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A metabolic switch to counteract oxidative stress in stored Red Blood Cells

In an elegant and extremely kind editorial appeared in Blood, Dr. John Hess - one of the fathers of modern transfusion medicine - comments on our recent paper on the role of glyceraldheyde 3-phosphate dehydrogenase as a relay switch between glycolysis and the pentose phosphate pathway to counteract the oxidative lesion in stored red blood cells. "The importance of the article by (Julie) Reisz and colleagues is the elegant demonstration of new “-omic” technologies brought to bear on the questions of RBC storage" Hess writes. "These technologies demonstrate atom-by-atom changes in proteins over the course of weeks of cold storage. The metabolomic findings may be the more important because they suggest that RBCs generally maintain their metabolism as well as decreasing pH allows despite the gradual oxidation of their proteins." While storage of red blood cells is a logistic necessity to make ~108 millions of units available for transfusion worldwide every year, refrigerated stoage in the blood bank results in the progressive impairment of red blood cell metabolism and morphology, potentially impacting the safety and efficacy of the transfusion practice. Even though current transfusion practices are overall safe and effective (and still remain the global most frequent medical procedure together with vaccination), "improving RBC storage generally can reduce the burden of effete RBCs and their toxic breakdown products for everyone, and lengthening safe storage can improve the logistics of RBC availability for units of uncommon phenotype and health care in isolated locations" Hess concludes.

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