A new kind of bank in town

It might not be the cutest thing about a new born baby, but the umbilical cord hanging from its belly may just save its life one day if you happen to freeze and store away part of its contents, that is. Though mainly packed with blood and goo, umbilical cords contain a rich supply of highly malleable stem cells. These are considered “unassigned” cells, ones which can later be employed as heart, brain, liver or hair cells, or in fact any other cells that may help to treat previously incurable diseases and disabling injuries.

Yet there’s a catch: these precious virgin cells start to die within five minutes of the baby’s birth. So how to catch them and keep them safely stored? Enter the newly established Cell Safe Cord Blood Bank. Operating since May 2009, Cell Safe essentially provides parents with the means to extract and store stem cells from their child’s umbilical cord. The process is known as cord blood harvesting.

The procedure is straightforward: upon delivery, a trained doctor extracts the cord blood and places it in a special container, which is then transferred to the bank’s laboratory where centrifugation singles out the stem cells. Once separated and coded for computerized identification, the packed cells are then directed to a large container where they are frozen in liquid nitrogen at -200°C. There they lie, indefinitely, only to be revived if misfortune befalls their owner or a close relative.

This type of bank is officially the first of its kind in Egypt. Its general manager is Hisham Issa, a lab doctor who specializes in blood diseases. “One of my closest friends had leukemia,” says Issa, describing how Cell Safe came about. “We travelled the world looking for matching stem cells to help with his treatment, but we couldn’t find any, and he died. That day, I decided to create a stem cell bank in Egypt.” The use of stem cells has attracted controversy and stirred an ongoing debate about the ethics of techniques used to harvest them. One method involves extracting the cells from human embryos, which are destroyed in the process – something pro-lifers object to, claiming that it is a form of murder.

Alternatively, adult stem cells can be taken from grown individuals to help treat certain diseases, but this method does not currently offer the same flexibility or potential as that of extracting stem cells from embryos. Stem cells from cord blood, on the other hand, avoid any ethical dilemma, and unlike adult stem cells, they have a higher chance of matching with close relatives of their owner. The problem is that if one’s parents do not opt for this newly available form of health insurance at the time of one’s birth, any future opportunity to make use of it is lost.

Issa first went to the Ministry of Health proposing the idea in the hope of making cord blood harvesting viable for Egyptians. “They had no idea about it,” says Issa, “so we worked together to help formulate a regulating law which all cord blood banks now have to follow.” Issa says that these regulations incorporate international regulatory standards, with an added requirement of obtaining approval from Al-Azhar, which Cell Safe has already done. So far almost 80 clients have deposited their children’s cord blood for storage in the bank, and Issa expects to ultimately reach a target of about 500 new customers per year. To date, no client of Cell Safe has withdrawn a stored sample. International retrieval rates average at about one in every 4000 samples, or one in just over 250 amongst samples from children with a family history of certain diseases.

The obvious question now is why Cell Safe is not overwhelmed with anxious couples wishing to store their expected infant’s cord blood. This may however have something to do with the LE11,500 necessary to extract the stem cells and to store them for the first year. Subsequent storage years are charged at LE1000 each, though slightly cheaper if paid in bulk. It’s a hefty price tag for most in Egypt, one that increases by LE600 for Egyptians outside Cairo, and one may well wonder what would happen if the building housing the storage containers collapses or if the electricity is cut.

“The containers are not dependent on electricity to do their job, but just on the liquid nitrogen, which has a normal temperature of -200°C,” explains Issa. “They are also fire and collapse resistant, and can last without a new supply of liquid nitrogen for one month – enough time to ship them anywhere in the world if necessary,” he says; which, in such cases of emergency, would be carried out free of charge. Nevine Hamdy, due to deliver within days, is not convinced. “I did some research and found that the amount of stem cells extracted from umbilical cords were only sufficient for treating kids, not adults,” she says. “Also giving birth itself costs about the same as having this procedure done, so having to suddenly pay double to deliver is a little much, especially since there may be alternative ways to treat some of the diseases [treatable through stem cell technology].”

But would she consider it if the service were cheaper? “Absolutely,” she says. Mohamed Abul Ghar, a radiologist with a background in stem cell research, says that cord blood harvesting is important, and that it is scientifically and ethically sound, though he also notes that its application at the present time is very limited. "It’s not cost effective either," he adds, "and by the time regenerative medicine really kicks off in the future, other sources [of stem cells] will have been perfected." Assem el-Essawy, a share holder at Cell Safe, holds a different view. After his wife unexpectedly delivered their baby prematurely, he was impressed at how responsive the bank was in dispatching the doctor to collect the cord blood, “and neither the doctor nor the person who I called knew I owned any shares,” he affirmed.

More to the point, however, el-Essawy, who has a background in medicine, says that even if there are limitations to the use of stem cells collected from umbilical cords, the current rate of advancement in stem cell based treatments suggests that the near future will see these limitations largely eliminated. "If you can afford to spend money on the best [stroller], bed and so on for your child," he says, "then this procedure is a worthwhile investment for the future." Ultimately, Cell Safe plays no role in how the retrieved stem cells are used. “We don’t interfere with the delivery … and we are not involved in stem cell treatments,” says Issa. Cell Safe’s mission, as its name implies, is merely to keep those precious cells safe.