November 20, 2000
Question from Cincinnati, Ohio, USA:
My wife has type 1 diabetes and is about to deliver twin girls within the next few weeks. She is curious if it is wise to keep the umbilical cord blood stored for later use in stem cell transplantation, if it is necessary, should our daughter(s) ever be diagnosed. She called some place that stores it (locally), but it is expensive: $2500 for 18 years per newborn. Please let me know any appropriate knowledge/feedback, options/alternatives, ideas/suggestions.
The potential for stem cell therapy has been much in the public eye recently, but to date, there have only been firm successes in humans in bone marrow implantation for aplastic anemias, in creating chimeras to reduce the needs for chemical immunosuppression in transplantation, and of course, for Parkinsonism. So far as I know, there have been there have been only a very few studies in mice in regard to islet cell replacement, which doesn’t mean to say that the idea is not being pursued. The special difficulty in type�1A (autoimmune) diabetes is that even if stem cells could be made to regenerate insulin producing cells in vivo, there would still be the problem that the destructive Th1 type lymphocytes would remain and that the stem cell induced beta cells would be vulnerable to them.
Another factor to consider is that if the twins are non-identical, each of them will have only about a 5% chance of getting Type 1A diabetes. Although, if they are identical and one is unlucky enough to develop diabetes, then the chances of the other twin developing the same problem at some time in her life are much higher.
At some stage, probably not until the twins are three years old or so, it would be important to have them HLA typed to see if they carry the susceptibility genes for this form of diabetes (call 1-800–425-8361 for information). If they did, then they should be followed at intervals for the development of antibodies. By that time, it may well be known whether techniques that are currently being explored like the use of oral insulin, inhaled insulin, nicotinamide or other immunomodulators can avert or prevent insulin dependence. At the moment, this range of possibilities seems much more optimistic than the stem cell approach.
If possible, they should be breast fed for as long as possible because there is some evidence that early exposure to cow’s milk may trigger antibody production, but only, of course, in the genetically susceptible.
In short, I personally think that you should save the $5000.