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It’s hard to ignore the ads for cord blood banks, offering a lifetime of protection for your children. If you’re an expectant mom, there’s information coming at you constantly from your doctor’s office, magazines, online, and perhaps even your yoga class.
Umbilical cord blood was once discarded as waste material but is now known to be a useful source of blood stem cells. Cord blood has been used to treat children with certain blood diseases since 1989 and research on using it to treat adults is making progress. So what are the current challenges for cord blood research and how may it be used – now and in the future?
Some brochures advertising private cord blood banking show children with cerebral palsy, a neurological disorder, who were treated with their own stem cells. In the case of Cord Blood Registry, the company lists all stem cell transplants conducted at Duke University. In a list of individuals treated in their “stem cell therapy data” cerebral palsy is listed. However, transplants were part of an early research study and studies of efficacy are just now underway.
The cord blood collection process is simple, safe, and painless. The process usually takes no longer than five minutes. Cord blood collection does not interfere with delivery and is possible with both vaginal and cesarean deliveries.
Preserving stem cells does not guarantee that the saved stem cells will be applicable for every situation. Ultimate use will be determined by a physician. Please note: Americord Registry’s activities are limited to collection of umbilical cord tissue from autologous donors. Americord Registry’s possession of a New York State license for such collection does not indicate approval or endorsement of possible future uses or future suitability of cells derived from umbilical cord tissue.
CBR is committed to advancing the science of newborn stem cells. We’ve awarded a grant to the Cord Blood Association, to help fund a multi-center clinical trial researching the use of cord blood for children with autism and cerebral palsy.
Umbilical cord blood is useful for research. For example, researchers are investigating ways to grow and multiply haematopoietic (blood) stem cells from cord blood so that they can be used in more types of treatments and for adult patients as well as children. Cord blood can also be donated altruistically for clinical use. Since 1989, umbilical cord blood transplants have been used to treat children who suffer from leukaemia, anaemias and other blood diseases.
Sign a consent form to donate. This consent form says that the donated cord blood may be used by any patient needing a transplant. If the cord blood cannot be used for transplantation, it may be used in research studies or thrown away. These studies help future patients have a more successful transplant.
As noted, there are different ways to process cord blood, and although the type of processing method doesn’t always enter the conversation on cord blood banking, it is a big part of the purity of any cord blood collection. Red blood cells can have a negative impact on a cord blood transfusion. In addition, there is a certain number of stem cells that need to be present in order for the cord blood to be effective in disease treatment. Each processing method has the ability to better reduce the number of RBCs and capture more stem cells. Some processing methods like AutoXpress and Sepax are automated to ensure a level of consistency across all collections. HES is preferred by some banks because it was the original processing method used by most banks and it has a proven track record. You can read more about the different cord blood processing methods here.
Similar to transplantation, the main disadvantage is the limited number of cells that can be procured from a single umbilical cord. Different ways of growing and multiplying HSCs in culture are currently being investigated. Once this barrier is overcome, HSCs could be used to create “universal donor” stem cells as well as specific types of red or white blood cells. Immunologic rejection is a possibility, as with any stem cell transplant. HSCs that are genetically modified are susceptible to cancerous formation and may not migrate (home) to the appropriate tissue and actively divide. The longevity of cord blood HSCs is also unknown.
Generalized stem cell lineage concept. The lineage is characterized by a self-maintaining “parent” true stem cell population that resides within a specialized niche microenvironment, which aids the regulation of stem cell division or quiescence (nondividing). Derivative cells (called progeny or daughter cells) are of two types: symmetric division produces two identical daughter cells to expand or maintain the stem cell population; asymmetric division produces an identical daughter and a specialized cell (a differentiated cell). The differentiated cell is an intermediate type of precursor cell, termed the transient dividing population. The number of divisions of the intermediate precursor is fairly tightly regulated by microenvironment and inborn regulation factors. The intermediate precursors are thought to have a limited proliferative capacity. Further tissue-specific specialization continues form the intermediate precursors, producing specialized populations with a commitment to a progressively more specialized (differentiated) fate. The end points are fully differentiated cells that are nondividing and that live for various, tissue-specific periods prior to senescence or damage that leads to cell death. In some tissues, the naturally occurring cell loss produces various feedback signals that trigger normal cell replacement via amplification/differentiation of either stem cells or the intermediate precursors.
One oft cited argument against cord blood banking is that it is not known how long these cells can remain viable in storage. While it is not known if cells taken from an individual as an infant will be beneficial to them as an adult, units stored for up to 10 years have been transplanted successfully. This indicates that there is no reason to suggest serious deterioration in the quality of cord blood units stored for longer periods of time.
Only 25-50% of donations to public cord blood banks end up being stored.4 Typically, public cord blood banks only store donations that meet the size threshold for transplant use. That means most public cord blood banks will only keep cord blood collections that are at least 3 ounces.2
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There are no health risks related to cord blood collection. Cord blood is retrieved from the umbilical cord after it has been cut, thus preventing any pain, discomfort, or harm. This process is completely safe.
In the procurement of embryonic stem cells for research, the embryo from which the cells are harvested is destroyed. For those who believe that human life begins at conception this research is obviously unethical. In contrast, adult stem cells can be isolated from tissue from a consenting patient. While cord blood stem cells are classified as adult stem cells, they appear to have greater potency (ability to differentiate into other cell types) than other adult stem cells, making them a potentially valuable option for use in a variety of treatments and therapies. Cord blood stem cells offer some of the advantages of ESCs without any of the ethical drawbacks. Research into the use of cord blood stem cells for the treatment of disease and disability is a promising and ethical avenue of stem cell research.
Just like other blood donations, there is no cost to the donor of cord blood. If you do not choose to store your baby’s blood, please consider donating it. Your donation could make a difference in someone else’s life.
You must give us your written permission to collect your cord blood. This consent form permits your doctor to perform the cord blood collection. It also allows us to do the necessary testing to determine whether it will be stored for public banking or made available for research. The consent form will be signed at the hospital when you deliver your baby. If you pre-registered with us, a copy will be sent to your home for you to review before you deliver. See the consent form here.
Carolinas Cord Blood Bank at Duke (CCBB) is headed by Dr. Joanne Kurtzberg. Expectant parents who have a child in need of therapy with cord blood, especially the new therapies in clinical trials at Duke, may be eligible for directed donation through CCBB.
If you go to the hospital to deliver your baby before you are able to complete the form, inform the hospital staff that you would like to donate your baby’s cord blood and they will provide a form to be completed at that time.
Yes, if you have any sick children who could benefit from umbilical cord blood. Public banks such as Carolinas Cord Bank at Duke University and private banks such as FamilyCord in Los Angeles offer programs in which the bank will assist with cord blood processing and storage if your baby has a biological sibling with certain diseases. FamilyCord will provide free cord blood storage for one year. See a list of banks with these programs at parentsguidecordblood.org/help.php.
In the last 10 yr, umbilical cord blood has been shown to be therapeutically useful for rescuing patients with bone marrow-related deficits and inborn errors of metabolism. Umbilical cord blood offers advantages over bone marrow because cord blood does not require perfect human leukocyte antigen (HLA) tissue matching, has less incidence of graft vs host disease, and may be used allogenically (11,12). In addition, cord blood may be banked, and thus is available for use “off-the-shelf.” Last year, a federally supported program was established to expand the national umbilical cord blood banks to include a wide sample of HLA types. By 2004, there were more than 6000 cord blood stem cell units banked. As of January 2006, it is estimated that there are about 300,000 units in public and private banks in the United States.
In the United States, the Food and Drug Administration regulates any facility that stores cord blood; cord blood intended for use in the person from whom it came is not regulated, but cord blood for use in others is regulated as a drug and as a biologic. Several states also have regulations for cord blood banks.
Like any insurance, cord-blood banking isn’t cheap. Banks initially charge from $1,000 to $2,000 to collect and process the stem-cell units, which are stored for a family’s exclusive use. When you factor in additional costs for shipping (about $150 for a medical courier), the doctor’s collection fee (prices can range from $150 to $500), and annual storage fees averaging $100 per year for 18 years, parents can expect to pay up to $4,000 in expenses not covered by insurance.
To learn more about umbilical cord blood and banking please watch Banking on cord blood, Cord blood – banking and uses, Cord blood transplantation – how stem cells can assist in the treatment of cancer in our video library.
Private cord blood banking can benefit those with a strong family history of certain diseases that harm the blood and immune system, such as leukemia and some cancers, sickle-cell anemia, and some metabolic disorders. Parents who already have a child (in a household with biological siblings) who is sick with one of these diseases have the greatest chance of finding a match with their baby’s cord blood. Parents who have a family history of autism, Alzheimer’s, and type 1 diabetes can benefit from cord blood. Although these diseases aren’t currently treated with umbilical cord steam cells, researchers are exploring ways to treat them (and many more) with cord blood.
There is not one right answer. Your family’s medical history and personal preferences will play a major role in this decision process. However, we can help you make sense of the available options. Continue to follow our guide on cord blood to understand what is the best choice for your family.
Parents often complain about cord blood banking costs. This is not an industry where costs can be cut by running a turn-key operation. Each cord blood unit must be individually tested and processed by trained technicians working in a medical laboratory.
Donating your baby’s cord blood to a public bank is always free. The limitations of the public banking network in the United States are: they only collect donations at large birthing hospitals in ethnically diverse communities, the mother must pass a health screening, they prefer registration by 34 weeks of pregnancy, and they only save the largest cord blood collections. The potential reward of public donation is that your baby could Be The Match to save a life!
Umbilical cord blood contains a large amount of stem cells. If parents sign up for personalized storage or donation, medical staff will remove stem cells from the umbilical cord and placenta. The blood is then cryogenically frozen, and put into long-term storage.
You can check the status of your child’s cord blood unit any time by contacting the public bank. In most cases, the parents won’t have much control over any donated stem cells, so you probably won’t hear much from the storage facility. They may keep you updated if your cells are being used in a patient or clinical trial, but this is up to the bank. By signing the consent form, you are giving the bank full rights to use your child’s cord blood in any patient or clinical trial available.
A nurse from the St. Louis Cord Blood Bank may contact you several weeks after your delivery to check on the health of you and your baby. If your child’s cord blood is identified as a potential match for a patient anytime in the future, an additional phone call will be made to check on the health of your child and family. This call is to obtain and update medical information only. At no time will you or your child be asked for additional blood samples.
There are over 130 public cord blood banks in 35 countries. They are regulated by Governments and adhere to internationally agreed standards regarding safety, sample quality and ethical issues. In the UK, several NHS facilities within the National Blood Service harvest and store altruistically donated umbilical cord blood. Trained staff, working separately from those providing care to the mother and newborn child, collect the cord blood. The mother may consent to donate the blood for research and/or clinical use and the cord blood bank will make the blood available for use as appropriate.
Each year, thousands of people are diagnosed with leukemia, lymphoma, or certain immune system or genetic metabolic disorder. Many of these patients need an umbilical cord blood or bone marrow transplant (also called a BMT). Because the qualities that make a suitable match for bone marrow or umbilical cord blood are inherited, a match from a sibling or other family member is often checked first. However, 70 percent of patients will not find a matching donor in their family. For these patients, a transplant of bone marrow or cord blood from an unrelated donor may be their only transplant option.
The parents who make the decision to store their baby’s cord blood and cord tissue are thinking ahead, wanting to do right from the start (even before the start), and taking steps to do whatever they can to protect their baby down the road. Today, many conscientious parents are also considering delayed cord clamping (DCC), a practice in which the umbilical cord is not clamped immediately but rather after it continues to pulse for an average of 30 seconds to 180 seconds. Many parents don’t realize that they can delay the clamping of the cord and still bank their baby’s cord blood. As noted early, our premium processing method, PrepaCyte-CB, is able to capture more immune system cells and reduce the greatest number of red blood cell contaminants. This makes it go hand in hand with delayed cord clamping because it is not as affected by volume, effectively making up for the smaller quantity with a superior quality. You can read more about delayed cord clamping vs. cord blood banking here.
Stem cells are the next frontier in medicine. Stem cells are thought to have great therapeutic and biotechnological potential. This will not only to replace damaged or dysfunctional cells, but also rescue them and/or deliver therapeutic proteins after they have been engineered to do so. Currently, ethical and scientific issues surround both embryonic and fetal stem cells and hinder their widespread implementation. In contrast, stem cells recovered postnatally from the umbilical cord, including the umbilical cord blood cells, amnion/placenta, umbilical cord vein, or umbilical cord matrix cells, are a readily available and inexpensive source of cells that are capable of forming many different cell types (i.e., they are “multipotent”). This review will focus on the umbilical cord-derived stem cells and compare those cells with adult bone marrow-derived mesenchymal stem cells.
Recently the minimal defining characteristics of MSCs was the subject of a blue ribbon panel of scientists (24). This panel ascribed three defining characteristics to MSCs. First, MSCs are plastic-adherent when maintained in standard culture conditions. Second, MSCs express the cell surface markers CD105, CD73, and CD90 and lack expression of CD45, CD34, CD14 or CD11b, CD79 or CD19, and HLA-DR. Third, MSCs differentiate to osteoblasts, adipocytes, and chondroblasts in vitro. As shown in Table 1, mesenchymal-like cells collected from the umbilical cord, placenta, and from umbilical cord blood, perivascular space, and placenta all share a relatively consistent set of surface markers, which is apparently consistent with the hypothesis that they are MSC-like.
Finally, the healthy stem cells are placed into long-term cryogenic storage. Compared to other stem cell sources, cord blood units are available very quickly since a doctor can remove them from storage and send them to the transplant hospital within a few days.
If you want the blood stored, after the birth, the doctor clamps the umbilical cord in two places, about 10 inches apart, and cuts the cord, separating mother from baby. Then she inserts a needle and collects at least 40 milliliters of blood from the cord. The blood is sealed in a bag and sent to a lab or cord blood bank for testing and storage. The process only takes a few minutes and is painless for mother and baby.
Pro: It gives you that peace of mind that if anything did happen to your child, the doctors would have access to their blood. This could potentially be a great benefit, and you would have no idea what would have happened if it weren’t for this blood.
^ a b Walther, Mary Margaret (2009). “Chapter 39. Cord Blood Hematopoietic Cell Transplantation”. In Appelbaum, Frederick R.; Forman, Stephen J.; Negrin, Robert S.; Blume, Karl G. Thomas’ hematopoietic cell transplantation stem cell transplantation (4th ed.). Oxford: Wiley-Blackwell. ISBN 9781444303537.
Taking time to consider helping another person when you are already busy planning for the birth of your child is greatly appreciated. A gift of cord blood may someday give someone a second chance at life.
There are several cord blood banks that are accredited by the American Association of Blood Banks. Most offer information on cord blood banking and provide private cord blood banking services. With a little research, you should be able to locate a credible cord blood bank online.