It is better to give

24 December 2005 From New Scientist Print Edition

By Christopher Thomas Scott
IMAGINE the following festive scene. A couple sits in the family room by the Christmas tree, the
woman visibly pregnant. A fire roars in the hearth. The man pulls out a large envelope with a
silver bow and hands it to his partner. Smiling with expectation, she tears it open to find an
embossed certificate. "Merry Christmas," the certificate proclaims. "Redeem this gift for 25 years
of cold storage for your baby's umbilical cord blood." "Oh honey," she exclaims, "you shouldn't
have!"
One company, Smart Cells International, has sold dozens of Christmas certificates like this to
parents and grandparents of unborn babies. Their pitch is that stem cells in cord blood already
cure diseases, and in 25 years' time they will cure many more. So what better gift for your family
than to freeze a few millilitres of blood and have them preserved in liquid nitrogen as insurance
against illness or injury? Some cord blood companies tell parents they can buy peace of mind for
an initial fee of a few thousand dollars and yearly storage charges of hundreds more. But how
much peace of mind?
If the couple already has a child with a life-threatening
blood cancer, then banking the cord blood of a healthy
newborn sibling is a fine idea, because that blood could
save the older child's life. The patient is given radiotherapy,
which destroys the cancer along with stem cells in the bone
marrow. The healthy blood is then transfused, and the cord
blood stem cells travel to the bone marrow, where they take
up residence and start to churn out billions of blood cells.
But blood cancers are relatively rare. The bigger promise pivots on the supposed power of cord
blood to cure common illnesses such as diabetes, heart disease and Alzheimer's. If you believe the
advertisements, stem cells will someday cure all of these, and may even be used to grow new
body parts that are a perfect genetic match for the recipient.
Scientists working at the cutting edge of stem-cell research paint a different picture. Cord stem
cells are scarce, and therefore not useful for most adults, who need large numbers of cells for
transplants. Some assert that cord stem cells are powerful because they ignore their bloodline
heritage and change into a multiplicity of cell types, including heart muscle and brain tissue. But
this is hotly contested, and researchers are slugging it out experimentally, testing whether cord
stem cells are as potent as the more optimistic scientists and cord blood banking companies claim.
Cord blood certainly has fascinating properties. The stem cells derived from it are
immunologically naive: they have not learned the signature of "self" that is so critical to immune
rejection. This means they work for a wide range of patients, and several units from different
donors can be mixed for adult transplants. Grafts of cord stem cells "take" readily, more so than
their bone marrow-derived brethren. Earlier this year, in fact, University of Minnesota researchers
reported transplant success in adults using as little as two units of cord blood from unrelated
donors.

But because the stem cells are carried in blood, the donor and recipient have to be quite closely
tissue-matched. Establishing cord blood banks could help: the more units are available, the better
the chances that a match will be found for a needy patient. That only partly solves the problem, as
once a unit is taken off the shelf it will take an
average of 60,000 collections from donors to
Public banks would greatly
replace it with an identical match. But what if
it were possible to multiply the stem cells in a
increase the likelihood that a
unit of cord blood 10 or even 20 times? Those
sick child would benefit
cells could then be used for research purposes,
to treat adults, and even for multiple rounds of therapy. Best of all, there would be enough cells
left over to put back on the shelf.
Using the hormones known as cytokines, it is already possible to "expand" populations of stem
cells to produce large numbers of new cells that appear to have the molecular signature of the
original stem cells. But appearances can be deceptive. In a recent nationwide clinical trial in
which terminally ill cancer patients were treated with one expanded and one normal unit of blood,
none of the expanded cells successfully grafted. Similar findings have been reported at
transplantation meetings.
For-profit cord blood banking is big business, generating over $300 million in revenues for the
top three US companies alone. Should families rely on the promise of future cures that many of
these companies hold out? For parents of children with certain illnesses or with a family history
of cancer, banking can be a wise choice. For others, it might be more beneficial if the spirit of
giving took another form. Rather than relying on the speculative prospect of therapies for their
own offspring, they could donate blood to public banks. That would greatly increase the
likelihood that a desperately sick child or adult would benefit from it.
Christopher Thomas Scott is executive director of the Stanford Program on Stem Cells
and Society and author of Stem Cell Now: From the experiment that shook the world to
the new politics of life (Pi Press, 2005)
From issue 2531 of New Scientist magazine, 24 December 2005, page 25