Transfusion-related acute lung injury: experimental models to study pathogenesis and therapeutic strategies

Transfusion-related acute lung injury (TRALI) is a life-threatening complication of blood transfusion, with mortality rates exceeding 40% in critically ill patients. Despite its clinical severity, TRALI pathogenesis remains unclear, leaving clinicians struggling to fully understand and manage it due to its unpredictable onset, complex causes, and lack of available treatments. Recent advances in experimental models, including in vitro, ex vivo, and in vivo models, have revealed novel mechanisms such as neutrophil extracellular trap formation, gut-microbiota crosstalk, and endothelial and neutrophil-derived reactive oxygen species, as well as some preclinical therapeutic advancements. This review synthesizes mechanistic insights from experimental models, critically evaluates their translational applicability, and proposes a roadmap for personalized prevention strategies, including biomarker-driven transfusion protocols.