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Vrignaud C, Mikdar M, Duval R, Reininger L, Damaraju VL, Sawyer M, Colin Y, Le Van Kim C, Gelly JC, Etchebest C, Peyrard T, Azouzi S. Molecular and structural characterization of a novel high-prevalence antigen of the Augustine blood group system. Transfusion 2023; 63:610-618. [PMID: 36744388 DOI: 10.1111/trf.17268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 12/19/2022] [Accepted: 12/27/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND An antibody directed against a high-prevalence red blood cell (RBC) antigen was detected in a 67-year-old female patient of North African ancestry with a history of a single pregnancy and blood transfusion. So far, the specificity of the proband's alloantibody remained unknown in our immunohematology reference laboratory. STUDY DESIGN AND METHODS Whole-exome sequencing (WES) was performed on the proband's DNA. The reactivity to the SLC29A1-encoded ENT1 adenosine transporter was investigated by flow cytometry analyses of ENT1-expressing HEK293 cells, and RBCs from Augustine-typed individuals. Erythrocyte protein expression level, nucleoside-binding capacity, and molecular structure of the proband's ENT1 variant were further explored by western blot, flow cytometry, and molecular dynamics calculations, respectively. RESULTS A missense variant was identified in the SLC29A1 gene, which encodes the Augustine blood group system. It arises from homozygosity for a rare c.242A > G missense mutation that results in a nonsynonymous p.Asn81Ser substitution within the large extracellular loop of ENT1. Flow cytometry analyses demonstrated that the proband's antibody was reactive against HEK-293 cells transfected with control but not proband's SLC29A1 cDNA. Consistent with this finding, proband's antibody was found to be reactive with At(a-) (AUG:-2), but not AUG:-1 (null phenotype) RBCs. Data from structural analysis further supported that the proband's p.Asn81Ser variation does not alter ENT1 binding of its specific inhibitor NBMPR. CONCLUSION Our study provides evidence for a novel high-prevalence antigen, AUG4 (also called ATAM after the proband's name) in the Augustine blood group system, encoded by the rare SLC29A1 variant allele AUG*04 (c.242A > G, p.Asn81Ser).
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Affiliation(s)
| | | | - Romain Duval
- Université de Paris Cité, Inserm, BIGR, Paris, France
- Centre National de Référence pour les Groupes Sanguins, Établissement Français de Sang (EFS), Paris, France
| | - Luc Reininger
- Université de Paris Cité, Inserm, BIGR, Paris, France
| | - Vijaya L Damaraju
- Department of Oncology, University of Alberta, Edmonton, Alberta, Canada
| | | | - Yves Colin
- Université de Paris Cité, Inserm, BIGR, Paris, France
| | | | | | | | - Thierry Peyrard
- Université de Paris Cité, Inserm, BIGR, Paris, France
- Centre National de Référence pour les Groupes Sanguins, Établissement Français de Sang (EFS), Paris, France
| | - Slim Azouzi
- Université de Paris Cité, Inserm, BIGR, Paris, France
- Centre National de Référence pour les Groupes Sanguins, Établissement Français de Sang (EFS), Paris, France
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Mathur S, Sawhney H, Bertoni MA, Gupta R. Antibody to a high-prevalence blood group antigen Ata associated with Sjögren's syndrome. Ann Hematol 2008; 87:497-8. [PMID: 18074134 DOI: 10.1007/s00277-007-0419-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2007] [Accepted: 11/20/2007] [Indexed: 10/22/2022]
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Arndt PA, Garratty G. A retrospective analysis of the value of monocyte monolayer assay results for predicting the clinical significance of blood group alloantibodies. Transfusion 2004; 44:1273-81. [PMID: 15318848 DOI: 10.1111/j.1537-2995.2004.03427.x] [Citation(s) in RCA: 90] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Cellular assays (e.g., monocyte monolayer assays [MMAs]) have been used to predict the clinical significance of red blood cell (RBC) alloantibodies. STUDY DESIGN AND METHODS Twenty years of MMA data were retrospectively analyzed to 1) determine the optimal cut point (by correlating MMA results from 46 patients with RBC survival study results and/or laboratory and clinical signs of hemolytic transfusion reactions [HTRs] when incompatible blood was transfused), and 2) determine what percentage of 251 unusual alloantibodies (most to high-incidence antigens) were predicted to be clinically significant. RESULTS Two MMA cut points (5% and 20%) were chosen using a receiver-operating characteristics curve. No patients with MMA results less than or equal to 5 percent had clinical signs of a reaction; one-third of patients with MMA results 5.1 to 20 percent versus two-thirds with results greater than 20 percent had clinical signs of a HTR after transfusion of incompatible blood. Using 5-percent or 20-percent cut points, 173 (69%) or 97 (39%) of 251 unusual alloantibodies gave positive MMAs, respectively. CONCLUSION A negative MMA (< or =5%) indicates that incompatible blood can be given without risk of an overt HTR but does not guarantee normal long-term survival of those RBCs. Most unusual alloantibodies are predicted to cause shortened RBC survival, but transfusion of incompatible blood may not result in any clinical or laboratory signs of a HTR. We have used the MMA for approximately 20 years, instead of a 1-hour chromium-51 RBC survival, to aid in the decision to transfuse RBCs incompatible with antibodies to high-incidence antigens.
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Affiliation(s)
- Patricia A Arndt
- Research Department, American Red Cross Blood Services, Southern California Region, Los Angeles, California, USA.
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Abstract
BACKGROUND Anti-At(a) is a rare red cell (RBC) alloantibody found in the black population. It has been described as causing one case of mild hemolytic disease of the newborn, but its ability to cause hemolytic transfusion reactions is uncertain. CASE REPORT The patient was a 60-year-old black female with a history of three uneventful pregnancies but no transfusions. On admission, her direct and indirect antiglobulin tests were negative, total bilirubin was 0.5 mg per dL, and lactate dehydrogenase was 224 IU per L. She received nine units of compatible RBCs in the perioperative period of a hemicolectomy. Her hemoglobin rose appropriately and stabilized at 12.6 g per dL by the 6th postoperative day. By Day 10 after surgery her hemoglobin had dropped to 6.8 g per dL, and her total bilirubin and lactate dehydrogenase had risen to 1.4 mg per dL and 783 IU per L, respectively. The direct and indirect antiglobulin tests were now newly positive with strengths of 3+. A warm hemolytic autoantibody was suspected. She was transfused two units of incompatible RBCs for a rapidly falling hemoglobin and symptomatic anemia. On Day 11, the total bilirubin rose to 3.5 mg per dL, and the lactate dehydrogenase was 1154 IU per L with a hemoglobin of 7.6 g per dL. Corticosteroids were begun. Studies of serum and an acid eluate revealed anti-At(a), but no other RBC antibodies. The patient stabilized, and further transfusion was avoided. CONCLUSION Although anti-At(a) was previously described as being of uncertain clinical significance, this patient demonstrated the ability of the antibody to cause a severe delayed hemolytic transfusion reaction.
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Affiliation(s)
- K L Cash
- Department of Pathology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York 10467, USA.
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Abstract
Ata is a high-frequency red blood cell (RBC) antigen. Anti-At(a) has been reported in rare At(a-) black subjects. We report two cases of anti-At(a). A clinically significant anti-At(a) was found in a 26-year-old black woman with systemic lupus erythematosus. The patient had a transfusion reaction with chills and nausea during a RBC survival study, and 95% of the radiolabeled At(a+) RBCs were destroyed within 3 h. A concurrently performed monocyte monolayer assay was strongly reactive. Anti-At(a) thus can cause rapid hemolysis of transfused RBCs, but At(a-) donor units are extremely scarce in rare donor registries. A second patient at our hospital had anti-At(a) which did not affect her newborn. She also had autoimmune disease, insulin-dependent diabetes mellitus.
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Affiliation(s)
- G Ramsey
- Department of Pathology, Northwestern University Medical School, Chicago, Ill., USA
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