Figure 4.

Potential gut microbiota influences on FVIII immunogenicity. The composition of the gut microbiome can have significant positive or negative effects on FVIII immunogenicity. These differences in the microbiome composition can derive from changes in diet, medications and coincident disease states. In most instances, the mechanisms responsible for changes to FVIII immune reactivity are not well-characterized but it is thought that antigenic mimicry and gut inflammation may play roles in initiating and boosting FVIII immunogenicity, while the delivery or generation of gut-derived immunomodulatory metabolites can mediate tolerogenic immune responses. SCFA, short chain fatty acids; MAC, microbiome accessible carbohydrate.