Pan Qinqin, Ma Xiao, You Yajie, Yu Yuejiao, Fan Su, Wang Xiaoyan, Wang Mengyuan, Gao Ming, Gong Guangming, Miao Kourong, Shen Jie, Zhou Xiaoyu
HLA Lab, Department of Transfusion, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, 210029, China.
Department of Pharmacy, Jinling Hospital, Nanjing University School of Medicine, Nanjing, 210002, China.
Immun Ageing. 2024 Feb 20;21(1):15. doi: 10.1186/s12979-024-00417-4.
With the development of Hematopoietic Stem Cell Transplantation (HSCT) technology, increasing numbers of elderly patients were undergoing allogeneic HSCT and elderly patients with hematologic malignancies could benefit most from it. Preformed donor-specific human leukocyte antigen (HLA) antibodies (DSA) were associated with graft failure in HLA-mismatched allogeneic HSCT and the absence of DSA was the main criterion of selecting the donor. Except for sensitization events such as transfusion, pregnancy or previous transplantation, ageing affects the humoral immune response both quantitatively and qualitatively. To evaluate the prevalence and distribution of anti-HLA and antibodies of MHC class I chain related antigens A (MICA) specificities in different age groups before initial HSCT would provide HLA and MICA specific antibody profiles under the impact of ageing, which could provide meaningful information in the process of selecting suitable HLA-mismatched donors by avoiding preformed DSA.
There were no significant differences in the distribution of anti-HLA class I, class II and anti-MICA antibodies among the three age groups in this study except that a significant lower negative ratio of anti-HLA class I, class II antibodies and higher positive rate of MICA antibodies with maximum mean fluorescent intensity (MFI) > 5000 in the elderly than in young age group. The distribution of antibody specificities against HLA -A, -B, -C, -DR, -DQ, -DP and MICA antigens in the three age groups were generally consistent. The anti-HLA class I antibody specificities with higher frequencies were A80,A68;B76,B45;Cw17, which were unlikely to become DSA in Chinese. Anti-HLA class II antibody specificities were more likely to become potential DSA than class I.DR7, DR9, DQ7, DQ8 and DQ9 were most likely to become potential DSA.
The prevalence of anti-HLA and anti-MICA antibodies increased slightly as age increased. While ageing had a small impact on the distribution of antibody specificity frequencies against HLA-A, -B, -C, -DR,-DQ, -DP and MICA antigens in recipients awaiting initial HSCT from East China. The risk of developing preformed DSA was basically consistent in the three age groups and the elderly group might be more favorable in HLA-mismatched HSCT due to higher positive rate of anti-MICA antibody.
随着造血干细胞移植（HSCT）技术的发展，越来越多的老年患者正在接受异基因HSCT，血液系统恶性肿瘤的老年患者可能从中获益最大。预先形成的供者特异性人类白细胞抗原（HLA）抗体（DSA）与HLA不匹配的异基因HSCT中的移植失败相关，而无DSA是选择供者的主要标准。除了输血、妊娠或先前移植等致敏事件外，衰老在数量和质量上都会影响体液免疫反应。评估初次HSCT前不同年龄组中抗HLA和MHC I类链相关抗原A（MICA）特异性抗体的流行情况和分布，将提供在衰老影响下的HLA和MICA特异性抗体谱，这可以在选择合适的HLA不匹配供者过程中通过避免预先形成的DSA提供有意义的信息。
本研究中，三个年龄组之间抗HLA I类、II类抗体和抗MICA抗体的分布没有显著差异，只是老年组中抗HLA I类、II类抗体的阴性率显著低于年轻组，且最大平均荧光强度（MFI）>5000的MICA抗体阳性率高于年轻组。三个年龄组中针对HLA -A、-B、-C、-DR、-DQ、-DP和MICA抗原的抗体特异性分布总体一致。频率较高的抗HLA I类抗体特异性为A80、A68；B76、B45；Cw17，在中国人群中这些不太可能成为DSA。抗HLA II类抗体特异性比I类更有可能成为潜在的DSA。DR7、DR9、DQ7、DQ8和DQ9最有可能成为潜在的DSA。
抗HLA和抗MICA抗体的流行率随年龄增长略有增加。虽然衰老对华东地区等待初次HSCT的受者中针对HLA-A、-B、-C、-DR、-DQ、-DP和MICA抗原的抗体特异性频率分布影响较小。三个年龄组中形成预先存在的DSA的风险基本一致，并且由于抗MICA抗体阳性率较高，老年组在HLA不匹配的HSCT中可能更有利。
