Cord Blood + Tissue Banking Fact Sheet This fact sheet has been prepared to assist parents in understanding more about umbilical cord blood and cord tissue banking. You may find it useful to review this information so that you can make an informed decision about whether you wish to store your baby’s cord blood and tissue. Your maternity health care providers are committed to patient choice and will support your decision whether you decide to store your child’s cord blood and tissue or not. Introduction What is Family Banking? The collection and storage of cord blood taken from the umbilical cord of a baby at birth is becoming increasingly common. The reason for this is that the cells contained in the blood have potential therapeutic value in the treatment of blood disorders, immune diseases and the emerging field of regenerative medicine. Recently, the option to collect and store a section of the umbilical cord itself has been introduced into Australia. The tissue of the umbilical cord contains different types of stem cells and other cells that are being studied in clinical trials for their medical benefit. Cord blood banking is the process of collecting the blood from the umbilical cord immediately after birth and storing it for potential medical uses. Family banking means your baby’s cord blood can be stored for use by your baby and other compatible family members. What is Cord Blood? Cord blood is the blood that remains in your baby’s umbilical cord and placenta after the birth and the umbilical cord has been cut. It is a rich source of stem cells which can be used in medical treatments. Cord blood stem cells are similar to those found in the bone marrow and have the ability to develop into all the different blood cell types, creating the blood and immune system. Cord blood stem cells may also have a role in the treatment of neurological injuries such as cerebral palsy and autoimmune diseases such as type 1 diabetes. What is Cord Tissue? Cord tissue fills the baby’s umbilical cord around the blood vessels and contains types of stem cells (mesenchymal stem cells or MSCs) that are not generally found in cord blood. MSCs are the stem cells that give rise to many of the “support tissues” in the body, including bone, cartilage, fat and muscle. They also have the potential to develop into nerve cells and are known to have a positive impact in reducing inflammation. Medical clinical trials in the use of MSCs are still at an early stage and no therapy using MSCs has yet been approved in Australia. It is, however, an area that is of major scientific interest and early results of trials are reported to be promising. An educational factsheet based on information provided by Parent’s Guide to Cord Blood Foundation. Table 1 Emerging Therapies where children use their own Cord Blood Diagnosis Occurrence in Stage of Use Australia Clinical Trial Reference (www.clinicaltrials.gov) Cerebral Palsy 2 per 1000 full Clinical Trials: Phase NCT01147653 term births1 1&2 NCT01072370 Pending in Australia Hypoxic Ischemic Encephalopathy 1 per 1000 full term births2 Clinical Trials: Phase 1 NCT00593242 NCT01506258 (oxygen deprivation) Traumatic Brain Injury 1 in 1,077 ages 0-143 Clinical Trial: Phase 1 NCT01251003 Type 1 Diabetes 1 in 2504 Clinical Trials: Phase NCT01343394 1&2 11/SCHN/211 (CHW/Cell Care) Hearing Loss, Sensorineural 20 per 10,000 at birth5 Clinical Trial: Phase 1 NCT01343394 Hypoplastic Left Heart Syndrome 1 in 6259 at birth6 Clinical Trial: Phase 1 NCT01445041 Autism 1 in 1607 Clinical Trial: Phase 2 NCT01638819 What are Cord Blood and Tissue used for? Cord blood has been used in transplant medicine to treat blood diseases and cancers since 1988. By the end of 2009 there had been approximately 20,000 cord blood transplants worldwide1. Currently, in Australia cord blood stem cells may be used in place of 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 (Table 1). This research has led to clinical trials using cord blood in experimental therapies to treat cerebral MSCs are currently being investigated in the treatment of bone fractures, cartilage damage, heart and skeletal muscle diseases. As with the immune cells in cord blood, MSCs dampen unwanted or excessive immune responses, and they are therefore being investigated for the treatment of autoimmune diseases and the complications of incompatibility in transplantation. Lastly, in animal studies, co-transplanting mesenchymal stem cells taken from cord tissue together with cord blood stem cells results in improved engraftment (ie acceptance of the transplant) - up to a 6-fold increase over cord blood alone. Their results suggest a potential role for MSCs in transplantation medicine, helping ensure better transplant take up and allowing lower volume cord blood units to be successfully used. Graph 1: Lifetime Probability of a Stem Cell Transplant How is cord blood and tissue collected? Collection of cord blood and tissue is normally performed by your obstetrician, midwife or trained collector. Immediately after the birth of your baby, the umbilical cord is clamped and cut, separating your baby from you and the placenta. The collector will then clean the umbilical cord and collect the cord blood in a sterile collection bag. Cord tissue is collected after the cord blood has been collected. A short section of the umbilical cord is cut from the cord, washed and placed in a storage vial. The cord blood and cord tissue is then labelled and packaged in the collection kit. The kit is then transported to the banking facility where the cord blood is processed to concentrate the stem cells and then frozen and stored under controlled conditions (for private banking you are responsible for calling the cord blood bank’s medical courier to arrange collection). Cord blood and cord tissue collection is quick, safe and painless for both mother and baby. This is a brief overview of cord blood and cord tissue banking. Further information can be obtained as follows: Public Donation: www.abmdr.org.au Private Cord Blood + Tissue Banking: www.cellcareaustralia.com Private Cord Blood Banking: www.cellcareaustralia.com www.stemlife.com.au www.cryosite.com References: 1. www.cerebralpalsy.org.au 2. www.health.qld.gov.au 3. www.bia.net.au 4. Australian Institute of Health and Welfare 2011. Diabetes prevalence in Australia: detailed estimates for 2007-08. Diabetes series no. 17. Cat no. CVD 56. Canberra: AIHW 5. www.hearingloss.com.au 6. www.aihw.gov.au 7. www.autismaus.com.au 8. Verter, F & JJ Nietfeld, Cytotherapy 2010;12:Suppl.1, abstract#157 9. Nietfeld JJ, Pasquini MC, Logan BR, Verter F, Horowitz MM. Lifetime probabilities of hematopoietic stem cell transplantation in the US. Biol Blood Marrow transplant. Mar 2008; 14(3): 316-322 An educational factsheet based on information provided by Parent’s Guide to Cord Blood Foundation. 0.50% 0.45% Cumulative Probability (%) palsy, brain injury and juvenile (Type 1) diabetes (www.clinicaltrials.gov). 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. 0.40% 0.35% 0.30% 0.25% 0.20% 0.15% 0.10% 0.05% 0.00% 0 10 20 30 40 50 60 70 80 Age (Years) Collection options in Australia If you are an expectant parent in Australia you have three choices with your baby’s cord blood: • • • Store your baby’s cord blood with a family cord bank for future individual or family use; Donate your baby’s cord blood to a government funded public cord blood bank for use by anyone needing a transplant; or Allow your baby’s cord blood to be discarded at birth. Family cord banks are commercial operations, and charge fees for their services. Ownership of the cord blood and tissue remains with you and your child and can only be released for use by your child or a compatible family member. All cord blood banks in Australia are regulated by the Therapeutic Goods Administration. With a public bank, your baby’s cord blood is a donation, and is then available for use in therapies by anyone (in Australia or overseas) who is a suitable genetic match. While public banks do not charge for their services, cord blood stored in a public bank may or may not be available for your child’s own use if the need arises. Collections for the public cord blood banks are carried out at a small number of hospitals throughout Australia. What is the likelihood of ever using banked cord blood? It is difficult to know the exact probability that cord blood banked today will be used, as new therapies are continually emerging and are still being investigated. The minimum odds of use come from the traditional therapy of stem cell transplants. Hospital statistics show that the probability of a person having a stem cell transplant, either using their own cells or from a donor, increases over one’s lifetime (Graph 1)8. While a person’s chance of transplant are only 1 in 1700 up to age 20, they rise to 1 in 200 by age 709. Families are even more likely to use their child’s cord blood if some of the experimental therapies become standard, such as cord blood therapy for cerebral palsy (1 in 400 children) or autism (1 in 160 children). The experience of private cord blood banks in the US, where storage has been taking place for considerably longer than in Australia, indicates a usage rate to date of 1 in 1,200 to 1 in 2,500 after an average length of storage of 5-6 years.
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