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Fischer S, Zilkenat S, Rosse M, Schulze TJ, Seltsam A, Handke W, Lepenies B, Gravemann U. Dose-dependent inactivation of Plasmodium falciparum in red blood cell concentrates by treatment with short-wavelength ultraviolet light. Vox Sang 2024. [PMID: 39048115 DOI: 10.1111/vox.13714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Revised: 07/01/2024] [Accepted: 07/01/2024] [Indexed: 07/27/2024]
Abstract
BACKGROUND AND OBJECTIVES Plasmodium species are naturally transmitted by Anopheles mosquitos. The parasite infects red blood cells (RBCs) and can be transfused with blood products. In non-endemic areas, the main risk of infection arises from travellers coming back and people immigrating from malaria-endemic regions. Endemic countries face a permanent risk of infection from transfusion-transmitted malaria (TTM). TTM may cause life-threatening complications in patients dependent on blood donations. This study aimed to investigate the efficacy of Plasmodium falciparum inactivation in RBC units by treatment with short-wavelength ultraviolet C (UVC) light in the absence of photochemical additives. MATERIALS AND METHODS RBC units were spiked with P. falciparum to a parasite density of 0.1%-1% and irradiated with up to 4.5 J/cm2 UVC. The parasite density of UVC-treated dilution series and untreated controls were compared over 3 weeks after irradiation. RESULTS The lowest dose of 1.5 J/cm2 UVC led to a 3.1 log reduction in parasite load compared with the untreated control. The inactivation capacity was dose-dependent. Strikingly, 4.5 J/cm2 led to ≥5.3 log unit reduction, which was equivalent to a complete inactivation in two out of three experiments. CONCLUSION Pathogen reduction with UVC light was previously shown to be effective for different bacteria and viruses, but the inactivation of parasites in RBC concentrates was not addressed until now. The present study provides evidence for significant inactivation of P. falciparum-infected RBCs by UVC light.
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Affiliation(s)
- Swantje Fischer
- Institute for Immunology, University of Veterinary Medicine Hannover, Hanover, Germany
- Research Center for Emerging Infections and Zoonoses, University of Veterinary Medicine Hannover, Hanover, Germany
| | - Susann Zilkenat
- DRK-Blutspendedienst NSTOB, Institut Springe, Springe, Germany
| | - Mona Rosse
- Institute for Immunology, University of Veterinary Medicine Hannover, Hanover, Germany
- Research Center for Emerging Infections and Zoonoses, University of Veterinary Medicine Hannover, Hanover, Germany
| | - Torsten J Schulze
- DRK-Blutspendedienst NSTOB, Institut Springe, Springe, Germany
- Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Oldenburg, Oldenburg, Germany
| | - Axel Seltsam
- Bavarian Red Cross Blood Service, Institute Nuremberg, Nuremberg, Germany
| | - Wiebke Handke
- Bavarian Red Cross Blood Service, Institute Nuremberg, Nuremberg, Germany
| | - Bernd Lepenies
- Institute for Immunology, University of Veterinary Medicine Hannover, Hanover, Germany
- Research Center for Emerging Infections and Zoonoses, University of Veterinary Medicine Hannover, Hanover, Germany
| | - Ute Gravemann
- DRK-Blutspendedienst NSTOB, Institut Springe, Springe, Germany
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Elmi A, Said Mohamed A, Mérito A, Charneau S, Amina M, Grellier P, Bouachrine M, Lawson AM, Abdoul-Latif FM, Kordofani MAY. The ethnopharmacological study of plant drugs used traditionally in Djibouti for malaria treatment. JOURNAL OF ETHNOPHARMACOLOGY 2024; 325:117839. [PMID: 38310984 DOI: 10.1016/j.jep.2024.117839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 01/23/2024] [Accepted: 01/27/2024] [Indexed: 02/06/2024]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Djibouti was a country where malaria has been endemic for centuries. The local population use the plants as repellents or first aid for uncomplicated malaria. AIM OF THE STUDY The aim was, for the first time, to collect and identify plants used by the local population to treat malaria and select the most interesting plants (those that are more commontly used, more available, and have fewer studies). These plants were evaluated for their antiplasmodial activity as well as their cytotoxicity on human cell lines for the most active ones. MATERIALS AND METHODS A semi-structured questionnaire was developed for this study to collect information about the use and identity of botanical drugs used to treat malaria. The use-reports (percentage) of each plant were recorded to determine their use importance. Also, the availability status of the plants was assessed; and those in critical condition were discarded excluded from further study. Fifteen plants, out of the 41 listed, were extracted with hydro alcohol, ethyl acetate, and dichloromethane for biological testing. Chloroquine-resistant strain FcB-1 of P. falciparum and a human diploid embryonic lung cell line were used for the antiplasmodial test, and to assess the cytotoxicity for human cells respectively. Preliminary analysis of extract constituents was carried out using thin layer chromatography (TLC). RESULTS This study identifies 41 plant taxa belonging to 32 families and records their use against malaria. Balanites rodunfolia, belonging to the Zygophyllaceae family, was the most commonly used plant, representing 44 % of use-reports. It was followed by Cadaba rodunfolia (15 %) from the Capparaceae family, and then the three species of Aloe: Aloe djiboutiensis (8.2 %), Aloe ericahenriettae (3.4 %), and Aloe rigens (3.4 %) from the Asphodelaceae family. The leaves are the most commonly used part of the plants to treat malaria, accounting for 76 % of usage. The preparation methods were decoction (52 %), maceration (29 %), and boiling (19 %). The administration routes were by oral (80 %), inhalation 19 %), and bathing (1 %). The best antiplasmodial activities were observed in the dichloromethane extracts of Cymbopogon commutatus and the ethyl acetate extracts of Aloe rigens and Terminalia brownii, with IC50 values of 9.8, 5, and 7.5 μg/mL, respectively. Their toxicity/activity levels were very favorable with selectivity indices of 5.6, 8.1, and 11.8 for C. commutatus, A. rigens, and T. Brownii, respectively. CONCLUSION Forty-one species of botanical drugs were listed as being used to treat malaria in Djibouti. All fifteen selected species showed antiplasmodial activity (IC50 < 50 μg/mL). This work will help guide the valorization of botanical drugs used to treat malaria in Djibouti.
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Affiliation(s)
- Abdirahman Elmi
- Centre d'Étude et de Recherche de Djibouti, Institut de Recherche Médicinale, Route de l'aéroport, Djibouti.
| | - A Said Mohamed
- Centre d'Étude et de Recherche de Djibouti, Institut de Recherche Médicinale, Route de l'aéroport, Djibouti
| | - Ali Mérito
- Centre d'Étude et de Recherche de Djibouti, Institut de Recherche Médicinale, Route de l'aéroport, Djibouti
| | - Sébastien Charneau
- Laboratory of Biochemistry and Protein Chemistry, Department of Cell Biology, Institute of Biology, University of Brasilia, Brasilia, Brazil
| | - Mohamed Amina
- Centre d'Étude et de Recherche de Djibouti, Institut de Recherche Médicinale, Route de l'aéroport, Djibouti
| | - Philippe Grellier
- Unité Molécules de Communication et Adaptation des Microorganismes (MCAM, UMR 7245), Muséum National d'Histoire Naturelle, CNRS, CP52, 57 Rue Cuvier, 75005, Paris, France
| | - Mohammed Bouachrine
- High School of Technology EST-Khenifra, Sultan Moulay Sliman University, Beni mellal, Morocco
| | - Ata M Lawson
- Normandie Univ., UNILEHAVRE, URCOM, UR 3221, INC3M, FR-CNRS 3038, 76600, Le Havre, France
| | - Fatouma M Abdoul-Latif
- Centre d'Étude et de Recherche de Djibouti, Institut de Recherche Médicinale, Route de l'aéroport, Djibouti
| | - Maha A Y Kordofani
- Department of Botany, Faculty of Science, University of Khartoum, P.O. Box 321, Khartoum, Sudan
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Tordon B, Drews SJ, Flahr F, Bennett K, Gaziano T, Anderson D, Nahirniak S, Gerges H, Tyrrell GJ, Mah J, Ndao M, Bigham M, Seftel M. Canadian Blood Services traceback investigation of a suspected case of transfusion-transmitted malaria. Transfusion 2023; 63:2001-2006. [PMID: 37715564 DOI: 10.1111/trf.17549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 07/25/2023] [Accepted: 07/25/2023] [Indexed: 09/17/2023]
Abstract
BACKGROUND A 4-month-old infant hospitalized since birth received multiple blood transfusions. In March 2022, Plasmodium falciparum was confirmed with nucleic acid testing. As the mother was assessed as unlikely to be the source of infection, the blood operator initiated a traceback investigation for a potential blood donor source. The patient had received 13 red blood cell (RBC) transfusions (aliquoted from 11 donors), 4 apheresis platelet (PLT) transfusions and 16 buffy coat pooled PLT transfusions. The blood operator medical team developed a supplementary malaria infection risk questionnaire to identify donors at highest risk of life-time malaria infection, based on birthplace, residence, or travel in malaria-endemic regions. RESULTS With 79 donors initially implicated, initial focus was on donors of RBC components. The 11 RBC donors were contacted and assessed using the supplementary questionnaire. Three donors, all of whom met current malaria-related donor eligibility criteria, were deemed high risk of prior malaria infection. These donors consented to P. falciparum serology and nucleic acid testing (NAT). One donor who was born and had resided in an endemic West African country for 14 years, was positive for P. falciparum by serology (indirect fluorescent antibody test) and NAT-(Ct ≥32). Lookback of this donor's transfused fresh co-components and prior donation identified no other malaria cases. CONCLUSION This was a probable transfusion-transmitted malaria (TTM) case from an eligible donor who in retrospect was found to have unrecognized, asymptomatic, semi-immune malaria infection, and who was potentially infectious. Blood donor lack of recall of prior malaria infection does not negate the risk of TTM from those who have lived in malaria-endemic countries.
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Affiliation(s)
- Bryan Tordon
- Alberta Precision Laboratories (APL), Calgary, Alberta, Canada
| | - Steven J Drews
- Microbiology, Donation Policy & Studies, Canadian Blood Services, Edmonton, Alberta, Canada
- University of Alberta, Edmonton, Alberta, Canada
| | | | | | | | | | - Susan Nahirniak
- University of Alberta, Edmonton, Alberta, Canada
- Alberta Precision Laboratories (APL), Edmonton, Alberta, Canada
| | - Hanan Gerges
- University of Alberta, Edmonton, Alberta, Canada
| | - Gregory J Tyrrell
- University of Alberta, Edmonton, Alberta, Canada
- Alberta Health Services, Edmonton, Alberta, Canada
- APL Public Health, Edmonton, Alberta, Canada
| | - Jordan Mah
- University of Alberta, Edmonton, Alberta, Canada
| | - Momar Ndao
- National Reference Centre for Parasitology, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
- Department of Medicine, Division of Infectious Diseases, McGill University, Montreal, Quebec, Canada
| | - Mark Bigham
- Canadian Blood Services, Vancouver, British Columbia, Canada
| | - Matthew Seftel
- Canadian Blood Services, Vancouver, British Columbia, Canada
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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Santa Maria F, Huang YJS, Vanlandingham DL, Bringmann P. Inactivation of SARS-CoV-2 in All Blood Components Using Amotosalen/Ultraviolet A Light and Amustaline/Glutathione Pathogen Reduction Technologies. Pathogens 2022; 11:pathogens11050521. [PMID: 35631042 PMCID: PMC9147860 DOI: 10.3390/pathogens11050521] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Revised: 04/24/2022] [Accepted: 04/25/2022] [Indexed: 12/04/2022] Open
Abstract
No cases of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transfusion-transmitted infections (TTI) have been reported. The detection of viral RNA in peripheral blood from infected patients and blood components from infected asymptomatic blood donors is, however, concerning. This study investigated the efficacy of the amotosalen/UVA light (A/UVA) and amustaline (S-303)/glutathione (GSH) pathogen reduction technologies (PRT) to inactivate SARS-CoV-2 in plasma and platelet concentrates (PC), or red blood cells (RBC), respectively. Plasma, PC prepared in platelet additive solution (PC-PAS) or 100% plasma (PC-100), and RBC prepared in AS-1 additive solution were spiked with SARS-CoV-2 and PR treated. Infectious viral titers were determined by plaque assay and log reduction factors (LRF) were determined by comparing titers before and after treatment. PR treatment of SARS-CoV-2-contaminated blood components resulted in inactivation of the infectious virus to the limit of detection with A/UVA LRF of >3.3 for plasma, >3.2 for PC-PAS-plasma, and >3.5 for PC-plasma and S-303/GSH LRF > 4.2 for RBC. These data confirm the susceptibility of coronaviruses, including SARS-CoV-2 to A/UVA treatment. This study demonstrates the effectiveness of the S-303/GSH treatment to inactivate SARS-CoV-2, and that PRT can reduce the risk of SARS-CoV-2 TTI in all blood components.
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Affiliation(s)
| | - Yan-Jang S. Huang
- Department of Diagnostic Medicine/Pathobiology, Biosecurity Research Institute, Kansas State University, Manhattan, KS 66506, USA; (Y.-J.S.H.); (D.L.V.)
| | - Dana L. Vanlandingham
- Department of Diagnostic Medicine/Pathobiology, Biosecurity Research Institute, Kansas State University, Manhattan, KS 66506, USA; (Y.-J.S.H.); (D.L.V.)
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Sow C, Bouissou A, Girard YA, Singh GB, Bounaadja L, Payrat JM, Haas D, Isola H, Lanteri MC, Bringmann P, Grellier P. Robust inactivation of Plasmodium falciparum in red blood cell concentrates using amustaline and glutathione pathogen reduction. Transfusion 2022; 62:1073-1083. [PMID: 35385146 PMCID: PMC9325390 DOI: 10.1111/trf.16867] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 02/22/2022] [Accepted: 03/08/2022] [Indexed: 12/20/2022]
Abstract
BACKGROUND Plasmodium falciparum is the parasite responsible for most malaria cases globally. The risk of transfusion-transmitted malaria (TTM) is mitigated by donor deferrals and blood screening strategies, which adversely impact blood availability. Previous studies showed robust inactivation of P. falciparum using nucleic acid-targeting pathogen reduction technologies (PRT) for the treatment of plasma and platelet components or whole blood (WB). The efficacy of the amustaline-glutathione (GSH) PRT to inactivate P. falciparum is here evaluated in red blood cells (RBC), as well the impact of PRT on parasite loads, stages, and strains. STUDY DESIGN AND METHODS RBC units resuspended in AS-1 or AS-5 additive solutions were spiked with ring stage-infected RBC and treated with the amustaline-GSH PRT. Parasite loads and viability were measured in samples at the time of contamination, and after treatment, using serial 10-fold dilutions of the samples in RBC cultures maintained for up to 4 weeks. RESULTS P. falciparum viability assays allow for the detection of very low levels of parasite. Initial parasite titer was >5.2 log10 /ml in AS-1/5 RBC. No infectious parasites were detected in amustaline-GSH-treated samples after 4 weeks of culture. Amustaline-GSH inactivated high parasite loads regardless of parasite stages and strains. Amustaline readily penetrates the parasite, irreversibly blocks development, and leads to parasite death and expulsion from RBC. DISCUSSION Amustaline-GSH PRT demonstrated robust efficacy to inactivate malaria parasites in RBC concentrates. This study completes the portfolio of studies demonstrating the efficacy of nucleic acid-targeting PRTs to mitigate TTM risks as previously reported for platelet concentrates, plasma, and WB.
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Affiliation(s)
- Cissé Sow
- UMR7245 MCAM, Muséum National d'Histoire Naturelle, Team PPL, CNRS, Paris, France
| | - Amélie Bouissou
- UMR7245 MCAM, Muséum National d'Histoire Naturelle, Team PPL, CNRS, Paris, France
| | | | | | - Lotfi Bounaadja
- UMR7245 MCAM, Muséum National d'Histoire Naturelle, Team PPL, CNRS, Paris, France
| | | | | | | | | | | | - Philippe Grellier
- UMR7245 MCAM, Muséum National d'Histoire Naturelle, Team PPL, CNRS, Paris, France
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Malaria. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2022; 65:512-524. [PMID: 35119479 PMCID: PMC8814801 DOI: 10.1007/s00103-022-03490-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Niederhauser C, Galel SA. Transfusion-Transmitted Malaria and Mitigation Strategies in Nonendemic Regions. Transfus Med Hemother 2022; 49:205-217. [PMID: 36159954 PMCID: PMC9421689 DOI: 10.1159/000525414] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 06/07/2022] [Indexed: 11/19/2022] Open
Abstract
Background Malaria is a mosquito-borne infectious disease caused by protozoan parasites of the genus Plasmodium. These parasites can be transmitted by blood transfusion especially through Red Cell Blood Concentrates collected from asymptomatic and parasitemic donors. As migration of populations from endemic areas to Europe and overseas recreational travel to endemic regions increase, there is growing risk of transfusion-transmitted malaria (TTM) in nonendemic regions of the world. The present work provides an overview of the mitigation strategies in nonendemic countries and their effectiveness and discusses possible approaches to evolve the strategies in order to maintain both a safe and adequate blood supply. Summary The historical and current situation of malaria and TTM in Europe and on the North American continent are described. The infectivity of Plasmodium in blood components and the consequences of TTM are presented, along with the regulations and guidelines for TTM mitigation in Europe, USA, and Canada. The regulations/guidelines currently in place in Europe allow a certain amount of leeway for local policies. A questionnaire was used to survey European countries regarding their current strategies and recent TTM cases. From the questionnaire and published cases, approximately 20 cases of TTM were identified in the past 20 years in the USA and Europe. The vast majority of implicated donors have been former residents of malaria-endemic areas, particularly former residents of hyperendemic areas in Africa. The most recent TTM cases are discussed in detail to provide insight into the gaps in current strategies. The utility and uncertainties of pathogen reduction and serological and molecular testing methods are discussed. Key Messages Overall, the risk of transfusion-associated malaria in nonendemic countries is considered to be low and very few TTM cases occurred in these regions in the last 20 years. The questionnaire-based strategy with questions about risk in relation to malaria exposure with or without selective testing based on questioning seems to be relatively effective, although rare and sometimes fatal transmissions still occur. An outstanding question is whether in the future molecular methods may further improve the safety of blood products and help constrain the loss of donors.
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Affiliation(s)
- Christoph Niederhauser
- Interregional Blood Transfusion SRC, Bern, Switzerland
- Institute for Infectious Disease, University of Bern, Bern, Switzerland
- *Christoph Niederhauser,
| | - Susan A. Galel
- Roche Diagnostics Solutions, Pleasanton, California, USA
- Stanford University School of Medicine, Palo Alto, California, USA
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Escolar G, Diaz-Ricart M, McCullough J. Impact of different pathogen reduction technologies on the biochemistry, function, and clinical effectiveness of platelet concentrates: An updated view during a pandemic. Transfusion 2021; 62:227-246. [PMID: 34870335 PMCID: PMC9300014 DOI: 10.1111/trf.16747] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Revised: 09/03/2021] [Accepted: 10/06/2021] [Indexed: 12/25/2022]
Abstract
Standard platelet concentrates (PCs) stored at 22°C have a limited shelf life of 5 days. Because of the storage temperature, bacterial contamination of PCs can result in life‐threatening infections in transfused patients. The potential of blood components to cause infections through contaminating pathogens or transmitting blood‐borne diseases has always been a concern. The current safety practice to prevent pathogen transmission through blood transfusion starts with a stringent screening of donors and regulated testing of blood samples to ensure that known infections cannot reach transfusion products. Pathogen reduction technologies (PRTs), initially implemented to ensure the safety of plasma products, have been adapted to treat platelet products. In addition to reducing bacterial contamination, PRT applied to PCs can extend their shelf life up to 7 days, alleviating the impact of their shortage, while providing an additional safety layer against emerging blood‐borne infectious diseases. While a deleterious action of PRTs in quantitative and qualitative aspects of plasma is accepted, the impact of PRTs on the quality, function, and clinical efficacy of PCs has been under constant examination. The potential of PRTs to prevent the possibility of new emerging diseases to reach cellular blood components has been considered more hypothetical than real. In 2019, a coronavirus‐related disease (COVID‐19) became a pandemic. This episode should help when reconsidering the possibility of future blood transmissible threats. The following text intends to evaluate the impact of different PRTs on the quality, function, and clinical effectiveness of platelets within the perspective of a developing pandemic.
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Affiliation(s)
- Gines Escolar
- Department of Hematopathology, Centre Diagnostic Biomedic, Hospital Clinic, Barcelona, Spain
| | - Maribel Diaz-Ricart
- Department of Hematopathology, Centre Diagnostic Biomedic, Hospital Clinic, Barcelona, Spain
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