Investigation of HLA susceptibility alleles and genotypes with hematological disease among Chinese Han population

Several genes involved in the pathogenesis have been identified, with the human leukocyte antigen (HLA) system playing an essential role. However, the relationship between HLA and a cluster of hematological diseases has received little attention in China. Blood samples (n = 123913) from 43568 patients and 80345 individuals without known pathology were genotyped for HLA class I and II using sequencing-based typing. We discovered that HLA-A*11:01, B*40:01, C*01:02, DQB1*03:01, and DRB1*09:01 were prevalent in China. Furthermore, three high-frequency alleles (DQB1*03:01, DQB1*06:02, and DRB1*15:01) were found to be hazardous in malignant hematologic diseases when compared to controls. In addition, for benign hematologic disorders, 7 high-frequency risk alleles (A*01:01, B*46:01, C*01:02, DQB1*03:03, DQB1*05:02, DRB1*09:01, and DRB1*14:54) and 8 high-frequency susceptible genotypes (A*11:01-A*11:01, B*46:01-B*58:01, B*46:01-B*46:01, C*01:02-C*03:04, DQB1*03:01-DQB1*05:02, DQB1*03:03-DQB1*06:01, DRB1*09:01-DRB1*15:01, and DRB1*14:54-DRB1*15:01) were observed. To summarize, our findings indicate the association between HLA alleles/genotypes and a variety of hematological disorders, which is critical for disease surveillance.

The novel HLA-DPB1*02:02:07 allele identified by Sanger dideoxy nucleotide sequencing in a Chinese individual

HLA-DPB1*02:02:07 differs from HLA-DPB1*02:02:01:01 by one nucleotide in exon 2.

[Detection of BCR-ABL Fusion Gene in Chronic Myeloid Leukemia by Novel Digital PCR]

OBJECTIVE

To establish a new digital polymerase chain reaction (dPCR) system for the detection of BCR-ABL fusion gene in patients with chronic myeloid leukemia (CML), and explore its analytical performance and clinical applicability in the detection of BCR-ABLp190/210/230.

METHODS

A new dPCR system for detecting BCR-ABLp190/210/230 was successfully developed, and its sensitivity difference with qPCR and improvement of drug side effects in patients with CML during drug reduction or withdrawal were compared.

RESULTS

Among 176 samples, qPCR and dPCR showed high consistency in the sensitivity of detecting BCR-ABL (82.39%), and the positive rate of dPCR was about 5 times higher that of qPCR (20.45% vs 3.98%). During follow-up, blood routine (25% vs 10%), kidney/liver/stomach (25% vs 20%) and cardiac function (10% vs 0) were significantly improved after drug reduction or withdrawal in patients with initial dPCR negative compared with before drug reduction or withdrawal.

CONCLUSIONS

This new dPCR detection system can be applied to the detection of BCR-ABLp190/210/230. It has better consistency and higher positive detection rate than qPCR. Drug withdrawal or dose reduction guided by dPCR has a certain effect on improving drug side effects.

Intensified conditioning regimen with fludarabine combined with post-transplantation cyclophosphamide for haploidentical allogeneic hematopoietic stem cell transplantation in children with high-risk acute leukemia

OBJECTIVE

Post-transplantation cyclophosphamide (PTCy) can reduce the incidence of graft versus host disease (GVHD) and this intervention is often applied on adults with hematologic malignancy. However, the high relapse rate hinders the development of the intervention and data of PTCy used on children with hematologic malignancy remains limited. In order to overcome issue of high relapse rate in PTCy treatment, we used fludarabine (Flu), enhanced dose of cytarabine (Ara-C, 9 g/m²), busulfan (Bu), Cy, anti-thymocyte globulin (ATG) combined with PTCy for an intensified conditioning regimen.

METHODS

A total of 22 children with acute leukemia received intensified PTCy conditioning regimen (PTCy intensified group). We matched with 18 children who received modified Bu-Cy and ATG conditioning regimen in the same period (ATG group).

RESULTS

The two-year cumulative incidences of grade II-IV acute GVHD was significantly lower in PTCy intensified group (13.6 ± 7.7% vs 38.9 ± 11.5%, P = 0.048). Two-year GVHD-free relapse free survival (GRFS) in PTCy seems to be better among the increment group despite not being significant (63.3 ± 10.3% vs 35.4 ± 11.9%, P = 0.092). The positive rate of minimal residual disease after transplantation was significantly lower than that before transplantation (20.0% vs 2.5%, P = 0.029).

CONCLUSION

In conclusion, ATG and PTCy combined with Flu-based increased intensity conditioning regimen is effective for acute leukemia in children. It could reduce GVHD rate significantly and potentially improve GRFS.

The novel HLA-DQB1*06:475 allele, identified by Sanger dideoxy nucleotide sequencing in a Chinese individual

HLA-DQB1*06:475 differs from HLA-DQB1*06:35 by one nucleotide in exon 2.

The Extract of Pinellia Ternata-Induced Apoptosis of Leukemia Cells by Regulating the Expression of Bax, Bcl-2 and Caspase-3 Protein Expression in Mice

The study aims to lessen the monetary burden on patients and society by decreasing the price of proprietary drugs used in leukemia therapy. Flow cytometry, reverse transcription polymerase chain reaction, western blot, and a patient-derived xenograft mouse model were used to confirm the therapeutic effect of Pinellia ternata extract on leukemia. Three types of leukemia cells (K562, HL-60, and C8166 cell lines) were found to undergo early apoptosis (P ≤ .05) after being exposed to P. ternata extract, as measured by flow cytometry. Reverse transcription polymerase chain reaction results showed that P. ternata extract at both middle (300 μg/mL) and high (500 μg/mL) concentrations was able to down-regulate Bcl-2 and upregulate mRNA expression of Bax and caspase-3. In the patient-derived xenograft mouse model formed by BALB/c-nu/nu nude mice, immunohistochemistry indicated that P. ternata extract effectively suppressed the proliferation of leukemia cells. Therefore, P. ternata extract at 300 μg/mL and 500 μg/mL could effectively inhibit myeloid and lymphocytic leukemia cell proliferation and promote leukemia cell apoptosis by regulating Bax/Bcl-2 and caspase-3.

The novel HLA-B*40:536N allele, identified by Sanger dideoxy nucleotide sequencing in a Chinese individual

HLA-B*40:536N differs from HLA-B*40:03:01:01 by one nucleotide in exon 3.

The novel HLA-A*30:01:24 allele, identified by Sanger dideoxy nucleotide sequencing in a Chinese individual

HLA-A*30:01:24 differs from HLA-A*30:01:01:01 by one nucleotide in exon 3.

The novel HLA-C*04:01:152 allele, identified by Sanger dideoxy nucleotide sequencing in a Chinese individual

HLA-C*04:01:152 differs from HLA-C*04:01:01:01 by one nucleotide in exon 1.

The novel HLA-A*68:302 allele, identified by Sanger dideoxynucleotide sequencing in a Chinese individual

HLA-A*68:302 differs from HLA-A*68:01:02:01 by one nucleotide in exon 4.

[Relationship between carotid atherosclerotic plaque characteristics in magnetic resonance imaging and perioperative hemodynamic instability]

Objective: To analyze the relationship between carotid atherosclerotic plaque characteristics in magnetic resonance imaging (MRI) and perioperative hemodynamic instability in patients with severe carotid artery stenosis undergoing carotid artery stenting (CAS). Methods: A total of 89 patients with carotid artery stenosis who underwent CAS treatment at Beijing Tsinghua Changgung Hospital affiliated to Tsinghua University from January 1, 2017, to December 31, 2021, were prospectively included. Among them, 74 were male and 15 were female, with an age range of 43 to 87 years (mean age: 67.8±8.2 years). Preoperative examinations included carotid artery MRI vessel wall imaging to analyze the existence of large lipid-rich necrotic core (LRNC), intraplaque hemorrhage (IPH), and fibrous cap rupture in carotid artery plaques. Plaques without the above-mentioned risk factors were defined as stable plaque group (34 cases), while those with such risk factors were defined as vulnerable plaque group (55 cases). The number of risk factors present in each plaque was also calculated. Intraoperative changes in blood pressure and heart rate were recorded, and the use of dopamine postoperatively was noted. Using the risk factors that the plaque has as independent variables and the clinical outcomes as dependent variables, the RR values were calculated, and the differences in clinical outcomes of patients with different risk factors were compared. Results: The incidence rates of hypotension and bradycardia were higher in patients with vulnerable plaques than those with stable plaques (60.0% (33/55) vs 14.7%(5/34) and 38.2%(21/55) vs 14.7%(5/34), respectively; both P<0.05). Based on MRI imaging features, the large LRNC was present in 45 cases, with RR values for hypotension and bradycardia of 3.15 (1.69-5.87) and 2.20 (1.07-4.53), respectively; IPH was present in 37 cases, with RR values for hypotension and bradycardia of 2.70 (1.61-4.55) and 2.25 (1.15-4.39), respectively; and fibrous cap rupture was present in 29 cases, with RR values for hypotension and bradycardia of 1.50 (0.94-2.40) and 1.29 (0.67-2.49), respectively. The higher the number of risk factors in vulnerable plaques, the higher the incidence of intraoperative blood pressure and heart rate decrease: when the number of risk factors ranged from 0 to 3, the incidence of blood pressure decrease was 14.7% (5/34), 9/18, 11/18, and 13/19, respectively (P<0.001), and the incidence of heart rate decrease was 14.7% (5/34), 6/18, 7/18, and 8/19, respectively (P=0.022). There was no significant difference in the number of cases of dopamine use between the two groups (P>0.05). Conclusion: Patients with a higher number of risk factors for vulnerable carotid plaques, as indicated by carotid artery MRI vessel wall imaging, are at a higher risk of experiencing blood pressure and heart rate decrease during CAS surgery.

Exploration of KIR genes and hematological-related diseases in Chinese Han population

The function of natural killer (NK) cells has previously been implicated in hematopoietic-related diseases. Killer immunoglobulin-like receptors (KIR) play an important role in NK cells after hematopoietic stem cell transplantation. To explore the immunogenetic predisposition of hematological-related diseases, herein, a multi-center retrospective study in China was conducted, analyzing and comparing 2519 patients with hematopathy (mainly, acute lymphoblastic leukemia, acute myeloid leukemia, aplastic anemia, and myelodysplastic syndrome) to 18,108 individuals without known pathology. Genotyping was performed by polymerase chain reaction with specific sequence primers (PCR-SSP). As a result, we discovered four genes including KIR2DL5 (OR: 0.74, 95% CI 0.59-0.93; Pc = 0.0405), 2DS1 (OR: 0.74, 95% CI 0.59-0.93; Pc = 0.0405), 2DS3 (OR: 0.58, 95% CI 0.41-0.81; Pc = 0.0180), and 3DS1 (OR: 0.74, 95% CI 0.58-0.94; Pc = 0.0405) to be protective factors that significantly reduce the risk of aplastic anemia. Our findings offer new approaches to immunotherapy for hematological-related diseases. As these therapies mature, they are promising to be used alone or in combination with current treatments to help to make blood disorders a manageable disease.

The novel HLA-B*51:381 allele, identified in a Chinese individual through Sanger dideoxy nucleotide sequencing

HLA-B*51:381 differs from HLA-B*51:01:01:01 by one nucleotide in exon 5.

The novel HLA-C*06:02:105 allele, identified by Sanger dideoxy nucleotide sequencing in a Chinese individual

HLA-C*06:02:105 differs from HLA-C*06:02:01:01 by one nucleotide in exon 1.

[Prophylactic vaccines for hepatitis type E]

Over the past few years, hepatitis type E has been increasingly recognized as an underestimated global disease burden. Populations with severe infection-related injuries or deaths include pregnant women, patients with underlying liver disease, and the elderly. Vaccines are the most effective means to prevent hepatitis type E virus (HEV) infection. However, the development of inactivated or attenuated vaccines is not feasible due to the lack of an efficient HEV cell culture system, so researchers have conducted in-depth research on recombinant vaccines. The capsid protein (pORF2), which the virion's open reading frame 2 encodes, contains almost exclusively the HEV neutralization site. Several candidate vaccines based on pORF2 have demonstrated potential for primate protection, with two being well tolerated and highly effective in preventing hepatitis type E in adults. Hecolin® (HEV 239 vaccine), the world's first hepatitis type E vaccine, was approved for marketing in China in 2012.

The novel HLA-B*44:03:67 allele, identified by Sanger dideoxy nucleotide sequencing in a Chinese individual

HLA-B*44:03:67 differs from HLA-B*44:03:02:01 by one nucleotide in exon 4.

The novel HLA-A*02:07:23 allele, identified by Sanger dideoxy nucleotide sequencing in a Chinese individual

HLA-A*02:07:23 differs from HLA-A*02:07:01:01 by one nucleotide in exon 2.

The novel HLA-DRB1*14:251 allele, identified by Sanger dideoxy nucleotide sequencing in a Chinese individual

HLA-DRB1*14:251 differs from HLA-DRB1*14:126:01 by one nucleotide in exon 2.

The novel HLA-C*12:368 allele, identified by Sanger dideoxy nucleotide sequencing in a Chinese individual

HLA-C*12:368 differs from HLA-C*12:03:01:01 by one nucleotide in exon 4.

The novel HLA-DPB1*05:01:18 allele, identified by Sanger dideoxy nucleotide sequencing in a Chinese individual

HLA-DPB1*05:01:18 differs from HLA-DPB1*05:01:01:01 by one nucleotide in exon 4.

The novel HLA-C*03:621 allele, identified by Sanger dideoxy nucleotide sequencing in a Chinese individual

HLA-C*03:621 differs from HLA-C*03:04:01:01 by one nucleotide in exon 1.

The novel HLA-DQB1*02:01:44 allele, identified by Sanger dideoxy nucleotide sequencing in a Chinese individual

HLA-DQB1*02:01:44 differs from HLA-DQB1*02:01:01:01 by one nucleotide in exon 2.

The novel HLA-C*01:239 allele, identified by Sanger dideoxy nucleotide sequencing in a Chinese individual

HLA-C*01:239 differs from HLA-C*01:02:01:01 by one nucleotide in exon 4.

The novel HLA-DQB1*03:03:29 allele, identified by sanger dideoxy nucleotide sequencing in a Chinese individual

HLA-DQB1*03:03:29 differs from HLA-DQB1*03:03:02:01 by one nucleotide in exon 2.

The novel HLA-DQB1*04:93 allele, identified by Sanger dideoxy nucleotide sequencing in a Chinese individual

HLA-DQB1*04:93 differs from HLA-DQB1*04:01:01:01 by one nucleotide in exon 2.

The novel HLA-DRB1*14:07:03 allele, identified by Sanger dideoxy nucleotide sequencing in a Chinese individual

HLA-DRB1*14:07:03 differs from HLA-DRB1*14:07:01 by one nucleotide in exon 2.

The novel HLA-B*15:644 allele, identified by Sanger dideoxy nucleotide sequencing in a Chinese individual

HLA-B*15:644 differs from HLA-B*15:17:01:02 by one nucleotide in exon 4.

The novel HLA-DQB1*03:499N allele identified by Sanger dideoxy nucleotide sequencing in a Chinese individual

HLA-DQB1*03:499N differs from HLA-DQB1*03:01:01:01 by one nucleotide in exon 2.

The novel HLA-A*02:1068Q allele, identified by Sanger dideoxy nucleotide sequencing in a Chinese individual

HLA-A*02:1068Q differs from HLA-A*02:03:01:01 by one nucleotide in exon 1.

The novel HLA-B*40:01:78 allele, identified by Sanger dideoxy nucleotide sequencing in a Chinese individual

HLA-B*40:01:78 differs from HLA-B*40:01:02:01 by one nucleotide in exon 3.

The novel HLA-B*55:131 allele, identified by Sanger dideoxy nucleotide sequencing in a Chinese individual

HLA-B*55:131 differs from HLA-B*55:02:01:01 by one nucleotide in exon 4.

The novel HLA-B*13:176 allele, identified by Sanger dideoxy nucleotide sequencing in a Chinese individual

HLA-B*13:176 differs from HLA-B*13:02:01:01 by one nucleotide in exon 1.

The novel HLA-C*01:02:89 allele, identified by Sanger dideoxy nucleotide sequencing in a Chinese individual

HLA-C*01:02:89 differs from HLA-C*01:02:01:01 by one nucleotide in exon 2.

The novel HLA-DRB1*14:246 allele, identified by Sanger dideoxy nucleotide sequencing in a Chinese individual

HLA-DRB1*14:246 differs from HLA-DRB1*14:18 by one nucleotide in exon 2.

The novel HLA-B*15:638 allele, identified by Sanger dideoxy nucleotide sequencing in a Chinese individual

HLA-B*15:638 differs from HLA-B*15:01:01:01 by one nucleotide in exon 2.

The novel HLA-B*52:110N allele, identified by Sanger dideoxy nucleotide sequencing in a Chinese individual

HLA-B*52:110N differs from HLA-B*52:01:01:01 by one nucleotide in exon 3.

The novel HLA-DPB1*1352:01 allele, identified by Sanger dideoxy nucleotide sequencing in a Chinese individual

HLA-DPB1*1352:01 differs from HLA-DPB1*02:01:02:01 by one nucleotide in exon 4.

The novel HLA-B*55:130 allele, identified by Sanger dideoxy nucleotide sequencing in a Chinese individual

HLA-B*55:130 differs from HLA-B*55:35 by two nucleotides in exon 2.

The novel HLA-C*03:04:74 allele, identified by Sanger dideoxy nucleotide sequencing in a Chinese individual

HLA-C*03:04:74 differs from HLA-C*03:04:01:01 by one nucleotide in exon 6.

The novel HLA-B*35:563 allele, identified by Sanger dideoxy nucleotide sequencing in a Chinese individual

HLA-B*35:563 differs from HLA-B*35:03:01:01 by one nucleotide in exon 4.

The novel HLA-A*24:582 allele, identified by Sanger dideoxy nucleotide sequencing in a Chinese individual

HLA-A*24:582 differs from HLA-A*24:02:01:01 by one nucleotide in exon 1.

The novel HLA-B*48:01:11 allele, identified by Sanger dideoxy nucleotide sequencing in a Chinese individual

HLA-B*48:01:11 differs from HLA-B*48:01:01:01 by one nucleotide in exon 4.

The novel HLA-A*02:07:22 allele, identified by Sanger dideoxy nucleotide sequencing in a Chinese individual

HLA-A*02:07:22 differs from HLA-A*02:07:01:01 by one nucleotide in exon 3.

The novel HLA-DQB1*06:208:02 allele, identified by Sanger dideoxy nucleotide sequencing in a Chinese individual

HLA-DQB1*06:208:02 differs from HLA-DQB1*06:02:02 by one nucleotide in exon 2.

The novel HLA-C*04:490 allele, identified by Sanger dideoxy nucleotide sequencing in a Chinese individual

HLA-C*04:490 differs from HLA-C*04:01:01:01 by one nucleotide in exon 3.

The novel HLA-C*15:02:58 allele, identified by Sanger dideoxy nucleotide sequencing in a Chinese individual

HLA-C*15:02:58 differs from HLA-C*15:02:01:01 by one nucleotide in exon 1.

The novel HLA-B*13:01:21 allele identified by Sanger dideoxy nucleotide sequencing in a Chinese individual

HLA-B*13:01:21 differs from HLA-B*13:01:01:01 by one nucleotide in exon 2.

The novel HLA-A*24:02:160 allele, identified by Sanger dideoxy nucleotide sequencing in a Chinese individual

HLA-A*24:02:160 differs from HLA-A*24:02:01:01 by one nucleotide in exon 3.

The novel HLA-A*02:1075 allele, identified by Sanger dideoxy nucleotide sequencing in a Chinese individual

HLA-A*02:1075 differs from HLA-A*02:07:01:01 by one nucleotide in exon 5.

The novel HLA-B*35:568 allele, identified by Sanger dideoxy nucleotide sequencing in a Chinese individual

HLA-B*35:568 differs from HLA-B*35:03:01:01 by one nucleotide in exon 4.