Banking on stem cells5 min read . Updated: 03 Dec 2013, 12:05 AM IST
Stem cells industry is setting itself the target of going from 2 per 1,000 to 5 per 1,000 babies over the next 2-3 years using aggressive awareness campaigns
New Delhi: One of the first decisions Shivangini Chaudhury took as a mother-to-be in 2012 was to opt for cord blood banking. However, the decision to freeze stem cells—cord blood is a rich source of stem cells—was not informed by research. She did not know how exactly it would help her child. Rather, wishing to do whatever she could for the unborn baby, the decision was an emotional one.
Manisha Jain, pregnant with her second child in October, pondered over the option for a while before deciding against it, for the second time. “A lot of the information is contradictory and the ethical implications (of how cord banks market themselves) concern me. Most stem cell banks market the service as an insurance, to almost mean that if you don’t opt for it, you are already bad parents—even before the child has arrived," she said.
Whether or not to store cord blood is one of the first tests of parenthood young Indian couples tackle these days. Cord blood banks offer to freeze and store the baby’s stem cells for up to 20 years, during which they can be used in medical emergencies.
For many would-be parents in India—like Chaudhury—it becomes an emotional decision because of the hard-sell surrounding cord blood banks as a way to insure the child against terminal ailments.
Cord blood, the blood that remains in the umbilical cord after birth, is a rich source of stem cells that are used for transplants as they regenerate other immune cells. Stem cells can be used to regenerate any body part as these primitive cells have the potential to be developed into any kind of tissue.
Cord blood is one of three main sources of stem cells, the others being bone marrow and embryonic cells. Bone marrow treatments usually require accurate matching with the donor, making the process complicated. Treatment options based on embryonic cells are considered controversial due to the requirement of embryo from waste foetus, such as the foetus from an abortion or a stillbirth. This leaves stem cells found in the cord blood as the most efficient for therapy.
Experts maintain that the use of embryonic stem cells evokes extreme responses from to-be parents. “Globally, the notion is perceived to be against Christianity, but in the Indian context, the therapy is yet to take off because of the level of discomfort from parents. Additionally, despite a lot of research going on in this area, there are very limited proven therapeutic results, which makes the option not worth pursuing," said a gynaecologist not wanting to be named.
The cord blood collected from a newborn is “cryopreserved" for 21 years. The process involves cooling the cord to −90 degrees Celsius, and then adding it to a liquid nitrogen tank where the cord blood is kept frozen at −196 degrees Celsius.
Stem cells from cord blood have been used in the treatment of more than 80 diseases, including leukaemia, lymphoma, multiple sclerosis, thalassemia, multiple myeloma and sickle cell anaemia.
However, the rate of usage in India is minimal. LifeCell—India’s largest accredited stem cell banking company—has released only 23 cord blood units for therapy out of an inventory of 70,000 units.
According to the Association of Stem Cell Banks of India, over 1.6 million units of cord blood are stored in 15 private banks.
Industry experts maintain that penetration of stem cell banking in India is very low, with the parents of only two per 1,000 babies opting for the service, against 50 per 1,000 in the US and 250 per 1,000 babies in Singapore.
Seeing the potential for growth in this sector, a number of private companies and even high-end hospital chains have moved into regenerative medicine, which uses stem cells from placentas, umbilical cords, aborted foetuses and even menstrual blood to treat a range of diseases.
The association maintains that cord blood banks in Gurgaon alone are reporting nearly an exponential increase in business every month. Banks in Gurgaon, a satellite city of Delhi, collect at least 500 samples every month, it says. Across India, there are three cord blood banks in the public sector and 15 private banks. “More recently, uptake has been increasing substantially. Keeping that in mind, we have launched more affordable EMI (equated monthly instalment) programmes. We are, however, hopeful because advances in science will harness the potential of stem cell in regenerative medicine and this science will be used for newer indications (diseases). Five new trials are currently being conducted for conditions that were not anticipated earlier. So the market is set to expand exponentially," said Mayur Abhaya, who heads the newly formed Association of Stem Cell Banks. According to Abhaya, private stem cell bankers across India add more than 50,000 clients every year. As a result, the industry is setting itself the target of going from two per 1,000 to five per 1,000 babies over the next two-three years using aggressive awareness campaigns.
However, like other new sectors in health, the stem cell industry, dominated by private companies, remains largely unregulated. The Indian Council of Medical Research (ICMR) has only a draft set of guidelines for stem cell research. Since no laws govern stem cell banking in India, most cord blood banks have to get an approval for laboratory status from the state government.
“We are hoping to have the regulations in place by the end of this year. The stakeholders have given us feedback on the guidelines and I hope the department of health research will be able to notify them within next month," said V.M. Katoch, director general of ICMR.
India’s first private cord blood bank was set up in 2004 by Chennai-based LifeCell in partnership with US’s Cryo-Cell International, one of the world’s largest and oldest stem cell banks. In its attempt to make this facility available for middle-class families, LifeCell has reduced the charge (for storing stem cells for 21 years) to ₹ 19,990 from ₹ 70,000 with an additional annual fee of ₹ 3,500.
“We want middle-income families to start storing cord blood units as well. It is a good gift to someone having a child. There are studies that show that 1 in 2,700 units is utilized,but for that particular family, which uses its frozen unit, this technology is invaluable. The costs have been reduced to make it a viable option for the masses," said Paramjit Dhot, medical director at LifeCell. The facility is available in 80 cities in India.