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Types of stem cells

Hematopoietic Stem Cells

These are mostly present in bone marrow, peripheral blood, cord blood, etc. They are blood forming cells and completely repair and regenerate the damaged tissue or organ.

Mesenchymal Stem Cells

These are mostly found in adipose/liver/ lung/ foetal tissue, Umbilical cord, placenta, amniotic fluid, peripheral blood and even in deciduous teeth. They are extensively used in gene therapy due to their high proliferation potential.

Sources of Stem Cells:

 Embryonic Stem Cells

 Umbilical Cord Stem Cells

 Adult Stem Cells

Embryonic Stem Cells

 Derived from blastocytes
 Most primitive and best source
 Numerous ethical and legal issue
 Possibility of some unwanted side effects and malignancies

Umbilical Cord Stem Cells

  Readily available source
  Rich source of stem cells
  Decease risk of viral infection
  Ease of collection
  Donor patient match 100% higher
  Highly proliferative
  Lower risk and severity of graft versus host disease in HLA match and unmatched recipients
  Have not developed ABO and HLA antigens so do not induce graft versus host reactions

Adult Stem Cells

Bone Marrow

• Most widely used transplants
• Bone marrow transplants into cancer patients to fight cancer
• Less preferred to umbilical cord as they may carry dormant viruses
• MSC population in scarce
• Significant drop in proliferative capacity with age

Blood Stream

• Stem Cells are collected by ‘apheresis’ with cell separator
• Generally for cell use (autologous)
• Lengthy procedure and low cell yield.
• Less plastic so homing and engraftment is a problem

Adult Tissue

• Stem cells can be collected from skin/ cornea/ fat/ teeth/ small intestine/ liver
• Gaining popularity
• Can be genetically modified
• Generally use for Self (autologous)

How Stem Cells work?

Stem cells divide and renew at will, thus replicate and proliferate to form a desired tissue or migrate to damaged area or site of injury.

Stem cells show

• Plasticity i.e. ability to generate into completely different tissue
• Homing i.e. get attracted to sight of injury
• Engraftment i.e. ability to unite with other tissue

Benefits of Stem cells

• Non toxic
• Devoid of side effects
• Low treatment cost
• Promote longer lives
• Potential to cure many diseases

Treatable Diseases

  Vascular Disorders

• Chronic Heart Failure
• Acute Myocardial Infarction
• Cardiomyopathy
• Buerger's Disease
• Peripheral Vascular Disease

Liver Disorders

• Liver Cirrhosis

Bone and Cartilage Disorders

• Osteoarthritis
• Non-healing fractures

Neuro-Muscular Disorders

• Cerebral Palsy
• Multiple Sclerosis
• Parkinson's Disease
• Spinal Cord Injury
• Stroke
• Alzheimer's Disease
• Muscular Dystrophy
• Spinal Muscular Atrophy
• ALS
• Autism

Haematological Disorders

• Acute Leukemias
• Chronic Leukemias
• Myelodysplastic Syndromes
• Marrow Failure
• Thallasemia
• Myeloproliferative Disorders
• Lymphoproliferative Disorders
• Inherited Immune System Disorders
• Plasma Cell Disorders
• Other Malignancies

Diabetes

Eye Disorders

Anti-Ageing

Cancers

Frequently asked questions

Q1.  What is the meaning of viability and potency of stem cells?
Ans.  “Viability” means “being alive” hence points to the ability of stem cells to withstand processing and storage conditions.

Potency by definition means the strength or power of stem cells to successfully assume roles that are assigned to them. The extent of potency is determined by:

• Capacity of the procured stem cells for extensive proliferation and multiplication.
• Differentiation into desired cell type or tissue.
• Integrate into surrounding tissue after transplant.
• Function well for an approximate duration of the recipient’s life.
• Avoid harming the recipient in any way.

Q2.  How does early processing help improve the quality of stem cells?
Ans. The cardinal rule says “Earlier the processing, greater is the final yield and quality of stem cells”. The quality of stem cells rapidly and progressively diminishes with each passing hour after the first six hours of collection.

Q3.  What is Stem Cell Banking?
Ans. A process where the cord blood (or any other source of stem cells) is essentially processed after collection; and stem cells that are isolated are stored or “banked”, under cryogenic conditions with the help of an adequate liquid nitrogen backup system. Most cord blood banks store the stem cells for twenty one years after processing.

Q4.  How long can the stem cells be preserved?
Ans. The stem cells are currently preserved for a period of 21 years. The cells are stored in cryogenic conditions with full-proof liquid nitrogen back up systems. The oldest cord blood bank is approximately 12 years old.

Q5.  What happens to the stem cells if I do not require them during the 20 year storage period?
Ans. However in case, for whatever reason your banked stem cells are not retrieved in the 20 year storage period, the option of extending the tenure is provided at a prescribed fee prevailing at that time. At this stage, the ownership of stem cells shall be legally transferred to the child.

Q6.  Is stem cell banking expensive?
Ans. Stem cell banking is not expensive at all. Further, multiple payment options are available to reduce any concerns of affordability. Compared to the peace of mind that Stem Cell banking provides, the cost is negligible.

Q7.  How do you measure the quality of stem cells?
Ans. After the processing and before cryopreservation part of the sample is tested for:

• Mononuclear (MNC) count
• Absolute CD34+ count
• Mesenchymal Cell Count
• Stem cell viability

These studies are carried out on an in house Flow Cytometer which gives accurate results. A preservation certificate or Certificate of analysis which mentions all the results is sent to the mother within 15 to 20 days of processing the sample.

Q8.  Where and how are the stem cells stored?

• The samples of stem cells bear barcoded cryolabels which include an identifier code, mother's name, date of storage and assigned inventory number. The accompanying software aids the tracking of samples during retrieval.



• The stem cells are stored in vacuum insulated Liquid Nitrogen containers filled with ample amount of liquid Nitrogen specifically designed to withstand cryogenic conditions for long durations. The storage can be in 5 ml vials or multi-compartmentalized cryobags.



• The cryopreservation is strictly maintained at controlled temperatures using liquid nitrogen (-196 deg℃) or its vapour (-175 deg ℃)

Q9.  What examinations and investigations are to be performed before the therapy?
Ans. few primary blood investigations along with some radiological investigations according to the diseases are conducted. These investigations provide detailed information about the patient’s condition and also help to understand the chronicity of the disease.

Q10.  How long does the patient needs to stay at the clinic?
Ans. The patient is required to stay for one day per session. The interval between two sessions varies from seven to thirty days as per the doctor’s discretion. The number of sessions may vary from patient to patient.

Q11.  What is the expected success rate from stem cell therapy?
Ans. This is an experimental therapy with expected result being 40 – 70 %. However, rare cases may not show desired results. Efficacy of the treatment varies for each patient depending on the nature and the type of disease.

Q12.  Can the other treatments be taken at the same time?
Ans. Ideally before going ahead with the therapy we review the medication which the patient is undergoing. After the review, medical decision regarding what should be included and eliminated from patient’s regimen during the treatment is decided on an individual basis.

Q13.  Are there any known side effects of the therapy?
Ans. No significant side effects with autologous stem cell therapy or cord stem cell therapy have been listed.

Q14.  During the therapy is the patient required to follow any special diet?
Ans. No.

Q15.  Are any nutritional supplements/ medications taken along with stem cell treatment?
Ans. Such prescriptions will be made on an individual basis, after scrutinizing the patient’s condition.

Q16.  Does drinking or smoking affect the therapy?
Ans. Alcohol consumption, narcotic drugs and cigarette smoking can be detrimental to the new progenitor stem cells. Hence, it is advisable that patients do not smoke or drink or consume any narcotic drugs like cocaine, ganja, hashish etc during the treatment.

Q17.  What is the estimated cost for the treatment?
Ans. This therapy is provided for about 1 lakh/session for all major illness.

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