C3d-binding assay for the detection of complement activating HLA antibodies: A useful tool for allocation to highly sensitised recipients in the post-CDC era?

The CDC crossmatch test is being phased out in solid organ donor allocation, and standard luminex single antigen bead assays do not differentiate complement activating function of HLA antibodies. The current study investigated the LIFECODES C3d-binding assay to determine if it could accurately predict actual T and B cell CDC results in a cohort of highly sensitised patients. Nineteen serum samples from different highly sensitised solid organ patients were crossmatched against cells from 62 unique donors, with 174 total T and B cell crossmatches performed. The sera also underwent SAB assay using OLI and LC platforms, and C3d-binding assay. Complement activating ability of each unique HLA antibody specificity detected using SAB was assigned based on the actual CDC results, which was then used to determine the accuracy of the C3d-binding assay. The C3d-binding assay was found to be highly accurate, with sensitivity of 95%, specificity 89% and negative predictive value 97% for class I DSA and the T cell CDC crossmatch results. Furthermore, we found 100% accuracy for prediction of the complement activating function of HLA-C antibodies. Negative predictive value of above 90% was also found for HLA class II DSA. C3d-binding proved more accurate than virtual crossmatch alone to predict CDC results. This study confirms that the C3d-binding assay predicts actual CDC crossmatch results accurately. In particular, the high negative predictive value of the C3d-binding assay may be extremely useful to define HLA antibodies that do not activate complement in highly sensitised recipients.

A novel allocation strategy for the difficult-to-allocate donor: audit of deceased donor kidneys utilised for preemptive recipients within Western Australia.

Kidney donor allocation can occasionally be difficult in Australia given a small population spread over vast distances. Therefore, between 2017 and 2019 our service allowed transplantation from deceased donors into local (same-state) preemptive recipients, only if no well-matched dialysis-dependent transplant waitlist recipient was available. Transplantation using this novel allocation pathway was associated with good clinical and immunological outcomes.

Do variations in the HLA-E ligand encoded by UL40 distinguish individuals susceptible to HCMV disease?

Human cytomegalovirus (HCMV) is carried lifelong by ∼80 % of adults worldwide, generating distinct disease syndromes in transplant recipients, people with HIV (PWH) and neonates. Amino acids 15-23 encoded by the HCMV gene UL40 match positions 3-11 of HLA-A and HLA-C, and constitute a "signal peptide" able to stabilise cell surface HLA-E as a restriction element and a ligand of NKG2A and NKG2C. We present next generation sequencing of UL40 amplified from 15 Australian renal transplant recipients (RTR), six healthy adults and four neonates, and 21 Indonesian PWH. We found no groupwise associations between the presence of multiple sequences and HCMV burden (highest in PWH) or HCMV-associated symptoms in neonates. Homology between UL40 and corresponding HLA-C and HLA-A peptides in 11 RTR revealed perfect matches with HLA-C in three individuals, all carrying HCMV encoding only VMAPRTLIL - a peptide previously associated with viremia. However indices of the burden of HCMV did not segregate in our cohort.

Protective HLA-B57: T cell and natural killer cell recognition in HIV infection.

Understanding the basis of the immune determinants controlling disease outcome is critical to provide better care to patients and could be exploited for therapeutics and vaccine design. The discovery of the human immunodeficiency virus (HIV) virus as the causing agent of acquired immunodeficiency syndrome (AIDS) decades ago, led to a tremendous amount of research. Among the findings, it was discovered that some rare HIV+ individuals, called HIV controllers (HICs), had the ability to control the virus and keep a low viral load without the need of treatment. This ability allows HICs to delay or avoid progression to AIDS. HIV control is strongly associated with the expression of human leukocyte antigen (HLA) alleles in HICs. From the HIV protective HLAs described, HLA-B57 is the most frequent in HIC patients. HLA-B57 can present a large range of highly conserved Gag-derived HIV peptides to CD8+ T cells and natural killer (NK) cells, both the focus of this review. So far there are limited differences in the immune response strength, magnitude, or receptor repertoire towards HIV epitopes that could explain viral control in HICs. Interestingly, some studies revealed that during early infection the large breadth of the immune response towards HIV mutants in HLA-B57+ HIC patients, might in turn influence the disease outcome.

High-resolution human KIR genotyping.

Killer immunoglobulin-like receptors (KIR) regulate the function of natural killer cells through interactions with various ligands on the surface of cells, thereby determining whether natural killer (NK) cells are to be activated or inhibited from killing the cell being interrogated. The genes encoding these proteins display extensive variation through variable gene content, copy number and allele polymorphism. The combination of KIR genes and their ligands is implicated in various clinical settings including haematopoietic stem cell and solid organ transplant and infectious disease progression. The determination of KIR genes has been used as a factor in the selection of optimal stem cell donors with haplotype variations in recipient and donor giving differential clinical outcomes. Methods to determine KIR genes have primarily involved ascertaining the presence or absence of genes in an individual. With the more recent introduction of massively parallel clonal next-generation sequencing and single molecule very long read length third-generation sequencing, high-resolution determination of KIR alleles has become feasible. Determining the extent and functional impact of allele variation has the potential to lead to further optimisation of clinical outcomes as well as a deeper understanding of the functional properties of the receptors and their interactions with ligands. This review summarizes recently published high-resolution KIR genotyping methods and considers the various advantages and disadvantages of the approaches taken. In addition the application of allele level genotyping in the setting of transplantation and infectious disease control is discussed.

Platelet-Reactive Antibodies in Patients after Ischaemic Stroke-An Epiphenomenon or a Natural Protective Mechanism.

Ischaemic brain damage induces autoimmune responses, including the production of autoantibodies with potential neuroprotective effects. Platelets share unexplained similarities with neurons, and the formation of anti-platelet antibodies has been documented in neurological disorders. The aim of this study was to investigate the presence of anti-platelet antibodies in the peripheral blood of patients after ischaemic stroke and determine any clinical correlations. Using a flow cytometry-based platelet immunofluorescence method, we detected platelet-reactive antibodies in 15 of 48 (31%) stroke patients and two of 50 (4%) controls (p < 0.001). Western blotting revealed heterogeneous reactivities with platelet proteins, some of which overlapped with brain proteins. Stroke patients who carried anti-platelet antibodies presented with larger infarcts and more severe neurological dysfunction, which manifested as higher scores on the National Institutes of Health Stroke Scale (NIHSS; p = 0.009), but they had a greater recovery in the NIHSS by the time of hospital discharge (day 7 ± 2) compared with antibody-negative patients (p = 0.043). Antibodies from stroke sera reacted more strongly with activated platelets (p = 0.031) and inhibited platelet aggregation by up to 30.1 ± 2.8% (p < 0.001), suggesting the potential to interfere with thrombus formation. In conclusion, platelet-reactive antibodies can be found in patients soon after ischaemic stroke and correlate with better short-term outcomes, suggesting a potential novel mechanism limiting thrombosis.

Different eplet software programs give discordant and incorrect results: An analysis of HLAMatchmaker vs Fusion Matchmaker Eplet calling software.

HLA eplet matching is a novel approach to define acceptable HLA mismatches for transplant recipients. We performed an eplet analysis of three different transplant case-series to determine if the available software programs gave accurate results. Eplet analysis was performed for three different transplant case-series typed by NGS for all HLA class I and II loci. The three different HLA datasets were entered into both the HLAMatchmaker program (v2.1) and OLI Fusion MatchMaker (v4.2) software tools. Eplet results which were discordant were cross referenced against eplet registry and published HLA allele sequence data to determine the correct assignments. The comparison reveals that there was poor concordance between the two eplet programs. Analysis of the same donor/recipient pair often gave rise to different total eplet scores, incorrect eplet mismatches and antibody verification status, and both programs have eplets assigned to incorrect HLA alleles. Overall, the OLI Fusion MatchMaker eplet tool gave more accurate and useful eplet results. Eplet matching is still primarily a research tool. Before eplet matching can enter routine clinical practice further work is required to validate the accuracy of available eplet software programs. Incorrect eplet assignment could have serious adverse consequences in the clinical transplant setting.

Quality control project of NGS HLA genotyping for the 17th International HLA and Immunogenetics Workshop.

The 17th International HLA and Immunogenetics Workshop (IHIW) organizers conducted a Pilot Study (PS) in which 13 laboratories (15 groups) participated to assess the performance of the various sequencing library preparation protocols, NGS platforms and software in use prior to the workshop. The organizers sent 50 cell lines to each of the 15 groups, scored the 15 independently generated sets of NGS HLA genotyping data, and generated "consensus" HLA genotypes for each of the 50 cell lines. Proficiency Testing (PT) was subsequently organized using four sets of 24 cell lines, selected from 48 of 50 PS cell lines, to validate the quality of NGS HLA typing data from the 34 participating IHIW laboratories. Completion of the PT program with a minimum score of 95% concordance at the HLA-A, HLA-B, HLA-C, HLA-DRB1 and HLA-DQB1 loci satisfied the requirements to submit NGS HLA typing data for the 17th IHIW projects. Together, these PS and PT efforts constituted the 17th IHIW Quality Control project. Overall PT concordance rates for HLA-A, HLA-B, HLA-C, HLA-DPA1, HLA-DPB1, HLA-DQA1, HLA-DQB1, HLA-DRB1, HLA-DRB3, HLA-DRB4 and HLA-DRB5 were 98.1%, 97.0% and 98.1%, 99.0%, 98.6%, 98.8%, 97.6%, 96.0%, 99.1%, 90.0% and 91.7%, respectively. Across all loci, the majority of the discordance was due to allele dropout. The high cost of NGS HLA genotyping per experiment likely prevented the retyping of initially failed HLA loci. Despite the high HLA genotype concordance rates of the software, there remains room for improvement in the assembly of more accurate consensus DNA sequences by NGS HLA genotyping software.

Morphology Changes Upon Scaling a High-Efficiency, Solution-Processed Solar Cell From Spin-Coating to Roll-to-Roll Coating.

Solution processing via roll-to-roll (R2R) coating promises a low cost, low thermal budget, sustainable revolution for the production of solar cells. Poly[(5,6-difluoro-2,1,3-benzothiadiazol-4,7-diyl)-alt-(3,3‴-di(2-octyldodecyl)-2,2';5',2″;5″,2‴-quaterthiophen-5,5-diyl)], PffBT4T-2OD, has recently been shown to achieve high power conversion efficiency (>10%) paired with multiple acceptors when thick films are spun-coat from hot solutions. We present detailed morphology studies of PffBT4T-2OD based bulk heterojunction films deposited by the volume manufacturing compatible techniques of blade-coating and slot-die coating. Significant aspects of the film morphology, the average crystal domain orientation and the distribution of the characteristic phase separation length scales, are remarkably different when deposited by the scalable techniques vs spun-coat. Yet, we find that optimized blade-coated devices achieve PCE >9.5%, nearly the same as spun-coat. These results challenge some widely accepted propositions regarding what is an optimal BHJ morphology and suggest the hypothesis that diversity in the morphology that supports high performance may be a characteristic of manufacturable systems, those that maintain performance when coated thicker than ≈200 nm. In situ measurements reveal the key differences in the solidification routes for spin- and blade- coating leading to the distinct film structures.

Relativistic Binaries in Globular Clusters.

Galactic globular clusters are old, dense star systems typically containing 104-106 stars. As an old population of stars, globular clusters contain many collapsed and degenerate objects. As a dense population of stars, globular clusters are the scene of many interesting close dynamical interactions between stars. These dynamical interactions can alter the evolution of individual stars and can produce tight binary systems containing one or two compact objects. In this review, we discuss theoretical models of globular cluster evolution and binary evolution, techniques for simulating this evolution that leads to relativistic binaries, and current and possible future observational evidence for this population. Our discussion of globular cluster evolution will focus on the processes that boost the production of tight binary systems and the subsequent interaction of these binaries that can alter the properties of both bodies and can lead to exotic objects. Direct N-body integrations and Fokker-Planck simulations of the evolution of globular clusters that incorporate tidal interactions and lead to predictions of relativistic binary populations are also discussed. We discuss the current observational evidence for cataclysmic variables, millisecond pulsars, and low-mass X-ray binaries as well as possible future detection of relativistic binaries with gravitational radiation.

The lymphocyte crossmatch by flow cytometry for kidney transplantation.

The flow cytometric lymphocyte crossmatch is a standard technique for evaluating the compatibility of potential kidney transplant recipients and donors. Recipient serum is incubated with donor lymphocytes and the latter are analysed in a flow cytometer for the presence of bound IgG antibodies. An increase in the level of IgG binding compared to a negative control indicates the presence of donor-specific antibodies which may lead to deleterious graft function. Described here is a method to perform T and B lymphocyte crossmatching in the same tube to detect IgG donor-reactive antibodies.

A fluorogenic dye activated by S-nitrosothiols.

Here we describe a coumarin-phosphine dye that undergoes activation of coumarin fluorescence upon reaction with S-nitrosothiols.

Room-temperature preparation of nanocrystalline TiO2 films and the influence of surface properties on dye-sensitized solar energy conversion.

An extremely easy method is presented for producing surfactant-free films of nanocrystalline TiO2 at room temperature with excellent mechanical stability when deposited on glass or plastic electrodes for dye-sensitized solar energy conversion. Prolonged magnetic stirring of commercial TiO2 nanoparticles (Degussa P25) in either ethanol or water results in highly homogeneous dispersions which are used to prepare TiO2 films with surface properties which depend on the solvent used for dispersing the particles, even after sintering. The optical and mechanical properties of films cast from ethanol and water dispersions are compared, and differences in the extent of surface defects and dye binding are observed. Optical absorption, photoluminescence, and resonance Raman spectra of TiO2 films sensitized with Ru(4,4'-dicarboxylic acid-2,2'-bipyridine)2(NCS)2 ("N3") reveal that the electronic coupling of the dye and semiconductor depends on the surface structure of the film which varies with film preparation. Current-voltage data for illuminated and dark dye-sensitized solar cells are obtained as a function of film preparation, and results are compared to spectroscopic data in order to interpret the microscopic basis for variations in solar cell performance, especially with regard to sintered versus unsintered TiO2 films. The results suggest that surface traps associated with oxygen vacancies play a critical role in determining the efficiency of dye-sensitized solar energy conversion through their influence on the binding and electronic coupling of the dye to the semiconductor.

Solvent effects on interfacial electron transfer from Ru(4,4'-dicarboxylic acid-2,2'-bipyridine)2(NCS)2 to nanoparticulate TiO2: spectroscopy and solar photoconversion.

Resonance Raman spectra are reported for Ru(4,4'-dicarboxylic acid-2,2'-bipyridine)2(NCS)2 (commonly called "N3") in ethanol solution and adsorbed on nanoparticulate colloidal TiO2 in ethanol (EtOH) and in acetonitrile (ACN), at wavelengths within the visible absorption band of the dye. Raman cross sections of free N3 in EtOH are found to be similar to those of N3 adsorbed on colloidal TiO2 in EtOH, and are generally lower than those of N3 on TiO2 in ACN. Strong electronic coupling mediated by surface states results in red-shifted absorption spectra and enhanced Raman signals for N3 adsorbed on nanocolloidal TiO2 in ACN compared to EtOH. In contrast, the absorption spectrum of N3 on nanocrystalline TiO2 in contact with solvent is similar for ACN and EtOH. Wavelength-dependent depolarization ratios for N3 Raman bands of both free and adsorbed N3 reveal resonance enhancement via two or more excited electronic states. Luminescence spectra of N3 adsorbed on nanocrystalline films of TiO2 and ZrO2 in contact with solvent reveal that the quantum yield of electron injection phi(ET) into TiO2 decreases in the order ACN > EtOH > DMSO. Dye-sensitized solar cells were fabricated with N3 adsorbed on nanocrystalline films of TiO2 in contact with ACN, EtOH, and DMSO solutions containing LiI/LiI3 electrolyte. Photoconversion efficiencies eta were found to be 2.6% in ACN, 1.3% in DMSO, and 0.84% in EtOH. Higher short circuit currents are found in cells using ACN, while the maximum voltage is found to be largest in DMSO. It is concluded that the increased photocurrent and quantum yield of interfacial electron transfer in acetonitrile as compared to ethanol and DMSO is primarily the result of faster electron injection of N3 when adsorbed on TiO2 in the presence of ACN as opposed to EtOH or DMSO.