1
|
|
2
|
Kjær M, Tiller H, Heide G, Kjeldsen-Kragh J, Skogen B, Husebekk A. Fetal exposure to maternal human platelet antigen-1a does not induce tolerance. An analytical observational study. PLoS One 2017; 12:e0182957. [PMID: 28837581 PMCID: PMC5570354 DOI: 10.1371/journal.pone.0182957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Accepted: 07/27/2017] [Indexed: 11/19/2022] Open
Abstract
Fetal and neonatal alloimmune thrombocytopenia (FNAIT) is a disease that may cause severe bleeding complications with risk of perinatal death or lifelong disability. The main cause of FNAIT is maternal antibodies against human platelet antigen (HPA)-1a. Both fetomaternal bleeding and transplacental trafficking of fetal cells during pregnancy could be the cause of alloimmunization. Persistence of fetal cells in the mother (fetal microchimerism) and maternal cells in the child (maternal microchimerism) are well-recognized phenomena. Thus, it could be envisaged that fetal exposure to the HPA-1a antigen could tolerize an HPA-1a negative female fetus and prevent production of anti-HPA-1a antibodies later in life if she becomes pregnant with an HPA-1a positive fetus. The objective of the current study was to assess if the risk of producing anti-HPA-1a antibodies and the severity of neonatal thrombocytopenia in HPA-1a negative women with HPA-1a positive mothers (i.e. the mother is HPA-1a/b), was lower than in HPA-1a negative women with HPA-1a negative mothers. HPA-1a negative women with HPA-1a antibodies, identified from a Norwegian screening study (1996-2004), where HPA-1 genotype of their mothers was available, were included in the study. The frequency of HPA-1a positive mothers to HPA-1a immunized daughters were compared to the calculated frequency in the general population. We did not find any difference in the frequency of HPA-1ab among mothers to daughters with HPA-1a antibodies as compared with the general population. Furthermore, acknowledging sample-size limitations, we neither found an association between the mothers' HPA type and their daughters' anti-HPA-1a antibody levels or any difference between the two groups of mothers (HPA-1ab vs HPA-1bb), with respect to frequency of thrombocytopenia in the children of their daughters with HPA-1a antibodies. Hence, there was no indication of tolerance against fetal HPA-1a antigen in HPA-1bb women who had been exposed to HPA-1a antigen during fetal development.
Collapse
Affiliation(s)
- Mette Kjær
- Laboratory Medicine, University Hospital North Norway, Tromsø, Norway
- Finnmark Hospital Trust, Hammerfest, Norway
- * E-mail:
| | - Heidi Tiller
- Immunology Research Group, Department of Medical Biology, UiT The Artic University of Norway, Tromsø, Norway
- Department of Obstetrics and Gynecology, University Hospital North Norway, Tromsø, Norway
| | - Gøril Heide
- Immunology Research Group, Department of Medical Biology, UiT The Artic University of Norway, Tromsø, Norway
| | - Jens Kjeldsen-Kragh
- Department of Clinical Immunology and Transfusion Medicine, University and Regional Laboratories, Skåne, Lund, Sweden
| | - Bjørn Skogen
- Laboratory Medicine, University Hospital North Norway, Tromsø, Norway
- Immunology Research Group, Department of Medical Biology, UiT The Artic University of Norway, Tromsø, Norway
| | - Anne Husebekk
- Immunology Research Group, Department of Medical Biology, UiT The Artic University of Norway, Tromsø, Norway
| |
Collapse
|
3
|
Kinder JM, Jiang TT, Ertelt JM, Xin L, Strong BS, Shaaban AF, Way SS. Tolerance to noninherited maternal antigens, reproductive microchimerism and regulatory T cell memory: 60 years after 'Evidence for actively acquired tolerance to Rh antigens'. CHIMERISM 2015; 6:8-20. [PMID: 26517600 PMCID: PMC5063085 DOI: 10.1080/19381956.2015.1107253] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Compulsory exposure to genetically foreign maternal tissue imprints in offspring sustained tolerance to noninherited maternal antigens (NIMA). Immunological tolerance to NIMA was first described by Dr. Ray D. Owen for women genetically negative for erythrocyte rhesus (Rh) antigen with reduced sensitization from developmental Rh exposure by their mothers. Extending this analysis to HLA haplotypes has uncovered the exciting potential for therapeutically exploiting NIMA-specific tolerance naturally engrained in mammalian reproduction for improved clinical outcomes after allogeneic transplantation. Herein, we summarize emerging scientific concepts stemming from tolerance to NIMA that includes postnatal maintenance of microchimeric maternal origin cells in offspring, expanded accumulation of immune suppressive regulatory T cells with NIMA-specificity, along with teleological benefits and immunological consequences of NIMA-specific tolerance conserved across mammalian species.
Collapse
Affiliation(s)
- Jeremy M Kinder
- a Division of Infectious Diseases and Perinatal Institute, Cincinnati Children's Hospital, Cincinnati , OH , USA
| | - Tony T Jiang
- a Division of Infectious Diseases and Perinatal Institute, Cincinnati Children's Hospital, Cincinnati , OH , USA
| | - James M Ertelt
- a Division of Infectious Diseases and Perinatal Institute, Cincinnati Children's Hospital, Cincinnati , OH , USA
| | - Lijun Xin
- a Division of Infectious Diseases and Perinatal Institute, Cincinnati Children's Hospital, Cincinnati , OH , USA
| | - Beverly S Strong
- b Center for Fetal Cellular and Molecular Therapy, Cincinnati Children's Hospital , Cincinnati , OH , USA
| | - Aimen F Shaaban
- b Center for Fetal Cellular and Molecular Therapy, Cincinnati Children's Hospital , Cincinnati , OH , USA
| | - Sing Sing Way
- a Division of Infectious Diseases and Perinatal Institute, Cincinnati Children's Hospital, Cincinnati , OH , USA
| |
Collapse
|
4
|
Kinder JM, Jiang TT, Ertelt JM, Xin L, Strong BS, Shaaban AF, Way SS. Cross-Generational Reproductive Fitness Enforced by Microchimeric Maternal Cells. Cell 2015. [PMID: 26213383 DOI: 10.1016/j.cell.2015.07.006] [Citation(s) in RCA: 95] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Exposure to maternal tissue during in utero development imprints tolerance to immunologically foreign non-inherited maternal antigens (NIMA) that persists into adulthood. The biological advantage of this tolerance, conserved across mammalian species, remains unclear. Here, we show maternal cells that establish microchimerism in female offspring during development promote systemic accumulation of immune suppressive regulatory T cells (Tregs) with NIMA specificity. NIMA-specific Tregs expand during pregnancies sired by males expressing alloantigens with overlapping NIMA specificity, thereby averting fetal wastage triggered by prenatal infection and non-infectious disruptions of fetal tolerance. Therefore, exposure to NIMA selectively enhances reproductive success in second-generation females carrying embryos with overlapping paternally inherited antigens. These findings demonstrate that genetic fitness, canonically thought to be restricted to Mendelian inheritance, is enhanced in female placental mammals through vertically transferred maternal cells that promote conservation of NIMA and enforce cross-generational reproductive benefits.
Collapse
Affiliation(s)
- Jeremy M Kinder
- Division of Infectious Diseases and Perinatal Institute, Cincinnati Children's Hospital. 3333 Burnet Avenue, Cincinnati, OH 45229, USA
| | - Tony T Jiang
- Division of Infectious Diseases and Perinatal Institute, Cincinnati Children's Hospital. 3333 Burnet Avenue, Cincinnati, OH 45229, USA
| | - James M Ertelt
- Division of Infectious Diseases and Perinatal Institute, Cincinnati Children's Hospital. 3333 Burnet Avenue, Cincinnati, OH 45229, USA
| | - Lijun Xin
- Division of Infectious Diseases and Perinatal Institute, Cincinnati Children's Hospital. 3333 Burnet Avenue, Cincinnati, OH 45229, USA
| | - Beverly S Strong
- Center for Fetal Cellular and Molecular Therapy, Cincinnati Children's Hospital. 3333 Burnet Avenue, Cincinnati, OH 45229, USA
| | - Aimen F Shaaban
- Center for Fetal Cellular and Molecular Therapy, Cincinnati Children's Hospital. 3333 Burnet Avenue, Cincinnati, OH 45229, USA
| | - Sing Sing Way
- Division of Infectious Diseases and Perinatal Institute, Cincinnati Children's Hospital. 3333 Burnet Avenue, Cincinnati, OH 45229, USA.
| |
Collapse
|
5
|
Brunker PAR. Chimerism in transfusion medicine: the grandmother effect revisited. CHIMERISM 2013; 4:119-25. [PMID: 24196285 PMCID: PMC3921192 DOI: 10.4161/chim.26912] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2013] [Revised: 10/09/2013] [Accepted: 10/22/2013] [Indexed: 01/11/2023]
Abstract
Transfusion therapy is complicated by the production of alloantibodies to antigens present in the donor and lacking in the recipient through the poorly-understood but likely multi-factorial process of alloimmunization. The low prevalence of alloimmunization in transfused patients (6.1%) (1) suggests that processes central to immunologic tolerance may be operating in the vast majority of transfused patients who do not produce alloantibodies. Using RhD as a prototype, evidence is reviewed that the ability to make antibodies to red blood cell (RBC) antigens may result in part from immunologic tolerance acquired in utero. These ideas are extended to other examples of maternal microchimerism (MMc) of other non-inherited maternal antigens (NIMA). An evolutionary argument is offered that multi-generational immunity supports the hypothesis that MMc may partly explain the "non-responder" phenotype in RBC alloimmunization.
Collapse
|
6
|
Hattevig G, Jonsson M, Kjellman B, Khellman H, Messeter L, Tibblin E. Screening of Rh-antibodies in Rh-negative female infants with Rh-positive mothers. ACTA PAEDIATRICA SCANDINAVICA 1981; 70:541-5. [PMID: 6797234 DOI: 10.1111/j.1651-2227.1981.tb05737.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
The sera of 96 consecutive Rh-negative female infants born to Rh-positive mothers were examined at birth, and sera from 88 of these infants were examined for the presence of Rh-antibodies at the ages of about three and eight months. A two-stage papain test and an AutoAnalyzer method were used for antibody screening and identification. Weak anti-D antibodies were found by the papain and AutoAnalyzer techniques in two cord sera, In neither case could the antibodies be demonstrated in samples taken on later occasions. Weak anti-D antibodies were found by the AutoAnalyzer technique but not by the manual methods in the sera of two other infants at the age of eight months. These antibodies could still be demonstrated by the same technique in samples taken about one month later. Though far from conclusively, the results support the "grandmother theory", but because of the low incidence of sensitization and uncertain nature of the anti-D antibodies demonstrable only by the AutoAnalyzer technique, anti-D prophylaxis is not recommended for newborn Rh-negative female infants with Rh-positive mothers.
Collapse
|
7
|
Murray S, Dewar PJ, Lee E, McNay RA, Collins AK. A study of HL-A types in Rh haemolytic disease of the newborn. Vox Sang 1976; 30:91-104. [PMID: 814714 DOI: 10.1111/j.1423-0410.1976.tb02799.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The HL-A types of 288 women, immunised to the Rh(D) antigen as a result of pregnancy, have been compared to the HL-A types of 139 women who although they have had Rh(D)-positive children have not produced anti-Rh(D). There is an indication that an increased incidence of the HL-A3 antigen is associated with the immunised mothers. A study of the HL-A types of husbands and children of both immunised and non-immunised women did not suggest that their HL-A types played a significant role in anti-Rh(D) production. The frequencies of the HL-A antigens in each category studied have been tabulated for record purposes, as well as the frequencies in a random panel of persons living in the Newcastle environs. Full ABO, Rh and HL-A details of 50 immunised mothers and their families and of 58 non-immunised mothers and their families are available.
Collapse
|
8
|
|
9
|
|
10
|
Affiliation(s)
- B. R. Cooke
- From the New South Wales Red Cross Blood Transfusion Service Sydney
- Department of Human GeneticsUniversity of New South Wales
| | - Margaret A. Bradley
- From the New South Wales Red Cross Blood Transfusion Service Sydney
- Department of Human GeneticsUniversity of New South Wales
| | - R. J. Walsh
- From the New South Wales Red Cross Blood Transfusion Service Sydney
- Department of Human GeneticsUniversity of New South Wales
| |
Collapse
|
11
|
|
12
|
|
13
|
|
14
|
|
15
|
|
16
|
|