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Lee JH, Ward KR. Blood failure: traumatic hemorrhage and the interconnections between oxygen debt, endotheliopathy, and coagulopathy. Clin Exp Emerg Med 2024; 11:9-21. [PMID: 38018069 PMCID: PMC11009713 DOI: 10.15441/ceem.23.127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Accepted: 09/28/2023] [Indexed: 11/30/2023] Open
Abstract
This review explores the concept of "blood failure" in traumatic injury, which arises from the interplay of oxygen debt, the endotheliopathy of trauma (EoT), and acute traumatic coagulopathy (ATC). Traumatic hemorrhage leads to the accumulation of oxygen debt, which can further exacerbate hemorrhage by triggering a cascade of events when severe. Such events include EoT, characterized by endothelial glycocalyx damage, and ATC, involving platelet dysfunction, fibrinogen depletion, and dysregulated fibrinolysis. To manage blood failure effectively, a multifaceted approach is crucial. Damage control resuscitation strategies such as use of permissive hypotension, early hemorrhage control, and aggressive transfusion of blood products including whole blood aim to minimize oxygen debt and promote its repayment while addressing endothelial damage and coagulation. Transfusions of red blood cells, plasma, and platelets, as well as the use of tranexamic acid, play key roles in hemostasis and countering ATC. Whole blood, whether fresh or cold-stored, is emerging as a promising option to address multiple needs in traumatic hemorrhage. This review underscores the intricate relationships between oxygen debt, EoT, and ATC and highlights the importance of comprehensive, integrated strategies in the management of traumatic hemorrhage to prevent blood failure. A multidisciplinary approach is essential to address these interconnected factors effectively and to improve patient outcomes.
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Affiliation(s)
- Jae Hyuk Lee
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Kevin R. Ward
- Department of Emergency Medicine, Max Harry Weil Institute for Critical Care Research and Innovation, University of Michigan, Ann Arbor, MI, USA
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA
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Use of Cold-Stored Whole Blood is Associated with Improved Mortality in Hemostatic Resuscitation of Major Bleeding: A Multicenter Study. Ann Surg 2022; 276:579-588. [PMID: 35848743 DOI: 10.1097/sla.0000000000005603] [Citation(s) in RCA: 55] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this study was to identify a mortality benefit with the use of whole blood as part of the resuscitation of bleeding trauma patients. SUMMARY BACKGROUND DATA Blood component therapy (BCT) is the current standard for resuscitating trauma patients, with whole blood (WB) emerging as the blood product of choice. We hypothesized that the use of WB versus BCT alone would result in decreased mortality. METHODS We performed a 14-center, prospective-observational study of trauma patients who received WB versus BCT during their resuscitation. We applied a generalized linear mixed-effects model with a random effect and controlled for age, sex, mechanism of injury (MOI), and injury severity score (ISS). All patients who received blood as part of their initial resuscitation were included. Primary outcome was mortality and secondary outcomes included AKI, DVT/PE, pulmonary complications, and bleeding complications. RESULTS A total of 1,623 (WB: 1,180(74%), BCT: 443(27%)) patients who sustained penetrating (53%) or blunt (47%) injury were included. Patients who received WB had a higher shock index (0.98 vs. 0.83), more comorbidities, and more blunt MOI (all P<0.05). After controlling for center, age, sex, MOI, and ISS, we found no differences in the rates of AKI, DVT/PE or pulmonary complications. WB patients were 9% less likely to experience bleeding complications and were 48% less likely to die than BCT patients (P<0.0001). CONCLUSIONS Compared with BCT, the use of WB was associated with a 48% reduction in mortality in trauma patients. Our study supports the use of WB use in the resuscitation of trauma patients.
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There and Back Again: The Once and Current Developments in Donor-Derived Platelet Products for Products for Hemostatic Therapy. Blood 2022; 139:3688-3698. [PMID: 35482959 DOI: 10.1182/blood.2021014889] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 04/20/2022] [Indexed: 01/19/2023] Open
Abstract
Over 100 years ago, Duke transfused whole blood to a thrombocytopenic patient to raise the platelet count and prevent bleeding. Since then, platelet transfusions have undergone numerous modifications from whole blood-derived platelet-rich plasma to apheresis-derived platelet concentrates. Similarly, the storage time and temperature have changed. The mandate to store platelets for a maximum of 5-7 days at room temperature has been challenged by recent clinical trial data, ongoing difficulties with transfusion-transmitted infections, and recurring periods of shortages, further exacerbated by the COVID-19 pandemic. Alternative platelet storage approaches are as old as the first platelet transfusions. Cold-stored platelets may offer increased storage times (days) and improved hemostatic potential at the expense of reduced circulation time. Frozen (cryopreserved) platelets extend the storage time to years but require storage at -80 °C and thawing before transfusion. Lyophilized platelets can be powder-stored for years at room temperature and reconstituted within minutes in sterile water but are probably the least explored alternative platelet product to date. Finally, whole blood offers the hemostatic spectrum of all blood components but has challenges, such as ABO incompatibility. While we know more than ever before about the in vitro properties of these products, clinical trial data on these products are accumulating. The purpose of this review is to summarize the findings of recent preclinical and clinical studies on alternative, donor-derived platelet products.
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Barry M, Pati S. Targeting repair of the vascular endothelium and glycocalyx after traumatic injury with plasma and platelet resuscitation. Matrix Biol Plus 2022; 14:100107. [PMID: 35392184 PMCID: PMC8981767 DOI: 10.1016/j.mbplus.2022.100107] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 02/10/2022] [Accepted: 03/10/2022] [Indexed: 02/06/2023] Open
Abstract
Endothelial glycocalyx shedding is a key instigator of the endotheliopathy of trauma. Plasma and platelet transfusions preserve vascular integrity in pre-clinical models. However, platelets may be less effective than plasma in preserving the glycocalyx.
Severely injured patients with hemorrhagic shock can develop endothelial dysfunction, systemic inflammation, and coagulation disturbances collectively known as the endotheliopathy of trauma (EOT). Shedding of the endothelial glycocalyx occurs early after injury, contributes to breakdown of the vascular barrier, and plays a critical role in the pathogenesis of multiple organ dysfunction, leading to poor outcomes in trauma patients. In this review we discuss (i) the pathophysiology of endothelial glycocalyx and vascular barrier breakdown following hemorrhagic shock and trauma, and (ii) the role of plasma and platelet transfusion in maintaining the glycocalyx and vascular endothelial integrity.
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Affiliation(s)
- Mark Barry
- University of California, San Francisco, Department of Surgery. 513 Parnassus Ave., San Francisco, CA 94143, United States
- Corresponding author.
| | - Shibani Pati
- University of California, San Francisco, Department of Surgery. 513 Parnassus Ave., San Francisco, CA 94143, United States
- University of California, San Francisco, Department of Laboratory Medicine. 513 Parnassus Ave., San Francisco, CA 94143, United States
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5
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The Missing Pieces to the Cold-Stored Platelet Puzzle. Int J Mol Sci 2022; 23:ijms23031100. [PMID: 35163024 PMCID: PMC8835703 DOI: 10.3390/ijms23031100] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2021] [Revised: 01/17/2022] [Accepted: 01/18/2022] [Indexed: 01/28/2023] Open
Abstract
Cold-stored platelets are making a comeback. They were abandoned in the late 1960s in favor of room-temperature stored platelets due to the need for longer post-transfusion platelet recoverability and survivability in patients with chronic thrombocytopenia. However, the current needs for platelet transfusions are rapidly changing. Today, more platelets are given to patients who are actively bleeding, such as ones receiving cardiac surgeries. It has been established that cold-stored platelets are more hemostatically effective, have reduced bacterial growth, and have longer potential shelf lives. These compelling characteristics led to the recent interest in bringing back cold-stored platelets to the blood systems. However, before reinstating cold-stored platelets in the clinics again, a thorough investigation of in vitro storage characteristics and in vivo transfusion effects is required. This review aims to provide an update on the recent research efforts into the storage characteristics and functions of cold-stored platelets using modern investigative tools. We will also discuss efforts made to improve cold-stored platelets to be a better and safer product. Finally, we will finish off with discussing the relevance of in vitro data to in vivo transfusion results and provide insights and directions for future investigations of cold-stored platelets.
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6
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Vulliamy P, Kornblith LZ, Kutcher ME, Cohen MJ, Brohi K, Neal MD. Alterations in platelet behavior after major trauma: adaptive or maladaptive? Platelets 2021; 32:295-304. [PMID: 31986948 PMCID: PMC7382983 DOI: 10.1080/09537104.2020.1718633] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 01/01/2020] [Accepted: 01/14/2020] [Indexed: 12/14/2022]
Abstract
Platelets are damage sentinels of the intravascular compartment, initiating and coordinating the primary response to tissue injury. Severe trauma and hemorrhage induce profound alterations in platelet behavior. During the acute post-injury phase, platelets develop a state of impaired ex vivo agonist responsiveness independent of platelet count, associated with systemic coagulopathy and mortality risk. In patients surviving the initial insult, platelets become hyper-responsive, associated with increased risk of thrombotic events. Beyond coagulation, platelets constitute part of a sterile inflammatory response to injury: both directly through release of immunomodulatory molecules, and indirectly through modifying behavior of innate leukocytes. Both procoagulant and proinflammatory aspects have implications for secondary organ injury and multiple-organ dysfunction syndromes. This review details our current understanding of adaptive and maladaptive alterations in platelet biology induced by severe trauma, mechanisms underlying these alterations, potential platelet-focused therapies, and existing knowledge gaps and their research implications.
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Affiliation(s)
- Paul Vulliamy
- Centre for Trauma Sciences, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, E1 2AT, United Kingdom
| | - Lucy Z. Kornblith
- Department of Surgery, Zuckerberg San Francisco General Hospital and the University of California, San Francisco, San Francisco, California
| | - Matthew E. Kutcher
- Division of Trauma, Critical Care, and Acute Care Surgery, University of Mississippi Medical Center, Jackson, Mississippi
| | - Mitchell J. Cohen
- Department of Surgery, University of Colorado, Aurora, Colorado
- Ernest E Moore Shock Trauma Center at Denver Health, Denver, Colorado
| | - Karim Brohi
- Centre for Trauma Sciences, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, E1 2AT, United Kingdom
| | - Matthew D. Neal
- Division of Trauma and Acute Care Surgery, Department of Surgery, University of Pittsburgh, Pittsburgh, PA
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Wood B, Padula MP, Marks DC, Johnson L. The immune potential of ex vivo stored platelets: a review. Vox Sang 2020; 116:477-488. [PMID: 33326606 DOI: 10.1111/vox.13058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 11/14/2020] [Accepted: 12/02/2020] [Indexed: 11/30/2022]
Abstract
Platelets are now acknowledged as key regulators of the immune system, as they are capable of mediating inflammation, leucocyte recruitment and activation. This activity is facilitated through platelet activation, which induces significant changes in the surface receptor profile and triggers the release of a range of soluble biological response modifiers (BRMs). In the field of transfusion medicine, the immune function of platelets has gained considerable attention as this may be linked to the development of adverse transfusion reactions. Further, component manufacturing and storage methodologies may impact the immunoregulatory role of platelets, and an understanding of this impact is crucial and should be considered alongside their haemostatic characteristics. This review highlights the key interactions between platelets and traditional immune modulators. Further, the potential impact of current and novel component storage methodologies, such as refrigeration and cryopreservation, on this functional capacity is examined, highlighting why further knowledge in this area would be of benefit.
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Affiliation(s)
- Ben Wood
- Research & Development, Australian Red Cross Lifeblood, Alexandria, NSW, Australia.,School of Life Sciences, University of Technology Sydney, Sydney, NSW, Australia
| | - Matthew P Padula
- School of Life Sciences, University of Technology Sydney, Sydney, NSW, Australia
| | - Denese C Marks
- Research & Development, Australian Red Cross Lifeblood, Alexandria, NSW, Australia.,Sydney Medical School, The University of Sydney, Camperdown, NSW, Australia
| | - Lacey Johnson
- Research & Development, Australian Red Cross Lifeblood, Alexandria, NSW, Australia
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Blessinger SA, Tran JQ, Jackman RP, Gilfanova R, Rittenhouse J, Gutierrez AG, Heitman JW, Hazegh K, Kanias T, Muench MO. Immunodeficient mice are better for modeling the transfusion of human blood components than wild-type mice. PLoS One 2020; 15:e0237106. [PMID: 32735605 PMCID: PMC7394438 DOI: 10.1371/journal.pone.0237106] [Citation(s) in RCA: 9] [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: 02/21/2020] [Accepted: 07/20/2020] [Indexed: 12/15/2022] Open
Abstract
Animal models are vital to the study of transfusion and development of new blood products. Post-transfusion recovery of human blood components can be studied in mice, however, there is a need to identify strains that can best tolerate xenogeneic transfusions, as well as to optimize such protocols. Specifically, the importance of using immunodeficient mice, such as NOD.Cg-Prkdcscid Il2rgtm1Wjl/SzJ (NSG) mice, to study human transfusion has been questioned. In this study, strains of wild-type and NSG mice were compared as hosts for human transfusions with outcomes quantified by flow cytometric analyses of CD235a+ erythrocytes, CD45+ leukocytes, and CD41+CD42b+ platelets. Complete blood counts were evaluated as well as serum cytokines by multiplexing methods. Circulating human blood cells were maintained better in NSG than in wild-type mice. Lethargy and hemoglobinuria were observed in the first hours in wild-type mice along with increased pro-inflammatory cytokines/chemokines such as monocyte chemoattractant protein-1, tumor necrosis factor α, keratinocyte-derived chemokine (KC or CXCL1), and interleukin-6, whereas NSG mice were less severely affected. Whole blood transfusion resulted in rapid sequestration and then release of human cells back into the circulation within several hours. This rebound effect diminished when only erythrocytes were transfused. Nonetheless, human erythrocytes were found in excess of mouse erythrocytes in the liver and lungs and had a shorter half-life in circulation. Variables affecting the outcomes of transfused erythrocytes were cell dose and mouse weight; recipient sex did not affect outcomes. The sensitivity and utility of this xenogeneic model were shown by measuring the effects of erythrocyte damage due to exposure to the oxidizer diamide on post-transfusion recovery. Overall, immunodeficient mice are superior models for xenotransfusion as they maintain improved post-transfusion recovery with negligible immune-associated side effects.
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Affiliation(s)
| | - Johnson Q. Tran
- Vitalant Research Institute, San Francisco, CA, United States of America
| | - Rachael P. Jackman
- Vitalant Research Institute, San Francisco, CA, United States of America
- Department of Laboratory Medicine, University of California, San Francisco, CA, United States of America
| | - Renata Gilfanova
- Vitalant Research Institute, San Francisco, CA, United States of America
| | | | - Alan G. Gutierrez
- Vitalant Research Institute, San Francisco, CA, United States of America
| | - John W. Heitman
- Vitalant Research Institute, San Francisco, CA, United States of America
| | - Kelsey Hazegh
- Vitalant Research Institute, Denver, CO, United States of America
| | - Tamir Kanias
- Vitalant Research Institute, Denver, CO, United States of America
- Department of Pathology, University of Colorado Denver Anschutz Medical Campus, Aurora, CO, United States of America
| | - Marcus O. Muench
- Vitalant Research Institute, San Francisco, CA, United States of America
- Department of Laboratory Medicine, University of California, San Francisco, CA, United States of America
- * E-mail:
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Morphological Characteristics and Correction of Long Tubular Bone Regeneration under Chronic Hyperglycemia Influence. Anal Cell Pathol (Amst) 2020; 2020:5472841. [PMID: 32322459 PMCID: PMC7165321 DOI: 10.1155/2020/5472841] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 03/25/2020] [Indexed: 01/08/2023] Open
Abstract
Introduction Unsatisfactory consequences of bone regeneration disorders in diabetes mellitus (DM) patients, their high prevalence, complication number, and difficulties in treatment require further study and deeper understanding of reparative osteogenesis mechanisms under chronic hyperglycemia and finding new effective and affordable approaches to their treatment. Therefore, the aim of our work was to study the histological, ultramicroscopic, and histomorphometric features of reparative osteogenesis in rats with chronic hyperglycemia (CH), as well as to investigate the possibility of platelet-rich plasma (PRP) use in a fracture area in order to correct the negative effects of CH on reparative osteogenesis processes. Study Object and Methods. The studies were performed on 70 white laboratory rats, mature males, which were divided into the following groups: control group, animals with posttraumatic tibial defect under conditions of CH exposure, rats with experimental CH that were administered with PRP into the bone defect, and animals for the assessment of glucose homeostasis and confirmation of simulated CH. Light microscopy was performed using an Olympus BH-2 microscope (Japan). Ultramicroscopic examination was performed using REM-102 scanning electron microscope. The statistical analysis was performed using SPSS-17 software package. Results The formation of new bone tissue in animals with CH did not occur after two weeks. Only on the 30th day of reparative osteogenesis the newly formed woven bone tissue was 61.54% of the total regenerated area. It was less than the reference value by 22.89% (P < 0.001). On the 14th day of reparative osteogenesis, the regenerated area in a group of animals with CH and PRP injection consisted of connective tissue by 68.94% (4.94% less than in animals with CH (P < 0.001)) and woven bone tissue by 31.06%, (13.51% less than in the control group (P < 0.001)). On the 30th day, the area of woven bone tissue in a regenerate of this group was less than that of the control group by 12.41% (P < 0.001). Conclusion Thus, chronic hyperglycemia contributes to inflammation delay within the bone defect site, which makes the process of reparative osteogenesis more prolonged. The results of chronic hyperglycemia effect on bone regeneration are also impairment of osteogenic cell proliferation and shift of their differentiation towards the fibrocartilage regenerate formation. The PRP corrects the negative impact of chronic hyperglycemia on reparative osteogenesis, promoting more rapid inflammatory infiltrate removal from the bone defect site and osteogenic beam formation and remodeling of woven bone into lamellar membranous bone tissue.
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The effect of platelet storage temperature on haemostatic, immune, and endothelial function: potential for personalised medicine. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2020; 17:321-330. [PMID: 31385802 DOI: 10.2450/2019.0095-19] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Accepted: 05/30/2019] [Indexed: 02/06/2023]
Abstract
Reports from both adult and paediatric populations indicate that approximately two-thirds of platelet transfusions are used prophylactically to prevent bleeding, while the remaining one-third are used therapeutically to manage active bleeding. These two indications, prophylactic and therapeutic, serve two very distinct purposes and therefore will have two different functional requirements. In addition, disease aetiology in a given patient may require platelets with different functional characteristics. These characteristics can be derived from the various manufacturing methods used in platelet product production, including collection methods, processing methods, and storage options. The iterative combinations of manufacturing methods can result in a number of unique platelet products with different efficacy and safety profiles, which could potentially be used to benefit patient populations by meeting diverse clinical needs. In particular, cold storage of platelet products causes many biochemical and functional changes, of which the most notable characterised to date include increased haemostatic activity and altered expression of molecules inherent to platelet:leucocyte interactions. The in vivo consequences, both short- and long-term, of these molecular and cellular cold-storage-induced changes have yet to be clearly defined. Elucidation of these mechanisms would potentially reveal unique biologies that could be harnessed to provide more targeted therapies. To this end, in this new era of personalised medicine, perhaps there is an opportunity to provide individual patients with platelet products that are tailored to their clinical condition and the specific indication for transfusion.
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Platelet Contributions to Trauma-Induced Coagulopathy: Updates in Post-injury Platelet Biology, Platelet Transfusions, and Emerging Platelet-Based Hemostatic Agents. CURRENT TRAUMA REPORTS 2019. [DOI: 10.1007/s40719-019-00176-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Horioka K, Tanaka H, Isozaki S, Okuda K, Asari M, Shiono H, Ogawa K, Shimizu K. Hypothermia-induced activation of the splenic platelet pool as a risk factor for thrombotic disease in a mouse model. J Thromb Haemost 2019; 17:1762-1771. [PMID: 31237986 PMCID: PMC6851562 DOI: 10.1111/jth.14555] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Accepted: 06/19/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND Hypothermia, either therapeutically induced or accidental (ie, an involuntary decrease in core body temperature to <35°C), results in hemostatic disorders. However, it remains unclear whether hypothermia enhances or inhibits coagulation, especially in severe hypothermia. The present study evaluated the thrombocytic and hemostatic changes in hypothermic mice. METHODS C57Bl/6 mice were placed at an ambient temperature of -20°C under general anesthesia. When the rectal temperature decreased to 15°C, 10 mice were immediately euthanized, while another 10 mice were rewarmed, kept in normal conditions for 24 hours, and then euthanized. These treatments were also performed in 20 splenectomized mice. RESULTS The hypothermic mice had adhesion of CD62P-positive platelets with high expression of von Willebrand factor (vWF) in their spleens, while the status of the peripheral platelets was unchanged. Furthermore, the plasma levels of platelet factor 4 (PF4) and pro-platelet basic protein (PPBP), which are biomarkers for platelet degranulation, were significantly higher in hypothermic mice than in control mice, indicating that hypothermia activated the platelets in the splenic pool. Thus, we analyzed these biomarkers in asplenic mice. There was no increase in either PF4 or PPBP in splenectomized hypothermic mice. Additionally, the plasma D-dimer elevation and microthrombosis were caused in rewarmed mice, but not in asplenic rewarmed mice. CONCLUSIONS Our results indicate that hypothermia leads to platelet activation in the spleen via the upregulation of vWF, and this activation causes hypercoagulability after rewarming.
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Affiliation(s)
- Kie Horioka
- Department of Legal MedicineAsahikawa Medical UniversityAsahikawaJapan
| | - Hiroki Tanaka
- Department of Legal MedicineAsahikawa Medical UniversityAsahikawaJapan
| | - Shotaro Isozaki
- Division of Gastroenterology and Hematology/OncologyAsahikawa Medical UniversityAsahikawaJapan
| | - Katsuhiro Okuda
- Department of Legal MedicineAsahikawa Medical UniversityAsahikawaJapan
| | - Masaru Asari
- Department of Legal MedicineAsahikawa Medical UniversityAsahikawaJapan
| | - Hiroshi Shiono
- Department of Legal MedicineAsahikawa Medical UniversityAsahikawaJapan
| | - Katsuhiro Ogawa
- Department of PathologyAsahikawa Medical UniversityAsahikawaJapan
| | - Keiko Shimizu
- Department of Legal MedicineAsahikawa Medical UniversityAsahikawaJapan
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Miyazawa B, Trivedi A, Togarrati PP, Potter D, Baimukanova G, Vivona L, Lin M, Lopez E, Callcut R, Srivastava AK, Kornblith LZ, Fields AT, Schreiber MA, Wade CE, Holcomb JB, Pati S. Regulation of endothelial cell permeability by platelet-derived extracellular vesicles. J Trauma Acute Care Surg 2019; 86:931-942. [PMID: 31124890 PMCID: PMC7381393 DOI: 10.1097/ta.0000000000002230] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Platelet (Plt)-derived extracellular vesicles (Plt-EVs) have hemostatic properties similar to Plts. In addition to hemostasis, Plts also function to stabilize the vasculature and maintain endothelial cell (EC) barrier integrity. We hypothesized that Plt-EVs would inhibit vascular EC permeability, similar to fresh Plts. To investigate this hypothesis, we used in vitro and in vivo models of vascular endothelial compromise and bleeding. METHODS In the vitro model, Plt-EVs were isolated by ultracentrifugation and characterized for Plt markers and particle size distribution. Effects of Plts and Plt-EVs on endothelial barrier function were assessed by transendothelial electrical resistance measurements and histological analysis of endothelial junction proteins. Hemostatic potential of Plt-EVs and Plts was assessed by multiple electrode Plt aggregometry. Using an in vivo model, the effects of Plts and Plt-EVs on vascular permeability and bleeding were assessed in non-obese diabetic-severe combined immunodeficient (NOD-SCID) mice by an established Miles assay of vascular permeability and a tail snip bleeding assay. RESULTS In the in vitro model, Plt-EVs displayed exosomal size distribution and expressed Plt-specific surface markers. Platelets and Plt-EVs decreased EC permeability and restored EC junctions after thrombin challenge. Multiplate aggregometry revealed that Plt-EVs enhanced thrombin receptor-activating peptide-mediated aggregation of whole blood, whereas Plts enhanced thrombin receptor-activating peptide-, arachidonic acid-, collagen-, and adenosine diphosphate-mediated aggregation. In the in vivo model, Plt-EVs are equivalent to Plts in attenuating vascular endothelial growth factor (VEGF)-A-induced vascular permeability and uncontrolled blood loss in a tail snip hemorrhage model. CONCLUSION Our study is the first to report that Plt-EVs might provide a feasible product for transfusion in trauma patients to attenuate bleeding, inhibit vascular permeability, and mitigate the endotheliopathy of trauma.
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Affiliation(s)
- Byron Miyazawa
- From the Department of Laboratory Medicine (B.M., A.T., D.P., L.V., M.L., S.P.), University of California; Blood Systems Research Institute (P.P.T., G.B.), San Francisco, California; Department of Surgery (EL., C.E.W.), University of Texas Health Science Center at Houston; Department of Pediatric Surgery (A.K.S., J.B.H.), McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas; Department of Surgery (R.C., L.Z.K., A.T.F.), University of California San Francisco, San Francisco, California; Department of Surgery (M.A.S.), Oregon Health Science and University, Portland, Oregon
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Yang JC, Liu FH, Sun Y, Ma T, Xu CX, Wang WH, Chen P, Xie XX, Song YJ, Yin W. Good hemostatic effect of platelets stored at 4°C in an in vitro model of massive blood loss and thrombocytopenia. Medicine (Baltimore) 2019; 98:e15454. [PMID: 31045818 PMCID: PMC6504340 DOI: 10.1097/md.0000000000015454] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
This study compared the corrective effects of storage of platelets at 4°C and at 22°C in an in vitro model of massive blood loss and thrombocytopenia to provide an experimental basis for the storage of platelets for clinical applications.In vitro model of massive blood loss and thrombocytopenia were constructed by the in vitro hemodilution method and cell washing method. Using storage of platelets at 4°C (1, 3, 5, 7, 10, 14 days) and at 22°C (1, 3, 5 days) to correct the coagulation condition of the different models, by thromboelastography and by routine blood indices.①Platelets stored at 4°C (1, 3, 5,7, 10, 14 days) and at 22°C (1, 3, 5 days) to correct the in vitro model of massive blood loss. Platelet count results improved from 17 to 27 × 10/L to greater than 120 × 10/L for 4°C storage, and 20 to 27 × 10/L to greater than 120 × 10/L for 22°C storage. Thromboelastography maximum amplitude (TEG-MA) results improved from 8.8 to 15.4 mm to greater than 43 mm for 4°C storage, and 12.2 to 14.4 mm to greater than 44.8 mm for 22°C storage. Thromboelastography reaction time values decreased from 9.9-24.9 minutes to 3.8-5.5 minutes for 4°C storage, and 9.9-22.7 minutes to 4.3-4.5 minutes for 22°C storage. ②Platelets stored at 4°C (1, 3, 5,7, 10, 14 days) and at 22°C (1, 3, 5 days) to correct the in vitro model of thrombocytopenia. Platelet count results improved from 12 to 34 × 10/L to greater than 99 × 10/L for 4°C storage, and 12 to 34 × 10/L to greater than 120 × 10/L for 22°C storage. TEG-MA results improved from 21.4 to 32.1 mm to greater than 49.1 mm for 4°C storage, and 21.4 to 31.6 mm to greater than 50.5 mm for 22°C storage.Platelets stored at 4°C and 22°C have the same correcting effect for 1, 3, and 5 days. Platelets stored at 4°C for 7 to 14 days have similarly hemostatic effect on the in vitro model of massive blood loss and thrombocytopenia.
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Affiliation(s)
- Jiang-Cun Yang
- Department of Transfusion Medicine, Shaanxi Provincial People's Hospital, Xi’an
| | - Feng-Hua Liu
- Department of Transfusion Medicine, First Affiliated Hospital of Harbin Medical University, Harbin
| | - Yang Sun
- Department of Transfusion Medicine, Shaanxi Provincial People's Hospital, Xi’an
| | - Ting Ma
- Department of Transfusion Medicine, Shaanxi Provincial People's Hospital, Xi’an
| | - Cui-Xiang Xu
- Department of Transfusion Medicine, Shaanxi Provincial People's Hospital, Xi’an
| | - Wen-Hua Wang
- Department of Transfusion Medicine, Shaanxi Provincial People's Hospital, Xi’an
| | - Ping Chen
- Department of Transfusion Medicine, Shaanxi Provincial People's Hospital, Xi’an
| | - Xin-Xin Xie
- Department of Transfusion Medicine, Shaanxi Provincial People's Hospital, Xi’an
| | - Yao-Jun Song
- Department of Transfusion Medicine, Shaanxi Provincial People's Hospital, Xi’an
| | - Wen Yin
- Department of Transfusion Medicine, Xijing Hospital, The Fourth Military Medical University, Xi’an, China
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15
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Ketter PM, Kamucheka R, Arulanandam B, Akers K, Cap AP. Platelet enhancement of bacterial growth during room temperature storage: mitigation through refrigeration. Transfusion 2019; 59:1479-1489. [DOI: 10.1111/trf.15255] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 02/25/2019] [Accepted: 02/27/2019] [Indexed: 12/25/2022]
Affiliation(s)
- Patrick M. Ketter
- U.S. Army Institute of Surgical Research Coagulation and Blood Research Task Area Texas
| | - Robin Kamucheka
- U.S. Army Institute of Surgical Research Coagulation and Blood Research Task Area Texas
| | | | - Kevin Akers
- U.S. Army Institute of Surgical Research Coagulation and Blood Research Task Area Texas
| | - Andrew P. Cap
- U.S. Army Institute of Surgical Research Coagulation and Blood Research Task Area Texas
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16
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Milford EM, Reade MC. Resuscitation Fluid Choices to Preserve the Endothelial Glycocalyx. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2019; 23:77. [PMID: 30850020 PMCID: PMC6408751 DOI: 10.1186/s13054-019-2369-x] [Citation(s) in RCA: 73] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
This article is one of ten reviews selected from the Annual Update in Intensive Care and Emergency Medicine 2019. Other selected articles can be found online at https://www.biomedcentral.com/collections/annualupdate2019. Further information about the Annual Update in Intensive Care and Emergency Medicine is available from http://www.springer.com/series/8901.
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Affiliation(s)
- Elissa M Milford
- Intensive Care Medicine, 2nd General Health Battalion, Australian Army, Brisbane, QLD, Australia. .,Faculty of Medicine, The University of Queensland, Herston, QLD, Australia.
| | - Michael C Reade
- Faculty of Medicine, The University of Queensland and Australian Defence Force Joint Health Command, Brisbane, QLD, Australia.,Clinical Services, 2nd General Health Battalion, Australian Army, Brisbane, QLD, Australia
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17
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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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18
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Hemorrhagic blood failure: Oxygen debt, coagulopathy, and endothelial damage. J Trauma Acute Care Surg 2019; 82:S41-S49. [PMID: 28328671 DOI: 10.1097/ta.0000000000001436] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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19
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Kornblith LZ, Robles AJ, Conroy AS, Hendrickson CM, Calfee CS, Fields AT, Callcut RA, Cohen MJ. Perhaps it's not the platelet: Ristocetin uncovers the potential role of von Willebrand factor in impaired platelet aggregation following traumatic brain injury. J Trauma Acute Care Surg 2018; 85:873-880. [PMID: 29985231 PMCID: PMC6202182 DOI: 10.1097/ta.0000000000002025] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Injury to the blood-brain barrier exposes endothelium rich in von Willebrand factor (vWF), which may play a role in altered platelet aggregation following traumatic brain injury (TBI). Ristocetin is an antimicrobial substance that induces vWF-mediated aggregation of platelets. We examined these mechanisms in injured patients by measuring the aggregation response of platelets to stimulating agonists (including ristocetin) via whole-blood multiple-electrode platelet aggregometry. We hypothesized that patients with TBI have an altered platelet aggregation response to ristocetin stimulation compared with patients without TBI. METHODS Blood was collected from 233 trauma patients without thrombocytopenia. Platelet aggregation was assessed using multiple-electrode platelet aggregometry (Multiplate). Platelet aggregation response to stimulating agonists collagen, thrombin receptor-activating peptide 6, adenosine diphosphate, arachidonic acid, and ristocetin was measured. Factor activity was measured. RESULTS Of the 233 patients, 23% had TBI. There were no differences in platelet aggregation responses to any agonists between TBI and non-TBI patients except ristocetin. Platelet aggregation response to ristocetin stimulation was significantly lower in TBI patients (p = 0.03). Patients with TBI also had higher factor VIII activity (215% vs. 156%, p = 0.01). In multivariate analysis, there was a significant independent association of impaired platelet aggregation response to ristocetin stimulation with TBI (odds ratio, 3.05; p = 0.04). CONCLUSIONS Given the importance of platelets in hemostasis, understanding the mechanisms of impaired platelet aggregation following injury is critical. The impaired platelet aggregation response to ristocetin stimulation and corresponding increase in factor VIII activity in TBI patients may be secondary to a TBI-induced effect on vWF quantity (due to injury-driven consumption of vWF) or vWF function with resultant increase in circulating factor VIII activity (due to impaired carrying capacity of vWF). Given there are multiple known therapies for vWF deficits including desmopressin, purified and recombinant vWF, and estrogens, these lines of investigation are particularly compelling in patients with TBI and hemorrhage. LEVEL OF EVIDENCE Prognostic study, level II.
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Affiliation(s)
- Lucy Z Kornblith
- Department of Surgery, Zuckerberg San Francisco General Hospital and the University of California, San Francisco; San Francisco, California
| | - Anamaria J Robles
- Department of Surgery, Zuckerberg San Francisco General Hospital and the University of California, San Francisco; San Francisco, California
| | - Amanda S Conroy
- Department of Surgery, Zuckerberg San Francisco General Hospital and the University of California, San Francisco; San Francisco, California
| | - Carolyn M Hendrickson
- Department of Medicine, Zuckerberg San Francisco General Hospital and the University of California, San Francisco; San Francisco, California
| | - Carolyn S. Calfee
- Department of Medicine, Zuckerberg San Francisco General Hospital and the University of California, San Francisco; San Francisco, California
| | - Alexander T. Fields
- Department of Surgery, Zuckerberg San Francisco General Hospital and the University of California, San Francisco; San Francisco, California
| | - Rachael A Callcut
- Department of Surgery, Zuckerberg San Francisco General Hospital and the University of California, San Francisco; San Francisco, California
| | - Mitchell J Cohen
- Department of Surgery, Denver Health Medical Center and the University of Colorado; Denver, Colorado
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20
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Sut C, Hamzeh-Cognasse H, Arthaud CA, Eyraud MA, Chettab K, Dumontet C, Laradi S, Burnouf T, Garraud O, Cognasse F. Platelet concentrate supernatants alter endothelial cell mRNA and protein expression patterns as a function of storage length. Transfusion 2018; 58:2635-2644. [PMID: 30325037 DOI: 10.1111/trf.14973] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2018] [Revised: 07/30/2018] [Accepted: 07/30/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND Platelet transfusions are safe but can nevertheless cause serious adverse reactions (SARs). This study investigated the effects of platelet biological response modifiers (BRMs) that accumulate during storage and are commonly associated with transfusion adverse reactions. STUDY DESIGN AND METHODS Endothelial cells (ECs), that is, EA.hy926, were exposed in vitro to supernatants of platelet components (PCs) that had been either implicated or not in SARs. The EC Biology RT2 Profiler PCR Array was used at the same time to study 84 genes related to functions of ECs. Soluble cytokines and surface expression of EC markers were determined by Luminex/enzyme-linked immunosorbent assay technology and flow cytometry, respectively. Apoptosis and scratch wound assays were performed using IncuCyte technology. RESULTS In vitro exposure of EA.hy926 monolayers with Day 0, 1-2, and 3-4 stored PC supernatants resulted in decreases in surface expression of markers of ECs. There was differential production of soluble BRMs in the tested cell line. Exposure to the supernatants of PCs that had been implicated in SARs showed a significant difference in the expression of the EC surface markers. EC mediators also responded differently when exposed to PC supernatants of different storage times and PCs involved in SARs. CONCLUSION PC supernatants collected at Day 1-2 activate fewer cell lines of ECs compared with supernatants collected at Day 3-4. Moreover, PC supernatants involved in SARs appear to alter EC activation compared with the control and storage length.
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Affiliation(s)
- Caroline Sut
- Université de Lyon, GIMAP-EA3064, Saint-Etienne, France.,Établissement Français du Sang, Auvergne-Rhône-Alpes, Saint-Etienne, France
| | | | | | - Marie-Ange Eyraud
- Établissement Français du Sang, Auvergne-Rhône-Alpes, Saint-Etienne, France
| | - Kamel Chettab
- Centre de Recherche en Cancérologie de Lyon, Equipe Anticorps Anticancer, UMR INSERM 1052-CNRS 5286, Lyon, France
| | - Charles Dumontet
- Centre de Recherche en Cancérologie de Lyon, Equipe Anticorps Anticancer, UMR INSERM 1052-CNRS 5286, Lyon, France
| | - Sandrine Laradi
- Université de Lyon, GIMAP-EA3064, Saint-Etienne, France.,Établissement Français du Sang, Auvergne-Rhône-Alpes, Saint-Etienne, France
| | - Thierry Burnouf
- Graduate Institute of Biomedical Materials and Tissue Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei, Taiwan.,International PhD Program in Biomedical Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei, Taiwan
| | - Olivier Garraud
- Université de Lyon, GIMAP-EA3064, Saint-Etienne, France.,Institut National de la Transfusion Sanguine, Paris, France
| | - Fabrice Cognasse
- Université de Lyon, GIMAP-EA3064, Saint-Etienne, France.,Établissement Français du Sang, Auvergne-Rhône-Alpes, Saint-Etienne, France
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21
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Cap AP, Reddoch-Cardenas KM. Can't get platelets to your bleeding patients? Just chill… the solution is in your refrigerator! Transfus Clin Biol 2018; 25:217-219. [PMID: 30033080 DOI: 10.1016/j.tracli.2018.06.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 06/27/2018] [Indexed: 01/01/2023]
Affiliation(s)
- Andrew P Cap
- U.S. Army Institute of Surgical Research, Coagulation and Blood Research Program, Fort Sam Houston, TX 78234, United States
| | - Kristin M Reddoch-Cardenas
- U.S. Army Institute of Surgical Research, Coagulation and Blood Research Program, Fort Sam Houston, TX 78234, United States.
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22
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Middleton EA, Rondina MT, Schwertz H, Zimmerman GA. Amicus or Adversary Revisited: Platelets in Acute Lung Injury and Acute Respiratory Distress Syndrome. Am J Respir Cell Mol Biol 2018; 59:18-35. [PMID: 29553813 PMCID: PMC6039872 DOI: 10.1165/rcmb.2017-0420tr] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2017] [Accepted: 02/20/2018] [Indexed: 12/21/2022] Open
Abstract
Platelets are essential cellular effectors of hemostasis and contribute to disease as circulating effectors of pathologic thrombosis. These are their most widely known biologic activities. Nevertheless, recent observations demonstrate that platelets have a much more intricate repertoire beyond these traditional functions and that they are specialized for contributions to vascular barrier integrity, organ repair, antimicrobial host defense, inflammation, and activities across the immune continuum. Paradoxically, on the basis of clinical investigations and animal models of disease, some of these newly discovered activities of platelets appear to contribute to tissue injury. Studies in the last decade indicate unique interactions of platelets and their precursor, the megakaryocyte, in the lung and implicate platelets as essential effectors in experimental acute lung injury and clinical acute respiratory distress syndrome. Additional discoveries derived from evolving work will be required to precisely define the contributions of platelets to complex subphenotypes of acute lung injury and to determine if these remarkable and versatile blood cells are therapeutic targets in acute respiratory distress syndrome.
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Affiliation(s)
- Elizabeth A. Middleton
- Division of Pulmonary and Critical Care Medicine, and
- Program in Molecular Medicine, University of Utah School of Medicine, Salt Lake City, Utah
| | - Matthew T. Rondina
- Division of General Internal Medicine, Department of Internal Medicine
- Program in Molecular Medicine, University of Utah School of Medicine, Salt Lake City, Utah
| | - Hansjorg Schwertz
- Division of Vascular Surgery, Department of Surgery, and
- Program in Molecular Medicine, University of Utah School of Medicine, Salt Lake City, Utah
| | - Guy A. Zimmerman
- Division of Pulmonary and Critical Care Medicine, and
- Program in Molecular Medicine, University of Utah School of Medicine, Salt Lake City, Utah
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23
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A Novel and Convenient Method for the Preparation and Activation of PRP without Any Additives: Temperature Controlled PRP. BIOMED RESEARCH INTERNATIONAL 2018; 2018:1761865. [PMID: 29862255 PMCID: PMC5971324 DOI: 10.1155/2018/1761865] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/03/2017] [Accepted: 02/26/2018] [Indexed: 12/16/2022]
Abstract
Platelet rich plasma (PRP) is a concentrate of autologous platelets which contain enrichment growth factors (GFs). However, the addition of exogenous anticoagulant and procoagulant may result in clinical side effects and raise the price of PRP. Herein, we report a novel method named temperature controlled PRP (t-PRP), in which exogenous additives are dispensable in the preparation and activation process. Human blood samples were processed by a two-step centrifugation process under hypothermic conditions (4°C) to obtain t-PRP and rewarming up to 37°C to activate t-PRP. Contemporary PRP (c-PRP) was processed as the control. t-PRP showed a physiological pH value between 7.46 and 7.48 and up to 6.58 ± 0.45-fold significantly higher platelet concentration than that of whole blood compared with c-PRP (4.06-fold) in the preparation process. Meanwhile, t-PRP also maintained a stable GF level between plasma and PRP. After activation, t-PRP demonstrated natural fiber scaffolding, which trapped more platelet and GFs, and exhibited a slow release and degradation rate of GFs. In addition, t-PRP exhibited the function of promoting wound healing. t-PRP is a novel and convenient method for the preparation and activation of PRP without any additives. Compared to c-PRP, t-PRP reflects more physiologic characteristics while maintaining high quality.
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24
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Potter DR, Miyazawa BY, Gibb SL, Deng X, Togaratti PP, Croze RH, Srivastava AK, Trivedi A, Matthay M, Holcomb JB, Schreiber MA, Pati S. Mesenchymal stem cell-derived extracellular vesicles attenuate pulmonary vascular permeability and lung injury induced by hemorrhagic shock and trauma. J Trauma Acute Care Surg 2018; 84:245-256. [PMID: 29251710 PMCID: PMC6378956 DOI: 10.1097/ta.0000000000001744] [Citation(s) in RCA: 70] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Mesenchymal stem cells (MSCs) have been shown to mitigate vascular permeability in hemorrhagic shock (HS) and trauma-induced brain and lung injury. Mechanistically, paracrine factors secreted from MSCs have been identified that can recapitulate many of the potent biologic effects of MSCs in animal models of disease. Interestingly, MSC-derived extracellular vesicles (EVs), contain many of these key soluble factors, and have therapeutic potential independent of the parent cells. In this study we sought to determine whether MSC-derived EVs (MSC EVs) could recapitulate the beneficial therapeutic effects of MSCs on lung vascular permeability induced by HS in mice. METHODS Mesenchymal stem cell EVs were isolated from human bone marrow-derived MSCs by ultracentrifugation. A mouse model of fixed pressure HS was used to study the effects of shock, shock + MSCs and shock + MSC EVs on lung vascular endothelial permeability. Mice were administered MSCs, MSC EVs, or saline IV. Lung tissue was harvested and assayed for permeability, RhoA/Rac1 activation, and for differential phosphoprotein expression. In vitro, human lung microvascular cells junctional integrity was evaluated by immunocytochemistry and endothelial cell impedance assays. RESULTS Hemorrhagic shock-induced lung vascular permeability was significantly decreased by both MSC and MSC EV infusion. Phosphoprotein profiling of lung tissue revealed differential activation of proteins and pathways related to cytoskeletal rearrangement and regulation of vascular permeability by MSCs and MSC EVs. Lung tissue from treatment groups demonstrated decreased activation of the cytoskeletal GTPase RhoA. In vitro, human lung microvascular cells, MSC CM but not MSC-EVs prevented thrombin-induced endothelial cell permeability as measured by electrical cell-substrate impedance sensing system and immunocytochemistry of VE-cadherin and actin. CONCLUSION Mesenchymal stem cells and MSC EVs modulate cytoskeletal signaling and attenuate lung vascular permeability after HS. Mesenchymal stem cell EVs may potentially be used as a novel "stem cell free" therapeutic to treat HS-induced lung injury.
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Affiliation(s)
- Daniel R. Potter
- Department of Laboratory Medicine, University of California at San Francisco, San Francisco, California
| | - Byron Y. Miyazawa
- Department of Laboratory Medicine, University of California at San Francisco, San Francisco, California
| | - Stuart L. Gibb
- Department of Laboratory Medicine, University of California at San Francisco, San Francisco, California
| | - Xutao Deng
- Blood Systems Research Institute, San Francisco, California
| | | | - Roxanne H. Croze
- Cardiovascular Research Institute, University of California, San Francisco
| | - Amit K. Srivastava
- Department of Pediatric Surgery, McGovern Medical School, University of Texas Health Sciences Center at Houston, Houston, Texas
| | - Alpa Trivedi
- Department of Laboratory Medicine, University of California at San Francisco, San Francisco, California
| | - Michael Matthay
- Cardiovascular Research Institute, University of California, San Francisco
| | | | | | - Shibani Pati
- Department of Laboratory Medicine, University of California at San Francisco, San Francisco, California
- Blood Systems Research Institute, San Francisco, California
- Corresponding author- , (415) 502-1634. Department of Laboratory Medicine, 513 Parnassus Avenue, HSE 760, San Francisco, CA 94143
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25
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Johnson L, Tan S, Jenkins E, Wood B, Marks DC. Characterization of biologic response modifiers in the supernatant of conventional, refrigerated, and cryopreserved platelets. Transfusion 2018; 58:927-937. [PMID: 29330877 DOI: 10.1111/trf.14475] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Revised: 11/27/2017] [Accepted: 11/28/2017] [Indexed: 12/17/2022]
Abstract
BACKGROUND Alternatives to room temperature storage of platelets (PLTs) are of interest to support blood banking logistics. The aim of this study was to compare the presence of biologic response modifiers (BRMs) in PLT concentrates stored under conventional room temperature conditions with refrigerated or cryopreserved PLTs. STUDY DESIGN AND METHODS A three-arm pool-and-split study was carried out using buffy coat-derived PLTs stored in 30% plasma/70% SSP+. The three matched treatment arms were as follows: room temperature (20-24°C), cold (2-6°C), and cryopreserved (-80°C with DMSO). Liquid-stored PLTs were tested over a 21-day period, while cryopreserved PLTs were tested immediately after thawing and reconstitution in 30% plasma/70% SSP+ and after storage at room temperature. RESULTS Coagulation factor activity was comparable between room temperature and cold PLTs, with the exception of protein S, while cryopreserved PLTs had reduced Factor (F)V and FVIII activity. Cold-stored PLTs retained α-granule proteins better than room temperature or cryopreserved PLTs. Cryopreservation resulted in 10-fold higher microparticle generation than cold-stored PLTs, but both groups contained significantly more microparticles than those stored at room temperature. The supernatant from both cold and cryopreserved PLTs initiated faster clot formation and thrombin generation than room temperature PLTs. CONCLUSION Cold storage and cryopreservation alter the composition of the soluble fraction of stored PLTs. These differences in coagulation proteins, cytokines, and microparticles likely influence both the hemostatic capacity of the components and the auxiliary functions.
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Affiliation(s)
- Lacey Johnson
- Research and Development, Australian Red Cross Blood Service
| | - Shereen Tan
- Research and Development, Australian Red Cross Blood Service
| | | | - Ben Wood
- Research and Development, Australian Red Cross Blood Service.,University of Technology Sydney, Sydney, NSW, Australia
| | - Denese C Marks
- Research and Development, Australian Red Cross Blood Service.,Sydney Medical School, University of Sydney
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26
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Wu X, Darlington DN, Montgomery RK, Liu B, Keesee JD, Scherer MR, Benov A, Chen J, Cap AP. Platelets derived from fresh and cold‐stored whole blood participate in clot formation in rats with acute traumatic coagulopathy. Br J Haematol 2017; 179:802-810. [DOI: 10.1111/bjh.14999] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Accepted: 08/11/2017] [Indexed: 01/23/2023]
Affiliation(s)
- Xiaowu Wu
- Coagulation and Blood Research Program United States Army Institute of Surgical Research Fort Sam Houston TX USA
| | - Daniel N. Darlington
- Coagulation and Blood Research Program United States Army Institute of Surgical Research Fort Sam Houston TX USA
| | - Robbie K. Montgomery
- Coagulation and Blood Research Program United States Army Institute of Surgical Research Fort Sam Houston TX USA
| | - Bin Liu
- Coagulation and Blood Research Program United States Army Institute of Surgical Research Fort Sam Houston TX USA
| | - Jeffrey D. Keesee
- Coagulation and Blood Research Program United States Army Institute of Surgical Research Fort Sam Houston TX USA
| | - Michael R. Scherer
- Coagulation and Blood Research Program United States Army Institute of Surgical Research Fort Sam Houston TX USA
| | - Avi Benov
- Israel Defence Forces Tel Aviv Israel
| | | | - Andrew P. Cap
- Coagulation and Blood Research Program United States Army Institute of Surgical Research Fort Sam Houston TX USA
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27
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Berzuini A, Spreafico M, Prati D. One size doesn't fit all: Should we reconsider the introduction of cold-stored platelets in blood bank inventories? F1000Res 2017; 6:95. [PMID: 28184297 PMCID: PMC5288671 DOI: 10.12688/f1000research.10363.1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/23/2017] [Indexed: 01/03/2023] Open
Abstract
Platelet concentrates are universally prepared with a standard method and stored for 5 days at room temperature (20–24°C) in gentle agitation. Currently, there is a renewed interest in the possibility of storing platelet concentrates below the standard temperatures. In fact, cold platelets might be more effective in bleeding patients and have a lower risk of bacterial transmission. Inventories including platelets at different temperatures may favour patient-centred strategies for prophylactic or therapeutic transfusions.
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Affiliation(s)
- Alessandra Berzuini
- Department of Transfusion Medicine and Hematology, Azienda Socio Sanitaria Territoriale (ASST) di Lecco, Alessandro Manzoni Hospital, Lecco, Italy
| | - Marta Spreafico
- Department of Transfusion Medicine and Hematology, Azienda Socio Sanitaria Territoriale (ASST) di Lecco, Alessandro Manzoni Hospital, Lecco, Italy
| | - Daniele Prati
- Department of Transfusion Medicine and Hematology, Azienda Socio Sanitaria Territoriale (ASST) di Lecco, Alessandro Manzoni Hospital, Lecco, Italy
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28
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Acker JP, Marks DC, Sheffield WP. Quality Assessment of Established and Emerging Blood Components for Transfusion. JOURNAL OF BLOOD TRANSFUSION 2016; 2016:4860284. [PMID: 28070448 PMCID: PMC5192317 DOI: 10.1155/2016/4860284] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Accepted: 11/02/2016] [Indexed: 12/16/2022]
Abstract
Blood is donated either as whole blood, with subsequent component processing, or through the use of apheresis devices that extract one or more components and return the rest of the donation to the donor. Blood component therapy supplanted whole blood transfusion in industrialized countries in the middle of the twentieth century and remains the standard of care for the majority of patients receiving a transfusion. Traditionally, blood has been processed into three main blood products: red blood cell concentrates; platelet concentrates; and transfusable plasma. Ensuring that these products are of high quality and that they deliver their intended benefits to patients throughout their shelf-life is a complex task. Further complexity has been added with the development of products stored under nonstandard conditions or subjected to additional manufacturing steps (e.g., cryopreserved platelets, irradiated red cells, and lyophilized plasma). Here we review established and emerging methodologies for assessing blood product quality and address controversies and uncertainties in this thriving and active field of investigation.
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Affiliation(s)
- Jason P. Acker
- Centre for Innovation, Canadian Blood Services, Edmonton, AB, Canada
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB, Canada
| | - Denese C. Marks
- Research and Development, Australian Red Cross Blood Service, Sydney, NSW, Australia
| | - William P. Sheffield
- Centre for Innovation, Canadian Blood Services, Hamilton, ON, Canada
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, ON, Canada
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Current Status of Platelet Transfusion in Pediatric Patients. Transfus Med Rev 2016; 30:230-4. [PMID: 27559006 DOI: 10.1016/j.tmrv.2016.07.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Revised: 07/20/2016] [Accepted: 07/29/2016] [Indexed: 01/19/2023]
Abstract
Outside the neonatal period, most platelets that are transfused to pediatric patients are given to those who are thrombocytopenic secondary to malignancy and associated therapy and/or hematopoietic progenitor cell transplant, or to those with significant bleeding associated with surgery, especially cardiac surgery. Indications for platelet transfusion, doses, and other practices for children largely mimic adult platelet transfusion protocols because there are few pediatric-specific studies in this area. Pediatric platelet transfusion practices would benefit from focused pediatric research. The appropriate indications and doses for platelet transfusions in oncology, hematopoietic progenitor cell transplant, and cardiac surgery patients need to be determined.
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