Stem cell science has been long heralded as the most promising new frontier of modern medicine. Stem cells have the potential to save lives and revolutionize the way we treat many diseases. Yet, most people don’t truly understand the science behind them. Instead, images of Aishwarya Rai tying a ribbon around a pregnant woman’s belly spring to mind, and indeed she’s become the face of a rapidly growing industry, publicly touting the benefits of umbilical cord stem cells and banking her own. But before being dazzled by stem cells’ seemingly limitless medical possibilities, or the face that promotes them, it’s important to understand the science behind both the cells and the concept of cord blood banking.

Quick take — should you bank cord blood?

“Bank your stem cells only if you have a family history of genetic disorders, metabolic disorder, leukemia or Hurler syndrome. Otherwise, it’s a sheer waste of money.” — Dr. Shobha Gupta, Mother’s Lap IVF Centre

The science behind cord blood banking

Creatures that can regenerate lost or damaged body parts have long been the subject of myth and movies. That they exist in the natural world makes them no less fascinating. There is something magical, even immortal, about the lizard that can grow back its tail, the starfish that can sprout new limbs, the flat worm that can replicate endlessly, even when sliced to ribbons. As long as this quality has existed in nature, humans have wanted to capture it for themselves. But for much of history, it seemed a quality unique to only a limited portion of the animal world, and certainly out of reach for humans.

However, as modern medicine advanced in the 19th and 20th centuries, researchers identified certain types of human cells that had the potential to replicate in a similar fashion. These were called stem cells—cells with the power to renew and regenerate. The discovery was intriguing, because, if these stem cells could be successfully isolated and cultivated, they could be used to grow or repair any damaged body part or tissue. It would give humans the power to treat diseases and injuries once believed beyond the realm of cure.

Though stem cells, based on their nature (that is, what they eventually become), are of many different kinds, science tends to club them into two broad sub-divisions:

What are embryonic stem cells?

Soon after fertilization, the process of developing life begins in the womb. In the 3- to 5-day period after fertilization, the ball of cells that make up the embryo is called the blastocyst, a rich breeding ground of stem cells. Embryonic stem cells are special because, like shapeshifters of sci-fi flicks, they have the potential to grow into any organ or tissue.

In theory, this means these stem cells could be directed to grow into anything a human needs to regenerate. But the difficulty lies in isolating the embryo at this stage. The process described above could be recreated in a lab, but not without plunging science and society into disconcerting ethical questions around using in-vitro fertilization to create embryos for the purpose of manufacturing stem cells.

What are adult stem cells?

In our bone marrow, muscles and brains, there are stem cells that constantly regenerate and repair other cells lost or damaged due to wear and tear. However, these differ from embryonic stem cells in that they can’t be guided into becoming whatever we want; adult stem cells have one tissue-specific destiny. Still, the potential for these cells are astounding. Adult stem cells are thought to exist in most of the body’s tissues and organs, deeply and invaluably embedded in the body’s make-up—and more or less inaccessible.

In 1978, researchers made a remarkable discovery—stem cells that resemble adult stem cells were also found in the blood that remained in the umbilical cord soon after birth. Much easier to access, these stem cells could be collected and used to regenerate specific tissues or organs.

The rise of the cord blood banking industry

In the decades since the 1978 discovery, the stem cell field has seen more opportunities for study—and commerce.

“Today, stem cell banking has become a routine practice for families across the world,” says Dr. Shobha Gupta, Medical Director, Gynecologist and IVF specialist at Mother’s Lap IVF Centre, New Delhi. “Researchers have found that the blood cells in the human umbilical cord were similar to those found in the bone marrow. It could treat life-threatening diseases, immunological and genetic disorders.”

Almost overnight, a whole industry around collecting and saving umbilical cord stem cells exploded. Cord blood banking involves paying a company – like the Rai-affiliated LifeCell, CordLife India, Cryobanks India, Reliance Life Sciences, BabyCell, and many more – to collect and preserve the stem cells found in the umbilical cord immediately after birth. These companies use emotional language to sell their product, framing the decision to bank as a foregone conclusion for any parent concerned for the well-being of their child.

But is it? At 1 lakh rupees as the average charge levied for collection, culture, and 20 years to a lifetime of preservation, deciding should you bank cord blood requires careful consideration of not only the benefits, but also the cost.

Cord blood banking in India is a risky bet on the future

Though the list of diseases currently treatable by stem cell therapy can seem long and enticing, most are extremely rare, say experts. Also keep in mind that most stem cell therapies in their current form are at a very experimental stage, questionably effective, and not without side-effects.

“Bank your stem cells only if you have a family history of genetic disorders, metabolic disorder, leukemia or Hurler syndrome,” says Dr Shobha. “Otherwise, it’s a sheer waste of money.”

It may be a waste of money now, but the concept of banking stem cells hinges on insurance against the future—when science has every reason to expect expansion of possible cures and refinements in therapy. One might think: Medicine has advanced in leaps and bounds within our own generation; why not in our children’s? But this kind of reasoning doesn’t take into account the industry itself. Banked stem cells aren’t magic beans that can be planted anytime and turn into a stalk; their usefulness is highly dependent on the conditions of preservation over the course of decades.

“When a mother banks her child’s stem cells, it is stored in a liquid nitrogen vessel at -198 Celsius after the process of isolation, separation and culturing,” says Nidhish Nath, microbiologist, stem cell consultant and former employee of Beike Biotechnology and Unistem for more than a decade.

“The stem cells can only be retrieved if the company you’re banking with has strictly followed the guidelines,” Nath says. “However, companies can compromise on storage, preservation and culture, which can make the cells futile.”

Just last year, two private stem cell banks, Stem One Biologicals in Pune and Stemplus Cryopreservation in Sangli, were charged with operating without a license and prohibited from further collection. Between the two, more than 700 units of umbilical cord blood had been collected, worth anywhere from 2.8 to 8.1 crore rupees. (Calls to the companies’ offices reveal disconnected numbers, suggesting they’ve since shut down.) The industry is attracting government scrutiny. The Indian Council of Medical Research and the Department of Biotechnology bemoaned the too-commercial evolution of stem cell banking in 2013 as it updated the guidelines on the ethics of stem cell research.

ICMR’s report emphasises that “there are ethical concerns about the promotional advertisements by private banks offering storage of cord blood for possible future use. Such advertisements are often misleading for the public and lack comprehensive and accurate information. It may be mentioned that there is no scientific basis for preservation of cord blood for future self-use and this practice is not recommended.”

Additional reporting by Liesl Goecker.

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More on these myriad ethical concerns in Part 2: Private versus Public Cord Blood Banking.