Abstract
The aim of this narrative review is to report on the current knowledge regarding the clinical use of umbilical cord blood (CB) based on articles from PubMed and clinical trials registered on ClinicalTrials.gov. An increasing amount of evidence suggests that CB may be used for both early diagnostics and treatment of cerebral palsy. The acidity of CB and its biochemical parameters, including dozens of cytokines, growth factors, and other metabolites (such as amino acids, acylcarnitines, phosphatidylcholines, succinate, glycerol, 3-hydroxybutyrate, and O-phosphocholine) are predictors of future neurodevelopment. In addition, several clinical studies confirmed the safety and efficacy of CB administration in both autologous and allogeneic models, including a meta-analysis of five clinical trials involving a total of 328 participants. Currently, nine clinical trials assessing the use of autologous umbilical CB in children diagnosed with hypoxic-ischemic encephalopathy or cerebral palsy are in progress. The total population assessed in these trials exceeds 2500 patients.
Highlights
The etiology of 70% of cerebral palsy (CP) cases remains unknown
The aim of this narrative review is to report on the current knowledge regarding the clinical use of umbilical cord blood (CB) based on articles from PubMed and clinical trials registered on ClinicalTrials.gov
Nine clinical trials assessing the use of autologous umbilical CB in children diagnosed with hypoxic-ischemic encephalopathy or cerebral palsy are in progress
Summary
The etiology of 70% of cerebral palsy (CP) cases remains unknown. In 20% of children, it may be associated with prematurity, perinatal trauma, or brain hypoxia. Early diagnosis is important in children with no aggravated perinatal history, as it allows an early start of therapy, especially with stem cells. Animal studies have shown that the timing of stem cell administration is crucial for the effectiveness of CP therapy [7] and suggest that results may be time-dependent in humans. A meta-analysis of 51 articles, including over 481,000 children, showed that CB acidity was significantly associated with neonatal mortality (odds ratio [OR] 16.9), hypoxic-ischemic encephalopathy (HIE) (OR 13.8), intraventricular hemorrhage or periventricular leukomalacia (OR 2.9), cerebral palsy (OR 2.3) [9], and the overall incidence of neonatal complications [10]. A similar study by Ahearne et al indicated that succinate, glycerol, 3-hydroxybutyrate, and O-phosphocholine levels can predict the three-year neurodevelopmental outcome in infants with perinatal asphyxia and HIE [14]. A suboptimal concentration of antioxidative micronutrients and heavy metal overload in CB, as well as alterations in DNA methylation in both placenta and CB, are associated with preterm birth [15,16]
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