Introduction
Cell Therapy: Give a Second Life
Saving the Placenta/Cord Blood
How Is Placenta/Blood Cord Collected?
Is Placenta/Cord Collection and Storage Covered by Insurance?
Who’s Who of Placenta/Cord Blood Storage and Transplant
The Safety of Storing Placenta/Cord Blood
The Future of Using Placenta/Cord Blood
The gift of life has been celebrated for centuries and with many customs. I recall from my position as a Medical Registrar in Obstetrics and Gynecology in Africa 20 years ago that women of different cultures and ethnicity had their own way to deliver babies. In our hospital in Ndola, Zambia, we had 35 deliveries a night. Some of the mothers were Whites, some were East Indians, and most were Africans.
The White mothers were quite reserved with their screams and pain, and they took a long time to deliver. The East Indian women were very verbal and required the presence of many members of their family around them in the delivery ward. Most of the African women delivered quickly and easily, sometimes insisting on delivering in a squatting position. While I had had some experience in European OB-GYN, the number of deliveries in Ndola gave me a unique experience. I witnessed and shared the pain and happiness of the new mothers, and was also confronted by unusual events.
I heard stories of mothers biting their own umbilical cords to separate from their newborn when they delivered in the bush and were far from medical assistance. In the Ndola hospital, I witnessed some unusual uses of the placenta. One of our colleagues from the dermatology unit used to collect the fresh placenta, which he would then apply to chronic leg ulcers of his elderly patients. The technique gave excellent results and was very inexpensive. He was never sued, as there was no acknowledgement on his part of the risk of cross-infection, but additionally, there was no hospital board and very few lawyers in Ndola.
In the West, obstetrics have been revolutionized by technology and monitoring, including epidural anesthesia. Mothers deliver with less pain and fewer complications. However, a new revolution is taking place in obstetrics, the possibility for parents to give life a second time to their child.
Cell Therapy: Give a Second Life
Health
Cell therapy is the transplantation of living cells in the treatment of medical disorders. Cell therapy started many years ago by blood transfusion. More recently cell therapies have expanded to include bone marrow transplants. In this procedure, stem cells (seed cells, the precursor cells) are transplanted into patients whose immune systems have been destroyed, for example, by aggressive chemotherapy used to treat a cancer. Therapy with blood cells of the placenta/cord has been used for 11 years and seems to have a bright future.
Some parents have the placenta/cord blood of their newborn collected and stored for future use. This blood contains stem cells and seed cells, which can be used to treat many hematological diseases, cancer, and genetic diseases.
The use of stem cells from the cord in the treatment of diseases was first described in 1989 by a French physician, Eliane Gluckman, who successfully used the placenta/cord blood in a patient suffering from Fanconi anemia (a recessive genetic disorder that affects the bone marrow of the bone marrow). The use of placenta/cord blood has many advantages as the newborn’s immune system is immature and, therefore, less prone to create a reaction between the donor and the receiver of a transplant. It is considered a valuable alternative to bone marrow transplant since bone marrow transplants are hard to find, difficult to collect, subject to infectious contamination, and a more expensive procedure.
The use of placenta/cord blood from a sibling with the same tissue type results in far fewer cases of both chronic and acute graft disease compared with the use of bone marrow from a sibling with the same tissue type.
One of the challenges of using stem cells or any organs from a donor is that the tissues need to be closely matched as any foreign substance introduced in an organism can be rejected. In some cases, the stem cells or some of the immune system components of an organ can attack the recipient. Such a reaction is known as the graft versus host disease (GVHD), a condition that can kill 20 to 40 percent of the recipients.
Many matches are sought within the direct family, such as siblings. Stem cells from the placenta/cord blood induce less frequent and less severe GVHD. About 2,000 patients have received placenta/cord blood transplants worldwide since the original work of Dr. Gluckman. Some of the patients transplanted by placenta/cord blood were suffering from a malignant disease such as acute leukemia (AL), chronic myeloid leukemia (CML), myelodysplastic syndrome (MDS), neuroblastoma, and non-Hodgkin lymphoma (NHL). Sufferers of non-malignant disease, such as aplastic anemia (AA), hemoglobinopathies, and genetic anomalies, have also benefited from the transplant.
The placenta/cord blood contains 10 to 20 times more stem cells than bone marrow cells.
There are very few reasons for a physician not to suggest the procedure to a patient or for a patient not to consider donating or keeping the cord blood of his or her own child.
What can a physician explain to a mother of a child suffering from leukemia? “Your child might have benefited from his own cord blood stem cells, but I forgot to mention it to you six years ago when you delivered.”
The procedure is done after the delivery and does not interfere with the well-being of the newborn or of the mother. It consists of a collection by a syringe or a bag. Many people choose to be organ donors. Why not use and recycle placenta/cord blood? We have discarded for many years a very unique and important organ, which maintains life for nine months in utero.
How Is Placenta/Blood Cord Collected?
Seventy to 140 milliliters of placenta/blood cord is collected after the birth in sterile conditions. The donating mother needs to give an informed consent. She is screened for infectious diseases such as HIV, (human T lymphotropic virus) HTLV, Hepatitis A, B, and C, and Cytomegalovirus (CMV, which is another virus that causes a variety of illnesses, especially in immunocompromised people).
The blood is tagged and catalogued and then forwarded by courier to placenta/cord banks. The blood needs to be frozen within 24 hours of the collection at -238o F.
Some placenta/cord blood banks freeze the sample whole while others process it; the processing isolates the stem cells from the red blood cells and plasma. Some banks, mainly in Europe, do not identify the donor and match donors and recipients in an anonymous manner by tissue-typing HLA. (Human Leukocyte Antigen: a system of identification of individuals. Transplants benefit from a close matching of the HLA of the donor and of the recipient.)
Is Placenta/Cord Collection and Storage Covered by Insurance?
The four major kinds of health insurance plans: private insurance, self-insured plans, health maintenance organizations (HMO), and government programs do not at this time cover placenta/cord collection and storage.
However, due to the high cost of bone marrow transplantation and tissue matching, insurance companies will have to decide whether to cover bone marrow transplants. A copayment of $100 to $200 for placenta/cord blood storage would limit the overall cost. For example, a patient using his own stem cells will not require extensive tissue matching, which is an expensive process. There are 3.5 million bone marrow donors in the world, but more than 50 percent of the recipients do not find the matching HLA donor.
Many health plans require preapproval and have a lifetime benefit per member regarding transplantation. It is important to discuss policies with insurance companies.
While insurance companies may be reluctant to pay for collection and storage, it will be difficult for insurance companies to justify not reimbursing the expenses of collection and storage if a child later requires his or her own stem cells of the placenta/cord blood.
Many parents have decided that the 14 to 50 cents a day expense for storage is part of their parental responsibilities.
Who’s Who of Placenta/Cord Blood Storage and Transplant
Several years ago the U.S. company Biocyte was granted a patent for “Hematopoietic stem and progenitor cells of neonatal and fetal blood, that are cryopreserved, and the therapeutic uses of such cells.”
The patent was successfully challenged in the USA and Europe by companies and individuals, who demonstrated that the patent “lacked novelty or an inventive step,” an important step against the limitation of human tissues transplant.
The leader in placenta/cord blood in Europe is Eurocord, headquartered at the Hospital St. Louis in Paris. Dr. Gluckmann is the chairwoman, with 14 research teams. Eurocord is associated with several centers all over Europe and is linked to Netcord, a communication system between bone marrow transplant centers and placenta/cord blood centers. Eurocord stored stem cells are anonymous and the typing is made by matching the recipient with the donor using markers of the immune system called the HLA typing.
In the USA and Canada several private and public companies are assisting physicians and parents in placenta/cord blood collection and storage such as California Cryobank, Cells for Life, CorCell, Cord Blood Registry, Cryobank for Oncologic and Reproductive Donors, Cryobanks International, Cryo-Cell (CCEL), Lifebank Cryogenic, Lifebank USA, LIFECord, Newborn Blood Banking, New England Cord Blood Bank, and Viacord.
Collection fees range from $275 to $1,500 with annual storage fees ranging from $50 to $100.
Some of the companies store only the placenta/cord blood of one’s own child in order to diminish the cost of HLA typing.
Efforts are made all over the world in standard regulation of the collection and storage of the specimens; specimen can be cryopreserved for more than 15 years in most of the facilities.
The Safety of Storing Placenta/Cord Blood
Parents and physicians have a choice in facilities and the following considerations are important:.
- How long has the bank been operating?
- Are they regulated or self-regulated?
- Are they licensed?
- Do they have educational support?
- Are the samples well coded?
- What freezing process do they use?
The Future of Using Placenta/Cord Blood
One interesting question, if new indications for placenta/cord blood are discovered every year, what will be the indications when your child is ten? Will the blood be indicated for many more diseases? Research is ongoing in that direction.
According to NIH, “such research promises new treatments and possible cures for many debilitating diseases and injuries, including Parkinson's disease, diabetes, heart disease, multiple sclerosis, burns, and spinal cord injuries. The NIH has developed the Guidelines for stem cell research in a careful and deliberate way to assure that the ethical, legal, and social issues relevant to human pluripotent stem cell research are addressed prior to NIH funding of that research.”
Another question is whether the two million CD34+ cells (average count from a placenta/cord blood specimen) will be sufficient to treat the conditions. The company Aastrom Biosciences (ASTM) has developed a system called Replicell, which allows cells to be replicated in vitro. Therefore, the stem cells of a newborn could be the precursor of many more cells and an endless source of tissue material. From a small volume of starting material Replicell expands the material in large quantities. Some of the stem cells can produce different cell types by the processing of the cells with different reagents, growth medium, and cytokines.
The use of Replicell provided a better 100-day survival in patients receiving cells augmented by the process compared to unaugmented placenta/cord blood transplants in patients with leukemia.
The future of stem cell therapy is bright in medicine. For future children it would be brighter if parents, physicians, midwives, health educators, and insurance providers plan for increased placenta/cord collection and storage. They will be ready to give life (if needed) more than once.
