Cord Blood
Donating umbilical cord blood could save a child’s life. Cord blood is the term used for the blood collected from the umbilical cord and placenta after birth when a healthy baby is born. The University of Texas Health Science Center at Houston (UTHealth) asked clinical cell therapy expert Fabio Triolo, DdR, PhD, to share the benefits of donating cord blood and what steps to take to do it. Triolo is an associate professor with McGovern Medical School at UTHealth and the director of UTHealth’s Cellular Therapy Core laboratories.
Cord blood contains stem cells that can be used in the treatment of the thousands of critically ill patients with blood diseases like leukemia and lymphoma, who are in urgent need of a life-saving transplant. Unfortunately, not every patient can find a potential donor match. Therefore, cord blood banks worldwide are calling on pregnant women to donate their cord blood after the birth of their child, so that it may be made available to any compatible patient in need of a transplant.
Cord blood is currently approved for use in “hematopoietic stem cell transplantation” procedures, which are done in patients with disorders affecting the hematopoietic (blood forming) system. Cord blood contains blood-forming stem cells that can be used in the treatment of patients with blood cancers such as leukemias and lymphomas, as well as certain disorders of the blood and immune systems, such as sickle cell disease and Wiskott-Aldrich syndrome. That said, several other types of investigational cord blood-based therapies are being tested in clinical trials. For example, UTHealth recently completed a trial in which pediatric patients with cerebral palsy were treated with their own cord blood stem cells. They are currently investigating if this treatment could also preserve brain function in infants with congenital diaphragm disease.
Cord blood donated to a public bank is processed, checked for volume and cell number, tested to be sure it is free from infection, genetic, and/or blood and metabolic disorders, tissue typed, cryopreserved and listed in a registry where it’s available for anyone in need of a transplant. Cord blood units that do not meet criteria for transplant are designated for research or discarded. Nationally, less than half of collected cord blood units are deemed bankable for transplant, typically because of inadequate volume and cell number.
Not all women who deliver are eligible to donate cord blood. For example, a diagnosis of cancer or leukemia (including skin cancers), an organ or tissue transplant within the last 12 months, or delivery of twins excludes a woman from donating. Regarding the latter, each umbilical cord has different tissue types, and it’s possible the two cord blood units could be mixed up during collection.
Biomarkers
Blood test are highly accurate at identifying Alzheimer’s disease before symptoms arise. Up to two decades before people develop the characteristic memory loss and confusion of Alzheimer’s disease (AD), damaging clumps of protein start to build up in their brains. Now, a blood test to detect such early brain changes has moved one step closer to clinical use.
Researchers from Washington University School of Medicine in St. Louis, MO, report that they can measure levels of the Alzheimer’s protein amyloid beta in the blood and use such levels to predict whether the protein has accumulated in the brain. When blood amyloid levels are combined with two other major Alzheimer’s risk factors—age and the presence of the genetic variant APOE4—people with early Alzheimer’s brain changes can be identified with 94 percent accuracy.
The findings, published in the journal Neurology, represent another step toward a blood test to identify people on track to develop Alzheimer’s before symptoms arise. Surprisingly, the test may be even more sensitive than a PET brain scan at detecting the beginnings of amyloid deposits in the brain.
Such a test may become available at doctors’ offices within a few years, but its benefits will be much greater once there are treatments to halt the disease process and forestall dementia. Clinical trials of preventive drug candidates have been hampered by the difficulty of identifying participants who have Alzheimer’s brain changes but no cognitive problems. The blood test could provide a way to efficiently screen for people with early signs of disease, so they can participate in clinical trials evaluating whether drugs can prevent Alzheimer’s dementia.
The test, an earlier version of which first was reported two years ago, uses mass spectrometry to precisely measure the amounts of two forms of amyloid beta in the blood: Amyloid beta 42 and amyloid beta 40. The ratio of the two forms goes down as the amount of amyloid beta deposits in the brain goes up.
The current study involved 158 adults over age 50. All but 10 of the participants in the new study were cognitively normal, and each provided at least one blood sample and underwent one PET brain scan. The researchers classified each blood sample and PET scan as amyloid positive or negative, and found that the blood test from each participant agreed with his or her PET scan 88 percent of the time, which is promising but not accurate enough for a clinical diagnostic test.
In an effort to improve the test’s accuracy, the researchers incorporated several major risk factors for Alzheimer’s. Age is the largest known risk factor; after age 65, the chance of developing the disease doubles every five years. A genetic variant called APOE4 raises the risk of developing Alzheimer’s three- to five-fold. Gender also plays a role: two out of three Alzheimer’s patients are women.
When the researchers included these risk factors in the analysis, they found that age and APOE4 status raised the accuracy of the blood test to 94 percent. Sex did not significantly affect the analysis.
Further, results of some people’s blood tests were initially considered false positives because the test was positive for amyloid beta but the brain scan came back negative. But some people with mismatched results tested positive on subsequent brain scans taken an average of four years later. The finding suggests that, far from being wrong, the initial blood tests had flagged early signs of disease missed by the gold-standard brain scan.
There is growing consensus among neurologists that Alzheimer’s treatment needs to begin as early as possible, ideally before any cognitive symptoms arise. By the time people become forgetful, their brains are so severely damaged no therapy is likely to fully heal them. But testing preventive treatments requires screening thousands of healthy people to find a study population of people with amyloid build-up and no cognitive problems, a slow and expensive process.
Blood Clots
Targeting inflammation to better understand dangerous blood clots. It’s the third-deadliest cardiovascular diagnosis, but doctors are still often stumped to explain why 40 percent of patients experience unprovoked venous thromboembolism (VTE). After a patient has dealt with these dangerous blood clots once, a second and subsequent events become much more likely.
New research from a team of University of Michigan (U-M) scientists may help solve how to detect and deal with higher-than-usual clot risk in patients’ veins. The study, published in the Journal of Clinical Investigation, focuses on clots’ relationship to the body’s defense and repair system, which causes inflammation.
“We don’t yet understand the molecular triggers which drive the development of life-threatening clots in deep veins,” said Yogen Kanthi, MD, the study’s senior author and a vascular cardiologist at U-M’s Frankel Cardiovascular Center. “Our work aimed to identify and block a previously unrecognized pathway linking inflammation and thrombosis.”
Kanthi, also an assistant professor of internal medicine at Michigan Medicine, says VTE is triggered by some combination of coagulation and inflammation. But current treatments come up short, he says, because they only focus on one side of the equation: anticoagulation. After VTE, patients are often prescribed blood thinners for life.
Kanthi’s lab is instead investigating inflammation’s role in the development of deep vein thrombosis. His team’s new study found an enzyme called CD39 diffused circulating “danger” signals and inflammatory cytokines in blood during thrombosis.
FDA-approved drugs already exist for other conditions that are affected by the same pathway, and in particular, the paradigmatic inflammatory cytokine molecule called interleukin-1 beta. In fact, when the researchers inhibited interleukin-1 signals in their study, they reduced the number and size of venous blood clots the animals formed. “Here, we focused on potential therapeutics at the intersection of inflammation and thrombosis,” Kanthi said. “We showed that blocking interleukin 1 beta, a ubiquitous inflammatory molecule, was a powerful means to stop clot formation.”
Blood Culture Contamination
Magnolia Medical Technologies and The Center for Phlebotomy Education expand continuing education program. Magnolia Medical and The Center for Phlebotomy Education announced the expansion of their training and education partnership dedicated to the prevention of blood culture contamination.
The web-based continuing education course, “Preventing Blood Culture Contamination with a Closed-System Mechanical Initial Specimen Diversion Device (ISDD)” is now available with Professional Acknowledgement for Continuing Education (PACE) credits. Sponsored by the American Society for Clinical Laboratory Science, PACE credits fulfill continuing education (CE) requirements for state and regional laboratory regulation boards.
The course, already available for continuing education units (CEU), now provides phlebotomists and laboratory personnel with the latest evidence-based best practices for preventing blood culture contamination. The course also analyzes the impact of sepsis misdiagnosis on unnecessary antibiotic treatment and the downstream impacts on patient safety as well as hospital costs. Each participant will earn one PACE credit hour toward their annual training and education requirements.
Each year, tens of millions of patients in the U.S. require a blood culture test for diagnosis of sepsis and other bloodstream infections. However, the current industry accepted a three-percent contamination benchmark in the U.S. which means that nearly half of all the positive blood cultures are actually false-positive because of contamination. This is unacceptable for diagnosing the number one cause of death and readmissions in U.S. hospitals.
