Glycoproteomic and Phenotypic Elucidation of B4GALNT2 Expression Variants in the SID Histo-Blood Group System

The Sd(a) histo-blood group antigen (GalNAc beta 1-4(NeuAc alpha 2-3)Gal beta-R) is implicated in various infections and constitutes a potential biomarker for colon cancer. Sd(a-) individuals (2-4% of Europeans) may produce anti-Sd(a), which can lead to incompatible blood transfusions, especially if donors with the high-expressing Sd(a++)/Cad phenotype are involved. We previously reported the association of B4GALNT2 mutations with Sd(a-), which established the SID blood-group system. The present study provides causal proof underpinning this correlation. Sd(a-) HEK293 cells were transfected with different B4GALNT2 constructs and evaluated by immunostaining and glycoproteomics. The predominant SIDnull candidate allele with rs7224888:T>C (p.Cys406Arg) abolished Sd(a) synthesis, while this antigen was detectable as N- or O-glycans on glycoproteins following transfection of wildtype B4GALNT2. Surprisingly, two rare missense variants, rs148441237:A>G and rs61743617:C>T, found in a Sd(a-) compound heterozygote, gave results similar to wildtype. To elucidate on whether Sd(a++)/Cad also depends on B4GALNT2 alterations, this gene was sequenced in five individuals. No Cad-specific changes were identified, but a detailed erythroid Cad glycoprotein profile was obtained, especially for glycophorin-A (GLPA) O-glycosylation, equilibrative nucleoside transporter 1 (S29A1) O-glycosylation, and band 3 anion transport protein (B3AT) N-glycosylation. In conclusion, the p.Cys406Arg beta 4GalNAc-T2 variant causes Sd(a)-deficiency in humans, while the enigmatic Cad phenotype remains unresolved, albeit further characterized.