‘India needs a registry of umbilical cord donors for stem cell transplants’

Dr Nalini Janakiraman, director of Bone Marrow Transplant Program, Henry Ford Hospital, United States, speaks about stem cell research

Challenges in sourcing the stem cells and transplantation

Until recently, blood stem cell transplants were known as bone marrow transplants, because marrow was the only source of blood stem cells used to treat diseases. However, of late, new sources have been identified. They are: peripheral blood and umbilical cord blood cells.

As far as the sourcing is concerned, the major challenge is the availability of donors. The bone marrow is always taken from the patients’ siblings, for the transplant to be a success, the donor’s cells must match the patient’s own cells as closely as possible. However, with umbilical cord, you can find match in unrelated, unknown people also.

To find a donor

In the US, we have a registry of several millions. The US based National Marrow Donor Program (NMDP) networks with transplant centres in the United States and across the world and facilitates the transplantation of unrelated donor stem cells. Umbilical cord blood is a rich source of stem cells. Months before the baby’s birth, the mother signs an agreement to donate the umbilical cord blood when the baby is born. At birth, the cord blood unit is collected and taken to a cord blood bank, where it is tissue-typed, processed and stored frozen until needed for a transplant.

The limitation is that some patients may need more stem cells and because cord blood is donated in a single unit when the baby is born, a second donation is not available when the patient needs more.

Assessment on the infrastructure facilities that India has for the stem cells transplantation

From what I hear, India needs a more comprehensive registry of donors of human umbilical cord, etc. First of all, we need high quality blood banks with proper set up. I understand that there are only a few blood banks in India that have the infrastructure to separate specific blood components, say red cells, and supply to the transplantation needs. Establishing such infrastructure is a costly proposition but it is a prerequisite for the stem cell transplantation.

Qualitative differences between medical education in the US and India

The difference is enormous. When you study in the US, you can do whatever you read and it is published. You are really at the forefront of the science and that is truly exciting. I only see graduates coming to the US from India. In India they were exposed to clinical medicine but in the US it is mostly laboratory medicine.

Recent research focus on stem cell transplantations

Research is focused on the possibilities of expanding the cells, increasing the numbers through various sources. Recently, “Cord Blood Farms” have been established that try to do the artificial culture of stem cells.

The outcomes will help us in addressing the inborn metabolical problems, red cell disorders, etc. The Stem Cell Plasticity is identified as the future research direction. The stem cells have the ability to differentiate into other cells - they can develop into any of the three major tissue types: endoderm (interior gut lining), mesoderm (muscle, bone, blood), and ectoderm (epidermal tissues and nervous system. In other words, through stem cell plasticity, we can grow stem cells into brain cells, heart muscle cells, etc and use for treatment.

- G Sankarnarayanan/Chennai