Potential Uses of Cord Blood in Cardiac Surgery

Despite advances in the fields of prevention, medical intervention and surgical therapy, cardiovascular disease remains a major public healthcare issue. A promising area of research is the potential application of regenerative therapies with pluripotential stem cells to reduce the burden of heart disease and its sequelae. Umbilical cord blood, a rich source of multiple populations of nonembryonic stem cells, will be a valuable resource and has the potential to advance therapeutic options for patients with acquired and congenital heart disease. 1. Introduction Atherosclerotic heart disease and chronic heart failure remain a major worldwide health problem [1]. According to the American Heart Association statistics, over one in three American adults have one or more types of cardiovascular disease resulting in an average of 1 death every 39 seconds. In addition, millions of people are now living with the results of palliated congenital heart disease such as artificial valves and conduits and declining ventricular function [2]. Significant advances in medical care; pharmacologic therapy, interventional catheterization, and surgical procedures; coronary artery bypass grafting and hybrid techniques, ventricular restoration, ventricular assist devices, and organ transplantation have improved the lives of many. Yet these therapies are expensive, yield variable results and are not available or applicable to all clinical states. Finally, many of these modalities do not get to the “heart” of the matter: a reduction in the effective contractile architecture or the need for true autologous cardiac structures. 2. Umbilical Cord Blood Stem Cells Undifferentiated cells capable of self-renewal and developing into various tissues and organs are referred to as stem cells (SC) [3]. Multiple sources of human stem cells, embryonic and nonembryonic (bone marrow, adipose tissue and umbilical cord blood), have been characterized and studied in preclinical scenarios. Each has its own particular advantageous and disadvantageous properties. Embryonic stem cells, for example, have great potential for regeneration given their high content of pluripotent cells. Currently mired in political and ethical debate, their use is further complicated by the risk of teratoma formation [4]. Stem cells from adult sources (bone and adipose tissue) can provide an alternative but may carry a higher risk of somatic mutations [5, 6]. Umbilical cord blood contains various populations of stem cells and progenitors including hematopoietic stem cells (HSCs), mesenchymal stem cells (MSCs), endothelial