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Growth-Promoting Effect of Rh(D) Antibody on Human Pancreatic Islet Cells

Department of Newborn Care (J.M.F.), Royal Hospital for Women and of Immunology and Rheumatology, Sydney Children’s Hospital, Randwick NSW 2031 Sydney, Australia; Department of Medical and Molecular Biosciences (A.M.S., C.T., B.A.O.), University of Technology, Sydney, NSW 2007 Sydney, Australia; Institute of Haematology (M.N.), Royal Prince Alfred Hospital, NSW 2050 Sydney, Australia; School of Medical Sciences (Anatomy and Histology) and Bosch Institute (M.A.S.) and the Centre for Transplant and Renal Research (P.J.O., W.J.H.), Westmead Millennium Institute, University of Sydney, Westmead Hospital, NSW 2006 Sydney, Australia

Address all correspondence and requests for reprints to: Dr. John M. Feller, Consultant Pediatrician, Department of Newborn Care, Royal Hospital for Women, Randwick NSW 2031, Sydney, Australia. E-mail: johnfeller{at}bigpond.com.

Context/Objective: Hyperinsulinism with islet cell hyperplasia is a frequent complication, of unknown cause, in hemolytic disease of the newborn, occurring in Rh(D)-positive infants of Rh-isoimmunized Rh(D)-negative mothers, but not in infants with other hemolytic disorders. We investigated the possibility that trans-placentally acquired anti-D Ig is the cause of both conditions.

Design: Monolayer cultures of human islet cells were exposed to sera from Rh-isoimmunized mothers and newborns, where jaundice, hyperinsulinism, and hypoglycemia in the infant had ensued. Parallel cultures with anti-D, specific anti-D monoclonal antibodies, normal human Ig (15 µg/ml), and serum controls were also undertaken. Islet cell proliferation was determined by [³H]thymidine incorporation. Insulin storage and chronic and acute insulin secretion to glucose were analyzed by RIA. Rh(D) surface antigen expression was determined on islet cells by flow cytometric analysis.

Results: Islet cell proliferation and insulin secretion were significantly greater in coculture with test sera (P < 0.01; n = 8) and with anti-D (P < 0.001; n = 8), compared with either controls or Ig. After 8 d of growth, the static incubation experiment showed a 3.5-fold response to glucose stimulus in all sera. Rh(D) antigen expression was detected on the islet cell surface by flow cytometry, and islet cell morphology was normal. Colocalization of the proliferation marker Ki67 with insulin by immunofluorescent staining further indicated that Rh(D) antibody promoted islet growth.

Conclusions: The anti-Rh(D) islet cell proliferative effect generates neonatal hyperinsulinism in Rh isoimmunization. Anti-Rh(D) may have application for islet cell proliferation in diabetes mellitus treatment for Rh(D)-positive subjects. Further analysis is required.