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Umbilical cord blood derived stem cell therapies for Stroke and traumatic brain injury
By James Braly, M.D.
A.B., a 77 year old businessman was paralyzed by a
stroke in 2002. A year later he received an injection of umbilical cord
derived stem cells. Within three weeks, A.B. had regained 80% of his
strength and motor function in his previously weak and paralyzed arm and
leg. Similar anecdotal results are being reported around the world from the use of human stem cells for the treatment of stroke, traumatic brain injury, cerebral palsy, multiple sclerosis, ALS, and macular degeneration.
What are stem cells?
At the beginning of life is the "FIRST
CELL" (zygote). This cell is "totipotent", i.e., capable of
generating every other cell of the body. As this FIRST CELL divides into
many cells, it forms different embryonic layers (the ectoderm, mesoderm and
endoderm).
The outer ectoderm layer becomes specialized into
brain and spinal cord nerve cells with their supporting cells (glia). The
glia help nourish and protect the neurons by forming a layer of insulation
around them, much like the black insulation around electrical wires in your
house. Instead of being black, the glia are white and form the "white
matter" of the brain and the blood-brain-barrier.
This white matter is partially destroyed in multiple
sclerosis, stroke, traumatic brain injury, cerebral palsy and congenital
brain disorders but appears to be repairable with stem cells.
Stem cells that come from the mesoderm make red
blood cells, white blood cells and platelets, as well as bone, muscle, fat,
cartilage and skin. Stem cells of the endoderm develop into cells for the digestive system and lungs. Of greatest interest and practicality is that the different stem cells are "multipotent" and can replace damaged tissues anywhere in the body.
What are the different sources of stem cells?
Three basic sources of stem cells include:
Embryonic stem cells currently present a number of
difficulties, including abortion and laboratory fertilization controversies.
Embryonic lines that are approved for research may be losing their potency
over time. They may contain mouse feeder cells and no longer be
"pure" human cells. In addition, serious Graft Versus Host
complications have been reported in patients treated with embryonic stem
cells outside the U.S. This could result from embryos having genetic
aberrations and diseases from uncontrolled parental sources. Quality control
for purity and potency is a major concern with the use of embryonic stem
cells.
Unfortunately, adult derived stem cells are also
associated with Graft Versus Host Disease. Umbilical cord derived stem cells are easily obtainable. They can be certified for purity and potency, and are much safer to use than embryonic or adult stem cells. At this time, umbilical cord derived stem cells may offer the best results with the least liability.
Umbilical Cord Derived Stem Cells CD34+ stem cells are now available that have been specially extracted from umbilical cord blood and which are similar in biological activity to stem cells taken from human embryos. CD34+ stem cells (named for having a specific human leukocyte differentiation antigen) are able to (1) divide symmetrically to re-create themselves and their multipotent capacity (self-renewal) and (2) through asymmetrical division, give rise to a variety of functional cells such as blood cells, immune cells, liver cells, neurons, etc.
Safe and Effective Track Record Since 1986 Umbilical cord blood has been approved for use by the FDA since the late 1980’s. Umbilical cord blood transfusions (which included CD34+ stem cells) have been used since 1986 in the United States in over 1,000 patients, both children and adults. Many of these treatments were for cancer patients who showed significant improvement after treatment. Thus cord blood stem cells are the "active" portion of the cord blood used to repair the bone marrow and immune system in patients treated with chemo and radiation therapy. In addition, umbilical cord blood (with its stem cells) has a 17 year track record of being used to treat cases of malignancy without increasing the risk of developing subsequent malignancies. Cord blood produces significantly less Graft Versus Host disease and is easier to obtain than bone marrow stem cells. In addition, only cord blood that is AABB (American Association of Blood Banks) certified is used.
Graft Versus Host Disease
New methods of separating stem cells from all other
blood components associated with Graft Versus Host disease have resulted in
a product that consists of only stem cells. Since these umbilical cord stem
cells are immature and have not developed ABO and HLA antigens on their
surfaces, they do not induce graft versus host reactions that may occur with
embryonic, bone marrow stem cells or to a lesser degree, cord blood. Since
the umbilical cord stem cells do not contain mature blood or tissue cells,
foreign protein reactions do not occur. This is important because immune
suppressive chemotherapies and radiation used in the past with bone marrow
and cord blood transplants are toxic to stem cells and new neurons. Both
chemotherapy and radiation are associated with neurotoxicity and symptoms of
memory loss, depression, and declining IQ scores. Therefore if "pure" umbilical cord derived stem cells (separated from blood components) are safe enough to use without immune suppressive therapies, the stem cell therapy should be more effective. This is what is being reported from patients being treated in other countries. CD34+ stem cells extracted from cord blood are being reported as safe and effective without the use of immune suppression.
Augmentation
The effectiveness of stem cells can be improved by
increasing their numbers. Each umbilical cord/placenta unit contains 80-220
ml of blood and an average unit of 100 ml of cord blood contains 300,000
stem cells. These stem cells can be stimulated by growth factors in the
laboratory to replicate up to several million stem cells that still retain
their potency and viability.
We know at this point that a million stem cells per
treatment is more effective than 300,000 stem cells and the larger dosage
further reduces Graft Versus Host complications. A subset of CD34+ stem cells are progenitor cells that give rise to new neurons. For brain injured patients, therapies can be created where 80% of the treatment consists of primitive neural progenitor cells called CD133+ cells.
How Stem Cells Help the Healing Process
When stem cells are injected intravenously,
intramuscularly or subcutaneously, they travel to those parts of the body
that have suffered from some type of injury. At these sites of injury, the
blood vessels have been damaged, narrowed and constricted. These
constrictions prevent the oxygen carrying red blood cells from passing
through to the tissues, which produces areas of reduced oxygen. Since stem
cells are large, they become lodged in these narrowed and constricted small
blood vessels. The low levels of oxygen in these damaged areas are just what
the stem cells need to grow and develop. In addition, endothelial cells, the
inner lining of the damaged blood vessels, express certain signals that
attract the stem cells.
In the early stages of human development prior to
the first cells becoming specialized, stem cells develop best in a low
oxygen environment. As the embryo grows and the stem cells become
specialized, they begin to require more oxygen. The more specialized the
cell, the greater the oxygen required. With an increase in oxygen demand,
there is also an increase in the number of mitochondria (energy producing
cells) to convert the oxygen to ATP to support rapid cell division into new
cells and tissue. As the stem cells divide into more specialized cells, they are able to transform into new blood vessels, neurons, muscle, eye, pancreas, kidney, liver, bone marrow, etc., depending on the local tissue and growth factors present.
Neurological Research
Research scientists have used stem cells from human
umbilical cord blood on rats with induced strokes. They found that the stem
cells would enter the brain, survive, change into new neurons, and improve
the neurological function of the paralyzed animals. Case results that are
similar are being reported for brain injured humans.
E.P. is a ten year old with cerebral palsy. She was
born "dead", having suffered 28 minutes without sufficient oxygen.
She is described as having extreme developmental delays and visual problems.
She was given umbilical cord derived stem cells in November, 2002. She has
since shown significant improvement in her ability to focus, concentrate and
speak. Her vocabulary has expanded and she now uses complex sentences. Her
articulation has improved so that strangers can now understand her. She can
now hold a crayon, make a line, count to 24, feed herself, make jokes and
interact with her siblings.
K.W. began suffering seizures when he was 3 months
old which resulted in brain damage and severe developmental delays. He is
now three years old. Within a month of receiving umbilical cord stem cells,
his seizures stopped and his appetite and memory improved. Three months
after treatment, there has been dramatic improvement in his eye/hand
coordination. He is able to roll from his back to tummy, flex his fingers,
sleep through the night (without waking up and crying), and is more curious
about his surroundings. His verbal sounds and expressions have increased,
his overall health has improved and he is a more active and happy child. A.B. was legally blind in his left eye due to macular degeneration and complications of a stroke. His vision was 500/20. The left eye was red and swollen at the time of treatment in January, 2003 with certified umbilical cord derived stem cells administered in Mexico. In the past six months, A.B.’s vision has steadily improved and is now 50/20.
Pre-Treatments
As effective as stem cells are, it appears that stem
cell treatment can be more effective if factors that kill or injure the stem
cells are reduced as much as possible before the injections.
The cleaner and healthier the body can be made prior
to the application of the stem cells, the better the results. Improvements following stem cell therapy begin to appear in some cases within 2 to 3 weeks but most people begin to see results within three to six months, which can continue for up to a year.
Post-Treatment
After the stem cell treatment, the patient needs the
assistance of family, friends and caregivers to continue to reduce emotional
and physical stress as much as possible.
More research is needed in this area but preliminary reports suggest that slower improvements are made in patients on predominantly grain diets.
Neuroprotectant Foods and Supplements
There are patients who see the glass as half full.
These patients seem to be improving more quickly with stem cell treatments.
There are those who not only see the glass as half empty, they see an ugly
old glass, the water inundated with germs, and the glass too far out of
reach. These people need greater supervised care through the first few
months after stem cell therapy to insure that they receive fresh organic
foods, daily supplements, intravenous antioxidant therapies, counseling,
physical therapy, etc. There is some support for depression being a symptom
of stem cell deficiency. Further research may also find that negative
emotions (anger, irritation, "thinking the worst", etc.) are a
symptom of an inability to repair and renew damaged cells.
While stem cells are engrafting, migrating,
proliferating and differentiating, they need antioxidant protection to help
them survive. This includes an "ORAC" (Oxygen Radical Absorbant
Capacity or high antioxidant) diet as well as supplements. Foods that
contain antioxidants can assist the mitochondria in pumping out enough
energy (ATP) to protect neurons from toxic assaults. Vegetables high in
antioxidants include kale, spinach, Brussels sprouts, alfalfa, broccoli,
beets, red bell pepper, onions and corn. Fruits high in antioxidants include
prunes, blueberries, blackberries, strawberries, raspberries, plums,
oranges, red grapes, cherries, kiwi and grapefruit. These fruits can be
eaten with other foods such as plain yogurt to slow their digestion.
Antioxidant seasonings include curcumin (curry),
ginger, natural vanilla flavoring, garlic, Fenugreek, parsley, thyme, sage
and rosemary. Glutathione protects cells and neurons against oxyradical damage and is associated with improvement in function after brain injury. Factors that increase and have a sparing effect on glutathione include vitamin D3, Fenugreek, fiboflavin, aloe vera, ginger, garlic, vitamin E, Ginkgo biloba, pycnogenol, green tea, succinate, citrate and natural vitamin C.
Preparing the Ground Work
Pioneering work is now being done in other countries
using stem cells separated and expanded from certified (absence of disease)
umbilical cord blood. Ten patients with various health problems have
recently received injections or infusions of this stem cell cocktail. No
immune suppressive treatments were used and there have been little or no
side effects reported.
For further information on umbilical cord-derived
stem cell therapies, go to
http://www.stemcelltherapies.org.
** DMSA Tests available from:
Doctor’s Data, Chicago, Illinois, phone:
800-323-2784,
http://www.DoctorsData.com
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