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{{Short description|Blood in the placenta and umbilical cord after birth}}
{{Globalize|date=May 2010}}'''Umbilical cord blood''' is ] that remains in the ] and in the attached ] after ]. Cord blood is collected because it contains ], which can be used to treat ] and ]s.
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==Definition and collection==
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Cord blood is a sample of blood taken from a newborn baby's umbilical cord. It is a rich source of ], which are precursors to blood cells. As such, they have been used to treat certain diseases of the blood and immune system. The next largest group is inherited diseases (of red blood cells, the immune system and certain metabolic abnormalities.) Patients with lymphoma, myelodysplasia and severe aplastic anemia have also been successfully transplanted with cord blood.{{citation needed|date=September 2013}} Cord blood is collected from the umbilical cord vein attached to the placenta after the umbilical cord has been detached from the ].<ref>, Buzzle.com</ref> Cord blood is collected because it contains stem cells, including ], which can be used to treat hematopoietic and genetic disorders. One unit of cord blood generally lacks stem cells in a quantity sufficient to treat an adult patient. The placenta is a much better source of stem cells since it contains up to ten times more than cord blood.<ref name="Cairo MS, Wagner JE 1997 4665–4678">{{cite journal
| tradename = Allocord, Ducord, Hemacord, others
|author=Cairo MS, Wagner JE
| Drugs.com = {{drugs.com|cons|allocord}}<br />{{drugs.com|cons|ducord}}
|title=Placental and/or umbilical cord blood: an alternative source of hematopoietic stem cells for transplantation.
| MedlinePlus =
|journal=Blood
| DailyMedID = Hematopoietic progenitor cell
|volume=90
| pregnancy_AU = <!-- A / B1 / B2 / B3 / C / D / X -->
|issue=12
| pregnancy_AU_comment =
|pages=4665–4678
| pregnancy_category =
|year=1997
| routes_of_administration = ]
|pmid=9389681
| class =
}}</ref> Some placental blood may be returned to the neonatal circulation if the ] is not prematurely clamped.<ref>, gentlebirth.org</ref> According to Eileen K. Hutton, PhD, and Eman S. Hassan, MBBch, cord clamping should be delayed a minimum of two minutes to prevent anemia over the first three months of life and enriching iron stores and ferritin levels for as long as six months. (Ref. "Late vs Early Clamping of the Umbilical Cord in Full-term Neonates," ''JAMA'', March 21, 2007) If the umbilical cord is not clamped, and it is not during an extended-] protocol, a ] occurs upon interaction with cold air, when the internal gelatinous substance, called ], swells around the umbilical artery and veins.
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Umbilical cord blood is the blood left over in the placenta and in the umbilical cord after the birth of the baby. The cord blood is composed of all the elements found in whole blood. It contains red blood cells, white blood cells, plasma, platelets and is also rich in ]. There are several methods for collecting cord blood. The method most commonly used in clinical practice is the "closed technique", which is similar to standard blood collection techniques. With this method, the technician ]tes the ] of the severed umbilical cord using a needle that is connected to a blood bag, and cord blood flows through the needle into the bag. On average, the closed technique enables collection of about 75 ml of cord blood.<ref name="isbn012-348-776-5">
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{{cite book
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|author= Christopher D. Hillyer, Ronald G. Strauss & Naomi L. C. Luban.
| legal_BR = <!-- OTC, A1, A2, A3, B1, B2, C1, C2, C3, C4, C5, D1, D2, E, F -->
|title=Handbook of Pediatric Transfusion Medicine
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|publisher=Academic Press
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|pages=295, 296
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|isbn=0-12-348776-5
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| legal_UK_comment =
| legal_US = Rx-only
| legal_US_comment = <ref name="Allocord FDA label">{{cite web | title=Allocord- human cord blood hematopoietic progenitor cell injection, solution | website=DailyMed | date=13 February 2018 | url=https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=ac6b4215-c905-4f4e-9dd8-b0eb7fa4f8b6 | access-date=19 November 2022}}</ref><ref name="Clevecord FDA label">{{cite web | title=Clevecord (hpc- hematopoietic progenitor cell, cord blood injection, suspension | website=DailyMed | date=25 April 2017 | url=https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=61e65daf-363f-4568-a2b9-9f1444207f78 | access-date=19 November 2022}}</ref><ref name="Cordcyte FDA label">{{cite web | title=Cordcyte- human cord blood hematopoietic progenitor cell injection, suspension | website=DailyMed | date=20 December 2015 | url=https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=a2d89045-a178-4732-bc2d-0c27f934e538 | access-date=19 November 2022}}</ref><ref name="Ducord FDA label">{{cite web | title=Ducord- human cord blood hematopoietic progenitor cell solution | website=DailyMed | date=4 November 2015 | url=https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=9c02fe26-efe8-4bca-9f38-c0f9e22d25cf | access-date=19 November 2022}}</ref><ref name="Hemacord FDA label">{{cite web | title=Hemacord- human cord blood hematopoietic progenitor cell injection | website=DailyMed | date=19 October 2022 | url=https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=bd9a5180-1773-11e0-980a-0002a5d5c51b | access-date=19 November 2022}}</ref>
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| legal_status = <!-- For countries not listed above -->


<!-- Pharmacokinetic data -->
Collected cord blood is ] and then stored in a ] for future transplantation. A cord blood bank may be private (i.e. the blood is stored for and the costs paid by donor families) or public (i.e. stored and made available for use by unrelated donors). While public cord blood banking is widely supported, private cord banking is controversial in both the medical and parenting community. Although umbilical cord blood is well-recognized to be useful for treating hematopoietic and genetic disorders, some controversy surrounds the collection and storage of umbilical cord blood by private banks for the baby's use. Only a small percentage of babies (estimated at between 1 in 1,000 to 1 in 200,000<ref name="AAP"/>) ever use the umbilical cord blood that is stored. ] 2007 Policy Statement on Cord Blood Banking states that:
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"Physicians should be aware of the unsubstantiated claims of private cord blood banks made to future parents that promise to insure infants or family members against serious illnesses in the future by use of the stem cells contained in cord blood;"<ref name="AAP">{{cite web|url=http://aappolicy.aappublications.org/cgi/content/full/pediatrics;119/1/165 2007|title=Policy Statement on Cord Blood Banking|publisher=]}}</ref>
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Cord blood is stored by both public and private ]s. Public cord blood banks store cord blood for the benefit of the general public, and most U.S. banks coordinate matching cord blood to patients through the ] (NMDP). Private cord blood banks are usually for-profit organizations that store cord blood for the exclusive use of the donor or donor's relatives. Public cord blood banking is supported by the medical community. However, private cord blood banking is generally not recommended unless there is a family history of specific genetic diseases. New parents have the option of storing their newborn's cord blood at a private ] or donating it to a public cord blood bank. The cost of private cord blood banking is approximately $2000 for collection and approximately $125 per year for storage, as of 2007. Donation to a public cord blood bank is not possible everywhere, but availability is increasing. Several local cord blood banks across the ] are now accepting donations from within their own states. The cord blood bank will not charge the donor for the donation; the ] may still charge a collection fee, although many OB/GYNs choose to donate their time. After the first sibling-donor cord blood transplant was performed in 1988, the ] (NIH) awarded a grant to ] to develop the world's first cord blood program at the New York Blood Center (NYBC),<ref></ref> in order to establish the inventory of non embryonal stem cell units necessary to provide unrelated, matched grafts for patients.<ref>In 2005, ] researcher Peter Zandstra developed a method to increase the yield of cord blood stem cells to enable their use in treating adults as well as children.</ref><ref name="UofT">{{cite web | author=Raymer, Elizabeth | date=2005-10-14 | url=http://www.news.utoronto.ca/bin6/051014-1723.asp| title=New strategy will boost cord blood stem cells | work= | accessdate=September 20, 2006 |archiveurl = http://web.archive.org/web/20060919013034/http://www.news.utoronto.ca/bin6/051014-1723.asp |archivedate = September 19, 2006}}</ref>
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'''Cord blood''' ('''umbilical cord blood''') is ] that remains in the ] and in the attached ] after ]. Cord blood is collected because it contains ], which can be used to treat ] and ]s such as ].
==Regulation==
In the United States, the ] regulates cord blood under the category of "Human Cells, Tissues, and Cellular and Tissue Based-Products." The Code of Federal Regulations under which the FDA regulates public and private cord blood banks is Title 21 Section 1271.<ref>http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfcfr/CFRSearch.cfm?CFRPart=1271</ref> Several states also require accreditation, including New York, New Jersey, and California. Any company not accredited within those states are not legally permitted to collect cord blood from those states, even if the company is based out of state. Potential clients can check the New York accreditation status from the New York Umbilical Cord Blood Banks Licensed to Collect in New York. Both public and private cord blood banks are also eligible for voluntary accreditation with either the American Association of Blood Banks AABB or the Foundation for the Accreditation of Cellular Therapy FACT. Potential clients can check the current accreditation status of laboratories from the AABB list of accredited cord blood laboratories (note that several companies, such as ], have AABB laboratories listed under different names) or the FACT search engine of accredited cord blood banks (on their home page). Other countries also have regulations pertaining to cord blood. In the United Kingdom, the Human Tissue Authority (www.hta.gov.uk) regulates the cord blood banking.


== Constituents ==
Today, cord blood banking in ] is primarily conducted by private cord blood banks, which require payment in order to store a child's cord blood stem cells. Recently,{{when|date=April 2015}} however, the government has launched an initiative that will fund the creation of a national public cord blood bank. The initiative will cost $48 million over the course of the next 8 years, and will provide families all over the country with the chance to donate their child's umbilical cord blood to a national registry.
Cord blood is composed of all the elements found in whole ] – ]s, ]s, ], ]s.<ref name="PrankeFailace2001">{{cite journal | vauthors = Pranke P, Failace RR, Allebrandt WF, Steibel G, Schmidt F, Nardi NB | title = Hematologic and immunophenotypic characterization of human umbilical cord blood | journal = Acta Haematologica | volume = 105 | issue = 2 | pages = 71–76 | year = 2001 | pmid = 11408707 | doi = 10.1159/000046537 | s2cid = 30909026 }}</ref> Compared to whole blood some differences in the blood composition exist, for example, cord blood contains higher numbers of ]s, lower absolute number of ] and a higher proportion of immature T-cells.<ref name="pmid17474296">{{cite journal | vauthors = Newcomb JD, Sanberg PR, Klasko SK, Willing AE | title = Umbilical cord blood research: current and future perspectives | journal = Cell Transplantation | volume = 16 | issue = 2 | pages = 151–158 | year = 2007 | pmid = 17474296 | pmc = 2720821 | doi = 10.3727/000000007783464623 }}</ref> However, the interest in cord blood is mostly driven by the observation that cord blood also contains various types of ] and ]s, mostly ]s.<ref name="PrankeFailace2001" /><ref name="pmid17474296" /><ref name="GalievaMukhamedshina2017">{{cite journal | vauthors = Galieva LR, Mukhamedshina YO, Arkhipova SS, Rizvanov AA | title = Human Umbilical Cord Blood Cell Transplantation in Neuroregenerative Strategies | journal = Frontiers in Pharmacology | volume = 8 | pages = 628 | year = 2017 | pmid = 28951720 | pmc = 5599779 | doi = 10.3389/fphar.2017.00628 | doi-access = free }}</ref> Some non-hematopoietic stem cell types are also present in cord blood, for example, ]s, however these are present in much lower numbers than what can be found in adult ].<ref name="pmid17474296" /><ref name="GalievaMukhamedshina2017" /> ]s and ] unrestricted ]s can also be found in cord blood.<ref name="GalievaMukhamedshina2017" /> Unlike ]s which are ], cord blood stem cells are multipotent.<ref name="GalievaMukhamedshina2017" /><ref name="cbhd_Cord">{{Cite web | title = Cord Blood Stem Cells: An Overview | date = 31 March 2009 | volume = 16 | issue = 1 | pages = 6–7 | access-date = 9 December 2018 | url = https://cbhd.org/content/cord-blood-stem-cells-overview | website=The Center for Bioethics & Human Dignity | vauthors = Riggan K | archive-date = 9 December 2018 | archive-url = https://web.archive.org/web/20181209124725/https://cbhd.org/content/cord-blood-stem-cells-overview | url-status = dead }}</ref><ref name="stem_Howd">{{Cite web | title = How do embryonic stem cells, somatic stem cells, and cord blood stem cells differ? | work = New York State Stem Cell Science | access-date = 9 December 2018 | url = https://stemcell.ny.gov/faqs/how-do-embryonic-stem-cells-somatic-stem-cells-and-cord-blood-stem }}</ref>
In the ] the NHS Cord Blood Bank was set up in 1996 to collect, process, store and supply cord blood. It is a public cord blood bank and part of the NHS.
* The first unrelated transplant (the patient was not related to the donor) occurred in February 1998
* Cord blood collected for the NHS Cord Blood Bank is collected by specially trained and dedicated staff. It is collected from the following hospitals – Barnet General, Northwick Park, Watford, Luton and Dunstable and St George’s in Tooting
* Trained NHS Cord Blood Bank staff contact mothers who have registered to donate before they have their baby to ask some simple lifestyle questions and to obtain verbal consent for the collection, testing and use of the donation
* The NHS Cord Blood Bank has issued cord blood units to 22 countries. This is a reciprocal arrangement internationally enabling patients worldwide to get the best treatment
* The NHS Cord Blood Bank is accredited by NetCord-FACT and licensed by the Human Tissue Authority


==Research== == Medical uses ==
Cord blood is used the same way that ] is used to reconstitute bone marrow following radiation treatment for various blood cancers, and for various forms of ].<ref name=milestones2016 /><ref name=Ballen2013rev /> Its efficacy is similar as well.<ref name=milestones2016 />
Though uses of cord blood beyond blood and immunological disorders is speculative, some research has been done in other areas.<ref name="Hal E. Broxmeyer PhD and Franklin O. Smith MD 2009">{{cite journal
|author= Hal E. Broxmeyer PhD and Franklin O. Smith MD
|title=Cord Blood Hematopoietic Cell Transplantation.
|journal=Thomas' Hematopoietic Cell Transplantation, Fourth Edition (Fourth Edition)
|year=2009
|url=http://www3.interscience.wiley.com/cgi-bin/summary/122239838/SUMMARY}}</ref> Any such potential beyond blood and immunological uses is limited by the fact that cord cells are ] stem cells (which can differentiate only into blood cells), and not ] stem cells (such as ], which can differentiate into any type of tissue). Cord Blood for Neonatal Hypoxic-Ischemic Encephalopathy<ref>{{cite journal
|author=Haller M J
|title=Autologous umbilical cord blood infusion for type 1 diabetes.
|journal=Exp. Hematol.
|volume=36
|issue=6
|pages=710–715
|year=2008
|pmid=18358588
|doi=10.1016/j.exphem.2008.01.009
|last2=Viener
|first2=HL
|last3=Wasserfall
|first3=C
|last4=Brusko
|first4=T
|last5=Atkinson
|first5=MA
|last6=Schatz
|first6=DA
|pmc=2444031
|display-authors=etal}}</ref><ref>http://clinicaltrials.gov/ct2/show/NCT00593242?term=NCT00593242&rank=1</ref> is being studied in humans, and earlier stage research is being conducted for treatments of stroke,<ref>{{cite journal
|author=Vendrame M
|title=Cord blood rescues stroke-induced changes in splenocyte phenotype and function
|journal=Exp. Neurol.
|volume=199
|issue=1
|pages=191–200
|year=2006
|pmid=16713598
|doi=10.1016/j.expneurol.2006.03.017
|last2=Gemma
|first2=Carmelina
|last3=Pennypacker
|first3=Keith R.
|last4=Bickford
|first4=Paula C.
|last5=Davis Sanberg
|first5=Cyndy
|last6=Sanberg
|first6=Paul R.
|last7=Willing
|first7=Alison E.
|display-authors=etal}}</ref><ref>{{cite journal
|author=Vendrame M
|title=Anti-inflammatory effects of human cord blood cells in a rat model of stroke
|journal=Stem Cells Dev.
|volume=14
|issue=5
|pages=595–604
|year=2005
|pmid=16305344
|doi=10.1089/scd.2005.14.595
|last2=Gemma
|first2=Carmelina
|last3=Mesquita
|first3=Dirson De
|last4=Collier
|first4=Lisa
|last5=Bickford
|first5=Paula C.
|last6=Sanberg
|first6=Cyndy Davis
|last7=Sanberg
|first7=Paul R.
|last8=Pennypacker
|first8=Keith R.
|last9=Willing
|first9=Alison E.
|display-authors=etal}}</ref><ref>{{cite journal
|author=Revoltella RP
|title=Cochlear repair by transplantation of human cord blood CD133+ cells to nod-scid mice made deaf with kanamycin and noise
|journal=Cell Transplant.
|volume=17
|issue=6
|pages=665–678
|year=2008
|pmid=18819255
|doi=10.3727/096368908786092685
|last2=Papini
|first2=Sandra
|last3=Rosellini
|first3=Alfredo
|last4=Michelini
|first4=Monica
|last5=Franceschini
|first5=Valeria
|last6=Ciorba
|first6=Andrea
|last7=Bertolaso
|first7=Lucia
|last8=Magosso
|first8=Sara
|last9=Hatzopoulos
|first9=Stavros
|last10=Lorito
|first10=Guiscardo
|last11=Giordano
|first11=Pietro
|last12=Simoni
|first12=Edi
|last13=Ognio
|first13=Emanuela
|last14=Cilli
|first14=Michele
|last15=Saccardi
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|last16=Urbani
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|last17=Jeffery
|first17=Rosemary
|last18=Poulsom
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|last19=Martini
|first19=Alessandro
|display-authors=etal}}</ref> However, apart from blood disorders, the use of cord blood for other diseases is not a routine clinical modality and remains a major challenge for the stem cell community.<ref name="Hal E. Broxmeyer PhD and Franklin O. Smith MD 2009"/><ref name="Harris DT, ''et al.'' 2007 1311–1322">{{cite journal
|author=Harris DT
|title=The potential of cord blood stem cells for use in regenerative medicine
|journal=Expert Opin. Biol. Ther.
|volume=7
|issue=9
|pages=1311–1322
|year=2007
|pmid=17727322
|doi=10.1517/14712598.7.9.1311
|last2=Badowski
|first2=Michael
|last3=Ahmad
|first3=Nafees
|last4=Gaballa
|first4=Mohamed A
|display-authors=etal}}</ref><ref>{{cite journal
|author=Haller MJ
|title=Autologous umbilical cord blood infusion for type 1 diabetes
|journal=Exp. Hematol.
|volume=36
|issue=6
|pages=710–715
|year=2008
|pmid=18358588
|doi=10.1016/j.exphem.2008.01.009
|pmc=2444031
|last2=Viener
|first2=Hilla-Lee
|last3=Wasserfall
|first3=Clive
|last4=Brusko
|first4=Todd
|last5=Atkinson
|first5=Mark A.
|last6=Schatz
|first6=Desmond A.
|display-authors=etal}}</ref>


== Adverse effects in transplantation ==
Training programs for clinicians and researchers have been adopted throughout the world, in order to coordinate the research efforts.
Adverse effects are similar to hematopoietic stem cell transplantation, namely ] if the cord blood is from a genetically different person, and the risk of severe infection while the immune system is reconstituted.<ref name=milestones2016 /> To assure that the smallest amount of complications occur during transplantation, levels of engraftment must be present; specifically both neutrophils and platelets must be being produced.<ref name="doi.org">{{cite journal | vauthors = Waller-Wise R | title = Umbilical cord blood: information for childbirth educators | journal = The Journal of Perinatal Education | volume = 20 | issue = 1 | pages = 54–60 | date = 2011 | pmid = 22211060 | pmc = 3209739 | doi = 10.1891/1058-1243.20.1.54 }}</ref> This process of neutrophil and platelet production after the transplant, however, takes much longer than that of stem cells.<ref name="doi.org" /> In many cases, the engraftment time depends on the cell dose, or the amount of stem cells obtained in the sample of blood.<ref name="doi.org" /> In Dr. Moise's article about umbilical cord blood, it was found that there is approximately 10% less stem cells in cord blood than there is in bone marrow.<ref name="doi.org" /><ref>{{cite journal | vauthors = Moise KJ | title = Umbilical cord stem cells | journal = Obstetrics and Gynecology | volume = 106 | issue = 6 | pages = 1393–1407 | date = December 2005 | pmid = 16319269 | doi = 10.1097/01.AOG.0000188388.84901.e4 | s2cid = 20999222 }}</ref> Therefore, a sufficient amount of cord blood must be obtained in order to collect an adequate cell dose, however this amount varies from infant to infant and is irreplaceable. Given that this idea is quite new, there is still a lot of research that needs to be completed. For example, it is still unknown how long cord blood can safely be frozen without losing its beneficial effects.<ref name="doi.org" /> There is a lower incidence with cord blood compared with traditional HSCT, despite less stringent HLA match requirements.<ref name=milestones2016 />
In 2004 Eurocord,<ref>http://www.eurocord-ed.org/</ref> an international platform specialized in clinical research on umbilical cord blood ]., was founded under efforts coordinated by Pr. ] and Eliane Gluckman. Eurocord centralizes and analyzes clinical data from 511 transplant centers in 56 countries. Funded by the European Union, Eurocord works closely with the European School of Haematology.<ref>http://www.esh.org/</ref> In 2007, the association was recognized by the '']''<ref>http://www.medicen.org/</ref> network of cell therapy clusters. Eurocord also develops training programs for clinicians and researchers specialized in blood cancer and cell therapy. In 2010, Eurocord became part of the French Agence de la biomédecine.<ref>http://www.agence-biomedecine.fr/article/528</ref>


== Collection and storage ==
Expectant parents can now also collect and preserve stem cells from the tissue of the umbilical cord, whose medical name is ]. Whereas cord blood is a rich source of ] (HSC) that differentiate to form the lineage of blood cells, cord tissue is a rich source of ] (MSC). The International Society of Cellular Therapy, ISCT, has established criteria for defining MSC.
Umbilical cord blood is the blood left over in the placenta and in the umbilical cord after the birth of the baby. There are several methods for collecting cord blood. The method most commonly used in clinical practice is the "closed technique", which is similar to standard blood collection techniques.<ref>{{cite journal | vauthors = Mousavi SH, Zarrabi M, Abroun S, Ahmadipanah M, Abbaspanah B | title = Umbilical cord blood quality and quantity: Collection up to transplantation | journal = Asian Journal of Transfusion Science | volume = 13 | issue = 2 | pages = 79–89 | year = 2019 | pmid = 31896912 | pmc = 6910041 | doi = 10.4103/ajts.AJTS_124_18 | doi-access = free }}</ref> With this method, the technician ]tes the ] of the severed umbilical cord using a needle that is connected to a blood bag, and cord blood flows through the needle into the bag. On average, the closed technique enables collection of about 75&nbsp;ml of cord blood.<ref name="isbn012-348-776-5">{{cite book | vauthors = Hillyer CD, Strauss RG, Luban NL |title=Handbook of Pediatric Transfusion Medicine |publisher=Academic Press |year=2004 |pages=295, 296 |isbn=978-0-12-348776-6}}</ref>
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Mesenchymal stem cells differentiate to build bone, cartilage and connective tissue, and they can also mediate the body’s inflammatory response to damaged or injured cells.
<ref>{{cite journal
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|pmid=19172693
|doi=10.1038/nri2395
|last2=Moretta
|first2=L
|last3=Pistoia
|first3=V
|display-authors=etal}}</ref>
<ref>{{cite journal
|title=Autologous umbilical cord blood infusion for type 1 diabetes
|journal=Journal of Biomedicine and Biotechnology
|volume=2009
|pages=1–11
|year=2009
|pmid=20037738
|doi=10.1155/2009/789526
|last2=Chirieleison
|first2=SM
|last3=Wescoe
|first3=KE
|last4=Schmidt
|first4=BT
|last5=Askew
|first5=Y
|last6=Nance
|first6=JJ
|last7=Evron
|first7=JM
|last8=Peault
|first8=B
|last9=Deasy
|first9=BM
|pmc=2796378


Collected cord blood is ] and then stored in a ] for future transplantation. Cord blood collection is typically depleted of red blood cells before cryopreservation to ensure high rates of stem cell recovery.<ref name="pmid26133757 ">{{cite journal | vauthors = Roura S, Pujal JM, Gálvez-Montón C, Bayes-Genis A | title = The role and potential of umbilical cord blood in an era of new therapies: a review | journal = Stem Cell Research & Therapy | volume = 6 | issue = 1 | pages = 123 | date = July 2015 | pmid = 26133757 | pmc = 4489204 | doi = 10.1186/s13287-015-0113-2 | doi-access = free }}</ref>
|last1 = Schugar|first1 = R.C.}}</ref>
<ref>{{cite journal
|title=Differences in quality between privately and publicly banked umbilical cord blood units: a pilot study of autologous cord blood infusion in children with acquired neurological disorders
|journal=Transfusion.
|volume=50
|issue=9
|pages=1980–1987
|year=2010
|pmid=20546200
|doi=10.1111/j.1537-2995.2010.02720.x
|last=Sun|first=J
|last2=Allison |first2=J
|last3=McLaughlin |first3=C
|last4=Sledge |first4=L
|last5=Waters-Pick |first5=B
|last6=Wease |first6=S
|last7=Kurtzberg |first7=J
}}</ref>
<ref>{{cite journal
|author=Giordano A
|title=From the laboratory bench to the patient’s bedside: An update on clinical trials with mesenchymal stem cells.
|journal=Exp. Hematol.
|volume=211
|issue=1
|pages=27–35
|year=2007
|pmid=17226788
|last2=Galderisi
|first2=U
|last3=Marino
|first3=IR
|doi=10.1002/jcp.20959
|display-authors=etal}}</ref>
There have been no clinical trials in humans yet that have used MSCs derived from cord tissue, though some have looked into the possibility of its use in treating certain diseases in animals.
<ref>{{cite journal
|author=Maurya DK
|title=Therapy with un-engineered naïve rat umbilical cord matrix stem cells markedly inhibits growth of murine lung adenocarcinoma
|journal=BMC Cancer.
|volume=10
|pages=590
|year=2010
|pmid=21029413
|doi=10.1186/1471-2407-10-590
|pmc=2988749
|last2=Doi
|first2=Chiyo
|last3=Kawabata
|first3=Atsushi
|last4=Pyle
|first4=Marla M
|last5=King
|first5=Clay
|last6=Wu
|first6=Zhihong
|last7=Troyer
|first7=Deryl
|last8=Tamura
|first8=Masaaki
|display-authors=etal}}</ref>
<ref>{{cite journal
|author=Fu, YS,
|title=Conversion of human umbilical cord mesenchymal stem cells in Wharton's jelly to dopaminergic neurons in vitro: potential therapeutic application for Parkinsonism
|journal=Stem Cells.
|volume=24
|issue=1
|pages=115–124
|year=2006
|pmid=16099997
|last2=Cheng
|first2=YC
|last3=Lin
|first3=MY
|last4=Cheng
|first4=H
|last5=Chu
|first5=PM
|last6=Chou
|first6=SC
|last7=Shih
|first7=YH
|last8=Ko
|first8=MH
|last9=Sung
|first9=MS
|doi=10.1634/stemcells.2005-0053


== History ==
}}</ref>
The first successful cord blood transplant (CBT) was done in 1988 in a child with ].<ref name=milestones2016>{{cite journal | vauthors = Juric MK, Ghimire S, Ogonek J, Weissinger EM, Holler E, van Rood JJ, Oudshoorn M, Dickinson A, Greinix HT | title = Milestones of Hematopoietic Stem Cell Transplantation - From First Human Studies to Current Developments | journal = Frontiers in Immunology | volume = 7 | pages = 470 | date = 9 November 2016 | pmid = 27881982 | pmc = 5101209 | doi = 10.3389/fimmu.2016.00470 | doi-access = free }}</ref> Early efforts to use CBT in adults led to mortality rates of about 50%, due somewhat to the procedure being done in very sick people, but perhaps also due to slow development of immune cells from the transplant.<ref name=milestones2016 /> By 2013, 30,000 CBT procedures had been performed and banks held about 600,000 units of cord blood.<ref name=Ballen2013rev>{{cite journal | vauthors = Ballen KK, Gluckman E, Broxmeyer HE | title = Umbilical cord blood transplantation: the first 25 years and beyond | journal = Blood | volume = 122 | issue = 4 | pages = 491–498 | date = July 2013 | pmid = 23673863 | pmc = 3952633 | doi = 10.1182/blood-2013-02-453175 }}</ref>
<ref>{{cite journal
|author=Liu, Y
|title=Therapeutic potential of human umbilical cord mesenchymal stem cells in the treatment of rheumatoid arthritis
|journal=Arthritis Research & Therapy
|volume=12
|issue=6
|pages=R210
|year=2010
|pmid=21080925
|doi=10.1186/ar3187
|pmc=3046518
|display-authors=etal}}</ref>
<ref>{{cite journal
|author=Limin Wang
|title=A Comparison of Human Bone Marrow–Derived Mesenchymal Stem Cells and Human Umbilical Cord–Derived Mesenchymal Stromal Cells for Cartilage Tissue Engineering
|journal=Tissue Engineering Part A.
|volume=15
|issue=8
|pages=2259–2266
|year=2009
|doi=10.1089/ten.tea.2008.0393
|last2=Tran
|first2=I
|last3=Seshareddy
|first3=K
|last4=Weiss
|first4=ML
|last5=Detamore
|first5=MS
|pmid=19260778
|display-authors=etal}}</ref>
<ref>{{cite journal
|author=Rita Anzalone
|title=Wharton's Jelly Mesenchymal Stem Cells as Candidates for Beta Cells Regeneration: Extending the Differentiative and Immunomodulatory Benefits of Adult Mesenchymal Stem Cells for the Treatment of Type 1 Diabetes
|journal=Stem Cell Reviews and Reports.
|volume=7
|issue=23
|pages=342–363
|year=2008
|pmid=20972649
|doi=10.1007/s12015-010-9196-4
|last2=Lo Iacono
|first2=Melania
|last3=Loria
|first3=Tiziana
|last4=Di Stefano
|first4=Antonino
|last5=Giannuzzi
|first5=Pantaleo
|last6=Farina
|first6=Felicia
|last7=La Rocca
|first7=Giampiero
|display-authors=etal}}</ref>


== Society and culture ==
Currently there is no standard procedure or accrediting criteria for storage of MSC from umbilical cord tissue. Many cord blood banks are storing the cord tissue by freezing an intact segment of the umbilical cord. This procedure has the advantage of waiting for the technology of cell separation to mature, but has the disadvantage that there is no guarantee it will be possible to efficiently retrieve viable stem cells from a previously frozen cord. A few cord blood banks are extracting stem cells from the cord tissue before cryogenic storage. This procedure has the disadvantage that it uses the current separation method, but the advantage that it yields minimally manipulated cells that are treatment ready and comply with FDA regulations on cell therapy products.
=== Legal status ===
Hemacord (HPC, cord blood) was approved for medical use in the US in 2011.<ref name="Hemacord FDA label" /><ref>{{cite web | title=Hemacord (HPC, cord blood) | website=U.S. Food and Drug Administration | date=1 October 2024 | url=https://www.fda.gov/vaccines-blood-biologics/cellular-gene-therapy-products/hemacord-hpc-cord-blood | access-date=24 November 2024}}</ref>


Ducord (HPC Cord Blood) was approved for medical use in the US in 2012.<ref name="Ducord FDA label" /><ref>{{cite web | title=Ducord (HPC Cord Blood) | website=U.S. Food and Drug Administration | date=1 October 2024 | url=https://www.fda.gov/vaccines-blood-biologics/cellular-gene-therapy-products/ducord-hpc-cord-blood | access-date=24 November 2024}}</ref>
== Controversy ==
The policy of the ] states that "private storage of cord blood as 'biological insurance' is unwise" unless there is a family member with a current or potential need to undergo a stem cell transplantation.<ref name=":0">http://pediatrics.aappublications.org/content/119/1/165.full
</ref><ref>{{Cite web|title = AAP News Release - AAP: CORD BLOOD BANKING FOR FUTURE TRANSPLANTATION NOT RECOMMENDED|url = http://www.nationalcordbloodprogram.org/AAP%20News%20Release%20-%20AAP%20CORD%20BLOOD%20BANKING%20FOR%20FUTURE%20TRANSPLANTATION%20NOT%20RECOMMENDED.htm|website = www.nationalcordbloodprogram.org|accessdate = 2015-04-17}}</ref><ref name="Thornley 1011–1017">{{Cite journal|title = Private Cord Blood Banking: Experiences and Views of Pediatric Hematopoietic Cell Transplantation Physicians|url = http://pediatrics.aappublications.org/content/123/3/1011|journal = Pediatrics|date = 03/01/2009|access-date = 2015-04-17|issn = 0031-4005|pmid = 19255033|pages = 1011–1017|volume = 123|issue = 3|doi = 10.1542/peds.2008-0436|first = Ian|last = Thornley|first2 = Mary|last2 = Eapen|first3 = Lillian|last3 = Sung|first4 = Stephanie J.|last4 = Lee|first5 = Stella M.|last5 = Davies|first6 = Steven|last6 = Joffe}}</ref> The American Academy of Pediatrics also notes that the odds of using one's own cord blood is 1 in 200,000 while the ] says that only 14 such procedures have ever been performed.<ref>{{Cite web|title = Umbilical cord blood banking: Pros & cons, costs, banking basics|url = http://www.webmd.com/parenting/baby/features/banking-your-babys-cord-blood?page=2|website = www.webmd.com|accessdate = 2015-04-17}}</ref> Private storage of one's own cord blood is unlawful in Italy and France, and it is also discouraged in some other European countries. The ] states "Private banking should be considered in the unusual circumstance when there exists a family predisposition to a condition in which umbilical cord stem cells are therapeutically indicated. However, because of its cost, limited likelihood of use, and inaccessibility to others, private banking should not be recommended to low-risk families."<ref>{{Cite web|title = Opinion 2.165 - Umbilical Cord Blood Banking|url = http://www.ama-assn.org/ama/pub/physician-resources/medical-ethics/code-medical-ethics/opinion2165.page|website = www.ama-assn.org|accessdate = 2015-04-17}}</ref> The American Society for Blood and Marrow Transplantation and the ] also encourage public cord banking and discourage private cord blood banking. Nearly all cord blood transfusions come from public banks, rather than private banks,<ref name="Thornley 1011–1017"/><ref name=":1">{{Cite web|title = Cord Blood: Marketing Before Medicine?|url = http://abcnews.go.com/WN/WorldNews/cord-blood-banking-marketing-medicine/story?id=10577020|website = ABC News|date = 2010-05-07|accessdate = 2015-04-17|first = Dr Richard|last = Besser|first2 = Susan|last2 = Schwartz|first3 = Christine|last3 = Romo}}</ref> partly because most treatable conditions can't use one's own cord blood.<ref>{{Cite journal|title = Cord Blood Banking for Potential Future Transplantation|url = http://pediatrics.aappublications.org/content/119/1/165|journal = Pediatrics|date = 2007-01-01|access-date = 2015-04-17|issn = 0031-4005|pmid = 17200285|pages = 165–170|volume = 119|issue = 1|doi = 10.1542/peds.2006-2901|first = Section on Hematology/Oncology and Section on|last = Allergy/Immunology}}</ref><ref>{{Cite news|title = Inside the Private Umbilical Cord Blood Banking Business|url = http://www.wsj.com/articles/SB10001424052702303887804579501500366071342|newspaper = Wall Street Journal|date = 2014-04-25T16:55:00.000Z|access-date = 2015-04-17|issn = 0099-9660|first = Dionne|last = Searcey|first2 = Christopher S.|last2 = Stewart}}</ref>


Allocord (HPC Cord Blood) was approved for medical use in the US in 2013.<ref name="Allocord FDA label" /><ref>{{cite web | title=Allocord (HPC Cord Blood) Lead Page | website=U.S. Food and Drug Administration | date=1 October 2024 | url=https://www.fda.gov/vaccines-blood-biologics/cellular-gene-therapy-products/allocord-hpc-cord-blood | access-date=24 November 2024}}</ref>
Cord blood contains ] stem cells (which can differentiate only into blood cells), and should not be confused with ] (]), which can differentiate into any cell in the body.<ref name=":0" /><ref name=":1" /> Cord blood stem cells are blood cell progenitors which can form red blood cells, white blood cells, and platelets. This is why cord blood cells are currently used to treat blood and immune system related genetic diseases, cancers, and blood disorders. On the possibility that cord blood stem cells could be used for other purposes, the World Marrow Donor Association and European Group on Ethics in Science and New Technologies states "The possibility of using one’s own cord blood stem cells for regenerative medicine is currently purely hypothetical....It is therefore highly hypothetical that cord blood cells kept for autologous use will be of any value in the future" and "the legitimacy of commercial cord blood banks for autologous use should be questioned as they sell a service which has presently no real use regarding therapeutic options."<ref>{{Cite web|title = http://bloodcell.transplant.hrsa.gov/cord/files/wmdapolicystatement.pdf|url = http://bloodcell.transplant.hrsa.gov/cord/files/wmdapolicystatement.pdf|website = bloodcell.transplant.hrsa.gov|accessdate = 2015-04-17}}</ref>


Cordcyte was approved for medical use in the US in 2013.<ref name="Cordcyte FDA label" />
The American Academy of Pediatrics supports efforts to provide information about the potential benefits and limitations of cord blood banking and transplantation, so that parents can make an informed decision. In addition, the American College of Obstetricians and Gynecologists recommends that if a patient requests information on umbilical cord blood banking, balanced information should be given. Cord blood education is also supported by legislators at the federal and state levels. In 2005, the National Academy of Sciences published an Institute of Medicine (IoM) report titled "Establishing a National Cord Blood Stem Cell Bank Program".<ref>{{Cite web|title = Establishing a National Cord Blood Stem Cell Bank Program - Institute of Medicine|url = http://www.iom.edu/en/Activities/Research/CordBloodBank.aspx|website = www.iom.edu|accessdate = 2015-04-17}}</ref> The IoM report recommended that expectant parents be given a balanced perspective on their options for cord blood banking. In response to their constituents, state legislators across the country are introducing legislation intended to help inform physicians and expectant parents on the options for donating, discarding or banking newborn stem cells. Currently 17 states, covering two-thirds of U.S. births, have enacted legislation recommended by the IoM guidelines.


Clevecord (HPC Cord Blood) was approved for medical use in the US in 2016.<ref name="Clevecord FDA label" /><ref>{{cite web | title=Clevecord (HPC Cord Blood) Lead Page | website=U.S. Food and Drug Administration | date=1 October 2024 | url=https://www.fda.gov/vaccines-blood-biologics/cellular-gene-therapy-products/clevecord-hpc-cord-blood | access-date=24 November 2024}}</ref>
While there is general support in the medical community for public ], the question of private banking has raised objections from many governments and nonprofit organizations. The controversy centers on varying assessments of the current and future likelihood of successful uses of the stored blood. In March 2008, a paper was published by Nietfeld et al.<ref>{{cite journal | doi = 10.1016/j.bbmt.2007.12.493 | last1 = Nietfield | first1 = J | last2 = Pasquini | year = 2008 | first2 = MC | last3 = Logan | first3 = BR | last4 = Verter | first4 = F | last5 = Horowitz | first5 = MM | title = Lifetime probabilities of hematopoietic stem cell transplantation in the U.S. | url = | journal = Biology of Blood and Marrow Transplantation | volume = 14 | issue = 3| pages = 316–322 | pmid = 18275898 | pmc = 2531159 }}</ref> The ] forecasts that by the year 2015, there will be 10,000 cord blood transplants worldwide per year using publicly banked cord blood. It is therefore beneficial to build public repositories of cord blood donations. In the United States, the Health Resources and Services Administration (HRSA) of the US Dept. of Health and Human Services is responsible for funding national programs to register marrow donors and bank cord blood donations.<ref></ref>


Regenecyte (HPC, Cord Blood) was approved for medical use in the US in November 2024.<ref>{{cite web | title=Regenecyte | website=U.S. Food and Drug Administration | date=1 October 2024 | url=https://www.fda.gov/vaccines-blood-biologics/cellular-gene-therapy-products/regenecyte | access-date=24 November 2024}}</ref><ref>{{cite press release | title=U.S. FDA Approves StemCyte Biologics License Application for Regenecyte Cord Blood Cell Therapy Product | publisher=Stemcyte | via=PR Newswire | date=22 November 2024 | url=https://www.prnewswire.com/news-releases/us-fda-approves-stemcyte-biologics-license-application-for-regenecyte-cord-blood-cell-therapy-product-302313955.html | access-date=24 November 2024}}</ref>
In March 2004, the European Union Group on Ethics (EGE) has issued Opinion No.19<ref name="EGE">, European Union Group on Ethics</ref> titled ''Ethical Aspects of Umbilical Cord Blood Banking''. The EGE concluded that "he legitimacy of commercial cord blood banks for autologous use should be questioned as they sell a service, which has presently, no real use regarding therapeutic options. Thus they promise more than they can deliver. The activities of such banks raise serious ethical criticisms."<ref name="EGE"/>


=== Regulation ===
In May 2006 The World Marrow Donor Association (WMDA) Policy Statement for the Utility of Autologous or Family Cord Blood Unit Storage<ref name="WMDAPolicyStatement062006">{{cite web | author=World Marrow Donor Association | year=2006 | url=http://www.worldmarrow.org/fileadmin/WorkingGroups_Subcommittees/DRWG/Cord_Blood_Registries/WMDA_Policy_Statement_Final_02062006.pdf|format=PDF| title=Policy Statement for the Utility of Autologous or Family Cord Blood Unit Storage| work= | accessdate=June 2, 2006 |archiveurl = http://web.archive.org/web/20060926115915/http://www.worldmarrow.org/fileadmin/WorkingGroups_Subcommittees/DRWG/Cord_Blood_Registries/WMDA_Policy_Statement_Final_02062006.pdf |archivedate = September 26, 2006}}</ref> stated that:
The ] has generated voluntary accreditation standards for cord blood banking facilities.<ref name=Armitage2016>{{cite journal | vauthors = Armitage S | title = Cord Blood Banking Standards: Autologous Versus Altruistic | journal = Frontiers in Medicine | volume = 2 | pages = 94 | date = 8 January 2016 | pmid = 26779485 | pmc = 4705863 | doi = 10.3389/fmed.2015.00094 | doi-access = free }}</ref>


In the United States, the ] regulates any facility that stores cord blood; cord blood intended for use in the person from whom it came is not regulated, but cord blood for use in others is regulated as a drug and as a biologic.<ref>{{cite web|title=Consumers (Biologics) – Cord Blood Banking – Information for Consumers|url=https://www.fda.gov/BiologicsBloodVaccines/ResourcesforYou/Consumers/ucm236044.htm|publisher=FDA Center for Biologics Evaluation and Research|date=23 July 2012}}</ref> Several states have regulations for cord blood banks.<ref name=Armitage2016 />
#The use of ] cord blood cells for the treatment of childhood leukemia is contra-indicated because pre-leukemic cells are present at birth. Autologous cord blood carries the same genetic defects as the donor and should not be used to treat genetic diseases.
#There is at present no known protocol where autologous cord blood stem cells are used in therapy.
#If autologous stem cell therapies should become reality in the future, these protocols will probably rely on easily accessible stem cells.


In the European Union, Canada, and Australia use of cord blood is regulated.<ref name=Armitage2016 /> In the United Kingdom, the NHS Cord Blood Bank was set up in 1996 to collect, process, store and supply cord blood; it is a public cord blood bank and part of the NHS.<ref>{{cite web|title=About the NHS Cord Blood bank|url=http://www.nhsbt.nhs.uk/cordblood/about/|publisher=NHS Cord Blood Bank|access-date=28 November 2016}}</ref>
As of spring 2008, there were several known instances where autologous use of cord blood was possible, though other areas of research are more speculative.<ref>Whereas the WMDA cautioned against autologous transplant for diseases with a genetic signature, there are pediatric cancers (ex: neuroblastoma) and acquired conditions (ex: aplastic anemia) which can be treated by autologous transplant. There has even been one autologous transplant for leukemia</ref><ref>{{cite journal | last1 = Hayani | first1 = A | year = 2007 | last2 = Lampeter | first2 = E. | last3 = Viswanatha | first3 = D. | last4 = Morgan | first4 = D. | last5 = Salvi | first5 = S. N. | title = First report of autologous cord blood transplantation in the treatment of a child with leukemia | url = | journal = Pediatrics | volume = 119 | issue =1 | pages = 296–300 | pmid=17200253 |doi=10.1542/peds.2006-1009 }}</ref>
<ref>{{cite journal | doi = 10.1016/j.exphem.2008.01.009 | last1 = Haller | first1 = M.J. | year = 2008 | last2 = Viener | first2 = HL | last3 = Wasserfall | first3 = C | last4 = Brusko | first4 = T | last5 = Atkinson | first5 = MA | last6 = Schatz | first6 = DA | title = Autologous umbilical cord blood infusion for type 1 diabetes | url = | journal = Exp. Hematol | volume = 36 | issue = 6| pages = 710–715 | pmid = 18358588 | pmc = 2444031 }}</ref><ref>Duke University, Neonatal Hypoxic-Ischemic Encephalopathy; Phase I clinical trial NCT00593242, </ref>


== See also == === Private and public banks ===
A cord blood bank may be private (i.e. the blood is stored for and the costs paid by donor families) or public (i.e. stored and made available for use by unrelated donors). While public cord blood banking is widely supported, private cord banking is controversial in both the medical and parenting community. Although umbilical cord blood is well-recognized to be useful for treating hematopoietic and genetic disorders, some controversy surrounds the collection and storage of umbilical cord blood by private banks for the baby's use. Only a small percentage of babies (estimated at between 1 in 1,000 to 1 in 200,000) ever use the umbilical cord blood that is stored.<ref name=AAP2007 /> ] 2007 Policy Statement on Cord Blood Banking stated: "Physicians should be aware of the unsubstantiated claims of private cord blood banks made to future parents that promise to insure infants or family members against serious illnesses in the future by use of the stem cells contained in cord blood." and "private storage of cord blood as 'biological insurance' is unwise" unless there is a family member with a current or potential need to undergo a stem cell transplantation.<ref name=AAP2007 /><ref name=Thornley2009>{{cite journal | vauthors = Thornley I, Eapen M, Sung L, Lee SJ, Davies SM, Joffe S | title = Private cord blood banking: experiences and views of pediatric hematopoietic cell transplantation physicians | journal = Pediatrics | volume = 123 | issue = 3 | pages = 1011–1017 | date = March 2009 | pmid = 19255033 | pmc = 3120215 | doi = 10.1542/peds.2008-0436 }}</ref> The American Academy of Pediatrics also notes that the odds of using a person's own cord blood is 1 in 200,000 while the ] says that only 14 such procedures have ever been performed.<ref>{{Cite web|title = Umbilical cord blood banking: Pros & cons, costs, banking basics|url = http://www.webmd.com/parenting/baby/features/banking-your-babys-cord-blood?page=2|website = www.webmd.com|access-date = 17 April 2015}}</ref>


Private storage of one's own cord blood is unlawful in Italy and France, and it is also discouraged in some other European countries. The ] states "Private banking should be considered in the unusual circumstance when there exists a family predisposition to a condition in which umbilical cord stem cells are therapeutically indicated. However, because of its cost, limited likelihood of use, and inaccessibility to others, private banking should not be recommended to low-risk families."<ref>{{Cite web|title = Opinion 2.165 – Umbilical Cord Blood Banking|url = http://www.ama-assn.org/ama/pub/physician-resources/medical-ethics/code-medical-ethics/opinion2165.page|website = www.ama-assn.org|access-date = 17 April 2015 |url-status=dead |archive-url=https://web.archive.org/web/20160220185110/http://www.ama-assn.org/ama/pub/physician-resources/medical-ethics/code-medical-ethics/opinion2165.page | archive-date=20 February 2016 }}</ref> The American Society for Blood and Marrow Transplantation and the ] also encourage public cord banking and discourage private cord blood banking. Nearly all cord blood transplantations come from public banks, rather than private banks, partly because most treatable conditions can't use a person's own cord blood.<ref>{{Cite web|title = Cord Blood: Marketing Before Medicine?|url = https://abcnews.go.com/WN/WorldNews/cord-blood-banking-marketing-medicine/story?id=10577020|website = ABC News|date = 7 May 2010|access-date = 17 April 2015| vauthors = Besser R, Schwartz S, Romo C }}</ref><ref name="AAP2007">{{cite journal | vauthors = Lubin BH, Shearer WT | title = Cord blood banking for potential future transplantation | journal = Pediatrics | volume = 119 | issue = 1 | pages = 165–170 | date = January 2007 | pmid = 17200285 | pmc = 6091883 | doi = 10.1542/peds.2006-2901 | doi-access = free }}</ref><ref name=Thornley2009 /><ref>{{Cite news|title = Inside the Private Umbilical Cord Blood Banking Business|url = https://www.wsj.com/articles/SB10001424052702303887804579501500366071342|newspaper = Wall Street Journal|date = 25 April 2014| vauthors = Searcey D, Stewart CS }}</ref> The World Marrow Donor Association and European Group on Ethics in Science and New Technologies states "The possibility of using one's own cord blood stem cells for regenerative medicine is currently purely hypothetical....It is therefore highly hypothetical that cord blood cells kept for autologous use will be of any value in the future" and "the legitimacy of commercial cord blood banks for autologous use should be questioned as they sell a service which has presently no real use regarding therapeutic options."<ref name=WMDA2011>{{cite web|title=WMDA Policy Statement on the Utility of Autologous or Family Cord Blood Unit Storage|url=http://bloodcell.transplant.hrsa.gov/cord/files/wmdapolicystatement.pdf|publisher=World Marrow Donation Association|date=April 2011|access-date=16 February 2015|archive-url=https://web.archive.org/web/20171010155416/https://bloodcell.transplant.hrsa.gov/cord/files/wmdapolicystatement.pdf|archive-date=10 October 2017|url-status=dead}}</ref>
*]

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The ], or AAP, supports efforts to provide information about the potential benefits and limitations of cord blood banking and transplantation so that parents can make an informed decision.<ref>{{cite journal | vauthors = Shearer WT, Lubin BH, Cairo MS, Notarangelo LD | title = Cord Blood Banking for Potential Future Transplantation | journal = Pediatrics | volume = 140 | issue = 5 | pages = e20172695 | date = November 2017 | pmid = 29084832 | pmc = 6091883 | doi = 10.1542/peds.2017-2695 }}</ref> Cord blood education is also supported by legislators at the federal and state levels. In 2005, the National Academy of Sciences published an Institute of Medicine (IoM) report titled "Establishing a National Cord Blood Stem Cell Bank Program".<ref>{{Cite web|title = Establishing a National Cord Blood Stem Cell Bank Program – Institute of Medicine|url = http://www.iom.edu/en/Activities/Research/CordBloodBank.aspx|website = www.iom.edu|access-date = 17 April 2015|url-status=dead|archive-url = https://web.archive.org/web/20091123092544/http://www.iom.edu/en/Activities/Research/CordBloodBank.aspx|archive-date = 23 November 2009}}</ref>
*]

*]
In March 2004, the European Union Group on Ethics (EGE) has issued Opinion No.19 titled ''Ethical Aspects of Umbilical Cord Blood Banking''.<ref name="EGE">{{cite web|url=http://ec.europa.eu/european_group_ethics/docs/avis19_en.pdf |title= Opinion No. 19 |archive-url=https://web.archive.org/web/20071201142808/http://ec.europa.eu/european_group_ethics/docs/avis19_en.pdf |archive-date=1 December 2007 |url-status=dead }}, European Union Group on Ethics</ref> The EGE concluded that "he legitimacy of commercial cord blood banks for autologous use should be questioned as they sell a service, which has presently, no real use regarding therapeutic options. Thus they promise more than they can deliver. The activities of such banks raise serious ethical criticisms."<ref name="EGE" />

== Research ==
Though uses of cord blood beyond blood and immunological disorders is speculative, some research has been done in other areas.<ref name=Walther2009>{{cite book| vauthors = Walther MM | veditors = Appelbaum FR, Forman SJ, Negrin RS, Blume KG |title=Thomas' hematopoietic cell transplantation stem cell transplantation|date=2009|publisher=Wiley-Blackwell|location=Oxford|isbn=978-1-4443-0353-7|edition=4th|chapter=Chapter 39. Cord Blood Hematopoietic Cell Transplantation}}</ref> Any such potential beyond blood and immunological uses is limited by the fact that cord cells are ] stem cells (which can differentiate only into blood cells), and not ] stem cells (such as ], which can differentiate into any type of tissue). Cord blood has been studied as a treatment for diabetes.<ref name=Haller2008>{{cite journal | vauthors = Haller MJ, Viener HL, Wasserfall C, Brusko T, Atkinson MA, Schatz DA | title = Autologous umbilical cord blood infusion for type 1 diabetes | journal = Experimental Hematology | volume = 36 | issue = 6 | pages = 710–715 | date = June 2008 | pmid = 18358588 | pmc = 2444031 | doi = 10.1016/j.exphem.2008.01.009 }}</ref> However, apart from blood disorders, the use of cord blood for other diseases is not in routine clinical use and remains a major challenge for the stem cell community.<ref name=Walther2009 /><ref name=Haller2008 />

Along with cord blood, ] and the ] have been explored as sources for ] (MSC), and as of 2015 had been studied in vitro, in animal models, and in early stage clinical trials for cardiovascular diseases, as well as neurological deficits, liver diseases, immune system diseases, diabetes, lung injury, kidney injury, and leukemia.<ref>{{cite journal | vauthors = Caseiro AR, Pereira T, Ivanova G, Luís AL, Maurício AC | title = Neuromuscular Regeneration: Perspective on the Application of Mesenchymal Stem Cells and Their Secretion Products | journal = Stem Cells International | volume = 2016 | pages = 9756973 | date = 2016 | pmid = 26880998 | pmc = 4736584 | doi = 10.1155/2016/9756973 | doi-access = free }}</ref><ref name="pmid25861654">{{cite journal | vauthors = Roura S, Pujal JM, Gálvez-Montón C, Bayes-Genis A | title = Impact of umbilical cord blood-derived mesenchymal stem cells on cardiovascular research | journal = BioMed Research International | volume = 2015 | pages = 975302 | year = 2015 | pmid = 25861654 | pmc = 4377460 | doi = 10.1155/2015/975302 | doi-access = free }}</ref><ref>{{cite journal | vauthors = Li T, Xia M, Gao Y, Chen Y, Xu Y | title = Human umbilical cord mesenchymal stem cells: an overview of their potential in cell-based therapy | journal = Expert Opinion on Biological Therapy | volume = 15 | issue = 9 | pages = 1293–1306 | date = 2015 | pmid = 26067213 | doi = 10.1517/14712598.2015.1051528 | s2cid = 25619787 }}</ref>

Cord blood is being used to get stem cells with which to test in people with ].<ref>{{cite journal | vauthors = Reddi AS, Kuppasani K, Ende N | title = Human umbilical cord blood as an emerging stem cell therapy for diabetes mellitus | journal = Current Stem Cell Research & Therapy | volume = 5 | issue = 4 | pages = 356–361 | date = December 2010 | pmid = 20528762 | doi = 10.2174/157488810793351668 }}</ref> The stem cells from umbilical cord blood are also being used in the treatment of a number of blood diseases including blood cancers.<ref name=Glu2015>{{cite journal | vauthors = Gluckman E | title = Umbilical cord blood transfusions in low-income countries | journal = The Lancet. Haematology | volume = 2 | issue = 3 | pages = e85–e86 | date = March 2015 | pmid = 26687800 | doi = 10.1016/s2352-3026(15)00019-8 | doi-access = free }}</ref>

Cord blood is also being studied as a substitute for normal ]s in the developing world.<ref name=Glu2015 /><ref>{{cite journal | vauthors = Proctor SJ, Dickinson AM, Parekh T, Chapman C | title = Umbilical cord blood banks in the UK | journal = BMJ | volume = 323 | issue = 7304 | pages = 60–61 | date = July 2001 | pmid = 11451765 | pmc = 1120738 | doi = 10.1136/bmj.323.7304.60 }}</ref> More research is necessary prior to the generalized utilization of cord blood transfusion.<ref name=Glu2015 />

Cord blood stem cells are being studied for treatment for COVID-19 ]s since these and other perinatal (cord tissue and placental tissue derived) stem cells can secrete anti-inflammatory molecules. Dozens of clinical trials are under way to see if they can help patients with ].<ref>{{Cite news|url=https://www.nytimes.com/interactive/2020/science/coronavirus-drugs-treatments.html|title=Coronavirus Drug and Treatment Tracker| vauthors = Wu KJ, Zimmer C, Corum J |newspaper=The New York Times|date=16 July 2020}}</ref>

Some clinical studies show that one year after the transplant of UM171 (a haematopoietic stem cell self-renewal agonist), transplant-related mortality was 5% and relapse incidence was at 21%. Furthermore, only 3 of 22 patients (~14%) who received the UM171-expanded cord blood transplantation died.<ref>{{cite journal | vauthors = Cohen S, Bambace N, Ahmad I, Roy J, Tang X, Zhang MJ, Burns L, Barabé F, Bernard L, Delisle JS, Kiss T, Lachance S, Roy DC, Veilleux O, Sauvageau G | title = Improved outcomes of UM171-expanded cord blood transplantation compared with other graft sources: real-world evidence | journal = Blood Advances | volume = 7 | issue = 19 | pages = 5717–5726 | date = October 2023 | pmid = 37467030 | doi = 10.1182/bloodadvances.2023010599 | doi-access = free | pmc = 10539875 }}</ref><ref>{{cite journal | vauthors = Cohen S, Roy J, Lachance S, Delisle JS, Marinier A, Busque L, Roy DC, Barabé F, Ahmad I, Bambace N, Bernard L, Kiss T, Bouchard P, Caudrelier P, Landais S, Larochelle F, Chagraoui J, Lehnertz B, Corneau S, Tomellini E, van Kampen JJ, Cornelissen JJ, Dumont-Lagacé M, Tanguay M, Li Q, Lemieux S, Zandstra PW, Sauvageau G | title = Hematopoietic stem cell transplantation using single UM171-expanded cord blood: a single-arm, phase 1-2 safety and feasibility study | journal = The Lancet. Haematology | volume = 7 | issue = 2 | pages = e134–e145 | date = February 2020 | pmid = 31704264 | doi = 10.1016/S2352-3026(19)30202-9 }}</ref>

A woman was reported to have been cured of ] (HIV), the third person ever to be cured of the disease, using a transplantation of cord blood.<ref>{{Cite news| vauthors = Mandavilli A |date=15 February 2022|title=A Woman Is Cured of H.I.V. Using a Novel Treatment|work=The New York Times|url=https://www.nytimes.com/2022/02/15/health/hiv-cure-cord-blood.html|access-date=16 February 2022}}</ref>


== References == == References ==
{{Reflist|30em}}<!--- {{Reflist}}
'''NOTICE: Please do not add links to commercial banking sites. If the site makes a profit by banking blood, it's a commercial site, even if it also provides information. Such links will be immediately removed. Only public information sites (on either side of the debate) should be included here. Thank you.'''
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'''NOTICE: Please do not add links to commercial banking sites. If the site makes a profit by banking blood, it's a commercial site, even if it also provides information. Such links will be immediately removed. Only public information sites (on either side of the debate) should be included here. Thank you.''' '''NOTICE: Please do not add links to commercial banking sites. If the site makes a profit by banking blood, it's a commercial site, even if it also provides information. Such links will be immediately removed. Only public information sites (on either side of the debate) should be included here. Thank you.'''
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{{DEFAULTSORT:Cord Blood}}
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Latest revision as of 11:40, 10 January 2025

Blood in the placenta and umbilical cord after birth

Pharmaceutical compound
Cord blood
Clinical data
Trade namesAllocord, Ducord, Hemacord, others
AHFS/Drugs.comMicromedex Detailed Consumer Information
Micromedex Detailed Consumer Information
License data
Routes of
administration		Intravenous
ATC code
  • None
Legal status
Legal status
Identifiers
DrugBank
UNII

Cord blood (umbilical cord blood) is blood that remains in the placenta and in the attached umbilical cord after childbirth. Cord blood is collected because it contains stem cells, which can be used to treat hematopoietic and genetic disorders such as cancer.

Constituents

Cord blood is composed of all the elements found in whole blood – red blood cells, white blood cells, plasma, platelets. Compared to whole blood some differences in the blood composition exist, for example, cord blood contains higher numbers of natural killer cells, lower absolute number of T-cells and a higher proportion of immature T-cells. However, the interest in cord blood is mostly driven by the observation that cord blood also contains various types of stem and progenitor cells, mostly hematopoietic stem cells. Some non-hematopoietic stem cell types are also present in cord blood, for example, mesenchymal stem cells, however these are present in much lower numbers than what can be found in adult bone marrow. Endothelial progenitor cells and multipotent unrestricted adult stem cells can also be found in cord blood. Unlike embryonic stem cells which are pluripotent, cord blood stem cells are multipotent.

Medical uses

Cord blood is used the same way that hematopoietic stem cell transplantation is used to reconstitute bone marrow following radiation treatment for various blood cancers, and for various forms of anemia. Its efficacy is similar as well.

Adverse effects in transplantation

Adverse effects are similar to hematopoietic stem cell transplantation, namely graft-versus-host disease if the cord blood is from a genetically different person, and the risk of severe infection while the immune system is reconstituted. To assure that the smallest amount of complications occur during transplantation, levels of engraftment must be present; specifically both neutrophils and platelets must be being produced. This process of neutrophil and platelet production after the transplant, however, takes much longer than that of stem cells. In many cases, the engraftment time depends on the cell dose, or the amount of stem cells obtained in the sample of blood. In Dr. Moise's article about umbilical cord blood, it was found that there is approximately 10% less stem cells in cord blood than there is in bone marrow. Therefore, a sufficient amount of cord blood must be obtained in order to collect an adequate cell dose, however this amount varies from infant to infant and is irreplaceable. Given that this idea is quite new, there is still a lot of research that needs to be completed. For example, it is still unknown how long cord blood can safely be frozen without losing its beneficial effects. There is a lower incidence with cord blood compared with traditional HSCT, despite less stringent HLA match requirements.

Collection and storage

Umbilical cord blood is the blood left over in the placenta and in the umbilical cord after the birth of the baby. There are several methods for collecting cord blood. The method most commonly used in clinical practice is the "closed technique", which is similar to standard blood collection techniques. With this method, the technician cannulates the vein of the severed umbilical cord using a needle that is connected to a blood bag, and cord blood flows through the needle into the bag. On average, the closed technique enables collection of about 75 ml of cord blood.

Collected cord blood is cryopreserved and then stored in a cord blood bank for future transplantation. Cord blood collection is typically depleted of red blood cells before cryopreservation to ensure high rates of stem cell recovery.

History

The first successful cord blood transplant (CBT) was done in 1988 in a child with Fanconi anemia. Early efforts to use CBT in adults led to mortality rates of about 50%, due somewhat to the procedure being done in very sick people, but perhaps also due to slow development of immune cells from the transplant. By 2013, 30,000 CBT procedures had been performed and banks held about 600,000 units of cord blood.

Society and culture

Legal status

Hemacord (HPC, cord blood) was approved for medical use in the US in 2011.

Ducord (HPC Cord Blood) was approved for medical use in the US in 2012.

Allocord (HPC Cord Blood) was approved for medical use in the US in 2013.

Cordcyte was approved for medical use in the US in 2013.

Clevecord (HPC Cord Blood) was approved for medical use in the US in 2016.

Regenecyte (HPC, Cord Blood) was approved for medical use in the US in November 2024.

Regulation

The AABB has generated voluntary accreditation standards for cord blood banking facilities.

In the United States, the Food and Drug Administration regulates any facility that stores cord blood; cord blood intended for use in the person from whom it came is not regulated, but cord blood for use in others is regulated as a drug and as a biologic. Several states have regulations for cord blood banks.

In the European Union, Canada, and Australia use of cord blood is regulated. In the United Kingdom, the NHS Cord Blood Bank was set up in 1996 to collect, process, store and supply cord blood; it is a public cord blood bank and part of the NHS.

Private and public banks

A cord blood bank may be private (i.e. the blood is stored for and the costs paid by donor families) or public (i.e. stored and made available for use by unrelated donors). While public cord blood banking is widely supported, private cord banking is controversial in both the medical and parenting community. Although umbilical cord blood is well-recognized to be useful for treating hematopoietic and genetic disorders, some controversy surrounds the collection and storage of umbilical cord blood by private banks for the baby's use. Only a small percentage of babies (estimated at between 1 in 1,000 to 1 in 200,000) ever use the umbilical cord blood that is stored. The American Academy of Pediatrics 2007 Policy Statement on Cord Blood Banking stated: "Physicians should be aware of the unsubstantiated claims of private cord blood banks made to future parents that promise to insure infants or family members against serious illnesses in the future by use of the stem cells contained in cord blood." and "private storage of cord blood as 'biological insurance' is unwise" unless there is a family member with a current or potential need to undergo a stem cell transplantation. The American Academy of Pediatrics also notes that the odds of using a person's own cord blood is 1 in 200,000 while the Institute of Medicine says that only 14 such procedures have ever been performed.

Private storage of one's own cord blood is unlawful in Italy and France, and it is also discouraged in some other European countries. The American Medical Association states "Private banking should be considered in the unusual circumstance when there exists a family predisposition to a condition in which umbilical cord stem cells are therapeutically indicated. However, because of its cost, limited likelihood of use, and inaccessibility to others, private banking should not be recommended to low-risk families." The American Society for Blood and Marrow Transplantation and the American Congress of Obstetricians and Gynecologists also encourage public cord banking and discourage private cord blood banking. Nearly all cord blood transplantations come from public banks, rather than private banks, partly because most treatable conditions can't use a person's own cord blood. The World Marrow Donor Association and European Group on Ethics in Science and New Technologies states "The possibility of using one's own cord blood stem cells for regenerative medicine is currently purely hypothetical....It is therefore highly hypothetical that cord blood cells kept for autologous use will be of any value in the future" and "the legitimacy of commercial cord blood banks for autologous use should be questioned as they sell a service which has presently no real use regarding therapeutic options."

The American Academy of Pediatrics, or AAP, supports efforts to provide information about the potential benefits and limitations of cord blood banking and transplantation so that parents can make an informed decision. Cord blood education is also supported by legislators at the federal and state levels. In 2005, the National Academy of Sciences published an Institute of Medicine (IoM) report titled "Establishing a National Cord Blood Stem Cell Bank Program".

In March 2004, the European Union Group on Ethics (EGE) has issued Opinion No.19 titled Ethical Aspects of Umbilical Cord Blood Banking. The EGE concluded that "he legitimacy of commercial cord blood banks for autologous use should be questioned as they sell a service, which has presently, no real use regarding therapeutic options. Thus they promise more than they can deliver. The activities of such banks raise serious ethical criticisms."

Research

Though uses of cord blood beyond blood and immunological disorders is speculative, some research has been done in other areas. Any such potential beyond blood and immunological uses is limited by the fact that cord cells are hematopoietic stem cells (which can differentiate only into blood cells), and not pluripotent stem cells (such as embryonic stem cells, which can differentiate into any type of tissue). Cord blood has been studied as a treatment for diabetes. However, apart from blood disorders, the use of cord blood for other diseases is not in routine clinical use and remains a major challenge for the stem cell community.

Along with cord blood, Wharton's jelly and the cord lining have been explored as sources for mesenchymal stem cells (MSC), and as of 2015 had been studied in vitro, in animal models, and in early stage clinical trials for cardiovascular diseases, as well as neurological deficits, liver diseases, immune system diseases, diabetes, lung injury, kidney injury, and leukemia.

Cord blood is being used to get stem cells with which to test in people with type 1 diabetes mellitus. The stem cells from umbilical cord blood are also being used in the treatment of a number of blood diseases including blood cancers.

Cord blood is also being studied as a substitute for normal blood transfusions in the developing world. More research is necessary prior to the generalized utilization of cord blood transfusion.

Cord blood stem cells are being studied for treatment for COVID-19 cytokine storms since these and other perinatal (cord tissue and placental tissue derived) stem cells can secrete anti-inflammatory molecules. Dozens of clinical trials are under way to see if they can help patients with COVID-19.

Some clinical studies show that one year after the transplant of UM171 (a haematopoietic stem cell self-renewal agonist), transplant-related mortality was 5% and relapse incidence was at 21%. Furthermore, only 3 of 22 patients (~14%) who received the UM171-expanded cord blood transplantation died.

A woman was reported to have been cured of human immunodeficiency virus (HIV), the third person ever to be cured of the disease, using a transplantation of cord blood.

References

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  39. Caseiro AR, Pereira T, Ivanova G, Luís AL, Maurício AC (2016). "Neuromuscular Regeneration: Perspective on the Application of Mesenchymal Stem Cells and Their Secretion Products". Stem Cells International. 2016: 9756973. doi:10.1155/2016/9756973. PMC 4736584. PMID 26880998.
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