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 

Autologous PBSC bone marrow transplantation for MS

Fantastic NEWS for MS patients. New hope in the horizon with OWN Peripheral Blood Stem Cells the way StemLife companies around SE Asia have been collecting and storing for the past 9 years. This novel phase US II/III study (click on the title to see the study) confirms what European scientists have been investigating in the past few years with dr Fassas in Northern Greece as one of them. So this study provides one more proof that in Patients with MS, their OWN Stem Cells can be their chance to live a normal life again!

If you wish a comprehensive list on MS, a presentation in pdf form is available after emailing to info@thaistemlife.co.th

Sel Stem dan Statistik Transplantasi Darah Tali Pusat

Bolehkah Sel Stem Darah Tali Pusat Bayi Merawat Penyakit Thalassaemia Kakak/Abang?

Apakah Statistik Kegunaan Sel Stem Darah Tali Pusat?

Asalamualaikum,

Salam dan semoga Sihat Sejahtera.

Baru-baru ini Saya telah mendapat beberapa soalan mengenai kegunaan sel stem darah tali pusat bayi.

Untuk soalan pertama, pembaca perlu menjawab beberapa soalan. Adakah pesakit sedang berulang ke hospital untuk dirawat oleh pakar Thalassaemia? Jika tidak, mungkin keadaan mereka, setakat ini, belum memerlukan rawatan. Jika ya, pembaca perlu tekun menyoal dan menyaran pakar Thalassaemia supaya meneliti samada keadaan pesakit sudah menurun dan perlu dirawat dengan kaedah lain seperti sel stem?

Sel stem boleh didapati dari sum-sum tulang, tetapi tekniknya agak invasif. Cara yang lebih senang untuk mendapatkanya ialah dari darah tali pusat yang diambil semasa bayi dilahirkan. Kedua-dua sumber ini ada bezanya dari segi kematangan sel, kaedah penggunaan, risiko dan keberkesananya.

Sel stem darah tali pusat bayi, jika disimpan semasa bayi dilahirkan, memang besar potensinya untuk diggunakan. Tetapi, ada beberapa syarat yang perlu dipatuhi. Darah tali pusat mestilah mengandungi jumlah sel stem yang mencukupi, padanan HLA yang tinggi dan tidak berpenyakit.

Sel Stem dari bayi perlu sepadan (secara ujian darah HLA) dengan sel kakak atau abangnya. Jika separa sepadan atau sepadan sepenuhnya, memang ada potensi ianya digunakan untuk menolong merawat kakak atau abang. Sel stem juga perlu bebas dari Thalassaemia dan penyakit lain. Pakar Thalassaemia perlu memutuskan samada keadaan pesakit sudah kritikal dan memerlukan rawatan sel stem.

Proses pengambilan darah tali pusat perlu dilakukan semasa bayi dilahirkan. Sejurus selepas bayi dilahirkan, dan sebelum uri dilahirkan. Doktor di Hospital akan mengambil darah dari tali pusat. Prosesnya senang, seperti proses derma darah biasa. Ianya cepat dan tidak melukakan bayi atau ibu. Kami tidak mengambil tali pusat atau pun uri. Penggunaan sel stem darah tali pusat dalam perubatan boleh dilakukan tanpa keraguan kerana pihak JAKIM telah pun mengeluarkan Fatwa pada tahun 2002.

Kami akan membekukan dan menyimpan sel stem darah tali pusat ini untuk kegunaan bayi sendiri atau mungkin untuk kegunaan kakak atau abangnya dimasa hadapan.

Apabila Pakar Thalassaemia berpendapat rawatan susulan kakak/Abang memang diperlukan, dan sel stem dijangka boleh memberi kesan, pakar-pakar akan meminta supaya sel stem darah tali pusat yang disimpan dibawa ke hospital untuk digunakan.

Pesakit Thalassaemia juga mungkin boleh mendapatkan sel stem darah tali pusat dari pihak Bank Darah Kerajaan di Pusat Darah Negara, KL, http://www.pdn.moh.gov.my/.

Senangkah untuk mendapatkan sel stem ini?

Saya belum pernah melihat statistik di Malaysia yang boleh menolong untuk membuat anggaran tepat. Sel stem yang disimpan di PDN telah didermakan. Agak sukar untuk membuat anggaran samada sel stem, yang sepadan dengan pesakit, boleh didapati dengan senang di Bank Darah Kerajaan atau pun tidak.

Saya pernah membaca di akhbar New Straits Times, 14 Ogos 2006, yang melaporkan pada masa itu, terdapat 17 kanak-kanak yang memerlukan transplantasi sel stem tetapi terpaksa menunggu untuk mendapatkan sel stem dengan padanan yang sesuai. Wartawan juga melaporkan bahawa ada yang tidak dapat menunggu dan tidak dapat diselamatkan walaupun Pusat Darah Negara telah menyimpan lebih kurang 1,000 beg sel stem darah tali pusat.

Jumlah itu, dari segi statistik, terlalu rendah untuk membekalkan darah tali pusat bagi pesakit yang memerlukanya. Ada beberapa anggaran yang sering disebut di laman web-laman web bank darah tali pusat. Anggaran untuk mendapatkan sel stem, bukan dari keluarga sendiri, yang sepadan dengan pesakit adalah dalam lingkungan 1 dalam 20,000. Dengan statistik kebarangkalian padanan yang amat rendah ini, peluang 17 kanak-kanak itu kelihatan agak tipis. Alternatif lain perlu di usahakan. Sebab itulah, kita sering dapat membaca dalam akhbar-akhbar tempatan pesakit-pesakit merayu untuk mendapatkan dermaan sel stem. Sebab itulah juga mengapa ramai pelanggan kami menyimpan sel stem sendiri bagi kegunaan keluarga sendiri.

Pembaca juga boleh layari laman web Persatuan Transplantasi Malaysia http://www.mst.org.my/, dimana terdapat Senarai Transplantasi Kebangsaan. Laporan itu menunjukkan setakat tahun 2006, 1174 pesakit telah menggunakkan sel stem dimana 50 telah menggunakkan samada sel stem darah tali pusat sahaja ataupun dengan tambahan sel stem yang didapati dari sum-sum tulang.

Setakat ini Syarikat StemLife Berhad telah menyimpan sel stem darah tali pusat untuk lebih dari 23,000 pelanggan. Empat (4) pelanggan kami telah berjaya menggunakan sel stem darah tali pusat mereka samada untuk abang, kakak atau adik mereka dalam menolong merawat penyakit Leukaemia dan Thalassaemia. Satu (1) telah dirawat di Hospital Kuala Lumpur dan tiga (3) di Pusat Perubatan Universiti Malaya.

Pembaca juga disyorkan untuk melayari laman web http://www.parentsguidecordblood.com/ dan http://www.apcbbc.org/ untuk mendapatkan statistik simpanan/kegunaan di seluruh dunia dan di rantau Asia Pasifik. Laman web yang kedua ada membentangkan jumlah simpanan ahli-ahli persatuan iaitu bank-bank sel stem darah tali pusat terkemuka di rantau Asia Pasifik yang pada masa ini dipengerusikan oleh Pengarah Urusan StemLife Berhad.

Saya harap telah dapat menjawab beberapa soalan anda. Jika jawapan yang lebih terperinci diperlukan, sila hantarkan nombor anda kepada info@stemlife.com dan kami boleh menghubungi anda untuk memberi maklumat yang lebih mendalam lagi.

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

Bank Sel Stem sudah lama wujud dalam bidang perubatan!

Assalamualaikum WBK,

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

Kebelakangan ini Menteri Kesihatan Malaysia Y.B. Dato’ Liow Tiong Lai telah melawat premis kami di Wisma Perintis untuk melihat sendiri operasi pengambilan sel stem dewasa StemLife serta untuk memahami dengan lebih mendalam lagi status penggunaan sel stem dewasa dalam bidang kepakaran penyakit jantung, barah darah, dan kecederaan sendi serta mendapat penjelasan mengenai projek-projek penyelidikan yang giat dijalankan di seluruh dunia.

Beliau telah menekankan komitmen Kerajaan dalam mengunakkan teknologi sel stem dalam bidang perubatan di Malaysia. Pada pendapat saya, ini adalah kerana fakta-fakta adalah jelas sekali tentang potensi sel stem dalam menolong pakar-pakar perubatan menangani beberapa penyakit yang setakat ini amat sukar ditangani. Ini sekaligus meningkatkan kebolehan pakar-pakar Negara supaya tidak ketinggalan zaman.

Seperti yang disiarkan akhbar-akhbar tempatan, Kerajaan menyokong bidang penyelidikan sel stem. Kabinet telah membuat peruntukkan lebih RM32juta untuk mengembangkan dan mengukuhkan aktiviti perbankan sel stem. RM5.86juta untuk memulakan makmal transplantasi sel stem di Institut Penyelidikan Perubatan (IMR). RM18.87juta untuk mengembangkan kemudahan simpanan sel stem darah tali pusat di Pusat Darah Negara dan di Hospital Sultan Abdul Halim, Sungai Petani. Kerajaan juga telah memperuntukan RM5.57juta untuk mengukuhkan perkhidmatan transplantasi sel stem dan sum-sum tulang di Hospital Ampang. Ini diharapkan akan meningkatkan jumlah simpanan beg sel stem darah tali pusat dan mengukuhkan tahap kemudahan perbankan kerajaan. Kami berharap pihak Kerajaan akan menyediakan peruntukan yang lebih dimasa akan datang supaya fasiliti dan kemudahan tempatan dapat bertanding diarena antarabangsa.

Ramai mungkin telah membaca akhbar-akhbar tempatan dan luar negara yang sering menerbitkan kes-kes rayuan pesakit untuk mencari penderma sel stem dan juga dermaan kewangan yang diperlukan dalam masa yang suntuk dan keadaan tertekan. Mengapakah ini boleh berlaku jika stok simpanan sel stem bank darah dalam dan luar negara mencukupi? Besar kemungkinan memang stoknya tidak mencukupi dan juga agak sukar bagi seorang pesakit untuk mendapatkan sel stem yang sepadan dengan sistem darah pesakit itu sendiri. Anggaran kebarangkalian mendapatkan penderma sel stem adalah satu (1) dalam dua puluh ribu (20,000) dan kebawah. Ini bermakna, jika saya memerlukan sel stem, terpaksalah saya mempelawa 20,000 rakan untuk diuji dan mungkin hanya 1 akan sepadan dan boleh menderma. Kemungkinan mendapatkan penderma bukanlah rendah sangat, tetapi, ia mungkin akan mengambil masa yang agak lama jika tiada simpanan sendiri. Ini seakan ”Sindrom Waiting List”.

Sepertimana kita boleh lihat dalam industri perubatan Malaysia, inisiatif swasta boleh dan perlu diusahakan seiring dengan inisiatif Kerajaan. Ini jelas dilihat dimana terdapat kewujudan Hospital Kerajaan dan Hospital Swasta, Doktor Kerajaan dan juga ramai lagi Doktor Swasta. Sudah terbukti di seluruh dunia kewujudan Bank Sel Stem Kerajaan/NGO boleh wujud seiring Bank Sel Stem Swasta malah beberapa bank Kerajaan/NGO dan Bank Swasta di UK telah berjaya berganding bahu untuk menawarkan perkhidmatan menyeluruh supaya warganegara dapat memilih perkhidmatan yang memenuhi kehendak mereka.

Bank Sel Stem darah tali pusat telah mula beroperasi di dunia mulai awal tahun ’90an. Bank-bank di Singapura, Taiwan, Korea, Jepun, Hong Kong sudah beroperasi lebih 10 tahun. Setakat ini terdapat anggaran 150 bank-bank darah tali pusat Kerajaan, NGO dan Swasta di dunia. Anda boleh layari laman web www.parentsguidecordblood.com untuk mendapatkan senarai bank-bank swasta dan Kerajaan/NGO. Negara-negara yang tidak membenarkan operasi bank sel stem swasta hanya segelintir sahaja. Kebanyakkan negara-negara besar di dunia seperti Amerika Syarikat, Kanada, UK, Perancis, Jerman, Australia, New Zealand dan kebanyakkan Negara Asia membenarkan malah menyediakan polisi, akta-akta, garispanduan dan piawaian supaya bank-bank in dapat berkembang serta menyumbang kepada Ekonomi Negara sambil meningkatkan tahap penyelidikan sel stem di negara masing-masing.

Dalam Tanahair pula, apa status nya? Bank sel stem StemLife telah beroperasi semenjak tahun 2001. Kami telah dijemput oleh ’Multimedia Development Coorporation’(MDC) untuk membuka makmal simpanan kami di Cyberjaya dan diberi status MSC. Makmal kami mula beroperasi di Cyberjaya di bangunan MDC iaitu ’Center for Health Innovation & Medical Enterprises’ (CHIME) yang dirasmikan oleh YB Tun Perdana Menteri pada tahun 2002. Bank sel stem Kerajaan di Pusat Darah Negara juga telah dibuka disekitar tahun-tahun yang berdekatan. Kali pertama Sel Stem dewasa/sum-sum tulang telah digunakkan dalam perubatan di hospital Tanahair adalah pada tahun 1987. Sel Stem darah tali pusat pula mula digunakkan di hospital tempatan pada tahun 1997. Setakat tahun 2006, Registry Transplantasi Kebangsaan telah mencatatkan 1,174 kes kegunaan sel stem yang dilaporkan oleh hospital-hospital tempatan Kerajaan dan swasta.

Pada tahun 2006, StemLife telah berjaya disenaraikan di bursa saham BSKL dibawah MESDAQ dan disenaraikan sebagai Stok Syariah. Pada tahun itu juga Jawatankuasa Etika Penyelidikan dibawah naungan KKM dan MOSTI telah mengeluarkan ’Garispanduan Penyelidikan Sel Stem’. Garispanduan ini juga menyatakan hasrat Kerajaan untuk menyokong dan mengembangkan penyelidikan sel stem dalam Negara.

Setelah terbukti kejayaan StemLife, beberapa lagi bank swasta sel stem telah mula beroperasi termasuk pembekal sel stem haiwan. Ramai yang mula membuat kenyataan dalam akhbar-akhbar tempatan mengenai keberkesanan produk mereka. Dalam usaha untuk menjaga kepentingan pengguna/pesakit, pada bulan Mac tahun 2008, Kementerian Kesihatan Malaysia telah mula mengeluarkan lesen dibawah Akta PHFS 1998 lalu menghadkan operasi kepada 4 bank sel stem darah tali pusat sahaja. Bersamaan dengan itu juga, KKM telah menerbitkan ’Piawaian Kebangsaan - Bank Darah Tali Pusat dan Transplantasi’.

Laporan juga menyatakan bahawa pihak KKM sedang dalam proses menyediakan ’Garispanduan Penyelidikan dan Terapi Sel Stem’ serta ’Piawaian Kebangsaan - Terapi Sel Stem’.

Pada masa akan datang, kami berpendapat Terapi Sel Stem akan menjadi salah satu dari Tiga teras perubatan setanding dengan bidang famasi dan bidang pembedahan. Sejarah perkembangan Kedua-dua bidang ini telah berkurun/berabad lamanya. Sesuatu ubat/prosedur pembedahan selalunya mengambil masa 10 tahun keatas untuk diselidik dan disahkan/diluluskan kegunaan dan keberkesananya. Sejarah bidang Sel Stem Dewasa/Sum-sum Tulang sudah dekat 50 tahun manakala Sel Stem Darah Tali Pusat dekat 20 tahun. Ini adalah jankamasa yang amat singkat kalau dibandingkan dengan bidang famasi. Tetapi, keberkesananya telah diiktiraf di seluruh dunia. Sekurang-kurangya 100,000 pesakit setahun menggunakkan sel stem di seluruh dunia.

Adakah statistik ini memberangsangkan? Sudah tentu. Bagi saya, jika saya berhadapan dengan statistik sedih penyakit kanser darah seperti Lukimia, sudah tentu saya akan berusaha dan merayu supaya pakar-pakar tempatan mencuba teknologi sel stem terkini yang diamalkan di luar negara dan bukan hanya mengesyorkan teknologi yang sudah lama diamalkan. Sampai bila hendak ketinggalan 20 tahun?

Irish Medicine Board Consults Professor Colin McGuckin on Cord Blood Stem Cells

NEWSFLASH: UMBILICAL CORD STEM CELL BAN MAY BE LIFTED

Since Prof. Colin visited us in April this year and shared with us the difficulty of convincing medical experts that cord blood stem cells provide a real alternative to bone marrow and are able to produce various cell lineages, I was most delighted to see that Irish Authorities are finally acknowledging that cord blood stem cells are useful and can be banked for their citizen's use (see previous entry on Cavan General Hospital).

Ireland has pretty high incidences of cancer, inline with the rest of the world, although the treatment of it may be restricted due to the available medical facilities and services offered to the patients. Ireland has one of the worst cancer survival incidences in Europe.

If you're wondering if cord blood stem cells really can be used in cancer treatment in adults, have a look at this article citing one of the world's most famous transplanters, Prof. Mary Laughlin who is the haematologist and oncologist at Case Comprehensive Cancer Center and University Hospitals of Cleveland Ireland Cancer Center.

Just in case the article is taken offline, the article is below:

=====================================================
By Fiachra O'Cionnaith

Friday July 18 2008

Official policy banning the retrieval of cord blood stem cells at Dublin's three main maternity hospitals could be set to come to an end under new Department of Health plans.

Since August 2005, official policy at the Rotunda, the Coombe and the National Maternity Hospital has meant that requests from new mothers for medics to retrieve stem cells from the umbilical cord have fallen on deaf ears.

But after confirmation from the Department of Health that it has met with international experts over the possibility of creating a public cord blood stem cell bank for medical and research purposes, the official policy ban may now be overruled.

Since the cord blood stem cell retrieval technology became a reality, a wide-ranging international debate has raged over the use of stem cells obtained in this way.

Those in favour of the medical technique say that cord blood stem cells significantly improve the chances of using the stem cells in question to help treat future medical conditions in the newborn baby or their relatives.

Ethical

But opponents have countered by pointing to ethical concerns over the use of cord blood stem cells and have added that there is not yet enough long-term research to support the claims made about the technique.

As a result of the increased profile of the cord blood stem cell retrieval -- which has been used in over 10,000 births, mainly in the US -- a rising number of Irish mothers have asked for the procedure when giving birth.

Until recently, they have been told the matter was against hospital policy at Dublin's three maternity hospitals, with a formal policy clarification signed by the Masters of the Rotunda, the Coombe, and the National Maternity Hospital in August 2005 noting: "There is insufficient scientific research to support the procedure of taking cord blood for stem cell retrieval. The three maternity hospitals do not support requests to take core blood for stem cell retrieval."

However, speaking to the Herald today, the head of the Irish Patients Association Stephen McMahon said that the Department of Health is now considering plans to potentially bring the policy to an end.

The Department of Health has confirmed that after consulting international experts on the matter it is now considering establishing a public bank for the storage of cord blood stem cells for medicinal and research purposes.

It is continuing to hold meetings with "relevant" interest groups on the matter.

Last week the Department, the HSE, the Irish Blood Transfusion Service and the Irish Medicines Board met with international expert Professor Colin McGuckin of the Institute of Human Genetics at the UK's Newcastle University to hear the benefits of freezing cord blood cells for future use.

The international expert said that the only major hurdle to the plans was the current financial restrictions in the health service.

- Fiachra O'Cionnaith

Stem Cell Snake Oil? When a rotten apple spoils the whole barrel

There's no need to tell me that this blog site seems to be gathering a rather thick layer of dust since we last posted in April. It certainly isn't for the lack of interest but simply the lack of time and sleep!

Well, there's been lots happening in the stem cell world and if you've been keeping up with the news (and if you've been doing that, you definitely have had more time than I have) you'll have seen the many various promotions by new companies, the new technological adoptions and the wide-scale criticism of certain organizations who offer purported stem cell treatments without credible medical data or volunteer themselves for western methods of accreditation and inspection.

There has been most unfortunate reports the media, highlighting the cases of families being "conned" into stem cell treatments and spending hard-earned or hard-raised cash flying to exotic countries for injections. The media certainly portray these families as having no money and no idea as to what they are getting into and are therefore considered "victims" of scams.

It does seem to me that some of these criticisms of the various centers, while valid, give too much credit and sympathy to the patient. Patients who are willing to spend that amount of money should certainly conduct their own research first and opt to try something experimental, knowing that the outcome at best may be to return home safely after a vacation from their usual drudgery and hopefully no worse than what conventional drugs or palliative treatment can offer.

Some of these centers have claims of miraculous cures and patients who have shown remarkable improvements in their conditions. What I'm wondering is whether these centers have been invited to the table to present their work and explain why they think a particular treatment worked in some patients and not in others.

The stem cell world is still new and many issues surrounding the understanding of how stem cells migrate and assist in tissue regeneration have yet to be elucidated.

In any case, the jury is still out and therefore it all depends on whether you believe in "innocent until proven guilty" or "guilty until proven innocent". Criticism is always easier when you haven't got a sick child or a parent with an incurable disease. Desperation itself is a powerful motivating factor to try anything or to try nothing, and is the individual's or family's decision.

One of the biggest problems that a patient faces is access to information and doctors who are really willing to discuss the issues knowledgeably and openly. Doctors could also inform the patients that there are no guarantees in any medical treatment and in the cases of the currently "incurable", inform the parents of the basis of the disease and why stem cells may or may not be able to help.

A short list of questions that might be useful for potential patient to ask are:

1) Are these treatments performed in licensed hospitals?
2) Who are the doctors performing the treatments?
3) How are the stem cells applied?
4) What is the source of the stem cells?
5) Can I see your laboratory facility? (sterility controls, infectious disease etc)
6) Can my medical doctor speak with your medical director?
7) What is the track record of your patients? (success vs. failures, how many still alive?)
8) What other therapies/ treatments do I have to undergo?
9) Adequate back-up facilities for complications?

There are no right or wrong answers but its good to understand the main motives of the providing organization to know whether it is purely for profit and the injections may only be saline.

Sel Stem Darah Tali Pusat Bayi - diiktiraf di seluruh Dunia!

Sel Stem Darah Tali Pusat Bayi - diiktiraf di seluruh Dunia!

Assalamualaikum WBK,

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

Beberapa hari kebelakangan ini kami telah mengambil bahagian dalam program-program ceramah topik Sel Stem Darah Tali Pusat dan kegunaanya dalam menangani masaalah Leukemia dan Talasemia di beberapa lokasi yang telah dianjurkan oleh beberapa organisasi berwawasan sempena Hari Ibu yang diraikan beramai-ramai bulan ini.

Organisasi termasuk Bank Negara, Pusat Perubatan MUIP dan Sekolah Sri Ayesha. Ketiga-tiga telah mengundang kami sebagai Pakar Sel Stem kerana ingin mendapatkan penjelasan yang terkini. Para hadirin ketiga-tiga program ingin penjelasan mengenai pengiktirafan dan status perkhidmatan Sel Stem darah Tali Pusat. Bersama-sama kami di Bank Negara adalah Ratu Jazz Sheila Majid yang telah turut serta di majlis ini kerana beliau juga telah menyimpan Sel Stem Darah Tali Pusat anaknya Khalifah tahun lepas dan ingin mengumumkan kepada peminat beliau mengapa beliau telah memilih untuk menyimpan sel stem darah tali pusat anaknya.

Sudah tentu ramai di antara anda telahpun membaca dalam akhbar-akhbar tempatan tentang penggunaan Sel Stem Binatang untuk mengubati penyakit-penyakit yang sering dihidap zaman ini. Saya berpendapat jika adanya Sel Stem sendiri ataupun yang diderma oleh saudara lain, kita tidak perlu menggunakkan Sel Stem Binatang. Sudah tentu ia tidak menjadi pilihan saya. Kita sering mendengar tentang penyakit ’Bird Flu’, ’Jangkitan Nipah Virus’, ’JE’, dan ’Mad Cow Disease’ yang mungkin menjangkiti manusia dan ada yang telah membunuh ramai - adakah mungkin selamat penggunaan sel stem binatang? Saya masih was-was dan menasihati semua supaya berwaspada. Jika betul ada kajian yang membuktikan keselamatan, kesahihan, dan keberkesanan sel stem binatang digguna bagi manusia dan jika betul ia diiktiraf negara Eropah seperti UK, di USA atau di Australia barulah saya akan menimbangkan penggunaanya. Ini juga jika sudah betul kesesakan dan betul tiada pilihan lain dan juga jika tidak melanggar hukum syarak. Teknologi terkini amat canggih dan mampu memberikan pelbagai pilihan semulajadi seperti sel stem sendiri, buat masa ini dan juga di masa hadapan.


Sel Stem darah tali pusat dan sum-sum tulang yang diderma oleh sahabat kita atau disimpan masa bayi dilahirkan yang sering diggunakan oleh pakar-pakar perubatan telah pun mendapat perhatian dan penerimaan oleh pihak Majlis Kebangsaan Bagi Hal Ehwal Agama Islam.

Penggunaan Sel Stem Darah Tali Pusat juga telah diterima oleh Kementerian Kesihatan Malaysia. Semenjak tahun 2002 lagi kerajaan telahpun mengiktiraf kepentingan sel stem darah tali pusat apabila Pusat Darah Negara telah memulakan perkhidmatan bank sel stem darah tali pusatnya di Pusat Darah Negara di Jalan Tun Razak Kuala Lumpur. PDN telah berganding bahu dengan Hospital Besar Kuala Lumpur dimana ibu-ibu yang bersalin di Hospital Besar KL boleh menderma darah tali pusat mereka kepada PDN.


Pada lewat tahun 2007, Menteri Kesihatan pada masa itu telah pun mengumumkan untuk meningkatkan lagi mutu perkhidmatan dan menambahkan saiz simpanan Sel Stem Darah Tali Pusat Kerajaan di Pusat Darah Negara dan juga membina bank sel stem darah tali pusat di Sg Petani, kedah. Menteri Kesihatan juga telah berjanji untuk meningkatkan perkhidmatan transplantasi sel stem di hospital-hospital Kerajaan tertentu. Pihak KKM juga telah mengiktiraf kewujudan Bank Sel Stem Darah Tali Pusat Swasta apabila telah melesenkan perkhidmatan StemLife Berhad di bawah Akta Perkhidmatan dan Fasiliti Perubatan Swasta 1998.

Terapi sel stem, transplantasi sel stem ataupun pemindahan sel stem telah mula diamalkan di Malaysia lebih dari 15 tahun yang lepas. Pusat perubatan Universiti-Universiti tempatan dan Hospital Kerajaan seperti Hospital Besar Kuala Lumpur sudah lama dan sering mengamalkan prosedur ini. Ianya masih belum kerap dilakukan atau diumumkan pihak media kerana masih ramai gagal mendapat bekalan sel stem.

Perangkaan dari NDMP-USA(Program Pendermaan Sum-Sum Tulang Nasional–USA) bagi tahun 2007 adalah lebih 6,000 pesakit mencari sel stem di bank-bank darah kerajaan USA setiap hari tetapi hanya 648 berjaya mendapatkan sel stem untuk menyelamatkan nyawa mereka. Setiap tahun sekurang-kurangnya 40,000 hingga 50,000 pesakit diseluruh dunia berjaya mendapatkan perkhidmatan pemindahan sel stem bagi penyakit-penyakit barah darah seperti Leukemia dan kepincangan sistem darah seperti Talasemia.

Kini, beberapa Kerajaan Negeri di Negeri-Negeri di bawah Negara USA telah pun menyarankan supaya doktor-doktor menasihati ibu-ibu tentang keggunaan sel stem darah tali pusat dan peluang sekali seumur hidup mereka. Peluang ibu-ibu untuk membuat pilihan samada menderma kepada bank darah Kerajaan untuk keggunaan umum atupun menyimpan di bank darah swasta untuk keggunaan keluarga sendiri.

20 tahun lepas, sel stem darah tali pusat hanya diggunakkan untuk menyelamatkan pesakit-pesakit bagi Satu penyakit. 10 tahun lepas, bilangan penyakit telah meningkat ke lebih kurang 10 penyakit. Kini, anggaran oleh Prof. Dr. Colin McGuckin dari Newcastle University adalah 85 penyakit dan jumlah penyakit akan makin meningkat.

Jadi, terapi sel stem darah tali pusat bayi bukanlah suatu prosedur amalan alternatif tetapi adalah prosedur biasa diamalkan dan diiktiraf pakar-pakar dan kerajaan-kerajaan di seluruh dunia.

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

Launch of NOVUSSANGUIS

Today marks the launch of a new international research consortium called Novussanguis for cord blood and adult stem cells. Its founding members, Professor Colin McGuckin and the Jerome LeJeune Foundation plan to bring together key researchers to discuss and collaborate on the development of stem cells for clinical application.


The launch is held in Paris today and I'll provide some insights about it later on. Here's a snapshot of the launch program.

UK-Singapore Stem Cell Symposium I

Just to remind the world that the UK isn't behind in science (vis-a-vis the US), the British High Commission probably decided that this exhibition panel was important to remind everyone of the UK's key scientific achievements.

So, if you didn't already know or can't read the words in the picture, here's three that you might have confused as a US invention...

UK GREATS
1953: Discovery of structure of DNA
1978: Birth of first test-tube baby
1985: Discovery of hole in Ozone layer
1990: Invention of World Wide Web (bet you all thought this was from the US!)

Anyway, I mentioned in my last post that I'd tell you a bit about what I learned in the symposium. My apologies for the delayed write up.

The first lecture after lunch was by Professor Tariq Enver, Professor of Stem Cell Biology at Oxford and Director of Stem Cell Research at the MRC's Molecular Haematology Unit in the Weatherall Institute for Molecular Medicine.

Prof. Enver's talk was of interest to me for 2 reasons - inspiring content AND all the key ingredients of a good presentation:

1. Clinical relevance (patient's photos to inspire the right emotional context)
2. Clear introductory statistics for the uninitiated
3. Direct genetic implications of the research
4. A happy conclusion (very important)


WHAT IT WAS ABOUT

The story begins with the introduction of stem cells and their existence in babies' blood. The first question he posed to the audience was whether anyone knew what a "Guthrie card" was (when a baby is born, a small heel prick is performed to obtain the baby's blood, which is stained on a filter paper- known as a Guthrie card- and used to test for inborn metabolic diseases). Prof. Enver suggests that Guthrie cards can be kept for extended periods of time so that if a child is later found to develop certain types of leukemia, it would be possible to identify whether the indications of leukemia were there at birth.


WHY IS THIS IMPORTANT?

The reason why it is useful to know whether the leukemic cells are present at birth, is because if the cells are present at birth, doctors may choose to treat the patient with different medications as leukemic cells (which behave like stem cells) have different chemo-sensitivities in children. Leukemic cells from birth may require more specific and less intensive drugs than adult patients.


At this point, I feel that it is important to point out the difference between "stem cells" and what is popularly termed "cancer stem cells".

Stem cells are cells which exist in the body and are responsible for continuous maintenance of the body and a controlled replacement of our cells and tissues. The stem cells are known to be "relatively immortal" (ie they live a far longer lifespan than our normal cells, which may die after 7-90days) and are key to our existence and survival of our blood and immune systems etc.

Cancer stem cells however, are like other cancers -cells gone wrong- except that the cell that has gone wrong is the stem cell. Hence, the cancer stem cell does not make other tissues and does not replace cells like it should. It merely makes more of itself, which isn't useful under the normal circumstances.

So, a pertinent question to ask is how do you know a stem cell from a cancer stem cell? Well, Prof Enver believes that there is a lot of talk about "markers" for stem cells, but there is no doubt that these markers have a long way to go in being defined and that the best way to know is to conduct functional studies (ie, to see how the cells really work in real life).


REAL LIFE SCENARIO

A pair of very beautiful twin girls from Bromley a city in Kent, were the subjects of the study. According to the news story, which was reported in January this year, Olivia Murphy developed acute lymphoblastic leukemia (ALL) when she was 2 years old, while her twin sister Isabella remained healthy. I'm not exactly sure how the case came to Prof. Enver's attention at the MRC (I wanted to ask him but didn't get a chance) but he and his group ended up researching why one of the twins developed the disease while the other remained healthy. Prof. Enver's team elucidated that both twins carried a gene that pre-disposes them to developing the ALL, but while Isabella only had one hit to her gene, Olivia had two hits which resulted in cancer development (cancer usually results from several mutations to certain genes which allow the cells to grow uncontrollably).

They proved to be the perfect research subjects to understand if genetics had a pivotal role in the stem cells, which could already be susceptible to chance changes after birth. The aim of the research, was to discover where the point of change was that resulted in the cancer, and whether it would be possible to design a method to protect the susceptible genes (prevention) or necessary drugs which would target the cancer cells.

There was a more detailed write up which describes how the twin's parents brought Olivia in for fever which the doctors had then thought was tonisilitis. The parents insisted on a blood test and were given the ALL diagnosis. Fortunately, Olivia's cancer responded well to the chemotherapy and was a success, but not without side effects.

The chemotherapy was so strong that her immune system was damaged and she suffered six attacks of shingles (chicken pox relative) which infected her eye and blinded it. In the course of research, Prof. Enver's team took regular samples of both the girls' blood and the doctors will screen Isabella regularly to monitor any signs of the 'second hit'.


OPTIMISM FOR TARGETING PRE-CANCER CELLS

According to Prof. Enver, as the total cancer relies on less than one per cent of the cancer generating cells to maintain the disease, this offers a unique opportunity to develop better drugs to kill off this one per cent of cells. He was quoted saying that there could be a day where the prevention of leukemia would be possible as the pre-leukemia cells could be eliminated at the source, potentially curing 90% of the cases detected.

However, no medical procedure is risk free and the strong chemotherapy may result in the death of 1-2% of cases treated. And for those couples with identical twins, you might like to know that nine out of ten children who have an identical twin with leukemia do not develop the disease.

That means that Isabella's chances of staying cancer free remains pretty high. :)

StemLife Berhad Pakar Sel Stem Darah Tali Pusat dalam Program NONA TV3

Sel Stem Darah Tali Pusat, Sel Stem Sum-Sum Tulang, Sel Stem Embrio, Transplantasi Sel Stem, Transplantasi Sum-Sum Tulang, Leukemia, Talasemia, Limfoma, Simpanan Krio, Bank Sel Stem Darah Tali Pusat – Apakah maknanya semua ini?, Apakah kepentingnya? Apakah perbezaan diantara kesemuanya?

Assalamualaikum WBK,

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

Pelbagai atikel, rencana, dan pendapat telah dan sentiasa diterbitkan dalam akhbar-akhbar serta majalah-majalah tempatan, antarabangsa serta laman web-laman web seluruh dunia. Jumlahnya memang tidak terkira. Ramai pembaca akan mengalami perasaan buta huruf dan kadang-kadang tersesat dalam kegelapan kerana terlalu banyak pencapaian yang dihebohkan, pendapat yang berbeza, serta kontroversi yang tidak dijelaskan. Banyak atikel-atikel ini juga agak teknikal dan saintifik tanpa mengesyorkan bagaimana teknologi ini dapat memberi manfaat kepada kami di Malaysia buat masa ini mahupun masa hadapan.

Saya akan cuba untuk memberi pendapat saya dari seorang pengamal sains dan akan cuba menterjemahkan atikel-atikel serta isu-isu yang tidak begitu rumit tetapi sentiasa lebih rumit dari yang sebenarnya.

Atikel-atikel yang telah diterbitkan di akhbar-akhbar tempatan serta seluruh dunia akan diteliti. Saya juga akan cuba menterjemahkan mesej-mesej dalam laman web-laman web antarabangsa seperti parentsguide.com dan banyak lagi.

Sebagai permulaan blog ini, saya ingin menjemput anda untuk menonton program NONA dari TV3 pada 23hb Mac 2008:



Nona TV3



Saya harap program ini dapat memberi anda sedikit latarbelakang tentang topik ini dan akan membolehkan Saya meneliti topik-topik yang lebih teknikal pada masa yang akan datang.



Sekian buat masa ini.. Wslm.

Blogging Live from Singapore at the UK-Singapore Stem Cell Symposium

Its been a long time since I sat in a room full of developmental biologists discussing the intricate biochemical pathways -some discovered and debated heatedly- and listened to the fundamental scientific research performed in the UK.

Organized by A*STAR’s Singapore Stem Cell Consortium and the British High Commission at Singapore’s Biopolis, it was another event which made evident Singapore’s financial commitment to establishing a scientific research base through educating its PhD students and motivating local researchers to aspire to international knowledge standards. Since I did spend a few years in a research position in Singapore, it is only right that I promote their efforts in scientific education.

15 scientists (of which 7 were Professors and researchers from their respective departments) from the Universities of Cardiff, Cambridge, UCL, Sheffield and Edinburgh presented a thirty-five minute summary of their work involving stem cell pathways derived from embryonic cell lines and cancer cells.

All the presentations were very technical (as they should be) and involved the investigation of signaling pathways in the cell.

For those who are less scientifically inclined, signaling pathway research, in plain language is finding out how a cell talks to another cell, and how each of the cells respond in body language according to what is said. Imagine that a cell is itself made up of many components (kind of like organs within your body) and these components need to synchronize in order to regulate and make the cell what it is, or what it is to become. In this case, the researchers were trying to find out which factors affect the embryonic stem cells and make them change or “differentiate” into a specialized cell type.

As always in basic scientific research, as long as governments don’t run dry on funding, scientists will always have work to do because we are still a long way off understanding how our cells talk to each other, and most importantly how to control unnecessary conversations which may spark off a chain of unwanted reactions.

You can find the list of speakers and topics here, and for the sake of brevity and also without having to go into too much basic cell biology, I’m going to give you an outline of a few of the talks which I find easier to explain and are relevant to the faithful readers of this blog. I've chosen 4 presentations (Prof. Tariq Enver, Dr. Phil Jones, Dr. James Hui and Prof. Pete Coffey) to share with you and you'll find them in the ensuing entries.

Viacell chose SEPAX

Well, it wouldn't be fair that other automated systems aren't discussed on this blog.

A burning question you must all have is:

What systems are all the other cord blood stem cell companies using?

Well, last year, Viacell announced in a short brief that they were integrating automation into its existing closed processing system using the SEPAX system, designed and manufactured by BioSafe, a Swiss rival of Thermogenesis.

The announcement stated that:

"SEPAX is the only FDA cleared cord blood processing system. Biosafe received FDA clearance in January 2007 and European CE mark approval in 2001."


THE SEPAX MACHINE: WHAT IS IT?

The SEPAX automated processing system is an all-in-one machine which is achieves a similar outcome of stem cell separation through an in-built centrifugal technology. It is approximately 14 Kg in weight (2 year old baby) and reminds me somewhat of a large square automated rice cooker (the newer Sanyo versions, that is).

The separation of stem cells from other blood components is achieved in a central core which spins the blood at high speed and through an optical reader, squeezes the separated components into the various compartments until the process is complete (watch the Quicktime animated demo). SEPAX kits are single use (just like AXP) and come with an option of storage bags, although it is rumoured that the kits will soon only come with a single compartment bag as Thermogenesis is revoking permission for the dual compartment design use (business as usual for public banks but potential consumer's angst in private banks).


THE PROS AND THE CONS

Let's start with the Pros.

1) The machine does away entirely with a centrifuge (no Beckmann or Sorvall)
2) One unit processed at a time
3) Portable
4) Closed system
5) Single disposable kit
6) No requirement for clean room
7) Used and endorsed by major european cord blood banks affiliated with Netcord*

The Cons.

1) Each unit takes approx 40 mins to process
2) One machine processes one unit at one time
(i.e. if you have 1 machines and 10 units, it will take you approx 5+ hours to complete the lot, more machines = more costs)
3) Possible breakdown of light detector (replacement downtime?)
4) Limitation of single compartmented storage systems
5) Technical oversight to ensure that the initial connections are placed correctly
6) Price (the euro has been incredibly expensive since last year)
7) Service when things go wrong (specialized engineer required from Switzerland)

CONSIDERATIONS FROM THE USER'S PERSPECTIVE

Both the AXP and the SEPAX have their pros and cons, and as a potential user, I'm interested in knowing the breakdown rates and other problems banks have in using the system. These are usually not disclosed and the user takes on the risk to find out. Unlike public banks which can afford to discard units which don't turn out right, private stem cell facilities have zero tolerance for error as every single one hurts both the client and the company's balance sheet. Additionally, if the system does not work out for the company for whatever reason, the expensive asset has to be written off (may cost millions) which would be an extremely painful decision to make.However, unlike the AXP system, the SEPAX system has been in use for a while and has not released any public recalls of their product. Hence, the only reason that I can think of for its slow uptake in the rest of the world is that unlike Europe, which promotes public banking largely for blood cancer use, America and the rest of the world is promoting cord blood stem cells for regenerative use- hence the need for a multi-compartmented bag- which is a different concept entirely.


PROFIT & LOSS

Certainly all companies selling the automated systems would stand to profit greatly from entering the cord blood stem cell market. Cord blood stem cell banks can still use generic products on the market, making it relatively affordable to bank as long as the team is technically competent. Now, automated systems will increase general standards of quality for those with less well trained staff (its a matter of practice and the total experience) but it also pushes prices up for the consumer or makes it less profitable for smaller operators. Public banks will also need to campaign for more funds in order to buy new systems and costs of processing will need to be revised from previous proposals.

For now, the small number of options in automated systems commands a forced loyalty as each system only accepts their own product. Many of the stem cell banking services that face the consumer directly will await the day that there is a generic design of standard quality which can be used with any machine, which will be more open to price transparency. Of course, that day may still be far away until either governments have budget surpluses to devote to a huge volume of public banking (when it takes precedence in funding over other healthcare priorities) or legislate to provide a conducive environment for the public to exercise their choice to bank privately should they wish to.

KNOW WHAT YOU'RE PAYING FOR

There is no doubt in my mind that automation is inevitable at some point but let's not forget that this is still version 1 with potential to move to version 2. In the meantime, I'd like to see who and how the AXP system and SEPAX system is used in private hands, and whether it is used according to manufacturer's recommendation** to achieve the desired result.


*Prof. Eliane Gluckman's - the first cord blood stem cell transplanter- facility Eurocord uses the SEPAX system, in direct rivalry with AXP whose public endorser is the New York Cord Blood Bank led by Dr. Pablo Rubenstein who developed cord blood storage procedures in the US.

**Manufacturers recommend certain minimum volumes and maximum volumes to be used with their system. Any deviation of this will not result in the promised outcomes, hence clients who are paying more for the promise of this system but don't meet the criteria will still ultimately be getting manual processing (which works well in a competent facility but not in one where the practice is limited).

The point of these systems is also to provide a "functionally closed" system of processing and there certainly wouldn't be any point in using the automated system if you had to transfer the cells from the final bag into a different storage method (e.g. vials) at the end, which would break it into a "functionally open" one instead.

US Recall News: AXP AutoXpress Cord Blood and Sick Cow Meat

In this week alone, I've received two articles from friends and colleagues informing me on the latest in a string of bad news from the US.

The first article was about Thermogenesis recalling 7,000 of its latest disposable bags custom designed to be used with the automated AXP device, used to process cord blood for stem cell separation.


WHAT'S THE PROBLEM?

Thermogenesis apparently failed to perform a quality control procedure on every shipment of the Auto-Xpress units from the time that the product first went on the market in 2006 up until now. The CEO, Willaim Osgood, who joined after the product went on the market, launched the recall after an internal audit found the flaw which was against the federal laws.

The flaw was the failure to perform quality control test for pyrogens (substances which cause fever, including bacterial toxins), which was omitted from the company's operating procedures.

This is one of my concerns in using any new products, as mentioned in my previous blog entry. It's always a real worry when products have problems and the service provider has to explain it to the clients. This is one of the reasons why we're evaluating if moving from a time trusted method to technology 1.0 is something that our clients would accept. Admittedly, cord blood stem cell clients need to be made aware of these concerns too.


WHAT'S BEING DONE ABOUT IT?

The CEO has admitted that "it was a mistake" on Thermogenesis's part and is now working with customers to retroactively test the Auto-XPress units, while the US FDA recommends that any cord blood units already stored be labeled as such so that they will be able to trace any problems if the unit is required for transplant.


According to the article:
There is currently no way to test whether a frozen cord blood sample is contaminated, according to the FDA recall notice. ThermoGenesis is in the process of validating a way to test for contaminants after a sample has been thawed.


While the AutoXpress sales accounts for 25% of Thermogenesis's USD 5.5 million revenue (making it the fastest growing product in the 22 year old company's history), its not the first problem with the bags due to the false-negative results in the first round which delayed shipments. This has depressed the company's share price (NASDAQ:KOOL) down by 6% to USD 1.53.

The AutoXpress bags are manufactured at an outsourced facility in Pennsylvania and the bags are tested at another outsourced facility.

GE Healthcare's Amersham division in Sweden signed an exclusive 15-year distribution deal with Thermogenesis to supply the AutoXpress system worldwide last October.

THE THERMOGENESIS REVENUE STREAM

The bulk of Thermogenesis's AutoXpress sales is currently from Cord Blood Registry (CBR) which collects and processes the majority of cord blood units in the US, though financial arrangements between them and Thermogenesis are not disclosed. The New York Cord Blood Bank also utilizes Thermogenesis's AutoXpress and I wonder how many units were used in public collections since June last year.

Thermogenesis predicts that first year revenue should be about USD 4 million with USD 50 million in total. Based on this number, between CBR, NYCBB and a smattering of other users around the world, approximately 35,000 to 40,000 AutoXpress units would have already been used for cord blood stem cell storage.


WHAT PROMPTED THE 143 MILLION KG BEEF RECALL?

The second news article was the US Beef recall that was sent to me via email... if you havent' already seen the nasty video and would like to see what prompted the recall, you can watch it here.

Bioengineering like the movies: Stem Cell Capturing Gadget

I'd hate to sound as if I was brought up on an entertainment diet of Hollywood movies, but back in the 1970's to 80's there was a real revolution in cinematic production and audience interest that led to a cult following of the science fiction genre.

Film directors often take what's probable in science and stretch them to the limits of our imagination, engaging us to just reflect on not only how far we've come but also how much further we can aspire. This next entry is a tribute to the 1987 movie "Inner Space"*.




In a recent announcement, MIT's bioengineers have designed an implantable device that is capable of capturing pure samples of stem cells from the circulating blood. The device is described as "a length of plastic tubing coated with proteins" which has been experimentally implanted into the bloodstream of rats.

The more accurate medical description of this plastic tubing is known as a "shunt" and the method of implantation would most likely involve the severance and reconnection of a small but high through-flow blood vessel. The proteins -known as selectins- attract and trap specific cells with the right signals on the surface (imagine a sticky mat). The cell capture devices are developed by chemical engineers led by Associate Professor Michael King from the Biomedical Engineering department at the University of Rochester. The technical details will be described in the March edition of the British Journal of Hematology.

(personal note: Mr. B.C. this is for you.)


WHY IS THIS DEVICE IMPORTANT?


The medical impact of this device could weigh in for cancer patients who may need to use autologous (one's own) stem cells for their treatment. These cancer patients are treated with chemotherapy to reduce and eliminate as many of the malignant circulating cancer cells as possible from the bloodstream and bone marrow. The treating doctor will collect the patient's own stem cells during this period of remission when the cancer load is at its lowest.

The patient's own stem cells are stimulated using GCSF (read about it here) and the stem cells are harvested and stored in anticipation of the possibility that the cancer cells will multiply again, requiring another round of chemotherapy which may damage the existing healthy marrow further. The collected stem cells will be infused back to the patient to ensure that the patient has sufficient stem cells to repopulate and replenish the marrow, thereby restoring normal cell levels to the bloodstream.

To address the concern that perhaps cancer cells from the patient might also be collected in the same fraction as the healthy stem cells (impossible to distinguish during harvesting) this device could lend a hand to filter out the cancer cells inside or out of the patient's body, i.e. the cancer cells would travel around the bloodstream until they reach the shunt, where they would then be immobilized.

Note though, that the inventors have conceded that this device will not be able to collect enough stem cells for a transplant, therefore the customary stem cell collection procedures will still need to be performed.


SOME INTERESTING STATISTICS


According the A/Prof. King, the shunt placed in an non-GCSF induced rat in a 2 hour period enabled the capture of 3-4 times the number of usual stem cells obtained in normal circulating bloodstream (approx 1%). Hence the device is thought to attract and specifically retain a significantly higher number of stem cells.

This stem cell number could be significantly higher in patients who have been mobilized.


WHAT ELSE CAN IT DO?


Well, it is a concept device which will be as good as its selectin coating. A/Prof. King has already forecasted the use of the device in trapping specific cancer cells in the body to prevent metastatic spread and layering in proteins which could help steer cell development processes by differentiating them while passing through the shunt. (analogy: think sticky mats for dust, sticky mats for cockroaches, sticky mats for cat fur...all requiring different levels of stickiness for its target)



WHEN CAN I BUY IT?


The entrepreneurial A/Prof. King has already started a company by the name of CellTraffix and the anti-metastasis implants are set for animal trials later this year in collaboration with bioengineers Professor Jeffrey Karp and Robert Langer at Harvard and MIT who will develop stable selectin coatings that will last over months than days. Meanwhile, the CEO of CellTraffix, Tom Fitzgerald has already announced that the company's first product for researchers to capture stem cells or cancer cells for lab experimentation will be marketed by early 2009, with clinical testing of the anti-cancer coatings in 2010.


Read how a chance encounter between a bioengineer and a haematology clinician gave rise to this work and watch the cells being captured here (note that you will need a high speed broadband connection as the video files are rather large).


*Why does this remind me of the movie Inner Space I hear you ask... well the term cell capturing device often conjurs up the image of a little machine (like the exploration submersible the protaganist uses) to grab and hold onto cells in circulation :)

Your OWN or your FAMILY's are always the BEST!

Use your OWN or a SIBLING’S cord blood stem cells and achieve CURE or REMISSION!

Data from a retrospective review of blood disorder patients treated with stem cells from their own cord blood (autologous transplant) or from the cord blood of a sibling (allogeneic-related transplant), presented at the American Society for Blood and Marrow Treatment (ASBMT) annual meeting showed that the majority of the patients were cured or achieved remission from their disease. Moreover, low risk of transplant-related complications with genetically-Related cord blood stem cells was seen.

Dr. Jennifer Willert, senior attending transplant physician and clinical professor at Rady Children's Hospital, University of California - San Diego, and lead author of this study said that “we now have important insights into the ability of transplant physicians to achieve successful outcomes using an individual's own cord blood to treat an environmentally-triggered blood disease or cord blood from a family member to treat certain genetic blood disorders and inherited bone marrow failure syndromes (IBMFs). Furthermore, the use of genetically-related cord blood may reduce the rate of mortality as well as the risk of treatment-related complications".

The analysis examined transplant recipient data from 16 cases of nonmalignant blood disorders. Four of the patients were infused with their own cord blood stem cells to treat aplastic anemia, an acquired condition. Twelve patients were transplanted with cord blood stem cells of a sibling for a range of inherited conditions including, thalassemia, sickle cell anemia, Fanconi anemia and Hurler syndrome. The review showed that two-thirds of the patients (10) are either cured or in remission, including half of the patients treated with their own cord blood. Three patients died of complications unrelated to their cord blood transplant; one patient experienced a relapse; and the outcomes status of two patients is not known. All 16 cord blood collections were processed and cryo-preserved at Cord Blood Registry and were viable for transplant when requested. The average storage time prior to use was about 27 months; however, one child's collection was stored for nine and half years and used to successfully cure that child's aplastic anemia (autologous use)!

Advantages of Genetically-Related Cord Blood Use in Transplantation

According to previously published data, transplantation of genetically-related umbilical cord blood has demonstrated clinical advantages over bone marrow, peripheral blood and unrelated umbilical cord blood. Since cord blood stem cells are immunologically younger than other "adult" stem cell sources, they demonstrate more versatility and flexibility when used in transplantation. Stem cell transplants from genetically-related sources (those from an immediate family member) result in better treatment outcomes than transplants from an unrelated donor and are associated with less frequent and less severe graft-vs.-host disease, a complication that occurs when the donor cells attack different parts of the body. Cord blood is rapidly becoming a preferred stem cell source in transplant therapy (a standard treatment in children's BMT already), with more than 10,000 cord blood transplants performed worldwide to-date.

Dr Willert said: "This study is relevant to any expectant parent considering whether or not to privately bank cord blood stem cells, Individuals who have access to their own cord blood stem cells, as well as a sibling's, have the best chance of treating a blood disorder that develops."

It is really not much to talk about here; the study really speaks for itself! The final comments of one of the authors say it all. Little miracles are hidden in our OWN veins!