Newsletter - April 2013

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Cord Blood Banking in Canada

Canada donation sites Canada donation sites close up Ontario & Quebec
Canada family banks Canada family banks close up Ontario & Quebec

This month the Canadian Blood Services is scheduled to launch a program to collect cord blood donations for a national public bank. Coinciding with this momentous occasion, the Parent's Guide to Cord Blood Foundation has expanded its searchable map of donation hospitals, from just the US, to cover all of North America donation sites.

The challenges in establishing a registry of cord blood donations for the benefit of patients in Canada are similar to those faced by many other nations: how to finance public cord blood banks, what role should the government play, and what relationships and efficiencies can be leveraged to collect more donations for the public good?

The population of Canada is about one tenth that of the US, mostly concentrated in a swath stretching about six thousand kilometers along the southern edge of the country. One logistical challenge faced by all cord blood bankers, both public and private, is the long distances that can be encountered in delivering cord blood from births to the laboratory.

In the United States, there would be 10,500 stem cell transplants from donors per year if patients had no problems with access to care, such as lack of affordable health insurance or lack of a matching donor (1). In practice, the NMDP facilitated 5573 transplants in 2011 (2). Canada has a nationalized health system, so that access to health care is not a limiting factor for patients, but finding matching donors has been a challenge. In 2012 more than 900 Canadian patients were seeking stem cell donors, but less than half received transplants, and only a few dozen found matches among Canada's OneMatch registry of bone marrow donors (3). Researchers have studied the genetic diversity of the Canadian population, including the Aboriginal peoples in the East and West, to predict how a reservoir of donated cord blood could improve match rates. Their publication found that an inventory of 20,000 public cord blood units would provide matches for most pediatric patients, ranging from 88% of blacks to 99% of Caucasians.

Like many nations, there is much more cord blood inventory in Canada's family cord blood banks than in their public banks. Among the 7 companies providing family cord blood banking in Canada, 6 have AABB accreditation, of these 2 also have FACT accreditation, and another is opening a new GMP laboratory. The combined inventory in Canada's family cord blood banks is over 118,000, and 32 families have used their privately stored cord blood for therapy.

The Canadian Parliament passed Bill C-630 in March 2011 to establish a national cord blood collection program. An announcement from Parliament states, "Canada is the only industrialized country in the world that does not have a national public cord blood bank" (4). However, the French-speaking Canadian province of Québec has been operating a public cord blood bank through their blood service Héma-Québec since 2004. Héma-Québec has their own cord blood laboratory in Montréal that is FACT accredited and currently collects from 8 hospitals in Québec; they have an inventory of about 6500, and have released 18 transplants (3,5). Even earlier, the Alberta Cord Blood Bank started the very first public bank in Canada in 1996, but had to stop collecting due to lack of funds. Currently, the Victoria Angel Registry of Hope is a charity that collects cord blood donations that are stored at a family bank.

The funding to establish the national OneMatch Public Cord Blood Bank operated by Canadian Blood Services consists of $36 million in government funding from the English-speaking provinces of Canada, combined with $12.5 million to be raised from philanthropy, over an 8 year period (3). The OneMatch program has used the bulk of its funding to establish a new cord blood laboratory located in Ottawa. In spring 2013 they will start collecting donations at two hospitals in Ottawa, and by 2014 they hope to establish additional collection hospitals in Vancouver, Toronto, and Edmonton.

How many cord blood donations could the OneMatch Public Cord Blood Bank have banked if, instead of building their own laboratory, they had partnered with the existing, accredited, cord blood laboratories in Canada? In a previous issue of this newsletter, Dr. Dennis Todd estimated that the cost to process each cord blood donation for a public bank is US$1500. Hence, the CA$36 million of government funding invested in OneMatch could cover the processing of 24,000 cord blood units, exceeding the OneMatch stated goal of 20,000 (assuming a monetary exchange rate of 1:1).

The development of public cord blood banking in Canada illustrates the inefficiencies that can occur when the public and private sector do not partner with each other, and the existing public resources are spread among factions that each want ownership.

References:
1. Be The Match (NMDP) 2011 presentation: "Unmet Need" - Jeffrey Chell
2. Be The Match (NMDP) 2012 presentation: "Cord Blood Banking in the Future" - Michael Boo
3. OneMatch 2012 presentation: "An Introduction to the Canadian OneMatch Public Cord Blood Bank" - Dr. Heidi Elmoazzen
4. Canada House of Commons letter from M.P. Paul Szabo, BSc, MBA, FCA
5. Héma-Québec 2011-2012 Annual Report

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Interview with Lee Buckler, founder of LinkedIn's Cell Therapy Industry Group

Lee Buckler

What prompted you to start the Cell Therapy Industry Group on LinkedIn?

Having been Executive Director of the International Society for Cellular Therapy (ISCT) for six years (2000-6), I had a lot of first-hand experience with the ongoing thirst for more and better information exchange as well as better tools for networking with colleagues of similar professional interests.

One of the most valued but difficult-to-manage aspects of the ISCT website was the online discussion forum. Other existing communication tools (e.g., journals, newsletters, even websites) were clunky and never sufficiently real-time to be optimally useful. In-person networking forums are expensive and infrequent. Platforms for online networking and information exchange have never been widely adopted by the scientific community.

When LinkedIn announced the ability to form groups in 2008 I jumped at the opportunity, hoping that it might provide the kind of information exchange and networking we needed, and that LinkedIn's popularity would support the widespread adoption of the Cell Therapy Industry Group.

What I also knew, having been in the sector for 8 years at the time, was that while there were forums largely dedicated to academics and research, those in industry were still in need of a place where the dominant topics of discussion were issues of import to companies in the sector. From its inception, I wanted to create a forum largely dedicated to industry and to clinical development, more than to academics and pre-clinical research.

What I've discovered is that people seem to appreciate having a moderated forum in which they can share information, discuss ideas, make connections, and debate issues facing their industry.

I learn something valuable from the group every day, and am so pleased that people are giving of their time and ideas in ways which make it such a useful tool.

What are the current vitals of the group?

As of today (3 April 2013) there are 4,812 members. It took 2.5 years to reach the first 1000 members, 9 months for the 2nd thousand to join, 6 months to bring in the 3rd thousand, another 6 months to reach the 4th thousand mark, and I expect we'll see the 5th round of one thousand members joining in just 5 months.

Approximately a third of the members have 'senior' or 'CxO' titles, 24% are in research, and 27% are at the manager or director level.

While the group was initially comprised largely of corporate people from the United States, the membership is now growing fastest among academic and people from outside North America. Approximately 21% are in the major US biotech/pharma cities (Boston, NYC, San Francisco, Washington D.C., San Diego), with the rest spread around the world (the highest national concentration outside the US is Israel).

Members describe their primary industry as 46% biotechnology, 14% research, 8% pharmaceuticals, 7% medical devices, and 6% hospital/healthcare.

The Cell Therapy Industry group is currently growing at a pace of approximately 50 members per week. I review each application to join, to ensure they have a professional link to the industry. I probably reject 4 applications per week on the basis of incomplete profiles. If the reason for someone's desire to join the group is not clear from their profile, I'll ask them to provide a rationale. I do all this to minimize unwanted spam. I move all job postings to the 'careers' tab and all conference notices and other adverts to the 'promotions' tab. If someone is a repeat 'spam' offender, or rude, I'll ask them to stop. I've only had to remove a couple of people from the group for being a repeat offender. The quality of the posts and discussion is very important to me, and I believe important to the value of the group to its members.

In terms of activity, we average 20 new posts and 40-50 comments or responses per week.

Clearly there are a lot of members who are passive readers/consumers and likely others who rarely visit the group. What's important is that there are a lot of ways to find value in a group like this, provided we all follow what few rules exist and respect other members.

Has the evolution of the group met your expectations or has it surprised you?

The way the group has grown continues to surprise me. We now have more members than the paid memberships of ISCT and ISSCR combined. We also have more members than either ISCT or ISSCR have in their free LinkedIn groups - and our group is really just devoted to industry and clinical development generally, not including topics related to pre-clinical research.

On a regular basis I'm pleasantly surprised by how useful the group is to me, but more importantly how it appears useful to colleagues in the sector - leaders and newbies alike.

Finally, I'm very proud of the way we've been able to engage in some very candid, passionate debates, and exchange of ideas, while generally being respectful of the participants. This is generally a forum where all ideas and contributions are welcomed (provided they do not turn 'personal') and where we try not to force a bias on or into the discussions.

Any closing thoughts?

While I'm not ashamed of the fact this is 'my' group, I try to make it very clear I want to run it in a way which accords with the group's consensus. As such, I try to reach out on occasion for feedback on 'sticky' issues or questions as a means of getting a sense for how the group wishes me to govern the group. I'm hoping this translates into members feeling like this is 'their' group - a group for the mutual benefit of all who are in or interested in the cell therapy industry. Finally, as always, I want to thank each and every member for making the group of whatever value it is today.

The easiest thing in the world is to do what I did - start a LinkedIn group - but it takes a critical mass of members who regularly contribute to make it a thing of value.

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Stem Cells for Lung Repair in Premature Infants

Bernard Thebaud, MD, PhD

Bernard Thébaud, M.D., Ph.D., Sprott Centre for Stem Cell Research, Ottawa Hospital Research Institute

Bronchopulmonary dysplasia (BPD) is a chronic lung disease that follows ventilator and oxygen treatment for acute failure to breath in babies born very prematurely (24-28 weeks of gestation instead of 40). BPD is a major complication of prematurity with a short and long term burden that reach into adulthood. Each year, 10,000 new babies suffer from BPD in the US. The economic burden is estimated at $6 billion/year, representing up to one fourth of all direct pediatric health care costs. Damage to the still developing lung stops the normal growth of the alveoli (the air sacs in the lung that allow the uptake of oxygen and release of waste carbon dioxide). Currently there is no treatment for this disease.

Our body contains stem cells, a pool of cells that can divide indefinitely and, under certain circumstances, have the ability to become any type of cell (i.e. bone, muscle, liver or blood cell, etc.) in the body. These cells are thought to maintain normal organ function and repair small injuries in our body. This is the case for a specific type of stem cell called mesenchymal stromal cell (or MSC). The bone marrow is a well-known source of stem cells, in particular MSCs. Many patients have been treated with MSCs from the bone marrow for various diseases. MSCs can also be found in the umbilical cord blood and umbilical cord tissue of babies. The umbilical cord is a rich source of MSCs with superior healing capabilities compared to adult bone marrow MSCs. The MSC in the umbilical cord can be safely collected and stored without risk for the mother or the baby. This is especially appealing for the treatment of conditions in babies, because the source for their therapy is right there at birth.

Our lab and others around the world have harnessed the healing potential of MSCs to repair lung injury in neonatal mice and rats. In these experimental studies, MSCs were given intravenously or directly into the lung through the airways. MSCs were able to prevent lung injury in these experimental models of BPD. When given right after established lung injury, MSCs derived from cord blood and tissue were able to restore normal lung growth and lung function in neonatal rats. Furthermore, when examined at the age of 6 months (the equivalent of a young adult in humans), the lungs of the rats were still healthy with no adverse effects, suggesting a long lasting effect and safety. These results are very promising and suggest MSCs from the umbilical cord as a potential therapy to prevent or treat BPD and improve the outcome of premature infants. To date, one study treating infants with MSCs from cord blood has been completed in South Korea. Another trial is ongoing in China. The results of these studies are still pending.

Much more needs to be learned about therapies based on MSC from umbilical cord blood and tissue, but experimental studies in the laboratory are very promising and may lead to a new breakthrough treatment for babies born extremely premature.

Dr. Thébaud is a clinician-scientist who is affiliated with the Ottawa Hospital Research Institute, a neonatologist with the Children's Hospital of Eastern Ontario, and a Professor of Pediatrics at the University of Ottawa. Dr. Thébaud obtained his MD at the University Louis Pasteur in Strasbourg, France in 1991 and trained in Pediatrics and Neonatology at the University Paris V in Paris, France, where he also obtained his MSc and PhD, before completing a 2 year post-doctoral fellowship at the University of Alberta. He was recruited to Ottawa in 2012 to accelerate the translation of stem cell-based therapies to improve the outcome of extreme prematurity. Dr. Thébaud led the international team that was the first to demonstrate that stem cells protect and repair the lungs of newborn rats. Dr. Thébaud has over 70 peer-reviewed publications, received the "Rising Star in Perinatal Research" award from the CIHR Institute for Human Development, Child and Youth Health in 2008, and the "Best in Current Canadian Child Health Research" Sanofi Pasteur Research Award in 2007. Dr. Thébaud holds a Tier 2 Canada Research Chair in Lung Development, Injury and Repair.

Reference

  • Maria Pierro, Lavinia Ionescu, Tiziana Montemurro, Arul Vadivel, Gaia Weissmann, Gavin Oudit, Derek Emery, Sreedhar Bodiga, Farah Eaton, Bruno Péault, Fabio Mosca, Lorenza Lazzari, & Bernard Thébaud
    Short-term, long-term and paracrine effect of human umbilical cord-derived stem cells in lung injury prevention and repair in experimental bronchopulmonary dysplasia
    Published in Thorax doi:10.1136/thoraxjnl-2012-202323