The Pathobiology of Red Cell Cryptantigen Exposure

Novak, Robert W.

doi:10.3109/15513819009064722

Cited by 27 publications

(24 citation statements)

References 25 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Pneumococcus-derived neuraminidase removes neuraminic acid residues from surfaces of red blood cells, platelets, and glomeruli, and then exposes the hidden T antigen. Binding of anti-T antibodies to the T antigen leads to the characteristic features of HUS: hemolytic anemia, thrombocytopenia and renal failure [6,9,21]. T-antigen exposure was proved in our patients.…”

Section: Discussionmentioning

confidence: 71%

Hemolytic uremic syndrome associated with pneumococcal pneumonia in Taiwan

et al. 2006

View full text Add to dashboard Cite

Streptococcus pneumoniae ( S. pneumoniae ) has been associated with hemolytic uremic syndrome (HUS), which is an unusual but serious disease in childhood. We conducted a retrospective review of children aged less than 18 years with S. pneumoniae -associated HUS in northern Taiwan from January 2000 to June 2005. The demographic characters, clinical courses, and outcomes were analyzed. Seven children (three girls, four boys) with S. pneumoniae -associated HUS were studied. The median age at onset of HUS was 40 months (range: 25-60 months). The median duration of hospital stay was 36 days (range: 15-50 days). The interval between the onset of illness attributable to S. pneumoniae and the development of HUS was around 1-2 weeks. The onset of oliguria developed within 2 weeks after illness. Six patients required dialysis with median duration of 16 days. Three patients had leukopenia as the initial presentation. All seven patients had pneumococcal pneumonia complicating with empyema, and two of them received decortication via video-assisted thoracoscopic surgery. Between patients who needed dialysis or not, there was no significant difference in age, sex, duration of thrombocytopenia, incidence of extra-renal complications, such as hepatitis, pancreatitis, and hypertension, and length of hospital stay. The seven patients survived with normal renal function. HUS is a potentially fatal complication of S. pneumoniae infection. Clinicians managing patients with pneumococcal pneumonia with empyema accompanied by leukopenia should beware of the development of HUS. The long-term prognosis for recovery of renal function appears to be good in these patients in northern Taiwan.

show abstract

Section: Discussionmentioning

confidence: 71%

Hemolytic uremic syndrome associated with pneumococcal pneumonia in Taiwan

et al. 2006

View full text Add to dashboard Cite

show abstract

“…Individual variations in the anti-T titer in patients compared with normal individuals have been reported [36,37]. This was attributed to the presence or absence of intestinal flora able to express a molecule either identical or very similar to the T-antigen, thereby stimulating anti-T antibody production [38,39,40]. It is likely that different strains produce different amounts of neuraminidase with variations in enzymatic activity.…”

Section: Discussionmentioning

confidence: 93%

Pneumococcus-induced T-antigen activation in hemolytic uremic syndrome and anemia

Cochran

Panzarino

Maes

et al. 2004

Pediatric Nephrology

View full text Add to dashboard Cite

The hemolytic uremic syndrome (HUS) is most commonly associated with Escherichia coli, but has been associated with other infections such as Streptococcus pneumoniae. Pneumococcus-induced HUS carries an increased risk of mortality and renal morbidity compared with E. coli-induced HUS. The pneumococcal organism produces an enzyme, which can expose an antigen (T-antigen) present on erythrocytes, platelets, and glomeruli. Antibodies to the T-antigen, normally found in human serum, bind the exposed T-antigen, and the resultant antigen-antibody reaction (T-activation) can lead to HUS and anemia. Clinicians need to be aware to request specific testing when pneumococcus-induced HUS/anemia is suspected, as current blood banking techniques do not routinely test for the presence of the T-antigen. Once this association is documented, washing all blood products and avoiding plasma products, if possible, is recommended. Plasmapheresis can be considered for the more critically ill patient. The incidence of pneumococcus-induced HUS may be increasing. We report six cases of pneumococcus-induced HUS/anemia presenting at our hospital.

show abstract

“…To establish clinical benefit of the early transfusion, however, a large scale of followup study of the relation between the population of cryptantigenpositive PNH erythrocytes and intravascular hemolysis is indispensable. As another application of these findings, attention should be paid to the hemolytic exacerbation induced by transfusion with blood products contaminated by natural antibodies, (12). Other noteworthy findings were that: (a) Arachis hypogaea aggregated the granulocytes obtained from the patient at the time of the hemolytic precipitation, as inferred from a previous report on the exposure of cryptantigen T on leukocytes and platelets (28), while sialidase treatment enhanced granulocyte aggregation in autologous serum (data not shown).…”

Section: Discussionmentioning

confidence: 71%

“…For example, infections infrequently disclose cryptantigens on blood cells by releasing nonreducing terminal carbohydrates of membrane glycoconjugates (8)(9)(10). Erythrocytes with these antigens become polyagglutinable and are rarely involved in hemolytic anemia, although the precise relationship is not clear (8)(9)(10)(11)(12). Thus, the expression of cryptantigens on erythrocytes may cause an immune reaction with natural antibodies, leading to complement activation on the erythrocytes, and resulting in hemolysis, especially when the erythrocytes are inherently susceptible to complement.…”

Section: Introductionmentioning

confidence: 99%

Expression of cryptantigen Th on paroxysmal nocturnal hemoglobinuria erythrocytes in association with a hemolytic exacerbation.

Nakakuma

Hidaka²,

Nagakura³

et al. 1995

J. Clin. Invest.

View full text Add to dashboard Cite

Paroxysmal nocturnal hemoglobinuria (PNH) erythrocytes lack complement regulatory membrane proteins and are susceptible to complement. Although the critical role of complement in intravascular hemolysis in PNH is accepted, the precise mechanism of complement activation in vivo is unknown. Accordingly, in a PNH patient who was suffering from a hemolytic precipitation soon after a common coldlike upper respiratory infection, we analyzed the erythrocytes with lectins and by flow cytometry to detect membrane alteration that lead to complement activation. The lectin reactivity of erythrocytes showed the expression of cryptantigen Th. The patient serum at the time of the hemolysis induced the expression of Th on erythrocytes from PNH patients and from healthy volunteers in vitro, whereas neither the patient serum after recovery from the hemolysis nor blood type-matched control serum from healthy donor showed this activity. Moreover, autologous serum selectively' hemolyzed Th + PNH erythrocytes, but not Th -PNH erythrocytes, or Th+ control erythrocytes. Hemolysis was not observed either in complement-inactivated serum or in blood type-matched cord blood serum, which lacks natural antibodies to cryptantigens. These findings indicate that the immunoreaction of infection-induced Th with natural antibody on PNH erythrocytes is a trigger of the complement activation, leading to intravascular hemolysis. (J. Clin. Invest. 1995. 96:201-206.)

show abstract

The Pathobiology of Red Cell Cryptantigen Exposure

Cited by 27 publications

References 25 publications

Hemolytic uremic syndrome associated with pneumococcal pneumonia in Taiwan

Hemolytic uremic syndrome associated with pneumococcal pneumonia in Taiwan

Pneumococcus-induced T-antigen activation in hemolytic uremic syndrome and anemia

Expression of cryptantigen Th on paroxysmal nocturnal hemoglobinuria erythrocytes in association with a hemolytic exacerbation.

Contact Info

Product

Resources

About