We recently sat down with Susana Cantero Peral, M.D., Ph.D., and cord blood expert here at the Todd and Karen Wanek Family Program for HLHS. She provided some insight into the whole process of umbilical cord blood banking and how the cell-rich umbilical cord blood can possibly be used in the future to treat diseases.
Q: What is umbilical cord blood (UCB)?
A: After a baby is born and the umbilical cord is cut, the leftover blood that remains in the blood vessels of the placenta and in the portion of the umbilical cord attached to it, is known as umbilical cord blood (UCB). After birth, the baby no longer needs this extra blood.
UCB contains all of the normal elements of blood – red cells, white cells, platelets, and plasma. It is also rich in hematopoietic (blood-forming) stem cells, similar to the stem cells found in bone marrow. Because of that fact, UCB can be used to treat a number of different disorders including being used for bone marrow transplantation. So far, UCB has been used to treat more than 80 different diseases, with the most common being leukemia. Patients with other blood diseases (such as myelodysplasia, severe aplastic anemia, and lymphoma), inherited diseases of red blood cells, immune system diseases, and metabolic diseases have also been successfully transplanted with UCB. Most transplants have been performed using unrelated UCB units donated to public banks.
As of August 2016, an estimated 698,609 cord blood units have been stored (1) and nearly 40,000 UCB transplants have been performed worldwide since 1988 (2). Now, more UCB transplants have been carried out than bone marrow transplants.
Q: How can UCB be preserved, and how long can it last in order to retain its properties?
A: The blood from a newborn’s umbilical cord must be collected immediately after delivery and either preserved privately or publically for possible future use or for research. This process is known as UCB banking. Stored properly, UCB can last indefinitely.
Q: Where can I bank my baby’s UCB?
A: There are a few options to bank UCB.
Public banks: By donating your newborn’s UCB to a public bank, you make it possible for public use by an individual struggling with a disease or for research. This donation could help someone who needs a hematopoietic stem cell transplant. To find out more information, speak to your doctor.
Private banks: This is an option for parents who wish to preserve their newborn’s UCB for possible individual or familial use in the future. There are numerous private cord blood banks that charge a fee to collect and store UCB for private use. All of them have information available on their websites and can be contacted via the internet or phone for more information. Another way to access a private cord blood bank is through your OB/GYN. Parents will receive the UCB collection kit with instructions before the delivery and are responsible for bringing to kit with them at the time of delivery. Usually, once the baby is born, the company takes care of the logistics of the transport from the birth center to its laboratory.
Directed banks: These banks are intended for a specific purpose. The Todd and Karen Wanek Family Program for HLHS is one example of a directed bank. The program collects, processes and stores UCB from HLHS babies to be potentially used for regenerative purposes in the future. To learn more, contact the program at HLHS@mayo.edu.
Q: Who can use UCB if it is privately banked?
A: If UCB is privately banked, it could be used by the individual whose cord blood it is (known as autologous) or by a member of the donor’s family but most likely a sibling (known as allogeneic). There is up to a 25% probability of a perfect human leukocyte antigen (HLA) match with siblings. (HLA is a protein used to match donors for a transplant.)
Q: If I donated my child’s UCB to a public bank, can I access it if my child or family member needs it and it hasn’t been used yet?
A: Yes, you can access your child’s UCB if you need it; however, the chances of it being available decrease over time.
Q: Is publically banked UCB stored the same way as privately banked UCB?
A: Private UCB banks should meet the same standards, quality control, and accreditation requirements as those required for public UCB banks. However, the standards for public UCB banking and private UCB banking may differ in terms of maternal eligibility and nucleated cell count requirements. These factors may influence the overall quality of the stored UCB. The long-term viability of privately banked UCB cells is a concern as the UCB cells collected at birth may not be used forever. So far, UCB has been studied to be viable for up to 23 years after cryopreservation (3).
Q: Does UCB contain any other “special” cells or properties?
A: In addition to its use as an alternative to bone marrow for stem cell transplantation, UCB has recently been used in a variety of regenerative medicine applications. Some researchers have shown that UCB contains a mixture of stem cells capable of giving rise to any cell of the body.
Q: What do critics say about UCB?
A: UCB is widely used in transplant medicine as an alternative source of bone marrow hematopoietic stem cells since 1988. At that time, the potential for these cells was not known, and some hematologists and transplant physicians regarded the new source of stem cells as “science fiction.” Today it a proven treatment. In regards to UCB usefulness in the regenerative medicine field, although the use of non-hematopoietic and hematopoietic stem cells remains speculative, wide-ranging research efforts are underway worldwide.
Q: What do you think are the biggest misunderstandings about banking UCB?
A: Many people think that every UCB unit collected can be used for clinical purposes, and unfortunately, a high portion of these cord blood units do not meet the criteria to be kept for further use. In those cases, the UCB units are discarded or used for research purposes.
Regarding private UCB banking, many parents considering banking have been informed of the remote likelihood that UCB will be used for the donor child or another family member. It should, however, be noted that these considerations are based on current hematologic indications without taking into account the potential use of UCB in non-hematologic diseases. Several studies are exploring the possibility of treating infants with different conditions using autologous UCB. If current clinical trials are successful, UCB banking used for self or family members may become more and more cost efficient as new indications appear.
The Todd and Karen Wanek Family Program for Hypoplastic Left Heart Syndrome (HLHS) is a collaborative network of specialists bonded by the vision of delaying or preventing heart failure for individuals affected by congenital heart defects including HLHS. The specialized team is addressing the various aspects of these defects by using research and clinical strategies ranging from basic science to diagnostic imaging to regenerative therapies.