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Publication : Modification of an exposed loop in the C1 domain reduces immune responses to factor VIII in hemophilia A mice.

First Author  Wroblewska A Year  2012
Journal  Blood Volume  119
Issue  22 Pages  5294-300
PubMed ID  22498747 Mgi Jnum  J:185146
Mgi Id  MGI:5427531 Doi  10.1182/blood-2011-11-391680
Citation  Wroblewska A, et al. (2012) Modification of an exposed loop in the C1 domain reduces immune responses to factor VIII in hemophilia A mice. Blood 119(22):5294-300
abstractText  Development of neutralizing Abs to blood coagulation factor VIII (FVIII) provides a major complication in hemophilia care. In this study we explored whether modulation of the uptake of FVIII by APCs can reduce its intrinsic immunogenicity. Endocytosis of FVIII by professional APCs is significantly blocked by mAb KM33, directed toward the C1 domain of FVIII. We created a C1 domain variant (FVIII-R2090A/K2092A/F2093A), which showed only minimal binding to KM33 and retained its activity as measured by chromogenic assay. FVIII-R2090A/K2092A/F2093A displayed a strongly reduced internalization by human monocyte-derived dendritic cells and macrophages, as well as murine BM-derived dendritic cells. We subsequently investigated the ability of this variant to induce an immune response in FVIII-deficient mice. We show that mice treated with FVIII-R2090A/K2092A/F2093A have significantly lower anti-FVIII Ab titers and FVIII-specific CD4(+) T-cell responses compared with mice treated with wild-type FVIII. These data show that alanine substitutions at positions 2090, 2092, and 2093 reduce the immunogenicity of FVIII. According to our findings we hypothesize that FVIII variants displaying a reduced uptake by APCs provide a novel therapeutic approach to reduce inhibitor development in hemophilia A.
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