Oxygen-controlled storage limits oxygen-driven damage and helps red cells behave more like freshly donated blood at transfusion. By reducing oxidative stress and preserving ATP and 2,3-DPG, oxygen-controlled cells stay flexible, functional and structurally more viable than conventionally stored units throughout their shelf-lives.^2–6

Oxygen-controlled storage minimizes the oxidative damage that accumulates during conventional storage, helping preserve red cell metabolism and structural integrity. Removing oxygen before storage reduces oxidative injury and reactive oxygen species (ROS) formation.^7,8 Oxygen-controlled conditions maintain higher ATP and 2,3-DPG levels, supporting improved energy metabolism and faster oxygen-unloading based on an in vivo model.^2,4 As a result, RBC remain more deformable and biochemically viable even at 42 days of storage.^3,6

What if more of every transfused unit actually stayed in circulation and delivered oxygen like freshly donated RBC?^2,4,8 Oxygen-controlled storage preserves red blood cell function, improves 24-hour in vivo recovery, and maintains oxygen-offloading ability compared to conventionally stored blood.^2,6

Oxygen-controlled storage preserves red blood cell (RBC) integrity in ways that may translate meaningfully into clinical benefit. RBC stored under low-oxygen conditions retain key metabolic pathways and structural stability, allowing more transfused RBC to remain in circulation and continue delivering oxygen for longer periods. As a result, patients may experience more durable hemoglobin responses and potentially longer intervals between transfusions.^4,9

These advantages are supported by in-vivo data; healthy-volunteer studies confirmed improved survival and persistence of oxygen-controlled RBC in the subjects’ circulation.⁴ The oxygen-controlled RBC demonstrated higher 24-hour post-transfusion recovery after 42 days of storage compared with conventionally stored units, meeting and exceeding established quality thresholds.^6,10

Beyond cell survival, oxygen-controlled RBC also preserve physiological oxygen-offloading. Recent work shows that oxygen-controlled RBC improve oxygen-release kinetics comparable to freshly donated blood.^2,11 Data obtained from resuscitation of animals in hemorrhagic shock also supports more efficient oxygen delivery at the tissue level.⁵

Together, these data show that Hemanext ONE delivers red blood cells that survive longer in circulation, and maintain faster oxygen-unloading, offering a meaningful improvement over conventional storage.^2,6

Oxygen-controlled storage helps red blood cells (RBC) break down less, potentially lowering the release of free hemoglobin and reactive iron after transfusion. This may reduce oxidative stress and slow the progression of iron overload in chronically transfused patients.^{4,5,7,13,15–17}

Oxygen-controlled storage slows the oxidative damage that drives hemolysis, keeping red cells intact and potentially limiting the rise of free hemoglobin during storage. With fewer cells breaking down, patients are exposed to far less non-transferrin bound iron (NTBI), a key contributor to oxidative injury after transfusion. By preserving membrane stability and reducing hemolysis, oxygen-controlled RBC may meaningfully slow the pace of iron loading in chronically transfused patients.^4,13,16–18

In addition, oxygen-controlled RBC demonstrated improved 24-hour recovery and faster oxygen unloading, so fewer units may be required to achieve the same hemoglobin targets thus potentially decreasing transfusion burden.^2,6 Preclinical models have shown equivalent hemoglobin restoration with fewer units of oxygen-controlled RBC⁵, a finding consistent with improved post-transfusion recovery in healthy-volunteer studies.⁴

In an animal model of severe hemorrhagic shock, 21-day-old oxygen-controlled RBC improved outcomes compared with conventionally stored units.

Oxygen-controlled RBC restored mean arterial pressure, cardiac function, and systemic vascular resistance with ~50% less transfusion volume required. They also produced a more favorable physiologic response, limiting metabolic acidosis, reducing lactate accumulation, and decreasing tissue hypoxia and organ injury across the liver, kidney, and lung.⁵

Inflammatory markers were markedly lower, including reduced IL-6 and CXCL1, and oxygen-controlled RBC preserved left-ventricular cardiac function, whereas conventionally stored RBC impaired these indices.⁵ These findings align with improved post-transfusion recovery observed in human volunteer studies, supporting the concept that oxygen-controlled RBC deliver oxygen more efficiently and function more like fresh blood.^2,4,17

Collectively, these data suggest that oxygen-controlled storage has the potential to reduce transfusion volume while improving physiologic recovery.

Hemanext ONE is advancing through a growing clinical development program across several transfusion-relevant patient groups. A first-in-human safety study in Norway demonstrated that oxygen-controlled red cells were safe and met all clinical and laboratory objectives.^19,20

A randomized, controlled trial is now underway evaluating the efficacy of oxygen-controlled RBC in patients with hematologic malignancies, focusing on transfusion effectiveness, hemoglobin response and safety assessments.

In the United States, Hemanext has received NIH funding to initiate a trial of oxygen-controlled RBC in patients with sickle cell anemia, where improved deformability, lower adhesion, and reduced hemolysis are highly relevant (NIH Award Number R44HL178006.)

Together, these clinical efforts reflect a broad and growing evidence base designed to evaluate oxygen-controlled RBC across the conditions in which red cell performance matters most.