The Human Leukocyte Antigen System
Continuing Education Credits
This course covers the human leukocyte antigen system. The basic functionality of the immune system with emphasis on the role of the human leukocyte antigen (HLA) system is discussed along with the major histocompatibility complex which gives rise to HLAs. Principles and methodologies behind the various forms of HLA analysis are included. Also explored is the human leukocyte antigen's associative role in potential predisposition for disease, transplantation acceptance/rejection, graft-versus-host disease (GVHD), and alloreactivity.
Objectives
- Describe the basic functionality of the immune system with emphasis on the role of the human leukocyte antigen (HLA) system.
- Explain the major histocompatibility complex which gives rise to HLAs.
- Compare and contrast the molecular structures of HLA molecules and describe their interactions with cells of the immune and other bodily systems.
- Detail the principles and methodologies behind the various forms of HLA analysis.
- Discuss the human leukocyte antigen's associative role in potential predisposition for disease, transplantation acceptance/rejection, graft-versus-host disease, and alloreactivity.
Course Outline
- Basics of the Immune System
- History of the MHC in Humans and Other Animals
- Discovery of the Major Histocompatibility Complex and Human Leukocyte Antigens
- HLA 101 Terminology
- HLA 101 Terminology
- Immune System Overview
- Overview of the Immune System
- Overview of Innate Immune System
- True or False: The innate immune response is characterized by antibody production, cell-mediated apoptosis, and memory cell formation towards a specific response to a foreign antigen or bacteria.
- Overview of Adaptive Immune System
- Review of Cells in Adaptive Immune System: Pathways & Activation
- Match the following cells of the adaptive immune response with their function.
- HLA Nomenclature
- Nomenclature of HLA Glycoproteins
- Nomenclature of HLA Typings: Example
- True or False: The first field of an HLA nomenclature is designated as the allele group or the antigenic level of the protein that is detectable serologically.
- Genomic Distribution of the HLA System
- Chromosome Location
- MHC/HLA Location on Human Chromosomes
- Which of the following is not a locus that is found in HLA class I?
- True or False: There are four regions on band 21 of chromosome 6 that give rise to HLA genes.
- Inheritance Patterns
- Inheritance Patterns of HLA Molecules
- HLA Linkage Disequilibrium
- Polymorphism
- True or False: Crossover/recombination for HLA glycoproteins is very common, occurs during mitosis, and results in a different haplotype that the offspring can inherit.
- Match the following terminology with the appropriate definition.
- Various Molecular Structures of the HLA System
- Lymphocytes
- Match the lymphocyte with its cluster of differentiation (CD) marker.
- Class I Structure and Functionality
- HLA Class I: Structure and Location
- HLA Class I: Functionality
- Class II Structure and Functionality
- HLA Class II: Structure and Location
- HLA Class II: Functionality
- Class I and II Structure and Function Summary
- True or False: Class I HLAs are expressed on all nucleated cells and present endogenous antigens to lymphocytes. Class II HLAs are expressed on antigen-presenting cells (APCs) and present exogenous antigens to lymphocytes.
- Match each of the functionalities described into the appropriate HLA class.
- Methodologies of HLA Analysis
- DNA Extraction and Quantitation
- Extraction of DNA
- Quantification of DNA
- SSO
- Sequence-Specific Oligonucleotide
- SSP
- Sequence-Specific Primers
- Types of HLA Crossmatches
- CDC Crossmatching
- Flow Cytometry Crossmatching (FXM)
- Engraftment Monitoring
- Engraftment Monitoring
- Engraftment Monitoring, continued
- Antibody Screening
- Serum Processing for HLA
- Antibody Screen and Percent Reactive Antibody Assay
- Antibody Screening Purpose and Interpretations
- NGS
- Next Generation Sequencing
- Match the testing with its methodology.
- HLA's Role in Transplantation, Alloreaction, and Disease Associations
- HLA Functionality and ABO/Rh in Transplantation
- Alloreactivity and Graft Versus Host Disease (GvHD)
- HLA Alleles and Predisposition to Diseases and Drug Reactions
- Match the types of rejection with the definition that meets the criteria for the type of reaction that would occur.
- A deceased donor's kidney becomes available (shown in the last row), and four patients are eligible (see image on the right). Which patient would be the ideal candidate to receive the organ?Hint: consider whether ABO is necessary for kidney transplants, what high versus low PRA means, HLA mismatches (GvHD or HvGD), and DSA (donor-specific antibody) directed against donor HLA.Patient 1 has no donor
- References
- References
Additional Information
Level of Instruction: Advanced
Intended Audience: Medical laboratory scientists, medical laboratory technicians, laboratory supervisors, and laboratory managers. This course is also appropriate for MLS and MLT students and pathology residents.
Author Information: Ethan Kentzel has earned a Master of Science in Biomedicine and Business at Drexel University. He holds a BS degree in Medical Technology from Slippery Rock University and an ASCP MLS certification. Ethan has experience as a medical laboratory scientist working in various labs, including Blood Bank, Immunogenetics/HLA, Microbiology, and briefly as a generalist. While working as a laboratory scientist, he was also an adjunct professor for the Medical Laboratory Science program at St. Christopher's Hospital for Children. He works as a Program Director for the Medical Laboratory Science and Phlebotomy programs at Reading Hospital School of Health Science. He continues to teach at St. Christopher's Hospital for Children and Reading Area Community College.
The author has no conflict of interest to disclose.
Reviewer Information:
Marissa Wildung, MLS(ASCP)CM, is a laboratory supervisor with nine years of experience as a medical laboratory scientist and a faculty instructor for an MLT/phlebotomy program in Central Minnesota. Marissa holds a bachelor's in medical laboratory science from the University of Cincinnati and is pursuing a master's in business administration from St. Cloud State University.
Joshua J. Cannon, MS, MLS(ASCP)CMSHCM received his Bachelor of Science and Master of Science in Medical Laboratory Science from Thomas Jefferson University in Philadelphia, PA. He holds Medical Laboratory Scientist and Specialist in Hematology certifications through the ASCP Board of Certification. He was a professor at Thomas Jefferson University for seven years before transitioning into his current role as Education Developer at MediaLab by Vastian. His areas of expertise and professional passions include clinical hematology and interprofessional education.