Twenty-eight years ago, on 6 October 1988, the Saint-Louis hospital in Paris was the scene of a historical landmark in the field of medicine. Thanks to the pioneering work of Dr Eliane Gluckman and scientist and physician Hal Broxmeyer, a five-year-old boy was cured of Fanconi anaemia (a rare inherited anaemia) after being given a transplant of stem cells from the blood of his sister's umbilical cord.
In 1990, the University of Minneapolis again proved the success of this procedure: a boy with leukemia received a successful transplant of stem cells of an umbilical cord, on this occasion from an unrelated donor. That operation was carried out by Dr John Wagner, who is considered nowadays the leading expert in this field.
In 2006, at a conference in Madrid, Dr Wagner described the stem cells of an umbilical cord as “the most valuable treasure of the United States”. Eleven years later, his opinion has not changed:
“The blood from the umbilical cord is still a unique medical resource. It is special and renewable, so why would we stop making use of it? It has a great many and excellent advantages,” he says.
Most common uses
This type of blood is collected with no risk to the donor and is immediately available at the moment the patient needs it. It is also free of viruses such as herpes, mononucleosis, varicella and zoster, because it has never been exposed to them; they can, however, be present in bone marrow. The HLA compatability at the time it is used is much less strict than with any other adult source of stem cells. In other words, “with just four compatible antigens it is suitable for a transplant, because the cells are immature and naive”.
Blood from the umbilical cord is mainly used for patients who need a bone marrow transplant, such as those with illnesses such as acute myeloid lukemia, acute lymphatic leukemia, myelodysplastic syndrome, Non-Hodgkin lymphoma, severe aplastic anaemia, metabolic disorders (Hurler syndrome and adrenoleukodystrophy), severe combined immunodeficiency, falciform anaemia and thalassemia. It is also “very valuable for auto-immune illnesses, such as severe Crohn's and sclemoderma, as well as serious types of epidermolisis bullosa,” says Dr Wagner.
Now aged 62, this American doctor has carried out more than 1,300 transplants of blood from the umbilical cord at the haematology unit of Minnesota University, where he is the medical director of the pediatric bone marrow transplant programme. He is also a member of the Bioethics and Medical-Scientific Committee at Vidacord, the first family cord blood bank authorised in Spain, which has its own laboratory in Alcalá de Henares (Madrid).
At present more than 600,000 units of umbilical cord blood are stored in banks worldwide and more than 30,000 transplants have been carried out. The patients were suffering from plasma cell disorders, leukemias (32 per cent), non-malignant disorders, solid tumors and also lymphoid neoplasias, Non-Hodgkins lymphoma and Hodgkins lymphoma. This is an impressive number for a technique which is barely 29 years old.
“At present, stem cells from the foetal cord are used to treat around 80 serious illnesses, but the potential to treat other anomalies in health is one of the most exciting discoveries in medicine,” says Dr Luis Madero, head of the Onco-hematology department at the Niño Jesús hospital in Madrid.
John Wagner agrees: “The use of blood from the umbilical cord is increasing. Studies are being carried out at present to look at its use in cardiopathies and other congenital malformations, autism and, most advanced of all, cerebral palsy and type 2 diabetes,” he explains.
The case of Tomás
Last summer, the case of little Tomás was in the news. This little boy from Ecuador suffered a lack of oxygen because the incubator in which he was placed after being born prematurely was not working properly. This error caused spastic tetraplegia, a form of cerebral palsy which affected the movement of his arms and legs. Luckily, his parents had decided to keep his umbilical cord, and this decision made it possible for Tomás to recover.
“I'll never forget that awful moment when the doctors told us our son would never be able to talk or walk. Now he lives a normal life, but he would never have been able to recover if we hadn't decided to keep the blood from the umbilical cord,” says Diana, his mother.
Dr Wagner says plenty of other research is being carried out at present: “The blood from the umbilical cord is also a source of non-hematopoietic cells which can help children with severe brain traumas. At the Duke University Hospital in North Carolina, they have been studying this for years. We have a group of children with cerebral palsy whose umbilical cord blood was kept when they were born and has been given to them intravenously. After a few months, we have seen notable improvements in their cerebral connections, which has meant they can even walk and talk, but we are still studying the way it works. We are still at the testing stage, so we have to be cautious.”
Dr Wagner also points out that regulatory T-cells (non-hematopoietic cells) are important in treating type 1 diabetes.
“Several studies are being carried out at present, using the blood from the umbilical cord with the aim of modulating the immune system of patients with type 1 diabetes, in such as way that it doesn't act against their own insulin-forming cells. The final objective is to reduce as far as possible the need for synthetic insulin, combined with good control of blood sugar levels,” he explains.
At the Mayo Clinic in the USA, Dr Susana Cantero explains that in the past ten years research has been carried out on another important area of medicine, iPS cells (induced pluripotent stem cells), from which any human tissue can be generated without having to use embryonic stem cells.
These are cells created in the laboratory, normally from a piece of skin, but also from the blood of an umbilical cord. “It could be a major advance in regenerative medicine. The advantage of the blood from the umbilical cord is that its cells are younger and and they have longer telomeres. Also, the blood from the umbilical cord is obtained from newly-born babies who have not been exposed to any viruses, unlike the skin from adults. That is why we consider the blood from the umbilical cord to be an ideal source for the creation of iPS cells,” she explains.