FVIII peptides presented on HLA-DP and identification of an A3 domain peptide binding with high affinity to the commonly expressed HLA-DP4

The development of neutralizing antibodies (inhibitors) against coagulation factor VIII (FVIII) poses a major challenge in hemophilia A (HA) treatment. The formation of FVIII inhibitors is a CD4+ T-cell-dependent mechanism which includes antigen presenting cells (APC), B- and T-helper lymphocytes. APC present FVIII-derived peptides on major histocompatibility complex class II (MHC-II) to CD4+ T cells. We previously established a mass spectrometry-based approach to delineate the FVIII repertoire presented on HLA-DR and HLA-DQ. In this study, specific attention was directed towards the identification of FVIII peptides presented on HLA-DP. A data-set of naturally processed FVIII peptides was generated by incubating human FVIII with immature monocyte-derived dendritic cells (moDC) from HLA-typed healthy donors. Using this method, we identified 176 to 1,352 different HLA-DP presented peptides per donor, including 26 different FVIII-derived peptides. The most frequently presented peptides derived from the A3 and C2 domains of FVIII. Comparison of the FVIII repertoire presented on HLA-DP with that presented on HLA-DR revealed considerable overlap but also suggested preferential presentation of specific peptides on either HLA-DR or HLA-DP. Fourteen FVIII peptides presented on HLA-DP were synthesized and evaluated for their binding ability to the commonly expressed HLA-DP4 molecule which is highly prevalent in the Caucasian population. Peptide binding studies showed that 7 of 14 peptides competed with a reference peptide to HLA-DP4. Interestingly, an A3 domain-derived peptide bound with high affinity to HLA-DP4, positioning this peptide as a prime candidate for the development of novel peptide-based tolerogenic strategies for FVIII inhibitors.