Parents raise questions about the quality of their childrens' stem cells
Parents often worry about the success of stem cell collection and storage and ask why their child's stem cell collection may not be successful.
The reasons for failure are quantitative and qualitative. The quantitative reasons include the small collection of umbilical-placenta blood in the delivery room, due to the conditions of the delivery and the construction of the placenta. The gynecologist in the delivery room collects a quantity of blood while the placenta is in the uterus. Rapid delivery, caesarean section and the more serious complications are reasons for a small collection, while the rest of the blood remains in the placenta, as long as the gynecologist closes the umbilical cord.Then there may be a 2nd collection of umbilical cord blood with the placenta outside the uterus, to collect the whole blood. The total capacity of the placenta is 150 cm3, which can be collected entirely by these two collection procedures.
Placental blood contains two types of stem cells, those that appear in the 1st trimester and those that appear in the 3rd trimester. The stem cells of the 1st trimester are the most primitive and pluripotent, with many similarities, but also important differences, with the embryonic stem cells and are the first stem cells of the organs.They appear in the 2nd week of fetal development, circulate in the blood of the placenta and are also present in the tissue of the umbilical cord. Their number remains constant in the organs and these stem cells constitute the regenerative potential of the organs. These cells are affected by aging and senescence is responsible for organ failure and death. These stem cells preserve fertility in patients undergoing chemotherapy. Today, hematopoietic stem cells are created from these stem cells, to enhance hematopoiesis, liver and heart cells in order to treat the failure of the respective organs in the future, and eggs and spermatozoa are also experimentally created to deal with infertility.
In the 3rd trimester of pregnancy, hematopoietic stem cells appear, which have a limited ability to differentiate, as they appear towards the end of pregnancy. They form blood and vessels and for this reason are used in the treatment of malignant diseases and in the treatment or prevention of cerebral palsy in newborns. Hematopoietic stem cells settle in the bone marrow and renew the blood, in cases of normal renewal or recovery after bleeding. Hematopoietic stem cells are used in gene therapies of inherited diseases. The stem cells of the 3rd trimester, as the last to appear, do not have the capacity for cell proliferation, they are used in doses according to the patient's weight and for this reason it is of particular importance to collect all the blood that remains in the placenta.
Quality reasons include contamination by microbes and viruses. The rate of microbial contamination has recently been reported to be around 10% and depends mainly on the route of administration. The antisepsis of the area of the umbilical cord, where the puncture is made, is essential for obtaining aseptic stem cells. In most cases the infection is caused by genital saprophytes which are treated by taking standard antibiotics and stem cells are used in the classical treatments.Only sterile stem cells are used in clinical studies, and for this reason obtaining sterile samples is important. In family care, the preservation of infected samples is allowed in cases where the microbe belongs to the usual microorganisms of the vaginal flora, has been identified and the antibiotic sensitivity test has been done. The virological test is done in the mother's blood initially and as long as a virus is found, the test continues with a molecular method (pcr) at the placenta blood. If a virus is detected in the OPA, the sample will be rejected.
All quality control in our country is controlled by the National Accreditation System (ESYD) and the international organizations AABB (Association for the Advancement of Blood and Biotherapies) and FACT (Federation of Accreditation for Cellular Therapies), the latter two are based in the USA . For this reason parents should always in their research on choosing a stem cell bank consider whether the bank has the highest level of accreditation. Because only then they will be sure of the quality of their children's stem cells and their stem cells will be able to be used for treatments in Transplantation Centers whether they are in Greece or abroad and even with insurance coverage. The law in Greece provides for FACT to be received within 4 years from the 1st licensing, according to the new Terms and Conditions. For this reason parents should consider whether the company is in the time slots for receiving FACT and be informed about the timing of the download. Today in our country there are banks for which the time limit has expired, others have not submitted never applied for accreditation and the legality of their operation is being investigated by the Ministry of Health. The banks in question do not even meet the basic requirements of accreditation by the ESYD.
Today the FDA has licensed the use of OPA for 80 diseases. In 2023, 800 children were treated using their own stem cells, while in the same year 590 children received stem cells from siblings. The chance that a child under the age of 20 will use their stem cells for one of 80 diseases is 3/5000 in the US. The most common use of OPA today in the US is for the treatment of prematurity and cerebral palsy newborns and children, and indeed with an increase in the age of treatment. For the gene therapy of rare diseases, placenta blood is the best source of obtaining stem cells, in exclusive autologous use. In a 2008 study the probability of using stem cells by the age of 70 was 1/2177, while from 2001-2003 it was 1/217, or 10% of children who would be in need had stem cells.