WO2016048942A1

WO2016048942A1 - Systems and methods for enhancing platelet biogenesis and extending platelet lifespan, in circulation and storage

Info

Publication number: WO2016048942A1
Application number: PCT/US2015/051323
Authority: WO
Inventors: Mei X. WU; Qi Zhang
Original assignee: The General Hospital Corporation Dba Massachusetts General Hospital
Priority date: 2014-09-24
Filing date: 2015-09-22
Publication date: 2016-03-31

Abstract

The present disclosure is directed to systems and methods that can apply low level light (LLL) to platelets and/or platelet precursor cells. While not wishing to be bound by theory, it is believed that LLL can enhance the ATP synthesis by the mitochondria within the platelets and/or the platelet precursor cells to help enhance platelet biogenesis and extend the platelet lifespan. In some instances, LLL can facilitate in vitro and/or in vivo platelet biogenesis. In other instances, LLL can extend platelet lifespan in circulation. In still other instances, LLL can be employed to prolong the shelf-life of stored platelets.

Description

SYSTEMS AND METHODS FOR ENHANCING PLATELET BIOGENESIS AND EXTENDING PLATELET LIFESPAN, IN CIRCULATION AND STORAGE

Related Applications

[0001] This application claims the benefit of U.S. Provisional Application No. 62/054,602, filed September 24, 2014, entitled "SYSTEMS AND METHODS FOR ENHANCING PLATELET BIOGENESISAND EXTENDING PLATELET LIFESPAN, IN CIRCULATION AND IN STORAGE, WITH LOW LEVEL LIGHT," the entirety of which is hereby incorporated by reference for all purposes.

Technical Field

[0002] The present disclosure relates generally to platelet biogenesis and storage and, more specifically, to systems and methods that employ low level light (1 ) to enhance either in vivo or in vitro platelet biogenesis and/or (2) to extend platelet lifespan in either in vivo circulation or in vitro storage.

Background

[0003] Platelets are irregular, disc-shaped elements in the blood that assist in blood clotting. An abnormally low level of platelets in the blood is referred to as thrombocytopenia. For example, thrombocytopenia can occur after γ-irradiation exposure, after trauma, after platelet donation, as a side effect of cancer

chemotherapy or radiotherapy, or in patients with an inherent deficiency in thrombopoiesis. Patients with thrombocytopenia can exhibit an increased risk of hemorrhage and death due to uncontrollable bleeding. The only effective means to manage thrombocytopenia is platelet transfusion because, although there are several biological agents and drugs that are either FDA-approved (e.g., IL-1 1 ) or in clinical trials, the effects of these drugs are modest and cause side effects, particularly with high dosages.

[0004] With a rising number of cancer patients undergoing single or multiple cycles of chemotherapy, radiotherapy and/or surgery, the threat of nuclear or radiological terrorism, as well as unpredictable γ-irradiation accidents, such as the Fukushima Daiichi nuclear disaster in 201 1 , the need for platelet transfusions is fast growing and expected to continue. However, due to increasingly stringent regulations, national blood donation rates are dropping and the platelets that are donated have a relatively short shelf life (limited to only five days by the U.S. Food and Drug Administration (FDA)), so a large number of donated platelet units are discarded every year.

[0005] Platelet transfusions are expensive and frequently associated with complications, including transfusion-transmitted diseases, allergic reactions, graft- versus-host reactions, infections, and platelet refractoriness. Accordingly, platelet transfusion is relatively rare, often limited to patients in critical condition, because the benefits of these transfusions must always outweigh the potential risks to the patient. A safe, convenient, and cost-effective modality to augment platelet regeneration in vivo would greatly reduce the need of platelet transfusions and confer primary or secondary prophylaxis of thrombocytopenia.

Summary

[0006] The present disclosure relates generally to platelet biogenesis and storage. More specifically, the present disclosure relates to employing low level light (LLL) to facilitate platelet biogenesis, prolong platelet life in circulation and in storage. One aspect of the present disclosure is directed to employing LLL (e.g., alone or in combination with other drugs and/or biological agents) to facilitate both in vitro and in vivo platelet biogenesis. A further aspect of the present disclosure is directed to employing LLL (e.g., alone or in combination with other agents), to prolong the shelf-life of stored platelets and the lifespan of circulating platelets within a patient's blood. [0007] In one aspect, the present disclosure can include a device configured to apply LLL to platelets and/or platelet precursors (e.g., megakaryocytes). For example, the LLL can be used to facilitate platelet biogenesis, prolong platelet life in in vivo circulation, and/or in in vitro platelet storage. The device can include a controller, comprising a non-transitory memory and a processor, that can be configured to generate a control signal comprising a parameter for LLL application. The device can also include a LLL generator that can be configured to receive the control signal, generate the LLL based on the parameter, and apply the generated LLL to the platelets and/or platelet precursors. The parameter can be at least one of an on time, an off time, a light density, a power, a power density, and an output characteristic.

[0008] In another aspect, the present disclosure can include a system that can include a controller device and a LLL generator device. The controller device can include a non-transitory memory and a processor and be configured to generate a control signal comprising a parameter for the LLL application. The LLL generator device can be configured to receive the control signal, generate the LLL based on the parameter, and apply the generated LLL to platelets and/or platelet precursors. For example, the LLL generator device can include a monochromatic laser and/or a light emitting diode (LED) configured to generate the LLL comprising a wavelength from 600 nm to 1 100 nm. The parameter can include an on time, an off time, a light density, a power, a power density, and/or an output characteristic. In some instances, the LLL can be delivered continuously and/or in a pulsed mode of operation. In other instances, the LLL generator device can include one or more Gallium Arsenide (GaAs) super pulsed diodes that emit radiation for an extremely short duration (e.g., 100 to 300 nanoseconds) at a wavelength from 600 to 1 1 00 nm.

[0009] In a further aspect, the present disclosure can include a method that can be performed by a LLL generator device. The method can include receiving a control signal from a controller device that can include a parameter for the LLL application. The method can also include obtaining the parameter from the control signal and applying LLL to at least one of platelets and platelet precursors according to the parameter. The parameter can include an on time, an off time, a light density, a power, a power density, and/or an output characteristic. In some instances, the energy of LLL can be delivered in vivo, while in other instances, the energy of LLL can be delivered in vitro. In instances of in vivo operation, the method can include administering LLL non-invasively over an area of a patient's body that includes one or more platelet-making bones. Alternatively, LLL can be applied directly to the platelet-making bone marrow by an invasive technique, such as a laser probe catheter. In certain instances, a method of enhancing platelet biogenesis in a patient can include administering thrombopoietic agents in conjunction with LLL to increase the platelet quantity, such as interleukin 1 1 (IL-1 1 ), thrombopoietin (TPO), TPO peptide or non-peptide mimics. In some embodiments, a method of extending platelet storage can include adding platelet additive solution (PSA) configured to enhance platelet function during long-term storage. In some instances, a method of extending platelet storage can include using ultraviolet-A, ultraviolet-C, or blue light (405-495 nm) radiation in conjunction with LLL to reduce pathogen contamination during long-term storage.

Brief Description of the Drawings

[0010] The foregoing and other features of the present disclosure will become apparent to those skilled in the art to which the present disclosure relates upon reading the following description with reference to the accompanying drawings, in which:

[0011] FIG. 1 is a schematic diagram illustrating a mechanism by which low level light (LLL) can act on cells;

[0012] FIG. 2 is a schematic diagram showing a path of platelet generation;

[0013] FIG. 3 is a schematic block diagram of a system that can apply LLL to facilitate platelet biogenesis, according to an aspect of the present disclosure;

[0014] FIG. 4 is a process flow diagram illustrating a method for delivering LLL to facilitate platelet biogenesis that can be employed by the low level light (LLL) generator of FIG. 3;

[0015] FIG. 5 is an experimental result showing that LLL increases the ATP synthesis in murine thrombopoietic cells; [0016] FIG. 6 is an experimental result showing that LLL enhances HSC differentiation ex vivo, in particular, after stress;

[0017] FIG. 7 is an experimental result showing that LLL preferably promotes the differentiation of MKs to platelets;

[0018] FIG. 8 is an experimental result showing that LLL enhances protoplatelet formation (PPF) ex vivo;

[0019] FIG. 9 is an experimental result showing that LLL enhances platelet formation from LLL-treated MKs in vivo;

[0020] FIG. 10 is an experimental result showing that LLL improves platelet regeneration in mice after γ-irradiation;

[0021] FIG. 1 1 is an experimental result showing that LLL enhances platelet biogenesis in vivo in the presence of anti-CD41 antibody;

[0022] FIG. 12 is a schematic block diagram of a system that can apply LLL to enhance platelet storage, according to another aspect of the present disclosure;

[0023] FIG. 13 is a process flow diagram illustrating a method for delivering LLL to enhance platelet storage that can be employed by the LLL generating incubator of FIG. 14;

[0024] FIG. 14 is an experimental result showing that LLL increases ATP synthesis in fresh platelets;

[0025] FIG. 15 is an experimental result showing that LLL does not activate platelets;

[0026] FIG. 16 is an experimental result showing that LLL significantly sustains ATP synthesis during platelet storage;

[0027] FIG. 17 is an experimental result showing LLL significantly blunts the decrease in the pH value of stored platelets over time;

[0028] FIG. 18 is an experimental result showing that LLL significantly improves viability of stored platelets; [0029] FIG. 19 is an experimental result showing that LLL significantly sustains mitochondrial membrane potential of stored platelets;

[0030] FIG. 20 is an experimental result showing that LLL reduces the production of reactive oxygen species (ROS) during platelet storage.

Detailed Description

Definitions

[0031] In the context of the present disclosure, the singular forms "a," "an" and "the" can also include the plural forms, unless the context clearly indicates otherwise.

[0032] The terms "comprises" and/or "comprising," as used herein, can specify the presence of stated features, steps, operations, elements, and/or components, but do not preclude the presence or addition of one or more other features, steps, operations, elements, components, and/or groups.

[0033] As used herein, the term "and/or" can include any and all combinations of one or more of the associated listed items.

[0034] Additionally, although the terms "first," "second," etc. may be used herein to describe various elements, these elements should not be limited by these terms. These terms are only used to distinguish one element from another. Thus, a "first" element discussed below could also be termed a "second" element without departing from the teachings of the present disclosure. The sequence of operations (or acts/steps) is not limited to the order presented in the claims or figures unless specifically indicated otherwise.

[0035] As used herein, the term "low level light (LLL)" can refer to a procedure that involves exposing cells (e.g., stem cells, other types of platelet precursor cells, platelets, etc.), tissue and/or at least a portion of a patient's body (e.g., platelet- making bone) to low levels of red and near infrared (NIR) light at energy densities that are low compared to other forms of laser therapy (e.g., ablation, cutting, thermal coagulation, etc.). As used herein, the term LLLT ("low level light therapy") can be used interchangeably with LLL). [0036] As used herein, the term "platelet can refer to a blood cell that contains fragments of cytoplasm and no nucleus that contributes to homeostasis by contributing to the process of stopping bleeding (or clotting).

[0037] As used herein, the term "biogenesis" can refer to the synthesis of a biological substance. The term "platelet biogenesis" can refer to the synthesis of platelets, platelet precursors, etc.

[0038] As used herein, the terms "subject" and "patient" can refer to any warmblooded living organism including, but not limited to, a human being, a pig, a rat, a mouse, a dog, a cat, a goat, a sheep, a horse, a monkey, an ape, a rabbit, a cow, etc.

Low Level Light

[0039] Generally, low level light (LLL) can be applied (in one dose or in multiple doses) to cells (e.g., stem cells, megakaryocytes, other platelet precursor cells, platelets, etc.), tissue, and/or at least a portion of a patient's body at energy densities that are low compared to other forms of laser therapy (e.g., ablation, cutting, thermal coagulation, etc.). The present disclosure relates to the application of LLL to enhance both in vivo and in vitro platelet biogenesis and to extend platelet lifespan in both in vivo circulation and in vitro storage. LLL is a simple, non-invasive, safe, convenient, and cost-effective modality that has been clinically employed for decades for pain relief and other applications.

[0040] While not wishing to be bound by theory, it is believed that LLL can be employed to enhance both in vivo and in vitro platelet biogenesis and to extend platelet lifespan in both in vivo circulation and in vitro storage at least because LLL can enhance ATP synthesis within cells and/or platelets. It is believed that mitochondria are likely site for the initial effects of LLL. As shown schematically in FIG. 1 , the LLL can excite several protein complexes (e.g., I, III, and/or IV,) in the mitochondrial respiratory chain (MRC). Normally, the MRC can produce more than 90% of the ATP in the cell, but the level of ATP synthesis would be reduced in a cell under stress, so with LLL, the amount of ATP within the cell can increase. In some instances, the LLL can lead (additionally or alternatively to the increased of ATP synthesis) to enhanced oxidative phosphorylation, enhanced mitochondrial membrane potential, reduced oxidative stress, and anti-apoptosis.

Platelet Biogenesis

[0041] LLL can promote both in vivo and in vitro platelet biogenesis.

Additionally, LLL can also prolong the lifespan of the platelets already circulating in the blood. As shown in FIG. 2, platelets 12 can be formed from mature

megakaryocytes (MKs) 14 (large bone marrow cells), which can be produced from hematopoietic stem cells (HSCs) 1 6. Accordingly, platelets can be formed from MKs 14 in a patient's bone marrow and then enter the patient's blood for circulation through the patient's body. For example, to facilitate platelet biogenesis, LLL can act on the HSCs 16, the MKs 14, the platelets 12, and/or other progenitors.

[0042] In some instances, the LLL can be applied as a single dose. In other instances, the LLL can be applied in multiple doses. Moreover, in some instances, the LLL application can be non-invasive. In other instances, the LLL application can be invasive. For instance, LLL can be administered transcutaneously and/or subcutaneously, so that it is transmitted into bone marrow, via one or more optical fibers (biodegradable/non-biodegradable, flexible/rigid, etc.) and/or via a mesh formed over an area of marrow-containing bone. Regardless of the source or the output, the LLL energy at the bone marrow can be between 1 and 20 J/cm².

[0043] In some instances, the LLL can be applied in conjunction with the administration of one or more pharmaceutical treatments. Examples of

pharmaceutical treatments that can be administered with the LLL can include, but are not limited to: agents that can promote megakaryopoiesis (e.g., thrombopoietin and its derivatives, any activators or stimulators wa thrombopoietin receptor, IL-6, IL- 1 1 , etc.), agents or chemical compounds or diet supplements that can enhances mitochondrial activity or improve mitochondrial functions (e.g., CoQ, metabolic substrates like pyruvate, lactate, glucose, vitamin D, etc.), growth factors and their analogs or peptides that can enhance the generation of megakaryocytes or myeloid progenitors, like colony stimulating factor (CSF), GM-CSF, platelet-derived growth factor (PDGF), megakaryocyte growth and development factors (MGDF). Examples of clinically-available agents that can be used in connection with LLL include, but are not limited to: Nplate/Romiplostim (Amgen)-fusion protein analog of thrombopoeitin; Promacta/Eltrombopag (Ligand/GSK) for ITP, a small molecule agonist to the c-mpl (human TPO receptor), the target of thrombopoeitin; Neumega/Oprelvekin

(Wyeth/Pfizer)-recombinant interleukin-1 1 , avatrombopag (Eisai, liver disease associated, Phlll), and CpG free thrombopoeitin gene therapy (InvivoGen, preclinical).

[0044] As shown in FIG. 3, application of the LLL can be controlled by a system 40 that can include a LLL generator 42, a controller 44, and a power source 46. The power source 46 can be configured to supply an operating power to the controller 44 and/or the LLL generator 42. In some instances, the controller 44 and/or the LLL generator 42 can be electrically coupled to the power source 46. For example, the power source 46 can be a device that is configured to generate a power signal (e.g., including enough power to power up the controller 44 and/or the LLL generator), such as a battery power source, a line power source (e.g., a plug), or the like. In other instances, the power source can include at least two power sources (e.g., one to power the LLL generator 42 and one to power the controller 44).

[0045] The controller 44 can be configured to generate and transmit a control signal (e.g., including dosage parameters for LLL) to the LLL generator 42. The controller 44 can be a computing device (e.g., a general purpose computer, special purpose computer, and/or other programmable data processing apparatus) that can include or be otherwise associated with a non-transitory memory storing instructions (e.g., computer program instructions) that, upon execution by a processor, can create a mechanism for implementing the functions of the controller 44 (e.g., generating and transmitting the control signal to the LLL generator 42). For example, one or more of the dosage parameters can be pre-set within the controller 44. As another example, one or more of the dosage parameters can be input by a user via a user interface associated with the controller 44.

[0046] The controller 44 and the LLL generator 42 can be communicatively coupled (e.g., via a wired connection and/or a wireless connection) to facilitate the transmission of the control signal. An example of a method 70 that the LLL generator 42 can utilize to apply the LLL according to the control signal is shown in FIG. 4. At 72, the LLL generator 42 can receive the control signal from the controller 44. The control signal can include dosage parameters, including an on time, an off time, a light density, a power (e.g., between 1 mW and 1000 mW), a power density e.g., between 0.1 mW/cm² and 5 W/cm²), and an output characteristic (pulsed (frequency = 1 Hz - 500 Hz) or continuous).

[0047] In some instances, the desired power density can be selected from 0.1 mW/cm² to 50 mW/cm² to be directly delivered to platelet-making bones. In some instances, to deliver the desired power density into bone marrow cavities and blood vessels, a relatively higher surface power density of LLL may be required, depending on patient's skin pigmentation, the location of the target bone or vessel, and the depth of the bone or vessel relative to the skin surface. In some embodiments, super pulsed GaAs laser may be employed to generate super pulses of LLL with extremely short duration (100 to 300 nanoseconds), that can penetrate into tissue depths of 3 to 13 cm and deeper.

[0048] At 74, the LLL generator 42 can obtain the dosage parameters for the LLL from the control signal. At 76, the LLL generator 42 can deliver the LLL according to the dosage. In some instances, the dosage can include a desired power density (e.g., .selected from 0.1 mW/cm² to 50 mW/cm²) to be delivered to target cells (e.g., MKs inside the bone marrow cavities, circulating platelets in the blood vessels, and stored platelets in storage bags). To deliver the desired power density into bone marrow cavities and blood vessels, a relatively higher surface power density of LLL may be required, depending on patient's skin pigmentation, the location of the target bone or vessel, and the depth of the bone or vessel relative to the skin surface. In some instances, super pulsed GaAs lasers can be employed to generate super pulses of LLL with extremely short duration (100 to 300 nanoseconds), that can penetrate into tissue depths of 3 to 13 cm and deeper to illuminate platelet-making bones.

[0049] The LLL generator 42 can be configured to apply LLL to a patient's body (e.g., the whole body or a portion of the body) and/or to an in vitro preparation based on the control signal. In some instances, the LLL generator 42 can include a monochromatic laser that radiates light in the red or NI R wavelengths (λ = 600 nm - 1 100 nm). In other instances, the LLL generator 42 can include a light emitting diode (LED) that radiates light in the red or NIR wavelengths (λ = 600 nm - 1 100 nm). [0050] In some instances, the LLL generator 42 can be configured to apply the LLL to the patient's body according to the control signal. In some instances, the LLL can be applied to a portion of the patient's body (e.g., vertebrae, pelvis, ribs, sternum, femur, tibia, etc.). One example of the LLL generator 42 that can deliver the LLL to the portion of the patient's body is a LLL blanket. The LLL blanket can be wrapped around a portion of the patient's body to deliver the LLL according to the control signal. Another example of the LLL generator 42 is a LLL vest. The LLL vest can cover the patient's vertebrae, sternum, and ribs to deliver LLL according to the control signal. Yet another example of the LLL generator 42 is an LLL chair. A patient can sit on the LLL chair, which can deliver the LLL to the patient's vertebrae, pelvis, ribs and/or sternum according to the control signal. In another example, an LLL bed can be arranged similarly to a tanning bed to deliver LLL to at least a portion of the patient's body. In each example, the LLL can provide a safe and effective mechanism that can promote platelet regeneration and extend the life of circulating platelets in vivo. Accordingly, in one example, LLL can provide a primary or secondary prophylaxis that can increase the number of platelets in the blood of a patient with thrombocytopenia, potentially reducing the need for platelet transfusions.

[0051] In another example, the LLL generator 42 can be configured to apply the LLL to an in vitro preparation according to the control signal to facilitate the generation of platelets. Due to the increasing demand of platelet transfusions each year, platelet shortages are common due to both limited donors and the short (5-day) shelf life for the stored platelets. To alleviate these shortages, much effort has been put into the development of donor-independent platelet generation in vitro using newly developed stem cell technologies. However, these stem cell technologies often lead to growing-limited processes for in vitro platelet generation. For example, in vitro platelet generation from CD34⁺ stem cells is a relatively low rate of platelet production. However, LLL can significantly increase the rate of platelet production in vitro, either alone or in combination with other agents, enhancing the yield of platelet biogenesis from MKs or various stem cell technologies. In some instances, additional factors that facilitate platelet growth or mitochondrial activity, also can be added to the in vitro preparation to further promote the biogenesis of platelets in vitro. [0052] Platelets can be generated in vivo from various stem cells, including both natural occurring and synthesized stem cells. LLL can be applied alone and/or in combination with one or more agents to induce platelet biogenesis in vitro. In some instances, LLL can promote platelet production from umbilical cord stem cells (ESC), induced pluripotent stem cells (iPSC), or other types of induced stem cells that can differentiate into myeloid progenitors and/or platelets.

[0053] It has been shown experimentally that LLL can promote platelet biogenesis. The following experimental results are shown for the purpose of illustration only and are not intended to limit the scope of the appended claims.

[0054] As shown in FIG. 5, LLL increases the ATP synthesis in murine thrombopoietic cells. The graph 92 illustrates how LLL enhances ATP synthesis in these thrombopoietic cells. Megakaryocytes (MKs), hematopoietic stem cells (HSCs), and bone marrow (BM) cells were prepared from 8-week-old C57BL/6 mice, and exposed to 81 0-nm diode laser at a power density of 10 mW/cm² for 5 min at an energy density (also called fluence) of 3 J/cm². The LLL treatment increased ATP formation immediately in these cells, which peaked at 60 min before returning to a base level in 90 min after LLL. The chart 94 illustrates the effects of various fluences from 0.3 to 30 J/cm² on ATP synthesis at 30 min post-LLL in MKs. n=6, ^*P<0.05, ^***P<0.001 compared to non-LLL-treated controls.

[0055] As shown in FIG. 6, LLL enhances HSC differentiation ex vivo. Murine HSCs were prepared from 8-week-old C57BL/6 mice and treated with or without 3- Gy γ-irradiation (IR), followed by a single dose of 3 J/cm² LLL at 6 hr after γ- irradiation. The treated HSCs were cultured in methylcellulose-based media supplemented with optimal cytokines at 1 x10³ cells per 35 mm dish for 14 days. These HSCs produced heterogeneous populations of actively dividing hematopoietic progenitors, forming discrete colonies that can be enumerated and characterized as colony-forming units (CFUs). Compared with non-IR-treatment controls, IR severely reduced the number of Granulocyte-Erythrocyte-Monocyte-Megakaryocyte (CFU- GEMM, chart 96) and Granulocyte-Macrophage (CFU-GM, chart 96), as well as Burst-Forming Units of Erythroid (BFU-E, chart 100), in agreement with myeloid suppression by γ-irradiation. Strikingly, the colony-forming ability of radiated HSCs was significantly restored by LLL (charts 96, 98, 100), with little effect on the differentiation of non-IR-HSC controls. Moreover, when radiated HSCs were cultured in StemSpan expansion medium supplied with a cytokine cocktail that favored HSC differentiation into MKs and platelets, the number of MKs and platelets increased significantly in the presence as compared to the absence of LLL (charts 102, 104), although it did not fully restore thrombopoiesis of these cells. n=4, ^*P<0.05, ^**P<0.01 , ^***P<0.001 , compared to indicated groups, ns, not significant.

[0056] As shown in FIG. 7, LLL preferably promotes the differentiation of MKs to platelets. To further investigate the thrombopoietic effect of LLL, a single dose of 3 J/cm² LLL was given to ηοη-γ-irradiated (as shown in chart 106) and 3-Gy v- irradiated (as shown in chart 108) HSCs at 6 hr (DO), 6 days (D6), or 12 days (D12), respectively, after initial culture. In ηοη-γ-irradiated HSC cultures, LLL administered in 6 hr or day 6 after γ-irradiation showed no significant influence over control groups. Platelet counts were increased robustly only when LLL was administered in 12 days of culture (chart 106) and this was a time when a number of MKs reached the highest level in the culture of HSC differentiation. The observation suggests that direct illumination of MKs vigorously promotes platelet generation. Consistent with this, a highest level of platelet production was also seen when γ-irradiated HSC cultures were exposed to LLL on day 12 of the culture as compared to LLL exposure at any other time points. n=6, ^*P<0.05, ^**P<0.01 , ^***P<0.001 , compared to non- treated control groups, ns, not significant.

[0057] As shown in FIG. 8, LLL enhances proplatelet formation (PPF).

Production of platelets from MKs involves an elaborate process that converts the cytoplasm into branched intermediate structures called "proplatelets". Proplatelets are decorated with multiple swellings of a similar size to a platelet, on which the individual platelet develops (pictures 1 10, 1 1 2, 1 14, and 1 1 6). The complex of these branches and the length and number of swellings on each proplatelet determine the quantity of platelets produced from a single MK. To verify that direct illumination of MKs gave rise to the higher level of platelet production, murine MKs were sorted from control mice or γ-irradiated mice in 6 hr after 3-Gy γ-irradiation. The MKs that were exposed to a single dose of 3 J/cm² LLL were differentiated into platelets in medium supplied with 100 ng/ml thrombopoietin (TPO) for 24 hr. Control MKs formed branched proplatelets with abundant swellings on them, and the terminally mature MKs were ~100-μιη in diameter on average (picture 1 10). In contrast, 3-Gy γ-irradiation gave rise to much shorter branches with a fewer swellings on the proplatelets, and the terminally mature MKs were only a half of the normal size (picture 1 14). Remarkably, a single dose of 3 J/cm² LLL completely normalized proplatelet elongation and swelling, leading to a normal morphology (picture 1 1 6). In accordance to this, about 27% of control MKs formed PPF within 24 hrs, and 1 9% of these cells were mature MKs of 100-μιη in diameter. However, only 21 % radiated MKs could form PPF, among which only -6% were normal in size. A single dose of LLL in γ-irradiated MKs increased percentages of large, mature MKs from 6% to 16% (chart 1 18). LLL also significantly elevated a proportion of ηοη-γ-irradiated MKs with ~100-μιη in size (picture 1 12 and chart 1 18). n=6, ^*P<0.05, ^***P<0.001 compared to indicated group.

[0058] As shown in FIG. 9, LLL enhances in vivo platelet production by treatment of mature MKs. To confirm more efficient differentiation of MKs to platelets following LLL illumination, CD41 ⁺ MKs were sorted from donor mice, treated with a single dose of 3 J/cm² LLL, and then labeled with a vital fluorescent dye, carboxyfluorescein succinimidyl ester (CFSE). The labeled MKs were intravenously infused into recipient mice at 1 x10⁵ MKs per mouse. The infused MKs produced a higher level of platelets in recipients with LLL than without it. As shown in graph 120, the peak of platelet production from LLL-treated MKs was almost as twice as that of control counterparts. n=8, ^*P<0.05, ^**P<0.01 , ^***P<0.001 .

[0059] As shown in FIG. 10, LLL improves platelet regeneration in mice after γ- irradiation. C57BL/6 mice at 8-week-old were subjected to 3-Gy whole body γ- irradiation, followed by a whole body exposure to LLL at 6 hr post-Y-irradiation. Two LLL regimens were one exposure with a 808-nm light-emitting diode (LED) at a fluence of 10 J/cm² (I R+1 xLLL); and a total of 4 exposures performed once per day up to 4 days with 1 0 J/ cm² at each point (IR+4xLLL). Control groups included mice receiving 3-Gy γ-irradiation alone (I R) or 4xLLL alone (Sham + 4xLLL). Completed blood counts were checked weekly and compared with IR control mice. LLL increased platelet counts to a pre-Y-irradiation level or above as early as 2 weeks (graph 1 22, IR+4xLLL) after γ-irradiation, in contrast to a 6-week recovery period in radiated mice without LLL or with only one LLL illumination (n=6, ^**P<0.01 ,

*^**P<0.001 ) compared to IR group. In accordance to this, radiated mice that received 4 x LLL reduced a tail bleeding time to a normal level, significantly shorter than that in the absence of LLL (P<0.001 ) when examined 3 weeks post-Y-irradiation (graph 124). Notably, control mice treated with 4XLLL showed little effect on their platelet counts, underscoring a safety of the approach since there would be few concerns about thrombosis even after repeated LLL uses.

[0060] As shown in FIG. 1 1 , LLL enhances platelet biogenesis in vivo in the presence of anti-CD41 antibody. Immune thrombocytopenia (ITP) occurs frequently after repeated platelet transfusions, cancer patients receiving chemotherapy, and patients with autoimmunity against platelets. To mimic immune thrombocytopenia, mice were given anti-CD41 antibody every other day for a week at a dose of 68 μg/kg body weight. Anti-CD41 antibody can bind to platelets, megakaryocytes, and their precursors and triggers platelet depletion in 24 hr after injection. The mice receiving anti-CD41 antibody were illuminated with 1 0 J/cm² LLL daily for 4 days with an initial illumination at 4 hr after first anti-CD41 injection. The LLL-illuminated mice displayed a much less severe decline in platelet counts in the first 2 days as compared to non-LLL-treated controls. This was followed by accelerating platelet recovery starting at as early as day 3 after anti-CD41 antibody injection. As shown in graph 122, again, there was no effect of LLL on platelet counts in control mice. n=6, ^*P<0.05, ^**P<0.01 , ^***P<0.001 compared to mice receiving anti-CD41 antibody only.

Platelet Storage

[0061] In another aspect, LLL can be used to increase the shelf life of the stored platelets (e.g., applied before storage in an incubator and/or while stored in the incubator). Platelets require special storage conditions, and their storage time is limited due to storage-related mitochondrial injury (e.g., the U.S. Food and Drug Administration has set an expiration date of 5 days for stored platelets). While not wishing to be bound by theory, it is believed that because LLL can sustain mitochondrial functionality under a variety of stresses, LLL can preserve the quality of stored platelets over an extended period of time. For example, LLL can extend a shelf life of stored platelets beyond the FDA-mandated expiration date of 5 days (e.g., to 8 days or more). Increasing the shelf life of platelets can increase the availability of platelets and help to meet an increasing demand of platelet transfusion. Additionally, in some instances, LLL can increase the efficacy of platelet transfusions even with a reduced number of platelets in each transfusion.

[0062] As shown in FIG. 12, application of LLL can be controlled by a system 180 that can be included in incubator 182 with a LLL generator 1 84, a controller 188, and a power source 190. Although the LLL generator 184 is illustrated as being housed within the incubator 182, in some instances, the LLL generator 184 can be independent from the incubator 182. In both instances, the LLL generator 184 can be configured to deliver the LLL to the stored platelets.

[0063] The power source 190 can be configured to supply an operating power to the controller 188, the incubator 182, and/or the LLL generator 184. In some instances, the controller 188, the incubator 1 82, and/or the LLL generator 1 84 can be electrically coupled to the power source 190. For example, the power source 190 can be a device that is configured to generate a power signal (e.g., including enough power to power up the controller 188, the incubator 1 82, and/or the LLL generator 184), such as a battery power source, a line power source (e.g., a plug), or the like.

[0064] The controller 188 can be configured to generate and transmit a control signal (e.g., including parameters for LLL and/or incubation parameters) to the LLL generator 184 and/or the incubator 182. For example, upon execution by the processor, the instructions can create a mechanism for implementing the functions of the controller 188 (e.g., generating and transmitting the control signal to the LLL generator 184 and/or the incubator 182). For example, one or more of the parameters can be pre-set within the controller 188. As another example, one or more of the dosage parameters can be input by a user via a user interface associated with the controller 188. In some instances, the controller 188 can be a computing device (e.g., a general purpose computer, special purpose computer, and/or other programmable data processing apparatus) that can include a non- transitory memory that stores instructions (e.g., computer program instructions) and a processor that can be configured to execute the instructions.

[0065] The controller 188, the incubator 182, and/or the LLL generator 1 84 can be communicatively coupled (e.g., via a wired connection and/or a wireless connection) to facilitate the transmission of the control signal. An example of a method 1 50 that the LLL generator 184 can utilize to apply the LLL according to the control signal is shown in FIG. 13. At 152, the platelets can be stored in the incubator 182. At 154, the LLL generator 184 can receive the control signal from the controller 186. The control signal can include parameters for the LLL, including an on time, an off time, a light density, a power (e.g., between 1 mW and 1000 mW), a power density e.g., between 0.1 mW/cm² and 5 W/cm²), and an output characteristic (pulsed (frequency = 1 Hz - 500 Hz) or continuous). At 156, the LLL generator 1 84 can deliver the LLL to the platelets according to the parameters.

[0066] The LLL generator 184 can be configured to apply LLL to stored platelets based on the control signal. In some instances, the LLL generator 184 can include a monochromatic laser that radiates light in the red or NI R wavelengths (λ = 600 nm - 1 100 nm). In other instances, the LLL generator 184 can include a light emitting diode (LED) that radiates light in the red or NIR wavelengths (λ = 600 nm - 1 100 nm).

[0067] In some instances, the LLL generator 184 can be integrated into the current platelet storages mechanisms. For example, the LLL generator 184 (e.g., a LED array) can be integrated into a flatbed to deliver the LLL to stored platelets. In some instances, the flatbed can be integrated within an incubator 182 to apply the LLL to the stored platelets throughout their storage period.

[0068] It has been shown experimentally that LLL can enhance platelet storage. In brief, the following data clearly suggest that LLL can sustain mitochondrial function during platelet storage, leading to far smaller reductions in ATP production, pH value, and mitochondrial membrane potential in stored platelets (as compared to non-LLL-treated control platelets stored under similar conditions). These much improved conditions of stored platelets concurred with increasing platelet counts and diminished ROS production. The following experimental results are shown for the purpose of illustration only and are not intended to limit the scope of the appended claims. [0069] As shown in FIG. 14, LLL increases ATP synthesis in fresh platelets. Platelet-rich plasma (PRP) were prepared from 8-week-old C57BL/6 mice, and illuminated with an 808-nm LED at 1 0 mW/cm². As shown in chart 1 58, ATP synthesis in platelets was enhanced significantly by LLL at energy densities from 0.5 J/cm² to 1 0 J/cm². n=6, *p<0.05, **p<0.01 , ***p<0.001 , ns, not significant.

[0070] As shown in FIG. 1 5, LLL does not activate platelets. Platelet storage is often associated with platelet activation that reduces efficacy of transfusion and should be avoided. To corroborate that LLL doesn't activate platelets, PRP illuminated by various doses of LLL (diagrams 1 62, 1 64, 1 66) and non-treated control (diagram 1 60) were stained with platelet marker CD41 and activation biomarker CD62p. LLL at energy densities from 0.5 J/cm² to 4 J/cm² did not affect platelet activation (p>0.05).

[0071 ] As shown in FIG. 1 6, LLL significantly sustains ATP synthesis during platelet storage. Platelet storage-associated mitochondrial injury reduces ATP production over time during storage. To determine whether LLL could sustain mitochondrial function during storage, murine PRP was prepared from 8-week-old C57BL/6 mice and stored for 8 days in a standard condition (22 °C with constant flatbed agitation at 70 cycles per minute). LLL was administered only once at 1 hr after PRP collection at an energy density of 0.5, 2 or 4 J/cm². ATP levels were determined every other day during storage. As shown in graph 1 68, ATP levels in PRP treated with LLL at 0.5, 2 or 4 J/cm² were significantly higher than control at all times tested. Importantly, the ATP level in 8-day-stored platelets treated with 0.5 J/cm² LLL was similar to that measured in 5-day stored platelets. The latter is a standard time of current platelet storage and the result clearly suggests a great potential to extend a platelet storage time to 8 days from 5 days. n=6, ***p<0.001 , compared to non-treated control.

[0072] As shown in FIG. 1 7, LLL significantly blunts a decrease in pH value in stored platelets (e.g., murine PRP). Murine PRP was prepared and treated with LLL similarly to the data shown in FIG. 20. pH values of each sample were determined every other day during storage. As shown in graph 1 70, LLL significantly retains pH values over controls during the 8 days of platelet storage. On day 8 of storage, platelets treated with LLL at all energy densities tested had a pH value as same as that in non-treated PRP stored for 5 days under similar conditions. n=6, ^***p<0.001 , compared to non-treated control.

[0073] As shown in FIG. 18, LLL significantly improves the viability of stored platelets. Murine PRP was prepared and treated with LLL similarly to the data shown in FIG. 20. Consistent with great improvement of energy metabolism, graph 172 illustrates that platelet counts were significantly higher with LLL treatment at 0.5 or 2 J/cm² than non-treated control at all time points. Once again, platelet counts on day 8 of the storage with 0.5 or 2 J/cm² LLL were similar as those platelets stored for 5 days in the absence of LLL. LLL at 4 J/cm² appeared to have relatively less effect on platelet viability as compared to 0.5 or 2 J/cm², in 8-day-storage. n=6,

*^**p<0.001 , compared to non-treated control.

[0074] As shown in FIG. 19, LLL significantly sustains mitochondrial membrane potential of stored platelets. Murine PRP was prepared d from 8-week-old C57BL/6 mice and stored as above. A single dose of 0.5 J/cm² LLL was administered at 1 hr after PRP collection. Changes of mitochondrial membrane potential were

determined by fluorochrome dye JC1 in platelets stored for 5 days. As shown in graph 174 and chart 176, compared to fresh platelets (Fresh), stored platelets showed a dramatic decline of mitochondrial membrane potential (stored), which was the major adverse event occurring during platelet storage. However, LLL

significantly retained mitochondrial membrane potential of stored platelets

(Stored+LLL). n=6, ^*p<0.05, ^**p<0.01 , ^***p<0.001 .

[0075] As shown in FIG. 20, LLL reduces the production of reactive oxygen species (ROS) during platelet storage. Increased ROS production secondarily to mitochondrial injury can damage platelets and mitochondria, reducing the viability of stored platelets. To determine the effect of LLL on ROS production during platelet storage, murine PRP was stored similarly to the data shown in FIG. 20. ROS levels were determined by cell-permeant fluorescent dye, 2',7'-dichlorodihydrofluorescein diacetate (H2DCFDA) (also known as dichlorofluores cin diacetate or DCF) in platelets stored for 5 days. As shown in graph 174 and chart 1 76, a significant reduction of ROS formation was found in platelets treated with a single dose of 0.5 J/cm² LLL before storage. n=6, ^**p<0.01 , ^***p<0.001 . [0076] From the above description, those skilled in the art will perceive improvements, changes and modifications. Such improvements, changes and modifications are within the skill of one in the art and are intended to be covered by the appended claims.

Claims

What is claimed is:

Claim 1. A device configured to apply low level light (LLL) to at least one of platelets and platelet precursors, comprising:

a controller, comprising a non-transitory memory and a processor, configured to generate a control signal comprising a parameter for the LLL application; and a LLL generator configured to receive the control signal, generate the LLL based on the parameter, and apply the generated LLL to the at least one of platelets and platelet precursors,

wherein the parameter comprises at least one of an on time, an off time, a light density, a power, a power density, and an output characteristic.

Claim 2. The device of claim 1 , wherein the LLL generator comprises at least one of a monochromatic laser and a light emitting diode (LED) configured to generate the LLL comprising a wavelength from 600 nm to 1 100 nm.

Claim 3. The device of claim 1 , wherein the parameter comprises a power comprising a value from 1 mW to 1000 mW.

Claim 4. The device of claim 1 , wherein the parameter comprises a power density comprising a value from 0.1 mW/cm² to 5 W/cm².

Claim 5. The device of claim 1 , wherein the parameter comprises an output characteristic comprising at least one of a pulsed output comprising a frequency from 1 Hz to 500 Hz and an a continuous output.

Claim 6. The device of claim 1 , wherein the device is embodied as an incubator configured to house stored platelets.

Claim 7. The device of claim 1 , further comprising a power source configured to supply power to at least one of the controller and the LLL generator.

Claim 8. The device of claim 1 , wherein the device is embodied as a laser probe catheter configured to deliver the LLL directly to a platelet-making bone.

Claim 9. A system, comprising:

a controller device, comprising a non-transitory memory and a processor, configured to generate a control signal comprising a parameter for a LLL application; and

a LLL generator device configured to receive the control signal, generate the LLL based on the parameter, and apply the generated LLL to at least one of platelets and platelet precursors and comprising at least one of a monochromatic laser and a light emitting diode (LED) configured to generate the LLL comprising a wavelength from 600 nm to 1 100 nm,

Claim 10. The system of claim 9, wherein the LLL generator device is configured to apply the LLL to at least a portion of a patient's body.

Claim 11. The system of claim 9, wherein the LLL generator device is configured to apply the LLL to stored platelets.

Claim 12. The system of claim 1 1 , further comprising an incubator device configured to house the stored platelets.

Claim 13. The system of claim 12, wherein the incubator device comprises the LLL generator device.

Claim 14. The system of claim 9, wherein the controller is coupled to a power source configured to supply power to at least one of the controller and the LLL generator.

Claim 15. The system of claim 9, wherein the LLL generator device is coupled to a laser probe catheter to deliver the LLL directly to a platelet-making bone.

Claim 16. A method, comprising:

receiving, at a low level light (LLL) generator device, a control signal from a controller device, wherein the control signal comprises a parameter for a LLL application;

obtaining, by the LLL generator device, the parameter from the control signal; and

applying, by the LLL generator device, LLL to at least one of platelets and platelet precursors according to the parameter,

Claim 17. The method of claim 16, wherein the LLL generator device is coupled to a laser probe catheter to deliver the LLL directly to a platelet-making bone.

Claim 18. The method of claim 17, wherein the applying further comprises administering a thrombopoietic agent in conjunction with the LLL to increase a quantity of platelets produced.

Claim 19. The method of claim 16, wherein the LLL generator device further comprises an incubator device configured to house stored platelets, and

wherein the applying further comprises applying platelet additive solution (PSA) in combination with the LLL to the stored platelets.

Claim 20. The method of claim 16, wherein the LLL generator device further comprises an incubator device configured to house stored platelets, and

wherein the applying further comprises applying ultraviolet-A or -C radiation in conjunction with LLL to the stored platelets.