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Distribution of blood derivatives by registered blood establishments that qualify as health care entities; Prescription Drug Marketing Act of 1987; Prescription Drug Amendments of 1992; delay of applicability date. Final rule; delay of applicability date.

The Food and Drug Administration (FDA) is further delaying, until December 1, 2008, the applicability date of a certain requirement of a final rule published in the Federal Register of December 3, 1999 (64 FR 67720) (the final rule). The final rule implements the Prescription Drug Marketing Act of 1987 (PDMA), as modified by the Prescription Drug Amendments of 1992 (PDA), and the Food and Drug Administration Modernization Act of 1997 (the Modernization Act). The provisions of the final rule became effective on December 4, 2000, except for certain provisions whose effective or applicability dates were delayed in five subsequent Federal Register notices, until December 1, 2006. The provision with the delayed applicability date would prohibit wholesale distribution of blood derivatives by registered blood establishments that meet the definition of a "health care entity." In the Federal Register of February 1, 2006 (71 FR 5200), FDA published a proposed rule specific to the distribution of blood derivatives by registered blood establishments that qualify as health care entities (the proposed rule). The proposed rule would amend certain limited provisions of the final rule to allow certain registered blood establishments that qualify as health care entities to distribute blood derivatives. In response to the proposed rule, FDA received substantive comments. As explained in the SUPPLEMENTARY INFORMATION section of this document, further delaying the applicability of Sec. 203.3(q) (21 CFR 203.3(q)) to the wholesale distribution of blood derivatives by health care entities is necessary to give the agency additional time to address comments on the proposed rule, consider whether regulatory changes are appropriate, and, if so, to initiate such changes.

Biological Products↗

Selective down-regulation of high-affinity IgE receptor (FcepsilonRI) alpha-chain messenger RNA among transcriptome in cord blood-derived versus adult peripheral blood-derived cultured human mast cells.

Substantial numbers of human mast cells (MCs) were generated from umbilical cord blood (CB) and from adult peripheral blood (PB). A single CB progenitor produced 15 436 MCs, whereas a single PB progenitor produced 807 MCs on average. However, PB-derived MCs were far more active than CB-derived MCs in terms of high-affinity IgE receptor (FcepsilonRI)-mediated reactions. One million sensitized PB-derived MCs released 3.6 microg histamine, 215 pg IL-5, and 14 ng granulocyte macrophage-colony-stimulating factor (GM-CSF), whereas 10(6) sensitized CB-derived MCs released only 0.8 microg histamine, 31 pg IL-5, and 0.58 ng GM-CSF on anti-IgE challenge. However, ionophore A23 187 released similar levels of histamine from the 2 MC types. PB-derived MCs highly expressed surface FcepsilonRI alpha chain, and CB-derived MCs almost lacked it in the absence of IgE. PB-derived MCs expressed approximately 5 times higher levels of messenger RNA (mRNA) for FcepsilonRI alpha chain than CB-derived MCs, but mRNAs for beta and gamma chains of the receptors were equally expressed. Among the approximately 5600 kinds of full-length human genes examined by using the high-density oligonucleotide probe-array system, FcepsilonRIalpha was ranked the fifth most increased transcript in PB-derived MCs. The 4 other increased transcripts were unrelated to MC function. These results suggest that IgE-mediated reactions may be restricted during early infancy through the selective inhibition of FcepsilonRIalpha transcription, which is probably committed at progenitor stages and is, at least in part, cytokine-insensitive.

Adult↗

Arterial blood derived low density lipoprotein increases platelet aggregation and macrophage cholesterol content in comparison to lipoprotein derived from veinous blood.

We studied the biochemical and biological properties of plasma lipoproteins taken from blood derived from either the aorta or femoral vein of patients with normal coronary arteriography. There were no significant differences in concentrations of cholesterol, triglycerides, apoprotein A-1 and apoprotein B derived from either source. The cholesterol content of very low density lipoprotein (VLDL) and high density lipoprotein (HDL) was similar in both aortic and venous blood. The low density lipoprotein (LDL) concentration, however, was significantly higher in the aortic blood sample. Arterial LDL significantly enhanced in vitro platelet aggregation when compared to venous LDL. (p less than 0.02). When incubated with mouse peritoneal macrophages (MPM) arterial LDL and VLDL caused an increased cholesterol accumulation and enhanced cholesterol esterification within these macrophages. The venous lipoproteins had little effect. The differences noted in the arterial lipoproteins in composition and biological function when compared to venous lipoproteins might be related to the much higher incidence of atherosclerosis found in the arterial tree.

Adult↗

Regulation of human basophil adhesion to endothelium under flow conditions: Different very late antigen 4 regulation on umbilical cord blood-derived and peripheral blood basophils.

BACKGROUND: Although soluble mediators released by basophils in tissue sites contribute to the chronic injury that occurs in hypersensitivity diseases, only limited information is available about how circulating basophils are recruited to tissues. In particular, the interaction of basophils with endothelium under conditions that mimic physiologic flow has not been explored. OBJECTIVE: We sought to identify adhesion molecules regulating the attachment of human basophils to IL-4-activated human umbilical vein endothelial cells (HUVECs) under flow conditions. METHODS: A parallel-plate flow chamber and blocking mAbs were used to define the adhesion molecules involved in the interactions of peripheral blood basophils (PBBs) and cord blood-derived basophils (CBDBs) with IL-4-activated HUVECs and with Chinese hamster ovary (CHO) cell transfectants expressing specific adhesion molecules. A fluorescent ligand specific for very late antigen 4 (VLA-4) was used to directly examine the VLA-4 affinity state of basophils. RESULTS: Flowing PBBs and CBDBs attached to activated HUVECs and to CHO cells expressing P- or E-selectin. However, only CBDBs attached to vascular cell adhesion molecule 1 (VCAM-1)-transfected CHO cells under flow conditions. The attachment of CBDBs to CHO cells was blocked by mAbs directed against E-selectin, P-selectin, and VCAM-1, whereas attachment of PBBs was blocked by E-selectin and P-selectin mAbs. Activating VLA-4 with Mn(2+) on PBBs resulted in adhesion to the VCAM-1-transfected CHO cells, indicating that VLA-4 activity on PBBs can be regulated, at least in part, through affinity changes. The Mn(2+)-induced upregulation of basophil VLA-4 affinity was demonstrated directly by using a fluorescent ligand for VLA-4 and flow cytometry. CONCLUSIONS: The interaction of human CBDBs and PBBs with endothelium under flow conditions is mediated in part by both P- and E-selectin. VLA-4 additionally contributes to the adhesion of flowing CBDBs. However, the affinity of VLA-4 is too low to support the adhesion under flow conditions of unstimulated PBBs.

Animals↗

Description of a closed plastic bag system for the collection and cryopreservation of leukapheresis-derived blood mononuclear leukocytes and CFUc from human donors.

Hemopoietic stem cells were collected from blood by means of continuous-flow centrifugation. The therapeutic use of large quantities of autologous blood stem cells requires a suitable, reliable and easily practicable cryopreservation technique which prevents loss of cell number and viability. This paper describes a closed plastic bag system consisting of one part for the collection and freezing of blood-derived mononuclear cells (MNC), among them granulocyte/macrophage progenitor cells (CFUc), and of a second part for thawing the cryopreserved cells and washing them free of DMSO before transfusion to a patient. In a series of 20 leukaphereses, the average number of collected MNC and CFUc was about 11 x 10(9) and 8 x 10(5) respectively. The recovery rate of the leukapheresis derived MNC and CFUc after cryopreservation, thawing, and washing was demonstrated to be 90 per cent of better. Sequential leukaphereses in the same donor showed little effect on red and white blood cell concentration. However, there was a significant decrease in the donor's blood platelet concentration prior to the third leukapheresis.

Adult↗

A comparison of prestorage WBC-reduced whole-blood-derived platelets and bedside-filtered whole-blood-derived platelets in autologous progenitor cell transplant.

BACKGROUND: Prestorage WBC-reduced platelet concentrates (PCs) can be manufactured from platelet-rich plasma (PRP) by in-line filtration of PRP. There are few published data on the clinical use of these products, as compared to bedside-filtered pools of standard PCs (S-PCs) manufactured from PRP. STUDY DESIGN AND METHODS: A prospective, randomized trial was conducted in autologous progenitor cell transplant patients requiring platelet transfusions with each patient as his or her own control who was given a pool of 5 units of WBC-reduced PCs and a pool of 6 units of S-PCs within a 3-hour period. The pools were characterized before transfusion for platelet and WBC content, P-selectin expression, and IL-8. The patients were monitored with platelet counts and vital signs and observed for reactions. Data were analyzed using Mann-Whitney U tests. RESULTS: Thirty-three transfusions were administered to 13 patients. Median platelet content in the WBC-reduced PC pools was lower than that in the S-PC pools (3.3 vs. 4.0 x 10(11), p<0.01). Median WBC content was 4 to 5 log less in the WBC-reduced PC pools (2.5 x 10(4) vs. 4.6 x 10(8), p<0.01). Median IL-8 levels (pg/mL) were lower in the WBC-reduced PC pools (2 vs. 36, p<0.01). No differences were observed in CCI, but the median absolute increase after transfusion of the S-PC pools was higher (25 vs. 19 x 10(9)/L, p<0.01), which reflected the larger size of the S-PC pools. No overall differences in vital signs were recorded. Two reactions were observed, both in temporal association with the transfusion of pools of S-PCs. CONCLUSIONS: A pool consisting of 5 units of WBC-reduced PCs gave a median platelet increment of 19 x 10(9) per L in these thrombocytopenic patients and has a median WBC content 1 to 2 log below the accepted threshold for primary alloimmunization or CMV transmission.

Blood Preservation↗

How similar are in vitro differentiated, cord blood derived eosinophils to peripheral blood eosinophils? A comparison of their peroxidase and eosinophil-derived neurotoxin contents and of their responses to various activators.

In this study we attempted to compare cord blood derived, in vitro differentiated eosinophils to peripheral blood eosinophils with respect to their capacity to respond to various activators and, therefore, their potential ability to contribute to an inflammatory response. The cells were compared with respect to their density, content of eosinophil peroxidase, and eosinophil-derived neurotoxin, and with respect to their responses to various activators. The in vitro cultured, cord blood derived eosinophils were distinctly lighter than the freshly isolated peripheral blood cells. This difference in cell density was reflected in a slightly reduced content of both eosinophil peroxidase (1.17 +/- 0.29 compared to 2.03 +/- 0.22 arbitrary units/2,000 cells) and eosinophil-derived neurotoxin (18.7 +/- 4.0 vs. 26.4 +/- 4.5 ng/10(4) cells). We compared the cells with respect to two different activation end points; the production of activated oxygen metabolites (superoxide anion) and the secretion of cationic proteins from their granules (eosinophil peroxidase and eosinophil-derived neurotoxin). In general, these responses were either the same in the two cell populations, or they were only slightly lower in the cord blood derived cells. There were, however, a few notable exceptions. Thus the secretory responses of the cultured cells to C5a and C3a anaphylatoxins and O2- production with the chemotactic peptide, formyl-methionyl-leucyl-phenylalanine, and with aggregated IgG were consistently greater than those of the normodense eosinophils. The possible implications of these differences on the state of maturation of the in vitro differentiated eosinophils are briefly discussed.

Cell Count↗

Anti-HIV activity of dideoxynucleosides, foscarnet and fusidic acid is potentiated by human leukocyte interferon in blood-derived macrophages.

Blood-derived macrophages were acutely infected with HIV and treated with a combination of leucocyte interferon (IFN) and five anti-HIV drugs. HIV growth was assayed by quantitation of p24 antigen in the supernatant and in some experiments by determination of reverse transcriptase activity. Both IFN and all drugs, with the exception of fusidic acid, inhibited HIV growth in a dose-dependent manner. IFN in combination with zidovudine, dideoxycytidine or fusidic acid exerted a synergistic effect on HIV titers, while IFN combined with dideoxyinosine or foscarnet had an additive effect.

Cells, Cultured↗

Preliminary in vitro growth cycle and transmission studies of HIV-1 in an autologous primary cell assay of blood-derived macrophages and peripheral blood mononuclear cells.

Recent interest focused on the dynamics of HIV-1 replication in primary monocytes/macrophages and T-lymphocytes of the immune system, as well as the standardization of virological and immunological in vitro assays with primary isolates, provided the impetus for these studies. These types of studies have never been performed as they would occur in vivo, i.e., where the envelope of the virus and cell membranes of the two cell types of the same host origin. Therefore, the biological and physicochemical properties of an uncloned, primary dual-tropic isolate HIV-1ADA during the initial lag, log, and stationary phases of viral replication were studied in an autologous donor cell assay in peripheral blood mononuclear cells (PBMC) and blood monocyte-derived macrophages (MDM). Similar total numbers (10(9) virus particles/ml) were produced by both cell types during the stationary period. On a per cell per day basis, during peak stationary periods, 0.92 x 10(3) virions/day for MDMs and 5.31 x 10(3) virions/day for PBMCs were produced. Interestingly, virus replicating from MDMs during the log-growth phase demonstrated the greatest infectious fraction which was 3 logs greater than virus replicating in PBMCs. Despite constant virus particle production in MDMs, the infectious fraction was found to fall 3 to 4 logs over a 10-day period. Due to an infectious fraction less than 1 (0.053 infectious unit/cell/24 hr), virus spread in PBMCs during the rapid log phase could only have occurred by cell-to-cell contact, whereas in MDMs with an infectious fraction of about one infectious particle (approximately 1/cell/24 hr), cell-free transmission could account for the observed results. Most of the MDMs (> 90%) became productively infected, whereas only 5-10% of the total PBMCs were found replicating virus. The period of peak stationary virus production (i.e., stationary phase) was at minimum 4 to 5 times longer in MDMs than PBMCs. Whereas the majority of p24, RT, and gp 120 found to be associated with MDM-derived virions, no increased dissociation of these components was observed in PBMC-derived virions. The virion-associated gp 120 was 3 to 4 times more stable on both PBMC- and MDM-derived virus (> 96 hr) and present at 10-25 times the concentration per virion than that observed for a T-cell-line-adapted laboratory strain of HIV-1 replicating in T-cell lines. These in vitro results suggest that important differences exist between MDMs and PBMCs with regard to the viral dynamics of infection and replication which should provide for a qualitative and quantitative basis to estimate virus replication on a per-cell basis for other known cellular targets of HIV-1. Studying the multiple biophysicochemical characteristics and viral replication dynamics as described herein provides an autologous in vitro model of additional quantifiable parameters for analysis and understanding of virus/host factor(s) and/or antivirals which influence them.

Cell Separation↗

The presence and absence of histocompatibility antigens in HIV type 1 produced by autologous blood-derived macrophages and peripheral blood lymphoblasts.

Acquisition of cellular proteins by HIV-1 virions is known to alter the physiology of the virus in vitro. Reported studies of this aspect have been largely limited to transformed T cell lines. In this study, we investigated the incorporation of major histocompatibility antigens (HLAs) on a primary macrophage-tropic isolate, HIV-1ADA, grown from autologous monocyte-derived macrophages (MDMs) and peripheral blood mononuclear cells (PBMCs). A virus precipitation assay (VPA) demonstrated that HIV-1ADA grown from PBMCs incorporated substantial amounts of HLA class I (alpha chain and beta2m) and DR antigens, comparable with a laboratory strain, HIV-1MN, grown from the same host cells. HIV-1ADA, however, grown from MDMs incorporated significantly lower amounts of HLAI and -II antigens despite the fact that the infected MDMs were found to express significant amounts of HLA antigens. The lack of incorporation of these important immunomodulatory cell surface proteins may be yet another unique characteristic of macrophage-tropic isolates and suggests a possible role in their biology and or immunology.

Chemical Precipitation↗

Blood-derived angioblasts accelerate blood-flow restoration in diabetic mice.

Endothelial cell progenitors, angioblasts, have been detected in the peripheral blood of adult humans, mice, and rabbits. These cells have been shown to incorporate into the endothelium of newly forming blood vessels in pathological and nonpathological conditions. Here we investigated the possibility that the CD34-expressing leukocytes (CD34(+) cells) that appear to be enriched for angioblasts could be used to accelerate the rate of blood-flow restoration in nondiabetic and diabetic mice undergoing neovascularization due to hindlimb ischemia. CD34(+) cells did not accelerate the restoration of flow in nondiabetic mice, but dramatically increased it in diabetic mice. Furthermore, CD34(+) cells derived from type 1 diabetics produced fewer differentiated endothelial cells in culture than did their type 2 diabetic- or nondiabetic-derived counterparts. In vitro experiments suggest that hyperglycemia per se does not alter the ability of angioblasts to differentiate or of angioblast-derived endothelial cells to proliferate. In contrast, hyperinsulinemia may enhance angioblast differentiation but impair angioblast-derived endothelial cell survival or proliferation. Our findings suggest that CD34(+) cells may be a useful tool for therapeutic angiogenesis in diabetics.

Adult↗

Human alveolar macrophage support of lymphocyte responses to mitogens and antigens. Analysis and comparison with autologous peripheral-blood-derived monocytes and macrophages.

Observations from animal studies and investigations using human peripheral-blood-derived macrophages may not be representative of human alveolar macrophage functions. Thus, we extensively examined and compared accessory cell functions of autologous human alveolar macrophages and peripheral-blood-derived monocytes and macrophages obtained from healthy, nonsmoking volunteer subjects. The alveolar and peripheral-blood-derived cells differed in ability to enhance mitogen- and antigen-stimulated transformation responses of purified autologous lymphocytes. Peripheral-blood-derived cells supported greater lymphocyte responses to optimal concentrations of several mitogens, but alveolar macrophages supported much greater responses to suboptimal concentrations of the mitogen phytohemagglutinin. Peripheral-blood-derived macrophages supported, but alveolar macrophages did not support, lymphocyte responses to streptococcal and influenza virus antigens. Such relative accessory cell functions of the different macrophages and monocytes were not due to different kinetics of response, nor were they due to differences in the proportion of macrophages required to support the lymphocyte responses. These data indicate that human alveolar macrophages have functional characteristics different from autologous peripheral-blood-derived monocytes and macrophages. Such differences may be important in both pulmonary immune homeostasis and in the pathogenesis of pulmonary disease.

Adult↗

Herpes simplex virus replication and protein synthesis in a human blood-derived cell line.

Herpes simplex virus (HSV) types 1 and 2 were shown to replicate in a newly described human cell line (Meg) derived from the peripheral blood of a healthy volunteer. The cell line has both megakaryocyte-like and B cell-like properties. Upon infection with HSV-1 or -2, at a m.o.i. between 0.5 and 5, unlike B and T cells, the Meg cells were growth-arrested and this was accompanied by cytopathic effects and virus replication. The HSV proteins and glycoproteins B and D (gB and gD) made in the blood-derived Meg cells were compared to the corresponding proteins made in the non-blood-derived cell lines, Vero (African green monkey kidney cell) and HEp-2 (human epidermoid carcinoma cell). The maximum level of HSV protein synthesis occurred earlier in the Meg cells than in the Vero and HEp-2 cells. The electrophoretic pattern of HSV-1 and -2 proteins made in the Meg cell line was similar to the corresponding proteins made in the Vero and HEp-2 cell lines; however, some qualitative and quantitative differences were evident. There were no apparent differences detected in the migration pattern of gB made in all three cell lines while significant differences were observed with the gD species. However, upon hydrolysis with Staphylococcus aureus V-8 protease of the monoclonal antibody-purified gB and gD, distinct differences were observed in the electrophoretic pattern of the generated peptide fragments of both gB and gD made in the three cell lines. The results demonstrate that a human blood cell can support HSV replication and that species-specific post-translational modification of gB and gD occurs in HSV-infected Vero cells as compared to HSV-infected human cells.

Animals↗

Predicting stroke using 4 ambulatory blood pressure monitoring-derived blood pressure indices: the Ohasama Study.

We investigated the association between stroke and blood pressure (BP) indices (systolic BP [SBP], diastolic BP [DBP], mean BP [MBP], and pulse pressure [PP]) determined by ambulatory BP monitoring. The predictive power for stroke of these indices was compared in the general Japanese population. We obtained ambulatory BP data in 1271 subjects (40% men) aged > or = 40 (mean: 61) years. During a mean follow-up of 11 years, 113 strokes were observed. The multivariate adjusted relative hazard and likelihood ratio for a 1-SD increase for each BP index was determined by Cox proportional hazard regression. Comparison of the likelihood ratio between Cox models including 2 indices and those including 1 index indicated that PP was significantly less informative than other indices (P<0.01 when adding MBP, SBP, or DBP to the PP model; P>0.09 when adding PP to the model including another index). However, after removing age from covariates, PP became more informative than DBP and MBP (P<0.0001 when adding PP to the MBP or DBP model, whereas SBP was more informative than PP even after removing age; P<0.05 when adding SBP to the PP model). In conclusion, PP was the weakest predictor of stroke. Exclusion of age from covariates increased the predictive power of PP, suggesting that the stroke risk associated with PP reflected the risk of aging per se.

Adult↗

Transplants of blood-derived hematopoietic cells.

Increasing numbers of transplants, particularly autotransplants, are performed using blood-derived cells. Most subjects have leukemia but others have solid tumors or even genetic disorders. Despite this expanding data base, several important issues are unresolved. Can blood-derived cells reconstitute short-term hematopoiesis? Here, the answer is likely yes, although this is not yet proven. Studies using genetically marked cells should resolve this issue. Next, can blood-derived cells reconstitute long-term hematopoiesis? Here, the answer is unknown, but it would not be surprising were this not so. However, since most (if not all) high-dose chemotherapy and radiation treatments do not completely eradicate endogenous hematopoietic stem cells, reconstitution of long-term hematopoiesis from the graft may not be necessary for blood-derived grafts to be useful clinically. Another unresolved area is whether blood-derived grafts have a lower likelihood of tumor recurrence because of a lower probability of tumor contamination (qualitative or quantitative) or because of a different cellular composition of the graft. This issue is only answerable in controlled trials. Most data suggest that recurrence rate would not be higher than bone marrow-derived grafts. Whether it is lower is unknown. Analysis of this point is confounded by the fact that most (perhaps all) relapses that occur post-transplant using current conditioning schedules are explicable by residual leukemia in the recipient. Thus, tumor contamination of the graft is not presently an operationally important issue. There are some recent developments in this area. One is the use of umbilical cord blood cells to reconstitute hematopoiesis in a child with Fanconi anemia. Additional data are needed to evaluate this approach.(ABSTRACT TRUNCATED AT 250 WORDS)

Blood Cells↗