Hemoglobin-Based Oxygen Carriers in Trauma Care

Trauma-induced haemorrhage remains a leading cause of preventable mortality worldwide, driving the search for safe and effective substitutes for donated blood. Hemoglobin-based oxygen carriers (HBOCs) are engineered to replicate the oxygen-transporting function of red blood cells, offering rapid restoration of tissue perfusion in austere or resource-limited environments. Early generations of HBOCs faced challenges including vasoactivity, oxidative damage and rapid renal clearance. Advances in molecular design—such as site-directed mutagenesis, carrier conjugation and nanostructured encapsulation—have sought to minimise nitric oxide scavenging, attenuate free radical formation and prolong circulatory half-life. These innovations aim to bridge the gap between conventional transfusion and immediate resuscitation, reducing reliance on blood products while mitigating risks of immunogenicity, transfusion-transmitted infections and logistical constraints. The global imperative for battlefield, pre-hospital and disaster-relief haemostatic support underscores the clinical significance of HBOCs and the imperative for rigorous translational research.

Research from Nature Portfolio

Safety evaluations of an albumin-wrapped haemoglobin cluster have demonstrated promising preclinical compatibility and pharmacokinetics. This core–shell construct exhibits minimal vasoactive response upon infusion, maintains blood pressure within physiological ranges and achieves a markedly extended circulatory half-life compared with unmodified albumin. Comprehensive biochemical panels and histopathological analyses in rodent models revealed no significant acute organ toxicity or inflammatory markers seven days post-administration. These findings establish a foundational safety profile for next-generation HBOCs as viable red cell substitutes in trauma resuscitation.

Hemoglobin-Based Oxygen Carriers in Trauma Care publication trend

The graph below shows the total number of articles in hemoglobin-based oxygen carriers in trauma care across all publications each year (not limited to Nature Index journals).

Technical terms

Hemoglobin-Based Oxygen Carrier (HBOC): A therapeutic agent composed of free or modified haemoglobin designed to transport oxygen in place of erythrocytes.

PEGylation: Covalent attachment of polyethylene glycol chains to proteins or particles to reduce immunogenicity and prolong plasma residence time.

Liposome: A spherical vesicle composed of lipid bilayers used to encapsulate therapeutic agents, providing biocompatible protection and controlled release.

Diaaspirin Cross-linked Haemoglobin (DCLHb): An early HBOC in which haemoglobin tetramers are chemically stabilised to prevent dissociation and vascular leakage.

Haptoglobin: A plasma glycoprotein that binds free haemoglobin, facilitating its clearance and reducing oxidative and vasculopathic sequelae.

References

1. Taming hemoglobin chemistry—a new hemoglobin-based oxygen carrier engineered with both decreased rates of nitric oxide scavenging and lipid oxidation. Experimental & Molecular Medicine (2024).
2. Nanomaterial-related hemoglobin-based oxygen carriers, with emphasis on liposome and nano-capsules, for biomedical applications: current status and future perspectives. Journal of Nanobiotechnology (2024).
3. Toxic side-effects of diaspirin cross-linked human hemoglobin are attenuated by the apohemoglobin-haptoglobin complex. Biomedicine & Pharmacotherapy (2024).
4. Safety Evaluation of Hemoglobin-Albumin Cluster “HemoAct” as a Red Blood Cell Substitute. Scientific Reports (2015).