Stem Cell/Cord Blood Banking
Introduction:
Collection and banking of umbilical cord blood (UCB)-derived cells have become a popular option worldwide.The first cord blood transplantation was performed in 1988 in Paris,France for Fanconi’s anemia.since then,we have come a long way and more than 25000 allogenic cord blood transplantations have been performed worldwide. However, there are questions regarding the cost versus the benefits of UCB banking, and it also raises complex ethical and legal issues.In the last few years it has become a status symbol amongst some, where without understanding the reason, they are opting for the concept.Celebrities are also going for the concept and many of them has endorsed the same also. But what is the reason behind the concept? Who should go for cord blood banking? What are the benefits? What are the risk involved? And the parameters to choose a stem cell bank is to be looked into.
Cord blood contains hematopoietic stem cells (which can differentiate only into blood cells), and should not be confused with embryonic stem cells or pluripotent stem cells, which can differentiate into any cell in the body.Cord blood stem cells are blood cell progenitors which can form red blood cells, white blood cells, and platelets. This is why cord blood cells are currently used to treat blood and immune system related genetic diseases, cancers, and blood disorders.Expectant parents do all kinds of things to ensure that they are prepared when the new family member comes. They go for ante natal classes, baby shower, painting of room, color combination, childproof their cabinets, searching internet for diet. Baby names — all months before their son or daughter is born.And some are now choosing a procedure that, they feel, could further protect their children from harm: umbilical cord blood banking. The procedure involves collecting blood and a portion of umbilical cord at birth and the same is stored in a private blood bank.
Collection, processing and cryopreservation of the specimen:
Collection is, as ever, a critical step and private banks will generally hand over a cord blood collection kit to the parents .Coordination of collection is managed with the doctor who, in turn, will ensure the collection either directly or through a nurse. Mother’s blood is also taken for testing of certain diseases as per national or international criteria .The collection of the cord blood and cord tissue is done only after the baby is separated from the mother so nowhere it interferes with the birthing process and is totally painless for the mother . The unit will be placed in a shipment box provided as part of the kit and a courier sent by the bank, preferably from a specialized provider, will be waiting to deliver the unit to the processing center.Umbilical cord blood cells are processed and stored in liquid or vapour phase nitrogen to maintain their viability and potential.Dimethyl sulfoxide(DMSO) is used for cryopreservation and freezing is done by either the red cell reduction method or the plasma depletion method.
Why Cord blood banking? Is it important?
The very concept of preserving baby’s umbilical cord and cord blood is for the sake of providing protection for the baby and or immediate family members. So the understanding is it is a “ Biological Insurance “
Clinical settings where stem cells are useful:
Hematological malignancies like acute leukemias,thalessemia,sickle cell anemia are the major disorders where stem cells are used.other areas under research are non hematological conditions like diabetes mellitus type 1,inborn metabolic disorders,bronchopulmonary dysplasia,liver disease(e.g.hepatitis B induced liver failure),multiple sclerosis and also areas of regenerative medicine like alzheimer’s disease,stroke,autism,spinal cord injury.
As of now, around 80 odd diseases has are treatable with stem cells , however , some of the diseases are so rare that the possibility is not even in lacs. Secondly, many of the diseases mentioned is by birth and if the baby suffers from the diseases, the utility of the stem cells for the same baby is impossible .
Many reports suggest that the probability of using own cord blood is as rare as 1 in 20000. Considering this very fact, the insurance policy of around 50000 rupees is very very costly.However, people are still opting for the concept. Be it US, Developed Asian countries like Singapore and China etc. has huge takers for the concept. The reason behind going for the concept is the hope.
Diseases like Diabetes Type 1, Multiple sclerosis, Liver disease, Cerebral palsy, Autism etc. has shown tremendous promise. There are multiple reports where the use of stem cells has shown dramatic results.
In 2014, when Duke Medicine received a grant of $15M, for the treatment of Autism and later when Sutter institute , California also came up with the similar treatment option, it is imperative that more and more conditions would be available .
Autism is a condition which cannot be diagnosed before 2 years of age. Neither can anyone predict the reason for the same. As of now, there is no cure to it. The probability of baby suffering from Autism in India is 1 in 250. The same probability increases in the US, with 1 in every 68.
Another condition which happens during birth is cerebral palsy. The probability of this disorder is 1 in 323 globally. If we consider only these two conditions also, suddenly the usage of stem cells could dramatically increase. So, idea behind opting for the stem banking sounds logical.
Public banking
Many developed countries around the world extensively promote this concept. However they insist on donating it to a public bank. A public bank accepts donated samples. These processed and stored for future use. Anyone in need of sample can approach these banks and get one at a price. However it is not so easy as stringent matching needs to be done before the actual use for a treatment. And the cost of procuring a sample is as high as US$ 30000(around 20 lac rupees)
Most of the public banks are either a nongovernment organizations or are under government grant.
In India, the number of public banks is handful . Most of the stem cell banks in India are private banks.
Private banks operate by collecting fees from the client and storing it for them.
Just like the way we select insurance companies before investing, certain parameters should be considered while selecting a stem cell bank. 21 years of association and confidence on a stem cell bank calls for a background check of the company.Financial stability of the company is critical and a major deciding factor.The next parameter could be the necessary licenses or recognitions by national / International authorities as preserved stem cells would only be verified by the client at the time of use .In India,ICMR(Indian council of medical research) and DBT(department of biotechnology) have published guidelines that need to be followed for umbilical cord blood banking.There are different methods to separate stem cells from the sample. The amount of the stem cells stored also depends upon the technology. Thus, technology also is an important factor before deciding on a stem cell bank.Last but not the least, all insurance companies insist on reading the service contract document carefully. So this cannot be an exception.
Conclusion:
The American academy of pediatrics recommends that private cord blood banking should only be done if there is a family member with a disorder potentially requiring current or future stem cell transplantation. The American Medical Association says private banking should be done only if there is a family predisposition to a condition wherein umbilical cord blood cells are therapeutically indicated.worldwide,the encouragement is more towards public cord blood banking than private banking.India is still in the infant stage with regards to umbilical cord blood banking and more policies and governmental participation is necessary.
All said and done, the final decision of opting for the concept lies with the would be parents.
IT’S THE POSSIBILITY WHICH KEEPS US GOING AND NOT THE GUARANTEE