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Prepublished online as a Blood First Edition Paper on September 11, 2003; DOI 10.1182/blood-2003-04-1321.

Submitted April 30, 2003
Accepted August 27, 2003
Deletion of Alanine 2201 in the FVIII C2 domain results in mild hemophilia A by impairing FVIII binding to vWF and phospholipids and destroys a major FVIII antigenic determinant involved in inhibitor development
Roseline d'Oiron, Jean-Maurice Lavergne, Renaud Lavend'homme, Abdellah Benhida, Jean-Claude Bordet, Claude Negrier, Kathelijne Peerlinck, Jos Vermylen, Jean-Marie Saint-Remy, and Marc Jacquemin*
Center for Molecular and Vascular Biology, University of Leuven, Leuven, Belgium
Hopital de Bicetre, le Kremlin-Bicetre, France
Faculte de Medecine RTH Laennec, INSERM, Unite 331, Laboratoire d'Hemobiologie, Lyon, France
Hopital de Bicetre, INSERM, Unite 143, le Kremlin-Bicetre, France
* Corresponding author; email: marc.jacquemin{at}med.kuleuven.ac.be.
The C2 domain of Factor VIII (FVIII) mediates FVIII binding to vWF and phospholipids (PL), thereby determining the stability and the activity of FVIII. A deletion of Ala2201 (Del2201) was identified in the FVIII C2 domain of two unrelated patients with mild hemophilia A (FVIII:C 11-33%). This mutation prevents FVIII binding to a human monoclonal antibody recognizing the C2 domain and inhibiting FVIII binding to vWF and phospholipids. By comparison to normal FVIII, Del2201FVIII had a significantly reduced binding to vWF, which likely contributes to reduced FVIII levels in plasma. Del2201FVIII interaction with phospholipids was evaluated in a FXa generation assay, using various concentrations of synthetic phospholipid vesicles mimicking an activated platelet surface. At the lowest phospholipid concentration allowing FXa generation, Del2201 FVIII activity was reduced 3-fold. This is the first report of a mutation altering FVIII binding to phospholipids and occurring in patients with hemophilia A.

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