Molecular basis of D variants between Uigur and Han blood donors in Xinjiang

DEL in China: the D antigen among serologic RhD-negative individuals

BACKGROUND

Providing RhD-negative red cell transfusions is a challenge in East Asia, represented by China, Korea, and Japan, where the frequency of RhD-negative is the lowest in the world.

FINDINGS

Among 56 ethnic groups in China, the RhD-negative frequency in Han, the prevalent ethnicity, is 0.5% or less, similar to most other ethnic groups. The Uyghur ethnic group has the highest reported RhD-negative frequency of up to 4.7%, as compared to 13.9% in the US. However, an estimated 7.15 million RhD-negative people live in China. The RhD-negative phenotype typically results from a loss of the entire RHD gene, causing the lack of the RhD protein and D antigen. The DEL phenotype carries a low amount of the D antigen and types as RhD-negative in routine serology. The DEL prevalence in RhD-negative individuals averages 23.3% in the Han, 17% in the Hui and 2.4% in the Uyghur ethnicities. The Asian type DEL, also known as RHD*DEL1 and RHD:c.1227G > A allele, is by far the most prevalent among the 13 DEL alleles observed in China.

CONCLUSION

The purpose of this review is to summarize the data on DEL and to provide a basis for practical strategy decisions in managing patients and donors with DEL alleles in East Asia using molecular assays.

Mutation differences in circulating tumor DNAs from non-small cell lung cancer patients between Uygur and Han populations

BACKGROUND

The incidence of non-small cell lung cancer (NSCLC) in Uygur population is gradually increasing recently. In view of the great diagnostic and prognostic values of cell-free DNAs (cfDNA) detection, this study focus on a liquid biopsy to explore the value of cfDNA mutation in healthy and NSCLC patients in 2 ethnicities.

METHODS

The concentration and sequencing of cfDNA in NSCLC and healthy subjects was assessed with a standard information analysis procedure, including detection, annotation, and statistical analysis. Gene ontology and Kyoto Encyclopedia of Genes and Genomes pathway analyses were conducted to analyze the function of mutant genes and related pathways. Totally, 133 subjects, including 35 Uygur NSCLC patients, 10 Uygur healthy subjects, 63 cases of Han NSCLC patients and 25 Han health control, were admitted to the hospital.

RESULTS

There were a lower proportion of adenocarcinoma and higher percentage of smoking rate for Uygur patients. For cfDNA level between NSCLC and healthy subjects, Han patients exhibited sharp increase while there was no statistical difference in Uygur population. In addition, the mutation frequency of cfDNA in Han patients (72.6%) was significantly higher than Uygur patients (45.7%). There were 5 gene mutations only found in Han patients and ABCC11 showed a higher mutation frequency in Uygur population as a common one. Finally, Go and Kyoto Encyclopedia of Genes and Genomes analysis showed apprent functional enrichments and pathway changes between 2 ethnicities.

CONCLUSION

There existed distinct distributions of cancer subtypes, smoking proportion, cfDNA level, and mutation patterns between Han and Uygur patients. The results may be a useful tool in NSCLC patients' diagnosis as well as individualized therapy between ethnicities in future.

Red Cell Immunohematology Research Conducted in China

ABO subtypes and RhD variants are the most studied blood groups in China. Some of the polymorphisms in these two blood groups have direct clinical relevance. Molecular diagnosis of blood group polymorphisms is underway in China. In addition, research groups have developed methods such as screening for blood group mimetic peptides using phage display technology. New reagents, akin to antibodies directed against RhD and ABO, are being investigated using aptamer-based techniques. Progress is also being made in the development of synthetic exoglycosidases for conversion of group A and/or B antigens to group O. Development of methoxy-polyethylene-glycol modified red cells has been successful in vitro but has not reached clinical application. In this paper, we summarize red cell immunohematology research that has been conducted in China.

Prospective Evaluation of a Transfusion Policy of RhD-Positive Red Blood Cells into DEL Patients in China

BACKGROUND

The D antigen is highly immunogenic, requiring only a small quantity of transfused red blood cells (RBCs) to cause alloimmunization in D- immunocompetent recipients. DEL was reported arousing alloimmunization to true Rh- patients. Molecular studies of the RHD gene have revealed that DEL individuals retain a grossly intact RHD gene or have a portion of RHD in their genomes. Avoiding immunization with clinically important antibodies is a primary objective in transfusion medicine.

METHODS

In order to determine whether pregnant DEL women carrying an RhD+ fetus are at risk of anti-D alloimmunization, 808 Rh- pregnant women with a history of gestations or parturitions who regularly visited hospitals for their prenatal anti-D screening and postpartum care from January 2011 to December 2012 were investigated. Samples were analyzed for DEL by PCR with specific primers, PCR-sequence-specific primers (PCR-SSP), reverse transcription-PCR (RT-PCR), PCRrestriction fragment length polymorphism (PCR-RFLP), and by gene sequencing to characterize different alleles.

RESULTS

Among the 808 Rh- pregnant women of our sample, 178 (22.0%) were typed as DEL; 168 DEL samples were confirmed to have the RHD (1,227 G>A) allele, 8 DEL samples were characterized by one base mutation of the RHD (3G >A) allele, and the remaining two DEL samples were determined to carry RHD-CE(4-9)-D or RHD-CE(2-5)-D. The observation of allo-anti-D in two prominent D epitope loss cases confirmed the partial nature of these DEL phenotypes.

CONCLUSIONS

In conclusion, evidence is provided that different DEL genotypes code either for partial or complete D antigen expression. It is suggested that the use of RhD+ RBCs in complete D antigen DEL patients does not induce adverse reaction.

Molecular basis and zygosity determination of D variants including identification of four novel alleles in Chinese individuals

BACKGROUND

The frequency and molecular basis of the D variants have been reported in the Caucasian and African populations, but relatively little information was known in the Chinese population. Here, a study was investigated in Chinese persons with weak or discrepant D serologic typing.

STUDY DESIGN AND METHODS

D variant was typed with a serologic method. The full coding regions of RHD of these variants were amplified with polymerase chain reaction and then directly sequenced. RHD zygosity test was performed using the hybrid Rhesus box technique and a multiplex ligation-dependent probe amplification (MLPA) assay was also used to analyze the variant alleles and RHD gene copy number.

RESULTS

Twelve distinct RHD mutation alleles were found in 32 D variant individuals, with eight weak D and four partial D alleles. Weak D Type 15 and DVI Type 3 were the major weak D and partial D alleles in Zhejiang Han persons. Three novel weak D alleles (RHD weak D 95A, 779G, and 670G) and one new partial D allele (RHD130-132 del TCT) were identified. The results of RHD zygosity in three individuals disagreed between the RHD zygosity test and the MLPA assay. The most known variant alleles can be detected, but four novel alleles were missed using the RH-MLPA assay.

CONCLUSION

The molecular basis and zygosity of D variants in Zhejiang Han persons were analyzed, and four novel RHD alleles were identified. These data extend the information of D variants and may help to improve the transfusion strategy of the D variants.

Molecular basis of the RHD gene in blood donors with DEL phenotypes in Shanghai

BACKGROUND AND OBJECTIVES

The purpose of the work was to analyse the genotype of D-elute (DEL) samples and to elucidate whether there were novel DEL alleles in Chinese population.

MATERIALS AND METHODS

D-negative samples were identified by an indirect antiglobulin test (IAT), and absorption\elution tests to screen weak D, partial D and DEL phenotypes. DELs were further analysed by multiplex PCR, PCR-sequence-specific primers (PCR-SSP) and sequencing. Some of the DEL samples were determined to show RHD zygosity by PCR-restriction fragment length polymorphism or real-time quantitative PCR.

RESULTS

Of 400 253 samples from individual donations, 1585 (0.40%) were typed as D negative. Among these D-negative samples, 279 DELs were observed. Two hundred and sixty-eight DELs were confirmed to have the RHD (K409 K) allele. Three DELs seemed to have RHD-CE-D hybrid alleles, including one RHD-CE(4-9)-D, one RHD-CE(2-5)-D and one suspected RHD(1-9)-CE. Five novel RHD alleles were found among the rest of the DEL samples, including four RHD 3 g > a, one RHD (R10W), one RHD (L18P), one RHD (L84P) and one RHD (A137E). Eighty-four DELs were analysed for Rhesus box zygosity, there were 77 RHD+/RHD-and seven RHD+/RHD+.

CONCLUSION

About 4.35% apparent D negative Chinese individuals were weak D or partial D, while 17.60% were DEL. Novel DEL alleles are rare, and all but 11 of the 279 DELs were due to the most common DEL allele, RHD (K409 K). The RHD 3G > A might be the second most frequent DEL allele in Chinese. Exploration of a complete molecular basis for DEL in Chinese ethnic groups is a long-term endeavour.