CO2 alleviates platelet storage lesion via stimulating fatty acid metabolism and reducing platelet glucose consumption

Background The timely administration of platelet transfusions is critical for patient survival, and the clinical demand for platelet transfusions has been steadily increasing. However, platelet storage lesion (PSL) that develops during in vitro preservation exacerbate these shortages. The PSL is significantly influenced by various factors, including temperature, gas composition, and buffering systems. Strategies to mitigate PSL and improve platelet storage have been actively explored in recent years. Objectives This study aimed to investigate whether elevated carbon dioxide (CO 2 ) levels improve platelet quality and functionality during storage. Methods Platelet concentrates from 28 donors were stored under control or 3% CO 2 conditions at 22 ± 2°C for up to 7 days. Platelet quality was evaluated through scanning electron microscopy, adhesion, aggregation, clot contraction, activation, apoptosis assays, blood gas, ATP, metabolomics analyses, and in vivo thrombosis and survival tests. Results Our findings indicate that increasing the CO 2 concentration in the storage environment mitigates PSL and improves platelet quality. Conclusions Our study highlights the potential benefits of utilizing a high-CO 2 storage environment to improve platelet preservation, offering a promising method to address clinical platelet shortages.