White blood cell inactivation after treatment with riboflavin and ultraviolet light

Abstract

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.

Treatment of Buffy Coat Platelets in Platelet Additive Solution with the Mirasol^® Pathogen Reduction Technology System

“…However, recent analyses have demonstrated that PRT-treated blood products may actually reduce the overall health care costs [21] and the duration of hospital stay associated with post-transfusion care for some patients. Due to the ability of the Mirasol PRT treatment to inactivate all remaining leukocytes in a product that mediate graft-versus-host disease (GvHD) [22], it can be used as an alternative to γ-irradiation. γ-Irradiation is both costly and cumbersome for hospitals to maintain and operate [23].…”

Pathogen Reduction Technology Treatment of Platelets, Plasma and Whole Blood Using Riboflavin and UV Light

“…Gamma irradiation (25-30 Gy) is currently the accepted standard of care for transfusions in immunocompromised patients or patient populations that are particularly susceptible to TA-GvHD. Mirasol treatment is as effective as gamma irradiation in inactivating leukocytes [36,37], providing an alternative to gamma irradiation. Additional…”

Role of Riboflavin- and UV Light-Treated Plasma in Prevention of Transfusion-Related Acute Lung Injury

“…Other benefits are those derived from the inactivation of leukocytes that are not removed by leukoreduction [10]. Essentially, preventing alloimmunization of leukocyte-borne antigens, and eliminating the risk of transfusion-associated graft-versus-host disease are important advantages of riboflavin- and UV light-based PRT [11,12,13]. …”