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Zhao L, Fang S, Ma Y, Ren J, Hao L, Wang L, Yang J, Lu X, Yang L, Wang G. Targeted genome engineering based on CRISPR/Cas9 system to enhance FVIII expression in vitro. Gene 2024; 896:148038. [PMID: 38036077 DOI: 10.1016/j.gene.2023.148038] [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: 08/30/2023] [Revised: 11/13/2023] [Accepted: 11/27/2023] [Indexed: 12/02/2023]
Abstract
BACKGROUND Hemophilia A is caused by a deficiency of coagulation factor VIII in the body due to a defect in the F8 gene. The emergence of CRISPR/Cas9 gene editing technology will make it possible to alter the expression of the F8 gene in hemophiliacs, while achieving a potential cure for the disease. METHODS Initially, we identified high-activity variants of FVIII and constructed donor plasmids using enzymatic digestion and ligation techniques. Subsequently, the donor plasmids were co-transfected with sgRNA-Cas9 protein into mouse Neuro-2a cells, followed by flow cytometry-based cell sorting and puromycin selection. Finally, BDD-hF8 targeted to knock-in the mROSA26 genomic locus was identified and validated for FVIII expression. RESULTS We identified the p18T-BDD-F8-V3 variant with high FVIII activity and detected the strongest pX458-mROSA26-int1-sgRNA1 targeted cleavage ability and no cleavage events were found at potential off-target sites. Targeted knock-in of BDD-hF8 cDNA at the mROSA26 locus was achieved based on both HDR/NHEJ gene repair approaches, and high level and stable FVIII expression was obtained, successfully realizing gene editing in vitro. CONCLUSIONS Knock-in of exogenous genes based on the CRISPR/Cas9 system targeting genomic loci is promising for the research and treatment of a variety of single-gene diseases.
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Affiliation(s)
- Lidong Zhao
- Department of Hematology, The Second Hospital of Shanxi Medical University, Taiyuan, China; Department of Hematology, Linfen Central Hospital, Linfen, Shanxi, China
| | - Shuai Fang
- Department of Hematology, The Second Hospital of Shanxi Medical University, Taiyuan, China; The Shanxi Provincial Center for Disease Control and Prevention, Taiyuan, Shanxi, China
| | - Yanchun Ma
- Department of Hematology, The Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Juan Ren
- Department of Hematology, The Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Lixia Hao
- Department of Hematology, The Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Lei Wang
- Department of Hematology, The Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Jia Yang
- Department of Hematology, The Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Xiaomei Lu
- Department of Hematology, The Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Linhua Yang
- Department of Hematology, The Second Hospital of Shanxi Medical University, Taiyuan, China.
| | - Gang Wang
- Department of Hematology, The Second Hospital of Shanxi Medical University, Taiyuan, China.
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Pipe SW, Dunn AL, Young G. Efficacy and safety evaluation of eptacog beta (coagulation factor VIIa [recombinant]-jncw) for the treatment of hemophilia A and B with inhibitors. Expert Rev Hematol 2023; 16:715-729. [PMID: 37602448 DOI: 10.1080/17474086.2023.2248385] [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: 04/20/2023] [Revised: 07/26/2023] [Accepted: 08/11/2023] [Indexed: 08/22/2023]
Abstract
INTRODUCTION Bypassing agents (BPAs) are used to treat acute bleeding episodes, manage bleeding during perioperative care, and prophylactically minimize bleed occurrence in persons with hemophilia A or B with inhibitors (PwHABI). However, the effectiveness of BPAs that have been prescribed for the last several decades can be variable, motivating the development of a new recombinant activated factor VII, eptacog beta. AREAS COVERED This review covers key eptacog beta findings from phase 1b and phase 3 (PERSEPT) clinical trials, which formed the basis for its regulatory approval to treat PwHABI ages 12 and older. Descriptions of eptacog beta structure and glycosylation profile, mechanism of action, preclinical study results, and cost analyses are also presented. EXPERT OPINION PwHABI have had only two options for bleed treatment for the past several decades. With its distinct glycosylation profile, eptacog beta offers a novel therapy aiming to improve upon BPAs currently in use, providing an option with more than one dosing regimen and a rapid response that allows most bleeds to be treated with just one dose. This has become particularly important given the use of subcutaneous medications (e.g., emicizumab) for prophylaxis of bleeding. Clinicians should consider eptacog beta as a BPA for all PwHABI.
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Affiliation(s)
- Steven W Pipe
- Departments of Pediatrics and Pathology, University of Michigan, Ann Arbor, MI, USA
| | - Amy L Dunn
- Nationwide Children's Hospital, The Ohio State University, Columbus, OH, USA
| | - Guy Young
- Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA, USA
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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3
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El Maamari J, Amid A, Pelland-Marcotte MC, Tole S. Between Scylla and Charybdis: thrombosis in children with hemophilia. Front Pediatr 2023; 11:1173549. [PMID: 37287631 PMCID: PMC10242037 DOI: 10.3389/fped.2023.1173549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 04/27/2023] [Indexed: 06/09/2023] Open
Abstract
Thromboembolism is an infrequent complication in children with hemophilia that has been traditionally associated with the presence of a central venous access device. Novel rebalancing agents have shown promising results as prophylactic therapies to minimize the risk of bleeding but both thromboembolism and thrombotic microangiopathy have been reported as complications. The management of thrombosis in children with hemophilia is particularly challenging given the inherent risk of bleeding. In this paper, we present clinical vignettes to review the literature, highlight challenges, and describe our approach to managing thromboembolism in children with hemophilia.
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Affiliation(s)
- Jad El Maamari
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, BC Children’s Hospital, Vancouver, BC, Canada
| | - Ali Amid
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, BC Children’s Hospital, Vancouver, BC, Canada
| | - Marie-Claude Pelland-Marcotte
- Division of Pediatric Hematology-Oncology, CHU deQuébec—Centre Mère-Enfant Soleil, Quebec City, QC, Canada
- Research Center of the CHU de Québec, Axe Reproduction, Santé de la Mère et de l’Enfant, Quebec City, Canada
| | - Soumitra Tole
- Department of Pediatrics, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
- Department of Pediatrics, Division of Hematology/Oncology, London Health Sciences Centre, London, ON, Canada
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4
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Dou X, Zhang W, Poon MC, Zhang X, Wu R, Feng X, Yang L, Cheng P, Chen S, Wang Y, Zhou H, Huang M, Song Y, Jin C, Zhang D, Chen L, Liu W, Zhang L, Xue F, Yang R. Factor IX inhibitors in haemophilia B: A report of National Haemophilia Registry in China. Haemophilia 2023; 29:123-134. [PMID: 36163649 DOI: 10.1111/hae.14665] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 08/25/2022] [Accepted: 09/12/2022] [Indexed: 01/27/2023]
Abstract
INTRODUCTION The development of inhibitors against factor FIX (FIX) is the most serious complication of FIX replacement therapy in haemophilia B (HB) patients. Currently, only few cohorts of HB inhibitor patients have been reported worldwide. AIM This Chinese nationwide study of HB inhibitor patients explored their risk factors for FIX inhibitor development and experience on their management. METHODS We retrospectively analysed patient characteristics, F9 genotypes, treatment strategies and outcomes of HB inhibitor patients registered to the Chinese National Registry and Patient Organization Registry. RESULTS Forty-four unique HB inhibitor patients were identified in 4485 unique HB patients registered by year 2021 to the two Registries. Inhibitor diagnosis were usually delayed and the low prevalence (.98%) may suggest some inhibitor patients were not identified. Their median age at inhibitor diagnosis was 7.5 (IQR, 3.0-14.8) years. Most patients (95.5%) had high-titre inhibitors. Allergic/Anaphylactic reactions occurred in 59.1% patients. Large deletions and nonsense mutations were the most common F9 mutation types in our FIX inhibitor patients. Patients with large F9 gene deletions were more likely to develop inhibitors (p = .0002), while those with missense mutations had a low risk (p < .0001). Thirteen (29.5%) patients received immune tolerance induction (ITI) therapy using low-dose prothrombin complex concentrate regimens. Twelve completed ITI with three (25.0%) achieving success. Nephrotic syndrome developed in two (16.7%) patients during ITI. CONCLUSION This study reports the largest Chinese cohort of HB inhibitor patients. Large deletions were most significantly associated with inhibitor development. Low-dose ITI might be feasible for FIX inhibitor eradication.
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Affiliation(s)
- Xueqing Dou
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin Key Laboratory of Gene Therapy for Blood Diseases, CAMS Key Laboratory of Gene Therapy for Blood Diseases, Tianjin, China.,National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Wenhui Zhang
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin Key Laboratory of Gene Therapy for Blood Diseases, CAMS Key Laboratory of Gene Therapy for Blood Diseases, Tianjin, China
| | - Man-Chiu Poon
- Departments of Medicine, Pediatrics and Oncology, Cumming School of Medicine, University of Calgary, and the Southern Alberta Rare Blood and Bleeding Disorders Comprehensive Care Program, Foothills Hospital, Alberta Health Services, Calgary, Alberta, Canada
| | - Xinsheng Zhang
- Shandong Hemophilia Treatment Center, Shandong Blood Center, Jinan, China
| | - Runhui Wu
- Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Xiaoqin Feng
- Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Linhua Yang
- Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Peng Cheng
- Department of Hematology, Guangxi Medical University First Affiliated Hospital, Nanning, China
| | - Shu Chen
- Department of Hematology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Ying Wang
- Shenzhen Children's Hospital, Shenzhen, China
| | - Hu Zhou
- The Affiliated Cancer Hospital of Zhengzhou University/Henan Cancer hospital, Zhengzhou, China
| | - Meijuan Huang
- Fujian Medical University Union Hospital, Fujian Institute of Haematology, Fuzhou, China
| | | | - Chenghao Jin
- Department of Hematology, Jiangxi Provincial People's Hospital, Nanchang, China
| | - Donglei Zhang
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin Key Laboratory of Gene Therapy for Blood Diseases, CAMS Key Laboratory of Gene Therapy for Blood Diseases, Tianjin, China
| | - Lingling Chen
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin Key Laboratory of Gene Therapy for Blood Diseases, CAMS Key Laboratory of Gene Therapy for Blood Diseases, Tianjin, China
| | - Wei Liu
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin Key Laboratory of Gene Therapy for Blood Diseases, CAMS Key Laboratory of Gene Therapy for Blood Diseases, Tianjin, China
| | - Lei Zhang
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin Key Laboratory of Gene Therapy for Blood Diseases, CAMS Key Laboratory of Gene Therapy for Blood Diseases, Tianjin, China
| | - Feng Xue
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin Key Laboratory of Gene Therapy for Blood Diseases, CAMS Key Laboratory of Gene Therapy for Blood Diseases, Tianjin, China
| | - Renchi Yang
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin Key Laboratory of Gene Therapy for Blood Diseases, CAMS Key Laboratory of Gene Therapy for Blood Diseases, Tianjin, China
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5
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Cho S, Perry AM, Cheng AM, Wang C, Rico JF. Advances in Hemophilia A Management. Adv Pediatr 2022; 69:133-147. [PMID: 35985706 DOI: 10.1016/j.yapd.2022.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Hemophilia A is an inherited insufficiency of Factor VIII (FVIII), one of the critical clotting factors. The gold standard for the management of moderate-to-severe hemophilia A is prophylaxis using regular replacement therapy with clotting factor concentrates. Compared with conventional treatment, extended half-life products reduce the burden of frequent factor replacement injections. Of note, up to 30% of patients with hemophilia A receiving prophylactic factor infusions develop "inhibitors," neutralizing anti-FVIII autoantibodies. Therapeutic options for patients with hemophilia A and inhibitors include the immune tolerance induction (ie, eradication of inhibitors) and the management of acute bleeds with bypassing agents and/or emicizumab. Emicizumab is a biphasic monoclonal antibody mimicking activated FVIII, approved for patients with hemophilia A with/without inhibitors. Gene therapy is an emerging therapy for hemophilia A, essentially curing patients with hemophilia A or transforming them to a milder phenotype by establishing continuous endogenous expression of FVIII after one-time treatment.
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Affiliation(s)
- Sukjoo Cho
- Division of Hematology/Oncology, Department of Pediatrics, University of South Florida Morsani College of Medicine, 2 Tampa General Circle, 5th Floor, Tampa, FL 33606, USA
| | - Ashley M Perry
- Division of Hematology/Oncology, Department of Pediatrics, University of South Florida Morsani College of Medicine, 2 Tampa General Circle, 5th Floor, Tampa, FL 33606, USA
| | - Anna M Cheng
- Department of Pediatrics, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA
| | - Carrie Wang
- University of South Florida Morsani College of Medicine, 560 Channelside Drive, Tampa, FL 33602, USA
| | - Juan Felipe Rico
- Division of Hematology/Oncology, Department of Pediatrics, University of South Florida Morsani College of Medicine, 2 Tampa General Circle, 5th Floor, Tampa, FL 33606, USA.
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6
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Sun J, Li Z, Huang K, Ai D, Li G, Xie X, Gu H, Liu G, Zhen Y, Chen Z, Wu R. F8 gene mutation spectrum in severe hemophilia A with inhibitors: A large cohort data analysis from a single center in China. Res Pract Thromb Haemost 2022; 6:e12723. [PMID: 35702590 PMCID: PMC9175357 DOI: 10.1002/rth2.12723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 04/05/2022] [Accepted: 04/13/2022] [Indexed: 12/02/2022] Open
Abstract
Introduction Type of F8 gene mutation is the most important risk factor for inhibitor development in people with severe hemophilia A. However, there are few large cohort studies on the F8 mutation spectrum of people with severe hemophilia A with inhibitors. Objective This was the first large cohort study in children with severe hemophilia A with inhibitors from China that aimed to analyze the association between F8 variant types and inhibitor status. Methods The single‐center retrospective cohort study was conducted on children with severe hemophilia A with inhibitors admitted from January 2015 to December 2021. The clinical data were collected, and F8 genetic tests were performed. Results Among the 203 patients investigated, a mutation in F8 was identified in 196 cases. Most patients had deleterious mutations (153; 75.4%), including 82 cases of intron 22 inversions (40.4%); 40 cases of nonsense mutations (19.7%), with 15 cases in the light chain and 25 cases in the heavy chain; and 31 cases of large deletions or insertions (15.3%), with 29 cases involving more than one exon and 2 cases involving one exon. The large deletions or insertions encompassing multiple exons and nonsense mutations residing in the light chain were associated with not only the progression to a high‐titer inhibitor (P < .05) but also higher peak inhibitor titer (P < .05). Conclusion The F8 gene deleterious mutations, including intron 22 inversions, nonsense mutations, and large deletions or insertions, constitute the main mutation types in people with severe hemophilia A with inhibitors in China, with the latter mutation types (large deletions or insertions in multiple exons, and nonsense mutations in the light chain) signifying for a higher peak titer of inhibitor.
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Affiliation(s)
- Jie Sun
- Hemophilia Comprehensive Care Center Hematology Center Beijing Key Laboratory of Pediatric Hematology-Oncology National Key Discipline of Pediatrics (Capital Medical University) Key Laboratory of Major Diseases in Children Ministry of Education Beijing Children's Hospital Capital Medical University National Center for Children's Health Beijing China.,Hematologic Disease Laboratory Hematology Center Beijing Key Laboratory of Pediatric Hematology-Oncology National Key Discipline of Pediatrics (Capital Medical University) Key Laboratory of Major Diseases in Children Ministry of Education Beijing Pediatric Research Institute, Beijing Children's Hospital Capital Medical University National Center for Children's Health Beijing China
| | - Zekun Li
- Hemophilia Comprehensive Care Center Hematology Center Beijing Key Laboratory of Pediatric Hematology-Oncology National Key Discipline of Pediatrics (Capital Medical University) Key Laboratory of Major Diseases in Children Ministry of Education Beijing Children's Hospital Capital Medical University National Center for Children's Health Beijing China.,Hematologic Disease Laboratory Hematology Center Beijing Key Laboratory of Pediatric Hematology-Oncology National Key Discipline of Pediatrics (Capital Medical University) Key Laboratory of Major Diseases in Children Ministry of Education Beijing Pediatric Research Institute, Beijing Children's Hospital Capital Medical University National Center for Children's Health Beijing China
| | - Kun Huang
- Hemophilia Comprehensive Care Center Hematology Center Beijing Key Laboratory of Pediatric Hematology-Oncology National Key Discipline of Pediatrics (Capital Medical University) Key Laboratory of Major Diseases in Children Ministry of Education Beijing Children's Hospital Capital Medical University National Center for Children's Health Beijing China.,Hematologic Disease Laboratory Hematology Center Beijing Key Laboratory of Pediatric Hematology-Oncology National Key Discipline of Pediatrics (Capital Medical University) Key Laboratory of Major Diseases in Children Ministry of Education Beijing Pediatric Research Institute, Beijing Children's Hospital Capital Medical University National Center for Children's Health Beijing China
| | - Di Ai
- Hemophilia Comprehensive Care Center Hematology Center Beijing Key Laboratory of Pediatric Hematology-Oncology National Key Discipline of Pediatrics (Capital Medical University) Key Laboratory of Major Diseases in Children Ministry of Education Beijing Children's Hospital Capital Medical University National Center for Children's Health Beijing China.,Hematologic Disease Laboratory Hematology Center Beijing Key Laboratory of Pediatric Hematology-Oncology National Key Discipline of Pediatrics (Capital Medical University) Key Laboratory of Major Diseases in Children Ministry of Education Beijing Pediatric Research Institute, Beijing Children's Hospital Capital Medical University National Center for Children's Health Beijing China
| | - Gang Li
- Hematologic Disease Laboratory Hematology Center Beijing Key Laboratory of Pediatric Hematology-Oncology National Key Discipline of Pediatrics (Capital Medical University) Key Laboratory of Major Diseases in Children Ministry of Education Beijing Pediatric Research Institute, Beijing Children's Hospital Capital Medical University National Center for Children's Health Beijing China
| | - Xingjuan Xie
- Hemophilia Comprehensive Care Center Hematology Center Beijing Key Laboratory of Pediatric Hematology-Oncology National Key Discipline of Pediatrics (Capital Medical University) Key Laboratory of Major Diseases in Children Ministry of Education Beijing Children's Hospital Capital Medical University National Center for Children's Health Beijing China.,Hematologic Disease Laboratory Hematology Center Beijing Key Laboratory of Pediatric Hematology-Oncology National Key Discipline of Pediatrics (Capital Medical University) Key Laboratory of Major Diseases in Children Ministry of Education Beijing Pediatric Research Institute, Beijing Children's Hospital Capital Medical University National Center for Children's Health Beijing China
| | - Hao Gu
- Hemophilia Comprehensive Care Center Hematology Center Beijing Key Laboratory of Pediatric Hematology-Oncology National Key Discipline of Pediatrics (Capital Medical University) Key Laboratory of Major Diseases in Children Ministry of Education Beijing Children's Hospital Capital Medical University National Center for Children's Health Beijing China.,Hematologic Disease Laboratory Hematology Center Beijing Key Laboratory of Pediatric Hematology-Oncology National Key Discipline of Pediatrics (Capital Medical University) Key Laboratory of Major Diseases in Children Ministry of Education Beijing Pediatric Research Institute, Beijing Children's Hospital Capital Medical University National Center for Children's Health Beijing China
| | - Guoqing Liu
- Hemophilia Comprehensive Care Center Hematology Center Beijing Key Laboratory of Pediatric Hematology-Oncology National Key Discipline of Pediatrics (Capital Medical University) Key Laboratory of Major Diseases in Children Ministry of Education Beijing Children's Hospital Capital Medical University National Center for Children's Health Beijing China
| | - Yingzi Zhen
- Hemophilia Comprehensive Care Center Hematology Center Beijing Key Laboratory of Pediatric Hematology-Oncology National Key Discipline of Pediatrics (Capital Medical University) Key Laboratory of Major Diseases in Children Ministry of Education Beijing Children's Hospital Capital Medical University National Center for Children's Health Beijing China
| | - Zhenping Chen
- Hematologic Disease Laboratory Hematology Center Beijing Key Laboratory of Pediatric Hematology-Oncology National Key Discipline of Pediatrics (Capital Medical University) Key Laboratory of Major Diseases in Children Ministry of Education Beijing Pediatric Research Institute, Beijing Children's Hospital Capital Medical University National Center for Children's Health Beijing China
| | - Runhui Wu
- Hemophilia Comprehensive Care Center Hematology Center Beijing Key Laboratory of Pediatric Hematology-Oncology National Key Discipline of Pediatrics (Capital Medical University) Key Laboratory of Major Diseases in Children Ministry of Education Beijing Children's Hospital Capital Medical University National Center for Children's Health Beijing China
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Hassan E, Lancashire J, Motwani J. Emicizumab in previously untreated and minimally treated infants. Haemophilia 2022; 28:e61-e63. [PMID: 34981874 DOI: 10.1111/hae.14485] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 11/15/2021] [Accepted: 12/19/2021] [Indexed: 01/11/2023]
Affiliation(s)
- Eman Hassan
- Department of Paediatric Haematology, Birmingham Children's Hospital, Birmingham, UK.,Department of Paediatrics, Haematology and Oncology Unit, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Jonathan Lancashire
- Department of Paediatric Haematology, Birmingham Children's Hospital, Birmingham, UK
| | - Jayashree Motwani
- Department of Paediatric Haematology, Birmingham Children's Hospital, Birmingham, UK
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Dargaud Y, Escuriola‐Ettingshausen C. Recombinant porcine factor VIII: Lessons from the past and place in the management of hemophilia A with inhibitors in 2021. Res Pract Thromb Haemost 2021; 5:e12631. [PMID: 34849451 PMCID: PMC8606027 DOI: 10.1002/rth2.12631] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Revised: 10/25/2021] [Accepted: 10/31/2021] [Indexed: 11/09/2022] Open
Abstract
The most serious complication of factor VIII (FVIII) replacement therapy is the occurrence of anti-FVIII alloantibodies that can strongly reduce or abolish the effect of human FVIII products. Bypassing agents to control bleeding episodes are recommended for these patients, but their efficacy is difficult to predict and monitor. FVIII products derived from porcine plasma had an important role in the treatment of hemophilia A for 50 years, from 1954 to 2004. Indeed, porcine FVIII could achieve hemostasis in patients in whom human FVIII products were ineffective. A recombinant porcine FVIII product is now available. This highly purified protein has the same biochemical and hemostatic properties, but much lower risks of infection and toxicity compared with plasma-derived porcine FVIII. The product is licensed in the United States and Europe for the treatment of acquired hemophilia A. However, this recombinant molecule could also be of clinical interest for people with inherited hemophilia A and inhibitors, particularly for the management of bleeding episodes in people receiving emicizumab as prophylactic treatment in the absence of anti-porcine FVIII antibodies.
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Affiliation(s)
- Yesim Dargaud
- Unite d’Hemostase CliniqueCentre National de Reference de l'HemophilieHôpital Louis PradelLyonFrance
- UR 4609 Hemostase and ThromboseUniversite Claude Bernard Lyon 1LyonFrance
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9
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Mancuso ME, Male C, Kenet G, Kavakli K, Königs C, Blatný J, Fijnvandraat K. Prophylaxis in children with haemophilia in an evolving treatment landscape. Haemophilia 2021; 27:889-896. [PMID: 34547160 DOI: 10.1111/hae.14412] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 08/25/2021] [Accepted: 09/02/2021] [Indexed: 01/16/2023]
Abstract
INTRODUCTION For children with haemophilia, early initiation of prophylaxis is crucial to prevent life-threatening bleeds and maintain joint health throughout life. Options for prophylaxis have recently increased from replacement therapy with standard or extended half-life coagulation factor products to include other haemostasis products, such as the non-replacement therapy emicizumab. AIM To review key factors that determine the choice of prophylaxis in young children. METHODS Key clinical questions on the implementation of prophylaxis for haemophilia in children were identified and PubMed was searched for evidence supporting guidance on the implementation of prophylaxis. RESULTS The results of the literature search and the practical experience of the authors were used to build consensus on when to start prophylaxis, the pros and cons of the products available to guide the choice of product, and practical aspects of starting prophylaxis to guide the choice of regimen. CONCLUSIONS In this era of increasing therapeutic choices, available information about the range of treatment options must be considered when initiating prophylaxis in young children. Parents or care givers must be sufficiently informed to allow informed shared decision making. Although plentiful data and clinical experience have been gathered on prophylaxis with clotting factor replacement therapy, its use in young children brings practical challenges, such as the need for intravenous administration. In contrast, our relatively brief experience and limited data with subcutaneously administered non-replacement therapy (i.e., emicizumab) in this patient group imply that starting emicizumab prophylaxis in young children requires careful consideration, despite the more convenient route of administration.
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Affiliation(s)
- Maria Elisa Mancuso
- Centre for Thrombosis and Haemorrhagic Diseases, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Christoph Male
- Thrombosis & Haemostasis Unit, Department of Paediatrics, Medical University of Vienna, Vienna, Austria
| | - Gili Kenet
- The National Haemophilia Centre, The Amalia Biron Thrombosis Research Institute, Sheba Medical Centre, Tel Hashomer, Tel Aviv University, Tel Aviv, Israel
| | - Kaan Kavakli
- Department of Haematology, Ege University Faculty of Medicine, Children's Hospital, Bornova, Izmir, Turkey
| | - Christoph Königs
- Department of Paediatrics and Adolescent Medicine, Clinical and Molecular Haemostasis, University Hospital Frankfurt, Goethe University, Frankfurt, Germany
| | - Jan Blatný
- Department of Paediatric Haematology and Biochemistry, University Hospital Brno and Masaryk University, Brno, Czech Republic
| | - Karin Fijnvandraat
- Department of Paediatric Haematology, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
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10
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Abstract
Haemophilia is an inherited bleeding disorder in which the haemostatic defect results from deficiency of coagulation factor VIII (FVIII) in haemophilia A or factor IX (FIX) in haemophilia B. Traditional treatments for haemophilia have largely worked by directly replacing the missing coagulation factor, but face challenges due to the short half-life of FVIII and FIX, the need for frequent intravenous access and development of neutralising antibodies to coagulation factors (inhibitors). Recent advances in haemophilia therapy have worked to eliminate these challenges. Half-life extension of factor concentrates has lengthened the time needed between infusions, enhancing quality of life. Subcutaneous administration of therapeutics utilising alternative mechanisms to overcome inhibitors have expanded the options to prevent bleeding. Finally, initial successes with gene therapy offer a cautious hope for durable cure. In the present review, we will discuss currently available treatments, as well as highlight therapeutics in various stages of clinical development for the treatment of haemophilia A and B. In this review, we present therapies that are currently clinically available and highlight therapeutics that are in various stages of clinical development for the treatment of haemophilia A and B.
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Affiliation(s)
- Hannah Fassel
- Tufts University School of Medicine, Boston, MA, USA
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11
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Young G. Management of children with hemophilia A: How emicizumab has changed the landscape. J Thromb Haemost 2021; 19:1629-1637. [PMID: 33872458 DOI: 10.1111/jth.15342] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 04/09/2021] [Accepted: 04/13/2021] [Indexed: 12/27/2022]
Abstract
The key to having a good quality of life for an adult with hemophilia rests largely on how he or she was managed as children. With effective prophylaxis, young men can begin their adult life with excellent joint function and few, if any, other sequelae from their disease. Unfortunately, this outcome is not always (nor often) attained because of the limitations of the mainstay of treatment, which is factor replacement therapy. In resource-rich countries with an adequate supply of factor concentrates, the treatment burden and formation of inhibitors limit the potential for an ideal outcome, whereas in much of the world, factor concentrates are too expensive to even be an option. The novel agent, emicizumab, which has become available in numerous countries around the world, is reshaping how one approaches the treatment of children with hemophilia A. This Forum Article, based on a State-of-the-Art lecture given at the 2020 International Society on Thrombosis and Haemostasis Virtual Meeting, presents an approach including clinically applicable algorithms for treating children with hemophilia A in the new era with emicizumab.
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Affiliation(s)
- Guy Young
- Hemostasis and Thrombosis Center, Cancer and Blood Diseases Institute, Children's Hospital Los Angeles, University of Southern California Keck School of Medicine, Los Angeles, CA, USA
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12
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Dou X, Liu W, Poon MC, Zhang X, Wu J, Zeng X, Wu R, Hu Q, Li C, Wang X, Song X, Chen L, Zhang L, Xue F, Yang R. Patients with haemophilia A with inhibitors in China: a national real-world analysis and follow-up. Br J Haematol 2021; 192:900-908. [PMID: 33534930 DOI: 10.1111/bjh.17322] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 12/21/2020] [Indexed: 12/25/2022]
Abstract
The development of alloantibodies (inhibitors) against coagulation factor VIII (FVIII) is the most serious complication of FVIII replacement therapy in patients with haemophilia A (HA). We carried out a nationwide study focussing on patients with HA with inhibitors in China to evaluate the condition and management of this population. The study retrospectively analysed patient characteristics, clinical history, manifestation, treatment strategy as well as individual haemophilia care of 493 patients with inhibitors (466 with severe HA and 27 with non-severe HA) registered all over China. The median (interquartile range) age at diagnosis of FVIII inhibitors was 13 (5-28) years in patients with severe HA and 24 (10·5-39·5) years in patients with non-severe HA. Most patients (85%) had high-titre inhibitors. Prothrombin complex concentrate and recombinant activated coagulation factor VII were used respectively in 76·2% and 29·2% of patients for acute bleeding. Only 22·3% of patients underwent immune tolerance induction (ITI) treatment, of whom 64·9% achieved negative inhibitor titre. In patients who did not undergo ITI, the inhibitors turned negative in 17·7%, and patients with low peak inhibitor titre were more likely to acquire negative titre spontaneously (odds ratio 11·524, 95% confidence interval 5·222-25·432; P = 0·000). We recorded that 3·2% of the patients died from haemophilia-related life-threatening bleeding.
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Affiliation(s)
- Xueqing Dou
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin Laboratory of Blood Disease Gene Therapy, CAMS Key Laboratory of Gene Therapy for Blood Diseases, CAMS Center for Stem Cell Medicine, PUMC Department of Stem Cell and Regenerative Medicine, Tianjin, China
| | - Wei Liu
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin Laboratory of Blood Disease Gene Therapy, CAMS Key Laboratory of Gene Therapy for Blood Diseases, CAMS Center for Stem Cell Medicine, PUMC Department of Stem Cell and Regenerative Medicine, Tianjin, China
| | - Man-Chiu Poon
- Departments of Medicine, Pediatrics and Oncology, University of Calgary, Cumming School of Medicine and Southern Alberta Rare Blood and Bleeding Disorders Comprehensive Care Program, Foothills Medical Centre, Alberta Health Services, Calgary, AB, Canada
| | | | - Jingsheng Wu
- First Affiliated Hospital, Chinese University of Science and Technology, Hefei, China
| | - Xiaojing Zeng
- The Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Runhui Wu
- Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Qun Hu
- Department of Pediatric Hematology, Tongji Hospital of Tongji Medical College, Huazhong University of Sciences and Technology, Wuhan, China
| | - Chengping Li
- First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Xiaomin Wang
- Xinjiang Uygur Autonomous Region People's Hospital, Urumchi, China
| | - Xuewen Song
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin Laboratory of Blood Disease Gene Therapy, CAMS Key Laboratory of Gene Therapy for Blood Diseases, CAMS Center for Stem Cell Medicine, PUMC Department of Stem Cell and Regenerative Medicine, Tianjin, China
| | - Lingling Chen
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin Laboratory of Blood Disease Gene Therapy, CAMS Key Laboratory of Gene Therapy for Blood Diseases, CAMS Center for Stem Cell Medicine, PUMC Department of Stem Cell and Regenerative Medicine, Tianjin, China
| | - Lei Zhang
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin Laboratory of Blood Disease Gene Therapy, CAMS Key Laboratory of Gene Therapy for Blood Diseases, CAMS Center for Stem Cell Medicine, PUMC Department of Stem Cell and Regenerative Medicine, Tianjin, China
| | - Feng Xue
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin Laboratory of Blood Disease Gene Therapy, CAMS Key Laboratory of Gene Therapy for Blood Diseases, CAMS Center for Stem Cell Medicine, PUMC Department of Stem Cell and Regenerative Medicine, Tianjin, China
| | - Renchi Yang
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin Laboratory of Blood Disease Gene Therapy, CAMS Key Laboratory of Gene Therapy for Blood Diseases, CAMS Center for Stem Cell Medicine, PUMC Department of Stem Cell and Regenerative Medicine, Tianjin, China
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13
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Brackmann HH, Schramm W, Oldenburg J, Cano V, Turecek PL, Négrier C. Origins, Development, Current Challenges and Future Directions with Activated Prothrombin Complex Concentrate for the Treatment of Patients with Congenital Haemophilia with Inhibitors. Hamostaseologie 2020; 40:606-620. [PMID: 32717751 PMCID: PMC7772007 DOI: 10.1055/a-1159-4273] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 04/16/2020] [Indexed: 12/17/2022] Open
Abstract
Congenital haemophilia A (HA) is caused by deficiency of coagulation factor VIII (FVIII) activity, leading to spontaneous or traumatic bleeding events. While FVIII replacement therapy can treat and prevent bleeds, approximately 30% of patients with severe HA develop inhibitor antibodies that render FVIII replacement therapy ineffective. The bypassing agents (BPAs), activated prothrombin complex concentrate (aPCC) and recombinant activated FVII, first approved in 1977 and 1996, respectively, act to generate thrombin independent of pathways that involve factors IX and VIII. Both may be used in patients with congenital haemophilia and inhibitors (PwHIs) for the treatment and prevention of acute bleeds and quickly became standard of care. However, individual patients respond differently to different agents. While both agents are approved for on-demand treatment and perioperative management for patients with congenital haemophilia with inhibitors, aPCC is currently the only BPA approved worldwide for prophylaxis in PwHI. Non-factor therapies (NFTs) have a mechanism of action distinct from BPAs and have reported higher efficacy rates as prophylactic regimens. Nonetheless, treatment challenges remain with NFTs, particularly regarding the potential for synergistic action on thrombin generation with concomitant use of other haemostatic agents, such as BPAs, for the treatment of breakthrough bleeds and in perioperative management. Concomitant use of NFTs with other haemostatic agents could increase the risk of adverse events such as thromboembolic events or thrombotic microangiopathy. This review focuses on the origins, development and on-going role of aPCC in the evolving treatment landscape in the management of PwHI.
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Affiliation(s)
- Hans H. Brackmann
- Haemophilia Center, Institute of Experimental Haematology and Blood Transfusion, University of Bonn, Bonn, Germany
| | - Wolfgang Schramm
- Rudolf Marx-Stiftung für Hämostaseologie, Universität München and Bluterbetreuung Bayern e. V. (BBB) - Germany
| | - Johannes Oldenburg
- Haemophilia Center, Institute of Experimental Haematology and Blood Transfusion, University of Bonn, Bonn, Germany
| | - Viridiana Cano
- Shire International GmbH, a Takeda company, Zürich, Switzerland
| | | | - Claude Négrier
- Haemophilia and Thrombosis Centre, Louis Pradel Hospital, University Claude Bernard Lyon 1, Lyon, France
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14
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Harkins Druzgal C, Kizilocak H, Brown J, Sennett M, Young G. Neutralizing antidrug antibody to emicizumab in a patient with severe hemophilia A with inhibitors: New case with detailed laboratory evaluation. J Thromb Haemost 2020; 18:2205-2208. [PMID: 32544268 DOI: 10.1111/jth.14957] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 05/28/2020] [Accepted: 06/03/2020] [Indexed: 01/14/2023]
Abstract
Hemophilia A is an inherited bleeding disorder characterized by deficiency of the coagulation protein factor VIII. Development of clotting factor concentrates has resulted in an excellent prognosis for this historically fatal disease. However, neutralizing antidrug antibodies to factor concentrates can develop, complicating management and worsening the prognosis, and thus creating an unmet need for novel therapies. One such agent is emicizumab, a bispecific monoclonal antibody which mimics the function of factor VIII. Collectively across the HAVEN clinical trial program, the rate of antidrug antibodies with neutralizing potential was 0.75%. Since its licensure, there have been no further reports of such antibodies, despite its use in thousands of patients. In this report, we describe a patient with severe hemophilia A with inhibitors who developed a neutralizing antidrug antibody to emicizumab, for whom we performed extensive testing in the special coagulation laboratory.
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Affiliation(s)
- Colleen Harkins Druzgal
- Division of Hematology-Oncology, Department of Pediatrics, University of Virginia Health System, Charlottesville, VA, USA
| | - Hande Kizilocak
- Hemostasis and Thrombosis Center, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Joshua Brown
- Department of Pathology and Laboratory Medicine, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Margaret Sennett
- Division of Hematology-Oncology, Department of Pediatrics, University of Virginia Health System, Charlottesville, VA, USA
| | - Guy Young
- Division of Hematology-Oncology, Department of Pediatrics, University of Virginia Health System, Charlottesville, VA, USA
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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15
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Ellsworth P, Chen SL, Key N, Abajas Y, Ma A. Recombinant porcine factor VIII use in bleed treatment in non-severe haemophilia A inhibitor patients: Dosing strategies and efficacy. Haemophilia 2020; 27:e147-e150. [PMID: 32842162 DOI: 10.1111/hae.14111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 06/22/2020] [Accepted: 07/07/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Patrick Ellsworth
- Division of Hematology-Oncology, Department of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA.,Division of Pediatric Hematology-Oncology, Department of Pediatrics, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Sheh-Li Chen
- Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Nigel Key
- Division of Hematology-Oncology, Department of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Yasmina Abajas
- Division of Pediatric Hematology-Oncology, Department of Pediatrics, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Alice Ma
- Division of Hematology-Oncology, Department of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
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16
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Samelson-Jones BJ, Arruda VR. Translational Potential of Immune Tolerance Induction by AAV Liver-Directed Factor VIII Gene Therapy for Hemophilia A. Front Immunol 2020; 11:618. [PMID: 32425925 PMCID: PMC7212376 DOI: 10.3389/fimmu.2020.00618] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 03/18/2020] [Indexed: 12/26/2022] Open
Abstract
Hemophilia A (HA) is an X-linked bleeding disorder due to deficiencies in coagulation factor VIII (FVIII). The major complication of current protein-based therapies is the development of neutralizing anti-FVIII antibodies, termed inhibitors, that block the hemostatic effect of therapeutic FVIII. Inhibitors develop in about 20-30% of people with severe HA, but the risk is dependent on the interaction between environmental and genetic factors, including the underlying F8 gene mutation. Recently, multiple clinical trials evaluating adeno-associated viral (AAV) vector liver-directed gene therapy for HA have reported promising results of therapeutically relevant to curative FVIII levels. The inclusion criteria for most trials prevented enrollment of subjects with a history of inhibitors. However, preclinical data from small and large animal models of HA with inhibitors suggests that liver-directed gene therapy can in fact eradicate pre-existing anti-FVIII antibodies, induce immune tolerance, and provide long-term therapeutic FVIII expression to prevent bleeding. Herein, we review the accumulating evidence that continuous uninterrupted expression of FVIII and other transgenes after liver-directed AAV gene therapy can bias the immune system toward immune tolerance induction, discuss the current understanding of the immunological mechanisms of this process, and outline questions that will need to be addressed to translate this strategy to clinical trials.
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Affiliation(s)
- Benjamin J. Samelson-Jones
- The Children’s Hospital of Philadelphia, Philadelphia, PA, United States
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
- Raymond G. Perelman Center for Cellular and Molecular Therapeutics, Philadelphia, PA, United States
| | - Valder R. Arruda
- The Children’s Hospital of Philadelphia, Philadelphia, PA, United States
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
- Raymond G. Perelman Center for Cellular and Molecular Therapeutics, Philadelphia, PA, United States
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17
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[Chinese guidelines on the treatment of hemophilia (version 2020)]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2020; 41:265-271. [PMID: 32295333 PMCID: PMC7364913 DOI: 10.3760/cma.j.issn.0253-2727.2020.04.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Indexed: 12/24/2022]
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18
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Villarreal-Martínez L, García-Chávez J, Sánchez-Jara B, Moreno-González AM, Soto-Padilla J, Aquino-Fernández E, Paredes-Aguilera R, Maldonado-Silva K, Rodríguez-Castillejos C, González-Ávila AI, Mora-Torres M, Tiznado-García HM, Padilla-Durón NE, Luna-Silva NC, Gutiérrez-Juárez EI, Nemi-Cueto J, Gómez-González CS, De León-Figueroa R, López-Miranda A, Ríos-Osuna MG, Tamez-Gómez EL, Reyes-Espinoza EA, Domínguez-Varela IA, González-Martínez G, Godoy-Salinas EA. Prevalence of inhibitors and clinical characteristics in patients with haemophilia in a middle-income Latin American country. Haemophilia 2020; 26:290-297. [PMID: 32141696 DOI: 10.1111/hae.13951] [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: 10/09/2019] [Revised: 02/04/2020] [Accepted: 02/10/2020] [Indexed: 01/25/2023]
Abstract
INTRODUCTION Development of inhibitors is the most serious complication in patients with haemophilia (PWH). The prevalence of inhibitors in patients with severe haemophilia A (HA) is approximately 25%-30%. Inhibitor prevalence differs among populations. Some studies report a prevalence of almost twice in Hispanic as compared to Caucasian patients. Most data available, on the prevalence of inhibitors and their predisposing factors, originate from centres in developed countries. AIM Establish the prevalence of inhibitors of FVIII and FIX in Mexico. METHODS This was an observational, cross-sectional and descriptive study. The records of all patients diagnosed with haemophilia A (HA) or B (HB), with and without inhibitors, were included. Clinical and demographical characteristics of patients with inhibitors were assessed. Statistical analysis was performed using IBM SPSS version 22. The Ethics Committees of the various participating institutions approved this study. RESULTS A total of 1455 patients from the 20 participating centres were recruited, from which 1208 (83.02%) had HA and 247 (16.97%) were diagnosed with HB. The presence of inhibitors in severe HA was reported in 93/777(11.96%), and 10/162 (6.17%) in severe HB. Of them, 91.7% exhibited high titres in HA and 100% in HB. CONCLUSION In Mexico, the general prevalence of inhibitors varies considerably among centres. This study established a basis of comparison for future development and advances in the treatment and follow-up of patients. These findings also augment our understanding of risk factors related to inhibitor development.
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Affiliation(s)
- Laura Villarreal-Martínez
- Hospital Universitario "Dr. José Eleuterio González" Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - Jaime García-Chávez
- Hospital de Especialidades "Antonio Fraga Mouret" del CMN La Raza, Mexico City, Mexico
| | - Berenice Sánchez-Jara
- Hospital General "Dr. Gaudencio González Garza " del CMN La Raza, Mexico City, Mexico
| | | | | | - Efraín Aquino-Fernández
- Hospital de especialidades pediátricas "Centro Regional de Alta Especialidad en Chiapas", Tuxtla Gutierrez, Mexico
| | | | | | | | | | | | | | | | | | | | - Jorge Nemi-Cueto
- Hospital General de Especialidades de Campeche "Dr. Javier Buenfil Osorio", Campeche, Mexico
| | | | | | | | | | | | | | | | - Gerardo González-Martínez
- Hospital Universitario "Dr. José Eleuterio González" Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - Elias Adán Godoy-Salinas
- Hospital Universitario "Dr. José Eleuterio González" Universidad Autónoma de Nuevo León, Monterrey, Mexico
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Le Quellec S. Clinical Evidence and Safety Profile of Emicizumab for the Management of Children with Hemophilia A. DRUG DESIGN DEVELOPMENT AND THERAPY 2020; 14:469-481. [PMID: 32099331 PMCID: PMC7007498 DOI: 10.2147/dddt.s167731] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Accepted: 01/22/2020] [Indexed: 01/03/2023]
Abstract
Emicizumab is a bispecific, humanized, monoclonal antibody mimicking the factor (F) VIII cofactor activity in mediating the generation of FXa by FIXa in patients with hemophilia A (HA). This subcutaneous non-factor agent has been recently extensively approved for the prophylaxis of patients of HA patients with and without FVIII-inhibitors of all ages, although few data are currently available in children. In Phase 3 clinical trials and case series, emicizumab prophylaxis significantly reduced bleeding rates compared to previous treatment in HA adolescents and children with or without FVIII-inhibitors and was generally well tolerated. In addition, subcutaneous administration of emicizumab provided beneficial effects on health-related quality of life, and lessened the burden of the disease in HA patients as well as in their caregivers. However, additional prospective studies are required to evaluate the long-term safety of emicizumab prophylaxis in very young patients, including previously untreated patients. The aim of this paper was to review the limited data available on the use of emicizumab prophylaxis in children and to highlight the need for further studies to address remaining concerns.
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Affiliation(s)
- Sandra Le Quellec
- Unité d'hémostase Clinique - Hôpital Cardiologique Louis Pradel - Hospices Civils de Lyon, Lyon, France.,Service d'hématologie biologique, Groupement Hospitalier Est - Hospices Civils de Lyon, Lyon, France
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20
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Puthenveetil G, Nugent D. Hemophilia - Impact of Recent Advances on Management. Indian J Pediatr 2020; 87:134-140. [PMID: 31529382 DOI: 10.1007/s12098-019-03062-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 08/09/2019] [Indexed: 01/19/2023]
Abstract
There have been numerous advances in the field of hemophilia management in the past decade, including long acting factor products, non-factor products, and potentially curative interventions such as gene therapy. Each of these interventions introduces exciting treatment modalities to patients with both hemophilia A and B, however they also pose a daunting array of possible management options. Adverse reactions to novel agents are being reported as more patients are treated and long-term sustainability of interventions such as gene therapy is yet to be determined. The practicing hematologist should be aware of the intricacies involved in customizing care for their individual patients and be aware of the monitoring strategies for each interventional strategy to avoid adverse events. Upfront cost vs. long term benefit should be considered as choices of treatment strategies are made, especially in resource poor countries. The goal of the newer agents is to decrease annualized bleed rates and avoid debilitating arthropathy. This article looks at current treatment models for prophylaxis and management of inhibitors, reviews the recent advances in the field (with bioengineered factor products, non-factor products and gene therapy) and summarizes the incorporation of these new interventions in the treatment plan for patients with hemophilia.
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Affiliation(s)
- Geetha Puthenveetil
- Department of Hematology, Children's Hospital of Orange County, Orange, CA, USA.
- Department of Pediatrics, University of California Irvine, Irvine, CA, USA.
| | - Diane Nugent
- Department of Hematology, Children's Hospital of Orange County, Orange, CA, USA
- Department of Pediatrics, University of California Irvine, Irvine, CA, USA
- Center for Inherited Blood Disorders, Orange, CA, USA
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21
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Yang RC. [How I treat hemophilia with inhibitors]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2019; 40:801-803. [PMID: 31775476 PMCID: PMC7364992 DOI: 10.3760/cma.j.issn.0253-2727.2019.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Indexed: 11/08/2022]
Affiliation(s)
- R C Yang
- Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Clinical Research Center for Blood Diseases, Tianjin 300020, China
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