Recent Developments of Coagulation Factor Products for Hemophilia Treatment

A special issue of Pharmaceuticals (ISSN 1424-8247). This special issue belongs to the section "Biopharmaceuticals".

Deadline for manuscript submissions: closed (30 July 2022) | Viewed by 6308

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Division of Basic Pharmaceutical Sciences, College of Pharmacy, Xavier University of Louisiana, New Orleans, LA 70125, USA
Interests: thrombosis; hemophilia; drug discovery and design
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Dear Colleagues,

Hemophilia management first started in the 1970s upon the introduction of plasma-derived concentrates of coagulation factor VIII and factor IX, which provided effective treatment of the bleeding episodes in patients with hemophilia A and B, respectively. During 1990s, the management of hemophilia was transformed from treating bleeding events using plasma concentrates to prophylactically preventing them by using recombinant coagulation factors. Importantly, the last decade has witnessed further progress toward better therapeutic interventions for hemophilia as represented by the introduction of extended half-life recombinant coagulation factors (Fc-fused FIX eftrenonacog alfa and Fc-fused FVIII efmoroctocog alfa among others). Despite such progress, certain needs remained unmet. Particularly, hemophilia patients with FVIII inhibitors are not good candidates for prophylaxis. Therefore, non-factor therapeutic interventions were developed. Some of those interventions are already approved, such as emicizumab, while others are in advanced clinical development. Emicizumab is a bispecific monoclonal antibody that facilitates interactions between factor IXa and factor X; thus, it promotes thrombin generation by mimicking factor VIIIa activity irrespective of factor VIII deficiency or the presence of its inhibitors. With this breakthrough in the way that different types of hemophilia are being treated, the horizon for new breakthrough interventions appears to be more promising.

This Special Issue titled “Recent Development of Therapeutics for Hemophilia Treatment” invites authors to contribute reviews or original research articles dedicated to the most recent advances on therapeutics for hemophilia treatment. The contributions include the discovery of new therapeutic entities, as well as their assessment in the context of hemophilia. Studies concerning the elucidation of mechanisms of action of new therapeutics are also welcomed.

Dr. Rami A. Al-Horani
Guest Editor

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Published Papers (2 papers)

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21 pages, 5396 KiB  
Article
Non-Cryoprecipitation Separation of Coagulation FVIII and Prothrombin Complex Proteins by Pseudoaffinity Calcium Elution Chromatography Using Anion Exchange Resin
by Gabriel Pinna Feliciano, Sara Hayama Arimori, Vinicius Watanabe Nakao, Joice Rodrigues Dos Santos, Elizabeth A. L. Martins, Marcelo Porto Bemquerer and Elisabeth Cheng
Pharmaceuticals 2022, 15(10), 1192; https://doi.org/10.3390/ph15101192 - 27 Sep 2022
Cited by 1 | Viewed by 1751
Abstract
Hemophilia A is treated with human plasma coagulation factor VIII (FVIII) replacement therapy and Hemophilia B with coagulation factor IX, which is purified from prothrombin complex concentrate (PCC). In this paper we evaluated the separation of FVIII and PCC by directly loading raw [...] Read more.
Hemophilia A is treated with human plasma coagulation factor VIII (FVIII) replacement therapy and Hemophilia B with coagulation factor IX, which is purified from prothrombin complex concentrate (PCC). In this paper we evaluated the separation of FVIII and PCC by directly loading raw thawed plasma to an anion exchange resin (AEX). Under this relatively high ionic strength, most of the plasma proteins such as albumin, immunoglobulins and others were not adsorbed. Five resins commonly used in protein purification (plasma fractionation) were tested. With all resins, PCC was eluted by pseudoaffinity in a calcium gradient step. Afterwards, FVIII could be recovered with a good yield and high purification factor in the salt gradient step with 400–500 mM NaCl. Using ANX Sepharose FF and Q Sepharose FF, the CaCl2 elution step was introduced after the intermediate wash with 200 mM NaCl, whereas using DEAE Sepharose FF, Fractogel EMD TMAE and Fractogel EMD DEAD, PCC eluted after the wash of the unbound proteins. Our results indicate that three important fractions: (1) albumin, immunoglobulin etc.; (2) PCC; and (3) FVIII can be separated in one chromatographic AEX column and the delicate and troublesome cryoprecipitation can be eliminated, making the purification of blood products faster and cheaper. Full article
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Review

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15 pages, 876 KiB  
Review
Immunogenicity of Current and New Therapies for Hemophilia A
by Alessandra N. L. Prezotti, Jéssica O. Frade-Guanaes, Gabriela G. Yamaguti-Hayakawa and Margareth C. Ozelo
Pharmaceuticals 2022, 15(8), 911; https://doi.org/10.3390/ph15080911 - 23 Jul 2022
Cited by 10 | Viewed by 4207
Abstract
Anti-drug antibody (ADA) development is a significant complication in the treatment of several conditions. For decades, the mainstay of hemophilia A treatment was the replacement of deficient coagulation factor VIII (FVIII) to restore hemostasis, control, and prevent bleeding events. Recently, new products have [...] Read more.
Anti-drug antibody (ADA) development is a significant complication in the treatment of several conditions. For decades, the mainstay of hemophilia A treatment was the replacement of deficient coagulation factor VIII (FVIII) to restore hemostasis, control, and prevent bleeding events. Recently, new products have emerged for hemophilia A replacement therapy, including bioengineered FVIII molecules with enhanced pharmacokinetic profiles: the extended half-life (EHL) recombinant FVIII products. However, the main complication resulting from replacement treatment in hemophilia A is the development of anti-FVIII neutralizing alloantibodies, known as inhibitors, affecting approximately 25–30% of severe hemophilia A patients. Therefore, the immunogenicity of each FVIII product and the mechanisms that could help increase the tolerance to these products have become important research topics in hemophilia A. Furthermore, patients with inhibitors continue to require effective treatment for breakthrough bleedings and procedures, despite the availability of non-replacement therapy, such as emicizumab. Herein, we discuss the currently licensed treatments available for hemophilia A and the immunogenicity of new therapies, such as EHL-rFVIII products, compared to other products available. Full article
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