Induction of factor VIII-specific unresponsiveness by intrathymic factor VIII injection in murine hemophilia A

Abstract

Background: Hemophilia A is a congenital bleeding disorder caused by a deficiency of coagulation factor VIII. Approximately 30% of hemophilia.A patients develop inhibitors against FVIII following replacement therapy. We have reported that neonatal exposure of FVIII antigen can induce antigen-specific immune tolerance by interferon-γ (IFN-γ)-dependent T-cell anergy in hemophilia A mice. Objective: The thymus plays crucial roles in self-tolerance, with negative selection of self-reactive effector T cells and positive selection of self-reactive regulatory T cells. We investigated the possibility of the induction of antigen-specific immune tolerance by intrathymic injection of FVIII in hemophilia.A mice. Methods: Hemophilia. A mice were injected with recombinant FVIII into the thymus under real-time high-resolution image guidance. Results: Anti-FVIII inhibitory antibody titers in mice challenged with intravenous administration of FVIII were significantly lower in mice (n = 22) that had received thymic FVIII injection than in mice (n = 18) without thymic injection (9.4 ± 2.3 vs. 122.5 ± 27.6 BU mL-1, respectively, P = 0.00078). The CD4 + T cells from thymic-injected mice could not proliferate or produce interleukin (IL)-2, IL-12 and IFN-γ in response to FVIII. The CD4+ CD25+ T cells generated from thymic-treated mice but not from naïve mice efficiently suppressed the in vitro proliferative response of CD4+ T cells and blocked the in vivo development of anti-FVIII antibodies in the adoptive transfer. Conclusion: These data suggest that intrathymic administration of FVIII could result in immune tolerance by induction of FVIII-specific regulatory T cells. © 2009 International Society on Thrombosis and Haemostasis.