Pool Of Healthy Donors Research Articles

THE EVALUATION OF PATTERN OF WHOLE BLOOD DONOR DEFERRALS IN A TERTIARY CARE CENTER OF NORTH INDIA

Objectives: Donor recruitment is critical to the supply of safe and adequate blood/blood components to meet patient’s need; the first and most crucial step to provide safe blood is proper selection of blood donors. Blood donor selection criteria are designed to ensure the donor as well as the recipient’s health. The objective of this study is to analyze the various causes of donor deferral, study their frequency pattern and to suggest changes to retain and retrieve donors in future. Methods: A retrospective study on analysis of deferred donors of whole blood was conducted in a blood center at tertiary care hospital in North India. The study included blood donors deferred from January 2022 to December 2022. Results: A total of 27,121 donors were registered for whole blood donation and 4534 (16.71%) were deferred. Female deferral (41.67%) was more as compared to male deferral (15.11%). Temporary deferrals (n=4238 [93.47%]) were significantly higher than permanent deferrals (n=296 [6.5%]). The most common reason for temporary deferral was anemia (n = 940 [20.7%]) while that for permanent deferral was jaundice (n=179 [3.94%]). Conclusion: Analyzing the causes, frequency and deferral pattern of blood donors will help to guide the recruitment and retention efforts to maintain a healthy donor pool at large.

Loss of Function of SETD2 Tumor Suppressor in Chronic Myeloid Leukemia (CML) Progenitors Fosters Genomic Instability and Enhances Clonogenic Potential

BACKGROUND AND AIMS - Genomic instability is a hallmark of chronic myeloid leukemia (CML) cells since the chronic phase (CP) of the disease, and results in BCR::ABL1 mutations and/or additional genetic and genomic aberrations that may drive resistance to tyrosine kinase inhibitors (TKIs) and progression to blast crisis (BC). Genomic instability is also a feature of CML stem and progenitor cells and may contribute to their persistence. The SETD2 tumor suppressor codes for a protein that trimethylates histone H3 at lysine 36 (H3K36me3). In solid tumors, SETD2 loss of function has been shown to impair H3K36me3-mediated recruitment of DNA damage response components. We have recently reported that non genomic loss of function of SETD2 is a feature of BC CML and results from premature proteasome-mediated degradation of the SETD2 protein triggered by Aurora kinase A phosphorylation and MDM2 ubiquitination. In the present study, we aimed to assess SETD2/H3K36me3 status in CD34+ progenitors of CP CML patients (pts) and whether SETD2/H3K36me3 deficiency may play a role in genomic instability in CML models. METHODS - Western blotting (WB) was used to assess SETD2 protein expression and H3K36me3 as a surrogate marker of SETD2 function in the CD34+ cell fraction isolated from the bone marrow of 20 newly diagnosed CP CML pts and from a pool of healthy donors (HD). SETD2 forced expression in CD34+ progenitors from newly diagnosed CP CML pts and in the SETD2-deficient KCL22 cell line was performed by nucleofection. SETD2 knock-down in the SETD2-proficient LAMA84 cell line was performed by RNAi. Clonogenic capacity was evaluated by clonogenic assays. Chromatin immunoprecipitation sequencing (ChIP-seq) for H3K36me3 was performed on an Illumina HiSeq2000 with a min 50 million 150-bp single-end reads per replicate. High resolution karyotyping wias perfomed with Cytoscan HD arrays. DNA damage and DNA repair activation were assessed in primary samples and cell lines by WB and immunofluorescence (IF) using antibodies specific for phospho-H2AX, mismatch repair (MMR) and homologous recombination repair (HR) proteins. RESULTS - WB demonstrated a marked down-modulation of SETD2 expression, paralleled by H3K36me3 deficiency, in the CD34+ cells of all newly diagnosed CP CML pts as compared to the total mononuclear fraction and to CD34+ cells from HDs. To investigate whether SETD2 loss affects the activation and proficiency of HR and MMR, we used chronic exposure to UV rays or a single exposure to hydrogen peroxide (1mM for 30 and 60 min). Both induced DNA damage in SETD2 siRNA-depleted LAMA84 cells. Compared to parental cells, cells silenced for SETD2 failed to activate the ATM-dependent repair pathway. Moreover, we found that ATM inactivation prevents H2AX foci formation, associated with a loss of RAD51 and RAD54 (HR) and MSH6 (MMR) repair foci. To confirm the hypothesis that SETD2 is a tumor suppressor implicated in maintaining genomic stability in CML, we transfected SETD2-deficient KCL22 cells with an ectopic SETD2 plasmid. SETD2 forced expression was able to restore DNA damage response, as demonstrated by WB and IF detection of ATM, p95 and H2AX phosphorylation, BRCA1, BRCA2 and CtIP expression and finally RAD51 and RAD54 localization on HR repair foci observed after UV or hydrogen peroxide exposure. High-resolution karyotyping after DNA damage showed increased rate of DNA breakpoints in SETD2-deficient cells, preferentially occuring at loci where H3K36me3 marks were lost as assessed by ChiP-seq. In line with the effects observed in cell line models, forced expression of SETD2 in CD34+ cells from 5 CP CML pts was found to restore proliferation control, since a >50% reduction in clonogenic potential was observed after nucleofection. CONCLUSIONS - Our findings demonstrate that SETD2 is a bona fide tumor suppressor in CML progenitors and establish a functional link between SETD2 loss of function and genomic instability. SETD2 inactivation may thus play a pivotal role in the harmful cascade of events that may foster drug resistance and ultimately lead to disease progression. Since SETD2 loss of function in CML is mediated by post-translation mechanisms, hence is reversible, therapeutic strategies aimed at interfering with these mechanisms may restore proliferation control and interrupt this cascade. Supported by AIRC IG 2019 (23001) and by Italian Ministry of Health, “Bando Ricerca Finalizzata 2016”, project GR-2016-02364880.

SETD2 Loss of Function Is a Recurrent Event in Advanced-Phase Chronic Myeloid Leukemia

Abstract In recent years, deregulation of epigenetic modifiers has turned out to be a recurrent event in cancer evolution. The SETD2 tumor suppressor gene encodes a histone methyltransferase that catalyzes the trimethylation of lysine 36 on histone H3 (H3K36Me3), the major chromatin mark associated with active transcription and alternative splicing. Recent studies have also implicated SETD2 in homologous recombination repair, mismatch repair, mitosis and cytokinesis. SETD2 loss of function was initially uncovered in clear cell renal cell carcinomas and was subsequently found in many other solid tumors. More recently, it has also been reported in a variety of hematologic myeloid and lymphoid malignancies, including acute lymphoblastic leukemia,acute myeloid leukemia, chronic lymphocytic leukemia, T-cell lymphoma, systemic mastocytosis and myeloproliferative neoplasms. We thus wondered whether advanced-phase chronic myeloid leukemia (CML), that shareS similarities with acute leukemias including a high level of genetic instability, may also exhibit SETD2 loss of function. To this purpose, we studied a relatively large cohort of 69 advanced phase CML patients (pts), including pts with accelerated phase (AP; n=15), myeloid blast crisis (my-BC; n=30), and lymphoid blast crisis (ly-BC; n=15) and pts with tyrosine kinase inhibitor (TKI)-resistant chronic phase harboring 2 or more BCR-ABL kinase domain mutations (mut-CP; n=9). Samples collected at diagnosis from CP pts (n=8) who achieved optimal response to therapy were also studied for comparison. A recent study in advanced systemic mastocytosis has demonstrated that SETD2 loss of function may result not only from genomic disruption but also from post-translational events, suggesting that the frequency of SETD2 involvement in solid tumors or hematologic malignancies might be higher than sequencing and copy number data alone would suggest. We thus decided to use a Western Blotting (WB) approach to assess H3K36Me3 levels as a surrogate marker of SETD2 loss of function and to screen for the expression of SETD2 full-length vs truncated protein isoforms, that are the most frequent result of inactivating nonsense or frameshift mutations. Reduced or null H3K36Me3 (as compared to a pool of healthy donors) was detected in the great majority of pts with advanced-phase CML (58/69, 84.1%; 12/15 AP, 24/30 my-BC, 12/15 ly-BC, 8/9 mut-CP). In contrast, CP pts at diagnosis showed H3K36Me3 levels superimposable to those of healthy donors. In some of them, however, the CD34+ cell fraction was available and reduced H3K36Me3 levels were detected in all cases. No evidence of abnormal SETD2 protein isoforms was detected, but pts with no H3K36Me3 also had no detectable SETD2 protein and pts with reduced H3K36Me3 had similarly reduced levels of full-length SETD2 protein as assessed by densitometric analysis of WB (Spearman R=0.95, p To rule out the possibility that SETD2 loss of function might be another age-associated alteration in an epigenetic regulator, we collected a series of 80 healthy individuals with an age ranging from 65 to 95 years. In this cohort, we checked for SETD2 mutations by sequencing and for SETD2 and H3K36 trimethylation levels by WB. No mutations were detected and protein levels were not significantly lower in older adults than in a pool of younger adults. Advanced-phase CML is characterized by a profound genetic heterogeneity. We here show the first evidence for a novel, nearly unifying alteration. However, SETD2 downmodulation and, consequently, H3K36Me3 deficiency seem to be most frequently accomplished at the post-translational level rather than being the results of genetic/genomic hits or transcriptional repression. Further studies aimed to assess whether H3K36Me3 loss might contribute to the genetic instability that is the hallmark of advanced-phase CML are warranted. Restoring physiological H3K36Me3 levels may help improve the outcome of this critical subset of pts. Supported by AIL and AIRC (project code 16996) Disclosures Castagnetti: Incyte: Consultancy, Honoraria; Pfizer: Consultancy, Honoraria; Novartis: Consultancy, Honoraria; Bristol Myers Squibb: Consultancy, Honoraria. Gugliotta: Incyte: Consultancy, Honoraria; Bristol Myers Squibb: Consultancy, Honoraria; Novartis: Consultancy, Honoraria. Rosti: Incyte: Research Funding, Speakers Bureau; Pfizer: Research Funding, Speakers Bureau; Bristol Myers Squibb: Research Funding, Speakers Bureau; Novartis: Research Funding, Speakers Bureau. Iurlo: Bristol Myers Squibb: Consultancy, Honoraria; Novartis: Consultancy, Honoraria; Pfizer: Consultancy, Honoraria. Abruzzese: Novartis: Consultancy; Pfizer: Consultancy; Incyte: Consultancy; BMS: Consultancy. Crugnola: BMS: Honoraria; Celgene: Honoraria; Novartis: Honoraria. Bonifacio: Bristol-Myers Squibb: Membership on an entity's Board of Directors or advisory committees; Incyte: Membership on an entity's Board of Directors or advisory committees; Pfizer: Membership on an entity's Board of Directors or advisory committees; Novartis: Membership on an entity's Board of Directors or advisory committees, Research Funding. Tiribelli: Novartis: Consultancy, Honoraria; Incyte: Consultancy, Honoraria; Bristol Myers Squibb: Consultancy, Honoraria. Galimberti: Bristol-Myers Squibb: Speakers Bureau; Incyte: Speakers Bureau; Novartis: Speakers Bureau; Pfizer: Speakers Bureau. Baccarani: Incyte ARIAD: Consultancy, Honoraria, Speakers Bureau; Bristol-Myers Squibb: Honoraria, Speakers Bureau; Pfizer: Honoraria, Speakers Bureau; Novartis: Consultancy, Honoraria, Speakers Bureau. Martinelli: Celgene: Consultancy; Amgen: Consultancy; JohnsonJ Pfizer: Consultancy; Ariad/Incyte: Consultancy; Roche: Consultancy. Soverini: Bristol-Myers Squibb: Consultancy; Incyte Biosciences: Consultancy; Novartis: Consultancy.

Saliva Is a Valid Alternative to Nasopharyngeal Swab in Chemiluminescence-Based Assay for Detection of SARS-CoV-2 Antigen.

Diagnostic methods based on SARS-CoV-2 antigens detection are a promising alternative to SARS-CoV-2 RNA amplification. We evaluated the automated chemiluminescence-based Lumipulse® G SARS-CoV-2 Ag assay on saliva samples, using Simplexa™ COVID-19 Direct assay as a reference test. Analytical performance was established on a pool of healthy donors’ saliva samples spiked with the 2019-nCoV/Italy-INMI1 isolate, whereas clinical performance was assessed on fresh saliva specimens collected from hospitalized patients with suspect or confirmed COVID-19 diagnosis. The limit of detection (LOD) was 0.65 Log TCID50/mL, corresponding to 18,197 copies/mL of SARS-CoV-2 RNA. Antigen concentrations and SARS-CoV-2 RNA were highly correlated (r = 0.99; p < 0.0001). Substantial agreement (80.3%) and significant correlation (r = −0.675; p = 0.0006) were observed between Lumipulse® G assay results and Ct values on clinical samples, with 52.4% sensitivity and specificity 94.1%. Sensitivity exceeded 90.0% when calculated on samples with Ct < 25, and specificity was 100% when excluding samples from recovered patients with previous COVID-19 diagnosis. Overall, chemiluminescence-based antigen assay may be reliably applied to saliva samples to identify individuals with high viral loads, more likely to transmit the virus. However, the low positive predictive value in a context of low SARS-CoV-2 prevalence underscores the need for confirmatory testing in SARS-CoV-2 antigen-positive cases.

Quantitative levels of serum N-glycans in type 1 diabetes and their association with kidney disease.

We investigated associations of quantitative levels of N-glycans with hemoglobin A1c (HbA1c), renal function and renal function decline in type 1 diabetes. We measured 46 total N-glycan peaks (GPs) on 1565 serum samples from the Scottish Diabetes Research Network Type 1 Bioresource Study (SDRNT1BIO) and a pool of healthy donors. Quantitation of absolute abundance of each GP used 2AB-labeled mannose-3 as a standard. We studied cross-sectional associations of GPs and derived measures with HbA1c, albumin/creatinine ratio (ACR) and estimated glomerular filtration rate (eGFR), and prospective associations with incident albuminuria and final eGFR. All GPs were 1.4 to 3.2 times more abundant in SDRTN1BIO than in the healthy samples. Absolute levels of all GPs were slightly higher with higher HbA1c, with strongest associations for triantennary trigalactosylated disialylated, triantennary trigalactosylated trisialylated structures with core or outer arm fucose, and tetraantennary tetragalactosylated trisialylated glycans. Most GPs showed increased abundance with worsening ACR. Lower eGFR was associated with higher absolute GP levels, most significantly with biantennary digalactosylated disialylated glycans with and without bisect, triantennary trigalactosylated trisialylated glycans with and without outer arm fucose, and core fucosylated biantennary monogalactosylated monosialylated glycans. Although several GPs were inversely associated prospectively with final eGFR, cross-validated multivariable models did not improve prediction beyond clinical covariates. Elevated HbA1c is associated with an altered N-glycan profile in type 1 diabetes. Although we could not establish GPs to be prognostic of future renal function decline independently of HbA1c, further studies to evaluate their impact in the pathogenesis of diabetic kidney disease are warranted.

CML-206: ReSETting SETD2/H3K36Me3 Deficiency as a New Therapeutic Strategy in Blast Crisis Chronic Myeloid Leukemia Patients

Context SETD2 is a tumor suppressor encoding a histone methyltransferase that trimethylates histone H3 at lysine 36 (H3K36Me3) and is involved in various cellular processes, including transcriptional regulation and repair of DNA damage. SETD2 loss of function due to mutations or deletions has been observed in some solid tumors and acute leukemias. Objective We aimed to investigate the frequency and underlying mechanisms of SETD2 loss of function in advanced phase of Chronic Myeloid Leukemia (CML). Patients A large cohort of 90 CML patients with advanced phase CML was screened for SETD2 and H3K36Me3 status. Results Reduced or null SETD2 and H3K36Me3 were detected by western blotting in 88% of advanced-phase CML patients, as compared to a pool of healthy donors and to CP patients at diagnosis. No genetic abnormalities or transcript downregulation were observed and enhanced SETD2 proteasome-mediated degradation was rather found to occur. After proteasome inhibition, accumulation of hyper-ubiquitinated SETD2 bound to MDM2 was observed. Both MDM2 pharmacological inhibition by SP-141 and siRNA-mediated silencing suggested that MDM2 is implicated in SETD2 loss. Aurora Kinase A, that is overexpressed in CML, was also found to co-immunoprecipitate with SETD2. Both pharmacological inhibition and knock-down of Aurora A rescued SETD2 and H3K36Me3. SETD2/H3K36Me3 loss was found to impair the proficiency of homologous recombination (HR) repair as demonstrated by comparison of phosphorylated histone 2A.X and Rad51 foci in steady-state conditions and after sub-lethal DNA damage by UV exposure in SETD2-deficient CML cells as well as in SETD2-proficient CML cells subjected to SETD2 silencing. Reduction of clonogenic growth after treatment with proteasome, MDM2, and Aurora kinase A inhibitors at nanomolar or subnanomolar concentrations was observed both in cell lines and in primary cells from SETD2-deficient advanced-phase CML patients. Conclusions In advanced-phase CML, phosphorylation by Aurora kinase A and hyper-ubiquitination by MDM2 are responsible for SETD2 non-genomic loss of function. Loss of SETD2/H3K36Me3 was associated with increased DNA damage and impaired HR repair. Restoring physiological H3K36Me3 levels should further be explored as a therapeutic strategy to help improve the outcome of this critical subset of patients.

Impact of concentration and dilution of three macrocyclic gadolinium-based contrast agents on MRI signal intensity at 1.5T and 3T and different pulse sequences: results of a phantom study in human plasma.

Many factors influence the increase in signal intensity (SI) provided by magnetic resonance imaging (MRI) contrast media. To assess the impact of different gadolinium concentrations and dilutions of three macrocyclic gadolinium-based contrast agents (GBCA) on SI. This phantom study investigated gadobutrol, gadoteridol, and gadoterate in human plasma of a healthy donor pool at 37 °C. Different molar concentrations served to mimic conditions typically relevant for steady-state imaging; different dilutions served to mimic influence on first-pass bolus imaging. For SI measurement at 1.5T and 3T, we used two Magnetom Scanners (Siemens), applying the T1-weighted sequences Flash 2D/3D and VIBE. Regions of interest were placed on the central slice of the test vials. In the concentration series, gadobutrol showed the highest SI of all three GBCAs up to 2 mM, followed by gadoteridol and gadoterate. No major differences were seen between 1.5T and 3T. In the dilution series, gadobutrol showed the highest SI of all three GBCAs up to 10 mL/L. The highest effect was recorded with Flash 3D and VIBE at 3T. SIs measured in phantoms using three macrocyclic GBCAs strongly depend on their relaxivity and on the local concentration. The latter can be influenced-when comparing dilutions-by their initial concentration in their formulation. Furthermore, the pulse sequences and the chosen parameters have essential influence. At steady-state concentrations (≤2 mM) and first-pass bolus dilutions (up to 10 ml/L), gadobutrol showed highest SIs, followed by gadoterate and gadoteridol.

Aurora Kinase a/MDM2-Mediated SETD2 Loss of Function in Chronic Myeloid Leukemia Patients in Blast Crisis Can be Therapeutically Targeted Inducing Apoptotic Cell Death in a Caspase-Dependent Way

Aurora Kinase a/MDM2-Mediated SETD2 Loss of Function in Chronic Myeloid Leukemia Patients in Blast Crisis Can be Therapeutically Targeted Inducing Apoptotic Cell Death in a Caspase-Dependent Way

In Systemic Masocytosis, Midostaurin Targets Both Kit and Aurora Kinase a Reverting H3K36Me3 Deficiency and Synergizes with Second-Generation Tyrosine Kinase Inhibitors

H3K36 tri-methylation by SETD2 has been linked to a plethora of pathways critical for the regulation of a multitude of cellular processes, including transcription, DNA replication and DNA repair after damage, yet the functional implications of perturbed H3K36 tri-methylation by SETD2 mutations or non-genomic loss of function in leukemia are still unclear. We have previously reported that the HMC-1.1 and -1.2 mast cell leukemia (MCL) cell lines and many patients (pts) with advanced systemic mastocytosis (advSM) display H3K36Me3 deficiency as a result of non-genomic loss of function of SETD2. Proteasome inhibition restored SETD2 protein expression and H3K36me3, suggesting that a functional protein is produced but rapidly degraded. To understand the mechanisms underlying this phenomenon, we used an in silico approach to identify candidate SETD2-interacting proteins, followed by experimental confirmation by co-immunoprecipitation. We found that, after proteasomal inhibition, SETD2 co-immunoprecipitates with Aurora Kinase A (AKA). We also found that AKA was overexpressed and hyper-activated in pts with advSM compared to ISM pts and to a pool of healthy donors, and that AKA can phosphorylate SETD2. Both pharmacological inhibition by Danusertib and siRNA-mediated knock-down of AKA rescued SETD2 expression and activity, raising the hypothesis that phosphorylation by AKA might be implicated in proteasome-mediated degradation of SETD2. The new standard of therapy in advSM is midostaurin, that inhibits the activity of both wild‐type and D816V mutant KIT, as well as of various other kinases including AKA. Therefore we investigated if midostaurin effects may be addressed to AKA inhibition and consequent SETD2/H3K36me3 rescue. To this purpose, HMC-1 cells were treated with 5 µM midostaurin for 24 h and AKA, SETD2 and H3K36me3 expression were evaluated by western blotting. Treatment with midostaurin was able to inhibit AKA activity by about 60%, partially restoring SETD2 expression and H3K36Me3. Moreover, midostaurin treatment of HMC-1 cells at micromolar doses induced cytostatic but not cytotoxic effects as shown by cell growth curves performed in liquid medium and as confirmed by annexin V/PI staining and subsequent cytofluorimetric analysis of apoptotic cell death. Our observations in cell lines were confirmed in neoplastic mast cells collected from six patients with advSM before and after three months of midostaurin treatment. Western blotting showed that midostaurin treatment in vivo indeed results in a rescue of SEDT2 expression and activity, associated with a partial de-phosphorylation of AKA. Our subsequent experimental step was therefore to hypothesize and test the possibility of a combined treatment between midostaurin and second generation TKIs to induce not only a cytostatic but also a cytotoxic effect both in our in vitro models and in primary cells obtained from bone marrow samples of advSM patients. We performed growth curves in liquid medium and clonogenic assays to evaluate the therapeutic potential of pharmacological combination of midostaurin with Nilotinib and Dasatinib in HMC-1 cells and in neoplastic mast cells from 3 patients with advSM and we observed in all cases synergistic effects at nanomolar doses. Moreover, cytofluorimetric analysis of apoptotic cell death in HMC-1 cells showed an important advantage in using the combination of the two drugs, compared to single agents, underlined by the significant reduction of drug doses used to obtain cytotoxic effects (Figure 1). Our results suggest that AKA-mediated post-translational modifications contribute to SETD2 non-genomic loss of function in advSM. Inhibiting AKA and c-Kit activity by midostaurin in combination with a second generation TKI is a promising therapeutic strategy in patients with SETD2/H3K36Me3 deficiency. Acknowledgments: study supported by AIRC (project code 16996) and AIL (Associazione Italiana contro le Leucemia, Linfomi e Mieloma). Disclosures Papayannidis: Incyte: Honoraria; Shire: Honoraria; Novartis: Honoraria; Teva: Honoraria; Amgen: Honoraria; Pfizer: Honoraria. Bonifacio:Pfizer: Honoraria; Amgen: Honoraria; Novartis: Honoraria; Incyte: Honoraria; BMS: Honoraria. Albano:Incyte: Membership on an entity's Board of Directors or advisory committees; Novartis: Membership on an entity's Board of Directors or advisory committees. Elena:Novartis: Consultancy; Pfizer: Consultancy. Valent:Deciphera: Honoraria, Research Funding; Blueprint: Research Funding; Pfizer: Honoraria; Celgene: Honoraria; Novartis: Consultancy, Honoraria, Research Funding. Cavo:celgene: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: travel accommodations, Speakers Bureau; janssen: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: travel accommodations, Speakers Bureau; bms: Honoraria, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; sanofi: Honoraria, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; novartis: Honoraria; takeda: Honoraria, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; amgen: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; AbbVie: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees. Soverini:Incyte: Consultancy.

Functional flow cytometry of monocytes for routine diagnosis of innate primary immunodeficiencies

Functional flow cytometry of monocytes for routine diagnosis of innate primary immunodeficiencies

S123 SETD2 LOSS OF FUNCTION IS A RECURRENT EVENT IN ADVANCED‐PHASE CHRONIC MYELOID LEUKEMIA INDUCED BY POST‐TRANSLATIONAL MECHANISMS THAT CAN BE THERAPEUTICALLY TARGETED

Background:Inactivating mutations in the SETD2 tumor suppressor occur in solid tumors and acute leukemias. SETD2 trimethylates histone H3 Lysine 36 (H3K36Me3) and plays a key role in transcription and splicing, homologous recombination (HR) and mismatch repair. In Systemic Mastocytosis, we have demonstrated that SETD2 loss of function may occur at the post‐translational level.Aims:In this study, we aimed to investigate post‐translational mechanisms involved in SETD2 loss of function and to asses if SETD2/H3K36me3 loss may contribute to genetic instability in CML.Methods:Western Blotting (WB) was used to assess proteins expression in a cohort of 90 advanced‐phase CML patients (pts). SETD2 mutations and transcript levels were investigated by NGS and real time PCR. Co‐immunoprecipitation (co‐IP) was used to study protein interactions. Immunofluorescence (IF) with an anti‐phospho‐histone2A.X (γH2AX) and an anti‐Rad51 antibody was used to evaluate DNA damage and HR repair. Apoptosis and clonogenic assays were performed to test sensitivity to proteasome, MDM2 and Aurora kinases inhibitors. siRNA‐mediated silencing of MDM2 and Aurora kinase A (AKA) was performed to assess MDM2 and AKA involvement in SETD2 reduced stability and proteasomal degradation.Results:Reduced or null SETD2 and H3K36Me3 were detected in 88% of pts as compared to a pool of healthy donors and to CP pts at diagnosis who achieved optimal responses to TKIs, but neither mutations/deletions nor mRNA down‐regulation were found. Proteasome inhibition in primary cells from pts with undetectable SETD2 restored H3K36Me3 and led to accumulation of hyper‐ubiquitinated SETD2. Moreover, it induced apoptosis and reduced clonogenic growth. In K562 cells (SETD2/H3K36Me3low), co‐IP performed before and after proteasome inhibition showed that SETD2 interacts with MDM2 and, as a result, it is hyper‐ubiquitinated. MDM2 inhibition by SP‐141 resulted in cytostatic effects and rescued SETD2 expression and activity. The latter was also achieved by siRNA‐mediated silencing of MDM2, suggesting that MDM2 is implicated in SETD2 reduced stability. Co‐IP also showed that SETD2 interacts with Aurora Kinase A (AKA) a Ser‐Thr kinase frequently overexpressed in CML. We found that AKA phosphorylates SETD2, and both pharmacological inhibition by Danusertib and siRNA‐mediated silencing rescued SETD2 expression and activity. Next, to investigate whether SETD2/H3K36Me3 loss may contribute to genetic instability, LAMA 84 (SETD2/H3K36Me3high) and K562 (SETD2/H3K36Me3low) cells were studied by WB and immunofluorescence (IF) to assess γH2AX and Rad51 foci in steady state conditions and after sub‐lethal DNA damage by UV exposure. The same studies were performed after SETD2 silencing for 14 weeks. Cells with low or silenced SETD2 had significantly higher levels of γH2AX and were unable to induce homologous recombination (HR) repair after DNA damage. Clonogenic assays performed in LAMA 84 cells before and after SETD2 silencing, in K562 (SETD2/H3K36Me3low) and in imatinib‐resistant (IM‐R) K562 cells which have lost SETD2 expression and activity, suggested that reduction of clonogenic growth after proteasomal or MDM2 inhibition is partly dependent on SETD2 expression and functional status.Summary/Conclusion:Phosphorylation by AKA and ubiquitination by MDM2 contribute to SETD2 non‐genomic loss of function in advanced‐phase CML. Loss of SETD2/H3K36Me3 result in increased DNA damage and impaired HR repair. Restoring physiological H3K36Me3 levels may help improve the outcome of this critical subset of pts. Supported by AIRC (project 16996) and AIL.

Detection of Nicotine and Nicotine Metabolites in Units of Banked Blood.

To determine the concentrations of nicotine and nicotine metabolites in RBC units as a means to estimate the point prevalence of exposure within the healthy donor pool. Segments from 105 RBC units were tested for the presence of nicotine, cotinine, or trans-3'-hydroxycotinine by liquid chromatography-tandem mass spectrometry. Of the 20 (19%) units that contained detectable concentrations of nicotine, cotinine, or trans-3'-hydroxycotinine, 19 (18.1%) contained concentrations consistent with the use of a nicotine-containing product within 48 hours of specimen collection. One RBC unit contained nicotine concentrations consistent with passive exposure. Chemicals from nicotine-containing products are detectable within the US RBC supply. Further investigation is needed to determine the risks of transfusion-associated exposure to nicotine and other tobacco-associated chemicals among vulnerable patient populations such as neonates.

Aurora Kinase a/MDM2-Mediated SETD2 Loss of Function in Chronic Myeloid Leukemia Patients in Blast Crisis Induces Genetic Instability and Can be Therapeutically Targeted

The SETD2 protein is a histone methyltransferase that specifically catalyzes the trimethylation of Lysine 36 on histone H3 (H3K36me3). SETD2/H3K36me3 are implicated in transcript elongation and splicing, DNA repair, chromosome segregation. SETD2 gene deletions and/or mutations (mostly frameshift or nonsense) have been reported in solid tumors (clear cell renal cell carcinoma, bladder cancer, lung cancer, melanoma, endometrial cancer) and in acute leukemias.Using a Western Blotting (WB) approach to screen for SETD2 protein expression and for H3K36me3 levels in a relatively large cohort of 80 advanced-phase chronic myeloid leukemia (CML) patients (pts), we could detect reduced or null SETD2 and H3K36me3 in 86% of pts as compared to a pool of healthy donors and to chronic phase (CP) pts at diagnosis who achieved optimal responses to TKI, but neither mutations/deletions nor transcriptional down-regulation were the underlying causes. Inhibition of proteasome-mediated degradation in primary cells from pts with undetectable SETD2 restored H3K36me3 and led to accumulation of hyper-ubiquitinated SETD2, suggesting that a functional protein is produced but rapidly degraded. Moreover, proteasome inhibition was found to induce apoptosis and to reduce clonogenic growth. In K562 cells (SETD2/H3K36me3low), co-immunoprecipitation (co-IP) performed before and after proteasome inhibition showed accumulation of the hyper-ubiquitinated form of SETD2 bound to MDM2. MDM2 inhibition by SP-141 resulted in cytostatic effects and restored SETD2 expression and activity. Superimposable results were achieved by siRNA-mediated silencing of MDM2, suggesting that MDM2 is implicated in SETD2 reduced stability. Co-IP also showed that SETD2 interacts with Aurora Kinase A a Ser-Thr kinase frequently overexpressed in CML. We found that Aurora Kinase A phosphorylates SETD2, and both pharmacological inhibition by Danusertib and siRNA-mediated silencing rescued SETD2 expression and activity.Next, to investigate whether SETD2/H3K36me3 loss may contribute to genetic instability, LAMA 84 (SETD2/H3K36Me3high) and K562 (SETD2/H3K36me3low) cells were studied by WB and immunofluorescence (IF) to assess phosphorylated histone 2A.X (γH2AX) and Rad51 foci in steady state conditions and after sub-lethal DNA damage by UV exposure. The same studies were performed after SETD2 silencing for 3 months. Cells with low or silenced SETD2 had significantly higher levels of γH2AX and were unable to induce homologous recombination (HR) repair after DNA damage. Clonogenic assays performed in LAMA 84 cells before and after SETD2 silencing, in K562 (SETD2/H3K36me3low) and in imatinib-resistant (IM-R) K562 cells which have lost SETD2 expression and activity, suggested that reduction of clonogenic growth after proteasomal or MDM2 inhibition is strictly dependent on SETD2 expression and functional status (Figure 1A).First and second generation proteasome inhibitors (bortezomib, carfilzomib and ixazomib) inhibited the clonogenic potential of the mononuclear cell fraction from both CP (n=2) and blast crisis (BC) (n=4) CML pts at subnanomolar concentrations, with the extent of anti-tumor activity clearly anti-correlated with SETD2 expression and H3K36me3 levels: pts with lower SETD2 expression showed lower LD50 when compared with pts with higher SETD2 expression and H3K36me3 levels (Figure 1B). Similarly, clonogenic assays performed by administrating increasing doses of SP-141 (from 0.25 to 1.25 µM) suggested that MDM2 specific inhibition had more significant effects in BC-CML pts showing low SETD2 levels and activity as compared to BC-CML pts showing intermediate SETD2 levels and activity and to CP CML pts.In conclusion, phosphorylation by Aurora Kinase A and ubiquitination by MDM2 contribute to SETD2 non-genomic loss of function in advanced-phase CML. Loss of SETD2/H3K36me3 is associated with increased DNA damage and impaired HR repair. Restoring physiological H3K36me3 levels may help improve the outcome of this critical subset of pts.Acknowledgments: study supported by AIRC (project code 16996) and AIL (Associazione Italiana contro le Leucemia, Linfomi e Mieloma). [Display omitted] DisclosuresCastagnetti:Incyte: Consultancy, Honoraria; Pfizer: Consultancy, Honoraria; Bristol Meyers Squibb: Consultancy, Honoraria; Novartis: Consultancy, Honoraria. Gugliotta:Novartis: Honoraria; Pfizer: Honoraria; Bristol-Myers Squibb: Honoraria; Incyte: Honoraria. Abruzzese:Pfizer: Consultancy; Novartis: Consultancy; BMS: Consultancy; Ariad: Consultancy. Bonifacio:Incyte: Consultancy; Pfizer: Consultancy; Amgen: Consultancy; Novartis: Research Funding; Bristol Myers Squibb: Consultancy. Martinelli:Ariad/incyte: Consultancy; Pfizer: Consultancy; Celgene: Consultancy; Amgen: Consultancy; Janssen: Consultancy; Roche: Consultancy. Cavo:Adaptive Biotechnologies: Honoraria, Membership on an entity's Board of Directors or advisory committees; GlaxoSmithKline: Honoraria, Membership on an entity's Board of Directors or advisory committees; Bristol-Myers Squibb: Honoraria, Membership on an entity's Board of Directors or advisory committees; Takeda: Honoraria, Membership on an entity's Board of Directors or advisory committees; AbbVie: Honoraria, Membership on an entity's Board of Directors or advisory committees; Janssen: Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding, Speakers Bureau; Celgene: Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding, Speakers Bureau; Amgen: Honoraria, Membership on an entity's Board of Directors or advisory committees. Soverini:Bristol Myers Squibb: Consultancy; Incyte Biosciences: Consultancy; Novartis: Consultancy.

VECTOR-BORNE PATHOGENS-TESTING IN A ROMANIAN CANINE BLOOD BANK

INTRODUCTION: Canine blood banking in veterinary medicine is an expanding market. Once the demand for blood products increased all over the world, canine blood banks have focused attention on the risk of spreading diseases through blood transfused products. The need to preserve a healthy donor-pool, free of blood-borne infectious diseases, mainly in endemic areas, led to the implementation of appropriate protocols for screening canine blood donors using specific tests.OBJECTIVES: The aim of this study was to evaluate the presence of Anaplasma phagocytophilum/Anaplasmaplatys, Echrlichiacanis/Echrlichiaewingii, Dirofilariaimmitis and Borrelia burgdorferi using the enzyme immunoassay technology (EIA) among the donors of a Romanian canine blood bank, from January 2015 to December 2016.METHODS: Blood samples from 575 donors were collected and 1253 tests were performed with SNAP 4DX Plus® (IDEXX Laboratories, Fremont, CA) to reveal the presence of D. immitis antigens and the antibodies toward A. phagocytophilum and/or A. platys, E. canis and/or E. ewingii and B. burgdorferi.RESULTS: The results of this holistic approach show that all blood samples provided negative results for B. burgdorferi and E.canis/E. ewingii (0/1253), while 0.87% (11/1253) samples provided positive results for A. phagocytophilum/A. platys and 6.94% (87/1253) for D. immitis.CONCLUSION: The next studied topic would be to compare the results provided by the EIA technology with results of real time PCR and qPCR regarding these vector-borne pathogens.

Randomised clinical trial: faecal microbiota transplantation for recurrent Clostridum difficile infection - fresh, or frozen, or lyophilised microbiota from a small pool of healthy donors delivered by colonoscopy.

Faecal microbiota transplantation (FMT) has become routine in managing recurrent C. difficile infection (CDI) refractory to antibiotics. To compare clinical response and improvements in colonic microbiota diversity in subjects with recurrent CDI using different donor product. Seventy-two subjects with ≥3 bouts of CDI were randomised in a double-blind study to receive fresh, frozen or lyophilised FMT product via colonoscopy from 50 g of stool per treatment from eight healthy donors. Recipients provided stools pre- and 7, 14 and 30 days post-FMT for C. difficile toxin and, in a subset, microbiome composition by 16S rRNA gene profiling. Overall resolution of CDI was 87% during 2 months of follow-up after FMT. Stool samples before FMT had significantly decreased bacterial diversity with a high proportion of Proteobacteria compared to donors. Cure rates were highest for the group receiving fresh product seen in 25/25 (100%), lowest for the lyophilised product 16/23 (78%; P = 0.022 vs. fresh and 0.255 vs. frozen) and intermediate for frozen product 20/24 (P = 0.233 vs. fresh). Microbial diversity was reconstituted by day 7 in the subjects receiving fresh or frozen product. Improvement in diversity was seen by day 7 in those randomised to lyophilised material with reconstitution by 30 days. Comparative efficacy in faecal microbiota transplantation was observed in subjects receiving fresh or frozen faecal product from the same donors. The lyophilised product had a slightly lowered efficacy compared with fresh product, but it resembled other treatments in microbial restoration 1 month after faecal microbiota transplantation.

Enhanced VISTA Expression in a Subset of Patients with Acute Myeloid Leukemia

Introduction: Identification of tumor associated antigens (TAA) in acute myeloid leukemia (AML) will facilitate the use of targeted immunotherapies such as chimeric antigen receptor T cell therapy and bispecific antibodies. The characteristics of an ideal TAA include tumor specificity, high expression level, large percentage of positive tumor cells, and evidence for expression on putative cancer stem cells. V-domain Ig Suppressor of T cell Activation (VISTA) is a cell surface protein previously shown to be present on hematologic cells and inhibitory towards T cells. VISTA's role and presence within AML has yet to be defined. We performed detailed studies to characterize VISTA expression on tumor cells and mononuclear cell subsets in patients with AML.Methods: Immunophenotyping was performed on mononuclear cells from primary AML patient specimens using mass cytometry (CyTOF) by staining samples with a panel containing 34 antibodies to surface markers and cytokines (Table 1). This antibody panel was used to identify blast cells (variable immunophenotype), leukemic stem cells (LSCs) (CD34+, CD38-), T cells (CD3+), monocytes (CD33+, CD14+, CD11b+, HLA-DR+), myeloid derived suppressor cells (MDSCs) (CD33+, CD11b+, HLA-DR-), and M2 macrophages (CD11b+, CD163+). Raw median VISTA expression and percentage of cells expressing VISTA were calculated for all of these cell types. Samples were split into 2 categories based on blast VISTA expression. A sample was considered VISTA high if >10% of the blasts expressed VISTA, and VISTA low if <10% of the blasts expressed VISTA. Similar data was generated from a pool of healthy donors for comparison.Results: Fourteen bone marrow samples from patients with newly diagnosed AML and 10 from healthy donors were obtained. The average percentage of blasts expressing VISTA was 68% (range 28% - 81%) in the VISTA high group and 4.2% (range 0.3% - 6.8%) in the VISTA low group (p<0.05). VISTA expression was higher in the VISTA high group than in the VISTA low group (17.7 vs -0.1, p<0.05). The VISTA high group had a lower blast percentage in the bone marrow compared to the VISTA low group (56% vs 91%, p<0.05). The VISTA high and low groups had similar percentages of LSCs (2.5% vs 0.6%, p=0.11), but the LSCs in the VISTA high group maintained higher VISTA expression than did those in the VISTA low group (6.81 vs -0.11, p<0.05). The LSCs within the VISTA high group had similar VISTA expression to the blast population (6.81 vs 17.7, p=0.15). Within the non-blast population, VISTA expression was higher on the myeloid cell subsets than on the T cells for both the AML samples (11.5 vs 0.17, p<0.05) and the healthy donor samples (8.07 vs 0.24, p<0.05). VISTA expression was similar between the VISTA high and low groups on T cells (0.36 vs 0.02, p=0.08), monocytes (15.7 vs 19, p=0.7), MDSCs (6.3 vs 4, p=0.26), and M2 macrophages (7.4 vs 16.6, p =0.25). VISTA expression was similar between AML and healthy donor samples for T cells (0.17 vs 0.24, p=0.6), monocytes (15.7 vs 14, p=0.41), MDSCs (6.3 vs 3.6, p=0.22), and M2 macrophages (7.4 vs 6.6, p=0.19). Monocytes had the highest expression of VISTA within the healthy donor samples (p<0.05) and this difference was maintained in the AML samples.Conclusion: A subset of patients with AML has a large percentage of blasts, including LSCs, with high VISTA expression on their surface. VISTA is expressed on normal myeloid cells in the bone marrow of patients with AML, but at low levels and to a similar degree as in the marrow of healthy donors. [Display omitted] [Display omitted] DisclosuresHuang:Janssen Research & Development, LLC: Employment, Other: I am an employee of Janssen and a stock owner . Sasser:Janssen Research & Development, LLC: Employment. Adams:Janssen Research & Development, LLC: Employment. Druker:Agios: Honoraria; Ambit BioSciences: Consultancy; ARIAD: Patents & Royalties, Research Funding; Array: Patents & Royalties; AstraZeneca: Consultancy; Blueprint Medicines: Consultancy, Equity Ownership, Other: travel, accommodations, expenses ; BMS: Research Funding; CTI: Equity Ownership; Curis: Patents & Royalties; Cylene: Consultancy, Equity Ownership; D3 Oncology Solutions: Consultancy; Gilead Sciences: Consultancy, Other: travel, accommodations, expenses ; Lorus: Consultancy, Equity Ownership; MolecularMD: Consultancy, Equity Ownership, Patents & Royalties; Novartis: Research Funding; Oncotide Pharmaceuticals: Research Funding; Pfizer: Patents & Royalties; Roche: Consultancy. Lind:Janssen: Research Funding; Fluidigm: Honoraria.

DNA methylation analysis by bisulfite next-generation sequencing for early detection of oral squamous cell carcinoma and high-grade squamous intraepithelial lesion from oral brushing.

Oral squamous cell carcinoma (OSCC) is commonly preceded by oral potentially malignant lesions (OPML). The aim of the present study was to assess, by bisulfite next-generation sequencing (NGS), the methylation status of a list of candidate genes obtained from oral brushings to early detect OPML and OSCC. Oral brushing specimens from 11 OSCC, 11 high-grade squamous intraepithelial lesions (HG-SIL), 9 low-grade SIL (LG-SIL), 9 oral lichen planus (OLP), and 8 healthy donors were included in this study. We investigated, by means of bisulfite NGS, the promoter of GP1BB, ZAP70, KIF1A, p16[CDKN2A], CDH1, miR137, and miR375. Statistical significance between lesions and a pool of healthy donors were evaluated with the Mann-Whitney U test. ZAP70 was found to be hypermethylated in 100% of OSCC and HG-SIL and in 28.6% of LG-SIL. GP1BB hypomethylation was detected in 90.9% OSCC and HG-SIL and in 37.5% of LG-SIL. MiR137 was hypermethylated in 100% of OLP, 44.4% of OSCC, 40% HG-SIL, and 25% LG-SIL. KIF1A hypermethylation was found to be associated with TP53 mutations (p < 0.0001). In the present preliminary cohort of patients, DNA methylation analysis of GP1BB and ZAP70 seems to be a promising noninvasive tool for early detection of OSCC and HG SIL from oral brushing specimens.

Standardization of a bioassay for thyrotropin receptor stimulating autoantibodies.

Cell-based bioassays for functional thyroid stimulating autoantibodies (TSAb) are sensitive diagnostic tools. However, there is no bioassay available that is standardized with international reference material. We aimed to promote the standardization of the test results among laboratories that perform TSAb bioassays and calibrate TSAb levels against the second international standard (IS) 08/204 from the National Institute for Biological Standards and Control (NIBSC). Serum TSAb activity was measured with a FDA-cleared bioassay that utilizes CHO cells expressing a chimeric thyrotropin receptor (TSHR) and a c-AMP response-element-dependent luciferase. The IS was applied for calibration. TSAb results were reported as percentage of specimen-to-reference ratio (SRR%) and converted into mIU/L. The IS dose-response curve was obtained using concentrations from 0.3125 to 200 mIU/L. Mean TSAb SRR%±standard deviation (SD) values for the IS concentrations 0.3125, 0.625, 1.25, 2.5, 5, 10, 20, 40, 60, 80, 100, 120, 160, and 200 mIU/L were 63±4 (CV 6.3%), 63±4 (6.3), 67±2 (3.0), 76±6 (7.9), 91±8 (8), 134±8 (5.9), 201±13 (6.5), 294±12 (4.1), 336±10 (3.0), 348±8 (2.3), 360±14 (3.8), 371±15 (4.0), 381±9 (2.4), and 389±10 (2.6), respectively. A total of 127 dilution experiments were performed using 12 high TSAb-positive sera from patients with Graves' disease. When diluting TSAb-positive sera, IS concentrations within the linear range 5, 10, 20, 40, and 80 mIU/L were used for the calibration curve. All standard curves had R(2) values >0.95. Low coefficient of variation (CV %) values for the IS calibration curve (4-6%) were obtained. Compared to bovine TSH, no significant differences were noted using either a pool of healthy donors or a normal serum as reference controls. The average IU measured value for the assay cutoff (SRR 140%) corresponded to 9.54±1.68 mIU/L, and clinical application was shown in 60 Graves' patients. The TSAb bioassay demonstrated excellent performance in terms of linear range, limit of quantitation, and imprecision. The dilution experiments showed a high correlation coefficient and excellent reproducibility. Thus, TSAb levels can be reliably converted from SRR% to IU/L. These results offer the perspective of standardizing TSAb levels among laboratories and enable more accurate comparison of TSAb studies.

COMPARISON OF PLASMA Aβ ASSAYS AS PHARMACODYNAMIC READ-OUT FOR BACE1 INHIBITOR TREATMENT IN CANINES

Background:With the urgent need to find an optimal therapeutic approach in Alzheimer’s disease (AD), immunization studies have been continuously performed with limited success till date. Intravenous immunoglobulins (IVIgs), a mix of purified human plasma product collected from a large pool of healthy donors, have been used as an alternative agent for immunotherapy. Anti-amyloid properties of IVIgs against Ab have been tested in pilot studies showing cognitive improvements in mild-to-moderately affected AD patients. According to a recent study, IVIgs also contain antibodies to recombinant human tau. In-depth analyses of anti-amyloid antibodies present in IVIg preparations are of great importance in order to optimize their role as a disease modifying therapeutic agent. Herein, we studied the presence of tau oligomer-specific antibodies in IVIg preparations, which with further characterization may provide neuroprotection in AD and other tauopathies. Methods: We used three different commercially available IVIg preparations: Gammagard (Baxter), Gamunex (Talecris) and Privigen (CSL Behring), a well-characterized anti-tau oligomer specific antibody (T22), as well as commercial generic tau antibodies for elaborate biochemical analyses of recombinant full-length tau aggregates and oligomers. Additionally, IVIg Gamunex was used to immunoprecipitate recombinant tau oligomers. Results: Western blot analyses with IVIg products consistently revealed strong immunoreactivity against recombinant tau oligomers at different molecular weights, from 75 kDa to 250 kDa and above, which was confirmed with generic tau antibodies. Direct ELISA analysis of stable tau oligomers preparations with IVIgs also demonstrated the presence of antibodies against tau oligomers in these preparations. Additionally, we immunoprecipitated tau oligomers from a stable oligomeric preparation using Gamunex which was also reconfirmed by immunoblotting with T22 and generic tau antibodies. Conclusions: To our knowledge, this is the first study which identifies the presence of endogenous antibodies from IVIgs against multiple conformers of tau aggregates and neurotoxic tau oligomers. Furtherextensive study is necessary for complete characterization of these naturally occurring tau antibodies, as well as these immunoglobulin preparations, which together would provide a better understanding of their potential beneficial mechanisms for AD and other neurodegenerative diseases.

Adverse events and safety issues in blood donation—A comprehensive review

Although blood donation is generally safe, a variety of risks and complications exist, the most common being iron deficiency, vasovagal reactions and citrate-related events. In the last decades, extensive efforts have significantly improved recipient and product safety, but there is still great potential to optimise donor care. Many therapies in modern medicine depend on the prompt availability of blood products, therefore it is crucial to maintain a motivated and healthy donor pool in view of a limited number of healthy volunteers willing and able to give blood or blood components. We present a comprehensive review on adverse events addressing all types of blood donation including whole blood, plasma, platelet, peripheral blood stem cell, leucocyte and bone marrow donation. In addition, we outline strategies for the prevention and treatment of these events and give a blueprint for future research in this field.