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Zwiers C, Slootweg YM, Koelewijn JM, Ligthart PC, van der Bom JG, van Kamp IL, Lopriore E, van der Schoot CE, Oepkes D, de Haas M. Disease severity in subsequent pregnancies with RhD immunization: A nationwide cohort. Vox Sang 2024. [PMID: 38772910 DOI: 10.1111/vox.13651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 04/22/2024] [Accepted: 04/24/2024] [Indexed: 05/23/2024]
Abstract
BACKGROUND AND OBJECTIVES To evaluate the severity of haemolytic disease of the foetus and newborn (HDFN) in subsequent pregnancies with RhD immunization and to identify predictive factors for severe disease. MATERIALS AND METHODS Nationwide prospective cohort study, including all pregnant women with RhD antibodies. All women with at least two pregnancies with RhD antibodies and RhD-positive foetuses were selected. The main outcome measure was the severity of HDFN in the first and subsequent pregnancy at risk. A subgroup analysis was performed for the group of women where RhD antibodies developed after giving birth to an RhD-positive child and thus after receiving anti-D at least twice (group A) or during the first pregnancy at risk for immunization (group B). RESULTS Sixty-two RhD immunized women with a total of 150 RhD-positive children were included. The severity of HDFN increased for the whole group significantly in the subsequent pregnancy (p < 0.001), although it remained equal or even decreased in 44% of women. When antibodies were already detected at first trimester screening in the first immunized pregnancy, after giving birth to an RhD-positive child (group A), severe HDFN in the next pregnancy was uncommon (22%). Especially when no therapy or only non-intensive phototherapy was indicated during the first immunized pregnancy (6%) or if the antibody-dependent cell-mediated cytotoxicity result remained <10%. Contrarily, women with a negative first trimester screening and RhD antibodies detected later during the first pregnancy of an RhD-positive child (group B), often before they had ever received anti-D prophylaxis, were most prone for severe disease in a subsequent pregnancy (48%). CONCLUSION RhD-mediated HDFN in a subsequent pregnancy is generally more severe than in the first pregnancy at risk and can be estimated using moment of antibody detection and severity in the first immunized pregnancy. Women developing antibodies in their first pregnancy of an RhD-positive child are at highest risk of severe disease in the next pregnancy.
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Affiliation(s)
- Carolien Zwiers
- Department of Obstetrics, Leiden University Medical Center, Leiden, the Netherlands
- Department of Experimental Immunohematology, Sanquin Research and Landsteiner Laboratory, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Yolentha M Slootweg
- Department of Obstetrics, Leiden University Medical Center, Leiden, the Netherlands
| | - Joke M Koelewijn
- Department of Experimental Immunohematology, Sanquin Research and Landsteiner Laboratory, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
- Department of Immunohematology, Sanquin Diagnostic Services, Amsterdam, the Netherlands
| | - Peter C Ligthart
- Department of Immunohematology, Sanquin Diagnostic Services, Amsterdam, the Netherlands
| | - Johanna G van der Bom
- Center for Clinical Transfusion Research, Sanquin Research, Leiden, the Netherlands
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Inge L van Kamp
- Department of Obstetrics, Leiden University Medical Center, Leiden, the Netherlands
| | - Enrico Lopriore
- Department of Pediatrics, Leiden University Medical Center, Leiden, the Netherlands
| | - C Ellen van der Schoot
- Department of Experimental Immunohematology, Sanquin Research and Landsteiner Laboratory, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Dick Oepkes
- Department of Obstetrics, Leiden University Medical Center, Leiden, the Netherlands
| | - Masja de Haas
- Department of Immunohematology, Sanquin Diagnostic Services, Amsterdam, the Netherlands
- Department of Hematology, Leiden University Medical Center, Leiden, the Netherlands
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2
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van 't Oever RM, Zwiers C, de Winter D, de Haas M, Oepkes D, Lopriore E, Verweij EJJ. Identification and management of fetal anemia due to hemolytic disease. Expert Rev Hematol 2022; 15:987-998. [PMID: 36264850 DOI: 10.1080/17474086.2022.2138853] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
INTRODUCTION Hemolytic disease of the fetus and newborn (HDFN) is a condition caused by maternal alloantibodies against fetal red blood cells (RBCs) that can cause severe morbidity and mortality in the fetus and newborn. Adequate screening programs allow for timely prevention and intervention resulting in significant reduction of the disease over the last decades. Nevertheless, HDFN still occurs and with current treatment having reached an optimum, focus shifts toward noninvasive therapy options. AREAS COVERED This review focusses on the timely identification of high risk cases and antenatal management. Furthermore, we elaborate on future perspectives including improvement of screening, identification of high risk cases and promising treatment options. EXPERT OPINION In high-income countries mortality and morbidity rates due to HDFN have drastically been reduced over the last decades, yet worldwide anti-D mediated HDFN still accounts for 160,000 perinatal deaths and 100,000 patients with disabilities every year. Much of these deaths and disabilities could have been avoided with proper identification and prophylaxis. By implementing sustainable prevention, screening, and disease treatment measures in all countries this will systemically reduce unnecessary perinatal deaths. There is a common responsibility to engage in this cause.
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Affiliation(s)
- Renske M van 't Oever
- Department of Obstetrics and Gynecology, Division of Fetal Medicine, Leiden University Medical Center, Leiden, The Netherlands.,Department of Immunohematology Diagnostics, Sanquin,Amsterdam, The Netherlands
| | - Carolien Zwiers
- Department of Obstetrics and Gynecology, Division of Fetal Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - Derek de Winter
- Department of Immunohematology Diagnostics, Sanquin,Amsterdam, The Netherlands.,Willem-Alexander Children's Hospital, department of Pediatrics, division of Neonatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Masja de Haas
- Department of Immunohematology Diagnostics, Sanquin,Amsterdam, The Netherlands.,Department of Immunohematology and Blood Transfusion, Leiden University Medical Center, Leiden, The Netherlands
| | - Dick Oepkes
- Department of Obstetrics and Gynecology, Division of Fetal Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - Enrico Lopriore
- Willem-Alexander Children's Hospital, department of Pediatrics, division of Neonatology, Leiden University Medical Center, Leiden, The Netherlands
| | - E J Joanne Verweij
- Department of Obstetrics and Gynecology, Division of Fetal Medicine, Leiden University Medical Center, Leiden, The Netherlands
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3
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Abstract
The discovery of almost universally present naturally occurring antibodies in blood plasma led to the discovery of the ABO blood group system which remains, more than 100 years later, the most important and clinically significant of all blood groups. Blood group antibodies play an important role in transfusion medicine, both in relation to the practice of blood transfusion and in pregnancy, but not all are clinically significant. Clinically significant antibodies are capable of causing adverse events following transfusion, ranging from mild to severe, and of causing hemolytic disease of the fetus and newborn following placental transfer from mother to fetus. Assessing the clinical significance of antibodies relies heavily on mode of reactivity and historical data relating to specificity; functional assays are sometimes employed. The principals of methodology for blood typing and antibody identification have changed little over the years, relying mainly on serological methods involving red cell agglutination. The recent advent of blood typing using DNA technology, although still in relative infancy, will surely eventually supersede serology. However, deciding on the clinical significance of an antibody when compatible blood is not immediately available is likely to remain as one of the most common dilemmas facing transfusion practitioners.
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Affiliation(s)
- Joyce Poole
- International Blood Group Reference Laboratory, Bristol, UK.
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4
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Downing I, Bromilow IM, Templeton JG, Fraser RH. A Retrospective Study of Red Cell Maternal Antibodies by Chemiluminescence. Vox Sang 2003. [DOI: 10.1046/j.1423-0410.1997.73100546_71_4.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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5
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Hadley AG. Laboratory assays for predicting the severity of haemolytic disease of the fetus and newborn. Transpl Immunol 2002; 10:191-8. [PMID: 12216949 DOI: 10.1016/s0966-3274(02)00065-5] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Haemolytic disease of the fetus and newborn (HDFN) is characterised by the presence of IgG antibodies in the maternal circulation which cause haemolysis in the fetus by crossing the placenta and sensitising red cells for destruction by macrophages in the fetal spleen. Serological, quantitative and cellular assays have all been developed to predict the severity of HDFN. These assays measure and/or characterise alloantibodies in the maternal circulation. Quantitative assays which accurately measure antibody levels correlate with disease severity better than serological assays which are inherently less precise. Nevertheless, high antibody levels are found in some cases of mild HFDN and relatively low antibody levels are found in some severe cases. This suggests that disease severity is influenced by factors in addition to antibody concentration. These factors remain to be fully elucidated but may include: the subclass and glycosylation of maternal antibodies; the structure, site density, maturational development and tissue distribution of blood group antigens; the efficiency of IgG transport to the fetus; the functional maturity of the fetal spleen; polymorphisms which affect Fc receptor function; and the presence of HLA-related inhibitory antibodies. Cellular assays which are sensitive to factors affecting antibody function have, therefore, been developed in an attempt to improve the prediction of disease severity. Although these assays are cumbersome, there are now sufficient data to suggest that some cellular assays provide clinically useful information to complement serological and quantitative assays.
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6
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Kumpel BM, Beliard R, Brossard Y, Edelman L, de Haas M, Jackson DJ, Kooyman P, Ligthart PC, Monchâtre E, Overbeeke MAM, Puillandre P, de Romeuf C, Wilkes AM. Section 1C: Assessment of the functional activity and IgG Fc receptor utilisation of 64 IgG Rh monoclonal antibodies. Coordinator's report. Transfus Clin Biol 2002; 9:45-53. [PMID: 11889899 DOI: 10.1016/s1246-7820(01)00215-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Sixty-four IgG Rh monoclonal antibodies (Mabs) submitted to the Fourth International Workshop on Monoclonal Antibodies Against Human Red Blood Cells and Related Antigens were characterised and tested in quantitative functional assays at five laboratories. The biological assays measured the ability of anti-D to mediate phagocytosis or extracellular lysis of RBC by IgG Fc receptor (Fc gamma R)-bearing effector cells. Interactions of RBC pre-sensitised with anti-D (EA-IgG) with monocytes in chemiluminescence (CL) assays were found proportional to the amount of IgG anti-D on the RBC. Using antibodies to inhibit Fc gamma RI, Fc gamma RII or Fc gamma RIII, the only receptor utilised in the monocyte CL and ADCC assays for interactions with EA-IgG1 was found to be Fc gamma RI. In these assays, enhanced interactions were promoted by EA-IgG3 and additional Fc gamma receptors may have contributed. IgG2 anti-D was not reactive in these assays and EA-IgG4 promoted weak reactions through Fc gamma RI. A macrophage ADCC assay showed that haemolysis of EA-IgG3 was greater than that of EA-IgG1, mediated mainly through Fc gamma RIII. In ADCC assays using lymphocytes (NK cells) as effector cells and papainised RBC target cells, only a minority of IgG1 anti-D Mabs were shown to be able to mediate haemolysis in the presence of monomeric IgG (AB serum or IVIg). These interactions were mediated solely through Fc gamma RIII. Haemolysis via Fc gamma RIII may depend on the presence of certain sugars on the oligosaccharide moiety of IgG. Most Mabs (IgG1, IgG2, IgG3 and IgG4) elicited intermediate, low or no haemolysis in these assays. Blocking studies indicated that low activity IgG1 and IgG4 anti-D utilised only Fc gamma RI. Other IgG1 and IgG3 Mabs appeared to promote haemolysis through Fc gamma RI and Fc gamma RIII while IgG2 was inhibited by Mabs to both Fc gamma RII and Fc gamma RIII, suggesting a variety of Fc gamma R are utilised for anti-D of low haemolytic activity. Excellent agreement between the results of the lymphocyte ADCC assays and antibody quantitation was observed between the participating laboratories.
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Affiliation(s)
- B M Kumpel
- International Blood Group Reference Laboratory, Bristol Institute of Transfusion Sciences, Southmead Road, Bristol BS10 5ND, UK.
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7
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Oepkes D, van Kamp IL, Simon MJ, Mesman J, Overbeeke MA, Kanhai HH. Clinical value of an antibody-dependent cell-mediated cytotoxicity assay in the management of Rh D alloimmunization. Am J Obstet Gynecol 2001; 184:1015-20. [PMID: 11303214 DOI: 10.1067/mob.2001.112970] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the clinical value of an antibody-dependent cell-mediated cytotoxicity assay relative to the indirect antiglobulin test titer in the management of Rh D-alloimmunized pregnancies. STUDY DESIGN Data from 172 Rh D-alloimmunized pregnancies were analyzed retrospectively. The accuracies of the highest antibody titer and of the highest antibody-dependent cell-mediated cytotoxicity assay result during pregnancy to predict fetal and neonatal Rh disease, defined as the need for intrauterine (n = 30) or neonatal (n = 37) blood transfusion, respectively, were assessed. RESULTS At different cutoff levels with equal sensitivities the antibody-dependent cell-mediated cytotoxicity assay consistently showed a higher specificity than the antibody titer for the prediction of fetal disease. No difference was found between the receiver operating characteristic curves of the 2 tests for the prediction of neonatal disease. CONCLUSIONS Selection of patients for referral and invasive testing for Rh D alloimmunization may be improved with the use of an antibody-dependent cell-mediated cytotoxicity assay.
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Affiliation(s)
- D Oepkes
- Division of Fetal Diagnosis and Treatment, Department of Obstetrics, Leiden University Medical Center, The Netherlands
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8
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Miescher S, Zahn-Zabal M, De Jesus M, Moudry R, Fisch I, Vogel M, Kobr M, Imboden MA, Kragten E, Bichler J, Mermod N, Stadler BM, Amstutz H, Wurm F. CHO expression of a novel human recombinant IgG1 anti-RhD antibody isolated by phage display. Br J Haematol 2000; 111:157-66. [PMID: 11091196 DOI: 10.1046/j.1365-2141.2000.02322.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Replacement of the hyperimmune anti-Rhesus (Rh) D immunoglobulin, currently used to prevent haemolytic disease of the newborn, by fully recombinant human anti-RhD antibodies would solve the current logistic problems associated with supply and demand. The combination of phage display repertoire cloning with precise selection procedures enables isolation of specific genes that can then be inserted into mammalian expression systems allowing production of large quantities of recombinant human proteins. With the aim of selecting high-affinity anti-RhD antibodies, two human Fab libraries were constructed from a hyperimmune donor. Use of a new phage panning procedure involving bromelin-treated red blood cells enabled the isolation of two high-affinity Fab-expressing phage clones. LD-6-3 and LD-6-33, specific for RhD. These showed a novel reaction pattern by recognizing the D variants D(III), D(IVa), D(IVb), D(Va), D(VI) types I and II. D(VII), Rh33 and DFR. Full-length immunoglobulin molecules were constructed by cloning the variable regions into expression vectors containing genomic DNA encoding the immunoglobulin constant regions. We describe the first, stable, suspension growth-adapted Chinese hamster ovary (CHO) cell line producing a high affinity recombinant human IgG1 anti-RhD antibody adapted to pilot-scale production. Evaluation of the Fc region of this recombinant antibody by either chemiluminescence or antibody-dependent cell cytotoxicity (ADCC) assays demonstrated macrophage activation and lysis of red blood cells by human lymphocytes. A consistent source of recombinant human anti-RhD immunoglobulin produced by CHO cells is expected to meet the stringent safety and regulatory requirements for prophylactic application.
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Affiliation(s)
- S Miescher
- ZLB Central Laboratory, Swiss Red Cross, Inselspital, Bern, Switzerland.
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9
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Abstract
When an RhD negative mother is exposed to the RhD positive red cells (usually as transplacental haemorrhage), she develops allo-anti-D which crosses the placenta and then results in the destruction of fetal red cells. Clinical manifestations of RhD haemolytic disease (HDN) range from asymptomatic mild anaemia to hydrops fetalis or stillbirth associated with severe anaemia and jaundice. HDN was a significant cause of fetal mortality and morbidity until the introduction of amniocentesis, intrauterine transfusion, controlled early delivery and exchange transfusion in the management of severely alloimmunised women and their fetuses. The objective of monitoring alloimmunised women is to identify fetal anaemia and prevent the development of life-threatening hydrops. Evaluation involves assessing the history of previous pregnancies; serial estimation of maternal anti-D levels; serial ultrasound measurements; serial amniocentesis; fetal blood sampling, and intrauterine transfusion when indicated. Diagnostic genotyping by DNA-based methods can identify at-risk RhD positive fetuses early in gestation. Identification of transplacental haemorrhage (TPH) as the stimulus for anti-D antibody production led to the development of anti-D immunoglobulin prophylaxis for at-risk RhD negative women who are not already alloimmunised. Prevention includes administration of anti-D immunoglobulin for any event associated with TPH during pregnancy, and at delivery of an RhD positive infant. Prophylactic routine administration of anti-D immunoglobulin at 28 (and 34) weeks gestation, in addition to the above, has reduced alloimmunisation to <1% of RhD negative women carrying an RhD positive fetus.
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Affiliation(s)
- S J Urbaniak
- Department of Medicine and Therapeutics, Aberdeen University, UK
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10
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Armstrong-Fisher SS, Carter MC, Downing I, Fraser RH, Inglis GE, Allan EK, Mackie A, Prowse CV, Templeton JG, Thorpe SJ, Urbaniak SJ. Evaluation of a panel of human monoclonal antibodies to D and exploration of the synergistic effects of blending IgG1 and IgG3 antibodies on their in vitro biologic function. Transfusion 1999; 39:1005-12. [PMID: 10533828 DOI: 10.1046/j.1537-2995.1999.39091005.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND The D immunoprophylaxis program has successfully reduced the incidence of Rh hemolytic disease of the newborn (HDN), but it has also reduced the availability of plasma-derived polyclonal anti-D, which constitutes the current therapeutic product. Human monoclonal anti-D from hybridoma cell lines may be an acceptable alternative, and clinical efficacy of each anti-D is being evaluated in several centers. STUDY DESIGN AND METHODS This study represents the largest assessment (outside of the International Workshops) of human D monoclonal antibodies for potential therapeutic use. The in vitro biologic activity and immunologic and serologic reactivity of a coded panel of 20 D antibodies (THERAD) was investigated. The bioassays used were lymphocyte (K-cell) antibody-dependent cell-mediated cytotoxicity (ADCC), monocyte ADCC, and monocyte chemiluminescence, which together reflect the processes involved in antibody-coated red cell destruction in vivo. From this panel, six antibodies (THERADs 14, 19, 22, 23, 27, and 28, comprising 3 IgG1 and 3 IgG3 D monoclonal antibodies) were further selected to investigate the effects of blending in the three bioassays. RESULTS Several THERAD blends displayed greater activity than their component parts, in the range of 6 to 124 percent. There was no evidence to suggest functional blocking effects with this restricted panel of antibodies. CONCLUSION The THERAD blends containing both IgG1 and IgG3 anti-D appeared to be the most functionally active, as did blends containing antibodies to two distinct D epitopes. This in vitro evidence has important implications for the future formulation of an effective monoclonal preparation for the prevention of Rh HDN.
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11
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Hadley AG. A comparison of in vitro tests for predicting the severity of haemolytic disease of the fetus and newborn. Vox Sang 1998; 74 Suppl 2:375-83. [PMID: 9704470 DOI: 10.1111/j.1423-0410.1998.tb05445.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Haemolytic disease of the newborn (HDN) is characterized by the presence of IgG antibodies in the maternal circulation which cause haemolysis in the fetus by crossing the placenta and sensitizing red cells for destruction by macrophages in the fetal spleen. Numerous serological, quantitative and cellular assays have been developed to predict the severity of HDN. These assays all measure and/or characterize alloantibodies in the maternal circulation. Quantitative assays which accurately measure antibody levels correlate with disease severity better than serological assays which are inherently less precise. Nevertheless, high antibody levels are found in some cases of mild HDN and relatively low antibody levels are found in some severe cases. This suggests that disease severity is influenced by factors in addition to antibody concentration. These factors remain to be fully elucidated but may include the subclass and glycosylation of maternal antibodies, the structure, site density, maturational development and tissue distribution of blood group antigens, the efficiency of IgG transport to the fetus, the functional maturity of the fetal spleen, polymorphisms which affect Fc receptor function, and the presence of HLA-related inhibitory antibodies. Cellular assays which are sensitive to factors affecting antibody function have therefore been developed in an attempt to improve the prediction of disease severity. Although these assays are cumbersome, there are now sufficient data to suggest that some cellular assays, when used as part of a structured approach to diagnostic testing, may provide clinically-useful information to complement serological and quantitative assays.
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Affiliation(s)
- A G Hadley
- International Blood Group Reference Laboratory, Bristol, UK.
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12
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Paterson T, Innes J, McMillan L, Downing I, Carter MC. Variation in IgG1 heavy chain allotype does not contribute to differences in biological activity of two human anti-Rhesus (D) monoclonal antibodies. IMMUNOTECHNOLOGY : AN INTERNATIONAL JOURNAL OF IMMUNOLOGICAL ENGINEERING 1998; 4:37-47. [PMID: 9661813 DOI: 10.1016/s1380-2933(98)00005-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Pooled human anti-Rhesus D antiserum is currently administered for the prevention of RhD alloimmunization. Increased demand, and decreased supply, of donated pooled antiserum has led to the investigation of the suitability of human monoclonal anti-RhD antibodies for use in its place. However, it is unclear which biological properties of monoclonal antibodies are important for function in RhD-positive foetal red cell clearance and the prevention of alloimmunization. Various antibodies behave differently in a number of in vitro assays of biological function. OBJECTIVES To compare the function and structure of two human anti-RhD IgG1 monoclonal antibodies which differ in their ability to promote red cell lysis in vitro. In particular to examine whether the functional differences correlate to differences in the IgG1 heavy chain constant region (allotype). STUDY DESIGN We report here the cloning, characterization and re-expression in stable myeloma cell transformants of cDNAs coding for two such antibodies, secreted by the heterohybridoma cell lines ESD-1 (THERAD 03) and LHM 70/45.3 (THERAD 06). The cDNAs were then recombined to exchange portions of the Fc encoding regions and the recombinant antibodies were assayed in vitro to determine RhD-positive red cell-dependent activity. RESULTS Recombinant THERAD 03 and 06 antibodies behaved identically to the parent antibodies. The 'inactive' THERAD 06 did not have biological activity reconstituted by exchange with the THERAD 03 Fc regions, nor was THERAD 03 activity abolished by the reciprocal Fc region exchange. CONCLUSIONS Human monoclonal anti-RhD antibodies can be cloned and re-expressed in stable cell lines, and exhibit identical properties to the parent antibodies. Differences in biological activity cannot be attributed to differences in IgG1 heavy chain allotype.
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Affiliation(s)
- T Paterson
- National Science Laboratory, Scottish National Blood Transfusion Service, Scotland, UK.
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13
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Downing I, Bromilow IM, Templeton JG, Fraser RH. A Retrospective Study of Red Cell Maternal Antibodies by Chemiluminescence. Vox Sang 1996. [DOI: 10.1046/j.1423-0410.1997.73100546.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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14
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Strachan AJ, Williams B, Mohabir L, Rowe GP. Human Rh monoclonal antibodies: assessment of functional activity by chemiluminescence and RhD antibody quantitation. Transfus Clin Biol 1996; 3:483-7. [PMID: 9018813 DOI: 10.1016/s1246-7820(96)80068-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
In vitro cellular assays have been described which are capable of evaluating the interactions between sensitised red cells and monocyte or K cells. The chemiluminescence assay (CL) has several advantages over other cellular assays used to assess functional activity. The CL assay unlike the ADCC assays does not require the use of radioisotopes and therefore can be easily integrated into the work of a Reference Serology laboratory. The CL assay is an objective test and not labour intensive which is the main criticism of the monocyte monolayer assay. Seventy-four monoclonal anti-Ds and 29 other Rh specificities have been evaluated by a CL assay. The use of the chemiluminescent response produced by erythrophagocytosis of sensitised red cells has been shown to correlate well with the in vivo response to red cells sensitized with polyclonal IgG antibodies. This study aimed at investigating whether the CL assay could identify and differentiate monoclonal antibodies that are capable of eliciting a response from human monocytes. Poor correlation was obtained between the CL assay results and anti-D quantitation (r = 0.236). The chemiluminescence assay discriminated between anti-D's with high quantitation levels but low predicted functional activity and anti-Ds of low quantitation levels which produced elevated CL responses. Only 3 of the 29 non-Rh D specificities tested produced a response in the CL assay emphasising the importance of specificity in the functional activity of monoclonal antibodies. The demonstration of significant differences in the functional capabilities of monoclonal antibodies has important implications for reviewing the possible use of monoclonal anti-D preparations for Rh immune prophylaxis and highlights the requirement for factors other than the antibody concentration to be examined.
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Affiliation(s)
- A J Strachan
- National Blood Transfusion Service, Rhydlafar, St Fagans, Cardiff, UK
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15
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Affiliation(s)
- A G Hadley
- International Blood Group Reference Laboratory, Bristol, United Kingdom
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16
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17
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Moise KJ, Perkins JT, Sosler SD, Brown SJ, Saade G, Carpenter RJ, Thorp JA, Ludomirski A, Wilkins IA, Grannum PA. The predictive value of maternal serum testing for detection of fetal anemia in red blood cell alloimmunization. Am J Obstet Gynecol 1995; 172:1003-9. [PMID: 7892839 DOI: 10.1016/0002-9378(95)90034-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVE Current management protocols for pregnancies complicated by red blood cell alloimmunization use the maternal antibody titer to predict the need for invasive testing for detection of fetal anemia. We investigated the use of three maternal serum tests to assess their usefulness in predicting fetal disease: indirect Coombs' titer, Marsh score, and monocyte monolayer assay. STUDY DESIGN Forty-seven serum samples from pregnant women with red blood cell antibodies associated with fetal anemia were analyzed at cordocentesis. Fetal blood was analyzed for hematocrit (corrected for gestational age) and antigen status. Fetal anemia was defined as a hematocrit value of < 2 SD from the mean value for gestational age. Fetuses were classified into three groups: Antigen positive with anemia (n = 19), antigen positive without anemia (n = 17), antigen negative (n = 11). Statistical methods included Kruskal-Wallis test, Newman-Keuls test, Spearman's rank correlation, and receiver-operator characteristic curves; p < 0.05 was considered significant. RESULTS The median monocyte monolayer assay (phagocytosis, adherence, and association) did not differ among the three groups. Both maternal titers and Marsh scores were significantly higher in fetuses with anemia compared with the other two groups of fetuses (256 vs 64 vs 64, p < 0.001, and 86 vs 69 vs 64, p = 0.02, respectively). Both titer and Marsh score exhibited significant correlations with corrected fetal hematocrit (r = -0.70, p < 0.001; r = -0.63, p < 0.001, respectively). Comparison of the overall receiver-operator characteristic curves for titer and Marsh score revealed no statistical difference; however, a Marsh score of 57 was noted to have a superior specificity than a titer of 16 (p = 0.02). CONCLUSION The maternal Marsh score can be performed in conjunction with standard indirect Coombs' titers to enhance the predictability of fetal anemia.
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Affiliation(s)
- K J Moise
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX 77030
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19
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Contreras M. Antenatal tests in the diagnosis and assessment of severity of haemolytic disease (Hd) of the fetus and newborn (hdn). Vox Sang 1994; 67 Suppl 3:207-10. [PMID: 7975494 DOI: 10.1111/j.1423-0410.1994.tb04577.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- M Contreras
- North London Blood Transfusion Centre, United Kingdom
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Contreras M, de Silva M. The Prevention and Management of Haemolytic Disease of the Newborn. Med Chir Trans 1994; 87:256-8. [PMID: 8207718 PMCID: PMC1294514 DOI: 10.1177/014107689408700505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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21
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Zupańska B. Clinical application of functional assays for assessing the red cell antibody activity. TRANSFUSION SCIENCE 1993; 14:371-81. [PMID: 10146644 DOI: 10.1016/s0955-3886(05)80010-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Functional assays (the monocyte monolayer assay, the chemiluminescence test, and the antibody dependent cellular cytotoxicity assay) aim to reflect an interaction between sensitized red calls and Fc-gamma receptor bearing mononuclear cells, which plays the main role in immune destruction of erythrocytes in vivo. These assays have been used for predicting the clinical significance of antibodies in hemolytic disease of the newborn, in patients with alloantibodies requiring transfusion and patients suspected of autoimmune hemolytic anemia. This review presents a brief summary of the literature on this subject. In many cases (especially in hemolytic disease of the newborn, RhD) the results of bioassays can assess the functional activity of antibodies in vivo, but further investigation is needed to establish their real value for clinical practice.
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Affiliation(s)
- B Zupańska
- Institute of Hematology and Blood Transfusion, Warsaw, Poland
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22
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McCann-Carter MC, Bruce M, Shaw EM, Thorpe SJ, Sweeney GM, Armstrong SS, James K. The production and evaluation of two human monoclonal anti-D antibodies. Transfus Med 1993. [DOI: 10.1111/j.1365-3148.1993.tb00114.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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23
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Hadley AG, Kumpel BM. The role of Rh antibodies in haemolytic disease of the newborn. BAILLIERE'S CLINICAL HAEMATOLOGY 1993; 6:423-44. [PMID: 8043933 DOI: 10.1016/s0950-3536(05)80153-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Recent insights into the structure-function relationship of IgG, the nature of Fc receptors and their interactions with antibodies, and the cellular mechanisms involved in the immune destruction of IgG-sensitized cells have all contributed to a fuller understanding of the role of Rh antibodies in HDN. As this understanding has increased, so different diagnostic and therapeutic approaches have been developed and evaluated in order either to predict or ameliorate disease severity. The role of Rh antibodies in HDN can be considered in three contexts: maternal anti-D, monoclonal anti-D and prophylactic anti-D. Anti-D formed after maternal alloimmunization may be transported across the placenta, resulting in destruction of sensitized red cells by mononuclear phagocytes in the fetus and infant. The use of monoclonal anti-D has given an insight into the cellular and molecular mechanisms involved in red cell destruction, and has facilitated the development and evaluation of assays which use maternal anti-D to predict the severity of HDN. Polyclonal anti-D, given prophylactically, can prevent maternal alloimmunization to D-positive fetal red cells. Future developments are likely in several areas. Prophylactic polyclonal anti-D may be replaced, wholly or partially, with monoclonal anti-D. The development and introduction of cellular assays as non-invasive tests for predicting disease severity is likely to continue as preliminary results are encouraging. Finally, new strategies for ameliorating disease severity may be assessed including the role of ivIgG and Fc gamma R-blocking antibodies.
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Affiliation(s)
- A G Hadley
- International Blood Group Reference Laboratory, Bristol, UK
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24
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Hadley AG, Poole GD, Fraser ID. Predicting the severity of haemolytic disease of the newborn: prospective evaluation of the chemiluminescence test. Vox Sang 1992; 63:291-2. [PMID: 1481481 DOI: 10.1111/j.1423-0410.1992.tb01242.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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26
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Maternal Immunity to Red Cell Antigens and Fetal Transfusion. Clin Lab Med 1992. [DOI: 10.1016/s0272-2712(18)30505-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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27
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Tovey LA. Oliver memorial lecture. Towards the conquest of Rh haemolytic disease: Britain's contribution and the role of serendipity. Transfus Med 1992; 2:99-109. [PMID: 1339195 DOI: 10.1111/j.1365-3148.1992.tb00142.x] [Citation(s) in RCA: 394] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
MESH Headings
- Adult
- Amniocentesis
- Anemia, Neonatal/etiology
- Anemia, Neonatal/history
- Anemia, Neonatal/prevention & control
- Anemia, Neonatal/therapy
- Antibodies, Monoclonal/therapeutic use
- Blood Transfusion, Intrauterine
- Erythroblastosis, Fetal/etiology
- Erythroblastosis, Fetal/history
- Erythroblastosis, Fetal/prevention & control
- Erythroblastosis, Fetal/therapy
- Female
- History, 20th Century
- Humans
- Hydrops Fetalis/etiology
- Hydrops Fetalis/history
- Hydrops Fetalis/prevention & control
- Hydrops Fetalis/therapy
- Immunoglobulins
- Infant, Newborn
- Labor, Induced
- Pregnancy
- Rh Isoimmunization/prevention & control
- Rh Isoimmunization/therapy
- Rh-Hr Blood-Group System/genetics
- Rh-Hr Blood-Group System/history
- Rh-Hr Blood-Group System/immunology
- Rho(D) Immune Globulin
- United Kingdom
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Affiliation(s)
- L A Tovey
- Yorkshire Regional Transfusion Centre, Leeds, U.K
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28
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Bakács T, Kumpel BM, Tusnády G. Haemolysis mediated by anti-D monoclonal antibodies in direct and cold target competition ADCC assays. Immunol Lett 1992; 32:223-31. [PMID: 1500093 DOI: 10.1016/0165-2478(92)90054-r] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Thirteen IgG anti-D human monoclonal antibodies (mAbs) were compared for their ability to mediate lysis of D-positive erythrocytes by PBMC in direct and cold target competition antibody-dependent cell-mediated cytotoxicity (ADCC) assays. In the latter assay, lysis of fluid-phase anti-D-sensitised O Rh D-positive papainised erythrocytes (E-IgG) was inhibited by A (or B) Rh D-negative papainised erythrocytes sensitised by fluid-phase anti-A (or anti-B) mAbs. The competitive and lytic activities of the anti-D mAbs were characterised by the equilibrium dilution (ED) values, which were the reciprocal of the dilution of anti-A (or anti-B) at which lysis of target E-IgG and competitor E-IgG were identical. There was a poor correlation between the number of erythrocyte-bound anti-D molecules and either the sensitivity of E-IgG anti-D to haemolysis in the direct ADCC assay, or to the ED values of the mAbs obtained in the cold target competition ADCC. The discriminatory power of the cold target competition ADCC was better than than of the direct ADCC to detect differences in the lytic potential of the anti-D mAbs.
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Affiliation(s)
- T Bakács
- National Institute of Oncology, Budapest, Hungary
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29
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Abstract
Red cells were pretreated with the proteolytic enzymes bromelain or papain prior to use in antibody-dependent cell-mediated cytotoxicity (ADCC) assays with lymphocytes or peripheral blood mononuclear cells (PBMC) as effector cells. At low concentrations of anti-D or anti-A, lysis of papain-treated cells by lymphocytes was greater than that of bromelain-treated cells. Papain digestion resulted in both greater sensitivity to haemolysis by lymphocytes or PBMC and higher agglutination titres of anti-D-sensitised red cells than bromelain. With anti-A, however, although papain also promoted greater haemolysis, it was slightly less effective at red cell agglutination than bromelain.
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Affiliation(s)
- B M Kumpel
- U.K. Transplant Support Services Authority, Bristol
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30
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Garner SF, Wiener E, Contreras M, Nicolini U, Kochenour N, Letsky E, Rodeck CH. Mononuclear phagocyte assays, autoanalyzer quantitation and IgG subclasses of maternal anti-RhD in the prediction of the severity of haemolytic disease in the fetus before 32 weeks gestation. Br J Haematol 1992; 80:97-101. [PMID: 1536816 DOI: 10.1111/j.1365-2141.1992.tb06406.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
In 40 cases of haemolytic disease of the fetus due to RhD immunization where the fetus required intrauterine transfusion, fetal packed cell volume was compared with the following parameters of maternal anti-D: (a) concentration, (b) IgG subclass, (c) activity in a macrophage binding assay, and (d) activity in a monocyte antibody-dependent cell mediated cytotoxicity (ADCC) assay. The anti-D concentration exceeded 4 iu/ml in all cases, correctly indicating the risk of haemolytic disease. A relationship between IgG subclass composition of the anti-D and severity of anaemia was not observed; IgG1, IgG3 and IgG1 + 3 antibodies were all detected. The ADCC assay gave the best correlation between assay results and fetal packed cell volume; high results correctly indicated fetal anaemia in 95% of cases. Macrophage binding assay results were only considered as high in 70% of cases. Overall, these results indicate that serological tests and bioassays in highly immunized mothers may not generate any information that proves more useful than ultrasonography and their previous obstetric history.
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Affiliation(s)
- S F Garner
- North London Blood Transfusion Centre, Colindale
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31
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Mollison P. Results of Tests with Different Cellular Bioassays in Relation to Severity of RhD Haemolytic Disease. Vox Sang 1991. [DOI: 10.1111/j.1423-0410.1991.tb00910.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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32
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Hadley AG, Kumpel BM, Leader KA, Poole GD, Fraser ID. Correlation of serological, quantitative and cell-mediated functional assays of maternal alloantibodies with the severity of haemolytic disease of the newborn. Br J Haematol 1991; 77:221-8. [PMID: 2004024 DOI: 10.1111/j.1365-2141.1991.tb07981.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Serum samples containing IgG red blood cell (RBC) antibodies were collected without reference to clinical information from 131 pregnant alloimmunized women. Anti-D and anti-K were present in sera from 75 and 20 patients respectively. Antibody titres were determined by indirect antiglobulin test (IAGT), anti-D levels were measured by AutoAnalyzer, RBC-binding IgG was quantified using an enzyme-linked immunosorbent assay (SOL-ELISA), and functional activities were measured using the monocyte chemiluminescence (CL) test, antibody-dependent monocyte-mediated and K cell-mediated cytotoxicity (ADCC) assays, and rosette formation with U937 cells. Details of clinical outcomes were obtained retrospectively from 104 pregnancies. Forty-one babies were 'antigen-negative', and of the remainder, four required top-up transfusions, 12 required exchange transfusions, three received intrauterine transfusions, and two died in utero. A comparison of test results with severity of haemolytic disease of the newborn (HDN) showed that, provided sera tested were collected within 8 weeks of the expected delivery date, the CL test and the monocyte-mediated ADCC assay differentiated those D-positive babies which required exchange transfusions from those unaffected or only mildly affected. The usefulness of results from the AutoAnalyzer and IAGT in predicting disease severity was compromised by the wide range of results from mothers of unaffected babies. This variability was less apparent in the SOL-ELISA which predicted severe HDN with greater precision. Results from the U937 rosette assay and the K cell-mediated ADCC assay failed to correlate with disease severity.
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Affiliation(s)
- A G Hadley
- International Blood Group Reference Laboratory, Bristol, U.K
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33
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Garratty G. Predicting the clinical significance of red cell antibodies with in vitro cellular assays. Transfus Med Rev 1990; 4:297-312. [PMID: 2134635 DOI: 10.1016/s0887-7963(90)70272-6] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- G Garratty
- American Red Cross Blood Services, Los Angeles-Orange Counties Region 90006
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34
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Abstract
Expansion of transfusion medicine has led to an increasing awareness of the importance of its practice. Specialists in this branch of haematology whose main aim is to provide adequate and safe supplies of blood (and blood products) and to ensure these are used appropriately, are increasingly aware that to do this efficiently requires the development and utilization of new laboratory and technical procedures. Review of cross-matching techniques has led to the introduction of more rapid methods using low ionic strength saline. Use of monoclonal antibodies for blood grouping has made use of new technology, whilst allowing scarce human plasma to be used more appropriately for therapeutic purposes. Similarly, the implementation of a more rational approach to blood ordering, as in a maximum surgical blood-order schedule, allows for the more efficient use of donor blood. The use of microtitre plates for grouping and cross-matching techniques allows for speed and economy in the transfusion laboratory. Their use is also associated with increased automation and computer use. The possibility of using solid-phase techniques, monocyte-macrophage assays and antibody-dependent cellular cytotoxicity assays introduces new techniques differing markedly from time-honoured liquid-phase serology methods. The application of flow cytometry, which has already been shown to be useful in many aspects of haematology, is also of benefit in the field of blood transfusion science. Safety of blood transfusion is an important aspect of its practice and has led to the introduction and development of screening tests for donor blood to exclude infection risks from such organisms as HIV-1, hepatitis B and non-A, non-B hepatitis. Another approach to ensure the safety of transfused blood has been increased usage of autologous transfusion by means of both predeposit donation and intraoperative cell salvage.
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35
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Engelfriet CP, Ouwehand WH. ADCC and other cellular bioassays for predicting the clinical significance of red cell alloantibodies. BAILLIERE'S CLINICAL HAEMATOLOGY 1990; 3:321-37. [PMID: 2224152 DOI: 10.1016/s0950-3536(05)80053-8] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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36
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Kumpel BM, Leader KA, Merry AH, Hadley AG, Poole GD, Blancher A, Goossens D, Hughes-Jones NC, Bradley BA. Heterogeneity in the ability of IgG1 monoclonal anti-D to promote lymphocyte-mediated red cell lysis. Eur J Immunol 1989; 19:2283-8. [PMID: 2481589 DOI: 10.1002/eji.1830191216] [Citation(s) in RCA: 33] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Thirty-four IgG anti-D human monoclonal antibodies (mAb) derived from 18 donor were assessed for their ability to mediate lysis of D+ red cells by lymphocytes in antibody-dependent cell-mediated cytotoxicity assays. Cell-bound antibody was quantified and the mAb were compared at similar levels of sensitization. The majority (23/31) of IgG1 and all (3/3) IgG3 mAb were ineffective; two donors produced both lytic and non-lytic anti-D mAb. Greater sensitivity was achieved using fluid-phase antibody (as culture supernatants) in the assay than was obtained with pre-sensitized red cells. Minimum levels of 2000 anti-D molecules per cell were required for lysis using pre-sensitized cells. Partial D red cells (DIVa, DVa and DVI) were lysed by three mAb that were lytic with normal D+ cells. There was no relationship between lytic ability and Gm allotype or D epitope specificity of the antibodies. Four mAb to other blood group specificities were tested: two (anti-E and anti-G) were lytic and two (anti-c and anti-Kell) were not lytic. Possible reasons for the heterogeneity of the lytic activity by the mAb are discussed.
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37
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Leader KA, Kumpel BM, Bradley BA. Rosette formation between immobilised human lymphocytes and erythrocytes sensitised with monoclonal anti-D. Immunol Lett 1989; 23:109-12. [PMID: 2517265 DOI: 10.1016/0165-2478(89)90121-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
A rapid, reproducible and sensitive assay was developed to investigate the ability of human lymphocytes to form rosettes with erythrocytes sensitised with human monoclonal anti-D. Erythrocytes sensitised with a known number of anti-D molecules per cell were incubated with lymphocytes immobilised on plastic by poly(L-lysine), the resulting rosettes fixed, unbound erythrocytes removed by washing and the cell preparation stained. IgG1 and IgG3 anti-D-coated erythrocytes gave similar rosette formation at sensitisation levels in the range of 5000-15,000 molecules per cell, although at lower sensitisation levels IgG3 gave greater rosette formation than IgG1. A minimum of 500 IgG3 and 1000 IgG1 anti-D molecules per erythrocyte were required for rosetting.
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Affiliation(s)
- K A Leader
- United Kingdom Transplant Service, Southmead, Bristol
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38
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Zupańska B, Brojer E, Richards Y, Lenkiewicz B, Seyfried H, Howell P. Serological and immunological characteristics of maternal anti-Rh(D) antibodies in predicting the severity of haemolytic disease of the newborn. Vox Sang 1989; 56:247-53. [PMID: 2503936 DOI: 10.1111/j.1423-0410.1989.tb02037.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
A number of factors were analyzed for their predictive value in indicating the severity of haemolytic disease of the newborn (HDN) in 72 infants. The factors investigated were: maternal antibody titre in the indirect antiglobulin test, the number of antibody molecules on sensitized standard red cells evaluated by a radiometric antiglobulin test, the IgG subclass specificity and the reactivity in monocyte-monolayer assay (MMA) and in the rosette assays with lymphocytes and granulocytes from healthy individuals. The results of the MMA correlate much better with the severity of HDN than the antibody titre. In clinically unaffected infants the reactivity in the MMA never exceeded 20%, while in the severe/very severe group it was always greater than 20% (in 95% of very severe cases even above 50%). The number of IgG-bound molecules was also shown to closely correlate with the clinical severity and there was a much greater proportion of severe/very severe cases exhibiting combined IgG1 and IgG3 specificity. Of all the evaluations performed the rosette assays with lymphocytes and granulocytes were found to be less useful in predicting the severity of HDN.
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Affiliation(s)
- B Zupańska
- Institute of Haematology, Warsaw, Poland
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39
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Kumpel BM, Wiener E, Urbaniak SJ, Bradley BA. Human monoclonal anti-D antibodies. II. The relationship between IgG subclass, Gm allotype and Fc mediated function. Br J Haematol 1989; 71:415-20. [PMID: 2539182 DOI: 10.1111/j.1365-2141.1989.tb04300.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Eight monoclonal antibodies (mabs) to the Rh antigen D produced by Epstein-Barr virus transformed B-lymphoblastoid cell lines from two individuals have been compared for their behaviour in in vitro cell-mediated assays. Three IgG1 Glm(1,17) and two IgG3 G3m(21) mabs from one donor and three IgG1 Glm(3) mabs from another were used. IgG3 anti-D mabs induced greater adherence and phagocytosis of sensitized red cells by U937 monocytes than IgG1 anti-D mabs or the polyclonal anti-D. Minimum sensitization levels for rosetting and phagocytosis by U937 monocytes were 2,000 molecules IgG/cell for IgG3 and 5,000 molecules/cell for IgG1 mabs; maximum rosetting mediated by both IgG1 and IgG3 mabs was obtained at 15,000-20,000 molecules/cell. The IgG3 anti-D mabs were comparable to polyclonal anti-D in mediating binding of sensitized red cells to gamma-interferon stimulated monocyte-derived cultured macrophages and were markedly more effective than the IgG1 anti-D mabs. However, in lymphocyte ADCC assays, only anti-D mabs which were IgG1 Glm(3) were effective in mediating high levels of lysis of sensitized red cells, unlike the IgG1 Glm (1,17) or IgG3 G3m(21) mabs. Minimum sensitization levels required for this lymphocyte-mediated red cell lysis were found to be approximately 5,000 molecules/cell with one IgG1 Glm(3) mab; maximum lysis with this mab was obtained at 10,000 molecules/cell. Polyclonal anti-D containing both IgG1 and IgG3 was effective in all three assays. These observations suggest that different isotypes and allotypes of anti-D antibodies mediate red cell removed or destruction by monocyte or lymphocyte effector cell through functionally dissimilar Fc receptor interactions.
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40
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Abstract
Rhesus haemolytic disease of the newborn is a condition which can result in intrauterine or perinatal death. Although the passive administration of therapeutic anti-D post-partum is a most effective method for the prevention of this condition, there is currently a shortage of immune plasma for the preparation of the therapeutic anti-D immunoglobulin product. In addition the availability of anti-D for use in blood grouping has also been reduced. The advances made in recent years in the techniques for the production of human monoclonal antibodies raise the possibility that human monoclonal anti-D-based products may provide solutions to both of these problems. There are now a number of reports of the production of stable cell lines secreting high titre human anti-D. In this review we consider the various strategies used in the production of human monoclonal anti-D-secreting cell lines, the basic properties of these reagents and their potential usefulness in blood grouping, in therapy and as research tools.
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Affiliation(s)
- M C McCann
- Protein Fractionation Centre, Scottish National Blood Transfusion Service, Edinburgh, U.K
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41
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Abstract
In the past 40 years, tremendous advances in the treatment of hemolytic disease have been made. The perinatal mortality has been reduced considerably. Rh immunoprophylaxis has decreased the incidence of Rh immunization to around 6 per 100,000 live births. Nevertheless, treatment of severe hemolytic disease is still essential. Increased reliability of diagnostic procedures have made early detection and optimal treatment of hemolytic disease possible. Treatment by plasmapheresis is still controversial. Although believed to be beneficial by some authors, conclusive evidence of its efficacy has not been obtained. With preterm induction of birth at 32 weeks of gestation, the chances for survival are 95%. Improvement of techniques and the use of modern real-time ultrasound equipment have made intrauterine intraperitoneal transfusion, in experienced hands, a relatively safe and successful procedure. Intravascular transfusion appears beneficial in early pregnancy. Combination of both techniques will probably be the answer for the future. The development of neonatal intensive care facilities has made a major contribution to the survival of children with haemolytic disease. The relative low incidence of haemolytic disease has made it imperative that treatment should take place in centers where experience and special skill are available.
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42
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SAMDAL HELVIHOLM, MICHAELSEN TERJEE, HEIER HANSERIK, NORDHAGEN RANNVEIG. Antibody dependent cell mediated cytotoxicity against anti-D sensitized human erythrocytes. APMIS 1988. [DOI: 10.1111/j.1699-0463.1988.tb05298.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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43
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Petri IB, Lörincz A, Berek I. Further investigation of nonspecific biological substance in anti-Rh(D) preparations. Vox Sang 1986; 51:287-91. [PMID: 2948323 DOI: 10.1111/j.1423-0410.1986.tb01970.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Fc receptor-blocking activity, based on the EA rosetting inhibition of anti-Rh(D) gamma-globulin preparations, was determined during biological analyses. After sample purification by means of precipitation with a low concentration of ammonium sulphate, fractions were obtained containing anti-D activity and Fc receptor-blocking activity separately. Fc receptor-blocking antibodies inhibited both the formation of EA rosettes and the antibody-dependent cellular cytotoxicity activity. It is suggested that Fc receptor-blocking antibodies obtained during hyperimmunization probably result in the immunosuppressive effect of Rh immune globulin (via the blocking of Fc receptors of activated lymphocytes) that decreases in turn the progress of Rh immunization.
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44
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Urbaniak SJ. Rh(D) haemolytic disease of the newborn: the changing scene. BMJ : BRITISH MEDICAL JOURNAL 1985; 291:4-6. [PMID: 2990630 PMCID: PMC1416181 DOI: 10.1136/bmj.291.6487.4] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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45
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Barclay GR, Forouhi P, McCann MC, Greiss MA, Urbaniak SJ. ADCC lysis of human erythrocytes sensitized with rhesus alloantibodies. IV. Characterization of anti-D sera which are inactive in ADCC. Br J Haematol 1985; 60:293-304. [PMID: 2408657 DOI: 10.1111/j.1365-2141.1985.tb07415.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Certain anti-D sera, selected on the basis of their agglutination characteristics in vitro, fail to induce lysis of Rh(D) positive red cells by lymphocyte mediated antibody dependent cell mediated cytotoxicity (ADCC). Further investigation revealed that the non-lytic anti-D blocked in an antigen specific manner the effect of other anti-D sera which were normally lytic in ADCC. Absorption selection studies and fractionation of a non-lytic anti-D serum showed that the blocking effect was associated with IgG anti-D. Antigen binding and lymphocyte Fc-receptor binding studies indicated that the non-lytic anti-D was bound to Rh(D) positive red cells and enabled them to be bound by lymphocytes, but failed to mediate ADCC.
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