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Vandenbroeke T, Gloor C, Wingfield T, Leite C, Carr K, Turner C, Ngamsuntikul S, Sutor L, Compton F, Nestheide S, Rugg N, Cancelas JA, Dumont LJ. In vitro quality parameters of whole blood-derived platelets pooled using two different platelet pooling sets and stored up to 7 days are similar. Transfusion 2024; 64:132-140. [PMID: 37991217 DOI: 10.1111/trf.17591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 09/28/2023] [Accepted: 10/14/2023] [Indexed: 11/23/2023]
Abstract
BACKGROUND Increasing the number of collections of whole blood-derived platelets (WBDP) and lengthening the allowable storage time may alleviate platelet (PLT) shortages. There is a need for new PLT pooling sets that can provide acceptable quality on Day 7 of storage. STUDY DESIGN AND METHODS This pool-and-split study compared WBDP prepared using the platelet-rich plasma method with the novel IMUGARD WB PLT pooling set and a control pooling set. After pooling and filtration, PLT products were tested on Days 1, 5, and 7. Large volume delayed sampling (LVDS) cultures were taken on Day 2. RESULTS The median postfiltration residual white blood cell (rWBC) content was 0.18 million per product (maximum 1.26 million; n = 69) with mean PLT recovery of 88.5 ± 2.8% for the new set and median 0.23 million (maximum 1.83 million) rWBC with 87.5 ± 2.5% recovery for the control. Day 5 mean pH22°C were 7.18 ± 0.12 and 7.13 ± 0.10 for the new and control set, respectively. Day 5 in vitro quality parameters were within 20% between the two pooling sets. The new set Day 7 pH22°C was acceptable (7.07 ± 0.17, 100% ≥ 6.3), and most parameters were within 20% of Day 5 values. CONCLUSION WBDP quality for the new pooling set is acceptable across a battery of in vitro tests when stored up to 7 days and meets FDA regulatory criteria. The quality parameters were similar between the new pooling set and the control set on Day 5. This new set is compatible with LVDS.
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Affiliation(s)
| | - Christina Gloor
- Research & Development, Terumo BCT, Inc., Lakewood, Colorado, USA
| | - Tyler Wingfield
- Research & Development, Terumo BCT, Inc., Lakewood, Colorado, USA
| | - Caroline Leite
- Vitalant Research Institute, Vitalant, Denver, Colorado, USA
| | - Kathlynn Carr
- Administrative and Components Divisions, South Texas Blood & Tissue, San Antonio, Texas, USA
| | - Chris Turner
- Administrative and Components Divisions, South Texas Blood & Tissue, San Antonio, Texas, USA
| | - Samantha Ngamsuntikul
- Administrative and Components Divisions, South Texas Blood & Tissue, San Antonio, Texas, USA
| | - Laurie Sutor
- Department of Medical Services, Carter BloodCare, Bedford, Texas, USA
| | - Frances Compton
- Department of Medical Services, Carter BloodCare, Bedford, Texas, USA
| | - Shawnagay Nestheide
- Hoxworth Blood Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Neeta Rugg
- Hoxworth Blood Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Jose A Cancelas
- Hoxworth Blood Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Larry J Dumont
- Vitalant Research Institute, Vitalant, Denver, Colorado, USA
- Department of Pathology, University of Colorado School of Medicine, Aurora, Colorado, USA
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Janoff EN, Brown ST, Belitskaya-Levy I, Curtis JL, Bonomo RA, Miller EK, Goldberg AM, Zehm L, Wills A, Hutchinson C, Dumont LJ, Gleason T, Shih MC. Design of VA CoronavirUs Research and Efficacy Studies-1 (VA CURES-1): A double-blind, randomized placebo-controlled trial of COVID-19 convalescent plasma in hospitalized patients with early respiratory compromise. Contemp Clin Trials Commun 2023; 35:101190. [PMID: 37560085 PMCID: PMC10407261 DOI: 10.1016/j.conctc.2023.101190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 07/07/2023] [Accepted: 07/15/2023] [Indexed: 08/11/2023] Open
Abstract
BACKGROUND Effective therapeutics for severe acute respiratory syndrome CoronaVirus-2 (SARS-CoV-2) infection are evolving. Under Emergency Use Authorization, COVID-19 convalescent plasma (CCP) was widely used in individuals hospitalized for COVID-19, but few randomized controlled trials supported its efficacy to limit respiratory failure or death. METHODS VA CoronavirUs Research and Efficacy Studies-1 (VA CURES-1) was a double-blind, multi-site, placebo-controlled, randomized clinical trial evaluating the efficacy and safety of CCP with conventional therapy in hospitalized Veterans with SARS-CoV-2 infection and early respiratory compromise (requirement for oxygen). Participants (planned sample size 702) were randomized 1:1 to receive CCP with high titer neutralizing activity or 0.9% saline, stratified by site and age (≥65 versus <65 years old). Participants were followed daily during initial hospitalization and at Days 15, 22 and 28. OUTCOMES The composite primary outcome was acute hypoxemic respiratory failure or all-cause death by Day 28. Secondary outcomes by day 28 included time-to-recovery, clinical severity, mortality, rehospitalization for COVID-19, and adverse events. Serial respiratory and blood samples were collected for safety, virologic and immunologic analyses and future studies. Key variables in predicting the success of CURES-1 were: (1) enrollment early in the course of severe infection; (2) use of plasma with high neutralizing activity; (3) reliance on unambiguous, clinically meaningful outcomes. CURES-1 was terminated for futility due to perceived inability to enroll in the lull between the Alpha and Delta waves of the SARS CoV-2 epidemic. CONCLUSIONS VA CURES-1 was a large multi-site trial designed to provide conclusive information about the efficacy of CCP in well-characterized patients at risk for progression of COVID-19. It utilized a rigorous study design with relevant initial timing, quality of product and outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04539275.
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Affiliation(s)
- Edward N. Janoff
- Rocky Mountain Regional VA Medical Center, Aurora, CO, USA
- University of Colorado Denver School of Medicine, Aurora, CO, USA
| | - Sheldon T. Brown
- James J. Peters Department of Veterans Affairs Medical Center, Bronx, NY, USA
- Icahn School of Medicine at Mt. Sinai, New York, NY, USA
| | - Ilana Belitskaya-Levy
- Department of Veterans Affairs, Cooperative Studies Program Coordinating Center, Palo Alto, CA, USA
| | - Jeffrey L. Curtis
- VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
- University of Michigan Medical School, Ann Arbor, MI, USA
| | - Robert A. Bonomo
- Louis Stokes Cleveland VA Medical Center, Cleveland, OH, USA
- Case VA CARES, Case Western Reserve University School of Medicine, USA
| | - Elliott K. Miller
- Department of Veterans Affairs, Cooperative Studies Program Clinical Research Pharmacy Coordinating Center, Albuquerque, NM, USA
| | - Alexa M. Goldberg
- Department of Veterans Affairs, Cooperative Studies Program Clinical Research Pharmacy Coordinating Center, Albuquerque, NM, USA
| | - Lisa Zehm
- Department of Veterans Affairs, Cooperative Studies Program Coordinating Center, Palo Alto, CA, USA
| | - Ashlea Wills
- Rocky Mountain Regional VA Medical Center, Aurora, CO, USA
| | | | - Larry J. Dumont
- University of Colorado Denver School of Medicine, Aurora, CO, USA
- Vitalant Research Institute, Denver, CO, USA
| | - Theresa Gleason
- Department of Veterans Affairs, Clinical Science Research and Development Service, Washington, DC, USA
| | - Mei-Chiung Shih
- Department of Veterans Affairs, Cooperative Studies Program Coordinating Center, Palo Alto, CA, USA
- Stanford University School of Medicine, Palo Alto, CA, USA
| | - ADD Caitlin MS in CCTC website
- Rocky Mountain Regional VA Medical Center, Aurora, CO, USA
- University of Colorado Denver School of Medicine, Aurora, CO, USA
- James J. Peters Department of Veterans Affairs Medical Center, Bronx, NY, USA
- Icahn School of Medicine at Mt. Sinai, New York, NY, USA
- Department of Veterans Affairs, Cooperative Studies Program Coordinating Center, Palo Alto, CA, USA
- VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
- University of Michigan Medical School, Ann Arbor, MI, USA
- Louis Stokes Cleveland VA Medical Center, Cleveland, OH, USA
- Case VA CARES, Case Western Reserve University School of Medicine, USA
- Department of Veterans Affairs, Cooperative Studies Program Clinical Research Pharmacy Coordinating Center, Albuquerque, NM, USA
- Vitalant Research Institute, Denver, CO, USA
- Department of Veterans Affairs, Clinical Science Research and Development Service, Washington, DC, USA
- Stanford University School of Medicine, Palo Alto, CA, USA
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3
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Dumont LJ, Wolfe B, Leite C, Moss R, Wegener C, Thompson K, Min K. Feasibility evaluation of two novel systems for the automated preparation and extended storage of DMSO cryopreserved platelets. Transfusion 2023; 63:1554-1562. [PMID: 37358313 DOI: 10.1111/trf.17464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 03/22/2023] [Accepted: 05/08/2023] [Indexed: 06/27/2023]
Abstract
BACKGROUND Manufacturing methods for dimethyl sulfoxide (DMSO)-cryopreserved platelets (CPPs) are manual and labor intensive. Thawing and prepare-for-transfusion steps are in an open system that requires transfusion within 4 h. A fill-and-finish system (CUE) can automate the manufacturing process. A newly configured bag system allows freezing, thawing, and use of resuspension solutions while maintaining the functionally closed system, and extending the post-thaw shelf life beyond 4 h. Our objective is to evaluate the feasibility of the CUE system and the functionally closed bag system. STUDY DESIGN AND METHODS DMSO was volumetrically added to double-dose apheresis platelets, concentrated, and delivered to a 50- or 500-mL ethylene-vinyl acetate (EVA) bag by the CUE (n = 12). The functionally closed bag system contained 25 mL platelet additive solution 3 (PAS-3) in a 50-mL EVA bag. Control CPP (n = 2) were manually prepared. PAS-3 and CPP were thawed together. CPP were stored up to 98 h (20-24°C) and tested using a standard assay panel. RESULTS CUE prepared CPP met the design targets: volume, platelet content, and DMSO concentration. CUE CPP P-selectin was high. CD42b, phosphatidylserine (PS) expression, and live cell percentage were favorable compared to controls and favorably maintained over storage. The thrombin generation potency was slightly reduced compared to controls. The 50 mL EVA bag maintained pH for up to 30 h, and the 500 mL EVA bag beyond 76 h. DISCUSSION The CUE system presents a technically feasible method to prepare CPP. A functionally closed bag system with resuspension solution was successful and can extend the post-thaw storage time of CPP.
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Affiliation(s)
- Larry J Dumont
- Vitalant Research Institute, Denver, Colorado, USA
- Department of Pathology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Brian Wolfe
- Vitalant Research Institute, Denver, Colorado, USA
| | | | - Raymond Moss
- Vitalant Research Institute, Denver, Colorado, USA
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Levine AC, Fukuta Y, Huaman MA, Ou J, Meisenberg BR, Patel B, Paxton JH, Hanley DF, Rijnders BJA, Gharbharan A, Rokx C, Zwaginga JJ, Alemany A, Mitjà O, Ouchi D, Millat-Martinez P, Durkalski-Mauldin V, Korley FK, Dumont LJ, Callaway CW, Libster R, Marc GP, Wappner D, Esteban I, Polack F, Sullivan DJ. Coronavirus Disease 2019 Convalescent Plasma Outpatient Therapy to Prevent Outpatient Hospitalization: A Meta-Analysis of Individual Participant Data From 5 Randomized Trials. Clin Infect Dis 2023; 76:2077-2086. [PMID: 36809473 PMCID: PMC10273382 DOI: 10.1093/cid/ciad088] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 01/06/2023] [Accepted: 02/14/2023] [Indexed: 02/23/2023] Open
Abstract
BACKGROUND Outpatient monoclonal antibodies are no longer effective and antiviral treatments for coronavirus disease 2019 (COVID-19) disease remain largely unavailable in many countries worldwide. Although treatment with COVID-19 convalescent plasma (CCP) is promising, clinical trials among outpatients have shown mixed results. METHODS We conducted an individual participant data meta-analysis from outpatient trials to assess the overall risk reduction for all-cause hospitalizations by day 28 in transfused participants. Relevant trials were identified by searching Medline, Embase, medRxiv, World Health Organization COVID-19 Research Database, Cochrane Library, and Web of Science from January 2020 to September 2022. RESULTS Five included studies from 4 countries enrolled and transfused 2620 adult patients. Comorbidities were present in 1795 (69%). The virus neutralizing antibody dilutional titer levels ranged from 8 to 14 580 in diverse assays. One hundred sixty of 1315 (12.2%) control patients were hospitalized, versus 111 of 1305 (8.5%) CCP-treated patients, yielding a 3.7% (95% confidence interval [CI], 1.3%-6.0%; P = .001) absolute risk reduction and 30.1% relative risk reduction for all-cause hospitalization. The hospitalization reduction was greatest in those with both early transfusion and high titer with a 7.6% absolute risk reduction (95% CI, 4.0%-11.1%; P = .0001) accompanied by at 51.4% relative risk reduction. No significant reduction in hospitalization was seen with treatment >5 days after symptom onset or in those receiving CCP with antibody titers below the median titer. CONCLUSIONS Among outpatients with COVID-19, treatment with CCP reduced the rate of all-cause hospitalization and may be most effective when given within 5 days of symptom onset and when antibody titer is higher.
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Affiliation(s)
- Adam C Levine
- Department of Emergency Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Yuriko Fukuta
- Infectious Disease, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Moises A Huaman
- Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Jiangda Ou
- Division of Brain Injury Outcomes, Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Barry R Meisenberg
- Department of Hematology–Oncology, Anne Arundel Medical Center, Annapolis, Maryland, USA
| | - Bela Patel
- Division of Critical Care Medicine, McGovern Medical School, University of Texas Health Science Center, Houston, Texas, USA
| | - James H Paxton
- Department of Emergency Medicine, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Daniel F Hanley
- Division of Brain Injury Outcomes, Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Bart J A Rijnders
- Department of Internal Medicine, Section of Infectious Diseases and Department of Medical Microbiology and Infectious Diseases, Erasmus University Medical Center, University Medical Center, Rotterdam, The Netherlands
| | - Arvind Gharbharan
- Department of Internal Medicine, Section of Infectious Diseases and Department of Medical Microbiology and Infectious Diseases, Erasmus University Medical Center, University Medical Center, Rotterdam, The Netherlands
| | - Casper Rokx
- Department of Internal Medicine, Section of Infectious Diseases and Department of Medical Microbiology and Infectious Diseases, Erasmus University Medical Center, University Medical Center, Rotterdam, The Netherlands
| | - Jaap Jan Zwaginga
- Department of Haematology, Leiden University Medical Centre, Leiden, The Netherlands
- Center for Clinical Transfusion Research, Sanquin Blood Supply, Amsterdam, The Netherlands
| | - Andrea Alemany
- Fight Infectious Diseases Foundation, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
- Infectious Diseases Department, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Oriol Mitjà
- Fight Infectious Diseases Foundation, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
- Infectious Diseases Department, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
- Lihir Medical Centre, International SOS, Lihir Island, Papua New Guinea
| | - Dan Ouchi
- Fight Infectious Diseases Foundation, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
- Infectious Diseases Department, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Pere Millat-Martinez
- ISGlobal, Department of Infectious Diseases, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Valerie Durkalski-Mauldin
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Frederick K Korley
- Department of Emergency Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Larry J Dumont
- Vitalant Research Institute, Research Department, Denver, Colorado, USA
- Department of Pathology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Clifton W Callaway
- Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Romina Libster
- Fundación INFANT, Buenos Aires, Argentina
- Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | | | | | | | - Fernando Polack
- Fundación INFANT, Buenos Aires, Argentina
- Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - David J Sullivan
- Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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McDyer JF, Azimpouran M, Durkalski-Mauldin VL, Clevenger RG, Yeatts SD, Deng X, Barsan W, Silbergleit R, El Kassar N, Popescu I, Dimitrov D, Li W, Lyons EJ, Lieber SC, Stone M, Korley FK, Callaway CW, Dumont LJ, Norris PJ. COVID-19 convalescent plasma boosts early antibody titer and does not influence the adaptive immune response. JCI Insight 2023; 8:e167890. [PMID: 36862515 PMCID: PMC10174456 DOI: 10.1172/jci.insight.167890] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 02/24/2023] [Indexed: 03/03/2023] Open
Abstract
Multiple randomized, controlled clinical trials have yielded discordant results regarding the efficacy of convalescent plasma in outpatients, with some showing an approximately 2-fold reduction in risk and others showing no effect. We quantified binding and neutralizing antibody levels in 492 of the 511 participants from the Clinical Trial of COVID-19 Convalescent Plasma in Outpatients (C3PO) of a single unit of COVID-19 convalescent plasma (CCP) versus saline infusion. In a subset of 70 participants, peripheral blood mononuclear cells were obtained to define the evolution of B and T cell responses through day 30. Binding and neutralizing antibody responses were approximately 2-fold higher 1 hour after infusion in recipients of CCP compared with saline plus multivitamin, but levels achieved by the native immune system by day 15 were almost 10-fold higher than those seen immediately after CCP administration. Infusion of CCP did not block generation of the host antibody response or skew B or T cell phenotype or maturation. Activated CD4+ and CD8+ T cells were associated with more severe disease outcome. These data show that CCP leads to a measurable boost in anti-SARS-CoV-2 antibodies but that the boost is modest and may not be sufficient to alter disease course.
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Affiliation(s)
| | | | | | | | - Sharon D. Yeatts
- Medical University of South Carolina, Charleston, South Carolina, USA
| | - Xutao Deng
- Vitalant Research Institute, San Francisco, California, USA
- Department of Laboratory Medicine, UCSF, San Francisco, California, USA
| | - William Barsan
- Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Robert Silbergleit
- Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Nahed El Kassar
- National Heart, Lung, and Blood Institute (NHLBI), NIH, Bethesda, Maryland, USA
| | - Iulia Popescu
- University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | | - Wei Li
- University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | | | | - Mars Stone
- Vitalant Research Institute, San Francisco, California, USA
- Department of Laboratory Medicine, UCSF, San Francisco, California, USA
| | - Frederick K. Korley
- Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | | | - Larry J. Dumont
- Vitalant Research Institute, San Francisco, California, USA
- University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Philip J. Norris
- Vitalant Research Institute, San Francisco, California, USA
- Department of Laboratory Medicine, UCSF, San Francisco, California, USA
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6
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Esparza O, Hernandez G, Rojas-Sanchez G, Calzada-Martinez J, Nemkov T, Kelher M, Kelly K, Silliman CC, DomBourian M, Dumont LJ, D’Alessandro A, Davizon-Castillo P. Platelets from blood diversion pouches (DPs) are a suitable alternative for functional, bioenergetic, and metabolomic analyses. Blood Transfus 2023; 21:BloodTransfus.519. [PMID: 37235734 PMCID: PMC10645348 DOI: 10.2450/bloodtransfus.519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 03/15/2023] [Indexed: 05/28/2023]
Abstract
BACKGROUND The collection of the first blood flow into a diversion pouch (DP) has become widely adopted in blood donation systems to reduce whole-blood unit contamination from skin bacteria. The strict control of pre-analytical variables, such as blood collection and proper anticoagulant selection, is critical to diminish experimental variability when studying different aspects of platelet biology. We hypothesize that the functional, mitochondrial, and metabolomic profiles of platelets isolated from the DP are not different from the ones isolated from standard venipuncture (VP), thus representing a suitable collection method of platelets for experimental purposes. MATERIALS AND METHODS Whole blood from the blood DP or VP was collected. Platelets were subsequently isolated and washed following standard protocols. Platelet function was assessed by flow cytometry, light transmission aggregometry, clot retraction, and under flow conditions using the total thrombus formation analyzer (T-TAS). Mitochondrial function and the platelet metabolome profiles were determined by the Seahorse extracellular flux analyzer (Agilent, Santa Clara, CA, USA) and ultra-high-pressure liquid chromatography-mass spectrometry metabolomics, respectively. RESULTS Platelets isolated from VP and the DP have similar functional, mitochondrial, and metabolic profiles with no significant differences between both groups at baseline and upon activation by any of the assays mentioned above. DISCUSSION The findings of our study support the use of platelets from the DP for performing functional and metabolic studies on platelets from a wide range of blood donors. The DP may serve as an alternative blood collection method to standard VP, allowing the study of diverse aspects of platelet biology, such as age, sex, race, and ethnicity, in many eligible individuals for blood donation.
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Affiliation(s)
- Orlando Esparza
- Department of Pediatrics Hematology/ Oncology and Bone Marrow Transplantation, University of Colorado Anschutz Medical Campus, Aurora CO, United States of America
| | - Giovanny Hernandez
- Department of Pediatrics Hematology/ Oncology and Bone Marrow Transplantation, University of Colorado Anschutz Medical Campus, Aurora CO, United States of America
| | - Guadalupe Rojas-Sanchez
- Department of Pediatrics Hematology/ Oncology and Bone Marrow Transplantation, University of Colorado Anschutz Medical Campus, Aurora CO, United States of America
| | - Jorge Calzada-Martinez
- Department of Pediatrics Hematology/ Oncology and Bone Marrow Transplantation, University of Colorado Anschutz Medical Campus, Aurora CO, United States of America
| | - Travis Nemkov
- Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora CO, United States of America
| | - Marguerite Kelher
- Department of Biochemistry and Molecular Genetics, University of Colorado Anschutz Medical Campus, Aurora CO, United States of America
| | - Kathleen Kelly
- Department of Pathology, University of Colorado Anschutz Medical Campus, Aurora CO, United States of America
| | - Christopher C. Silliman
- Department of Pediatrics Hematology/ Oncology and Bone Marrow Transplantation, University of Colorado Anschutz Medical Campus, Aurora CO, United States of America
- Department of Biochemistry and Molecular Genetics, University of Colorado Anschutz Medical Campus, Aurora CO, United States of America
- Vitalant Research Institute, Denver CO, United States of America
| | - Melkon DomBourian
- Department of Pathology, University of Colorado Anschutz Medical Campus, Aurora CO, United States of America
| | - Larry J. Dumont
- Vitalant Research Institute, Denver CO, United States of America
| | - Angelo D’Alessandro
- Department of Biochemistry and Molecular Genetics, University of Colorado Anschutz Medical Campus, Aurora CO, United States of America
| | - Pavel Davizon-Castillo
- Department of Pediatrics Hematology/ Oncology and Bone Marrow Transplantation, University of Colorado Anschutz Medical Campus, Aurora CO, United States of America
- Hemophilia and Thrombosis Center, University of Colorado School of Medicine, Aurora CO, United States of America
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7
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Levine AC, Fukuta Y, Huaman MA, Ou J, Meisenberg BR, Patel B, Paxton JH, Hanley DF, Rijnders BJA, Gharbharan A, Rokx C, Zwaginga JJ, Alemany A, Mitjà O, Ouchi D, Millat-Martinez P, Durkalski-Mauldin V, Korley FK, Dumont LJ, Callaway CW, Libster R, Marc GP, Wappner D, Esteban I, Polack F, Sullivan DJ. COVID-19 Convalescent Plasma Outpatient Therapy to Prevent Outpatient Hospitalization: A Meta-analysis of Individual Participant Data From Five Randomized Trials. medRxiv 2022:2022.12.16.22283585. [PMID: 36561181 PMCID: PMC9774226 DOI: 10.1101/2022.12.16.22283585] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Background Monoclonal antibody and antiviral treatments for COVID-19 disease remain largely unavailable worldwide, and existing monoclonal antibodies may be less active against circulating omicron variants. Although treatment with COVID-19 convalescent plasma (CCP) is promising, randomized clinical trials (RCTs) among outpatients have shown mixed results. Methods We conducted an individual participant data meta-analysis from all outpatient CCP RCTs to assess the overall risk reduction for all-cause hospitalizations by day 28 in all participants who had transfusion initiated. Relevant trials were identified by searching MEDLINE, Embase, MedRxiv, WHO, Cochrane Library, and Web of Science from January 2020 to September 2022. Results Five included studies from four countries enrolled and transfused 2,620 adult patients. Comorbidities were present in 1,795 (69%). The anti-Spike or virus neutralizing antibody titer range across all trials was broad. 160 (12.2%) of 1315 control patients were hospitalized, versus 111 (8.5%) of 1305 CCP-treated patients, yielding a 3.7% (95%CI: 1.3%-6.0%; p=.001) ARR and 30.1% RRR for all-cause hospitalization. The effect size was greatest in those with both early transfusion and high titer with a 7.6% ARR (95%CI: 4.0%-11.1%; p=.0001) accompanied by at 51.4% RRR. No significant reduction in hospitalization was seen with treatment > 5 days after symptom onset or in those receiving CCP with antibody titers below the median titer. Conclusions Among outpatients with COVID-19, treatment with CCP reduced the rate of all-cause hospitalization. CCP may be most effective when given within 5 days of symptom onset and when antibody titer is higher. Key Points While the outpatient COVID-19 randomized controlled trial meta-analysis indicated heterogeneity in participant risk factors and convalescent plasma, the combined CCP efficacy for reducing hospitalization was significant, improving with transfusion within 5 days of symptom onset and high antibody neutralization levels.
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Affiliation(s)
- Adam C. Levine
- Department of Emergency Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Yuriko Fukuta
- Department of Medicine – Infectious Disease, Baylor College of Medicine, Houston, Texas, USA
| | - Moises A. Huaman
- Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Jiangda Ou
- Division of Brain Injury Outcomes, Department of Neurology, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Barry R. Meisenberg
- Department of Hematology – Oncology, Anne Arundel Medical Center, Annapolis, Maryland, USA
| | - Bela Patel
- Division of Critical Care Medicine, McGovern Medical School, University of Texas Health Science Center, Houston, Texas, USA
| | - James H. Paxton
- Department of Emergency Medicine, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Daniel F. Hanley
- Division of Brain Injury Outcomes, Department of Neurology, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Bart JA Rijnders
- Department of Internal Medicine, Section of Infectious Diseases and department of Medical Microbiology and Infectious Diseases, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Arvind Gharbharan
- Department of Internal Medicine, Section of Infectious Diseases and department of Medical Microbiology and Infectious Diseases, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Casper Rokx
- Department of Internal Medicine, Section of Infectious Diseases and department of Medical Microbiology and Infectious Diseases, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Jaap Jan Zwaginga
- Department of Haematology, Leiden University Medical Centre, Leiden, The Netherlands and; CCTR, Sanquin Blood Supply, Amsterdam, The Netherlands
| | - Andrea Alemany
- Fight Infectious Diseases Foundation, Badalona, Spain; Infectious Diseases Department, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Oriol Mitjà
- Fight Infectious Diseases Foundation, Badalona, Spain; Infectious Diseases Department, Hospital Universitari Germans Trias i Pujol, Badalona, Spain,Universitat de Vic-Universitat Central de Catalunya, Vic, Spain; Lihir Medical Centre, International SOS, Lihir Island, Papua New Guinea
| | - Dan Ouchi
- Fight Infectious Diseases Foundation, Badalona, Spain; Infectious Diseases Department, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | | | | | | | - Larry J. Dumont
- Vitalant Research Institute, Denver, CO; University of Colorado School of Medicine, Aurora, CO
| | | | - Romina Libster
- Fundación INFANT, Buenos Aires, Argentina,Vanderbilt University, Nashville, TN, USA
| | | | | | | | - Fernando Polack
- Fundación INFANT, Buenos Aires, Argentina,Vanderbilt University, Nashville, TN, USA
| | - David J. Sullivan
- Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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8
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Hadley JB, Kelher MR, Coleman JR, Kelly KK, Dumont LJ, Esparza O, Banerjee A, Cohen MJ, Jones K, Silliman CC. Hormones, age, and sex affect platelet responsiveness in vitro. Transfusion 2022; 62:1882-1893. [PMID: 35929193 PMCID: PMC9464702 DOI: 10.1111/trf.17054] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 06/24/2022] [Accepted: 06/24/2022] [Indexed: 01/02/2023]
Abstract
BACKGROUND Female sex confers a survival advantage following severe injury in the setting of trauma-induced coagulopathy, with female platelets having heightened responsiveness likely due to estrogen. The effects of testosterone on platelet biology are unknown, and platelets express both estradiol and androgen receptors on the plasma membrane. We hypothesize testosterone decreases platelet responses in vitro, and there are baseline differences in platelet function and metabolism stratified by sex/age. STUDY DESIGN AND METHODS Apheresis platelets were collected from: older males (OM) ≥45 years, younger males (YM) <45 years, older females (OF) ≥54 years, and younger females (YF) <54 years, and testosterone and estradiol were measured. Platelets were incubated with testosterone (5.31 ng/ml), estradiol (105 pg/ml) or vehicle and stimulated with buffer, adenosine diphosphate (20 μM), platelet activating factor (2 μM), or thrombin (0.3 U/ml). Aggregation, CD62P surface expression, fibrinogen receptor surface expression, and platelet mitochondrial metabolism were measured. RESULTS Testosterone significantly inhibited aggregation in OF and OM (p < .05), inhibited CD41a expression in YF, YM, and OM (p < .05), and affected a few of the baseline amounts of CD62P surface expression but not platelet activation to platelet-activating factor and adenosine diphosphate, and variably changed platelet metabolism. DISCUSSION Platelets have sex- and age-specific aggregation, receptor expression, and metabolism. Testosterone decreases platelet function dependent on the stimulus, age, and sex. Similarly, platelet metabolism has varying responses to sex hormones with baseline metabolic differences dependent upon sex and age.
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Affiliation(s)
- Jamie B Hadley
- The Department of Surgery, University of Colorado Denver, Aurora, Colorado, USA
| | - Marguerite R Kelher
- The Department of Pediatrics, University of Colorado Denver, Aurora, Colorado, USA
- Vitalant Research Institute, Denver, Colorado, USA
| | - Julia R Coleman
- The Department of Surgery, University of Colorado Denver, Aurora, Colorado, USA
| | | | - Larry J Dumont
- Vitalant Research Institute, Denver, Colorado, USA
- The Department of Pathology School of Medicine, University of Colorado Denver, Aurora, Colorado, USA
| | - Orlando Esparza
- The Department of Pediatrics, University of Colorado Denver, Aurora, Colorado, USA
- Vitalant Research Institute, Denver, Colorado, USA
| | - Anirban Banerjee
- The Department of Surgery, University of Colorado Denver, Aurora, Colorado, USA
| | - Mitchell J Cohen
- The Department of Surgery, University of Colorado Denver, Aurora, Colorado, USA
| | - Kenneth Jones
- Department of Biostatistics, University of Oklahoma School of Medicine, Oklahoma City, Oklahoma, USA
| | - Christopher C Silliman
- The Department of Surgery, University of Colorado Denver, Aurora, Colorado, USA
- The Department of Pediatrics, University of Colorado Denver, Aurora, Colorado, USA
- Vitalant Research Institute, Denver, Colorado, USA
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9
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Helander L, McKinney C, Kelly K, Mack S, Sanders M, Gurley J, Dumont LJ, Annen K. Chronic granulomatous disease and McLeod syndrome: Stem cell transplant and transfusion support in a 2-year-old patient—a case report. Front Immunol 2022; 13:994321. [PMID: 36081507 PMCID: PMC9445126 DOI: 10.3389/fimmu.2022.994321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 08/02/2022] [Indexed: 11/21/2022] Open
Abstract
Chronic granulomatous disease (CGD) with McLeod neuroacanthocytosis syndrome (MLS) is a contiguous gene deletion disorder characterized by defective phagocytic function and decreased Kell antigen expression. CGD cure is achieved through hematopoietic stem cell transplant (HSCT) usually in the peri-pubescent years. The presence of MLS makes peri-transfusion support complex, however. Herein, we present the youngest known case of HSCT for CGD in the setting of MLS. A 2-year-old male patient was diagnosed with CGD plus MLS. Due to the severity of the child’s systemic fungal infection at diagnosis, HSCT was deemed the best treatment option despite his small size and age. A related, matched donor was available, and a unique red blood cell support plan had been implemented. Reduced-intensity conditioning was used to reduce the transplant-related mortality risk associated with myeloablative protocols. The transplant course was uneventful; autologous red blood cell (RBC) transfusion support was successful and allowed for the avoidance of possible antibody formation if allogeneic units had been used. The patient achieved 1-year relapse-free survival. The developed protocols provide a viable path to transplant in the very young, and early transplant to cure could reduce disease-related morbidity.
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Affiliation(s)
- Louise Helander
- ClinImmune Cell and Gene Therapy, Department of Medicine, University of Colorado Anschutz School of Medicine, Denver, CO, United States
- Transfusion Medicine and Apheresis, Department of Pathology, Children’s Hospital Colorado, Denver, CO, United States
- *Correspondence: Louise Helander,
| | - Chris McKinney
- Blood and Marrow Transplant Therapy Program, Children’s Hospital Colorado, Denver, CO, United States
| | - Kathleen Kelly
- Vitalant Research Institute, Vitalant, Denver, CO, United States
| | - Samantha Mack
- Vitalant Research Institute, Vitalant, Denver, CO, United States
- Department of Pathology, University of Colorado Anschutz School of Medicine, Denver, CO, United States
| | - Mary Sanders
- Transfusion Medicine and Apheresis, Department of Pathology, Children’s Hospital Colorado, Denver, CO, United States
| | - Janice Gurley
- Transfusion Medicine and Apheresis, Department of Pathology, Children’s Hospital Colorado, Denver, CO, United States
| | - Larry J. Dumont
- Vitalant Research Institute, Vitalant, Denver, CO, United States
- Department of Pathology, University of Colorado Anschutz School of Medicine, Denver, CO, United States
| | - Kyle Annen
- Transfusion Medicine and Apheresis, Department of Pathology, Children’s Hospital Colorado, Denver, CO, United States
- Department of Pathology, University of Colorado Anschutz School of Medicine, Denver, CO, United States
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10
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Kelly K, Sen S, Ilyin I, Dumont LJ. Hyperbaric treatment of platelets extends in vitro storage to 14 days. Transfusion 2022; 62:1736-1742. [PMID: 35919959 DOI: 10.1111/trf.17048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 06/27/2022] [Accepted: 07/04/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Platelets for transfusion have a storage time of 5-7 days at 22°C-24°C, which results in a strain on the supply chain and supply shortages. We describe a novel method to extend platelet storage using xenon (Xe) gas under high pressure and refrigeration. STUDY DESIGN AND METHODS Apheresis platelets (APU) prepared in 65% platelet additive solution (PAS) were stored under standard conditions (SC) at 20°C-24°C to Day 5. Paired APUs were prepared with Xe and stored to Day 14 at 2°C-6°C under hyperbaric conditions (XHC). A standard panel of in vitro assays was conducted. RESULTS XHC platelets were viable out to Day 14. The average pH of Day 14 platelets was 6.58, and 86% maintained some degree of swirl compared with 7.02 and 100% swirl for Day 5 SC platelets. The rate of glycolysis was reduced under XHC storage with less glucose consumption and lactate generation. Activation levels for Day 14 platelets, while increased, did not prevent response to agonists in vitro, including epinephrine + Adenosine 5-Diphosphate (EPI/ADP) and thrombin receptor-activating peptide (TRAP) aggregation. Thromboelastogram (TEG) assessment showed 80% or greater conservation of platelet function for Day 14 xenon stored platelets compared with Day 5 SC platelets. DISCUSSION Platelet storage with the Xe/hyperbaric/cold method is a feasible candidate for extension of storage to 14 days based on in vitro characteristics. In vivo recovery and survival studies are indicated. The capability to extend platelet storage to 14 days would make large strides toward resolving issues of platelet outdating for prophylactic use.
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Affiliation(s)
| | - Sharon Sen
- Vitalant Research Institute, Denver, Colorado, USA
| | - Ilya Ilyin
- Cellular Preservation Technologies, Buffalo, New York, USA
| | - Larry J Dumont
- Vitalant Research Institute, Denver, Colorado, USA.,University of Colorado School of Medicine, Aurora, Colorado, USA
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11
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Cancelas JA, Genthe JR, Stolla M, Rugg N, Bailey SL, Nestheide S, Shaz B, Mack S, Schroeder K, Anani W, Szczepiorkowski ZM, Dumont LJ, Yegneswaran S, Corash L, Mufti N, Benjamin RJ, Erickson AC. Evaluation of amotosalen and UVA pathogen-reduced apheresis platelets after 7-day storage. Transfusion 2022; 62:1619-1629. [PMID: 35808974 PMCID: PMC9546462 DOI: 10.1111/trf.17003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 05/15/2022] [Accepted: 05/25/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Amotosalen/UVA pathogen-reduced platelet components (PRPCs) with storage up to 7 days are standard of care in France, Switzerland, and Austria. PRPCs provide effective hemostasis with reduced risk of transfusion-transmitted infections and transfusion-associated graft versus host disease, reduced wastage and improved availability compared with 5-day-stored PCs. This study evaluated the potency of 7-day PRPCs by in vitro characterization and in vivo pharmacokinetic analysis of autologous PCs. STUDY DESIGN AND METHODS The in vitro characteristics of 7-day-stored apheresis PRPCs suspended in 100% plasma or 65% platelet additive solution (PAS-3)/35% plasma, thrombin generation, and in vivo radiolabeled post-transfusion recovery and survival of 7-day-stored PRPCs suspended in 100% plasma were compared with either 7-day-stored or fresh autologous conventional platelets. RESULTS PRPCs after 7 days of storage maintained pH, platelet dose, in vitro physiologic characteristics, and thrombin generation when compared to conventional 7-day PCs. In vivo, the mean post-transfusion survival was 151.4 ± 20.1 h for 7-day PRPCs in 100% plasma (Test) versus 209.6 ± 13.9 h for the fresh autologous platelets (Control), (T-ΔC: 72.3 ± 8.8%: 95% confidence interval [CI]: 68.5, 76.1) and mean 24-h post-transfusion recovery 37.6 ± 8.4% for Test versus 56.8 ± 9.2% for Control (T-ΔC: 66.2 ± 11.2%; 95% CI: 61.3, 71.1). DISCUSSION PRPCs collected in both 100% plasma as well as 65% PAS-3/35% plasma and stored for 7 days retained in vitro physiologic characteristics. PRPCs stored in 100% plasma for 7 days retained in vivo survival. Lower in vivo post-radiolabeled autologous platelet recovery is consistent with reported reduced count increments for allogenic transfusion.
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Affiliation(s)
| | | | - Moritz Stolla
- Bloodworks Northwest, Seattle, Washington, USA.,Division of Hematology, Department of Medicine, University of Washington Medical Center, Seattle, Washington, USA
| | - Neeta Rugg
- Hoxworth Blood Center, Cincinnati, Ohio, USA
| | | | | | - Beth Shaz
- Duke University, Durham, North Carolina, USA
| | | | | | | | - Zbigniew M Szczepiorkowski
- Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire, USA.,Institute of Hematology and Transfusion Medicine, Warsaw, Poland
| | | | | | | | - Nina Mufti
- Cerus Corporation, Concord, California, USA
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12
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Dumont LJ. Commentary on the 1976
Transfusion
paper by Aster, Becker, and Filip. Transfusion 2022; 62:942-947. [DOI: 10.1111/trf.16852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 03/07/2022] [Indexed: 11/29/2022]
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13
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Kelly K, Helander L, Hazegh K, Stanley C, Moss R, Mack S, Sanders ML, Gurley J, McKinney C, Dumont LJ, Annen K. Cryopreservation of rare pediatric red blood cells for support following bone marrow transplant. Transfusion 2022; 62:954-960. [DOI: 10.1111/trf.16878] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 03/01/2022] [Accepted: 03/08/2022] [Indexed: 12/01/2022]
Affiliation(s)
| | - Louise Helander
- ClinImmune Labs/Department of Medicine University of Colorado Aurora Colorado USA
- Department of Pathology and Laboratory Medicine Children's Hospital Colorado Aurora Colorado USA
| | | | | | | | | | - Mary L. Sanders
- Department of Pathology and Laboratory Medicine Children's Hospital Colorado Aurora Colorado USA
| | - Janice Gurley
- Department of Pathology and Laboratory Medicine Children's Hospital Colorado Aurora Colorado USA
| | - Chris McKinney
- Center for Cancer and Blood Disorders Children's Hospital Colorado Aurora Colorado USA
- Medical Department of Pediatrics University of Colorado Aurora Colorado USA
| | - Larry J. Dumont
- Vitalant Research Institute Denver Colorado USA
- Department of Pathology and Laboratory Medicine University of Colorado Medical School Aurora Colorado USA
| | - Kyle Annen
- Department of Pathology University of Colorado Aurora Colorado USA
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14
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Van Rompay KKA, Olstad KJ, Sammak RL, Dutra J, Watanabe JK, Usachenko JL, Immareddy R, Roh JW, Verma A, Shaan Lakshmanappa Y, Schmidt BA, Di Germanio C, Rizvi N, Liu H, Ma ZM, Stone M, Simmons G, Dumont LJ, Allen AM, Lockwood S, Pollard RE, Ramiro de Assis R, Yee JL, Nham PB, Ardeshir A, Deere JD, Jain A, Felgner PL, Coffey LL, Iyer SS, Hartigan-O’Connor DJ, Busch MP, Reader JR. Early post-infection treatment of SARS-CoV-2 infected macaques with human convalescent plasma with high neutralizing activity had no antiviral effects but moderately reduced lung inflammation. PLoS Pathog 2022; 18:e1009925. [PMID: 35443018 PMCID: PMC9060337 DOI: 10.1371/journal.ppat.1009925] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 05/02/2022] [Accepted: 03/24/2022] [Indexed: 11/24/2022] Open
Abstract
Early in the SARS-CoV-2 pandemic, there was a high level of optimism based on observational studies and small controlled trials that treating hospitalized patients with convalescent plasma from COVID-19 survivors (CCP) would be an important immunotherapy. However, as more data from controlled trials became available, the results became disappointing, with at best moderate evidence of efficacy when CCP with high titers of neutralizing antibodies was used early in infection. To better understand the potential therapeutic efficacy of CCP, and to further validate SARS-CoV-2 infection of macaques as a reliable animal model for testing such strategies, we inoculated 12 adult rhesus macaques with SARS-CoV-2 by intratracheal and intranasal routes. One day later, 8 animals were infused with pooled human CCP with a high titer of neutralizing antibodies (RVPN NT50 value of 3,003), while 4 control animals received normal human plasma. Animals were monitored for 7 days. Animals treated with CCP had detectable but low levels of antiviral antibodies after infusion. In comparison to the control animals, CCP-treated animals had similar levels of viral RNA in upper and lower respiratory tract secretions, similar detection of viral RNA in lung tissues by in situ hybridization, but lower amounts of infectious virus in the lungs. CCP-treated animals had a moderate, but statistically significant reduction in interstitial pneumonia, as measured by comprehensive lung histology. Thus overall, therapeutic benefits of CCP were marginal and inferior to results obtained earlier with monoclonal antibodies in this animal model. By highlighting strengths and weaknesses, data of this study can help to further optimize nonhuman primate models to provide proof-of-concept of intervention strategies, and guide the future use of convalescent plasma against SARS-CoV-2 and potentially other newly emerging respiratory viruses.
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Affiliation(s)
- Koen K. A. Van Rompay
- California National Primate Research Center, University of California, Davis, California, United States of America
- Department of Pathology, Microbiology and Immunology, University of California, Davis, California, United States of America
| | - Katherine J. Olstad
- California National Primate Research Center, University of California, Davis, California, United States of America
- Department of Pathology, Microbiology and Immunology, University of California, Davis, California, United States of America
| | - Rebecca L. Sammak
- California National Primate Research Center, University of California, Davis, California, United States of America
| | - Joseph Dutra
- Department of Medical Microbiology and Immunology, School of Medicine, University of California, Davis, California, United States of America
| | - Jennifer K. Watanabe
- California National Primate Research Center, University of California, Davis, California, United States of America
| | - Jodie L. Usachenko
- California National Primate Research Center, University of California, Davis, California, United States of America
| | - Ramya Immareddy
- California National Primate Research Center, University of California, Davis, California, United States of America
| | - Jamin W. Roh
- Center for Immunology and Infectious Diseases, University of California, Davis, California, United States of America
- Graduate Group in Immunology, University of California, Davis, California, United States of America
| | - Anil Verma
- Center for Immunology and Infectious Diseases, University of California, Davis, California, United States of America
| | - Yashavanth Shaan Lakshmanappa
- Center for Immunology and Infectious Diseases, University of California, Davis, California, United States of America
| | - Brian A. Schmidt
- Center for Immunology and Infectious Diseases, University of California, Davis, California, United States of America
| | - Clara Di Germanio
- Vitalant Research Institute, San Francisco, California, United States of America
| | - Nabeela Rizvi
- Vitalant Research Institute, San Francisco, California, United States of America
| | - Hongwei Liu
- Department of Pathology, Microbiology and Immunology, University of California, Davis, California, United States of America
| | - Zhong-Min Ma
- California National Primate Research Center, University of California, Davis, California, United States of America
| | - Mars Stone
- Vitalant Research Institute, San Francisco, California, United States of America
| | - Graham Simmons
- Vitalant Research Institute, San Francisco, California, United States of America
| | - Larry J. Dumont
- Vitalant Research Institute, Denver, Colorado; University of Colorado School of Medicine, Aurora, Colorado, United States of America
| | - A. Mark Allen
- California National Primate Research Center, University of California, Davis, California, United States of America
| | - Sarah Lockwood
- California National Primate Research Center, University of California, Davis, California, United States of America
| | - Rachel E. Pollard
- School of Veterinary Medicine, University of California, Davis, California, United States of America
| | - Rafael Ramiro de Assis
- Vaccine Research and Development Center, Department of Physiology and Biophysics, School of Medicine, University of California, Irvine, California, United States of America
| | - JoAnn L. Yee
- California National Primate Research Center, University of California, Davis, California, United States of America
| | - Peter B. Nham
- California National Primate Research Center, University of California, Davis, California, United States of America
| | - Amir Ardeshir
- California National Primate Research Center, University of California, Davis, California, United States of America
| | - Jesse D. Deere
- Department of Medical Microbiology and Immunology, School of Medicine, University of California, Davis, California, United States of America
| | - Aarti Jain
- Vaccine Research and Development Center, Department of Physiology and Biophysics, School of Medicine, University of California, Irvine, California, United States of America
| | - Philip L. Felgner
- Vaccine Research and Development Center, Department of Physiology and Biophysics, School of Medicine, University of California, Irvine, California, United States of America
| | - Lark L. Coffey
- Department of Pathology, Microbiology and Immunology, University of California, Davis, California, United States of America
| | - Smita S. Iyer
- California National Primate Research Center, University of California, Davis, California, United States of America
- Department of Pathology, Microbiology and Immunology, University of California, Davis, California, United States of America
- Center for Immunology and Infectious Diseases, University of California, Davis, California, United States of America
| | - Dennis J. Hartigan-O’Connor
- California National Primate Research Center, University of California, Davis, California, United States of America
- Department of Medical Microbiology and Immunology, School of Medicine, University of California, Davis, California, United States of America
| | - Michael P. Busch
- Vitalant Research Institute, San Francisco, California, United States of America
- Department of Laboratory Medicine, University of California San Francisco, San Francisco, California, United States of America
| | - J. Rachel Reader
- California National Primate Research Center, University of California, Davis, California, United States of America
- Department of Pathology, Microbiology and Immunology, University of California, Davis, California, United States of America
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15
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Levy JH, Faraoni D, Almond CS, Baumann-Kreuziger L, Bembea MM, Connors JM, Dalton HJ, Davies R, Dumont LJ, Griselli M, Karkouti K, Massicotte MP, Teruya J, Thiagarajan RR, Spinella PC, Steiner ME. Consensus Statement: Hemostasis Trial Outcomes in Cardiac Surgery and Mechanical Support. Ann Thorac Surg 2022; 113:1026-1035. [PMID: 34826386 DOI: 10.1016/j.athoracsur.2021.09.080] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 08/08/2021] [Accepted: 09/27/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Research evaluating hemostatic agents for the treatment of clinically significant bleeding has been hampered by inconsistency and lack of standardized primary clinical trial outcomes. Clinical trials of hemostatic agents in both cardiac surgery and mechanical circulatory support, such as extracorporeal membrane oxygenation and ventricular assist devices, are examples of studies that lack implementation of universally accepted outcomes. METHODS A subgroup of experts convened by the National Heart, Lung, and Blood Institute and the US Department of Defense developed consensus recommendations for primary outcomes in cardiac surgery and mechanical circulatory support. RESULTS For cardiac surgery the primary efficacy endpoint of total allogeneic blood products (units vs mL/kg for pediatric patients) administered intraoperatively and postoperatively through day 5 or hospital discharge is recommended. For mechanical circulatory support outside the perioperative period the recommended primary outcome for extracorporeal membrane oxygenation is a 5-point ordinal score of thrombosis and bleeding severity adapted from the Common Terminology Criteria for Adverse Events version 5.0. The recommended primary endpoint for ventricular assist device is freedom from disabling stroke (Common Terminology Criteria for Adverse Events AE ≥ grade 3) through day 180. CONCLUSIONS The proposed composite risk scores could impact the design of upcoming clinical trials and enable comparability of future investigations. Harmonizing and disseminating global consensus definitions and management guidelines can also reduce patient heterogeneity that would confound standardized primary outcomes in future research.
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Affiliation(s)
- Jerrold H Levy
- Division Cardiothoracic Anesthesiology and Critical Care, Departments of Anesthesiology and Surgery (Cardiothoracic), Duke University School of Medicine, Durham, North Carolina.
| | - David Faraoni
- Division of Cardiac Anesthesia, Department of Anesthesia and Pain Medicine, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Christopher S Almond
- Heart Failure Service, Cardiac Anticoagulation Service, Lucile Packard Children's Hospital Stanford, Stanford University School of Medicine, Palo Alto, California
| | | | - Melania M Bembea
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jean M Connors
- Hematology Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Heidi J Dalton
- INOVA Heart and Vascular Institute; Department of Pediatrics, INOVA Fairfax Medical Center, Falls Church, Virginia
| | - Ryan Davies
- Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical Center and Children's Health, Dallas, Texas
| | - Larry J Dumont
- Vitalant Research Institute, Denver, Colorado; Department of Pathology, University of Colorado Medical School, Denver, Colorado; Department of Pathology and Laboratory Medicine, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - Massimo Griselli
- Division of Pediatric Cardiovascular Surgery, University of Minnesota, Minneapolis, Minnesota
| | - Keyvan Karkouti
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada
| | - M Patricia Massicotte
- Division of Cardiology, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Jun Teruya
- Division of Transfusion Medicine and Coagulation, Department of Pathology and Immunology, Pediatrics and Medicine, Texan Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - Ravi R Thiagarajan
- Cardiac Intensive Care Unit, Boston Children's Hospital, Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Philip C Spinella
- Division of Critical Care, Department of Pediatrics, Washington University School of Medicine, St Louis, Missouri
| | - Marie E Steiner
- Divisions of Hematology and Critical Care, Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota
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16
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Stone M, Grebe E, Sulaeman H, Di Germanio C, Dave H, Kelly K, Biggerstaff BJ, Crews BO, Tran N, Jerome KR, Denny TN, Hogema B, Destree M, Jones JM, Thornburg N, Simmons G, Krajden M, Kleinman S, Dumont LJ, Busch MP. Evaluation of Commercially Available High-Throughput SARS-CoV-2 Serologic Assays for Serosurveillance and Related Applications. Emerg Infect Dis 2022; 28:672-683. [PMID: 35202525 PMCID: PMC8888213 DOI: 10.3201/eid2803.211885] [Citation(s) in RCA: 44] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) serosurveys can estimate cumulative incidence for monitoring epidemics, requiring assessment of serologic assays to inform testing algorithm development and interpretation of results. We conducted a multilaboratory evaluation of 21 commercial high-throughput SARS-CoV-2 serologic assays using blinded panels of 1,000 highly characterized specimens. Assays demonstrated a range of sensitivities (96%–63%), specificities (99%–96%), and precision (intraclass correlation coefficient 0.55–0.99). Durability of antibody detection was dependent on antigen and immunoglobulin targets; antispike and total Ig assays demonstrated more stable longitudinal reactivity than antinucleocapsid and IgG assays. Assays with high sensitivity, specificity, and durable antibody detection are ideal for serosurveillance, but assays demonstrating waning reactivity are appropriate for other applications, including correlation with neutralizing activity and detection of anamnestic boosting by reinfections. Assay performance must be evaluated in context of intended use, particularly in the context of widespread vaccination and circulation of SARS-CoV-2 variants.
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17
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Senefeld JW, Johnson PW, Kunze KL, Bloch EM, van Helmond N, Golafshar MA, Klassen SA, Klompas AM, Sexton MA, Diaz Soto JC, Grossman BJ, Tobian AAR, Goel R, Wiggins CC, Bruno KA, van Buskirk CM, Stubbs JR, Winters JL, Casadevall A, Paneth NS, Shaz BH, Petersen MM, Sachais BS, Buras MR, Wieczorek MA, Russoniello B, Dumont LJ, Baker SE, Vassallo RR, Shepherd JRA, Young PP, Verdun NC, Marks P, Haley NR, Rea RF, Katz L, Herasevich V, Waxman DA, Whelan ER, Bergman A, Clayburn AJ, Grabowski MK, Larson KF, Ripoll JG, Andersen KJ, Vogt MNP, Dennis JJ, Regimbal RJ, Bauer PR, Blair JE, Buchholtz ZA, Pletsch MC, Wright K, Greenshields JT, Joyner MJ, Wright RS, Carter RE, Fairweather D. Access to and safety of COVID-19 convalescent plasma in the United States Expanded Access Program: A national registry study. PLoS Med 2021; 18:e1003872. [PMID: 34928960 PMCID: PMC8730442 DOI: 10.1371/journal.pmed.1003872] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 01/05/2022] [Accepted: 11/18/2021] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND The United States (US) Expanded Access Program (EAP) to coronavirus disease 2019 (COVID-19) convalescent plasma was initiated in response to the rapid spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the causative agent of COVID-19. While randomized clinical trials were in various stages of development and enrollment, there was an urgent need for widespread access to potential therapeutic agents. The objective of this study is to report on the demographic, geographical, and chronological characteristics of patients in the EAP, and key safety metrics following transfusion of COVID-19 convalescent plasma. METHODS AND FINDINGS Mayo Clinic served as the central institutional review board for all participating facilities, and any US physician could participate as a local physician-principal investigator. Eligible patients were hospitalized, were aged 18 years or older, and had-or were at risk of progression to-severe or life-threatening COVID-19; eligible patients were enrolled through the EAP central website. Blood collection facilities rapidly implemented programs to collect convalescent plasma for hospitalized patients with COVID-19. Demographic and clinical characteristics of all enrolled patients in the EAP were summarized. Temporal patterns in access to COVID-19 convalescent plasma were investigated by comparing daily and weekly changes in EAP enrollment in response to changes in infection rate at the state level. Geographical analyses on access to convalescent plasma included assessing EAP enrollment in all national hospital referral regions, as well as assessing enrollment in metropolitan areas and less populated areas that did not have access to COVID-19 clinical trials. From April 3 to August 23, 2020, 105,717 hospitalized patients with severe or life-threatening COVID-19 were enrolled in the EAP. The majority of patients were 60 years of age or older (57.8%), were male (58.4%), and had overweight or obesity (83.8%). There was substantial inclusion of minorities and underserved populations: 46.4% of patients were of a race other than white, and 37.2% of patients were of Hispanic ethnicity. Chronologically and geographically, increases in the number of both enrollments and transfusions in the EAP closely followed confirmed infections across all 50 states. Nearly all national hospital referral regions enrolled and transfused patients in the EAP, including both in metropolitan and in less populated areas. The incidence of serious adverse events was objectively low (<1%), and the overall crude 30-day mortality rate was 25.2% (95% CI, 25.0% to 25.5%). This registry study was limited by the observational and pragmatic study design that did not include a control or comparator group; thus, the data should not be used to infer definitive treatment effects. CONCLUSIONS These results suggest that the EAP provided widespread access to COVID-19 convalescent plasma in all 50 states, including for underserved racial and ethnic minority populations. The study design of the EAP may serve as a model for future efforts when broad access to a treatment is needed in response to an emerging infectious disease. TRIAL REGISTRATION ClinicalTrials.gov NCT#: NCT04338360.
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Affiliation(s)
- Jonathon W. Senefeld
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Patrick W. Johnson
- Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, Florida, United States of America
| | - Katie L. Kunze
- Department of Quantitative Health Sciences, Mayo Clinic, Scottsdale, Arizona, United States of America
| | - Evan M. Bloch
- Division of Transfusion Medicine, Department of Pathology, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Noud van Helmond
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, United States of America
- Department of Anesthesiology, Cooper Medical School of Rowan University, Cooper University Health Care, Camden, New Jersey, United States of America
| | - Michael A. Golafshar
- Department of Quantitative Health Sciences, Mayo Clinic, Scottsdale, Arizona, United States of America
| | - Stephen A. Klassen
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Allan M. Klompas
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Matthew A. Sexton
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Juan C. Diaz Soto
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Brenda J. Grossman
- Department of Pathology and Immunology, Washington University School of Medicine in St. Louis, St. Louis, Missouri, United States of America
| | - Aaron A. R. Tobian
- Division of Transfusion Medicine, Department of Pathology, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Ruchika Goel
- Division of Transfusion Medicine, Department of Pathology, Johns Hopkins University, Baltimore, Maryland, United States of America
- ImpactLife, Davenport, Iowa, United States of America
| | - Chad C. Wiggins
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Katelyn A. Bruno
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, Florida, United States of America
| | - Camille M. van Buskirk
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, United States of America
| | - James R. Stubbs
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Jeffrey L. Winters
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Arturo Casadevall
- Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Nigel S. Paneth
- Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, East Lansing, Michigan, United States of America
- Department of Pediatrics and Human Development, College of Human Medicine, Michigan State University, East Lansing, Michigan, United States of America
| | - Beth H. Shaz
- Department of Pathology, Duke University, Durham, North Carolina, United States of America
| | - Molly M. Petersen
- Department of Quantitative Health Sciences, Mayo Clinic, Scottsdale, Arizona, United States of America
| | - Bruce S. Sachais
- New York Blood Center Enterprises, New York City, New York, United States of America
| | - Matthew R. Buras
- Department of Quantitative Health Sciences, Mayo Clinic, Scottsdale, Arizona, United States of America
| | - Mikolaj A. Wieczorek
- Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, Florida, United States of America
| | - Benjamin Russoniello
- Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, Florida, United States of America
| | - Larry J. Dumont
- Vitalant Research Institute, Denver, Colorado, United States of America
- University of Colorado School of Medicine, Aurora, Colorado, United States of America
- Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, United States of America
| | - Sarah E. Baker
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, United States of America
| | | | - John R. A. Shepherd
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Pampee P. Young
- American Red Cross, Washington, District of Columbia, United States of America
| | - Nicole C. Verdun
- Center for Biologics Evaluation and Research, U. S. Food and Drug Administration, Silver Spring, Maryland, United States of America
| | - Peter Marks
- Center for Biologics Evaluation and Research, U. S. Food and Drug Administration, Silver Spring, Maryland, United States of America
| | - N. Rebecca Haley
- Bloodworks Northwest, Seattle, Washington, United States of America
| | - Robert F. Rea
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Louis Katz
- ImpactLife, Davenport, Iowa, United States of America
| | - Vitaly Herasevich
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Dan A. Waxman
- Versiti, Indianapolis, Indiana, United States of America
| | - Emily R. Whelan
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, Florida, United States of America
| | - Aviv Bergman
- Department of Systems and Computational Biology, Albert Einstein College of Medicine, New York City, New York, United States of America
| | - Andrew J. Clayburn
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Mary Kathryn Grabowski
- Division of Transfusion Medicine, Department of Pathology, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Kathryn F. Larson
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Juan G. Ripoll
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Kylie J. Andersen
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Matthew N. P. Vogt
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Joshua J. Dennis
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Riley J. Regimbal
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Philippe R. Bauer
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Janis E. Blair
- Division of Infectious Diseases, Department of Internal Medicine, Mayo Clinic, Phoenix, Arizona, United States of America
| | - Zachary A. Buchholtz
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Michaela C. Pletsch
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Katherine Wright
- School of Sustainability, Arizona State University, Tempe, Arizona, United States of America
| | - Joel T. Greenshields
- Department of Kinesiology, Indiana University, Bloomington, Indiana, United States of America
| | - Michael J. Joyner
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, United States of America
| | - R. Scott Wright
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Rickey E. Carter
- Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, Florida, United States of America
| | - DeLisa Fairweather
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, Florida, United States of America
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18
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Korley FK, Durkalski-Mauldin V, Yeatts SD, Schulman K, Davenport RD, Dumont LJ, El Kassar N, Foster LD, Hah JM, Jaiswal S, Kaplan A, Lowell E, McDyer JF, Quinn J, Triulzi DJ, Van Huysen C, Stevenson VLW, Yadav K, Jones CW, Kea B, Burnett A, Reynolds JC, Greineder CF, Haas NL, Beiser DG, Silbergleit R, Barsan W, Callaway CW. Early Convalescent Plasma for High-Risk Outpatients with Covid-19. N Engl J Med 2021; 385:1951-1960. [PMID: 34407339 PMCID: PMC8385553 DOI: 10.1056/nejmoa2103784] [Citation(s) in RCA: 150] [Impact Index Per Article: 50.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Early administration of convalescent plasma obtained from blood donors who have recovered from coronavirus disease 2019 (Covid-19) may prevent disease progression in acutely ill, high-risk patients with Covid-19. METHODS In this randomized, multicenter, single-blind trial, we assigned patients who were being treated in an emergency department for Covid-19 symptoms to receive either one unit of convalescent plasma with a high titer of antibodies against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) or placebo. All the patients were either 50 years of age or older or had one or more risk factors for disease progression. In addition, all the patients presented to the emergency department within 7 days after symptom onset and were in stable condition for outpatient management. The primary outcome was disease progression within 15 days after randomization, which was a composite of hospital admission for any reason, seeking emergency or urgent care, or death without hospitalization. Secondary outcomes included the worst severity of illness on an 8-category ordinal scale, hospital-free days within 30 days after randomization, and death from any cause. RESULTS A total of 511 patients were enrolled in the trial (257 in the convalescent-plasma group and 254 in the placebo group). The median age of the patients was 54 years; the median symptom duration was 4 days. In the donor plasma samples, the median titer of SARS-CoV-2 neutralizing antibodies was 1:641. Disease progression occurred in 77 patients (30.0%) in the convalescent-plasma group and in 81 patients (31.9%) in the placebo group (risk difference, 1.9 percentage points; 95% credible interval, -6.0 to 9.8; posterior probability of superiority of convalescent plasma, 0.68). Five patients in the plasma group and 1 patient in the placebo group died. Outcomes regarding worst illness severity and hospital-free days were similar in the two groups. CONCLUSIONS The administration of Covid-19 convalescent plasma to high-risk outpatients within 1 week after the onset of symptoms of Covid-19 did not prevent disease progression. (SIREN-C3PO ClinicalTrials.gov number, NCT04355767.).
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Affiliation(s)
- Frederick K Korley
- From the University of Michigan, Ann Arbor (F.K.K., R.D.D., C.V.H., V.L.W.S., C.F.G., N.L.H., R.S., W.B.), Spectrum Health, Grand Rapids (J.C.R.), and Michigan State University, East Lansing (J.C.R.) - all in Michigan; the Medical University of South Carolina, Charleston (V.D.-M., S.D.Y., L.D.F., E.L.); Stanford University, Palo Alto, CA (K.S., J.M.H., S.J., J.Q.); Vitalant Research Institute, Scottsdale, AZ (L.J.D.); the National Heart, Lung, and Blood Institute, Bethesda, MD (N.E.K.); the University of Pittsburgh, Pittsburgh (A.K., J.F.M., D.J.T., C.W.C.); Harbor-UCLA Medical Center, Los Angeles (K.Y.); Cooper University Hospital, Camden, NJ (C.W.J.); Oregon Health and Science University, Portland (B.K.); Health Partners Methodist Hospital, St. Louis Park, MN (A.B.); and the University of Chicago, Chicago (D.G.B.)
| | - Valerie Durkalski-Mauldin
- From the University of Michigan, Ann Arbor (F.K.K., R.D.D., C.V.H., V.L.W.S., C.F.G., N.L.H., R.S., W.B.), Spectrum Health, Grand Rapids (J.C.R.), and Michigan State University, East Lansing (J.C.R.) - all in Michigan; the Medical University of South Carolina, Charleston (V.D.-M., S.D.Y., L.D.F., E.L.); Stanford University, Palo Alto, CA (K.S., J.M.H., S.J., J.Q.); Vitalant Research Institute, Scottsdale, AZ (L.J.D.); the National Heart, Lung, and Blood Institute, Bethesda, MD (N.E.K.); the University of Pittsburgh, Pittsburgh (A.K., J.F.M., D.J.T., C.W.C.); Harbor-UCLA Medical Center, Los Angeles (K.Y.); Cooper University Hospital, Camden, NJ (C.W.J.); Oregon Health and Science University, Portland (B.K.); Health Partners Methodist Hospital, St. Louis Park, MN (A.B.); and the University of Chicago, Chicago (D.G.B.)
| | - Sharon D Yeatts
- From the University of Michigan, Ann Arbor (F.K.K., R.D.D., C.V.H., V.L.W.S., C.F.G., N.L.H., R.S., W.B.), Spectrum Health, Grand Rapids (J.C.R.), and Michigan State University, East Lansing (J.C.R.) - all in Michigan; the Medical University of South Carolina, Charleston (V.D.-M., S.D.Y., L.D.F., E.L.); Stanford University, Palo Alto, CA (K.S., J.M.H., S.J., J.Q.); Vitalant Research Institute, Scottsdale, AZ (L.J.D.); the National Heart, Lung, and Blood Institute, Bethesda, MD (N.E.K.); the University of Pittsburgh, Pittsburgh (A.K., J.F.M., D.J.T., C.W.C.); Harbor-UCLA Medical Center, Los Angeles (K.Y.); Cooper University Hospital, Camden, NJ (C.W.J.); Oregon Health and Science University, Portland (B.K.); Health Partners Methodist Hospital, St. Louis Park, MN (A.B.); and the University of Chicago, Chicago (D.G.B.)
| | - Kevin Schulman
- From the University of Michigan, Ann Arbor (F.K.K., R.D.D., C.V.H., V.L.W.S., C.F.G., N.L.H., R.S., W.B.), Spectrum Health, Grand Rapids (J.C.R.), and Michigan State University, East Lansing (J.C.R.) - all in Michigan; the Medical University of South Carolina, Charleston (V.D.-M., S.D.Y., L.D.F., E.L.); Stanford University, Palo Alto, CA (K.S., J.M.H., S.J., J.Q.); Vitalant Research Institute, Scottsdale, AZ (L.J.D.); the National Heart, Lung, and Blood Institute, Bethesda, MD (N.E.K.); the University of Pittsburgh, Pittsburgh (A.K., J.F.M., D.J.T., C.W.C.); Harbor-UCLA Medical Center, Los Angeles (K.Y.); Cooper University Hospital, Camden, NJ (C.W.J.); Oregon Health and Science University, Portland (B.K.); Health Partners Methodist Hospital, St. Louis Park, MN (A.B.); and the University of Chicago, Chicago (D.G.B.)
| | - Robertson D Davenport
- From the University of Michigan, Ann Arbor (F.K.K., R.D.D., C.V.H., V.L.W.S., C.F.G., N.L.H., R.S., W.B.), Spectrum Health, Grand Rapids (J.C.R.), and Michigan State University, East Lansing (J.C.R.) - all in Michigan; the Medical University of South Carolina, Charleston (V.D.-M., S.D.Y., L.D.F., E.L.); Stanford University, Palo Alto, CA (K.S., J.M.H., S.J., J.Q.); Vitalant Research Institute, Scottsdale, AZ (L.J.D.); the National Heart, Lung, and Blood Institute, Bethesda, MD (N.E.K.); the University of Pittsburgh, Pittsburgh (A.K., J.F.M., D.J.T., C.W.C.); Harbor-UCLA Medical Center, Los Angeles (K.Y.); Cooper University Hospital, Camden, NJ (C.W.J.); Oregon Health and Science University, Portland (B.K.); Health Partners Methodist Hospital, St. Louis Park, MN (A.B.); and the University of Chicago, Chicago (D.G.B.)
| | - Larry J Dumont
- From the University of Michigan, Ann Arbor (F.K.K., R.D.D., C.V.H., V.L.W.S., C.F.G., N.L.H., R.S., W.B.), Spectrum Health, Grand Rapids (J.C.R.), and Michigan State University, East Lansing (J.C.R.) - all in Michigan; the Medical University of South Carolina, Charleston (V.D.-M., S.D.Y., L.D.F., E.L.); Stanford University, Palo Alto, CA (K.S., J.M.H., S.J., J.Q.); Vitalant Research Institute, Scottsdale, AZ (L.J.D.); the National Heart, Lung, and Blood Institute, Bethesda, MD (N.E.K.); the University of Pittsburgh, Pittsburgh (A.K., J.F.M., D.J.T., C.W.C.); Harbor-UCLA Medical Center, Los Angeles (K.Y.); Cooper University Hospital, Camden, NJ (C.W.J.); Oregon Health and Science University, Portland (B.K.); Health Partners Methodist Hospital, St. Louis Park, MN (A.B.); and the University of Chicago, Chicago (D.G.B.)
| | - Nahed El Kassar
- From the University of Michigan, Ann Arbor (F.K.K., R.D.D., C.V.H., V.L.W.S., C.F.G., N.L.H., R.S., W.B.), Spectrum Health, Grand Rapids (J.C.R.), and Michigan State University, East Lansing (J.C.R.) - all in Michigan; the Medical University of South Carolina, Charleston (V.D.-M., S.D.Y., L.D.F., E.L.); Stanford University, Palo Alto, CA (K.S., J.M.H., S.J., J.Q.); Vitalant Research Institute, Scottsdale, AZ (L.J.D.); the National Heart, Lung, and Blood Institute, Bethesda, MD (N.E.K.); the University of Pittsburgh, Pittsburgh (A.K., J.F.M., D.J.T., C.W.C.); Harbor-UCLA Medical Center, Los Angeles (K.Y.); Cooper University Hospital, Camden, NJ (C.W.J.); Oregon Health and Science University, Portland (B.K.); Health Partners Methodist Hospital, St. Louis Park, MN (A.B.); and the University of Chicago, Chicago (D.G.B.)
| | - Lydia D Foster
- From the University of Michigan, Ann Arbor (F.K.K., R.D.D., C.V.H., V.L.W.S., C.F.G., N.L.H., R.S., W.B.), Spectrum Health, Grand Rapids (J.C.R.), and Michigan State University, East Lansing (J.C.R.) - all in Michigan; the Medical University of South Carolina, Charleston (V.D.-M., S.D.Y., L.D.F., E.L.); Stanford University, Palo Alto, CA (K.S., J.M.H., S.J., J.Q.); Vitalant Research Institute, Scottsdale, AZ (L.J.D.); the National Heart, Lung, and Blood Institute, Bethesda, MD (N.E.K.); the University of Pittsburgh, Pittsburgh (A.K., J.F.M., D.J.T., C.W.C.); Harbor-UCLA Medical Center, Los Angeles (K.Y.); Cooper University Hospital, Camden, NJ (C.W.J.); Oregon Health and Science University, Portland (B.K.); Health Partners Methodist Hospital, St. Louis Park, MN (A.B.); and the University of Chicago, Chicago (D.G.B.)
| | - Jennifer M Hah
- From the University of Michigan, Ann Arbor (F.K.K., R.D.D., C.V.H., V.L.W.S., C.F.G., N.L.H., R.S., W.B.), Spectrum Health, Grand Rapids (J.C.R.), and Michigan State University, East Lansing (J.C.R.) - all in Michigan; the Medical University of South Carolina, Charleston (V.D.-M., S.D.Y., L.D.F., E.L.); Stanford University, Palo Alto, CA (K.S., J.M.H., S.J., J.Q.); Vitalant Research Institute, Scottsdale, AZ (L.J.D.); the National Heart, Lung, and Blood Institute, Bethesda, MD (N.E.K.); the University of Pittsburgh, Pittsburgh (A.K., J.F.M., D.J.T., C.W.C.); Harbor-UCLA Medical Center, Los Angeles (K.Y.); Cooper University Hospital, Camden, NJ (C.W.J.); Oregon Health and Science University, Portland (B.K.); Health Partners Methodist Hospital, St. Louis Park, MN (A.B.); and the University of Chicago, Chicago (D.G.B.)
| | - Siddartha Jaiswal
- From the University of Michigan, Ann Arbor (F.K.K., R.D.D., C.V.H., V.L.W.S., C.F.G., N.L.H., R.S., W.B.), Spectrum Health, Grand Rapids (J.C.R.), and Michigan State University, East Lansing (J.C.R.) - all in Michigan; the Medical University of South Carolina, Charleston (V.D.-M., S.D.Y., L.D.F., E.L.); Stanford University, Palo Alto, CA (K.S., J.M.H., S.J., J.Q.); Vitalant Research Institute, Scottsdale, AZ (L.J.D.); the National Heart, Lung, and Blood Institute, Bethesda, MD (N.E.K.); the University of Pittsburgh, Pittsburgh (A.K., J.F.M., D.J.T., C.W.C.); Harbor-UCLA Medical Center, Los Angeles (K.Y.); Cooper University Hospital, Camden, NJ (C.W.J.); Oregon Health and Science University, Portland (B.K.); Health Partners Methodist Hospital, St. Louis Park, MN (A.B.); and the University of Chicago, Chicago (D.G.B.)
| | - Alesia Kaplan
- From the University of Michigan, Ann Arbor (F.K.K., R.D.D., C.V.H., V.L.W.S., C.F.G., N.L.H., R.S., W.B.), Spectrum Health, Grand Rapids (J.C.R.), and Michigan State University, East Lansing (J.C.R.) - all in Michigan; the Medical University of South Carolina, Charleston (V.D.-M., S.D.Y., L.D.F., E.L.); Stanford University, Palo Alto, CA (K.S., J.M.H., S.J., J.Q.); Vitalant Research Institute, Scottsdale, AZ (L.J.D.); the National Heart, Lung, and Blood Institute, Bethesda, MD (N.E.K.); the University of Pittsburgh, Pittsburgh (A.K., J.F.M., D.J.T., C.W.C.); Harbor-UCLA Medical Center, Los Angeles (K.Y.); Cooper University Hospital, Camden, NJ (C.W.J.); Oregon Health and Science University, Portland (B.K.); Health Partners Methodist Hospital, St. Louis Park, MN (A.B.); and the University of Chicago, Chicago (D.G.B.)
| | - Ezekiel Lowell
- From the University of Michigan, Ann Arbor (F.K.K., R.D.D., C.V.H., V.L.W.S., C.F.G., N.L.H., R.S., W.B.), Spectrum Health, Grand Rapids (J.C.R.), and Michigan State University, East Lansing (J.C.R.) - all in Michigan; the Medical University of South Carolina, Charleston (V.D.-M., S.D.Y., L.D.F., E.L.); Stanford University, Palo Alto, CA (K.S., J.M.H., S.J., J.Q.); Vitalant Research Institute, Scottsdale, AZ (L.J.D.); the National Heart, Lung, and Blood Institute, Bethesda, MD (N.E.K.); the University of Pittsburgh, Pittsburgh (A.K., J.F.M., D.J.T., C.W.C.); Harbor-UCLA Medical Center, Los Angeles (K.Y.); Cooper University Hospital, Camden, NJ (C.W.J.); Oregon Health and Science University, Portland (B.K.); Health Partners Methodist Hospital, St. Louis Park, MN (A.B.); and the University of Chicago, Chicago (D.G.B.)
| | - John F McDyer
- From the University of Michigan, Ann Arbor (F.K.K., R.D.D., C.V.H., V.L.W.S., C.F.G., N.L.H., R.S., W.B.), Spectrum Health, Grand Rapids (J.C.R.), and Michigan State University, East Lansing (J.C.R.) - all in Michigan; the Medical University of South Carolina, Charleston (V.D.-M., S.D.Y., L.D.F., E.L.); Stanford University, Palo Alto, CA (K.S., J.M.H., S.J., J.Q.); Vitalant Research Institute, Scottsdale, AZ (L.J.D.); the National Heart, Lung, and Blood Institute, Bethesda, MD (N.E.K.); the University of Pittsburgh, Pittsburgh (A.K., J.F.M., D.J.T., C.W.C.); Harbor-UCLA Medical Center, Los Angeles (K.Y.); Cooper University Hospital, Camden, NJ (C.W.J.); Oregon Health and Science University, Portland (B.K.); Health Partners Methodist Hospital, St. Louis Park, MN (A.B.); and the University of Chicago, Chicago (D.G.B.)
| | - James Quinn
- From the University of Michigan, Ann Arbor (F.K.K., R.D.D., C.V.H., V.L.W.S., C.F.G., N.L.H., R.S., W.B.), Spectrum Health, Grand Rapids (J.C.R.), and Michigan State University, East Lansing (J.C.R.) - all in Michigan; the Medical University of South Carolina, Charleston (V.D.-M., S.D.Y., L.D.F., E.L.); Stanford University, Palo Alto, CA (K.S., J.M.H., S.J., J.Q.); Vitalant Research Institute, Scottsdale, AZ (L.J.D.); the National Heart, Lung, and Blood Institute, Bethesda, MD (N.E.K.); the University of Pittsburgh, Pittsburgh (A.K., J.F.M., D.J.T., C.W.C.); Harbor-UCLA Medical Center, Los Angeles (K.Y.); Cooper University Hospital, Camden, NJ (C.W.J.); Oregon Health and Science University, Portland (B.K.); Health Partners Methodist Hospital, St. Louis Park, MN (A.B.); and the University of Chicago, Chicago (D.G.B.)
| | - Darrell J Triulzi
- From the University of Michigan, Ann Arbor (F.K.K., R.D.D., C.V.H., V.L.W.S., C.F.G., N.L.H., R.S., W.B.), Spectrum Health, Grand Rapids (J.C.R.), and Michigan State University, East Lansing (J.C.R.) - all in Michigan; the Medical University of South Carolina, Charleston (V.D.-M., S.D.Y., L.D.F., E.L.); Stanford University, Palo Alto, CA (K.S., J.M.H., S.J., J.Q.); Vitalant Research Institute, Scottsdale, AZ (L.J.D.); the National Heart, Lung, and Blood Institute, Bethesda, MD (N.E.K.); the University of Pittsburgh, Pittsburgh (A.K., J.F.M., D.J.T., C.W.C.); Harbor-UCLA Medical Center, Los Angeles (K.Y.); Cooper University Hospital, Camden, NJ (C.W.J.); Oregon Health and Science University, Portland (B.K.); Health Partners Methodist Hospital, St. Louis Park, MN (A.B.); and the University of Chicago, Chicago (D.G.B.)
| | - Carol Van Huysen
- From the University of Michigan, Ann Arbor (F.K.K., R.D.D., C.V.H., V.L.W.S., C.F.G., N.L.H., R.S., W.B.), Spectrum Health, Grand Rapids (J.C.R.), and Michigan State University, East Lansing (J.C.R.) - all in Michigan; the Medical University of South Carolina, Charleston (V.D.-M., S.D.Y., L.D.F., E.L.); Stanford University, Palo Alto, CA (K.S., J.M.H., S.J., J.Q.); Vitalant Research Institute, Scottsdale, AZ (L.J.D.); the National Heart, Lung, and Blood Institute, Bethesda, MD (N.E.K.); the University of Pittsburgh, Pittsburgh (A.K., J.F.M., D.J.T., C.W.C.); Harbor-UCLA Medical Center, Los Angeles (K.Y.); Cooper University Hospital, Camden, NJ (C.W.J.); Oregon Health and Science University, Portland (B.K.); Health Partners Methodist Hospital, St. Louis Park, MN (A.B.); and the University of Chicago, Chicago (D.G.B.)
| | - Valerie L W Stevenson
- From the University of Michigan, Ann Arbor (F.K.K., R.D.D., C.V.H., V.L.W.S., C.F.G., N.L.H., R.S., W.B.), Spectrum Health, Grand Rapids (J.C.R.), and Michigan State University, East Lansing (J.C.R.) - all in Michigan; the Medical University of South Carolina, Charleston (V.D.-M., S.D.Y., L.D.F., E.L.); Stanford University, Palo Alto, CA (K.S., J.M.H., S.J., J.Q.); Vitalant Research Institute, Scottsdale, AZ (L.J.D.); the National Heart, Lung, and Blood Institute, Bethesda, MD (N.E.K.); the University of Pittsburgh, Pittsburgh (A.K., J.F.M., D.J.T., C.W.C.); Harbor-UCLA Medical Center, Los Angeles (K.Y.); Cooper University Hospital, Camden, NJ (C.W.J.); Oregon Health and Science University, Portland (B.K.); Health Partners Methodist Hospital, St. Louis Park, MN (A.B.); and the University of Chicago, Chicago (D.G.B.)
| | - Kabir Yadav
- From the University of Michigan, Ann Arbor (F.K.K., R.D.D., C.V.H., V.L.W.S., C.F.G., N.L.H., R.S., W.B.), Spectrum Health, Grand Rapids (J.C.R.), and Michigan State University, East Lansing (J.C.R.) - all in Michigan; the Medical University of South Carolina, Charleston (V.D.-M., S.D.Y., L.D.F., E.L.); Stanford University, Palo Alto, CA (K.S., J.M.H., S.J., J.Q.); Vitalant Research Institute, Scottsdale, AZ (L.J.D.); the National Heart, Lung, and Blood Institute, Bethesda, MD (N.E.K.); the University of Pittsburgh, Pittsburgh (A.K., J.F.M., D.J.T., C.W.C.); Harbor-UCLA Medical Center, Los Angeles (K.Y.); Cooper University Hospital, Camden, NJ (C.W.J.); Oregon Health and Science University, Portland (B.K.); Health Partners Methodist Hospital, St. Louis Park, MN (A.B.); and the University of Chicago, Chicago (D.G.B.)
| | - Christopher W Jones
- From the University of Michigan, Ann Arbor (F.K.K., R.D.D., C.V.H., V.L.W.S., C.F.G., N.L.H., R.S., W.B.), Spectrum Health, Grand Rapids (J.C.R.), and Michigan State University, East Lansing (J.C.R.) - all in Michigan; the Medical University of South Carolina, Charleston (V.D.-M., S.D.Y., L.D.F., E.L.); Stanford University, Palo Alto, CA (K.S., J.M.H., S.J., J.Q.); Vitalant Research Institute, Scottsdale, AZ (L.J.D.); the National Heart, Lung, and Blood Institute, Bethesda, MD (N.E.K.); the University of Pittsburgh, Pittsburgh (A.K., J.F.M., D.J.T., C.W.C.); Harbor-UCLA Medical Center, Los Angeles (K.Y.); Cooper University Hospital, Camden, NJ (C.W.J.); Oregon Health and Science University, Portland (B.K.); Health Partners Methodist Hospital, St. Louis Park, MN (A.B.); and the University of Chicago, Chicago (D.G.B.)
| | - Bory Kea
- From the University of Michigan, Ann Arbor (F.K.K., R.D.D., C.V.H., V.L.W.S., C.F.G., N.L.H., R.S., W.B.), Spectrum Health, Grand Rapids (J.C.R.), and Michigan State University, East Lansing (J.C.R.) - all in Michigan; the Medical University of South Carolina, Charleston (V.D.-M., S.D.Y., L.D.F., E.L.); Stanford University, Palo Alto, CA (K.S., J.M.H., S.J., J.Q.); Vitalant Research Institute, Scottsdale, AZ (L.J.D.); the National Heart, Lung, and Blood Institute, Bethesda, MD (N.E.K.); the University of Pittsburgh, Pittsburgh (A.K., J.F.M., D.J.T., C.W.C.); Harbor-UCLA Medical Center, Los Angeles (K.Y.); Cooper University Hospital, Camden, NJ (C.W.J.); Oregon Health and Science University, Portland (B.K.); Health Partners Methodist Hospital, St. Louis Park, MN (A.B.); and the University of Chicago, Chicago (D.G.B.)
| | - Aaron Burnett
- From the University of Michigan, Ann Arbor (F.K.K., R.D.D., C.V.H., V.L.W.S., C.F.G., N.L.H., R.S., W.B.), Spectrum Health, Grand Rapids (J.C.R.), and Michigan State University, East Lansing (J.C.R.) - all in Michigan; the Medical University of South Carolina, Charleston (V.D.-M., S.D.Y., L.D.F., E.L.); Stanford University, Palo Alto, CA (K.S., J.M.H., S.J., J.Q.); Vitalant Research Institute, Scottsdale, AZ (L.J.D.); the National Heart, Lung, and Blood Institute, Bethesda, MD (N.E.K.); the University of Pittsburgh, Pittsburgh (A.K., J.F.M., D.J.T., C.W.C.); Harbor-UCLA Medical Center, Los Angeles (K.Y.); Cooper University Hospital, Camden, NJ (C.W.J.); Oregon Health and Science University, Portland (B.K.); Health Partners Methodist Hospital, St. Louis Park, MN (A.B.); and the University of Chicago, Chicago (D.G.B.)
| | - Joshua C Reynolds
- From the University of Michigan, Ann Arbor (F.K.K., R.D.D., C.V.H., V.L.W.S., C.F.G., N.L.H., R.S., W.B.), Spectrum Health, Grand Rapids (J.C.R.), and Michigan State University, East Lansing (J.C.R.) - all in Michigan; the Medical University of South Carolina, Charleston (V.D.-M., S.D.Y., L.D.F., E.L.); Stanford University, Palo Alto, CA (K.S., J.M.H., S.J., J.Q.); Vitalant Research Institute, Scottsdale, AZ (L.J.D.); the National Heart, Lung, and Blood Institute, Bethesda, MD (N.E.K.); the University of Pittsburgh, Pittsburgh (A.K., J.F.M., D.J.T., C.W.C.); Harbor-UCLA Medical Center, Los Angeles (K.Y.); Cooper University Hospital, Camden, NJ (C.W.J.); Oregon Health and Science University, Portland (B.K.); Health Partners Methodist Hospital, St. Louis Park, MN (A.B.); and the University of Chicago, Chicago (D.G.B.)
| | - Colin F Greineder
- From the University of Michigan, Ann Arbor (F.K.K., R.D.D., C.V.H., V.L.W.S., C.F.G., N.L.H., R.S., W.B.), Spectrum Health, Grand Rapids (J.C.R.), and Michigan State University, East Lansing (J.C.R.) - all in Michigan; the Medical University of South Carolina, Charleston (V.D.-M., S.D.Y., L.D.F., E.L.); Stanford University, Palo Alto, CA (K.S., J.M.H., S.J., J.Q.); Vitalant Research Institute, Scottsdale, AZ (L.J.D.); the National Heart, Lung, and Blood Institute, Bethesda, MD (N.E.K.); the University of Pittsburgh, Pittsburgh (A.K., J.F.M., D.J.T., C.W.C.); Harbor-UCLA Medical Center, Los Angeles (K.Y.); Cooper University Hospital, Camden, NJ (C.W.J.); Oregon Health and Science University, Portland (B.K.); Health Partners Methodist Hospital, St. Louis Park, MN (A.B.); and the University of Chicago, Chicago (D.G.B.)
| | - Nathan L Haas
- From the University of Michigan, Ann Arbor (F.K.K., R.D.D., C.V.H., V.L.W.S., C.F.G., N.L.H., R.S., W.B.), Spectrum Health, Grand Rapids (J.C.R.), and Michigan State University, East Lansing (J.C.R.) - all in Michigan; the Medical University of South Carolina, Charleston (V.D.-M., S.D.Y., L.D.F., E.L.); Stanford University, Palo Alto, CA (K.S., J.M.H., S.J., J.Q.); Vitalant Research Institute, Scottsdale, AZ (L.J.D.); the National Heart, Lung, and Blood Institute, Bethesda, MD (N.E.K.); the University of Pittsburgh, Pittsburgh (A.K., J.F.M., D.J.T., C.W.C.); Harbor-UCLA Medical Center, Los Angeles (K.Y.); Cooper University Hospital, Camden, NJ (C.W.J.); Oregon Health and Science University, Portland (B.K.); Health Partners Methodist Hospital, St. Louis Park, MN (A.B.); and the University of Chicago, Chicago (D.G.B.)
| | - David G Beiser
- From the University of Michigan, Ann Arbor (F.K.K., R.D.D., C.V.H., V.L.W.S., C.F.G., N.L.H., R.S., W.B.), Spectrum Health, Grand Rapids (J.C.R.), and Michigan State University, East Lansing (J.C.R.) - all in Michigan; the Medical University of South Carolina, Charleston (V.D.-M., S.D.Y., L.D.F., E.L.); Stanford University, Palo Alto, CA (K.S., J.M.H., S.J., J.Q.); Vitalant Research Institute, Scottsdale, AZ (L.J.D.); the National Heart, Lung, and Blood Institute, Bethesda, MD (N.E.K.); the University of Pittsburgh, Pittsburgh (A.K., J.F.M., D.J.T., C.W.C.); Harbor-UCLA Medical Center, Los Angeles (K.Y.); Cooper University Hospital, Camden, NJ (C.W.J.); Oregon Health and Science University, Portland (B.K.); Health Partners Methodist Hospital, St. Louis Park, MN (A.B.); and the University of Chicago, Chicago (D.G.B.)
| | - Robert Silbergleit
- From the University of Michigan, Ann Arbor (F.K.K., R.D.D., C.V.H., V.L.W.S., C.F.G., N.L.H., R.S., W.B.), Spectrum Health, Grand Rapids (J.C.R.), and Michigan State University, East Lansing (J.C.R.) - all in Michigan; the Medical University of South Carolina, Charleston (V.D.-M., S.D.Y., L.D.F., E.L.); Stanford University, Palo Alto, CA (K.S., J.M.H., S.J., J.Q.); Vitalant Research Institute, Scottsdale, AZ (L.J.D.); the National Heart, Lung, and Blood Institute, Bethesda, MD (N.E.K.); the University of Pittsburgh, Pittsburgh (A.K., J.F.M., D.J.T., C.W.C.); Harbor-UCLA Medical Center, Los Angeles (K.Y.); Cooper University Hospital, Camden, NJ (C.W.J.); Oregon Health and Science University, Portland (B.K.); Health Partners Methodist Hospital, St. Louis Park, MN (A.B.); and the University of Chicago, Chicago (D.G.B.)
| | - William Barsan
- From the University of Michigan, Ann Arbor (F.K.K., R.D.D., C.V.H., V.L.W.S., C.F.G., N.L.H., R.S., W.B.), Spectrum Health, Grand Rapids (J.C.R.), and Michigan State University, East Lansing (J.C.R.) - all in Michigan; the Medical University of South Carolina, Charleston (V.D.-M., S.D.Y., L.D.F., E.L.); Stanford University, Palo Alto, CA (K.S., J.M.H., S.J., J.Q.); Vitalant Research Institute, Scottsdale, AZ (L.J.D.); the National Heart, Lung, and Blood Institute, Bethesda, MD (N.E.K.); the University of Pittsburgh, Pittsburgh (A.K., J.F.M., D.J.T., C.W.C.); Harbor-UCLA Medical Center, Los Angeles (K.Y.); Cooper University Hospital, Camden, NJ (C.W.J.); Oregon Health and Science University, Portland (B.K.); Health Partners Methodist Hospital, St. Louis Park, MN (A.B.); and the University of Chicago, Chicago (D.G.B.)
| | - Clifton W Callaway
- From the University of Michigan, Ann Arbor (F.K.K., R.D.D., C.V.H., V.L.W.S., C.F.G., N.L.H., R.S., W.B.), Spectrum Health, Grand Rapids (J.C.R.), and Michigan State University, East Lansing (J.C.R.) - all in Michigan; the Medical University of South Carolina, Charleston (V.D.-M., S.D.Y., L.D.F., E.L.); Stanford University, Palo Alto, CA (K.S., J.M.H., S.J., J.Q.); Vitalant Research Institute, Scottsdale, AZ (L.J.D.); the National Heart, Lung, and Blood Institute, Bethesda, MD (N.E.K.); the University of Pittsburgh, Pittsburgh (A.K., J.F.M., D.J.T., C.W.C.); Harbor-UCLA Medical Center, Los Angeles (K.Y.); Cooper University Hospital, Camden, NJ (C.W.J.); Oregon Health and Science University, Portland (B.K.); Health Partners Methodist Hospital, St. Louis Park, MN (A.B.); and the University of Chicago, Chicago (D.G.B.)
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19
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Hazegh K, Anawalt BD, Dumont LJ, Kanias T. Toxic masculinity in red blood cell units? Testosterone therapy in blood donors revisited. Transfusion 2021; 61:3174-3180. [PMID: 34519056 PMCID: PMC8568643 DOI: 10.1111/trf.16658] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 08/19/2021] [Accepted: 08/24/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND FDA guidelines limit the use of blood from donors taking testosterone replacement therapy (TRT) to red blood cell (RBC) concentrates, whereas plasma and platelets are discarded. The purpose of this study is to bring awareness to above-average free testosterone concentrations in RBC units from TRT donors. STUDY DESIGN We quantified the concentrations of free (bioavailable; pg/ml) and total (protein bound and free; ng/dl) testosterone in plasma (frozen within 24 h) and supernatants from 42-day stored leukocyte-reduced RBC units from 17 TRT male donors and 17 matched controls (no TRT). Total testosterone concentrations were determined by liquid chromatography with tandem mass spectrometry (LC-MS/MS). Free testosterone concentrations were quantified in the same samples using equilibrium dialysis/LC-MS/MS. RESULTS Plasma free and total testosterone concentrations in TRT donors were 2.9 and 1.8 times higher than that of controls. Total testosterone concentrations in RBC supernatants were about 30% of that of plasma. In contrast, free testosterone concentrations in RBC supernatants were 80%-100% of that of plasma and were significantly (p = .005) higher in TRT compared with controls (252.3 ± 245.3 vs. 103.4 ± 88.2 pg/ml). Supraphysiological free testosterone concentrations (>244 pg/ml) in RBC supernatants were observed in five TRT donors and two control donors. CONCLUSIONS RBC units from TRT donors may contain supraphysiological concentrations of free testosterone. This may be resolved by avoiding blood collections soon after testosterone dosing and by enhanced screening of TRT donors. These data establish a rationale for new studies and reexamination of the current guidelines concerning the utilization of blood components from TRT donors.
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Affiliation(s)
| | - Bradley D. Anawalt
- Division of General Internal Medicine, University of Washington Medical Center, Seattle, Washington, USA
| | - Larry J. Dumont
- Vitalant Research Institute, Denver, Colorado, USA
- Department of Pathology, University of Colorado Denver Anschutz Medical Campus, Aurora, Colorado, USA
| | - Tamir Kanias
- Vitalant Research Institute, Denver, Colorado, USA
- Department of Pathology, University of Colorado Denver Anschutz Medical Campus, Aurora, Colorado, USA
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20
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van der Wijst MGP, Vazquez SE, Hartoularos GC, Bastard P, Grant T, Bueno R, Lee DS, Greenland JR, Sun Y, Perez R, Ogorodnikov A, Ward A, Mann SA, Lynch KL, Yun C, Havlir DV, Chamie G, Marquez C, Greenhouse B, Lionakis MS, Norris PJ, Dumont LJ, Kelly K, Zhang P, Zhang Q, Gervais A, Le Voyer T, Whatley A, Si Y, Byrne A, Combes AJ, Rao AA, Song YS, Fragiadakis GK, Kangelaris K, Calfee CS, Erle DJ, Hendrickson C, Krummel MF, Woodruff PG, Langelier CR, Casanova JL, Derisi JL, Anderson MS, Ye CJ. Type I interferon autoantibodies are associated with systemic immune alterations in patients with COVID-19. Sci Transl Med 2021; 13:eabh2624. [PMID: 34429372 PMCID: PMC8601717 DOI: 10.1126/scitranslmed.abh2624] [Citation(s) in RCA: 138] [Impact Index Per Article: 46.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
A subset of patients diagnosed with coronavirus disease 2019 (COVID-19) present with autoantibodies specific to type I interferons (IFNs). However, the systemic impacts of type I IFN–specific autoantibodies are not fully understood. Here, van der Wijst et al. longitudinally evaluated the relationship between type I IFN–specific autoantibody abundance and changes to the immune system of individuals with COVID-19. Using single-cell transcriptomics, the authors found that the presence of type I IFN autoantibodies correlated with reduced type I IFN–stimulated gene (ISG) expression in patients with critical COVID-19. Reduced ISG expression, in turn, correlated with increased expression of the inhibitory receptor, leukocyte-associated immunoglobulin-like receptor 1 (LAIR1), on monocytes. Together, these findings suggest that early evidence of type I IFN autoantibodies and increased LAIR1 expression may help distinguish severe cases of COVID-19. Neutralizing autoantibodies against type I interferons (IFNs) have been found in some patients with critical coronavirus disease 2019 (COVID-19), the disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). However, the prevalence of these antibodies, their longitudinal dynamics across the disease severity scale, and their functional effects on circulating leukocytes remain unknown. Here, in 284 patients with COVID-19, we found type I IFN–specific autoantibodies in peripheral blood samples from 19% of patients with critical disease and 6% of patients with severe disease. We found no type I IFN autoantibodies in individuals with moderate disease. Longitudinal profiling of over 600,000 peripheral blood mononuclear cells using multiplexed single-cell epitope and transcriptome sequencing from 54 patients with COVID-19 and 26 non–COVID-19 controls revealed a lack of type I IFN–stimulated gene (ISG-I) responses in myeloid cells from patients with critical disease. This was especially evident in dendritic cell populations isolated from patients with critical disease producing type I IFN–specific autoantibodies. Moreover, we found elevated expression of the inhibitory receptor leukocyte-associated immunoglobulin-like receptor 1 (LAIR1) on the surface of monocytes isolated from patients with critical disease early in the disease course. LAIR1 expression is inversely correlated with ISG-I expression response in patients with COVID-19 but is not expressed in healthy controls. The deficient ISG-I response observed in patients with critical COVID-19 with and without type I IFN–specific autoantibodies supports a unifying model for disease pathogenesis involving ISG-I suppression through convergent mechanisms.
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Affiliation(s)
- Monique G P van der Wijst
- Department of Genetics, University of Groningen, University Medical Center Groningen, 9713AV Groningen, Netherlands.,Institute of Human Genetics, University of California, San Francisco, San Francisco, CA 94143, USA.,Division of Rheumatology, Department of Medicine, University of California, San Francisco, San Francisco, CA 94143, USA
| | - Sara E Vazquez
- Medical Scientist Training Program, University of California, San Francisco, San Francisco, CA 94143, USA.,Tetrad Graduate Program, University of California, San Francisco, San Francisco, CA 94143, USA.,Diabetes Center, University of California, San Francisco, San Francisco, CA 94143, USA.,Department of Biochemistry and Biophysics, University of California, San Francisco, San Francisco, CA 94158, USA
| | - George C Hartoularos
- Institute of Human Genetics, University of California, San Francisco, San Francisco, CA 94143, USA.,Division of Rheumatology, Department of Medicine, University of California, San Francisco, San Francisco, CA 94143, USA
| | - Paul Bastard
- Laboratory of Human Genetics of Infectious Diseases, Necker Branch, INSERM U1163, Necker Hospital for Sick Children, 75015 Paris, France.,University of Paris, Imagine Institute, 75015 Paris, France.,St. Giles Laboratory of Human Genetics of Infectious Diseases, Rockefeller Branch, Rockefeller University, New York, NY 10065, USA
| | - Tianna Grant
- Institute of Human Genetics, University of California, San Francisco, San Francisco, CA 94143, USA.,Division of Rheumatology, Department of Medicine, University of California, San Francisco, San Francisco, CA 94143, USA
| | - Raymund Bueno
- Institute of Human Genetics, University of California, San Francisco, San Francisco, CA 94143, USA.,Division of Rheumatology, Department of Medicine, University of California, San Francisco, San Francisco, CA 94143, USA
| | - David S Lee
- Institute of Human Genetics, University of California, San Francisco, San Francisco, CA 94143, USA.,Division of Rheumatology, Department of Medicine, University of California, San Francisco, San Francisco, CA 94143, USA.,ImmunoX Initiative, University of California, San Francisco, San Francisco, CA 94143, USA
| | - John R Greenland
- Department of Medicine, University of California, San Francisco, San Francisco Medical Service, San Francisco Veterans Affairs Health Care System, San Francisco, CA 94121, USA
| | - Yang Sun
- Institute of Human Genetics, University of California, San Francisco, San Francisco, CA 94143, USA.,Division of Rheumatology, Department of Medicine, University of California, San Francisco, San Francisco, CA 94143, USA.,ImmunoX Initiative, University of California, San Francisco, San Francisco, CA 94143, USA
| | - Richard Perez
- Institute of Human Genetics, University of California, San Francisco, San Francisco, CA 94143, USA.,School of Medicine, University of California, San Francisco, San Francisco, CA 94143, USA
| | - Anton Ogorodnikov
- Institute of Human Genetics, University of California, San Francisco, San Francisco, CA 94143, USA.,Division of Rheumatology, Department of Medicine, University of California, San Francisco, San Francisco, CA 94143, USA
| | - Alyssa Ward
- Institute of Human Genetics, University of California, San Francisco, San Francisco, CA 94143, USA.,Division of Rheumatology, Department of Medicine, University of California, San Francisco, San Francisco, CA 94143, USA
| | - Sabrina A Mann
- Department of Biochemistry and Biophysics, University of California, San Francisco, San Francisco, CA 94158, USA.,Chan Zuckerberg Biohub, San Francisco, CA 94158, USA
| | - Kara L Lynch
- Zuckerberg San Francisco General, San Francisco, CA 94110, USA.,Department of Laboratory Medicine, University of California, San Francisco, San Francisco, CA 94143, USA
| | - Cassandra Yun
- Zuckerberg San Francisco General, San Francisco, CA 94110, USA.,Department of Laboratory Medicine, University of California, San Francisco, San Francisco, CA 94143, USA
| | - Diane V Havlir
- Division of HIV, Infectious Disease and Global Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA 94143, USA
| | - Gabriel Chamie
- Division of HIV, Infectious Disease and Global Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA 94143, USA
| | - Carina Marquez
- Division of HIV, Infectious Disease and Global Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA 94143, USA
| | - Bryan Greenhouse
- Division of HIV, Infectious Disease and Global Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA 94143, USA
| | - Michail S Lionakis
- Laboratory of Clinical Immunology and Microbiology, Division of Intramural Research, National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Bethesda, MD 20814, USA
| | - Philip J Norris
- Zuckerberg San Francisco General, San Francisco, CA 94110, USA.,Department of Laboratory Medicine, University of California, San Francisco, San Francisco, CA 94143, USA.,Vitalant Research Institute, San Francisco, CA 94118, USA
| | - Larry J Dumont
- Vitalant Research Institute, Denver, CO 80230, USA.,University of Colorado School of Medicine, Aurora, CO 80045, USA.,Geisel School of Medicine at Dartmouth, Lebanon, NH 03755, USA
| | | | - Peng Zhang
- St. Giles Laboratory of Human Genetics of Infectious Diseases, Rockefeller Branch, Rockefeller University, New York, NY 10065, USA
| | - Qian Zhang
- St. Giles Laboratory of Human Genetics of Infectious Diseases, Rockefeller Branch, Rockefeller University, New York, NY 10065, USA
| | - Adrian Gervais
- University of Paris, Imagine Institute, 75015 Paris, France.,St. Giles Laboratory of Human Genetics of Infectious Diseases, Rockefeller Branch, Rockefeller University, New York, NY 10065, USA
| | - Tom Le Voyer
- University of Paris, Imagine Institute, 75015 Paris, France.,St. Giles Laboratory of Human Genetics of Infectious Diseases, Rockefeller Branch, Rockefeller University, New York, NY 10065, USA
| | - Alexander Whatley
- Department of Electrical Engineering and Computer Sciences, University of California, Berkeley, Berkeley, CA 94720, USA
| | - Yichen Si
- Department of Biostatistics, University of Michigan, Ann Arbor, MI 48109, USA
| | - Ashley Byrne
- Chan Zuckerberg Biohub, San Francisco, CA 94158, USA
| | - Alexis J Combes
- ImmunoX Initiative, University of California, San Francisco, San Francisco, CA 94143, USA.,Department of Pathology, University of California, San Francisco, San Francisco, CA 94143, USA.,UCSF CoLabs, University of California, San Francisco, San Francisco, CA 94143, USA
| | - Arjun Arkal Rao
- ImmunoX Initiative, University of California, San Francisco, San Francisco, CA 94143, USA.,Department of Pathology, University of California, San Francisco, San Francisco, CA 94143, USA.,UCSF CoLabs, University of California, San Francisco, San Francisco, CA 94143, USA
| | - Yun S Song
- Chan Zuckerberg Biohub, San Francisco, CA 94158, USA.,Department of Electrical Engineering and Computer Sciences, University of California, Berkeley, Berkeley, CA 94720, USA.,Department of Statistics, University of California, Berkeley, Berkeley, CA 94720, USA
| | - Gabriela K Fragiadakis
- Division of Rheumatology, Department of Medicine, University of California, San Francisco, San Francisco, CA 94143, USA.,ImmunoX Initiative, University of California, San Francisco, San Francisco, CA 94143, USA.,UCSF CoLabs, University of California, San Francisco, San Francisco, CA 94143, USA
| | - Kirsten Kangelaris
- Division of Hospital Medicine, University of California, San Francisco, San Francisco, CA 94143, USA
| | - Carolyn S Calfee
- Division of Pulmonary, Critical Care, Allergy and Sleep, Department of Medicine and the Cardiovascular Research Institute, University of California, San Francisco, San Francisco, CA 94143, USA
| | - David J Erle
- Institute of Human Genetics, University of California, San Francisco, San Francisco, CA 94143, USA.,ImmunoX Initiative, University of California, San Francisco, San Francisco, CA 94143, USA.,Zuckerberg San Francisco General, San Francisco, CA 94110, USA
| | - Carolyn Hendrickson
- Division of Pulmonary, Critical Care, Allergy and Sleep, Department of Medicine and the Cardiovascular Research Institute, University of California, San Francisco, San Francisco, CA 94143, USA
| | - Matthew F Krummel
- ImmunoX Initiative, University of California, San Francisco, San Francisco, CA 94143, USA.,Department of Pathology, University of California, San Francisco, San Francisco, CA 94143, USA
| | - Prescott G Woodruff
- ImmunoX Initiative, University of California, San Francisco, San Francisco, CA 94143, USA.,Division of Pulmonary, Critical Care, Allergy and Sleep, Department of Medicine and the Cardiovascular Research Institute, University of California, San Francisco, San Francisco, CA 94143, USA
| | - Charles R Langelier
- Division of Infectious Disease, Department of Medicine, University of California, San Francisco, San Francisco, CA 94143, USA
| | - Jean-Laurent Casanova
- Laboratory of Human Genetics of Infectious Diseases, Necker Branch, INSERM U1163, Necker Hospital for Sick Children, 75015 Paris, France.,University of Paris, Imagine Institute, 75015 Paris, France.,St. Giles Laboratory of Human Genetics of Infectious Diseases, Rockefeller Branch, Rockefeller University, New York, NY 10065, USA.,Howard Hughes Medical Institute, New York, NY 10065, USA
| | - Joseph L Derisi
- Department of Biochemistry and Biophysics, University of California, San Francisco, San Francisco, CA 94158, USA.,Chan Zuckerberg Biohub, San Francisco, CA 94158, USA
| | - Mark S Anderson
- Diabetes Center, University of California, San Francisco, San Francisco, CA 94143, USA.,Division of Endocrinology and Metabolism, Department of Medicine, University of California, San Francisco, San Francisco, CA 94143, USA
| | - Chun Jimmie Ye
- Institute of Human Genetics, University of California, San Francisco, San Francisco, CA 94143, USA.,Division of Rheumatology, Department of Medicine, University of California, San Francisco, San Francisco, CA 94143, USA.,ImmunoX Initiative, University of California, San Francisco, San Francisco, CA 94143, USA.,Chan Zuckerberg Biohub, San Francisco, CA 94158, USA.,Departments of Epidemiology and Biostatistics and Bioengineering and Therapeutic Sciences, University of California, San Francisco, San Francisco, CA 94143, USA.,Bakar Computational Health Sciences Institute, University of California, San Francisco, San Francisco, CA 94143, USA.,Parker Institute for Cancer Immunotherapy, San Francisco, CA 94129, USA
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21
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Van Rompay KKA, Olstad KJ, Sammak RL, Dutra J, Watanabe JK, Usachenko JL, Immareddy R, Roh JW, Verma A, Shaan Lakshmanappa Y, Schmidt BA, Di Germanio C, Rizvi N, Stone M, Simmons G, Dumont LJ, Allen AM, Lockwood S, Pollard RE, de Assis RR, Yee JL, Nham PB, Ardeshir A, Deere JD, Patterson J, Jain A, Felgner PL, Iyer SS, Hartigan-O'Connor DJ, Busch MP, Reader JR. Early post-infection treatment of SARS-CoV-2 infected macaques with human convalescent plasma with high neutralizing activity reduces lung inflammation. bioRxiv 2021:2021.09.01.458520. [PMID: 34494025 DOI: 10.1101/2021.08.06.455491] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
UNLABELLED Early in the SARS-CoV-2 pandemic, there was a high level of optimism based on observational studies and small controlled trials that treating hospitalized patients with convalescent plasma from COVID-19 survivors (CCP) would be an important immunotherapy. However, as more data from controlled trials became available, the results became disappointing, with at best moderate evidence of efficacy when CCP with high titers of neutralizing antibodies was used early in infection. To better understand the potential therapeutic efficacy of CCP, and to further validate SARS-CoV-2 infection of macaques as a reliable animal model for testing such strategies, we inoculated 12 adult rhesus macaques with SARS-CoV-2 by intratracheal and intranasal routes. One day later, 8 animals were infused with pooled human CCP with a high titer of neutralizing antibodies (RVPN NT 50 value of 3,003), while 4 control animals received normal human plasma. Animals were monitored for 7 days. Animals treated with CCP had detectable levels of antiviral antibodies after infusion. In comparison to the control animals, they had similar levels of virus replication in the upper and lower respiratory tract, but had significantly reduced interstitial pneumonia, as measured by comprehensive lung histology. By highlighting strengths and weaknesses, data of this study can help to further optimize nonhuman primate models to provide proof-of-concept of intervention strategies, and guide the future use of convalescent plasma against SARS-CoV-2 and potentially other newly emerging respiratory viruses. AUTHOR SUMMARY The results of treating SARS-CoV-2 infected hospitalized patients with COVID-19 convalescent plasma (CCP), collected from survivors of natural infection, have been disappointing. The available data from various studies indicate at best moderate clinical benefits only when CCP with high titer of neutralizing antibodies was infused early in infection. The macaque model of SARS-CoV-2 infection can be useful to gain further insights in the value of CCP therapy. In this study, animals were infected with SARS-CoV-2 and the next day, were infused with pooled human convalescent plasma, selected to have a very high titer of neutralizing antibodies. While administration of CCP did not result in a detectable reduction in virus replication in the respiratory tract, it significantly reduced lung inflammation. These data, combined with the results of monoclonal antibody studies, emphasize the need to use products with high titers of neutralizing antibodies, and guide the future development of CCP-based therapies.
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Affiliation(s)
- Koen K A Van Rompay
- California National Primate Research Center, University of California, Davis, CA 95616
- Department of Pathology, Microbiology and Immunology, University of California, Davis, CA 95616
| | - Katherine J Olstad
- California National Primate Research Center, University of California, Davis, CA 95616
- Department of Pathology, Microbiology and Immunology, University of California, Davis, CA 95616
| | - Rebecca L Sammak
- California National Primate Research Center, University of California, Davis, CA 95616
| | - Joseph Dutra
- Department of Medical Microbiology and Immunology, School of Medicine, University of California, Davis, CA 95616
| | - Jennifer K Watanabe
- California National Primate Research Center, University of California, Davis, CA 95616
| | - Jodie L Usachenko
- California National Primate Research Center, University of California, Davis, CA 95616
| | - Ramya Immareddy
- California National Primate Research Center, University of California, Davis, CA 95616
| | - Jamin W Roh
- Center for Immunology and Infectious Diseases, University of California, Davis, CA 95616
- Graduate Group in Immunology, University of California, Davis, CA 95616
| | - Anil Verma
- Center for Immunology and Infectious Diseases, University of California, Davis, CA 95616
| | | | - Brian A Schmidt
- Center for Immunology and Infectious Diseases, University of California, Davis, CA 95616
| | | | - Nabeela Rizvi
- Vitalant Research Institute, San Francisco, CA 94118
| | - Mars Stone
- Vitalant Research Institute, San Francisco, CA 94118
| | | | - Larry J Dumont
- Vitalant Research Institute, Denver, CO 80230; University of Colorado School of Medicine, Aurora, CO 80045
| | - A Mark Allen
- California National Primate Research Center, University of California, Davis, CA 95616
| | - Sarah Lockwood
- California National Primate Research Center, University of California, Davis, CA 95616
| | - Rachel E Pollard
- School of Veterinary Medicine, University of California, Davis, CA 95616
| | - Rafael Ramiro de Assis
- Vaccine Research and Development Center, Department of Physiology and Biophysics, School of Medicine, University of California, Irvine, CA 92697
| | - JoAnn L Yee
- California National Primate Research Center, University of California, Davis, CA 95616
| | - Peter B Nham
- California National Primate Research Center, University of California, Davis, CA 95616
| | - Amir Ardeshir
- California National Primate Research Center, University of California, Davis, CA 95616
| | - Jesse D Deere
- Department of Medical Microbiology and Immunology, School of Medicine, University of California, Davis, CA 95616
| | - Jean Patterson
- Translational Research Section, Virology Branch, DMID/NIAID/NIH, MD 20852
| | - Aarti Jain
- Vaccine Research and Development Center, Department of Physiology and Biophysics, School of Medicine, University of California, Irvine, CA 92697
| | - Philip L Felgner
- Vaccine Research and Development Center, Department of Physiology and Biophysics, School of Medicine, University of California, Irvine, CA 92697
| | - Smita S Iyer
- California National Primate Research Center, University of California, Davis, CA 95616
- Department of Pathology, Microbiology and Immunology, University of California, Davis, CA 95616
- Center for Immunology and Infectious Diseases, University of California, Davis, CA 95616
| | - Dennis J Hartigan-O'Connor
- California National Primate Research Center, University of California, Davis, CA 95616
- Department of Medical Microbiology and Immunology, School of Medicine, University of California, Davis, CA 95616
| | - Michael P Busch
- Vitalant Research Institute, San Francisco, CA 94118
- Department of Laboratory Medicine, University of California San Francisco, San Francisco, CA, 94118
| | - J Rachel Reader
- California National Primate Research Center, University of California, Davis, CA 95616
- Department of Pathology, Microbiology and Immunology, University of California, Davis, CA 95616
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22
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Van Rompay KK, Olstad KJ, Sammak RL, Dutra J, Watanabe JK, Usachenko JL, Immareddy R, Roh JW, Verma A, Shaan Lakshmanappa Y, Schmidt BA, Di Germanio C, Rizvi N, Stone M, Simmons G, Dumont LJ, Allen AM, Lockwood S, Pollard RE, de Assis RR, Yee JL, Nham PB, Ardeshir A, Deere JD, Patterson J, Jain A, Felgner PL, Iyer SS, Hartigan-O’Connor DJ, Busch MP, Reader JR. Early post-infection treatment of SARS-CoV-2 infected macaques with human convalescent plasma with high neutralizing activity reduces lung inflammation. bioRxiv 2021:2021.09.01.458520. [PMID: 34494025 PMCID: PMC8423222 DOI: 10.1101/2021.09.01.458520] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Early in the SARS-CoV-2 pandemic, there was a high level of optimism based on observational studies and small controlled trials that treating hospitalized patients with convalescent plasma from COVID-19 survivors (CCP) would be an important immunotherapy. However, as more data from controlled trials became available, the results became disappointing, with at best moderate evidence of efficacy when CCP with high titers of neutralizing antibodies was used early in infection. To better understand the potential therapeutic efficacy of CCP, and to further validate SARS-CoV-2 infection of macaques as a reliable animal model for testing such strategies, we inoculated 12 adult rhesus macaques with SARS-CoV-2 by intratracheal and intranasal routes. One day later, 8 animals were infused with pooled human CCP with a high titer of neutralizing antibodies (RVPN NT 50 value of 3,003), while 4 control animals received normal human plasma. Animals were monitored for 7 days. Animals treated with CCP had detectable levels of antiviral antibodies after infusion. In comparison to the control animals, they had similar levels of virus replication in the upper and lower respiratory tract, but had significantly reduced interstitial pneumonia, as measured by comprehensive lung histology. By highlighting strengths and weaknesses, data of this study can help to further optimize nonhuman primate models to provide proof-of-concept of intervention strategies, and guide the future use of convalescent plasma against SARS-CoV-2 and potentially other newly emerging respiratory viruses. AUTHOR SUMMARY The results of treating SARS-CoV-2 infected hospitalized patients with COVID-19 convalescent plasma (CCP), collected from survivors of natural infection, have been disappointing. The available data from various studies indicate at best moderate clinical benefits only when CCP with high titer of neutralizing antibodies was infused early in infection. The macaque model of SARS-CoV-2 infection can be useful to gain further insights in the value of CCP therapy. In this study, animals were infected with SARS-CoV-2 and the next day, were infused with pooled human convalescent plasma, selected to have a very high titer of neutralizing antibodies. While administration of CCP did not result in a detectable reduction in virus replication in the respiratory tract, it significantly reduced lung inflammation. These data, combined with the results of monoclonal antibody studies, emphasize the need to use products with high titers of neutralizing antibodies, and guide the future development of CCP-based therapies.
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Affiliation(s)
- Koen K.A. Van Rompay
- California National Primate Research Center, University of California, Davis, CA 95616
- Department of Pathology, Microbiology and Immunology, University of California, Davis, CA 95616
| | - Katherine J. Olstad
- California National Primate Research Center, University of California, Davis, CA 95616
- Department of Pathology, Microbiology and Immunology, University of California, Davis, CA 95616
| | - Rebecca L. Sammak
- California National Primate Research Center, University of California, Davis, CA 95616
| | - Joseph Dutra
- Department of Medical Microbiology and Immunology, School of Medicine, University of California, Davis, CA 95616
| | - Jennifer K. Watanabe
- California National Primate Research Center, University of California, Davis, CA 95616
| | - Jodie L. Usachenko
- California National Primate Research Center, University of California, Davis, CA 95616
| | - Ramya Immareddy
- California National Primate Research Center, University of California, Davis, CA 95616
| | - Jamin W. Roh
- Center for Immunology and Infectious Diseases, University of California, Davis, CA 95616
- Graduate Group in Immunology, University of California, Davis, CA 95616
| | - Anil Verma
- Center for Immunology and Infectious Diseases, University of California, Davis, CA 95616
| | | | - Brian A. Schmidt
- Center for Immunology and Infectious Diseases, University of California, Davis, CA 95616
| | | | - Nabeela Rizvi
- Vitalant Research Institute, San Francisco, CA 94118
| | - Mars Stone
- Vitalant Research Institute, San Francisco, CA 94118
| | | | - Larry J. Dumont
- Vitalant Research Institute, Denver, CO 80230; University of Colorado School of Medicine, Aurora, CO 80045
| | - A. Mark Allen
- California National Primate Research Center, University of California, Davis, CA 95616
| | - Sarah Lockwood
- California National Primate Research Center, University of California, Davis, CA 95616
| | - Rachel E. Pollard
- School of Veterinary Medicine, University of California, Davis, CA 95616
| | - Rafael Ramiro de Assis
- Vaccine Research and Development Center, Department of Physiology and Biophysics, School of Medicine, University of California, Irvine, CA 92697
| | - JoAnn L. Yee
- California National Primate Research Center, University of California, Davis, CA 95616
| | - Peter B. Nham
- California National Primate Research Center, University of California, Davis, CA 95616
| | - Amir Ardeshir
- California National Primate Research Center, University of California, Davis, CA 95616
| | - Jesse D. Deere
- Department of Medical Microbiology and Immunology, School of Medicine, University of California, Davis, CA 95616
| | - Jean Patterson
- Translational Research Section, Virology Branch, DMID/NIAID/NIH, MD 20852
| | - Aarti Jain
- Vaccine Research and Development Center, Department of Physiology and Biophysics, School of Medicine, University of California, Irvine, CA 92697
| | - Philip L. Felgner
- Vaccine Research and Development Center, Department of Physiology and Biophysics, School of Medicine, University of California, Irvine, CA 92697
| | - Smita S. Iyer
- California National Primate Research Center, University of California, Davis, CA 95616
- Department of Pathology, Microbiology and Immunology, University of California, Davis, CA 95616
- Center for Immunology and Infectious Diseases, University of California, Davis, CA 95616
| | - Dennis J. Hartigan-O’Connor
- California National Primate Research Center, University of California, Davis, CA 95616
- Department of Medical Microbiology and Immunology, School of Medicine, University of California, Davis, CA 95616
| | - Michael P. Busch
- Vitalant Research Institute, San Francisco, CA 94118
- Department of Laboratory Medicine, University of California San Francisco, San Francisco, CA, 94118
| | - J. Rachel Reader
- California National Primate Research Center, University of California, Davis, CA 95616
- Department of Pathology, Microbiology and Immunology, University of California, Davis, CA 95616
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23
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Di Germanio C, Simmons G, Kelly K, Martinelli R, Darst O, Azimpouran M, Stone M, Hazegh K, Grebe E, Zhang S, Ma P, Orzechowski M, Gomez JE, Livny J, Hung DT, Vassallo R, Busch MP, Dumont LJ. SARS-CoV-2 antibody persistence in COVID-19 convalescent plasma donors: Dependency on assay format and applicability to serosurveillance. Transfusion 2021; 61:2677-2687. [PMID: 34121205 PMCID: PMC8447038 DOI: 10.1111/trf.16555] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 05/23/2021] [Accepted: 05/23/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND Antibody response duration following severe acute respiratory syndrome coronavirus 2 infection tends to be variable and depends on severity of disease and method of detection. STUDY DESIGN AND METHODS COVID-19 convalescent plasma from 18 donors was collected longitudinally for a maximum of 63-129 days following resolution of symptoms. All the samples were initially screened by the Ortho total Ig test to confirm positivity and subsequently tested with seven additional direct sandwich or indirect binding assays (Ortho, Roche, Abbott, Broad Institute) directed against a variety of antigen targets (S1, receptor binding domain, and nucleocapsid [NC]), along with two neutralization assays (Broad Institute live virus PRNT and Vitalant Research Institute [VRI] Pseudovirus reporter viral particle neutralization [RVPN]). RESULTS The direct detection assays (Ortho total Ig total and Roche total Ig) showed increasing levels of antibodies over the time period, in contrast to the indirect IgG assays that showed a decline. Neutralization assays also demonstrated declining responses; the VRI RVPN pseudovirus had a greater rate of decline than the Broad PRNT live virus assay. DISCUSSION These data show that in addition to variable individual responses and associations with disease severity, the detection assay chosen contributes to the heterogeneous results in antibody stability over time. Depending on the scope of the research, one assay may be preferable over another. For serosurveillance studies, direct, double Ag-sandwich assays appear to be the best choice due to their stability; in particular, algorithms that include both S1- and NC-based assays can help reduce the rate of false-positivity and discriminate between natural infection and vaccine-derived seroreactivity.
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Affiliation(s)
| | - Graham Simmons
- Vitalant Research InstituteSan FranciscoCaliforniaUSA
- Department of Laboratory MedicineUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | | | | | - Orsolya Darst
- Vitalant Research InstituteSan FranciscoCaliforniaUSA
| | | | - Mars Stone
- Vitalant Research InstituteSan FranciscoCaliforniaUSA
- Department of Laboratory MedicineUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | | | - Eduard Grebe
- Vitalant Research InstituteSan FranciscoCaliforniaUSA
- Department of Laboratory MedicineUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Shuting Zhang
- Infectious Disease and Microbiome ProgramBroad Institute of MIT & HarvardCambridgeMassachusettsUSA
- Department of Molecular Biology and Center for Computational and Integrative Biology, Massachusetts General HospitalBostonMassachusettsUSA
- Department of GeneticsHarvard Medical SchoolBostonMassachusettsUSA
| | - Peijun Ma
- Infectious Disease and Microbiome ProgramBroad Institute of MIT & HarvardCambridgeMassachusettsUSA
- Department of Molecular Biology and Center for Computational and Integrative Biology, Massachusetts General HospitalBostonMassachusettsUSA
- Department of GeneticsHarvard Medical SchoolBostonMassachusettsUSA
| | - Marek Orzechowski
- Infectious Disease and Microbiome ProgramBroad Institute of MIT & HarvardCambridgeMassachusettsUSA
| | - James E. Gomez
- Infectious Disease and Microbiome ProgramBroad Institute of MIT & HarvardCambridgeMassachusettsUSA
| | - Jonathan Livny
- Infectious Disease and Microbiome ProgramBroad Institute of MIT & HarvardCambridgeMassachusettsUSA
| | - Deborah T. Hung
- Infectious Disease and Microbiome ProgramBroad Institute of MIT & HarvardCambridgeMassachusettsUSA
- Department of Molecular Biology and Center for Computational and Integrative Biology, Massachusetts General HospitalBostonMassachusettsUSA
- Department of GeneticsHarvard Medical SchoolBostonMassachusettsUSA
| | | | - Michael P. Busch
- Vitalant Research InstituteSan FranciscoCaliforniaUSA
- Department of Laboratory MedicineUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Larry J. Dumont
- Vitalant Research InstituteDenverColoradoUSA
- University of Colorado School of MedicineAuroraColoradoUSA
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24
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Vassallo RR, Kamel H, Dumont LJ, Bravo MD. The evolution of COVID-19 vaccination within a US blood center. Transfusion 2021; 61:2528-2529. [PMID: 34173235 PMCID: PMC8446984 DOI: 10.1111/trf.16579] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 06/17/2021] [Accepted: 06/17/2021] [Indexed: 11/28/2022]
Affiliation(s)
| | - Hany Kamel
- Vitalant, Medical Affairs, Scottsdale, Arizona, USA
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25
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Vazquez SE, Bastard P, Kelly K, Gervais A, Norris PJ, Dumont LJ, Casanova JL, Anderson MS, DeRisi JL. Neutralizing Autoantibodies to Type I Interferons in COVID-19 Convalescent Donor Plasma. J Clin Immunol 2021; 41:1169-1171. [PMID: 34009544 PMCID: PMC8132742 DOI: 10.1007/s10875-021-01060-0] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 05/03/2021] [Indexed: 11/25/2022]
Affiliation(s)
| | - Paul Bastard
- Laboratory of Human Genetics of Infectious Diseases, Necker Branch, INSERM U1163, Necker Hospital for Sick Children, Paris, France
- University of Paris, Imagine Institute, Paris, France
- St. Giles Laboratory of Human Genetics of Infectious Diseases, Rockefeller Branch, The Rockefeller University, New York, NY, USA
| | | | - Adrian Gervais
- Laboratory of Human Genetics of Infectious Diseases, Necker Branch, INSERM U1163, Necker Hospital for Sick Children, Paris, France
- University of Paris, Imagine Institute, Paris, France
| | - Philip J Norris
- University of California, San Francisco, CA, USA
- Vitalant Research Institute, Denver, CO, USA
| | - Larry J Dumont
- Vitalant Research Institute, Denver, CO, USA
- University of Colorado School of Medicine, Aurora, CO, USA
- Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Jean-Laurent Casanova
- Laboratory of Human Genetics of Infectious Diseases, Necker Branch, INSERM U1163, Necker Hospital for Sick Children, Paris, France
- University of Paris, Imagine Institute, Paris, France
- St. Giles Laboratory of Human Genetics of Infectious Diseases, Rockefeller Branch, The Rockefeller University, New York, NY, USA
- Howard Hughes Medical Institute, New York, NY, USA
| | | | - Joseph L DeRisi
- University of California, San Francisco, CA, USA
- Chan Zuckerberg Biohub, San Francisco, CA, USA
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26
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Assis R, Jain A, Nakajima R, Jasinskas A, Khan S, Davies H, Corash L, Dumont LJ, Kelly K, Simmons G, Stone M, Di Germanio C, Busch M, Felgner PL. Distinct SARS-CoV-2 antibody reactivity patterns in coronavirus convalescent plasma revealed by a coronavirus antigen microarray. Sci Rep 2021; 11:7554. [PMID: 33824382 PMCID: PMC8024395 DOI: 10.1038/s41598-021-87137-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 03/19/2021] [Indexed: 01/06/2023] Open
Abstract
A coronavirus antigen microarray (COVAM) was constructed containing 11 SARS-CoV-2, 5 SARS-1, 5 MERS, and 12 seasonal coronavirus recombinant proteins. The array is designed to measure immunoglobulin isotype and subtype levels in serum or plasma samples against each of the individual antigens printed on the array. We probed the COVAM with COVID-19 convalescent plasma (CCP) collected from 99 donors who recovered from a PCR+ confirmed SARS-CoV-2 infection. The results were analyzed using two computational approaches, a generalized linear model (glm) and random forest (RF) prediction model, to classify individual specimens as either Reactive or non-reactive against the SARS-CoV-2 antigens. A training set of 88 pre-COVID-19 specimens (PreCoV) collected in August 2019 and102 positive specimens from SARS-CoV-2 PCR+ confirmed COVID-19 cases was used for these analyses. Results compared with an FDA emergency use authorized (EUA) SARS-CoV2 S1-based total Ig chemiluminescence immunoassay (Ortho Clinical Diagnostics VITROS Anti-SARS-CoV-2 Total, CoV2T) and with a SARS-CoV-2 S1-S2 spike-based pseudovirus micro neutralization assay (SARS-CoV-2 reporter viral particle neutralization titration (RVPNT) showed high concordance between the three assays. Three CCP specimens that were negative by the VITROS CoV2T immunoassay were also negative by both COVAM and the RVPNT assay. Concordance between VITROS CoV2T and COVAM was 96%, VITROS CoV2T and RVPNT 93%, and RVPNT and COVAM 91%. The discordances were all weakly reactive samples near the cutoff threshold of the VITROS CoV2T immunoassay. The multiplex COVAM allows CCP to be grouped according to antibody reactivity patterns against 11 SARS-CoV-2 antigens. Unsupervised K-means analysis, via the gap statistics, as well as hierarchical clustering analysis revealed three main clusters with distinct reactivity intensities and patterns. These patterns were not recapitulated by adjusting the VITROS CoV2T or RVPNT assay thresholds. Plasma classified by COVAM reactivity patterns offers potential to improve CCP therapeutic efficacy CoV2T alone. The use of a SARS-CoV-2 antigen array can qualify CCP for administration as a treatment for acute COVID-19, and interrogate vaccine immunogenicity and performance in preclinical, clinical studies, and routine vaccination to identify antibody responses predictive of protection from infection and disease.
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Affiliation(s)
- Rafael Assis
- Vaccine Research and Development Center, Department of Physiology and Biophysics, School of Medicine, University of California, Irvine, CA, USA
| | - Aarti Jain
- Vaccine Research and Development Center, Department of Physiology and Biophysics, School of Medicine, University of California, Irvine, CA, USA
| | - Rie Nakajima
- Vaccine Research and Development Center, Department of Physiology and Biophysics, School of Medicine, University of California, Irvine, CA, USA
| | - Algis Jasinskas
- Vaccine Research and Development Center, Department of Physiology and Biophysics, School of Medicine, University of California, Irvine, CA, USA
| | - Saahir Khan
- Division of Infectious Diseases, Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Huw Davies
- Vaccine Research and Development Center, Department of Physiology and Biophysics, School of Medicine, University of California, Irvine, CA, USA
| | | | - Larry J Dumont
- University of Colorado School of Medicine, Aurora, CO, USA.,Vitalant Research Institute, Denver, CO, USA.,Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | | | | | - Mars Stone
- Vitalant Research Institute, San Francisco, CA, USA
| | | | - Michael Busch
- Vitalant Research Institute, San Francisco, CA, USA.,University of California, San Francisco, San Francisco, CA, USA
| | - Philip L Felgner
- Vaccine Research and Development Center, Department of Physiology and Biophysics, School of Medicine, University of California, Irvine, CA, USA.
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27
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Goodhue Meyer E, Simmons G, Grebe E, Gannett M, Franz S, Darst O, Di Germanio C, Stone M, Contestable P, Prichard A, Reik R, Vassallo R, Young P, Busch MP, Williamson P, Dumont LJ. Selecting COVID-19 convalescent plasma for neutralizing antibody potency using a high-capacity SARS-CoV-2 antibody assay. Transfusion 2021; 61:1160-1170. [PMID: 33554362 PMCID: PMC8013397 DOI: 10.1111/trf.16321] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 12/14/2020] [Accepted: 12/15/2020] [Indexed: 12/27/2022]
Abstract
BACKGROUND Efficacy of COVID-19 convalescent plasma (CCP) is hypothesized to be associated with the concentration of neutralizing antibodies (nAb) to SARS-CoV-2. High capacity serologic assays detecting binding antibodies (bAb) have been developed; nAb assays are not adaptable to high-throughput testing. We sought to determine the effectiveness of using surrogate bAb signal-to-cutoff ratios (S/Co) in predicting nAb titers using a pseudovirus reporter viral particle neutralization (RVPN) assay. METHODS CCP donor serum collected by three US blood collectors was tested with a bAb assay (Ortho Clinical Diagnostics VITROS Anti-SARS-CoV-2 Total, CoV2T) and a nAb RVPN assay. Prediction effectiveness of various CoV2T S/Co criteria was evaluated for RVPN nAb NT50 titers using receiver operating characteristics. RESULTS Seven hundred and fifty-three CCPs were tested with median CoV2T S/Co and NT50 of 71.2 of 527.5. Proportions of donors with NT50 over target nAb titers were 86% ≥1:80, 76% ≥1:160, and 62% ≥1:320. Increasing CoV2T S/Co criterion reduced the sensitivity to predict NT50 titers, while specificity to identify those below increased. As target NT50 titers increase, the CoV2T assay becomes less accurate as a predictor with a decline in positive predictive value and rise in negative predictive value. CONCLUSION Selection of a clinically effective nAb titer will impact availability of CCP. Product release with CoV2T assay S/Co criterion must balance the risk of releasing products below target nAb titers with the cost of false negatives. A two-step testing scheme may be optimal, with nAb testing on CoV2T samples with S/Cos below criterion.
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Affiliation(s)
- Erin Goodhue Meyer
- Medical Office, Biomedical Services, American Red CrossWashingtonDistrict of ColumbiaUSA
- Nationwide Children's HospitalColumbusOhioUSA
| | | | - Eduard Grebe
- Vitalant Research InstituteSan FranciscoCaliforniaUSA
- University of California, San FranciscoSan FranciscoCaliforniaUSA
| | | | - Sergej Franz
- Vitalant Research InstituteSan FranciscoCaliforniaUSA
| | - Orsolya Darst
- Vitalant Research InstituteSan FranciscoCaliforniaUSA
| | | | - Mars Stone
- Vitalant Research InstituteSan FranciscoCaliforniaUSA
| | | | | | | | - Ralph Vassallo
- VitalantScottsdaleArizonaUSA
- University of New Mexico School of MedicineAlbuquerqueNew MexicoUSA
| | - Pampee Young
- Medical Office, Biomedical Services, American Red CrossWashingtonDistrict of ColumbiaUSA
- Vanderbilt School of MedicineNashvilleTennesseeUSA
| | - Michael P. Busch
- Vitalant Research InstituteSan FranciscoCaliforniaUSA
- University of California, San FranciscoSan FranciscoCaliforniaUSA
| | | | - Larry J. Dumont
- Vitalant Research InstituteDenverColoradoUSA
- Geisel School of Medicine at DartmouthLebanonNew HampshireUSA
- University of Colorado School of MedicineAuroraColoradoUSA
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28
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van der Wijst MGP, Vazquez SE, Hartoularos GC, Bastard P, Grant T, Bueno R, Lee DS, Greenland JR, Sun Y, Perez R, Ogorodnikov A, Ward A, Mann SA, Lynch KL, Yun C, Havlir DV, Chamie G, Marquez C, Greenhouse B, Lionakis MS, Norris PJ, Dumont LJ, Kelly K, Zhang P, Zhang Q, Gervais A, Le Voyer T, Whatley A, Si Y, Byrne A, Combes AJ, Rao AA, Song YS, Fragiadakis GK, Kangelaris K, Calfee CS, Erle DJ, Hendrickson C, Krummel MF, Woodruff PG, Langelier CR, Casanova JL, Derisi JL, Anderson MS, Ye CJ. Longitudinal single-cell epitope and RNA-sequencing reveals the immunological impact of type 1 interferon autoantibodies in critical COVID-19: Anti-IFN antibodies in critical COVID-19 correlate with poor ISG response and upregulation of LAIR1 surface protein in PBMCs. bioRxiv 2021:2021.03.09.434529. [PMID: 33758859 PMCID: PMC7987018 DOI: 10.1101/2021.03.09.434529] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Type I interferon (IFN-I) neutralizing autoantibodies have been found in some critical COVID-19 patients; however, their prevalence and longitudinal dynamics across the disease severity scale, and functional effects on circulating leukocytes remain unknown. Here, in 284 COVID-19 patients, we found IFN-I autoantibodies in 19% of critical, 6% of severe and none of the moderate cases. Longitudinal profiling of over 600,000 peripheral blood mononuclear cells using multiplexed single-cell epitope and transcriptome sequencing from 54 COVID-19 patients, 15 non-COVID-19 patients and 11 non-hospitalized healthy controls, revealed a lack of IFN-I stimulated gene (ISG-I) response in myeloid cells from critical cases, including those producing anti-IFN-I autoantibodies. Moreover, surface protein analysis showed an inverse correlation of the inhibitory receptor LAIR-1 with ISG-I expression response early in the disease course. This aberrant ISG-I response in critical patients with and without IFN-I autoantibodies, supports a unifying model for disease pathogenesis involving ISG-I suppression via convergent mechanisms.
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Affiliation(s)
- Monique G P van der Wijst
- Department of Genetics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Institute of Human Genetics, University of California, San Francisco, CA, USA
- Division of Rheumatology, Department of Medicine, University of California, San Francisco, California, USA
| | - Sara E Vazquez
- Medical Scientist Training Program, University of California. San Francisco, CA, USA
- Tetrad Graduate Program, University of California, San Francisco, CA, USA
- Diabetes Center, University of California, San Francisco, CA, USA
- Department of Biochemistry and Biophysics, University of California, San Francisco, CA, USA
| | - George C Hartoularos
- Institute of Human Genetics, University of California, San Francisco, CA, USA
- Division of Rheumatology, Department of Medicine, University of California, San Francisco, California, USA
| | - Paul Bastard
- Laboratory of Human Genetics of Infectious Diseases, Necker Branch, INSERM U1163, Necker Hospital for Sick Children, Paris, France
- University of Paris, Imagine Institute, Paris, France
- St. Giles Laboratory of Human Genetics of Infectious Diseases, Rockefeller Branch, The Rockefeller University, New York, NY, USA
| | - Tianna Grant
- Institute of Human Genetics, University of California, San Francisco, CA, USA
- Division of Rheumatology, Department of Medicine, University of California, San Francisco, California, USA
| | - Raymund Bueno
- Institute of Human Genetics, University of California, San Francisco, CA, USA
- Division of Rheumatology, Department of Medicine, University of California, San Francisco, California, USA
| | - David S Lee
- Institute of Human Genetics, University of California, San Francisco, CA, USA
- Division of Rheumatology, Department of Medicine, University of California, San Francisco, California, USA
- ImmunoX Initiative, University of California, San Francisco, CA, USA
| | - John R Greenland
- Department of Medicine, San Francisco VA Health Care System, University of California, San Francisco, CA, USA
| | - Yang Sun
- Institute of Human Genetics, University of California, San Francisco, CA, USA
- Division of Rheumatology, Department of Medicine, University of California, San Francisco, California, USA
- ImmunoX Initiative, University of California, San Francisco, CA, USA
| | - Richard Perez
- Institute of Human Genetics, University of California, San Francisco, CA, USA
- School of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Anton Ogorodnikov
- Institute of Human Genetics, University of California, San Francisco, CA, USA
- Division of Rheumatology, Department of Medicine, University of California, San Francisco, California, USA
| | - Alyssa Ward
- Institute of Human Genetics, University of California, San Francisco, CA, USA
- Division of Rheumatology, Department of Medicine, University of California, San Francisco, California, USA
| | - Sabrina A Mann
- Department of Biochemistry and Biophysics, University of California, San Francisco, CA, USA
- Chan Zuckerberg Biohub, San Francisco, CA, USA
| | - Kara L Lynch
- Zuckerberg San Francisco General, San Francisco, CA, USA
| | - Cassandra Yun
- Zuckerberg San Francisco General, San Francisco, CA, USA
| | - Diane V Havlir
- Division of HIV, Infectious Disease and Global Medicine, Department of Medicine, University of California, San Francisco, CA, USA
| | - Gabriel Chamie
- Division of HIV, Infectious Disease and Global Medicine, Department of Medicine, University of California, San Francisco, CA, USA
| | - Carina Marquez
- Division of HIV, Infectious Disease and Global Medicine, Department of Medicine, University of California, San Francisco, CA, USA
| | - Bryan Greenhouse
- Division of HIV, Infectious Disease and Global Medicine, Department of Medicine, University of California, San Francisco, CA, USA
| | - Michail S Lionakis
- Laboratory of Clinical Immunology and Microbiology, Division of Intramural Research, National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Bethesda, MD, USA
| | - Philip J Norris
- Zuckerberg San Francisco General, San Francisco, CA, USA
- Department of Laboratory Medicine, University of California, San Francisco, CA, USA
- Vitalant Research Institute, San Francisco, CA, USA
| | - Larry J Dumont
- Vitalant Research Institute, Denver, CO, USA
- University of Colorado School of Medicine, Aurora, CO, USA
- Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | | | - Peng Zhang
- St. Giles Laboratory of Human Genetics of Infectious Diseases, Rockefeller Branch, The Rockefeller University, New York, NY, USA
| | - Qian Zhang
- St. Giles Laboratory of Human Genetics of Infectious Diseases, Rockefeller Branch, The Rockefeller University, New York, NY, USA
| | - Adrian Gervais
- University of Paris, Imagine Institute, Paris, France
- St. Giles Laboratory of Human Genetics of Infectious Diseases, Rockefeller Branch, The Rockefeller University, New York, NY, USA
| | - Tom Le Voyer
- University of Paris, Imagine Institute, Paris, France
- St. Giles Laboratory of Human Genetics of Infectious Diseases, Rockefeller Branch, The Rockefeller University, New York, NY, USA
| | - Alexander Whatley
- Department of Electrical Engineering and Computer Sciences, University of California, Berkeley, CA, USA
| | - Yichen Si
- Department of Biostaticstics, University of Michigan
| | | | - Alexis J Combes
- ImmunoX Initiative, University of California, San Francisco, CA, USA
- Department of Pathology, University of California, San Francisco, CA, USA
- UCSF CoLabs, University of California, San Francisco, CA, USA
| | - Arjun Arkal Rao
- ImmunoX Initiative, University of California, San Francisco, CA, USA
- Department of Pathology, University of California, San Francisco, CA, USA
- UCSF CoLabs, University of California, San Francisco, CA, USA
| | - Yun S Song
- Chan Zuckerberg Biohub, San Francisco, CA, USA
- Department of Electrical Engineering and Computer Sciences, University of California, Berkeley, CA, USA
- Department of Statistics, University of California, Berkeley, CA, USA
| | - Gabriela K Fragiadakis
- Division of Rheumatology, Department of Medicine, University of California, San Francisco, California, USA
- ImmunoX Initiative, University of California, San Francisco, CA, USA
- UCSF CoLabs, University of California, San Francisco, CA, USA
| | - Kirsten Kangelaris
- Division of Infectious Disease, Department of Medicine, University of California, San Francisco, CA, USA
| | - Carolyn S Calfee
- Division of Pulmonary and Critical Care Medicine, Department of Medicine and the Cardiovascular Research Institute, University of California, San Francisco, CA, USA
| | - David J Erle
- Institute of Human Genetics, University of California, San Francisco, CA, USA
- ImmunoX Initiative, University of California, San Francisco, CA, USA
- Zuckerberg San Francisco General, San Francisco, CA, USA
| | - Carolyn Hendrickson
- Division of Pulmonary and Critical Care Medicine, Department of Medicine and the Cardiovascular Research Institute, University of California, San Francisco, CA, USA
| | - Matthew F Krummel
- ImmunoX Initiative, University of California, San Francisco, CA, USA
- Department of Pathology, University of California, San Francisco, CA, USA
| | - Prescott G Woodruff
- ImmunoX Initiative, University of California, San Francisco, CA, USA
- Division of Pulmonary and Critical Care Medicine, Department of Medicine and the Cardiovascular Research Institute, University of California, San Francisco, CA, USA
| | - Charles R Langelier
- Division of Infectious Disease, Department of Medicine, University of California, San Francisco, CA, USA
| | - Jean-Laurent Casanova
- Laboratory of Human Genetics of Infectious Diseases, Necker Branch, INSERM U1163, Necker Hospital for Sick Children, Paris, France
- University of Paris, Imagine Institute, Paris, France
- St. Giles Laboratory of Human Genetics of Infectious Diseases, Rockefeller Branch, The Rockefeller University, New York, NY, USA
- Howard Hughes Medical Institute, New York, NY, USA
| | - Joseph L Derisi
- Department of Biochemistry and Biophysics, University of California, San Francisco, CA, USA
- Chan Zuckerberg Biohub, San Francisco, CA, USA
| | - Mark S Anderson
- Diabetes Center, University of California, San Francisco, CA, USA
- Endocrine Division, Department of Medicine, University of California, San Francisco, CA, USA
| | - Chun Jimmie Ye
- Institute of Human Genetics, University of California, San Francisco, CA, USA
- Division of Rheumatology, Department of Medicine, University of California, San Francisco, California, USA
- ImmunoX Initiative, University of California, San Francisco, CA, USA
- Chan Zuckerberg Biohub, San Francisco, CA, USA
- Departments of Epidemiology and Biostatistics, Bioengineering and Therapeutic Sciences
- Bakar Computational Health Sciences Institute, University of California, San Francisco, CA, USA
- Parker Institute for Cancer Immunotherapy, San Francisco, CA, USA
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29
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Nemkov T, Stefanoni D, Bordbar A, Issaian A, Palsson BO, Dumont LJ, Hay A, Song A, Xia Y, Redzic JS, Eisenmesser EZ, Zimring JC, Kleinman S, Hansen KC, Busch MP, D'Alessandro A. Blood donor exposome and impact of common drugs on red blood cell metabolism. JCI Insight 2021; 6:146175. [PMID: 33351786 PMCID: PMC7934844 DOI: 10.1172/jci.insight.146175] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 12/18/2020] [Indexed: 12/12/2022] Open
Abstract
Computational models based on recent maps of the RBC proteome suggest that mature erythrocytes may harbor targets for common drugs. This prediction is relevant to RBC storage in the blood bank, in which the impact of small molecule drugs or other xenometabolites deriving from dietary, iatrogenic, or environmental exposures (“exposome”) may alter erythrocyte energy and redox metabolism and, in so doing, affect red cell storage quality and posttransfusion efficacy. To test this prediction, here we provide a comprehensive characterization of the blood donor exposome, including the detection of common prescription and over-the-counter drugs in blood units donated by 250 healthy volunteers in the Recipient Epidemiology and Donor Evaluation Study III Red Blood Cell–Omics (REDS-III RBC-Omics) Study. Based on high-throughput drug screenings of 1366 FDA-approved drugs, we report that approximately 65% of the tested drugs had an impact on erythrocyte metabolism. Machine learning models built using metabolites as predictors were able to accurately predict drugs for several drug classes/targets (bisphosphonates, anticholinergics, calcium channel blockers, adrenergics, proton pump inhibitors, antimetabolites, selective serotonin reuptake inhibitors, and mTOR), suggesting that these drugs have a direct, conserved, and substantial impact on erythrocyte metabolism. As a proof of principle, here we show that the antacid ranitidine — though rarely detected in the blood donor population — has a strong effect on RBC markers of storage quality in vitro. We thus show that supplementation of blood units stored in bags with ranitidine could — through mechanisms involving sphingosine 1–phosphate–dependent modulation of erythrocyte glycolysis and/or direct binding to hemoglobin — improve erythrocyte metabolism and storage quality.
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Affiliation(s)
- Travis Nemkov
- Department of Biochemistry and Molecular Genetics, University of Colorado Denver - Anschutz Medical Campus, Aurora, Colorado, USA.,Omix Technologies Inc., Aurora, Colorado, USA
| | - Davide Stefanoni
- Department of Biochemistry and Molecular Genetics, University of Colorado Denver - Anschutz Medical Campus, Aurora, Colorado, USA
| | | | - Aaron Issaian
- Department of Biochemistry and Molecular Genetics, University of Colorado Denver - Anschutz Medical Campus, Aurora, Colorado, USA
| | | | | | - Ariel Hay
- University of Virginia, Charlottesville, Virginia, USA
| | - Anren Song
- University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Yang Xia
- University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Jasmina S Redzic
- Department of Biochemistry and Molecular Genetics, University of Colorado Denver - Anschutz Medical Campus, Aurora, Colorado, USA
| | - Elan Z Eisenmesser
- Department of Biochemistry and Molecular Genetics, University of Colorado Denver - Anschutz Medical Campus, Aurora, Colorado, USA
| | | | - Steve Kleinman
- University of British Columbia, Victoria, British Columbia, Canada
| | - Kirk C Hansen
- Department of Biochemistry and Molecular Genetics, University of Colorado Denver - Anschutz Medical Campus, Aurora, Colorado, USA.,Omix Technologies Inc., Aurora, Colorado, USA
| | | | - Angelo D'Alessandro
- Department of Biochemistry and Molecular Genetics, University of Colorado Denver - Anschutz Medical Campus, Aurora, Colorado, USA.,Omix Technologies Inc., Aurora, Colorado, USA
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30
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Bloch EM, Goel R, Wendel S, Burnouf T, Al-Riyami AZ, Ang AL, DeAngelis V, Dumont LJ, Land K, Lee CK, Oreh A, Patidar G, Spitalnik SL, Vermeulen M, Hindawi S, Van den Berg K, Tiberghien P, Vrielink H, Young P, Devine D, So-Osman C. Guidance for the procurement of COVID-19 convalescent plasma: differences between high- and low-middle-income countries. Vox Sang 2020; 116:18-35. [PMID: 32533868 PMCID: PMC7323328 DOI: 10.1111/vox.12970] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 06/08/2020] [Accepted: 06/08/2020] [Indexed: 12/11/2022]
Abstract
Background and objectives COVID‐19 convalescent plasma (CCP) has been used, predominantly in high‐income countries (HICs) to treat COVID‐19; available data suggest the safety and efficacy of use. We sought to develop guidance for procurement and use of CCP, particularly in low‐ and middle‐income countries (LMICs) for which data are lacking. Materials and methods A multidisciplinary, geographically representative group of individuals with expertise spanning transfusion medicine, infectious diseases and haematology was tasked with the development of a guidance document for CCP, drawing on expert opinion, survey of group members and review of available evidence. Three subgroups (i.e. donor, product and patient) were established based on self‐identified expertise and interest. Here, the donor and product‐related challenges are summarized and contrasted between HICs and LMICs with a view to guide related practices. Results The challenges to advance CCP therapy are different between HICs and LMICs. Early challenges in HICs related to recruitment and qualification of sufficient donors to meet the growing demand. Antibody testing also posed a specific obstacle given lack of standardization, variable performance of the assays in use and uncertain interpretation of results. In LMICs, an extant transfusion deficit, suboptimal models of donor recruitment (e.g. reliance on replacement and paid donors), limited laboratory capacity for pre‐donation qualification and operational considerations could impede wide adoption. Conclusion There has been wide‐scale adoption of CCP in many HICs, which could increase if clinical trials show efficacy of use. By contrast, LMICs, having received little attention, require locally applicable strategies for adoption of CCP.
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Affiliation(s)
- Evan M Bloch
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ruchika Goel
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Division of Hematology/Oncology, Simmons Cancer Institute at SIU School of Medicine and Mississippi Valley Regional Blood Center, Springfield, Illinois, USA
| | | | - 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
| | - Arwa Z Al-Riyami
- Department of Hematology, Sultan Qaboos University Hospital, Muscat, Sultanate of Oman
| | - Ai Leen Ang
- Blood Services Group, Health Sciences Authority, Singapore, Singapore
| | | | - Larry J Dumont
- Vitalant Research Institute, Denver, CO, USA.,University of Colorado School of Medicine, Denver, CO, USA.,Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Kevin Land
- Vice President Clinical Services, Vitalant, Scottsdale, AZ, USA.,Department of Pathology, UT Health Science Center San Antonio, San Antonio, TX, USA
| | - Cheuk-Kwong Lee
- Hong Kong Red Cross Blood Transfusion Service, Hong Kong, China, China.,King's Park Rise, Kowloon, China
| | - Adaeze Oreh
- National Blood Transfusion Service, Department of Hospital Services, Federal Ministry of Health, Abuja, Nigeria
| | - Gopal Patidar
- Department of Transfusion Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Steven L Spitalnik
- Department of Pathology & Cell Biology, Columbia University, New York, NY, USA
| | - Marion Vermeulen
- The South African National Blood Service, Johannesbur, South Africa
| | - Salwa Hindawi
- Haematology & Transfusion Medicine, King Abdalaziz University, Jeddah, Saudi Arabia
| | | | | | - Hans Vrielink
- Department Unit Transfusion Medicine, Sanquin Blood Supply Foundation, Amsterdam, NL, Netherlands
| | | | - Dana Devine
- Canadian Blood Services, Vancouver, BC, Canada.,Department of Pathology & Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Cynthia So-Osman
- Department Unit Transfusion Medicine, Sanquin Blood Supply Foundation, Amsterdam, NL, Netherlands.,Department of Haematology, Erasmus Medical Center, Rotterdam, NL, Netherlands
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31
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Stefely JA, Gailey M, Knudson M, Dumont LJ, Raife TJ, Samia NI. Retrospective cohort studies of repeat donors reveal donor-dependent variability in the recovery of transfused platelets. Transfusion 2020; 60:1837-1845. [PMID: 32483843 DOI: 10.1111/trf.15865] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 04/03/2020] [Accepted: 04/14/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND The in vivo recovery of transfused platelets is variable and often unpredictable. Although many recipient-dependent factors are well described, donor-dependent variables remain poorly understood. STUDY DESIGN AND METHODS To explore donor-dependent variables we conducted 2 retrospective studies of platelet transfusion outcomes in repeat donors. One study analyzed multiple autologous, radiolabeled platelet transfusions, and a second study analyzed multiple clinical platelet transfusions from a small cohort of repeat donors. RESULTS In 36 subjects, multiple within-subject determinations of recovery and survival of radiolabeled autologous platelets revealed a relative consistency in platelet recoveries within donors compared to the range of recoveries among donors. Intraclass correlation coefficients for platelet recovery were 43% to 93%. In 524 ABO-compatible clinical platelet transfusions derived from seven donors, a linear mixed-effects model revealed significant donor-dependent differences in corrected count increments for units stored for 4 or 5 days. CONCLUSIONS These two studies indicate reproducible donor-dependent differences in transfused platelet recovery, suggesting a possible heritable influence on the quality of transfused platelets.
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Affiliation(s)
- Jonathan A Stefely
- Department of Pathology and Laboratory Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, USA.,Medical Scientist Training Program, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Michael Gailey
- Department of Pathology, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Michael Knudson
- Department of Pathology, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Larry J Dumont
- Vitalant Research Institute, Denver, Colorado, USA.,Department of Pathology and Laboratory Medicine, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, USA.,Department of Pathology, University of Colorado School of Medicine, Denver, Colorado, USA
| | - Thomas J Raife
- Department of Pathology and Laboratory Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, USA.,Department of Pathology, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Noelle I Samia
- Department of Statistics, Northwestern University, Evanston, Illinois, USA
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32
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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: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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.
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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
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Reisz JA, Nemkov T, Dzieciatkowska M, Culp-Hill R, Stefanoni D, Hill RC, Yoshida T, Dunham A, Kanias T, Dumont LJ, Busch M, Eisenmesser EZ, Zimring JC, Hansen KC, D'Alessandro A. Methylation of protein aspartates and deamidated asparagines as a function of blood bank storage and oxidative stress in human red blood cells. Transfusion 2018; 58:2978-2991. [PMID: 30312994 DOI: 10.1111/trf.14936] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 07/30/2018] [Accepted: 08/15/2018] [Indexed: 12/24/2022]
Abstract
BACKGROUND Being devoid of de novo protein synthesis capacity, red blood cells (RBCs) have evolved to recycle oxidatively damaged proteins via mechanisms that involve methylation of dehydrated and deamidated aspartate and asparagine residues. Here we hypothesize that such mechanisms are relevant to routine storage in the blood bank. STUDY DESIGN AND METHODS Within the framework of the REDS-III RBC-Omics (Recipient Epidemiology Donor Evaluation Study III Red Blood Cell-Omics) study, packed RBC units (n = 599) were stored under blood bank conditions for 10, 23, and 42 days and profiled for oxidative hemolysis and time-dependent metabolic dysregulation of the trans-sulfuration pathway. RESULTS In these units, methionine consumption positively correlated with storage age and oxidative hemolysis. Mechanistic studies show that this phenomenon is favored by oxidative stress or hyperoxic storage (sulfur dioxide >95%), and prevented by hypoxia or methyltransferase inhibition. Through a combination of proteomics approaches and 13 C-methionine tracing, we observed oxidation-induced increases in both Asn deamidation to Asp and formation of methyl-Asp on key structural proteins and enzymes, including Band 3, hemoglobin, ankyrin, 4.1, spectrin beta, aldolase, glyceraldehyde 3-phosphate dehydrogenase, biphosphoglycerate mutase, lactate dehydrogenase and catalase. Methylated regions tended to map proximal to the active site (e.g., N316 of glyceraldehyde 3-phosphate dehydrogenase) and/or residues interacting with the N-terminal cytosolic domain of Band 3. CONCLUSION While methylation of basic amino acid residues serves as an epigenetic modification in nucleated cells, protein methylation at carboxylate side chains and deamidated asparagines is a nonepigenetic posttranslational sensor of oxidative stress and refrigerated storage in anucleated human RBCs.
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Affiliation(s)
- Julie A Reisz
- Department of Biochemistry and Molecular Genetics, University of Colorado Denver-Anschutz Medical Campus, Aurora, Colorado
| | - Travis Nemkov
- Department of Biochemistry and Molecular Genetics, University of Colorado Denver-Anschutz Medical Campus, Aurora, Colorado
| | - Monika Dzieciatkowska
- Department of Biochemistry and Molecular Genetics, University of Colorado Denver-Anschutz Medical Campus, Aurora, Colorado
| | - Rachel Culp-Hill
- Department of Biochemistry and Molecular Genetics, University of Colorado Denver-Anschutz Medical Campus, Aurora, Colorado
| | - Davide Stefanoni
- Department of Biochemistry and Molecular Genetics, University of Colorado Denver-Anschutz Medical Campus, Aurora, Colorado
| | - Ryan C Hill
- Department of Biochemistry and Molecular Genetics, University of Colorado Denver-Anschutz Medical Campus, Aurora, Colorado
| | | | | | - Tamir Kanias
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | - Michael Busch
- Blood Systems Research Institute, San Francisco, California
| | - Elan Z Eisenmesser
- Department of Biochemistry and Molecular Genetics, University of Colorado Denver-Anschutz Medical Campus, Aurora, Colorado
| | | | - Kirk C Hansen
- Department of Biochemistry and Molecular Genetics, University of Colorado Denver-Anschutz Medical Campus, Aurora, Colorado
| | - Angelo D'Alessandro
- Department of Biochemistry and Molecular Genetics, University of Colorado Denver-Anschutz Medical Campus, Aurora, Colorado.,Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
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Six KR, Delabie W, Devreese KMJ, Johnson L, Marks DC, Dumont LJ, Compernolle V, Feys HB. Comparison between manufacturing sites shows differential adhesion, activation, and GPIbα expression of cryopreserved platelets. Transfusion 2018; 58:2645-2656. [PMID: 30312492 DOI: 10.1111/trf.14828] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 03/22/2018] [Accepted: 03/22/2018] [Indexed: 12/24/2022]
Abstract
BACKGROUND Transfusion of cryopreserved platelets (cryoplatelets) is not common but may replace standard liquid-preserved platelets (PLTs) in specific circumstances. To better understand cryoplatelet function, frozen concentrates from different manufacturing sites were compared. STUDY DESIGN AND METHODS Cryoplatelets from Denver, Colorado (DEN); Sydney, Australia (SYD); and Ghent, Belgium (GHE) were compared (n = 6). A paired noncryopreserved control was included in Ghent. Microfluidic-flow chambers were used to study PLT adhesion and fibrin deposition in reconstituted blood. Receptor expression was measured by flow cytometry. Coagulation in static conditions was evaluated by rotational thromboelastometry (ROTEM). RESULTS Regardless of the manufacturing site, adhesion of cryoplatelets under shear flow (1000/sec) was significantly (p < 0.05) reduced compared to control. Expression of GPIbα was decreased in a subpopulation of cryoplatelets comprising 45% ± 11% (DEN), 63% ± 9% (GHE), and 94% ± 6% (SYD). That subpopulation displayed increased annexin V binding and decreased integrin activation. PLT adhesion, agglutination, and aggregation were moreover decreased in proportion to that subpopulation. Fibrin deposition under shear flow was normal but initiated faster (546 ± 163 sec GHE) than control PLTs (631 ± 120 sec, p < 0.01), only in the absence of tissue factor. In static conditions, clotting time was faster, but clot firmness decreased compared to control. Coagulation was not different between manufacturing sites. CONCLUSION Cryopreservation results in a subset of PLTs with enhanced GPIbα shedding, increased phosphatidylserine expression, reduced integrin response, and reduced adhesion to collagen in microfluidic models of hemostasis. The proportion of this phenotype is different between manufacturing sites. The clinical effects, if any, will need to be verified.
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Affiliation(s)
- Katrijn R Six
- Transfusion Research Center, Belgian Red Cross-Flanders, Ghent, Belgium.,Faculty of Medicine and Health Sciences, Department of Diagnostic Sciences, Ghent University, Ghent, Belgium
| | - Willem Delabie
- Transfusion Research Center, Belgian Red Cross-Flanders, Ghent, Belgium
| | - Katrien M J Devreese
- Faculty of Medicine and Health Sciences, Department of Diagnostic Sciences, Ghent University, Ghent, Belgium.,Coagulation Laboratory, Department of Laboratory Medicine, Ghent University Hospital, Ghent, Belgium
| | - Lacey Johnson
- Research & Development, Australian Red Cross Blood Service, Sydney, Australia
| | - Denese C Marks
- Research & Development, Australian Red Cross Blood Service, Sydney, Australia.,Sydney Medical School, University of Sydney, Sydney, Australia
| | - Larry J Dumont
- Blood Systems Research Institute, Denver, Colorado.,Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, USA
| | - Veerle Compernolle
- Transfusion Research Center, Belgian Red Cross-Flanders, Ghent, Belgium.,Faculty of Medicine and Health Sciences, Department of Diagnostic Sciences, Ghent University, Ghent, Belgium.,Blood Service of the Belgian Red Cross-Flanders, Mechelen, Belgium
| | - Hendrik B Feys
- Transfusion Research Center, Belgian Red Cross-Flanders, Ghent, Belgium.,Faculty of Medicine and Health Sciences, Department of Diagnostic Sciences, Ghent University, Ghent, Belgium
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Slichter SJ, Dumont LJ, Cancelas JA, Jones M, Gernsheimer TB, Szczepiorkowski ZM, Dunbar NM, Prakash G, Medlin S, Rugg N, Kinne B, Macdonald VW, Housler G, Valiyaveettil M, Hmel P, Ransom JH. Safety and efficacy of cryopreserved platelets in bleeding patients with thrombocytopenia. Transfusion 2018; 58:2129-2138. [DOI: 10.1111/trf.14780] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Accepted: 03/30/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Sherrill J. Slichter
- Research Institute, Bloodworks Northwest; Seattle Washington
- University of Washington School of Medicine; Seattle Washington
| | - Larry J. Dumont
- Geisel School of Medicine at Dartmouth and Dartmouth-Hitchcock Medical Center; Lebanon New Hampshire
- Blood Systems Research Institute; Denver Colorado
| | - Jose A. Cancelas
- Hoxworth Blood Center; University of Cincinnati; Cincinnati Ohio
| | - MeLinh Jones
- Research Institute, Bloodworks Northwest; Seattle Washington
| | | | | | - Nancy M. Dunbar
- Geisel School of Medicine at Dartmouth and Dartmouth-Hitchcock Medical Center; Lebanon New Hampshire
| | - Gautham Prakash
- Geisel School of Medicine at Dartmouth and Dartmouth-Hitchcock Medical Center; Lebanon New Hampshire
| | - Stephen Medlin
- University of Cincinnati Health Hospital; Cincinnati Ohio
| | - Neeta Rugg
- Hoxworth Blood Center; University of Cincinnati; Cincinnati Ohio
| | - Bridget Kinne
- University of Cincinnati Health Hospital; Cincinnati Ohio
| | | | - Greggory Housler
- U.S. Army Medical Research and Materiel Command; Fort Detrick Maryland
| | | | - Peter Hmel
- Fast-Track Drugs & Biologics, LLC; North Potomac Maryland
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Coker SA, Szczepiorkowski ZM, Siegel AH, Ferrari A, Mambrini G, Anand R, Hartman RD, Benatti L, Dumont LJ. A Study of the Pharmacokinetic Properties and the In Vivo Kinetics of Erythrocytes Loaded With Dexamethasone Sodium Phosphate in Healthy Volunteers. Transfus Med Rev 2018. [PMID: 29031409 DOI: 10.1016/j.tmry.2017.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/16/2023]
Abstract
The objectives of this 2-phase study were to elucidate pharmacokinetics (PK), in vivo 24-hour recovery, and red blood cell (RBC) survival properties of RBC-encapsulated dexamethasone sodium phosphate (DSP) prepared using the EryDex System (EDS). The 24-hour RBC recovery and T50 survival phase studied subjects were randomized to receive autologous RBCs loaded with either 15-20 mg DSP (Group 1A) or sham saline (Group 2A). Loaded RBCs were radiolabeled with 51-Cr, and the labeled RBCs were followed over time in vivo. The PK phase evaluated dose levels of 2.5-5 mg (Group 1B) and 15-20 mg (Group 2B) DSP encapsulated in RBCs infused into healthy randomized subjects. The mean ± SD 24-hour RBC recovery was 77.9% ± 3.3% and 72.7% ± 10.5% for Groups 1A and 2A, respectively. The mean ± SD RBC life span was 84.3 ± 8.3 days in Group 1A and 88.9 ± 6.2 days in Group 2A. The PK phase actual DSP loading doses (mean ± SEM) were 4.2 ± 0.27 mg and 16.9 ± 0.90 mg in Groups 1B and 2B, respectively. Release of dexamethasone from RBCs in vivo peaked at 1 hour, and a sustained release of dexamethasone could be detected until 35 days after the single intravenous infusion in Group 2B. The mean RBC in vivo recovery for DSP-loaded processed cells compares similarly to the 24-hour recovery of regulated RBC products intended for transfusion. There was a minimal but acceptable adverse impact on the survival of EDS-processed RBCs. DSP-loaded autologous RBCs, prepared using the EDS, delivered a sustained dose of dexamethasone in vivo.
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Affiliation(s)
- Shodeinde A Coker
- Section of Hematology and Oncology and The Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - Zbigniew M Szczepiorkowski
- Department of Pathology, The Geisel School of Medicine at Dartmouth and The Dartmouth-Hitchcock Medical Center, Lebanon, NH; Institute of Hematology and Transfusion Medicine, Warsaw, Poland
| | - Alan H Siegel
- Department of Radiology, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | | | | | | | | | | | - Larry J Dumont
- Department of Pathology, The Geisel School of Medicine at Dartmouth and The Dartmouth-Hitchcock Medical Center, Lebanon, NH.
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Coker SA, Szczepiorkowski ZM, Siegel AH, Ferrari A, Mambrini G, Anand R, Hartman RD, Benatti L, Dumont LJ. A Study of the Pharmacokinetic Properties and the In Vivo Kinetics of Erythrocytes Loaded With Dexamethasone Sodium Phosphate in Healthy Volunteers. Transfus Med Rev 2018; 32:102-110. [DOI: 10.1016/j.tmrv.2017.09.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Revised: 07/24/2017] [Accepted: 09/07/2017] [Indexed: 10/18/2022]
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Szczepiorkowski ZM, Burnett CA, Dumont LJ, Abhyankar SH. Apheresis buffy coat collection without photoactivation has no effect on apoptosis, cell proliferation, and total viability of mononuclear cells collected using photopheresis systems. Transfusion 2018; 58:943-950. [PMID: 29451308 DOI: 10.1111/trf.14532] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Revised: 11/13/2017] [Accepted: 11/21/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND Extracorporeal photopheresis (ECP) has been approved for the treatment of advanced cutaneous T-cell lymphoma since 1988. While the precise mechanisms resulting in clinical effects are not fully understood, the photoactivation of mononuclear cells (MNCs) using ultraviolet A (UVA) light and methoxsalen is believed to be the predominant initiating process. The effects of MNC passage through the instrument without photoactivation are unknown. The objective of this study was to evaluate the effect of cell processing through the photopheresis instruments on MNCs. STUDY DESIGN AND METHODS Fourteen healthy male subjects underwent one simulated ECP procedure without reinfusion of buffy coats (BCs) in a two-center, open-label, prospective trial. Baseline peripheral blood BC, apheresis-separated untreated BC (BC1), and photoactivated BC (BC2) were evaluated in culture for viability by dye exclusion, apoptosis by annexin V binding, and cell proliferation response to phytohemagglutinin (PHA) stimulation by bromodeoxyuridine (BrdU) incorporation. RESULTS Photoactivation (BC2) resulted in 88% expression of annexin V by Day 1 of culture compared with 37 and 39% for baseline and untreated BC1. Cell viability by propidium iodide exclusion was reduced to 10% in BC2 on Day 1 versus 65 and 60% for baseline and BC1. The proliferative response to PHA stimulation was 97% inhibited in the photoactivated BC2. CONCLUSIONS These results demonstrate that the mechanical processes used for cell separation and processing of the BC in the absence of photoactivation do not induce a significant amount of apoptosis compared to the standard ECP with methoxsalen and UVA photoactivation.
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Affiliation(s)
- Zbigniew M Szczepiorkowski
- Department of Pathology and Laboratory Medicine.,Department of Medicine, Dartmouth-Hitchcock, Lebanon, New Hampshire.,Dartmouth Geisel School of Medicine, Hanover, New Hampshire.,Institute of Hematology and Transfusion Medicine, Warsaw, Poland
| | | | - Larry J Dumont
- Department of Pathology and Laboratory Medicine.,Dartmouth Geisel School of Medicine, Hanover, New Hampshire
| | - Sunil H Abhyankar
- Bone Marrow Transplant Program, University of Kansas Medical Center, Kansas City, Kansas
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Cohn CS, Dumont LJ, Lozano M, Marks DC, Johnson L, Ismay S, Bondar N, T'Sas F, Yokoyama APH, Kutner JM, Acker JP, Bohonek M, Sailliol A, Martinaud C, Pogłód R, Antoniewicz-Papis J, Lachert E, Pun PBL, Lu J, Cid J, Guijarro F, Puig L, Gerber B, Alberio L, Schanz U, Buser A, Noorman F, Zoodsma M, van der Meer PF, de Korte D, Wagner S, O'Neill M. Vox Sanguinis International Forum on platelet cryopreservation: Summary. Vox Sang 2017; 112:684-688. [PMID: 28929502 DOI: 10.1111/vox.12533] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- C S Cohn
- Department of Laboratory Medicine and Pathology, University of Minnesota, D242 Mayo Building, MMC 609, 420 Delaware Street SE, Minneapolis, MN, 55455, USA
| | - L J Dumont
- Blood Systems Research Institute Denver, 717 Yosemite Street, Denver, CO, 80230, USA
| | - M Lozano
- Department of Hemotherapy and Hemostasis, University Clinic Hospital, University of Barcelona, 08036, Barcelona, Spain
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41
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D'Alessandro A, Gray AD, Szczepiorkowski ZM, Hansen K, Herschel LH, Dumont LJ. Red blood cell metabolic responses to refrigerated storage, rejuvenation, and frozen storage. Transfusion 2017; 57:1019-1030. [PMID: 28295356 DOI: 10.1111/trf.14034] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2016] [Revised: 11/10/2016] [Accepted: 12/19/2016] [Indexed: 01/28/2023]
Abstract
BACKGROUND Storage of red blood cells (RBCs) under blood bank conditions promotes metabolic modulation within the RBC. This "metabolic storage lesion" may affect the quality and safety of the transfused RBCs. The aim of this study is to determine the metabolic changes in stored RBCs over 42 days of routine storage followed by a US Food and Drug Administration-approved method of rejuvenation, freezing, and preparation for transfusion. STUDY DESIGN AND METHODS We exploited a mass spectrometry-based metabolomics approach to monitor 42-day-stored citrate phosphate dextrose/AS-1 RBCs (n = 29) that were rejuvenated, glycerolized and frozen, then thawed and deglycerolized, and held for 24 hours at 1 to 6ºC in saline-glucose. RESULTS Previously reported metabolic alterations were confirmed in 42-day-old RBCs. In this study, in total, 181 (62%) of the biochemical compounds exhibited significant (p ≤ 0.05) change compared with Day 0 values. Rejuvenation restored adenosine triphosphate and 2,3-diphosphoglycerate levels, replenished purine reservoirs, up regulated glycolysis, increased levels of pentose phosphate pathway intermediates, and partially rescued glutathione biosynthesis. Increased levels of lysophospholipid in rejuvenated RBCs suggests the activation of recycling pathways of damaged membrane lipids, in which a total of 167 (57%) biochemical compounds showed significant change compared with Day 42 values. CONCLUSION Rejuvenation reversed over one-half of the metabolic biochemical compounds evaluated compared with Day 42 values, and the compounds were stable through frozen storage and preparation for transfusion. Rejuvenation promoted significant metabolic reprogramming, including the reactivation of energy-generating and antioxidant pathways (the pentose phosphate pathway and glutathione homeostasis), salvage reactions, cofactor reservoirs, and membrane lipid recycling.
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Affiliation(s)
- Angelo D'Alessandro
- Department of Biochemistry and Molecular Genetics, University of Colorado Denver-Anschutz Medical Campus, Aurora, Colorado
| | | | - Zbigniew M Szczepiorkowski
- Department of Pathology, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire.,Institute of Hematology and Transfusion Medicine, Warsaw, Poland
| | - Kirk Hansen
- Department of Biochemistry and Molecular Genetics, University of Colorado Denver-Anschutz Medical Campus, Aurora, Colorado
| | | | - Larry J Dumont
- Department of Pathology, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
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Chapuy CI, Aguad MD, Nicholson RT, AuBuchon JP, Cohn CS, Delaney M, Fung MK, Unger M, Doshi P, Murphy MF, Dumont LJ, Kaufman RM. International validation of a dithiothreitol (DTT)-based method to resolve the daratumumab interference with blood compatibility testing. Transfusion 2016; 56:2964-2972. [PMID: 27600566 DOI: 10.1111/trf.13789] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Revised: 06/15/2016] [Accepted: 06/25/2016] [Indexed: 01/26/2023]
Abstract
BACKGROUND Daratumumab (DARA) consistently interferes with routine blood bank serologic testing by directly binding to CD38 expressed on reagent red blood cells (RBCs). Treating RBCs with dithiothreitol (DTT) eliminates the DARA interference. We conducted an international, multicenter, blinded study aimed at validating the DTT method for use by blood bank laboratories worldwide. STUDY DESIGN AND METHODS Paired plasma sample unknowns were sent to 25 participating blood bank laboratories. Sample 1 was spiked with DARA only (10 µg/mL), and Sample 2 with DARA plus a clinically significant RBC antibody (anti-D [n = 6], anti-Fya [n = 9], or anti-s [n = 10]). Sites were instructed to perform an antibody screen with and without DTT-treated RBCs and to use a DTT-treated RBC panel for antibody identification. Qualitative data about the DTT method were collected by online survey. The primary outcome was the proportion of study sites able to identify the antibody unknown in the presence of DARA. RESULTS All sites observed the DARA interference with the antibody screen. The DARA interference was seen with all testing methods (gel, tube, or solid phase). Using the DTT method, 25 of 25 sites (100%) successfully identified the antibody unknown in the presence of DARA. Feedback on the DTT method was positive, with 17 of 19 (90%) sites responding to the survey indicating that they planned to use the DTT method to test clinical samples from DARA-treated patients. CONCLUSION The DTT method is robust and reproducible and can be implemented by transfusion services worldwide to help provide safe blood products to patients treated with DARA.
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Affiliation(s)
- Claudia I Chapuy
- Dana-Farber Cancer Institute at St Elizabeth's Medical Center, Boston, Massachusetts
| | | | | | | | | | - Meghan Delaney
- Bloodworks Northwest, Seattle Children's Hospital, University of Washington, Seattle, Washington
| | - Mark K Fung
- University of Vermont Medical Center, Burlington, Vermont
| | | | - Parul Doshi
- Janssen Research & Development, Springhouse, Pennsylvania
| | | | - Larry J Dumont
- Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
- Dartmouth-Hitchcock Medical Center, Hanover, New Hampshire
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Dunbar NM, Dumont LJ, Szczepiorkowski ZM. How do we implement Day 6 and Day 7 platelets at a hospital-based transfusion service? Transfusion 2016; 56:1262-6. [DOI: 10.1111/trf.13577] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Revised: 02/11/2016] [Accepted: 02/11/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Nancy M. Dunbar
- Department of Pathology and Laboratory Medicine; Dartmouth-Hitchcock Medical Center; Lebanon New Hampshire
- Department of Medicine; Dartmouth-Hitchcock Medical Center; Lebanon New Hampshire
- Geisel School of Medicine at Dartmouth; Hanover New Hampshire
| | - Larry J. Dumont
- Department of Pathology and Laboratory Medicine; Dartmouth-Hitchcock Medical Center; Lebanon New Hampshire
- Center for Transfusion Medicine Research; Dartmouth-Hitchcock Medical Center; Lebanon New Hampshire
- Geisel School of Medicine at Dartmouth; Hanover New Hampshire
| | - Zbigniew M. Szczepiorkowski
- Department of Pathology and Laboratory Medicine; Dartmouth-Hitchcock Medical Center; Lebanon New Hampshire
- Geisel School of Medicine at Dartmouth; Hanover New Hampshire
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de Wolski K, Fu X, Dumont LJ, Roback JD, Waterman H, Odem-Davis K, Howie HL, Zimring JC. Metabolic pathways that correlate with post-transfusion circulation of stored murine red blood cells. Haematologica 2016; 101:578-86. [PMID: 26921359 DOI: 10.3324/haematol.2015.139139] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2015] [Accepted: 02/15/2016] [Indexed: 12/22/2022] Open
Abstract
Transfusion of red blood cells is a very common inpatient procedure, with more than 1 in 70 people in the USA receiving a red blood cell transfusion annually. However, stored red blood cells are a non-uniform product, based upon donor-to-donor variation in red blood cell storage biology. While thousands of biological parameters change in red blood cells over storage, it has remained unclear which changes correlate with function of the red blood cells, as opposed to being co-incidental changes. In the current report, a murine model of red blood cell storage/transfusion is applied across 13 genetically distinct mouse strains and combined with high resolution metabolomics to identify metabolic changes that correlated with red blood cell circulation post storage. Oxidation in general, and peroxidation of lipids in particular, emerged as changes that correlated with extreme statistical significance, including generation of dicarboxylic acids and monohydroxy fatty acids. In addition, differences in anti-oxidant pathways known to regulate oxidative stress on lipid membranes were identified. Finally, metabolites were identified that differed at the time the blood was harvested, and predict how the red blood cells perform after storage, allowing the potential to screen donors at time of collection. Together, these findings map out a new landscape in understanding metabolic changes during red blood cell storage as they relate to red blood cell circulation.
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Affiliation(s)
| | - Xiaoyoun Fu
- Bloodworks NW Research Institute, Seattle, WA, USA University of Washington Department of Internal Medicine, Division of Hematology, Seattle, WA, USA
| | | | - John D Roback
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | | | | | | | - James C Zimring
- Bloodworks NW Research Institute, Seattle, WA, USA University of Washington Department of Internal Medicine, Division of Hematology, Seattle, WA, USA University of Washington Department of Laboratory Medicine and Department of Internal Medicine, Division of Hematology, Seattle, WA, USA
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Nemkov T, Hansen KC, Dumont LJ, D'Alessandro A. Metabolomics in transfusion medicine. Transfusion 2015; 56:980-93. [PMID: 26662506 DOI: 10.1111/trf.13442] [Citation(s) in RCA: 87] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Revised: 11/09/2015] [Accepted: 11/09/2015] [Indexed: 12/13/2022]
Abstract
Biochemical investigations on the regulatory mechanisms of red blood cell (RBC) and platelet (PLT) metabolism have fostered a century of advances in the field of transfusion medicine. Owing to these advances, storage of RBCs and PLT concentrates has become a lifesaving practice in clinical and military settings. There, however, remains room for improvement, especially with regard to the introduction of novel storage and/or rejuvenation solutions, alternative cell processing strategies (e.g., pathogen inactivation technologies), and quality testing (e.g., evaluation of novel containers with alternative plasticizers). Recent advancements in mass spectrometry-based metabolomics and systems biology, the bioinformatics integration of omics data, promise to speed up the design and testing of innovative storage strategies developed to improve the quality, safety, and effectiveness of blood products. Here we review the currently available metabolomics technologies and briefly describe the routine workflow for transfusion medicine-relevant studies. The goal is to provide transfusion medicine experts with adequate tools to navigate through the otherwise overwhelming amount of metabolomics data burgeoning in the field during the past few years. Descriptive metabolomics data have represented the first step omics researchers have taken into the field of transfusion medicine. However, to up the ante, clinical and omics experts will need to merge their expertise to investigate correlative and mechanistic relationships among metabolic variables and transfusion-relevant variables, such as 24-hour in vivo recovery for transfused RBCs. Integration with systems biology models will potentially allow for in silico prediction of metabolic phenotypes, thus streamlining the design and testing of alternative storage strategies and/or solutions.
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Affiliation(s)
- Travis Nemkov
- Department of Biochemistry and Molecular Genetics, University of Colorado Denver-Anschutz Medical Campus, Aurora, Colorado
| | - Kirk C Hansen
- Department of Biochemistry and Molecular Genetics, University of Colorado Denver-Anschutz Medical Campus, Aurora, Colorado
| | - Larry J Dumont
- Department of Pathology, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - Angelo D'Alessandro
- Department of Biochemistry and Molecular Genetics, University of Colorado Denver-Anschutz Medical Campus, Aurora, Colorado
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Dumont LJ, D'Alessandro A, Szczepiorkowski ZM, Yoshida T. CO2 -dependent metabolic modulation in red blood cells stored under anaerobic conditions. Transfusion 2015; 56:392-403. [PMID: 26477888 DOI: 10.1111/trf.13364] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Revised: 08/27/2015] [Accepted: 08/27/2015] [Indexed: 12/16/2022]
Abstract
BACKGROUND Anaerobic red blood cell (RBC) storage reduces oxidative damage, maintains adenosine triphosphate (ATP) and 2,3-diphosphoglycerate (DPG) levels, and has superior 24-hour recovery at 6 weeks compared to standard storage. This study will determine if removal of CO2 during O2 depletion by gas exchange may affect RBCs during anaerobic storage. STUDY DESIGN AND METHODS This is a matched three-arm study (n = 14): control, O2 and CO2 depleted with Ar (AN), and O2 depleted with 95%Ar/5%CO2 (AN[CO2 ]). RBCs in additives AS-3 or OFAS-3 were evenly divided into three bags, and anaerobic conditions were established by gas exchange. Bags were stored at 1 to 6°C in closed chambers under anaerobic conditions or ambient air, sampled weekly for up to 9 weeks for a panel of in vitro tests. A full metabolomics screening was conducted for the first 4 weeks of storage. RESULTS Purging with Ar (AN) results in alkalization of the RBC and increased glucose consumption. The addition of 5% CO2 to the purging gas prevented CO2 loss with an equivalent starting and final pH and lactate to control bags (p > 0.5, Days 0-21). ATP levels are higher in AN[CO2 ] (p < 0.0001). DPG was maintained beyond 2 weeks in the AN arm (p < 0.0001). Surprisingly, DPG was lost at the same rate in both control and AN[CO2 ] arms (p = 0.6). CONCLUSION Maintenance of ATP in the AN[CO2 ] arm demonstrates that ATP production is not solely a function of the pH effect on glycolysis. CO2 in anaerobic storage prevented the maintenance of DPG, and DPG production appears to be pH dependent. CO2 as well as O2 depletion provides metabolic advantage for stored RBCs.
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Affiliation(s)
- Larry J Dumont
- Pathology, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - Angelo D'Alessandro
- Department of Biochemistry and Molecular Genetics, University of Colorado Denver-Anschutz Medical Campus, Aurora, Colorado.,Metabolomics Core, Mass Spectrometry Shared Resource-SOM, University of Colorado Denver, Aurora, Colorado
| | - Zbigniew M Szczepiorkowski
- Pathology, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire.,Pathology, Dartmouth-Hitchcock, Lebanon, New Hampshire
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Cid J, Escolar G, Galan A, López‐Vilchez I, Molina P, Díaz‐Ricart M, Lozano M, Dumont LJ. In vitro evaluation of the hemostatic effectiveness of cryopreserved platelets. Transfusion 2015; 56:580-6. [DOI: 10.1111/trf.13371] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Revised: 08/17/2015] [Accepted: 08/21/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Joan Cid
- Department of Hemotherapy and HemostasisCDB, IDIBAPS, Hospital Clinic University of BarcelonaBarcelona Spain
| | - Ginés Escolar
- Department of Hemotherapy and HemostasisCDB, IDIBAPS, Hospital Clinic University of BarcelonaBarcelona Spain
| | - Ana Galan
- Department of Hemotherapy and HemostasisCDB, IDIBAPS, Hospital Clinic University of BarcelonaBarcelona Spain
| | - Irene López‐Vilchez
- Department of Hemotherapy and HemostasisCDB, IDIBAPS, Hospital Clinic University of BarcelonaBarcelona Spain
| | - Patricia Molina
- Department of Hemotherapy and HemostasisCDB, IDIBAPS, Hospital Clinic University of BarcelonaBarcelona Spain
| | - Maribel Díaz‐Ricart
- Department of Hemotherapy and HemostasisCDB, IDIBAPS, Hospital Clinic University of BarcelonaBarcelona Spain
| | - Miguel Lozano
- Department of Hemotherapy and HemostasisCDB, IDIBAPS, Hospital Clinic University of BarcelonaBarcelona Spain
| | - Larry J. Dumont
- Center for Transfusion Medicine Research, Department of Pathology the Geisel School of Medicine at DartmouthDartmouth‐Hitchcock Medical Center Lebanon New Hampshire
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D'Alessandro A, Nemkov T, Hansen KC, Szczepiorkowski ZM, Dumont LJ. Red blood cell storage in additive solution-7 preserves energy and redox metabolism: a metabolomics approach. Transfusion 2015; 55:2955-66. [PMID: 26271632 DOI: 10.1111/trf.13253] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Revised: 06/05/2015] [Accepted: 06/21/2015] [Indexed: 12/28/2022]
Abstract
BACKGROUND Storage and transfusion of red blood cells (RBCs) has a huge medical and economic impact. Routine storage practices can be ameliorated through the implementation of novel additive solutions (ASs) that tackle the accumulation of biochemical and morphologic lesion during routine cold liquid storage in the blood bank, such as the recently introduced alkaline solution AS-7. Here we hypothesize that AS-7 might exert its beneficial effects through metabolic modulation during routine storage. STUDY DESIGN AND METHODS Apheresis RBCs were resuspended either in control AS-3 or experimental AS-7, before ultrahigh-performance liquid chromatography-mass spectrometry metabolomics analysis. RESULTS Unambiguous assignment and relative quantitation was achieved for 229 metabolites. AS-3 and AS-7 results in many similar metabolic trends over storage, with AS-7 RBCs being more metabolically active in the first storage week. AS-7 units had faster fueling of the pentose phosphate pathway, higher total glutathione pools, and increased flux through glycolysis as indicated by higher levels of pathway intermediates. Metabolite differences are especially observed at 7 days of storage, but were still maintained throughout 42 days. CONCLUSION AS-7 formulation (chloride free and bicarbonate loading) appears to improve energy and redox metabolism in stored RBCs in the early storage period, and the differences, though diminished, are still appreciable by Day 42. Energy metabolism and free fatty acids should be investigated as potentially important determinants for preservation of RBC structure and function. Future studies will be aimed at identifying metabolites that correlate with in vitro and in vivo circulation times.
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Affiliation(s)
- Angelo D'Alessandro
- Department of Biochemistry and Molecular Genetics, University of Colorado Denver-Anschutz Medical Campus, Aurora, Colorado
| | - Travis Nemkov
- Department of Biochemistry and Molecular Genetics, University of Colorado Denver-Anschutz Medical Campus, Aurora, Colorado
| | - Kirk C Hansen
- Department of Biochemistry and Molecular Genetics, University of Colorado Denver-Anschutz Medical Campus, Aurora, Colorado
| | | | - Larry J Dumont
- Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
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Affiliation(s)
- Larry J Dumont
- Center for Transfusion Medicine Research, Lebanon, NH; The Geisel School of Medicine at Dartmouth, Lebanon, NH.
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