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Crowder LA, Dodd RY, Schonberger LB. Absence of evidence of transfusion transmission risk of Creutzfeldt-Jakob disease in the United States: Results froma 28-year lookback study. Transfusion 2024. [PMID: 38650381 DOI: 10.1111/trf.17837] [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: 02/24/2024] [Revised: 03/24/2024] [Accepted: 03/26/2024] [Indexed: 04/25/2024]
Abstract
BACKGROUND For many years, there has been concern about the risk of transmission of classic forms of Creutzfeldt-Jakob disease (CJD) by blood transfusion, particularly after the recognition of such transmission of variant CJD (vCJD). We report on a 28-year lookback study of recipients of blood from donors who subsequently developed CJD. METHODS Patients with diagnosed CJD and a history of blood donation were identified. Blood centers were asked to provide information about the distribution of the donations and consignees were requested to provide information about the recipients of the donations. Vital status of each available recipient was determined and, if deceased, the reported cause(s) of death were obtained primarily from the National Death Index. All recipients included in the study database contributed person-time up to the last recorded review of vital status. RESULTS There were 84 eligible donors who gave 3284 transfusable components, and it was possible to evaluate 1245 recipients, totaling 6495 person-years of observation. The mean observation period per recipient was 5.5 years with a maximum of 51 years. No case of CJD or prion disease was reported among the recipient population. DISCUSSION The study suggests that CJD may not be transfusion-transmissible, a position in agreement with similar findings from two similar European reports amounting to an overall observation period of 15,500 person-years. These studies have supported the conclusion that the risk, if any, of transmission of CJD by blood products is extremely small and remains theoretical.
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Affiliation(s)
- Lauren A Crowder
- American Red Cross, Medical & Scientific Office, Rockville, Maryland, USA
| | - Roger Y Dodd
- American Red Cross, Medical & Scientific Office, Rockville, Maryland, USA
| | - Lawrence B Schonberger
- Division of High-Consequence Pathogens and Pathology, US Centers for Disease Control and Prevention, National Center for Emerging and Zoonotic Infectious Diseases, Atlanta, Georgia, USA
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2
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Prion agents (1st section). Transfusion 2024; 64 Suppl 1:S4-S18. [PMID: 38394039 DOI: 10.1111/trf.17627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 12/01/2023] [Indexed: 02/25/2024]
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3
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Goldman M, Jacquot C, Land K. Medication Deferrals in Blood Donors. Transfus Med Rev 2024; 38:150777. [PMID: 37919209 DOI: 10.1016/j.tmrv.2023.150777] [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: 08/23/2023] [Revised: 09/19/2023] [Accepted: 10/01/2023] [Indexed: 11/04/2023]
Abstract
Medication use is extremely common in blood donors. Blood centers use various methods to obtain a history of medication use, all of which have strengths and weaknesses. Some data are available to develop policies for medications that impact product quality, transmissible disease testing, and infectious risks. Many blood centers defer donors for use of a small number of highly teratogenic medications, as a precautionary measure. Others also defer for possible harms related to the pharmacologic effects of medications. However, a single exposure to a blood component containing medication, with immediate dilution in the recipient's blood stream, is a very different situation from ongoing use of medication in a patient, with steady state concentrations achieved over time. It is therefore highly unlikely that these effects are relevant for recipient safety.
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Affiliation(s)
| | - Cyril Jacquot
- Division of Pathology and Laboratory Medicine, Children's National Hospital, Washington, DC, USA
| | - Kevin Land
- Department of Pathology, UT Health, San Antonio, TX, USA
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4
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James K, Nabuuma B, Mugarura JT, Kirabira JB. Blood bank programs and transfusion sustainability. A serial mediating model. EVALUATION AND PROGRAM PLANNING 2023; 101:102365. [PMID: 37633232 DOI: 10.1016/j.evalprogplan.2023.102365] [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: 12/01/2022] [Revised: 08/18/2023] [Accepted: 08/21/2023] [Indexed: 08/28/2023]
Abstract
INTRODUCTION Researchers establish that the current challenges of blood safety and shortage are based on relationship between master production scheduling and blood transfusion sustainability of blood banks. OBJECTIVE The objective of this study is to evaluate program relationship between master production scheduling and blood transfusion sustainability through total quality management and blood production. METHODS A survey questionnaire was adopted with staff from regional and government university teaching hospital blood banks. Simple random sampling was used to collect data from respondents. Preliminary and main data analysis was done using SPSS AMOS23. RESULTS The results revealed that master production scheduling influence blood transfusion sustainability when serially mediated by total quality management and blood production with 34% variation change at 95% confidence interval. Again, the results obtained show that master production scheduling influence total quality management significantly. Furthermore, total quality management influence blood production significantly. Finally, blood production influence blood transfusion sustainability significantly. CONCLUSION AND RECOMMENDATIONS Master production scheduling program actions has a positive significant relationship with blood transfusion sustainability through total quality management and blood production programs as serial mediators. This research contributes to the management of blood banks and suggests to have a greater relational management of total quality management, blood production and master production scheduling program actions in order to achieve high levels of blood transfusion sustainability, and in general, a greater benefit for society.
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5
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Pozzo di Borgo A, Rochette S, Gaussen A, O'Brien SF, Germain M, Renaud C, Lewin A. Transmission of Variant Creutzfeldt-Jakob Disease Through Blood Transfusion and Plasma-Derived Products: A Narrative Review of Observed and Modeled Risks. Transfus Med Rev 2023; 37:150747. [PMID: 37827587 DOI: 10.1016/j.tmrv.2023.150747] [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: 04/11/2023] [Revised: 05/13/2023] [Accepted: 05/15/2023] [Indexed: 10/14/2023]
Abstract
Secondary transmission of variant Creutzfeldt-Jakob disease (vCJD) can occur through blood transfusion or receipt of plasma-derived products. However, published reviews on this topic are outdated, focused on a single country or product type, or did not comprehensively review modeling studies on the risk of transfusion-transmission. We reviewed existing data on observed and modeled risks of transfusion-transmission of vCJD. To date, five patients are suspected to have acquired clinical vCJD or a vCJD infection after receiving a blood or plasma-derived product from a donor who later developed clinical vCJD. All of these cases received a nonleukodepleted blood-derived product in the United Kingdom between 1994 and 1999. Thus, all transfusion-associated cases occurred before the adoption of universal leukodepletion in 1999, which supports the preferential tropism of vCJD for leukocytes. In descriptive cohort studies, no cases of clinical vCJD were observed over ∼13 years of follow-up. In modeling studies, the risk of collecting a contaminated donation was generally <23 per million donations, that of infection was generally <10 per million transfusions or doses, and that of clinical vCJD was generally <2 per million transfusions or doses. These low risk estimates and the two-decade long absence of new cases of transfusion-associated vCJD suggest vCJD poses minimal risks to the safety of the blood supply. Furthermore, despite concerns of a second wave driven by individuals harboring a non-MM genotype at codon 129 of PRNP, there has been only 1 autopsy-confirmed case of clinical vCJD in an MV individual in 2016. The current trend to reassess or (in some countries) fully withdraw the blood donation criteria related to vCJD therefore seems justified, safe, and may significantly expand the donor base.
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Affiliation(s)
| | - Samuel Rochette
- Medical Affairs and Innovation, Héma-Québec, Montreal, Quebec, Canada.
| | - Amaury Gaussen
- Medical Affairs and Innovation, Héma-Québec, Quebec, Quebec, Canada.
| | - Sheila F O'Brien
- Epidemiology and Surveillance, Canadian Blood Services, Ottawa, Ontario, Canada.
| | - Marc Germain
- Medical Affairs and Innovation, Héma-Québec, Quebec, Quebec, Canada.
| | - Christian Renaud
- Medical Affairs and Innovation, Héma-Québec, Montreal, Quebec, Canada.
| | - Antoine Lewin
- Medical Affairs and Innovation, Héma-Québec, Montreal, Quebec, Canada.
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6
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Thomas S, Roberts B, Domanović D, Kramer K, Klochkov D, Sivasubramaniyam S, Miloslavich D, Plançon JP, Rossi F, Misztela D, Kirkpatrick L, Miflin G, Birchall J, McLintock L, Knight R. Safety profile of plasma for fractionation donated in the United Kingdom, with respect to variant Creutzfeldt-Jakob disease. Vox Sang 2023; 118:345-353. [PMID: 36880992 DOI: 10.1111/vox.13416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 01/16/2023] [Accepted: 02/07/2023] [Indexed: 03/08/2023]
Abstract
Plasma-derived medicinal products (PDMPs) are life-saving and life-improving therapies, but the raw material is in short supply: Europe depends on importation from countries including the United States. Plasma from donors resident in the United Kingdom has not been fractionated since 1999 when a precautionary measure was introduced in response to the outbreak of variant Creutzfeldt-Jakob disease (vCJD). Cases of vCJD have been far fewer than originally predicted in the 1990s. Since the introduction of leucodepletion in 1999, and accounting for the incubation period, more than 40 million UK-derived blood components have been issued with no reports of TT vCJD. In February 2021, the UK Government authorized manufacture of immunoglobulin from UK plasma. Following separate reviews concluding no significant difference in the risk posed, the United States, Australia, Ireland and Hong Kong also lifted their deferrals of blood donors with a history of living in the United Kingdom. Other countries are actively reviewing their position. Demand is rising for PDMPs, and Europe faces a threat of supply shortages. Industry and patient groups are clear that using UK plasma would bring significant immediate benefits to patients and to the resilience of the European supply chain. From this scientific review, we conclude that UK plasma is safe for fractionation and urge blood regulators and operators to take account of this safety profile when considering fractionation of UK plasma, and to revise their guidelines on the deferral of donors who have lived in, or received a transfusion in, the United Kingdom.
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Affiliation(s)
- Stephen Thomas
- Joint UK Blood Transfusion and Tissue Transplantation Services Professional Advisory Committee, London, UK
| | | | | | - Koen Kramer
- Communication, Philosophy, Technology, and Education section, Wageningen University, Wageningen, The Netherlands
| | | | | | | | | | - Françoise Rossi
- International Plasma and Fractionation Association, Amsterdam, The Netherlands
| | | | | | | | | | | | - Richard Knight
- UK National CJD Research & Surveillance Unit, University of Edinburgh, Edinburgh, UK
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7
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The Evolution of the Safety of Plasma Products from Pathogen Transmission-A Continuing Narrative. Pathogens 2023; 12:pathogens12020318. [PMID: 36839590 PMCID: PMC9967166 DOI: 10.3390/pathogens12020318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 02/09/2023] [Accepted: 02/13/2023] [Indexed: 02/17/2023] Open
Abstract
Chronic recipients of plasma products are at risk of infection from blood-borne pathogens as a result of their inevitable exposure to agents which will contaminate a plasma manufacturing pool made up of thousands of individual donations. The generation of such a pool is an essential part of the large-scale manufacture of these products and is required for good manufacturing practice (GMP). Early observations of the transmission of hepatitis by pooled plasma and serum led to the incorporation of heat treatment of the albumin solution produced by industrial Cohn fractionation of plasma. This led to an absence of pathogen transmission by albumin over decades, during which hepatitis continued to be transmitted by other early plasma fractions, as well as through mainstream blood transfusions. This risk was decreased greatly over the 1960s as an understanding of the epidemiology and viral aetiology of transfusion-transmitted hepatitis led to the exclusion of high-risk groups from the donor population and the development of a blood screening test for hepatitis B. Despite these measures, the first plasma concentrates to treat haemophilia transmitted hepatitis B and other, poorly understood, forms of parenterally transmitted hepatitis. These risks were considered to be acceptable given the life-saving nature of the haemophilia treatment products. The emergence of the human immunodeficiency virus (HIV) as a transfusion-transmitted infection in the early 1980s shifted the focus of attention to this virus, which proved to be vulnerable to a number of inactivation methods introduced during manufacture. Further developments in the field obviated the risk of hepatitis C virus (HCV) which had also infected chronic recipients of plasma products, including haemophilia patients and immunodeficient patients receiving immunoglobulin. The convergence of appropriate donor selection driven by knowledge of viral epidemiology, the development of blood screening now based on molecular diagnostics, and the incorporation of viral inactivation techniques in the manufacturing process are now recognised as constituting a "safety tripod" of measures contributing to safety from pathogen transmission. Of these three components, viral inactivation during manufacture is the major contributor and has proven to be the bulwark securing the safety of plasma derivatives over the past thirty years. Concurrently, the safety of banked blood and components continues to depend on donor selection and screening, in the absence of universally adopted pathogen reduction technology. This has resulted in an inversion in the relative safety of the products of blood banking compared to plasma products. Overall, the experience gained in the past decades has resulted in an absence of pathogen transmission from the current generation of plasma derivatives, but maintaining vigilance, and the surveillance of the emergence of infectious agents, is vital to ensure the continued efficacy of the measures in place and the development of further interventions aimed at obviating safety threats.
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8
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Dodd RY, Stramer SL. How do we forecast tomorrow's transfusion: Infectious safety? Transfus Clin Biol 2023; 30:35-38. [PMID: 35987477 DOI: 10.1016/j.tracli.2022.08.143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Continuous improvement has led to a very high degree of microbial safety of transfusion. Four issues are likely to impact the future of this safety. There will be further advances in the efficacy and efficiency of donation testing and pathogen reduction, increasing safety and hopefully eliminating unnecessary procedures. While system failures have been essentially eliminated, there will be ongoing, unpredictable issues that are inevitable. Emerging infections are likely the greatest concern and will continue, although advances in science and technology will permit increasingly rapid responses to outbreaks. Finally, the practice of transfusion may eventually impact safety as usage of blood is reduced and perhaps as alternatives to conventional blood components are developed.
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Affiliation(s)
- Roger Y Dodd
- American Red Cross Blood Services, Scientific Affairs, Rockville, Maryland, USA.
| | - Susan L Stramer
- American Red Cross Blood Services, Scientific Affairs, Rockville, Maryland, USA
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9
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McManus H, Seed CR, Hoad VC, Kiely P, Kaldor JM, Styles CE, Yang H, Law M, Gosbell IB. Risk of variant Creutzfeldt-Jakob disease transmission by blood transfusion in Australia. Vox Sang 2022; 117:1016-1026. [PMID: 35609012 PMCID: PMC9544957 DOI: 10.1111/vox.13290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 03/01/2022] [Accepted: 04/14/2022] [Indexed: 11/30/2022]
Abstract
Background and Objectives Most of the 233 worldwide cases of variant Creutzfeldt–Jakob disease (vCJD) have been reported in the United Kingdom and 3 have been associated with transfusion‐transmission. To mitigate the potential vCJD risk to blood safety, Australian Red Cross Lifeblood imposes restrictions on blood donation from people with prior residency in, or extended travel to, the United Kingdom during the risk period 1980–1996. We have modified a previously published methodology to estimate the transfusion‐transmission risk of vCJD associated with fresh component transfusion in Australia if the UK residence deferral was removed. Materials and Methods The prevalence of current pre‐symptomatic vCJD infection in the United Kingdom by age at infection and genotype was estimated based on risk of exposure to the bovine spongiform encephalopathy agent for the period 1980–1996. These results were used to estimate the age‐specific prevalence of undiagnosed, pre‐symptomatic vCJD in the Australian population in the current year due to prior UK residency or travel. The primary model outputs were the 2020 vCJD risks/unit of vCJD contamination, transfusion‐transmission (infections) and clinical cases. Results The overall (prior UK residency in and travel to United Kingdom, 1980–1996) mean risk of contamination per unit was 1 in 29,900,000. The risks of resulting vCJD transmission (infection) and clinical case were 1 in 389,000,000 and 1 in 1,450,000,000, respectively. Conclusion Our modelling suggests that removing the Lifeblood donation deferral for travel to, or UK residence, would result in virtually no increased risk of vCJD transfusion‐transmission and would be a safe and effective strategy for increasing the donor base.
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Affiliation(s)
- Hamish McManus
- Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Clive R Seed
- Australian Red Cross Lifeblood, Melbourne, Victoria, Australia
| | - Veronica C Hoad
- Australian Red Cross Lifeblood, Melbourne, Victoria, Australia
| | - Philip Kiely
- Australian Red Cross Lifeblood, Melbourne, Victoria, Australia
| | - John M Kaldor
- Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Claire E Styles
- Australian Red Cross Lifeblood, Melbourne, Victoria, Australia
| | - Hong Yang
- US Food and Drug Administration, Rockville, Maryland, USA
| | - Matthew Law
- Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Iain B Gosbell
- Australian Red Cross Lifeblood, Melbourne, Victoria, Australia.,School of Medicine, Western Sydney University, Penrith, New South Wales, Australia
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10
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The risk of Creutzfeldt-Jakob disease infection in cadaveric surgical training. Anat Sci Int 2022; 97:297-302. [PMID: 35312964 DOI: 10.1007/s12565-022-00662-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 03/16/2022] [Indexed: 11/01/2022]
Abstract
The usefulness of cadaver surgical training in the clinical field is already well known. In Japan, the number of universities introducing cadaver surgical training is increasing. In addition to formalin fixation, various fixation methods are used, such as the Thiel method, saturated salt solution method, N-vinyl-2-pyrrolidone method, and fresh-frozen cadavers. Although protection against infections during fixation and cadaver surgical training has been implemented in most universities, it is currently inadequate. Furthermore, the possibility of undiagnosed infectious diseases in donors cannot be excluded. Prion diseases, such as Creutzfeldt-Jakob disease, are relatively rare, but they are fatal, with no effective treatment. The abnormal prion protein that causes prion diseases is resistant to formaldehyde and cannot be inactivated by all methods of cadaver fixation presently in use. Recently developed real-time quaking-induced conversion has been reported to be a useful screening method for prion infection. In addition, this article aims to raise awareness of prion diseases in cadaver surgical training by reviewing the current understanding of prion diseases in cadavers and their screening methods.
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Tsou A, Chen PJ, Tsai KW, Hu WC, Lu KC. THαβ Immunological Pathway as Protective Immune Response against Prion Diseases: An Insight for Prion Infection Therapy. Viruses 2022; 14:v14020408. [PMID: 35216001 PMCID: PMC8877887 DOI: 10.3390/v14020408] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 01/29/2022] [Accepted: 02/15/2022] [Indexed: 01/08/2023] Open
Abstract
Prion diseases, including Creutzfeldt–Jakob disease, are mediated by transmissible proteinaceous pathogens. Pathological changes indicative of neuro-degeneration have been observed in the brains of affected patients. Simultaneously, microglial activation, along with the upregulation of pro-inflammatory cytokines, including IL-1 or TNF-α, have also been observed in brain tissue of these patients. Consequently, pro-inflammatory cytokines are thought to be involved in the pathogenesis of these diseases. Accelerated prion infections have been seen in interleukin-10 knockout mice, and type 1 interferons have been found to be protective against these diseases. Since interleukin-10 and type 1 interferons are key mediators of the antiviral THαβ immunological pathway, protective host immunity against prion diseases may be regulated via THαβ immunity. Currently no effective treatment strategies exist for prion disease; however, drugs that target the regulation of IL-10, IFN-alpha, or IFN-β, and consequently modulate the THαβ immunological pathway, may prove to be effective therapeutic options.
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Affiliation(s)
- Adam Tsou
- Department of Neurology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City 231, Taiwan;
| | - Po-Jui Chen
- Department of Pediatrics, Taoyuan Armed Forces General Hospital, Taoyuan City 325, Taiwan;
| | - Kuo-Wang Tsai
- Department of Medical Research, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City 231, Taiwan; (K.-W.T.); (K.-C.L.)
| | - Wan-Chung Hu
- Department of Clinical Pathology and Medical Research, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City 231, Taiwan
- Correspondence:
| | - Kuo-Cheng Lu
- Department of Medical Research, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City 231, Taiwan; (K.-W.T.); (K.-C.L.)
- Division of Nephrology, Department of Medicine, Fu-Jen Catholic University Hospital, School of Medicine, Fu-Jen Catholic University, New Taipei City 243, Taiwan
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12
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Woerman AL, Tamgüney G. Body-first Parkinson's disease and variant Creutzfeldt-Jakob disease - similar or different? Neurobiol Dis 2022; 164:105625. [PMID: 35026401 DOI: 10.1016/j.nbd.2022.105625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 01/03/2022] [Accepted: 01/07/2022] [Indexed: 10/19/2022] Open
Abstract
In several neurodegenerative disorders, proteins that typically exhibit an α-helical structure misfold into an amyloid conformation rich in β-sheet content. Through a self-templating mechanism, these amyloids are able to induce additional protein misfolding, facilitating their propagation throughout the central nervous system. This disease mechanism was originally identified for the prion protein (PrP), which misfolds into PrPSc in a number of disorders, including variant Creutzfeldt-Jakob disease (vCJD) and bovine spongiform encephalopathy (BSE). More recently, the prion mechanism of disease was expanded to include other proteins that rely on this self-templating mechanism to cause progressive degeneration, including α-synuclein misfolding in Parkinson's disease (PD). Several studies now suggest that PD patients can be subcategorized based on where in the body misfolded α-synuclein originates, either the brain or the gut, similar to patients developing sporadic CJD or vCJD. In this review, we discuss the human and animal model data indicating that α-synuclein and PrPSc misfolding originates in the gut in body-first PD and vCJD, and summarize the data identifying the role of the autonomic nervous system in the gut-brain axis of both diseases.
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Affiliation(s)
- Amanda L Woerman
- Institute for Applied Life Sciences and Department of Biology, University of Massachusetts Amherst, Amherst, MA, USA.
| | - Gültekin Tamgüney
- Institut für Physikalische Biologie, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Germany; Institute of Biological Information Processing, Structural Biochemistry (IBI-7), Forschungszentrum Jülich, Jülich, Germany.
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13
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Sarker T, Katz LM, Bloch EM, Goel R. Blood Product (Donor) Noninfectious and Infectious Testing and Modification. Clin Lab Med 2021; 41:579-598. [PMID: 34689966 DOI: 10.1016/j.cll.2021.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Blood transfusion begins with safe donor selection and testing. In the United States, the blood supply and transfusion are highly regulated. Blood transfusion safety is multifaceted, whereby each of the elements of the blood safety value chain, spanning donor recruitment and qualification, to collection, blood processing, testing, transfusion practice, and posttransfusion surveillance, must be optimized to minimize risk. Pathogen inactivation is a promising approach to decrease bacterial contamination of platelets, inactivate parasites and viruses, and decrease risks associated with emerging and unidentified pathogens. This article offers an overview of blood donor infectious and noninfectious testing in the United States.
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Affiliation(s)
- Tania Sarker
- Department of Pathology and Laboratory Medicine, Center for Transfusion and Cellular Therapies, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - Louis M Katz
- Mississippi Valley Regional Blood Center, Davenport, IA, USA; Carver College of Medicine, UIHC, Iowa City, IA, USA
| | - Evan M Bloch
- Department of Pathology, Transfusion Medicine, Johns Hopkins University School of Medicine, 600 North Wolfe Street/Carnegie 446 D1, Baltimore, MD 21287, USA
| | - Ruchika Goel
- Mississippi Valley Regional Blood Center, Davenport, IA, USA; Division of Hematology/Oncology, Simmons Cancer Institute at SIU SOM; Division of Transfusion Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, USA.
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14
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Prion Dissemination through the Environment and Medical Practices: Facts and Risks for Human Health. Clin Microbiol Rev 2021; 34:e0005919. [PMID: 34319151 DOI: 10.1128/cmr.00059-19] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Prion diseases are a group of fatal, infectious neurodegenerative disorders affecting various species of mammals, including humans. The infectious agent in these diseases, termed prion, is composed exclusively of a misfolded protein that can spread and multiply in the absence of genetic materials. In this article, we provide an overview of the mechanisms of prion replication, interindividual transmission, and dissemination in communities. In particular, we review the potential role of the natural environment in prion transmission, including the mechanisms and pathways for prion entry and accumulation in the environment as well as its roles in prion mutation, adaptation, evolution, and transmission. We also discuss the transmission of prion diseases through medical practices, scientific research, and use of biological products. Detailed knowledge of these aspects is crucial to limit the spreading of existing prion diseases as well as to prevent the emergence of new diseases with possible catastrophic consequences for public health.
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15
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Balkema-Buschmann A, Ziegler U, Priemer G, Tauscher K, Köster F, Ackermann I, Fatola OI, Balkema D, Schinköthe J, Hammerschmidt B, Fast C, Ulrich R, Groschup MH. Absence of classical and atypical (H- and L-) BSE infectivity in the blood of bovines in the clinical end stage of disease as confirmed by intraspecies blood transfusion. J Gen Virol 2021; 102. [PMID: 32589123 PMCID: PMC8116782 DOI: 10.1099/jgv.0.001460] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
While the presence of bovine spongiform encephalopathy (BSE) infectivity in the blood of clinically affected sheep has been proven by intraspecies blood-transfusion experiments, this question has remained open in the case of BSE-affected cattle. Although the absence of infectivity can be anticipated from the restriction of the agent to neuronal tissues in this species, evidence for this was still lacking. This particularly concerns the production and use of medicinal products and other applications containing bovine blood or preparations thereof. We therefore performed a blood-transfusion experiment from cattle in the clinical end stage of disease after experimental challenge with either classical (C-BSE) or atypical (H- and l-) BSE into calves at 4–6 months of age. The animals were kept in a free-ranging group for 10 years. Starting from 24 months post-transfusion, a thorough clinical examination was performed every 6 weeks in order to detect early symptoms of a BSE infection. Throughout the experiment, the clinical picture of all animals gave no indication of a BSE infection. Upon necropsy, the brainstem samples were analysed by BSE rapid test as well as by the highly sensitive Protein Misfolding Cyclic Amplification (PMCA), all with negative results. These results add resilient data to confirm the absence of BSE infectivity in the donor blood collected from C-, H- and l-BSE-affected cattle even in the final clinical phase of the disease. This finding has important implications for the risk assessment of bovine blood and blood products in the production of medicinal products and other preparations.
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Affiliation(s)
- Anne Balkema-Buschmann
- Friedrich-Loeffler-Institut, Institute of Novel and Emerging Infectious Diseases, Greifswald Insel Riems, Germany
| | - Ute Ziegler
- Friedrich-Loeffler-Institut, Institute of Novel and Emerging Infectious Diseases, Greifswald Insel Riems, Germany
| | - Grit Priemer
- Friedrich-Loeffler-Institut, Institute of Novel and Emerging Infectious Diseases, Greifswald Insel Riems, Germany
| | - Kerstin Tauscher
- Friedrich-Loeffler-Institut, Institute of Novel and Emerging Infectious Diseases, Greifswald Insel Riems, Germany
| | - Frauke Köster
- Friedrich-Loeffler-Institut, Institute of Novel and Emerging Infectious Diseases, Greifswald Insel Riems, Germany
| | - Ivett Ackermann
- Friedrich-Loeffler-Institut, Institute of Novel and Emerging Infectious Diseases, Greifswald Insel Riems, Germany
| | - Olanrewaju I Fatola
- Friedrich-Loeffler-Institut, Institute of Novel and Emerging Infectious Diseases, Greifswald Insel Riems, Germany
| | - Daniel Balkema
- Friedrich-Loeffler-Institut, Institute of Novel and Emerging Infectious Diseases, Greifswald Insel Riems, Germany
| | - Jan Schinköthe
- Friedrich-Loeffler-Institut, Department of Experimental Animal Facilities and Biorisk Management, Greifswald Insel Riems, Germany
| | - Bärbel Hammerschmidt
- Friedrich-Loeffler-Institut, Department of Experimental Animal Facilities and Biorisk Management, Greifswald Insel Riems, Germany
| | - Christine Fast
- Friedrich-Loeffler-Institut, Institute of Novel and Emerging Infectious Diseases, Greifswald Insel Riems, Germany
| | - Reiner Ulrich
- Institute of Veterinary Pathology, Leipzig University, Leipzig, Germany.,Friedrich-Loeffler-Institut, Department of Experimental Animal Facilities and Biorisk Management, Greifswald Insel Riems, Germany
| | - Martin H Groschup
- Friedrich-Loeffler-Institut, Institute of Novel and Emerging Infectious Diseases, Greifswald Insel Riems, Germany
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Verity C, Baker E, Maunder P, Pal S, Winstone AM. Differential diagnosis of progressive intellectual and neurological deterioration in children. Dev Med Child Neurol 2021; 63:287-294. [PMID: 32970345 PMCID: PMC7891454 DOI: 10.1111/dmcn.14691] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/25/2020] [Indexed: 01/15/2023]
Abstract
AIM To report the differential diagnosis in children with progressive intellectual and neurological deterioration (PIND) in the UK. METHOD Since 1997 the PIND Study has searched for variant Creutzfeldt-Jakob disease (vCJD) in children, using the British Paediatric Surveillance Unit to perform prospective surveillance of those younger than 16 years with PIND. RESULTS From May 1997 to October 2019, 2255 children meeting PIND criteria had been notified, of whom 2008 (1085 males, 923 females) had underlying diagnoses. There were over 220 different diseases, including six cases of vCJD. The numbers presenting in four age groups were: <1 year, 805 (40%); 1 to 4 years inclusive, 825 (41%); 5 to 9 years inclusive, 264 (13%); and 10 to 15 years inclusive, 114 (6%). The two largest ethnic groups were White and Pakistani (58.2% and 17% of diagnosed cases). The most common diseases in these two ethnic groups are shown for the four age groups. The distribution of diseases varied with age but was quite similar in White and Pakistani children. INTERPRETATION This paper provides a unique guide to the complex differential diagnosis of childhood PIND, showing considerable differences between four age groups, but similarities between ethnic groups. The PIND Study still provides the only systematic surveillance for vCJD in children in the UK. WHAT THIS PAPER ADDS The prevalence of diseases causing childhood progressive intellectual and neurological deterioration in the UK is low (approximately 0.1/1000 live births). There were more than 220 different disorders, mainly genetically determined. The majority of disorders presented early in childhood: 81% before the age of 5 years. There were similarities in the disease spectrum in White and Pakistani children.
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Affiliation(s)
| | - Elaine Baker
- The PIND Research GroupAddenbrooke’s HospitalCambridgeUK
| | - Polly Maunder
- The PIND Research GroupAddenbrooke’s HospitalCambridgeUK
| | - Suvankar Pal
- The National Creutzfeldt‐Jakob Disease Research and Surveillance UnitUniversity of EdinburghEdinburghUK
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Salamat MKF, Blanco ARA, McCutcheon S, Tan KBC, Stewart P, Brown H, Smith A, de Wolf C, Groschup MH, Becher D, Andréoletti O, Turner M, Manson JC, Houston EF. Preclinical transmission of prions by blood transfusion is influenced by donor genotype and route of infection. PLoS Pathog 2021; 17:e1009276. [PMID: 33600501 PMCID: PMC7891701 DOI: 10.1371/journal.ppat.1009276] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 01/04/2021] [Indexed: 11/23/2022] Open
Abstract
Variant Creutzfeldt-Jakob disease (vCJD) is a human prion disease resulting from zoonotic transmission of bovine spongiform encephalopathy (BSE). Documented cases of vCJD transmission by blood transfusion necessitate on-going risk reduction measures to protect blood supplies, such as leucodepletion (removal of white blood cells, WBCs). This study set out to determine the risks of prion transmission by transfusion of labile blood components (red blood cells, platelets, plasma) commonly used in human medicine, and the effectiveness of leucodepletion in preventing infection, using BSE-infected sheep as a model. All components were capable of transmitting prion disease when donors were in the preclinical phase of infection, with the highest rates of infection in recipients of whole blood and buffy coat, and the lowest in recipients of plasma. Leucodepletion of components (<106 WBCs/unit) resulted in significantly lower transmission rates, but did not completely prevent transmission by any component. Donor PRNP genotype at codon 141, which is associated with variation in incubation period, also had a significant effect on transfusion transmission rates. A sensitive protein misfolding cyclic amplification (PMCA) assay, applied to longitudinal series of blood samples, identified infected sheep from 4 months post infection. However, in donor sheep (orally infected), the onset of detection of PrPSc in blood was much more variable, and generally later, compared to recipients (intravenous infection). This shows that the route and method of infection may profoundly affect the period during which an individual is infectious, and the test sensitivity required for reliable preclinical diagnosis, both of which have important implications for disease control. Our results emphasize that blood transfusion can be a highly efficient route of transmission for prion diseases. Given current uncertainties over the prevalence of asymptomatic vCJD carriers, this argues for the maintenance and improvement of current measures to reduce the risk of transmission by blood products. Variant Creutzfeldt-Jakob disease (vCJD) resulted from zoonotic transmission of bovine spongiform encephalopathy (BSE), and has also been transmitted by blood transfusion. One of the most important risk reduction measures introduced by human transfusion services to safeguard the blood supply is leucodepletion (removal of white blood cells) of blood components. This study represents the largest experimental analysis to date of the risks of prion infection associated with transfusion of labile blood components, and the effectiveness of leucodepletion in preventing transmission. Using a BSE-infected sheep model, we found that red blood cells, platelets and plasma from preclinical donors were all infectious, even after leucodepletion, although leucodepletion significantly reduced transmission rates. In addition, the time course of detection of prions in blood varied significantly depending on the route and method of infection. This has important implications for the risk of onward transmission, and suggests that further improvements in sensitivity of diagnostic tests will be required for reliable preclinical diagnosis of vCJD and other prion diseases. The results of this study support the continuation of current measures to reduce the risk of vCJD transmission by blood products, and suggest areas for further improvement.
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Affiliation(s)
- M. Khalid F. Salamat
- The Roslin Institute, Royal (Dick) School of Veterinary Studies, University of Edinburgh, Easter Bush, Midlothian, Edinburgh, United Kingdom
| | - A. Richard Alejo Blanco
- The Roslin Institute, Royal (Dick) School of Veterinary Studies, University of Edinburgh, Easter Bush, Midlothian, Edinburgh, United Kingdom
| | - Sandra McCutcheon
- The Roslin Institute, Royal (Dick) School of Veterinary Studies, University of Edinburgh, Easter Bush, Midlothian, Edinburgh, United Kingdom
| | - Kyle B. C. Tan
- The Roslin Institute, Royal (Dick) School of Veterinary Studies, University of Edinburgh, Easter Bush, Midlothian, Edinburgh, United Kingdom
| | - Paula Stewart
- The Roslin Institute, Royal (Dick) School of Veterinary Studies, University of Edinburgh, Easter Bush, Midlothian, Edinburgh, United Kingdom
| | - Helen Brown
- The Roslin Institute, Royal (Dick) School of Veterinary Studies, University of Edinburgh, Easter Bush, Midlothian, Edinburgh, United Kingdom
| | - Allister Smith
- The Roslin Institute, Royal (Dick) School of Veterinary Studies, University of Edinburgh, Easter Bush, Midlothian, Edinburgh, United Kingdom
| | - Christopher de Wolf
- The Roslin Institute, Royal (Dick) School of Veterinary Studies, University of Edinburgh, Easter Bush, Midlothian, Edinburgh, United Kingdom
| | - Martin H. Groschup
- Friedrich-Loeffler-Institut, Institute of Novel and Emerging Infectious Diseases, Greifswald, Germany
| | | | - Olivier Andréoletti
- UMR INRA ENVT 1225, Interactions Hôtes Agents Pathogènes, Ecole Nationale Vétérinaire de Toulouse, Toulouse, France
| | - Marc Turner
- Scottish National Blood Transfusion Service (SNBTS), The Jack Copland Centre, Edinburgh, United Kingdom
| | - Jean C. Manson
- The Roslin Institute, Royal (Dick) School of Veterinary Studies, University of Edinburgh, Easter Bush, Midlothian, Edinburgh, United Kingdom
| | - E. Fiona Houston
- The Roslin Institute, Royal (Dick) School of Veterinary Studies, University of Edinburgh, Easter Bush, Midlothian, Edinburgh, United Kingdom
- * E-mail:
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18
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De Vries K, Cousins E, Harrison Dening K. Palliative care in Creutzfeldt-Jakob disease: looking back, thinking ahead. BMJ Support Palliat Care 2021:bmjspcare-2020-002799. [PMID: 33483321 DOI: 10.1136/bmjspcare-2020-002799] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 12/23/2020] [Indexed: 11/03/2022]
Abstract
Creutzfeldt-Jakob disease (CJD) is a rare and fatal neurodegenerative disease for which there is no cure. However, it is difficult to diagnose and is unique in that it is both a genetic and transmissible disease. The disease is characterised by symptoms of a rapidly progressive dementia. Palliation is the only treatment and early diagnosis is an important aspect in relation to gaining speedy access to palliative and end-of-life care services. People with CJD may be cared for in a diversity of settings including; general hospital wards, neurological units, hospices; care homes and in their own home. Management of physical and psychosocial symptoms and dealing with family bereavement is complex and challenging. Due to the complexity of the physical symptoms input from clinicians with palliative care expertise is an important consideration. Given transmission risk and the latent incidence of infection in the general population, following the emergence of variant CJD; plus the recent hypothesis of a potential relationship between immune responses to COVID-19 and the acceleration of preclinical or evident neurodegenerative disease, there is a need for renewed interest in research in this field. Over the past 20 years, many thousands of articles have been published on CJD. These have been predominately in the medical and science literature and very few publications have addressed the nursing care of persons and families dealing with CJD. There is a need for renewed interest in the management of the disease by supportive and palliative care services.
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Affiliation(s)
- Kay De Vries
- Faculty Health & Life Sciences, De Montfort University, Leicester, UK
| | - Emily Cousins
- Faculty Health & Life Sciences, De Montfort University, Leicester, UK
| | - Karen Harrison Dening
- Research & Publications, Dementia UK, London, UK
- De Montfort University, Leicester, UK
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Kal'nov SL, Verkhovsky OA, Tsibezov VV, Alekseev KP, Chudakova DA, Filatov IE, Grebennikova TV. [Problems of ante mortem diagnostics of prion diseases]. Vopr Virusol 2021; 65:326-334. [PMID: 33533229 DOI: 10.36233/0507-4088-2020-65-6-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 01/07/2021] [Indexed: 11/05/2022]
Abstract
The review presents the state-of-the-art on the problem of diagnosis of prion diseases (PD) in humans and animals with a brief description of their etiology and pathogenesis. We pointed out that understanding the nature of the etio logical agent of PD determined their zoonotic potential and led to the development of highly specific immunological diagnostic methods aimed at identifying the infectious isoform of prion protein (PrPd) as the only marker of the disease. In this regard, we briefly summarize the results of studies, including our own, concerning the conversion of normal prion protein molecules (PrPc) to PrPd, the production of monoclonal antibodies and their application as immunodiagnostic reagents for the post-mortem detection of PrPd in various formats of immunoassay. We also emphasize the issues related to the development of methods for ante mortem diagnostics of PD. In this regard, a method for amplifying amino acid sequences using quacking-induced conversion of PrPc to PrPd in real time (RTQuIC) described in details. The results of recent studies on the assessment of the sensitivity, specificity and reproducibility of this method, carried out in various laboratories around the world, are presented. The data obtained indicate that RT-QuIC is currently the most promising laboratory assay for detecting PrPd in biological material at the preclinical stage of the disease. The significant contribution of US scientists to the introduction of this method into clinical practice on the model of diagnosis of chronic wasting disease of wild Cervidae (CWD) is noted. The possible further spread of CWD in the population of moose and deer in the territories bordering with Russia, as well as the established fact of alimentary transmission of CWD to macaques, indicate the threat of the appearance of PD in our country. In conclusion, the importance of developing new hypersensitive and/or selective components of known methods for PrPd identification from the point of view of assessing the risks of creating artificial infectious prion proteins in vivo or in vitro, primarily new pathogenic isoforms ("strains") and synthetic prions, was outlined.
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Affiliation(s)
- S L Kal'nov
- FSBI «National Research Centre of Epidemiology and Microbiology named after honorary academician N.F. Gamaleya» of the Ministry of Health of Russia
| | - O A Verkhovsky
- ANO «Diagnostic and Prevention for Human and Animal Diseases Research Institute»
| | - V V Tsibezov
- FSBI «National Research Centre of Epidemiology and Microbiology named after honorary academician N.F. Gamaleya» of the Ministry of Health of Russia
| | - K P Alekseev
- FSBI «National Research Centre of Epidemiology and Microbiology named after honorary academician N.F. Gamaleya» of the Ministry of Health of Russia
| | - D A Chudakova
- School of Biological sciences, University of Auckland
| | - I E Filatov
- FSBI «National Research Centre of Epidemiology and Microbiology named after honorary academician N.F. Gamaleya» of the Ministry of Health of Russia
| | - T V Grebennikova
- FSBI «National Research Centre of Epidemiology and Microbiology named after honorary academician N.F. Gamaleya» of the Ministry of Health of Russia
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Bolcato M, Russo M, Trentino K, Isbister J, Rodriguez D, Aprile A. Patient blood management: The best approach to transfusion medicine risk management. Transfus Apher Sci 2020; 59:102779. [DOI: 10.1016/j.transci.2020.102779] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Revised: 03/24/2020] [Accepted: 04/05/2020] [Indexed: 02/07/2023]
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Abstract
PURPOSE OF REVIEW Prion diseases are rapidly progressive neurodegenerative conditions that can be difficult to diagnose and are transmissible under specific circumstances. The authors will provide background regarding prion disease and focus on diagnostic tools. RECENT FINDINGS Prion disease is caused by misfolded prion protein. The three possible causes of prion disease include sporadic (85%), genetic (10-15%), and acquired (<1%). Acquired prion diseases include kuru, iatrogenic, and variant Creutzfeldt-Jakob disease. Prion diseases differ in their clinical manifestation, neuropathology, and diagnostic test results. A variety of recent diagnostic tools have evolved that allow more reliable antemortem diagnosis of prion disease such as brain MRI and cerebrospinal fluid real-time quaking-induced conversion. Special infectivity guidelines must be followed when dealing with central nervous system tissue, but only standard precautions are needed for routine clinical care of patients with prion disease. SUMMARY The only way to definitely diagnose prion disease and determine its type is via neuropathologic examination. However, brain MRI and cerebrospinal fluid real-time quaking-induced conversion have drastically increased diagnostic accuracy and are important tests to use when evaluating patients with suspected prion disease.
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22
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Gill ON, Spencer Y, Richard-Loendt A, Kelly C, Brown D, Sinka K, Andrews N, Dabaghian R, Simmons M, Edwards P, Bellerby P, Everest DJ, McCall M, McCardle LM, Linehan J, Mead S, Hilton DA, Ironside JW, Brandner S. Prevalence in Britain of abnormal prion protein in human appendices before and after exposure to the cattle BSE epizootic. Acta Neuropathol 2020; 139:965-976. [PMID: 32232565 PMCID: PMC7244468 DOI: 10.1007/s00401-020-02153-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 03/23/2020] [Accepted: 03/23/2020] [Indexed: 12/20/2022]
Abstract
Widespread dietary exposure of the population of Britain to bovine spongiform encephalopathy (BSE) prions in the 1980s and 1990s led to the emergence of variant Creutzfeldt-Jakob Disease (vCJD) in humans. Two previous appendectomy sample surveys (Appendix-1 and -2) estimated the prevalence of abnormal prion protein (PrP) in the British population exposed to BSE to be 237 per million and 493 per million, respectively. The Appendix-3 survey was recommended to measure the prevalence of abnormal PrP in population groups thought to have been unexposed to BSE. Immunohistochemistry for abnormal PrP was performed on 29,516 samples from appendices removed between 1962 and 1979 from persons born between 1891 through 1965, and from those born after 1996 that had been operated on from 2000 through 2014. Seven appendices were positive for abnormal PrP, of which two were from the pre-BSE-exposure era and five from the post BSE-exposure period. None of the seven positive samples were from appendices removed before 1977, or in patients born after 2000 and none came from individuals diagnosed with vCJD. There was no statistical difference in the prevalence of abnormal PrP across birth and exposure cohorts. Two interpretations are possible. Either there is a low background prevalence of abnormal PrP in human lymphoid tissues that may not progress to vCJD. Alternatively, all positive specimens are attributable to BSE exposure, a finding that would necessitate human exposure having begun in the late 1970s and continuing through the late 1990s.
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Affiliation(s)
- O Noel Gill
- STI and HIV Department and CJD Section' Blood Safety, Hepatitis, STIs and HIV Division Public Health England National Infection Service, 61 Colindale Avenue, London, NW9 5EQ, United Kingdom
| | - Yvonne Spencer
- Pathology and Animal Sciences Department Science Directorate Animal and Plant Health Agency Addlestone, Surrey, KT15 3NB, United Kingdom
| | - Angela Richard-Loendt
- Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology Queen Square, London, WC1N 3BG, United Kingdom
- Division of Neuropathology, The National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust Queen Square, London, WC1N 3BG, United Kingdom
| | - Carole Kelly
- STI and HIV Department and CJD Section' Blood Safety, Hepatitis, STIs and HIV Division Public Health England National Infection Service, 61 Colindale Avenue, London, NW9 5EQ, United Kingdom
| | - David Brown
- Virus Reference Department Public, Health England National Infection Service, 61 Colindale Avenue, London, NW9 5HT, United Kingdom
| | - Katy Sinka
- STI and HIV Department and CJD Section' Blood Safety, Hepatitis, STIs and HIV Division Public Health England National Infection Service, 61 Colindale Avenue, London, NW9 5EQ, United Kingdom
| | - Nick Andrews
- STI and HIV Department and CJD Section' Blood Safety, Hepatitis, STIs and HIV Division Public Health England National Infection Service, 61 Colindale Avenue, London, NW9 5EQ, United Kingdom
| | - Reza Dabaghian
- Virus Reference Department Public, Health England National Infection Service, 61 Colindale Avenue, London, NW9 5HT, United Kingdom
| | - Marion Simmons
- Pathology and Animal Sciences Department Science Directorate Animal and Plant Health Agency Addlestone, Surrey, KT15 3NB, United Kingdom
| | - Philip Edwards
- Department of Cellular and Anatomical, Pathology University Hospitals Plymouth, Plymouth, PL6 8DH, United Kingdom
| | - Peter Bellerby
- Pathology and Animal Sciences Department Science Directorate Animal and Plant Health Agency Addlestone, Surrey, KT15 3NB, United Kingdom
| | - David J Everest
- Pathology and Animal Sciences Department Science Directorate Animal and Plant Health Agency Addlestone, Surrey, KT15 3NB, United Kingdom
| | - Mark McCall
- STI and HIV Department and CJD Section' Blood Safety, Hepatitis, STIs and HIV Division Public Health England National Infection Service, 61 Colindale Avenue, London, NW9 5EQ, United Kingdom
| | - Linda M McCardle
- National Creutzfeldt-Jakob Disease Research and Surveillance Unit Centre for Clinical Brain Sciences, University of Edinburgh, Western General Hospital, Edinburgh, EH4 2XU, United Kingdom
| | - Jacqueline Linehan
- MRC Prion Unit at UCL, UCL Institute of Prion Diseases Courtauld Building, 33 Cleveland Street, London, W1W 7FF, United Kingdom
| | - Simon Mead
- MRC Prion Unit at UCL, UCL Institute of Prion Diseases Courtauld Building, 33 Cleveland Street, London, W1W 7FF, United Kingdom
| | - David A Hilton
- Department of Cellular and Anatomical, Pathology University Hospitals Plymouth, Plymouth, PL6 8DH, United Kingdom
| | - James W Ironside
- National Creutzfeldt-Jakob Disease Research and Surveillance Unit Centre for Clinical Brain Sciences, University of Edinburgh, Western General Hospital, Edinburgh, EH4 2XU, United Kingdom
| | - Sebastian Brandner
- Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology Queen Square, London, WC1N 3BG, United Kingdom.
- Division of Neuropathology, The National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust Queen Square, London, WC1N 3BG, United Kingdom.
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Khan F, Singh K, Friedman MT. Artificial Blood: The History and Current Perspectives of Blood Substitutes. Discoveries (Craiova) 2020; 8:e104. [PMID: 32309621 PMCID: PMC7086064 DOI: 10.15190/d.2020.1] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 03/07/2020] [Accepted: 03/07/2020] [Indexed: 01/09/2023] Open
Abstract
Blood transfusions are one of the most common procedures performed in hospitalized patients. Yet, despite all of the measures taken to ensure the safety of the blood supply, there are known risks associated with transfusions, including infectious and noninfectious complications. Meanwhile, issues with blood product availability, the need for compatibility testing, and the storage and transport requirements of blood products, have presented challenges for the administration of blood transfusions. Additionally, there are individuals who do not accept blood transfusions (e.g., Jehovah's Witnesses). Therefore, there is a need to develop alternative agents that can reliably and safely replace blood. However, although there have been many attempts to develop blood substitutes over the years, there are currently no such products available that have been approved by the United States Food and Drug Administration (FDA). However, a more-recently developed hemoglobin-based oxygen carrier has shown promise in early clinical trials and has achieved the status of "Orphan Drug" under the FDA.
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Affiliation(s)
- Fahad Khan
- Mount Sinai Health System, Department of Pathology and Laboratory Medicine, Icahn School of Medicine, New York, NY, USA
| | - Kunwar Singh
- Mount Sinai Health System, Department of Pathology and Laboratory Medicine, Icahn School of Medicine, New York, NY, USA
| | - Mark T. Friedman
- Mount Sinai Health System, Department of Pathology and Laboratory Medicine, Icahn School of Medicine, New York, NY, USA
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Bohonek M, Kutac D, Acker JP, Seghatchian J. Optimizing the supply of whole blood-derived bioproducts through the combined implementation of cryopreservation and pathogen reduction technologies and practices: An overview. Transfus Apher Sci 2020; 59:102754. [PMID: 32165117 DOI: 10.1016/j.transci.2020.102754] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The essential historical knowledge and expertise developed over the past 5-6 decades on the safety / efficacy of conventional blood components therapy by blood transfusion establishments have guided the development of validated methods which have ensure optimal safety margins for frozen blood and its bioproducts with or even without pathogen reduction. Newer generations of pathogen reduced frozen red blood cell, plasma and platelet products and the standardised and safer pooling of human platelet lysate are now become available for potential clinical use. These types of whole blood-derived bioproducts not only reduce the risk of transmission of range of pathogenic blood-borne pathogen. As cryopreservation can be combined with PRT without significantly compromising in vitro quality characteristics or physiological capabilities, it allows us to maximize the available inventory of these blood products in both civil and military trauma settings. The main objective of this overview is to update readers and scientific / medical communities of the various building blocks needed to optimally grantee the pathogen safety of whole blood-derived bioproducts, with minimal untoward events to the recipients. While this is an emerging area, we are seeing the numerous potential opportunities that cryopreservation and pathogen inactivation can have on the transfused patient outcomes. This manuscript is informed by recent publications on this topic.
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Affiliation(s)
- Milos Bohonek
- Department of Haematology and Blood Transfusion, Military University Hospital Prague, Faculty of Biomedical Engineering, Czech Technical University in Prague, Prague, Czech Republic.
| | - Dominik Kutac
- Department of Haematology and Blood Transfusion, Military University Hospital Prague, Faculty of Military Health Sciences, University of Defence Hradec Kralove, Hradec Kralove, Czech Republic.
| | - Jason P Acker
- Centre for Innovation, Canadian Blood Services, Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada.
| | - Jerard Seghatchian
- International Consultancy in Blood Components Quality/Safety Improvement, Audit/Inspection, and DDR Strategies, London, England, UK.
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Burnouf T, Barro L, Nebie O, Wu YW, Goubran H, Knutson F, Seghatchian J. Viral safety of human platelet lysate for cell therapy and regenerative medicine: Moving forward, yes, but without forgetting the past. Transfus Apher Sci 2019; 58:102674. [PMID: 31735652 DOI: 10.1016/j.transci.2019.102674] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Growth factor-rich pooled human platelet lysate (HPL), made from human platelet concentrates, is one new blood-derived bioproduct that is attracting justified interest as a xeno-free supplement of growth media for human cell propagation for cell therapy. HPL can also find potentially relevant applications in the field of regenerative medicine. Therefore, the therapeutic applications of HPL go far beyond the standard clinical applications of the traditional blood products typically used in patients suffering from life-threatening congenital or acquired deficiencies in cellular components or proteins due to severe genetic diseases or trauma. A wider population of patients, suffering from various pathologies than has traditionally been the case, is thus, now susceptible to receiving a human blood-derived product. These patients would, therefore, be exposed to the possible, but avoidable, side effects of blood products, including transfusion-transmitted infections, most specifically virus transmissions. Unfortunately, not all manufacturers, suppliers, and users of HPL may have a strong background in the blood product industry. As such, they may not be fully aware of the various building blocks that should contribute to the viral safety of HPL as is already the case for any licensed blood products. The purpose of this manuscript is to reemphasize all the measures, including in regulatory aspects, capable of assuring that HPL exhibits a sufficient pathogen safety margin, especially when made from large pools of human platelet concentrates. It is vital to remember the past to avoid that the mistakes, which happened 30 to 40 years ago and led to the contamination of many blood recipients, be repeated due to negligence or ignorance of the facts.
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Affiliation(s)
- 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; Research Center of Biomedical Devices, College of Biomedical Engineering, Taipei Medical University, Taipei, Taiwan; International PhD Program in Cell Therapy and Regeneration Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
| | - Lassina Barro
- International PhD Program in Biomedical Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei, Taiwan
| | - Ouada Nebie
- Graduate Institute of Biomedical Materials and Tissue Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei, Taiwan
| | - Yu-Wen Wu
- Graduate Institute of Biomedical Materials and Tissue Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei, Taiwan
| | - Hadi Goubran
- Saskatoon Cancer Centre, Division of Oncology, College of Medicine, University of Saskatchewan, Canada
| | - Folke Knutson
- Clinical Immunology and Transfusion Medicine IGP, Uppsala University, Uppsala, Sweden
| | - Jerard Seghatchian
- International Consultancy in Blood Components Quality/Safety Improvement, Audit/Inspection and DDR Strategies, London, UK
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Schallmoser K, Henschler R, Gabriel C, Koh MBC, Burnouf T. Production and Quality Requirements of Human Platelet Lysate: A Position Statement from the Working Party on Cellular Therapies of the International Society of Blood Transfusion. Trends Biotechnol 2019; 38:13-23. [PMID: 31326128 DOI: 10.1016/j.tibtech.2019.06.002] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 06/12/2019] [Accepted: 06/12/2019] [Indexed: 12/28/2022]
Abstract
Human platelet lysate (HPL), rich in growth factors, is an efficient alternative supplement to fetal bovine serum (FBS) for ex vivo propagation of stromal cell-based medicinal products. Since 2014, HPL has been a focus of the Working Party for Cellular Therapies of the International Society of Blood Transfusion (ISBT). Currently, as several Good Manufacturing Practice (GMP)-compliant manufacturing protocols exist, an international consensus defining the optimal modes of industrial production, product specification, pathogen safety, and release criteria of this ancillary material (AM) is needed. This opinion article by the ISBT Working Party summarizes the current knowledge on HPL production and proposes recommendations on manufacturing and quality management in line with current technological innovations and regulations of biological products and advanced therapy medicinal products.
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Affiliation(s)
- Katharina Schallmoser
- Department of Transfusion Medicine, and Spinal Cord Injury and Tissue Regeneration Center Salzburg (Sci-TReCS), Paracelsus Medical University, Salzburg, Austria.
| | - Reinhard Henschler
- Institute of Transfusion Medicine, University Hospital Leipzig AöR, Leipzig, Germany
| | - Christian Gabriel
- Department of Blood Group Serology and Transfusion Medicine, Medical University of Graz, Graz, Austria; Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Austrian Cluster for Tissue Regeneration, Vienna, Austria
| | - Mickey B C Koh
- St George's Hospital and Medical School, London, UK; Cell Therapy Facility, Blood Services Group, Health Sciences Authority, Singapore
| | - 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; International PhD Program in Cell Therapy and Regeneration Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
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27
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Verity C, Winstone AM, Will R, Powell A, Baxter P, de Sousa C, Gissen P, Kurian M, Livingston J, McFarland R, Pal S, Pike M, Robinson R, Wassmer E, Zuberi S. Surveillance for variant CJD: should more children with neurodegenerative diseases have autopsies? Arch Dis Child 2019; 104:360-365. [PMID: 30337492 PMCID: PMC6530073 DOI: 10.1136/archdischild-2018-315458] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 08/30/2018] [Accepted: 09/26/2018] [Indexed: 11/07/2022]
Abstract
OBJECTIVES To report investigations performed in children with progressive neurodegenerative diseases reported to this UK study. DESIGN Since 1997 paediatric surveillance for variant Creutzfeldt-Jakob disease (vCJD) has been performed by identifying children aged less than 16 years with progressive intellectual and neurological deterioration (PIND) and searching for vCJD among them. SETTING The PIND Study obtains case details from paediatricians who notify via the British Paediatric Surveillance Unit. PARTICIPANTS Between May 1997 and October 2017, a total of 2050 cases meeting PIND criteria had been notified and investigated. RESULTS Six children had vCJD. 1819 children had other diagnoses, made in 12 cases by antemortem brain biopsy and in 15 by postmortem investigations. 225 children were undiagnosed: only 3 had antemortem brain biopsies and only 14 of the 108 who died were known to have had autopsies; postmortem neuropathological studies were carried out in just 10% (11/108) and only two had prion protein staining of brain tissue. Of the undiagnosed cases 43% were known to come from Asian British families. CONCLUSIONS Most of the notified children had a diagnosis other than vCJD to explain their neurological deterioration. None of the undiagnosed cases had the clinical phenotype of vCJD but brain tissue was rarely studied to exclude vCJD. Clinical surveillance via the PIND Study remains the only practical means of searching for vCJD in UK children.
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Affiliation(s)
| | | | - Robert Will
- The National Creutzfeldt-Jakob Disease Research and Surveillance Unit, Western General Hospital, Edinburgh, UK
| | - Alison Powell
- PIND Research Group, Addenbrooke’s Hospital, Cambridge, UK
| | - Peter Baxter
- Paediatric Neurology Department, Sheffield Children’s NHS Foundation Trust, Sheffield, UK
| | - Carlos de Sousa
- Neurology Department, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Paul Gissen
- Neurology Department, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Manju Kurian
- Institute of Child Health, Great Ormond Street Hospital for Children, London, UK
| | - John Livingston
- Paediatric Neurology Department, Leeds General Infirmary, Leeds, UK
| | - Robert McFarland
- Wellcome Trust Centre for Mitochondrial Research, Institute of Neuroscience, The Medical School, Newcastle upon Tyne, UK
| | - Suvankar Pal
- The National Creutzfeldt-Jakob Disease Research and Surveillance Unit, Western General Hospital, Edinburgh, UK
| | - Michael Pike
- Paediatric Neurology Department, Oxford Children’s Hospital, John Radcliffe Hospital site, Oxford, UK
| | | | - Evangeline Wassmer
- Paediatric Neurology Department, Birmingham Children’s Hospital, Birmingham, UK
| | - Sameer Zuberi
- Paediatric Neurosciences Research Group, Royal Hospital for Children and School of Medicine, University of Glasgow, Glasgow, UK
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28
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Wood EM, Ang AL, Bisht A, Bolton-Maggs PH, Bokhorst AG, Flesland O, Land K, Wiersum-Osselton JC, Schipperus MR, Tiberghien P, Whitaker BI. International haemovigilance: what have we learned and what do we need to do next? Transfus Med 2019; 29:221-230. [PMID: 30729612 DOI: 10.1111/tme.12582] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 11/05/2018] [Accepted: 01/12/2019] [Indexed: 02/06/2023]
Abstract
The International Haemovigilance Network (IHN) defines haemovigilance as 'a set of surveillance procedures covering the whole transfusion chain (from the collection of blood and its components to the follow-up of recipients), intended to collect and assess information on unexpected or undesirable effects resulting from the therapeutic use of labile blood products, and to prevent their occurrence or recurrence'. IHN, the International Society of Blood Transfusion and World Health Organization work together to support both developing and established haemovigilance systems. Haemovigilance systems provide valuable data on a range of adverse events related to blood donation and clinical transfusion, from donor syncopal events to transfusion-transmitted infections, immunological complications and the impact of human errors. Harmonised definitions for most adverse reactions have been developed and validated internationally. Definitions of pulmonary complications are again under review. Haemovigilance data have resulted in changes in policy, products and practice, and can complement and inform clinical audit and research, leading to improved blood donor safety, optimised product use and better clinical outcomes after transfusion. However, more work is needed. Not all countries have haemovigilance systems in place. More robust data and careful analysis are required to improve the understanding of the causes, occurrence and clinical outcomes of these events. Wider dissemination of results will facilitate health policy development internationally, and implementation of haemovigilance recommendations will support further important progress in blood safety.
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Affiliation(s)
- E M Wood
- Transfusion Research Unit, Monash University, Melbourne, Victoria, Australia.,Department of Clinical Haematology, Monash Health, Melbourne, Victoria, Australia
| | - A L Ang
- Blood Services Group, Health Sciences Authority, Singapore.,Department of Haematology, Singapore General Hospital, Singapore
| | - A Bisht
- Haemovigilance Programme of India, National Institute of Biologicals, Ministry of Health & Family Welfare, Noida, India
| | - P H Bolton-Maggs
- Serious Hazards of Transfusion, Manchester, UK.,University of Manchester, Manchester, UK
| | - A G Bokhorst
- Transfusion and Transplantation Reactions in Patients (TRIP), National Haemovigilance and Biovigilance Office, Leiden, The Netherlands
| | - O Flesland
- Norwegian Directorate of Health, Oslo, Norway
| | - K Land
- Blood Systems Inc., Tempe, Arizona, USA.,Department of Pathology, University of Texas Health Science Center, San Antonio, Texas, USA
| | - J C Wiersum-Osselton
- Transfusion and Transplantation Reactions in Patients (TRIP), National Haemovigilance and Biovigilance Office, Leiden, The Netherlands
| | - M R Schipperus
- Transfusion and Transplantation Reactions in Patients (TRIP), National Haemovigilance and Biovigilance Office, Leiden, The Netherlands.,Department of Haematology, Haga Teaching Hospital, The Hague, The Netherlands
| | - P Tiberghien
- Etablissement Français du Sang, La Plaine St Denis, France.,Université de Franche-Comté, Inserm, EFS, UMR 1098, Besançon, France
| | - B I Whitaker
- Office of Biostatistics and Epidemiology, Center for Biologics Evaluation and Review US Food & Drug Administration, Silver Spring, Maryland, USA
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29
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Prediction and Prevention: Interventions to Enhance Blood Safety. BLOOD SAFETY 2019. [PMCID: PMC7120977 DOI: 10.1007/978-3-319-94436-4_1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The transmission of infectious disease by blood transfusion has been a major problem since the middle of the twentieth century. Since about 1960, there has been a concerted and prolonged effort to reduce or eliminate this outcome; the efforts have been successful, but new challenges continue to appear, mostly in the form of emerging infectious diseases. This chapter reviews two relevant issues: the possibility of predicting microbial threats to blood safety and the interventions that may be used to reduce the risks of transfusion transmission. While there are only limited opportunities to predict relevant infections, there are effective measures to enhance blood safety. These involve appropriate selection of donors, implementation of effective tests, and development and implementation of pathogen reduction.
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30
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Review: Fluid biomarkers in the human prion diseases. Mol Cell Neurosci 2018; 97:81-92. [PMID: 30529227 DOI: 10.1016/j.mcn.2018.12.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 11/29/2018] [Accepted: 12/03/2018] [Indexed: 01/27/2023] Open
Abstract
The human prion diseases are a diverse set of often rapidly progressive neurodegenerative conditions associated with abnormal forms of the prion protein. We review work to establish diagnostic biomarkers and assays that might fill other important roles, particularly those that could assist the planning and interpretation of clinical trials. The field now benefits from highly sensitive and specific diagnostic biomarkers using cerebrospinal fluid: detecting by-products of rapid neurodegeneration or specific functional properties of abnormal prion protein, with the second generation real time quaking induced conversion (RT-QuIC) assay being particularly promising. Blood has been a more challenging analyte, but has now also yielded valuable biomarkers. Blood-based assays have been developed with the potential to screen for variant Creutzfeldt-Jakob disease, although it remains uncertain whether these will ever be used in practice. The very rapid neurodegeneration of prion disease results in strong signals from surrogate protein markers in the blood that reflect neuronal, axonal, synaptic or glial pathology in the brain: notably the tau and neurofilament light chain proteins. We discuss early evidence that such tests, applied alongside robust diagnostic biomarkers, may have potential to add value as clinical trial outcome measures, predictors of future disease course (including for asymptomatic individuals at high risk of prion disease), and as rapidly accessible and sensitive markers to aid early diagnosis.
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Silva CJ. Food Forensics: Using Mass Spectrometry To Detect Foodborne Protein Contaminants, as Exemplified by Shiga Toxin Variants and Prion Strains. JOURNAL OF AGRICULTURAL AND FOOD CHEMISTRY 2018; 66:8435-8450. [PMID: 29860833 DOI: 10.1021/acs.jafc.8b01517] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Food forensicists need a variety of tools to detect the many possible food contaminants. As a result of its analytical flexibility, mass spectrometry is one of those tools. Use of the multiple reaction monitoring (MRM) method expands its use to quantitation as well as detection of infectious proteins (prions) and protein toxins, such as Shiga toxins. The sample processing steps inactivate prions and Shiga toxins; the proteins are digested with proteases to yield peptides suitable for MRM-based analysis. Prions are detected by their distinct physicochemical properties and differential covalent modification. Shiga toxin analysis is based on detecting peptides derived from the five identical binding B subunits comprising the toxin. 15N-labeled internal standards are prepared from cloned proteins. These examples illustrate the power of MRM, in that the same instrument can be used to safely detect and quantitate protein toxins, prions, and small molecules that might contaminate our food.
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Affiliation(s)
- Christopher J Silva
- Produce Safety and Microbiology Research Unit, Western Regional Research Center, Agricultural Research Service , United States Department of Agriculture , Albany , California 94710 , United States
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