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Folques C, de Sá B, Agostinho M, do Agro J, Martinho A, Rangel G, Marques J, Azevedo J. Combined Neonatal Alloimmune Neutropenia and Thrombocytopenia in Dizygotic Twins Conceived After Oocyte Donation. Cureus 2023; 15:e35950. [PMID: 37050990 PMCID: PMC10085481 DOI: 10.7759/cureus.35950] [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] [Accepted: 03/09/2023] [Indexed: 04/14/2023] Open
Abstract
Neonatal alloimmune thrombocytopenia (NAIT) and neonatal alloimmune neutropenia (NAIN) may have severe consequences in the neonatal period. We report two dizygotic twins conceived after donated oocytes, suffering NAIT and NAIN in the context of alloantibodies to human platelet antigens (anti-HPA-5b) and human leukocyte antigens (anti-HLA class I). Genotyping demonstrated paternal homozygosity for HPA-5a, while the neonates were heterozygous for HPA-5b.
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Affiliation(s)
- Carolina Folques
- Pediatric Hematology Unit, Department of Clinical Hematology, Hospital and University Centre of Coimbra, Children's Hospital of Coimbra, Coimbra, PRT
- Department of Pediatrics, Leiria Hospital Centre, Leiria, PRT
| | - Beatriz de Sá
- Department of Pediatrics, Leiria Hospital Centre, Leiria, PRT
| | | | - João do Agro
- Department of Pediatrics, Leiria Hospital Centre, Leiria, PRT
| | - António Martinho
- Blood and Transplant Center of Coimbra, Instituto Português do Sangue e Transplantação, Coimbra, PRT
| | - Gabriela Rangel
- Blood and Transplant Center of Porto, Instituto Português do Sangue e Transplantação, Porto, PRT
| | - Joana Marques
- Blood and Transplant Center of Porto, Instituto Português do Sangue e Transplantação, Porto, PRT
| | - Joana Azevedo
- Pediatric Hematology Unit, Department of Clinical Hematology, Hospital and University Centre of Coimbra, Children's Hospital of Coimbra, Coimbra, PRT
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McCormick AD, Wilde MM, Cusick M, Schumacher KR, Peng DM, Lim HM. I got it from my mamma: Sensitization by transplacental transfer of maternal HLA antibodies managed with manual exchange transfusion. J Heart Lung Transplant 2023; 42:539-540. [PMID: 36775747 DOI: 10.1016/j.healun.2023.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 01/05/2023] [Indexed: 01/25/2023] Open
Affiliation(s)
- Amanda D McCormick
- Department of Pediatrics, Michigan Medicine, University of Michigan, Ann Arbor, Michigan.
| | - Megan M Wilde
- Department of Pediatrics, Riley Hospital for Children, Indiana University Health, Indianapolis, Indiana
| | - Matthew Cusick
- Department of Pathology, Michigan Medicine, University of Michigan, Ann Arbor, Michigan
| | - Kurt R Schumacher
- Department of Pediatrics, Michigan Medicine, University of Michigan, Ann Arbor, Michigan
| | - David M Peng
- Department of Pediatrics, Michigan Medicine, University of Michigan, Ann Arbor, Michigan
| | - Heang M Lim
- Department of Pediatrics, Michigan Medicine, University of Michigan, Ann Arbor, Michigan
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Suchard MS, Martinson N, Malfeld S, de Assis Rosa D, Mackelprang RD, Lingappa J, Hou X, Rees H, Delany-Moretlwe S, Goldfein H, Ranchod H, Coetzee D, Otwombe K, Morris L, Tiemessen CT, Savulescu DM. Alloimmunity to Class 2 Human Leucocyte Antigens May Reduce HIV-1 Acquisition – A Nested Case-Control Study in HIV-1 Serodiscordant Couples. Front Immunol 2022; 13:813412. [PMID: 35401581 PMCID: PMC8987441 DOI: 10.3389/fimmu.2022.813412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 02/21/2022] [Indexed: 11/13/2022] Open
Abstract
Enveloped viruses, including the Human Immunodeficiency Virus-1 (HIV), incorporate host proteins such as human leucocyte antigens (HLA) into their envelope. Pre-existing antibodies against HLA, termed HLA antibodies, may bind to these surface proteins and reduce viral infectivity. Related evidence includes macaque studies which suggest that xenoimmunization with HLA antigens may protect against simian immunodeficiency virus infection. Since HIV gp120 shows homology with class 2 HLA, including shared affinity for binding to CD4, class 2 HLA antibodies may influence HIV acquisition via binding to gp120 on the viral envelope. We conducted a nested case-control study on HIV serodiscordant couples, comparing the frequency of HLA antibodies among highly exposed persistently seronegative controls with those who went on to acquire HIV (HIV-seroconverters). We first performed low resolution HLA typing on 143 individuals who were HIV-infected at enrollment (index partners) and their corresponding sexual partners (115 highly exposed persistently seronegative individuals and 28 HIV-seroconverters). We then measured HLA class 1 and 2 antibodies in the highly exposed persistently seronegative individuals and HIV-seroconverters at early and late timepoints. We analyzed whether such antibodies were directed at HLA specificities of their HIV-infected index partners, and whether autoantibodies or complement-fixing class 2 HLA antibodies were present. Seventy-nine percent of highly exposed persistently seronegative individuals had HLA antibodies; 56% against class 1 and 50% against class 2 alleles. Half of the group of highly exposed persistently seronegative individuals, prior to seroconversion, expressed class 2 HLA antibodies, compared with only 29% of controls (p=0.05). HIV infection was a sensitizing event leading to de novo development of antibodies against HLA-A and HLA-B loci, but not against class 2 loci. HLA autoantibodies were present in 27% of highly exposed persistently seronegative individuals. Complement-fixing class 2 HLA antibodies did not differ significantly between highly exposed persistently seronegative individuals and seroconverters. In multivariable regression, presence of class 2 HLA antibodies at early timepoints was associated with reduced odds of HIV acquisition (odds ratio 0.330, confidence interval 0.112-0.976, p=0.045). These epidemiological data suggest that pre-existing class 2 HLA antibodies were associated with reduced odds of HIV acquisition.
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Affiliation(s)
- Melinda S. Suchard
- National Institute for Communicable Diseases, A Division of the National Health Laboratory Service, Johannesburg, South Africa
- Chemical Pathology, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- *Correspondence: Melinda S. Suchard,
| | - Neil Martinson
- Perinatal Health Research Unit (PHRU), University of The Witwatersrand, Johannesburg, South Africa
- Johns Hopkins University Centre for TB Research, Baltimore, MD, United States
| | - Susan Malfeld
- National Institute for Communicable Diseases, A Division of the National Health Laboratory Service, Johannesburg, South Africa
| | - Debbie de Assis Rosa
- School of Molecular and Cell Biology, Faculty of Science, University of the Witwatersrand, Johannesburg, South Africa
| | - Romel D. Mackelprang
- Department of Global Health, University of Washington, Seattle, WA, United States
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA, United States
| | - Jairam Lingappa
- Department of Global Health, University of Washington, Seattle, WA, United States
- Department of Medicine and Department of Paediatrics, University of Washington, Seattle, WA, United States
| | - Xuanlin Hou
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Helen Rees
- Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Sinead Delany-Moretlwe
- Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Hadassa Goldfein
- School of Molecular and Cell Biology, Faculty of Science, University of the Witwatersrand, Johannesburg, South Africa
| | - Heena Ranchod
- National Institute for Communicable Diseases, A Division of the National Health Laboratory Service, Johannesburg, South Africa
- Chemical Pathology, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - David Coetzee
- Division of Public Health Medicine, School of Public Health and Family Medicine, University of Cape Town, Johannesburg, South Africa
| | - Kennedy Otwombe
- Perinatal Health Research Unit (PHRU), University of The Witwatersrand, Johannesburg, South Africa
- Epidemiology and Biostatistics Department, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Lynn Morris
- National Institute for Communicable Diseases, A Division of the National Health Laboratory Service, Johannesburg, South Africa
- Virology Department, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Caroline T. Tiemessen
- National Institute for Communicable Diseases, A Division of the National Health Laboratory Service, Johannesburg, South Africa
- Virology Department, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Dana M. Savulescu
- National Institute for Communicable Diseases, A Division of the National Health Laboratory Service, Johannesburg, South Africa
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Savulescu DM, Groome M, Malfeld SCK, Madhi S, Koen A, Jones S, Duxbury V, Scheuermaier K, De Assis Rosa D, Suchard M. HLA antibody repertoire in infants suggests selectivity in transplacental crossing. Am J Reprod Immunol 2020; 84:e13264. [PMID: 32395838 PMCID: PMC7507134 DOI: 10.1111/aji.13264] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 05/03/2020] [Accepted: 05/05/2020] [Indexed: 12/24/2022] Open
Abstract
Problem Late in pregnancy, women produce and transfer high amounts of antibodies to the foetus. During gestation, women produce antibodies against human leukocyte antigens (HLA), including antibodies directed at foetal HLA. There is paucity of data on transplacental crossing, specificity and role of HLA antibodies in pregnancy and new‐borns. Method of study Using highly sensitive Luminex technology, we measured prevalence of IgG HLA antibodies in 30 mother‐infant pairs six weeks post‐partum. Additionally, in six pregnant women, we measured HLA antibodies longitudinally and HLA‐typed infant DNA to assess whether maternal HLA antibodies were directed at infant specificities. Results Overall, 68% of mothers and 44% of infants expressed HLA‐I antibodies and 56% of mothers and 52% of infants expressed HLA‐II antibodies. Infants shared up to 78% of antibodies with their mothers, suggesting that the remaining antibodies were self‐made. Less than 25% of maternal HLA antibodies were detected in infants, possibly due to selection in transplacental crossing. We detected complement‐fixing HLA antibodies in mothers and at low levels in infants. In a third of our pregnant subjects, we detected infant‐directed HLA antibodies. Conclusion Our findings raise the possibility of selection in transplacental crossing of HLA antibodies. As HLA antibodies may act as autoantibodies in the neonate, the mechanism of a selective transfer may give important insights into immune tolerance. Findings also suggest that infants start producing their own HLA antibodies in the first weeks of life, which, together with maternally derived antibodies may impact the infant's immune reaction to HLA proteins.
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Affiliation(s)
- Dana M Savulescu
- Centre for Vaccines and Immunology (CVI), National Institute for Communicable Diseases (NICD), A Division of the National Health Laboratory Service, Johannesburg, Gauteng, South Africa
| | - Michelle Groome
- Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Gauteng, South Africa.,Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Gauteng, South Africa
| | - Susan C K Malfeld
- Centre for Vaccines and Immunology (CVI), National Institute for Communicable Diseases (NICD), A Division of the National Health Laboratory Service, Johannesburg, Gauteng, South Africa
| | - Shabir Madhi
- Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Gauteng, South Africa.,Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Gauteng, South Africa
| | - Anthonet Koen
- Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Gauteng, South Africa.,Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Gauteng, South Africa
| | - Stephanie Jones
- Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Gauteng, South Africa.,Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Gauteng, South Africa
| | - Vania Duxbury
- Brain Function Research Group, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Gauteng, South Africa
| | - Karine Scheuermaier
- Brain Function Research Group, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Gauteng, South Africa
| | - Debbie De Assis Rosa
- School of Molecular and Cell Biology, Faculty of Science, University of the Witwatersrand, Johannesburg, Gauteng, South Africa
| | - Melinda Suchard
- Centre for Vaccines and Immunology (CVI), National Institute for Communicable Diseases (NICD), A Division of the National Health Laboratory Service, Johannesburg, Gauteng, South Africa.,Department of Chemical Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Gauteng, South Africa
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