Inhibitory anti-factor V antibodies bind to the factor V C2 domain and are associated with hemorrhagic manifestations

Thomas L. Ortel, Karen D. Moore, Mary Ann Quinn-Allen, Takashi Okamura, Allen J. Sinclair, John Lazarchick, Ramaswamy Govindan, Françoise Carmagnol, William H. Kane

Research output: Contribution to journalArticlepeer-review

77 Scopus citations

Abstract

Factor V inhibitors may develop as spontaneous autoantibodies, as alloantibodies after exposure to bovine thrombin preparations, or in factor V-deficient patients after plasma therapy. Clinical manifestations range from asymptomatic laboratory abnormalities to life-threatening hemorrhage. We have characterized the anti-factor V antibodies from 12 patients diagnosed with factor V inhibitors. In 8 patients, hemorrhagic complications (5 autoantibodies and 3 bovine thrombin-induced alloantibodies) developed, and 4 were asymptomatic (2 autoantibodies and 2 alloantibodies). The IgG fractions from all 12 patients immunoprecipitated the factor Va light chain, but only the 8 IgG fractions associated with hemorrhage inhibited factor V activity in a prothrombinase assay. Nine IgG fractions, including the 8 patients with hemorrhage, immunoprecipitated the isolated second C-type domain (C2). The 8 IgG fractions from the symptomatic patients also immunoprecipitated recombinant chimeras containing only the N-terminal third of the factor V C2 domain, and isolated recombinant C2 domain abrogated the inhibitory effect of the antibodies. Five of the inhibitory IgG fractions blocked binding of factor V to phosphatidylserine. These results suggest that inhibitory anti- factor V antibodies are associated with hemorrhagic manifestations and frequently bind to a common region within the C2 domain, whether originating spontaneously or after exposure to bovine thrombin.

Original languageEnglish
Pages (from-to)4188-4196
Number of pages9
JournalBlood
Volume91
Issue number11
DOIs
StatePublished - Jun 1 1998

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