HLA antigens in hemophiliacs A with or without factor VIII antibodies in a Venezuelan Mestizo population

Immunogenicity to biologics: mechanisms, prediction and reduction

Currently, there is a significant rise in the development and clinical use of a unique class of pharmaceuticals termed as Biopharmaceuticals or Biologics, in the management of a range of disease conditions with, remarkable therapeutic benefits. However, there is an equally growing concern regarding development of adverse effects like immunogenicity in the form of anti-drug antibodies (ADA) production and hypersensitivity. Immunogenicity to biologics represents a significant hurdle in the continuing therapy of patients in a number of disease settings. Efforts focussed on the identification of factors that contribute towards the onset of immunogenic response to biologics have led to reductions in the incidence of immunogenicity. An in-depth understanding of the cellular and molecular mechanism underpinning immunogenic responses will likely improve the safety profile of biologics. This review addresses the mechanistic basis of ADA generation to biologics, with emphasis on the role of antigen processing and presentation in this process. The article also addresses the potential contribution of complement system in augmenting or modulating this response. Identifying specific factors that influences processing and presentation of biologic-derived antigens in different genotype and disease background may offer additional options for intervention in the immunogenic process and consequently, the management of immunogenicity to biologics.

HLA and in vitro susceptibility to HIV infection

Since the beginning of the epidemic of acquired immunodeficiency syndrome (AIDS), evidence has accumulated that genetic factors are involved in the pathogenesis of the disease. Among the candidate molecules suspected to control susceptibility to human immunodeficiency virus (HIV) infection and fast or slow progression of AIDS are the human leukocyte antigens (HLA). Investigating HLA-HIV correlation was mainly performed by investigating cohorts of patients with HIV/AIDS for a period of time and then statistically correlating certain features of AIDS with particular HLA alleles. This type of in vivo investigations resulted in the generation of an immense literature on the subject with so many HLA alleles being found to correlate with certain features of AIDS. Because of the complexity of AIDS pathogenesis and the involvement of many factors in the disease process, the different investigators failed to agree on the involvement of certain HLA molecules in AIDS pathogenesis. Some reports deny, or fail to confirm the existence of association between HLA and HIV progression to AIDS. This is probably due to the different ethnic backgrounds of the populations studied, the complexity of the HLA system, and to the ways these studies were conducted. This article briefly addresses our current knowledge on the HLA-HIV correlation in vivo and discusses alternative in vitro studies.

Histocompatibility antigens and alleles in Japanese haemophilia A patients with or without factor VIII antibodies

We carried out human leukocyte antigen (HLA)-A, B, Cw, DR and DQ serological typing and HLA-DQA1, DQB1, DRB1 and DPB1 genetic typing for 46 Japanese haemophilia A patients, including 20 who had developed an antibody to factor VIII. It appears that anti FVIII inhibitor formation is associated with the major histocompatibility complex in Japanese haemophilia A patients. Absence of HLA-A24 is a principal risk factor for inhibitor formation in Japanese haemophilia A patients. As supplemental risk factors, HLA-DR4.1, DQ4 and DQA1*0301=2 are positively associated with patients exhibiting inhibitor compared with normal subjects. This and previous studies show that the association between HLA antigens and the formation of inhibitor depends on race. Data of HLA typing may be useful for the recognition of groups at high risk for the possible formation of inhibitor among Japanese haemophilia A patients.

Characterization of a monoclonal anti-idiotype antibody to human anti-factor VIII antibodies

Approximately 15% of individuals with hemophilia A develop antibodies (inhibitors) to therapeutically infused factor VIII that interfere with F.VIII coagulant activity. By using isoelectric focusing and immunospecific detection of anti-factor VIII antibodies, inhibitor plasma showed varied patterns of reactivity characteristic of a polyclonal response. Inhibitor plasma from patient Bt was observed to have an isolated banding pattern, or spectrotype, at pI 8.4 (SP8.4) distinct from his remaining anti-factor VIII antibodies. SP8.4 antibodies from this patient were partially purified and used to prepare monoclonal anti-idiotype antibodies. Monoclonal antibody Mab20-2H was found to detect a spectrotype in isoelectric-focused Bt plasma identical to SP8.4 and to bind anti-factor VIII antibodies. Furthermore, Mab20-2H binding could inhibit the binding of these anti-factor VIII antibodies to antigen, indicating that Mab20-2H recognizes an idiotope associated with antigen binding. Mab20-2H was also found to recognize antibodies from another inhibitor patient. This and other anti-idiotype reagents will be useful for defining genetic factors involved in the human immune response to factor VIII and in designing approaches to prevent or ameliorate this response.

Susceptibility to HIV infection and AIDS in Italian haemophiliacs is HLA associated

We compared the frequencies of HLA antigens in two matched groups of 31 HIV-seronegative and 31 HIV-seropositive haemophiliacs, exposed during the years 1981-85 to comparable amounts and batches of presumably infectious clotting factor concentrates. The frequency of A2 was significantly higher in HIV-seropositive than in seronegative haemophiliacs, with a relative risk (RR) of seroconversion of 3.92, whereas both Bw52 and DR4 were negatively associated with it. We also studied the distribution of HLA antigens in a larger group of 76 HIV-seropositive haemophiliacs, who were at different clinical stages of HIV infection (CDC classes II-IV) but were comparable for age and time elapsed since seroconversion. DR3 and DQw2 antigens were, particularly when concomitantly present, associated with a high risk of developing symptomatic HIV infection (RR = 11.79 and 25.33). Our data suggest that the HLA region controls susceptibility to infection with HIV and its progression to symptomatic disease in Italian haemophiliacs.

The HLA polymorphism in five Brazilian populations

A total of 977 White individuals living in five Brazilian cities, as well as 173 Black individuals from two of these cities have been studied in relation to HLA-A and HLA-B. Allele frequency similarities among these populations are much more impressive than dissimilarities, and the differences, considering putative ancestors, are not remarkable. This limited variability can be only partially explained in terms of racial admixture, estimates of the latter using different alleles in the various populations showing disparate results. Linkage disequilibrium values vary between groups, that for A1-B8 being the most consistent, independent of sample or race. But four other haplotypes observed to be in significant disequilibrium in Portugal showed the same pattern in at least one of the five Brazilian White samples.

HLA typing in heavily transfused haemophiliacs with or without antibodies against human immunodeficiency virus (HIV)

HLA-A, B, DR antigens were determined in 46 patients, heavily transfused with blood products. Patients were 44 haemophiliacs, one case of afibrinogenemia and one case of von Willebrand's disease. Thirty-three patients had HIV antibodies. No significant difference for HLA antigen frequencies was observed in haemophiliacs with or without HIV antibodies, nor between haemophiliacs and a control population.

High frequency of HLA-DR5 in Greek patients with haemophilia A and haemophilia B

Sixty unrelated Greek patients with haemophilia (46 with haemophilia A and 14 with haemophilia B) were typed for HLA-A, B and DR antigens. A highly significant increase in the frequency of HLA-DR5 was observed in both groups of patients (58.6% vs 30.0%, chi 2 = 10.47, pc less than 0.03, RR = 3.31 for haemophilia A and 78.5% vs 30.0%, chi 2 = 12.32, pc less than 0.007, RR = 8.5 for haemophilia B). An increased frequency of HLA-B13 was also observed in patients with haemophilia A (15.2% vs 5.7%, chi 2 = 5.74, pc less than 0.4, RR = 2.9). Thirty of the 60 patients (50.0%) were positive for LAV/HTLVIII antibodies. HLA-DR5 was equally distributed in patients with and without these antibodies (63.3% and 63.3%, respectively). The presence of DR5 did not correlate with the severity of haemophilia A or B. These results may suggest an influence of gene(s) on chromosome 6 in haemophilia A and haemophilia B and no effect of HLA antigens in the susceptibility to LAV/ HTLVIII infection among haemophiliac patients.