If the recommendations in 1999 by the American Academy of Pediatrics were strongly in favour of public cord blood banking, the new set of guidelines that the Academy published recently in the journal Pediatrics is no different.
In India, cord blood banking has been more of private than public banking. Private cord blood banking is based on the fact that banked sample will be made available to the same child or its family members when the need arises.
With the potential of treating many conditions and disorders, banking cord blood even if expensive, is been projected as a sensible option by the companies. They call it a form of `biological insurance.’
But the inability to treat malignancies and the less possibility of actual use at a later date by individuals who had donated the cord blood were some of the main reasons for the Academy to strongly discourage private cord blood banking and instead support the cause of public banking in 1999.
Medicine, as it is currently practiced, does not permit using cord blood of a child who has developed certain malignancies. This is because the stem cells in the cord blood are already preconditioned to become malignant when transplanted to the same individual or others.
The inability to make headway in using such preconditioned stem cells as well as other issues in the last eight years has been promptly reflected in the Academy’s latest recommendations.That is not to say that no research is taking place to make even such preconditioned stem cells usable. It clearly makes a mention that gene-therapy research is trying to address this issue. ” … Although experimental at the present time, [gene-therapy] may prove to be of value,” it notes.
While in 1999 the Academy had only a few years to assess the rate of use by individuals who had banked their cord blood in private banks for use at a later stage when the need arose, it has now had eight more years to draw a more studied assessment of actual self-use by individuals.
The latest recommendations do not help the cause of private cord blood banking. The possibility of self-use, which was put at 1 in 1000 to 1 in 2,00,000 in 1999 has remained the same this time as well. Though the range is very wide, the lack of scientific data to support the possibility of self-use in a larger number of disorders cannot be disputed.
All this is not to negate the real potential of cord blood stem cells harvested at the time of birth of the baby and which would otherwise be discarded as waste.
The recommendation clearly states that cord blood stem cells can be used to treat malignancies, bone marrow failure, haemoglobinopathies, immununodefiencies and inborn errors of metabolism. As in 1999, the Academy has made a strong case for storing cord blood in private banks when one of the older siblings is suffering from a medical condition, whether malignant or genetic, for which cord blood can be used for treatment.
In India, dedicated public cord banks are yet to become a reality. Instead, companies or entities run both private and public cord blood banks. The Chennai based LifeCell that started a private bank in 2004 is now planning to start a public bank. According to Mr. S. Abhaya Kumar, Vice Chairman of the company, a public cord blood bank should be in place by April this year. The company will be involved in research using cord blood stem cells banked in their public bank.
“We will be using 10 per cent of samples for research and the remaining 90 per cent will be provided to the public for treatment,” he said. The Academy has not touched upon the issue of what proportion of samples stored in public banks should be used for treatment and what proportion for research.
It becomes all the more tricky when the entity that runs a public bank is actively involved in research.That brings us to the core issue of having an institutional review body that draws up the stipulations and makes sure that they are followed.