Fetal Alloimmune Hemolytic Anemia (AHA) as a Potential Target for Transamniotic Fetal Immunotherapy (TRAFIT).

Autor: Whitlock AE; Departments of Surgery, Boston Children's Hospital & Harvard Medical School, Boston, MA, USA., Moskowitzova K; Departments of Surgery, Boston Children's Hospital & Harvard Medical School, Boston, MA, USA., Kycia I; Departments of Surgery, Boston Children's Hospital & Harvard Medical School, Boston, MA, USA., Zurakowski D; Departments of Surgery, Boston Children's Hospital & Harvard Medical School, Boston, MA, USA., Fauza DO; Departments of Surgery, Boston Children's Hospital & Harvard Medical School, Boston, MA, USA. Electronic address: dario.fauza@childrens.harvard.edu.
Jazyk: angličtina
Zdroj: Journal of pediatric surgery [J Pediatr Surg] 2023 Jun; Vol. 58 (6), pp. 1107-1110. Date of Electronic Publication: 2023 Feb 17.
DOI: 10.1016/j.jpedsurg.2023.02.034
Abstrakt: Purpose: Fetal alloimmune hemolytic anemia (AHA) resulting from maternal antibodies against fetal erythrocytes may require fetal administration of immunoglobulin-G (IgG) via invasive methods. IgG can reach the fetal circulation after transamniotic fetal immunotherapy (TRAFIT). We sought to both develop a model of AHA and to test TRAFIT as a potential treatment.
Methods: Sprague-Dawley fetuses (n = 113) received intra-amniotic injections on gestational-day 18 (E18, term = E21) of either saline (control; n = 40), anti-rat-erythrocyte antibodies (AHA; n = 37), or anti-rat-erythrocyte antibodies plus IgG (AHA + IgG; n = 36). At term, blood was procured for red blood count (RBC), hematocrit, or ELISA for inflammatory markers.
Results: There was no difference in survival [95% (107/113)] across groups (p = 0.87). Both hematocrit and RBC were significantly lower in the AHA group than controls (p < 0.001). Although still significantly lower than controls (p < 0.001), both hematocrit and RBC significantly increased in AHA + IgG group compared to AHA alone (p < 0.001). Pro-inflammatory TNF-α and IL1-β were significantly elevated from controls in the AHA group, but not in AHA + IgG (p < 0.001-0.159).
Conclusions: Intra-amniotic injection of anti-rat-erythrocyte antibodies can reproduce manifestations of fetal AHA, constituting a practical model of this disease. Transamniotic fetal immunotherapy with IgG reduces anemia in this model and may emerge as a new minimally invasive means of treatment.
Type of Study: Animal and laboratory study.
Level of Evidence: N/A (animal and laboratory study).
(Copyright © 2023 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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