Storing Cord Blood - Can We Evaluate Today the Clinical Potential?

To better evaluate the future benefits of storingreceives cells from another donor, which may be
cord blood cells, it is imperative to understand thefound for example in the public cord blood banks).
present knowledge of its clinical utilization. Every day,For many, but not for all, hematological malignancies,
new studies are published, describing the potential ofit is better to use allogeneic transplant since the anti
cord blood cells to treat various diseases. How do wetumor effect seems to be stronger in such
know that a certain scientific claim regarding thecombination. If so, why should one store his baby's
clinical benefit of any technology is valid? The ultimatecells? The answer is that for BMT indications, the
proof for any claimed benefit is its approvedcord stem cells can be used for family members as
utilization by regulatory agency such as the FDA.well. In this case, the allogeneic combination, together
However, the road to obtain such approval is longwith the other advantages of cord blood cells, make
and costly.it worth storing and using if necessary. In addition, a
Nonetheless, preliminary results in clinical studies, orsuitable donor is not always easy to find, and thus,
even prove of concept in animal disease models, maythe stored autologous cells present in such case a
provide a good indication on future potential ofgood alternative.
certain technology, if taken with caution. In this longThe most promising future utilization of cord blood
road of proving clinical effectiveness, the earliercells are for the second category of clinical indications,
stages of research are usually experiments carriednamely for tissue regeneration. This category covers
out in test tubes, or "ex vivo", as termed fornumerous deteriorating and life threatening diseases
biological activities tested in artificial laboratory setup.such as osteoporosis, Alzheimer's disease, cardiac
Except for bone marrow transplantation (BMT), mostfailure, muscle degeneration diseases, severe hepatitis
of the claims attributing potential clinical benefit toand many other diseases for which there are
cord blood cells are based today on these very earlynumerous treatments, but no effective cure. The
stages of test tube studies. This does not diminishstem and progenitor cells that are found in cord blood
the validity of such scientific data, but should be parthave the potential to regenerate damaged tissues
of the considerations in any investment that anand thus present new emerging alternative to treat
individual would like to commit.such diseases.
Clinical utilization of cord blood cells may be dividedIt should be emphasized however, that today, most
into two major categories. The first is regenerationof the studies demonstrating promising results were
of ablated bone marrow, and the second isperformed only in test tube or experimental animals'
regeneration of many other tissues which arelaboratory models. Very few have gone through
affected by numerous diseases. The first, boneregulatory pathway of clinical development and non
marrow transplantation (BMT), which is the use ofhave yet been approved by FDA. We can also learn
stem and progenitor blood cells to rebuild theabout the potential of cord blood stem cells from
damaged tissue responsible to produce all the bloodstudies performed with adult stem cells obtained
cells in our body. BMT is widely used today forfrom other sources such as bone marrow, peripheral
treatment of hematological malignancies. The secondblood, fat tissue and others. Taking together, the
category is a broad range of diseases which occurpotential of stem cells for treating many deteriorating
more frequently in elderly people, and are associatedconditions and diseases is overwhelming, but the real
with degeneration and malfunction of tissues such asprove for their effectiveness will come from clinical
heart, liver, blood vessels, bone, neural cells andstudies, and is only in its very beginning.
others. It is believed that this category of diseasesIf we consider specifically cord blood, it has been
would be amenable to treatment with living cells, andshown recently that in addition to blood stem cells,
especially with stem cells, an approach termedthe cord blood contain additional very potent cell
regenerative medicine.populations. Among them, cells like mesenchymal
Cord blood cells have been used in BMT for almostprogenitors that can turn into bone and cartilage, cells
two decades to replace other sources of stem cells,like endothelial progenitors that can form blood
such as bone marrow and mobilized peripheral blood.vessels, pluripotent cells that can turn into many
About 20,000 transplants were done with cord blooddifferent cell types, including muscle, nerves and
cells, compared to about 45,000 transplants doneinsulin producing cells. It was also demonstrated that
yearly worldwide using other cell sources. There arethe lymphoid cells of the cord blood can be used for
several limitations to cord blood, but on the otherimmunotherapy of malignant diseases. Additional
hand, there are also significant advantages. Theresearch and development, as well as clinical studies
limitations are gradually overcome today with thethat will probably take years are required to bring
introduction of new technologies such as expansionsuch promising laboratory results into clinical
of stem cells or using several cord units per patient.applicability. The clinical potential however is
Still, the question remains, how effective is aulologoustremendous, and increasing numbers of high quality
transplant (the patient receives his own cells);scientific publications are accumulating constantly, and
compared to allogeneic transplant (the patientpointing to the right direction.