Monday, August 21, 2006

Two years ago — just as a precaution — Cathy Pell decided to store the umbilical cord blood stem cells when her fifth child, Abby, was delivered. “I’ve always had the easiest pregnancies,” Mrs. Pell says. “I was doing it for the benefit of our other kids or anyone [else]. I didn’t know how it worked.”

A complication involving her digestive system caused Mrs. Pell to have a traumatic birth, leaving young Abby with serious medical complications.

“She had moderate to severe brain damage in three out of her four lobes,” she says.

Neurologists told Mrs. Pell there was nothing they could do to reverse the damage.

“Everywhere you went you got a door slammed in your face,” she says. “Thank God we’re hardheaded.”

They finally found Dr. Joanne Kurtzberg at Duke University. Dr. Kurtzberg works with umbilical cord cells and agreed to infuse Abby’s stored cells into her brain.

Storing cord stem cells sounds like more moral quicksand. Stem cell research is the hottest of hot-button topics of late, what with President George W. Bush’s recent veto blocking federal funding for such research and some scientists announcing the cells could help cure a number of stubborn diseases.

But the cells culled from a baby’s umbilical cord involves material typically discarded, making it a far less contentious source of biological materials.

The Cord Blood Registry’s Newborn Possibilities Program seeks to offer hope to infants at risk of developing neurological disorders. All parents are eligible for the program, but likely those whose children fail their Apgar test — which measures a baby’s physical condition at birth — will consider using it.

The program stores the cells at no charge for the first four years of a child’s life, the window of time when the cell injection program may be of some benefit. Parents wishing to continue storing the material must pay an annual fee of $125. The Cord Blood Registry (CBR) preserves more than 400,000 newborn stem cell units from more than 130,000 families worldwide. The Newborn Possibilities Program is a new offshoot of this service.

Researchers aren’t sure precisely how much hope the infusion process provides, but for Mrs. Pell, the evidence is already conclusive. Abby underwent her first infusion in February 2005 when she was 5 months old.

Before the first of two infusions, which cost $10,000 each, “[Abby] was always Stevie Wonder,” she says, her daughter’s head turning left and right without looking at anything or anyone. “Two weeks later, she looks straight in my eyes and smiled big as day. … I knew in my heart it’s working.”

Today, at 22 months old, Abby can sit up and reach for her toys, Mrs. Pell says.

CBR adviser and pediatrician Dr. Robert Sears says using stem cells to repair brain injuries has been going on for years with animal subjects with “very promising results.”

“This is really brand new in humans,” Dr. Sears says. “Maybe a handful of babies so far have undergone the treatment.”

Currently, about 70 diseases are treated with cord blood stem cells infused in areas other than the brain, many of them concerning blood disorders, Dr. Sears says.

Dr. David Perlmutter, a neurologist based in Naples, Fla., says using these particular cells in the human brain is “a bigger stretch” than the blood replacement scenario.

“Having [healthy] brain cells alone is half the battle … having them connect together is another matter,” says Dr. Perlmutter.

That said, Dr. Perlmutter strongly endorses banking such cells, if only for the hope that future breakthroughs will enable doctors to use them to treat patients in ways not possible today.

Stem cells carry the capacity to branch out into different cell types, from blood cells to neurons, but Dr. Perlmutter is cautious to ascribe success to the early cases of cord cell infusion in the brain. If progress does occur, it could be due to the relative age of the infants in question.

“It’s an age where there’s still development in the brain,” he says.

The doctor also warns of potential complications from the infusion process.

“Anytime you engage in a technique, there’s certainly the possibility of some untoward reaction,” he says.

Valina Dawson, a neurology professor at Johns Hopkins University School of Medicine, cautions that researchers still don’t know enough about cord cells to promise credible hope.

“It’s worrisome to me … so many potentials that could happen that might not be positive,” Ms. Dawson says, citing tumor growth as one possible outcome.

Once the cord cells are introduced into an infant’s brain, no one knows what instructions within the cell are necessary to drive it toward the appropriate brain cell replacement, she says.

“It will be quite a while before technology has caught up with this,” she says. “I think banking the stem cells is a good idea, but it may be decades before we can use these cells in an appropriate, therapeutic way.”

Dr. Bertram Lubin, a spokesman with the American Academy of Pediatrics, sees the program offered as a work in progress, not scientific fact.

“There’s no data to support this,” Dr. Lubin says of the promise that infusing infants with their own cord cells could alleviate brain injuries. “But it’s not an unreasonable theory.”

His concern stems in part from the process hitting the market before researchers have had the chance to measure, study and record the effect these cord cells may have on the children in question.

The CBR says it collaborates with several medical research groups as well as Dr. David T. Harris at the University of Arizona to study the benefits of cord blood cell infusions. The Newborn Possibilities Program hopes to focus more attention and research on regenerative therapies.

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