Semin Thromb Hemost 2002; 28(3): 291-296
DOI: 10.1055/s-2002-32665
Copyright © 2002 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Tel.: +1(212) 584-4662

New Characteristics of Anti-Factor VIII Inhibitor Antibody Epitopes and Unusual Immune Responses to Factor VIII

Dorothea Scandella
  • Holland Laboratory, American Red Cross, Rockville, Maryland
Further Information

Publication History

Publication Date:
04 July 2002 (online)

ABSTRACT

Treatment of individuals with severe hemophilia A by plasma-derived or recombinant factor VIII leads to the production of anti-factor VIII antibodies in approximately 30% of such patients. Because some of these antibodies inactivate factor VIII, they are considered a major factor in preventing optimal therapeutic treatment. Factor VIII is a cofactor that must bind to factors IX and X and phospholipids in order for normal blood coagulation to occur. The inhibition of factor VIII activity is due to binding by anti- factor VIII antibodies in the patient plasma to the same sites required for factors IX and X and phospholipid binding. Previously, inhibitor epitopes were localized to the A2, A3, and C2 domains and to a region of acidic amino acids between the A1 and A2 domains. Inhibitor binding to these domains prevented factor VIII binding to factor IXa (A2, A3), factor Xa (C2), and phospholipids (C2), and binding to the acidic region interfered with factor X binding. Antibody binding to a minor C2 domain epitope slowed activated factor VIII release from von Willebrand factor (vWF) and interfered with factor Xa binding to factor VIII.

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