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Car H, Karahan GE, Dreyer GJ, Brand-Schaaf SH, de Vries APJ, van Kooten C, Kramer CSM, Roelen DL, Claas FHJ, Heidt S. Low incidence of IgA isotype of HLA antibodies in alloantigen exposed individuals. HLA 2020; 97:101-111. [PMID: 33227174 PMCID: PMC7898292 DOI: 10.1111/tan.14146] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 09/30/2020] [Accepted: 11/09/2020] [Indexed: 11/30/2022]
Abstract
Human leukocyte antigen (HLA) antibodies are induced by pregnancy, transfusion, or transplantation. Serum from transplant recipients is regularly screened for IgG HLA antibodies because of their clinical relevance for transplant outcome. While other isotypes of HLA antibodies, such as IgA may also contribute to the alloimmune response, validated detection assays for IgA HLA antibody detection are lacking. Therefore, we modified the commonly used luminex screening assay for IgG HLA antibody detection (IgG-LMX) into an IgA HLA antibody screening assay (IgA-LMX). Optimization and validation was performed with IgG, IgA1, and IgA2 isotype variants of HLA-specific human recombinant monoclonal antibodies (mAbs). Reactivity patterns of IgA1 and IgA2 isotype HLA-specific mAbs in IgA-LMX were identical to those of the IgG isotype. Cross-reactivity with IgG and IgM antibodies and nonspecific binding to the beads were excluded. Further assay validation showed the absence of IgA HLA antibodies in serum from individuals without alloantigen exposure (n = 18). When the IgA-LMX assay was applied to sera from 289 individuals with known alloantigen exposure through pregnancy (n = 91) or kidney transplantation (n = 198), IgA HLA antibodies were detected in 3.5% of individuals; eight patients on the kidney retransplant waitlist and two women immunized through pregnancy. The majority (90%) of IgA HLA antibodies were directed against HLA class II and were always present in conjunction with IgG HLA antibodies. Results of this study show that this validated IgA-LMX method can serve as a screening assay for IgA HLA antibodies and that the incidence of IgA HLA antibodies in alloantigen exposed individuals is low.
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Affiliation(s)
- Helena Car
- Department of Immunology, Leiden University Medical Center, Leiden, The Netherlands
| | - Gonca E Karahan
- Department of Immunology, Leiden University Medical Center, Leiden, The Netherlands.,Leiden Transplant Center, Leiden University Medical Center, Leiden, The Netherlands
| | - Geertje J Dreyer
- Leiden Transplant Center, Leiden University Medical Center, Leiden, The Netherlands.,Department of Nephrology, Leiden University Medical Center, Leiden, The Netherlands
| | - Simone H Brand-Schaaf
- Department of Immunology, Leiden University Medical Center, Leiden, The Netherlands.,Leiden Transplant Center, Leiden University Medical Center, Leiden, The Netherlands
| | - Aiko P J de Vries
- Leiden Transplant Center, Leiden University Medical Center, Leiden, The Netherlands.,Department of Nephrology, Leiden University Medical Center, Leiden, The Netherlands
| | - Cees van Kooten
- Leiden Transplant Center, Leiden University Medical Center, Leiden, The Netherlands.,Department of Nephrology, Leiden University Medical Center, Leiden, The Netherlands
| | - Cynthia S M Kramer
- Department of Immunology, Leiden University Medical Center, Leiden, The Netherlands
| | - Dave L Roelen
- Department of Immunology, Leiden University Medical Center, Leiden, The Netherlands.,Leiden Transplant Center, Leiden University Medical Center, Leiden, The Netherlands
| | - Frans H J Claas
- Department of Immunology, Leiden University Medical Center, Leiden, The Netherlands
| | - Sebastiaan Heidt
- Department of Immunology, Leiden University Medical Center, Leiden, The Netherlands.,Leiden Transplant Center, Leiden University Medical Center, Leiden, The Netherlands
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2
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Schiano C, Benincasa G, Infante T, Franzese M, Castaldo R, Fiorito C, Mansueto G, Grimaldi V, Della Valle G, Fatone G, Soricelli A, Nicoletti GF, Ruocco A, Mauro C, Salvatore M, Napoli C. Integrated analysis of DNA methylation profile of HLA-G gene and imaging in coronary heart disease: Pilot study. PLoS One 2020; 15:e0236951. [PMID: 32790754 PMCID: PMC7425923 DOI: 10.1371/journal.pone.0236951] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 07/16/2020] [Indexed: 02/06/2023] Open
Abstract
Aims Immune endothelial inflammation, underlying coronary heart disease (CHD) related phenotypes, could provide new insight into the pathobiology of the disease. We investigated DNA methylation level of the unique CpG island of HLA-G gene in CHD patients and evaluated the correlation with cardiac computed tomography angiography (CCTA) features. Methods Thirty-two patients that underwent CCTA for suspected CHD were enrolled for this study. Obstructive CHD group included fourteen patients, in which there was a stenosis greater than or equal to 50% in one or more of the major coronary arteries detected; whereas subjects with Calcium (Ca) Score = 0, uninjured coronaries and with no obstructive CHD (no critical stenosis, NCS) were considered as control subjects (n = 18). For both groups, DNA methylation profile of the whole 5’UTR-CpG island of HLA-G was measured. The plasma soluble HLA-G (sHLA-G) levels were detected in all subjects by specific ELISA assay. Statistical analysis was performed using R software. Results For the first time, our study reported that 1) a significant hypomethylation characterized three specific fragments (B, C and F) of the 5’UTR-CpG island (p = 0.05) of HLA-G gene in CHD patients compared to control group; 2) the hypomethylation level of one specific fragment of 161bp (+616/+777) positively correlated with coronary Ca score, a relevant parameter of CCTA (p<0.05) between two groups evaluated and was predictive for disease severity. Conclusions Reduced levels of circulating HLA-G molecules could derive from epigenetic marks. Epigenetics phenomena induce hypomethylation of specific regions into 5'UTR-CpG island of HLA-G gene in CHD patients with obstructive non critical stenosis vs coronary stenosis individuals.
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Affiliation(s)
- Concetta Schiano
- Department of Advanced Medical and Surgical Sciences (DAMSS), University of Campania “L. Vanvitelli”, Naples, Italy
- * E-mail:
| | - Giuditta Benincasa
- Department of Advanced Medical and Surgical Sciences (DAMSS), University of Campania “L. Vanvitelli”, Naples, Italy
| | - Teresa Infante
- Department of Advanced Medical and Surgical Sciences (DAMSS), University of Campania “L. Vanvitelli”, Naples, Italy
| | | | | | - Carmela Fiorito
- U.O.C. Division of Clinical Immunology, Immunohematology, Transfusion Medicine and Transplant Immunology [SIMT], University of Campania "L. Vanvitelli", Naples, Italy
| | - Gelsomina Mansueto
- Department of Advanced Medical and Surgical Sciences (DAMSS), University of Campania “L. Vanvitelli”, Naples, Italy
| | - Vincenzo Grimaldi
- Division of Clinical Immunology, Immunohematology, Transfusion Medicine and Transplant Immunology [SIMT], Clinical Department of Internal Medicine and Specialistic Units, Regional Reference Laboratory of Transplant Immunology [LIT], Azienda Universitaria Policlinico (AOU), Naples, Italy
| | - Giovanni Della Valle
- Department of Veterinary Medicine and Animal Production, University of Napoli Federico II, Napoli, Italy
| | - Gerardo Fatone
- Department of Veterinary Medicine and Animal Production, University of Napoli Federico II, Napoli, Italy
| | - Andrea Soricelli
- IRCCSSDN, Naples, Italy
- Department of Exercise and Wellness Sciences, University of Naples Parthenope, Naples, Italy
| | - Giovanni Francesco Nicoletti
- Multidisciplinary Department of Medical, Surgical and Dental Sciences, Plastic Surgery Unit, University of Campania “L. Vanvitelli”, Naples, Italy
| | - Antonio Ruocco
- Cardiovascular Diseases Department, “Cardarelli Hospital”, Naples, Italy
| | - Ciro Mauro
- Cardiovascular Diseases Department, “Cardarelli Hospital”, Naples, Italy
| | | | - Claudio Napoli
- Department of Advanced Medical and Surgical Sciences (DAMSS), University of Campania “L. Vanvitelli”, Naples, Italy
- IRCCSSDN, Naples, Italy
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Saraf A, De Staercke C, Everitt I, Haouzi A, Ko YA, Jennings S, Kim JH, Rodriguez FH, Kalogeropoulos AP, Quyyumi A, Book W. Biomarker profile in stable Fontan patients. Int J Cardiol 2020; 305:56-62. [PMID: 31959411 DOI: 10.1016/j.ijcard.2020.01.012] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Revised: 11/21/2019] [Accepted: 01/08/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND As the population of adults with congenital heart disease (CHD) grows, cardiologists continue to encounter patients with complex anatomies that challenge the standard treatment of care. Single ventricle Fontan palliated patients are the most complex within CHD, with a high morbidity and mortality burden. Factors driving this early demise are largely unknown. METHODS AND RESULTS We analyzed biomarker expression in 44 stable Fontan outpatients (29.2 ± 10.7 years, 68.2% female) seen in the outpatient Emory Adult Congenital Heart Center and compared them to 32 age, gender and race matched controls. In comparison to controls, Fontan patients had elevated levels of multiple cytokines within the inflammatory pathway including Tumor Necrosis Factor-α (TNF-α) (p < 0.001), Interleukin-6 (IL-6) (p < 0.011), Growth Derived Factor-15 (GDF-15) (p < 0.0001), β2-macroglobulin, (p = 0.0006), stem cell mobilization: Stromal Derived Factor-1∝ (SDF-1α) (p = 0.006), extracellular matrix turnover: Collagen IV (p < 0.0001), neurohormonal activation: Renin (p < 0.0001), renal dysfunction: Cystatin C (p < 0.0001) and Urokinase Receptor (uPAR) (p = 0.022), cardiac injury: Troponin-I (p < 0.0004) and metabolism: Adiponectin (p = 0.0037). Within 1 year of enrollment 50% of Fontan patients had hospitalizations, arrhythmias or worsening hepatic function. GDF-15 was significantly increased in Fontan patients with clinical events (p < 0.0001). In addition, GDF-15 moderately correlated with longer duration of Fontan (r = 0.55, p = 0.01) and was elevated in atriopulmonary (AP) Fontan circulation. Finally, in a multivariate model, VEGF-D and Collagen IV levels were found to be associated with a change in MELDXI, a marker of liver dysfunction. CONCLUSION Multiple clinical and molecular biomarkers are upregulated in Fontan patients, suggesting a state of chronic systemic dysregulation.
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Affiliation(s)
- Anita Saraf
- Division of Cardiology, Department of Medicine, Emory University Department of Medicine, Atlanta, GA 30322, United States of America.
| | - Christine De Staercke
- Hemostasis Laboratory Branch, Division of Blood Disorders, Centers for Disease Control and Prevention, Atlanta, GA 30329, United States of America
| | - Ian Everitt
- Division of Cardiology, Department of Medicine, Emory University Department of Medicine, Atlanta, GA 30322, United States of America
| | - Alice Haouzi
- Division of Cardiology, Department of Medicine, Emory University Department of Medicine, Atlanta, GA 30322, United States of America
| | - Yi-An Ko
- Department of Biostatistics and Bioinformatics, Emory University, Atlanta, GA 30322, United States of America
| | - Staci Jennings
- Division of Cardiology, Department of Medicine, Emory University Department of Medicine, Atlanta, GA 30322, United States of America
| | - Jonathan H Kim
- Division of Cardiology, Department of Medicine, Emory University Department of Medicine, Atlanta, GA 30322, United States of America
| | - Fred H Rodriguez
- Division of Cardiology, Department of Medicine, Emory University Department of Medicine, Atlanta, GA 30322, United States of America; Sibley Heart Center Cardiology, Atlanta, GA 30341, United States of America
| | | | - Arshed Quyyumi
- Division of Cardiology, Department of Medicine, Emory University Department of Medicine, Atlanta, GA 30322, United States of America
| | - Wendy Book
- Division of Cardiology, Department of Medicine, Emory University Department of Medicine, Atlanta, GA 30322, United States of America
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Weinstock C, Schnaidt M. Human Leucocyte Antigen Sensitisation and Its Impact on Transfusion Practice. Transfus Med Hemother 2019; 46:356-369. [PMID: 31832061 DOI: 10.1159/000502158] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Accepted: 07/13/2019] [Indexed: 01/25/2023] Open
Abstract
Human leucocyte antigen (HLA) sensitisation, including the formation of antibodies against HLA, can cause serious effects in patients receiving blood. Under certain circumstances, donor HLA antibodies in the blood product can trigger the patient's granulocytes to release mediators that cause transfusion-associated lung injury (TRALI), a serious complication of transfusion. The HLA systems of both donor and patient are involved in transfusion-associated graft-versus-host disease, which is a rare disease with a high mortality. Patient HLA antibodies can destroy incompatible platelets and may cause refractoriness to platelet transfusion. Identification of a patient's HLA antibody specificities is necessary for issuing compatible platelets to overcome refractoriness. Many techniques for the detection and identification of HLA antibodies have been developed, including complement-dependent cytotoxicity assay, bead-based assays, the platelet adhesion immunofluorescence test, and the monoclonal antibody-specific immobilisation of platelet antigens assay. Different strategies for the selection of HLA-compatible platelets are applied. These strategies depend on the breadth of antibody reactivity and range from avoiding single HLA antigens in the platelet concentrates issued to apheresis of platelets from HLA-identical donors. The mechanisms of HLA sensitisation and the efforts made to provide compatible blood products to sensitised patients are reviewed in this article from the perspective of clinical transfusion medicine.
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Affiliation(s)
- Christof Weinstock
- Institute for Clinical Transfusion Medicine and Immunogenetics Ulm, German Red Cross Blood Service Baden-Württemberg-Hessen, Institute Ulm, Institute of Transfusion Medicine, Ulm University, Ulm, Germany
| | - Martina Schnaidt
- Centre for Clinical Transfusion Medicine, Medical Faculty of Tübingen, University of Tübingen, Tübingen, Germany
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Roux A, Thomas KA, Sage E, Suberbielle-Boissel C, Beaumont-Azuar L, Parquin F, Le Guen M, Harre N, Hamid AM, Reed EF. Donor-specific HLA antibody-mediated complement activation is a significant indicator of antibody-mediated rejection and poor long-term graft outcome during lung transplantation: a single center cohort study. Transpl Int 2018; 31:761-772. [PMID: 29537702 PMCID: PMC5995657 DOI: 10.1111/tri.13149] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Revised: 11/12/2017] [Accepted: 03/02/2018] [Indexed: 12/20/2022]
Abstract
Complement-mediated allograft injury, elicited by donor-specific HLA antibodies (DSA), is a defining pathophysiological characteristic of allograft damage. We aimed to study DSA-induced complement activation as a diagnostic marker of antibody-mediated rejection (AMR) and a risk stratification tool for graft loss in the context of lung transplantation (LT). We identified 38 DSA-positive patients whose serum samples were submitted for C3d deposition testing via the C3d assay. Among these 38 patients, 15 had AMR (DSAPos AMRPos ). Results were reported for each patient as the C3d ratio for each DSA, the immunodominant DSA, and the C3d ratio for all DSA present in a sample (C3d ratioSUM ). DSAPos AMRPos patients had higher C3d ratioSUM values (58.66 (-1.32 to 118.6) vs. 1.52 (0.30 to 2.74), P = 0.0016) and increased immunodominant C3d ratios (41.87 (1.72 to 82.02) vs. 0.69 (0.21 to 1.19), P = 0.001) when compared with DSAPos AMRNeg patients. Specificity and calculated positive predictive value of the immunodominant C3d ratio and BCMsum tests for AMR diagnosis were both 100% (CI = 17.4-100) in this cohort. Worst graft survival was associated with both immunodominant C3d ratio ≥4 or C3d ratioSUM ≥10 or BCMsum >7000, suggesting that the antibody composition and/or strength are the principal determinants of an HLA DSA's capacity to activate complement.
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Affiliation(s)
- Antoine Roux
- Pneumology, Adult CF Center and Lung Transplantation department, Foch Hospital, Suresnes France
- Université Versailles Saint-Quentin-en-Yvelines, Montigny le Bretonneux
| | - Kimberly A. Thomas
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles CA, USA
| | - Edouard Sage
- Thoracic Surgery Department, Foch Hospital, Suresnes France
| | - Caroline Suberbielle-Boissel
- Laboratoire Régional d’Histocompatibilité, Saint-Louis Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Laurence Beaumont-Azuar
- Pneumology, Adult CF Center and Lung Transplantation department, Foch Hospital, Suresnes France
| | | | - Morgan Le Guen
- Université Versailles Saint-Quentin-en-Yvelines, Montigny le Bretonneux
- Anesthesiology Department, Foch Hospital, Suresnes France
| | - Nicholas Harre
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles CA, USA
| | - Abdul Monem Hamid
- Pneumology, Adult CF Center and Lung Transplantation department, Foch Hospital, Suresnes France
| | - Elaine F. Reed
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles CA, USA
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