The collection and conservation in Italy of stem cells from umbilical cord blood.

The blood obtained from the umbilical cord (UBC) has the advantages of containing pluripotent stem cells (USC) and being readily available at birth with no risk of harm to the donor or ethical difficulties, as this type of withdrawal surely falls within the parameters of the donation of bodily material for the purposes of therapeutic transplant. The use of USC for therapeutic purposes for certain haematological illnesses offers undeniable practical and biological advantages over parallel donation of bone marrow. No invasive procedure is required to extract USC; its immediate availability, and the fewer restrictions in the necessary HLA system compatibility, greatly increase the chances of matching donors to recipients. In addition, USC involves much less risk for transmittable viral diseases and grave post-transplant immunological reactions (GVHD). Since 1988, umbilical cord stem cells have been used to treat Gunther’s disease, Hunter’s Syndrome, Hurler’s Syndrome, acute lymphocytic leukaemia, and many other pathologies that affect children in particular. Currently, the therapeutic applications effectively possible with these cells regard treatment of rare and very grave pathologies, and the only certainties we have about their future use is the fact that they have made it through the experimental phase and that the number of pathologies they may treat can only increase with the possibility of extending their use to pathologies in adults, given that as at the moment, there are no adults with their own their umbilical cord stem cells conserved, only children. Studies underway concern above all haematology, cardiology and neurology, but it seems premature to speak about new treatment strategies or the time necessary for their development. Incessant laboratory research must be combined with an operative capability to translate results into clinical protocols applicable to patients, with assurances of safety and sterility, as well as ethical acceptability. Hopefulness is understandable, but given the current status, it would hardly be responsible to promise cell therapy cures for many illnesses afflicting the public. It would be more judicious to maintain a cautious optimism about the potential expressed to date by the international scientific community. In addition, the constant increase in the presence of emergent ethic minorities should be taken into consideration, as this factor significantly influences the number of births, with the need to recruit donors who could increase the availability of rare haplotypes. Finally, almost all countries have the theoretical possibility of long term USC conservation for possible therapies of haematological pathologies in paediatric and/or adult age, through the creation of private sector personalized banks. Notwithstanding these real possibilities, the Italian governments have long maintained a prohibitionist policy against the establishment of private umbilical cord blood banks, barely leaving space for exportation for conservation abroad, with ministerial authorization, or for donation, as much to assure quality of the technical procedure as to safeguard ethical and deontological aspects, above all in terms of information, consent and social equity that it proposes. For the Health Minister Livia Turco , “…the conservation of the umbilical cord appertains to this public network that at the moment is the most efficient, one of the safest, and the one with the highest number of transplants performed in Europe.”