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Ishcemic stroke treatment
Ishcemic stroke treatment Degenerative Problem: Ischemic Stroke ®® One in six people worldwide will be affected in some way by a stroke. ®® In the U.S., 87% of strokes are ischemic strokes. ®® According to the US National Stroke Association, two out of three stroke survivors will experience minor to severe physical and/or cognitive impairments over the long term. ®® Up to 25% of stroke patients recover their capabilities, but the reality is that many do not, and there are no therapeutic cord blood treatments available in the U.S. WHAT IS ISCHEMIC STROKE? Ischemic stroke is the most common type of strokes, accounting for about 87% of all strokes. It occurs when the blood supply to part of your brain is interrupted or reduced, depriving brain tissue of oxygen and nutrients. Within minutes, brain cells begin to die, potentially resulting in devastating changes to muscles and nerves of the body with either isolated or complex impairments. According to the US Centers for Disease Control and Prevention (CDC), stroke is the leading cause of death in the United States, killing nearly 140,000 Americans each year. On average, one American dies from stroke every 4 minutes. The majority of those surviving a stroke will have some form of long-term functional and/or cognitive disability. Stroke costs the United States an estimated $34 billion each year including the cost of healthcare services, missed days of work, and medicines to treat stroke. Many people with ischemic strokes are older (60 or more years old), and the risk of stroke increases with age. However, strokes can – and do – occur at any age. Many people with stroke have other problems or conditions which put them at higher risk for strokes, such as high blood pressure (hypertension), high cholesterol, heart disease, smoking, or diabetes. (1,2) WHAT IS CORD BLOOD? Cord blood is the blood that remains in the placenta and umbilical cord after birth. Umbilical cord blood has several unique capabilities, such as being able to create all types of blood cells, stimulate regenerative processes in a brain damaged by an ischemic stroke, and serve as the core building blocks for dozens of regenerative therapies that are reshaping medicine today. Donated cord blood has been successfully used for 25 years to restore blood production in patients after chemotherapy. In the past decade, cord blood infusions have shown beneficial therapeutic effects for children diagnosed with cerebral palsy, and for children with cerebral strokes. (3) In a recent clinical trial studying cerebral strokes in adults, patients registered significant therapeutic improvements, safely, when infused in the first ten days after the stroke event. (4) Cord blood can be collected, cryopreserved, and stored for decades. Cord blood is tested for pathogens using modern blood screening methods. The cord blood stem cells contained in CBC Health’s infusions are allogeneic. CBC Health’s parent company, Cord Blood Center Group, is a pioneer in cord blood banking. It has more than 20 years of cord blood experience and has successfully processed and stored stem cells for over 160,000 children for later use. WHY USE UMBILICAL BASED CORD BLOOD FOR THE TREATMENT OF ISCHEMIC STROKE? The only currently available FDA–approved drug for acute ischemic stroke is intravenous tissue plasminogen activator (tPA). While tPA has markedly improved stroke care, it must be administered within a narrow time frame of no more than 4.5 hours, limiting its clinical utility. Less than 10% of stroke patients can benefit from such treatments due, in large part, to late referral to the hospital and an inability to meet other eligibility criteria including bleeding risk. (5,6) Consequently, most of the patients are left with physical therapy and antiplatelet drugs such as aspirin in parallel with long-term nursing. All in all, the burden of stroke is felt by patients and their families across the globe. Thus, while acute therapy exists, there is a distinct need for improved stroke recovery therapy. Numerous clinical trials conducted during the past two decades have tested a variety of pharmacological interventions to reduce tissue injury and improve functional outcomes following acute stroke, but their outcomes have not been as promising as desired. (7-9) In the past few years, promising research has been completed indicating the potential for therapeutic benefits from stem cell-based treatments for stroke victims. So far, more than 100 studies that have been listed by the National Institute of Health (NIH) show that there is a significant improvement in the recovery and rehabilitation processes for stroke victims. Clinical researchers suggest that stem cells can migrate to the injured area of the brain and help to repair and reduce neuronal damage – a major breakthrough in the medical treatment of stroke patients. In comparison to other stem cell sources, umbilical based cord blood stem cells offer improved plasticity and faster growth rates, are more immunologically tolerant, and are readily available without the need for invasive procedures in compromised patients. Moreover compared to other stem cell sources, umbilical based cord blood also contains other therapeutic cells and paracrine factors including immunological and anti-inflammatory proteins and growth factors to support the formation of new neural connections. In June 2014, Duke Medicine was awarded $15 million to explore the use of umbilical based cord blood to treat stroke and other brain disorders like cerebral palsy and autism. In May 2018, this group published their latest breakthrough findings in a clinical trial showing that the intravenous infusion of non‐HLA matched allogeneic, unrelated donor umbilical based cord blood administered in adults after acute ischemic stroke is safe, well‐tolerated, and feasible. Also, improvements in functional outcomes were observed in all participants by three months post-infusion. (10) HOW DO UMBILICAL BASED CORD BLOOD STEM CELLS DIFFER FROM OTHER SOURCES OF STEM CELLS? Worldwide, allogeneic umbilical based cord blood is being increasingly used as an alternative source of stem cells for cell based therapy for malignant and non-malignant diseases. Especially in the past few years, it has proven great potential in regenerative medicine because it possesses many advantages in contrast to other sources of human stem cells like bone marrow and adipose fat. Umbilical based cord blood is readily available with low potential for graft-versus-host disease and tumorigenicity as well as infectious complications. Therefore, only blood type must be matched in normal blood transfusions, and no immunosuppression is required. Moreover, umbilical based cord blood is rich in diverse types of stem cells, mainly blood-forming stem cells, also known as “hematopoietic” stem cells or (HSC), as well as mesenchymal stem cells (MSC). In addition, cord blood cells release high amounts of regenerative proteins that signal the body to heal itself (paracrine effect). Over the past few years, infusions of umbilical based cord blood have been intensively used around the world as therapy for infants with cerebral palsy. Published studies have shown that umbilical based cord blood stem cells benefit young children with neurologic injury and with almost no adverse effects. In the United States, umbilical based cord blood cells have been used in clinical trials for adults with stroke, and more trials are planned for demyelinating diseases like multiple sclerosis, as well as autism and metabolic diseases like diabetes. In China, cord blood stem cells are being administered in a trial for spinal cord injury. DO PATIENTS NEED TO PROVIDE THEIR OWN BLOOD? One of the primary benefits of CBC Health’s process is that the patient doesn’t need to provide autologous (self-derived) stem cells. Instead, patients have access to cord blood sourced from one of Europe’s most reputable cord blood providers, Cord Blood Center Group. Perhaps Joanne Kurtzberg, MD of Duke University says it best: “I predict that the use of cord blood cells, in both autologous and allogeneic settings, as cellular therapies in the emerging field of regenerative medicine…will emerge as one of the major great advances in novel therapeutics in medicine over the next decade.” Regenerative Solution: Cord Blood Center Health in the treatment of Ischemic Stroke Treatment CBC Health is offering an experimental, therapeutic solution that is based on infusing ischemic stroke survivors with cord blood. Recent clinical trials have demonstrated that infusing cord blood can noticeably help ischemic stroke survivors improve cognitively and physically. View trial here.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4916840/ A medical case report demonstrated long-term, therapeutic effectiveness when cord blood was infused five years after a stroke event. View medical case report here. ®® CBC Health’s Ischemic Stroke Treatment is available in a specially designed day-clinic in Munich, Germany. The German healthcare system is noted for its high standards for efficiency, cleanliness, quality, and innovation. Anavara Limited is tied up with CBC health to bring you the superior health care you deserve. Send your enquiry to https://www.anavara.com/enquiry/ REFERENCES
  1. Feigin VL, Forouzanfar MH, Krishnamurthi R et al. Global and regional burden of stroke during 1990–2010: Findings from the Global Burden of Disease Study 2010. Lancet 2014;383:245–25.
  2. BenjaminEJ,BlahaMJ,ChiuveSE,etal.onbehalfoftheAmericanHeartAssociationStatisticsCommitteeandStroke Statistics Subcommittee. Heart disease and stroke statistics—2017 update: a report from the American Heart Association. Circulation. 2017;135:e229-e445
  3. Feng M, Lu A, Gao H, Qian C, Zhang J, Lin T, Zhao Y. Safety of Allogeneic Umbilical Cord Blood Stem Cells Therapy in Patients with Severe Cerebral Palsy: A Retrospective Study. Stem Cells Int. 2015;2015:325652
  4. Laskowitz DT, Bennett ER, Durham RJ, Volpi JJ, Wiese JR, Frankel M, Shpall E, Wilson JM, Troy J, Kurtzberg J. Allogeneic Umbilical Cord Blood Infusion for Adults with Ischemic Stroke: Clinical Outcomes from a Phase 1 Safety Study. Stem Cells Transl Med. 2018 May 12.
  5. Allen NB, Kaltenbach L, Goldstein LB, Olson DM, Smith EE, Peterson ED, Schwamm L, Lichtman JH. Regional variation in recommended treatments for ischemic stroke and TIA: Get with the Guidelines-Stroke 2003-2010. Stroke. 2012 Jul; 43(7):1858-64
  6. Demaerschalk BM. Alteplase treatment in acute stroke: Incorporating food and drug administration prescribing information into existing acute stroke management guide. Curr Atheroscler Rep 2016;18:53.Heather Pagram, Andrew Bivard, Lisa F Lincz, Christopher Levi.
  7. Immunity and stroke, the hurdles of stroke research translation. International Journal of Stroke. 2017 Feb; Volume: 12 issue: 2: 123-131.
  8. Veltkamp R, Gill D. Clinical trials of immunomodulation in ischemic stroke. Neurotherapeutics 2016;13:791–800.
  9. Kidwell CS, Liebeskind DS, Starkman S et al. Trends in acute ischemic stroke trials through the 20th century. Stroke 2001;32:1349–1359.
  10. Laskowitz DT, Bennett ER, Durham RJ, Volpi JJ, Wiese JR, Frankel M, Shpall E, Wilson JM, Troy J, Kurtzberg J: Allogeneic Umbilical Cord Blood Infusion for Adults with Ischemic Stroke: Clinical Outcomes from a Phase I Safety Study. Stem Cells Transl Med. 2018 Jul; 7(7): 521–529.
  11. Kurtzberg J. 2014; Presentation at ISCT meeting; https://parentsguidecordblood.org/en/faqs/how-are-cord-blood-stem-cells-different-other-sources-stem-cells.
  12. Reddi AS1, Kuppasani K, Ende N.; Human umbilical cord blood as an emerging stem cell therapy for diabetes mellitus. Curr Stem Cell Res Ther. 2010 Dec;5(4):356-61.
  13. Sun JM, Grant GA, McLaughlin C, Allison J, Fitzgerald A, Waters-Pick B, Kurtzberg J.; Repeated autologous umbilical cord blood infusions are feasible and had no acute safety issues in young babies with congenital hydrocephalus. Pediatr Res. 2015 Dec;78(6):712-6.
  14. Park SJ, et al.; Tumorigenicity Evaluation of Umbilical Cord Blood derived Mesenchymal Stem Cells. Toxicol Res. 2016 Jul;32(3):251-8.
  15. “A History of Cord Blood Banking and Transplantation.” Stem Cells Translational Medicine, 3/29/17.
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