1
|
Nemkov T, Stephenson D, Earley EJ, Keele GR, Hay A, Key A, Haiman ZB, Erickson C, Dzieciatkowska M, Reisz JA, Moore A, Stone M, Deng X, Kleinman S, Spitalnik SL, Hod EA, Hudson KE, Hansen KC, Palsson BO, Churchill GA, Roubinian N, Norris PJ, Busch MP, Zimring JC, Page GP, D'Alessandro A. Biological and genetic determinants of glycolysis: Phosphofructokinase isoforms boost energy status of stored red blood cells and transfusion outcomes. Cell Metab 2024:S1550-4131(24)00232-8. [PMID: 38964323 DOI: 10.1016/j.cmet.2024.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 01/04/2024] [Accepted: 06/07/2024] [Indexed: 07/06/2024]
Abstract
Mature red blood cells (RBCs) lack mitochondria and thus exclusively rely on glycolysis to generate adenosine triphosphate (ATP) during aging in vivo or storage in blood banks. Here, we leveraged 13,029 volunteers from the Recipient Epidemiology and Donor Evaluation Study to identify associations between end-of-storage levels of glycolytic metabolites and donor age, sex, and ancestry-specific genetic polymorphisms in regions encoding phosphofructokinase 1, platelet (detected in mature RBCs); hexokinase 1 (HK1); and ADP-ribosyl cyclase 1 and 2 (CD38/BST1). Gene-metabolite associations were validated in fresh and stored RBCs from 525 Diversity Outbred mice and via multi-omics characterization of 1,929 samples from 643 human RBC units during storage. ATP and hypoxanthine (HYPX) levels-and the genetic traits linked to them-were associated with hemolysis in vitro and in vivo, both in healthy autologous transfusion recipients and in 5,816 critically ill patients receiving heterologous transfusions, suggesting their potential as markers to improve transfusion outcomes.
Collapse
Affiliation(s)
- Travis Nemkov
- Department of Biochemistry and Molecular Genetics, University of Colorado Denver - Anschutz Medical Campus, Aurora, CO, USA; Omix Technologies Inc., Aurora, CO, USA
| | - Daniel Stephenson
- Department of Biochemistry and Molecular Genetics, University of Colorado Denver - Anschutz Medical Campus, Aurora, CO, USA
| | | | | | - Ariel Hay
- Department of Pathology, University of Virginia, Charlottesville, VA, USA
| | - Alicia Key
- Department of Biochemistry and Molecular Genetics, University of Colorado Denver - Anschutz Medical Campus, Aurora, CO, USA
| | - Zachary B Haiman
- Department of Bioengineering, University of California, San Diego, La Jolla, CA, USA
| | - Christopher Erickson
- Department of Biochemistry and Molecular Genetics, University of Colorado Denver - Anschutz Medical Campus, Aurora, CO, USA
| | - Monika Dzieciatkowska
- Department of Biochemistry and Molecular Genetics, University of Colorado Denver - Anschutz Medical Campus, Aurora, CO, USA
| | - Julie A Reisz
- Department of Biochemistry and Molecular Genetics, University of Colorado Denver - Anschutz Medical Campus, Aurora, CO, USA
| | | | - Mars Stone
- Vitalant Research Institute, San Francisco, CA, USA; Department of Laboratory Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Xutao Deng
- Vitalant Research Institute, San Francisco, CA, USA; Department of Laboratory Medicine, University of California, San Francisco, San Francisco, CA, USA
| | | | - Steven L Spitalnik
- Department of Pathology & Cell Biology, Columbia University Irving Medical Center, New York, NY, USA
| | - Eldad A Hod
- Department of Pathology & Cell Biology, Columbia University Irving Medical Center, New York, NY, USA
| | - Krystalyn E Hudson
- Department of Pathology & Cell Biology, Columbia University Irving Medical Center, New York, NY, USA
| | - Kirk C Hansen
- Department of Biochemistry and Molecular Genetics, University of Colorado Denver - Anschutz Medical Campus, Aurora, CO, USA; Omix Technologies Inc., Aurora, CO, USA
| | - Bernhard O Palsson
- Department of Bioengineering, University of California, San Diego, La Jolla, CA, USA
| | | | - Nareg Roubinian
- Vitalant Research Institute, San Francisco, CA, USA; Department of Laboratory Medicine, University of California, San Francisco, San Francisco, CA, USA; Kaiser Permanente Northern California Division of Research, Oakland, CA, USA
| | - Philip J Norris
- Vitalant Research Institute, San Francisco, CA, USA; Department of Laboratory Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Michael P Busch
- Vitalant Research Institute, San Francisco, CA, USA; Department of Laboratory Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - James C Zimring
- Department of Pathology, University of Virginia, Charlottesville, VA, USA
| | | | - Angelo D'Alessandro
- Department of Biochemistry and Molecular Genetics, University of Colorado Denver - Anschutz Medical Campus, Aurora, CO, USA; Omix Technologies Inc., Aurora, CO, USA.
| |
Collapse
|
2
|
Nemkov T, Stephenson D, Earley EJ, Keele GR, Hay A, Key A, Haiman Z, Erickson C, Dzieciatkowska M, Reisz JA, Moore A, Stone M, Deng X, Kleinman S, Spitalnik SL, Hod EA, Hudson KE, Hansen KC, Palsson BO, Churchill GA, Roubinian N, Norris PJ, Busch MP, Zimring JC, Page GP, D'Alessandro A. Biological and Genetic Determinants of Glycolysis: Phosphofructokinase Isoforms Boost Energy Status of Stored Red Blood Cells and Transfusion Outcomes. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2023.09.11.557250. [PMID: 38260479 PMCID: PMC10802247 DOI: 10.1101/2023.09.11.557250] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Abstract
Mature red blood cells (RBCs) lack mitochondria, and thus exclusively rely on glycolysis to generate adenosine triphosphate (ATP) during aging in vivo or storage in the blood bank. Here we leveraged 13,029 volunteers from the Recipient Epidemiology and Donor Evaluation Study to identify an association between end-of-storage levels of glycolytic metabolites and donor age, sex, and ancestry-specific genetic polymorphisms in regions encoding phosphofructokinase 1, platelet (detected in mature RBCs), hexokinase 1, ADP-ribosyl cyclase 1 and 2 (CD38/BST1). Gene-metabolite associations were validated in fresh and stored RBCs from 525 Diversity Outbred mice, and via multi-omics characterization of 1,929 samples from 643 human RBC units during storage. ATP and hypoxanthine levels - and the genetic traits linked to them - were associated with hemolysis in vitro and in vivo, both in healthy autologous transfusion recipients and in 5,816 critically ill patients receiving heterologous transfusions, suggesting their potential as markers to improve transfusion outcomes. eTOC and Highlights Highlights Blood donor age and sex affect glycolysis in stored RBCs from 13,029 volunteers;Ancestry, genetic polymorphisms in PFKP, HK1, CD38/BST1 influence RBC glycolysis;Modeled PFKP effects relate to preventing loss of the total AXP pool in stored RBCs;ATP and hypoxanthine are biomarkers of hemolysis in vitro and in vivo.
Collapse
|
3
|
Yee MEM, Covington ML, Zerra PE, McCoy JW, Easley KA, Joiner CH, Bryksin J, Francis RO, Lough CM, Patel N, Kutlar A, Josephson CD, Roback JD, Stowell SR, Fasano RM. Survival of transfused red blood cells from a donor with alpha-thalassemia trait in a recipient with sickle cell disease. Transfusion 2024; 64:1109-1115. [PMID: 38693059 PMCID: PMC11144116 DOI: 10.1111/trf.17857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 04/15/2024] [Accepted: 04/16/2024] [Indexed: 05/03/2024]
Abstract
BACKGROUND Post-transfusion survival of donor red blood cells (RBCs) is important for effective chronic transfusion therapy in conditions including sickle cell disease (SCD). Biotin labeling RBCs allows direct in vivo measurement of multiple donor RBC units simultaneously post-transfusion. STUDY DESIGN AND METHODS In an observational trial of patients with SCD receiving monthly chronic transfusion therapy, aliquots of RBCs from one transfusion episode were biotin-labeled and infused along with the unlabeled RBC units. Serial blood samples were obtained to measure RBC survival. Donor units were tested for RBC indices, hemoglobin fractionation, and glucose-6-phosphate dehydrogenase (G6PD) enzyme activity. For microcytic donor RBCs (MCV < 70 fL), HBA1 and HBA2 genetic testing was performed on whole blood. RESULTS We present one recipient, a pediatric patient with SCD and splenectomy who received two RBC units with aliquots from each unit labeled at distinct biotin densities (2 and 18 μg/mL biotin). One donor unit was identified to have microcytosis (MCV 68.5 fL after biotinylation); whole blood sample obtained at a subsequent donation showed 2-gene deletion alpha-thalassemia trait (ɑ-3.7kb/ɑ-3.7kb) and normal serum ferritin. G6PD activity was >60% of normal mean for both. The RBCs with alpha-thalassemia RBC had accelerated clearance and increased surface phosphatidylserine post-transfusion, as compared with the normocytic RBC (half life 65 vs. 86 days, respectively). DISCUSSION Post-transfusion RBC survival may be lower for units from donors with alpha-thalassemia trait, although the impact of thalassemia trait donors on transfusion efficacy requires further study.
Collapse
Affiliation(s)
- Marianne E M Yee
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Mischa L Covington
- Joint Program in Transfusion Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Patricia E Zerra
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
- Center for Transfusion and Cellular Therapies, Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - James W McCoy
- Center for Transfusion and Cellular Therapies, Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Kirk A Easley
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Atlanta, Georgia, USA
| | - Clinton H Joiner
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Janetta Bryksin
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Richard O Francis
- Department of Pathology and Cell Biology, Columbia University Medical Center, New York Presbyterian Hospital, New York, New York, USA
| | | | - Niren Patel
- Department of Medicine, Medical College of Georgia at Augusta University, Augusta, Georgia, USA
| | - Abdullah Kutlar
- Department of Medicine, Medical College of Georgia at Augusta University, Augusta, Georgia, USA
| | - Cassandra D Josephson
- Cancer and Blood Disorders Institute, Johns Hopkins All Children's Hospital, St. Petersburg, Florida, USA
- Departments of Oncology and Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - John D Roback
- Center for Transfusion and Cellular Therapies, Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Sean R Stowell
- Joint Program in Transfusion Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Ross M Fasano
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
- Center for Transfusion and Cellular Therapies, Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| |
Collapse
|
4
|
D'Alessandro A, Hod EA. Red Blood Cell Storage: From Genome to Exposome Towards Personalized Transfusion Medicine. Transfus Med Rev 2023; 37:150750. [PMID: 37574398 PMCID: PMC10834861 DOI: 10.1016/j.tmrv.2023.150750] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 06/02/2023] [Accepted: 06/04/2023] [Indexed: 08/15/2023]
Abstract
Over the last decade, the introduction of omics technologies-especially high-throughput genomics and metabolomics-has contributed significantly to our understanding of the role of donor genetics and nongenetic determinants of red blood cell storage biology. Here we briefly review the main advances in these areas, to the extent these contributed to the appreciation of the impact of donor sex, age, ethnicity, but also processing strategies and donor environmental, dietary or other exposures - the so-called exposome-to the onset and severity of the storage lesion. We review recent advances on the role of genetically encoded polymorphisms on red cell storage biology, and relate these findings with parameters of storage quality and post-transfusion efficacy, such as hemolysis, post-transfusion intra- and extravascular hemolysis and hemoglobin increments. Finally, we suggest that the combination of these novel technologies have the potential to drive further developments towards personalized (or precision) transfusion medicine approaches.
Collapse
Affiliation(s)
- Angelo D'Alessandro
- Department of Biochemistry and Molecular Genetics, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
| | - Eldad A Hod
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, NY, USA
| |
Collapse
|
5
|
Gerritsma JJ, van der Bolt N, van Bruggen R, Ten Brinke A, van Dam J, Guerrero G, Vermeulen C, de Bruin S, Vlaar APJ, Biemond BJ, Nur E, van der Schoot E, Fijnvandraat K. Measurement of post-transfusion red blood cell survival kinetics in sickle cell disease and β-Thalassemia: A biotin label approach. Transfusion 2022; 62:1984-1996. [PMID: 35916478 DOI: 10.1111/trf.17033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 04/11/2022] [Accepted: 04/13/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Red blood cell (RBC) transfusions are an important treatment modality for patients with sickle cell disease (SCD) and β-thalassemia. A subgroup of these patients relies on a chronic RBC transfusion regimen. Little is known about RBC survival (RCS) of the transfused allogeneic RBCs. In this study, we aimed to study the RCS kinetics of transfused RBCs in SCD and β-thalassemia and to investigate factors that determine RCS. METHODS AND MATERIALS We performed a prospective cohort study on fourteen adults with SCD and β-thalassemia disease receiving a chronic transfusion regimen. RCS and the influence of donor and patient characteristics on RCS were assessed by simultaneous transfusion of two allogeneic RBCs using RBC biotinylation. Phenotyping of well-known RBC markers over time was performed using flow cytometry. RESULTS RCS of the two transfused RBC units was similar in most patients. Although intra-individual variation was small, inter-individual variation in RCS kinetics was observed. Most patients demonstrated a non-linear trend in RCS that was different from the observed linear RCS kinetics in healthy volunteers. After an initial slight increase in the proportion of biotinylated RBCs during the first 24 h, a rapid decrease within the first 10-12 days was followed by a slower clearance rate. CONCLUSION These are the first data to demonstrate that patient-related factors largely determine post-transfusion RCS behavior of donor RBC in SCD and β-thalassemia, while donor factors exert a negligible effect. Further assessment and modeling of RCS kinetics and its determinants in SCD and β-thalassemia patients may ultimately improve transfusion therapy.
Collapse
Affiliation(s)
- Jorn J Gerritsma
- Sanquin Research and Landsteiner Laboratory, Immunopathology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.,Amsterdam UMC, University of Amsterdam, Emma Children's Hospital, Pediatric Hematology, Amsterdam, the Netherlands
| | - Nieke van der Bolt
- Sanquin Research and Landsteiner Laboratory, Immunopathology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.,Sanquin Research and Landsteiner Laboratory, Immunohematology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Robin van Bruggen
- Sanquin Research and Landsteiner Laboratory, Blood Cell Research, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Anja Ten Brinke
- Sanquin Research and Landsteiner Laboratory, Immunopathology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - John van Dam
- Sanquin Research and Landsteiner Laboratory, Molecular Hematology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Guillermo Guerrero
- Sanquin Research and Landsteiner Laboratory, Immunohematology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Christie Vermeulen
- Sanquin Research and Landsteiner Laboratory, Product and Process Development, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Sanne de Bruin
- Amsterdam UMC, University of Amsterdam, Intensive Care Medicine, Amsterdam, the Netherlands
| | - Alexander P J Vlaar
- Amsterdam UMC, University of Amsterdam, Intensive Care Medicine, Amsterdam, the Netherlands
| | - Bart J Biemond
- Amsterdam UMC, University of Amsterdam, Department of Hematology, Amsterdam, the Netherlands
| | - Erfan Nur
- Amsterdam UMC, University of Amsterdam, Department of Hematology, Amsterdam, the Netherlands
| | - Ellen van der Schoot
- Sanquin Research and Landsteiner Laboratory, Immunohematology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Karin Fijnvandraat
- Amsterdam UMC, University of Amsterdam, Emma Children's Hospital, Pediatric Hematology, Amsterdam, the Netherlands.,Sanquin Research and Landsteiner Laboratory, Molecular and Cellular Hemostasis, Amsterdam UMC, University of Amsterdam, Sanquin Research, Amsterdam, the Netherlands
| | | |
Collapse
|
6
|
Roubinian NH, Reese SE, Qiao H, Plimier C, Fang F, Page GP, Cable RG, Custer B, Gladwin MT, Goel R, Harris B, Hendrickson JE, Kanias T, Kleinman S, Mast AE, Sloan SR, Spencer BR, Spitalnik SL, Busch MP, Hod EA. Donor genetic and nongenetic factors affecting red blood cell transfusion effectiveness. JCI Insight 2022; 7:e152598. [PMID: 34793330 PMCID: PMC8765041 DOI: 10.1172/jci.insight.152598] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 11/17/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUNDRBC transfusion effectiveness varies due to donor, component, and recipient factors. Prior studies identified characteristics associated with variation in hemoglobin increments following transfusion. We extended these observations, examining donor genetic and nongenetic factors affecting transfusion effectiveness.METHODSThis is a multicenter retrospective study of 46,705 patients and 102,043 evaluable RBC transfusions from 2013 to 2016 across 12 hospitals. Transfusion effectiveness was defined as hemoglobin, bilirubin, or creatinine increments following single RBC unit transfusion. Models incorporated a subset of donors with data on single nucleotide polymorphisms associated with osmotic and oxidative hemolysis in vitro. Mixed modeling accounting for repeated transfusion episodes identified predictors of transfusion effectiveness.RESULTSBlood donor (sex, Rh status, fingerstick hemoglobin, smoking), component (storage duration, γ irradiation, leukoreduction, apheresis collection, storage solution), and recipient (sex, BMI, race and ethnicity, age) characteristics were associated with hemoglobin and bilirubin, but not creatinine, increments following RBC transfusions. Increased storage duration was associated with increased bilirubin and decreased hemoglobin increments, suggestive of in vivo hemolysis following transfusion. Donor G6PD deficiency and polymorphisms in SEC14L4, HBA2, and MYO9B genes were associated with decreased hemoglobin increments. Donor G6PD deficiency and polymorphisms in SEC14L4 were associated with increased transfusion requirements in the subsequent 48 hours.CONCLUSIONDonor genetic and other factors, such as RBC storage duration, affect transfusion effectiveness as defined by decreased hemoglobin or increased bilirubin increments. Addressing these factors will provide a precision medicine approach to improve patient outcomes, particularly for chronically transfused RBC recipients, who would most benefit from more effective transfusion products.FUNDINGFunding was provided by HHSN 75N92019D00032, HHSN 75N92019D00034, 75N92019D00035, HHSN 75N92019D00036, and HHSN 75N92019D00037; R01HL126130; and the National Institute of Child Health and Human Development (NICHD).
Collapse
Affiliation(s)
- Nareg H. Roubinian
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
- Vitalant Research Institute, San Francisco, California, USA
| | | | | | - Colleen Plimier
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Fang Fang
- Division of Biostatistics and Epidemiology, RTI International, Durham, North Carolina, USA
| | - Grier P. Page
- Division of Biostatistics and Epidemiology, RTI International, Atlanta, Georgia, USA
| | | | - Brian Custer
- Vitalant Research Institute, San Francisco, California, USA
| | - Mark T. Gladwin
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Ruchika Goel
- Department of Pathology, Johns Hopkins University, Baltimore, Maryland, USA
| | | | | | - Tamir Kanias
- Vitalant Research Institute, Denver, Colorado, USA
| | - Steve Kleinman
- Department of Pathology and Laboratory Medicine, University of British Columbia, Victoria, British Colombia, Canada
| | - Alan E. Mast
- Versiti Blood Research Institute, Milwaukee, Wisconsin, USA
| | - Steven R. Sloan
- Department of Pathology, Children’s Hospital Boston, Boston, Massachusetts, USA
| | | | - Steven L. Spitalnik
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, New York, USA
| | | | - Eldad A. Hod
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, New York, USA
| | | |
Collapse
|
7
|
Rapid clearance of storage-induced microerythrocytes alters transfusion recovery. Blood 2021; 137:2285-2298. [PMID: 33657208 DOI: 10.1182/blood.2020008563] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 01/16/2021] [Indexed: 12/19/2022] Open
Abstract
Permanent availability of red blood cells (RBCs) for transfusion depends on refrigerated storage, during which morphologically altered RBCs accumulate. Among these, a subpopulation of small RBCs, comprising type III echinocytes, spheroechinocytes, and spherocytes and defined as storage-induced microerythrocytes (SMEs), could be rapidly cleared from circulation posttransfusion. We quantified the proportion of SMEs in RBC concentrates from healthy human volunteers and assessed correlation with transfusion recovery, investigated the fate of SMEs upon perfusion through human spleen ex vivo, and explored where and how SMEs are cleared in a mouse model of blood storage and transfusion. In healthy human volunteers, high proportion of SMEs in long-stored RBC concentrates correlated with poor transfusion recovery. When perfused through human spleen, 15% and 61% of long-stored RBCs and SMEs were cleared in 70 minutes, respectively. High initial proportion of SMEs also correlated with high retention of RBCs by perfused human spleen. In the mouse model, SMEs accumulated during storage. Transfusion of long-stored RBCs resulted in reduced posttransfusion recovery, mostly due to SME clearance. After transfusion in mice, long-stored RBCs accumulated predominantly in spleen and were ingested mainly by splenic and hepatic macrophages. In macrophage-depleted mice, splenic accumulation and SME clearance were delayed, and transfusion recovery was improved. In healthy hosts, SMEs were cleared predominantly by macrophages in spleen and liver. When this well-demarcated subpopulation of altered RBCs was abundant in RBC concentrates, transfusion recovery was diminished. SME quantification has the potential to improve blood product quality assessment. This trial was registered at www.clinicaltrials.gov as #NCT02889133.
Collapse
|
8
|
|
9
|
Pulliam KE, Joseph B, Veile RA, Friend LA, Makley AT, Caldwell CC, Lentsch AB, Goodman MD, Pritts TA. Expired But Not Yet Dead: Examining the Red Blood Cell Storage Lesion in Extended-Storage Whole Blood. Shock 2021; 55:526-535. [PMID: 32826814 PMCID: PMC7937408 DOI: 10.1097/shk.0000000000001646] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
ABSTRACT Whole blood is a powerful resuscitation strategy for trauma patients but has a shorter shelf life than other blood products. The red blood cell storage lesion in whole blood has not previously been investigated beyond the standard storage period. In the present study, we hypothesized that erythrocytes in stored whole blood exhibit similar aspects of the red blood cell storage lesion and that transfusion of extended storage whole blood would not result in a more severe inflammatory response after hemorrhage in a murine model. To test this hypothesis, we stored low-titer, O-positive, whole blood units, and packed red blood cells (pRBCs) for up to 42 days, then determined aspects of the red blood cell storage lesion. Compared with standard storage pRBCs, whole blood demonstrated decreased microvesicle and free hemoglobin at 21 days of storage and no differences in osmotic fragility. At 42 days of storage, rotational thromboelastometry demonstrated that clotting time was decreased, alpha angle was increased, and clot formation time and maximum clot firmness similar in whole blood as compared with pRBCs with the addition of fresh frozen plasma. In a murine model, extended storage whole blood demonstrated decreased microvesicle formation, phosphatidylserine, and cell-free hemoglobin. After hemorrhage and resuscitation, TNF-a, IL-6, and IL-10 were decreased in mice resuscitated with whole blood. Red blood cell survival was similar at 24 h after transfusion. Taken together, these data suggest that red blood cells within whole blood stored for an extended period of time demonstrate similar or reduced accumulation of the red blood cell storage lesion as compared with pRBCs. Further examination of extended-storage whole blood is warranted.
Collapse
Affiliation(s)
- Kasiemobi E Pulliam
- Section of General Surgery, Department of Surgery, University of Cincinnati, Cincinnati, Ohio
| | | | | | | | | | | | | | | | | |
Collapse
|
10
|
Buehler PW, Flood AB, Swartz HM. Measurement of Tissue Oxygen as a Novel Approach to Optimizing Red Blood Cell Quality Assessment. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2021; 1269:379-386. [PMID: 33966246 DOI: 10.1007/978-3-030-48238-1_60] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
The effectiveness of blood transfusions can be impacted by storage and extensive processing techniques that involve treatment of red blood cells (RBCs) with pathogen reduction technologies (e.g., UV-light and chemical treatment), ex vivo stem cell derivation/maturation methods, and bioengineering of RBCs using nanotechnology. Therefore, there is a need to have methods that assess the evaluation of the effectiveness of transfusions to achieve their intended purpose: to increase oxygenation of critical tissues. Consequently, there has been intense interest in the development of techniques targeted at optimizing the assessment of RBC quality in preclinical and clinical settings. We provide a critical assessment of the ability of currently used methods to provide unambiguous information on oxygen levels in tissues and conclude that they cannot do this. This is because they are based on surrogates for the true goal of transfusion, which is to increase oxygenation of critical organs. This does not mean that they are valueless, but it does indicate that other methods are needed to provide direct measurements of oxygen in tissues. We report here on the initial results of a method that can provide direct assessment of the impact of the transfusion on tissue oxygen: EPR oximetry. It has the potential to provide such information in both preclinical and clinical settings for the assessment of blood quality posttransfusion.
Collapse
Affiliation(s)
- Paul W Buehler
- Department of Pathology, Department of Pediatrics, Center for Blood Oxygen Transport and Hemostasis, University of Maryland School of Medicine, Baltimore, MD, USA.
| | - Ann Barry Flood
- Radiology, Geisel School of Medicine at Dartmouth College, Hanover, NH, USA
| | - Harold M Swartz
- Radiology, Geisel School of Medicine at Dartmouth College, Hanover, NH, USA.,Radiation Oncology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| |
Collapse
|
11
|
Marin M, Roussel C, Dussiot M, Ndour PA, Hermine O, Colin Y, Gray A, Landrigan M, Le Van Kim C, Buffet PA, Amireault P. Metabolic rejuvenation upgrades circulatory functions of red blood cells stored under blood bank conditions. Transfusion 2020; 61:903-918. [PMID: 33381865 DOI: 10.1111/trf.16245] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 11/13/2020] [Accepted: 11/15/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Red blood cells (RBC) change upon hypothermic conservation, and storage for 6 weeks is associated with the short-term clearance of 15% to 20% of transfused RBCs. Metabolic rejuvenation applied to RBCs before transfusion replenishes energetic sources and reverses most storage-related alterations, but how it impacts RBC circulatory functions has not been fully elucidated. STUDY DESIGN AND METHODS Six RBC units stored under blood bank conditions were analyzed weekly for 6 weeks and rejuvenated on Day 42 with an adenine-inosine-rich solution. Impact of storage and rejuvenation on adenosine triphosphate (ATP) levels, morphology, accumulation of storage-induced microerythrocytes (SMEs), elongation under an osmotic gradient (by LORRCA), hemolysis, and phosphatidylserine (PS) exposure was evaluated. The impact of rejuvenation on filterability and adhesive properties of stored RBCs was also assessed. RESULTS Rejuvenation of RBCs restored intracellular ATP to almost normal levels and decreased the PS exposure from 2.78% to 0.41%. Upon rejuvenation, the proportion of SME dropped from 28.2% to 9.5%, while the proportion of normal-shaped RBCs (discocytes and echinocytes 1) increased from 47.7% to 67.1%. In LORCCA experiments, rejuvenation did not modify the capacity of RBCs to elongate and induced a reduction in cell volume. In functional tests, rejuvenation increased RBC filterability in a biomimetic splenic filter (+16%) and prevented their adhesion to endothelial cells (-87%). CONCLUSION Rejuvenation reduces the proportion of morphologically altered and adhesive RBCs that accumulate during storage. Along with the improvement in their filterability, these data show that rejuvenation improves RBC properties related to their capacity to persist in circulation after transfusion.
Collapse
Affiliation(s)
- Mickaël Marin
- Université de Paris, UMR_S1134, BIGR, INSERM, Paris, France.,Institut National de la Transfusion Sanguine, Paris, France.,Laboratoire d'Excellence GR-Ex, Paris, France
| | - Camille Roussel
- Université de Paris, UMR_S1134, BIGR, INSERM, Paris, France.,Institut National de la Transfusion Sanguine, Paris, France.,Laboratoire d'Excellence GR-Ex, Paris, France.,Université de Paris, U1163, Laboratory of cellular and molecular mechanisms of hematological disorders and therapeutic implications, INSERM, Paris, France
| | - Michael Dussiot
- Laboratoire d'Excellence GR-Ex, Paris, France.,Université de Paris, U1163, Laboratory of cellular and molecular mechanisms of hematological disorders and therapeutic implications, INSERM, Paris, France
| | - Papa A Ndour
- Université de Paris, UMR_S1134, BIGR, INSERM, Paris, France.,Institut National de la Transfusion Sanguine, Paris, France.,Laboratoire d'Excellence GR-Ex, Paris, France
| | - Olivier Hermine
- Laboratoire d'Excellence GR-Ex, Paris, France.,Université de Paris, U1163, Laboratory of cellular and molecular mechanisms of hematological disorders and therapeutic implications, INSERM, Paris, France.,Assistance publique des hôpitaux de Paris, Paris, France
| | - Yves Colin
- Université de Paris, UMR_S1134, BIGR, INSERM, Paris, France.,Institut National de la Transfusion Sanguine, Paris, France.,Laboratoire d'Excellence GR-Ex, Paris, France
| | - Alan Gray
- Citra labs, a Zimmer Biomet company, Braintree, Massachusetts, USA
| | - Matt Landrigan
- Zimmer Biomet Southwest Ohio, Braintree, Massachusetts, USA
| | - Caroline Le Van Kim
- Université de Paris, UMR_S1134, BIGR, INSERM, Paris, France.,Institut National de la Transfusion Sanguine, Paris, France.,Laboratoire d'Excellence GR-Ex, Paris, France
| | - Pierre A Buffet
- Université de Paris, UMR_S1134, BIGR, INSERM, Paris, France.,Institut National de la Transfusion Sanguine, Paris, France.,Laboratoire d'Excellence GR-Ex, Paris, France.,Assistance publique des hôpitaux de Paris, Paris, France
| | - Pascal Amireault
- Université de Paris, UMR_S1134, BIGR, INSERM, Paris, France.,Institut National de la Transfusion Sanguine, Paris, France.,Laboratoire d'Excellence GR-Ex, Paris, France.,Université de Paris, U1163, Laboratory of cellular and molecular mechanisms of hematological disorders and therapeutic implications, INSERM, Paris, France
| |
Collapse
|
12
|
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.
Collapse
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:
| |
Collapse
|
13
|
D'Alessandro A, Fu X, Reisz JA, Kanias T, Page GP, Stone M, Kleinman S, Zimring JC, Busch M. Stored RBC metabolism as a function of caffeine levels. Transfusion 2020; 60:1197-1211. [PMID: 32394461 DOI: 10.1111/trf.15813] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 03/04/2020] [Accepted: 03/11/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Coffee consumption is extremely common in the United States. Coffee is rich with caffeine, a psychoactive, purinergic antagonist of adenosine receptors, which regulate red blood cell energy and redox metabolism. Since red blood cell (purine) metabolism is a critical component to the red cell storage lesion, here we set out to investigate whether caffeine levels correlated with alterations of energy and redox metabolism in stored red blood cells. STUDY DESIGN AND METHODS We measured the levels of caffeine and its main metabolites in 599 samples from the REDS-III RBC-Omics (Recipient Epidemiology Donor Evaluation Study III Red Blood Cell-Omics) study via ultra-high-pressure-liquid chromatography coupled to high-resolution mass spectrometry and correlated them to global metabolomic and lipidomic analyses of RBCs stored for 10, 23, and 42 days. RESULTS Caffeine levels positively correlated with increased levels of the main red cell antioxidant, glutathione, and its metabolic intermediates in glutathione-dependent detoxification pathways of oxidized lipids and sugar aldehydes. Caffeine levels were positively correlated with transamination products and substrates, tryptophan, and indole metabolites. Expectedly, since caffeine and its metabolites belong to the family of xanthine purines, all xanthine metabolites were significantly increased in the subjects with the highest levels of caffeine. However, high-energy phosphate compounds ATP and DPG were not affected by caffeine levels, despite decreases in glucose oxidation products-both via glycolysis and the pentose phosphate pathway. CONCLUSION Though preliminary, this study is suggestive of a beneficial correlation between the caffeine levels and improved antioxidant capacity of stored red cells.
Collapse
Affiliation(s)
- Angelo D'Alessandro
- Department of Biochemistry and Molecular Genetics, University of Colorado Denver, Aurora, Colorado.,Vitalant Research Institute, Denver, Colorado.,Department of Pathology, University of Colorado Denver, Aurora, Colorado
| | - Xiaoyun Fu
- BloodWorks Northwest, Seattle, Washington
| | - Julie A Reisz
- Department of Biochemistry and Molecular Genetics, University of Colorado Denver, Aurora, Colorado
| | - Tamir Kanias
- Vitalant Research Institute, Denver, Colorado.,Department of Pathology, University of Colorado Denver, Aurora, Colorado
| | | | - Mars Stone
- Vitalant Research Institute, San Francisco, California
| | - Steve Kleinman
- University of British Columbia, Victoria, British Columbia, Canada
| | | | - Michael Busch
- Vitalant Research Institute, San Francisco, California
| | | |
Collapse
|
14
|
Francis RO, D’Alessandro A, Eisenberger A, Soffing M, Yeh R, Coronel E, Sheikh A, Rapido F, La Carpia F, Reisz JA, Gehrke S, Nemkov T, Thomas T, Schwartz J, Divgi C, Kessler D, Shaz BH, Ginzburg Y, Zimring JC, Spitalnik SL, Hod EA. Donor glucose-6-phosphate dehydrogenase deficiency decreases blood quality for transfusion. J Clin Invest 2020; 130:2270-2285. [PMID: 31961822 PMCID: PMC7191001 DOI: 10.1172/jci133530] [Citation(s) in RCA: 61] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 01/14/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUNDGlucose-6-phosphate dehydrogenase (G6PD) deficiency decreases the ability of red blood cells (RBCs) to withstand oxidative stress. Refrigerated storage of RBCs induces oxidative stress. We hypothesized that G6PD-deficient donor RBCs would have inferior storage quality for transfusion as compared with G6PD-normal RBCs.METHODSMale volunteers were screened for G6PD deficiency; 27 control and 10 G6PD-deficient volunteers each donated 1 RBC unit. After 42 days of refrigerated storage, autologous 51-chromium 24-hour posttransfusion RBC recovery (PTR) studies were performed. Metabolomics analyses of these RBC units were also performed.RESULTSThe mean 24-hour PTR for G6PD-deficient subjects was 78.5% ± 8.4% (mean ± SD), which was significantly lower than that for G6PD-normal RBCs (85.3% ± 3.2%; P = 0.0009). None of the G6PD-normal volunteers (0/27) and 3 G6PD-deficient volunteers (3/10) had PTR results below 75%, a key FDA acceptability criterion for stored donor RBCs. As expected, fresh G6PD-deficient RBCs demonstrated defects in the oxidative phase of the pentose phosphate pathway. During refrigerated storage, G6PD-deficient RBCs demonstrated increased glycolysis, impaired glutathione homeostasis, and increased purine oxidation, as compared with G6PD-normal RBCs. In addition, there were significant correlations between PTR and specific metabolites in these pathways.CONCLUSIONBased on current FDA criteria, RBCs from G6PD-deficient donors would not meet the requirements for storage quality. Metabolomics assessment identified markers of PTR and G6PD deficiency (e.g., pyruvate/lactate ratios), along with potential compensatory pathways that could be leveraged to ameliorate the metabolic needs of G6PD-deficient RBCs.TRIAL REGISTRATIONClinicalTrials.gov NCT04081272.FUNDINGThe Harold Amos Medical Faculty Development Program, Robert Wood Johnson Foundation grant 71590, the National Blood Foundation, NIH grant UL1 TR000040, the Webb-Waring Early Career Award 2017 by the Boettcher Foundation, and National Heart, Lung, and Blood Institute grants R01HL14644 and R01HL148151.
Collapse
Affiliation(s)
- Richard O. Francis
- Department of Pathology and Cell Biology, Columbia University Vagelos College of Physicians and Surgeons and NewYork-Presbyterian Hospital, New York, New York, USA
| | - Angelo D’Alessandro
- University of Colorado Denver-Anschutz Medical Campus, Aurora, Colorado, USA
| | | | - Mark Soffing
- Department of Nuclear Medicine, Columbia University Vagelos College of Physicians and Surgeons and NewYork-Presbyterian Hospital, New York, New York, USA
| | - Randy Yeh
- Department of Nuclear Medicine, Columbia University Vagelos College of Physicians and Surgeons and NewYork-Presbyterian Hospital, New York, New York, USA
| | - Esther Coronel
- Department of Nuclear Medicine, Columbia University Vagelos College of Physicians and Surgeons and NewYork-Presbyterian Hospital, New York, New York, USA
| | - Arif Sheikh
- Division of Nuclear Medicine and Molecular Imaging, Icahn School of Medicine at Mount Sinai Hospital, New York, New York, USA
| | - Francesca Rapido
- Department of Anesthesia and Critical Care Medicine, Montpellier University Hospital Gui de Chauliac, Montpellier, France
| | - Francesca La Carpia
- Department of Pathology and Cell Biology, Columbia University Vagelos College of Physicians and Surgeons and NewYork-Presbyterian Hospital, New York, New York, USA
| | - Julie A. Reisz
- University of Colorado Denver-Anschutz Medical Campus, Aurora, Colorado, USA
| | - Sarah Gehrke
- University of Colorado Denver-Anschutz Medical Campus, Aurora, Colorado, USA
| | - Travis Nemkov
- University of Colorado Denver-Anschutz Medical Campus, Aurora, Colorado, USA
| | - Tiffany Thomas
- Department of Pathology and Cell Biology, Columbia University Vagelos College of Physicians and Surgeons and NewYork-Presbyterian Hospital, New York, New York, USA
| | - Joseph Schwartz
- Department of Pathology and Cell Biology, Columbia University Vagelos College of Physicians and Surgeons and NewYork-Presbyterian Hospital, New York, New York, USA
| | - Chaitanya Divgi
- Department of Nuclear Medicine, Columbia University Vagelos College of Physicians and Surgeons and NewYork-Presbyterian Hospital, New York, New York, USA
| | | | | | - Yelena Ginzburg
- Division of Hematology Oncology, Icahn School of Medicine at Mount Sinai Hospital, New York, New York, USA
| | - James C. Zimring
- Carter Immunology Center, University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - Steven L. Spitalnik
- Department of Pathology and Cell Biology, Columbia University Vagelos College of Physicians and Surgeons and NewYork-Presbyterian Hospital, New York, New York, USA
| | - Eldad A. Hod
- Department of Pathology and Cell Biology, Columbia University Vagelos College of Physicians and Surgeons and NewYork-Presbyterian Hospital, New York, New York, USA
| |
Collapse
|
15
|
Bertolone L, Roy MK, Hay AM, Morrison EJ, Stefanoni D, Fu X, Kanias T, Kleinman S, Dumont LJ, Stone M, Nemkov T, Busch MP, Zimring JC, D'Alessandro A. Impact of taurine on red blood cell metabolism and implications for blood storage. Transfusion 2020; 60:1212-1226. [PMID: 32339326 DOI: 10.1111/trf.15810] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 02/18/2020] [Accepted: 02/22/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Taurine is an antioxidant that is abundant in some common energy drinks. Here we hypothesized that the antioxidant activity of taurine in red blood cells (RBCs) could be leveraged to counteract storage-induced oxidant stress. STUDY DESIGN AND METHODS Metabolomics analyses were performed on plasma and RBCs from healthy volunteers (n = 4) at baseline and after consumption of a whole can of a common, taurine-rich (1000 mg/serving) energy drink. Reductionistic studies were also performed by incubating human RBCs with taurine ex vivo (unlabeled or 13 C15 N-labeled) at increasing doses (0, 100, 500, and 1000 μmol/L) at 37°C for up to 16 hours, with and without oxidant stress challenge with hydrogen peroxide (0.1% or 0.5%). Finally, we stored human and murine RBCs under blood bank conditions in additives supplemented with 500 μmol/L taurine, before metabolomics and posttransfusion recovery studies. RESULTS Consumption of energy drinks increased plasma and RBC levels of taurine, which was paralleled by increases in glycolysis and glutathione (GSH) metabolism in the RBC. These observations were recapitulated ex vivo after incubation with taurine and hydrogen peroxide. Taurine levels in the RBCs from the REDS-III RBC-Omics donor biobank were directly proportional to the total levels of GSH and glutathionylated metabolites and inversely correlated to oxidative hemolysis measurements. Storage of human RBCs in the presence of taurine improved energy and redox markers of storage quality and increased posttransfusion recoveries in FVB mice. CONCLUSION Taurine modulates RBC antioxidant metabolism in vivo and ex vivo, an observation of potential relevance to transfusion medicine.
Collapse
Affiliation(s)
- Lorenzo Bertolone
- Department of Biochemistry and Molecular Genetics, University of Colorado Denver-Anschutz Medical Campus Denver, Aurora, Colorado, USA.,University of Verona, Verona, Italy
| | - Micaela Kalani Roy
- Department of Biochemistry and Molecular Genetics, University of Colorado Denver-Anschutz Medical Campus Denver, Aurora, Colorado, USA
| | - Ariel M Hay
- University of Virginia, Charlottesville, Virginia, USA
| | - Evan J Morrison
- Department of Biochemistry and Molecular Genetics, University of Colorado Denver-Anschutz Medical Campus Denver, Aurora, Colorado, USA
| | - Davide Stefanoni
- Department of Biochemistry and Molecular Genetics, University of Colorado Denver-Anschutz Medical Campus Denver, Aurora, Colorado, USA
| | - Xiaoyun Fu
- BloodWorks Northwest, Seattle, Washington, USA
| | - Tamir Kanias
- Vitalant Research Institute, Denver, Colorado, USA
| | - Steve Kleinman
- University of British Columbia, Victoria, British Columbia, Canada
| | | | - Mars Stone
- Vitalant Research Institute, San Francisco, California, USA
| | - Travis Nemkov
- Department of Biochemistry and Molecular Genetics, University of Colorado Denver-Anschutz Medical Campus Denver, Aurora, Colorado, USA
| | | | | | - Angelo D'Alessandro
- Department of Biochemistry and Molecular Genetics, University of Colorado Denver-Anschutz Medical Campus Denver, Aurora, Colorado, USA.,University of Verona, Verona, Italy
| |
Collapse
|
16
|
D’Alessandro A, Yoshida T, Nestheide S, Nemkov T, Stocker S, Stefanoni D, Mohmoud F, Rugg N, Dunham A, Cancelas JA. Hypoxic storage of red blood cells improves metabolism and post-transfusion recovery. Transfusion 2020; 60:786-798. [PMID: 32104927 PMCID: PMC7899235 DOI: 10.1111/trf.15730] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 12/17/2019] [Accepted: 01/13/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Blood transfusion is a lifesaving intervention for millions of recipients worldwide every year. Storing blood makes this possible but also promotes a series of alterations to the metabolism of the stored erythrocyte. It is unclear whether the metabolic storage lesion is correlated with clinically relevant outcomes and whether strategies aimed at improving the metabolic quality of stored units, such as hypoxic storage, ultimately improve performance in the transfused recipient. STUDY DESIGN AND METHODS Twelve healthy donor volunteers were recruited in a two-arm cross-sectional study, in which each subject donated 2 units to be stored under standard (normoxic) or hypoxic conditions (Hemanext technology). End-of-storage measurements of hemolysis and autologous posttransfusion recovery (PTR) were correlated to metabolomics measurements at Days 0, 21, and 42. RESULTS Hypoxic red blood cells (RBCs) showed superior PTR and comparable hemolysis to donor-paired standard units. Hypoxic storage improved energy and redox metabolism (glycolysis and 2,3-diphosphoglycerate), improved glutathione and methionine homeostasis, decreased purine oxidation and membrane lipid remodeling (free fatty acid levels, unsaturation and hydroxylation, acyl-carnitines). Intra- and extracellular metabolites in these pathways (including some dietary purines) showed significant correlations with PTR and hemolysis, though the degree of correlation was influenced by sulfur dioxide (SO2 ) levels. CONCLUSION Hypoxic storage improves energy and redox metabolism of stored RBCs, which results in improved posttransfusion recoveries in healthy autologous recipients-a Food and Drug Administration gold standard of stored blood quality. In addition, we identified candidate metabolic predictors of PTR for RBCs stored under standard and hypoxic conditions.
Collapse
Affiliation(s)
- Angelo D’Alessandro
- Department of Biochemistry and Molecular Genetics, University of Colorado Denver – Anschutz Medical Campus, Aurora, Colorado,Department of Medicine – Division of Hematology, University of Colorado Denver – Anschutz Medical Campus, Aurora, Colorado
| | | | - Shawnagay Nestheide
- Hoxworth Blood Center, University of Cincinnati Academic Health Center, Cincinnati, Ohio
| | - Travis Nemkov
- Department of Biochemistry and Molecular Genetics, University of Colorado Denver – Anschutz Medical Campus, Aurora, Colorado
| | - Sarah Stocker
- Hoxworth Blood Center, University of Cincinnati Academic Health Center, Cincinnati, Ohio
| | - Davide Stefanoni
- Department of Biochemistry and Molecular Genetics, University of Colorado Denver – Anschutz Medical Campus, Aurora, Colorado
| | - Fatima Mohmoud
- Hoxworth Blood Center, University of Cincinnati Academic Health Center, Cincinnati, Ohio
| | - Neeta Rugg
- Hoxworth Blood Center, University of Cincinnati Academic Health Center, Cincinnati, Ohio
| | | | - Jose A. Cancelas
- Hoxworth Blood Center, University of Cincinnati Academic Health Center, Cincinnati, Ohio,Division of Experimental Hematology and Cancer Biology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| |
Collapse
|
17
|
Baek JH, Shin HKH, Gao Y, Buehler PW. Ferroportin inhibition attenuates plasma iron, oxidant stress, and renal injury following red blood cell transfusion in guinea pigs. Transfusion 2020; 60:513-523. [PMID: 32064619 DOI: 10.1111/trf.15720] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 12/03/2019] [Accepted: 12/18/2019] [Indexed: 12/25/2022]
Abstract
BACKGROUND Red blood cell (RBC) transfusions result in the sequestration and metabolism of storage-damaged RBCs within the spleen and liver. These events are followed by increased plasma iron concentrations that can contribute to oxidant stress and cellular injury. We hypothesized that administration of a ferroportin inhibitor (FPN-INH) immediately after acute RBC exchange transfusion could attenuate posttransfusion circulatory compartment iron exposure, by retaining iron in spleen and hepatic macrophages. STUDY DESIGN AND METHODS Donor guinea pig blood was leukoreduced, and RBCs were preserved at 4°C. Recipient guinea pigs (n = 5/group) were exchange transfused with donor RBCs after refrigerator preservation and dosed intravenously with a small-molecule FPN-INH. Groups included transfusion with vehicle (saline), 5 mg/kg or 25 mg/kg FPN-INH. A time course of RBC morphology, plasma non-transferrin-bound iron (NTBI) and plasma hemoglobin (Hb) were evaluated. End-study spleen, liver, and kidney organ iron levels, as well as renal tissue oxidation and injury, were measured acutely (24-hr after transfusion). RESULTS RBC transfusion increased plasma NTBI, with maximal concentrations occurring 8 hours after transfusion. Posttransfusion iron accumulation resulted in tubule oxidation and acute kidney injury. FPN inhibition increased spleen and liver parenchymal/macrophage iron accumulation, but attenuated plasma NTBI, and subsequent renal tissue oxidation/injury. CONCLUSION In situations of acute RBC transfusion, minimizing circulatory NTBI exposure by FPN inhibition may attenuate organ-specific adverse consequences of iron exposure.
Collapse
Affiliation(s)
- Jin Hyen Baek
- Laboratory of Biochemistry and Vascular Biology, Division of Blood Components and Devices, Center of Biologics Evaluation and Research (CBER), FDA, Silver Spring, Maryland, USA
| | - Hye Kyung H Shin
- Laboratory of Biochemistry and Vascular Biology, Division of Blood Components and Devices, Center of Biologics Evaluation and Research (CBER), FDA, Silver Spring, Maryland, USA
| | - Yamei Gao
- Division of Viral Products, Center of Biologics Evaluation and Research (CBER), FDA, Silver Spring, Maryland, USA
| | - Paul W Buehler
- Department of Pathology, Center for Blood Oxygen Transport, Baltimore, Maryland, USA.,Center for Blood Oxygen Transport and Hemostasis, Department of Pediatrics, University of Maryland Baltimore School of Medicine, Baltimore, Maryland, USA
| |
Collapse
|
18
|
|
19
|
Effect of donor, component, and recipient characteristics on hemoglobin increments following red blood cell transfusion. Blood 2019; 134:1003-1013. [PMID: 31350268 DOI: 10.1182/blood.2019000773] [Citation(s) in RCA: 79] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 07/17/2019] [Indexed: 01/28/2023] Open
Abstract
Significant research has focused individually on blood donors, product preparation and storage, and optimal transfusion practice. To better understand the interplay between these factors on measures of red blood cell (RBC) transfusion efficacy, we conducted a linked analysis of blood donor and component data with patients who received single-unit RBC transfusions between 2008 and 2016. Hemoglobin levels before and after RBC transfusions and at 24- and 48-hour intervals after transfusion were analyzed. Generalized estimating equation linear regression models were fit to examine hemoglobin increments after RBC transfusion adjusting for donor and recipient demographic characteristics, collection method, additive solution, gamma irradiation, and storage duration. We linked data on 23 194 transfusion recipients who received one or more single-unit RBC transfusions (n = 38 019 units) to donor demographic and component characteristics. Donor and recipient sex, Rh-D status, collection method, gamma irradiation, recipient age and body mass index, and pretransfusion hemoglobin levels were significant predictors of hemoglobin increments in univariate and multivariable analyses (P < .01). For hemoglobin increments 24 hours after transfusion, the coefficient of determination for the generalized estimating equation models was 0.25, with an estimated correlation between actual and predicted values of 0.5. Collectively, blood donor demographic characteristics, collection and processing methods, and recipient characteristics accounted for significant variation in hemoglobin increments related to RBC transfusion. Multivariable modeling allows the prediction of changes in hemoglobin using donor-, component-, and patient-level characteristics. Accounting for these factors will be critical for future analyses of donor and component factors, including genetic polymorphisms, on posttransfusion increments and other patient outcomes.
Collapse
|
20
|
Bitan ZC, Zhou A, McMahon DJ, Kessler D, Shaz BH, Caccappolo E, Schwartz J, Francis RO, Brittenham GM, Spitalnik SL, Hod EA. Donor Iron Deficiency Study (DIDS): protocol of a study to test whether iron deficiency in blood donors affects red blood cell recovery after transfusion. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2019; 17:274-280. [PMID: 31385800 PMCID: PMC6683873 DOI: 10.2450/2019.0066-19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 05/30/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND Despite fulfilling all requirements for blood donation, a large proportion of regular blood donors are iron deficient. Red blood cells (RBC) from iron-deficient donors may be particularly susceptible to damage induced by standard refrigerated storage. Herein, we present a study protocol for testing whether correcting iron deficiency in donors with iron-deficient erythropoiesis will improve the quality of their refrigerator-stored RBC. MATERIALS AND METHODS This is a randomised, controlled, double-blind clinical trial. Sixty healthy regular donors who meet donation standards, while exhibiting iron-deficient erythropoiesis by laboratory testing criteria, will donate a single standard RBC unit that will be leucoreduced and stored in a refrigerator under standard conditions for 40-42 days. A 51Cr-radiolabelled 24-hour RBC recovery study will be performed and then these donors will be randomised to receive, in a double-blinded fashion, either intravenous saline, as a control, or low-molecular weight iron dextran (1 g), to provide total iron repletion. Four to six months later, they will donate a second RBC unit, which will be similarly stored, and autologous 51Cr-labelled 24-hour post-transfusion RBC recovery will again be determined. RESULTS The primary endpoint will be the change in 24-hour post-transfusion recovery from the first to the second donation. The primary outcome will be the group mean difference in the primary endpoints between the group receiving intravenous saline and the group receiving intravenous iron dextran. Secondary outcomes will be quality of life, fatigue, and emotional health, assessed by surveys. CONCLUSION This study will provide definitive evidence as to whether donor iron deficiency affects the quality of the blood supply and will assess the severity of symptoms affecting iron-deficient blood donors.
Collapse
Affiliation(s)
- Zachary C. Bitan
- Pathology and Cell Biology, Columbia University Irving Medical Center, Presbyterian Hospital, New York, NY, United States of America
| | - Alice Zhou
- Pathology and Cell Biology, Columbia University Irving Medical Center, Presbyterian Hospital, New York, NY, United States of America
| | - Donald J. McMahon
- Pathology and Cell Biology, Columbia University Irving Medical Center, Presbyterian Hospital, New York, NY, United States of America
| | - Debra Kessler
- New York Blood Center, New York, NY, United States of America
| | - Beth H. Shaz
- New York Blood Center, New York, NY, United States of America
| | - Elise Caccappolo
- Cognitive Neuroscience Division, Department of Neurology, Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Columbia University Irving Medical Center, New York, NY, United States of America
| | - Joseph Schwartz
- Pathology and Cell Biology, Columbia University Irving Medical Center, Presbyterian Hospital, New York, NY, United States of America
| | - Richard O. Francis
- Pathology and Cell Biology, Columbia University Irving Medical Center, Presbyterian Hospital, New York, NY, United States of America
| | - Gary M. Brittenham
- Pediatrics, Columbia University Irving Medical Center-New York Presbyterian Hospital, New York, NY, United States of America
| | - Steven L. Spitalnik
- Pathology and Cell Biology, Columbia University Irving Medical Center, Presbyterian Hospital, New York, NY, United States of America
| | - Eldad A. Hod
- Pathology and Cell Biology, Columbia University Irving Medical Center, Presbyterian Hospital, New York, NY, United States of America
| |
Collapse
|
21
|
Personalised Transfusion Medicine. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2019; 17:255-257. [PMID: 31385798 PMCID: PMC6683867 DOI: 10.2450/2018.0142-19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
|