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Cardoso M, Ragan I, Hartson L, Goodrich RP. Emerging Pathogen Threats in Transfusion Medicine: Improving Safety and Confidence with Pathogen Reduction Technologies. Pathogens 2023; 12:911. [PMID: 37513758 PMCID: PMC10383627 DOI: 10.3390/pathogens12070911] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 06/30/2023] [Accepted: 07/02/2023] [Indexed: 07/30/2023] Open
Abstract
Emerging infectious disease threats are becoming more frequent due to various social, political, and geographical pressures, including increased human-animal contact, global trade, transportation, and changing climate conditions. Since blood products for transfusion are derived from donated blood from the general population, emerging agents spread by blood contact or the transfusion of blood products are also a potential risk. Blood transfusions are essential in treating patients with anemia, blood loss, and other medical conditions. However, these lifesaving procedures can contribute to infectious disease transmission, particularly to vulnerable populations. New methods have been implemented on a global basis for the prevention of transfusion transmissions via plasma, platelets, and whole blood products. Implementing proactive pathogen reduction methods may reduce the likelihood of disease transmission via blood transfusions, even for newly emerging agents whose transmissibility and susceptibility are still being evaluated as they emerge. In this review, we consider the Mirasol PRT system for blood safety, which is based on a photochemical method involving riboflavin and UV light. We provide examples of how emerging threats, such as Ebola, SARS-CoV-2, hepatitis E, mpox and other agents, have been evaluated in real time regarding effectiveness of this method in reducing the likelihood of disease transmission via transfusions.
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Affiliation(s)
- Marcia Cardoso
- Terumo BCT, Inc., TERUMO Böood and Cell Technologies, Zaventem, 41 1930 Brussels, Belgium
| | - Izabela Ragan
- Infectious Disease Research Center, Department of Biomedical Science, Colorado State University, Fort Collins, CO 80521, USA
| | - Lindsay Hartson
- Infectious Disease Research Center, Department of Microbiology, Immunology and Pathology, Colorado State University, Fort Collins, CO 80521, USA
| | - Raymond P Goodrich
- Infectious Disease Research Center, Department of Microbiology, Immunology and Pathology, Colorado State University, Fort Collins, CO 80521, USA
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2
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Hoad VC, Kiely P, Seed CR, Gosbell IB. Comment on White paper on pandemic preparedness in the blood supply. Vox Sang 2023; 118:409-410. [PMID: 36922182 DOI: 10.1111/vox.13423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 02/14/2023] [Indexed: 03/17/2023]
Affiliation(s)
- Veronica C Hoad
- Australian Red Cross Lifeblood, Perth, Western Australia, Australia
| | - Philip Kiely
- Australian Red Cross Lifeblood, Perth, Western Australia, Australia
| | - Clive R Seed
- Australian Red Cross Lifeblood, Perth, Western Australia, Australia
| | - Iain B Gosbell
- Australian Red Cross Lifeblood, Perth, Western Australia, Australia.,School of Medicine, Western Sydney University, Penrith, New South Wales, Australia
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3
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Zhang S, Gao L, Wang P, Ma Y, Wang X, Wen J, Cheng Y, Liu C, Zhang C, Liu C, Yan Y, Zhao C. A minimally manipulated preservation and virus inactivation method for amnion/chorion. Front Bioeng Biotechnol 2022; 10:952498. [PMID: 36032718 PMCID: PMC9403546 DOI: 10.3389/fbioe.2022.952498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 07/18/2022] [Indexed: 11/15/2022] Open
Abstract
Allogeneic amnion tissues have been widely used in tissue repair and regeneration, especially a remarkable trend of clinical uses in chronic wound repair. The virus inactivation procedures are necessary and required to be verified for the clinical use and approval of biological products. Cobalt-60 (Co-60) or electron-beam (e-beam) is the common procedure for virus and bacterial reduction, but the excessive dose of irradiation was reported to be harmful to biological products. Herein, we present a riboflavin (RB)-ultraviolet light (UV) method for virus inactivation of amnion and chorion tissues. We used the standard in vitro limiting dilution assay to test the viral reduction capacity of the RB-UV method on amnion or chorion tissues loaded with four types of model viruses. We found RB-UV was a very effective procedure for inactivating viruses of amnion and chorion tissues, which could be used as a complementary method to Co-60 irradiation. In addition, we also screened the washing solutions and drying methods for the retention of growth factors.
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Affiliation(s)
- Shang Zhang
- Success Bio-Tech Co., Ltd., Biomedical Material Engineering Laboratory of Shandong Province, Jinan, China
- *Correspondence: Shang Zhang,
| | - Lichang Gao
- Success Bio-Tech Co., Ltd., Biomedical Material Engineering Laboratory of Shandong Province, Jinan, China
| | - Pin Wang
- Success Bio-Tech Co., Ltd., Biomedical Material Engineering Laboratory of Shandong Province, Jinan, China
| | - Yuyan Ma
- Department of Gynecology and Obstetrics, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Xiaoliang Wang
- Liangchen Biotechnology (Suzhou) Co., Ltd., Suzhou, China
| | - Jie Wen
- Liangchen Biotechnology (Suzhou) Co., Ltd., Suzhou, China
| | - Yu Cheng
- Success Bio-Tech Co., Ltd., Biomedical Material Engineering Laboratory of Shandong Province, Jinan, China
| | - Changlin Liu
- Success Bio-Tech Co., Ltd., Biomedical Material Engineering Laboratory of Shandong Province, Jinan, China
| | - Chunxia Zhang
- Success Bio-Tech Co., Ltd., Biomedical Material Engineering Laboratory of Shandong Province, Jinan, China
| | - Changfeng Liu
- Success Bio-Tech Co., Ltd., Biomedical Material Engineering Laboratory of Shandong Province, Jinan, China
| | - Yongli Yan
- Success Bio-Tech Co., Ltd., Biomedical Material Engineering Laboratory of Shandong Province, Jinan, China
| | - Chengru Zhao
- Success Bio-Tech Co., Ltd., Biomedical Material Engineering Laboratory of Shandong Province, Jinan, China
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4
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Ferrari A, Cassaniti I, Sammartino JC, Mortellaro C, Del Fante C, De Vitis S, Barone E, Troletti D, Prati F, Baldanti F, Percivalle E, Cesare P. SARS-CoV-2 variants inactivation of plasma units using a riboflavin and ultraviolet light-based photochemical treatment. Transfus Apher Sci 2022; 61:103398. [PMID: 35227599 PMCID: PMC8847076 DOI: 10.1016/j.transci.2022.103398] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 01/24/2022] [Accepted: 02/12/2022] [Indexed: 11/19/2022]
Abstract
Background Test the ability of Mirasol Pathogen Reduction Technology (PRT, Terumo BCT, Lakewood Co, USA) treatment with riboflavin and ultraviolet light (R + UV) in reducing SARS-CoV-2 infectivity while maintaining blood product quality. Material and methods SARS-CoV-2 strains were isolated and titrated to prepare cell free virus for plasma units infection. The units were then under treatment with Mirasol PRT. The infectious titers were determined before and after treatment with an in house microtitration assay on Vero E6 cells. Thirty-six plasma pool bags underwent PRT treatment. Results In all the experiments, the measured titer following riboflavin and UV treatment was below the limit of detection of microtitration assay for all the different SARS-CoV-2 strains. Despite the high copies number detected by RT-PCR for each viral strain after treatment, viruses were completely inactivated and not able to infect VERO E6 cells. Conclusion Riboflavin and UV light treatment effectively reduced the virus titers of human plasma to the limit of detection in tissue culture, regardless of the strain. These data suggest that pathogen reduction in blood products highlight the safety of CP therapy procedures for critically ill COVID-19 patients, while maintaining blood product quality.
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Affiliation(s)
- Alessandro Ferrari
- Molecular Virology Unit, Microbiology and Virology Department, IRCCS Policlinico San Matteo, Pavia, 27100, Italy
| | - Irene Cassaniti
- Molecular Virology Unit, Microbiology and Virology Department, IRCCS Policlinico San Matteo, Pavia, 27100, Italy
| | - Josè Camilla Sammartino
- Molecular Virology Unit, Microbiology and Virology Department, IRCCS Policlinico San Matteo, Pavia, 27100, Italy
| | - Cristina Mortellaro
- Immunohaematology and Transfusion Service, Fondazione IRCCS Policlinico San Matteo, Viale Golgi 19, 27100, Pavia, Italy
| | - Claudia Del Fante
- Immunohaematology and Transfusion Service, Fondazione IRCCS Policlinico San Matteo, Viale Golgi 19, 27100, Pavia, Italy
| | - Simona De Vitis
- Immunohaematology and Transfusion Service, Fondazione IRCCS Policlinico San Matteo, Viale Golgi 19, 27100, Pavia, Italy
| | - Eugenio Barone
- Immunohaematology and Transfusion Service, Fondazione IRCCS Policlinico San Matteo, Viale Golgi 19, 27100, Pavia, Italy
| | - Daniela Troletti
- Immunohaematology and Transfusion Service, Fondazione IRCCS Policlinico San Matteo, Viale Golgi 19, 27100, Pavia, Italy
| | - Federica Prati
- Immunohaematology and Transfusion Service, Fondazione IRCCS Policlinico San Matteo, Viale Golgi 19, 27100, Pavia, Italy
| | - Fausto Baldanti
- Molecular Virology Unit, Microbiology and Virology Department, IRCCS Policlinico San Matteo, Pavia, 27100, Italy; Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, 27100, Italy
| | - Elena Percivalle
- Molecular Virology Unit, Microbiology and Virology Department, IRCCS Policlinico San Matteo, Pavia, 27100, Italy.
| | - Perotti Cesare
- Immunohaematology and Transfusion Service, Fondazione IRCCS Policlinico San Matteo, Viale Golgi 19, 27100, Pavia, Italy
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5
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Liu H, Wang X. Pathogen reduction technology for blood component: A promising solution for prevention of emerging infectious disease and bacterial contamination in blood transfusion services. JOURNAL OF PHOTOCHEMISTRY AND PHOTOBIOLOGY 2021. [DOI: 10.1016/j.jpap.2021.100079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Abstract
To resolve the growing problem of drug resistance in the treatment of bacterial and fungal pathogens, specific cellular targets and pathways can be used as targets for new antimicrobial agents. Endogenous riboflavin biosynthesis is a conserved pathway that exists in most bacteria and fungi. In this review, the roles of endogenous and exogenous riboflavin in infectious disease as well as several antibacterial agents, which act as analogues of the riboflavin biosynthesis pathway, are summarized. In addition, the effects of exogenous riboflavin on immune cells, cytokines, and heat shock proteins are described. Moreover, the immune response of endogenous riboflavin metabolites in infectious diseases, recognized by MHC-related protein-1, and then presented to mucosal associated invariant T cells, is highlighted. This information will provide a strategy to identify novel drug targets as well as highlight the possible clinical use of riboflavin.
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Affiliation(s)
- Junwen Lei
- Molecular Biotechnology Platform, Public Center of Experimental Technology, School of Basic Medical Sciences, Southwest Medical University, Luzhou People's Republic of China
| | - Caiyan Xin
- Molecular Biotechnology Platform, Public Center of Experimental Technology, School of Basic Medical Sciences, Southwest Medical University, Luzhou People's Republic of China
| | - Wei Xiao
- Molecular Biotechnology Platform, Public Center of Experimental Technology, School of Basic Medical Sciences, Southwest Medical University, Luzhou People's Republic of China
| | - Wenbi Chen
- Molecular Biotechnology Platform, Public Center of Experimental Technology, School of Basic Medical Sciences, Southwest Medical University, Luzhou People's Republic of China
| | - Zhangyong Song
- Molecular Biotechnology Platform, Public Center of Experimental Technology, School of Basic Medical Sciences, Southwest Medical University, Luzhou People's Republic of China
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7
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Yonemura S, Hartson L, Dutt TS, Henao-Tamayo M, Goodrich R, Marschner S. Preservation of neutralizing antibody function in COVID-19 convalescent plasma treated using a riboflavin and ultraviolet light-based pathogen reduction technology. Vox Sang 2021; 116:1076-1083. [PMID: 33835489 PMCID: PMC8251479 DOI: 10.1111/vox.13108] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 03/11/2021] [Accepted: 03/11/2021] [Indexed: 12/26/2022]
Abstract
Background and objectives Convalescent plasma (CP) has been embraced as a safe therapeutic option for coronavirus disease 2019 (COVID‐19), while other treatments are developed. Severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) is not transmissible by transfusion, but bloodborne pathogens remain a risk in regions with high endemic prevalence of disease. Pathogen reduction can mitigate this risk; thus, the objective of this study was to evaluate the effect of riboflavin and ultraviolet light (R + UV) pathogen reduction technology on the functional properties of COVID‐19 CP (CCP). Materials and methods COVID‐19 convalescent plasma units (n = 6) from recovered COVID‐19 research donors were treated with R + UV. Pre‐ and post‐treatment samples were tested for coagulation factor and immunoglobulin retention. Antibody binding to spike protein receptor‐binding domain (RBD), S1 and S2 epitopes of SARS‐CoV‐2 was assessed by ELISA. Neutralizing antibody (nAb) function was assessed by pseudovirus reporter viral particle neutralization (RVPN) assay and plaque reduction neutralization test (PRNT). Results Mean retention of coagulation factors was ≥70%, while retention of immunoglobulins was 100%. Starting nAb titres were low, but PRNT50 titres did not differ between pre‐ and post‐treatment samples. No statistically significant differences were detected in levels of IgG (P ≥ 0·3665) and IgM (P ≥ 0·1208) antibodies to RBD, S1 and S2 proteins before and after treatment. Conclusion R + UV PRT effects on coagulation factors were similar to previous reports, but no significant effects were observed on immunoglobulin concentration and antibody function. SARS‐CoV‐2 nAb function in CCP is conserved following R + UV PRT treatment.
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Affiliation(s)
| | - Lindsay Hartson
- Infectious Disease Research Center, Colorado State University, Fort Collins, CO, USA
| | - Taru S Dutt
- Department of Microbiology, Immunology & Pathology, Colorado State University, Fort Collins, CO, USA
| | - Marcela Henao-Tamayo
- Department of Microbiology, Immunology & Pathology, Colorado State University, Fort Collins, CO, USA
| | - Raymond Goodrich
- Infectious Disease Research Center, Colorado State University, Fort Collins, CO, USA
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Focosi D, Franchini M. Impact of pathogen-reduction technologies on COVID-19 convalescent plasma potency. Transfus Clin Biol 2021; 28:132-134. [PMID: 33675992 PMCID: PMC7927574 DOI: 10.1016/j.tracli.2021.02.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 02/03/2021] [Accepted: 02/20/2021] [Indexed: 12/31/2022]
Abstract
Pathogen reduction technologies (PRT) have been recommended by many regulatory authorities to minimize the residual risk of transfusion-transmitted infections associated with COVID19 convalescent plasma. While its impact on safety and its cost-effectiveness are nowadays well proven, there is theoretical concern that PRT could impact efficacy of convalescent plasma by altering concentration and/or function of the neutralizing antibodies (nAb). We review here the evidence supporting a lack of significant detrimental effect from PRTs on nAbs.
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Affiliation(s)
- D Focosi
- North-Western Tuscany Blood Bank, Pisa University Hospital, via Paradisa 2, 56124 Pisa, Italy.
| | - M Franchini
- Department of Hematology and Transfusion Medicine, Carlo Poma Hospital, Mantua, Italy
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9
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Kumukova I, Trakhtman P, Starostin N, Borsakova D, Ignatova A, Bayzyanova Y. Quality assessment of red blood cell suspensions derived from pathogen-reduced whole blood. Vox Sang 2020; 116:547-556. [PMID: 33222171 DOI: 10.1111/vox.13039] [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: 07/24/2020] [Revised: 11/06/2020] [Accepted: 11/09/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND We used laboratory indicators to evaluate the quality of pathogen-reduced red blood cell suspension (RBCS) compared with gamma-irradiated RBCS. MATERIALS AND METHODS To determine biochemical and metabolic parameters of RBCS, we obtained 50 whole blood units from healthy volunteers and randomized them into 2 groups: 25 were pathogen-reduced, and then, RBCS prepared from them. RBCS from the other 25 was gamma-irradiated. Sampling was carried out on day zero before and after treatment and at 7, 14, 21 and 28 days. To determine lymphocyte inactivation, we collected another 35 whole blood units. Each was sampled to form 3 study groups: untreated, gamma-irradiated and pathogen-reduced. Daily sampling was carried out during 3 days of storage. RESULTS The quality of RBCS from both groups was largely the same, except for haemolysis and red blood cell fragility, which were more pronounced in the pathogen-reduced group. This finding limited the shelf life of pathogen-reduced RBCS to 14 days. Lymphocyte viability was significantly reduced after both treatments. Proliferation of lymphocytes after pathogen reduction was reduced to the detection limit, while low-level proliferation was observed in gamma-irradiated samples. CONCLUSION Pathogen-reduced red blood cells have acceptable quality and can be used for transfusion within 14 days. Results of inactivation of lymphocytes demonstrate that pathogen reduction technology, applied on WB, can serve as an alternative to irradiation.
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Affiliation(s)
- Irina Kumukova
- Dmitry Rogachev National Medical Research Center of Pediatric Hematology Oncology and Immunology, Moscow, Russia
| | - Pavel Trakhtman
- Dmitry Rogachev National Medical Research Center of Pediatric Hematology Oncology and Immunology, Moscow, Russia
| | - Nicolay Starostin
- Dmitry Rogachev National Medical Research Center of Pediatric Hematology Oncology and Immunology, Moscow, Russia
| | - Daria Borsakova
- Dmitry Rogachev National Medical Research Center of Pediatric Hematology Oncology and Immunology, Moscow, Russia.,Laboratory of Physiology and Biophysics of the Cell, Center for Theoretical Problems of Physicochemical Pharmacology, Russian Academy of Sciences, Moscow, Russia
| | - Anastasia Ignatova
- Dmitry Rogachev National Medical Research Center of Pediatric Hematology Oncology and Immunology, Moscow, Russia
| | - Yana Bayzyanova
- Dmitry Rogachev National Medical Research Center of Pediatric Hematology Oncology and Immunology, Moscow, Russia
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10
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Keil SD, Ragan I, Yonemura S, Hartson L, Dart NK, Bowen R. Inactivation of severe acute respiratory syndrome coronavirus 2 in plasma and platelet products using a riboflavin and ultraviolet light-based photochemical treatment. Vox Sang 2020; 115:495-501. [PMID: 32311760 PMCID: PMC7264728 DOI: 10.1111/vox.12937] [Citation(s) in RCA: 72] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 04/16/2020] [Accepted: 04/16/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND OBJECTIVE Severe acute respiratory distress syndrome coronavirus-2 (SARS-CoV-2), the causative agent of coronavirus disease 2019 (COVID-19), is a member of the coronavirus family. Coronavirus infections in humans are typically associated with respiratory illnesses; however, viral RNA has been isolated in serum from infected patients. Coronaviruses have been identified as a potential low-risk threat to blood safety. The Mirasol Pathogen Reduction Technology (PRT) System utilizes riboflavin and ultraviolet (UV) light to render blood-borne pathogens noninfectious, while maintaining blood product quality. Here, we report on the efficacy of riboflavin and UV light against the pandemic virus SARS-CoV-2 when tested in both plasma and platelets units. MATERIALS AND METHODS Stock SARS-CoV-2 was grown in Vero cells and inoculated into either plasma or platelet units. Those units were then treated with riboflavin and UV light. The infectious titres of SARS-CoV-2 were determined by plaque assay using Vero cells. A total of five (n = 5) plasma and three (n = 3) platelet products were evaluated in this study. RESULTS In both experiments, the measured titre of SARS-CoV-2 was below the limit of detection following treatment with riboflavin and UV light. The mean log reductions in the viral titres were ≥3·40 and ≥4·53 for the plasma units and platelet units, respectively. CONCLUSION Riboflavin and UV light effectively reduced the titre of SARS-CoV-2 in both plasma and platelet products to below the limit of detection in tissue culture. The data suggest that the process would be effective in reducing the theoretical risk of transfusion transmitted SARS-CoV-2.
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Affiliation(s)
| | - Izabela Ragan
- Department of Biomedical SciencesColorado State UniversityFort CollinsCOUSA
| | | | - Lindsay Hartson
- Infectious Disease Research CenterColorado State UniversityFort CollinsCOUSA
| | | | - Richard Bowen
- Department of Biomedical SciencesColorado State UniversityFort CollinsCOUSA
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11
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Bartolini B, Gruber CE, Koopmans M, Avšič T, Bino S, Christova I, Grunow R, Hewson R, Korukluoglu G, Lemos CM, Mirazimi A, Papa A, Sanchez-Seco MP, Sauer AV, Zeller H, Nisii C, Capobianchi MR, Ippolito G, Reusken CB, Di Caro A. Laboratory management of Crimean-Congo haemorrhagic fever virus infections: perspectives from two European networks. ACTA ACUST UNITED AC 2020; 24. [PMID: 30722811 PMCID: PMC6386216 DOI: 10.2807/1560-7917.es.2019.24.5.1800093] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Background Crimean-Congo haemorrhagic fever virus (CCHFV) is considered an emerging infectious disease threat in the European Union. Since 2000, the incidence and geographic range of confirmed CCHF cases have markedly increased, following changes in the distribution of its main vector, Hyalomma ticks. Aims To review scientific literature and collect experts’ opinion to analyse relevant aspects of the laboratory management of human CCHF cases and any exposed contacts, as well as identify areas for advancement of international collaborative preparedness and laboratory response plans. Methods We conducted a literature review on CCHF molecular diagnostics through an online search. Further, we obtained expert opinions on the key laboratory aspects of CCHF diagnosis. Consulted experts were members of two European projects, EMERGE (Efficient response to highly dangerous and emerging pathogens at EU level) and EVD-LabNet (Emerging Viral Diseases-Expert Laboratory Network). Results Consensus was reached on relevant and controversial aspects of CCHF disease with implications for laboratory management of human CCHF cases, including biosafety, diagnostic algorithm and advice to improve lab capabilities. Knowledge on the diffusion of CCHF can be obtained by promoting syndromic approach to infectious diseases diagnosis and by including CCHFV infection in the diagnostic algorithm of severe fevers of unknown origin. Conclusion No effective vaccine and/or therapeutics are available at present so outbreak response relies on rapid identification and appropriate infection control measures. Frontline hospitals and reference laboratories have a crucial role in the response to a CCHF outbreak, which should integrate laboratory, clinical and public health responses.
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Affiliation(s)
- Barbara Bartolini
- 'L. Spallanzani' National Institute for Infectious Diseases IRCCS (INMI), WHO Collaborating Center for Clinical Care, Diagnosis, Response and Training on Highly Infectious Diseases, Rome, Italy
| | - Cesare Em Gruber
- 'L. Spallanzani' National Institute for Infectious Diseases IRCCS (INMI), WHO Collaborating Center for Clinical Care, Diagnosis, Response and Training on Highly Infectious Diseases, Rome, Italy
| | - Marion Koopmans
- Erasmus MC, Department of Viroscience, WHO Collaborating Centre for Arbovirus and Viral Hemorrhagic Fever Reference and Research, Rotterdam, The Netherlands
| | - Tatjana Avšič
- Institute of Microbiology and Immunology, Faculty of Medicine, Ljubljana, Slovenia
| | - Sylvia Bino
- Control of Infectious Diseases Department Institute of Public Health, Tirana, Albania
| | - Iva Christova
- National Center of Infectious and Parasitic Diseases, Sofia, Bulgaria
| | | | - Roger Hewson
- Public Health England, National Infection Service WHO Collaborating Centre for Virus Reference and Research (Special Pathogens), Porton Down, Salisbury, United Kingdom
| | | | - Cinthia Menel Lemos
- Consumers, Health, Agriculture and Food Executive Agency (CHAFEA), Luxembourg, Luxembourg
| | - Ali Mirazimi
- Department of Laboratory Medicine, Clinical Microbiology, Karolinska Institute and Karolinska University Hospital, Solna, Sweden.,National Veterinary Institute, Uppsala, Sweden.,Public Health agency of Sweden, Solna, Sweden
| | - Anna Papa
- Department of Microbiology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Aisha V Sauer
- European Commission, Directorate General for Health and Food Safety, Unit for Crisis Management and Preparedness in Health, Luxembourg, Luxembourg
| | - Hervè Zeller
- European Center for Disease Prevention and Control, Office of the Chief Scientist, Stockholm, Sweden
| | - Carla Nisii
- 'L. Spallanzani' National Institute for Infectious Diseases IRCCS (INMI), WHO Collaborating Center for Clinical Care, Diagnosis, Response and Training on Highly Infectious Diseases, Rome, Italy
| | - Maria Rosaria Capobianchi
- 'L. Spallanzani' National Institute for Infectious Diseases IRCCS (INMI), WHO Collaborating Center for Clinical Care, Diagnosis, Response and Training on Highly Infectious Diseases, Rome, Italy
| | - Giuseppe Ippolito
- 'L. Spallanzani' National Institute for Infectious Diseases IRCCS (INMI), WHO Collaborating Center for Clinical Care, Diagnosis, Response and Training on Highly Infectious Diseases, Rome, Italy
| | - Chantal B Reusken
- Authors contributed equally to the work and share last authorship.,Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands.,Erasmus MC, Department of Viroscience, WHO Collaborating Centre for Arbovirus and Viral Hemorrhagic Fever Reference and Research, Rotterdam, The Netherlands
| | - Antonino Di Caro
- Authors contributed equally to the work and share last authorship.,'L. Spallanzani' National Institute for Infectious Diseases IRCCS (INMI), WHO Collaborating Center for Clinical Care, Diagnosis, Response and Training on Highly Infectious Diseases, Rome, Italy
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12
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Haemostatic function measured by thromboelastography and metabolic activity of platelets treated with riboflavin and UV light. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2020; 18:280-289. [PMID: 32530405 DOI: 10.2450/2020.0314-19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 04/20/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND Pathogen reduction technology (PRT) may damage platelet (PLT) components. To study this, metabolic activity and haemostatic function of buffy coat (BC) PLT concentrates, with or without riboflavin and UV light PRT treatment, were compared. MATERIAL AND METHODS Twenty-four BC PLT concentrates, leukoreduced and diluted in additive solution, were grouped into 12 type-matched pairs, which were pooled and divided into 12 non-PRT-treated BC PLT concentrates (control units) and 12 riboflavin and UV PRT-treated BC PLT concentrates (test units). Haemostatic function and metabolic parameters were monitored by thrombelastography at days 1, 3, 7 and 14 post collection in both PLT groups. RESULTS Loss of PLT discoid shape, glucose consumption, lactate production, and decrease in pH were greater in the PRT-treated PLTs than in control PLTs over time (p<0.001). PLT haemostatic function evaluated by clot strength was also significantly weaker in PRT-treated PLTs compared with the excellent clot quality of control PLTs at day 7 (maximum amplitude: 41.27 vs 64.27; p<0.001), and even at day 14 (21.16 vs 60.39; p<0.001) of storage. DISCUSSION Pathogen reduction technology treatment accelerates and increases platelet storage lesion, resulting in glucose depletion, lactate accumulation, PLT acidification, and discoid shape loss. The clots produced by control PLTs at day 14 were still remarkably strong, whereas at day 7 PRT-treated PLTs produced weaker clots compared to the control group. Clinical trials investigating the efficacy of PRT-treated PLTs transfused at the end of the storage period (day 7), when the in vitro clot strength is weaker, are needed.
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13
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Herzig MC, Fedyk CG, Montgomery RK, Schaffer BS, Bynum JA, Pidcoke HF, Cap AP. Blood component separation of pathogen-reduced whole blood by the PRP method produces acceptable red cells but platelet yields and function are diminished. Transfusion 2020; 60 Suppl 3:S124-S133. [PMID: 32478864 DOI: 10.1111/trf.15766] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 03/03/2020] [Accepted: 03/03/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND This study evaluated blood components processed by the platelet rich plasma (PRP) method from fresh whole blood (FWB) treated with a pathogen reduction technology (PRT). The effects of storage temperature on PRT treated platelet concentrates (PCs) were also examined. STUDY DESIGN AND METHODS PRT was performed using riboflavin and ultraviolet light on FWB in citrate phosphate dextrose anticoagulant. Following PRT, red blood cells (RBCs), PCs, and plasma for fresh frozen plasma (FFP), were isolated by sequential centrifugation. RBCs were stored at 4°C, FFP at -80°C, and PC at 22°C or at 4°C. Components were assayed throughout their storage times for blood gases, chemistry and CBC, hemostatic function as well as platelet (PLT) and RBC integrity. RESULTS Component processing following PRT resulted in a significant drop in platelet recovery. Most PRT-PC bags fell below AABB guidelines for platelet count. PRT-PC also showed a decrease in clot strength and decreased aggregometry response. Platelet caspases were activated by PRT. Storage at 4°C improved platelet function. In PRT-FFP, prothrombin time and partial thromboplastin time (PT and aPTT) were prolonged; factors V, VII, VIII, and XI, protein C, and fibrinogen were significantly decreased. Free hemoglobin was elevated two-fold in PRT-RBC. CONCLUSION Blood components isolated by the PRP method from PRT-treated WB result in a high percentage of PC that fail to meet AABB guidelines. FFP also shows diminished coagulation capacity. However, PRT-RBC are comparable to control-RBC. PRT-WB retains acceptable hemostatic function but alternatives to the PRP method of component separation may be more suitable.
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Affiliation(s)
- Maryanne C Herzig
- Coagulation & Blood Research, US Army Institute of Surgical Research, JBSA Fort Sam Houston, Texas, USA
| | - Chriselda G Fedyk
- Coagulation & Blood Research, US Army Institute of Surgical Research, JBSA Fort Sam Houston, Texas, USA
| | - Robbie K Montgomery
- Coagulation & Blood Research, US Army Institute of Surgical Research, JBSA Fort Sam Houston, Texas, USA
| | - Beverly S Schaffer
- Coagulation & Blood Research, US Army Institute of Surgical Research, JBSA Fort Sam Houston, Texas, USA
| | - James A Bynum
- Coagulation & Blood Research, US Army Institute of Surgical Research, JBSA Fort Sam Houston, Texas, USA.,Institute of Biomedical Studies, Baylor University, Waco, Texas, USA.,Joint Interdisciplinary Biomedical Engineering Program, UT San Antonio & UT Health San Antonio, San Antonio, Texas, USA
| | - Heather F Pidcoke
- Coagulation & Blood Research, US Army Institute of Surgical Research, JBSA Fort Sam Houston, Texas, USA
| | - Andrew P Cap
- Coagulation & Blood Research, US Army Institute of Surgical Research, JBSA Fort Sam Houston, Texas, USA.,Department of Surgery, UT Health San Antonio, San Antonio, Texas, USA
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14
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Brown BL, McCullough J. Treatment for emerging viruses: Convalescent plasma and COVID-19. Transfus Apher Sci 2020; 59:102790. [PMID: 32345485 PMCID: PMC7194745 DOI: 10.1016/j.transci.2020.102790] [Citation(s) in RCA: 96] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Revised: 04/13/2020] [Accepted: 04/14/2020] [Indexed: 12/28/2022]
Abstract
Use of convalescent plasma transfusions could be of great value in the current pandemic of coronavirus disease (COVID-19), given the lack of specific preventative and therapeutic options. This convalescent plasma therapy is of particular interest when a vaccine or specific therapy is not yet available for emerging viruses, such as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which causes COVID-19. This report summarizes existing literature around convalescent plasma as a therapeutic option for COVID-19. It also includes recommendations for establishing a convalescent plasma program, enhancement considerations for convalescent plasma, and considerations around pathogen reduction treatment of convalescent plasma. Time is of the essence to set up protocols for collection, preparation, and administration of apheresis-collected convalescent plasma in response to the current pandemic. The immediate use of convalescent plasma provides prompt availability of a promising treatment while specific vaccines and treatments are evaluated and brought to scale. Further development of improved convalescent plasma, vaccines and other therapeutics depends on quick generation of additional data on pathogenesis and immune response. Additionally, given the lack of information around the natural history of this disease, PRT should be considered to add a layer of safety to protect recipients of convalescent plasma.
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MESH Headings
- Antibodies, Neutralizing/blood
- Antibodies, Neutralizing/therapeutic use
- Antibodies, Viral/blood
- Antibodies, Viral/therapeutic use
- Betacoronavirus/immunology
- Blood Safety
- COVID-19
- Communicable Diseases, Emerging/therapy
- Communicable Diseases, Emerging/virology
- Convalescence
- Coronavirus Infections/blood
- Coronavirus Infections/prevention & control
- Coronavirus Infections/therapy
- Donor Selection
- Humans
- Immunization, Passive
- Meta-Analysis as Topic
- Pandemics/prevention & control
- Plasmapheresis
- Pneumonia, Viral/blood
- Pneumonia, Viral/prevention & control
- Pneumonia, Viral/therapy
- SARS-CoV-2
- Severe Acute Respiratory Syndrome/therapy
- United States
- United States Food and Drug Administration
- Virus Inactivation
- COVID-19 Serotherapy
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15
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Ragan I, Hartson L, Pidcoke H, Bowen R, Goodrich R. Pathogen reduction of SARS-CoV-2 virus in plasma and whole blood using riboflavin and UV light. PLoS One 2020; 15:e0233947. [PMID: 32470046 PMCID: PMC7259667 DOI: 10.1371/journal.pone.0233947] [Citation(s) in RCA: 71] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 05/16/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) has recently been identified as the causative agent for Coronavirus Disease 2019 (COVID-19). The ability of this agent to be transmitted by blood transfusion has not been documented, although viral RNA has been detected in serum. Exposure to treatment with riboflavin and ultraviolet light (R + UV) reduces blood-borne pathogens while maintaining blood product quality. Here, we report on the efficacy of R + UV in reducing SARS-CoV-2 infectivity when tested in human plasma and whole blood products. STUDY DESIGN AND METHODS SARS-CoV-2 (isolate USA-WA1/2020) was used to inoculate plasma and whole blood units that then underwent treatment with riboflavin and UV light (Mirasol Pathogen Reduction Technology System, Terumo BCT, Lakewood, CO). The infectious titers of SARS-CoV-2 in the samples before and after R + UV treatment were determined by plaque assay on Vero E6 cells. Each plasma pool (n = 9) underwent R + UV treatment performed in triplicate using individual units of plasma and then repeated using individual whole blood donations (n = 3). RESULTS Riboflavin and UV light reduced the infectious titer of SARS-CoV-2 below the limit of detection for plasma products at 60-100% of the recommended energy dose. At the UV light dose recommended by the manufacturer, the mean log reductions in the viral titers were ≥ 4.79 ± 0.15 Logs in plasma and 3.30 ± 0.26 in whole blood units. CONCLUSION Riboflavin and UV light effectively reduced the titer of SARS-CoV-2 to the limit of detection in human plasma and by 3.30 ± 0.26 on average in whole blood. Two clades of SARS-CoV-2 have been described and questions remain about whether exposure to one strain confers strong immunity to the other. Pathogen-reduced blood products may be a safer option for critically ill patients with COVID-19, particularly those in high-risk categories.
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Affiliation(s)
- Izabela Ragan
- Department of Biomedical Sciences, Colorado State University, Fort Collins, Colorado, United States of America
| | - Lindsay Hartson
- Infectious Disease Research Center, Colorado State University, Fort Collins, Colorado, United States of America
| | - Heather Pidcoke
- Translational Medicine Institute, Colorado State University, Fort Collins, Colorado, United States of America
| | - Richard Bowen
- Department of Biomedical Sciences, Colorado State University, Fort Collins, Colorado, United States of America
| | - Raymond Goodrich
- Infectious Disease Research Center, Colorado State University, Fort Collins, Colorado, United States of America
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16
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Pathogen reduction of blood components during outbreaks of infectious diseases in the European Union: an expert opinion from the European Centre for Disease Prevention and Control consultation meeting. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2019; 17:433-448. [PMID: 31846608 DOI: 10.2450/2019.0288-19] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 11/16/2019] [Accepted: 11/21/2019] [Indexed: 12/13/2022]
Abstract
Pathogen reduction (PR) of selected blood components is a technology that has been adopted in practice in various ways. Although they offer great advantages in improving the safety of the blood supply, these technologies have limitations which hinder their broader use, e.g. increased costs. In this context, the European Centre for Disease Prevention and Control (ECDC), in co-operation with the Italian National Blood Centre, organised an expert consultation meeting to discuss the potential role of pathogen reduction technologies (PRT) as a blood safety intervention during outbreaks of infectious diseases for which (in most cases) laboratory screening of blood donations is not available. The meeting brought together 26 experts and representatives of national competent authorities for blood from thirteen European Union and European Economic Area (EU/EEA) Member States (MS), Switzerland, the World Health Organization, the European Directorate for the Quality of Medicines and Health Care of the Council of Europe, the US Food and Drug Administration, and the ECDC. During the meeting, the current use of PRTs in the EU/EEA MS and Switzerland was verified, with particular reference to emerging infectious diseases (see Appendix). In this article, we also present expert discussions and a common view on the potential use of PRT as a part of both preparedness and response to threats posed to blood safety by outbreaks of infectious disease.
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17
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Atreya C, Glynn S, Busch M, Kleinman S, Snyder E, Rutter S, AuBuchon J, Flegel W, Reeve D, Devine D, Cohn C, Custer B, Goodrich R, Benjamin RJ, Razatos A, Cancelas J, Wagner S, Maclean M, Gelderman M, Cap A, Ness P. Proceedings of the Food and Drug Administration public workshop on pathogen reduction technologies for blood safety 2018 (Commentary, p. 3026). Transfusion 2019; 59:3002-3025. [PMID: 31144334 PMCID: PMC6726584 DOI: 10.1111/trf.15344] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 05/06/2019] [Accepted: 05/06/2019] [Indexed: 12/13/2022]
Affiliation(s)
- Chintamani Atreya
- US Food and Drug Administration, Center for Biologics Evaluation and ResearchOffice of Blood Research and ReviewSilver SpringMaryland
| | - Simone Glynn
- National Heart Lung and Blood InstituteBethesdaMarylandUSA
| | | | | | - Edward Snyder
- Blood BankYale‐New Haven HospitalNew HavenConnecticut
| | - Sara Rutter
- Department of Pathology and Laboratory MedicineYale School of MedicineNew HavenConnecticut
| | - James AuBuchon
- Department of PathologyDartmouth‐Hitchcock Medical CenterLebanonNew Hampshire
| | - Willy Flegel
- Department of Transfusion MedicineNIH Clinical CenterBethesdaMaryland
| | - David Reeve
- Blood ComponentsAmerican Red CrossRockvilleMaryland
| | - Dana Devine
- Department of Lab Medicine and PathologyUniversity of Minnesota Medical CenterMinneapolisMinnesota
| | - Claudia Cohn
- Department of Lab Medicine and PathologyUniversity of Minnesota Medical CenterMinneapolisMinnesota
| | - Brian Custer
- Vitalant Research InstituteSan FranciscoCalifornia
| | - Raymond Goodrich
- Department of Microbiology, Immunology and PathologyColorado State UniversityFort CollinsColorado
| | | | | | - Jose Cancelas
- Hoxworth Blood CenterUniversity of Cincinnati HealthCincinnatiOhio
| | | | - Michelle Maclean
- The Robertson Trust Laboratory for Electronic Sterilisation Technologies (ROLEST)University of StrathclydeGlasgowScotland
| | - Monique Gelderman
- Department of HematologyCenter for Biologics Evaluation and Research, US Food and Drug AdministrationSilver SpringMaryland
| | - Andrew Cap
- U.S. Army Institute of Surgical ResearchSan AntonioTexas
| | - Paul Ness
- Blood BankJohns Hopkins HospitalBaltimoreMaryland
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18
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Trakhtman P, Kumukova I, Starostin N, Borsakova D, Balashov D, Ignatova A, Kadaeva L, Novichkova G, Rumiantcev A. The pathogen‐reduced red blood cell suspension: single centre study of clinical safety and efficacy in children with oncological and haematological diseases. Vox Sang 2019; 114:223-231. [DOI: 10.1111/vox.12757] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 12/19/2018] [Accepted: 01/10/2019] [Indexed: 12/15/2022]
Affiliation(s)
- Pavel Trakhtman
- National Medical Research Center for Pediatric Hematology, Oncology and Immunology Moscow Russia
| | - Irina Kumukova
- National Medical Research Center for Pediatric Hematology, Oncology and Immunology Moscow Russia
| | - Nikolay Starostin
- National Medical Research Center for Pediatric Hematology, Oncology and Immunology Moscow Russia
| | - Daria Borsakova
- National Medical Research Center for Pediatric Hematology, Oncology and Immunology Moscow Russia
- Laboratory of Physiology and Biophysics of the Cell Center for Theoretical Problems of Physicochemical Pharmacology Russian Academy of Sciences Moscow Russia
| | - Dmitry Balashov
- National Medical Research Center for Pediatric Hematology, Oncology and Immunology Moscow Russia
| | - Anastasia Ignatova
- National Medical Research Center for Pediatric Hematology, Oncology and Immunology Moscow Russia
| | - Leilya Kadaeva
- National Medical Research Center for Pediatric Hematology, Oncology and Immunology Moscow Russia
| | - Galina Novichkova
- National Medical Research Center for Pediatric Hematology, Oncology and Immunology Moscow Russia
| | - Alexander Rumiantcev
- National Medical Research Center for Pediatric Hematology, Oncology and Immunology Moscow Russia
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19
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Reddoch-Cardenas K, Bynum J, Meledeo M, Nair P, Wu X, Darlington D, Ramasubramanian A, Cap A. Cold-stored platelets: A product with function optimized for hemorrhage control. Transfus Apher Sci 2019; 58:16-22. [DOI: 10.1016/j.transci.2018.12.012] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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20
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Jimenez-Marco T, Garcia-Recio M, Girona-Llobera E. Our experience in riboflavin and ultraviolet light pathogen reduction technology for platelets: from platelet production to patient care. Transfusion 2018; 58:1881-1889. [DOI: 10.1111/trf.14797] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 03/19/2018] [Accepted: 03/19/2018] [Indexed: 12/18/2022]
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21
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Filovirus – Auslöser von hämorrhagischem Fieber. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2018; 61:894-907. [DOI: 10.1007/s00103-018-2757-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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22
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Abhimanyu, Coussens AK. The role of UV radiation and vitamin D in the seasonality and outcomes of infectious disease. Photochem Photobiol Sci 2018; 16:314-338. [PMID: 28078341 DOI: 10.1039/c6pp00355a] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The seasonality of infectious disease outbreaks suggests that environmental conditions have a significant effect on disease risk. One of the major environmental factors that can affect this is solar radiation, primarily acting through ultraviolet radiation (UVR), and its subsequent control of vitamin D production. Here we show how UVR and vitamin D, which are modified by latitude and season, can affect host and pathogen fitness and relate them to the outcomes of bacterial, viral and vector-borne infections. We conducted a thorough comparison of the molecular and cellular mechanisms of action of UVR and vitamin D on pathogen fitness and host immunity and related these to the effects observed in animal models and clinical trials to understand their independent and complementary effects on infectious disease outcome. UVR and vitamin D share common pathways of innate immune activation primarily via antimicrobial peptide production, and adaptive immune suppression. Whilst UVR can induce vitamin D-independent effects in the skin, such as the generation of photoproducts activating interferon signaling, vitamin D has a larger systemic effect due to its autocrine and paracrine modulation of cellular responses in a range of tissues. However, the seasonal patterns in infectious disease prevalence are not solely driven by variation in UVR and vitamin D levels across latitudes. Vector-borne pathogens show a strong seasonality of infection correlated to climatic conditions favoring their replication. Conversely, pathogens, such as influenza A virus, Mycobacterium tuberculosis and human immunodeficiency virus type 1, have strong evidence to support their interaction with vitamin D. Thus, UVR has both vitamin D-dependent and independent effects on infectious diseases; these effects vary depending on the pathogen of interest and the effects can be complementary or antagonistic.
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Affiliation(s)
- Abhimanyu
- Clinical Infectious Diseases Research Initiative, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Anzio Rd, Observatory, 7925, Western Cape, South Africa.
| | - Anna K Coussens
- Clinical Infectious Diseases Research Initiative, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Anzio Rd, Observatory, 7925, Western Cape, South Africa. and Division of Medical Microbiology, Department of Pathology, University of Cape Town, Anzio Rd, Observatory, 7925, Western Cape, South Africa
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23
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Eickmann M, Gravemann U, Handke W, Tolksdorf F, Reichenberg S, Müller TH, Seltsam A. Inactivation of Ebola virus and Middle East respiratory syndrome coronavirus in platelet concentrates and plasma by ultraviolet C light and methylene blue plus visible light, respectively. Transfusion 2018; 58:2202-2207. [PMID: 29732571 PMCID: PMC7169708 DOI: 10.1111/trf.14652] [Citation(s) in RCA: 76] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 03/22/2018] [Accepted: 03/23/2018] [Indexed: 01/09/2023]
Abstract
BACKGROUND Ebola virus (EBOV) and Middle East respiratory syndrome coronavirus (MERS‐CoV) have been identified as potential threats to blood safety. This study investigated the efficacy of the THERAFLEX UV‐Platelets and THERAFLEX MB‐Plasma pathogen inactivation systems to inactivate EBOV and MERS‐CoV in platelet concentrates (PCs) and plasma, respectively. STUDY DESIGN AND METHODS PCs and plasma were spiked with high titers of cell culture–derived EBOV and MERS‐CoV, treated with various light doses of ultraviolet C (UVC; THERAFLEX UV‐Platelets) or methylene blue (MB) plus visible light (MB/light; THERAFLEX MB‐Plasma), and assessed for residual viral infectivity. RESULTS UVC reduced EBOV (≥4.5 log) and MERS‐CoV (≥3.7 log) infectivity in PCs to the limit of detection, and MB/light decreased EBOV (≥4.6 log) and MERS‐CoV (≥3.3 log) titers in plasma to nondetectable levels. CONCLUSIONS Both THERAFLEX UV‐Platelets (UVC) and THERAFLEX MB‐Plasma (MB/light) effectively reduce EBOV and MERS‐CoV infectivity in platelets and plasma, respectively.
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Affiliation(s)
- Markus Eickmann
- Institute for Virology, Philipps University Marburg, Marburg, Germany
| | - Ute Gravemann
- German Red Cross Blood Service NSTOB, Springe, Germany
| | - Wiebke Handke
- German Red Cross Blood Service NSTOB, Springe, Germany
| | | | | | | | - Axel Seltsam
- German Red Cross Blood Service NSTOB, Springe, Germany
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24
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Jacquot C, Delaney M. Efforts Toward Elimination of Infectious Agents in Blood Products. J Intensive Care Med 2018; 33:543-550. [PMID: 29562814 DOI: 10.1177/0885066618756589] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The US blood supply has never been safer. This level of safety depends on a multifaceted approach including blood donor screening, sensitive infectious disease testing, and good manufacturing practice. However, risks remain for transfusion-transmitted infections due to bacterial contamination of platelets and emerging diseases. Thus, ongoing improvements in screening and testing are required. Newer pathogen reduction technologies have shown promise in further ameliorating the safety of the blood supply.
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Affiliation(s)
- Cyril Jacquot
- 1 Division of Laboratory Medicine, Center for Cancer and Blood Disorders, Children's National Health System, Sheikh Zayed Campus for Advanced Children's Medicine, Washington, DC, USA.,2 Division of Hematology, Center for Cancer and Blood Disorders, Children's National Health System, Sheikh Zayed Campus for Advanced Children's Medicine, Washington, DC, USA.,3 Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, DC, USA.,4 Department of Pathology, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Meghan Delaney
- 1 Division of Laboratory Medicine, Center for Cancer and Blood Disorders, Children's National Health System, Sheikh Zayed Campus for Advanced Children's Medicine, Washington, DC, USA.,2 Division of Hematology, Center for Cancer and Blood Disorders, Children's National Health System, Sheikh Zayed Campus for Advanced Children's Medicine, Washington, DC, USA.,3 Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, DC, USA.,4 Department of Pathology, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
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25
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Oluwagbemi O, Awe O. A comparative computational genomics of Ebola Virus Disease strains: In-silico Insight for Ebola control. INFORMATICS IN MEDICINE UNLOCKED 2018. [DOI: 10.1016/j.imu.2018.07.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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26
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Allain JP, Goodrich R. Pathogen reduction of whole blood: utility and feasibility. Transfus Med 2017; 27 Suppl 5:320-326. [PMID: 28875531 DOI: 10.1111/tme.12456] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 07/06/2017] [Accepted: 08/07/2017] [Indexed: 12/26/2022]
Abstract
OBJECTIVES To collect information on pathogen reduction applied to whole blood. BACKGROUND Pathogen reduction (PR) of blood components has been developed over the past two decades, and pathogen-reduced fresh-frozen plasma and platelet concentrates are currently in clinical use. High cost and incomplete coverage of components make PR out of reach for low- and middle-income countries (LMIC). However, should PR become applicable to whole blood (WB), the main product transfused in sub-Saharan Africa, and be compatible with the preparation of clinically suitable components, cost would be minimised, and a range of safety measures in place at high cost in developed areas would become redundant. METHODS All articles called with "pathogen reduction", "pathogen inactivation" and "whole blood" were retrieved from Medline. References in articles were utilised. RESULTS One such PR technology (PRT) applied to WB has been developed and has shown efficacious against viruses, bacteria and parasites in vitro; and has been able to inactivate nucleated blood cells whilst retaining the ability to prepare components with acceptable characteristics. The efficacy of this WB PRT has been demonstrated in vivo using the inactivation of Plasmodium falciparum as a model and showing a high degree of correlation between in vitro and in vivo data. Obtaining further evidence of efficacy on other suitable targets is warranted. Shortening of the process, which is currently around 50 min, or increasing the number of units simultaneously processed would be necessary to make PRT WB conducive to LMIC blood services' needs. CONCLUSIONS Even if not 100% effective against agents that are present in high pathogen load titres, WB PRT could massively impact blood safety in LMIC by providing safer products at an affordable cost.
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Affiliation(s)
| | - R Goodrich
- Infectious Disease Research Center, University of Colorado, Denver, Colorado, USA
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27
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Di Minno G, Navarro D, Perno CF, Canaro M, Gürtler L, Ironside JW, Eichler H, Tiede A. Pathogen reduction/inactivation of products for the treatment of bleeding disorders: what are the processes and what should we say to patients? Ann Hematol 2017; 96:1253-1270. [PMID: 28624906 PMCID: PMC5486800 DOI: 10.1007/s00277-017-3028-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Accepted: 05/22/2017] [Indexed: 12/11/2022]
Abstract
Patients with blood disorders (including leukaemia, platelet function disorders and coagulation factor deficiencies) or acute bleeding receive blood-derived products, such as red blood cells, platelet concentrates and plasma-derived products. Although the risk of pathogen contamination of blood products has fallen considerably over the past three decades, contamination is still a topic of concern. In order to counsel patients and obtain informed consent before transfusion, physicians are required to keep up to date with current knowledge on residual risk of pathogen transmission and methods of pathogen removal/inactivation. Here, we describe pathogens relevant to transfusion of blood products and discuss contemporary pathogen removal/inactivation procedures, as well as the potential risks associated with these products: the risk of contamination by infectious agents varies according to blood product/region, and there is a fine line between adequate inactivation and functional impairment of the product. The cost implications of implementing pathogen inactivation technology are also considered.
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Affiliation(s)
- Giovanni Di Minno
- Dipartimento di Medicina Clinica e Chirurgia, Regional Reference Centre for Coagulation Disorders, Federico II University, Via S. Pansini 5, 80131, Naples, Italy.
| | - David Navarro
- Department of Microbiology, Microbiology Service, Hospital Clínico Universitario, School of Medicine, University of Valencia, Valencia, Spain
| | - Carlo Federico Perno
- Department of Experimental Medicine and Surgery, University of Rome Tor Vergata, Rome, Italy
| | - Mariana Canaro
- Department of Hemostasis and Thrombosis, Son Espases University Hospital, Palma de Mallorca, Spain
| | - Lutz Gürtler
- Max von Pettenkofer Institute for Hygiene and Medical Microbiology, University of München, Munich, Germany
| | - James W Ironside
- National Creutzfeldt-Jakob Disease Research and Surveillance Unit, School of Clinical Sciences, University of Edinburgh, Western General Hospital, Edinburgh, UK
| | - Hermann Eichler
- Institute of Clinical Hemostaseology and Transfusion Medicine, Saarland University Hospital, Homburg, Germany
| | - Andreas Tiede
- Department of Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany
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28
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Pickering BS, Collignon B, Smith G, Marszal P, Kobinger G, Weingartl HM. Detection of Zaire ebolavirus in swine: Assay development and optimization. Transbound Emerg Dis 2017; 65:77-84. [PMID: 28345293 DOI: 10.1111/tbed.12606] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Indexed: 01/14/2023]
Abstract
Ebolaviruses (family Filoviridae, order Mononegavirales) cause often fatal, haemorrhagic fever in primates including humans. Pigs have been identified as a species susceptible to Reston ebolavirus (RESTV) infection, with indicated transmission to humans in the Philippines; however, their role during Ebola outbreaks in Africa needs to be clarified. To perform surveillance studies, detection of ebolavirus requires a prerequisite validation of viral RNA and antibody detection methods in swine samples. These diagnostic tests also need to be suitable for deployment to low-level containment laboratories. In this study, we developed a set of tests for detection of antibodies against Zaire ebolavirus (EBOV) in swine. Recombinant EBOV nucleoprotein was produced using a baculovirus expression system for indirect ELISA development. Evaluation of this assay was performed using laboratory and field samples, achieving a diagnostic specificity of 99%. Importantly, the indirect ELISA was able to detect antibodies to EBOV at 7 dpi, 3 days earlier than virus neutralization tests (VNT). The format of the VNT in this work was modified to a microtitre plaque reduction neutralization assay (miPRNT) complemented with immunostaining to provide a more rapid and highly specific assay. Finally, a confirmatory immunoblot assay was generated to supplement the indirect ELISA results.
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Affiliation(s)
- B S Pickering
- National Centre for Foreign Animal Disease, Canadian Food Inspection Agency, Winnipeg, MB, Canada
| | - B Collignon
- National Centre for Foreign Animal Disease, Canadian Food Inspection Agency, Winnipeg, MB, Canada
| | - G Smith
- National Centre for Foreign Animal Disease, Canadian Food Inspection Agency, Winnipeg, MB, Canada
| | - P Marszal
- National Centre for Foreign Animal Disease, Canadian Food Inspection Agency, Winnipeg, MB, Canada
| | - G Kobinger
- Department of Microbiology, Immunology, faculty of Medicine, Université Laval, Québec, QC, Canada
| | - H M Weingartl
- National Centre for Foreign Animal Disease, Canadian Food Inspection Agency, Winnipeg, MB, Canada.,Department of Medical Microbiology, Faculty of Medicine, University of Manitoba, Winnipeg, MB, Canada
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Arbaeen AF, Schubert P, Serrano K, Carter CJ, Culibrk B, Devine DV. Pathogen inactivation treatment of plasma and platelet concentrates and their predicted functionality in massive transfusion protocols. Transfusion 2017; 57:1208-1217. [DOI: 10.1111/trf.14043] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 01/04/2017] [Accepted: 01/04/2017] [Indexed: 12/23/2022]
Affiliation(s)
- Ahmad F. Arbaeen
- Department of Pathology and Laboratory Medicine and Centre for Blood Research; University of British Columbia; Vancouver British Columbia Canada
- Faculty of Applied Medical Sciences, Department Laboratory Medicine; Umm al-Qura University; Makkah Al Mukarramah Saudi Arabia
| | - Peter Schubert
- Department of Pathology and Laboratory Medicine and Centre for Blood Research; University of British Columbia; Vancouver British Columbia Canada
- Centre for Innovation, Canadian Blood Services; Vancouver British Columbia Canada
| | - Katherine Serrano
- Department of Pathology and Laboratory Medicine and Centre for Blood Research; University of British Columbia; Vancouver British Columbia Canada
- Centre for Innovation, Canadian Blood Services; Vancouver British Columbia Canada
| | - Cedric J. Carter
- Department of Pathology and Laboratory Medicine and Centre for Blood Research; University of British Columbia; Vancouver British Columbia Canada
| | - Brankica Culibrk
- Centre for Innovation, Canadian Blood Services; Vancouver British Columbia Canada
| | - Dana V. Devine
- Department of Pathology and Laboratory Medicine and Centre for Blood Research; University of British Columbia; Vancouver British Columbia Canada
- Centre for Innovation, Canadian Blood Services; Vancouver British Columbia Canada
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Bibby K, Fischer RJ, Casson LW, de Carvalho NA, Haas CN, Munster VJ. Disinfection of Ebola Virus in Sterilized Municipal Wastewater. PLoS Negl Trop Dis 2017; 11:e0005299. [PMID: 28146555 PMCID: PMC5287448 DOI: 10.1371/journal.pntd.0005299] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Accepted: 01/03/2017] [Indexed: 11/18/2022] Open
Abstract
Concerns have been raised regarding handling of Ebola virus contaminated wastewater, as well as the adequacy of proposed disinfection approaches. In the current study, we investigate the inactivation of Ebola virus in sterilized domestic wastewater utilizing sodium hypochlorite addition and pH adjustment. No viral inactivation was observed in the one-hour tests without sodium hypochlorite addition or pH adjustment. No virus was recovered after 20 seconds (i.e. 4.2 log10 unit inactivation to detection limit) following the addition of 5 and 10 mg L-1 sodium hypochlorite, which resulted in immediate free chlorine residuals of 0.52 and 1.11 mg L-1, respectively. The addition of 1 mg L-1 sodium hypochlorite resulted in an immediate free chlorine residual of 0.16 mg L-1, which inactivated 3.5 log10 units of Ebola virus in 20 seconds. Further inactivation was not evident due to the rapid consumption of the chlorine residual. Elevating the pH to 11.2 was found to significantly increase viral decay over ambient conditions. These results indicate the high susceptibility of the enveloped Ebola virus to disinfection in the presence of free chlorine in municipal wastewater; however, we caution that extension to more complex matrices (e.g. bodily fluids) will require additional verification.
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Affiliation(s)
- Kyle Bibby
- Department of Civil and Environmental Engineering, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
- Department of Computational and Systems Biology, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Robert J. Fischer
- Laboratory of Virology, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Hamilton, Montana, United States of America
| | - Leonard W. Casson
- Department of Civil and Environmental Engineering, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Nathalia Aquino de Carvalho
- Department of Civil and Environmental Engineering, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Charles N. Haas
- Department of Civil, Architectural & Environmental Engineering, Drexel University, Philadelphia, Pennsylvania, United States of America
| | - Vincent J. Munster
- Laboratory of Virology, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Hamilton, Montana, United States of America
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Abstract
The recent Ebola virus epidemics which threatened three West African countries (Dec.2014-Apr.2016) has urged global collaborative health organizations and countries to set up measures to stop the infection and to treat patients, near half of them being at risk of death. Convalescent plasma-recovered from rescued West Africans-was considered a feasible therapeutic option. Efficacy was difficult to evaluate because of numerous unknowns (especially evolution of neutralizing antibodies), prior to the cessation of active transmission. This raises a large body of questions spanning epidemiological, virological, immunological but also ethical, sociological and anthropological aspects, alongside with public health concerns, in order to be better prepared to the next outbreak. This essay summarizes efforts made by a large number of groups worldwide, and attempts to address still unanswered questions on the benefit of specific versus non-specific plasma on altered-leaking-vascular endothelia in Ebola infection.
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Affiliation(s)
- Olivier Garraud
- EA3064 University of Lyon, Faculty of Medicine of Saint-Etienne, 42023 Saint-Etienne Cedex 02, France; Institut National de la Transfusion Sanguine, 75015 Paris, France.
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Jackman RP, Muench MO, Inglis H, Heitman JW, Marschner S, Goodrich RP, Norris PJ. Reduced MHC alloimmunization and partial tolerance protection with pathogen reduction of whole blood. Transfusion 2016; 57:337-348. [PMID: 27859333 DOI: 10.1111/trf.13895] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Revised: 09/08/2016] [Accepted: 09/09/2016] [Indexed: 12/23/2022]
Abstract
BACKGROUND Allogeneic blood transfusion can result in an immune response against major histocompatibility complex (MHC) antigens, potentially complicating future transfusions or transplants. We previously demonstrated that pathogen reduction of platelet-rich plasma (PRP) with riboflavin and ultraviolet light (UV+R) can prevent alloimmunization in mice. A similar pathogen-reduction treatment is currently under development for the treatment of whole blood using riboflavin and a higher dose of UV light. We sought to determine the effectiveness of this treatment in the prevention of alloimmunization. STUDY DESIGN AND METHODS BALB/cJ mice were transfused with untreated or UV+R-treated, allogeneic C57Bl/6J whole blood with or without leukoreduction. Mice were evaluated for donor-specific antibodies, ex vivo splenocyte cytokine responses, and changes in the frequency of regulatory T (Treg ) cells. RESULTS UV+R treatment blocked cytokine priming and reduced anti-MHC alloantibody responses to transfused whole blood. Leukoreduction reduced alloantibody levels in both the untreated and UV+R-treated groups. Mice transfused with UV+R-treated whole blood had reduced alloantibody and cytokine responses when subsequently transfused with untreated blood from the same donor type. This reduction in responses was not associated with increased Treg cells. CONCLUSIONS Pathogen reduction of whole blood with UV+R significantly reduces, but does not eliminate, the alloimmune response. Exposure to UV+R-treated whole blood transfusion does appear to induce tolerance to alloantigens, resulting in reduced anti-MHC alloantibody and cytokine responses to subsequent exposures to the same alloantigens. This tolerance does not appear to be driven by an increase in Treg cells.
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Affiliation(s)
| | - Marcus O Muench
- Blood Systems Research Institute.,Department of Laboratory Medicine, University of California-San Francisco, San Francisco, California
| | | | | | | | | | - Philip J Norris
- Blood Systems Research Institute.,Department of Laboratory Medicine, University of California-San Francisco, San Francisco, California
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Koepsell SA, Winkler AM, Roback JD. The Role of the Laboratory and Transfusion Service in the Management of Ebola Virus Disease. Transfus Med Rev 2016; 31:149-153. [PMID: 27894669 PMCID: PMC7126423 DOI: 10.1016/j.tmrv.2016.11.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Revised: 11/09/2016] [Accepted: 11/10/2016] [Indexed: 01/15/2023]
Abstract
The Ebola outbreak that began in 2013 infected and killed record numbers of individuals and created unprecedented challenges, including containment and treatment of the virus in resource-strained West Africa as well as the repatriation and treatment for patients in the United States and Europe. Valuable lessons were learned, especially the important role that the laboratory and transfusion service plays in the treatment for patients with Ebola virus disease (EVD) by providing data for supportive care and fluid resuscitation as well as the generation of investigational therapies such as convalescent plasma (CP). To provide treatment support, laboratories had to evaluate and update procedures to ensure the safety of laboratory personnel. Because there is no licensed EVD-specific treatment, CP was used in more than 99 patients with only 1 possible severe adverse event reported. However, given the biologic variability inherent in CP as well as the small number of patient treated in a nonrandomized fashion, the efficacy of CP in the treatment of EVD remains unknown. Patients with Ebola virus disease were treated in the United States and Europe for the first time. Laboratories played a vital role in supportive care and experimental therapies for Ebola virus disease. Convalescent plasma has unknown efficacy in treating Ebola virus disease.
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Affiliation(s)
- Scott A Koepsell
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, NE.
| | | | - John D Roback
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA
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34
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Weiskopf RB. What is innovation? Transfusion 2016; 56 Suppl 1:S3-5. [DOI: 10.1111/trf.13531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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