Hematopoietic Stem Cell Function in a Murine Model of Sickle Cell Disease

Previous studies have shown that the sickle environment is highly enriched for reactive oxygen species (ROS). We examined the oxidative effects of sickle cell disease on hematopoietic stem cell function in a sickle mouse model. In vitro colony-forming assays showed a significant decrease in progenitor colony formation derived from sickle compared to control bone marrow (BM). Sickle BM possessed a significant decrease in the KSL (c-kit+, Sca-1+, Lineage−) progenitor population, and cell cycle analysis showed that there were fewer KSL cells in the G0 phase of the cell cycle compared to controls. We found a significant increase in both lipid peroxidation and ROS in sickle-derived KSL cells. In vivo analysis demonstrated that normal bone marrow cells engraft with increased frequency into sickle mice compared to control mice. Hematopoietic progenitor cells derived from sickle mice, however, demonstrated significant impairment in engraftment potential. We observed partial restoration of engraftment by n-acetyl cysteine (NAC) treatment of KSL cells prior to transplantation. Increased intracellular ROS and lipid peroxidation combined with improvement in engraftment following NAC treatment suggests that an altered redox environment in sickle mice affects hematopoietic progenitor and stem cell function

Aspect structurels et fonctionnels du facteur viii dans l'initiation de la réponse immunitaire anti-facteur viii

Immunogenicity of Factor VIII (FVIII) is a major hurdle that affects about 30% of severe hemophilia A patients. Though a significant advancement has been accomplished in the development of newer FVIII molecules, the factors that drive FVIII immune responses remain elusive. Many genetic and environmental risk factors have been identified or suggested but a complete understanding of the immunological basis for the antibody formation and the mechanism(s) behind tolerance induction, in the 30% of the patients that never develop anti-FVIII antibodies, are not understood. My thesis involves overlapping aspects important for initiation of an anti-FVIII immune response in a mouse model of hemophilia A. The primary role of FVIII is its participation in coagulation-associated events and thus, the first part of my thesis addresses whether coagulation events per se are implicated in the initiation of anti-FVIII immune responses. The second part of my thesis focuses on the importance of the membrane binding residues within the C2 domain of FVIII in antigen uptake and presentation by antigen presenting cells in vitro and discusses its relevance in vivo.L’apparition d’une réponse immunitaire contre le Facteur VIII (FVIII) de la coagulation est une complication majeur qui survient chez 30% des hémophile A sévères. Bien que des avancées importantes aient abouti au développement de nouvelles molécules de FVIII thérapeutiques, les mécanismes conduisant à l’apparition d’une réponse immunitaire anti-FVIII restent non élucidés. Des facteurs de risques génétiques et environnementaux ont été identifiés ou suggérés, mais une compréhension complète des processus immunologiques permettant l’initiation de cette réponse au dépend de l’induction de tolérance immune chez 30% des patients restent incomprise. Ma thèse porte sur les aspects fonctionnels et structurels du FVIII et leur rôle dans l’initiation de la réponse immunitaire anti-FVIII chez le modèle murin hémophile A. Le premier rôle du FVIII est sa participation à la cascade de la coagulation, et donc la première partie de ma thèse adresse le rôle du processus de coagulation dans l’initiation de la réponse immunitaire anti-FVIII. La seconde partie de ma thèse se concentre sur l’importance des résidus du domaine C2 impliqué dans la liaison aux phospholipides dans l’endocytose et la présentation du FVIII par les cellules présentatrices de l’antigène in vitro et discute de leur relevance in vivo

Potentiation of thrombin generation in hemophilia A plasma by coagulation factor VIII and characterization of antibody-specific inhibition.

Development of inhibitory antibodies to coagulation factor VIII (fVIII) is the primary obstacle to the treatment of hemophilia A in the developed world. This adverse reaction occurs in 20-30% of persons with severe hemophilia A treated with fVIII-replacement products and is characterized by the development of a humoral and neutralizing immune response to fVIII. Patients with inhibitory anti-fVIII antibodies are treated with bypassing agents including recombinant factor VIIa (rfVIIa). However, some patients display poor hemostatic response to bypass therapy and improved treatment options are needed. Recently, we demonstrated that fVIII inhibitors display widely variable kinetics of inhibition that correlate with their respective target epitopes. Thus, it was hypothesized that for antibodies that display slow rates of inhibition, supplementation of rfVIIa with fVIII would result in improved thrombin generation and be predictive of clinical responses to this novel treatment regimen. In order to test this hypothesis, 10 murine monoclonal antibodies (MAbs) with non-overlapping epitopes spanning fVIII, differential inhibition titers, and inhibition kinetics were studied using a thrombin generation assay. Of the 3 MAbs with high inhibitory titers, only the one with fast and complete (classically defined as "type I") kinetics displayed significant inhibition of thrombin generation with no improvement upon supplementation of rfVIIa with fVIII. The other two MAbs that displayed incomplete (classically defined as "type II") inhibition did not suppress the potentiation of thrombin generation by fVIII. All antibodies that did not completely inhibit fVIII activity demonstrated potentiation of thrombin generation by the addition of fVIII as compared to rfVIIa alone. In conclusion, fVIII alone or in combination with rfVIIa corrects the thrombin generation defect produced by the majority of anti-fVIII MAbs better than single agent rfVIIa. Therefore, combined fVIII/rfVIIa therapy may provide better hemostatic control than current therapy in some patients with anti-fVIII inhibitors

Oxidation of factor VIII increases its immunogenicity in mice with severe hemophilia A

International audienceThe development of antibodies against therapeutic factor VIII (FVIII) represents the major complication of replacement therapy in patients with severe hemophilia A. Amongst the environmental risk factors that influence the anti-FVIII immune response, the presence of active bleeding or hemarthrosis has been evoked. Endothelium damage is typically associated with the release of oxidative compounds. Here, we addressed whether oxidation contributes to FVIII immunogenicity. The control with N-acetyl cysteine of the oxidative status in FVIII-deficient mice, a model of severe hemophilia A, reduced the immune response to exogenous FVIII. Ex vivo exposure of therapeutic FVIII to HOCl induced a mild oxidation of the molecule as evidenced by the loss of free amines and resulted in increased FVIII immunogenicity in vivo when compared to native FVIII. The increased immunogenicity of oxidized FVIII was not reverted by treatment of mice with N-acetyl cysteine, and did not implicate an increased maturation of professional antigen-presenting cells. Our data document that oxidation influences the immunogenicity of therapeutic FVIII

Epitope map of non-overlapping MAbs.

<p>The relative epitopes of anti-fVIII MAbs are shown. MAbs 4A4, 2–54, 1D4 and 2–93 target non-overlapping epitopes in the A2 domain. MAbs G38 and 2–113 target non-overlapping epitopes in the A3 domain at residues 1690–1817 and 1818–1916, respectively. MAbs I109 and 2–77 target non-overlapping epitopes in the C2 domain. <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0048172#pone.0048172-Meeks1" target="_blank">[13]</a>.</p

Prevention of the anti-factor VIII memory B-cell response by inhibition of the Bruton's tyrosine kinase in experimental hemophilia A

International audienceHemophilia A is a rare hemorrhagic disorder due to the lack of functional pro-coagulant factor VIII. Factor VIII replacement therapy in patients with severe hemophilia A results in the development of inhibitory anti-factor VIII IgG in up to 30% of the cases. To date, immune tolerance induction upon daily injection of large amounts of factor VIII is the only strategy to eradicate factor VIII inhibitors. It is however efficient in only 60-80% of the patients. Here, we investigated whether blocking B-cell receptor signaling upon inhibition of the Bruton's tyrosine kinase prevents anti-factor VIII immune responses in a mouse model of severe hemophilia A. Naive and factor VIII-sensitized factor VIII-deficient mice were fed with the selective inhibitor of the Bruton's tyrosine kinase, (R)-5-amino-1-(1-cyanopiperidin-3-yl)-3-(4-[2,4-difluorophenoxyl] phenyl)-1H pyrazole-4-carboxamide (PF-06250112), to inhibit B-cell receptor signaling prior to challenge with exogenous factor VIII. The consequences on the anti-factor VIII immune response were studied. Inhibition of the Bruton's tyrosine kinase during the primary anti-factor VIII immune response in naïve mice did not prevent the development of inhibitory anti-factor VIII IgG. In contrast, the anti-factor VIII memory B-cell response was consistently reduced upon treatment of factor VIII-challenged mice with the Bruton's tyrosine kinase inhibitor. The Brutonvs tyrosine kinase inhibitor reduced the differentiation of memory B cells ex vivo and in vivo following adoptively-transferred to naïve animals. Taken together, our data identify inhibition of the Bruton's tyrosine kinase using PF-06250112 as a strategy to limit the reactivation of factor VIII-specific memory B cells upon re-challenge with therapeutic factor VIII

Inhibition of thrombin generation by group 1 anti-fVIII MAbs.

<p>Thrombin generation curves are shown for fVIII deficient plasma (negative control), fVIII deficient plasma with 1 U/ml of fVIII (positive control) and 1 U/ml of fVIII in the presence of 5 µg/ml of specified group 1 MAb. Data represent mean ± sample standard deviation for 3 experiments where duplicates of each measurement were taken and averaged.</p

Amount of fVIII needed to restore thrombin generation of rfVIIa.

<p>Varying concentrations of fVIII were mixed 1∶1 with rfVIIa at a final concentration of 2.25 µg/ml to determine the level of fVIII activity necessary for restoration of thrombin generation of rfVIIa to fVIII at 1 U/ml. The resulting data was transformed using manufacturer’s software to yield thrombin generation curves (A), peak thrombin concentration (B) and index velocity (C). Error bars represent sample standard deviation.</p

Development and characterization of recombinant ovine coagulation factor VIII.

Animal models of the bleeding disorder, hemophilia A, have been an integral component of the biopharmaceutical development process and have facilitated the development of recombinant coagulation factor VIII (fVIII) products capable of restoring median survival of persons with hemophilia A to that of the general population. However, there remain several limitations to recombinant fVIII as a biotherapeutic, including invasiveness of intravenous infusion, short half-life, immunogenicity, and lack of availability to the majority of the world's population. The recently described ovine model of hemophilia A is the largest and most accurate phenocopy. Affected sheep die prematurely due to bleeding-related pathogenesis and display robust adaptive humoral immunity to non-ovine fVIII. Herein, we describe the development and characterization of recombinant ovine fVIII (ofVIII) to support further the utility of the ovine hemophilia A model. Full-length and B-domain deleted (BDD) ofVIII cDNAs were generated and demonstrated to facilitate greater biosynthetic rates than their human fVIII counterparts while both BDD constructs showed greater expression rates than the same-species full-length versions. A top recombinant BDD ofVIII producing baby hamster kidney clone was identified and used to biosynthesize raw material for purification and biochemical characterization. Highly purified recombinant BDD ofVIII preparations possess a specific activity nearly 2-fold higher than recombinant BDD human fVIII and display a differential glycosylation pattern. However, binding to the carrier protein, von Willebrand factor, which is critical for stability of fVIII in circulation, is indistinguishable. Decay of thrombin-activated ofVIIIa is 2-fold slower than human fVIII indicating greater intrinsic stability. Furthermore, intravenous administration of ofVIII effectively reverses the bleeding phenotype in the murine model of hemophilia A. Recombinant ofVIII should facilitate the maintenance of the ovine hemophilia A herd and their utilization as a relevant large animal model for the research and development of novel nucleic acid and protein-based therapies for hemophilia A