REDS Family of Research
The Vital Role of Blood in Combating Covid
There’s a whole network of researchers and specialists who work tirelessly behind the scenes to safeguard the nation’s blood supply, and their heroic efforts have recently kicked into high gear. Another unsung hero in the coronavirus pandemic is blood, the lifeline that underlies our understanding, diagnosing and potential treatment of Covid-19.
“To increase our understanding of SARS-CoV-2 and how it causes disease, it is important to conduct blood research,” said Dr. Iman Martin, an epidemiologist and program director in the National Heart, Lung, and Blood Institute’s Blood Epidemiology and Clinical Therapeutics Branch.
The group is evaluating questions about blood safety and availability as well as new research to further our understanding of viruses and their pathogenesis. When a new infectious agent emerges, such as SARS-CoV-2, it becomes part of a longstanding research program created 30 years ago, born of the HIV/AIDS epidemic.
Today, NHLBI’s Recipient Epidemiology & Donor Evaluation Study (REDS) continues to meet its goals by conducting research to evaluate and improve the safety and availability of the blood supply as well as the safety and effectiveness of transfusion therapies. Another core mission: evaluating whether a new emerging infectious agent represents a threat to blood safety.
“When there is an emergency, NHLBI and its partners can flip a switch and turn the REDS infrastructure into a response asset,” said Martin, underscoring the critical role of public-private partnerships established through the REDS framework. This REDS family of researchers unites HHS partners with blood collection facilities and industry partners across the U.S. to achieve its research objectives.
“This switch was turned on as soon as we realized that we were dealing with a severe emerging infectious threat,” said Dr. Simone Glynn, chief of NHLBI’s Blood Epidemiology and Clinical Therapeutics Branch, who is managing the REDS domestic program at NHLBI and is helping launch a new REDS effort targeted at SARS-CoV-2 called RESPONSE—REDS Epidemiology, Surveillance and Preparedness of the Novel SARS-CoV-2 Epidemic. This project, which is jointly supported by the National Institute of Allergy and Infectious Diseases and NHLBI, represents a collaboration between REDS investigators and several blood collection organizations including Bloodworks Northwest, New York Blood Center, Vitalant and the American Red Cross.
“RESPONSE will help us answer key questions about theoretical blood safety concerns, seroprevalence in blood donors, and will further our understanding of the SARS-CoV-2 pathogenesis through follow-up studies of previously infected donors and patients,” Glynn said.
REDS is harnessing the nation’s vast network of blood donors. Millions of people donate blood each year; within that pool lies the potential to gauge the extent of infections and virus immunity across the country. “We’re sitting on a treasure trove of the potential milieu of antibodies available in the blood supply,” said Martin.
“We’re trying to leverage that large surveillance system of blood donors who are screened across the nation to help gather information on new infections,” said Glynn. For this reason, the RESPONSE program is now focused on testing blood samples in select Covid-19 outbreak regions to help determine how many people may have developed protective antibodies against the virus.
This serology survey to test blood donations for covid antibodies recently launched across 6 major U.S. regions. The effort will help track how many people were exposed to SARS-CoV-2 and developed antibodies against the virus. “These sero-surveys, which will be conducted monthly, will also track the percentage of people who have antibodies over time,” explained Glynn. “We are working closely with CDC on this effort.”
Through REDS, heightened efforts continue to advance blood science while protecting the blood supply from infectious agents. For SARS-CoV-2, RESPONSE researchers will evaluate available tests that could potentially be used to screen the blood supply if evidence of transfusion transmission became apparent.
“This risk is theoretical right now because there are no reported cases of transfusion transmission, but it doesn’t mean we shouldn’t double-check,” Glynn said. The RESPONSE team will collect data to evaluate this question and inform the FDA to allow them to take appropriate actions, as necessary.
Another goal is to enroll people who are found to be SARS-CoV-2 positive, or who report a history of covid, into a longitudinal study. Participants will be asked to return at regular intervals throughout the year, allowing investigators to measure the virus itself (if present), the quality and quantity of the antibodies and how long those antibodies appear to last.
“That informs the natural history of this new virus and it’s also quite important to have that information for vaccine research,” Glynn said.
The RESPONSE study will also play a role in vaccine development and better diagnostics: NHLBI is creating a biorepository of blood and tissue specimens that can be accessed and shared among SARS-CoV-2/Covid-19 investigators.
Still another large initiative underway is to evaluate whether convalescent plasma can be effective against Covid-19. Through donations of convalescent plasma from people who have recovered, researchers will find and characterize covid-specific antibodies that could then be used as therapeutic agents.
“We’re evaluating whether convalescent plasma is a therapy that can be used early on in infection, when someone just starts having symptoms,” said Glynn, “and especially in people who are at high risk of severe infection, to prevent their condition from progressing.”
Blood is the unsung hero that will help us better address the Covid-19 pandemic, these researchers say. Through blood, they will learn more about the trajectory of covid within a person. Another area of interest is to assess how to prevent and/or treat the coagulation defects that seem to cause patients with Covid-19 to develop blood clots in their blood vessels that can cause severe organ damage.
“In terms of preparedness, we couldn’t be luckier with the expertise we have at NIH,” concludes Martin, who works directly with Glynn. “When you combine the institutional, multi-decade wisdom—of [those who worked on] the HIV epidemic, Zika—with the energy of the younger staff working together, I think we’re going to continue to move forward.”
NHLBI’s Martin Finds Her Calling in the PHS
Her bags are packed as she awaits word of her next assignment. NHLBI’s Dr. Iman Martin is an active duty lieutenant commander in the Public Health Service, ready to assist local health authorities during national disasters.
“[I’m part of] an interdisciplinary team of health workers and mental health providers that deploy not only during a catastrophe but also throughout the recovery period of a catastrophe, and we help people reconnect with life after they’ve been through it,” she said.
When she deploys, Martin works on a services access team (SAT). Under the aegis of the HHS National Response Framework’s emergency support function, these teams provide a range of emergency health, social services and medical support.
“We have interdisciplinary rapid deployment assets that swoop in when the emergency is happening,” she said. “I applied to be on this team, in particular, in 2016 because it serves people through all disaster phases: preparatory, rescue and recovery. I felt that was my calling.”
Martin has deployed many times in her 5 years in the PHS, including on a SAT supporting the Hurricane Irma and Maria responses and multiple missions to West Africa during the Ebola crisis.
Most recently, she was deployed on a Covid-19-related mission in early February in cooperation with HHS’s Administration for Children and Families. Stationed in Nebraska, Martin was among a team of officers who oversaw the quarantine of Americans returning from Wuhan, China. She helped attend to their health needs during quarantine and repatriation.
Back at NIH, she supports the efforts of the Blood Division at NHLBI by helping manage a grant and contract portfolio in blood science and may be called at any time for another deployment.
Before coming to NIH, Martin spent more than a decade working and training in epidemiology in sub-Saharan Africa and remains dedicated to addressing global health issues. She is especially proud to be a PHS officer with the opportunity to serve at NIH.
“It’s something special about our country,” Martin said, “that we have the Public Health Service Commissioned Corps, this more than 200-year-old asset to protect, promote and advance the health and safety of our nation.”—Dana Talesnik