For the past seven years, the Sethys had a faint but haunting feeling that they had let their daughter down. Danya, 10, is their only child and the Sethys strive for the best for her: She takes Japanese language, traditional Indian dance and keyboard lessons. They take her for checkups with Delhi's best doctors; they have all kinds of insurance policies.
But they missed one: when Danya was born, the Sethys had never heard of the practice of banking stem cells that could be used to treat their daughter for future serious illnesses.
"In 2004 it came in India, this umbilical cord-blood banking, and then it was always in our mind we have missed on something for our child," said Kanwal Sethy, an artist whose husband Capt. A. S. Sethy is an officer in India's merchant navy.
But earlier this year, Ms. Sethy took her daughter for a checkup and crossed paths with an efficient young representative from a company called Stemade Biotech Ltd. He had some good news for her: It wasn't too late after all. Danya still had some of her baby teeth, and Stemade could extract stem cells from the dental pulp in those teeth and bank them.
Ms. Sethy suddenly looked at Danya's little white teeth in a whole new way. "We could make use of it, when we had just been giving it away to fairies!" she said.
In India, a fascination with stem-cell medicine combined with a growing demographic of affluent parents who pour their resources into one or two children have consumerized the stem-cell banking industry like nowhere else.
In obstetricians' offices today, the pamphlets from different cord-blood banking operations form a tower six inches high. There are also a number of companies that bank baby teeth (although Stemade insists it is the only one with facilities to bank the dental pulp stem cells in-country, while the rest export the teeth.) In women's magazines, cryptic advertisements from companies such as LifeCell use the line "Periods. Proof that women are luckier than men!" LifeCell banks stem cells from menstrual blood.
India has no laws, and only unenforceable guidelines on what stem-cell research is permitted here; many institutions are working on the fringes of mainstream scientific pursuits, using embryonic, fetal and umbilical stem cells in experiments that are not permitted in North America. The Indian stem-cell industry – including research and therapies, many unproven, provided to international medical tourists – is worth an estimated $500-million a year. As a consequence, there is a comparatively high level of awareness of stem-cell medicine in the general population.
At the same time, as technological processes for the preservation of cells are "indigenized," they are becoming considerably cheaper to operate in India than they are in the West. That, combined with the sheer size of the Indian market, makes a practice such as banking baby teeth or menstrual cells suddenly feasible as a mainstream pursuit.
Researchers in India confirm that dental cells have shown considerable utility in trials, but that doesn't mean they will cure sick children, at least not any time soon.
Rakhi Pal, a scientist with Advanced Neuroscience Allies, a stem-cell research firm in Bangalore, sounded a note of caution for parents. "There is a lot of hype around it," she said. "Clinical trials are ongoing to be able to establish this as a conventional mode of treatment and only time will tell. It would take a few years before these trials are completed on a large population and it is accepted as a part of mainstream therapy." Parents, she said, should not lose sight of the fact that stem cells aren't a miracle fix for "any or all diseases their children might suffer from."
The discovery of stem cells in the dental pulp of milk teeth was made by an academic researcher in Napoli, Italy, in 2001, and shortly thereafter patented by a French firm. There are companies that provide the service to parents in the developed world, including Canada – but these are operations with a handful of customers.
Stem cells from dental pulp, as Ms. Sethy was told, have a host of potential uses: they have been used in clinical trials for bone regeneration (instead of repairing shattered limbs with steel rods or grafts); to repair the cardiac muscle after the damage of heart attack or angioplasty; and to regenerate a cornea, outside the body, and then transplant it back into the patient. (Umbilical cord stem cells, in contrast, are used to treat blood disorders.) While stem cells have been extracted from adult teeth, the cells that come from children between the ages of six and 12 are the ones best able to grow into new tissues.
Stemade has the Asia-Pacific and Middle East licence for dental-cell banking, and chose India as their first market. Manager Shailesh Gadre says they built a cryopreservation facility in Chennai and launched in Delhi and Mumbai last November. Now they are working with dentists in six cities to collect teeth; they processed some 750 in their first eight months, he said.
The service costs 10,000 rupees to register ($215); $1,100 for processing an extracted tooth, and $130 a year for banking, if viable cells are harvested. It's not a small price tag, in a country where more than half the population lives on $1.50 a day.
Still, Mr. Gadre points out, there are ever-larger numbers of people whose budget extends to this kind of prophylactic step. "There are a lot of affluent people in India who don't mind paying this price for the kind of service that their kids might need in the future," he said. Some of their customers have big salaries from multinational corporations, he said, but others have scraped together the cash; Stemade helpfully offers a monthly payment plan, and assists customers with bank loans.
To Ms. Sethy, it all sounded good. After many hours of Internet research, she arranged with Stemade to have Danya's teeth X-rayed. Results showed she had two healthy canine teeth, the ones most likely to have viable stem cells. Dhanya had one extracted in May – but it had too few viable cells to bank.
So in June, Danya had another tooth pulled. "I was just praying – and my daughter was praying, 'My cells should be viable this time.'" Danya sent her prayers to someone she calls the "stem-cell tooth fairy." This time the news was good; the cells are banked.
"I'm not over-cautious," Ms. Sethy said. "If we can afford this much we should do it. I will cross my fingers I don't use it – but in the back of my mind I have the feeling we have done very good for our child."