The Immune System in Transfusion-Related Acute Lung Injury Prevention and Therapy: Update and Perspective

Abstract

As an initiator of respiratory distress, transfusion-related acute lung injury (TRALI) is regarded as one of the rare complications associated with transfusion medicine. However, to date, the pathogenesis of TRALI is still unclear, and specific therapies are unavailable. Understanding the mechanisms of TRALI may promote the design of preventive and therapeutic strategies. The immune system plays vital roles in reproduction, development and homeostasis. Sterile tissue damage, such as physical trauma, ischemia, or reperfusion injury, induces an inflammatory reaction that results in wound healing and regenerative mechanisms. In other words, in addition to protecting against pathogens, the immune response may be strongly associated with TRALI prevention and treatment through a variety of immunomodulatory strategies to inhibit excessive immune system activation. Immunotherapy based on immune cells or immunological targets may eradicate complications. For example, IL-10 therapy is a promising therapeutic strategy to explore further. This review will focus on ultramodern advances in our understanding of the potential role of the immune system in TRALI prevention and treatment.

A Systematic Review on the Management of Transfusion-Related Acute Lung Injury in Transfusion-Dependent Sickle Cell Disease

“…TRALI refers to the onset of acute lung injury caused by blood transfusions that result in respiratory distress [ 11 ]. The onset of TRALI often causes hemodynamic instability and presents with symptoms, such as tachycardia, hypotension, and fever.…”

“…Though similar to transfusion-associated circulatory overload (TACO), TRALI has a few distinguishing characteristics, such as hypotension versus hypertension, lack of widened pulse pressure, exudate pulmonary edema fluid, balanced fluids, and minimal response to diuretics [ 15 ]. In the past, TRALI was misdiagnosed or underdiagnosed as a complication related to blood transfusion [ 6 , 11 , 15 ]. Identifying its presence and distinguishing it from TACO is key to selecting appropriate management and treatment options.…”

“…Researchers and hematologists are constantly seeking improved treatment options to provide SCD patients with minimal adverse effects and enhance the treatment options of TRALI. Currently, the research and clinical testing process include the use of anti-CD40L monoclonal antibodies and immunotherapy [ 4 , 11 , 12 ]. Clinical trials for anti-CD40L are currently underway using rats.…”

“…The studies and trials have produced positive results, and the use of this antibody has demonstrated success in preventing the onset of pulmonary edema in the TRALI mouse study [ 12 ]. Alternatively, research has indicated that the immune system plays a vital role in the onset of TRALI, making immunotherapy a focus of research [ 11 ]. One therapeutic approach currently being studied includes IL-10 therapy [ 4 ].…”

“…Preventative measures that are being employed and explored include blood antibody testing of donors, enhanced and standardized blood and plasma selection protocols, rapid reporting to blood banks, and rituximab prophylaxis [ 5 , 8 - 10 ]. Finally, due to limited effective treatment modalities, the use of the anti-CD40L monoclonal antibody, as well as immunotherapy, is being studied as a potential option in the future [ 11 , 12 ]. The purpose of this review article is to explore each of these aspects and summarize the current state of SCD-related TRALI management and treatment.…”