We report the use of bioactive paper for typing of secondary human blood groups. Our recent work on using bioactive paper for human blood typing has led to the discovery of a new method for identifying haemagglutination of red blood cells. The primary human blood groups, i.e., ABO and RhD groups, have been successfully typed with this method. Clinically, however, many secondary blood groups can also cause fatal blood transfusion accidents, despite the fact that the haemagglutination reactions of secondary blood groups are generally weaker than those of the primary blood groups. We describe the design of a user-friendly sensor for rapid typing of secondary blood groups using bioactive paper. We also present mechanistic insights into interactions between secondary blood group antibodies and red blood cells obtained using confocal microscopy. Haemagglutination patterns under different conditions are revealed for optimization of the assay conditions.
Modern techniques for quantifying blood group antibody-antigen interactions are very limited, especially for weaker interactions which result from low antigen expression and/or partial expression of the antigen structure. Surface plasmon resonance (SPR) detection is often used to monitor and quantify bio-interactions. Previously, a regenerable, multi-fucntional platform for quantitative RBC phenotyping of normal antigen expression using SPR detection was reported. However, detection of weaker variants were not explored. Here, this sensitivity study used anti-human IgG antibodies immobilized to a gold sensor surface to two clinically important types of weaker D variants using SPR; weak D and partial D. Positive pre-sensitised cells bind to the anti-human IgG monolayer, and the response unit (RU) is reported (>100 RU). Unbound negative cells are directly eluted (<100 RU). Weak D cells were detected between a range of 180–580 RU, due to a lower expression of antigens. Partial D cells, category D VI, were also positively identified (352–1147 RU), similar to that of normal D antigens. The detection of two classes of weaker D variants was achieved for the first time using this fully regenerable SPR platform, opening up a new avenue to replace the current subjective and arbitrary methods for quantifying blood group antibody-antigen interactions.
Paper-based diagnostics provide a low-cost, reliable and easy to use mode of blood typing. The shelf-life of such products, however, can be limited due to the reduced activity of reagent antibodies sorbed on the paper cellulose fibers. This study explores the effects of aging on antibody activity for periods up to 12 months on paper and in solution under different aging and drying conditions—air-dried, lyophilized, and kept as a liquid. Paper kept wet with undiluted antibody is shown to have the longest shelf-life and the clearest negatives. Antibody diluted with bovine serum albumin (BSA) protects against the lyophilization process, however, beyond 9 months aging, false positives are seen. Paper with air-dried antibodies is not suitable for use after 1 month aging. These results inform preparation and storage conditions for the development of long shelf-life blood grouping paper-based diagnostics.
The most widely known blood groups, ABO and RhD, have been extensively observed as having strong antibody-antigen interactions during blood typing. However, not all interactions show the same binding affinity. The Duffy blood group system, where Fy and Fy antigens are the most clinically significant, are only available with an IgG antibody structure, and display weak binding interactions. While current blood typing techniques are well established, methods for quantifying the binding strength are more limited. Surface Plasmon Resonance (SPR) provides avenues for developing more robust detection methods, and serve as a sensitive quantification technique by itself. This study tested SPR for the detection of weaker antibody-antigen interactions using the Duffy blood groups, Fy and Fy, as a model. This study shows a minimum threshold of antibody concentration is required for successful detection. Some instances of detection were successful using concentrated commercial anti-Fy and anti-Fy solution during the incubation stage. However, these results were not fully reproducible. We found that a significant dissociation of the Duffy antigen-antibody complex occurs over time. A combination of factors affects the detection of the Duffy antigens using SPR; these include antibody concentration, antigen expression, and antigen structure. This results in weak, unstable and reversible antibody-antigen interactions which are currently limiting accurate and reproducible detection by SPR. Despite these issues, detection of Duffy antigens Fy and Fy was demonstrated using SPR; however, further development is required for SPR to become a robust clinical blood typing technique.
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