Acid sphingomyelinase inhibition in stored erythrocytes reduces transfusion-associated lung inflammation

Richard S. Hoehn, Peter L. Jernigan, Lukasz Japtok, Alex L. Chang, Emily F. Midura, Charles C. Caldwell, Burkhard Kleuser, Alex B. Lentsch, Michael J. Edwards, Erich Gulbins, Timothy A. Pritts

Research output: Contribution to journalArticlepeer-review

29 Scopus citations


Objective: We aimed to identify the role of the enzyme acid sphingomyelinase in the aging of stored units of packed red blood cells (pRBCs) and subsequent lung inflammation after transfusion. Summary Background Data: Large volume pRBC transfusions are associated with multiple adverse clinical sequelae, including lung inflammation. Microparticles are formed in stored pRBCs over time and have been shown to contribute to lung inflammation after transfusion. Methods: Human and murine pRBCs were stored with or without amitriptyline, a functional inhibitor of acid sphingomyelinase, or obtained from acid sphingomyelinase-deficient mice, and lung inflammation was studied in mice receiving transfusions of pRBCs and microparticles isolated from these units. Results: Acid sphingomyelinase activity in pRBCs was associated with the formation of ceramide and the release of microparticles. Treatment of pRBCs with amitriptyline inhibited acid sphingomyelinase activity, ceramide accumulation, and microparticle production during pRBC storage. Transfusion of aged pRBCs or microparticles isolated from aged blood into mice caused lung inflammation. This was attenuated after transfusion of pRBCs treated with amitriptyline or from acid sphingomyelinase-deficient mice. Conclusions: Acid sphingomyelinase inhibition in stored pRBCs offers a novel mechanism for improving the quality of stored blood.

Original languageEnglish (US)
Pages (from-to)218-226
Number of pages9
JournalAnnals of surgery
Issue number1
StatePublished - 2017
Externally publishedYes

Bibliographical note

Funding Information:
This work was supported in part by grant R01 GM107625 from the National Institute of General Medical Sciences of the US National Institutes of Health and DFG grant GU 335/30-1.

Publisher Copyright:
Copyright © 2016 Wolters Kluwer Health, Inc.


  • Acid sphingomyelinase
  • Blood banking
  • Ceramide
  • Lung inflammation
  • Microparticle


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