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eMedicineLive - Stem Cell Banking - Dr.Saranya Narayan Interview

Stem Cell Banking - Dr.Saranya Narayan Interview

Dr.Saranya Narayan is the Medical Director of Jeevan Blood Bank & Research Centre, one of the few centers in the country that offers cord blood stem cell banking. Jeevan in a non-profit organisation and in the past 12 years has made available 1,20,000 units of blood and blood products to the community. Jeevan started its cord blood bank in 2008 and offers both public and private banking of cord blood stem cells. As the organisation is not for profit, the cost of private stem cell banking is less at Jeevan compared to other stem cell bankers. Jeevan cord blood bank serves all parts of India and couples who wish to preserve the cord blood of their baby can contact Jeevan through the contact information given below.

1)What are the diseases do think can be managed with the stem cells if I store my baby's stem cells now?
Currently the hematological or blood related conditions, both benign and malignant can be treated with stem cells. Eg of benign conditions would be thalassemia , red cell disorders, platelet disorders etc and malignancies such as all forms of leukemia. In addition, a few other conditions such as stroke and spinal cord injuries have been treated with a fair degree of success. Initial trials are going on in various other conditions like auto-immune disorders such as Diabetes Type 1, Rheumatoid Arthritis, cardiac ailments like myocardial infarction (heart attack) and cardiac failure, various other neurolgical illnesses such as Parkinson's disease, cerebral palsy to name a few. The results from these trials look very encouraging, and in a few years hopefully, there should be more concrete information.
 
2)What is the extent of geographical area your organization provides service? You center is based in Chennai. Suppose a couple in Kanyakumari wants to preserve the stem cells. Can  you help them?. If so how do you transport the cord blood from Kanyakumari to Chennai. Does the cost of storing cord blood stem cells differ if the baby is delivered in Kanyakumari rather than in Chennai, considering the additional cost of transport?
Barring two states in India, we have collected samples from all other regions in India. We can certainly help a couple in Kanyakumari as long as there is a functional courier service or the family is willing to take the responsibility of bringing the sample to Chennai. Our temperature controlled collection boxes are picked up by the designated courier service from the hospital and brought to us within 24-48 hrs of collection of the sample. If it is a private banking sample, the cost of storing the stem cells remains the same irrespective of where the sample is collected from. If it is a donated sample, there is no cost involved.
 
3)You provide both public and private stem cell bank. The awareness among the public regarding the potential utility of cord blood is pretty low. How do you ensure you get regular cord blood donations for the public bank?
Compared to a few years ago, awareness levels among the obstetricians and the general public has improved tremendously. We get our registrations a) directly through our website,b)  through word of mouth from one family that has experienced our services, c) through awareness talks we give at various forums, d) through information brochures that we place at doctor's clinics and e) directly from doctor who suggests donation of cord blood to her client.
 
4) Most cord blood bankers claim that they provide a biological insurance against a variety of diseases including hematological malignancies. The likehood that the stored cord blood may be used later for the same baby is very minimal. The incidence of hematological malignancies in the general public is not very high to warrant such a storage during every child birth. There are also critics who argue that one's own cord blood may not be suitable for use in case of hematological malignancies as if may also contain the same genetic defect. Many major medical societies do not encourage storing cord blood for personal use. But alternate thought is that with the rapid research work going in the stem cell field, there ought be some breakthrough in the next 1 to 3 decades and failing to preserve the stem cells now may deprive us of the ability to use some stem cell based therapeutic modality later especially for common diseases like coronary artery disease and diabetes. What is your opinion on the necessity of storing cord blood for personal use later. Should everyone be encouraged to do that ?
No, there is no need to encourage everyone to do this. If however there is a requirement in the family or an illness that might require stem cells at a later point in time, it will be useful. In any situation, the family must be informed that the likelihood of using the cells is minimal and subject to HLA compatibility, and if despite knowing this, they are ready to set the money aside, then they can opt for private banking.
 
5) Do you have any success stories based on the preserved stem cells in your center?
We have had no issue of stem cells as yet. The numbers we have with us are very small currently and once our numbers increase, I'm sure we will have success stories to share with you.

6)Given a chance  and if it does not affect the baby in anyway most couples would want to store the cord blood for what ever it is worth as future scientific breakthroughs may open up possibilities that are not available now.  But the major limiting factor is the cost of storing the cord blood. How much does it cost for preserving the cord blood stem cells in your private bank? You are a non-profit organization and hence does the cost of stem cell banking lower at you center compared to other commercial entities involved in cord blood banking?
We have two packages - With HLA typing and without.
 
With HLA typing - we charge Rs 55,000 /= for a period of storage of 21 years
Without HLA typing - we charge Rs 40,000 /= for the same period.
 
We basically work on a cost recovery basis and have kept our costs as low as possible. I would not like to compare our costs with any of the other organisations.

7) When the first child is born, most couples are in delicate financial situation as they are young and have less savings. Cost seems to be factor for them when opting to store the cord blood stem cells. Since the cost is calculated for storing 20 years or so, it seems to be high. Is there an option for storing the cord cells for 5 years, as most of the diseases such as childhood malignancies, where the cord cells seem to be a solution occurs in a relatively young age. And if needed after 5 years the cord cells can be stored still more for 5 years.
We do not have such an option currently.
 
8) Does the collection of cord blood affect the baby's well being. Some critics claim that collection the cord blood may deprive the baby of 50 to 100 ml of blood with increased risk for anaemia and depletion of neonatal iron stores. What is your opinion on this?
Cord blood is collected only after the cord has been clamped and cut. The blood that remains in the placenta and cord that is of no use any longer to the baby is collected. As long as the cord blood collection is done by trained personnel and only after the baby has been separated from its mother, it does not harm the baby at all. If the cord blood is collected before the cord stops pulsating, then there is a possibility of the baby being deprived of blood. This does not happen as the obstetrician takes the decision on the cord clamping and it is ONLY with her concurrence,  that the cord blood can be collected.
 
9) The number of stem cells collected in the cord blood sample may be inadequate to match the adult life requirement later. Also some of the stored samples would turn out unviable later due to technological errors. Is there a process available to increase the number of stem cells by propagating them in a media just like other cells?
As long as the initial counts pre-storage are fairly good, the cell viability is between 90 and 100% and the storage conditions are optimum, cells placed inside the liquid Nitrogen cylinder have been found to remain viable for upto 24 years. Cell expansion or multiplication of cells in the laboratory is possible as a research tool. However, as of now, there is no information available on the optimum storage conditions for these  expanded cells. 

10) In the west where the cord blood banking industry is mature, how many percent of stem cells stored are utilized later ?
Stem cell therapy is a field of medicine that has grown rapidly since 2006.While it has been roughly at the rate of 2000 CB transplants a yr since 2006, predictions are that by 2015, it will be 10000 transplants each year.Currently of those requiring transplants in the US, one in every 2 Caucasians are able to find a match, while only 1 in 16 Asians or Pacific Highlanders are able to find a match. This is basically because of the roughly 160,000 CB units that have been banked, most belong to the Caucasian race. Hence while several units may not be utilized for several years, the larger the inventory size, the greater a likelihood of finding a match for all those who require it.

Probability of a person receiving an autologous transplant of her own cells is .02% by age 20, .05% by age 40, and .23% by age 70 years (ie: 1 in 435 by age 70). Probability of a person receiving an allogeneic transplant of cells from a donor, with no limitations on donor availability, is .04% by age 20, .10% by age 40, and .25% by age 70 years (ie: 1 in 400 by age 70). The net probability of a person receiving either type of transplant is .06% by age 20, .15% by age 40, and .46% by age 70 years (ie: 1 in 200 by age 70). (Reference - Nietfeld et al. 2008)
 

Contact Information
Jeevan Stem Cell Bank
18, Besant Road (off Lloyds Road),
Royapettah, Chennai 600014, India.
phone: +91 44 43524242, +91 44 28351200, +91 97908 97918
e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it.
website: www.jeevan.org