Pathogen Reduction Technologies and Their Impact on Metabolic and Functional Properties of Treated Platelet Concentrates: A Systematic Review

Abstract

Pathogen reduction technologies (PRTs) such as Mirasol and Intercept were developed to eliminate transfusion-transmitted infections. The impact of PRTs on platelet function during the storage period, their effect on platelet storage lesions, and the optimal storage duration following PRTs have not been clearly defined. The aim of this study was to systematically review the existing literature and investigate the impact of PRTs on functional alterations of PRT-treated platelets during the storage period. The authors identified 68 studies suitable to be included in this review. Despite the high heterogeneity in the literature, the results of the published studies indicate that PRTs may increase platelet metabolic activity, accelerate cell apoptosis, and enhance platelet activation, which can subsequently lead to a late exhaustion of activation potential and reduced aggregation response. However, these effects have a minor impact on platelet function during the early storage period and become more prominent beyond the fifth day of the storage period. Large in vivo trials are required to evaluate the effectiveness of PRT-treated platelets during the storage period and investigate whether their storage can be safely extended to more than 5 days, and up to the traditional 7-day storage period.

Results of clinical effectiveness of conventional versus Mirasol‐treated Apheresis Platelets in Patients with Hypoproliferative Thrombocytopenia (MiPLATE) trial

“…Furthermore, PRT has been shown to increase metabolic activity and decrease hemostatic capacity of treated PLTs within the 7-day storage period in vitro. 26 Therefore, it is possible that the high percentage of both irradiated and Mirasoltreatment in the treatment group contributed to the increased number of days with grade ≥2 bleeding observed in the MIRASOL arm of the MiPLATE trial.…”

“…Irradiation is known to cause biochemical changes that can affect the hemostatic potential of transfused PLTs, 25 and the combination of the PR followed by irradiation may have damaged the PLTs. Furthermore, PRT has been shown to increase metabolic activity and decrease hemostatic capacity of treated PLTs within the 7‐day storage period in vitro 26 . Therefore, it is possible that the high percentage of both irradiated and Mirasol‐treatment in the treatment group contributed to the increased number of days with grade ≥2 bleeding observed in the MIRASOL arm of the MiPLATE trial.…”

Editorial Compilation—XIII

“…Another platelet-related systematic review follows, from the team of Tsallas et al, this time on pathogen reduction technologies (PRTs) and their impact on metabolic and functional properties of treated platelet concentrates. 15 PRTs such as Mirasol and Intercept were developed to eliminate transfusion-transmitted infections. The impact of PRTs on platelet function during the storage period, their effect on “platelet storage lesions,” and the optimal storage duration following PRTs have not been clearly defined.…”

X-rays Stimulate Granular Secretions and Activate Protein Kinase C Signaling in Human Platelets

“…However, it is also a fact that gamma rays induce free radicals generation, which can be fatal for platelet quality and function during storage [8]. Similarly, the use of UV radiation has been found to be more destructive to platelet quality and can lead to apoptosis upon storage for a long time [9][10][11][12]. Despite these adverse effects, it is still thought that neither gamma nor UV rays have any immediate effect on platelet quality and are considered safe.…”