Association of HLA-DRB1 and DQB1 alleles with red blood cell alloimmunization in Chinese

Few systematic investigations have assessed the correlations between red blood cell (RBC) antibodies and human leukocyte antigen (HLA)-DRB1 alleles in the Chinese population. In this case-control study, we investigated whether specific HLA-DRB1 alleles were associated with RBC alloimmunization by calculating the odds ratios for the frequencies of HLA alleles associated with alloimmunization to different RBC antigens. Three hundred and eight patients harboring RBC alloantibodies were analyzed as the case group, and the frequencies of the HLA-DRB1and HLA-DQB1 alleles in control individuals were analyzed by collecting data from the China Marrow Donor Program (including more than 1.6 million healthy people). HLA alleles were genotyped by single specific primer-polymerase chain reaction. The development of anti-C was associated with DRB1*07, DQB1*06, and DQB1*08; anti-C,e was associated with DRB1*07 and DQB1*06; and anti-E and anti-M were associated with DQB1. Other associations were identified between anti-E and DRB1*09 and between anti-Le^a and DRB1*01. Thus, our findings confirmed that HLA-DRB1 and DQB1 restriction played an important role in the generation of RBC alloantibodies in Chinese individuals.     

Prevalence and specificity of some rare red cell pan-reactive alloantibodies against high frequency red cell antigens among hospitalized Saudi patients

Some patients'' sera react with all available donors'' red cells and a compatible donor is difficult or impossible to be found. These may either be due to a complex mixture of antibodies or the presence of alloantibodies against high-frequency antigens (HFAs). The aim of this study is to identify the prevalence and characteristics of antibodies to HFAs in Saudi Arabian patients. A total of 23 out of 172 000 patients who received blood transfusions had rare alloantibodies to HFAs at an incidence of 0.013%. Twenty-three patients suspected with pan-reactive alloantibodies against HFAs had their red cells tested using antisera to HFAs, while their plasma was tested against a selected panel of red blood cells with rare phenotypes. Anti-Ge2 antibody was found in the highest number of patients (56.5%), whereas anti-U, anti JK3, anti H, anti-RH 29, anti-hr^s, anti-Kn^a, anti-Ch, anti-Rg, anti-Yt^a, and anti-Cr^a antibodies were found in the remaining patients (43.5%). This study suggests that although antibodies such as anti-Ge2, anti- Kn^a, anti-Ch, anti-Rg, anti-Yt^a , and anti-Cr^a are not clinically significant, they cause a delay in the provision of compatible blood. Whereas, anti-U, anti JK3, anti H, anti-RH29 and anti-hr^s are clinically significant antibodies. An understanding of antibody characteristics to HFAs and the widespread use of the extended red cell phenotype and antibody identification panel will both be helpful for the diagnosis of these HFAs.     

Bovine monoclonal alloantibodies to blood group antigens prepared by murine x bovine or (murine x bovine) x bovine interspecies fusions.

In order to obtain monoclonal alloantibodies against bovine blood group antigens, lymph node cells from calves immunized with bovine red blood cells (RBC) were fused with either murine NSO/1 myeloma cells or a HAT sensitive murine x bovine heterohybridoma cell line. Both fusion partners resulted in heterohybridoma cell lines, producing monoclonal alloantibodies against bovine red blood cell antigens. Several clones produced antibodies against identical antigens and some of these clones have been further analysed. The antibodies produced by these selected cell lines have been compared with conventional polyclonal antisera used in bovine blood typing service. Thus extensive tests--including the ISAG Comparison Tests 1989/90 and 1991/92--have proved that monoclonal alloantibodies specific for the internationally recognized bovine red cell antigens A2, I1, O1, Q, A', B', Q', C1, R1, X1, S and Z have been produced. The Q, A', B', and C1 antibodies react weakly with certain phenogroups, whereas the A2, I1, O1, Q', R1, X1, S and Z antibodies have proved to be excellent blood typing reagents and have now substituted the polyclonal antisera in routine bovine blood typing in our laboratory.     

Frequency of unexpected red blood cell antibodies in Nanjing

The development of unexpected red blood cell antibodies can significantly complicate transfusion therapy and result in more difficulties in cross-matching of blood. This study aimed to determine the occurrence rate of red blood cell alloimmunization in patients from Nanjing and the surrounding area. The antibody screening tests were carried out on 604 patients in Nanjing Red Cross Blood Center from January 2014 to December 2016, and the results were compiled and statistically analyzed. In the 604 patients, 483 cases revealed autoantibodies with or without underlying alloantibodies, while 121 patients had only alloantibodies in their serum. The overall frequency of alloimmunization was 32.5%. The most frequent antibodies were what against the Rh systerm(72.39%), followed by MN system (25.71%).     

Incidence of unexpected red blood cell antibodies in the north of China

This study aimed to investigate the frequency of unexpected antibodies and evaluate the cumulative incidence of additional unexpected antibodies in Beijing. From January 1, 2011 to December 31, 2014, blood samples from 2,095 patients from 98 medical institutes in Beijing were sent to the Beijing Red Cross Blood Center for antibody identification. Of the unexpected antibodies, 29.5% were autoantibodies and 70.5% were alloantibodies. Anti-E was the most prevalent form of allo-antibodies (n = 445), accounting for 52.9% of the Rh system, followed by anti-M (76.6% of the MNS system) and then 142 cases of anti-C,e, 128 cases of anti-E,c, and 113 cases of anti-Lea. The cumulative incidences of additional antibodies were 0.55% (after the first transfusion), 1.82% (second time), 2.33% (fourth time), 3.07% (firth time), and 4.24% (seventh time). Antibody against the Rh system was the most prevalent, followed by antibodies against MNS, Lewis, Kidd, P1, and Duffy.     

Antigens Protected Functional Red Blood Cells By The Membrane Grafting Of Compact Hyperbranched Polyglycerols

Red blood cell (RBC) transfusion is vital for the treatment of a number of acute and chronic medical problems such as thalassemia major and sickle cell anemia ^1-3. Due to the presence of multitude of antigens on the RBC surface (~308 known antigens ⁴), patients in the chronic blood transfusion therapy develop alloantibodies due to the miss match of minor antigens on transfused RBCs ^{4, 5}. Grafting of hydrophilic polymers such as polyethylene glycol (PEG) and hyperbranched polyglycerol (HPG) forms an exclusion layer on RBC membrane that prevents the interaction of antibodies with surface antigens without affecting the passage of small molecules such as oxygen ,glucose, and ions³. At present no method is available for the generation of universal red blood donor cells in part because of the daunting challenge presented by the presence of large number of antigens (protein and carbohydrate based) on the RBC surface and the development of such methods will significantly improve transfusion safety, and dramatically improve the availability and use of RBCs. In this report, the experiments that are used to develop antigen protected functional RBCs by the membrane grafting of HPG and their characterization are presented. HPGs are highly biocompatible compact polymers ^{6, 7}, and are expected to be located within the cell glycocalyx that surrounds the lipid membrane ^{8, 9} and mask RBC surface antigens^{10, 11}.     

Serological and molecular analysis of anti-Tja: Case report

P antigen frequency is very low in the Chinese population. However, the presence of anti-P1PP^k (anti-Tja) is a huge risk for patients undergoing clinical transfusions and recurrent abortions. This report aims to describe p antigen and anti-Tja serological test features and suggests ways in which we may better identify the p antigen. Polymerase chain reaction was used to amplify A4GALT and B3GALNT1, which were then analysed for polymorphisms using Sanger sequencing. The A4GALT sequence results revealed c. 547-548delAT (HE818933), which resulted in a frame shift at aa 183 stopping at aa 281 (M183fs, 281X). Compared with the reference sequence, B3GALNT1 did not show any variations in any of the subjects assessed. Eggs from Columba livia were used in the neutralised P substance test, but failed to neutralise anti-Tja. The serological test and molecular analysis confirmed that the P blood antigens are caused by A4GALTc. 547-548 AT deletion, and the neutralised P substance test cannot identify anti-PP1Pk from RBC alloantibodies against high frequency antigens.     

Blood typing in Saimiri sciureus monkeys: influence of anti-red blood cell alloantibodies on Plasmodium falciparum parasitaemia in vivo

The Saimiri sciureus monkey is a well-established host for experimental studies with human malaria parasites. During the course of iterative inoculations with Plasmodium falciparum parasitised red blood cells (RBC), anti-RBC alloantibodies were detected in the sera of two of eight Saimiri monkeys. These anti-RBC antibodies were further used to investigate RBC phenotypes in 35 colony-reared Saimiri monkeys by flow cytometry. Three RBC phenotypes (named I-III) were observed. Their distribution was I (86%), II (11%) and III (3%). Using the Palo Alto FUP-2 strain, a variant P. falciparum line insensitive to hyperimmune serum and the passive transfer of anti-RBC alloantibodies, a dramatic drop in parasite growth was documented in an incompatible monkey.     

Study of equivalents of rhesus antigens in non-human primates]

Human alloantibodies specific of some Rh antigens cross-react with non human primates red blood cells. These crossreactions demonstrated that only African apes express equivalents of Rho (D) and hr' (c). The antigenic resemblance between these two human antigens and their primate homologues is confirmed by the reactivities of human anti-D and anti-c monoclonal antibodies. The use of a human Rh cDNA probe allowed to confirm by Southern blot hybridization that nonhuman primates possess Rh-like genes. The number of Rh-like genes per haploid genome was deduced from the results obtained with exon-specific probes.     

Further studies on non-H-2 histocompatibility alloantibodies in the mouse

Immunofluorescence tests indicate that alloantibodies specific for mouse histocompatibility antigens H-1^a, H-3^a, and H-13^a have been produced, using four different immunizations. Furthermore, an immunization employing donors and recipients which were H-2^k at the MHC produced stronger anti-H-3^a and anti-H-13^a than did immunizations where donors and recipients were H-2^b at the MHC.     

Synthesis of sialyl Lewis<Superscript>a</Superscript> (sLe<Superscript>a</Superscript>, CA19-9) and construction of an immunogenic sLe<Superscript>a</Superscript> vaccine

Sialyl Lewis^a (sLe^a), also termed CA19-9 antigen, is recognized by murine mAb19-9 and is expressed on the cancer cell surface as a glycolipid and as an O-linked glycoprotein. It is highly expressed in a variety of gastrointestinal epithelial malignancies including colon cancer and pancreatic cancer, and in breast cancer and small cell lung cancer, but has a limited expression on normal tissues. sLe^a is known to be the ligand for endothelial cell selectins suggesting a role for sLe^a in cancer metastases and adhesion. For these reasons, sLe^a may be a good target for antibody mediated immunotherapy including monoclonal antibodies and tumor vaccines. However, sLe^a is structurally similar to sLe^x and other blood group related carbohydrates which are widely expressed on polymorphonucleocytes and other circulating cells, raising concern that immunization against sLe^a will induce antibodies reactive with these more widely expressed autoantigens. We have shown previously both in mice and in patients that conjugation of a variety of carbohydrate cancer antigen to keyhole limpet hemocyanin (KLH) and administration of this conjugate mixed with saponin adjuvants QS-21 or GPI-0100 are the most effective methods for induction of antibodies against these cancer antigens. We describe here for the first time the total synthesis of pentenyl glycoside of sLe^a hexasaccharide and its conjugation to KLH to construct a sLe^a-KLH conjugate. Groups of five mice were vaccinated subcutaneously four times over 6 weeks. Sera were tested against sLe^a-HSA by ELISA and against sLe^a positive human cell lines adenocarcinoma SW626 and small cell lung cancer (SCLC) DMS79 by FACS. As expected, mice immunized with unconjugated sLe^a plus GPI-0100 or unconjugated sLe^a mixed with KLH plus GPI-0100 failed to produce antibodies against sLe^a. However, mice immunized with sLe^a-KLH conjugate without GPI-0100 produced low levels of antibodies and mice immunized with sLe^a-KLH plus GPI-0100 produced significantly higher titer IgG and IgM antibodies against sLe^a by ELISA. These antibodies were highly reactive by FACS and mediated potent complement mediated cytotoxicity against sLe^a positive SW626 and DMS79 cells. They showed no detectable cross reactivity against a series of other blood group-related antigens, including Le^y, Le^x, and sLe^x by dot blot immune staining. This vaccine is ready for testing as an active immunotherapy for treating sLe^a positive cancer in clinical settings. Govind Ragupathi and Philip O. Livingston are paid consultants and shareholders in MabVax Therapeutics, Inc., San Diego, CA 92121. The sLe^a vaccine is licensed to MabVax.     

Autoantibodies against red blood cell antigens are common in a malaria endemic area

Plasmodium falciparum malaria can cause severe anemia. Even after treatment, hematocrit can decrease. The role of autoantibodies against erythrocytes is not clearly elucidated and how common they are, or what they are directed against, is still largely unknown.We have investigated antibodies against erythrocytes in healthy adult men living in a highly malaria endemic area in Uganda. We found antibodies in more than half of the individuals, which is significantly more than in a non-endemic area (Sweden). Some of the Ugandan samples had a broad reactivity where it was not possible to determine the exact target of the autoantibodies, but we also found specific antibodies directed against erythrocyte surface antigens known to be of importance for merozoite invasion such as glycophorin A (anti-En^a, anti-M) and glycophorin B (anti-U, anti-S). In addition, several autoantibodies had partial specificities against glycophorin C and the blood group systems Rh, Diego (located on Band 3), Duffy (located on ACKR1), and Cromer (located on CD55), all of which have been described to be important for malaria and therefore of interest for understanding how autoantibodies could potentially stop parasites from entering the erythrocyte.In conclusion, specific autoantibodies against erythrocytes are common in a malaria endemic area.     

Human-type blood groups and Gm factors in gibbons (Hylobates)

Blood specimens from 69 gibbons (63Hylobates lar, 4Hylobates concolor, and 2Hylobates pileatus) were tested for human-type ABO, MN, and Rh blood groups. AmongH. lar, three phenotypes were noted in the ABO and MN blood groups respectively, but all fourH. concolor were grouped as AM. All group A gibbons were of subgroup A₁; subgroups A₂B and A₁₂B were observed at a low frequency in group AB gibbons. Le^b antigen was detected in about 30% of the red cell samples fromH. lar, but all the samples were negative for Le^a. All the gibbons tested had c(hr) antigen but no other Rh antigens (D, C, E, and e) in their red cells. Some selected blood samples fromH. lar were also tested for some other blood group antigens and for the Gm and Inv factors. The Jk^a antigen was detected in all the red cell samples tested, but the S, s, U, K, k, and Fy^a antigens were not. In the tests of plasma with anti-Gm (1),H. lar could be divided into two groups, i.e., Gm(1)^Gi and Gm(–1)^Gi; Gm(2), Gm(4), and Inv(1) were absent in the species.     

Generation of ‘designer erythroblasts’ lacking one or more blood group systems from CRISPR/Cas9 gene-edited human-induced pluripotent stem cells

Despite the recent advancements in transfusion medicine, red blood cell (RBC) alloimmunization remains a challenge for multiparous women and chronically transfused patients. At times, diagnostic laboratories depend on difficult-to-procure rare reagent RBCs for the identification of different alloantibodies in such subjects. We have addressed this issue by developing erythroblasts with custom phenotypes (Rh null, GPB null and Kx null/Kell low) using CRISPR/Cas9 gene-editing of a human induced pluripotent stem cell (hiPSC) parent line (OT1-1) for the blood group system genes: RHAG, GYPB and XK. Guide RNAs were cloned into Cas9-puromycin expression vector and transfected into OT1-1. Genotyping was performed to select puromycin-resistant hiPSC KOs. CRISPR/Cas9 gene-editing resulted in the successful generation of three KO lines, RHAG KO, GYPB KO and XK KO. The OT1-1 cell line, as well as the three KO hiPSC lines, were differentiated into CD34⁺CD41⁺CD235ab⁺ hematopoietic progenitor cells (HPCs) and subsequently to erythroblasts. Native OT1-1 erythroblasts were positive for the expression of Rh, MNS, Kell and H blood group systems. Differentiation of RHAG KO, GYPB KO and XK KO resulted in the formation of Rh null, GPB null and Kx null/Kell low erythroblasts, respectively. OT1-1 as well as the three KO erythroblasts remained positive for RBC markers—CD71 and BAND3. Erythroblasts were mostly at the polychromatic/ orthochromatic stage of differentiation. Up to ~400-fold increase in erythroblasts derived from HPCs was observed. The availability of custom erythroblasts generated from CRISPR/Cas9 gene-edited hiPSC should be a useful addition to the tools currently used for the detection of clinically important red cell alloantibodies.     

Studies of the antigenicity and immunogenicity of bromelain-pretreated red blood cells

The effects of the proteolytic enzyme bromelain (Br) on the antigenicity and immunogenicity of sheep and mouse red blood cells (RBC) have been investigated. The results presented support the previous claim that there are antigens present on Br RBC that are not present in an exposed form on untreated RBC and that Br RBC have lost some of the antigens present on the surface of normal RBC. The susceptibility of Br RBC to osmotic lysis was very similar to that of normal RBC, implying that the modified RBC were not more fragile than normal RBC. Injection of mice with Br mouse-RBC did not increase the unusually high "background" number of cells producing IgM antibodies against Br mouse-RBC and mice did not mount delayed-type hypersensitivity reactions against Br mouse-RBC, either before or after sensitizing injections of Br mouse-RBC. However, mouse-RBC and Br mouse-RBC elicited similar antibody responses in rabbits and guinea pigs. Although mice appeared unresponsive to Br mouse-RBC injections, delayed-type hypersensitivity responses and antibody production in primary and secondary responses were of similar levels irrespective of whether sheep-RBC or Br sheep-RBC were used as immunogens. From these studies it appears that mice have B-cells producing antibodies against the "new" antigens on Br mouse-RBC, but there are no T-cells that respond to these antigens by way of "helper" activity in antibody production or by way of cell-mediated immune reactions.     

“Natural” chicken antibodies to red blood cells are mainly directed against the B-G antigen,and their occurrence is independent of spontaneous autoimmune thyroiditis

Using an indirect hemagglutination assay we tested sera from 94 healthy normal White Leghorn (NWL) and 117 Obese strain (OS) chickens with spontaneous autoimmune thyroiditis for the presence of natural antibodies against major histocompatibility complex (MHC) antigens expressed on red blood cells (RBC). In both groups older animals had a significantly increased frequency of such antibodies, but the titer was age-independent. OS chickens showed almost the same frequency of natural antibodies as NWL, and a comparison between OS birds with high antithyroglobulin autoantibody (Tg-AAb) titers and those with low titers also did not reveal a significant difference. We conclude that the occurrence of natural antibodies has no relation to Tg-AAb. The specificity of natural antibodies for MHC-encoded antigens was investigated in indirect immunofluorescence tests including absorption experiments with RBC and white blood cells (WBC). This analysis revealed that of 14 MHC-specific sera 13 were reacting with the B-G antigen, which is present on RBC only. One serum reacted with the B-F antigen, expressed on all somatic cells, i. e., both on RBC and WBC.     

Frequencies of red blood cell major blood group antigens and phenotypes in the Chinese Han population from Mainland China

Some patients' sera react with all available donors' red cells and a compatible donor is difficult or impossible to be found. These may either be due to a complex mixture of antibodies or the presence of alloantibodies against high-frequency antigens (HFAs). The aim of this study is to identify the prevalence and characteristics of antibodies to HFAs in Saudi Arabian patients. A total of 23 out of 172 000 patients who received blood transfusions had rare alloantibodies to HFAs at an incidence of 0.013%. Twenty-three patients suspected with pan-reactive alloantibodies against HFAs had their red cells tested using antisera to HFAs, while their plasma was tested against a selected panel of red blood cells with rare phenotypes. Anti-Ge2 antibody was found in the highest number of patients (56.5%), whereas anti-U, anti JK3, anti H, anti-RH 29, anti-hr^s, anti-Kn^a, anti-Ch, anti-Rg, anti-Yt^a, and anti-Cr^a antibodies were found in the remaining patients (43.5%). This study suggests that although antibodies such as anti-Ge2, anti-Kn^a, anti-Ch, anti-Rg, anti-Yt^a, and anti-Cr^a are not clinically significant, they cause a delay in the provision of compatible blood. Whereas, anti-U, anti JK3, anti H, anti-RH29 and anti-hr^s are clinically significant antibodies. An understanding of antibody characteristics to HFAs and the widespread use of the extended red cell phenotype and antibody identification panel will both be helpful for the diagnosis of these HFAs.     

Genome-wide variants of Eurasian facial shape differentiation and a prospective model of DNA based face prediction

It is a long-standing question as to which genes define the characteristic facial features among different ethnic groups. In this study, we use Uyghurs, an ancient admixed population to query the genetic bases why Europeans and Han Chinese look different. Facial traits were analyzed based on high-dense 3D facial images; numerous biometric spaces were examined for divergent facial features between European and Han Chinese, ranging from inter-landmark distances to dense shape geometrics. Genome-wide association studies(GWAS) were conducted on a discovery panel of Uyghurs. Six significant loci were identified, four of which, rs1868752, rs118078182, rs60159418 at or near UBASH3B, COL23A1, PCDH7 and rs17868256 were replicated in independent cohorts of Uyghurs or Southern Han Chinese. A prospective model was also developed to predict 3D faces based on top GWAS signals and tested in hypothetic forensic scenarios.     

The prevalence of alloantibody in the population of Xinjiang area of China

Alloantibodies are the major cause of hemolytic transfusion reaction and newborn hemolytic disease. It is highly recommended to screen alloantibodies before transfusion and pregnancy. This report applied the microcolum gel method to screen for available alloantibodies, enrolling 20,098 patients from January 2016 to December 2017 in the Xinjiang General Hospital. Seventy-two patients were found alloantibody-positive, at an overall positive rate of 0.35%. The distribution of alloantibody varied according to age, gender or treatment. The patients aged 70 plus and the patients admitted in the Department of Hematology and Department of Gynecology & Obstetrics had a higher incidence rate of alloantibodies. By using 10 screening cell panel systems, 9 types of alloantibodies including anti-D, anti-E, anti-e, anti-C, anti-c, anti-M, anti-s, anti-Fy^b and anti-Ce were identified. This study suggests that the transfusion of red blood cells(RBCs) and pregnancy are the main causes of alloantibodies.