1
|
Halimi H, Mirzazadeh S, Kalantar K, Hajimaghsoodi M, Ramzi M, Farjadian S. Activating KIR/HLA-I combinations as a risk factor of adult B-ALL. Hum Immunol 2024; 85:110750. [PMID: 38262874 DOI: 10.1016/j.humimm.2024.110750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Revised: 01/05/2024] [Accepted: 01/08/2024] [Indexed: 01/25/2024]
Abstract
B-cell acute lymphoblastic leukemia (B-ALL), the most predominant type of ALL, is less common and incurable among adults. Regarding the pivotal role of NK cells in immune surveillance against hematological malignancies, studying the effective factors in regulating their function, particularly KIRs as the most important NK cell receptors and HLA-I molecules as their main ligands, is of importance. Since NK responses against malignant lymphoblasts are influenced by KIR signals, we did a case-control study on 154 adult patients with B-ALL and 181 healthy controls to investigate the correlation of KIR/HLA-I combinations with susceptibility to B-ALL in Iranians. The genotyping of KIR genes and HLA-I alleles was performed by PCR-SSP with 11 and 9 primer pairs, respectively. Our data revealed an increased frequency of activating (a)KIRs and aKIR/HLA-I combinations in our patients: KIR3DS1 (p = 0.009, OR = 1.81), Bx genotype (p = 0.038, OR = 1.81), KIR3DS1(+)/HLA-Bw4Thr80(+) (p = 0.004, OR = 3.61), and KIR3DS1(+)/HLA-B Bw4(+) (p = 0.037, OR = 1.76). The presence of inhibitory (i)KIRs in the absence of their cognate HLA-I ligands was also more frequent among the patients. However, the frequency of inhibitory combinations was more common in controls: KIR2DL1(+)/HLA-C2(+) (p = 0.027, OR = 0.57), KIR2DL2/3(+)/HLA-C1(+) (p = 0.004, OR = 0.5), and KIR3DL2(+)/HLA-A3/A11(+) (p = 0.0012, OR = 0.46). To sum up, the less inherited iKIR/HLA-I combinations might make individuals more susceptible to B-ALL because of inefficient education of NK cells.
Collapse
Affiliation(s)
- Hossein Halimi
- Department of Immunology, Shiraz Medical School, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sara Mirzazadeh
- Department of Immunology, Shiraz Medical School, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Kurosh Kalantar
- Department of Immunology, Shiraz Medical School, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Maryam Hajimaghsoodi
- Department of Hematology and Medical Oncology, Namazi Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mani Ramzi
- Department of Hematology and Medical Oncology, Namazi Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Shirin Farjadian
- Department of Immunology, Shiraz Medical School, Shiraz University of Medical Sciences, Shiraz, Iran.
| |
Collapse
|
2
|
Mirzazadeh S, Bemani P, Halimi H, Sanaee MN, Karami N, Ramzi M, Farjadian S. Association of killer cell immunoglobulin-like receptors and their cognate HLA class I ligands with susceptibility to acute myeloid leukemia in Iranian patients. Sci Rep 2023; 13:11456. [PMID: 37454198 PMCID: PMC10349836 DOI: 10.1038/s41598-023-38479-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 07/09/2023] [Indexed: 07/18/2023] Open
Abstract
Acute myeloid leukemia (AML) is one of the most prevalent leukemia in adults. Among the various NK receptors, killer immunoglobulin-like receptors (KIRs) carry out indispensable roles in NK cell development and function through engaging with class I human leukocyte antigens (HLA-I) as their ligands. Besides divergent KIR and HLA loci, KIR/HLA-I combinations have a significant effect on NK cell response. In this case-control study, we aimed to verify the association of KIR/HLA-I combinations with susceptibility to AML in the Southwestern Iranian population. KIR and HLA genotyping was performed with PCR-SSP by some novel primers for 181 patients with AML and 181 healthy controls. According to our results, the frequencies of KIR3DS1 (p = 0.0001, OR = 2.32, 95% CI 1.51-3.58), KIR2DS4fl (p = 0.02, OR = 1.53, 95% CI 1.05-2.21), CxT4 genotypes (p = 0.03, OR = 2.0, 95% CI 1.05-3.82), and T4 gene cluster (p = 0.01, OR = 1.99, 95% CI 1.17-3.41) were significantly higher in patients than controls, while C1/C2 genotype (p = 0.00002, OR = 0.39, 95% CI 0.25-0.61), HLA-A Bw4 (p = 0.02, OR = 0.6, 95% CI 0.38-0.94), and HLA-A*11 (p = 0.03, OR = 0.57, 95% CI 0.34-0.95) alleles were more frequent in controls. In addition, inhibitory (i)KIR/HLA-I combinations analysis revealed higher frequencies of KIR2DL1( +)/HLA-C2( +), KIR2DL2/3( +)/HLA-C1( +), KIR3DL1( +)/HLA-A Bw4( +), and KIR3DL2( +)/HLA-A*03/11( +) in the control group (p = 0.002, OR = 0.49, 95% CI 0.3-0.78; p = 0.04, OR = 0.62, 95% CI 0.39-0.99; p = 0.04, OR = 0.63, 95% CI 0.4-0.99; and p = 0.03, OR = 0.62, 95% CI 0.4-0.95, respectively). Overall, the number of iKIR/HLA-I combinations was more in the control group. Moreover, KIR3DS1( +)/HLA-B Bw4Ile80( +) and the sum of HLA-B Bw4/A Bw4 combined with KIR3DS1 as activating KIR/HLA-I combinations were more frequent among patients than controls (p = 0.01, OR = 1.99, 95% CI 1.14-3.49 and p = 0.005, OR = 1.97, 95% CI 1.22-3.19, respectively). In conclusion, our results postulate that inhibitory combinations play a protective role against AML by developing potent NK cells during education. It is noteworthy that KIR/HLA-I combination studies can be applicable in donor selection for allogeneic NK cell therapy in hematological malignancies.
Collapse
Affiliation(s)
- Sara Mirzazadeh
- Department of Immunology, Shiraz Medical School, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Peyman Bemani
- Department of Immunology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Hossein Halimi
- Department of Immunology, Shiraz Medical School, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Nabi Sanaee
- Department of Hematology and Medical Oncology, Namazi Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Narges Karami
- Department of Immunology, Shiraz Medical School, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mani Ramzi
- Department of Hematology and Medical Oncology, Namazi Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Shirin Farjadian
- Department of Immunology, Shiraz Medical School, Shiraz University of Medical Sciences, Shiraz, Iran.
| |
Collapse
|
3
|
Amanda M, Daniela C, Fernando G, Silvia M, Sofia L, Márcia D, Francisco A, Jeane V, Cármino DS. Association of KIR genes polymorphism and its HLA ligands in Diffuse Large B-cell Lymphoma. CLINICAL LYMPHOMA MYELOMA AND LEUKEMIA 2023; 23:438-445. [PMID: 37105848 DOI: 10.1016/j.clml.2023.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 02/18/2023] [Accepted: 03/02/2023] [Indexed: 03/11/2023]
Abstract
INTRODUCTION Non-Hodgkin lymphoma (NHL) is a heterogeneous disease, with each subtype associated with different risk factors. Within this group, diffuse large B-cell lymphoma (DLBCL) can be highlighted, the most common type of NHL.NK cells are key components of the innate immune response and may play an important antitumor role. OBJECTIVE The objective of the present work was to determine the polymorphism of KIR genes in Brazilian patients with DLBCL. MATERIALS AND METHODS Furthermore, we evaluated the association between the polymorphism of these genes and their ligands with the clinical course of the disease. For the study, 112 patients with DLBCL and 222 voluntary blood and bone marrow donors. The genetic material of these samples were extracted for KIR and HLA typing, determination of HLA ligands, determination of the KIR haplotype and search for the deletion of 22 bp in the KIR2DS4 gene. KIR genotype distributions were made by direct counting using 2 × 2 contingency tables using Fisher's exact test. The magnitude of the association was measured by odds ratio (OR) and 95% confidence interval. P values <.05 were considered significant. Overall survival and progression-free survival were assessed with a Kaplan-Meier estimator. RESULTS In the present study, an association of HLA-Bw4 and HLA-Bw480I ligand was found with more advanced stages of the disease. Also, an association of the KIR2DL3 gene with a better response to treatment was found. CONCLUSION With this, we can conclude that the polymorphism of KIR genes and the association with HLA ligands can influence the prognosis of DLBCL, as well as the response to treatment was found. With this, we can conclude that the polymorphism of KIR genes and the association with HLA ligands can influence the prognosis of DLBCL, as well as the response to treatment.Non-Hodgkin lymphoma (NHL) is a heterogeneous disease, with each subtype associated with different risk factors. Within this group, diffuse large B-cell lymphoma (DLBCL) can be highlighted, the most common type of NHL.NK cells are key components of the innate immune response and may play an important antitumor role. The objective of the present work was to determine the polymorphism of KIR genes in Brazilian patients with DLBCL. Furthermore, we evaluated the association between the polymorphism of these genes and their ligands with the clinical course of the disease. For the study, 112 patients with DLBCL and 222 voluntary blood and bone marrow donors. The genetic material of these samples were extracted for KIR and HLA typing, determination of HLA ligands, determination of the KIR haplotype and search for the deletion of 22 bp in the KIR2DS4 gene. KIR genotype distributions were made by direct counting using 2 × 2 contingency tables using Fisher's exact test. The magnitude of the association was measured by odds ratio (OR) and 95% confidence interval. P values <.05 were considered significant. Overall survival and progression-free survival were assessed with a Kaplan-Meier estimator. In the present study, an association of HLA-Bw4 and HLA-Bw480I ligand was found with more advanced stages of the disease. Also, an association of the KIR2DL3 gene with a better response to treatment was found. With this, we can conclude that the polymorphism of KIR genes and the association with HLA ligands can influence the prognosis of DLBCL, as well as the response to treatment was found. With this, we can conclude that the polymorphism of KIR genes and the association with HLA ligands can influence the prognosis of DLBCL, as well as the response to treatment.
Collapse
|
4
|
Aggarwal R, Sharma M, Singh U, Poulton K, Bhatia T, Mangat N, Kakkar N, Bansal D. Understanding the killer-cell immunoglobulin like receptor polymorphism in retinoblastoma. Ophthalmic Genet 2023; 44:1-5. [PMID: 36594723 DOI: 10.1080/13816810.2022.2163404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND The KIR receptors present on the natural killer (NK) cells play a crucial role by exercising cytotoxicity to eliminate tumor cells. Both KIR and class-I HLA molecules exhibit extensive polymorphism. Although RB1 inactivation triggers the initiation of retinoblastoma; however additional immune alterations trigger tumor development. The aim was to explore the KIR/HLA polymorphism and its role in the pathogenesis of retinoblastoma. METHODS Patients with unilateral, non-familial retinoblastoma were enrolled as cases. Healthy individuals matched for ethnicity were enrolled as controls. KIR genotyping was performed by sequence-specific primer assay. The investigated KIR genes included: inhibitory (2DL1, 2DL2, 2DL3, 2DL4, 2DL5A, 2DL5B), activating (2DS1, 2DS2, 2DS3, 2DS4*FUL, 2DS4*DEL, 2DS5, 3DL1, 3DL2, 3DL3, 3DS1) and pseudogenes (2DP1, 3DP1*FUL, 3DP1*DEL). In addition, HLA ligands were investigated by sequence-specific oligonucleotide assay for HLA-A, B, and C locus. RESULTS KIR genotyping was performed in 48 cases and 107 controls. The mean age of cases was 2.9 ± 2.2 years (range: 0.25-10). Among the 19 KIR genes, the frequency of KIR2DS4*FUL (p = 0.0019) and 2DS5 (p = 0.0095) was increased among cases. HLA ligands were investigated in 25 cases and 50 controls. The frequency of HLA ligands (C1/C2, Bw4, A3/A11) was similar among cases and controls. However, the KIR/HLA combination frequency for KIR3DS1/HLA-Bw4 was decreased in cases (p = 0.006). CONCLUSION It is the pioneer study to report the association of killer cell immunoglobulin-like receptors in retinoblastoma. KIR2DS4*FUL and KIR2DS5 had a susceptible, and KIR3DS1/HLA-BW4 had a protective role in retinoblastoma. The results will aid in exploring the therapeutic potential of NK cell-based therapy for retinoblastoma.
Collapse
Affiliation(s)
- Ritu Aggarwal
- Department of Immunopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Madhulika Sharma
- Department of Immunopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Usha Singh
- Department of Ophthalmology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Kay Poulton
- Transplantation Laboratory, Manchester Royal Infirmary, Manchester, UK
| | - Tanvi Bhatia
- Department of Immunopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Navdeep Mangat
- Department of Immunopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Nandita Kakkar
- Department of Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Deepak Bansal
- Hematology-Oncology unit, Department of Pediatrics, Advanced Pediatric Center, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| |
Collapse
|
5
|
Expression of Killer Immunoglobulin Receptor Genes among HIV-Infected Individuals with Non-AIDS Comorbidities. J Immunol Res 2022; 2022:1119611. [PMID: 35071606 PMCID: PMC8769865 DOI: 10.1155/2022/1119611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 12/01/2021] [Accepted: 12/17/2021] [Indexed: 11/18/2022] Open
Abstract
Combined antiretroviral therapy (cART) increased the life expectancy of people living with HIV (PLHIV) and remarkably reduced the morbidity and mortality associated with HIV infection. However, non-AIDS associated comorbidities including diabetes, hypertension, hyperlipidemia, and cardiovascular diseases (CVD) are increasingly reported among PLHIV receiving cART. Killer cell immunoglobulin receptors (KIRs) expressed on the surface of natural killer (NK) cells have been previously implicated in controlling HIV disease progression. The aim of this study is to investigate the role of KIRs in developing non-AIDS associated comorbidities among PLHIV. Demographic and behavioral data were collected from voluntary participants using a standardized questionnaire. Whole blood samples were collected for KIR genotyping. Hypertension (29.5%) and hyperlipidemia (29.5%) followed by diabetes (23.7%) and CVD (9.7%) were mainly reported among our study participants with higher rate of comorbid conditions observed among
years old. The observed KIR frequency (OF) was ≥90% for inhibitory KIR2DL1 and KIR3DL1, activating KIR2DS4 and the pseudogene KIR2DP1 among study participants. We detected significant differences in the expression of KIR3DS4 and KIR3DL1 (
) between diabetic and nondiabetic and in the expression of KIR2DL3 between hypertensive and normotensive HIV-infected individuals (
). Moreover, KIR2DL1 and KIR2DP1 were associated with significantly reduced odds of having CVD (OR 0.08; 95% CI: 0.01-0.69;
). Our study suggests the potential role of KIR in predisposition to non-AIDS comorbidities among PLHIV and underscores the need for more studies to further elucidate the role of KIRs in this population.
Collapse
|
6
|
He M, Zheng ZZ, He QQ, Li DY, Liao KZ, An L, Weng Q, Wang NJ, Wang LP, Sun Q, Wang J, Xiao PL, Du KM, Jiang M. Distribution of killer cell immunoglobulin-like receptor (KIR) genes in a large, multi-centre cohort of Chinese donors. Ann Hum Biol 2021; 48:133-141. [PMID: 34097546 DOI: 10.1080/03014460.2021.1913223] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND The killer cell immunoglobulin-like receptor (KIR), which mediates the killing function of NK cells, is an attractive candidate for adoptive cellular therapy. The ethnic distribution for China provides a unique opportunity to investigate KIR gene distribution. AIM The aim of this study was to explore the relationship between population history and the rapidly evolving KIR genetic diversity. SUBJECTS AND METHODS 8050 Chinese donors from 184 hospitals were included to analyse frequency, haplotype, and B-content data of 16 KIR genes, by PCR-SSP for KIR genotyping. RESULTS KIR gene carrier frequencies were found similar to those observed in other studies on Han, but different from Thais, Japanese, Africans, and populations of West Eurasian ancestry. High-frequency KIR genotype profiles found in the present population were consistent with other studies on Han populations but different from those conducted on other cohorts. The majority of our cohort carried group A KIR gene motifs. Additionally, populations with similar geographic locations in China were shown clustered together, while Hainan and Xinjiang provinces were slightly separated from these. CONCLUSION The distribution of KIR genes varies by geographic region, and different ethnic groups may be a confounding factor of KIR diversity.
Collapse
Affiliation(s)
- Min He
- Hematologic Disease Center, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China.,Xinjiang Uygur Autonomous Region Research Institute of Hematology, Urumqi, China
| | | | - Qing-Qing He
- Shanghai Tissuebank Biotechnology Co., Ltd., Shanghai, China
| | - Dai-Yang Li
- Shanghai Tissuebank Biotechnology Co., Ltd., Shanghai, China
| | - Kuan-Zhen Liao
- Shanghai Tissuebank Biotechnology Co., Ltd., Shanghai, China
| | - Lin An
- Shanghai Tissuebank Biotechnology Co., Ltd., Shanghai, China
| | - Qi Weng
- Shanghai Tissuebank Biotechnology Co., Ltd., Shanghai, China
| | - Ning-Juan Wang
- Shanghai Tissuebank Biotechnology Co., Ltd., Shanghai, China
| | - Li-Ping Wang
- Shanghai Tissuebank Biotechnology Co., Ltd., Shanghai, China
| | - Qin Sun
- Shanghai Tissuebank Biotechnology Co., Ltd., Shanghai, China
| | - Jian Wang
- Shanghai Tissuebank Biotechnology Co., Ltd., Shanghai, China
| | - Pei-Li Xiao
- Shanghai Tissuebank Biotechnology Co., Ltd., Shanghai, China
| | - Ke-Ming Du
- Xinjiang Uygur Autonomous Region Research Institute of Hematology, Urumqi, China
| | - Ming Jiang
- Hematologic Disease Center, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China.,Xinjiang Uygur Autonomous Region Research Institute of Hematology, Urumqi, China
| |
Collapse
|
7
|
Dizaji Asl K, Velaei K, Rafat A, Tayefi Nasrabadi H, Movassaghpour AA, Mahdavi M, Nozad Charoudeh H. The role of KIR positive NK cells in diseases and its importance in clinical intervention. Int Immunopharmacol 2021; 92:107361. [PMID: 33429335 DOI: 10.1016/j.intimp.2020.107361] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 12/14/2020] [Accepted: 12/28/2020] [Indexed: 12/20/2022]
Abstract
Natural killer (NK) cells are essential for the elimination of the transformed and cancerous cells. Killer cell immunoglobulin-like receptors (KIRs) which expressed by T and NK cells, are key regulator of NK cell function. The KIR and their ligands, MHC class I (HLA-A, B and C) molecules, are highly polymorphic and their related genes are located on 19 q13.4 and 6 q21.3 chromosomes, respectively. It is clear that particular interaction between the KIRs and their related ligands can influence on the prevalence, progression and outcome of several diseases, like complications of pregnancy, viral infection, autoimmune diseases, and hematological malignancies. The mechanisms of immune signaling in particular NK cells involvement in causing pathological conditions are not completely understood yet. Therefore, better understanding of the molecular mechanism of KIR-MHC class I interaction could facilitate the treatment strategy of diseases. The present review focused on the main characteristics and functional details of various KIR and their combination with related ligands in diseases and also highlights ongoing efforts to manipulate the key checkpoints in NK cell-based immunotherapy.
Collapse
Affiliation(s)
- Khadijeh Dizaji Asl
- Stem Cell Research Centre, Tabriz University of Medical Sciences, Tabriz, Iran; Department of Anatomical Sciences, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Kobra Velaei
- Department of Anatomical Sciences, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ali Rafat
- Stem Cell Research Centre, Tabriz University of Medical Sciences, Tabriz, Iran; Department of Anatomical Sciences, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Hamid Tayefi Nasrabadi
- Department of Anatomical Sciences, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ali Akbar Movassaghpour
- Hematology and Oncology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Majid Mahdavi
- Department of Biology, Faculty of Natural Science, University of Tabriz, Tabriz, Iran
| | | |
Collapse
|
8
|
Alavianmehr A, Mansouri M, Ramzi M, Faghih M, Monabati A, Arandi N, Faghih Z, Farjadian S. Association of killer-cell immunoglobulin-like receptor genes with acute myelogenous leukaemia. Int J Immunogenet 2020; 47:512-521. [PMID: 32767509 DOI: 10.1111/iji.12509] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Revised: 07/07/2020] [Accepted: 07/09/2020] [Indexed: 11/30/2022]
Abstract
Killer-cell immunoglobulin-like receptors (KIRs) are important because of their key roles in NK cell development and function. Some KIR genes have been associated with the incidence of haematological malignancies. This study was designed to determine whether the inheritance of specific KIR genes is associated with susceptibility to acute myelogenous leukaemia (AML) in Persians living in south-western Iran. KIR genes and KIR2DS4 variants were typed by polymerase chain reaction-sequence-specific primer (PCR-SSP) in 167 patients with AML and 169 healthy controls. Our results showed 10% of patients-mostly females-were classified as M3. Flt3 mutations were detected in 26% of patients, most of whom had internal tandem duplication (ITD). The frequency of activating KIRs (aKIRs)-mainly KIR3DS1-was higher in patients, whereas inhibitory KIRs (iKIRs)-particularly KIR3DL1 and KIR2DL1-were more common among controls. The incidence of the KIR2DS4fl allele was higher among patients with non-M3 AML than controls. We also found a higher frequency of 4 or more iKIR genes in the controls and a higher frequency of 4 or more aKIR genes in the patients. Individuals with more iKIR than aKIR belonged predominantly to the control group. Individuals with the telomeric AA genotype who had inherited the KIR2DS4fl allele were more frequent in the patient group. According to our results, increased frequency of aKIRs in patients with AML may lead to the hyperactivation of NK cells against malignant cells with reduced or lack of HLA class I molecules followed by NK cell exhaustion which allow malignant cells to progress.
Collapse
Affiliation(s)
- Ali Alavianmehr
- Department of Immunology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Marzieh Mansouri
- Department of Immunology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mani Ramzi
- Hematology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Masoumeh Faghih
- Department of Pathology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ahmad Monabati
- Department of Pathology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Nargess Arandi
- Hematology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Zahra Faghih
- Institute for Cancer Research, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Shirin Farjadian
- Department of Immunology, Shiraz University of Medical Sciences, Shiraz, Iran
| |
Collapse
|
9
|
Bao X, Zhang T, Wu X, Yuan X, Li Y, Chen L, He J. Population‐specific criterion to distinguish killer cell immunoglobulin‐like receptor genotypes and haplotypes in a large Eastern Han population. HLA 2019; 95:15-22. [PMID: 31496074 DOI: 10.1111/tan.13686] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 08/14/2019] [Accepted: 09/04/2019] [Indexed: 11/27/2022]
Affiliation(s)
- Xiaojing Bao
- Department of HLA Laboratory, Jiangsu Institute of Hematology First Affiliated Hospital of Soochow University Suzhou Jiangsu PR China
| | - Tengteng Zhang
- Department of HLA Laboratory, Jiangsu Institute of Hematology First Affiliated Hospital of Soochow University Suzhou Jiangsu PR China
| | - Xiaojin Wu
- Department of Hematology, Jiangsu Institute of Hematology First Affiliated Hospital of Soochow University Suzhou Jiangsu PR China
| | - Xiaoni Yuan
- Department of HLA Laboratory, Jiangsu Institute of Hematology First Affiliated Hospital of Soochow University Suzhou Jiangsu PR China
| | - Yang Li
- Department of HLA Laboratory, Jiangsu Institute of Hematology First Affiliated Hospital of Soochow University Suzhou Jiangsu PR China
| | - Luyao Chen
- Department of HLA Laboratory, Jiangsu Institute of Hematology First Affiliated Hospital of Soochow University Suzhou Jiangsu PR China
| | - Jun He
- Department of HLA Laboratory, Jiangsu Institute of Hematology Center for Clinical Laboratory, Collaborative Innovation Center of Hematology, First Affiliated Hospital of Soochow University Suzhou Jiangsu PR China
| |
Collapse
|
10
|
Deng Z, Zhao J, Cai S, Qi Y, Yu Q, Martin MP, Gao X, Chen R, Zhuo J, Zhen J, Zhang M, Zhang G, He L, Zou H, Lu L, Zhu W, Hong W, Carrington M, Norman PJ. Natural Killer Cells Offer Differential Protection From Leukemia in Chinese Southern Han. Front Immunol 2019; 10:1646. [PMID: 31379844 PMCID: PMC6646668 DOI: 10.3389/fimmu.2019.01646] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Accepted: 07/02/2019] [Indexed: 12/27/2022] Open
Abstract
Interactions of human natural killer (NK) cell inhibitory receptors with polymorphic HLA-A, -B and -C molecules educate NK cells for immune surveillance against tumor cells. The KIR A haplotype encodes a distinctive set of HLA-specific NK cell inhibiting receptors having strong influence on immunity. We observed higher frequency of KIR A homozygosity among 745 healthy Chinese Southern Han than 836 adult patients representing three types of leukemia: ALL (OR = 0.68, 95% CI = 0.52-0.89, p = 0.004), AML (OR = 0.76, 95% CI = 0.59-0.98, p = 0.034), and CML (OR = 0.72 95% CI = 0.51-1.0, ns). We observed the same trend for NHL (OR = 0.47 95% CI = 0.26-0.88 p = 0.017). For ALL, the protective effect of the KIR AA genotype was greater in the presence of KIR ligands C1 (Pc = 0.01) and Bw4 (Pc = 0.001), which are tightly linked in East Asians. By contrast, the C2 ligand strengthened protection from CML (Pc = 0.004). NK cells isolated from KIR AA individuals were significantly more cytotoxic toward leukemic cells than those from other KIR genotypes (p < 0.0001). These data suggest KIR allotypes encoded by East Asian KIR A haplotypes are strongly inhibitory, arming NK cells to respond to leukemogenic cells having altered HLA expression. Thus, the study of populations with distinct KIR and HLA distributions enlightens understanding of immune mechanisms that significantly impact leukemia pathogenesis.
Collapse
Affiliation(s)
- Zhihui Deng
- Immunogenetics Laboratory, Shenzhen Blood Center, Shenzhen, China
| | - Jun Zhao
- School of Ophthalmology and Optometry, Shenzhen Eye Hospital, Shenzhen University, Shenzhen, China
| | - Siqi Cai
- Immunogenetics Laboratory, Shenzhen Blood Center, Shenzhen, China
| | - Ying Qi
- Basic Science Program, Frederick National Laboratory for Cancer Research, Frederick, MD, United States
| | - Qiong Yu
- Immunogenetics Laboratory, Shenzhen Blood Center, Shenzhen, China
| | - Maureen P. Martin
- Basic Science Program, Frederick National Laboratory for Cancer Research, Frederick, MD, United States
| | - Xiaojiang Gao
- Basic Science Program, Frederick National Laboratory for Cancer Research, Frederick, MD, United States
| | - Rui Chen
- Immunogenetics Laboratory, Shenzhen Blood Center, Shenzhen, China
| | - Jiacai Zhuo
- Department of Hematology, Shenzhen Second People's Hospital, Shenzhen, China
| | - Jianxin Zhen
- Immunogenetics Laboratory, Shenzhen Blood Center, Shenzhen, China
- Central Laboratory, Baoan Maternal and Child Health Hospital, Shenzhen, China
| | - Mingjie Zhang
- Research and Development Department, Shenzhen Hank Bioengineering Institute, Shenzhen, China
| | - Guobin Zhang
- Immunogenetics Laboratory, Shenzhen Blood Center, Shenzhen, China
| | - Liumei He
- Immunogenetics Laboratory, Shenzhen Blood Center, Shenzhen, China
| | - Hongyan Zou
- Immunogenetics Laboratory, Shenzhen Blood Center, Shenzhen, China
| | - Liang Lu
- Immunogenetics Laboratory, Shenzhen Blood Center, Shenzhen, China
| | - Weigang Zhu
- Immunogenetics Laboratory, Shenzhen Blood Center, Shenzhen, China
| | - Wenxu Hong
- Immunogenetics Laboratory, Shenzhen Blood Center, Shenzhen, China
| | - Mary Carrington
- Basic Science Program, Frederick National Laboratory for Cancer Research, Frederick, MD, United States
- Ragon Institute of MGH MIT and Harvard, Cambridge, MA, United States
| | - Paul J. Norman
- Division of Biomedical Informatics and Personalized Medicine, Department of Microbiology and Immunology, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| |
Collapse
|
11
|
Thöns C, Senff T, Hydes TJ, Manser AR, Heinemann FM, Heinold A, Heilmann M, Kim AY, Uhrberg M, Scherbaum N, Lauer GM, Khakoo SI, Timm J. HLA-Bw4 80(T) and multiple HLA-Bw4 copies combined with KIR3DL1 associate with spontaneous clearance of HCV infection in people who inject drugs. J Hepatol 2017; 67:462-470. [PMID: 28412292 DOI: 10.1016/j.jhep.2017.03.040] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Revised: 03/16/2017] [Accepted: 03/31/2017] [Indexed: 12/14/2022]
Abstract
BACKGROUND & AIMS Natural killer (NK) cell function is regulated by inhibitory and activating receptors including killer cell immunoglobulin-like receptors (KIRs). Here, we analyzed the impact of different KIR/KIR-ligand genotypes on the outcome of hepatitis C virus (HCV) infection in people who inject drugs (PWID). METHODS KIR/KIR-ligand genotypes associated with spontaneous clearance of HCV infection were identified in a cohort of PWID from Germany (n=266) and further validated in a second anti-HCV positive cohort of PWID recruited in North America (n=342). NK cells of PWID and healthy donors were functionally characterized according to their KIR/KIR-ligand genotype by flow cytometry. RESULTS Multivariate logistic regression analysis revealed that KIR3DL1/HLA-Bw4 80(T) was associated with spontaneous clearance of HCV infection in PWID, which was confirmed in the PWID cohort from North America. Compared with PWID with detectable HCV RNA, the frequency of individuals with multiple HLA-Bw4 alleles was significantly higher in anti-HCV positive PWID with resolved HCV infection (29.7% vs. 15.2%; p=0.0229) and in anti-HCV seronegative PWID (39.2%; p=0.0006). KIR3DL1+ NK cells from HLA-Bw4 80(T)-positive PWID showed superior functionality compared to HLA-Bw4 80(I)-positive PWID. This differential impact was not observed in healthy donors; however, the HLA-Bw4 copy number strongly correlated with the functionality of KIR3DL1+ NK cells. CONCLUSIONS HLA-Bw4-80(T) and multiple HLA-Bw4 copies in combination with KIR3DL1 are associated with protection against chronic hepatitis C in PWID by distinct mechanisms. Better licensing of KIR3DL1+ NK cells in the presence of multiple HLA-Bw4 copies is beneficial prior to seroconversion whereas HLA-Bw4 80(T) may be beneficial during acute hepatitis C. Lay summary: Natural killer (NK) cells are part of the innate immune system and are regulated by a complex network of activating and inhibiting receptors. The regulating receptor-ligand pairs of an individual are genetically determined. Here, we identified a particular set of ligand and receptor genes that are associated with better functionality of NK cells and better outcome upon exposure to HCV in a high-risk group.
Collapse
Affiliation(s)
- Christine Thöns
- Institute for Virology, Heinrich Heine University, Medical Faculty, Düsseldorf, Germany
| | - Tina Senff
- Institute for Virology, Heinrich Heine University, Medical Faculty, Düsseldorf, Germany
| | - Theresa J Hydes
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, Hampshire, UK
| | - Angela R Manser
- Institute for Transplantation Diagnostics and Cell Therapeutics, University Hospital Düsseldorf, Heinrich Heine University, Düsseldorf, Germany
| | - Falko M Heinemann
- Institute for Transfusion Medicine, University of Duisburg-Essen, University Hospital, Essen, Germany
| | - Andreas Heinold
- Institute for Transfusion Medicine, University of Duisburg-Essen, University Hospital, Essen, Germany
| | - Martin Heilmann
- Department for Addiction Medicine and Addictive Behavior, LVR-Hospital Essen, Faculty of Medicine, University of Duisburg-Essen, Essen, Germany
| | - Arthur Y Kim
- Division of Infectious Diseases, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Markus Uhrberg
- Institute for Transplantation Diagnostics and Cell Therapeutics, University Hospital Düsseldorf, Heinrich Heine University, Düsseldorf, Germany
| | - Norbert Scherbaum
- Department for Addiction Medicine and Addictive Behavior, LVR-Hospital Essen, Faculty of Medicine, University of Duisburg-Essen, Essen, Germany
| | - Georg M Lauer
- Gastrointestinal Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Salim I Khakoo
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, Hampshire, UK
| | - Jörg Timm
- Institute for Virology, Heinrich Heine University, Medical Faculty, Düsseldorf, Germany.
| |
Collapse
|
12
|
Tao S, He Y, Dong L, He J, Chen N, Wang W, Han Z, Zhang W, He J, Zhu F. Associations of killer cell immunoglobulin-like receptors with acute myeloid leukemia in Chinese populations. Hum Immunol 2017; 78:269-273. [PMID: 28111167 DOI: 10.1016/j.humimm.2017.01.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Revised: 01/13/2017] [Accepted: 01/14/2017] [Indexed: 12/28/2022]
Abstract
Many studies have investigated the relationship between KIR, HLA and acute myeloid leukemia (AML), but the results were different in different laboratories, and the data in Chinese population were limited. In this study, the distribution of KIR gene, KIR genotypes, HLA-C groups, HLA-Bw4, and KIR-HLA interaction from 273 healthy participants and 253 AML patients (M0-M6) in southern Chinese Han were determined to investigate the relationships among KIR, HLA and AML. The results showed that the frequencies of 2DS4del in M5 patients were significantly higher than those of the controls (65.0% vs 46.5%, P=0.0104, OR=2.135, P<ɑ'). The frequency of KIR genotype BX13 in the healthy controls was significantly higher than that in AML patients (3.7% vs 0%, P=0.0019, OR=20.2, P<ɑ'). No other significant differences in the frequencies of KIR, HLA and KIR-HLA interaction were identified between AML patients and controls. Our study suggests that 2DS4del may conduct a susceptibility to AML, and genotype BX13 might conduct a protective effect on AML.
Collapse
Affiliation(s)
- Sudan Tao
- Blood Center of Zhejiang Province, Hangzhou, Zhejiang, People's Republic of China; Key Laboratory of Blood Safety Research, Ministry of Health, Hangzhou, Zhejiang, People's Republic of China; Zhejiang Provincial Key Laboratory of Blood Safety Research, Hangzhou, Zhejiang, People's Republic of China
| | - Yanmin He
- Blood Center of Zhejiang Province, Hangzhou, Zhejiang, People's Republic of China; Key Laboratory of Blood Safety Research, Ministry of Health, Hangzhou, Zhejiang, People's Republic of China; Zhejiang Provincial Key Laboratory of Blood Safety Research, Hangzhou, Zhejiang, People's Republic of China
| | - Lina Dong
- Blood Center of Zhejiang Province, Hangzhou, Zhejiang, People's Republic of China; Key Laboratory of Blood Safety Research, Ministry of Health, Hangzhou, Zhejiang, People's Republic of China; Zhejiang Provincial Key Laboratory of Blood Safety Research, Hangzhou, Zhejiang, People's Republic of China
| | - Junjun He
- Blood Center of Zhejiang Province, Hangzhou, Zhejiang, People's Republic of China; Key Laboratory of Blood Safety Research, Ministry of Health, Hangzhou, Zhejiang, People's Republic of China; Zhejiang Provincial Key Laboratory of Blood Safety Research, Hangzhou, Zhejiang, People's Republic of China
| | - Nanying Chen
- Blood Center of Zhejiang Province, Hangzhou, Zhejiang, People's Republic of China; Key Laboratory of Blood Safety Research, Ministry of Health, Hangzhou, Zhejiang, People's Republic of China; Zhejiang Provincial Key Laboratory of Blood Safety Research, Hangzhou, Zhejiang, People's Republic of China
| | - Wei Wang
- Blood Center of Zhejiang Province, Hangzhou, Zhejiang, People's Republic of China; Key Laboratory of Blood Safety Research, Ministry of Health, Hangzhou, Zhejiang, People's Republic of China; Zhejiang Provincial Key Laboratory of Blood Safety Research, Hangzhou, Zhejiang, People's Republic of China
| | - Zhedong Han
- Blood Center of Zhejiang Province, Hangzhou, Zhejiang, People's Republic of China; Key Laboratory of Blood Safety Research, Ministry of Health, Hangzhou, Zhejiang, People's Republic of China; Zhejiang Provincial Key Laboratory of Blood Safety Research, Hangzhou, Zhejiang, People's Republic of China
| | - Wei Zhang
- Blood Center of Zhejiang Province, Hangzhou, Zhejiang, People's Republic of China; Key Laboratory of Blood Safety Research, Ministry of Health, Hangzhou, Zhejiang, People's Republic of China; Zhejiang Provincial Key Laboratory of Blood Safety Research, Hangzhou, Zhejiang, People's Republic of China
| | - Ji He
- Blood Center of Zhejiang Province, Hangzhou, Zhejiang, People's Republic of China; Key Laboratory of Blood Safety Research, Ministry of Health, Hangzhou, Zhejiang, People's Republic of China; Zhejiang Provincial Key Laboratory of Blood Safety Research, Hangzhou, Zhejiang, People's Republic of China
| | - Faming Zhu
- Blood Center of Zhejiang Province, Hangzhou, Zhejiang, People's Republic of China; Key Laboratory of Blood Safety Research, Ministry of Health, Hangzhou, Zhejiang, People's Republic of China; Zhejiang Provincial Key Laboratory of Blood Safety Research, Hangzhou, Zhejiang, People's Republic of China.
| |
Collapse
|
13
|
Augusto DG. The Impact of KIR Polymorphism on the Risk of Developing Cancer: Not as Strong as Imagined? Front Genet 2016; 7:121. [PMID: 27446203 PMCID: PMC4923111 DOI: 10.3389/fgene.2016.00121] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Accepted: 06/14/2016] [Indexed: 11/13/2022] Open
Abstract
The polymorphism of killer cell immunoglobulin-like receptors (KIR) has been associated with several diseases, including infection, autoimmunity and cancer. KIR molecules are a family of receptors expressed on the surface of natural killer cells (NK), frontline defense of innate immunity against microorganisms and neoplastic cells. Some studies have shown conflicting results concerning the role that KIR polymorphism plays in tumor susceptibility, particularly in leukemia and lymphoma. Interestingly, the presence of HLA ligands is sometimes strongly associated with several types of cancer and apparently is not related with their interaction with KIR. This manuscript briefly reviews the uncommon polymorphism of KIR and critically summarizes the recent findings with regards of the importance of KIR variation for cancer susceptibility.
Collapse
Affiliation(s)
- Danillo G Augusto
- Laboratório de Genética Molecular Humana, Departamento de Genética, Universidade Federal do Paraná Curitiba, Brazil
| |
Collapse
|
14
|
Varbanova V, Naumova E, Mihaylova A. Killer-cell immunoglobulin-like receptor genes and ligands and their role in hematologic malignancies. Cancer Immunol Immunother 2016; 65:427-40. [PMID: 26874942 PMCID: PMC11029164 DOI: 10.1007/s00262-016-1806-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Accepted: 01/29/2016] [Indexed: 12/22/2022]
Abstract
Natural killer (NK) cells are considered crucial for the elimination of emerging tumor cells. Effector NK-cell functions are controlled by interactions of inhibitory and activating killer-cell immunoglobulin-like receptors (KIRs) on NK cells with human leukocyte antigen (HLA) class I ligands on target cells. KIR and HLA are highly polymorphic genetic systems segregating independently, creating a great diversity in KIR/HLA gene profiles in different individuals. There is an increasing evidence supporting the relevance of KIR and HLA ligand gene background for the occurrence and outcome of certain cancers. However, the data are still controversial and the mechanisms of receptor-ligand mediated NK-cell action remain unclear. Here, the main characteristics and functions of KIRs and their HLA class I ligands are reviewed. In addition, we review the HLA and KIR correlations with different hematological malignancies and discuss our current understanding of the biological significance and mechanisms underlying these associations.
Collapse
Affiliation(s)
- Viktoria Varbanova
- National Specialized Hospital for Active Treatment of Haematological Diseases, Sofia, Bulgaria
| | - Elissaveta Naumova
- Department of Clinical Immunology and Stem Cell Bank, University Hospital "Alexandrovska", Medical University, 1, Georgi Sofiiski Str., 1431, Sofia, Bulgaria
| | - Anastasiya Mihaylova
- Department of Clinical Immunology and Stem Cell Bank, University Hospital "Alexandrovska", Medical University, 1, Georgi Sofiiski Str., 1431, Sofia, Bulgaria.
| |
Collapse
|
15
|
Shen M, Linn YC, Ren EC. KIR-HLA profiling shows presence of higher frequencies of strong inhibitory KIR-ligands among prognostically poor risk AML patients. Immunogenetics 2015; 68:133-44. [PMID: 26649563 DOI: 10.1007/s00251-015-0888-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Accepted: 12/01/2015] [Indexed: 12/15/2022]
Abstract
The expression and interaction between killer cell immunoglobulin-like receptors (KIRs) and HLA are known to be associated with pathogenesis of diseases, including hematological malignancies. Presence of B haplotype KIR in donors is associated with a lower relapse risk for acute myeloid leukemia (AML) after hematopoietic stem cell transplants (HSCT). However, the association of KIR and HLA repertoire with disease development and other clinical features is not well studied for AML. In this study, 206 Chinese patients with AML were analyzed for their FAB subtypes, risk groups, and chemo-responsiveness to assess possible association with their KIR and HLA profile. The results revealed that a B-content score of 2 was significantly more prevalent in AML patients when compared to normal controls. Notably, there is also a differential frequency in the distribution of B haplotype KIR across distinct FAB subtypes, where the M3 subtype had significantly lower frequencies of B haplotype KIR compared to the M5 subtype (p < 0.05). In addition, the stronger inhibitory KIR ligands HLA-C2 and HLA-Bw4-80I were present in significantly higher frequencies in the prognostically "poor" risk group compared to those with "favourable" risk (p < 0.01). Taken together, these associations with clinical features of AML suggest a role of the KIR-HLA repertoire in the development and biological behavior of AML.
Collapse
Affiliation(s)
- Meixin Shen
- Singapore Immunology Network, A*STAR, 8A Biomedical Grove, Immunos #03-06, Singapore, 138648, Singapore
| | - Yeh-Ching Linn
- Department of Haematology, Singapore General Hospital, Academia, 20 College Road, Singapore, 169856, Singapore.
| | - Ee-Chee Ren
- Singapore Immunology Network, A*STAR, 8A Biomedical Grove, Immunos #03-06, Singapore, 138648, Singapore. .,Department of Microbiology, National University of Singapore, 21 Lower Kent Ridge Road, Singapore, 119077, Singapore.
| |
Collapse
|
16
|
Comparison of the KIR3DS1/Bw4 distribution in Chinese healthy and acute myeloid leukemia individuals. Hum Immunol 2015; 76:79-82. [DOI: 10.1016/j.humimm.2015.01.024] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Revised: 10/20/2014] [Accepted: 01/15/2015] [Indexed: 01/03/2023]
|