Better Than Blood?

DR. BLOOD

Spiess's office, #007, is in the basement of a building not far from the ER where Bess-Lyn was rushed after her accident. Stuck among a bunch of animal laboratories along a cinder-block hallway, the office is far less prominent than you would expect for someone in charge of a major research center. Along with two other physicians, Spiess heads the Virginia Commonwealth University Reanimation Engineering Shock Center. Formed in 2000, the institute, which goes by the acronym VCURES, comprises some 50 scientists, engineers and doctors, all focused on developing treatments for traumatic injury. VCURES's research dovetails perfectly with the needs of the military; its current projects include an implanted sensor that could detect the severity of a soldier's wounds on a battlefield and a kitty-litter-like compound that could quickly stop bleeding from an open wound. Artificial blood, however, is perhaps VCURES's most ambitious project.And artificial blood's most dedicated advocate at VCURES is Bruce Spiess.

For years, the anesthesiologist has advanced ideas that seem downright heretical, ranging from his stance that traditional blood transfusions usually cause more harm than good, to his belief-reached before most in the industry–that blood substitutes should not actually be used in place of blood. "I realized very early on that going head to head with a unit of blood was going to be difficult," Spiess, 52, says from behind his cluttered desk. "Instead, why not take these compounds, understand how they deliver oxygen to tissues better than blood stored from a bank, and use that as a real advantage. Go find some diseased states to treat that, right now, we don't have a treatment for." He leans back in his chair and smiles, as if this last point is so obvious he can't believe he's still making it.

It was during Spiess's final year of anesthesiology training, in 1982, that his professor at the Mayo Clinic asked him to compile a summary of the three blood substitutes created up to that point. Two of them were made with PFCs, and Spiess found those two particularly intriguing. Developed in the 1940s during the Manhattan Project to stabilize highly reactive uranium isotopes, PFCs are completely inert oils. Like Teflon, almost nothing sticks to them, which is why they must be emulsified before they can be soluble in blood. "These chemists were working on trying to blow things up," Spiess says. It was just by luck that they eventually noticed that these liquid PFCs carried huge amounts of oxygen.

Now, more than 20 years after he first studied artificial blood, Spiess has worked with nearly every substitute ever made. "Bruce was one of the first and best academic people in this field," says Robert Winslow, the former head of the Army's now-defunct artificial-blood program. "He was one of the first people who said, 'This isn't just blood; that's way too simple. These solutions have to be thought of as therapeutic agents in and of themselves.'" In the past two decades, Spiess has been involved in overseeing more than a dozen human and animal studies, both of hemoglobin-based and PFC-based blood substitutes. Manufacturers routinely approach him for advice and invite him to conduct research on their products-as did Synthetic Blood International, the maker of the PFC Oxycyte. In late 2005, Spiess teamed up with noted VCU neurosurgeon Ross Bullock to design the Phase II pilot trial (Bullock had earlier conducted successful animal studies with the drug). The trial, Spiess says, is the first step in determining whether Oxycyte will ultimately be adopted to treat a wide array of injuries, including
traumatic brain injury, which affects everyone from car-accident victims to pummeled boxers to bicyclists like Bess-Lyn. Aside from giving patients oxygen and anti-inflammatories and, in extreme cases, removing part of the skull to release the pressure of the swelling brain, there are few treatments for TBI-and no drug therapy. Which is precisely why Spiess has chosen to focus on it.

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