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Banking on Stem Cells

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Advertisements in the media advise parents to “plan and protect your children’s future and their health status”. These are not commercials for insurance plans, but private stem cell banking facilities, where, for a steep price, your baby’s umbilical cord stem cells can be preserved for future use.
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Stem cells are in the news. Independent national and international laboratories are making claims and counterclaims about the “miracles” they have achieved with them. Paralysed people have been able to walk, rare degenerative nervous and muscular system diseases been reversed, and some cancers of the blood cells cured. People with terminal illnesses have also been offered hope…..click & see

Actress Lisa Ray underwent stem cell therapy for multiple myeloma, a cancer of the white blood cells...click & see

Stem cells may be embryonic, adult or derived from umbilical cords. Embryonic stem cells are obtained from the extra fertilised eggs at in vitro fertilisation (IVF) centres. The use of these cells is controversial, as, theoretically, they have the potential to become human beings. They are the “spare babies” belonging to a particular IVF couple. When supplied to a stem cell research facility, they are grown in a nutrient broth in a culture dish and used for research or treatment.

Adult stem cells are found in bone marrow. These are harvested from the bone marrow of living donors. It’s a surgical procedure done under anaesthesia with some post-operative discomfort. The cells are capable of eventually forming either various types of blood cells or stromal cells from which cartilage and fat tissues arise.

Haematologists treat a variety of hereditary blood disorders and some of the blood cancers with either autologous (the person’s own) stem cells or compatible donor cells from bone marrow transplants. This technology has been used for the last 30 years. Bone marrow transplants are life saving for people with certain blood cancers. They can also be used for serious blood disorders such as aplastic anaemia. They can also help boost the immune system if it is impaired because of an inherited genetic defect or destroyed by cancer.

Umbilical cords are a rich and non-controversial source of stem cells. Cord blood has a greater ability to generate new blood cells than does bone marrow. Also, smaller quantities of cord blood cells are needed for successful transplantation. These cords are normally discarded along with the placenta from labour wards all over the world.

At present, in India, patients who require stem cell treatment or a bone marrow transplant have to search for a relative who is an appropriate tissue match. Sometimes even close first-degree relatives like a parent or sibling are not compatible. India does not as yet have a centralised national bone marrow registry to match recipients and donors.

Some foresighted countries with efficient national health schemes like the United Kingdom and Brazil do have public cord blood banks. Blood is screened for infective agents, documented in a registry and stored. The chances of finding compatible stem cells are high because of the large volumes stored.

India has private cord blood banks which store blood only for the use of that particular child for a period of 21 years. It may be a cost effective option for parents who have a family history of certain genetic diseases, such as severe hereditary anaemias, immune disorders or certain cancers. Even then, the chance that the blood can be used for that particular child is only 1 in 2,000. In families with no such risk factors, there is only about a 1-in-20,000 chance of the child ever needing a stem cell transplantation. Also, even if the child does require a stem cell transplant, it is unlikely that his or her own cord blood would be the desired source of stem cells. The same chromosomal or genetic defect causing the leukaemia, any other cancer or metabolic disorder, is likely to be present in the child’s stem cell line. There is no proof that a transplant using the child’s own stem cells is effective or even safe, especially in cases of childhood cancers.

Indians have a very diverse genetic make-up. The large-scale collection and storage of cord blood in public banks will be very useful. It can be used for matched unrelated recipients who urgently need blood cell transplants.

Stem cells are probably the future of medicine and the human race. They are multifaceted and have the potential to develop into different cell types. They can theoretically keep dividing as long as the person is alive. When a stem cell divides, each new cell has the potential to either remain a stem cell or become another specialised cell like a muscle cell, red blood cell, or brain cell. This means stem cells can be infused as a sort of emergency repair mechanism to replenish damaged tissues.

Perhaps disease, aging, cancer and even death can be controlled and conquered. And living healthily forever may become a reality.

Source
:The Telegraph (Kolkata, India)

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Diagnonistic Test

Endometrial Biopsy

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Introduction:An endometrial biopsy is a way for your doctor to take a small sample of the lining of the uterus (endometrium). The sample is looked at under a microscope for abnormal cells. An endometrial biopsy helps your doctor find any problems in the endometrium. It also lets your doctor check to see if your body’s hormone levels that affect the endometrium are in balance.

Doctors take biopsies of areas that look abnormal and use them to detect cancer, precancerous cells, infections, and other conditions. For some biopsies, the doctor inserts a needle into the skin and draws out a sample; in other cases, tissue is removed during a surgical procedure.

The lining of the uterus changes throughout a woman’s menstrual cycle. Early in the menstrual cycle, the lining grows thicker until a mature egg is released from an ovary (ovulation). If the egg is not fertilized by a sperm, the lining is shed during normal menstrual bleeding.

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There are several ways to do an endometrial biopsy. Your doctor may use:

*A soft, straw-like device (pipelle) to suction a small sample of lining from the uterus. This method is fast and is not very painful.

*A sharp-edged tool called a curette. Your doctor will scrape a small sample and collect it with a syringe or suction. This is called a dilation and curettage (D&C). A D&C may be done to control heavy uterine bleeding (hemorrhage) or to help find the cause of bleeding. This is done with general or regional anesthesia.

*An electronic suction device (Vabra aspiration). This method can be uncomfortable.

*A spray of liquid (jet irrigation) to wash off some of the tissue that lines the uterus. A brush may be used to remove some of the lining before the washing is done.

When a woman is having a hard time becoming pregnant, an endometrial biopsy may be done to see whether the lining of her uterus can support a pregnancy.

An endometrial biopsy may also be done to find the cause of abnormal uterine bleeding, to check for overgrowth of the lining (endometrial hyperplasia), or to check for cancer.

An endometrial biopsy is sometimes done at the same time as another test, called hysteroscopy, which allows your doctor to look through a small lighted tube at the lining of the uterus.

Why It Is Done
An endometrial biopsy is done to:

*Check for cancer. For example, an endometrial biopsy may be done to help determine the cause of some abnormal Pap test results.
*Find the cause of heavy, prolonged, or irregular uterine bleeding. It is often done to find the cause of uterine bleeding in women who have gone through menopause.

*See whether the lining of the uterus (endometrium) is going through the normal menstrual cycle changes.

How To Prepare
Tell your doctor if you:

*Are or might be pregnant. An endometrial biopsy is not done during pregnancy.

*Are taking any medicines.

*Are allergic to any medicines.

*Have had bleeding problems or take blood-thinners, such as aspirin or warfarin (Coumadin).

*Have been treated for a vaginal, cervical, or pelvic infection.

*Have any heart or lung problems.
Do not douche, use tampons, or use vaginal medicines for 24 hours before the biopsy. You will empty your bladder just before your biopsy.

If you are not bleeding heavily, you might want to take an NSAID medicine such as ibuprofen one to two hours before the test, to reduce the possibility of uterine cramps during the procedure. Ask your physician for a recommendation ahead of time.

You will need to sign a consent form that says you understand the risks of an endometrial biopsy and agree to have the test done. Talk to your doctor about any concerns you have regarding the need for the test, its risks, how it will be done, or what the results may mean. To help you understand the importance of this test, fill out the medical test information form (What is a PDF document?) .

If you are having a dilation and curettage (D&C) and will go to sleep (general anesthesia) for the test, do not eat or drink anything for 8 hours before the test. If you are taking any medicines, ask your doctor what medicines you can take the day of the test.

How It Is Done
An endometrial biopsy is usually done by a gynecologist, a family medicine physician, or a nurse practitioner who has been trained to do the test. The sample will be looked at by a pathologist. The biopsy can be done in your doctor’s office.

Your cervix may be numbed with a spray or injection of local anesthetic.

You will need to take off your clothes below the waist. You will be given a covering to drape around your waist. You will then lie on your back on an examination table with your feet raised and supported by foot rests (stirrups).

Your doctor will put an instrument with smooth, curved blades (speculum) into your vagina. The speculum gently spreads apart the vaginal walls so your doctor can see inside the vagina and the cervix. See a picture of a pelvic examination with a speculum. The cervix is washed with a special solution and may be grasped and held in place with a clamp called a tenaculum.

The tool to collect the sample is guided through the cervix into the uterus. The tool may be moved up and down to collect the sample. Most women have some cramping during the biopsy.

An endometrial biopsy takes 5 to 15 minutes.

Dilation and curettage (D&C)
A D&C is usually done in a hospital or clinic. Most women do not need to stay overnight but can go home the same day.

Your doctor will put an instrument with smooth, curved blades (speculum) into your vagina. The speculum gently spreads apart the vaginal walls so your doctor can see inside the vagina and the cervix. Your cervix will be gently spread open (dilated). Depending on the reason for the D&C, your doctor may use a tool called a hysteroscope to look inside the uterus. A small spoon-shaped instrument (curette) is then guided through the cervix and into the uterus. The top layer of the lining of the uterus is carefully scraped off and removed (along with any other tissue that looks abnormal) for biopsy.

If you have general anesthesia, you will be watched by a nurse in the recovery room until you are fully awake.

You can do most of your normal activities in a few days. Do not lift anything heavy for a few days after the test. Do not douche or have sex for one week after the test.

How It Feels
If you have not had any pain medicine, you may feel a sharp cramp as the tool is guided through your cervix. You may feel more cramping when the biopsy sample is collected. Most women find that the cramping feels like a really bad menstrual cramp.

Some women feel dizzy and sick to their stomachs. This is called a vasovagal reaction. This feeling will go away after the biopsy.

An endometrial biopsy usually causes some vaginal bleeding. You can use a pad for the bleeding or spotting.

Dilation and curettage (D&C)
If general anesthesia is used during a D&C, you will be asleep and feel nothing. After the test, you will feel sleepy for a few hours. You may be tired for a few days after the test. You may also have a mild sore throat if a tube (endotracheal tube, or ET) was placed in your throat to help you breathe during the test. Using throat lozenges and gargling with warm salt water may help relieve your sore throat.

Risks Factors:
You might have pelvic cramps (sometimes intense) during the procedure and sometimes for a day or two afterward; you may also experience a small amount of vaginal bleeding. It is extremely rare to have heavy bleeding or to develop an infection that needs treatment.There is also a small risk of disturbing a very early pregnancy. To guard against this, your doctor might order a pregnancy test before performing the biopsy.

After the test:
You may feel some soreness in your vagina for a day or two. Some vaginal bleeding or discharge is normal for up to a week after a biopsy. You can use a sanitary pad for the bleeding. Do not do strenuous exercise or heavy lifting for one day after your biopsy. Do not douche. You may have to avoid sex or using tampons for several days. Ask your doctor when you can have sex or use tampons again.

Follow any instructions your doctor gave you. Call your doctor if you have:

*Heavy vaginal bleeding (more than a normal menstrual period).

*A fever.

*Belly pain.

*Bad-smelling vaginal discharge.

Results:
Time to know the results:
An endometrial biopsy is a way for your doctor to take a small sample of the lining of the uterus (endometrium). Lab results from a biopsy may take several days to get back.


Endometrial biopsy  Normal
: No abnormal cells or cancer is found. For women who have menstrual cycles, the lining of the uterus is at the right stage for the time in the menstrual cycle when the biopsy was done.

Endometrial biopsy  Abnormal:

*A noncancerous (benign) growth, called a polyp, is present.

*Overgrowth of the lining of the uterus (endometrial hyperplasia) is present.

*Cell changes that may lead to cancer are present.

For women who have menstrual cycles, the lining of the uterus is not at the right stage for the time in the menstrual cycle when the biopsy was done. More tests may be needed.

Resources:
https://www.health.harvard.edu/fhg/diagnostics/endometrial-biopsy.shtml
http://women.webmd.com/endometrial-biopsy

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A Possible Cure for Diabetes Ignored by Big Pharma

Twelve years ago, Professor Irving Weissman discovered a treatment that could have saved the lives of thousands of women with advanced breast cancer. Pharmaceutical companies weren’t interested in developing the therapy at the time.

Though interest in his methods are finally being ignited, Weissman regrets the wasted time. In a set of lectures, Weissman repeatedly expressed frustration that while many of his discoveries in the field of stem cell research seemed to hold remarkable potential for life-saving treatments, commercial or regulatory hurdles have prevented his scientific findings from benefiting patients.

One example is Weissman’s research on type I diabetes, in which he demonstrated the ability to fully cure type I diabetes in mice using stem cells. But even though his experiments avoided political controversy by using adult stem cells, which do not come from embryos, Weissman ran into a road block when pharmaceutical companies refused to sponsor clinical trials.

Weissman believes that the pharmaceutical companies put profit over principle, preferring to keep diabetes sufferers dependent on costly insulin than to cure them once and for all.

Sources: Columbia Spectator January 23, 2009

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‘Menstrual Blood’ May Save Life

Depicts the variation through the menstrual cy...Image via Wikipedia

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Many refer to it as ‘nature’s curse on women’. It’s commonly thought of as unclean. In some cultures, women are not even allowed to cook during those days of month. But, path-breaking new research could change the way people view the menstrual cycle. And it’s here in India, for the first time ever. The blood that uselessly leaks away from a woman’s body every month until she hits menopause is a good source of stem cells, which are still at an early stage of development and retain the potential to turn into many different types of cell.

Stem cell research classifies them as a super “repair kit” for the body because they can be used to grow new fat, cartilage, bone, skin, heart and brain cells. Japan and American researchers say menstrual blood could actually be banked and used to save lives. It is supposed to contain adult stem cells that can develop into any of nine different types of cells, including heart, lung, nerve and muscle.

Ajit Kumar is chief scientific officer of LifeCell International, India’s biggest stem cell banking facility and the first in the country to launch a menstrual stem cell banking facility. He says, “The menstrual stem cell comes from the uterine lining (endometrium) that is shed as part of a woman’s menstrual period.”

Research is ongoing but if established as a success, it would be a huge advance for stem cell research. Stem cell therapy has become controversial in some parts of the world beca-use scientists believe the most useful ones come from embryos. Adult stem cells are rare in mature tissue. But if they are sourced from hitherto-useless, “unclean” menstrual blood, it would redefine the woman’s role as life-giver.

The master stem cell is the zygote and all of human life really begins here. A zygote is created when an egg is fertilised. Thereafter, this master stem cell multiplies as the embryo develops into millions of cells, including a large number of other stem cells. Less specialised stem cells become ever more so with the process continuing throughout pregnancy to create different cells — skin, muscle, nerve or bone. Throughout the life, the body continues to produce stem cells. Kumar says menstrual stem cells are similar to those from bone marrow and embryos, with the added bonus of even faster replication and higher compatibility.

It is an amazing bit of news for stem cell therapy, which is gaining ground across the world as a wonder cure for Parkinson’s, Alz-heimer’s, heart disease, diabetes, spinal cord damage and much more. Till now, umbilical cord stem cells have been used in 8,000 transplant operations worldwide, says Cryo-Cell a leading global stem cell banking company.

During lab tests, scientists created different types of cells from menstrual stem cells or endometrial regenerative cells (ERCs) as they are known. Within five days, fledgling heart cells had been generated. Kumar says this showed ERCs may be a source of patient-specific stem cells.

It is not hard to bank menstrual blood. The procedure is almost the same as giving a urine sample. Kumar says it may be easier to harvest stem cells from menstrual blood than bone marrow or skin because it is a painless and non-invasive procedure. “Unlike cord blood stem cells, where the cells are frozen directly after extraction, here the blood is expanded before being stored,” he explains.

Preliminary research suggests that menst-rual stem cells could be used to cure a woman’s genetic family, such as parents, sibling or child.

Sources: The Times Of India

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Leukemia stem cells to map how disease begins

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In a major breakthrough that could help devise better treatment for blood cancer and aid the development of drugs that would stop the process before it advances, Canadian scientists have for the first time converted normal human blood cells to leukemia stem cells in the lab.

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The team then transplanted the converted cells into lab mice and watched it replicate the entire disease process, from the very moment it begins. Till now, most human leukemia research involved studying a patient’s diseased cells. But because cancer takes months to develop, “just studying the cells at the end of the process does not tell us the series of changes that caused the cells to become leukemic and when they happened. We have now duplicated the natural process of cell death, as it happens. This will help us understand how cancer begins,” Dr John Dick at Ontario Cancer Institute said.

According to Dick, this peek into leukemia’s development will allow scientists to ask questions that include: Is the childhood disease different from that in adults? In which cell type does leukemia arise? And which genes are involved and in which order do they have to operate?

Reacting to the study, former head of Rajiv Gandhi Cancer Institute Dr Y P Bhatia told TOI, “Once the basic cellular structure is known, better treatment solutions can be devised. This is a major breakthrough. Scientists can now see the first cells that will give birth to leukemia and then watch as the disease as it slowly progresses.”

The groundbreaking research involved infecting cells from umbilical cord blood with a virus engineered to carry one of the genes known to cause certain types of leukemia. Dr Dick’s team introduced a specific leukemia gene into normal stem cells and injected the genetically altered cells into mice that lacked immune systems. This resulted in the mices developing leukemia, displaying the same characteristics and patterns of human disease.

He said, “We are studying how leukemia arises in the first place. We found that with the leukemia gene we were using, the disease only arose from immature stem and progenitor cells. The leukemic stem cells that were created seemed to change as the human leukemia was grown for longer times in a series of transplanted mice.”

Source:The Times Of India

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