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History and Future |
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A Brief History of Cord Blood Banking
1983 : The concept of using umbilical cord blood as an alternative source of stem cells for transplant is proposed.
1988 : The first successful cord blood transplant to regenerate blood and immune cells is performed in Paris on a 6-year-old boy suffering from Fanconi’s anemia, a blood disorder.
1992 : The New York Blood Center establishes the first public bank for umbilical cord blood through funding provided by the National Institutes of Health.
1993 : First unrelated cord blood transplant occurs at Duke University and in 1995 : The first family bank, Cord Blood Registry, opens.
1996 : The FDA launches an investigational new drug for cord blood under the National Institutes of Health and National Heart Lung and Blood Institute-sponsored Cord Blood Transplantation Study.
1997 : A successful cord blood transplant is performed on a 46-year-old man with chronic myelogenous leukemia, a type of cancer, during a clinical trial using cord blood that was expanded "ex vivo," which means outside of a living organism.
1998 : Doctors conduct the first successful transplant to cure sickle cell anemia. Twelve-year-old Keone Penn, suffering from sickle cell anemia, was treated at the Emory University Department of Pediatrics.
According to the National Cord Blood Program, one year after the transplant, doctors pronounced him cured.
2000 : The world's first umbilical cord blood transplant is performed using pre-implantation genetic testing to ensure a perfect tissue match. The transplant took place at the University of Minnesota Medical Center-Fairview Blood and Marrow Transplant Services in Minneapolis.
2004 : Illinois becomes first state to enact legislation mandating that birthing women have the option to donate their babies cord blood to a public bank at no cost.
2005 : U.S. Congress passes national cord blood legislation, The Stem Cell Research and Therapeutic Act of 2005 (H.R. 2520), to create a national inventory of 150,000 high-quality cord blood samples.
2006 : More than 8,000 cord blood stem cell transplants have been performed worldwide.
2008 : More than 12,000 cord blood stem cell transplants have been performed worldwide |
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Beginnings
The first successful cord blood transplant was made to a six-year-old boy in Paris, France who suffered from a blood disorder called Fanconi's anemia in 1988. The procedure aimed to regenerate the boy's blood and immune cells. Another successful cord blood transplant was made in 1991 to a child suffering from a type of cancer known as chronic myelogenous leukemia.
In 1992, the world's first family cord blood sample was banked at the University of Arizona. In the following year, it established and began its Designated Transplant Program (DTP) that provided free banking of cord blood for individuals and families with medical needs. Then in 1998, it has become the first family cord blood bank to be accredited by the American Association of Blood Banks (AABB).
Development through the years
A series of successful cord blood transplant was performed during the late 1990s on both children and adult patients. The diseases that needed cord blood transplant then included chronic leukemia, sickle cell anemia, and cancer. The cord blood transplant procedure was proven effective and it cured many patients in many parts of the United States.
From 1999 to 2005, researchers and medical experts continued to cure several kinds of blood diseases, cancers, and genetic disorders with newborn cord blood stem cells. Today, the transfusion of newborn stem cells is being used to treat more than 70 kinds of diseases.
Milestone
The one important event that marked the history of cord blood banking is the enactment of the legislation mandating that birthing mothers should be given the option to donate their cord blood to a blood bank free of charge. Illinois was the first state to follow this mandate in 2004. In 2005, the number of states in the US that followed the legislation increased.
Statistics
In that same year, there were already more than 6,000 cord blood stem cell transplants performed worldwide. More than 400,000 cord blood stem cell units were banked at the Cord Blood Registry for use of over 120,000 clients including hospitals and other medical centers. It was also in this year that researchers have discovered the positive effect of cord blood for anoxic brain injury, traumatic brain injury, and cerebral palsy.
Presently, researchers and medical experts around the world continue to explore and discover strategies that will maximize the advantages of cell expansion, the process where more cord blood stem cells can be yielded, to allow more patients to be treated with cord blood transfusion.
Although it began only recently, the cord blood banking is rapidly progressing, benefiting more individuals and families suffering from various diseases.
Stem cells generate various cell lines |
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Sources of stem cells: bone marrow, peripheral blood (after stimulation), and umbilical cord blood |
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These sources can generate hematopoietic and mesenchymal cell lines |
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Committed cells may generate other tissue specific cell lines |
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Rich source of stem cells from all ethnic groups |
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Readily available
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1988: First successful cord blood sibling-sibling transplant was for Fanconi’s anemia
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May treat many diseases including: leukemia, lymphoma, sickle cell anemia
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Estimates of the risk of needing stem cell transplant range
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Current thoughts |
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Indefinite storage frozen in liquid nitrogen
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Perfect HLA match is not needed unlike marrow transplants
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Increases the probability of finding an acceptable donor cord blood
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Less Graft vs. Host Disease in transplanted recipients
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Best predictor of engraftment is the total nucleated cell count present in the original collection, i.e. cell dose
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The more donor cells per recipient weight the better chance of successful engraftment
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Limitation of size of recipient, <40 kg, for single cord transplants
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Increases the probability of finding an acceptable donor for transplant since the HLA match does not need to be identical
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Future thoughts |
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Many adult leukemia patients may be eligible for umbilical cord blood transplantation by using multiple cord bloods |
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Research done combining two units, median dose 35 million nucleated cells/kg, found 21/23 transplants successfully engrafted |
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Barker, NJ et al. Transplantation of two partially HLA-matched UCB units to enhance engraftment in adults with hematologic malignancy, Blood. |
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May be useful in Tissue Engineering (TE), a process controlling cell behavior to allow their implantation along with non-biologic scaffolds, in place of traditional synthetic prostheses, to repair and reconstruct tissue |
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Examples: Blood Vessels, Heart Valves, Muscle, Cornea |
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Tissue Engineered Vascular Grafts |
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Start with cell source of desired cell function, e.g. endothelial progenitor cells from bone marrow, blood or cord blood |
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Stem Cell Transplantation in Myocardial Infarction (MI) |
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Intracoronary transplantation of Autologous, mononuclear bone marrow cells subsequent to an acute anterior MI showed improved myocardial perfusion |
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Maybe cord blood could be a source for allogeneic repair research? |
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