- The RESTORE trial aims to create red blood cells in the laboratory to make lab-grown blood.
- The technique uses donor stem cells to artificially produce RBCs. 500,000 stem cells were used to create 50 billion red blood cells.
- This trial, if successful, may be used to cure blood diseases such as sickle cell anaemia and to transfuse rare blood groups.
The RESTORE Trial
The RESTORE trial is a joint research initiative by NHS Blood and Transplant (NHSBT) and the University of Bristol, working with the University of Cambridge, Guy’s and St Thomas’ NHS Foundation Trust, National Institute for Health and Care Research (NIHR) Cambridge Clinical Research Facility, and Cambridge University Hospitals NHS Foundation Trust.
This programme aimed to “grow” red blood cells(RBC) in an artificial set-up in the laboratory. The manufactured blood cells were grown from stem cells from donors. The red cells were then transfused into volunteers in this first-of-its-kind clinical trial.
Donors for the stem cells were recruited from NHSBT’s blood donor base. After they donated blood to the trial, the stem cells were separated out from their blood. These stem cells were then grown to produce red blood cells in a laboratory at the Advanced Therapies Unit in Bristol. The recipients of the blood were recruited from healthy members of the NIHR BioResource.
The procedure of the trial
Two people have so far been transfused with the lab-grown red cells. They were kept under close monitoring and no untoward side effects were reported. The identities of participants infused are not currently being released, to help keep the trial ‘blinded’ to prevent bias in this randomized control study.
The amount of lab-grown cells being infused varies but is around 5-10mls – about one to two teaspoons. However to achieve this too the research team needed 500,000 stem cells. This was useful to create 50 billion red blood cells, according to the BBC. Of that volume, 15 billion cells were at the right stage of development for transfusion.
Furthermore, a minimum of 10 participants will receive two mini transfusions at least four months apart, one of the standards donated red cells and one of the lab-grown red cells. This will be useful to find out if the young red blood cells made in the laboratory last longer than cells made in the body.
The implications: a future of successful treatment
Further trials will be needed before clinical use, but this research marks a significant step in using lab-grown red blood cells to improve treatment for patients with rare blood types or people with complex transfusion needs.
If the study successfully confirms that lab-grown cells do last longer in the body than regular RBCs which have a lifespan of 120 days, it implies that patients who need regular blood transfusions wouldn’t need them as often.
This, in turn, is useful to reduce the complications of repeated blood transfusions such as deadly iron overload as well as fever, risk of infections and thrombophlebitis which is inflammation of blood vessels.
A common example of a disease which can be eradicated by the success of this trial is sickle cell anaemia. It’s a disease characterized by the presence of such blood in patients which contains a defective form of haemoglobin which in turn causes the RBCs to attain a diseased sickle shape as compared to the normal disc shape.
These abnormally shaped RBCs clot together and may result in deadly blocks in arteries supplying major organs such as the heart or brain. With the new lab-grown blood research teams could theoretically use the technique to produce lab-grown blood without the problematic haemoglobin.
Also, if successful, this trial may be used to create rare blood groups which are difficult to procure at the time of need. When patients with such rare blood groups meet with an accident or require surgery it’s very difficult to find blood banks to transfuse them. This is where this technique might be useful.
