Prediction of Red Blood Cell Antibody Significance Using the Monocyte-Macrophage Assay

Summary

We have developed enhancements and updated methods for the existing monocyte-monolayer assay (MMA), in which macrophages are used to help better predict the clinical relevance of red cell alloantibodies in transfusion medicine and immunology. This assay is named the monocyte-macrophage assay (M-MA).

Abstract

Derived from monocytes in the bone marrow, macrophages are large, innate immune cells that play a major role in clearing dead cells, debris, tumor cells, and foreign pathogens. The phagocytic capacity of monocytes versus macrophages is a concept that is not well understood. Here, we aim to examine a difference in the phagocytosis of monocytes versus macrophages, specifically M1/M2 macrophages, against various opsonized red cells using a modified and updated version of the established monocyte monolayer assay (MMA). Peripheral blood mononuclear cells (PBMCs) were isolated from donor buffy coats. Using purified monocytes, inflammatory M1 and anti-inflammatory M2 macrophages were produced by in vitro culture and polarization. M1/M2 cells were harvested and used in an MMA-like assay, which we refer to as the M-MA, to decipher clinically significant phagocytosis of various red cell antibodies. A phagocytic index (PI) > 5 was deemed clinically significant phagocytosis with the use of monocytes. A phagocytic index (PI) > 12 was deemed clinically significant phagocytosis with the use of M1/M2 macrophages. M2 macrophages demonstrate an increased ability to phagocytose opsonized RBCs compared to monocytes and M1s. The same weak antibody (anti-S) yields significant phagocytosis with only M2 macrophages (PI=43) but not M1s (PI=2) or monocytes (PI=0), and this was demonstrated repeatedly using various antibodies. The use of M2 macrophages instead of monocytes may allow for more accurate results as these cells are more phagocytic, offering further clinical relevance to the assay. Further studies with different antibodies to red blood cells, including validation of the monocyte-macrophage assay (M-MA) with antibodies having known clinical significance, may show the M-MA more useful to help predict clinically significant red cell alloantibodies and transfusion reactions. This method will advance the field of transfusion medicine and immunology.

Introduction

Predicting transfusion reactions remains a significant challenge in the field of transfusion medicine. Over the past 4 decades, the monocyte-monolayer assay (MMA), pioneered by Tong and Branch^1,2, has served as a valuable in vitro cellular assay for predicting the clinical outcome of hemolysis in blood transfusion patients¹. Indeed, this assay has been instrumental in distinguishing between clinically significant and insignificant red blood cell (RBC) antibodies². While monocytes have traditionally been the standard leukocyte used in this assay, our rese....

Protocol

This research was performed in compliance with institutional guidelines for conducting ethical research involving human subjects. Ethics approval was granted from the Canadian Blood Services Research Ethics Board (REB), approval CBSREB#2023.008. All steps of this protocol are to be carried out in a biosafety cabinet under sterile conditions.

1. Isolation of PBMCs

1. Obtain whole human blood from a donor in an ACD tube. Store the blood at room temperature (18 °C–22 °C) for up to 36 h.
2. Transfer the whole blood ACD tubes to 50 mL centrifuge tubes (a single 50 mL tube for every two ACD tubes). Add ....

Discussion

To ensure the method’s success, one must adhere to the following critical steps: 1) successful M1/M2 polarization, 2) generation of the macrophage layer and RhD+ control 3) quantification of phagocytic index. While our methods state to use isolated monocytes for the cell culture, PBMCs may be used, but we recommend using purified monocytes. It is known that PBMCs contain various cell types, with these cells secreting multiple different cytokines and mediating factors. This may have an impact on the differentia.......

Materials

Name	Company	Catalog Number	Comments
1X PBS, pH 7.4, without Ca2+/Mg2+	Wisent Bioproducts	311-425-CL	Store at 4 degrees or room temperauture
AccutaseTM	STEMCELL Technologies	7920	Cell detachment solution
ACK Lysis Buffer	STEMCELL Technologies	07850, 07800	Store at 4 degrees
Anti-Human Globulin	NOVACLONE, Immunocor.	N/A	NOVACLONE Anti-igG for IAT testing
Anti-Rh(D) (WinRho. SDF CDN)	Saol Therapeutics	1003092	Any commerical source of Rh immune globin will suffice
Cell Scraper	UofT Medstore	83.395	cell detachement
Cell Strainer 70uM nylon	Falcon	352350	filter of cells
Chamber slide Nunc. Lab-TekTM II with Cover, RS Glass Slide Sterile	Thermo Fisher Scientific	154534	chamber slides for MMA
Coverslips	VWR	48393-081	24 x 50 mm
Cytiva Ficoll Paque Plus, density 1.077 g/L	Thermo Fisher Scientific	17-1440-03	sepeation of PBMCS from whole blood; density gradient medium
Elvanol Mounting Medium	N/A	N/A	Dulbecco’s PBS (D-PBS) without Ca2+/Mg2+, 15% (w/v) polyvinyl resin, and 30% (v/v) glycerine.
Fresh whole blood (ACD tube) or Buffy coat	Canadian Blood Services		May rest at room tempruatre for up to 36 hours
Human Recombinant GM-CSF	STEMCELL Technologies	78015.1	Cytokine for polarization of M1 macrophages
Human Recombinant IFN-gamma	STEMCELL Technologies	78020	Cytokine for polarization of M1 macrophages
Human Recombinant IL-4	STEMCELL Technologies	78045.1	Cytokine for polarization of M2 macrophages
Human Recombinant M-CSF	STEMCELL Technologies	78057.1	Cytokine for polarization of M2 macrophages
ID-CellStab	Bio-Rad	005650 05740	RBC cell storage/stabilization solution
Isolation Medium	N/A	N/A	PBS Ca2+ and Mg2+ free + FBS 2% + 1mM EDTA
Lipopolysaaracide (LPS)	Sigma Aldrich	L3024-5MG	Cytokine for polarization of M1 macrophages
Methanol (100%)	N/A	N/A	Fixing of slides
Monocyte Isolation Kit STEM-cells EasySep Human Monocyte Enrichment Kit without CD16 Depletion	STEMCELL Technologies	19058	Isolation of monocytes from PBMCs
Poly-D-ysine	UofT Medstore	P6407	Cell attachment solution
Rh(D) positive R2R2 RBCs	Canadian Blood Services	N/A	Also commerically avaiable
RPMI-1640	Wisent Bioproducts	350-000-CL	supplemented with 10% heat-inactivated FBS,1 mM GlutaMAX supplement, 1 mM HEPES, and 1%penicillin/streptomycin. Store at 4 degrees.
Trypan Blue solution	Thermo Fisher Scientific	15250061	Cell counting solution