CordLife

What is cord blood?

Cord blood, also called “placental blood”, is blood that remains in the umbilical cord and placenta following birth and after the umbilical cord is cut. Cord blood is normally discarded with the placenta and umbilical cord.

During pregnancy, the umbilical cord functions as a lifeline between mother and child. The cord blood present in the cord could offer hope for the child or members of the family. The umbilical cord blood is a rich source of haematopoietic stem cells (HSCs), a proven resource for treatment of certain diseases.

Cord blood banking is now available to parents who wish to store their baby’s cord blood stem cells now for potential medical uses later.

The cord blood collection procedure is painless and risk-free to both mother and baby. It takes about 3 minutes and does not interfere with the birthing process in any way.

HSCs are primarily responsible for replenishing blood and regenerating the immune system. HSCs are also known as precursor cells, as they have the unique ability to differentiate into different types of cells found in blood, namely:

The current 80 diseases that have known treatments involving transplantation are listed here.. Not all diseases have been treated specifically with cord blood stem cells.

Some of the research currently being conducted using stem cells for treatment includes repair and regeneration.

Yes! Umbilical cord blood stem cells (UCBSC) have a number of clear advantages over stem cells collected later in life. Some include:

• Reduced ageing
All cells in the body undergo continuous ageing, which results in mutations, loss of plasticity and loss of proliferative capacity. UCBSC are the “youngest”, safely available stem cells collected as a by-product of another miracle – a live birth. As a result, they have been shown to be up to 10 times more potent, cell-for-cell, than adult bone marrow.

• Immunological naivety
One of the main complications of stem cell transplantation is Graft vs Host Disease (GvHD), where the cells of the donor (i.e Graft) attack the cells of the recipient (i.e Host). This occurs when there is some degree of incompatibility between the donor and the recipient. The cells in cord blood are less reactive than those from adult sources, and as a result cause less GvHD. This means greater safety when there is incompatibility, thus increasing the range of potential recipients.

• Ease of collection
Collecting cord blood is a quick, painless and easy procedure undertaken immediately after the delivery of a baby, and only after the baby has been moved from the birthing area. This process involves no risk to the mother or baby. Bone marrow, in contrast, requires an invasive operation under general anaesthesia to extract these needed bone marrow cells.

Immediate availability (A source of autologous cells)
In stem cell transplantation, the recipient’s immune system is destroyed by chemotherapy and radiotherapy before the transplant, to prevent rejection. The best source of compatible cells is your own, so having UCBSC stored will ensure a source of compatible cells for treatments in future. You also do not need to invest in a time consuming process of sourcing for an unrelated bone marrow supply.

A primary concern when using umbilical cord blood stem cells is the limited amount of blood and hence number of nucleated cells that can be collected. Typically 30 – 100ml of umbilical cord blood is collected from a single cord. The number of stem cells (measured as a proportion of nucleated cells harvested from a single cord may be adequate for only one therapeutic application regardless of how the cord blood is stored. A transplant clinician will determine the amount of stem (or nucleated) cell numbers required for transplant based on the weight of the recipient. While there have been successful reports of using umbilical cord blood stem cells with various transplantation regimens for larger-sized adults, on average, the amount of stem (or nucleated) cells from one cord would only be sufficient for a child, due to a smaller body mass.

To overcome this limitation, there is significant research being conducted on the expansion of stem cells outside the human body. Should this research be successful, it will be possible to multiply (or expand) the number of stem cells, while maintaining their unique properties. As such, with expansion technologies, multiple therapies will be possible from a single cord blood collection. Till then, doctors may need to combine several cord blood units to treat a single adult or child.

Since 1988, UCB stem cells have been used to treat an increasing number of diseases. Today, this numbers more than 80, including blood and metabolic disorders, immunodeficiency ailments and autoimmune diseases. For a full list of treatable diseases, click here.

When transplanted into a patient, the haematopoietic stem cells (HSCs) migrate to the bone marrow and produce new blood cells, boosting the immune system. With the rapid advances in technology, the number of diseases treated by stem cell therapies is expected to increase.

Advantages of storing UCB stem cells are:

A guaranteed match for autologous transplants (where the donor and recipient are the same individual)
A readily available supply of stored HSCs. This compares well to having to do a national or international search which is costly and time-consuming in an already time critical situation.
Lower risk of Graft vs. Host Disease for autologous transplants, a situation where the transplanted tissue attacks the patients own tissue.
Ease of collection, which is pain-free and risk-free to both mother and child.
UCB stem cells are more vigorous, have a higher rate of engraftment and are more tolerant to tissue mismatches, compared to other types of stem cells, e.g. bone marrow.
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Isn’t the use of stem cells only limited to leukaemia? If so, there isn’t a great need to bank privately ?.

There are 80 diseases that can be treated with the current use of haematopoetic stem
cells. The true potential of cord blood stem cells is only now being realised. Since 2000, scientists have shown that umbilical cord blood stem cells can give rise to many other types of cells in the body, including liver cells, nerve cells, lung cells, heart cells, bone, cartilage and many others, a phenomenon known as “stem cell plasticity”.

In the last few years, these amazing discoveries have started to lead to clinical applications in a wide range of diseases, including heart attacks and spinal cord injuries, and in the next few years we expect to see clinical trials in diseases ranging from cystic fibrosis to Alzheimers disease and diabetes.

Whether there is a great need for private banking is a purely personal decision, made by
expectant parents like you. Our duty is to provide accurate, factual and reliable
information to aid you in making that decision.

I heard I can use the cord blood sample multiple times – all I need is to split the sample up. Is this true?

We wish it was as simple as that – if this was true, you only need to store one family member’s cord blood for everyone’s use.

This misconception is perpetuated by marketing messages crafted by several banks. As evidenced by the 8,000 transplants using cord blood, none of them indicated a fraction of the total cell dose was used for treatment. All existing scientific papers on transplantation speak about how cell dose is a key, if not, the most vital element to ensure higher engraftment and survival rates. Cord blood has one limiting factor – the amount collected is limited, typically enough only for one therapeutic application and on average the amount of stem cells from one cord would only be sufficient for a child, due to a smaller body mass.

However, to overcome this, there is significant research conducted on the expansion of stem cells outside the human body. Should this research be successful, it will be possible to multiply (or expand) the number of stem cells, while maintaining their unique properties. As such, with expansion technologies, multiple therapies will be possible from a single cord blood collection.

From a scientific point of view, the chances of a cord blood sample having identical tissue type to a sibling (biological brother or sister) is around 25%. There is an additional 50% chance that the sample will be “haploidentical” (half identical or better) with a sibling, and 100% chance of the same level of compatibility with the parents. The odds decrease with more distant relatives.

One of the advantages of cord blood is that it can possibly be used even when there is only 50% compatibility, though the results are not quite as good, and the cord blood would only be used in a situation where there was no better match found elsewhere.

CordLife, in 2002, had a successful directed transplant. Ryan was saved, using Rachel, his younger sister’s cord blood. Rachel’s cord blood was collected, processed, tested and stored at CordLife’s Singapore facilities prior to the transplant.

Click here to read more about Ryan’s case.

Why are doctors turning to cord blood instead of bone marrow?

Easier to Match
It is more difficult for bone marrow match between the donor and recipient because a 100% perfect match is required. Compared to bone marrow, cord blood stem cells can be successfully used even when there is a 50% match because the cells are younger. This translates to more opportunity for transplants between family members when cord blood is stored.

Immediate availability
Banking cord blood stem cells ensures that these cells are readily available when you and your family need it most, allowing treatment to begin almost immediately, without time spent searching for a match. Early treatment of many illnesses can minimize disease progression.

Less graft vs host disease (GVHD)
Patients who receive cord blood transplants from a relative experience significantly less Graft vs. Host Disease (GVHD), a transplant rejection that is the leading cause of death in stem cell transplant patients.

How long can cord blood be stored?

Although cord blood banking industry is relatively new, and the first cord blood transplant (allogeneic, or non-self) was performed in 1988, the method of cryogenic storage is not new, and has been used to store bone marrow for over 40 years.

The current understanding of cryogenic storage indicates that materials (or tissue) stored under liquid nitrogen temperatures can be stored indefinitely¹. As cord blood banking is a relatively new field, not many studies specific to evaluating the long term storage of umbilical cord blood are available yet. In 2003, Broxmeyer et al reported that umbilical cord blood stem cells that have been stored for 15 years under cryogenic temperatures retained their ability to proliferate and engraft².

¹Guidelines for Collection, Process and Storage of Cord Blood Stem Cells; New York State Department of Health
²Broxmeyer et al, Proc Natl Acad Sci U.S.A, 2003, Jan 21; 100(2): 645-50

Am i depriving the public registry of a sample if i privately bank my baby’s cord blood?

Currently, only a small percentage of births internationally (especially in Asia and Australia) result in a public cord blood registry. Donor eligibility is also decreased tremendously, with maternal blood exposure to viruses, tattoos, and international travel. The limited cord blood supply in most public banks is largely due to a lack of public funding – not as a direct result of a private banking option.

However, we sincerely believe that no one should have to discard this precious resource, as someone can benefit from its healing potential. If you are considering banking, please do weigh the options and judge which suits you best. If you eventually do not wish to privately store your baby’s cord blood, please do donate it.

Why bother banking privately in the first place? Isn’t this a resource to be shared?

Private or public banking is a very personal choice, made after all available information is provided to expectant parents. Considering that the cause of most cancers is unknown and with the rapid inroads in the stem cell therapeutic arena, families may be able to benefit from private storage of their own stem cells. Based on current data, there are no expiration dates for newborn stem cells. If every mother knew about both private and public cord blood storage options, there would still be enough in public registries to ensure the resource is available for others.

• Family History
If there is a family history of a disease that is treatable using stem cells, such as leukaemia, cord blood banking may be a prudent choice. However, the causes of cancer are still unknown, and may surface in families who have no history of the disease.

• Ethnic or Mixed Ethnicity
Ethnic minorities or families with mixed heritage have greater difficulty finding suitable donors when needed. Moreover, some genetic diseases such as cystic fibrosis or thalassemia are more common in certain ethnic populations.

• In Vitro Pregnancies
Couples who have undergone fertility treatments with donated sperms or eggs may consider cord blood banking because this opportunity to secure a genetically related sample may not be available later.

• Peace of mind
With the potential of developing more applications for stem cells, some families consider this a form of ‘biological insurance’, saving a precious resource that they hope they will never need to use.

Isn’t banking one child’s cord blood enough? Do ineed to bank for my second child?

Just as each child is genetically unique, so are their cord blood stem cells. Parents may wish to consider ensuring an exact genetic match by collecting cord blood from each child. This also may increase the likelihood of finding a useful match between family members.

In identical twins, it is still important to save as many stem cells as possible, and it is recommended that cord blood be collected for each twin. In general, collection volume per baby is smaller, so collecting from both babies helps to have adequate stem cell yield for transplants if ever needed. In such cases, the cord blood is banked separately, even for identical twins. However, such pregnancies are considered “high risk”, and your obstetrician / certified midwife will always have the mother and babies as his/her top priority, and as a result, cord blood may not be collected.