18 August 2020
There is increasing uptake of cord blood and tissue banking in the UK. This is due to medical advances, growing awareness and rising numbers of parents who see this as having the potential to invest in their child’s long term health and provide a form of ‘biological insurance’. This is despite the case that disorders of the blood (e.g. certain blood cancers and immune deficiencies) and inherited metabolic diseases are currently the only cases for which a cord blood stem cell transplant is generally accepted by the medical community as an established treatment.
Information obtained by the BBC following a request to the Human Tissue Authority (HTA) under the Freedom of Information Act, shows that the number of umbilical cord tissue units processed privately almost doubled between 2014 and 2018, rising from 6,289 to 11,950. There was also an increase in the number of cord blood units processed, increasing from 10,676 in 2014 to 15,078 in 2018. Overall, 27,028 blood and tissue units were banked privately in 2018 compared with 16,965 units in 2014.
Is cord blood and tissue banking regulated in the UK?
Since 5 July 2008, the HTA has regulated the collection, testing, processing, storage, distribution, import and export of cord blood and tissue.
In the UK, the child’s mother must give informed consent to the collection and storage of cord blood and tissue. All licensed activities in relation to cord blood and tissue must be carried out by suitably qualified professionals in appropriate premises to minimise risks to the mother and child and any patient who receives the sample. All cord blood and tissue banks licensed by the HTA must also meet minimum quality standards.
How is cord blood and tissue collected?
Saving and storing cord blood and tissue represents a once in a lifetime option, requiring careful consideration and planning in advance of the birth.
Cord blood and tissue samples can be collected from the umbilical cord at the time of childbirth. This process is undertaken by a doctor or a specially trained mobile cord blood phlebotomist in the UK. The samples are then usually processed within 12- 24 hours and cryopreserved until they are needed for future treatment.
What storage options are there for cord blood and tissue?
Cord blood can be stored in either public or private cord blood banks in the UK. Public cord blood banking is an altruistic, lifesaving act. In contrast, private cord blood and tissue samples are typically used in the future treatment of the individual or a close family member (e.g. a sibling) and are not made available to the public.
There are two public cord blood banks in the UK, namely the NHS Cord Blood Bank and the Anthony Nolan Cord Blood Bank. It is free to donate to a UK public cord bank and donations do not attract payment. Public cord blood banks around the world list their samples on national and international registries so that they can be provided to recipients worldwide.
There are also a number of HTA-licensed private cord blood banks in the UK including: Biovault, Cells4Life, Future Health BioBank and Smart Cells International. Some private banks can store both blood and tissue samples and costs can range from approximately £1,500 – £2,500 with annual storage fees of £65 – £100 although costs vary in practice.
What can cord blood and tissue be used for?
The human body has over 200 types of cells, including hair, skin, organs, brain and nervous system cells. Each of these cells comes from a stem cell. Blood and tissue found in the umbilical cord and placenta contain the purest and most powerful form of stem cells, which can be used to treat over 80 different diseases including: Fanconi Anaemia, Severe Combined Immune Deficiency (SCID) which is a life-threatening condition due to a deficiency of B cells and T cells needed to fight infection and Sickle Cell Anaemia which is a hereditary blood disorder common in Black, Asian, Middle Eastern and Mediterranean heritage.
Haematopoietic stem cells (HSCs) can transform into various blood cells, including white blood cells. HSC stem cells are used in current therapies, such as cancer therapy, to repair the immune system. Mesenchymal stem cells (MSCs) can transform into a wide range of tissue types including: nerve and muscle tissue, bone cells and cartilage. Medical studies suggest that MSC cells play an important role in the repair and renewal of nerve, muscle and cartilage cells and have the potential to regenerate organs like the heart following a heart attack and degenerative brain conditions like Parkinson’s disease.
However, in some cases an individual’s own cord blood may not be a suitable treatment, for example for certain genetic and blood disorders. This is because the individual’s bone marrow and blood system is diseased and they will then require donated stem cells. For a cord blood unit to be used in a transplant, it must contain enough stem cells. In some cases where a cord blood unit does not contain enough cells, cord blood units from two different donors may be combined to treat one patient.
Storing a baby’s cord blood (rich in HSCs) and cord tissue (rich in MSCs), can result in storage of two types of stems cells that are a 100% match, giving current and future potential to treat a wide range of injuries or diseases. That said, cord blood and tissue is not an individual’s only opportunity to access their own stem cells as blood stem cells and bone marrow stem cells can also be harvested. Additionally, siblings of the same biological parents have a 25% chance of being a perfect stem cell match, a 50% chance of being a partial match, and a 25% chance they are not a match whilst biological parents will always be a partial match.
Regenerative medicine using stem cells and tissue has increasing potential to help treat many health conditions although more medical research and evidence is required. As such, there are numerous medical studies currently looking at cord blood and tissue to help treat conditions such as type 1 diabetes, cerebral palsy, multiple sclerosis, traumatic brain injury, stroke, autism, eye disorders, eczema, asthma and hearing loss.
Increasingly, we are seeing rapid medical advances in areas of stem cell and gene therapies and their growing intersection. Bringing together stem cell and genetic technologies offers unprecedented opportunities as well as responsibilities and risks that need to be carefully and effectively managed. Genetics provide the genetic code and stem cells are the units of human life. How these developing technologies are used and regulated will require sensible and informed public debate and decision-making as they will increasingly gain traction, creating a very significant legacy for future generations.
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