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Bansal N, West LJ, Simmonds J, Urschel S. ABO-incompatible heart transplantation-evolution of a revolution. J Heart Lung Transplant 2024; 43:1514-1520. [PMID: 38604353 DOI: 10.1016/j.healun.2024.03.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 03/28/2024] [Accepted: 03/29/2024] [Indexed: 04/13/2024] Open
Abstract
In the 1990s, neonates born with severe congenital heart disease faced more than 50% mortality awaiting an ABO-compatible (ABOc) transplant donor. This desperate situation, together with knowledge of gaps in the adaptive immune system in early childhood, led to the clinical exploration of intentional ABO-incompatible (ABOi) heart transplantation. In 2001, West et al. reported the first series of 10 infants in Canada. Since then, consideration of ABOi heart donors has become the standard of care for children awaiting transplantation in the first few years of life, resulting in reduced wait times and better organ utilization with noninferior post-transplant outcomes compared to ABOc recipients. This state-of-the-art review discusses the clinical development and evolution, underlying and resulting immunological aspects, current challenges, and future directions of ABOi heart transplantation.
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Affiliation(s)
- Neha Bansal
- Pediatric Cardiology, Mount Sinai Kravis Children's Hospital, New York, New York
| | - Lori J West
- Department of Pediatrics, University of Alberta/Stollery Children's Hospital, Edmonton, Alberta, Canada; Alberta Transplant Institute, Edmonton, Alberta, Canada
| | - Jacob Simmonds
- Pediatric Cardiology, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK
| | - Simon Urschel
- Department of Pediatrics, University of Alberta/Stollery Children's Hospital, Edmonton, Alberta, Canada; Alberta Transplant Institute, Edmonton, Alberta, Canada
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2
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Jensen M, Stenfelt L, Ricci Hagman J, Pichler MJ, Weikum J, Nielsen TS, Hult A, Morth JP, Olsson ML, Abou Hachem M. Akkermansia muciniphila exoglycosidases target extended blood group antigens to generate ABO-universal blood. Nat Microbiol 2024; 9:1176-1188. [PMID: 38684911 DOI: 10.1038/s41564-024-01663-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 03/04/2024] [Indexed: 05/02/2024]
Abstract
Matching donor and recipient blood groups based on red blood cell (RBC) surface ABO glycans and antibodies in plasma is crucial to avoid potentially fatal reactions during transfusions. Enzymatic conversion of RBC glycans to the universal group O is an attractive solution to simplify blood logistics and prevent ABO-mismatched transfusions. The gut symbiont Akkermansia muciniphila can degrade mucin O-glycans including ABO epitopes. Here we biochemically evaluated 23 Akkermansia glycosyl hydrolases and identified exoglycosidase combinations which efficiently transformed both A and B antigens and four of their carbohydrate extensions. Enzymatic removal of canonical and extended ABO antigens on RBCs significantly improved compatibility with group O plasmas, compared to conversion of A or B antigens alone. Finally, structural analyses of two B-converting enzymes identified a previously unknown putative carbohydrate-binding module. This study demonstrates the potential utility of mucin-degrading gut bacteria as valuable sources of enzymes for production of universal blood for transfusions.
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Affiliation(s)
- Mathias Jensen
- Department of Biotechnology & Biomedicine, Technical University of Denmark, Kongens Lyngby, Denmark
| | - Linn Stenfelt
- Department of Biotechnology & Biomedicine, Technical University of Denmark, Kongens Lyngby, Denmark
- Division of Hematology and Transfusion Medicine, Department of Laboratory Medicine, Lund University, Lund, Sweden
| | - Jennifer Ricci Hagman
- Division of Hematology and Transfusion Medicine, Department of Laboratory Medicine, Lund University, Lund, Sweden
- Department of Clinical Immunology and Transfusion Medicine, Office for Medical Services, Region Skåne, Sweden
| | - Michael Jakob Pichler
- Department of Biotechnology & Biomedicine, Technical University of Denmark, Kongens Lyngby, Denmark
| | - Julia Weikum
- Department of Biotechnology & Biomedicine, Technical University of Denmark, Kongens Lyngby, Denmark
| | - Tine Sofie Nielsen
- Department of Biotechnology & Biomedicine, Technical University of Denmark, Kongens Lyngby, Denmark
| | - Annika Hult
- Department of Clinical Immunology and Transfusion Medicine, Office for Medical Services, Region Skåne, Sweden
| | - Jens Preben Morth
- Department of Biotechnology & Biomedicine, Technical University of Denmark, Kongens Lyngby, Denmark
| | - Martin L Olsson
- Division of Hematology and Transfusion Medicine, Department of Laboratory Medicine, Lund University, Lund, Sweden.
- Department of Clinical Immunology and Transfusion Medicine, Office for Medical Services, Region Skåne, Sweden.
| | - Maher Abou Hachem
- Department of Biotechnology & Biomedicine, Technical University of Denmark, Kongens Lyngby, Denmark.
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3
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Mendelian inheritance revisited: dominance and recessiveness in medical genetics. Nat Rev Genet 2023:10.1038/s41576-023-00574-0. [PMID: 36806206 DOI: 10.1038/s41576-023-00574-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/14/2022] [Indexed: 02/22/2023]
Abstract
Understanding the consequences of genotype for phenotype (which ranges from molecule-level effects to whole-organism traits) is at the core of genetic diagnostics in medicine. Many measures of the deleteriousness of individual alleles exist, but these have limitations for predicting the clinical consequences. Various mechanisms can protect the organism from the adverse effects of functional variants, especially when the variant is paired with a wild type allele. Understanding why some alleles are harmful in the heterozygous state - representing dominant inheritance - but others only with the biallelic presence of pathogenic variants - representing recessive inheritance - is particularly important when faced with the deluge of rare genetic alterations identified by high throughput DNA sequencing. Both awareness of the specific quantitative and/or qualitative effects of individual variants and the elucidation of allelic and non-allelic interactions are essential to optimize genetic diagnosis and counselling.
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4
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Tasaki M, Tateno H, Sato T, Narimatsu H, Saito K, Nakagawa Y, Aoki T, Kamimura M, Ushiki T, Takahashi K, Tomita Y. Hyporesponsiveness against donor's ABO antigens of renal grafts after ABO-incompatible kidney transplantation. Clin Exp Nephrol 2023; 27:89-95. [PMID: 36209259 DOI: 10.1007/s10157-022-02280-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 09/13/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND ABO antigens expressed on the red blood cells (RBCs) are not identical to those expressed on the renal endothelial cells. The isohemagglutinin assay employing the RBCs is the gold standard for evaluating anti-ABO antibody (Ab) levels. However, it remains unclear whether the anti-ABO Abs detected by the isohemagglutinin assay after ABO-incompatible (ABOi) kidney transplantations (KTx) that are not associated with antibody-mediated rejection can bind to renal graft endothelial cells. METHODS Ninety plasma samples were collected from patients with stable graft function after ABO-compatible (ABOc) or ABOi KTx. Anti-ABO Ab titers were examined by both the isohemagglutinin assay and the CD31-ABO microarray, which was developed as a mimic of the ABO antigens expressed on the renal endothelial cells. RESULTS The antibody titers detected by the isohemagglutinin assay and the CD31-ABO microarray after the ABOc KTx relatively correlated with each other. However, the CD31-ABO microarray results showed low antibody levels against donor blood group antigens after ABOi KTx and did not correlate with the isohemagglutinin assay. In contrast, the antibody levels against non-donor blood group antigens after ABOi KTx were comparable to those after the ABOc KTx. Fourteen patients received graft biopsies, and no antibody-mediated rejection was observed in ABOi KTx recipients, except for two patients who had anti-donor-HLA Abs. CONCLUSION The present study suggested that the anti-ABO Abs detected by the isohemagglutinin assay after ABOi KTx with stable graft function were hyporeactive to the ABO antigen of graft renal endothelial cells.
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Affiliation(s)
- Masayuki Tasaki
- Division of Urology, Department of Regenerative and Transplant Medicine, Graduate School of Medical and Dental Sciences, Niigata University, 1-757, Asahimachi-dori, Chuo-ku, Niigata, Japan.
| | - Hiroaki Tateno
- Cellular and Molecular Biotechnology Research Institute, National Institute of Advanced Industrial Science and Technology (AIST), Tsukuba, Japan
| | - Takashi Sato
- Cellular and Molecular Biotechnology Research Institute, National Institute of Advanced Industrial Science and Technology (AIST), Tsukuba, Japan
| | - Hisashi Narimatsu
- Cellular and Molecular Biotechnology Research Institute, National Institute of Advanced Industrial Science and Technology (AIST), Tsukuba, Japan
| | - Kazuhide Saito
- Division of Urology, Department of Regenerative and Transplant Medicine, Graduate School of Medical and Dental Sciences, Niigata University, 1-757, Asahimachi-dori, Chuo-ku, Niigata, Japan
| | - Yuki Nakagawa
- Department of Urology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Toshinari Aoki
- Department of Transfusion Medicine, Cell Therapy and Regenerative Medicine, Niigata University Medical and Dental Hospital, Niigata, Japan
| | - Masami Kamimura
- Department of Transfusion Medicine, Cell Therapy and Regenerative Medicine, Niigata University Medical and Dental Hospital, Niigata, Japan
| | - Takashi Ushiki
- Department of Transfusion Medicine, Cell Therapy and Regenerative Medicine, Niigata University Medical and Dental Hospital, Niigata, Japan
| | - Kota Takahashi
- Division of Urology, Department of Regenerative and Transplant Medicine, Graduate School of Medical and Dental Sciences, Niigata University, 1-757, Asahimachi-dori, Chuo-ku, Niigata, Japan
| | - Yoshihiko Tomita
- Division of Urology, Department of Regenerative and Transplant Medicine, Graduate School of Medical and Dental Sciences, Niigata University, 1-757, Asahimachi-dori, Chuo-ku, Niigata, Japan
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Gil-Manso S, Miguens Blanco I, Motyka B, Halpin A, López-Esteban R, Pérez-Fernández VA, Carbonell D, López-Fernández LA, West L, Correa-Rocha R, Pion M. ABO blood group is involved in the quality of the specific immune response anti-SARS-CoV-2. Virulence 2022; 13:30-45. [PMID: 34967260 PMCID: PMC9794011 DOI: 10.1080/21505594.2021.2019959] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Since December 2019, the coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has spread throughout the world. To eradicate it, it is crucial to acquire a strong and long-lasting anti-SARS-CoV-2 immunity, by either natural infection or vaccination. We collected blood samples 12-305 days after positive polymerase chain reactions (PCRs) from 35 recovered individuals infected by SARS-CoV-2. Peripheral blood mononuclear cells were stimulated with SARS-CoV-2-derived peptide pools, such as the spike (S), nucleocapsid (N) and membrane (M) proteins, and we quantified anti-S immunoglobulins in plasma. After 10 months post-infection, we observed a sustained SARS-CoV-2-specific CD4+ T-cell response directed against M-protein, but responses against S- or N-proteins were lost over time. Besides, we demonstrated that O-group individuals presented significantly lower frequencies of specific CD4+ T-cell responses against Pep-M than non O-group individuals. The non O-group subjects also needed longer to clear the virus, and they lost cellular immune responses over time, compared to the O-group individuals, who showed a persistent specific immune response against SARS-CoV-2. Therefore, the S-specific immune response was lost over time, and individual factors might determine the sustainability of the body's defenses, which must be considered in the future design of vaccines to achieve continuous anti-SARS-CoV-2 immunity.
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Affiliation(s)
- Sergio Gil-Manso
- Laboratory of Immune- Gregorio Marañón Health Research Institute (IiSGM), Gregorio Marañón University General Hospital, Madrid, Spain
| | - Iria Miguens Blanco
- Department of Emergency, Gregorio Marañón University General Hospital, Madrid, Spain
| | - Bruce Motyka
- Department of Pediatrics, Alberta Transplant Institute and Canadian Donation and Transplantation Research Program; University of Alberta, Edmonton, Alberta, Canada
| | - Anne Halpin
- Department of Pediatrics, Alberta Transplant Institute and Canadian Donation and Transplantation Research Program; University of Alberta, Edmonton, Alberta, Canada,Laboratory Medicine & Pathology, University of Alberta, Edmonton, Alberta, Canada
| | - Rocío López-Esteban
- Laboratory of Immune- Gregorio Marañón Health Research Institute (IiSGM), Gregorio Marañón University General Hospital, Madrid, Spain
| | - Verónica Astrid Pérez-Fernández
- Laboratory of Immune- Gregorio Marañón Health Research Institute (IiSGM), Gregorio Marañón University General Hospital, Madrid, Spain
| | - Diego Carbonell
- Laboratory of Immune- Gregorio Marañón Health Research Institute (IiSGM), Gregorio Marañón University General Hospital, Madrid, Spain,Department of Hematology, Gregorio Marañón University General Hospital, Madrid, Spain
| | - Luis Andrés López-Fernández
- Service of Pharmacy, Gregorio Marañón Health Research Institute (IiSGM), Gregorio Marañón University General Hospital, Spanish Clinical Research Network (SCReN), Madrid, Spain
| | - Lori West
- Department of Pediatrics, Alberta Transplant Institute and Canadian Donation and Transplantation Research Program; University of Alberta, Edmonton, Alberta, Canada,Medical Microbiology & Immunology, Surgery, and Laboratory Medicine & Pathology; University of Alberta, Edmonton, Alberta, Canada
| | - Rafael Correa-Rocha
- Laboratory of Immune- Gregorio Marañón Health Research Institute (IiSGM), Gregorio Marañón University General Hospital, Madrid, Spain,CONTACT Rafael Correa-Rocha
| | - Marjorie Pion
- Laboratory of Immune- Gregorio Marañón Health Research Institute (IiSGM), Gregorio Marañón University General Hospital, Madrid, Spain,Marjorie Pion
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Shinoda K, Hyodo Y, Oguchi H, Mikami T, Nishikawa K, Sakurabayashi K, Yonekura T, Aoki Y, Itabashi Y, Muramatsu M, Kawamura T, Sakai K, Shishido S. Outcome of ABO-incompatible kidney transplantation using a modified desensitization protocol without plasmapheresis. Int J Urol 2022; 29:1017-1025. [PMID: 35661428 DOI: 10.1111/iju.14944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 05/11/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVES Several controversies regarding desensitization strategies for successful ABO-incompatible (ABOi) kidney transplantation still exist. This study aimed to investigate whether pretransplant anti-A/B antibody removal is mandatory in an ABOi kidney transplant recipient with low baseline isoagglutinin titers. METHODS We adopted a modified desensitization protocol with two doses of rituximab (RTX, 100 mg/body) without pretransplant antibody removal for ABOi kidney transplant recipients with a titer of ≤1:64 (group A; n = 35) and investigated the feasibility of this protocol by comparing it with the clinical outcomes of patients undergoing standard pretransplant plasmapheresis (group B; n = 21). RESULTS There was no significant difference in the rate of antibody-mediated rejection within the first month after transplantation between the two groups (11.4% in group A vs. 2% in group B, p = 0.6019). Moreover, no differences were observed in the short- and long-term graft outcomes between the groups. However, two major critical acute antibody-mediated events occurred in group A; one patient lost the graft due to hyperacute rejection, and the other patient developed thrombotic microangiopathy after surgery. Risk factors predicting these perioperative complications were not identified. CONCLUSIONS We conclude that not only B-cell depletion using RTX but also pretransplant antibody removal is still recommended even for patients with low isoagglutinin titers. In addition, a new diagnostic tool is needed for accurate risk stratification.
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Affiliation(s)
- Kazunobu Shinoda
- Department of Nephrology, Toho University Faculty of Medicine, Tokyo, Japan.,Department of Urology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Yoji Hyodo
- Department of Urology, Dokkyo Medical University Saitama Medical Center, Koshigaya, Japan
| | - Hideyo Oguchi
- Department of Nephrology, Toho University Faculty of Medicine, Tokyo, Japan
| | - Tetuo Mikami
- Department of Pathology, Toho University Faculty of Medicine, Tokyo, Japan
| | - Kenta Nishikawa
- Department of Nephrology, Toho University Faculty of Medicine, Tokyo, Japan
| | - Kei Sakurabayashi
- Department of Nephrology, Toho University Faculty of Medicine, Tokyo, Japan
| | - Takashi Yonekura
- Department of Nephrology, Toho University Faculty of Medicine, Tokyo, Japan
| | - Yujiro Aoki
- Department of Nephrology, Toho University Faculty of Medicine, Tokyo, Japan
| | - Yoshihiro Itabashi
- Department of Nephrology, Toho University Faculty of Medicine, Tokyo, Japan
| | - Masaki Muramatsu
- Department of Nephrology, Toho University Faculty of Medicine, Tokyo, Japan
| | - Takeshi Kawamura
- Department of Nephrology, Toho University Faculty of Medicine, Tokyo, Japan
| | - Ken Sakai
- Department of Nephrology, Toho University Faculty of Medicine, Tokyo, Japan
| | - Seiichiro Shishido
- Department of Nephrology, Toho University Faculty of Medicine, Tokyo, Japan.,Department of Pediatric Nephrology, Toho University Faculty of Medicine, Tokyo, Japan
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7
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Tasaki M, Tateno H, Sato T, Tomioka A, Kaji H, Narimatsu H, Saito K, Nakagawa Y, Aoki T, Kamimura M, Ushiki T, Okada M, Miwa Y, Hotta K, Yoshida Y, Takahashi K, Tomita Y. A Novel Method of CD31-Combined ABO Carbohydrate Antigen Microarray Predicts Acute Antibody-Mediated Rejection in ABO-Incompatible Kidney Transplantation. Transpl Int 2022; 35:10248. [PMID: 35401036 PMCID: PMC8985549 DOI: 10.3389/ti.2022.10248] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 02/16/2022] [Indexed: 12/22/2022]
Abstract
Isohemagglutinin assays employing red blood cells (RBCs) are the most common assays used to measure antibody titer in ABO-incompatible kidney transplantation (ABOi KTx). However, ABO antigens expressed on RBCs are not identical to those of kidney and antibody titers do not always correlate with clinical outcome. We previously reported that CD31 was the main protein linked to ABO antigens on kidney endothelial cells (KECs), which was different from those on RBCs. We developed a new method to measure antibody titer using a microarray of recombinant CD31 (rCD31) linked to ABO antigens (CD31-ABO microarray). Mass spectrometry analysis suggested that rCD31 and native CD31 purified from human kidney had similar ABO glycan. To confirm clinical use of CD31-ABO microarray, a total of 252 plasma samples including volunteers, hemodialysis patients, and transplant recipients were examined. In transplant recipients, any initial IgG or IgM antibody intensity >30,000 against the donor blood type in the CD31-ABO microarray showed higher sensitivity, specificity, positive predictive value, and negative predictive value of AABMR, compared to isohemagglutinin assays. Use of a CD31-ABO microarray to determine antibody titer specifically against ABO antigens expressed on KECs will contribute to precisely predicting AABMR or preventing over immunosuppression following ABOi KTx.
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Affiliation(s)
- Masayuki Tasaki
- Division of Urology, Department of Regenerative and Transplant Medicine, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan
| | - Hiroaki Tateno
- Cellular and Molecular Biotechnology Research Institute, National Institute of Advanced Industrial Science and Technology (AIST), Tsukuba, Japan
| | - Takashi Sato
- Cellular and Molecular Biotechnology Research Institute, National Institute of Advanced Industrial Science and Technology (AIST), Tsukuba, Japan
| | - Azusa Tomioka
- Cellular and Molecular Biotechnology Research Institute, National Institute of Advanced Industrial Science and Technology (AIST), Tsukuba, Japan
| | - Hiroyuki Kaji
- Cellular and Molecular Biotechnology Research Institute, National Institute of Advanced Industrial Science and Technology (AIST), Tsukuba, Japan
| | - Hisashi Narimatsu
- Cellular and Molecular Biotechnology Research Institute, National Institute of Advanced Industrial Science and Technology (AIST), Tsukuba, Japan
| | - Kazuhide Saito
- Division of Urology, Department of Regenerative and Transplant Medicine, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan
| | - Yuki Nakagawa
- Department of Urology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Toshinari Aoki
- Department of Transfusion Medicine, Cell Therapy and Regenerative Medicine, Niigata University Medical and Dental Hospital, Niigata, Japan
| | - Masami Kamimura
- Department of Transfusion Medicine, Cell Therapy and Regenerative Medicine, Niigata University Medical and Dental Hospital, Niigata, Japan
| | - Takashi Ushiki
- Department of Transfusion Medicine, Cell Therapy and Regenerative Medicine, Niigata University Medical and Dental Hospital, Niigata, Japan
| | - Manabu Okada
- Department of Transplant Surgery, Nagoya Daini Red Cross Hospital, Nagoya, Japan
| | - Yuko Miwa
- Department of Kidney Disease and Transplant Immunology, Aichi Medical University School of Medicine, Nagoya, Japan
| | - Kiyohiko Hotta
- Department of Urology, Hokkaido University Hospital, Sapporo, Japan
| | - Yutaka Yoshida
- Department of Structural Pathology, Kidney Research Center, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan
| | | | - Yoshihiko Tomita
- Division of Urology, Department of Regenerative and Transplant Medicine, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan
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Bentall A, Jeyakanthan M, Braitch M, Cairo CW, Lowary TL, Maier S, Halpin A, Motyka B, Zou L, West LJ, Ball S. Characterization of ABH-subtype donor-specific antibodies in ABO-A-incompatible kidney transplantation. Am J Transplant 2021; 21:3649-3662. [PMID: 34101982 PMCID: PMC8597088 DOI: 10.1111/ajt.16712] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 04/30/2021] [Accepted: 05/15/2021] [Indexed: 01/25/2023]
Abstract
ABO-incompatible (ABOi) transplantation requires preemptive antibody reduction; however, the relationship between antibody-mediated rejection (AMR) and ABO-antibodies, quantified by hemagglutination (HA), is inconsistent, possibly reflecting variable graft resistance to AMR or HA assay limitations. Using an ABH-glycan microarray, we quantified ABO-A antigen-subtype (A-subtype)-specific IgM and IgG in 53 ABO-O recipients of ABO-A kidneys, before and after antibody removal (therapeutic plasma exchange [TPE] or ABO-A-trisaccharide immunoadsorption [IA]) and 1-year posttransplant. IgM binding to all A-subtypes correlated highly (R2 ≥ .90) and A-subtype antibody specificities was reduced equally by IA versus TPE. IgG binding to the A-subtypes (II-IV) expressed in kidney correlated poorly (.27 ≤ R2 ≤ .69). Reduction of IgG specific to A-subtype-II was equivalent for IA and TPE, whereas IgG specific to A-subtypes-III/IV was not as greatly reduced by IA (p < .005). One-year posttransplant, IgG specific to A-II remained the most reduced antibody. Immunostaining revealed only A-II on vascular endothelium but A-subtypes II-III/IV on tubular epithelium. These results show that ABO-A-trisaccharide is sufficient for IgM binding to all A-subtypes; this is true for IgG binding to A-II, but not subtypes-III/IV, which exhibits varying degrees of specificity. We identify A-II as the major, but importantly not the sole, antigen relevant to treatment and immune modulation in adult ABO-A-incompatible kidney transplantation.
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Affiliation(s)
- Andrew Bentall
- Department of NephrologyUniversity HospitalBirminghamUK,Division of Nephrology and HypertensionMayo Clinic College of MedicineRochesterMinnesotaUSA
| | - Mylvaganam Jeyakanthan
- Department of Cardiothoracic SurgeryJames Cook University HospitalMiddlesbroughUK,Department of PediatricsUniversity of AlbertaEdmontonABCanada
| | | | - Christopher W. Cairo
- Alberta Glycomics Centre and Department of ChemistryUniversity of AlbertaEdmontonABCanada
| | - Todd L. Lowary
- Alberta Glycomics Centre and Department of ChemistryUniversity of AlbertaEdmontonABCanada
| | - Stephanie Maier
- Alberta Transplant Institute and Canadian Donation and Transplantation Research ProgramUniversity of AlbertaEdmontonABCanada
| | - Anne Halpin
- Department of PediatricsUniversity of AlbertaEdmontonABCanada,Alberta Transplant Institute and Canadian Donation and Transplantation Research ProgramUniversity of AlbertaEdmontonABCanada,Department of Laboratory Medicine and PathologyUniversity of AlbertaEdmontonABCanada
| | - Bruce Motyka
- Department of PediatricsUniversity of AlbertaEdmontonABCanada,Alberta Transplant Institute and Canadian Donation and Transplantation Research ProgramUniversity of AlbertaEdmontonABCanada
| | - Lu Zou
- Alberta Glycomics Centre and Department of ChemistryUniversity of AlbertaEdmontonABCanada
| | - Lori J. West
- Department of PediatricsUniversity of AlbertaEdmontonABCanada,Alberta Transplant Institute and Canadian Donation and Transplantation Research ProgramUniversity of AlbertaEdmontonABCanada,Department of Laboratory Medicine and PathologyUniversity of AlbertaEdmontonABCanada,Department of SurgeryUniversity of AlbertaEdmontonABCanada,Department of Medical Microbiology and ImmunologyUniversity of AlbertaEdmontonABCanada
| | - Simon Ball
- Department of NephrologyUniversity HospitalBirminghamUK,School of Immunity and InfectionUniversity of BirminghamBirminghamUK
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9
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Wang X, Zhang F, Jiang Y, Xu Z, Feng X, Li L, Fan Y, Song T, Shi Y, Huang Z, Lin T. Highly individual- and tissue-specific expression of glycoprotein group A and B blood antigens in the human kidney and liver. BMC Immunol 2021; 22:66. [PMID: 34598667 PMCID: PMC8485463 DOI: 10.1186/s12865-021-00456-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 09/23/2021] [Indexed: 02/08/2023] Open
Abstract
Background Currently, research on the quantitative distribution of ABO antigens in different organs and tissues remains limited. We aimed to examine the individual characteristics of blood group glycoprotein A and B antigen expression in human kidneys and livers. Methods We obtained human samples, including the renal artery, renal vein, renal tissue, hepatic artery, hepatic vein, portal vein, and hepatic tissue, from 24 deceased organ transplant donors. The expression of the blood group antigens glycoprotein A and B was analysed and compared by Western blotting. Results There was no significant difference in the expression between blood group glycoprotein A and B antigens at any of the seven sites (p > 0.05). The expression of both A and B antigens was highest in renal tissue and the portal vein and was lowest in the renal artery. A large difference in glycoprotein antigen expression was observed among various donors or different regions of the same individual. Univariate analysis revealed that glycoprotein A/B antigens were affected by the age and sex of donors and were significantly higher in males and in young people. Conclusions Our study found that blood group glycoprotein antigen expression showed certain trends and distinct distribution in the kidney, liver, and vessels among individuals and in different regions of the same individual, which may explain the different clinical outcomes of patients who received ABO-incompatible transplantation.
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Affiliation(s)
- Xianding Wang
- Department of Urology/Institute of Urology, West China Hospital, Sichuan University, Number 37, Guoxue Alley, Chengdu, 610041, Sichuan, China.,Organ Transplantation Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Fan Zhang
- West China School of Clinical Medicine, Sichuan University, Chengdu, Sichuan, China
| | - Yamei Jiang
- Department of Urology/Shanghai Key Laboratory of Organ Transplantation, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Zilin Xu
- West China School of Clinical Medicine, Sichuan University, Chengdu, Sichuan, China
| | - Xiaobing Feng
- Department of Urology/Institute of Urology, West China Hospital, Sichuan University, Number 37, Guoxue Alley, Chengdu, 610041, Sichuan, China.,Organ Transplantation Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Linde Li
- Department of Urology/Institute of Urology, West China Hospital, Sichuan University, Number 37, Guoxue Alley, Chengdu, 610041, Sichuan, China.,Organ Transplantation Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yu Fan
- Department of Urology/Institute of Urology, West China Hospital, Sichuan University, Number 37, Guoxue Alley, Chengdu, 610041, Sichuan, China.,Organ Transplantation Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Turun Song
- Department of Urology/Institute of Urology, West China Hospital, Sichuan University, Number 37, Guoxue Alley, Chengdu, 610041, Sichuan, China.,Organ Transplantation Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yunying Shi
- Department of Nephrology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Zhongli Huang
- Department of Urology/Institute of Urology, West China Hospital, Sichuan University, Number 37, Guoxue Alley, Chengdu, 610041, Sichuan, China.,Organ Transplantation Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Tao Lin
- Department of Urology/Institute of Urology, West China Hospital, Sichuan University, Number 37, Guoxue Alley, Chengdu, 610041, Sichuan, China. .,Organ Transplantation Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
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10
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Datta SS, Basu S, Reddy M, Gupta K, Sinha S. Comparative evaluation of the conventional tube test and column agglutination technology for ABO antibody titration in healthy individuals: a report from India. Immunohematology 2021; 37:25-32. [PMID: 33962486 DOI: 10.21307/immunohematology-2021-006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Determination of accurate anti-A/-B titers is important for treatment selection in ABO-incompatible stem cell and solid-organ transplants. The standard method for ABO antibody titration is the conventional tube test (CTT). Dithiothreitol (DTT) is commonly used to inactivate the IgM antibody component. The aim of this study was to compare six different methods for ABO antibody titration and to observe the effectiveness of DTT on antibody estimation. A total of 90 healthy voluntary blood donors were enrolled in this study, including 30 each for blood groups A, B, and O. Antibody titrations were performed and tested using the CTT-immediate spin (IS), CTT-antihuman globulin (AHG) with and without DTT, column agglutination technology (CAT)-IS, and CAT-AHG with and without DTT methods. Bead-CAT was used, and the positive cutoff value was set to 1+ for each method to determine the endpoint of the titer. The median values of anti-A/-B titers by IS were found to be higher than those values by AHG in CTT and CAT among group B and A individuals, whereas no statistically significant differences were observed in values from group O individuals for IS and AHG anti-A/-B titers, estimated by each method. Although there was positive correlation between the anti-A/-B titer results obtained using the CTT and CAT in all blood groups, testing using AHG showed poor agreement with and without DTT pretreatment (kappa value of 0.11 and 0.20, respectively). Moderate agreement was observed between CTT-IS and CAT-IS (kappa value of 0.46). Median anti-A/-B AHG titers were reduced by the use of DTT in all blood group samples. Significant differences in the interpretability of anti-A/-B titers were observed among different methods. A uniform approach for selecting the method for ABO antibody titration is highly recommended, and DTT pretreatment of plasma to neutralize IgM activity should be considered to obtain precise values of IgG anti-A/-B titers. Immunohematology 2021;37:25-32 . Determination of accurate anti-A/-B titers is important for treatment selection in ABO-incompatible stem cell and solid-organ transplants. The standard method for ABO antibody titration is the conventional tube test (CTT). Dithiothreitol (DTT) is commonly used to inactivate the IgM antibody component. The aim of this study was to compare six different methods for ABO antibody titration and to observe the effectiveness of DTT on antibody estimation. A total of 90 healthy voluntary blood donors were enrolled in this study, including 30 each for blood groups A, B, and O. Antibody titrations were performed and tested using the CTT-immediate spin (IS), CTT-antihuman globulin (AHG) with and without DTT, column agglutination technology (CAT)-IS, and CAT-AHG with and without DTT methods. Bead-CAT was used, and the positive cutoff value was set to 1+ for each method to determine the endpoint of the titer. The median values of anti-A/-B titers by IS were found to be higher than those values by AHG in CTT and CAT among group B and A individuals, whereas no statistically significant differences were observed in values from group O individuals for IS and AHG anti-A/-B titers, estimated by each method. Although there was positive correlation between the anti-A/-B titer results obtained using the CTT and CAT in all blood groups, testing using AHG showed poor agreement with and without DTT pretreatment (kappa value of 0.11 and 0.20, respectively). Moderate agreement was observed between CTT-IS and CAT-IS (kappa value of 0.46). Median anti-A/-B AHG titers were reduced by the use of DTT in all blood group samples. Significant differences in the interpretability of anti-A/-B titers were observed among different methods. A uniform approach for selecting the method for ABO antibody titration is highly recommended, and DTT pretreatment of plasma to neutralize IgM activity should be considered to obtain precise values of IgG anti-A/-B titers. Immunohematology 2021;37:25–32 .
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Affiliation(s)
- S S Datta
- Transfusion Medicine, Tata Medical Center , 14 Middle Arterial Road (EW), Rajarhat, New Town, Kolkata 700160 , India
| | - S Basu
- Transfusion Medicine, Tata Medical Center , Kolkata , India
| | - M Reddy
- Transfusion Medicine, Tata Medical Center , Kolkata , India
| | - K Gupta
- Transfusion Medicine, Tata Medical Center , Kolkata , India
| | - S Sinha
- Tata Medical Center , Kolkata , India
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11
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Zhu H, Ma Q, Li R, Fu M, Lu P. Blood group-related antigen Le y on human platelets and its involvement in platelet aggregation via a possible interaction with CD61. Transfusion 2020; 60:2130-2138. [PMID: 32757229 DOI: 10.1111/trf.15981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 05/11/2020] [Accepted: 05/11/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND The Ley antigen is a carbohydrate chain belonging to the ABH-Lewis blood group family. Ley has been reported to be present on red blood cells (RBCs) and granulocytes, but its distribution and function in platelets remain unknown. There are a variety of glycoproteins on platelets, which may carry the Ley antigen. This study aims to investigate the expression pattern and the function of Ley in human platelets. STUDY DESIGN AND METHODS Flow cytometry, Western blot, and immunofluorescence assays were performed to determine Ley expression on human platelets. ADP (1.25-10 μM) and thrombin (0.05-1 IU/mL) were used to activate platelets in the presence or absence of prostaglandin E1 (PGE1) and the Ley expression was evaluated again by flow cytometry. Blockade was performed with an anti-Ley monoclonal antibody to verify the role of this epitope in platelet function. Finally, coimmunoprecipitation was performed to identify glycoproteins associated with Ley . RESULTS Ley was expressed on human platelets independent of ABO blood type. Ley expression was decreased in a dose-dependent manner after activation with either ADP or thrombin, and this effect could be partially reversed by PGE1. Anti- Ley mAb treatment increased alpha-granule release and neutralized the inhibitory effect of the anti-CD61 antibody on platelet aggregation. In addition, Ley was proven to interact and colocalize with CD61. CONCLUSIONS These results demonstrate nondifferential expression of Ley in platelets of different ABO blood types and suggest the involvement of Ley in platelet function, possibly via interaction with CD61.
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Affiliation(s)
- Huijun Zhu
- Immunohematology Platelet Lab, Shanghai Blood Center, Shanghai, China
| | - Qinqin Ma
- Immunohematology Platelet Lab, Shanghai Blood Center, Shanghai, China
| | - Ruishu Li
- Immunohematology Platelet Lab, Shanghai Blood Center, Shanghai, China
| | - Min Fu
- Immunohematology Platelet Lab, Shanghai Blood Center, Shanghai, China
| | - Ping Lu
- Immunohematology Platelet Lab, Shanghai Blood Center, Shanghai, China
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12
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Shewell LK, Day CJ, Jen FEC, Haselhorst T, Atack JM, Reijneveld JF, Everest-Dass A, James DBA, Boguslawski KM, Brouwer S, Gillen CM, Luo Z, Kobe B, Nizet V, von Itzstein M, Walker MJ, Paton AW, Paton JC, Torres VJ, Jennings MP. All major cholesterol-dependent cytolysins use glycans as cellular receptors. SCIENCE ADVANCES 2020; 6:eaaz4926. [PMID: 32494740 PMCID: PMC7244308 DOI: 10.1126/sciadv.aaz4926] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 03/17/2020] [Indexed: 05/03/2023]
Abstract
Cholesterol-dependent cytolysins (CDCs) form pores in cholesterol-rich membranes, but cholesterol alone is insufficient to explain their cell and host tropism. Here, we show that all eight major CDCs have high-affinity lectin activity that identifies glycans as candidate cellular receptors. Streptolysin O, vaginolysin, and perfringolysin O bind multiple glycans, while pneumolysin, lectinolysin, and listeriolysin O recognize a single glycan class. Addition of exogenous carbohydrate receptors for each CDC inhibits toxin activity. We present a structure for suilysin domain 4 in complex with two distinct glycan receptors, P1 antigen and αGal/Galili. We report a wide range of binding affinities for cholesterol and for the cholesterol analog pregnenolone sulfate and show that CDCs bind glycans and cholesterol independently. Intermedilysin binds to the sialyl-TF O-glycan on its erythrocyte receptor, CD59. Removing sialyl-TF from CD59 reduces intermedilysin binding. Glycan-lectin interactions underpin the cellular tropism of CDCs and provide molecular targets to block their cytotoxic activity.
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Affiliation(s)
- Lucy K. Shewell
- Institute for Glycomics, Griffith University, Gold Coast, QLD 4222, Australia
| | - Christopher J. Day
- Institute for Glycomics, Griffith University, Gold Coast, QLD 4222, Australia
| | - Freda E.-C. Jen
- Institute for Glycomics, Griffith University, Gold Coast, QLD 4222, Australia
| | - Thomas Haselhorst
- Institute for Glycomics, Griffith University, Gold Coast, QLD 4222, Australia
| | - John M. Atack
- Institute for Glycomics, Griffith University, Gold Coast, QLD 4222, Australia
| | | | - Arun Everest-Dass
- Institute for Glycomics, Griffith University, Gold Coast, QLD 4222, Australia
| | - David B. A. James
- Department of Microbiology, New York University School of Medicine, New York, NY 10016, USA
| | | | - Stephan Brouwer
- School of Chemistry and Molecular Biosciences and the Australian Infectious Diseases Research Centre, University of Queensland, Brisbane, QLD 4072, Australia
| | - Christine M. Gillen
- School of Chemistry and Molecular Biosciences and the Australian Infectious Diseases Research Centre, University of Queensland, Brisbane, QLD 4072, Australia
| | - Zhenyao Luo
- School of Chemistry and Molecular Biosciences and the Australian Infectious Diseases Research Centre, University of Queensland, Brisbane, QLD 4072, Australia
- Institute for Molecular Bioscience, University of Queensland, Brisbane, QLD 4072, Australia
| | - Bostjan Kobe
- School of Chemistry and Molecular Biosciences and the Australian Infectious Diseases Research Centre, University of Queensland, Brisbane, QLD 4072, Australia
- Institute for Molecular Bioscience, University of Queensland, Brisbane, QLD 4072, Australia
| | - Victor Nizet
- Department of Pediatrics and Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California, San Diego, La Jolla, CA 92093, USA
| | - Mark von Itzstein
- Institute for Glycomics, Griffith University, Gold Coast, QLD 4222, Australia
| | - Mark J. Walker
- School of Chemistry and Molecular Biosciences and the Australian Infectious Diseases Research Centre, University of Queensland, Brisbane, QLD 4072, Australia
| | - Adrienne W. Paton
- Research Centre for Infectious Diseases, Department of Molecular and Biomedical Science, University of Adelaide, Adelaide 5005, Australia
| | - James C. Paton
- Research Centre for Infectious Diseases, Department of Molecular and Biomedical Science, University of Adelaide, Adelaide 5005, Australia
| | - Victor J. Torres
- Department of Microbiology, New York University School of Medicine, New York, NY 10016, USA
| | - Michael P. Jennings
- Institute for Glycomics, Griffith University, Gold Coast, QLD 4222, Australia
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13
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Rahfeld P, Withers SG. Toward universal donor blood: Enzymatic conversion of A and B to O type. J Biol Chem 2019; 295:325-334. [PMID: 31792054 DOI: 10.1074/jbc.rev119.008164] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Transfusion of blood, or more commonly red blood cells (RBCs), is integral to health care systems worldwide but requires careful matching of blood types to avoid serious adverse consequences. Of the four main blood types, A, B, AB, and O, only O can be given to any patient. This universal donor O-type blood is crucial for emergency situations where time or resources for typing are limited, so it is often in short supply. A and B blood differ from the O type in the presence of an additional sugar antigen (GalNAc and Gal, respectively) on the core H-antigen found on O-type RBCs. Thus, conversion of A, B, and AB RBCs to O-type RBCs should be achievable by removal of that sugar with an appropriate glycosidase. The first demonstration of a B-to-O conversion by Goldstein in 1982 required massive amounts of enzyme but enabled proof-of-principle transfusions without adverse effects in humans. New α-galactosidases and α-N-acetylgalactosaminidases were identified by screening bacterial libraries in 2007, allowing improved conversion of B and the first useful conversions of A-type RBCs, although under constrained conditions. In 2019, screening of a metagenomic library derived from the feces of an AB donor enabled discovery of a significantly more efficient two-enzyme system, involving a GalNAc deacetylase and a galactosaminidase, for A conversion. This promising system works well both in standard conditions and in whole blood. We discuss remaining challenges and opportunities for the use of such enzymes in blood conversion and organ transplantation.
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Affiliation(s)
- Peter Rahfeld
- Department of Chemistry, University of British Columbia, Vancouver, British Columbia V6T 1Z1, Canada; Michael Smith Laboratories, University of British Columbia, Vancouver, British Columbia V6T 1Z4, Canada
| | - Stephen G Withers
- Department of Chemistry, University of British Columbia, Vancouver, British Columbia V6T 1Z1, Canada; Michael Smith Laboratories, University of British Columbia, Vancouver, British Columbia V6T 1Z4, Canada; Department of Biochemistry and Molecular Biology, University of British Columbia, Vancouver, British Columbia V6T 1Z3, Canada.
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14
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Ryzhov IM, Bovin NV. Synthesis of glycans functioning as antigens of the ABO blood group system. MENDELEEV COMMUNICATIONS 2019. [DOI: 10.1016/j.mencom.2019.11.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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15
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Tasaki M, Saito K, Nakagawa Y, Imai N, Ito Y, Yoshida Y, Ikeda M, Ishikawa S, Narita I, Takahashi K, Tomita Y. Analysis of the prevalence of systemic de novo thrombotic microangiopathy after ABO-incompatible kidney transplantation and the associated risk factors. Int J Urol 2019; 26:1128-1137. [PMID: 31587389 DOI: 10.1111/iju.14118] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 08/27/2019] [Indexed: 12/11/2022]
Abstract
OBJECTIVES To analyze the prevalence of systemic de novo thrombotic microangiopathy in ABO-incompatible kidney transplantation and risk factors associated with this condition. METHODS A total of 201 patients who received living-donor kidney transplantation (114 patients with ABO-identical kidney transplantation and 87 patients with ABO-incompatible kidney transplantation) were retrospectively analyzed. Systemic de novo thrombotic microangiopathy was diagnosed clinically according to the presence of thrombocytopenia with microangiopathic hemolytic anemia and pathological findings of thrombotic microangiopathy. Anti-A and anti-B antibodies were purified from human plasma, and these antibodies' bindings to human kidney were investigated in vitro. RESULTS ABO-incompatible kidney transplantation was a significant risk factor of systemic de novo thrombotic microangiopathy (odds ratio 55.9, 95% CI 1.8-8.9, P < 0.001) after transplantation. Multivariate logistic regression analysis showed that non-use of mycophenolate mofetil, pretreatment immunoglobulin G antibody titer ≥64-fold and pretransplant immunoglobulin M antibody titer ≥16-fold were significant risk factors for systemic de novo thrombotic microangiopathy in ABO-incompatible kidney transplantation. Microvascular inflammation of 1-h post-transplant biopsy could be observed more frequently in thrombotic microangiopathy patients than in non-thrombotic microangiopathy patients. Anti-A and anti-B antibodies purified from human plasma showed a strong in vitro reaction against human kidney when the antibody titer was ≥16-fold. CONCLUSIONS Antibody titer should be decreased to ≤16-fold until the day of ABO-incompatible kidney transplantation by desensitization therapy including mycophenolate mofetil. The 1-h biopsy results might help to diagnose systemic de novo thrombotic microangiopathy.
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Affiliation(s)
- Masayuki Tasaki
- Division of Urology, Department of Regenerative and Transplant Medicine, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan
| | - Kazuhide Saito
- Division of Urology, Department of Regenerative and Transplant Medicine, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan
| | - Yuki Nakagawa
- Division of Urology, Department of Regenerative and Transplant Medicine, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan
| | - Naofumi Imai
- Division of Clinical Nephrology and Rheumatology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan
| | - Yumi Ito
- Division of Clinical Nephrology and Rheumatology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan
| | - Yutaka Yoshida
- Department of Structural Pathology, Kidney Research Center, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan.,Institute for Research Promotion, Niigata University, Niigata, Japan
| | - Masahiro Ikeda
- Division of Urology, Department of Regenerative and Transplant Medicine, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan
| | - Shoko Ishikawa
- Division of Urology, Department of Regenerative and Transplant Medicine, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan
| | - Ichiei Narita
- Division of Clinical Nephrology and Rheumatology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan
| | | | - Yoshihiko Tomita
- Division of Urology, Department of Regenerative and Transplant Medicine, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan
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16
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Tajima K, Takizawa K, Yasuda T, Tsumanuma R, Okuyama S, Kumagai H, Omoto E, Okumura W. Characterization of reemergent anti-B red blood cell antibodies in a patient with recurrent acute myeloid leukemia with ABO-incompatible allogeneic peripheral blood stem cell transplantation. Transfusion 2019; 59:3319-3323. [PMID: 31503348 DOI: 10.1111/trf.15510] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 08/15/2019] [Accepted: 08/16/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Isohemagglutinins against ABO antigens absent on both recipient and donor red blood cells (RBCs) increase or decrease after ABO-incompatible hematopoietic stem cell transplantation (HSCT). However, few reports have described the changes in the isohemagglutinin titers and the characteristics in patients with recurrent hematologic conditions after ABO-incompatible HSCT. CASE REPORT A 59-year-old female with acute erythroid leukemia received a peripheral blood stem cell transplant from her HLA-haploidentical daughter. The patient was typed as group O with anti- A (4+) and B (4+) isohemagglutinins, while the donor was typed as group B. The bone marrow cells achieved complete donor cell chimerism on Day 13 after HSCT. On Day 120, the patient showed 97% B RBC type with persistent anti-A (3+) and without anti-B antibodies. On Day 375, her leukemia relapsed, and recipient type O RBCs and anti-B antibodies sequentially reemerged. However, clinicolaboratory hemolysis and erythroid aplasia were not detected in the patient. RESULTS The post-HSCT sera agglutinated the allo B RBCs, but not the donor B RBCs, while the pre-HSCT sera agglutinated both RBCs. The burst-forming/colony-forming units of erythroid formation from the donor peripheral blood stem cells were impaired by only the pre-HSCT sera and not by the post-HSCT sera. CONCLUSION To our knowledge, this is the first report investigating the characteristic changes of isohemagglutinins between the pre- and post-HSCT sera in a patient with recurrent acute myeloid leukemia. The present study suggests that the plasma cells producing anti-donor B RBCs in the patient have been selectively eliminated or induced into an anergic state by the post-HSCT immunologic reconstruction.
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Affiliation(s)
- Katsushi Tajima
- Department of Hematology, Yamagata Prefectural Central Hospital, Yamagata, Japan.,Research Center for Radiation Emergency Medicine, National Institute of Radiological Sciences, Chiba, Japan
| | - Kazuya Takizawa
- Research Center for Radiation Emergency Medicine, National Institute of Radiological Sciences, Chiba, Japan
| | - Takeshi Yasuda
- Research Center for Radiation Emergency Medicine, National Institute of Radiological Sciences, Chiba, Japan
| | - Riko Tsumanuma
- Department of Hematology, Yamagata Prefectural Central Hospital, Yamagata, Japan
| | - Shuhei Okuyama
- Department of Hematology, Yamagata Prefectural Central Hospital, Yamagata, Japan
| | - Hiroaki Kumagai
- Department of Hematology, Yamagata Prefectural Central Hospital, Yamagata, Japan
| | - Eijiro Omoto
- Department of Hematology, Yamagata Prefectural Central Hospital, Yamagata, Japan
| | - Wataru Okumura
- Department of Laboratory Medicine, Yamagata Prefectural Central Hospital, Yamagata, Japan
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17
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Kidney transplantation across minor ABO incompatibility: the use of A2 to B transplants. Curr Opin Organ Transplant 2019; 24:365-369. [DOI: 10.1097/mot.0000000000000672] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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18
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Stowell SR, Stowell CP. Biologic roles of the ABH and Lewis histo-blood group antigens part II: thrombosis, cardiovascular disease and metabolism. Vox Sang 2019; 114:535-552. [PMID: 31090093 DOI: 10.1111/vox.12786] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 04/08/2019] [Accepted: 04/10/2019] [Indexed: 12/14/2022]
Abstract
The ABH and Lewis antigens were among the first of the human red blood cell polymorphisms to be identified and, in the case of the former, play a dominant role in transfusion and transplantation. But these two therapies are largely twentieth-century innovations, and the ABH and related carbohydrate antigens are not only expressed on a very wide range of human tissues, but were present in primates long before modern humans evolved. Although we have learned a great deal about the biochemistry and genetics of these structures, the biological roles that they play in human health and disease are incompletely understood. This review and its companion, which appeared in a previous issue of Vox Sanguinis, will focus on a few of the biologic and pathologic processes which appear to be affected by histo-blood group phenotype. The first of the two reviews explored the interactions of two bacteria with the ABH and Lewis glycoconjugates of their human host cells, and described the possible connections between the immune response of the human host to infection and the development of the AB-isoagglutinins. This second review will describe the relationship between ABO phenotype and thromboembolic disease, cardiovascular disease states, and general metabolism.
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Affiliation(s)
- Sean R Stowell
- Center for Apheresis, Center for Transfusion and Cellular Therapies, Emory Hospital, Emory University School of Medicine, Atlanta, GA, USA.,Department of Pathology, Emory University School of Medicine, Atlanta, GA, USA
| | - Christopher P Stowell
- Blood Transfusion Service, Massachusetts General Hospital, Boston, MA, USA.,Department of Pathology, Harvard Medical School, Boston, MA, USA
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19
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Stowell CP, Stowell SR. Biologic roles of the ABH and Lewis histo-blood group antigens Part I: infection and immunity. Vox Sang 2019; 114:426-442. [PMID: 31070258 DOI: 10.1111/vox.12787] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 04/08/2019] [Accepted: 04/10/2019] [Indexed: 12/22/2022]
Abstract
The ABH and Lewis antigens were among the first of the human red blood cell polymorphisms to be identified and, in the case of the former, play a dominant role in transfusion and transplantation. But these two therapies are largely twentieth century innovations, and the ABH and related carbohydrate antigens are not only expressed on a very wide range of human tissues, but were present in primates long before modern humans evolved. Although we have learned a great deal about the biochemistry and genetics of these structures, the biological roles that they play in human health and disease are incompletely understood. This review and its companion, to appear in a later issue of Vox Sanguinis, will focus on a few of the biologic and pathologic processes which appear to be affected by histo-blood group phenotype. The first of the two reviews will explore the interactions of two bacteria with the ABH and Lewis glycoconjugates of their human host cells, and describe the possible connections between the immune response of the human host to infection and the development of the AB-isoagglutinins. The second review will describe the relationship between ABO phenotype and thromboembolic disease, cardio-vascular disease states, and general metabolism.
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Affiliation(s)
- Christopher P Stowell
- Blood Transfusion Service, Massachusetts General Hospital, Boston, MA, USA.,Department of Pathology, Harvard Medical School, Boston, MA, USA
| | - Sean R Stowell
- Center for Apheresis, Center for Transfusion and Cellular Therapies, Emory Hospital, Emory University School of Medicine, Atlanta, GA, USA.,Department of Pathology, Emory University School of Medicine, Atlanta, GA, USA
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20
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New Answers to Old Conundrums: What Antibodies, Exosomes and Inflammasomes Bring to the Conversation. Canadian National Transplant Research Program International Summit Report. Transplantation 2018; 102:209-214. [PMID: 28731910 PMCID: PMC5802265 DOI: 10.1097/tp.0000000000001872] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Antibody-mediated injury is a major cause of allograft dysfunction and loss. Antibodies to ABH(O) blood group antigens are classic mediators of ABO-incompatible graft rejection, whereas donor-specific anti-HLA antibodies and, more recently, autoantibodies are appreciated as important contributors to allograft inflammation and dysfunction. In August 2016, the International Summit of the Canadian National Transplant Research Program focused on recent advances in the field of antibody-mediated rejection. Here, we describe work presented and discussed at the meeting, with a focus on 3 major themes: the importance of (1) natural antibodies and autoantibodies, (2) tissue injury-derived exosomes and autoimmunity, (3) inflammasome activation and innate immune responses in regulating allograft inflammation and dysfunction. Finally, we explore novel areas of therapeutic intervention that have recently emerged from these 3 major and overlapping fields of transplantation research.
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21
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Dean CL, Sullivan HC, Stowell SR, Fasano RM, West LJ, Robitaille N, Josephson CD. Current state of transfusion practices for ABO-incompatible pediatric heart transplant patients in the United States and Canada. Transfusion 2018; 58:2243-2249. [DOI: 10.1111/trf.14775] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Revised: 04/15/2018] [Accepted: 04/16/2018] [Indexed: 01/06/2023]
Affiliation(s)
- Christina L. Dean
- Center for Transfusion and Cellular Therapies, Department of Pathology and Laboratory Medicine; Emory University School of Medicine
| | - Harold C. Sullivan
- Center for Transfusion and Cellular Therapies, Department of Pathology and Laboratory Medicine; Emory University School of Medicine
| | - Sean R. Stowell
- Center for Transfusion and Cellular Therapies, Department of Pathology and Laboratory Medicine; Emory University School of Medicine
| | - Ross M. Fasano
- Center for Transfusion and Cellular Therapies, Department of Pathology and Laboratory Medicine; Emory University School of Medicine
- Departments of Hematology and Clinical Pathology; Children's Healthcare of Atlanta; Atlanta Georgia
| | - Lori J. West
- Department of Pediatrics; Alberta Transplant Institute, Stollery Children's Hospital, University of Alberta; Edmonton Alberta Canada
| | - Nancy Robitaille
- Division of Hematology-Oncology, Department of Pediatrics; CHU Sainte-Justine; Montreal Quebec Canada
| | - Cassandra D. Josephson
- Center for Transfusion and Cellular Therapies, Department of Pathology and Laboratory Medicine; Emory University School of Medicine
- Departments of Hematology and Clinical Pathology; Children's Healthcare of Atlanta; Atlanta Georgia
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22
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Daskhan GC, Tran HTT, Meloncelli PJ, Lowary TL, West LJ, Cairo CW. Construction of Multivalent Homo- and Heterofunctional ABO Blood Group Glycoconjugates Using a Trifunctional Linker Strategy. Bioconjug Chem 2018; 29:343-362. [PMID: 29237123 DOI: 10.1021/acs.bioconjchem.7b00679] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
The design and synthesis of multivalent ligands displaying complex oligosaccharides is necessary for the development of therapeutics, diagnostics, and research tools. Here, we report an efficient conjugation strategy to prepare complex glycoconjugates with 4 copies of 1 or 2 separate glycan epitopes, providing 4-8 carbohydrate residues on a tetravalent poly(ethylene glycol) scaffold. This strategy provides complex glycoconjugates that approach the size of glycoproteins (15-18 kDa) while remaining well-defined. The synthetic strategy makes use of three orthogonal functional groups, including a reactive N-hydroxysuccinimide (NHS)-ester moiety on the linker to install the first carbohydrate epitope via reaction with an amine. A masked amine functionality on the linker is revealed after the removal of a fluorenylmethyloxycarbonyl (Fmoc)-protecting group, allowing the attachment to the NHS-activated poly(ethylene glycol) (PEG) scaffold. An azide group in the linker was then used to incorporate the second carbohydrate epitope via catalyzed alkyne-azide cycloaddition. Using a known tetravalent PEG scaffold (PDI, 1.025), we prepared homofunctional glycoconjugates that display four copies of lactose and the A-type II or the B-type II human blood group antigens. Using our trifunctional linker, we expanded this strategy to produce heterofunctional conjugates with four copies of two separate glycan epitopes. These heterofunctional conjugates included Neu5Ac, 3'-sialyllactose, or 6'-sialyllactose as a second antigen. Using an alternative strategy, we generated heterofunctional conjugates with three copies of the glycan epitope and one fluorescent group (on average) using a sequential dual-amine coupling strategy. These conjugation strategies should be easily generalized for conjugation of other complex glycans. We demonstrate that the glycan epitopes of heterofunctional conjugates engage and cluster target B-cell receptors and CD22 receptors on B cells, supporting the application of these reagents for investigating cellular response to carbohydrate antigens of the ABO blood group system.
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Affiliation(s)
- Gour Chand Daskhan
- Alberta Glycomics Centre, Department of Chemistry, University of Alberta , Edmonton, Alberta T6G 2G2, Canada
| | - Hanh-Thuc Ton Tran
- Alberta Glycomics Centre, Department of Chemistry, University of Alberta , Edmonton, Alberta T6G 2G2, Canada
| | - Peter J Meloncelli
- Alberta Glycomics Centre, Department of Chemistry, University of Alberta , Edmonton, Alberta T6G 2G2, Canada
| | - Todd L Lowary
- Alberta Glycomics Centre, Department of Chemistry, University of Alberta , Edmonton, Alberta T6G 2G2, Canada.,Canadian National Transplant Research Program, University of Alberta , Edmonton, Alberta T6G 2E1, Canada
| | - Lori J West
- Alberta Glycomics Centre, Department of Chemistry, University of Alberta , Edmonton, Alberta T6G 2G2, Canada.,Department of Pediatrics, Surgery, Medical Microbiology and Immunology, and Laboratory Medicine and Pathology, Alberta Transplant Institute, University of Alberta Edmonton, Alberta T6G 2E1, Canada.,Canadian National Transplant Research Program, University of Alberta , Edmonton, Alberta T6G 2E1, Canada
| | - Christopher W Cairo
- Alberta Glycomics Centre, Department of Chemistry, University of Alberta , Edmonton, Alberta T6G 2G2, Canada.,Canadian National Transplant Research Program, University of Alberta , Edmonton, Alberta T6G 2E1, Canada
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The 2017 Seventh World Congress of Pediatric Cardiology & Cardiac Surgery: Week in Review: heart failure, transplantation, and pulmonary hypertension. Cardiol Young 2017; 27:2018-2022. [PMID: 29286265 DOI: 10.1017/s1047951117002207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The heart failure, heart transplantation, and pulmonary hypertension workgroups of the Scientific Committee were honoured to be asked to plan a full slate of sessions at the 2017 World Congress of Pediatric Cardiology and Cardiac Surgery. In all there were 35 oral platform presentations, a further 14 oral platform presentations in "Bridging Together" sessions with other workgroups/specialties, a terrific debate about transplant listing in adult CHD patients, and a further 23 oral abstract presentations. The speakers were clear and concise, the research presented was ground-breaking, and the global representation was evident.
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Abstract
Overlooked for decades, the humoral alloimmune response is increasingly recognized as a leading cause of graft loss after transplantation. However, improvement in the diagnosis of antibody-mediated rejection has not yet translated into better outcomes for transplanted patients. After an update on B cell physiology and antibody generation, the 2015 Beaune Seminar in Transplant Research challenged the conventional view of antibody-mediated rejection pathophysiology and discussed the latest promising therapeutic approaches.
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25
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Tasaki M, Saito K, Nakagawa Y, Imai N, Ito Y, Aoki T, Kamimura M, Narita I, Tomita Y, Takahashi K. Acquired Downregulation of Donor-Specific Antibody Production After ABO-Incompatible Kidney Transplantation. Am J Transplant 2017; 17:115-128. [PMID: 27343838 DOI: 10.1111/ajt.13937] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Revised: 05/31/2016] [Accepted: 06/21/2016] [Indexed: 01/25/2023]
Abstract
The mechanism of long-term B cell immunity against donor blood group antigens in recipients who undergo ABO-incompatible (ABOi) living-donor kidney transplantation (LKTx) is unknown. To address this question, we evaluated serial anti-A and anti-B antibody titers in 50 adult recipients. Donor-specific antibody titers remained low (≤1:4) in 42 recipients (84%). However, antibodies against nondonor blood group antigens were continuously produced in recipients with blood type O. We stimulated recipients' peripheral blood mononuclear cells in vitro to investigate whether B cells produced antibodies against donor blood group antigens in the absence of graft adsorption in vivo. Antibodies in cell culture supernatant were measured using specific enzyme-linked immunosorbent assays (ELISAs). Thirty-five healthy volunteers and 57 recipients who underwent ABO-compatible LKTx served as controls. Antibody production in vitro against donor blood group antigens by cells from ABOi LKTx patients was lower than in the control groups. Immunoglobulin deposits were undetectable in biopsies of grafts of eight recipients with low antibody titers (≤1:4) after ABOi LKTx. One patient with blood type A1 who received a second ABOi LKTx from a type B donor did not produce B-specific antibodies. These findings suggest diminished donor-specific antibody production function in the setting of adult ABOi LKTx.
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Affiliation(s)
- M Tasaki
- Division of Urology, Department of Regenerative & Transplant Medicine, Niigata Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - K Saito
- Division of Urology, Department of Regenerative & Transplant Medicine, Niigata Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Y Nakagawa
- Division of Urology, Department of Regenerative & Transplant Medicine, Niigata Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - N Imai
- Division of Clinical Nephrology and Rheumatology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan
| | - Y Ito
- Division of Clinical Nephrology and Rheumatology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan
| | - T Aoki
- Division of Transfusion Medicine and Regenerative Medicine, Bioscience Medical Center, Niigata University Medical and Dental Hospital, Niigata, Japan
| | - M Kamimura
- Division of Transfusion Medicine and Regenerative Medicine, Bioscience Medical Center, Niigata University Medical and Dental Hospital, Niigata, Japan
| | - I Narita
- Division of Clinical Nephrology and Rheumatology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan
| | - Y Tomita
- Division of Urology, Department of Regenerative & Transplant Medicine, Niigata Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - K Takahashi
- Division of Urology, Department of Regenerative & Transplant Medicine, Niigata Graduate School of Medical and Dental Sciences, Niigata, Japan.,Niigata Prefecture Organ Transplant Promotion Foundation, Tokyo, Japan
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26
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O'Connor MJ, Pahl E, Webber SA, Rossano JW. Recent advances in heart transplant immunology: The role of antibodies. PROGRESS IN PEDIATRIC CARDIOLOGY 2016. [DOI: 10.1016/j.ppedcard.2016.07.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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27
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Abstract
PURPOSE OF REVIEW ABO-incompatible (ABOi) heart transplantation (HTx) in young children has evolved from an experimental approach to a standard allocation option in many countries. Clinical and immunological research in ABOi transplantation has revealed insight into the immature immune system and its role in superior graft acceptance in childhood and antigen-specific tolerance. RECENT FINDINGS Multicenter experience has confirmed equal actuarial survival, freedom from rejection, and graft vasculopathy comparing ABOi with ABO-compatible HTx. Observations of reduced antibody production and B-cell immunity toward the donor blood group have been confirmed in long-term follow-up. Mechanisms contributing to tolerance in this setting involve the interplay between B-cells and the complement system and the development of B-cell memory. Better characterization of the ABH polysaccharide antigens has improved diagnostic methods and clinical assessment of blood group antibodies. Boundaries regarding age, immune maturity, and therapeutic interventions to extend the applicability of ABOi HTx have been explored and resulted in data that may be useful for HTx patients beyond infancy and ABOi transplantation of other organs. Tolerance of ABH antigens possibly extends to HLA response. SUMMARY The review provides insight into the clinical evolution of ABOi HTx and associated immunologic discoveries. Current experiences and boundaries are discussed together with recent and potential future developments for utilization in other patient and age groups.
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Bentall A, R Barnett AN, Braitch M, Kessaris N, McKane W, Newstead C, McHaffie G, Brown A, Griffin S, Mamode N, Briggs D, Ball S. Clinical outcomes with ABO antibody titer variability in a multicenter study of ABO-incompatible kidney transplantation in the United Kingdom. Transfusion 2016; 56:2668-2679. [PMID: 27562458 DOI: 10.1111/trf.13770] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Revised: 06/04/2016] [Accepted: 07/01/2016] [Indexed: 12/19/2022]
Abstract
BACKGROUND ABO blood group-incompatible kidney transplantation (ABOiKTx) outcomes are good, but complications are more common than in conventional transplantation. Regimens that use extracorporeal antibody removal therapy (EART) and enhanced immunosuppression are guided by titration of ABO blood group antibodies (using hemagglutination [HA] dilution assays), and these assays vary significantly in performance between centers. This study aims to describe the differences in titer measurement and the effect on clinical practice and outcomes. STUDY DESIGN AND METHODS This multicentre, prospective cohort study of 100 ABOiKTx recipients assessed treatment and outcome data, including HA assay results measured retrospectively in a single central laboratory. RESULTS Patient and allograft survival at 1 year was 99% and 94%, respectively. There were significant differences in the number of pretransplantation EART sessions in centers undertaking plasma exchange (PEx), compared with immunoadsorption (IA) (median, 6 vs. 4 sessions; p = 0.007). The pre-EART HA titer in both groups was the same when centrally assayed. The local HA assay used to guide treatment yielded significantly higher titers in centers undertaking PEx compared with IA (median, 128 vs. 32; p < 0.005). Patients undergoing PEx rather than IA were significantly more likely to suffer postoperative hematoma (12.9% vs. 1.8%; p = 0.05) or any perioperative collection requiring drainage (19.4% vs. 3.6%; p = 0.02). CONCLUSION The colinearity of HA assay sensitivity with the receipt of PEx and EART limits some conclusions regarding the likely direction of causation. However, the association of differences in clinical practice with recognized perioperative complications of ABOiKTx identifies targets for further investigation and quality improvement.
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Affiliation(s)
- Andrew Bentall
- Department of Renal Medicine, Queen Elizabeth Hospital.,School of Immunity and Infection, University of Birmingham, Birmingham, United Kingdom
| | - A Nicholas R Barnett
- Department of Transplantation, Guy's and St Thomas' Hospital, London, United Kingdom
| | - Manjit Braitch
- School of Immunity and Infection, University of Birmingham, Birmingham, United Kingdom
| | - Nicos Kessaris
- Department of Transplantation, Guy's and St Thomas' Hospital, London, United Kingdom
| | - Will McKane
- Sheffield Kidney Institute, Sheffield Teaching Hospitals, Sheffield, United Kingdom
| | - Chas Newstead
- Department of Nephrology and Transplantation, Leeds Teaching Hospitals National Health Service Trust, Leeds, United Kingdom
| | - Gavin McHaffie
- Department of Nephrology and Transplantation, Nottingham, United Kingdom
| | - Alison Brown
- Department of Nephrology and Transplantation, Newcastle, United Kingdom
| | - Sian Griffin
- Department of Nephrology and Transplantation, Cardiff, United Kingdom
| | - Nizam Mamode
- Department of Transplantation, Guy's and St Thomas' Hospital, London, United Kingdom
| | - David Briggs
- Department of Histocompatibility and Immunogenetics, National Health Service Blood and Transplant, Birmingham Centre, Birmingham, United Kingdom
| | - Simon Ball
- Department of Renal Medicine, Queen Elizabeth Hospital.,School of Immunity and Infection, University of Birmingham, Birmingham, United Kingdom
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29
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Abstract
The Canadian National Transplant Research Program, launched in 2013 with funding from the Canadian Institutes for Health Research and partners, bridges research in the fields of solid organ transplant, hematopoietic cell transplant, and organ donation. We describe the philosophy, structure, accomplishments, and challenges faced by the Canadian National Transplant Research Program to expand on facilitators and overcome roadblocks to successfully developing a transdisciplinary national research structure.
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30
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Abstract
PURPOSE OF REVIEW The phenomenon of tolerance induced during immunologic immaturity has been explored for more than 60 years. Although direct application of neonatal tolerance to organ transplantation in human newborns is limited, exploiting discrete components of neonatal immaturity is proving fruitful. RECENT FINDINGS Two reviews comprehensively considered features and impact of neonatal tolerance as described in the 1950s. Recent imaging studies in mice demonstrated complex functional interactions especially of donor regulatory T cells with emerging neonatal immune components. The propensity of the developing immune system toward tolerance rather than immunity to non-self carbohydrates in ABO-incompatible transplantation was shown using glyconanotechnology tools to have exquisite specificity, and is associated with age-related changes in the B-cell compartment and complement components. Discarded infant thymus was found to be a source of abundant therapeutic regulatory T cells. Erythroid precursors transiently present in newborn mice and humans were shown to have immunosuppressive properties that may contribute to a tolerogenic environment. SUMMARY Neonatal tolerance has profound impact on immunology well beyond transplantation. Continued exploration of mechanisms underlying the malleability of the developing immune system and exploitation of particular components are leading to tools for immune manipulation beyond infancy.
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31
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Jeyakanthan M, Meloncelli PJ, Zou L, Lowary TL, Larsen I, Maier S, Tao K, Rusch J, Chinnock R, Shaw N, Burch M, Beddows K, Addonizio L, Zuckerman W, Pahl E, Rutledge J, Kanter KR, Cairo CW, Buriak JM, Ross D, Rebeyka I, West LJ. ABH-Glycan Microarray Characterizes ABO Subtype Antibodies: Fine Specificity of Immune Tolerance After ABO-Incompatible Transplantation. Am J Transplant 2016; 16:1548-58. [PMID: 26602221 DOI: 10.1111/ajt.13625] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Revised: 10/18/2015] [Accepted: 11/07/2015] [Indexed: 01/25/2023]
Abstract
Organ transplantation from ABO blood group-incompatible (ABOi) donors requires accurate detection, effective removal and subsequent surveillance of antidonor antibodies. Because ABH antigen subtypes are expressed differently in various cells and organs, measurement of antibodies specific for the antigen subtypes in the graft is essential. Erythrocyte agglutination, the century-old assay used clinically, does not discriminate subtype-specific ABO antibodies and provides limited information on antibody isotypes. We designed and created an ABO-glycan microarray and demonstrated the precise assessment of both the presence and, importantly, the absence of donor-specific antibodies in an international study of pediatric heart transplant patients. Specific IgM, IgG, and IgA isotype antibodies to nonself ABH subtypes were detected in control participants and recipients of ABO-compatible transplants. Conversely, in children who received ABOi transplants, antibodies specific for A subtype II and/or B subtype II antigens-the only ABH antigen subtypes expressed in heart tissue-were absent, demonstrating the fine specificity of B cell tolerance to donor/graft blood group antigens. In contrast to the hemagglutination assay, the ABO-glycan microarray allows detailed characterization of donor-specific antibodies necessary for effective transplant management, representing a major step forward in precise ABO antibody detection.
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Affiliation(s)
- M Jeyakanthan
- Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - P J Meloncelli
- Alberta Glycomics Centre and Department of Chemistry, University of Alberta, Edmonton, Alberta, Canada
| | - L Zou
- Alberta Glycomics Centre and Department of Chemistry, University of Alberta, Edmonton, Alberta, Canada
| | - T L Lowary
- Alberta Glycomics Centre and Department of Chemistry, University of Alberta, Edmonton, Alberta, Canada
| | - I Larsen
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - S Maier
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - K Tao
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - J Rusch
- Pediatrtic Cardiology, Loma Linda University Medical Center, Loma Linda, CA
| | - R Chinnock
- Pediatrtic Cardiology, Loma Linda University Medical Center, Loma Linda, CA
| | - N Shaw
- Pediatric Cardiology, Great Ormond Street Hospital for Sick Children, London, UK
| | - M Burch
- Pediatric Cardiology, Great Ormond Street Hospital for Sick Children, London, UK
| | - K Beddows
- Division of Pediatric Cardiology, Columbia University, New York, NY
| | - L Addonizio
- Division of Pediatric Cardiology, Columbia University, New York, NY
| | - W Zuckerman
- Division of Pediatric Cardiology, Columbia University, New York, NY
| | - E Pahl
- Pediatric Cardiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - J Rutledge
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - K R Kanter
- Department of Surgery, Emory University School of Medicine, Atlanta, GA
| | - C W Cairo
- Alberta Glycomics Centre and Department of Chemistry, University of Alberta, Edmonton, Alberta, Canada
| | - J M Buriak
- National Institute for Nanotechnology, University of Alberta, Edmonton, Alberta, Canada
| | - D Ross
- Department of Surgery, University of Alberta, Edmonton, Alberta, Canada.,Alberta Transplant Institute, University of Alberta, Edmonton, Alberta, Canada
| | - I Rebeyka
- Department of Surgery, University of Alberta, Edmonton, Alberta, Canada.,Alberta Transplant Institute, University of Alberta, Edmonton, Alberta, Canada
| | - L J West
- Department of Surgery, University of Alberta, Edmonton, Alberta, Canada.,Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada.,Alberta Transplant Institute, University of Alberta, Edmonton, Alberta, Canada.,Department of Medical Microbiology & Immunology, University of Alberta, Edmonton, Alberta, Canada
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32
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Slaney AM, Dijke IE, Jeyakanthan M, Li C, Zou L, Plaza-Alexander P, Meloncelli PJ, Bau JA, Allan LL, Lowary TL, West LJ, Cairo CW, Buriak JM. Conjugation of A and B Blood Group Structures to Silica Microparticles for the Detection of Antigen-Specific B Cells. Bioconjug Chem 2016; 27:705-15. [PMID: 26816334 DOI: 10.1021/acs.bioconjchem.5b00672] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Silica microparticles were functionalized with A and B blood group carbohydrate antigens (A type I, A type II, B type I, and B type II) to enable the detection and monitoring of ABO antigen-specific B cells. Microparticles were prepared via the Stöber synthesis, labeled with an Alexafluor fluorescent dye, and characterized via TEM and fluorescence microscopy. The silica microparticles were functionalized with (3-aminopropyl)trimethoxysilane (APTMS), followed by the use of an established fluorenylmethyloxycarbonyl (Fmoc)-protected PEG-based linker. The terminal Fmoc moiety of the PEG-based linker was then deprotected, yielding free amino groups, to which the A and B antigens were coupled. The carbohydrate antigens were synthesized with a p-nitrophenol ester to enable conjugation to the functionalized silica microparticles via an amide bond. The number of free amine groups available for coupling for a given mass of PEG-functionalized silica microparticles was quantified via reaction with Fmoc-glycine. The antigen-functionalized microparticles were then evaluated for their specificity in binding to A and B antigen-reactive B-cells via flow cytometry, and for blocking of naturally occurring antibodies in human serum. Selective binding of the functionalized microparticles to blood group-reactive B cells was observed by flow cytometry and fluorescence microscopy. The modular approach outlined here is applicable to the preparation of silica microparticles containing any carbohydrate antigen and alternative fluorophores or labels. This approach therefore comprises a novel, general platform for screening B cell populations for binding to carbohydrate antigens, including, in this case, the human A and B blood group antigens.
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Affiliation(s)
- Anne M Slaney
- National Institute for Nanotechnology (NINT), National Research Council , 11421 Saskatchewan Drive, Edmonton, Alberta, Canada T6G 2M9
| | | | | | | | | | | | | | - Jeremy A Bau
- National Institute for Nanotechnology (NINT), National Research Council , 11421 Saskatchewan Drive, Edmonton, Alberta, Canada T6G 2M9
| | - Lenka L Allan
- Pathology and Laboratory Medicine, Faculty of Medicine, Vancouver General Hospital, JP Pavilion North, University of British Columbia , 855 West 12th Avenue, Vancouver, British Columbia, Canada V5Z 1M9
| | | | | | | | - Jillian M Buriak
- National Institute for Nanotechnology (NINT), National Research Council , 11421 Saskatchewan Drive, Edmonton, Alberta, Canada T6G 2M9
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Gildersleeve JC, Wright WS. Diverse molecular recognition properties of blood group A binding monoclonal antibodies. Glycobiology 2016; 26:443-8. [PMID: 26755806 DOI: 10.1093/glycob/cwv171] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Accepted: 12/24/2015] [Indexed: 12/23/2022] Open
Abstract
Information about specificity and affinity is critical for use of carbohydrate-binding antibodies. Herein, we evaluated eight monoclonal antibodies to the blood group A (BG-A) antigen. Antibodies 87-G, 9A, HE-10, HE-24, HE-193, HE-195, T36 and Z2A were profiled on a glycan microarray to assess specificity, relative affinity and the influence of glycan density on recognition. Our studies highlight several noteworthy recognition properties. First, most antibodies bound GalNAcα1-3Gal and the BG-A trisaccharide nearly as well as larger BG-A oligosaccharides. Second, several antibodies only bound the BG-A trisaccharide when displayed on certain glycan chains. These first two points indicate that the carrier glycan chains primarily influence selectivity, rather than binding strength. Third, binding of some antibodies was highly dependent on glycan density, illustrating the importance of glycan presentation for recognition. Fourth, some antibodies recognized the tumor-associated Tn antigen, and one antibody only bound the variant composed of a GalNAc-alpha-linked to a serine residue. Collectively, these results provide new insights into the recognition properties of anti-BG-A antibodies.
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Affiliation(s)
- Jeffrey C Gildersleeve
- Chemical Biology Laboratory, National Cancer Institute, NIH, 376 Boyles St., Frederick, MD 21702, USA
| | - Whitney Shea Wright
- Chemical Biology Laboratory, National Cancer Institute, NIH, 376 Boyles St., Frederick, MD 21702, USA
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34
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Bryan CF, Cherikh WS, Sesok-Pizzini DA. A2 /A2 B to B Renal Transplantation: Past, Present, and Future Directions. Am J Transplant 2016; 16:11-20. [PMID: 26555020 DOI: 10.1111/ajt.13499] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Revised: 07/30/2015] [Accepted: 08/21/2015] [Indexed: 01/25/2023]
Abstract
One component of the new national kidney allocation system (KAS) in the United States that was implemented on December 4, 2014, was the allocation of kidneys from A2 and A2 B (A, non-A1 and AB, non-A1 B) deceased donors into blood group B candidates (A2 /A2 B → B). In so far as this is an important component of the new KAS that has the potential to further increase the access to transplantation for blood group B candidates on the waiting list, most of whom are minority candidates, we will review the body of evidence and historical perspectives that led to its inclusion in the new KAS. This review will also describe prospects for more widespread use of A2 /A2 B → B transplantation and a novel mechanism of humoral immunosuppression in B patients before and after transplantation with an A2 or A2 B kidney.
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Affiliation(s)
- C F Bryan
- Midwest Transplant Network, Westwood, KS
| | - W S Cherikh
- United Network for Organ Sharing, Richmond, VA
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35
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Abstract
Kidney transplantation across the ABO blood group barrier was long considered a contraindication for transplantation, but in an effort to increase donor pools, specific regimens for ABO-incompatible (ABOi) transplantation have been developed. These regimens are now widely used as an integral part of the available treatment options. Various desensitization protocols, commonly based on transient depletion of preformed anti-A and/or anti-B antibodies and modulation of B-cell immunity, enable excellent transplant outcomes, even in the long-term. Nevertheless, the molecular mechanisms behind transplant acceptance facilitated by a short course of anti-humoral treatment are still incompletely understood. With the evolution of efficient clinical programmes, tailoring of recipient preconditioning based on individual donor-recipient blood type combinations and the levels of pretransplant anti-A/B antibodies has become possible. In the context of low antibody titres and/or donor A2 phenotype, immunomodulation and/or apheresis might be dispensable. A concern still exists, however, that ABOi kidney transplantation is associated with an increased risk of surgical and infectious complications, partly owing to the effects of extracorporeal treatment and intensified immunosuppression. Nevertheless, a continuous improvement in desensitization strategies, with the aim of minimizing the immunosuppressive burden, might pave the way to clinical outcomes that are comparable to those achieved in ABO-compatible transplantation.
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