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Cord Blood Stem Cells

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What makes this cell special ?
Plasticity, ability to differentiate
Ability to divide continuously
Immunological immaturity

Published in: Health & Medicine
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Cord Blood Stem Cells

  1. 1. Iraq - Erbil 2013 Marwan Alhalabi MD PhD Professor in Reproductive Medicine Faculty of Medicine Damascus University And Medical Director Orient Hospital Assisted Reproduction Center Damascus – Syria Andalus University 2015
  2. 2. 1 – THE RIGHT GROWTH FACTORS 2 – THE RIGHT RECEPTORS 3 – THE RIGHT NUTRIENTS
  3. 3. • Plasticity, ability to differentiate • Ability to divide continuously • Immunological immaturity “Self renewal” “Stem cell” “Progenitor cell” “TA cells” “Differentiated cells” Differentiation Pluripotency
  4. 4. REPROGRAMMINGDEPROGRAMMING
  5. 5. CREATE THE FIRST iPS (2007) 8 MELTON YAMANAKA AUGUST 2008 BETA CELL NOT PRODUCING INSULIN TO ONE THAT PRODUCES INSULIN ** NO STEM CELLS ** REPROGRAMMING
  6. 6. Multipotent Stem Cells Potency
  7. 7. Stem cell type Description Examples Totipotent Each cell can develop into a new individual Cells from early (1-3 days) embryos Pluripotent Cells can form any (212) cell types Some cells of blastocyst (5 to 14 days) Multipotent Cells differentiated, but can form a number of other tissues Fetal tissue, cord blood, and adult stem cells Unipotent Cells differentiated, into one cell lines Neural Stem cells, etc..
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  9. 9. Embryo Splitting
  10. 10. Embryo Splitting 6-cell embryo splitting
  11. 11. • Embryonic stem cells Derived from the blastocyst, which is a very young embryo shaped like a hollow sphere that contains 200- 250 cells (pre-implantation embryos)1 • Adult stem cells Misnomer, can be found in children and infants too Derived from the umbilical cord and placenta, or from blood, bone marrow, skin, or other tissues
  12. 12. ICM Trophectoderm
  13. 13. ICM isolation culture Feeder cells hESC colony Culture
  14. 14. mechanical passaging Cystic EB formation 7-10 days of culture Gelatin-coated dishes (endoderm) (ectoderm) (mesoderm)
  15. 15. Adult stem cells Umbilical CordIVF Embryos Placenta Aborted fetus
  16. 16. • Bone marrow • Peripheral blood • Umbilical cord blood (since 1988) • Placenta (LifebankUSA) • Peripheral Blood
  17. 17. • Wharton’s jelly. • Differentiate into: adipocyte, chondrocytes, osteoblasts, myocytes, endothelial cells, hepatic, and nervus cells. • Role in regenerative medicen.
  18. 18. • >13 folds in prolifertion. • Fibroblast-like. • Having immunomodulatory potential: Application in treatment of autoimmune deseases ( Rheumatoid arthritic and crohn’sdesease and Multiple sclerosis.
  19. 19. The blood that is left in the umbilical cord and placenta after the delivery of the infant
  20. 20. Garbage Can Public Banking Private Banking Cord Blood what to do with it?
  21. 21. Option Advantages Disadvantages The Garbage can •No cost •No headaches •Wasting of valuable stem cells Public cord blood banking (donation) •Can be used by anyone in need •Increases the pool of HSC donors •Increases the pool of minority donors •No cost to the donor •Needs public/government financial support •Not designated for the donor / family Private cord blood collection •Saved for own use •Future potential ??? Regenerative use ?? •Cost $$$ •Will probably never be used •Socioeconomic disparity •Reducing public pool •Professional liability •Legal/ownership issues •Safety of use •Viability, duration of storage
  22. 22. • Rich in hematopoietic stem cell. Pluripotent stem cell?? • Younger cells. Longer life span • Less GVHD when used for allogeniec transplant • Immediate easy availability • Less likely to be contaminated with viruses. • 100% Compatible graft for the child. • Not painful. • Could be used in conjunction with future medical advance.
  23. 23. Stem Cell Donor Registries Need Help! • Both bone marrow and cord blood donors are needed world wide. • Arab HLA types are severely under represented on International Stem Cell Registries. § Today the world registries are where UAE patients find stem cell donors. On the International Registries Arab populations are <1%.
  24. 24. Criteria for Donor Eligibility 1. informed consent. 2. Absence of family History of inherited diseases and negative history for Hepatitis B, hepatitis C and HIV antibodies. 3. Obstetric criteria: 1. Gestation ≥ 34 weeks. 2. Rupture of membranes < 12 hrs 3. Absence of maternal fever intrapartum 4. Absence of congenital abnormalities .
  25. 25. Insert needle close to cord blood clamp. Gravity or syringe. Collect a minimum of 40ml (incl. anticoag.). Collection time: 2-5 minutes. Collection of cord blood
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  27. 27. 41
  28. 28. • Depends on kind of twin pregnancy • If 2 separate sacs, can be collected after each twin is born • If 1 sac, collect only AFTER the birth of the second twin
  29. 29. • Mother: • Hepatitis B,C • HIV, HTLV • CMV • RPR. • Antibody screen • Baby: • ABO/RH typing • Total nucleated cells • CD34+ cell count • Bacterial and fungal cultures • Trypan Blue viability. • HLA
  30. 30. Bone Marrow Qty of harvest larger Engraftment faster GVHR 75% Contamination more Tedious collection Longer time to find donors HLA typing –5/6 or 6/6 Limited supply Cord blood Harvest quantum less Engraftment takes longer GVHR 38% Less contamination Simple collection Donor search time –halved HLA match –3/6 or 4/6 Limitless supply
  31. 31. ü 1958 – HLA typing ü 1988 – First reported cord blood transplant in France to cure fanconi Anemia ü 1992 – international Cord Blood transplant registry founded. ü 1996 – First unrelated cord blood transplant at Tata Memorial Hospital, Bombay. ü 2007 – First Collection of UCB in ORIENT HOSPITSL – Syria (OCBB)
  32. 32. • Use of umbilical cord blood stem cells is growing every year. • 30,000-40,000 transplants performedyearly worldwide. • >20,000 patients have survived >5 years Lazarus HM. Autologous and allogeneic transplantation procedures for hematologic malignancies. Manual of Clinical Hematology, 3rd edition 2002:399-409
  33. 33. • Cancer • High risk • Relapse • Bone marrow failure • Immunodeficiency • Hemoglobinopathy • Thalassemia • Sickle cell disease • Aplastic anemia • Metabolic/Genetic disorders • Autoimmune disorders • Cellular repair (regenerative medicine)?
  34. 34. 1. Define the problem 2. Find the right type of stem cell 3. Match the stem cells with the transplant recipient 4. Put the stem cells in the right place 5. Make the transplanted cells perform
  35. 35. Current Stem Cell Applications Acute Leukemias Acute Biphenotypic Leukemia Acute Lymphocytic Leukemia (ALL) Acute Myelogenous Leukemia (AML) Acute Undifferentiated Leukemia Chronic Leukemias Chronic Lymphocytic Leukemia (CLL) Chronic Myelogenous Leukemia (CML) Juvenile Chronic Myelogenous Leukemia (JCML) Juvenile Myelomonocytic Leukemia (JMML) Myelodysplastic Syndromes Amyloidosis Chronic Myelomonocytic Leukemia (CMML) Refractory Anemia (RA) Refractory Anemia with Excess Blasts (RAEB) Refractory Anemia with Excess Blasts in Transformation (RAEB-T) Refractory Anemia with Ringed Sideroblasts (RARS) Stem Cell Disorders Aplastic Anemia (Severe) Congenital Cytopenia Dyskeratosis Congenita Fanconi Anemia Paroxysmal Nocturnal Hemoglobinuria (PNH) Myeloproliferative Disorders Acute Myelofibrosis Agnogenic Myeloid Metaplasia (Myelofibrosis) Essential Thrombocythemia Polycythemia Vera Lymphoproliferative Disorders Hodgkin's Disease Non-Hodgkin's Lymphoma Prolymphocytic Leukemia Plasma Cell Disorders Multiple Myeloma Plasma Cell Leukemia Waldenstrom's Macroglobulinemia nPhagocyte Disorders Chediak-Higashi Syndrome Chronic Granulomatous Disease Neutrophil Actin Deficiency Reticular Dysgenesis nLiposomal Storage Diseases Adrenoleukodystrophy Gaucher's Disease Hunter's Syndrome (MPS-II) Hurler's Syndrome (MPS-IH) Krabbe Disease Maroteaux-Lamy Syndrome (MPS-VI) Metachromatic Leukodystrophy Morquio Syndrome (MPS-IV) Mucolipidosis II (I-cell Disease) Mucopolysaccharidoses (MPS) Niemann-Pick DiseaseSanfilippo Syndrome (MPS-III) Scheie Syndrome (MPS-IS) Sly Syndrome, Beta-Glucuronidase Deficiency (MPS-VII) Wolman Disease Histiocytic Disorders Familial Erythrophagocytic Lymphohistiocytosis Hemophagocytosis Histiocytosis-X Langerhans' Cell Histiocytosis Inherited Erythrocyte Abnormalities Beta Thalassemia Major Blackfan-Diamond Anemia Pure Red Cell Aplasia Sickle Cell Disease Congenital (Inherited) Immune System Disorders Absence of T & B Cells SCID Absence of T Cells, Normal B Cell SCID Ataxia-Telangiectasia Bare Lymphocyte Syndrome Common Variable Immunodeficiency DiGeorge Syndrome Kostmann Syndrome Leukocyte Adhesion Deficiency Omenn's Syndrome Severe Combined Immunodeficiency (SCID) SCID with Adenosine Deaminase Deficiency Wiskott-Aldrich Syndrome X-Linked Lymphoproliferative Disorder Inherited Platelet Abnormalities Amegakaryocytosis / Congenital Thrombocytopenia Other Malignancies Brain Tumors Breast Cancer Ewing Sarcoma Neuroblastoma Ovarian Cancer Renal Cell Carcinoma Small-Cell Lung Cancer Testicular Cancer Autoimmune Diseases Evan Syndrome Multiple Sclerosis (Experimental) Rheumatoid Arthritis (Experimental) Systemic Lupus Erythematosus (Experimental) Other Inherited Disorders Cartilage-Hair Hypoplasia Ceroid Lipofuscinosis Congenital Erythropoietic Porphyria Glanzmann Thrombasthenia Lesch-Nyhan Syndrome Osteopetrosis Tay Sachs Disease Potential Future Stem Cell Applications* Alzheimer's Disease Diabetes Heart Disease Liver Disease Muscular Dystrophy Parkinson's Disease Spinal Cord Injury Stroke
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  38. 38. Adult cord blood stem cells injected into the hearts arteries are believed to improve cardiac function in victims of heart failure or heart attack.
  39. 39. • Regenerate spinal cord or any other major tissue in the body.
  40. 40. • Studies show leukemia patients treated with stem cells emerge free of disease. • Injection of stem cells have also reduced pancreatic cancer in some patieents.
  41. 41. Stem Cell and Dermatology 57
  42. 42. ParkinsonLiver cirrhosis Diabetes
  43. 43. Future Potential of Stem Cells
  44. 44. • Probably indefinitely. At least 10 years.
  45. 45. Why do families choose to collect and store their baby’s cord blood? Once – in- a- lifetime opportunity – only at birth
  46. 46. • Our estimates : (for self, for cancer): 1 in 2000 • Cord Blood RegistryR: • For self: 1 in 400 • For other family members: 1 in 200
  47. 47. It’s better to have them and not need them , Than need them and not have them .
  48. 48. Acknowledgement Clinical Team S. Samawi N. Kafri S. Modi M. Mousa IVF Lab J. Sharif R. Doghoz A. Kadri A. Konali Fetal Med. A. Taha M. Khalaf M. Hazemah Andrology Lab W. Hamad N. Assaf M. Othman N. Mazzawi S. Sheko Bio-Ginitic Lab H. Droubi A. Khatib M. Kinj A. Othman Administration F. Hamad R. Qamar M. Haj hasan N. Olabi E. Fayad W. Saker Med Engineering Y. Khabori S. Khayat Anesthesia R. Tarko Y. Lakkis M. Khadra H. Sulaiman

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