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Elmakki EE, Madkhali MA, Oraibi O, Alqassimi S, Saleh E. Transfusion-Associated Graft-Versus-Host Disease in Adults. Cureus 2023; 15:e44148. [PMID: 37753040 PMCID: PMC10518734 DOI: 10.7759/cureus.44148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/25/2023] [Indexed: 09/28/2023] Open
Abstract
Transfusion-associated graft-versus-host disease (TA-GVHD) is a rare but fatal complication of blood transfusion that usually develops two to 30 days following a blood transfusion giving rise to graft versus host disease (GVHD) clinical features that are consisting of fever, skin rash, jaundice, diarrhea, and pancytopenia. The disease is fulminant in most patients with a mortality rate of >90% of cases. The main aim of this review is to enhance awareness among medical practitioners about this fatal disease. Data were extracted manually from the main medical databases (Medline, Scopus, and Google Scholar) after the revision of selected articles and assessed for their contribution to the knowledge of TA-GVHD. TA-GVHD occurs when the viable donor T-cells in the blood or blood products attack the recipient's tissues which his/her immune system is incapable to destroy due to several reasons. The recipient's tissues that are usually involved in TA-GVHD include the liver, intestine, skin, lungs, and bone marrow. Any blood component either whole blood, packed red blood cells (RBCs), platelets, or fresh non-frozen plasma that contains viable T lymphocytes can cause TA-GVHD. Host immunodeficiency, transfusion of fresh blood, and partial human leukocyte antigen (HLA) matching between the donors and the recipients represent the major risk factors of TA-GVHD. Partial HLA matching includes immunocompetent recipients who receive blood from a first-degree relative also, seen in genetically homogenous populations because of high rates of consanguineous marriage. The diagnosis of TA-GVHD is mainly suspected based on clinical manifestations. However, a histopathological study of either skin or rectal biopsy is diagnostic. The treatment of TA-GVHD is generally not effective, unless the patient received emergency stem cell transplantation, while prevention via irradiation of blood or blood products represents the standard of care for this disease. In conclusion, medical practitioners should have a high index of suspicion for this disease. Moreover, future clinical trials targeting and comparing the outcomes of the different therapeutic options for TA-GVHD are required.
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Affiliation(s)
- Erwa Eltayib Elmakki
- Department of Internal Medicine, Faculty of Medicine, Jazan University, Jazan, SAU
| | | | - Omar Oraibi
- Department of Internal Medicine, Faculty of Medicine, Jazan University, Jazan, SAU
| | - Sameer Alqassimi
- Department of Internal Medicine, Faculty of Medicine, Jazan University, Jazan, SAU
| | - Eman Saleh
- Department of Internal Medicine, Faculty of Medicine, Jazan University, Jazan, SAU
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2
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Kutac D, Bohonek M, Landova L, Staskova E, Blahutova M, Lovecky J, Horacek JM, Stansbury LG, Hess JR. Effects of pre-freeze pathogen reduction with riboflavin and UV light on red cells stored post-thaw in AS-3 additive solution. Transfusion 2023; 63:1067-1073. [PMID: 36938976 DOI: 10.1111/trf.17313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 02/10/2023] [Accepted: 02/27/2023] [Indexed: 03/21/2023]
Abstract
BACKGROUND Pathogen reduction technology (PRT) may improve the safety of RBCs for transfusion. As the Czech Republic considers PRT, we asked what effects riboflavin and UV light PRT pre-freezing has on the post-thaw recovery and properties of cryopreserved RBCs (CRBCs) after deglycerolization and liquid storage. STUDY DESIGN AND METHODS 24 Group O whole blood (WB) units were leukoreduced and then treated with riboflavin and UV light PRT (Mirasol, Terumo BCT, USA) before cryopreservation (T-CRBC); 20 similarly-collected units were untreated controls (C-CRBC). Units were processed to RBCs and then cryopreserved with 40% glycerol (wt/vol), frozen at -80°C, stored >118 days, reconstituted as deglycerolized RBC units in AS-3, and stored at 4 ± 2°C for 21 days. One treated unit sustained massive hemolysis during the post-thaw wash process and was removed from data analysis. The remaining units were assessed pre-PRT, post-PRT, and post-thaw-wash on days 0, 7, 14, and 21 for hematocrit, volume, hemoglobin per transfusion unit, pH, % hemolysis, hemoglobin in the supernatant, potassium, phosphorus, NH3 , osmolality, ATP, and 2,3-diphosphoglycerate. RESULTS PRT with leukoreduction caused a 5% loss of RBC followed by a 24% freeze-thaw-wash related loss for a total 28% loss but treated units contained an average of 45 g of hemoglobin, meeting European Union guidelines for CRBC. T-CRBCs displayed higher post-wash hemolysis, potassium, and ammonia concentrations, and lower ATP at the end of storage. CONCLUSIONS Cryopreserved RBCs from Riboflavin and UV light-treated WB meet the criteria for clinical use for 7 days after thawing and provide additional protection against infectious threats.
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Affiliation(s)
- Dominik Kutac
- Department of Hematology and Blood Transfusion, Military University Hospital, Prague, Czech Republic
- Department of Military Internal Medicine and Military Hygiene, Faculty of Military Health Sciences, University of Defence, Hradec Kralove, Czech Republic
| | - Milos Bohonek
- Department of Hematology and Blood Transfusion, Military University Hospital, Prague, Czech Republic
- Faculty of Biomedical Engineering, Czech Technical University, Prague, Czech Republic
| | - Ludmila Landova
- Department of Hematology and Blood Transfusion, Military University Hospital, Prague, Czech Republic
| | - Eva Staskova
- Department of Hematology and Blood Transfusion, Military University Hospital, Prague, Czech Republic
| | - Marie Blahutova
- Department of Hematology and Blood Transfusion, Military University Hospital, Prague, Czech Republic
| | - Juraj Lovecky
- Department of Biochemistry, St. Sisters of Mercy Hospital Karel Boromejsky, Prague, Czech Republic
| | - Jan M Horacek
- Department of Military Internal Medicine and Military Hygiene, Faculty of Military Health Sciences, University of Defence, Hradec Kralove, Czech Republic
- Department of Internal Medicine IV - Hematology, University Hospital, Hradec Kralove, Czech Republic
| | - Lynn G Stansbury
- Harborview Injury Prevention and Research Center, Harborview Medical Center, Seattle, Washington, USA
- Department of Anesthesia and Pain Medicine, University of Washington, Seattle, Washington, USA
| | - John R Hess
- Harborview Injury Prevention and Research Center, Harborview Medical Center, Seattle, Washington, USA
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, Washington, USA
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Malvaux N, Defraigne F, Bartziali S, Bellora C, Mommaerts K, Betsou F, Schuhmacher A. In Vitro Comparative Study of Platelets Treated with Two Pathogen-Inactivation Methods to Extend Shelf Life to 7 Days. Pathogens 2022; 11:pathogens11030343. [PMID: 35335667 PMCID: PMC8949436 DOI: 10.3390/pathogens11030343] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 02/18/2022] [Accepted: 02/22/2022] [Indexed: 11/26/2022] Open
Abstract
Background and Objectives: Since 2015, platelet products have been pathogen-inactivated (PI) at the Luxemburgish Red Cross (LRC) using Riboflavin and UV light (RF-PI). As the LRC should respond to hospital needs at any time, platelet production exceeds the demand, generating a discard rate of 18%. To reduce this, we consider the extension of storage time from 5 to 7 days. This study’s objective was to evaluate the in vitro 7-day platelet-storage quality, comparing two PI technologies, RF-PI and amotosalen/UVA light (AM-PI), for platelet pools from whole-blood donations (PPCs) and apheresis platelets collected from single apheresis donation (APCs). Materials and Methods: For each product type, 6 double-platelet concentrates were prepared and divided into 2 units; one was treated with RF-PI and the other by AM-PI. In vitro platelet-quality parameters were tested pre- and post-PI, at days 5 and 7. Results: Treatment and storage lesions were observed in PPCs and APCs with both PI methods. We found a higher rate of lactate increase and glucose depletion, suggesting a stronger stimulation of the glycolytic pathway, a higher Annexin V binding, and a loss of swirling in the RF-PI-treated units from day 5. The platelet loss was significantly higher in the AM-PI compared with the RF-PI units. Conclusions: Results suggest that RF-PI treatment has a higher deleterious impact on in vitro platelet quality compared to AM-PI, but we observed higher loss of platelets with AM-PI due to the post-illumination amotosalen adsorption step. If 7-day storage is needed, it can only be achieved with AM-PI, based on our quality criteria.
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Affiliation(s)
- Nicolas Malvaux
- Red Cross of Luxemburg, Boulevard Joseph II, 40, L-1840 Luxembourg, Luxembourg; (F.D.); (S.B.); (A.S.)
- Correspondence: ; Tel.: +352-2755-4000
| | - Fanette Defraigne
- Red Cross of Luxemburg, Boulevard Joseph II, 40, L-1840 Luxembourg, Luxembourg; (F.D.); (S.B.); (A.S.)
| | - Styliani Bartziali
- Red Cross of Luxemburg, Boulevard Joseph II, 40, L-1840 Luxembourg, Luxembourg; (F.D.); (S.B.); (A.S.)
| | - Camille Bellora
- Integrated Biobank of Luxembourg, 1 rue Louis Rech, L-3555 Dudelange, Luxembourg; (C.B.); (K.M.); (F.B.)
| | - Kathleen Mommaerts
- Integrated Biobank of Luxembourg, 1 rue Louis Rech, L-3555 Dudelange, Luxembourg; (C.B.); (K.M.); (F.B.)
- Luxembourg Center for Systems Biomedicine, 6 Av. du Swing, L-4367 Esch-sur-Alzette, Luxembourg
| | - Fay Betsou
- Integrated Biobank of Luxembourg, 1 rue Louis Rech, L-3555 Dudelange, Luxembourg; (C.B.); (K.M.); (F.B.)
- Laboratoire National de Sante, 1 rue Louis Rech, L-3555 Dudelange, Luxembourg
| | - Anne Schuhmacher
- Red Cross of Luxemburg, Boulevard Joseph II, 40, L-1840 Luxembourg, Luxembourg; (F.D.); (S.B.); (A.S.)
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Hosseini E, Kianinodeh F, Ghasemzadeh M. Irradiation of platelets in Transfusion Medicine: risk and benefit judgments. Platelets 2021; 33:666-678. [PMID: 34697994 DOI: 10.1080/09537104.2021.1990250] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Irradiation of platelet products is generally used to prevent transfusion-associated graft-versus-host disease (TA-GvHD) as well as transfusion-transmitted infections. As an essential prerequisite, gamma-irradiation of blood products prior to transfusion is required in patients who may develop TA-GVHD. Most studies suggest that gamma irradiation has no significant effect on the quality of platelet products; however, more recent studies have shown that the oxidative effects of gamma irradiation can lead to the induction of platelet storage lesion (PSL) and to some extent reduce the efficiency of transfused platelets. As the second widely used irradiation technique, UV-illumination was primarily introduced to reduce the growth of infectious agents during platelet storage, with the advantage that this method can also prevent TA-GvHD. However, the induction of oxidative conditions and platelet pre-activation that lead to PSL is more pronounced after UV-based methods of pathogen reduction. Since these lesions are large enough to clearly affect the post-transfusion platelet recovery and survival, more studies are needed to improve the safety and effectiveness of pathogen reduction technologies (PRTs). Therefore, pointing to other benefits of PRTs, such as preventing TA-GvHD or prolonging the shelf life of products by eliminating the possibility of pathogen growth during storage, does not yet seem to justify their widespread use due to above-mentioned effects. Even for gamma-irradiated platelets, some researchers have suggested that due to decreased 1-hour post-transfusion increments and increased risk of platelet refractoriness, their use should be limited to the patients who may develop TA-GVHD. It is noteworthy that due to the effect of X-rays in preventing TA-GvHD, some recent studies are underway to examine its effects on the quality and effectiveness of platelet products and determine whether X-rays can be used as a more appropriate and cost-effective alternative to gamma radiation. The review presented here provides a detailed description about irradiation-based technologies for platelet products, including their applications, mechanistic features, advantages, and disadvantages.
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Affiliation(s)
- Ehteramolsadat Hosseini
- Blood Transfusion Research Center, High Institute for Research and Education in Transfusion Medicine, Tehran, Iran
| | - Fatemeh Kianinodeh
- Blood Transfusion Research Center, High Institute for Research and Education in Transfusion Medicine, Tehran, Iran
| | - Mehran Ghasemzadeh
- Blood Transfusion Research Center, High Institute for Research and Education in Transfusion Medicine, Tehran, Iran
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5
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Sowemimo-Coker SO, Fast LD. Effects of hypoxic storage on the efficacy of gamma irradiation in abrogating lymphocyte proliferation and on the quality of gamma-irradiated red blood cells in additive solution 3. Transfusion 2021; 61:3443-3454. [PMID: 34671985 DOI: 10.1111/trf.16683] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 08/25/2021] [Accepted: 09/03/2021] [Indexed: 01/14/2023]
Abstract
BACKGROUND Gamma irradiation of blood products is used to prevent transfusion-associated graft-versus-host disease by inhibiting the proliferation of lymphocytes that are implicated in the disease. Gamma irradiation also damages the red blood cells (RBCs). It is unknown whether hypoxia reduces the efficacy of gamma irradiation in inhibiting lymphocyte proliferation (LP). The objectives of the study were to investigate the effects of hypoxia on gamma irradiation-induced inhibition of LP and on the in vitro properties of RBCs. MATERIALS AND METHODS Forty-four units (300-340 ml each) of less than 8-h-old ABO-matched leukocyte reduced red cell concentrates (LR-RCC) in additive solution 3 were pooled in pairs. Peripheral blood mononuclear cells were isolated from non-leukocyte reduced RCCs and added back to the pool at a final concentration of 2 × 105 /ml. The pool was divided equally into a conventional storage bag A and a hypoxic processing and storage bag B. The units were gamma-irradiated at 25Gy on day 7 for the LP experiment and on either day 7 or 14 for the RBC quality experiments. LP was measured using a limiting dilution assay, and several in vitro metrics of RBCs were measured. RESULTS Gamma irradiation inhibited T-lymphocyte proliferation by 4.7 × 104 -fold reduction in both hypoxic and conventional storage. The in vitro metrics of RBC quality were better preserved in hypoxic storage. DISCUSSION T lymphocytes present in hypoxic RBC are equally susceptible to gamma irradiation as conventional storage. Hypoxic storage also reduces the deleterious effects of gamma irradiation on RBCs.
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Affiliation(s)
| | - Loren D Fast
- Department of Medicine, Rhode Island Hospital and Warren Alpert School of Medicine at Brown University, Providence, Rhode Island, USA
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6
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Davis AM, Aung HH, Costa MJ, Dennington PM, van der Wal DE, Marks DC. X-irradiation and gamma-irradiation inactivate lymphocytes in blood components. Transfusion 2021; 61:3081-3086. [PMID: 34554562 DOI: 10.1111/trf.16674] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 08/24/2021] [Accepted: 09/03/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Irradiation of selected blood components is standard practice for the prevention of transfusion-associated graft-versus-host disease (TA-GvHD). Currently, gamma-irradiation is the most widely used form of irradiation, but there is an increasing interest in X-irradiation, which is considered to be functionally equivalent and safer. However, there is a paucity of contemporary data regarding the ability of X-irradiation to inactivate lymphocytes in blood components. Therefore, the effect of gamma- and X-irradiation on lymphocyte viability and function in blood components was compared. STUDY DESIGN AND METHODS Lymphocytes were isolated from venous blood by density gradient centrifugation, spiked into plasma/SSP+ to simulate a blood component, and either gamma- or X-irradiated. The phenotype of the isolated lymphocytes was confirmed. Lymphocyte viability was measured using a LIVE/DEAD assay, and function was assessed using mixed lymphocyte culture and CD69 expression post-phorbol-12 myristate 13-acetate (PMA) stimulation. RESULTS Lymphocyte viability and CD69 expression following PMA stimulation were significantly reduced by both gamma-irradiation and X-irradiation in simulated blood components. Allorecognition and allostimulation were also significantly reduced by both gamma-irradiation and X-irradiation. CONCLUSION Lymphocyte viability and function are reduced to a similar extent by gamma- and X-irradiation in simulated blood components. As such, X-irradiation is suitable for the irradiation of blood components and, in terms of lymphocyte inactivation, could be used instead of gamma-irradiation.
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Affiliation(s)
- April M Davis
- Australian Red Cross Lifeblood, Research and Development, Sydney, Australia
| | - Htet Htet Aung
- Australian Red Cross Lifeblood, Research and Development, Sydney, Australia
| | - Marylia J Costa
- Australian Red Cross Lifeblood, Research and Development, Sydney, Australia
| | - Peta M Dennington
- Australian Red Cross Lifeblood, Clinical Services and Research, Sydney, Australia
| | | | - Denese C Marks
- Australian Red Cross Lifeblood, Research and Development, Sydney, Australia.,Sydney Medical School, The University of Sydney, Camperdown, Australia
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7
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Nodeh FK, Hosseini E, Ghasemzadeh M. The effect of gamma irradiation on platelet redox state during storage. Transfusion 2020; 61:579-593. [PMID: 33231307 DOI: 10.1111/trf.16207] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 09/16/2020] [Accepted: 10/28/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND As a method with insignificant adverse effects on in vitro quality of platelet concentrates (PCs), gamma irradiation is applied to abrogate the risk of transfusion-associated graft-vs-host disease in vulnerable recipients. However, there is some evidence of lower posttransfusion responses and proteomic alterations in gamma-irradiated platelets (PLTs), which raises some questions about their quality, safety, and efficacy. Since reactive oxygen species (ROS) are considered as markers of PLT storage lesion (PSL), the study presented here investigated oxidant state in gamma-irradiated PCs. STUDY DESIGN AND METHODS PLT-rich plasma PC was split into two bags, one kept as control while other was subjected to gamma irradiation. Within 7 days of storage, the levels of intra-PLT superoxide, H2 O2 , mitochondrial ROS, P-selectin expression, and phosphatidylserine (PS) exposure were detected by flow cytometry while intracellular reduced glutathione (GSH), glucose concentration, and lactate dehydrogenase (LDH) activity were measured by enzymocolorimetric method. RESULTS GSH decreased, while ROS generation and LDH activity increased, during storage. Gamma irradiation significantly attenuated GSH whereas increased ROS generation in earlier and later stages of storage associated with either P-selectin or PS exposure increments. CONCLUSION Gamma irradiation can significantly increase cytosolic ROS generation in two distinct phases, one upon irradiation and another later in longer-stored PCs. While earlier ROS influx seems to be governed by direct effect of irradiation, the second phase of oxidant stress is presumably due to the storage-dependent PLT activation. Intriguingly, these observations were also in line with early P-selectin increments and increased PS exposure in longer-stored PLTs. Given the mutual link between ROS generation and PLT activation, further investigation is required to explore the effect of gamma irradiation on the induction of PSL.
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Affiliation(s)
- Fatemeh Kiani Nodeh
- Blood Transfusion Research Center, High Institute for Research and Education in Transfusion Medicine, Tehran, Iran
| | - Ehteramolsadat Hosseini
- Blood Transfusion Research Center, High Institute for Research and Education in Transfusion Medicine, Tehran, Iran
| | - Mehran Ghasemzadeh
- Blood Transfusion Research Center, High Institute for Research and Education in Transfusion Medicine, Tehran, Iran
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8
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Pathogen-reduced PRP blocks T-cell activation, induces Treg cells, and promotes TGF-β expression by cDCs and monocytes in mice. Blood Adv 2020; 4:5547-5561. [PMID: 33166410 DOI: 10.1182/bloodadvances.2020002867] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 10/14/2020] [Indexed: 02/06/2023] Open
Abstract
Alloimmunization against platelet-rich plasma (PRP) transfusions can lead to complications such as platelet refractoriness or rejection of subsequent transfusions and transplants. In mice, pathogen reduction treatment of PRP with UVB light and riboflavin (UV+R) prevents alloimmunization and appears to induce partial antigen-specific tolerance to subsequent transfusions. Herein, the in vivo responses of antigen-presenting cells and T cells to transfusion with UV+R-treated allogeneic PRP were evaluated to understand the cellular immune responses leading to antigen-specific tolerance. Mice that received UV+R-treated PRP had significantly increased transforming growth factor β (TGF-β) expression by CD11b+ CD4+ CD11cHi conventional dendritic cells (cDCs) and CD11bHi monocytes (P < .05). While robust T-cell responses to transfusions with untreated allogeneic PRP were observed (P < .05), these were blocked by UV+R treatment. Mice given UV+R-treated PRP followed by untreated PRP showed an early significant (P < .01) enrichment in regulatory T (Treg) cells and associated TGF-β production as well as diminished effector T-cell responses. Adoptive transfer of T-cell-enriched splenocytes from mice given UV+R-treated PRP into naive recipients led to a small but significant reduction of CD8+ T-cell responses to subsequent allogeneic transfusion. These data demonstrate that pathogen reduction with UV+R induces a tolerogenic profile by way of CD11b+ CD4+ cDCs, monocytes, and induction of Treg cells, blocking T-cell activation and reducing secondary T-cell responses to untreated platelets in vivo.
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Saris A, Pavenski K. Human Leukocyte Antigen Alloimmunization and Alloimmune Platelet Refractoriness. Transfus Med Rev 2020; 34:250-257. [PMID: 33127210 DOI: 10.1016/j.tmrv.2020.09.010] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Revised: 09/13/2020] [Accepted: 09/16/2020] [Indexed: 02/06/2023]
Abstract
Despite significant advancements in the production of platelet products, storage, and transfusion, transfusion refractoriness remains a significant clinical problem, affecting up to 14% of hematological patients receiving platelet transfusions. Human leukocyte antigen (HLA) alloimmunization is a major cause of immune platelet refractoriness, and its rate can be significantly reduced by implementation of leukoreduction. Despite promising preclinical results, pathogen reduction does not reduce HLA alloimmunization. Patients with HLA alloimmune refractoriness are usually managed with HLA-selected platelet transfusions. In this review, we describe the pathophysiology of HLA alloimmunization and alloimmune refractoriness, as well as options to prevent and treat these transfusion complications. We discuss the evidence supporting these options and point out the outstanding gaps. Finally, we review the possible future directions for prevention and treatment of alloimmune refractoriness.
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Affiliation(s)
- Anno Saris
- Department of Infectious Diseases, Leiden University Medical Centre, Leiden, the Netherlands.
| | - Katerina Pavenski
- Departments of Medicine and Laboratory Medicine, St. Michael's Hospital and University of Toronto, Toronto, Ontario, Canada.
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New strategies for the control of infectious and parasitic diseases in blood donors: the impact of pathogen inactivation methods. EUROBIOTECH JOURNAL 2020. [DOI: 10.2478/ebtj-2020-0007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Abstract
Around 70 infectious agents are possible threats for blood safety.
The risk for blood recipients is increasing because of new emergent agents like West Nile, Zika and Chikungunya viruses, or parasites such as Plasmodium and Trypanosoma cruzi in non-endemic regions, for instance.
Screening programmes of the donors are more and more implemented in several Countries, but these cannot prevent completely infections, especially when they are caused by new agents.
Pathogen inactivation (PI) methods might overcome the limits of the screening and different technologies have been set up in the last years.
This review aims to describe the most widely used methods focusing on their efficacy as well as on the preservation integrity of blood components.
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Chun S, Phan MTT, Hong S, Yang J, Yoon Y, Han S, Kang J, Yazer MH, Kim J, Cho D. Double-filtered leukoreduction as a method for risk reduction of transfusion-associated graft-versus-host disease. PLoS One 2020; 15:e0229724. [PMID: 32214402 PMCID: PMC7098637 DOI: 10.1371/journal.pone.0229724] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 02/13/2020] [Indexed: 11/20/2022] Open
Abstract
Background Transfusion-associated graft-versus-host disease (TA-GvHD) is caused by leukocytes, specifically T cells within a transfused blood product. Currently, the prevention of transfusion-associated graft-versus-host disease is performed by irradiation of blood products. With a sufficient reduction of leukocytes, the risk for TA-GvHD can be decreased. With consistent advances in current state-of-the-art blood filters, we herein propose that double filtration can sufficiently reduce leukocytes to reduce the risk for TA-GvHD. Materials Thirty RBC concentrates were filtered with leukocyte filters, followed by storage at 1–6 oC for 72 hours, and then a second filtration was performed. Residual leukocytes in the double-filtered RBC units (n = 30) were assessed with flow cytometric methods, and an additional assay with isolated peripheral blood mononuclear cells (PBMCs) (n = 6) was done by both flow cytometric methods and an automated hematology analyzer. Quality of the RBCs after filtration was evaluated by hematological and biochemical tests. In vitro T cell expansion was performed using anti-CD3/CD28-coated Dynabeads or anti-CD3 (OKT3). In vivo experiment for GvHD was performed by using NOD.Cg-Prkdcscid Il2rgtm1Wjl/SzJ (NSG) mice. Results Double-filtered blood products showed residual leukocyte levels below detection limits, which calculated to be below 1200–2500 cells per blood unit. In vitro expansion rate of T cells showed that 6x103 and 1x103 cell-seeded specimens showed 60.8±10.6 fold and 10.2±9.7-fold expansion, respectively. Cell expansion was not sufficiently observed in wells planted with 1x102 or 10 cells. In vivo experiments showed that mice injected with 1x105 or more cells cause fatal GvHD. GvHD induced inflammation was observed in mice injected with 1x104 or more cells. No evidence of GvHD was found in mice injected with 103 cells. Conclusions Our study suggests that additional removal of contaminating lymphocytes by a second leukodepletion step may further reduce the risk for TA-GvHD.
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Affiliation(s)
- Sejong Chun
- Department of Laboratory Medicine, Chonnam National University Medical School & Hospital, Gwangju, Korea
| | - Minh-Trang Thi Phan
- Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunwan University School of Medicine, Seoul, Korea
| | - Saetbyul Hong
- Animal Research and Molecular Imaging Center, Samsung Medical Center, Seoul, Korea
| | - Jehoon Yang
- Animal Research and Molecular Imaging Center, Samsung Medical Center, Seoul, Korea
| | - Yeup Yoon
- Animal Research and Molecular Imaging Center, Samsung Medical Center, Seoul, Korea
- Samsung Advanced Institute for Health Sciences & Technology, Sungkyunwan University School of Medicine, Seoul, Korea
| | - Sangbin Han
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jungwon Kang
- Blood Transfusion Research Institute, Korean Red Cross, Wonju, Korea
| | - Mark H. Yazer
- Department of Pathology, University of Pittsburgh, Pittsburgh, PA, United States of America
| | - Jaehyun Kim
- Blood Transfusion Research Institute, Korean Red Cross, Wonju, Korea
- * E-mail: (DC); (JK)
| | - Duck Cho
- Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunwan University School of Medicine, Seoul, Korea
- Samsung Advanced Institute for Health Sciences & Technology, Sungkyunwan University School of Medicine, Seoul, Korea
- * E-mail: (DC); (JK)
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12
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Nelson KA, Aldea GS, Warner P, Latchman Y, Gunasekera D, Tamir A, Gernsheimer T, Bolgiano D, Slichter SJ. Transfusion‐related immunomodulation: gamma irradiation alters the effects of leukoreduction on alloimmunization. Transfusion 2019; 59:3396-3404. [DOI: 10.1111/trf.15555] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 08/21/2019] [Accepted: 08/21/2019] [Indexed: 12/28/2022]
Affiliation(s)
| | - Gabriel S. Aldea
- Department of Surgery, Division of Cardiothoracic Surgery University of Washington Seattle Washington
| | | | - Yvette Latchman
- Bloodworks Northwest Seattle Washington
- Silverback Therapeutics Seattle Washington
| | - Devi Gunasekera
- Bloodworks Northwest Seattle Washington
- Uniformed Services University of Health Sciences Bethesda Maryland
| | | | - Terry Gernsheimer
- Bloodworks Northwest Seattle Washington
- Division of Hematology University of Washington School of Medicine Seattle Washington
- Seattle Cancer Care Alliance Seattle Washington
| | | | - Sherrill J. Slichter
- Bloodworks Northwest Seattle Washington
- Division of Hematology University of Washington School of Medicine Seattle Washington
- Seattle Cancer Care Alliance Seattle Washington
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13
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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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14
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Rebulla P. The long and winding road to pathogen reduction of platelets, red blood cells and whole blood. Br J Haematol 2019; 186:655-667. [PMID: 31304588 DOI: 10.1111/bjh.16093] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 06/22/2019] [Indexed: 02/07/2023]
Abstract
Pathogen reduction technologies (PRTs) have been developed to further reduce the current very low risks of acquiring transfusion-transmitted infections and promptly respond to emerging infectious threats. An entire portfolio of PRTs suitable for all blood components is not available, but the field is steadily progressing. While PRTs for plasma have been used for many years, PRTs for platelets, red blood cells (RBC) and whole blood (WB) were developed more slowly, due to difficulties in preserving cell functions during storage. Two commercial platelet PRTs use ultra violet (UV) A and UVB light in the presence of amotosalen or riboflavin to inactivate pathogens' nucleic acids, while a third experimental PRT uses UVC light only. Two PRTs for WB and RBC have been tested in experimental clinical trials with storage limited to 21 or 35 days, due to unacceptably high RBC storage lesion beyond these time limits. This review summarizes pre-clinical investigations and selected outcomes from clinical trials using the above PRTs. Further studies are warranted to decrease cell storage lesions after PRT treatment and to test PRTs in different medical and surgical conditions. Affordability remains a major administrative obstacle to PRT use, particularly so in geographical regions with higher risks of transfusion-transmissible infections.
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Affiliation(s)
- Paolo Rebulla
- Department of Transfusion Medicine and Haematology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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15
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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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16
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Saris A, Kerkhoffs JL, Norris PJ, van Ham SM, Ten Brinke A, Brand A, van der Meer PF, Zwaginga JJ. The role of pathogen-reduced platelet transfusions on HLA alloimmunization in hemato-oncological patients. Transfusion 2018; 59:470-481. [PMID: 30499599 DOI: 10.1111/trf.15056] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 09/19/2018] [Accepted: 09/19/2018] [Indexed: 12/30/2022]
Abstract
BACKGROUND Platelet transfusions can induce alloimmunization against HLA antigens. The use of pathogen-reduced platelet concentrates (PCs) was suggested to reduce HLA alloimmunization and concomitant transfusion refractoriness. METHODS This study investigated HLA alloimmunization in available samples from 448 hemato-oncological patients who were randomized for the Pathogen Reduction Evaluation and Predictive Analytical Rating Score (PREPAReS) trial to receive either untreated or pathogen-reduced PCs (Mirasol, Terumo BCT Inc.). Anti-HLA Class I and II antibodies were determined before the first platelet transfusion and weekly thereafter using multiplex assay with standard cutoffs to detect low- as well as high-level antibodies. RESULTS When using the lower cutoff, in patients who were antibody negative at enrollment, 5.4% (n = 12) developed anti-HLA Class I antibodies after receiving untreated PCs, while this was significantly higher in patients receiving pathogen-reduced PCs, 12.8% (n = 29; p = 0.009, intention-to-treat [ITT] analysis). A similar but nonsignificant trend was observed in the per-protocol (PP) analysis (5.4% vs. 10.1%; p = 0.15). HLA class II antibody formation was similar between both types of PCs in the ITT analysis, while the PP analysis showed a trend toward lower immunization after receiving pathogen-reduced PCs. Multivariate analysis identified receiving pathogen-reduced platelets as an independent risk factor for HLA Class I alloimmunization (ITT: odds ratio [95% confidence interval] = 3.02 [1.42-6.51], PP: odds ratio [95% confidence interval] = 2.77 [1.00-5.40]), without affecting HLA Class II alloimmunization. When using the high cutoff value, the difference in HLA Class I alloimmunization between study arms remained significant in the ITT analysis and again was not significant in the PP analysis. CONCLUSION Our data clearly indicate that Mirasol pathogen inactivation does not prevent HLA Class I or II alloimmunization after platelet transfusions.
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Affiliation(s)
- Anno Saris
- Department of Immunopathology, Sanquin Research, Amsterdam, The Netherlands.,Landsteiner Laboratory, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Jean Louis Kerkhoffs
- Center for Clinical Transfusion Research, Sanquin Research, Leiden, The Netherlands.,Jon J. van Rood Center for Clinical Transfusion Science, Leiden University Medical Center, Leiden, The Netherlands
| | - Philip J Norris
- Blood Systems Research Institute, San Francisco, California.,Department of Laboratory Medicine, University of California, San Francisco, San Francisco, California
| | - S Marieke van Ham
- Department of Immunopathology, Sanquin Research, Amsterdam, The Netherlands.,Landsteiner Laboratory, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.,Swammerdam Institute for Life Sciences, University of Amsterdam, Amsterdam, The Netherlands
| | - Anja Ten Brinke
- Department of Immunopathology, Sanquin Research, Amsterdam, The Netherlands.,Landsteiner Laboratory, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Anneke Brand
- Center for Clinical Transfusion Research, Sanquin Research, Leiden, The Netherlands.,Jon J. van Rood Center for Clinical Transfusion Science, Leiden University Medical Center, Leiden, The Netherlands
| | - Pieter F van der Meer
- Center for Clinical Transfusion Research, Sanquin Research, Leiden, The Netherlands.,Jon J. van Rood Center for Clinical Transfusion Science, Leiden University Medical Center, Leiden, The Netherlands
| | - Jaap Jan Zwaginga
- Center for Clinical Transfusion Research, Sanquin Research, Leiden, The Netherlands.,Jon J. van Rood Center for Clinical Transfusion Science, Leiden University Medical Center, Leiden, The Netherlands.,Department of Immunohematology and Blood Transfusion, Leiden University Medical Center, Leiden, The Netherlands
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17
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Kleinman S, Stassinopoulos A. Transfusion-associated graft-versus-host disease reexamined: potential for improved prevention using a universally applied intervention. Transfusion 2018; 58:2545-2563. [DOI: 10.1111/trf.14930] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 07/27/2018] [Accepted: 07/29/2018] [Indexed: 02/06/2023]
Affiliation(s)
- Steven Kleinman
- Clinical Pathology; University of British Columbia, School of Medicine; Vancouver British Columbia Canada
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18
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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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19
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Schubert P, Johnson L, Marks DC, Devine DV. Ultraviolet-Based Pathogen Inactivation Systems: Untangling the Molecular Targets Activated in Platelets. Front Med (Lausanne) 2018; 5:129. [PMID: 29868586 PMCID: PMC5949320 DOI: 10.3389/fmed.2018.00129] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 04/19/2018] [Indexed: 12/13/2022] Open
Abstract
Transfusions of platelets are an important cornerstone of medicine; however, recipients may be subject to risk of adverse events associated with the potential transmission of pathogens, especially bacteria. Pathogen inactivation (PI) technologies based on ultraviolet illumination have been developed in the last decades to mitigate this risk. This review discusses studies of platelet concentrates treated with the current generation of PI technologies to assess their impact on quality, PI capacity, safety, and clinical efficacy. Improved safety seems to come with the cost of reduced platelet functionality, and hence transfusion efficacy. In order to understand these negative impacts in more detail, several molecular analyses have identified signaling pathways linked to platelet function that are altered by PI. Because some of these biochemical alterations are similar to those seen arising in the context of routine platelet storage lesion development occurring during blood bank storage, we lack a complete picture of the contribution of PI treatment to impaired platelet functionality. A model generated using data from currently available publications places the signaling protein kinase p38 as a central player regulating a variety of mechanisms triggered in platelets by PI systems.
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Affiliation(s)
- Peter Schubert
- Canadian Blood Services, Vancouver, BC, Canada.,Centre for Blood Research, University of British Columbia, Vancouver, BC, Canada
| | - Lacey Johnson
- Research and Development, Australian Red Cross Blood Service, Sydney, NSW, Australia
| | - Denese C Marks
- Research and Development, Australian Red Cross Blood Service, Sydney, NSW, Australia.,Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
| | - Dana V Devine
- Canadian Blood Services, Vancouver, BC, Canada.,Centre for Blood Research, University of British Columbia, Vancouver, BC, Canada
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20
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Castro G, Merkel PA, Giclas HE, Gibula A, Andersen GE, Corash LM, Lin JS, Green J, Knight V, Stassinopoulos A. Amotosalen/UVA treatment inactivates T cells more effectively than the recommended gamma dose for prevention of transfusion-associated graft-versus-host disease. Transfusion 2018; 58:1506-1515. [PMID: 29607502 DOI: 10.1111/trf.14589] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 01/30/2018] [Accepted: 02/01/2018] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Transfusion-associated graft-versus-host disease (TA-GVHD) is a rare complication after transfusion of components containing viable donor T cells. Gamma irradiation with doses that stop T-cell proliferation is the predominant method to prevent TA-GVHD. Treatment with pathogen inactivation methodologies has been found to also be effective against proliferating white blood cells, including T cells. In this study, T-cell inactivation was compared, between amotosalen/ultraviolet A (UVA) treatment and gamma-irradiation (2500 cGy), using a sensitive limiting dilution assay (LDA) with an enhanced dynamic range. METHODS AND MATERIALS Matched plasma units (N = 8), contaminated with 1 × 106 peripheral blood mononuclear cells (PBMCs) per mL, were either treated with amotosalen/UVA or gamma irradiation, or retained as untreated control. Posttreatment, cells were cultured under standardized conditions. T-cell proliferation was determined by the incorporation of 3 H-thymidine and correlated with microscopic detection. RESULTS Range-finding experiments showed that after gamma irradiation (2500 cGy), significant T-cell proliferation could be observed at a 1 × 107 cell culture density, some proliferation at 1 × 106 , and none at 1 × 105 cells/well. Based on these facts, a quantitative comparison was carried out between amotosalen/UVA at the highest challenge of 1 × 107 PBMCs/well, and gamma irradiation at 1 × 106 and 1 × 105 PBMCs/well. Complete inactivation of the T cells after amotosalen/UVA treatment was observed, equivalent to greater than 6.2 log inactivation. Complete inactivation of the T cells was also observed after gamma irradiation when 1 × 105 PBMCs/well were cultured (>4.2 log inactivation). Proliferation was observed when 1 × 106 PBMCs/well were cultured (≤5.2 log inactivation) after gamma irradiation. CONCLUSION Amotosalen/UVA treatment more effectively inactivates T cells than the current standard of gamma irradiation (2500 cGy) for the prevention of TA-GVHD.
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21
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Salunkhe V, De Cuyper IM, Papadopoulos P, van der Meer PF, Daal BB, Villa-Fajardo M, de Korte D, van den Berg TK, Gutiérrez L. A comprehensive proteomics study on platelet concentrates: Platelet proteome, storage time and Mirasol pathogen reduction technology. Platelets 2018; 30:368-379. [PMID: 29553857 DOI: 10.1080/09537104.2018.1447658] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Platelet concentrates (PCs) represent a blood transfusion product with a major concern for safety as their storage temperature (20-24°C) allows bacterial growth, and their maximum storage time period (less than a week) precludes complete microbiological testing. Pathogen inactivation technologies (PITs) provide an additional layer of safety to the blood transfusion products from known and unknown pathogens such as bacteria, viruses, and parasites. In this context, PITs, such as Mirasol Pathogen Reduction Technology (PRT), have been developed and are implemented in many countries. However, several studies have shown in vitro that Mirasol PRT induces a certain level of platelet shape change, hyperactivation, basal degranulation, and increased oxidative damage during storage. It has been suggested that Mirasol PRT might accelerate what has been described as the platelet storage lesion (PSL), but supportive molecular signatures have not been obtained. We aimed at dissecting the influence of both variables, that is, Mirasol PRT and storage time, at the proteome level. We present comprehensive proteomics data analysis of Control PCs and PCs treated with Mirasol PRT at storage days 1, 2, 6, and 8. Our workflow was set to perform proteomics analysis using a gel-free and label-free quantification (LFQ) approach. Semi-quantification was based on LFQ signal intensities of identified proteins using MaxQuant/Perseus software platform. Data are available via ProteomeXchange with identifier PXD008119. We identified marginal differences between Mirasol PRT and Control PCs during storage. However, those significant changes at the proteome level were specifically related to the functional aspects previously described to affect platelets upon Mirasol PRT. In addition, the effect of Mirasol PRT on the platelet proteome appeared not to be exclusively due to an accelerated or enhanced PSL. In summary, semi-quantitative proteomics allows to discern between proteome changes due to Mirasol PRT or PSL, and proves to be a methodology suitable to phenotype platelets in an unbiased manner, in various physiological contexts.
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Affiliation(s)
- Vishal Salunkhe
- a Department of Blood Cell Research , Sanquin Research and Landsteiner Laboratory, Academic Medical Centre (AMC), University of Amsterdam (UvA) , Amsterdam , The Netherlands
| | - Iris M De Cuyper
- a Department of Blood Cell Research , Sanquin Research and Landsteiner Laboratory, Academic Medical Centre (AMC), University of Amsterdam (UvA) , Amsterdam , The Netherlands
| | - Petros Papadopoulos
- b Department of Hematology , Hospital Clínico San Carlos, Instituto de Investigación Sanitaria San Carlos (IdISSC) , Madrid , Spain
| | - Pieter F van der Meer
- c Department of Product and Process Development , Sanquin Blood Bank , Amsterdam , The Netherlands
| | - Brunette B Daal
- c Department of Product and Process Development , Sanquin Blood Bank , Amsterdam , The Netherlands
| | - María Villa-Fajardo
- b Department of Hematology , Hospital Clínico San Carlos, Instituto de Investigación Sanitaria San Carlos (IdISSC) , Madrid , Spain
| | - Dirk de Korte
- a Department of Blood Cell Research , Sanquin Research and Landsteiner Laboratory, Academic Medical Centre (AMC), University of Amsterdam (UvA) , Amsterdam , The Netherlands.,c Department of Product and Process Development , Sanquin Blood Bank , Amsterdam , The Netherlands
| | - Timo K van den Berg
- a Department of Blood Cell Research , Sanquin Research and Landsteiner Laboratory, Academic Medical Centre (AMC), University of Amsterdam (UvA) , Amsterdam , The Netherlands
| | - Laura Gutiérrez
- a Department of Blood Cell Research , Sanquin Research and Landsteiner Laboratory, Academic Medical Centre (AMC), University of Amsterdam (UvA) , Amsterdam , The Netherlands.,b Department of Hematology , Hospital Clínico San Carlos, Instituto de Investigación Sanitaria San Carlos (IdISSC) , Madrid , Spain
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22
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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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23
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Kim S, Handke W, Gravemann U, Döscher A, Brixner V, Müller TH, Seltsam A. Mitochondrial DNA multiplex real-time polymerase chain reaction inhibition assay for quality control of pathogen inactivation by ultraviolet C light in platelet concentrates. Transfusion 2017; 58:758-765. [PMID: 29282743 DOI: 10.1111/trf.14464] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Revised: 11/20/2017] [Accepted: 11/20/2017] [Indexed: 12/19/2022]
Abstract
BACKGROUND Several ultraviolet (UV) light-based pathogen inactivation (PI) technologies for platelet (PLT) products have been developed or are under development. Upon implementation of PI technologies, quality control measures are required to ensure consistent efficiency of the treatment process. Previous reports showed that amotosalen/UVA and riboflavin/UV-based PI technologies induce modifications of the PLT-derived mitochondrial DNA (mtDNA) that can be detected by polymerase chain reaction (PCR) inhibition assays. In this study, we sought to establish a PCR inhibition assay to document the impact of ultraviolet C (UVC) treatment with the THERAFLEX UV-Platelets system on the mitochondrial genome in PLT concentrates (PCs). STUDY DESIGN AND METHODS A multiplex real-time PCR inhibition assay with simultaneous short-amplicon (143 bp) and long-amplicon (794 bp) amplification was developed to detect mtDNA modifications in PLTs after UVC treatment. Assay performance was tested in UVC-treated and untreated, plasma-reduced pooled PCs, and apheresis PCs and challenged using PCs manufactured for a clinical trial under routine-like conditions. RESULTS UVC illumination of PLTs resulted in dose-dependent inhibition of mtDNA amplification for the larger amplicon. Amplification of the shorter amplicon was not affected by UVC treatment. Evaluation of 283 blinded apheresis and pooled PLT samples from routine-like PC production resulted in prediction of UVC treatment status with 100% accuracy. CONCLUSION The proposed dual-amplicon size real-time mtDNA PCR assay effectively detects nucleic acid damage induced by UVC illumination of PLTs and could be useful as an informative indicator of PI quality of the THERAFLEX UV-Platelets system.
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Affiliation(s)
- Sinyoung Kim
- German Red Cross Blood Service NSTOB, Institute Springe, Springe, Germany.,Department of Laboratory Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Wiebke Handke
- German Red Cross Blood Service NSTOB, Institute Springe, Springe, Germany
| | - Ute Gravemann
- German Red Cross Blood Service NSTOB, Institute Springe, Springe, Germany
| | - Andrea Döscher
- German Red Cross Blood Service NSTOB, Institute Oldenburg-Bremen, Oldenburg, Germany
| | - Veronika Brixner
- German Red Cross Blood Service Baden-Württemberg-Hessen, Frankfurt, Germany
| | - Thomas H Müller
- German Red Cross Blood Service NSTOB, Institute Springe, Springe, Germany
| | - Axel Seltsam
- German Red Cross Blood Service NSTOB, Institute Springe, Springe, Germany
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24
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Induced Pluripotent Stem Cell-Derived Red Blood Cells and Platelet Concentrates: From Bench to Bedside. Cells 2017; 7:cells7010002. [PMID: 29280988 PMCID: PMC5789275 DOI: 10.3390/cells7010002] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Revised: 12/20/2017] [Accepted: 12/23/2017] [Indexed: 12/20/2022] Open
Abstract
Red blood cells and platelets are anucleate blood components indispensable for oxygen delivery and hemostasis, respectively. Derivation of these blood elements from induced pluripotent stem (iPS) cells has the potential to develop blood donor-independent and genetic manipulation-prone products to complement or replace current transfusion banking, also minimizing the risk of alloimmunization. While the production of erythrocytes from iPS cells has challenges to overcome, such as differentiation into adult-type phenotype that functions properly after transfusion, platelet products are qualitatively and quantitatively approaching a clinically-applicable level owing to advances in expandable megakaryocyte (MK) lines, platelet-producing bioreactors, and novel reagents. Guidelines that assure the quality of iPS cells-derived blood products for clinical application represent a novel challenge for regulatory agencies. Considering the minimal risk of tumorigenicity and the expected significant demand of such products, ex vivo production of iPS-derived blood components can pave the way for iPS translation into the clinic.
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25
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Photochemical inactivation of lymphocytes by riboflavin with visible light for TA-GVHD prevention. JOURNAL OF PHOTOCHEMISTRY AND PHOTOBIOLOGY B-BIOLOGY 2017; 174:276-283. [DOI: 10.1016/j.jphotobiol.2017.08.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Revised: 08/01/2017] [Accepted: 08/06/2017] [Indexed: 11/15/2022]
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26
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Yang P, Wen H, Zhong T, Hu H, Zhu B, Xia K, Xu M, Bian M. GADD45α is involved in the apoptosis of lymphocytes induced by riboflavin and ultraviolet light. Transfusion 2016; 57:646-656. [PMID: 27905125 DOI: 10.1111/trf.13945] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Revised: 10/19/2016] [Accepted: 10/21/2016] [Indexed: 01/02/2023]
Abstract
BACKGROUND Riboflavin plus ultraviolet (UV) pathogen reduction technology (RF-PRT) is an effective method for inactivating the residual white blood cells (WBCs) in blood components. The RF-PRT system for platelets is known to activate many signaling pathways, including p38 and NF-κB. Nevertheless, proteomic studies in WBCs after riboflavin plus UV treatment requires further analysis. STUDY DESIGN AND METHODS ABO/D-matched lymphocytes were pooled, split, and treated with RF-PRT or UV light or left untreated. After treatment, cell apoptosis was measured. In addition, cell proliferation and the cycle distribution were evaluated upon stimulation with phytohemagglutinin. The changes in the protein expression levels of growth arrest and DNA damage-inducible (GADD)45α, p38, and c-Jun N-terminal kinase (JNK) were determined by Western blotting. The effect of GADD45α, p38, and JNK on apoptosis was assessed. RESULTS RF-PRT significantly inhibited proliferation and induced G1 arrest in lymphocytes. Furthermore, the percentage of apoptotic cells was increased in RF-PRT-treated lymphocytes compared to UV-treated cells or untreated cells, associated with the up regulation of GADD45α expression. Consistent with these observations, the inhibition of GADD45α expression partially counteracted the effects of riboflavin plus UV treatment. The p38 and JNK signaling pathways were activated by GADD45α in RF-PRT-treated lymphocytes. CONCLUSIONS These data revealed that RF-PRT effectively inhibited proliferation and induced apoptosis of lymphocytes by promoting GADD45α expression, which subsequently activates p38 and JNK signaling pathways.
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Affiliation(s)
- Peng Yang
- Department of Blood Transfusion, the First Affiliated Hospital of Anhui Medical University, Anhui, PR China
| | - Huiqin Wen
- Department of Blood Transfusion, the First Affiliated Hospital of Anhui Medical University, Anhui, PR China
| | - Tao Zhong
- Department of Blood Transfusion, the First Affiliated Hospital of Anhui Medical University, Anhui, PR China
| | - Hailiang Hu
- Department of Blood Transfusion, the First Affiliated Hospital of Anhui Medical University, Anhui, PR China
| | - Bangqiang Zhu
- Department of Blood Transfusion, the First Affiliated Hospital of Anhui Medical University, Anhui, PR China
| | - Kang Xia
- Department of Blood Transfusion, the First Affiliated Hospital of Anhui Medical University, Anhui, PR China
| | - Mo Xu
- Department of Pathophysiology, School of Basic Medical Science, Anhui Medical University, Anhui, PR China
| | - Maohong Bian
- Department of Blood Transfusion, the First Affiliated Hospital of Anhui Medical University, Anhui, PR China
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28
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Muszynski JA, Spinella PC, Cholette JM, Acker JP, Hall MW, Juffermans NP, Kelly DP, Blumberg N, Nicol K, Liedel J, Doctor A, Remy KE, Tucci M, Lacroix J, Norris PJ. Transfusion-related immunomodulation: review of the literature and implications for pediatric critical illness. Transfusion 2016; 57:195-206. [PMID: 27696473 DOI: 10.1111/trf.13855] [Citation(s) in RCA: 96] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Revised: 08/01/2016] [Accepted: 08/15/2016] [Indexed: 02/06/2023]
Abstract
Transfusion-related immunomodulation (TRIM) in the intensive care unit (ICU) is difficult to define and likely represents a complicated set of physiologic responses to transfusion, including both proinflammatory and immunosuppressive effects. Similarly, the immunologic response to critical illness in both adults and children is highly complex and is characterized by both acute inflammation and acquired immune suppression. How transfusion may contribute to or perpetuate these phenotypes in the ICU is poorly understood, despite the fact that transfusion is common in critically ill patients. Both hyperinflammation and severe immune suppression are associated with poor outcomes from critical illness, underscoring the need to understand potential immunologic consequences of blood product transfusion. In this review we outline the dynamic immunologic response to critical illness, provide clinical evidence in support of immunomodulatory effects of blood product transfusion, review preclinical and translational studies to date of TRIM, and provide insight into future research directions.
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Affiliation(s)
- Jennifer A Muszynski
- Division of Critical Care Medicine, Canadian Blood Services, Edmonton, Alberta, Canada.,The Research Institute, Canadian Blood Services, Edmonton, Alberta, Canada
| | - Philip C Spinella
- Department of Pediatrics, Division Pediatric Critical Care, Canadian Blood Services, Edmonton, Alberta, Canada
| | - Jill M Cholette
- Pediatric Critical Care and Cardiology, Canadian Blood Services, Edmonton, Alberta, Canada
| | - Jason P Acker
- Centre for Innovation, Canadian Blood Services.,Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada
| | - Mark W Hall
- Division of Critical Care Medicine, Canadian Blood Services, Edmonton, Alberta, Canada.,The Research Institute, Canadian Blood Services, Edmonton, Alberta, Canada
| | - Nicole P Juffermans
- Department of Intensive Care Medicine, Academic Medical Center, Amsterdam, the Netherlands
| | - Daniel P Kelly
- Division of Critical Care, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Neil Blumberg
- Transfusion Medicine/Blood Bank and Clinical Laboratories, Departments of Pathology and Laboratory Medicine, University of Rochester, Rochester, New York
| | - Kathleen Nicol
- Department of Pathology, Nationwide Children's Hospital, Columbus, Ohio
| | - Jennifer Liedel
- Pediatric Critical Care Medicine, Albert Einstein College of Medicine, Children's Hospital at Montefiore, Bronx, New York
| | - Allan Doctor
- Departments of Pediatrics and Biochemistry, Washington University in St Louis, St Louis, Missouri
| | - Kenneth E Remy
- Department of Pediatrics, Division Pediatric Critical Care, Canadian Blood Services, Edmonton, Alberta, Canada
| | - Marisa Tucci
- Department of Pediatrics, Sainte-Justine Hospital, Université de Montréal, Montreal, Quebec, Canada
| | - Jacques Lacroix
- Department of Pediatrics, Sainte-Justine Hospital, Université de Montréal, Montreal, Quebec, Canada
| | - Philip J Norris
- Blood Systems Research Institute.,Departments of Laboratory Medicine and Medicine, University of California, San Francisco, San Francisco, California
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Schmidt AE, Refaai MA, Blumberg N. Past, present and forecast of transfusion medicine: What has changed and what is expected to change? Presse Med 2016; 45:e253-72. [PMID: 27474234 DOI: 10.1016/j.lpm.2016.06.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Blood transfusion is the second most used medical procedures in health care systems worldwide. Over the last few decades, significant changes have been evolved in transfusion medicine practices. These changes were mainly needed to increase safety, efficacy, and availability of blood products as well as reduce recipients' unnecessary exposure to allogeneic blood. Blood products collection, processing, and storage as well as transfusion practices throughout all patient populations were the main stream of these changes. Health care systems across the world have adopted some or most of these changes to reduce transfusion risks, to improve overall patients' outcome, and to reduce health care costs. In this article, we are going to present and discuss some of these recent modifications and their impact on patients' safety.
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Affiliation(s)
- Amy E Schmidt
- University of Rochester medical center, department of pathology and laboratory medicine, 14642 Rochester, NY, USA
| | - Majed A Refaai
- University of Rochester medical center, department of pathology and laboratory medicine, 14642 Rochester, NY, USA
| | - Neil Blumberg
- University of Rochester medical center, department of pathology and laboratory medicine, 14642 Rochester, NY, USA.
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Schubert P, Culibrk B, Karwal S, Goodrich RP, Devine DV. Protein translation occurs in platelet concentrates despite riboflavin/UV light pathogen inactivation treatment. Proteomics Clin Appl 2016; 10:839-50. [DOI: 10.1002/prca.201500139] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Revised: 05/15/2016] [Accepted: 05/22/2016] [Indexed: 12/21/2022]
Affiliation(s)
- Peter Schubert
- Centre for Innovation; Canadian Blood Services, University of British Columbia; Vancouver BC Canada
- Centre for Blood Research, University of British Columbia; Vancouver BC Canada
- Department of Pathology and Laboratory Medicine; University of British Columbia; Vancouver BC Canada
| | - Brankica Culibrk
- Centre for Innovation; Canadian Blood Services, University of British Columbia; Vancouver BC Canada
- Centre for Blood Research, University of British Columbia; Vancouver BC Canada
| | - Simrath Karwal
- Centre for Innovation; Canadian Blood Services, University of British Columbia; Vancouver BC Canada
- Centre for Blood Research, University of British Columbia; Vancouver BC Canada
| | | | - Dana V. Devine
- Centre for Innovation; Canadian Blood Services, University of British Columbia; Vancouver BC Canada
- Centre for Blood Research, University of British Columbia; Vancouver BC Canada
- Department of Pathology and Laboratory Medicine; University of British Columbia; Vancouver BC Canada
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31
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Kaplan A, Lindgren B, Marschner S, Aznar M, Zalba S, Sánchez P, Ayape ML, Olavarría E, Antelo ML. Evaluation of the post-transfusion platelet increment and safety of riboflavin-based pathogen reduction technology (PRT) treated platelet products stored in platelet additive solution for 5 days or less versus 6–7 days. Transfus Apher Sci 2016; 54:248-52. [DOI: 10.1016/j.transci.2015.08.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2015] [Revised: 08/19/2015] [Accepted: 08/20/2015] [Indexed: 11/24/2022]
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Focosi D, Pistello M. Effect of Induced Pluripotent Stem Cell Technology in Blood Banking. Stem Cells Transl Med 2016; 5:269-74. [PMID: 26819256 DOI: 10.5966/sctm.2015-0257] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2015] [Accepted: 12/04/2015] [Indexed: 01/25/2023] Open
Abstract
Population aging has imposed cost-effective alternatives to blood donations. Artificial blood is still at the preliminary stages of development, and the need for viable cells seems unsurmountable. Because large numbers of viable cells must be promptly available for clinical use, stem cell technologies, expansion, and banking represent ideal tools to ensure a regular supply. Provided key donors can be identified, induced pluripotent stem cell (iPSC) technology could pave the way to a new era in transfusion medicine, just as it is already doing in many other fields of medicine. The present review summarizes the current state of research on iPSC technology in the field of blood banking, highlighting hurdles, and promises.
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Affiliation(s)
- Daniele Focosi
- North-Western Tuscany Blood Bank, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Mauro Pistello
- Retrovirus Center and Virology Section, Department of Translational Research, University of Pisa, Pisa, Italy Virology Unit, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
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Ignatova AA, Karpova OV, Trakhtman PE, Rumiantsev SA, Panteleev MA. Functional characteristics and clinical effectiveness of platelet concentrates treated with riboflavin and ultraviolet light in plasma and in platelet additive solution. Vox Sang 2015; 110:244-52. [DOI: 10.1111/vox.12364] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2015] [Revised: 09/30/2015] [Accepted: 10/07/2015] [Indexed: 12/27/2022]
Affiliation(s)
- A. A. Ignatova
- Federal Scientific Clinical Centre of Pediatric Hematology, Oncology and Immunology named after Dmitry Rogachev Ministry of Health of Russian; Moscow Russian Federation
| | - O. V. Karpova
- Federal Scientific Clinical Centre of Pediatric Hematology, Oncology and Immunology named after Dmitry Rogachev Ministry of Health of Russian; Moscow Russian Federation
| | - P. E. Trakhtman
- Federal Scientific Clinical Centre of Pediatric Hematology, Oncology and Immunology named after Dmitry Rogachev Ministry of Health of Russian; Moscow Russian Federation
| | - S. A. Rumiantsev
- Federal Scientific Clinical Centre of Pediatric Hematology, Oncology and Immunology named after Dmitry Rogachev Ministry of Health of Russian; Moscow Russian Federation
| | - M. A. Panteleev
- Federal Scientific Clinical Centre of Pediatric Hematology, Oncology and Immunology named after Dmitry Rogachev Ministry of Health of Russian; Moscow Russian Federation
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Dalal A. Intestinal transplantation: The anesthesia perspective. Transplant Rev (Orlando) 2015; 30:100-8. [PMID: 26683875 DOI: 10.1016/j.trre.2015.11.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Revised: 06/30/2015] [Accepted: 11/11/2015] [Indexed: 12/12/2022]
Abstract
Intestinal transplantation is a complex and challenging surgery. It is very effective for treating intestinal failure, especially for those patients who cannot tolerate parenteral nutrition nor have extensive abdominal disease. Chronic parental nutrition can induce intestinal failure associated liver disease (IFALD). According to United Network for Organ Sharing (UNOS) data, children with intestinal failure affected by liver disease secondary to parenteral nutrition have the highest mortality on a waiting list when compared with all candidates for solid organ transplantation. Intestinal transplant grafts can be isolated or combined with the liver/duodenum/pancreas. Organ Procurement and Transplantation Network (OPTN) has defined intestinal donor criteria. Living donor intestinal transplant (LDIT) has the advantages of optimal timing, short ischemia time and good human leukocyte antigen matching contributing to lower postoperative complications in the recipient. Thoracic epidurals provide excellent analgesia for the donors, as well as recipients. Recipient management can be challenging. Thrombosis and obstruction of venous access maybe common due to prolonged parenteral nutrition and/or hypercoaguability. Thromboelastography (TEG) is helpful for managing intraoperative product therapy or thrombosis. Large fluid shifts and electrolyte disturbances may occur due to massive blood loss, dehydration, third spacing etc. Intestinal grafts are susceptible to warm and cold ischemia and ischemia-reperfusion injury (IRI). Post-reperfusion syndrome is common. Cardiac or pulmonary clots can be monitored with transesophageal echocardiography (TEE) and treated with recombinant tissue plasminogen activator. Vasopressors maybe used to ensure stable hemodynamics. Post-intestinal transplant patients may need anesthesia for procedures such as biopsies for surveillance of rejection, bronchoscopy, endoscopy, postoperative hemorrhage, anastomotic leaks, thrombosis of grafts etc. Asepsis, drug interactions between anesthetic and immunosuppressive agents and venous access are some of the anesthetic considerations for this group.
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Affiliation(s)
- Aparna Dalal
- Department of Anesthesiology, Icahn School of Medicine at Mount Sinai, 1428 Madison Avenue, New York, NY 10029, United States.
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van der Meer PF, Bontekoe IJ, Daal BB, de Korte D. Riboflavin and UV light treatment of platelets: a protective effect of platelet additive solution? Transfusion 2015; 55:1900-8. [PMID: 25752624 DOI: 10.1111/trf.13033] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Revised: 01/13/2015] [Accepted: 01/13/2015] [Indexed: 01/19/2023]
Abstract
BACKGROUND Pathogen reduction technologies (PRTs) increase the safety of the blood supply, but are also associated with cell damage. Our aim was to investigate the effect of Mirasol PRT on platelet (PLT) concentrates stored in plasma and whether the use of a PLT additive solution (PAS) is able to improve in vitro quality. STUDY DESIGN AND METHODS Twenty-two buffy coats (BCs) were pooled and split into two equal parts. To one half, 2 units of plasma were added, and to the other, 2 units of SSP+ PAS were added. Each part was equally split in half again (to resemble pooling five BCs) and PLT concentrates were prepared. One plasma PLT concentrate was Mirasol treated, and the other served as control; similarly, one SSP+ PLT concentrate was Mirasol treated, and the other not. PLT concentrates were stored for 8 days (n = 12). RESULTS Mirasol PRT led to elevated lactate production in PLT concentrates in plasma, giving lower pH values throughout storage. The use of SSP+ mostly abrogated this effect, and Mirasol-treated PLT concentrates in SSP+ had only slightly higher lactate production rates and annexin A5 binding as control PLT concentrates in plasma. However, irrespective whether plasma or SSP+ was used, Mirasol PRT led to higher CD62P expression and lower hypotonic shock response (HSR) scores. CONCLUSION Mirasol treatment leads to higher PLT activation and lower HSR scores both when stored in plasma or SSP+. However, if Mirasol-treated PLTs are stored in SSP+, lactate metabolism and annexin A5 binding are lower, showing that PAS can partly mitigate the effect of PRT. The clinical relevance of this finding needs to be demonstrated.
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Affiliation(s)
- Pieter F van der Meer
- Department of Product and Process Development, Sanquin Blood Bank, Amsterdam, the Netherlands
| | - Ido J Bontekoe
- Department of Product and Process Development, Sanquin Blood Bank, Amsterdam, the Netherlands
| | - Brunette B Daal
- Department of Product and Process Development, Sanquin Blood Bank, Amsterdam, the Netherlands
| | - Dirk de Korte
- Department of Product and Process Development, Sanquin Blood Bank, Amsterdam, the Netherlands
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Mundt JM, Rouse L, Van den Bossche J, Goodrich RP. Chemical and biological mechanisms of pathogen reduction technologies. Photochem Photobiol 2014; 90:957-64. [PMID: 25041351 PMCID: PMC4277684 DOI: 10.1111/php.12311] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Accepted: 07/01/2014] [Indexed: 01/25/2023]
Abstract
Within the last decade new technologies have been developed and implemented which employ light, often in the presence of a photosensitizer, to inactivate pathogens that reside in human blood products for the purpose of transfusion. These pathogen reduction technologies attempt to find the proper balance between pathogen kill and cell quality. Each system utilizes various chemistries that not only impact which pathogens they can inactivate and how, but also how the treatments affect the plasma and cellular proteins and to what degree. This paper aims to present the various chemical mechanisms for pathogen reduction in transfusion medicine that are currently practiced or in development.
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Jonsdottir-Buch SM, Sigurgrimsdottir H, Lieder R, Sigurjonsson OE. Expired and Pathogen-Inactivated Platelet Concentrates Support Differentiation and Immunomodulation of Mesenchymal Stromal Cells in Culture. Cell Transplant 2014; 24:1545-54. [PMID: 25198449 DOI: 10.3727/096368914x683043] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Platelet lysates have been reported as suitable cell culture supplement for cultures of mesenchymal stromal cells (MSCs). The demand for safe and animal-free cultures of MSCs is linked to the potential application of MSCs in clinics. While the use of platelet lysates offers an alternative to animal serum in MSC cultures, obtaining supplies of fresh platelet concentrates for lysate production is challenging and raises concerns due to the already existing shortage of platelet donors. We have previously demonstrated that expired platelet concentrates may represent a good source of platelets for lysate production without competing with blood banks for platelet donors. The INTERCEPT Blood System™ treatment of platelet concentrates allows for prolonged storage up to 7 days, using highly specific technology based on amotosalen and UV-A light. The INTERCEPT system has therefore been implemented in blood processing facilities worldwide. In this study, we evaluated the suitability of INTERCEPT-treated, expired platelet concentrates, processed into platelet lysates, for the culture of MSCs compared to nontreated expired platelets. Bone marrow-derived MSCs were cultured in media supplemented with either platelet lysates from traditionally prepared expired platelet concentrates or in platelet lysates from expired and pathogen-inactivated platelet concentrates. The effects of pathogen inactivation on the ability of the platelets to support MSCs in culture were determined by evaluating MSC immunomodulation, immunophenotype, proliferation, and trilineage differentiation. Platelet lysates prepared from expired and pathogen-inactivated platelet concentrates supported MSC differentiation and immunosuppression better compared to traditionally prepared platelet lysates from expired platelet units. Pathogen inactivation of platelets with the INTERCEPT system prior to use in MSC culture had no negative effects on MSC immunophenotype or proliferation. In conclusion, the use of expired pathogen-inactivated platelet units from blood banks to prepare platelet lysates for the culture of MSCs is desirable and attainable.
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Zhu M, Xu W, Wang BL, Su H. Hemostatic function and transfusion efficacy of apheresis platelet concentrates treated with gamma irradiation in use for thrombocytopenic patients. Transfus Med Hemother 2014; 41:189-96. [PMID: 25053932 PMCID: PMC4086760 DOI: 10.1159/000363523] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Accepted: 05/12/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND During the transfusion of blood components, the transfer of allogeneic donor white blood cells (WBCs) can mediate transfusion-associated graft-versus-host disease (TA-GVHD). To minimize the reaction, exposure of blood products to gamma irradiation is currently the standard of care. The aim of our study was to evaluate and compare hemostatic function, transfusion efficacy, and safety of gamma-irradiated single-donor apheresis platelet concentrates (PCs) and of conventional non-irradiated PCs in patients with chemotherapy-induced thrombocytopenia. METHODS 20 double-dose single-donor leukoreduced PCs were split in two identical units; one was gamma-irradiated with 25 Gy (study arm A) and the other remains non-irradiated (study arm B). Both units were stored under equal conditions. Hematologic patients were randomly assigned to receive gamma-irradiated or conventional non-irradiated PCs. Hemostatic function was evaluated by thrombelastography (TEG). TEG measurements were taken pre transfusion and 1 and 24 h post transfusion. TEG profiles were measured, noting the time to initiate clotting (R), the angle of clot formation (α), and the maximum amplitude (clot strength (MA)). Whole blood samples were collected from these thrombocytopenic patients at 1 and 24 h for PLT count increments (CIs) and corrected count increments (CCIs) with assessments of transfusion efficacy. Time to next PLT transfusion, transfusion requirement of RBCs, active bleeding, and adverse events (AEs), were analyzed. RESULTS No differences could be found in hemostatic function parameters (MA, R, and α) between study arms A and B (all p values > 0.096) pre transfusion as well as 1 and 24 h post transfusion. No differences between study arms A and B were observed for mean (± standard deviation (SD)) 1-hour CCI (12.83 ± 6.33 vs. 11.59 ± 5.97) and 24-hour CCI (6.56 ± 4.10 vs. 5.76 ± 4.05). Mean 1-hour CI and 24-hour CI were not significantly different in both study arms (p = 0.254 and p = 0.242 respectively). Median time to the next PC transfusion after study PC was not significantly different between groups: (2.4 vs. 2.2 days, p = 0.767). No differences could be found in transfusion requirement of red blood cells (p = 0.744) between both study arms. There were also no regarding bleeding, adverse events, and acute transfusion reaction(s). CONCLUSIONS This study confirms safety of gamma-irradiated PCs for treatment thrombocytopenia. Hemostatic function, transfusion efficacy, bleeding, and safety of single-donor apheresis PCs treated with gamma irradiation versus untreated control PCs are comparable.
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Affiliation(s)
- Mei Zhu
- Department of Nuclear Medicine, The Third Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Wei Xu
- Department of Blood Transfusion, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Bao-Long Wang
- Department of Nuclear Medicine, The Third Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Hong Su
- Department of Epidemiology & Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China
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Prudent M, D’Alessandro A, Cazenave JP, Devine DV, Gachet C, Greinacher A, Lion N, Schubert P, Steil L, Thiele T, Tissot JD, Völker U, Zolla L. Proteome Changes in Platelets After Pathogen Inactivation—An Interlaboratory Consensus. Transfus Med Rev 2014; 28:72-83. [DOI: 10.1016/j.tmrv.2014.02.002] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2013] [Revised: 01/31/2014] [Accepted: 02/07/2014] [Indexed: 12/21/2022]
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Mastroianni MA, Llohn AH, Akkök ÇA, Skogheim R, Ødegaard ER, Nybruket MJ, Flesland A, Mousavi SA. Effect of Mirasol pathogen reduction technology system on in vitro quality of MCS+ apheresis platelets. Transfus Apher Sci 2013; 49:285-90. [DOI: 10.1016/j.transci.2013.06.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2012] [Revised: 05/24/2013] [Accepted: 06/07/2013] [Indexed: 10/26/2022]
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Affiliation(s)
- B. Custer
- Blood Systems Research Institute; Masonic Ave; San Francisco; CA; USA
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Current methods for the reduction of blood-borne pathogens: a comprehensive literature review. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2013; 11:343-8. [PMID: 23522896 DOI: 10.2450/2013.0218-12] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Received: 10/01/2012] [Accepted: 12/06/2012] [Indexed: 11/21/2022]
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Castrillo A, Cardoso M, Rouse L. Treatment of buffy coat platelets in platelet additive solution with the mirasol(®) pathogen reduction technology system. ACTA ACUST UNITED AC 2013; 40:44-8. [PMID: 23637649 DOI: 10.1159/000345679] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2011] [Accepted: 04/24/2012] [Indexed: 11/19/2022]
Abstract
BACKGROUND The Mirasol pathogen reduction technology (PRT) system uses riboflavin and ultraviolet light and is currently approved and used in Europe for the treatment of platelets and plasma. Mirasol treatment is intended to reduce the infectious pathogen load and to inactivate leukocytes in blood products. Our objective was to evaluate buffy coat platelet concentrates (BCPCs) prepared with platelet additive solution (PAS) and treated with the Mirasol system and to examine the effects on platelet cell quality during storage. METHODS 26 BCPCs were prepared and split, creating 13 paired control and test units. The test units were treated with the Mirasol system and the platelet quality was assessed in all units over 7 days of storage. RESULTS All products met the incoming specifications for Mirasol treatment, and the pH of all Mirasol-treated BCPCs in PAS met the requirements of the Council of Europe guidelines throughout storage. Analysis of lactate production and glucose consumption rates, CD62p expression and cytokines indicates enhanced cellular metabolism in treated platelets, but the levels were within previously published ranges. CONCLUSION While Mirasol-treated BCPCs in PAS had increased metabolism and activation compared to controls, the results indicate that these units can be stored for 7 days with acceptable cell quality.
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Johansson PI, Simonsen AC, Brown PN, Ostrowski SR, Deberdt L, Van Hoydonck P, Yonemura SS, Goodrich RP. A pilot study to assess the hemostatic function of pathogen-reduced platelets in patients with thrombocytopenia. Transfusion 2012; 53:2043-52. [PMID: 23278371 DOI: 10.1111/trf.12055] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2012] [Revised: 10/08/2012] [Accepted: 10/15/2012] [Indexed: 12/01/2022]
Abstract
BACKGROUND Platelet (PLT) support is critical to the care of patients with thrombocytopenia, but allogeneic transfusions carry risk. Pathogen reduction mitigates some transfusion risks, but effects on PLT function remain a concern. This clinical pilot study assessed the effect of pathogen reduction technology with riboflavin plus ultraviolet light using thrombelastography (TEG). STUDY DESIGN AND METHODS This prospective, randomized, crossover study compared Mirasol-treated (MIR) and standard reference (REF) PLT transfusions. PLT counts and TEG measurements were taken at pretransfusion and 1- and 24-hour-posttransfusion time points. The primary outcome measure was the pretransfusion to 1-hour-posttransfusion change in maximum amplitude (ΔMA(1 hr)). Secondary endpoints included ΔMA among other time points, relative MA, and the PLT count-MA correlation. RESULTS Of 16 enrolled patients, one withdrew before study treatment and three did not require two transfusions, leaving 12 patients in the efficacy analyses (seven MIR-REF, five REF-MIR). ΔMA(1 hr) (mean ± SD) was 10.60 ± 6.47 mm for MIR and 14.33 ± 5.38 mm for REF (p = 0.20, n = 10). ΔMA(24hr) was 9.49 ± 7.94 for MIR and 7.13 ± 3.08 for REF (p = 0.38, n = 9); ΔMA(24hr-1 hr) was -1.11 ± 2.95 for MIR and -7.20 ± 4.81 for REF (p = 0.016, n = 8). MA values for MIR and REF correlated with the log of PLT count (rMIR = 0.6901, rREF = 0.7399). CONCLUSION TEG is sensitive to changes in hemostatic function resulting from a single PLT transfusion. MIR and REF provided similar increments in hemostatic function in the immediate posttransfusion period and at 24 hours. A significant difference detected for ΔMA(24hr-1 hr) suggests different PLT clearance mechanisms. The relationship of these variables to clinically meaningful outcomes, for example, bleeding events or transfusion requirements, has yet to be determined.
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Affiliation(s)
- Pär I Johansson
- Department of Clinical Immunology, Section of Transfusion Medicine, Copenhagen, Denmark; Department of Hematology, University of Copenhagen, Copenhagen, Denmark; Terumo BCT, Lakewood, Colorado
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Evaluation of platelet function during extended storage in additive solution, prepared in a new container that allows manual buffy-coat platelet pooling and leucoreduction in the same system. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2012; 10:480-9. [PMID: 22682335 DOI: 10.2450/2012.0112-11] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 09/14/2011] [Accepted: 12/28/2011] [Indexed: 12/14/2022]
Abstract
BACKGROUND A novel and practical storage container designed for manual buffy-coat pooling and leucodepletion was evaluated to assess its filtration performance and to analyse the quality of stored leucoreduced buffy-coat-derived platelet pools. MATERIALS AND METHODS To analyse the grifols leucored transfer PL system, blood was collected from random donors into standard triple bag systems, and fractionated using standard procedures to obtain buffy-coats. Ten leucodepleted platelet pools were prepared each from five units of buffy-coats in additive solution. Concentrates were stored for 10 days at 22 °C on an end-over-end agitator. On days 0, 5, 7, and 10 of storage, samples were tested using standard in vitro platelet parameters. RESULTS The use of this novel system for volume reduction and leucodepletion of buffy-coats resuspended in additive solution led to platelet pools that met the European requirements. pH was maintained well, declining from an initial value of 7.11±0.04 to 6.88±0.08 after 10 days. Parameters of cell lysis, response to a hypotonic stimulus and aggregation induced by agonists (arachidonic acid, ristocetin, collagen or thrombin receptor activating peptide) were also well-preserved. During storage, the quality profile of the platelet pools remained very similar to that previously reported in platelet concentrates in terms of metabolism, platelet activation (CD62, CD63, sCD62), expression of glycoproteins Ib and IIb/IIIa, capacity of glycoprotein IIb/IIIa to become activated upon ADP stimulation, and release of biological response modifiers (sCD40L and RANTES). DISCUSSION This new system allows the preparation of leucodepleted buffy-coat platelet pools in additive solution with good preservation of platelet function. The logistics of the procedure are relatively simple and it results in good-quality components, which may reduce costs and ease the process of buffy-coat pooling and leucocyte reduction in transfusion services.
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49
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Marschner S, Goodrich R. Pathogen Reduction Technology Treatment of Platelets, Plasma and Whole Blood Using Riboflavin and UV Light. Transfus Med Hemother 2011; 38:8-18. [PMID: 21779202 PMCID: PMC3132976 DOI: 10.1159/000324160] [Citation(s) in RCA: 155] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2010] [Accepted: 01/13/2011] [Indexed: 11/19/2022] Open
Abstract
Bacterial contamination and emerging infections combined with increased international travel pose a great risk to the safety of the blood supply. Tests to detect the presence of infection in a donor have a 'window period' during which infections cannot be detected but the donor may be infectious. Agents and their transmission routes need to be recognized before specific tests can be developed. Pathogen reduction of blood components represents a means to address these concerns and is a proactive approach for the prevention of transfusion-transmitted diseases. The expectation of a pathogen reduction system is that it achieves high enough levels of pathogen reduction to reduce or prevent the likelihood of disease transmission while preserving adequate cell and protein quality. In addition the system needs to be non-toxic, non-mutagenic and should be simple to use. The Mirasol® Pathogen Reduction Technology (PRT) System for Platelets and Plasma uses riboflavin (vitamin B2) plus UV light to induce damage in nucleic acid-containing agents. The system has been shown to be effective against clinically relevant pathogens and inactivates leukocytes without significantly compromising the efficacy of the product or resulting in product loss. Riboflavin is a naturally occurring vitamin with a well-known and well-characterized safety profile. The same methodology is currently under development for the treatment of whole blood, making pathogen reduction of all blood products using one system achievable. This review gives an overview of the Mirasol PRT System, summarizing the mechanism of action, toxicology profile, pathogen reduction performance and clinical efficacy of the process.
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