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A LECTURETTE ON

STEM CELL FROM UMBILICAL CORD BLOOD AND TISSUE

In Partial Fulfillment of the Course Requirements in NLM 107 B

PRACTICING CLINICAL INSTRUCTOR ROTATION

Submitted to:

Milagrosa Candida V. Caburnay, RN, MN Clinical Instructor

Submitted by:

Judeah G. Salangsang, St. N BSN 4I

November 21, 2012

TABLE
Objectives Content

OF

CONTENTS
3 5 6 6 7 7 8 8 9 10 10 12

Introduction . . ..............................................................................................

Anatomy and Physiology of the umbilical cord . Stem cells defined Function of stem cells

Umbilical cord and stem cells

Method of collecting stem cells from umbilical cord

Preservation and Banking ... Treatable diseases and future uses Advantages and Disadvantages References

INTRODUCTION
Colon cancer. DiGeorge syndrome. Alzheimers disease. These are only three that is part of the long list of illnesses that scare the modern man. They leave one incapable of living a normal life, psychologically terrified and in the process, debilitate the very person within. Some of these illnesses have known cures, however, there are still those that do not. The response of the physician whenever the family asks of the course of treatment would be what would be done would be palliative. Treating and managing the symptoms yet not curing the disease itself. This leaves the patient and the family hopeless and often times, helpless. However, over the years, scientists have tried and experimented again and again on possible cures for these illnesses. And lately, what has been a hot topic on media and the web is the emergence of the famous stem cell therapy. Many known

personalities have already availed of this particular treatment like the former president Joseph Ejercito Estrada. But, together with the magic this treatment brings is the fact that it is pricey. The stem cells used were drawn from animals and then processed in order to be injected to clients who want to avail such. But, according to research, theres another source of stem cells that are highly useful and practicable. The source? Well, its from the newly bred of our generation. The newborns. Studies have shown that the umbilical cord blood and tissue contain stem cells which are mesenchymal cells that shall serve as treatment for illnesses such as acute myeloid leukemia, diabetes, systemic lupus erythematosus and more. The said innovations caught my attention. I then decided to use this topic for my lecturette to third year student nurses who are on their delivery room rotation. This lecturette defines what stem cells are and their function. Also, the human umbilical cord shall be tackled and then later on connected with stem cell therapy. This lecturette shall also discuss the means of extraction, preservation, banking and the illnesses that can be treated by umbilical cord blood and tissue. Also, this lecturette

also tackles the advantages and disadvantages of stem cell from umbilical cord. This topic would be of help not only to me, but also to other students, who shall be future nurses. With the knowledge that we can gain from this lecturette, it shall equip us with correct information should we encounter a client who shall ask about preserving cord blood and tissue. In addition, since majority of us desire to go abroad to practice, knowing about this will help us in assisting collection of cord blood and tissue should we be delivery room nurses in the future. In terms of education, this supplementation and update shall further broaden our knowledge in the maternal and child nursing. Aside from that, this topic shall also help those who are conducting research about this topic and also those who would like to know more about stem cell therapy from umbilical cord blood and tissue.

OBJECTIVES
General objective: At the end of the 40-minute lecture, I will be able to tackle comprehensively umbilical cord blood and tissue stem cells that shall broaden the knowledge of BSN3E group 1 students about maternal and child care nursing.

Specifically, I aim to:

a. Give a brief overview of the content of the lecturette; b. review the students of the anatomy and physiology of the umbilical cord; c. tackle stem cells and their function; d. discuss stem cells that are found in the umbilical cord blood and tissue; e. enumerate the steps of collecting umbilical cord blood and tissue; f. present the methods of preservation and banking of stem cells; g. list the treatable illnesses and future uses of stem cells drawn from umbilical cord blood and tissue; h. tackle the advantages and disadvantages of umbilical cord blood and tissue stem cells; i. j. give a quiz; and enumerate the references utilized in making this lecturette;

CONTENT
I. ANATOMY AND PHYSIOLOGY OF THE UMBILICAL CORD The umbilical cord is formed from the amnion and chorion and provides a circulatory pathway connecting the embryo to the chorionic villi. The function of the cord is to transport oxygen and nutrients to the fetus from the placenta and to return waste products from the fetus to the placenta. The umbilical cord is about 53

centimeters (21 inches) in length at term. It is about 2 centimeters (3/4 inch) thick. It contains one vein (carrying blood from the placental villi to the fetus) and two arteries (carrying blood from the fetus back to the placental villi). The remant of the yolk sac may be found in the fetal end of the cord as a white fibrous streak at term. The bulk of the cord is a gelatinous mucopolysaccharide called Whartons jelly, which gives the cord body and prevents pressure on the veins and arteries. covered with amniotic membrane. The rate of blood flow through an umbilical cord is rapid (350 mL/minute at term). Whether an adequate blood flow (blood velocity) is present in the cord can be determined by ultrasound. Both systolic and diastolic pressure can be determined by this method. The rapid rate of blood flow through the cord makes it unlikely that a cord will twist or know enough to interfere with the fetal oxygen supply. In about 20% of all births, a loose loop of cord is found around the fetal neck ( a nuchal cord). If this loop of cord is removed before the newborns shoulders are extruded, so there is no traction on it, the oxygen supply to the fetus remains unimpaired. Smooth muscle is abundant in the arteries of the cord. Constriction of these muscles after birth contributes to hemostasis and helps prevents hemorrhage of the newborn through the cord. Because the umbilical cord contain no nerve supply, it can be cut a birth without discomfort to the child or mother. The outer surface is

II.

STEM CELLS DEFINED

Stem cells are immature, undifferentiated cells that divide to replace lost or damaged cells. Stem cells are the building blocks of our blood and immune systems. characteristics. They have three main

They are particularly powerful because they

have the ability to replace or repair damaged cells throughout the body. These are: i. They are NOT specialized cells, in contrast to cells of muscles, brain and heart; ii. They are capable to divide during long time and in the result of the division is the formation of two identical cells; iii. They have the ability to differentiate into specialized cells, like muscle cells, brain cells, blood cells and other. Cells of 1-day embryo can differentiate into any of 240 types of cells. In adult organism small amount of stem cells is present in all organs, providing the reparation (restoration) of injures and sick tissues. The younger the organism is the bigger stem cell reserve is, and accordingly, bodys restoration potential. It is considered that application of stem cells in medicine will give the possibility to successfully combat diseases that are regarded incurable today.

III.

FUNCTION OF STEM CELLS

Stem cells ensure restoration of injured areas of organs and tissues. Its mechanism of action is following: after receiving a signal about trouble they are directed to injured organ, where they transform into cells necessary for organism and stimulate internal organisms reserves for organ or tissue regeneration. Stem cells are used therapeutically in transplants to help cure, treat and repair damaged blood and immune systems. This is especially valuable when the systems have been damaged by radiation or chemotherapy.

IV.

Umbilical cord and stem cells

Amazingly, a newborns umbilical cord provides expecting parents the

opportunity to secure stem cells from three main sources:

1. Umbilical Cord Blood The blood remaining in the umbilical vein after the cord is clamped and cut. This blood is an excellent source hematopoietic stem cells (HSCs) and mesenchymal stem cells (MSCs). 2. Umbilical Cord Tissue The connective tissue surrounding the vein and arteries of the umbilical cord. This tissue, also called Whartons Jelly, is an abundant source of mesenchymal stem cells (MSCs). 3. Perivascular Region Surrounding Umbilical Vessels The area located directly around the arteries and vein in the umbilical cord, containing the highest concentration of mesenchymal stem cells (MSCs). They have the ability to form all of the structural cell types of our body (bone, cartilage, muscle, fibrous tissue and fat).

V.

Method of collecting stem cells from umbilical cord

After the baby is born, the following steps are done by the health care professional: 1. Clamp and cut the umbilical cord 2. Cord blood is then collected by inserting the collection needle into the umbilical vein and allowing the blood to flow into the collection bag by gravity until it stops.

3. Once blood is drained, as much of the umbilical cord tissue as possible will be collected and placed into the sterile, protective cup/bag that shall be provided by the institution that shall preserve it. 4. The sterile cup/bag is then sealed and labeled for easy identification. The collection of such takes 2-4 minutes and is painless for both the mother and the child.

VI.

Preservation and Banking

There are two ways to store cord blood with a public bank or a family bank.

a. Public cord blood banking stores cord blood donated by individuals. That blood is then available to anyone who needs a stem cell transplant. Those who donate their cord blood to a public bank are not guaranteed that it will be available if it is ever needed for their own family. In addition, public banking is only available in a limited number of hospitals in the United States. b. Family cord blood bank stores the newborn's cord blood stem cells exclusively for his/her family. There is up to a 75% chance that the baby's cord blood will be an acceptable match for his/her siblings. It's also important to remember that transplants using cord blood from a family member are nearly twice as successful as transplants using cord blood from a non-relative (i.e., a public source).

The New York State Health Department Guidelines for cord blood banking state that umbilical stem cells can be stored indefinitely under liquid nitrogen. The policy states, "There is no evidence at present that cells stored at -196C in an undisturbed manner lose either in-vitro determined viability or biologic activity. Therefore, at the current time, no expiration date need be assigned to cord blood stored continuously under liquid nitrogen." Current data reflects that cord blood cells that have been stored for fifteen

years have the same composition as they did at the time of storage. All science involving cryogenic storage of cells also indicates that the cells should remain viable indefinitely.

VII.

Treatable diseases and future uses

Today, cord blood stems cells are used in the treatment of nearly 80 life-threatening diseases, including a wide range of cancers, genetic diseases, immune system deficiencies, and blood disorders. Some of which are cancers such as acute

lymphoblastic leukemia, acute myeloid leukemia, lymphoma, and non-hodgkins lymphoma. Also, bone marrow failure syndromes such as amegakaryocytic thrombocytopenia, autoimmune neutropenia, evans syndrome and Fanconi anemia. Other illnesses that are said to be treatable with the use of stem cell from the umbilical cord are blood disorders/hemoglobinopathies, metabolic disorders, immunodeficiences, and osteoporosis. .Emerging treatments are also seen or discovered for the illnesses diabetes, cerebral palsy and brain injury Cord tissue stem cells are currently being evaluated in clinical trials as therapies for: Heart disease Stroke Serious wounds Spinal cord injury Cartilage injury Liver disease Diabetes Human Immunodeficiency Virus (HIV)

VIII.

ADVANTAGES AND DISADVANTAGES

There are several different kinds of stem cells found throughout the body; however umbilical cord blood stem cells offer several advantages over other sources. a. Umbilical cord blood, like bone marrow is a non-controversial and rich source of stem cells, free from political and ethical debate.

b. Stem cells from cord blood are now used to treat nearly 80 life-threatening diseases. c. Stem cells from cord blood have successfully treated children and adults. d. Transplants using cord blood from a family member (e.g., a sibling) are proven to be more successful than transplants using cord blood from a non-relative (e.g., from a public bank). e. When a child receives his or her own cord blood, there is no risk of rejection.

Cord blood has a number of advantages over bone marrow as a source of cells for transplantation. Compared to marrow, cord blood transplants have less stringent matching requirements, a lower incidence of a rejection reaction, a lower risk of virus transmission to the recipient, and are more immediately available. Potential disadvantages are that cord blood stem cells provide a limited number of cells and therefore may not be sufficient for some larger patients. However, there have been many successful transplants in adults, and several groups are actively developing techniques to grow and increase the numbers of cells from their original numbers. This could enable transplants for all ages, and sizes of people. Having the ability to expand these cells in artificial culture systems will also help doctors deal with two other limitations of cord blood, i.e., length of time to engraftment and repeat transplantation from the same source.

References:

Books: Butler, M., Menitove, J. (2011) Umbilical cord blood banking: an update. J. Assist Reprod Genet Lloyd, E. (2006). Umbilical Cord Blood: The future of Stem cell research? National Geographic News. USA Pilliteri, A. (2009). Maternal and Child health nursing. Lippincott Williams & Wilkins. Philadelphia Tortora, G., Derrickson, B. (2007). Principles of Anatomy and Physiology. John Wiley & Sons, Inc. USA Troyer, D., Weiss, M. (2008) Whartons jelly-derived cells are a primitive stromal cell cell population. Stem Cells. National Marrow Donor Program; Trends in Allogeneic Transplants http://marrow.org/Physicians/Unrelated_Search_and_Transplant/Trends_in_Allo_ Transplants.aspx#grafts Retrieved from http://www.medicalnewstoday.com/releases/222092.php