Cord and peripheral blood stem cells - Causes, symptoms and treatment. MF.

Stem cells are a hierarchy of special cells of living organisms, each of which can later be changed( differentiated) in a special way( that is, to receive specialization and further develop as an ordinary cell).The difference between stem cells is that they can divide unrestrictedly, until they "turn" into mature cells, and mature cells usually have a limited number of fission cycles.

According to modern hypotheses and ideas, mammals have stem cells for all types of tissues and organs throughout the life of the individual.

Moreover, there is evidence that there is a single multipotent( universal) stem cell. Its further specialization is determined by the set of stimuli with which this cell is found in the body.

It is convincingly proved that not only all the germs of the hematopoies come from these cells, but also other cells of the body. Under certain conditions, a skeletal muscle cell, a cardiac muscle cell, a real bone and cartilage can be obtained from the blood stem cell, and even a brain cell can be grown - a neuron. These laboratory data were used in the clinic. With the help of blood cell transplantation, the first steps are being taken in the treatment of skeletal muscle diseases( Duchenne myopathy), endocrine pathology( diabetes mellitus), degenerative diseases of the central nervous system( Alzheimer's disease, multiple sclerosis).Treatment of acute myocardial infarction with the use of stem cells went beyond the scope of the experiment and entered clinical practice. Periodic transfusion of cells,

obtained in the early stages of life of , can contribute to slowing down the aging process. The transplantation of stem cells, which are given certain properties by the method of genetic engineering, makes the first successful steps.

Given the speed of development of biotechnology, it is possible to confidently predict the emergence of programs using transplants of modified blood stem cells for the treatment of invalid and incurable diseases at the present time.

In the time of the world, more than 20,000 stem cell transplantations are carried out every year for various diseases.

Sources of stem cells

The umbilical cord blood of a newborn is the most rich with stem cells. These stem cells, among other things, have the greatest capacity for division and specialization, and have not been influenced by the external and internal environment.

The umbilical cord collection procedure is well designed and safe for mother and child. From the beginning of the 90s in the USA, Europe, Japan, Australia, and now in Russia, at the request of parents, the collection, freezing and lifelong storage of cord blood cells of the newborn are practiced. To date, banks have more than 100,000 samples.

The second source of stem cells is the human bone marrow. Under certain conditions, stem cells enter the peripheral blood and circulate there for a short time.

Over the past two decades, a technique has been developed that allows obtaining stem cells from the blood and storing them for a long time without loss of properties. This technique provides for preliminary stimulation of the donor's blood to increase the content of cells of interest in the blood stream by dozens of times and to withdraw them using a cellular blood separator.

As the organism ages, the stem cells' capital is depleted, their ability to divide significantly decreases, the vital processes slow down, which leads to a disruption in the functions of organs and systems, and the aging of the organism, which can cause tumors. The earlier collected and mothballed stem cells, the greater their potential in terms of restoring lost functions. Thus, each person can become a donor of stem cells for himself.

Large scientific medical centers of the Russian Federation, for example, GU RNCTS them. N.N.Blokhin, RAMS, Cardiological Scientific Center. Bakulev et al., Developed and implemented protocols for the treatment of patients using blood stem cells.

The possibility of isolating and using stem cells from menstrual blood of women of childbearing age is being studied.

The effectiveness of cell therapy is shown and proven in the following medical fields:

1. Oncology( transplantation of blood stem cells of a properly ill or healthy donor with blood diseases or solid tumors).
2. Hematology( transplantation of donor blood cells in acquired or congenital aplastic anemia).
3. Radiomedicine( acute and chronic radiation sickness).
4. Immunology( congenital immunodeficiency states).
5. Inflammatory diseases( rheumatoid arthritis, systemic lupus erythematosus).
Clinical trials conducted over the past decade have extended indications for cell therapy and allowed it to be introduced into:
1. cardiology( cell transplantation into the focus of myocardial infarction, therapy of atherosclerosis);
2. Neurology( rehabilitation after injuries and diseases of the brain and spinal cord);
3. Traumatology and orthopedics( treatment of long-term healing fractures of bones).

The positive results of the use of stem cells in the complex treatment of congenital diseases( accumulation diseases, example of Gaucher disease, Neumann-Pick disease) have also been obtained.

In the short term( 5-10 years) treatment of patients with diabetes mellitus, degenerative diseases, by transplantation of modified or cloned donor stem cells( by genetic engineering methods)

Due to the high value of stem cells as a "building material" for the sick person's body,the following collection program is proposed, cryopreservation and long-term storage of hematopoietic stem cells derived from cord blood of a newborn child or peripheral blood of an adultabout the person.

Obtaining stem cells from umbilical cord blood

Cord blood belongs to a newborn child and contains several times more stem cells that are at different degrees of maturity than adult blood. Until the end of the 1980s, umbilical cord blood was practically not used for the needs of the child or his parents. The first transplantation of cord blood stem cells showed its effectiveness and the appropriateness of personal storage. If the umbilical cord blood is not collected, it is destroyed along with the placenta. Collection of umbilical cord blood after the birth of a child is a unique, one-time opportunity to provide a stock of stem cells without any medical manipulation and administration of drugs. Obtaining stem cells from any other part of the umbilical cord and the placenta is a widespread myth.

Advantages of cord blood.

1. Cord blood is collected after the birth of the child and his separation from the mother, by crossing the umbilical cord.
2. The procedure for collecting blood is painless and safe for both the mother and the newborn( the baby is already separated from the umbilical cord, and the placenta has no common vessels and nerve endings with the mother's womb wall).
3. Only the blood that is in the vessels of the placenta and the umbilical cord is collected. This means that neither the woman in labor, nor the newborn does not take blood.
4. Blood collection does not require special manipulation and administration of any drugs.
5. The collection procedure takes only a few minutes.
6. Cord blood is the most abundant substance in the human body.
7. In the cord blood there are young stem cells with unlimited potential of division and differentiation.

A brief description of the method for obtaining umbilical cord blood cells.

Cord blood is collected after the birth of the child and separation from the umbilical cord. Neither mother nor child has pain. In some cases, it is possible to take cord blood from the placenta, if there is no doubt about its integrity. Blood is collected in a special system with a preservative by puncturing the umbilical vein with a needle. After the blood flows from the umbilical cord into a special system, it is delivered to the laboratory for treatment, isolation of the cells for their preservation and long-term storage.

Mother examination before and after cord blood sampling.

Before the umbilical cord blood is collected, the woman in labor should be examined by a doctor and examined for carriage of dangerous infections( hepatitis B and C, HIV, syphilis, gonorrhea, etc.).It is also necessary to make a general and biochemical blood test( determine the number of blood cells, glucose, bilirubin, protein, enzymes, etc.).

Preparation in cord blood cryopreservation and long-term storage of stem cells

After the delivery of a special cord blood system, the stem cells are isolated in the laboratory, the cells are placed in a special container and frozen at ultra low temperatures( minus 196 0С).Further, the frozen material is stored in the individual cell of the cryopreservation under an individual number. Based on the results of processing the umbilical cord blood, a protocol is drawn up containing the description of the procedure and the material quality indicators.

The shelf life of cells in liquid nitrogen is unlimited.

Obtaining stem cells from an adult( donor)

If cord blood has not been harvested immediately after delivery, stem cells can be obtained from the peripheral blood of healthy, adult donors, subject to certain conditions.

Brief description of the method of obtaining stem cells.

The procedure is conditionally divided into two parts

1) Mobilization of stem cells into peripheral blood:
To increase the number of stem cells in peripheral blood, the donor receives 8 injections of granulocyte colony-stimulating factor( G-CSF), subcutaneously at an interval of 10-12 hours for4 days. G-CSF is a medical preparation obtained by genetic engineering.

2) Stem cell collection or separation:
It is performed on day 5 from the onset of stimulation of G-CSF on a blood separator using a disposable separation system and standard solutions. The duration of the procedure is no more than 3 hours, depending on the speed of the procedure, donor weight and blood test parameters. The procedure for collecting cells is carried out by taking blood from one vein, treating it inside the separator, taking a certain amount of stem cells and returning the remaining blood components to the donor through another vein.

Advantages of blood stem cells.

1. The possibility of obtaining from peripheral blood without using general anesthesia with minimal traumatism for the donor.
2. Possibility of carrying out repeated and repeated sessions of obtaining stem cells.3. Relative speed of receipt.
4. Rapid hematopoiesis recovery in case of transplantation, reduction of hospital stay.

Cryopreservation of stem cells.

After the delivery of the separator to the laboratory, it is processed. Then the cell concentrate is transferred to a special cryocontainer and frozen at ultra-low temperature( minus 196 0С).Further, the frozen material is stored in an individual cell of the cryo-storage facility under an individual number. Based on the results of processing the umbilical cord blood, a protocol is drawn up containing the description of the procedure and the material quality indicators.

Application of stem cells.

Cells can be used for the treatment of hematological and oncological patients( transplantation of blood stem cells of a patient or a healthy donor in case of blood diseases or solid tumors).In hematology, radiomedicine, immunology and other fields of medicine: transplantation of donor blood cells with acquired or congenital aplastic anemia;acute and chronic radiation sickness, congenital immunodeficiency states;multiple sclerosis;rheumatoid arthritis, systemic lupus erythematosus, etc.

For example, only in Moscow there are several state medical institutions that use stem cells in treating patients. Among them, there are such centers as: Rossiysky Cancer Research Center. N.N.Blokhin, Medical and Surgical Center. N.V.Pirogova, Hematology Research Center, Scientific Center for Cardiovascular Surgery. AN Bakuleva RAMS, FNTS transplantology and artificial organs named after Academician Shumakov and others.

A favorable prognosis for transplantation is higher with the highest likeness of the donor and recipient to the tissue compatibility antigens( HLA - human leucocyte antigens - tissue compatibility antigens, human leukocyte antigens).Finding a donor that is fully compatible with the recipient for HLA antigens is very difficult, since the number of combinations made up of more than 100 antigens of this family is extremely large. It is almost impossible to find a donor that is fully compatible with the recipient of HLA antigens among people who are not his relatives. The probability of selecting a fully compatible donor among siblings is 1: 4, since HLA genes are inherited according to the laws of Mendel. When the HLA antigens are inherited, the child receives one gene from each locus from both parents;half of the tissue compatibility antigens is inherited from the mother and half from the father.

Thus, the presented program of collection, cryopreservation and long-term storage of stem hematopoietic cells will help to provide the donor and his close relatives with "unique" stem cells available to them only, and will also enable the use of cells if necessary.