Evaluation of Platelet Responses in Transfusion-Related Acute Lung Injury (TRALI)

Zeeuw van der Laan, Eveline A.N.; van der Velden, Saskia; Porcelijn, Leendert; Semple, John W.; van der Schoot, C. Ellen; Kapur, Rick

Platelets are versatile cells which are capable of eliciting non-hemostatic immune functions, especially under inflammatory conditions. Depending on the specific setting, platelets may be either protective or pathogenic in acute lung injury and Acute respiratory distress syndrome (ARDS). Their role in Transfusion-related acute lung injury (TRALI) is less well defined, however, it has been hypothesized that recipient platelets and transfused platelets both play a pathogenic role in TRALI. Overall, despite conflicting findings, it appears that recipient platelets may play a pathogenic role in antibody-mediated TRALI, however, their contribution appears to be limited. It is imperative to first validate the involvement of recipient platelets by standardizing the animal models, methods, reagents and read-outs for lung injury and taking the animal housing environment into consideration. For the involvement of transfused platelets in TRALI, it appears that predominantly lipids such as ceramide in stored platelets are able to induce TRALI in animal models. These studies will also need to be validated and moreover, the platelet-derived lipid-mediated mechanisms leading to TRALI will need to be investigated.