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Saudi Journal of Kidney Diseases and Transplantation
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Table of Contents   
LETTER TO THE EDITOR  
Year : 2013  |  Volume : 24  |  Issue : 5  |  Page : 1000-1002
Finding new HLA-C alleles is useful for the success of bone marrow transplantation


1 U.O.C. Immunohematology, Transfusion Medicine and Transplant Immunology, Regional Reference Laboratory of Transplant Immunology, Naples, Italy
2 U.O.C. Immunohematology, Transfusion Medicine and Transplant Immunology, Regional Reference Laboratory of Transplant Immunology; Department of General Pathology, Chair of Clinical Pathology, and Excellence Research Centre on Cardiovascular Diseases, Azienda Universitaria Policlinico (AOU), Second University of Naples, Naples, Italy

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Date of Web Publication12-Sep-2013
 

How to cite this article:
Vasco M, Paolillo R, Napoli C. Finding new HLA-C alleles is useful for the success of bone marrow transplantation. Saudi J Kidney Dis Transpl 2013;24:1000-2

How to cite this URL:
Vasco M, Paolillo R, Napoli C. Finding new HLA-C alleles is useful for the success of bone marrow transplantation. Saudi J Kidney Dis Transpl [serial online] 2013 [cited 2019 Nov 22];24:1000-2. Available from: http://www.sjkdt.org/text.asp?2013/24/5/1000/118071
To the Editor,

We read with great interest the article "HLA-C polymorphisms in two cohorts of donors for bone marrow transplantation" by Jawdat et al. [1] This study focused its message on the importance of typing the human leukocyte antigen (HLA) loci of bone marrow donors by using molecular methods despite the serological analysis. Specifically, they described the difference between two methods used in identifying all possible HLA-C alleles. Thanks to the molecular method, they were able to identify two new HLA-C alleles resulting as blanks or homozygous. Therefore, they concluded that it is important to identify HLA-C alleles by molecular methods to investigate the role of HLA-C in the allograft and its contribution to better overall survival.

We agree to use the molecular HLA-C typing because it will be helpful for finding new allelic forms that could be involved in the bone marrow allograft rejection. [2] Patients affected by severe hematological pathologies are treated by bone marrow transplantation. [3] Because the intrafamilial donor is not always found, donors are recruited from international Registers. The success of transplantation strongly depends on the HLA matching between the donor and the recipient. [4] In view of the changing donor trends, there is an increase in number of unrelated bone marrow transplants. Possible solutions are recommended to increase the frequency with which all alleles can be determined. [2]

Current criteria for the selection of unrelated donors for hematopoietic cell transplantation is based on a high-resolution definition of the class I HLA-A, B and C and class II DRB1 and DQB1 alleles. [5],[6] In the past 30 years, the importance of the classical HLA-C gene has been underestimated, in part because of its low surface expression relative to HLA-A and -B, and, partially, it had been speculated that HLA-C molecules are deteriorating or lacking in function. [7],[8] In the recent ten years, HLA-C has attracted revived research interests on its biologic functions and influence on marrow transplantation [9],[10],[11],[12],[13] as well as allelic diversity in human populations. [14],[15] HLA-C mismatching could be implicated in graft rejection and graft-versus-host disease after bone marrow transplantation, as previously demonstrated. [16] The impact of mismatching most likely depends on a variety of recipient factors, although the impact of each variable has not yet been well established.

Studies from Fred Hutchinson Cancer Research Center (FHCRC) and the National Marrow Donor Program (NMDP) have demonstrated that HLA-C mismatching is associated with a strong adverse effect on the outcome of transplantation and may result in a decrease in survival. [9],[10] Another study performed by Froelich et al. [17] emphasized that the high-resolution typing by sequence-based typing (SBT) of the unrelated bone marrow donor HLA-C revealed an extremely rare situation. This study also emphasized the ability of SBT performed after mono-allelic amplification of HLA alleles in a case where SBT performed after bi-allelic amplification could only suggest as the typing result an allelic combination with mismatch(es).

Another study showed that knowledge of HLA-C alleles should be used to prioritize the selection or the exclusion of donors for further testing. [18] We retain that the authors underestimated an important aspect in the present study. [1] The duration of the recipient's waiting time was taken to select a matching unrelated bone marrow donor. A study performed by Dubois et al. [19] in the French population demonstrated how important it is to improve HLA typing for volunteers for first selection and how the French Transplant Centre requests significantly increased when additional typing of HLA-C or allelic typing for HLA-A, -B, -C and -DRB1 were carried out.

The application of DNA-based methodologies to the selection of unrelated donors for hematopoietic cell transplantation are more expensive than the serology method, but they have contributed to the improved survival of transplant recipients and have shed light on the basis of alloreactivity in transplantation.

In the future, it would be useful to use highresolution typing of major HLA loci involved in the allograft success at the time of enrolment in the registers as volunteers. Therefore, the costs will be elevated but they would be less higher than a number of subsequent tests that need to be performed on a potential donor. The main objective of the bone marrow registers should be to reduce the time employed for selecting a potential donor, because the time gained from rapid transplantation could save the recipient's life in the case of acute and proliferative diseases.

 
   References Top

1.Jawdat D, Al Saleh S, Sutton P, et al. HLA-C polymorphisms in two cohorts of donors for bone marrow transplantation. Saudi J Kidney Dis Transpl 2012;23:467-70.  Back to cited text no. 1
[PUBMED]  Medknow Journal  
2.Woolfrey A, Klein JP, Haagenson M, et al. HLA-C antigen mismatch is associated with worse outcome in unrelated donor peripheral blood stem cell transplantation. Biol Blood Marrow Transplant 2011;17:885-92.  Back to cited text no. 2
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3.Copelan EA. Hematopoietic stem-cell transplantation. N Engl J Med 2006;354:1813-26.  Back to cited text no. 3
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4.Petersdorf EW, Anasetti C, Martin PJ, et al. Limits of HLA mismatching in unrelated hematopoietic cell transplantation. Blood 2004;104:2976-80.  Back to cited text no. 4
[PUBMED]    
5.Bray RA, Hurley CK, Kamani NR, et al. National marrow donor program HLA matching guidelines for unrelated adult donor hematopoietic cell transplants. Biol Blood Marrow Transplant 2008;14:45-53.  Back to cited text no. 5
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6.Park M, Seo JJ. Role of HLA in Hematopoietic Stem Cell Transplantation. Bone Marrow Res 2012;2012:680841.  Back to cited text no. 6
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7.Snary D, Barnstable CJ, Bodmer WF, Crumpton MJ. Molecular structure of human histocompatibility antigens: The HLA-C series. Eur J Immunol 1977;7:580-5.  Back to cited text no. 7
[PUBMED]    
8.Güssow D, Rein RS, Meijer I, et al. Isolation, expression, and the primary structure of HLA-Cw1 and HLA-Cw2 genes: Evolutionary aspects. Immunogenetics 1987;25:313-22.  Back to cited text no. 8
    
9.Flomenberg N, Baxter-Lowe LA, Confer D, et al. Impact of HLA class I and class II high-resolution matching on outcomes of unrelated donor bone marrow transplantation: HLA-C mismatching is associated with a strong adverse effect on transplantation outcome. Blood 2004;104:1923-30.  Back to cited text no. 9
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10.Lee SJ, Klein J, Haagenson M, et al. High-resolution donor-receipt HLA matching contributes to the success of unrelated donor marrow transplantation. Blood 2007;110:4576-83.  Back to cited text no. 10
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11.Bray RA, Hurley CK, Kamani NR, et al. National marrow donor program HLA matching guidelines for unrelated adult donor hematopoietic cell transplants. Biol Blood Marrow Transplant 2008;14:45-53.  Back to cited text no. 11
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12.Morishima Y, Sasazuki T, Inoko H, et al. The clinical significance of human leukocyte antigen (HLA) allele compatibility in patients receiving a marrow transplant from serologi-cally HLA-A, HLA-B and HLA-DR matched unrelated donors. Blood 2002;99:4200-6.  Back to cited text no. 12
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13.Kawase T, Morishima Y, Matsuo K, et al. Japan marrow Donor Program. High-risk HLA allele mismatch combinations responsible for severe acute graft-versus-host disease and implication for its molecular mechanism. Blood 2007;110:2235-41.  Back to cited text no. 13
[PUBMED]    
14.Turner S, Ellexson ME, Hickman HD, et al. Sequence-based typing provides a new look at HLA-C diversity. J Immunol 1998;161:1406-13.  Back to cited text no. 14
[PUBMED]    
15.Lebedeva TV, Ohashi M, Huang A, Vasconcellos S, Flesch S, Yu N. Emerging new alleles suggest high diversity of HLA-C locus. Tissue Antigens 2005;65:101-6.  Back to cited text no. 15
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16.Petersdorf EW. Optimal HLA matching in hematopoietic cell transplantation. Curr Opin Immunol 2008;20:588-93.  Back to cited text no. 16
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17.Froelich N, Weschler B, Hanau D, Parissiadis A, Tourne S. Two new HLA-C alleles identified in one volunteer bone marrow donor: C*15:44 and C*07:137:02. Tissue Antigens 2011;78:73-4.  Back to cited text no. 17
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18.Hurley CK, Maiers M, Marsh SG, Oudshoorn M. Overview of registries, HLA typing and diversity, and search algorithms. Tissue Antigens 2007;69 Suppl 1:3-5.  Back to cited text no. 18
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19.Dubois V, Giannoli C, Balère ML, Rey S, Raffoux C, Rigal D. Does high-resolution donor typing of HLA-C or other loci upon registration confer advantages to patients? Hum Immunol 2011;72:1033-8.  Back to cited text no. 19
    

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Correspondence Address:
Maria Vasco
U.O.C. Immunohematology, Transfusion Medicine and Transplant Immunology, Regional Reference Laboratory of Transplant Immunology, Naples
Italy
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DOI: 10.4103/1319-2442.118071

PMID: 24029270

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