1
|
Rawal A, Kidchob C, Ou J, Sauna ZE. Application of machine learning approaches for predicting hemophilia A severity. J Thromb Haemost 2024; 22:1909-1918. [PMID: 38718927 DOI: 10.1016/j.jtha.2024.04.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 04/19/2024] [Accepted: 04/22/2024] [Indexed: 05/27/2024]
Abstract
BACKGROUND Hemophilia A (HA) is an X-linked congenital bleeding disorder, which leads to deficiency of clotting factor (F) VIII. It mostly affects males, and females are considered carriers. However, it is now recognized that variants of F8 in females can result in HA. Nonetheless, most females go undiagnosed and untreated for HA, and their bleeding complications are attributed to other causes. Predicting the severity of HA for female patients can provide valuable insights for treating the conditions associated with the disease, such as heavy bleeding. OBJECTIVES To predict the severity of HA based on F8 genotype using a machine learning (ML) approach. METHODS Using multiple datasets of variants in the F8 and disease severity from various repositories, we derived the sequence for the FVIII protein. Using the derived sequences, we used ML models to predict the severity of HA in female patients. RESULTS Utilizing different classification models, we highlight the validity of the datasets and our approach with predictive F1 scores of 0.88, 0.99, 0.93, 0.99, and 0.90 for all the validation sets. CONCLUSION Although with some limitations, ML-based approaches demonstrated the successful prediction of disease severity in female HA patients based on variants in the F8. This study confirms previous research findings that ML can help predict the severity of hemophilia. These results can be valuable for future studies in achieving better treatment and clinical outcomes for female patients with HA, which is an urgent unmet need.
Collapse
Affiliation(s)
- Atul Rawal
- Hemostasis Branch, Division of Plasma Protein Therapeutics, Center for Biologics Evaluation and Research, Food and Drug Administration, Silver Spring, Maryland, USA
| | - Christopher Kidchob
- Hemostasis Branch, Division of Plasma Protein Therapeutics, Center for Biologics Evaluation and Research, Food and Drug Administration, Silver Spring, Maryland, USA
| | - Jiayi Ou
- Hemostasis Branch, Division of Plasma Protein Therapeutics, Center for Biologics Evaluation and Research, Food and Drug Administration, Silver Spring, Maryland, USA
| | - Zuben E Sauna
- Hemostasis Branch, Division of Plasma Protein Therapeutics, Center for Biologics Evaluation and Research, Food and Drug Administration, Silver Spring, Maryland, USA.
| |
Collapse
|
2
|
Alayoubi AM, Khawaji ZY, Mohammed MA, Mercier FE. CRISPR-Cas9 system: a novel and promising era of genotherapy for beta-hemoglobinopathies, hematological malignancy, and hemophilia. Ann Hematol 2024; 103:1805-1817. [PMID: 37736806 DOI: 10.1007/s00277-023-05457-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 09/15/2023] [Indexed: 09/23/2023]
Abstract
Gene therapy represents a significant potential to revolutionize the field of hematology with applications in correcting genetic mutations, generating cell lines and animal models, and improving the feasibility and efficacy of cancer immunotherapy. Compared to different genetic engineering tools, clustered regularly interspaced short palindromic repeats (CRISPR) CRISPR-associated protein 9 (Cas9) emerged as an effective and versatile genetic editor with the ability to precisely modify the genome. The applications of genetic engineering in various hematological disorders have shown encouraging results. Monogenic hematological disorders can conceivably be corrected with single gene modification. Through the use of CRISPR-CAS9, restoration of functional red blood cells and hemostasis factors were successfully attained in sickle cell anemia, beta-thalassemia, and hemophilia disorders. Our understanding of hemato-oncology has been advanced via CRIPSR-CAS9 technology. CRISPR-CAS9 aided to build a platform of mutated genes responsible for cell survival and proliferation in leukemia. Therapeutic application of CRISPR-CAS9 when combined with chimeric antigen receptor (CAR) T cell therapy in multiple myeloma and acute lymphoblastic leukemia was feasible with attenuation of CAR T cell therapy pitfalls. Our review outlines the latest literature on the utilization of CRISPR-Cas9 in the treatment of beta-hemoglobinopathies and hemophilia disorders. We present the strategies that were employed and the findings of preclinical and clinical trials. Also, the review will discuss gene engineering in the field of hemato-oncology as a proper tool to facilitate and overcome the drawbacks of chimeric antigen receptor T cell therapy (CAR-T).
Collapse
Affiliation(s)
- Abdulfatah M Alayoubi
- Department of Biochemistry and Molecular Medicine, College of Medicine, Taibah University, Madinah, Saudi Arabia
| | | | | | - François E Mercier
- Divisions of Experimental Medicine & Hematology, Department of Medicine, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| |
Collapse
|
3
|
Badulescu OV, Badescu MC, Bojan IB, Vladeanu M, Filip N, Dobreanu S, Tudor R, Ciuntu BM, Tanevski A, Ciocoiu M. Thrombotic Disease in Hemophilic Patients: Is This a Paradox in a State of Hypocoagulability? Diagnostics (Basel) 2024; 14:286. [PMID: 38337802 PMCID: PMC10854955 DOI: 10.3390/diagnostics14030286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 01/20/2024] [Accepted: 01/23/2024] [Indexed: 02/12/2024] Open
Abstract
Hemophilia patients have a deficiency in or dysfunction of clotting factors, which can lead to a bleeding tendency. However, paradoxically, some hemophilia patients may also be at an increased risk of developing thrombotic events such as deep vein thrombosis or pulmonary embolism. The pathophysiology of thrombosis in hemophilia patients is not fully understood, but it is thought to involve a complex interplay of various factors, including the severity of the hemophilia, the presence of other risk factors such as obesity, smoking, or the use of hormonal therapies, and the presence of certain genetic mutations that increase the risk of thrombosis. In addition, it has been suggested that the use of clotting factor replacement therapy, which is a standard treatment for hemophilia, may also contribute to the development of thrombosis in some cases.
Collapse
Affiliation(s)
- Oana Viola Badulescu
- Department of Pathophysiology, Morpho-Functional Sciences (II), Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (O.V.B.); (M.V.); (M.C.)
| | - Minerva Codruta Badescu
- Department of Internal Medicine, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Iris Bararu Bojan
- Department of Pathophysiology, Morpho-Functional Sciences (II), Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (O.V.B.); (M.V.); (M.C.)
| | - Maria Vladeanu
- Department of Pathophysiology, Morpho-Functional Sciences (II), Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (O.V.B.); (M.V.); (M.C.)
| | - Nina Filip
- Department of Biochemistry, Morpho-Functional Sciences (II), Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania;
| | - Stefan Dobreanu
- Institute of Cardiovascular Diseases, G.I.M. Georgescu, 700503 Iasi, Romania
| | - Razvan Tudor
- Department of Orthopedics and Traumatology, Surgical Science (II), Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania;
| | - Bogdan-Mihnea Ciuntu
- Department of General Surgery, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iași, Romania; (B.-M.C.); (A.T.)
| | - Adelina Tanevski
- Department of General Surgery, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iași, Romania; (B.-M.C.); (A.T.)
| | - Manuela Ciocoiu
- Department of Pathophysiology, Morpho-Functional Sciences (II), Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (O.V.B.); (M.V.); (M.C.)
| |
Collapse
|
4
|
Nguyen NH, Jarvi NL, Balu-Iyer SV. Immunogenicity of Therapeutic Biological Modalities - Lessons from Hemophilia A Therapies. J Pharm Sci 2023; 112:2347-2370. [PMID: 37220828 DOI: 10.1016/j.xphs.2023.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 05/17/2023] [Accepted: 05/17/2023] [Indexed: 05/25/2023]
Abstract
The introduction and development of biologics such as therapeutic proteins, gene-, and cell-based therapy have revolutionized the scope of treatment for many diseases. However, a significant portion of the patients develop unwanted immune reactions against these novel biological modalities, referred to as immunogenicity, and no longer benefit from the treatments. In the current review, using Hemophilia A (HA) therapy as an example, we will discuss the immunogenicity issue of multiple biological modalities. Currently, the number of therapeutic modalities that are approved or recently explored to treat HA, a hereditary bleeding disorder, is increasing rapidly. These include, but are not limited to, recombinant factor VIII proteins, PEGylated FVIII, FVIII Fc fusion protein, bispecific monoclonal antibodies, gene replacement therapy, gene editing therapy, and cell-based therapy. They offer the patients a broader range of more advanced and effective treatment options, yet immunogenicity remains the most critical complication in the management of this disorder. Recent advances in strategies to manage and mitigate immunogenicity will also be reviewed.
Collapse
Affiliation(s)
- Nhan H Nguyen
- Department of Pharmaceutical Sciences, School of Pharmacy and Pharmaceutical Sciences, University at Buffalo, Buffalo, NY, USA; Currently at Truvai Biosciences, Buffalo, NY, USA
| | - Nicole L Jarvi
- Department of Pharmaceutical Sciences, School of Pharmacy and Pharmaceutical Sciences, University at Buffalo, Buffalo, NY, USA
| | - Sathy V Balu-Iyer
- Department of Pharmaceutical Sciences, School of Pharmacy and Pharmaceutical Sciences, University at Buffalo, Buffalo, NY, USA.
| |
Collapse
|
5
|
Almohammadi AT, Radhwi O, AlAhwal H, Barefah A, Bahashwan S, Ashankyty IM, Almashjari M, Ayaz R, Al-Marzouki A, Zaher GF, Hussain H, Samman AA, Zakariyah A. Association of Genetic Variant FVIII Gene and Factor VIII: A Pilot Study Among Hemophilia A Female Relatives in Saudi Arabia. Cureus 2023; 15:e42038. [PMID: 37593302 PMCID: PMC10431930 DOI: 10.7759/cureus.42038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/17/2023] [Indexed: 08/19/2023] Open
Abstract
Hemophilia A (HA) is an X-linked recessive disorder that results from mutations in the factor VIII gene (FVIII). Most affected patients are males due to the inheritance of mutations in the FVIII gene from their mothers. Females are mostly found to be carriers unless they inherited the mutation from both parents. Obligate carriers of HA are mothers whose sons are affected with HA, or daughters who inherit the mutation from their affected fathers. A possible carrier of HA could be any female who has one or more affected relatives with HA in her family. Hemophilia A carriers (HACs) could present with similar symptoms to affected patients, including low factor VIII level, and risk of bleeding especially after surgical procedures or postpartum hemorrhage. OBJECTIVES Assessing the phenotype of possible HAC and its association with genetic variants in the FVIII gene for better screening methods for HAC. METHODS From the period between 25 June and 25 October 2021, the study was conducted at King Abdulaziz University Hospital in Jeddah, Saudi Arabia. We recruited seven mothers whose sons were affected with HA, and 18 possible HAC who are relatives to sever affected patients with HA. All 25 candidates were assessed for the FVIII level, activated partial thromboplastin time (APTT), and bleeding risk and sequenced a part of Exon14 in their FVIII gene. RESULTS Twenty-five percent of the participants show a low level of FVIII, however, none of them have prolonged bleeding nor suffer from bleeding tendency. We also identified two missense variants in six of the candidates, but the clinical significance of these variants has not been determined previously. CONCLUSION This pilot study is the first to explore the phenotype of several HAC in Saudi Arabia. A larger scale study with more HA patients and their female relatives is needed to understand the correlation between phenotype and genotype for better screening for HAC.
Collapse
Affiliation(s)
- Abdullah T Almohammadi
- Hematology, King Abdulaziz University, Faculty of Medicine, Jeddah, SAU
- Hematology Research Unit, King Fahd Medical Research Center, Jeddah, SAU
| | - Osman Radhwi
- Hematology, King Abdulaziz University, Faculty of Medicine, Jeddah, SAU
- Hematology Research Unit, King Fahd Medical Research Center, Jeddah, SAU
| | - Hatem AlAhwal
- Hematology, King Abdulaziz University, Faculty of Medicine, Jeddah, SAU
- Hematology Research Unit, King Fahd Medical Research Center, Jeddah, SAU
| | - Ahmed Barefah
- Hematology, King Abdulaziz University, Faculty of Medicine, Jeddah, SAU
- Hematology Research Unit, King Fahd Medical Research Center, Jeddah, SAU
| | - Salem Bahashwan
- Hematology, King Abdulaziz University, Faculty of Medicine, Jeddah, SAU
- Hematology Research Unit, King Fahd Medical Research Center, Jeddah, SAU
| | - Ibraheem M Ashankyty
- Medical Laboratory Sciences, King Abdulaziz University, Faculty of Applied Medical Sciences, Jeddah, SAU
- Hematology Research Unit, King Fahd Medical Research Center, Jeddah, SAU
| | - Majed Almashjari
- Medical Laboratory Sciences, King Abdulaziz University, Faculty of Applied Medical Sciences, Jeddah, SAU
- Hematology Research Unit, King Fahd Medical Research Center, Jeddah, SAU
| | - Rawan Ayaz
- Medical Laboratory Sciences, King Abdulaziz University, Faculty of Applied Medical Sciences, Jeddah, SAU
| | - Adel Al-Marzouki
- Hematology, King Abdulaziz University, Jeddah, SAU
- Hematology Research Unit, King Fahad Medical Research Center, Jeddah, SAU
| | - Galila F Zaher
- Hematology, King Abdulaziz University, Faculty of Medicine, Jeddah, SAU
- Hematology Research Unit, King Fahd Medical Research Center, Jeddah, SAU
| | - Hend Hussain
- Hematology, King Abdulaziz University, Faculty of Medicine, Jeddah, SAU
| | - Abeer A Samman
- Internal Medicine, King Abdulaziz University, Faculty of Medicine, Jeddah, SAU
| | | |
Collapse
|
6
|
Malec L, Van Damme A, Chan AKC, Spasova M, Jain N, Sensinger C, Dumont J, Lethagen S, Carcao M, Peyvandi F. Recombinant factor VIII Fc fusion protein for first-time immune tolerance induction: final results of the verITI-8 study. Blood 2023; 141:1982-1989. [PMID: 36735911 PMCID: PMC10646781 DOI: 10.1182/blood.2022017780] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 11/28/2022] [Accepted: 12/13/2022] [Indexed: 02/05/2023] Open
Abstract
Inhibitor development remains a major challenge in factor VIII (FVIII) replacement therapy. verITI-8 is the first prospective study of a recombinant FVIII Fc fusion protein (rFVIIIFc; efmoroctocog alfa) for first-time immune tolerance induction (ITI) in males with severe hemophilia A and high-titer inhibitors (historical peak ≥5 Bethesda units [BU]/mL). In this single-arm, open-label, multicenter study, screening was followed by ITI (rFVIIIFc 200 IU/kg per day until tolerization or maximum of 48 weeks). Those who achieved ITI success entered a tapering period, returning to standard prophylaxis, and then entered follow-up. Primary end point was time to tolerization with rFVIIIFc defined by inhibitor titer <0.6 BU/mL, incremental recovery (IR) ≥66% of expected IR (IR ≥1.32 IU/dL per IU/kg), and half-life (t½) ≥7 hours within 48 weeks. Sixteen patients received ≥1 rFVIIIFc dose. Twelve (75%), 11 (69%), and 10 patients (63%), respectively, achieved negative inhibitor titers, an IR ≥66%, and a t½ ≥7 hours (ie, tolerance) within 48 weeks. Median times in weeks to achieve these markers of success were 7.4 (interquartile range [IQR], 2.2-17.8), 6.8 (IQR, 5.4-22.4), and 11.7 (IQR, 9.8-26.2), respectively. All patients experienced ≥1 treatment-emergent adverse event (TEAE), and 1 reported ≥1 related TEAE (injection site pain). Nine patients experienced ≥1 treatment-emergent serious AE. No thrombotic events, discontinuations because of AEs, or deaths were reported during the study. As the first extended half-life rFVIII with prospective data in ITI, rFVIIIFc offered short time to tolerization with durable responses in almost two-thirds of patients and was well tolerated. This trial was registered at www.clinicaltrials.gov as #NCT03093480.
Collapse
Affiliation(s)
- Lynn Malec
- Versiti Blood Research Institute, Milwaukee, WI
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI
| | - An Van Damme
- Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Anthony K. C. Chan
- Department of Pediatrics, McMaster Children's Hospital, McMaster University, Hamilton, ON, Canada
| | | | | | | | | | | | - Manuel Carcao
- Division of Haematology/Oncology, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Flora Peyvandi
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
- Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| |
Collapse
|
7
|
Sarmiento Doncel S, Díaz Mosquera GA, Cortes JM, Agudelo Rico C, Meza Cadavid FJ, Peláez RG. Haemophilia A: A Review of Clinical Manifestations, Treatment, Mutations, and the Development of Inhibitors. Hematol Rep 2023; 15:130-150. [PMID: 36810557 PMCID: PMC9944491 DOI: 10.3390/hematolrep15010014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 09/07/2022] [Accepted: 02/10/2023] [Indexed: 02/18/2023] Open
Abstract
The purpose of this narrative review was to provide an overview that allows readers to improve their understanding of hemophilia A, which is considered a genetic disease with a high impact on the quality of life of people who suffer from it is considered one of the diseases with the highest cost for health systems (In Colombia it is part of the five diseases with the greatest economic impact). After this exhaustive review, we can see that the treatment of hemophilia is on the way to precision medicine, which involves genetic variables specific to each race and ethnicity, pharmacokinetics (PK), as well as environmental factors and lifestyle. Knowing the impact of each of these variables and their relationship with the efficacy of treatment (prophylaxis: regular infusion of the missing clotting factor VIII in order to prevent spontaneous bleeding) will allow for individualizing the medical behavior in a cost-effective way. For this is required to build more strong scientific evidence with statistical power that allows us to infer.
Collapse
Affiliation(s)
- Samuel Sarmiento Doncel
- Integral Solutions SD SAS, Integral Solutions Research, Bogota 110121, Colombia
- Life Sciences and Health Research Group, Graduates School, CES University, Medellin 050021, Colombia
| | | | | | - Carol Agudelo Rico
- Integral Solutions SD SAS, Integral Solutions Research, Bogota 110121, Colombia
| | - Francisco Javier Meza Cadavid
- Integral Solutions SD SAS, Integral Solutions Research, Bogota 110121, Colombia
- Hospital Universitario San Jorge, Pereira 660002, Colombia
| | - Ronald Guillermo Peláez
- Life Sciences and Health Research Group, Graduates School, CES University, Medellin 050021, Colombia
| |
Collapse
|
8
|
Feher M, Saguner AM, Kirstein B, Vogler J, Eitel C, Phan HL, Keelani A, Cimen T, Hatahet S, Trajanoski D, Samara O, Kuck KH, Tilz RR, Heeger CH. Safety and Feasibility of Catheter Ablation Procedures in Patients with Bleeding Disorders. J Clin Med 2022; 11:jcm11236956. [PMID: 36498531 PMCID: PMC9739729 DOI: 10.3390/jcm11236956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 11/14/2022] [Accepted: 11/24/2022] [Indexed: 11/29/2022] Open
Abstract
Aims/Objectives: Patients with bleeding disorders are a rare and complex population in catheter ablation (CA) procedures. The most common types of bleeding disorders are von Willebrand disease (VWD) and hemophilia A (HA). Patients with VWD or HA tend to have a higher risk of bleeding complications compared to other patients. There is a lack of data concerning peri- and postinterventional coagulation treatment. We sought to assess the optimal management of patients with VWD and HA referred for catheter ablation procedures. Methods and Results: In this study, we analyzed patients with VWD or HA undergoing CA procedures at two centers in Germany and Switzerland between 2016 and 2021. Clotting factors were administered in conjunction with hemostaseological recommendations. CA was performed as per the institutional standard. During the procedure, unfractionated heparin (UFH) was given intravenously with respect to the activated clotting time (ACT). Primary endpoints included the feasibility of the procedure, bleeding complications, and thromboembolic events during the procedure. Secondary endpoints included bleeding complications and thromboembolic events up to one year after catheter ablation. A total of seven patients (three VWD Type I, one VWD Type IIa, three HA) underwent 10 catheter ablation procedures (pulmonary vein isolation (PVI): two × radiofrequency (RF), one × laser balloon (LB), one × cryoballoon (CB); PVI + cavotricuspid isthmus (CTI): one × RF; PVI + left atrial appendage isolation (LAAI): one × RF; Premature ventricular contraction (PVC): three × RF; Atrioventricular nodal reentrant tachycardia (AVNRT): one × RF). VWD patients received 2000−3000 IE Wilate i.v. 30 to 45 min prior to ablation. Patients with HA received 2000−3000 IE factor VIII before the procedure. All patients undergoing PVI received UFH (cumulative dose 9000−18,000 IE) with a target ACT of >300 s. All patients after PVI were started on oral anticoagulation (OAC) 12 h after ablation. Two patients received aspirin (acetylsalicylic acid; ASA) for 4 weeks after the ablation of left-sided PVCs. No anticoagulation was prescribed after slow pathway modulation in a case with AVNRT. No bleeding complications or thromboembolic events were reported. During a follow-up of one year, one case of gastrointestinal bleeding occurred following OAC withdrawal after LAA occlusion. Conclusions: After the substitution of clotting factors, catheter ablation in patients with VWD and HA seems to be safe and feasible.
Collapse
Affiliation(s)
- Marcel Feher
- Department of Rhythmology, University Heart Center Lübeck, University Hospital Schleswig-Holstein, 24105 Kiel, Germany
| | - Ardan M. Saguner
- Department of Cardiology, Universitätsspital Zurich, 8091 Zurich, Switzerland
| | - Bettina Kirstein
- Department of Rhythmology, University Heart Center Lübeck, University Hospital Schleswig-Holstein, 24105 Kiel, Germany
| | - Julia Vogler
- Department of Rhythmology, University Heart Center Lübeck, University Hospital Schleswig-Holstein, 24105 Kiel, Germany
| | - Charlotte Eitel
- Department of Rhythmology, University Heart Center Lübeck, University Hospital Schleswig-Holstein, 24105 Kiel, Germany
| | - Huong-Lan Phan
- Department of Rhythmology, University Heart Center Lübeck, University Hospital Schleswig-Holstein, 24105 Kiel, Germany
| | - Ahmad Keelani
- Department of Rhythmology, University Heart Center Lübeck, University Hospital Schleswig-Holstein, 24105 Kiel, Germany
| | - Tolga Cimen
- Department of Cardiology, Universitätsspital Zurich, 8091 Zurich, Switzerland
| | - Sascha Hatahet
- Department of Rhythmology, University Heart Center Lübeck, University Hospital Schleswig-Holstein, 24105 Kiel, Germany
| | - Darko Trajanoski
- Department of Rhythmology, University Heart Center Lübeck, University Hospital Schleswig-Holstein, 24105 Kiel, Germany
| | - Omar Samara
- Department of Rhythmology, University Heart Center Lübeck, University Hospital Schleswig-Holstein, 24105 Kiel, Germany
| | - Karl-Heinz Kuck
- Department of Rhythmology, University Heart Center Lübeck, University Hospital Schleswig-Holstein, 24105 Kiel, Germany
- LANS Cardio, 20354 Hamburg, Germany
| | - Roland R. Tilz
- Department of Rhythmology, University Heart Center Lübeck, University Hospital Schleswig-Holstein, 24105 Kiel, Germany
- LANS Cardio, 20354 Hamburg, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Lübeck, 20246 Hamburg, Germany
| | - Christian-H. Heeger
- Department of Rhythmology, University Heart Center Lübeck, University Hospital Schleswig-Holstein, 24105 Kiel, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Lübeck, 20246 Hamburg, Germany
- Correspondence: ; Tel.: +49-451-500-75293
| |
Collapse
|
9
|
Mafisa L, Dlova AN, Moodley V. The profile of patients with haemophilia managed at a haemophilia treatment centre in Pretoria, Gauteng. S Afr Fam Pract (2004) 2022; 64:e1-e7. [DOI: 10.4102/safp.v64i1.5551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 05/28/2022] [Accepted: 05/29/2022] [Indexed: 11/01/2022] Open
|
10
|
Noé V, Aubets E, Félix AJ, Ciudad CJ. Nucleic acids therapeutics using PolyPurine Reverse Hoogsteen hairpins. Biochem Pharmacol 2020; 189:114371. [PMID: 33338475 DOI: 10.1016/j.bcp.2020.114371] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 12/10/2020] [Accepted: 12/11/2020] [Indexed: 02/08/2023]
Abstract
PolyPurine Reverse Hoogsteen hairpins (PPRHs) are DNA hairpins formed by intramolecular reverse Hoogsteen bonds which can bind to polypyrimidine stretches in dsDNA by Watson:Crick bonds, thus forming a triplex and displacing the fourth strand of the DNA complex. PPRHs were first described as a gene silencing tool in vitro for DHFR, telomerase and survivin genes. Then, the effect of PPRHs directed against the survivin gene was also determined in vivo using a xenograft model of prostate cancer cells (PC3). Since then, the ability of PPRHs to inhibit gene expression has been explored in other genes involved in cancer (BCL-2, mTOR, topoisomerase, C-MYC and MDM2), in immunotherapy (SIRPα/CD47 and PD-1/PD-L1 tandem) or in replication stress (WEE1 and CHK1). Furthermore, PPRHs have the ability to target the complementary strand of a G-quadruplex motif as a regulatory element of the TYMS gene. PPRHs have also the potential to correct point mutations in the DNA as shown in two collections of CHO cell lines bearing mutations in either the dhfr or aprt loci. Finally, based on the capability of PPRHs to form triplexes, they have been incorporated as probes in biosensors for the determination of the DNA methylation status of PAX-5 in cancer and the detection of mtLSU rRNA for the diagnosis of Pneumocystis jirovecii. Of note, PPRHs have high stability and do not present immunogenicity, hepatotoxicity or nephrotoxicity in vitro. Overall, PPRHs constitute a new economical biotechnological tool with multiple biomedical applications.
Collapse
Affiliation(s)
- Véronique Noé
- Department of Biochemistry and Physiology, School of Pharmacy and Food Sciences, & IN2UB, University of Barcelona, 08028 Barcelona, Spain
| | - Eva Aubets
- Department of Biochemistry and Physiology, School of Pharmacy and Food Sciences, & IN2UB, University of Barcelona, 08028 Barcelona, Spain
| | - Alex J Félix
- Department of Biochemistry and Physiology, School of Pharmacy and Food Sciences, & IN2UB, University of Barcelona, 08028 Barcelona, Spain
| | - Carlos J Ciudad
- Department of Biochemistry and Physiology, School of Pharmacy and Food Sciences, & IN2UB, University of Barcelona, 08028 Barcelona, Spain.
| |
Collapse
|
11
|
Villarreal-Martínez L, Ibarra-Ramirez M, Calvo-Anguiano G, Lugo-Trampe JDJ, Luna-Záizar H, Martínez-de-Villarreal LE, Meléndez-Aranda L, Jaloma-Cruz AR. Molecular genetic diagnosis by next-generation sequencing in a cohort of Mexican patients with haemophilia and report of novel variants. Blood Cells Mol Dis 2020; 83:102423. [PMID: 32224444 DOI: 10.1016/j.bcmd.2020.102423] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 03/08/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Molecular analysis in haemophilia is currently used in the diagnosis, treatment and prognosis of this disease. Hispanic populations in Latin America have been of interest to researchers due to the reportedly high prevalence of inhibitors in these patients. AIM To perform next-generation sequencing (NGS) in a cohort of Mexican patients with HA and HB and correlate with clinical phenotypes. METHODS Patients with Haemophilia A (HA) or haemophilia B (HB), were evaluated using NGS with an Ion AmpliSeq Custom Panel. Odds ratios (ORs) for associations between F8 variants and inhibitors were obtained. RESULTS A total of 85 patients (60 with HA and 25 with HB) were included. Pathogenic variants in F8 were found in 93.3% of HA patients and in F9 in 96% of HB patients. Twelve novel potentially pathogenic variants were found. Inhibitors were observed in 20% of patients with severe HA. Four patients clinically diagnosed with HA were negative for F8 variants. CONCLUSION Overall detection rate of pathogenic variants in F8 and F9 genes was 94.6%. We identified 12 non previously reported variants and pathogenic variants in other coagulation related genes. Molecular diagnosis of HA and HB permits better options for management, assessment and genetic counseling.
Collapse
Affiliation(s)
- Laura Villarreal-Martínez
- Hematology Service, Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León. Monterrey, Nuevo León, Mexico
| | - Marisol Ibarra-Ramirez
- Department of Genetics, Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León. Monterrey, Nuevo León, Mexico
| | - Geovana Calvo-Anguiano
- Department of Genetics, Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León. Monterrey, Nuevo León, Mexico
| | - José de Jesús Lugo-Trampe
- Department of Genetics, Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León. Monterrey, Nuevo León, Mexico
| | - Hilda Luna-Záizar
- Departamento de Química, Centro Universitario de Ciencias Exactas e Ingenierías, Universidad de Guadalajara. Guadalajara, Jalisco, Mexico
| | - Laura Elia Martínez-de-Villarreal
- Department of Genetics, Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León. Monterrey, Nuevo León, Mexico
| | - Lennon Meléndez-Aranda
- División de Genética, Centro de Investigación Biomédica de Occidente, Instituto Mexicano del Seguro Social, Guadalajara, Jalisco, Mexico; Doctorado en Genética Humana, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara Guadalajara, Jalisco, Mexico
| | - Ana-Rebeca Jaloma-Cruz
- División de Genética, Centro de Investigación Biomédica de Occidente, Instituto Mexicano del Seguro Social, Guadalajara, Jalisco, Mexico.
| |
Collapse
|
12
|
Low Dose Prophylaxis in Hemophilia Care. Indian J Hematol Blood Transfus 2019; 36:16-25. [PMID: 32158085 DOI: 10.1007/s12288-019-01147-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 06/10/2019] [Indexed: 01/25/2023] Open
Abstract
Hemophilia is an inherited bleeding disorder which causes impaired blood clotting. The severity of disease depends on the type of Hemophilia, level of clotting factor concentrate (CFC), phenotypic heterogeneity and the development of inhibitors. The currently accepted standard of care of this disease is prophylaxis therapy (PT) with CFC. Prophylaxis therapy for Hemophilia is given in developed countries for the last few decades. On the contrary, episodic therapy (ET) is still the mode of treatment in middle and low income countries. ET is documented to have several potential risks such as increased bleeding rate, disability due to haemarthrosis, poor quality of life and increased chances of mortality. Several studies conducted in developed countries have confirmed the clinical efficacy of PT in Hemophilia treatment. Currently, there exist several challenges for implementation of this effective treatment in resource poor nations. Low dose prophylaxis (LDP) has been developed as a solution to minimize these challenges and to provide better care for subjects with Hemophilia from low resource countries. The impact of LDP was evaluated by several recent studies and the reported clinical outcomes seem to suggest an optimistic future for this line of therapy. Several themes related to Hemophilia care like inhibitor development, tolerance, pharmacokinetics of CFCs and cost-benefit analysis of different prophylaxis regimens are currently understood poorly. These distinct elements are highly relevant to assess the actual benefits of LDP regimen in a global scale.
Collapse
|
13
|
Gangodkar P, Ranade S, Anand S, Bapat A, Khatod K, Shah P, Agarwal M, Phadke N. Use of two complementary new molecular techniques, next-generation sequencing and droplet digital PCR, for diagnosis of an F8 gene deletion and subsequent carrier analysis in a family with haemophilia A: A Case Report. Haemophilia 2018; 24:e425-e427. [PMID: 30299569 DOI: 10.1111/hae.13613] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 07/30/2018] [Accepted: 08/28/2018] [Indexed: 12/20/2022]
Affiliation(s)
- Priyanka Gangodkar
- GenePath Dx, Causeway Healthcare Private Limited, Phadke Hospital, Pune, India.,I-SHARE Foundation, Pune, India
| | - Shatakshi Ranade
- GenePath Dx, Causeway Healthcare Private Limited, Phadke Hospital, Pune, India.,I-SHARE Foundation, Pune, India
| | - Siddharth Anand
- GenePath Dx, Causeway Healthcare Private Limited, Phadke Hospital, Pune, India.,I-SHARE Foundation, Pune, India
| | - Ashwini Bapat
- GenePath Dx, Causeway Healthcare Private Limited, Phadke Hospital, Pune, India.,I-SHARE Foundation, Pune, India
| | - Kavita Khatod
- GenePath Dx, Causeway Healthcare Private Limited, Phadke Hospital, Pune, India
| | - Parth Shah
- Supratech Micropath Laboratories, Ahmedabad, India
| | - Meenal Agarwal
- GenePath Dx, Causeway Healthcare Private Limited, Phadke Hospital, Pune, India.,I-SHARE Foundation, Pune, India
| | - Nikhil Phadke
- GenePath Dx, Causeway Healthcare Private Limited, Phadke Hospital, Pune, India.,I-SHARE Foundation, Pune, India
| |
Collapse
|
14
|
Ibrahim UA, Ahmed SG. Pathophysiology of bleeding diathesis in haemophilia-A: A sequential and critical appraisal of non-FVIII related haemostatic dysfunctions and their therapeutic implications. EGYPTIAN JOURNAL OF MEDICAL HUMAN GENETICS 2018. [DOI: 10.1016/j.ejmhg.2018.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
|
15
|
Ibrahim UA, Ahmed SG. Determinants and modifiers of bleeding phenotypes in haemophilia-A: General and tropical perspectives. EGYPTIAN JOURNAL OF MEDICAL HUMAN GENETICS 2018. [DOI: 10.1016/j.ejmhg.2017.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
|
16
|
Abstract
: Hemophilia A carriers have an abnormal X chromosome with a molecular abnormality of FVIII gene. These carriers, long considered to be free of bleeding risk, could have the same symptoms as mild hemophiliacs. This study aim to assess bleeding risk of hemophilia A carriers monitored at the Clinical Hematology Department of Dakar. This is a prospective study of a period of 6 months including 22 hemophilia A carriers aged between 8 and 48 years. Hemophilia carriers were recruited using the genealogical tree of hemophiliacs followed in the service. Their diagnosis was carried out by long range PCR and Sanger sequencing method searching the molecular abnormality responsible for hemophilia in their family. Bleeding risk was determined using a questionnaire consisting of different bleeding symptoms quoted from -1 to 4 according to the severity. Total of different values allow to determine the bleeding score which was pathological if it was greater than or equal to 1. Medium age was 22.5 years (8-48) (SD = 9.28). Four hemophilia A carriers (18.1%) presented bleeding symptoms and had a bleeding score at least 1 (P = 0.02). Menorrhagia was predominant (13.6%) followed by epistaxis (9%), gingivorrhagia (9%), and prolonged bleeding after tooth extraction (9%). Factor VIII level was lower in hemophilia carriers who presented bleeding (42 ± 8.61 UI/l) versus hemophilia carriers without bleeding (100 ± 50.95 UI/l) (P = 0.001). There was no significant correlation between bleeding occurrence and age (P = 0.81), activated patial thromboplastin time value (P = 0.97) and FVIII/Von Willebrand Factor ratio (P = 0.12). One in five hemophilia carriers presented bleeding and the questionnaire was effective to identify hemophilia carriers who had a risk of bleeding.
Collapse
|
17
|
Chen M, Chang SP, Ma GC, Lin WH, Chen HF, Chen SU, Tsai HD, Tsai FP, Shen MC. Preimplantation genetic diagnosis of hemophilia A. Thromb J 2016; 14:33. [PMID: 27766059 PMCID: PMC5056473 DOI: 10.1186/s12959-016-0098-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Preimplantation genetic diagnosis (PGD) is a powerful tool to tackle the transmission of monogenic inherited disorders in families carrying the diseases from generation to generation. It currently remains a challenging task, despite PGD having been developed over 25 years ago. The major difficulty is it does not have an easy and general formula for all mutations. Different gene locus needs individualized, customized design to make the diagnosis accurate enough to be applied on PGD, in which the quantity of DNA is scanty, whereas timely laboratory diagnosis is mandatory if fresh embryo transfer is desired occasionally. Indicators for outcome assessment of a successful PGD program include the successful diagnosis rate on blastomeres (Day 3 cleavage-stage embryo biopsy) or trophectoderm cells (Day 5/6 blastocyst biopsy), the implantation rate per embryo transferred, and the livebirth rate per oocyte retrieval cycle. Hemophilia A (HA) is an X-linked recessive bleeding disorder caused by various types of pathological defects in the factor VIII gene (F8). The mutation spectrum of the F8 is complex, according to our previous report, including large segmental intra-gene inversions, large segmental deletions spanning a few exons, point mutations, and total deletion caused by chromosomal structural rearrangements. In this review, the molecular methodologies used to tackle different mutants of the F8 in the PGD of HA are to be explained, and the experiences of successful use of amplification refractory mutation system-quantitative polymerase chain reaction (ARMS-qPCR) and linkage analysis for PGD of HA in our laboratory are also provided.
Collapse
Affiliation(s)
- Ming Chen
- Department of Genomic Medicine and Center for Medical Genetics, Changhua Christian Hospital, Changhua, Taiwan.,Department of Genomic Science and Technology, Changhua Christian Hospital Healthcare System, Changhua, Taiwan.,Department of Obstetrics and Gynecology, College of Medicine and Hospital, National Taiwan University, Taipei, Taiwan.,Department of Medical Genetics, National Taiwan University Hospital, Taipei, Taiwan.,Department of Life Science, Tunghai University, Taichung, Taiwan.,Department of Obstetrics and Gynecology, Changhua Christian Hospital, Changhua, Taiwan
| | - Shun-Ping Chang
- Department of Genomic Medicine and Center for Medical Genetics, Changhua Christian Hospital, Changhua, Taiwan.,Department of Genomic Science and Technology, Changhua Christian Hospital Healthcare System, Changhua, Taiwan
| | - Gwo-Chin Ma
- Department of Genomic Medicine and Center for Medical Genetics, Changhua Christian Hospital, Changhua, Taiwan.,Department of Genomic Science and Technology, Changhua Christian Hospital Healthcare System, Changhua, Taiwan.,Institute of Biochemistry, Microbiology and Immunology, Chung Shan Medical University, Taichung, Taiwan.,Department of Medical Laboratory Science and Biotechnology, Central Taiwan University of Science and Technology, Taichung, Taiwan
| | - Wen-Hsian Lin
- Department of Genomic Medicine and Center for Medical Genetics, Changhua Christian Hospital, Changhua, Taiwan.,Department of Genomic Science and Technology, Changhua Christian Hospital Healthcare System, Changhua, Taiwan
| | - Hsin-Fu Chen
- Department of Obstetrics and Gynecology, College of Medicine and Hospital, National Taiwan University, Taipei, Taiwan
| | - Shee-Uan Chen
- Department of Obstetrics and Gynecology, College of Medicine and Hospital, National Taiwan University, Taipei, Taiwan
| | - Horng-Der Tsai
- Institute of Biochemistry, Microbiology and Immunology, Chung Shan Medical University, Taichung, Taiwan
| | - Feng-Po Tsai
- Po-Yuan Women's Clinic and IVF Center, Changhua, Taiwan
| | - Ming-Ching Shen
- Department of Internal Medicine, and Thrombosis and Hemostasis Center, Changhua Christian Hospital, Changhua, Taiwan
| |
Collapse
|
18
|
AlFadhli S, Nizam R. Violating the theory of single gene-single disorder: inhibitor development in hemophilia. Indian J Hematol Blood Transfus 2015; 31:162-8. [PMID: 25825553 PMCID: PMC4375149 DOI: 10.1007/s12288-014-0473-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Accepted: 10/27/2014] [Indexed: 11/26/2022] Open
Abstract
Hemophilia is clinically and genetically heterogeneous blood disorder with several known gene defects accounting for the diversity of disease phenotype and inhibitor production. Although increasing number of causative mutations have been reported, not much is known regarding the root cause of inhibitor development against infused blood clotting factors, which represents a major challenge in the treatment of disease. The variations in the severity and frequency of bleeding in hemophiliacs with same molecular defect, indicates the role of modifier genes in the pathogenesis of disease. Herein, we aim to review and summarise the literature over the past decade, to gain insight into what is critical for the development of inhibitors in hemophilia. Aside from potential mutations in factor VIII and IX, polymorphisms in various genes such as human leukocyte antigen-I (HLA-I), HLA-II, tumor necrosis factor-alpha, interleukin-10 and cytotoxic T-lymphocyte associated antigen-4, also tends to contribute to the development of inhibitors. Violating the theory of single gene-single disorder, new research indicates that inhibitor arise from a complex interplay of multiple genetic, immunological and environmental factors. With the revolutionary advances in whole genome sequencing, we propose a detailed genome wide study to identify the spectrum of genetic markers involved in the development of inhibitors for better diagnostics and therapeutics.
Collapse
Affiliation(s)
- Suad AlFadhli
- Department of Medical Laboratory Sciences, Faculty of Allied Health Sciences, Kuwait University, 31470, Sulaibekhat, Kuwait
| | - Rasheeba Nizam
- Department of Medical Laboratory Sciences, Faculty of Allied Health Sciences, Kuwait University, 31470, Sulaibekhat, Kuwait
| |
Collapse
|