Cord blood Banking

1. Cord blood Banking Module 1 Session 2

2. Today�s topics Multiple pregnancies What we know and don�t know about stem cells at the moment � Public / Family banking

3. Collection during multiple pregnancies 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

4. Multiple pregnancies Inter-villous circulation between twins can exist if only I sac is present Quadruplets As long as volume is sufficient, no problem Labeling is critical especially if non-identical twins Time of birth, birth weight, volume of collection Twin 1 and 2 or A, B and so on

5. Stem cell banking 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 Shorter telomeres 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 Longer telomeres

6. Disadvantages of UC Banking Quantity of stem cells less in harvest Rate of engraftment is slower Cord blood stem cells might harbour genetic mistakes. Can be collected just once in a person�s lifetime.

7. HLA typing of cord blood 3/6 or 4/6 match sufficient only in malignant conditions Perfect match preferable for non malignant conditions. If only 3 or 4/6 match present DR matching vital Likelihood of finding a CB donor match , more than a bone marrow match

8. Likelihood of HLA match Identical twin with same genetic complement - no match required Sibling of same parents � 1 in 4 chance of 100% match Parents � some degree of matching likely ANYONE ELSE IN THE FAMILY- no predictions possible - similar to unrelated donors

9. Studies on Viability Proceedings of the National Academy of Sciences, Broxmeyer and his co-author � study conclusions Human cord blood frozen in 1985 and 1986 was able to grow in laboratory cultures with the same vigour as fresh cord blood. Such cells frozen for a decade and a half can be used successfully to treat patients.

10. Factors vital for transplant success The number of cells per kilogram of the patient's body weight b) HLA match Conclusively proved by John Wagner's research.

11. What we know about stem cells Stem cells are attracted to the site of injury Stem cells can be injected in several ways Embryonic stem cells have a will of their own Adult stem cells need to be manipulated ex vivo Bone marrow stem cells less effective than cord blood stem cells � cell for cell as far as heamatopoietic properties

12. Some more known facts� Bone marrow has larger number of stem cells , hence engraftment is sooner, usually 2-3 weeks Cord blood stem cells take about double the length Post transplant period therefore critical with CB transplants � more care required

13. Umbilical cord � a treasure Outer lining � rich in epithelial and mesenchymal stem cells Wharton�s Jelly � rich in mesenchymal stem cells Cord blood � mainly heamatopoeitic stem cells, small amounts of mesenchymal stem cells

14. Homing and engraftment A study in the August 13 Science reveals that the inhibition or genetic deletion of the peptidase CD26 on donor stem cells increases transplantation efficiency. A clue to a way to expand stem cells came from the observation that inhibition of CD26�s peptidase activity on the molecule CXCL12, which is though to be involved in the homing of stem cells, might therefore increase stem cell homing and engraftment. Being studied in mice -Broxmeyer, lead author Kent Christopherson

15. Status of cord blood transplants Around 6000 transplants done world-wide Around 20 done in India (reported cases) 5 done in Chennai (Thalassemia and Leukemia)

17. Ongoing Research Identifying factors affecting homing and engraftment Cell expansion / ex vivo culture / �selective� cell differentiation techniques Fat stem cell differentiation into other cell types Olfactory Ensheathing cells (OEC) down differentiation

18. Distribution of banks world-wide Around 100 of which 75 are public banks 40 in US, 30 in the UK, 20 in Asia and 10 in Australia 2002

19. Cord Blood Banks in India Already existing in chronological order Reliance Life Sciences (2001)� Mumbai � Public mainly, private to a small extent-now increasing Cryo Stem Karnataka (2003)- Bangalore � Private mainly LC (2004) Chennai � ONLY one with franchisee model To come soon Histostem � tie up with Apollo (Public+Private) Indian govt at PGI Chandigarh (Public) Pacific Hospitals � Hyderabad (Singapore based) Public

20. Types of cord blood banks Public banks Use not restricted. No remuneration collected Usage subject to availability Private banks For use of the family Facility paid for by the family Availability guaranteed

21. Public Banking Form filling very critical � maternal history No anonymous donor collections Identity a must for follow up Recipient will not know the source of sample No remuneration given to donor

22. Public Banking contd� All samples positive for ANY test will be rejected Greater the rejection � greater the loss to bank 40% average rejections in a public bank Only public banking samples can be used for unrelated third party or for research

23. What LC plans to do Identify 2 / 3 hospitals, located fairly close to LC office to rush kits Educate the hospital personnel about form filling and informed consent If planned earlier- usual process followed � no fees collected If in the last minute � hospital must have at least 2 kits as standby

24. Public Banking at LC Different coding for Ids Sticker on cardboard box Plastic box inside will have a different lid colour HLA typing will be done immediately for all samples No reports to be sent to donor