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Clinical impact of H-Y alloimmunity

  • IMMUNOLOGY AT STANFORD UNIVERSITY
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Abstract

H-Y antigens are a group of minor histocompatibility antigens encoded on the Y-chromosome with homologous H-X antigens on the X-chromosome. The disparate regions of the H-Y antigens are highly immunogenic and play an important role in understanding human alloimmunity. In this review, we investigate the history of H-Y antigen discovery along with their critical contributions in transplantation and pregnancy. In hematopoietic cell transplantation, male recipients with female donors who become seropositive for B-cell responses as H-Y antibodies following transplantation have increased rates of chronic graft-versus-host disease and decreased rates of relapse. Conversely, female patients who receive male kidney allografts are more likely than other gender combinations to develop H-Y antibodies and reject their allografts. Finally, in the setting of pregnancy, mothers who initially gave birth to boys are more likely to have subsequent pregnancy complications, including miscarriages, in association with H-Y antibody development. H-Y antigens continue to serve as a model for alloimmunity in new clinical scenarios. Our development of more sensitive antibody detection and next-generation DNA sequencing promises to further advance our understanding and better predict the clinical consequences of alloimmunity.

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References

  1. Brickner AG. Mechanisms of minor histocompatibility antigen immunogenicity: the role of infinitesimal versus structurally profound polymorphisms. Immunol Res. 2006;36(1–3):33–41.

    Article  CAS  PubMed  Google Scholar 

  2. Miklos DB, Kim HT, Zorn E, et al. Antibody response to DBY minor histocompatibility antigen is induced after allogeneic stem cell transplantation and in healthy female donors. Blood. 2004;103(1):353–9.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  3. Arai S, Jagasia M, Storer B, et al. Global and organ-specific chronic graft-versus-host disease severity according to the 2005 NIH Consensus Criteria. Blood. 2011;118(15):4242–9.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  4. Carlens S, Ringdén O, Remberger M, et al. Risk factors for chronic graft-versus-host disease after bone marrow transplantation: a retrospective single centre analysis. Bone Marrow Transplant. 1998;22(8):755–61.

    Article  CAS  PubMed  Google Scholar 

  5. Zorn E, Miklos DB, Floyd BH, et al. Minor histocompatibility antigen DBY elicits a coordinated B and T cell response after allogeneic stem cell transplantation. J Exp Med. 2004;199(8):1133–42.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  6. Gratwohl A, Döhler B, Stern M, Opelz G. H-Y as a minor histocompatibility antigen in kidney transplantation: a retrospective cohort study. Lancet. 2008;372(9632):49–53.

    Article  CAS  PubMed  Google Scholar 

  7. Tan JC, Wadia PP, Coram M, et al. H-Y antibody development associates with acute rejection in female patients with male kidney transplants. Transplantation. 2008;86(1):75–81.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  8. Nielsen HS. Secondary recurrent miscarriage and H-Y immunity. Hum Reprod Update. 2011;17(4):558–74.

    Article  CAS  PubMed  Google Scholar 

  9. Eichwald EJ, Silmser CR. Skin. Transplant Bull. 1955;2:148–9.

    CAS  PubMed  Google Scholar 

  10. Eichwald EJ, Silmser CR, Wheeler N. The genetics of skin grafting. Ann NY Acad Sci. 1957;64(5):737–40.

    Article  CAS  PubMed  Google Scholar 

  11. Lustgraaf EC, Fuson RB, Eichwald EJ. Sex tolerance and split tolerance. Transplant Bull. 1960;26:145–50.

    Article  CAS  PubMed  Google Scholar 

  12. Eichwald EJ, Lustgraaf EC, Weissman I, Strainer M. Attempts to demonstrate sex-linked histocompatibility genes. Transplant Bull. 1958;5(4):387–8.

    Article  CAS  PubMed  Google Scholar 

  13. Billingham RE, Silvers WK. Induction of tolerance of skin isografts from male donors in female mice. Science. 1958;128(3327):780–1.

    Article  CAS  PubMed  Google Scholar 

  14. Billingham RE, Silvers WK. Studies on tolerance of the Y chromosome antigen in mice. J Immunol. 1960;85:14–26.

    CAS  PubMed  Google Scholar 

  15. Carlens S, Ringdén O, Remberger M, et al. Factors affecting risk of relapse and leukemia-free survival in HLA-identical sibling marrow transplant recipients with leukemia. Transplant Proc. 1997;29(7):3147–9.

    Article  CAS  PubMed  Google Scholar 

  16. Remberger M, Kumlien G, Aschan J, et al. Risk factors for moderate-to-severe chronic graft-versus-host disease after allogeneic hematopoietic stem cell transplantation. Biol Blood Marrow Transplant. 2002;8(12):674–82.

    Article  PubMed  Google Scholar 

  17. Remberger M, Mattsson J, Hassan Z, et al. Risk factors for acute graft-versus-host disease grades II–IV after reduced intensity conditioning allogeneic stem cell transplantation with unrelated donors: a single centre study. Bone Marrow Transplant. 2008;41(4):399–405.

    Article  CAS  PubMed  Google Scholar 

  18. Spierings E, Kim YH, Hendriks M, et al. Multicenter analyses demonstrate significant clinical effects of minor histocompatibility antigens on GvHD and GvL after HLA-matched related and unrelated hematopoietic stem cell transplantation. Biol Blood Marrow Transplant. 2013;19(8):1244–53.

    Article  CAS  PubMed  Google Scholar 

  19. Randolph SS, Gooley TA, Warren EH, Appelbaum FR, Riddell SR. Female donors contribute to a selective graft-versus-leukemia effect in male recipients of HLA-matched, related hematopoietic stem cell transplants. Blood. 2004;103(1):347–52.

    Article  CAS  PubMed  Google Scholar 

  20. Kollman C, Howe CW, Anasetti C, et al. Donor characteristics as risk factors in recipients after transplantation of bone marrow from unrelated donors: the effect of donor age. Blood. 2001;98(7):2043–51.

    Article  CAS  PubMed  Google Scholar 

  21. Loren AW, Bunin GR, Boudreau C, et al. Impact of donor and recipient sex and parity on outcomes of HLA-identical sibling allogeneic hematopoietic stem cell transplantation. Biol Blood Marrow Transplant. 2006;12(7):758–69.

    Article  PubMed  Google Scholar 

  22. Goulmy E, Termijtelen A, Bradley BA, van Rood JJ. Y-antigen killing by T cells of women is restricted by HLA. Nature. 1977;266(5602):544–5.

    Article  CAS  PubMed  Google Scholar 

  23. Goulmy E, Bradley BA, Lansbergen Q, van Rood JJ. The importance of H-Y incompatibility in human organ transplantation. Transplantation. 1978;25(6):315–9.

    Article  CAS  PubMed  Google Scholar 

  24. Goulmy E, Gratama JW, Blokland E, Zwaan FE, van Rood JJ. A minor transplantation antigen detected by MHC-restricted cytotoxic T lymphocytes during graft-versus-host disease. Nature. 1983;302(5904):159–61.

    Article  CAS  PubMed  Google Scholar 

  25. Goulmy E, van Leeuwen A, Blokland E, Sachs ES, Geraedts JP. The recognition of abnormal sex chromosome constitution by HLA-restricted anti-H-Y cytotoxic T cells and antibody. Immunogenetics. 1983;17(5):523–31.

    Article  CAS  PubMed  Google Scholar 

  26. Goulmy E, Schipper R, Pool J, et al. Mismatches of minor histocompatibility antigens between HLA-identical donors and recipients and the development of graft-versus-host disease after bone marrow transplantation. N Engl J Med. 1996;334(5):281–5.

    Article  CAS  PubMed  Google Scholar 

  27. Goulmy E. Human minor histocompatibility antigens. Curr Opin Immunol. 1996;8(1):75–81.

    Article  CAS  PubMed  Google Scholar 

  28. Wang W, Meadows LR, den Haan JM, et al. Human H-Y: a male-specific histocompatibility antigen derived from the SMCY protein. Science. 1995;269(5230):1588–90.

    Article  CAS  PubMed  Google Scholar 

  29. Mutis T, Gillespie G, Schrama E, Falkenburg JH, Moss P, Goulmy E. Tetrameric HLA class I-minor histocompatibility antigen peptide complexes demonstrate minor histocompatibility antigen-specific cytotoxic T lymphocytes in patients with graft-versus-host disease. Nat Med. 1999;5(7):839–42.

    Article  CAS  PubMed  Google Scholar 

  30. Tilford CA, Kuroda-Kawaguchi T, Skaletsky H, et al. A physical map of the human Y chromosome. Nature. 2001;409(6822):943–5.

    Article  CAS  PubMed  Google Scholar 

  31. Skaletsky H, Kuroda-Kawaguchi T, Minx PJ, et al. The male-specific region of the human Y chromosome is a mosaic of discrete sequence classes. Nature. 2003;423(6942):825–37.

    Article  CAS  PubMed  Google Scholar 

  32. Lahn BT, Page DC. Functional coherence of the human Y chromosome. Science. 1997;278(5338):675–80.

    Article  CAS  PubMed  Google Scholar 

  33. Eljaafari A, Yuruker O, Ferrand C, et al. Isolation of human CD4/CD8 double-positive, graft-versus-host disease-protective, minor histocompatibility antigen-specific regulatory T cells and of a novel HLA-DR7-restricted HY-specific CD4 clone. J Immunol. 2013;190(1):184–94.

    Article  CAS  PubMed  Google Scholar 

  34. Warren EH, Gavin MA, Simpson E, et al. The human UTY gene encodes a novel HLA-B8-restricted H-Y antigen. J Immunol. 2000;164(5):2807–14.

    Article  CAS  PubMed  Google Scholar 

  35. Pennisi E. Long-sought H-Y antigen found. Science. 1995;269(5230):1515–6.

    Article  CAS  PubMed  Google Scholar 

  36. Vogt MH, de Paus RA, Voogt PJ, Willemze R, Falkenburg JH. DFFRY codes for a new human male-specific minor transplantation antigen involved in bone marrow graft rejection. Blood. 2000;95(3):1100–5.

    CAS  PubMed  Google Scholar 

  37. Vogt MH, Goulmy E, Kloosterboer FM, et al. UTY gene codes for an HLA-B60-restricted human male-specific minor histocompatibility antigen involved in stem cell graft rejection: characterization of the critical polymorphic amino acid residues for T-cell recognition. Blood. 2000;96(9):3126–32.

    CAS  PubMed  Google Scholar 

  38. Vogt MH, van den Muijsenberg JW, Goulmy E, et al. The DBY gene codes for an HLA-DQ5-restricted human male-specific minor histocompatibility antigen involved in graft-versus-host disease. Blood. 2002;99(8):3027–32.

    Article  CAS  PubMed  Google Scholar 

  39. Pierce RA, Field ED, den Haan JM, et al. Cutting edge: the HLA-A*0101-restricted HY minor histocompatibility antigen originates from DFFRY and contains a cysteinylated cysteine residue as identified by a novel mass spectrometric technique. J Immunol. 1999;163(12):6360–4.

    CAS  PubMed  Google Scholar 

  40. Rosinski KV, Fujii N, Mito JK, et al. DDX3Y encodes a class I MHC-restricted H-Y antigen that is expressed in leukemic stem cells. Blood. 2008;111(9):4817–26.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  41. Spierings E, Vermeulen CJ, Vogt MH, et al. Identification of HLA class II-restricted H-Y-specific T-helper epitope evoking CD4+ T-helper cells in H-Y-mismatched transplantation. Lancet. 2003;362(9384):610–5.

    Article  CAS  PubMed  Google Scholar 

  42. Torikai H, Akatsuka Y, Miyazaki M, et al. A novel HLA-A*3303-restricted minor histocompatibility antigen encoded by an unconventional open reading frame of human TMSB4Y gene. J Immunol. 2004;173(11):7046–54.

    Article  CAS  PubMed  Google Scholar 

  43. Ofran Y, Kim HT, Brusic V, et al. Diverse patterns of T-cell response against multiple newly identified human Y chromosome–encoded minor histocompatibility epitopes. Clin Cancer Res. 2010;16(5):1642–51.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  44. Ivanov R, Aarts T, Hol S, et al. Identification of a 40S ribosomal protein S4-derived H-Y epitope able to elicit a lymphoblast-specific cytotoxic T lymphocyte response. Clin Cancer Res. 2005;11(5):1694–703.

    Article  CAS  PubMed  Google Scholar 

  45. Mortensen BK, Rasmussen AH, Larsen ME, et al. Identification of a novel UTY-encoded minor histocompatibility antigen. Scand J Immunol. 2012;76(2):141–50.

    Article  CAS  PubMed  Google Scholar 

  46. Miklos DB, Kim HT, Miller KH, et al. Antibody responses to H-Y minor histocompatibility antigens correlate with chronic graft-versus-host disease and disease remission. Blood. 2005;105(7):2973–8.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  47. Porcheray F, Miklos DB, Floyd BH, et al. Combined CD4 T-cell and antibody response to human minor histocompatibility antigen DBY after allogeneic stem-cell transplantation. Transplantation. 2011;92(3):359–65.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  48. Veerapathran A, Pidala J, Beato F, et al. Human regulatory T cells against minor histocompatibility antigens: ex vivo expansion for prevention of graft-versus-host disease. Blood. 2013;122(13):2251–61.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  49. Stern M, Brand R, de Witte T, et al. Female-versus-male alloreactivity as a model for minor histocompatibility antigens in hematopoietic stem cell transplantation. Am J Transplant. 2008;8(10):2149–57.

    Article  CAS  PubMed  Google Scholar 

  50. Markiewicz M, Siekiera U, Karolczyk A, et al. Immunogenic disparities of 11 minor histocompatibility antigens (mHAs) in HLA-matched unrelated allogeneic hematopoietic SCT. Bone Marrow Transplant. 2009;43(4):293–300.

    Article  CAS  PubMed  Google Scholar 

  51. Markiewicz M, Siekiera U, Dzierzak-Mietla M, Zielinska P, Kyrcz-Krzemien S. The impact of H-Y mismatches on results of HLA-matched unrelated allogeneic hematopoietic stem cell transplantation. Transplant Proc. 2010;42(8):3297–300.

    Article  CAS  PubMed  Google Scholar 

  52. Li L, Wadia P, Chen R, et al. Identifying compartment-specific non-HLA targets after renal transplantation by integrating transcriptome and “antibodyome” measures. Proc Natl Acad Sci USA. 2009;106(11):4148–53.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  53. Wadia PP, Sahaf B, Miklos DB. Recombinant antigen microarrays for serum/plasma antibody detection. Methods Mol Biol. 2011;723:81–104.

    Article  CAS  PubMed  Google Scholar 

  54. Sahaf B, Yang Y, Arai S, Herzenberg LA, Miklos DB. H-Y antigen-binding B cells develop in male recipients of female hematopoietic cells and associate with chronic graft vs. host disease. Proc Natl Acad Sci USA. 2013;110(8):3005–10.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  55. Cutler C, Miklos D, Kim HT, et al. Rituximab for steroid-refractory chronic graft-versus-host disease. Blood. 2006;108(2):756–62.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  56. Zaja F, Bacigalupo A, Patriarca F, et al. Treatment of refractory chronic GVHD with rituximab: a GITMO study. Bone Marrow Transplant. 2007;40(3):273–7.

    Article  CAS  PubMed  Google Scholar 

  57. Kharfan-Dabaja MA, Mhaskar AR, Djulbegovic B, Cutler C, Mohty M, Kumar A. Efficacy of rituximab in the setting of steroid-refractory chronic graft-versus-host disease: a systematic review and meta-analysis. Biol Blood Marrow Transplant. 2009;15(9):1005–13.

    Article  CAS  PubMed  Google Scholar 

  58. Arai S, Sahaf B, Narasimhan B, et al. Prophylactic rituximab after allogeneic transplantation decreases B-cell alloimmunity with low chronic GVHD incidence. Blood. 2012;119(25):6145–54.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  59. Cutler C, Kim HT, Bindra B, et al. Rituximab prophylaxis prevents corticosteroid-requiring chronic GVHD after allogeneic peripheral blood stem cell transplantation: results of a phase 2 trial. Blood. 2013;122(8):1510–7.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  60. Dzierzak-Mietla M, Markiewicz M, Siekiera U, et al. Occurrence and impact of minor histocompatibility antigens’ disparities on outcomes of hematopoietic stem cell transplantation from HLA-matched sibling donors. Bone Marrow Res. 2012;2012:257086.

    Article  PubMed Central  PubMed  Google Scholar 

  61. Hobo W, Broen K, van der Velden WJ, et al. Association of disparities in known minor histocompatibility antigens with relapse-free survival and graft-versus-host disease after allogeneic stem cell transplantation. Biol Blood Marrow Transplant. 2013;19(2):274–82.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  62. Verdijk RM, Kloosterman A, Pool J, et al. Pregnancy induces minor histocompatibility antigen-specific cytotoxic T cells: implications for stem cell transplantation and immunotherapy. Blood. 2004;103(5):1961–4.

    Article  CAS  PubMed  Google Scholar 

  63. James E, Chai JG, Dewchand H, Macchiarulo E, Dazzi F, Simpson E. Multiparity induces priming to male-specific minor histocompatibility antigen, HY, in mice and humans. Blood. 2003;102(1):388–93.

    Article  CAS  PubMed  Google Scholar 

  64. Piper KP, McLarnon A, Arrazi J, et al. Functional HY-specific CD8+ T cells are found in a high proportion of women following pregnancy with a male fetus. Biol Reprod. 2007;76(1):96–101.

    Article  CAS  PubMed  Google Scholar 

  65. Takemoto SK, Terasaki PI, Gjertson DW, Cecka JM. Twelve years’ experience with national sharing of HLA-matched cadaveric kidneys for transplantation. N Engl J Med. 2000;343(15):1078–84.

    Article  CAS  PubMed  Google Scholar 

  66. Cecka JM, Zhang Q, Reed EF. Preformed cytotoxic antibodies in potential allograft recipients: recent data. Hum Immunol. 2005;66(4):343–9.

    Article  CAS  PubMed  Google Scholar 

  67. Clatworthy MR. Targeting B cells and antibody in transplantation. Am J Transplant. 2011;11(7):1359–67.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  68. Jordan SC, Kahwaji J, Toyoda M, Vo A. B-cell immunotherapeutics: emerging roles in solid organ transplantation. Curr Opin Organ Transplant. 2011;16(4):416–24.

    Article  CAS  PubMed  Google Scholar 

  69. Platt JL, Cascalho M. Donor specific antibodies after transplantation. Pediatr Transplant. 2011;15(7):686–90.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  70. van Rood JJ, van Leeuwen A, Persijn GG, et al. Role of the HLA system in transplantation. HLA compatibility in clinical transplantation. Transplant Proc. 1977;9(1):459–67.

    PubMed  Google Scholar 

  71. Bestard O, Cruzado JM, la Franquesa M, Grinyó JM. Biomarkers in renal transplantation. Curr Opin Organ Transplant. 2010;15(4):467–73.

    Article  PubMed  Google Scholar 

  72. Terasaki PI. Deduction of the fraction of immunologic and non-immunologic failure in cadaver donor transplants. Clin Transpl. 2003;449–452.

  73. Cecka JM. The OPTN/UNOS Renal Transplant Registry. Clin Transpl. 2005;1–16.

  74. Stegall MD, Chedid MF, Cornell LD. The role of complement in antibody-mediated rejection in kidney transplantation. Nat Rev Nephrol. 2012;8(11):670–8.

    Article  CAS  PubMed  Google Scholar 

  75. Cornell LD. Renal allograft pathology in the sensitized patient. Curr Opin Organ Transplant. 2013;18(3):327–36.

    Article  CAS  PubMed  Google Scholar 

  76. Haas M. Pathology of C4d-negative antibody-mediated rejection in renal allografts. Curr Opin Organ Transplant. 2013;18(3):319–26.

    Article  CAS  PubMed  Google Scholar 

  77. Kim SJ, Gill JS. H-Y incompatibility predicts short-term outcomes for kidney transplant recipients. J Am Soc Nephrol. 2009;20(9):2025–33.

    Article  PubMed Central  PubMed  Google Scholar 

  78. Wagner S. H-Y antigen in kidney transplant: Does gender matter? Gend Med. 2012;9(5):387–8.

    Article  PubMed  Google Scholar 

  79. Pfeffer PF, Thorsby E. HLA-restricted cytotoxicity against male-specific (H-Y) antigen after acute rejection of an HLA-identical sibling kidney: clonal distribution of the cytotoxic cells. Transplantation. 1982;33(1):52–6.

    Article  CAS  PubMed  Google Scholar 

  80. Keith DS, Patrie JT. H-Y antigen incompatibility not associated with adverse immunologic graft outcomes: deceased donor pair analysis of the OPTN database. J Transplant. 2011;2011:148457.

    Article  PubMed Central  PubMed  CAS  Google Scholar 

  81. Khush KK, Kubo JT, Desai M. Influence of donor and recipient sex mismatch on heart transplant outcomes: analysis of the International Society for Heart and Lung Transplantation Registry. J Heart Lung Transplant. 2012;31(5):459–66.

    Article  PubMed Central  PubMed  Google Scholar 

  82. Kittleson MM, Patel JK, Moriguchi JD, et al. Heart transplant recipients supported with extracorporeal membrane oxygenation: outcomes from a single-center experience. J Heart Lung Transplant. 2011;30(11):1250–6.

    Article  PubMed  Google Scholar 

  83. Kfoury AG, Hammond ME, Snow GL, et al. Cardiovascular mortality among heart transplant recipients with asymptomatic antibody-mediated or stable mixed cellular and antibody-mediated rejection. J Heart Lung Transplant. 2009;28(8):781–4.

    Article  PubMed  Google Scholar 

  84. Welp H, Spieker T, Erren M, Scheld HH, Baba HA, Stypmann J. Sex mismatch in heart transplantation is associated with increased number of severe rejection episodes and shorter long-term survival. Transplant Proc. 2009;41(6):2579–84.

    Article  CAS  PubMed  Google Scholar 

  85. Candinas D, Gunson BK, Nightingale P, Hubscher S, McMaster P, Neuberger JM. Sex mismatch as a risk factor for chronic rejection of liver allografts. Lancet. 1995;346(8983):1117–21.

    Article  CAS  PubMed  Google Scholar 

  86. Thellin O, Heinen E. Pregnancy and the immune system: between tolerance and rejection. Toxicology. 2003;185(3):179–84.

    Article  CAS  PubMed  Google Scholar 

  87. Mor G, Cardenas I, Abrahams V, Guller S. Inflammation and pregnancy: the role of the immune system at the implantation site. Ann NY Acad Sci. 2011;1221:80–7.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  88. Christiansen OB, Steffensen R, Nielsen HS. The impact of anti-HY responses on outcome in current and subsequent pregnancies of patients with recurrent pregnancy losses. J Reprod Immunol. 2010;85(1):9–14.

    Article  CAS  PubMed  Google Scholar 

  89. Christiansen OB, Pedersen B, Nielsen HS, Nybo Andersen AM. Impact of the sex of first child on the prognosis in secondary recurrent miscarriage. Hum Reprod. 2004;19(12):2946–51.

    Article  CAS  PubMed  Google Scholar 

  90. Christiansen OB, Steffensen R, Nielsen HS. Anti-HY responses in pregnancy disorders. Am J Reprod Immunol. 2011;66(Suppl 1):93–100.

    Article  PubMed  Google Scholar 

  91. Nielsen HS, Steffensen R, Lund M, et al. Frequency and impact of obstetric complications prior and subsequent to unexplained secondary recurrent miscarriage. Hum Reprod. 2010;25(6):1543–52.

    Article  CAS  PubMed  Google Scholar 

  92. Christiansen OB. Reproductive immunology. Mol Immunol. 2013;55(1):8–15.

    Article  CAS  PubMed  Google Scholar 

  93. Khosrotehrani K, Bianchi DW. Multi-lineage potential of fetal cells in maternal tissue: a legacy in reverse. J Cell Sci. 2005;118(Pt 8):1559–63.

    Article  CAS  PubMed  Google Scholar 

  94. Linscheid C, Petroff MG. Minor histocompatibility antigens and the maternal immune response to the fetus during pregnancy. Am J Reprod Immunol. 2013;69(4):304–14.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  95. Nielsen HS, Mogensen M, Steffensen R, Kruse C, Christiansen OB. Indications of anti-HY immunity in recurrent placental abruption. J Reprod Immunol. 2007;75(1):63–9.

    Article  CAS  PubMed  Google Scholar 

  96. Nielsen HS, Steffensen R, Varming K, et al. Association of HY-restricting HLA class II alleles with pregnancy outcome in patients with recurrent miscarriage subsequent to a firstborn boy. Hum Mol Genet. 2009;18(9):1684–91.

    Article  CAS  PubMed  Google Scholar 

  97. Nielsen HS, Wu F, Aghai Z, et al. H-Y antibody titers are increased in unexplained secondary recurrent miscarriage patients and associated with low male: female ratio in subsequent live births. Hum Reprod. 2010;25(11):2745–52.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  98. Christiansen OB, Pedersen B, Rosgaard A, Husth M. A randomized, double-blind, placebo-controlled trial of intravenous immunoglobulin in the prevention of recurrent miscarriage: evidence for a therapeutic effect in women with secondary recurrent miscarriage. Hum Reprod. 2002;17(3):809–16.

    Article  CAS  PubMed  Google Scholar 

  99. Christiansen OB, Nielsen HS, Pedersen B. Active or passive immunization in unexplained recurrent miscarriage. J Reprod Immunol. 2004;62(1–2):41–52.

    Article  CAS  PubMed  Google Scholar 

  100. Hutton B, Sharma R, Fergusson D, et al. Use of intravenous immunoglobulin for treatment of recurrent miscarriage: a systematic review. BJOG. 2007;114(2):134–42.

    Article  CAS  PubMed  Google Scholar 

  101. Stephenson MD, Kutteh WH, Purkiss S, et al. Intravenous immunoglobulin and idiopathic secondary recurrent miscarriage: a multicentered randomized placebo-controlled trial. Hum Reprod. 2010;25(9):2203–9.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  102. Somerset DA, Zheng Y, Kilby MD, Sansom DM, Drayson MT. Normal human pregnancy is associated with an elevation in the immune suppressive CD25+ CD4+ regulatory T-cell subset. Immunology. 2004;112(1):38–43.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  103. van Halteren AG, Jankowska-Gan E, Joosten A, et al. Naturally acquired tolerance and sensitization to minor histocompatibility antigens in healthy family members. Blood. 2009;114(11):2263–72.

    Article  PubMed Central  PubMed  CAS  Google Scholar 

  104. Kahn DA, Baltimore D. Pregnancy induces a fetal antigen-specific maternal T regulatory cell response that contributes to tolerance. Proc Natl Acad Sci USA. 2010;107(20):9299–304.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

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Acknowledgments

We would like to thank Fang Wu and John Coller, Director of the Stanford Functional Genomics Facility, for their technical assistance, along with Carl Grumet and Joanne Otani for their helpful comments and suggestions. This work was supported by National Heart Lung and Blood Institute Grant R21 HL084318, National Cancer Institute Grant P01 CA049605 and Stanford University Cancer Institute Support Grant 1P030CA124435-01.

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The authors declare no conflict of interest.

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Correspondence to David B. Miklos.

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Popli, R., Sahaf, B., Nakasone, H. et al. Clinical impact of H-Y alloimmunity. Immunol Res 58, 249–258 (2014). https://doi.org/10.1007/s12026-014-8514-3

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