Lea blood group antigen on human platelets

Immunochemical and immunohistological expression of Lewis histo-blood group antigens in small intestine including individuals of the Le(a+b+) and Le(a-b-) nonsecretor phenotypes

Histological samples and total non-acid glycosphingolipids were prepared from small intestine of human cadavers with the Le(a+b+) and Le(a-b-) nonsecretor phenotypes and contrasted with the more common Lewis phenotypes. Glycolipid fractions were analysed by thin-layer chromatography and tested for Lewis activity with monoclonal antibodies reactive to Lewis epitopes. Paraffin-embedded small intestine sections were also fluorescently immunostained with anti-Lewis antibodies. Unlike the common Lewis positive phenotypes, we were immunochemically able to demonstrate the copresence of large amounts of Lea and Leb glycolipids in the Le(a+b+) sample. In addition we demonstrated increased formation of extended Lewis structures in this phenotype. By immunohistochemistry Lea, Leb and type 1 precursor chain epitopes could be demonstrated in the brush border. These results show that the expression of the Le(a+b+) phenotype at the erythrocyte phenotyping level parallels the small intestinal expression of this phenotype, and the patterns of Lewis antigen expressions are unique to this phenotype. By immunohistochemistry and immunochemistry we also demonstrated the presence of trace amounts of Lewis active glycoconjugates in the small intestine of the Le(a-b-) nonsecretor and Le(a+b-) samples. In the Le(a-b-) nonsecretor Lea and Leb activity was absent and type 1 precursor was present in brush border, while Leb activity was immunohistologically demonstrated in the Golgi apparatus of the deep glands. Trace amounts of both Lea and Leb glycolipids were identified in this sample. In parallel trace Leb activity could also be detected in the glycolipids of the Le(a+b-) sample and could be immunohistologically demonstrated to be fully expressed in occasional cells in the deep glands of the small intestine, a pattern quite dissimilar to that of the Le(a-b-) nonsecretor.(ABSTRACT TRUNCATED AT 250 WORDS)

Expression of Lewis histo-blood group glycolipids in the plasma of individuals of Le(a+b+) and partial secretor phenotypes

Red cell Lewis antigens are carried by glycosphingolipids passively absorbed from plasma. Plasma was collected from a spectrum of individuals with normal and unusual Lewis/secretor phenotypes in order to investigate the glycolipid basis for the unusual phenotypes. Samples were obtained from: a Le(a+b-) ABH nonsecretor who secreted Lewis substances; a Le(a+b-) partial secretor; Le(a+b+) partial secretors; Le(a+b+) secretors; and a full range of normal Lewis/secretor phenotypes as controls. The Le(a+b+) samples represented Polynesian, Asian and Réunion Island ethnic backgrounds. Nonacid glycolipids were prepared, separated by thin-layer chromatography, and then immunostained with potent monoclonal antibodies of known specificity. Despite different serological profiles of the Le(a+b-) and Le(a+b+) Polynesian samples, their plasma glycolipid expressions were very similar, with both Le(a) and Le(b) co-expressed. The copresence of Le(a) and Le(b) in Le(a+b+) samples is in marked contrast to Caucasians with normal Lewis phenotypes, who have predominantly either Le(a) or Le(b). These results suggest that there is a range of the secretor transferases in different individuals, possibly due to different penetrance or to several weak variants. We also show that Lewis epitopes on longer and/or more complex core chains appear to be predominant in the Polynesian Le(a+b+) samples. The formation of these extended glycolipids is compatible with the concept that in the presence of reduced secretor fucosyltransferase activity, increased elongation of the precursor chain occurs, which supports the postulate that fucosylation of the precursor prevents or at least markedly reduces chain elongation.

Plasma and red-cell glycolipid patterns of Le(a+b+) and Le(a+b-) Polynesians as further evidence of the weak secretor gene Se(w)

Monoclonal antibodies and thin-layer chromatography were used to study the unusual erythrocyte Lewis phenotypes found in healthy Polynesians. A single monoclonal anti-Leb reagent 073 (clone LM129) was found which could detect Leb antigen on the Polynesian erythrocytes of samples that were unreactive with various polyclonal and monoclonal anti-Leb reagents. Glycolipid fractions prepared from the plasma and erythrocytes of selected Polynesian samples of red-cell Le(a-b-), Le(a+b-) and Le(a+b+) phenotypes were found to have Leb glycolipids. The Leb antigen in some individuals is so weakly expressed that it is undetectable by routine erythrocyte phenotyping. Unusually large glycolipids bearing the Leb epitope were also found in some Polynesian samples, although the contribution of these novel glycolipids to phenotyping is unclear. The inability to detect Leb by routine methods and the presence of novel structures can be partially explained in terms of the presence of a weak secretor gene Se(w).

A bone marrow transplant with an acquired anti-Le(a): a case study

A patient with aplastic anemia received an ABO incompatible bone marrow transplant (BMT) from an HLA identical sibling. Weekly HLA antibody screens were performed as part of the BMT protocol. At the time of transplant, a hemolytic anti-Le(a) was detected in the Le (a-b-) donor. The Le (a-b+) recipient had no red cell or LCT antibody. A hemolytic anti-Le(a) was detected in the recipient on day 8, but no LCT reactivity was noted at this time. On day 15, the LCT panel demonstrated reactivity with 9 of 50 panel cells without apparent HLA specificity. Graft vs. host disease (GVHD) was present on the skin at this time. The dose of cyclosporin A was increased, but by day 20 the GVHD worsened and the LCT titers increased to 8. This strong reactivity was noted only in the Le (a+) panel members (12/50) and was neutralized with commercial Lewis substance. On day 34 there was no evidence of GVHD, but the lymphocytotoxic anti-Lea continued to be present. The patient began experiencing renal and gastrointestinal difficulties by day 48, and expired on day 60. In renal transplants the kidneys retain their Lewis type and secrete Lewis substance in the urine. In our experience BMT patients retain their Lewis type regardless of the type of the donor. The Lewis system has been linked to renal allograft rejection, and Lewis antigens may function as transplantation antigens in BMT patients as well. In addition, lymphocytotoxic Lewis antibodies can mask other significant HLA antibodies and must be identified when screening patients in need of plateletpheresis products.

Identification of anti-Lea by platelet complement fixation

Two anti-Lea sera which were able to detect Lea antigen on platelets were identified in a screening for anti-platelet antibodies by means of a platelet complement fixation test. These two antisera hemolyzed erythrocytes without enzyme treatment. The anti-Lea activity could be completely absorbed by red cells, platelets and lymphocytes of Le(a+b-) donors but not by cells from Le(a-b+) or Le(a-b-) donors. The antibody activity against red cells was eliminated by treatment of the antisera with dithiothreitol, thereby suggesting that the activity resided in the IgM class of immunoglobulins. As the anti-Lea was more reactive at 37 degrees C than at room temperature against both red cells and platelets, we suggest that transfusion of platelets of Lea-negative donors should be considered for patients with this type of anti-Lea.

Quantitative determination of platelet surface alloantigens using a monoclonal probe

A monoclonal antibody with specificity for the Fc portion of IgG was used to determine the number of IgG alloantibody molecules bound at saturation to alloantigens of the PlA1 and HLA systems on normal human platelets. In preliminary studies, it was found that the number of cell-bound IgG molecules recognized by this probe correlates well with the number measured by electroimmunoassay, an independent measure of alloantibody binding. PlA1-positive platelets could be divided into two groups binding 34,000-43,000 or 19,000-24,000 alloantibody molecules. Family studies and studies with a cytolytic assay showed that the former group is homozygous and the latter heterozygous for PlA1. Because the number of glycoprotein IIIa (GPIIIa) molecules carrying the PlA1 determinant on the surface of normal platelets is thought to be about 40,000, these findings suggest that each GPIIIa molecule carries one PlA1 determinant. The number of class I HLA molecules expressed on normal platelets was considerably smaller than the number of PlA1 determinants, ranging from 4400 to 10,000 (HLA-A2), 870 to 8400 (Bw4), and 1300 to 5800 (Bw6). Preliminary analysis indicates that stronger or weaker expression of Bw4 and of Bw6 correlates with certain "private" HLA-B determinants carried on the HLA-B molecule as found in previous studies using an indirect method to measure alloantigen density. These findings appear to explain why antibodies reactive with platelet-specific antigens such as PlA1 react more strongly with platelets than HLA-specific antibodies in most serologic tests. The weak expression of HLA determinants on platelets of some subjects may account for the less than perfect correlation between in vitro compatibility tests and post-transfusion platelet survivals observed in most studies.