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Sedzro JC, Adam F, Auditeau C, Bianchini E, De Carvalho A, Peyron I, Daramé S, Gandrille S, Thomassen S, Hackeng TM, Christophe OD, Lenting PJ, Denis CV, Borgel D, Saller F. Antithrombotic potential of a single-domain antibody enhancing the activated protein C-cofactor activity of protein S. J Thromb Haemost 2022; 20:1653-1664. [PMID: 35445541 DOI: 10.1111/jth.15736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 04/05/2022] [Accepted: 04/19/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Protein S (PS) is a natural anticoagulant acting as a cofactor for activated protein C (APC) in the proteolytic inactivation of activated factors V (FVa) and VIII (FVIIIa), but also for tissue factor pathway inhibitor α (TFPIα) in the inhibition of activated factor X (FXa). OBJECTIVE For therapeutic purposes, we aimed at generating single-domain antibodies (sdAbs) that could specifically modulate the APC-cofactor activity of PS in vivo. METHODS A llama-derived immune library of sdAbs was generated and screened on recombinant human PS by phage display. PS binders were tested in a global activated partial thromboplastin time (APTT)-based APC-cofactor activity assay. RESULTS A PS-specific sdAb (PS003) was found to enhance the APC-cofactor activity of PS in our APTT-based assay, and this enhancing effect was greater for a bivalent form of PS003 (PS003biv). Further characterization of PS003biv demonstrated that PS003biv also enhanced the APC-cofactor activity of PS in a tissue factor (TF)-induced thrombin generation assay and stimulated APC in the inactivation of FVa, but not FVIIIa, in plasma-based assays. Furthermore, PS003biv was directed against the sex hormone-binding globulin (SHBG)-like domain but did not inhibit the binding of PS to C4b-binding protein (C4BP) and did not interfere with the TFPIα-cofactor activity of PS. In mice, PS003biv exerted an antithrombotic effect in a FeCl3 -induced thrombosis model, while not affecting physiological hemostasis in a tail-clip bleeding model. DISCUSSION Altogether, these results showed that pharmacological enhancement of the APC-cofactor activity of PS through an original anti-PS sdAb might constitute a promising and safe antithrombotic strategy.
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Affiliation(s)
- Josepha C Sedzro
- Hémostase, Inflammation, Thrombose (HITh), UMR-S1176, INSERM, Université Paris-Saclay, Le Kremlin-Bicêtre, France
| | - Frédéric Adam
- Hémostase, Inflammation, Thrombose (HITh), UMR-S1176, INSERM, Université Paris-Saclay, Le Kremlin-Bicêtre, France
| | - Claire Auditeau
- Hémostase, Inflammation, Thrombose (HITh), UMR-S1176, INSERM, Université Paris-Saclay, Le Kremlin-Bicêtre, France
- Service d'Hématologie Biologique, Hôpital Necker Enfants Malades, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Elsa Bianchini
- Hémostase, Inflammation, Thrombose (HITh), UMR-S1176, INSERM, Université Paris-Saclay, Le Kremlin-Bicêtre, France
| | - Allan De Carvalho
- Hémostase, Inflammation, Thrombose (HITh), UMR-S1176, INSERM, Université Paris-Saclay, Le Kremlin-Bicêtre, France
| | - Ivan Peyron
- Hémostase, Inflammation, Thrombose (HITh), UMR-S1176, INSERM, Université Paris-Saclay, Le Kremlin-Bicêtre, France
| | - Sadyo Daramé
- Hémostase, Inflammation, Thrombose (HITh), UMR-S1176, INSERM, Université Paris-Saclay, Le Kremlin-Bicêtre, France
| | - Sophie Gandrille
- Innovations Thérapeutiques en Hémostase, UMR-S1140, INSERM, Université de Paris, Paris, France
- Service d'Hématologie Biologique, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Stella Thomassen
- Cardiovascular Research Institute Maastricht (CARIM), University Maastricht, Maastricht, the Netherlands
| | - Tilman M Hackeng
- Cardiovascular Research Institute Maastricht (CARIM), University Maastricht, Maastricht, the Netherlands
| | - Olivier D Christophe
- Hémostase, Inflammation, Thrombose (HITh), UMR-S1176, INSERM, Université Paris-Saclay, Le Kremlin-Bicêtre, France
| | - Peter J Lenting
- Hémostase, Inflammation, Thrombose (HITh), UMR-S1176, INSERM, Université Paris-Saclay, Le Kremlin-Bicêtre, France
| | - Cécile V Denis
- Hémostase, Inflammation, Thrombose (HITh), UMR-S1176, INSERM, Université Paris-Saclay, Le Kremlin-Bicêtre, France
| | - Delphine Borgel
- Hémostase, Inflammation, Thrombose (HITh), UMR-S1176, INSERM, Université Paris-Saclay, Le Kremlin-Bicêtre, France
- Service d'Hématologie Biologique, Hôpital Necker Enfants Malades, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - François Saller
- Hémostase, Inflammation, Thrombose (HITh), UMR-S1176, INSERM, Université Paris-Saclay, Le Kremlin-Bicêtre, France
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Pfeiffer C, Batorova A, Giansily-Blaizot M, Schved J, Mariani G, Pinotti M, Branchini A, Baroni M, Bernardi F. Coagulation factor VII variants resistant to inhibitory antibodies. Thromb Haemost 2017; 112:972-80. [DOI: 10.1160/th14-03-0198] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Accepted: 06/19/2014] [Indexed: 11/05/2022]
Abstract
SummaryReplacement therapy is currently used to prevent and treat bleeding episodes in coagulation factor deficiencies. However, structural differences between the endogenous and therapeutic proteins might increase the risk for immune complications. This study was aimed at identifying factor (F)VII variants resistant to inhibitory antibodies developed after treatment with recombinant activated factor VII (rFVIIa) in a FVII-deficient patient homozygous for the p.A354V-p.P464Hfs mutation, which predicts trace levels of an elongated FVII variant in plasma. We performed fluorescent bead-based binding, ELISA-based competition as well as fluorogenic functional (activated FX and thrombin generation) assays in plasma and with recombinant proteins. We found that antibodies displayed higher affinity for the active than for the zymogen FVII (half-maximal binding at 0.54 ± 0.04 and 0.78 ± 0.07 BU/ml, respectively), and inhibited the coagulation initiation phase with a second-order kinetics. Isotypic analysis showed a polyclonal response with a large predominance of IgG1. We hypothesised that structural differences in the carboxyl-terminus between the inherited FVII and the therapeutic molecules contributed to the immune response. Intriguingly, a naturally-occurring, poorly secreted and 5-residue truncated FVII (FVII-462X) escaped inhibition. Among a series of truncated rFVII molecules, we identified a well-secreted and catalytically competent variant (rFVII-464X) with reduced binding to antibodies (half-maximal binding at 0.198 ± 0.003 BU/ml) as compared to the rFVII-wt (0.032 ± 0.002 BU/ml), which led to a 40-time reduced inhibition in activated FX generation assays. Taken together our results provide a paradigmatic example of mutation-related inhibitory antibodies, strongly support the FVII carboxyl-terminus as their main target and identify inhibitor-resistant FVII variants.
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Andersson HM, Arantes MJ, Crawley JTB, Luken BM, Tran S, Dahlbäck B, Lane DA, Rezende SM. Activated protein C cofactor function of protein S: a critical role for Asp95 in the EGF1-like domain. Blood 2010; 115:4878-85. [PMID: 20308596 PMCID: PMC2884152 DOI: 10.1182/blood-2009-11-256610] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2009] [Accepted: 02/20/2010] [Indexed: 11/20/2022] Open
Abstract
Protein S has an established role in the protein C anticoagulant pathway, where it enhances the factor Va (FVa) and factor VIIIa (FVIIIa) inactivating property of activated protein C (APC). Despite its physiological role and clinical importance, the molecular basis of its action is not fully understood. To clarify the mechanism of the protein S interaction with APC, we have constructed and expressed a library of composite or point variants of human protein S, with residue substitutions introduced into the Gla, thrombin-sensitive region (TSR), epidermal growth factor 1 (EGF1), and EGF2 domains. Cofactor activity for APC was evaluated by calibrated automated thrombography (CAT) using protein S-deficient plasma. Of 27 variants tested initially, only one, protein S D95A (within the EGF1 domain), was largely devoid of functional APC cofactor activity. Protein S D95A was, however, gamma-carboxylated and bound phospholipids with an apparent dissociation constant (Kd(app)) similar to that of wild-type (WT) protein S. In a purified assay using FVa R506Q/R679Q, purified protein S D95A was shown to have greatly reduced ability to enhance APC-induced cleavage of FVa Arg306. It is concluded that residue Asp95 within EGF1 is critical for APC cofactor function of protein S and could define a principal functional interaction site for APC.
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Affiliation(s)
- Helena M Andersson
- Department of Haematology, Faculty of Medicine, Imperial College London, London, UK
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Baroni M, Pavani G, Marescotti D, Kaabache T, Borgel D, Gandrille S, Marchetti G, Legnani C, D'Angelo A, Pinotti M, Bernardi F. Membrane binding and anticoagulant properties of protein S natural variants. Thromb Res 2009; 125:e33-9. [PMID: 19878975 DOI: 10.1016/j.thromres.2009.09.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2009] [Revised: 09/17/2009] [Accepted: 09/21/2009] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Protein S (PS) is a vitamin K-dependent plasma glycoprotein with a key role in the control of coagulation pathway on phospholipid membranes. We compared anticoagulant and membrane binding properties of PS altered by natural mutations (N217S, DelI203D204) affecting the epidermal growth factor like-domain 4 (EGF4) and causing PS deficiency. MATERIALS AND METHODS Binding of recombinant, immunopurified PS (rPS) to several conformation-specific antibodies, to C4BP and to phospholipid liposomes was investigated by ELISA. PS binding to cells was analysed by flow cytometry. PS inhibitory activities were studied in plasma and purified systems. RESULTS AND CONCLUSIONS Conformational changes produced by mutations were revealed by mapping with calcium-dependent antibodies. The immunopurified recombinant mutants (rPS) showed at 200-800 nM concentration reduced inhibition of coagulation (rPS217S, 10.2-17.3%; rPSDelI203D204, 5.8-8.9% of rPSwt) in FXa 1-stage clotting assay with APC. In thrombin generation assays the inhibition of ETP was reduced to 51.6% (rPS217S) and 24.1% (rPSDelI203D204) of rPSwt. A slightly shortened lag time (minutes) was also observed (rPS217S, 2.58; rPSDelI203D204, 2.33; rPSwt, 3.17; PS deficient plasma, 2.17). In flow cytometry analysis both mutants efficiently bound apoptotic cells in adhesion or in suspension. The affinity for phosphatidylserine-rich vesicles (apparent Kd: rPSwt 27.7+/-1.6 nM, rPS217S 146.0+/-16.1 nM and rPSDelI203D204 234.1+/-28.1 nM) was substantially increased by membrane oxidation (10.9+/-0.6, 38.2+/-3.5 and 81.4+/-6.0 nM), which resulted in a virtually normal binding capacity of mutants at physiological PS concentration. These properties help to define the molecular bases of PS deficiency, and provide further elements for PS-mediated bridging of coagulation and inflammation.
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Affiliation(s)
- Marcello Baroni
- Department of Biochemistry and Molecular Biology, ICSI, University of Ferrara, Ferrara, Italy.
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