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Young-Ho Lee, MD
Abstract
Cord blood (CB) has been used as an important source for hematopoietic stem cell transplantation and has been stored in public CB banks (CBBs) worldwide since the mid-1990s. Recently, the application of cell-based therapy using CB has expanded its clinical utility for various refractory diseases and immunologic diseases through the manufacture of mesenchymal stem cells or induced pluripotent stem cells and the isolation of mononuclear cells from CB. In this review, I briefly summarize the biologic characteristics and banking process of CB, as well as the current status of public and private CBBs. I also review the current status of stem cell transplantation and cell-based therapy using CBs. Finally, I suggest strategies of banking CBs in anticipation of future medical advances.
Figures and Tables
Figure 1
Cord blood contains hematopoietic stem cells as well as multipotent stem cells such as mesenchymal stem cells which have the ability to regenerate numerous tissue types. RBC, red blood cell; WBC, white blood cell.
Figure 2
Cryopreservation process following separation of mononuclear cells from collected cord blood. (A) After removal of the newborn from the operative field, the free end of the cord was wiped with betadine to ensure sterility of the collections. While the placenta was still in utero, the umbilical vein is punctured and the cord blood (CB) is collected by gravity in the collection bag. (B) The CB unit is first centrifuged. (C) The white blood cell-rich supernatant is expressed into the original collection bag and the plasma discarded into the satellite bag after a second centrifugation, leaving a volume of about 25 mL. (D) Cryoprotectant, 10% dimethysuloxide is mixed with separated mononuclear cells from CB. (E) Processed CB units are cryopreserved using an automated microprocessor-controlled rate freezer until −90℃. (F) At the end of the freezing procedure the cells are stored in the liquid phase of a liquid nitrogen freezer.
Figure 3
Suggested business model for public and private cord blood banks (CBBs) operating as current good manufacturing practice (cGMP) cell factories. The total nucleated cell counts of cord blood (CB) banking guidelines need to be increased to enhance the utilization rate of stored CBs in public CBBs, and private and public CB samples with low cell doses should be released for use in clinical trials in transplant settings as well as non-transplant settings. cGMP cell factories could manipulate fractionated CBs and generate cellular products that could be released for cell therapies. HSCT, hematopoietic stem cell transplantation; DM, diabetes mellitus; HSC, hematopoietic stem cell; DLI, donor lymphocyte infusion; MSC, mesenchymal stem cell; GVHD, graft versus host disease; HIE, hypoxic ischemic encephalopathy; CMP, cardiomyopathy; BPD, bronchopulmonary dysplasia; Treg, regulatory T; DC, dendrtitic cell; NK natural killer; CAR, chimeric antigen receptors; iPS, induced pluripotent stem cell.
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