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Pathogen inactivation by riboflavin and ultraviolet light illumination accelerates the red blood cell storage lesion and promotes eryptosis
Author(s) -
Qadri Syed M.,
Chen Deborah,
Schubert Peter,
Perruzza Darian L.,
Bhakta Varsha,
Devine Dana V.,
Sheffield William P.
Publication year - 2017
Publication title -
transfusion
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.045
H-Index - 132
eISSN - 1537-2995
pISSN - 0041-1132
DOI - 10.1111/trf.13959
Subject(s) - phosphatidylserine , adenosine triphosphate , oxidative stress , red blood cell , cytosol , intracellular , chemistry , biology , biochemistry , microbiology and biotechnology , membrane , enzyme , phospholipid
BACKGROUND Pathogen reduction treatment using riboflavin and ultraviolet light illumination (Mirasol) effectively reduces the risk of transfusion‐transmitted infections. This treatment is currently licensed for only platelets and plasma products, while its application to whole blood (WB) to generate pathogen‐inactivated red blood cells (RBCs) is under development. RBC storage lesion, constituting numerous morphologic and biochemical changes, influences RBC quality and limits shelf life. Stored RBCs further show enhanced susceptibility to RBC programmed cell death (eryptosis) characterized by increased cytosolic Ca 2+ ‐provoked membrane phosphatidylserine (PS) externalization. STUDY DESIGN AND METHODS Using a “pool‐and‐split” approach, we examined multiple variables of RBC storage lesion and eryptosis in RBC units, derived from Mirasol‐treated or untreated WB, after 4 to 42 days of storage, under blood bank conditions. RESULTS In comparison to untreated RBC units, Mirasol treatment significantly altered membrane microvesiculation, supernatant hemoglobin, osmotic fragility, and intracellular adenosine triphosphate levels but did not influence membrane CD47 expression and 2,3‐diphosphoglycerate levels. Mirasol‐treated RBCs showed significantly higher PS exposure after 42, but not after not more than 21, days of storage, which was accompanied by enhanced cytosolic Ca 2+ activity, ceramide abundance, and oxidative stress, but not p38 kinase activation. Mirasol treatment significantly augmented PS exposure, Ca 2+ entry, and protein kinase C activation after energy depletion, a pathophysiologic cell stressor. Mirasol‐treated RBCs were, however, more resistant to cell shrinkage. CONCLUSIONS Prolonged storage of Mirasol‐treated RBCs significantly increases the proportion of eryptotic RBCs, while even short‐term storage enhances the susceptibility of RBCs to stress‐induced eryptosis, which could reduce posttransfusion RBC recovery in patients.