There have unfortunately been a number of radio adverts implying that by banking your child’s stem cells, future “diseases (will be) eliminated (and) conditions cured” with specific references made to diabetes and autism. These statements are misleading and irresponsible.
The benefits of using cord blood stem cells to treat a number of blood related diseases is well-established and whilst stem cell technology shows much promise in the treatment of a number of other diseases, there is still a lot of scientific progress required in making the treatment as well as the curing of diseases a reality, if at all.
Netcells distances itself from these misleading and unsubstantiated claims, that purport to offer false hope to new parents. Parents are encouraged to fully investigate the advantages of banking their baby’s stem cells, and distinguish this from inappropriate hype. Please chat to us and we’d be delighted to explain the evidence-based truths.
The collection and storage of cord blood and cord tissue taken from the umbilical cord of a baby at birth is becoming increasingly common.
Cells contained in the blood and tissue, have potential therapeutic value in the treatment of blood disorders, immune diseases and the emerging field of regenerative medicine.
Stem Cells are the cells that make up the embryo and are the original building blocks of life. Stem cells develop into various cell types in the body such as: skin, blood cells, muscle, bone, nerves and cartilage.
After birth, stem cells are found all over our bodies and they serve to repair and maintain our body cells throughout our lives. Stem cells are abundant in the umbilical cord blood and tissue and can easily be collected at the birth of the baby (less invasive than harvesting them later in life). They are normally discarded as medical waste, making their collection free of moral, ethical and religious concerns.
Cord blood is rich in haematopoietic (blood forming) stem cells that are used to treat over 80 blood related diseases. Cord blood is a valuable source of stem cells for a bone marrow transplant and can be used to replace diseased cells with healthy new cells, and rebuild an individual’s blood and immune system.
Cord blood is collected immediately after the birth of your baby by your obstetrician or midwife. The umbilical cord is cut and clamped, a needle is inserted into the umbilical vein and blood is collected into a sterile collection bag. Cord blood collection is quick, safe and painless for both mother and baby.
Approximately 100-150ml of blood needs to be collected for successful storage.
Cord tissue contains mesenchymal stem cells (MSCs) which are stem cells that give rise to the connective tissues of the body i.e. skin, muscle, bone, cartilage, nerve and fat.
MSCs are being employed in research environments for a wide variety of aesthetic and medical conditions.
Cord tissue is collected after the cord blood has been collected and the placenta has been delivered.
A 10-15cm piece of umbilical cord is cut, cleaned and placed in a sterile collection tube.
Diseases treated with cord blood and/or cord tissue can be split into 3 categories:
It is also important to distinguish between the different types of transplants:
In our bodies, bone marrow is the source of all blood cells.
Haematopoietic stem cells are contained in the bone marrow and they continuously make new blood cells to replace old ones.
If bone marrow is damaged by disease or medication, it cannot make these essential blood cells, leading to fatal consequences. Therefore, haematopoietic stem cells must be replaced as part of the treatment.
This is done via whole bone marrow transplant or stem cell transplant.
Cord blood is an alternative source of stem cell for a transplant.
List of diseases where haematopoietic stem cell transplants are standard treatment.
There are also many experimental pre-clinical therapies not yet in human clinical trials for a diverse range of medical conditions.
These are being studied either in the laboratory with cell cultures or in animal models similar to the human disease.
A “clinical trial” is a study in human patients for an emerging therapy that has not been adopted as standard therapy.
Parents’ Guide to Cord Blood Foundation has a portal that allows patients to search worldwide for currently recruiting clinical trials with either cord blood or umbilical cord tissue.
List of all diagnoses that have ever been treated in clinical trials with cord blood or cord tissue, in various stages of completion.
Netcells has released cord blood units for autologous use for Cerebral Palsy, the recipients were accepted into clinical trials taking place at Duke University in the States.
Smart Cells International, our sister company in the UK, has released a number of samples of stem cells for clinical use. Smart Cells has released more samples than any other private cord blood bank in the UK.
Here is a summary of Cord Blood samples used by Smart Cells customers:
Next Biosciences strongly recommends that each parent reads their Frequently Asked Questions to gain a better understanding of Stem Cells.
Stem cell banking is seen as a form of medical insurance – by investing in the service, you buy a “ticket” to future medical options.
You should strongly consider stem cell banking if:
Remember, if you do not collect and store your baby’s stem cells at birth, there are still other options available to you, including getting stem cells from a donor:
However, this is not guaranteed, can take time, and be extremely costly.
No. The doctor or midwife can collect umbilical cord blood and tissue at either type of delivery.
The umbilical cord blood stem cells are a perfect match for the child whose cells have been stored, and there is a 1 in 4 possibility that the stem cells will be a match for a sibling (brother or sister).
Please note, the child’s own stem cells cannot be used to treat certain inherited blood disorders, as the genes that code for the inherited disorder will be present in those stem cells. In this case, a sibling or unrelated donor’s stem cells would be needed.
Cord blood and cord tissue contain different types of cells that have different uses.
| CORD BLOOD | CORD TISSUE | |
| Type of Stem Cells | Haematopoietic (blood) stem cells | Mesenchymal stem cells |
| What can they be used for? | Bone marrow transplants for blood-related diseases. | Connective tissues (skin, bone, muscle, cartilage), nerve (neurological) and organ regeneration. |
| Who can use them? | The child (autologous) or a close matching relative (allogeneic). | The child (autologous) or a close matching relative (allogeneic). |
| How are they stored? | Stem cells are extracted, frozen and stored in a bag. Additionally, small vials of the cord blood are separately stored for testing for a match (HLA-typing). | Cord tissue is processed rich in mesenchymal stem cells. This is stored in 5 vials. |
| Preparation for use? | Ready to be used upon thawing. | Additional laboratory work will be required to expand the isolated stem cells to grow sufficient numbers for therapy. |
| How many times can they be used? | Once, with today’s technology. The blood is stored in bags that have the potential to be split. | Many times, as mesenchymal stem cells are easily expandable. |
Cord blood stem cells can be used to regenerate bone marrow to treat a range of blood disorders and immune system conditions such as leukaemia, anaemia and autoimmune diseases. They are largely used in the treatment of children but have also started being used for adults following chemotherapy treatment.
Cord blood is also being researched for use in regenerative medicine where stem cells may help induce healing or regenerate cells to repair damaged tissues. This research has led to clinical trials using cord blood in experimental therapies to treat cerebral palsy, autism, brain injury and juvenile (type 1) diabetes.
Furthermore, many clinical trials are underway looking at the use of stem cells taken from bone marrow. For many of these potential treatments, cord blood stems cells may be a suitable substitute and offer many advantages over bone marrow.
Cord tissue contains mesenchymal stem cells that are being employed in both research and clinical environments for a variety of aesthetic and medical conditions, including skin regeneration, neurology (motor neuron disease, multiple sclerosis), orthopaedics (cartilage and bone repair), sports injury (cartilage and ligament repair); cardiology (heart muscle regeneration) and many other areas.
The cord blood is stored in bags with an 80:20 split. With today’s technology, the whole cord blood unit is used for a bone marrow transplant. The 80:20 split is a contingency plan for the future, when possibly the number of cells could be expanded and then the unit could be used twice.
The cord tissue is divided into 4 vials for multiple use. The mesenchymal cells from cord tissue can be cultured and expanded and may have many more applications than the cord blood stem cells in the future.
If stem cells are not collected at birth, there are other options available.
Should your child need a bone marrow transplant, stem cells can be collected from donor bone marrow or blood from a:
This is, however, not guaranteed, as matches cannot always be easily found, they take time and are extremely costly.
Mesenchymal stem cells can be found in most of our tissues or organs, but can be difficult to harvest. They’re most readily available from adult fat (adipose) tissue, but the “young cells” from umbilical cord tissue have better regenerative potential, and are easily collected with no discomfort to mother or child.
Probability of finding a match for patients in need of an HSC transplant depends on race/ethnicity as our HLA/ tissue types are different.
References
There are 2 types of transplants:
Patients are given chemotherapy for blood-related and auto-immune disorders to destroy the existing damaged or diseased bone marrow, and then the new stem cells are infused.
The cord blood stem cells are ready to use and require thawing before they are infused into the patient. If your child requires a stem cell transplant your doctor should contact us for all the necessary documentation to decide if the treatment should go ahead. Next Biosciences will only release the stem cells upon written approval from the parents and the treating doctor indicating the date, time and place of the transplant (to allow us to plan the transport of the unit).
If an allogeneic transplant is needed (for a sibling) then HLA (human leukocyte antigen) match testing needs to take place. This process takes approximately 3 weeks and requires a blood sample from the child who needs the transplant, and we send off a sample of the cord blood (we store 2 extra frozen vials for this purpose). If there is an acceptable match, the doctor will request the stem cells to be transported to their facility. The cost of transport is for the clients own account.
Haemoglobinopathy testing will be done on the donor when the unit is requested for transplant. If the donor is not available, testing may be done on the frozen cryovial sample stored with the unit, which will be submitted by Netcells. This frozen cryovial sample may not be accurately reflective of haemoglobinopathy status, however. The cost of the haemoglobinopathy testing will be for the client’s own account.
Delayed cord clamping can be beneficial to the baby however delaying for too long (for the cord to stop pulsating) carries the risk of there not being enough blood for cord blood collection.
Each case varies as each birthing situation is unique and therefore the final decision must be made by the Obstetrician or Midwife at the time of delivery.
Netcells advises that should clients choose delayed cord clamping:
Newest Industry Recommendations by American College of Gynaecology Guidelines:[2]
Conclusion
Provided the mother is not iron deficient and baby is at term, delaying cord clamping by 30-60 secs should ensure a safe outcome for baby and allow for adequate cord blood collection.
[1] South African Bone Marrow Registry. http://www.sabmr.co.za/
[2] Gragert et al., NEJM 2014; 371:339-348 HLA Match Likelihoods for Hematopoietic Stem-Cell Grafts in the U.S. Registry
This depends on the number of stem cells stored in each individual unit and the size of the person who requires the transplant. The optimal dose is 10 -20 million nucleated (CD45) cells per kilogram of body weight. The cell counts are different for every collection, and depend on the volume of blood collected as well as other factors in pregnancy. Your baby’s cell counts will be reported to you on your storage certificate.
The average number of stem cells collected from an average volume of 100 ml can usually treat up to a 50kg person, but this varies. In larger adults, often two matched units can be combined (either from a sibling or an unrelated donor).
Companies are developing techniques to expand (grow more) stem cells in a laboratory environment, and we hope this will become a reality soon.
It must be noted that lower stem cell counts are currently being used in clinical trials for cerebral palsy and brain injury, as these recipients are often small, low birth weight babies and children.
Our storage tanks do NOT operate off electricity. The stem cells are stored in the vapour phase of liquid nitrogen, which is readily available in South Africa. Electricity is critical to our laboratory equipment, and we have UPS backup on all equipment, as well as a large generator, so we can continue to process during load shedding.
Theoretically, the stem cells should be able to be stored for the lifetime of the child, as they are cryopreserved and stored at -196 degrees Celsius, where all ageing is halted. However, there is only scientific proof that stem cells are viable for as long as 23 years, as this is currently the longest period in which stem cells have been stored, thawed and tested for viability.
You are able to pay for storage upfront for periods of 5, 10 or 20 years. Storage fees currently average around R350 per annum, and these will be adjusted annually for inflation. Storage fees will be market related and, if at any time you wish to move your stem cells to alternative storage location, you’re welcome to do so.
More than 90% of the work involving stem cells is not controversial. This includes research, accredited processing and storage facilities such as ours and legitimate therapies being administered around the world.
However, there are a few areas that are controversial:
Embryonic stem cells are derived from embryos and result in the destruction of the embryo and the loss of potential life. Netcells is not involved in any form of embryonic stem cell science.
Cloning is banned worldwide in humans, as it involves making a copy of a something from a single cell.
Non-regulated stem cell clinics operating worldwide offering unproven therapies at exorbitant prices to many vulnerable and desperate patients. These unproven treatments generally don’t comply with the ethical, legal and scientific standards required of registered clinical trials.
Netcells is a processing and storage laboratory, and as such, does not offer treatments to clients. We facilitate the handover of stem cells to the transplanting unit or trial centre.
Netcells has released two cord blood units to date: the first cord blood unit was released in March 2015 to treat an eight-month old baby boy with cerebral palsy and the 2nd cord blood unit was released in July 2016 to treat a two-year-old boy with Cerebral Palsy. Both units were accepted into stem cell treatment programmes taking place at Duke University in the USA.
We have had a few siblings who required stem cell transplants but these were unfortunately not a match.
Our sister company Smart Cells in the UK has already released 19 cord blood units for the treatment for cerebral palsy, thalassaemia, leukaemia, brain injury, severe combined immunodeficiency disorder, sickle cell anaemia and encephalitis.
You should be comfortable with the company you choose, as you are storing your child’s stem cells for life. Do your homework and investigate all your options. Make sure that the company you choose:
We collected our first cord blood unit in 2005, and to-date have stored stem cells for over 15,000 babies.
Our sister company, Smart Cells international (the UK’s longest established stem cell bank) will take over the storage of the stem cells in the unlikely event of anything ever happening to Next Biosciences. Next Biosciences and Smart Cells employ similar technology so it is easy to transfer cells between the two laboratories. Next Biosciences and Smart Cells are each other’s offshore back-up laboratories and Netcells has processed and stored stem cells for Smart Cells clients from all over the world, when there have been flight disruptions in the UK and Europe due to weather (volcano, snow) and strikes.
Netcells will always refund the portion of fee relating to the service that wasn’t utilized. Additionally, Netcells takes the risk on processing, so if for whatever reason there are not enough stem cells for storage and you don’t store, then Netcells will refund the Banking Fee and Storage Fee.
The stem cells are stored in cryogenic tanks at our laboratory in Midrand. You are welcome to visit our laboratory at any time to come and see how we process and store stem cells.
It is best to store the whole unit and not to split units into separate bags. This increases the risk of contamination, bears the risk of unnecessary transportation and decreases the cell count available for transplant thus ½ + ½ ≠ 2. Further comment by Dr Pablo Rubenstein who pioneered the cryopreservation of cord blood stem cells: “Given that the cell dose is an important predictor of successful transplant outcomes, such ‘split CB units’ might place their potential recipients at a disadvantage and their application, therefore, unlikely, unless successful stem cell expansion becomes practical in this setting.”1 Reference 1. Rubinstein, P. (2009) Cord blood banking for clinical transplantation. Bone Marrow Transplantation. 44. pp. 635-642
As this is a private bank and we store for your family only, we do not carry out HLA-typing on the stem cells and therefore we will never know if they are a match for anyone else. Additionally, we comply with the Human Tissue Act and therefore are not permitted to use your stem cells for research without your prior written consent.
Once the cord blood and tissue are collected, the cells start deteriorating, so it is imperative to get this to the laboratory as soon as possible. Local storage ensures less transport risk (courier delays, customs clearance, weather disruption, extreme changes in temperature) so that the cells can arrive as soon as possible at the laboratory with least risk of being compromised for processing.
It is recommended that you continue to keep the stem cells stored with Netcells until they are ever needed for a transplant as one does not want to stand the risk of thawing them unnecessarily. However should you wish to move the stem cells you may do so- the stem cells can be shipped in their frozen state anywhere in the world to another stem cell bank that accepts them for storage. The cost of this will, however, be for your own account.
You will need to liaise with your medical practitioner, who will contact us and inform us that the stem cells are required for transplant, indicating the date, time and place. Netcells will only release the stem cells upon written approval by the mother and treating doctor.
