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Kalandadze V, Di Simone PE, Mohammed I, Murari D, Follenzi A, Borsotti C. Elevated memory T-cell conversion in a preclinical mouse model of hemophilia A. Eur J Immunol 2024:e2350807. [PMID: 38873896 DOI: 10.1002/eji.202350807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 05/27/2024] [Accepted: 05/31/2024] [Indexed: 06/15/2024]
Abstract
One of the major challenges in the choice of the best therapeutic approach for the treatment of patients affected by hemophilia A (HA) is the definition of criteria predicting the formation of factor VIII (FVIII) neutralizing antibodies, called inhibitors. Both genetic and environmental elements influencing the immune response toward FVIII have been identified but still not all the factors causing the pathological rejection of FVIII have been identified. Since there is a connection between coagulation and inflammation, here we assessed the role played by the FVIII deficiency in shaping the humoral and cellular response toward an antigen other than FVIII itself. To this aim, we challenged both HA and wild-type (WT) mice with either FVIII or ovalbumin (OVA) and followed antigen-specific antibody level, immune cell population frequency and phenotype up to 9 weeks after the last antigen booster. The activation threshold was evaluated in vitro by stimulating the murine T cells with a decreasing dose of α-CD3. The humoral response to FVIII was similar between the two groups while both the in vivo and in vitro experiments highlighted an antigen-independent sensitivity of HA compared with WT T cells causing an increase in memory T-cell conversion and proliferation capability.
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Affiliation(s)
- Vakhtang Kalandadze
- Department of Health Sciences, University of Piemonte Orientale, Novara, Italy
| | - Paolo E Di Simone
- Department of Health Sciences, University of Piemonte Orientale, Novara, Italy
| | | | - Daniele Murari
- Department of Health Sciences, University of Piemonte Orientale, Novara, Italy
| | - Antonia Follenzi
- Department of Health Sciences, University of Piemonte Orientale, Novara, Italy
| | - Chiara Borsotti
- Department of Health Sciences, University of Piemonte Orientale, Novara, Italy
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2
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Li F, He L, Chen G, Lu Y, Li R, Zhang Y, Jing X, Ling R, Li D, Liao C. Variant spectrum of F8 and F9 in hemophilia patients from southern China and 26 novel variants. Front Genet 2023; 14:1254265. [PMID: 38196513 PMCID: PMC10775173 DOI: 10.3389/fgene.2023.1254265] [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: 07/06/2023] [Accepted: 12/11/2023] [Indexed: 01/11/2024] Open
Abstract
Hemophilia, an X-linked recessive disorder, is characterized by spontaneous or trauma-induced prolonged bleeding. It is classified as hemophilia A when caused by variants in the F8 gene, and hemophilia B when caused by F9 variants. Few studies have described hemophilia variants in the Chinese population. This study aimed to investigate the clinical and genetic profiles of 193 hemophilia patients from southern China. Utilizing Sanger sequencing, multiplex ligation-dependent probe amplification, gap detection, long-range PCR, and multiplex PCR, we identified both F8 and F9 gene variants. Pregnant women with a history of hemophilia A offspring underwent amniocentesis or villus sampling for the variant detection. Variants in F8 and F9 were pinpointed in 183 patients, with 26 being novel discoveries. Notably, genetic testing was absent in the initial evaluation of 133 out of 161 patients, leading to a protracted average definitive diagnosis timeline of 2 years. Remarkably, two hemophilia A cases with anticipated severe phenotypes due to protein-truncating variants presented with only moderate or mild clinical manifestations. Among the 40 fetuses tested, 34 were males, with 17 exhibiting hemizygous variants in the F8 gene. Our results contribute to the broader understanding of F8 and F9 variant spectrum and highlight the underuse of genetic analyses in southern China.
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Affiliation(s)
- Fucheng Li
- Department of Prenatal Diagnostic Center, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Liya He
- Hematology Department, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Guilan Chen
- Department of Prenatal Diagnostic Center, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Yan Lu
- Department of Prenatal Diagnostic Center, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Ru Li
- Department of Prenatal Diagnostic Center, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Yongling Zhang
- Department of Prenatal Diagnostic Center, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Xiangyi Jing
- Department of Prenatal Diagnostic Center, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Rujuan Ling
- Department of Internal Medicine, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Dongzhi Li
- Department of Prenatal Diagnostic Center, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Can Liao
- Department of Prenatal Diagnostic Center, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, China
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Munawar Ali R, Abid M, Zafar S, Ali MS, Nadeem R, Ahmed R, Borhany M. Management of Severe Hemophilia A: Low-Dose Prophylaxis vs. On-Demand Treatment. Cureus 2023; 15:e41410. [PMID: 37546069 PMCID: PMC10402932 DOI: 10.7759/cureus.41410] [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] [Accepted: 06/30/2023] [Indexed: 08/08/2023] Open
Abstract
INTRODUCTION Prophylactic clotting factor infusion regimens to prevent bleeding and joint deformity has become the standard of care in severe hemophilia A patients. AIM To assess low-dose factor prophylaxis in our population as an alternative approach to managing severe hemophilia A. METHODS A prospective cohort study that included 68 hemophilia A patients divided into two groups, i.e., Prophylaxis and on-demand. The two groups were compared for annualized bleeding rate (ABR), hospitalization, units of factor VIII (FVIII) infused, or plasma products transfused, i.e., fresh frozen plasma (FFP) and cryoprecipitate (CP), and development of FVIII inhibitors. RESULTS Of the 68 patients recruited in this study, 25 (36.7%) were in the prophylaxis group, and 43(63.3%) were in the on-demand group. The on-demand group presented a higher median-IQR ABR [8(20-3) vs. 5(10-1.5), p-value 0.024], several hospitalizations (39.7% vs. 0, p-value 0.001), and inhibitor development (9.3% vs. 0, p-value 0.289) compared to the prophylaxis group. The prophylaxis approach demonstrated a significant negative correlation of ABR with FVIII prophylaxis (r=-0484, p=value=0.014). Moreover, no hospitalizations or inhibitor development was observed in the prophylaxis group. The estimated annual consumption of FVIII was 328 IU/kg/year in the on-demand group and 1662.6 IU/kg/year in the prophylaxis group. However, a highly significant difference in plasma product utilization was observed between the two groups, i.e., p-value <0.001 and 0.038 for FFP and CP, respectively. CONCLUSION Low-dose factor prophylaxis resulted in improved outcomes compared to on-demand treatment in terms of ABR, joint bleeding, hospitalization, and the development of inhibitors. This treatment approach should be adopted as an economically feasible alternative to high-dose Prophylaxis in resource-constrained countries.
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Affiliation(s)
- Rabeea Munawar Ali
- Hematology, National Institute of Blood Disease & Bone Marrow Transplantation, Karachi, PAK
| | - Madiha Abid
- Hematology, National Institute of Blood Disease & Bone Marrow Transplantation, Karachi, PAK
| | - Sidra Zafar
- Research and Development, National Institute of Blood Disease & Bone Marrow Transplantation, Karachi, PAK
| | - Muhammad Shujat Ali
- Hematology, National Institute of Blood Disease & Bone Marrow Transplantation, Karachi, PAK
| | - Rukhshanda Nadeem
- Physical Medicine and Rehabilitation, Hemophilia Welfare Society, Karachi, PAK
| | - Raheel Ahmed
- Hematology, Haemophilia Welfare Society, Karachi, PAK
| | - Munira Borhany
- Hematology, National Institute of Blood Disease & Bone Marrow Transplantation, Karachi, PAK
- Hematology, Haemophilia Welfare Society, Karachi, PAK
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López‐Jaime FJ, Fernández‐Bello I, Calavia‐Aranda E, Reina‐Monsó B, Montaño A. Excellent hemostatic control during cardiac surgery in a patient with hemophilia B treated with albutrepenonacog alfa (rIX-FP): A case report. Clin Case Rep 2023; 11:e7439. [PMID: 37323270 PMCID: PMC10268225 DOI: 10.1002/ccr3.7439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 02/16/2023] [Accepted: 05/19/2023] [Indexed: 06/17/2023] Open
Abstract
Key Clinical Message In hemophilia patients undergoing cardiac surgery, ROTEM® and Quantra® viscoelastic tests are useful to monitor perioperative hemostatic status and a single dose of rIX-FP is safe and avoids any hemorrhagic or thrombotic complication. Abstract Cardiac surgery poses a high hemostatic risk in patients with hemophilia. We present the first case of an adult patient with hemophilia B on treatment with albutrepenonacog alfa (rIX-FP) who underwent surgery for acute coronary syndrome. Treatment with rIX-FP made it possible to perform the surgery safely.
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Affiliation(s)
| | | | - Eva Calavia‐Aranda
- Unidad de Hemostasia y TrombosisHospital Universitario Regional de Málaga, IBIMAMalagaSpain
| | - Begoña Reina‐Monsó
- Servicio de CardiologíaHospital Universitario Regional de Málaga, IBIMAMalagaSpain
| | - Adrián Montaño
- Unidad de Hemostasia y TrombosisHospital Universitario Regional de Málaga, IBIMAMalagaSpain
- Universidad de SalamancaSalamancaSpain
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5
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Hale MM, Medina SH. Biomaterials-Enabled Antithrombotics: Recent Advances and Emerging Strategies. Mol Pharm 2022; 19:4453-4465. [PMID: 36149250 PMCID: PMC9728464 DOI: 10.1021/acs.molpharmaceut.2c00626] [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: 07/26/2022] [Revised: 09/13/2022] [Accepted: 09/14/2022] [Indexed: 12/13/2022]
Abstract
Antithrombotic and thrombolytic therapies are used to prevent, treat, and remove blood clots in various clinical settings, from emergent to prophylactic. While ubiquitous in their healthcare application, short half-lives, off-target effects, overdosing complications, and patient compliance continue to be major liabilities to the utility of these agents. Biomaterials-enabled strategies have the potential to comprehensively address these limitations by creating technologies that are more precise, durable, and safe in their antithrombotic action. In this review, we discuss the state of the art in anticoagulant and thrombolytic biomaterials, covering the nano to macro length scales. We emphasize current methods of formulation, discuss how material properties affect controlled release kinetics, and summarize modern mechanisms of clot-specific drug targeting. The preclinical efficacy of these technologies in an array of cardiovascular applications, including stroke, pulmonary embolism, myocardial infarction, and blood contacting devices, is summarized and performance contrasted. While significant advances have already been made, ongoing development efforts look to deliver bioresponsive "smart" biomaterials that will open new precision medicine opportunities in cardiology.
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Affiliation(s)
- Macy M. Hale
- Department
of Biomedical Engineering, Pennsylvania
State University, University
Park, Pennsylvania 16802-4400, United States
| | - Scott H. Medina
- Department
of Biomedical Engineering, Pennsylvania
State University, University
Park, Pennsylvania 16802-4400, United States
- Huck
Institutes of the Life Sciences, Pennsylvania
State University, University Park, Pennsylvania 16802-4400, United States
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6
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Pillai R, Nugent K, Wolfe AD, Voeller J. Acute Right Arm Swelling in a 6-month-old Girl. Pediatr Rev 2022; 43:517-520. [PMID: 36045153 DOI: 10.1542/pir.2021-004945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Radhika Pillai
- The Children's Hospital of San Antonio, Baylor College of Medicine, San Antonio, TX
| | - Kimberly Nugent
- The Children's Hospital of San Antonio, Baylor College of Medicine, San Antonio, TX
| | - Adam D Wolfe
- The Children's Hospital of San Antonio, Baylor College of Medicine, San Antonio, TX
| | - Julie Voeller
- The Children's Hospital of San Antonio, Baylor College of Medicine, San Antonio, TX
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7
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Liu L, Gao H, Guo C, Liu T, Li N, Qian Q. Therapeutic Mechanism of Nucleic Acid Drugs. ChemistrySelect 2021. [DOI: 10.1002/slct.202002901] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Lianxiao Liu
- Nucleic Acid Drug Division Shanghai Cell Therapy Group Co., Ltd. 75 A Qianyang Rd, Jiading District Shanghai 201805 China
| | - Haixia Gao
- Nucleic Acid Drug Division Shanghai Cell Therapy Group Co., Ltd. 75 A Qianyang Rd, Jiading District Shanghai 201805 China
| | - Chuanxin Guo
- Nucleic Acid Drug Division Shanghai Cell Therapy Group Co., Ltd. 75 A Qianyang Rd, Jiading District Shanghai 201805 China
| | - Tao Liu
- Nucleic Acid Drug Division Shanghai Cell Therapy Group Co., Ltd. 75 A Qianyang Rd, Jiading District Shanghai 201805 China
| | - Ning Li
- Nucleic Acid Drug Division Shanghai Cell Therapy Group Co., Ltd. 75 A Qianyang Rd, Jiading District Shanghai 201805 China
| | - Qijun Qian
- Nucleic Acid Drug Division Shanghai Cell Therapy Group Co., Ltd. 75 A Qianyang Rd, Jiading District Shanghai 201805 China
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8
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A cross-sectional analysis of cardiovascular disease in the hemophilia population. Blood Adv 2019; 2:1325-1333. [PMID: 29895623 DOI: 10.1182/bloodadvances.2018018226] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Accepted: 05/01/2018] [Indexed: 01/13/2023] Open
Abstract
Men with hemophilia were initially thought to be protected from cardiovascular disease (CVD), but it is now clear that atherothrombotic events occur. The primary objective of the CVD in Hemophilia study was to determine the prevalence of CVD and CVD risk factors in US older men with moderate and severe hemophilia and to compare findings with those reported in age-comparable men in the Atherosclerosis Risk in Communities (ARIC) cohort. We hypothesized if lower factor levels are protective from CVD, we would see a difference in CVD rates between more severely affected and unaffected men. Beginning in October 2012, 200 patients with moderate or severe hemophilia A or B (factor VIII or IX level ≤ 5%), aged 54 to 73 years, were enrolled at 19 US hemophilia treatment centers. Data were collected from patient interview and medical records. A fasting blood sample and electrocardiogram (ECG) were obtained and assayed and read centrally. CVD was defined as any angina, any myocardial infarction by ECG or physician diagnosis, any self-reported nonhemorrhagic stroke or transient ischemic attack verified by physicians, or any history of coronary bypass graft surgery or coronary artery angioplasty. CVD risk factors were common in the population. Compared with men of similar age in the ARIC cohort, patients with hemophilia had significantly less CVD (15% vs 25.8%; P < .001). However, on an individual patient level, CVD events occur and efforts to prevent cardiovascular events are warranted. Few men were receiving secondary prophylaxis with low-dose aspirin, despite published opinion that it can be used safely in this patient population.
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9
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Fernando RJ, Farmer BE, Augoustides JG, Gardner JC, Johnson SD, Ha B, Friess JO, Luedi MM, Erdoes G, Miller PJ, Ripat C, Fabbro M. Perioperative Management of Mild Hemophilia B During and After Coronary Artery Bypass Grafting: Challenges and Solutions. J Cardiothorac Vasc Anesth 2018; 33:549-555. [PMID: 30177475 DOI: 10.1053/j.jvca.2018.06.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Indexed: 01/19/2023]
Affiliation(s)
- Rohesh J Fernando
- Cardiothoracic Section, Department of Anesthesiology, Wake Forest School of Medicine, Winston Salem, NC
| | - Blaine E Farmer
- Cardiothoracic Section, Department of Anesthesiology, Wake Forest School of Medicine, Winston Salem, NC
| | - John G Augoustides
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
| | - Jeffrey C Gardner
- Cardiothoracic Section, Department of Anesthesiology, Wake Forest School of Medicine, Winston Salem, NC
| | - Sean D Johnson
- Cardiothoracic Section, Department of Anesthesiology, Wake Forest School of Medicine, Winston Salem, NC
| | - Bao Ha
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Jan-Oliver Friess
- Department of Anesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Markus M Luedi
- Department of Anesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Gabor Erdoes
- Department of Anesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Peter J Miller
- Critical Care Section, Department of Anesthesiology, Wake Forest School of Medicine, Winston Salem, NC; Hematology and Oncology Section, Department of Medicine, Wake Forest School of Medicine, Winston Salem, NC
| | - Caroline Ripat
- Cardiothoracic Anesthesiology, Department of Anesthesiology, Perioperative Medicine and Pain Management, Miller School of Medicine, University of Miami, Miami, FL
| | - Michael Fabbro
- Cardiothoracic Anesthesiology, Department of Anesthesiology, Perioperative Medicine and Pain Management, Miller School of Medicine, University of Miami, Miami, FL
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10
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Şalcıoğlu Z, Bayram C, Şen H, Ersoy G, Aydoğan G, Akçay A, Tuğcu D, Akıcı F, Gökçe M, Demirkaya M, Ayçiçek A, Başlar Z. Congenital Factor Deficiencies in Children: A Report of a Single-Center Experience. Clin Appl Thromb Hemost 2017; 24:901-907. [PMID: 29050499 PMCID: PMC6714728 DOI: 10.1177/1076029617731596] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Congenital factor deficiencies (CFDs) refer to inherited deficiency of coagulation factors in the blood. A total of 481 patients with CFDs, who were diagnosed and followed at our Pediatric Hematology and Oncology Clinic between 1990 and 2015, were retrospectively evaluated. Of the 481 cases, 134 (27.8%) were hemophilia A, 38 (7.9%) were hemophilia B, 57 (11.8%) were von Willebrand disease (vWD), and 252 (52.3%) were rare bleeding disorders (RBDs). The median age of the patients at the time of diagnosis and at the time of the study was 4.1 years (range: 2 months to 20.4 years) and 13.4 years (range: 7 months to 31.3 years), respectively. The median duration of the follow-up time was 6.8 years (range: 2.5 months to 24.8 years). One hundred nineteen (47.2%) of 252 patients with RBDs were asymptomatic, 49 (41.1%) of whom diagnosed by family histories, 65 (54.6%) through preoperative laboratory studies, and 5 (4.2%) after prolonged bleeding during surgeries. Consanguinity rate for the RBDs was 47.2%. Prophylactic treatment was initiated in 80 patients, 58 of whom were hemophilia A, 7 were hemophilia B, 13 were RBDs, and 2 were vWD. Significant advances have been achieved during the past 2 decades in the treatment of patients with CFDs, particularly in patients with hemophilias. The rarity and clinical heterogeneity of RBDs lead to significant diagnostic challenges and improper management. In this regard, multinational collaborative efforts are needed with the hope that can improve the management of patients with RBDs.
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Affiliation(s)
- Zafer Şalcıoğlu
- 1 Department of Pediatric Hematology and Oncology, İstanbul Kanuni Sultan Süleyman Education and Research Hospital, İstanbul, Turkey
| | - Cengiz Bayram
- 1 Department of Pediatric Hematology and Oncology, İstanbul Kanuni Sultan Süleyman Education and Research Hospital, İstanbul, Turkey
| | - Hülya Şen
- 1 Department of Pediatric Hematology and Oncology, İstanbul Kanuni Sultan Süleyman Education and Research Hospital, İstanbul, Turkey
| | - Gizem Ersoy
- 1 Department of Pediatric Hematology and Oncology, İstanbul Kanuni Sultan Süleyman Education and Research Hospital, İstanbul, Turkey
| | - Gönül Aydoğan
- 1 Department of Pediatric Hematology and Oncology, İstanbul Kanuni Sultan Süleyman Education and Research Hospital, İstanbul, Turkey
| | - Arzu Akçay
- 1 Department of Pediatric Hematology and Oncology, İstanbul Kanuni Sultan Süleyman Education and Research Hospital, İstanbul, Turkey
| | - Deniz Tuğcu
- 1 Department of Pediatric Hematology and Oncology, İstanbul Kanuni Sultan Süleyman Education and Research Hospital, İstanbul, Turkey
| | - Ferhan Akıcı
- 1 Department of Pediatric Hematology and Oncology, İstanbul Kanuni Sultan Süleyman Education and Research Hospital, İstanbul, Turkey
| | - Müge Gökçe
- 1 Department of Pediatric Hematology and Oncology, İstanbul Kanuni Sultan Süleyman Education and Research Hospital, İstanbul, Turkey
| | - Metin Demirkaya
- 1 Department of Pediatric Hematology and Oncology, İstanbul Kanuni Sultan Süleyman Education and Research Hospital, İstanbul, Turkey
| | - Ali Ayçiçek
- 1 Department of Pediatric Hematology and Oncology, İstanbul Kanuni Sultan Süleyman Education and Research Hospital, İstanbul, Turkey
| | - Zafer Başlar
- 2 Department of Hematology-Internal Medicine, Cerrahpaşa Medical School, İstanbul University, İstanbul, Turkey
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11
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Ellgaard TW, Bindslev L, Kamstrup S. Evaluation of the virus clearance capacity and robustness of the manufacturing process for the recombinant factor VIII protein, turoctocog alfa. Protein Expr Purif 2017; 129:94-100. [DOI: 10.1016/j.pep.2016.09.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Revised: 09/05/2016] [Accepted: 09/08/2016] [Indexed: 01/11/2023]
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12
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El-Din Hamdy MS, Nasr AS, Makhlouf MM, El-Saadany ZA, Samir M, Morgan DS. Impact of Prothrombotic Risk Factors in a Cohort of Egyptian Hemophilia A Patients. Mol Diagn Ther 2016; 20:151-9. [PMID: 26891731 DOI: 10.1007/s40291-015-0185-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Hemophilias are a group of related bleeding disorders that show an X-linked pattern of inheritance. The clinical phenotype of severe hemophilia may vary markedly among patients as a result of many factors, including genetic prothrombotic risk factors. OBJECTIVES Our objective was to study the incidence of the most common prothrombotic risk factors for additive effects among Egyptian patients with hemophilia A and their impact on clinical phenotype; annual bleeding frequency and severity of hemophilic arthropathy, as well as the effect of a single variation in these patients. METHODS This study was carried out in 100 patients with hemophilia A. Genotyping for factor V Leiden (FVL) G1691A, prothrombin G20210A, MTHFR C677T, and A1298C mutations was conducted using a real time-polymerase chain reaction (RT-PCR) assay. RESULTS Our study revealed mutations in hemophilia patients as follows: prothrombin G20210A (3 %), FVL (14 %), MTHFR C677T (42 %), and A1298C (59 %). Despite a lack of statistical significance when each gene was analysed separately, heterozygosity of prothrombin G20210A or FVL was always associated with either a mild or moderate, but never a severe, clinical presentation. The lowest bleeding frequency (less than once per month) was identified among patients with two heterozygous variants irrespective of the involved genes. In addition, the incidence of hemarthrosis was significantly higher among patients with a wild genotype of the prothrombin gene and FVL, and the average number of affected joints was significantly higher among patients with wild-type prothrombin and FVL genes than among heterozygous patients. CONCLUSION These prothrombotic mutations have a cumulative effect in amelioration of the severity of bleeding in hemophiliacs. The most prominent effect is that of prothrombin G20210A and FVL, while MTHFR C677A and A1298C gene mutations are less conclusive.
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Affiliation(s)
- Mona Salah El-Din Hamdy
- Department of Clinical and Chemical Pathology, Faculty of Medicine, El-Kasr El-Aini Hospital, Cairo University, El-Manial, Cairo, Egypt
| | - Aml Soliman Nasr
- Department of Clinical and Chemical Pathology, Faculty of Medicine, El-Kasr El-Aini Hospital, Cairo University, El-Manial, Cairo, Egypt
| | - Manal Mohamed Makhlouf
- Department of Clinical and Chemical Pathology, Faculty of Medicine, El-Kasr El-Aini Hospital, Cairo University, El-Manial, Cairo, Egypt.
| | - Zainab Ali El-Saadany
- Department of Clinical and Chemical Pathology, Faculty of Medicine, El-Kasr El-Aini Hospital, Cairo University, El-Manial, Cairo, Egypt
| | - Magy Samir
- Department of Pediatrics, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Dalia Saber Morgan
- Department of Pediatrics, Faculty of Medicine, Beni Suef University, Beni Suef, Egypt
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13
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Low-dose tertiary prophylactic therapy reduces total number of bleeds and improves the ability to perform activities of daily living in adults with severe haemophilia A. Blood Coagul Fibrinolysis 2016; 27:136-40. [DOI: 10.1097/mbc.0000000000000389] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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14
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Prasad JM, Migliorini M, Galisteo R, Strickland DK. Generation of a Potent Low Density Lipoprotein Receptor-related Protein 1 (LRP1) Antagonist by Engineering a Stable Form of the Receptor-associated Protein (RAP) D3 Domain. J Biol Chem 2015; 290:17262-8. [PMID: 26013822 DOI: 10.1074/jbc.m115.660084] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2015] [Indexed: 12/17/2022] Open
Abstract
The low density lipoprotein receptor-related protein 1 (LRP1) is a member of the low density lipoprotein receptor family and plays important roles in a number of physiological and pathological processes. Expression of LRP1 requires the receptor-associated protein (RAP), a molecular chaperone that binds LRP1 and other low density lipoprotein receptor family members in the endoplasmic reticulum and traffics with them to the Golgi where the acidic environment causes its dissociation. Exogenously added RAP is a potent LRP1 antagonist and binds to LRP1 on the cell surface, preventing ligands from binding. Following endocytosis, RAP dissociates in the acidic endosome, allowing LRP1 to recycle back to the cell surface. The acid-induced dissociation of RAP is mediated by its D3 domain, a relatively unstable three-helical bundle that denatures at pH <6.2 due to protonation of key histidine residues on helices 2 and 3. To develop an LRP1 inhibitor that does not dissociate at low pH, we introduced a disulfide bond between the second and third helices in the RAP D3 domain. By combining this disulfide bond with elimination of key histidine residues, we generated a stable RAP molecule that is resistant to both pH- and heat-induced denaturation. This molecule bound to LRP1 with high affinity at both neutral and acidic pH and proved to be a potent inhibitor of LRP1 function both in vitro and in vivo, suggesting that our stable RAP molecule may be useful in multiple pathological settings where LRP1 blockade has been shown to be effective.
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Affiliation(s)
- Joni M Prasad
- From the Center for Vascular and Inflammatory Disease and the Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland 21201
| | - Mary Migliorini
- From the Center for Vascular and Inflammatory Disease and the Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland 21201
| | - Rebeca Galisteo
- From the Center for Vascular and Inflammatory Disease and the Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland 21201
| | - Dudley K Strickland
- From the Center for Vascular and Inflammatory Disease and the Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland 21201
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15
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Harroche A, Merckx J, Salvi N, Faivre J, Jacqmarcq O, Dazet D, Makhloufi M, Clairicia M, Torchet MF, Aouba A, Rothschild C. Long-term follow-up of children with haemophilia - low incidence of infections with central venous access devices. Haemophilia 2015; 21:465-8. [DOI: 10.1111/hae.12638] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/04/2014] [Indexed: 11/29/2022]
Affiliation(s)
- A. Harroche
- Department of Haematology; Haemophilia Care Centre; Universitaire Necker-Enfants Malades; Paris France
| | - J. Merckx
- Department of Anaesthesia; Universitaire Necker-Enfants Malades; Paris France
| | - N. Salvi
- Department of Anaesthesia; Universitaire Necker-Enfants Malades; Paris France
| | - J. Faivre
- Department of Anaesthesia; Universitaire Necker-Enfants Malades; Paris France
| | - O. Jacqmarcq
- Department of Anaesthesia; Universitaire Necker-Enfants Malades; Paris France
| | - D. Dazet
- Department of Haematology; Haemophilia Care Centre; Universitaire Necker-Enfants Malades; Paris France
| | - M. Makhloufi
- Department of Haematology; Haemophilia Care Centre; Universitaire Necker-Enfants Malades; Paris France
| | - M. Clairicia
- Home Care Education Centre for Children; Universitaire Necker-Enfants Malades; Paris France
| | - M.-F. Torchet
- Department of Haematology; Haemophilia Care Centre; Universitaire Necker-Enfants Malades; Paris France
| | - A. Aouba
- Department of Haematology; Haemophilia Care Centre; Universitaire Necker-Enfants Malades; Paris France
| | - C. Rothschild
- Department of Haematology; Haemophilia Care Centre; Universitaire Necker-Enfants Malades; Paris France
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16
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Faranoush M, Abolghasemi H, Mahboudi F, Toogeh G, Karimi M, Eshghi P, Managhchi M, Hoorfar H, Dehdezi BK, Mehrvar A, khoeiny B, Vaziri B, Kamyar K, Heshmat R, Baghaeipour MR, Mirbehbahani NB, Fayazfar R, Ahmadinejad M, Naderi M. A Comparison of Efficacy Between Recombinant Activated Factor VII (Aryoseven) and Novoseven in Patients With Hereditary FVIII Deficiency With Inhibitor. Clin Appl Thromb Hemost 2014; 22:184-90. [DOI: 10.1177/1076029614555902] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Introduction: This study compared the efficacy of Aryoseven with Novoseven to control bleeding episodes in patients with hemophilia A with inhibitors. Methods: Sixty-six patients were randomized into 2 groups, with 4 consecutive block randomization. These groups received Aryoseven and Novoseven dosages of 90 to 120 μg/kg intravenously every 2 hours. Results: Median (interquartile range) level of factor VIII (FVIII) inhibitor in groups A and B was 15.0 and 19.0 Bethesda Unit (BU) preadministration. Bleeding onset in group A was 1246 ± 1104 minutes and in group B was 2301 ± 1693 minutes ( P = .311). The Kavakli global response scores and treatment success rate was comparable in both the groups. The side effects in groups A (9.7%) and B (2.9%) were comparable. Conclusion: Biosimilar recombinant activated FVII is found to be as effective as Novoseven in the treatment of acute joint bleeding in patients with hemophilia with inhibitors. Its usage will decrease the gaps in hemophilia.
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Affiliation(s)
- M. Faranoush
- Iran university of Medical Sciences, Rasool Akram Hospital, Tehran, Iran
| | - H. Abolghasemi
- Pediatric Congenital Hematologic Disorders Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - F. Mahboudi
- Biotechnology Research Center, Pasteur Institute of Iran, Tehran Iran
| | - Gh. Toogeh
- Thrombosis and Hemostasis Research Center, Tehran University of Medical Sciences, Imam Khomeini Hospital, Tehran, Iran
| | - M. Karimi
- Hematology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - P. Eshghi
- Pediatric Congenital Hematologic Disorders Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - M. Managhchi
- Thrombosis and Hemostasis Research Center, Tehran University of Medical Sciences, Imam Khomeini Hospital, Tehran, Iran
| | - H. Hoorfar
- Isfahan University of Medical Sciences, Isfahan, Iran
| | | | | | | | - B. Vaziri
- Biotechnology Research Center, Pasteur Institute of Iran, Tehran Iran
| | - K. Kamyar
- Aryogen Zist Darou Company, Karaj, Iran
| | - R. Heshmat
- Thrombosis and Hemostasis Research Center, Tehran University of Medical Sciences, Imam Khomeini Hospital, Tehran, Iran
| | | | | | - R. Fayazfar
- MD, Kerman University of Medical Sciences, Kerman, Iran
| | - M. Ahmadinejad
- High Institute of Research, Iranian Blood Transfusion Organization, Tehran, Iran
| | - M. Naderi
- Zahedan University of Medical Sciences, Ahwaz, Iran
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17
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Singh N, Mishra P, Tyagi S, Pati HP, Mahapatra M, Seth T, Saxena R. Clinicohematologic Profile of Patients With Factor VIII Inhibitors: A Case Series. Clin Appl Thromb Hemost 2014; 21:246-50. [PMID: 25172870 DOI: 10.1177/1076029614548720] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Factor VIII (FVIII) inhibitors present major clinical challenge as a complication of hemophilia A in patients on treatment with FVIII concentrates and as acquired autoantibodies in patients without hemophilia A. We aimed to study the prevalence of FVIII inhibitors in Indian settings, risk factors involved in early development of inhibitors in patients with hemophilia, differences in their clinical behavior, and approach to treatment, in comparison to patients with acquired hemophilia. The overall prevalence of FVIII inhibitors in patients with severe hemophilia A was found to be 22.3%. Two cases of acquired hemophilia were reported. Due to heterogeneity of our study population, cases have been discussed individually. We observed that the early development of FVIII inhibitors in patients with hemophilia A is dependent upon an interplay of several risk factors that need to be studied in a multivariable analysis to bring out significant correlation with response to treatment. Also, they differ from patients without hemophilia A entirely in terms of presentation and management.
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Affiliation(s)
- Neha Singh
- Department of Hematology, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Pravas Mishra
- Department of Hematology, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Seema Tyagi
- Department of Hematology, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - H P Pati
- Department of Hematology, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - M Mahapatra
- Department of Hematology, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Tulika Seth
- Department of Hematology, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Renu Saxena
- Department of Hematology, All India Institute of Medical Sciences, New Delhi, Delhi, India
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18
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Abstract
The development of a new recombinant factor VIII was designed and implemented to answer a number of unmet needs of patients affected by hemophilia A. Turoctocog alfa is bioengineered in a specific Chinese hamster ovary clone to present translational and posttranslational characteristics (sulphation, glycosylation) biosimilar to natural circulating forms of FVIII, with the aim to devoid any minimal change which may impact immunogenicity and antigenicity of recombinant protein. Both producer cell line and media are maintained free of any animal or human plasma derivative. Downstream processes of purification are performed by five steps (immunoaffinity chromatography, ion-exchange chromatography, virus inactivation by means of solvent-detergent treatment and nanofiltration, and to end with gel filtration), to provide the best possible margin of safety from known and unknown infectious agents. Large clinical trials seem to confirm the expectations placed in Turoctocog alfa in terms of high quality and safety of recombinant FVIII toward the goal of overcoming actual and future challenges of hemophilia therapy.
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Affiliation(s)
- Massimo Morfini
- Previous Director of Haemophilia Center, University Hospital of Florence, Via dello Statuto n.1-50129 Florence, Italy
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