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Enhanced opsonisation of Rhesus D-positive human red blood cells by recombinant polymeric immunoglobulin G anti-G antibodies. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2017; 16:200-208. [PMID: 28686149 DOI: 10.2450/2017.0176-16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Accepted: 03/15/2017] [Indexed: 11/21/2022]
Abstract
BACKGROUND Anti-RhD antibodies (anti-D) are important in the prophylaxis of haemolytic disease of the foetus and newborn (HDFN) due to RhD incompatibility. Current preparations of anti-D are sourced from hyperimmune human plasma, so its production carries a risk of disease and is dependent on donor availability. Despite the efforts to develop a monoclonal preparation with similar prophylactic properties to the plasma-derived anti-D, no such antibody is yet available. Here we studied the agglutinating, opsonic and haemolytic activities of two recombinant polymeric immunoglobulins (Ig) against the G antigen of the Rh complex. MATERIALS AND METHODS Recombinant polymeric anti-G IgG1 (IgG1μtp) and IgG3 (IgG3μtp) were produced in vitro, purified by protein G-affinity chromatography, and analysed by gel electrophoresis. Their agglutinating, opsonic and haemolytic activities were evaluated using haemagglutination, erythrophagocytosis, and complement activation assays. RESULTS The recombinant IgG1μtp and IgG3μtp anti-G antibodies ranged from 150,000 to 1,000,000 Da in molecular weight, indicating the formation of polymeric IgG. No complement activation or haemolytic activity was detected upon incubation of RhD-positive red-blood cells with the polymeric anti-G IgG. Both polymers were better opsonins than a prophylactic preparation of plasma-derived anti-D. DISCUSSION The enhanced opsonic properties of the polymeric anti-G IgG1μtp and IgG3μtp could allow them to mediate the clearance of RhD-positive red blood cells from circulation more efficiently than natural or other synthetic prophylactic anti-D options. Their inability to induce complement-mediated haemolysis would be prophylactically convenient and is comparable in vitro to that of the available plasma-derived polyclonal anti-D preparations. The described properties suggest that polymeric antibodies like these (but with anti-D specificity) may be testable candidates for prophylaxis of HDFN caused by anti-D.
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Aitken SL, Tichy EM. Rh(O)D immune globulin products for prevention of alloimmunization during pregnancy. Am J Health Syst Pharm 2015; 72:267-76. [PMID: 25631833 DOI: 10.2146/ajhp140288] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE The pharmacologic properties of Rhesus (Rh) immune globulin (RhIG) and clinical data on its effectiveness in preventing Rh-antigen alloimmunization in pregnant women are reviewed. SUMMARY RhIG is a human plasma derivative that targets red blood cells (RBCs) positive for Rh(O) antigen (also called D antigen). In the United States and other countries, the widespread use of RhIG has markedly reduced the occurrence of hemolytic disease of the fetus and newborn (HDFN), a devastating condition caused by D-antigen sensitization of a pregnant woman via exposure to fetal RBCs (usually during detachment of the placenta in labor) that results in a maternal immune response leading to severe hemolysis in the fetus. Routine administration of RhIG at 26-30 weeks' gestation and again within 72 hours of delivery has been shown to be highly effective in preventing maternal Rh alloimmunization, with very low rates of D-antigen sensitization (in the range of 0-2.2%) reported in multiple studies of at-risk women. The four RhIG products currently available in the United States have common clinical indications but differ in certain attributes. Pharmacists can play an important role in guiding other clinicians on the rationale for the use of RhIG, important differences between products, and appropriate timing of RhIG therapy. CONCLUSION Routine administration of RhIG to women at risk for Rh alloimmunization is clinically effective and has made HDFN a rare clinical event. The available RhIG products are not the same and should be carefully reviewed to ensure that they are administered safely.
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Affiliation(s)
- Samuel L Aitken
- Samuel L. Aitken, Pharm.D., BCPS, is Clinical Pharmacy Specialist in Infectious Diseases, The University of Texas MD Anderson Cancer Center, Houston. Eric M. Tichy, Pharm.D., FCCP, BCPS, is Senior Clinical Pharmacy Specialist, Solid Organ Transplantation, and Director, Postgraduate Year 2 Residency, Department of Pharmacy Services, Yale-New Haven Hospital, New Haven, CT
| | - Eric M Tichy
- Samuel L. Aitken, Pharm.D., BCPS, is Clinical Pharmacy Specialist in Infectious Diseases, The University of Texas MD Anderson Cancer Center, Houston. Eric M. Tichy, Pharm.D., FCCP, BCPS, is Senior Clinical Pharmacy Specialist, Solid Organ Transplantation, and Director, Postgraduate Year 2 Residency, Department of Pharmacy Services, Yale-New Haven Hospital, New Haven, CT.
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Helbert MR, Bangs C, Bishop M, Molesworth A, Ironside J. No evidence of asymptomatic variant CJD infection in immunodeficiency patients treated with UK-sourced immunoglobulin. Vox Sang 2015; 110:282-4. [PMID: 26529032 DOI: 10.1111/vox.12358] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Revised: 09/18/2015] [Accepted: 09/20/2015] [Indexed: 11/28/2022]
Abstract
Surveillance of 75 immunodeficiency patients exposed to UK-sourced immunoglobulin, including batches derived from donors who went on to develop vCJD, has not detected any clinical cases of vCJD, or of asymptomatic infection in 15 patients with available tissue samples of sufficient quality for testing.
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Affiliation(s)
- M R Helbert
- Central Manchester University Hospitals, Manchester, UK
| | - C Bangs
- Central Manchester University Hospitals, Manchester, UK
| | - M Bishop
- National Creutzfeldt-Jakob Disease Research and Surveillance Unit, University of Edinburgh, Edinburgh, UK
| | - A Molesworth
- National Creutzfeldt-Jakob Disease Research and Surveillance Unit, University of Edinburgh, Edinburgh, UK
| | - J Ironside
- National Creutzfeldt-Jakob Disease Research and Surveillance Unit, University of Edinburgh, Edinburgh, UK
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Hemophilic arthropathy of the elbow: prophylaxis, imaging, and the role of invasive management. J Shoulder Elbow Surg 2015; 24:1669-78. [PMID: 26385390 DOI: 10.1016/j.jse.2015.06.018] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Revised: 06/14/2015] [Accepted: 06/22/2015] [Indexed: 02/01/2023]
Abstract
Hemophilia is an X-linked recessive deficiency of clotting factor VIII (hemophilia A) or IX (hemophilia B) that can result in hemarthrosis of various joints, including the elbow. Left unchecked, this can lead to progressive joint destruction and significant morbidity. Appropriate management of the elbow joint through prophylactic measures, accurate imaging, and timely intervention is essential. Replacing or supplementing deficient factor with a plasma-derived or recombinant factor concentrate can minimize bleeding episodes. Joints should be routinely monitored for damage. Plain films offer an inexpensive window into bone disease and joint space changes but lack soft tissue detail and may not detect early changes. Magnetic resonance imaging provides a high level of detail but may be limited by its cost and need for sedation in younger patients. Ultrasound may not achieve the same level of resolution as magnetic resonance imaging, but it is increasingly used as a convenient, effective, and relatively inexpensive alternative. Patients who experience hemarthrosis of the elbow with joint damage often require more invasive treatment. Radiosynovectomy and arthroscopic synovectomy are effective at minimizing pain and preventing future bleeding episodes, whereas extensive joint damage may necessitate total elbow replacement.
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Aouba A, Harroche A, Frenzel L, Torchet MF, Rothschild C, François I, Mamzer-Bruneel MF. Batch recall of French plasma-derived products due to variant Creutzfeldt-Jakob disease risk: the psychological impact on haemophilic patients, changes in their therapeutic demands and behaviour and ethical considerations. Haemophilia 2014; 21:27-33. [DOI: 10.1111/hae.12515] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2014] [Indexed: 11/28/2022]
Affiliation(s)
- A. Aouba
- Center for Haemophilia Care and Department of Haematology; Hôpital Necker Enfants-Malades; Université Paris-Descartes; Assistance Publique-Hôpitaux de Paris; Paris France
- Medical Ethics Department EA 4569; Université Paris-Descartes; PRES Sorbonne-Paris-Cité Paris France
| | - A. Harroche
- Center for Haemophilia Care and Department of Haematology; Hôpital Necker Enfants-Malades; Université Paris-Descartes; Assistance Publique-Hôpitaux de Paris; Paris France
| | - L. Frenzel
- Center for Haemophilia Care and Department of Haematology; Hôpital Necker Enfants-Malades; Université Paris-Descartes; Assistance Publique-Hôpitaux de Paris; Paris France
| | - M. -F. Torchet
- Center for Haemophilia Care and Department of Haematology; Hôpital Necker Enfants-Malades; Université Paris-Descartes; Assistance Publique-Hôpitaux de Paris; Paris France
| | - C. Rothschild
- Center for Haemophilia Care and Department of Haematology; Hôpital Necker Enfants-Malades; Université Paris-Descartes; Assistance Publique-Hôpitaux de Paris; Paris France
| | - I. François
- Medical Ethics Department EA 4569; Université Paris-Descartes; PRES Sorbonne-Paris-Cité Paris France
| | - M. -F. Mamzer-Bruneel
- Medical Ethics Department EA 4569; Université Paris-Descartes; PRES Sorbonne-Paris-Cité Paris France
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Diack AB, Head MW, McCutcheon S, Boyle A, Knight R, Ironside JW, Manson JC, Will RG. Variant CJD. 18 years of research and surveillance. Prion 2014; 8:286-95. [PMID: 25495404 PMCID: PMC4601215 DOI: 10.4161/pri.29237] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
It is now 18 years since the first identification of a case of vCJD in the UK. Since that time, there has been much speculation over how vCJD might impact human health. To date there have been 177 case reports in the UK and a further 51 cases worldwide in 11 different countries. Since establishing that BSE and vCJD are of the same strain of agent, we have also shown that there is broad similarity between UK and non-UK vCJD cases on first passage to mice. Transgenic mouse studies have indicated that all codon 129 genotypes are susceptible to vCJD and that genotype may influence whether disease appears in a clinical or asymptomatic form, supported by the appearance of the first case of potential asymptomatic vCJD infection in a PRNP 129MV patient. Following evidence of blood transfusion as a route of transmission, we have ascertained that all blood components and leucoreduced blood in a sheep model of vCJD have the ability to transmit disease. Importantly, we recently established that a PRNP 129MV patient blood recipient with an asymptomatic infection and limited PrP(Sc) deposition in the spleen could readily transmit disease into mice, demonstrating the potential for peripheral infection in the absence of clinical disease. This, along with the recent appendix survey which identified 16 positive appendices in a study of 32,441 cases, underlines the importance of continued CJD surveillance and maintaining control measures already in place to protect human health.
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Affiliation(s)
- Abigail B Diack
- The Roslin Institute and R(D)SVS; University of Edinburgh; Easter Bush; Midlothian, Scotland, UK,These authors contributed equally to this work.
| | - Mark W Head
- National CJD Research & Surveillance Unit; School of Clinical Sciences; University of Edinburgh; Western General Hospital; Edinburgh, Scotland, UK,These authors contributed equally to this work.
| | - Sandra McCutcheon
- The Roslin Institute and R(D)SVS; University of Edinburgh; Easter Bush; Midlothian, Scotland, UK
| | - Aileen Boyle
- The Roslin Institute and R(D)SVS; University of Edinburgh; Easter Bush; Midlothian, Scotland, UK
| | - Richard Knight
- National CJD Research & Surveillance Unit; School of Clinical Sciences; University of Edinburgh; Western General Hospital; Edinburgh, Scotland, UK
| | - James W Ironside
- National CJD Research & Surveillance Unit; School of Clinical Sciences; University of Edinburgh; Western General Hospital; Edinburgh, Scotland, UK
| | - Jean C Manson
- The Roslin Institute and R(D)SVS; University of Edinburgh; Easter Bush; Midlothian, Scotland, UK,These authors contributed equally to this work.,Correspondence to: Jean C Manson;
| | - Robert G Will
- National CJD Research & Surveillance Unit; School of Clinical Sciences; University of Edinburgh; Western General Hospital; Edinburgh, Scotland, UK,These authors contributed equally to this work.
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Hall V, Brookes D, Nacul L, Gill ON, Connor N. Managing the risk of iatrogenic transmission of Creutzfeldt-Jakob disease in the UK. J Hosp Infect 2014; 88:22-7. [PMID: 25082752 DOI: 10.1016/j.jhin.2014.06.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2012] [Accepted: 06/17/2014] [Indexed: 11/17/2022]
Abstract
BACKGROUND With the emergence of bovine spongiform encephalopathy (BSE) and variant Creutzfeldt-Jakob disease (CJD) in the UK, there is concern about iatrogenic transmission, and the approach to managing this risk is unique. AIM To describe and review CJD incident management and the notification of individuals 'at increased risk' as a strategy for reducing iatrogenic transmission. METHODS A description of iatrogenic CJD transmission, the CJD Incidents Panel's role, the number and nature of CJD incidents reported and the individuals considered 'at increased risk' by mid-2012. FINDINGS Seventy-seven UK cases of CJD are likely to have resulted from iatrogenic transmission, among recipients of human-derived growth hormone (64 cases), dura mater grafts (eight cases), blood transfusions (four cases) and plasma products (one case). To limit transmission, the Panel reviewed 490 incidents and advised on look-backs, recalls of blood and plasma products, and quarantining and disposing of surgical instruments. Additionally, on Panel advice, around 6000 asymptomatic individuals have been informed they are at increased risk of CJD and have been asked to follow public health precautions. CONCLUSION The strategy to reduce iatrogenic transmission of CJD has been developed in a context of scientific uncertainty. The rarity of transmission events could indicate that incident-related exposures present negligible transmission risks, or--given the prolonged incubation and subclinical phenotypes of CJD--infections could be yet to occur or have been undetected. Scientific developments, including better estimates of infection prevalence, a screening test, or improvements in decontaminating surgical instruments, may change future risk management.
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Affiliation(s)
- V Hall
- CJD Section, Health Protection Services, Public Health England, London, UK.
| | - D Brookes
- CJD Section, Health Protection Services, Public Health England, London, UK
| | - L Nacul
- London School of Hygiene and Tropical Medicine, London, UK
| | - O N Gill
- CJD Section, Health Protection Services, Public Health England, London, UK
| | - N Connor
- CJD Section, Health Protection Services, Public Health England, London, UK
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Norja P, Lassila R, Makris M. Parvovirus transmission by blood products - a cause for concern? Br J Haematol 2012; 159:385-93. [PMID: 23025427 DOI: 10.1111/bjh.12060] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
The introduction of dual viral inactivation of clotting factor concentrates has practically eliminated infections by viruses associated with significant pathogenicity over the last 20 years. Despite this, theoretical concerns about transmission of infection have remained, as it is known that currently available viral inactivation methods are unable to eliminate parvovirus B19 or prions from these products. Recently, concern has been raised following the identification of the new parvoviruses, human parvovirus 4 (PARV4) and new genotypes of parvovirus B19, in blood products. Parvoviruses do not cause chronic pathogenicity similar to human immunodeficiency virus or hepatitis C virus, but nevertheless may cause clinical manifestations, especially in immunosuppressed patients. Manufacturers should institute measures, such as minipool polymerase chain reaction testing, to ensure that their products contain no known viruses. So far, human bocavirus, another new genus of parvovirus, has not been detected in fractionated blood products, and unless their presence can be demonstrated, routine testing during manufacture is not essential. Continued surveillance of the patients and of the safety of blood products remains an important ongoing issue.
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Affiliation(s)
- Päivi Norja
- Department of Virology, Haartman Institute, Helsinki University, Helsinki, Finland
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Millar CM, Makris M. Dealing with the uncertain risk of variant Creutzfeldt-Jakob disease transmission by coagulation replacement products. Br J Haematol 2012; 158:442-52. [DOI: 10.1111/j.1365-2141.2012.09201.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
| | - Mike Makris
- Department of Haematology; Sheffield Haemophilia and Thrombosis Centre; Sheffield; UK
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Prowse C, Cuthbertson B, Turner M. Risk reduction strategies for variant Creutzfeldt-Jakob disease transmission by UK plasma products. Haemophilia 2011; 17:703. [PMID: 21362112 DOI: 10.1111/j.1365-2516.2010.02485.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
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ZAMAN SMA, HILL FGH, PALMER B, MILLAR CM, BONE A, MOLESWORTH AM, CONNOR N, LEE CA, DOLAN G, WILDE JT, GILL ON, MAKRIS M. The risk of variant Creutzfeldt-Jakob disease among UK patients with bleeding disorders, known to have received potentially contaminated plasma products. Haemophilia 2011; 17:931-7. [DOI: 10.1111/j.1365-2516.2011.02508.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Abstract
SUMMARY Variant Creutzfeldt-Jakob disease (CJD) is an emerging form of human prion disease caused by oral exposure to the bovine spongiform encephalopathy agent. Most cases have occurred in the UK, but smaller numbers of cases have been identified in 10 other countries worldwide. All confirmed cases belong to a single genetic subgroup defined by methionine homozygosity at codon 129 in the prion protein gene. Variant CJD has a widespread distribution of infectivity in the body, involving lymphoid tissues during at least the latter part of the incubation period. This is unlike other forms of human prion disease, and raised concerns that the transmissible agent might also be present in blood. To date, four probable cases of variant CJD infection have been identified following transfusion of packed red blood cells from asymptomatic donors who subsequently died from variant CJD. Recently, one case of likely transmission of variant CJD infection by UK factor VIII (FVIII) concentrates has been reported in an elderly haemophilic patient in the UK, who had been treated with FVIII produced from pooled plasma to which a donor who subsequently died from variant CJD had contributed. The recipient showed no signs or symptoms of variant CJD during life, but evidence of variant CJD infection was detected in his spleen following a postmortem examination. Continued surveillance is required to investigate the prevalence of secondary variant CJD infection in other patients with bleeding disorders who have been treated with UK-sourced pooled plasma products.
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Affiliation(s)
- J W Ironside
- National Creutzfeldt-Jakob Disease Surveillance Unit, Division of Pathology, School of Molecular and Clinical Medicine, University of Edinburgh, Western General Hospital, Edinburgh, UK.
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Hoots K. A commentary on variant Creutzfeld-Jacob disease. Haemophilia 2010; 16:238-239. [PMID: 20487441 DOI: 10.1111/j.1365-2516.2010.02234.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Affiliation(s)
- K Hoots
- Division of Blood Diseases and Resources, National Heart, Lung and Blood Institute, National Institutes of Health Bethesda, Maryland, USA
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