Why is cord blood collected? How is the collection procedure performed? Does it make sense to save the placenta? Where can this biological material be stored? How to choose a cord blood bank? In Western countries, these questions of pregnant women are answered by a doctor. In Ukraine, future mothers often look for information about cord blood and placenta storage on their own. One of the ways to familiarize yourself with this topic and make a decision whether to store the umbilical cord blood and placenta is to visit the Doors Open Day, which is held every month by the leading Ukrainian cord blood bank, launched in 2003 at the Institute of Cell Therapy.
Cord blood stem cells are a unique donor material
Stem cell transplant may be needed in various diseases. Bone marrow stem cells are widely used in the world, but their obtaining and use is associated with great complications: it is very difficult to find a donor with a sufficient degree of immune similarity – at best, the probability of matching is 1:1,000, but it can reach 1:1,000,000, therefore sometimes the patient has to wait too long for the transplant. In addition, obtaining hematopoietic stem cells is associated with painful and сomplicated intervention – they are taken from an adult donor, to whom a surgery has to be performed to extract a certain amount of bone marrow, sometimes it needs to be done repeatedly.
Cord blood is unique in that it is the most accessible source of stem cells. Its collection is safe and ethical, in most cases it is possible to collect enough blood volume to isolate the number of stem cells necessary for treatment (for different diseases it may be different). Cord blood stem cells are used throughout the world (and in Ukraine) as donor, that is, they are selected based on immunologic indices, and also – what is a huge advantage – as autologous. That is, stem cells obtained at birth of a child can later be used for it without the risk of an immune mismatch. They are highly likely to be compatible with the immune system of a child’s siblings, sometimes they can be used for close relatives. In addition to different types of stem cells (mesenchymal, hematopoietic), cord blood also contains other types of cells that are also used in medicine. The most valuable of them are endothelial progenitor cells that are promising in the treatment of vascular diseases. Due to the number of stem cells, umbilical cord blood is recognized as an alternative to the bone marrow, it has more stem cells and they have a higher potential for division in comparison with peripheral blood cells.
Where is the cord blood stored?
Most countries are banking umbilical cord blood, i.e. the services of umbilical cord blood banks of various forms of ownership are provided. The storage of this biological material launched in USA – in 1992, the first cord blood bank was created there. Today, in 28 American states, various educational programs have been introduced, in the framework of which the doctors should inform a pregnant woman in the second – early third trimester of pregnancy about the opportunities to store the umbilical cord blood and donorship of this biological material. Women have a choice: to donate the umbilical cord blood to a public bank for donor purposes or to store it in a private cryobank for personal use. The activities of public banks are financed with the expense of taxpayers, and there are states in which citizens themselves can decide that they want to transfer part of the income tax to maintain the public system of umbilical cord blood banking.
In Europe, in accordance with the resolution of the European Parliament of September 11, 2012, all women and men in the European Union countries should receive information on the possibilities of umbilical cord blood storage. Now all over the world, such banks are storing nearly 5 million cord blood samples. Approximately two-thirds of them are stored in private banks (they are also called family-type banks), about a third – in public cord blood banks, which are supported by state budgets. There are simultaneously state and private banks in some countries (among them the US), in some, like in Ukraine, only private cord blood banks are operating, and some countries only allow state banks to operate. For example, in Italy, private storage of stem cells was prohibited until 2009, in China and Iran it is not allowed now, and 16 banks of various forms of ownership operate in South Korea.
Cryobank, whose Doors Open Day we have visited, is a part of the structure, uniting several medical units. This is directly the Institute of Cell Therapy, Cord Blood Bank (Cryobank in Kiev), Clinic of Cell Therapy, the Institute of Cell Therapy Center of Science, as well as innovative clinic Tilaclinic. All divisions have licenses for activities, diplomas and accreditation certificates of the Ministry of Health of Ukraine, as well as confirmation of compliance with ISO 9001:2015 quality standards. Patents and certificates of authorship on the developed methods of freezing, isolation and storage of various types of cells are the subject of pride of the Institute of Cell Therapy. Learn more about scientific advances here.
Cryobank specialists do not disclose details of the cell cryostorage technique. It is based on the results of 50 years of research by Galina Lobintseva, PhD, Ukraine’s State Prize holder in the field of hematopoietic cells cryopreservation for clinical use – this is the person, who heads the Institute of Cell Therapy Cryobank. Due to the unique elaborations in the field of cryoconservation, which are used only in the Cryobank and meet the strictest international standards, biological material can be kept utmost viable for unlimited period of time. After thawing, up to 96% of cells remain viable.
Storage of the placenta: why expectant mothers should not reject such an opportunity
For centuries, various nations have used the placenta as a therapeutic and cosmetic agent. It really contains a unique set of substances, as it provides good nutrition for the developing fetus. After giving birth, this valuable biological material can either be disposed of (as it was done before), or collected for the purpose of further storage. The peculiarity of the placenta is that different preparations can be obtained from it, depending on the processing and storage methods. One of the ways is to extract mesenchymal stem cells from the placenta tissue and then to store them, as well as to prepare the placenta extract. Cryobank experts recommend that women store this biological material, as its presence in the future will provide great therapeutic opportunities in the treatment of various diseases (for example, vascular) to all family members, because placental preparations do not require immune compatibility. In addition to therapeutic purposes, they are also used in cosmetology.
How is the collection of cord blood and placenta performed, as well as their delivery to Cryobank
The expected date of delivery and the maternity hospital, where it is scheduled, are indicated in the contract with Cryobank for the collection and storage of umbilical cord blood, placenta and umbilical cord (or only umbilical cord blood at the request of the family, entering into the contract). 10 days before the estimated date, the Cryobank delivers to the maternity clinic a personalized thermocontainer, containing all the necessary containers and materials for cord blood and placenta collection. The biomaterial is collected by a midwife or obstetrician-gynecologist, who are present at childbirth. All of them undergo training, at which Cryobank representatives recall the rules for the cord blood and placenta collection. This whole process is regulated by the orders of the Ministry of Health of Ukraine, so the woman does not need to worry whether the midwife or doctor knows how to collect the biological material. Cryobank will provide the delivery of the collected biological material from any city of Ukraine within the required time.
Laboratory testing of blood quality
All biological material is tested in a certified laboratory directly in the cord blood bank. While blood and placenta samples are checked for infections, all the biological material obtained is processed, the stem cells containing fraction is isolated, a cryoprotectant (a substance protecting the cells during freezing) is added to it, the volume is divided into small ampoules and cooled using special equipment. The family, that has signed a storage agreement is informed on the obtained results of laboratory tests. If there are no infections, the ampoules are transferred to tanks with liquid nitrogen, where stem cells, placenta extract, and other biomaterials are stored at -196°C.
Communication within the framework of the Doors Open Day at Cryobank also involves issues for expectant mothers. Answers to them will certainly be useful for future parents, who plan to preserve the umbilical cord and placenta at birth.
– Is it true that stem cells can only be stored for 20 years?
– This is not true. Theoretically, at a temperature of liquid nitrogen (-196˚С), stem cells of umbilical cord blood and placenta can be stored indefinitely. The cord blood bank of the Institute of Cell Therapy has its own experience of using cells that have been stored for 30 years: they were defrosted without changes. However, Cryobank signs a contract for the storage of stem cells for 20 years. This is dictated by the fact that upon reaching the age of majority the child can resign the contract and deal with the saved cells at their own discretion.
– Where can stem cells be used for treatment?
– In many diseases, treatment with the use of stem cells can be taken at the Cell Therapy Clinic. But there are no restrictions. If the depositor, that is, the one who has stored the cells, wants to use them in any other clinic, regardless of the form of ownership, they will receive their holding (or part of it – on demand). This applies not only to clinics in Ukraine. In many cases, it is possible to deliver and use stem cells in clinics in other countries.
– Can the maternity hospital refuse to collect the material?
– According to the law, cord blood or placenta collection can not be refused. The only situation when the refusal will be justified is the circumstances, in which it was a question of saving the life of the mother and child. Fortunately, this happens very rarely.
– Can a maternity clinic ask for something to bring or any extra payment for the collection of blood?
– Collection of cord blood and placenta is carried out as a part of the birth process and is not associated with any difficulties for doctors, does not require additional training or special skills. In the container that Cryobank delivers to the maternity hospital, there is absolutely everything that is needed to collect the biological material: sterile containers, gloves, alcohol, needles – everything that may be needed.
– How is Cryobank informed about the need to collect the container from the maternity clinic?
– The relatives of the woman in labor should inform the Cryobank about it. This can be anyone: husband, mother-in-law, sister, or even a maternity hospital employee, if a woman asks for it. The Cryobank must be provided with the following information: the name and surname of the pregnant woman, who signed the contract, the contract number and the time when the birth took place
If you have questions about the use of stem cells, the collection and storage of cord blood, placenta and umbilical cord, the work of Cryobank – you can personally ask about everything during the Doors Open Days, which are held every month, every last Saturday of the month.