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The Potential of Cord Blood and Cord Tissue

By Prof. Phan Toan Thang
Department of Surgery, Yong Loo Lin School of Medicine (NUS)

The umbilical cord tissue comprise an outer cord lining membrane (the amniotic lining membrane) that contains Wharton’s jelly in which is embedded two umbilical arteries and one umbilical vein. Cord blood is contained within the umbilical arteries and veins.

The umbilical cord tissues as well as the cord blood are great sources of stem cells. Stem cells may either be haematopoietic stem cells (which form blood cells), mesenchymal stem cells (which form solid organ cells) or epithelial stem cells (which form surface cells outside and inside the body). Cord blood contains only haematopoietic stem cells and a few mesenchymal stem cells. The cord lining membrane contains BOTH epithelial and mesenchymal stem cells. The rest of the cord tissue only contains mesenchymal stem cells.

What is important to realise are that these stem cells are infant stem cells that are more robust and potent than adult stem cells (for example bone marrow stem cells). Truly it can be said that the umbilical cord and its contents is a stem cell store for the baby in the womb.

When cord blood is stored with cord tissues, you are storing ALL the precursor cells that are available for regenerative purposes. If a child develops leukaemia (a blood cell cancer), after the cancerous blood cells are destroyed by irradiation, the stored cord blood can be used to replenish the blood cell population. Similarly, if an individual suffers a severe burn injury and loses skin, stored epithelial cells could potentially be used to restore the skin surface. In another scenario, bone loss from trauma or surgical removal could potentially regenerate using mesenchymal stem cells.

Latest research has shown that sometimes these cells can help each other! Combined administration of mesenchymal stem cells with haematopoietic stem cells has been shown to increase the survival and engraftment of the haematopoietic stem cells as the mesenchymal stem cells dampen the body’s immune response, which tends to reject the transplanted haematopoietic stem cells. Resurfacing of skin (in a chronic ulcer, for example) is also expedited by combined administration of epithelial and mesenchymal stem cells.

New developments in stem cell research occur daily, and scientists the world over continue to be amazed by the potential of stem cells and their role in the treatment of an ever-increasing spectrum of diseases. Stem cells have been converted into the basic cellular building blocks of all the major tissue types of the body (skin, bone, cartilage, fat, nerve, insulin producing cells, liver cells, etc) Transfusion of a certain type of cord blood (which lack a receptor called CCR) has even been shown to cure HIV infection! Saving cord blood and cord tissue allows the individual all opportunities for regeneration. Certainly this may not be available tomorrow, or even the day after- but it will be available very soon, and faster than you think.

 

Epithelial Stem Cells are saving injured eyes!

The cornea is the transparent part of the eye through which light is transmitted to reach the retina at the back of the eye. Injury to the cornea results in loss of the surface cells of the cornea and an ulcer is formed. Corneal ulcers are exceedingly painful, and restrict the amount of light passing through it, resulting in diminished vision. Sometimes, these ulcers become chronic if the cornea does not heal properly (persistent corneal deficiency), and worse still, scar formation might make the cornea opaque, light does not pass through, and the eye is effectively blinded.

Epithelial Stem Cells which come from the cord lining membrane and have been used effectively to treat such defects. These Cord Lining Epithelial Stem Cells are placed on a supporting structure called a scaffold that is only a fraction of a millimetre in thickness. The scaffold layered with Cord Lining Stem Cells is placed on the chronic ulcer to allow it to heal. To date, more than 60 eyes have had vision restored using this technique- another reason to bank your Cord Lining Stem Cells.

 

Liver Regeneration with Cord Lining Epithelial Cells

The function of the liver in the body is multifaceted- from the metabolism (breaking down and conversion) of ingested nutrients, to the production of bile necessary for digestion.

One of the important functions of the liver is also to break down ingested medicines so that the final product absorbed by the intestines is different from what was originally consumed (what doctors call first pass metabolism).

Cord Lining Stem Cells have been successfully differentiated (converted) into liver cells, and the potential of this for liver regenerative purposes is considerable. Animal studies are ongoing to explore liver regeneration in pigs where a large part of the liver has been surgically removed (large enough to compromise the survival of the animal in normal circumstances) to assess if Cord Lining Stem Cells can physically reconstitute the liver. Suffice to say, but the pigs treated with Cord Lining Stem Cells remain alive to this day!

Cord Lining Stem Cells converted to liver cells are also being used as a laboratory based drug discovery platform to assess liver cell conversion of medicinal drugs (the first pass metabolism mentioned earlier).

 

Stem Cells and Blood Vessels

When blood vessels to the limbs get clogged from cholesterol deposits or other causes, blood flow is decreased, and the limb becomes ischaemic (starved of blood). Blood flow is important as it carries oxygen to the muscles (muscles use a lot of oxygen to work), and waste products away from the muscles for removal from the body (e.g. in the urine). Ischaemic limbs are painful and activity is restricted. Untreated, affected patients are unable to walk, and any limb injuries fail to heal as reparative blood is not flowing to the injured site. Interestingly, diabetics suffer chronic ulcers for a similar reason. Small vessels (called microvessels) get blocked, and therefore the ulcers do not heal. In extreme circumstances, the ulcers get badly infected, involve the bone, and the limb may need to be amputated.

The latest studies in mice have shown that the infusion of stem cells into ischaemic limbs can restore blood flow by the rapid opening of new blood vessels (called a collateral circulation). This takes away the pain, and restores muscle and therefore limb activity. At the current time, the limbs have been studied as limb blood flow is easy to assess. In the future they may also be applied to clogged vessels to the brain which causes stroke!

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