Induction of heme oxygenase-1 in factor VIII–deficient mice reduces the immune response to therapeutic factor VIII

Blood ◽  
2010 ◽  
Vol 115 (13) ◽  
pp. 2682-2685 ◽  
Author(s):  
Jordan D. Dimitrov ◽  
Suryasarathi Dasgupta ◽  
Ana-Maria Navarrete ◽  
Sandrine Delignat ◽  
Yohann Repesse ◽  
...  

Abstract Replacement therapy with exogenous factor VIII (FVIII) to treat hemorrhages induces anti-FVIII inhibitory immunoglobulin G in up to 30% of patients with hemophilia A. Chronic inflammation associated with recurrent bleedings is a proposed risk factor for FVIII inhibitor development. Heme oxygenase-1 (HO-1) is a stress-inducible enzyme with potent anti-inflammatory activity. Here, we demonstrate that induction of HO-1 before FVIII administration drastically reduces the onset of the anti-FVIII humoral immune response. The protective effect was specific for HO-1 because it was reproduced on administration of the end products of HO-1 activity, carbon monoxide, and bilirubin, and prevented by the pharmacologic inhibition of HO-1 using tin mesoporphyrin IX. HO-1 induction was associated with decreased major histocompatibility complex class II expression by splenic antigen-presenting cells and reduced T-cell proliferation. Triggering the endogenous anti-inflammatory machinery before FVIII administration may represent a novel therapeutic option for preventing the development of FVIII inhibitors in hemophilia A patients.

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 38-38
Author(s):  
Yohann Repesse ◽  
Ivan Peyron ◽  
Jordan Dimitrov ◽  
Suryasarathi Dasgupta ◽  
Elika Farrokhi Moshai ◽  
...  

Abstract Abstract 38 The occurrence of inhibitory anti-factor VIII (FVIII) antibodies is the major complication of replacement therapy in patients with hemophilia A. Heme oxygenase-1 (HO-1) is a stress inducible enzyme with anti-inflammatory activity. Induction of HO-1 in hemophilic mice reduces the immunogenicity of therapeutic FVIII. Interestingly, polymorphisms in the promoter of the HO-1-encoding gene (HMOX1) modulate the expression of HO-1. We investigated the relationship between polymorphisms in the promoter of HMOX1 in severe hemophilia A patients and the development of FVIII inhibitors. We analyzed 362 patients with severe hemophilia A involving 99 patients with FVIII inhibitors and 263 patients who did not develop inhibitor within the first 150 cumulative exposure days to therapeutic FVIII. Direct sequencing and DNA fragment analysis were used to study the variable (GT)n polymorphism and single nucleotide polymorphisms located at −1135 and −413 in the promoter of HMOX1. We assessed associations between the individual allele frequencies and genotypes, and the development of inhibitors. Our results demonstrate a higher frequency of alleles with large (GT)n repeat (n≥30, L, associated with a lesser expression of HO-1) in inhibitor-positive patients [odds ratio (OR) 2.31; 95% CI 1.46–3.66, p<0.001]. Six genotypes (L/L, L/M, L/S, M/M, M/S and S/S) of (GT)n repeats were identified (S: n<21; M: 21≤n<30). The genotype group including L alleles (L/L, L/M and L/S) was statistically more frequent among inhibitor-positive than inhibitor-negative patients, as compared to the other genotypes (33.3% vs 17.1%) [OR 2.21, 95% CI 1.30–3.76, p<0.01]. To our knowledge, this is the first association between HMOX1 promoter polymorphism and development of anti-drug antibodies. Modulating the endogenous anti-inflammatory machinery of hemophilia A patients appears as a plausible therapeutic option for reducing the risk of inhibitor development. Disclosures: No relevant conflicts of interest to declare.


2018 ◽  
Author(s):  
Dina Schneidman-Duhovny ◽  
Natalia Khuri ◽  
Guang Qiang Dong ◽  
Michael B. Winter ◽  
Eric Shifrut ◽  
...  

AbstractAccurate predictions of T-cell epitopes would be useful for designing vaccines, immunotherapies for cancer and autoimmune diseases, and improved protein therapies. The humoral immune response involves uptake of antigens by antigen presenting cells (APCs), APC processing and presentation of peptides on MHC class II (pMHCII), and T-cell receptor (TCR) recognition of pMHCII complexes. Most in silico methods predict only peptide-MHCII binding, resulting in significant over-prediction of CD4 T-cell epitopes. We present a method, ITCell, for prediction of T-cell epitopes within an input protein antigen sequence for given MHCII and TCR sequences. The method integrates information about three stages of the immune response pathway: antigen cleavage, MHCII presentation, and TCR recognition. First, antigen cleavage sites are predicted based on the cleavage profiles of cathepsins S, B, and H. Second, for each 12-mer peptide in the antigen sequence we predict whether it will bind to a given MHCII, based on the scores of modeled peptide-MHCII complexes. Third, we predict whether or not any of the top scoring peptide-MHCII complexes can bind to a given TCR, based on the scores of modeled ternary peptide-MHCII-TCR complexes and the distribution of predicted cleavage sites. Our benchmarks consist of epitope predictions generated by this algorithm, checked against 20 peptide-MHCII-TCR crystal structures, as well as epitope predictions for four peptide-MHCII-TCR complexes with known epitopes and TCR sequences but without crystal structures. ITCell successfully identified the correct epitopes as one of the 20 top scoring peptides for 22 of 24 benchmark cases. To validate the method using a clinically relevant application, we utilized five factor VIII-specific TCR sequences from hemophilia A subjects who developed an immune response to factor VIII replacement therapy. The known HLA-DR1-restricted factor VIII epitope was among the six top-scoring factor VIII peptides predicted by ITCall to bind HLA-DR1 and all five TCRs. Our integrative approach is more accurate than current single-stage epitope prediction algorithms applied to the same benchmarks. It is freely available as a web server (http://salilab.org/itcell).Author summaryKnowledge of T-cell epitopes is useful for designing vaccines, improving cancer immunotherapy, studying autoimmune diseases, and engineering protein replacement therapies. Unfortunately, experimental methods for identification of T-cell epitopes are slow, expensive, and not always applicable. Thus, a more accurate computational method for prediction of T-cell epitopes needs to be developed. While the T-cell response to extracellular antigens proceeds through multiple stages, current computational methods rely only on the prediction of peptide binding affinity to an MHCII receptor on antigen presenting cells, resulting in a relatively high number of false-positive predictions of T-cell epitopes within protein antigens. We developed an integrative approach to predict T-cell epitopes that computationally combines information from three stages of the humoral immune response pathway: antigen cleavage, MHCII presentation, and TCR recognition, resulting in an increased accuracy of epitope predictions. This method was applied to predict epitopes within blood coagulation factor VIII (FVIII) that were recognized by TCRs from hemophilia A subjects who developed an anti-FVIII antibody response. The correct epitope was predicted after modeling all possible 12-mer FVIII peptides bound in ternary complexes with the relevant MHCII (HLA-DR1) and each of five experimentally determined FVIII-specific TCR sequences.


Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 2247-2247
Author(s):  
Rebecca Markovitz ◽  
John (Pete) S. Lollar ◽  
John F. Healey ◽  
Ernest T Parker ◽  
Shannon Meeks

Abstract Abstract 2247 Hemophilia A is an X-linked recessive disorder that is caused by a deficiency or defect of factor VIII (fVIII) coagulant protein. The major complication of treatment is the development of anti-fVIII antibodies (inhibitors) in approximately 20–30% of patients with severe hemophilia A. The majority of these inhibitors are directed against the A2 or C2 domains (Prescott R et al. Blood 1997). This study examines the structural and functional diversity of the humoral immune response to the A2 domain of human fVIII. A panel of 24 murine anti-A2 monoclonal antibodies (MAbs) produced in our laboratory plus MAb413 (American Red Cross) and GMA012 (Green Mountain, Burlington, VA) were used in this study. Previous studies have shown that anti-C2 MAbs produced from murine anti-fVIII hybridomas had a similar spectrum of epitopes to those found in inhibitor patient plasmas (Meeks SL et al. Blood 2008). A competition sandwich ELISA with immobilized anti-A2 primary MAb, human fVIII, biotinylated anti-A2 secondary MAb and streptavidin–alkaline phosphatase conjugate for detection was used to determine overlapping epitopes. Each antibody was used as both a capture and detection antibody. Antibody pairs were classified as having non-overlapping or overlapping epitopes based on whether the binding of the secondary antibody was present or absent, respectively. Porcine/human hybrid fVIII proteins were employed in a direct ELISA to fine map the epitopes of the anti-A2 MAbs. The results of both the competition and human/porcine mapping ELISAs were compiled into a Venn diagram describing overlapping epitopes for all MAbs. Functional mapping of the MAbs included fVIII inhibitor titers by modified Bethesda assay, inhibition in a purified intrinsic Xase assay, and inhibition of thrombin cleavage of fVIII. Thrombin activation assays were run with varying concentrations of MAbs, and fVIII cleavage by thrombin was analyzed by SDS-PAGE. The competition ELISA results demonstrated 7 non-overlapping epitopes on the A2 domain of human fVIII (Figure 1). In addition, the human/porcine mapping ELISA revealed that the epitopes of the anti-A2 MAbs covered the majority of the A2 domain. The inhibitor titers of the anti-A2 MAbs ranged from non-inhibitory to 40,000 Bethesda units (BU)/mg IgG (Table). The inhibitory MAbs displayed both type I (greater than 95% inhibition at saturating MAb concentrations) and type II-(incomplete inhibition at saturating MAb concentrations) behavior. MAb413, a group D MAb, noncompetitively inhibits factor VIIIa cofactor activity without affecting thrombin cleavage. 2–54, a group G MAb, inhibits thrombin cleavage of both heavy and light chains. In contrast, 1D4, which overlaps groups B, E, and F, only inhibited light chain cleavage. Overall these results indicate that the humoral immune response to the A2 domain of fVIII is complex in terms of both structural and functional epitopes. These anti-A2 MAbs were found to target 7 non-overlapping epitopes spanning the majority of the A2 domain. Elucidation of the structural and functional complexity of the anti-A2 repertoire will lead to a better understanding of the pathogenicity of A2 inhibitors.Table:A2 MAb CharacteristicsMAbInhibitor Titer (BU/mg)GroupStructural EpitopeB25100A444–5082G10500B468–484G323000C468–508MAb41321,000D484–5082–934E541–604B664000F604–7402–5433,000G508–541, 604–740 Disclosures: No relevant conflicts of interest to declare.


1997 ◽  
Vol 78 (05) ◽  
pp. 1352-1356 ◽  
Author(s):  
Emel Aygören-Pürsün ◽  
Inge Scharrer ◽  

SummaryIn this open multicenter study the safety and efficacy of recombinant factor VIII (rFVIII) was assessed in 39 previously treated patients with hemophilia A (factor VIII basal activity ≤15%).Recombinant FVIII was administered for prophylaxis and treatment of bleeding episodes and for surgical procedures. A total of 3679 infusions of rFVIII were given. Efficacy of rFVIII as assessed by subjective evaluation of response to infusion and mean annual consumption of rFVIII was comparable to that of plasma derived FVIII concentrates. The incremental recovery of FVIII (2.4 ± 0,83%/IU/kg, 2.12 ± 0.61%/IU/kg, resp.) was within the expected range. No clinical significant FVIII inhibitor was detected in this trial. Five of 16 susceptible patients showed a seroconversion for parvovirus B19. However, the results are ambiguous in two cases and might be explained otherwise in one further case. Thus, in two patients a reliable seroconversion for parvovirus B19 was observed.


2006 ◽  
Vol 106 (3) ◽  
pp. 364-371 ◽  
Author(s):  
Byung-Chul Kim ◽  
Joung-Woo Choi ◽  
Hye-Young Hong ◽  
Sin-Ae Lee ◽  
Suntaek Hong ◽  
...  

2007 ◽  
Vol 110 (1) ◽  
pp. 23-28 ◽  
Author(s):  
Suryasarathi Dasgupta ◽  
Ana-Maria Navarrete ◽  
Sandrine Delignat ◽  
Bharath Wootla ◽  
Sebastien Andre ◽  
...  

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