• Matias Guimaraes

What you need to know about Cord Blood Banking

Both private and public cord blood banks have developed in response to the potential for cord blood in treating diseases of the blood and immune systems. Public cord blood banks accept donations to be used for anyone in need, and as such function like public blood banks. Traditionally, public cord blood banking has been more widely accepted by the medical community. Private cord blood banks store cord blood solely for potential use by the donor or donor's family. Today I'd like to dive into the real current advantages and disadvantages and the possible future development of this business.


What it is cord blood? Cord blood is the blood that remains in the umbilical cord after a baby is born. Throughout pregnancy, the umbilical cord functions as the lifeline between mom and baby, carrying nutrient-rich, oxygenated blood from the placenta to the developing baby.





Why is cord blood so special? Cord Blood contains special cells called hematopoietic stem cells which can mature into different types of blood cells in the body. On the other side, other cells can make copies only of themselves, for example a skin cell can make another skin cell. Hematopoietic stem cells can be used to treat more than 70 types of diseases, including diseases of the immune system, genetic disorders, neurologic disorders, and some forms of cancer, including leukaemia and lymphoma.



What are the advantages of cord blood? Stem cells from cord blood can be given to more people, more matches are possible when a transplant is needed and is less likely to cause rejection than those in bone marrow. Also is much harder collect bone marrow than cord blood and it can be painful for the donor. Cord blood can be frozen and stored, bone marrow must be used soon after it is collected, and bone marrow stem cells cannot be used to strengthen the immune system during cancer treatments.



What are the disadvantages of cord blood? Cord blood does not contain many stem cells, but units from several donors can be combined to increase the number of stem cells if a transplant is needed for an adult. Also a child’s stem cells (collected at birth) cannot be used to treat genetic diseases in that child and cannot be used to treat that child’s leukaemia because all of the stem cells have the same genes that cause the disease. But the child can use someone’s else stem cells (the donor can be a relative or be unrelated to the child) but there must be a good match between donor and recipient. A donor is a good match when certain things about his or her cells and the recipient’s cells are alike. E.g. Brothers and sisters with the same biological parents have a 25% chance of being a perfect match, and a 50% chance of being a partial match. Other family members are much less likely to be a match. Sometimes not enough cord blood can be collected if the baby is preterm or if it is decided to delay clamping of the umbilical cord, (which means the umbilical cord is not clamped immediately after birth. Instead, it is clamped and cut between one and three minutes after birth) practice that can reduce the volume of stem cells remaining in the umbilical cord. The reality is the chance for an individual to use his or her own blood is miniscule and factors like limited cell dose cord blood units and inability to use one's own stem cells in genetic disorders have conveniently been overlooked by advertisement campaigns. For instance, Frances Verter, Ph.D., and founder of Parent’s Guide to Cord Blood Foundation, estimates there is only a 1 in 217 chance that your child will ever need a stem cell transplant with cord blood.



Why take stem cells from cord and not from other sources? You can take stem cells from cord, bone marrow and peripheral blood. But taking stem cells from cord it is more beneficial for the following reasons:

· Unlike cells from adult donors, cord blood has not been as exposed to viruses, chemicals and environmental pollutants that can alter cell function.

· Cord blood immune cells are immature and can tolerate a recipient better than adult cells, so cord blood cells do not have to be matched as closely to the patient as do cells from adult donors.

· Cord blood may be accessed more quickly than stem cells from an adult donor who may have registered for donation years ago. The donor must be located, consented, tested, and harvested.



Why are you telling us this? Not many knows that there are cord blood banks, which basically are facilities which stores umbilical cord blood for future use. There are two available options:

Public cord banks do not charge anything for storage. Any donation made is available for anyone who needs it. The bank may also use the donated cord blood for research.

Private (commercial) cord banks will store the donated blood for use by the donor and family members only. They can be expensive. These banks charge a fee for processing and an annual fee for storage.



How do they do it? The service consists of four key procedures:

· Cord Blood Collection: Takes place in hospitals immediately after the babies are born and is conducted by qualified doctors or trained midwife nurses. Once stored, the samples are picked up and delivered to their laboratories within 24 hrs with special courier vehicles. Upon arrival they will examine the blood to determine if it meets certain standards and it will be assigned a specific barcode.

· Cord Blood Processing: Rooms built strictly following national GMP standards (1000 class clean rooms and 100 class clean benches). Process consist of separation of stem cell by removing red blood cells and plasma.

· Laboratory Testing: More than 20 tests need to be performed for each cord blood units before it is distributed for use, including infectious diseases tests, HPC tests, HLA typing et al.

· Cord Cryopreservation: The processed cord blood units are first gradually frozen using a controlled-rate freezer to lower their temperature to -90˚C before they can be transferred into the liquid nitrogen tanks (-196˚C) for long-term storage. There are computerized security systems including fingerprint door locks, smoke sensors, oxygen content monitors, 24-hours liquid nitrogen monitoring and alarm system and infrared alarm system.



Does the business have upside potential in the future? Many believes that such business could do great in the future, but after doing our proper researches and talked with people in the industry we believe that it’s too soon to make speculative predictions about the future development of cord blood needing. The reasons that leads us to that conclusions are the following (we are taking into consideration only Private Cord Blood Banking):

· In over 98% of birds, cord blood is thrown away as medical waste because of a lack of awareness and education about cord blood. But we do not believe that percentage will change significantly in the future since Private Cord Blood Banking is expensive (2,000$ to 4,000$ fee for processing and annual fees for storage of 200$ to 400$). Even if they manage to educate more families about potentials benefit of cord banking, many will not do it because of the expensive fees for doing so. We believe that families will prefer to donate cord blood to public banks, which charge no fees.

· Collect or donate cord blood is not a last-minute decision, expecting parents should talk to their obstetrical physician or other health care provider between the 28th and 34th week of pregnancy about their interest in storing or donating a baby’s cord blood.

· Given the importance and hope parents attach to the idea of protecting their children’s future health, many decided to store cord blood but were not aware about the real chances of their baby needing it because of the misleading information given from advertisement campaigns.

· When we asked to competent doctors what they think about private cord blood banking they do not recommend banking cord blood on the slight chance that your baby will need stem cells someday. If your baby were to need stem cells, he or she would probably need stem cells from someone else rather than his or her own stem cells. Dr. Michelle Hudspeth is the director of adult and pediatric blood & marrow transplantation at the Medical University of South Carolina. She said, “We do not recommend privately banking cord blood unless you have a first-degree relative who has a disorder that can be cured by cord blood transplant. And that is going to be such a tiny amount of people.”



In conclusion

Experts encourage to donate to public banking because of chances of needing it are low given the high costs of privately storing it. However, in 2019 there was a new theory that says cord blood storing could be useful for NK (Natural Killer) cells which are particularly important because they kill cancer cells without needing prior activation. These cells play a role in the autoimmune response and are involved in the development of pathologies such as multiple sclerosis, rheumatoid arthritis, and systemic lupus erythematosus. Researchers found one unit of cord blood could yield enough NK cells to treat five patients.

Also, Cord blood holds great promise in regenerative medicine to potentially treat autism, cerebral palsy, hearing loss, stroke, spinal cord injury and more.

As research continues to bridge the gap between the unknown and the proven, we may see the popularity in NK and other umbilical cell products rise. The possibility to manufacture NK cells with coronavirus antibodies would be an innovative concept and could serve as a treatment option to advance in the upcoming years. The logistics surrounding engineered cord blood NK cells may deliver a nearly immediate solution in response to the limitations associated with current cell therapies.

That’s why we believe it’s “too soon”, for the moment; given the current data we have found and considering our approach to investments, we do not believe that Private Cord Blood Banking companies are a value pick, but looking at the potential benefits it could have in the future we strongly recommend to keep an eye on the development of this sector. Sources:

https://en.wikipedia.org/wiki/Cord_blood_bank https://timesofindia.indiatimes.com/india/cord-blood-bank-to-be-used-for-treating-covid-19-patients-mamata/articleshow/77395498.cms https://primefeed.in/news/3926111/cord-blood-banking-services-market-segments-leading-player-application-and-forecast-analysis/ https://www.nst.com.my/lifestyle/heal/2020/07/612395/cord-blood-banking-should-be-encouraged https://www.lexology.com/library/detail.aspx?g=0c50c6e7-370d-4cc3-baee-46596ed4c489 https://www.prnewswire.com/news-releases/world-cord-blood-day-2020-discover-cord-bloods-potential-in-stem-cell-transplants-and-regenerative-medicine-following-covid-19-301106358.html https://www.worldcordbloodday.org/ https://pubmed.ncbi.nlm.nih.gov/15625985/#:~:text=Hematopoietic%20stem%20cell%20transplantation%20is,graft%2Dvs%2Dhost%20disease. https://www.savethecordfoundation.org/research/share-the-science-immune-reconstitution-after-cord-blood-transplantation-jaap-jan-boelens-md-phd# https://www.cb-association.org/myths-and-facts Personal Interviews with Doctors

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