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Floch A, Galochkina T, Pirenne F, Tournamille C, de Brevern AG. Molecular dynamics of the human RhD and RhAG blood group proteins. Front Chem 2024; 12:1360392. [PMID: 38566898 PMCID: PMC10985258 DOI: 10.3389/fchem.2024.1360392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 03/07/2024] [Indexed: 04/04/2024] Open
Abstract
Introduction: Blood group antigens of the RH system (formerly known as "Rhesus") play an important role in transfusion medicine because of the severe haemolytic consequences of antibodies to these antigens. No crystal structure is available for RhD proteins with its partner RhAG, and the precise stoichiometry of the trimer complex remains unknown. Methods: To analyse their structural properties, the trimers formed by RhD and/or RhAG subunits were generated by protein modelling and molecular dynamics simulations were performed. Results: No major differences in structural behaviour were found between trimers of different compositions. The conformation of the subunits is relatively constant during molecular dynamics simulations, except for three large disordered loops. Discussion: This work makes it possible to propose a reasonable stoichiometry and demonstrates the potential of studying the structural behaviour of these proteins to investigate the hundreds of genetic variants relevant to transfusion medicine.
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Affiliation(s)
- Aline Floch
- University Paris Est Créteil, INSERM U955 Equipe Transfusion et Maladies du Globule Rouge, IMRB, Créteil, France
- Laboratoire de Biologie Médicale de Référence en Immuno-Hématologie Moléculaire, Etablissement Français du Sang Ile-de-France, Créteil, France
| | - Tatiana Galochkina
- Université Paris Cité and Université des Antilles and Université de la Réunion, Biologie Intégrée du Globule Rouge, UMR_S1134, BIGR, INSERM, DSIMB Bioinformatics team, Paris, France
| | - France Pirenne
- University Paris Est Créteil, INSERM U955 Equipe Transfusion et Maladies du Globule Rouge, IMRB, Créteil, France
- Laboratoire de Biologie Médicale de Référence en Immuno-Hématologie Moléculaire, Etablissement Français du Sang Ile-de-France, Créteil, France
| | - Christophe Tournamille
- University Paris Est Créteil, INSERM U955 Equipe Transfusion et Maladies du Globule Rouge, IMRB, Créteil, France
- Laboratoire de Biologie Médicale de Référence en Immuno-Hématologie Moléculaire, Etablissement Français du Sang Ile-de-France, Créteil, France
| | - Alexandre G. de Brevern
- Université Paris Cité and Université des Antilles and Université de la Réunion, Biologie Intégrée du Globule Rouge, UMR_S1134, BIGR, INSERM, DSIMB Bioinformatics team, Paris, France
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Hutchison CJ, Srivastava K, Polin H, Bueno MU, Flegel WA. Rh flow cytometry: An updated methodology for D antigen density applied to weak D types 164 and 165. Transfusion 2023; 63:2141-2151. [PMID: 37792462 PMCID: PMC10680490 DOI: 10.1111/trf.17543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 08/29/2023] [Accepted: 08/29/2023] [Indexed: 10/05/2023]
Abstract
BACKGROUND An original methodology for determining the D antigen density on red cells was published in 2000 and has been applied in many publications since. This flow cytometry-based assay remained largely unrevised utilizing monoclonal anti-Ds that are not readily available anymore. We updated the methodology to quantify erythrocyte D antigen sites using microspheres and monoclonal anti-Ds that are commercially available today. METHODS The absolute D antigen density of a frozen standard CcDEe cell, drawn in 2003, a fresh blood donation from the same individual, drawn in 2022, and an internal control CcDEe cell, was quantified by flow cytometry using fluorescence-labeled microspheres. The internal control CcDEe cell was used in conjunction with 9 commercial anti-Ds to determine D antigen densities of 7 normal D, 4 partial D, and 11 weak D type samples, including 2 novel alleles. RESULTS The reproducibility of the updated assay was evaluated with red cells of published D antigen densities. The current results matched the known ones closely. The new weak D types 164 and 165 carried 4500 and 1505 D antigens/red cell, respectively. The absolute D antigen density decreased from 27,231 to 26,037 in an individual over 19 years. DISCUSSION The updated assay gave highly reproducible results for the D antigen densities of Rh phenotypes. Readily available anti-Ds allowed for the determination of the D antigen densities of 7 weak D types. The assay is suitable to evaluate the effects of distinct amino acid substitutions on the RhD phenotype.
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Affiliation(s)
- Chloe Jayne Hutchison
- Department of Transfusion Medicine, NIH Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - Kshitij Srivastava
- Department of Transfusion Medicine, NIH Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - Helene Polin
- Department of Immunogenetics, Red Cross Transfusion Service for Upper Austria, Linz, Austria
| | - Marina Ursula Bueno
- Department of Transfusion Medicine, NIH Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - Willy Albert Flegel
- Department of Transfusion Medicine, NIH Clinical Center, National Institutes of Health, Bethesda, MD, USA
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3
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Stainer S, Reisetbauer S, Ahiable JEA, Ebner L, Zhu R, Reindl D, Körmöczi GF, Ebner A. Single molecule distribution of RhD binding epitopes on ultraflat erythrocyte ghosts. NANOSCALE 2020; 12:22097-22106. [PMID: 33118583 DOI: 10.1039/d0nr04393a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The Rh blood group system plays a key role in transfusion and organ transplant medicine. The complex transmembrane Rh polypeptides RhD and RhCE carry numerous antigens, including the extremely immunogenic D antigen. The Rh polypeptides form multimolecular Rh complexes with certain transmembrane and skeletal proteins, with so far only incompletely understood physiological functions. Determination of the energy landscape of individual Rh binding epitopes towards their specific interaction partners as well as their localization across the red blood cell (RBC) membrane requires single molecule approaches including large area high resolution recognition imaging. Atomic force microscopy based molecular recognition force spectroscopy in combination with single molecule recognition imaging fulfills these requirements. For unbiased single molecule results, nano-mechanical influences due to cell elasticity have to be eliminated. This is realized by generation of ultra flat erythrocyte ghosts on a solid support. We developed a protocol for the preparation of complete ultraflat erythrocyte ghosts and determined the molecular binding behaviour of different anti-D antibodies towards their binding epitopes on RhD positive and negative erythrocytes. Performing optimized topography and recognition imaging at 16 Mpixel resolution allowed localisation of individual RhD molecules at the single molecule level across an entire RBC. A map of Rh antigens across integer ultraflat RBC ghosts was generated with nanometer resolution. Here we show a homogeneous distribution on rim and dimple regions with comparable receptor densities. Furthermore, differences in the energy landscape between specific monoclonal antibodies were determined at the single molecule level.
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Affiliation(s)
- Sarah Stainer
- Molecular Biosensing group, Institute of Biophysics, Johannes Kepler University Linz, Austria.
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4
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de Brevern AG, Floch A, Barrault A, Martret J, Bodivit G, Djoudi R, Pirenne F, Tournamille C. Alloimmunization risk associated with amino acid 223 substitution in the RhD protein: analysis in the light of molecular modeling. Transfusion 2018; 58:2683-2692. [DOI: 10.1111/trf.14809] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 04/09/2018] [Accepted: 04/21/2018] [Indexed: 12/26/2022]
Affiliation(s)
- Alexandre G. de Brevern
- INSERM UMR_S 1134; Univ. Paris Diderot, Sorbonne Paris Cité, Univ. de la Réunion, Univ. Antilles; Paris
- Laboratory of Excellence GR-Ex; Paris
- Institut National de la Transfusion Sanguine (INTS); Paris
| | - Aline Floch
- Laboratory of Excellence GR-Ex; Paris
- Etablissement Français du Sang Ile de France; Créteil France
- IMRB-INSERM U955 Team 2 “Transfusion et Maladies du Globule Rouge”; Créteil France
- UPEC; Université Paris Est-Créteil; Créteil France
| | | | | | - Gwellaouen Bodivit
- Laboratory of Excellence GR-Ex; Paris
- Etablissement Français du Sang Ile de France; Créteil France
- IMRB-INSERM U955 Team 2 “Transfusion et Maladies du Globule Rouge”; Créteil France
| | - Rachid Djoudi
- Etablissement Français du Sang Ile de France; Créteil France
| | - France Pirenne
- Laboratory of Excellence GR-Ex; Paris
- Etablissement Français du Sang Ile de France; Créteil France
- IMRB-INSERM U955 Team 2 “Transfusion et Maladies du Globule Rouge”; Créteil France
- UPEC; Université Paris Est-Créteil; Créteil France
| | - Christophe Tournamille
- Laboratory of Excellence GR-Ex; Paris
- Etablissement Français du Sang Ile de France; Créteil France
- IMRB-INSERM U955 Team 2 “Transfusion et Maladies du Globule Rouge”; Créteil France
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5
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Turley E, McGowan EC, Hyland CA, Schoeman EM, Flower RL, Skoll A, Delisle MF, Nelson T, Clarke G, Au N. Severe hemolytic disease of the fetus and newborn due to allo-anti-D in a patient with a partial DEL phenotype arising from the variant allele described as RHD*148+1T (RHD*01EL.31). Transfusion 2018; 58:2260-2264. [PMID: 30222865 DOI: 10.1111/trf.14944] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 07/28/2018] [Accepted: 08/17/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUND RhD DEL variants may show complete or partial expression of RhD epitopes. There have been only rare reports of anti-D causing hemolytic disease of the fetus and newborn (HDFN) in this context. We report a case of severe HDFN associated with a recently described DEL variant. CASE REPORT A multiparous woman presented with an allo-anti-D and showed incongruent phenotyping and genotyping results on initial study. Further investigations identified the RHD mutation, defined as RHD*148+1T and named RHD*01EL.31, which had been previously associated with a DEL phenotype. Extended RhD phenotyping by adsorption-elution showed that there was reactivity with four of nine monoclonal anti-D antibodies, suggesting a partial DEL phenotype. The first child showed no clinical evidence of HDFN, although the cord direct antiglobulin test was positive. The second child developed fetal anemia treated with intrauterine transfusion, and neonatal hyperbilirubinemia requiring exchange transfusion. CONCLUSION The RHD allele, RHD*148+1T, results in a partial Del phenotype, and the anti-D formed in pregnant women with this phenotype is capable of causing severe HDFN.
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Affiliation(s)
- Elona Turley
- Department of Laboratory Medicine and Pathology, University of Alberta.,Alberta Health Services, Edmonton, Alberta, Canada
| | - Eunike C McGowan
- Research and Development, Australian Red Cross Blood Service, Kelvin Grove, Brisbane, Queensland, Australia
| | - Catherine A Hyland
- Research and Development, Australian Red Cross Blood Service, Kelvin Grove, Brisbane, Queensland, Australia
| | - Elizna M Schoeman
- Research and Development, Australian Red Cross Blood Service, Kelvin Grove, Brisbane, Queensland, Australia
| | - Robert L Flower
- Research and Development, Australian Red Cross Blood Service, Kelvin Grove, Brisbane, Queensland, Australia
| | - Amanda Skoll
- Maternal Fetal Medicine, Department of Obstetrics and Gynecology, BC Women's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Marie-France Delisle
- Maternal Fetal Medicine, Department of Obstetrics and Gynecology, BC Women's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Tanya Nelson
- Molecular Genetics Laboratory, Department of Pathology and Laboratory Medicine, BC Children's Hospital and BC Women's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Gwen Clarke
- Department of Laboratory Medicine and Pathology, University of Alberta.,Canadian Blood Services, Edmonton, Alberta, Canada
| | - Nicholas Au
- Hematopathology, Department of Pathology and Laboratory Medicine, BC Children's Hospital and BC Women's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
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McGowan EC, Lopez GH, Knauth CM, Liew YW, Condon JA, Ramadi L, Parsons K, Turner EM, Flower RL, Hyland CA. Diverse and novelRHDvariants in Australian blood donors with a weak D phenotype: implication for transfusion management. Vox Sang 2017; 112:279-287. [DOI: 10.1111/vox.12488] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Revised: 12/21/2016] [Accepted: 12/21/2016] [Indexed: 12/13/2022]
Affiliation(s)
- E. C. McGowan
- Clinical Services and Research; Australian Red Cross Blood Service; Kelvin Grove QLD Australia
| | - G. H. Lopez
- Clinical Services and Research; Australian Red Cross Blood Service; Kelvin Grove QLD Australia
| | - C. M. Knauth
- Clinical Services and Research; Australian Red Cross Blood Service; Kelvin Grove QLD Australia
- School of Biomedical Sciences; Faculty of Health; Queensland University of Technology; Brisbane QLD Australia
| | - Y.-W. Liew
- Red Cell Reference Laboratory; Australian Red Cross Blood Service; Kelvin Grove QLD Australia
| | - J. A. Condon
- Red Cell Reference Laboratory; Australian Red Cross Blood Service; West Melbourne Vic. Australia
| | - L. Ramadi
- Red Cell Reference Laboratory; Australian Red Cross Blood Service; West Melbourne Vic. Australia
| | - K. Parsons
- Red Cell Reference Laboratory; Australian Red Cross Blood Service; Alexandria NSW Australia
| | - E. M. Turner
- Red Cell Reference Laboratory; Australian Red Cross Blood Service; Kelvin Grove QLD Australia
| | - R. L. Flower
- Clinical Services and Research; Australian Red Cross Blood Service; Kelvin Grove QLD Australia
| | - C. A. Hyland
- Clinical Services and Research; Australian Red Cross Blood Service; Kelvin Grove QLD Australia
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Golovkina LL, Stremoukhova AG, Pushkina TD, Kalandarov RS, Atroshchenko GV, Vasilyeva MN, Surin VL, Salomashkina VV, Pshenichnikova OS, Miterev GY, Parovichnikova EN, Savchenko VG. [Molecular serological characteristics of weak D antigen types of the Rhesus system]. TERAPEVT ARKH 2016; 88:78-83. [PMID: 27459619 DOI: 10.17116/terarkh201688778-83] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
AIM to estimate the spread of weak D antigen types of the Rhesus system in the citizens of the Russian Federation and a possibility of serologically identifying these types. SUBJECTS AND METHODS The red blood cells and DNA of people with weakened expression of D antigen were investigated using erythrocyte agglutination reaction in salt medium (2 methods); agglutination reaction in the gel columns containing IgM + IgG anti-D antibodies, indirect antiglobulin test with IgG anti-D antibodies (2 methods); polymerase chain reaction to establish the type of weak D. RESULTS A rhesus phenotype was determined in 5100 people in 2014-2015. The weakened agglutinable properties of red blood cells were detected in 102 (2%) examinees. 63 examinees underwent genotyping to identify the variants of the weak D antigen, which identified 6 weak D types. There were the most common weak D types 3 (n=31 (49.2%)) and weak D type 1 (n=18 (28.6%)), including weak D type 1.1 in one (1.6%) case. The other 4 weak D antigen types were as follows: weak D type 2 (14.3% (n=9)), weak D type 15 (4.8% (n=3)), weak D type 4.2 (DAR) (1.6% (n=1)) and weak D type 6 (1.6% (n=1)). The antiglobulin test in the gel column containing antiglobulin serum was the most sensitive serological assay to identify the weak D antigen. Only a molecular test could establish weak D type 15 in 2 samples of red blood cells with Ccdee and ccdEe phenotypes. CONCLUSION The weak D antigen could be serologically identified in 96.8% of cases. When testing for weak D, particular attention should be given to people with the D-negative phenotype who had the C or E antigens. Our investigations conducted for the first time in Russia will be able to improve the immunological safety of red blood cell-containing medium transfusions for patients.
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Affiliation(s)
- L L Golovkina
- National Research Centre for Hematology, Ministry of Health of Russia, Moscow, Russia
| | - A G Stremoukhova
- National Research Centre for Hematology, Ministry of Health of Russia, Moscow, Russia
| | - T D Pushkina
- National Research Centre for Hematology, Ministry of Health of Russia, Moscow, Russia
| | - R S Kalandarov
- National Research Centre for Hematology, Ministry of Health of Russia, Moscow, Russia
| | - G V Atroshchenko
- National Research Centre for Hematology, Ministry of Health of Russia, Moscow, Russia
| | - M N Vasilyeva
- National Research Centre for Hematology, Ministry of Health of Russia, Moscow, Russia
| | - V L Surin
- National Research Centre for Hematology, Ministry of Health of Russia, Moscow, Russia
| | - V V Salomashkina
- National Research Centre for Hematology, Ministry of Health of Russia, Moscow, Russia
| | - O S Pshenichnikova
- National Research Centre for Hematology, Ministry of Health of Russia, Moscow, Russia
| | - G Yu Miterev
- National Research Centre for Hematology, Ministry of Health of Russia, Moscow, Russia
| | - E N Parovichnikova
- National Research Centre for Hematology, Ministry of Health of Russia, Moscow, Russia
| | - V G Savchenko
- National Research Centre for Hematology, Ministry of Health of Russia, Moscow, Russia
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8
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Lopez GH, McGowan EC, McGrath KA, Abaca‐Cleopas ME, Schoeman EM, Millard GM, O'Brien H, Liew Y, Flower RL, Hyland CA. A D+ blood donor with a novelRHD*D‐CE(5‐6)‐Dgene variant exhibits the low‐frequency antigen RH23 (DW) characteristic of the partial DVa phenotype. Transfusion 2016; 56:2322-30. [DOI: 10.1111/trf.13713] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2016] [Revised: 05/23/2016] [Accepted: 05/24/2016] [Indexed: 12/28/2022]
Affiliation(s)
- Genghis H. Lopez
- Clinical Services and ResearchAustralian Red Cross Blood ServiceKelvin Grove Queensland Australia
| | - Eunike C. McGowan
- Clinical Services and ResearchAustralian Red Cross Blood ServiceKelvin Grove Queensland Australia
| | - Kelli A. McGrath
- Red Cell Reference LaboratoryAustralian Red Cross Blood ServiceKelvin Grove Queensland Australia
| | - Maria E. Abaca‐Cleopas
- Red Cell Reference LaboratoryAustralian Red Cross Blood ServiceKelvin Grove Queensland Australia
| | - Elizna M. Schoeman
- Clinical Services and ResearchAustralian Red Cross Blood ServiceKelvin Grove Queensland Australia
| | - Glenda M. Millard
- Clinical Services and ResearchAustralian Red Cross Blood ServiceKelvin Grove Queensland Australia
| | - Helen O'Brien
- Clinical Services and ResearchAustralian Red Cross Blood ServiceKelvin Grove Queensland Australia
| | - Yew‐Wah Liew
- Red Cell Reference LaboratoryAustralian Red Cross Blood ServiceKelvin Grove Queensland Australia
| | - Robert L. Flower
- Clinical Services and ResearchAustralian Red Cross Blood ServiceKelvin Grove Queensland Australia
| | - Catherine A. Hyland
- Clinical Services and ResearchAustralian Red Cross Blood ServiceKelvin Grove Queensland Australia
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Wang M, Wang BL, Xu W, Fan DD, Peng ML, Pan J, Yao P, Jiang GM, Wan XJ. Anti-D alloimmunisation in pregnant women with DEL phenotype in China. Transfus Med 2015; 25:163-9. [PMID: 26033335 DOI: 10.1111/tme.12211] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Revised: 04/02/2015] [Accepted: 05/03/2015] [Indexed: 01/28/2023]
Affiliation(s)
- M. Wang
- The Department of Blood Transfusion; Affiliated Provincial Hospital of Anhui Medical University; Hefei Anhui China
- The Department of Laboratory Medicine; Affiliated Provincial Hospital of Anhui Medical University; Hefei Anhui China
| | - B. L. Wang
- The Department of Laboratory Medicine; Affiliated Provincial Hospital of Anhui Medical University; Hefei Anhui China
| | - W. Xu
- The Department of Blood Transfusion; The First Affiliated Hospital of Anhui Medical University; Hefei Anhui China
| | - D. D. Fan
- The Department of Epidemiology & Biostatistics, School of Public Health; Anhui Medical University; Hefei Anhui China
| | - M. L. Peng
- The Department of Epidemiology & Biostatistics, School of Public Health; Anhui Medical University; Hefei Anhui China
| | - J. Pan
- The Department of Blood Transfusion; Affiliated Provincial Hospital of Anhui Medical University; Hefei Anhui China
| | - P. Yao
- The Department of Laboratory Medicine; Affiliated Provincial Hospital of Anhui Medical University; Hefei Anhui China
| | - G. M. Jiang
- The Department of Blood Transfusion; Affiliated Provincial Hospital of Anhui Medical University; Hefei Anhui China
| | - X. J. Wan
- The Department of Blood Transfusion; Affiliated Provincial Hospital of Anhui Medical University; Hefei Anhui China
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Van Sandt VS, Gassner C, Emonds MP, Legler TJ, Mahieu S, Körmöczi GF. RHDvariants in Flanders, Belgium. Transfusion 2014; 55:1411-7. [DOI: 10.1111/trf.12947] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Revised: 09/22/2014] [Accepted: 10/10/2014] [Indexed: 11/29/2022]
Affiliation(s)
- Vicky S.T. Van Sandt
- Histocompatibility and Immunogenetic Laboratory; Red Cross Flanders; Mechelen Belgium
| | - Christoph Gassner
- Blood Transfusion Service Zürich; Swiss Red Cross; Schlieren Switzerland
| | - Marie-Paule Emonds
- Histocompatibility and Immunogenetic Laboratory; Red Cross Flanders; Mechelen Belgium
| | - Tobias J. Legler
- Department of Transfusion Medicine; University of Göttingen; Göttingen Germany
| | - Sarah Mahieu
- Histocompatibility and Immunogenetic Laboratory; Red Cross Flanders; Mechelen Belgium
- ZNA Stuivenberg; Antwerp Belgium
| | - Günther F. Körmöczi
- Department of Blood Group Serology and Transfusion Medicine; Medical University of Vienna; Vienna Austria
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11
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Scott SA, Nagl L, Tilley L, Liew YW, Condon J, Flower R, Hyland CA. The RHD(1227G>A) DEL-associated allele is the most prevalent DEL allele in Australian D- blood donors with C+ and/or E+ phenotypes. Transfusion 2014; 54:2931-40. [PMID: 24894016 DOI: 10.1111/trf.12701] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2013] [Revised: 02/20/2014] [Accepted: 03/02/2014] [Indexed: 12/16/2022]
Abstract
BACKGROUND Red blood cells (RBCs) with D antigen levels only detected by anti-D adsorption-elution and an antiglobulin test express a DEL phenotype. For two DEL types, including RHD(1227G>A), immunization of D- recipients has been reported. This study's aim was to measure the prevalence of DEL-associated RHD alleles in a cohort of Australian D- donors to develop a model to estimate alloimmunization risk. STUDY DESIGN AND METHODS D-, C+ and/or E+ blood donors were screened for RHD exons using quantitative polymerase chain reaction. Donors with RHD signals were DEL phenotyped with MCAD6 anti-D. RHD alleles were characterized via single-nucleotide polymorphism array or sequencing. Extended DEL phenotyping was performed with an anti-D panel. RESULTS Among 2027 donors, 39 carried RHD alleles that have been previously reported to associate with either the DEL or the weak D phenotype. An additional five donors carried previously unreported RHD alleles and exhibited the DEL phenotype: RHD(IVS2-2delA), RHD(IVS1+5G>C), RHD(ex9:del/CE), and RHD(ex8:del/CE) represented twice. In total, DEL/weak D-associated RHD alleles were detected in 44 of 2027 donors or 2.17% (95% confidence interval, 1.54%-2.81%). The RHD(1227G>A) DEL allele was the most frequent (n = 16). The risk of transfusing D- females not more than 40 years of age with an RHD(1227G>A) DEL RBC unit (when managed as D-) is estimated to be one in 149,109 transfusions (range, 100,680-294,490). CONCLUSION DEL/weak D-associated RHD alleles were found in 2.17% of Australian D-, C+ and/or E+ blood donors. This differs from previous European reports in that the clinically significant RHD(1227G>A) DEL allele is the most prevalent.
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Affiliation(s)
- Stacy A Scott
- Research and Development, Australian Red Cross Blood Service, Brisbane, Australia
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12
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Analysis of density and epitopes of D antigen on the surface of erythrocytes from DEL phenotypic individuals carrying the RHD1227A allele. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2013; 12:244-9. [PMID: 24333082 DOI: 10.2450/2013.0091-13] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 03/14/2013] [Accepted: 08/28/2013] [Indexed: 11/21/2022]
Abstract
BACKGROUND The characteristics of the D antigen are important as they influence the immunogenicity of D variant cells. Several studies on antigenic sites have been reported in normal D positive, weak D and partial D cases, including a comprehensive analysis of DEL types in Caucasians. The aim of this study was to assess D antigen density and epitopes on the erythrocyte surface of Asian type DEL phenotypic individuals carrying the RHD1227A allele in the Chinese population. MATERIALS AND METHODS A total of 154 DEL phenotypic individuals carrying the RHD1227A allele were identified through adsorption and elution tests and polymerase chain reaction analysis with sequence-specific primers in the Chinese population. D antigen density on the erythrocyte surface of these individuals was detected using a flow cytometric method. An erythrocyte sample with known D antigen density was used as a standard. Blood samples from D-negative and D-positive individuals were used as controls. In addition, D antigen epitopes on the erythrocyte surface of DEL individuals carrying the RHD1227A allele were investigated with 18 monoclonal anti-D antibodies specific for different D antigen epitopes. RESULTS The means of the median fluorescence intensity of D antigen on the erythrocyte membrane surface of D-negative, D-positive and DEL individuals were 2.14±0.25, 193.61±11.43 and 2.45±0.82, respectively. The DEL samples were estimated to have approximately 22 D antigens per cell. The samples from all 154 DEL individuals reacted positively with 18 monoclonal anti-D antibodies specific for different D antigen epitopes. DISCUSSION In this study, D antigen density on the erythrocyte surface of DEL individuals carrying the RHD1227A allele was extremely low, there being only very few antigenic molecules per cell, but the D antigen epitopes were grossly complete.
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13
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Goossens D, da Silva N, Metral S, Cortes U, Callebaut I, Picot J, Mouro-Chanteloup I, Cartron JP. Mice expressing RHAG and RHD human blood group genes. PLoS One 2013; 8:e80460. [PMID: 24260394 PMCID: PMC3832391 DOI: 10.1371/journal.pone.0080460] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2013] [Accepted: 10/02/2013] [Indexed: 11/18/2022] Open
Abstract
Anti-RhD prophylaxis of haemolytic disease of the fetus and newborn (HDFN) is highly effective, but as the suppressive mechanism remains uncertain, a mouse model would be of interest. Here we have generated transgenic mice expressing human RhAG and RhD erythrocyte membrane proteins in the presence and, for human RhAG, in the absence, of mouse Rhag. Human RhAG associates with mouse Rh but not mouse Rhag on red blood cells. In Rhag knockout mice transgenic for human RHAG, the mouse Rh protein is “rescued” (re-expressed), and co-immunoprecipitates with human RhAG, indicating the presence of hetero-complexes which associate mouse and human proteins. RhD antigen was expressed from a human RHD gene on a BAC or from RHD cDNA under control of β-globin regulatory elements. RhD was never observed alone, strongly indicative that its expression absolutely depends on the presence of transgenic human RhAG. This first expression of RhD in mice is an important step in the creation of a mouse model of RhD allo-immunisation and HDFN, in conjunction with the Rh-Rhag knockout mice we have developed previously.
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Affiliation(s)
- Dominique Goossens
- Institut National de la Transfusion Sanguine, Paris, France
- Inserm UMR_S 665, Paris, France
- Université Paris Diderot, Sorbonne Paris Cité, UMR-S665, Paris, France
- * E-mail:
| | - Nelly da Silva
- Institut National de la Transfusion Sanguine, Paris, France
| | - Sylvain Metral
- Institut National de la Transfusion Sanguine, Paris, France
| | - Ulrich Cortes
- Institut National de la Transfusion Sanguine, Paris, France
| | - Isabelle Callebaut
- IInstitut de Minéralogie et de Physique des milieux Condensés UMR 7590 CNRS, Université Pierre et Marie Curie, Paris, France
| | - Julien Picot
- Institut National de la Transfusion Sanguine, Paris, France
- Inserm UMR_S 665, Paris, France
- Université Paris Diderot, Sorbonne Paris Cité, UMR-S665, Paris, France
| | - Isabelle Mouro-Chanteloup
- Institut National de la Transfusion Sanguine, Paris, France
- Inserm UMR_S 665, Paris, France
- Université Paris Diderot, Sorbonne Paris Cité, UMR-S665, Paris, France
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Lejon Crottet S, Haer-Wigman L, Gowland P, Fontana S, Niederhauser C, Hustinx H. Serologic and molecular investigations of DAR1 (weak D Type 4.2), DAR1.2, DAR1.3, DAR2 (DARE), and DARA. Transfusion 2013; 53:3000-8. [PMID: 23902153 DOI: 10.1111/trf.12363] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2012] [Revised: 06/17/2013] [Accepted: 06/25/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND The partial D variant DAR1 (weak D Type 4.2) is caused by three single-point mutations, 602C>G, 667T>G, and 1025T>C. Here we report a molecular study on different D variants belonging to the DAR category (DAR1, DAR1.2, DAR1.3, and DAR2) and their serologic data. STUDY DESIGN AND METHODS A total of 42 samples belonging to the DAR category were screened for the presence of the silent mutations 744C>T and 957G>A. The samples were phenotyped for RhD and RhCE, characterized for RhD epitope expression, and sequenced for RHD exons. Flow cytometry was performed to determine RhD antigen density. RESULTS The silent mutation 744C>T was found in all six samples previously typed as RHD*DAR2 (602C>G, 667T>G, 957G>A, 1025T>C). In addition to the three nucleotide changes originally reported for the RHD*DAR1 allele, the silent mutations 744C>T and 957G>A were found in 14 of 16 samples previously typed as RHD*DAR1. In the remaining two samples one additional silent mutation, 744C>T, was found. Serologically the DAR1.2 and DAR1.3 samples analyzed in this study showed no distinct difference in their anti-D reaction pattern compared to each other. The anti-D reaction pattern of DARA/DAR2 showed some distinct differences compared to those of DAR1.2 and DAR1.3. CONCLUSION RHD*DARA and RHD*DAR2 are the same allele. Furthermore, the alleles RHD*DAR1.2 and RHD*DAR1.3 both exist; however, the silent mutation 957G>A (V319) showed no influence on the RhD phenotype.
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Gassner C, Utz I, Schennach H, Ramoni A, Steiner H, Scholz S, Kreklau U, Körmöczi GF. Novel RHD alleles with weak hemagglutination and genetic Exon 9 diversity: weak D Types 45.1, 75, and 76. Transfusion 2013; 53:2954-9. [PMID: 23550956 DOI: 10.1111/trf.12180] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2012] [Revised: 01/22/2013] [Accepted: 02/10/2013] [Indexed: 11/26/2022]
Abstract
BACKGROUND Molecular variant RHD allele analysis is best complemented by detailed characterization of the associated D phenotype. STUDY DESIGN AND METHODS Variant D types were characterized using molecular typing, RHD sequencing, extended serologic D antigen investigations, and flow cytometric D antigen quantification. RESULTS We discovered three novel weak D types termed weak D Types 45.1, 75, and 76 with RHD nucleotide substitutions coding for amino acid exchanges in predicted intracellular RhD polypeptide stretches; antigen densities of approximately 1.990, 900, and 240 D sites per red blood cell were found, respectively. Adsorption-elution technique-supported D epitope mapping of these three weak D types demonstrated the expression of all tested D epitopes. Initial molecular typing of the three investigated samples by RHD gene exon scanning polymerase chain reaction using sequence-specific priming yielded a negative reaction for A1193 located in RHD Exon 9 and could be explained by specific mutations for weak D Types 45.1 (C818T, G1195A), 75 (G1194C), and 76 (A1215C). CONCLUSION All novel weak D types expressed all tested D epitopes. It is of interest that for weak D Types 45.1, 75, and 76, similar alleles with a maximal divergence of one amino acid only, that is, weak D Types 45, 41, and 68, respectively, have been reported so far.
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Affiliation(s)
- Christoph Gassner
- Blood Transfusion Service Zurich, Swiss Red Cross, Zurich, Switzerland; Central Institute for Blood Transfusion and Immunological Department, General Hospital and University Clinics Innsbruck, Innsbruck, Austria; Department of Obstetrics and Gynecology, Medical University Innsbruck, Innsbruck, Austria; Urology, Medical University Innsbruck, Innsbruck, Austria; inno-Train Diagnostik GmbH, Kronberg i.T., Germany; Labor Wisplinghoff, Cologne, Germany; Department of Blood Group Serology and Transfusion Medicine, Medical University of Vienna, Vienna, Austria
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16
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Westhoff CM, Vege S, Halter Hipsky C, Hue-Roye K, Copeland T, Velliquette RW, Horn T, Lomas-Francis C, Reid ME. RHCE*ceTI encodes partial c and partial e and is often in cis to RHD*DIVa. Transfusion 2013; 53:741-6. [PMID: 22804620 PMCID: PMC3477252 DOI: 10.1111/j.1537-2995.2012.03800.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND In the Rh blood group system, variant RhD and RhCE express several partial antigens. We investigated RH in samples with partial DIVa that demonstrated weak and variable reactivity with anti-C. STUDY DESIGN AND METHODS Standard hemagglutination techniques, polymerase chain reaction-based assays, and RH sequencing were used. RESULTS DNA analysis showed that six red blood cell (RBC) samples with weak and inconsistent reactivity with anti-C lacked RHCE*C, but all had RHD*DIVa, which encodes partial D and Go(a) . We then tested RBCs from 19 Go(a+) cryopreserved samples (confirmed to have RHD*DIVa) with four anti-C and observed weak variable reactions. RHCE genotyping found all but one of the samples with RHD*DIVa also had RHCE nt 48G>C and 1025C>T, named RHCE*ceTI. Lookback of samples referred for workup and found to have either allele revealed 47 of 55 had both RHD*DIVa and RHCE*ceTI, four had RHD*DIVa without RHCE*ceTI, and four had RHCE*ceTI without RHD*DIVa. Alloanti-c was found in a patient with c+ RBCs and RHCE*ceTI in trans to RHCE*Ce, and alloanti-e was found in a patient with e+ RBC and RHCE*ceTI in trans to RHCE*cE. RHD*DIVa in trans to RHD erroneously tested as RHD hemizygous. CONCLUSIONS RHD*DIVa and RHCE*ceTI almost always, but not invariably, travel together. This haplotype is found in people of African ancestry and the RBCs can demonstrate aberrant reactivity with anti-C. RHCE*ceTI encodes partial c and e antigens. We confirm that RHD zygosity assays are unreliable in samples with RHD*DIVa.
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Affiliation(s)
- Connie M Westhoff
- Laboratory of Immunohematology and Genomics, New York Blood Center, Long Island City, New York 10065, USA.
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17
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von Zabern I, Wagner FF, Moulds JM, Moulds JJ, Flegel WA. D category IV: a group of clinically relevant and phylogenetically diverse partial D. Transfusion 2013; 53:2960-73. [PMID: 23461862 DOI: 10.1111/trf.12145] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2012] [Revised: 01/06/2013] [Accepted: 01/10/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND The D typing strategies in several European countries protect carriers of D category VI (DVI) from anti-D immunization but not carriers of other partial D. Besides DVI, one of the clinically most important partial D is D category IV (DIV). A detailed description and direct comparison of the different DIV types was missing. STUDY DESIGN AND METHODS RHD nucleotide sequences were determined from genomic DNA. D epitope patterns were established with commercial monoclonal anti-D panels. RESULTS DIV comprises several variants of the D antigen with distinct serology, molecular structures, evolutionary origins, and ethnic prevalences. The DIV phenotype is determined by 350H shared by all, but not limited to, DIV variants which are further divided into DIVa and DIVb. The DIVa phenotype is expressed by DIV Type 1.0 harboring 350H and the dispersed amino acids 62F, 137V, and 152T. The DIVb phenotype is expressed by DIV Type 3 to Type 5 representing RHD-CE-D hybrids. Four of the six postulated DIV variants were encountered among 23 DIV samples analyzed. Of 12 DIV carriers with anti-D, 10 were female and seven likely immunized by pregnancy. Two DIV-related alleles are newly described: DWN, which differs from DIV Type 4 by 350D and epitope pattern. DNT carries 152T, known to cause a large D antigen density. CONCLUSION DIV alleles arose from at least two independent evolutionary events. DIV Type 1.0 with DIVa phenotype belongs to the oldest extant human RHD alleles. DIV Type 2 to Type 5 with DIVb phenotype arose from more recent gene conversions. Anti-D immunization, especially dreaded in pregnancies, will be avoided not only in carriers of DVI but also in carriers of other D variants like DIV, if our proposed D typing strategy is adopted.
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Affiliation(s)
- Inge von Zabern
- Department of Transfusion Medicine, University Hospital, Ulm, Germany; Institute for Clinical Transfusion Medicine and Immunogenetics, Ulm, Germany; DRK (German Red Cross) Blood Donor Service Baden-Württemberg-Hessen, Institute, Ulm, Germany; DRK Blood Donor Service NSTOB, Institute, Springe, Germany; Scientific Support Services, LifeShare Blood Centers, Shreveport, Louisiana; Department of Transfusion Medicine, Clinical Center, National Institutes of Health, Bethesda, Maryland
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18
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Affiliation(s)
- Geoff Daniels
- International Blood Group Reference Laboratory; NHS Blood and Transplant; Bristol UK
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19
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Abstract
The postpartum dose of Rh immune globulin varies according to an individual laboratory estimation of fetal red blood cells in each mother's peripheral blood. In the United States, a four-step procedure determines the postpartum dose (number of vials of 300 micrograms; 1,500 international units) of Rh immune globulin (anti-D) for each RhD-negative mother who has delivered an RhD-positive newborn and has not already formed anti-D. The first step is a rosette fetal red blood cell screen to determine whether an excessive (greater than 30 mL fetal whole blood) fetomaternal hemorrhage occurred. If the rosette screen is negative, the mother receives one vial of Rh immune globulin for Rh immunoprophylaxis. If the rosette screen is positive, the blood sample is retested by a quantitative method, typically an acid-elution (Kleihauer-Betke) assay. The result of the acid-elution assay is converted to an estimation of the volume of the fetomaternal hemorrhage, which is the basis for calculating the dose of Rh immune globulin. The acid-elution assay is subjective, imprecise, and poorly reproducible. As a result, the formula for calculating the dose includes a precautionary adjustment, adding an extra vial in borderline situations to prevent underdosing. Flow cytometry is a more precise method for quantifying a fetomaternal hemorrhage. However, few hospitals use flow cytometry, because it is not cost-effective to maintain an expensive, high-technology laboratory service for the relatively few occasions when a precise quantitative determination of fetomaternal hemorrhage is required.
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Haer-Wigman L, Veldhuisen B, Jonkers R, Lodén M, Madgett TE, Avent ND, de Haas M, van der Schoot CE. RHDandRHCEvariant and zygosity genotyping via multiplex ligation-dependent probe amplification. Transfusion 2012; 53:1559-74. [DOI: 10.1111/j.1537-2995.2012.03919.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2012] [Revised: 07/17/2012] [Accepted: 08/20/2012] [Indexed: 01/23/2023]
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21
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Yver A, Homery MC, Fuseau E, Guemas E, Dhainaut F, Quagliaroli D, Beliard R, Prost JF. Pharmacokinetics and safety of roledumab, a novel human recombinant monoclonal anti-RhD antibody with an optimized Fc for improved engagement of FCγRIII, in healthy volunteers. Vox Sang 2012; 103:213-22. [DOI: 10.1111/j.1423-0410.2012.01603.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Silvy M, Chapel-Fernandes S, Callebaut I, Beley S, Durousseau C, Simon S, Lauroua P, Dubosc-Marchenay N, Babault C, Mouchet C, Ferrera V, Chiaroni J, Bailly P. Characterization of novel RHD alleles: relationship between phenotype, genotype, and trimeric architecture. Transfusion 2012; 52:2020-9. [DOI: 10.1111/j.1537-2995.2011.03544.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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23
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Gardener GJ, Legler TJ, Hyett JA, Liew YW, Flower RL, Hyland CA. Anti-D in pregnant women with the RHD(IVS3+1G>A)-associated DEL phenotype. Transfusion 2012; 52:2016-9. [DOI: 10.1111/j.1537-2995.2011.03538.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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24
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Ye L, Wang P, Gao H, Zhang J, Wang C, Li Q, Han S, Guo Z, Yang Y, Zhu Z. Partial D phenotypes and genotypes in the Chinese population. Transfusion 2011; 52:241-6. [DOI: 10.1111/j.1537-2995.2011.03266.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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25
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Hipsky CH, Lomas-Francis C, Fuchisawa A, Reid ME, Moulds M, Christensen J, Nickle P, Vege S, Westhoff C. RHCE*ceCF encodes partial c and partial e but not CELO, an antigen antithetical to Crawford. Transfusion 2011; 51:25-31. [PMID: 20609196 DOI: 10.1111/j.1537-2995.2010.02764.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND RH43 (Crawford) is encoded by RHCE*ce with nucleotide changes 48G>C, 697C>G, and 733C>G (RHCE*ceCF). We investigated the Rh antigen expression and antibody specificities in four patients with this allele. STUDY DESIGN AND METHODS Hemagglutination tests, DNA extraction, polymerase chain reaction (PCR)-restriction fragment length polymorphism, allele-specific PCR, reticulocyte RNA isolation, reverse transcription-PCR cDNA analyses, cloning, and sequencing were performed by standard procedures. RESULTS Red blood cells (RBCs) from two patients typed D+C-E-c+e+/-, hrS-/+W, hrB- and their serum was reactive (3+) with all RBC samples of common Rh phenotype tested, but nonreactive with Rhnull or D-- RBCs (apparent alloanti-Rh17). At the RHCE locus, Patient 1 was homozygous for RHCE*ceCF, and Patient 2 inherited RHCE*ceCF in trans to a silenced RHCE*cE. Cross-testing of serum and RBCs from these two samples showed mutual compatibility, indicating that both antibodies define the same novel high-prevalence antigen on Rhce. Two additional patients, one whose serum contained alloanti-c but the RBCs typed C+c+ and one whose serum contained anti-e but the RBCs typed E+e+, also had RHCE*ceCF. RHCE*Ce was present in trans in the former and RHCE*cE in the latter patient. CONCLUSION We report that amino acid changes on RhceCF (Trp16Cys, Gln233Glu, and Leu245Val) alter the protein to the extent that c and e antigens are partial, and a high-prevalence antigen, we have named CELO (provisional ISBT Number 004058; RH58) is not expressed. CELO is antithetical to RH43 (Crawford).
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Affiliation(s)
- Christine Halter Hipsky
- Laboratories of Immunohematology and Immunochemistry, New York Blood Center, New York, New York 10065, USA
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Flegel WA, von Zabern I, Doescher A, Wagner FF, Strathmann KP, Geisen C, Palfi M, Písacka M, Poole J, Polin H, Gabriel C, Avent ND. D variants at the RhD vestibule in the weak D type 4 and Eurasian D clusters. Transfusion 2009; 49:1059-69. [PMID: 19309476 PMCID: PMC10710224 DOI: 10.1111/j.1537-2995.2009.02102.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND One branch of the RHD phylogenetic tree is represented by the weak D type 4 cluster of alleles with F223V as the primordial amino acid substitution. F223V as well as a large number of further substitutions causing D variants are located at the extracellular RhD protein vestibule, which represents the entrance to the transmembraneous channel of the RhD protein. STUDY DESIGN AND METHODS RHD and RHCE nucleotide sequences were determined from genomic DNA and cDNA. D epitope patterns were established with commercial monoclonal anti-D panels. RESULTS The RHD alleles DOL-1 and DOL-2 had the two amino acid substitutions M170T (509T>C) and F223V (667T>G) in common. DOL-2 harbored the additional substitution L378V (1132C>G). Both alleles were observed in Africans and are probably evolutionary related. DMI carried M170I (510G>A), which differed from the DOL-typical substitution. DFW and DFL harbored the substitutions H166P (497A>C) and Y165C (494A>G). The antigen densities of DOL-1, DFL, and DFW were only moderately reduced. CONCLUSION DOL-1 and DOL-2 belong to the weak D type 4 cluster of RHD alleles. Together with DMI, DFL, and DFW they represent D variants with amino acid substitutions located at extracellular loops 3 or 4 lining the RhD protein vestibule. These substitutions were of minor influence on antigen density while adjacent substitutions in the transmembraneous section caused weak D antigen expression. All these D variants were partial D and alloanti-D immunizations have been observed in DOL-1, DMI, and DFL carriers. The substitution at position 170 causes partial D although located deep in the vestibule.
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Affiliation(s)
- Willy A Flegel
- Institute for Transfusion Medicine, University Hospital, Ulm, Germany.
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27
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Hustinx H, Poole J, Bugert P, Gowland P, Still F, Fontana S, Scharberg EA, Tilley L, Daniels G, Niederhauser C. Molecular basis of the Rh antigen RH48 (JAL). Vox Sang 2009; 96:234-9. [PMID: 19207167 DOI: 10.1111/j.1423-0410.2008.01142.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- H Hustinx
- Blood Transfusion Service SRC Bern, Murtenstrasse 133, Berne, Switzerland.
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28
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Lai M, Grasso C, Boschi I, D'Onofrio G, Pascali V, Leone G. Characterization of anti-D monoclonal antibody reagents based on their reactivity with the weak D phenotype. Transfusion 2009; 49:937-42. [PMID: 19175552 DOI: 10.1111/j.1537-2995.2008.02066.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Anti-D monoclonal antibody (MoAb) reagents have improved D typing in routine tests. However, they exhibit a wide range of reactivity with the weak D phenotype depending on the characteristics of the different MoAbs used. We analyzed the reactivity of immunoglobulin (IgM) anti-D by cluster analysis to characterize MoAb that have similar reactivities with the weak D phenotype. STUDY DESIGN AND METHODS We used 36 consecutive samples with weak D phenotype in routine testing and determined their reactivity with different IgM and IgG anti-D MoAbs. The samples were characterized as belonging to a weak D type or category using commercial molecular biology kits. RESULTS The various anti-D MoAbs showed a wide grade of reactivity with the weak D samples. Similarities and dissimilarities in the behavior of the anti-D MoAbs with the weak D phenotype samples were detected with cluster analysis and the multidimensional scaling analysis. These analyses indicated different families of MoAbs characterized as having a high degree of homogeneity in their reactivity with the weak D phenotype. Between these MoAb families, the most effective at reacting with the weak D phenotype were RUM-1 and 175-2. CONCLUSIONS The results show that it is possible to classify the anti-D MoAbs on the basis of their reactivity with the weak D phenotype. This provides information about different MoAbs' properties on the basis of their belonging to a given of anti-D family.
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Affiliation(s)
- Marco Lai
- Immunohematology Laboratory, Transfusion Centre, Catholic University of Sacred Heart, Rome, Italy.
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29
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Abstract
The molecular background of blood group antigen expression of the major clinically significant blood group antigens has been largely accomplished. Despite this large body of work, blood group phenotype prediction by genotyping has a marginal supporting role in the routine blood bank. It has however had a major impact in the prenatal determination of fetal blood group status in the management of haemolytic disease of the fetus and newborn. In the past few years several high throughput systems have been in development that have the potential capacity to perform genotyping on a mass scale. Such systems have been designed for use on donor- and patient-derived DNA and provide much more comprehensive information regarding an individuals blood group than is possible by using serological methods alone. DNA-based typing methodology is easier to standardize than serology and has the potential to replace it as a front line diagnostic in blood banks. This review overviews the current situation in this area and attempts to predict how blood group genotyping will evolve in the future.
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Affiliation(s)
- Neil D Avent
- Centre for Research in Biomedicine and UWE, Bristol Genomics Research Institute, Faculty of Health and Life Sciences, University of the West of England, Bristol, UK.
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30
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Kulkarni S, Colah R, Gorakshakar A, Gupte S, Vasantha K, Mohanty D, Ghosh K. Frequency of partial D in Western India. Transfus Med 2008; 18:91-6. [PMID: 18399842 DOI: 10.1111/j.1365-3148.2008.00848.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- S Kulkarni
- Institute of Immunohaematology (ICMR), 13th floor, New Multistoreyed building, KEM Hospital Campus, Parel, Mumbai, India.
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31
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Flegel WA, von Zabern I, Doescher A, Wagner FF, Vytisková J, Písacka M. DCS-1, DCS-2, and DFV share amino acid substitutions at the extracellular RhD protein vestibule. Transfusion 2007; 48:25-33. [PMID: 17900276 DOI: 10.1111/j.1537-2995.2007.01506.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND RhD and RhCE are structurally related to ammonium transporter proteins, yet their physiologic function remains unclear. Recent three-dimensional homology modeling with Escherichia coli AmtB as a template defined a putative transmembraneous channel. Three RhD variants with amino acid substitutions located at the extracellular channel aperture are described. STUDY DESIGN AND METHODS Blood samples were selected because of serologic abnormalities. RHD, RHCE, and LW nucleotide sequences were determined from genomic DNA. D epitope patterns were established with monoclonal anti-D panels. Three-dimensional Rh structures were calculated by alignment to AmtB. RESULTS The RHD allele DCS-1 was found to carry the two amino acid substitutions F223V (667T > G) and A226P (676G > C) caused by missense mutations in RHD exon 5. This study compared DCS-1 with the D variants DFV (F223V) and DCS-2 (A226P), harboring solely one or the other of the two substitutions. All three D variants were associated with a cDE haplotype. The antigen densities were approximately 3,000 D antigens per red blood cell for DCS-1, 800 for DCS-2, and 9,300 for DFV. DCS-1 and DCS-2 were partial D, because they lacked distinct epitopes. DFV presented as an almost normal D phenotype; the sample contained allo-anti-LW(a). The D(w) antigen was absent from DCS-1, DFV, and DAU-4, but expressed by DAU-5. CONCLUSION DCS-1, DCS-2, and DFV carry amino acid substitutions at the extracellular vestibule, visualized by 3-dimensional modeling. Proline at position 226 greatly influenced the D antigen density and may reduce the RhD membrane integration. Although the F223V substitution is regarded as the initial event in the evolution of the weak D Type 4 cluster, the current DFV allele probably evolved independently, as evident from different RHCE haplotypes.
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Affiliation(s)
- Willy A Flegel
- Institute for Transfusion Medicine, University Hospital Ulm, Ulm Germany.
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32
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Körmöczi GF, Dauber EM, Haas OA, Legler TJ, Clausen FB, Fritsch G, Raderer M, Buchta C, Petzer AL, Schönitzer D, Mayr WR, Gassner C. Mosaicism due to myeloid lineage–restricted loss of heterozygosity as cause of spontaneous Rh phenotype splitting. Blood 2007; 110:2148-57. [PMID: 17537994 DOI: 10.1182/blood-2007-01-068106] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
AbstractSpontaneous Rh phenotype alteration interferes with pretransfusion and prenatal blood group examinations and may potentially indicate hematologic disease. In this study, the molecular background of this biologic phenomenon was investigated. In 9 patients (3 with hematologic disease), routine RhD typing showed a mixture of D-positive and D-negative red cells not attributable to transfusion or hematopoietic stem-cell transplantation. In all patients, congenital and acquired chimerism was excluded by microsatellite analysis. In contrast to D-positive red cells, D-negative subpopulations were also negative for C or E in patients genotyped CcDdee or ccDdEe, respectively, which suggested the presence of erythrocyte precursors with an apparent homozygous cde/cde or hemizygous cde/— genotype. Except for one patient with additional Fyb antigen anomaly, no other blood group systems were affected. RH genotyping of single erythropoietic burst-forming units, combined with microsatellite analysis of blood, different tissues, sorted blood cell subsets, and erythropoietic burst-forming units, indicated myeloid lineage–restricted loss of heterozygosity (LOH) of variable chromosome 1 stretches encompassing the RHD/RHCE gene loci. Fluorescent in situ hybridization studies indicated that LOH was caused by either somatic recombination or deletion. Therefore, most cases of spontaneous Rh phenotype splitting appear to be due to hematopoietic mosaicism based on LOH on chromosome 1.
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Affiliation(s)
- Günther F Körmöczi
- Department of Blood Group Serology and Transfusion Medicine, Medical University of Vienna, Vienna, Austria.
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K¨orm¨oczi G. I06 Unusual RhD phenotypes recent advances and clinical implications. Blood Rev 2007. [DOI: 10.1016/s0268-960x(07)70007-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Flegel WA, Eicher NI, Doescher A, Hustinx H, Gowland P, Mansouri Taleghani B, Petershofen EK, Bauerfeind U, Ernst M, von Zabern I, Schrezenmeier H, Wagner FF. In-frame triplet deletions in RHD alter the D antigen phenotype. Transfusion 2007; 46:2156-61. [PMID: 17176329 DOI: 10.1111/j.1537-2995.2006.01046.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND The deletion of three adjacent nucleotides in an exon may cause the lack of a single amino acid, while the protein sequence remains otherwise unchanged. Only one such in-frame deletion is known in the two RH genes, represented by the RHCE allele ceBP expressing a "very weak e antigen." STUDY DESIGN AND METHODS Blood donor samples were recognized because of discrepant results of D phenotyping. Six samples came from Switzerland and one from Northern Germany. The molecular structures were determined by genomic DNA nucleotide sequencing of RHD. RESULTS Two different variant D antigens were explained by RHD alleles harboring one in-frame triplet deletion each. Both single-amino-acid deletions led to partial D phenotypes with weak D antigen expression. Because of their D category V-like phenotypes, the RHD(Arg229del) allele was dubbed DVL-1 and the RHD(Lys235del) allele DVL-2. These in-frame triplet deletions are located in GAGAA or GAAGA repeats of the RHD exon 5. CONCLUSION Partial D may be caused by a single-amino-acid deletion in RhD. The altered RhD protein segments in DVL types are adjacent to the extracellular loop 4, which constitutes one of the most immunogenic parts of the D antigen. These RhD protein segments are also altered in all DV, which may explain the similarity in phenotype. At the nucleotide level, the triplet deletions may have resulted from replication slippage. A total of nine amino acid positions in an Rhesus protein may be affected by this mechanism.
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Affiliation(s)
- Willy A Flegel
- Department of Transfusion Medicine, University Hospital, Ulm, Germany
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Flegel WA, Wagner FF, Chen Q, Schlanser G, Frame T, Westhoff CM, Moulds MK. The RHCE allele ceCF: the molecular basis of Crawford (RH43). Transfusion 2006; 46:1334-42. [PMID: 16934069 DOI: 10.1111/j.1537-2995.2006.00901.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND The Crawford antigen (RH43) was described in 1980. It occurred in African American people, as a low-prevalence Rhesus antigen, who were also VS+. STUDY DESIGN AND METHODS Twelve blood samples were analyzed because of inquiries into discrepant reactions in routine anti-D typing. The RHCE alleles were determined by nucleotide sequencing from genomic DNA. The D epitope profile was determined with 60 monoclonal anti-D. The population frequency was estimated in four major US regional blood centers. RESULTS The novel RHce(W16C, Q233E, L245V) allele, dubbed ceCF, was found to be occurring in the cde haplotype as cause of the reactivity with the immunoglobulin M anti-D GAMA401. The ceCF phenotype expressed few D epitopes resembling but not matching the reaction patterns observed with other RhCE variants, like R0 (Har), ceRT, and ceSL. The frequency of the ceCF phenotype was 0.056 percent among African American persons and 0.007 percent in the general US population. CONCLUSION The novel RHce(W16C, Q233E, L245V) allele, which is a variant of the known ce(s) allele, RHce(W16C, L245V), occurs in a haplotype with the RHD deletion and represents the molecular basis of the Crawford antigen.
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Affiliation(s)
- Willy A Flegel
- Department of Transfusion Medicine, University Hospital, Ulm, Germany.
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Yu X, Wagner FF, Witter B, Flegel WA. Outliers in RhD membrane integration are explained by variant RH haplotypes. Transfusion 2006; 46:1343-51. [PMID: 16934070 DOI: 10.1111/j.1537-2995.2006.00902.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND Variations in a multipass transmembrane protein may affect its membrane integration. To study this effect, the systematic molecular characterization of variant D antigen density is a suitable model. Unlike most other membrane proteins, the expression of the D antigen is often determined by a single allele, because it occurs frequently in hemizygous form. STUDY DESIGN AND METHODS The D antigen density distribution of 530 CcDee, 475 ccDEe, and 514 ccDee random samples was established by flow cytometry. The molecular bases of samples with D antigen densities outside a bell-shaped peak was investigated. RESULTS The antigen densities of 499 CcDee, 437 ccDEe, and 480 ccDee samples formed bell-shaped peaks. Three, 10, and 12 samples, respectively, had decreased antigen densities and carried variant RHD alleles. Weak D type 19, RHD(I204T); weak D type 20, RHD(F417S); and the partial D DYU (also known as DQC), RHD(R234W) were new RHD alleles. Twenty-eight CcDee, 28 ccDEe, and 22 ccDee samples had increased antigen densities; 53 of them lacked a hybrid Rhesus box and were thus predicted to be RHD homozygous. Eight ccDee samples were predicted to be heterozygous despite a large relative dose of RHD to RHCE alleles in quantitative polymerase chain reaction. One of these samples was further investigated and carried an RHD-CE hybrid transcript characteristic for a -D- haplotype. CONCLUSIONS Unusual little and large RhD protein integration into the membrane could be traced to a host of distinct protein variants. Weak expression of D antigen was invariably associated with variant RHD alleles. Larger than normal D antigen density may often be caused by the presence of two D encoding alleles, which may be located in cis, and confounding zygosity testing that is solely based on gene copy number.
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Affiliation(s)
- Xinjian Yu
- Department of Transfusion Medicine, University Hospital, and the Institute for Clinical Transfusion Medicine and Immunogenetics, Ulm, Germany
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Esteban R, Montero R, Flegel WA, Wagner FF, Subirana L, Parra R, Ribera A, Nogués N. The D category VI type 4 allele is prevalent in the Spanish population. Transfusion 2006; 46:616-23. [PMID: 16584438 DOI: 10.1111/j.1537-2995.2006.00762.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND The D category VI (DVI) is one of the clinically most important partial D. Three different molecular structures causing the DVI phenotype have been described. STUDY DESIGN AND METHODS To determine the molecular basis of the DVI phenotype in the Spanish population, 20 DVI samples, previously detected in serologic screening, were examined by polymerase chain reaction with RHD exon-specific primers. Unexpected findings were further pursued by cDNA nucleotide sequencing. RESULTS A novel pattern of RHD exon amplification was detected, which did not correspond to any of the previously described molecular structures. The cDNA sequence led to the identification of the new hybrid RHD-Ce(3-5)-D allele. The origin of exon 2 is undeterminable, because the 5' breakpoint was located within a region of RHD and RHCE identical sequence, which encompasses this exon. Sequencing of intron 5 allowed the 3' breakpoint to be mapped between the sixth and seventh polymorphic sites. Serologically, the hybrid protein has a D epitope expression pattern identical to the previously described DVI phenotypes and an antigen density slightly lower than DVI type 3. The new DVI variant is linked to the DCe haplotype and expresses the low-incidence BARC antigen. CONCLUSION A novel structure causing the DVI phenotype, here named DVI type 4, has been characterized. This novel structure is the most frequent cause of DVI in Spain.
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Affiliation(s)
- Rosa Esteban
- Immunohematology Service, Banc de Sang i Teixits, Barcelona, Spain
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Grootkerk-Tax MGHM, van Wintershoven JD, Ligthart PC, van Rhenen DJ, van der Schoot CE, Maaskant-van Wijk PA. RHD(T201R, F223V) cluster analysis in five different ethnic groups and serologic characterization of a new Ethiopian variant DARE, the DIII type 6, and the RHD(F223V). Transfusion 2006; 46:606-15. [PMID: 16584437 DOI: 10.1111/j.1537-2995.2006.00759.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The RHD phylogeny in humans shows four main clusters of which three are predominantly observed in (African) black persons. Each of the African clusters is characterized by specific amino acid substitutions relative to the Eurasian RHD allele. RH phylogeny defines the framework for identification of clinically relevant aberrant alleles. This study focuses on the weak D type 4 cluster (characterized by RHD(T201R, F223V) (602C>G 667T>G)) in five ethnic groups. STUDY DESIGN AND METHODS A total of 1702 samples were screened for the presence of 602C>G and 667T>G by sequence-specific polymerase chain reaction (PCR-SSP). Eighty samples were assigned to the weak D type 4 cluster and were molecularly characterized by PCR-SSP and RHD sequencing. Antigens of aberrant alleles were characterized with monoclonal anti-D according to the 37-epitope model when possible. RESULTS Five new aberrant alleles, DIII type 6, DIII type 7, DARE, RHD(T201R, F223V) (without 819G>A), and RHD(F223V), were identified and DIII type 6, DARE, and RHD(F223V) were serologically characterized with monoclonal anti-D. Both the DARE and RHD(F223V) showed epitope loss. It is postulated that the 1136C>T nucleotide substitution (characteristic for the DAU allele cluster) is present on the DVa(KOU) allele. CONCLUSION Identification of the new variant alleles refines the phylogeny of RHD in humans. The proposed DVa(KOU) allele with 1136C>T (DVa(KOU)T379M) is probably caused by conversion of the DAU0 allele and the DVa(KOU) allele, forming a phylogenetic link between the DV allele and the DAU cluster. By describing the RHD(F223V) (602C>G) and RHD(T201R, F223V) (602C>G and 667T>G) alleles formal proof is given for the origin of the non-Eurasian cluster.
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Chen Q, Hustinx H, Flegel WA. The RHCE allele ceSL: the second example for D antigen expression without D-specific amino acids. Transfusion 2006; 46:766-72. [PMID: 16686844 DOI: 10.1111/j.1537-2995.2006.00795.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND The example of ceRT proved that the expression of some D epitopes does not require D-specific amino acids. This allele denoted as RHce(R154T) caused the "false-positive" reactions that were observed in ccddee blood donors who typed positive for the D antigen with some monoclonal anti-D. No other example exposing a similar molecular mechanism was known. STUDY DESIGN AND METHODS Eleven donor and 1 patient ccddee samples were collected in Switzerland that typed "false-positive" with some monoclonal anti-D in bromelain technique. Their RHCE alleles were determined by nucleotide sequencing from genomic DNA and by a polymerase chain reaction with sequence-specific priming. The D epitope profile was compared to ceRT. The population frequencies were estimated in Switzerland and Germany by serology or at the molecular level, respectively. RESULTS The "false-positive" reactions were caused by the RHCE allele RHce(S122L) occurring in the cde haplotype. Its ceSL phenotype expressed few D epitopes that belonged to the D epitope 6 group. The frequency of ceSL among D- donors was about 1:675 in the region of Bern, Switzerland. No ceSL donors were found elsewhere in Switzerland or in southwestern Germany. CONCLUSION ceSL represented the second molecular mechanism for D antigen expression without any D-specific amino acids. ceSL and ceRT were useful to delineate the molecular mechanisms of D expression by RhCE proteins carrying amino acids not representative for the RhD proteins. The ceSL population frequencies differed significantly among three Swiss and German populations.
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Affiliation(s)
- Qing Chen
- Department of Transfusion Medicine, University Hospital, Ulm, Germany
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Körmöczi GF, Gassner C, Shao CP, Uchikawa M, Legler TJ. A comprehensive analysis of DEL types: partial DEL individuals are prone to anti-D alloimmunization. Transfusion 2005; 45:1561-7. [PMID: 16181205 DOI: 10.1111/j.1537-2995.2005.00584.x] [Citation(s) in RCA: 88] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The D antigen of the polymorphic Rh blood group system is of particular clinical importance regarding transfusion- and pregnancy-induced alloimmunization. Different RhD variants with specific clinical implications have been characterized. The least expressed D variants collectively called DEL are serologically detectable only by adsorption-elution techniques, with so far only poorly defined antigenic properties. STUDY DESIGN AND METHODS A comprehensive immunohematologic analysis of five of the six currently known DEL genotypes was performed. DEL phenotypes associated with the RHD(M295I), RHD(IVS3+1g>a), RHD(K409K), RHD(X418L), or RHD(IVS5-38del4) allele were characterized with extended serology and flow cytometry. RESULTS Epitope mapping with adsorption-elution revealed a prominent D epitope loss in the RHD(IVS3+1g>a)-associated DEL phenotype, whereas in the other four DEL types no signs of qualitative D antigen alteration were detected. The observation of alloanti-D in two RHD(IVS3+1g>a) cases confirmed the partial nature of this DEL phenotype. The RHD(M295I) phenotype exhibited the highest D antigen expression among all investigated DEL types, as determined by a semiquantitative adsorption-elution approach and flow cytometry. CONCLUSION In conclusion, evidence is provided that different DEL genotypes code either for partial or complete D antigen expression and that this finding is clinically relevant.
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Affiliation(s)
- Günther F Körmöczi
- Department of Blood Group Serology and Transfusion Medicine, Medical University of Vienna, Vienna, Austria.
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Körmöczi GF, Förstemann E, Gabriel C, Mayr WR, Schönitzer D, Gassner C. Novel weak D types 31 and 32: adsorption-elution-supported D antigen analysis and comparison to prevalent weak D types. Transfusion 2005; 45:1574-80. [PMID: 16181207 DOI: 10.1111/j.1537-2995.2005.00580.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND Weak D types are thought to express rather quantitative than qualitative D antigen variants. Distinct type-specific phenotypes and weak D cases with anti-D alloimmunization, however, suggest a variable degree of D antigen alteration. STUDY DESIGN AND METHODS Variant D types were investigated by use of molecular typing, RHD sequencing, extended serologic D antigen investigations, and flow cytometric D antigen density determination. RESULTS Two novel weak D types were discovered, termed weak D type 31 and 32 with single RHD nucleotide substitutions coding for amino acid exchanges in predicted intracellular RhD polypeptide stretches, with antigen densities of approximately 130 and 50 D sites per red blood cell, respectively. Adsorption-elution technique-supported D epitope mapping of these two weak D types, the recently described weak D type 26, and of the most common Central European weak D types (weak D types 1, 2, 3, 4.0, and 4.1) demonstrated the expression of all tested D epitopes. In contrast, a distinct D epitope loss was detected in weak D type 15 and partial D control samples. CONCLUSION All novel and prevalent weak D types expressed all tested D epitopes. Our results indicate that adsorption-elution techniques may be of advantage whenever D epitope loss is suspected in extremely weak D variants.
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Affiliation(s)
- Günther F Körmöczi
- Department of Blood Group Serology and Transfusion Medicine, Medical University of Vienna, Vienna, Austria.
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Wagner T, Körmöczi GF, Buchta C, Vadon M, Lanzer G, Mayr WR, Legler TJ. Anti-D immunization by DEL red blood cells. Transfusion 2005; 45:520-6. [PMID: 15819672 DOI: 10.1111/j.0041-1132.2005.04256.x] [Citation(s) in RCA: 131] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND No data are available on the immunogenicity of extremely weak D variants called DEL. Evaluation of alloanti-D formation in a D- female patient after transfusion of apparently D- blood from an Austrian donor led to discovery of a so far unknown DEL type. STUDY DESIGN AND METHODS Standard blood group serologic methods were applied. Molecular typing, RHD sequencing, and D epitope mapping was performed and the absolute D antigen density determined. RESULTS After transfusion of RBCs typed D- by routine serology, the recipient developed alloanti-D. Further evaluation with an indirect antiglobulin test confirmed donor RBCs to be D-. Molecular typing, however, demonstrated the presence of the RHD gene in one donor, and RHD sequencing revealed a deletion of four nucleotides in RHD intron 5 (RHD IVS5-38del4) as the only difference compared to the normal RHD gene. Adsorption-elution techniques demonstrated a DEL phenotype without apparent loss of D epitopes. CONCLUSION This study documents the clinical significance of the DEL phenotype in blood units that was capable of inducing anti-D in a recipient. Qualitative data are provided on D epitope expression in DEL RBCs.
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Affiliation(s)
- Thomas Wagner
- Department of Blood Group Serology and Transfusion Medicine, Medical University of Graz, Graz, Austria.
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Lai M, Mavilia G, d'Onofrio G, Leone G. Detection of weak D with a fully automated solid-phase red cell adherence system. Transfusion 2005; 45:689-93. [PMID: 15847655 DOI: 10.1111/j.1537-2995.2005.04250.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Microplate agglutination methods (MAMs) and column agglutination technology are widely employed for red cell typing and can be automated. Some tests, however, such as detection of weak D, require manual testing. The possibility of detecting weak D by a solid-phase RBC adherence (SPRCA) test was studied in a fully automated system. STUDY DESIGN AND METHODS The results of 2609 blood samples, characterized as being D- or with a incomplete agglutination reaction, were analyzed for the presence of the weak D phenotype. The 2609 samples were tested by a weak D tube test (antiglobulin method) and a weak D-test with the new SPRCA method. When weak D was detected, which D epitope was involved and whether it was associated with a partial D phenotype were determined. RESULTS Weak D was detected in 60 (2.3%) of the 2609 samples. The 60 samples that were weak D by the tube test were also weak D+ with the new automated SPRCA test. The sensitivity and specificity for the new weak D typing method were 100 percent, when compared with the standard weak D manual test. CONCLUSIONS These results support the possibility of performing weak D detection with a SPRCA fully automated system. These preliminary results are encouraging, showing good sensitivity and specificity of the test. Detection of weak D will permit full automation of blood typing.
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Affiliation(s)
- Marco Lai
- Transfusion Center, Clinical Hematology, Catholic University of Sacred Heart, Rome, Italy.
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Affiliation(s)
- M L Scott
- Bristol Institute for Transfusion Sciences, National Blood Service, Southmead Road, Bristol BS10 5ND, UK.
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Abstract
BACKGROUND The method most commonly used for measuring the affinity of MoAbs specific for the D antigen is a binding assay using 125I-labeled MoAb. Although the method is relatively simple, there are several drawbacks that can lead to inaccurate results. The objective of the present work was to develop a method for the determination of the affinity of anti-D MoAb using unlabelled antibodies. STUDY DESIGN AND METHODS Rh-positive RBCs were sensitized with varying amounts of unlabeled anti-D MoAb, and, at equilibrium, the amount of anti-D bound to the RBCs was measured by ELISA. The affinity and the number of antigenic sites were determined with the Scatchard and Langmuir equations. RESULTS The method was applied to determine the affinity of several MoAbs specific for the D antigen on RBCs of different Rh-positive phenotypes. Similar results were observed with both equations. The affinity constant (Ka) for 3 MoAbs specific for the D antigen on group O R1r RBCs ranged from 1.3 to 7.4 108 M-1, depending on the antibody. When measured by a binding assay with 125I-labeled anti-D MoAbs, the Ka were significantly lower, indicating that 125I-labeling diminishes anti-D affinity, even when the labeling is at a low level. CONCLUSION A simple ELISA method was developed for the measurement of the affinity of anti-D MoAbs for the D antigen and for the number of antigenic sites per RBC. As a result, the affinity of anti-D can be estimated accurately, thus avoiding the drawbacks inherent in modification of the antibody by 125I-labeling.
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Affiliation(s)
- Martine Debbia
- Immunology Transfusion Unit, National Institute of Blood Transfusion, 6 rue Alexandre Cabanel, 75015 Paris, France
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Körmöczi GF, Legler TJ, Daniels GL, Green CA, Struckmann R, Jungbauer C, Moser S, Flexer M, Schönitzer D, Panzer S, Gassner C. Molecular and serologic characterization of DWI, a novel “high-grade” partial D. Transfusion 2004; 44:575-80. [PMID: 15043574 DOI: 10.1111/j.1537-2995.2003.03318.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Accurate D antigen identification is essential for pretransfusion and prenatal evaluation to prevent anti-D alloimmunization. Quantitative and qualitative D variants may pose typing problems and require particular consideration because of differing potential for anti-D induction. STUDY DESIGN AND METHODS A novel partial D, DWI, was discovered in an anti-D-alloimmunized D+ Austrian woman. This D variant was investigated by RHD genotyping and nucleotide sequencing, as well as characterization of its serologic properties. RESULTS The proposita exhibited a single-nucleotide exchange in RHD Exon 7 (1073T>C) predicting a Met358Thr substitution in the sixth extracellular loop of the RhD polypeptide. All DWI individuals identified (the proposita and two relatives) were genotyped DWIdCcee, which, together with the family tree, was highly suggestive of a DWICe haplotype association. Epitope mapping studies revealed only minor D antigen modification with weakening but not loss of epitopes D1.1, D9.1, and D16.1. Antigen density varied individually between 8000 and 8600 D sites per erythrocyte. No known low-frequency Rh antigen was detected. Despite the highly retained D epitope composition, the DWI proposita's serum sample contained alloanti-D from an immunization event many years earlier. CONCLUSION The findings of this investigation emphasize the possible clinical significance of "high-grade" partial D variants that are likely to be missed by routine serology.
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Flegel WA, Wagner FF. Blutgruppen: Alloantigene auf Erythrozyten. TRANSFUSIONSMEDIZIN 2004. [DOI: 10.1007/978-3-662-10597-9_9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Wagner FF, Ladewig B, Flegel WA. The RHCE allele ceRT: D epitope 6 expression does not require D-specific amino acids. Transfusion 2003; 43:1248-54. [PMID: 12919427 DOI: 10.1046/j.1537-2995.2003.00495.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND False-positive D typing in patients may lead to anti-D immunization caused by D+ transfusions or by omission of anti-D prophylaxis. Known causes of such errors are RhCE variants carrying RhD-specific amino acids and cold agglutinin activity of some frequently used monoclonal anti-D. STUDY DESIGN AND METHODS The molecular basis of eight samples referred because of "false-positive" reactions with some commercial monoclonal anti-D was investigated by PCR and nucleotide sequencing from genomic DNA. PCR with sequence-specific priming was developed to specifically detect the underlying aberrant RHCE allele. The D epitope profile of the allele was determined by serology. RESULTS The aberrant reactivity of the samples was caused by the RHCE allele RHCE(R154T) that occurred in a cde haplotype. The phenotype dubbed ceRT expressed the important D epitope 6, which is the target epitope of most monoclonal anti-D used in routine typing. DISCUSSION The characterization of ceRT demonstrated a previously unknown mechanism of antigen D expression that does not require any D-specific amino acid. At least for some D epitopes, D-like structures may be mimicked by RhCE proteins carrying amino acid substitutions not representative for RhD.
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Affiliation(s)
- Franz F Wagner
- Department of Transfusion Medicine, University of Ulm, Ulm, Germany
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Thorpe SJ, Fox B, Turner C, Scott M. Competitive enzyme-linked immunoassay of monoclonal immunoglobulin G anti-D preparations. Transfus Med 2003; 13:153-9. [PMID: 12791083 DOI: 10.1046/j.1365-3148.2003.00436.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The development of monoclonal immunoglobulin G (IgG) anti-D for prophylaxis necessitates estimation of their potency in terms of their red cell-binding ability, but it is unclear which quantification methodology is most suitable for this. The aim of this study was to assess 50 monoclonal anti-D from the 4th International Workshop for quantitative and qualitative binding to red cells in a competitive enzyme-linked immunoassay (EIA) in which varying amounts of monoclonal antibodies (MoAbs) and a constant amount of biotinylated monoclonal anti-D (BRAD-5) compete for red cell binding. The potencies of the MoAb were estimated against the International Reference Preparation (IRP) for anti-D Ig. Two MoAbs as supplied were insufficiently inhibitory of biotinylated BRAD-5 binding to be quantified; the potencies of the remainder ranged from 4 to 343 IU mL-1 and included 11 MoAbs showing dose-responses that were nonparallel to those of other MoAb and the IRP. Estimation of the concentration of antibody in the supernatants by radial immunodiffusion ranged from 0.5 to 61 micro g mL-1, giving specific activities of <1-24 IU micro g-1. The results show that competitive EIA is suitable for quantitating most monoclonal anti-D for development and quality control purposes, regardless of their D epitope reactivity.
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Affiliation(s)
- S J Thorpe
- National Institute for Biological Standards and Control, Potters Bar, Herts, UK.
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