Properties of Cord Blood
The growing interest in cord blood storage is underpinned by the value of two types of stem cells derived from cord blood – the blood forming hematopoietic stem cells (HSC) and the multipotent mesenchymal stem cells (MSC).
Hematopoietic stem cells (HSC) In the human body, new blood cells are constantly produced to replenish mature cells which are routinely lost and destroyed. This process of blood cell generation is called hematopoiesis and it takes place largely in bone marrow.
Historically, transplant of HSC is the most common treatment for blood cancer patients. There are three sources for collecting HSC for transplantation: bone marrow, peripheral blood, and cord blood. Before Broxmeyer discovered the hematopoietic property of cord blood, bone marrow transplants were most commonly used for the replenishment of blood cells.
To date, one half of all transplants from unrelated donors in children now use cord blood in the United States . In Japan, this is true for adults as well . Cord blood transplant not only provides an alternate option to bone marrow transplant, but more important, it has offered new hope for patients who had not been able to find a bone marrow match.
In recent years, MSC were reported to have been isolated from cord blood and expanded under specific conditions .
 “Cord blood can save lives” www.nationalcordbloodprogram.org (accessed 13 June 2007).
 Bieback K et al.(2004), Stem Cells. 22(4):625-34
Cord blood transplant is a treatment option to bone marrow transplant.
Since the clinical application of cord blood is a relatively recent phenomenon, there is no conclusive agreement yet on the comparative benefits of cord blood over bone marrow in HSC transplants. However, a number of observations, outlined in the table below, are generally accepted by the medical community.
|Bone Marrow/Peripheral Blood||Cord Blood|
|Donation requires surgery. Matched donors are hard to find, and even if they are found, only 1/3 can avail themselves to the hospital for the donation .||Collection of cord blood is painless and risk free, independent of the transplant operation. Once processed and HLA typing completed, the cord blood unit is ready for matching|
|Requires a perfect match of HLA for successful grafting.||Partial donor-recipient matching is possible in cord blood transplant although patients generally benefit from a higher matched cord blood unit. Because partial matching is viable, transplants to adults using multiple cord blood units were reported.|
|A higher chance of inducing graft-versus-host diseases (GvHD)  since stem cells harvested from bone marrow are more matured.||Less likely to induce a GvHD complication because the cord blood stem cells appear to be immunologically primitive.|
|More prone to virus infection, particularly those viruses which were dormant in the donor's body might become active and attack the patient when his/her immunity system is most vulnerable.||Cord blood stem cell is less likely to be exposed to virus infection.|
|Provides a large dose of stem cells and thus enables rapid engraftment.||Limited dose of stem cells and thus slower engraftment.|
In Hong Kong, in a retrospective study aimed at reviewing the outcome of unrelated umbilical cord blood transplantation in children using cord blood from the Hong Kong Red Cross, doctors had confirmed that “the outcome of which (umbilical cord blood transplantation) was comparable to that of bone marrow transplantation.” Depending on the disease and the patient's condition, cord blood transplant and bone marrow transplant may each have its own merits specific to the situation.
 "Cord Blood: A Solution for Bone Marrow Transplantation", http://www.nationalcordbloodprogram.org, (accessed 10 May 2007).
 GvHD stands for graft vs host disease which is a condition whereby the white blood cells from a donor attack the tissues of the recipient after a transplant.
 Laughlin, M.J. (2001). "Umbilical cord blood for allogeneic transplantation in children and adults", Bone Marrow Transplant. 27, 1–6.
Stem cell compatibility in HSC transplants
One of the major discoveries found during the initial bone marrow transplants was the human leukocyte antigen (HLA). The HLA is a type of antigen protein found on the cell surface. HLA mainly contains of six major antigens that are highly variable in the human population, therefore they are almost unique to each individual.
They are markers present on the outer surface of body cells, recognized by the immune system, to distinguish between self cell, pathogen-infected cell and foreign cell. A child inherits HLA antigens from both parents to form his/her own unique HLA typing. For a bone marrow transplant to be operable it requires a perfect match of HLA types between the donor and the recipient.
However, a partial match of only 4 pairs of antigen is sufficient for cord blood transplant.
|Example of search for compatible cord blood unit|
|HLA type||A1||A2||B1||B2||DRB11||DRB12||Matching result|
|Sample 2||*02CRFN||*11BDFZ||*15DJVP||*51DREH||*0803||*0406||Perfect match|
|Sample 3||*02ANDC||*11BDFZ||*1511||*3905||*0901||*14SXE||1/6 HLA match only|
|Sample 4||802ANJ||*11BDFZ||*40DGWB||*51DREH||*0803||*0406||4/6 HLA|
Bone marrow transplant：only sample 2 is suitable for transplant
Cord blood transplant：sample 2 and 4 are suitable for transplant.
The Functions of Cord Stem Cells
Cord blood stem cells vs. Cord tissue cells:
|Cord tissue cell||Cord blood stem cell|
|Type of stem cell||Mesenchymal stem cell
(create structural and connective tissue)
|Mesenchymal stem cell
(create structural and connective tissue)
|Usage||Repair damage organ such as: stroke, spinal cord injury||Blood Disorders such as: Aplastic Anemia, Fanconi’s Anemia, Sickle Cell Anemia Thalassemia|
Umbilical cord contains rich sources of Mesenchymal Stem Cells (MSCs).
Mesenchymal Stem Cells (MSCs)
MSC is a multipotent stem cell that can differentiate into a variety of cell types in the laboratory, including fat cells, cartilage, bone, tendon and ligaments, muscles cells, skin cells and even nerve cells .
Unlike other adult stem cells, MSC can be obtained in appropriate quantities for clinical applications, thus making it the perfect candidate for tissue repair .
 S Kadereit, “Adult Stem Cells” http://www.isscr.org/public/adultstemcells.htm, (accessed 20 June 2007).
Research & Clinical Uses
According to the National Cord Blood Program in the US, up till October 2011, their cord blood inventory alone has benefited a total of 83 different diseases. New clinical results are coming out literally every day.
Diseases commonly treated with cord blood transplant
|Malignancies||Acute Lymphoblastic Leukemia (ALL)
Acute Myelogenous Leukemia (AML)
Chronic Lymphocytic Leukemia (CLL)
Chronic Myelocytic Leukemia (CML)
Sickle Cell Anemia
|Immunodeficiency||Adenosine Deaminase Deficiency|
For More up to date information, please visit the websites of:
National Cord Blood Program at www.nationalcordbloodprogram.org
National Marrow Donor Program at www.marrow.org
Beike Biotechnology at www.beikebiotech.com
* Patient Statistics - 2,199 cord blood transplants worldwide using NCBP units (as of 9/30/06), http://www.nationalcordbloodprogram.org, (accessed 13 June 2009).
Diseases treated with cord transplant (Clinical trial status)
Ischemic Heart Disease
|Kidney||Acute Kidney Injury
In recent years, research in regenerative medicine is advancing and producing encouraging results. In a report published in Cytotherapy in August 2005, it was suggested that "human cord blood (UCB)-derived multipotent stem cells improved sensory perception and movement in the SPI (spinal cord injury) patient's hips and thighs within 41 days of cell transplantation."  The case examined a 37-year-old female patient suffering from SPI who had received a transplant of HLA-matched cord blood-derived multipotent stem cells direct into the injured spinal cord site and the finding was most encouraging: "it is suggested that UCB multipotent stem cell transplantation could be a good treatment method for SPI patients." 
In Feb 2006, the University of Minnesota Medical School announced they have discovered a new population of cells in human cord blood that have the properties of primitive stem cells. In other words, these cells have the potential to produce a greater variety of cell types. Laboratory research found that transplantation of these stem cells to rodents with experimental strokes resulted in "significant reduction in the size of the brain lesion."  The report also claimed "some of the transplanted stem cells developed into "neuron-like" cells that are typically found in the brain."
Treatment on Cerebral Palsy and Type 1 Diabetes Recently, the world’s largest private cord blood bank Cord Blood Registry (CBR) collaborated with the Duke University in US to conduct research on stem cell therapy to treat Cerebral Palsy (CP). In the research, scientists observed significant improvement in CP patents; speech and motor abilities in a few weeks after an autologous cord blood transplant. 
In another research project in the US, Type 1 Diabetes patients were invited to undergo autologous cord blood transplant to treat their conditions. Results indicated that patients were able to maintain a normal blood glucose level without the intervention of insulin injection after the transplant. This outcome suggested possible migration of the infused stem cell to the pancreas and restore the β–cell function necessary to produce insulin for regulating patients’ blood glucose level. 
 K-S Kang, SW Kim, YH Oh, JW Yu, K-Y Kim, HK Park, C-H Song and H Han (2005), "A 37-year-old spinal cord-injured female patient transplanted of multipotent stem cells from human UC blood, with improved sensory perception and mobility, both functionally and morphologically: a case study", Cytotherapy Vol. 7, No. 4, 368-373
 "Researchers Identify New Cord Blood Stem Cell: Discovery Suggests Potential Treatment For Regenerating Nerve Tissue After Stroke", press release issued by the University of Minnesota, 16 February 2006.
 David T. Harris, Stem Cell Rev (2008) 4:269-247
 Brusko T et al., Cell Biochem Biophys. 2007;48:165-175
|Hong Kong Medical Association|
|Hong Kong Medical Journal|
|Hong Kong Journal of Gynaecology Obstetrics and Midwifery
|Hong Kong Red Cross Centralized Cord Blood Bank
|Adipose stem cells
|Mesenchymal Stem Cells
13. Autologous immune enhancement therapy against an advanced epithelioid sarcoma: A case report (2013)
|Umbilical Cord Blood
|Umbilical Cord Blood Banking
|Umbilical Cord Mesenchymal Stem Cells|
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