Newsletter - August 2014

CORD:USE
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What your placenta can and can't do

Nancy L. Sapanara, MD, JD, FCAP

Nancy L. Sapanara, MD, JD, FCAP

Many expectant parents research their options for their child's cord blood - whether to donate it, privately bank it, or have it discarded as medical waste - but what about the placenta? Can it, too, be a valuable source of cells that one should consider saving? Before we address that question, let's first discuss the placenta itself.

The placenta is a maternal-fetal organ that develops in the uterus during pregnancy and, among other things, is responsible for providing the growing fetus with oxygen and nutrients while also removing toxins. The maternal side of the placenta fills with blood from the uterus. The fetal side of the placenta receives the baby's blood from the umbilical cord. The fetal and maternal blood vessels are close enough within the placenta to allow for the transfer of nutrients, oxygen, and waste products, however the two circulations do not mix. Once the baby is born, the placenta detaches from the uterine wall and is expelled from the body. The placenta is often referred to as the "afterbirth".

There's no doubt that the placenta is an amazing organ, but to date, when it comes to stem cell banking, it often takes a back seat to cord blood. This is not surprising, though, as the first cord blood transplant occurred more than 25 years ago, whereas the first human transplant of placental derived stem cells occurred a little more than six years ago in March of 2008.

Options for banking placental stem cells

Just as it is possible to bank umbilical cord blood and cord tissue, there are options available to bank blood and tissue from the placenta.

What is placental blood?

Placental blood is the blood that remains within the blood vessels of the placenta after the baby is born. It is collected after cord blood collection has been completed. Placental blood contains similar cells to those found in the cord blood, including hematopoietic stem cells (cells which make blood cells). What makes placental blood unique is that is it contains a higher concentration of certain stem cells, and in more immature stages of development when compared to cord blood. This is important because the number of stem cells used in treatment has been linked to transplant outcome (the more the better), and more immature cells are less likely to invoke a graft-versus-host response in the transplant recipient.

Placental blood also contains a greater fraction of a special type of stem cell, called mesenchymal stem cells (MSCs), than cord blood, and these cells are currently being studied around the world for a possible role in regenerative medicine, which aims to use these special cells to repair or replace damaged or diseased cells or organs.

If you are interested in banking your baby's placental blood in addition to the cord blood (currently, only LifebankUSA offers this service) your doctor, nurse, or midwife will package the entire placenta to be sent to LifebankUSA along with the cord blood. Once at the lab, the placental blood is collected in a sterile environment by specially trained laboratory technicians. To date, 10 patients have received placental blood infusions along with cord blood transplants from LifebankUSA.

placenta perfusion by trained technician at LifebankUSA

Photo shows a technician at LifebankUSA harvesting blood from the placenta by a technique called perfusion.

What is so special about placental tissue?

Placental tissue banking gives one the opportunity to store cells that may have unique applications quite different from those for cord or placental blood. Cord and placental blood are predominantly used for transplants where hematopoietic reconstitution (the rebuilding of the blood cells) is needed. Tissue from the placenta, on the other hand, contains abundant MSC and MSC-like cells which are being studied in regenerative medicine. MSC and MSC-like cells are currently being studied in variety of clinical settings for conditions such as Crohn's disease, type 1 and type 2 diabetes, heart failure, diabetic foot ulcer, amyotrophic lateral sclerosis (ALS, or Lou Gehrig disease), and rheumatoid arthritis. The cells are most commonly administered intravenously or intramuscularly.

Several of the above studies use placental derived MSC and MSC-like cells obtained from LifebankUSA. This is important to note: LifebankUSA uses the same method to procure and store the placenta tissue for both the manufacturing of material for human clinical trials and for private placental tissue banking clients. In addition, while storage of umbilical cord tissue is offered by several cord blood banks, storage of placental tissue is currently only available with LifebankUSA.

Other choices

Of course, no one should feel obligated to store their child's cord blood, cord tissue, placental blood, or placental tissue. If you decide this is not right for your family, please consider donating these tissues to LifebankUSA, or another cord blood bank, so that others might benefit from your gift.

Lastly, a word on eating your placenta. Yes, eating. There is growing trend for mothers to take their placenta home for consumption (recipes available on the internet) or ship their placenta to any number of companies to have it ground into small pieces and made into capsules for swallowing. While consuming your placenta may seem holistic, or natural, be aware there are no clinical studies proving any benefit, nor is there any health or safety regulation of companies that prepare your placenta.

Conclusion

The placenta is your child's life support system for nine months. After your child is born, stem cell rich placental blood may be collected in addition to cord blood for a variety of hematologic (blood related), immunologic, and metabolic conditions, and MSC-rich placental tissue may be saved for possible future use in regenerative medicine applications. If you choose not to bank your child's placental blood or tissue, please consider donating it so that research into, and treatment with, this amazing organ can continue.

Reference: Tsagias N, Koliakos I, Lappa M, Karagiannis V, Koliakos GG. Placenta perfusion has hematopoietic and mesenchymal progenitor stem cell potential. Transfusion 2011;51:976-985 DOI:10.1111/j.1537-2995.2011.03077.x

LifebankUSA Nancy L. Sapanara, MD, JD, FCAP, is the Medical Director of LifebankUSA, a public-private cord blood bank hybrid, in Cedar Knolls, NJ. Prior to this, she was an attending pathologist and Blood Bank Medical Director of Mercy Fitzgerald and Mercy Philadelphia Hospitals in Pennsylvania. Dr. Sapanara is a graduate of the VCU Medical College of Virginia and completed her residency in Anatomic and Clinical Pathology at Hahnemann University Hospital in Philadelphia. While living in Philadelphia, she earned her law degree at the Temple University James E. Beasley School of Law. When not working, you may find Dr. Sapanara relaxing with her rescued greyhound, riding her motorcycle, or tending to her garden.

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Americord Launches the Gravity Stand™

traditional ex-utero placenta collection by trained technician

Photo shows a technician harvesting blood from the placenta by the traditional ex utero technique.

Americord Registry, a leading cord blood banking company based in New York City, has made major strides in addressing one of the major limitations of cord blood banking: the relatively low volume of stem cells that are typically collected from cord blood. A typical cord blood collection generally harvests enough stem cells to treat a patient who weighs up to 65 pounds. This volume of stem cells may be used to treat a patient over 65 pounds as a last resort, but these transplants have a much lower success rate than transplants containing an appropriate number of stem cells.

To help increase the volume of stem cells that can be harvested from cord blood, the CEO of Americord, Martin Smithmyer, and its Medical Director, Robert Dracker, MD, MHA, MBA, have developed Cord Blood 2.0™.

Soon to be available from Americord, Cord Blood 2.0™ uses a combination of best practices and an innovative collection device to harvest and preserve up to twice as many stem cells as the cord blood industry median of 470 million TNC as reported by Sun et al. 2010 in the journal Transfusion.

Americord Gravity Stand Cord Blood 2.0™ utilizes the novel proprietary and patent pending Gravity Stand™, which secures the placenta in the ideal position for optimal gravity-assisted drainage of cord blood.

"Cord Blood 2.0™ enables families everywhere to save a significantly larger amount of stem cells from their baby's cord blood", said Smithmyer. "By introducing this technology, we are hoping to expand the universe of patients who can benefit from stem cell therapies and increase the instances of successful cord blood transplantation treatments".

Americord is the first private cord blood banking company to offer clients an enhanced cord blood collection method using a disposable and portable gravity collection stand. Public cord blood banks have been using a collection stand for some time, and Americord has adapted and improved this collection method. Collection stands provided by public cord blood banks are located in designated collection rooms within the hospitals that are associated with public cord blood banks. This means that a very limited number of patients have access to the benefits of a gravity-assisted collection. The Gravity Stand™, which can be used virtually anywhere the doctors deem to be appropriate, eliminates the need to transfer the placenta and umbilical cord to a specified collection room.

The Gravity Stand™ is used for ex-utero cord blood collections, which take place immediately after both the baby and the placenta have been delivered. If the doctor chooses to first perform an in-utero cord blood collection (prior to delivery of the placenta), he or she can still use the Gravity Stand™ to harvest additional cord blood from the placenta once it is delivered.

In addition to enabling doctors to perform gravity-assisted cord blood collections in a more simple and intuitive way, collections involving the Gravity Stand™ take place away from the area directly surrounding the mother who has just given birth. This greatly decreases the chance that the sample will become contaminated and have to be discarded.

Americord Americord is dedicated to delivering the highest quality stem cell collection and storage services at the best value and pursuing innovative ways to improve cord blood banking technologies. For more information on Cord Blood 2.0™ or the Gravity Stand™, contact Americord at (866) 503-6005 or visit cordadvantage.com.

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Nevelash's story

Revathi Raj, MBBS, DCH, MRCP

Photo of Revathi Raj, MBBS, DCH, MRCP, the pediatric hematologist at Apollo Hospital who treated Nevelash

Nevelash brought cheer to his parents' life when he was born two years ago. Basically an Indian family, Nevelash's parents were settled in Malaysia, earning their daily bread by working for laborer's wages.

Nevelash's parents were quite concerned and worried when he repeatedly fell sick, and could not be treated by routine protocols followed in local hospitals. They were shocked to learn that small Nevelash was a victim of a genetic disorder called Griscelli Syndrome. This is an inherited disease, meaning that Nevelash unfortunately picked up defective genes from both of his parents. Children with this syndrome cannot produce skin pigment and have very low disease-fighting power (immunity). Most of the children with this syndrome succumb to death in early childhood.

Nevelash's parents decided to leave no stone unturned in searching for a cure, and they came to India to seek medical help. As they had exhausted all their financial resources, they had initiated a fund-raising drive in Malaysia with the help of an NGO and the Indian Community.

Back in India, it was Dr. Revathi Raj, world-renowned transplant physician at Apollo Hospital in Chennai, who suggested to Nevelash's parents the option of a Cord Blood Transplant.

Upon Dr. Revathi's request, StemCyte searched the inventory of its international public cord blood bank seeking a transplant for Nevelash. Luckily, they found a stored cord blood donation that was a 5 out of 6 HLA match. Considering the parents' financial inadequacy, StemCyte generously offered a huge discount on the cord blood unit price.

Nevelash underwent a cord blood stem cell transplant with all the standard pre-conditioning on 28th March 2014. Nevelash showed progressive recovery from day one and showed very good engraftment of the new stem cells into his bloodstream. He was declared disease-free and was discharged from the hospital on 12th May 2014.

Nevelash is an example that such rare and incurable diseases can be treated with the best quality stem cells.

StemCyte India StemCyte India Therapeutics Pvt. Ltd. is a joint venture between three participants: StemCyte Inc. the global public/private cord blood bank, Apollo Hospital Enterprises Ltd. the largest chain of private hospitals in Asia with 51 hospitals, and Cadila Pharmaceuticals Ltd. a well-known pharma since three decades. StemCyte has provided 2000 cord blood transplants globally and 30 in India.