Nonneutralizing FVIII-specific antibody signatures in patients with Hemophilia A and in healthy donors.

Previous studies identified nonneutralizing FVIII-specific antibodies in the circulation of severe and non-severe hemophilia A patients without FVIII inhibitors and also in some healthy individuals. To gain a better understanding of the nature of these nonneutralizing antibody responses, we analyzed and compared anti-FVIII antibody signatures in three study cohorts - previously treated severe as well as non-severe hemophilia A patients without FVIII inhibitors, and healthy donors. FVIII-binding IgM, IgG1-4 and IgA antibodies were differentiated, FVIII-specificity was assessed and associated apparent affinity constants were determined. Our results indicate that the nonneutralizing FVIII-specific antibody response in all study cohorts is dominated by IgG1 and IgA. Prevalences, titers and affinities of these nonneutralizing antibodies were higher in the hemophilia A cohorts than in healthy donors. Stratification for the anti-HCV antibody status demonstrated the presence of FVIII-specific IgA with elevated titers in severe hemophilia A patients with an active or past HCV infection when compared to HCV antibody positive non-severe patients or HCV antibody negative patients and healthy donors. Increased titers and affinities of FVIII-specific IgG1 antibodies were observed in a considerable number of hemophilia A patients as opposed to healthy subjects independently of the patients' anti-HCV antibody status. Overall, our findings support the hypothesis that the generation of nonneutralizing anti-FVIII antibodies in healthy individuals and in non-inhibitor hemophilia A patients might be based on similar immune mechanisms. However, differences in prevalences, titers and affinities of these antibodies indicate distinct differences in the antibody evolution between healthy individuals and patients.