HLA-F and LILRB1 Genetic Polymorphisms Associated with Alloimmunisation in Sickle Cell Disease.

Red blood cell (RBC) transfusion remains a critical component in caring for the acute and chronic complications of sickle cell disease (SCD). Patient alloimmunisation is the main limitation of transfusion, which can worsen anaemia and lead to delayed haemolytic transfusion reaction or transfusion deadlock. Although biological risk factors have been identified for immunisation, patient alloimmunisation remains difficult to predict. We aimed to characterise genetic alloimmunisation factors to optimise the management of blood products compatible with extended antigen matching to ensure the self-sufficiency of labile blood products. Considering alloimmunisation in other clinical settings, like pregnancy and transplantation, many studies have shown that HLA Ib molecules (HLA-G, -E, and -F) are involved in tolerance mechanism; these molecules are ligands of immune effector cell receptors (LILRB1, LILRB2, and KIR3DS1). Genetic polymorphisms of these ligands and receptors have been linked to their expression levels and their influence on inflammatory and immune response modulation. Our hypothesis was that polymorphisms of HLA Ib genes and of their receptors are associated with alloimmunisation susceptibility in SCD patients. The alloimmunisation profile of thirty-seven adult SCD patients was analysed according to these genetic polymorphisms and transfusion history. Our results suggest that the alloimmunisation of SCD patients is linked to both HLA-F and LILRB1 genetic polymorphisms located in their regulatory region and associated with their protein expression level.

Good outcome after rituximab treatment for a mixed warm and cold autoimmune haemolytic anaemia.

Mixed warm and cold autoimmune anaemia is a rare haemolytic anaemia that is commonly associated with lymphoproliferative disorders and autoimmune diseases. Although steroid therapy is the first-line treatment, rituximab represents a good alternative. The present study reports on a successful treatment with rituximab in a young woman suffering from a mixed warm and cold autoimmune haemolytic anaemia associated with a mixed connective tissue disease.

HLA-DRB1 polymorphism is associated with Kell immunisation.

K immunisation is observed in some polytransfused patients and pregnant women but does not occur in all cases of K incompatibility. This study analysed the role of genetic background in this selective response to K antigen by investigating HLA-DRB1 alleles associated with K immunisation in a southern European population. HLA-DRB1 genotyping was performed by polymerase chain reaction sequence-specific oligonucleotide/sequence-specific primer procedures in 54 K immunised patients and 200 healthy controls. The frequency of HLA-DRB1*11 was significantly higher in K immunised patients than healthy controls: 31 of 54 (57%) vs. 56 of 200 (28%) (P(c) < 0.001). In the remaining K immunised HLA-DRB1*11-negative patients, the frequency of HLA-DRB1*13 was increased: 14 of 23 (61%) vs. 49 of 144 in healthy controls (34%) (P < 0.02). The combined frequency of the two HLA-DRB1 alleles (HLA-DRB1*11 and HLA-DRB1*13) was 83% in K immunised patients when compared with 52% in healthy controls (P(c) < 0.001). K and k differ by a single amino acid T193 (M). The DRB1*11 and DRB1*13 alleles share a HLA-DRB1 gene sequence containing S in position 13, D in 70 and A in 74, and coding for the P4 pocket within the HLA-DR binding groove. This feature of the HLA-DRB1 gene could be involved in the K peptide presentation through a polymorphism ligand specific for the T193 (M) of K. In conclusion, this study demonstrated a high frequency of HLA-DRB1*11 or HLA-DRB1*13 alleles in K immunised patients, which could be due to specific K peptide presentation by HLA-DR molecules.

HLA-DRB1 alleles and Jk(a) immunization.

BACKGROUND: In transfusion medicine, anti-Jk(a) has been implicated in hemolytic transfusion reactions. Development of anti-Jk(a) after transfusion does not always occur after Jk(a-) patients receive at least 1 unit of Jk(a+) blood unit. This study was designed to identify HLA-DRB1 alleles associated with predisposition to Jk(a) immunization after blood transfusion or pregnancy. STUDY DESIGN AND METHODS: Genotyping by polymerase chain reaction and sequence-specific oligonucleotide probe nonradioactive hybridization/sequence-specific primers was performed in 20 Jk(a)-immunized patients and 200 controls from the same southern European population. RESULTS: Genotyping showed that HLA-DRB1*01 was significantly more frequent in Jk(a)-immunized patients than controls: 55 percent versus 17 percent (odds ratio [OR], 5.9; confidence interval [CI], 2.3-15.5; corrected p value<0.05). Because HLA-DRB1*0101, DRB1*0102, and DRB1*1001 share a common sequence in their B1 chain, that is, F in 13, R in 71, and A in 74, HLA genetic predisposition was analyzed by comparing patients and controls with respect to the distribution of F13/R71/A74-positive and -negative alleles. Results demonstrated greater positivity of the F13/R71/A74 sequence (DRB1*0101, *0102, or *1001) in patients than in controls: 65 percent versus 19.5 percent (OR, 7.7; CI, 2.9-20.5; p<0.001). CONCLUSION: In conclusion, HLA-DRB1*0101, DRB1*0102, and DRB1*1001, which share a common DRB1 sequence, appeared to be overrepresented in Jk(a)-immunized patients.