Background: Antibody KM33 blocks factor VIII (FVIII) endocytosis and phospholipid binding. Results: Hydrogen-deuterium exchange mass spectrometry reveals that KM33 binds C1 domain spikes 2092-2093 and 2158 -2159. Glycosylated FVIII-R2159N shows reduced endocytosis and decreased binding to phospholipid membranes with low phosphatidylserine content. Conclusion: Spikes 2092-2093 and 2158 -2159 modulate FVIII endocytosis and phospholipid binding. Significance: Novel insight is obtained about the role of the C1 domain for FVIII biology.
The C1 domain of factor VIII (FVIII) has been implicated in binding to multiple constituents, including phospholipids, vonWillebrand factor, and low-density lipoprotein receptor-related protein (LRP). We have previously described a human monoclonal antibody called KM33 that blocks these interactions as well as cellular uptake by LRP-expressing cells. To unambiguously identify the apparent "hot spot" on FVIII to which this antibody binds, we have employed hydrogen-deuterium exchange mass spectrometry. The results showed that KM33 protects FVIII regions 2091-2104 and 2157-2162 from hydrogen-deuterium exchange. These comprise the two C1 domain spikes 2092-2093 and 2158 -2159. Spike 2092-2093 has been demonstrated recently to contribute to assembly with lipid membranes with low phosphatidylserine (PS) content. Therefore, spike 2158 -2159 might serve a similar role. This was assessed by replacement of Arg-2159 for Asn, which introduces a motif for N-linked glycosylation. Binding studies revealed that the purified, glycosylated R2159N variant had lost its interaction with antibody KM33 but retained substantial binding to von Willebrand factor and LRP. Cellular uptake of the R2159N variant was reduced both by LRP-expressing U87-MG cells and by human monocytederived dendritic cells. FVIII activity was virtually normal on membranes containing 15% PS but reduced at low PS content. These findings suggest that the C1 domain spikes 2092-2093 and 2158 -2159 together modulate FVIII membrane assembly by a subtle, PS-dependent mechanism. These findings contribute evidence in favor of an increasingly important role of the C1 domain in FVIII biology.Activated coagulation factor VIII (FVIIIa) is a cofactor that assembles with activated factor IX (FIXa) 3 on lipid membranes that expose phosphatidylserine (PS) in the outer leaflet (1). This complex effectively generates activated factor X, ultimately leading to blood clot formation at sites of vascular injury. Current treatment of hemophilia A patients, who lack functional factor VIII (FVIII), involves intravenous infusion with either recombinant or plasma-derived FVIII (2). This treatment is, however, limited by the particularly effective clearance of FVIII from the circulation. Moreover, about 20% of patients develop antibodies against FVIII (3). The molecular determinants that drive the assembly of FVIII with membranes, including those of cells involved in clearance and immune response, remain incompletely understood.FVIII is a multidomain protein that ...