Facilitating virtual social connections for youth with disabilities: lessons for post-COVID-19 programming

PURPOSE

Social connections are essential for the development of life skills for youth. Youth with disabilities have long faced barriers to meaningful social connections. The onset of COVID-19 increased barriers to social connections for all youth, and also led to enhanced use of virtual platforms in paediatric rehabilitation programming. Harnessing this opportunity, service providers created a suite of online programs to foster social connections and friendships. The current study explores participant and service provider experiences of such programs.

METHODS

This qualitative descriptive study used interviews and focus groups to explore how youth with disabilities (n = 8), their parents (n = 7), and service providers (n = 13) involved in program development and delivery experienced the programs, the accessibility of the virtual platforms, and their social connections in relation to program participation.

RESULTS

Participants were satisfied with the programs' content, accessibility and ability to meet their social needs. Qualitative themes included facilitating social connections, accessibility of virtual spaces, and recommendations for future virtual programming.

DISCUSSION

For youth with disabilities who have been historically marginalized in social spheres, the newly ubiquitous infrastructure regarding virtual programming must be supported and enhanced. A hybrid approach involving virtual/in-person options in future programming is recommended.

"What their expectations could be": a narrative study of mothers and service providers in paediatric rehabilitation

PURPOSE

To better understand and visualise how and why mothers' and service providers' expectations for therapy can change over time spanning their journeys and careers in the paediatric rehabilitation system.

METHODS

Narrative analysis was used to construct two parallel collective stories that illustrate and explain phases and turning points of developing expectations. Five mothers and nine service providers participated in interviews discussing their expectations when new and more experienced with therapy.

RESULTS

Each collective story had five chapters illustrating how expectations became more relational, controllable, and informed. For mothers, the chapters were: (1) expecting therapy to be a saviour; (2) being turned away and alone; (3) expecting to advocate from necessity; (4) finding new solutions in the environment; and (5) expecting to combine mother and service provider expertise. For service providers, the chapters were: (1) expecting to rescue and fix; (2) searching for an alternative sense of professional worth; (3) expecting to lose control; (4) being the authentic self before expected self; and (5) expecting the unexpected.

CONCLUSIONS

Mothers' experiences with feeling alone and learning ways to modify their child's environments, and service providers' experiences with feeling inadequate and embracing authenticity, were essential to the developmental trajectories of expectations.Implications for Rehabilitation:Mapping expectations for therapy on a line graph shaped as a wave shows promise in reflecting the developmental trajectory of mothers' and service providers' expectations over time.Service providers should become aware of how to work with three distinct groups of mothers as determined by the phase of expectations for therapy they are currently experiencing (i.e., hyped, disillusioned, or enlightened).Therapy programmes can optimise expectations for therapy through redesigns that emphasise elements of networking, self-compassion, ethics, and authenticity.

Negotiating expectations for therapy between mothers and service providers: a narrative analysis

PURPOSE

To use stories about mothers and service providers negotiating expectations for therapy to illuminate processes contributing to power differences within partnerships.

METHODS

This narrative study presented stories from three mothers and three service providers. Stories were co-constructed between participants and researchers and analyzed using narrative analysis. Building on An and Palisano's (2014) Model of Family-Professional Collaboration, stories were organized into the stages of goal setting, planning, and doing therapy.

RESULTS

Each story illuminated a process unique to that story that can redistribute power between mothers, service providers, and therapy environments while negotiating expectations: protecting sacred issues, facilitating knowledge exposure, filling voids/vacuums, recognizing cultural conditioning, re-discovering eclipsed roles, and connecting relay teams. We propose including three additional strategies to An and Palisano's model to increase the readiness of mothers and service providers to negotiate expectations for therapy and collaborate fully as the model intends: 1) exploring power-sharing conversations; 2) looking for social context clues; and 3) adopting a humility stance.

CONCLUSION

Information on the six illuminated processes can help structure a client story grounded in optimal negotiation of expectations and equal partnerships.Implications for RehabilitationKnowledge of diverse stories about mothers and service providers negotiating expectations for therapy can be a resource to guide actions in related situations.Leaving the topic of expectations for therapy implicit or unchallenged increases the risks that negotiations remain unbalanced and unproductive.Service providers may enhance collaboration with mothers in paediatric rehabilitation by exploring power-sharing conversations, looking for social context clues, and adopting a humility stance.

Programs Promoting Virtual Social Connections and Friendships for Youth with Disabilities: A Scoping Review

AIMS

This scoping review explores what is known about programs that support youth with physical and developmental disabilities to create virtual social connections as a means toward friendships.

METHODS

Peer-reviewed studies were searched in six electronic databases: CINAHL, EMBASE, ERIC, MEDLINE, PsycINFO, and Scopus. Two reviewers screened articles that described programs in which participants, ages 8-20, interacted with others online, and reported outcomes related to virtual social connections and friendships in their personal social networks. Data extraction involved program characteristics (e.g., duration, group members, online platform) plus qualitative description outlining access and participation experiences.

RESULTS

After screening 12,605 articles, 9 were determined eligible. Programs followed two approaches: (1) training youth to use the internet and technology to access virtual spaces independently; and (2) designing virtual opportunities and activities that encourage youth interaction and collaboration. Each approach was grounded in the principles of fostering privacy and independence (i.e., socializing with peers without relying on caregivers), safety and self-expression (i.e., communicating authentically), plus confidence and capability (i.e., trying new skills).

CONCLUSIONS

This scoping review provides guidance on enhancing access and participation of youth with disabilities in virtual spaces where they can develop social connections that increase chances for friendships.

Expectations for therapy in pediatric rehabilitation: reframing meaning through metaphor

PURPOSE

To propose a holistic approach and an accompanying tool to facilitate conversations about expectations of therapy in pediatric rehabilitation based on meanings generated through metaphor.

METHODS

In this study, five parents and nine service providers took part in narrative interviews. Topics included the content and development of expectations over time. Participants reviewed written summaries of their interviews and provided feedback. Data analysis was grounded in a narrative methodological approach. Multiple levels of meaning from participant experiences were constructed through a parallel thematic analysis and metaphor analysis, revealing meaning participants attributed to expectations directly, and inferred indirectly.

RESULTS

The thematic analysis produced three themes related to the difficult to define characteristics and mixed value of expectations. The metaphor analysis produced four metaphorical concepts related to how expectations affect the therapy process by adding a sense of Force (i.e., therapy momentum), Appreciation (i.e., understanding of the client), Illumination (i.e., envisioning new therapy activities), and Relationship (i.e., therapeutic rapport).

CONCLUSIONS

We propose the "F.A.I.R." approach and tool comprising terminology that can help reframe the meaning of expectations away from focusing on binary realistic or unrealistic outcomes, and toward focusing on a plurality of optimal therapy processes.Implications for RehabilitationMeaningful conversations about expectations for therapy between parents and service providers in pediatric rehabilitation can be challenging, one-sided, or missed.Attention to metaphors used to describe expectations for therapy introduces additional terminology parents and service providers may use to help facilitate conversations.Service providers are encouraged to use a resource proposed here to learn about parents' expectations for therapy through a collaborative process involving shared questioning, observation, and reflection.

Social participation interventions targeting relational outcomes for young people with physical and developmental disabilities: an umbrella review and narrative synthesis

Purpose: To synthesize knowledge about social participation interventions targeting relational outcomes for young people with physical and developmental disabilities.Method: An umbrella review with a narrative synthesis was conducted to integrate findings of review articles examining social participation interventions targeting relational outcomes (e.g., peer interaction and friendships). Six databases were searched to identify reviews published between 2010 and 2021.Results: Five reviews were identified, examining participation interventions, social/community integration interventions, recreational sport programs, online peer mentorship programs, and augmentative and alternative communication interventions to promote social interaction with peers. Interventions associated with improvements in relational outcomes included group-based programs, programs involving personalized goals, arts-based programs, and multi-component social communication interventions. Recommendations for future research included better description of interventions to identify active ingredients and key mechanisms, measurement of participants' experiences, and the need for interventions to be aligned with the nature of the outcomes examined. Preliminary intervention principles are proposed to guide the design of social participation interventions: individualizing, contextualizing, and immersion in social settings.Conclusions: There are multiple pathways by which to influence the relational outcomes of young people with disabilities. There are implications for the design of social participation interventions based on an ecological/experiential and relational perspective.IMPLICATIONS FOR REHABILITATIONImprovements in relational outcomes are associated with participation in group-based programs, programs involving personalized goals, arts-based programs, and multi-component social communication interventions.Three evidence-informed principles can help guide the design of social participation interventions: (1) personalizing, (2) contextualizing, and (3) immersion in social settings.Greater attention to aligning the nature of intervention with desired outcomes is needed to more effectively measure and promote relational outcomes.

The Nature, Value, and Experience of Engagement in Pediatric Rehabilitation: Perspectives of Youth, Caregivers, and Service Providers

Purpose: To conduct a qualitative investigation of engagement in pediatric rehabilitation therapy.Methods: Interviews were conducted with 10 youth, 10 caregivers, and 10 service providers. Transcripts were analyzed thematically using an inductive approach.Results: Themes illustrated three perspectives: engagement as a connection with components of the therapy process, engagement as working together, and engagement as an affective and motivational process. Engagement created valued connections with therapy components and forward momentum for therapy.Conclusions: The themes supported a view of engagement as complex, transactional, and multidimensional. Participants focused on different, yet not discrepant, aspects of engagement. Youth focused on having fun and personal connection with service providers. Caregivers provided a more complex perspective encompassing both their own and their child's engagement, with an emphasis on relationship, understanding what is taking place, and feeling valued in the process. Service providers highlighted goal attainment and the value of engagement in bringing about outcomes.

'I Didn't Know What to Expect': Describing Parents' Expectations in Children's Rehabilitation Services

Aims: The aim of this paper is to provide a holistic description of the nature, formation and impact of parents' therapy related expectations.Methods: This qualitative descriptive study drew from initial and follow up interviews with 20 parents of children ≤ 6 years who had a developmental disability or delay and used therapy services at a children's treatment center in Ontario, Canada. Conventional content analysis was used to inductively generate themes and investigator triangulation was completed.Results: Parent's child related expectations focused on whether the child would receive a diagnosis and what they might achieve. Parents held expectations about the availability of service and how it would be offered. Parents' expectations of service providers included their knowledge, skills, relationships and communication with the children and parents. Parents held expectations of themselves related to attendance and roles in therapy sessions and home practice. These expectations are described according to how they are shaped and changed them over time. The impact of matched/mismatched expectations is explored.Conclusion: Service providers can improve family-centred care and collaboration with parents by explicitly discussing parents' expectations when beginning, and throughout, therapy. Parent satisfaction and therapy engagement may improve if parents and service providers negotiate and agree upon expectations.

The complexities and synergies of engagement: an ethnographic study of engagement in outpatient pediatric rehabilitation sessions

PURPOSE

To investigate client (youth/caregiver) and service provider engagement in outpatient pediatric rehabilitation therapy sessions.

METHODS

In an ethnographic study, five research assistants attended 28 outpatient sessions, mostly delivered by occupational, physical, and speech-language therapists, and rated signs of client, provider, and relational engagement using the Pediatric Rehabilitation Intervention Measure of Engagement - Observation version. Post-session interviews were conducted individually with 13 youth, 15 caregivers, and 26 providers.

RESULTS

Overall, there was a moderate to great extent of engagement. Provider engagement was rated as higher than client engagement, particularly in sessions with activities focusing on body structure/function. The interviews indicated associations among engagement-related constructs: (a) expectations influenced engagement/disengagement and therapy progress, (b) engagement was associated with positive affect and relationships, and (c) engagement was strongly associated with relationships and collaboration.

CONCLUSIONS

Engagement is a central process within a complex system of psychosocial constructs operating in therapy. Engagement is emergent, synergistic, and change-inducing - it emanates from, involves, and influences multiple aspects of therapy. Notably, engagement ties two pivotal elements - positive expectations and positive affect - to positive relationships, collaboration, and therapy progress. Implications for practice include an understanding of how providers manage the therapeutic context and work to foster engagement.Implications for rehabilitationEngagement, and its various elements, plays a central role in shaping how clients, parents, and clinicians value therapeutic encounters.Optimal therapy is often thought to include engagement, relationships, and collaboration; the importance of therapy expectations, positive affect, and perceptions of progress are frequently overlooked.Engagement and motivation may be maximized when youth and caregivers are asked explicitly about how they view their engagement in therapy.In addition to clarifying and aligning expectations with youth and caregivers, service providers can enhance engagement and motivation by intentionally creating enjoyable and meaningful interactions, developing relationships, negotiating consensus on goals and plans, and demonstrating therapy progress.Service providers can harness engagement and the system of related constructs by listening and communicating effectively, by entering the world of the client and family, and by being aware of, anticipating, and responding to engagement and disengagement.

Generating Expectations: What Pediatric Rehabilitation Can Learn From Mental Health Literature

Family-Centered Care (FCC) represents the ideal service delivery approach in pediatric rehabilitation. Nonetheless, implementing FCC as intended in clinical settings continues to be hindered by knowledge gaps. One overlooked gap is our understanding of clients' therapy expectations. This perspective article synthesizes knowledge from the mental health services literature on strategies recommended to service providers for generating transparent and congruent therapy expectations with clients, and applies this knowledge to the pediatric rehabilitation literature, where this topic has been researched significantly less, for the purpose of improving FCC implementation. Dimensions of the Measure of Processes of Care, an assessment tool that measures clients' perceptions of the extent a service is family-centered, inform the organization of therapy expectation-generating strategies: (1) Providing Respectful and Supportive Care (assessing and validating clients' expectations); (2) General and Specific Information (foreshadowing therapy journeys, explaining treatment rationale, and conveying service provider qualifications); (3) Coordinated and Comprehensive Care (socializing clients to roles and reflecting on past socialization); and (4) Enabling and Partnership (applying a negotiation framework and fostering spaces safe to critique). Strategies can help pediatric rehabilitation service providers work with families to reframe unrealistic expectations, establish congruent beliefs supporting effective partnerships, and prevent possible disillusionment with therapy over time.

Performance and visual arts-based programs for children with disabilities: a scoping review focusing on psychosocial outcomes

Purpose: There is a growing movement in pediatric rehabilitation to understand how approaches addressing aspects beyond body function contribute to enhanced psychosocial well-being. Among such approaches is the use of creative arts. A scoping review was undertaken to synthesize the current literature on performance and visual arts-based programs and outcomes for children with disabilities.Methods: Data sources included CINAHL, MEDLINE, and PsycINFO. Eligible articles described programs involving performing or visual art activities in community and ambulatory care settings, delivered to children between 6 and 18 years with physical or developmental disabilities, and reported on at least one psychosocial outcome. Domains of interest included emotional, social, behavioral, physical, cognitive, and/or communicative functioning, which are known to impact well-being and participation. No limits were applied to study design.Results: Twelve articles using primarily case study and quasi-experimental designs were identified, encompassing an 11-year period. Most programs focused on theater as the central modality. A majority of papers addressed changes in physical, cognitive, and communicative function (n = 8), followed by social function (n = 6), emotional function (n = 5), and finally, behavioral function (n = 3). Across individual papers, diverse study designs, measures, and outcomes were examined with positive qualitative and/or quantitative findings noted across all domains.Conclusions: Within an emerging evidence base, arts-based programs show potential to positively impact psychosocial well-being and warrant further investigation with broader populations of children with physical and developmental disabilities. A greater emphasis on programmatic approaches and enhanced methodological rigor to establishing benefits is needed to advance understanding.Implications for rehabilitationPediatric therapists may wish to consider recommending arts-based programs for children with ASD, TBI, and other developmental disabilities given their potential in achieving psychosocial outcomesArts-based programs in rehabilitation provide creative ideas (e.g., drawing, painting) and techniques (e.g., modeling, role-play), which may be incorporated into individualized or group-based therapy to promote psychosocial well-beingProgram evaluators and researchers are encouraged to adopt a programmatic approach to further explore how art activities facilitate psychosocial outcomes.

Polychlorinated biphenyl-induced VCAM-1 expression is attenuated in aortic endothelial cells isolated from caveolin-1 deficient mice

Exposure to environmental contaminants, such as polychlorinated biphenyls (PCBs), is a risk factor for the development of cardiovascular diseases such as atherosclerosis. Vascular cell adhesion molecule-1 (VCAM-1) is a critical mediator for adhesion and uptake of monocytes across the endothelium in the early stages of atherosclerosis development. The upregulation of VCAM-1 by PCBs may be dependent on functional membrane domains called caveolae. Caveolae are particularly abundant in endothelial cell membranes and involved in trafficking and signal transduction. The objective of this study was to investigate the role of caveolae in PCB-induced endothelial cell dysfunction. Primary mouse aortic endothelial cells (MAECs) isolated from caveolin-1-deficient mice and background C57BL/6 mice were treated with coplanar PCBs, such as PCB77 and PCB126. In addition, siRNA gene silencing technique was used to knockdown caveolin-1 in porcine vascular endothelial cells. In MAECs with functional caveolae, VCAM-1 protein levels were increased after exposure to both coplanar PCBs, whereas expression levels of VCAM-1 were not significantly altered in cells deficient of caveolin-1. Furthermore, PCB-induced monocyte adhesion was attenuated in caveolin-1-deficient MAECs. Similarly, siRNA silencing of caveolin-1 in porcine endothelial cells confirmed the caveolin-1-dependent VCAM-1 expression. Treatment of cells with PCB77 and PCB126 resulted in phosphorylation of extracellular signal-regulated kinase-1/2 (ERK1/2), and pharmacological inhibition of ERK1/2 diminished the observed PCB-induced increase in monocyte adhesion. These findings suggest that coplanar PCBs induce adhesion molecule expression, such as VCAM-1, in endothelial cells, and that this response is regulated by caveolin-1 and functional caveolae. Our data demonstrate a critical role of functional caveolae in the activation and dysfunction of endothelial cells by coplanar PCBs.

Up-regulation of endothelial monocyte chemoattractant protein-1 by coplanar PCB77 is caveolin-1-dependent

Atherosclerosis, the primary cause of heart disease and stroke is initiated in the vascular endothelium, and risk factors for its development include environmental exposure to persistent organic pollutants. Caveolae are membrane microdomains involved in regulation of many signaling pathways, and in particular in endothelial cells. We tested the hypothesis that intact caveolae are required for coplanar PCB77-induced up-regulation of monocyte chemoattractant protein-1 (MCP-1), an endothelium-derived chemokine that attracts monocytes into sub-endothelial space in early stages of the atherosclerosis development. Atherosclerosis-prone LDL-R(-/-) mice (control) or caveolin-1(-/-)/LDL-R(-/-) mice were treated with PCB77. PCB77 induced aortic mRNA expression and plasma protein levels of MCP-1 in control, but not caveolin-1(-/-)/LDL-R(-/-) mice. To study the mechanism of this effect, primary endothelial cells were used. PCB77 increased MCP-1 levels in endothelial cells in a time- and concentration-dependent manner. This effect was abolished by caveolin-1 silencing using siRNA. Also, MCP-1 up-regulation by PCB77 was prevented by inhibiting p38 and c-Jun N-terminal kinase (JNK), but not ERK1/2, suggesting regulatory functions via p38 and JNK MAPK pathways. Finally, pre-treatment of endothelial cells with the aryl hydrocarbon receptor (AhR) inhibitor alpha-naphthoflavone (alpha-NF) partially blocked MCP-1 up-regulation. Thus, our data demonstrate that coplanar PCB77 can induce MCP-1 expression by endothelial cells and that this effect is mediated by AhR, as well as p 38 and JNK MAPK pathways. Intact caveolae are required for these processes both in vivo and in vitro. This further supports a key role for caveolae in vascular inflammation induced by persistent organic pollutants.

Coplanar polychlorinated biphenyl-induced CYP1A1 is regulated through caveolae signaling in vascular endothelial cells

Polychlorinated biphenyls (PCBs) are persistent environmental contaminants that can induce inflammatory processes in the vascular endothelium. We hypothesize that the plasma membrane microdomains called caveolae are critical in endothelial activation and toxicity induced by PCBs. Caveolae are particularly abundant in endothelial cells and play a major role in endothelial trafficking and the regulation of signaling pathways associated with the pathology of vascular diseases. We focused on the role of caveolae and their major protein component, caveolin-1 (Cav-1), on aryl hydrocarbon receptor (AhR)-mediated induction of cytochrome P450 1A1 (CYP1A1) by coplanar PCBs. Endothelial cell exposure to PCB77 increased both caveolin-1 and CYP1A1 levels in a time-dependent manner in total cell lysates, with a maximum increase at 6h. Furthermore, PCB77 accumulated mainly in the caveolae-rich fraction, as determined by gas chromatograph-mass spectrometry. Immunoprecipitation analysis revealed that PCB77 increased AhR binding to caveolin-1. Silencing of caveolin-1 significantly attenuated PCB77-mediated induction of CYP1A1 and oxidative stress. Similar effects were observed in caveolin-1 null mice treated with PCB77. These data suggest that caveolae may play a role in regulating vascular toxicity induced by persistent environmental pollutants such as coplanar PCBs. This may have implications in understanding mechanisms of inflammatory diseases induced by environmental pollutants.

COX-2 Up-regulation and vascular smooth muscle contractile hyperreactivity in spontaneous diabetic / mice

OBJECTIVE

Abnormalities in vascular constriction and dilatation are associated with early diabetes and contribute to diabetic vascular complications. However, mechanisms underlying such vascular dysfunction remain to be fully elucidated. The current study tests the role of cyclooxygenase-2 (COX-2) in diabetic vascular smooth muscle dysfunction.

METHODS

Small mesenteric artery and aorta are isolated from type 2 diabetic db/db and control mice. Isometric contractions in response to serotonin, angiotensin II, phenylephrine and high potassium are determined in small spiral mesenteric arterial or aortic strips. COX-2 mRNA and protein levels are analyzed by using DNA microarray, real-time PCR and immunoblot.

RESULTS

Contractions induced by serotonin, angiotensin II, phenylephrine and high potassium are significantly higher in endothelium-denuded smooth muscle strips isolated from db/db mice than in those isolated from control mice. The contractile hyperreactivity is observed in aortic and third-order branch small mesenteric arterial smooth muscle strips. DNA microarray, real-time PCR and immunoblot analysis show that compared with control mice, COX-2 mRNA and protein are significantly increased in db/db mice aortic smooth muscle. The COX-2 up-regulation is temporally associated with the development of diabetes mellitus and vascular smooth muscle contractile hyperreactivity. Inhibition of COX-2 with NS-398 or SC-58125 partially--but significantly--alleviates agonist-induced but not potassium-induced contractile hyperreactivity. In addition, serum isolated from db/db mice induces COX-2 expression and increases thromboxane A2 production in primary cultured vascular smooth muscle cells (VSMC). SQ-29548, a TP receptor antagonist, diminished the db/db mice vascular smooth muscle contractile hyperreactivity.

CONCLUSIONS

COX-2 is up-regulated and contributes at least in part to the vascular smooth muscle contractile hyperreactivity in db/db mice.

Zinc deficiency increases plasma lipids and atherosclerotic markers in LDL-receptor-deficient mice

Low zinc concentration can be associated with an increased risk of cardiovascular diseases. In the current study, we hypothesize that zinc deficiency can increase and zinc supplementation can decrease proatherosclerotic events in LDL receptor knock-out (LDL-R-/-) mice fed a moderate-fat diet. Mice were fed either a zinc-deficient (0 micromol Zn/g), a control (0.45 micromol Zn/g), or a zinc-supplemented (1.529 micromol Zn/g) diet for 4 wk. Mice fed the zinc-deficient diet had significantly increased concentrations of cholesterol and triacylglycerides in the VLDL and HDL fractions. Zinc supplementation decreased these lipid variables compared with control mice. We detected significantly higher concentrations of glutathione reductase mRNA in the thoracic aortae of zinc-deficient mice. Furthermore, inflammatory markers, such as nuclear factor-kappaB and vascular cell adhesion molecule-1, were significantly increased in zinc-deficient mice compared with mice of the control or supplemented groups. In addition, zinc deficiency significantly reduced the DNA binding activity of peroxisome proliferator activate receptors (PPARs) in liver extracts. Interestingly, mRNA expression levels of PPARgamma were significantly increased in thoracic aortae of zinc-deficient mice, indicating an adaptation process to decreased PPAR signaling. These data provide in vivo evidence of zinc deficiency inducing proinflammatory events in an atherogenic mouse model. These data also suggest that adequate zinc may be a critical component in protective PPAR signaling during atherosclerosis.

The Abantu phenotype in the ABO blood group system is due to a splice-site mutation in a hybrid between a new O1-like allelic lineage and the A2 allele

BACKGROUND AND OBJECTIVES

Many phenotypic variations in the expression of blood group A have been explained by variations in gene structure, but unresolved samples are frequently encountered in the reference laboratory. Among ABO subgroups, A(bantu) has the highest frequency in a specified population. The molecular basis of this phenotype is now described.

MATERIALS AND METHODS

Blood from Black donors phenotyped as A(bantu) was subjected to genomic ABO screening and direct sequencing of polymerase chain reaction (PCR)-amplified ABO exons 1-7 and introns 2-6. Total RNA was extracted and ABO cDNA was synthesized by reverse transcription (RT)-PCR. Control material comprised Black South African, Swedish, Jordanian and Brazilian blood samples with common phenotypes.

RESULTS

Genomic ABO typing indicated the presence of an A(2) allele in each A(bantu) donor, in combination with an O allele. No previously reported mutations associated with weak A or B expression were found. Direct sequencing indicated the common A(2) sequence with a single nucleotide deletion (AGGT>AGT) at the exon 4/intron 4 junction, predicted either to disrupt the reading frame (resulting in a premature stop codon) or to cause erroneous splicing (resulting in the exclusion of exon 4 from the mRNA). O mRNA, but no transcripts from the A(bantu) allele, could be detected. Surprisingly, the splice-site mutation was also found in approximately 5% of O alleles in Black South Africans, but not in other blood donors, or in non-O(1) alleles. Utilizing intron polymorphisms, the A(bantu) allele was shown to be a recombination between a new allelic lineage (O(1bantu)) and A(2), with a cross-over region near exon 5.

CONCLUSION

The A(bantu) phenotype is caused by an O(1bantu)-A(2) hybrid at the ABO locus.

Dietary fat interacts with PCBs to induce changes in lipid metabolism in mice deficient in low-density lipoprotein receptor

There is evidence that dietary fat can modify the cytotoxicity of polychlorinated biphenyls (PCBs) and that coplanar PCBs can induce inflammatory processes critical in the pathology of vascular diseases. To test the hypothesis that the interaction of PCBs with dietary fat is dependent on the type of fat, low-density lipoprotein receptor-deficient (LDL-R(-/-)) mice were fed diets enriched with either olive oil or corn oil for 4 weeks. Half of the animals from each group were injected with PCB-77. Vascular cell adhesion molecule-1 (VCAM-1) expression in aortic arches was nondetectable in the olive-oil-fed mice but was highly expressed in the presence of PCB-77. PCB treatment increased liver neutral lipids and decreased serum fatty acid levels only in mice fed the corn-oil-enriched diet. PCB treatment increased mRNA expression of genes involved in inflammation, apoptosis, and oxidative stress in all mice. Upon PCB treatment, mice in both olive- and corn-oil-diet groups showed induction of genes involved in fatty acid degradation but with up-regulation of different key enzymes. Genes involved in fatty acid synthesis were reduced only upon PCB treatment in corn-oil-fed mice, whereas lipid transport/export genes were altered in olive-oil-fed mice. These data suggest that dietary fat can modify changes in lipid metabolism induced by PCBs in serum and tissues. These findings have implications for understanding the interactions of nutrients with environmental contaminants on the pathology of inflammatory diseases such as atherosclerosis.

An Alu-mediated large deletion of the FUT2 gene in individuals with the ABO-Bombay phenotype

Recently, we have found an allelic deletion of the secretor alpha(1,2)fucosyltransferase (FUT2) gene in individuals with the classical Bombay phenotype of the ABO system. The FUT2 gene consists of two exons separated by an intron that spans approximately 7 kb. The first exon is noncoding, whereas exon 2 contains the complete coding sequence. Since the 5' breakpoint of the deletion has previously been mapped to the single intron of FUT2, we have cloned the junction region of the deletion in a Bombay individual by cassette-mediated polymerase chain reaction. In addition, the region from the 3' untranslated region of FUT2 to the 3' breakpoint sequence has been amplified from a control individual. DNA sequence analysis of this region indicates that the 5' breakpoint is within a free left Alu monomer (FLAM-C) sequence that lies 1.3 kb downstream of exon 1, and that the 3' breakpoint is within a complete Alu element (AluSx) that is positioned 1.5 kb downstream of exon 2. The size of the deletion is estimated to be about 10 kb. There is a 25-bp sequence identity between the reference DNA sequences surrounding the 5' and 3' breakpoints. This demonstrates that an Alu-mediated large gene deletion generated by unequal crossover is responsible for secretor alpha(1,2)fucosyltransferase deficiency in Indian Bombay individuals.

The presence of an RHD pseudogene containing a 37 base pair duplication and a nonsense mutation in africans with the Rh D-negative blood group phenotype

Antigens of the Rh blood group system are encoded by 2 homologous genes, RHD and RHCE, that produce 2 red cell membrane proteins. The D-negative phenotype is considered to result, almost invariably, from homozygosity for a complete deletion of RHD. The basis of all PCR tests for predicting fetal D phenotype from DNA obtained from amniocytes or maternal plasma is detection of the presence of RHD. These tests are used in order to ascertain the risk of hemolytic disease of the newborn. We have identified an RHD pseudogene (RHD psi) in Rh D-negative Africans. RHDpsi contains a 37 base pair (bp) insert in exon 4, which may introduce a stop codon at position 210. The insert is a sequence duplication across the boundary of intron 3 and exon 4. RHDpsi contains another stop codon in exon 6. The frequency of RHDpsi in black South Africans is approximately 0.0714. Of 82 D-negative black Africans, 66% had RHDpsi, 15% had the RHD-CE-D hybrid gene associated with the VS+ V- phenotype, and only 18% completely lacked RHD. RHDpsi is present in about 24% of D-negative African Americans and 17% of D-negative South Africans of mixed race. No RHD transcript could be detected in D-negative individuals with RHDpsi, probably as a result of nonsense-mediated mRNA decay. Existing PCR-based methods for predicting D phenotype from DNA are not suitable for testing Africans or any population containing a substantial proportion of people with African ethnicity. Consequently, we have developed a new test that detects the 37 bp insert in exon 4 of RHDpsi. (Blood. 2000; 95:12-18)

Production and characterization of anti-kell monoclonal antibodies using transfected cells as the immunogen

Monoclonal antibodies (Mabs) to blood group antigens are valuable as diagnostic reagents for typing red blood cells (RBCs) in the clinical setting, and for structure-function studies of proteins. Here, we report a powerful system that enabled us to produce Mabs to blood group antigens. A murine erythroleukaemia (MEL) cell line expressing Kell protein, a transmembrane glycoprotein that carries a number of clinically relevant antigens, was used as a novel immunogen. Mabs with different specificities to the Kell protein were produced from a single mouse fusion: an anti-Jsb (MIMA-8), and two antibodies (MIMA-9 and MIMA-10) with novel specificities, that reacted with RBCs with the common Kell phenotype but not with RBCs with K+k- or Kp(a+b-) or K0 phenotypes. The non-reactivity with both K+k- or Kp(a+b-) RBCs implied that the epitope was influenced by the molecular changes associated with an absence of the k or Kpb antigens. MIMA-8 is the first example of a Mab anti-Jsb and was used in the clinical laboratory for screening donor RBCs for Js(b-) blood and for typing RBCs from patients even when the RBCs were coated with anti-IgG as is the case in autoimmune haemolytic anaemia. Heavy and light chain variable regions of MIMA-8 were cloned and the sequence is given. This study illustrates the potential of this novel immunization approach for making monoclonal antibodies to blood group antigens.

The VS and V blood group polymorphisms in Africans: a serologic and molecular analysis

BACKGROUND

VS and V are common red cell antigens in persons of African origin. The molecular background of these Rh system antigens is poorly understood.

STUDY DESIGN AND METHODS

Red cells from 100 black South Africans and 43 black persons from Amsterdam, the Netherlands, were typed serologically for various Rh system antigens. Allele-specific polymerase chain reaction and sequencing of polymerase chain reaction products were used to analyze C733G (Leu245Val) and G1006T (Gly336Cys) polymorphisms in exons 5 and 7 of RHCE and the presence of a D-CE hybrid exon 3.

RESULTS

The respective frequencies of all VS+ and of VS+ V-(r's) phenotypes were 43 percent and 9 percent in the South Africans and 49 percent and 12 percent in the Dutch donors. All VS+ donors had G733 (Val245), but six with G733 were VS- (4 V+w, 2 V-). The four VS- V+w donors with G733 appeared to have a CE-D hybrid exon 5. T1006 (Cys336) was present in 12 percent and 16 percent of donors from the two populations. With only a few exceptions, T1006, a D-CE hybrid exon 3, and a C410T (Ala137Val) substitution were associated with a VS+ V-phenotype ((C)ces or r's haplotype). Two VS+ V-individuals, with the probable genotype, (C)ces/(C)ces), were homozygous for G733 and for T1006.

CONCLUSIONS

It is likely that anti-VS and anti-V recognize the conformational changes created by Val245, but that anti-V is sensitive to additional conformational changes created by Cys336.

Missense mutation of FUT1 and deletion of FUT2 are responsible for Indian Bombay phenotype of ABO blood group system

The Bombay phenotype fails to express the ABH antigens of ABO blood group system on red blood cells and in secretions because of a lack in activities of the H gene (FUT1)- and Secretor gene (FUT2)-encoded alpha (1,2)fucosyltransferases. In this study, we have examined the FUT1 and the FUT2 from three unrelated Indian individuals with the Bombay phenotype. These three individuals were found to be homozygous for a T725G mutation in the coding region of the FUT1, which inactivated the enzyme activity. In addition, we did not detect any hybridized band corresponding to the FUT2 by Southern blot analysis using the catalytic domain of the FUT2 as a probe, indicating that the three individuals were homozygous for a gene deletion in the FUT2. These results suggest that the T725G mutation of FUT1 and the gene deletion of FUT2 are responsible for the classical Indian Bombay phenotype.

Alternative splicing of a novel glycophorin allele GPHe(GL) generates two protein isoforms in the human erythrocyte membrane

The Henshaw antigen (synonym: He or MNS6) is carried by an altered form of glycophorin B (GPB), but the molecular basis for its variable expression or quantitative polymorphism remains largely undefined. We report here the identification and analysis of a novel glycophorin He allele, GPHe(GL), which gives rise to the expression of two protein isoforms in the erythrocyte membrane. In addition to the nucleotide changes defining the epitopic sequence of He, a single C-to-G nucleotide transversion in exon V coding for the membrane domain was found to cause aberrant RNA splicings by creating a new acceptor splice site. In addition, a T-to-G transversion at -6 position of the acceptor splice site for exon IV was identified. Both full-length and truncated transcripts of GPHe(GL) were detected as the result of partial activation of the new acceptor splice site and partial inactivation of the normal splice sites. The full-length cDNA encoded He, S, and U antigens, whereas the three truncated ones lacked either the sequence for S and U antigens or a large portion of the membrane domain or both. The GPB gene on the other chromosome was apparently normal and its transcript encoded N, s, and U antigens. These results correlate alternative RNA splicing with the expression of two GPHe isoforms and thus delineate a new mechanism for the phenotypic diversity of membrane glycophorins.

Blood group antigens Rb(a), Tr(a), and Wd(a) are located in the third ectoplasmic loop of erythroid band 3

BACKGROUND

Rb(a), Tr(a), and Wd(a) are three low-incidence blood group antigens that have not been assigned to a particular structure of the red cell membrane. Recent genetic and serologic data suggested erythroid band 3 as a possible carrier of these three antigens.

STUDY DESIGN AND METHODS

Ten band 3 gene exons that encode the membrane domain of band 3 were screened for single strand conformation polymorphism (SSCP). Exons displaying SSCP were cloned and sequenced, and the presence of the mutations was verified by restriction digestion.

RESULTS

Substitutions 548 Pro-->Leu, 551 Lys-->Asn, and 557 Val-->Met, all located in the third ectoplasmic loop of band 3, were detected in the subjects with Rb(a+), Tr(a+), and Wd(a+) red cells, respectively. The presence of the Rb(a) and Wd(a) mutations was confirmed in additional carriers of these blood group antigens. Chymotryptic cleavage at Tyr 553 and Tyr 555 abolished the agglutinability of Tr(a+) and Wd(a+) cells with the corresponding antisera, further demonstrating that the epitopes are located in the third ectoplasmic loop of band 3. Similar quantities of mRNA corresponding of the two band 3 alleles, a normal pattern of red cell membrane proteins, and normal DIDS (4,4'-diisothiocyanatostilbene-2,2'-disulphonic acid, disodium salt)-inhibitable sulfate flux were detected, which suggests that the mutations do not affect band 3 mRNA stability or band 3 protein expression and transport function.

CONCLUSION

Wd(a) and Rb(a), and tentatively Tr(a), can be assigned to the Diego blood group system.

Expression of the erythrocyte antigen Henshaw (He; MNS6): serological and immunochemical studies

Production of murine monoclonal antibodies to the low prevalence MNS antigen Henshaw (He; MNS6) has enabled more detailed study of this antigen. Using these directly hemagglutinating anti-He, red blood cells (RBCs) from 1695 people of African origin were screened in the USA and England. The prevalence of He+ samples among these donors was 2.1%. In Natal, blood samples from 1218 black donors were screened with rabbit anti-He. The prevalence of He+ donors in this population was 7.0%. Immunoblotting confirmed that the He antigen is carried on an erythrocyte membrane component with a molecular mass that is indistinguishable from glycophorin B. Hemagglutination and immunoblotting demonstrated that ten of 56 He+ samples tested more extensively had a reduced expression of the He antigen. The majority of He+ RBCs were S+; those He+ RBC samples that were S-s+ more frequently had a weakened expression of He.

ERIK, a low-frequency red cell antigen of the MNS blood group system associated with Sta

A new low-frequency red cell antigen, ERIK (MNS37), is associated with the Sta antigen of the MNS system. Four ERIK+ propositi have been identified: all are St(a+). Thirteen other St(a+) samples, including one of the Mz type, and over 200 St(a-) samples were ERIK-. In two of the propositi ERIK is associated with an abnormal trypsin-resistant M antigen; in the others it is associated with N, which is shown to be expressed weakly in one family. Immunoblotting with an antibody to an epitope common to glycophorin A (GPA) and glycophorin B (GPB) gave identical results with St(a+) ERIK+ and St(a+) ERIK- cells, revealing GPA, GPB, an abnormal structure GPSta and aggregates of these components. In the propositi with trypsin-resistant M, GPSta carries the unusual M antigen, whereas in the M-N+ERIK+ individual analysed by immunoblotting GPSta carries N. Immunoblotting with anti-Sta and anti-ERIK showed that Sta is located on GPSta but that ERIK is located on GPA, presumably the GPA molecule encoded by the GYPA gene contiguous to the gene encoding GPSta.

STEM, a new low-frequency Rh antigen associated with the e-variant phenotypes hrS-(Rh: -18, -19) and hrB-(Rh: -31, -34)

The new low-frequency antigen STEM was identified when a Cape coloured woman with an unknown antibody in her plasma (which agglutinated the red cells of her husband and a minority of other individuals) gave birth to a baby suffering mildly from haemolytic disease of the new-born. Most, but not all, examples of anti-STEM distinguish different strengths of STEM antigen on the red cells of different people; the different strengths are inherited. Family studies established that STEM was inherited as a Mendelian dominant character. STEM subdivides hrS-(Rh: -18, -19) and hrB- (Rh: -31, -34) red cells into two types: STEM+ and STEM-. The manually calculated lod score for STEM being associated with the Rh system is 3.91 and LIPED calculated lod score 4.35. The International Society of Blood Transfusion has allocated STEM the Rh number 49.

Serology and genetics of the red blood cell factor Rh34

Rh34 antibodies were found to have a unique, previously only partly characterised, specificity within the Rh system. No evidence was seen that they were mixtures of hrB and Hr-like antibodies, or that hrB antibodies existed independently in the natural state. The term anti-hrB applied to Rh34 antibodies after they had been partially absorbed with R2R2 red cells. Four haplotypes not expressing Rh34 antigen were identified in the present study. The prefix * has been used to indicate them in this text. They were *r's (*dCces), *Ro (*Dce), *Rou (*D(uce)) and *R(od) (category III *Dce). Red cells with partially deleted or Rh(null) phenotypes were therefore not the sole red cells compatible with anti-Rh34. R2R2 red cells, which are known to carry weak Rh34 antigen, were incompatible. Twenty-two family and mother-child studies established that the Rh:-34 haplotypes were inherited as normal Mendelian dominant characters. Anti-Rh34 was capable of recognising RH 34 dosage and of excluding some men who had been wrongly accused in disputed paternity tests.