Cord blood: Difference between revisions

Revision as of 02:11, 28 November 2006

Latest revision as of 23:15, 1 August 2025

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{{Short description|Blood in the placenta and umbilical cord after birth}}

'''Umbilical cord blood''' is human [[blood]] from the [[placenta]] and [[umbilical cord]] that is rich in [[hematopoietic]] [[stem cell]]s. Cord blood is collected after the umbilical cord has been detached from the [[Infant|newborn]], and utilized as a source of stem cells for transplantation.

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Cord blood is stored by both public and private [[cord blood bank]]s. Public cord blood banks store cord blood for the benefit of the general public, and most U.S. banks coordinate matching cord blood to patients through the [[National Marrow Donor Program]] (NMDP). Private cord blood banks are for-profit organizations that store cord blood for the exclusive use of the donor or donor's relatives.

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| tradename = Allocord, Ducord, Hemacord, others

| Drugs.com = {{drugs.com|cons|allocord}}<br />{{drugs.com|cons|ducord}}

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| DailyMedID = Hematopoietic progenitor cell

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Public cord blood banking is strongly supported by the medical community. However, private cord blood banking is generally not recommended unless there is a family history of specific genetic diseases. Private banking is unlawful in France and Italy, and opposed by the European Group on Ethics in Science and New Technologies. See [[cord blood bank]].

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| legal_US = Rx-only

| legal_US_comment = <ref name="Allocord FDA label">{{cite web | title=Allocord- human cord blood hematopoietic progenitor cell injection, solution | website=DailyMed | date=13 February 2018 | url=https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=ac6b4215-c905-4f4e-9dd8-b0eb7fa4f8b6 | access-date=19 November 2022}}</ref><ref name="Clevecord FDA label">{{cite web | title=Clevecord (hpc- hematopoietic progenitor cell, cord blood injection, suspension | website=DailyMed | date=25 April 2017 | url=https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=61e65daf-363f-4568-a2b9-9f1444207f78 | access-date=19 November 2022}}</ref><ref name="Cordcyte FDA label">{{cite web | title=Cordcyte- human cord blood hematopoietic progenitor cell injection, suspension | website=DailyMed | date=20 December 2015 | url=https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=a2d89045-a178-4732-bc2d-0c27f934e538 | access-date=19 November 2022}}</ref><ref name="Ducord FDA label">{{cite web | title=Ducord- human cord blood hematopoietic progenitor cell solution | website=DailyMed | date=4 November 2015 | url=https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=9c02fe26-efe8-4bca-9f38-c0f9e22d25cf | access-date=19 November 2022}}</ref><ref name="Hemacord FDA label">{{cite web | title=Hemacord- human cord blood hematopoietic progenitor cell injection | website=DailyMed | date=19 October 2022 | url=https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=bd9a5180-1773-11e0-980a-0002a5d5c51b | access-date=19 November 2022}}</ref>

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| legal_status = <!-- For countries not listed above -->

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==Properties==

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Cord blood stem cells are more proliferative and have a higher chance of matching family members than stem cells from [[bone marrow]]. Fathers have a 25% chance of matching their child's cord blood stem cells. Siblings have a 25% chance of being a perfect cord blood match.

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==Collection, storage and costs==

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{{Main|cord blood bank}}

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| DrugBank = DB11054

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| UNII = XU53VK93MC

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There are 2 main methods in cord blood collection from the umbilical vein; before the placenta is delivered (''in utero'') or after (''ex utero''.)

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With ''ex'Cord uteroblood''' collection method, the('''umbilical cord blood''') is collected[[blood]] afterthat remains in the [[placenta is delivered]] and in the attached [[umbilical cord]] isafter clamped off from the newborn[[childbirth]]. TheCord placentablood is placedcollected inbecause ait contains [[sterilestem cells]], supportingwhich structurecan withbe theused umbilicalto cordtreat hanging[[hematopoietic]] throughand the[[genetic support.disorder]]s such Theas cord blood is collected by gravity drainage yielding between 40-150 mL[[cancer]].

== Constituents ==

A similar collection method is done for ''in utero'' except that the cord blood is collected after the baby has been delivered but before the delivery of the placenta.

Cord blood is composed of all the elements found in whole [[blood]] – [[red blood cell]]s, [[white blood cell]]s, [[Blood plasma|plasma]], [[platelet]]s.<ref name="PrankeFailace2001">{{cite journal | vauthors = Pranke P, Failace RR, Allebrandt WF, Steibel G, Schmidt F, Nardi NB | title = Hematologic and immunophenotypic characterization of human umbilical cord blood | journal = Acta Haematologica | volume = 105 | issue = 2 | pages = 71–76 | year = 2001 | pmid = 11408707 | doi = 10.1159/000046537 | s2cid = 30909026 }}</ref> Compared to whole blood some differences in the blood composition exist, for example, cord blood contains higher numbers of [[natural killer cell]]s, lower absolute number of [[T cell|T-cells]] and a higher proportion of immature T-cells.<ref name="pmid17474296">{{cite journal | vauthors = Newcomb JD, Sanberg PR, Klasko SK, Willing AE | title = Umbilical cord blood research: current and future perspectives | journal = Cell Transplantation | volume = 16 | issue = 2 | pages = 151–158 | year = 2007 | pmid = 17474296 | pmc = 2720821 | doi = 10.3727/000000007783464623 }}</ref> However, the interest in cord blood is mostly driven by the observation that cord blood also contains various types of [[Stem cell|stem]] and [[progenitor cell]]s, mostly [[hematopoietic stem cell]]s.<ref name="PrankeFailace2001" /><ref name="pmid17474296" /><ref name="GalievaMukhamedshina2017">{{cite journal | vauthors = Galieva LR, Mukhamedshina YO, Arkhipova SS, Rizvanov AA | title = Human Umbilical Cord Blood Cell Transplantation in Neuroregenerative Strategies | journal = Frontiers in Pharmacology | volume = 8 | pages = 628 | year = 2017 | pmid = 28951720 | pmc = 5599779 | doi = 10.3389/fphar.2017.00628 | doi-access = free }}</ref> Some non-hematopoietic stem cell types are also present in cord blood, for example, [[mesenchymal stem cell]]s, however these are present in much lower numbers than what can be found in adult [[bone marrow]].<ref name="pmid17474296" /><ref name="GalievaMukhamedshina2017" /> [[Endothelial progenitor cell]]s and [[Cell potency|multipotent]] unrestricted [[adult stem cell]]s can also be found in cord blood.<ref name="GalievaMukhamedshina2017" /> Unlike [[embryonic stem cell]]s which are [[pluripotent]], cord blood stem cells are multipotent.<ref name="GalievaMukhamedshina2017" /><ref name="cbhd_Cord">{{Cite web | title = Cord Blood Stem Cells: An Overview | date = 31 March 2009 | volume = 16 | issue = 1 | pages = 6–7 | access-date = 9 December 2018 | url = https://cbhd.org/content/cord-blood-stem-cells-overview | website=The Center for Bioethics & Human Dignity | vauthors = Riggan K | archive-date = 9 December 2018 | archive-url = https://web.archive.org/web/20181209124725/https://cbhd.org/content/cord-blood-stem-cells-overview | url-status = dead }}</ref><ref name="stem_Howd">{{Cite web | title = How do embryonic stem cells, somatic stem cells, and cord blood stem cells differ? | work = New York State Stem Cell Science | access-date = 9 December 2018 | url = https://stemcell.ny.gov/faqs/how-do-embryonic-stem-cells-somatic-stem-cells-and-cord-blood-stem }}</ref>

== Medical uses ==

After collection the cord blood units must be immediately shipped to a [[cord blood bank]] facility. At public cord blood banks, this blood is then analyzed for infectious agents and the tissue-type is determined. Cord blood is processed and depleted of red blood cells before being stored in [[liquid nitrogen]] for later use.

Cord blood is used the same way that [[hematopoietic stem cell transplantation]] is used to reconstitute bone marrow following radiation treatment for various blood cancers, and for various forms of [[anemia]].<ref name=milestones2016 /><ref name=Ballen2013rev /> Its efficacy is similar as well.<ref name=milestones2016 />

== Adverse effects in transplantation ==

New parents have the option of storing their newborn's cord blood at a private [[cord blood bank]] or donating it to a public cord blood bank. The cost of private cord blood banking is approximately $2000 for collection and approximately $125 per year for storage as of 2006. The donation of cord blood may not be available in all areas, however the opportunity to donate is becoming more available. Several local cord blood banks across the [[United States]] are now accepting donations from within their own states. The cord blood bank will not charge the donor for the donation, but the [[Obstetrics and gynaecology|OB/GYN]] may still charge a collection fee of $100-$250, which is usually not covered by [[Medical insurance|insurance]]. However, many OB/GYNs choose to donate their time.

Adverse effects are similar to hematopoietic stem cell transplantation, namely [[graft-versus-host disease]] if the cord blood is from a genetically different person, and the risk of severe infection while the immune system is reconstituted.<ref name=milestones2016 /> To assure that the smallest amount of complications occur during transplantation, levels of engraftment must be present; specifically both neutrophils and platelets must be being produced.<ref name="doi.org">{{cite journal | vauthors = Waller-Wise R | title = Umbilical cord blood: information for childbirth educators | journal = The Journal of Perinatal Education | volume = 20 | issue = 1 | pages = 54–60 | date = 2011 | pmid = 22211060 | pmc = 3209739 | doi = 10.1891/1058-1243.20.1.54 }}</ref> This process of neutrophil and platelet production after the transplant, however, takes much longer than that of stem cells.<ref name="doi.org" /> In many cases, the engraftment time depends on the cell dose, or the amount of stem cells obtained in the sample of blood.<ref name="doi.org" /> In Dr. Moise's article about umbilical cord blood, it was found that there is approximately 10% less stem cells in cord blood than there is in bone marrow.<ref name="doi.org" /><ref>{{cite journal | vauthors = Moise KJ | title = Umbilical cord stem cells | journal = Obstetrics and Gynecology | volume = 106 | issue = 6 | pages = 1393–1407 | date = December 2005 | pmid = 16319269 | doi = 10.1097/01.AOG.0000188388.84901.e4 | s2cid = 20999222 }}</ref> Therefore, a sufficient amount of cord blood must be obtained in order to collect an adequate cell dose, however this amount varies from infant to infant and is irreplaceable. Given that this idea is quite new, there is still a lot of research that needs to be completed. For example, it is still unknown how long cord blood can safely be frozen without losing its beneficial effects.<ref name="doi.org" /> There is a lower incidence with cord blood compared with traditional HSCT, despite less stringent HLA match requirements.<ref name=milestones2016 />

== Collection and storage ==

"According to research in the Journal of Pediatric Hematology/Oncology (1997, 19:3, 183-187), the odds that a child will need to use his or her own stem cells by age twenty-one for current treatments are about 1:2,700, and the odds that a family member would need to use those cells are about 1:1,400." <ref name="CBR">{{cite web | author=Cbr Systems, Inc. | year=2006 | url=http://www.cordblood.com/cord_blood_banking_with_cbr/common_misconceptions/index.asp | title=Common Misconceptions About Cord Blood Banking | work=[http://www.cordblood.com/ Cord Blood Registry] | accessdate=September 20 | accessyear=2006}}</ref>

Umbilical cord blood is the blood left over in the placenta and in the umbilical cord after the birth of the baby. There are several methods for collecting cord blood. The method most commonly used in clinical practice is the "closed technique", which is similar to standard blood collection techniques.<ref>{{cite journal | vauthors = Mousavi SH, Zarrabi M, Abroun S, Ahmadipanah M, Abbaspanah B | title = Umbilical cord blood quality and quantity: Collection up to transplantation | journal = Asian Journal of Transfusion Science | volume = 13 | issue = 2 | pages = 79–89 | year = 2019 | pmid = 31896912 | pmc = 6910041 | doi = 10.4103/ajts.AJTS_124_18 | doi-access = free }}</ref> With this method, the technician [[cannula]]tes the [[Umbilical vein|vein]] of the severed umbilical cord using a needle that is connected to a blood bag, and cord blood flows through the needle into the bag. On average, the closed technique enables collection of about 75&nbsp;ml of cord blood.<ref name="isbn012-348-776-5">{{cite book | vauthors = Hillyer CD, Strauss RG, Luban NL |title=Handbook of Pediatric Transfusion Medicine |publisher=Academic Press |year=2004 |pages=295, 296 |isbn=978-0-12-348776-6}}</ref>

Collected cord blood is [[Cryopreservation|cryopreserved]] and then stored in a [[cord blood bank]] for future transplantation. Cord blood collection is typically depleted of red blood cells before cryopreservation to ensure high rates of stem cell recovery.<ref name="pmid26133757 ">{{cite journal | vauthors = Roura S, Pujal JM, Gálvez-Montón C, Bayes-Genis A | title = The role and potential of umbilical cord blood in an era of new therapies: a review | journal = Stem Cell Research & Therapy | volume = 6 | issue = 1 | pages = 123 | date = July 2015 | pmid = 26133757 | pmc = 4489204 | doi = 10.1186/s13287-015-0113-2 | doi-access = free }}</ref>

In 2005, [[University of Toronto]] researcher Peter Zandstra developed a method to increase the yield of cord blood stem cells to enable their use in treating adults as well as children.<ref name="UofT">{{cite web | author=Raymer, Elizabeth | date=October 14, 2005 | url=http://www.news.utoronto.ca/bin6/051014-1723.asp| title=New strategy will boost cord blood stem cells | work=[http://www.news.utoronto.ca/ University of Toronto] | accessdate=September 20 | accessyear=2006}}</ref>

==Usage History ==

The first successful cord blood transplant (CBT) was done in 1988 in a child with [[Fanconi anemia]].<ref name=milestones2016>{{cite journal | vauthors = Juric MK, Ghimire S, Ogonek J, Weissinger EM, Holler E, van Rood JJ, Oudshoorn M, Dickinson A, Greinix HT | title = Milestones of Hematopoietic Stem Cell Transplantation - From First Human Studies to Current Developments | journal = Frontiers in Immunology | volume = 7 | pages = 470 | date = 9 November 2016 | pmid = 27881982 | pmc = 5101209 | doi = 10.3389/fimmu.2016.00470 | doi-access = free }}</ref> Early efforts to use CBT in adults led to mortality rates of about 50%, due somewhat to the procedure being done in very sick people, but perhaps also due to slow development of immune cells from the transplant.<ref name=milestones2016 /> By 2013, 30,000 CBT procedures had been performed and banks held about 600,000 units of cord blood.<ref name=Ballen2013rev>{{cite journal | vauthors = Ballen KK, Gluckman E, Broxmeyer HE | title = Umbilical cord blood transplantation: the first 25 years and beyond | journal = Blood | volume = 122 | issue = 4 | pages = 491–498 | date = July 2013 | pmid = 23673863 | pmc = 3952633 | doi = 10.1182/blood-2013-02-453175 }}</ref>

== Society and culture ==

When [[Cryopreservation|cryopreserved]] cord blood is needed, it is thawed, washed of the cryoprotectant, and injected through a vein of the patient. This kind of treatment, where the stem cells are collected from another donor, is called [[allogeneic treatment]]. When the cells are collected from the same patient on whom they will be used, it is called [[autologous treatment|autologous]] and when collected from identical individuals, it is referred to as syngeneic. [[Xenogeneic treatment|Xenogeneic]] transfer of cells (between different species) is very underdeveloped and is said to have little research potential.{{fact}}

=== Legal status ===

Hemacord (HPC, cord blood) was approved for medical use in the US in 2011.<ref name="Hemacord FDA label" /><ref>{{cite web | title=Hemacord (HPC, cord blood) | website=U.S. Food and Drug Administration | date=1 October 2024 | url=https://www.fda.gov/vaccines-blood-biologics/cellular-gene-therapy-products/hemacord-hpc-cord-blood | archive-url=https://web.archive.org/web/20190929220940/https://www.fda.gov/vaccines-blood-biologics/cellular-gene-therapy-products/hemacord-hpc-cord-blood | url-status=dead | archive-date=29 September 2019 | access-date=24 November 2024}}</ref>

Ducord (HPC Cord Blood) was approved for medical use in the US in 2012.<ref name="Ducord FDA label" /><ref>{{cite web | title=Ducord (HPC Cord Blood) | website=U.S. Food and Drug Administration | date=1 October 2024 | url=https://www.fda.gov/vaccines-blood-biologics/cellular-gene-therapy-products/ducord-hpc-cord-blood | archive-url=https://web.archive.org/web/20190929220734/https://www.fda.gov/vaccines-blood-biologics/cellular-gene-therapy-products/ducord-hpc-cord-blood | url-status=dead | archive-date=29 September 2019 | access-date=24 November 2024}}</ref>

==Diseases treated with cord blood==

Allocord (HPC Cord Blood) was approved for medical use in the US in 2013.<ref name="Allocord FDA label" /><ref>{{cite web | title=Allocord (HPC Cord Blood) Lead Page | website=U.S. Food and Drug Administration | date=1 October 2024 | url=https://www.fda.gov/vaccines-blood-biologics/cellular-gene-therapy-products/allocord-hpc-cord-blood | archive-url=https://web.archive.org/web/20190929220456/https://www.fda.gov/vaccines-blood-biologics/cellular-gene-therapy-products/allocord-hpc-cord-blood | url-status=dead | archive-date=29 September 2019 | access-date=24 November 2024}}</ref>

Beginning in the late [[1980s]], cord blood stem cells have been used to treat a number of blood and immune-sytem related [[genetic disease]]s, [[cancer]]s, and disorders. Because of medical issues around using one's own cells, in nearly every instance the treatments are done using cells from another donor, with the vast majority being unrelated donors.

Cordcyte was approved for medical use in the US in 2013.<ref name="Cordcyte FDA label" />

The principal diseases and disorders currently treated are listed at the [http://www.marrow.org/PATIENT/Undrstnd_Disease_Treat/Lrn_about_Disease/index.html National Donor Marrow Program website].

Clevecord (HPC Cord Blood) was approved for medical use in the US in 2016.<ref name="Clevecord FDA label" /><ref>{{cite web | title=Clevecord (HPC Cord Blood) Lead Page | website=U.S. Food and Drug Administration | date=1 October 2024 | url=https://www.fda.gov/vaccines-blood-biologics/cellular-gene-therapy-products/clevecord-hpc-cord-blood | access-date=24 November 2024}}</ref>

==See also==

*[[cord blood bank]]

*[[stem cell]]

*[[umbilical cord]]

Regenecyte (HPC, Cord Blood) was approved for medical use in the US in November 2024.<ref>{{cite web | title=Regenecyte | website=U.S. Food and Drug Administration | date=1 October 2024 | url=https://www.fda.gov/vaccines-blood-biologics/cellular-gene-therapy-products/regenecyte | archive-url=https://web.archive.org/web/20241124053726/https://www.fda.gov/vaccines-blood-biologics/cellular-gene-therapy-products/regenecyte | url-status=dead | archive-date=24 November 2024 | access-date=24 November 2024}}</ref><ref>{{cite press release | title=U.S. FDA Approves StemCyte Biologics License Application for Regenecyte Cord Blood Cell Therapy Product | publisher=Stemcyte | via=PR Newswire | date=22 November 2024 | url=https://www.prnewswire.com/news-releases/us-fda-approves-stemcyte-biologics-license-application-for-regenecyte-cord-blood-cell-therapy-product-302313955.html | access-date=24 November 2024}}</ref>

==References==

<references/>

=== Regulation ===

==External links==

The [[AABB]] has generated voluntary accreditation standards for cord blood banking facilities.<ref name=Armitage2016>{{cite journal | vauthors = Armitage S | title = Cord Blood Banking Standards: Autologous Versus Altruistic | journal = Frontiers in Medicine | volume = 2 | pages = 94 | date = 8 January 2016 | pmid = 26779485 | pmc = 4705863 | doi = 10.3389/fmed.2015.00094 | doi-access = free }}</ref>

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In the United States, the [[Food and Drug Administration]] regulates any facility that stores cord blood; cord blood intended for use in the person from whom it came is not regulated, but cord blood for use in others is regulated as a drug and as a biologic.<ref>{{cite web|title=Consumers (Biologics) – Cord Blood Banking – Information for Consumers|url=https://www.fda.gov/BiologicsBloodVaccines/ResourcesforYou/Consumers/ucm236044.htm|archive-url=https://web.archive.org/web/20101212214959/http://www.fda.gov/BiologicsBloodVaccines/ResourcesforYou/Consumers/ucm236044.htm|url-status=dead|archive-date=12 December 2010|publisher=FDA Center for Biologics Evaluation and Research|date=23 July 2012}}</ref> Several states have regulations for cord blood banks.<ref name=Armitage2016 />

===General information===

*[http://www.marchofdimes.com/professionals/681_1160.asp The March of Dimes - Umbilical Cord Blood]

*[http://www.nationalcordbloodprogram.org/qa/ National Cord Blood Program] &mdash; Cord Blood Q&A

*[http://www.gentlebirth.org/archives/cordIssues.html GentleBirth.org] &mdash; Umbilical cord issues

*[http://www.parentsguidecordblood.com Parents Guide to Cord Blood]

In the European Union, Canada, and Australia use of cord blood is regulated.<ref name=Armitage2016 /> In the United Kingdom, the NHS Cord Blood Bank was set up in 1996 to collect, process, store and supply cord blood; it is a public cord blood bank and part of the NHS.<ref>{{cite web|title=About the NHS Cord Blood bank|url=http://www.nhsbt.nhs.uk/cordblood/about/|publisher=NHS Cord Blood Bank|access-date=28 November 2016}}</ref>

===Free, public donation information===

*[http://www.marrow.org/MEDICAL/cord_blood_donation_advanced.html National Marrow Donor Program] &mdash; Details on umbilical cord blood donation

*[http://www.cryo-intl.com Cryobanks International] &mdash; Accepts collections throughout the USA

*[http://www.acbb.ca/ Alberta Cord Blood Bank] &mdash; accepts collections throughout Canada

*[http://www.babiesforlife.org/ Babies for Life Foundation] &mdash; Public cord blood donation and education

===Diseases treatedPrivate withand cordpublic banks blood===

A cord blood bank may be private (i.e. the blood is stored for and the costs paid by donor families) or public (i.e. stored and made available for use by unrelated donors). While public cord blood banking is widely supported, private cord banking is controversial in both the medical and parenting community. Although umbilical cord blood is well-recognized to be useful for treating hematopoietic and genetic disorders, some controversy surrounds the collection and storage of umbilical cord blood by private banks for the baby's use. Only a small percentage of babies (estimated at between 1 in 1,000 to 1 in 200,000) ever use the umbilical cord blood that is stored.<ref name=AAP2007 /> [[The American Academy of Pediatrics]] 2007 Policy Statement on Cord Blood Banking stated: "Physicians should be aware of the unsubstantiated claims of private cord blood banks made to future parents that promise to insure infants or family members against serious illnesses in the future by use of the stem cells contained in cord blood." and "private storage of cord blood as 'biological insurance' is unwise" unless there is a family member with a current or potential need to undergo a stem cell transplantation.<ref name=AAP2007 /><ref name=Thornley2009>{{cite journal | vauthors = Thornley I, Eapen M, Sung L, Lee SJ, Davies SM, Joffe S | title = Private cord blood banking: experiences and views of pediatric hematopoietic cell transplantation physicians | journal = Pediatrics | volume = 123 | issue = 3 | pages = 1011–1017 | date = March 2009 | pmid = 19255033 | pmc = 3120215 | doi = 10.1542/peds.2008-0436 }}</ref> The American Academy of Pediatrics also notes that the odds of using a person's own cord blood is 1 in 200,000 while the [[Institute of Medicine]] says that only 14 such procedures have ever been performed.<ref>{{Cite web|title = Umbilical cord blood banking: Pros & cons, costs, banking basics|url = http://www.webmd.com/parenting/baby/features/banking-your-babys-cord-blood?page=2|website = www.webmd.com|access-date = 17 April 2015}}</ref>

*[http://www.nationalcordbloodprogram.org/patients/ncbp_diseases.htm National Cord Blood Program] &mdash; Frequency of patients transplanted with cord blood by disease

*[http://www.cordbloodcenter.com/en/01_oc_li.htm Cord Blood Center] &mdash; The list of diseases treated with haematopoietic cells transplantation, including autologous cord blood, cord blood from a sibling, autologous bone marrow, and bone marrow from a donor

Private storage of one's own cord blood is unlawful in Italy and France, and it is also discouraged in some other European countries. The [[American Medical Association]] states "Private banking should be considered in the unusual circumstance when there exists a family predisposition to a condition in which umbilical cord stem cells are therapeutically indicated. However, because of its cost, limited likelihood of use, and inaccessibility to others, private banking should not be recommended to low-risk families."<ref>{{Cite web|title = Opinion 2.165 – Umbilical Cord Blood Banking|url = http://www.ama-assn.org/ama/pub/physician-resources/medical-ethics/code-medical-ethics/opinion2165.page|website = www.ama-assn.org|access-date = 17 April 2015 |url-status=dead |archive-url=https://web.archive.org/web/20160220185110/http://www.ama-assn.org/ama/pub/physician-resources/medical-ethics/code-medical-ethics/opinion2165.page | archive-date=20 February 2016 }}</ref> The American Society for Blood and Marrow Transplantation and the [[American Congress of Obstetricians and Gynecologists]] also encourage public cord banking and discourage private cord blood banking. Nearly all cord blood transplantations come from public banks, rather than private banks, partly because most treatable conditions can't use a person's own cord blood.<ref>{{Cite web|title = Cord Blood: Marketing Before Medicine?|url = https://abcnews.go.com/WN/WorldNews/cord-blood-banking-marketing-medicine/story?id=10577020|website = ABC News|date = 7 May 2010|access-date = 17 April 2015| vauthors = Besser R, Schwartz S, Romo C }}</ref><ref name="AAP2007">{{cite journal | vauthors = Lubin BH, Shearer WT | title = Cord blood banking for potential future transplantation | journal = Pediatrics | volume = 119 | issue = 1 | pages = 165–170 | date = January 2007 | pmid = 17200285 | pmc = 6091883 | doi = 10.1542/peds.2006-2901 | doi-access = free }}</ref><ref name=Thornley2009 /><ref>{{Cite news|title = Inside the Private Umbilical Cord Blood Banking Business|url = https://www.wsj.com/articles/SB10001424052702303887804579501500366071342|newspaper = Wall Street Journal|date = 25 April 2014| vauthors = Searcey D, Stewart CS }}</ref> The World Marrow Donor Association and European Group on Ethics in Science and New Technologies states "The possibility of using one's own cord blood stem cells for regenerative medicine is currently purely hypothetical....It is therefore highly hypothetical that cord blood cells kept for autologous use will be of any value in the future" and "the legitimacy of commercial cord blood banks for autologous use should be questioned as they sell a service which has presently no real use regarding therapeutic options."<ref name=WMDA2011>{{cite web|title=WMDA Policy Statement on the Utility of Autologous or Family Cord Blood Unit Storage|url=http://bloodcell.transplant.hrsa.gov/cord/files/wmdapolicystatement.pdf|publisher=World Marrow Donation Association|date=April 2011|access-date=16 February 2015|archive-url=https://web.archive.org/web/20171010155416/https://bloodcell.transplant.hrsa.gov/cord/files/wmdapolicystatement.pdf|archive-date=10 October 2017|url-status=dead}}</ref>

The [[American Academy of Pediatrics]], or AAP, supports efforts to provide information about the potential benefits and limitations of cord blood banking and transplantation so that parents can make an informed decision.<ref>{{cite journal | vauthors = Shearer WT, Lubin BH, Cairo MS, Notarangelo LD | title = Cord Blood Banking for Potential Future Transplantation | journal = Pediatrics | volume = 140 | issue = 5 | pages = e20172695 | date = November 2017 | pmid = 29084832 | pmc = 6091883 | doi = 10.1542/peds.2017-2695 }}</ref> Cord blood education is also supported by legislators at the federal and state levels. In 2005, the National Academy of Sciences published an Institute of Medicine (IoM) report titled "Establishing a National Cord Blood Stem Cell Bank Program".<ref>{{Cite web|title = Establishing a National Cord Blood Stem Cell Bank Program – Institute of Medicine|url = http://www.iom.edu/en/Activities/Research/CordBloodBank.aspx|website = www.iom.edu|access-date = 17 April 2015|url-status=dead|archive-url = https://web.archive.org/web/20091123092544/http://www.iom.edu/en/Activities/Research/CordBloodBank.aspx|archive-date = 23 November 2009}}</ref>

In March 2004, the European Union Group on Ethics (EGE) has issued Opinion No.19 titled ''Ethical Aspects of Umbilical Cord Blood Banking''.<ref name="EGE">{{cite web|url=http://ec.europa.eu/european_group_ethics/docs/avis19_en.pdf |title= Opinion No. 19 |archive-url=https://web.archive.org/web/20071201142808/http://ec.europa.eu/european_group_ethics/docs/avis19_en.pdf |archive-date=1 December 2007 |url-status=dead }}, European Union Group on Ethics</ref> The EGE concluded that "[t]he legitimacy of commercial cord blood banks for autologous use should be questioned as they sell a service, which has presently, no real use regarding therapeutic options. Thus they promise more than they can deliver. The activities of such banks raise serious ethical criticisms."<ref name="EGE" />

== Research ==

Though uses of cord blood beyond blood and immunological disorders is speculative, some research has been done in other areas.<ref name=Walther2009>{{cite book| vauthors = Walther MM | veditors = Appelbaum FR, Forman SJ, Negrin RS, Blume KG |title=Thomas' hematopoietic cell transplantation stem cell transplantation|date=2009|publisher=Wiley-Blackwell|___location=Oxford|isbn=978-1-4443-0353-7|edition=4th|chapter=Chapter 39. Cord Blood Hematopoietic Cell Transplantation}}</ref> Any such potential beyond blood and immunological uses is limited by the fact that cord cells are [[hematopoietic]] stem cells (which can differentiate only into blood cells), and not [[pluripotent]] stem cells (such as [[embryonic stem cells]], which can differentiate into any type of tissue). Cord blood has been studied as a treatment for diabetes.<ref name=Haller2008>{{cite journal | vauthors = Haller MJ, Viener HL, Wasserfall C, Brusko T, Atkinson MA, Schatz DA | title = Autologous umbilical cord blood infusion for type 1 diabetes | journal = Experimental Hematology | volume = 36 | issue = 6 | pages = 710–715 | date = June 2008 | pmid = 18358588 | pmc = 2444031 | doi = 10.1016/j.exphem.2008.01.009 }}</ref> However, apart from blood disorders, the use of cord blood for other diseases is not in routine clinical use and remains a major challenge for the stem cell community.<ref name=Walther2009 /><ref name=Haller2008 />

Along with cord blood, [[Wharton's jelly]] and the [[cord lining]] have been explored as sources for [[mesenchymal stem cells]] (MSC), and as of 2015 had been studied in vitro, in animal models, and in early stage clinical trials for cardiovascular diseases, as well as neurological deficits, liver diseases, immune system diseases, diabetes, lung injury, kidney injury, and leukemia.<ref>{{cite journal | vauthors = Caseiro AR, Pereira T, Ivanova G, Luís AL, Maurício AC | title = Neuromuscular Regeneration: Perspective on the Application of Mesenchymal Stem Cells and Their Secretion Products | journal = Stem Cells International | volume = 2016 | pages = 9756973 | date = 2016 | pmid = 26880998 | pmc = 4736584 | doi = 10.1155/2016/9756973 | doi-access = free }}</ref><ref name="pmid25861654">{{cite journal | vauthors = Roura S, Pujal JM, Gálvez-Montón C, Bayes-Genis A | title = Impact of umbilical cord blood-derived mesenchymal stem cells on cardiovascular research | journal = BioMed Research International | volume = 2015 | pages = 975302 | year = 2015 | pmid = 25861654 | pmc = 4377460 | doi = 10.1155/2015/975302 | doi-access = free }}</ref><ref>{{cite journal | vauthors = Li T, Xia M, Gao Y, Chen Y, Xu Y | title = Human umbilical cord mesenchymal stem cells: an overview of their potential in cell-based therapy | journal = Expert Opinion on Biological Therapy | volume = 15 | issue = 9 | pages = 1293–1306 | date = 2015 | pmid = 26067213 | doi = 10.1517/14712598.2015.1051528 | s2cid = 25619787 }}</ref>

Cord blood is being used to get stem cells with which to test in people with [[type 1 diabetes mellitus]].<ref>{{cite journal | vauthors = Reddi AS, Kuppasani K, Ende N | title = Human umbilical cord blood as an emerging stem cell therapy for diabetes mellitus | journal = Current Stem Cell Research & Therapy | volume = 5 | issue = 4 | pages = 356–361 | date = December 2010 | pmid = 20528762 | doi = 10.2174/157488810793351668 }}</ref> The stem cells from umbilical cord blood are also being used in the treatment of a number of blood diseases including blood cancers.<ref name=Glu2015>{{cite journal | vauthors = Gluckman E | title = Umbilical cord blood transfusions in low-income countries | journal = The Lancet. Haematology | volume = 2 | issue = 3 | pages = e85–e86 | date = March 2015 | pmid = 26687800 | doi = 10.1016/s2352-3026(15)00019-8 | doi-access = free }}</ref>

Cord blood is also being studied as a substitute for normal [[blood transfusion]]s in the developing world.<ref name=Glu2015 /><ref>{{cite journal | vauthors = Proctor SJ, Dickinson AM, Parekh T, Chapman C | title = Umbilical cord blood banks in the UK | journal = BMJ | volume = 323 | issue = 7304 | pages = 60–61 | date = July 2001 | pmid = 11451765 | pmc = 1120738 | doi = 10.1136/bmj.323.7304.60 }}</ref> More research is necessary prior to the generalized utilization of cord blood transfusion.<ref name=Glu2015 />

Cord blood stem cells are being studied for treatment for COVID-19 [[cytokine storm]]s since these and other perinatal (cord tissue and placental tissue derived) stem cells can secrete anti-inflammatory molecules. Dozens of clinical trials are under way to see if they can help patients with [[COVID-19]].<ref>{{Cite news|url=https://www.nytimes.com/interactive/2020/science/coronavirus-drugs-treatments.html|title=Coronavirus Drug and Treatment Tracker| vauthors = Wu KJ, Zimmer C, Corum J |newspaper=The New York Times|date=16 July 2020}}</ref>

Some clinical studies show that one year after the transplant of [[UM171]] (a haematopoietic stem cell self-renewal agonist), transplant-related mortality was 5% and relapse incidence was at 21%. Furthermore, only 3 of 22 patients (~14%) who received the UM171-expanded cord blood transplantation died.<ref>{{cite journal | vauthors = Cohen S, Bambace N, Ahmad I, Roy J, Tang X, Zhang MJ, Burns L, Barabé F, Bernard L, Delisle JS, Kiss T, Lachance S, Roy DC, Veilleux O, Sauvageau G | title = Improved outcomes of UM171-expanded cord blood transplantation compared with other graft sources: real-world evidence | journal = Blood Advances | volume = 7 | issue = 19 | pages = 5717–5726 | date = October 2023 | pmid = 37467030 | doi = 10.1182/bloodadvances.2023010599 | doi-access = free | pmc = 10539875 }}</ref><ref>{{cite journal | vauthors = Cohen S, Roy J, Lachance S, Delisle JS, Marinier A, Busque L, Roy DC, Barabé F, Ahmad I, Bambace N, Bernard L, Kiss T, Bouchard P, Caudrelier P, Landais S, Larochelle F, Chagraoui J, Lehnertz B, Corneau S, Tomellini E, van Kampen JJ, Cornelissen JJ, Dumont-Lagacé M, Tanguay M, Li Q, Lemieux S, Zandstra PW, Sauvageau G | title = Hematopoietic stem cell transplantation using single UM171-expanded cord blood: a single-arm, phase 1-2 safety and feasibility study | journal = The Lancet. Haematology | volume = 7 | issue = 2 | pages = e134–e145 | date = February 2020 | pmid = 31704264 | doi = 10.1016/S2352-3026(19)30202-9 }}</ref>

A woman was reported to have been cured of [[human immunodeficiency virus]] (HIV), the third person ever to be cured of the disease, using a transplantation of cord blood.<ref>{{Cite news| vauthors = Mandavilli A |date=15 February 2022|title=A Woman Is Cured of H.I.V. Using a Novel Treatment|work=The New York Times|url=https://www.nytimes.com/2022/02/15/health/hiv-cure-cord-blood.html|access-date=16 February 2022}}</ref>

== References ==

{{Reflist}}

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