Role of anti-Nak(a) antibody, monocytes and platelets in the development of transfusion-related acute lung injury.
OBJECTIVE
Transfusion-related acute lung injury (TRALI) is one of the most serious side-effects of transfusion. We report here the first two cases of TRALI caused by anti-Nak(a) (anti-CD36) antibody from a single blood donor. The aim of this study was to clarify the role of the anti-Nak(a) antibody in TRALI development.


METHODS
Human lung microvascular endothelial cells were co-cultured with Nak(a)-positive monocytes and Nak(a)-positive platelets together with serum prepared from blood products of a TRALI-caused anti-Nak(a) antibody-carrying donor. Expressions of leukotriene B(4) (LTB(4)) and tumour necrosis factor alpha (TNF-alpha) in the co-culture supernatants were determined.


RESULTS
The expressions of LTB(4) and TNF-alpha were found to be markedly increased, particularly in the presence of both Nak(a)-positive monocytes and platelets. The expressions of these mediators were almost completed within 4 h after the initiation of co-culture. Monocyte contribution seemed to be stronger than that of platelets. In the absence of human lung microvascular endothelial, no significant LTB(4) or TNF-alpha release was observed.


CONCLUSIONS
Anti-Nak(a) antibody may be strongly implicated in lung microvascular endothelial dysfunctions that lead to TRALI in a monocyte- and platelet-dependent manner.
Nakajima
F
F
Research and Development Department, Central Blood Institute, Japanese Red Cross, Koutou-ku, Tokyo, Japan.
Nishimura
M
M
Hashimoto
S
S
Okazaki
H
H
Tadokoro
K
K
D055371:Acute Lung Injury / Q000209:etiology*; D000906:Antibodies; D016824:Antigens, Human Platelet / Q000276:immunology*; D001792:Blood Platelets; D018920:Coculture Techniques; D004730:Endothelium, Vascular; D006801:Humans; D007975:Leukotriene B4; D008168:Lung / Q000098:blood supply; D008833:Microcirculation; D009000:Monocytes; D065227:Transfusion Reaction; D014409:Tumor Necrosis Factor-alpha
D000906:Antibodies; D016824:Antigens, Human Platelet; C062601:Naka isoantigen, human; D014409:Tumor Necrosis Factor-alpha; D007975:Leukotriene B4