[Artificial blood in 1990: from a lifelong dream to today's reality]

Human blood is a very complex tissue. Therefore the idea of rediscovery its different cellular and plasmatic constituents would seem to be utopic. To be efficient the oxygen carrier, be it natural or by synthesis, must be stripped of antigenicity, be easily stockable and transportable. Thus these properties permit its use in urgent circumstances (accidents, natural disasters, war...), in those countries where there is a non existent or limited transfusional structure. This, under certain conditions, during very specific pathologies (localised ischemia for example). Among several hypotheses, they are two main lines of research that of "hemoglobin solutions" the oldest and the most physiological. This will be developed here in more lengthy terms due to our personal work on the subject. The second line of research concerns fluorocarbons, the most modern and artificial and without doubt better known to doctors and the public. 1. HEMOGLOBIN SOLUTIONS. Other than nephrotoxicity, which has proved affordable, research han revealed four large limitations with hemoglobin solutions (a high affinity for oxygen due to absence or loss of 2.3 DPG, a short half life due to vascular loss, rapid dimerisation and elimination of urine, insufficient concentration of prepared solutions (70 g/L) with as a result a weak oncotic pressure and oxygen supply, oxidation in methemoglobin). In order to overcome the two inconveniences, proposals were made to modify hemoglobin chemically, the idea coming from the putting into operation of potential analogues to or substitutes for 2.3 DPG which it is advisable to bring or to keep--by covalent bonding--near to the fixation site of the natural ligand. Thus our group has already deposed several patents and is now working on a complex hemoglobin-dextran benzine tetracarboxylate which appears promising. Today, due to the quality and reproduction of the results obtained on animals with chemically modified hemoglobin preparations clinical assays should be carried out soon. 2. FLUOROCARBONS. In this very different approach which uses totally synthetic compounds oxygen carrying can only be realised in dissolved form. Due to this fluorocarbons, even though they are remarkable solvents of gas, do not reach their full efficiency unless the patient breathes in a very rich oxygen atmosphere. This is therefore a considerable limiting factor. The other big problem is the insolubility of these compounds and therefore the need to emulsify them, but unfortunately these emulsions are difficult, if not impossible to stabilise.(ABSTRACT TRUNCATED AT 400 WORDS)