Sep 27, 9:31 PM
By Susan Jenks
FLORIDA TODAY

Brianna Fisher entered the world on June 28 perfectly healthy as the fourth child of Titusville residents Terry and Dr. Brian Fisher.

About three weeks before her birth, the couple decided to store blood from Brianna's umbilical cord, and the potentially lifesaving stem cells inside it, at a private cord-blood bank in Arizona.

There, the blood will sit cryogenically frozen at an initial processing cost of $1,300 and $100 a year thereafter, even if the Fisher family never uses it.

"With all the medical advances out there, we thought maybe they can use it for her or her siblings some day," should a need arise, Terry Fisher said, explaining the couple's reasoning. "We decided to do this and hope we will never have to think about it again."

Once routinely discarded after childbirth, the umbilical cord that connects mother to child has begun to find a valuable niche medically for some children and even some adults with cancers, blood disorders or genetic diseases.

"This is a product that used to be thrown out in the trash," said Judi Cavazos, a nurse who acts as the organ and tissue donation liaison for Holmes Regional Medical Center in Melbourneand Cape Canaveral Hospital in Cocoa Beach -- twohospitals operated byHealth First. "Here is a source of stem cells that shouldn't offend anyone."

During the past decade, researchers have used the blood from the umbilical cord as a backup or substitute "transplant" for some 3,000 patients worldwide who failed to find a bone-marrow match from a sibling or unrelated donor in a public registry. Bone-marrow transplantation is the usual method for rebuilding a damaged or diseased blood supply and immune system after high doses of radiation and chemotherapy.

But whether privately storing cord blood as insurance against a future health disaster in one's family makes biological sense has experts advising caution and urging cost-free anonymous donations instead.

"There is no federal regulation or oversight of cord-blood banking yet," including routine screening tests for cord blood, said Liana Harvath, deputy director of the National Heart, Lung and Blood Institute's Division of Blood Diseases and Resources. "Consumers need to beware."

The federal agency, the principal financial backer of an ongoing study of cord blood that ends next year, considers cord-blood transplantation a "promising, but still emerging, technology," she stressed.

"Families need to consider their financial resources and family history before deciding on private banking" with a for-profit company, she said.

Moreover, even if umbilical cord blood is stored for personal use, "there is no guarantee they (the cells) will be viable, or that a transplant physician will use them," according to Harvath and others.

"A lot of companies play on parents' emotions, telling them if your child gets leukemia (a blood cancer), this will protect them," said Dr. Joanne Kurtzberg, a pioneer in the field of cord-blood transplantation and the director of the pediatric bone-marrow transplant program at Duke University in Durham, N.C.

But, often, even if leukemia is diagnosed when a child is 10 or 11 years old, cancerous cells may be present in the cord blood, rendering it useless, said Kurtzberg, who spoke about organ and tissue donation at a recent conference in Melbourne sponsored by local health-care provider Health First Inc.

However, Kurtzberg, a consultant to the American Academy of Pediatrics, said she supports the academy's position that families with children who already have one of these life-threatening illnesses might consider privately banking a sibling's cord blood for later use. The reason: a better chance for a genetic match and a successful stem-cell transplant.

"Yes, I think it makes sense to put cord blood away, if you already have a child with cancer or a genetic disease in the family," she said.

Donor pool

Otherwise, Kurtzberg and other experts suggest donating cord blood to one of the 12 to 18 banks collecting cord blood in the United States free of charge, such as that at Duke, part of the Carolinas Cord Blood Bank, to expand the scarce donor pool.

Blood donated at these institutions can be used by anyone with a need who has a reasonable genetic match.

Medically, "cord blood is easier to use (than bone marrow), because the immune system is more primitive," said transplant physician Dr. Jan Moreb, director of the stem-cell laboratory at Shands Hospital at the University of Florida.

That means the six genetic proteins sitting on the surface of cells to distinguish "self " from "non-self " in an immune response don't have to match as closely as they do with a bone-marrow transplantation to be successful, or to avoid graft-versus-host disease -- an often-deadly immune reaction in which transplanted cells attack a patient's tissues.

With fewer matchup points, the hope is cord blood eventually will provide a broader, more ethnically diverse choice of donors for an estimated 15,000 to 20,000 Americans now seeking bone-marrow transplants each year without success.

Limited use

Moreb said the number of cord-blood donations in Central Florida is up -- at Shands, averaging 30 to 40 donations a month -- but the use of cord blood still is limited.

One problem is getting ample stem cells from these tiny cords to regenerate blood cells inside the marrow quickly. Dose, or the number of cells actually infused, has been closely linked to cord-blood transplant's success.

"Most surgeons still prefer bone-marrow transplants because we can get more stem cells," Moreb said.

More stem cells translate into better replenishment of blood cells in the marrow, faster recovery for the patient and less risk of dangerous opportunistic infections as the immune system struggles to rebuild itself, he said.

Stem cells are the body's most basic cells, capable of transforming themselves into any type of human tissue. Found in cord blood and bone marrow, stem cells also can be isolated from the circulating blood and from aborted embryos, the richest, yet most-controversial source.

"There is a lot of interest in what these cells do," said Ed Scott, an associate professor in molecular genetics and microbiology at the University of Florida and director of the program in stem-cell biology.

'Mature' cells

Although stem cells can be coaxed into doing more than one thing, he said, "the thing they do best is make blood," so when a patient's blood cells have been damaged by high-dose chemotherapy, or radiation, these cells can resupply all of the blood's components, from infection-fighting white blood cells and clot-forming platelets to the oxygen-carrying red blood cells.

Cord blood is a rich source of stem cells, though more differentiated or "mature" than those found in the embryo, which Scott describes as an "empty slate." That means stem cells in the cord blood are further along in development and harder to turn into the cell type a patient might need, he said.

So, for now, "the jury is still out" on whether, as a source of stem cells, cord blood will quiet the ethical debate over embryonic stem-cell use, Scott said.

Medical promise

Stem cells' medical promise ranges from repairing the heart after a heart attack to restoring function to insulin-producing cells to cure diabetes.

Recent federal legislation, introduced in the House in July, hopes to expand the supply of available cord-blood units nationally to enhance research and step up their therapeutic use, as well as to establish a central registry.

The bipartisan bill, sponsored by eight congressmen, including U.S. Rep. Dave Weldon, R-Melbourne, would pump $45 million in federal funds over the next two years into the creation of a national network of about 150,000 cord-blood units.

"The government has only funded cord blood as research. There are no public funds yet," said Kurtzberg, noting the legislation would provide the first such money.

Yet harvesting and transplanting cord blood is a costly process, averaging $268,000 for the first year, she said. Most insurers generally cover the bulk of that expense, however.

Boosting supply

In Brevard County, some health-care providers also are attempting to boost the cord-blood supply.

Through brochures and planned seminars, Health First, for example, hopes to spread the word to new mothers that a baby's cord blood could bring better health to another child.

Although none of the six local hospitals collects cord blood, interested parents are put in contact with Cryobanks International in Altamonte Springs, a for-profit company that deviates from the traditional for-profit model. It provides a retrieval kit for doctors or hospital staff, along with consent forms for potential donors.

Unlike traditional for-profit private banks, the Central Florida company charges nothing for cord-blood donations, which then are put on at least two international registries, so "anyone can have access to cord blood who needs it," said Dwight Brunoehler, the company's founder and president.

Information about the company's stored cord-blood units is available on the Caitlin Raymond International Registry, run by the University of Massachusetts, and also on Bone Marrow Donors Worldwide.

But Cryobanks also hopes to list its units with a third nonprofit, the National Marrow Donor Program in Minneapolis, by November, according to Brunoehler.

"We are a for-profit company, but we are not making a profit yet," he said. "Right now, we do everything a nonprofit does, except we pay taxes."

Brunoehler said the company hopes to make money in the future as "the inventory source of record" for cord blood, or through the success of several research ventures it sponsors, including one at the University of South Florida, involving amyotrophic lateral sclerosis, or Lou Gehrig's disease.

The idea would be to patent and license whatever drug products might evolve, Brunoehler said.

At least one well-known biotechnology company, California-based Amgen, already has succeeded using this tactic.

"They made a gazillion dollars over marketing a growth factor that tells the bone-marrow stem cells to make more red blood cells," said the University of Florida's Scott. "I think, eventually, we will be able to do this for many other types of cells."

Duke's Kurtzberg also envisions endless possibilities one day.

"We are on the brink of many cellular therapies" involving stem cells, she said. "I think we are on the brink of a whole new era outside simple blood repair."