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Yu EA, Stone M, Bravo MD, Grebe E, Bruhn RL, Lanteri MC, Townsend M, Kamel H, Jones JM, Busch MP, Custer B. Associations of Temporal Cardiometabolic Patterns and Incident SARS-CoV-2 Infection Among U.S. Blood Donors With Serologic Evidence of Vaccination. AJPM Focus 2024; 3:100186. [PMID: 38304025 PMCID: PMC10832374 DOI: 10.1016/j.focus.2024.100186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Abstract
Introduction Cardiometabolic diseases are associated with greater COVID-19 severity; however, the influences of cardiometabolic health on SARS-CoV-2 infections after vaccination remain unclear. Our objective was to investigate the associations between temporal blood pressure and total cholesterol patterns and incident SARS-CoV-2 infections among those with serologic evidence of vaccination. Methods In this prospective cohort of blood donors, blood samples were collected in 2020-2021 and assayed for binding antibodies of SARS-CoV-2 nucleocapsid protein antibody seropositivity. We categorized participants into intraindividual pattern subgroups of blood pressure and total cholesterol (persistently, intermittently, or not elevated [systolic blood pressure <130 mmHg, diastolic blood pressure <80 mmHg, total cholesterol <200 mg/dL]) across the study time points. Results Among 13,930 donors with 39,736 donations representing 1,127,071 person-days, there were 221 incident SARS-CoV-2 infections among those with serologic evidence of vaccination (1.6%). Intermittent hypertension was associated with greater SARS-CoV-2 infections among those with serologic evidence of vaccination risk (adjusted incidence rate ratio=2.07; 95% CI=1.44, 2.96; p<0.01) than among participants with consistent normotension on the basis of a multivariable Poisson regression. Among men, intermittently elevated total cholesterol (adjusted incidence rate ratio=1.90; 95% CI=1.32, 2.74; p<0.01) and higher BMI at baseline (adjusted hazard ratio=1.44; 95% CI=1.07, 1.93; p=0.01; per 10 units) were associated with greater SARS-CoV-2 infections among those with serologic evidence of vaccination probability; these associations were null among women (both p>0.05). Conclusions Our findings underscore that the benefits of cardiometabolic health, particularly blood pressure, include a lower risk of SARS-CoV-2 infection after vaccination.
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Affiliation(s)
- Elaine A. Yu
- Vitalant Research Institute, San Francisco, California
- Department of Laboratory Medicine, University of California San Francisco, San Francisco, California
| | - Mars Stone
- Vitalant Research Institute, San Francisco, California
- Department of Laboratory Medicine, University of California San Francisco, San Francisco, California
| | | | - Eduard Grebe
- Vitalant Research Institute, San Francisco, California
- Department of Laboratory Medicine, University of California San Francisco, San Francisco, California
| | - Roberta L. Bruhn
- Vitalant Research Institute, San Francisco, California
- Department of Laboratory Medicine, University of California San Francisco, San Francisco, California
| | - Marion C. Lanteri
- Department of Laboratory Medicine, University of California San Francisco, San Francisco, California
- Creative Testing Solutions, Tempe, Arizona
| | | | | | | | - Michael P. Busch
- Vitalant Research Institute, San Francisco, California
- Department of Laboratory Medicine, University of California San Francisco, San Francisco, California
- Vitalant, Scottsdale, Arizona
| | - Brian Custer
- Vitalant Research Institute, San Francisco, California
- Department of Laboratory Medicine, University of California San Francisco, San Francisco, California
- Vitalant, Scottsdale, Arizona
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2
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Lewin A, Goldman M, Busch MP, Davison K, van de Laar T, Tiberghien P, Shinar E, O'Brien SF, Lambert G, Field S, Hervig T, Tan DHS, Custer B, Drews SJ, Lanteri MC, Klochkov D, Widmer E, Domingue MP, Renaud C, Germain M. End of selection criteria based on sexual orientation: An international symposium on alternatives to donation deferral. Vox Sang 2024; 119:388-401. [PMID: 38270352 DOI: 10.1111/vox.13587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 12/07/2023] [Accepted: 12/21/2023] [Indexed: 01/26/2024]
Abstract
BACKGROUND AND OBJECTIVES Until recently, gay, bisexual and other men who have sex with men (MSM) were deferred from donating blood for 3-12 months since the last male-to-male sexual contact. This MSM deferral has been discontinued by several high-income countries (HIC) that now perform gender-neutral donor selection. MATERIALS AND METHODS An international symposium (held on 20-04-2023) gathered experts from seven HICs to (1) discuss how this paradigm shift might affect the mitigation strategies for transfusion-transmitted infections and (2) address the challenges related to gender-neutral donor selection. RESULTS Most countries employed a similar approach for implementing a gender-neutral donor selection policy: key stakeholders were consulted; the transition was bridged by time-limited deferrals; donor compliance was monitored; and questions or remarks on anal sex and the number and/or type of sexual partners were often added. Many countries have now adopted a gender-neutral approach in which questions on pre- and post-exposure prophylaxis for human immunodeficiency virus (HIV) have been added (or retained, when already in place). Other countries used mitigation strategies, such as plasma quarantine or pathogen reduction technologies for plasma and/or platelets. CONCLUSION The experience with gender-neutral donor selection has been largely positive among the countries covered herein and seems to be acceptable to stakeholders, donors and staff. The post-implementation surveillance data collected so far appear reassuring with regards to safety, although longer observation periods are necessary. The putative risks associated with HIV antiretrovirals should be further investigated.
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Affiliation(s)
- Antoine Lewin
- Medical Affairs and Innovation, Héma-Québec, Montréal and Québec, Quebec, Canada
| | - Mindy Goldman
- Donation Policy and Studies, Canadian Blood Services, Ottawa, Ontario, Canada
| | - Michael P Busch
- Vitalant Research Institute, San Francisco, California, USA
- Department of Laboratory Medicine, University of California in San Francisco, San Francisco, California, USA
| | - Katy Davison
- NHS Blood and Transplant/UK Health Security Agency (UKHSA) Epidemiology Unit, UKHSA, London, UK
| | - Thijs van de Laar
- Department of Donor Medicine Research, Sanquin Research, Amsterdam, The Netherlands
- Laboratory of Medical Microbiology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
| | - Pierre Tiberghien
- Établissement Français du Sang, La Plaine Saint Denis, France
- UMR 1098, Inserm, Établissement Français du Sang, Université de Franche-Comté, Besançon, France
| | - Eilat Shinar
- National Blood Services, Magen David Adom, Tel Aviv, Israel
| | - Sheila F O'Brien
- Epidemiology and Surveillance, Canadian Blood Services, Ottawa, Ontario, Canada
| | - Gilles Lambert
- Direction régionale de santé publique - Montréal, Montréal, Québec, Canada
- Institut national de santé publique du Québec, Montréal, Québec, Canada
| | - Stephen Field
- Irish Blood Transfusion Service, Dublin, County Dublin, Ireland
| | - Tor Hervig
- Irish Blood Transfusion Service, Dublin, County Dublin, Ireland
| | - Darrell H S Tan
- Division of Infectious Diseases, Department of Medicine, St Michael's Hospital, Toronto, Ontario, Canada
| | - Brian Custer
- Vitalant Research Institute, San Francisco, California, USA
- Department of Laboratory Medicine, University of California in San Francisco, San Francisco, California, USA
| | - Steven J Drews
- Donation Policy and Studies, Canadian Blood Services, Edmonton, Alberta, Canada
| | - Marion C Lanteri
- Department of Laboratory Medicine, University of California in San Francisco, San Francisco, California, USA
- Scientific Affairs, Creative Testing Solutions, Tempe, Arizona, USA
| | - Denis Klochkov
- Research and Development, CSL Behring, Bern, Switzerland
| | | | - Marie-Pier Domingue
- Medical Affairs and Innovation, Héma-Québec, Montréal and Québec, Quebec, Canada
- Faculté des Sciences, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Christian Renaud
- Medical Affairs and Innovation, Héma-Québec, Montréal and Québec, Quebec, Canada
| | - Marc Germain
- Medical Affairs and Innovation, Héma-Québec, Montréal and Québec, Quebec, Canada
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3
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Conti G, Notari E, Dodd RY, Kessler D, Custer B, Reik R, Lanteri MC, Hailu B, Yang H, Stramer SL. Syphilis seroprevalence and incidence in US blood donors from 2020 to 2022. Transfusion 2024; 64:325-333. [PMID: 38180267 PMCID: PMC10922865 DOI: 10.1111/trf.17707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 12/22/2023] [Accepted: 12/22/2023] [Indexed: 01/06/2024]
Abstract
BACKGROUND HIV, HBV, and HCV infections for ~60% of the US blood supply are monitored by TTIMS with syphilis added in 2020. STUDY DESIGN AND METHODS Data were compiled from October 2020 to September 2022. Syphilis prevalence was estimated for allogeneic and directed donors who were consensus positive (CP) and the subset of those with confirmed-active infections (AI). Prevalence and incidence were stratified by demographics for two consecutive 1-year periods, starting October 1, 2020 and for both years combined. Incidence was estimated for repeat donors. Associations between syphilis positivity and other infections were evaluated. RESULTS Among 14.75 million donations, syphilis prevalence was 28.4/100,000 donations and significantly higher during the second year compared to the first year. Overall, syphilis incidence for the two-year period was 10.8/100,000 person-years. The adjusted odds of a CP infection were 1.18 (95% CI: 1.11, 1.26) times higher in the second year compared to the first, and for AI, 1.22 (95% CI: 1.10, 1.35) times higher in year 2. Highest rates occurred among males, first-time, Black, and younger (ages 18-39) donors, and those in the South US Census region. Syphilis CP donors were 64 (95% CI: 46, 89) times more likely to be HIV CP, and AI donors 77 (95% CI: 52, 114) times more likely to be HIV CP than non-CP donors, when controlling for confounders. SUMMARY/CONCLUSIONS Syphilis prevalence increased over the study period mirroring national trends reported by CDC and is significantly associated with HIV CP.
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Affiliation(s)
- Galen Conti
- American Red Cross, Scientific Affairs, Rockville, MD
| | - Ed Notari
- American Red Cross, Scientific Affairs, Rockville, MD
| | - Roger Y. Dodd
- American Red Cross, Scientific Affairs, Rockville, MD
| | | | - Brian Custer
- Vitalant Research Institute, San Francisco, CA
- Department of Laboratory Medicine, University of California San Francisco, San Francisco, CA
| | | | - Marion C. Lanteri
- Department of Laboratory Medicine, University of California San Francisco, San Francisco, CA
- Creative Testing Solutions, Tempe, AZ
| | | | - Hong Yang
- US Food and Drug Administration, Silver Spring, MD
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Jones JM, Manrique IM, Stone MS, Grebe E, Saa P, Germanio CD, Spencer BR, Notari E, Bravo M, Lanteri MC, Green V, Briggs-Hagen M, Coughlin MM, Stramer SL, Opsomer J, Busch MP. Estimates of SARS-CoV-2 Seroprevalence and Incidence of Primary SARS-CoV-2 Infections Among Blood Donors, by COVID-19 Vaccination Status - United States, April 2021-September 2022. MMWR Morb Mortal Wkly Rep 2023; 72:601-605. [PMID: 37262007 DOI: 10.15585/mmwr.mm7222a3] [Citation(s) in RCA: 22] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Changes in testing behaviors and reporting requirements have hampered the ability to estimate the U.S. SARS-CoV-2 incidence (1). Hybrid immunity (immunity derived from both previous infection and vaccination) has been reported to provide better protection than that from infection or vaccination alone (2). To estimate the incidence of infection and the prevalence of infection- or vaccination-induced antibodies (or both), data from a nationwide, longitudinal cohort of blood donors were analyzed. During the second quarter of 2021 (April-June), an estimated 68.4% of persons aged ≥16 years had infection- or vaccination-induced SARS-CoV-2 antibodies, including 47.5% from vaccination alone, 12.0% from infection alone, and 8.9% from both. By the third quarter of 2022 (July-September), 96.4% had SARS-CoV-2 antibodies from previous infection or vaccination, including 22.6% from infection alone and 26.1% from vaccination alone; 47.7% had hybrid immunity. Prevalence of hybrid immunity was lowest among persons aged ≥65 years (36.9%), the group with the highest risk for severe disease if infected, and was highest among those aged 16-29 years (59.6%). Low prevalence of infection-induced and hybrid immunity among older adults reflects the success of public health infection prevention efforts while also highlighting the importance of older adults staying up to date with recommended COVID-19 vaccination, including at least 1 bivalent dose.*,†.
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5
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Van Rompay KK, Coffey LL, Yee JL, Singapuri A, Stuart J, Lanteri MC, Maria FS, Lu K, Singh I, Bakkour S, Stone M, Williamson PC, Muench MO, Busch MP, Simmons G. Plasma transfusion-transmission of Zika virus in mice and macaques. Transfusion 2023; 63:574-585. [PMID: 36621777 PMCID: PMC10134791 DOI: 10.1111/trf.17243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 12/05/2022] [Accepted: 12/05/2022] [Indexed: 01/10/2023]
Abstract
BACKGROUND Zika virus (ZIKV) epidemics with infections in pregnant women are associated with severe neurological disease in newborns. Although an arbovirus, ZIKV is also blood transfusion-transmitted (TT). Greater knowledge of the efficiency of ZIKV TT would aid decisions on testing and pathogen reduction technologies (PRT). STUDY DESIGN AND METHODS Plasma units from ZIKV RNA-reactive blood donors were used to study infectivity in vitro, in mice, and in macaques. Furthermore, plasma units were subjected to PRT using amotosalen/ultraviolet light A (A/UVA) before transfusion. RESULTS In vitro infectivity of ZIKV RNA-reactive plasma varied between 100 and 1000 international units (IU) of ZIKV RNA. Immunodeficient mice were more sensitive with as low as 32 IU sufficient to infect 50% of mice. 50-5500 IU of RNA led to TT in macaques using dose escalation of three different RNA-positive, seronegative plasma units. In contrast, RNA-reactive units collected postseroconversion were not infectious in macaques, even at a dose of 9 million IU RNA. After A/UVA PRT, transfusion of plasma containing up to 18 million IU was no longer infectious in vitro and did not result in ZIKV TT in macaques. CONCLUSION Significant risks of ZIKV TT are likely confined to a relatively short viremic window before seroconversion, and that sensitive nucleic acid amplification testing likely identifies the majority of infectious plasma. PRT was demonstrated to be effective at preventing ZIKV TT. Considering that there is no approved ZIKV vaccine, these data are relevant to mitigate the risk of TT during the future ZIKV outbreaks.
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Affiliation(s)
- Koen K.A. Van Rompay
- California National Primate Research Center, University of California, Davis, CA, United States of America
- Department of Pathology, Microbiology and Immunology, University of California, Davis, CA, United States of America
| | - Lark L. Coffey
- Department of Pathology, Microbiology and Immunology, University of California, Davis, CA, United States of America
| | - JoAnn L. Yee
- California National Primate Research Center, University of California, Davis, CA, United States of America
| | - Anil Singapuri
- Department of Pathology, Microbiology and Immunology, University of California, Davis, CA, United States of America
| | - Jackson Stuart
- Department of Pathology, Microbiology and Immunology, University of California, Davis, CA, United States of America
| | | | | | - Kai Lu
- Vitalant Research Institute, San Francisco, California, United States of America
| | - Inderdeep Singh
- Vitalant Research Institute, San Francisco, California, United States of America
| | - Sonia Bakkour
- Vitalant Research Institute, San Francisco, California, United States of America
| | - Mars Stone
- Vitalant Research Institute, San Francisco, California, United States of America
- Department of Laboratory Medicine, University of California San Francisco, San Francisco, CA, United States of America
| | | | - Marcus O. Muench
- Vitalant Research Institute, San Francisco, California, United States of America
- Department of Laboratory Medicine, University of California San Francisco, San Francisco, CA, United States of America
| | - Michael P. Busch
- Vitalant Research Institute, San Francisco, California, United States of America
- Department of Laboratory Medicine, University of California San Francisco, San Francisco, CA, United States of America
| | - Graham Simmons
- Vitalant Research Institute, San Francisco, California, United States of America
- Department of Laboratory Medicine, University of California San Francisco, San Francisco, CA, United States of America
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6
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Stramer SL, Lanteri MC, Brodsky JP, Foster GA, Krysztof DE, Groves JA, Townsend RL, Notari E, Bakkour S, Stone M, Simmons G, Spencer B, Tonnetti L, Busch MP. Mitigating the risk of transfusion-transmitted infections with vector-borne agents solely by means of pathogen reduction. Transfusion 2022; 62:1388-1398. [PMID: 35726756 PMCID: PMC9541364 DOI: 10.1111/trf.16950] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 05/13/2022] [Accepted: 05/13/2022] [Indexed: 12/01/2022]
Abstract
Background This study evaluated whether pathogen reduction technology (PRT) in plasma and platelets using amotosalen/ultraviolet A light (A/UVA) or in red blood cells using amustaline/glutathione (S‐303/GSH) may be used as the sole mitigation strategy preventing transfusion‐transmitted West Nile (WNV), dengue (DENV), Zika (ZIKV), and chikungunya (CHIKV) viral, and Babesia microti, Trypanosoma cruzi, and Plasmodium parasitic infections. Methods Antibody (Ab) status and pathogen loads (copies/mL) were obtained for donations from US blood donors testing nucleic acid (NAT)‐positive for WNV, DENV, ZIKV, CHIKV, and B. microti. Infectivity titers derived from pathogen loads were compared to published PRT log10 reduction factors (LRF); LRFs were also reviewed for Plasmodium and T. cruzi. The potential positive impact on donor retention following removal of deferrals from required questioning and testing for WNV, Babesia, Plasmodium, and T. cruzi was estimated for American Red Cross (ARC) donors. Results A/UVA and S‐303/GSH reduced infectivity to levels in accordance with those recognized by FDA as suitable to replace testing for all agents evaluated. If PRT replaced deferrals resulting from health history questions and/or NAT for WNV, Babesia, Plasmodium, and T. cruzi, 27,758 ARC donors could be retained allowing approximately 50,000 additional donations/year based on 1.79 donations/donor for calendar year 2019 (extrapolated to an estimated 125,000 additional donations nationally). Conclusion Pathogen loads in donations from US blood donors demonstrated that robust PRT may provide an opportunity to replace deferrals associated with donor questioning and NAT for vector‐borne agents allowing for significant donor retention and likely increased blood availability.
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Affiliation(s)
- Susan L Stramer
- American Red Cross, Scientific Affairs, Gaithersburg, Maryland, USA
| | | | | | - Gregory A Foster
- American Red Cross, Scientific Affairs, Gaithersburg, Maryland, USA
| | - David E Krysztof
- American Red Cross, Scientific Affairs, Gaithersburg, Maryland, USA
| | - Jamel A Groves
- American Red Cross, Scientific Affairs, Gaithersburg, Maryland, USA
| | | | - Edward Notari
- American Red Cross, Scientific Affairs, Rockville, Maryland, USA
| | - Sonia Bakkour
- Vitalant Research Institute, San Francisco, California, USA
| | - Mars Stone
- Vitalant Research Institute, San Francisco, California, USA
| | - Graham Simmons
- Vitalant Research Institute, San Francisco, California, USA
| | - Bryan Spencer
- American Red Cross, Scientific Affairs, Dedham, Massachusetts, USA
| | - Laura Tonnetti
- American Red Cross, Scientific Affairs, Rockville, Maryland, USA
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7
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Sow C, Bouissou A, Girard YA, Singh GB, Bounaadja L, Payrat JM, Haas D, Isola H, Lanteri MC, Bringmann P, Grellier P. Robust inactivation of Plasmodium falciparum in red blood cell concentrates using amustaline and glutathione pathogen reduction. Transfusion 2022; 62:1073-1083. [PMID: 35385146 PMCID: PMC9325390 DOI: 10.1111/trf.16867] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 02/22/2022] [Accepted: 03/08/2022] [Indexed: 12/20/2022]
Abstract
BACKGROUND Plasmodium falciparum is the parasite responsible for most malaria cases globally. The risk of transfusion-transmitted malaria (TTM) is mitigated by donor deferrals and blood screening strategies, which adversely impact blood availability. Previous studies showed robust inactivation of P. falciparum using nucleic acid-targeting pathogen reduction technologies (PRT) for the treatment of plasma and platelet components or whole blood (WB). The efficacy of the amustaline-glutathione (GSH) PRT to inactivate P. falciparum is here evaluated in red blood cells (RBC), as well the impact of PRT on parasite loads, stages, and strains. STUDY DESIGN AND METHODS RBC units resuspended in AS-1 or AS-5 additive solutions were spiked with ring stage-infected RBC and treated with the amustaline-GSH PRT. Parasite loads and viability were measured in samples at the time of contamination, and after treatment, using serial 10-fold dilutions of the samples in RBC cultures maintained for up to 4 weeks. RESULTS P. falciparum viability assays allow for the detection of very low levels of parasite. Initial parasite titer was >5.2 log10 /ml in AS-1/5 RBC. No infectious parasites were detected in amustaline-GSH-treated samples after 4 weeks of culture. Amustaline-GSH inactivated high parasite loads regardless of parasite stages and strains. Amustaline readily penetrates the parasite, irreversibly blocks development, and leads to parasite death and expulsion from RBC. DISCUSSION Amustaline-GSH PRT demonstrated robust efficacy to inactivate malaria parasites in RBC concentrates. This study completes the portfolio of studies demonstrating the efficacy of nucleic acid-targeting PRTs to mitigate TTM risks as previously reported for platelet concentrates, plasma, and WB.
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Affiliation(s)
- Cissé Sow
- UMR7245 MCAM, Muséum National d'Histoire Naturelle, Team PPL, CNRS, Paris, France
| | - Amélie Bouissou
- UMR7245 MCAM, Muséum National d'Histoire Naturelle, Team PPL, CNRS, Paris, France
| | | | | | - Lotfi Bounaadja
- UMR7245 MCAM, Muséum National d'Histoire Naturelle, Team PPL, CNRS, Paris, France
| | | | | | | | | | | | - Philippe Grellier
- UMR7245 MCAM, Muséum National d'Histoire Naturelle, Team PPL, CNRS, Paris, France
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Uhrlaub JL, Jergović M, Bradshaw CM, Sonar S, Coplen CP, Dudakov J, Murray KO, Lanteri MC, Busch MP, van den Brink MRM, Nikolich‐Žugich J. Quantitative restoration of immune defense in old animals determined by naive antigen-specific CD8 T-cell numbers. Aging Cell 2022; 21:e13582. [PMID: 35289071 PMCID: PMC9009107 DOI: 10.1111/acel.13582] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 01/18/2022] [Accepted: 02/19/2022] [Indexed: 01/27/2023] Open
Abstract
Older humans and animals often exhibit reduced immune responses to infection and vaccination, and this often directly correlates to the numbers and frequency of naive T (Tn) cells. We found such a correlation between reduced numbers of blood CD8+ Tn cells and severe clinical outcomes of West Nile virus (WNV) in both humans naturally exposed to, and mice experimentally infected with, WNV. To examine possible causality, we sought to increase the number of CD8 Tn cells by treating C57BL/6 mice with IL-7 complexes (IL-7C, anti-IL-7 mAb bound to IL-7), shown previously to efficiently increase peripheral T-cell numbers by homeostatic proliferation. T cells underwent robust expansion following IL-7C administration to old mice increasing the number of total T cells (>fourfold) and NS4b:H-2Db -restricted antigen-specific CD8 T cells (twofold). This improved the numbers of NS4b-specific CD8 T cells detected at the peak of the response against WNV, but not survival of WNV challenge. IL-7C-treated old animals also showed no improvement in WNV-specific effector immunity (neutralizing antibody and in vivo T-cell cytotoxicity). To test quantitative limits to which CD8 Tn cell restoration could improve protective immunity, we transferred graded doses of Ag-specific precursors into old mice and showed that injection of 5400 (but not of 1800 or 600) adult naive WNV-specific CD8 T cells significantly increased survival after WNV. These results set quantitative limits to the level of Tn reconstitution necessary to improve immune defense in older organisms and are discussed in light of targets of immune reconstitution.
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Affiliation(s)
- Jennifer L. Uhrlaub
- Department of ImmunobiologyUniversity of Arizona College of MedicineTucsonArizonaUSA,University of ArizonaCenter on AgingUniversity of ArizonaCollege of Medicine, TucsonTucsonArizonaUSA
| | - Mladen Jergović
- Department of ImmunobiologyUniversity of Arizona College of MedicineTucsonArizonaUSA,University of ArizonaCenter on AgingUniversity of ArizonaCollege of Medicine, TucsonTucsonArizonaUSA
| | - Christine M. Bradshaw
- Department of ImmunobiologyUniversity of Arizona College of MedicineTucsonArizonaUSA,University of ArizonaCenter on AgingUniversity of ArizonaCollege of Medicine, TucsonTucsonArizonaUSA
| | - Sandip Sonar
- Department of ImmunobiologyUniversity of Arizona College of MedicineTucsonArizonaUSA,University of ArizonaCenter on AgingUniversity of ArizonaCollege of Medicine, TucsonTucsonArizonaUSA
| | - Christopher P. Coplen
- Department of ImmunobiologyUniversity of Arizona College of MedicineTucsonArizonaUSA,University of ArizonaCenter on AgingUniversity of ArizonaCollege of Medicine, TucsonTucsonArizonaUSA
| | - Jarrod Dudakov
- Program in ImmunologyClinical Research Division, and Immunotherapy Integrated Research CenterFred Hutchinson Cancer Research CenterSeattleWashingtonUSA,Department of ImmunologyUniversity of WashingtonSeattleWashingtonUSA
| | - Kristy O. Murray
- Department of PediatricsSection of Pediatric Tropical Medicine and National School of Tropical MedicineBaylor College of MedicineHoustonTexasUSA,William T. Shearer Center for Human ImmunobiologyTexas Children’s HospitalHoustonTexasUSA
| | - Marion C. Lanteri
- Blood Systems Research InstituteVitalant Research InstituteSan FranciscoCaliforniaUSA
| | - Michael P. Busch
- Blood Systems Research InstituteVitalant Research InstituteSan FranciscoCaliforniaUSA
| | - Marcel R. M. van den Brink
- Department of Medicine and Immunology ProgramMemorial Sloan Kettering Cancer CenterNew YorkNew York CityUSA
| | - Janko Nikolich‐Žugich
- Department of ImmunobiologyUniversity of Arizona College of MedicineTucsonArizonaUSA,University of ArizonaCenter on AgingUniversity of ArizonaCollege of Medicine, TucsonTucsonArizonaUSA
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9
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Page GP, Kanias T, Guo YJ, Lanteri MC, Zhang X, Mast AE, Cable RG, Spencer BR, Kiss JE, Fang F, Endres-Dighe SM, Brambilla D, Nouraie M, Gordeuk VR, Kleinman S, Busch MP, Gladwin MT. Multiple-ancestry genome-wide association study identifies 27 loci associated with measures of hemolysis following blood storage. J Clin Invest 2021; 131:146077. [PMID: 34014839 DOI: 10.1172/jci146077] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 05/13/2021] [Indexed: 12/17/2022] Open
Abstract
BackgroundThe evolutionary pressure of endemic malaria and other erythrocytic pathogens has shaped variation in genes encoding erythrocyte structural and functional proteins, influencing responses to hemolytic stress during transfusion and disease.MethodsWe sought to identify such genetic variants in blood donors by conducting a genome-wide association study (GWAS) of 12,353 volunteer donors, including 1,406 African Americans, 1,306 Asians, and 945 Hispanics, whose stored erythrocytes were characterized by quantitative assays of in vitro osmotic, oxidative, and cold-storage hemolysis.ResultsGWAS revealed 27 significant loci (P < 5 × 10-8), many in candidate genes known to modulate erythrocyte structure, metabolism, and ion channels, including SPTA1, ALDH2, ANK1, HK1, MAPKAPK5, AQP1, PIEZO1, and SLC4A1/band 3. GWAS of oxidative hemolysis identified variants in genes encoding antioxidant enzymes, including GLRX, GPX4, G6PD, and SEC14L4 (Golgi-transport protein). Genome-wide significant loci were also tested for association with the severity of steady-state (baseline) in vivo hemolytic anemia in patients with sickle cell disease, with confirmation of identified SNPs in HBA2, G6PD, PIEZO1, AQP1, and SEC14L4.ConclusionsMany of the identified variants, such as those in G6PD, have previously been shown to impair erythrocyte recovery after transfusion, associate with anemia, or cause rare Mendelian human hemolytic diseases. Candidate SNPs in these genes, especially in polygenic combinations, may affect RBC recovery after transfusion and modulate disease severity in hemolytic diseases, such as sickle cell disease and malaria.
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Affiliation(s)
- Grier P Page
- Division of Biostatistics and Epidemiology, RTI International, Atlanta, Georgia, USA
| | - Tamir Kanias
- Vitalant Research Institute, Denver, Colorado, USA
| | - Yuelong J Guo
- Division of Biostatistics and Epidemiology, RTI International, Durham, North Carolina, USA
| | - Marion C Lanteri
- Vitalant Research Institute and the Department of Laboratory Medicine, UCSF, San Francisco, California, USA
| | - Xu Zhang
- Department of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Alan E Mast
- Blood Research Institute, Blood Center of Wisconsin, and Department of Cell Biology, Neurobiology and Anatomy, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | | | | | - Joseph E Kiss
- Vitalant Northeast Division, Pittsburgh, Pennsylvania, USA
| | - Fang Fang
- Division of Biostatistics and Epidemiology, RTI International, Durham, North Carolina, USA
| | - Stacy M Endres-Dighe
- Division of Biostatistics and Epidemiology, RTI International, Rockville, Maryland, USA
| | - Donald Brambilla
- Division of Biostatistics and Epidemiology, RTI International, Rockville, Maryland, USA
| | - Mehdi Nouraie
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, University of Pittsburgh, Pennsylvania, USA
| | - Victor R Gordeuk
- Department of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Steve Kleinman
- University of British Columbia, Victoria, British Columbia, Canada
| | - Michael P Busch
- Vitalant Research Institute and the Department of Laboratory Medicine, UCSF, San Francisco, California, USA
| | - Mark T Gladwin
- Pittsburgh Heart, Lung, and Blood Vascular Medicine Institute, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
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10
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Stone M, Bakkour S, Lanteri MC, Brambilla D, Simmons G, Bruhn R, Kaidarova Z, Lee TH, Orlando Alsina J, Williamson PC, Galel SA, Pate LL, Linnen JM, Kleinman S, Busch MP. Zika virus RNA and IgM persistence in blood compartments and body fluids: a prospective observational study. Lancet Infect Dis 2020; 20:1446-1456. [PMID: 32673593 PMCID: PMC10029720 DOI: 10.1016/s1473-3099(19)30708-x] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 09/01/2019] [Accepted: 11/14/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND Characterisation of the dynamics of Zika virus persistence following acute infection is needed to inform blood donor and diagnostic testing policies and understand the natural history of Zika virus infection. We aimed to characterise the natural history, persistence, and clinical outcomes of Zika virus infection through a prospective study in initially asymptomatic Zika virus RNA-positive blood donors. METHODS Zika virus-infected blood donors identified through Zika virus nucleic acid amplification test (NAAT) screening at three blood collection organisations in the USA were enrolled into a 1-year follow-up study, with blood and body fluid samples and detailed symptom data collected at up to seven visits. All samples were tested for Zika virus RNA by real-time PCR (rtPCR); follow-up plasma, whole blood, and urine were also tested by replicate NAAT. Plasma was tested for flavivirus-specific IgM and IgG by ELISA. Zika virus RNA persistence for each assay or sample type and plasma antibody persistence from estimated date of plasma NAAT-detectable infection were calculated from follow-up data using survival statistical methods. FINDINGS Between July 6, 2016 and March 7, 2017, we enrolled 53 participants. From the estimated date of plasma NAAT-detectable infection, Zika virus RNA was detectable in plasma for 9·9 days (95% CI 8·1-12·0), in red blood cells for 95·4 days (62·8-129·1), and in whole blood for 73·5 days (39·8-107·5). Replicate NAATs (one or more of eight replicates positive) extended detection of Zika virus RNA in plasma to 34·8 days (19·9-56·2) and in whole blood (at least one of two tests positive) to 104·8 days (76·7-129·9). Urine was rtPCR reactive up to 14·5 days (10·5-20·3) and saliva up to 26·4 days (19·7-38·7). Zika virus IgM persisted for 237·7 days (128·7-459·5) from estimated time since plasma NAAT-detectable infection. Zika virus RNA fell below detectable limits more rapidly in the saliva of participants with pre-existing dengue virus IgG than in those without. Of 25 donors identified pre-seroconversion with symptom data at the first or second study visit, 16 (64%) developed multiple Zika virus-related symptoms after asymptomatic index donations, compared with nine (36%) of 25 donors detected after seroconversion. INTERPRETATION Determination of viral marker persistence is enhanced by follow-up of blood donors who are pre-symptomatic or asymptomatic, Zika virus RNA-positive, and antibody negative. Zika virus RNA persists in red blood cells for several months following clearance from plasma and body fluids, and replicate, highly sensitive NAATs extend RNA detection in all compartments. Whole blood testing can extend detection of acute infection for diagnostics and monitoring of pregnant women, sexual partners, and travellers. FUNDING National Heart, Lung, and Blood Institute, Biomedical Advanced Research and Development Authority.
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Affiliation(s)
- Mars Stone
- Vitalant Research Institute, San Francisco, CA, USA; Department of Laboratory Medicine, University of California, San Francisco, CA, USA.
| | - Sonia Bakkour
- Vitalant Research Institute, San Francisco, CA, USA; Department of Laboratory Medicine, University of California, San Francisco, CA, USA
| | - Marion C Lanteri
- Vitalant Research Institute, San Francisco, CA, USA; Department of Laboratory Medicine, University of California, San Francisco, CA, USA; Cerus Corporation, Concord, CA, USA
| | | | - Graham Simmons
- Vitalant Research Institute, San Francisco, CA, USA; Department of Laboratory Medicine, University of California, San Francisco, CA, USA
| | - Roberta Bruhn
- Vitalant Research Institute, San Francisco, CA, USA; Department of Laboratory Medicine, University of California, San Francisco, CA, USA
| | | | | | | | | | | | - Lisa L Pate
- Roche Molecular Systems, Pleasanton, CA, USA
| | | | - Steve Kleinman
- Department of Pathology and Laboratory Medicine, University of British Columbia, Victoria, BC, Canada
| | - Michael P Busch
- Vitalant Research Institute, San Francisco, CA, USA; Department of Laboratory Medicine, University of California, San Francisco, CA, USA
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11
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Fridey JL, Stramer SL, Nambiar A, Moayeri M, Bakkour S, Langelier C, Crawford E, Lu T, Lanteri MC, Kamm J, Miller S, Wagner SJ, Benjamin RJ, Busch MP. Sepsis from an apheresis platelet contaminated with Acinetobacter calcoaceticus/baumannii complex bacteria and Staphylococcus saprophyticus after pathogen reduction. Transfusion 2020; 60:1960-1969. [PMID: 32738079 DOI: 10.1111/trf.15951] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 05/18/2020] [Accepted: 05/18/2020] [Indexed: 12/27/2022]
Abstract
BACKGROUND Strategies to reduce platelet (PLT) bacterial contamination include donor screening, skin disinfection, sample diversion, bacterial culture, pathogen reduction (PR), and day-of-transfusion tests. We report bacterial sepsis following a pathogen-reduced PLT transfusion. CASE REPORT An adult male with relapsed acute lymphoblastic leukemia was successfully treated for central catheter-associated Staphylococcus aureus bacteremia. A peripherally inserted central catheter (PICC) was placed. Chills, rigors, and flushing developed immediately after PICC-infused pathogen-reduced PLTs, progressing to septic shock requiring intensive care management. METHODS PICC and peripheral blood (PB), transfused bag saline flushes (TBFs), environmental samples, and the pathogen-reduced untransfused co-component (CC) were cultured. Plasma metagenomic and bacterial isolate whole-genome sequencing; PLT mitochondrial DNA (mtDNA) testing of untransfused CC and TBF; CC testing for amotosalen (S-59)/S-59 photoproducts; isolate PR studies (INTERCEPT); and TBF polymerase chain reaction for recipient Y-chromosome DNA were performed. RESULTS PB and PICC cultures grew Acinetobacter calcoaceticus/baumannii complex (ACBC). TBF was gram-positive; mass spectrometry identified ACBC and Staphylococcus saprophyticus (SS). CC Gram stain and cultures were negative. Environmental cultures, some done after decontamination, were ACBC/SS negative. Posttransfusion patient plasma and TBF ACBC sequences were genetically identical. No Y-chromosome signal was detected in TBF. S-59 photoproducts and evidence of mtDNA amplification inhibition were found in the CC. Spiking PR studies showed >5.9-log inactivation for both isolates. Donor skin cultures for Acinetobacter were negative. CONCLUSION CC sterility, PR studies, residual S-59 photoproducts, and mtDNA amplification inhibition suggest successful PR. Unidentified environmental sources and inherent or acquired bag defects may have contributed to postmanufacturing pathogen-reduced PLT contamination.
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Affiliation(s)
- Joy L Fridey
- Southern California Region, American Red Cross, Pomona, California, USA
| | - Susan L Stramer
- Scientific Affairs, American Red Cross, Gaithersburg, Maryland, USA
| | - Ashok Nambiar
- Department of Laboratory Medicine, University of California San Francisco, San Francisco, California, USA
| | - Morvarid Moayeri
- Department of Laboratory Medicine, University of California San Francisco, San Francisco, California, USA
| | - Sonia Bakkour
- Vitalant Research Institute, San Francisco, California, USA
| | - Charles Langelier
- Chan Zuckerberg Biohub, University of California San Francisco, San Francisco, California, USA
| | - Emily Crawford
- Chan Zuckerberg Biohub, University of California San Francisco, San Francisco, California, USA
| | - Thea Lu
- Cerus Corporation, Concord, California, USA
| | | | - Jack Kamm
- Chan Zuckerberg Biohub, University of California San Francisco, San Francisco, California, USA
| | - Steve Miller
- Department of Laboratory Medicine, University of California San Francisco, San Francisco, California, USA
| | - Stephen J Wagner
- Transfusion Innovation, American Red Cross, Rockville, Maryland, USA
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12
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Lanteri MC, Santa-Maria F, Laughhunn A, Girard YA, Picard-Maureau M, Payrat JM, Irsch J, Stassinopoulos A, Bringmann P. Inactivation of a broad spectrum of viruses and parasites by photochemical treatment of plasma and platelets using amotosalen and ultraviolet A light. Transfusion 2020; 60:1319-1331. [PMID: 32333396 PMCID: PMC7317863 DOI: 10.1111/trf.15807] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 03/12/2020] [Accepted: 03/13/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND The INTERCEPT Blood System pathogen reduction technology (PRT), which uses amotosalen and ultraviolet A light treatment (amotosalen/UV-PRT), inactivates pathogens in plasma and platelet components (PCs). This review summarizes data describing the inactivation efficacy of amotosalen/UVA-PRT for a broad spectrum of viruses and parasites. METHODS Twenty-five enveloped viruses, six nonenveloped viruses (NEVs), and four parasites species were evaluated for sensitivity to amotosalen/UVA-PRT. Pathogens were spiked into plasma and PC at high titers. Samples were collected before and after PRT and assessed for infectivity with cell cultures or animal models. Log reduction factors (LRFs) were defined as the difference in infectious titers before and after amotosalen/UV-PRT. RESULTS LRFs of ≥4.0 log were reported for 19 pathogens in plasma (range, ≥4.0 to ≥7.6), 28 pathogens in PC in platelet additive solution (PC-PAS; ≥4.1-≥7.8), and 14 pathogens in PC in 100% plasma (PC-100%; (≥4.3->8.4). Twenty-five enveloped viruses and two NEVs were sensitive to amotosalen/UV-PRT; LRF ranged from >2.9 to ≥7.6 in plasma, 2.4 or greater to greater than 6.9 in PC-PAS and >3.5 to >6.5 in PC-100%. Infectious titers for four parasites were reduced by >4.0 log in all PC and plasma (≥4.9 to >8.4). CONCLUSION Amotosalen/UVA-PRT demonstrated effective infectious titer reduction for a broad spectrum of viruses and parasites. This confirms the capacity of this system to reduce the risk of viral and parasitic transfusion-transmitted infections by plasma and PCs in various geographies.
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Affiliation(s)
- Marion C Lanteri
- Department of Scientific Affairs, Cerus Corporation, Concord, California, USA
| | | | - Andrew Laughhunn
- Department of Microbiology, Cerus Corporation, Concord, California, USA
| | - Yvette A Girard
- Department of Microbiology, Cerus Corporation, Concord, California, USA
| | | | - Jean-Marc Payrat
- Department of Scientific Affairs, Cerus Europe BV, Amersfoort, The Netherlands
| | - Johannes Irsch
- Department of Scientific Affairs, Cerus Europe BV, Amersfoort, The Netherlands
| | | | - Peter Bringmann
- Department of Microbiology, Cerus Corporation, Concord, California, USA
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13
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Sow C, Laughhunn A, Girard YA, Lanteri MC, Amar El Dusouqui S, Stassinopoulos A, Grellier P. Inactivation of Plasmodium falciparum in whole blood using the amustaline and glutathione pathogen reduction technology. Transfusion 2020; 60:799-805. [PMID: 32129497 PMCID: PMC7187285 DOI: 10.1111/trf.15734] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 01/16/2020] [Accepted: 02/04/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND Risk of transfusion-transmitted (TT) malaria is mainly associated with whole blood (WB) or red blood cell (RBC) transfusion. Risk mitigation relies mostly on donor deferral while a limited number of countries perform blood testing, both negatively impacting blood availability. This study investigated the efficacy of the pathogen reduction system using amustaline and glutathione (GSH) to inactivate Plasmodium falciparum in WB. STUDY DESIGN AND METHODS WB units were spiked with ring stage P. falciparum infected RBCs. Parasite loads were measured in samples at time of infection, after 24 hours at room temperature (RT), and after a 24-hour incubation at RT post-treatment with 0.2 mM amustaline and 2 mM GSH. Serial 10-fold dilutions of the samples were inoculated to RBC cultures and maintained up to 4 weeks. Parasitemia was quantified by cytometry. RESULTS The P. falciparum viability assay has a limit of detection of a single live parasite per sample. Input parasite titer was >5.7 log10 TCID50 per mL. A 24-hour incubation at RT paused parasite development in controls, but they retained viability and infectivity when tested in culture. In contrast, no infectious parasites were detected in the amustaline/GSH-treated sample after 4 weeks of culture. CONCLUSION A robust level of P. falciparum inactivation was achieved in WB using amustaline/GSH treatment. Parasite log reduction was >5.7 log10 TCID50 per mL. Development of such a pathogen reduction system may provide an opportunity to reduce the risk of TT malaria and improve blood availability.
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Affiliation(s)
- Cissé Sow
- MCAM, UMR 7245, Muséum National dʼHistoire Naturelle, CNRSParisFrance
| | | | | | | | | | | | - Philippe Grellier
- MCAM, UMR 7245, Muséum National dʼHistoire Naturelle, CNRSParisFrance
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14
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Girard YA, Santa Maria F, Lanteri MC. Inactivation of yellow fever virus with amotosalen and ultraviolet A light pathogen-reduction technology. Transfusion 2020; 60:622-627. [PMID: 31957887 PMCID: PMC7078960 DOI: 10.1111/trf.15673] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 10/14/2019] [Accepted: 10/30/2019] [Indexed: 12/24/2022]
Abstract
BACKGROUND The reemergence of yellow fever virus (YFV) in Africa and Brazil, and massive vaccine campaigns triggered to contain the outbreaks, have raised concerns over blood transfusion safety and availability with increased risk of YFV transfusion-transmitted infections (TTIs) by native and vaccine-acquired YFV. Blood donor deferral for 2 to 4 weeks following live attenuated YFV vaccination, and deferral for travel to endemic/epidemic areas, may result in blood donor loss and impact platelet component (PC) stocks. This study investigated the efficacy of INTERCEPT Blood System pathogen reduction (PR) with use of amotosalen and ultraviolet A (UVA) light to inactivate high levels of YFV in PCs. MATERIALS Four units of apheresis platelets prepared in 35% plasma/65% platelet additive solution (PC-PAS) and 4 units of PC in 100% human plasma (PC-Plasma) were spiked with high infectious titers of YFV (YFV-17D vaccine strain). YFV-17D infectious titers were measured by plaque assay and expressed as plaque-forming units (PFU) before and after amotosalen/UVA treatment to determine log reduction. RESULTS The mean YFV-17D infectious titers in PC before inactivation were 5.5 ± 0.1 log PFU/mL in PC-PAS and 5.3 ± 0.1 log PFU/mL in PC-Plasma. No infectivity was detected immediately after amotosalen/UVA treatment. CONCLUSION The amotosalen/UVA PR system inactivated high titers of infectious YFV-17D in PC. This PR technology could reduce the risk of YFV TTI and help secure PC supplies in areas experiencing YFV outbreaks where massive vaccination campaigns are required.
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Affiliation(s)
- Yvette A Girard
- Department of Microbiology, Cerus Corporation, Concord, California
| | | | - Marion C Lanteri
- Department of Scientific Affairs, Cerus Corporation, Concord, California
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15
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Ferreira LRP, Ferreira FM, Nakaya HI, Deng X, Cândido DDS, de Oliveira LC, Billaud JN, Lanteri MC, Rigaud VOC, Seielstad M, Kalil J, Fernandes F, Ribeiro ALP, Sabino EC, Cunha-Neto E. Corrigendum to: Blood Gene Signatures of Chagas Cardiomyopathy With or Without Ventricular Dysfunction. J Infect Dis 2019; 221:1564. [PMID: 31884515 DOI: 10.1093/infdis/jiz661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Ludmila Rodrigues Pinto Ferreira
- Laboratory of Immunology.,Division of Clinical Immunology and Allergy, School of Medicine.,Institute for Investigation in Immunology, National Institute of Science and Technology.,Universidade Santo Amaro, São Paulo
| | - Frederico Moraes Ferreira
- Laboratory of Immunology.,Division of Clinical Immunology and Allergy, School of Medicine.,Institute for Investigation in Immunology, National Institute of Science and Technology.,Universidade Santo Amaro, São Paulo
| | - Helder Imoto Nakaya
- Department of Pathophysiology and Toxicology, School of Pharmaceutical Sciences.,Department of Pathology, Emory University School of Medicine, Atlanta, Georgia
| | - Xutao Deng
- Blood Systems Research Institute.,Department of Laboratory Medicine
| | - Darlan da Silva Cândido
- Laboratory of Immunology.,Division of Clinical Immunology and Allergy, School of Medicine.,Institute for Investigation in Immunology, National Institute of Science and Technology
| | - Lea Campos de Oliveira
- Institute of Tropical Medicine, Department of Infectious Disease, University of São Paulo
| | | | - Marion C Lanteri
- Blood Systems Research Institute.,Institute for Human Genetics, Department of Laboratory Medicine, University of California, San Francisco
| | - Vagner Oliveira-Carvalho Rigaud
- Laboratory of Immunology.,Division of Clinical Immunology and Allergy, School of Medicine.,Institute for Investigation in Immunology, National Institute of Science and Technology
| | - Mark Seielstad
- Blood Systems Research Institute.,Institute for Human Genetics, Department of Laboratory Medicine, University of California, San Francisco
| | - Jorge Kalil
- Laboratory of Immunology.,Division of Clinical Immunology and Allergy, School of Medicine.,Institute for Investigation in Immunology, National Institute of Science and Technology
| | | | - Antônio Luiz Pinho Ribeiro
- Hospital das Clínicas.,Faculdade de Medicina, Universidade Federal de Minas Gerais, Minas Gerais, Brazil
| | - Ester Cerdeira Sabino
- Institute of Tropical Medicine, Department of Infectious Disease, University of São Paulo
| | - Edecio Cunha-Neto
- Laboratory of Immunology.,Division of Clinical Immunology and Allergy, School of Medicine.,Institute for Investigation in Immunology, National Institute of Science and Technology
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16
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Castrillo Fernández A, Lanteri MC, Arcas Otero C, Díaz Pereira A, Adelantado Pérez M. In vitro evaluation of pathogen inactivated platelet quality: An 8 year experience of routine use in Galicia, Spain. Transfus Apher Sci 2018; 58:87-93. [PMID: 30579750 DOI: 10.1016/j.transci.2018.12.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 12/04/2018] [Accepted: 12/06/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND Platelet concentrates (PCs) treated by the pathogen inactivation technology (PI) using amotosalen and UVA illumination (PI-PCs) can be manufactured in additive solutions (PAS-III and PAS-IIIM) or in 100% Plasma. Quality control (QC) is an integral part of the production. We capitalized on our ongoing QC program to capture 8 years-worth of data on parameters related to the quality of 116,214 PI-PCs produced under different manufacturing methods. MATERIALS AND METHODS Selected in vitro parameters of metabolism, activation, and storage were analyzed for the different manufacturing periods to compare PI-PCs versus conventional PCs (C-PCs) resuspended in different PAS. RESULTS AND DISCUSSION All BC-PCs met quality standards for pH and dose and residual leucocytes. As expected, storage time correlated with increased lactate, LDH, Annexin V, CD62, sCD40 L levels and decreased glucose and pH. With PAS-IIIM, higher levels of glucose were observed toward the end of shelf life (p < 0.0001) with lower platelet activation markers Annexin V (p = 0.038) and CD62 (p = 0.0006). Following PI implementation, a low expire rate of <0.5% was observed. While a 2.3% mean increase in the production of PCs occurred from 2011 to 2015, the distribution of red blood cell concentrates dropped by 4.4%. A mean incidence of 0.14% for transfusion-related adverse reaction was observed while PI-PCs were distributed, similar to the one observed with C-PCs. Overall, PI-PCs prepared in additive solutions consistently met quality standards. Those prepared in PAS-IIIM appeared to have better retention of in vitro characteristics compared to PAS-III though all demonstrated functionality and clinical effectiveness.
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Affiliation(s)
| | - Marion C Lanteri
- Department of Scientific Affairs, Cerus Corporation, Concord, California, USA
| | - Carina Arcas Otero
- Axencia Galega de Sangue, Órganos e Tecidos Santiago de Compostela, Spain
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17
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Stone M, Keating SM, Kanias T, Lanteri MC, Lebedeva M, Sinchar D, Hampton D, Jakub A, Rychka V, Brewer G, Bakkour S, Gefter N, Murcia K, Page GP, Endres-Dighe S, Bialkowski W, Fu X, Zimring J, Raife TJ, Kleinman S, Gladwin MT, Busch MP. Piloting and implementation of quality assessment and quality control procedures in RBC-Omics: a large multi-center study of red blood cell hemolysis during storage. Transfusion 2018; 59:57-66. [PMID: 30566231 DOI: 10.1111/trf.15099] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 11/08/2018] [Accepted: 11/09/2018] [Indexed: 12/22/2022]
Abstract
BACKGROUND The major aims of the RBC-Omics study were to evaluate the genomic and metabolomic determinants of spontaneous and stress-induced hemolysis during RBC storage. This study was unique in scale and design to allow evaluation of RBC donations from a sufficient number of donors across the spectrum of race, ethnicity, sex, and donation intensity. Study procedures were carefully piloted, optimized, and controlled to enable high-quality data collection. METHODS The enrollment goal of 14,000 RBC donors across four centers, with characterization of RBC hemolysis across two testing laboratories, required rigorous piloting and optimization and establishment of a quality assurance (QA) and quality control (QC) program. Optimization of WBC elution from leukoreduction (LR) filters, development and validation of small-volume transfer bags, impact of manufacturing and sample-handling procedures on hemolysis parameters, and testing consistency across laboratories and technicians and over time were part of this quality assurance/quality control program. RESULTS LR filter elution procedures were optimized for obtaining DNA for analysis. Significant differences between standard and pediatric storage bags led to use of an alternative LR-RBC transfer bag. The impact of sample preparation and freezing methods on metabolomics analyses was evaluated. Proficiency testing monitored and documented testing consistency across laboratories and technicians. CONCLUSION Piloting and optimization, and establishment of a robust quality assurance/quality control program documented process consistency throughout the study and was essential in executing this large-scale multicenter study. This program supports the validity of the RBC-Omics study results and a sample repository that can be used in future studies.
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Affiliation(s)
- Mars Stone
- Vitalant Research Institute (Formerly Blood Systems Research Institute), San Francisco, California.,Department of Laboratory Medicine, University of California, San Francisco, California
| | - Sheila M Keating
- Vitalant Research Institute (Formerly Blood Systems Research Institute), San Francisco, California.,Department of Laboratory Medicine, University of California, San Francisco, California
| | - Tamir Kanias
- Pittsburgh Heart, Lung, Blood and Vascular Medicine Institute, University of Pittsburgh, Pittsburgh, Pennsylvania.,Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Marion C Lanteri
- Vitalant Research Institute (Formerly Blood Systems Research Institute), San Francisco, California.,Department of Laboratory Medicine, University of California, San Francisco, California
| | - Mila Lebedeva
- Vitalant Research Institute (Formerly Blood Systems Research Institute), San Francisco, California
| | - Derek Sinchar
- Pittsburgh Heart, Lung, Blood and Vascular Medicine Institute, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Dylan Hampton
- Vitalant Research Institute (Formerly Blood Systems Research Institute), San Francisco, California
| | - Adam Jakub
- Pittsburgh Heart, Lung, Blood and Vascular Medicine Institute, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Val Rychka
- Pittsburgh Heart, Lung, Blood and Vascular Medicine Institute, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Greg Brewer
- Pittsburgh Heart, Lung, Blood and Vascular Medicine Institute, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Sonia Bakkour
- Vitalant Research Institute (Formerly Blood Systems Research Institute), San Francisco, California
| | - Nelly Gefter
- Vitalant Research Institute (Formerly Blood Systems Research Institute), San Francisco, California
| | - Karla Murcia
- Vitalant Research Institute (Formerly Blood Systems Research Institute), San Francisco, California
| | | | | | - Walter Bialkowski
- Blood Research and Medical Sciences Institutes, Blood Center of Wisconsin, Milwaukee, Wisconsin
| | - Xiaoyun Fu
- Bloodworks NW Research Institute; and the Department of Laboratory Medicine and the Department of Medicine, Division of Hematology, University of Washington School of Medicine, Seattle, Washington
| | - Jim Zimring
- Bloodworks NW Research Institute; and the Department of Laboratory Medicine and the Department of Medicine, Division of Hematology, University of Washington School of Medicine, Seattle, Washington
| | - Thomas J Raife
- Department of Pathology and Laboratory Medicine, University of Wisconsin-Madison, Madison, Wisconsin
| | - Steve Kleinman
- Clinical Pathology, University of British Columbia, School of Medicine, Vancouver, British Columbia, Canada
| | - Mark T Gladwin
- Pittsburgh Heart, Lung, Blood and Vascular Medicine Institute, University of Pittsburgh, Pittsburgh, Pennsylvania.,Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Michael P Busch
- Vitalant Research Institute (Formerly Blood Systems Research Institute), San Francisco, California.,Department of Laboratory Medicine, University of California, San Francisco, California
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18
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Kanias T, Stone M, Page GP, Guo Y, Endres-Dighe SM, Lanteri MC, Spencer BR, Cable RG, Triulzi DJ, Kiss JE, Murphy EL, Kleinman S, Gladwin MT, Busch MP, Mast AE. Frequent blood donations alter susceptibility of red blood cells to storage- and stress-induced hemolysis. Transfusion 2018; 59:67-78. [PMID: 30474858 DOI: 10.1111/trf.14998] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2018] [Revised: 05/14/2018] [Accepted: 05/27/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND Frequent whole blood donations increase the prevalence of iron depletion in blood donors, which may subsequently interfere with normal erythropoiesis. The purpose of this study was to evaluate the associations between donation frequency and red blood cell (RBC) storage stability in a racially/ethnically diverse population of blood donors. STUDY DESIGN Leukoreduced RBC concentrate-derived samples from 13,403 donors were stored for 39 to 42 days (1-6°C) and then evaluated for storage, osmotic, and oxidative hemolysis. Iron status was evaluated by plasma ferritin measurement and self-reported intake of iron supplements. Donation history in the prior 2 years was obtained for each subject. RESULTS Frequent blood donors enrolled in this study were likely to be white, male, and of older age (56.1 ± 5.0 years). Prior donation intensity was negatively associated with oxidative hemolysis (p < 0.0001) in multivariate analyses correcting for age, sex, and race/ethnicity. Increased plasma ferritin concentration was associated with increased RBC susceptibility to each of the three measures of hemolysis (p < 0.0001 for all), whereas self-reported iron intake was associated with reduced susceptibility to osmotic and oxidative hemolysis (p < 0.0001 for both). CONCLUSIONS Frequent blood donations may alter the quality of blood components by modulating RBC predisposition to hemolysis. RBCs collected from frequent donors with low ferritin have altered susceptibility to hemolysis. Thus, frequent donation and associated iron loss may alter the quality of stored RBC components collected from iron-deficient donors. Further investigation is necessary to assess posttransfusion safety and efficacy in patients receiving these RBC products.
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Affiliation(s)
- Tamir Kanias
- Pittsburgh Heart, Lung, Blood and Vascular Medicine Institute, University of Pittsburgh, Pittsburgh, Pennsylvania.,Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Mars Stone
- Blood Systems Research Institute, San Francisco, and Department of Laboratory Medicine, University of California, San Francisco, California
| | | | - Yuelong Guo
- RTI International, Research Triangle Park, North Carolina
| | | | - Marion C Lanteri
- Blood Systems Research Institute, San Francisco, and Department of Laboratory Medicine, University of California, San Francisco, California
| | | | | | - Darrell J Triulzi
- Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania.,The Institute for Transfusion Medicine, Pittsburgh, Pennsylvania
| | - Joseph E Kiss
- The Institute for Transfusion Medicine, Pittsburgh, Pennsylvania
| | - Edward L Murphy
- Blood Systems Research Institute, San Francisco, and Department of Laboratory Medicine, University of California, San Francisco, California
| | - Steve Kleinman
- University of British Columbia, Victoria, British Columbia, Canada
| | - Mark T Gladwin
- Pittsburgh Heart, Lung, Blood and Vascular Medicine Institute, University of Pittsburgh, Pittsburgh, Pennsylvania.,Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Michael P Busch
- Blood Systems Research Institute, San Francisco, and Department of Laboratory Medicine, University of California, San Francisco, California
| | - Alan E Mast
- Blood Research Institute, Blood Center of Wisconsin, and Department of Cell Biology, Neurobiology and Anatomy, Medical College of Wisconsin, Milwaukee
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19
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Lanteri MC, Kanias T, Keating S, Stone M, Guo Y, Page GP, Brambilla DJ, Endres-Dighe SM, Mast AE, Bialkowski W, D'Andrea P, Cable RG, Spencer BR, Triulzi DJ, Murphy EL, Kleinman S, Gladwin MT, Busch MP. Intradonor reproducibility and changes in hemolytic variables during red blood cell storage: results of recall phase of the REDS-III RBC-Omics study. Transfusion 2018; 59:79-88. [PMID: 30408207 DOI: 10.1111/trf.14987] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 09/11/2018] [Accepted: 09/12/2018] [Indexed: 12/18/2022]
Abstract
BACKGROUND Genetic determinants may underlie the susceptibility of red blood cells (RBCs) to hemolyze in vivo and during routine storage. This study characterized the reproducibility and dynamics of in vitro hemolysis variables from a subset of the 13,403 blood donors enrolled in the RBC-Omics study. STUDY DESIGN AND METHODS RBC-Omics donors with either low or high hemolysis results on 4°C-stored leukoreduced (LR)-RBC samples from enrollment donations stored for 39 to 42 days were recalled 2 to 12 months later to donate LR-RBCs. Samples of stored LR-RBCs from the unit and from transfer bags were evaluated for spontaneous and stress-induced hemolysis at selected storage time points. Intradonor reproducibility of hemolysis variables was evaluated in transfer bags over two donations. Hemolysis data at serial storage time points were generated on LR-RBCs from parent bags and analyzed by site, sex, race/ethnicity, and donation frequency. RESULTS A total of 664 donors were successfully recalled. Analysis of intradonor reproducibility revealed that osmotic and oxidative hemolysis demonstrated good and moderate reproducibility (Pearson's r = 0.85 and r = 0.53, respectively), while spontaneous hemolysis reproducibility was poor (r = 0.40). Longitudinal hemolysis in parent bags showed large increases over time in spontaneous (508.6%) and oxidative hemolysis (399.8%) and smaller increases in osmotic (9.4%) and mechanical fragility (3.4%; all p < 0.0001). CONCLUSION Spontaneous hemolysis is poorly reproducible in donors over time and may depend on site processing methods, while oxidative and osmotic hemolysis were reproducible in donors and hence could reflect consistent heritable phenotypes attributable to genetic traits. Spontaneous and oxidative hemolysis increased over time of storage, whereas osmotic and mechanical hemolysis remained relatively stable.
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Affiliation(s)
- Marion C Lanteri
- Vitalant Research Institute (previously Blood Systems Research Institute), University of San Francisco, San Francisco, California.,Department of Laboratory Medicine, University of San Francisco, San Francisco, California
| | - Tamir Kanias
- Pittsburgh Heart, Lung, Blood and Vascular Medicine Institute, Atlanta, Georgia.,Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, Atlanta, Georgia
| | - Sheila Keating
- Vitalant Research Institute (previously Blood Systems Research Institute), University of San Francisco, San Francisco, California.,Department of Laboratory Medicine, University of San Francisco, San Francisco, California
| | - Mars Stone
- Vitalant Research Institute (previously Blood Systems Research Institute), University of San Francisco, San Francisco, California.,Department of Laboratory Medicine, University of San Francisco, San Francisco, California
| | | | | | | | | | - Alan E Mast
- Blood Research and Medical Sciences Institutes, Blood Center of Wisconsin, Milwaukee, Wisconsin
| | - Walter Bialkowski
- Blood Research and Medical Sciences Institutes, Blood Center of Wisconsin, Milwaukee, Wisconsin
| | - Pam D'Andrea
- The Institute for Transfusion Medicine, Pittsburgh, Pennsylvania
| | | | | | - Darrell J Triulzi
- The Institute for Transfusion Medicine, Pittsburgh, Pennsylvania.,Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Edward L Murphy
- Vitalant Research Institute (previously Blood Systems Research Institute), University of San Francisco, San Francisco, California.,Department of Laboratory Medicine, University of San Francisco, San Francisco, California
| | - Steven Kleinman
- University of British Columbia, Victoria, British Columbia, Canada
| | - Mark T Gladwin
- Pittsburgh Heart, Lung, Blood and Vascular Medicine Institute, Atlanta, Georgia.,Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, Atlanta, Georgia
| | - Michael P Busch
- Vitalant Research Institute (previously Blood Systems Research Institute), University of San Francisco, San Francisco, California.,Department of Laboratory Medicine, University of San Francisco, San Francisco, California
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20
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Laughhunn A, Huang YJS, Vanlandingham DL, Lanteri MC, Stassinopoulos A. Inactivation of chikungunya virus in blood components treated with amotosalen/ultraviolet A light or amustaline/glutathione. Transfusion 2018; 58:748-757. [DOI: 10.1111/trf.14442] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Revised: 11/03/2017] [Accepted: 11/11/2017] [Indexed: 12/19/2022]
Affiliation(s)
| | - Yan-Jang S. Huang
- Biosecurity Research Institute and Department of Diagnostic Medicine/Pathobiolgoy; Kansas State University; Manhattan Kansas
| | - Dana L. Vanlandingham
- Biosecurity Research Institute and Department of Diagnostic Medicine/Pathobiolgoy; Kansas State University; Manhattan Kansas
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21
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Aubry M, Laughhunn A, Santa Maria F, Lanteri MC, Stassinopoulos A, Musso D. Amustaline (S-303) treatment inactivates high levels of Chikungunya virus in red-blood-cell components. Vox Sang 2018; 113:232-241. [PMID: 29314033 DOI: 10.1111/vox.12626] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Revised: 11/16/2017] [Accepted: 11/16/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND OBJECTIVES Chikungunya virus (CHIKV) infections have been reported in all continents, and the potential risk for CHIKV transfusion-transmitted infections (TTIs) was demonstrated by the detection of CHIKV RNA-positive donations in several countries. TTIs can be reduced by pathogen inactivation (PI) of blood products. In this study, we evaluated the efficacy of amustaline and glutathione (S-303/GSH) to inactivate CHIKV in red-blood-cell concentrates (RBCs). MATERIAL AND METHODS Red-blood-cells were spiked with high level of CHIKV. Infectious titres and RNA loads were measured before and after PI treatment. Residual CHIKV infectivity was also assessed after five successive cell culture passages. RESULTS The mean CHIKV titres in RBCs before inactivation was 5·81 ± 0·18 log10 50% tissue culture infectious dose (TCID50 )/mL, and the mean viral RNA load was 10·49 ± 0·15 log10 genome equivalent (GEq)/mL. No CHIKV TCID was detected after S-303 treatment nor was replicative CHIKV particles and viral RNA present after five cell culture passages of samples obtained immediately after S-303 treatment. CONCLUSION Chikungunya virus was previously shown to be inactivated by the PI technology using amotosalen and ultraviolet A light for the treatment of plasma and platelets. This new study demonstrates that S-303/GSH can inactivate high titres of CHIKV in RBCs.
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Affiliation(s)
- M Aubry
- Pôle de recherche et de veille sur les maladies infectieuses émergentes, Institut Louis Malardé, Tahiti, French Polynesia.,Aix Marseille Univ, IRD (Dakar, Marseille, Papeete), AP-HM, IHU-Méditerranée Infection, UMR Vecteurs - Infections Tropicales et Méditerranéennes (VITROME), Marseille, France
| | | | | | | | | | - D Musso
- Pôle de recherche et de veille sur les maladies infectieuses émergentes, Institut Louis Malardé, Tahiti, French Polynesia.,Aix Marseille Univ, IRD (Dakar, Marseille, Papeete), AP-HM, IHU-Méditerranée Infection, UMR Vecteurs - Infections Tropicales et Méditerranéennes (VITROME), Marseille, France
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22
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Musso D, Bossin H, Mallet HP, Besnard M, Broult J, Baudouin L, Levi JE, Sabino EC, Ghawche F, Lanteri MC, Baud D. Zika virus in French Polynesia 2013-14: anatomy of a completed outbreak. Lancet Infect Dis 2017; 18:e172-e182. [PMID: 29150310 DOI: 10.1016/s1473-3099(17)30446-2] [Citation(s) in RCA: 82] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Revised: 06/15/2017] [Accepted: 06/30/2017] [Indexed: 10/18/2022]
Abstract
The Zika virus crisis exemplified the risk associated with emerging pathogens and was a reminder that preparedness for the worst-case scenario, although challenging, is needed. Herein, we review all data reported during the unexpected emergence of Zika virus in French Polynesia in late 2013. We focus on the new findings reported during this outbreak, especially the first description of severe neurological complications in adults and the retrospective description of CNS malformations in neonates, the isolation of Zika virus in semen, the potential for blood-transfusion transmission, mother-to-child transmission, and the development of new diagnostic assays. We describe the effect of this outbreak on health systems, the implementation of vector-borne control strategies, and the line of communication used to alert the international community of the new risk associated with Zika virus. This outbreak highlighted the need for careful monitoring of all unexpected events that occur during an emergence, to implement surveillance and research programmes in parallel to management of cases, and to be prepared to the worst-case scenario.
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Affiliation(s)
- Didier Musso
- Pôle de Recherche et de Veille sur les Maladies Infectieuses Émergentes, Institut Louis Malardé, Paea, Tahiti, French Polynesia.
| | - Hervé Bossin
- Unité d'Entomologie Médicale, Institut Louis Malardé, Paea, Tahiti, French Polynesia
| | - Henri Pierre Mallet
- Bureau de Veille Sanitaire, Direction de la Santé, Papeete, Tahiti, French Polynesia
| | - Marianne Besnard
- Service de Réanimation néonatale, Centre Hospitalier du Taaone, Pirae, Tahiti, French Polynesia
| | - Julien Broult
- Centre de Transfusion Sanguine, Centre Hospitalier du Taaone, Pirae, Tahiti, French Polynesia
| | - Laure Baudouin
- Réanimation, Centre Hospitalier du Taaone, Pirae, Tahiti, French Polynesia
| | - José Eduardo Levi
- Tropical Medicine Institute, University of São Paulo, São Paulo, Brazil; Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Ester C Sabino
- Tropical Medicine Institute, University of São Paulo, São Paulo, Brazil; Department of Infectious Diseases, Medical School, University of São Paulo, São Paulo, Brazil
| | - Frederic Ghawche
- Service de Neurologie, Centre Hospitalier du Taaone, Pirae, Tahiti, French Polynesia
| | - Marion C Lanteri
- Blood Systems Research Institute, San Francisco, CA, USA; Department of Laboratory Medicine, University of California San Francisco, San Francisco, CA, USA; Cerus Corporation, Concord, CA, USA
| | - David Baud
- Materno-Fetal and Obstetrics Research Unit, Department Femme-Mère-Enfant, University Hospital, Lausanne, Switzerland
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23
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Abstract
The epidemic history of Zika virus began in 2007, with its emergence in Yap Island in the western Pacific, followed in 2013-14 by a larger epidemic in French Polynesia, south Pacific, where the first severe complications and non-vector-borne transmission of the virus were reported. Zika virus emerged in Brazil in 2015 and was declared a national public health emergency after local researchers and physicians reported an increase in microcephaly cases. In 2016, WHO declared the recent cluster of microcephaly cases and other neurological disorders reported in Brazil a global public health emergency. Similar clusters of microcephaly cases were also observed retrospectively in French Polynesia in 2014. In 2015-16, Zika virus continued its spread to cause outbreaks in the Americas and the Pacific, and the first outbreaks were reported in continental USA, Africa, and southeast Asia. Non-vector-borne transmission was confirmed and Zika virus was established as a cause of severe neurological complications in fetuses, neonates, and adults. This Review focuses on important updates and gaps in the knowledge of Zika virus as of early 2017.
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Affiliation(s)
- David Baud
- Materno-fetal and Obstetrics Research Unit, Obstetric Service, Department "Femme-Mère-Enfant", University Hospital, Lausanne, Switzerland.
| | - Duane J Gubler
- Program in Emerging Infectious Diseases, Duke-NUS Medical School, Singapore
| | - Bruno Schaub
- Centre Pluridisciplinaire de Diagnostic Prénatal de Martinique, Service de Gynécologie Obstétrique, Maison de la Femme de la Mère et de l'Enfant, Fort de France, Martinique, France; Registre des Malformations des Antilles (REMALAN), Maison de la Femme de la Mère et de l'Enfant, Centre Hospitalier Universitaire de Martinique, Fort de France, Martinique, France
| | - Marion C Lanteri
- Blood Systems Research Institute, San Francisco, CA, USA; Department of Laboratory Medicine, University of California San Francisco, San Francisco, CA, USA; Cerus Corporation, Concord, CA, USA
| | - Didier Musso
- Unit of Emerging Infectious Diseases, Institut Louis Malardé, Tahiti, French Polynesia
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24
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Aubry M, Laughhunn A, Santa Maria F, Lanteri MC, Stassinopoulos A, Musso D. Pathogen inactivation of Dengue virus in red blood cells using amustaline and glutathione. Transfusion 2017; 57:2888-2896. [DOI: 10.1111/trf.14318] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Revised: 06/29/2017] [Accepted: 08/02/2017] [Indexed: 12/21/2022]
Affiliation(s)
- Maite Aubry
- Pôle de Recherche et de Veille sur les Maladies Infectieuses Émergentes, Institut Louis Malardé; Tahiti, Polynésie Française
| | | | | | - Marion C. Lanteri
- Scientific Affairs Department; Cerus Corporation; Concord California
| | | | - Didier Musso
- Pôle de Recherche et de Veille sur les Maladies Infectieuses Émergentes, Institut Louis Malardé; Tahiti, Polynésie Française
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25
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Musso D, Richard V, Teissier A, Stone M, Lanteri MC, Latoni G, Alsina J, Reik R, Busch MP. Detection of Zika virus RNA in semen of asymptomatic blood donors. Clin Microbiol Infect 2017; 23:1001.e1-1001.e3. [PMID: 28711704 PMCID: PMC6016846 DOI: 10.1016/j.cmi.2017.07.006] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Revised: 06/27/2017] [Accepted: 07/04/2017] [Indexed: 11/05/2022]
Abstract
Objectives Zika virus (ZIKV) transmission through semen donation has never been reported but the risk is supported by the detection of ZIKV in semen and the demonstration of ZIKV sexual transmission. The potential impact of ZIKV on assisted reproductive procedures should be evaluated. Methods We tested longitudinally collected semen samples provided by asymptomatic blood donors who tested positive for ZIKV RNA in plasma during ZIKV outbreaks in Puerto Rico and Florida in 2016. Results Five of the 14 (35.7%) asymptomatic blood donors provided semen samples that tested positive for ZIKV RNA, with ZIKV RNA loads ranging from 8.03 × 103 to 2.55 × 106 copies/mL. Plasma collected at the same time as the semen tested negative for ZIKV RNA for most ZIKV RNA-positive semen collections; all corresponding plasma samples tested positive or equivocal for anti-ZIKV IgG antibodies and all except one tested positive for ZIKV IgM antibodies. The rate of detection of ZIKV RNA in semen in asymptomatic donors is not significantly different from the rate previously reported for symptomatic patients. Conclusions Our results that show a high percentage of detection of ZIKV RNA in the semen of asymptomatic men confirm that ZIKV is a new threat for reproductive medicine and should have important implications for assisted reproductive technology. We recommend that semen donations from men at risk for ZIKV infection should be tested for ZIKV RNA, regardless of symptoms of ZIKV infection.
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Affiliation(s)
- D Musso
- Pole de recherche et de veille sur les maladies infectieuses émergentes, Institut Louis Malardé, Tahiti, French Polynesia
| | - V Richard
- Pole de recherche et de veille sur les maladies infectieuses émergentes, Institut Louis Malardé, Tahiti, French Polynesia
| | - A Teissier
- Pole de recherche et de veille sur les maladies infectieuses émergentes, Institut Louis Malardé, Tahiti, French Polynesia
| | - M Stone
- Blood Systems Research Institute, San Francisco, CA, USA
| | - M C Lanteri
- Blood Systems Research Institute, San Francisco, CA, USA
| | - G Latoni
- Banco de Sangre, San Juan, PR, USA
| | - J Alsina
- Banco de Sangre, San Juan, PR, USA
| | - R Reik
- One-Blood, Orlando, FL, USA
| | - M P Busch
- Blood Systems Research Institute, San Francisco, CA, USA.
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26
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Santa Maria F, Laughhunn A, Lanteri MC, Aubry M, Musso D, Stassinopoulos A. Inactivation of Zika virus in platelet components using amotosalen and ultraviolet A illumination. Transfusion 2017; 57:2016-2025. [DOI: 10.1111/trf.14161] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Revised: 04/06/2017] [Accepted: 04/07/2017] [Indexed: 12/16/2022]
Affiliation(s)
| | | | | | - Maite Aubry
- Pôle de Recherche et de Veille sur les Maladies Infectieuses Émergentes, Institut Louis Malardé; Tahiti Polynésie Française
| | - Didier Musso
- Pôle de Recherche et de Veille sur les Maladies Infectieuses Émergentes, Institut Louis Malardé; Tahiti Polynésie Française
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27
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Ferreira LRP, Ferreira FM, Nakaya HI, Deng X, Cândido DDS, de Oliveira LC, Billaud JN, Lanteri MC, Rigaud VOC, Seielstad M, Kalil J, Fernandes F, Ribeiro ALP, Sabino EC, Cunha-Neto E. Blood Gene Signatures of Chagas Cardiomyopathy With or Without Ventricular Dysfunction. J Infect Dis 2017; 215:387-395. [PMID: 28003350 DOI: 10.1093/infdis/jiw540] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2016] [Accepted: 11/29/2016] [Indexed: 11/12/2022] Open
Abstract
Chagas disease, caused by the protozoan parasite Trypanosoma cruzi, affects 7 million people in Latin American areas of endemicity. About 30% of infected patients will develop chronic Chagas cardiomyopathy (CCC), an inflammatory cardiomyopathy characterized by hypertrophy, fibrosis, and myocarditis. Further studies are necessary to understand the molecular mechanisms of disease progression. Transcriptome analysis has been increasingly used to identify molecular changes associated with disease outcomes. We thus assessed the whole-blood transcriptome of patients with Chagas disease. Microarray analysis was performed on blood samples from 150 subjects, of whom 30 were uninfected control patients and 120 had Chagas disease (1 group had asymptomatic disease, and 2 groups had CCC with either a preserved or reduced left ventricular ejection fraction [LVEF]). Each Chagas disease group displayed distinct gene expression and functional pathway profiles. The most different expression patterns were between CCC groups with a preserved or reduced LVEF. A more stringent analysis indicated that 27 differentially expressed genes, particularly those related to natural killer (NK)/CD8+ T-cell cytotoxicity, separated the 2 groups. NK/CD8+ T-cell cytotoxicity could play a role in determining Chagas disease progression. Understanding genes associated with disease may lead to improved insight into CCC pathogenesis and the identification of prognostic factors for CCC progression.
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Affiliation(s)
- Ludmila Rodrigues Pinto Ferreira
- Laboratory of Immunology and.,Division of Clinical Immunology and Allergy, School of Medicine.,Institute for Investigation in Immunology, National Institute of Science and Technology, and.,Universidade Santo Amaro, São Paulo, and
| | - Frederico Moraes Ferreira
- Laboratory of Immunology and.,Division of Clinical Immunology and Allergy, School of Medicine.,Institute for Investigation in Immunology, National Institute of Science and Technology, and.,Universidade Santo Amaro, São Paulo, and
| | - Helder Imoto Nakaya
- Department of Pathophysiology and Toxicology, School of Pharmaceutical Sciences, and.,Department of Pathology, Emory University School of Medicine, Atlanta, Georgia; and
| | - Xutao Deng
- Blood Systems Research Institute and.,Department of Laboratory Medicine and
| | - Darlan da Silva Cândido
- Laboratory of Immunology and.,Division of Clinical Immunology and Allergy, School of Medicine.,Institute for Investigation in Immunology, National Institute of Science and Technology, and
| | - Lea Campos de Oliveira
- Institute of Tropical Medicine, Department of Infectious Disease, University of São Paulo
| | | | - Marion C Lanteri
- Blood Systems Research Institute and.,Institute for Human Genetics, Department of Laboratory Medicine, University of California, San Francisco, and
| | - Vagner Oliveira-Carvalho Rigaud
- Laboratory of Immunology and.,Division of Clinical Immunology and Allergy, School of Medicine.,Institute for Investigation in Immunology, National Institute of Science and Technology, and
| | - Mark Seielstad
- Blood Systems Research Institute and.,Institute for Human Genetics, Department of Laboratory Medicine, University of California, San Francisco, and
| | - Jorge Kalil
- Laboratory of Immunology and.,Division of Clinical Immunology and Allergy, School of Medicine.,Institute for Investigation in Immunology, National Institute of Science and Technology, and
| | | | - Antonio Luiz P Ribeiro
- Hospital das Clínicas and.,Faculdade de Medicina, Universidade Federal de Minas Gerais, Minas Gerais, Brazil
| | - Ester Cerdeira Sabino
- Institute of Tropical Medicine, Department of Infectious Disease, University of São Paulo
| | - Edecio Cunha-Neto
- Laboratory of Immunology and.,Division of Clinical Immunology and Allergy, School of Medicine.,Institute for Investigation in Immunology, National Institute of Science and Technology, and
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28
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Musso D, Rouault E, Teissier A, Lanteri MC, Zisou K, Broult J, Grange E, Nhan TX, Aubry M. Molecular detection of Zika virus in blood and RNA load determination during the French Polynesian outbreak. J Med Virol 2017; 89:1505-1510. [PMID: 27859375 PMCID: PMC5575554 DOI: 10.1002/jmv.24735] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2016] [Accepted: 11/11/2016] [Indexed: 11/06/2022]
Abstract
Zika virus (ZIKV) viremia is reported as low and transient; however, these estimates rely on limited data. We report RNA loads in sera collected from symptomatic patients during the 2013-2014 French Polynesian ZIKV outbreak. We performed molecular detection of ZIKV RNA in sera from 747 patients presenting with suspected acute phase ZIKV infection. Among patients with confirmed infection, we analyzed the duration of viremia, assessed viral RNA loads and recorded the main clinical symptoms. A total of 210/747 (28.1%) sera tested positive using a ZIKV-specific RT-PCR. Viral RNA loads in symptomatic patients that ranged from 5 to 3.7 × 106 copies/mL (mean 9.9 × 104 copies/mL) were not related to a particular clinical presentation, and were significantly lower than those previously obtained from asymptomatic ZIKV infected blood donors. The rate of detection of ZIKV RNA in sera from suspected cases of acute phase ZIKV infection was low. ZIKV RNA loads were lower in symptomatic patients compared to asymptomatic blood donors and were lower than RNA loads usually reported in dengue infections. As there is no abrupt onset of symptoms in ZIKV infections, we suggest that infected patients sought for medical attention when viremia was already decreasing or had resolved.
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Affiliation(s)
- Didier Musso
- Laboratoire de Biologie Médicale, Institut Louis Malardé, Tahiti, Polynésie Française.,Unit of Emerging Infectious Diseases, Institut Louis Malardé, Tahiti, Polynésie Française
| | - Eline Rouault
- Laboratoire de Biologie Médicale, Institut Louis Malardé, Tahiti, Polynésie Française
| | - Anita Teissier
- Unit of Emerging Infectious Diseases, Institut Louis Malardé, Tahiti, Polynésie Française
| | - Marion C Lanteri
- Blood System Research Institute, San Francisco, California.,Department of Laboratory Medicine, University of California San Francisco, San Francisco, California
| | - Karen Zisou
- Laboratoire de Biologie Médicale, Institut Louis Malardé, Tahiti, Polynésie Française
| | - Julien Broult
- Centre de Transfusion Sanguine, Tahiti, Polynésie Française
| | - Emilie Grange
- Laboratoire de Biologie Médicale, Institut Louis Malardé, Tahiti, Polynésie Française
| | - Tu-Xuan Nhan
- Laboratoire de Biologie Médicale, Institut Louis Malardé, Tahiti, Polynésie Française
| | - Maite Aubry
- Unit of Emerging Infectious Diseases, Institut Louis Malardé, Tahiti, Polynésie Française
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Musso D, Lanteri MC. Emergence of Zika virus: where does it come from and where is it going to? The Lancet Infectious Diseases 2017; 17:255. [DOI: 10.1016/s1473-3099(17)30070-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Accepted: 01/10/2017] [Indexed: 11/16/2022]
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Stone M, Lanteri MC, Bakkour S, Deng X, Galel SA, Linnen JM, Muñoz-Jordán JL, Lanciotti RS, Rios M, Gallian P, Musso D, Levi JE, Sabino EC, Coffey LL, Busch MP. Relative analytical sensitivity of donor nucleic acid amplification technology screening and diagnostic real-time polymerase chain reaction assays for detection of Zika virus RNA. Transfusion 2017; 57:734-747. [PMID: 28194799 DOI: 10.1111/trf.14031] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Revised: 01/02/2017] [Accepted: 01/03/2017] [Indexed: 01/28/2023]
Abstract
BACKGROUND Zika virus (ZIKV) has spread rapidly in the Pacific and throughout the Americas and is associated with severe congenital and adult neurologic outcomes. Nucleic acid amplification technology (NAT) assays were developed for diagnostic applications and for blood donor screening on high-throughput NAT systems. We distributed blinded panels to compare the analytical performance of blood screening relative to diagnostic NAT assays. STUDY DESIGN AND METHODS A 25-member, coded panel (11 half-log dilutions of a 2013 French Polynesia ZIKV isolate and 2015 Brazilian donor plasma implicated in transfusion transmission, and 3 negative controls) was sent to 11 laboratories that performed 17 assays with 2 to 12 replicates per panel member. Results were analyzed for the percentage reactivity at each dilution and by probit analysis to estimate the 50% and 95% limits of detection (LOD50 and LOD95 , respectively). RESULTS Donor-screening NAT assays that process approximately 500 µL of plasma into amplification reactions were comparable in sensitivity (LOD50 and LOD95 , 2.5 and 15-18 copies/mL) and were approximately 10-fold to 100-fold more sensitive than research laboratory-developed and diagnostic reverse transcriptase-polymerase chain reaction tests that process from 10 to 30 µL of plasma per amplification. Increasing sample input volume assayed with the Centers for Disease Control and Prevention reverse transcriptase-polymerase chain reaction assays increased the LODs by 10-fold to 30-fold. CONCLUSIONS Blood donor-screening ZIKV NAT assays demonstrate similar excellent sensitivities to assays currently used for screening for transfusion-transmitted viruses and are substantially more sensitive than most other laboratory-developed and diagnostic ZIKV reverse transcriptase-polymerase chain reaction assays. Enhancing sensitivities of laboratory-developed and diagnostic assays may be achievable by increasing sample input.
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Affiliation(s)
- Mars Stone
- Blood Systems Research Institute, University of California-San Francisco, San Francisco, California
| | - Marion C Lanteri
- Blood Systems Research Institute, University of California-San Francisco, San Francisco, California.,Department of Laboratory Medicine, University of California-San Francisco, San Francisco, California
| | - Sonia Bakkour
- Blood Systems Research Institute, University of California-San Francisco, San Francisco, California
| | - Xutao Deng
- Blood Systems Research Institute, University of California-San Francisco, San Francisco, California
| | - Susan A Galel
- Roche Molecular Systems, Inc, Pleasanton, California
| | | | | | | | - Maria Rios
- Center for Biologics Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland
| | - Pierre Gallian
- Etablissement Français du Sang, Aix-Marseille Université and French Institute of Research for Development, Institut National de la Santé et de la Recherche Médicale, Institut Hospitalo-Universitaire Méditerranée Infection, Unité Mixte de Recherche, D190 Emergence des Pathologies Virales, Marseille, France.,Aix-Marseille Université and French Institute of Research for Development, Institut National de la Santé et de la Recherche Médicale, Institut Hospitalo-Universitaire Méditerranée Infection, Unité Mixte de Recherche, D190 Emergence des Pathologies Virales, Marseille, France
| | - Didier Musso
- Institut Louis Malarde, Papeete, Tahiti, Polynésie Française
| | - José E Levi
- Departamento de Biologia Molecular, Fundação Pró-Sangue/Hemocentro de São Paulo
| | - Ester C Sabino
- Departmento de Molestias Infecciosas e Parasitarias, Instituto de Medicina Tropical, Universidade de São Paulo, São Paulo, Brazil
| | - Lark L Coffey
- Department of Pathology, Microbiology, and Immunology, School of Veterinary Medicine, University of California-Davis, Davis, California
| | - Michael P Busch
- Blood Systems Research Institute, University of California-San Francisco, San Francisco, California.,Department of Laboratory Medicine, University of California-San Francisco, San Francisco, California
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Laughhunn A, Santa Maria F, Broult J, Lanteri MC, Stassinopoulos A, Musso D, Aubry M. Amustaline (S-303) treatment inactivates high levels of Zika virus in red blood cell components. Transfusion 2017; 57:779-789. [DOI: 10.1111/trf.13993] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Revised: 12/01/2016] [Accepted: 12/04/2016] [Indexed: 12/16/2022]
Affiliation(s)
| | | | - Julien Broult
- Centre de Transfusion Sanguine de la Polynésie Française, Hôpital du Taaone
| | | | | | - Didier Musso
- Pôle de Recherche et de Veille sur les Maladies Infectieuses Émergentes, Institut Louis Malardé; Tahiti Polynésie Française
| | - Maite Aubry
- Pôle de Recherche et de Veille sur les Maladies Infectieuses Émergentes, Institut Louis Malardé; Tahiti Polynésie Française
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Musso D, Gould E, Lanteri MC. Documentation of transfusion-transmitted arbovirus infections in endemic areas. Transfusion 2016; 56:3143-3144. [DOI: 10.1111/trf.13861] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Revised: 07/30/2016] [Accepted: 08/15/2016] [Indexed: 01/02/2023]
Affiliation(s)
- Didier Musso
- Unit of Emerging Infectious Diseases; Institut Louis Malardé; Tahiti French Polynesia
| | - Ernest Gould
- UMR Emergence des Pathologies Virales; INSERM 1207; Marseille France
| | - Marion C. Lanteri
- Blood Systems Research Institute, Department of Laboratory Medicine; University of California San Francisco; San Francisco CA
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Lanteri MC, Kleinman SH, Glynn SA, Musso D, Keith Hoots W, Custer BS, Sabino EC, Busch MP. Zika virus: a new threat to the safety of the blood supply with worldwide impact and implications. Transfusion 2016; 56:1907-14. [PMID: 27282638 DOI: 10.1111/trf.13677] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Revised: 04/26/2016] [Accepted: 05/02/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Marion C Lanteri
- Blood Systems Research Institute and.,Department of Laboratory Medicine, University of California at San Francisco, San Francisco, California
| | | | - Simone A Glynn
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Didier Musso
- Unit of Emerging Infectious Diseases, Institut Louis Malardé, Tahiti, French Polynesia
| | - W Keith Hoots
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Brian S Custer
- Blood Systems Research Institute and.,Department of Laboratory Medicine, University of California at San Francisco, San Francisco, California
| | - Ester C Sabino
- Departmento de Molestias Infecciosas e Parasitarias, Instituto de Medicina Tropical, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Michael P Busch
- Blood Systems Research Institute and.,Department of Laboratory Medicine, University of California at San Francisco, San Francisco, California
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Kaidarova Z, Bravo MD, Kamel HT, Custer BS, Busch MP, Lanteri MC. Blood group A and D negativity are associated with symptomatic West Nile virus infection. Transfusion 2016; 56:1699-706. [PMID: 27189860 DOI: 10.1111/trf.13622] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Revised: 03/16/2016] [Accepted: 03/17/2016] [Indexed: 01/19/2023]
Abstract
BACKGROUND West Nile virus (WNV) infection is mostly asymptomatic (AS) but 20% of subjects report WNV fever and 1% of patients experience neurologic diseases with higher rates in elderly and immunosuppressed persons. With no treatment and no vaccine to prevent the development of symptomatic (S) infections, it is essential to understand prognostic factors influencing S disease outcome. Host genetic background has been linked to the development of WNV neuroinvasive disease. This study investigates the association between the ABO and D blood group status and WNV disease outcome. STUDY DESIGN AND METHODS The distribution of blood groups was investigated within a cohort of 374 WNV+ blood donors including 244 AS and 130 S WNV+ blood donors. Logistic regression analyses were used to examine associations between A, B, O, and D blood groups and WNV clinical disease outcome. RESULTS S WNV+ donors exhibited increased frequencies of blood group A (S 47.6%, AS 36.8%, p = 0.04; odds ratio [OR], 1.56; 95% confidence interval [CI], 1.01-2.40) and D- individuals (S 21.5%, AS 13.1%, p = 0.03; OR, 1.82; 95% CI, 1.04-3.18). CONCLUSION The findings suggest a genetic susceptibility placing blood group A and D- individuals at risk for the development of S disease outcome after WNV infection.
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Affiliation(s)
| | | | | | - Brian S Custer
- Blood Systems Research Institute, San Francisco, California.,Department of Laboratory Medicine, University of California at San Francisco, San Francisco, California
| | - Michael P Busch
- Blood Systems Research Institute, San Francisco, California.,Department of Laboratory Medicine, University of California at San Francisco, San Francisco, California
| | - Marion C Lanteri
- Blood Systems Research Institute, San Francisco, California.,Department of Laboratory Medicine, University of California at San Francisco, San Francisco, California
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James EA, Gates TJ, LaFond RE, Yamamoto S, Ni C, Mai D, Gersuk VH, O’Brien K, Nguyen QA, Zeitner B, Lanteri MC, Norris PJ, Chaussabel D, Malhotra U, Kwok WW. Neuroinvasive West Nile Infection Elicits Elevated and Atypically Polarized T Cell Responses That Promote a Pathogenic Outcome. PLoS Pathog 2016; 12:e1005375. [PMID: 26795118 PMCID: PMC4721872 DOI: 10.1371/journal.ppat.1005375] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Accepted: 12/09/2015] [Indexed: 11/18/2022] Open
Abstract
Most West Nile virus (WNV) infections are asymptomatic, but some lead to neuroinvasive disease with symptoms ranging from disorientation to paralysis and death. Evidence from animal models suggests that neuroinvasive infections may arise as a consequence of impaired immune protection. However, other data suggest that neurologic symptoms may arise as a consequence of immune mediated damage. We demonstrate that elevated immune responses are present in neuroinvasive disease by directly characterizing WNV-specific T cells in subjects with laboratory documented infections using human histocompatibility leukocyte antigen (HLA) class II tetramers. Subjects with neuroinvasive infections had higher overall numbers of WNV-specific T cells than those with asymptomatic infections. Independent of this, we also observed age related increases in WNV-specific T cell responses. Further analysis revealed that WNV-specific T cell responses included a population of atypically polarized CXCR3+CCR4+CCR6- T cells, whose presence was highly correlated with neuroinvasive disease. Moreover, a higher proportion of WNV-specific T cells in these subjects co-produced interferon-γ and interleukin 4 than those from asymptomatic subjects. More globally, subjects with neuroinvasive infections had reduced numbers of CD4+FoxP3+ Tregs that were CTLA4 positive and exhibited a distinct upregulated transcript profile that was absent in subjects with asymptomatic infections. Thus, subjects with neuroinvasive WNV infections exhibited elevated, dysregulated, and atypically polarized responses, suggesting that immune mediated damage may indeed contribute to pathogenic outcomes.
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Affiliation(s)
- Eddie A. James
- Benaroya Research Institute at Virginia Mason, Seattle, Washington, United States of America
| | - Theresa J. Gates
- Benaroya Research Institute at Virginia Mason, Seattle, Washington, United States of America
| | - Rebecca E. LaFond
- Benaroya Research Institute at Virginia Mason, Seattle, Washington, United States of America
| | - Shinobu Yamamoto
- Benaroya Research Institute at Virginia Mason, Seattle, Washington, United States of America
| | - Chester Ni
- Benaroya Research Institute at Virginia Mason, Seattle, Washington, United States of America
| | - Duy Mai
- Benaroya Research Institute at Virginia Mason, Seattle, Washington, United States of America
| | - Vivian H. Gersuk
- Benaroya Research Institute at Virginia Mason, Seattle, Washington, United States of America
| | - Kimberly O’Brien
- Benaroya Research Institute at Virginia Mason, Seattle, Washington, United States of America
| | - Quynh-Anh Nguyen
- Benaroya Research Institute at Virginia Mason, Seattle, Washington, United States of America
| | - Brad Zeitner
- Benaroya Research Institute at Virginia Mason, Seattle, Washington, United States of America
| | - Marion C. Lanteri
- Blood Systems Research Institute, San Francisco, California, United States of America
| | - Philip J. Norris
- Blood Systems Research Institute, San Francisco, California, United States of America
- Departments of Laboratory Medicine and Medicine, University of California, San Francisco, San Francisco, California, United States of America
| | - Damien Chaussabel
- Benaroya Research Institute at Virginia Mason, Seattle, Washington, United States of America
| | - Uma Malhotra
- Virginia Mason Medical Center, Seattle, Washington, United States of America
- Department of Medicine, University of Washington, Seattle, Washington, United States of America
| | - William W. Kwok
- Benaroya Research Institute at Virginia Mason, Seattle, Washington, United States of America
- Department of Medicine, University of Washington, Seattle, Washington, United States of America
- * E-mail:
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Lanteri MC, Vahidnia F, Tan S, Stapleton JT, Norris PJ, Heitman J, Deng X, Keating SM, Brambilla D, Busch MP, Custer B. Downregulation of Cytokines and Chemokines by GB Virus C After Transmission Via Blood Transfusion in HIV-Positive Blood Recipients. J Infect Dis 2014; 211:1585-96. [PMID: 25425697 DOI: 10.1093/infdis/jiu660] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2014] [Accepted: 11/19/2014] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND An association between GB virus C (GBV-C) and improved outcomes of human immunodeficiency virus (HIV) infection has been reported in HIV-positive individuals with active GBV-C coinfection. This study provides insights into the immune mechanisms underlying the protective role of GBV-C in HIV-infected patients. METHODS The concentrations of 64 cytokines and chemokines were measured in plasma samples obtained from the Viral Activation Transfusion Study cohort before transfusion and longitudinally from 30 patients positive for both HIV and GBV-C (hereafter, "cases") and 30 patients positive for HIV and negative for GBV-C (hereafter, "controls"). RESULTS Cases had lower HIV viral loads and higher CD4 T-cell counts than controls after acquisition of GBV-C infection. Most of the modulated cytokines and chemokines were reduced after GBV-C detection, including many proinflammatory cytokines, suggesting an overall antiinflammatory effect of GBV-C in HIV-positive subjects. Most pathways and functions of the measured cytokines were downregulated in cases, except cell death pathways, which were upregulated in various cell subsets in the 3 months after GBV-C detection. CONCLUSIONS GBV-C has a protective effect, in part through a competition mechanism leading to decreased inflammation and improved HIV disease outcome in cases. Further studies are necessary to establish whether GBV-C may have deleterious effects on the host at the cellular level, including depleting the cells that are the targets of HIV.
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Affiliation(s)
| | | | | | - Jack T Stapleton
- Iowa City Veterans Affairs Hospital University of Iowa Carver College of Medicine, Iowa City
| | - Philip J Norris
- Blood Systems Research Institute Department of Laboratory Medicine Department of Medicine, University of California-San Francisco, California
| | | | | | | | | | - Michael P Busch
- Blood Systems Research Institute Department of Laboratory Medicine
| | - Brian Custer
- Blood Systems Research Institute Department of Laboratory Medicine
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Tandon R, Chew GM, Byron MM, Borrow P, Niki T, Hirashima M, Barbour JD, Norris PJ, Lanteri MC, Martin JN, Deeks SG, Ndhlovu LC. Galectin-9 is rapidly released during acute HIV-1 infection and remains sustained at high levels despite viral suppression even in elite controllers. AIDS Res Hum Retroviruses 2014; 30:654-64. [PMID: 24786365 DOI: 10.1089/aid.2014.0004] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Galectin-9 (Gal-9) is a β-galactosidase-binding lectin that promotes apoptosis, tissue inflammation, and T cell immune exhaustion, and alters HIV infection in part through engagement with the T cell immunoglobulin mucin domain-3 (Tim-3) receptor and protein disulfide isomerases (PDI). Gal-9 was initially thought to be an eosinophil attractant, but is now known to mediate multiple complex signaling events that affect T cells in both an immunosuppressive and inflammatory manner. To understand the kinetics of circulating Gal-9 levels during HIV infection we measured Gal-9 in plasma during HIV acquisition, in subjects with chronic HIV infection with differing virus control, and in uninfected individuals. During acute HIV infection, circulating Gal-9 was detected as early as 5 days after quantifiable HIV RNA and tracked plasma levels of interleukin (IL)-10, tumor necrosis factor (TNF)-α, and IL-1β. In chronic HIV infection, Gal-9 levels positively correlated with plasma HIV RNA levels (r=0.29; p=0.023), and remained significantly elevated during suppressive antiretroviral therapy (median: 225.3 pg/ml) and in elite controllers (263.3 pg/ml) compared to age-matched HIV-uninfected controls (54 pg/ml). Our findings identify Gal-9 as a novel component of the first wave of the cytokine storm in acute HIV infection that is sustained at elevated levels in virally suppressed subjects and suggest that Gal-9:Tim-3 crosstalk remains active in elite controllers and antiretroviral (ARV)-suppressed subjects, potentially contributing to ongoing inflammation and persistent T cell dysfunction.
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Affiliation(s)
- Ravi Tandon
- Hawaii Center for AIDS, Department of Tropical Medicine, University of Hawaii, John A. Burns School of Medicine, Honolulu, Hawaii
| | - Glen M. Chew
- Hawaii Center for AIDS, Department of Tropical Medicine, University of Hawaii, John A. Burns School of Medicine, Honolulu, Hawaii
| | - Mary M. Byron
- Hawaii Center for AIDS, Department of Tropical Medicine, University of Hawaii, John A. Burns School of Medicine, Honolulu, Hawaii
| | - Persephone Borrow
- Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom
| | - Toshiro Niki
- Department of Immunology and Immunopathology, Kagawa University, Kagawa, Japan
| | - Mitsuomi Hirashima
- Department of Immunology and Immunopathology, Kagawa University, Kagawa, Japan
| | - Jason D. Barbour
- Hawaii Center for AIDS, Department of Tropical Medicine, University of Hawaii, John A. Burns School of Medicine, Honolulu, Hawaii
| | - Philip J. Norris
- Blood Systems Research Institute, San Francisco, California
- Department of Laboratory Medicine, San Francisco General Hospital, University of California San Francisco, San Francisco, California
- Department of Medicine, San Francisco General Hospital, University of California San Francisco, San Francisco, California
| | | | - Jeffrey N. Martin
- Department of Epidemiology and Biostatistics, Department of Medicine, San Francisco General Hospital, University of California San Francisco, San Francisco, California
| | - Steven G. Deeks
- HIV/AIDS Division, Department of Medicine, San Francisco General Hospital, University of California San Francisco, San Francisco, California
| | - Lishomwa C. Ndhlovu
- Hawaii Center for AIDS, Department of Tropical Medicine, University of Hawaii, John A. Burns School of Medicine, Honolulu, Hawaii
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Lanteri MC, Lee TH, Wen L, Kaidarova Z, Bravo MD, Kiely NE, Kamel HT, Tobler LH, Norris PJ, Busch MP. West Nile virus nucleic acid persistence in whole blood months after clearance in plasma: implication for transfusion and transplantation safety. Transfusion 2014; 54:3232-41. [PMID: 24965017 DOI: 10.1111/trf.12764] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Revised: 05/15/2014] [Accepted: 05/15/2014] [Indexed: 12/20/2022]
Abstract
BACKGROUND Previous reports of West Nile virus (WNV) RNA persistence in blood compartments have raised concerns around the remaining risk of WNV transfusion transmission. This study characterized the dynamics of WNV viremia in blood compartments in a longitudinal cohort of 54 WNV-infected blood donors. STUDY DESIGN AND METHODS Blood samples were collected throughout the year after WNV RNA-positive blood donation (index) and characterized for WNV immunoglobulin (Ig)M and IgG antibodies and for WNV RNA by real-time reverse transcription-polymerase chain reaction. WNV viral loads were compared in plasma and whole blood samples and correlated with blood groups and clinical outcomes. RESULTS WNV RNA persisted in the red blood cell (RBC) compartment up to 3 months postindex in 42% of the donors. Donors with the highest WNV RNA levels in plasma at index maintained the highest WNV RNA levels in whole blood over the 3 months postindex. Blood group A donors maintained higher postindex WNV viral load in whole blood than blood group O individuals (p = 0.027). Despite a trend for WNV RNA to persist longer in whole blood from symptomatic subjects, no significant association was found between WNV RNA levels in whole blood and disease outcome. CONCLUSION This study confirmed that WNV RNA persists in the RBC fraction in whole blood and further suggested that the level of persistence in whole blood may be a reflection of initial viral burden in plasma. The association with blood groups suggests that WNV adherence to RBCs may be mediated by molecules overrepresented at the surface of blood group A RBCs.
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Law JP, Hirschkorn DF, Owen RE, Biswas HH, Norris PJ, Lanteri MC. The importance of Foxp3 antibody and fixation/permeabilization buffer combinations in identifying CD4+CD25+Foxp3+ regulatory T cells. Cytometry A 2010; 75:1040-50. [PMID: 19845018 DOI: 10.1002/cyto.a.20815] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Foxp3 is a key marker for CD4(+) regulatory T cells (T(regs)) and was used in developing a multiparameter flow cytometric panel to identify T(regs). Achieving reproducible staining and analysis first required optimization of Foxp3 staining. We present a comparative study of PCH101, 236A/E7, 3G3, 206D, 150D, and 259D/C7 clones of anti-human-Foxp3 antibodies used in combination with five different fixation/permeabilization buffers. Staining for CD25, CD152, and CD127 was also compared between fixation/permeabilization treatments. Promising antibody/buffer combinations were tested in a panel of peripheral blood mononuclear cells from 10 individuals, and then on fresh versus frozen cells from four individuals. Finally, different fluorochromes coupled to two representative antibodies were compared to optimize separation of Foxp3(+) from Foxp3(-) events. Foxp3 gates were set using two gating strategies based on CD127(+)CD25(-) "non-T(regs)" or based on isotype controls. For Foxp3 staining, the best conditions for fixation/permeabilization were obtained using the eBioscience Foxp3, Imgenex, BioLegend, and BD Foxp3 buffers. Comparing results from 10 subjects, 259D/C7, PCH101, 236A/E7, and 206D antibodies yielded statistically higher levels of Foxp3 cells than those by 150D and 3G3 antibodies (mean = 6.9, 5.1, 4.7, and 3.7% compared with 1.7, and 0.3% of CD25(+)Foxp3(+) events within CD4(+) cells, respectively). Importantly, the "nonspecificity" of some antibodies observed with a Foxp3 gate based on isotype controls could be eliminated by setting the Foxp3 gate on "non-T(regs)". Better separation of Foxp3(+) and Foxp3(-) populations was observed using the PCH101 clone coupled to Alexa647 compared with FITC or the 259D/C7 clone coupled to PE compared with Alexa488 fluorochrome. Foxp3 staining can be highly variable and depends on the choice of antibody/buffer pair and the fluorochrome used. Selecting the correct population for setting the Foxp3 gate is critical to avoid including non-T(regs) in the Foxp3(+) gate. The experiments presented here will aid in optimization of flow cytometry staining panels to quantify T(reg) frequencies in humans.
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Affiliation(s)
- Jacqueline P Law
- Blood Systems Research Institute, San Francisco, California 94118, USA
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Lanteri MC, O'Brien KM, Purtha WE, Cameron MJ, Lund JM, Owen RE, Heitman JW, Custer B, Hirschkorn DF, Tobler LH, Kiely N, Prince HE, Ndhlovu LC, Nixon DF, Kamel HT, Kelvin DJ, Busch MP, Rudensky AY, Diamond MS, Norris PJ. Tregs control the development of symptomatic West Nile virus infection in humans and mice. J Clin Invest 2009; 119:3266-77. [PMID: 19855131 DOI: 10.1172/jci39387] [Citation(s) in RCA: 145] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2009] [Accepted: 08/19/2009] [Indexed: 12/21/2022] Open
Abstract
West Nile virus (WNV) causes asymptomatic infection in most humans, but for undefined reasons, approximately 20% of immunocompetent individuals develop West Nile fever, a potentially debilitating febrile illness, and approximately 1% develop neuroinvasive disease syndromes. Notably, since its emergence in 1999, WNV has become the leading cause of epidemic viral encephalitis in North America. We hypothesized that CD4+ Tregs might be differentially regulated in subjects with symptomatic compared with those with asymptomatic WNV infection. Here, we show that in 32 blood donors with acute WNV infection, Tregs expanded significantly in the 3 months after index (RNA+) donations in all subjects. Symptomatic donors exhibited lower Treg frequencies from 2 weeks through 1 year after index donation yet did not show differences in systemic T cell or generalized inflammatory responses. In parallel prospective experimental studies, symptomatic WNV-infected mice also developed lower Treg frequencies compared with asymptomatic mice at 2 weeks after infection. Moreover, Treg-deficient mice developed lethal WNV infection at a higher rate than controls. Together, these results suggest that higher levels of peripheral Tregs after infection protect against severe WNV disease in immunocompetent animals and humans.
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Affiliation(s)
- Marion C Lanteri
- Blood Systems Research Institute, San Francisco, California 94118, USA
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Law JP, Hirschkorn DF, Owen RE, Biswas HH, Norris PJ, Lanteri MC. The importance of Foxp3 antibody and fixation/permeabilization buffer combinations in identifying CD4+CD25+Foxp3+ regulatory T cells. Cytometry A 2009. [DOI: 10.1002/cyto.a.20843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Tobler LH, Cameron MJ, Lanteri MC, Prince HE, Danesh A, Persad D, Lanciotti RS, Norris PJ, Kelvin DJ, Busch MP. Interferon and interferon-induced chemokine expression is associated with control of acute viremia in West Nile virus-infected blood donors. J Infect Dis 2008; 198:979-83. [PMID: 18729779 PMCID: PMC7202400 DOI: 10.1086/591466] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
To understand early host responses controlling West Nile virus (WNV) infection, acutely viremic blood donors, identified by nucleic acid amplification testing, were enrolled and monitored for RNA-clearance and WNV-specific IgM and IgG antibodies. Viral load and chemokine and cytokine assays were performed on serial samples from donors whose index and first follow-up samples tested negative for IgM. A total of 84% of the specimens obtained from viremic donors before IgM/IgG seroconversion demonstrated a decreasing viral load. Levels of interferon (IFN)-α ere significantly increased before IgM seroconversion, relative to those in control specimens. CXCL10 and CCL2 were significantly elevated in donor specimens obtained before IgM seroconversion, compared with those obtained after IgM seroconversion. These findings suggest that IFN-mediated innate immunity plays a key role in initial control of WNV replication.
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