Nonalcoholic fatty liver disease (NAFLD) has become one of the most common hepatic diseases worldwide, making the diagnosis and management of NAFLD an emerging public health issue. Theories associated with NAFLD surmise that inflammation may be the root cause, along with the complex interplay of other chronic conditions such as obesity, metabolic syndrome, diabetes, dyslipidemia, and cardiovascular disease (CVD). It is unknown if other inflammatory conditions such as rheumatoid arthritis (RA), along with the use of methotrexate (MTX), might confer increased risk for NAFLD. Longitudinal data collected from a retrospective cohort of 17,481 adult RA patients in the United States were used to determine the incidence and factors associated with the development of NAFLD using a noninvasive tool (Fibrosis-4 score). Results of the Kaplan Meier analysis showed that 31% of this cohort developed NAFLD, in about 7 years from baseline, with most having mild to moderate disease and only 1.4% with advanced disease. RA patients also had a prevalence of chronic conditions associated with NAFLD, as seen in the general population. In the Cox proportional hazard multivariate analysis, age (middle and elderly), hypertension, CVD, dyslipidemia, metabolic syndrome, exercise, use of MTX, and non-MTX antirheumatic drugs were independent predictors for the development of NAFLD. This research could improve early diagnosis of NAFLD using a novel noninvasive tool. Increase awareness of the prevalence and causes of NALFD inform clinical practice and management of the disease and influence policy about this chronic condition in patients with RA.

Immunotherapy has emerged as a current and future paradigm of cancer treatment, which utilizes the body’s immune system to eradicate cancer. Natural Killer (NK) cells as part of the innate immune system have immense potential in their anti-tumor cytotoxic activities and host cell surveillance properties. NK cells comprise approximately five to fifteen percent of peripheral blood lymphocytes and can be proliferated in vitro using recently developed methods with co-cultures with feeder cells (derived from engineered tumor cells) or plasma membrane (PM) particles, produced from the fore mentioned feeder cells, in combination with soluble cytokines. For efficient growth and maintenance of these NK cells, Interleukin-2 (IL-2) is utilized. IL-2 in solution, through receptor mediated signaling, stimulates proliferation of T-cells and NK cells. NK cells have lower responsiveness to IL-2 and consequently require a larger systemic dose to stimulate them as opposed to competing cell populations that have higher expression of receptors for IL-2, such as T-cells, which can have the effect of lower effective stimulation of NK cell growth. Such difference in the stimulatory capability of IL-2 toward NK cells and the short circulation lifetime of soluble IL-2 require higher dosages of soluble IL-2 for effective in vivo NK cell proliferation for therapeutic application against cancer, but is toxic. Therefore establishing another form of IL-2 delivery that improves its specific targeting to NK cells would be beneficial and may be crucial for novel therapeutic improvement. The Copik Laboratory has made an IL-2 fusion protein construct having a membrane anchor for expression of membrane-bound IL-2 on K562-41bbl-21 cells (K562-IL21). K562-IL21 cells are selectively recognized by NK cells and stimulate their proliferation and cytotoxicity. Hence, a K562-IL21 membrane–bound IL-2 form should be targeted to NK cells with IL-2 delivery. K562-IL21-2 cells were then used to prepare PM21-2 particles which have the potential to provide NK cell targeted, long-lived form of IL-2 for use as an injectable drug for in vivo adjuvant stimulation of NK cells. The presence of IL-2 on the in the PM21-2 particle product was verified by Western blot, and ELISA. Particle preparations from the modified K562 cells should possess characteristics that allow them to possibly replace soluble IL-2 and more specifically increase the numbers or anti-tumor activity of NK cell populations. The effect of PM21-2 particles was studied in in vitro culture based experiments, which tested the effectiveness the PM21-2 particles to induce selective NK cells expansion as compared to PM21 particles in the presence or absence of soluble IL-2.

Human immunodeficiency virus (HIV) and hepatitis C virus (HCV) infections induce a myriad of disturbances to CD4 T cell functions, including mitochondrial compromise, excessive inflammation, increased telomeric DNA damage and attrition, cellular exhaustion and senescence, and accelerated aging. In this dissertation, the mechanisms underlying metabolic failure, accelerated aging, and cellular dysfunctions were evaluated in CD4 T cells from healthy subjects (HS) treated with a telomere-targeting drug (KML001) or HCV-infected individuals or people living with HIV (PLHIV) compared to HS. We observed that KML001-induced telomere injury resulted in mitochondrial swelling and decreased mitochondrial membrane potential, cellular respiration, mitochondrial DNA (mtDNA) copy number, and ATP production mediated by p53-mediated repression of the master mitochondrial regulators peroxisome proliferator-activated receptor gamma coactivator 1-alpha (PGC-1α) and nuclear respiratory factor 1 (NRF-1). We then investigated the mechanisms responsible for T cell dysfunction and metabolic failure during chronic viral infections (HCV, HIV). We observed that chronic HCV infection leads to elevated production of cellular and mitochondrial reactive oxygen species (ROS), impaired mtDNA, and altered levels of proteins responsible for mediating oxidative stress, apoptosis, and mtDNA maintenance, as well as mitochondrial regulators PGC-1α and mitochondrial transcription factor A (mtTFA), contributing to impaired cellular respiration and mtDNA content. Similarly, we demonstrated that latent HIV infection induced disruptions to CD4 T cell homeostasis and increased cellular exhaustion, senescence, and apoptosis and reduced proliferation. We also observed significant repression of mitochondrial respiration, mtDNA content, and mtTFA levels in CD4 T cells from PLHIV, which was reversed via ectopic expression of mtTFA. Finally, we observed elevated cellular and mitochondria ROS production in CD4 T cells from PLHIV, along with significant deregulation of levels of antioxidant defense (superoxide dismutase 1, SOD1) and oxidative stress-induced DNA damage repair (apurinic/apyrimidinic endonuclease 1, APE1) proteins, which were shown to be essential for cellular respiration independently of mtDNA content. Taken together, this research highlights novel multi-leveled mechanisms by which chronic viral infection induces accelerated T cell aging and mitochondrial compromise via deregulating master mitochondrial regulators and provides a diverse collection of novel therapeutic targets that may be applied to various infectious diseases.

Human Immunodeficiency Virus (HIV) infection initiates major metabolic and cell- survival complications. Anti-retroviral therapy (ART) is the current approach to suppress active HIV replication to a level of undetected viral load, but it is not a curative approach. Newer and sophisticated gene editing technologies could indeed be a potent antiviral therapy to achieve a clinical sterilization/cure of HIV infection. Chronic HIV patients, even under a successful ART regimen, exhibit a low-grade inflammation, immune senescence, premature aging, telomeric DNA attrition, T cell apoptosis, and cellular homeostasis. In this dissertation, we investigated CD4 T cell homeostasis, degree of T cell apoptosis, an associated telomeric DNA damage, DNA damage repair signaling, and the apoptotic pathways in CD4 T cells during HIV infection with or without ART treatment. Our data support a DNA damage accumulation, and impaired DNA damage repair in chromosome ends via recruitment of 53BP1 protein to the damaged foci. We found that a key player of DNA damage and repair enzyme, ATM, and its associated checkpoint proteins (CHK1, CKH2) are affected by HIV infection. HIV infection also altered another multifunctional master regulator protein AKT that is crucial in maintaining cellular homeostasis. Curing HIV is the ultimate redemption against HIV-associated complications. To explore the possibility of a functional cure, we investigated the use of a transient and a non-viral CRISPR/Cas9-based gene editing technology targeting the latently incorporated HIV provirus. After performing a nucleofection/electroporation using an in vitro formulated ribonucleoprotein (RNP) constituting a synthetic guide RNA (gRNA) and Cas9 nuclease protein, we demonstrated a significant (maximum 97%) reduction of HIV-mRNA and p24-capsid protein expression, upon stimulation (using PMA) and latency reactivation of latently HIV-infected CD4 T cells and latent-monocytes. Notably, the RNP treatment did not induce any cytotoxic effects, without affecting the abilility of cell proliferation. A sequence specific cleavage of HIV-provirus in two crucial gene locations (targeting vpr/tat genes) showed the most significant suppression of HIV reactivation or latency reversal. We have used DNA sequencing, and T7EI assay to confirm the target-site-specific cleavage of the HIV-proviral genome. Our data confirm the activation of non- homologous end joining (NHEJ) pathway to repair the double-stranded DNA break created by the CRISPR/Cas9 treatment. Taken together, this study provides a new gene therapeutic approach using synthetic gRNA/Cas9 targeting HIV genome, which warrant further in vivo animal and human studies.

Preterm birth is the number one cause of death in neonates, accounting for 35% of neonatal mortality. The preterm birth rate in the U.S. in 2021 was 10.5%, disproportionally affected by race and ethnicity. Obese women have an increased risk of preterm pregnancy, and if delivered before 37 weeks of gestation, the offspring have higher rates of complications that extend from the neonatal period into life-long metabolic and immune adverse outcomes. In the early months after delivery, preterm infants have higher rates of adverse health outcomes than term infants, including infections, extrauterine growth restrictions, respiratory, metabolic, and neurological complications, necrotizing enterocolitis (NEC), and bronchopulmonary dysplasia (BPD). Diet for the preterm infant is crucial for infection prevention, and maternal breast milk is most beneficial when given in the first few days after birth. Expectant and breastfeeding mothers should consume appropriate food and supplements to optimize their nutrition. In addition to nutrients, bioactive components, vitamins, and minerals found in breast milk (BM), there is evidence that microbes (microbiome) are a significant factor in infant development, contributing to protection against pathogens and playing a role in the development of the immune and nervous systems. Maternal BM composition and microbiome are affected by many factors, including maternal body mass index (BMI), maternal health, antibiotics use, mode of delivery, maternal parity, gestational age, and time and duration of lactation. Maternal body composition, however, and not maternal nutritional status, is associated with breast milk nutritional composition. Altogether, these maternal factors may modify the premature infant gut microbiome. We examined the role of maternal adiposity and how it impacts the composition of human breast milk, specifically hormones, nutrient composition, short and long chain fatty acids, and microbiome. We also examined the role of maternal adiposity and how it impacts the short-chain fatty acids and microbiome in infant fecal samples. We found that maternal adiposity affects breast milk hormones, potentially modulating infant metabolism. Additionally, we found that maternal adiposity does not alter the nutrient composition of breast milk; however, differences in both short and long chain fatty acids and maternal adiposity were detected. In our small cross-sectional cohort of preterm infants, we did not observe differences in short-chain fatty acids in the preterm infant stool samples compared to maternal adiposity. Concerning maternal adiposity and its impact on the microbiomes of breast milk and infants, we observed differences in phyla and genera between the maternal BMI groups on the outcome of breast milk and preterm infant microbiomes but no statistical significance in alpha and beta diversities between the groups. Thus, our results indicate that maternal adiposity impacts hormonal, microbial composition, and short-chain fatty acid profiles in breast milk, which tremendously influences infant growth and development.

<p><strong>Rationale: </strong>Lung-homing of bone marrow (BM)-derived progenitor cells is associated with inflammatory and remodeling changes in asthma. Stromal cell derived factor-1α (SDF-1α) is a potent progenitor cell chemoattractant and its local production in the lung promotes lung homing of progenitor cells. The role of pro-inflammatory cytokines in promoting traffic of progenitor cells to the site of inflammation in asthma has not been investigated. The TH2 cytokines, interleukin (IL)-4 and IL-13, are key regulators of asthma pathology.</p> <p><strong>Objective: </strong>To investigate the role of IL-4 and IL-13 in modulating the trans-migrational responses of hemopoietic progenitor cells (HPC).</p> <p><strong>Methods: </strong>HPC were isolated from cord blood (CB) and peripheral blood (PB) and migrational and adhesive responses were assessed using transwell migration assays and adhesion to fibronectin-coated wells, respectively. Responding cells were enumerated by flow cytometry.</p> <p><strong>Results: </strong>IL-4 and IL-13 had no direct effect on progenitor cell migration. Pre-incubation with each of these cytokines primed SDF-1α stimulated migration of CB and PB-derived HPC (CD34+45+ cells) but not eosinophil-lineage committed progenitors (CD34+45+IL- 5Rα+ cells) or mature eosinophils to SDF-1α. For HPC, priming effects of IL-4 (0.1ng/ml) and IL-13 (0.1ng/ml) were detectable within 1hr and optimal at 18hr post- incubation and IL-4 was the more effective priming agent. Disruption of lipid rafts inhibited IL-4 priming of SDF-1α stimulated migration of HPC indicating that increased incorporation of CXCR4 into membrane lipid rafts mediates the cytokine primed migrational response of HPC. This was confirmed by confocal fluorescent microscopy.</p> <p><strong>Conclusions: </strong>IL-4 and IL-13 prime the migrational response of HPC to SDF-1α by enhancing the incorporation of CXCR4 into lipid rafts. The priming effect of these cytokines is specific to primitive HPC. These data suggest that increased local production of IL-4 and IL-13 within the lungs may promote increased SDF-1α mediated homing of BM-derived HPC to the airways in asthma.</p> / Master of Science in Medical Sciences (MSMS)

<h4> </h4> / <p>Asthma is an inflammatory disorder of the airways, and there has been growing insight into the cellular and molecular mechanisms underlying the inflammatory basis of this disease. Research into the inflammatory mechanisms of asthma has progressively shifted focus from downstream effectors, such as mast cells and eosinophils, up to Th2 lymphocytes and their proallergic cytokines. Even more upstream in the allergic cascade are dendritic cells (DCs), potent APCs that orchestrate immune responses. Evidence supporting a role of DCs in regulating airway allergic inflammation is derived mainly from animal studies. In animal models of asthma, myeloid DCs (mDCs) induce and maintain airway inflammation, while plasmacytoid DCs (pDCs) mediate tolerance and lung homeostasis. It remains uncertain, however, whether this concept of pro-allergic mDCs and anti-allergic pDCs translates from animal to human models. The overall objective of this thesis was to investigate the biology of DC subsets in allergen-induced asthma in asthmatic subjects. Initially, we demonstrate that both mDCs and pDCs increase in the airways of subjects with mild asthma after allergen inhalation. Next, we describe a distinct subpopulation of mDCs, called mDC2s, and demonstrate their association with allergy and asthma severity. Expanding on these findings, we show that mDC2s increase in the airways of mild asthmatics after allergen challenge. Lastly, we explore the potential of pharmacological therapies, anti-OX40L MAb and anti-TSLP MAb, to affect DCs in subjects with mild asthma, and demonstrate no effect of either drug on circulating DC subsets. The studies presented here provide evidence for multiple DC subtypes being involved in the regulation of allergen-induced inflammatory responses, and support continued investigations into the biology of different DC subsets in allergen-induced asthma.</p> / Doctor of Philosophy (Medical Science)

First identified over a decade ago, Astrocyte Elevated Gene-1 (AEG-1) has been studied extensively due to early reports of its overexpression in various cancer cell lines. Research groups all over the globe including our own have since identified AEG-1 overexpression in cancers of diverse lineages including cancers of the liver, colon, skin, prostate, breast, lung, esophagus, neurons and neuronal glia as compared to matched normal tissue. A comprehensive and convincing body of data currently points to AEG-1 as an essential component, critical to the progression and perhaps onset of cancer. AEG-1 is a potent activator of multiple pro-tumorigenic signal transduction pathways such as mitogen-activated protein extracellular kinase (MEK)/ extracellular signal-regulated kinase (ERK), phosphotidyl-inositol-3-kinase (PI3K)/Akt/mTOR, NF-κB and Wnt/β-catenin pathway. In addition, studies show that AEG-1 not only alters global gene and protein expression profiles, it also modulates fundamental intracellular processes, such as transcription, translation and RNA interference in cancer cells most likely by functioning as a scaffold protein. The mechanisms by which AEG-1 is overexpressed in cancer have been studied extensively and it is clear that multiple layers of regulation including genomic amplification, transcriptional, posttranscriptional, and posttranslational controls are involved however; the mechanism by which AEG 1 itself induces its oncogenic effects is still poorly understood. Just as questions remain about the exact role of AEG-1 in carcinogenesis, very little is known about the role of AEG-1 in regulating normal physiological functions in the liver. With the help of the Massey Cancer Center Transgenic/Knockout Mouse Core, our lab has successfully created a germline-AEG-1 knockout mouse (AEG-1-/-) as a model to interrogate AEG-1 function in vivo. Here I present the insights gained from efforts to analyze this novel AEG-1-/- mouse model. Aspects of the physiological functions of AEG-1 will be covered in chapter two wherein details of the characterization of the AEG-1-/- mouse are described including the role of AEG-1 in lipid metabolism. Chapter three discusses novel discoveries about the specific role of AEG-1 in mediating hepatocarcinogenesis by modulating NF-κB, a critical inflammatory pathway. First identified over a decade ago, Astrocyte Elevated Gene-1 (AEG-1) has been studied extensively due to early reports of its overexpression in various cancer cell lines. Research groups all over the globe including our own have since identified AEG-1 overexpression in cancers of diverse lineages including cancers of the liver, colon, skin, prostate, breast, lung, esophagus, neurons and neuronal glia as compared to matched normal tissue. A comprehensive and convincing body of data currently points to AEG-1 as an essential component, critical to the progression and perhaps onset of cancer. AEG-1 is a potent activator of multiple pro-tumorigenic signal transduction pathways such as mitogen-activated protein extracellular kinase (MEK)/ extracellular signal-regulated kinase (ERK), phosphotidyl-inositol-3-kinase (PI3K)/Akt/mTOR, NF-κB and Wnt/β-catenin pathway. In addition, studies show that AEG-1 not only alters global gene and protein expression profiles, it also modulates fundamental intracellular processes, such as transcription, translation and RNA interference in cancer cells most likely by functioning as a scaffold protein. The mechanisms by which AEG-1 is overexpressed in cancer have been studied extensively and it is clear that multiple layers of regulation including genomic amplification, transcriptional, posttranscriptional, and posttranslational controls are involved however; the mechanism by which AEG 1 itself induces its oncogenic effects is still poorly understood. Just as questions remain about the exact role of AEG-1 in carcinogenesis, very little is known about the role of AEG-1 in regulating normal physiological functions in the liver. With the help of the Massey Cancer Center Transgenic/Knockout Mouse Core, our lab has successfully created a germline-AEG-1 knockout mouse (AEG-1-/-) as a model to interrogate AEG-1 function in vivo. Here I present the insights gained from efforts to analyze this novel AEG-1-/- mouse model. Aspects of the physiological functions of AEG-1 will be covered in chapter two wherein details of the characterization of the AEG-1-/- mouse are described including the role of AEG-1 in lipid metabolism. Chapter three discusses novel discoveries about the specific role of AEG-1 in mediating hepatocarcinogenesis by modulating NF-κB, a critical inflammatory pathway.

A febre reumática é uma das sequelas da infecção causada por Streptococcus pyogenes, afetando notadamente crianças e jovens, com altas taxas de morbidade e mortalidade em várias regiões do mundo, incluindo Brasil. Perfis imunoquímicos desenvolvidos por antígenos celulares e extracelulares desta bactéria e isotipos de anticorpos presentes em pacientes com febre reumática foram averiguados, em virtude da escassez de informação a este respeito na literatura. Na primeira fase do trabalho, as condições para o preparo de antígenos, bem como de técnicas, em especial a técnica super-micro de neutralização de anticorpos (Ac) anti-estreptolisina O (ASLO) foram padronizadas. Na segunda etapa, foram identificadas as bandas de antígenos celulares e extracelulares reconhecidas por 56 soros de pacientes com febre reumática (Grupo A), 91 soros de indivídos sem diagnóstico de sequelas não-supurativas da infecção, mas com títulos baixos, médios e altos de Ac ASLO (Grupo B), e 41 soros de crianças sem infecção (Grupo C). Em pacientes com febre reumática, Acs IgG e IgA foram detectados, mas Acs IgM não foram encontrados. Anticorpos IgG de pacientes do grupo A reconheceram um total de 30 bandas do antígeno celular, sendo específicas 18 (14, 17, 19,22,23,28,29,32,36, 73, 83, 102, 104, 108, 11 0, 116, 118 e 125 kDa). O resto das 12 bandas foram consideradas não específicas por serem reconhecidas por soros do grupo C. Um total de 19 bandas do antígeno extracelular foi reconhecido por Acs IgG do grupo A, sendo apenas 3 bandas (40, 46, 125 kDa) específicas. No grupo C, Acs IgA não foram detectados. Um total de 14 bandas (23, 30, 38, 42, 43, 46, 48, 54, 57, 60, 67, 73, 78 e 116 kDa) do antígeno celular foram identificadas por Acs IgA do grupo A. No antígeno extracelular, 8 bandas (38, 48, 54, 60, 67,\" 73, 78 e 95 kDa) foram reconhecidas por Acs IgA do mesmo grupo. Critério adotado de combinar dados imunoquímicos ou seja, bandas iguais ou maiores que 102 kDa e/ou bandas iguais ou menores que 29 kDa do antígeno celular de S. pyogenes, acrescido da presença de Acs IgA, possibilitaram a discriminação de pacientes com febre reumática e de não infectados, fornecendo máxima sensibilidade, especificidade, eficiência, bem como de valores preditivos de resultados positivo e negativo. Ademais, os achados de Acs IgG contra banda de 28 kDa que está relacionada a antígeno do tecido cardíaco, um dos 6 perfís imunoquímicos fornecidos por antígeno celular e Acs IgG do presente estudo, e a presença de Acs IgA parecem constituir sinais precoces associados à patogênese da febre reumática. Desta forma no grupo B, 9 pacientes revelaram a banda de 23 kDa do antígeno celular, destes 7 apresentaram perfis compatíveis com os do grupo A, sendo que apenas 1 deles não apresentou Acs IgA. Os dados sugerem que estes pacientes tendem a evoluir para a forma sintomática da febre reumática, requerendo acompanhamento clínico e laboratorial cuidadoso. / The rheumatic fever is one of the sequelae from the Streptococcus pyogenes infection, affecting manly children and young persons, with high rates of morbidity and mortality in many regions of the world. Immunological profiles developed by cellular and extracellular antigens from this bacterium and antibody isotypes found in the patients with rheumatic fever were investigated, due to the scarcity of information about this aspect in the literature. In the first step of this work, conditions to prepare antigens, as well as of techniques, in particular the super-micro technique for the neutralization of antistreptolysin O (ASLO) antibodies (Abs), were standardized. In the second step, bands of cellular and extracellular antigens recognized by 56 serum sera from patients with rheumatic fever (Grupo A), 91 sera from individuals with no diagnosis of supurative sequelae from the infection, but with low, moderate and high ASLO titers (Group B), and 41 sera from children with no infection (Group C) were identified. In patients with rheumatic fever, IgG and IgA antibodies were found, but IgM antibodies were absent. IgG antibodies from rheumatic fever patients recognized 30 bands of the cellular antigens, of these 18 were specific (14,17,19,22,23,28,29,32,36,73,83,102, 104, 108, 110, 116, 118 e 125 kDa). The remaing 12 bands were considered nonspecific because they were recognized by sera from the group C. A total of 19 bands of the extracellular antigen were recognized by IgG Abs from the group A and 3 of these (40, 46 and 125 kDa) were specific. In the group C, no IgA Abs were detected. A total of 14 specific bands (23, 30, 38, 42, 43, 46, 48, 54, 57, 60, 67, 73, 78 and 116 kDa) of the cellular antigen were identified by IgA Abs from the group A. The extracellular antigen had 8 bands (38, 48, 54, 60, 67, 73, 78 and 95 kDa) recognized by IgA Abs from the same group. A criterion adopted of combining immunchemical data, i.e. bands equal or higher than 102 kDa and/or bands equal or lower than 29 kDa of the cellular antigen of S. pyogenes plus the IgA Ab finding, allowed to discriminate rheumatic fever from noninfected individuals, providing maximum sensitivity, specificity, efficiency as well as predictives of positive and negative results. Moreover, the findings of IgG Abs to 23 kDa of the cellular antigen which is associated to the heart tissue antigen, one of those 6 immunochemical profiles provided by cellular antigen and IgG Abs from this study, and the presence of IgA Abs seem to constitute early immunologic signals related to the pathogenesis of the rhematic fever. Thus in the group B, 9 patients revealed a 23 kDa band of cellular antigen, 7 of these showed immunochemical profiIes consistent with those from the group A, and lacking IgA Abs in onIy one of them. The data suggest these patients are prone to deveIop rheumatic fever, requiring a close clinical and laboratory follow-up.

Over the past several decades and increasingly in recent years, blood transfusions in the United States have plummeted as surgery has gotten more precise and less invasive. Alongside this decrease in general transfusions has been an increase in specific blood products for patients whose immune systems require special treatment. Simultaneously, trends in healthcare in the United States have incentivized regional hospitals to join large conglomerates. These coexisting factors have left regional blood banks, traditionally economically viable, in much weakened states. This thesis was born out of an initial curiosity to discover whether or not genetic science, and genotyping in particular, could benefit small regional blood banks by allowing them to bring down their costs of pre-transfusion blood testing or offer new products. I focus on the San Diego Blood Bank (SDBB) as a case study of the larger blood banking industry. In the course of this research, economic factors were taken into consideration as well as social and health. A minor question that was also discussed was whether genotyping not only help regional blood banks survive fiscally but also open the gateway to better patient outcomes and lower costs nationally of blood transfusions and their associated costs. Feasibility analyses and financial modeling suggest support for genotyping blood donors and transfusion recipients in order to more perfectly match blood transfusions through extended antigen matching.