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Cord Blood: Biological Insurance
|by Usha Raman|
"The miracle is not just your baby. It's what comes attached." The large vinyl hoarding is hard to miss as one drives through the glass-and-concrete-tower-lined western pocket of 'Cyberabad' known as Hi-Tech City. This part of the city is populated by young techies and their young families, couples just about to embark on parenthood, a sub-section of the population that lives by and with high technology.
The high-tech advertised on the hoarding refers to an exciting area of medicine that has fascinated biologists and biotechnologists for a couple of decades now - regenerative medicine. Specifically, it sells the idea of cord blood banking - harvesting and storing the blood that is retained in the umbilical cord after the birth of a baby. "This blood is rich in haemopoetic stem cells - proliferative cells that have the capacity to develop into blood cells," explains Dr Geeta Vemuganti, a scientist who works in the stem cell laboratory at L V Prasad Eye Institute, Hyderabad. "There are also indications that these cells may have the capacity to develop into other kinds of lineages, such as nerve cells or cardiac tissue."
So what does all this have to do with prospective parents? Known sources of stem cells are adult bone marrow, peripheral blood to some extent, embryos and umbilical cord blood. The use of human embryos for therapeutic or research purposes is fraught with ethical and legal problems. The availability of adult bone marrow is dependent on voluntary donations and the possibilities of tissue matching are very low. Besides, it has been found that cord blood is some 10 times richer than bone marrow in its proportion of haemopoetic stem cells. Such cells have primarily been used to treat blood disorders, such as some forms of leukaemia, thalassemia and other blood malignancies.
Cord blood is harvested immediately after the child is born. The blood that remains in the umbilical cord before the placenta is discarded is harvested and immediately transported to a storage facility, where it is stored in liquid nitrogen at below -186 degrees Celsius. This can be used in case the child - or a sibling or other family member - develops a condition that requires stem cell therapy.
Research indicates that these cells remain viable in storage for up to 18 years, and some suggest, even 21 years.
"When a couple decides to bank the cord blood at the time of childbirth, they are in a way taking biological insurance for their child," says K P Rajendra, Centre Head, LifeCell, one of the first private cord blood banking companies in the country. The advertising and other promotional measures have certainly caught the imagination of young couples in Hyderabad.
"We have about 30 prospective mothers registering with us every month in Hyderabad alone," he says. This 'biological insurance' costs couples close to Rs.60,000, with LifeCell now offering a variety of part-payment options.
Farha Raju is one of the young mothers who decided to go in for the service. "My parents had heard about it, and it seemed like it was not that much to pay for something that might be useful in the future," she says. Raju and her family asked her obstetrician about it, and she referred them to LifeCell. The one concern Raju had was the quality of storage and processing, "since we had read that these were crucial to the viability of the cells." Once she was convinced on this count, there was no looking back.
However, the aggressive marketing is something that clients as well as the medical community are not entirely comfortable with. "Their representatives would call us at all hours; it was quite a hard sell," says Raju.
The literature too is more promotional than scientific, often quite emotional, suggesting that cord blood could provide more solutions than is actually borne out by research. "Much stem cell research is in the pre-clinical stage," says Vemuganti. While cord blood has been successfully used to treat blood malignancies, it has yet to be used to regenerate other organs.
"Besides, the chances of a person actually needing to use it are extremely low," notes Dr Evita Fernandez, a gynecologist with a successful practice in Hyderabad. Thirty of her patients have gone in for cord blood banking in the past nine months. It is estimated that an individual's chances of using personal cord blood for blood disorders before the age of 20 - the limit of the cells' viability - is very low; around 1 in 2,700. "What they are offering is a promise - and a promise is just that," quips Vemuganti.
Transparency in processes and procedures is another issue that concerns the medical community. "After the few bad experiences we've had with in-vitro fertilization, where we've heard rumors of semen samples being switched and so on, practitioners tend to be wary of private companies that sell such technologies," says Fernandez.Dr K Gayathri, a haemotologist with a special interest in inherited blood disorders, agrees.
"Everyone is a bit wary of private ventures." She feels that there tends to be a lack of transparency in the industry in general, and while this may not relate specifically to cord blood banking, there is a definite lack of comfort with such activities, "because of the history in our country, especially". This general lack of trust, combined with a low level of awareness about new technologies, leads to a situation where few medical practitioners champion these new services. "There's such a resource crunch in general; most doctors are fighting even for basic amenities in their nursing homes. They don't really want to spend time learning about new areas - and stem cell therapy is kind of esoteric," says Gayathri.
As a result, companies like LifeCell spend considerable resources and time convincing medical practitioners to refer patients. Some doctors, however, feel there is a thin line between 'educating' the medical fraternity and 'persuading' them through means such as fees for referrals. While most do not have a quarrel with the technology itself, they do worry about the cost and the ultimate benefit to the patient.
A scientific advisory paper published by the London-based Royal College of Obstetricians and Gynecologists notes that while cord blood banking offers definite advantages, compared to say bone marrow, in terms of availability, tissue matching, lower rates of transmitted infections and other graft-related problems. It says, however, that the debate should shift to the need for public rather than for-profit or private cord blood banking.
In Europe, professional bodies actively discourage private banking and instead recommend publicly funded cord blood banks that collect voluntary donations.
"Cord blood is such an easily available resource, and most mothers would have no issues with donating something that is otherwise discarded," says Gayathri.
With the low likelihood of a donor requiring the blood for personal use - and the relative ease of finding matches for those who do require stem cell therapy - it makes sense for cord blood to become a community resource, much like bone marrow registries in the US and Europe, which are available to anyone in the world. "It could be like a blood bank - no one pays for the blood; it is a common resource," says Vemuganti. She also feels that the availability of a voluntary, community bank would encourage more research into the actual potential of cord blood stem cells - thus taking us beyond a mere promise.
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