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Li Z, Chen Z, Cheng X, Wu X, Li G, Zhen Y, Poon MC, Wu R. A previously treated severe haemophilia A patient developed high-titre inhibitor after vaccinations. Int J Immunopathol Pharmacol 2021; 34:2058738420934618. [PMID: 32627611 PMCID: PMC7338642 DOI: 10.1177/2058738420934618] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
The factor VIII (FVIII)-neutralizing antibody (inhibitor) seen in 25%–30% of
patients with severe haemophilia A (SHA). Vaccination is a non-genetic risk
factor of inhibitor development as ‘danger signal’ which may provide a
pro-inflammatory microenvironment to increase FVIII immunogenicity. We reported
a previously treated SHA patient postponed the first vaccination to 15-month age
received diphtheria-pertussis-tetanus intramuscularly. At 18-month age, the
patient received Hepatitis A intramuscularly and Varicella Zoster Virus
subcutaneously with 2 weeks interval and FVIII infusion was given <24 h prior
for each. Successive bleedings occurred 1 week later with inefficacy of FVIII
replacement. High-titre inhibitor was tested at 117 exposure days. This case
suggested that continuous vaccinations in close proximity to FVIII could induce
inhibitor. The relationship between vaccination and FVIII immunogenicity still
needs to be revealed by further study.
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Affiliation(s)
- Zekun Li
- Hemophilia Work Group, Hematology Oncology Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Zhenping Chen
- Hemophilia Work Group, Hematology Oncology Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Xiaoling Cheng
- Hemophilia Work Group, Hematology Oncology Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Xinyi Wu
- Hemophilia Work Group, Hematology Oncology Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Gang Li
- Hemophilia Work Group, Hematology Oncology Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Yingzi Zhen
- Hemophilia Work Group, Hematology Oncology Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Man-Chiu Poon
- Departments of Medicine, Pediatrics and Oncology, University of Calgary, Cumming School of Medicine, and Southern Alberta Rare Blood and Bleeding Disorders Comprehensive Care program, Foothills Hospital, Alberta Health Services, Calgary, AB, Canada
| | - Runhui Wu
- Hemophilia Work Group, Hematology Oncology Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
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Peyron I, Dimitrov JD, Delignat S, Gangadharan B, Srivastava A, Kaveri SV, Lacroix-Desmazes S. Oxidation of factor VIII increases its immunogenicity in mice with severe hemophilia A. Cell Immunol 2018; 325:64-68. [PMID: 29395036 DOI: 10.1016/j.cellimm.2018.01.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 12/30/2017] [Accepted: 01/13/2018] [Indexed: 02/04/2023]
Abstract
The development of antibodies against therapeutic factor VIII (FVIII) represents the major complication of replacement therapy in patients with severe hemophilia A. Amongst the environmental risk factors that influence the anti-FVIII immune response, the presence of active bleeding or hemarthrosis has been evoked. Endothelium damage is typically associated with the release of oxidative compounds. Here, we addressed whether oxidation contributes to FVIII immunogenicity. The control with N-acetyl cysteine of the oxidative status in FVIII-deficient mice, a model of severe hemophilia A, reduced the immune response to exogenous FVIII. Ex vivo exposure of therapeutic FVIII to HOCl induced a mild oxidation of the molecule as evidenced by the loss of free amines and resulted in increased FVIII immunogenicity in vivo when compared to native FVIII. The increased immunogenicity of oxidized FVIII was not reverted by treatment of mice with N-acetyl cysteine, and did not implicate an increased maturation of professional antigen-presenting cells. Our data document that oxidation influences the immunogenicity of therapeutic FVIII.
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Affiliation(s)
- Ivan Peyron
- INSERM, UMR S 1138, Centre de recherche des Cordeliers, Paris F-75006, France; Université Pierre et Marie Curie-Paris6, UMR S 1138, Centre de recherche des Cordeliers, Paris F-75006, France; Université Paris Descartes, UMR S 1138, Centre de recherche des Cordeliers, Paris F-75006, France
| | - Jordan D Dimitrov
- INSERM, UMR S 1138, Centre de recherche des Cordeliers, Paris F-75006, France; Université Pierre et Marie Curie-Paris6, UMR S 1138, Centre de recherche des Cordeliers, Paris F-75006, France; Université Paris Descartes, UMR S 1138, Centre de recherche des Cordeliers, Paris F-75006, France
| | - Sandrine Delignat
- INSERM, UMR S 1138, Centre de recherche des Cordeliers, Paris F-75006, France; Université Pierre et Marie Curie-Paris6, UMR S 1138, Centre de recherche des Cordeliers, Paris F-75006, France; Université Paris Descartes, UMR S 1138, Centre de recherche des Cordeliers, Paris F-75006, France
| | - Bagirath Gangadharan
- INSERM, UMR S 1138, Centre de recherche des Cordeliers, Paris F-75006, France; Université Pierre et Marie Curie-Paris6, UMR S 1138, Centre de recherche des Cordeliers, Paris F-75006, France; Université Paris Descartes, UMR S 1138, Centre de recherche des Cordeliers, Paris F-75006, France
| | - Alok Srivastava
- Department of Haematology, Christian Medical College, Vellore, India
| | - Srinivas V Kaveri
- INSERM, UMR S 1138, Centre de recherche des Cordeliers, Paris F-75006, France; Université Pierre et Marie Curie-Paris6, UMR S 1138, Centre de recherche des Cordeliers, Paris F-75006, France; Université Paris Descartes, UMR S 1138, Centre de recherche des Cordeliers, Paris F-75006, France
| | - Sébastien Lacroix-Desmazes
- INSERM, UMR S 1138, Centre de recherche des Cordeliers, Paris F-75006, France; Université Pierre et Marie Curie-Paris6, UMR S 1138, Centre de recherche des Cordeliers, Paris F-75006, France; Université Paris Descartes, UMR S 1138, Centre de recherche des Cordeliers, Paris F-75006, France.
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