Program Manager: Lt Col Daniel J. Wattendorf, M.D
 The Surviving Blood Loss (SBL) program is developing novel strategies to radically extend the time warfighters can survive critical blood loss on the battlefield before initiation of fluid and blood resuscitation. Achieving this goal will allow increased time—perhaps many hours or even days—for evacuation, triage, and initiation of supportive therapies. An interdisciplinary effort is under way to develop a comprehensive understanding of energy production, metabolism, and oxygen utilization, and to identify and control the protective mechanisms that preserve cellular function despite critically depressed oxygen delivery. Specific investigational foci include mechanisms to control the metabolic state on demand, including the induction of a hibernation-like state, and the development of low-volume therapies that reduce tissue demand for O2 and metabolites when full resuscitation is not available.
Significant progress has been made toward achieving program goals including—
- Metabolic rate reduction using hydrogen sulfide: Exposure to low levels of H2S were shown to induce a "hibernation-like state" in mammals, which is highly protective against blood loss or low oxygen environments. The treatment is hypothesized to reduce cellular O2 consumption by both reversibly inhibiting the mitochondrial enzyme cytochrome oxidase and by acting as an electron acceptor alternative for oxygen.
- Hormone-induced resistance: Resistance to the effects of trauma and blood loss were demonstrated with a single dose of the female hormone 17β estradiol (E2). The mechanism of action is likely related to the induction of widespread adaptive mechanisms at the biochemical, cellular, and physiologic levels.
Other promising approaches are also under investigation, including novel mitochondrial targeted anti-oxidants as well as therapeutics affecting the epigenetic response to stress.
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