H. Kaabi

HLA polymorphism in type 1 diabetes Tunisians.

Several studies of the association between HLA and type 1 diabetes have been carried out revealing differences between ethnic groups. Our study, as part of the studies that should be performed about this association in the rest of the word, aims at elucidating the HLA DRB1, DQB1 polymorphism in Tunisian type 1 diabetes. This study includes 43 unrelated type 1 diabetes patients, and their mean age at onset is less than 15 years. Analysis of the frequency of alleles and haplotypes in these subjects, compared to a reference group (n = 101) led to the following results. 1) The Tunisian insulin-dependent diabetics present similarities as well as differences with other ethnic groups (Caucasians, North Africans). 2) The haplotype DRB1*04 DQ*0302 and DRB1*03 DQB1*0201 is positively associated to type 1 diabetes. 3) The heterozygotic genotype DRB1*04 DQB1*0302 / DRB1*03 DQB1*0201 is strongly associated to type 1 diabetes. 4) The haplotypes DRB1*01501 DQB1*0602 and DRB1*11 DQB1*0301 proved to be protective. In addition, the study of the subtypes DRB1*04 showed that alleles DRB1*0405 predispose to type 1 diabetes, whereas the allele DRB1*0403, which is in linkage disequilibrium with the DQB1*0402 in the Tunisian population, has a protective effect.

Duffy blood group system genotyping in an urban Tunisian population.

Background: The Duffy blood group system, besides its relevance in transfusion medicine, is of major interest for population genetics. In fact, the Duffy molecule is the only red cell receptor for Plasmodium vivax, thus the fixation of FY*silent allele in western south-Saharan Africa resulted in the absence of this type of malaria in that area (for a review see Kwiatowski, Am J Hum Genet 77:171–192, 2005). For the Duffy functional role see, for example, Daniels (Vox Sanguinis 93:331–340, 2007). Methods: Duffy blood group distribution in 115 unrelated Tunisians was determined using the polymerase chain reaction with sequence specific primer (PCR-SSP) method detecting the five allelic versions of the FY gene. The red cell antigenic FY phenotype, for each donor, was deduced through DNA analysis. The blood samples of the positive FY*X alleles were investigated by serological methods, mainly the fixation–elution technique. Results: The following allele frequencies were found (after having excluded FY*X, which had frequency of 0.0174): FY*1 = 0.291 (expressed 0.260; silent 0.031); FY*2 = 0.709 (expressed 0.427; silent 0.282). The most surprising result in this work is the detection of the FY*1 silent allele, usually quite rare, in four samples (1.74%). For FY*2 silent, the predominant allele in Africans, genotyping results showed a prevalence of 29.57%. The FY locus was in Hardy–Weinberg equilibrium in the present sample. Conclusion: When compared with European and African data, Tunisian samples demonstrated the presence of the common signs of these two ancestries (FY*2 and FY*X for the first population; and FY*2 silent for the last one). These data confirm the mixed roots of this urban Tunisian population already suggested by numerous studies on other haematological markers.

Effect of donor CTLA-4 alleles and haplotypes on graft-versus-host disease occurrence in Tunisian patients receiving a human leukocyte antigen-identical sibling hematopoietic stem cell transplant.

The CTLA-4 genetic variation, such as single nucleotide polymorphisms (SNPs) may be critical and can affect the functional activity of cells that initiate the graft-versus-host disease (GVHD) effects. The aim of this study is to examine the effect of donor CTLA-4 alleles and haplotypes for the -318C>T and the 49A>G polymorphisms on the occurrence of GVHD in Tunisians recipients of HSCs. A total of 112 patients and their 112 respective sibling donors of HSCs were enrolled in this study. All patients had either grades 0-I or grades II-IV acute GVHD, or chronic GVHD. The SNPs genotyping assay was performed using sets of sequence specific primers (SSP-PCR). The single marker association analysis showed that the 49G allele, in a genetic recessive model, may be a potential risk factor only for the chronic GVHD (p = 0.032, odds ratio [OR] = 2.58, 95% confidence interval = 1.05-6.32). The haplotypes analyses showed that the CTLA-4 -318C49G nucleotide combination is significantly associated with the incidence of chronic GVHD (p = 0.043, χ² = 3.27). Donor CTLA-4 -318C49G haplotype may be a significant risk factor for developing chronic GVHD after allo-stem cell transplantation. We suppose that donor T cells expressing this haplotype in a homozygous state have higher proliferation than those expressing other haplotypes, especially after recognition of the recipients minor histocompatibility antigens.

HLA class I and class II polymorphism in a population from south‐eastern Tunisia (Gabes Area)

The gene frequencies of HLA class I and class II alleles were investigated in 95 healthy Tunisian individuals from Gabes. Our aim was to compare the genetic relationship between Gabesians and Mediterraneans and sub‐Sahara Africans using genetic distances, Neighbour‐Joining dendrograms, correspondence and haplotypes analysis, thereby providing additional information about evolutionary history of modern‐day Tunisians. Subjects were unrelated and of both genders, and HLA class I and class II genes were genotyped using the polymerase chain reaction‐sequence specific primer (PCR‐SSO) technique. Our data show that south‐eastern Tunisians (Gabes area) are related to present‐day North Africans (Algerians, Moroccans, Tunisians) and Iberians (Spaniards, Basques), and along with other North Africans, appear to be genetically related to Berbers, an indication that the Arab invasion (7th–11th centuries) of North Africa had minimal contribution on the HLA makeup of North Africans. On the other hand, Iberians including Spaniards and Basques show relatedness to (native Tunisian) Berbers, suggesting that the gene flow of 7th century AD invaders was also low in Iberians. In conclusion, the successive invasions of North Africa in general, and Tunisia in particular, did not modify markedly the genetic makeup of present‐day Tunisians. With the exception of Greeks who have a sub‐Saharan genetic profile, all Mediterranean populations depict a typical mediterranean substratum.

Successful Haploidentical Stem Cell Transplantation with Post-Transplant Cyclophosphamide in a Severe Combined Immune Deficiency Patient: a First Report

Allogeneic hematopoietic stem cell transplantation (HSCT) is still the mainstay of treatment in the majority of severe combined immune deficiency (SCID) patients [1]. In the absence of a matched related donor (MRD), several alternative stem cell sources are available, including unrelated volunteer donors (UD), umbilical cord blood (UCB) units, or haploidentical transplantation (HT) [2]. Although overall survival rates after HT have improved significantly over time for SCID patients, problems with ex vivo T cell depletion still exist, including graft manipulation, high technology cost, slow immune recovery, and high rate of infections [1, 2]. T cell replete grafts with post-transplant cyclophosphamide (PT-CY) is an emerging recent approach to HT in adult patients with malignant hematological conditions. It seems to overcome many of the obstacles associated with ex vivo Tdepleted HT [3–5]. We report, to our knowledge, the first successful haploidentical transplantation using T cell replete graft and PT-CY in a SCID patient.

HA-1 and HA-2 minor histocompatibility antigens in Tunisians

Minor histocompatibility antigens (MiHAgs), such as HA-1 and HA-2, are the main targets of immune responses after allogeneic stem cell transplantation (SCT). HA-1 and HA-2 are two hematopoietic system-restricted antigens encoded, respectively, by HMHA1 and MYO1G genes. In order to estimate their frequencies in Tunisians, we performed a molecular-based allele analysis for 160 healthy and unrelated subjects. Genomic DNAs were extracted mainly by the salting out method. Single nucleotide polymorphism (SNP) genotyping assays for selected sites at HMHA1 gene (rs3764653 and rs1801284) and at MYO1G gene (rs61739531) were performed with a sequence specific primers-polymerase chain reaction (SSP-PCR) method. Statistical analysis of our results showed that the HA-2 antigen is more frequent than the HA-1 antigen in the Tunisian population because their frequencies were 97% and 57%, respectively. Allele analysis for HMHA1 gene showed that the R variant (500T-504G) was predominant in our population (64%). For the MYO1G gene, the C allele was predominant (84%). All loci were in Hardy-Weinberg equilibrium (minimum P value = 0.06). Our frequencies were close to those reported in African and Caucasian groups.

Evidence that erythrocyte DARC-positive phenotype can affect the GVHD occurrence after HLA-identical sibling HSCT.

Chemokine receptors are very important players in the pathogenesis of GVHD. The aim of this study is to test the hypothesis that the lack of expression of the DARC receptor on erythrocytes can affect the GVHD incidence. A total of 105 recipients and their 105 respective sibling donors of HSCs were enrolled in this study. All patients were evaluated for acute and chronic GVHD. The DARC genotyping assay was performed using the SSP-PCR method. The case-control analyses showed that the donor DARC 146G allele and T(-46)G(146) haplotype, coding for the FY2 version of DARC, are very significant in the GVHD paradigm because they are associated with the incidence of acute effects of this outcome in recipients (p=0.007, χ²=7.200). It seems that this version of DARC receptor is a powerful facilitator of chemokine transcytosis and subsequently leukocyte migration into GVHD target organs.

Does minor histocompatibility antigen HA-1 disparity affect the occurrence of graft-versus-host disease in tunisian recipients of hematopoietic stem cells?

INTRODUCTION: Minor histocompatibility antigen HA‐1 (MiHAg‐HA‐1) disparity between a patient and his or her human leukocyte antigen (HLA) genoidentical donor has been widely associated with an increased risk of graft‐versus‐host disease following allogeneic hematopoietic stem cell transplantation. OBJECTIVE: To examine the effect of HA‐1 disparity on the incidence of both acute and chronic graft‐versus‐host disease in Tunisian recipients of hematopoietic stem cells. METHODS: A total of 60 patients and their 60 respective sibling hematopoietic stem cell donors were enrolled in this study. All patients prophylactically received cyclosporine A and/or methotrexate for graft‐versus‐host disease. An HA‐1 genotyping assay was performed with the SSP‐PCR method, and HLA‐A*0201‐ and/or HLA‐A*0206‐positive samples were identified using the Luminex HLA typing method. RESULTS: The Luminex HLA typing assay showed that 54 patients were positive for either the HLA‐A*0201 or HLA‐A*0206 alleles. Among these cases, six pairs were mismatched for MiHAg‐HA‐1. Both acute and chronic graft‐versus‐host disease occurred in four mismatched patients (Fishers p‐values were 0.044 and 0.170, respectively). A univariate logistic regression model analysis showed that only acute graft‐versus‐host disease may be affected by recipient MiHAg‐HA‐1 disparity (p: 0.041, OR: 6.727), while chronic graft‐versus‐host disease correlates with both age and recipient/donor sex mismatch (p: 0.014, OR: 8.556 and p: 0.033, OR: 8.664, respectively). CONCLUSION: Our findings support previously reported data suggesting a significant association between HA‐1 disparity and the risk of acute graft‐versus‐host disease following hematopoietic stem cell transplantation.

Acute graft-vs.-host disease correlates with the disparity for the PECAM-1 S536N polymorphism only in the HLA-B44-like positive Tunisian recipients of HSCs.

GVHD is the major cause of mortality after HLA-identical HSCT. Such complication has been widely linked to donor/recipient disparity for minor histocompatibility antigens (MiHAgs). PECAM-1 is one of potential human MiHAgs but its effect on the GVHD occurrence remains not clear. In order to examine such association in the Tunisian cohort of HSCs recipients, we performed a retrospective study on patients who undergone HLA-identical HSCT between 2000 and 2009. Genotyping of the three selected PECAM-1 polymorphisms (rs668, rs12953 and rs1131012) was performed with SSP-PCR method. Univariate analyses showed that grades II-IV acute GVHD were considerably linked to the non-identity for rs12953 only in HLA-B44-like positive patients (p=0.010, OR=10.000). Multivariate analysis for chronic GVHD showed that this outcome may be affected only by the adulthood and the conditioning regimen. Our findings support the previously reported data suggesting a significant association between the PECAM-1 disparity and the risk of acute GVHD.

Allogeneic hematopoietic stem cell transplantation for acquired aplastic anemia using cyclophosphamide and antithymocyte globulin: a single center experience

Between February 1998 and October 2007, 97 (69 male, 28 female) patients with acquired aplastic anemia and a median age of 18 years (range, 2-39) received related allogeneic hematopoietic stem cell transplantation. Ninety-five patients received bone marrow grafts and two patients G-CSF primed peripheral blood stem cell transplantation. The donors were genotypically HLA-identical siblings in 94 cases, HLA-matched parents in 2 cases and a syngeneic twin in 1 case. Median time from diagnosis to transplantation was 2 months (range, 1-15). Conditioning regimen consisted of cyclophosphamide combined with antithymocyte globulin in all patients. For graft versus host disease (GVHD) prophylaxis, all patients received methotrexate and cyclosporine. Eighty-six patients showed evidence of hematopoietic engraftment. Eight patients died before engraftment. Rejection rate was 14.8% with three primary graft failures and eight secondary graft rejections occurring between 2 and 27 months post transplantation. Of the 11 rejecting patients, 3 died from infection and 8 proceeded to a second transplantation. Among the eight patients re-transplanted, seven are alive with successful second engraftments and one died from acute grade III GVHD. Acute GVHD occurred in 15.5% and extensive chronic GVHD in only 5.3% of patients. The 4-year overall probability of survival was 76.8%. Infection was the cause of 81.1% of deaths. The major factor affecting survival was onset of infection before transplantation. Major ABO donor-recipient incompatibility, disease severity and acute GVHD had also negative impact on survival. These results could be improved by reducing the time to transplant and by a more efficient supportive care policy.Bone Marrow Transplantation advance online publication, 27 July 2009; doi:10.1038/bmt.2009.175.