Differential expression of HLA-DR and HLA-DQ antigens on normal cells of the myelomonocytic lineage

HLA-DQ heterodimers in hematopoietic cell transplantation

HLA-DQ heterodimers increase the susceptibility to autoimmune diseases, but their role in hematopoietic cell transplantation is unknown. We tested the hypothesis that outcome after HLA-matched and HLA-DQ-mismatched hematopoietic cell transplantation is influenced by HLA-DQ heterodimers. Heterodimers were defined in 5164 HLA-matched and 520 HLA-DQ-mismatched patients and their transplant donors according to well-established crystallographic criteria. Group 1 (G1) heterodimers are any DQA1*02/03/04/05/06α paired with any DQB1*02/03/04β. Group 2 (G2) heterodimers are DQA1*01α paired with any DQB1*05/06β. Multivariable models identified significantly higher relapse risk in G1G2 and G2G2 compared with G1G1 HLA-matched patients with malignant disease; risk increased with an increasing number of G2 molecules. In HLA-DQ-mismatched transplantation for malignant diseases, matching or mismatching for G2 increased relapse risk. G2 lowered disease-free survival after both HLA-matched and HLA-DQ-mismatched transplantation. A paradigm based on HLA-DQ heterodimers provides a functional definition of the hematopoietic cell transplantation barrier and a means to lower risks for future patients.

Expression levels of HLA-DR in acute myeloid leukemia: implications for antigenicity and clinical outcome

Low human leukocyte antigen (HLA)-DR expression might compromise CD4⁺ T-cell-mediated anti-tumor immunity. Its immunological and clinical significance however remain undefined in non-promyelocytic acute myeloid leukemia (AML). Taking advantage of mass spectrometry-based immunopeptidome analysis of primary AML samples (n = 31), we studied the implications of low HLA-DR expression for antigen presentation and analyzed its association with disease characteristics and survival within a cohort of 399 AML patients. Remarkably, overall HLA-DR/DQ immunopeptidome diversity was preserved in AML with low HLA-DR expression (HLA-DR^low AML) and was associated with a shift in HLA-DR/DQ allotype abundances (HLA-DQ to HLA-DR/DQ ligand ratio 0.36 vs 0.19 in HLA-DR^low and HLA-DR^high patients, respectively). Consistent with unimpaired antigenicity, survival was similar in HLA-DR^low and HLA-DR^high patients. Demonstrating for the first time that overall HLA-DR/DQ antigen presentation is preserved in HLA-DR^low AML, our findings provide a rationale for the non-inferior outcome observed in HLA-DR^low AML patients.

Renal replacement therapies in the elderly: Part II. Renal transplantation

The United States end-stage renal disease (ESRD) population is growing progressively older. As a percentage of the overall ESRD population, the number of patients 65 years of age and older approached 40% by 1989. However, the percentage of ESRD patients with a functioning transplant was only 2.7% in this age group. Success of transplantation in geriatric ESRD patients over the last decade is due to improved patient selection as well as the use of cyclosporine A and lower doses of corticosteroids, with the achievement of 1-year patient and graft survival rates of 85% and 75%, respectively. For patients older than 60 or 65 years, the 5-year "functional" graft survival is 55% to 60%. Although overall results are excellent, the management of transplantation in the elderly requires an understanding of pharmacology, immunology, and physiology peculiar to this age group. Since the elderly have a degree of immune incompetence, they require less aggressive immunotherapy. Elderly patients have decreased hepatic enzyme activity, especially the P450 system, and therefore require a lower cyclosporine dose. Although elderly patients experience less rejection episodes than younger patients, graft loss in the elderly transplant recipient is due mainly to patient death. Most common causes of death in the elderly transplant recipient are cardiovascular disease and infection related to peaks of immunosuppression. Shortage of cadaver kidneys and limited life expectancy of the geriatric ESRD patient make allocation of cadaver kidneys to patients over 70 years (and even 65 years) a controversial issue and an ethical dilemma. Use of elderly cadaver donors (over 55 to 60 years) is associated with inferior success rates and is not an optimal solution to shortage of cadaver kidneys.

Impaired antigen-presenting capability of monocytes correlated with their decreased expression of HLA-II antigens in patients with myeloid leukemia

Antigen-presenting capability and expression of HLA-II antigens on peripheral blood monocytes were analyzed by isotope incorporation technique and indirect immunofluorescence assay with monoclonal antibodies Tü 22, Tü 36 and anti-Leu-M2 in patients with acute and chronic myeloid leukemias (AML, CML). All patients (17 AML and 13 CML) demonstrated impaired antigen-presenting capability of monocytes (P < 0.001), when compared with simultaneously studied controls, which were HLA-identical normal siblings of the patients. These patients also showed a markedly decreased proportion of MAC-120- and HLA-DQ-positive monocytes as compared with the controls (P < 0.001), while the percentage of HLA-DR-positive monocytes in the patients was similar to that observed in the controls (P > 0.05). These findings suggested, therefore, that impaired antigen-presenting capability of monocytes correlated with their decreased expression of HLA-DQ in patients with acute and chronic myeloid leukemias.

Transcription of a subset of human class II major histocompatibility complex genes is regulated by a nucleoprotein complex that contains c-fos or an antigenically related protein

Transcriptional regulation of the human major histocompatibility complex class II genes requires at least two upstream elements, the X and Y boxes, located in the -50- to -150-base-pair region of all class II promoters. The DRA and DPB promoters contain phorbol ester-responsive elements overlapping the 3' side of their X boxes. Mutation of this sequence down-regulates the efficiency of the DRA promoter, suggesting that a positive regulator(s) binds to this site. In this report, anti-sense c-fos RNA and an anti-c-fos antibody were used to show that the product of the protooncogene c-fos or an antigenically related protein is a component of a complex that binds to the X box and is required for maximal transcription from the DRA and DPB promoters. As c-fos (or its related proteins) cannot bind alone to DNA, these results suggest that it may dimerize with other members of the JUN/AP-1 family, such as hXBP1, to participate in the activation of a subset of class II major histocompatibility complex genes.

Differential expression of HLA-DR, HLA-DP, HLA-DQ and associated invariant chain (Ii) in normal colorectal mucosa, adenoma and carcinoma

The expression of MHC class II antigens (HLA-DR, HLA-DP and HLA-DQ) and the associated invariant chain (Ii) was studied in epithelial cells of normal colorectal mucosae, colorectal adenomas and carcinomas, using a sensitive immunoperoxidase technique with monoclonal antibodies on frozen sections. In contrast to class II antigens, Ii was detected in some normal mucosae distant from the tumour. In residual non-neoplastic mucosa adjacent to carcinomas, Ii and class II antigens were induced in the order Ii greater than or equal to HLA-DR greater than or equal to HLA-DP greater than or equal to HLA-DQ, the reactions being most pronounced in cases with inflammatory alteration of the crypts. In 22/37 adenomas and 77/123 carcinomas, Ii expression clearly exceeded class II antigen expression. Class II antigens were found in 20/37 adenomas and 62/123 carcinomas, mostly in a non-coordinate manner, following the above order. A detailed analysis of the expression patterns in normal and neoplastic colon epithelial cells revealed a closer association of HLA-DP with HLA-DQ than of HLA-DR with HLA-DP, or HLA-DQ.

Antigen expression by cells near the maternal-fetal interface

The purpose of the present study was to evaluate the potential for immunologic interaction between the mother and fetus by documenting 1) fetal and maternal cell histocompatibility antigen (HLA) expression and 2) populations of immunologically relevant cells near the maternal-fetal interface through all stages of normal pregnancy. Mesenchymal cells in extraembryonic tissues demonstrated a gradual and progressive development of both class I and class II HLA, with class I expression preceding class II. Coordinated development of expression of two subclasses of class II HLA-D, HLA-DR and HLA-DQ, by fetal mesenchymal cells was noted. In adjacent tissue, maternal decidual cells were strongly class I HLA positive; but in contrast to fetal cells, expression of HLA-D subclasses was discoordinate. HLA-DR was present throughout gestation but HLA-DQ expression was detectable only in second and third trimester tissues. Immunologically relevant cells were present in both fetal and maternal tissues. The major leukocyte population and the major class II-bearing cell type at the maternal-fetal interface was of monocyte/macrophage lineage. T and B lymphocytes were present only in very low densities (1-3% of all cells), whereas at all stages of gestation, macrophages were present in high density in both the fetal mesenchyme (14-25%) and in maternal decidua (27-32%). Documentation of class I and class II HLA expression and the cell types available to participate in immunologic events at the maternal-fetal interface may assist in understanding the immunologic basis of the maternal-fetal relationship during successful pregnancy.

HLA-class II antigens on human hematopoietic progenitors

A panel of alloindifferent monoclonal antibodies (MAB's) was used in complement-dependent lysis to characterize human myeloid, erythroid and multipotential progenitors (CFU-GM, BFU-E, CFU-GEMM) for their expression of MHC class II HLA-DR, -DP, and -DQ products. 7-16 donors were tested in each system. MAB Tü 34, detecting DR products, caused reduction of CFU-GM by a mean of 89%, whereas BFU-E and CFU-GEMM were reduced by 67% and 66% respectively. 35% of CFU-GM, 27% of BFU-E and 32% of CFU-GEMM were lysed by MAB B7/21, recognizing HLA-DP determinants, while Tü 22, binding HLA-DQ antigens, lysed 32% only of CFU-GM and did not lyse the other progenitors. Employing the "broad" MAB Tü 39, which binds at least DR and DP, inhibition of colony formation by CFU-GM was generally greater than that caused by Tü 34 alone or even by combinations of Tü 34, Tü 22, and B7/21. This suggests that there may be a subset of DR-, DP-, DQ- hematopoietic progenitors, which nonetheless bind MAB Tü 39, previously proposed as a candidate for the recognition of novel class II antigens.

Ontogenic and functional implications of the differential expression of HLA-DQ antigens on leukemic cells

We have examined the HLA class II antigenic profiles on different types of leukemic cells and have attempted to relate these findings to the normal differentiation pathways of the cells from which they have arisen. Monoclonal antibodies reacting with the different HLA class II determinants, HLA-DR, DRw52(MT), and DQ, were used to study the expression of these antigens on Epstein-Barr virus transformed cell lines, chronic lymphocytic leukemic cells, acute lymphoblastic leukemic blasts, acute myeloblastic leukemic blasts, and established leukemic cell lines by indirect immunofluorescence binding and immunoprecipitations. The results showed that whereas the HLA-DR and HLA-DRw52(MT2) antigens are normally expressed on the majority of the cells tested, there is a different expression of the HLA-DQ antigens on acute leukemic blasts, chronic lymphocytic leukemic cells, and leukemic cell lines indicating that the DQ molecules may be differentiation antigens preferentially expressed on mature cells. Furthermore, when the pre-B cell leukemic line NALM 6 was induced to differentiate with phorbol ester (TPA), normal expression of the HLA-DQ antigen was obtained after 5 days of culture. The absence of HLA-DQ antigens from the acute leukemic blasts suggests that these immature cells "froze" in the early stages of cell differentiation. We discuss these findings in relation to the role of these HLA class II antigens in cell differentiation and the immune response.