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Neutralizing antibodies against factor VIII (FVIII), also known as FVIII inhibitors, remain the major challenge in treating congenital hemophilia A with FVIII products. They may also arise as autoantibodies, causing the rare bleeding disorder acquired hemophilia A.FVIII-specific IgG4 emerged as a distinguishing subclass because it was found exclusively in patients with FVIII inhibitors. The signals produced by monovalent protein antigens such as FVIII are considered to be insufficient to induce clonal expansion of B cells and their differentiation into antibody-producing plasma cells.