巢式序列特异性引物PCR方法检测HLA单倍体相合供受者间母胎微嵌合的临床应用研究

目的 探索临床应用巢式序列特异性引物聚合酶链式反应(PCR-SSP)方法 检测HLA单倍体相合供受者间母胎微嵌合状态的可行性.方法 选取25对拟行HLA单倍体相合造血L干细胞移植治疗的实体肿瘤患者及其供者,供受者为母子关系15例,父子关系10例.采集供受者外周血提取基因组DNA,采用巢式PCR-SSP方法 检测患者外周血中供者来源的HLA-DRB1位点,并计算母胎微嵌合阳性率.随机选取经巢式PCR.SSP证实嵌合刚性和阴性且供受者性别不同的患者各4例,采用荧光原位杂交(FISH)技术进行重复检测,并与巢式PCR-SSP方法 的检测阳性率进行比较,同时采用噻唑蓝法检测这8例患者分别与其亲缘供者和HLA完全不相合无关第3人之间的混合淋巴细胞增殖反应(MLR),并计算增殖指数(SI).结果 巢式PCR-SSP方法 灵敏度町高达0.001%,并具有较好的特异性.巢式PCR-SSP检测显示,在母子移植关系患者中母胎微嵌合阳性检出率为40%(6/15),而在父子移植关系患者中母胎微嵌合阳性检出率为0.巢式PCR-SSP方法 的检测灵敏度与FISH技术相比明显增高,其检测阳性率分别为50%(4/8)和12.5%(1,8).MLR检测显示,嵌合阳性患者对其亲缘供者和无关第3人外周血单个核细胞(PBMC)的S1分别为(0.949±0.023)、(1.320±0.095),嵌合阴性患者对其亲缘供者和无关第3人PBMC的SI分别为(1.133±0.036)、(1.245±0.069);嵌合阳性患者对其亲缘供者PBMC的增殖反应强度与嵌合阴性患者相比明显降低(P=0.001),并且也显著低于其对无关第3人PBMC的增殖反应强度(P=0.003).结论 巢式PCR-SSP方法 灵敏度高、特异性好,适用于临床HLA单倍体相合供受者间母胎微嵌合状态的快速检测.     

HLA单倍体与全相合异基因造血干细胞移植治疗恶性血液病

背景：异基因造血干细胞移植是治疗恶性血液病的一种非常有效的方法。单倍体相合的造血干细胞移植扩大了移植的应用范围,是无HLA相合供者患者的一种重要选择。 目的：比较HLA单倍体相合与全相合异基因造血干细胞移植治疗恶性血液病的临床疗效。 方法：回顾性分析接受异基因造血干细胞移植79例恶性血液病患者的临床资料,其中HLA单倍体相合组26例、全相合组53例,对比两组受者移植物抗宿主病的发生率、复发率、2年生存率等。 结果与结论：78例受者获得完全、持久供者干细胞植入;1例受者在移植后28 d尚未植入,后因感染死亡。两组慢性移植物抗宿主病发生率、复发率和2年无病生存率差异无显著性意义(P > 0.05)。单倍体相合组急性移植物抗宿主病发生率高于全相合组(P < 0.05);2年总生存率低于全相合组(P < 0.05)。提示血缘HLA单倍体相合移植治疗恶性血液病的安全性及疗效接近于全相合移植,在缺乏HLA相合供者的情况下,行HLA单倍体相合造血干细胞移植治疗恶性血液病是切实可行的选择。     

减低剂量预处理方案在亲缘HLA单倍体相合造血干细胞移植中的应用

背景：近年来减低剂量预处理异基因造血干细胞移植已被证明是安全有效的治疗手段,在同胞全相合和无关供者中应用逐年增多,它特别适合老年人或年轻人合并器官功能障碍的患者,然而由于找到HLA配型相合供体的概率不高,使得同胞全相合和无关供者减低剂量预处理异基因造血干细胞移植开展受限,而HLA不相合/单倍体供体则可以迅速找到,但减低剂量预处理的单倍体造血干细胞移植应用的报道还较少,国内尚未见报道,因此对减低剂量预处理的单倍体造血干细胞移植的开展情况进行综述非常重要。 目的：综述减低剂量预处理在亲缘HLA单倍体造血干细胞移植中的应用现状。 方法：以“减低剂量预处理方案、非清髓性预处理方案、HLA单倍体相合、造血干细胞移植和No-nmyeloablative  conditioning,Reduced-intensity conditioning,HLA-haploidentical,Hematopoietic stem cell transplantation”为检索词,应用计算机检索1997至2014年万方数据库、CNKI和PubMed数据库、外文医学信息资源检索平台检索关于减低剂量预处理在亲缘HLA单倍体造血干细胞移植中应用的相关文献,根据纳入标准和排除标准,最终选取25篇文献进行分析,全部为英文。 结果与结论：减低剂量预处理异基因造血干细胞移植在HLA同胞全相合及无关供者中开展的较多且效果愈来愈好。减低剂量预处理的单倍体造血干细胞移植开展的较晚且报道较少,其植入、感染、移植相关死亡、移植物抗宿主病、长期无病生存率和总生存率等各个研究的结果差异较大,早期结果稍差,而近期总体情况有明显改善。目前看减低剂量预处理的单倍体造血干细胞移植是可行的,尤其对于找不到同胞相合及无关全相合供者的患者来说,HLA单倍体相合的血缘关系亲属成为最有潜力的干细胞来源。减低剂量预处理的单倍体造血干细胞移植保留较强的移植物抗白血病效应,且寻找供者容易,有足够的细胞后续治疗如供者淋巴细胞输注,同时通过发挥移植物抗白血病效应,可有效清除患者体内的肿瘤细胞,为处在疾病进展期或经历多次治疗失败的患者,尤其是老年患者、合并器官功能障碍及并发症患者,提供有效的挽救治疗手段。但由于开展的时间较短,今后在应用中该如何选择最佳方案、最佳时机以及减低移植物抗宿主病、移植相关死亡率及复发率等尚需进一步深入的研究。中国组织工程研究杂志出版内容重点：干细胞;骨髓干细胞;造血干细胞;脂肪干细胞;肿瘤干细胞;胚胎干细胞;脐带脐血干细胞;干细胞诱导;干细胞分化;组织工程全文链接：     

单倍体相合异基因造血干细胞移植治疗白血病

背景：对于无HLA全相合同胞供者的患者,采用单倍体相合造血干细胞移植面临移植物抗宿主病重、移植相关死亡率高的风险,但通过不同的移植模式,将有可能获取相近的疗效。 目的：观察亲缘HLA单倍体相合异基因造血干细胞移植治疗白血病的疗效,并与亲缘HLA全相合异基因造血干细胞移植相比较。 方法：45例白血病患者分为2组。单倍体组移植方式为外周血或联合骨髓干细胞移植,预处理方案为改良白消安与环磷酰胺或加抗胸腺细胞球蛋白,移植物抗宿主病的预防采用环孢素A+甲氨蝶呤+霉酚酸脂;全相合组移植方式为外周血干细胞移植,预处理方案为BuCY,移植物抗宿主病的预防采用环孢素A+甲氨蝶呤。 结果与结论：两组均获得造血重建时间差异无显著性意义。单倍体及全相合组急性移植物抗宿主病的累积发病率分别为73%对52%(P > 0.05);慢性移植物抗宿主病的累积发病率分别为56%对45%(P > 0.05);移植相关死亡率分别为36%对17%(P > 0.05);单倍体组无复发,全相合组复发2例;两组的预计3年累积无病生存率分别为61%对60%(P > 0.05)。结果提示,亲缘单倍体异基因造血干细胞移植的总体疗效与亲缘全相合异基因造血干细胞移植相似,但中重度急性移植物抗宿主病的发生率较后者为高。     

HLA-E基因与allo-HSCT移植效果关系的研究

目的： 探讨HLA-E基因与异基因造血干细胞移植（allo-HSCT）效果的关系。方法：用PCR-SSP方法分别检测22对allo-HSCT供者及受者的HLA-E基因型，并分2组：供受者HLA-E相合组和供受者HLA-E不合组。比较2组在移植后植入率、移植物抗宿主病（GVHD）、免疫重建、自体恢复或恶性病复发等方面的差异。结果：22对移植病例的供受者中，共检出3个HLA-E等位基因，分别为E*0101、E*01031和E*01032，未检出E*0102和*0104。供受者HLA-E相合组9对，供受者HLA-E不合组13对。两组在移植后植入率、GVHD、免疫重建、自体恢复或恶性病复发等无统计学差异。结论：HLA-E基因多态性与allo-HSCT移植效果未见相关性。     

HLA-Cw基因的高分辨分型在造血干细胞移植中意义的初步探讨

目的研究HLA-Cw基因的高分辨分型在急性白血病非亲缘性造血干细胞移植中的意义。方法对中国造血干细胞捐献者资料库中提供的76例白血病患者（ALL21例、CML32例、AML23例），采用序列特异性引物聚合酶链反应（PCR—SSP）联合序列特异性寡核苷酸探针（PCR．SSOP）方法进行HLA高分辨分型。结果舭患者中HLA—Cw高分辨分型的常见位点：Cw＊0102、Cw＊0304、Cw＊0302、Cw＊0702、Cw＊0801；表型频率分别为0．57、0．33、0．19、0．14、0．14。ALL患者与志愿者相比其Cw＊0102、Cw＊0304的表型频率差异有统计学意义，P〈0．05；而Cw＊0302、Cw＊0702、Cw＊0801的表型频率无统计学意义，P〉0．05。7例ALL患者与供者HLA的10个位点全相合，占33．3％，mA-Cw全相合最常见的基因亚位点为Cw＊0102（4，7），次之为Cw＊0702（2／7）。CML患者中mA-Cw高分辨分型的常见位点：Cw＊0702、Cw＊0102、Cw＊0304、Cw＊0801、Cw＊0401、Cw＊0303；表型频率分别为0．41、0．34、0．22、0．19、0．16、0．13，这些基因位点与志愿者相比其表型频率均无统计学意义，P〉0．05。8例患者与供者的10个位点全相合，占25．0％，HLA—Cw全相合最常见的基因亚位点为Cw＊0702（5／8），次之为Cw＊0304（3／8）。在23例AML患者中4例与供者HLA的10个位点全相合患者均为M2型。结论在ALL患者中其Cw＊0102和Cw＊0304基因表型频率明显增高，有利于ALL患者寻找到相合位点的供体。HLA—Cw基因是造成移植物抗宿主病（GVHD）发生和影响移植效果的重要因素，在非亲缘性和单倍体移植中必须进行HLA-Cw基因的高分辨检测。     

供者特异性HLA抗体在配型不合Allo-SCT植入失败中的作用:现状与挑战

单倍型相合供者已经成为缺乏人类白细胞分化抗原(human leukocyte antigen, HLA)相合供者的移植候选患者的重要替代干细胞来源之一。然而,植入失败仍是单倍型相合移植、HLA不合无关供者和脐血移植后的主要并发症和死亡原因之一。近年来的研究发现,供者特异性抗HLA抗体(donor specific anti-HLA antibody, DSA)与HLA不合移植后的植入失败密切相关。了解DSA检测方法、流行病学以及处理手段对于减少植入失败、改善移植预后具有重要意义。     

小鼠非清髓外周造血干细胞移植后供者淋巴细胞输注的实验研究

目的:探讨受者皮肤致敏后的供者淋巴细胞输注对受者嵌合状态的影响及供者嵌合比率与混合淋巴细胞反应(MLR)和受者重建的T细胞亚群间的关系。方法:受鼠C57BL/6小(H-2b)第0天接受X射线全身照射,4小时内移植经rhG-CSF动员后的BALB/c小鼠(H-2d)外周血干细胞2×107个,第2天腹腔注射环磷酰胺200mg/kg,并分别于第28天输注致敏/未致敏的供者淋巴细胞2×106个。结果:移植后第21天模型组小鼠PCR检测结果均呈混合嵌合(MC)状态;致敏后DLI的受鼠60天时转变为完全供者嵌合(CC),CD4+/CD8+T淋巴细胞比值早期下降,60天时有所升高,仍略低于正常水平,MLR呈现供者特异性低反应性;未致敏的DLI受鼠嵌合率虽稍有上升,仍为MC,CD4+/CD8+比值早期升高,后期降至正常水平,MLR供者反应性亦有所下降。结论:经rhG-CSF动员后可以成功建立非清髓性allo-PBSCT小鼠MC模型;经受者皮肤致敏后的DLI能够诱导稳定的CC,高比率嵌合与供者CD4+/CD8+比值下降及MLR的特异性免疫低反应性间具有良好相关性。     

KIR受配体模式在治疗急性淋巴细胞白血病中的研究

目的 研究在无关供体造血干细胞移植中急性淋巴细胞白血病(ALL)的杀伤细胞免疫球蛋白样受体(KIR)受配体模式对自然杀伤(NK)细胞的异源反应性活性预示造血干细胞移植的影响.方法 采用基因测序和序列特异性引物聚合酶链反应(PCR-SSP)的方法,对中国造血干细胞捐献者资料库中提供的23对HLA全相合供受者进行KIR及HLA高分辨基因分型;流式缃胞术动态随访CD158分子表达水平;患者均为ALL.结果 23对供受者中17例供者KIR2D12/L3有相应的患者配体HLACw1、3、7、8、12、14;6例供者KIR2DL1有相应的患者配体HLA-Cw6、15;16例供者KIR3DL1有相应的患者配体HLA-Bw4;12例供者3DL2有相应的患者配体HLA-A11.23对供受者中有19对接受了造血干细胞移植,供受者KIR基因完全相同或宿主抗移植物(HVG)方向移植相关死亡率高,分别为33.3%和40.0%;移植物抗宿主(GVH)方向移植卡甘关死亡率低,为12.5%.供受者在GVH方向时,移植物抗宿主病(GVHD)发生率高(50.0%)且有多种激活性(aKIR)的组合;而HVG方向GVHD发生率低(20.0%).19对供受者有5对均为KIR基因A单体型,其中2对供受者为KIR2DS4*001/002亚型,移植后死亡;3对供受者KIR2DS4为KIR2DS4*003-007亚型,1年后无病生存.移植后随访无GVHD发生时,CD158a的表达逐渐下降;有GVHD发生时,CD158a的表达逐渐增高;移植后早期受者NK细胞百分比为(23.4±3.8)%,高于正常人水平[(2.04±0.58)%,P<0.05],差异有统计学意义.结论 供者的KIR2DL1、KIR3DL1是引起NK细胞异源反应活性的重要抑制性KIR.KIR受配体模式不仅能预示无关供体异基因造血于细胞移植的预后,更能帮助临床提高ALL异基凶造血干细胞移植的总生存率及无病生存率,降低移植后相关死亡率和防止白血病复发.     

干细胞移植治疗重型再生障碍性贫血：研究应用与进展

文题释义：获得性再生障碍性贫血：是一种免疫介导的骨髓衰竭性疾病,主要表现为骨髓有核细胞增生低下、一系或多系血细胞减少及其所致的贫血、出血和感染。获得性再生障碍性贫血的发病机制尚未完全阐明,目前认为T淋巴细胞异常活化、功能亢进造成骨髓造血功能衰竭在获得性再生障碍性贫血发病机制中占主要地位。 人类白细胞抗原：即HLA,是人类主要组织相容性复合体的表达产物,HLA的研究最初是在器官移植研究推动下开展起来的,因此HLA又称移植抗原。在遗传学中,主要组织相容性复合体是作为一个单位孟德尔式传递的。因此,同胞之间可有HLA相同、半相同和不同3种情况。 背景：异基因造血干细胞移植仍然是获得性重型再生障碍性贫血患者的唯一治愈方法,如何选择适合移植的重型再生障碍性贫血患者进行治疗成为近年的研究热点。 目的：从HLA全相合无关供者造血干细胞移植、非血缘脐血移植和单倍体相合造血干细胞移植3个方面进行综述,阐述异基因造血干细胞移植的研究进展。 方法：检索2000至2018年期间收录在PubMed、中国知网期刊全文数据库及万方数据库中异基因造血干细胞移植治疗重型再生障碍性贫血的相关文献,检索词为“unrelated donor,haploidentical,unrelated cord blood,severe aplastic anemia”及“无关供者,单倍体相合,无血缘脐血,重型再生障碍性贫血”。 结果与结论：①HLA全相合同胞供者造血干细胞移植是治疗重型再生障碍性贫血的一线治疗方案,但鉴于HLA相合同胞供者不易寻找,HLA全相合无关供者造血干细胞移植作为重要的替代治疗手段,目前疗效已接近HLA全相合同胞供者造血干细胞移植,但移植物抗宿主病、严重感染的发生率仍高于HLA全相合同胞供者造血干细胞移植,在选择HLA全相合无关供者造血干细胞移植治疗时仍然需要多因素综合考虑;②脐血造血干细胞来源丰富且配型成功率高,使得非血缘脐血移植的应用变得普遍,预冻存总有核细胞量>3.9×10⁷/kg时非血缘脐血植入概率较高,但鉴于非血缘脐血植入延迟、免疫功能重建延迟等因素,临床治疗重型再生障碍性贫血时只有在其他移植方式不可行且第1个疗程免疫抑制治疗失败后才应考虑非血缘脐血移植;③单倍体相合造血干细胞移植具有供者易获得且依从性好等优点,疗效接近全相合移植,现已成为一种重要的替代移植选择;巴利昔单抗和(或)抗胸腺细胞球蛋白的使用有望降低移植物抗宿主病的发生率以拓展单倍体相合造血干细胞移植的临床应用范围。 ORCID: 0000-0003-3509-920X(丁宇斌) 中国组织工程研究杂志出版内容重点：干细胞;骨髓干细胞;造血干细胞;脂肪干细胞;肿瘤干细胞;胚胎干细胞;脐带脐血干细胞;干细胞诱导;干细胞分化;组织工程     

Detection of HLA-DRB1 microchimerism using nested polymerase chain reaction and single-strand conformation polymorphism analysis

For the detection of microchimerism, molecular methods detecting donor-specific HLA-DRB1 alleles in the recipient are most commonly used. Nested polymerase chain reaction sequence specific primer (nested PCR-SSP) methods widely used to increase the sensitivity of detection have been reported to give frequent false-positive reactions. We have developed a new method combining nested PCR with single-strand conformation polymorphism analysis (nested PCR-SSCP) and tested the 1 to 0.00001% level of microchimerism for 27 different HLA-DRB1 alleles. For most (26/27) of the HLA-DRB1 alleles tested, this method could detect 0.01 to 0.001% of microchimerism and its sensitivity was equal to or better than that of nested PCR-SSP tested in parallel. Its specificity was verified by visualizing particular DRB1-specific SSCP bands under test. Nested PCR-SSP indicated frequent false-positive reactions, mainly caused by nonspecific amplification of DRB3/B4/B5 alleles present in the major (recipient) DNAs. We have compared a real-time quantitative PCR for non-human leukocyte antigen (HLA) target (insertion/deletion marker) using a commercial kit (AlleleSEQR Chimerism assay), and its microchimerism detection sensitivity (around 0.1%) was 1 step (10 times) lower than that of nested PCR-SSP or -SSCP methods for HLA-DRB1 alleles. We validated that the newly designed nested PCR-SSCP affords good sensitivity and specificity and may be useful for studying microchimerism in clinical settings.     

Matched-Pair Analysis of Transplant from Haploidentical,Unmanipulated Bone Marrow Donor versus HLA Identical Sibling for Patients with Hematologic Malignancies

A matched-pair analysis of transplant-related outcomes was carried out in 116 of 255 consecutive patients who received transplants from an HLA identical sibling (n = 58) or haploidentical related donor (n = 58). The 2 patient series were matched with 9 variables: period of transplant, patient and donor age, sex, diagnosis, disease phase, conditioning regimen, donor-recipient sex, and cytomegalovirus (CMV) status combinations. As graft-versus-host disease (GVHD) prophylaxis, all patients received the standard cyclosporine and methotrexate association with the addition of anti-thymocyte globulins, mycophenolate mofetil, and basiliximab in haploidentical, unmanipulated bone marrow recipients. Anti-infectious management, transfusion policy, and supportive care were identical for all patients. By comparing the 2 patient series, no statistically significant difference was observed for the cumulative incidence of advanced acute and extensive chronic GVHD, transplant-related mortality, and relapse. With a median follow-up of 3.5 years, the 5-year disease-free survival was 37% ± 6% and 36% ± 6% for HLA identical sibling and haploidentical recipients, respectively. The results of transplant from HLA identical siblings and haploidentical donors are comparable. Regardless of the HLA matching, other factors known to affect the transplant outcomes, such as donor-recipient age, sex, and CMV status combinations, might drive the search for the best donor.     

Selection of unrelated bone marrow donors by PCR-SSP typing and subsequent nonradioactive sequence-based typing for HLA DRB1/3/4/5, DQB1, and DPB1 alleles

Abstract: HLA incompatibility between bone marrow recipients and unrelated donors is one of the main obstacles in bone marrow transplantation. HLA class I and generic class II DR and DQ typing is generally performed by serology. Precise subtyping of HLA class II genes, however, can only be achieved by molecular genetic methods. Here, the final selection of serologically pretyped unrelated bone marrow donors by confirmatory PCR-SSP (PCR-sequence-specific primers) typing and subsequent nucleic acid sequence analysis of the second exon of DRB1, DRB3, DRB4, DRB5, DQB1, and DPB1 alleles is presented. Serologically identical potential marrow donors and their corresponding recipients were analyzed for HLA-DRB identity by PCR-SSP analysis. After solid-phase single-strand separation, direct sequencing of the allele- or group-specific DRB amplified products was performed by applying fluorophor-labelled sequencing primers. Electrophoretically separated sequencing products were detected by means of an automated DNA sequencer. Group-specific amplification and sequencing of DQB1 alleles was carried out for all potential bone marrow donors and recipients, while only the final donor-recipient pair was analyzed for DPB1 alleles. Thus, the presented amplification strategy in combination with direct sequencing of PCR products allows matching of bone marrow transplant pairs with the highest degree of reliability for the assessment of HLA class II identity.     

HLA class I DNA typing of 215 "HLA-A, -B, -DR zero mismatched" kidney transplants

DNA typing for HLA class II improves the typing quality and this was shown previously to be relevant for kidney graft survival. In this project we addressed the question whether molecular typing for HLA class I also increases the efficacy of HLA matching in kidney transplantation. 215 HLA-A,-B,-DR zero-mismatched donor/recipient pairs as defined by serological typing were selected. Retrospective HLA-A and HLA-B typing was performed both by the PCR-SSP and the PCR-SSOP method. DNA typing for HLA-A revealed discrepant results to serology in 5.7% of the donors and 2.8% of the recipients. HLA-B typing discrepancies were found in 6.6% of the donors and 5.6% of the recipients. 10.4% of the donors and 6.5% of the recipients showed either an HLA-A or an HLA-B discrepancy. Nearly one-third of the HLA-A discrepancies affected A19 splits. The most common reason for HLA-A discrepancies was the erroneous assignment of serological blanks, whereas HLA-B errors were caused mainly by the assignment of incorrect specificities. DNA typing allowed the definition of HLA-A and -B split specificities in all 118 "splitable" cases for which only broad specificities were reported based on serological typing. A total of 183 DNA class I compatible transplants had a 15% higher one-year graft survival rate than 32 transplants for which DNA typing revealed a class I incompatibility.     

Paucity of HLA-Identical Unrelated Donors for African-Americans with Hematologic Malignancies: The Need for New Donor Options

Identification of an HLA identical donor/recipient pair using high-resolution techniques at HLA A, B, C, and DRB1 optimizes survival after adult unrelated hematopoietic stem cell transplant. It has been estimated that roughly 50% of African-Americans have suitable unrelated donors based on serologic typing, but there is little information on the likelihood of identifying an HLA-identical unrelated donor using molecular techniques. From February 2002 to May 2007, we performed 51 unrelated donor searches for African-American patients using the National Marrow Donor Program^® and found HLA identical unrelated donors for only 3. By contrast, 50 (98%) had at least 1, and often multiple, appropriately matched cord blood units available. Very few African-American recipients have HLA-identical unrelated donors. To allow more African-American patients to proceed to transplant, innovative donor strategies, including adult cord blood transplantation, haploidentical transplant, or the identification of permissive mismatches should be investigated.     

转化生长因子-β1基因型在移植肾慢性排斥反应中的作用

 目的 探讨供、受者转化生长因子-β1 (TGF-β1)基因型与移植肾慢性排斥反应的关系。方法 用序列特异引物聚合酶链反应（PCR-SSP）方法，对144例肾移植受者和65例部分供者的TGF-β1基因分泌型进行检测。结果 受者TGF-β1为高分泌型时移植肾慢性排斥反应发生率与受者为中低分泌型者相比差异有统计学意义（P<0.01）。供者TGF-β1为高分泌型时移植肾慢性排斥反应发生率与供者为中低分泌型者相比差异无统计学意义（P>0.05）。受者高分泌/供者高分泌TGF-β1基因型组合的受者慢性排斥反应发生率比所有其它基因型组合者高（P<0.01）。而受者中低分泌/供者中低分泌TGF-β1基因型组合的受者慢性排斥反应发生率比所有其它基因型组合者低(P<0.01)。结论 同时检测供、受者TGF-β1基因分泌型对预测移植肾慢性排斥反应发生率有意义。     

HLA-AB typing by polymerase-chain reaction with sequence-specific primers: more accurate, less errors, and increased resolution compared to serological typing

Until recently, serological typing has been the primary technique used for HLA class I analysis. But because of limitations, molecular-typing techniques have replaced or supplemented the microlymphocytotoxicity test. It has been assumed that HLA class I serological typing was more accurate than serological HLA-DR typing; the latter has been shown to have 10-25% errors. But several studies have shown that HLA-AB typing was poorer than expected, and error frequencies between 5-25% were reported. This study systematically investigated the accuracy of HLA class I serological AB typing in healthy, bone-marrow registry donors, necrokidney donors, kidney-transplantation patients (on waiting lists), and haematological disorder patients. Genomic HLA class I typing, which uses polymerase-chain reaction with sequence-specific primers (PCR-SSP), gave discrepant results in 3-24% of the patients, compared to serological typings. The highest error rate (24%) was found among haematological disorder patients. Among the kidney waiting-list patients and necrokidney donors, 11% discrepancies were found. In the consecutively typed bone-marrow donors group, 3% errors were found. But among those with only one detected HLA-A specificity, 12% discrepancies were found, and among donors with only one detected HLA-B specificity, 19% errors were found. Based on these results, we recommend that patients with haematological disorders should be typed using genomic techniques. In investigations of bone-marrow registry donors and kidney patients, in which only one serological specificity is found, additional typing by genomic methods should be done.     

Human leucocyte antigen diversity: A biological gift to escape infections,no longer a barrier for haploidentical Hemopoietic Stem Cell Transplantation

Since the beginning of life, every multicellular organism appeared to have a complex innate immune system although the adaptive immune system, centred on lymphocytes bearing antigen receptors generated by somatic recombination, arose in jawed fish approximately 500 million years ago. The major histocompatibility complex MHC, named the Human leucocyte antigen (HLA) system in humans, represents a vital function structure in the organism by presenting pathogen‐derived peptides to T cells as the main initial step of the adaptive immune response. The huge level of polymorphism observed in HLA genes definitely reflects selection, favouring heterozygosity at the individual or population level, in a pathogen‐rich environment, although many are located in introns or in exons that do not code for the antigen‐biding site of the HLA. Over the past three decades, the extent of allelic diversity at HLA loci has been well characterized using high‐resolution HLA‐DNA typing and the number of new HLA alleles, produced through next‐generation sequencing methods, is even more rapidly increasing. The level of the HLA system polymorphism represents an obstacle to the search of potential compatible donors for patients affected by haematological disease proposed for a hematopoietic stem cell transplant (HSCT). Data reported in literature clearly show that antigenic and/or allelic mismatches between related or unrelated donors and patients influences the successful HSCT outcome. However, the recent development of the new transplant strategy based on the choice of haploidentical donors for HSCT is questioning the role of HLA compatibility, since the great HLA disparities present do not worsen the overall clinical outcome. Nowadays, NGS has contributed to define at allelic levels the HLA polymorphism and solve potential ambiguities. However, HLA functions and tissue typing probably need to be further investigated in the next future, to understand the reasons why in haploidentical transplants the presence of a whole mismatch haplotype between donors and recipients, both the survival rate and the incidence of acute GvHD or graft rejection are similar to those reported for unrelated HSCTs.     

Immune Reconstitution Following Unmanipulated HLA-Mismatched/Haploidentical Transplantation Compared with HLA-Identical Sibling Transplantation

In this study, we prospectively investigated the immune reconstitution in patients with hematological malignancies after human leukocyte antigen (HLA)-mismatched/unmanipulated haploidentical transplantation (50 cases) and HLA-matched transplant (25 cases). Transplant-related mortality, relapse, leukemia-free survival, and overall survival were similar between the two transplant strategies, although the cumulative incidence of CMV antigenemia was significantly higher in haploidentical recipients than in HLA-matched recipients (49.9 ± 7.2% versus 13 ± 7%, P = 0.007). Compared with HLA-matched recipients, T-cell subset and dendritic cell subgroup cell counts in the first 90 days after grafting were lower in haploidentical recipients. The difference was most striking for CD4⁺ and CD4⁺ na?ve T cells. Reconstitution of B cells and monocytes was comparable between groups. T cells appeared equally functional in both groups among patients without graft-versus-host disease. Our results suggest that the clinical outcomes were not compromised by the early delayed immune reconstitution following haploidentical transplantation.     

中国汉族人群供-受者HLA-A、B、Cw、DRB1和DQB1高分辨等位基因频率分布及错配比例的研究

目的 从基因高分辨水平,分析中国汉族人群供-受者人类白细胞抗原(human leukocyte antigens,HLA)-A、B、Cw、DRB1、DQB1各位点等位基因频率和分布的多态性;及供-受者等位基因匹配情况.方法 采用基因测序分型(sequence based typing,SBT)、序列特异性寡核苷酸探针法(sequence specific oligonueleotide probe,SSOP)和序列特异性引物法(sequence specific primer,SSP),对2540名中国汉族人的(其中1168名受者,1372名供者)DNA标本进行HLA高分辨基因分型,并作统计学处理.结果 2540份样本中共检测到44种HLA-A等位基因,频率高于0.05的A*1101、A*2402、A*0201、A*0207、A*3303、A*0206、A*3001共占80.4%;81种HLA-B等位基因,频率高于0.05的B*4001、B*4601、B*5801、B*1302、B*5101共占43.0%;44种HLA-Cw等位基因,频率高于0.05的Cw*0702、Cw*0102、Cw*0304、Cw*0801、Cw*0602、Cw*0303、Cw*0302、Cw*0401共占80.3%;61种HLA-DRB1等位基因,频率高于0.05的DRB1*0901、DRB1*1501、DRB1*1202、DRB1*0803、DRB1*0701、DRB1*0405、DRB1*0301、DRB1*1101共占70.1%;22种HLA-DQB1等位基因,频率高于0.05的DQB1*0301、DQB1*0303、DQB1*0601、DQB1*0602、DQB1*0202、DQB1*0302、DQB1*0401、DQB1*0502、DQB1*0201共占87.4%.这5个位点均处于杂合子缺失状态,其中A、B、DRB1位点符合HardyWeinberg平衡(Hardy-Weinberg equi1ibrium,HWE)(P＞0.05);Cw、DQB1位点偏离HWE(P＜0.05);排除个别基因型观察值与期望值偏差较大外,这5个位点均符合HWE.在供-受者数据的比较中,HLA全相合(10/10)的比例仅22.4%;单个等位基因错配(9/10)的比例为24.6%;两个等位基因错配(8/10)的比例为26.3%.结论 中国汉族人群高分辨水平HLA-A、B、Cw、DRB1,DQB1等位基因频率及分布特点,对非亲缘造血干细胞移植供者检索有重要参考价值;并为中华骨髓库数据入库和利用提供遗传学依据.

Abstract：

Objective To analyze the allele frequencies and polymorphism of human leukocyte antigens (HLA) -A, B, Cw, DRB1 and DQB1 between donors-recipients on high-resolution typing; and to analyze the matching and mismatching proportion between donors and recipients. Methods HLA highresolution types were determined by sequence based typing (SBT), sequence specific oligonucleotide probe (SSOP) and sequence specific primer (SSP) on 2540 unrelated Chinese Han individuals including 1168 recipients and 1372 donors, then statistical analyses were carried out. Results Forty-four HLA-A alleles were detected, and among them the frequencies of A * 1101, A * 2402, A * 0201, A * 0207, A * 3303, A *0206 and A * 3001 exceeded 0.05, and accounted for 80.4%. Eighty-one HLA-B alleles were detected, and frequencies of B * 4001, B * 4601, B * 5801, B * 1302 and B * 5101 exceeded 0. 05, and accounted for 43. 0% of total. There were 44 HLA- Cw alleles, among them the frequencies of Cw * 0702, Cw * 0102,Cw * 0304, Cw * 0801, Cw * 0602, Cw * 0303, Cw * 0302 and Cw * 0401 exceeded 0.05, and were 80.3 %of total. There were 61 HLA-DRB1 alleles, the frequencies of DRB1 * 0901, DRB1 * 1501, DRB1 * 1202,DRB1 * 0803, DRB1 * 0701, DRB1 * 0405, DRB1 * 0301 and DRB1 * 1101 exceeded 0. 05, and were 70. 1% of total. Finally, 22 HLA-DQB1 alleles were detected, the frequencies of DQB1 * 0301, DQB1 *0303, DQB1 * 0601, DQB1 * 0602, DQB1 * 0202, DQB1 * 0302, DQB1 * 0401, DQB1 * 0502 and DQB1 *0201 exceeded 0. 05, and they were 87.4% of total. All the five loci were of heterozygote deficiency. The HLA-A, B and DRB1 loci conformed to Hardy-Weinberg equilibrium (HWE) (P＞0. 05); but HLA-Cw and HLA-DQB1 loci did not (P＜0.05). Except several particular genotypes, all the five loci conformed to HWE. After comparing data between donors and recipients, only 22.4% of recipients found HLA matched donors (10/10); 24. 6% of recipients found single HLA allele mismatched donors (9/10); 26. 3% of recipients had two HLA alleles mismatched donors (8/10). Conclusion The characteristics of allele frequencies and polymorphism of HLA-A, B, Cw, DRB1 and DQB1 on high-resolution typing in Chinese Han population is valuable for donor searching in unrelated hematopoietic stem cell transplantation, and it provides genetic basis for donor registry and usage of donor resource for Chinese Marrow Donor Program.