May 15, 1998

U of A doctors lead the way in umbilical cord blood transplants

Dr. John Akabutu

Canada's first successful cord blood transplant relied on University of Alberta expertise and facilities. The operation was performed at Toronto's Sick Children's Hospital on Judd Cameron who recently moved to Toronto with his family from St. Albert. However, the blood for the procedure was housed at the Alberta Cord Blood Bank where research into the use of cord blood has flourished under the direction of Dr. John Akabutu, pediatric hematologist and professor of pediatrics at the University of Alberta.

Judd's parents, Bruce and Keri, donated the umbilical cord from the birth of their son Cole last July to the Alberta Cord Blood Bank. Little did they know that it would be used to save their next child the following year.

The Alberta Cord Blood Bank began in October of 1996. It is a public non-profit bank dedicated to the collection, processing, and cryopreservation (freezing) of umbilical cord blood. The blood is then used to harvest stem cells for curing blood-related diseases, particularly forms of leukemia. The procedure has also found use for acute lymphoblastic leukemia, Hodgkin's disease, and other forms of leukemia.

Expectant mothers register one month prior to their due date. Once the infant is born, blood is drained from the severed umbilical cord. This precious blood and the umbilical cord would usually be discarded as medical waste.

Once collected, the stem cells are enriched by removing some of the other blood cells and stored by cryopreservation. The blood is quarantined for six months and the health of the newborn is checked before the sample becomes part of the database. Samples are thawed and cultured to check their health. The new stem cells can then be transplanted intravenously into the patient. Because stem cells are undifferentiated, they are not associated with the usual problems of rejection that can occur with bone marrow transplants. The stem cells automatically begin to regenerate in the new host 14-21 days after the transplant occurs and they supply the blood components needed in patients whose own stem cells have been damaged by disease.

There are research projects underway to separate the stem cells and grow them in culture to increase the numbers.

Akabutu along with Lab Director Dr. Locksley McGann, and Technical Director Dr. Hongyou Yang have been deliberate in neither attracting attention nor promoting the bank at this time. The centre can only process two to three samples per day because of the great cost involved in processing and preserving the samples. "We are hoping that with increased funding, we will be able to process about 10-15 samples per day -- that is one of our goals," says Akabutu.

Other than trying to seek funding, ethical questions must also be addressed in the research and development of banking umbilical cord blood: "There is only one ethical consideration that I can foresee to date: What if the bank contains a sample that matches two patients?" says Akabutu. Making a decision as to who would receive the transplant is a grim reality. "I hope that such a scenario never occurs."

How does a doctor from Toronto or anywhere else in the world find out if the Alberta Cord Blood Bank has a match? When all other methods of detection have been exhausted -- immediate families have been tested for matches and no other treatment options exist -- doctors can contact the Alberta bank to see if there are any matches. If the Alberta sample is not needed for a Canadian, the bank is able to donate the sample internationally.

Sustaining the life of the bank is no easy task. Cryopreservation (freezing) and sampling analysis costs are high. Funding for the bank was started in the memory of Tanya Smale who died of acute lumphoblastic leukemia in 1987. Currently the bank relies on individual donations. A presentation was given to the Alberta government in January 1998, prior to the successful Cameron transplant, and was very well received. The best scenario would be a combination of both government and private donations. "Now that we have actually proven the methodology to be effective, we are hoping that the centre can grow," says Akabutu.

Akabutu is optimistic about the future of this research and its potential. Experiments using the new stem cells for gene and cell therapy show encouraging results: "There could also be other uses that we have not yet tapped into, it all depends on how imaginative we can be."

There is great opportunity for research because the bank is in Alberta. A multi-disciplinary approach is required for further research that includes biological, ethical, and developmental considerations. "We have a great deal to learn."

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