Proteolytic antibodies activate factor IX in patients with acquired hemophilia.
Acquired hemophilia is a rare bleeding disorder characterized by the spontaneous occurrence of inhibitory antibodies against endogenous factor VIII (FVIII). IgG from some patients with acquired hemophilia hydrolyze FVIII. Because of the complex etiology of the disease, no clinical parameter, including the presence of FVIII-hydrolyzing IgG, has been associated with patient's survival or death. Here, we demonstrate the presence of anti-FIX antibodies in acquired hemophilia patients. IgG from some patients were found to hydrolyze FIX. In most cases, IgG-mediated FIX-hydrolysis resulted in FIX activation. IgG-mediated hydrolysis of FIX thus led to the significant generation of activated FIX in 25 of 65 patients. Based on the estimated kinetic parameters, patients' IgG activated up to 0.3nM FIX in 24 hours, an amount that restored thrombin generation in vitro provided the presence of more than or equal to 3% residual FVIII activity in plasma. This work identifies proteolytic IgG as novel molecules able to activate FIX under pathologic conditions. IgG-mediated FIX activation is a prevalent phenomenon among acquired hemophilia patients. The presence of FIX-activating IgG may partly compensate for the antibody-mediated inhibition of endogenous FVIII in restoring thrombin generation. This clinical trial was registered at www.clinicaltrials.gov as #NCT00213473.
Centre de Recherche des Cordeliers, Université Pierre et Marie Curie, Paris, France.
Bharath
B
Wootla
Olivier D
OD
Christophe
Ankit
A
Mahendra
Jordan D
JD
Dimitrov
Yohann
Y
Repessé
Véronique
V
Ollivier
Alain
A
Friboulet
Annie
A
Borel-Derlon
Hervé
H
Levesque
Jeanne-Yvonne
JY
Borg
Sebastien
S
Andre
Jagadeesh
J
Bayry
Thierry
T
Calvez
Srinivas V
SV
Kaveri
Sébastien
S
Lacroix-Desmazes
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001323:Autoantibodies / Q000097:blood*; D005164:Factor IX / Q000276:immunology* / Q000378:metabolism*; D005169:Factor VIII / Q000276:immunology / Q000378:metabolism; D005260:Female; D006467:Hemophilia A / Q000097:blood / Q000276:immunology; D006801:Humans; D006868:Hydrolysis; D007074:Immunoglobulin G / Q000097:blood*; D066298:In Vitro Techniques; D007700:Kinetics; D008297:Male; D008875:Middle Aged; D011994:Recombinant Proteins / Q000276:immunology / Q000378:metabolism
D001323:Autoantibodies; D007074:Immunoglobulin G; D011994:Recombinant Proteins; D005169:Factor VIII; D005164:Factor IX