Banking on a cure
STATEN ISLAND, N.Y. -- At 7 pounds, 14 ounces, Briana Reese Britman's birth four months ago was bittersweet. Arriving nearly two weeks early and by C-section, she was a welcome addition to the family of four.
But lying in the hospital bed at Richmond University Medical Center, new mom Josette Britman couldn't help but ponder the "what ifs."
"If I would have had her three years ago, I could have saved my father's life," recalled the 36-year-old Eltingville woman during a recent interview in her home.
It's why Josette and her husband, Brian, decided to have stem cells from Briana's umbilical cord blood and placenta banked. Her father, Joseph Pontrello, died from leukemia in 2004.
Stem cells have been used in treating over 70 medical conditions, including leukemia, sickle cell disease, and certain types of cancer and immune system disorders. A stem cell transplant can cure some diseases and put others into remission.
The transplant is an injection of healthy stem cells into a patient that morph into and create new cells to replace those lost to disease.
Cord blood and -- more recently -- placenta-derived stem cells are known as "adult stem cells" because they are not harvested from embryos. They are a perfect match for the donor baby and can potentially help siblings and other family members.
'PEACE OF MIND'
"It's a little peace of mind," said Brian, whose mother died from complications of multiple sclerosis earlier in the year.
Banking cord blood is a practice that a growing number of families are choosing, especially those with a history of medical risk factors.
"More and more couples are requesting banking of the cord blood for possible further use," said Dr. Michael Moretti, chairman of obstetrics and gynecology at RUMC. Over the last few years he's seen it increase from about 10 percent of couples to 40 to 50 percent at the West Brighton hospital. "It's commonplace to do it now."
But placenta banking is another story.
"The placenta is relatively new and somewhat experimental," said Dr. Moretti. "We don't get as many requests for banking of placental tissues because that's still in its early stages."
Since April 2006, LifebankUSA, a biotechnology firm and private cord blood banking company in Cedar Knolls, N.J., has been cryogenically freezing placenta-derived stem cells. To date, more than 1,200 couples have opted for the pioneering technology.
Developed by Dr. Robert Hariri, a Somerset County, N.J., neurosurgeon, the procedure draws cells from the placenta, which has a richer supply of hematopoietic (blood-forming) cells than the umbilical cord. These cells can transform into red blood cells, white blood cells and platelets, as well as other types of tissue.
"Tragically the placenta's been a resource that's been thrown away for years and years and people have ignored it," said Dr. Hariri, CEO of LifebankUSA.
Plus, these stem cells have many of the same characteristics of cells extracted from embryos with none of the ethical or biological limitations.
For example, when you recover stems cells from an embryo you don't necessarily know whether that embryo was of "good enough quality" to go on to a full-term normal pregnancy, explained Dr. Hariri.
"The benefit of getting cells from the moment of birth is that those cells have gone through nature's quality control process," he said.
COLLECTION KIT
Couples like the Britmans are given a collection kit to take with them to the hospital at the time of delivery. Once the baby is born, the umbilical cord is cut and blood from it is drained and collected. The intact placenta is placed into a sealed bag.
Both the cord blood and placenta are put inside the kit along with maternal blood samples. The kit is then brought by courier to the Cedar Knolls complex for processing.
According to Ralph Fariello, director of LifebankUSA, an average of 25 kits are processed each day. The site operates on a 24/7 basis.
Starting in the protocol verification room, client kits are checked for a 12-number bar code on each sample to ensure that all codes match.
From there, the samples are parceled out to one of four different labs for testing, processing and storage.
During a recent tour of LifebankUSA, a lab technician was observed through a window massaging a placenta to draw out blood and fluids.
Next, the organ is brought to a lab to be infused with liquids for several hours. A pinkish solution is collected and its components separated -- white blood cells (where the stem cells are found), red blood cells and plasma -- by a centrifuge.
The stem cell portion, which includes the white blood cells and a small percentage of red blood cells, is put into a freezing bag and then a metal cassette.
Before storing, the cassette is placed in a controlled-rate freezer to lower it from room temperature.
CRYOGENICALLY FROZEN
The chilled cassette is then placed in a stainless steel, vapor-phase liquid nitrogen-cooled freezer tank, which holds between 4,000 to 9,000 units. The temperature inside hovers at -196 degrees Celsius.
"It's cold enough that if you took a rose or flower from outside and stuck it in there and then pulled it out and dropped it on the floor, it would shatter," explained Chris Goodman, director of operations of Celgene, LifebankUSA's parent company.
Weeks after the Britmans complete the banking process they are told it yields 728,200,000 nucleated cells -- of which 2 percent or about 14 million -- are stem cells.
The cost of the procedure: $2,950 for both placenta and cord blood banking, or $1,850 for just the cord blood. Add to that a yearly storage fee of $125 for cord blood or $225 for both.
"The ordinary person can do this. It's feasible," said Brian, 38, an appliance repairman and owner of AAA Appliance in Eltingville.
The Britmans' reason for banking both is based on supply and demand -- a limited amount of stem cells and the potential for its need.
"This gives me twice the chance of helping someone," said Josette, a mother of twin 11-year-old boys and a fourth grade teacher at PS 16. "If my husband got sick and then one of my kids got sick, I would be able to help both of them with the two collections. If I only did the cord, I would only be able to help one of them."
When a stem cell transplant is done, the doctor uses the entire unit, said Dr. Hariri. This is one of the reasons that cord blood and placenta-derived stem cells are frozen in separate units.
"There isn't a convention today for recovering stem cells, banking a portion of it while using another portion of it," explained Dr. Hariri.
Researchers are looking into whether these stem cells can be used to treat illnesses such as Parkinson's disease, lupus, multiple sclerosis, arthritis and diabetes.
Such scientific investigation gives Brian, who periodically deals with bouts of rheumatoid arthritis, much hope for the future.
"This is the only way that I figure we have a chance."
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posted by Bill at 9:44 PM
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