Nakajima F, Nishimura M, Hashimoto S, Okazaki H, Tadokoro K
Research and Development Department, Central Blood Institute, Japanese Red Cross, Koutou-ku, Tokyo, Japan.
Vox Sang. 2008 Nov;95(4):318-23. doi: 10.1111/j.1423-0410.2008.01095.x.
Transfusion-related acute lung injury (TRALI) is one of the most serious side-effects of transfusion. We report here the first two cases of TRALI caused by anti-Nak(a) (anti-CD36) antibody from a single blood donor. The aim of this study was to clarify the role of the anti-Nak(a) antibody in TRALI development.
Human lung microvascular endothelial cells were co-cultured with Nak(a)-positive monocytes and Nak(a)-positive platelets together with serum prepared from blood products of a TRALI-caused anti-Nak(a) antibody-carrying donor. Expressions of leukotriene B(4) (LTB(4)) and tumour necrosis factor alpha (TNF-alpha) in the co-culture supernatants were determined.
The expressions of LTB(4) and TNF-alpha were found to be markedly increased, particularly in the presence of both Nak(a)-positive monocytes and platelets. The expressions of these mediators were almost completed within 4 h after the initiation of co-culture. Monocyte contribution seemed to be stronger than that of platelets. In the absence of human lung microvascular endothelial, no significant LTB(4) or TNF-alpha release was observed.
Anti-Nak(a) antibody may be strongly implicated in lung microvascular endothelial dysfunctions that lead to TRALI in a monocyte- and platelet-dependent manner.
输血相关急性肺损伤（TRALI）是输血最严重的副作用之一。我们在此报告首例由单一献血者的抗Nak(a)（抗CD36）抗体引起的两例TRALI。本研究的目的是阐明抗Nak(a)抗体在TRALI发生中的作用。
将人肺微血管内皮细胞与Nak(a)阳性单核细胞和Nak(a)阳性血小板共同培养，并加入由携带导致TRALI的抗Nak(a)抗体的献血者血液制品制备的血清。测定共培养上清液中白三烯B4（LTB4）和肿瘤坏死因子α（TNF-α）的表达。
发现LTB4和TNF-α的表达显著增加，特别是在同时存在Nak(a)阳性单核细胞和血小板的情况下。这些介质的表达在共培养开始后4小时内几乎完成。单核细胞的作用似乎比血小板更强。在没有人类肺微血管内皮细胞的情况下，未观察到明显的LTB4或TNF-α释放。
抗Nak(a)抗体可能与以单核细胞和血小板依赖方式导致TRALI的肺微血管内皮功能障碍密切相关。
