If you’re planning to have a baby soon or ever wondering about what “stem cell business” means and how they can make money, you may have come across “cord blood banking business“.
I was not able to miss a great discussion based on an excellent review of Michael Sullivan – Banking on cord blood stem cells, published in Nature Review Cancer. I have inserted a lot of citations below to get you to the point of this discussion.
The altruistic gifting of umbilical cord blood stem cells from one’s newborn child for the benefit an anonymous individual anywhere across the world is a remarkably generous gesture. These unrelated cord blood donations are stored and curated by an international network
of 36 public non-profit umbilical cord blood banks in 23 countries, and made available to accredited stem cell transplant centers for the treatment of life-threatening diseases, including cancer, bone marrow failure syndromes and genetic metabolic disorders.
Private (or family) cord blood banks offer a service to store a newborn child’s umbilical cord blood for possible autologous or related (family) allogeneic stem cell therapy. Development of private cord blood banking has always been under discussion. Many experts indicated pros and cons of this type of “stem cell business”.
I’m going to cite rationales against private cord blood banking, indicated in Michael Sullivan’s review (.pdf):
European commission’s Group on ethics in Science and new Technologies (eGe)
report on the ethics of private umbilical cord banking:
“The legitimacy of commercial cord blood banks for autologous use should be questioned as they sell a service, which has presently, no real use regarding therapeutic options. Thus they promise more than they can deliver. The activities of such banks raise serious ethical criticisms.”
American academy of Pediatrics:
“Cord blood donation should be discouraged when cord blood stored in a bank is to be directed for later personal or family use, because most conditions that might be helped by cord blood stem cells already exist in the infant’s cord blood (ie, premalignant changes in stem cells). Physicians should be aware of the unsubstantiated claims of private cord blood banks that promise to insure infants or family members against serious illnesses in the future by use of the stem cells contained in cord blood”.
“Given the difficulty of making an accurate estimate of the need for autologous transplantation and the ready availability of allogeneic transplantation, private storage of cord blood, as biological insurance, is unwise.”
Royal college of obstetricians and Gynaecologists (rcoG)
“The RCOG strongly supports the concept of a NHS Cord Blood Bank for allogeneic storage of donated cord blood and would like to see it well funded. However, it remains unconvinced of the benefit of personal commercial banking for low-risk families.”
World Marrow Donor Association: Policy Statement for the Utility of autologous or Family cord Blood Unit Storage (see Url in further information)
“Today the likelihood that an autologous cord blood unit will be used for transplantation is very low. There is currently no clear proof that these cells will be able to be used for regenerative medicine or to treat other diseases in the future.”
“The legitimacy of commercial cord blood banks for autologous use should be questioned as they sell a service which has presently no real use regarding therapeutic options. Thus they promise more than they can deliver.”
Dr. Nietfeld in his commentary (.pdf) argued Dr. Sullivan, indicating that most negative opinions (came from respected organizations) about autologous cord blood banking are based on incorrect calculation for a probability of the future use, and data need to be updated.
First, that the probability of undergoing an HSCT is much higher than others believed
1:200 according Dr. Nietfeld calculation
Second, that the quality of CB cells has been maintained over a 15‑year period of cryogenic storage and that in cryobiology there are no reasons why this would not also be the case for a lifetime.
Third, that stem cell expansion technology could solve the problem of there being too few cells in a CB unit.
Fourth, that research and clinical trials in areas such as neurological disorders (NCT00593242) and diabetes (NCT00305344) show the developments in the direction of autologous CB treatments for diseases that have a much higher incidence than those requiring haematopoietic reconstitution.
Fifth, the number of children who have received autologous CB treatment is more than 60 to date.
Dr. Sullivan replied (.pdf) that, Nietfeld’s calculation included some children’s tumors, which could be treated by autologous cord blood transplantation as an alternative only and clinical trials are still in progress.
The prospect of stem cell therapy is tantalizingly close, although reviewing the publicity material on many commercial cord blood bank websites would give the lay public the impression that stem cell therapy for regenerative medicine is already in routine clinical use – it is not!
and something about business:
A recent survey of US commercial cord blood banks by the American Society for Blood and Marrow Transplantation reported a total of 490,000 privately banked cord blood units. At an average of US$2,000 to collect and store a cord blood unit for 20 years, the US health consumer has invested nearly US$1 billion, resulting in the treatment of just 17 patients with malignancy or marrow failure and with no peer‑reviewed published clinical outcome data.
David Harris in his commentary (.pdf) – Cord blood stem cells: worth the investment also argues against Dr. Sullivan’s point:
The overall premise of Sullivan’s commentary is that commercial cord blood banks currently offer a “superfluous service“. I do not understand how one can make that claim when solid scientific evidence supports the benefits of using related allogeneic cord blood over an unrelated source.
So it seems that discussion between the experts will never finish. Alternatively, hybrid private-public banking model for CB storage has been proposed (.pdf).
In its 2008 annual meeting, the WMDA established an ad hoc ethics subcommittee to determine the combination of private and public CB banking and to consider types of CB banking models, based on patient priority, conditional donation and CB unit sharing.
I’d agree with this innovative model (if we forget the business issue), as far as patients will benefit from it more.
What do you think?
Wiki: Cord blood bank (especially read: Controversy Among Medical societies)
picture credit: TEK IMAGE / SCIENCE PHOTO LIBRARY