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Gravemann U, Boelke M, Könenkamp L, Söder L, Maurer M, Ziegler U, Schulze TJ, Seltsam A, Becker SC, Steffen I. West Nile and Usutu viruses are efficiently inactivated in platelet concentrates by UVC light using the THERAFLEX UV-Platelets system. Vox Sang 2024. [PMID: 38699884 DOI: 10.1111/vox.13648] [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: 12/19/2023] [Revised: 04/10/2024] [Accepted: 04/17/2024] [Indexed: 05/05/2024]
Abstract
BACKGROUND AND OBJECTIVES West Nile virus (WNV) and Usutu virus (USUV) are mosquito-borne flaviviruses (Flaviviridae) that originated in Africa, have expanded their geographical range during the last decades and caused documented infections in Europe in the last years. Acute WNV and USUV infections have been detected in asymptomatic blood donors by nucleic acid testing. Thus, inactivation of both viral pathogens before blood transfusion is necessary to ensure blood product safety. This study aimed to investigate the efficacy of the THERAFLEX UV-Platelets system to inactivate WNV and USUV in platelet concentrates (PCs). MATERIALS AND METHODS Plasma-reduced PCs were spiked with the virus suspension. Spiked PC samples were taken after spiking (load and hold sample) and after UVC illumination on the Macotronic UV illumination machine with different light doses (0.05, 0.1, 0.15 and 0.2 (standard) J/cm2). Virus loads of WNV and USUV before and after illumination were measured by titration. RESULTS Infectivity assays showed that UVC illumination inactivated WNV and USUV in a dose-dependent manner. At a UVC dose of 0.2 J/cm2, the WNV titre was reduced by a log10 factor of 3.59 ± 0.43 for NY99 (lineage 1) and 4.40 ± 0.29 for strain ED-I-33/18 (lineage 2). USUV titres were reduced at the same UVC dose by a log10 factor of 5.20 ± 0.70. CONCLUSIONS Our results demonstrate that the THERAFLEX UV-Platelets procedure is an effective technology to inactivate WNV and USUV in contaminated PCs.
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Affiliation(s)
- Ute Gravemann
- German Red Cross Blood Service NSTOB, Springe, Germany
| | - Mathias Boelke
- Institute for Parasitology, University of Veterinary Medicine, Hannover, Germany
- Research Center for Emerging Infections and Zoonoses, University of Veterinary Medicine, Hannover, Germany
| | - Laura Könenkamp
- Research Center for Emerging Infections and Zoonoses, University of Veterinary Medicine, Hannover, Germany
- Department of Biochemistry, University of Veterinary Medicine, Hannover, Germany
| | - Lars Söder
- Institute of Virology, University of Veterinary Medicine, Hannover, Germany
| | - Maurice Maurer
- Institute for Parasitology, University of Veterinary Medicine, Hannover, Germany
- Research Center for Emerging Infections and Zoonoses, University of Veterinary Medicine, Hannover, Germany
| | - Ute Ziegler
- Institute of Novel and Emerging Infectious Diseases, Friedrich-Loeffler-Institut, Greifswald-Island of Riems, Germany
| | - Torsten J Schulze
- German Red Cross Blood Service NSTOB, Springe, Germany
- Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Oldenburg, Oldenburg, Germany
| | - Axel Seltsam
- Bavarian Red Cross Blood Service, Institute Nuremberg, Nuremberg, Germany
| | - Stefanie C Becker
- Institute for Parasitology, University of Veterinary Medicine, Hannover, Germany
- Research Center for Emerging Infections and Zoonoses, University of Veterinary Medicine, Hannover, Germany
| | - Imke Steffen
- Research Center for Emerging Infections and Zoonoses, University of Veterinary Medicine, Hannover, Germany
- Department of Biochemistry, University of Veterinary Medicine, Hannover, Germany
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2
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Brixner V, Bug G, Pohler P, Krämer D, Metzner B, Voss A, Casper J, Ritter U, Klein S, Alakel N, Peceny R, Derigs HG, Stegelmann F, Wolf M, Schrezenmeier H, Thiele T, Seifried E, Kapels HH, Döscher A, Petershofen EK, Müller TH, Seltsam A. Efficacy of UVC-treated, pathogen-reduced platelets versus untreated platelets: a randomized controlled non-inferiority trial. Haematologica 2021; 106:1086-1096. [PMID: 33538149 PMCID: PMC8018132 DOI: 10.3324/haematol.2020.260430] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Indexed: 12/13/2022] Open
Abstract
Pathogen reduction (PR) technologies for blood components have been established to reduce the residual risk of known and emerging infectious agents. THERAFLEX UV-Platelets, a novel ultraviolet C (UVC) light-based PR technology for platelet concentrates, works without photoactive substances. This randomized, controlled, double-blind, multicenter, non-inferiority trial was designed to compare the efficacy and safety of UVC-treated platelets to that of untreated platelets in thrombocytopenic patients with hematologic-oncologic diseases. The primary objective was to determine non-inferiority of UVC-treated platelets, assessed by the 1-hour corrected count increment (CCI) in up to eight per-protocol platelet transfusion episodes. Analysis of the 171 eligible patients showed that the defined non-inferiority margin of 30% of UVC-treated platelets was narrowly missed as the mean differences in 1-hour CCI between standard platelets versus UVC-treated platelets for intention-to-treat and per-protocol analyses were 18.2% (95% Confidence Interval [CI]: 6.4-30.1) and 18.7% (95% CI: 6.3-31.1), respectively. In comparison to the control, the UVC group had a 19.2% lower mean 24-hour CCI and was treated with an about 25% higher number of platelet units, but the average number of days to the next platelet transfusion did not differ significantly between both treatment groups. The frequency of low-grade adverse events was slightly higher in the UVC group and the frequencies of refractoriness to platelet transfusion, platelet alloimmunization, severe bleeding events, and red blood cell transfusions were comparable between groups. Our study suggests that transfusion of pathogen-reduced platelets produced with the UVC technology is safe but non-inferiority was not demonstrated. (clinicaltrials gov. Identifier: DRKS00011156).
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Affiliation(s)
- Veronika Brixner
- German Red Cross Blood Transfusion Service and Goethe University Clinics, Frankfurt/Main
| | - Gesine Bug
- Department of Hematology and Oncology, University Hospital Frankfurt, Goethe University, Frankfurt/Main
| | | | - Doris Krämer
- Department of Oncology and Hematology, University Hospital, Oldenburg
| | - Bernd Metzner
- Department of Oncology and Hematology, University Hospital, Oldenburg
| | - Andreas Voss
- Department of Oncology and Hematology, University Hospital, Oldenburg
| | - Jochen Casper
- Department of Oncology and Hematology, University Hospital, Oldenburg
| | - Ulrich Ritter
- Department of Hematology and Oncology, Municipal Hospital Bremen, Bremen
| | - Stefan Klein
- Department of Hematology and Oncology, University Hospital, Mannheim
| | - Nael Alakel
- Medical Clinic I, Department of Hematology and Oncology, University Hospital, Carl Gustav Carus Faculty of Medicine, Dresden
| | - Rudolf Peceny
- Department of Hematology and Oncology, Municipal Hospital, Osnabrück
| | - Hans G Derigs
- Department of Hematology and Oncology, Municipal Hospital Frankfurt-Hoechst, Frankfurt/Main
| | | | - Martin Wolf
- Department of Hematology and Oncology, Municipal Hospital, Kassel
| | - Hubert Schrezenmeier
- Institute for Transfusion Medicine, University Hospital Ulm, Ulm, Germany; and Institute for Clinical Transfusion Medicine and Immunogenetics Ulm, German Red Cross Blood Service Baden-Württemberg - Hessia, Ulm
| | - Thomas Thiele
- Institute for Immunology and Transfusion Medicine, University Medicine, Greifswald
| | - Erhard Seifried
- German Red Cross Blood Transfusion Service and Goethe University Clinics, Frankfurt/Main
| | | | | | | | | | - Axel Seltsam
- German Red Cross Blood Service NSTOB, Springe, Germany; Bavarian Red Cross Blood Service, Nuremberg.
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3
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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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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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5
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Makert GR, Vorbrüggen S, Krautwald-Junghanns ME, Voss M, Sohn K, Buschmann T, Ulbert S. A method to identify protein antigens of Dermanyssus gallinae for the protection of birds from poultry mites. Parasitol Res 2016; 115:2705-13. [PMID: 27026505 DOI: 10.1007/s00436-016-5017-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Accepted: 03/16/2016] [Indexed: 10/22/2022]
Abstract
The poultry red mite (PRM) Dermanyssus gallinae causes high economic losses and is among the most important parasites in poultry farming worldwide. Different chemical, physical, and biological strategies try to control the expansion of PRM. However, effective solutions to this problem still have to be found. Here, we present a method for the development of an immunological control strategy, based on the identification of mite protein antigens which elicit antibodies with anti-mite activity in the immunized chicken. Hens were immunized with different PRM protein extracts formulated with two different adjuvants, and IgY-antibodies were isolated from the eggs. A PRM in vitro feeding assay which used chicken blood spiked with these IgY-preparations was used to detect antibodies which caused PRM mortality. In vitro feeding of mites with IgY isolated from hens immunized with PRM extract formulated with one of the adjuvants showed a statistically significant increase in the mortality as compared to control mites. After the separation of total PRM extracts in two-dimensional gels, several protein spots were recognized by such IgY preparations. Ten protein spots were subjected to mass spectrometry (MS/MS) for the identification of the corresponding proteins. Complete protein sequences were deduced from genomic and transcriptomic assemblies derived from high throughput sequencing of total PRM DNA and RNA. The results may contribute to the development of an immunological control strategy of D. gallinae.
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Affiliation(s)
- Gustavo R Makert
- Fraunhofer Institute for Cell Therapy and Immunology, Perlickstr. 1, 04103, Leipzig, Germany.,Clinic for Birds and Reptiles, Leipzig University, An den Tierkliniken 17, 04103, Leipzig, Germany
| | - Susanne Vorbrüggen
- Clinic for Birds and Reptiles, Leipzig University, An den Tierkliniken 17, 04103, Leipzig, Germany
| | | | - Matthias Voss
- Lohmann Tierzucht GmbH, Am Seedeich 9-11, 27454, Cuxhaven, Germany
| | - Kai Sohn
- Fraunhofer Institute for Interfacial Engineering and Biotechnology, Nobelstr. 12, 70569, Stuttgart, Germany
| | - Tilo Buschmann
- Fraunhofer Institute for Cell Therapy and Immunology, Perlickstr. 1, 04103, Leipzig, Germany
| | - Sebastian Ulbert
- Fraunhofer Institute for Cell Therapy and Immunology, Perlickstr. 1, 04103, Leipzig, Germany.
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6
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Faddy HM, Fryk JJ, Prow NA, Watterson D, Young PR, Hall RA, Tolksdorf F, Sumian C, Gravemann U, Seltsam A, Marks DC. Inactivation of dengue, chikungunya, and Ross River viruses in platelet concentrates after treatment with ultraviolet C light. Transfusion 2016; 56:1548-55. [PMID: 26926832 DOI: 10.1111/trf.13519] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Revised: 12/04/2015] [Accepted: 01/04/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Arboviruses, including dengue (DENV 1-4), chikungunya (CHIKV), and Ross River (RRV), are emerging viruses that are a risk for transfusion safety globally. An approach for managing this risk is pathogen inactivation, such as the THERAFLEX UV-Platelets system. We investigated the ability of this system to inactivate the above mentioned arboviruses. STUDY DESIGN AND METHODS DENV 1-4, CHIKV, or RRV were spiked into buffy coat (BC)-derived platelet (PLT) concentrates in additive solution and treated with the THERAFLEX UV-Platelets system at the following doses: 0.05, 0.1, 0.15, and 0.2 J/cm(2) (standard dose). Pre- and posttreatment samples were taken for each dose, and the level of viral infectivity was determined. RESULTS At the standard ultraviolet C (UVC) dose (0.2 J/cm(2) ), viral inactivation of at least 4.43, 6.34, and 5.13 log or more, was observed for DENV 1-4, CHIKV, and RRV, respectively. A dose dependency in viral inactivation was observed with increasing UVC doses. CONCLUSIONS Our study has shown that DENV, CHIKV, and RRV, spiked into BC-derived PLT concentrates, were inactivated by the THERAFLEX UV-Platelets system to the limit of detection of our assay, suggesting that this system could contribute to the safety of PLT concentrates with respect to these emerging arboviruses.
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Affiliation(s)
- Helen M Faddy
- Research and Development, Australian Red Cross Blood Service.,School of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Jesse J Fryk
- Research and Development, Australian Red Cross Blood Service
| | - Natalie A Prow
- Australian Infectious Disease Research Centre, School of Chemistry and Molecular Biosciences, University of Queensland.,QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Daniel Watterson
- Australian Infectious Disease Research Centre, School of Chemistry and Molecular Biosciences, University of Queensland
| | - Paul R Young
- Australian Infectious Disease Research Centre, School of Chemistry and Molecular Biosciences, University of Queensland
| | - Roy A Hall
- Australian Infectious Disease Research Centre, School of Chemistry and Molecular Biosciences, University of Queensland
| | | | | | - Ute Gravemann
- German Red Cross Blood Service NSTOB, Springe, Germany
| | - Axel Seltsam
- German Red Cross Blood Service NSTOB, Springe, Germany
| | - Denese C Marks
- Research and Development, Australian Red Cross Blood Service
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7
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Van Aelst B, Devloo R, Vandekerckhove P, Compernolle V, Feys HB. Ultraviolet C light pathogen inactivation treatment of platelet concentrates preserves integrin activation but affects thrombus formation kinetics on collagen in vitro. Transfusion 2015; 55:2404-14. [DOI: 10.1111/trf.13137] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Revised: 03/03/2015] [Accepted: 03/18/2015] [Indexed: 12/21/2022]
Affiliation(s)
- Britt Van Aelst
- Transfusion Research CenterBelgian Red Cross‐FlandersGhent Belgium
| | - Rosalie Devloo
- Transfusion Research CenterBelgian Red Cross‐FlandersGhent Belgium
| | - Philippe Vandekerckhove
- Blood Service of the Belgian Red Cross‐FlandersMechelen Belgium
- Department of Public Health and Primary CareCatholic University of LeuvenLeuven Belgium
- Faculty of Medicine and Health SciencesUniversity of GhentGhent Belgium
| | - Veerle Compernolle
- Transfusion Research CenterBelgian Red Cross‐FlandersGhent Belgium
- Blood Service of the Belgian Red Cross‐FlandersMechelen Belgium
- Faculty of Medicine and Health SciencesUniversity of GhentGhent Belgium
| | - Hendrik B. Feys
- Transfusion Research CenterBelgian Red Cross‐FlandersGhent Belgium
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8
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Thiele T, Pohler P, Kohlmann T, Sümnig A, Aurich K, Selleng K, Westphal A, Bakchoul T, Petersmann A, Müller TH, Greinacher A, Seltsam A. Tolerance of platelet concentrates treated with UVC-light only for pathogen reduction--a phase I clinical trial. Vox Sang 2015; 109:44-51. [PMID: 25754418 DOI: 10.1111/vox.12247] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Revised: 12/15/2014] [Accepted: 12/15/2014] [Indexed: 12/30/2022]
Abstract
BACKGROUND The THERAFLEX UV-Platelets pathogen reduction system for platelet concentrates (PCs) operates with ultraviolet C light (UVC; 254 nm) only without addition of photosensitizers. This phase I study evaluated safety and tolerability of autologous UVC-irradiated PCs in healthy volunteers. METHODS Eleven volunteers underwent two single (series 1 and 2) and one double apheresis (series 3). PCs were treated with UVC, stored for 48 h and retransfused in a dose-escalation scheme: 12·5, 25% and 50% of a PC (series 1); one complete PC (series 2); two PCs (series 3). Platelet counts, fibrinogen, activated partial thromboplastin time, prothrombin time, D-dimer, standard haematology, temperature, heart rate, blood pressure and clinical chemistry parameters were measured. One- and 24-h corrected count increments were determined in series 2 and 3. Platelet-specific antibodies were assessed before and at the end of the study. RESULTS Neither adverse reactions related to transfusions nor antibodies against UVC-treated platelets were observed. Corrected count increments did not differ between series 2 and 3. CONCLUSIONS Repeated transfusions of autologous UVC-treated PCs were well tolerated and did not induce antibody responses in all volunteers studied. EudraCT No. 2010-023404-26.
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Affiliation(s)
- T Thiele
- Institut für Immunologie und Transfusionsmedizin, Universitätsmedizin Greifswald, Greifswald, Germany
| | - P Pohler
- DRK Blutspendedienst NSTOB, Institut Springe, Springe, Germany
| | - T Kohlmann
- Institut für Community Medicine, Universitätsmedizin Greifswald, Greifswald, Germany
| | - A Sümnig
- Institut für Immunologie und Transfusionsmedizin, Universitätsmedizin Greifswald, Greifswald, Germany
| | - K Aurich
- Institut für Immunologie und Transfusionsmedizin, Universitätsmedizin Greifswald, Greifswald, Germany
| | - K Selleng
- Institut für Immunologie und Transfusionsmedizin, Universitätsmedizin Greifswald, Greifswald, Germany
| | - A Westphal
- Institut für Immunologie und Transfusionsmedizin, Universitätsmedizin Greifswald, Greifswald, Germany
| | - T Bakchoul
- Institut für Immunologie und Transfusionsmedizin, Universitätsmedizin Greifswald, Greifswald, Germany
| | - A Petersmann
- Institut für Klinische Chemie und Labormedizin, Universitätsmedizin Greifswald, Greifswald, Germany
| | - T H Müller
- DRK Blutspendedienst NSTOB, Institut Springe, Springe, Germany
| | - A Greinacher
- Institut für Immunologie und Transfusionsmedizin, Universitätsmedizin Greifswald, Greifswald, Germany
| | - A Seltsam
- DRK Blutspendedienst NSTOB, Institut Springe, Springe, Germany
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Salunkhe V, van der Meer PF, de Korte D, Seghatchian J, Gutiérrez L. Development of blood transfusion product pathogen reduction treatments: A review of methods, current applications and demands. Transfus Apher Sci 2015; 52:19-34. [DOI: 10.1016/j.transci.2014.12.016] [Citation(s) in RCA: 89] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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10
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Affiliation(s)
- D. C. Marks
- Research and Development; Australian Red Cross Blood Service; Sydney New South Wales Australia
| | - H. M. Faddy
- Research and Development; Australian Red Cross Blood Service; Brisbane Queensland Australia
| | - L. Johnson
- Research and Development; Australian Red Cross Blood Service; Sydney New South Wales Australia
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Schlenke P. Pathogen inactivation technologies for cellular blood components: an update. Transfus Med Hemother 2014; 41:309-25. [PMID: 25254027 PMCID: PMC4164100 DOI: 10.1159/000365646] [Citation(s) in RCA: 87] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2013] [Accepted: 03/27/2014] [Indexed: 01/19/2023] Open
Abstract
Nowadays patients receiving blood components are exposed to much less transfusion-transmitted infectious diseases than three decades before when among others HIV was identified as causative agent for the acquired immunodeficiency syndrome and the transmission by blood or coagulation factors became evident. Since that time the implementation of measures for risk prevention and safety precaution was socially and politically accepted. Currently emerging pathogens like arboviruses and the well-known bacterial contamination of platelet concentrates still remain major concerns of blood safety with important clinical consequences, but very rarely with fatal outcome for the blood recipient. In contrast to the well-established pathogen inactivation strategies for fresh frozen plasma using the solvent-detergent procedure or methylene blue and visible light, the bench-to-bedside translation of novel pathogen inactivation technologies for cell-containing blood components such as platelets and red blood cells are still underway. This review summarizes the pharmacological/toxicological assessment and the inactivation efficacy against viruses, bacteria, and protozoa of each of the currently available pathogen inactivation technologies and highlights the impact of the results obtained from several randomized clinical trials and hemovigilance data. Until now in some European countries pathogen inactivation technologies are in in routine use for single-donor plasma and platelets. The invention and adaption of pathogen inactivation technologies for red blood cell units and whole blood donations suggest the universal applicability of these technologies and foster a paradigm shift in the manufacturing of safe blood.
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Affiliation(s)
- Peter Schlenke
- Department for Blood Group Serology and Transfusion Medicine, Medical University Graz, Graz, Austria
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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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13
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Affiliation(s)
- B. Custer
- Blood Systems Research Institute; Masonic Ave; San Francisco; CA; USA
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