Chemische und physikalische Verfahren zur Inaktivierung von pathogenen Mikroorganismen in allogenen Knochentransplantaten

Abstract

In allogeneic bone transplantation, the transmission of viral and non-viral infectious pathogens is the most severe undesirable concomitant phenomenon. The investigations published were examined regarding the inactivating capacity of inactivation procedures that are presently performed in bone banks (peracetic acid/ethanol, gamma irradiation, moist heat) against clinically relevant pathogens (aiming at a virus titer reduction of at least 4 log10 TCID50/ml or titer reduction of non-viral micro-organisms of at least 5 log10 cfu/ml). In the suspension experiments, treatment with peracetic acid/ethanol (peracetic acid 2%, ethanol 96%, aqua ad iniectabilia 2:1:1, 4 hours, 200 mbar, agitation) achieved a titer reduction of > 4 log10 already after 5 minutes for a number of viruses (PSR, PV, BVDV). HIV-2 was also inactivated within 5 minutes below the level of detection ( 4 log10 TCID50/ml was only reached after 4 hours. The results mentioned could be confirmed in the carrier test (contaminated spongiosa cuboids used as ‘worst case’ scenario). In the suspension experiment as well as in the carrier test, the HAV titer was reduced after 4 hours by only 3.7 log10 and 2.87 log10, respectively. The preceding step of defatting the spongiosa tissue by chloroform/ethanol was validated using cell-associated HAV and showed an HAV titer reduction of 7 log10. In the investigations regarding non-viral pathogens, all test organisms were completely inactivated by more than 5 log 10 steps (cfu/ml). Gamma irradiation was the second procedure examined. D10 values (irradiation dose required to reduce 90% of the pathogen titers by one log10 step) that were determined in inactivation kinetics experiments (irradiation conditions: –30°C, 60Co source) corresponded to data published so far. In order to provide for maximal safety, an irradiation dose of 34 kGy was recommended for allogeneic bone transplants using BPV and a diaphysis model from human femurs. The ‘Marburg bone bank system’ was the third procedure examined (thermal disinfection, guaranteed temperature of at least 82.5°C for a minimum of 15 min) using centrally contaminated human femoral heads. All viruses were completely inactivated and their titer reduced by more than 4 log10 steps. Vegetative bacteria and fungi were also completely inactivated (>= 6 log10 in the supernatant). As expected, spores and spore-forming pathogens were not sufficiently inactivated and not inactivated, respectively (titer reduction of less than 2 log10 cfu/ml). However, the latter group can be disregarded, since femoral heads are procured in the operation room under sterile conditions and the following production process rules out a secondary contamination with spores. It could be shown in the investigations presented that all three procedures examined guarantee an inactivation of the viruses investigated according to the recommendations by the senior federal authorities. The three treatment procedures offer additional biosafety by a comprehensive inactivation of non-viral pathogens.