Background
Factor VIII (FVIII) pharmacokinetics (PK) in adult hemophilia A populations are highly variable and have been previously determined to be influenced by von Willebrand factor:antigen (VWF:Ag), ABO blood group, and age. However, additional genetic determinants of FVIII PK are largely unknown.
Objectives
The contribution of VWF clearance, VWFâFVIIIâbinding activity, and genetic variants in VWF clearance receptors to FVIII PK in adult patients were assessed.
Methods
FVIII PK assessment was performed in 44 adult subjects (age 18â61 years) with moderate or severe hemophilia A. VWF:Ag, VWF propeptide (VWFpp), VWFpp/VWF:Ag, and VWF:FVIII binding activity were measured. The VWF modifying loci CLEC4M, SCARA5, STAB2, and ABO, and the DâČD3 FVIIIâbinding region of the VWF gene were genotyped.
Results
VWF:Ag, VWFpp, and VWF:FVIIIB positively correlated with FVIII halfâlife and negatively correlated with FVIII clearance. VWFpp/VWF:Ag negatively correlated with FVIII halfâlife and positively correlated with FVIII clearance. The correlation between VWFpp/VWF:Ag and FVIII halfâlife was stronger for type nonâO patients than for type O patients, suggesting that slower VWF clearance increases FVIII halfâlife. Patients heterozygous for the CLEC4M rs868875 variant had increased FVIII clearance when compared with individuals homozygous for the reference allele. The CLEC4M variable number of tandem repeat (VNTR) alleles were also associated with the rate of FVIII clearance. When compared with the quartile of patients with the fastest FVIII clearance, the quartile of patients with the slowest FVIII clearance had a decreased frequency of the CLEC4M 5âVNTR.
Conclusions
VWFâFVIII binding activity and genetic determinants of VWF clearance are important contributors to FVIII pharmacokinetics in adult patients.