Lab-grown blood given to people in world-first clinical trial

https://www.bbc.com/news/health-63513330

by sohkamyung • 4 years ago

448 111 4 years ago

clintonb3• 4 years ago

I wonder how long it will take for the technology to reach the point where it’s used for performance enhancement in sports. For example, if these red blood cells can hold a bit more oxygen, that’s an advantage for an endurance athlete.

Gatsky2• 4 years ago

Athletes already do this - they collect their own blood and store it and then transfuse themselves to supranormal levels prior to their sporting event. Lance Armstrong did this.

Lab grown blood would make this a bit more convenient, albeit at astronomical cost.

fbdab103• 4 years ago

I assumed the reason to use their own blood was to avoid detection. Presumably synthetic blood is weird enough that it becomes trivial to detect its presence that would make it a no-go for cheating.

clintonb3• 4 years ago

True. I imagine a scenario where the athlete is given supranormal blood without the extra step of collecting from themselves.

This is just me speaking “out loud”. Today, this would be quite expensive. I can see a future where the technology scales and the richer teams/individuals try this out.

ChrisKnott• 4 years ago

Nowadays they just take EPO

casefields• 4 years ago

Lance Armstrong was busted for blood doping. The cutting edge is way beyond that.

solatic• 4 years ago

Obviously if this succeeds, then the life-saving implications are tremendous. It would become practical to keep a stock of lab-grown blood in ambulances, as it can just be rotated out when it expires, but the immediate availability of blood in the field can mean the difference between life and death.

I just hope that blood donation doesn't go away as a result. There are both ethical and personal benefits - ethical, because it's a visceral experience of doing something good for society that most people can do, and with little effort; personal, because of potential health benefits from donating blood, see e.g. https://jamanetwork.com/journals/jamanetworkopen/fullarticle... .

armchairhacker• 4 years ago

also financial: some people rely on blood donations for extra cash to pay for food and bills. Though, there are better ways to give people opportunities…

AkshatJ27• 4 years ago

People get paid to donate blood?

bearmode3• 4 years ago

You don't get paid to donate blood, you get paid for selling your plasma to pharmaceutical companies.

senkora• 4 years ago

I don’t think this is the right way to think about it. If donating blood is no longer a useful societal good, then there are no ethical benefits. If there are health benefits to bloodletting, then we can do that independently of donating the blood.

TheSpiceIsLife• 4 years ago

And are those substances filtered out before being used? Could a recipient end up with higher concentrations in their blood?

dsign• 4 years ago

Well I do hope that this succeeds beyond the wildest expectations, and blood-donations go the way of the horse[^1]. We can cultivate ethics in everything else.

--------------------------------

[^1]: We still have horses. So there is a chance some people will become recreational vampire-feeders and some people will adopt vampirism as a hobby. Fine, I won't judge.

hutzlibu• 4 years ago

"So there is a chance some people will become recreational vampire-feeders and some people will adopt vampirism as a hobby. Fine, I won't judge. "

Not very surprising, that is already a thing.

Edit: https://en.m.wikipedia.org/wiki/Clinical_vampirism

frozenport• 4 years ago

>then the life-saving implications are tremendous

Are people in medical settings dying because of a lack of blood? It seems that unless you're in some exotic blood group you will likely find a compatible donor, and it is not clear as to severity of an imperfect match to rarer groups like the mentioned "Bombay" group.

ip262• 4 years ago

Your parent is theorizing that people in edge medical settings are. For example, an EMT might not be able to give you a transfusion while you lay bleeding in the dirt, because they may not have twenty units of blood to spare in the bus.

clintonb3• 4 years ago

This is not a solution to a general need for blood, but a need for rare blood types. Hospitals may keep the lab-grown rate blood, but not ambulances.

tempestn• 4 years ago

Initially, but once the technology is proven I don't see why it wouldn't become more generalized over time.

russdill• 4 years ago

I think a lot of people commenting just didn't read the article. The feedstock is donor blood.

Terr_• 4 years ago

I imagine that donations will continue to be important for a range of subtler purposes, such as using the plasma for immunological stuff.

gus_massa3• 4 years ago

Donation to get antigens for the RH group to give to RH- mother after a RH+ baby is an important application. For example https://edition.cnn.com/2018/05/11/health/james-harrison-blo...

lesuorac• 4 years ago

While your article calls out PFAS in firefighters, there are people who for other reasons need blood letting. It's one of my biggest gripes with blood donation in the US is that those people are prohibited from donating blood because they're getting "value" from doing so (instead of having to pay somebody to draw their blood the red cross would be drawing it for free -- note, the blood isn't unusable for any other reason than drawing it provides value to the donater).

Like you have a population that must give blood by some means and regularly the various blood banks complain about a shortage and they never seem to be able to put two and two together ...

tait9• 4 years ago

I would love to see more donor centers allow hemochromatosis patients to donate.

I think there is not actually regulatory ban. Last I looked into this, it was because of the conflict of interest - the FDA requires blood from donors with hemochromatosis be labeled as such.

And even that requirement can be worked around. See, for example, https://clinicalcenter.nih.gov/blooddonor/donationtypes/hemo.... Background, most centers charge for therapeutic phlebotomy but obviously not for volunteer blood donation. The exception is permissable if the center agrees to allow the patient's blood to be drawn for free, whether or not they would qualify as a blood donor.

The issue with "getting value" from donating is that people sometimes lie in order to be able to get that value. The downstream issues can be very painful - I have personally taken care of patients who got HIV or hepatitis from blood transfusion. I am pretty sure any of them would emphatically agree it is important to ensure the blood supply is as safe as possible.

So it can be done, but it has to be done carefully.

kyleyeats• 4 years ago

This actually reversed just this year, with most major blood banks (following the example of the Red Cross) now allowing donations from diagnosed hemochromatosis patients.

pcurve2• 4 years ago

"some groups were "really, really rare" and there "might only be 10 people in the country" able to donate."

oooof.... I knew some blood type was rare, but this is another level.

d4mi3n• 4 years ago

What’s more is that the identities of those people need to be protected lest they be bombarded constantly for lab studies or requests for life saving donations.

Many counties have laws about paying for blood donations and don’t allow donors to be compensated in any way, so they either need to take on the financial burden of flying to wherever their blood is needed or refusing to take on the financial burden and knowingly allowing someone to die.

It’s not fair to them and while most of these laws prevent darker forms of abuse of vulnerable demographics, they don’t really account for cases like donation of rare blood types.

tait9• 4 years ago

so they either need to take on the financial burden of flying to wherever their blood is needed or refusing to take on the financial burden and knowingly allowing someone to die.

Is that a real case or hypothetical? If real, I would like to explore further as it does seem rather inappropriate.

In my experience, the blood can be drawn locally and then sent to the recipient. That's also true for bone marrow & peripheral blood stem cell donations.

Source: I am a transfusion medicine physician.

beambot• 4 years ago

Always reminds me of this:

Harrison, known as the “Man With the Golden Arm,” has donated blood nearly every week for 60 years. After all those donations, the 81-year-old Australian man “retired” Friday. The occasion marked the end of a monumental chapter. According to the Australian Red Cross Blood Service, he has helped saved the lives of more than 2.4 million Australian babies.

https://www.cnn.com/2018/05/11/health/james-harrison-blood-d...

pcurve2• 4 years ago

I wonder if they were able to find additional sources to replace him...

gus_massa3• 4 years ago

It's a different case. The article you posted is about someone that has a high level of RH antibodies.

In the main article, the rare blood type is because the the A, B, AB, 0 and RH+/RH- groups are due to 3 antigens (2^3=8). But there are like 20 or 25 more antigens that your blood may or may not have, so there are like 2^23 or 2^28 blood types. Some are very rare, some combinations are very rare. Most of the time the other 20 antigens don't produce a reaction that is so strong [1], so for most transfusions it's enough to classify using the A, B, and RH.

[1] Why? I'd really like to know why, or if I'm oversimplifying too much.

nigerianbrince2• 4 years ago

Don't people with such blood groups preserve their own blood for emergencies?

tait9• 4 years ago

Some can and do, but there are some challenges for it being a general solution:

- Some people don't know they need rare blood (because they didn't have the antibody at first, then found they had it later).

- Some people may donate blood to have it available for a need, then a need comes up (either themselves or someone else). At that point, the blood gets used up - what happens when the need is greater than the number of stored units?

- Some people may not be able to donate. We had a patient with something north of 9 antibodies who, due to sickle cell disease wasn't able to donate - (banking blood for long term storage requires freezing, which doesn't work with blood from patients with sickle cell disease).

tomcam3• 4 years ago

Pretty neat. They take a pint of blood, separate out the stem cells, “guide” aka convert them (not explained, but I think it can be done with gene therapy and complicated physical/chemical treatment) to become red blood cells, and culture those red cells in vats.

World-changing if it works.

inglor_cz• 4 years ago

The price tag is important. So far, these therapies are expensive. If, in the future, the stem cells can be nudged into their work more cheaply, the effect will be world-changing indeed.

2Gkashmiri3• 4 years ago

imagine falling into one of those vats, https://ibb.co/zhH2QYX this feeling is more like it

tomcam3• 4 years ago

We dodged a bullet! They’re pretty small vats right now. Whew.

boxed• 4 years ago

The bulk of blood transfusions will always rely on people regularly rolling up their sleeve to donate.

I always cringe when I read sentences like that. "Always"? Really? How could you possibly know that?

harry8• 4 years ago

...seems likely to always rely on...

Poor expression. (May be completely wrong too for all I know, but I think it's the expression that is rubbing you up the wrong way).

cultofmetatron• 4 years ago

and 4kb of ram is all you'll ever need!

habitue2• 4 years ago

The bulk of blood transfusions will always rely on people regularly rolling up their sleeve to donate.

Who is this line for? It's comically certain about this

_tom_3• 4 years ago

People literally ALWAYS say this when a new disruptive technology comes up. I'm not sure why, maybe people like the idea of stability?

"Digital will never replace film"

"Landlines will always be the majority of calls"

"Computers are cool, but will never replace typewriters"

habitue2• 4 years ago

I would much prefer: "Hey, your shit's about to get fucked up. Here's what's going to happen:"

bdg2• 4 years ago

Blood is highly complicated.

I think the HN audience understands it at a level of "blood is red cells, white cells, and platelets", but that's really not the whole picture. Blood also has plasma which is composed of gas, nutrients, proteins, ions, and water. We can actually refine blood plasma down to a state where it's basically 100% safe even if someone with "bad blood" donated it.

These 4 different blood components all get seperated at the lab, frozen for storage, and turned into individual products which can be mixed+matched depending on medical need.

Don't get me wrong, growing red cells in a lab is awesome, but I don't see it the same way a lot of comments in this thread do (solving a storage issue, saving a lot of lives, etc).

I think the realistic applications of lab-grown-blood over the next 15 years will be closer to treating rare diseases or possibly rare blood types (some people exist outside the typical A, B, AB, O groupings). I don't see this fixing logistics or supply/demand issues in the next 15 years, especially with how highly regulated the blood supply is in any first world nation.

cookieswumchorr• 4 years ago

the application i immediately thought about is disaster medicine.

This is when you need huge amounts of blood, and my guess is that it can be less perfect, when there is simply no other choice to save lives.

An inferior substitute is better than nothing

6stringmerc• 4 years ago

Yeah field work sounds great for this! Stabilize then treat. Good observation.

est31• 4 years ago

What about coagulation? It is needed in situations where you have acute blood loss, and plasma contains the coagulation factors. You already probably want to give your patient coagulants in such a situation but I don't know if those are enough on their own or they need cooperation from existing factors in the plasma.

kibwen• 4 years ago

I think it might be the opposite, actually. In a disaster, when you need a sudden surge of supply, you're not going to have time to scale up your production. Even if we had reliable supplies of synthetic blood, I think disasters are always going to call for mass donations from the old-fashioned blood producers.

Cthulhu_• 4 years ago

That's also where blood plasma comes in, which can be donated once a month (as opposed to blood which is only a few times a year).

I mean if this can be scaled up to producing gallons an hour in the field then sure, but we're a ways away from that still.

bearmode3• 4 years ago

There is a LOT more to blood! There are a total of 36 different blood group systems, with the most important being the ABO group that everyone knows gives you your A, B, O, or AB blood, and the (RHD gene of the) Rh group that gives you the + or - part of it.

When given a single transfusion, a patient can usually be given blood based on the ABO and +/- part of the Rh groups alone, but there's more to the Rh system than most people know.

As well as the RHD gene, there's also the RHCE gene. The RHD gene can either be present (D, gives you positive blood) or not present (d, gives you negative blood), but the RHCE gene can give you one of four variations of the C, c, E and e antigens. When the two genes combine, you can have any of the following combinations: Dce, DCe, DcE, DCE, dce, dCe, dcE, dCE (which were given simplified names: Ro, R1, R2, Rz, r, r', r", ry respectively).

When patients have to be given regular blood transfusions, especially on a long-term basis, the blood they receive has to be more precisely matched. That's often why there's always a huge push for black donors - because many black people suffer from sickle cell anaemia, for which the treatment is regular blood transfusions, they need blood that better matches their own.

junon• 4 years ago

This is fascinating, thanks for sharing. Are there more groups than just A, B and O?

echelon• 4 years ago

It's so complicated.

Just one more example: infants express a different set of hemes that have higher oxygen binding affinity. The switch from fetal to adult heme is being investigated as a potential cause of SIDS.

_tom_3• 4 years ago

Another comment says this is based on the donor. So, if you can self donate, or find one matching donor, you should be able to get a match every time.

Obviously, custom tailored stuff is likely to take longer to develop, but it seems feasible.

Blikkentrekker2• 4 years ago

We can actually refine blood plasma down to a state where it's basically 100% safe even if someone with "bad blood" donated it.

Do you have a source on this? Given that many blood donation facilities still refuse many “risk groups”, which honestly always carried the stench of politics to me how arbitrarily they are selected, from donating blood?

bdg2• 4 years ago

I'm concerned that someone might take my previous statement and assume this means all blood donations are safe -- they're not. Without a bunch of steps in place they're horrifyingly risky, and our screening technology is not good enough. I'll explain more in a moment.

To answer your direct question, in Toronto there was a doctor who wanted to open a pay-for-plasma clinic like they have in the US. In Canada, blood donations are not paid for which is one of the core reasons the supply is considered to be safer than other first world countries. The regulators shut it down and stopped him, not because of cleaning the plasma from the blood, but for policy reasons.

Back to the point about safe blood... Being a person who is allowed to donate blood is not related to this cleaning process but statistics about risk and also related to costs. So this is part of why there are no plasma clinics in Canada.

The blood donation is tested, but the tests don't catch everything. Really horrible diseases can test negative, which is why the process to donate blood includes an interview to categorize a high risk donor. This is why they don't let you donate blood when you have been living in europe for many years, have tattoos, multiple sexual partners, or had male-with-male sex. A lot of people hear about this and are totally outraged and jump to assumptions that the blood donation system is stuck in some anti-gay-rights 1900s puritan mindset, but that's not what's going on.

People regularly walk into blood donor clinics, lie about their high risk factors because they want to "prove a point", the tests for things like HIV can't always catch it all the time (especially in early stages; stages where there are no symptoms), and one blood donation could actually make it to several other people (like a baby, a motorcycle accident victim, and a surgery patient). It happens regularly enough that your nation's blood supply has a "lookback/traceback" program where they have 10-100 people who sit there all day working on cases and sending letters to people who received bad blood, and it can even come up 5+ years later when someone who donated blood in 2015 just got a diagnosis in 2020, all those people in the "bloodline" get notified, banned from the system, and advised to get tested too.

Doctors depend on multiple layers of checks to keep the blood supply clean, one of them is a statistical layer, one is a testing layer, one is the processing to keep the blood clean/safe, another is policy. Please don't interpret my point about plasma being highly cleanable to mean that all blood components in general can be safely received from the homeless.

WeylandYutani• 4 years ago

Don't homeless people in America sell their blood for money? Was a bit of a scandal when it ended up in my country. Might as well buy organs from the Chinese lol.

cguess• 4 years ago

You can donate plasma for money, yes. It's not just homeless people, rarely it is. College students trying to make drinking money and such are very common. It's considered less exploitative because the cells are pumped back in, with just the plasma being kept for later use.

You cannot sell whole blood donations though by law, that's all volunteer.

CapitalistCartr• 4 years ago

Yes, plasma. I did it when I was poor(er). It's hard as we age, but it pays.

pkaye• 4 years ago

US is one of the 5 countries (US, Germany, Austria, Hungary and Czesh Republic) that pays for plasma donations. It represents 60%+ of plasma donations worldwide. Most other countries other than the 5 don't sufficiently produce plasma domestically to supply their needs and must import it. It appears some compensation is needed for people to donations sufficiently. The Plasma is broken down it various components used to treat all types of diseases. During the pandemic there were all kinds of worldwide shortages of plasma products because US plasma donations went down. Other countries should reconsider their approach to plasma donations to reduce risks of shortages.

https://www.euractiv.com/section/health-consumers/news/us-bl...

Noumenon72• 4 years ago

How do you make the stem cells produce the certain rare blood type that you need? What distinguishes it?

nigerianbrince2• 4 years ago

The blood group of the person who donated stem cells.

steve_mcdougall• 4 years ago

It's well and truly Morbin' time

photochemsyn• 4 years ago

For more comprehensive report, see:

https://www.bristol.ac.uk/news/2022/november/labblood-study....

"The lab-grown blood cells are all fresh, so the trial team expect them to perform better than a similar transfusion of standard donated red cells, which contains cells of varying ages. Additionally, if manufactured cells last longer in the body, patients who regularly need blood may not need transfusions as often. That would reduce iron overload from frequent blood transfusions, which can lead to serious complications."

They discuss automating the process, but the costs are still likely to be high as you'd need near-clean-room standards of sterility to avoid contamination problems - although that's also a problem with blood donation. Notably, some countries (incl USA, China) allow people to sell their blood, which tends to draw in poor and desperate people who may be more at risk of having transmissible diseases:

https://www.theatlantic.com/business/archive/2018/03/plasma-...

In the long run however, this might become the normal process. Bio-synthetic blood cell production has been talked about for over 20 years, it's cool to see it actually happening. (Synthetic immune system cells are also an interesting possibility, i.e. white blood cells).

zdragnar• 4 years ago

Something of a minor nit, but the US does not allow blood donors to be paid, only plasma donors.

tait9• 4 years ago

That's right, and I have taught that point to trainees. However, there is a subtlety and I am sharing it as penance for having taught incorrectly:

The FDA does allows blood donation by paid blood donors. The blood must be labeled as from paid donors, but it is legal.

See https://www.statnews.com/2016/01/22/paid-plasma-not-blood/ for example...

Am4TIfIsER0ppos• 4 years ago

A nice way to undercut my market of "pay me". Although maybe this will set a price floor above 0 for blood.

kadomony• 4 years ago

Isn't this the plot to the movie Daybreakers? True Blood? Morbin' time?

thecosas• 4 years ago

Was thinking this too; vampires will soon be free to come "out of the coffin" :-)

nathias• 4 years ago

get ready for "I drain my blood and replace it with synthetic every morning to increase coding efficiency" hn posts in a year or two ...

inportb• 4 years ago

This appears to be a transfusion of mature blood cells derived from donor CD34+ hematopoietic stem cells, and it sounds like they're able to collect usable numbers of stem cells from a regular unit of whole blood... but how?

People normally don't have a whole lot of stem cells in the peripheral circulation (if they did, they'd have leukemia). For the purpose of stem cell transplantation, the donor is given medications to mobilize stem cells from the bone marrow before collection. I'm sure they're present in very small numbers in the blood, and perhaps they could be cultured in the lab, but even stem cells become exhausted eventually. This is the innovation, probably.

tait9• 4 years ago

The number of circulating CD34+ cells varies by individual, and by age.

I volunteered for an unstimulated collection when we were validating the process of stem cell collection at my work. I was at the upper limit of normal, but I technically had enough in CD34+ cells in my circulation to do a transplant even without stimulation, and I was in my early 30s at the time.

A single CD34+ cell can probably make a lot of RBCs. (Ok, to be pedantic, I'm not 100 percent sure they are really CD34+ cells, I was taught that CD34+ is a marker for myeloblasts, and the cell population you would probably want are the CD34- hematogones as they are self-replenishing. The article didn't seem to say either way).

nottorp• 4 years ago

I wonder if it's white...

_tom_3• 4 years ago

If we can grow it with whatever factor James Harrison had, that would be another huge benefit.

https://www.cnn.com/2018/05/11/health/james-harrison-blood-d...

eloff• 4 years ago

Wow, what a legacy that man left behind. I don't trust the numbers in the article, but even if his impact was a fraction of the 2.4M lives saved, he's had a remarkable impact in Australia. Thanks for sharing!

olddustytrail• 4 years ago

It is hoped the lab-grown blood will be more potent than normal.

Interesting. I've been expecting artificial blood for a while but hadn't considered this angle. Athletes and the wealthy with better performance blood!

imwillofficial• 4 years ago

You want 28 days later? Because this is how you get 28 days later.

Lab-grown blood given to people in world-first clinical trial

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