1
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Rademacher MP, Rohn T, Haselbach W, Ott AT, Bringmann PW, Gilch P. Spectroscopic view on the interaction between the psoralen derivative amotosalen and DNA. Photochem Photobiol Sci 2024; 23:693-709. [PMID: 38457118 DOI: 10.1007/s43630-024-00545-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 02/01/2024] [Indexed: 03/09/2024]
Abstract
Psoralens are eponymous for PUVA (psoralen plus UV-A radiation) therapy, which inter alia can be used to treat various skin diseases. Based on the same underlying mechanism of action, the synthetic psoralen amotosalen (AMO) is utilized in the pathogen reduction technology of the INTERCEPT® Blood System to inactivate pathogens in plasma and platelet components. The photophysical behavior of AMO in the absence of DNA is remarkably similar to that of the recently studied psoralen 4'-aminomethyl-4,5',8-trimethylpsoralen (AMT). By means of steady-state and time-resolved spectroscopy, intercalation and photochemistry of AMO and synthetic DNA were studied. AMO intercalates with a higher affinity into A,T-only DNA (KD = 8.9 × 10-5 M) than into G,C-only DNA (KD = 6.9 × 10-4 M). AMO covalently photobinds to A,T-only DNA with a reaction quantum yield of ΦR = 0.11. Like AMT, it does not photoreact following intercalation into G,C-only DNA. Femto- and nanosecond transient absorption spectroscopy reveals the characteristic pattern of photobinding to A,T-only DNA. For AMO and G,C-only DNA, signatures of a photoinduced electron transfer are recorded.
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Affiliation(s)
- Michelle P Rademacher
- Institut für Physikalische Chemie, Heinrich-Heine-Universität Düsseldorf, Universitätsstr. 1, 40225, Düsseldorf, Germany
| | - Tim Rohn
- Institut für Physikalische Chemie, Heinrich-Heine-Universität Düsseldorf, Universitätsstr. 1, 40225, Düsseldorf, Germany
| | - Wiebke Haselbach
- Institut für Physikalische Chemie, Heinrich-Heine-Universität Düsseldorf, Universitätsstr. 1, 40225, Düsseldorf, Germany
| | - A Theresa Ott
- Institut für Physikalische Chemie, Heinrich-Heine-Universität Düsseldorf, Universitätsstr. 1, 40225, Düsseldorf, Germany
| | | | - Peter Gilch
- Institut für Physikalische Chemie, Heinrich-Heine-Universität Düsseldorf, Universitätsstr. 1, 40225, Düsseldorf, Germany.
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2
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Adane T, Enawgaw B. Human leukocyte antigen alloimmunization prevention mechanisms in blood transfusion. Asian J Transfus Sci 2023; 17:264-272. [PMID: 38274979 PMCID: PMC10807525 DOI: 10.4103/ajts.ajts_144_21] [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: 09/23/2021] [Revised: 11/01/2021] [Accepted: 12/05/2021] [Indexed: 11/04/2022] Open
Abstract
In many fields of clinical medicine and blood transfusion, the human leukocyte antigen (HLA) system is crucial. Alloimmunization happens as a result of an immune response to foreign antigens encountered during blood transfusion. This gives rise to alloantibodies against red blood cells (RBCs), HLA, or human platelet antigen (HPA). HLA alloimmunization following allogeneic transfusion was shown to be a result of contaminating white blood cells (WBCs) present in the product. It is a common complication of transfusion therapy that leads to difficulties in clinical intolerance and refractoriness to platelet transfusion during patient management. Single-donor platelets, prophylactic HLA matching, leukoreduction, and irradiation of cellular blood products are some of the mechanisms to prevent HLA alloimmunization during a blood transfusion. Now, the best approach to reduce the occurrence of primary HLA alloimmunization is the removal of WBCs from the blood by filtration.
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Affiliation(s)
- Tiruneh Adane
- Department of Hematology and Immunohematology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Bamlaku Enawgaw
- Department of Hematology and Immunohematology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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3
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Kordyukova LV, Moiseenko AV, Serebryakova MV, Shuklina MA, Sergeeva MV, Lioznov DA, Shanko AV. Structural and Immunoreactivity Properties of the SARS-CoV-2 Spike Protein upon the Development of an Inactivated Vaccine. Viruses 2023; 15:v15020480. [PMID: 36851694 PMCID: PMC9961907 DOI: 10.3390/v15020480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 01/21/2023] [Accepted: 02/07/2023] [Indexed: 02/11/2023] Open
Abstract
Inactivated vaccines are promising tools for tackling the COVID-19 pandemic. We applied several protocols for SARS-CoV-2 inactivation (by β-propiolactone, formaldehyde, and UV radiation) and examined the morphology of viral spikes, protein composition of the preparations, and their immunoreactivity in ELISA using two panels of sera collected from convalescents and people vaccinated by Sputnik V. Transmission electron microscopy (TEM) allowed us to distinguish wider flail-like spikes (supposedly the S-protein's pre-fusion conformation) from narrower needle-like ones (the post-fusion state). While the flails were present in all preparations studied, the needles were highly abundant in the β-propiolactone-inactivated samples only. Structural proteins S, N, and M of SARS-CoV-2 were detected via mass spectrometry. Formaldehyde and UV-inactivated samples demonstrated the highest affinity/immunoreactivity against the convalescent sera, while β-propiolactone (1:2000, 36 h) and UV-inactivated ones were more active against the sera of people vaccinated with Sputnik V. A higher concentration of β-propiolactone (1:1000, 2 h) led to a loss of antigenic affinity for both serum panels. Thus, although we did not analyze native SARS-CoV-2 for biosafety reasons, our comparative approach helped to exclude some destructive inactivation conditions and select suitable variants for future animal research. We believe that TEM is a valuable tool for inactivated COVID-19 vaccine quality control during the downstream manufacturing process.
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Affiliation(s)
- Larisa V. Kordyukova
- Belozersky Institute of Physico-Chemical Biology, Lomonosov Moscow State University, 119991 Moscow, Russia
- Correspondence: (L.V.K.); (A.V.S.)
| | - Andrey V. Moiseenko
- Faculty of Biology, Lomonosov Moscow State University, 119991 Moscow, Russia
| | - Marina V. Serebryakova
- Belozersky Institute of Physico-Chemical Biology, Lomonosov Moscow State University, 119991 Moscow, Russia
| | - Marina A. Shuklina
- WHO National Influenza Center, Smorodintsev Research Institute of Influenza, 197376 Saint-Petersburg, Russia
| | - Maria V. Sergeeva
- WHO National Influenza Center, Smorodintsev Research Institute of Influenza, 197376 Saint-Petersburg, Russia
| | - Dmitry A. Lioznov
- WHO National Influenza Center, Smorodintsev Research Institute of Influenza, 197376 Saint-Petersburg, Russia
| | - Andrei V. Shanko
- R&D Department, FORT LLC, 119435 Moscow, Russia
- Correspondence: (L.V.K.); (A.V.S.)
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4
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Sharma A, Sharma R, Chander J, Nirankari V. In vitro antimicrobial efficacy of riboflavin, ultraviolet-A radiation, and combined riboflavin/ultraviolet-A radiation on ocular pathogens. Taiwan J Ophthalmol 2023; 13:21-27. [DOI: 10.4103/tjo.tjo_28_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 06/14/2021] [Indexed: 03/14/2023] Open
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5
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Crocker LB, Lee JH, Mital S, Mills GC, Schack S, Bistrović-Popov A, Franck CO, Mela I, Kaminski CF, Christie G, Fruk L. Tuning riboflavin derivatives for photodynamic inactivation of pathogens. Sci Rep 2022; 12:6580. [PMID: 35449377 PMCID: PMC9022420 DOI: 10.1038/s41598-022-10394-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 03/28/2022] [Indexed: 11/14/2022] Open
Abstract
The development of effective pathogen reduction strategies is required due to the rise in antibiotic-resistant bacteria and zoonotic viral pandemics. Photodynamic inactivation (PDI) of bacteria and viruses is a potent reduction strategy that bypasses typical resistance mechanisms. Naturally occurring riboflavin has been widely used in PDI applications due to efficient light-induced reactive oxygen species (ROS) release. By rational design of its core structure to alter (photo)physical properties, we obtained derivatives capable of outperforming riboflavin's visible light-induced PDI against E. coli and a SARS-CoV-2 surrogate, revealing functional group dependency for each pathogen. Bacterial PDI was influenced mainly by guanidino substitution, whereas viral PDI increased through bromination of the flavin. These observations were related to enhanced uptake and ROS-specific nucleic acid cleavage mechanisms. Trends in the derivatives' toxicity towards human fibroblast cells were also investigated to assess viable therapeutic derivatives and help guide further design of PDI agents to combat pathogenic organisms.
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Affiliation(s)
- Leander B Crocker
- Department of Chemical Engineering and Biotechnology, University of Cambridge, Philippa Fawcett Drive, Cambridge, CB3 0AS, UK
| | - Ju Hyun Lee
- Department of Chemical Engineering and Biotechnology, University of Cambridge, Philippa Fawcett Drive, Cambridge, CB3 0AS, UK
| | - Suraj Mital
- Department of Chemical Engineering and Biotechnology, University of Cambridge, Philippa Fawcett Drive, Cambridge, CB3 0AS, UK
| | - Gabrielle C Mills
- Department of Chemical Engineering and Biotechnology, University of Cambridge, Philippa Fawcett Drive, Cambridge, CB3 0AS, UK
| | - Sina Schack
- Department of Chemical Engineering and Biotechnology, University of Cambridge, Philippa Fawcett Drive, Cambridge, CB3 0AS, UK
| | - Andrea Bistrović-Popov
- Department of Chemical Engineering and Biotechnology, University of Cambridge, Philippa Fawcett Drive, Cambridge, CB3 0AS, UK
| | - Christoph O Franck
- Department of Chemical Engineering and Biotechnology, University of Cambridge, Philippa Fawcett Drive, Cambridge, CB3 0AS, UK
| | - Ioanna Mela
- Department of Chemical Engineering and Biotechnology, University of Cambridge, Philippa Fawcett Drive, Cambridge, CB3 0AS, UK
| | - Clemens F Kaminski
- Department of Chemical Engineering and Biotechnology, University of Cambridge, Philippa Fawcett Drive, Cambridge, CB3 0AS, UK
| | - Graham Christie
- Department of Chemical Engineering and Biotechnology, University of Cambridge, Philippa Fawcett Drive, Cambridge, CB3 0AS, UK
| | - Ljiljana Fruk
- Department of Chemical Engineering and Biotechnology, University of Cambridge, Philippa Fawcett Drive, Cambridge, CB3 0AS, UK.
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6
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Kasirye R, Hume HA, Bloch EM, Lubega I, Kyeyune D, Shrestha R, Ddungu H, Musana HW, Dhabangi A, Ouma J, Eroju P, de Lange T, Tartakovsky M, White JL, Kakura C, Fowler MG, Musoke P, Nolan M, Grabowski MK, Moulton LH, Stramer SL, Whitby D, Zimmerman PA, Wabwire D, Kajja I, McCullough J, Goodrich R, Quinn TC, Cortes R, Ness PM, Tobian AAR. The Mirasol Evaluation of Reduction in Infections Trial (MERIT): study protocol for a randomized controlled clinical trial. Trials 2022; 23:257. [PMID: 35379302 PMCID: PMC8978156 DOI: 10.1186/s13063-022-06137-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 03/02/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Transfusion-transmitted infections (TTIs) are a global health challenge. One new approach to reduce TTIs is the use of pathogen reduction technology (PRT). In vitro, Mirasol PRT reduces the infectious load in whole blood (WB) by at least 99%. However, there are limited in vivo data on the safety and efficacy of Mirasol PRT. The objective of the Mirasol Evaluation of Reduction in Infections Trial (MERIT) is to investigate whether Mirasol PRT of WB can prevent seven targeted TTIs (malaria, bacteria, human immunodeficiency virus, hepatitis B virus, hepatitis C virus, hepatitis E virus, and human herpesvirus 8). METHODS MERIT is a randomized, double-blinded, controlled clinical trial. Recruitment started in November 2019 and is expected to end in 2024. Consenting participants who require transfusion as medically indicated at three hospitals in Kampala, Uganda, will be randomized to receive either Mirasol-treated WB (n = 1000) or standard WB (n = 1000). TTI testing will be performed on donor units and recipients (pre-transfusion and day 2, day 7, week 4, and week 10 after transfusion). The primary endpoint is the cumulative incidence of one or more targeted TTIs from the Mirasol-treated WB vs. standard WB in a previously negative recipient for the specific TTI that is also detected in the donor unit. Log-binomial regression models will be used to estimate the relative risk reduction of a TTI by 10 weeks associated with Mirasol PRT. The clinical effectiveness of Mirasol WB compared to standard WB products in recipients will also be evaluated. DISCUSSION Screening infrastructure for TTIs in low-resource settings has gaps, even for major TTIs. PRT presents a fast, potentially cost-effective, and easy-to-use technology to improve blood safety. MERIT is the largest clinical trial designed to evaluate the use of Mirasol PRT for WB. In addition, this trial will provide data on TTIs in Uganda. TRIAL REGISTRATION Mirasol Evaluation of Reduction in Infections Trial (MERIT) NCT03737669 . Registered on 9 November 2018.
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Affiliation(s)
- Ronnie Kasirye
- grid.421981.7MUJHU Research Collaboration, Kampala, Uganda
| | - Heather A. Hume
- grid.14848.310000 0001 2292 3357Department of Pediatrics, University of Montreal, Montréal, QC Canada
| | - Evan M. Bloch
- grid.21107.350000 0001 2171 9311Department of Pathology, School of Medicine, Johns Hopkins University, Baltimore, MD USA
| | - Irene Lubega
- grid.421981.7MUJHU Research Collaboration, Kampala, Uganda
| | | | - Ruchee Shrestha
- grid.21107.350000 0001 2171 9311Department of Pathology, School of Medicine, Johns Hopkins University, Baltimore, MD USA
| | - Henry Ddungu
- grid.512320.70000 0004 6015 3252Uganda Cancer Institute, Kampala, Uganda
| | | | - Aggrey Dhabangi
- grid.11194.3c0000 0004 0620 0548Child Health and Development Centre, Makerere University College of Health Sciences, Kampala, Uganda
| | - Joseph Ouma
- grid.421981.7MUJHU Research Collaboration, Kampala, Uganda
| | | | - Telsa de Lange
- grid.419681.30000 0001 2164 9667National Institute of Allergy and Infectious Diseases Office of Cyber Infrastructure and Computational Biology, Bethesda, MD USA
| | - Michael Tartakovsky
- grid.419681.30000 0001 2164 9667National Institute of Allergy and Infectious Diseases Office of Cyber Infrastructure and Computational Biology, Bethesda, MD USA
| | - Jodie L. White
- grid.21107.350000 0001 2171 9311Department of Pathology, School of Medicine, Johns Hopkins University, Baltimore, MD USA
| | - Ceasar Kakura
- grid.421981.7MUJHU Research Collaboration, Kampala, Uganda
| | - Mary Glenn Fowler
- grid.21107.350000 0001 2171 9311Department of Pathology, School of Medicine, Johns Hopkins University, Baltimore, MD USA
| | - Philippa Musoke
- grid.11194.3c0000 0004 0620 0548Makerere University, Kampala, Uganda
| | - Monica Nolan
- grid.421981.7MUJHU Research Collaboration, Kampala, Uganda
| | - M. Kate Grabowski
- grid.21107.350000 0001 2171 9311Department of Pathology, School of Medicine, Johns Hopkins University, Baltimore, MD USA
| | - Lawrence H. Moulton
- grid.21107.350000 0001 2171 9311Department of International Health, School of Public Health, Johns Hopkins University, Baltimore, MD USA
| | - Susan L. Stramer
- grid.281926.60000 0001 2214 8581Department of Scientific Affairs, American Red Cross, Gaithersburg, MD USA
| | - Denise Whitby
- grid.418021.e0000 0004 0535 8394Leidos Biomedical Research, AIDS and Cancer Virus Program, Frederick National Laboratory for Cancer Research, Frederick, MD USA
| | - Peter A. Zimmerman
- grid.67105.350000 0001 2164 3847The Center for Global Health & Diseases, Pathology Department, Case Western Reserve University, Cleveland, OH USA
| | - Deo Wabwire
- grid.421981.7MUJHU Research Collaboration, Kampala, Uganda
| | - Isaac Kajja
- grid.11194.3c0000 0004 0620 0548Department of Orthopaedics, Makerere University College of Health Sciences, Kampala, Uganda
| | - Jeffrey McCullough
- grid.215654.10000 0001 2151 2636College of Health Solutions, Arizona State University, Phoenix, AZ USA
| | - Raymond Goodrich
- grid.47894.360000 0004 1936 8083Department of Microbiology, Immunology and Pathology, Colorado State University, Fort Collins, CO USA
| | - Thomas C. Quinn
- grid.21107.350000 0001 2171 9311Department of Pathology, School of Medicine, Johns Hopkins University, Baltimore, MD USA ,grid.21107.350000 0001 2171 9311Department of International Health, School of Public Health, Johns Hopkins University, Baltimore, MD USA ,grid.94365.3d0000 0001 2297 5165Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD USA
| | | | - Paul M. Ness
- grid.21107.350000 0001 2171 9311Department of Pathology, School of Medicine, Johns Hopkins University, Baltimore, MD USA
| | - Aaron A. R. Tobian
- grid.21107.350000 0001 2171 9311Department of Pathology, School of Medicine, Johns Hopkins University, Baltimore, MD USA ,grid.11194.3c0000 0004 0620 0548Department of Paediatrics and Child Health, College of Health Sciences, Makerere University, Kampala, Uganda
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7
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Cloutier M, De Korte D. Residual risks of bacterial contamination for
pathogen‐reduced
platelet components. Vox Sang 2022; 117:879-886. [DOI: 10.1111/vox.13272] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 12/22/2021] [Accepted: 02/10/2022] [Indexed: 12/14/2022]
Affiliation(s)
- Marc Cloutier
- Medical Affairs and Innovation Héma‐Québec Québec Canada
- Biochemistry, Microbiology and Bio‐informatics Université Laval Québec Canada
| | - Dirk De Korte
- Blood Cell Research Sanquin Research Amsterdam The Netherlands
- Product and Process Development Sanquin Blood Bank Amsterdam The Netherlands
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8
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A comparative study of pathogen inactivation technologies in human platelet lysate and its optimal efficiency in human placenta-derived stem cells culture. J Virol Methods 2022; 302:114478. [DOI: 10.1016/j.jviromet.2022.114478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 01/22/2022] [Accepted: 01/23/2022] [Indexed: 11/22/2022]
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9
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Escolar G, Diaz-Ricart M, McCullough J. Impact of different pathogen reduction technologies on the biochemistry, function, and clinical effectiveness of platelet concentrates: An updated view during a pandemic. Transfusion 2021; 62:227-246. [PMID: 34870335 PMCID: PMC9300014 DOI: 10.1111/trf.16747] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Revised: 09/03/2021] [Accepted: 10/06/2021] [Indexed: 12/25/2022]
Abstract
Standard platelet concentrates (PCs) stored at 22°C have a limited shelf life of 5 days. Because of the storage temperature, bacterial contamination of PCs can result in life‐threatening infections in transfused patients. The potential of blood components to cause infections through contaminating pathogens or transmitting blood‐borne diseases has always been a concern. The current safety practice to prevent pathogen transmission through blood transfusion starts with a stringent screening of donors and regulated testing of blood samples to ensure that known infections cannot reach transfusion products. Pathogen reduction technologies (PRTs), initially implemented to ensure the safety of plasma products, have been adapted to treat platelet products. In addition to reducing bacterial contamination, PRT applied to PCs can extend their shelf life up to 7 days, alleviating the impact of their shortage, while providing an additional safety layer against emerging blood‐borne infectious diseases. While a deleterious action of PRTs in quantitative and qualitative aspects of plasma is accepted, the impact of PRTs on the quality, function, and clinical efficacy of PCs has been under constant examination. The potential of PRTs to prevent the possibility of new emerging diseases to reach cellular blood components has been considered more hypothetical than real. In 2019, a coronavirus‐related disease (COVID‐19) became a pandemic. This episode should help when reconsidering the possibility of future blood transmissible threats. The following text intends to evaluate the impact of different PRTs on the quality, function, and clinical effectiveness of platelets within the perspective of a developing pandemic.
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Affiliation(s)
- Gines Escolar
- Department of Hematopathology, Centre Diagnostic Biomedic, Hospital Clinic, Barcelona, Spain
| | - Maribel Diaz-Ricart
- Department of Hematopathology, Centre Diagnostic Biomedic, Hospital Clinic, Barcelona, Spain
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10
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Lu Y, Yin Y, Hu T, Du K, Fu Y, Xiang A, Fu Q, Wu X, Li Y, Wen D. Polymicrobial keratitis after accelerated corneal collagen cross-linking in keratoconus: Case reports and literature review. Eur J Ophthalmol 2021; 32:1375-1385. [PMID: 34821524 DOI: 10.1177/11206721211051922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To report two cases of polymicrobial keratitis following corneal collagen cross-linking for keratoconus and to review the literature. METHODS Retrospective case note and literature review. RESULTS The first case involved a 27-year-old male who presented with amebic corneal ulcers 3 days after the collagen cross-linking procedure. Some gram-negative (gram-ve) cocci were found upon staining, and cysts were observed by confocal microscopy at 7 days after surgery. Acanthamoeba infection mixed with gram-ve organisms was diagnosed. In the second case, a 14-year male developed Staphylococcus aureus corneal infection with anterior chamber empyema 3 days after the collagen cross-linking procedure for keratoconus. Occasional gram-positive (gram + ve) cocci and gram-ve bacilli were observed under a microscope. The mixed keratitis in the two patients resolved after systemic and topical antibiotic therapy, but the infection ultimately resulted in corneal scarring. Follow-up keratoplasty was needed to improve vision acuity in both patients. CONCLUSION Although ultraviolet irradiation and the reactive oxygen released by riboflavin during collagen cross-linking have bactericidal effects, a lack of a corneal epithelial barrier, bandage contact lens usage, perioperative hygiene, and an abnormal immune state are risk factors for infectious keratitis after collagen cross-linking. Perioperative management of collagen cross-linking is important to prevent infection.
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Affiliation(s)
- Ying Lu
- 159374Eye Center of Xiangya Hospital, Central South University, Changsha, China.,Hunan Key Laboratory of Ophthalmology, Central South University, Changsha, China
| | - Yewei Yin
- 159374Eye Center of Xiangya Hospital, Central South University, Changsha, China.,Hunan Key Laboratory of Ophthalmology, Central South University, Changsha, China
| | - Tu Hu
- 159374Eye Center of Xiangya Hospital, Central South University, Changsha, China.,Hunan Key Laboratory of Ophthalmology, Central South University, Changsha, China
| | - Kaixuan Du
- 159374Eye Center of Xiangya Hospital, Central South University, Changsha, China.,Hunan Key Laboratory of Ophthalmology, Central South University, Changsha, China
| | - Yanyan Fu
- 159374Eye Center of Xiangya Hospital, Central South University, Changsha, China.,Hunan Key Laboratory of Ophthalmology, Central South University, Changsha, China
| | - Aiqun Xiang
- 159374Eye Center of Xiangya Hospital, Central South University, Changsha, China.,Hunan Key Laboratory of Ophthalmology, Central South University, Changsha, China
| | - Qiuman Fu
- 159374Eye Center of Xiangya Hospital, Central South University, Changsha, China.,Hunan Key Laboratory of Ophthalmology, Central South University, Changsha, China
| | - Xiaoying Wu
- 159374Eye Center of Xiangya Hospital, Central South University, Changsha, China.,Hunan Key Laboratory of Ophthalmology, Central South University, Changsha, China
| | - Yuanjun Li
- 159374Eye Center of Xiangya Hospital, Central South University, Changsha, China.,Hunan Key Laboratory of Ophthalmology, Central South University, Changsha, China
| | - Dan Wen
- 159374Eye Center of Xiangya Hospital, Central South University, Changsha, China.,Hunan Key Laboratory of Ophthalmology, Central South University, Changsha, China
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11
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Trufanov SV, Shakhbazyan NP, Zaitsev AV, Rozinova VN. [Surgical management of infectious keratitis]. Vestn Oftalmol 2021; 137:128-135. [PMID: 34410068 DOI: 10.17116/oftalma2021137041128] [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] [Indexed: 11/17/2022]
Abstract
Infectious keratitis is one of the most common causes of blindness worldwide. Despite the existence of a wide arsenal of quite effective antimicrobial drugs, some forms of bacterial and viral keratitis are resistant. Advanced acanthamoeba and mycotic lesions of the cornea, as well as mixed forms of infection usually do not respond well to conservative treatment. In the absence of positive dynamics from the applied etiotropic therapy with observed further progression of the microbial process, there is a risk of corneal perforation and spread of infection to the sclera or deep ocular structures with a high probability of irreversible functional disorders or anatomical death of the eye. In such cases, a timely transition to surgical treatment is necessary in order to maintain structural integrity of the eyeball. For this purpose, corneal crosslinking, microdiathermocoagulation, tissue adhesive, autoconjunctival plasty, amniotic membrane, corneoscleral flap coating, various combinations of these methods, as well as therapeutic keratoplasty are used most often in clinical practice. The choice depends on the etiology, size and depth of the lesion, its localization, prognosis of visual outcomes, somatic status of the patient. Therapeutic keratoplasty is the most radical and effective method of surgical intervention that allows eradication of the infectious focus and best possible restoration of the structural integrity of the eyeball. However, in some cases due to inaccessibility of donor material or high risks of the surgery and non-transparent graft engraftment, it is advised to use alternative surgical approaches, and keratoplasty, if necessary, should be carried out for optical purposes at a further, "quiet" period.
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Affiliation(s)
- S V Trufanov
- Research Institute of Eye Diseases, Moscow, Russia
| | | | - A V Zaitsev
- Research Institute of Eye Diseases, Moscow, Russia
| | - V N Rozinova
- Research Institute of Eye Diseases, Moscow, Russia
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12
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Hafezi F, Richoz O, Torres-Netto EA, Hillen M, Hafezi NL. Corneal Cross-linking at the Slit Lamp. J Refract Surg 2021; 37:78-82. [PMID: 33577692 DOI: 10.3928/1081597x-20201123-02] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 11/09/2020] [Indexed: 11/20/2022]
Abstract
PURPOSE To describe a new surgical technique where corneal cross-linking (CXL) (to treat corneal ectasias) and photo-activated chromophore for keratitis-CXL (PACK-CXL) are performed while the patient is seated in an upright position at the slit lamp. METHODS Topical anesthesia is applied in the waiting room, 10 minutes before the procedure. Once in the office or procedure room, eyelids and periorbital areas are disinfected with chloramphenicol and the patient is seated at the slit lamp. Epithelial debridement is performed with a cotton swab soaked in freshly prepared 40% ethanol, using 70 seconds of tapping, followed by gentle pressure to remove the epithelium. The patient is placed in the supine position for riboflavin application for 10 minutes. Stromal thickness is assessed using ultrasound pachymetry after 5 and 10 minutes. Finally, the patient is returned to the slit lamp to receive ultraviolet irradiation. RESULTS CXL at the slit lamp is an easy-to-perform technique that substantially reduces the infrastructure needed to perform CXL and PACK-CXL procedures. CONCLUSIONS A significant advantage of allowing CXL treatment at the slit lamp is that CXL technology can now be used in clinics that do not have easy access to an operating room infrastructure. Slit-lamp CXL can also reduce procedure costs by eliminating the technical fees related to the use of an operating room, making this treatment not only more accessible for patients, but also affordable. [J Refract Surg. 2021;37(2):78-82.].
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Feizi S, Karimian F, Esfandiari H. Corneal crosslinking for the treatment of infectious keratitis: a review. EXPERT REVIEW OF OPHTHALMOLOGY 2021. [DOI: 10.1080/17469899.2021.1933440] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Sepehr Feizi
- Ophthalmic Research Center, Department of Ophthalmology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farid Karimian
- Ophthalmic Research Center, Department of Ophthalmology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hamed Esfandiari
- Department of Ophthalmology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
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Alabdullatif M, Osman IE, Alrasheed M, Ramirez-Arcos S, Alyousef M, Althawadi S, Alhumiadan H. Evaluation of riboflavin and ultraviolet light treatment against Klebsiella pneumoniae in whole blood-derived platelets: A pilot study. Transfusion 2021; 61:1562-1569. [PMID: 33687079 DOI: 10.1111/trf.16347] [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] [Received: 10/03/2020] [Revised: 12/27/2020] [Accepted: 12/27/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND Bacterial contamination of platelet concentrates (PCs) is the predominant cause of infectious transfusion reactions. The Pathogen Inactivation Mirasol system was implemented at the King Faisal Specialist Hospital (Saudi Arabia) to reduce the risk of transfusing contaminated PCs. This pilot study evaluated the effectiveness of Mirasol against Klebsiella pneumoniae, a pathogen associated with transfusion reactions, in whole blood-derived PCs. STUDY DESIGN AND METHODS Whole blood (WB) units inoculated with one of six K. pneumoniae strains (five clinical isolates and ATCC-700603) at a concentration of 3-38 CFU/unit, were processed using the platelet-rich plasma (PRP) method. Each spiked PC was pooled with four unspiked units. The pooled PC was split into three Mirasol storage bags: an untreated unit (control), and two units treated with Mirasol at 26 and 32 h post-WB collection, respectively. PC samples obtained before and after Mirasol treatment were used for BacT/ALERT cultures and determination of bacteria quantification. Each experiment was repeated three independent times. RESULTS Five strains were detected prior to PC treatment (24 h post-WB spiking), while one clinical isolate was not detected. Mirasol treatment after 26 h of WB collection resulted in complete inactivation of all K. pneumoniae strains. However, treatment 32 h post-WB collection resulted in the breakthrough of one clinical isolate in two of the three replicates with ~7.8 log10 CFU/unit detected on day 5 of PC storage. CONCLUSION Delayed Mirasol treatment from 26 to 32 h post-WB collection, resulted in one breakthrough. These results highlight the importance of minimizing the time between WB collection and PI treatment.
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Affiliation(s)
- Meshari Alabdullatif
- Department of Pathology, College of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, Saudi Arabia.,Department of Microbiology, SmartLab, Riyadh, Saudi Arabia
| | - Imad Eldin Osman
- King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Mai Alrasheed
- King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | | | - Manal Alyousef
- King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Sahar Althawadi
- King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Hind Alhumiadan
- King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
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15
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Kaplan A. Preparation, Storage, and Characteristics of Whole Blood, Blood Components, and Plasma Derivatives. Transfus Med 2021. [DOI: 10.1002/9781119599586.ch5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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16
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McCullough J. Pathogen Reduced Blood Products. Transfus Med 2021. [DOI: 10.1002/9781119599586.ch14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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17
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Ye H, Xu H, Qiao M, Guo R, Ji Y, Yu Y, Chen Y, Gai X, Li H, Liu Q, Zhuang Y. MicroRNA expression profiles analysis of apheresis platelets treated with vitamin B 2 and ultraviolet-B during storage. Transfus Apher Sci 2021; 60:103079. [PMID: 33602623 DOI: 10.1016/j.transci.2021.103079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 01/30/2021] [Accepted: 02/04/2021] [Indexed: 11/18/2022]
Abstract
Whether platelet (PLT) microRNA (miRNA) profiles are affected by pathogen reduction technology (PRT) using vitamin B2 and ultraviolet-B (VB2-PRT) remains unclear. Samples from VB2-PRT-treated (experimental group, E_) and untreated (control group, C_) apheresis PLTs were taken on days 1, 3 and 5 of storage, designated as E_1, E_3, E_5, C_1, C_3 and C_5, respectively. The miRNA expression profiles were assessed by DNA Nano Ball (DNB) sequencing technology, and verified by quantitive real-time fluorescence quantitative PCR (qRT-PCR). Compared with the expression profiles of PLT miRNAs, 3895 miRNAs were identified in the E_ groups while 4106 were in the C_ groups. There were 487 significant differentially expressed miRNAs in E_1 vs C_1 group, including 220 upregulated and 287 downregulated, such as miR-146a-5p and let-7b-5p. There were 908 significant differentially expressed miRNAs in E_3 vs C_3 group, including 297 upregulated and 611 downregulated, such as miR-142-5p and miR-7-5p. There were 229 significant differentially expressed miRNAs in E_5 vs C_5 group, including 80 upregulated and 149 downregulated, such as miR-3529-3p and miR-451a. These differentially expressed miRNAs had been suggested to have functional roles in energy homeostasis, cell communication, proliferation, migration and apoptosis. GO analysis showed a significant enrichmen in relevant biological process categories as receptor activity, signal transduction, cell transport, motility and chemotaxis. The significantly enriched KEGG pathway of predicted target genes was Glycosaminoglycan biosynthesis in E_ vs C_ groups. These new observation could provide insights on the understanding of change of miRNA profiles of PLT treated with VB2-PRT.
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Affiliation(s)
- Hui Ye
- Institute of Hematology, Blood Center of Shandong Province, Jinan 250014, Shandong Province, China; School of Medicine, Shandong University, Jinan 250012, Shandong Province, China
| | - Huicong Xu
- Domestic Marketing System of Shenzhen Mindray Biomedical Electronics Co, Ltd, Jinan 250012, Shandong Province, China
| | - Mingming Qiao
- Institute of Hematology, Blood Center of Shandong Province, Jinan 250014, Shandong Province, China
| | - Rui Guo
- Shandong Provincial Qianfoshan Hospital, the First Hospital Affiliated With Shandong First Medical University, Jinan 250014, Shandong Province, China
| | - Yanbo Ji
- Shandong Provincial Qianfoshan Hospital, the First Hospital Affiliated With Shandong First Medical University, Jinan 250014, Shandong Province, China
| | - Yuan Yu
- Institute of Hematology, Blood Center of Shandong Province, Jinan 250014, Shandong Province, China
| | - Yuanfeng Chen
- Institute of Hematology, Blood Center of Shandong Province, Jinan 250014, Shandong Province, China
| | - Xia Gai
- Institute of Hematology, Blood Center of Shandong Province, Jinan 250014, Shandong Province, China
| | - Honglei Li
- School of Medicine, Shandong University, Jinan 250012, Shandong Province, China
| | - Qun Liu
- Institute of Hematology, Blood Center of Shandong Province, Jinan 250014, Shandong Province, China
| | - Yunlong Zhuang
- Institute of Hematology, Blood Center of Shandong Province, Jinan 250014, Shandong Province, China.
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Contemporary resuscitation of hemorrhagic shock: What will the future hold? Am J Surg 2020; 220:580-588. [PMID: 32409009 PMCID: PMC7211588 DOI: 10.1016/j.amjsurg.2020.05.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 04/28/2020] [Accepted: 05/07/2020] [Indexed: 02/07/2023]
Abstract
Resuscitation of the critically ill patient with fluid and blood products is one of the most widespread interventions in medicine. This is especially relevant for trauma patients, as hemorrhagic shock remains the most common cause of preventable death after injury. Consequently, the study of the ideal resuscitative product for patients in shock has become an area of great scientific interest and investigation. Recently, the pendulum has swung towards increased utilization of blood products for resuscitation. However, pathogens, immune reactions and the limited availability of this resource remain a challenge for clinicians. Technologic advances in pathogen reduction and innovations in blood product processing will allow us to increase the safety profile and efficacy of blood products, ultimately to the benefit of patients. The purpose of this article is to review the current state of blood product based resuscitative strategies as well as technologic advancements that may lead to safer resuscitation.
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Mohan KVK, Leiby DA. Emerging tick-borne diseases and blood safety: summary of a public workshop. Transfusion 2020; 60:1624-1632. [PMID: 32208532 DOI: 10.1111/trf.15752] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 02/24/2020] [Accepted: 02/24/2020] [Indexed: 12/12/2022]
Abstract
Tick-borne agents of disease continue to emerge and subsequently expand their geographic distribution. The threat to blood safety by tick-borne agents is ever increasing and requires constant surveillance concomitant with implementation of appropriate intervention methods. In April 2017, the Food and Drug Administration organized a public workshop on emerging tick-borne pathogens (excluding Babesia microti and Lyme disease) designed to provide updates on the current understanding of emerging tick-borne diseases, thereby allowing for extended discussions to determine if decisions regarding mitigation strategies need to be made proactively. Subject matter experts and other stakeholders participated in this workshop to discuss issues of biology, epidemiology, and clinical burden of tick-borne agents, risk of transfusion-transmission, surveillance, and considerations for decision making in implementing safety interventions. Herein, we summarize the scientific presentations, panel discussions, and considerations going forward.
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Affiliation(s)
- Krishna V K Mohan
- Product Review Branch, Division of Emerging & Transfusion Transmitted Diseases, Center for Biologics Evaluation and Research, US Food & Drug Administration, Silver Spring, Maryland, USA
| | - David A Leiby
- Product Review Branch, Division of Emerging & Transfusion Transmitted Diseases, Center for Biologics Evaluation and Research, US Food & Drug Administration, Silver Spring, Maryland, USA
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Zhu L, Li C, Wang D. A novel ultraviolet illumination used in riboflavin photochemical method to inactivate drug-resistant bacteria in blood components. JOURNAL OF PHOTOCHEMISTRY AND PHOTOBIOLOGY B-BIOLOGY 2020; 204:111782. [PMID: 32062389 DOI: 10.1016/j.jphotobiol.2020.111782] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Revised: 01/06/2020] [Accepted: 01/07/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Ultraviolet (UV) fluorescent lamp (FL) was applied in mainstream riboflavin photochemical method (RPM) to inactivate pathogens in blood components. Low UV irradiance emitted by UV-FL resulted in more time to achieve effective inactivation. MATERIALS AND METHODS A novel light emitting diode (LED) UV illumination with adjustable irradiance was developed by us. Two strains of drug-resistant bacteria (DRB), pan-drug resistant Acinetobacter baumannii (PDRAB) and methicillin-resistant Staphylococcus aureus (MRSA) were cultured and used for evaluating the inactivation effectiveness of RPM using UV-LED or UV-FL against DRB in plasma or platelets. Three plasma factors and four platelet parameters were measured after treatments. RESULTS There was a linear relationship between UV-LED irradiance and electric current, the minimum UV irradiance was 24 mW/cm2, and the maximum was 258 mW/cm2. At the same UV dose of 15 J/cm2, inactivation effectiveness of UV-LED with 258 mW/cm2 against PDRAB in plasma or platelets were comparable to that of UV-FL with 16 mW/cm2, both above 98%. UV-FL treatment required 10-15 min, but UV-LED only required 1-2 min. However, MRSA showed a resistance to UV-LED (inactivation effectiveness was around 40%) compared with UV-FL (inactivation effectiveness was above 98%). The retention of fibrinogen, factor V, factor VII in plasma and platelet counts in platelets with UV-LED treatment were significantly higher than UV-FL at the same UV dose. CONCLUSION The treatment of RPM using UV-LED with high UV irradiance was able to dramatically shorten inactivation time against PDRAB in plasma or platelets and improve retention of blood components compared with UV-FL.
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Affiliation(s)
- Liguo Zhu
- Institute of Blood Transfusion, Peking Union Medical College and Chinese Academy of Medical Sciences, No.26 Huacai Road, Chenghua District, Chengdu, China.
| | - Changqing Li
- Institute of Blood Transfusion, Peking Union Medical College and Chinese Academy of Medical Sciences, No.26 Huacai Road, Chenghua District, Chengdu, China.
| | - Deqing Wang
- Department of Blood Transfusion, Chinese PLA General Hospital, No.28 Fuxing Road, Haidian District, Beijing, China.
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Gorria C, Labata G, Lezaun M, López FJ, Pérez Aliaga AI, Pérez Vaquero MÁ. Impact of implementing pathogen reduction technologies for platelets on reducing outdates. Vox Sang 2019; 115:167-173. [DOI: 10.1111/vox.12860] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 10/15/2019] [Accepted: 10/15/2019] [Indexed: 01/10/2023]
Affiliation(s)
- Carlos Gorria
- Department of Applied Mathematics, Statistics and Operations Research University of the Basque Country ‐ UPV/EHU Bizkaia Spain
| | | | - Mikel Lezaun
- Department of Applied Mathematics, Statistics and Operations Research University of the Basque Country ‐ UPV/EHU Bizkaia Spain
| | - F. Javier López
- Department of Statistical Methods and Institute for Biocomputation and Physics of Complex Systems University of Zaragoza Zaragoza Spain
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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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Jacquot C, Mo YD, Luban NLC. New Approaches and Trials in Pediatric Transfusion Medicine. Hematol Oncol Clin North Am 2019; 33:507-520. [PMID: 31030816 DOI: 10.1016/j.hoc.2019.01.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Blood transfusions are frequently lifesaving, but there is growing awareness of their associated infectious and noninfectious adverse events. Patient blood management advocates for judicious use of transfusions and considerations of alternatives to correct anemia or achieve hemostasis. Several transfusion practices, either already implemented or under investigation, aim to further improve the safety of transfusions. An enduring challenge in pediatric and neonatal transfusion practice is that studies typically focus on adults, and findings are extrapolated to younger patients. This article aims to summarize some of the newer developments in transfusion medicine with a focus on the neonatal and pediatric population.
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Affiliation(s)
- Cyril Jacquot
- Division of Laboratory Medicine, Center for Cancer and Blood Disorders, Children's National Health System, Sheikh Zayed Campus for Advanced Children's Medicine, 111 Michigan Avenue Northwest, Washington, DC 20010, USA; Division of Hematology, Center for Cancer and Blood Disorders, Children's National Health System, Sheikh Zayed Campus for Advanced Children's Medicine, 111 Michigan Avenue Northwest, Washington, DC 20010, USA; Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, DC, USA; Department of Pathology, George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
| | - Yunchuan Delores Mo
- Division of Laboratory Medicine, Center for Cancer and Blood Disorders, Children's National Health System, Sheikh Zayed Campus for Advanced Children's Medicine, 111 Michigan Avenue Northwest, Washington, DC 20010, USA; Division of Hematology, Center for Cancer and Blood Disorders, Children's National Health System, Sheikh Zayed Campus for Advanced Children's Medicine, 111 Michigan Avenue Northwest, Washington, DC 20010, USA; Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, DC, USA; Department of Pathology, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Naomi L C Luban
- Division of Laboratory Medicine, Center for Cancer and Blood Disorders, Children's National Health System, Sheikh Zayed Campus for Advanced Children's Medicine, 111 Michigan Avenue Northwest, Washington, DC 20010, USA; Division of Hematology, Center for Cancer and Blood Disorders, Children's National Health System, Sheikh Zayed Campus for Advanced Children's Medicine, 111 Michigan Avenue Northwest, Washington, DC 20010, USA; Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, DC, USA; Department of Pathology, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
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Goubran H, Goubran M, Seghatchian J, Burnouf T. New monoclonal/bi-specific antibodies: Reshaping transfusion medicine beyond replacement. Transfus Apher Sci 2019; 58:208-211. [DOI: 10.1016/j.transci.2019.03.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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25
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Stolla M. Pathogen reduction and HLA alloimmunization: more questions than answers. Transfusion 2019; 59:1152-1155. [DOI: 10.1111/trf.15211] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2019] [Accepted: 01/27/2019] [Indexed: 12/31/2022]
Affiliation(s)
- Moritz Stolla
- From the Bloodworks Northwest Research Institute, Platelet Transfusion Research Laboratory, Seattle, Washington; and the Department of Medicine, Division of Hematology, University of Washington School of Medicine; Seattle Washington
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Viau S, Eap S, Chabrand L, Lagrange A, Delorme B. Viral inactivation of human platelet lysate by gamma irradiation preserves its optimal efficiency in the expansion of human bone marrow mesenchymal stromal cells. Transfusion 2019; 59:1069-1079. [PMID: 30793328 DOI: 10.1111/trf.15205] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 11/09/2018] [Accepted: 11/12/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND Human platelet lysate (hPL) represents a powerful medium supplement for human mesenchymal stromal cell (hMSC) expansion. The recently published general chapters of the Pharmacopeia require the addition of a step of viral inactivation during the production process of such raw biological material used for cell-based medicinal products. STUDY DESIGN AND METHODS The ability of gamma irradiation to inactivate viruses from a panel representative of the virus diversity was evaluated. The impact of gamma irradiation on hPL composition and efficiency as a supplement for hMSC culture was evaluated. RESULTS An efficient inactivation of all the viruses tested was demonstrated, with the minimum reduction factors obtained being superior to 4.5 log10 for human immunodeficiency virus (HIV) and hepatitis A virus (HAV) and superior to 5 log10 for bovine viral diarrhea virus (BVDV), pseudorabies virus (PRV) and porcine parvovirus (PPV). The gamma irradiation did not affect the content in interesting biochemical factors for cell culture or in growth factors (GF), except to basic fibroblast GF (bFGF) whereas it highly impacted the contents in the factors involved in the coagulation cascade. Finally, gamma irradiated hPL remained as efficient as non-irradiated hPL for the proliferation, clonogenic potential, differentiation potential, and immunosuppressive properties of hMSCs. CONCLUSION The feasibility of using gamma irradiation to efficiently inactivate viruses in hPL while maintaining its optimal efficacy as a supplement for hMSC expansion was demonstrated. Such an inactivated hPL represents a very attractive raw material for the efficient production of safe cellular therapy products.
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Affiliation(s)
- Sabrina Viau
- Biotherapy Division, Macopharma, Mouvaux, France
| | - Sandy Eap
- Biotherapy Division, Macopharma, Mouvaux, France
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Reflections on the dynamics of bacterial and viral contamination of blood components and the levels of efficacy for pathogen inactivation processes. Transfus Apher Sci 2018; 57:683-688. [DOI: 10.1016/j.transci.2018.09.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Jacquot C, Delaney M. Pathogen-inactivated blood products for pediatric patients: blood safety, patient safety, or both? Transfusion 2018; 58:2095-2101. [DOI: 10.1111/trf.14811] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 04/16/2018] [Accepted: 04/19/2018] [Indexed: 12/21/2022]
Affiliation(s)
- Cyril Jacquot
- Divisions of Pathology & Laboratory Medicine; Children's National Health System; Washington DC
- Departments of Pathology & Pediatrics, School of Medicine and Health Sciences; The George Washington University; Washington DC
| | - Meghan Delaney
- Divisions of Pathology & Laboratory Medicine; Children's National Health System; Washington DC
- Departments of Pathology & Pediatrics, School of Medicine and Health Sciences; The George Washington University; Washington DC
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Castiglia S, Adamini A, Rustichelli D, Castello L, Mareschi K, Pinnetta G, Leone M, Mandese A, Ferrero I, Mesiano G, Fagioli F. Cytokines induced killer cells produced in good manufacturing practices conditions: identification of the most advantageous and safest expansion method in terms of viability, cellular growth and identity. J Transl Med 2018; 16:237. [PMID: 30157948 PMCID: PMC6116438 DOI: 10.1186/s12967-018-1613-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 08/21/2018] [Indexed: 12/14/2022] Open
Abstract
Background Cytokine-induced killer (CIK) cells are a very promising cell population raising growing interest in the field of cellular antitumor therapy. The aim of our study was to validate the most advantageous expansion method for this advanced therapy medicinal product (ATMP) and to translate it from preclinical field to good manufacturing practices (GMP). GMP ensures that ATMP are consistently produced and controlled to the quality standards required to their intended use. For this reason, the use of the xenogenic sera tended to be minimized by GMP for their high variability and the associated risk of transmitting infectious agents. Results We decided to replace Fetal Bovine Serum (FBS), largely used as medium supplement for CIKs expansion, with other culture media. Firstly, Human Serum (HS) and Human Pool Plasma (HPP) were tested as medium supplements giving not compliant results to acceptance criteria, established for CIKs, probably for the great batch to batch variability. Consequently, we decided to test three different serum free expansion media: X-VIVO 15, (largely used by other groups) and Tex Macs and Cell Genix GMP SCGM: two GMP manufactured media. We performed a validation consisting in three run-sand even if the small number of experiments didn’t permit us to obtained statistical results we demonstrated that both X-VIVO 15 and Tex Macs fulfilled the quality standards in terms of cellular growth, viability and identity while Cell Genix GMP SCGM resulted not compliant as it caused some technical problems such as high mortality. Conclusion In conclusion, these preclinical validation data lay the bases for a GMP-compliant process to improve the CIKs expansion method.
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Affiliation(s)
- Sara Castiglia
- City of Health and Science Hospital of Turin, Pediatric Oncoematology, Regina Margherita Children's Hospital, Piazza Polonia 94, 10126, Turin, Italy.
| | - Aloe Adamini
- City of Health and Science Hospital of Turin, Pediatric Oncoematology, Regina Margherita Children's Hospital, Piazza Polonia 94, 10126, Turin, Italy
| | - Deborah Rustichelli
- City of Health and Science Hospital of Turin, Pediatric Oncoematology, Regina Margherita Children's Hospital, Piazza Polonia 94, 10126, Turin, Italy
| | - Laura Castello
- City of Health and Science Hospital of Turin, Pediatric Oncoematology, Regina Margherita Children's Hospital, Piazza Polonia 94, 10126, Turin, Italy
| | - Katia Mareschi
- City of Health and Science Hospital of Turin, Pediatric Oncoematology, Regina Margherita Children's Hospital, Piazza Polonia 94, 10126, Turin, Italy.,Department of Public Health and Pediatrics, University of Turin, 10126, Turin, Italy
| | - Giuseppe Pinnetta
- City of Health and Science Hospital of Turin, Pediatric Oncoematology, Regina Margherita Children's Hospital, Piazza Polonia 94, 10126, Turin, Italy
| | - Marco Leone
- City of Health and Science Hospital of Turin, Pediatric Oncoematology, Regina Margherita Children's Hospital, Piazza Polonia 94, 10126, Turin, Italy
| | - Alessandra Mandese
- City of Health and Science Hospital of Turin, Pediatric Oncoematology, Regina Margherita Children's Hospital, Piazza Polonia 94, 10126, Turin, Italy
| | - Ivana Ferrero
- City of Health and Science Hospital of Turin, Pediatric Oncoematology, Regina Margherita Children's Hospital, Piazza Polonia 94, 10126, Turin, Italy.,Department of Public Health and Pediatrics, University of Turin, 10126, Turin, Italy
| | | | - Franca Fagioli
- City of Health and Science Hospital of Turin, Pediatric Oncoematology, Regina Margherita Children's Hospital, Piazza Polonia 94, 10126, Turin, Italy.,Department of Public Health and Pediatrics, University of Turin, 10126, Turin, Italy
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30
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Ravanat C, Dupuis A, Marpaux N, Naegelen C, Mourey G, Isola H, Laforêt M, Morel P, Gachet C. In vitro
quality of amotosalen‐
UVA
pathogen‐inactivated mini‐pool plasma prepared from whole blood stored overnight. Vox Sang 2018; 113:622-631. [DOI: 10.1111/vox.12697] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Revised: 06/26/2018] [Accepted: 06/28/2018] [Indexed: 12/22/2022]
Affiliation(s)
- Catherine Ravanat
- Université de Strasbourg INSERM EFS Grand‐Est BPPS UMR‐S1255 FMTS Strasbourg France
| | - Arnaud Dupuis
- Université de Strasbourg INSERM EFS Grand‐Est BPPS UMR‐S1255 FMTS Strasbourg France
| | | | | | - Guillaume Mourey
- EFS Bourgogne‐Franche‐Comté UMR1098 Besançon France
- Université Bourgogne Franche Comté INSERM EFS Bourgogne‐Franche‐Comté UMR1098 Besançon France
| | - Herve Isola
- Université de Strasbourg INSERM EFS Grand‐Est BPPS UMR‐S1255 FMTS Strasbourg France
| | - Michel Laforêt
- Université de Strasbourg INSERM EFS Grand‐Est BPPS UMR‐S1255 FMTS Strasbourg France
| | - Pascal Morel
- EFS Bourgogne‐Franche‐Comté UMR1098 Besançon France
- Université Bourgogne Franche Comté INSERM EFS Bourgogne‐Franche‐Comté UMR1098 Besançon France
| | - Christian Gachet
- Université de Strasbourg INSERM EFS Grand‐Est BPPS UMR‐S1255 FMTS Strasbourg France
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31
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Hemostatic efficacy of pathogen-inactivated vs untreated platelets: a randomized controlled trial. Blood 2018; 132:223-231. [DOI: 10.1182/blood-2018-02-831289] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Accepted: 04/25/2018] [Indexed: 11/20/2022] Open
Abstract
Key Points
Pathogen-inactivated platelets were noninferior in preventing bleeding only in intention-to-treat analysis. In contrast to animal models, alloimmunization could not be prevented when using pathogen-inactivated platelets.
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32
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Pathogen-Inaktivierungssysteme für Thrombozytenkonzentrate. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2018; 61:874-893. [PMID: 29931520 PMCID: PMC7079973 DOI: 10.1007/s00103-018-2766-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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33
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Feys HB, Van Aelst B, Compernolle V. Biomolecular Consequences of Platelet Pathogen Inactivation Methods. Transfus Med Rev 2018; 33:29-34. [PMID: 30021699 DOI: 10.1016/j.tmrv.2018.06.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 06/12/2018] [Accepted: 06/12/2018] [Indexed: 12/21/2022]
Abstract
Pathogen inactivation (PI) for platelet concentrates (PC) is a fairly recent development in transfusion medicine that is intended to decrease infectious disease transmission from the donor to the receiving patient. Effective inactivation of viruses, bacteria and eukaryotic parasites adds a layer of safety, protecting the blood supply against customary and emerging pathogens. Three PI methods have been described for platelets. These are based on photochemical damage of nucleic acids which prevents replication of most infectious pathogens and contaminating donor leukocytes. Because platelets do not replicate, the collateral damage to platelet function is considered low to non-existing. This is disputable however because photochemistry is not specific for nucleic acids and significantly affects platelet biomolecules as well. The impact of these biomolecular changes on platelet function and hemostasis is not well understood, but is increasingly being studied. The results of these studies can help explain current and future clinical observations with PI platelets, including the impact on transfusion yield and bleeding. This review summarizes the biomolecular effects of PI treatment on platelets. We conclude that despite a comparable principle of photochemical inactivation, all three methods affect platelets in different ways. This knowledge can help blood banks and transfusion specialists to guide their choice when considering the implementation or clinical use of PI treated platelets.
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Affiliation(s)
- Hendrik B Feys
- Transfusion Research Center, Belgian Red Cross-Flanders, Ghent, Belgium; Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.
| | - Britt Van Aelst
- Transfusion Research Center, Belgian Red Cross-Flanders, Ghent, Belgium; Blood Service of the Belgian Red Cross-Flanders, Mechelen, Belgium
| | - Veerle Compernolle
- Transfusion Research Center, Belgian Red Cross-Flanders, Ghent, Belgium; Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium; Blood Service of the Belgian Red Cross-Flanders, Mechelen, Belgium
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34
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Bello-López JM, Delgado-Balbuena L, Rojas-Huidobro D, Rojo-Medina J. Treatment of platelet concentrates and plasma with riboflavin and UV light: Impact in bacterial reduction. Transfus Clin Biol 2018; 25:197-203. [PMID: 29656962 DOI: 10.1016/j.tracli.2018.03.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Accepted: 03/16/2018] [Indexed: 02/06/2023]
Abstract
OBJECTIVES Transfusion of hemocomponents is essential for clinical and surgical procedures and therefore their safety has increased. An option for pathogen reduction includes the combination of riboflavin and UV light. To our knowledge, there are no studies in Latin America that demonstrate the effectiveness of the pathogen reduction in hemocomponents. The objective of this work was to evaluate the efficiency of a pathogens reduction system in platelets concentrates (PC) and plasma. MATERIALS AND METHODS PC and plasma were contaminated with Escherichia coli, Klebsiella pneumoniae, Streptococcus pyogenes and Staphylococcus epidermidis at 104 to 106 CFU and subjected to bacterial reduction. After bacterial reduction, hemocomponents were subjected to cultivation of surviving bacteria by automated method and classical colonies quantification. Additionally, quality control testing was performed in order to confirm the integrity of platelets and coagulation laboratory values in plasma before and after bacterial reduction. RESULTS The bacterial death in PC/plasma was expressed by Logarithmic Reduction Value as follows: for both strains (E. coli and S. pyogenes) 4/4, 5/5 and 6/6; for K. pneumoniae 2.54/2.23, 2.94/2.22 and 3.44/2.98, for S. epidermidis 4/4, 3.11/5 and 3.23/4.19, for 104, 105 and 106 CFU, respectively. In PC and plasma, platelet count, pH (at 22°C), activated partial thromboplastin time (aPTT), prothrombin time (PT), fibrinogen, factor VIII and total proteins (TP) were slightly modified. CONCLUSIONS UV light with riboflavin is able to reduce an important number of pathogens in hemocomponents; however, the bacterial reduction is influenced by the nature and quantity of the pathogen.
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Affiliation(s)
- J M Bello-López
- Centro Nacional de la Transfusión Sanguínea, Av. Othón de Mendizábal 195, Zacatenco, Gustavo A. Madero, 07360 México City, Mexico; Hospital Juárez de México, Av. Instituto Politécnico Nacional 5160, Zacatenco, Gustavo A. Madero, 07360 México City, Mexico.
| | - L Delgado-Balbuena
- Centro Nacional de la Transfusión Sanguínea, Av. Othón de Mendizábal 195, Zacatenco, Gustavo A. Madero, 07360 México City, Mexico
| | - D Rojas-Huidobro
- Centro Nacional de la Transfusión Sanguínea, Av. Othón de Mendizábal 195, Zacatenco, Gustavo A. Madero, 07360 México City, Mexico
| | - J Rojo-Medina
- Centro Nacional de la Transfusión Sanguínea, Av. Othón de Mendizábal 195, Zacatenco, Gustavo A. Madero, 07360 México City, Mexico
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35
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Jacquot C, Delaney M. Efforts Toward Elimination of Infectious Agents in Blood Products. J Intensive Care Med 2018; 33:543-550. [PMID: 29562814 DOI: 10.1177/0885066618756589] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The US blood supply has never been safer. This level of safety depends on a multifaceted approach including blood donor screening, sensitive infectious disease testing, and good manufacturing practice. However, risks remain for transfusion-transmitted infections due to bacterial contamination of platelets and emerging diseases. Thus, ongoing improvements in screening and testing are required. Newer pathogen reduction technologies have shown promise in further ameliorating the safety of the blood supply.
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Affiliation(s)
- Cyril Jacquot
- 1 Division of Laboratory Medicine, Center for Cancer and Blood Disorders, Children's National Health System, Sheikh Zayed Campus for Advanced Children's Medicine, Washington, DC, USA.,2 Division of Hematology, Center for Cancer and Blood Disorders, Children's National Health System, Sheikh Zayed Campus for Advanced Children's Medicine, Washington, DC, USA.,3 Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, DC, USA.,4 Department of Pathology, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Meghan Delaney
- 1 Division of Laboratory Medicine, Center for Cancer and Blood Disorders, Children's National Health System, Sheikh Zayed Campus for Advanced Children's Medicine, Washington, DC, USA.,2 Division of Hematology, Center for Cancer and Blood Disorders, Children's National Health System, Sheikh Zayed Campus for Advanced Children's Medicine, Washington, DC, USA.,3 Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, DC, USA.,4 Department of Pathology, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
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36
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Waters L, Cameron M, Padula MP, Marks DC, Johnson L. Refrigeration, cryopreservation and pathogen inactivation: an updated perspective on platelet storage conditions. Vox Sang 2018; 113:317-328. [PMID: 29441601 DOI: 10.1111/vox.12640] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Revised: 11/28/2017] [Accepted: 01/15/2018] [Indexed: 01/08/2023]
Abstract
Conventional storage of platelet concentrates limits their shelf life to between 5 and 7 days due to the risk of bacterial proliferation and the development of the platelet storage lesion. Cold storage and cryopreservation of platelets may facilitate extension of the shelf life to weeks and years, and may also provide the benefit of being more haemostatically effective than conventionally stored platelets. Further, treatment of platelet concentrates with pathogen inactivation systems reduces bacterial contamination and provides a safeguard against the risk of emerging and re-emerging pathogens. While each of these alternative storage techniques is gaining traction individually, little work has been done to examine the effect of combining treatments in an effort to further improve product safety and minimize wastage. This review aims to discuss the benefits of alternative storage techniques and how they may be combined to alleviate the problems associated with conventional platelet storage.
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Affiliation(s)
- L Waters
- Research & Development, Australian Red Cross Blood Service, Alexandria, NSW, Australia.,School of Life Sciences, University of Technology Sydney, Sydney, NSW, Australia
| | - M Cameron
- Research & Development, Australian Red Cross Blood Service, Alexandria, NSW, Australia.,School of Life Sciences, University of Technology Sydney, Sydney, NSW, Australia
| | - M P Padula
- School of Life Sciences, University of Technology Sydney, Sydney, NSW, Australia
| | - D C Marks
- Research & Development, Australian Red Cross Blood Service, Alexandria, NSW, Australia
| | - L Johnson
- Research & Development, Australian Red Cross Blood Service, Alexandria, NSW, Australia
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37
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Ware AD, Jacquot C, Tobian AAR, Gehrie EA, Ness PM, Bloch EM. Pathogen reduction and blood transfusion safety in Africa: strengths, limitations and challenges of implementation in low-resource settings. Vox Sang 2017; 113:3-12. [PMID: 29193128 DOI: 10.1111/vox.12620] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Revised: 10/27/2017] [Accepted: 11/06/2017] [Indexed: 12/31/2022]
Abstract
Transfusion-transmitted infection risk remains an enduring challenge to blood safety in Africa. A high background incidence and prevalence of the major transfusion-transmitted infections (TTIs), dependence on high-risk donors to meet demand, suboptimal testing and quality assurance collectively contribute to the increased risk. With few exceptions, donor testing is confined to serological evaluation of human immunodeficiency virus (HIV), hepatitis B and C (HBV and HCV) and syphilis. Barriers to implementation of broader molecular methods include cost, limited infrastructure and lack of technical expertise. Pathogen reduction (PR), a term used to describe a variety of methods (e.g. solvent detergent treatment or photochemical activation) that may be applied to blood following collection, offers the means to diminish the infectious potential of multiple pathogens simultaneously. This is effective against different classes of pathogen, including the major TTIs where laboratory screening is already implemented (e.g. HIV, HBV and HCV) as well pathogens that are widely endemic yet remain unaddressed (e.g. malaria, bacterial contamination). We sought to review the available and emerging PR techniques and their potential application to resource-constrained parts of Africa, focusing on the advantages and disadvantages of such technologies. PR has been slow to be adopted even in high-income countries, primarily given the high costs of use. Logistical considerations, particularly in low-resourced parts of Africa, also raise concerns about practicality. Nonetheless, PR offers a rational, innovative strategy to contend with TTIs; technologies in development may well present a viable complement or even alternative to targeted screening in the future.
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Affiliation(s)
- A D Ware
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - C Jacquot
- Children's National Health System and George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - A A R Tobian
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - E A Gehrie
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - P M Ness
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - E M Bloch
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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38
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Pathogen reduction through additive-free short-wave UV light irradiation retains the optimal efficacy of human platelet lysate for the expansion of human bone marrow mesenchymal stem cells. PLoS One 2017; 12:e0181406. [PMID: 28763452 PMCID: PMC5538655 DOI: 10.1371/journal.pone.0181406] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Accepted: 06/30/2017] [Indexed: 12/17/2022] Open
Abstract
Background We recently developed and characterized a standardized and clinical grade human Platelet Lysate (hPL) that constitutes an advantageous substitute for fetal bovine serum (FBS) for human mesenchymal stem cell (hMSC) expansion required in cell therapy procedures, avoiding xenogenic risks (virological and immunological) and ethical issues. Because of the progressive use of pathogen-reduced (PR) labile blood components, and the requirement of ensuring the viral safety of raw materials for cell therapy products, we evaluated the impact of the novel procedure known as THERAFLEX UV-Platelets for pathogen reduction on hPL quality (growth factors content) and efficacy (as a medium supplement for hMSC expansion). This technology is based on short-wave ultraviolet light (UV-C) that induces non-reversible damages in DNA and RNA of pathogens while preserving protein structures and functions, and has the main advantage of not needing the addition of any photosensitizing additives (that might secondarily interfere with hMSCs). Methodology / Principal findings We applied the THERAFLEX UV-Platelets procedure on fresh platelet concentrates (PCs) suspended in platelet additive solution and prepared hPL from these treated PCs. We compared the quality and efficacy of PR-hPL with the corresponding non-PR ones. We found no impact on the content of five cytokines tested (EGF, bFGF, PDGF-AB, VEGF and IGF-1) but a significant decrease in TGF-ß1 (-21%, n = 11, p<0.01). We performed large-scale culture of hMSCs from bone marrow (BM) during three passages and showed that hPL or PR-hPL at 8% triggered comparable BM-hMSC proliferation as FBS at 10% plus bFGF. Moreover, after proliferation of hMSCs in an hPL- or PR-hPL-containing medium, their profile of membrane marker expression, their clonogenic potential and immunosuppressive properties were maintained, in comparison with BM-hMSCs cultured under FBS conditions. The potential to differentiate towards the adipogenic and osteogenic lineages of hMSCs cultured in parallel in the three conditions also remained identical. Conclusion / Significance We demonstrated the feasibility of using UV-C-treated platelets to subsequently obtain pathogen-reduced hPL, while preserving its optimal quality and efficacy for hMSC expansion in cell therapy applications.
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39
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Estcourt LJ, Malouf R, Hopewell S, Trivella M, Doree C, Stanworth SJ, Murphy MF. Pathogen-reduced platelets for the prevention of bleeding. Cochrane Database Syst Rev 2017; 7:CD009072. [PMID: 28756627 PMCID: PMC5558872 DOI: 10.1002/14651858.cd009072.pub3] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Platelet transfusions are used to prevent and treat bleeding in people who are thrombocytopenic. Despite improvements in donor screening and laboratory testing, a small risk of viral, bacterial, or protozoal contamination of platelets remains. There is also an ongoing risk from newly emerging blood transfusion-transmitted infections for which laboratory tests may not be available at the time of initial outbreak.One solution to reduce the risk of blood transfusion-transmitted infections from platelet transfusion is photochemical pathogen reduction, in which pathogens are either inactivated or significantly depleted in number, thereby reducing the chance of transmission. This process might offer additional benefits, including platelet shelf-life extension, and negate the requirement for gamma-irradiation of platelets. Although current pathogen-reduction technologies have been proven to reduce pathogen load in platelet concentrates, a number of published clinical studies have raised concerns about the effectiveness of pathogen-reduced platelets for post-transfusion platelet count recovery and the prevention of bleeding when compared with standard platelets.This is an update of a Cochrane review first published in 2013. OBJECTIVES To assess the effectiveness of pathogen-reduced platelets for the prevention of bleeding in people of any age requiring platelet transfusions. SEARCH METHODS We searched for randomised controlled trials (RCTs) in the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library 2016, Issue 9), MEDLINE (from 1946), Embase (from 1974), CINAHL (from 1937), the Transfusion Evidence Library (from 1950), and ongoing trial databases to 24 October 2016. SELECTION CRITERIA We included RCTs comparing the transfusion of pathogen-reduced platelets with standard platelets, or comparing different types of pathogen-reduced platelets. DATA COLLECTION AND ANALYSIS We used the standard methodological procedures expected by Cochrane. MAIN RESULTS We identified five new trials in this update of the review. A total of 15 trials were eligible for inclusion in this review, 12 completed trials (2075 participants) and three ongoing trials. Ten of the 12 completed trials were included in the original review. We did not identify any RCTs comparing the transfusion of one type of pathogen-reduced platelets with another.Nine trials compared Intercept® pathogen-reduced platelets to standard platelets, two trials compared Mirasol® pathogen-reduced platelets to standard platelets; and one trial compared both pathogen-reduced platelets types to standard platelets. Three RCTs were randomised cross-over trials, and nine were parallel-group trials. Of the 2075 participants enrolled in the trials, 1981 participants received at least one platelet transfusion (1662 participants in Intercept® platelet trials and 319 in Mirasol® platelet trials).One trial included children requiring cardiac surgery (16 participants) or adults requiring a liver transplant (28 participants). All of the other participants were thrombocytopenic individuals who had a haematological or oncological diagnosis. Eight trials included only adults.Four of the included studies were at low risk of bias in every domain, while the remaining eight included studies had some threats to validity.Overall, the quality of the evidence was low to high across different outcomes according to GRADE methodology.We are very uncertain as to whether pathogen-reduced platelets increase the risk of any bleeding (World Health Organization (WHO) Grade 1 to 4) (5 trials, 1085 participants; fixed-effect risk ratio (RR) 1.09, 95% confidence interval (CI) 1.02 to 1.15; I2 = 59%, random-effect RR 1.14, 95% CI 0.93 to 1.38; I2 = 59%; low-quality evidence).There was no evidence of a difference between pathogen-reduced platelets and standard platelets in the incidence of clinically significant bleeding complications (WHO Grade 2 or higher) (5 trials, 1392 participants; RR 1.10, 95% CI 0.97 to 1.25; I2 = 0%; moderate-quality evidence), and there is probably no difference in the risk of developing severe bleeding (WHO Grade 3 or higher) (6 trials, 1495 participants; RR 1.24, 95% CI 0.76 to 2.02; I2 = 32%; moderate-quality evidence).There is probably no difference between pathogen-reduced platelets and standard platelets in the incidence of all-cause mortality at 4 to 12 weeks (6 trials, 1509 participants; RR 0.81, 95% CI 0.50 to 1.29; I2 = 26%; moderate-quality evidence).There is probably no difference between pathogen-reduced platelets and standard platelets in the incidence of serious adverse events (7 trials, 1340 participants; RR 1.09, 95% CI 0.88 to 1.35; I2 = 0%; moderate-quality evidence). However, no bacterial transfusion-transmitted infections occurred in the six trials that reported this outcome.Participants who received pathogen-reduced platelet transfusions had an increased risk of developing platelet refractoriness (7 trials, 1525 participants; RR 2.94, 95% CI 2.08 to 4.16; I2 = 0%; high-quality evidence), though the definition of platelet refractoriness differed between trials.Participants who received pathogen-reduced platelet transfusions required more platelet transfusions (6 trials, 1509 participants; mean difference (MD) 1.23, 95% CI 0.86 to 1.61; I2 = 27%; high-quality evidence), and there was probably a shorter time interval between transfusions (6 trials, 1489 participants; MD -0.42, 95% CI -0.53 to -0.32; I2 = 29%; moderate-quality evidence). Participants who received pathogen-reduced platelet transfusions had a lower 24-hour corrected-count increment (7 trials, 1681 participants; MD -3.02, 95% CI -3.57 to -2.48; I2 = 15%; high-quality evidence).None of the studies reported quality of life.We did not evaluate any economic outcomes.There was evidence of subgroup differences in multiple transfusion trials between the two pathogen-reduced platelet technologies assessed in this review (Intercept® and Mirasol®) for all-cause mortality and the interval between platelet transfusions (favouring Intercept®). AUTHORS' CONCLUSIONS Findings from this review were based on 12 trials, and of the 1981 participants who received a platelet transfusion only 44 did not have a haematological or oncological diagnosis.In people with haematological or oncological disorders who are thrombocytopenic due to their disease or its treatment, we found high-quality evidence that pathogen-reduced platelet transfusions increase the risk of platelet refractoriness and the platelet transfusion requirement. We found moderate-quality evidence that pathogen-reduced platelet transfusions do not affect all-cause mortality, the risk of clinically significant or severe bleeding, or the risk of a serious adverse event. There was insufficient evidence for people with other diagnoses.All three ongoing trials are in adults (planned recruitment 1375 participants) with a haematological or oncological diagnosis.
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Affiliation(s)
- Lise J Estcourt
- NHS Blood and TransplantHaematology/Transfusion MedicineLevel 2, John Radcliffe HospitalHeadingtonOxfordUKOX3 9BQ
| | - Reem Malouf
- University of OxfordNational Perinatal Epidemiology Unit (NPEU)Old Road CampusOxfordUKOX3 7LF
| | - Sally Hopewell
- University of OxfordOxford Clinical Trials Research UnitNuffield Department of Orthopaedics, Rheumatology and Musculoskeletal SciencesWindmill RoadOxfordUKOX3 7LD
| | - Marialena Trivella
- University of OxfordCentre for Statistics in MedicineBotnar Research CentreWindmill RoadOxfordUKOX3 7LD
| | - Carolyn Doree
- NHS Blood and TransplantSystematic Review InitiativeJohn Radcliffe HospitalOxfordUKOX3 9BQ
| | - Simon J Stanworth
- Oxford University Hospitals NHS Foundation Trust and University of OxfordNational Institute for Health Research (NIHR) Oxford Biomedical Research CentreJohn Radcliffe Hospital, Headley WayHeadingtonOxfordUKOX3 9BQ
| | - Michael F Murphy
- Oxford University Hospitals NHS Foundation Trust and University of OxfordNHS Blood and Transplant; National Institute for Health Research (NIHR) Oxford Biomedical Research CentreJohn Radcliffe HospitalHeadingtonOxfordUK
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40
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Leukofiltration plus pathogen reduction prevents alloimmune platelet refractoriness in a dog transfusion model. Blood 2017; 130:1052-1061. [PMID: 28705838 DOI: 10.1182/blood-2016-07-726901] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Accepted: 06/28/2017] [Indexed: 11/20/2022] Open
Abstract
Human lymphocyte antigen alloimmunization to filter leukoreduced (F-LR) platelets occurs in about 18% of immunosuppressed thrombocytopenic hematology/oncology patients and represents a significant challenge for effective chemotherapy. In a dog platelet transfusion model, we have evaluated other methods of preventing alloimmune platelet refractoriness and demonstrated that successful methods in our dog model are transferable to man. In the present study, donor/recipient pairs were dog lymphocyte antigen DR-B incompatible (88% of the pairs), and recipient dogs received up to 8 weekly treated transfusions from a single donor (a highly immunogenic stimulus), or until platelet refractoriness. Continued acceptance of F-LR platelets occurred in 6 of 13 recipients (46%), but neither γ-irradiation (γ-I; 0 of 5) nor Mirasol pathogen reduction (MPR; 1 of 7) treatment of donor platelets prevented alloimmune platelet refractoriness. Combining γ-I with F-LR was associated with only 2 of 10 (20%) recipients accepting the transfused platelets. Surprisingly, F-LR platelets that then underwent MPR were accepted by 21 of 22 (95%) recipients (P < .001 vs F-LR + γ-I recipients). Furthermore, 7 of 21 (33%) of these accepting recipients demonstrated specific tolerance to 8 more weekly donor transfusions that had not been treated. In addition, platelet concentrates prepared from F-LR + MPR whole blood were also nonimmunogenic; that is, 10 of 10 (100%) recipients accepted donor platelets. Overall, 31 of 32 (97%) recipients accepted F-LR + MPR platelets; none developed antibodies to donor lymphocytes. These data are the highest rate of acceptance for platelet transfusions reported in either animals or man. This approach to platelet transfusion may be particularly important when supporting patients with intact immune systems, such as in myelodysplastic syndromes.
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Narsing Rao MP, Xiao M, Li WJ. Fungal and Bacterial Pigments: Secondary Metabolites with Wide Applications. Front Microbiol 2017; 8:1113. [PMID: 28690593 PMCID: PMC5479939 DOI: 10.3389/fmicb.2017.01113] [Citation(s) in RCA: 173] [Impact Index Per Article: 24.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Accepted: 05/31/2017] [Indexed: 12/21/2022] Open
Abstract
The demand for natural colors is increasing day by day due to harmful effects of some synthetic dyes. Bacterial and fungal pigments provide a readily available alternative source of naturally derived pigments. In contrast to other natural pigments, they have enormous advantages including rapid growth, easy processing, and independence of weather conditions. Apart from colorant, bacterial and fungal pigments possess many biological properties such as antioxidant, antimicrobial and anticancer activity. This review outlines different types of pigments. It lists some bacterial and fungal pigments and current bacterial and fungal pigment status and challenges. It also focuses on possible fungal and bacterial pigment applications.
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Affiliation(s)
- Manik Prabhu Narsing Rao
- State Key Laboratory of Biocontrol and Guangdong Provincial Key Laboratory of Plant Resources, School of Life Sciences, Sun Yat-sen UniversityGuangzhou, China
| | - Min Xiao
- State Key Laboratory of Biocontrol and Guangdong Provincial Key Laboratory of Plant Resources, School of Life Sciences, Sun Yat-sen UniversityGuangzhou, China
| | - Wen-Jun Li
- State Key Laboratory of Biocontrol and Guangdong Provincial Key Laboratory of Plant Resources, School of Life Sciences, Sun Yat-sen UniversityGuangzhou, China.,Key Laboratory of Biogeography and Bioresource in Arid Land, Xinjiang Institute of Ecology and Geography, Chinese Academy of SciencesÛrúmqi, China
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Mirasol pathogen reduction technology treatment of human whole blood does not induce acute lung injury in mice. PLoS One 2017; 12:e0178725. [PMID: 28570672 PMCID: PMC5453573 DOI: 10.1371/journal.pone.0178725] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Accepted: 05/17/2017] [Indexed: 12/02/2022] Open
Abstract
In resource-limited settings and in the military theater, fresh human whole blood is commonly transfused, but infectious risks are a concern. Sophisticated molecular testing for potential infectious agents in the whole blood is often unavailable. To address this unmet need, pathogen reduction technology (PRT) has been developed, and it is an effective approach to inactivate a broad range of pathogens found in human blood. However, studies are needed to determine if it is harmful to blood cells and whether these cells could damage the transfused recipient, including the development of acute lung injury/acute respiratory distress syndrome. In this study, we used a commercial PRT system to treat human whole blood that was then transfused into immunodeficient mice, and the development of acute lung injury was determined. In a model of transfusion-related acute lung injury (TRALI), BALB/c SCID mice developed more robust lung injury when challenged with a MHC Class I monoclonal antibody compared to BALB/c wild-type and NOD/SCID mice. Transfusion of control versus Mirasol PRT-treated whole blood (25% blood volume exchange) into BALB/c SCID mice did not produce lung injury at storage day 1. However, mild lung injury at storage days 14 and 21 was observed without significant differences in lung injury measurements between Mirasol PRT-treated and control groups. The mild storage-dependent acute lung injury correlated with trends for increased levels of cell-free hemoglobin that accumulated in both the control and Mirasol PRT-treated groups. Neutrophil extracellular traps were elevated in the plasma of BALB/c SCID mice in the monoclonal antibody TRALI model, but were not different in mice that received exchange transfusions. In conclusion, exchange transfusion of human whole blood into immunodeficient mice produces mild lung injury that is storage-dependent and not related to pathogen reduction treatment.
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Taha M, Culibrk B, Kalab M, Schubert P, Yi QL, Goodrich R, Ramirez-Arcos S. Efficiency of riboflavin and ultraviolet light treatment against high levels of biofilm-derived Staphylococcus epidermidis in buffy coat platelet concentrates. Vox Sang 2017; 112:408-416. [PMID: 28378343 DOI: 10.1111/vox.12519] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Revised: 03/03/2017] [Accepted: 03/05/2017] [Indexed: 12/22/2022]
Abstract
BACKGROUND AND OBJECTIVES Staphylococcus epidermidis forms surface-attached aggregates (biofilms) in platelet concentrates (PCs), which are linked to missed detection during PC screening. This study was aimed at evaluating the efficacy of riboflavin-UV treatment to inactivate S. epidermidis biofilms in buffy coat (BC) PCs. MATERIALS AND METHODS Biofilm and non-biofilm cells from S. epidermidis ST-10002 and S. epidermidis AZ-66 were individually inoculated into whole blood (WB) units (~106 colony-forming units (CFU)/ml) (N = 4-5). One spiked and three unspiked WB units were processed to produce a BC-PC pool. Riboflavin was added to the pool which was then split into two bags: one for UV treatment and the second was untreated. Bacterial counts were determined before and after treatment. In vitro PC quality was assessed by flow cytometry and dynamic light scattering. RESULTS Bacterial counts were reduced during BC-PC production from ~106 CFU/ml in WB to 103 -104 CFU/ml in PCs (P < 0·0001). Riboflavin-UV treatment resulted in significantly higher reduction of S. epidermidis AZ-66 than strain ST-10002 (≥3·5 log reduction and 2·6-2·8 log reduction, respectively, P < 0·0001). Remaining bacteria post-treatment were able to proliferate in PCs. No differences in S. epidermidis inactivation were observed in PCs produced from WB inoculated with biofilm or non-biofilm cells (P > 0·05). Platelet activation was enhanced in PCs produced with WB inoculated with biofilms compared to non-biofilm cells (P < 0·05). CONCLUSION Riboflavin-UV treatment was similarly efficacious in PCs produced from WB inoculated with S. epidermidis biofilm or non-biofilm cells. Levels of biofilm-derived S. epidermidis ≥103 CFU/ml were not completely inactivated; however, further testing is necessary with lower (real-life) bacterial levels.
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Affiliation(s)
- M Taha
- Canadian Blood Services, Ottawa, ON, Canada
| | - B Culibrk
- Canadian Blood Services, Ottawa, ON, Canada
| | - M Kalab
- Agriculture and Agri-Food Canada, Ottawa, ON, Canada
| | - P Schubert
- Canadian Blood Services, Ottawa, ON, Canada
| | - Q-L Yi
- Canadian Blood Services, Ottawa, ON, Canada
| | - R Goodrich
- Infectious Disease Research Center, Colorado State University, Fort Collins, CO, USA
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Chen Z, Schubert P, Bakkour S, Culibrk B, Busch MP, Devine DV. p38 mitogen-activated protein kinase regulates mitochondrial function and microvesicle release in riboflavin- and ultraviolet light-treated apheresis platelet concentrates. Transfusion 2017; 57:1199-1207. [DOI: 10.1111/trf.14035] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Revised: 12/03/2016] [Accepted: 12/31/2016] [Indexed: 12/11/2022]
Affiliation(s)
- Zhongming Chen
- Centre for Innovation; Canadian Blood Services; Vancouver British Columbia Canada
- Centre for Blood Research; University of British Columbia; Vancouver British Columbia Canada
| | - Peter Schubert
- Centre for Innovation; Canadian Blood Services; Vancouver British Columbia Canada
- Centre for Blood Research; University of British Columbia; Vancouver British Columbia Canada
- Department of Pathology and Laboratory Medicine; University of British Columbia; Vancouver British Columbia Canada
| | - Sonia Bakkour
- Blood Systems Research Institute; University of California; San Francisco California
| | - Brankica Culibrk
- Centre for Innovation; Canadian Blood Services; Vancouver British Columbia Canada
- Centre for Blood Research; University of British Columbia; Vancouver British Columbia Canada
| | - Michael P. Busch
- Blood Systems Research Institute; University of California; San Francisco California
- Department of Laboratory Medicine; University of California; San Francisco California
| | - Dana V. Devine
- Centre for Innovation; Canadian Blood Services; Vancouver British Columbia Canada
- Centre for Blood Research; University of British Columbia; Vancouver British Columbia Canada
- Department of Pathology and Laboratory Medicine; University of British Columbia; Vancouver British Columbia Canada
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45
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Preparation, Storage, and Characteristics of Blood Components and Plasma Derivatives. Transfus Med 2016. [DOI: 10.1002/9781119236504.ch5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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A New Proof of Concept in Bacterial Reduction: Antimicrobial Action of Violet-Blue Light (405 nm) in Ex Vivo Stored Plasma. JOURNAL OF BLOOD TRANSFUSION 2016; 2016:2920514. [PMID: 27774337 PMCID: PMC5059568 DOI: 10.1155/2016/2920514] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Accepted: 08/28/2016] [Indexed: 11/17/2022]
Abstract
Bacterial contamination of injectable stored biological fluids such as blood plasma and platelet concentrates preserved in plasma at room temperature is a major health risk. Current pathogen reduction technologies (PRT) rely on the use of chemicals and/or ultraviolet light, which affects product quality and can be associated with adverse events in recipients. 405 nm violet-blue light is antibacterial without the use of photosensitizers and can be applied at levels safe for human exposure, making it of potential interest for decontamination of biological fluids such as plasma. As a pilot study to test whether 405 nm light is capable of inactivating bacteria in biological fluids, rabbit plasma and human plasma were seeded with bacteria and treated with a 405 nm light emitting diode (LED) exposure system (patent pending). Inactivation was achieved in all tested samples, ranging from low volumes to prebagged plasma. 99.9% reduction of low density bacterial populations (≤103 CFU mL−1), selected to represent typical “natural” contamination levels, was achieved using doses of 144 Jcm−2. The penetrability of 405 nm light, permitting decontamination of prebagged plasma, and the nonrequirement for photosensitizing agents provide a new proof of concept in bacterial reduction in biological fluids, especially injectable fluids relevant to transfusion medicine.
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Chatterjee K, Zaman S, Chaurasia R, Singh S, Keil SD, Tewari S, Bisht A, Agarwal N, Rout D, Chand S, Saha K. Evaluation of Mirasol pathogen reduction system by artificially contaminating platelet concentrates with Staphylococcus epidermidis: A pilot study from India. Asian J Transfus Sci 2016; 10:127-31. [PMID: 27605849 PMCID: PMC4993081 DOI: 10.4103/0973-6247.187946] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND AND OBJECTIVES This study was conducted to assess the efficacy of Mirasol pathogen reduction system for platelets aimed at preventing bacterial regrowth by spiking buffy coat pooled platelets (BCPP) with clinically relevant load of Staphylococous epidermidis. MATERIALS AND METHODS BCPP units were prepared using Teruflex BP-kit with Imugard III-S-PL (Terumo BCT, Tokyo, Japan). Two BCPP units were pooled, of which 40 ml of negative control (NC) was removed. The remaining volume of the platelet unit was inoculated with clinically relevant load of bacteria (total of 30 CFU of S. epidermidis in 1 ml); following this the platelet unit was split into two parts. One part served as positive control (PC) and the other part was subjected to pathogen reduction technique (Mirasol PRT, CaridianBCT Biotechnologies, Lakewood, CO, USA). Bacterial detection was performed using BacT/ALERT system, controls after day 1 and day 7 following inoculation of bacteria and on day 7 for Mirasol-treated unit. RESULTS Of the 32 treatment cycles, 28 were valid and 4 were invalid. No regrowth was observed in 96.4% (27 of 28) after treatment with Mirasol pathogen reduction system. Of four invalid tests, on two instances the NC showed growth, whereas in other 2 no regrowth was detected in 7(th) day PC. Bacterial screening of PCs by BacT/ALERT after 24 h of incubation was 28.6%, whereas the effectiveness increased to 100% when incubated for 7 days. CONCLUSIONS Mirasol system was effective in inactivating S. epidermidis when it was deliberately inoculated into BCPP at clinically relevant concentrations. Such systems may significantly improve blood safety by inactivating traditional and emerging transfusion-transmitted pathogens.
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Affiliation(s)
- Kabita Chatterjee
- Department of Transfusion Medicine, All Institute of Medical Sciences, New Delhi, India
| | - Shamsuz Zaman
- Department of Transfusion Medicine, All Institute of Medical Sciences, New Delhi, India
| | - Rahul Chaurasia
- Department of Transfusion Medicine, All Institute of Medical Sciences, New Delhi, India
| | - Surinder Singh
- National Institute of Biologicals, Noida, Uttar Pradesh, India
| | | | - Shalini Tewari
- National Institute of Biologicals, Noida, Uttar Pradesh, India
| | - Akanksha Bisht
- Haemovigilance Programme, National Institute of Biologicals, Noida, Uttar Pradesh, India
| | - Nitin Agarwal
- Department of Transfusion Medicine, All Institute of Medical Sciences, New Delhi, India
| | - Diptiranjan Rout
- Department of Transfusion Medicine, All Institute of Medical Sciences, New Delhi, India
| | - Subhash Chand
- National Institute of Biologicals, Noida, Uttar Pradesh, India
| | - Kallol Saha
- National Institute of Biologicals, Noida, Uttar Pradesh, India
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Cicchetti A, Berrino A, Casini M, Codella P, Facco G, Fiore A, Marano G, Marchetti M, Midolo E, Minacori R, Refolo P, Romano F, Ruggeri M, Sacchini D, Spagnolo AG, Urbina I, Vaglio S, Grazzini G, Liumbruno GM. Health Technology Assessment of pathogen reduction technologies applied to plasma for clinical use. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2016; 14:287-386. [PMID: 27403740 PMCID: PMC4942318 DOI: 10.2450/2016.0065-16] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Although existing clinical evidence shows that the transfusion of blood components is becoming increasingly safe, the risk of transmission of known and unknown pathogens, new pathogens or re-emerging pathogens still persists. Pathogen reduction technologies may offer a new approach to increase blood safety. The study is the output of collaboration between the Italian National Blood Centre and the Post-Graduate School of Health Economics and Management, Catholic University of the Sacred Heart, Rome, Italy. A large, multidisciplinary team was created and divided into six groups, each of which addressed one or more HTA domains.Plasma treated with amotosalen + UV light, riboflavin + UV light, methylene blue or a solvent/detergent process was compared to fresh-frozen plasma with regards to current use, technical features, effectiveness, safety, economic and organisational impact, and ethical, social and legal implications. The available evidence is not sufficient to state which of the techniques compared is superior in terms of efficacy, safety and cost-effectiveness. Evidence on efficacy is only available for the solvent/detergent method, which proved to be non-inferior to untreated fresh-frozen plasma in the treatment of a wide range of congenital and acquired bleeding disorders. With regards to safety, the solvent/detergent technique apparently has the most favourable risk-benefit profile. Further research is needed to provide a comprehensive overview of the cost-effectiveness profile of the different pathogen-reduction techniques. The wide heterogeneity of results and the lack of comparative evidence are reasons why more comparative studies need to be performed.
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Affiliation(s)
- Americo Cicchetti
- Postgraduate School of Health Economics and Management (Altems), Catholic University of the Sacred Heart, Rome, Italy
| | - Alexandra Berrino
- Health Technology Assessment Unit of “Gemelli” Teaching Hospital, Catholic University of the Sacred Heart, Rome, Italy
| | - Marina Casini
- Institute of Bioethics, Catholic University of the Sacred Heart, Rome, Italy
| | - Paola Codella
- Postgraduate School of Health Economics and Management (Altems), Catholic University of the Sacred Heart, Rome, Italy
| | - Giuseppina Facco
- Italian National Blood Centre, National Institute of Health, Rome, Italy
| | - Alessandra Fiore
- Postgraduate School of Health Economics and Management (Altems), Catholic University of the Sacred Heart, Rome, Italy
| | - Giuseppe Marano
- Italian National Blood Centre, National Institute of Health, Rome, Italy
| | - Marco Marchetti
- Health Technology Assessment Unit of “Gemelli” Teaching Hospital, Catholic University of the Sacred Heart, Rome, Italy
| | - Emanuela Midolo
- Institute of Bioethics, Catholic University of the Sacred Heart, Rome, Italy
| | - Roberta Minacori
- Institute of Bioethics, Catholic University of the Sacred Heart, Rome, Italy
| | - Pietro Refolo
- Institute of Bioethics, Catholic University of the Sacred Heart, Rome, Italy
| | - Federica Romano
- Postgraduate School of Health Economics and Management (Altems), Catholic University of the Sacred Heart, Rome, Italy
| | - Matteo Ruggeri
- Postgraduate School of Health Economics and Management (Altems), Catholic University of the Sacred Heart, Rome, Italy
| | - Dario Sacchini
- Institute of Bioethics, Catholic University of the Sacred Heart, Rome, Italy
| | - Antonio G. Spagnolo
- Institute of Bioethics, Catholic University of the Sacred Heart, Rome, Italy
| | - Irene Urbina
- Health Technology Assessment Unit of “Gemelli” Teaching Hospital, Catholic University of the Sacred Heart, Rome, Italy
| | - Stefania Vaglio
- Italian National Blood Centre, National Institute of Health, Rome, Italy
| | - Giuliano Grazzini
- Italian National Blood Centre, National Institute of Health, Rome, Italy
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50
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Ohlmann P, Hechler B, Chafey P, Ravanat C, Isola H, Wiesel ML, Cazenave JP, Gachet C. Hemostatic properties and protein expression profile of therapeutic apheresis plasma treated with amotosalen and ultraviolet A for pathogen inactivation. Transfusion 2016; 56:2239-47. [PMID: 27250038 DOI: 10.1111/trf.13670] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Revised: 04/21/2016] [Accepted: 04/21/2016] [Indexed: 12/26/2022]
Abstract
BACKGROUND The INTERCEPT Blood System (IBS) using amotosalen-HCl and ultraviolet (UV)A inactivates a large spectrum of microbial pathogens and white blood cells in therapeutic plasma. Our aim was to evaluate to what extent IBS modifies the capacity of plasma to generate thrombin and induces qualitative or quantitative modifications of plasma proteins. STUDY DESIGN AND METHODS Plasma units from four donors were collected by apheresis. Samples were taken before (control [CTRL]) and after IBS treatment and stored at -80°C until use. The activities of plasma coagulation factors and inhibitors and the thrombin generation potential were determined using assays measuring clotting times and the calibrated automated thrombogram (CAT), respectively. The proteomic profile of plasma proteins was examined using a two-dimensional differential in-gel electrophoresis (2D-DIGE) method. RESULTS Nearly all of the procoagulant and antithrombotic factors tested retained at least 78% of their initial pre-IBS activity. Only FVII and FVIII displayed a lower level of conservation (67%), which nevertheless remained within the reference range for conventional plasma coagulation factors. The thrombin generation profile of plasma was conserved after IBS treatment. Among the 1331 protein spots revealed by 2D-DIGE analysis, only four were differentially expressed in IBS plasma compared to CTRL plasma and two were identified by mass spectrometric analysis as transthyretin and apolipoprotein A1. CONCLUSION The IBS technique for plasma moderately decreases the activities of plasma coagulation factors and antithrombotic proteins, with no impact on the thrombin generation potential of plasma and very limited modifications of the proteomic profile.
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Affiliation(s)
- Philippe Ohlmann
- UMR_S949, INSERM, Strasbourg, France.,EFS-Alsace-Lorraine-Champagne-Ardenne, Strasbourg, France.,Université de Strasbourg, Strasbourg, France.,Fédération de Médecine Translationnelle de Strasbourg, Strasbourg, France
| | - Béatrice Hechler
- UMR_S949, INSERM, Strasbourg, France.,EFS-Alsace-Lorraine-Champagne-Ardenne, Strasbourg, France.,Université de Strasbourg, Strasbourg, France.,Fédération de Médecine Translationnelle de Strasbourg, Strasbourg, France
| | - Philippe Chafey
- Plateforme Protéomique 3P5, Université Paris Descartes, Sorbonne Paris Cité,INSERM, U1016, Institut Cochin, Paris, France.,CNRS, UMR 8104, Paris, France
| | - Catherine Ravanat
- UMR_S949, INSERM, Strasbourg, France.,EFS-Alsace-Lorraine-Champagne-Ardenne, Strasbourg, France.,Université de Strasbourg, Strasbourg, France.,Fédération de Médecine Translationnelle de Strasbourg, Strasbourg, France
| | - Hervé Isola
- EFS-Alsace-Lorraine-Champagne-Ardenne, Strasbourg, France
| | | | | | - Christian Gachet
- UMR_S949, INSERM, Strasbourg, France.,EFS-Alsace-Lorraine-Champagne-Ardenne, Strasbourg, France.,Université de Strasbourg, Strasbourg, France.,Fédération de Médecine Translationnelle de Strasbourg, Strasbourg, France
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