Preliminary work on brain injury also beckons. Joanne Kurtzberg of Duke is testing cord-blood transfusions for children with cerebral palsy as well as brain damage caused by oxygen deprivation in utero or during delivery. Preclinical work in rabbits and rats suggests that stem cells in cord blood can cross into the brain and help to heal damage—possibly by reducing inflammation, integrating into brain tissue, or prodding this tissue to repair itself, says Kurtzberg. In early stage work with kids, she is now transfusing patients' own privately-banked cells.
One of Kurtzberg's patients, an adorable kid with cerebral palsy named Dallas Hextell, has become a high-profile poster-child for private banking. But patients with cerebral palsy often get better to some degree on their own, says Kurtzberg. So until she conducts a controlled trial, it's hard to say whether Dallas has cord blood to thank or not. Kurtzberg herself runs a large public bank in North Carolina and is piloting a program that would give families access to their own baby's blood for a year before it's released into a general pool. That's because some brain injury becomes apparent in the first year. And for now at least, Kurtzberg's experimental treatments rely on a patient's own cells because these are unlikely to cause an immune reaction. Ultimately, however, she argues that less-closely matched blood, available to all, might also help children with brain injury based on her work.
The same cloud of ifs and maybes applies to cord-blood research for Type 1 diabetes, heart disease, and a host of other illnesses. No one knows which, if any, of these applications will work out; whether umbilical cord blood will be the best stem cell source; or how cord blood stem cells will compare to others—like those created from adult cells—for still-speculative applications. Some stem-cell treatments will probably flourish in the long-run. But it isn't easy to predict which ones or from what cells.
Parents with money to spend may decide that private banking, for all its uncertainty, is worth the gamble. And they may in fact be serving the common good. If their kids do use the blood, in many cases it will be for experimental therapies like Kurtzberg's—in which case they're paying cash and assuming risk (always part of research) so that all of us can learn whether speculative treatments have merit. Still, moms and dads who donate to a public bank, where the cells are more likely to be used, are probably doing the greatest public service. Most cord blood is thrown in the trash, after all. So why not avoid the waste and recycle?
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