[Industrial pasteurization of plasma and criteria of quality]

[Viral attenuation of labile blood products]

Viral inactivation is one of the possibilities to reduce the residual risk of blood products. It is now applied to all plasma derived products (PDP). Application of such techniques to labile blood products (LBP) is difficult for two main reasons: any method should inactivate cell-associated viruses and should avoid any injury of the cells constituting the active ingredient. Physical techniques may reduce the viral content of cellular BPL (leucodepletion, washing, gamma irradiation), but none of them is active enough to comply with the present requirements for efficacy. An important work has been dedicated to the development of virus photoinactivation techniques. They consist of the addition of a photoreagent followed by illumination at an appropriate wavelength which results in a photochemical reaction responsible for the viral inactivation. Treatment of platelet concentrates by psoralen derivatives and UV-A illumination significantly inactivate in vitro enveloped and naked viruses, free and cell-associated viruses and also sequences integrated in the viral genome. Recent progresses have led to these results without detectable functional alteration of platelets and mutagenicity. Viral inactivation of red blood cells yet did not reach the same level because hemoglobin does not allow the use of the photoreagent compounds applicable to platelet concentrates. Viral decontamination of fresh frozen plasma by solvent and detergent, active on enveloped viruses, has been used in France since 1992. Other techniques of comparable efficacy, have received an agreement in other countries. The research on viral inactivation of LBP could prove to be of great importance in the near future in bringing additional safety to patients not only for the residual viral risk but maybe also for the residual bacterial risk of LBP.

[Viral safety of intravenous immunoglobulins G for therapeutic use]

Even though IV IgG concentrates are considered to be among the safest products derived from human plasma, some preparations have been associated with the sporadic transmission of NANB hepatitis and, specifically of hepatitis C. The risk of transmission may have decreased markedly for several IgG preparations since the availability of an immunological test to detect the antibodies against HCV in the starting plasma, but it has not been fully eradicated. Thus, in addition to established viral inactivation treatments, such as acid pH incubation, new methods have been (or are being) implemented to further reduce the risk of HCV infection through IV IgG concentrates. Among these methods are the solvent-detergent treatment already shown to be highly effective for the inactivation of HCV and other enveloped viruses in clotting factor concentrates, and nanofiltration for the specific removal of viruses on the basis of their size. Also, chromatographic methods have helped to improve the overall safety of the product not only by removing viruses but also by improving purity and thus favoring a better in vivo tolerance. This paper reviews the reported cases of HCV transmission and the viral validation data for various IV IgG processing steps and current specific viral inactivation methods. An overview of the present safety status of IV IgG concentrates is presented as well as the recent introduction of new promising techniques for the overall improvement of the safety of this plasma derivative.