Q: The more I read about stem cell research, and all it may do to potentially impact our health, the more confused I become. Is it a good idea to bank my baby's umbilical cord blood, which I understand is rich in stem cells?
Stem cells obtained from banked umbilical cord blood (UCB) have the potential to save lives. Referred to by some as "magic cells" or "miracle cells", stem cells have the tremendous potential to rapidly multiply and to develop into more mature, useful cells when transplanted later in life.
In fact, the main motive for banking cord blood is to save these stem cells for possible future transplantation, thus avoiding the need for bone marrow transplants. The concern with a bone marrow transplant is that a match with a sibling, done through a process called HLA (Human Leukocyte Antigen) typing, is found in only 25% of cases. This process tends to be tedious, and it comes with other risks such as higher odds for rejection and infections.
The first UCB transplant was performed in 1970 in a 16-year old boy with leukemia. The process was then refined over a number of years. In 1988, a 5-year old boy in Paris received a UCB transplant from his sister, curing his Fanconi anemia. In 1992, the New York Blood Centre established the Placental Blood Program. The wave of UBC transplants hit the UK shores in 1996, and in the same year the Alberta Cord Blood Bank became the first public UCB bank in Canada (see www.acbb.ca).
Currently, there are close to 40 medical conditions where UCB transplants have a role to play. Diseases treated with cord blood transplantation include malignancies such as leukemia, lymphoma, neuroblastoma, and some immunodeficiency syndromes. Some non-malignant conditions such as metabolic diseases, anemia, errors in metabolism, thalassemia, and sickle cell disease are included in a long list of relatively rare situations.
The cord blood is collected under sterile conditions after the baby's delivery, but prior to the delivery of the placenta (The risk to the mother and baby are minimal to none). The cord is clamped within 30 seconds after delivery, and an average volume of 50 to150 ml. of blood is collected within minutes. It is then transported to the blood bank, where the blood is screened for bacteria, fungi and viruses such as cytomegalovirus, Epstein-Barr virus, HIV and hepatitis B. Finally, it is frozen and banked. The UCB is generally thought to be useful for at least the next 10-15 years. Most UCB that is used clinically has been cryopreserved for 6 years or less.
Consent to collect UCB is required prior to delivery, and according to the web site of the Alberta Cord Blood Bank, consent is required no later than the 34th week of pregnancy. Currently, the site has a warning that a great number of donations are rejected due to the improper completion of forms. These forms are designed to filter out undesired donations, in order to maintain a high standard of safety and ideal ethical standards.
Currently, Canadian patients have two options: dealing with a public bank or using a private, for profit blood bank. A survey of pregnant Canadian women indicated that 86% of patients preferred to store blood in a public bank, while 14% would use a private cord bank. Women who preferred public banking gave altruism (UCB can be used by blood relatives, but can also be donated to appropriately screened non-relatives) and the expense of private UCB banking as their rationale. The cost of commercial cord blood banking varies in North America, with an initiation fee from $500 to $2,000 as well as an annual storage fee of $50 to $150.
There are still some issues which require further investigation before it may become standard practice to collect and bank UCB from all babies. The big question is do potential future needs justify the collection and banking costs, especially at a time when both the medical community and parents wrestle with its pros and cons?
According to The Society of Obstetricians and Gynecologists of Canada (JOGC, March 2005), the risk of a child requiring a bone marrow transplant before his or her 10th birthday is between 1:10,000 and 1:200,000. Less than 5% of privately stored UCB has been used clinically, and the use of UCB on the patient who originally provided the blood (referred to as autologous use) occurs in 1:20,000 collections. These figures indicate how, for some families, the cost of banking UCB may not justify the reality of needing a bone marrow transplant.
The transfer of genetically abnormal cells via UCB remains a potential drawback. Another potential negative is that UCB transplantation in adults requires an uncertain volume of cord blood; although stem cells or “magic cells” from UCB have a tremendous potential to rapidly multiply.
Currently, the Canadian Pediatric Society has no information regarding UBC banking on its web site. A survey published in the Canadian Medical Association Journal (2003) revealed that 70% of pregnant patients felt that their knowledge of cord blood banking was poor to very poor; 68% wanted to receive information from their doctors or midwifes about UCB banking and transplantation.
One company which is prominently marketing itself (most do as a result of intense competition for credibility) claims it has been audited by Health Canada, and deemed to be superbly reliable and trustworthy (see www.healthcord.com).
The American Academy of Pediatrics (www.aap.org) has endeavored to update its own members about some of the controversies and unresolved ethical issues surrounding UBC banking; in particular, the susceptibility of new parents to aggressive and inaccurate marketing practices preformed by some private blood banks.
For more information on stem cell research, see The International Journal of Cell Differentiation and Proliferation (http://stemcells.alphamedpress.org/).
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