Publications by authors named "Barbera Veldhuisen"

29 Publications

  • Page 1 of 1

Development and validation of a universal blood donor genotyping platform: a multinational prospective study.

Blood Adv 2020 08;4(15):3495-3506

Department of Pathology, Brigham and Women's Hospital, Boston, MA; and.

Each year, blood transfusions save millions of lives. However, under current blood-matching practices, sensitization to non-self-antigens is an unavoidable adverse side effect of transfusion. We describe a universal donor typing platform that could be adopted by blood services worldwide to facilitate a universal extended blood-matching policy and reduce sensitization rates. This DNA-based test is capable of simultaneously typing most clinically relevant red blood cell (RBC), human platelet (HPA), and human leukocyte (HLA) antigens. Validation was performed, using samples from 7927 European, 27 South Asian, 21 East Asian, and 9 African blood donors enrolled in 2 national biobanks. We illustrated the usefulness of the platform by analyzing antibody data from patients sensitized with multiple RBC alloantibodies. Genotyping results demonstrated concordance of 99.91%, 99.97%, and 99.03% with RBC, HPA, and HLA clinically validated typing results in 89 371, 3016, and 9289 comparisons, respectively. Genotyping increased the total number of antigen typing results available from 110 980 to >1 200 000. Dense donor typing allowed identification of 2 to 6 times more compatible donors to serve 3146 patients with multiple RBC alloantibodies, providing at least 1 match for 176 individuals for whom previously no blood could be found among the same donors. This genotyping technology is already being used to type thousands of donors taking part in national genotyping studies. Extraction of dense antigen-typing data from these cohorts provides blood supply organizations with the opportunity to implement a policy of genomics-based precision matching of blood.
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http://dx.doi.org/10.1182/bloodadvances.2020001894DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7422129PMC
August 2020

Transient and chronic childhood immune thrombocytopenia are distinctly affected by Fc-γ receptor polymorphisms.

Blood Adv 2019 07;3(13):2003-2012

Department of Immunohematology Diagnostics, Sanquin Diagnostic Services, Amsterdam, The Netherlands.

In childhood immune thrombocytopenia (ITP), anti-platelet autoantibodies mediate platelet clearance through Fc-γ receptor (FcγR)-bearing phagocytes. In 75% to 90% of patients, the disease has a transient, self-limiting character. Here we characterized how polymorphisms of FcγR genes affect disease susceptibility, response to intravenous immunoglobulin (IVIg) treatment, and long-term recovery from childhood ITP. Genotyping of the locus was performed in 180 children with newly diagnosed ITP, 22 children with chronic ITP, and 180 healthy control children by multiplex ligation-dependent probe amplification. Children with newly diagnosed ITP were randomly assigned to a single administration of IVIg or observation, and followed for 1 year (Treatment With or Without IVIg for Kids With ITP [TIKI] trial). We defined transient ITP as a complete recovery (≥100 × 10/L) 3 months after diagnosis, including both self-limiting disease/IVIg responders and chronic ITP as absence of a complete recovery at 12 months. ITP susceptibility, as well as spontaneous recovery and response to IVIg, was associated with the genetic variants *ORF and *27W and the promoter variant 2B.4. These variants were overrepresented in patients with transient (N = 131), but not chronic (N = 43), disease. The presence of *ORF predisposed to transient ITP with an odds ratio of 4.7 (95% confidence interval, 1.9-14.3). Chronic ITP was associated with a deletion of (copy number region 1) with an odds ratio of 6.2 (95% confidence interval, 1.8-24.7). Taken together, susceptibility to transient and chronic ITP is distinctly affected by polymorphic variants of genes. Our data suggest that genotyping of the locus may be useful for prognosis and guidance of treatment decisions in newly diagnosed childhood ITP.
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http://dx.doi.org/10.1182/bloodadvances.2019000068DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6616256PMC
July 2019

Identification of a novel single-nucleotide mutation in SMIM1 gene that results in low Vel antigen expression.

Transfusion 2019 10 19;59(10):E8-E10. Epub 2019 Jun 19.

Department of Experimental Immunohematology, Sanquin Research and Landsteiner Laboratory, AUMC, Amsterdam, The Netherlands.

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http://dx.doi.org/10.1111/trf.15411DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7079045PMC
October 2019

Frequency and characterization of RHD variants in serologically D- Surinamese pregnant women and D- newborns.

Transfusion 2019 08 10;59(8):2672-2677. Epub 2019 Jun 10.

Department of Experimental Immunohematology, Sanquin Research, Amsterdam, The Netherlands.

Background: Numerous RHD variant genes affect the expression of D on the red blood cell surface. In Suriname, 4.3% of pregnant women were D-, ranging from virtually zero to 7% among ethnic groups. Characterization of RHD variants, which are associated with a variable potential to induce anti-D, is of practical clinical importance especially in case of limited access to preventive measures. Here we report on the occurrence of RHD variant genes in Surinamese serologically D- pregnant women and their D- newborns from different ethnic groups.

Study Design And Methods: The RheSuN study is a cross-sectional cohort study in D- pregnant women and their newborns, who visited hospitals in Paramaribo, Suriname, during routine pregnancy care. The presence of RHD variants was investigated using quantitative polymerase chain reaction targeting RHD Exons 5 and 7 and RH-multiplex ligation-dependent probe amplification.

Results: Seven RHD variant genes were detected in 35 of 84 women and four RHD variant genes in 15 of 36 newborns. The RHD*03 N.01 and RHD*08 N.01 variants represented 87% of a total of 62 variant genes. Variants were comparably frequent among ethnicities. In four cases genotyping would have changed anti-D prophylaxis policy: one woman with a RHD*01EL.01 variant, not associated with anti-D formation and three D- newborns with RHD*09.01 and RHD*09.03.01 variants, potentially capable of inducing anti-D.

Conclusion: RHD variants at risk for anti-D are common among serologic D- individuals from African descent in Suriname. While genotyping D- women has limited added value, it may be considered in newborns from D- women.
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http://dx.doi.org/10.1111/trf.15394DOI Listing
August 2019

Associations between single nucleotide polymorphisms and erythrocyte parameters in humans: A systematic literature review.

Mutat Res 2019 Jan - Mar;779:58-67. Epub 2019 Feb 2.

Department of Donor Medicine Research - Donor Studies, Sanquin Research, Plesmanlaan 125, 1066 CX Amsterdam, the Netherlands.

Individual variations in erythrocyte parameters are influenced by factors like sex, age, diet and season. Genetic variations have also been associated with erythrocyte parameters. The aim of this systematic review is to provide an overview of associations between single nucleotide polymorphisms (SNPs) and erythrocyte parameters in humans. A systematic review protocol was published at the international prospective register of systematic reviews (registration number CRD42016053052). Literature searches were conducted in Medline and Embase. Studies were included if: investigating a(n) causality/association/correlation; population-based; investigating a human population of Caucasian/mixed-ethnic descent; and written in English, Dutch or German. Study quality was assessed using the quality of genetic association studies tool. In total, 4385 studies were screened on title/abstract and 194 studies were screened on full text. Inclusion criteria were met by 13 candidate gene studies (n = 126-49,488) and eight genome-wide association studies (GWASes, n = 1664-116,666). One moderate and six good quality GWAS(es) identified 1237 SNPs located in/near 241 genes. SNPs in/near ten genes were found to be associated with one or more erythrocyte parameter(s) by multiple GWASes, namely HIST1H2AC, MPST, SLC17A1 and SLC17A3 with mean cell hemoglobin (MCH), HIST1H1T and KCTD17 with MCH and mean cell volume (MCV), HBS1L and MYB with MCH, MCV and red cell count (RCC), HFE with MCH, MCV and hemoglobin, and TMPRSS6 with MCH, MCV, hemoglobin and mean cell hemoglobin concentration (MCHC). Four genes were found across multiple erythrocyte parameters by one study in each parameter. Fourteen SNPs were associated with one or more erythrocyte parameter(s) in multiple cohorts, namely rs129128, rs17342717, rs228129 and rs5756504 (MCH), rs4895441, rs7775698, rs9376092 and rs9494145 (MCH, MCV, RCC), rs6569992 (MCH, RCC), rs1800562 (hemoglobin, MCH, MCV), rs130624 and rs198846 (MCH, MCV), rs4820268 and rs855791 (MCH, MCV, MCHC). Further research on these fourteen genes in erythropoiesis is recommended, especially eight whose role in erythropoiesis is unclear.
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http://dx.doi.org/10.1016/j.mrrev.2019.01.002DOI Listing
March 2020

Development of a recombinant anti-Vel immunoglobulin M to identify Vel-negative donors.

Transfusion 2019 04 31;59(4):1359-1366. Epub 2019 Jan 31.

Department of Experimental Immunohematology, Sanquin Research and Landsteiner Laboratory, AUMC, Amsterdam, The Netherlands.

Background: Alloimmunization against the high-frequency Vel blood group antigen may result in transfusion reactions or hemolytic disease of fetus and newborn. Patients with anti-Vel alloantibodies require Vel-negative blood but Vel-negative individuals are rare (1:4000). Identification of Vel-negative donors ensures availability of Vel-negative blood; however, accurate Vel blood group typing is difficult due to variable Vel antigen expression and limited availability of anti-Vel typing sera. We report the production of a recombinant anti-Vel that also identifies weak Vel expression.

Study Design And Methods: A recombinant anti-Vel monoclonal antibody was produced by cloning the variable regions from an anti-Vel-specific B cell isolated from an alloimmunized patient into a vector harboring the constant regions of immunoglobulin (Ig)G1-kappa or IgM-kappa. Antibody Vel specificity was tested by reactivity to SMIM1-transfected HEK293T cells and by testing various red blood cells (RBCs) of donors with normal, weak, or no Vel expression. High-throughput donor screening applicability was tested using an automated blood group analyzer.

Results: A Vel-specific IgM class antibody was produced. The antibody was able to distinguish between Vel-negative and very weak Vel antigen-expressing RBCs by direct agglutination and in high-throughput settings using a fully automated blood group analyzer and performed better than currently used human anti-Vel sera. High-throughput screening of 13,288 blood donations identified three new Vel-negative donors.

Conclusion: We generated a directly agglutinating recombinant anti-Vel IgM, M3F5S-IgM, functional in manual, automated agglutination assays and flow cytometry settings. This IgM anti-Vel will improve diagnostics by facilitating the identification of Vel-negative blood donors.
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http://dx.doi.org/10.1111/trf.15147DOI Listing
April 2019

Performance evaluation study of ID RHD XT, a new genotyping assay for the detection of high-prevalence RhD negative and weak D types.

Vox Sang 2018 Oct 19;113(7):694-700. Epub 2018 Aug 19.

R&D Area, Progenika Biopharma A Grifols Company, Derio, Spain.

Background And Objectives: Routine serologic D typing does not distinguish between weak D subtypes and partial D phenotypes. The goal of this study was to validate the performance of the ID RHD XT genotyping assay.

Material And Methods: Previously serotyped samples for D antigen (n = 1000; 16% weak D serotyped donors) were analysed. The reference methods used for comparison were licensed serology tests for D antigen phenotype, and bidirectional sequencing (BDS) for weak D type confirmation and HPA-1 phenotype prediction. Discrepancies were solved with BDS and BLOODchip Reference.

Results: There were no system failure, a 100% call rate and no inconclusive results. ID RHD XT correctly called all (88/88) weak D types 1, 2 and 3. Review of other 87 apparent discrepancies identified a small number of serology errors and showed that ID RHD XT correctly signalled the presence of other RHD variants which were further confirmed by BDS and BLOODchip Reference. The predicted HPA-1 phenotype by ID RHD XT was 100% concordant with BDS.

Conclusion: ID RHD XT genotype predictions for high-prevalence RhD negative and weak D types 1, 2 and 3 as well as for HPA-1a/HPA-1b antigens were accurate, which is of clinical significance in guiding transfusion needs.
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http://dx.doi.org/10.1111/vox.12701DOI Listing
October 2018

A Conceptual Framework for Optimizing Blood Matching Strategies: Balancing Patient Complications Against Total Costs Incurred.

Front Med (Lausanne) 2018 25;5:199. Epub 2018 Jul 25.

Department of Transfusion Technology Assessment, Sanquin Research, Amsterdam, Netherlands.

Alloimmunization is currently the most frequent adverse blood transfusion event. Whilst completely matched donor blood would nullify the alloimmunization risk, this is practically infeasible. Current matching strategies therefore aim at matching a limited number of blood groups only, and have evolved over time by systematically including matching strategies for those blood groups for which (serious) alloimmunization complications most frequently occurred. An optimal matching strategy for controlling the risk of alloimmunization however, would balance alloimmunization complications and costs within the entire blood supply chain, whilst fulfilling all practical requirements and limitations. In this article the outline of an integrated blood management model is described and various potential challenges and prospects foreseen with the development of such a model are discussed.
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http://dx.doi.org/10.3389/fmed.2018.00199DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6069448PMC
July 2018

RhIg-prophylaxis is not influenced by FCGR2/3 polymorphisms involved in red blood cell clearance.

Blood 2017 02 12;129(8):1045-1048. Epub 2017 Jan 12.

Department of Experimental Immunohematology, Sanquin Research and Landsteiner Laboratory, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.

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http://dx.doi.org/10.1182/blood-2016-05-716365DOI Listing
February 2017

Performance evaluation study of ID CORE XT, a high throughput blood group genotyping platform.

Blood Transfus 2018 02 25;16(2):193-199. Epub 2016 Nov 25.

Progenika Biopharma, a Grifols Company, Derio, Spain.

Background: Traditionally, red blood cell antigens have been identified using serological methods, but recent advances in molecular biology have made the implementation of methods for genetic testing of most blood group antigens possible. The goal of this study was to validate the performance of the ID CORE XT blood group typing assay.

Materials And Methods: One thousand independent samples from donors, patients and neonates were collected from three research institutes in Spain and the Netherlands. DNA was extracted from EDTA-anticoagulated blood. The data were processed with the ID CORE XT to obtain the genotypes and the predicted blood group phenotypes, and results were compared to those obtained with well-established serological and molecular methods. All 1,000 samples were typed for major blood group antigens (C, c, E, e, K) and 371-830 samples were typed for other antigens depending on the rarity and availability of serology comparators.

Results: The incorrect call rate was 0%. Four "no calls" (rate: 0.014%) were resolved after repetition. The sensitivity of ID CORE XT for all phenotypes was 100% regarding serology. There was one discrepancy in E- antigen and 33 discrepancies in Fy- antigen. After bidirectional sequencing, all discrepancies were resolved in favour of ID CORE XT (100% specificity). ID CORE XT detected infrequent antigens of Caucasians in the sample as well as rare allelic variants.

Discussion: In this evaluation performed in an extensive sample following the European Directive, the ID CORE XT blood genotyping assay performed as a reliable and accurate method for correctly predicting the genotype and phenotype of clinically relevant blood group antigens.
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http://dx.doi.org/10.2450/2016.0146-16DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5839617PMC
February 2018

Validation of the multiplex ligation-dependent probe amplification assay and its application on the distribution study of the major alleles of 17 blood group systems in Chinese donors from Guangzhou.

Transfusion 2017 02 27;57(2):423-432. Epub 2016 Nov 27.

Sanquin Research and Landsteiner Laboratory, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.

Background: Genotyping platforms for common red blood cell (RBC) antigens have been successfully applied in Caucasian and black populations but not in Chinese populations. In this study, a genotyping assay based on multiplex ligation-dependent probe amplification (MLPA) technology was applied in a Chinese population to validate the MLPA probes. Subsequently, the comprehensive distribution of 17 blood group systems also was obtained.

Study Design And Methods: DNA samples from 200 Chinese donors were extracted and genotyped using the blood-MLPA assay. To confirm the MLPA results, a second independent genotyping assay (ID Core+) was conducted in 40 donors, and serological typing of 14 blood-group antigens was performed in 91 donors. In donors who had abnormal copy numbers of an allele (DI and GYPB) determined by MLPA, additional experiments were performed (polymerase chain reaction, sequencing, and flow cytometry analysis).

Results: The genotyping results obtained using the blood-MLPA and ID Core+ assays were consistent. Serological data were consistent with the genotyping results except for one donor who had a Lu(a-b-) phenotype. Of the 17 blood group systems, the distribution of the MNS, Duffy, Kidd, Diego, Yt, and Dombrock systems was polymorphic. The Mur and St antigens of the MNS system were distributed with a frequency of 9% (18 of 200) and 2% (4 of 200), respectively. One donor with chimerism and one who carried a novel DI*02(A845V) allele, which predicts the depression of Di antigen expression, were identified.

Conclusions: The blood-MLPA assay could easily identify the common blood-group alleles and correctly predicted phenotype in the Chinese population. The Mur and St antigens were distributed with high frequency in a Southern Chinese Han population.
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http://dx.doi.org/10.1111/trf.13940DOI Listing
February 2017

Sensitivity of fetal RHD screening for safe guidance of targeted anti-D immunoglobulin prophylaxis: prospective cohort study of a nationwide programme in the Netherlands.

BMJ 2016 Nov 7;355:i5789. Epub 2016 Nov 7.

Department of Experimental Immunohematology, Sanquin Research, Amsterdam and Landsteiner Laboratory, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands.

Objective:  To determine the accuracy of non-invasive fetal testing for the RHD gene in week 27 of pregnancy as part of an antenatal screening programme to restrict anti-D immunoglobulin use to women carrying a child positive for RHD DESIGN:  Prospectively monitoring of fetal RHD testing accuracy compared with serological cord blood typing on introduction of the test. Fetal RHD testing was performed with a duplex real time quantitative polymerase chain reaction, with cell-free fetal DNA isolated from 1 mL of maternal plasma The study period was between 4 July 2011 and 7 October 2012. The proportion of women participating in screening was determined.

Setting:  Nationwide screening programme, the Netherlands. Tests are performed in a centralised setting.

Participants:  25 789 RhD negative pregnant women.

Main Outcome Measures:  Sensitivity, specificity, false negative rate, and false positive rate of fetal RHD testing compared with serological cord blood typing; proportion of technical failures; and compliance to the screening programme.

Results:  A fetal RHD test result and serological cord blood result were available for 25 789 pregnancies. Sensitivity for detection of fetal RHD was 99.94% (95% confidence interval 99.89% to 99.97%) and specificity was 97.74% (97.43% to 98.02%). Nine false negative results for fetal RHD testing were registered (0.03%, 95% confidence interval 0.01% to 0.06%). In two cases these were due to technical failures. False positive fetal RHD testing results were registered for 225 samples (0.87%, 0.76% to 0.99%). Weak RhD expression was shown in 22 of these cases, justifying anti-D immunoglobulin use. The negative and positive predictive values were 99.91% (95% confidence interval 99.82% to 99.95%) and 98.60% (98.40% to 98.77%), respectively. More than 98% of the women participated in the screening programme.

Conclusions:  Fetal RHD testing in week 27 of pregnancy as part of a national antenatal screening programme is highly reliable and can be used to target both antenatal and postnatal anti-D immunoglobulin use.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5098549PMC
http://dx.doi.org/10.1136/bmj.i5789DOI Listing
November 2016

Identification of a novel frequent RHCE*ce308T variant allele in Chinese D- individuals, resulting in a C+c- phenotype.

Transfusion 2016 09 24;56(9):2314-21. Epub 2016 Jun 24.

Sanquin Research and Landsteiner Laboratory, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.

Background: The RHCE allele is highly polymorphic; more than 60 variants have been described leading to diminished expression of C, c, E, and e antigens. Not much is known about the prevalence of RHCE variants in the Chinese population. Individuals carrying a variant are at risk to develop alloantibodies in response to mismatched pregnancy or transfusion. In this study, phenotyping and genotyping of the RHCE allele in Chinese donors revealed a new clinically relevant mutation.

Study Design And Methods: Blood samples from 200 D- and 200 D+ Chinese donors were analyzed by the RH multiplex ligation-dependent probe amplification (MLPA) assay and compared to serologically typed RhCE phenotypes, when available. All exons of the RHCE gene were sequenced in samples with aberrant genotyping results. The phenotype of the new variant RHCE allele was tested by transducing cultured human erythroblasts.

Results: Aberrant copy numbers for Exon 2 of the RHCE gene were discovered by MLPA in six D- donors (6/200), but not in D+ donors (0/200). Sequencing of the RHCE gene in these six donors identified a new variant RHCE*ce308C>T (p.103Pro>Leu) allele with an allele frequency of 0.015 within the D- individuals in this study. This variant was not detected in D+ individuals showing linkage with the D- haplotype. Serologically weak C expression and loss of c expression was demonstrated on donor red blood cells. In vitro transfection studies of the RHCE*ce308T variant in cDe/ce and CDe/CDe erythroblasts confirmed that the variant is associated with anti-C reactivity while abolishing c expression.

Conclusion: Genotyping of individuals carrying this variant by standard RHCE genotyping might falsely predict a C- phenotype or a c+ phenotype. This new variant should be taken into account in RHCE genotyping assays designed for the Chinese population.
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http://dx.doi.org/10.1111/trf.13709DOI Listing
September 2016

Fetal RHD genotyping after bone marrow transplantation.

Transfusion 2016 08 30;56(8):2122-6. Epub 2016 May 30.

Department of Experimental Immunohematology, Amsterdam and Landsteiner Laboratory, Academic Medical Center, Sanquin, University of Amsterdam, Amsterdam, The Netherlands.

Background: Fetal RHD genotyping allows targeted diagnostic testing, fetal surveillance, and eventually intrauterine treatment to D-alloimmunized pregnant women who carry an RHD+ fetus. However, false-positive and false-negative results of noninvasive prenatal fetal RHD genotyping have been described due to a variety of causes. In this case report we present two cases where noninvasive fetal RHD typing was complicated by a previous bone marrow transplantation (BMT).

Case Report: We describe two women with a history of allogeneic BMT in early childhood. Both were born D+ and received a transplant of their D- male sibling. Anti-D were detected during pregnancy in one of them. The biologic father of this pregnancy was D+. In both cases polymerase chain reaction procedures specific for RHD on maternal plasma DNA were positive whereas a D- neonate was born in one case (Case 1).

Conclusion: False-positive results of noninvasive fetal RHD genotyping occur in D+ women transplanted with marrow of a D- donor, due to circulating cell-free DNA originating from nonhematopoietic tissue. The cases highlight that health care professionals and laboratories should be aware that allogeneic BMT can be a cause for false-positive results in fetal RHD genotyping with cell-free DNA in maternal plasma, and likewise the wrong fetal sex can be reported in the case of a male donor and a female fetus. Based on one of the cases we also recommend giving D- blood products to young female patients who receive a BMT of D- donors.
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http://dx.doi.org/10.1111/trf.13669DOI Listing
August 2016

Prevalence of RhD status and clinical application of non-invasive prenatal determination of fetal RHD in maternal plasma: a 5 year experience in Cyprus.

BMC Res Notes 2016 Apr 1;9:198. Epub 2016 Apr 1.

Molecular Genetics Thalassaemia Department, The Cyprus Institute of Neurology and Genetics, 6 Internanional Airport Ave, Agios Dometios, 1683, Nicosia, Cyprus.

Background: After the discovery that cell-free fetal DNA (cffDNA) is circulating in the maternal plasma of pregnant women, non-invasive prenatal diagnosis for fetal RhD in maternal plasma in RhD negative women at risk for haemolytic disease of the newborn (HDN) was clinically established and used by many laboratories. The objectives of this study are: (a) to assess the feasibility and report our experiences of the routine implementation of fetal RHD genotyping by analysis of cffDNA extracted from maternal plasma of RhD negative women at risk of HDN, and (b) to estimate the RhD phenotype frequencies, the RHD genotype frequencies and the RhD zygosity in the Cypriot population.

Methods: cffDNA was extracted from maternal plasma of 73 RhD negative pregnant women. Real-Time Multiplex-PCR was used to amplify regions of RHD gene in exons 4, 5 and 10. RhD phenotypes were determined on 445 random samples using conventional agglutination slide test.

Results: The fetus was predicted to be positive in 53 cases and negative in 18 cases. Two of cases were identified as D-variants, weak D type-1 and 11. The frequency of RhD negative homozygosity in the Cypriot population was estimated to be 7.2%, while the frequencies of RHD hemizygosity and RhD positive homozygosity was calculated to be 39.2 and 53.6%, respectively.

Conclusion: Fetal RHD genotyping can be accurately determined using cffDNA from maternal plasma. The implementation of the test has eliminated all use of unnecessary anti-D and reduced the total use of anti-D by 25.3% while achieving appropriate management of the RhD negative pregnancies.
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http://dx.doi.org/10.1186/s13104-016-2002-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4818414PMC
April 2016

Frequency and characterization of known and novel RHD variant alleles in 37 782 Dutch D-negative pregnant women.

Br J Haematol 2016 05 27;173(3):469-79. Epub 2016 Mar 27.

Sanquin Research and Landsteiner Laboratory, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.

To guide anti-D prophylaxis, Dutch D- pregnant women are offered a quantitative fetal-RHD-genotyping assay to determine the RHD status of their fetus. This allowed us to determine the frequency of different maternal RHD variants in 37 782 serologically D- pregnant women. A variant allele is present in at least 0·96% of Dutch D- pregnant women The D- serology could be confirmed after further serological testing in only 54% of these women, which emphasizes the potential relevance of genotyping of blood donors. 43 different RHD variant alleles were detected, including 15 novel alleles (11 null-, 2 partial D- and 2 DEL-alleles). Of those novel null alleles, one allele contained a single missense mutation (RHD*443C>G) and one allele had a single amino acid deletion (RHD*424_426del). The D- phenotype was confirmed by transduction of human D- erythroblasts, consolidating that, for the first time, a single amino acid change or deletion causes the D- phenotype. Transduction also confirmed the phenotypes for the two new variant DEL-alleles (RHD*721A>C and RHD*884T>C) and the novel partial RHD*492C>A allele. Notably, in three additional cases the DEL phenotype was observed but sequencing of the coding sequence, flanking introns and promoter region revealed an apparently wild-type RHD allele without mutations.
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http://dx.doi.org/10.1111/bjh.13960DOI Listing
May 2016

Multiplex ligation-dependent probe amplification (MLPA) assay for blood group genotyping, copy number quantification, and analysis of RH variants.

Immunohematology 2015 ;31(2):58-61

MD, PhD, Cluster Manager of the Department of Immunohematology Diagnostics, Sanquin Diagnostic Services, Amsterdam, the Netherlands.

The blood group multiplex ligation-dependent probe amplification (MLPA) is a comprehensive assay, developed for genotyping the majority of clinically relevant blood group antigens in both patients and donors. The MLPA is an easy method to apply and only requires a thermal cycler and capillary electrophoresis equipment. Because the molecular basis of blood group antigens can be a single nucleotide polymorphism, an insertion/deletion polymorphism, or genetic recombination, a single assay such as the MLPA to facilitate these different types of genetic variation is a prerequisite in blood group typing. An MLPA assay allows the simultaneous detection of up to 50 polymorphisms in a single tube. The blood group MLPA currently consists of three separate probe pools targeting 104 different blood group alleles of 18 blood group systems. The assay is performed in a 96-well plate; therefore, a maximum of 32 genomic DNA samples can be processed simultaneously. Results are available within 24 hours,and software for analysis of the MLPA results is available free of charge. In addition to the analysis of genetic variation in blood group genes, a major advantage of the test is the ability to detect aberrations in gene copy numbers, which is especially useful for the determination of homo- or hemizygous status of RHD or other blood group genes and for detection of blood chimerism. A relatively large number of RH wild-type and mutation-specific probes are included in the assay, allowing an extensive analysis of RHD variants. In our reference lab in the Netherlands, the MLPA was validated to detect RH variants in patients, donors, and pregnant women. Furthermore, we have used the MLPA to provide comprehensive typing after blood transfusion of 52 blood group antigens simultaneously, in patients with red cell autoantibodies or patients with rare phenotypes.
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April 2016

Novel alleles at the Kell blood group locus that lead to Kell variant phenotype in the Dutch population.

Transfusion 2015 Feb 25;55(2):413-21. Epub 2014 Aug 25.

Sanquin Research and Landsteiner Laboratory, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands; Institute of Clinical Blood Transfusion, Guangzhou Blood Center, Guangzhou, People's Republic of China.

Background: Alloantibodies directed against antigens of the Kell blood group system are clinically significant. In the Netherlands, the KEL1 antigen is determined in all blood donors. In this study, after phenotyping of KEL:1-positive donors, genotyping analysis was conducted in KEL:1,-2 donors to identify possible KEL*02 variant alleles.

Study Design And Methods: A total of 407 donors with the KEL:1,-2 phenotype were genotyped for the KEL*01/02 polymorphism, followed by direct sequencing of the KEL gene if the KEL*02 allele was detected. Two K0 patients were also included. Transcript analysis was conducted in two probands with the KEL*02. M05 allele defined by a synonymous mutation (G573G). Flow cytometry analysis to determine the expression of Kell antigen was performed.

Results: Thirty KEL:1,-2 individuals (30/407, 7.4%) with discrepant KEL*01/02 genotype were identified. Seven novel alleles were identified: KEL*02(R86Q, R281W)mod, KEL*02(L133P)null, KEL*02(436delG)null, KEL*02(F418S)null, KEL*02(R492X)null, KEL*02(L611R)null, and KEL*02(R700X)null. Nine variant alleles described before were detected: KEL*02N.06, KEL*02N.15, KEL*02N.17, KEL*02N.19, KEL*02N.21, KEL*02M.02, KEL*02M.04, KEL*02M.05, and KEL*02(Q362K)mod. A transcript lacking Exon 16 was identified in two probands with the KEL*02M.05 allele as described before. Finally, flow cytometry analysis showed a decreased total Kell expression and a relatively increased KEL1 expression in individuals with the KEL:1,2null or KEL:1,2mod phenotype, compared to KEL:1,2 controls.

Conclusion: In 7.4% of a group of tested KEL:1,-2 Dutch donors, a KEL*02null or KEL*02mod allele was found. A relatively increased KEL1 antigen expression in KEL:1,2null and KEL:1,2mod individuals suggest that the expression of Kell-XK complexes depends on the availability of the XK protein.
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http://dx.doi.org/10.1111/trf.12838DOI Listing
February 2015

Molecular typing of human platelet and neutrophil antigens (HPA and HNA).

Transfus Apher Sci 2014 Apr 6;50(2):189-99. Epub 2014 Mar 6.

Sanquin Diagnostic Services, Department of Diagnostic Immunohematology, Amsterdam, The Netherlands.

Genotyping is an important tool in the diagnosis of disorders involving allo-immunisation to antigens present on the membranes of platelets and neutrophils. To date 28 human platelet antigens (HPAs) have been indentified on six polymorphic glycoproteins on the surface of platelets. Antibodies against HPAs play a role in foetal and neonatal alloimmune thrombocytopenia (FNAIT), post-transfusion purpura (PTP) and refractoriness to donor platelets. The 11 human neutrophil antigens (HNAs) described to date have been indentified on five polymorphic proteins on the surface of granulocytes. Antibodies to HNAs are implicated with foetal and neonatal alloimmune neutropenia (FNAIN), autoimmune neutropenia (AIN) and transfusion related acute lung injury (TRALI). In this report, we will review the molecular basis and techniques currently available for the genotyping of human platelet and neutrophil antigens.
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http://dx.doi.org/10.1016/j.transci.2014.02.014DOI Listing
April 2014

Noninvasive prenatal blood group and HPA-1a genotyping: the current European experience.

Transfusion 2013 Nov 4;53(11 Suppl 2):2834-6. Epub 2013 Sep 4.

Department of Experimental Immunohematology, Sanquin Research, Landsteiner Laboratory, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.

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http://dx.doi.org/10.1111/trf.12411DOI Listing
November 2013

Comprehensive genotyping for 18 blood group systems using a multiplex ligation-dependent probe amplification assay shows a high degree of accuracy.

Transfusion 2013 Nov 29;53(11 Suppl 2):2899-909. Epub 2013 Aug 29.

Sanquin Research, Amsterdam and Landsteiner Laboratory, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands.

Background: In recent years genotyping methods have been implemented in blood banks as alternative to comprehensive serologic typing. We evaluated a newly developed assay for convenient and comprehensive genotyping of blood group alleles based on multiplex ligation-dependent probe amplification (MLPA) technology.

Study Design And Methods: We analyzed 103 random and 150 selected samples to validate the specificity of the blood-MLPA assay that is able to determine the presence, absence, and copy number of 48 blood group and 112 variant alleles of 18 blood group systems. A total of 4038 serologic typing results, including 52 different antigens, were available for these samples.

Results: In 4018 (99.5%) of the 4038 serologic typing results the predicted phenotypes by the blood-MLPA were in concordance with serologic typing. Twenty discordant results were due to false-positive serologic results (n = 2), false-negative serologic results (n = 1), inability of routine serologic typing to detect variant antigens (n = 14), or false-positive prediction from the blood-MLPA due to the presence of a null allele (n = 3).

Conclusion: The blood-MLPA reliably predicts the presence or absence of blood group antigens, including almost all clinically relevant blood group antigens, except ABO, in patients and donors. Furthermore, it is the first assay that determines copy numbers of blood group alleles in the same test. It even provides more detailed and accurate information than serologic typing, because most variant alleles are immediately recognized. Since only standard laboratory equipment is needed, this assay finally offers the possibility to comprehensively type recipients and makes extensive matching for selected patients groups more feasible.
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http://dx.doi.org/10.1111/trf.12410DOI Listing
November 2013

RHD and RHCE variant and zygosity genotyping via multiplex ligation-dependent probe amplification.

Transfusion 2013 Jul 9;53(7):1559-74. Epub 2012 Oct 9.

Sanquin Research and Landsteiner Laboratory, Academic Medical Centre, University of Amsterdam, and MRC-Holland, Amsterdam, the Netherlands.

Background: The presence of a D variant may hamper correct serologic D typing, which may result in D immunization. D variants can be determined via RHD genotyping. However, a convenient single assay to identify D variants is still lacking. We developed and evaluated a multiplex ligation-dependent probe amplification (MLPA) assay to determine clinically relevant RHD and RHCE variant alleles and RHD zygosity.

Study Design And Methods: We analyzed 236 cases (73 normal and 163 selected samples) with the RH-MLPA assay, which is able to determine 79 RHD and 17 RHCE variant alleles and RHD zygosity. To confirm the results, mutations were verified by RHD and/or RHCE exon-specific sequencing and RHD zygosity was verified by quantitative real-time polymerase chain reaction (PCR) for 18 cases.

Results: In 99% of the cases, the RH-MLPA assay correctly determined whether a person carried only wild-type RHD and RHCE alleles (n = 69) or (a) variant RHD allele(s) and/or (a) variant RHCE allele(s) (n = 164). In only three cases, including two new RHD variant alleles, the variant allele was not identified, due to lack of detecting probes. These were RHD*DCS2, a new partial RHD allele, RHD*525T (Phe175Leu), and a new D- null allele, RHD*443G (Thr148Arg). All RHD (n = 175) and RHCE variant alleles (n = 79) indicated by the RH-MLPA assay were confirmed by sequencing. RHD zygosity was confirmed by quantitative PCR. Two hematopoietic chimeras were recognized.

Conclusion: The RH-MLPA genotyping assay is a fast, easy, and reliable method to determine almost all clinically relevant RHD and RHCE variant alleles, RHD zygosity, and RHD+/RHD- chimeras in blood donors, blood recipients, and pregnant women.
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http://dx.doi.org/10.1111/j.1537-2995.2012.03919.xDOI Listing
July 2013

Molecular analysis of the York antigen of the Knops blood group system.

Transfusion 2011 Jul 7;51(7):1389-96. Epub 2011 Jan 7.

Department of Experimental Immunohematology, Sanquin Research, Plesmanlaan 125, 1066 CX Amsterdam, The Netherlands.

Background: Antigens of the Knops blood group system are present on complement component (3b/4b) receptor 1 (CR1/CD35), which is a transmembrane glycoprotein encoded by the CR1 gene. Eight of the nine known antigens of this system are linked to polymorphisms in Exon 29. The molecular background of one antigen, York (Yk(a)), has not yet been described.

Study Design And Methods: We aimed to identify a polymorphism associated with the absence of Yk(a) to enable molecular typing. Yk(a)-negative individuals were identified by serologic typing. Their CR1 gene was partially sequenced and compared to that of Yk(a)-positive individuals. Loss of Yk(a) antigen was investigated by expressing the SCR22/23 domain of both wild-type and mutated CR1 as a GPI-linked protein on HEK293 cells.

Results: We observed that absence of the Yk(a) antigen is caused by a mutation in Exon 26 of the CR1 gene. This 4223C>T mutation results in a 1408T>M change at the protein level. Ten of 117 donors (8.5%) were homozygous TT, confirming the Caucasian frequency of 8% Yk(a)-negative individuals. Serologically, these TT donors showed a Yk(a)-negative phenotype, while CC/CT individuals were Yk(a)-positive. While the Yk(a) antigen was present on HEK293 cells expressing wild-type constructs, cells expressing the 4223C>T variant were Yk(a) negative.

Conclusion: We identified a 4223C>T sequence variation in the CR1 gene causing absence of the Yk(a) antigen of the Knops blood group system. With this finding, all polymorphisms of the known Knops blood group antigens have been revealed, enabling molecular testing to contribute to red blood cell alloantibody identification procedures.
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http://dx.doi.org/10.1111/j.1537-2995.2010.02999.xDOI Listing
July 2011

Hippocampal CARP over-expression solidifies consolidation of contextual fear memories.

Physiol Behav 2011 Mar 2;102(3-4):323-31. Epub 2010 Dec 2.

Division of Medical Pharmacology, Leiden/Amsterdam Centre for Drug Research, Einsteinweg 55, 2333 CC Leiden, The Netherlands.

The Doublecortin-Like Kinase (DCLK) gene is involved in neuronal migration during development. Through alternative splicing the DCLK gene also produces a transcript called Ca(2+)/calmodulin dependent protein kinase (CaMK)-related peptide (CARP) that is expressed exclusively during adulthood in response to neuronal activity. The function of CARP, however, is poorly understood. To study CARP function, we have generated transgenic mice with over-expression of the CARP transcript in, amongst other brain areas, the hippocampus. We aimed to characterize possible behavioral adaptations of these mice by using a Pavlovian fear conditioning approach. This type of fear conditioning, in which both the hippocampus and amygdala are critically involved, allows studying the formation and extinction of fear related memories. We here report on the behavioral adaptations of two distinct transgenic lines: one with high levels of CARP in the hippocampus and amygdala, whilst the other has high levels of CARP in the hippocampal formation, but not in the amygdala. We tested both mouse lines separately by comparing them to their wild-type littermate controls. We provide evidence suggesting consolidation of contextual fear memories is strengthened in mice of both transgenic lines.
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http://dx.doi.org/10.1016/j.physbeh.2010.11.024DOI Listing
March 2011

Over-expression of δC-DCLK-short in mouse brain results in a more anxious behavioral phenotype.

Physiol Behav 2010 Nov 10;101(4):541-8. Epub 2010 Aug 10.

Division of Medical Pharmacology, Leiden/Amsterdam Centre for Drug Research, Einsteinweg 55, 2300 RA Leiden, The Netherlands.

Products of the Doublecortin-Like Kinase (DCLK) gene are associated with cortical migration and hippocampal maturation during embryogenesis. However, the functions of those DCLK gene transcripts that encode kinases and are expressed during adulthood are incompletely understood. To elucidate potential functions of these DCLK gene splice variants we have generated and analyzed transgenic mice with neuronal over-expression of a truncated, constitutively active form of DCLK-short, designated δC-DCLK-short. Previously, we have performed an extensive molecular characterization of these transgenic δC-DCLK-short mice and established that a specific subunit of the GABA(A) receptor, which is involved in anxiety-related GABAergic neurotransmission, is down-regulated in the hippocampus. Here we show that δC-DCLK-short mRNA is highly expressed in the hippocampus, cortex and amygdala of transgenic mice. We provide evidence that the δC-DCLK-short protein is expressed and functional. In addition, we examined anxiety-related behavior in δC-DCLK-short mice in the elevated plus maze. Interestingly, δC-DCLK-short mice spend less time, move less in the open arms of the maze and show a reduction in the number of rim dips. These behaviors indicate that δC-DCLK-short mice display a more anxious behavioral phenotype.
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http://dx.doi.org/10.1016/j.physbeh.2010.08.002DOI Listing
November 2010

Over-expression of the DCLK gene transcript CARP decreases CA3/CA1 network excitability.

Brain Res 2010 Sep 24;1352:21-34. Epub 2010 Jul 24.

Division of Medical Pharmacology, Leiden/Amsterdam Centre for Drug Research/Leiden University Medical Centre, Einsteinweg 55, Leiden, The Netherlands.

Products of the Doublecortin Like Kinase (DCLK) gene are implicated in cortical migration and hippocampal maturation during embryogenesis. However, one of its splice variants, called CaMK Related Peptide (CARP), is expressed during adulthood in response to neurological stimuli, such as kainic acid-induced seizures and BDNF-LTP. The function of this transcript of the DCLK gene is poorly understood. To elucidate its function during adulthood we have created transgenic mice with over-expression of CARP in the brain. To study potential functions of CARP in the hippocampus we performed an electrophysiological characterization of the CA3/CA1 network of transgenic and wild-type mice and showed that field excitatory post synaptic potentials (fEPSPs) are highly increased in transgenic mice, while population spike amplitudes (PSAs) remained equal between genotypes. Consequently, hippocampal CA3/CA1 network excitability was decreased in transgenic mice. In addition we show a 2-fold up-regulation of the Ca(2+)-binding protein calretinin and a down-regulation of Rapgef4, a guanine exchange factor for Rap1, in the hippocampus. Given previously established conditions during which CARP is induced and our current data, we propose that this DCLK gene product affects glutamatergic neuronal transmission in response to neurological stimuli.
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http://dx.doi.org/10.1016/j.brainres.2010.07.068DOI Listing
September 2010

Will Genotyping Replace Serology in Future Routine Blood Grouping? - Opinion 5.

Transfus Med Hemother 2009 28;36(3):234-235. Epub 2009 May 28.

Sanquin Research, Amsterdam and Landsteiner Laboratory, Academic Medical Centre, University of Amsterdam, the Netherlands.

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http://dx.doi.org/10.1159/000214840DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2980536PMC
May 2009

Alpha-1 antitrypsin Null mutations and severity of emphysema.

Respir Med 2008 Jun 18;102(6):876-84. Epub 2008 Mar 18.

Department of Pulmonology, Leiden University Medical Centre, Leiden, The Netherlands.

Background: Alpha-1 antitrypsin (AAT) deficiency is an autosomal-codominant disorder, caused by mutations in the SERPINA1 gene on chromosome 14. Individuals affected by the most common mutations, SZ and ZZ, have serum AAT concentrations of 25% and 15% of normal levels, and present a higher risk of emphysema. Mutations causing total absence of serum AAT (Null mutations) were suggested to be associated with very early onset emphysema but their clinical phenotype is poorly known.

Hypothesis: Absence of AAT in Null mutations results in more severe emphysema as compared to ZZ and SZ.

Methods: We genotyped all known Dutch subjects (n=12) with absent serum AAT, and compared their lung function values (FEV1 and KCO) with those of individuals with ZZ and SZ genotype, matched for age and smoking history.

Results: All subjects with absent serum AAT presented homozygous Null mutations. In three subjects, a new mutation in exon 2 of the SERPINA1 gene was found. Subjects with Null mutations showed significantly lower lung function values than SZ and ZZ individuals (p=0.000 and 0.001 for FEV1 and KCO, respectively). In all groups, there was a positive correlation between serum AAT and lung function values (p=0.025 and 0.014 for FEV1 and KCO, respectively).

Conclusions: Serum levels of AAT are correlated with the severity of pulmonary phenotype. Subjects with Null mutations should be considered a subgroup at particularly high risk of emphysema within AAT deficiency (AATD). Early detection of carriers of this genotype would be important for preventive and therapeutic interventions.
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http://dx.doi.org/10.1016/j.rmed.2008.01.009DOI Listing
June 2008