Issue No.
13380
Catherine Stavropoulos-Giokas
EXPECTANT parents have always had plenty of decisions to make before a baby arrives: which obstetrician to choose, whether to give birth in a public or private hospital and whether to breastfeed or not.
But in recent years parents have been facing relatively new and pressing maternity options: whether or not to bank their baby’s umbilical-cord blood for free or to have part of the cord frozen for future medical use, a procedure that can cost between 1,200 and 2,000 euros. Or, in fact, to do nothing and simply discard the placenta, as most parents currently do.
Dismissed by some critics as emotional blackmail, the storage of stem cells is said by others to hold the potential for innovative medical therapies - including spinal repairs and heart treatments - one that will only increase as research into the area grows.
Making a decision, however, can be difficult. Indeed, the advertising methods used by some of the dozen or so Greek companies involved in cryopreservation, the longterm freezing of umbilical cord cells, present parents with an apparently stark choice: that they have a one-time opportunity to make an investment that could potentially save their baby’s life at some later date, or fail to act.
In reality, the choice is more nuanced. The British Royal College of Obste-tricians and Gynaecolo-gists, for example, says that “there is still insufficient evidence to recommend directed commercial cord blood collection and stem-cell storage in low-risk families”.
Cord blood
In Greece, there are two public blood cord banks, both linked to existing research institutions: the Hellenic Cord Blood Bank, affiliated with the Academy of Athens, and Biohellenika, affiliated with the National Hellenic Research Foundation (EIE).
Given the importance of cord blood (see FAQs), the Hellenic Society of Haematology estimates that Greece needs to collect, process and store at least 10,000 unrelated cord blood unit donations in order to cover the needs of the Greek population and diaspora.
As there must be a high level of genetic compatibility - known as histocompatibility - between donor and recipient, obtaining cord blood from minorities and from the offspring of mixed marriages is also very important.
According to its director Catherine Stavropoulos-Giokas, the Hellenic Cord Blood Bank now has a stock of 2,000 units, which are available to be used worldwide as they are registered with NetCord, the worldwide cord blood bank network.
“It’s very important to have available units and not to have to resort to soliciting donations in times of need,” says Stavropoulos-Giokas, whose bank, like Biohellenika, accepts free donations of placenta.
The cord blood extracted from these donations is not kept in the name of the donor and is available for so-called allogeneic transplantation, that is for use by patients anywhere in the world who need it.
But they are also being used closer to home, in Evangelismos hospital for example, Stavropoulos-Giokas says.
Cryopreservation
Much of the debate over the potential therapies offered by stem cell bank centres on the cryopreservation of mesenchymal cells (see below) from the umbilical cord.
The controversy has arisen because of the growth in private for-profit banks that only serve as storage facilities and do not participate in the public cord blood bank networks.
These mesenchymal cells are stored - at a fee - for a period of 20 to 25 years in the name of the donor.
According to Kokona Kouzi-Koliakou, scientific director with Biohel-lenika, currently about one-tenth of Greek parents opt for the procedure when their child is born, a percentage that mirrors the rates in other European countries, she says.
Of the parents who seek the cord-blood services of the HCCB, “about half” opt for private cryopreservation, says Stavropoulos-Giokas, who insists that parents should be well aware of the options they have.
While research into the application of mesenchymal cells is still at the stage of clinical trials, Stavropoulos-Giokas is adamant that they hold great promise.
“The potential of these cells is well known from bone marrow transplants. They are a solution for a host of problems such as spinal damage, heart defects, diabetes type one and multiple sclerosis.”
Indeed, Kouzi-Koliakou can point to cases where two Greek infants (see left) who developed cerebral palsy after difficult births, were infused, at Duke University in the USA, with stem cells that his parents had cryopreserved with her company.
Whatever they opt for in the end, parents should carefully study their choices, the HCBB’s Stavropoulos-Giokas says.
“They shouldn’t confuse the two: one therapy is free and for allogeneic transplantation; the other, cryopreservation, involves a fee and is for private use.”
Two children’s stories
THE FUTURE of two Greek infant sufferers of cerebral palsy is looking significantly better after the successful implantation of cord stem cells at a leading haematological clinic in the United States.
Both children - Athanasios and Danae - developed cerebral palsy as a result of difficult natural births, during which their brains were deprived of oxygen.
In both cases their parents decided to cryopreserve the umbilical cord cells with Thessaloniki-based cord blood bank Biohellenika, which contacted Duke University, North Carolina, where the revolutionary treatment is being developed.
Danae was 31 months old in July 2009 when she was implanted with her cells. Since then her doctors say she has made significant improvements in her speech and mobility. She is now able to speak more fluently, communicate with her family, stand and walk and, generally, she has more confidence in starting and finishing actions.
“I don’t think we can speak of this child having cerebral palsy any more,” says Kokona Kouzi-Koliakou, scientific director with Biohellenika.
Athanasios, who was 26 months old, had his infusion in late January, which proceeded without any side-effects. His doctors are hoping that he will show an improvement similar to Danae’s.
FAQs
What is cord blood?
After a baby is born and the umbilical cord is cut, some blood remains in the blood vessels of the placenta and the portion of the umbilical cord that remains attached to it. After birth, the baby no longer needs this extra blood. This blood is called placental blood, or umbilical cord blood. Cord blood, for short.
Cord blood contains all the normal elements of blood - red and white blood cells, platelets and plasma. But it is also rich in haematopoietic (blood-forming) stem cells, similar to those found in bone marrow. This is why cord blood can be used for transplantation instead of bone marrow.
Cord blood is being used increasingly on an experimental basis as a source of stem cells, an alternative to bone marrow. Most cord blood transplants have been done to treat diseases of the blood and immune system. It has also been used to restore the functional deficiencies of several genetically based metabolic disorders. To date, more than 70 different diseases have been treated with cord blood transplants.
Source: nationalcordbloodprogram.org
What are mesenchymal stem cells?
Mesenchymal stem cells are found in a part of the umbilical cord called Wharton’s jelly. The only remnant of embryonic tissue in the newborn, these stem cells are collected from a part of the umbilical cord about 15cm of length. The cells are separated through enzymatic digestion, cryopreserved and stored in two cryovials for the next 20 years.
Scientists expect that these cells will play an important role in regenerative medicine, ie the process of creating living, functional tissues to repair or replace tissue or organ function lost due to age, disease, damage or congenital defects. Their most important use, however, is the regulation effect on the immune system that leads to the reduction of so-called allogeneic haematopoietic transplant (not fully matched) rejection in the treatment of leukaemia and malignancies.
Source: Biohellenika
‘Not a question of money’
WELL BEFORE the birth of his first child, Vassilis Vassilopoulos had already made up his mind.
“It wasn’t a question of money,” he says of his decision to preserve his daughter’s stem cells. “Ultimately, you want to do the best for your child.”
But other factors weighed in as well.
“In Greece, you feel a lot of peer pressure, there’s a guilt trip, even before your baby is born,” Vassilopoulos says.
Hold promise
Last December, the journalist and his wife decided to store mesenchymal stem cells after their daughter was born. Current research suggests the cells, harvested from umbilical cord tissue, hold promise in some day treating a host of ailments and injuries.
“I’d first heard of cord blood banks about three years ago,” he says. “I think it’s more a Greek thing. I haven’t really heard friends of mine who’ve given birth abroad talking about it.”
Like many parents, Vassilopoulos did extensive reading before making his decision. Aware that private and public companies offered stem cell storage, he approached both.
“I didn’t immediately rule out using a private company, although I was quite cynical of the situation in Greece considering that there was no legal framework governing the sector, but I decided to see what they would tell us.
“We only went to one private company, which had been recommended to us as one of the better ones. To be honest, it was as if they were trying to sell me a car.”
Impressed
Afterwards, the couple attended a seminar organised by the Hellenic Cord Blood Bank (HCCB), part of the Academy of Athens. They were instantly impressed, particularly as no mention was made of the mesenchymal stem cell option, which costs money.
“I really appreciated the fact that they did not try to sell you anything. After all the other parents had left, I asked the doctor who made the presentation and she informed me about the mesenchymal option, which we finally opted for.”
Vassilopoulos delivered the placenta to the HCCB on the day his child was born, in a specially designed bag. It cost 1,190 euros to have the cells stored for 20 years.
‘Very much experimental’
FOR SECONDARY school teacher Foteini Galati, her decision to use the services of a cord cell bank was ultimately motivated by a desire “to be on the safe side”.
“God forbid, but were anything to happen to my child and cord stem cells could help, I would never forgive myself for not opting for the procedure for the sake of a thousand euros,” Galati says.
That’s how most Greeks think, she feels. “They mightn’t understand exactly what this is all about, but they’ll do it to be safe. On top of that, it’s also become a sort of fashion.”
Introduction
Galati first learned about stem cell banks while attending a prenatal course at a state maternity hospital.
“One morning at the weeklong course, a representative from the Hellenic Cord Blood Bank, of the Academy of Athens, spoke to us. I didn’t ask any questions at that stage, as I knew nothing about it. But other expectant mothers who knew about it asked plenty and I learned from that.”
She feels that the speaker was fair in her presentation of the facts. “She stressed that the procedure cannot help in all illnesses and that everything is very much in the experimental phase. She did mention some cases where sick children did benefit from mesenchymal stem cell treatment.”
Galati added that because she made the conscious choice to give birth in a state hospital the decision to spend the 1,200 euros on stem cell cryopreservation was that bit easier.
Dollars and sense
“I paid 460 euros in hospital fees, plus about 1,500 in under-the-table payments to my obstetrician, which together is a far cry from the 5,000 euros charged by private birthing clinics.”
Ultimately, she opted for the Hellenic Cord Blood Bank “because it seemed the safer option”.
Galati said that while waiting to see her obstetrician, she was handed a brochure by one of the private companies offering stem cell freezing.
“To be honest, I didn’t like their style. It was like they were trying to sell a product and I didn’t trust them.”
ATHENS NEWS 16/11/2009, page: 8-9
