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Blood, 15 October 2004, Vol. 104, No. 8, pp. 2425-2431.
Prepublished online as a Blood First Edition Paper on June 24, 2004; DOI 10.1182/blood-2004-05-1839.


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IMMUNOBIOLOGY

Diazepam-binding inhibitor-related protein 1: a candidate autoantigen in acquired aplastic anemia patients harboring a minor population of paroxysmal nocturnal hemoglobinuria–type cells

Xingmin Feng, Tatsuya Chuhjo, Chiharu Sugimori, Takeharu Kotani, Xuzhang Lu, Akiyoshi Takami, Hiroyuki Takamatsu, Hirohito Yamazaki, and Shinji Nakao

From the Cellular Transplantation Biology, Kanazawa University Graduate School of Medical Science, Ishikawa, Japan; and the Protected Environmental Unit, Kanazawa University Hospital, Kanazawa, Ishikawa, Japan.

To identify candidate antigens in aplastic anemia (AA), we screened proteins derived from a leukemia cell line with serum of an AA patient and identified diazepam-binding inhibitor-related protein 1 (DRS-1). Enzyme-linked immunosorbent assay (ELISA) revealed high titers of anti–DRS-1 antibodies (DRS-1 Abs) in 27 (38.0%) of 71 AA patients displaying increased paroxysmal nocturnal hemoglobinuria (PNH)–type cells (PNH+), 2 (6.3%) of 32 PNH AA patients, 5 (38.5%) of 13 PNH+ myelodysplastic syndrome (MDS) patients, and none of 42 PNH MDS patients. DRS-1 gene was abundantly expressed in myeloid leukemia cell lines and in CD34+ cells derived from healthy individuals. Stimulation of T cells from an AA patient displaying high DRS-1 Abs with a putative CD4+ T-cell epitope (amino acid residues [aa's] 191-204) presented by HLA-DR15, which overlapped with a hot spot (aa's 173-198) of DRS-1 Ab epitopes, gave rise to T cells cytotoxic for L cells (murine fibroblasts) that were transfected with DRB1*1501 and DRS-1. Enzyme-linked immunospot assay demonstrated increased frequency of T-cell precursors specific to the DRS-1 peptide in other HLA-DR15+ AA patients displaying high DRS-1 Ab titers. These findings indicate that DRS-1 may serve as an autoantigen eliciting immune attack against hematopoietic stem cells in a subset of AA patients characterized by increased PNH-type cells.


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