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Abdi A, Bordbar MR, Hassan S, Rosendaal FR, van der Bom JG, Voorberg J, Fijnvandraat K, Gouw SC. Prevalence and Incidence of Non-neutralizing Antibodies in Congenital Hemophilia A- A Systematic Review and Meta-Analysis. Front Immunol 2020; 11:563. [PMID: 32457734 PMCID: PMC7221178 DOI: 10.3389/fimmu.2020.00563] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 03/12/2020] [Indexed: 12/21/2022] Open
Abstract
Objectives: In hemophilia A the presence of non-neutralizing antibodies (NNAs) against Factor VIII (FVIII) may predict the development of neutralizing antibodies (inhibitors) and accelerate the clearance of administrated FVIII concentrates. This systematic review aimed to assess: (1) the prevalence and incidence of NNAs in patients with congenital hemophilia without inhibitors and (2) the association between NNAs and patient and treatment characteristics. Methods: We conducted a search in MEDLINE, Embase, Web of Science and the Cochrane database. We included cross-sectional and longitudinal studies reporting on NNAs in patients with hemophilia A and B, who were inhibitor-negative at the start of the observation period. Data were extracted on: hemophilia type and severity, patient and treatment characteristics, NNA prevalence and incidence, NNA assays and inhibitor development. Two independent reviewers performed study selection, data extraction and risk of bias assessment, using adapted criteria of the Joanna Briggs Institute. Studies were classified as high-quality when ≥5/9 criteria were met. NNA assays were classified as high-quality when both quality criteria were met: (1) use of positive controls and (2) competition with FVIII to establish FVIII-specificity. We reported NNA prevalence and incidence for each study. The pooled NNA prevalence was assessed for well-designed studies in previously treated patients, employing high-quality NNA assays. Results: We included data from 2,723 inhibitor-negative patients with hemophilia A, derived from 28 studies. Most studies were cross-sectional (19/28) and none reported on NNAs in hemophilia B. Study design was of high quality in 16/28 studies and the NNA assay quality was high in 9/28 studies. Various NNA assays were used, predominantly ELISA (18/28) with different cut-off values. We found a large variety in NNA prevalence (Range, 0–100%). The pooled NNA prevalence in high-quality studies was 25% (95% CI, 16–38%). The incidence of new NNA development was reported in one study (0.01 NNA per person-exposure day). Conclusion: This systematic review identified studies that were heterogeneous in study design, patient population and NNA assay type, with NNA prevalence ranging from 0 to 100% in inhibitor-negative patients with hemophilia A. The pooled NNA prevalence was 25% in high-quality studies including only previously treated patients and performing high-quality NNA assays.
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Affiliation(s)
- A Abdi
- Department of Pediatric Hematology, Amsterdam UMC, Emma Children's Hospital, University of Amsterdam, Amsterdam, Netherlands
| | - M R Bordbar
- Hematology Research Center, Nemazee Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - S Hassan
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, Netherlands
| | - F R Rosendaal
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, Netherlands
| | - J G van der Bom
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, Netherlands.,Center for Clinical Transfusion Research, Sanquin Research, Leiden, Netherlands
| | - J Voorberg
- Department of Molecular Cellular Hemostasis, Sanquin Research and Landsteiner Laboratory, Amsterdam, Netherlands.,Department of Experimental Vascular Medicine, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - K Fijnvandraat
- Department of Pediatric Hematology, Amsterdam UMC, Emma Children's Hospital, University of Amsterdam, Amsterdam, Netherlands.,Department of Molecular Cellular Hemostasis, Sanquin Research and Landsteiner Laboratory, Amsterdam, Netherlands
| | - S C Gouw
- Department of Pediatric Hematology, Amsterdam UMC, Emma Children's Hospital, University of Amsterdam, Amsterdam, Netherlands.,Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, Netherlands
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Strandberg K, Astermark J. The role of the laboratory in diagnosis and management of inhibitory antibodies in haemophilia. Haemophilia 2018; 24 Suppl 6:9-14. [DOI: 10.1111/hae.13474] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2018] [Indexed: 01/01/2023]
Affiliation(s)
- K. Strandberg
- Department of Clinical Chemistry; Institution of Laboratory Medicine; Malmö Sweden
| | - J. Astermark
- Department for Hematology Oncology and Radiation Physics; Center for Thrombosis and Hemostasis; Skåne University Hospital; Malmö Sweden
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Irigoyen MB, Primiani L, Felippo M, Candela M, de Bracco MME, Galassi NV. IgG subclasses of FVIII inhibitors in an argentine cohort of severe hemophilia A patients: Analysis by flow cytometry. Int J Lab Hematol 2017; 39:569-576. [DOI: 10.1111/ijlh.12696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Accepted: 04/18/2017] [Indexed: 11/28/2022]
Affiliation(s)
- M. B. Irigoyen
- Instituto de Medicina Experimental-Consejo Nacional de Investigaciones Científicas y Técnicas-Academia Nacional de Medicina de Buenos Aires; Buenos Aires Argentina
| | - L. Primiani
- Fundación Argentina de Hemofilia; Buenos Aires Argentina
| | - M. Felippo
- Instituto de Medicina Experimental-Consejo Nacional de Investigaciones Científicas y Técnicas-Academia Nacional de Medicina de Buenos Aires; Buenos Aires Argentina
| | - M. Candela
- Fundación Argentina de Hemofilia; Buenos Aires Argentina
- Instituto de Investigaciones Hematológicas -Academia Nacional de Medicina de Buenos Aires; Buenos Aires Argentina
| | - M. M. E. de Bracco
- Instituto de Medicina Experimental-Consejo Nacional de Investigaciones Científicas y Técnicas-Academia Nacional de Medicina de Buenos Aires; Buenos Aires Argentina
| | - N. V. Galassi
- Instituto de Medicina Experimental-Consejo Nacional de Investigaciones Científicas y Técnicas-Academia Nacional de Medicina de Buenos Aires; Buenos Aires Argentina
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Adcock DM, Mammen J, Nair SC, de Lima Montalvão SA. Quality laboratory issues in bleeding disorders. Haemophilia 2016; 22 Suppl 5:84-9. [DOI: 10.1111/hae.12991] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2016] [Indexed: 12/19/2022]
Affiliation(s)
- D. M. Adcock
- Colorado Coagulation, Laboratory Corporation of America Holdings; Englewood CO USA
| | - J. Mammen
- Department of Transfusion Medicine and Immunohaematology; Christian Medical College; Vellore Tamil Nadu India
| | - S. C. Nair
- Department of Transfusion Medicine and Immunohaematology; Christian Medical College; Vellore Tamil Nadu India
| | - S. A. de Lima Montalvão
- IHTC Hemophilia Unit “Cláudio L. P. Corrêa”; Instituto Nacional de Ciência e Tecnologia do Sangue; Hemocentro Unicamp; University of Campinas; São Paulo Brazil
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Differential expression of immunogenic proteins on virulent Mycobacterium tuberculosis clinical isolates. BIOMED RESEARCH INTERNATIONAL 2014; 2014:741309. [PMID: 25105140 PMCID: PMC4109345 DOI: 10.1155/2014/741309] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Revised: 05/29/2014] [Accepted: 05/31/2014] [Indexed: 11/18/2022]
Abstract
Molecular epidemiology has revealed that Mycobacterium tuberculosis (Mtb), formerly regarded as highly conserved species, displays a considerable degree of genetic variability that can influence the outcome of the disease as well as the innate and adaptive immune response. Recent studies have demonstrated that Mtb families found worldwide today differ in pathology, transmissibility, virulence, and development of immune response. By proteomic approaches seven proteins that were differentially expressed between a local clinical isolate from Latin-American-Mediterranean (LAM) and from Haarlem (H) lineages were identified. In order to analyze the immunogenic ability, recombinant Rv2241, Rv0009, Rv0407, and Rv2624c proteins were produced for testing specific antibody responses. We found that these proteins induced humoral immune responses in patients with drug-sensitive and drug-resistant tuberculosis with substantial cross-reactivity among the four proteins. Moreover, such reactivity was also correlated with anti-Mtb-cell surface IgM, but not with anti-ManLAM, anti-PPD, or anti-Mtb-surface IgG antibodies. Therefore, the present results describe new Mtb antigens with potential application as biomarkers of TB.
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Lewis KB, Hughes RJ, Epstein MS, Josephson NC, Kempton CL, Kessler CM, Key NS, Howard TE, Kruse-Jarres R, Lusher JM, Walsh CE, Watts RG, Ettinger RA, Pratt KP. Phenotypes of allo- and autoimmune antibody responses to FVIII characterized by surface plasmon resonance. PLoS One 2013; 8:e61120. [PMID: 23667433 PMCID: PMC3648518 DOI: 10.1371/journal.pone.0061120] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2012] [Accepted: 03/06/2013] [Indexed: 11/19/2022] Open
Abstract
Evidence of antibody isotype/subtype switching may provide prognostic value regarding the state of immune responses to therapeutic proteins, e.g. anti-factor VIII (FVIII) antibodies that develop in many hemophilia A patients, clinically termed “inhibitors”. A sensitive, high- information-content surface plasmon resonance (SPR) assay has been developed to quantify IgG subtype distributions and the domain specificity of anti-drug antibodies. Plasma samples from 22 subjects with an allo- or auto-immune reaction to FVIII were analyzed. Pre-analytical treatment protocols were developed to minimize non-specific binding and specific matrix interference due to von Willebrand factor-FVIII interactions. The dynamic range for IgG quantification was 0.2–5 µg/ml (∼1–33 nM), allowing characterization of inhibitor-positive samples. Subtype-specific monoclonal antibodies were used to quantify the IgG subtype distribution of FVIII-specific antibodies. Most samples obtained from multiply-infused inhibitor subjects contained IgG4 antibodies. Several distinct phenotypes were assigned based on the IgG subtype distribution: IgG1, IgG4, IgG1 & IgG4, and IgG1, IgG2 & IgG4. An IgG1-only response was found in mild/moderate HA subjects during early FVIII infusions, and analysis of serial samples followed antibody class switching as several subjects’ immune responses developed. Competition studies utilizing a recombinant FVIII-C2 domain indicated 40–80% of FVIII-specific antibodies in most samples were directed against this domain.
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Affiliation(s)
- Kenneth B. Lewis
- Puget Sound Blood Center Research Institute, Seattle, Washington, United States of America
| | - Richard J. Hughes
- Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California, United States of America
| | - Melinda S. Epstein
- Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California, United States of America
| | - Neil C. Josephson
- Puget Sound Blood Center Research Institute, Seattle, Washington, United States of America
- Division of Hematology, University of Washington, Seattle, Washington, United States of America
| | | | | | - Nigel S. Key
- University of North Carolina, Chapel Hill, North Carolina, United States of America
| | - Tom E. Howard
- Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California, United States of America
- Division of Hematology and Oncology, Department of Medicine, David Geffen School of Medicine at UCLA and Department of Pathology and Laboratory Medicine, Keck School of Medicine at USC, Los Angeles, California, United States of America
| | | | - Jeanne M. Lusher
- Wayne State University, Detroit, Michigan, United States of America
| | | | - Raymond G. Watts
- University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Ruth A. Ettinger
- Puget Sound Blood Center Research Institute, Seattle, Washington, United States of America
| | - Kathleen P. Pratt
- Puget Sound Blood Center Research Institute, Seattle, Washington, United States of America
- Division of Hematology, University of Washington, Seattle, Washington, United States of America
- * E-mail:
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Hausammann S, Vogel M, Kremer Hovinga JA, Lacroix-Desmazes S, Stadler BM, Horn MP. Designed ankyrin repeat proteins: a new approach to mimic complex antigens for diagnostic purposes? PLoS One 2013; 8:e60688. [PMID: 23626669 PMCID: PMC3634029 DOI: 10.1371/journal.pone.0060688] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2012] [Accepted: 03/01/2013] [Indexed: 11/18/2022] Open
Abstract
Inhibitory antibodies directed against coagulation factor VIII (FVIII) can be found in patients with acquired and congenital hemophilia A. Such FVIII-inhibiting antibodies are routinely detected by the functional Bethesda Assay. However, this assay has a low sensitivity and shows a high inter-laboratory variability. Another method to detect antibodies recognizing FVIII is ELISA, but this test does not allow the distinction between inhibitory and non-inhibitory antibodies. Therefore, we aimed at replacing the intricate antigen FVIII by Designed Ankyrin Repeat Proteins (DARPins) mimicking the epitopes of FVIII inhibitors. As a model we used the well-described inhibitory human monoclonal anti-FVIII antibody, Bo2C11, for the selection on DARPin libraries. Two DARPins were selected binding to the antigen-binding site of Bo2C11, which mimic thus a functional epitope on FVIII. These DARPins inhibited the binding of the antibody to its antigen and restored FVIII activity as determined in the Bethesda assay. Furthermore, the specific DARPins were able to recognize the target antibody in human plasma and could therefore be used to test for the presence of Bo2C11-like antibodies in a large set of hemophilia A patients. These data suggest, that our approach might be used to isolate epitopes from different sets of anti-FVIII antibodies in order to develop an ELISA-based screening assay allowing the distinction of inhibitory and non-inhibitory anti-FVIII antibodies according to their antibody signatures.
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Affiliation(s)
- Stefanie Hausammann
- University Institute of Immunology, University of Bern, Inselspital, Bern, Switzerland
| | - Monique Vogel
- University Institute of Immunology, University of Bern, Inselspital, Bern, Switzerland
| | - Johanna A. Kremer Hovinga
- Department of Hematology and Central Hematology Laboratory, University Hospital and University of Bern, Bern, Switzerland
| | - Sebastien Lacroix-Desmazes
- INSERM, UMR S 872, Les Cordeliers, Paris
- Université Pierre et Marie Curie-Paris, UMR S 872, Les Cordeliers, Paris
- Université Paris Descartes, UMR S 872, Les Cordeliers, Paris
| | - Beda M. Stadler
- University Institute of Immunology, University of Bern, Inselspital, Bern, Switzerland
| | - Michael P. Horn
- University Institute of Immunology, University of Bern, Inselspital, Bern, Switzerland
- * E-mail:
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Butenas S, Krudysz-Amblo J, Rivard GE, G Mann K. Product-dependent anti-factor VIII antibodies. Haemophilia 2013; 19:619-25. [PMID: 23557464 DOI: 10.1111/hae.12127] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/19/2013] [Indexed: 01/12/2023]
Abstract
The development of anti-factor (F)VIII antibodies in haemophilia A (HA) subjects undergoing replacement therapy has been well documented. The correlation between antibody development and the FVIII product used for replacement therapy remains a subject of discussion. The aim of this study was to evaluate the presence of anti-FVIII antibodies towards three commercial rFVIII products in 34 HA subjects' plasmas. Antibodies were quantitated by a Multiplex Fluorescence Immunoassay. All plasmas contained anti-FVIII antibodies at variable concentrations ranging from 50 nm to 570 μm. Eleven of the 20 HA subjects treated with one (r)FVIII product contained inhibitory anti-FVIII antibodies (0.8-3584 BU). The inhibitory antibody titre and the molar concentrations of total antibody were mildly correlated (r(2) = 0.6). Pronounced differences in antibody recognition with the three rFVIII products were observed. For the group treated with Product 'A', the titre towards this product was 2.4-fold higher than that observed with another full-length rFVIII-containing product (Product 'B') and almost four-fold higher than that measured with a B domain-less rFVIII product (Product 'C'). For the group of 14 HA subjects treated with FVIII other than Product 'A', only one showed higher antibody titre when measured with this product. Our data suggest that the development of anti-FVIII antibodies is biased towards the product used for treatment and that a significant fraction of antibodies bind to the B domain of FVIII.
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Affiliation(s)
- S Butenas
- Department of Biochemistry, College of Medicine, University of Vermont, Burlington, VT 05446, USA
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IRIGOYEN MB, FELIPPO ME, PRIMIANI L, CANDELA M, BIANCO RP, DE BRACCO MM, GALASSI N. Severe haemophilia A patients have reduced numbers of peripheral memory B cells. Haemophilia 2011; 18:437-43. [DOI: 10.1111/j.1365-2516.2011.02642.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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