Pemindahan/Transplantasi Sel Stem - Hospital, Kos dan Sumbernya

Sumber Sel Stem penderma bukan adik-beradik?

Hospital selain dari PPUM yang boleh membuat pemindahan sel stem?

Kos pemindahan sel stem dan kos pendermaan sel stem?

Assalamualaikum WBK,

Salam Sejahtera kepada rakan-rakan saya sekelian, ibu-bapa, bakal ibu-bapa, pengunjung dan pembaca blog ini.

Kali ini Saya ingin menjawab beberapa soalan yang ditujukan oleh pembaca blog ini.


Pembaca juga boleh menghubungi Persatuan Thalassaemia di malaysiathalassaemia@yahoo.com dan melayari laman web mereka di www.tam.org.my.

Jika Doktor anda telah memutuskan untuk melakukan transplant/pemindahan sel stem menggunakan sel stem yang boleh didapati dari darah tali pusat atau pun dari penderma dewasa (sel stem sum-sum tulang yang mengalir melalui saluran darah) atau terus dari tulang (sel stem sum-sum tulang), pihak Hospital patut boleh membantu mengusahakanya. Mereka boleh berhubung dengan Pusat Darah Negara (PDN) Malaysia. PDN memang ada menyimpan sel stem darah tali pusat, masaalahnya adalah untuk mendapatkan sel stem yang sepadan atau serasi dengan anak anda. Kebarangkalian mendapatkan sumber yang sepadan adalah agak rendah. Ada yang menganggarkan sekadar 1 dalam 20 hingga 30 puloh ribu keatas (kurang dari 1 peratus).

Selain dari itu, pihak hospital patut boleh membantu mencari dari bank-bank sel stem kerajaan atau NGO luar negara. Sekali lagi masaalahnya adalah dalam mencari sel stem yang sepadan/serasi dengan pesakit.

Pembaca juga boleh berhubung dengan pihak Pusat Terapi Sel Stem Hospital UKM. Baru-baru ini Pakar Perunding Kanan Hematologi HUKM Profesor Doktor S. Fadilah Abdul Majid telah ditemuramah oleh Bernama TV. Beliau telah menerangkan bahawa HUKM ada menyimpan sel stem sum-sum tulang sumbernya dari saluran darah. Beliau juga telah menerangkan bahawa kebarangkalian untuk mendapatkan penderma bukan adik-beradik, yang serasi/sepadan dari sumber ini adalah 20 hinga 30 peratus.

Setakat yang saya lihat dalam Laporan Transplant Kebangsaan Malaysia, Hospital yang pernah melakukan transplant/pemindahan sel stem termasuk Hospital Kuala Lumpur, Hospital Ampang, Pusat Perubatan Universiti Malaya dan Hospital UKM. Bagi hospital swasta pula saya difahamkan adalah Gleneagles Medical Centre Pulau Pinang, Lam Wah Ee Hospital Pulau Pinang, Sime Darby Medical Center Subang, dan Ampang Puteri KL.

Hospital-hospital ini pernah melakukan pemindahan sel stem. Pembaca perlu bertanya sama ada kesemuanya masih ada pakar yang berkhidmat dan mampu melakukanya. Apa yang berlainan adalah jenis penyakit yang dirawat. Ada yang pakar dalam penyakit dewasa dan ada yang pakar penyakit kanak-kanak. Ada juga yang pakar Talasemia dan ada pula yang pakar Lukimia.

Kosnya juga berbeza dan terpulang kepada jenis penyakit dan jenis rawatan. Apa yang telah diterbitkan adalah sekitar RM60,000 bagi Pusat Perubatan Universiti Malaya. Harga untuk mendapatkan sel stem darah tali pusat dari luar Negara adalah sekitar RM100,000.

Sekian buat masa ini.. Wslm.

Sel Stem: Pengunaan - 1 dalam 200

Maklumat dari laman web www.parentsguidecordblood.org.…….

....Sel Stem Darah Tali Pusat Berupaya Menyelamatkan Nyawa….

….1 dalam 200 mungkin mengunakan Sel Stem Sendiri................

Assalamualaikum WBK,

Salam Sejahtera kepada rakan-rakan saya sekelian, ibu-bapa, bakal ibu-bapa, pengunjung dan pembaca blog ini.

Kali ini Saya ingin terjemahkan dan mengulas maklumat yang boleh didapati dalam laman web www.parentsguidecordblood.org.


Pertubuhan Parents Guide to Cord Blood adalah organisasi yang ditubuhkan bagi tujuan amal dan bukan untuk mencari keuntungan. Ia satu-satunya organisasi di Amerika Syarikat yang menerbitkan maklumat dari kedua-dua jenis bank, iaitu, bank darah tali pusat swasta dan bank kegunaan masyarakat umum. Semenjak tahun 1988 lagi, laman web organisasi ini telah menyediakan maklumat perubatan yang tepat bagi ibu-bapa dalam perihal perbankan/simpanan darah tali pusat.

Pengasasnya Doktor Frances Verter, adalah seorang ibu yang telah kehilangan anak kesayanganya kerana penyakit barah. Beliau juga seorang pakar sains, penyelidik, serta penulis dalam bidang simpanan sel stem darah tali pusat. Pertubuhan ini telah didedikasikan untuk anak kesayanganya.

Misi utama pertubuhan adalah dalam mengajar ibu-bapa dan memberikan maklumat tepat dalam bidang penyelidikan perubatan darah tali pusat, serta menjelaskan jenis-jenis simpanan darah tali pusat yang sedia ada.

Misi keduanya adalah dalam menjalankan serta menulis tentang analisis statistik dan data penyelidikan perubatan, serta perkembangan polisi yang mungkin membawa kepada peningkatan kegunaan darah tali pusat.

“Darah dalam tali pusat bayi berkemampuan untuk menyelamatkan nyawa. Apabila memilih untuk menyimpan darah tali pusat, ibu-bapa sebenarnya membekalkan potensi untuk menolong anak mereka, ahli keluarga, malah orang yang tidak dikenali. Beberapa daerah di Amerika Syarikat telah mengubalkan undang-undang dimana bakal ibu-bapa mesti diberi maklumat mengenai simpanan darah tali pusat.”

Definasi darah tali pusat adalah, darah yang diambil dari tali pusat selepas bayi dilahirkan. Dahulunya, bahan tingalan ini sering dibuang sebagai sisa buangan perubatan. Darah tali pusat mengandungi sejenis sel stem (sel ibu atau sel induk) yang mampu dibekukan untuk kegunaan masa hadapan bagi rawatan perubatan, seperti dalam rawatan transplantasi/pemindahan sel stem dan perubatan regenerasi.

Tali pusat dan uri adalah sumber yang kaya dengan sel stem. Ia berbeza dari sel stem embrio yang bermula dari telur yang telah dipersenyawakan, atau pun mana-mana sel stem yang didapati dari kanak-kanak atau dewasa. Sel stem darah tali pusat akan matang menjadi darah, sistem sel immun, dan berkebolehan untuk berubah manjadi sel-sel jenis lain.

Proses pengambilan darah tali pusat tidak membahayakan atau menyakitkan ibu atau bayi. Darah akan diambil dari tali pusat selepas bayi dilahirkan dan selepas tali pusat telah dikepit dan dipotong. Sel stem darah tali pusat masih mampu berkesan walaupun disimpan pada suhu bilik selama dua hari. Tempuh masa ini adalah cukup untuk menghantarkanya kepada makmal di bandar atau daerah/negeri lain. Di makmal, sel akan diproses dan dikrio-bekukan untuk disimpan. Setelah dibekukan, sel stem mampu berkesan walaupun selepas disimpan berpuluhan tahun.

Kini, jumlah peratusan pesakit yang dirawat dengan kaedah transplantasi sel stem semakin meningkat. Pesakit-pesakit telah menerima darah tali pusat untuk merawat lebih dari 70 jenis penyakit. Tujuh puluh peratus (70%) pesakit yang memerlukan sel stem pembina sistem darah bagi transplantasi, tidak berjaya mendapatkan penderma sel stem yang sepadan, dari kalangan keluarga. Maka, pakar perubatan perlu berusaha untuk mencari penderma dari bank-bank simpanan sel stem masyarakat umum. Program penderma sum-sum kebangsaan (National Marrow Donor Program - www.marrow.org), didedikasikan untuk mendapatkan penderma sum-sum, atau darah tali pusat, dari seluruh dunia, untuk kegunaan pesakit di Amerika Syarikat. Jumlah penderma sum-sum tulang yang sepadan bagi pesakit berketurunan etnik minoriti amat kekurangan. Penderma darah tali pusat mampu menolong pesakit berketurunan etnik minoriti dan pesakit berketurunan etnik campuran. Ini adalah kerana sel darah tali pusat tidak perlu sepadan sepenuhnya dengan pesakit, manakala sel sum-sum tulang dewasa pula perlu sepadan sepenuhnya.

Penyelidik perubatan sedang berusaha untuk menemui rawatan baru dimana sel stem mampu menolong dalam rawatan/pemulihan badan sendiri, ini digelar perubatan regenerasi. Setakat ini, rawatan ini memerlukan sel stem pesakit sendiri dan bukanya sel stem dari penderma. Bagi kanak-kanak yang mempunyai simpanan sel stem sendiri, mereka berpotensi untuk mendapatkan bermacam jenis rawatan perubatan pada masa hadapan. Setakat ini, penyelidik perubatan sedang menjalankan percubaan klinikal bagi penyakit ’Cerebral Palsy’ dan ’Diabetes Type 1’, dengan mengunakan darah tali pusat sendiri pesakit kanak-kanak.

Bagi kebanyakan penyakit seperti penyakit barah dan penyakit genetik, dimana kanak-kanak perlu menerima transplantasi sel stem, mereka memerlukan sel stem penderma, bukanya sel stem sendiri. Bagi transplantasi pesakit dewasa pula, pesakit yang mengunakan sel stem sendiri, sama banyaknya seperti pesakit yang mengunakan sel stem penderma.

Setakat ini, kebarangkalian pesakit mengunakan sel stem pembina sistem darah, bagi mana-mana jenis tranplantasi, dianggarkan 1 dalam 1,700 sebelum sampai umur 20 tahun. Manakala, sebelum umur mencecah 70 tahun, anggaran kegunaanya adalah 1 dalam 200. Pada masa hadapan, jika menjadi kebiasaan, dimana darah tali pusat digunakan bagi perubatan regenerasi, maka tahap kegunaan sel stem diri sendiri akan meningkat.

Sekian buat masa ini.. Wslm.

Latest Parent's Guide to Cord Blood Brochure

I was most pleased to receive Dr. Frances Verter's email informing me yesterday that the Parent's Guide to Cord Blood Brochure (many months in the making) was now available online to download. She's done a wonderful job putting the decision making process into perspective and the artwork is simple but very tastefully done.

You can get a copy of the brochure at this link. It is currently available in three languages.

Rawatan Sel Stem Penyakit Talasemia di Malaysia

Bolehkah Rawatan Sel Stem untuk Penyakit Talasemia didapati di Malaysia?

Berapakah Kos Rawatanya?

Jawapan Profesor Doktor Aw Tar Choon ........
..............Sudah ada di Malaysia................RM60,000+


Assalamualaikum WBK,

Salam Sejahtera kepada rakan-rakan saya sekelian, ibu-bapa, bakal ibu-bapa, pengunjung dan pembaca blog ini.

Kali ini Saya ingin menterjemahkan jawapan kepada soalan pembaca blog ini, daripada Profesor Doktor Aw Tar Choon, Profesor dan Doktor Pakar dalam bidang Perubatan Dalaman serta Pakar Patologi.


1. Transplantasi atau Rawatan mengunakan Sel Stem sum-sum tulang untuk penyakit Talasemia major telah dilakukan untuk kali pertama di dunia pada tahun 1981.

2. Kali Pertama Rawatan mengunakan Sel Stem sum-sum tulang di Pusat Perubatan Universiti Malaya, Malaysia, adalah pada tahun 1987.

3. Kali Pertama Rawatan mengunakan Sel Stem Darah Tali Pusat di Thailand adalah pada tahun 1995.

4. Kali Pertama Rawatan mengunakan Sel Stem Darah Tali Pusat di Malaysia adalah pada tahun 1997.

5. Kini Rawatan ini boleh dilakukan di Pusat Perubatan Universiti Malaya, Hospital Universiti Kebangsaan Malaysia, Hospital Besar Kuala Lumpur serta beberapa Hospital Swasta.

6. Empat (4) pelanggan StemLife Berhad telah berjaya mengunakkan Darah Tali Pusat dan lebih Seratus Lima Puloh (150+) pelanggan Dewasa kami telah mengunakkan Sel Stem Dewasa mereka.

7. Antara empat (4) pelanggan itu, dua (2) adalah untuk penyakit Lukemia dan dua (2) lagi untuk penyakit Talasemia. Rawatan Lukemia pertama pelanggan StemLife telah dilakukan di Hospital Besar Kuala Lumpur pada tahun 2004 dan yang kedua pada tahun 2007 di Pusat Perubatan Universiti Malaya. Rawatan Talasemia pelanggan StemLife adalah pada tahun 2005 dan 2008 di Pusat Perubatan Universiti Malaya.

8. Sepertimana dilapurkan dalam akhbar-akhbar tempatan bagi kes-kes yang tertentu, anggaran Kos untuk pesakit bayaran penuh di Pusat Perubatan Universiti Malaya adalah RM60,000 dan di Hospital Swasta pula kosnya telah dilapurkan sekitar RM200,000.

Sekian buat masa ini......Wslm..WBK

Sel Stem Darah Tali Pusat - Bank Swasta atau Bank Umum?

Simpanan Sel Stem Darah Tali Pusat - Pilihan Bank Simpanan - Bank Swasta atau Bank Masyarakat Umum?

Jawapan dari AABB.......Ada Dua konsep perkhidmatan!

Assalamualaikum WBK,

Salam Sejahtera kepada rakan-rakan saya sekelian, ibu-bapa, bakal ibu-bapa, pengunjung dan pembaca blog ini. Kepada pembaca dari beberapa syarikat tertentu, janganlah cetak rompak atikel ini ya!

Kali ini Saya akan menterjemahkan beberapa lagi jawapan kepada soalan popular (FAQ) yang diterbitkan di laman web Persatuan Bank Darah Amerika (American Association of Blood Banks – AABB www.aabb.org). Ini adalah hanya sebahagian dari soalan-soalan yang dijawab. Saya akan cuba menterjemahkan soalan-soalan yang lain jika masa mengizinkan, Insyallah.


Adakah semua Bank Darah Tali Pusat Sama?

Tidak. Terdapat dua kategori perkhidmatan Bank Darah Tali Pusat (DTP) iaitu Bank Swasta dan Bank Masyarakat Umum (Bank Kerajaan atau Bank NGO). Ada Bank yang menawarkan kedua-dua perkhidmatan sekali gus, tetapi DTP yang disimpan didedikasikan kepada satu jenis kegunaan sahaja. Untuk menerima perkhidmatan dari Bank-Bank itu, Ibu perlu memberikan kebenaran. Perbezaan antara Bank-Bank adalah dari segi ujian, dimana ujian yang dilakukan kepada Ibu dan DTP mungkin berlainan dan terpulang kepada jenis Bank. Organisasi Pentadbiran Pemakanan dan Ubatan USA (The Food and Drug Administration - FDA), yang mengawal industri ini di USA memerlukan supaya kedua-dua jenis Bank, Swasta dan Umum, didaftarkan dengan FDA.


Apakah itu Bank Darah Tali Pusat Masyarakat Umum?

Bank DTP Masyarakat Umum memproses dan menyimpan DTP yang telah diderma oleh masyarakat untuk kegunaan masyarakat umum. Bank Umum menghadkan jumlah DTP minima (dan jumlah sel minima) yang diterima. Had minima ini ditetapkan berdasarkan kepada jumlah yang mungkin mencukupi untuk pesakit yang memerlukan transpantasi. DTP yang tidak memenuhi tahap minima akan dibuang atau akan digunakkan dalam penyelidikan (ini tertakluk dan memerlukan kebenaran dari Ibu). Beberapa Bank Umum mendapati bahawa lebih kurang satu pertiga hingga ke tiga suku dari DTP yang diterimanya tidak mencukupi untuk digunakan dalam transplantasi diatas sebab-sebab tertentu. Oleh kerana ia mungkin bertahun lamanya sebelum DTP itu digunakkan untuk transplantasi, sejarah perubatan keluarga penderma perlu diselidik dan ujian yang terperinci akan dilakukan keatas Ibu. Sejarah keluarga perlu diselidik untuk mengurangkan risiko pesakit terdedah dan dijangkiti penyakit genetik yang mungkin dibawa dalam DTP tersebut. Sampel darah diperlukan dari Ibu dan DTP untuk beberapa ujian, termasuk ujian penyakit berjangkit dan kontaminasi Bakteria. Kesemua maklumat mengenai keluarga yang menderma DTP ini akan disimpan rapi dan dirahsiakan.

Setiap orang mempunyai jenis tisu atau jenis Antijen Lukosit Manusia (Human Leucocyte Antigen - HLA) yang berbeza dan unik. Setiap DTP yang diderma juga adalah kombinasi unik dari ibu dan bapa penderma. Setiap DTP yang diderma akan diuji jenis HLA nya. kandungan selnya juga diselidik. Maklumat ini akan dimasukkan kedalam pengkalan data supaya pakar-pakar dapat mencari DTP yang sepadan apabila mana-mana pesakit memerlukan dermaan DTP. DTP yang disimpan Bank Masyarakat Umum sedia digunakkan oleh sesiapa yang memerlukanya dan bukanya disimpan khas untuk penderma atau pun keluarga penderma. Bank DTP Masyarakat Umum tidak mengenakan apa-apa bayaran/Fi kepada penderma. Tetapi Bank-Bank ini membiayai semula kos mereka dengan mengenakan bayaran/Fi kepada pesakit (atau insuran pesakit) apabila pesakit mengunakkan DTP yang disimpan. Malangnya, bukan semua Hospital dapat berganding bahu dengan Bank DTP Masyarakat Umum, jadi bukanya semua Ibu yang ingin menderma akan dapat mendermakan DTP mereka.

Kongres USA telah meluluskan rang undang-undang yang memulakan dana untuk membina program simpanan DTP Nasional bagi Masyarakat Umum. Salah satu tujuan rang undang-undang ini adalah untuk menambahkan jumlah dan jenis DTP yang sedia ada untuk Masyarakat Umum. Masyarakat minoriti pula kurang bilanganya dalam program ini. Jadi, pesakit dari masyarakat minoriti mungkin mengalami kesukaran untuk mendapatkan DTP yang sepadan denganya.


Apakah itu Bank DTP Swasta?

Bank DTP swasta memproses dan menyimpan DTP khusus untuk kegunaan pelanggan dan keluarga pelanggan. Oleh kerana Bank DTP swasta tidak bekerjasama khusus dengan mana-mana satu Hospital, ibu-ibu akan deberikan kotak koleksi DTP untuk diberikan kepada Doktor pakar pada hari kelahiran bayi. Kotak koleksi sudah sedia mengandungi beg koleksi, pelekat nama, dan bahan-bahan lain yang diperlukan untuk koleksi dan penghantaran DTP ke makmal pemprosesan. Ibu-Bapa akan membayar Fi permulaan untuk pemprosesan dan juga seringkali Fi simpanan tahunan. Maklumat terperinci mengenai perkhidmatan ini termasuk pengangkutan, tanggungjawab penghantaran, tanggungjawab keatas DTP dan isu kegagalan perkhidmatan perlu dijelaskan dalam kontrak antara pelanggan dan Bank. Oleh kerana DTP disimpan khusus untuk kegunaan keluarga sendiri, maka ujian pelanggan, ujian jenis tisu dan ujian-ujian lain mungkin ada atau mungkin tidak dilakukan. Polisi yang diamalkan mungkin berlainan antara Bank-Bank Swasta. Adalah penting untuk diketahui bahawa DTP yang disimpan dalam Bank Swasta tidak boleh didermakan dan digunakkan oleh Masyarakat Umum melainkan kesemua syarat-syarat dipatuhi seperti mendapatkan kebenaran pelanggan (Ibu), ujian umum, ujian penyakit berjangkit, dan ujian jenis tisu. Bank DTP perlu menyediakan lapuran yang mengandungi maklumat makmal untuk setiap ujian dan juga perlu memberi penjelasan dan intepretasi keputusan ujian.

Sekian buat masa ini......Wslm..WBK

Simpanan Sel Stem Darah Tali Pusat

Jawapan dari AABB......."Simpan Dalam Beg Bukan Vail" !!!!!

Assalamualaikum WBK,

Salam Sejahtera kepada rakan-rakan saya sekelian, ibu-bapa, bakal ibu-bapa, pengunjung dan pembaca blog ini. Kepada pembaca dari beberapa syarikat tertentu, janganlah cetak rompak atikel ini ya!

Kali ini Saya ingin menterjemahkan beberapa jawapan kepada soalan popular (FAQ) yang diterbitkan di laman web Persatuan Bank Darah Amerika (American Association of Blood Banks – AABB www.aabb.org). Ini adalah hanya sebahagian dari soalan-soalan yang dijawab. Saya akan cuba menterjemahkan soalan-soalan yang lain jika masa mengizinkan, Insyallah.

Sebelum bermula, Saya ingin menyatakan perbezaan antara Keahlian AABB dan Akreditasi AABB. Semua yang ingin boleh membayar fi dan menjadi ahli AABB, tetapi tiada sesiapa di Malaysia yang mempunyai Akreditasi AABB. StemLife bukanya ahli dan tidak mempunyai Akreditasi AABB. Saya tidak sesekali pun inginkan adanya salah faham. Saya hanya menterjemahkan FAQ yang ada dalam laman web AABB. Petikan dibawah menyatakan betapa beratnya kesalahan mengunakkan logo AABB tanpa kebenaran.

”Only cord blood banks with a current accreditation have permission to use the AABB logo, and AABB investigates reports of misrepresentation or fraudulent use once the misuse is brought to its attention.”

Apakah itu Sel Darah Tali Pusat?

Darah Tali Pusat (DTP), yang pada satu ketika dianggap sebagai sisa buangan, sekarang diterima sebagai sumber sel stem hematopoetik (sel permulaan hematopoetik). DTP serupa dengan sel stem hematopoetik yang boleh didapati dalam sum-sum tulang dan sistem saluran darah. Sel-sel ini boleh digunakan dalam transplantasi sel stem untuk menambahkuatkan sistem imun pesakit, sepertimana sum-sum tulang dan sel stem dari sistem saluran darah digunakan dalam transplantasi untuk merawat penyakit malignan seperti lukemia dan penyakit bukan malignan seperti kepincangan sistem imun dan anemia aplastik, dan penyakit kongenital seperti anemia sel sikle dan talasemia. DTP mengandungi bermacam jenis sel darah, tetapi, hanya sel stem hematopoetik (sel stem pembina darah) sahaja yang berguna dalam transplantasi. Kegunaan lain untuk sel stem DTP masih dalam fasa penyelidikan. Setiap sumber (samada sum-sum tulang, sistem saluran darah, atau DTP) ada kelebihan dan kekuranganya dalam transplantasi. Pesakit perlu berbincang dengan Pakar sel stem sebelum membuat pilihan tentang sumber sel stem paling sesuai yang sepadan dengan pesakit. Pilihan yang sesuai akan bergantung kepada opsen yang sediada dan keadaan pesakit.


What are umbilical cord blood cells?

Umbilical cord blood (UCB), once regarded as biological waste, has become an accepted source of hematopoietic stem cells/hematopoietic progenitor cells (HSCs/HPCs), similar to those found in bone marrow and peripheral blood. These cells can be used to replenish a patient’s immune system by providing stem cells for transplantation, just as bone marrow or peripheral blood stem cell transplants can be used to treat malignant diseases such as leukemia and non-malignant diseases such as immune deficiencies and severe aplastic anemia, and congenital disorders such as sickle cell anemia and thalassemia. UCB contains many types of blood cells but only the hematopoietic — or blood-making — stem cells in the UCB are currently useful for transplant. Other uses of UCB stem cells are currently undergoing research. Each source of HPCs (bone marrow, peripheral blood or cord blood) has advantages and disadvantages associated with its use in a transplant. Decisions about the most appropriate source of stem cells — which must be matched by tissue type to some degree with the recipient — must be made by each patient in consultation with his or her physician based on available options.

Bagaimana Darah Tali Pusat dikumpulkan?

Sejurus selepas bayi dilahirkan, tali pusat akan dikepit dan dipotong. Jarum akan digunakan untuk menyalurkan darah dari saluran vena tali pusat kedalam beg derma darah. Oleh kerana proses ini dilakukan selepas kelahiran bayi, tiada risiko atau sakit dijangka kepada ibu atau bayi. Pengambilan darah boleh dilakukan samada sebelum atau selepas kelahiran uri. Tekniknya berbeza sedikit sesama doktor pakar. Beg DTP akan dilabel dan dihantar ke makmal untuk diproses, dibekukan dan disimpan. Jumlah darah yang diambil berbeza tetapi seringkali dari 50 hingga 200 ml (lebih kurang separuh sehingga secawan penuh).


How are cord blood cells collected?

After the delivery of a newborn, the umbilical cord is clamped and then cut. A needle is then used to draw the blood from the umbilical cord vein into a collection bag. Since this happens after delivery, there is no pain or risk to mother or infant. The collection may take place either before or after delivery of the placenta, and techniques vary slightly among physicians. The UCB product is labeled and shipped to the processing facility for processing, freezing and storage. The volume collected varies but usually ranges from 50 to 200 ml (about one-half to one cup).

Adakah Darah Tali Pusat patut disimpan dalam Beg atau Vail?

AABB menggalakkan inovasi dan penambahbaikan teknologi dan tidak mengesyorkan mana-mana teknik atau pembekal. Ini termasuk koleksi/pendermaan, pemprosesan dan simpanan DTP. Oleh kerana kebanyakkan DTP disalurkan ke dalam beg atau cara simpanan berlainan sebelum dihantar ke makmal untuk diproses, tiada sistem yang ”Tertutup” sepenuhnya. DTP yang didermakan juga besar kemungkinan tidak sterile (bersih dari kuman). Oleh itu, kebanyakan makmal pemprosesan beroperasi diantara sistem separuh-tertutup atau tertutup secara fungsi (termasuk pada masa pendermaan). Tiada definasi yang diterimapakai secara umum untuk mengambarkan proses yang tertutup sepenuhnya. Operasi pengambilan dan pemprosesan DTP secara teorinya mengambilkira bahawa lebih banyak kali DTP terdedah kepada luaran, lebih tinggilah peluang untuk DTP terdedah kepada kontaminasi secara tidak sengaja.

Perdebatan beg lawan vail agak kontroversi. Kerja-kerja awal dalam pemprosesan DTP dalam makmal penyelidikan termasuk pengunaan vail-krio. Vail kecil yang lebih kurang sais jari halus dewasa adalah tidak begitu mahal. DTP dibahagikan ke dalam beberapa vail yang kemudian diletakkan ke dalam kotak kecil untuk disimpan.

Pengamal-pengamal sistem vail ini berpendapat bahawa jika bidang sains simpanan sel stem dapat dimajukan kelak dimana hanya sedikit DTP sahaja diperlukan, maka keseluruhan simpanan DTP tidak perlu dicairkan. DTP secara umum hanya dapat dicairkan sekali sahaja tanpa kehilangan banyak sel stem hidup. Vail juga memerlukan kurang ruang simpanan oleh itu membolehkan lebih DTP disimpan dalam satu tanki simpanan. Sebaliknya, vail kecil lebih sukar untuk dilabel dengan kesemua maklumat yang diperlukan.

Beg simpanan khas untuk simpanan krio sudah direka. Beg ini lebih mahal dan memerluka ruang yang lebih dari vail. Satu kelebihan penggunaan Beg Krio adalah ia merupakan sistem yang lebih ”Tertutup” dan bukanya ”Terdedah” jadi mengurangkan risiko kontaminasi yang tidak sengaja. Satu lagi kelebihan sistem Beg Krio adalah ia membolehkan DTP yang disimpan dalam Beg disambungkan terus kepada sedikit sampel DTP yang disimpan asing dalam ”Tiub/Saluran Bersambung DTP” (Integral Segment). AABB memerlukan DTP disambungkan terus kepada sedikit sampel DTP yang disimpan dalam ”Integral Segment” supaya ujian lanjutan dapat dilakukan keatas sedikit sampel DTP itu. ”Integral Segment” dapat dibentuk apabila tiub/saluran yang bersambung kepada Beg yang mengandungi unit DTP dikepit supaya terbentuk ”Segment”. Sedikit DTP diasingkan tetapi masih bersambung dengan unit DTP asal. Ini dilakukan supaya ujian lanjutan dan konfirmasi keatas sampel DTP dapat dilakukan jika diperlukan.

Ini adalah penting kerana bank-bank sering menerima beberapa beg DTP sekali gus. Walaupun prosedur telah diadakan untuk menghalang dari berlakunya apa-apa pertukaran beg yang tidak diingini tanpa diketahui, malah persoalan dan keraguan mengenai tuan punya sebenar DTP itu masih wujud.

Dengan adanya ”Tiub Bersambung DTP” (Integral Segment) yang bersambung terus kepada beg DTP, atau sistem yang serupa denganya, maka ini meningkatkan lagi tahap jaminan bahawa sampel DTP yang diuji memang dari sumber DTP yang asal. Ujian perlu dilakukan sebelum DTP digunakkan untuk rawatan transplantasi. AABB memahami bahawa bank-bank akan memerlukan masa dan perbelanjaan kos tinggi untuk bertukar dari sistem Vail kepada Beg, jadi, AABB telah memberi tempoh masa kepada beberapa bank untuk berubah, iaitu sehingga 1 Januari 2007. Bilangan bank yang diberi tempoh masa tambahan ini hanya segelintir dan hanya kepada bank yang telah menunjukkan pelan program pertukaran sistem dari Vail kepada Beg.

Simpanan dalam sistem lain: Dengan adanya perubahan teknologi, sistem simpanan baru mungkin akan direka kelak yang memenuhi kehendak dan tujuan piawaian. Tujuan piawaian adalah untuk memastikan supaya sampel DTP yang perlu diuji memangnya diambil dari Beg DTP yang sama. Sistem-sistem baru ini perlu diselidik dan diuji samada ianya memenuhi tujuan dan keperluan yang ditetapi oleh Unit Program Piawaian Terapi Sel AABB.

Should cord blood be stored in bags or vials?

AABB encourages innovations and improvements in technology and does not endorse any one method or manufacturer over another. This includes encouraging improvements in the collection, processing and storage of UCB products. Since most products are collected into a bag or other container before transfer to a processing facility, no system is completely “closed.” Even the product (UCB) entering the container may not be sterile. Therefore, facilities operate on a spectrum of semi-closed or functionally closed processing (including collection) and there is no uniformly accepted definition or criteria to define such a system. The practice is based on the theoretical deduction that the number of entries or exposures to the environment that a product receives, the higher the chance for accidental contamination.
The bag versus vial storage debate is quite controversial. Early work with cord blood processing in research labs included the use of “cryovials.” These small vials are about the size of an adult pinky and are relatively inexpensive. The UCB product is divided among several vials, which are usually placed into small boxes for storage. Proponents of this storage container assert that if science ever advances to the point where only some of the product is needed, the entire UCB unit will not have to be thawed. Products can generally only be thawed once without losing a significant number of live stem cells. The vials also occupy relatively less storage space and, therefore, permit more products (patients) to be stored in the storage tank. On the other hand, the small vials may be more difficult to label with all of the required information.
Specially designed bags intended for cryostorage have also been developed. These bags cost more and may occupy a larger amount of freezer space than vials. One advantage of using bags is that they render a more “closed” rather than an “open” system, thereby reducing the risk of accidental contamination. Another advantage to the bag system is that it permits the unit to have integral segments of tubing. AABB requires that integral segments be attached to cord blood units for subsequent testing. Integral segments are created when the tubing leading from the storage container is sealed to provide little portions or “segments” of product, which can be used for subsequent or confirmatory testing of the product if needed.
This is important because banks sometimes receive several products at once, and while procedures are in place to prevent mix-ups, questions regarding identity may occur. The availability of attached segments or an equivalent system provides a higher level of assurance that the test sample material can be traced to the original product if needed for confirmatory or additional testing before the product is distributed for transplant. AABB recognizes the investment of resources required to switch from vials to bags and, therefore, has granted variances to a few facilities until Jan. 1, 2007, to give them time to implement the change. These variances were few in number and only granted to those that presented a plan for implementing the change.
Other containers: As technology evolves, other containers or processes may be developed which meet the intent of the Standards. The intent is to ensure that the sample for additional testing is from the product. Such methods would currently require review and approval by the AABB Cellular Therapy Standards Program Unit.

Sekian buat masa ini......Wslm..WBK

Autologous-OWN-Stem Cell Infusion And Hyperbaric Oxygen Treatment Improve Islet Function In Diabetes

A study to determine if patients with type 2 diabetes can benefit from a combination of autologous (patient OWN self-donated) stem cell infusions (ASC) and hyperbaric (above the normal air pressure of ) oxygen treatment (HBO) before and after ASC has found "significant benefits" in terms of "improvements in glycemic control" along with "reduced insulin requirements."

The combination therapy could decrease type 2 diabetes morbidity and mortality, said the authors, who published their study results in a recent issue of Cell Transplantation (Vol. 17 No.12).

"Autologous stem cell therapies are an emerging set of therapies with promising results and low side effects profiles," said corresponding co-author Esteban Estrada, MD, of Stem Cell Argentina.

"In addition, hyperbaric oxygen therapy, used primarily in the treatment of carbon monoxide poisoning, air embolism suffered by divers, and as an enhancement to wound healing, has been shown to increase stem cell mobilization and the release of endothelial progenitor cells via a nitric oxide-dependent mechanism."

The clinical trial evaluated the safety of ASC-HBO combination treatment in 25 patients with type 2 diabetes.

According to the researchers, it is well known that with type 2 diabetes, there is an ongoing inflammation of the pancreas. Their hypothesis suggested that mobilizing stem cells would cause the growth of blood vessels (angiogenesis) and release factors that would result in the local differentiation of progenitor cells with a resulting anti-inflammatory effect. Diabetes, they added, has been shown to impair progenitor cell mobilization, a problem that local stem cell infusion could remedy.

Once more, the effect of the hyperbaric oxygen therapy, they hypothesized, would be to increase stem cell mobilization in such a way as "to target more than one crucial reparative step" to counteract the chronic injury that attack the endothelial progenitor cells and the islet cells.

"Overall, our results show that a close follow-up with intensive diabetic management alone could not be the only cause of the positive, progressive and consistent outcomes we obtained in this trial over one year of follow-up," said Dr. Estrada.

"A decade ago, research had explored stem cell transplantation and hyperbaric oxygen therapy as stand alone treatments. This study highlights the potential benefits of using an unusual combination therapy to treat diabetes" said Dr. Cesar V Borlongan, Associate Editor of Cell Transplantation and Professor at the University of South Florida College of Medicine.


References

Estrada, Esteban J.; Valacchi, Fabian; Nicora, Eduardo; Brieva, Sergio; Esteve, Claudio; Echevarria, Laura; Froud, Tatiana; Bernetti, Karina; Cayetano, Shari Messinger; Velazquez, Omaida; Alejandro, Rodolfo; Ricordi, Camillo. Combined Treatment of Intrapancreatic Autologous Bone Marrow Stem Cells and Hyperbaric Oxygen in Type 2 Diabetes Mellitus. Cell Transplantation 2008; 17 (12): 1295-1304.

Multiple Route AUTOLOGOUS Bone Marrow Stem Cell Injections Show Promise To Treat Spinal Cord Injury

Just published a few days ago in the current issue of Cell Transplantation (Vol. 17 No.12), researchers from DaVinci Biosciences, Costa Mesa, California, in collaboration with Hospital Luis Vernaza in Ecuador, have determined that injecting a patient's own bone marrow-derived stem cells (own-autologous BMCs) directly into the spinal column using multiple routes can be an effective treatment for spinal cord injury (SCI) that returns some quality of life for SCI patients without serious adverse events.

The researchers reported on eight patients with SCI (four acute and four chronic) to whom they administered BMCs directly into the spinal column, spinal canal and intravenously for each patient and followed for two years using MRI imaging to assess morphological changes in the spinal cord.

"Our objective in this study was to demonstrate that multiple route administration of BMCs for SCI is safe and feasible," said corresponding author Dr. Francisco Silva. "To date, we have administered BMCs into 52 patients with SCI and have had no tumor formations, no cases of infection or increased pain, and few instances of minor adverse events. We also found that patient quality of life improved.

According to Dr. Silva, presently there is no cure or effective treatment for spinal cord injury, a disorder affecting millions globally. Tissue loss from the primary injury and the complexity of cell types required for functional recovery lead the list of considerations. Once more, to be considered successful, any treatment should ultimately help to improve patient quality of life and demonstrate functional improvements.

"Autologous stem cell transplantation of BMCs can promote the growth of blood vessels and, therefore, represent an alternative therapy," said Dr. Silva. Following primary trauma to the adult spinal cord there is evidence of hemorrhage and blood flow is attenuated, he explained. The disruption of blood flow leads to spinal cord infarction, the disruption of the blood-spinal cord injury barrier, swelling and the release of molecules influencing spinal cord perfusion and ischemia, a restriction in blood supply.

"BMCs are well known for their ability to grow blood vessels," explained Dr. Silva. "This angiogenesis is necessary for wound healing and establishing a growth permissive environment. We hypothesized that improved blood flow and oxygen supply could contribute to functional improvements for SCI transplanted with autologous BMCs.

In eight patients who received BMC transplants through various routes and followed for two years, the scientists reported several functional improvements, perhaps the most important of which was improved bladder control.

Finally, the researchers noted that one of their cases suffered a gunshot wound and that their study marked the first time a gunshot wound victim had received BMC transplants through multiple routes."It is important to note," concluded Dr. Silva," that all of our patients with acute injuries improved significantly with no signs of deterioration or impediment of presumed spontaneous recovery.

According to Dr. Svitlana Garbuzova-Davis, a spinal cord researcher at the University of South Florida, the study highlights the value of using several different simultaneous routes for the administration of stem cells, as well as the benefit of the cells themselves."While it would be interesting to know the respective contribution of each route of administration, this study does appear to support the need to move to carry out double blind clinical trials of BMCs in SCI, especially if a non-invasive route could be used.


Reference:

1. Geffner, L. F.; Santacruz, P.; Izurieta, M.; Flor, L.; Maldonado, B.; Auad, A. H.; Montenegro, X.; Gonzalez, R.; Silva, F. Administration of Autologous Bone Marrow Stem Cells Into Spinal Cord Injury Patients Via Multiple Routes Is Safe and Improves Their Quality of Life: Comprehensive Case Studies. Cell Transplantation, 2008; 17 (12): 1277

STROKE and Your OWN STEM CELLS

"Every five minutes someone in the UK has a stroke and it is vital that we do all we can to help those affected by stroke."

Wise words from a team of wise scientists in the UK that pushed effective stem cell treatment for strokes a significant step forward as they revealed in their work is published in the Journal Biomaterials how they have replaced stroke-damaged brain tissue in rats.

The team of scientists is funded by the Biotechnology and Biological Sciences Research Council (BBSRC) and led by Dr Mike Modo of the Institute of Psychiatry, King's College London. The work, carried out at the Institute of Psychiatry and University of Nottingham, shows that by inserting tiny scaffolding with stem cells attached, it is possible to fill a hole left by stroke damage with brand new brain tissue within 7 days. Previous experiments where stem cells have been injected into the void left by stroke damage have had some success in improving outcomes in rats.

The problem is that in the damaged area there is no structural support for the stem cells and so they tend to migrate into the surrounding healthy tissues rather than filling up the hole left by the stroke.

Dr Modo said: "We would expect to see a much better improvement in the outcome after a stroke if we can fully replace the lost brain tissue, and that is what we have been able to do with our technique."

Using individual particles of a biodegradable polymer called PLGA that have been loaded with neural stem cells, the team of scientists have filled stroke cavities with stem cells on a ready-made support structure.

Dr Modo continued: "This works really well because the stem cell-loaded PLGA particles can be injected through a very fine needle and then adopt the precise shape of the cavity. In this process the cells fill the cavity and can make connections with other cells, which helps to establish the tissue. (picture)

"Over a few days we can see cells migrating along the scaffold particles and forming a primitive brain tissue that interacts with the host brain. Gradually the particles biodegrade leaving more gaps and conduits for tissue, fibres and blood vessels to move into."

The research published today uses an MRI scanner to pinpoint precisely the right place to inject the scaffold-cell structure. MRI is also used to monitor the development of the new brain tissue over time.

The next stage of the research will be to include a factor called VEGF with the particles. VEGF will encourage blood vessels to enter the new tissue.
Professor Douglas Kell, BBSRC Chief Executive said: "Stroke is a leading cause of disability in industrialised countries. It is reassuring to know that the technology for treating stroke by repairing brain damage is getting ever closer to translation into the clinic.

This crucial groundwork by Dr Modo and his colleagues will surely be a solid foundation of basic research for much better treatments in the future. Joe Korner, Director of Communications at The Stroke Association commented: "This research is another step towards using stem cell therapy in treating and reversing the brain damage caused by stroke. It is exciting because researchers have shown they are able to overcome some of the many challenges in translating the potential of using stem cells into reality."

The potential to reverse the disabling effects of stroke seems to have been proved. However the development of stem cell therapy for stroke survivors is still in the early stages and much more research will be needed before it can be tested in humans or used in practice.

Cord Blood Banking in the Middle East

If there's one building that I never get tired of looking at in KL, it has definitely got to be the Petronas Twin Towers. If the number of tourists in the park just beneath it is any indication, it confirms that I am certainly not the only one. Since the sunshine brings such perfect days and stormy nights, even the movie producers are out in full force, taking full advantage of the predictability of cloudless skies.

These towers were once the tallest in the world (est 1998), but it has now been beaten by the Taipei 101 (2004) and I read that the completion of Dubai's Burj Dubai which is a huge structural icon in the making, will rank number one as of next year if the project finishes on schedule (estimated completion Dec 2009).

I know you must be wondering where I'm going with this but please indulge me a little longer.

As someone who has yet to visit the middle east nations, I can only imagine what their cities and populations are like. Dubai has a population of just over a million people, so I'm wondering what all the space in the Burj will be used for, but I suppose that they are planning to attract migrants to the city and plan to expand the city's population to three times of what it is today in the next one or two decades.

The population in other Arab Emirates is also fairly small. Doha, the capital of Qatar which lies westerly of Dubai across the sparkling Persian Gulf competes with Dubai in terms of infrastructure and is likewise in the process of establishing itself for other activities apart from finance. Doha laid claim to a fantastic sports center built to groom and train athletes for modern Olympics and apparently also has some architecturally tasteful and stylish designer buildings which serve as office and varsities.

Qatar is wealthy due to their oil and gas deposits which provide the financial bedrock for the economy and with a small population of less than a million, the GDP is thus very high.

It is in Doha which Richard Branson and his partner Excalibur (PE fund) have decided to relocate and re-launch the Virgin Cord Blood Bank with the new name of Virgin Health Bank QSTP (where QSTP is an abbreviation for Qatar Science and Technology Park).


WHY DOHA?

According to the press article, the Virgin Team did consider other major cities in the UAE but decided on Doha due to the Qatari commitment from the government and its Queen:

BACKED BY THE GOVERNMENT
"Branson said today that the bank chose Qatar because “the government of Qatar and the queen in particular understood the importance of this and wanted it.” Evans said that the presence of facilities such as the Weill Cornell Medical College campus and the future Sidra Medical & Research Center (now under construction) in Qatar were also part of the country’s draw."

The Qatar Science Center (featured on the right)


HOW MUCH?

At the press conference held on Tuesday, the investment in starting a cord blood bank was announced to require 9 million British Pounds (46 million RM) while stating that 10 million USD had already been spent.

As for the charge for Virgin's services which encompass a private-public model, nothing is confirmed but it is supposed that the Qatari government will initiate the project by footing the bill. Given a birth rate of approx. 16 births per 1000 people, all of Qatar would have a birth rate of 16,000 per year. Not too much to handle if most deliveries are managed by a few hospitals.

The shareholders have declared that all profits from the service will be channeled back into health care charities, and to be fair to the corporates, probably less operational and running costs.


NEW GOALS

"The company’s goal is to create a comprehensive source of stem cells that could be of particular use for treating people of Middle Eastern descent, whose tissue types are often underrepresented in the public tissue banks such as those in the U.S. and elsewhere. “This cord blood bank could end up being bigger than the U.K.’s bank quite quickly,” Branson noted at a press conference today marking the company’s inaugural board meeting in Qatar."

I wrote about Virgin's plan previously and if you need a helpful reminder of what it was, click here.


Cultural Mind-Shift

One of the acknowledged challenges of the service would be to convince the Qataris to participate and engage the cord blood service. I was very impressed to know that the Qatari Islamic religious leaders are forward thinking and have already issued a fatwa (muslim sharia law) approving the collection of cord blood and encouraging its use. Dr. Yousuf Qaradawi a prominent Islamic scholar has endorsed its use.

Here in Malaysia, it would be great if the Islamic leaders would take up the issue and do the same in responding to the concept of cord blood banking.

We're being SPAMMED by StemTech

I'm not sure how we've managed to make it onto StemTech's spambot list of blogsites, but we've just been patiently deleting them as they come in.

Today, I changed my mind and instead of just going ahead to hit delete, I've decided to dedicate an entire post entry to them due to the fact that they have been actively making their rounds in Malaysia.

One bottle of algae based supplements sells for RM 200+ per bottle (I'm told by those who have bought it) and is supposed to raise your own body's endogenous stem cells by an amount significant enough to increase one's sense of well-being.

My colleague Prof. Aw - who by the way is a recent convert to supplementation- was contacted by one of the StemTech agents/ distributors before. He asked them to send him journal papers (which they claimed they had) and on a second encounter, asked them to do a proof of concept trial by checking on the amount of stem cells raised after taking the supplements for a month.

NO REPLY was forthcoming.

I was even more surprised when I discovered that the french neurologist scientist who is the founder of the organization was invited to present at one of the major hospital's inaugural lecture series here. Due to the heavy downpour, none of us were able to attend but we were most curious as to whether they had received some sort of approval from our government, or whether the major hospital chain was endorsing their product.

I've asked some of the people who are taking this supplement to subject themselves to a simple trial which we'll conduct to see if what they've claimed is true. If I'm able to convince them, I'll be sharing the results with you.

If you're from StemTech and you're reading this, you might like to sponsor the trial if the confidence you have in your product is high.

If not, please stop misleading the public and don't use the term stem cells - call it what it probably is- a vitamin supplement.

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Stem Cell Enhancers: The NEW Science

Standing singly, away from all the controversy, some of the scientific community is giving rise to the world's very first patented, organic stem cell enhancer. With only a single dose of this modern day amazement your body can begin the renewal process. In fact, within just one hour after taking this wonder supplement,three to 4 million, yes MILLION stem cells are added to your bloodstream and go to work.

StemEnhance is a revolutionary breakthrough, all natural product that supports adult stem cell physiology. It's the first patented product on the market in the latest phytoceutical category called "Stem Cell Enhancers".http://www.phyl247.com or http://www.phyl247.biz phyl247 970-985-4076
As we age, the number and quality of stem cells that circulate in our body gradually decrease, leaving our body more susceptible to injury and other age-related health challenges. StemTech Health Science's Stem Enhance is the alternative to the controversial stem cells we hear about in the news. Patented Product StemEnhance supports the natural release of stem cells to promote optimal healing and stem cell physiology.

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Note to StemTech: Please stop spamming us.

Menstrual Stem Cell Banking by LifeCell India

Note to Indian Women: If you're having your period this week, you're probably an immediate target for LifeCell India.

One of the latest news articles to come out of Chennai this week is LifeCell India's announcement that they will be offering menstrual blood cell banking at their facility, adding to the cord blood business.

Personally, I think that most asian women would find this quite disgusting (and disturbing!) given that there are far more hygenic sources. What do you think?

The new service which commences on the 8th of March (Sunday) and apparently designated "Women's day" will be the launch, though I wonder how exactly one would launch a service like this.

LifeCell India signed on to license the technology from Cryo-cell which sent letters to all cord blood stem cell banks around the world (or at least they were courteous to send one my way) inviting any interested parties to license the technology which they were probably going to charge six to seven figures for.

Ironically, with the difficulties of obtaining parents to bank cord blood stem cells, LifeCell India seems unperturbed by the fact that menstrual cells are not even a proven source of stem cells and that culturally, there would be no objections.

"The limited availability of bone marrow led to the discovery of cord blood stem cells. Now it is proved that the success rate of menstrual blood stem cells is about 100 times higher than the 0.2 to 0.3% of stem cells derived from human bone marrow," said Mayur Abhaya, executive director, Lifecell International.

I'm a little skeptical about these statements, though to be fair I haven't read any scientific literature describing menstrual blood contents. But why would the body waste precious stem cells in menstrual blood? One can understand baby's cord blood, as that is blood that circulates through the placenta and the baby's developing blood system, but cells that are meant to be shed are probably already hormonally directed down a self-destruct pathway.

"These stem cells are unique because they multiply rapidly and can differentiate into many other types of cells such as neural, cardiac, bone, fat, cartilage etc," said Dr Ajit Kumar, chief scientific officer, LifeCell International. They can be used to treat everything from heart disease to diabetes to neurological disorders.

Assuming that stem cells can truly treat everything, they would still have to prove that menstrual stem cells can be manipulated to the same extent.

LifeCell will introduce special collection kits for women who wish to bank their stem cells. The kit has a silicon cup that can collect up to 30 ml of menstrual blood. "It is like a sanitary napkin or tampon, and can last up to eight hours," explained Abhaya.

Kind of messy isn't it?

If you'd like to know what questions to ask and what kind of assurances you're getting for your money, you might want to check out this posting that we reviewed a while ago.

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Singapore advertises Cord Blood Stem Cell Banking (Part 2)

A Cordlife ad was timed right after the appearance of the Singapore Cord Blood Bank's news article - and that wasn't a coincidence.



In fact this latest ad was a masterful stroke of PR execution, citing rates of stem cell usage from the SCBB's own article and adding on the other applications worldwide. It highlights what families ought to store their own babies stem cells for their own use and advocates that private cord blood banking ensures 100% accessibility to your own banked cells.


If you can't see the facts and figures in the picture above here's the wording on the left:

Incidence rate of stem cell treatable diseases:

6 people are diagnosed with blood related diseases in Singapore every day
2 of the top 10 cancers afflicting Singaporeans are Lymphoma and Leukemia
1 in 500 babies are diagnosed with Cerebral Palsy
2 children are diagnosed with Type 1 diabetes in Singapore every month
80 diseases are now treatable using cord blood stem cells and possibly more in the future.

Chances of using stem cells:

1 in 217 chance that a person may need cord blood stem cells for treatment in their lifetime
80 cord blood units were released for transplants and therapeutic applications by Cordlife.

Higher chance of finding a match within the patient's family:

70% of cord blood transplants by Cord Blood Registry were from siblings. 30% was for self use.
75% chance of a sibling match
25% chance of a 100% match between siblings. A perfect match is required for bone marrow transplants but not in cord blood transplants.
$26,000 is the minimum cost of buying back a donated cord blood unit if it is still in storage.

Availability of stem cells:
50% of all donations to a public cord blood bank are normally discarded for various reasons
100% - your accessibility to your privately stored cord blood stem cells.



All true of course, and I've always wondered this: Singapore's birth rate is at thirty to forty thousand per year and it's conceivable that there may be a time when every Singaporean has his or her cord blood stem cells banked in the future. Given Singapore's small population, its probably the best place imagining that this could happen, a very accessible and heterogenous database which could be leveraged for treatment and if consented, research for autologous regenerative purposes.


Now that would be really cool.


** Unfortunately the online version of this article isn't the full version that was published in print.


Malaysian Medical Advertising Regulations prohibits any form of advertising using terms ranging from "treatment" to "Thalassemia" so it is virtually impossible for us to advertise as our neighbors did (all brochures and the stem cell organization are required to be separately licensed by the Ministry of Health, so make sure the stem cell bank you're talking to has all the documented approvals and are operating within legal guidelines).

However, since all of it was factual and cited from peer-reviewed journals and both local and international news articles, its good to share these statistics with our patient base here too.


More information on StemLife's stem cell banking services can be found at www.StemLife.com

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Cord Blood Stem Cells to treat Breast Cancer?

In a groundbreaking study (click on title for abstract), just published and not yet picked up by the media, researchers from the Departments of Anatomy and Physiology and Diagnostic Medicine/Pathobiology at the College of Veterinary Medicine in Kansas State University in Kansas, reported in the February edition of the journal "Cancer Research" that "Rat Umbilical Cord Stem Cells Completely Abolish Rat Mammary Carcinomas with No Evidence of Metastasis or Recurrence 100 Days Post-Tumor Cell Inoculation."

What they did was that they transplanted Fisher 344 rat-derived mammary adenocarcinoma cells (Mat B III-breast cancer) orthotopically (meaning into the breast of the female rats) into syngeneic (related) F344 rats with an intact immune system. Then they injected rat umbilical cord matrix stem (rUCMS) cells derived from Wharton's jelly, intratumoral (i.t. meaning into the tumor) or i.v. (into the veins of the animals) 4 days later.

Then they compared the tumor attenuation effect (meaning how the tumor was suppressed-fought / extinguished) at day 14 after the injection in the tumor or in the veins in cord blood stem cell-transplanted rats compared with sham-transplanted rats (meaning animals that received an injection but no stem cells). What they saw was amazing!

Unmodified rUCMS cord blood stem cell-transplanted rats showed complete regression of tumors to undetectable levels by 34 to 38 days with no evidence of metastasis or recurrence 100 days post-tumor cell inoculation (injection in the tumor). They concluded that their findings suggest that "unmodified human UCMS cells (cord blood stem cells from the Wharton's jelly of the umbilical cord) could be used for targeted cytotherapy for breast cancer".

Well, this is REALLY something to look out for, isn't it?! [Cancer Res 2009; 69(5): 1815-20]

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And... the blog is back!

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Apologies to all blog readers, it appears that our blog on Google is experiencing a display glitch. We are trying to contact Google now to establish what the problem is.. Please bear with us!

Singapore Advertises Cord Blood Stem Cell Banking (Part 1)

Last week in the Singapore Straits Times, there were two snippets about cord blood stem cell banking. The first one was a news piece on the Singapore public cord blood bank (entitled Cord Blood Bank has saved 21 lives**) which was campaigning for an increase in units (arguably an ad in itself). The other snippet was an ad by a local private Singapore Cord Blood Bank Cordlife. The ad appeared 2 days after the news article and I don't think its a coincidence to keep the conversation and interest in Singaporean's minds.

The first article from the Singapore Cord Blood Bank at a press conference reveals quite a lot about what its like to be an operator of a public bank:

How many cord blood stem cell units have been released and where have they gone?

"In the 3 years it has been open, the Singapore Cord Blood Bank has saved 21 lives - here and overseas... a 22nd donation was winging its way over to France"

"Of the 21 recipients, 12 were patients here while the other nine were ethnic Asians in Europe and Malaysia."

Comment: 21 cord blood units utilized in transplantation is very respectable for a small bank. Financially, at a purchase price of SGD 26,000 per unit in Singapore, the SCBB would have generated SGD 312,000 in revenue for the 12 Singaporean patients and another approximately SGD 320,000 from the 9 overseas patients (assumption is that these patients came through the NMDP network and paid the standard price). That would bring the SCBB's total revenue to SGD 632,000 or slightly more than this.


How many Singaporeans have donated cord blood and how many of those have been successfully banked?

"The repository has been able to bank about half of the 9,000 donations so far. Donations sometimes do not yield enough stem cells to be viable*."

Comment: The yield of 50% is very much in line with what I've heard from other public cord blood banks. However the article doesn't explain that units are discarded due to bacterial / viral contamination (let's not forget that vaginal flora and fauna can be quite substantial) and that the cord blood bank sets its own guidelines as to the volume and/ or cell count required at the beginning before they proceed to process the unit.

As a guide, at the time of receipt of the cord blood unit, most public cord blood banks insist on a minimum volume of 100 mls or total cell counts exceeding 1 billion. The rationale for this is that the cord blood unit needs to be at a level high enough to treat an adult (including caucasian weight & bigger sized asians), otherwise its not worth keeping (bearing in mind that this inventory can and most certainly will take years to clear). *Thus the term "viable" in the article refers to the unit's chances of being used.

Targets for the Singapore Cord Blood Bank?

"An earlier target of banking 10,000 samples by next year has been extended to 2013 said Mr. Sobak (SCBB's CEO and COO of SingHealth), since its been harder to get good-quality donations."

Comment: 10,000 units in the tank is an ambitious target but let's consider the following points:

1) The SCBB is based in the KK Women's and Children's Hospital, which alone delivers the vast majority of Singaporean babies has handled almost 40,000 babies at its peak, but more likely in the range of fifteen to twenty thousand now.

If the SCBB were able to collect all of the cord blood units from all the babies delivered there per year, without approaching any other hospitals (and discounting the 50%) the SCBB would have had about twenty thousand or so units by now. But, that would mean that they would have been working at a pace of 20 units per day seven days a week, all year round for 3 years. Hence the limitation of time, processing space and cost all plays a part in the operational capacity. [4 years more for 5000 units]

2) Cordlife, the first local Singaporean private cord blood bank started in 2001 only recently achieved 13,000 units in 2008 (announced in an ad) and claim only a 1% contamination rate, which means that they store almost every unit they receive. So repositories take a long time to build. [7 years for 13,000 units]

3) StemLife achieved 10,000 units in 2006, about 4 years after operational commencement (I assure you, not without toil).


Another target mentioned by the CEO was 30 transplants for the financial year 2009. I find this to be an interesting target, as I suspect it greatly depend on whether the requests just happen to match the units in the tank? Or perhaps it is now possible to analyze the recipient population and to try to identify the relevant donors to collect the cord blood from.

Anyway, getting back to the financial year for SCBB, I suppose the financial target would be in excess of SGD 1 million in revenue - if they manage to sell the inventory overseas. It is a business after all.


What are the likelihoods of use?

"At least six people are diagnosed daily in Singapore with different types of blood-related diseases said the bank's medical director William Hwang."

"Many of these patients will require a blood stem cell transplant to survive"

"With these samples and those fom banks worldwide, the odds of local patients finding a match is about 10-20%"


OK, quick back of the envelope calculation here. 6 people diagnosed daily in Singapore with a blood related disorder, ie 2000+ people. Let's say 50% will require a transplant at some stage, so let's bring the figure to about 1000 people needing a transplant.

And since only 10-20% will be able to find a match from all available units locally and internationally, ie 100-200 people will get their stem cell treatment... and the rest will have to wait.

The Suze Ormon Show on Cord Blood Stem Cell Banking

I was watching late night TV last year and happened to stumble across the Suze Ormon Show which I had never seen before. Her program entitled "Can I afford it?" discusses the value and worth of any particular item a person, couple or family would like to purchase in the USA.

In this episode, there was a lady who rang up to ask her opinion on cord blood stem cell banking and I thought it would be good to share with StemLife parents. She's quite keen on the subject but I don't think it was sponsored (no brands in sight). Anyway, if you missed it here it is and Suze Ormon is usually on CNBC late in the evening.

Risks involved in receiving treatment with donated fetal neural stem cells: Donor-Derived Brain Tumor Following Neural Stem Cell Transplantation

I find that the PloS Editor's summary in the article itself is an excellent popularized explanation of what the study means so I present it as is (except some added parentheses).

Editor's Summary

Most of the cells in the human body are highly specialized (‘‘differentiated’’). The brain and the spinal cord, for example, contain two main cell types—neurons, which transmit electrical signals to and from the brain, and glial cells, which support and protect the neurons. If these essential neural cells become damaged or diseased, the body cannot replace them. Scientists think, however, that it might be possible to use ‘‘neural stem cell’’ transplants to replace the neural cells that are lost in neurodegenerative diseases (for example, Parkinson’s disease) or damaged by strokes or trauma. Stem cells are undifferentiated cells that replicate indefinitely and that have the potential to develop into many different specialized cells. Pluripotent stem cells (which are able to develop into any kind of specialized cell) can be isolated from early human embryos; ‘‘multipotent’’ stem cells (which develop into only a few cell types) can be isolated from many differentiated tissues, including the brain. Human fetuses (unborn offspring from the end of the 8th week after conception) are thought to be a particularly good source of neural stem cells because many new neural cells are made in fetal brains.

Although stem cell transplantation might provide treatments for many debilitating diseases, some concerns have been raised over its safety (added: especially when unmatched embryonic or fetal stem cells are being used after donation). In particular, some experts fear that tumors might sometimes develop from (added: donated) transplanted stem cells. Tumor cells actually behave very much like stem cells—they divide indefinitely and they tend to be undifferentiated. It is very important, therefore, that every patient who receives a (added: donated, that is a non-self) human stem cell transplant is carefully followed up to see whether any tumors develop as a result. In this study, the researchers describe a case in which multiple, slow-growing, donor-derived brain tumors formed in a patient after the transplantation of (added: donated) human fetal neural stem cells.


What Did the Researchers Do and Find?

Beginning in 2001, (added: donated) fetal neural stem cells were injected several times into the brain and the fluid surrounding it of a boy with ataxia telangiectasia at a Moscow hospital. Ataxia telangiectasia*, a rare disorder characterized by degeneration of the brain region that controls movement and speech, occurs when both copies of the ATM gene (human cells contain two copies of most genes) contain a genetic change that stops the production of functional ATM protein. In 2005, the boy had a magnetic resonance imaging scan at the Sheba Medical Center (Israel) because of recurrent headaches. The scan revealed abnormal growths in his brain and spinal cord. In September 2006, when the boy was 14, the spinal cord growth was surgically removed. This growth has never reappeared but the mass in the boy’s brain has continued to grow slowly. The material removed from the boy’s spinal cord contained both neurons and glial cells, the researchers
report, and resembled a glioneuronal tumor. In addition, it contained both XX (female) and XY (male) cells and the tumor cells had two normal copies of the ATM gene (added: meaning it could not be derived from the recipient since the gene was normal). Finally, a technique called HLA typing showed that the tumor contained cells from at least two donors.


What Do These Findings Mean?

These findings indicate that the growth in the patient’s spinal cord was donor-cell derived and contained cells from two or more donors, at least one of whom was female. Although the growth in the patient’s brain has not been examined, the multiple masses seen in this patient probably arose independently from transplanted cells injected at different sites, suggest the researchers. Importantly, the slow growth of the tumors and the well-differentiated appearance of the cells removed from the patient suggest that the tumors are relatively benign. Donor-derived cells might have been able to establish tumors in this particular patient because people with ataxia telangiectasia often have an impaired immune system and the immune system normally helps to reject tumor cells. Nevertheless, this first example of a donor-derived brain tumor developing after fetal neural cell transplantation is worrying and suggests that further work should be done to assess the safety of this therapy.



This very important study highlights that we know as yet very little about embryonic and fetal stem cells and that their behavior when injected in human tissues is highly unpredictable. Treatments in humans are as yet not advisable but similar uncontrolled experiments are continuously occurring in uncontrolled centers and in desperate situations.

Everyone must be advised, patients and doctors equally that donor embryonic and/or fetal stem cells carry unknown risks. Embryonic and/or fetal stem cell treatment may in the future be a solution to many of today's untreatable diseases but must first be studied in well planned experiments, performed in specialized centers in animal models and must not be ill advised solutions in desperate human patients.


Important for readers to note the difference:

We also need to remember that this is about fetal stem cells obtained from unborn offsprings from the end of the 8th week after conception and not about current approved treatments as bone marrow transplantation using own or matched adult stem cells from cord blood, bone marrow or peripheral blood.



References

1. Amariglio N et al. Donor-Derived Brain Tumor Following Neural Stem Cell Transplantation in an Ataxia Telangiectasia Patient. PloS Medicine 2009; 6(2): e1000029



*More information on Ataxia Telangiectasia from the NIH Neurological Disorders Site

What is Ataxia Telangiectasia?

Ataxia-telangiectasia is a rare, childhood neurological disorder that causes degeneration in the part of the brain that controls motor movements and speech. Its most unusual symptom is an acute sensitivity to ionizing radiation, such as X-rays or gamma-rays. The first signs of the disease, which include delayed development of motor skills, poor balance, and slurred speech, usually occur during the first decade of life. Telangiectasias (tiny, red "spider" veins), which appear in the corners of the eyes or on the surface of the ears and cheeks, are characteristic of the disease, but are not always present and generally do not appear in the first years of life. About 20% of those with A-T develop cancer, most frequently acute lymphocytic leukemia or lymphoma. Many individuals with A-T have a weakened immune system, making them susceptible to recurrent respiratory infections. Other features of the disease may include mild diabetes mellitus, premature graying of the hair, difficulty swallowing, and delayed physical and sexual development. Children with A-T usually have normal or above normal intelligence.


Is there any treatment?

There is no cure for A-T and, currently, no way to slow the progression of the disease. Treatment is symptomatic and supportive. Physical and occupational therapy may help maintain flexibility. Speech therapy may also be needed. Gamma-globulin injections may be given to help supplement a weakened immune system. High-dose vitamin regimens may also be used.


What is the prognosis?

The prognosis for individuals with A-T is poor. Those with the disease usually die in their teens or early 20s.





Read a news account of this story.

The IMPORTANCE of YOUR FAMILY'S STEM CELLS

Haemopoietic stem cell transplantation for children in Australia and New Zealand, 1998–2006:a report on behalf of the Australasian Bone Marrow Transplant Recipient Registry and the Australian and New Zealand Children’s Haematology Oncology Group.

This above study is an important milestone epidemiological study in CHILDREN published in the Medical Journal of Australia in February 2009. It gives us invaluable information and insight on the source of stem cells used (from bone marrow, peripheral blood or cord blood), their origin (autologous: own; related allogeneic: matched siblings; unrelated allogeneic: matched strangers) and on the indications for which a bone marrow transplantation has been performed. Moreover, it studies the important aspect of Transplant Related Mortality (TRM). Few of us actually have insight in those issues and understanding them will aid in deciding whether to keep your own stem cells or not.

Let's have a look!

Over a period of 9 years (1998-2006) 1,259 BMTs were performed in children in Australia and New Zealand, of which 41% were autologous (used the child's own stem cells from bone marrow or peripheral blood) while 59% were allogeneic (someone else's stem cells). Of the latter 40% were from a matched sibling (23.6% of the total) and 60% from matched strangers. That brings the total number of children ultimately finding stem cells from themselves or within their immediate family up to 65% while the remaining 35% had to depend on matched strangers to donate or on donated cord blood. It means that at the end of the day when a child was ill and in need of stem cells for BMT, then those were found in 65% of the cases from the child or the immediate family. More important is that the stem cells used were bone marrow or peripheral blood stem cells and that means that in that perilous period of a family's and a child's life an extra burden in collecting stem cells from the bone marrow or peripheral blood is added on top of all stress that is already evident. One can also speculate how this additional psychological stress and wait may impact on disease progression. If those families had been informed about cord blood stem cells and had kept their children's cord blood stem cells then those little frozen bags would have been stored and waiting to be used at any given time! Furthermore, the importance of using your own or those of a matched immediate relative is reflected in the TRM; Transplant Related Mortality is 22-28% when one receives a matched stranger's stem cells and only 5-7% if one receives their own or a matched sibling's stem cells.

The other important issue is that the matched stranger stem cells come nowadays more from donated cord blood stem cells than bone marrow/peripheral blood. In the latest years more than half, almost 2/3, come from donated cord blood and subsequently since cord blood stem cells are immunologically naïve and cause 30% less rejections, more mismatched transplants have been performed. One can speculate if this is the reason for the difference in Transplant Related Mortality that is higher in mismatched stem cells from strangers. So, if one would not keep for own use one should definitely donate for public use!

In the words of the authors of the study “Autologous BMT has an important role in a range of childhood cancers, including neuroblastoma, medulloblastoma, Ewing sarcoma/PNET, Hodgkin lymphoma and non-Hodgkin lymphoma” while “allogeneic (matched siblings or strangers) transplantation is most frequently offered to children with high-risk and relapsed leukaemias, myelodysplastic syndromes, aplastic anaemia, congenital bone marrow failure syndromes, thalassaemia major, sickle cell anaemia and various inborn errors of metabolism”.

The results of this study are similar to a previous one published in the Biology of Blood and Marrow Transplantation in 2007, entitled “Haematopoietic Stem Cell Transplantation in Australia and New Zealand, 1992-2004”. In this study that encompasses all transplantations in Australia and New Zealand both in adults and children, the same trend is evident and even more pronounced. That is, when you need stem cells you find them in you or in your immediate family! In2004 alone, 68% of the patients used their own stem cells (889/1,313) while another 19% received stem cells from matched siblings and only 13% managed to find stem cells from matched strangers. That means that a total of 87% found the needed stem cells in themselves or within the immediate family! Importantly, Transplant Related Mortality was 8.1% for stem cells from strangers compared 1.1% for own stem cells! One can also in the adult cases speculate how the effect of the additional psychological stress of stem cell collection and/or wait to find stem cells from strangers may impact on disease progression. If those families had kept their own peripheral blood stem cells then those little frozen bags would then have been stored and waiting to be used at any given time!

Cord blood stem cells and peripheral blood stem cells have an immense importance be it for a family's own use or for complete strangers where anyone can offer the hope of life. Regardless the use or the intention, those stem cells must be kept for their purpose to be fulfilled! Do not let them go wasted!

References

1. Moore AS, Shaw PJ, Hallahan AR, Carter TL, Kilo T, Nivison-Smith I, O'Brien TA, 
Tapp H, Teague L, Wilson SR, Tiedemann K. Haemopoietic stem cell transplantation
for children in Australia and New Zealand, 1998-2006: a report on behalf of the
Australasian Bone Marrow Transplant Recipient Registry and the Australian and
New Zealand Children's Haematology Oncology Group. Med J Aust 2009; 190(3): 121-5  

2. Nivison-Smith I, Bradstock KF, Dodds AJ, Hawkins PA, Ma DD, Moore JJ,
Simpson JM, Szer J.Hematopoietic stem cell transplantation in Australia and New Zealand,
1992-2004. Biol Blood Marrow Transplant 2007; 13(8): 905-12