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Abstract
Bacterial contamination of blood components is a recurrent topic in transfusion medicine community. This issue is even more important with platelet transfusions because of storage of platelet components at room temperature for 5 days. Pathogen inactivation methods are a proactive approach to deal with an infectious agent. All available methods use UV light, with or without a photosensitizer, to inactivate potential pathogens. As with other medical interventions, pathogen inactivation methods carry benefits and risks. Among benefits, inactivation of known and unknown transfusion-transmitted pathogens, inactivation of residual leukocytes, and increased storage length from 5 to 7 days are the most interesting. The main risk is the impact on clinical efficacy of pathogen-reduced platelets. After inactivation, pathogen-reduced platelets are associated with a lower number of platelets in the final product, lower 24-hour corrected count increment, and shorter transfusion interval when compared with non-inactivated platelets. However, eight of nine randomized controlled trials showed that transfusing pathogen-reduced platelets were not inferior to transfusing usual platelet components in the prevention of bleeding episodes. In conclusion, in our opinion, increasing safety of platelet transfusions with pathogen inactivation methods is worthy, even the trade-off of causing damage to platelets.
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Affiliation(s)
- Joan Cid
- Apheresis & Cellular Therapy Unit, Department of Hemotherapy & Hemostasis, ICMHO, IDIBAPS, UB,Hospital Clínic,Barcelona, Catalonia, Spain
| | - Miquel Lozano
- Apheresis & Cellular Therapy Unit, Department of Hemotherapy & Hemostasis, ICMHO, IDIBAPS, UB,Hospital Clínic,Barcelona, Catalonia, Spain
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2
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Atreya C, Glynn S, Busch M, Kleinman S, Snyder E, Rutter S, AuBuchon J, Flegel W, Reeve D, Devine D, Cohn C, Custer B, Goodrich R, Benjamin RJ, Razatos A, Cancelas J, Wagner S, Maclean M, Gelderman M, Cap A, Ness P. Proceedings of the Food and Drug Administration public workshop on pathogen reduction technologies for blood safety 2018 (Commentary, p. 3026). Transfusion 2019; 59:3002-3025. [PMID: 31144334 PMCID: PMC6726584 DOI: 10.1111/trf.15344] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 05/06/2019] [Accepted: 05/06/2019] [Indexed: 12/13/2022]
Affiliation(s)
- Chintamani Atreya
- US Food and Drug Administration, Center for Biologics Evaluation and ResearchOffice of Blood Research and ReviewSilver SpringMaryland
| | - Simone Glynn
- National Heart Lung and Blood InstituteBethesdaMarylandUSA
| | | | | | - Edward Snyder
- Blood BankYale‐New Haven HospitalNew HavenConnecticut
| | - Sara Rutter
- Department of Pathology and Laboratory MedicineYale School of MedicineNew HavenConnecticut
| | - James AuBuchon
- Department of PathologyDartmouth‐Hitchcock Medical CenterLebanonNew Hampshire
| | - Willy Flegel
- Department of Transfusion MedicineNIH Clinical CenterBethesdaMaryland
| | - David Reeve
- Blood ComponentsAmerican Red CrossRockvilleMaryland
| | - Dana Devine
- Department of Lab Medicine and PathologyUniversity of Minnesota Medical CenterMinneapolisMinnesota
| | - Claudia Cohn
- Department of Lab Medicine and PathologyUniversity of Minnesota Medical CenterMinneapolisMinnesota
| | - Brian Custer
- Vitalant Research InstituteSan FranciscoCalifornia
| | - Raymond Goodrich
- Department of Microbiology, Immunology and PathologyColorado State UniversityFort CollinsColorado
| | | | | | - Jose Cancelas
- Hoxworth Blood CenterUniversity of Cincinnati HealthCincinnatiOhio
| | | | - Michelle Maclean
- The Robertson Trust Laboratory for Electronic Sterilisation Technologies (ROLEST)University of StrathclydeGlasgowScotland
| | - Monique Gelderman
- Department of HematologyCenter for Biologics Evaluation and Research, US Food and Drug AdministrationSilver SpringMaryland
| | - Andrew Cap
- U.S. Army Institute of Surgical ResearchSan AntonioTexas
| | - Paul Ness
- Blood BankJohns Hopkins HospitalBaltimoreMaryland
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3
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Wiehe A, O'Brien JM, Senge MO. Trends and targets in antiviral phototherapy. Photochem Photobiol Sci 2019; 18:2565-2612. [PMID: 31397467 DOI: 10.1039/c9pp00211a] [Citation(s) in RCA: 152] [Impact Index Per Article: 30.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Photodynamic therapy (PDT) is a well-established treatment option in the treatment of certain cancerous and pre-cancerous lesions. Though best-known for its application in tumor therapy, historically the photodynamic effect was first demonstrated against bacteria at the beginning of the 20th century. Today, in light of spreading antibiotic resistance and the rise of new infections, this photodynamic inactivation (PDI) of microbes, such as bacteria, fungi, and viruses, is gaining considerable attention. This review focuses on the PDI of viruses as an alternative treatment in antiviral therapy, but also as a means of viral decontamination, covering mainly the literature of the last decade. The PDI of viruses shares the general action mechanism of photodynamic applications: the irradiation of a dye with light and the subsequent generation of reactive oxygen species (ROS) which are the effective phototoxic agents damaging virus targets by reacting with viral nucleic acids, lipids and proteins. Interestingly, a light-independent antiviral activity has also been found for some of these dyes. This review covers the compound classes employed in the PDI of viruses and their various areas of use. In the medical area, currently two fields stand out in which the PDI of viruses has found broader application: the purification of blood products and the treatment of human papilloma virus manifestations. However, the PDI of viruses has also found interest in such diverse areas as water and surface decontamination, and biosafety.
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Affiliation(s)
- Arno Wiehe
- biolitec research GmbH, Otto-Schott-Str. 15, 07745 Jena, Germany. and Institut für Chemie und Biochemie, Freie Universität Berlin, Takustr. 3, 14195 Berlin, Germany
| | - Jessica M O'Brien
- Medicinal Chemistry, Trinity Translational Medicine Institute, Trinity Centre for Health Sciences, Trinity College Dublin, The University of Dublin, St. James's Hospital, Dublin 8, Ireland.
| | - Mathias O Senge
- Medicinal Chemistry, Trinity Translational Medicine Institute, Trinity Centre for Health Sciences, Trinity College Dublin, The University of Dublin, St. James's Hospital, Dublin 8, Ireland.
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4
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Garraud O, Lozano M. Pathogen inactivation/reduction technologies for platelet transfusion: Where do we stand? Transfus Clin Biol 2018; 25:165-171. [DOI: 10.1016/j.tracli.2018.07.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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5
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Schubert P, Johnson L, Marks DC, Devine DV. Ultraviolet-Based Pathogen Inactivation Systems: Untangling the Molecular Targets Activated in Platelets. Front Med (Lausanne) 2018; 5:129. [PMID: 29868586 PMCID: PMC5949320 DOI: 10.3389/fmed.2018.00129] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 04/19/2018] [Indexed: 12/13/2022] Open
Abstract
Transfusions of platelets are an important cornerstone of medicine; however, recipients may be subject to risk of adverse events associated with the potential transmission of pathogens, especially bacteria. Pathogen inactivation (PI) technologies based on ultraviolet illumination have been developed in the last decades to mitigate this risk. This review discusses studies of platelet concentrates treated with the current generation of PI technologies to assess their impact on quality, PI capacity, safety, and clinical efficacy. Improved safety seems to come with the cost of reduced platelet functionality, and hence transfusion efficacy. In order to understand these negative impacts in more detail, several molecular analyses have identified signaling pathways linked to platelet function that are altered by PI. Because some of these biochemical alterations are similar to those seen arising in the context of routine platelet storage lesion development occurring during blood bank storage, we lack a complete picture of the contribution of PI treatment to impaired platelet functionality. A model generated using data from currently available publications places the signaling protein kinase p38 as a central player regulating a variety of mechanisms triggered in platelets by PI systems.
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Affiliation(s)
- Peter Schubert
- Canadian Blood Services, Vancouver, BC, Canada.,Centre for Blood Research, University of British Columbia, Vancouver, BC, Canada
| | - Lacey Johnson
- Research and Development, Australian Red Cross Blood Service, Sydney, NSW, Australia
| | - Denese C Marks
- Research and Development, Australian Red Cross Blood Service, Sydney, NSW, Australia.,Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
| | - Dana V Devine
- Canadian Blood Services, Vancouver, BC, Canada.,Centre for Blood Research, University of British Columbia, Vancouver, BC, Canada
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6
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Rebulla P, Vaglio S, Beccaria F, Bonfichi M, Carella A, Chiurazzi F, Coluzzi S, Cortelezzi A, Gandini G, Girelli G, Graf M, Isernia P, Marano G, Marconi M, Montemezzi R, Olivero B, Rinaldi M, Salvaneschi L, Scarpato N, Strada P, Milani S, Grazzini G. Clinical effectiveness of platelets in additive solution treated with two commercial pathogen-reduction technologies. Transfusion 2017; 57:1171-1183. [DOI: 10.1111/trf.14042] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Revised: 12/13/2016] [Accepted: 12/20/2016] [Indexed: 12/21/2022]
Affiliation(s)
- Paolo Rebulla
- Blood Transfusion Service, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico; Milan Italy
| | - Stefania Vaglio
- Italian National Blood Center, National Institute of Health; Rome Italy
| | - Francesco Beccaria
- Blood Transfusion Service and Hematology 1; IRCCS San Martino University Hospital; Genoa Italy
| | - Maurizio Bonfichi
- Blood Transfusion Service and Hematology; IRCCS Policlinico San Matteo; Pavia Italy
| | - Angelo Carella
- Blood Transfusion Service and Hematology 1; IRCCS San Martino University Hospital; Genoa Italy
| | - Federico Chiurazzi
- Blood Transfusion Service and Hematology; Federico II University Hospital; Naples Italy
| | - Serelina Coluzzi
- Blood Transfusion Service and Hematology; Umberto I Hospital; Rome Italy
| | - Agostino Cortelezzi
- Hematology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico and University of Milan; Milan Italy
| | - Giorgio Gandini
- Blood Transfusion Service and Hematology; University Hospital; Verona Italy
| | - Gabriella Girelli
- Blood Transfusion Service and Hematology; Umberto I Hospital; Rome Italy
| | - Maria Graf
- Blood Transfusion Service and Hematology; Federico II University Hospital; Naples Italy
| | - Paola Isernia
- Blood Transfusion Service and Hematology; IRCCS Policlinico San Matteo; Pavia Italy
| | - Giuseppe Marano
- Italian National Blood Center, National Institute of Health; Rome Italy
| | - Maurizio Marconi
- Blood Transfusion Service, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico; Milan Italy
| | - Rachele Montemezzi
- Blood Transfusion Service and Hematology; University Hospital; Verona Italy
| | - Barbara Olivero
- Blood Transfusion Service, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico; Milan Italy
| | - Marianna Rinaldi
- Blood Transfusion Service and Hematology; University Hospital; Verona Italy
| | - Laura Salvaneschi
- Blood Transfusion Service and Hematology; IRCCS Policlinico San Matteo; Pavia Italy
| | - Nicola Scarpato
- Blood Transfusion Service and Hematology; Federico II University Hospital; Naples Italy
| | - Paolo Strada
- Blood Transfusion Service and Hematology 1; IRCCS San Martino University Hospital; Genoa Italy
| | - Silvano Milani
- Laboratory of Medical Statistics and Biometry, Department of Clinical Sciences and Community Health; University of Milan; Milan Italy
| | - Giuliano Grazzini
- Italian National Blood Center, National Institute of Health; Rome Italy
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Infektionsschutz und spezielle Hygienemaßnahmen in klinischen Disziplinen. KRANKENHAUS- UND PRAXISHYGIENE 2016. [PMCID: PMC7152143 DOI: 10.1016/b978-3-437-22312-9.00005-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
The spectrum of adverse reactions to blood product transfusion ranges from a benign clinical course to serious morbidity and mortality. There have been many advances in technologies and transfusion strategies to decrease the risk of adverse reactions. Our aim is to address a few of the advancements in increasing the safety of the blood supply, specifically pathogen reduction technologies, bacterial contamination risk reduction, and transfusion associated acute lung injury risk mitigation strategies.
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Affiliation(s)
- Thomas S Rogers
- Blood Bank & Transfusion Medicine, University of Vermont Medical Center, Burlington, Vermont, 05401, USA; Department of Pathology and Laboratory Medicine, University of Vermont College of Medicine, Burlington, Vermont, 05401, USA
| | - Mark K Fung
- Blood Bank & Transfusion Medicine, University of Vermont Medical Center, Burlington, Vermont, 05401, USA; Department of Pathology and Laboratory Medicine, University of Vermont College of Medicine, Burlington, Vermont, 05401, USA
| | - Sarah K Harm
- Blood Bank & Transfusion Medicine, University of Vermont Medical Center, Burlington, Vermont, 05401, USA; Department of Pathology and Laboratory Medicine, University of Vermont College of Medicine, Burlington, Vermont, 05401, USA
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Pineault N, Boisjoli GJ. Megakaryopoiesis andex vivodifferentiation of stem cells into megakaryocytes and platelets. ACTA ACUST UNITED AC 2015. [DOI: 10.1111/voxs.12155] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- N. Pineault
- Center for Innovation; Canadian Blood Services; Ottawa ON Canada
- Department of Biochemistry, Microbiology and Immunology; University of Ottawa; Ottawa ON Canada
| | - G. J. Boisjoli
- Center for Innovation; Canadian Blood Services; Ottawa ON Canada
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Jonsdottir-Buch SM, Sigurgrimsdottir H, Lieder R, Sigurjonsson OE. Expired and Pathogen-Inactivated Platelet Concentrates Support Differentiation and Immunomodulation of Mesenchymal Stromal Cells in Culture. Cell Transplant 2014; 24:1545-54. [PMID: 25198449 DOI: 10.3727/096368914x683043] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Platelet lysates have been reported as suitable cell culture supplement for cultures of mesenchymal stromal cells (MSCs). The demand for safe and animal-free cultures of MSCs is linked to the potential application of MSCs in clinics. While the use of platelet lysates offers an alternative to animal serum in MSC cultures, obtaining supplies of fresh platelet concentrates for lysate production is challenging and raises concerns due to the already existing shortage of platelet donors. We have previously demonstrated that expired platelet concentrates may represent a good source of platelets for lysate production without competing with blood banks for platelet donors. The INTERCEPT Blood System™ treatment of platelet concentrates allows for prolonged storage up to 7 days, using highly specific technology based on amotosalen and UV-A light. The INTERCEPT system has therefore been implemented in blood processing facilities worldwide. In this study, we evaluated the suitability of INTERCEPT-treated, expired platelet concentrates, processed into platelet lysates, for the culture of MSCs compared to nontreated expired platelets. Bone marrow-derived MSCs were cultured in media supplemented with either platelet lysates from traditionally prepared expired platelet concentrates or in platelet lysates from expired and pathogen-inactivated platelet concentrates. The effects of pathogen inactivation on the ability of the platelets to support MSCs in culture were determined by evaluating MSC immunomodulation, immunophenotype, proliferation, and trilineage differentiation. Platelet lysates prepared from expired and pathogen-inactivated platelet concentrates supported MSC differentiation and immunosuppression better compared to traditionally prepared platelet lysates from expired platelet units. Pathogen inactivation of platelets with the INTERCEPT system prior to use in MSC culture had no negative effects on MSC immunophenotype or proliferation. In conclusion, the use of expired pathogen-inactivated platelet units from blood banks to prepare platelet lysates for the culture of MSCs is desirable and attainable.
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11
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Abstract
Blood banking/immunohematology is an area of laboratory medicine that involves the preparation of blood and blood components for transfusion as well as the selection and monitoring of those components following transfusion. The preparation, modification, and indications of both traditional and newer products are described in this review, along with special considerations for neonates, patients undergoing hematopoietic stem cell transplantation, those with sickle cell disease, and others. Immunohematological techniques are critical in the provision of blood and blood products and are briefly discussed.
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Affiliation(s)
- Edward C C Wong
- Division of Laboratory Medicine, Center for Cancer and Blood Disorders, Children's National Medical Center, Sheikh Zayed Campus for Advanced Children's Medicine, 111 Michigan Avenue, Northwest, Washington, DC 20010, USA; Departments of Pediatrics and Pathology, George Washington University School of Medicine and Health Sciences, Washington, DC 20010, USA.
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12
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