[Serological Characteristics and Molecular Biological Mechanism of AEL.02 Subtype]

To explore the serological characteristics and molecular biological mechanism of an a_el subtype specimen.

The ABO blood typing was identified by routine blood group serological and absorption/elution methods; PCR-SBT method for ABO genotyping: 7 exons of ABO gene were amplified by PCR, the amplified products were purified, and then sequencing primers were designed and the amplified products were sequenced directly for analysis; 3D molecular model was constructed and the difference of free energy (ΔΔG) was used to predict the GTA mutant stability.

A antigen was not detected on erythrocytes through absorption and elution tests, which was not consistent with the serological characteristics of a_el, and the serological typing results were ambiguous. The ABO genotype was ABO*AEL.02/O.01.01, and there were two mutations in exon 7 of the gene, c.467C>T and c.646T>A, which could lead to the replacement of proline with leucine at position 156 (p.Pro156Leu) and phenylalanine with isoleucine at position 216 on the GTA, respectively. The 3D model predicts that the mutations do not introduce new hydrogen bonds to the GTA mutant and do not form a new secondary structure, but can lead to an increase in the ΔΔG value of the GTA mutant, suggesting a decrease in protein stability.

The serological characteristics alone is not reliable to determine the a_el subype; the a_el phenotype may be due to the GTA mutant that reduces enzyme stability.