The enzymic products of the human A and B blood group genes in the serum of "Bombay" O(h) donors

A novel observation on grouping anomaly: The phenomena mimicking the Bel genetic variant of the ABO blood groups

BACKGROUND:

Discrepancy in “forward/reverse” grouping leads to confusion in assigning ABO group to a person. It could be genetic in nature and classified according to the presence/absent of antigen on red blood cell (RBC) vis-a-vis corresponding alloantibody in plasma.

AIM:

The aim of the study was to investigate the grouping anomaly found in a recently delivered woman who required transfusion.

MATERIALS AND METHODS:

A standard protocol for investigation was followed.

RESULTS:

A 27-year-old female, gravida 4, para 3, was grouped O on forward grouping, but her serum did not agglutinate Group B RBCs tested. Absorption-elution study gave an active eluate from her sensitized RBCs with anti-B or anti-A+B. Saliva showed H, but no B antigens indicating to her Bel phenotype. However, 2-week latter in the follow-up study, her serum revealed a presence of complement binding high titer anti-B. The problem of missing anti-B on the previous occasion was attributed to hemagglutination inhibition caused by accumulated complement macromolecules on RBCs that gave rise to physical hindrance in the formation hemagglutination clumps.

CONCLUSION:

The unusual case of erroneous reversed grouping was attributed to complement-mediated hemagglutination inhibition. The positive eluate obtained from sensitized RBCs of the mother was considered to be due to a contamination of fetal RBCs in maternal circulation entered during her postpartum phase of pregnancy. It could also be due to a conversion of H to B antigen no matter in trace amount by the fetal B group-specific transferase percolated into maternal circulation.

Unravelling the biochemical basis of blood group ABO and Lewis antigenic specificity

The ABO blood-group polymorphism is still the most clinically important system in blood transfusion practice. The groups were discovered in 1900 and the genes at the ABO locus were cloned nearly a century later in 1990. To enable this goal to be reached intensive studies were carried out in the intervening years on the serology, genetics, inheritance and biochemistry of the antigens belonging to this system. This article describes biochemical genetic investigations on ABO and the related Lewis antigens starting from the time in the 1940s when serological and classical genetical studies had established the immunological basis and mode of inheritance of the antigens but practically nothing was known about their chemical structure. Essential steps were the definition of H as the product of a genetic system Hh independent of ABO, and the establishment of the precursor-product relationship of H to A and B antigens. Indirect methods gave first indications that the specificity of antigens resided in carbohydrate and revealed the immunodominant sugars in the antigenic structures. Subsequently chemical fragmentation procedures enabled the complete determinant structures to be established. Degradation experiments with glycosidases revealed how loss of one specificity by the removal of a single sugar unit exposed a new specificity and suggested that biosynthesis proceeded by a reversal of this process whereby the oligosaccharide structures were built up by the sequential addition of sugar units. Hence, the primary blood-group gene products were predicted to be glycosyltransferase enzymes that added the last sugar to complete the determinant structures. Identification of these enzymes gave new genetic markers and eventually purification of the blood-group A-gene encoded N-acetylgalactosaminyltransferase gave a probe for cloning the ABO locus. Blood-group ABO genotyping by DNA methods has now become a practical possibility.

Serologic characteristics of H-deficient phenotypes among Chinese in Hong Kong

BACKGROUND

The occasional presence of H-deficient red cells among both referred and donor blood samples prompted the mass screening of donated blood in Hong Kong for H-deficient phenotypes; 96 percent of the donors tested are Chinese from the southern province of Kwongtung.

STUDY DESIGN AND METHODS

Donor blood was screened for H-deficient red cells with the use of Ulex europaeus. Lewis phenotyping was carried out on all H-deficient individuals, and saliva testing was performed on most such individuals. The thermal amplitude and potency of their anti-H and anti-HI in the serum were also estimated.

RESULTS

Between 1984 and 1993, 28 H-deficient blood donors were identified; 16 H-deficient patient samples were also identified, and family studies revealed an additional 7 H-deficient subjects. The H-deficient red cells did not react with anti-H lectin, the levels of ABH substances in saliva were normal or near-normal, normal levels of A or B transferase were found in plasma, minute quantities of A or B (in persons who were genetically group A or B) were detected on the red cells, and anti-H or anti-HI was detected in the serum (about 66.7% of which reacted at 37 degrees C). Atypical anti-A or anti-B was demonstrated in 81.8 percent of the cases.

CONCLUSION

The H-deficient phenotype among the Hong Kong Chinese seems to represent a homogeneous group. Despite the presence of normal quantities of ABH substance in the saliva, anti-H or anti-HI that was active at 37 degrees C was detected in most cases. The incidence of the H-deficient phenotype was 1 in 15,620.

Blood group antigens on human erythrocytes-distribution, structure and possible functions

Human erythrocyte blood group antigens can be broadly divided into carbohydrates and proteins. The carbohydrate-dependent antigens (e.g., ABH, Lewis, Ii, P1, P-related, T and Tn) are covalently attached to proteins and/or sphingolipids, which are also widely distributed in body fluids, normal tissues and tumors. Blood group gene-specific glycosyltransferase regulate the synthesis of these antigens. Protein-dependent blood group antigens (e.g., MNSs, Gerbich, Rh, Kell, Duffy and Cromer-related) are carried on proteins, glycoproteins and proteins with glycosylphosphatidylinositol anchor. The functions of these molecules on human erythrocytes remain unknown; some of them may be involved in maintaining the erythrocyte shape. This review describes the distribution, structures and probable biological functions of some of these antigens in normal and pathological conditions.

UDP-N-acetyl-D-galactosamine as a donor substrate for the glycosyltransferase encoded by the B gene at the human blood group ABO locus

The properties of the enzyme in the serum of blood group B individuals that catalyses the transfer of small amounts of N-acetyl-D-galactosamine to H-active precursor structures were compared with those of the blood group B gene-associated alpha-(1----3)-D-galactosyltransferase and with the blood group A gene-associated alpha-(1----3)-N-acetyl-D-galactosaminyltransferases in the serum of blood group A1 and A2 individuals. The biosynthetic products formed by the enzyme in B serum were identical with the A-active structures synthesised by the A1 and A2 gene-associated alpha-(1----3)-N-acetyl-D-galactosaminyltransferases but the enzyme differed from the A1 and A2 transferases in its apparent Km for UDP-N-acetyl-D-galactosamine, its heat susceptibility, its failure to bind to Sepharose 4B, and its adsorption to H-active sites on group O red cell ghosts under conditions which bind the B transferase but fail to adsorb the A1 and A2 transferases. The correlation between the levels of alpha-(1----3)-D-galactosyltransferase and alpha-(1----3)-N-acetyl-D-galactosaminyltransferase activities in all the group B serum samples tested, the maintenance of the same ratio of activities after successive cycles of binding to group O red cell ghosts, the retention of the ability to convert blood group O to A-active cells after treatment of the serum with Sepharose 4B, and the failure to detect any comparable activity in group O serum samples tested under the same conditions indicated that the enzyme in group B serum that utilises UDP-N-acetyl-D-galactosamine to make blood group A-active structures is the B gene-associated alpha-(1----3)-D-galactosyltransferase.

Mouse monoclonal IgM antibody against human lung cancer line SK-LC-3 with specificity for H(O) blood group antigen

Spleen cells from mice immunized with the human lung cancer line SK-LC-3 were fused with mouse NS-1 myeloma cells. One of the hybrid clones produced a monoclonal IgM antibody (designated F-3), detected with antimouse Ig-MHA and hemagglutination assays. This antibody was completely absorbed by O red cells and completely inhibited by low concentrations of H(O) glycoproteins and hog mucin (A + H). Bombay (Oh) red cells completely failed to absorb F-3 activity even after treatment with neuraminidase. A1, A2, A1B, A2B, and B red cells and A- and B-glycoproteins were less effective in absorbing or inhibiting F-3 activity. Other glycoproteins (including those having Lea or blood group precursor structures) showed little or no inhibitory activity. Serum from nude mice carrying F-3 hybridoma agglutinated O and A2 red cells at a titer of 1:40,000 and 1:640, respectively. A1, A1B, A2B, and B red cells were agglutinated with titers of 1:80 or less. Monoclonal antibody F-3 is, therefore, highly specific for H(O) blood group determinants.

An H-deficient blood with normal H transferase levels

An H-deficient blood is described which, unlike other H-deficient, Bombay and para-Bombay bloods, has normal H transferase levels. In previous examples of Bombay and para-Bombay phenotypes the absence of H transferase has explained the lack of H substrate and therefore the weak A and B antigens which are characteristic of these phenotypes. This explanation obviously does not hold in the case described here and it is proposed that the biochemical block must be further back, either in the enzymes synthesising the oligosaccharide chains or in those making the GDP-fucose substrate for the H and the Le gene-specified fucosyltransferases. Inhibition of the synthesis of Leb substance, as well as H substance, although the saliva of the propositus contains the Le gene-specified transferase, supports this proposition.

Probable biosynthetic pathway for the synthesis of the B antigen for Bh variants

Red cells and serum from two Bh variants (B+H-cells) have been investigated for B and H blood group glycosyltransferases. The H enzyme could not be detected using either type 1 or type 2 chain acceptors. The B enzyme was present in normal amount when 2'-fucosyllactose was used as substrate, neither 6'-fucosyllactose nor 6'-fucosyllactosamine could act as acceptors for the B enzyme. Upon treatment of the Bh red cells by the B-degrading enzyme from Trichomonas foetus the B antigen was destroyed while H determinants were uncovered (B-H + cells). The cells thus treated could be further converted into A&H-red cells by the action of the A transferase from human blood group A serum. Previous treatment of the B-H + cells by the H-degrading enzyme from T. foetus, however, led to B-/-erythrocytes and prevented their conversion into A red blood cells by the A enzyme. The results clearly demonstrate that, as found in normal B individuals, the B antigen from Bh cells is built up from the H precursor and provide additional evidence that H is not a completely silent gene in Bh individuals.

Carbohydrate deficiency of the factor VIII/von Willebrand factor Protein in von Willebrand's disease variants

Study of the normal human factor VIII/von Willebrand factor reveals a macromolecular glycoprotein composed of apparently identical subunits. This purified glycoprotein has procoagulant, antigen, and von Willebrand factor activities. In three patients with a variant of the von Willebrand's disease syndrome, their factor VIII/von Willebrand factor protein was present in normal amounts and had normal procoagulant and antigen activities; however, this protein was deficient in both carbohydrate and von Willebrand factor activity. The carbohydrate portion of the factor VIII/von Willebrand factor glycoprotein is of major importance in its interactions with platelets or the blood vessel wall, or both.

Hemagglutination inhibition studies for the evaluation of blood group antigens in ethanol soluble substances (ESS) obtained from human, baboon and vervet monkey red blood cells

Soluble blood group substances, isolated from the red blood cells of humans, baboons, and vervet monkeys by ethanol extraction, possessed serologically active specificities for the following antigens: A, B, H, Lea, LebL, P, P19 Pk and I. Human red blood cells lacking any of these specificities by the direct hemagglutination test also lacked the related antigens in their soluble extract. The only exception was in "Bombay" Oh cells, from which soluble H substance could be readily isolated. Soluble substances obtained from baboon and vervet monkey red blood cells, which lack the human variety of A, B, and H antigens on their red blood cells, inhibited both human and lectin anti-H reagents. The detection of "hidden" H activity in Oh cells will pose some important questions regarding membrane characteristics and the role of immune surveilance.

The action of group Bm or CisAB sera on group O red cells in the presence of UDP-D-galactose

Group B and AB sera, acting on O red cells in the presence of UDP-galactose, each converted them into B active cells, which were agglutinated by anti-B human serum (1:512) at the titer of 128-fold, while group Bm and A-1 Bm sera, converted O red cells similarly incubated into B active cells, which were agglutinated by anti-B human serum (1:512) at the titer of 8- to 16-fold. This indicates that alpha-galactosyltransferase activity in Bm and A-1 Bm sera may be about 1/8-1/16 that in B and AB sera. Group CisAB sera, even after absorption of cold anti-B agglutinins with packed, washed group B red cells, did not convert O red cells in the presence of UDP-galactose in such a way that they might agglutinate against anti-B human serum.

Assay of alpha-N-acetylgalactosaminyltransferases in human sera. Further evidence for several types of Am individuals

The study of the alpha-N-acetylgalactosaminyltransferase in the sera of 19 individuals belonging to the rare Am blood group makes it possible to confirm the heterogeneity of this phenotype established on genetical and immunological criteria. Two groups of subjects, Am and Ay, can be distinguished. For the individuals of the first group, named Am, 15 samples (7 families) have been studied, the phenotype is inherited as an allele at the ABO locus. 14 of these subjects, have an alpha-N-acetylgalactosaminyltransferase whose kinetic properties were similar to those of A1 subjects. In one family, however, the A transferase detected is of the A1 type. On a quantitative level, the enzyme activities of these sera only reached 30-50 percent of the average value observed for A1 or A2 subjects, respectively. These facts suggest the existence of a genetic inhibitor, possibly linked to the ABO locus, preventing either an A1 or A2 gene from acting at the level of some cellular lines and leading therefore to the recognition of phenotypes named A-m-A1 and A-m-A2. On the contrary, under the experimental conditions used, no alpha-N-acetylgalactosaminyl-transferase activity was detected among the four individuals of the second group, named A-y by Weiner et al. (37), and whose appeareance in siblings results from the action of a recessive modifying y-A gene.