1 Approaches to Plasma Fractionation for Improved Recovery and the Development of Potentially Useful Clinical Factors

Treatment of congenital coagulopathies, from biologic to biotechnological drugs: The relevance of gene editing (CRISPR/Cas)

Congenital coagulopathies have, throughout the history of medicine, been a focus of scientific study and of great interest as they constitute an alteration of one of the most important and conserved pathways of evolution. The first therapeutic strategies developed to address them were aimed at restoring the blood components lost during hemorrhage by administering whole blood or plasma. Later on, the use of cryoprecipitates was a significant breakthrough as it made it possible to decrease the volumes of blood infused. In the 1970' and 80', clotting factor concentrates became the treatment and, from the 1990's to the present day, recombinant factors -with increasingly longer half-lives- have taken over as the treatment of choice for certain coagulopathies in a seamless yet momentous transition from biological to biotechnological drugs. The beginning of this century, however, saw the emergence of new advanced (gene and cell) treatments, which are currently transforming the therapeutic landscape. The possibility to use cells and viruses as well as specific or bispecific antibodies as medicines is likely to spark a revolution in the world of pharmacology where therapies will be individualized and have long-term effects. Specifically, attention is nowadays focused on the development of gene editing strategies, chiefly those based on CRISPR/Cas technology. Rare coagulopathies such as hemophilia A and B, or even ultra-rare ones such as factor V deficiency, could be among those deriving the greatest benefit from these new developments.

Future trends in blood component preparation

In the coming years, blood banking and transfusion medicine are expected to undergo a number of changes in areas such as the refinement of plasma fractionation, advanced pheresis techniques and in the improvement of safety of blood products. In addition, recombinant DNA technology is believed to hold much promise as an alternate source of plasma proteins and within 5-10 years will probably replace at least several plasma derivatives. Substitutes for red cells and platelets, although more difficult to develop, may also become available in the future. These developments will affect the need for and the supply of blood in times to come. It is expected that the traditional supply system will continue to function for many more years but will most likely have increasing difficulty to meet the enlarged demand for safe products and to compete with the progress of biotechnology.