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Hwang JH, Tung JP, Harkin DG, Flower RL, Pecheniuk NM. Extracellular vesicles in fresh frozen plasma and cryoprecipitate: Impact on in vitro endothelial cell viability. Transfusion 2024. [PMID: 39021332 DOI: 10.1111/trf.17959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2024] [Revised: 06/24/2024] [Accepted: 06/30/2024] [Indexed: 07/20/2024]
Abstract
BACKGROUND Transfusion-related acute lung injury (TRALI) remains a major contributor to transfusion-associated mortality. While the pathogenesis of TRALI remains unclear, there is evidence of a role for blood components. We therefore investigated the potential effects of fresh frozen plasma (FFP), cryoprecipitate, and extracellular vesicles (EVs) derived from these blood components, on the viability of human lung microvascular endothelial cells (HLMVECs) in vitro. METHODS EVs were isolated from FFP and cryoprecipitate using size-exclusion chromatography and characterized by nanoparticle tracking analysis, western blotting, and transmission electron microscopy. The potential effects of these blood components and their EVs on HLMVEC viability (determined by trypan blue exclusion) were examined in the presence and absence of neutrophils, either with or without prior treatment of HLMVECs with LPS. RESULTS EVs isolated from FFP and cryoprecipitate displayed morphological and biochemical properties conforming to latest international criteria. While FFP, cryoprecipitate, and EVs derived from FFP, each reduced HLMVEC viability, no effect was observed for EVs derived from cryoprecipitate. CONCLUSION Our findings demonstrate clear differences in the effects of FFP, cryoprecipitate, and their respective EVs on HLMVEC viability in vitro. Examination of the mechanisms underlying these differences may lead to an improved understanding of the factors that promote development of TRALI.
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Affiliation(s)
- Ji Hui Hwang
- School of Biomedical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia
- Strategy and Growth, Australian Red Cross Lifeblood, Brisbane, Queensland, Australia
| | - John-Paul Tung
- School of Biomedical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia
- Strategy and Growth, Australian Red Cross Lifeblood, Brisbane, Queensland, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
- School of Health, University of the Sunshine Coast, Sippy Downs, Queensland, Australia
| | - Damien G Harkin
- School of Biomedical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia
- Strategy and Growth, Australian Red Cross Lifeblood, Brisbane, Queensland, Australia
| | - Robert L Flower
- School of Biomedical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia
- Strategy and Growth, Australian Red Cross Lifeblood, Brisbane, Queensland, Australia
| | - Natalie M Pecheniuk
- School of Biomedical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia
- Strategy and Growth, Australian Red Cross Lifeblood, Brisbane, Queensland, Australia
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2
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van den Akker TA, Grimes ZM, Friedman MT. Transfusion-Associated Circulatory Overload and Transfusion-Related Acute Lung Injury. Am J Clin Pathol 2021; 156:529-539. [PMID: 33822854 DOI: 10.1093/ajcp/aqaa279] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVES To review the new current diagnostic criteria of transfusion-associated circulatory overload (TACO) and transfusion-related acute lung injury (TRALI) from the literature while highlighting distinguishing features. We provide comprehensive understanding of the importance of hemovigilance and its role in appropriately identifying and reporting these potentially fatal transfusion reactions. METHODS A review of the English language literature was performed to analyze TACO and TRALI while providing further understanding of the rationale behind the historical underrecognition and underreporting. RESULTS Our review demonstrates the new 2018 and 2019 case definitions for TACO and TRALI, respectively. With more comprehensive diagnostic strategies, adverse transfusion events can be better recognized from mimicking events and underlying disease. In addition, there are mitigation strategies in place to help prevent complications of blood product transfusion, with emphasis on the prevention of TACO and TRALI. CONCLUSIONS TACO and TRALI are potentially fatal adverse complications of blood transfusion. Both have been historically underrecognized and underreported due to poor defining criteria and overlapping symptomatology. Developing a thorough clinical understanding between these two entities can improve hemovigilance reporting and can contribute to risk factor identification and preventative measures.
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Affiliation(s)
- Tayler A van den Akker
- Department of Pathology and Laboratory Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Zachary M Grimes
- Department of Pathology and Laboratory Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Mark T Friedman
- Department of Pathology, NYU Long Island School of Medicine, Mineola, NY, USA
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3
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Ochi H, Iijima T, Ushiyama A. Intra-vital Observation of Lung Water Retention Following Intravenous Injection of Anti-MHC-class I (H-2K) Monoclonal Antibody in Mice. In Vivo 2020; 33:1477-1484. [PMID: 31471395 DOI: 10.21873/invivo.11627] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 07/17/2019] [Accepted: 07/18/2019] [Indexed: 01/08/2023]
Abstract
BACKGROUND/AIM Leukocyte activation is thought to be a major step in sepsis-induced pulmonary edema. We attempted to confirm whether pulmonary edema can be reproduced under intravital microscopy in a model of transfusion-related acute lung injury (TRALI) using MHC class I-specific antibody. MATERIALS AND METHODS The surface pulmonary microcirculation was observed using an epi-fluorescence microscope through a thoracic window in 50 male mice. Monoclonal MHC class I-specific antibody (Ab) was administered to the animals, while the control group received saline. The leukocytes and macro-molecular leakage in the pulmonary circulation were analyzed. RESULTS Leukocytes accumulated in the capillaries (52.5±12.7 leukocytes per designated area in Ab group vs. 20.8±3.1 in control). The air-containing alveolus area significantly shrank from 2,224.9±934.9 μm2 to 509.7±380.8 μm2 in the Ab group. CONCLUSION Pulmonary edema develops rapidly following leukocyte accumulation in the lung. We confirmed that leukocyte accumulation without an underlining condition is sufficient to induce pulmonary edema.
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Affiliation(s)
- Hideyuki Ochi
- Department of Perioperative Medicine, Division of Anesthesiology, Showa University, School of Dentistry, Tokyo, Japan
| | - Takehiko Iijima
- Department of Perioperative Medicine, Division of Anesthesiology, Showa University, School of Dentistry, Tokyo, Japan
| | - Akira Ushiyama
- Department of Environmental Health, National Institute of Public Health, Saitama, Japan
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4
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Neubert E, Senger-Sander SN, Manzke VS, Busse J, Polo E, Scheidmann SEF, Schön MP, Kruss S, Erpenbeck L. Serum and Serum Albumin Inhibit in vitro Formation of Neutrophil Extracellular Traps (NETs). Front Immunol 2019; 10:12. [PMID: 30733715 PMCID: PMC6354573 DOI: 10.3389/fimmu.2019.00012] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2018] [Accepted: 01/04/2019] [Indexed: 01/06/2023] Open
Abstract
The formation of neutrophil extracellular traps (NETs) is an immune defense mechanism of neutrophilic granulocytes. Moreover, it is also involved in the pathogenesis of autoimmune, inflammatory, and neoplastic diseases. For that reason, the process of NET formation (NETosis) is subject of intense ongoing research. In vitro approaches to quantify NET formation are commonly used and involve neutrophil stimulation with various activators such as phorbol 12-myristate 13-acetate (PMA), lipopolysaccharides (LPS), or calcium ionophores (CaI). However, the experimental conditions of these experiments, particularly the media and media supplements employed by different research groups, vary considerably, rendering comparisons of results difficult. Here, we present the first standardized investigation of the influence of different media supplements on NET formation in vitro. The addition of heat-inactivated (hi) fetal calf serum (FCS), 0.5% human serum albumin (HSA), or 0.5% bovine serum albumin (BSA) efficiently prevented NET formation of human neutrophils following stimulation with LPS and CaI, but not after stimulation with PMA. Thus, serum components such as HSA, BSA and hiFCS (at concentrations typically found in the literature) inhibit NET formation to different degrees, depending on the NETosis inducer used. In contrast, in murine neutrophils, NETosis was inhibited by FCS and BSA, regardless of the inducer employed. This shows that mouse and human neutrophils have different susceptibilities toward the inhibition of NETosis by albumin or serum components. Furthermore, we provide experimental evidence that albumin inhibits NETosis by scavenging activators such as LPS. We also put our results into the context of media supplements most commonly used in NET research. In experiments with human neutrophils, either FCS (0.5–10%), heat-inactivated (hiFCS, 0.1–10%) or human serum albumin (HSA, 0.05–2%) was commonly added to the medium. For murine neutrophils, serum-free medium was used in most cases for stimulation with LPS and CaI, reflecting the different sensitivities of human and murine neutrophils to media supplements. Thus, the choice of media supplements greatly determines the outcome of experiments on NET-formation, which must be taken into account in NETosis research.
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Affiliation(s)
- Elsa Neubert
- Department of Dermatology, Venereology and Allergology, University Medical Center Göttingen, Göttingen, Germany.,Institute of Physical Chemistry, University of Göttingen, Göttingen, Germany
| | - Susanne N Senger-Sander
- Department of Dermatology, Venereology and Allergology, University Medical Center Göttingen, Göttingen, Germany
| | - Veit S Manzke
- Department of Dermatology, Venereology and Allergology, University Medical Center Göttingen, Göttingen, Germany
| | - Julia Busse
- Department of Dermatology, Venereology and Allergology, University Medical Center Göttingen, Göttingen, Germany
| | - Elena Polo
- Institute of Physical Chemistry, University of Göttingen, Göttingen, Germany
| | - Sophie E F Scheidmann
- Department of Dermatology, Venereology and Allergology, University Medical Center Göttingen, Göttingen, Germany
| | - Michael P Schön
- Department of Dermatology, Venereology and Allergology, University Medical Center Göttingen, Göttingen, Germany.,Lower Saxony Institute of Occupational Dermatology, University Medical Center Göttingen and University of Osnabrück, Göttingen, Germany
| | - Sebastian Kruss
- Institute of Physical Chemistry, University of Göttingen, Göttingen, Germany
| | - Luise Erpenbeck
- Department of Dermatology, Venereology and Allergology, University Medical Center Göttingen, Göttingen, Germany
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Trauma-Related Acute Lung Injury Develops Rapidly Irrespective of Resuscitation Strategy in the Rat. Shock 2018; 46:108-14. [PMID: 27172150 DOI: 10.1097/shk.0000000000000652] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Acute lung injury (ALI) has been observed clinically after severe trauma. We have recently developed a rat model of polytrauma that shows evidence of multi-organ failure and coagulopathy. In this study, we investigate whether ALI occurs after severe trauma and resuscitation, and the cellular mechanisms involved. METHODS Polytrauma and hemorrhage was induced in anesthetized Sprague-Dawley rats. Five groups were prepared: control, no resuscitation, and resuscitation with Lactated Ringer (LR), fresh whole blood or whole blood stored 7days at 4°C. Resuscitation was begun 1 hr after trauma. Lung injury was determined by lung wet/dry weight ratios. RESULTS Polytrauma and hemorrhage (no resuscitation) led to a significant increase in the number of neutrophils, monocytes, macrophages, platelets, and the levels of myeloperoxidase, pro-inflammatory cytokines (IL-6, IL-1α, IL-1β), anti-inflammatory Th2 cytokines (IL-4, IL-10, IL-13), and chemokines (MIP-1α, GRO KC) in the lung tissue. Resuscitation with LR, fresh whole blood or stored blood led to a significant change in the lung wet/dry ratio signifying fluid movement into the lungs. However, fluid did not move into the lungs in non-resuscitated controls. CONCLUSION This study shows that trauma related acute lung injury occurs early after polytrauma and hemorrhage in rat. This ALI is secondary to the trauma, and likely due to an elevation in leukocytes, platelets, inflammatory cytokines and myeloperoxidase in the lung tissue prior to any resuscitation. Resuscitation with either LR or whole blood demonstrated similar lung edema. Blood was neither more protective nor more damaging than LR during early resuscitation.
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6
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Savage W. Transfusion Reactions to Blood and Cell Therapy Products. Hematology 2018. [DOI: 10.1016/b978-0-323-35762-3.00119-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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7
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Zimring JC, Spitalnik SL, Odem-Davis K. Lost in translation: signal and frequency amplification in animal modeling. Transfusion 2016; 56:773-4. [PMID: 26954453 DOI: 10.1111/trf.13457] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Accepted: 11/25/2015] [Indexed: 12/29/2022]
Affiliation(s)
- James C Zimring
- BloodworksNW Research Institute, Seattle, WA.,Departments of Laboratory Medicine, and Internal Medicine, Division of Hematology, University of Washington, Seattle, WA
| | - Steven L Spitalnik
- Department of Pathology & Cell Biology, Laboratory of Transfusion Biology, Columbia University, New York, NY
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8
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Bockhold C, Crumpler S. Responding to pulmonary-related blood transfusion reactions. Nursing 2015; 45:36-42. [PMID: 26248201 DOI: 10.1097/01.nurse.0000470412.33450.b1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Affiliation(s)
- Colleen Bockhold
- Colleen Bockhold is a quality management clinician and Sherron Crumpler is a quality management clinician/risk management assistant, both at Central Texas Veterans Healthcare System in Temple, Tex
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9
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Maślanka K, Uhrynowska M, Łopacz P, Wróbel A, Smoleńska-Sym G, Guz K, Lachert E, Ostas A, Brojer E. Analysis of leucocyte antibodies, cytokines, lysophospholipids and cell microparticles in blood components implicated in post-transfusion reactions with dyspnoea. Vox Sang 2014; 108:27-36. [PMID: 25134637 DOI: 10.1111/vox.12190] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2013] [Revised: 06/26/2014] [Accepted: 07/08/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND OBJECTIVES Post-transfusion reactions with dyspnoea (PTR) are major causes of morbidity and death after blood transfusion. Transfusion-related acute lung injury (TRALI) and transfusion-associated circulatory overload (TACO) are most dangerous, while transfusion-associated dyspnoea (TAD) is a milder respiratory distress. We investigated blood components for immune and non-immune factors implicated in PTR. MATERIAL AND METHODS We analysed 464 blood components (RBCs, PLTs, L-PLTs, FFP) transfused to 271 patients with PTR. Blood components were evaluated for 1/antileucocyte antibodies, 2/cytokines: IL-1β, IL-6, IL-8, TNF-α, sCD40L, 3/lysophosphatidylcholines (LysoPCs), 4/microparticles (MPs) shed from plateletes (PMPs), erythrocytes (EMPs) and leucocytes (LMPs). RESULTS Anti-HLA class I/II antibodies or granulocyte-reactive anti-HLA antibodies were detected in 18.2% of blood components (RBC and FFP) transfused to TRALI and in 0.5% of FFP transfused to TAD cases. Cytokines and LysoPCs concentrations in blood components transfused to PTR patients did not exceed those in blood components transfused to patients with no PTR. Only EMPs percentage in RBCs transfused to patients with TRALI was significantly higher (P < 0.05) than in RBCs transfused to patients with no PTR. CONCLUSION Immune character of PTR was confirmed mainly in 1/5 TRALI cases. Among non-immune factors, only MPs released from stored RBCs are suggested as potential mediators of TRALI. Our results require further observations in a more numerous and better defined group of patients.
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Affiliation(s)
- K Maślanka
- Department of Immunohematology and Immunology of Transfusion Medicine, Institute of Hematology and Transfusion Medicine, Warsaw, Poland
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10
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The impact of perioperative packed red blood cell transfusion on survival in epithelial ovarian cancer. Int J Gynecol Cancer 2014; 23:1612-9. [PMID: 24172098 DOI: 10.1097/01.igc.0000436089.03581.6b] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE Perioperative packed red blood cell transfusion (PRBCT) has been implicated as a negative prognostic marker in surgical oncology. There is a paucity of evidence on the impact of PRBCT on outcomes in epithelial ovarian cancer (EOC). We assessed whether PRBCT is an independent risk factor of recurrence and death from EOC. METHODS Perioperative patient characteristics and process-of-care variables (defined by the National Surgical Quality Improvement Program) were retrospectively abstracted from 587 women who underwent primary EOC staging between January 2, 2003, and December 29, 2008. Associations with receipt of PRBCT were evaluated using univariate logistic regression models. The associations between receipt of PRBCT and disease-free survival and overall survival were evaluated using multivariable Cox proportional hazards models and using propensity score matching and stratification, respectively. RESULTS The rate of PRBCT was 77.0%. The mean ± SD units transfused was 4.1 ± 3.1 U. In the univariate analysis, receipt of PRBCT was significantly associated with older age, advanced stage (≥ IIIA), undergoing splenectomy, higher surgical complexity, serous histologic diagnosis, greater estimated blood loss, longer operating time, the presence of residual disease, and lower preoperative albumin and hemoglobin. Perioperative packed red blood cell transfusion was not associated with an increased risk for recurrence or death, in an analysis adjusting for other risk factors in a multivariable model or in an analysis using propensity score matching or stratification to control for differences between the patients with and without PRBCT. CONCLUSIONS Perioperative packed red blood cell transfusion does not seem to be directly associated with recurrence and death in EOC. However, lower preoperative hemoglobin was associated with a higher risk for recurrence. The need for PRBCT seems to be a stronger prognostic indicator than the receipt of PRBCT.
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Menis M, Anderson SA, Forshee RA, McKean S, Johnson C, Warnock R, Gondalia R, Mintz PD, Holness L, Worrall CM, Kelman JA, Izurieta HS. Transfusion-related acute lung injury and potential risk factors among the inpatient US elderly as recorded in Medicare claims data, during 2007 through 2011. Transfusion 2014; 54:2182-93. [PMID: 24673344 DOI: 10.1111/trf.12626] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Revised: 01/17/2014] [Accepted: 01/23/2014] [Indexed: 01/25/2023]
Abstract
BACKGROUND Transfusion-related acute lung injury (TRALI) is a serious complication leading to pulmonary edema and respiratory failure. This study's objective was to assess TRALI occurrence and potential risk factors among inpatient US elderly Medicare beneficiaries, ages 65 and older, during 2007 through 2011. STUDY DESIGN AND METHODS This retrospective claims-based study utilized large Medicare administrative databases. Transfusions were identified by recorded procedure and revenue center codes. TRALI was ascertained via ICD-9-CM diagnosis code. The study evaluated TRALI rates among the inpatient elderly overall and by calendar year, age, sex, race, blood components, and units transfused. Logistic regression analyses were used to assess potential risk factors. RESULTS Of 11,378,264 inpatient transfusion stays for elderly Medicare beneficiaries, 2556 had a recorded TRALI diagnosis code, an overall rate of 22.46 per 100,000 stays. TRALI rates were higher for platelet (PLT)- and plasma-containing transfusions and increased by year and number of units transfused (p < 0.0001). Significantly higher odds of TRALI were also found for persons ages 65 to 79 years versus more than 79 years (OR, 1.19; 95% confidence interval CI, 1.09-1.29), females versus males (OR, 1.26; 95% CI, 1.16-1.38), white versus nonwhite (OR, 1.43; 95% CI, 1.27-1.66), and with 6-month histories of postinflammatory pulmonary fibrosis (OR, 1.89; 95% CI, 1.52-2.20), tobacco use (OR, 1.16; 95% CI, 1.00-1.26), and other diseases. CONCLUSION Our study among the elderly suggests TRALI to be a severe event and identifies a substantially increased TRALI occurrence with greater number of units and with PLT- or plasma-containing transfusions. The study also suggests importance of underlying health conditions, prior recipient alloimmunization, and nonimmune mechanism in TRALI development among the elderly.
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Hamzeh-Cognasse H, Damien P, Nguyen KA, Arthaud CA, Eyraud MA, Chavarin P, Absi L, Osselaer JC, Pozzetto B, Cognasse F, Garraud O. Immune-reactive soluble OX40 ligand, soluble CD40 ligand, and interleukin-27 are simultaneously oversecreted in platelet components associated with acute transfusion reactions. Transfusion 2013; 54:613-25. [PMID: 23944651 DOI: 10.1111/trf.12378] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2013] [Accepted: 06/10/2013] [Indexed: 12/16/2022]
Abstract
BACKGROUND Leukoreduction of labile blood components dramatically decreases the frequency of minor, intermediate, and severe adverse events (AEs), referred to as acute transfusion reactions (ATRs), especially after transfusion of platelet components (PCs). The pathophysiology of AEs may result from accumulation of soluble, secreted, platelet (PLT) factors with proinflammatory functions stored in PCs. Thus, several cosynergizing factors associated with PLT accumulation in PCs may contribute to clinically reported ATRs with inflammatory symptoms. STUDY DESIGN AND METHODS We screened for 65 PLT-associated secretory products in PCs that caused ATRs and identified PLT molecules associated with ATRs and inflammation. A functional in vitro study using PC supernatants assayed on reporting immune cells was performed to indicate relevance. RESULTS Among 10,600 apheresis PCs, 30 caused inflammatory ATRs and contained significantly elevated levels of soluble CD40 ligand (sCD40L), interleukin (IL)-27, and soluble OX40 ligand (sOX40L). Normal PLTs secreted IL-27 and sOX40L at bioactive concentrations upon thrombin stimulation and were up regulated in association with ATRs, similar to sCD40L. Other secreted products were identified but not investigated further as their positivity was not consistent. CONCLUSIONS This study demonstrates the putative participation of PLT-derived sOX40L, IL-27, and sCD40L, which accumulate in PC supernatants, with inflammatory-type ATRs. Further studies are required to determine the clinical significance of these findings to forecast preventive measures whenever possible.
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Hu XB, Yin DD, Chen YZ, Yang HFO, Zhang XQ. Mac1+/Gr1+ cells contribute to transfusion-related acute lung injury. Transfus Apher Sci 2013; 49:474-81. [PMID: 23548440 DOI: 10.1016/j.transci.2013.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2012] [Revised: 02/18/2013] [Accepted: 03/05/2013] [Indexed: 10/27/2022]
Abstract
Transfusion-related acute lung injury (TRALI) is a serious complication associated with blood transfusion and can cause transfusion associated fatalities. Both antibody dependent and non-dependent mechanisms are involved in TRALI, as proposed over the past years. Nonetheless, many details of the immune cells involved in TRALI, particularly the Mac1(+)/Gr1(+) cells from donors, are not fully understood yet. Here we used an in vitro transwell system and a mouse model to study the role of donor leukocytes, present in the donor material, in the occurrence of TRALI reactions. We found that there is a number of immature myeloid cells with Mac1(+)/Gr1(+) phenotype present in the red blood cell (RBC) products, when prepared by regular methods. We found that murine Mac1(+)/Gr1(+) cells from stored RBC products display an elevated MHC I and CD40 expression, as well as an enhanced tumor necrosis factor alpha(TNF-α), interlukin-6(IL-6) and macrophage inflammatory protein 2 (MIP-2) secretion. When tested in a transwell endothelial migration assay, Mac1(+)/Gr1(+) cells showed a significant capability to cross the endothelial barrier. In vivo investigation demonstrated that compared to the purified RBC transfusion, more murine Mac1(+)/Gr1(+) cells from the regular method produced RBC sequestered in the lung, which associated to shorter survival. Taken together, these data suggest that donor derived Mac1(+)/Gr1(+) cells can play a significant role in TRALI reactions, and that reduction of Mac1(+)/Gr1(+) cell number from RBC products is necessary to control the severity of TRALI reactions in clinic.
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Affiliation(s)
- Xing-bin Hu
- Department of Blood Transfusion, Xijing Hospital, The Fourth Military Medical University, 17th Changlexi Road, Xi'an 710032, China.
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Gosselin RC, Marshall C, Dwyre DM, Gresens C, Davis D, Scherer L, Taylor D. Coagulation profile of liquid-state plasma. Transfusion 2012; 53:579-90. [DOI: 10.1111/j.1537-2995.2012.03772.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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15
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Tamarozzi MB, Soares SG, Sá-Nunes A, Paiva HH, Saggioro FP, Garcia AB, Lucena-Araujo AR, Falcão RP, Bordin JO, Rego EM. Comparative analysis of the pathological events involved in immune and non-immune TRALI models. Vox Sang 2012; 103:309-21. [DOI: 10.1111/j.1423-0410.2012.01613.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Susen S, Muller JY, Ozier Y. TRALI : aspects physiopathologiques. MEDECINE INTENSIVE REANIMATION 2012. [DOI: 10.1007/s13546-011-0427-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Strait RT, Hicks W, Barasa N, Mahler A, Khodoun M, Köhl J, Stringer K, Witte D, Van Rooijen N, Susskind BM, Finkelman FD. MHC class I-specific antibody binding to nonhematopoietic cells drives complement activation to induce transfusion-related acute lung injury in mice. ACTA ACUST UNITED AC 2011; 208:2525-44. [PMID: 22025304 PMCID: PMC3256958 DOI: 10.1084/jem.20110159] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
In a manner partially independent of activating Fcγ receptors, antibody-mediated production of complement component C5a and recruitment of macrophages elicit transfusion-related acute lung injury in mice. Transfusion-related acute lung injury (TRALI), a form of noncardiogenic pulmonary edema that develops during or within 6 h after a blood transfusion, is the most frequent cause of transfusion-associated death in the United States. Because development of TRALI is associated with donor antibodies (Abs) reactive with recipient major histocompatibility complex (MHC), a mouse model has been studied in which TRALI-like disease is caused by injecting mice with anti–MHC class I monoclonal Ab (mAb). Previous publications with this model have concluded that disease is caused by FcR-dependent activation of neutrophils and platelets, with production of reactive oxygen species that damage pulmonary vascular endothelium. In this study, we confirm the role of reactive oxygen species in the pathogenesis of this mouse model of TRALI and show ultrastructural evidence of pulmonary vascular injury within 5 min of anti–MHC class I mAb injection. However, we demonstrate that disease induction in this model involves macrophages rather than neutrophils or platelets, activation of complement and production of C5a rather than activation of FcγRI, FcγRIII, or FcγRIV, and binding of anti–MHC class I mAb to non-BM–derived cells such as pulmonary vascular endothelium. These observations have important implications for the prevention and treatment of TRALI.
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Affiliation(s)
- Richard T Strait
- Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA
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Drouet C, Khoy K, Masson D, Bardy B, Giannoli C, Dubois V. [The immunological conflict in the transfusion-related acute lung injury or TRALI]. Transfus Clin Biol 2011; 18:224-9. [PMID: 21470890 DOI: 10.1016/j.tracli.2011.02.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2011] [Accepted: 02/12/2011] [Indexed: 10/18/2022]
Abstract
Despite its underrated incidence, transfusion-related acute lung injury (TRALI) is the leading cause of transfusion-related morbidity and mortality worldwide. The pulmonary edema in TRALI occurs in the course of the transfusion of apheresis products or erythrocyte concentrates. Its pathogenesis is attributed to the infusion of donor antibodies that recognize leucocyte antigens in the transfused host, with subsequent sequestration of leucocytes in the pulmonary vessels. It is also associated with the passive transfer of lipids and other biological response modifiers that accumulate during the storage or processing of blood components. The innate immunity and inflammatory kinins are key components. The knowledge of its etiopathogenesis must come into play for improving prevention and diagnosis and for application of adapted care of the patient.
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Affiliation(s)
- C Drouet
- GREPI/AGIM CNRS FRE 3405, CHU de Grenoble, BP 217, 38043 Grenoble, France.
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