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  • 1
    In: Blood, American Society of Hematology, Vol. 106, No. 11 ( 2005-11-16), p. 59-59
    Abstract: Inhibitory antibodies against ADAMTS13 have been detected in the majority of patients with acquired thrombotic thrombocytopenic purpura. Epitope-mapping studies revealed that antibodies binding to the cysteine-rich/spacer domains of ADAMTS13 are present in plasma of all patients analyzed so far. We have previously shown that a major antigenic determinant located within the spacer domain. To confirm these results we constructed a recombinant fragment consisting of the disintegrin/TSR1/cysteine-rich domains of ADAMTS13 and the spacer domain of ADAMTS1. The resulting ADAMTS13/ADAMTS1 chimera did not react with IgG present in plasma of a panel of patients with acquired TTP. To identify the amino acid residues that are involved in binding of anti-ADAMTS13 antibodies, we constructed a series of 15 hybrids (designated A–O) in which 5–10 amino acids of the ADAMTS13 spacer were exchanged for the homologous sequence of ADAMTS1. Plasma from 6 patients with antibodies directed against the spacer domain was analyzed for reactivity with the ADAMTS13/ADAMTS1 chimeras. Exchange of residues 572–579 (hybrid C) and 657–666 (hybrid M) of ADAMTS13 for the corresponding sequence of ADAMTS1 completely abolished the binding of antibodies from all 6 patients. Other regions of the ADAMTS13 spacer were also involved in binding of antibodies from patient plasma. Regions 580–587 (D), 602–620 (G,H), 629–638 (J), and 667–767 (N) of the ADAMTS13 spacer domain contributed to binding of antibodies from patients 2, 4, and 5 (epitope present within regions CDGHJMN). IgG derived from patient 1 required region 602–620 (G,H) for binding to the ADAMTS13 spacer (CGHM-epitope). For antibodies of patient 3, residues 564–571 (B), 580–587 (D), and 629–638 (J) were required (BCDJM-epitope), whereas replacement of residues 602–610 (G) and 629–638 (J) greatly diminished binding of antibodies derived from patient 6 (CGJM-epitope). Despite the presumably polyclonal origin of the antibodies present in plasma of the patients, our results suggest that residues 572–579 (C) and 657–666 (M) comprise a common antigenic core region within the spacer domain that is crucial for binding of anti-ADAMTS13 antibodies in all six patients. Amino acid residues derived from other regions that spatially surround this common antigenic core further modulate binding of antibodies to the spacer domain.
    Type of Medium: Online Resource
    ISSN: 0006-4971 , 1528-0020
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    Language: English
    Publisher: American Society of Hematology
    Publication Date: 2005
    detail.hit.zdb_id: 1468538-3
    detail.hit.zdb_id: 80069-7
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  • 2
    In: Blood, American Society of Hematology, Vol. 110, No. 11 ( 2007-11-16), p. 2158-2158
    Abstract: Acquired thrombotic thrombocytopenic purpura (TTP) is characterized by the presence of circulating antibodies directed towards ADAMTS13. This results in the formation of large platelet aggregates that occlude the microvasculature giving rise to thrombocytopenia and micro-angiopathic hemolytic anemia in patients with TTP who lack functional ADAMTS13. Antibodies directed towards the spacer domain of ADAMTS13 are present in the majority of patients with acquired TTP. We have previously isolated a panel of human monoclonal antibodies directed towards ADAMTS13 from the immunoglobulin repertoire of one patient with acquired TTP employing phage display. To further extend these observations we obtained a panel of human anti-ADAMTS13 antibodies from a second patient with acquired TTP. Sequence analysis revealed that the variable heavy chain domains of the majority of anti-ADAMTS13 antibodies were encoded by germline gene segment VH1–69. The VH1–69 encoded antibody II-1 and the previously described antibody I-9, which was also encoded by VH1–69 were selected for further study. Epitope-mapping studies employing a hybrid ADAMTS13 variant containing the spacer domain of ADAMTS1 showed that both antibodies were directed towards the spacer domain. Both antibodies inhibited ADAMTS13 activity as measured by cleavage of FRETS-VWF73 substrate and also inhibited cleavage of VWF multimers under static conditions as well as under flow on the surface of endothelial cells. We subsequently developed an assay to monitor the presence of VH1-69 encoded antibodies in plasma of patients with acquired TTP using the anti-idiotypic monoclonal antibody G8 which specifically reacts with human antibodies that use the VH1-69 gene segment. Analysis of a large cohort of patients with acquired TTP revealed that antibodies reactive with the spacer domain of ADAMTS13 express the VH1-69 derived idiotype that is recognized by monoclonal antibody G8. These results support the notion that VH1-69 derived human antibodies directed towards the spacer domain of ADAMTS13 develop in the majority of patients with acquired TTP.
    Type of Medium: Online Resource
    ISSN: 0006-4971 , 1528-0020
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    Language: English
    Publisher: American Society of Hematology
    Publication Date: 2007
    detail.hit.zdb_id: 1468538-3
    detail.hit.zdb_id: 80069-7
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  • 3
    In: Blood, American Society of Hematology, Vol. 112, No. 11 ( 2008-11-16), p. 275-275
    Abstract: Thrombotic thrombocytopenic purpura (TTP) is a severe disorder characterized by the absence or dysfunction of the von Willebrand factor cleaving protease ADAMTS13. In plasma of the majority of patients with TTP autoantibodies directed towards the metalloprotease ADAMTS13 are present. We have previously shown that the spacer domain of ADAMTS13 contains a major binding site for antibodies that develop in patients with TTP. More detailed analysis revealed that residues Tyr657-Tyr666 within the spacer domain comprise part of a common antigenic core that is critical for binding of anti-ADAMTS13 antibodies. Here, we determined individual amino acids within region Tyr657-Tyr666 are involved in binding of a panel of human monoclonal and polyclonal anti-ADAMTS13 antibodies. A series of human monoclonal antibodies reactive with the spacer domain has been isolated from the immunoglobulin repertoire of patients with acquired TTP using phage display. Two human monoclonal antibodies, designated I-9 and II-1 that were both directed against the spacer domain were included in this analysis. Individual amino acids within region Tyr657-Tyr666 were introduced and expressed in the context of an ADAMTS13 variant truncated after the spacer domain. Reactivity of human monoclonal antibodies I-9 and II-1 with the spacer domain variants was determined by immunoprecipation using conditioned medium of stably transfected High Five cells expressing the different variants. Replacement of Arg660, Tyr661 or Tyr665 resulted in a loss of reactivity of the corresponding spacer domain variants with antibody I-9 and II-1. Reactivity of variants in which Gly662 or Glu664 were replaced by an alanine resulted in a reduced binding to antibody I-9 whereas binding to antibody II-1 was not affected by these amino acid replacements. We subsequently addressed the reactivity of polyclonal IgG present in plasma of six patients with acquired TTP with the spacer domain variants described above. First, we showed that polyclonal IgG derived from these patients did react exclusively with the spacer domain and not with other domains on ADAMTS13. Polyclonal antibodies derived from plasma of patients with acquired TTP were subsequently evaluated for binding to the spacer domain variants. For only one of six patients, binding of polyclonal IgG to ADAMTS13 was lost when either Arg660, Tyr661 or Tyr665 was replaced by an alanine. For the other patient plasma’s a reduced reactivity with some of the spacer domain variants was observed; however binding was never completely abolished. These findings suggest that multiple residues within Tyr658-Tyr665 are involved in the binding of polyclonal anti-ADAMTS13 antibodies. To further explore this possibility we generated variants in which double and triple combinations of residues Arg660, Tyr661 or Tyr665 were replaced by an alanine. The resulting variants designated RY1 (both Arg660 and Tyr661 replaced for Ala), RY2 (both Arg660 and Tyr665 replaced for an Ala), YY (both Tyr661 and Tyr665 replaced for an Ala) and RYY (both Arg660, Tyr661 and Tyr665 replaced for an Ala) were evaluated for binding to polyclonal IgG present in plasma. Plasma of two patients showed a lack of binding to variants RY1 and RY2. Three patients showed a lack of reactivity with the YY and the RYY variants. A reduced binding of the three other patients to the RYY variant was observed. These data suggest that Arg660, Tyr661 and Tyr665 contribute to an antigenic surface present on the spacer domain of ADAMTS13. Based on our findings we speculate that an oligoclonal population of anti-ADAMTS13 antibodies targets residues present within this antigenic surface in the spacer domain.
    Type of Medium: Online Resource
    ISSN: 0006-4971 , 1528-0020
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    Language: English
    Publisher: American Society of Hematology
    Publication Date: 2008
    detail.hit.zdb_id: 1468538-3
    detail.hit.zdb_id: 80069-7
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  • 4
    In: Blood, American Society of Hematology, Vol. 91, No. 7 ( 1998-04-01), p. 2347-2352
    Abstract: Inhibitory antibodies directed against factor VIII develop in a substantial number of patients with hemophilia A as a consequence of factor VIII replacement therapy. These antibodies usually recognize discrete epitopes within the A2 and/or the C2 domains of factor VIII. Here, we have characterized the antibodies present in the plasma of a patient affected by severe hemophilia A. The antibodies reacted readily with the metabolically labeled factor VIII light chain and fragments thereof when analyzed by immunoprecipitation. The inhibitory activity could be neutralized by the complete light chain, whereas only slight neutralization occurred with a fragment comprising the isolated C2 domain. Binding of the majority of antibodies to in vitro synthesized factor VIII fragments was dependent on the presence of amino acid residues Gln1778-Met1823, a region known to contain a factor IXa binding site. Functional characterization showed that purified IgG from the patient's serum inhibited binding of factor IXa to immobilized factor VIII light chain in a dose-dependent manner. These data indicate that human alloantibodies may inhibit factor VIII activity by interfering with factor IXa–factor VIIIa complex assembly.
    Type of Medium: Online Resource
    ISSN: 1528-0020 , 0006-4971
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    Language: English
    Publisher: American Society of Hematology
    Publication Date: 1998
    detail.hit.zdb_id: 1468538-3
    detail.hit.zdb_id: 80069-7
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  • 5
    In: Blood, American Society of Hematology, Vol. 89, No. 12 ( 1997-06-15), p. 4371-4377
    Abstract: The development of inhibitory antibodies to factor VIII in patients affected by a mild form of hemophilia A (factor VIII 〈 0.05 IU/mL) is considered a rare event. In this study, we evaluated the relationship between genotype and anti-factor VIII antibody formation in a patient with mild hemophilia A. Mutation analysis showed that a missense mutation in the factor VIII gene leading to replacement of Arg593 by Cys in the A2 domain of factor VIII was associated with hemophilia A in this patient. The anti-factor VIII antibodies present in the patient's plasma were characterized using metabolically labeled factor VIII fragments expressed in insect cells. The anti-factor VIII antibodies, composed of subclasses IgG2 and IgG4, reacted with both the fragment corresponding to the factor VIII heavy chain and the A2 domain. The Arg593 → Cys substitution was introduced into the cDNA encoding the A2 domain of factor VIII and the resulting construct was expressed in insect cells. Strikingly, the metabolically labeled A2 domain carrying the Arg593 → Cys mutation was not recognized by the anti-factor VIII antibodies present in the plasma of the patient. These data indicate that the anti-factor VIII antibodies are exclusively directed against exogenous factor VIII. This strongly suggests that the Arg593 → Cys substitution results in recognition of wild-type factor VIII as nonself and is thereby related to the formation of anti-factor VIII antibodies after factor VIII replacement therapy in this particular patient.
    Type of Medium: Online Resource
    ISSN: 1528-0020 , 0006-4971
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    Language: English
    Publisher: American Society of Hematology
    Publication Date: 1997
    detail.hit.zdb_id: 1468538-3
    detail.hit.zdb_id: 80069-7
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  • 6
    In: Thrombosis and Haemostasis, Georg Thieme Verlag KG, Vol. 93, No. 02 ( 2005), p. 267-283
    Abstract: Thrombotic thrombocytopenic purpura (TTP) is a microangiopathy often associated with a severely decreased activity of ADAMTS13. In plasma of the majority of patients withTTP, antibodies are present that inhibit the vonWillebrand factor (VWF) processing activity of ADAMTS13.We describe a sensitive assay that monitors binding of recombinant ADAMTS13 to immobilized IgG derived from patient plasma. Analysis of fifteen patients with TTP and severely reduced ADAMTS13 activity revealed that in all patients antibodies directed toADAMTS13 were present. Levels of anti-ADAMTS13 antibodies varied considerably among patients, specific antibody levels in plasma range from less than 100 ng/ml to over 1 μg/ml. Longitudinal analysis in three patients revealed that anti-ADAMTS13 antibody levels declined with different kinetics. For further characterization of anti- ADAMTS13 antibodies, we prepared a series of recombinan fragments corresponding to the various ADAMTS13 domains. All seven TTP plasma samples tested, showed reactivity of antibodies towards a fragment consisting of the disintegrin/ TSR1/cysteine-rich/spacer domains. In one patient, we also observed reactivity towards the TSR2–8 repeats. No binding of antibodies to propeptide, metalloprotease and CUB domains was detected. To further delineate the binding site in the disintegrin/ TSR1/cysteine-rich/spacer region, we prepared additional ADAMTS13 fragments. Antibodies directed towards the cysteine- rich/spacer fragment were found in all plasma samples analyzed. No antibodies reacting with the disintegrin/TSR1 domains were detected. A recombinant fragment comprising the spacer domain was recognized by all patients samples analyzed, suggesting that the 130-amino-acid spacer domain harbors a major binding site for anti-ADAMTS-13 antibodies.
    Type of Medium: Online Resource
    ISSN: 0340-6245 , 2567-689X
    Language: English
    Publisher: Georg Thieme Verlag KG
    Publication Date: 2005
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  • 7
    In: Blood, American Society of Hematology, Vol. 91, No. 7 ( 1998-04-01), p. 2347-2352
    Abstract: Inhibitory antibodies directed against factor VIII develop in a substantial number of patients with hemophilia A as a consequence of factor VIII replacement therapy. These antibodies usually recognize discrete epitopes within the A2 and/or the C2 domains of factor VIII. Here, we have characterized the antibodies present in the plasma of a patient affected by severe hemophilia A. The antibodies reacted readily with the metabolically labeled factor VIII light chain and fragments thereof when analyzed by immunoprecipitation. The inhibitory activity could be neutralized by the complete light chain, whereas only slight neutralization occurred with a fragment comprising the isolated C2 domain. Binding of the majority of antibodies to in vitro synthesized factor VIII fragments was dependent on the presence of amino acid residues Gln1778-Met1823, a region known to contain a factor IXa binding site. Functional characterization showed that purified IgG from the patient's serum inhibited binding of factor IXa to immobilized factor VIII light chain in a dose-dependent manner. These data indicate that human alloantibodies may inhibit factor VIII activity by interfering with factor IXa–factor VIIIa complex assembly.
    Type of Medium: Online Resource
    ISSN: 1528-0020 , 0006-4971
    RVK:
    RVK:
    Language: English
    Publisher: American Society of Hematology
    Publication Date: 1998
    detail.hit.zdb_id: 1468538-3
    detail.hit.zdb_id: 80069-7
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  • 8
    In: Blood, American Society of Hematology, Vol. 108, No. 11 ( 2006-11-16), p. 1069-1069
    Abstract: Acquired thrombotic thrombocytopenic purpura (TTP) is often accompanied by the presence of (auto-) antibodies directed against the plasma metalloprotease ADAMTS13. The antibodies prevent efficient proteolytic cleavage of unusually large von Willebrand factor multimers by ADAMTS13, which is highly reactive with platelets. This may result in the formation of platelet aggregates that occlude the microvasculature of patients with TTP. In all presently characterized patients with acquired TTP and detectable anti-ADAMTS13 antibodies, antibodies directed to the (cysteine-rich) spacer domain were present. In order to study anti-ADAMTS13 antibodies at the molecular level, we have isolated single-chain Fv antibody fragments (scFv) from an immunoglobulin V-gene phage-display library derived from CD19+ B-cells of a patient with acquired TTP. From this library scFv I-9 was isolated, of which the variable heavy chain segment is homologous to members of the VH1-69 family. Using ELISA and immunoprecipitation analysis we confirmed that antibody I-9 also binds to the spacer domain. We converted the scFv antibody fragment into a full-length human antibody to better study its effect on proteolytic cleavage of VWF and substrate binding. Antibody I-9 was included into a modified FRETS-VWF73 assay and a dose-dependent inhibition of VWF73 proteolysis by ADAMTS13 was observed. In addition, antibody I-9 was able to inhibit the proteolysis of plasma-derived VWF multimers by ADAMTS13. In both assays inhibition was not very efficient; which is most likely due to the low affinity of antibody I-9 for ADAMTS13. Chimeric ADAMTS13 variants in which 5–10 amino acid residues of the ADAMTS13 spacer domain have been exchanged for the corresponding sequence of ADAMTS1 were used to determine the binding site for antibody I-9 in the spacer domain. Our findings show that amino acid regions 572–579 and 657–666 of the spacer domain are required for binding of antibody I-9, although several other regions are also involved in the interaction. We have previously shown that these amino acid regions are also crucial for binding of (polyclonal) antibodies present in plasma of patients with acquired TTP. Additionally, competition experiments were performed to address whether antibodies with similar properties as antibody I-9 are indeed present in plasma from patients with acquired TTP during acute disease. Plasma from 6 patients with acquired TTP was able to compete in a dose-dependent manner with antibody I-9 for binding to immobilized ADAMTS13, including plasma from the patient whose lymphocytes were used for construction of the phage-display library. These results show that antibodies with similar epitope-specificity as antibody I-9 are present in plasma of patients with acquired TTP. Since anti-spacer domain antibodies have been found in all presently characterized patients with anti-ADAMTS13 antibodies, the current data suggest that antibody I-9 is representative of the pathogenic antibodies present in plasma of the majority of patients with acquired TTP.
    Type of Medium: Online Resource
    ISSN: 0006-4971 , 1528-0020
    RVK:
    RVK:
    Language: English
    Publisher: American Society of Hematology
    Publication Date: 2006
    detail.hit.zdb_id: 1468538-3
    detail.hit.zdb_id: 80069-7
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  • 9
    In: Blood, American Society of Hematology, Vol. 104, No. 11 ( 2004-11-16), p. 257-257
    Abstract: Thrombotic thrombocytopenic purpura (TTP) is associated with a severe deficiency of the von Willebrand factor-cleaving protease ADAMTS13. In plasma of the majority of patients with acquired TTP, antibodies that inhibit ADAMTS13 activity have been detected. In this study we have used phage display to isolate anti-ADAMTS13 antibodies from the total immunoglobulin repertoire of a patient with acquired TTP. The immunoglobulin G variable heavy chain (VH) gene repertoire was amplified from CD19 positive B cells and combined with a variable light chain (VL) gene repertoire. The resulting library consisted of 3.4 x 108 individual clones. Combined VH and VL segments, expressed as single-chain Fv fragments (scFv) on the surface of filamentous phage, were selected for binding to an ADAMTS13 fragment consisting of the disintegrin/ first thrombospondin type 1 repeat (TSR1)/ cysteine-rich/ spacer domains. After three rounds of selection, six different scFv antibody clones were identified that were assigned to four groups based on the use of VH germline gene segments. ScFv 9, 10, and 27, all use the VH1–69 germline gene segments, possess the same CDR3, and show a similar pattern of somatic hypermutation. These results suggest that scFv 9, 10 and 27 are derived from a common B cell precursor. ScFv 26 also belongs to the VH1 family, but uses germline gene segment VH1–02 instead. Clones 16 and 41 are both part of the VH3 family and are derived from germline gene segments VH3–07 and VH3–09 respectively. The affinity of the scFv for the ADAMTS13 disintegrin/ TSR1/ cysteine-rich/ spacer fragment was determined by surface plasmon resonance analysis. Purified disintegrin/ TSR1/ cysteine-rich/ spacer fragment was immobilized on an activated CM5-sensor chip and subsequently different concentrations of purified scFv were added. Binding and dissociation of scFv was followed for 2 minutes and the affinity of the different scFv for the immobilized ADAMTS13 fragment was calculated from the obtained binding curves. ScFv 9 binds with high affinity to the disintegrin/ TSR1/ cysteine-rich/ spacer fragment (Kd 3.6 ± 0.8 nM); whereas scFv 10, 16, 26, 27 and 41 displayed a somewhat lower affinity (Kd ranging from 20–200 nM). Epitope mapping using several smaller ADAMTS13 fragments in the disintegrin/ TSR1/ cysteine-rich/ spacer region revealed that scFv 9, 10, and 41, bind specifically to the ADAMTS13 spacer domain. The epitope of scFv 16 however, resides in the disintegrin/ TSR1 domains. Our results indicate that multiple B cell clones that produce antibodies recognizing epitopes in the spacer and disintegrin/ TSR1 domains of ADAMTS13 are present in the immunoglobulin repertoire of a patient with acquired TTP.
    Type of Medium: Online Resource
    ISSN: 0006-4971 , 1528-0020
    RVK:
    RVK:
    Language: English
    Publisher: American Society of Hematology
    Publication Date: 2004
    detail.hit.zdb_id: 1468538-3
    detail.hit.zdb_id: 80069-7
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