“This knowledge will be crucial to develop new storage strategies…”

van_bruggen

Robin van Bruggen

Can you tell us something about your current research?
The focus of my research group is on red blood cells, especially the transfusion product itself. We also perform research in which we study more fundamental aspects of red blood cells. For example how red blood cells deform and how they can transport bacteria to the spleen to be cleared by macrophages. But most of all we perform transfusion research.
Within 24 hours after a blood transfusion, a large percentage of the donor red blood cells is lost from the circulation. Although the transfusion product is safe and effective we think that it could perhaps be further improved. We want to know for instance to what extent the quality of the product declines over time. In order to do so we are identifying the relevant parameters to measure the quality of the product. Then, we can try to improve the product and ideally also increase its shelf life. This is of importance for different patient groups, which receive frequent transfusions, such as sickle cell patients. Due to the repeated transfusions, these patients have to clear many red blood cells which causes problems like iron overload and tissue damage. For people who are critically ill and receive blood transfusions it is also of great importance to optimize transfusion products. Currently, many studies are performed to examine if transfusing critically ill patients is good or bad, and how this is influenced by the storage time of the product. However, what we do know is that there may be a large amount of clearance, which is a burden for patients. Our primary goal is thus to improve the recovery of donor red blood cells.

Why are red blood cells important for our health?
Naturally, for the transport of oxygen. A low number of red cells in the body leads to a shortage of oxygen in many organs like the kidneys and the brain. This is harmful and leads to permanent damage to the organs when it takes too long and eventually the patient will die.

Can someone have too many red blood cells?
People that are diagnosed with hemochromatosis have too many red blood cells. In order to reduce the level of red blood cells therapeutic phlebotomy is used. At a certain level of red blood cells, (called hematocrit) the blood gets too thick and the heart must pump too hard which can cause different problems.

What are the most important lines of research/approaches that have developed in your field over the past 5 or 10 years?
The biggest change in the field is that the realization has come that a red blood cell transfusion may potentially also be harmful. There used to be a lot of overtransfusion, exaggerating the adverse effects, while not improving the benefits. Doctors nowadays transfuse a lot less than they used to. Ten years ago, red cell research was rather quiet but due to this realization, there is a huge expansion of the field, especially in the amount of clinical studies on blood transfusion. However, as a negative side-effect, many studies are published that claim how bad especially old (long stored) blood can be. People suggest it can cause many serious side effects. A lot of these studies are definitely exaggerating the effects of long stored blood, and unfortunately these sort of studies sell very well to the media. However, there is still no substitute for a transfusion and in many cases a transfusion is a life-saving therapy. We need to do a lot of research on our transfusion products to be able to determine the real side-effects of transfusions and how we can improve our products to prevent these.
Red blood cells and platelets are funny products because in the past people just transfused patients without any knowledge. In the era of evidence based medicine it is unthinkable to just do treatment without research. However, because of its historical development, it was never really studied in the right way. Nevertheless, the realization is now growing that blood products are perishable and that they should be systematically analyzed, not just in a test tube, but especially after administration to the patient.

What is, according to you, the biggest challenge in current research in your field?
My focus is on the clearance of red blood cells. I really want to know why red blood cells are broken down, for example in the spleen, during normal life, but especially after transfusion. This knowledge will be crucial to develop new storage strategies to prevent the changes in the red blood cells during storage and improve the recovery after transfusion. The ultimate goal of everything we do is to relate what we discover to what happens in the body. To fundamentally improve the recovery of donor red blood cells is quite a challenge but the answer might be closer than we think.

Why does your line of research matter? Why should people put money into it?
Because it is important we provide blood products of the highest quality and the best safety. For instance, we could try to improve the quality of life of chronically transfused patients with an improved product, which is of course of high importance.
Furthermore, I think that the spin-off of our research will be that we can make special products. For example, red blood cells with certain enzymes in order to treat patients. Fundamental knowledge to manipulate red blood cells and can also help with these special requests. But the primary goal is to improve the product.

It is hard to obtain funding for fundamental research; is this something you also experience?
I think everyone experiences this. Funding has become more and more competitive, there is just less money available for research. It is difficult to be competitive when you are working on red blood cells which aren’t as hip as cancer or diabetes research. Fortunately, Sanquin has some money available for research and we have the advantage that our research is fundamental but also applied, which improves our possibilities to apply for funding.

Who or what will benefit from your research?
Especially patients will benefit and in the end I think, healthcare as well. When we can deliver an improved product, with a better recovery and potentially less side-effects, it will be better and cheaper. Nevertheless, the patients will benefit most.

How does your research suits Sanquin?
Red blood cells have always been, and will always be, the primary product of Sanquin.

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