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Stubbs JR, Shaz BH, Vassallo RR, Roback JD. Expanding the platelet inventory to mitigate the impact of severe shortages. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2022; 2022:424-429. [PMID: 36485081 PMCID: PMC9821291 DOI: 10.1182/hematology.2022000379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
The platelet collection and distribution system, based on volunteer nonremunerated donors, apheresis platelet collections, and primarily 1-directional distribution of platelets for up to 5-day room temperature storage at hospitals, typically performs well and provides therapeutic support for hundreds of thousands of patients annually. However, direct and indirect effects of the coronavirus disease 2019 pandemic, particularly during the Omicron wave, produced dramatic systemic failures and severe shortages. We propose 4 initiatives to reinforce the existing platelet pipeline and buffer the platelet supply against future unexpected disruptions.
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Affiliation(s)
- James R. Stubbs
- Division of Transfusion Medicine, Mayo Clinic, Rochester, MN
| | - Beth H. Shaz
- Department of Pathology, Duke University School of Medicine, Durham, NC
| | | | - John D. Roback
- Center for Transfusion and Cellular Therapies, Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA
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Kasirye R, Hume HA, Bloch EM, Lubega I, Kyeyune D, Shrestha R, Ddungu H, Musana HW, Dhabangi A, Ouma J, Eroju P, de Lange T, Tartakovsky M, White JL, Kakura C, Fowler MG, Musoke P, Nolan M, Grabowski MK, Moulton LH, Stramer SL, Whitby D, Zimmerman PA, Wabwire D, Kajja I, McCullough J, Goodrich R, Quinn TC, Cortes R, Ness PM, Tobian AAR. The Mirasol Evaluation of Reduction in Infections Trial (MERIT): study protocol for a randomized controlled clinical trial. Trials 2022; 23:257. [PMID: 35379302 PMCID: PMC8978156 DOI: 10.1186/s13063-022-06137-8] [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: 01/14/2022] [Accepted: 03/02/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Transfusion-transmitted infections (TTIs) are a global health challenge. One new approach to reduce TTIs is the use of pathogen reduction technology (PRT). In vitro, Mirasol PRT reduces the infectious load in whole blood (WB) by at least 99%. However, there are limited in vivo data on the safety and efficacy of Mirasol PRT. The objective of the Mirasol Evaluation of Reduction in Infections Trial (MERIT) is to investigate whether Mirasol PRT of WB can prevent seven targeted TTIs (malaria, bacteria, human immunodeficiency virus, hepatitis B virus, hepatitis C virus, hepatitis E virus, and human herpesvirus 8). METHODS MERIT is a randomized, double-blinded, controlled clinical trial. Recruitment started in November 2019 and is expected to end in 2024. Consenting participants who require transfusion as medically indicated at three hospitals in Kampala, Uganda, will be randomized to receive either Mirasol-treated WB (n = 1000) or standard WB (n = 1000). TTI testing will be performed on donor units and recipients (pre-transfusion and day 2, day 7, week 4, and week 10 after transfusion). The primary endpoint is the cumulative incidence of one or more targeted TTIs from the Mirasol-treated WB vs. standard WB in a previously negative recipient for the specific TTI that is also detected in the donor unit. Log-binomial regression models will be used to estimate the relative risk reduction of a TTI by 10 weeks associated with Mirasol PRT. The clinical effectiveness of Mirasol WB compared to standard WB products in recipients will also be evaluated. DISCUSSION Screening infrastructure for TTIs in low-resource settings has gaps, even for major TTIs. PRT presents a fast, potentially cost-effective, and easy-to-use technology to improve blood safety. MERIT is the largest clinical trial designed to evaluate the use of Mirasol PRT for WB. In addition, this trial will provide data on TTIs in Uganda. TRIAL REGISTRATION Mirasol Evaluation of Reduction in Infections Trial (MERIT) NCT03737669 . Registered on 9 November 2018.
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Affiliation(s)
- Ronnie Kasirye
- grid.421981.7MUJHU Research Collaboration, Kampala, Uganda
| | - Heather A. Hume
- grid.14848.310000 0001 2292 3357Department of Pediatrics, University of Montreal, Montréal, QC Canada
| | - Evan M. Bloch
- grid.21107.350000 0001 2171 9311Department of Pathology, School of Medicine, Johns Hopkins University, Baltimore, MD USA
| | - Irene Lubega
- grid.421981.7MUJHU Research Collaboration, Kampala, Uganda
| | | | - Ruchee Shrestha
- grid.21107.350000 0001 2171 9311Department of Pathology, School of Medicine, Johns Hopkins University, Baltimore, MD USA
| | - Henry Ddungu
- grid.512320.70000 0004 6015 3252Uganda Cancer Institute, Kampala, Uganda
| | | | - Aggrey Dhabangi
- grid.11194.3c0000 0004 0620 0548Child Health and Development Centre, Makerere University College of Health Sciences, Kampala, Uganda
| | - Joseph Ouma
- grid.421981.7MUJHU Research Collaboration, Kampala, Uganda
| | | | - Telsa de Lange
- grid.419681.30000 0001 2164 9667National Institute of Allergy and Infectious Diseases Office of Cyber Infrastructure and Computational Biology, Bethesda, MD USA
| | - Michael Tartakovsky
- grid.419681.30000 0001 2164 9667National Institute of Allergy and Infectious Diseases Office of Cyber Infrastructure and Computational Biology, Bethesda, MD USA
| | - Jodie L. White
- grid.21107.350000 0001 2171 9311Department of Pathology, School of Medicine, Johns Hopkins University, Baltimore, MD USA
| | - Ceasar Kakura
- grid.421981.7MUJHU Research Collaboration, Kampala, Uganda
| | - Mary Glenn Fowler
- grid.21107.350000 0001 2171 9311Department of Pathology, School of Medicine, Johns Hopkins University, Baltimore, MD USA
| | - Philippa Musoke
- grid.11194.3c0000 0004 0620 0548Makerere University, Kampala, Uganda
| | - Monica Nolan
- grid.421981.7MUJHU Research Collaboration, Kampala, Uganda
| | - M. Kate Grabowski
- grid.21107.350000 0001 2171 9311Department of Pathology, School of Medicine, Johns Hopkins University, Baltimore, MD USA
| | - Lawrence H. Moulton
- grid.21107.350000 0001 2171 9311Department of International Health, School of Public Health, Johns Hopkins University, Baltimore, MD USA
| | - Susan L. Stramer
- grid.281926.60000 0001 2214 8581Department of Scientific Affairs, American Red Cross, Gaithersburg, MD USA
| | - Denise Whitby
- grid.418021.e0000 0004 0535 8394Leidos Biomedical Research, AIDS and Cancer Virus Program, Frederick National Laboratory for Cancer Research, Frederick, MD USA
| | - Peter A. Zimmerman
- grid.67105.350000 0001 2164 3847The Center for Global Health & Diseases, Pathology Department, Case Western Reserve University, Cleveland, OH USA
| | - Deo Wabwire
- grid.421981.7MUJHU Research Collaboration, Kampala, Uganda
| | - Isaac Kajja
- grid.11194.3c0000 0004 0620 0548Department of Orthopaedics, Makerere University College of Health Sciences, Kampala, Uganda
| | - Jeffrey McCullough
- grid.215654.10000 0001 2151 2636College of Health Solutions, Arizona State University, Phoenix, AZ USA
| | - Raymond Goodrich
- grid.47894.360000 0004 1936 8083Department of Microbiology, Immunology and Pathology, Colorado State University, Fort Collins, CO USA
| | - Thomas C. Quinn
- grid.21107.350000 0001 2171 9311Department of Pathology, School of Medicine, Johns Hopkins University, Baltimore, MD USA ,grid.21107.350000 0001 2171 9311Department of International Health, School of Public Health, Johns Hopkins University, Baltimore, MD USA ,grid.94365.3d0000 0001 2297 5165Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD USA
| | | | - Paul M. Ness
- grid.21107.350000 0001 2171 9311Department of Pathology, School of Medicine, Johns Hopkins University, Baltimore, MD USA
| | - Aaron A. R. Tobian
- grid.21107.350000 0001 2171 9311Department of Pathology, School of Medicine, Johns Hopkins University, Baltimore, MD USA ,grid.11194.3c0000 0004 0620 0548Department of Paediatrics and Child Health, College of Health Sciences, Makerere University, Kampala, Uganda
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Pérez Aliaga AI, Labata G, Aranda A, Cardoso M, Puente F, Domingo JM, Garcés C. Improvement of Blood Processing and Safety by Automation and Pathogen Reduction Technology. Transfus Med Hemother 2021; 48:290-297. [PMID: 34803572 DOI: 10.1159/000516696] [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: 09/21/2020] [Accepted: 04/02/2021] [Indexed: 01/18/2023] Open
Abstract
Introduction The objective of the present study was to describe the experience of the Blood and Tissues Bank of Aragon with the Reveos® Automated Blood Processing System and Mirasol® Pathogen Reduction Technology (PRT) System, comparing retrospectively routine quality data obtained in two different observation periods. Methods Comparing quality data encompassing 6,525 blood components from the period 2007-2012, when the semi-automated buffy coat method was used in routine, with 6,553 quality data from the period 2014-2019, when the Reveos system and subsequently the Mirasol system were implemented in routine. Results Moving from buffy coat to Reveos led to decreased discard rates of whole blood units (1.2 to 0.1%), increased hemoglobin content (48.1 ± 7.6 to 55.4 ± 6.6 g/unit), and hematocrit (58.9 ± 6.5% to 60.0 ± 4.9%) in red blood cell concentrates. Platelet concentrates (PCs) in both periods had similar yields (3.5 ×1011). Whereas in the earlier period, PCs resulted from pooling 5 buffy coats, in the second period 25% of PCs were prepared from 4 interim platelet units. The mean level of factor VIII in plasma was significantly higher with Reveos (92.8 vs. 97.3 IU). Mirasol PRT treatment of PCs reduced expiry rates to 1.2% in 2019. One septic transmission was reported with a non-PRT treated PCs, but none with PRT-treated PCs. Conclusion Automation contributed to standardization, efficiency, and improvement of blood processing. Released resources enabled the effortless implementation of PRT. The combination of both technologies guaranteed the self-sufficiency and improvement of blood safety.
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Affiliation(s)
| | - Gorka Labata
- Technological Institute of Aragón, Zaragoza, Spain
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Retrospective Study of the Seroprevalence of HIV, HCV, and HBV in Blood Donors at a Blood Bank of Western Mexico. Pathogens 2021; 10:pathogens10070878. [PMID: 34358028 PMCID: PMC8308904 DOI: 10.3390/pathogens10070878] [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] [Received: 06/03/2021] [Revised: 07/08/2021] [Accepted: 07/08/2021] [Indexed: 11/17/2022] Open
Abstract
Obtaining blood which is safe for transfusions is one of the principal challenges in the health systems of developing countries. Supply of contaminated blood increases morbidity, mortality, and the costs of patient care. In Mexico, serological screening is mandatory, but only a few of the main blood banks routinely perform a nucleic acid test (NAT). Data from 80,391 blood donations processed between August 2018 and December 2019 at the Central Blood Bank of the Western National Medical Center of the Mexican Social Security Institute (IMSS) were analyzed. All donors were screened for serological markers and NAT was performed. Reactive donors were followed-up to confirm their results. The number of reactive donors and seroprevalence rates for HIV, HCV, and HBV were 152 (18.91/10,000), 385 (47.89/10,000), and 181 (22.51/10,000), respectively; however, these rates decreased when NAT-confirmed reactive results were considered. Male donors were found to have a higher seroprevalence than females, and younger donors higher than older donors. The present study shows that HIV, HCV, and HBV seroprevalence in blood donors in Western Mexico is low. We propose that Mexico should establish future strategies, including pathogen reduction technologies (PRTs), in order to improve blood safety and reduce transfusion-transmissible infections (TTIs).
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Cornish NE, Anderson NL, Arambula DG, Arduino MJ, Bryan A, Burton NC, Chen B, Dickson BA, Giri JG, Griffith NK, Pentella MA, Salerno RM, Sandhu P, Snyder JW, Tormey CA, Wagar EA, Weirich EG, Campbell S. Clinical Laboratory Biosafety Gaps: Lessons Learned from Past Outbreaks Reveal a Path to a Safer Future. Clin Microbiol Rev 2021; 34:e0012618. [PMID: 34105993 PMCID: PMC8262806 DOI: 10.1128/cmr.00126-18] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Patient care and public health require timely, reliable laboratory testing. However, clinical laboratory professionals rarely know whether patient specimens contain infectious agents, making ensuring biosafety while performing testing procedures challenging. The importance of biosafety in clinical laboratories was highlighted during the 2014 Ebola outbreak, where concerns about biosafety resulted in delayed diagnoses and contributed to patient deaths. This review is a collaboration between subject matter experts from large and small laboratories and the federal government to evaluate the capability of clinical laboratories to manage biosafety risks and safely test patient specimens. We discuss the complexity of clinical laboratories, including anatomic pathology, and describe how applying current biosafety guidance may be difficult as these guidelines, largely based on practices in research laboratories, do not always correspond to the unique clinical laboratory environments and their specialized equipment and processes. We retrospectively describe the biosafety gaps and opportunities for improvement in the areas of risk assessment and management; automated and manual laboratory disciplines; specimen collection, processing, and storage; test utilization; equipment and instrumentation safety; disinfection practices; personal protective equipment; waste management; laboratory personnel training and competency assessment; accreditation processes; and ethical guidance. Also addressed are the unique biosafety challenges successfully handled by a Texas community hospital clinical laboratory that performed testing for patients with Ebola without a formal biocontainment unit. The gaps in knowledge and practices identified in previous and ongoing outbreaks demonstrate the need for collaborative, comprehensive solutions to improve clinical laboratory biosafety and to better combat future emerging infectious disease outbreaks.
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Affiliation(s)
- Nancy E. Cornish
- Centers for Disease Control and Prevention, Center for Surveillance, Epidemiology and Laboratory Services (CSELS), Atlanta, Georgia, USA
| | - Nancy L. Anderson
- Centers for Disease Control and Prevention, Center for Surveillance, Epidemiology and Laboratory Services (CSELS), Atlanta, Georgia, USA
| | - Diego G. Arambula
- Centers for Disease Control and Prevention, Center for Surveillance, Epidemiology and Laboratory Services (CSELS), Atlanta, Georgia, USA
| | - Matthew J. Arduino
- Centers for Disease Control and Prevention, National Center for Emerging & Zoonotic Infectious Diseases (NCEZID), Atlanta, Georgia, USA
| | - Andrew Bryan
- Department of Laboratory Medicine, University of Washington, Seattle, Washington, USA
| | - Nancy C. Burton
- Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health (NIOSH), Cincinnati, Ohio, USA
| | - Bin Chen
- Centers for Disease Control and Prevention, Center for Surveillance, Epidemiology and Laboratory Services (CSELS), Atlanta, Georgia, USA
| | - Beverly A. Dickson
- Department of Clinical Pathology, Texas Health Presbyterian Hospital Dallas, Dallas, Texas, USA
| | - Judith G. Giri
- Centers for Disease Control and Prevention, Center for Global Health (CGH), Atlanta, Georgia, USA
| | | | | | - Reynolds M. Salerno
- Centers for Disease Control and Prevention, Center for Surveillance, Epidemiology and Laboratory Services (CSELS), Atlanta, Georgia, USA
| | - Paramjit Sandhu
- Centers for Disease Control and Prevention, Center for Surveillance, Epidemiology and Laboratory Services (CSELS), Atlanta, Georgia, USA
| | - James W. Snyder
- Department of Pathology and Laboratory Medicine, University of Louisville, Louisville, Kentucky, USA
| | - Christopher A. Tormey
- Department of Laboratory Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
- Pathology & Laboratory Medicine Service, Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut, USA
| | - Elizabeth A. Wagar
- Department of Laboratory Medicine, University of Texas, M.D. Anderson Cancer Center, Houston, Texas, USA
| | - Elizabeth G. Weirich
- Centers for Disease Control and Prevention, Center for Surveillance, Epidemiology and Laboratory Services (CSELS), Atlanta, Georgia, USA
| | - Sheldon Campbell
- Department of Laboratory Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
- Pathology & Laboratory Medicine Service, Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut, USA
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Ragan IK, Hartson LM, Dutt TS, Obregon-Henao A, Maison RM, Gordy P, Fox A, Karger BR, Cross ST, Kapuscinski ML, Cooper SK, Podell BK, Stenglein MD, Bowen RA, Henao-Tamayo M, Goodrich RP. A Whole Virion Vaccine for COVID-19 Produced via a Novel Inactivation Method and Preliminary Demonstration of Efficacy in an Animal Challenge Model. Vaccines (Basel) 2021; 9:vaccines9040340. [PMID: 33916180 PMCID: PMC8066708 DOI: 10.3390/vaccines9040340] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 03/25/2021] [Accepted: 03/27/2021] [Indexed: 12/16/2022] Open
Abstract
The COVID-19 pandemic has generated intense interest in the rapid development and evaluation of vaccine candidates for this disease and other emerging diseases. Several novel methods for preparing vaccine candidates are currently undergoing clinical evaluation in response to the urgent need to prevent the spread of COVID-19. In many cases, these methods rely on new approaches for vaccine production and immune stimulation. We report on the use of a novel method (SolaVAX) for production of an inactivated vaccine candidate and the testing of that candidate in a hamster animal model for its ability to prevent infection upon challenge with SARS-CoV-2 virus. The studies employed in this work included an evaluation of the levels of neutralizing antibody produced post-vaccination, levels of specific antibody sub-types to RBD and spike protein that were generated, evaluation of viral shedding post-challenge, flow cytometric and single cell sequencing data on cellular fractions and histopathological evaluation of tissues post-challenge. The results from this preliminary evaluation provide insight into the immunological responses occurring as a result of vaccination with the proposed vaccine candidate and the impact that adjuvant formulations, specifically developed to promote Th1 type immune responses, have on vaccine efficacy and protection against infection following challenge with live SARS-CoV-2. This data may have utility in the development of effective vaccine candidates broadly. Furthermore, the results of this preliminary evaluation suggest that preparation of a whole virion vaccine for COVID-19 using this specific photochemical method may have potential utility in the preparation of one such vaccine candidate.
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Affiliation(s)
- Izabela K Ragan
- Department of Biomedical Sciences, Colorado State University, Fort Collins, CO 80523, USA; (I.K.R.); (R.M.M.); (P.G.); (R.A.B.)
| | - Lindsay M Hartson
- Infectious Disease Research Center, Colorado State University, Fort Collins, CO 80521, USA;
| | - Taru S Dutt
- Department of Microbiology, Immunology, and Pathology, Colorado State University, Fort Collins, CO 80523, USA; (T.S.D.); (A.O.-H.); (A.F.); (B.R.K.); (S.T.C.); (M.L.K.); (S.K.C.); (B.K.P.); (M.D.S.); (M.H.-T.)
| | - Andres Obregon-Henao
- Department of Microbiology, Immunology, and Pathology, Colorado State University, Fort Collins, CO 80523, USA; (T.S.D.); (A.O.-H.); (A.F.); (B.R.K.); (S.T.C.); (M.L.K.); (S.K.C.); (B.K.P.); (M.D.S.); (M.H.-T.)
| | - Rachel M Maison
- Department of Biomedical Sciences, Colorado State University, Fort Collins, CO 80523, USA; (I.K.R.); (R.M.M.); (P.G.); (R.A.B.)
| | - Paul Gordy
- Department of Biomedical Sciences, Colorado State University, Fort Collins, CO 80523, USA; (I.K.R.); (R.M.M.); (P.G.); (R.A.B.)
| | - Amy Fox
- Department of Microbiology, Immunology, and Pathology, Colorado State University, Fort Collins, CO 80523, USA; (T.S.D.); (A.O.-H.); (A.F.); (B.R.K.); (S.T.C.); (M.L.K.); (S.K.C.); (B.K.P.); (M.D.S.); (M.H.-T.)
| | - Burton R Karger
- Department of Microbiology, Immunology, and Pathology, Colorado State University, Fort Collins, CO 80523, USA; (T.S.D.); (A.O.-H.); (A.F.); (B.R.K.); (S.T.C.); (M.L.K.); (S.K.C.); (B.K.P.); (M.D.S.); (M.H.-T.)
| | - Shaun T Cross
- Department of Microbiology, Immunology, and Pathology, Colorado State University, Fort Collins, CO 80523, USA; (T.S.D.); (A.O.-H.); (A.F.); (B.R.K.); (S.T.C.); (M.L.K.); (S.K.C.); (B.K.P.); (M.D.S.); (M.H.-T.)
| | - Marylee L Kapuscinski
- Department of Microbiology, Immunology, and Pathology, Colorado State University, Fort Collins, CO 80523, USA; (T.S.D.); (A.O.-H.); (A.F.); (B.R.K.); (S.T.C.); (M.L.K.); (S.K.C.); (B.K.P.); (M.D.S.); (M.H.-T.)
| | - Sarah K Cooper
- Department of Microbiology, Immunology, and Pathology, Colorado State University, Fort Collins, CO 80523, USA; (T.S.D.); (A.O.-H.); (A.F.); (B.R.K.); (S.T.C.); (M.L.K.); (S.K.C.); (B.K.P.); (M.D.S.); (M.H.-T.)
| | - Brendan K Podell
- Department of Microbiology, Immunology, and Pathology, Colorado State University, Fort Collins, CO 80523, USA; (T.S.D.); (A.O.-H.); (A.F.); (B.R.K.); (S.T.C.); (M.L.K.); (S.K.C.); (B.K.P.); (M.D.S.); (M.H.-T.)
| | - Mark D Stenglein
- Department of Microbiology, Immunology, and Pathology, Colorado State University, Fort Collins, CO 80523, USA; (T.S.D.); (A.O.-H.); (A.F.); (B.R.K.); (S.T.C.); (M.L.K.); (S.K.C.); (B.K.P.); (M.D.S.); (M.H.-T.)
| | - Richard A Bowen
- Department of Biomedical Sciences, Colorado State University, Fort Collins, CO 80523, USA; (I.K.R.); (R.M.M.); (P.G.); (R.A.B.)
| | - Marcela Henao-Tamayo
- Department of Microbiology, Immunology, and Pathology, Colorado State University, Fort Collins, CO 80523, USA; (T.S.D.); (A.O.-H.); (A.F.); (B.R.K.); (S.T.C.); (M.L.K.); (S.K.C.); (B.K.P.); (M.D.S.); (M.H.-T.)
| | - Raymond P Goodrich
- Infectious Disease Research Center, Colorado State University, Fort Collins, CO 80521, USA;
- Department of Microbiology, Immunology, and Pathology, Colorado State University, Fort Collins, CO 80523, USA; (T.S.D.); (A.O.-H.); (A.F.); (B.R.K.); (S.T.C.); (M.L.K.); (S.K.C.); (B.K.P.); (M.D.S.); (M.H.-T.)
- Correspondence:
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7
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Mangano VD, Prato M, Marvelli A, Moscato G, Bruschi F. Screening of at-risk blood donors for Chagas disease in non-endemic countries: Lessons from a 2-year experience in Tuscany, Italy. Transfus Med 2020; 31:63-68. [PMID: 33295054 PMCID: PMC7953894 DOI: 10.1111/tme.12741] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 11/09/2020] [Accepted: 11/12/2020] [Indexed: 01/17/2023]
Abstract
Background Chagas disease (CD) is caused by the protozoan parasite Trypanosoma cruzi and is transmitted by blood‐sucking triatomine insects in endemic areas of Latin America. Transmission can also occur via blood transfusion and is a major cause of CD in non‐endemic areas. Objectives The aim of the study was to assess the prevalence of anti‐T. cruzi antibodies in blood donors at risk of infection in Tuscany, Italy, following the introduction of blood safety Italian legislation. Material and methods Donors (N = 1985) were tested in 2016 to 2018 for anti‐T. cruzi IgG using an immunochromatographic test (ICT). Chemiluminescent immunoassay (CLIA) was performed on ICT‐positive donors to exclude CD, whereas enzyme‐linked immunosorbent assay and western blot were performed in case of discordant results. All assays were performed on CD patients (N = 10) for validation. Results Ten blood donors had a positive ICT result, with a resulting T. cruzi seroprevalence of 0.5% but demonstrated negative results to CLIA, as well as to the other serological assays. The comparison of serological assays suggested a lower relative sensitivity of ICT. Conclusion The results of this study confirm the significance of serological testing in the screening strategy for CD. However, they provide evidence for discontinuing the use of ICT as a screening test and suggest that a sensitive, specific and multi‐sample format assay should be used at the national level for uniformity of results.
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Affiliation(s)
- Valentina D Mangano
- Department of Translational Research, N.T.M.S., Università di Pisa, Pisa, Italy.,Department of Laboratory Medicine, Unit of Microbiology, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | - Marco Prato
- Postgraduate School of Microbiology and Virology, Università di Pisa, Pisa, Italy
| | - Antonella Marvelli
- Postgraduate School of Clinical Pathology and Biochemistry, Università di Pisa, Pisa, Italy
| | - Giovanna Moscato
- Department of Laboratory Medicine, Unit of Clinical Chemistry Analyses, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | - Fabrizio Bruschi
- Department of Translational Research, N.T.M.S., Università di Pisa, Pisa, Italy.,Department of Laboratory Medicine, Programme of Parasitic Disease monitoring, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
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8
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Park H, Gladstone M, Shanley C, Goodrich R, Guth A. A novel cancer immunotherapy utilizing autologous tumour tissue. Vox Sang 2020; 115:525-535. [PMID: 32378223 PMCID: PMC8344074 DOI: 10.1111/vox.12935] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 02/18/2020] [Accepted: 04/14/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND With the recent interest in personalized medicine for cancer patients and immune therapy, the field of cancer vaccines has been resurrected. Previous autologous, whole cell tumour vaccine trials have not produced convincing results due, in part to poor patient selection and inactivation methos that are harsh on the cells. These methods can alter protein structure and antigenic profiles making vaccine candidates ineffective in stimulating immune response to autochthonous tumour cells. MATERIALS AND METHODS We investigated a novel method for inactivating tumour cells that uses UVA/UVB light and riboflavin (vitamin B2) (RF + UV). RF + UV inactivates the tumour cells' ability to replicate, yet preserves tumour cell integrity and antigenicity. RESULTS Our results demonstrate that proteins are preserved on the surface of RF + UV-inactivated tumour cells and that they are immunogenic via induction of dendritic cell maturation, increase in IFNγ production and generation of tumour cell-specific IgG. Moreover, when formulated with an adjuvant ('Innocell vaccine') and tested in different murine tumour primary and metastatic disease models, decreased tumour growth, decreased metastatic disease and prolonged survival were observed. In addition, immune cells obtained from tumour tissue following vaccination had decreased exhausted and regulatory T cells, suggesting that activation of intra-tumoural T cells may be playing a role leading to reduced tumour growth. CONCLUSIONS These data suggest that the RF + UV inactivation of tumour cells may provide an efficacious method for generating autologous whole tumour cell vaccines for use in cancer patients.
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Affiliation(s)
- Haemin Park
- Department of Clinical Sciences, Colorado State University, Fort Collins, CO, USA
- Department of Microbiology, Immunology and Pathology, Colorado State University, Fort Collins, CO, USA
| | | | - Crystal Shanley
- Department of Microbiology, Immunology and Pathology, Colorado State University, Fort Collins, CO, USA
| | - Raymond Goodrich
- Department of Microbiology, Immunology and Pathology, Colorado State University, Fort Collins, CO, USA
| | - Amanda Guth
- Department of Clinical Sciences, Colorado State University, Fort Collins, CO, USA
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9
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Abstract
Allogeneic platelets collected for transfusion treated with pathogen reduction technology (PRT), which has been available in some countries for more than a decade, are now increasingly available in the United States (US). The implementation of PRT-treated platelets, also known as pathogen-reduced platelets (PRPs), has been spurred by the need to further decrease the risk of sepsis associated with bacterial contamination coupled with the potential of this technology to reduce the risk of infections due to already recognized, new, and emerging infectious agents. This article will review available PRP products, examine their benefits, highlight unresolved questions surrounding this technology, and summarize pivotal research studies that have compared transfusion outcomes (largely in adult patients) for PRPs with non-PRT-treated conventional platelets (CPs). In addition, studies describing the use of PRPs in pediatric patients and work done on the association between PRPs and HLA alloimmunization are discussed. As new data emerge, it is critical to re-evaluate the risks and benefits of existing PRPs and newer technologies and reassess the financial implications of adopting PRPs to guide our decision-making process for the implementation of transfusing PRPs.
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Affiliation(s)
- Wen Lu
- Section of Transfusion Medicine, Robert Tomsich Pathology & Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Mark Fung
- Department of Pathology and Laboratory Medicine, University of Vermont Medical Center, Burlington, VT, USA
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Atreya C, Glynn S, Busch M, Kleinman S, Snyder E, Rutter S, AuBuchon J, Flegel W, Reeve D, Devine D, Cohn C, Custer B, Goodrich R, Benjamin RJ, Razatos A, Cancelas J, Wagner S, Maclean M, Gelderman M, Cap A, Ness P. Proceedings of the Food and Drug Administration public workshop on pathogen reduction technologies for blood safety 2018 (Commentary, p. 3026). Transfusion 2019; 59:3002-3025. [PMID: 31144334 PMCID: PMC6726584 DOI: 10.1111/trf.15344] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 05/06/2019] [Accepted: 05/06/2019] [Indexed: 12/13/2022]
Affiliation(s)
- Chintamani Atreya
- US Food and Drug Administration, Center for Biologics Evaluation and ResearchOffice of Blood Research and ReviewSilver SpringMaryland
| | - Simone Glynn
- National Heart Lung and Blood InstituteBethesdaMarylandUSA
| | | | | | - Edward Snyder
- Blood BankYale‐New Haven HospitalNew HavenConnecticut
| | - Sara Rutter
- Department of Pathology and Laboratory MedicineYale School of MedicineNew HavenConnecticut
| | - James AuBuchon
- Department of PathologyDartmouth‐Hitchcock Medical CenterLebanonNew Hampshire
| | - Willy Flegel
- Department of Transfusion MedicineNIH Clinical CenterBethesdaMaryland
| | - David Reeve
- Blood ComponentsAmerican Red CrossRockvilleMaryland
| | - Dana Devine
- Department of Lab Medicine and PathologyUniversity of Minnesota Medical CenterMinneapolisMinnesota
| | - Claudia Cohn
- Department of Lab Medicine and PathologyUniversity of Minnesota Medical CenterMinneapolisMinnesota
| | - Brian Custer
- Vitalant Research InstituteSan FranciscoCalifornia
| | - Raymond Goodrich
- Department of Microbiology, Immunology and PathologyColorado State UniversityFort CollinsColorado
| | | | | | - Jose Cancelas
- Hoxworth Blood CenterUniversity of Cincinnati HealthCincinnatiOhio
| | | | - Michelle Maclean
- The Robertson Trust Laboratory for Electronic Sterilisation Technologies (ROLEST)University of StrathclydeGlasgowScotland
| | - Monique Gelderman
- Department of HematologyCenter for Biologics Evaluation and Research, US Food and Drug AdministrationSilver SpringMaryland
| | - Andrew Cap
- U.S. Army Institute of Surgical ResearchSan AntonioTexas
| | - Paul Ness
- Blood BankJohns Hopkins HospitalBaltimoreMaryland
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11
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Factors affecting the quality, safety and marketing approval of clotting factor concentrates for haemophilia. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2018; 16:525-534. [PMID: 30201084 DOI: 10.2450/2018.0150-18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 08/22/2018] [Indexed: 12/27/2022]
Abstract
Selecting therapeutic products for the treatment of haemophilia follows the process of obtaining market approval of products submitted to the scrutiny of a regulatory agency. In well-resourced countries, key decisions on whether a product is sufficiently safe and of high quality are made by highly expert and well-resourced agencies, such as the US Food and Drug Administration (FDA) and the European Medicines Agency (EMA). In countries lacking such agencies, well-informed decisions can still be made through an appreciation of the key issues affecting the quality, safety and efficacy of haemophilia products. A number of well-established principles may then be applied in order to make a choice. In this review, reflecting principles outlined by the World Federation of Hemophilia, we outline the key features in determining the acceptability of therapeutic products for haemophilia in order to ensure an optimal choice in all the environments providing haemophilia care.
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Budget impact of implementing platelet pathogen reduction into the Italian blood transfusion system. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2018; 16:483-489. [PMID: 30201081 DOI: 10.2450/2018.0115-18] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 07/26/2018] [Indexed: 02/08/2023]
Abstract
BACKGROUND Despite improvements in blood donor selection and screening procedures, transfusion recipients can still develop complications related to infections by known and emerging pathogens. Pathogen reduction technologies (PRT) have been developed to reduce such risks. The present study, developed whithin a wider health technology assessment (HTA) process, was undertaken to estimate the costs of the continuing increase in the use of platelet PRT in Italy. MATERIALS AND METHODS A multidisciplinary team was established to perform the HTA and conduct a budget impact analysis. Quantitative data on platelet use were derived from the 2015 national blood transfusion report and from the Italian Platelets Transfusion Assessment Study (IPTAS). The current national fee of 60 Euro per platelet PRT procedure was used to quantify the costs to the Italian National Health Service (INHS). The analysis adopts a 3-year time-frame. In order to identify the impact on budget we compared a scenario representing an increased use of PRT platelets over time with a control scenario in which standard platelets are used. RESULTS Progressive implementation of PRT for 20%, 40% and 66% of annual adult platelet doses could generate an increase in annual costs for the INHS amounting to approximately 7, 14 and 23 million Euros, respectively. Use of kits and devices suitable for the treatment of multiple adult platelet doses in one PRT procedure could lower costs. DISCUSSION In order to fully evaluate the societal perspective of implementing platelet PRT, the increase in costs must be balanced against the expected benefits (prevention of transfusion-transmissible infections, white cell inactivation, extension of platelet storage, discontinuation of pathogen detection testing). Further studies based on actual numbers of platelet transfusion complications and their societal cost at a local level are needed to see the full cost to benefit ratio of platelet PRT implementation in Italy, and to promote equal treatment for all citizens.
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