Background
Although transfusion is a life-saving intervention, it may be associated with significant morbidity in injured patients. We hypothesize that stored red blood cells induce pro-inflammatory activation of human pulmonary microvascular endothelium (HMVECs) resulting in neutrophil (PMN) adhesion and predisposition to acute lung injury (ALI).
Methods
Ten units of red blood cells (RBCs) were collected and 50% (by weight) were leukoreduced (LR-RBCs) and the remainder was unmodified and stored in additive solution-5 (AS-5). Another 10 units of RBCs were collected, leukoreduced, and stored in AS-3. HMVECs were incubated with [10–40%]FINAL of the supernatants day (D)1-D42 of storage, lipid extracts and purified lipids. Endothelial surface expression of ICAM-1, IL-8 release, and PMN adhesion to HMVECs were measured. HMVEC signaling via the BLT2 receptor was evaluated. Supernatants and lipids were also employed as the first event in a two-event model of ALI.
Results
The supernatants [10–40%]FINAL from D21 LR-RBCs and D42 RBCs and LR-RBCs and the lipids from D42 stored in AS-5 induced increased ICAM-1 surface expression on endothelium, IL-8 release, and PMN adhesion. In addition, the supernatants [20–40%]FINAL from D21 and D42 RBCs in AS-5 also increased endothelial surface expression of ICAM-1. D42 supernatants and lipids also caused co-precipitation of β-arrestin-1 with BLT2, PKCβI, and PKCδand served as the first event in a two-event rodent model of ALI. In conclusion, lipids that accumulate during RBC storage activate endothelium and predispose to ALI, which may explain some of the adverse events associated with the transfusion of critically injured patients.