Better than the real thing?

For transfusion scientists, the search to create a readily available universal blood alternative has been likened to trying to find their own personal holy grail. Despite many promising solutions being trialled recently, in particular by the biotechnical and pharmaceutical communities, there still seems to be no substitute for the real thing, namely donated human allogeneic blood. Blood as a resource has never been more in demand than it is today. Escalating elective surgery, an ageing population and spiraling costs due to ongoing safety introductions have all conspired to ensure that blood remains very much a scarce liquid asset to the NHS. Ensuring that donated blood is safe for transfusion to patients is also an expensive and time-consuming process, involving collection, fractionation, processing, testing and issuing at blood centres, not to mention distribution and transport costs. In the UK alone, 2.2 million units of blood are transfused each year and although all blood in the UK is donated freely by the general public, once UK Blood Services’ processing costs have been taken into account each unit currently costs the NHS around £140 and in total accounts for around 3% of its annual budget. A series of new safety tests have been introduced over recent years to minimise the risks of viral transmissions such as HIV and HCV as well as reducing the possibility of bacterial contamination, all of which has added to the current costs. In addition, the possibility of vCJD transmission via blood products is another factor, resulting in the introduction of the leucodepletion of all blood components by the UK Blood Services in 1999 to remove the mostly likely transmission route. The threat posed by vCJD to the blood supply has also resulted in stringent donor restrictions being introduced which have reduced availability by an estimated 52,000 donors, with more forecasted shortfalls expected in the coming years in the wake of the possible introduction of a donor screening test for the presence of vCJD itself. In addition to donated blood’s strict storage temperature requirements and a limited shelf life, the availability of certain blood groups is another problem.

In particular, stocks of group O RhD Negative are always in demand due to its requirement for emergency situations, combined with factor, resulting in the introduction of the leucodepletion of all blood components by the UK Blood Services in 1999 to remove the mostly likely transmission route. The threat posed by vCJD to the blood supply has also resulted in stringent donor restrictions being introduced which have reduced availability by an estimated 52,000 donors, with more forecasted shortfalls expected in the coming years in the wake of the possible introduction of a donor screening test for the presence of vCJD itself. In addition to donated blood’s strict storage temperature requirements and a limited shelf life, the availability of certain blood groups is another problem. In particular, stocks of group O RhD Negative are always in demand due to its requirement for emergency situations, combined with beneficial use. But if an alternative product to donated blood could be produced safely and cost effectively then its value in routine, emergency situations and for use in elective surgery would be enormous, which is why there is such high interest in the current work being undertaken by the Scottish National Blood Transfusion Service (SNBTS) and the University of Glasgow. Joanne Mountford is a member of the team currently researching into the manufacture of red cells derived from pluripotent stem cells (PSCs) for transfusion on what is envisaged in the future to be an industrial scale. The project is a collaboration between SNBTS and four leading Scottish universities, comprising The University of Glasgow, along with Heriot-Watt, Edinburgh and Dundee Universities.

According to Ms Mountford, the project team hopes to start translating basic laboratory science into industrial processes. She explains: “One of the main challenges of this project is the very large number of red cells that will be needed – therefore we will need to develop new bio-process and engineering solutions alongside the biology to address the issue of large scale production as well as the industrialisation of the process.” The project, co-ordinated by the stem cell research team at the University of Glasgow, will also include specialists from biochemistry, engineering and social science fields and was initially started with a Wellcome Trust grant 18 months ago, with the long-term aim of providing a solution to a long-standing problem, namely ensuring there is a safe sufficient blood supply to improve patients’ lives.