48 research outputs found

    A new computational approach to analyze human protein complexes and predict novel protein interactions

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    We propose a new approach to identify interacting proteins based on gene expression data. By using hypergeometric distribution and extensive Monte-Carlo simulations, we demonstrate that looking at synchronous expression peaks in a single time interval is a high sensitivity approach to detect co-regulation among interacting proteins. Combining gene expression and Gene Ontology similarity analyses enabled the extraction of novel interactions from microarray datasets. Applying this approach to p21-activated kinase 1, we validated α-tubulin and early endosome antigen 1 as its novel interactors

    Advances in Cardiovascular Disease Lipid Research Can Provide Novel Insights Into Mycobacterial Pathogenesis

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    Cardiovascular disease (CVD) is the leading cause of death in industrialized nations and an emerging health problem in the developing world. Systemic inflammatory processes associated with alterations in lipid metabolism are a major contributing factor that mediates the development of CVDs, especially atherosclerosis. Therefore, the pathways promoting alterations in lipid metabolism and the interplay between varying cellular types, signaling agents, and effector molecules have been well-studied. Mycobacterial species are the causative agents of various infectious diseases in both humans and animals. Modulation of host lipid metabolism by mycobacteria plays a prominent role in its survival strategy within the host as well as in disease pathogenesis. However, there are still several knowledge gaps in the mechanistic understanding of how mycobacteria can alter host lipid metabolism. Considering the in-depth research available in the area of cardiovascular research, this review presents an overview of the parallel areas of research in host lipid-mediated immunological changes that might be extrapolated and explored to understand the underlying basis of mycobacterial pathogenesis

    Role of the proinflammatory environment in the immunogenicity of therapeutic factor viii in patients with severe hemophilia A

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    L’hĂ©mophilie A est une maladie hĂ©morragique rare liĂ©e au chromosome X qui se traduit par un dĂ©ficit en facteur VIII (FVIII) fonctionnel. Chez les patients atteints de la forme sĂ©vĂšre de l’hĂ©mophilie A, l’apparition d’hĂ©morragies incontrĂŽlĂ©es augmente la morbiditĂ© et affecte leur qualitĂ© de vie. Le traitement de choix permettant de prĂ©venir ou de traiter les saignements consiste en l’injection intraveineuse de FVIII thĂ©rapeutique. Cependant, chez 5 Ă  30% des patients, une rĂ©ponse immunitaire dirigĂ©e contre le FVIII se dĂ©veloppe. La rĂ©ponse anti-FVIII est caractĂ©risĂ©e par l’apparition d’anticorps qui inhibent l’activitĂ© pro-coagulante du FVIII. Ainsi l’apparition de ces anticorps, appelĂ©s « inhibiteurs » reprĂ©sente-t-elle la complication majeure du traitement des patients hĂ©mophiles A. Plusieurs facteurs de risque ont Ă©tĂ© suggĂ©rĂ©s ou proposĂ©s comme affectant le dĂ©veloppement de la rĂ©ponse anti-FVIII. Parmi eux, supportĂ© par la thĂ©orie du « danger », la prĂ©sence de mĂ©diateurs pro-inflammatoires gĂ©nĂ©rĂ©s par les Ă©pisodes de saignement est considĂ©rĂ©e comme adjuvant dans la rĂ©ponse immunitaire anti-FVIII. Cependant, les saignements induisent de nombreux mĂ©canismes pro mais aussi anti-inflammatoires. Ainsi, l’activation de l’endothĂ©lium vasculaire induit-elle le recrutement et l’activation des cellules effectrices appartenant aux compartiments innĂ©s et adaptatifs du systĂšme immunitaire. Au cours de ma thĂšse, je me suis concentrĂ© sur le rĂŽle des saignements dans le dĂ©veloppement de la rĂ©ponse immunitaire dirigĂ©e contre le FVIII. Ainsi, ai-je dĂ©couvert une association entre la prĂ©sence d’un polymorphisme dans un gĂšne induit par les saignements et la prĂ©sence d’inhibiteurs du FVIII dans une cohorte de patients hĂ©mophiles A sĂ©vĂšres. J’ai Ă©galement Ă©tudiĂ© le dĂ©veloppement de la rĂ©ponse immunitaire dirigĂ©e contre le FVIII thĂ©rapeutique dans un modĂšle murin qui mime les saignements locaux observĂ©s chez les patients hĂ©mophiles A sĂ©vĂšres. Finalement, j’ai caractĂ©risĂ© l’effet des formes rĂ©actives de l’oxygĂšne (FRO), qui sont gĂ©nĂ©rĂ©es au niveau du site de saignement, sur la structure, la fonction et l’immunogĂ©nicitĂ© du FVIII. Les rĂ©sultats obtenus au cours de ma thĂšse dĂ©montrent que les saignements ne sont pas associĂ©s Ă  un risque plus Ă©levĂ© de dĂ©velopper des inhibiteurs dans le modĂšle murin largement utilisĂ© d’hĂ©mophilie A sĂ©vĂšre, contrairement Ă  ce qui est communĂ©ment admis. De plus, j’ai dĂ©montrĂ© une association entre un polymorphisme prĂ©sent dans le promoteur du gĂšne HMOX1 et la survenue d’inhibiteurs dans une cohorte de patients atteints d’hĂ©mophilie A sĂ©vĂšre. En parallĂšle, je dĂ©cris pour la premiĂšre fois une altĂ©ration du statut oxydatif chez les souris dĂ©ficientes en FVIII et je dĂ©montre que le contrĂŽle du statut oxydatif in vivo permet de moduler la rĂ©ponse immunitaire anti-FVIII. Au contraire, l’exposition du FVIII aux FRO augmente son immunogĂ©nicitĂ©. De fait, mes rĂ©sultats suggĂšrent que, bien que les molĂ©cules pro-inflammatoires libĂ©rĂ©es suite aux saignements puissent affecter positivement la rĂ©ponse immunitaire dirigĂ©e contre le FVIII, de puissants mĂ©diateurs anti-inflammatoires sont gĂ©nĂ©rĂ©s in vivo et amenuisent l’effet potentiellement adjuvant des saignements. Également, ces rĂ©sultats soulignent la balance complexe entre les mĂ©diateurs pro- et anti-inflammatoires qui sont gĂ©nĂ©rĂ©s consĂ©cutivement aux saignements ainsi que leurs effets sur la rĂ©ponse immunitaire dirigĂ©e contre le FVIII thĂ©rapeutique.Hemophilia A is a rare X-linked hemorrhagic disease consecutive to the lack of functional pro-coagulant factor VIII (FVIII). In patients with the severe form of hemophilia A, uncontrolled hemorrhages increase the morbidity and affect the quality of life. To prevent or treat bleeding episodes, therapeutic FVIII is administered intravenously. However, an anti-FVIII immune response develops in 5 to 30% of the patients. The anti-FVIII immune response is characterized by the development of anti-FVIII IgG antibodies that inhibit FVIII activity. These antibodies, referred to as “FVIII inhibitors” represent the major complication in the treatment of hemophilia A patients. Several risk factors have been suggested or proposed to predispose to the development of FVIII inhibitors. Amongst them, inspired by the “danger” theory, the presence of inflammatory mediators released upon bleeding episodes is thought to adjuvant the anti-FVIII immune response. Bleeding episodes trigger several pro and anti-inflammatory mechanisms. Thus, damage to the endothelium triggers the recruitment and activation of effector cells from the innate and adaptive compartments of the immune system. During my PhD, I investigated the role of bleedings in the development of the anti-FVIII immune response. Thus, I discovered an association between a polymorphism in the promoter region of a gene that is induced in response to bleedings, and the presence of FVIII inhibitors in a cohort of patients with severe hemophilia A. I followed the development of the immune response to therapeutic FVIII in a mouse model that mimics the localized bleedings found in patients with severe hemophilia A. Ultimately, I characterized the effects of reactive oxygen species (ROS) that are potentially released at the bleeding site in view of the structure, function and immunogenicity of the FVIII molecule. The results I obtained during my PhD demonstrate that bleedings are not associated with a higher risk for FVIII inhibitor development in the commonly used mouse model of severe FVIII deficiency. Additionally, I demonstrated an association between a polymorphism in the promoter of the HMOX1 gene and the presence of FVIII inhibitors. In parallel, I report for the first time an exacerbated oxidative status in FVIII-deficient mice as compared to control mice, and demonstrate that the control of the oxidative status in vivo reduces the anti-FVIII immune response. Conversely, the exposure of FVIII to ROS ex vivo increases the immunogenicity of the FVIII molecule. Taken together, my results suggest that, although the pro-inflammatory molecules released upon bleeding may positively affect the anti-FVIII immune response, several strong anti-inflammatory compounds are generated in vivo that dampen the potential adjuvant effect of bleedings. Ultimately, these results highlight the complex balance between the pro and anti-inflammatory mediators generated upon bleeding and their effect on the anti-FVIII immune response

    Role of the proinflammatory environment in the immunogenicity of therapeutic factor viii in patients with severe hemophilia A

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    L’hĂ©mophilie A est une maladie hĂ©morragique rare liĂ©e au chromosome X qui se traduit par un dĂ©ficit en facteur VIII (FVIII) fonctionnel. Chez les patients atteints de la forme sĂ©vĂšre de l’hĂ©mophilie A, l’apparition d’hĂ©morragies incontrĂŽlĂ©es augmente la morbiditĂ© et affecte leur qualitĂ© de vie. Le traitement de choix permettant de prĂ©venir ou de traiter les saignements consiste en l’injection intraveineuse de FVIII thĂ©rapeutique. Cependant, chez 5 Ă  30% des patients, une rĂ©ponse immunitaire dirigĂ©e contre le FVIII se dĂ©veloppe. La rĂ©ponse anti-FVIII est caractĂ©risĂ©e par l’apparition d’anticorps qui inhibent l’activitĂ© pro-coagulante du FVIII. Ainsi l’apparition de ces anticorps, appelĂ©s « inhibiteurs » reprĂ©sente-t-elle la complication majeure du traitement des patients hĂ©mophiles A. Plusieurs facteurs de risque ont Ă©tĂ© suggĂ©rĂ©s ou proposĂ©s comme affectant le dĂ©veloppement de la rĂ©ponse anti-FVIII. Parmi eux, supportĂ© par la thĂ©orie du « danger », la prĂ©sence de mĂ©diateurs pro-inflammatoires gĂ©nĂ©rĂ©s par les Ă©pisodes de saignement est considĂ©rĂ©e comme adjuvant dans la rĂ©ponse immunitaire anti-FVIII. Cependant, les saignements induisent de nombreux mĂ©canismes pro mais aussi anti-inflammatoires. Ainsi, l’activation de l’endothĂ©lium vasculaire induit-elle le recrutement et l’activation des cellules effectrices appartenant aux compartiments innĂ©s et adaptatifs du systĂšme immunitaire. Au cours de ma thĂšse, je me suis concentrĂ© sur le rĂŽle des saignements dans le dĂ©veloppement de la rĂ©ponse immunitaire dirigĂ©e contre le FVIII. Ainsi, ai-je dĂ©couvert une association entre la prĂ©sence d’un polymorphisme dans un gĂšne induit par les saignements et la prĂ©sence d’inhibiteurs du FVIII dans une cohorte de patients hĂ©mophiles A sĂ©vĂšres. J’ai Ă©galement Ă©tudiĂ© le dĂ©veloppement de la rĂ©ponse immunitaire dirigĂ©e contre le FVIII thĂ©rapeutique dans un modĂšle murin qui mime les saignements locaux observĂ©s chez les patients hĂ©mophiles A sĂ©vĂšres. Finalement, j’ai caractĂ©risĂ© l’effet des formes rĂ©actives de l’oxygĂšne (FRO), qui sont gĂ©nĂ©rĂ©es au niveau du site de saignement, sur la structure, la fonction et l’immunogĂ©nicitĂ© du FVIII. Les rĂ©sultats obtenus au cours de ma thĂšse dĂ©montrent que les saignements ne sont pas associĂ©s Ă  un risque plus Ă©levĂ© de dĂ©velopper des inhibiteurs dans le modĂšle murin largement utilisĂ© d’hĂ©mophilie A sĂ©vĂšre, contrairement Ă  ce qui est communĂ©ment admis. De plus, j’ai dĂ©montrĂ© une association entre un polymorphisme prĂ©sent dans le promoteur du gĂšne HMOX1 et la survenue d’inhibiteurs dans une cohorte de patients atteints d’hĂ©mophilie A sĂ©vĂšre. En parallĂšle, je dĂ©cris pour la premiĂšre fois une altĂ©ration du statut oxydatif chez les souris dĂ©ficientes en FVIII et je dĂ©montre que le contrĂŽle du statut oxydatif in vivo permet de moduler la rĂ©ponse immunitaire anti-FVIII. Au contraire, l’exposition du FVIII aux FRO augmente son immunogĂ©nicitĂ©. De fait, mes rĂ©sultats suggĂšrent que, bien que les molĂ©cules pro-inflammatoires libĂ©rĂ©es suite aux saignements puissent affecter positivement la rĂ©ponse immunitaire dirigĂ©e contre le FVIII, de puissants mĂ©diateurs anti-inflammatoires sont gĂ©nĂ©rĂ©s in vivo et amenuisent l’effet potentiellement adjuvant des saignements. Également, ces rĂ©sultats soulignent la balance complexe entre les mĂ©diateurs pro- et anti-inflammatoires qui sont gĂ©nĂ©rĂ©s consĂ©cutivement aux saignements ainsi que leurs effets sur la rĂ©ponse immunitaire dirigĂ©e contre le FVIII thĂ©rapeutique.Hemophilia A is a rare X-linked hemorrhagic disease consecutive to the lack of functional pro-coagulant factor VIII (FVIII). In patients with the severe form of hemophilia A, uncontrolled hemorrhages increase the morbidity and affect the quality of life. To prevent or treat bleeding episodes, therapeutic FVIII is administered intravenously. However, an anti-FVIII immune response develops in 5 to 30% of the patients. The anti-FVIII immune response is characterized by the development of anti-FVIII IgG antibodies that inhibit FVIII activity. These antibodies, referred to as “FVIII inhibitors” represent the major complication in the treatment of hemophilia A patients. Several risk factors have been suggested or proposed to predispose to the development of FVIII inhibitors. Amongst them, inspired by the “danger” theory, the presence of inflammatory mediators released upon bleeding episodes is thought to adjuvant the anti-FVIII immune response. Bleeding episodes trigger several pro and anti-inflammatory mechanisms. Thus, damage to the endothelium triggers the recruitment and activation of effector cells from the innate and adaptive compartments of the immune system. During my PhD, I investigated the role of bleedings in the development of the anti-FVIII immune response. Thus, I discovered an association between a polymorphism in the promoter region of a gene that is induced in response to bleedings, and the presence of FVIII inhibitors in a cohort of patients with severe hemophilia A. I followed the development of the immune response to therapeutic FVIII in a mouse model that mimics the localized bleedings found in patients with severe hemophilia A. Ultimately, I characterized the effects of reactive oxygen species (ROS) that are potentially released at the bleeding site in view of the structure, function and immunogenicity of the FVIII molecule. The results I obtained during my PhD demonstrate that bleedings are not associated with a higher risk for FVIII inhibitor development in the commonly used mouse model of severe FVIII deficiency. Additionally, I demonstrated an association between a polymorphism in the promoter of the HMOX1 gene and the presence of FVIII inhibitors. In parallel, I report for the first time an exacerbated oxidative status in FVIII-deficient mice as compared to control mice, and demonstrate that the control of the oxidative status in vivo reduces the anti-FVIII immune response. Conversely, the exposure of FVIII to ROS ex vivo increases the immunogenicity of the FVIII molecule. Taken together, my results suggest that, although the pro-inflammatory molecules released upon bleeding may positively affect the anti-FVIII immune response, several strong anti-inflammatory compounds are generated in vivo that dampen the potential adjuvant effect of bleedings. Ultimately, these results highlight the complex balance between the pro and anti-inflammatory mediators generated upon bleeding and their effect on the anti-FVIII immune response

    RÎle de l'environnement inflammatoire dans l'immunogénicité du facteur VIII thérapeutique chez les patients hémophiles A

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    Hemophilia A is a rare X-linked hemorrhagic disease consecutive to the lack of functional pro-coagulant factor VIII (FVIII). In patients with the severe form of hemophilia A, uncontrolled hemorrhages increase the morbidity and affect the quality of life. To prevent or treat bleeding episodes, therapeutic FVIII is administered intravenously. However, an anti-FVIII immune response develops in 5 to 30% of the patients. The anti-FVIII immune response is characterized by the development of anti-FVIII IgG antibodies that inhibit FVIII activity. These antibodies, referred to as “FVIII inhibitors” represent the major complication in the treatment of hemophilia A patients. Several risk factors have been suggested or proposed to predispose to the development of FVIII inhibitors. Amongst them, inspired by the “danger” theory, the presence of inflammatory mediators released upon bleeding episodes is thought to adjuvant the anti-FVIII immune response. Bleeding episodes trigger several pro and anti-inflammatory mechanisms. Thus, damage to the endothelium triggers the recruitment and activation of effector cells from the innate and adaptive compartments of the immune system. During my PhD, I investigated the role of bleedings in the development of the anti-FVIII immune response. Thus, I discovered an association between a polymorphism in the promoter region of a gene that is induced in response to bleedings, and the presence of FVIII inhibitors in a cohort of patients with severe hemophilia A. I followed the development of the immune response to therapeutic FVIII in a mouse model that mimics the localized bleedings found in patients with severe hemophilia A. Ultimately, I characterized the effects of reactive oxygen species (ROS) that are potentially released at the bleeding site in view of the structure, function and immunogenicity of the FVIII molecule. The results I obtained during my PhD demonstrate that bleedings are not associated with a higher risk for FVIII inhibitor development in the commonly used mouse model of severe FVIII deficiency. Additionally, I demonstrated an association between a polymorphism in the promoter of the HMOX1 gene and the presence of FVIII inhibitors. In parallel, I report for the first time an exacerbated oxidative status in FVIII-deficient mice as compared to control mice, and demonstrate that the control of the oxidative status in vivo reduces the anti-FVIII immune response. Conversely, the exposure of FVIII to ROS ex vivo increases the immunogenicity of the FVIII molecule. Taken together, my results suggest that, although the pro-inflammatory molecules released upon bleeding may positively affect the anti-FVIII immune response, several strong anti-inflammatory compounds are generated in vivo that dampen the potential adjuvant effect of bleedings. Ultimately, these results highlight the complex balance between the pro and anti-inflammatory mediators generated upon bleeding and their effect on the anti-FVIII immune response.L’hĂ©mophilie A est une maladie hĂ©morragique rare liĂ©e au chromosome X qui se traduit par un dĂ©ficit en facteur VIII (FVIII) fonctionnel. Chez les patients atteints de la forme sĂ©vĂšre de l’hĂ©mophilie A, l’apparition d’hĂ©morragies incontrĂŽlĂ©es augmente la morbiditĂ© et affecte leur qualitĂ© de vie. Le traitement de choix permettant de prĂ©venir ou de traiter les saignements consiste en l’injection intraveineuse de FVIII thĂ©rapeutique. Cependant, chez 5 Ă  30% des patients, une rĂ©ponse immunitaire dirigĂ©e contre le FVIII se dĂ©veloppe. La rĂ©ponse anti-FVIII est caractĂ©risĂ©e par l’apparition d’anticorps qui inhibent l’activitĂ© pro-coagulante du FVIII. Ainsi l’apparition de ces anticorps, appelĂ©s « inhibiteurs » reprĂ©sente-t-elle la complication majeure du traitement des patients hĂ©mophiles A. Plusieurs facteurs de risque ont Ă©tĂ© suggĂ©rĂ©s ou proposĂ©s comme affectant le dĂ©veloppement de la rĂ©ponse anti-FVIII. Parmi eux, supportĂ© par la thĂ©orie du « danger », la prĂ©sence de mĂ©diateurs pro-inflammatoires gĂ©nĂ©rĂ©s par les Ă©pisodes de saignement est considĂ©rĂ©e comme adjuvant dans la rĂ©ponse immunitaire anti-FVIII. Cependant, les saignements induisent de nombreux mĂ©canismes pro mais aussi anti-inflammatoires. Ainsi, l’activation de l’endothĂ©lium vasculaire induit-elle le recrutement et l’activation des cellules effectrices appartenant aux compartiments innĂ©s et adaptatifs du systĂšme immunitaire. Au cours de ma thĂšse, je me suis concentrĂ© sur le rĂŽle des saignements dans le dĂ©veloppement de la rĂ©ponse immunitaire dirigĂ©e contre le FVIII. Ainsi, ai-je dĂ©couvert une association entre la prĂ©sence d’un polymorphisme dans un gĂšne induit par les saignements et la prĂ©sence d’inhibiteurs du FVIII dans une cohorte de patients hĂ©mophiles A sĂ©vĂšres. J’ai Ă©galement Ă©tudiĂ© le dĂ©veloppement de la rĂ©ponse immunitaire dirigĂ©e contre le FVIII thĂ©rapeutique dans un modĂšle murin qui mime les saignements locaux observĂ©s chez les patients hĂ©mophiles A sĂ©vĂšres. Finalement, j’ai caractĂ©risĂ© l’effet des formes rĂ©actives de l’oxygĂšne (FRO), qui sont gĂ©nĂ©rĂ©es au niveau du site de saignement, sur la structure, la fonction et l’immunogĂ©nicitĂ© du FVIII. Les rĂ©sultats obtenus au cours de ma thĂšse dĂ©montrent que les saignements ne sont pas associĂ©s Ă  un risque plus Ă©levĂ© de dĂ©velopper des inhibiteurs dans le modĂšle murin largement utilisĂ© d’hĂ©mophilie A sĂ©vĂšre, contrairement Ă  ce qui est communĂ©ment admis. De plus, j’ai dĂ©montrĂ© une association entre un polymorphisme prĂ©sent dans le promoteur du gĂšne HMOX1 et la survenue d’inhibiteurs dans une cohorte de patients atteints d’hĂ©mophilie A sĂ©vĂšre. En parallĂšle, je dĂ©cris pour la premiĂšre fois une altĂ©ration du statut oxydatif chez les souris dĂ©ficientes en FVIII et je dĂ©montre que le contrĂŽle du statut oxydatif in vivo permet de moduler la rĂ©ponse immunitaire anti-FVIII. Au contraire, l’exposition du FVIII aux FRO augmente son immunogĂ©nicitĂ©. De fait, mes rĂ©sultats suggĂšrent que, bien que les molĂ©cules pro-inflammatoires libĂ©rĂ©es suite aux saignements puissent affecter positivement la rĂ©ponse immunitaire dirigĂ©e contre le FVIII, de puissants mĂ©diateurs anti-inflammatoires sont gĂ©nĂ©rĂ©s in vivo et amenuisent l’effet potentiellement adjuvant des saignements. Également, ces rĂ©sultats soulignent la balance complexe entre les mĂ©diateurs pro- et anti-inflammatoires qui sont gĂ©nĂ©rĂ©s consĂ©cutivement aux saignements ainsi que leurs effets sur la rĂ©ponse immunitaire dirigĂ©e contre le FVIII thĂ©rapeutique

    Hunting down factor VIII in the immunopeptidome

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    Major histocompatibility complex class II (MHCII)-restricted peptide presentation is crucial for the selection and subsequent proliferation of antigen specific CD4+ T cells. While selection of antigen-specific CD4+ T cells is beneficial in the context of vaccination, emergence of antigen CD4+ T cells following administration of therapeutic proteins like factor VIII (FVIII) is not desirable. The mechanism of uptake, processing and presentation of FVIII by antigen-presenting cells (APCs) has been the subject of intense study over the past 10 years. Multiple receptors have been implicated in the uptake of FVIII by APCs. A crucial determinant directing its entry in APCs resides in the C1 domain of FVIII. Until recently, our knowledge on the repertoire of FVIII derived presented on MHCII was limited. Peptide sequences on FVIII recognized by CD4+ T cells have been identified using MHCII tetramers as well as by directly monitoring peptide-induced proliferation of CD4+ T cells. More recently, the repertoire of naturally presented peptides derived from FVIII has been identified by pulsing of immature dendritic cells with FVIII. In a complementary approach HLA-DRB1(∗)15 transgenic mice were used to identify HLA-DRB1(∗)15 restricted CD4+ T cells reactive towards human FVIII. In this review we summarize our current knowledge on FVIII derived peptides that are presented on MHCII and discuss the relevance of these findings for the etiology of inhibitor development in patients with hemophilia

    The C1 and C2 domains of blood coagulation factor VIII mediate its endocytosis by dendritic cells

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    The development of inhibitory antibodies to therapeutic factor VIII is the major complication of replacement therapy in patients with hemophilia A. The first step in the initiation of the anti-factor VIII immune response is factor VIII interaction with receptor(s) on antigen-presenting cells, followed by endocytosis and presentation to naĂŻve CD4(+) T cells. Recent studies indicate a role for the C1 domain in factor VIII uptake. We investigated whether charged residues in the C2 domain participate in immunogenic factor VIII uptake. Co-incubation of factor VIII with BO2C11, a monoclonal C2-specific immunoglobulin G, reduced factor VIII endocytosis by dendritic cells and presentation to CD4(+) T cells, and diminished factor VIII immunogenicity in factor VIII-deficient mice. The mutation of basic residues within the BO2C11 epitope of C2 replicated reduced in vitro immunogenic uptake, but failed to prevent factor VIII immunogenicity in mice. BO2C11 prevents factor VIII binding to von Willebrand factor, thus potentially biasing factor VIII immunogenicity by perturbing its half-life. Interestingly, a factor VIII(Y1680C) mutant, that does not bind von Willebrand factor, demonstrated unaltered endocytosis by dendritic cells as well as immunogenicity in factor VIII-deficient mice. Co-incubation of factor VIII(Y1680C) with BO2C11, however, resulted in decreased factor VIII immunogenicity in vivo. In addition, a previously described triple C1 mutant showed decreased uptake in vitro, and reduced immunogenicity in vivo, but only in the absence of endogenous von Willebrand factor. Taken together, the results indicate that residues in the C1 and/or C2 domains of factor VIII are implicated in immunogenic factor VIII uptake, at least in vitro. Conversely, in vivo, the binding to endogenous von Willebrand factor masks the reducing effect of mutations in the C domains on factor VIII immunogenicity

    To serve and protect: The modulatory role of von Willebrand factor on factor VIII immunogenicity

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    Hemophilia A is a bleeding disorder characterized by the absence or dysfunction of blood coagulation factor VIII (FVIII). Patients are treated with regular infusions of FVIII concentrate. In response to treatment, approximately 30% of patients with severe hemophilia A develop inhibitory antibodies targeting FVIII. Both patient and treatment related risk factors for inhibitor development have been described. Multiple studies comparing the immunogenicity of recombinant and plasma-derived FVIII have yielded conflicting results. The randomized controlled SIPPET (Survey of Inhibitors in Plasma-Product Exposed Toddlers) trial demonstrated an increased risk of inhibitor development of recombinant FVIII when compared to von Willebrand factor (VWF)-containing plasma-derived FVIII. Presently, it is unclear which mechanism underlies the reduced immunogenicity of plasma-derived FVIII. In this review we address the potential role of VWF on FVIII immunogenicity and we discuss how VWF affects the immune recognition, processing and presentation of FVIII. We also briefly discuss the potential impact of glycan-composition on FVIII immunogenicity. It is well established that VWF shields the uptake of FVIII by antigen presenting cells. We have recently shown that VWF binds to the surface of dendritic cells. Here, we present a novel model in which surface bound FVIII-VWF complexes regulate the internalization of FVIII. Binding of FVIII to VWF is critically dependent on sulfation of Tyr1699 (HVGS numbering) in the light chain of FVIII. Incomplete sulfation of Tyr1699 has been suggested to occur in several recombinant FVIII products resulting in a loss of VWF binding. We hypothesize that this results in alternative pathways of FVIII internalization by antigen presenting cells which are not regulated by VWF. This hypothetical mechanism may explain the reduced immunogenicity of VWF containing plasma-derived FVIII concentrates as found in the SIPPET stud
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