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Preserving personal stem cells from umbilical cord blood has gained significant momentum in recent years. Here is a comprehensive explanation.
Preserving personal stem cells from umbilical cord blood has become a rapidly advancing field, particularly in recent years, causing concern and indecision for many couples. Among the myriad of tasks they face before and after childbirth, they must grapple with the question of whether to collect and preserve their baby's umbilical cord blood, just in case, god forbids...
Just a few minutes after birth, before the umbilical cord is discarded, new and proud parents have the opportunity to help others. They can donate the stem cells from umbilical cord blood to a public cord blood bank, which is intended for individuals suffering from genetic or acquired diseases who require a bone marrow transplant. This bank serves as the hope for patients who do not have a suitable donor within their immediate family. Another option is to collect and store the cord blood in a private bank, serving as a form of biological insurance for your family alone.
Cord blood preservation is a medical field that has evolved significantly in the past decade, experiencing rapid growth, especially in recent years. The first successful transplantation of cord blood stem cells originated from umbilical cord blood in a child with Fanconi anemia was conducted in France in 1989. Since then, approximately 20,000 successful bone marrow stem cell transplants have been performed worldwide using cord blood as the source.
Stem cells are undifferentiated cells that have not undergone final specialization into specific functional cells. Therefore, they can differentiate, depending on the environment they are placed in, into various types of tissues. Stem cells obtained from the blood left in the umbilical cord and placenta following birth are called cord blood stem cells. During fetal development, the blood and immune system stem cells are primarily produced in the liver. Toward the end of pregnancy, these stem cells "migrate" into the fetal circulation, and after birth, they "settle" in the bone marrow. Therefore, the umbilical cord blood and placenta are rich in stem cells at the time of birth.
The collection of cord blood is a simple and non-invasive medical procedure performed after the umbilical cord is cut from the newborn. A needle is inserted into the vein of the umbilical cord, and approximately 80-140 ml of cord blood (preferably as much as possible) is withdrawn into a collection bag containing an anticoagulant. The cord blood is processed and cryopreserved gradually and carefully in liquid nitrogen at a temperature of minus 196 degrees Celsius, allowing it to be preserved for 15-20 years. Cord blood can be collected after birth while the placenta is still in the mother's womb, making the entire process painless and safe for both the baby and the mother.
Today, stem cells intended for transplantation are usually harvested from the bone marrow of donors or from peripheral blood after their mobilization using growth factors.
However, umbilical cord blood serves as a more efficient alternative source for stem cells due to its unique characteristics:
The public cord blood bank in Israel is available to anyone in need of a bone marrow transplant and searching for a compatible donor based on tissue classification. The preserved cord blood units in the public cord blood bank are available to everyone worldwide, not just in Israel. In contrast to personal preservation, which is carried out by private companies and intended solely for the donor's family, donating cord blood to the public bank is anonymous, and the connection with the child is severed. Every bone marrow transplant using cord blood from a volunteer donor or cord blood stored in a public bank is given within the framework of transplant therapy, and there is no monetary exchange involved.
The public cord blood bank operates in collaboration with three main entities: the Hadassah University Hospital, Magen David Adom (the Israeli Red Cross), and the Dor Yesharim organization (an association aiming to prevent genetic diseases prevalent among Jews). The Hadassah University Hospital houses the tissue typing center and the genetic data repository of cord blood units intended for transplantation. Cord blood collection is currently performed at Hadassah University Hospital, Shaare Zedek Medical Center, Bikur Holim Hospital in Jerusalem, Wolfson Medical Center in Holon, and the Sourasky Medical Center (Ichilov) in Tel Aviv, as well as at the Government Hospital in Nahariya.
Since the public cord blood bank operates within a limited budget, it cannot collect cord blood from every willing donor. However, over the past year, it has successfully collected and preserved approximately 1,000 units of cord blood (which theoretically equates to 50,000 voluntary donors). In three years of operation, it has collected a total of about 3,000 units of cord blood. In comparison, there are over 12 million potential donors worldwide, while in Israel, there are 400,000 potential donors in two cord blood registries: Hadassah University Hospital and the “Help from Zion” organization. Currently, the quantity of cord blood units stored in public banks worldwide is approximately 450,000.
The advantage of cord blood stem cells, as previously mentioned, is that they can be transplanted even when there is not a perfect tissue match between the donor and the recipient. This increases the chance of finding a suitable cord blood unit when searching through a broad database. Furthermore, in Israel, there are minority populations such as Ethiopian Jews, Circassians, and Druze whose genetic likelihood of finding a match in global registries is very low. Therefore, the public cord blood bank in Israel must include cord blood units suitable for these populations.
For those interested in more information about the public cord blood bank and the possibility of donating, please contact the Donor Center at “Hadassah” at 02-6434035.
In Israel, several companies offer private umbilical cord blood banking services in exchange for a considerable fee. Representatives from the chosen company will be present in the delivery room to collect, test, and preserve the cord blood for years. This practice effectively serves as a biological family insurance policy since the preserved stem cells are a perfect genetic match for the newborn and have high compatibility with other family members when needed. This decision is akin to the choices couples make when opting for various genetic tests before pregnancy. Ultimately, for each family, it is a budgetary decision.
Statistically speaking, the likelihood of actually using the cord blood, in cases of routine births without a family history of diseases, is exceedingly low. The current estimation for the probability of a family member exploiting cord blood for bone marrow transplantation stands at 1 in 250,000.
Another essential point to note is that cord blood stem cells are not suitable for treating certain hereditary diseases or leukemia, for instance. In the case of childhood leukemia, it typically occurs during pregnancy, so the potential leukemic cells are already present in the fetal cord blood. Therefore, if a child develops leukemia, their cord blood cannot be used for transplantation. In the case of various hereditary diseases that can be treated with bone marrow transplantation, cord blood from a familial source cannot be used due to the presence of the same genetic defect.
Nevertheless, many researchers believe that umbilical cord blood stem cells hold significant potential in both disease research and treatment. Their use may expand in the future, such as for tissue regeneration and as partial or complete replacements for organ transplants, including heart and skeletal muscle cells, nerve cells, liver cells, and insulin-producing cells. While this vision sounds promising, it is essential to remember that these potential future applications are still in the experimental research phase and not yet widely applicable.
A critical consideration is that when a family already has an ill child, it is recommended to collect and preserve the umbilical cord blood of a healthy newborn within the same family. As mentioned earlier, these cells have a good chance of matching the sibling in need of a transplant. The umbilical cord blood from another child in the family can potentially save lives in cases of blood cancer, lymphoma, hereditary diseases, metabolic diseases caused by enzyme, hormone, or biochemical deficiencies, among others.
Private cord blood banking companies usually offer entirely personal preservation services intended exclusively for family use. However, in theory, if the stored sample is suitable for someone in need, it could be sold for a fee. With the family's consent and under specific conditions, the private cord blood sample can become publicly available and sold to a patient who requires it.
Dr. Aryeh Grover is a specialist in obstetrics and gynecology and the director of Leumit’s Nursing and Ambulatory Services Department.
Prof. Reuven Or is the director of the Bone Marrow Transplantation Department at Hadassah Medical Center and the medical director of the Public Umbilical Cord Blood Bank and Donor Registry of “Hadassah” in Israel.
