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Wise words…

Dr Wise Young answered your questions on the future of umbilical cord stem cell therapy to cure spinal cord injury when he visited New Zealand as a guest of CordBank in February 2011.

Q. ” In your opinion, how far do you think we are, realistically, from finding a cure for SCI?”

A: I believe that it is a matter of time and not a matter of if we will have a “cure” for spinal cord injury, of course, how fast the cure comes will depend on the investment by society into research. Clinical trials are going on right now

Q. “Is this cure for people who have just had an injury, or for those who have been in wheelchairs for some time?”

A: We are focussing on chronic spinal cord injury which we define as more that one year after injury and stable neurologically for at least 6 months. Our trials are for people from age 18 years through to 60 years old.

Q. “What are the side effects of Lithium in the lab rats?”

A: Lithium has been used to treat manic depression for over 50 years. In the United States, about 3% of people have the diagnosis of depression and half have taken lithium. So this is a very commonly used drug. Its side effects are relatively minor if the serum levels are carefully titrated.

Q. ” Would you inject this cord blood and lithium directly onto point of injury? or is it injected intravenously?”

A: The cells are transplanted into the spinal cord above and below the injury. The lithium is taken orally for 6 weeks.

Q. Is any of your intense rehab being done with “Project Walk”? (San Diego)

A: We are doing intensive rehabilitation for our clinical trials. I am aware of the work being done by Project Walk in San Diego.

Q. Dear Dr Young, Our little boy aged 22 months was born with Spina Bifida and we banked his cordblood at birth. In terms of spinal injuries I have always asked if someone could provide an accurate definition of injury ie. does the spinal cord have to suffer some form of trauma, or could spina bifida, although termed a birth defect also be classed as a spinal injury. I would be interested to know if any research has been done using cord blood to treat SB and if so what of any results have been collated.

A: We are not currently doing trails on spina bifida. However, I am aware of other promising work relating to nerve bridging to restore bladder function in children with spina bifida.

Q. Hi Dr Young, I have a cousin in Australia who suffered a spinal injury almost 3 years ago. He is now a quadriplegic. Would the cord blood that I have stored from my two children’s births be able to be used to help him? He is my cousin on my mothers side. He also has another cousin who is about to have twins and we were wondering if their stem cell blood would be helpful (the cousin is on his mothers side) Would these match’s be closer than using a ‘unknown’ donor?

If I did this would there still be enough stem cells remaining in the bank for our children if they needed it? We are very keen to help him out!

A: Cord blood from relatives is more likely to match but there is no guarantee, especially for distant relationships. Usually the chances of siblings matching 6/6 HLA is 1:4, so, the likelihood of a perfect match will be less. However, cord blood will often engraft even with 4/6 match. It is worthwhile, when the time comes, to do an HLA match of your children’s blood and your cousin. We will know in about 2 years time whether the cord blood plus lithium therapy is effective for spinal cord injury. I hope that is effective.

Q. Is possible for you to take stem cells from a part of the body several years after the baby born?

A: Unfortunately, no.

Q. My 11 year old son has mild spina bifida.  I did cord blood banking with his 3 year old sister.  Is this able to be used for him to assist in a bit more healing and to repair nerve damage and bring back some feeling in his leg that was affected from his lipoma surgery?

He is a normal boy, no problems with toileting, but does not have much feeling in the affected leg from nerve damage during his surgery at 9mths of age.  His leg has been burnt accidentally on the motorbike resulting in huge blisters and he didn’t even feel it.  The foot was always cold when he was younger, but is slightly better now.  He also has a withered calf muscle and the leg at present is about 2cm shorter than the other one.  The leg is always covered in bruises and sores.  He has problems with the knee and requires Botox to help the muscles work.  He drags the leg when tired and it slows him down quite a bit, especially with things like swimming.  The leg is turned out, but the average person would not detect this.

He wore a leg brace until the age of 5 and wore special made shoes. He has had 1 operation for a tendon lengthening, but may require more.Can still not stand on his toes as such. He is improving slowly as he matures.

I worry about the future and how his actual back will cope, as the surgeon did remove a large lipoma and bone.

Any info would be much appreciated thanks.

A: I am not sure that umbilical blood cells will do much for children with spina bifida. However, there is promising work suggesting that nerve transfer may be useful. Several groups in Sweden, Michigan (USA) and New York are running clinical trials the results of which suggest that the nerve transfers can restore bladder function in children with spina bifida. I don’t know about individual leg muscles.

Q.Can you let me know where the research is at for curing diabetes type 1 with stem cells?  Can you suggest any recent articles I can read?

A: There is anecdotal evidence that children who have had umbilical cord blood transplants to replace bone marrow for other reasons will resolve their Type 1 diabetes. This is because, as you know, Type 1 diabetes is an autoimmune disease. Replacing bone marrow will eliminate the auto immune disease. Unfortunately, there has been no large scale clinical trial confirming these findings. On the other hand, if a child has his or her own umbilical cord blood, it would be worthwhile considering a trial.

Q. What is the % of success rate for another immediate family member to have a successful cure of (for example cancer) using a siblings/sons/daughters cord blood if it was allowed?

A: The probability of a perfect 6/6 HLA match with a sibling is about 1:4, it could be higher if the mother and the father shared one or more HLA antigens. There are of course public banks providing HLA-matched cord blood should the available related cord blood units not match.

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