Advanced

Targeting Transfusion-Related Acute Lung Injury: The Journey From Basic Science to Novel Therapies

Semple, John W LU ; McVey, Mark J. ; Kim, Michael ; Rebetz, Johan LU ; Kuebler, Wolfgang M. and Kapur, Rick LU (2018) In Critical Care Medicine 46(5). p.452-458
Abstract


Objectives: Transfusion-related acute lung injury is characterized by the onset of respiratory distress and acute lung injury following blood transfusion, but its pathogenesis remains poorly understood. Generally, a two-hit model is presumed to underlie transfusion-related acute lung injury with the first hit being risk factors present in the transfused patient (such as inflammation), whereas the second hit is conveyed by factors in the transfused donor blood (such as antileukocyte antibodies). At least 80% of transfusion-related acute lung injury cases are related to the presence of donor antibodies such as antihuman leukocyte or antihuman neutrophil antibodies. The remaining cases may be related to nonantibody-mediated factors... (More)


Objectives: Transfusion-related acute lung injury is characterized by the onset of respiratory distress and acute lung injury following blood transfusion, but its pathogenesis remains poorly understood. Generally, a two-hit model is presumed to underlie transfusion-related acute lung injury with the first hit being risk factors present in the transfused patient (such as inflammation), whereas the second hit is conveyed by factors in the transfused donor blood (such as antileukocyte antibodies). At least 80% of transfusion-related acute lung injury cases are related to the presence of donor antibodies such as antihuman leukocyte or antihuman neutrophil antibodies. The remaining cases may be related to nonantibody-mediated factors such as biolipids or components related to storage and ageing of the transfused blood cells. At present, transfusion-related acute lung injury is the leading cause of transfusion-related fatalities and no specific therapy is clinically available. In this article, we critically appraise and discuss recent preclinical (bench) insights related to transfusion-related acute lung injury pathogenesis and their therapeutic potential for future use at the patients’ bedside in order to combat this devastating and possibly fatal complication of transfusion.

Data Sources: We searched the PubMed database (until August 22, 2017).

Study Selection: Using terms: “Transfusion-related acute lung injury,” “TRALI,” “TRALI and therapy,” “TRALI pathogenesis.”

Data Extraction: English-written articles focusing on transfusion-related acute lung injury pathogenesis, with potential therapeutic implications, were extracted.

Data Synthesis: We have identified potential therapeutic approaches based on the literature.

Conclusions: We propose that the most promising therapeutic strategies to explore are interleukin-10 therapy, down-modulating C-reactive protein levels, targeting reactive oxygen species, or blocking the interleukin-8 receptors; all focused on the transfused recipient. In the long-run, it may perhaps also be advantageous to explore other strategies aimed at the transfused recipient or aimed toward the blood product, but these will require more validation and confirmation first.
(Less)
Please use this url to cite or link to this publication:
author
; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Critical Care Medicine
volume
46
issue
5
pages
452 - 458
publisher
Lippincott Williams & Wilkins
external identifiers
  • pmid:29384784
  • pmid:29384784
  • scopus:85054135319
ISSN
1530-0293
DOI
10.1097/CCM.0000000000002989
language
English
LU publication?
yes
id
42fe09c0-7001-41de-afc6-81e9808caa76
date added to LUP
2018-03-14 11:39:12
date last changed
2020-10-11 03:22:42
@article{42fe09c0-7001-41de-afc6-81e9808caa76,
  abstract     = {<br/><br/>Objectives: Transfusion-related acute lung injury is characterized by the onset of respiratory distress and acute lung injury following blood transfusion, but its pathogenesis remains poorly understood. Generally, a two-hit model is presumed to underlie transfusion-related acute lung injury with the first hit being risk factors present in the transfused patient (such as inflammation), whereas the second hit is conveyed by factors in the transfused donor blood (such as antileukocyte antibodies). At least 80% of transfusion-related acute lung injury cases are related to the presence of donor antibodies such as antihuman leukocyte or antihuman neutrophil antibodies. The remaining cases may be related to nonantibody-mediated factors such as biolipids or components related to storage and ageing of the transfused blood cells. At present, transfusion-related acute lung injury is the leading cause of transfusion-related fatalities and no specific therapy is clinically available. In this article, we critically appraise and discuss recent preclinical (bench) insights related to transfusion-related acute lung injury pathogenesis and their therapeutic potential for future use at the patients’ bedside in order to combat this devastating and possibly fatal complication of transfusion.<br/><br/>Data Sources: We searched the PubMed database (until August 22, 2017).<br/><br/>Study Selection: Using terms: “Transfusion-related acute lung injury,” “TRALI,” “TRALI and therapy,” “TRALI pathogenesis.”<br/><br/>Data Extraction: English-written articles focusing on transfusion-related acute lung injury pathogenesis, with potential therapeutic implications, were extracted.<br/><br/>Data Synthesis: We have identified potential therapeutic approaches based on the literature.<br/><br/>Conclusions: We propose that the most promising therapeutic strategies to explore are interleukin-10 therapy, down-modulating C-reactive protein levels, targeting reactive oxygen species, or blocking the interleukin-8 receptors; all focused on the transfused recipient. In the long-run, it may perhaps also be advantageous to explore other strategies aimed at the transfused recipient or aimed toward the blood product, but these will require more validation and confirmation first.<br/>},
  author       = {Semple, John W and McVey, Mark J. and Kim, Michael and Rebetz, Johan and Kuebler, Wolfgang M. and Kapur, Rick},
  issn         = {1530-0293},
  language     = {eng},
  number       = {5},
  pages        = {452--458},
  publisher    = {Lippincott Williams & Wilkins},
  series       = {Critical Care Medicine},
  title        = {Targeting Transfusion-Related Acute Lung Injury: The Journey From Basic Science to Novel Therapies},
  url          = {http://dx.doi.org/10.1097/CCM.0000000000002989},
  doi          = {10.1097/CCM.0000000000002989},
  volume       = {46},
  year         = {2018},
}