Investigation of Bacterial Infections Among Patients Treated With Umbilical Cord Blood–Derived Products Marketed as Stem Cell Therapies
Authors: Kathleen P. Hartnett, Krista M. Powell, Danielle Rankin, Paige Gable, Janice J. Kim, Samantha Spoto, Erin Breaker, Robert Hunter, Nychie Dotson, Gillian McAllister, Valerie Stevens, Alison Laufer Halpin, Hollis Houston, Erin Epson, Mary Malarkey, Melissa Mendoza, Lorrie McNeill, Kiran M. Perkins
Journal: JAMA Network Open (2021)

<h3>Importance</h3> The number of clinics marketing stem cell products for joint diseases, chronic pain, and most recently, COVID-19, has increased despite warnings from the US Food and Drug Administration that stem cell products for these and other indications have not been proven safe or effective. <h3>Objective</h3> To examine bacterial infections in 20 patients who received umbilical cord blood–derived products marketed as stem cell treatment. <h3>Design, Setting, and Participants</h3> This case series is a national public health investigation including case-finding, medical record review and abstraction, and laboratory investigation, including sterility testing of products and whole-genome sequencing of patient and product isolates. Participants included patients who developed bacterial infections following administration of umbilical cord blood–derived products marketed as stem cell treatment during August 2017 to September 2018. Data analysis was performed from March 2019 to September 2021. <h3>Exposures</h3> Umbilical cord blood–derived products marketed as stem cell treatment. <h3>Main Outcomes and Measures</h3> Data were collected on patient infections and exposures. The Centers for Disease Control and Prevention performed sterility testing on undistributed and distributed vials of product marketed as stem cell treatment and performed whole-genome sequencing to compare patient and product bacterial isolates. <h3>Results</h3> Culture-confirmed bacterial infections were identified in 20 patients (median [range] age, 63 [2-89] years; 13 male patients [65%]) from 8 US states who sought stem cell treatment for conditions including pain, osteoarthritis, rheumatoid arthritis, and injury; all but 1 required hospitalization. The most frequently isolated bacteria from patients with infections were common enteric species, including<i>Escherichia coli</i>(14 patients) and<i>Enterobacter cloacae</i>(7 patients). Of unopened, undistributed products sampled for testing, 65% (22 of 34 vials) were contaminated with at least 1 of 16 bacterial species, mostly enteric. A patient isolate from Arizona matched isolates obtained from products administered to patients in Florida, and patient isolates from Texas matched undistributed product sent from the company in California. <h3>Conclusions and Relevance</h3> Unapproved stem cell products can expose patients to serious risks without proven benefit. Sequencing results suggest a common source of extensive contamination, likely occurring during the processing of cord blood into product. Patients and health care practitioners who are considering the use of unapproved products marketed as stem cell treatment should be aware of their unproven benefits and potential risks, including serious infections.