Klein H G, Bryant B J
Department of Transfusion Medicine, Clinical Center, National Institutes of Health, Bethesda, MD 20892, USA.
Blood Bank division, Department of Pathology, University of Texas at Galveston, Galveston, TX, USA.
ISBT Sci Ser. 2009 Mar;4(1):154-160. doi: 10.1111/j.1751-2824.2009.01224.x. Epub 2009 Feb 13.
Pathogen-reduction (inactivation) provides a proactive approach to reducing transfusion-transmitted infection. Pathogen-reduction technologies have been successfully implemented by plasma fractionators resulting in no transmission of human immunodeficiency, hepatitis C, or hepatitis B viruses by US-licensed plasma derivatives since 1987. Fractionation technologies cannot be used to treat cellular blood components. Although blood donor screening, deferral and disease testing have drastically reduced the incidence of transfusion-transmitted diseases, the threat of new or re-emerging pathogens remains. Of particular concern is the silent emergence of a new agent with a prolonged latent period in which asymptomatic infected carriers would donate and spread infection. The ultimate goal of pathogen-inactivation is to reduce transmission of potential pathogens without significantly compromising the therapeutic efficacy of the cellular and protein constituents of blood. The acceptable technology must not introduce toxicities into the blood supply nor result in neoantigen formation and subsequent antibody production. Several promising pathogen-inactivation technologies are being developed and tested, and others are currently in use, but all of them have limits. Pathogen-reduction promises an additional 'layer of protection' from infectious agents and has the potential to impact the safety of blood transfusions worldwide.
病原体灭活（失活）为减少输血传播感染提供了一种积极主动的方法。自1987年以来，病原体灭活技术已被血浆分馏商成功应用，美国获批的血浆衍生物未出现人类免疫缺陷病毒、丙型肝炎病毒或乙型肝炎病毒的传播。分馏技术不能用于处理细胞血液成分。尽管对献血者的筛查、延期献血和疾病检测已大幅降低了输血传播疾病的发生率，但新出现或再次出现的病原体的威胁依然存在。特别令人担忧的是，一种潜伏期延长的新型病原体悄然出现，无症状感染携带者会献血并传播感染。病原体灭活的最终目标是减少潜在病原体的传播，同时又不会显著损害血液中细胞和蛋白质成分的治疗效果。可接受的技术不得将毒性引入血液供应中，也不得导致新抗原形成及随后的抗体产生。目前正在研发和测试几种有前景的病原体灭活技术，其他一些技术也正在使用，但它们都有局限性。病原体灭活有望为防范感染因子提供额外的“一层保护”，并有可能影响全球输血的安全性。
