Heavy bleeding remains one of the most critical challenges faced in emergency medicine, especially on the battlefield and in terror attacks, road accidents, and other events involving physical trauma. Now, a team of researchers at the Hebrew University of Jerusalem and the IDF Medical Corps has made a major breakthrough that could save countless lives in emergencies involving severe blood hemorrhaging.
Their new treatment involves activating a protein called PKC soon after intense bleeding occurs. In their studies, this approach tripled survival rates, increasing them from 25% to an impressive 73%. The team said the treated animals also had significantly better cardiovascular stability, including blood pressure, heart rate, and cardiac output – all critical indicators of effective response during severe trauma. The treatment maintained healthy organ function by boosting cellular energy levels and offering hope for improved outcomes in emergency trauma care.
The study, led by Dr. Ariel Furer and Dr. Maya Simchoni from the Institute for Research in Military Medicine – a joint project between Hebrew University-Hadassah Medical School and the IDF Medical Corps – has just been published in the prestigious journal Scientific Reports under the title “Protein kinase C epsilon activation improves early survival in an acute porcine model of controlled hemorrhage.”
In a carefully controlled experiment using a porcine (involving pigs) model – which are of similar size and have a biological functioning very similar to that in humans – the researchers induced hemorrhagic shock by withdrawing 35% of the animals’ total blood volume. Animals treated with a PKC-activator peptide just five minutes after the onset of bleeding showed dramatically improved survival rates. A detailed analysis of mitochondrial activity revealed enhanced function within the heart tissues of animals receiving the PKC activator. As mitochondria are vital producers of cellular energy, these findings suggest that activating PKC helps maintain organ energy levels under stress, potentially protecting tissues against further damage associated with severe blood loss.
Eleven of 15 pigs treated with the PKC activator peptide survived the hemorrhage until the end of the follow-up after seven hours, compared to only two of eight non-treated control animals.
Of all trauma-related complications, hemorrhage remains the most prevalent cause of preventable death in military and civilian settings, contributing to an estimated 60% to 90% of cases and totaling about 1.5 million deaths annually around the world. In hemorrhagic shock, reduced blood flow to the tissues causes an insufficient supply of oxygen and essential substances necessary for normal cell function. Conventional treatment for severe hemorrhage involves hemostasis – either by direct pressure, tourniquets, or more advanced procedures such as resuscitative endovascular balloon occlusion of the aorta and transfusing blood products, including plasma and/or red blood cells or whole blood.
But this treatment can lead to severe hemorrhagic shock resuscitation that can unintentionally worsen tissue damage by triggering ischemic-reperfusion injury (hypoxia that causes rapid and severe cellular acidosis because the absence of blood flow causes the localized accumulation of cellular metabolic by-products). This new approach – giving the patient a PKC activator peptide – has the potential to significantly minimize these detrimental effects, thereby improving survival chances and reducing complications associated with severe trauma.
Furer noted that the new study “marks a critical step forward in trauma medicine, but further clinical research is necessary before this treatment can be widely adopted in clinical settings. Our findings open new avenues for targeted therapeutic strategies that can be administered by first responders in emergency settings, potentially saving countless lives worldwide,” he said. “Future clinical trials will be essential to validate these promising results and to move towards practical implementation.”
He added, however, that it will take years to develop a safe protocol and test the new technique to make sure that it is beneficial to soldiers and civilians who are hurt and lose massive amounts of blood.
How can this benefit soldiers?
FURER, CURRENTLY an IDF divisional chief medical officer, told The Jerusalem Post that the Medical Corps previously discovered that giving whole blood is beneficial to soldiers who hemorrhaged significantly and couldn’t be evacuated immediately and needed a gap solution.
But more was needed to protect the wounded from damage due to reperfusion. He has been working on the idea for a decade, when Prof. Miriam Souroujon – his wife’s mother, who was doing research at Stanford University – and her Stanford colleague, a professor of chemical and systems biology, Prof. Daria Mochly-Rosen – suggested it.
For many years, it was customary to infuse wounded soldiers and civilian patients in hospitals suffering from serious blood loss or severe anemia with fluids. This was then changed to plasma – a light yellow liquid that is the main component of whole blood, carrying the blood components throughout the body, and is comprised of salts, enzymes, hormones, proteins, and water. Then, the IDF decided to supply medics with powdered blood mixed with fluids, which could be restored to treat the wounded on the battlefield.
The policy was changed yet again, this time to give parts of blood, including red blood cells, which are made by bone marrow and contain a protein called hemoglobin, which carries oxygen from the lungs to all parts of the body. But the breakout of the war in Gaza on October 7, 2023, meant that immediately supplying whole blood matched by type was even better for saving the wounded – to the satisfaction of the Medical Corps. Whole-blood transfusions became one of the key tools of the Medical Corps during the war.
Recently, some Israeli hospitals, including Laniado Medical Center in Netanya, decided to adopt the IDF’s policy for civilian patients – supplying whole blood immediately in rare circumstances. Dr. Yochay Raviv, a senior anesthesiologist at Laniado, decided to implement this method in operating rooms or in the shock room for specific cases.
Raviv was the first doctor there to give a patient whole blood, followed by a second case handled by another doctor for a patient who had suffered a work accident, in which he sustained a deep cut by a disc that severed the carotid arteries. The whole blood transfusions given to him in the emergency room stabilized his condition immediately and allowed for continued treatment in the operating room.