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Abstract
Placental and umbilical cord blood (UCB) is becoming an important source of haematopoietic stem cells for use in clinical transplantation. Now that over 500 cord blood transplantations have occurred worldwide, clinical experience is demonstrating some distinct advantages to these cells over the traditional bone marrow sources. These advantages include distinctive proliferative capacities which favour engraftment. Umbilical cord blood use is associated with a reduced incidence and severity of Graft versus Host disease, and recipients may tolerate a greater number of HLA mismatches than with bone marrow source stem cells.
Umbilical cord blood stem cells have also opened up areas of active laboratory and clinical investigation that could ultimately result in further therapeutic options. The most exciting areas are those of ex vivo cell expansion and a variety of applications involving stem cells as vehicles for potential gene therapy.
Cord blood banks can retain these separated stem and progenitor cells to provide an additional, immediately accessible resource to a bone marrow registry. In Europe, NETCORD links three cord blood banks to its bone marrow donor worldwide registry, and in the United States, three cord blood banks are also linked to a central bone transplant registry. In Canada, the Bone Marrow Transplant Registry, administered by The Canadian Red Cross, is investigating options for a similar structure. However, there is no established funding at this time for a Canadian system of this scale.
Résumé
Le sang placentaire et le sang cordonal deviennent une source importante de cellules souches hématopoïétiques à des fins de greffe clinique. Maintenant qu’on a effectué plus de 500 greffes de sang cordonal dans le monde entier, l’expérience clinique prouve certains avantages particuliers à ces cellules par rapport aux sources classiques de moelle osseuse. Ces avantages comprennent la prise de greffes à des concentrations inférieures à celles des cellules de moelle osseuse et une capacité de prolifération supérieure de ces cellules. Le recours au sang cordonal est associé à une incidence réduite de réaction du greffon contre l’hôte, et les receveurs semblent tolérer un nombre plus élevé d’incompatibilités HLA qu’avec les cellules souches issues de la moelle osseuse.
Les cellules souches du sang cordonai ont aussi permis l’ouverture de domaines d’activités de recherche en laboratoire et de recherche clinique pouvant donner lieu à d’autres options thérapeutiques. Les domaines les plus passionnants sont ceux de l’expansion cellulaire ex vivo et de diverses applications où les cellules souches constituent des moyens éventuels de thérapie génique.
Les banques de sang cordonal conservent ces cellules souches et progénitrices afin d’assurer une ressource supplémentaire à un registre de moelle osseuse. En Europe, NETCORD relie trois banques de sang cordonal à son registre mondial de donneurs de moelle osseuse et, aux États-Unis, trois banques de sang cordonal sont également liées à un registre central de greffe osseuse. Au Canada, le Registre de donneurs non apparentés de moelle osseuse, administré par la Société canadienne de la Croix-Rouge, étudie les possibilités de création d’une structure semblable. Cependant, aucun financement n’est actuellement affecté à un système canadien de cette ampleur.
Key Words
References
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Article info
Publication history
Accepted:
January 5,
1998
Received in revised form:
January 5,
1998
Received:
November 5,
1997
Identification
Copyright
© 1998 Published by Elsevier Inc.
