Development of neutralizing
IntroductionOver the past decades protein therapeutics such as hormones, enzymes, blood coagulation factors, or Abs have provided effective treatment for numerous diseases. 1 Treatment commonly requires frequent high-dose administration of protein therapeutics and, although generally considered safe, they often induce immune responses. 2 The factors that underlie immunogenicity of biomedical products can be related to the structure of protein, such as the presence of promiscuous T-cell epitopes 3 or posttranslational modifications, 4 but also to the formulation of the biomolecule. 5 Treatment-related parameters such as dosage, frequency, route of administration, and concomitant infections may also contribute to the induction of antidrug immune responses. 2 In patients with protein deficiencies administered therapeutics may be recognized by the immune system as non-self, thereby greatly increasing the risk of Ab development. 2 Hemophilia A is an X-linked bleeding disorder that is caused by a deficiency in blood coagulation factor VIII (FVIII). Conventional treatment comprising frequent administration of FVIII often results in formation of neutralizing Abs, which inhibit FVIII activity. 6,7 Both treatment-related factors, such as intensive treatment episodes, 8 and genetic risk factors can contribute to the development of inhibitors. Polymorphic sites in genes involved in the adaptive immune response have been associated with anti-FVIII Ab formation. 9-11 Development of high-affinity IgG Abs directed against FVIII is a CD4 ϩ T cell-dependent process. 12,13 Endocytosis of FVIII by professional APCs comprises the initial step leading to activation of helper T cells. Uptake and transfer of Ags through the lyso-endosomal pathway results in intracellular processing and presentation of FVIII-derived peptides on MHC II molecules to CD4 ϩ helper T cells. 14 Here, we hypothesized that prevention of FVIII uptake by APCs will lead to diminished T-and B-cell responses. Previously, we have shown that endocytosis of FVIII by APCs is mediated via its C1 domain, because administration of a mAb directed toward an antigenic surface in the C1 domain reduced inhibitor titers in FVIII-deficient mice. 15 With the use of an Ab-guided mutagenesis strategy we designed a C1 domain variant of FVIII which displayed a strongly reduced internalization by APCs. In vivo studies revealed that this C1 domain variant showed decreased immunogenicity in a murine model for inhibitor development in hemophilia A. Our findings provide a novel paradigm for the reduction of the intrinsic immunogenicity of FVIII by modulating its uptake by APCs.
Methods MaterialsFicoll-Paque Plus (GE Healthcare), CD14 microbeads (Miltenyi Biotech), and human recombinant GM-CSF and IL-4 (both Cellgenix Technology Transfer) were used for generation of human monocyte-derived dendritic cells (MDDCs); M-CSF (PeproTech) was used to generate human monocytederived macrophages (MDM⌽s). For culturing murine BM-derived DCs (BMDCs), mouse recombinant GM-CSF ...