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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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Submitted May 13, 2004
Accepted June 11, 2004

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*

Cellular Transplantation Biology, Kanazawa University Graduate School of Medical Science, Kanazawa, Ishikawa, Japan
Protected Environmental Unit, Kanazawa University Hospital, Kanazawa, Ishikawa, Japan

* Corresponding author; email: snakao{at}med3.m.kanazawa-u.ac.jp.

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). ELISA revealed high titers of anti-DRS-1 antibodies (DRS-1 Ab) in 27 of 71 (38.0%) AA patients displaying increased paroxysmal nocturnal hemoglobinuria (PNH)-type cells (PNH+), 2 of 32 (6.3%) PNH- AA patients, 5 of 13 (38.5%) 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 normal individuals. Stimulation of T cells from an AA patient displaying high DRS-1 Ab with a putative CD4+ T-cell epitope (aa 191-204) presented by HLA-DR15, which overlapped with a hot spot (aa 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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