Evaluation of solid-phase panreactivity with negative direct antiglobulin testing.

Solid-phase red cell adherence (SPRCA) is a sensitive platform for antibody detection, but nonspecific reactions may occur. One pattern of apparent nonspecific reactivity is a panagglutinin with a negative direct antiglobulin test (DAT). The purpose of this study was to define the clinical characteristics of patients with these nonspecific reactions and their associated serologic findings. Twenty patients with panreactive SPRCA testing results were identified between November 2022 and May 2023. In addition to panagglutinins, these patients had (1) a negative polyethylene glycol (PEG) antibody detection test, (2) a negative PEG autocontrol, and (3) a negative DAT. The strength of SPRCA panreactivity and the results of eluate testing (by tube and SPRCA) were studied. Clinical characteristics of patients included age, sex, and primary diagnosis. Each patient was also assessed for evidence of hemolysis. Fourteen female and six male patients were evaluated (average age 44 years). Primary diagnoses included pregnancy (n = 10), acute bleeding (n = 4), orthopedic (n = 3), and other (n = 3). There was no clinical or laboratory evidence of hemolysis. The predominant strength of SPRCA panreactivity was evenly distributed across reaction grades (1+ to 3+). Fifty-five percent of the eluates tested in PEG showed panreactivity, consistent with warm-reactive autoantibodies, while 85 percent of eluates tested by SPRCA were panreactive. Six discrepant cases, in which PEG eluate testing was negative and solid-phase eluate testing showed panreactivity, were associated with weak solid-phase plasma panreactivity (1+). In addition, the reactivity strengths of the eluates tested by SPRCA were invariably more strongly reactive than those eluates tested in PEG. Panagglutination is a distinct SPRCA-only plasma reactivity pattern. Despite a negative PEG tube and DAT, most panagglutinins are warm-reactive autoantibodies. Fortunately, these "interfering" panagglutinins do not appear to be clinically significant and are easily managed by an alternative testing method such as PEG.

Restricted VH gene usage by murine hybridomas directed against the human N, but not M, blood group antigen.

The M and N human blood group antigens are complex glycopeptide determinants at the amino terminus of the red blood cell membrane glycoprotein, glycophorin A. The heavy and light chain variable region cDNA sequences were determined for seven murine monoclonal antibodies recognizing glycophorin A. Three of the antibodies were anti-M and four were anti-N. Each of the anti-M antibodies was composed of VH and VL regions derived from distinct germline gene families (VH1 (J558), VH4 (X24), VH5 (7183), VK5, VK8, and VK19). In contrast, all four anti-N heavy chains were composed of VH regions derived from the VH2 (Q52) germline gene family and all used the same J4 gene segment. In addition, two of the anti-N light chains were composed of VK regions from the VK8 germline gene family and used the J1 gene segment. Since each anti-N hybridoma was derived from different mice immunized by different protocols, these results suggest that the murine immune response to the N, but not the M, human blood group antigen is restricted.

Preparation and characterization of fluorescein-labeled plasma membrane vesicles from transfected Chinese hamster ovary cells.

Plasma membrane vesicles have been used to study a wide variety of biological events including the nature of receptor-ligand interactions and the physiology of molecular transport across membranes. Plasma membrane vesicles were chemically induced from an adherent Chinese hamster ovary cell line expressing recombinant glycophorin A, a well-studied intrinsic membrane protein of the red blood cell. They were also prepared from Chinese hamster ovary cells in suspension culture. Biochemical and immunological assays demonstrated the equivalence of glycophorin A on cell membranes and vesicles. The transfected Chinese hamster ovary cell membrane was also labeled with a highly aliphatic fluorescent cell linker. Vesicles produced by the fluorescein-labeled cells demonstrated bright surface staining of the plasma membrane. They too expressed glycophorin A biochemically and immunologically indistinguishable from cellular-based glycophorin A. Plasma membrane vesicles are non-adherent in culture and stably retain the fluorescent probe in the cell membrane. Fluorescein-labeled vesicles will be particularly useful for studying cellular interactions in which both constituents of a receptor-ligand pair are expressed on adherent cell lines. Unlabeled vesicles may also prove to be useful as soluble immunoadsorbants in both the clinical laboratory and basic science research settings.

Sialic acid-dependent binding of baculovirus-expressed recombinant antigens from Plasmodium falciparum EBA-175 to Glycophorin A.

The Plasmodium falciparum Erythrocyte Binding Antigen-175, EBA-175, is a soluble merozoite stage parasite protein which binds to glycophorin A surface receptors on human erythrocytes. We have expressed two conserved cysteine-rich regions, region II and region VI, of this protein as soluble His-tagged polypeptides in insect cell culture, and have tested their function in erythrocyte and glycophorin A binding assays. Recombinant region II polypeptides comprised of the F2 sub-domain or the entire region II (F1 and F2 sub-domains together) bound to erythrocytes and to purified glycophorin A in a manner similar to the binding of native P. falciparum EBA-175 to human red cells. Removal of sialic acid residues from the red cell surface totally abolished recombinant region II binding, while trypsin treatment of the erythrocyte surface reduced but did not eliminate recombinant region II binding. Synthetic peptides from three discontinuous regions of the F2 sub-domain of region II inhibited human erythrocyte cell binding and glycophorin A receptor recognition. Immune sera raised against EBA-175 recombinant proteins recognized native P. falciparum-derived EBA-175, and sera from malaria-immune adults recognized recombinant antigens attesting to both the antigenicity and immunogenicity of proteins. These results suggest that the functionally-active recombinant region II domain of EBA-175 may be an attractive candidate for inclusion in multi-component asexual blood stage vaccines.

Severe intravascular hemolysis associated with brown recluse spider envenomation. A report of two cases and review of the literature.

Envenomation by the brown recluse spider (loxoscelism) is classically associated with a necrotic ulcer. Systemic manifestations occur in a minority of cases, but are generally mild and self-limited. The hematologic complications of brown recluse spider bite range from mild hemolysis to fulminant intravascular hemolysis with or without evidence of disseminated intravascular coagulation. Intravascular hemolysis is a rare but occasionally lethal complication of brown recluse spider envenomation. This article presents two cases of severe hemolysis associated with loxoscelism occurring in two young women in Memphis, Tennessee. The second documented death in an adult from severe hemolysis due to a brown recluse spider bite is reported. A review of the literature emphasizing the pathogenic mechanisms of spider bite hemolysis is also included.

A maternal warm-reactive autoantibody presenting as a positive direct antiglobulin test in a neonate.

Autoimmune hemolytic anemia in pregnancy is a rare cause of hemolytic disease of the newborn. This report describes a neonate with a mild hemolytic process and a positive direct antiglobulin test (DAT) presenting as the first manifestations of a maternal warm-reactive autoantibody. A full-term male neonate, blood group O, had a strongly positive DAT and laboratory evidence suggestive of a mild hemolytic process. The neonate's mother was also group O and had a negative antibody screen. Umbilical cord blood testing revealed a panreactive eluate though the antibody was not detected in cord serum. The neonate's mother was also found to have a positive DAT. A panagglutinin was identified in an eluate of her red cells, although the autoantibody could not be detected in her serum by a variety of sensitive techniques. There was no clinical or laboratory evidence of maternal hemolysis.

Recombinant blood group antigens are useful for studying the fine specificity of antibodies against glycophorin A encoded antigens.

Recombinant wild-type and variant forms of glycophorin A (GPA) were expressed in wild-type and glycosylation-defective Chinese hamster ovary cells. The binding to recombinant GPA of antibodies submitted to the Third International Workshop was assessed by immunoprecipitation and indirect immunofluorescence. This is a powerful approach for determining the fine specificity of antibodies to blood group antigens. The advantages and limitations of this approach are discussed.

Clinical utility of plasma membrane vesicles expressing recombinant glycophorin A-encoded blood group antigens.

BACKGROUND: Although the genes encoding most of the major blood group determinants are now cloned, recombinant blood group antigens are not commonly used in the clinical laboratory. This study assessed the feasibility of using plasma membrane vesicles expressing recombinant glycophorin A blood group antigens as soluble immunoadsorbants. STUDY DESIGN AND METHODS: Chinese hamster ovary cells were transfected with plasmids containing the cDNA encoding the M- or N-allele of glycophorin A. Plasma membrane vesicles were chemically induced from stable, high-expressing cell lines. Antibodies were assessed for reactivity in hemagglutination-inhibition assays. RESULTS: Eight anti-M antibodies were evaluated. Vesicles expressing the M-allele of glycophorin A neutralized four antibodies (two murine monoclonals; two human sera), while the activity of four human sera was unaffected. Three anti-N reagents were also evaluated (murine monoclonal antibody; rabbit polyclonal antibody; Vicia graminea lectin). All were neutralized by vesicles expressing the N-allele of glycophorin A. There was no detectable neutralization of other clinically significant blood group antibodies. CONCLUSIONS: Plasma membrane vesicles expressing recombinant glycophorin blood group determinants may prove to be useful reagents in the clinical laboratory. However, the partial failure of M antibody recognition requires further study. This general approach could be utilized for any similarly expressed recombinant blood group antigen.

The binding of human alloantibodies to recombinant glycophorin A.

Chinese hamster ovary (CHO) cells were transfected with the wild-type, M allele of glycophorin A cDNA. The binding of human alloantibodies to recombinant glycophorin A was assessed with a modified hemagglutination-inhibition assay. Patient sera were incubated with acetone powders derived from CHO cells, and the adsorbed supernatants were tested in standard hemagglutination assays. Five M antibodies and one sample containing anti-En(a) bound to transfected CHO cells expressing glycophorin A but did not bind to untransfected CHO cells. Three N antibodies as well as 21 other alloantibodies (representing other major red cell blood group specificities) bound to neither CHO cell line. The M allele specificity of recombinant glycophorin A was further verified by the demonstration that a high-titer D alloantibody maintained the same titer of agglutination after incubation with recombinant glycophorin A. Transfected CHO cells thus express an M blood group antigen that appears to be serologically equivalent to that found on human red cells. A panel of cell lines expressing mutant glycophorin A molecules with defined variations in amino acid sequence and carbohydrate composition will be useful in studies of the fine specificity of human glycophorin alloantibodies. This approach may also provide an abundant source of artificial antigens for clinical use in blood group serology.

Polyethylene glycol-coated red blood cells fail to bind glycophorin A-specific antibodies and are impervious to invasion by the Plasmodium falciparum malaria parasite.

This study was designed to assess the binding of glycophorin A-specific antibodies to polyethylene glycol (PEG)-modified red blood cells (RBCs) and evaluate their resistance to invasion by Plasmodium falciparum malaria parasites. RBCs were conjugated with a range of concentrations (0.05 to 7.5 mM) of activated PEG derivatives of either 3.35 or 18.5 kd molecular mass. The binding of glycophorin A-specific antibodies was assessed by hemagglutination and flow cytometry. PEG-modified RBCs were assessed for their ability to form rosettes around Chinese hamster ovary (CHO) cells transiently expressing the glycophorin A binding domain of EBA-175, a P falciparum ligand crucial to RBC invasion. PEG-RBCs were also tested for their ability to be invaded by the malaria parasite. RBCs coated with 3.35 and 18.5 kd PEG demonstrated a dose-dependent inhibition of glycophorin A-specific antibody binding, CHO cell rosetting, and P falciparum invasion. These results indicate that glycophorin A epitopes responsible for antibody and parasite binding are concealed by PEG coating, rendering these cells resistant to P falciparum invasion. These studies confirm the effectiveness of PEG modification for masking RBC-surface glycoproteins. This may provide a means to prevent alloimmunization in the setting of RBC transfusion and suggests a novel method to enhance the effectiveness of exchange transfusion for the treatment of cerebral malaria.

Plasmodium falciparum merozoite adhesion is mediated by sialic acid.

The invasion of host red blood cells by Plasmodium falciparum merozoites is a complex process requiring multiple receptor-ligand interactions. Glycophorin A, a sialic acid-rich integral membrane protein, is an important RBC receptor for merozoites. We stably expressed glycophorin A in wild type Chinese hamster ovary (CHO) cells and in Lec 2 CHO cells which have a defect in the ability to sialylate proteins. Malaria merozoites were assessed for the ability to adhere to CHO cells that were either untransfected or expressed recombinant glycophorin A. Merozoites only adhered to wild type CHO cells and they did so irrespective of the expression of glycophorin A. These results suggest that cellular adhesion, the earliest event in the malaria invasion process, is mediated by sialic acid residues. This model system will provide valuable molecular information regarding early events in the malaria invasion process.

A molecular biologic approach to study the fine specificity of antibodies directed to the MN human blood group antigens.

The human MN blood group Ags on glycophorin A are linear complex glycopeptide Ags determined by a combination of amino acid polymorphisms and O-glycans. M Ag has Ser and Gly, and N Ag has Leu and Glu, at positions 1 and 5, respectively. Amino acids 2 to 4 are O-glycosylated. To analyze the fine specificity of Abs recognizing these Ags, recombinant glycophorin A molecules were expressed in Chinese hamster ovary (CHO) cells. The M-allele cDNA was used to generate the N-allele by site-directed mutagenesis. Two chimeric mutants were similarly constructed: Gly5-->Glu mimics the rare Mc phenotype; Ser1-->Leu is not found in human populations. Each type of glycophorin A was transfected into wild type CHO cells. In addition, the M-allele was expressed by mutant CHO cells defective in sialylation. The binding of M and N Abs and an anti-N lectin to recombinant glycophorin A was assessed by various methods. Two anti-N mouse mAbs and the anti-N lectin required leucine at position 1, whereas Glu5 was not essential. One anti-M mAb required both Gly5 and sialic acid. Three human anti-M sera required Ser1, whereas Gly5 was not essential. Four anti-M and -N mouse mAbs failed to bind recombinant glycophorin A, probably due to undersialylation of the recombinant glycoprotein. These results show that CHO cells expressing glycophorin A molecules varying in amino acid sequence and carbohydrate composition are useful for studying the fine specificity of Ab and lectin interactions with this glycoprotein. This is a novel approach and model system for investigating the immune response to linear complex glycopeptide Ags, a class of Ags that has received little attention previously.

Biochemical characterization of the O-glycans on recombinant glycophorin A expressed in Chinese hamster ovary cells.

Alterations in N- and O-linked glycosylation affect cell surface expression and antigenicity of recombinant glycophorin A expressed in transfected Chinese hamster ovary (CHO) cells. To understand these effects further, glycophorin A was purified by immunoaffinity chromatography from transfected wild type and glycosylation deficient CHO cells. The O-glycans were characterized both biochemically, using gel filtration and high performance anion exchange chromatography, and immunologically, using carbohydrate specific monoclonal antibodies to probe Western blots. The O-glycans of human erythrocyte glycophorin A consist mainly of short oligosaccharides with one, two, or three sialic acid residues linked to a common disaccharide core, Gal beta 1-3GalNAc alpha 1-Ser/Thr, with the disialylated structure being the most abundant. With the exception of the trisialylated derivative, the same structures were found on recombinant glycophorin A expressed by wild type CHO cells. However, in contrast to human erythrocyte glycophorin A, the monosialylated oligosaccharide was the most abundant structure on the recombinant protein. Furthermore, recombinant glycophorin A was shown to express a small amount of the Tn antigen (GalNAc alpha 1-Ser/Thr). Recombinant glycophorin A had the same O-glycan composition, whether purified from clones expressing high or moderate levels of the recombinant glycoprotein. This indicates that the level of expression of the transfected glycoprotein did not affect its O-glycan composition. Deletion of the N-linked glycosylation site at Asn26, by introducing the Mi.I mutation (Thr28-->Met) by site-directed mutagenesis, did not markedly affect the O-glycan composition of the resulting recombinant glycoprotein expressed in wild type CHO cells.(ABSTRACT TRUNCATED AT 250 WORDS)

Recombinant Miltenberger I and II human blood group antigens: the role of glycosylation in cell surface expression and antigenicity of glycophorin A.

Glycophorin A is a heavily glycosylated glycoprotein (1 N-linked and 15 O-linked oligosaccharides) and is highly expressed on the surface of human red blood cells. It is important in transfusion medicine because it carries several clinically relevant human blood group antigens. To study further the role of glycosylation in surface expression of this protein, four mutations were separately introduced into glycophorin A cDNA by site-directed mutagenesis. Each of these mutations blocks N-linked glycosylation at Asn26 of this glycoprotein by affecting the Asn-X-Ser/Thr acceptor sequence. Two of these mutations are identical to the amino acid polymorphisms found at position 28 in the Mi.I and Mi.II Miltenberger blood group antigens. The mutated recombinant glycoproteins were expressed in transfected wild-type and glycosylation-deficient Chinese hamster ovary (CHO) cells. When expressed in wild-type CHO cells and analyzed on Western blots, each of the four mutants had a faster electrophoretic mobility than wild-type glycophorin A, corresponding to a difference of approximately 4 Kd. This change is consistent with the absence of the N-linked oligosaccharide at Asn26. Each of the four mutants was highly expressed on the surface of CHO cells, confirming that, in the presence of normal O-linked glycosylation, the N-linked oligosaccharide is not necessary for cell surface expression of this glycoprotein. To examine the role of O-linked glycosylation in this process, the Mi.I mutant cDNA was transfected into the IdlD glycosylation-deficient CHO cell line. When the transfected IdlD cells were cultured in the presence of N-acetylgalactosamine alone, only intermediate levels of cell surface expression were seen for Mi.I mutant glycophorin A containing truncated O-linked oligosaccharides. In contrast, when cultured in the presence of galactose alone, or in the absence of both galactose and N-acetylgalactosamine, Mi.I mutant glycophorin A lacking both N-linked and O-linked oligosaccharides was not expressed at the cell surface. This extends previous results (Remaley et al, J Biol Chem 266:24176, 1991) showing that, in the absence of O-linked glycosylation, some types of N-linked glycosylation can support cell surface expression of glycophorin A. The glycophorin A mutants were also used for serologic testing with defined human antisera. These studies showed that the recombinant Mi.I and Mi.II glycoproteins appropriately bound anti-Vw and anti-Hut, respectively. They also demonstrated that these antibodies recognized the amino acid polymorphisms encoded by Mi.I and Mi.II rather than cryptic peptide antigens uncovered by the lack of N-linked glycosylation.