Newsletter - Issue 1, March 2012

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Preeclampsia, Premature Birth, and Cord Blood Banking

Dr. Dado photo

Gina Dado, M.D.
OB/GYN in Scottsdale, AZ at Arizona OBGYN Affiliates (Paradise Valley Branch)

Preeclampsia is a life-threatening medical condition that complicates about 5% of the pregnancies in the United States. Onset of this disease commonly occurs after 32 weeks gestation but can occur late in the second trimester, and is one of the most common causes of premature birth.

The presentation of this condition varies widely, and can be either mild or severe. The most common symptom is a dangerous rise in blood pressure. Many women will develop sudden swelling in the hands, face, and lower extremities, and unrelenting headaches. Some will develop renal or liver impairment leading to spilling more protein in their urine, a decrease in urine output, elevation of liver enzymes and a decrease in platelets which impair the blood's ability to clot. Rarely, this may lead to a seizure and increase maternal and fetal mortality. This disease may even occur up to 6 weeks after delivery.

What is incredible about preeclampsia is it can occur with only one or two subtle signs or symptoms, and quickly progress without much warning. Sometimes hospitalization is warranted, keeping the patient on bed rest and keeping mom and baby under close surveillance. The only cure for preeclampsia is delivery of the baby, after which preeclampsia most commonly goes away in a few days after the birth.

Physicians have to weigh the severity of the disease, and the risk to the mother by delaying delivery, against the risk to the baby if delivered prematurely. At times we are walking a fine line to get a healthy mom and baby through this disease. Good communication between all healthcare professionals and the patient is crucial in maximizing good outcomes.

One of the discussions that should occur when caring for a mother with any high risk scenario like preeclampsia is making an informed decision about her umbilical cord blood. The more preterm an infant is at the time of delivery, the higher the incidence is of that child being born with Cerebral Palsy (CP). CP is a debilitating neurodevelopmental condition that affects the child and family forever. However, an exciting regenerative medicine trial ongoing at Duke University, lead by Dr. Joanne Kurtzberg, is showing incredible promise. The trial gives children with CP their own umbilical cord blood saved from delivery.

When collecting cord blood from a premature delivery, it is crucial for physicians to maximize the amount of blood collected, since preterm babies especially have smaller volumes of cord blood and hence less stem cells. Unfortunately, these lower numbers make the collection unsuitable for public donation.

To insure the best care for a mother with preeclampsia, we must minimize risk and maximize benefit of both mom and baby, not only in utero, but after delivery as well.

Gina M. Dado, MD, went to medical school at Loyola Stritch School of Medicine and continued to do her residency there as well. She has been in obstetrics practice for almost 16 years. She is married to her college sweetheart Robert Dudek, MD, an anesthesiologist, and they have two daughters, ages 11 and 13. With her first pregnancy, Dr. Dado experienced preeclampsia and had her daughter 3 weeks early, on Christmas Eve. Therefore, she understands this disease uniquely from both a doctor's and a patient's perspective. She has been an active umbilical cord blood educator for the past 6 years, speaking to healthcare professionals and patients around the U.S.

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Icla da Silva Foundation

Icla da Silva logo

The Icla da Silva Foundation is the largest recruitment center for the Be The Match Registry in the United States. It recruits over 38,000 new potential bone marrow donors every year, with a strong focus on minority communities.

The Icla da Silva Foundation was established in 1992, in memory of the 13-year-old Brazilian girl named Icla da Silva. After three years of fighting leukemia, Icla passed away in New York City, where she came hoping to get her life saving treatment: a stem cell transplant. The young girl never found a matching donor.

With offices across the East Coast of the United States and Puerto Rico, the Foundation is continuously expanding its efforts in providing assistance and hope to thousands of families in the United States and all over the world. Starting in 2012, the Icla da Silva Foundation is also hosting educational events about cord blood banking.

The Icla da Silva Foundation is a nonprofit organization under section 501(c) 3 of the IRS Code

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Cell Therapy — Is it any better than Tribal Medicine?

Dr. Belle photo

Vaijayantee Belle, M.D.
Research Fellow at Case Western Reserve University

Two hundred years back, the shaman would say to the patient, "Oh, unfortunate man, give me your blood and bring me the blood of a new born, and I shall mix the two and use my magical chants and my secret potions to teach your blood to heal thyself and put it back into you. I tell you that it will work, if you come to me early in your illness, and if you trust me do as told and if you have pure heart and good liver. And if you heal, you will give me your goat, in return."

Fast-forward to 2012: The chief scientific officer of the biotech company says, "We use our patented technology to trans-differentiate cord blood stem cells into desirable cell lines so that these cells assist endogenous stem cells in regeneration. The results of the clinical trial showed favorable outcomes when treatment was administered early on in the course of the disease and when subjects had better cardiac indexes. The secondary outcome was better in those patients who participated in a post-treatment rehabilitation program. We expect to commercialize this therapy over the next few years."

Cell therapy is a process that introduces new live cells into a tissue in order to treat a disease and/or promote regeneration. It is hypothesized that the cells will help either by replacing damaged cells, or by secreting growth factors, or by reducing tissue destruction. The most important commonality between tribal medicine and cell therapy are that in both cases we do not know exactly how it works.

Cell therapy, as it stands today, has more similarity with ancient tribal medicine than with pharmaceutical therapeutics. In drug therapeutics, when a molecule is patented, it remains essentially the same across all generic brands. That way one brand can be compared to another, and the differences in therapeutic results can be explained. This is not at all the case with cell therapeutics, where the exclusivity of a patented product is not just its processing methodology but also its source of the cells. The "medicine" itself is largely proprietary in nature. Just like a tribal medicine man, who guards the sources of key ingredients in his potion, like some exotic plant or animal, the protection of an exclusive cellular product lies in guarding the seed cell lines, which are owned by the biotech company. Like tribal medicine, one cell therapy concoction cannot be compared against another and the differences cannot be explained.

While tribal medicine and cell therapy are both essentially empirical therapies, tribal medicine has the advantage that a large body of human data has been handed down over centuries, and the therapy has been refined by trial and error. In the case of cell therapy, an extensive amount of short term animal data is available, but cell therapies in humans are mostly at experimental stages or costly, with the notable exception of hematopoietic stem cell transplantation.

It could be said that tribal medicine is practiced with conviction but hardly discussed, while stem cell therapy is discussed with enthusiasm but hardly practiced. Yet in the future, cell therapy has the potential to change the face of human disease and alleviate suffering.

So how can cell therapies do better than tribal medicine? The most important change that is needed to advance the status of cell therapy beyond empiricism is to reexamine our theories of disease causation and healing. If one drug is one molecule, then one stem cell is a bag of a thousand different molecules of different concentrations, and these concentrations are changing every minute depending on its niche, which varies in the dynamic micro-environment of the body. Since nature achieves healing by way of mobilizing intrinsic cells, stem cell therapy is intuitive and makes a lot of sense. But in order to work with cells that heal, we need to go beyond the single molecule and single disease model that has dominated pharmaceuticals and modern medicine. We need a science and a philosophy of stem-cell healing, so that we can work with medicines that have minds of their own.

Dr. Vaijayantee Belle is amongst the first ten women neurosurgeons of India. She has served as chief neurosurgeon at S.P. Institute of Neuroscience, in central part of India- one of the very few private centers of its kind serving the rural population with state-or-art super-specialty care at subsidized cost. There she established and directed a neurosurgery unit from 2004 to 2010. Starting in 2007, she designed clinical trials that used adult stem cells to treat patients for various traumatic and neuro-degenerative neurological conditions. Among these patients, she has treated children with cerebral palsy using cord blood stem cells from the patient, a sibling, or an unrelated donor. Since Oct. 2010, Dr. Belle is conducting research at Case Western Reserve University on the use of mesenchymal stem cells for regeneration of tissues.