Most of us have heard
of haemophilia.
The treatment
of haemophilia, dialysis and the medical applications of ultrasound are just a few historical examples.
«We think we can change the whole concept
of haemophilia treatment,» Shima says.
When injected together with factor VIII into mouse models
of haemophilia A, the nanoparticles deliver their payload to cells in the lymphoid tissue that are responsible for initiating immune responses.
This led to long - lived tolerance in mouse models
of haemophilia A and B.
Pills made from lettuce leaves could help to prevent one of the most serious complications
of haemophilia treatment
Earlier this year, the two researchers and their teams documented suppression of inhibitor formation and even reversal of pre-existing inhibitors in mouse models
of haemophilia A.
Indeed, exposure of the protein produced by the nanoparticle - based gene therapy to the gut mucosa prevents inhibitor development and restores clotting - factor activity in mouse models
of both haemophilia A and B. «This approach really could hold big benefit for patients,» says Jörg Schüttrumpf, a transfusion - medicine specialist who led one of the studies performed at the German Red Cross Blood Donor Service in Frankfurt.
Experiments in mice suggest that treatment
of haemophilia could be more successful if the baby's immune system is primed while in the womb
Clotting - factor infusions treat symptoms
of haemophilia, but gene therapy could provide a cure.
In the same year that Novo Nordisk launched its concizumab trial, Baxter struck a deal to purchase a suite
of haemophilia - related assets from the former therapeutics company Archemix.
Not exact matches
Biopharmaceutical treatments, led by
haemophilia, make up around 20 percent
of Novo's sales, with diabetes and obesity products accounting for the remaining 80 percent.
But many
of the physicians who treat patients with
haemophilia are not convinced.
Concizumab and similar therapies represent «a completely different way
of approaching
haemophilia compared to anything we've been doing for the last 50 years», he says.
The next phase
of the study will include people with
haemophilia, and there will not be the same limitation.
When he delved into the genomes
of those with a milder disease, he often saw not just a mutation in the affected clotting - factor gene, but also a mutation in another gene — the first causing
haemophilia, the tendency to bleed, and the second causing thrombophilia, the tendency to clot.
Roughly 5 %
of those with
haemophilia B fall into this category, and 30 %
of those with
haemophilia A (see page S12).
The test developed can be carried out on mothers at risk
of X-linked genetic recessive diseases including
haemophilia and Duchenne muscular dystrophy and mothers at risk
of haemolytic disease
of the new - born.
«These are remarkable data,» says Amit Nathwani at University College London, who is using AAVs in potential treatments for a blood disorder called
haemophilia B. «Liver fibrosis is a major clinical problem and if these data can be reproduced clinically, the National Health Service would save billions and patients would be given a new lease
of life.»
Down's syndrome,
haemophilia, fragile X syndrome, sickle - cell anaemia, thalassaemia and a plethora
of other disorders are also down to genetic defects.
People with
haemophilia A, the commonest form
of the disease, need infusions
of factor 8 because a hereditary gene defect means they can not make their own.
With so many therapeutic tactics moving through the preclinical pipeline, scientists and clinicians remain hopeful that at least one will ultimately succeed, eliminating the problem
of inhibitor formation for people with
haemophilia altogether.
He focused first on
haemophilia B. Adapting a technique that he had previously developed to delay the onset
of type 1 diabetes, Daniell and his group genetically modified tobacco plants to express human factor IX in their chloroplasts.
When treated with replacement coagulation proteins, the dog naturally develops antibodies, or inhibitors, against the therapy — a problem that is also seen in some 5 %
of humans with
haemophilia B.
The nanotechnology approach that is being tested for inhibitor control could also improve the
haemophilia treatment that is now at the cutting edge
of clinical research: gene therapy.
Still, the standard form
of liver - targeted gene therapy carries a range
of potential complications, including the risk
of harmful mutations and
of the body mounting an immune response against the viral vectors used to carry the correct forms
of the defective genes responsible for
haemophilia.
Shire CEO Flemming Ornskov - who has a large conventional
haemophilia business and is also chasing Biomarin and Spark in hunting a cure for the bleeding disorder - sees both the opportunities and the difficulties
of gene therapy.
«In an area like
haemophilia I think that approach is going to make a ton
of sense, since the budget impact there starts to get more significant,» Marrazzo said.
After decades
of frustrations, firms believe there are now major opportunities for gene therapy in treating inherited conditions such as
haemophilia.
In Madrid last week, Amit Nathwani
of the Royal Free NHS Trust in London announced that six people treated for
haemophilia using AAV in early 2011 are still producing the blood clotting factor they previously lacked.
About 30 %
of people with
haemophilia A develop inhibitors, and once they do, treating their bleeding becomes much more difficult.
Depending on the person, the amount
of factor VIII — the protein missing in
haemophilia A — in the bloodstream drops by half in a mere 8 — 12 hours.
For the parents
of a child born with
haemophilia, the diagnosis comes with both good and bad news.
One barrier to
haemophilia therapy is the tendency
of factor VIII to prompt the body into producing anti-factor VIII antibodies, known as inhibitors.
One 2001 study suggested that up to 40 %
of people with severe
haemophilia do not follow the prophylactic schedule.
For all the advantages
of these extended - life molecules, the researchers predict that they will be supplanted in perhaps a decade by advances in gene therapy, which will enable people with
haemophilia to produce their own clotting factors.
Only about 4 %
of people with
haemophilia B develop inhibitors to factor IX.
A «cure» for
haemophilia is one step closer, following results published in the New England Journal
of Medcine
of a groundbreaking gene therapy trial led by the NHS in London.
A hereditary genetic condition dominantly affecting men, people with severe
haemophilia A have virtually none
of the protein factor VIII which is essential for blood to clot.
Ohmori, Tsukasa, et al. «CRISPR / Cas9 - mediated genome editing via postnatal administration
of AAV vector cures
haemophilia B mice.»
Almost exactly a year ago, we reported on a gene therapy for
haemophilia that was in development by the Children's Hospital
of Philadelphia (and subsequently the CHOP spinout Spark Therapeutics).
«People who live with
haemophilia today face a lifelong need for vigilant monitoring and recurrent factor concentrate infusions to prevent spontaneous, potentially life - threatening bleeds and to protect their joints,» said Katherine High, President and Head
of Research and Development at Spark Therapeutics.
The therapy hoped to resolve some
of the problems surrounding
haemophilia treatment by exchanging the continual infusions for a single vector infusion that could permanently boost Factor IX expression.
The results, published in the New England Journal
of Medicine, demonstrate the therapy being used to treat 10 male
haemophilia patients without significant side effects.
iPS cells have been employed to generate cells for the treatment
of various diseases including diabetes, cardiovascular disease, sickle cell anaemia, Parkinson's disease and
haemophilia [19]--[23].
The current study protocol points to an innovative research that can contribute to better understand the impact and potential benefits
of psychological interventions in
haemophilia care setting.
Another noteworthy issue is that psychological or psychiatric conditions are reported by 47 %
of PWH, with 29 % relating these symptoms to
haemophilia.4 This is even more relevant considering that psychological factors can influence both pain experience and QoL in PWH.12 Interestingly, Cassis et al 6 state that variations in QoL are better explained by psychosocial, rather than clinical predictors.
Indeed, psychological interventions have been proven to be effective in a broad range
of disorders and illnesses.15 — 18 Although a few former works have focused on psychological interventions in
haemophilia, showing positive and promising results, 19 — 25 the lack
of recent papers exploring this issue is somewhat surprising, despite the recommendations and guidelines that emphasise their relevance.