Platelet Toll-like Receptor 4-related Innate Immunity Potentially Participates in Transfusion Reactions Independent of ABO Compatibility: An ex Vivo Study
Abstract Purpose: The role of platelet TLR4 in transfusion reactions remains unclear. This study analyzed platelet TLR4, certain DAMPs, and the effect of ABO compatibility on TLR4 expression after a simulated transfusion ex vivo.Methods: Donor red blood cells were harvested from a blood bank. Recipient blood from patients undergoing cardiac surgery was processed to generate a washed platelet suspension. Donor blood was added to the washed platelets at 1%, 5%, or 10% (v/v). Blood mixing experiments were performed using four groups: 0.9% saline control group (n = 31); M, matched blood type mixing (n = 20); S, uncross-matched ABO type-specific mixing (n = 20); and I, ABO incompatible blood mixing (n = 20). Platelet TLR4 expression was determined after blood mixing. Levels of TLR4-binding DAMPs (HMGB1, S100A8, S100A9, and SAA) and that of LPS-binding protein and endpoint proteins (TNF-α, IL-1β, and IL-6) in the TLR4 signaling pathway were evaluated.Results: The 1%, 5%, and 10% blood mixtures significantly increased TLR4 expression in three groups (M, S, and I; all P < 0.001) in a concentration-dependent manner. TLR4 expression did not significantly differ among the three groups (P = 0.148). HMGB1, S100A8, and S100A9 showed elevated levels in response to blood mixing; SAA, LPS-binding protein, TNF-α, IL-1β, and IL-6 did not. Conclusion: Blood mixing may elicit innate immune responses by upregulating platelet TLR4 and DAMPs unassociated with ABO compatibility, suggesting that innate immunity through TLR4-mediated signaling may induce transfusion reactions. The trial was retrospectively registered at Chinese Clinical Trial Registry (ChiCTR2100045606) with date of registration on 19 April 2021.