Kidd antigen system

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The Kidd antigen system (also known as Jk antigen) are proteins found in the Kidd's blood group, which act as antigens, i.e., they have the ability to produce antibodies under certain circumstances. The Jk antigen is found on a protein responsible for urea transport in the red blood cells and the kidney. [1] They are important in transfusion medicine. People with two Jk(a) antigens, for instance, may form antibodies against donated blood containing two Jk(b) antigens (and thus no Jk(a) antigens). This can lead to hemolytic anemia, in which the body destroys the transfused blood, leading to low red blood cell counts. Another disease associated with the Jk antigen is hemolytic disease of the newborn, in which a pregnant woman's body creates antibodies against the blood of her fetus, leading to destruction of the fetal blood cells. Hemolytic disease of the newborn associated with Jk antibodies is typically mild, though fatal cases have been reported. [2]

Contents

The gene encoding this protein is found on chromosome 18. [3] Three Jk alleles are Jk (a), Jk (b)and Jk3. Jk (a) was discovered by Allen et al. in 1951 and is named after a patient (Mrs Kidd delivered a baby with a haemolytic disease of the newborn associated with an antibody directed against a new antigen Jk (a). Whereas Jk (b) was discovered by Plant et al. in 1953, individuals who lack the Jk antigen (Jk null) are unable to maximally concentrate their urine. [4]

Genetics and biochemistry

Kidd comprises three antigens on a glycoprotein with 10 transmembrane spanning domains, cytoplasmic N- and C-termini and one extracellular N-glycosylation site. [5] The Kidd gene has 11 exons with exons 4-11 encoding the mature protein. The Kidd gene (SLC14A1) is on chromosome 18q12.3.[ citation needed ]

Kidd antigens

Jka (JK1) and Jkb (JK2)

Jka and Jkb are the products of alleles with Asp280 and Asn280 in the fourth external loop of the Kidd glycoprotein. Jka and Jkb have similar prevalences in White and Asian populations but Jka is more common in Black populations than Jkb. [5]

Kidd antigens are enhanced by enzymes[ citation needed ]

Jk(a-b-) and Jk3

Jk(a-b-) represents the null phenotype and usually results from homozygosity for a silent gene at the JK locus. [5] The null phenotype is rare in most populations but does have increased prevalence in Polynesians (one in 400) and Niueans (1.4%). [5]

In Polynesians the null allele contains a splice site mutation in intron 5 causing a loss of exon 6 from the mRNA product.[ citation needed ]

In Finns (null phenotype less rare than in other European populations), the null phenotype results from a mutation encoding a Ser291Pro substitution.[ citation needed ]

A rare null phenotype in Japanese individuals results from heterozygosity for an inhibitor gene. In(Jk) in analogy with the In(Lu) dominant inhibitor of Lutheran and other antigens. [5]

Immunized individuals with the Jk(a-b-) phenotype may produce anti-Jk3.[ citation needed ]

Very weak expression of Jka and/or Jkb can be detected on In(Jk) red blood cells in adsorption/elution tests. [5]

Kidd antibodies and clinical significance

Interpretation of antibody panel to detect patient antibodies towards the most relevant human blood group systems, including Kidd. .mw-parser-output .hatnote{font-style:italic}.mw-parser-output div.hatnote{padding-left:1.6em;margin-bottom:0.5em}.mw-parser-output .hatnote i{font-style:normal}.mw-parser-output .hatnote+link+.hatnote{margin-top:-0.5em} Further information: Blood compatibility testing Serology interpretation of antibody panel for blood group antigens.jpg
Interpretation of antibody panel to detect patient antibodies towards the most relevant human blood group systems, including Kidd.

Antibody subtypes and complement fixation

Anti-Jka and -Jkb are not common. They are usually warm-reacting IgG1 and IgG3 but may also include IgG2, IgG4 or IgM. Approximately 50% of anti-Jka and -Jkb antibodies are capable of binding complement. [6]

Dosage

Kidd antibodies display dosage: red cells from homozygous individuals (JkaJka or Jk(a+b-)) express more antigen than heterozygous individuals (JkaJkb or Jk(a+b+)). [7] Anti-Kidd antibodies appear to react more strongly against cells that are homozygous.[ citation needed ]

Laboratory detection

Kidd antibodies can be difficult to detect by direct agglutination testing and generally require addition of antihuman globulin after a warm incubation period.[ citation needed ]

Clinical significance

Kidd antibodies are dangerous as they are capable of causing severe acute hemolytic transfusion reactions. They are unique in that they are capable of dropping to low or even undetectable levels after several months following an exposure. [5] Thus, on pre-transfusion testing, an anti-Jka or -Jkb may go undetected. Following transfusion, a subsequent robust antibody response in the patient can occur (anamnestic response), resulting in hemolysis of the transfused red blood cells. Kidd antibodies are often capable of binding complement and causing intravascular hemolysis. More often, however, Kidd antibodies cause acute extravascular hemolysis. [7] They are a notorious cause of delayed hemolytic transfusion reactions, and may occur up to a week after transfusion in some instances. Kidd antibodies only rarely cause hemolytic disease of the fetus and newborn. [5]

Kidd glycoprotein as urea transporter

Kidd antigens are located on a red blood cell urea transporter (human urea transporter 11- HUT11 or UT-B1). [8] As red blood cells approach the renal medulla (where there is a high concentration of urea), the urea transporter allows for rapid uptake of urea and prevents cell shrinkage in the hypertonic environment of the medulla. [5] As the red cell leaves the medulla, the urea is transported back out of the cell, preventing cellular swelling and preventing the urea from being carried away from the kidney. [5] HUT11 was detected on endothelial cells of the vasa recta (vascular supply of the renal medulla) but it is not present in renal tubules. [5]

Due to absence of the urea transporter, Jk(a-b-) cells are not hemolyzed by 2M urea. This can be used as a screening test for Jk(a-b-) donors.[ citation needed ]

The Jk(a-b-) phenotype has no clinical defect, although two individuals with this phenotype have been reported to have mild urine-concentrating defects. [4]

Kidd antibodies in transplant patients

Kidd antibodies are capable of behaving as histocompatibility antigens in renal transplants and may be responsible for allograft rejection in some cases. [9]

Related Research Articles

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A blood type is a classification of blood, based on the presence and absence of antibodies and inherited antigenic substances on the surface of red blood cells (RBCs). These antigens may be proteins, carbohydrates, glycoproteins, or glycolipids, depending on the blood group system. Some of these antigens are also present on the surface of other types of cells of various tissues. Several of these red blood cell surface antigens can stem from one allele and collectively form a blood group system.

Rh disease is a type of hemolytic disease of the fetus and newborn (HDFN). HDFN due to anti-D antibodies is the proper and currently used name for this disease as the Rh blood group system actually has more than 50 antigens and not only the D-antigen. The term "Rh Disease" is commonly used to refer to HDFN due to anti-D antibodies, and prior to the discovery of anti-Rho(D) immune globulin, it was the most common type of HDFN. The disease ranges from mild to severe, and occurs in the second or subsequent pregnancies of Rh-D negative women when the biologic father is Rh-D positive.

<span class="mw-page-title-main">Hemolytic disease of the newborn</span> Fetal and neonatal alloimmune blood condition

Hemolytic disease of the newborn, also known as hemolytic disease of the fetus and newborn, HDN, HDFN, or erythroblastosis foetalis, is an alloimmune condition that develops in a fetus at or around birth, when the IgG molecules produced by the mother pass through the placenta. Among these antibodies are some which attack antigens on the red blood cells in the fetal circulation, breaking down and destroying the cells. The fetus can develop reticulocytosis and anemia. The intensity of this fetal disease ranges from mild to very severe, and fetal death from heart failure can occur. When the disease is moderate or severe, many erythroblasts are present in the fetal blood, earning these forms of the disease the name erythroblastosis fetalis.

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In ABO hemolytic disease of the newborn maternal IgG antibodies with specificity for the ABO blood group system pass through the placenta to the fetal circulation where they can cause hemolysis of fetal red blood cells which can lead to fetal anemia and HDN. In contrast to Rh disease, about half of the cases of ABO HDN occur in a firstborn baby and ABO HDN does not become more severe after further pregnancies.

Hemolytic disease of the newborn (anti-Kell1) is the second most common cause of severe hemolytic disease of the newborn (HDN) after Rh disease. Anti-Kell1 is becoming relatively more important as prevention of Rh disease is also becoming more effective.

Hemolytic disease of the newborn (anti-Rhc) can range from a mild to a severe disease. It is the third most common cause of severe HDN. Rh disease is the most common and hemolytic disease of the newborn (anti-Kell) is the second most common cause of severe HDN. It occurs more commonly in women who are Rh D negative.

The Kell antigen system is a human blood group system, that is, a group of antigens on the human red blood cell surface which are important determinants of blood type and are targets for autoimmune or alloimmune diseases which destroy red blood cells. The Kell antigens are K, k, Kpa, Kpb, Jsa and Jsb. The Kell antigens are peptides found within the Kell protein, a 93-kilodalton transmembrane zinc-dependent endopeptidase which is responsible for cleaving endothelin-3.

<span class="mw-page-title-main">Rh blood group system</span> Human blood group system involving 49 blood antigens

The Rh blood group system is a human blood group system. It contains proteins on the surface of red blood cells. After the ABO blood group system, it is the most likely to be involved in transfusion reactions. The Rh blood group system consists of 49 defined blood group antigens, among which the five antigens D, C, c, E, and e are the most important. There is no d antigen. Rh(D) status of an individual is normally described with a positive (+) or negative (−) suffix after the ABO type. The terms Rh factor, Rh positive, and Rh negative refer to the Rh(D) antigen only. Antibodies to Rh antigens can be involved in hemolytic transfusion reactions and antibodies to the Rh(D) and Rh antigens confer significant risk of hemolytic disease of the fetus and newborn.

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<span class="mw-page-title-main">Ii antigen system</span> Human blood group system

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<span class="mw-page-title-main">Blood compatibility testing</span> Testing to identify incompatibilities between blood types

Blood compatibility testing is conducted in a medical laboratory to identify potential incompatibilities between blood group systems in blood transfusion. It is also used to diagnose and prevent some complications of pregnancy that can occur when the baby has a different blood group from the mother. Blood compatibility testing includes blood typing, which detects the antigens on red blood cells that determine a person's blood type; testing for unexpected antibodies against blood group antigens ; and, in the case of blood transfusions, mixing the recipient's plasma with the donor's red blood cells to detect incompatibilities (crossmatching). Routine blood typing involves determining the ABO and RhD type, and involves both identification of ABO antigens on red blood cells and identification of ABO antibodies in the plasma. Other blood group antigens may be tested for in specific clinical situations.

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References

  1. ↑ Olives B, Mattei MG, Huet M, Neau P, Martial S, Cartron JP, Bailly P. "Kidd blood group and urea transport function of human erythrocytes are carried by the same protein." Journal of Biological Chemistry. 1995 Jun 30;270(26):15607-10. doi : 10.1074/jbc.270.26.15607 PMID   7797558
  2. ↑ Kim WD, Lee YH. "A fatal case of severe hemolytic disease of newborn associated with anti-Jk(b)." Journal of Korean Medical Science. 2006 Feb;21(1):151-4. PMID   16479082
  3. ↑ Geitvik GA, Hoyheim B, Gedde-Dahl T, Grzeschik KH, Lothe R, Tomter H, Olaisen B. "The Kidd (JK) blood group locus assigned to chromosome 18 by close linkage to a DNA-RFLP." Human Genetics. 1987 Nov;77(3):205-9. doi : 10.1007/BF00284470 PMID   2890568
  4. 1 2 Sands JM, Gargus JJ, Frohlich O, Gunn RB, Kokko JP. "Urinary concentrating ability in patients with Jk(a-b-) blood type who lack carrier-mediated urea transport." Journal of the American Society of Nephrology. 1992 Jun;2(12):1689-96. PMID   1498276
  5. 1 2 3 4 5 6 7 8 9 10 11 Roback et al. AABB Technical Manual, 16th Ed. Bethesda, AABB Press, 2008.
  6. ↑ Klein HG, Anstee DJ. Mollison's Blood Transfusion in Clinical Medicine. 11th Ed. Oxford: Blackwell Publishing, 2005.
  7. 1 2 Mais DD. ASCP Quick Compendium of Clinical Pathology, 2nd Ed. Chicago: ASCP Press, 2009.
  8. ↑ Sands JM. Molecular Mechanisms of Urea Transport. Journal of Membrane Biology. 2003; 191: 149-63.
  9. ↑ Hold S, Donaldson H, Hazelhurst G, et al. Acute Transplant Rejection Induced By Blood Transfusion Reaction to the Kidd Blood Group System. Nephrology Dialysis Transplantation. 2004; 19: 2403-6.


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