Some concepts relating to the molecular genetic basis of certain MNS blood group antigens

Delivery of drugs bound to erythrocytes: new avenues for an old intravascular carrier

For several decades, researchers have used erythrocytes for drug delivery of a wide variety of therapeutics in order to improve their pharmacokinetics, biodistribution, controlled release and pharmacodynamics. Approaches include encapsulation of drugs within erythrocytes, as well as coupling of drugs onto the red cell surface. This review focuses on the latter approach, and examines the delivery of red blood cell (RBC)-surface-bound anti-inflammatory, anti-thrombotic and anti-microbial agents, as well as RBC carriage of nanoparticles. Herein, we discuss the progress that has been made in surface loading approaches, and address in depth the issues relevant to surface loading of RBC, including intrinsic features of erythrocyte membranes, immune considerations, potential surface targets and techniques for the production of affinity ligands.

Drug delivery by red blood cells: vascular carriers designed by mother nature

IMPORTANCE OF THE FIELD

Vascular delivery of several classes of therapeutic agents may benefit from carriage by red blood cells (RBC), for example, drugs that require delivery into phagocytic cells and those that must act within the vascular lumen. The fact that several protocols of infusion of RBC-encapsulated drugs are now being explored in patients illustrates a high biomedical importance for the field. AREAS COVERED BY THIS REVIEW: Two strategies for RBC drug delivery are discussed: encapsulation into isolated RBC ex vivo followed by infusion in compatible recipients and coupling therapeutics to the surface of RBC. Studies of pharmacokinetics and effects in animal models and in human studies of diverse therapeutic enzymes, antibiotics and other drugs encapsulated in RBC are described and critically analyzed. Coupling to RBC surface of compounds regulating immune response and complement, affinity ligands, polyethylene glycol alleviating immune response to donor RBC and fibrinolytic plasminogen activators are described. Also described is a new, translation-prone approach for RBC drug delivery by injection of therapeutics conjugated with fragments of antibodies providing safe anchoring of cargoes to circulating RBC, without need for ex vivo modification and infusion of RBC.

WHAT THE READER WILL GAIN

Readers will gain historical perspective, current status, challenges and perspectives of medical applications of RBC for drug delivery.

TAKE HOME MESSAGE

RBC represent naturally designed carriers for intravascular drug delivery, characterized by unique longevity in the bloodstream, biocompatibility and safe physiological mechanisms for metabolism. New approaches for encapsulating drugs into RBC and coupling to RBC surface provide promising avenues for safe and widely useful improvement of drug delivery in the vascular system.

Novel single-nucleotide change in GYP*A in a person who made an alloantibody to a new high-prevalence MNS antigen called ENEV

BACKGROUND

Alloantibodies that define some high-prevalence MNS antigens are made by people with glycophorin A (GPA) altered by a single-amino-acid change or replacement of amino acids from part of the Pseudoexon 3 of GYP*B. The finding of a patient whose plasma contained a novel alloanti-En(a)FR prompted this study.

RESULTS

The patient's serum contained an alloantibody to a high-prevalence antigen, resistant to papain, ficin, trypsin, alpha-chymotrypsin, or dithiothreitol. The antibody was strongly reactive with all panel red blood cells (RBCs) tested, showed reduced reactivity with ENEP- and ENAV- RBCs, and was nonreactive with M(k)M(k), En(a-), GP.Hil/GP.Hil, and GP.JL/M(k) RBCs. The patient's RBCs typed M+N-S+s-, Wr(a-b+(w)), ENEP-, and ENAV-. These results indicated that the antibody recognized a new high-prevalence antigen in the MNS system. Sequencing of DNA prepared from the patient's white blood cells revealed a GYP*A nucleotide substitution of 242T>G (predicted to change Val62 of GPA to Gly). This change ablates an RsaI restriction enzyme site and polymerase chain reaction-restriction fragment length polymorphism confirmed that the proband was homozygous for Nucleotide 242G.

CONCLUSIONS

We describe a novel high-prevalence MNS antigen, characterized by Val62 in GPA and named ENEV. The absence of the antigen is associated with Gly62. The change explains the weakened reactivity of the patient's serum with ENEP- and ENAV- RBCs and nonreactivity with anti-ENEP and anti-ENAV against her RBCs. The ENEV antigen has been assigned the ISBT number MNS45.

Novel GYP(A-B-A) hybrid gene in a DANE+ person who made an antibody to a high-prevalence MNS antigen

BACKGROUND

The glycophorin (GP) molecule associated with the GP.Dane phenotype is a GP(A-B-A) hybrid that contains some amino acids encoded by the Pseudoexon 3 of GYPB and Asn(45) of GPA and carries the low-prevalence MNS antigens DANE and Mur. Serum from a woman of English ancestry contained an immunoglobulin M alloantibody to a high-prevalence MNS antigen, and the purpose of this study was to identify the molecular basis of her phenotype.

STUDY DESIGN AND METHODS

Hemagglutination, Western blotting, and DNA analyses were performed by standard methods.

RESULTS

Tests of the proband's RBCs with monoclonal antibodies indicated a change of amino acids between positions 27 and 55 of GPA. Her RBCs expressed M, s, Mur, and DANE antigens and were M(g)-negative. The antigen recognized by her antibody was sensitive to treatment with papain, ficin, and trypsin and resistant to alpha-chymotrypsin and dithiothreitol. Sequencing of DNA from the proband revealed a sequence of nucleotides identical to the GYP(A-B-A) encoding GP.Dane but without the adenyl nucleotide substitution, which has been predicted to change Ile(46) of GPA to Asn(45). Testing of her immediate family revealed the presence of an M(k) gene.

CONCLUSION

The proband had a novel GYP(A-B-A) encoding a DANE+ GP that is in cis to GYPB(s) and in trans to M(k). The high-prevalence antigen lacking from this GP.Dane phenotype and recognized by the proband's serum is called ENDA (ISBT Number MNS44). Our results indicate that the change of Ile(46) of GPA to Asn(45) of GP.Dane is not required for expression of the DANE antigen.

Direct evidence for the existence of Miltenberger antigen

The Miltenberger (Mi) subsystem, which originally consisted of four phenotypes, now has 11 phenotypes. The antigens of this subsystem belong to the MNS blood group system. The Mia antigen has been reported to be present on red blood cells with several Miltenberger phenotypes, namely: Mi.I, Mi.II, Mi.III, Mi.IV, Mi.VI and Mi.X. However, the existence of the Mia antigen as a separate entity has been in question and difficult to prove with polyclonal reagents. We report the first monoclonal anti-Mia (GAMA210), whose epitope is TNDKHKRD or QTNDMHKR, and thereby confirm the existence of the Mia antigen.

Antigenic Properties of Human Glycophorins - An Update

Glycophorins are complex heavily glycosylated antigens carrying peptidic and glycopeptidic epitopes. Detailed immunochemical studies showed that GPA/GPB and GPC/GPD molecules have defined sites which are particularly immunogenic. These sites include N-terminal portions of all glycophorins, internal fragments of their extracellular domains, and cytoplasmic tails. The extracellular epitopes involve directly oligosaccharide chains (e.g. blood group M- and N-related epitopes, or N-terminal epitopes of GPC) or have peptidic character, shown by the reaction of respective antibodies with synthetic peptides. Peptidic eitopes are independent of glycosylation, or are variably affected by adjacent O-glycans which may mask the epitopes or may be required for a proper exposure of an antibody binding site. Several low incidence epitopes are present on variant glycophorin molecules. Among anti-glycophorin antibodies there are the 'bispecific' ones, or antibodies recognizing an epitope formed by an interaction of two proteins (Wr(b)). Alltogether, the glycophorins serve as convenient model antigens for studying Ag-Ab interaction and a role of O-glycosylation in protein antigenic properties. Moreover, well defined specificty of monoclonal anti-glycophorin antibodies makes them more precise tools in serological investigation and identification of normal and variant antigens. Last but not least, elucidation of antigenic properties of glycophorins is important for identification and characterization of human anti-glycophorin antibodies, which in some cases create medical problems at transfusion or pregnancy.

Red cell antigens on band 3 and glycophorin A

Band 3 and glycophorin A (GPA) are the two most abundant integral proteins of the red cell membrane, being present in approximately 10(6) copies per cell. The main functions of band 3 are membrane anion transport and maintenance of red cell membrane stability through interaction with the cytoskeleton. GPA plays an important role in prevention of red cell aggregation in the circulation and contribution to the glycocalyx. The extracellular domains of both proteins are highly polymorphic. Band 3 carries the antigens (currently 19) of the Diego blood group system and GPA and glycophorin B the antigens (currently 43) of the MNS system. There is substantial evidence that band 3 and GPA associate in the red cell membrane and the Wr(b) antigen, although a product of the band 3 gene, is known to require a complex of GPA and band 3 for normal expression. The discovery of a novel GPA mutation (Ala65-->Pro) giving rise to aberrant Wr(b) expression has been informative with regard to the site of interaction of the two proteins. The extensive array of GPA-related antigens is largely due to genetic events between two closely linked genes and different genetic mechanisms can give rise to the same antigen. This is in contrast to the antigens on band 3 which are exclusively due to single nucleotide mutations in the band 3 gene.

Glycophorin A mutation Ala65 --> Pro gives rise to a novel pair of MNS alleles ENEP (MNS39) and HAG (MNS41) and altered Wrb expression: direct evidence for GPA/band 3 interaction necessary for normal Wrb expression

We report here a novel Glycophorin A (GPA) mutation Ala65 --> Pro which gives rise to a low-incidence antigen HAG, lack of a high-incidence antigen ENEP and aberrant expression of the high-incidence Wrb antigen. Anti-ENEP was identified in the serum of a transfused male patient (E.H.) who was homozygous for a GPA Ala65 --> Pro mutation and possessed a novel low-incidence antigen which we have called HAG. An unrelated HAG-positive individual, heterozygous for the Ala65 --> Pro mutation, has also been identified. Anti-HAG was present in several multispecific antisera to low-incidence antigens and in one monospecific serum. Normal expression of the Wrb antigen depends on the presence of amino acid Glu658 of band 3 and on the presence of GPA. However, a specific epitope on GPA has not previously been implicated. DNA sequence analysis of band 3 from patient E.H. was normal in the region of Wra/Wrb polymorphism with homozygous presence of Glu658 and therefore the abnormal Wrb expression results from the Ala65 --> Pro mutation in GPA. The ENEP and HAG antigens have been assigned the MNS blood group system numbers 002.039 and 002.041, respectively, by the ISBT Working Party on Terminology for Red Cell Surface Antigens.

Blood group antigens defined by the amino acid sequences of red cell surface proteins

The antigens of 18 blood group systems are expressed on proteins that are intrinsic to the red cell. The proteins which carry the antigens of these systems have been identified and primary sequence information is available for all but two (SC, DO). Several different functional groups are evident. Antigens of the DI, CO, RH, XK and JK systems are located on proteins which have the structure of membrane transport proteins. The FY antigens mark a cytokine receptor. The IN, LW, XG antigens are associated with molecules which have adhesion functions and the LU glycoprotein also has a structure which suggests a role in adhesion. YT and KEL antigens are located on cell surface enzymes and the CR and KN antigen on molecules involved in complement regulation. Finally, the MN and GE antigens are located on sialic acid-rich glycoproteins (glycophorins A, B and C/D respectively), a group of molecules which do not, as yet, have a clearly defined function. The molecular basis of antigens in several blood group systems have been defined and shown to depend upon the amino acid sequence.