Sanguinate: History and Clinical Evaluation of a Multimodal HBOCs

Sanguinate is a unique polyethylene glycol modified form of bovine hemoglobin that represents the latest generation of hemoglobin-based oxygen carriers. Its structural characteristics and altered hemoglobin-oxygen binding affinity allow it to bypass obstructions in the microcirculation and effectively deliver oxygen to ischemic tissues. Sanguinate is also able to endogenously deliver carbon monoxide, which has been shown to reduce inflammation, oxidative stress, mitigate ischemia-reperfusion injury, and promote vasodilation. Only results from phase I trials using Sanguinate have been published, although several phase II trials have been completed. While these trials suggest a possible risk of myocardial injury there was little evidence that it was due to Sanguinate. Additional larger studies are needed to better define this relationship. It has been successfully used under emergency circumstances in over 100 patients with severe anemia and impaired oxygen delivery where blood transfusion was contraindicated. The additional therapeutic effects (anti-inflammatory, anti-vasoconstrictive, plasma expansion) may make Sanguinate useful in the treatment of disorders in which blood is ineffective, such as stroke, inflammatory diseases, and sepsis. As such, Sanguinate is more effectively termed a resuscitation fluid than blood substitute.