Hybrid cord blood banking in a private-public-partnership: Women's perspectives.

BACKGROUND: The increasing demand for umbilical cord blood (UCB) used in stem cell transplantation led to the establishment of cord blood (CB) banks worldwide. These include public foreign donor banks and private family-directed donor banks. Recently, our department has introduced a third banking model within a private-public-partnership. This hybrid banking allows for storage of family-directed CB units, while also getting Human leukocyte antigen (HLA)-typed and included in the national stem cell donor registry. So if the need arises, the HLA-compatible CB unit can be released to an unrelated recipient as a foreign donor stem cell graft. OBJECTIVES: The aim of this study was to evaluate women's perspectives on the different CB banking options as well as retrospective satisfaction with their decisions. METHODS: We performed a prospective survey study in postpartum women, using a validated questionnaire. RESULTS: A total of 157 women were included in this survey study; 68% of them decided to have their UCB stored or donated. Among those women, 25% of them opted for hybrid storage, 72% of respondents stored UCB publicly, and 3% decided for private family-directed storage. CONCLUSIONS: Our study shows the potential of hybrid banking as an attractive UCB storage option, as an alternative to family-directed banking rather than a substitute for public donation. Hybrid storage potentially combines advantages of family-directed banking as well as unrelated CB donation expanding the number of registered CB units available for transplantation and giving every pregnant woman the possibility to store UCB.

Case Report: Metagenomic Next-Generation Sequencing in Diagnosis of Legionella pneumophila Pneumonia in a Patient After Umbilical Cord Blood Stem Cell Transplantation.

We report a case of hospital-acquired Legionella pneumonia that was detected by metagenomic next-generation sequencing (mNGS) of blood from a 7-year-old girl after umbilical cord blood stem cell transplantation (UCBT) with myelodysplastic syndrome. UCBT is traditionally associated with an increased risk of infection, particularly during the first 3 months after transplantation. Controlling interstitial pneumonia and severe infection is the key to reducing patient mortality from infection. Legionella pneumophila can cause a mild cough to rapidly fatal pneumonia. After mNGS confirmed that the pathogen was L. pneumophila, azithromycin, cefoperazone sulbactam, and posaconazole were used for treatment, and the patient's temperature decreased and remained normal. The details of this case highlight the benefits of the timely use of metagenomic NGS to identify pathogens for the survival of immunocompromised patients.

Beneficial Effects of Human Umbilical Cord Blood Mononuclear Cells on Persistent Erectile Dysfunction After Treatment of 5-Alpha Reductase Inhibitor in Rats.

BACKGROUND: Effects of human umbilical cord blood (HUCB) as a valuable source for stem cell-based therapies have not been studied in persistent post-5-alpha reductase inhibitors (5ARI) erectile dysfunction (PPED). AIM: To determine the effect of intracavernosal injection of HUCB mononuclear cells (MNCs) on ED associated with dutasteride treatment. METHODS: Twenty five adult male Sprague-Dawley rats were divided into 5 groups (n = 5 per group): (i) control, (ii) 8-week dutasteride (0.5 mg/kg/day, in drinking water), (iii) 12-week dutasteride, (iv) 8-week dutasteride+HUCB-MNCs (1 × 106) and (v) 12-week dutasteride+HUCB-MNCs. HUCB-MNCs were administered intracavernosally after eight weeks of dutasteride treatment. Experiments were performed at 4 weeks following the injection of HUCB-MNCs. Erectile responses and isometric tension of corpus cavernosum (CC) were measured. The protein expressions of phosphodiesterase type 5 (PDE5), endothelial nitric oxide synthase (eNOS), neuronal NOS (nNOS), hypoxia-inducible factor (HIF)-1α and smooth muscle/collagen contents in penile tissue were evaluated by Western blotting, immunohistochemistry, and Masson's trichrome staining, respectively. MAIN OUTCOME: In vivo erectile function, in vitro relaxant and contractile responses of CC, protein expression and localization of PDE5, eNOS, nNOS, HIF-1α, and smooth muscle content in penile tissue. RESULTS: Erectile responses in the dutasteride-treated groups were significantly decreased compared with controls (P < .001), persisting after 4-wk of washout. HUCB-MNCs restored diminished intracavernosal pressure responses, acetylcholine-, sodium nitroprusside-, sildenafil-induced relaxations, and increased phenylephrine and electrical field stimulation (EFS)-induced contractions. Decreased EFS-induced relaxations in dutasteride-treated groups were not restored by HUCB-MNCs. Increased PDE5 and reduced nNOS expressions in dutasteride groups were restored by HUCB-MNCs in the 12-week dutasteride group. eNOS and HIF-1α protein expression and serum total and free testosterone  levels were similar among groups. HUCB-MNCs reversed the decreased smooth muscle/collagen ratio in dutasteride-treated tissues. There was a significant increase in PDE5 and HIF-1α staining in 8-week dutasteride animals. CLINICAL TRANSLATION: This study demonstrates the corrective potential of HUCB-MNCs on some persistent structural and functional deterioration caused by 5ARI treatment in rats, which may encourage further evaluation of HUCB-MNCs in men with PPED. STRENGTHS AND LIMITATIONS: Therapeutic application of intracavernosal HUCB-MNCs is a novel approach for the rat model of post-5ARI ED. Lack of serum and tissue dihydrotestosterone measurements, vehicle injections and characterization of the cells remain limitations of our study. CONCLUSION: The persistent ED after prolonged administration of dutasteride in rats is reversed by HUCB-MNC treatment, which holds promise as a realistic therapeutic modality for this type of ED. Oztekin CV, Yilmaz-Oral D, Kaya-Sezginer E, et al. Beneficial Effects of Human Umbilical Cord Blood Mononuclear Cells on Persistent Erectile Dysfunction After Treatment of 5-Alpha Reductase Inhibitor in Rats. J Sex Med 2021;18:889-899.

Effect of pretransplant iron overload on clinical efficacy of allogeneic hematopoietic stem cell transplantation on severe aplastic anemia / 器官移植

Objective To evaluate the effect of pretransplant iron overload on the clinical efficacy of allogeneic hematopoietic stem cell transplantation (allo-HSCT) in patients with severe aplastic anemia (SAA). Methods Clinical data of 80 SAA recipients who underwent allo-HSCT for the first time were retrospectively analyzed. According to the incidence of iron overload, all recipients were divided into the iron overload group (n=20) and non-iron overload group (n=60). The engraftment rate, incidence of postoperative complications and clinical prognosis of the recipients afterallo-HSCT were statistically compared between two groups. The influencing factors of 2-year overall survival (OS) and 180 d transplantation related mortality (TRM) were analyzed by Cox proportional hazards regression model. Results The engraftment rate of neutrophils in the non-iron overload group was 98% (59/60), significantly higher than 75% (15/20) in the iron overload group (P < 0.05). The engraftment rate of platelet in the non-iron overload group was 90% (54/60), significantly higher than 65% (13/20) in the iron overload group (P < 0.05). The incidence rate of bloodstream infection in the non-iron overload group was 23% (14/60), remarkably lower than 40% (8/20) in the iron overload group (P < 0.05). The 180 d TRM of the recipients in the non-iron overload group was 17%, significantly lower than 45% in the iron overload group (P < 0.05). The 1- and 2-year OS of the recipients in the non-iron overload group were 82% and 80%, significantly higher than 50% and 44% in the iron overload group (both P < 0.05). Iron overload or not was an independent risk factor of the OS and TRM of the recipients (both P < 0.05). Conclusions Iron overload can affect the OS and TRM of SAA patients after allo-HSCT.

Hematopoietic Stem Cell Transplantation in Mucopolysaccharidosis Type II: A Literature Review and Critical Analysis

Abstract Mucopolysaccharidosis II (MPS II—Hunter syndrome) is an X-linked lysosomal storage disorder caused by a deficiency in iduronate-2 sulfatase. Enzyme replacement therapy does not cross the blood-brain barrier (BBB), limiting the results in neurological forms of the disease. Another treatment option for MPS, hematopoietic stem cell transplantation (HSCT) has become the treatment of choice for the severe form of MPS I since it can preserve neurocognition when performed early in the course of the disease. Even though the intravenous therapy does not cross the BBB, it has become the recommended treatment for MPS II, and HSCT was not often indicated. In an attempt to understand why this treatment modality is rejected by most specialists as a treatment option for patients with Hunter syndrome, we sought to raise all HSCT cases already reported in the scientific literature. Databases used were Medline/PubMed, Lilacs/BVS Cochrane Library, DARE, SciELO, and SCOPUS. Different combinations of the terms "mucopolysaccharidosis II," "Hunter syndrome," "hematopoietic stem cell transplantation," "bone marrow transplantation," and "umbilical cord blood stem cell transplantation" were used. A total of 780 articles were found. After excluding redundant references and articles not related to the theme, 26 articles were included. A descriptive summary of each article is presented, and the main features are summed up. The clinical experience with HSCT in MPS II is small, and most of the available literature is outdated. The available data reveal poor patient selection criteria, varied conditioning regimens, distinct follow-up parameters, and post-HSCT outcomes of interest, making impossible to compare and generalize the results obtained. Recently, after the development of new conditioning protocols and techniques and the creation of bone marrow donor registries and umbilical cord banks, HSCT has become more secure and accessible. It seems now appropriate to reconsider HSCT as a treatment option for the neuronopathic form of MPS II.

Safe and effective administration of BCG for bladder carcinoma in situ after umbilical cord blood stem cell transplantation.

Although intravesical Bacillus Calmette-Guérin (BCG) instillation is the standard treatment for carcinoma in situ of the bladder, it is generally contraindicated in immunocompromised patients. Here we report the first case, to our knowledge, of BCG treatment for a bladder cancer patient who had received umbilical cord blood stem cell transplantation (UCBSCT). BCG can be given safely and effectively in select cases where reconstitution of the immune system has been achieved at least 2 years after UCBSCT.

Clinical study of the umbilical blood stem cells transplantation in the treatment of chronic liver failure / 实用医学杂志

Objective To observe the safety and clinic effect of umbilical blood stem cell transplantation for the patients with chronic liver failure (CLF).Methods 44 patients with CLF were included in the research and divided into two groups,22 in control group received internal medicine treatment,the other 22 in treatment group received umbilical blood stem cell transplantation in addition to internal medicine treatment.The biochemical index,MELD scores,clinical symptoms,survival situation and adverse reaction of the patients were observed within 2,4,12 and 24 weeks.Results Albumin and prothrombin activity of treatment group were higher than those of control group,the MELD scores of the treatment group was lower than that of control group,the survival rate was higher than the control group,and the difference is significant between the two groups (P ＜ 0.05).There was no significant difference between the two groups in terms of alanine aminotransferase and total bilirubin (P ＞ 0.05).After 4 weeks treatment,fatigue,inappetite,abdominal distention and ascitic fluid of the treatment group were better than that of control group,the difference was statistically significant (P ＜ 0.05).Besides,the patients of the both groups did not have any adverse reaction or hepatocellular carcinoma.Conclusion Umbilical blood stem cell transplantation is safe and effective for the patients with CLF and can improve the survival rate of the patients.

Therapeutic effect of the umbilical blood stem cell transplantation on the treatment of hepatitis B liver cirrhosis / 实用医学杂志

Objective To investigate the clinical efficacy of umbilical blood stem cell transplantation (UCBSCT) on the treatment of hepatitis B liver cirrhosis. Methods Forty-eight patients with hepatitis B liver cirrhosis were enrolled and divided into the treatment group and the control group. There were 25 patients in the treatment group , who received UCBSCT treatment based on conventional liver protection treatment and 23 patients in the control group , who received conventional liver protection treatment. The changes of liver function , coagulation function, clinical symptoms, signs and side effects were studied before the treatment and at 2, 4, 12 and 24 weeks post-treatment. Results The levels of albumin, cholinesterase, and prothrombin activity in the treatment group were higher than those before treatment and were higher than those in the control group. The parameters in the control group were not significantly changed before and after the treatment (P > 0.05). The levels of alanine aminotransferase,aspartate aminotransferase,total bilirubin in both two groups were not significantly changed before and after the treatment (P > 0.05). After 4-week treatment,the differences on improvement of appetite , lacking in strength , abdominal distension , ascites were statistically significant in the treatment group compared with the control group (P < 0.05). No adverse reactions were observed in all groups. Conclusion UCBSCT on the treatment of hepatitis B liver cirrhosis is safe and reliable.

Feasibility of trialling cord blood stem cell treatments for cerebral palsy in Australia.

AIM: Umbilical cord blood may have therapeutic benefit in children with cerebral palsy (CP), but further studies are required. On first appearance it seems that Australia is well placed for such a trial because we have excellence in CP research backed by extensive CP registers, and both public and private cord blood banks. We aimed to examine the possibilities of conducting a trial of autologous umbilical cord blood cells (UCBCs) as a treatment for children with CP in Australia. METHODS: Data linkages between CP registers and cord blood banks were used to estimate potential participant numbers for a trial of autologous UCBCs for children with CP. RESULTS: As of early 2013, one Victorian child with CP had cord blood stored in the public bank, and between 1 and 3 children had their cord blood stored at Cell Care Australia (private cord blood bank). In New South Wales, we counted two children on the CP register who had their stored cord blood available in early 2013. We estimate that there are between 10 and 24 children with CP of any type who have autologous cord blood available across Australia. CONCLUSIONS: In nations with small populations like Australia, combined with Australia's relatively low per capita cord blood storage to date, it is not currently feasible to conduct trials of autologous UCBCs for children with CP. Other options must be explored, such as allogeneic UCBCs or prospective trials for neonates at risk of CP.

Clinical observation of the effect of umbilical cord blood stem cell transplantation in treatment of decompensated cirrhosis / 中国医师进修杂志

Objective To explore the clinical eficacy of umbilical cord blood stem cell transplantation in treatment of decompensated cirrhosis.Methods Thirty patients with decompensated cirrhosis were given umbilical cord blood stem cell transplantation (treatment group) and 30 patients with decompensated cirrhosis were given traditional treatment (control group).Liver function and blood coagulation function was tested after 4,8 weeks treatment respectively,and adverse effects were recorded at the same time.Results After 8 weeks treatment,total bilirubin,albumin and prothrombin time in treatment group was improved compared with that before treatment[(71.3 ± 37.8) μ mol/L vs.(107.3 ± 53.2) μ mol/L,(30.1 ± 4.9) g/L vs.(27.5 ± 5.1) g/L,(15.0 ± 2.9) s vs.(16.7 ± 3.9) s],and there was significant difference (P ＜ 0.05).There was no significant difference in the index before and after treatment in control group (P＞ 0.05).No obvious adverse reactions were observed in the process of umbilical cord blood stem cell transplantation.Conclusion Umbilical cord blood stem cell transplantation is safe and effective in treatment of deeompensated cirrhosis.

Células-tronco hematopoéticas: utilidades e perspectivas / Hematopoietic stem cells: uses and perspectives

As células-tronco hematopoéticas (CTH) são células que possuem a capacidade de se autorrenovar e se diferenciar em células especializadas do tecido sanguíneo e do sistema imune. Na medicina, sua importância pode ser evidenciada por seu uso rotineiro do tratamento de doenças onco-hematológicas e imunológicas. A dificuldade de se encontrarem doadores compatíveis de medula óssea tem estimulado a busca por fontes alternativas de CTH, notadamente o sangue de cordão umbilical e placentário (SCUP) e o sangue periférico. O número de unidades de SCUP armazenadas no mundo tem sido crescente desde a década de 1990. Em 2004 foi criada a rede BrasilCord, estabelecendo uma rede nacional de bancos de SCUP com o objetivo de aumentar as chances de localização de doadores e ampliar o número de bancos de SCUP no país. A despeito do baixo volume coletado e do maior tempo necessário para regenerar o tecido hematopoético, as CTH de SCUP vêm em alta concentração sanguínea, sua utilização como fonte de CTH para transplante apresenta menor risco de causar doença enxerto versus hospedeiro e possuem maior facilidade de obtenção do que as CTH provenientes de medula óssea.

Hematopoietic stem cells (HSC) are cells capable of self-renewal and differentiation into specialized blood tissue and immune system cells. In medicine, their importance is evidenced by their routine use in the treatment of onco-hematological and immunologic diseases. The difficulty of finding compatible bone marrow donors has motivated the search for alternative sources of HSC, notably placental/umbilical cord blood (PUCB). The number of PUCB units stored worldwide has been increasing since 1990. In 2004, the BrasilCord network was created, establishing a national network of PUCB banks with the aim of increasing the chances of finding donors and expanding the number of PUCB banks in the country. Despite the small volume collected and the greater amount of time required for the regeneration of the hematopoietic tissue, the blood concentration of HSC in PUCB is higher, their use as a source for HSC for transplantation presents a lower risk of causing graft versus host disease and they are more easily obtained compared to HSC originating from the bone marrow.

The Correlation between CD34+ Cell and Nucleated RBC Counts in Human Cord Blood

PURPOSE: Human umbilical cord blood as a potential source of hematopoietic stem cell for stem cell transplantation in children has recently been advocated. Clinical application of cord blood transplantation, however, requires adequate blood volume and number of stem cells. Currently, the number of stem cells in the cord blood is usually measured by flowcytometry, which requires strict quality control and high costs. Here, we postulate that the number of nucleated red blood cells(NRBC) which are relatively immature erythroid cells may correlate well with that of CD34-expressing(CD34+) cells which are considered lymphohematopoietic precursors. If so, CD34+ cell-rich cord blood can be selected and such cells enumerated by a simple and cost-effective blood smears. METHODS: Correlation between CD34+ cell and nucleated RBC in human cord blood were checked. Sixty cord blood specimens(30 specimens for group A with NRBC>500/mul and 30 specimens for group B with NRBC500/ul; 55+/-61(SD))(p<0.005). 3.Regression relationship among CD34+ cell, WBC, and NRBC counts was as following. ln(CD34+ cell) = -12.21 + 1.46xln(WBC)+ 0.25xln(NRBC) gamma2=30.07 p=0.0001 4.There was a significant correlation between CD34+ cell counts and NRBC counts(gamma=0.4334, p<0.005) CONCLUSIONS: Our results suggest that there is a significant correlation between CD34+ cell counts and NRBC counts, and that CD34+ cell-rich cord blood specimens can be selected by a simple NRBC counting.