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Jeudi, 08 Décembre 2011 12:30

Inside the Strange Science of Cord Blood Banking

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Entryway to Cord Blood America's corporate headquarters, Las Vegas.

In a nondescript commercial park on the outskirts of Las Vegas, a large cryogenic stem cell storage facility is ready to accept your baby’s blood.

Cord Blood America in Las Vegas is one of dozens of private cord blood banks in the United States that, for a fee, will store stem cell-rich blood taken from a newborn baby’s umbilical cord.

Over one hundred thousand families save or donate cord blood annually, in the hopes it will one day provide medical help to their child or someone else.

“My vision is within the next 10 years we’ll see organizations like this develop into cellular therapy labs,” said Dr. Geoffrey O’Neill, vice president of CorCell, the subsidiary company that runs Cord Blood America’s Las Vegas facility. It’s beginning to happen now in countries like China and Mexico, he says.

But while banking cord blood is legal and safe, many health care professionals question the value of private banks. Regenerative therapies based on stem cells from cord blood have had mixed preliminary success, and researchers are split over when and whether they’ll ever come through.

In the meantime, private cord blood banks are expensive, their marketing can be misleading and their practicality is suspect.

Using cord blood medically began in Paris in 1988 with a transplantation to regenerate blood and immune cells in a young child with Fanconi’s anemia, a blood disorder. The blood came from the umbilical cord of a sibling who didn’t suffer from the disease. The patient’s own cord blood wouldn’t have helped him.

For parents, the details of cord blood use aren’t always clear, said Dr. Lawrence Goldstein, a University of California, San Diego cell biologist and author of Stem Cells for Dummies.

Walk into an obstetrician’s office, scan the advertisements for private banks, and “you see these wonderful promises: ‘Your child might die someday, and you should get them a transplant of cord blood ready,’” Goldstein said. Implied is a promise that “we’ll be able to treat everything under the sun with cord blood.”

Reality is different. Leukemia, bone marrow failure, immune deficiency, metabolic diseases and sickle cell anemia — the diseases cord blood is typically needed for — require transplants of healthy cells. The cord blood of a child with leukemia would also carry the disease.

“If you have the money, and you want to bank your child’s own cord blood, you’re essentially investing in one of two things,” said Dr. Joanne Kurtzberg, director of the Duke Pediatric Bone Marrow and Stem Cell Transplant Program. “One, the possibility that another child in your family will need that cord blood, and that it matches. Or two, that somewhere in the future there will be new developments and new uses for your child’s cord blood — say in regenerative medicine or cell therapy. But to date, none of those exist.”

While a few rare diseases, such as multiple myeloma and lymphoma, use stem cells taken from a patient’s own body, the chances of a child having these are vanishingly small. The chances are so small, in fact, the American Academy of Pediatrics does not recommend private cord blood storing. Parents should only consider it, they say, if a family member has a disease that could be treated with stem cell transplants.

Parents also have the option of donating cord blood to the National Marrow Donor Program. The NMDP is a large, partially government-funded public system existing alongside the private banking system. It supports a nationwide registry of 9.5 million potential bone marrow donors. Marrow is a concentrated source of stem cells; when needed, this program supplements bone marrow transfusions with stem cells from cord blood.

The NMDP is able to find a match for Caucasian patients about 60 percent of the time, said Dr. Willis Navarro, the NMDP’s medical director of transplant services. For African Americans, who are genetically more diverse than Caucasians, they find a match only 15 to 20 percent of the time. With the addition of cord blood donations, NMDP is able to find a match for Caucasians 93 percent of the time, and a match for African Americans 65 percent of the time.

Parents can donate to the public registry at no cost to themselves. They don’t, however, own the blood after it has been donated. If their child or a relative became sick, they would need to apply to the NMDP like anyone else. This is one reason why families might decide to use the private banking system.

“It’s a real reassurance not just for the child,” O’Neill said, “but for the extended family.”

After contacting CorCell and signing up for their services, expectant parents receive a collection package in the mail — essentially a box with a sterile bag and needle, which they bring with them to the hospital. After the baby is delivered and the umbilical cord clamped and detached, a doctor or nurse inserts the needle into the umbilical cord vein, letting the blood drain into the bag. Parents then send the bag back to CorCell, keeping it at ambient temperature, via a medical courier.

Parents pay $2,075 for the kit, courier fees and one year’s storage. CorCell charges a $125 annual storage fee after that. Some insurance companies offer discounts. CorCell has been in business for six years and stores about 30,000 samples; Geoffrey O’Neill, the vice president, says he recalls seven or eight samples being pulled for use. A CorCell customer service representative later estimated this at 25 to 30 samples.

Inside the Cord Blood America facility, quotes painted on the walls are the first thing to capture the visitors’ attention: “The entire history of science is a progression of exploded fallacies,” proclaims Ayn Rand on one wall. “Do or do not, there is no try,” says Yoda on another. On another wall, Micky Rooney offers some advice: “You always pass failure on the way to success.”

Photos: Jim Merithew/Wired.com Creative Commons licensed under BY-NC.


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