CaridianBCT Biotechnologies, LLC, Lakewood, Colorado 80215, USA.
Transfusion. 2010 Nov;50(11):2489-98. doi: 10.1111/j.1537-2995.2010.02714.x.
Functional white blood cells (WBCs) in blood components may be responsible for a number of adverse transfusion effects, including transfusion-associated graft-versus-host disease (TA-GVHD), alloimmunization, and alloimmune platelet (PLT) refractoriness. TA-GVHD occurs when functional lymphocytes are transfused into a patient who is unable to mount an immune response to the human leukocyte antigen (HLA) due to HLA compatibility or immunosuppression. Alloantibodies against HLA antigens on donor WBCs and PLTs are the major cause of refractoriness to PLT transfusions in patients receiving repeated blood transfusions. Attempts to reduce these undesirable effects have included leukoreduction filters and gamma irradiation. Studies have shown that exposure of PLT concentrates to riboflavin and light (Mirasol pathogen reduction technology [PRT], CaridianBCT Biotechnologies) causes irreparable modifications of nucleic acids that result in inactivation of a wide range of pathogens as well as inhibition of the immunologic responses mediated by WBCs present in PLT concentrates. This article summarizes these studies and also reports on additional findings from the Trial to Reduce Alloimmunization to Platelets (TRAP) and Mirasol Clinical Evaluation (MIRACLE) trials. Data from in vitro studies and this clinical trial suggest that PRT treatment may be as effective as gamma irradiation in preventing TA-GVHD and more effective than leukoreduction in preventing alloimmunization.
血液成分中的功能性白细胞（WBC）可能导致许多不良输血效应，包括输血相关性移植物抗宿主病（TA-GVHD）、同种异体免疫和同种异体血小板（PLT）反应性降低。当功能性淋巴细胞输注到因 HLA 相容性或免疫抑制而无法对人类白细胞抗原（HLA）产生免疫反应的患者中时，就会发生 TA-GVHD。供体 WBC 和 PLT 上 HLA 抗原的同种抗体是接受重复输血的患者对 PLT 输注反应性降低的主要原因。为了减少这些不良影响，已经尝试使用白细胞减少过滤器和γ射线照射。研究表明，PLT 浓缩物暴露于核黄素和光（Mirasol 病原体减少技术[PRT]，CaridianBCT Biotechnologies）会导致核酸不可逆转的修饰，从而使广泛的病原体失活，并抑制 PLT 浓缩物中存在的 WBC 介导的免疫反应。本文总结了这些研究，并报告了来自减少血小板同种免疫试验（TRAP）和 Mirasol 临床评估（MIRACLE）试验的其他发现。来自体外研究和这项临床试验的数据表明，PRT 处理在预防 TA-GVHD 方面可能与γ射线照射一样有效，并且在预防同种免疫方面比白细胞减少更有效。
