stem cells (MSCs). These stem cells play a significant role in the treatment of cancers, blood disorders, metabolic disorders, and immune system disorders, as well as in the scope of other degenerative conditions. As such, families see the need for preserving stem cells for future, personal use. There is a misconception that once a family banks the umbilical stem cells of one child, that they do not need to bank with each subsequent child. However, this notion stems from a lack of education about the uses of cord blood that have since been uncovered through more progressive clinical trial research and procedure results. Since 1988 when the first sibling-directed transplant occurred, and through today, the sibling’s umbilical cord blood stem cells have provided life-saving treatment options for families worldwide.
What Research Reveals
It has been established that umbilical-derived MSCs are more committed to angiogenesis,whereas bone marrow MSCs are more committed to osteogenesis.Umbilical cord MSCs are also reported to exhibit a higher proliferative activity and a lower expression of both CD106 and HLA-ABC, which, in turn, leads to lower alloreactivity of these cells. A study conducted by John Wagner and colleagues revealed that a closely HLA-matched sibling increases the likelihood of successful engraftment and minimized the potential of graft-versus-host-disease. It is also reported that patients who received cord blood transplants from siblings had less than a 10% chance of developing graft-versus-host-disease, which is less than that observed of bone marrow from the same type of donor.
Due to the work of Dr. Kurtzberg, Dr. Gluckman, and other experts in the field of stem cell therapies, it is now known that HLA matching and cell dose are significant factors in umbilical cord blood transplant success outcomes. Cord blood stem cells allow for more leniency in HLA matching; more than that of bone marrow. Patients of diverse ethnic backgrounds, or of mixed background tend to have a more difficult time finding compatible HLA types. Cord blood remains a desirable method for which to treat such patients, so it becomes even more imperative that families have access to a pool of autologous and related-allogenic specimens.
Double Transplantation Studies
Through research, it has also been discovered that some neurodegenerative conditions are best managed with multiple infusions, as one such study found in the case of congenital hydrocephalus. One challenge of cord blood use is the volume of umbilical cord blood is relatively small. Due to low cell content, cord blood transplants have generally been limited to patients who are low-weight or children. However, approaches to overcoming this challenge have been managed with success, which involves co-infusion of two partially HLA-matched specimens.
According to data from the Eurocord Registry, it is reported that, since 2005, the number of adult patients undergoing double umbilical cord transplantation has surpassed the number of adults with single cord blood units. Therefore, it becomes even more necessary to have each child’s cord blood specimen available for use in cases where multiple infusions are necessary; not only for the siblings, but also for the parents.
5 Reasons to Bank Cord Blood For Each Child
1. Clinical studies show that haploidentical, or half-matched sibling transplantations are successful, and graft versus host disease is less common than in matched, unrelated bone marrow transplantations.
2. A child with a genetic disease can’t use their own cord blood because those cells also carry the same disease, as is the case with most pediatric leukemias. In these cases, a sibling’s cord blood specimen would be preferred.
3. Banking for each child provides each child with the option to use their own cord blood (autologous). A child's own cord blood is always a 100% match. The second highest chance of a genetic match comes from siblings, and especially those with a family history of conditions that can be treated through umbilical stem cells. Full siblings have a 25% chance of being a perfect match and a 75% chance of being a partial match.
4. A transplant dose requires harvesting 1.3 mL of cord blood for every pound of patient weight when treating cancer. In some cases, more cord blood is needed beyond the specimen collected. Sibling specimens may provide the answer to address additional blood transplantation requirements. Families should be aware of this fact and store with a bank that offers multi-chambered storage units for several cord blood applications.
5. Having more related cord blood specimens (from siblings) covers more possibilities for the chance of successful transplantation for any of the children in that family. Currently, cord blood is FDA-approved in the standardized treatment of 80 diseases. There are over 100 clinical trials underway to explore the treatment of other conditions such as autism, brain injury, stroke, and cerebral palsy through cord blood and cord tissue.