36th EFI Conference, Nantes

I'm back from almost a week in Nantes, feeling connected, more informed, and relaxed; the latter being the most surprising after a conference...

Connected

This was my first EFI conference since Liverpool 2012 and I had forgotten how much bigger EFI can feel. Unlike BSHI, which usually has contingents from most UK labs in attendance, there seemed to be clusters from some of the UK and Irish labs at EFI.

It was great fun getting to know colleagues from Manchester Royal Infirmary , Anthony Nolan , Welsh Blood Service , Irish Blood Transfusion Service , Beaumont Hospital , Liverpool, Barts, Kairos Biotech Ltd and NHS Blood and Transplant (both at the conference and either side of it). H&I's community feel never ceases to amaze me.

I also met colleagues from One Lambda | A Thermo Fisher Scientific Brand and Devyser , who had just announced a partnership to provide post-transplant monitoring solutions (using microchimerism and dd-cfDNA; keep your eyes peeled from July!). It was great to gain insights into some of the work happening behind the scenes at One Lambda at the Channel Partner meetings. They asked us questions like, "What is affecting recruitment into H&I labs?", and "What can we do to help?", which I was pleasantly surprised by. They were genuinely lovely people, who clearly care a lot about the field.

More Informed

With plenary sessions starting from 08:30 and poster exhibitions finishing at 20:00, there was ample opportunity to learn about developments in H&I from some of the very best. I liked that plenary sessions were kept to around 30 minutes each with 3 different presenters. In some ways, it meant that speakers couldn't go into as much detail as they/we would have liked, but in others it kept listeners engaged and gave a really good overview of each area.

I built upon my understanding of allogeneic HSCT transplantation, CAR T cells, Graft vs Host Disease, and advancements in T regulatory cells.

With a teaching session and two abstract sessions to choose from next, I opted for Abstract Session 2: New Technologies & Approaches in Immunogenetics, mostly because I was interested to see how NHSBT were getting on with their assessment of a universal blood donor genotyping platform (Gene Titan), delivered by Dr. Colin Brown . Having spent a good few years HPA genotyping by PCR-SBT, I was not surprised to see issues with HPA-3 (difficult to design primers for) and HPA-6 (the clinical utility of the which could be disputed, having only ever reported one case of NAIT due to HPA-6b antibodies, for example).

Other interesting topics included: dd-cfDNA in lung transplantation (and whether it is possible to discriminate between organ injury due to infection vs rejection); HLA-E, -DO, and -DM; an open source online tool for transplant matching; and urinary markers (CXCL10) of renal allograft rejection and BK virus activation (no significant results in this case).

Sandwiched between learning and plenary sessions were sponsored symposia, with laboratory representatives providing feedback of their experiences (good and bad) using assays from the various vendors; launching of the ETHIQ Diploma (a new qualification for H&I technical staff in Europe); and various committee meetings.

Abstract presentations and teaching sessions on NK cells and KIR, and Immunogenetics in Organ Transplantation continued into the afternoon, before a plenary session on HLA Immunogenetics, Population Genetics & Evolution, and a chance to meet the authors of the posters above the exhibition hall.

Friday's plenary session on HLA in Solid Organ Transplantation covered topics like molecular matching with Dr. ANAT TAMBUR demonstrating that antibodies are neither directed at the HLA-DQ alpha chain nor beta chain, but instead the heterodimer DQ molecule, showing an association between dimers with DQA1*05 and increased relapse risk/ lower disease-free survival. This was followed by Prof. Olga Timofeeva presenting the use of DSA as a predicitive biomarker for the efficacy of desensitisation therapies (such as plasma exchange and IVIg) by looking at antibody titres at 1:16 and 1:64 dilutions and evaluating commonalities in non-responders. Prof. Timofeeva gave further evidence that DQA1*05 was highly immunogenic (also citing work by McCaughan et al here).

I also attended sessions on Precision Medicine, looking at the diversity of gut microbiota vs graft survival in HSCT, use of antibiotics and breast cancer survival, and how (fascinatingly) bacteria have genes flanked by inversions that can flip/invert genes to encode different proteins, affecting how they interact with our immune systems (and cause inflammation).

The sheer volume of data generated by methodologies described, and the analysis of such data (using heat maps, for example), is a recurring theme this year (also noted at the BTS/NHSBT congress in Edinburgh in March), so it makes sense that EFI 2023's main theme was "Big Data".

Dr Effie Pettersdorf beautifully presented findings on MICA-NKG2D affinity in the presence of exon 5 STR mismatching, reviewing Met129Val and risk of GvHD/overall survival, noting that certain combinations of MICA-129 and -STR matching/mismatching showed a protective effect.

Relaxed

With such a full schedule that week, it was important that we took some time to stretch our legs and discover some of the lovely gems Nantes had to offer. It was also a wonderful opportunity to get to know my boss, Alison Wortley (Managing Director of VH Bio) better. We took advantage of the free public transport at the weekend and racked up tens of thousands of steps (must remember to take trainers next time)!

Thank you to the organisers for a fantastic conference, and to all the lovely people I got to meet for all the chats! Hopefully, I'll be seeing many of you again soon.

á bient?t!

N.B. My hastily-written notes were used to write this post so may not be completely accurate. Get in touch if you notice anything erroneous or would like more information and I will happily direct you to the relevant presenters/ institutions for source material :)