I was sitting on the sterile operating table, about to receive my spinal injection before the c-section that would yield my oldest daughter, when the doctor sprung a loaded question on me – do you want to bank your baby’s umbilical cord blood? By “umbilical cord blood” or “cord blood”, they mean blood that resides in the umbilical cord just after delivery of the baby, and they collect it because it contains stem cells that could potentially be used in future stem cell therapies for the child. Suddenly, I ached for my computer so I could look up the benefits and the costs of cord blood banking, but I didn’t have any clothes let alone a computer to look it up on. I suddenly felt horribly unprepared because I had never heard of cord blood banking, let alone considered it. All I could think was “have I already overlooked a critical step for keeping my child healthy?”. How important is cord blood banking? How could it help my kid? And how expensive is it? Since I didn’t have time or the resources to do the research on that operating table, my answer to the doctor was “no”, and with the immediate need to learn how to keep a new helpless creature alive, I forgot the question entirely after that…until I got pregnant with my second. This time, I vowed that I would go in armed with the necessary knowledge to make an informed decision. Except I didn’t. I got so immersed in searching for the best car seat and watching my baby grow through what was frankly a tumultuous pregnancy, that I once again forgot about cord blood banking. I was asked earlier the second time around, during hospital intake, but I still didn’t have a good answer, and ultimately did not bank her cord blood either. But while I was researching a related blog post on banking baby teeth for stem cells, I decided that it was about time to see what (if anything) I missed by not banking the cord blood for my girls. Hopefully this research can help one of you expectant mothers out there so you can make an informed decision when the doc pops the question. But first…
What exactly ARE stem cells?
We all start out as just two cells – a sperm and an egg. These two cells join together to form a single complete cell that then divides again and again until we start to resemble a functional being. But given that these first cells are just copies of the same, how to they end up making different structures, like skin, bone, stomach, and brain? It turns out that some of these cells develop the potential to form any of many different types of cells in our bodies, and exposure to signals outside of them triggers those cells to become the different cell types (and ultimately structures) that are needed in the different parts of the growing embryo.
Embryonic stem cells are truly pluripotent, which means that they can differentiate into virtually any cell type there is. Many current therapies out there use cells collected from embryos that were part of in vitro fertilization attempts and were donated by the parents. These cells are the best to use for stem cell therapies because they divide easily and can differentiate into so many different tissue types. Once a baby is born, there are no more embryonic stem cells because they have all differentiated into the structures that formed the parts of your baby. But in the 1950s, scientists discovered that there are also adult stem cells, which are stem cells that can be found in multiple locations throughout our adult bodies, and can differentiate into a variety of cell types. Adult stem cells are not able to turn into all cell types in the body, but there are different types of adult stem cells with different capacities to turn into different cell types. Some stem cells collected from the bone marrow, for example, have the ability to turn into blood cells (called hematopoietic stem cells), while a much smaller population of cells also collected from the bone marrow (called mesenchymal stem cells) can turn into bone, cartilage, and fat.
Umbilical cord blood is a good source of high quality stem cells!
In 1974, a scientist name Søren Knudtzon noticed that blood from the umbilical cord had the capability to form colonies of cells, indicating that these cells could form more of themselves. This was exciting, because blood from adults has very little ability to do that, since the cells in the blood are already too mature and fated simply to do their jobs in circulation. In the 1980’s multiple teams of scientists showed that these cells from the umbilical cord couldn’t just divide, they could also differentiate into multiple different types of cells and tissues. Then, in 1988, scientists used these cells to treat a disease in a human child for the first time. The child had Fanconi anemia, which is an inherited disease where the body can’t produce enough blood cells. When his sister was born, the doctors collected blood from her umbilical cord and then transfused it directly into his body. The cells formed a grafted population in his body that could produce the needed blood cells, and as of 2016, the patient was a healthy 27-year old.
Blood from the umbilical cord is actually a better source of stem cells than the bone marrow because it contains a set of cells that are intermediate between embryonic cells and bone marrow cells in their development. More of the cells in cord blood have the capacity to differentiate into a variety of different tissues than cells collected from bone marrow. The cells from cord blood are also better at replicating, producing more of the same beneficial cells. And finally, the blood from the umbilical cord contains immune cells that are very immature, which means that they aren’t as reactive in the recipient’s body, so there is less chance of rejection than there is with bone marrow-derived cells.
Wow, this sounds perfect, right?
Well nothing is perfect. There are certainly challenges associated with using cord blood stem cells, mostly due to the fact that umbilical cords are quite small and there isn’t all that much blood there. So while bone marrow has a lower concentration of the stem cell type that you may need for a successful transplant, you can and infuse a lot more of it to make sure you transfer enough of those stem cells. Cord blood has a higher concentration of cells, but it is often difficult to get enough of it to perform a successful transplant. Researchers are working on ways to make these transplants more effective. One way is to perform a double-transfer, where cord blood from two different donors is used to make sure there are enough cells for the transplant to be successful. The second is to inject the blood directly where it needs to go in the body to improve the localization of the stem cells.
Despite these challenges, cord blood IS being used for successful human therapies!
Umbilical cord blood has now been tested for use in many different kinds of disorders, ranging from blood disorders to neurological disorders, and even to cancer! For example, one study tested the effects of umbilical cord blood infusion in 96 cerebral palsy patients, and resulted in higher mental and motor scores in these patients. In another case, a child came to the hospital with a major heart attack that results in brain damage. As a result, he suffered from blindness, quadriplegia, and a variety of other symptoms. Treatment with umbilical cord blood improved his motor skills such that he could then walk with the help of a support and recovered his eyesight as well! Umbilical stem cells have also been used to treat atopic dermatitis (which causes exzema), gingival recession, which is a genetic gum disorder, and completely eliminated the symptoms of lupus after 8 months of treatment in a 26-year old patient! The effects of cord blood on cancer are equally promising. In one case study, two children were successfully treated for acute myeloid leukemia, and studies have shown that it is effective for other types of leukemia as well. What’s more, work in both animals and humans shows that cell from umbilical cord blood can be used to combat cancers other than leukemia as well!
Cord Blood Banking – What are the options?
There are two options for cord blood banking. The first is a public bank called the New York Blood Center, and it is funded by the National Institutes of Health. This means that banking the blood is free to you, but the blood is donated anonymously and is then distributed to transplant centers around the country. This makes the blood available to the general public. Really? No cost? Yes! There is no cost to you for this! This means that if you don’t want to keep the blood for use by your family, you can tell your doctor that you want to donate it for other families in need. I am really wishing that I knew to do this back when I was delivering my two girls, because someone could have quite possibly benefited from their blood. As is, the blood just went to waste.
The second option is to bank the blood privately, which means it is not released to the public and is available only to your family. Unfortunately, this does come with a pretty hefty cost. The cost of private banking in the US ranges from $2,000-$5,000 for 20 years of storage. A detailed study of the cost effectiveness of this practice deduced that this is not cost-effective, because the authors calculated that your child only has a 1 in 2,500 chance of getting a disease for which there is an applicable stem cell therapy. It becomes cost-effective if your child or a member of the family already has a disease for which the stem cells may be used, or if the cost eventually drops down to about $200 for 20 years of storage. Note, though, that if the disease is an inherited one, your child will not likely be able to use his/her own stem cells from umbilical cord blood, because those cells would also contain the same genetic defect.
Below are the costs of some of the major private cord banking facilities as of September 2019. Miracle Cord seems to be a particularly good option with the lowest initial fee, the lowest monthly costs, and even a 70-year lifetime policy! Cord blood registry also offers a “lifetime” policy, but it is only for 35 years, and I certainly hope our children live longer than that! Note that when finding these prices, I just included basic cord blood banking. You can also get premium options, and you can also bank cord tissue as well.
Should I bank blood and tissue or just blood?
Like the blood from the umbilical cord, the umbilical cord tissue that houses the blood also contains stem cells. Below is a diagram of the portions of the umbilical cord that contain stem cells. We do now know that these parts, especially Wharton’s jelly, have the potential to provide stem cells that could be very useful for disease therapies. However, while the freeze-thaw protocols have been well-developed for blood samples, similar protocols for tissue have not yet been well-tested. As a result, while you may bank these tissue samples, there is no guarantee that the cell in those tissue pieces will be useable when they are thawed. So, banking of umbilical cord tissue is not likely worth it at this point.
What is the take-home?
Stem cell therapies that use umbilical cord blood are very exciting, and there has also been clear demonstration that these cells can help to cure a variety of diseases in humans. However, given the low likelihood that a child or member of your family might need these cells for a disease that already has a stem cell therapy designed, it is not really cost-effective to use private storage. Because the NIH has generated the public storage center, you would likely have access to stem cells from cord blood, and stem cell treatments for more and more diseases are being covered by insurance. Collection of stem cells from the umbilical cord for deposition in the public database is painless and free to you, the patient. I wish I had looked that up, because I certainly would have requested to store mine for anyone out there who might need them!
Contributing References
Jensen, A., & Hamelmann, E. (2013). First autologous cell therapy of cerebral palsy caused by hypoxic-ischemic brain damage in a child after cardiac arrest—individual treatment with cord blood. Case Reports in Transplantation, 2013.
Jawdat, D. (2016). Banking of human umbilical cord blood stem cells and their clinical applications. In Recent Advances in Stem Cells (pp. 159-177). Humana Press, Cham.
Kaimal, A. J., Smith, C. C., Laros Jr, R. K., Caughey, A. B., & Cheng, Y. W. (2009). Cost-effectiveness of private umbilical cord blood banking. Obstetrics & Gynecology, 114(4), 848-855.
Blundell, R., & Azzopardi, J. I. (2018). Umbilical Cord Stem Cells. Stem Cell Discovery, 8(1), 720-726.
Barker, J. N., & Wagner, J. E. (2003). Umbilical-cord blood transplantation for the treatment of cancer. Nature Reviews Cancer, 3(7), 526.
Zumwalde, N. A., & Gumperz, J. E. (2018). Modeling human antitumor responses in vivo using umbilical cord blood-engrafted mice. Frontiers in immunology, 9, 54.
Balassa, K., & Rocha, V. (2018). Anticancer cellular immunotherapies derived from umbilical cord blood. Expert opinion on biological therapy, 18(2), 121-134.
