A and B and A1Leb substances in glycosphingolipid fractions of human serum

Pathogenesis and mechanisms of antibody-mediated hemolysis

BACKGROUND

The clinical consequences of antibodies to red blood cells (RBCs) have been studied for a century. Most clinically relevant antibodies can be detected by sensitive in vitro assays. Several mechanisms of antibody-mediated hemolysis are well understood. Such hemolysis after transfusion is reliably avoided in a donor-recipient pair, if one individual is negative for the cognate antigen to which the other has the antibody.

STUDY DESIGN AND RESULTS

Mechanisms of antibody-mediated hemolysis were reviewed based on a presentation at the Strategies to Address Hemolytic Complications of Immune Globulin Infusions Workshop addressing intravenous immunoglobulin (IVIG) and ABO antibodies. The presented topics included the rates of intravascular and extravascular hemolysis; immunoglobulin (Ig)M and IgG isoagglutinins; auto- and alloantibodies; antibody specificity; A, B, A,B, and A1 antigens; A1 versus A2 phenotypes; monocytes-macrophages, other immune cells, and complement; monocyte monolayer assay; antibody-dependent cell-mediated cytotoxicity; and transfusion reactions due to ABO and other antibodies.

CONCLUSION

Several clinically relevant questions remained unresolved, and diagnostic tools were lacking to routinely and reliably predict the clinical consequences of RBC antibodies. Most hemolytic transfusion reactions associated with IVIG were due to ABO antibodies. Reducing the titers of such antibodies in IVIG may lower the frequency of this kind of adverse event. The only way to stop these events is to have no anti-A or anti-B in the IVIG products.

Soluble type A substance in fresh-frozen plasma as a function of ABO and Secretor genotypes and Lewis phenotype

Soluble ABO blood group substance (SAS) in fresh-frozen plasma (FFP) and its cognate alloantibody titer reduction capacity (TRC) are not considered when prescribing this product for plasma exchange (PEX) therapy of ABO incompatible transplant recipients. SAS was quantified in 250 single FFPs using ELISA. Total and IgG class-specific anti-A TRCs of FFPs were measured using a microhemagglutination inhibition assay. SAS level depended not only on the A subtype (p < 0.0001) and the Secretor status (p < 0.0001), but also on the expression of ALe(b) in A1 secretors (p < 0.0001). The variation was as great as 137.6 arbitrary units (aU) for 14 A1 Le(a-b-) secretors and 1.2 aU for 6 A2 non-secretors. Homozygous expression of the A1, A2 and Secretor alleles did not increase SAS levels. Only total anti-A TRC, but not IgG class-specific TRC depended on the detected SAS level (r = 0.566, p = 0.0003).

Molecular behavior of mutant Lewis enzymes in vivo

The expression of type-1 Lewis antigens on erythrocytes and in digestive organs is determined by a Lewis type alpha(1,3/1, 4)-fucosyltransferase (Lewis enzyme) encoded by the Fuc-TIII gene ( FUT3 gene; Lewis gene). We have classified the Lewis alleles in the Japanese population into four types, the wild-type allele ( Le ) and three mutated alleles, i.e., le1, which has missense mutations T59G and G508A, le2, which has T59G and T1067A, and le3, which has only T59G. Here we carried out an extensive study on the biological properties of the three mutant Lewis enzymes, the le1, le2, and le3 enzymes, using native tissues and obtained the following results. (1) In in vivo and in vitro experiments, the le1 and le2 enzymes were found to be susceptible to protease digestion probably because the one missense mutation in the catalytic domains, i.e., Gly170 to Ser in the le1 enzyme and Ile356 to Lys in the le2 enzyme, makes the three-dimensional structures of the enzymesunstable, while the le3 and wild-type Lewis enzymes wereresistant to protease digestion. (2) The le1 and le2 enzymes cannot synthesize type 1 Lewis antigens on either glycolipids or mucins. The le3 enzyme cannot synthesize Lewis-active glycolipids, which result in the Lewis antigen-negative phenotype of erythrocytes, while it can synthesize Lewis antigens on mucins in normal and cancerous colon tissues. The missense mutation, Leu20 to Arg, in the transmembrane domain reduces retention of the le3 enzyme in the Golgi membrane resulting in an apparent reduction of enzyme activity as revealed by the lack of Lewis antigen synthesis. (3) The Lewis gene dosage actually has effects in vivo on the amount of the Lewis enzyme, its activity, and finally the amounts of Lewis carbohydrate antigens. This is the first article that clearly demonstrates the gene dosage effects on the amount of the glycosyltransferase protein, its activity, and the amounts of carbohydrate products in vivo.

Regulation of expression of carbohydrate blood group antigens

The carbohydrate antigens associated with the human ABO and Lewis blood group systems are excellent models for the study of the genetic regulation of glycoconjugate biosynthesis because their expression on erythrocytes and in saliva has been thoroughly investigated in terms of classical genetics and the chemical structures and pathways for the formation of the antigens are now well understood. The primary protein products of the blood group genes are believed to be the glycosyltransferase enzymes that complete the biosynthesis of the determinants. The important controlling factors still to be elucidated are the genetic and environmental influences leading to the tissue specific expression of these antigens. The 3 types of regulation mechanisms discussed in this review are those arising: 1) from the specificity requirements of the glycosyltransferases encoded by the blood group genes; 2) from the competition or co-operation of glycosyltransferases encoded by genes at the same or independent loci; and 3) from the existence and tissue distribution of glycosyltransferases with related, but not identical, substrate specificities.

Studies and observations on Lewis grouping of body fluids and stains

Leb positive individuals may phenotypically express both Lea and Leb in their secreted body fluids. Therefore, the interpretation of a Le(a + ,b-), non-secretor result is dependent on the absence of Leb. This study emphasises the importance of accurate procedure and biased selection of antisera such that Leb is preferentially detected in comparison with Lea. The relationship of the ABO group to the expression of Le is discussed in conjunction with the selection of samples for testing antisera and inclusion as control standards.

The chemical basis for expression of the sialyl-Le(a) antigen

The SLe(a) antigen, originally defined by monoclonal antibody 19-9, is a complex carbohydrate epitope that differs from the normal human blood group Lea antigen only by the presence of an additional sialic acid residue. SLe(a)-active oligosaccharides occur in both gangliosides and mucin-like glycoproteins in developing embryonic gut, as well as in many normal adult glandular tissues and secretions, but the antigen is virtually absent from normal adult gastrointestinal lumenal epithelial cells. Following malignant transformation of adult gastrointestinal lining epithelium and many other endodermally-derived glandular epithelia, SLe(a)-active mucins released from the ensuing tumor appear in blood plasma. The level of circulating SLe(a) antigen is currently being investigated as a means of following tumor recurrence, progression, and therapy. Recent studies on the biosynthesis of SLe(a) explain the observations that, 1) the antigen does not occur in individuals of Le(a-b-) blood group, and 2) individuals that belong to the Le(a+b-) blood group express SLe(a) more strongly than Le(a-b+) individuals. Further, the biosynthetic studies predict a new tumor antigen, NeuAc alpha 2-3Gal beta 1-3GlcNAc beta 1.... (the immediate precursor to SLe(a)) that should be expressed in Le(a-b-) individuals in nearly the same tissue distribution as found for the SLe(a) antigen in Le(a+b-) and Le(a-b+) individuals. Based upon studies of SLe(a) expression in normal saliva and the pathway for biosynthesis of SLe(a), it seems likely that future clinical studies could be profitably directed towards improving the predictive value of the plasma SLe(a) level by adjusting the quantitative results according to the Lewis blood group and ABH secretor phenotype of the individual patient.

Tissue specificity of glycosphingolipids as expressed in pancreas and small intestine of blood group A and B human individuals

A chemical investigation has been done on blood group active glycosphingolipids of both small intestine and pancreas from two individuals, one blood group A and one blood group B. Total non-acid glycolipid fractions were prepared and the major blood group fucolipids present were purified and structurally characterized by mass spectrometry, proton NMR spectroscopy, and degradation methods. The glycolipid structures identified were a blood group Leb hexaglycosylceramide, a B-hexaglycosylceramide with a type 1 (Gal beta 1 leads to 3GlcNAc) carbohydrate chain, A-hexaglycosylceramides with types 1 and 2 (Gal beta 1 leads to 4GlcNAc) carbohydrate chains, a B-heptaglycosylceramide with a type 1 carbohydrate chain, and A-heptaglycosylceramides with type 1 and 2 carbohydrate chains. In addition several minor glycolipids having more than seven sugar residues were detected by thin-layer chromatography. The small intestine and pancreas had some distinct differences in their expression of the major fucolipids. The small intestine contained only glycolipids based upon type 1 carbohydrate chain while the pancreas had both type 1 and type 2 structures. The intestines contained mainly difucosyl compounds while the pancreas tissues contained both mono- and difucosyl glycolipids. Monofucosylglycolipids based on both types 1 and 2 saccharides were present in one pancreas while the other one contained only monofucosylcomponents based on type 1 chain. The ceramides of the intestinal glycolipids were found to be more hydroxylated (trihydroxy long-chain base, hydroxy fatty acids) compared to the pancreas glycolipids (dihydroxy long-chain base, non-hydroxy fatty acids).

Glycosphingolipids of a green monkey kidney cell line (GMK AH-1). Evidence for a novel pentaglycosylceramide based on globotetraosylceramide

Total non-acid glycolipid fractions have been isolated from GMK AH-1 cells grown in fetal calf serum and in horse serum. For comparison, glycolipids were also prepared from green monkey (Cercopithecus aetiops) kidney and from fetal calf serum. The major glycolipids from GMK AH-1 cells grown in fetal calf serum were isolated by silicic acid column chromatography and preparative thin-layer chromatography. These fractions were characterized mainly by thin-layer chromatography, mass spectrometry and gas chromatography. The structures of the glycolipids isolated were proposed as: Glc1 leads to 1Cer, Gal1 leads to 1Cer, Gal1 leads to 4Glc1 leads to 1Cer, Gal1 leads to 4Gal1 leads to 4Glc1 leads to 1Cer, GalNAcl leads to 3Gal1 leads to 4Gal1 leads 4Glc1 leads to 1Cer. In addition, a novel pentaglycosylceramide with the probable structure Ga1 beta 1 leads to 3GalNAc beta 1 leads to Gal alpha 1 leads to 4Gal beta 1 leads to 4Glc beta 1 leads to 1Cer was also present. THe ceramides contained mainly dihydroxy 18:1 long-chain base in combination with non-hydroxy 16:0-24:0 fatty acids. Small amounts of trihydroxy 18:0 long-chain base and hydroxy 22:0-24:0 fatty acids were also present in the mono- and diglycosylceramide fractions. The glycolipid patterns of GMK AH-1 cells grown in fetal calf serum or horse serum were identical. The pentaglycosylceramide present in the cultured cells could not be detected with certainty in the kidney tissue. The uptake of this glycolipid from the culture medium is unlikely as it seems to be lacking in calf serum.

Glycolipid receptors for uropathogenic Escherichia coli on human erythrocytes and uroepithelial cells

A specific family of glycolipids, the globoseries, was shown to act as receptors on human uroepithelial cells and erythrocytes for the majority of uropathogenic Escherichia coli strains attaching to or hemagglutinating those cells. This was demonstrated in three different ways: (i) correlation between the natural presence of glycolipid in the target cell (erythrocytes of different species) and binding of bacteria; (ii) inhibition of attachment to human uroepithelial cells by preincubation of bacteria and glycolipid; and (iii) induction of binding to unreactive cells by coating of these cells with glycolipid. Strains reacting with the receptor agglutinated guinea pig erythrocytes in a mannose-resistant way after, but not before, coating of the cells with globotetraosylceramide. Unrelated glycolipids were not recognized. The reaction was made independent of simultaneous occurrence of mannose-sensitive adhesions on the strains by addition of D-mannose. The receptor-coated cells were used as a tool to screen for prevalence of receptor recognition in a collection of 453 E. coli strains isolated from patients with urinary tract infection or from the stools of healthy children. Of 150 strains attaching to human uroepithelial cells and agglutinating human erythrocytes, 121 bound to globotetraosylceramide (81%). Globoside recognition was especially frequent among pyelonephritis strains (74/81). The glycolipid composition of the urogenital epithelium and kidney tissue and the ability of uropathogenic E. coli to bind to these glycolipids may be a determinant in host-parasite interaction leading to urinary tract infection.

ABO blood group activities in human albumin preparations

By using hemagglutination-inhibition technique, A and B blood group activities were demonstrated in all of the tested batches of Plasma Protein Fraction and Human Serum Albumin prepared by one manufacturer in the period of 1975-1978; whereas all the tested batches prepared by other manufacturers were found to be free of blood group activities. With some batches of Plasma Protein Fraction prepared by the above-mentioned manufacturer, the presence A blood group activity was confirmed by the anti-A response in immunized rabbits. The blood group activities were localized in earlier fractions in Sephadex G-200 gel filtration analysis. The active principles were resistant to boiling for one hour. They were recovered in the aqueous phase by chilled buthanol treatment and could not be extracted with chloroform-methanol. These results seem to suggest that the blood group active principles detected in the albumin preparations are more likely of water-soluble glycoprotein nature than being glycosphingolipids.

Lymphocytotoxic definition of combined ABH and Lewis antigens and their transfer from sera to lymphocytes

Analysis of lymphocytotoxic reactions with peripheral blood lymphocytes from 74 donors, typed for ABO, secretor, and Lewis phenotypes, identified clusters of reactions distinguishing six antigens resulting from the interactions of Lewis, secretor, and ABO systems: Lea, Leb, ALed, BLed, ALeb, and BLeb. In these experiments, Led on O lymphocytes and Lec were not detected as expected from the experience of other authors with A antigen, B and Leb were detected only on the lymphocytes of ABH secretors, demonstrating that all the ABH antigens of lymphocytes are controlled by the secretor system as are the ABH antigens in external secretions. The ABH and Lewis antigens identified on lymphocytes could be transferred in vitro to lymphocytes, cultured for 2 to 7 days at 37 degrees C in the serum of donors of selected ABO, Lewis, and secretor phenotypes, confirming that ABH and Lewis antigens are not synthesized by lymphocytes but are acquired from circulation as are the Lewis antigens on erythrocytes. As expected, the HLA antigens of lymphocytes were not modified after culture.

Structures and fatty acid compositions of neutral glycosphingolipids of human plasma

Major neutral glycosphingolipids were isolated from human plasma and their structures and fatty acid compositions studied. The four neutral glycosphingolipids of plasma were characterized as Glc beta(1 leads to 1)ceramide, Gal beta(1 leads to 1)- ceramide, Gal beta(1 leads to 4) Glc beta (1 leads to 1)ceramide, Gal alpha(1 leads to 4) Gal beta(1 leads to 4) Glc beta(1 leads to 1)ceramide and GalNAc beta(1 leads to 3) Gal (1 leads to 4) Gal (1 leads to 4) Glc beta(1 leads to 1)-ceramide. The glycosphingolipids contained mostly short chain fatty acids of which most prominent was C16. Erythrocyte glucosylceramide and lactosylceramide exhibited similar fatty acid compositions as their plasma counterparts. Triglycosylceramide and globoside of erythrocytes contained almost exclusively long-chain fatty acids. In lactosylceramide obtained from "p" erythrocytes, an accumulation of long-chain fatty acids was found; this accumulation was not observed, however, in lactosylceramide isolated from "p" plasma. It was concluded that plasma and erythrocyte glycosphingolipids are synthesized at separate sites where short- and long-chain fatty acids, respectively, are available. Plasma and erythrocyte glucosylceramide, and probably a fraction of lactosylceramide, exchange between plasma and erythrocyte pools. The latter conclusion is discussed in the light of the relative roles of carbohydrate and lipid moieties of the glycosphingolipids in maintaining their association with erythrocyte membranes.

Isolation and purification of Lea blood-group active and related glycolipids from human plasma of blood-group A Lea individuals

From 81 of human plasma of blood-group A Lea nonsecretors three different Lea blood-group active ceramide pentasaccharides (a total of 4.65 mg) have been isolated, all revealing glucose, galactose, N-acetylglucosamine and fucose in molar ratios of 1 : 2 : 1 : 1 as determined by gas liquid chromatography. A fourth blood-group active fraction (0.72 mg) represents a mixture of a Lea active ceramide pentasaccharide and an A active ceramide hexasaccharide (molar ration 7.7 : 2.3 as calculated from the content of different aminosugars). Additionally, two different globosides, two different hematosides and a new N-acetylglucosamine containing ceramide tetrasaccharide were obtained. All 9 glycolipid fractions demonstrated homogeneity in analytical high performance thin layer chromatography (HPTLC) using 4 different solvent systems. 0.2 microgram of each Lea active glycolipid completely inhibited the agglutination of O Le(a+b-) erythrocytes by 50 microliter of 4 hemagglutinating units of caprine anti Lea serum. At least 0.04 microgram of each Lea antigen are sufficient for incubation to convert 9 x 10(7) O Le(a-b-) erythrocytes into Lea-positive cells. Mainly due to the relatively low content of the blood-group A glycolipid in plasma (0.17 mg/81), previously negative erythrocytes readily become agglutinable by anti Lea sera and not by anti A sera after incubation with appropriate plasma.

Blood-group antigens and antibodies in human brain-tumor cysts

Cyst fluids from 12 human brain tumors were studied for their blood-group content and compared to autologous saliva, serum, and cerebrospinal fluid (CSF). Lewisa substance, which is a fucolipid, was present in four of 12 cysts studied. Lewisb, which differs from Lewisa by a single fucose, was found in eight of 12 sera and/or saliva and in one CSF specimen; Lewisb substance, however, was not detected in any corresponding cyst fluids. Isohemagglutinins, blood-group antibodies anti-A and/or anti-B, were present in nine of nine cyst fluids studied, were of lower titers as compared to autologous serum, and occurred as either IgG or IgM immunoglobulins. The results further delineate the biochemical requirements necessary for molecular penetration into human brain-tumor cysts.

Further observations on the Birmingham chimaera

The appropriate ABH-gene specified glycosyltransferases in the plasma of the Birmingham chimaera were estimated. These observatiions and the demonstration of A1Leb blood group specific glycosphingolipid in the plasma indicate that the minority population of red blood cells probably represents the true blood groups of the patient.

Characterization of B and H blood-group active glycosphingolopids from human B erythrocyte membranes

Two blood group B active glycosphingolipids (B-I and B-II) previously isolated and highly purified from human B erythrocytes [21] were analysed first by degradation with alpha-D-galactosidase from coffee beans, alpha-L-fucosidase from bovine kidney and with 0,1 N trichloracetic acid; the native B-glycolipids as well as their degradation products were then investigated by methylation analysis with combined gas chromatography-mass spectromety, by thin layer chromatography, two dimensional immunodiffusion and by the hemagglutination inhibition technique. Together with the results obtained by mass spectrometry of permethylated glycolipids [26] the following structures were elucidated: alpha-D-gakactpurampsu;-(1 leads to 3) [alpha-L-fucopyranosyl-(1 leads to 2)]-D-galactopyranosyl-(1 leads to 4)-N-acetyl-D-glucosaminosyl-(1 leads to 3)-D-galactopyranosyl-(1 leads to 4)-D-glucopyranosyl-(1 leads to 1)-ceramide for the B-I glycosphingolipid and alpha-D-galactopyransosyl-(1 leads to 3)-[alpha-L-fucopyranosyl-(1 leads to 2)]-D-galactopyranosyl-(1 leads to 4)-N-acetyl-D-glucosaminosyl-(1 leads to 3)-D-galactopyranosyl-(1 leads to 4)-N-acetyl-D-glucosaminosyl-(1 leads to 3)-D-galactopyranosyl-(1 leads to 4)-D-glucopyranosyl-(1 leads to 1)-ceramide for the B-II glycophingolipid. AH active glycolipid fraction from B erythrocytes further purified by thin layer chromatography was also investigated by methylation analysis. The pattern of its partially methylated alditol acetates was essentially the same as that of the alpha-galactosidase treated and permethylated B-I glycoliped. It is also exhibited strongly precipitating and hemagglutination inhibiting H properties as well as the two alpha-galactosidase treated B-I and B-II glycosphingolipids. Based upon these data the following tentative structure was proposed: alpha-L-fucopyranosyl-(1 leads to 2)-D-galactopyranosyl-(1 leads to 4)-N-acetyl-D-glucosaminosyl-(1 leads to 3)-D-Galactopyranosyl-(1 leads to 4)-D-glucopyranosyl-( 1 leads to 1)-ceramide. Gas chromatographic analysis revealed sphingosine and lignoceric, nervonic and behenic acids to be the main components of the ceramide residues of the three glycophingolipids. From the data presented the H active substance very probably can be regarded as the immediate precursor of the B-I gly cosphingolipid from human B erythrocyte membranes.