Catholic hospital’s umbilical cord blood donations among world’s largest

Dr. Donna Wall was becoming frustrated with her job. As a transplant physician at SSM Cardinal Glennon Children’s Hospital more than 10 years ago, Wall was attempting to treat her African-American patients with illnesses such as leukemia, sickle cell anemia and immune system disorders.

But Wall was having difficulty in finding a good match for transplanting healthy stem cells to her patients.

So with success, she turned to umbilical cord blood.

Since its inception in 1995, the St. Louis Cord Blood Bank at Cardinal Glennon has quickly grown to become the second- largest independent cord blood bank in the world, according to quality manager Donna Regan. Its purpose is to collect, process and store blood donated from an infant’s umbilical cord. The stem cells from that blood eventually are used in the transplantation of hematopoietic cells, which Regan said are used to make human blood and build up a person’s immune system.

What’s even better for Regan and the staff at the St. Louis Cord Blood Bank is the fact that they are treating illnesses and at the same time doing so in a manner considered morally acceptable by the Catholic Church.

Unlike embryonic stem cells, which have been the subject of an intense battle at the state level this past year to ban human cloning, the stem cells derived from an infant’s umbilical cord blood are referred to as adult stem cells. Adult stem cells come from any human being who is born.

The Church has repeatedly taught that these stem cells are morally acceptable for research and treatments and do not bring harm to a person. Human embryos, created through a process called somatic cell nuclear transfer — better known as cloning — are destroyed once the needed stem cells are derived.

(Missouri’s bishops announce stem-cell education initiative. See story, Page 7.)

Cord blood bank manager Mario Alonso said the promise scientists and others in the biotechnology community express when talking about embryonic stem-cell research can be misleading.

Embryonic stem cells "have the potential to do anything," he said. "They are multipotent — they can become any cell in the body. But what they lack are the regulatory systems that come with a little bit more mature stem cell, like a cord blood stem cell."

Alonso said supporters of embryonic stem-cell research will say that the method has the "potential to be big, and progress is right around the corner.

"Well right around the corner in the medical field is 10-20 years," he said. "I think the general public just thinks when they say it’s right around the corner, it’s within six months to a year."

Alonso pointed out that in more than 20 years of embryonic stem-cell research around the world, there has not been one single success story in using these cells in human treatment.

But the same can’t be said for human treatments using umbilical cord blood.

Since 1997, more than 830 units of cord blood have been exported around the world to treat diseases such as acute lymphocytic leukemia, Hodgkin’s Disease, osteopetrosis and severe combined immunodeficiency disorder (SCID), among others.

"That’s a huge number considering there’s only been around 4,000 (umbilical cord blood) transplants worldwide," said Regan.

And while almost 90 percent of cord blood units have been exported in North America, said Regan, almost 7 percent has gone to Europe, just over 2 percent to South America, 1 percent to Australia and almost 1 percent to Asia.

"Because of the philanthropy of the women and doctors and nurses who work in this area, we have been able to serve people all over the world," she said.

What makes stem cells from cord blood so successful, said Kathy Mueckl, nurse coordinator for the bank, is that a perfect match is not needed to be able to use the cells for treatment.

Cord blood stem cells are more immature and have a better chance of adapting to another person’s system, she said. However, a grown adult’s blood stem cells — in bone marrow for example — already are accustomed to the body in which they had been residing, and have a harder time adapting to another person’s system. In a bone marrow transplant, a person would have to have a perfect match of six factors using human leukocyte antigen typing — a testing that determines whether a patient has a suitable donor for stem-cell transplant.

But with a baby’s cord blood, transplantation is acceptable even with a match as low as four out of six, said Mueckl.

Which means ethnic boundaries can be crossed when trying to find a match, she noted.

"Maybe a Caucasian person is the best match for an African-American person. Or an African American is good for a Hispanic" person, said Mueckl.

The survival rate of those who receive a stem-cell transplant from umbilical cord blood is currently at about 45 to 50 percent. But that percentage is good compared with a survival rate of about 35 percent for bone marrow transplants, according to Regan.

"This is an investigative protocol," she said. "A lot of times, it’s a last ditch effort for people. It’s also great for people who can’t wait for a bone marrow search."

Alonso said there also is a method using double cord blood transplants, which uses two infused cord blood units at the same time. In those cases, he said, the survival rate is at about 45 percent, and it is becoming a more commonly used method in adults.

"As those protocols are being refined and expanded, the outcomes become much better," he said.

As a non-profit organization, Regan said the bank relies on the generosity of parents and the doctors and nurses who support the program. Since the bank started taking donations in 1996, more than 48,000 cord blood units have been collected. The bank works in collaboration with more than 400 physicians at 30 hospitals in St. Louis and the Metro East area to bring in donations.

Because cord blood donations are so small — ranging from a teaspoon to eight ounces — the units were first only used in treating children.

"It was thought that the numbers of cells that were in a cord blood unit — that’s all you’ve got," said Regan. "You can’t go back to the baby and draw more cells."

But researchers at the bank quickly found that because of their adaptability, there are different ways in which adults could be treated using cord blood stem cells. Now, Regan said there is an equal split of adults and children who receive donations from the bank.

The bank currently has more than 12,000 units that are available for transplant, said Regan. Between 25 and 30 percent of donated units go into the transplant inventory. The remaining units are used for research purposes, she said.

Regan noted that the majority of donors are Caucasian and admitted that like other donor registries, such as bone marrow, it’s harder to find minority donors.

That’s why the bank participates in the Charles Drew Community Cord Blood Donor Campaign, an effort of the American Red Cross, St. Louis University, Cardinal Glennon Hospital, St. Louis Children’s Hospital and the Washington University School of Medicine, to increase African American cord blood donations.

Regan said the bank continues to gain exposure thanks to affiliations with registries such as the National Marrow Donor Program and the Caitlin Raymond International Registry, another stem cell donor registry.

While cord blood stem cells already are bringing hope to those with life-threatening illnesses, the future of treatments using these stem cells remains promising, said Mueckl, in treating other diseases such as spinal cord injury, Alzheimer’s and Parkinson’s diseases, HIV/AIDS, multiple sclerosis and diabetes.

"There’s no reason to think that you couldn’t find all of those applications from cord blood or adult stem cells that you could find from embryonic stem cells," she said.

But unlike those who promote the promises of embryonic stem-cell research, "we’re very sensitive about making those claims," said Regan, because of the bank’s affiliation with the Food and Drug Administration as an investigational new drug application.

"The FDA tells us you can’t make false claims about your products," she said.

"We like to say with the technology available today, this is what we know will work," said Regan. "We get those calls every day — ‘My daughter has diabetes,’ or ‘So and so has this. Will it help?’ We just say honestly we don’t know, but this is what we know it does today."

The above article was written by Jennifer Brinker and appeared in the St. Louis Review on November 4, 2005.