Principles of HLA for clinicians

Transcription

1 Principles of HLA for clinicians Professor Alejandro Madrigal Scientific Director Anthony Nolan Research Institute FIT FOR THE FUTURE ANRI Site Visit 2012

2 32,000 patients in search of a donor for stem cell transplantation. 16,000 patients searching for an unrelated bone marrow donor, or alternative stem cell transplantation. 1,400 patients in the UK searching for a donor - less than 45% of patients find a donor.

3 Science - Transplant Activity Survey FIT FOR THE FUTURE Name of meeting here 3

4 FIT FOR THE FUTURE Name of meeting here And then the sibling search

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7 FIT FOR THE FUTURE ANRI Site Visit 2012

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9 ANTHONY NOLAN Development of the Anthony Nolan Register Anthony Nolan born suffering from Wiskott-Aldrich Syndrome Donor recruitment commenced to establish a panel of donors Anthony died without receiving a transplant Number of donor on Regsiter = >500, Number of donors provided for transplant = >10,000

10 THE OPPORTUNITY FIT FOR THE FUTURE ANRI Site Visit 2012

11 >25,000,000 unrelated donors FIT FOR THE FUTURE Name of meeting here

12 Survival dependant on HLA Matching (10/10) P=0.003 Why are these patients still dying? Why are these patients still alive? N = 727

13 FACTORS THAT INFLUENCE THE OUTCOME OF BONE MARROW TRANSPLANTS HLA matching of donor and recipient Gender of donor and recipient Allo-immunisation of the donor Age of the patient/donor Type and stage of the disease Conditioning and immunosuppressive regimen CMV status of donor and recipient

14 HLA-A HLA-B HLA-C HLA-DR HLA-DQ HLA-DP A1, 24 B7, 27 Cw1, 6 DR1, 8 DQ3,7 DP2,4!!!!! MATCH!!!!!

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17 T Cell B8 B44 A3 A1 HLA-A A1, A3 HLA-B B8, B44 Cw1 Cw6 HLA-C Cw1, Cw6 APC Cell

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23 VIRUS Nucleos

24 HLA-B*3501 VS B*3503 (S-116 -F) 2 9 B*3501 P Y, F, M B*3503 P M, L (F)

25 B*3503 B*3501

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29 Chromosome 6 6p Mb HLA-A 3 Mb HLA-C HLA-B 2 Mb HLA-DR HLA-DQ HLA-DP 1 Mb 0 Mb

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31 HLA Polymorphism Class II Class I DPB1 DPA1 DQB1 DQA1 DRB1 DRB3/4/5 DRA B C A

32 HLA Class I Polymorphism located in exons 2 & 3 exon protein domain L a a a TM CYT 3'UT

33 Class I HLA-A

34 HLA Class II Polymorphism located in exon 2 exon a-chain gene protein domain L a a TM/CYT 3'UT exon b-chain gene protein domain L b b TM CYT 3'UT

35 Class II HLA-DR

36 HLA alleles, a patchwork pattern of polymorphism

37 Number of HLA alleles, July 2013 HLA-A HLA-B HLA-C 2373 (24) 3048 (49) 1938 (9) HLA-E HLA-F HLA-G HLA-DRA HLA-DRB HLA-DQA1 HLA-DQB1 HLA-DPA1 HLA-DPB (20) (7) HLA-DMA HLA-DMB HLA-DOA HLA-DOB MICA MICB TAP1 TAP

38 HLA Alleles 1987 July Class I alleles Class II alleles

39 HLA Allele Nomenclature 2010 Separator Subtype Differences outside the coding sequence, introns, 3, 5 HLA - A * 24 : 02 : 01 : 02 L Gene Type Corresponds to the serological antigen or allele family Silent substitution Expression L = Low N = Null S = Secreted Q = Questionable

40 Low resolution HLA-A*02

41 Medium resolution HLA-A*0201/09/43N/66/78/88/89/90/91+

42 High resolution HLA-A*0201/0209

43 HLA Typing Techniques Serology Uses antibodies to type for HLA molecules on viable cells DNA based Sequence Specific Oligonucleotide Probing (SSOP) Sequence Specific Priming (SSP) Sequencing Based Typing (SBT)

44 Source of lymphocytes for HLA typing whole blood collected in heparin dilute 1x tissue-typing tray contains antiserum reactive with a range of HLA specificities centrifugation density gradient medium plasma, platelets lymphocytes RBCs lymphocytes washed and added to tissue typing tray

45 Lymphocytotoxicity Test Antibody 1 dead cells = positive reaction anti-hla antibodies react with cells expressing appropriate HLA molecules Antibody 2 addition of complement live cells = negative reaction

46 DNA Extraction Maternal Allele Paternal Allele

47 PCR Amplification Step Test DNA 5 and 3 primers Buffer Water Taq Polymerase Exons 1 & 2 for HLA Class I Exon 2 for HLA Class II

48 SSOP Probe for sequence motif Individual 1 allele 1 allele Individual 2 allele 3 allele Ambiguous combination -- get same results for two individuals with different HLA type

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50 Sequence Specific Priming (SSP) Individual 1 PCR primer pairs for sequence motifs allele 1 allele Individual 2 allele 3 allele SSP discriminates ambiguity

51 M N6681 DRB5 N6680 DRB4 M N6683 N6684 M C5041 DRB1*02 DRB1*15 N6682 Failed reaction

52 Sequencing Based Typing (SBT) Individual 1 Sequences analysed in combination allele 1 allele 2 Individual 2 allele 3 allele 4 Ambiguous combination -- get same results for two individuals with different HLA type

53 A or G A or T

54 Sequence Based Typing (SBT) C + G A + T FIT FOR THE FUTURE ANRI Site Visit 2012

55 FIT FOR THE FUTURE ANRI Site Visit 2012 The right vision for the challenges

56 Future Proofing The ability to HLA type, accurately, quickly and cost effectively relies on changing the technology The ability to type more genes To be able to react to the demands of the community FIT FOR THE FUTURE ANRI Site Visit 2012

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60 Permissive HLA-DPB1 mismatching compared to a non-permissive mismatching significantly improves overall survival following allogeneic transplantation in patients with both 10/10 and 9/10 matched unrelated donors B E Shaw, K Fleischhauer, M Malkki, T Gooley, E Zino, S Spellman, Y Morishima, A Velardi, P Bardy, J Bignon, J A Madrigal, E W Petersdorf on behalf of the International Histocompatibility Working Group in Hematopoietic Cell Transplantation FIT FOR THE FUTURE ANRI Site Visit 2012

61 % R e l a p s e The impact of HLA-DPB1 mismatching in 282 UD transplant pairs matched for HLA-A HLA-DQB1 (10/10 alleles) DPB1 match (n=72) DPB1 mismatch (n=189). 2 P= D a y s u n t i l R e l a p s e Cox regression: DP mismatch HR 0.56 (p=0.004) FIT FOR THE FUTURE ANRI Site Visit 2012 Shaw et al, Blood, 2006

62 p=.0001 FIT FOR THE FUTURE ANRI Site Visit 2012 Shaw et al, Blood, 2007

63 Cum Survival % OS % Relapse Combining genetic data DPB1 matching and recipient NOD2 group D haplotypes P= DPB1 matching and recipient NOD2 group D haplotypes High risk P= High risk Low risk Intermediate risk Low risk Time till Death Intermediate risk Time (years) Time (years) Low risk: mm & Hom. Int. risk: mm & Het. OR M & Hom. High risk: M & Het. FIT FOR THE FUTURE ANRI Site Visit 2012

64 FIT FOR THE FUTURE Name of meeting here