Department of Immunology

The recognition of non-selfentities (such as viruses, bacteria, fungi, parasites, foreign antigenic structures from transplanted cells, tissues, or organs, tumor tissues, allergens, etc.) as foreign by the organism and the activation of defense mechanisms to protect itself, resulting in a series of reactions against the foreign entities, constitutes immunity. The branch of science that investigates the structure and functions of cells constituting natural or acquired immunity within the organism, explores the roles of immunological mechanisms in the pathogenesis of diseases, and conducts research aimed at eliminating disorders that may occur in these mechanisms is termed "Immunology."

The balance of the immune system can be disrupted by external factors such as poor nutrition, alcohol, lack of sleep, radiation, air pollution, as well as internal factors like stress and genetic factors. Diseases may arise when the immune system's responses are excessive, deficient, or faulty. While an effective immune system can protect against many diseases, insufficient or excessive responses can lead to allergies, anaphylaxis, autoimmunity, AIDS, cancer, and other disease states. Therefore, immunology is a broadly encompassing field that includes sub-disciplines like infection immunology, cancer immunology, transplantation immunology, transfusion immunology, autoimmunity, allergy, hemato-immunology, neuroimmunology, and immunodeficiencies.

The department of immunology aims to contribute to literature and science through projects targeting clinical studies and scientific research, and by training experienced scientists with substantial knowledge in the wide spectrum of immunology topics. It also aims to share research outcomes on both national and international levels.

Under the Department of Immunology, there are two laboratories operating at the Başkent University Adana Dr. Turgut Noyan Application and Research Center:

- Tissue Typing and Transplantation Laboratory

- Molecular Immunology Research Laboratory

Tissue Typing and Transplantation Laboratory

The Tissue Typing and Transplantation Laboratory at Başkent University Adana Dr. Turgut Noyan Application and Research Center commenced operations with the license numbered 11292 dated 18.03.2010 by the Ministry of Health. This laboratory conducts transplantation immunology tests to determine the best recipient-donor compatibility, matching for solid organ (kidney, heart, liver) transplants and hematopoietic stem cell transplantation preparations, including post-transplant patient monitoring.

Transplantation Immunology

Organ transplantation is the most effective treatment method for patients with end-stage organ failure. Kidney transplantation, one of the most common transplants, is preferred for its ability to improve patient survival and quality of life over other treatment methods. Immunological studies are crucial in the transplant process chain, which involves a team effort across various units. These studies aims at investigating the compatibility between potential donors and recipient candidates, the presence and nature of cellular and secretory components that could cause early rejection of the transplanted organ/tissue, and to determine the most suitable donor by modern and up-to-date immunological tests before the transplant, ensuring the longevity and functionality of the transplanted organ or tissue.

At our tissue typing and transplantation laboratory, various tests including HLA tissue typing tests, Anti-HLA antibody tests (panel reactive antibody (PRA), single antigen identification (single antigen: SA), C1Q, and lymphocyte crossmatch tests (cross-match)) are conducted for patients preparing for solid organ (kidney, liver, and heart) transplants and hematopoietic stem cell transplantation, as well as their potential donors.

* HLA Tissue Typing Tests: Low-resolution HLA (human leukocyte antigens) typing is performed using PCR-SSP and PCR-SSO methods, while high-resolution typing is done through NGS and SBT methods.

* HLA, a group of proteins found on the surface of nucleated cells, helps the immune system recognize self from non-selfcells. Each individual inherits a unique combination of HLA antigens from their parents. The presence or absence of each antigen creates a distinct HLA combination for every person. HLA antigens are generally classified into Class I (HLA -A,-B,-C) and Class II (HLA -DR,-DP,-DQ).

The compatibility between the donor and recipient tissue groups is critical for transplant success, as the immune system vigorously responds to the transplanted tissue it recognizes as foreign.

The presence of anti-HLA antibodies, or panel reactive antibodies (PRA), can result from blood transfusions, pregnancy (especially in multiparous women), or cell, tissue, or organ transplants (for patients preparing for their second or third transplant). Patients who have received blood transfusions can develop antibodies against the HLA antigens of the donor blood, which can lead to immune system reactions affecting the transplanted organ/tissue and patient survival post-transplant.

The presence of HLA antibodies is initially screened for using PRA tests for Class I (HLA A,-B,-C) and Class II (HLA DR,-DQ) antigens, which detect IgG antibodies formed against Class I and II HLA antigens in the patient's serum. Patients with positive PRA results undergo PRA identification tests to determine the antibodies, and whether they are donor specific antibodies (DSA), which is crucial for planning treatment and follow-up.

Crossmatch (XM) tests are conducted particularly in kidney transplants to test for immune responses that could lead to graft rejection despite overall compatibility between the donor and recipient. This involves bringing the serum and cells of the donor and recipient together after donor selection to identify immunological reactions that could develop shortly after transplant and potentially cause graft rejection.

The lymphocyte subgroups, consisting of T Cells, B Cells, and NK (natural killer) cells, play a vital role in both the cellular and humoral components of the immune system. Our laboratory uses flow cytometry for post-transplant patient monitoring to assess peripheral blood cells and lymphocyte subgroups.

Organ or tissue transplant patients, especially in the post-transplant period, are monitored using flow cytometry to evaluate cells in peripheral blood and lymphocyte subgroups, highlighting the critical role of evaluating pre-transplant results for both patients and donors to ensure clinical significance, identify risks, and improve patient and organ survival outcomes.

Quality

The tissue typing and transplantation laboratory (DTTL) undergoes annual license inspections by the Ministry of Health, General Directorate of Health Services under the Tissue Typing Laboratories Directive, annual quality inspections under the Health Quality Standards by the Ministry of Health, Quality and Accreditation Directorate, at least one internal audit per year according to ISO, and an external audit per year to ensure the quality and safety of the services provided in the field of transplantation immunology.

Accreditation

Our laboratory was accredited in 2014 by the European Federation for Immunogenetics (EFI) in the field of HLA tissue typing, a crucial step for tissue and organ transplants, earning the accreditation certificate (EFI No:08-TR-014.986). It was re-accredited by EFI in 2017 to include high-resolution molecular hla tissue typing tests.

As the first Foundation University Tissue Typing and Transplantation Laboratory to receive the EFI accreditation certificate, our laboratory operates according to European standards and responds 24/7 to requests from both in-house departments and external centers domestically and internationally.

ANNEX 1: CURRENT EFI CERTIFICATE TO BE ADDED

The laboratory staff consists of individuals who are trained and experienced in their fields, utilizing current technological devices and tools to provide reliable, top-quality, and swift services to patients.

Laboratory results offer critical information to clinicians for diagnosis, monitoring, and treatment of diseases. The goal in modern laboratory practices is to shorten the time from test requests to delivering results to the relevant parties while ensuring accuracy.

Test results from our laboratory should be evaluated by the patient's doctor in conjunction with clinical findings. Laboratory results should not be used alone for diagnosis and treatment.

Professionals working in this field from various institutions can participate as observers in routine operations (HLA tissue typing, serologic cross match, flow cytometry cross match, panel reactive antibody, single antigen) tests at Başkent University Adana Dr. Turgut Noyan Application and Research Center Tissue Typing and Transplantation Laboratory for educational purposes upon request.

Services are also provided to domestic and international external centers upon completing necessary procedures/agreements as per requests.

Scientific Studies

The laboratory infrastructure is conducive to scientific studies, with research being presented at numerous conferences, symposiums, and congresses both domestically and internationally. Many scientists from within the country and abroad have visited our laboratory for information sharing and planning joint studies. Additionally, our laboratory serves for master's thesis/projects, doctoral thesis/projects, and other research activities.

Awards

"Case Presentation; Comparison of Anti-HLA Antibodies in Graft Tissue and Patient Serum Samples," Bilkay BAŞTÜRK, Atila SEZGİN, Elif SADE, Binnaz Handan ÖZDEMİR, Ayşen TERZİOĞLU, Bircan KANTAROĞLU, Mehmet HABERAL. 7th National Congress of Transplantation Immunology and Genetics, 4-7 April 2019, Bodrum (First Place in Poster Presentation Category)

"Determining the Prevalence of Respiratory and Food Allergy in the Eastern Mediterranean Region," Bilkay Baştürk, Miray Kavuzlu, Bircan Kantaroğlu, Dilek Doğruel, Mete Baba, Çağla Sarıtürk. 23rd National Immunology Congress, 26-30 April 2015, Lara-Antalya (Best Poster Award in Allergy Category)

External Quality Controls

HLA tissue typing tests (molecular low and high resolution typing) and cross match tests (with CDC and flow cytometry methods) are monitored by external quality control samples provided by Balkan EPT and Panel Reactive Antibody Screening tests NEQAS (UK). Samples for external quality control tests are selected by quality control centers and sent from abroad within specified time frames.

Our Team

Prof. Dr. Bilkay BAŞTÜRK (Laboratory Head)

Uzm. Dr. Enes ALTUNAY (Assistant Laboratory Head)

Uzm. Dr. Tunzala ASGAROVA (Assistant Laboratory Head)

Biologist Bircan ZENGEL (Responsible Biologist for Solid Organ Transplant)

Biologist Miray KAVUZLU (Responsible Biologist for Hematopoietic Stem Cell Transplant)

Technician Elif ÇOBAN

Technician Tuğba BOZKURT

Our Visitors

Molecular Immunology Research Laboratory

In the field of pre-graduation education, Immunology courses are provided to students of the Faculty of Medicine, Periods II and III, and to students of the Faculty of Dentistry, Period II, as well as to students of the Faculty of Science, Department of Molecular Biology and Genetics, with the participation of our department's faculty members. Theoretical and practical trainings that allow regular follow-up of current developments in immunological laboratory studies, especially organ and tissue transplants, are given to employees of tissue typing laboratories serving at Başkent University hospitals in Ankara, Adana, and Istanbul. Practical trainings include DNA-based molecular routine studies, molecular research techniques, and the latest technological knowledge and experience that can be used in diagnosis and treatment follow-up.

In the field of post-graduation education, our department offers a master's program in transplantation immunology with thesis, which started in 2021 and accepts students with a prerequisite of medical faculty graduation. The program has so far had two graduates, with four students currently enrolled, two of whom are in the thesis phase and two in the course phase.

The Molecular Immunology Research Laboratory serves all centers of our university and other health centers with research studies. The laboratory, which allows for research activities and students' thesis work, has the capacity to serve requests from external centers as well.

The outcomes of the conducted studies are shared at congresses, symposiums, and various scientific events and are published in national and international publications.