Blood substitutes. Haemoglobin therapeutics in clinical practice

Area of Science:

• Biomedical engineering
• Hematology
• Pharmacology

Background:

• Stroma-free hemoglobin solutions were early oxygen carriers, offering storage stability and eliminating blood typing needs.
• Chemical modifications enhance hemoglobin stability, leading to therapeutic applications for ischemia and as blood alternatives.
• Current hemoglobin therapeutics derive from human, bovine, or genetically engineered sources.

Purpose of the Study:

• To review the development and clinical investigation of hemoglobin therapeutics as oxygen carriers.
• To assess the potential of hemoglobin-based oxygen carriers (HBOCs) as alternatives to blood transfusion and treatments for various medical conditions.

Main Methods:

• Review of clinical trials and development of diaspirin cross-linked hemoglobin (DCLHb) and bovine polymerized hemoglobin.
• Analysis of hemoglobin product sources: human, bovine, and genetically engineered.

Main Results:

• Diaspirin cross-linked hemoglobin (DCLHb) showed efficacy in avoiding transfusions in several trials but faced development halts after unsuccessful trauma patient studies.
• Bovine polymerized hemoglobin has undergone extensive Phase II and III trials for surgical applications, with data pending publication.
• Hemoglobin therapeutics demonstrate potential in diverse clinical settings, including surgery, trauma, and septic shock.

Conclusions:

• Hemoglobin therapeutics represent a significant advancement as alternatives to blood transfusion.
• These agents hold potential for immediate hemorrhage control, prevention of ischemia and organ failure, and hemodynamic support in critical conditions like septic shock.