When I was six months pregnant, carrying my first child, I got a call from an executive from a stem cell bank, requesting a meeting. I had heard the words ‘stem cells’ buzzed around from time to time in my gynaecologist’s waiting room and even on online baby sites. Curiosity prompted me to consent. I received a sales pitch about the wonders of stem cells. How research in this field was making tremendous strides, and a day would come when you could inject stem cells into a diseased organ and expect a full recovery. The monologue appeared more like a screenplay of a science fiction movie, and less like proper medical information. It all sounded too good (flawless actually) to be true. So what is the reality about stem cell banking? Is it really worth the hype? And the high price tag that accompanies it?
Here is everything you need to know about stem cell banking before you decide to go for it or not.
#1 What are stem cells?
The human body needs cells to function. However, before each cell is assigned a specific job, they are stem cells. These blank or uncoded cells that have the potential to become specialised cells anywhere in the body be it in the brain, liver, heart or even your blood. They can help heal the body, as they can be used to replace damaged cells. Which is why medical research is extremely fixated on using them as a treatment for various diseases.
#2 Is the umbilical cord the only source of stem cells or are there others? Why haven’t we heard much about them?
Lately, cord blood has become the most advertised source of stem cells. However, since the 1990s, stem cells were taken from different tissues in the body, like bone marrow, skin or even the brain. The marrow cells have been used to treat diseases for over 40 years. What’s interesting here is that while stem cells were successfully used for treatment, the applications were limited. Stem cells taken from the bone marrow can only become blood cells, they can’t change to liver or skin cells.
Right now, even cord blood cells are mostly blood-forming cells, which is why they’ve been used to treat leukaemia patients. Scientists believe that they can eventually find ways to use cord blood cells to treat any part of the body. This is where all the hype concerning stem cells comes in: the possibility of future discoveries. Clinical trials are exploring the effects of cord blood therapy for serious ailments such as brain injury, autism and diabetes. No conclusive results have been shown as yet.
So why do we hear about cord blood cells more than donor stem cells? It’s purely because since there are no storage facilities required for donor-based stem cells, there aren’t any marketing or advertising campaigns surrounding it. It comes down to just this fact.
#3 Why does private stem cell banking cost so much?
Private banking of cord blood is a business. They offer you a service. This involves retrieving, storing and processing your umbilical cord blood in specially designed, temperature regulated storage facilities for a minimum of 2 decades. You also pay for ownership. The blood cells stored are your property and can’t be used by anyone else. All this adds up to a sizeable bill anywhere between Rs 20,000 to 70,000, depending on the private bank you choose, the storage duration and any discount or deal offered. Whether the high cost justifies the service provided is debatable, as the research surrounding stem cell treatment is still mostly theoretical, and it may take considerable time before we know if the investment made is worth the high price.
Public banking, on the other hand, free storage. You can donate your cord blood cells, and anyone can make use of it when required. You don’t have any control over the donated cells, but you can make a withdrawal if you need one.
#4 What problems can occur during blood collection?
An inexperienced nurse might collect less blood than needed. If this happens, banking the sample is pointless. Also, if the baby is born premature, the collection of blood might be insufficient. In a case of emergency, a doctor’s priority is a healthy mother and baby, not the blood collection and delayed clamping of the umbilical cord will hamper the cord blood collection.
#5 How do I know the stem cells will be viable later on? Can they expire?
Once your cord blood cells are extracted, the stem cells are processed and tested to check for viability. After that, they are slowly frozen to preserve the cells, until the temperature reaches -190 degrees. Then they are kept in a cryogenic state for decades. If they haven’t been accurately cryopreserved, the cells won’t be functional when thawed for treatment. The survival of the cells depend on a host of factors. The competence of the storage facility, whether nitrogen tanks were consistently maintained at a low temperature for cryopreservation and whether technicians have adequate skills to thaw the frozen cells correctly.
To ensure the conditions have been met, you can either request a site visit or trust the word of the private stem cell bank. As of now, cord blood cells have been cryogenically preserved for 30 years. Doctors aren’t really aware of how much longer they can be kept, as we don’t have any further data. But some researchers believe they can be preserved for a lifetime. Only time will tell.
#6 Does India have any regulations for stem cell banking?
The The Indian government has released a set of guidelines to curb false declarations and indiscriminate use of stem cells. The Indian Council of Medical Research has infact issued regulations that prohibit doctors from indulging in unauthorised and experimental usage of stem cells. However, there is no government guideline or law for storage. That is done at your risk.
#7 How can I know if my child or family will benefit from stem cell therapy?
It makes the most sense to bank cord stem cells if you have a relative suffering from a disease curable by stem cell therapy, or if you have a family history of a similar disease. While most private banks claim that over 80 diseases could be cured if you harvest cord blood, the reality isn’t quite there yet. Most treatments are still in clinical trials, and it will take ages before they are medically approved. So far, only blood-related disorders and autoimmune diseases have been successfully treated.
Also, the chances of your baby using his own stem cells are very low. In fact, some studies claim the stem cells could be tainted by a pre-existing genetic defect, rendering them ineffective. So banking them wouldn’t help anyone. But, there have been a few cases where children have been treated successfully through stem cells taken from their cord blood. It’s very hard to pinpoint whether or not you stand to gain. It’s a game of dice, at this point. Except, you won’t know if you’ve won or lost for quite a few years.
#8 Why is public banking preferred over private banks?
Think of public stem cell banks like blood banks. They are easily accessible to everyone, especially those in dire need. You also have a wide variety of cord blood units to tap into, from different races, gene pools, communities, etc. And it’s not a money-making business, so it’s clearly meant solely for medical purposes. Private banks, on the other hand, charge you a premium to reserve your samples. And if you never make a withdrawal, those cells are wasted.
Stem cell banking is like insurance. You hope your child will never have to use it, but you might feel secure knowing it’s there. Right now, there is no definite research or proof that stem cells are the key to future medical treatments, or that they are some kind of ‘miracle’ cure. While it’s true, that some medical cases have responded well to stem cell therapy, we need more numbers before we can be assured. Research does show us new things every day. And who knows? We might get closer to creating effective, regenerative medicine soon. But for right now, stem cell banking is still shrouded in mystery and controversy.
Note: Thank you to Dr Minal Nagvekar for your valuable inputs!