Department of Microbiology and Immunology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
CREATE Inflammatory Diseases Programme, Singapore, Singapore.
Sci Rep. 2020 Oct 27;10(1):18397. doi: 10.1038/s41598-020-75355-4.
The current state-of-the-art technology employed to assess anti-human leukocyte antigen antibodies (Anti-HLA Ab) for donor-recipient matching and patient risk stratification in renal transplantation is the single antigen bead (SAB) assay. However, there are limitations to the SAB assay as it is not quantitative and due to variations in techniques and reagents, there is no standardization across laboratories. In this study, a structurally-defined human monoclonal alloantibody was employed to provide a mechanistic explanation for how fundamental alloantibody biology influences the readout from the SAB assay. Performance of the clinical SAB assay was evaluated by altering Anti-HLA Ab concentration, subclass, and detection reagents. Tests were conducted in parallel by two internationally accredited laboratories using standardized protocols and reagents. We show that alloantibody concentration, subclass, laboratory-specific detection devices, subclass-specific detection reagents all contribute to a significant degree of variation in the readout. We report a significant prozone effect affecting HLA alleles that are bound strongly by the test alloantibody as opposed to those bound weakly and this phenomenon is independent of complement. These data highlight the importance for establishing international standards for SAB assay calibration and have significant implications for our understanding of discordance in previous studies that have analyzed its clinical relevance.
目前,用于评估肾移植中供体-受者匹配和患者风险分层的抗人白细胞抗原抗体(Anti-HLA Ab)的最先进技术是单抗原珠(SAB)检测。然而,SAB 检测存在局限性,因为它不是定量的,并且由于技术和试剂的差异,实验室之间没有标准化。在这项研究中,我们使用结构定义的人单克隆同种异体抗体来提供机制解释,说明基本同种异体抗体生物学如何影响 SAB 检测的结果。通过改变 Anti-HLA Ab 浓度、亚类和检测试剂来评估临床 SAB 检测的性能。两个具有国际认可资质的实验室使用标准化的方案和试剂进行平行测试。我们表明,同种异体抗体浓度、亚类、实验室特定的检测设备、亚类特异性的检测试剂都对结果的变化有很大的影响。我们报告了一个显著的前带效应,影响了被测试同种异体抗体强烈结合的 HLA 等位基因,而不是那些结合较弱的等位基因,这种现象与补体无关。这些数据强调了为 SAB 检测校准建立国际标准的重要性,并对我们理解之前分析其临床相关性的研究中的差异具有重要意义。