Minimal modification in the factor VIII B-domain sequence ameliorates the murine hemophilia A phenotype

Blood. 2013 May 23;121(21):4396-403. doi: 10.1182/blood-2012-10-464164. Epub 2013 Jan 31.

Abstract

Recombinant canine B-domain deleted (BDD) factor VIII (FVIII) is predominantly expressed as a single-chain protein and exhibits greater stability after activation compared with human FVIII-BDD. We generated a novel BDD-FVIII variant (FVIII-RH) with an amino acid change at the furin cleavage site within the B domain (position R1645H) that mimics the canine sequence (HHQR vs human RHQR). Compared with human FVIII-BDD, expression of FVIII-RH protein revealed a 2.5-fold increase in the single-chain form. Notably, FVIII-RH exhibited a twofold increase in biological activity compared with FVIII-BDD, likely due to its slower dissociation of the A2-domain upon thrombin activation. Injection of FVIII-RH protein in hemophilia A (HA) mice resulted in more efficacious hemostasis following vascular injury in both the macro- and microcirculation. These findings were successfully translated to adeno-associated viral (AAV)-based liver gene transfer in HA mice. Expression of circulating FVIII-RH was approximately twofold higher compared with AAV-FVIII-BDD-injected mice. Moreover, FVIII-RH exhibits superior procoagulant effects compared with FVIII-BDD following a series of hemostatic challenges. Notably, the immunogenicity of FVIII-RH did not differ from FVIII-BDD. Thus, FVIII-RH is an attractive bioengineered molecule for improving efficacy without increased immunogenicity and may be suitable for both protein- and gene-based strategies for HA.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Animals
  • Dogs
  • Factor VIII / chemistry
  • Factor VIII / genetics*
  • Factor VIII / immunology
  • Genetic Therapy / methods*
  • Genetic Variation
  • Hemophilia A / genetics*
  • Hemophilia A / therapy*
  • Hemostasis / genetics
  • Hemostasis / physiology
  • Humans
  • Immune Tolerance
  • Liver / physiology
  • Mice
  • Mice, Inbred C57BL
  • Mice, Knockout
  • Phenotype
  • Protein Structure, Tertiary / genetics
  • Recombinant Proteins / chemistry
  • Recombinant Proteins / genetics
  • Recombinant Proteins / immunology
  • Species Specificity

Substances

  • Recombinant Proteins
  • Factor VIII