Benefits of Stem Cells in Pediatrics

 

Vinod V. Bagilkar¹, Ashwini A. Patil²

Lecturer in Pediatric Nursing, College of  Public Health, Jimma University, Jimma, Ethiopia

 

ABSTRACT:

In developing countries, is facing an accelerating demographic switch to non-communicable diseases. In the cities congenital malformations and genetic disorders are important causes of morbidity and mortality. Due to the high birth rate in India a very large number of infants with genetic disorders are born every year almost half a million with malformations and 21000 with Down syndrome. Cord blood contains stem cells, which have the ability to generate new tissue in the body. They are the building blocks of various organs and tissues in the body and have the remarkable potential to develop into many different cell types in the body. Serving as a sort of repair system for the body, they can theoretically divide without limit to replenish other cells as long as the person or animal is still alive. While a stem cell divide, each new cell has the potential to either remain a stem cell or become another type of cell with a more specialized function, such as a muscle cell, a red blood cell.

 

 

 

INTRODUCTION :

The fetus gets its nutrition for survival from mother through umbilical cord¹. The placenta which is attached to womb supplies the essential nutrients to fetus for its growth and development. Umbilical cord acts as a bridge between both mother and fetus. Umbilical cord blood is a blood that remains in the placenta and is attached to umbilical cord after birth². Umbilical Cord Blood, which provides fetus vital activity in course of intrauterine development usually is utilized (i.e. eliminated) after child birth³.

 

In developing countries, is facing an accelerating demographic switch to non-communicable diseases. In the cities congenital malformations and genetic disorders are important causes of morbidity and mortality.

 

Due to the high birth rate in India a very large number of infants with genetic disorders are born every year almost half a million with malformations and 21000 with Down syndrome⁴.

 

Cord blood contains stem cells, which have the ability to generate new tissue in the body. They are the building blocks of various organs and tissues in the body and have the remarkable potential to develop into many different cell types in the body. Serving as a sort of repair system for the body, they can theoretically divide without limit to replenish other cells as long as the person or animal is still alive. While a stem cell divide, each new cell has the potential to either remain a stem cell or become another type of cell with a more specialized function, such as a muscle cell, a red blood cell⁵.

 

DEFINITIONS AND MEANING:

Umbilical Cord Blood is blood that remains in the placenta and in the attached umbilical cord after childbirth. Cord blood is obtained from the umbilical cord at the time of childbirth, after the cord has been detached from the newborn⁶.

 

Fig 1: Above fig representing the site of collection of blood for cord blood sampling

 

Stem Cells : are the specialized cells which are able to regenerate new tissues in the body⁶.

 

Fig 2: Above fig representing the types of cells in cord blood

 

Methods Of Cord Blood Collection:

Cord blood collection is painless procedure. It takes just 5 to 10 minutes to collect cord blood after the baby is born and the umbilical cord has been clamped and cut.

 

There are two methods for collecting cord blood. The methods are:

·      Syringe method

·      Bag method or “closed techniques⁷”

 

1. The Syringe Method:

 

Fig 3: Above fig representing the site of collection of blood for cord blood sampling

With the Syringe method, the caregiver also waits for the umbilical cord to stop pulsating before clamping and cutting it. Then, similar to the procedure used for a simple blood draw, an empty syringe is used to extra blood from the placenta and remaining cord. In either method, the bag/syringe is pre-marked with a number specially coded to the baby. The collection must occur within the first fifteen minutes after birth. The laboratory should process the cord blood sample within two days. The collection procedure should not interfere with birth or later bonding and can be performed after both cesarean sections and vaginal births⁷.

 

2. The Bag Method:

 

Fig 4: Above fig representing the storage bags of cord blood. 

 

With the Bag Method, the caregiver first waits for the umbilical cord to stop pulsating (usually less than 5 minutes for a natural delivery and up to 15 minutes for a medicated birth, including cesarean section), then clamps the cord and cuts it. Once this is completed, the placenta and cord are elevated, using the force of gravity to drain the blood from the placenta into the bag⁷.

 

Most commonly used in clinical practice is the “closed technique”, which is similar to standard blood collection techniques. With this method, the technician cannulates the vein of the severed umbilical cord using a needle that is connected to a blood bag, and cord blood flows through the needle into the bag. On average, the closed technique enables collection of about 75 ml of cord blood⁸.

 

Collected cord blood is cryo preserved and then stored in a cord blood bank for future transplantation. A cord blood bank may be private i.e. the blood is stored for and the costs paid by donor families or public i.e. stored and made available for use by unrelated donors. While public cord blood banking is widely supported, private cord banking is controversial in both the medical and parenting community⁹.

 

 

STUDIES RELATED TO BENEFITS OF STEM CELLS COLLECTION:

There are many studies conducted in the field of stem cell collection and their benefits in young and elderly ages, some studies An experimental study was conducted to investigate uses of cord blood stem cells among 500 neonates having leukemia, underwent transplantation for about a month. The results predicted that about 60% of the neonates had good progress and 20% were coping with the treatment and 20% of them were having minimal complications. It was concluded that cord blood stem cells have great ability to treat leukemia¹⁰.

 

A study conducted to know the effectiveness of Umbilical cord blood transplantation in Wiskott Aldrich syndrome (WAS).3 children with WAS received unrelated umbilical cord blood stem cell transplantation after a preparative regimen for the treatment of combined immunodeficiency diseases. The patients ranged in age from 1.9 to 7.9 years. The cord blood units were 4/6 HLA antigen matches in 2 children and 5/6 in 1 child, with molecular HLA-DR match in all 3 children. The result indicated neutrophil engraftment (ANC >500/mm³) was 11 to 16 days, and the average time for platelet engraftment was 36 to 49 days. 1 patient had no evidence of GVHD, 1 patient grade I, and 1 patient grade II. No patient had chronic GVHD. The patient with grade II GVHD also had gut involvement. Immunologic reconstitution demonstrated that cord blood stem cell transplantation resulted in consistent and stable T-, B-, and NK-cell development. Functional B-cell antibody responses revealed that 2 of the patients in whom IVIG has been discontinued had low detectable antibody responses to tetanus and diphtheria toxoid immunizations at 18 to 24 months after transplantation¹¹.

 

A study was conducted to compare outcomes in 682 adults with acute leukemia who received a hematopoietic stem-cell transplant from an unrelated donor. 98 samples received cord blood and 584 received bone marrow. The transplantations were performed. The results revealed that; recipients of cord blood were younger than recipients of bone marrow (median, 24.5 vs. 32 years of age; P<0.001), weighed less (median, 58 vs. 68 kg; P<0.001), and had more advanced disease at the time of transplantation (52 percent vs. 33 percent, P<0.001). All marrow transplants were Human Leukocyte. Antigen matched, whereas 94% of cord-blood grafts were Human Leukocyte. Antigen mismatched (P<0.001). Multivariate analysis showed lower risks of grade II, III, or IV acute graft-versus-host disease (GVHD) after cord-blood transplantation and hence the study confirms that, cord blood from an unrelated donor is an alternative source of hematopoietic stem cells for adults with acute leukemia who lack Human Leukocyte Antigen -matched bone marrow donor¹².

A study was conducted on use of cord blood stem cells for transplantation in thalassemic patients in Thailand. Stem cells for transplantation, was successfully transplanted into patients with several diseases after myeloablative therapy. 20 cord blood samples from unaffected neonates whose siblings had severe thalassemia were collected. The median volume was 80 ml. The median number of cells and colony forming units-granulocyte-macrophage in cord blood was 9.2 x 10(8) and 3.4 x 10(5), respectively. Four of 20 cord blood samples had HLA-matched to the affected siblings. One patient underwent cord blood transplantation with success; one patient is waiting for transplantation¹³.

 

LABELLING OF CORD BLOOD:

At the completion of collection, the primary collection container should bear, at a minimum, sufficient information to identify the product, the source and destination, the donor and recipient (if known), recommended conditions for storage and transportation, and product characteristics such as anticoagulant used¹⁴.

 

PROCESSING AND STORAGE METHODS:

Processing of cord blood should commence within 48 hours of collection. Pre-processing cord blood storage temperature is maintained at between one degree Celsius and ambient temperature, depending on methods used. After processing, cells should be stored within a temperature range of minus 196 degrees Celsius to minus 80 degrees Celsius. If the storage period exceeds one year, cells should be stored at a temperature of less than minus 130 degrees Celsius. Cells are stored continuously in either a mechanical freezer or liquid nitrogen tank equipped with an audible alarm. Usually 75ml of cord blood is required for storage and can be stored upon 21 years¹⁵.

 

COLLECTION AND STORAGE VESSELS:

Cord blood should be collected and stored in vials, bags, or other containers approved for crypreservant of hematopoietic progenitor cells or validated by the cord blood bank to maintain viability¹⁵.

 

HLA MATCHING:

HLA or human leukocyte antigens are the proteins that control tissue compatibility. The closer the match, the less risk of a potentially fatal condition called GVHD or graft-versus-host diseases (also called rejection) . There is no risk of GVHD when a child receives his or her own cord blood. Within family, there is a high probability of matching a sibling or parent, 75% for sibling and 50% for parents. Outside the family, the situation is much different. HLA antigens are highly polymorphic, with hundreds of different HLA antigens found in the human population one of the best chance of providing a match for family is to bank baby’s own cord blood¹⁶

 

DISEASES TREATED BY CORD BLOOD:

Today, nearly 80 pediatric diseases and conditions are routinely being treated with cord blood stem cells, including hemopoietic and genetic disorders other includes

·      Cancers  - Ex:  Acute and chronic leukemia

·      Blood disorders  - Ex: Fanconi anemia and sickle cell anemia

·      Immune Disorders – Ex: chronic granulomatous disease, leukocyte adhesion deficiency.

·      Inherited immune system disorder – Ex: congential neutropenia , leukocyte adhesion deficiency.

·      Other inherited disorders – Ex: osteopetrosis

·      Metabolic disorder – Ex: Krabbe disease, hurler syndrome

·      Myelodysplastic syndrome – Ex: refractory anemia 

·      Lymphomas – Ex: Hodgkin’s  and non Hodgkin’s

·      Current research in regenerative medicine has shown successful results in treating diabetes, cerebral palsy, spinal cord injuries and heart disease.

·      The potential for future treatments using cord blood stem cells is infinite

·      Fanconi’s anemia was first treated at Paris by Elaine Gluckman

·      Currently 400 – 500 children are receiving cord blood transplantation annually.

·      Current studies are evaluating the effects of using cord blood stem cells to treat diabetes, cerebral palsy, spinal cord injuries, heart disease and more.

·      Current research has revealed positive results in the treatment of a wide variety of different medical conditions including ischemic heart disease, cancer, spinal cord lesions, bone fractures, burns, strokes, multiple sclerosis, Alzheimer's disease, Parkinson's disease, Huntington’s disease and diabetes.

·      Other research into its use in regenerating organs, repairing damaged muscle tissue and tendons and helping create skin grafts for burns.

·      India succeeded in treating Type 1 diabetes mellitus¹⁷

 

SUMMARY:

Cord blood is defined as blood contained within the umbilical cord and blood in the contiguous placental circulation. Collection of cord blood for the purpose of harvesting stem cells should be performed in manner which would not alter the delivery of the infant; would not increase the likelihood of any adverse reaction in the infant or mother; and/or would not preclude appropriate medical management of the infant or mother, including collection of cord blood diagnostic specimens. Cord blood collection should be performed by staff with documented appropriate training, experience, and proficiency in the technique utilized. Health professionals with experience in venipuncture, infection control, and handling of biohazardous material (e.g. physicians, nurses, licensed midwives or bone marrow technicians) should receive training sufficient to perform the procedure. Other health professional staff will require additional training.

 

CONCLUSION:

Storing cord blood as biological insurance is vital and new trend in treating genetic disorders and a new hope for the people who are suffering with diseases. Nurses should have adequate knowledge on collection and storage of cord blood stem cells and educate parents

 

REFERENCES:

1.     Umbilical cord. From Wikipedia, the free encyclopedia. Available from:   http://en.wikipedia.org/.

2.     Rubinstein P .Why cord blood? Human Immunology. Epub 2006 June; 67(6): 398-404.

3.     Elizabeth B. Hurlock. Child Growth and Development.5^th Edition 2006.Tata Mc. Graw-Hill Edition. Pg.no.1 and 17.

4.     Verma I C. Indian Journal of  Pediatrics. 2001 Jan 68(1):25 Available on : http://www.ncbi.nlm.nih.gov/ pubmed/11262988.

5.     Stem cells: Life`s Building Block. Available from:  www.cryo-save.com.

6.     http:/en.wikipedia.org/ wiki/cord blood.

7.     http:/pediatrics.about.com/od/a grand stages/cord- blood-bank.htm.

8.     Path Care Labs Launches ‘Cord Care’ – cord blood stem cell bank in India. 2010 January 28; 16: 59.

9.     Banking Your Newborn's Cord Blood. 1995-2010 The Nemours Foundation. Available from: http://kidshealth.org/parent/ cancer center/treatment/cord blood.html.

10.   Ravindranath Y, Chang M, Steuber CP, et al. Pediatric Oncology Group (POG) studies  of acute myeloid leukemia (AML): a review of four consecutive childhood AML trials  Leukemia.2005;19 :2101– 2116.Available from: http://www.nature.com/leu/journal /v19/n12/abs/2403927a.html.

11.   Kernan N. Schroeder  et al. Umbilical cord blood infusion in a patient for correction of  Wiskott-Aldrich syndrome. Available from:http://www. ncbi.nlm.nih.gov/pubmed/ 7749101.

12.   Rocha V. Myriam L et al. Transplants of umbilical- cord blood or bone  marrow from   unrelated donors in adults with acute leukaemia. Journal of Medicine (2004) Volume: 351, Issue: 22, Publisher: Mass Med Soc, Pages: 2276-2285 Available  from:  http://www.mendeley.com/research/research/transplants-of umbilical cord-blood- bone-marrow-from unrelated donors-in adults-with-acute-leukemia.

13.   Issaragrisil S, Visuthisakchai S, et.al.Stem Cells. Collection of cord blood stem cells for transplantation in thalassemic patients. 1995 Dec;13 Suppl 3: pg.no.71-5. Avaliable from : http :// www. ncbi.nlm.nih.nlm.gov/                pubmed?term=Collection%20%ofcord%20blood%20stem %20cells% 20for%20transplatation.

14.   Whaley and Wong’s “Nursing care of Infants and children” 5th edition 1997, page no: 980.

15.   Editorial in “Indian express”, oct 2010.

16.   http:/www.dancewithshadow.com/pillscribe/pathcare-labs.

17.   Method of collection. Available from .http:/theonologist. alphamedpics.org/cgi/ful/215134017.

 

 

 

 

 

Received on 06.03.2017           Modified on 02.05.2017

Accepted on 09.08.2017        © A&V Publications all right reserved