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Blood, 1 July 2001, Vol. 98, No. 1, pp. 13-19
PLENARY PAPER
Structure of a factor VIII C2
domain-immunoglobulin G4 Fab complex: identification
of an inhibitory antibody epitope on the surface of factor
VIII
Paul Clint Spiegel Jr,
Marc Jacquemin,
Jean-Marie R. Saint-Remy,
Barry L. Stoddard, and
Kathleen P. Pratt
From the Graduate Program in Biomolecular Structure and
Design, University of Washington, and Division of Basic Sciences, Fred
Hutchinson Cancer Research Center, Seattle, WA; and Center for
Molecular and Vascular Biology, Katholieke Universiteit Leuven, Campus
Gasthuisberg, Leuven, Belgium.
The development of an immune response to infused factor VIII is a
complication affecting many patients with hemophilia A. Inhibitor
antibodies bind to antigenic determinants on the factor VIII molecule
and block its procoagulant activity. A patient-derived inhibitory
immunoglobulin G4 antibody (BO2C11) produced by an immortalized
memory B-lymphocyte cell line interferes with the binding of factor
VIII to phospholipid surfaces and to von Willebrand factor. The
structure of a Fab fragment derived from this antibody complexed with
the factor VIII C2 domain was determined at 2.0 Å resolution. The Fab
interacts with solvent-exposed basic and hydrophobic side chains that
form a membrane-association surface of factor VIII. This atomic
resolution structure suggests a variety of amino acid
substitutions in the C2 domain of factor VIII that might prevent the
binding of anti-C2 inhibitor antibodies without significantly
compromising the procoagulant functions of factor VIII.

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