The Notch receptor plays a key role in modulating cell fate decisions throughout the development of invertebrate and vertebrate species. Four Notch homologues have been identified in the human genome and aberrant Notch function has been associated with a number of human diseases. An intriguing pathway of Notch signalling has been elucidated involving multiple proteolytic steps and this pathway offers several targets for potential therapeutic intervention. While a consensus model has emerged, in the details there is much that is contentious. This review will primarily focus on our current understanding of the proteolytic events involved in generating and regulating Notch signalling.
For more information click here too see the original article.
Wednesday 17 February 2010
Monday 15 February 2010
Natural health myths busted
When it comes to natural health products, do you have all the pieces of the information puzzle? Here's what you may be missing
Does this product live up to its claims? Is it safe? And is it worth a try?
It's not surprising that people have questions about natural health products (or NHPs for short). There are many misconceptions out there, some which could put your safety at risk and some which may have you dismissing potentially-helpful remedies altogether. Information can be conflicting or hard to find, so we've explored some of the common misconceptions surrounding the products.
Myth #1: Most people don't use them.
You might be surprised to learn that natural health products are actually quite common. According to a 2005 Health Canada survey, 71 per cent of Canadians over the age of 18 use natural health products. Sales of natural health products continue to climb, and are even expected to reach $2.75 billion by 2010.
Bear in mind that "natural health product" is a fairly broad term that encompasses vitamins and minerals, herbal products, homeopathic medicines, traditional medicines (like traditional Chinese medicines), probiotics, and other products like amino acids and essential fatty acids.
In short, if you take vitamin C for a cold you're a consumer of natural health products. Not surprisingly, the stigma attached to taking a "natural remedy" is slowly disappearing as people seek gentler and safer alternatives to traditional medications.
Myth #2: It's natural, therefore it's safe.
More than half of Canadians make this assumption. However, just because an ingredient comes from a natural source, doesn't mean it's safe for everyone to consume. (Technically, poison ivy and snake venom are natural too). People are at risk for allergic reactions and other problems, just as they are for any medication.
NHPs are marketed as supplements or food products for legal reasons, but they often contain medicinal ingredients which can lead to side effects. For example, common products like Echinacea, ginkgo, and St. John's wort don't "agree" with everyone -- they've been found to cause adverse reactions like dizziness, pain, vertigo and high blood pressure in some individuals. (For more information, see Healthy solution or gamble?)
Some NHPs can also contraindicate with medications you're taking. For instance, drinking green tea or taking green tea extract can backfire on cancer patients because the beverage was recently found to block the effects of a common cancer drug. Other products can react with certain medications -- but manufacturers aren't required to put warning information on the labels.
Worse yet, some imported products are tainted with dangerous chemicals. It can be difficult for retailers and consumers to stay on top of the recalls.
The bottom line: You should to ask questions and do some research first. Look up the main ingredients online, and talk to your doctor and pharmacist. Pregnant women and others at risk need to be especially careful.
Myth #3: There's no science behind it.
Can science prove the claims of NHP products? Yes... and no. The benefits of some products like amino acids and certain vitamins have been proven to some extent -- that is, they've been investigated in clinical trials and the findings have been peer-reviewed and published in scientific journals. That's why you'll see doctors recommending supplements for therapeutic reasons.
In other cases, science is just now catching up to what alternative and traditional medicine providers have known for centuries. For example, people have traditionally thought that drinking tea has many health benefits, but it's only been in the last couple of decades that science provided the data to back up the claims. Ditto with probiotics -- years ago, taking supplements like acidophilus was considered "unusual" but now it's the latest health trend.
The fact is that some NHPs simply haven't undergone rigorous testing yet, so most of the evidence is anecdotal or based on other methods of evaluation -- but that doesn't mean they are or aren't effective. The information simply isn't there to prove whether or not a medication works, so it's up to the buyer to decide.
Myth #4: The product claims must be true, right?
Unfortunately, you can't believe everything you read. Despite that fact that companies legally can't make claims that aren't proven, many will try to take advantage of people willing to "try anything" to help with a serious condition or to lose weight. The result: People spend a lot of money on expensive treatments that don't work, or they're risking their health by bypassing a known course of treatment.
Sometimes the issue goes beyond misleading advertising. For example, according to an article in The Globe and Mail officials recently cracked down on yet another Canadian company for making unsubstantiated claims about curing or treating cancer. In the past year, over 100 organizations in Canada have been told to stop making similar claims. The false promises can have a devastating effect on people.
So what you can do? It's important to carefully evaluate any promises, and try to confirm or contradict the information by looking to independent sources. While you likely won't lose much on a cold remedy that doesn't work, expensive treatments and too-good-to-be-true promises should be treated with suspicion.
Myth #5: Natural versus traditional - It's an either/or situation.
Still feel like you have to choose between "traditional" and "natural" or alternative medicine? You don't -- the two can be complementary. If you've never heard of integrative medicine (IM), it's a growing body of medicine that aims to treat the whole person (body, mind and spirit) using the therapies that work the best -- whether they are conventional or alternative.
In other words, IM provides the best of both worlds. Take specialist Dr. Woodson Merrell, for example. He has conventional medical training, but he's also licensed in acupuncture, and trained in homeopathy, botanical medicine and nutrition. Merrell, and experts like him, are part of this emerging field that is taking hold in many prominent academic institutions like Johns Hopkins, Harvard, McMaster University and Laval.
While we shouldn't expect sweeping changes to the way things are done to happen overnight, it's important to know that there are experts out there exploring this approach, thinking about it and writing about it. There's growing scientific precedence for incorporating alternative medicine into a holistic approach to health -- and this will change medicine as we know it.
(For more information on Merrell, see our article Sick of feeling tired?)
Myth #6: It's on the shelf, therefore I can help myself.
Walking up and down the drugstore aisles can be a confusing task -- and one that could be harmful. People don't always understand how to use the products they find or how much to take. There are risks inherent to self-diagnosing an ailment and self-selecting a treatment. You might not find the right product, or you might end up taking something your body doesn't need at all.
Part of the problem is that products don't always contain the ingredients they claim to, or in the amount indicated on the bottle. Ingredients aren't standardized, and different companies offer different formulas and combinations of ingredients.
Many people also don't know to look for the NPN or DIN-HM number -- the eight digit product license number that means the product has been reviewed and approved by Health Canada.
So which vitamin D product do you choose, and how do you know if a digestive aid is right for you? You may need some expert help to decide -- like consulting a pharmacist just as you would for an over-the-counter medication. Don't be afraid to ask for a second opinion, or third if you must.
(For more information and tips, see Natural health products: what you need to know).
Myth #7: All the information out there is biased.
Feel like everything you read is trying to sell you something, or push some hidden agenda? W hen it comes to medical treatment, there's a fine line between helpful advice and marketing speak. It's also tricky to find clinical evidence -- and studies can be confusing and conflicting. While you shouldn't discount the product information from a NHP company, you'll likely want to look beyond it to make sure you're getting a balanced view.
There are many sources online that summarize what is known about certain products and ingredients, and evaluates the evidence (if any). Try:
-- National Center for Complementary and Alternative Medicine (Part of the U.S. National Institute of Health).
-- MedlinePlus (from the U.S. National Library of Medicine).
-- Health Canada: Natural Health Products has information on current regulations, licensing and safety).
-- Health Canada: Natural Health Products Online Solution (this recently-launched system lets you look up ingredients and licensing information for products sold in Canada).
-- CAMline.ca (an evidence-based website on complementary and alternative medicine).
-- The MayoClinic.com
So should you consider taking a natural health product, or drop one you're already using? In many cases, there aren't any clear answers. Overall, it's important to carefully consider any new product you're thinking of trying, and keep your doctor and pharmacist in the loop about what you're taking.
ON THE WEB
Read the Health Canada survey here
Does this product live up to its claims? Is it safe? And is it worth a try?
It's not surprising that people have questions about natural health products (or NHPs for short). There are many misconceptions out there, some which could put your safety at risk and some which may have you dismissing potentially-helpful remedies altogether. Information can be conflicting or hard to find, so we've explored some of the common misconceptions surrounding the products.
Myth #1: Most people don't use them.
You might be surprised to learn that natural health products are actually quite common. According to a 2005 Health Canada survey, 71 per cent of Canadians over the age of 18 use natural health products. Sales of natural health products continue to climb, and are even expected to reach $2.75 billion by 2010.
Bear in mind that "natural health product" is a fairly broad term that encompasses vitamins and minerals, herbal products, homeopathic medicines, traditional medicines (like traditional Chinese medicines), probiotics, and other products like amino acids and essential fatty acids.
In short, if you take vitamin C for a cold you're a consumer of natural health products. Not surprisingly, the stigma attached to taking a "natural remedy" is slowly disappearing as people seek gentler and safer alternatives to traditional medications.
Myth #2: It's natural, therefore it's safe.
More than half of Canadians make this assumption. However, just because an ingredient comes from a natural source, doesn't mean it's safe for everyone to consume. (Technically, poison ivy and snake venom are natural too). People are at risk for allergic reactions and other problems, just as they are for any medication.
NHPs are marketed as supplements or food products for legal reasons, but they often contain medicinal ingredients which can lead to side effects. For example, common products like Echinacea, ginkgo, and St. John's wort don't "agree" with everyone -- they've been found to cause adverse reactions like dizziness, pain, vertigo and high blood pressure in some individuals. (For more information, see Healthy solution or gamble?)
Some NHPs can also contraindicate with medications you're taking. For instance, drinking green tea or taking green tea extract can backfire on cancer patients because the beverage was recently found to block the effects of a common cancer drug. Other products can react with certain medications -- but manufacturers aren't required to put warning information on the labels.
Worse yet, some imported products are tainted with dangerous chemicals. It can be difficult for retailers and consumers to stay on top of the recalls.
The bottom line: You should to ask questions and do some research first. Look up the main ingredients online, and talk to your doctor and pharmacist. Pregnant women and others at risk need to be especially careful.
Myth #3: There's no science behind it.
Can science prove the claims of NHP products? Yes... and no. The benefits of some products like amino acids and certain vitamins have been proven to some extent -- that is, they've been investigated in clinical trials and the findings have been peer-reviewed and published in scientific journals. That's why you'll see doctors recommending supplements for therapeutic reasons.
In other cases, science is just now catching up to what alternative and traditional medicine providers have known for centuries. For example, people have traditionally thought that drinking tea has many health benefits, but it's only been in the last couple of decades that science provided the data to back up the claims. Ditto with probiotics -- years ago, taking supplements like acidophilus was considered "unusual" but now it's the latest health trend.
The fact is that some NHPs simply haven't undergone rigorous testing yet, so most of the evidence is anecdotal or based on other methods of evaluation -- but that doesn't mean they are or aren't effective. The information simply isn't there to prove whether or not a medication works, so it's up to the buyer to decide.
Myth #4: The product claims must be true, right?
Unfortunately, you can't believe everything you read. Despite that fact that companies legally can't make claims that aren't proven, many will try to take advantage of people willing to "try anything" to help with a serious condition or to lose weight. The result: People spend a lot of money on expensive treatments that don't work, or they're risking their health by bypassing a known course of treatment.
Sometimes the issue goes beyond misleading advertising. For example, according to an article in The Globe and Mail officials recently cracked down on yet another Canadian company for making unsubstantiated claims about curing or treating cancer. In the past year, over 100 organizations in Canada have been told to stop making similar claims. The false promises can have a devastating effect on people.
So what you can do? It's important to carefully evaluate any promises, and try to confirm or contradict the information by looking to independent sources. While you likely won't lose much on a cold remedy that doesn't work, expensive treatments and too-good-to-be-true promises should be treated with suspicion.
Myth #5: Natural versus traditional - It's an either/or situation.
Still feel like you have to choose between "traditional" and "natural" or alternative medicine? You don't -- the two can be complementary. If you've never heard of integrative medicine (IM), it's a growing body of medicine that aims to treat the whole person (body, mind and spirit) using the therapies that work the best -- whether they are conventional or alternative.
In other words, IM provides the best of both worlds. Take specialist Dr. Woodson Merrell, for example. He has conventional medical training, but he's also licensed in acupuncture, and trained in homeopathy, botanical medicine and nutrition. Merrell, and experts like him, are part of this emerging field that is taking hold in many prominent academic institutions like Johns Hopkins, Harvard, McMaster University and Laval.
While we shouldn't expect sweeping changes to the way things are done to happen overnight, it's important to know that there are experts out there exploring this approach, thinking about it and writing about it. There's growing scientific precedence for incorporating alternative medicine into a holistic approach to health -- and this will change medicine as we know it.
(For more information on Merrell, see our article Sick of feeling tired?)
Myth #6: It's on the shelf, therefore I can help myself.
Walking up and down the drugstore aisles can be a confusing task -- and one that could be harmful. People don't always understand how to use the products they find or how much to take. There are risks inherent to self-diagnosing an ailment and self-selecting a treatment. You might not find the right product, or you might end up taking something your body doesn't need at all.
Part of the problem is that products don't always contain the ingredients they claim to, or in the amount indicated on the bottle. Ingredients aren't standardized, and different companies offer different formulas and combinations of ingredients.
Many people also don't know to look for the NPN or DIN-HM number -- the eight digit product license number that means the product has been reviewed and approved by Health Canada.
So which vitamin D product do you choose, and how do you know if a digestive aid is right for you? You may need some expert help to decide -- like consulting a pharmacist just as you would for an over-the-counter medication. Don't be afraid to ask for a second opinion, or third if you must.
(For more information and tips, see Natural health products: what you need to know).
Myth #7: All the information out there is biased.
Feel like everything you read is trying to sell you something, or push some hidden agenda? W hen it comes to medical treatment, there's a fine line between helpful advice and marketing speak. It's also tricky to find clinical evidence -- and studies can be confusing and conflicting. While you shouldn't discount the product information from a NHP company, you'll likely want to look beyond it to make sure you're getting a balanced view.
There are many sources online that summarize what is known about certain products and ingredients, and evaluates the evidence (if any). Try:
-- National Center for Complementary and Alternative Medicine (Part of the U.S. National Institute of Health).
-- MedlinePlus (from the U.S. National Library of Medicine).
-- Health Canada: Natural Health Products has information on current regulations, licensing and safety).
-- Health Canada: Natural Health Products Online Solution (this recently-launched system lets you look up ingredients and licensing information for products sold in Canada).
-- CAMline.ca (an evidence-based website on complementary and alternative medicine).
-- The MayoClinic.com
So should you consider taking a natural health product, or drop one you're already using? In many cases, there aren't any clear answers. Overall, it's important to carefully consider any new product you're thinking of trying, and keep your doctor and pharmacist in the loop about what you're taking.
ON THE WEB
Read the Health Canada survey here
Scientists develop synthetic protein that may be capable of killing cancer
Singapore scientists have developed a synthetic protein fragment that stops cancer cells from dividing and thus destroys them. This alternative way to treat cancer produces fewer side effects and should be more successful than traditional medications. It targets cancer cells only and thus is less debilitating than radiotherapy and chemotherapy which tends to destroy healthy cells as well. The research group hopes to have their product commercially available within five years. They are currently developing a synthetic protein to target genital warts and cervical cancer.
Sunday 14 February 2010
Malcolm Moore
Malcolm Moore, DPhil received his Bachelor of Medicine and Doctor of Philosophy degrees from the University of Oxford. Shortly thereafter, he was appointed a Prize Fellow at Magdalen College, Oxford. He was a Queen Elizabeth II Visiting Fellow and Senior Research Scientist and Head of the Laboratory of Developmental Biology at the Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia. Since 1974 he has been a Member at the Sloan-Kettering Institute for Cancer Research and heads the James Ewing Laboratory of Developmental Hematopoiesis. He is perhaps best known for identifying and purifying a human growth factor, G-CSF, that stimulates white blood cell production (neutrophils). In collaboration with Amgen, recombinant G-CSF (Neupogen) was developed. This therapy has significantly improved survival in cancer patients.
More posts come later to find out how this biomedical scientist can going to produce artififical blood ex vivo.
We will discuss his pulications and areas of research in future posts.
Friday 12 February 2010
Wednesday 10 February 2010
Transfusion Medicine in the year 2025: Facts or Fantasy?
Blood transfusion science has made tremendous progress over the last century. It started with the discovery of ABO blood groups by Karl Landsteiner at the beginning of the century. The journey continued throughout the century towards safer blood transfusion. This ‘march’ was in the direction of achieving zero risk transfusion. Initial focus was targeted towards gathering knowledge about different aspects of red cell antigen structures. As a result, major blood group antigens were discovered around the first half of the last century. Red cell serology made an opening to the new horizon called immunohematology. Research scope gradually extended to other cellular components. Towards the end of the century, all cellular blood components were brought to the use of human beings in one way or the other. Most interesting developments were in the field of progenitor cells.
Few months back, in one evening, I was resting on the terrace of my house, all alone, after a long day of hard work, trying to recollect what transpired during the day. Gradually, I drifted into thinking what will happen in the coming years to blood banking and the field of transfusion medicine. In that week, I discussed with a few friends to consolidate my thoughts about ‘Transfusion Medicine by the Year 2025’.
The first thought that came to mind was whether this specialty would survive at all beyond 2025. Transfusion therapy is life-saving; however, it is need-based. If we look into the need, it differs across different specialties and between specialties; the need varies according to the individual's clinical situations. Transfusion need depends upon multiple factors. It has been observed that blood requirement has come down in many surgical procedures. It is because of improved techniques, use of better equipment and expertise gained by surgeons and clinicians. Good examples are open heart surgery procedures and gastro surgery procedures like cholecystectomy. About a decade back, it was a routine practice to use (or keep in reserve) two to four units of blood for these types of procedures. However, blood utilization has come down drastically for the above reasons. Moreover, transfusion services are spreading awareness to avoid unnecessary transfusions and to use blood judiciously.
Emergence of new specialties is another hallmark of medical sciences in the previous century. This emergence was due to high-end medical care and segregation of specialties into super-specialties. A good example is stem cell therapy, which has become a routine mode of treatment in many countries. Because of high-end medical interventions, the demand for blood and blood components is increasing gradually all over the world. The demand for blood is gradually increasing although some branches of medicine have brought down its necessity.
In the field of blood banking, the main focus of attention remains in making transfusion therapy safe. Scientists involved in this field are making concerted efforts to improve methodologies and techniques. The journey begins with very simple tests like microscopy or passive haemagglutination to highly sensitive tests like nucleic acid test. Efforts were made for higher sensitivity of diagnostic tests to increase the detectable limit of pathogens. Apart from increasing the sensitivity of different tests, modern tests were included as newer pathogens were continuously emerging as threats. Some pathogens were never thought to be transfusion-associated threats. Due to change in the behavior of human and animals, improved knowledge and detection techniques as well as better vigilance in the part of transfusion services, new diseases associated with transfusion have come to limelight.
In the last century, transfusion medicine had become a semi-clinical discipline. Unlike other pre- and para-clinical specialties, it dealt not only with patient's samples but also with blood donors and patients who are alive. For the blood donor, blood bankers carry out simple procedures like screening and whole blood collection to complex procedures like apheresis, stem cell harvesting, cord blood banking, etc. On the other hand, this specialty has gone to the bedside, as we call it ‘bed side transfusion medicine’. There is active involvement in patient consultation by clinicians. Many centers are even taking up complex procedures like therapeutic apheresis and exchange procedures in patients as bedside procedures.
In this article, we have summed up what we have been seeing in practical life or reading the literature. What will be the future of transfusion medicine? What progress will be made? Will this specialty survive beyond 2025? We do not know! I discussed with few specialists in this field and tried to provoke their thinking for the future of transfusion medicine. Their reactions about the status of this specialty by the year 2025 were vivid. I will try to pen our thoughts together in following paragraphs. None of us knew what would become reality.
There is anxiety in the minds of blood bankers, , ‘What would happen if substitutes for blood components come in the market?’ This is a genuine fear due to the advancement of research at the molecular level. Quite a few commercial companies are working hard to find out substitutes for red blood cells (RBC). One of these almost succeeded in developing a hemoglobin solution; however, the whole project was scrapped and millions of dollars dissipated. To come up with a substitute for RBC is a Herculean task due to the complex nature and function of the cell. Not much of information in literature or the internet is available on this subject because of the involvement of patents and secret nature of research carried out by (mainly) commercial companies. Recently, advancement was made in the development of universal red cells by using enzymes and by blocking antigen sites on the RBC surface. This will make RBC transfusion safer by removing and reducing antigenicity of the cells. However, a question remains about feasibility of producing this component at commercial level and its price. In case of the artificial oxygen-carrying substances, we may see it in practical use by the year 2025. Some research materials may come into use at the level of clinical trials but it is unlikely they will come to the market. In the most optimistic tone, if anything equivalent to RBC may come to the market, it cannot probably be able to replace RBC because of price and biological half-life. Artificial blood will be helpful for immediate transfusion in case of resuscitation. However, it seems that blood transfusion services are going to survive for another 15 or 20 years (?) because patients with chronic requirements always need their help. Moreover, cost will be a prohibitive factor if artificial blood comes into reality. Especially in developing countries, blood transfusion will continue for years to come with more focus on safety.
Another future prospect is to develop artificial blood from culture plate. Genetically modified blood cells are targeted for production in laboratory. Although it sounds a fantasy, progress can be expected within 10 or 15 years. Advantages in these types of blood components will be no risk of transfusion, neutral blood group and no fear of alloimmunization. However, the success and wide use of these components is questionable because of anticipated high price and risk of development in artificial culture medium.
Transfusion medicine specialists from many developed and developing countries are already involved in the different phases of stem cell collection, processing, preservation and transfusion. Stem cell culture and manipulation has already been taken up by many blood centers in developed countries. The role of stem cells in different areas of medical sciences is gradually increasing, especially in R&D. Recently, clinicians and scientists from different fields of medical sciences have started using stem cells for different purposes, including infusing in cardiac, spinal, neural tissues and other areas in the human body. This is just a beginning. Transfusion medicine specialists have good prospects in the field of R&D in stem cell biology.
There will be much progress in protein chemistry. At present, most of the therapeutic proteins for clinical use come from fractionation. There is much advancement in protein production by recombinant technology. Another cutting-edge technology in the horizon will be transgenic technology where high value and purified proteins will be produced for infusion/transfusion. Genetically modified female animals will produce human coagulation factors (e.g. F.VIII) and proteins in the milk as engineered by scientists. The limitations of this technology at present are low volume of production and high cost involvement.
There would be more involvement from the side of central/regional blood centers in tissue banking activities. Bone banking, skin banking and sperm banking may become a routine banking facility in the major blood centers. Associated facilities like donor and patient screening for HLA, TTI testing and post-transfusion/transplant monitoring will be an integral part of the blood centers’ responsibilities. Cryobiology will be another new frontier opened to transfusion medicine specialists. Manipulation and preservation of different liquid and solid tissues using cryobiology, documentation, retrieval and supply will be a routine job for these specialists. Blood bankers are most suitable for this job because they are very familiar with production, testing, preservation, regulatory affairs and documentations.
It is hoped that some major changes may take place in the blood banking service sector in developing countries like India. There will be restructuring of blood transfusion services for better efficiency and service delivery. The number of blood banks will come down, and high-capacity, technically up-scaled central blood banks will function in their place to reduce the costs of operation. Two types of blood transfusion services would exist in future. One will be the large central/regional blood centers as mentioned earlier. There will be smaller hospital-based blood banks having responsibilities limited only to that hospital. They may not collect blood units but receive tested blood units from the central/regional blood centers for use by the hospital. Transfusion medicine specialists placed in these blood banks will focus more on the clinical interface including clinical consultations and bedside transfusion medicine. They will explore into other areas of interest including tissue banking. Excessive control and interference by the managerial personnel in the daily working of technical personnel is not advisable because blood banking in the hands of administrators usually becomes another mode of profit-making.
As a whole, we foresee good prospects for transfusion medicine specialists by the year 2025, at least in the developing countries. However, traditional blood banking will gradually fade out. Transfusion medicine specialists will lead big blood centers. They will be more clinically oriented and actively associated with transfusion regime in the patients. There will be opening for at least one specialist in every big hospital. Stem cell production and dispensing will be a routine job. In such competitive environment, ‘survival of the fittest’ is the benchmark. Blood transfusion services - both central blood banks and hospital blood banks – will place highly skilled and qualified specialists.
Few months back, in one evening, I was resting on the terrace of my house, all alone, after a long day of hard work, trying to recollect what transpired during the day. Gradually, I drifted into thinking what will happen in the coming years to blood banking and the field of transfusion medicine. In that week, I discussed with a few friends to consolidate my thoughts about ‘Transfusion Medicine by the Year 2025’.
The first thought that came to mind was whether this specialty would survive at all beyond 2025. Transfusion therapy is life-saving; however, it is need-based. If we look into the need, it differs across different specialties and between specialties; the need varies according to the individual's clinical situations. Transfusion need depends upon multiple factors. It has been observed that blood requirement has come down in many surgical procedures. It is because of improved techniques, use of better equipment and expertise gained by surgeons and clinicians. Good examples are open heart surgery procedures and gastro surgery procedures like cholecystectomy. About a decade back, it was a routine practice to use (or keep in reserve) two to four units of blood for these types of procedures. However, blood utilization has come down drastically for the above reasons. Moreover, transfusion services are spreading awareness to avoid unnecessary transfusions and to use blood judiciously.
Emergence of new specialties is another hallmark of medical sciences in the previous century. This emergence was due to high-end medical care and segregation of specialties into super-specialties. A good example is stem cell therapy, which has become a routine mode of treatment in many countries. Because of high-end medical interventions, the demand for blood and blood components is increasing gradually all over the world. The demand for blood is gradually increasing although some branches of medicine have brought down its necessity.
In the field of blood banking, the main focus of attention remains in making transfusion therapy safe. Scientists involved in this field are making concerted efforts to improve methodologies and techniques. The journey begins with very simple tests like microscopy or passive haemagglutination to highly sensitive tests like nucleic acid test. Efforts were made for higher sensitivity of diagnostic tests to increase the detectable limit of pathogens. Apart from increasing the sensitivity of different tests, modern tests were included as newer pathogens were continuously emerging as threats. Some pathogens were never thought to be transfusion-associated threats. Due to change in the behavior of human and animals, improved knowledge and detection techniques as well as better vigilance in the part of transfusion services, new diseases associated with transfusion have come to limelight.
In the last century, transfusion medicine had become a semi-clinical discipline. Unlike other pre- and para-clinical specialties, it dealt not only with patient's samples but also with blood donors and patients who are alive. For the blood donor, blood bankers carry out simple procedures like screening and whole blood collection to complex procedures like apheresis, stem cell harvesting, cord blood banking, etc. On the other hand, this specialty has gone to the bedside, as we call it ‘bed side transfusion medicine’. There is active involvement in patient consultation by clinicians. Many centers are even taking up complex procedures like therapeutic apheresis and exchange procedures in patients as bedside procedures.
In this article, we have summed up what we have been seeing in practical life or reading the literature. What will be the future of transfusion medicine? What progress will be made? Will this specialty survive beyond 2025? We do not know! I discussed with few specialists in this field and tried to provoke their thinking for the future of transfusion medicine. Their reactions about the status of this specialty by the year 2025 were vivid. I will try to pen our thoughts together in following paragraphs. None of us knew what would become reality.
There is anxiety in the minds of blood bankers, , ‘What would happen if substitutes for blood components come in the market?’ This is a genuine fear due to the advancement of research at the molecular level. Quite a few commercial companies are working hard to find out substitutes for red blood cells (RBC). One of these almost succeeded in developing a hemoglobin solution; however, the whole project was scrapped and millions of dollars dissipated. To come up with a substitute for RBC is a Herculean task due to the complex nature and function of the cell. Not much of information in literature or the internet is available on this subject because of the involvement of patents and secret nature of research carried out by (mainly) commercial companies. Recently, advancement was made in the development of universal red cells by using enzymes and by blocking antigen sites on the RBC surface. This will make RBC transfusion safer by removing and reducing antigenicity of the cells. However, a question remains about feasibility of producing this component at commercial level and its price. In case of the artificial oxygen-carrying substances, we may see it in practical use by the year 2025. Some research materials may come into use at the level of clinical trials but it is unlikely they will come to the market. In the most optimistic tone, if anything equivalent to RBC may come to the market, it cannot probably be able to replace RBC because of price and biological half-life. Artificial blood will be helpful for immediate transfusion in case of resuscitation. However, it seems that blood transfusion services are going to survive for another 15 or 20 years (?) because patients with chronic requirements always need their help. Moreover, cost will be a prohibitive factor if artificial blood comes into reality. Especially in developing countries, blood transfusion will continue for years to come with more focus on safety.
Another future prospect is to develop artificial blood from culture plate. Genetically modified blood cells are targeted for production in laboratory. Although it sounds a fantasy, progress can be expected within 10 or 15 years. Advantages in these types of blood components will be no risk of transfusion, neutral blood group and no fear of alloimmunization. However, the success and wide use of these components is questionable because of anticipated high price and risk of development in artificial culture medium.
Transfusion medicine specialists from many developed and developing countries are already involved in the different phases of stem cell collection, processing, preservation and transfusion. Stem cell culture and manipulation has already been taken up by many blood centers in developed countries. The role of stem cells in different areas of medical sciences is gradually increasing, especially in R&D. Recently, clinicians and scientists from different fields of medical sciences have started using stem cells for different purposes, including infusing in cardiac, spinal, neural tissues and other areas in the human body. This is just a beginning. Transfusion medicine specialists have good prospects in the field of R&D in stem cell biology.
There will be much progress in protein chemistry. At present, most of the therapeutic proteins for clinical use come from fractionation. There is much advancement in protein production by recombinant technology. Another cutting-edge technology in the horizon will be transgenic technology where high value and purified proteins will be produced for infusion/transfusion. Genetically modified female animals will produce human coagulation factors (e.g. F.VIII) and proteins in the milk as engineered by scientists. The limitations of this technology at present are low volume of production and high cost involvement.
There would be more involvement from the side of central/regional blood centers in tissue banking activities. Bone banking, skin banking and sperm banking may become a routine banking facility in the major blood centers. Associated facilities like donor and patient screening for HLA, TTI testing and post-transfusion/transplant monitoring will be an integral part of the blood centers’ responsibilities. Cryobiology will be another new frontier opened to transfusion medicine specialists. Manipulation and preservation of different liquid and solid tissues using cryobiology, documentation, retrieval and supply will be a routine job for these specialists. Blood bankers are most suitable for this job because they are very familiar with production, testing, preservation, regulatory affairs and documentations.
It is hoped that some major changes may take place in the blood banking service sector in developing countries like India. There will be restructuring of blood transfusion services for better efficiency and service delivery. The number of blood banks will come down, and high-capacity, technically up-scaled central blood banks will function in their place to reduce the costs of operation. Two types of blood transfusion services would exist in future. One will be the large central/regional blood centers as mentioned earlier. There will be smaller hospital-based blood banks having responsibilities limited only to that hospital. They may not collect blood units but receive tested blood units from the central/regional blood centers for use by the hospital. Transfusion medicine specialists placed in these blood banks will focus more on the clinical interface including clinical consultations and bedside transfusion medicine. They will explore into other areas of interest including tissue banking. Excessive control and interference by the managerial personnel in the daily working of technical personnel is not advisable because blood banking in the hands of administrators usually becomes another mode of profit-making.
As a whole, we foresee good prospects for transfusion medicine specialists by the year 2025, at least in the developing countries. However, traditional blood banking will gradually fade out. Transfusion medicine specialists will lead big blood centers. They will be more clinically oriented and actively associated with transfusion regime in the patients. There will be opening for at least one specialist in every big hospital. Stem cell production and dispensing will be a routine job. In such competitive environment, ‘survival of the fittest’ is the benchmark. Blood transfusion services - both central blood banks and hospital blood banks – will place highly skilled and qualified specialists.
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