Objective
Hemophilia inhibitor formation is a T-cell dependent immune response to infused factor VIII (F.VIII). As immature dendritic cells (DCre) regulate immune response and promote tolerance, we evaluated F.VIII-pulsed DCre, propagated from bone marrow in the presence of GM-CSF and TGFβ, in achieving F.VIII tolerance.
Methods
The effects of intravenous F.VIII-pulsed DCre in C57BL/6 hemophilia A mice were determined by total F.VIII inhibitory antibodies, T cell proliferation, thymidine uptake, cytokine profile, and surface molecule expression.
Results
After tail vein injection of 2.5 U recombinant F.VIII (rF.VIII) on day 0, 2, and 4, anti-F.VIII antibody peaked on day 6, and increased further on day 17 following rF.VIII re-challenge on day 12, 14, and 16, with increased T cell proliferative response to in vitro F.VIII. When mice were pretreated with 2×106 F.VIII-pulsed immature DCre (deficient NF-kB nuclear protein binding, low CD80, low CD86, high IL-10 phenotype) 7 days before rF.VIII challenge, anti-F.VIII was reduced on day 6 and on day 8, 0.1±0.0 BU/ml (Bethesda units/ml) vs. control PBS-treated hemophilia A mice, 2.0±0.1 BU/ml, p<0.01. Re-challenge with rF.VIII on day 12 produced no increase in anti-F.VIII antibody response. This was associated with high serum IL-10 and low IL-2 levels by ELISA, and splenic T cell hyporesponsivess to F.VIII, with IL-10 production, high FoxP3 expression by qT-PCR, and T regulatory cell expansion, confirmed in OVA-TCR transgenic mice.
Conclusions
These findings suggest F.VIII-pulsed DCre reduce anti-F.VIII antibody formation in hemophilia A mice by induction of regulatory T cell-mediated hyporesponsiveness of T helper cells to F.VIII.