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Jajosky R, Patel SR, Wu SC, Patel K, Covington M, Vallecillo-Zúniga M, Ayona D, Bennett A, Luckey CJ, Hudson KE, Hendrickson JE, Eisenbarth SC, Josephson CD, Zerra PE, Stowell SR, Arthur CM. Prior immunization against an intracellular antigen enhances subsequent red blood cell alloimmunization in mice. Blood 2023; 141:2642-2653. [PMID: 36638335 PMCID: PMC10356576 DOI: 10.1182/blood.2022016588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 12/27/2022] [Accepted: 12/28/2022] [Indexed: 01/15/2023] Open
Abstract
Antibodies against red blood cell (RBC) alloantigens can increase morbidity and mortality among transfusion recipients. However, alloimmunization rates can vary dramatically, as some patients never generate alloantibodies after transfusion, whereas others not only become alloimmunized but may also be prone to generating additional alloantibodies after subsequent transfusion. Previous studies suggested that CD4 T-cell responses that drive alloantibody formation recognize the same alloantigen engaged by B cells. However, because RBCs express numerous antigens, both internally and externally, it is possible that CD4 T-cell responses directed against intracellular antigens may facilitate subsequent alloimmunization against a surface RBC antigen. Here, we show that B cells can acquire intracellular antigens from RBCs. Using a mouse model of donor RBCs expressing 2 distinct alloantigens, we demonstrate that immune priming to an intracellular antigen, which would not be detected by any currently used RBC compatibility assays, can directly influence alloantibody formation after exposure to a subsequent distinct surface RBC alloantigen. These findings suggest a previously underappreciated mechanism whereby transfusion recipient responders may exhibit an increased rate of alloimmunization because of prior immune priming toward intracellular antigens.
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Affiliation(s)
- Ryan Jajosky
- Joint Program in Transfusion Medicine, Brigham and Women’s Hospital, National Center for Functional Glycomics, Harvard School of Medicine, Boston, MA
| | - Seema R. Patel
- Aflac Cancer and Blood Disorders Center, Children’s Healthcare of Atlanta/Emory University School of Medicine, Atlanta, GA
| | - Shang-Chuen Wu
- Joint Program in Transfusion Medicine, Brigham and Women’s Hospital, National Center for Functional Glycomics, Harvard School of Medicine, Boston, MA
| | - Kashyap Patel
- Joint Program in Transfusion Medicine, Brigham and Women’s Hospital, National Center for Functional Glycomics, Harvard School of Medicine, Boston, MA
| | - Mischa Covington
- Joint Program in Transfusion Medicine, Brigham and Women’s Hospital, National Center for Functional Glycomics, Harvard School of Medicine, Boston, MA
| | - Mary Vallecillo-Zúniga
- Joint Program in Transfusion Medicine, Brigham and Women’s Hospital, National Center for Functional Glycomics, Harvard School of Medicine, Boston, MA
| | - Diyoly Ayona
- Joint Program in Transfusion Medicine, Brigham and Women’s Hospital, National Center for Functional Glycomics, Harvard School of Medicine, Boston, MA
| | - Ashley Bennett
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA
| | - C. John Luckey
- Department of Pathology, University of Virginia, Charlottesville, VA
| | - Krystalyn E. Hudson
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York City, NY
| | | | - Stephanie C. Eisenbarth
- Center for Human Immunology, Department of Medicine, Northwestern University School of Medicine, Chicago, IL
| | - Cassandra D. Josephson
- Cancer and Blood Disorders Institute and Blood Bank/Transfusion Medicine Division, Johns Hopkins All Children’s Hospital, St. Petersburg, FL
- Departments of Oncology and Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Patricia E. Zerra
- Center for Transfusion Medicine and Cellular Therapies, Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA
| | - Sean R. Stowell
- Joint Program in Transfusion Medicine, Brigham and Women’s Hospital, National Center for Functional Glycomics, Harvard School of Medicine, Boston, MA
- Center for Transfusion Medicine and Cellular Therapies, Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA
| | - Connie M. Arthur
- Joint Program in Transfusion Medicine, Brigham and Women’s Hospital, National Center for Functional Glycomics, Harvard School of Medicine, Boston, MA
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Wolanskyj-Spinner AP, Go RS. Autoimmune Hemolytic Anemia: An Old Disease with New Twists. Hematol Oncol Clin North Am 2022; 36:ix-x. [PMID: 35339261 DOI: 10.1016/j.hoc.2022.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Alexandra P Wolanskyj-Spinner
- Mayo Clinic Alix School of Medicine, Department of Internal Medicine, Hematology Division, Core Consultative Hematology Group, Mayo Clinic College of Medicine and Science, Mayo Clinic 200 1st Street SW, Rochester, MN 55905, USA.
| | - Ronald S Go
- Department of Internal Medicine, Hematology Division, Chair Core Consultative Hematology Group, Mayo Clinic College of Medicine and Science, 200 1st Street SW, Rochester, MN 55905, USA.
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3
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Watson C, Hassan M, Breeland G. Multifactorial jaundice and pigmented choledocholithiasis secondary to warm autoimmune hemolytic anemia and alcoholic cirrhosis. Proc AMIA Symp 2021; 35:229-231. [DOI: 10.1080/08998280.2021.1995107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Affiliation(s)
- Colten Watson
- Texas A&M Medical School Dallas Campus, Dallas, Texas
| | - Mazen Hassan
- Department of Internal Medicine, Baylor University Medical Center, Dallas, Texas
| | - Grant Breeland
- Department of Internal Medicine, Baylor University Medical Center, Dallas, Texas
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Das SS, Chakrabarty R, Zaman RU. Immunohematological and clinical characterizations of mixed autoimmune hemolytic anemia. Asian J Transfus Sci 2019; 12:99-104. [PMID: 30692792 PMCID: PMC6327768 DOI: 10.4103/ajts.ajts_105_17] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND AND AIM: Patients with warm autoimmune hemolytic anemia (AIHA) may carry immunoglobulin (Ig) M antibodies that react at room temperature and are nonpathological, but few may have cold agglutinins that react at or above 30°C and are referred to as “mixed” AIHA (MAIHA). Here, we present our experience on characterizing MAIHA both clinically and serologically. MATERIALS AND METHODS: Out of 134 AIHA patients, 13 diagnosed as MAIHA were subjected to detailed immunohematological characterization. Most patients were severely anemic and required urgent transfusions. Resolution of blood group discrepancy, elution, Donath-Landsteiner test, and adsorption study were performed following established protocol. “Best match” blood units were selected and transfused to patients. RESULTS: Eight of the 13 patients had severe hemolysis. The median age of patient was 37 years with a female preponderance and secondary MAIHA was observed in 8 (61.5%) patients. Blood group discrepancy was encountered in 4 (30.8%) patients. Multiple red cell bound autoantibodies and high titer serum-free IgM autoantibodies were detected in all samples. Twenty-nine units of “best match” packed red blood cells were transfused to 12 patients without any adverse reaction. Improvement in hematological and biochemical values was observed in all follow-up patients. CONCLUSION: Patients with MAIHA often present with severe hemolysis necessitating blood transfusions. While red cells are coated with multiple autoantibodies, both warm reactive IgG and cold reactive IgM autoantibodies are present in the serum. These serological complexities not only render a crossmatch incompatibility but often lead to blood group discrepancy. “Best match” blood transfusion is always lifesaving.
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Affiliation(s)
- Sudipta Sekhar Das
- Department of Transfusion Medicine, Apollo Gleneagles Hospitals, Kolkata, West Bengal, India
| | - Ritam Chakrabarty
- Department of Transfusion Medicine, Apollo Gleneagles Hospitals, Kolkata, West Bengal, India
| | - R U Zaman
- Department of Transfusion Medicine, Apollo Gleneagles Hospitals, Kolkata, West Bengal, India
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Maral S, Bakanay S, Akıncı S, Yıkılmaz A, Comert P, Dilek I. The least incompatible crossmatch red blood cell transfusion by biological compatibility test. GLOBAL JOURNAL OF TRANSFUSION MEDICINE 2019. [DOI: 10.4103/gjtm.gjtm_37_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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6
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Martins R, Knapp S. Heme and hemolysis in innate immunity: adding insult to injury. Curr Opin Immunol 2018; 50:14-20. [DOI: 10.1016/j.coi.2017.10.005] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Accepted: 10/04/2017] [Indexed: 12/11/2022]
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Giudice V, Rosamilio R, Ferrara I, Seneca E, Serio B, Selleri C. Efficacy and safety of splenectomy in adult autoimmune hemolytic anemia. Open Med (Wars) 2016; 11:374-380. [PMID: 28352823 PMCID: PMC5329855 DOI: 10.1515/med-2016-0068] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Accepted: 08/19/2016] [Indexed: 02/07/2023] Open
Abstract
Autoimmune hemolytic anemia (AIHA) is a rare hematologic disease, primarily affecting adults or children with immunodeficiency disease. First-line therapy consists of long course of steroids administration, with an early complete response rate (CRr) of 75-80%, but up to 20-30% of patients requires a second-line therapy. Rituximab is the first choice in refractory old AIHA patients, because of its safety and efficacy (early CRr at 80-90% and at 68% at 2-3 years). For this reason, splenectomy is even less chosen as second-line therapy in elderly, even though laparoscopic technique decreased complication and mortality rates. However, splenectomy can be still considered a good therapeutic option with a CRr of 81% at 35.6 months in patients older than 60 year-old, when rituximab administration cannot be performed.
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Affiliation(s)
- Valentina Giudice
- Hematology and Transplant Center, Department of Medicine and Surgery, University of Salerno, Salerno, 84131, Italy
| | - Rosa Rosamilio
- Hematology and Transplant Center, Department of Medicine and Surgery, University of Salerno, Salerno, 84131, Italy
| | - Idalucia Ferrara
- Hematology and Transplant Center, Department of Medicine and Surgery, University of Salerno, Salerno, 84131, Italy
| | - Elisa Seneca
- Hematology and Transplant Center, Department of Medicine and Surgery, University of Salerno, Salerno, 84131, Italy
| | - Bianca Serio
- Hematology and Transplant Center, Department of Medicine and Surgery, University of Salerno, Salerno, 84131, Italy
| | - Carmine Selleri
- Hematology and Transplant Center, Department of Medicine and Surgery, University of Salerno, Salerno, 84131, Italy , Tel. +39 089673150, mobile: 3356166591
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Burberry A, Suzuki N, Wang JY, Moccia R, Mordes DA, Stewart MH, Suzuki-Uematsu S, Ghosh S, Singh A, Merkle FT, Koszka K, Li QZ, Zon L, Rossi DJ, Trowbridge JJ, Notarangelo LD, Eggan K. Loss-of-function mutations in the C9ORF72 mouse ortholog cause fatal autoimmune disease. Sci Transl Med 2016; 8:347ra93. [PMID: 27412785 PMCID: PMC5024536 DOI: 10.1126/scitranslmed.aaf6038] [Citation(s) in RCA: 197] [Impact Index Per Article: 24.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Accepted: 06/21/2016] [Indexed: 12/14/2022]
Abstract
C9ORF72 mutations are found in a significant fraction of patients suffering from amyotrophic lateral sclerosis and frontotemporal dementia, yet the function of the C9ORF72 gene product remains poorly understood. We show that mice harboring loss-of-function mutations in the ortholog of C9ORF72 develop splenomegaly, neutrophilia, thrombocytopenia, increased expression of inflammatory cytokines, and severe autoimmunity, ultimately leading to a high mortality rate. Transplantation of mutant mouse bone marrow into wild-type recipients was sufficient to recapitulate the phenotypes observed in the mutant animals, including autoimmunity and premature mortality. Reciprocally, transplantation of wild-type mouse bone marrow into mutant mice improved their phenotype. We conclude that C9ORF72 serves an important function within the hematopoietic system to restrict inflammation and the development of autoimmunity.
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Affiliation(s)
- Aaron Burberry
- Harvard Stem Cell Institute, Department of Stem Cell and Regenerative Biology, Harvard University, Cambridge, MA 02138, USA. Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA
| | - Naoki Suzuki
- Harvard Stem Cell Institute, Department of Stem Cell and Regenerative Biology, Harvard University, Cambridge, MA 02138, USA. Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA
| | - Jin-Yuan Wang
- Harvard Stem Cell Institute, Department of Stem Cell and Regenerative Biology, Harvard University, Cambridge, MA 02138, USA. Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA
| | - Rob Moccia
- Harvard Stem Cell Institute, Department of Stem Cell and Regenerative Biology, Harvard University, Cambridge, MA 02138, USA. Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA
| | - Daniel A Mordes
- Harvard Stem Cell Institute, Department of Stem Cell and Regenerative Biology, Harvard University, Cambridge, MA 02138, USA. Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA. Department of Pathology, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Morag H Stewart
- Harvard Stem Cell Institute, Department of Stem Cell and Regenerative Biology, Harvard University, Cambridge, MA 02138, USA. Program in Cellular and Molecular Medicine, Division of Hematology/Oncology, Boston Children's Hospital, Boston, MA 02115, USA
| | - Satomi Suzuki-Uematsu
- Harvard Stem Cell Institute, Department of Stem Cell and Regenerative Biology, Harvard University, Cambridge, MA 02138, USA. Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA
| | - Sulagna Ghosh
- Harvard Stem Cell Institute, Department of Stem Cell and Regenerative Biology, Harvard University, Cambridge, MA 02138, USA. Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA
| | - Ajay Singh
- Harvard Stem Cell Institute, Department of Stem Cell and Regenerative Biology, Harvard University, Cambridge, MA 02138, USA. Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA
| | - Florian T Merkle
- Harvard Stem Cell Institute, Department of Stem Cell and Regenerative Biology, Harvard University, Cambridge, MA 02138, USA. Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA
| | - Kathryn Koszka
- Harvard Stem Cell Institute, Department of Stem Cell and Regenerative Biology, Harvard University, Cambridge, MA 02138, USA. Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA
| | - Quan-Zhen Li
- Departments of Immunology and Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Leonard Zon
- Harvard Stem Cell Institute, Department of Stem Cell and Regenerative Biology, Harvard University, Cambridge, MA 02138, USA. Harvard Medical School, Boston, MA 02115, USA
| | - Derrick J Rossi
- Harvard Stem Cell Institute, Department of Stem Cell and Regenerative Biology, Harvard University, Cambridge, MA 02138, USA. Program in Cellular and Molecular Medicine, Division of Hematology/Oncology, Boston Children's Hospital, Boston, MA 02115, USA. Harvard Medical School, Boston, MA 02115, USA
| | | | - Luigi D Notarangelo
- Harvard Medical School, Boston, MA 02115, USA. Division of Immunology, Boston Children's Hospital, Boston, MA 02115, USA
| | - Kevin Eggan
- Harvard Stem Cell Institute, Department of Stem Cell and Regenerative Biology, Harvard University, Cambridge, MA 02138, USA. Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA.
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Patel PA, Ghadimi K, Coetzee E, Myburgh A, Swanevelder J, Gutsche JT, Augoustides JGT. Incidental Cold Agglutinins in Cardiac Surgery: Intraoperative Surprises and Team-Based Problem-Solving Strategies During Cardiopulmonary Bypass. J Cardiothorac Vasc Anesth 2016; 31:1109-1118. [PMID: 27624931 DOI: 10.1053/j.jvca.2016.06.024] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Indexed: 11/11/2022]
Affiliation(s)
- Prakash A Patel
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Kamrouz Ghadimi
- Divisions of Cardiothoracic Anesthesiology and Critical Care, Anesthesiology and Critical Care, Duke University Medical Center, Durham, NC
| | - Ettienne Coetzee
- Cardiothoracic Anesthesia, Department of Anesthesia and Perioperative Medicine, School of Medicine, University of Cape Town, Cape Town, South Africa
| | - Adriaan Myburgh
- Cardiothoracic Anesthesia, Department of Anesthesia and Perioperative Medicine, School of Medicine, University of Cape Town, Cape Town, South Africa
| | - Justiaan Swanevelder
- Cardiothoracic Anesthesia, Department of Anesthesia and Perioperative Medicine, School of Medicine, University of Cape Town, Cape Town, South Africa
| | - Jacob T Gutsche
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - John G T Augoustides
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
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Heuft HG, Pruß A. Autoimmune Hemolytic Anemia - Fascinating from a Laboratory as well as from a Clinical Point of View. Transfus Med Hemother 2015; 42:276-7. [PMID: 26696794 PMCID: PMC4678311 DOI: 10.1159/000441157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2015] [Accepted: 09/21/2015] [Indexed: 11/19/2022] Open
Affiliation(s)
- Hans-Gert Heuft
- Institute for Transfusion Medicine, Hannover Medical School, Hanover, Germany
- *PD Dr. Hans-Gert Heuft, Institut für Transfusionsmedizin, Medizinische Hochschule Hannover, Carl-Neuberg-Straße 1, 30625 Hannover, Germany,
| | - Axel Pruß
- Institute for Transfusion Medicine, Charite, Berlin, Germany
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