RESUMO
A match of HLA loci between patients and donors is critical for successful hematopoietic stem cell transplantation. However, the extreme polymorphism of HLA loci - an outcome of millions of years of natural selection - reduces the chances that two individuals will carry identical combinations of multilocus HLA genotypes. Further, HLA variability is not homogeneously distributed throughout the world: African populations on average have greater variability than non-Africans, reducing the chances that two unrelated African individuals are HLA identical. Here, we explore how self-identification (often equated with "ethnicity" or "race") and genetic ancestry are related to the chances of finding HLA compatible donors in a large sample from Brazil, a highly admixed country. We query REDOME, Brazil's Bone Marrow Registry, and investigate how different criteria for identifying ancestry influence the chances of finding a match. We find that individuals who self-identify as "Black" and "Mixed" on average have lower chances of finding matches than those who self-identify as "White" (up to 57% reduction). We next show that an individual's African genetic ancestry, estimated using molecular markers and quantified as the proportion of an individual's genome that traces its ancestry to Africa, is strongly associated with reduced chances of finding a match (up to 60% reduction). Finally, we document that the strongest reduction in chances of finding a match is associated with having an MHC region of exclusively African ancestry (up to 75% reduction). We apply our findings to a specific condition, for which there is a clinical indication for transplantation: sickle-cell disease. We show that the increased African ancestry in patients with this disease leads to reduced chances of finding a match, when compared to the remainder of the sample, without the condition. Our results underscore the influence of ancestry on chances of finding compatible HLA matches, and indicate that efforts guided to increasing the African component of registries are necessary.
Assuntos
Anemia Falciforme/genética , População Negra/genética , Medula Óssea/cirurgia , Transplante de Medula Óssea/métodos , Brasil , Etnicidade/genética , Frequência do Gene/genética , Genótipo , Antígenos HLA/genética , Transplante de Células-Tronco Hematopoéticas/métodos , Teste de Histocompatibilidade/métodos , Humanos , Polimorfismo Genético/genética , Sistema de Registros , Doadores não Relacionados , População Branca/genéticaRESUMO
A frequente utilização de sangue de cordão umbilical - SCU como fonte de células- tronco hematopoéticas - CTH, tanto em crianças, como em adultos, que não dispõem de doador na família, tem levado ao estabelecimento da padronização de critérios em sua seleção, objetivando a obtenção de melhores resultados. A escolha da unidade de SCU deve basear-se no número total de células nucleadas e no número de diferenças de antígenos leucocitários humanos (HLA). Diante de uma unidade com celularidade mínima, deve-se considerar a possibilidade da utilização de duplo cordão. Frente a mais de uma unidade com características semelhantes, a realização da contagem de células CD34 e da compatibilidade ABO, assim como a qualidade e a rapidez para obtenção da unidade, podem definir a escolha.
The frequent use of umbilical cord blood as the source of hematopoietic stem cells, both in children and adults who do not have related donors, has led to the establishment of a better standardization of selection criteria aiming at improving the results. The choice of the umbilical cord blood unit should be based on the total number of nucleated cells and the number of differences in the human leukocyte antigen (HLA) system. When a unit has minimal cellularity, the use of a double cord blood transplant should be considered. When two or more units have similar characteristics, the choice may be determined by the CD34 count, ABO compatibility and the quality and speed to obtain the unit.
Assuntos
Humanos , Masculino , Feminino , Lactente , Sangue Fetal , Células-Tronco Hematopoéticas , TransplanteRESUMO
A compatibilidade HLA é o fator mais valorizado na escolha do doador de medula óssea voluntário, preconizando-se a realização de HLA de alta resolução nos locos HLA-A,B,C, DRB1 e DQB1. Tem sido dado preferência para o doador com consanguinidade alélica 8x8 (A,B,C, DRB1). Na presença de incompatibilidade na classe-I sugere-se a busca de doador com compatibilidade DQB1 (9x10). Já as incompatibilidades dos locos DPB1 não constituem critério de exclusão de doador, exceto quando existir presença de anticorpo contra o loco HLA-DP do doador.
The HLA system is considered the most important factor in choosing a volunteer bone marrow donor with the recommendation of performing high resolution HLA tests for the HLA-A, B, C, DRB1 and DQB1 loci. A preference has been given for donor 8x8 (A, B, C, DRB1) allele matching. In the presence of class-I incompatibility a search for DQB1 (9x10) donor compatibility is suggested. The incompatibility of the DPB1 locus does not constitute exclusion of the donor, except when there is the presence of antibodies against the HLA-DP locus of the donor.
Assuntos
Humanos , Antígenos HLA/análise , Medula Óssea , Seleção do Doador , Transplante de Células-Tronco Hematopoéticas , HistocompatibilidadeRESUMO
Apesar da presença de anticorpos anti-HLA em transplantes de órgãos sólidos estar associada à rejeição, essa correlação não havia sido pesquisada em transplante alogênico de células progenitoras hematopoéticas (TCPH). Estudos mais recentes na literatura têm demonstrado que a falência da enxertia no TCPH pode ser mediada por aloanticorpos anti-HLA doador especifico (DSA). A especificidade desses anticorpos pode ser evidenciada pelas técnicas de fase sólida, onde os antígenos HLA únicos são aderidos a pérolas de poliestireno, que permite a realização da prova cruzada virtual. Na presença de DSA, é recomendável selecionar outro doador ou realizar as estratégias de remoção dos anticorpos.
In spite of Anti-HLA antibodies being associated to rejection in solid organs transplantation, this correlation has not been well established yet in allogenic bone marrow transplantation.Recent studies in the literature have demonstrated that engraftment failure in hematopoietic cell transplantation (HCT) can be mediated by donor specific anti-HLA antibodies (DSA). These antibodies specificity can be detected by solid-phase techniques, where single HLA antigens are adhered to microbeads, which allows the interpretation of host reactivity by "virtual crossmatch". In the presence of DSA, it is advisable to either search for another donor or remove the antibodies prior to transplantation.
Assuntos
Humanos , Seleção do Doador , Rejeição de Enxerto , Transplante de Células-Tronco Hematopoéticas , Antígenos HLA , Transplante HomólogoRESUMO
ETHNOPHARMACOLOGICAL RELEVANCE: Plectranthus amboinicus (Lour.) Spreng is a medicinal specie often used in Brazil, especially in Northeast Region, for the treatment of several diseases including inflammations and cancer. AIM OF THE STUDY: To evaluate the anti-inflammatory and antitumor activities of the hydroalcoholic extract from leaves of P. amboinicus in an attempt to determine whether the medicinal uses are supported by pharmacological effects. MATERIALS AND METHODS: Anti-inflammatory activity was determined by carrageenan-induced paw edema method. The antitumor effect was evaluated in an in vivo experimental study, using the following tumors: Sarcoma-180 and Erlich ascite carcinoma. RESULTS: There were statistically significant decreases (p<.05) of edema paw in at the doses of 150, 250 and 350 mg/kg (i.p.) of the hydroalcoholic extract of P. amboinicus. Similarly, the administration of P. amboinicus at the doses of 100, 150, 250 and 350 mg/kg (i.p.) inhibited the growth of sarcoma-180 and Ehrlich ascite carcinoma tumors in mice. CONCLUSION: The results suggest that the hydroalcoholic extract of P. amboinicus possesses anti-inflammatory and antitumor activities, supporting the folk use of this medicinal specie.