For 14 years, Bristol obstetrician/gynecologist Dr. Alan L. Gorrell has offered his patients the option of collecting and saving stem cell-rich umbilical cord blood following the birth of their newborn. He estimates that he’s collected this placenta blood from about 140 babies.
Now, parents have the option of not only preserving their newborn’s cord blood, but an actual segment of the umbilical cord as well. Cord Blood Registry (CBR), the largest private cord blood bank, is offering this new service as researchers say the umbilical cord tissue itself is a rich source of unique stem cells called mesenchymal stem cells (MSCs) that may offer a wider range of potential therapeutic uses.
It’s a new concept, and not one that has caught on with Gorrell’s patients just yet, perhaps because of the expense involved, and perhaps because the potential uses for MSCs are still being researched.
“It took awhile for the cord blood to become popular,” Gorrell said, noting that only one parent took him up on the offer the first year he presented it. “I think as the uses become more publicized, if the uses become different than of the cord blood itself, from those stem cells, that’s when I think a lot of people will consider doing it.
Most of his obstetrical patients are familiar with cord blood collection, Gorrell said, and he lets them know that there are multiple medical companies that offer the service.
“I’m not trying to sell it. I’m trying to present it so they can make their own decision. ... I also tell them if the person doesn’t do this, they’re not bad parents. It’s not for me to decide whether that’s appropriate for them,” he said.
The San Bruno, Ca.-based Cord Blood Registry announced in March the launch of the new stem cell collection system that saves a greater number and diversity of a newborn’s stem cells from the umbilical cord tissue. While cord blood stem cells turn into all of the cells in the body's blood and immune system, cord tissue stem cells create structural and connective tissue. These two types of stem cells can help repair the body in different ways so each offers potential treatments for different diseases and injuries.
“It’s an educational process and it’s beginning to grow in its scope. People are becoming more aware of the options of what you can do versus throwing away the cord blood,” said Kathy Engle, CBR’s director of corporate communications. “Unfortunately 90 percent of umbilical cord blood is discarded as medical waste. That is why education is our primary goal, ensuring parents know about options for storing cord blood and cord tissue.”
Since both cord blood and umbilical cord tissue can only be collected immediately after birth, there are no ethical concerns in preserving them for future medical use. The Christian Medical & Dental Associations, headquartered in Bristol, Tenn., endorses “the goals of stem cell research to treat human illness and relieve human suffering,” and endorses “retrieval and use of adult stem cells from a variety of sources — umbilical cord blood, placenta, amniotic fluid, adult organs, etc.”
By collecting and freezing a baby’s cord blood stem cells, parents are saving a biological resource that could have many important uses. Newborn stem cells have the ability to regenerate into other types of cells in the body. For more than 20 years, transplant medicine specialists have used cord blood to regenerate the blood and immune cells following chemotherapy for cancers and blood disorders.
Engle said that MSCs were isolated more than 30 years ago from bone marrow. Today, it’s known that MSCs are present in cord blood as well as in other tissues, including fat tissue, placenta and whole umbilical cord.
“MSCs from the cord tissue, just like the stem cells from the cord blood itself, are considered newer sources in their own life cycle ... and most people believe that newer is better,” Engle said. “Fewer instances to be exposed to chemicals and exterior forces.”
MSCs are currently being researched for use in treating conditions like heart disease, stroke, bone disease and injury, and autoimmune diseases like type 1 diabetes and multiple sclerosis. MSCs are needed for building connective tissue, so another potential treatment application may be for common joint and sports injuries.
“It’s a completely different set of conditions, typically around structural and connective tissues,” Engle said. “Of the clinical trials under way today, using MSCs from all over the body, they’re looking at treating conditions that include spinal cord injury, heart repair following heart attack, bone repair, cartilage regeneration, regeneration to tissue systems; whereas, cord blood ... is being used to treat blood and immune disorders and potentially looking at regenerating hearing loss, traumatic brain injury. Different systems within the body are being targeted by different kinds of clinical research.”
Engle said all the potential uses of MSCs are being studied in clinical trials, and information on more than 80 clinical trials involving MSCs is available online at www.clinicaltrials.gov, a Web site of the National Institutes of Health.
Since March, parents have banked umbilical cord tissue, but Engle wouldn’t give numbers.
“We are having people do it. We’re seeing the rates of people choosing to do it are above our expectations,” she said. “We don’t want to say at this point what that is because we don’t want to tip off our competition.”
CBR encourages the collection and storage of both cord blood and umbilical cord tissue. It maintains a laboratory and storage facility in Tucson, Ariz., and the facility and systems are monitored 24 hours a day, 365 days a year.
Once parents make the decision to collect cord blood and/or umbilical tissue (although right now only CBR offers to collect and store umbilical tissue) they are given a kit by whichever collection company they decide to use. The kit contains all the items the physician will need to collect the baby’s cord blood. However, parents must remember to take the kit with them to the hospital when the baby is delivered. The hospital does not provide any materials for collection.
After the baby’s umbilical cord has been clamped and cut, and after cord blood collection (if also performed), a doctor or midwife will collect a four- to eight-inch segment of the umbilical cord and place it in the CBR collection kit, which is then returned to CBR’s laboratory by an express courier. CBR requests that samples be received at its laboratory within 24 to 32 hours.
According to CBR, it has processed and stored cord blood units for more than 300,000 newborns from around the world and has released more client cord blood units for therapeutic use than any other family cord blood bank. It has provided nearly 150 samples for use in transplantation. In all cases, the stem cells proved viable for transplant.
While most samples were used for siblings, there have been two exceptions. In one, a newborn’s cord blood stem cells were transplanted to her mother to treat chronic myelogenous leukemia. In the second, CBR facilitated a transplant for a child who was diagnosed with aplastic anemia at age 2. His own cord blood stem cells were used in his transplant.
Engle said one of the most common misconceptions about storing cord blood and cord tissue is that its too expensive. Initial fees for collection and storage of cord tissue are $595 when purchased in combination with cord blood; thereafter, the annual storage fee for cord tissue is $125, the same as the current annual storage fee for cord blood.
“We try to offer payment opportunities that allow for a broader range of folks to benefit,” she said.
Among the options:
• Monthly payment plans, including $61 per month for 48 months for cord blood banking.
• A Gift Registry to which family and friends can contribute.
• Grandparents-to-be gifting of cord blood banking.
CBR also offers a Designated Treatment Program, which provides cord blood collection, processing and storage at no cost to families with a medical need.
“Another misconception is the odds that you will use or need to access stored cord blood are very low,” she said. “There are numbers thrown around called ‘odds of use’ ... and the most cited odds of use are 1 in over 200,000 odds/chance that you would need to use stored cord blood. That statistic is based on transplant medicine alone and as science evolves, that odds of use is going to become a moving target.”
Other sources, Engle said, indicate that a child born today who lives to be 70 has a 1 in 400 chance of needing their cord blood.
Whether or not stem cells are the appropriate treatment choice for a specific individual is the decision of the treating physician, Engle said.
“Lists are a nice starting point, but of course they provide no guarantee. CBR works with the family and their physician by providing information about the stored sample, but it is the physician who ultimately decides if the sample can be used to treat her patient’s disease or condition,” she said. “That decision can be based on a great many factors, such as the type of disease, the disease state, whether another source of stem cells — for example a sibling’s — is more promising, the sample’s cell count, the cells’ viability, and HLA compatibility. All of these factors go into deciding a course of treatment, but it is ultimately the decision of the medical professionals and families, not CBR. CBR’s job is to make sure that the cells are viable and available for use should we be called upon to provide them.”
Engle admits that stem cell collection can be yet another difficult decision among so many when you’re expecting a baby, particularly for first-time parents.
“But with fast-changing science, the ability to collect tissue as well as cord blood is something we urge folks to educate themselves about,” she said. “Science changes so rapidly and the difficult thing is to educate consumers, expectant families about the pace of change as well as the potential so that people make a choice that they’re comfortable with. There’s only the one chance to save this particular type of stem cells. ... Really, our primary focus is educating as many people as we can to the unique characteristics and value of both cord blood stem cells and cord tissue stems cells. We’re building and continue to enhance an education site of our own, we call the Cord Blood Education Center.”
To visit the CBR’s Cord Blood Education Center, visit cordblood.com/education.