Genética Humana e Embriologia

Umbilical Cord Blood: Medical Waste or Important Source of Stem Cells?

Abstract

Alexandrina Burlacu

The identification of new sources of stem cells may provide significant clinical benefits in the regenerative medicine. Although sometimes still regarded as a medical waste, the blood remained in the umbilical vein after birth (Umbilical Cord Blood, UCB) has become a valuable alternative source of haematopoietic stem cells for the treatment of various disorders. Using UCB is advantageous because it is obtained by a simple, safe and painless procedure when the baby is delivered. The immaturity of UCB cells resulted in a reduced graft-versus-host disease when compared to bone marrow grafts. Furthermore, there may be particular utility in using UCB in the context of HLA mismatch between available donor and recipient. However, due to the limited number of stem cells, the progress in the field has been largely restricted to children. Nevertheless, evidence supporting the efficacy of a double transplant of UCB in adults has significantly increased over the past years, as an alternative to bone marrow transplantation in those adult patients where no compatible donors are available. Today, new parents may choose to have the UCB stored in a stem cell bank. These banks can be public (non-profit) or private (for-profit). The public banks store UCB from donors and provide it when transplantation is prescribed to an unrelated patient. Unfortunately, donation to a public bank is not possible everywhere, although their number is growing. On contrary, the private banks offer a commercial service to parents in order to preserve the UCB for future needs of their child. Storing UCB in such private banks is controversial and recommended only in the case of historical existence of a genetic disease; otherwise the likelihood of stored UCB being used in autologous transplant is negligible. This and other ethical aspects of UCB banking are discussed in this paper.