Lance Armstrong, arguably the best endurance athlete in the world, has been the subject of medical scrutiny. Through intensive training and good genes (it has been determined), Armstrong’s maximum muscle efficiency, strong rapidly beating heart, and maximal oxygen consumption make him the best of the best of elite athletes. Endurance depends on oxygen uptake and delivery. Oxygen in the blood, a topic that may interest athletes in Telluride, is the subject of this week’s Pinhead Town Talk. Entitled “Blood and Blood Substitutes: How oxygen gets where it is needed,” it will be given by David A. Case, a senior scientist at one of the worlds leading modern biomedical research institutions, The Scripps Research Institute in San Diego, California.          Oxygen carrying hemoglobin also interests emergency room doctors and surgeons, who often deal with life threatening blood loss in patients. During an accident or surgery, rapid loss of blood volume can lead to deadly shock and severe permanent damage to organs, including the brain. Since the 1930s, when blood banks were first developed, scientists and the medical community have been searching for an effective blood substitute as supply was spotty, storage difficult, and blood type compatibility an issue. During World War II, and again during the Vietnam War, the military invested heavily in the development of blood substitutes, but only in the last few years has progress on oxygen delivering blood substitutes gained significant ground. The last of the summer series, this Town Talk will be a rare encounter between a cutting-edge science researcher, Case, and an on-the-ground practitioner, David Dreitlein, an emergency and high altitude medical doctor at Montrose Hospital and the Himalayan Rescue Association. After a 30-minute presentation by Case, Dreitlein will have a chance to interview him, followed by Q & A with the audience. As a high altitude rescue and small town emergency doctor, Dreitlein is keenly interested in the work of Case and other researchers like him. He has his concerns about the application of blood substitutes in rural and remote settings. And he wants to know when these substitutes will be routinely, safely, and economically available. Dreitlein worked four months of this year as a rescue doctor in the town of Pheriche, Nepal that sits 14,600 feet above sea level in the Himalayan Mountains near Mount Everest; he is now curious about the effect of high altitudes on the oxygen carrying capacities of blood substitutes. As an extreme athlete himself, 33-year-old Boulder-born Dreitlein will have questions about the mechanisms by which blood carries oxygen to the body during strenuous activities such as mountaineering in harsh climates. He did his residency at Brown University in Boston, after attending undergraduate and medical school at the University of Colorado in Boulder. Case, a computational molecular researcher says. “There is a need, a desire, to develop from molecular principles something that can substitute for blood in an emergency situation or in surgery.” He hopes to give the Town Talk audience a sense of how scientists like him think about a process like this, “I am not a physician, so what things do we scientists confront in thinking about the problem of developing blood substitutes?” Today, the genome revolution and our vastly improved ability to manipulate biochemical molecules makes the field much more sophisticated than when it started in the 1940s.          “People are trying to develop blood substitutes that are ‘faithful mimics,’ made of proteins that carry oxygen,” says Case. “Some blood substitutes are being used today; there are some practical applications in place today, but they are not yet routine or widespread and are still experimental, so you don’t read about it in Time or Newsweek yet. But there has been lots of progress.” The creation of a good blood substitute is an interesting medical challenge that could make a tremendous difference in how blood banks work. Real blood only lasts about two weeks. There are storage and shipping problems, and the danger of blood born diseases, like Hepatitis and AIDS, being transmitted. Even a tiny error rate in detection of blood born diseases can have very bad consequences.                     The dream is to develop a blood substitute that can replace the oxygen carrying capability of real blood; a substitute that can load oxygen rapidly to all organs, have no side effects, be compatible with all blood types, have a long shelf life, be user friendly for practitioners, and be produced in large quantities at a low cost. Case adds, “Blood substitutes are unlikely to ever replace blood transfusion of the ordinary kind. If one has the time, real blood is ideal, a luxury.”   “The work on blood substitutes that I have done is an outgrowth of the computational modelling work I do,” says researcher Case. “Computer simulations offer an exciting approach to the study of many aspects of biochemical interactions. Our overall goal, in our lab, is to extract the maximum amount of information about biomolecular structure and dynamics from nuclear magnetic resonance (NMR) experiments.” While Case’s lab is filled with 700 computers, stacked in high-tech cabinetry drawers, working to mimic processes like oxygen delivering proteins, Dreitlein’s work environment in a hospital emergency room is a lot more bloody.   Hospitals throughout the world currently rely solely on donor blood (also referred to as allogeneic blood) for transfusions, although some are experimenting with new blood substitutes in their emergency rooms. Estimates put worldwide blood demand somewhere between 75 and 90 million units per year. The requirements of the United States are a disproportionate 12 million units per year. One unit of blood is approximately 450ml, with a price tag of about $500 U.S. per unit. The shelf life of donor blood is a maximum of 42 days, but after two weeks the oxygen levels are altered, making older blood less effective in transfusions. The average adult human body contains about 20 cups of blood, compared to a baby, which is born with only a cup of blood. Recipients of donor blood risk a 1 in 30,000 – 100,000 chance of contracting Hepatitis C from blood transfusions. The estimate of when demand will outstrip supply at a crisis level is 2030. "If the blood substitute works the way we hope it will, it could be the first major advance since the introduction of saline, or salt water, to replace volume after blood loss, around the time of World War I," said Dr. Richard L. Gamelli, chair of the Department of Surgery and professor of trauma surgery, Loyola University Chicago Stritch School of Medicine. Most doctors are hopeful that the blood substitute dream becomes a reality soon. But, in the future, blood substitutes might be used (or abused) by athletes to increase their endurance by boosting oxygen levels in their blood. What Armstrong does with discipline, some athletes do with supplements. Admission to the Pinhead Town Talk is free and there will be a cash bar. For more information contact Pinhead Institute at 970-728-0713 or visit www.pinheadinstitute.org. August 15, 2005 For more information contact Nana Naisbitt 970-728-0713