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Mechanism and Kinetics of Factor VIII Inactivation: Study With an
IgG4 Monoclonal Antibody Derived From a Hemophilia A Patient With
Inhibitor
Marc G. Jacquemin,
Benoît G. Desqueper,
Abdellah Benhida,
Luc Vander Elst,
Marc F. Hoylaerts,
Marleen Bakkus,
Kris Thielemans,
Jef Arnout,
Kathelijne Peerlinck,
Jean Guy G. Gilles,
Jos Vermylen, and
Jean-Marie R. Saint-Remy
From the Center for Molecular and Vascular Biology, Katholieke
Universiteit Leuven, Leuven, Belgium; and the Department of
Hematology-Immunology, Vrije Universiteit Brussels, Brussels, Belgium.
The development of an immune response towards factor VIII (fVIII)
remains a major complication for hemophilia A patients receiving fVIII
infusions. The design of a specific therapy to restore unresponsiveness to fVIII has been hampered by the diversity of the anti-fVIII antibody.
Molecular analysis of the specific immune response is therefore
required. To this end, we have characterized an fVIII-specific human
IgG4 monoclonal antibody (BO2C11) produced by a cell line derived
from the memory B-cell repertoire of a hemophilia A patient with
inhibitor. BO2C11 recognizes the C2 domain of fVIII and inhibits its
binding to both von Willebrand factor (vWF) and phospholipids. It
completely inhibits the procoagulant activity of native and activated
fVIII, with a specific activity of approximately 7,000 Bethesda
units/mg. vWF reduces the rate of fVIII inactivation by BO2C11. The
antibody-fVIII association rate constant
(kass ~7.4 × 105
M 1 s 1) is eightfold lower than that
for vWF-fVIII association, whereas its dissociation rate constant
(kdiss 1 × 10 5
s 1) is 100-fold lower than that for the vWF-fVIII
complex, which suggests that BO2C11 almost irreversibly neutralizes
fVIII after its dissociation from vWF. BO2C11 is the first human
monoclonal anti-fVIII IgG antibody that has been isolated and allows
the study of fVIII inactivation at the molecular level.
Blood, Vol. 92 No. 2 (July 15), 1998:
pp. 496-506
© 1998 by the American Society of Hematology.

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