Animal Models of Transfusion-Related Acute Lung Injury

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Currently, more than 50 years after its apparent early recognition in case reports, and more than 20 years after its name was coined to denote a distinct entity of pulmonary transfusion reactions, transfusion-related acute lung injury (TRALI) has emerged as a serious cause of transfusion-associated morbidity and the subject of an exponentially growing scientific literature. However, review articles, clinical case reports, and case series continue to dominate the published literature on the topic and experimental studies aimed at modeling and elucidating TRALI mechanisms are less frequent. This article reviews the current status of the known experimental models of TRALI, with particular emphasis on efforts to establish in vivo animal models of this important pulmonary transfusion reaction.

Section snippets

In Vitro TRALI Models

Until recently, published experimental approaches to model TRALI-mechanisms were exclusively in vitro or ex vivo studies, either based on defined cellular systems31, 32, 33 or relying on perfused explanted lungs from rats or rabbits.20,34, 35, 36 These models are described in more detail below.

In Vivo TRALI Models

The in vitro models described above mimic aspects of TRALI-like reactions in rodents but are limited compared with reproducible whole animal in vivo models. Until recently, however, no such model had been described in the peer-reviewed literature,37, 38 which perhaps is not surprising given the complexity of TRALI and the current uncertainty about its pathogenesis. Indeed, considerable investment in “trial and error”–based experimental approaches may be needed in order to tease out the

Conclusions

Whether TRALI is a distinct clinical entity or a subset syndrome of ARDS, TRALI has increased in clinical importance in recent years. Long unrecognized and existing as only scattered reports of noncardiogenic pulmonary edema after transfusions, TRALI remained largely underrecognized even after a case-series report brought it to clinicians' attention and led to coining its name 2 decades ago.30 As the threat of transfusion-transmitted viral diseases has been brought largely under control in the

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