[Harvest of Stem Cells from Umbilical Cord Blood: Relevance of Perinatal Factors for the Quality of Umbilical Cord Transplant Units]

Einleitung Nabelschnurblut (NSB) enthält hämatopoetische Stammzellen mit therapeutischem Potenzial und einzigartigen zellulären Eigenschaften. Aufgrund der begrenzten Anzahl an Stammzellen im NSB (Surrogatmarker total nucleated cells, TNC) eignet sich nur jede fünfte Spende für eine Transplantation. Ziel dieser Studie war es, zu untersuchen, ob prädiktive Faktoren für eine TNC-Zahl über der 99. Perzentile existieren.

Material und Methodik Retrospektive Datenanalyse der 100 größten NSB-Spenden (Top100-Kohorte) aus 2299 registrierten Einheiten. Unterschiede zwischen maternalen, fetalen und geburtshilflichen Faktoren wurden analysiert und mit einer standardisierten Kohorte von 731 NSB-Spenden verglichen.

Ergebnisse Das mütterliche Alter und der BMI in der Top100-Kohorte waren höher als in der Vergleichskohorte (32 vs. 31 Jahre, p=0,007; 30 kg/m2 vs. 29 kg/m2, p=0,024). Es gab mehr Erstgebärende (76,0 vs. 62,8%, p=0,013) und Gestationsdiabetikerinnen (5,00 vs. 1,65%, p=0,044). Die Schwangerschaftswoche, das Geburtsgewicht, der Anteil vaginal-operativer Geburten und sekundärer Sectiones war in der Top100-Kohorte höher (40+4 vs. 40+1 SSW, p=0,002), (3700 vs. 3450 g, p<0,001), (53,0 vs. 22,7%, p<0,001) (10 vs. 6,2%, p=0,014).

Fazit Für eine erfolgreiche Transplantation ist die Höhe der TNC-Zahl entscheidend. Vaginal-operative Entbindungen, sekundäre Sectiones und ein Geburtsgewicht über 3700 g sind günstige Faktoren. Gerade bei Geburten mit einem pathologischen Verlauf sollte nach sicherer Versorgung von Mutter und Kind nicht auf eine Entnahme verzichtet werden.

Antenatal predictors of stem cell content for successful umbilical cord blood donation

Purpose

The most important HLA-independent factor for the selection of cord blood units (CBU) for hematopoietic stem cell transplantation is the total nucleated cell (TNC) count over 150 × 10⁷ as a surrogate marker for stem cell content. The purpose of this prospective study was to define prenatal clinical predictors for TNC count that would help to identify successful CBU donors before the onset of active labor.

Methods

This was a prospective analysis of 594 CBUs, collected from all eligible term singleton pregnancies at Basel University Hospital between 4/2015 and 9/2016 analyzing several maternal and fetal factors. The impact of these factors on TNC count (< 150 × 10⁷ cells vs. ≥ 150 × 10⁷ cells) of the CBUs was modeled in a multivariate analysis.

Results

A total of 114 (19.2%) CBUs had a TNC count of ≥ 150 × 10⁷. In a ROC analysis there was no significant difference between the AUC of all prenatal factors (AUC 0.62) and estimated fetal birth weight by ultrasound alone (AUC 0.62). For women planning a trial of labor a recruitment cut-off at an estimated birth weight of 3300 g would allow 72.6% of all donors with sufficient TNC count to be recruited and 22.8% of all collected CBUs would have a sufficient TNC count for banking. For women planning for elective CS a cut-off of 3400 g would allow 71.4% of all donors with sufficient TNC count to be recruited and 22.7% of all collected CBUs would have sufficient TNC count for banking.

Conclusion

The estimated fetal birth weight within 2 weeks of delivery by ultrasound as single parameter can be considered at the time of recruitment to estimate the chances of a successful CBU donation.

Umbilical cord blood cells for the treatment of preterm white matter injury: Potential effects and treatment options

Preterm birth is a global public health problem. A large number of preterm infants survive with preterm white matter injury (PWMI), which leads to neurological deficits, and has multifaceted etiology, clinical course, monitoring, and outcomes. The principal upstream insults leading to PWMI initiation are hypoxia-ischemia and infection and/or inflammation and the key target cells are late oligodendrocyte precursor cells. Current PWMI treatments are mainly supportive, and thus have little effect in terms of protecting the immature brain or repairing injury to improve long-term outcomes. Umbilical cord blood (UCB) cells comprise abundant immunomodulatory and stem cells, which have the potential to reduce brain injury, mainly due to anti-inflammatory and immunomodulatory mechanisms, and also through their release of neurotrophic or growth factors to promote endogenous neurogenesis. In this review, we briefly summarize PWMI pathogenesis and pathophysiology, and the specific properties of different cell types in UCB. We further explore the potential mechanism by which UCB can be used to treat PWMI, and discuss the advantages of and potential issues related to UCB cell therapy. Finally, we suggest potential future studies of UCB cell therapy in preterm infants.

Factors associated with blood cord unit bankability: an analysis of a 15-year-long case series

Blood banking is a long and complex process requiring an accurate screening of potential donors and high-quality control systems. Previous studies in literature investigated factors potentially determining a higher cell levels with the aim of optimizing donors' selection and improving banking process. This study aims to identify factors associated with the concentration of stem cells in umbilical cord blood, so increasing the probability of bankability, focusing on the possible implications in terms of obstetric and resources management. This is a retrospective study conducted in the Obstetric Units of two Italian Hospitals in Montebelluna and Castelfranco Veneto. Study has been conducted on cord blood units banked between 1999 and 2015. Data on medical histories and clinical characteristics of mother and baby have been retrieved via a retrospective examination of medical records. A total of 869 cord blood units were studied. At multivariable analysis, in agreement with literature, birthweight and placental weight have been found to be associated with higher concentration of total nucleated cells. As additional factor, amount of fluid infused was associated with cord blood units' count. This study is the first one to clearly identify the role of fluid infusion on cord blood units' counts in addition to placental weight and delivery. Some non-modifiable features can help in predicting bankability from pre-natal aspects to factors more related with obstetric management is suggested.

Umbilical cord blood stem cell therapy in premature brain injury: Opportunities and challenges

Preterm birth and associated brain injury are the primary cause of cerebral palsy and developmental disabilities and are among the most serious global health issues that modern society faces. Current therapy for infants suffering from premature brain injury is still mainly supportive, and there are no effective treatments. Thus there is a pressing need for comparative and translational studies on how to reduce brain injury and to increase regeneration and brain repair in preterm infants. There is strong supporting evidence for the use of umbilical cord blood (UCB)-derived stem cell therapy for treating preterm brain injury and neurological sequelae. UCB-derived stem cell therapy is effective in many animal models and has been shown to be feasible in clinical trials. Most of these therapies are still experimental, however. In this review, we focus on recent advances on the efficacy of UCB-derived stem cell therapy in preterm infants with brain injury, and discuss the potential mechanisms behind their therapeutic effects as well as application strategies for future preclinical and clinical trials.

From cord to caudate: characterizing umbilical cord blood stem cells and their paracrine interactions with the injured brain

Stem cells are proving to be a promising therapy for a wide range of pediatric disorders, from neonatal hypoxic-ischemic encephalopathy to pediatric leukemia. Owing to their low immunogenicity and ease of availability, umbilical cord blood (UCB) progenitor cells are increasingly replacing fetal- and adult-derived cells in therapeutic settings. Multiple environmental and demographic factors affect the number and type of stem cells extracted from UCB, and these differences have been associated with disparities in outcomes after transplantation. To avoid variations in efficacy, as well as the potential adverse effects of stem cell transplantation, evaluation of the stem cell secretome is critical to identify key paracrine signals released by the stem cells that could be used to provide similar neuroprotective effects to stem cell transplantation. This article describes the cell types found in UCB and reviews the available literature surrounding the effects of collection timing and volume, maternal risk factors, delivery characteristics, and neonatal demographics on the cellular composition of UCB. In addition, the current findings regarding the stem cell secretome are discussed to identify factors that could be used to supplement or replace stem cell transplantation in pediatric neuroprotection.

Associated factors of umbilical cord blood collection quality

After 30 years of hematopoietic stem cell use for various indications, umbilical cord blood is considered as an established source of cells with marrow and postmobilization peripheral blood. The limited number of cells still remains a problematic element restricting their use, especially in adults who require to be grafted with a higher cell number. Improving the quality of harvested cord blood, at least in terms of volume and amount of cells, is essential to decrease the number of discarded units. In this review, we examine several variables related to parturient, pregnancy, labor, delivery, collection, the newborn, umbilical cord, and placenta. We aim to understand the biologic mechanisms that can impact cord blood quality. This knowledge will ultimately allow targeting donors, which could provide a rich graft and improve the efficiency of the collection.