ARABIAN SOCIETY FOR - ARSHI

ARABIAN SOCIETY FOR Histocompatibility and

Immunogenomics NewsletterMarch 2019

ARSHI Newsletter ISSUE #1

ARSHI President Message

Dear Colleagues and ARSHI members

With the beginning of 2019, I would like to thank and congratulate our ARSHI members and

colleagues for the achievements and progress done in 2018. It is with great pleasure to

announce that because of the commitment and dedication of ARSHI executive board members,

the planned objectives were met. Starting in 2018, short term plans were set including: ARSHI

board organization chart, legal society registration, establish society partnership categories,

conduct educational activities, build ARSHI website and various of other accomplishments.

During last ASHI meeting in Baltimore, ARSHI signed the agreement with the most important Histocompatibility societies “ASHI, APHIA

and EFI” to participate as well to host International Summer School.

All these achievements build a strong basis and a stable bridge for the ARSHI to be at international level with our colleagues in other

Histocompatibility Societies. In the last year the activities of the ARSHI was remarkably increased. For example the ARSHI education

division organized the 1st ARSHI educational course in April 2018 in Dubai, with the participation of experts from the region and from

aboard. Another excellent example is 1st ARSHI technical workshop, which was conducted in Jordan-Amman in last December. The

workshop was held at King Hussein Cancer Center (KHCC) with attendees from 11 countries in the region. The feedback was excellent

with the participation of distinguished national and international speakers. The attendees practiced performance of Flow cytometry

Crossmatch, Cell Isolation using Magnetic Beads by stem Cell Technologies, Round table case studies and practical session on Epitope

Matching by One lambda team.

At the end of 2018, ARSHI Board members created society bylaws and in January 2019 the executive board met to put the board serving

timeline. I would like to announce that the ARSHI election is coming this year, notification email is already shared to all members.

Therefore I encourage all interested candidates to apply and members to vote afterwards.

Finally, it is innovative in the development of ARSHI to have this ARSHI newsletter as our own platform for announcing and displaying of

news, contributions and achievements etc. I am very grateful to see the first edition of ARSHI newsletter as the product of collaborative

efforts of ARSHI Editorial Board Members with the participation of our highly regarded members and colleagues. I encourage our ARSHI

members to participate and share news, achievements and contributions in the field of Histocompatibility and Immunogenetics in the

future editions.

I hope that you enjoy reading this newsletter . Fadi Alzayer

2 ARSHI Newsletter ISSUE #1


On behalf of the new formed Newsletter Editorial Board, it is my great pleasure to welcome you to the ARSHI newsletter. It is my honor and privilege to introduce you the 1st edition of ARSHI newsletter, which is a milestone for development of ARSHI.

We hope the newsletter, which is rich with informatics materials, will be helpful tips for you in enhancing your knowledge not only in the area of Histocompatibility but also in other topics related to this field. We also included activities and events that carried out by our courteous ARSHI members during the previous weeks and months. It is our truthful hopefulness that this is something you expect and look forward to such newsletter.

We obliged our thanks to the dedicated and enthusiastic Newsletter Board Members for tirelessly initiating this new project and pursuing the goal of publishing the newsletter timely, in spite of their busy work schedule and many other commitments. We extend our sincere thanks and appreciation for each one who gave their valuable time and effort to write articles in this first edition. We are optimistic that the information shared will benefit the readers.

Initiating and finalizing the newsletter is really a great example of involvement of more ARSHI volunteers and talented members, including young associates. This enhances the spirit and team work of ARSHI trainees and experts from different countries. For issuing further editions of this new born project we count on you and your valuable support. We are open and very grateful for constructive suggestions and tips to improve our performance and optimize the form and contents of the newsletter.

Wishing you all the best.

Ashraf Dada

Editor-in-Chief Letter

ARSHI President Message

Editor-in-Chief Letter

Message of ASHI

CHT Certification Journey

The 6th Histocompatibility

Workshop KFSH

Discrepant Antibody Testing:

Which One to Believe?

Fully Automation of HLA

Typing

The 1st ARSHI Technical

Workshop

Participation of ARSHI Members

in MEDLAB Congress 2019

Transplantation Society

Education Committee Workshop

Member spotlight

ESHI Diploma

Upcommin Events

Newsletter Editorial Board

and Newsletter Guidlines

ARSHI Gallery

Sponsors

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Last Page

Contents


Message of ASHI


I write this brief message to welcome the Arabic Society for Histocompatibility and Immunogenomics (ARSHI) as an organizing society for the International Summer School on Immunogenetics. From July 14 – 18, the Summer School will take place in Montreal Canada.

The American Society for Histocompatibility and Immunogenetics (ASHI) will be the host for the 2019 course. Support will be received from EFI, APHIA, and now for the first time, we welcome the addition of ARSHI faculty and members to this educational opportunity.

This meeting is limited to a small group of participants and is geared toward graduate students, post-doctoral fellows, laboratory directors-in-training and experienced technologists in the field of histocompatibility and/or immunogenetics with an interest in research or advanced learning opportunities. Faculty representatives from each Society provide lectures that cover HLA topics from very basic introductory material to discussions of cutting edge technologies and applications.

What is unique about the summer school is the opportunity for attendees to present data. Each attendee is required to submit an abstract of work they have been involved in and share it in a short (~10 minute) presentation to the faculty and attendees. Because of the personalized activities, the number of attendees accepted into this program is limited.

We look forward to attendance by ARSHI faculty and attendees in Montreal next summer at what will be an outstanding opportunity to get an international perspective on clinical histocompatibility testing. As the meeting plans develop, ASHI will provide updates to keep you informed.

Best wishes.

John Schmitz


Certified Histocompatibility Technologist -Certification Journey-

Khalid Elhassan, HLA lab, King Faisal Specialist Hospital& Research Center, Jeddah/KSA

Shortly I obtained the Certified Histocompatibility Technologist (CHT) and for me obtaining the CHT was a great professional development steps in my carrier. It is actually a dream which became reality. Therefore it is my great pleasure to share with you my experience and draw map for applying, preparation, and do so for examination, for who would like to sit for exam. I will just simply start by introduce the board and exam.

The following five requirements are needed for applying for CHT or Certified Histocompatibility Specialist (CHS): Baccalaureate degree in clinical science (foreign education: official transcript, the detailed course by course evaluation by International Education Research Foundation (IERF) must be submitted.

At least one year documented work experience for CHT. Five years documented experience for CHS. The documentation of the training must be submitted in the form of statement of competency or letter from the laboratory director. The director/lab must be accredited by EFI or ASHI, if not you can sit through sponsorship route. The CHT and CHS examination offered 4 times a year in March, June, September and December. Applications are processed for the corresponding examination eligibility date according to the table below:

I studied from the following materials which I would like to recommend: ASHI laboratory manual,4th Ed, DNA methods for HLA typing, Cellular and Molecular Immunology, A. Abbas, Histocompatibility & Immunogenetics A collection of brief revision notes, serological equivalents, parent antigens and splits, http://hla.alleles.org/antigens/recognised_serology.html, Be familiar with CREG groups, Know DRB1- DRB3/4/5 associations and Understand HLA inheritance and pedigree analysis of family studies. I do believe that when you have basic experience from all mentioned study materials you will for sure pass the examination successfully.

For further information you could contact me at any time. My e-mail is: [email protected]

The fees for the examine are: CHT: 225 USD + reservation international test center require additional fee of 225 USD = 450 USD

CHS: 250 + 225 = 475 USD

APPLICATION DATES ELIGIBILITY DATES

October 16 - January 15 March 1 - March 31

January 16 - April 15 June 1 - June 30

April 16 - July 15 September 1 - September 30

July 16 - October 15 December 1 - December 31


The 6th Histocompatibility

WorkshopMuhammad Amro, Medical Technologist, Histocompatibility and Immunogenetics Laboratory KFSH & RC, Riyadh/KSA

The 6th Histocompatibility Technical Hands-on-Training workshop was organized by King Faisal Specialist Hospital and Research Centre (KFSH & RC) in Riyadh (Saudi Arabia) and held at the Histocompatibility and Immunogenetics Laboratory in the hospital from 26 to 28 November 2018. The workshop has a warded a Continuing Medical Education (CME) hours approved by the American Board of Histocompatibility and Immunogenetics (ABHI).

The Training workshop was attended by participants from Saudi Arabia and other neighbor’s Golf Cooperation Countries (GCC). The objectives of the workshop were:

1. How to optimize the anti-HLA antibody single antigen testing.

2. How to raise the performance efficiency in Flow Cytometry Crossmatch.

3. How to overcome the technical challenges in anti-HLA antibody testing and Crossmatching.

The workshop was a combination of lectures presented by local and international speakers and practical sessions, focused on learning and training in the use of the Optimized Flow Cytometry Crossmatching and Solid phase Antibody Testing.

Overall, the participants were positive in their feedback and they considered the workshop well organized and have met its objectives. The third day, the participants were enrolled in a full day of transplantation immunology lectures by distinguish speakers from different institutions organized by the Saudi Society of Nephrology and Transplantation at the Crowne Plaza Hotel.

Among the subjects presented and discussed: the new era of HLA typing, non-HLA antibodies in kidney transplantation and the day was ended by well-liked case studies.

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Rabab A. ET AL, Histocompatibility and Immunogenetic Laboratory (HIL), DPLM/, King Fahd Specialist Hospital Dammam/KSA

In a COMPARISON STUDY the HLA-team from King Fahd Specialist Hospital (KFSH) Dammam compared the results of actual flow cytometry crossmatch (aFXM) with virtual flow cytometry crossmatch (vFXM). The authors found positive predictive value 99 % and negative predictive value 96 %. This result reflects the accuracy of the testing in KFSH Dammam and documents the excellent prediction of vFXM in the setting of organ transplantation.

In a further investigation Dr. Rabab and co-workers found in a research project that there is a better correlation of FlowPRA® and Single Antigen Beads (SAB) compared to Lab Screen Mixed (LSM) and SAB (68% Vs 94%) which has been further supported by FXM results is unique.

This finding could be utilized to establish a practical HLA-antibody test algorithm to verify conflicting results.

Furthermore the authors conclude that flow PRA screening method constitute an excellent complementary test to resolve discordant LSM and L-SAB tests.

The test can be incorporated into routine practice to verify conflicting antibody results that emerged at midnight during deceased donor- crossmatch workup, to give more updated immunization information and or explain unexpected positive crossmatch in the context of negative SAB using the same crossmatch platform.

Discrepant Antibody Testing: Which One to Believe?

vFXM

Positive Negative

aFXMPositive 197 23

Negative 3 540

Table: comparison of vFXM and aFXM

‘VIRTUAL VERSUS ACTUAL’


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The implementation of good laboratory practice (GLP) requires standardized methods of laboratory testing as human errors due to manual processing still result in a significant cause of errors and complications. The use of automated techniques reduces the impact of human errors in the HLA lab and also improves standardization and quality of achieved results.

Recently we established fully automated technologies for the HLA typing at King Faisal Specialist Hospital Jeddah. We validated new automation methods using Immucor SSO typing starting with DNA extraction. Previously, we used for the extraction of DNA semi-automated technology (EZ1 Advance XL), which needs manual step for collecting buffy coat and transfer from tube to tube.

The new method (QIAsymphony SP instrument) is fully automated device and designed to perform automated purification of nucleic acids, so no need for buffy coat layer. It uses whole blood, 8 to 96 sample extract per run. The same plate which used for extraction is also used for storage.

For the DNA amplification setup we moved from manual pipetting for each sample, master mix and Taq polymerase to the automated PCR setup QIAgility instrument. This fully automated device totally eliminates manual pipetting steps and reduces contamination significantly. In the last step Hybridization, we switched from manual hybridization to Hamilton fully automated liquid handler. This instrument does not need any manual steps and it has the option to be linked with luminex for reading.

Automated DNA extraction results were more standardized, constant and better in alignment with our internal policy for DNA concentration which is 60 ng/μl. The average of DNA concentration was before automation 96 ng/μl and after automation 58 ng/μl. The amplification products were of high quality and always present, while in the manual method no amplifications were observed sporadically.

The same applies for Hybridization steps. In total, the overall turnaround time of HLA typing until the release of the results was reduced from 10 days to 6 days. Furthermore, repeating of HLA typing testing was reduced from 17% by 6%. The same applies for mislabeling which was totally eliminated, as the whole blood tubes used as it received from the collection area without any manipulation. Fully automated HLA typing boosts the productivity and enhances the reliability of HLA testing results. Furthermore it results in optimizing man power usage and it also reduces TAT by delivering faster results.

Fully Automation of HLA Typing

Osama Alsuraihi , HLA Lab, King Faisal Specialist Hospital and Research Center Jeddah/KSA

Before Automation After Automation

REPEATING TESTS BEFORE AND AFTER AUTOMATION

FLUCTUATION OF EXTRACTED DNA

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Before Automation

After Automation

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ng/ul

ng/ul

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Abdelghani Tbakhi, MD, King Hussein Cancer Center, Amman/ Jordan

The 1st ARSHI technical Workshop was held at King Hussein Cancer Center (KHCC) in the Hashemite Kingdom of Jordan during the period December 12-13, 2018. It was our great pleasure and honor to have hosted many of ARSHI registered trainees at KHCC in Amman-Jordan for this event.

As alluded in the welcome letter, the workshop consisted of a symphony of presentations, delivered by distinguished regional and international experts in the field of Histocompatibility and Immunogenomics, as well several hand on mini workshops.

In the 1st session of day 1 of the workshop, there was a lecture on the utilization of Next Generation Sequencing (NGS) in HLA typing, followed by a presentation on HLA antibodies in the context of organ transplantations.

In the 2nd session, there were talks about HLA techniques optimization and difficulties in antibodies screening. The 3rd session consisted of a detailed mini-symposium on Design Thinking Strategy and how we can apply it career planning in the field of Histocompatibility and Immunogenomics.

In addition lectures in quality metrics in Flow cytometry crossmatch were given, which included details for performing accurate and high quality HLA flow cytometry crossmatch The concluding 4th session of the day was a very interactive and engaging discussion on laboratory data analysis training.

In Day 2 of the workshop, the attendees were divided into five groups, participating in three collateral hands on mini workshops (HLA Epitope matching; Cell isolation; and HLA Flow cross match set up, reading and interpretation).

In summary, this was a very successful and informative technical workshop that set the stage for future workshops and conferences in the region.

The 1st ARSHITechnical Workshop


Participation of ARSHI Members in MEDLAB Congress 2019

Gehad Elghazali , MD, PhD, HLA Lab, Sheikh Khalifa Medical City, Abu Dhabi, UAE

On the second day of MEDLAB Congress (04-07 Feb 2019), the ARSHI members conducted a presentation of Immunology which was chaired by Dr. Gehad Elghazali and Dr. Zain Al Yafei.

In this session Dr. Ali Hajir presented an excellent presentation about the history of the of HLA typing starting by the serology testing, through sequence specific primer (SSP), sequence specific oligonucleotide (SSO) and ending by the new next generation sequencing (NGS) technology.

Dr. Ali has spoken short about the Sanger technique which is now replaced by NGS technology. The NGS technique was presented in details and Dr. Ali explained in details both Ion Torrent and Illumina systems. He described the difference between these two competitive technologies.

Dr. Moheeb Alawwami has spoken about the HLA antibody screening and identification along with some interesting studies about the clinical relevance of the HLA Antibodies.

He also explained how to overcome difficulties in HLA screening and Identification and further presented a study about the clinical relevance of C1q testing in renal transplantation.

On the whole the presentations held by the ARSHI members Dr. Ali and Dr. Moheeb were excellent and crowd engaging. A questionnaire was conducted with enthusiastic questioner and all the questions were correctly attended by the speakers. At the end of the presentation Dr. Gehad Elghazali thanked the splendid audience for their active participation in the presentation. The presentations and the entire session were a tremendous success.


Medhat Askar, MD, PhD, Department of Pathology and Laboratory Medicine, Baylor University Medical Center, Dallas TX, USA

The Transplantation Society (TTS) Education committee

in collaboration with The International Society for Donatio

n and Procurement (ISDOP), the UAE national Transplant

committee, Abu Dhabi Health Services company SEHA and

Cleveland Clinic Abu Dhabi hospital organized a TTS Education

Committee Regional Workshop on December 8th 2018 which

was entitled “The Best Practices in Deceased Organ Donation and

Transplantation”.

The workshop was co-chaired by Dr. Medhat Askar, the co-chair of the TTS education committee and professor of Pathology &

Laboratory medicine at Baylor University Medical Center in USA and by Dr. Ali Abdul Kareem Al Obaidli, the chair of the UAE National

Transplant Committee and the Chief Academic Affairs Officer of Abu Dhabi Health Services Company (SEHA).

This workshop was designed in the context of this year’s education committee motto: “Transplantation 360: Learning Together” and to

advance the mission of TTS by fostering transplant education around the globe. This state-of-the-art program addressed the region’s

need to promote solid organ transplantation with a specific focus on deceased donor solid organ transplantation including heart, lung,

kidney, pancreas, liver and intestinal. There were local, regional and international speakers who addressed the topics on current status

of organ donation in the Middle East countries by experts practicing in the Middle East and worldwide.

Other topics included how to establish an organ procurement organization and an effective donation program involving brain death

declaration, intensive care of brain-dead donors, organ acceptance criteria, extended criteria donors, donor derived infections

and malignancies.

The program also highlighted leadership development strategies among transplant professionals. There were also speakers from other

countries in the Middle East and around the world in donor and recipient selection, pre/postoperative care, as well as immunological

aspects.

This workshop was attended by a diverse audience of professionals in various stages of their careers, both genders (132 men and

110 women), multiples countries and various disciplines of specialization including physicians, surgeons, nurses, pharmacists, other

healthcare workers, medical students and trainees, health insurance and health policy, ministry of health representatives and health

economists. Total participants were 242 representing UAE and seven other Asian countries, four African countries, USA, Canada, UK,

Australia, Spain and Portugal.

The workshop emphasized the importance of developing organ donation and transplantation systems and practical aspects of

building a sustainable multi-organ transplant program. The proceedings of the workshop were highlighted in the local newspapers

and media. The success of this workshop could not have been possible without Dr. Ali Obaidli and his team including 2 ARSHI Board

members, Dr. Gehad El-Ghazali and Dr. Zain Elyafee.

During this educational workshop it was highlighted the upcoming 1st TTS Regional Meeting that will take place in Istanbul, Turkey

on March 28-29, 2019. The topic is Deceased Donation, Expanding the donor pool. The TTS leadership committed to collaborating

with regional meeting organizers around the world to co-organize similar workshops. Details regarding this opportunity to promote

transplantation and organ donation worldwide in collaboration with TTS is available on the TTS Website.

Transplantation Society Education Committee Workshop


Happiness had to be present in this first ARSHI newsletter member spotlight, so with pride and joy our highlights will be directed to Dr.Farha Elchennawy, Professor of clinical pathology at Mansoura University in Egypt . An extraordinary Lady scientist who committed herself to excellence, spread of knowledge and advancements in the fields of Immunology and Immunogenetics not only in Egypt but overseas as well. That commitment and dedication led her to be honoured by the French President and she received the grand officer rank for her achievements and contribution to Science in 2017.

Prof.Dr. Farha Elchennawy built up her career step by step, she graduated from Mansoura Medical school with Honours ranked the third on her class. She received a scholarship to study in France in 1983. She became a full professor at the clinical pathology department in Mansoura medical school, Mansoura university in 1992.

It is worth noting that her paper on HLA population genetics1 was the first ever to show the HLA antigens in the Egyptian population in 1986.

She excelled in every aspect till she became the first ever female dean of Mansoura medical school from 2005 to 2007.

Her scientific achievements grew from teaching staff, mentoring post graduates, many publications in the field of Immunology, Immunogenetics and Histocompatibility as well as several research projects to the establishment of the first institutional embryonic stem cells research centre and cord blood bank in Mansoura Medical school and Egypt as a whole.

The other side of Dr Farha Elchennawy career was her belief in women education, she helped launch the first French cultural centre in Egypt Delta, the first ever French experimental school in Mansoura. She holds now the position of the Rapporteur of the National Council of Women in Egypt.

It is really a great honor for the Arabian Society for Histocompatibility and Imunogenomics (ARSHI) to have Prof. Dr Farha Elchennawy as one of our highly valued members and the center of our first member spotlight

Member spotlight

Professor Dr. Farha ElChennawy

Sally AlFishawi, MD


The European Specialization in Transplantation Immunology, Histocompatibility and Immunogenetics (ESHI) Diploma

In 2015 the European Union of Medical Specialists (UEMS) - represented by the European Board of Transplantation Immunology (EBTI) - and the European Federation of Immunogenetics (EFI) have singed a non-binding Memorandum of Understanding to enhance the quality of medical and scientific practice in the field of transplantation Immunology across the countries of the European Union. This will be achieved by promoting the harmonization of training standards in the field of transplantation immunology for specialists and physicians within the member countries of European Union.

This agreement opened the route for high level training program and established a new European examination in the field of Histocompatibility and Immunogenetics called the “European Specialization in Histocompatibility and Immunogenetics (ESHI) Diploma”.

Joannis Mytilineos, MD, PhD, EFI President -Department of Transplantation Immunology, Ulm, Germany


The two institutions UEMS/EBTI and EFI complement each other and have a closed relationship, an intensive communication and supplementary rules as UEMS is considered the governmental-like body of the European Union and EFI is the professional society which presents and represents the transplantation immunology from technical and professional point of view.

ESHI Diploma can be achieved

Examination (4 Modules)

1. Solid Organ Transplantation Service (SOTS)

2. Hematopoietic Stem Cell Transplantation (HSCT)

3. SOT/HSCT + Disease Association Testing

4. SOT/HSCT + Transfusion Support

EFI BoardUEMS-

Section of Surgery Division of Transplantation

EFIEducation Committee

UEMS-EBTIExecutive Committee

UEMS-EBTI-ASSEMBLY

EFIMembers

National H&I or TxSocieties or Medical

Authorities

‘Liaising’ Relationship

‘Reports’ Relationship


The EBTI come together annually and the representative of each country are nominated by the national society for

histocompatibility, or the national society for transplantation or the national Ministry of Health or by the EFI. The

current elected chairman of the EBTI is Dr. Marco Andrani from Rom/Italy.

To obtain the ESHI Diploma a person must not be a citizen of the European Union and therefore every ARSHI

member can apply for this examination. ARSHI members can apply for the ESHI diploma through the website of

the UEMS using the link mentioned below. However Training of applicant must have been carried out in an EFI or

ASHI accredited laboratory or an equally certified institution.

Example for ESHI Diploma


UPCOMING Events 2019

07-08 MARCH 2019 2nd ARSHI Histocompatibility Educational Course Location: Cairo, Egypt

11-13 APRIL 2019 ASHI Regional Education Workshop 1Location: Portland, Oregon, USA

04-07 MAY 2019 10th Congress of the International Pediatric Transplant AssociationLocation: Vancouver, British Columbia, Canada

08-11 MAY 2019 EFI 2019: 33rd European Immunogenetics and Histocompatibility ConferenceLocation: Lisbon, Portugal

26-27 JUNE 2019 BSHI Annual Conference 2019: HLA and AncestryLocation: Leicester, UK

27-29 JUNE 2019 ASHI Regional Education Workshop 2Location: Savannah, Georgia, USA

14-17 JULY 2019 International Summer School, APHIA, ASHI, EFI, ARSHILocation: Montreal, Canada

19-20 JULY 2019 Paul I. Terasaki Antibody SymposiumLocation: Los Angeles , USA

23-27 SEPTEMBER 2019 ASHI 2019: ASHI 45th Annual Meeting Location: Pittsburgh, Pennsylvania, USA

ARSHI Newsletter ISSUE #1


ARSHI NEWSLETTER TEAM Editorial Board

ARSHI NEWSLETTER GUIDELINES

Editor-in-ChiefAshraf Dada, MD, Ph.D.

Co. EditorsAhmad Abu Khader, Ph.D. Hatim Alabass, Ph.D.

Editorial Board MembersNezar Elshaikh, Ph.D.

Osama Alsuraihi, MT, MSc

Khalid Alhassan, CHT/ABHI

Adil Lafi, MLT, MSc

Ala Hejazi, MSc, CG (ASCP) CM

Board MembersLaith Mahrama, BSc

Kenneth Cuares, MLT, BSc

Frequency

ARSHI Newsletter is published twice in the year by the

ARSHI Editorial Board.

Goal

To provide scientific and general information about

HLA and related topics

Submission

Kindly consider the following for submission:

• Document should be submitted in word format

• Submitted article should be a half or maximum one

page (A4) with 12 font size

• If possible article might be supported with photos

• To submit an article for publication in ARSHI

Newsletter please contact us through the following

mail: [email protected]


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