Mechanisms of anti-D action in the prevention of hemolytic disease of the fetus and newborn

Hematology Am Soc Hematol Educ Program. 2009:185-91. doi: 10.1182/asheducation-2009.1.185.

Abstract

Anti-D is routinely and effectively used to prevent hemolytic disease of the fetus and newborn (HDFN) caused by the antibody response to the D antigen on fetal RBCs. Anti-D is a polyclonal IgG product purified from the plasma of D-alloimmunized individuals. The mechanism of anti-D has not been fully elucidated. Antigenic epitopes are not fully masked by anti-D and are available for immune system recognition. However, a correlation has frequently been observed between anti-D-mediated RBC clearance and prevention of the antibody response, suggesting that anti-D may be able to destroy RBCs without triggering the adaptive immune response. Anti-D-opsonized RBCs may also elicit inhibitory FcgammaRIIB signaling in B cells and prevent B cell activation. The ability of antigen-specific IgG to inhibit antibody responses has also been observed in a variety of animal models immunized with a vast array of different antigens, such as sheep RBCs (SRBC). This effect has been referred to as antibody-mediated immune suppression (AMIS). In animal models, IgG inhibits the antibody response, but the T-cell response and memory may still be intact. IgG does not mask all epitopes, and IgG-mediated RBC clearance or FcgammaRIIB-mediated B-cell inhibition do not appear to mediate the AMIS effect. Instead, IgG appears to selectively disrupt B cell priming, although the exact mechanism remains obscure. While the applicability of animal models of AMIS to understanding the true mechanism of anti-D remains uncertain, the models have nevertheless provided us with insights into the possible IgG effects on the immune response.

Publication types

  • Review

MeSH terms

  • Adult
  • Animals
  • Cattle
  • Disease Models, Animal
  • Erythroblastosis, Fetal / etiology
  • Erythroblastosis, Fetal / immunology
  • Erythroblastosis, Fetal / prevention & control*
  • Erythrocyte Membrane / immunology
  • Female
  • Fetal Blood / immunology
  • Humans
  • Immunoglobulin G / immunology
  • Immunoglobulin G / therapeutic use
  • Infant, Newborn
  • Isoantibodies / biosynthesis
  • Isoantibodies / immunology
  • Isoantibodies / therapeutic use*
  • Lymphocyte Activation
  • Lymphocyte Subsets / immunology
  • Mice
  • Mice, SCID
  • Mice, Transgenic
  • Models, Immunological*
  • Opsonin Proteins / immunology
  • Phagocytosis
  • Pregnancy
  • Rabbits
  • Rats
  • Receptors, IgG / antagonists & inhibitors
  • Receptors, IgG / immunology
  • Rh Isoimmunization / therapy*
  • Rh-Hr Blood-Group System / immunology*
  • Rho(D) Immune Globulin

Substances

  • FCGR2B protein, human
  • Immunoglobulin G
  • Isoantibodies
  • Opsonin Proteins
  • RHO(D) antibody
  • Receptors, IgG
  • Rh-Hr Blood-Group System
  • Rho(D) Immune Globulin
  • Rho(D) antigen