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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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Zverev VV, Makarov OV, Khashukoeva AZ, Svitich OA, Dobrokhotova YE, Markova EA, Labginov PA, Khlinova SA, Shulenina EA, Gankovskaya LV. In vitro studies of the antiherpetic effect of photodynamic therapy. Lasers Med Sci 2016; 31:849-55. [PMID: 27003896 DOI: 10.1007/s10103-016-1912-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Accepted: 02/10/2016] [Indexed: 11/29/2022]
Abstract
The number of viral infection cases in the Department of Gynecology and Obstetrics has tended to increase over last few years. Viruses form herpesvirus and cytomegalovirus families are associated with an increased risk for recurrent pregnancy loss. Photodynamic therapy (PDT) is a promising new approach to treat viral infections in which viral particles are inactivated. It exhibits great therapeutic potential, particularly among this group of patients. This study examined the use of PDT to treat herpesvirus infection (HVI) using an in vitro model. In this study, we used the Vero сell lineage as a suitable model of HVI, strains of HSV-1 (strain VR-3) and HSV-2 (strain MS) obtained from The National Virus Collection (London, UK), the photosensitizer Fotoditazine (Veta-Grand, Russia), an AFS physiotherapeutic device (Polironic Corporation, Russia). Laser light irradiation and the photosensitizer had different cytotoxic effects on the Vero cell cultures depending on the doses used. The optimal laser light and photosensitizer doses were determined. PDT had an antiviral effect on an in vitro model of HVI in cell culture. PDT has been shown to be effective treatment for HVI in vitro, leading to a reliable decrease of viral titer.
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Affiliation(s)
- V V Zverev
- Mechnikov Scientific Research Institute of Vaccines and Serums, Maly Kazeynny per., 5A, 105064, Moscow, Russia
| | - O V Makarov
- Department of Obstetrics and Gynecology of Medical Faculty, Pyrogov Russian National Research Medical University, Str. Ostrovityanova, 1, 117997, Moscow, Russia
| | - A Z Khashukoeva
- Department of Obstetrics and Gynecology of Medical Faculty, Pyrogov Russian National Research Medical University, Str. Ostrovityanova, 1, 117997, Moscow, Russia
| | - O A Svitich
- Mechnikov Scientific Research Institute of Vaccines and Serums, Maly Kazeynny per., 5A, 105064, Moscow, Russia
| | - Y E Dobrokhotova
- Department of Obstetrics and Gynecology of Medical Faculty, Pyrogov Russian National Research Medical University, Str. Ostrovityanova, 1, 117997, Moscow, Russia
| | - E A Markova
- Department of Obstetrics and Gynecology of Medical Faculty, Pyrogov Russian National Research Medical University, Str. Ostrovityanova, 1, 117997, Moscow, Russia.
| | - P A Labginov
- Mechnikov Scientific Research Institute of Vaccines and Serums, Maly Kazeynny per., 5A, 105064, Moscow, Russia
| | - S A Khlinova
- Department of Obstetrics and Gynecology of Medical Faculty, Pyrogov Russian National Research Medical University, Str. Ostrovityanova, 1, 117997, Moscow, Russia
| | - E A Shulenina
- Mechnikov Scientific Research Institute of Vaccines and Serums, Maly Kazeynny per., 5A, 105064, Moscow, Russia
| | - L V Gankovskaya
- Department of Immunology, Pyrogov Russian National Research Medical University, Str. Ostrovityanova, 1, 117997, Moscow, Russia
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Yin H, Zhang G, Chen H, Wang W, Kong D, Li Y. Preliminary safety evaluation of photodynamic therapy for blood purification: an animal study. Artif Organs 2014; 38:510-5. [PMID: 24443947 DOI: 10.1111/aor.12206] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Photodynamic therapy (PDT) has been shown to inactivate blood-borne pathogenic microorganisms in vitro. The method may be used to purify blood in the body, kill pathogenic microorganisms, and treat difficult diseases. Our aim was to investigate the safety of photodynamic blood purification (PBP) therapy using an in vivo blood circulation experiment in an animal model. Twenty-four New Zealand rabbits were used as experimental subjects; 12 received PDT and 12 served as negative controls. Extracorporeal blood bypass was established using the femoral artery and vein. A sterile disposable irradiation chamber was connected in the bypass pathway. Hematoporphyrin monomethyl ether was injected intravenously as a photosensitizer with an initial bolus of 3.7 mg, followed by a continuous infusion at 24 mg/h during PDT administration. Five minutes after initial injection, a laser beam was vertically focused on the irradiation chamber side wall, with a 9.5 cm(2) spot area, 1 h exposure time, and 20 mW/cm(2) power density. Six animals received a single PDT application, and six received PDT every other day for three applications. The 12 control group animals underwent extracorporeal blood circulation but did not receive the photosensitizer or light treatment. Blood samples were taken 20 min, 1 day, 4 days, and 7 days after PDT treatment for analysis of cell counts, coagulation, liver and renal function, and other biochemical changes. On the 7th day, animals were sacrificed, and parenchymal organs were evaluated for morphological changes. There were no significant differences in white blood cells, red blood cells, or destroyingplatelets after PDT compared with the control group. There was a little significant difference in alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, γ-glutamyl transpeptidase, uric acid, blood urea nitrogen, and creatinine in the PDT group compared with the control group, except at individual time points. We found no significant damage in the heart, liver, spleen, lungs, kidneys, or other organs after PDT. This short-duration, fixed-strength PBP method did not cause changes in blood parameters or in the structure or function of major organs in an animal model. These findings suggest that PBP is safe in vivo and has potential as a new therapy for inactivating blood-borne microorganisms.
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Affiliation(s)
- Huijuan Yin
- Laboratorie of Laser Medicine, Biomedical Engineering Institute, Chinese Academy of Medical Sciences, Tianjin, China; Tianjin Laser Technology Medical Center, Tianjin, China
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Photoinactivation of cell-free human immunodeficiency virus by hematoporphyrin monomethyl ether. Lasers Med Sci 2011; 27:943-50. [PMID: 22045116 PMCID: PMC3414705 DOI: 10.1007/s10103-011-1013-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2011] [Accepted: 10/06/2011] [Indexed: 11/30/2022]
Abstract
Human immunodeficiency virus (HIV) particles that remain in the blood of patients are frequently ignored as targets for AIDS treatment. We therefore investigated the use of photodynamic therapy (PDT) with hematoporphyrin monomethyl ether (HMME) as a means of inactivating cell-free HIV in vitro. Virus particles including HIV-1IIIB, resistant HIV-1 variants, HIV-1 clinical variants, and HIV-2 variants were incubated with HMME for 40 min, followed by irradiation with a 630-nm semiconductor laser at an energy density of 0.3 J/cm2. The antiviral effects were evaluated by counting syncytium formation or measuring p24 antigen expression levels in supernatants by enzyme-linked immunosorbent assay. The relationships between photoinactivation and HMME concentrations, energy density, power density and antioxidants (NaN3 and d-mannitol) were also assessed using the above methods. All the tested virus particles were completely responsive to HMME-PDT. HMME concentration and energy density were positively correlated with photoinactivation of HIV, while power density was negatively correlated. Both sodium azide and d-mannitol weakened the inhibitory effect of PDT on virus-induced membrane fusion, with d-mannitol having a stronger effect. HMME-PDT can inactivate HIV particles, and may therefore represent a promising treatment for AIDS patients.
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Yin H, Li Y, Zheng Y, Ye X, Li C, Zou Z, Zhao Y. Retraction: ANTI-HIV-1 Activities of Photodynamic Therapy Using Hematoporphyrin Monomethyl Ether. Photochem Photobiol 2010; 86:994. [DOI: 10.1111/j.1751-1097.2009.00698.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Hirayama J, Abe H, Kamo N, Ikebuchi K, Ikeda H. Comparison of the Effects of Different Antiviral Treatments on the Antioxidant Systems of Stroma-free Hemoglobin¶. Photochem Photobiol 2007. [DOI: 10.1562/0031-8655(2001)0740461coteod2.0.co2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Singh Y, Sawyer LS, Pinkoski LS, Dupuis KW, Hsu JC, Lin L, Corash L. Photochemical treatment of plasma with amotosalen and long-wavelength ultraviolet light inactivates pathogens while retaining coagulation function. Transfusion 2006; 46:1168-77. [PMID: 16836564 PMCID: PMC7201872 DOI: 10.1111/j.1537-2995.2006.00867.x] [Citation(s) in RCA: 119] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
BACKGROUND: The INTERCEPT Blood System, a photochemical treatment (PCT) process, has been developed to inactivate pathogens in platelet concen‐trates. These studies evaluated the efficacy of PCT to inactivate pathogens in plasma and the effect of PCT on plasma function. STUDY DESIGN AND METHODS: Jumbo (600 mL) plasma units were inoculated with high titers of test pathogens and treated with 150 µmol per L amotosalen and 3 J per cm2 long‐wavelength ultraviolet light. The viability of each pathogen before and after treatment was measured with biological assays. Plasma function was evaluated through measurement of coagulation factors and antithrombotic protein activities. RESULTS: The levels of inactivation expressed as log‐reduction were as follows: cell‐free human immunodeficiency virus‐1 (HIV‐1), greater than 6.8; cell‐associated HIV‐1, greater than 6.4; human T‐lymphotropic virus‐I (HTLV‐I), 4.5; HTLV‐II, greater than 5.7; hepatitis B virus (HBV) and hepatitis C virus, greater than 4.5; duck HBV, 4.4 to 4.5; bovine viral diarrhea virus, 6.0; severe acute respiratory syndrome coronavirus, 5.5; West Nile virus, 6.8; bluetongue virus, 5.1; human adenovirus 5, 6.8; Klebsiella pneumoniae, greater than 7.4; Staphylococcus epidermidis and Yersinia enterocolitica, greater than 7.3; Treponema pallidum, greater than 5.9; Borrelia burgdorferi, greater than 10.6; Plasmodium falciparum, 6.9; Trypanosoma cruzi, greater than 5.0; and Babesia microti, greater than 5.3. Retention of coagulation factor activity after PCT was expressed as the proportion of pretreatment (baseline) activity. Retention was 72 to 73 percent of baseline fibrinogen and Factor (F)VIII activity and 78 to 98 percent for FII, FV, FVII, F IX, FX, FXI, FXIII, protein C, protein S, antithrombin, and α2‐antiplasmin. CONCLUSION: PCT of plasma inactivated high levels of a wide range of pathogens while maintaining adequate coagulation function. PCT has the potential to reduce the risk of transfusion‐transmitted diseases in patients requiring plasma transfusion support.
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Williamson LM, Cardigan R, Prowse CV. Methylene blue-treated fresh-frozen plasma: what is its contribution to blood safety? Transfusion 2003; 43:1322-9. [PMID: 12919437 DOI: 10.1046/j.1537-2995.2003.00483.x] [Citation(s) in RCA: 134] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Lorna M Williamson
- University of Cambridge and National Blood Service, Cambridge, United Kingdom.
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Abstract
Hepatitis C virus is an RNA virus in the Flavivirus family that was identified in 1989. Since then, blood donor screening has reduced the incidence of acute infections; however, because this virus frequently leads to asymptomatic chronic infection, the prevalence of infection remains high. Chronic infection leads to increased risks of cirrhosis and hepatocellular carcinoma, as well as extrahepatic manifestations. Guidelines for widespread screening continue to evolve, and early diagnosis is likely to become more important with the development of more effective treatments. Current recommendations regarding screening are reviewed.
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Affiliation(s)
- Robert A Yoho
- Department of Dermatology, Martin Luther King Hospital, Los Angeles, CA, USA
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Odawara F, Abe H, Kohno T, Nagai-Fujii Y, Arai K, Imamura S, Misaki H, Azuma H, Ikebuchi K, Ikeda H, Mohan S, Sano K. A highly sensitive chemiluminescent reverse transcriptase assay for human immunodeficiency virus. J Virol Methods 2002; 106:115-24. [PMID: 12367736 DOI: 10.1016/s0166-0934(02)00142-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
A simple and highly sensitive reverse transcriptase (RT) assay was developed by combining a previously reported non-radioisotopic RT assay with the use of a template-primer-immobilized microplate, an enzyme capture protocol, product digestion and a chemiluminescent substrate. The assay was able to detect directly the RT activity in serum samples, plasma and cell culture medium without the need for concentration and extraction of the enzyme. The assay was able to detect RT activity equivalent to 100 virions/ml of HIV-1. These results suggest that this highly sensitive chemiluminescent RT assay can be used not only for virological investigation but also for routine screening of biopharmaceuticals.
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Affiliation(s)
- Fumitomo Odawara
- Fine Chemicals and Diagnostic Division, Asahi Kasei Corporation, 632-1 Mifuku, Ohito-cho, Tagata-gun, Shizuoka 410-2321, Japan.
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Gresens CJ, Holland PV. The disappearance of transfusion-transmitted hepatitis C virus infections in the United States. Clin Liver Dis 2001; 5:1105-13. [PMID: 11685798 DOI: 10.1016/s1089-3261(05)70212-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Because of anti-HCV testing, rates of transfusion-transmitted HCV infections have dropped from a high level (approximately 1 per 200 units, even using volunteer, repeat donors) to an extremely low one (approximately 1 per 125,000 units). Moreover, preliminary data indicate that pooled- (and perhaps, eventually, single-) specimen NAT for HCV-RNA or EIA for HCV core antigen may reduce this risk even further. It is anticipated that implementation of one or more of these methods, coupled with one or more pathogen-inactivation steps, may functionally eliminate the risk of transmitting HCV by transfusions.
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Affiliation(s)
- C J Gresens
- SMF Blood Centers, Sacramento, California, USA.
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Yamada-Ohnishi Y, Owada T, Abe H, Hirayama J, Ikeda H, Ikebuchi K. Cell-associated virus infectivity of primary HIV-1 isolate can be eliminated by a filtration/methylene blue photoinactivation system. Transfusion 2000; 40:1542-3. [PMID: 11134578 DOI: 10.1046/j.1537-2995.2000.t01-1-40121542.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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