Umbilical cord blood and amniotic fluid stem cells in therapy

Fetal stem cells are quickly gaining popularity as therapeutic tools to assist with a variety of disorders. Part of their appeal is the fact that they are obtained without causing any harm to the donor, and avoid the ethical conundrums surrounding embryonic stem cells. The umbilical cord, placenta, and amniotic sac and fluid are all normally discarded following birth, but are rich sources of stem cells. Here we are going to look into the uses of umbilical cord blood and amniotic stem cells in modern therapy, and whether there are benefits to using one type or the other for different applications.

There are two major types of stem cells that are typically used for therapies today: hematopoietic stem cells (HSCs) and mesenchymal stem cells (MSCs). HSCs are found in the bone marrow in adults, and give rise to all types of blood and immune cells. MSCs develop into connective tissues and can grow into bone, cartilage, muscle, and fat. Both kinds of stem cells are found in the umbilical cord as well as the amniotic fluid which surrounds and cushions a developing fetus. However, umbilical cord blood has a much higher concentration of these cells, especially HSCs.1,2
Since stem cells can develop into a variety of specialized cell types (a process known as differentiation), they are useful for a range of applications. In addition to their ability to grow and repair different types of tissue, stems cells come with a very low risk of graft-versus-host disease.1,2 Therefore, stem cells that have been banked from birth can be used to help the donor as they grow older as well as other patients that may not be related to the donor.

Amniotic fluid stem cells offer a couple of advantages over umbilical cord stem cells. First is that some of these cells can actually be obtained before birth through a process known as amniocentesis.3 This comes in handy if the developing baby is found to have a congenital disorder such as a heart defect. The baby’s own stem cells can be collected ahead of time, then used to repair the defective organ immediately after birth4 or to treat post-natal complications such as encephalopathy5 or lung problems.6 Second is that amniotic fluid contains a very small amount of embryonic stem cells (ESCs) on top of the other stem cell types. ESCs are able to differentiate into a greater variety of mature cells types than either HSCs or MSCs, and studies have suggested they may be better at repairing certain tissues such as cardiac muscle.4

The downside to amniotic fluid is the relatively low concentration of stem cells. Stem cells from amniotic fluid have to be filtered and concentrated a great degree before they are usable. Beware of companies selling products simply labeled as “amniotic fluid”, “amniotic tissue”, “amniotic cells” or “birth tissue”; they likely have very few if any actual stem cells in them! Any products that use the term “stem cells” are regulated by the FDA, and organizations following FDA guidelines (including Rejuva Stem Cell Clinic) are held to high standards for safety and quality.7 There are rogue clinics locally and nationally that purchase a much cheaper product and can deliver that cheaper product to patients for less money. Obviously, the expectation of a good result drops dramatically with these treatments.

Most research on the use of fetal stem cells for treating adult diseases has been done with umbilical cord blood stem cells. To date, clinical trials have tested the use of umbilical cord blood stem cells on many diseases including cardiac disease,8 muscle disorders,1 cancers including leukemia,9 cerebral palsy,10 eye and skin burns,11,12stroke,13 kidney injury,14 brain damage,15 blood and immune disorders,16 and musculoskeletal injuries.17 It is likely we are only seeing the beginning of what stem cell therapy will one day be capable of.

umbilical cord blood

Resources
1. Pozzobon M, Franzin C, Piccoli M, De Coppi P. Fetal stem cells and skeletal muscle regeneration: a therapeutic approach. Frontiers in aging neuroscience. 2014;6:222.
2. Weiss ML, Troyer DL. Stem cells in the umbilical cord. Stem cell reviews. 2006;2(2):155-162.
3. Savickiene J, Treigyte G, Baronaite S, et al. Human Amniotic Fluid Mesenchymal Stem Cells from Second- and Third-Trimester Amniocentesis: Differentiation Potential, Molecular Signature, and Proteome Analysis. Stem cells international. 2015;2015:319238.
4. Gao Y, Jacot JG. Stem Cells and Progenitor Cells for Tissue-Engineered Solutions to Congenital Heart Defects. Biomarker insights. 2015;10(Suppl 1):139-146.
5. Nabetani M, Shintaku H, Hamazaki T. Future perspectives of cell therapy for neonatal hypoxic-ischemic encephalopathy. Pediatric research. 2018;83(1-2):356-363.
6. Ahn SY, Chang YS, Park WS. Stem cell therapy for bronchopulmonary dysplasia: bench to bedside translation. Journal of Korean medical science. 2015;30(5):509-513.
7. Administration USFaD. Cellular & Gene Therapy Products. 2018; https://www.fda.gov/BiologicsBloodVaccines/CellularGeneTherapyProducts/default.htm. Accessed 06/01/2018, 2018.
8. Bollini S, Silini AR, Banerjee A, Wolbank S, Balbi C, Parolini O. Cardiac Restoration Stemming From the Placenta Tree: Insights From Fetal and Perinatal Cell Biology. Frontiers in physiology. 2018;9:385.
9. Mehta RS, Randolph B, Daher M, Rezvani K. NK cell therapy for hematologic malignancies. International journal of hematology. 2018;107(3):262-270.
10. McDonald CA, Fahey MC, Jenkin G, Miller SL. Umbilical cord blood cells for treatment of cerebral palsy; timing and treatment options. Pediatric research. 2018;83(1-2):333-344.
11. Sharma N, Kaur M, Agarwal T, Sangwan VS, Vajpayee RB. Treatment of acute ocular chemical burns. Survey of ophthalmology. 2018;63(2):214-235.
12. Ma K, Tan Z, Zhang C, Fu X. Mesenchymal stem cells for sweat gland regeneration after burns: From possibility to reality. Burns : journal of the International Society for Burn Injuries. 2016;42(3):492-499.
13. Venkat P, Shen Y, Chopp M, Chen J. Cell-based and pharmacological neurorestorative therapies for ischemic stroke. Neuropharmacology. 2018;134(Pt B):310-322.
14. Hu H, Zou C. Mesenchymal Stem Cells in Renal Ischemia-Reperfusion Injury: Biological and Therapeutic Perspectives. Current stem cell research & therapy. 2017;12(3):183-187.
15. Sun JM, Kurtzberg J. Cord blood for brain injury. Cytotherapy. 2015;17(6):775-785.
16. Shearer WT, Lubin BH, Cairo MS, Notarangelo LD. Cord Blood Banking for Potential Future Transplantation. Pediatrics. 2017;140(5).
17. Teng M, Huang Y, Zhang H. Application of stems cells in wound healing–an update. Wound repair and regeneration : official publication of the Wound Healing Society [and] the European Tissue Repair Society. 2014;22(2):151-160.

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