Anastasiadi Alkmini T, Stamoulis Konstantinos, Kriebardis Anastasios G, Tzounakas Vassilis L
Department of Biochemistry, School of Medicine, University of Patras, Patras, Greece.
Hellenic National Blood Transfusion Centre, Acharnes, Greece.
Front Physiol. 2024 Oct 30;15:1499308. doi: 10.3389/fphys.2024.1499308. eCollection 2024.
The development of red blood cell (RBC) storage lesion during hypothermic storage has long posed challenges for blood transfusion efficacy. These alterations are primarily driven by oxidative stress, concern both structural and biochemical aspects of RBCs, and affect their interactions with the recipient's tissues post-transfusion. Efforts to counteract these effects focus on improving the antioxidant capacity within stored RBCs, reducing oxygen exposure, and scavenging harmful molecules that accumulate during storage. Various supplements, such as ascorbic acid, N-acetylcysteine, polyphenolic compounds, and specific metabolites have shown the potential to improve RBC quality by reducing oxidative lesions and lysis phenomena, and enhancing antioxidant, energy, or proteostasis networks. Accordingly, anaerobic storage has emerged as a promising strategy, demonstrating improved RBC storability and recovery in both animal models and preliminary human studies. Finally, targeted scavenging of harmful storage-related phenotypes and molecules, like removal signals, oxidized proteins, and extracellular hemoglobin, while not so studied, also has the potential to benefit both the unit and the patient in need. Omics technologies have aided a lot in these endeavors by revealing biomarkers of superior storability and, thus, potential novel supplementation strategies. Nonetheless, while the so far examined storage modifications show significant promise, there are not many post-transfusion studies (either , in animal models, or humans) to evaluate RBC efficacy in the transfusion setting. Looking ahead, the future of blood storage and transfusion will likely depend on the optimization of these interventions to extend the shelf-life and quality of stored RBCs, as well as their therapeutic outcome.
低温储存期间红细胞（RBC）储存损伤的发展长期以来一直给输血疗效带来挑战。这些改变主要由氧化应激驱动，涉及红细胞的结构和生化方面，并影响其输血后与受者组织的相互作用。应对这些影响的努力集中在提高储存红细胞内的抗氧化能力、减少氧气暴露以及清除储存期间积累的有害分子。各种补充剂，如抗坏血酸、N-乙酰半胱氨酸、多酚化合物和特定代谢物，已显示出通过减少氧化损伤和溶血现象以及增强抗氧化、能量或蛋白质稳态网络来改善红细胞质量的潜力。因此，无氧储存已成为一种有前景的策略，在动物模型和初步人体研究中均显示出改善的红细胞储存性和恢复能力。最后，对与储存相关的有害表型和分子进行靶向清除，如清除信号、氧化蛋白和细胞外血红蛋白，虽然研究较少，但也有可能使储存单位和有需要的患者受益。组学技术通过揭示具有优异储存性的生物标志物以及潜在的新型补充策略，在这些努力中提供了很大帮助。尽管如此，虽然迄今为止所研究的储存修饰显示出巨大潜力，但在动物模型或人体中，用于评估输血环境中红细胞疗效的输血后研究并不多。展望未来，血液储存和输血的未来可能取决于对这些干预措施的优化，以延长储存红细胞的保质期和质量，以及它们的治疗效果。
