The BIG Question: Can We Stop the Use of HBIG?

Authors: Lee, R; Alukal, JJ; Gish, RG

Affiliations: Community Hosp, Dept Med, Riverside, CA USA. Univ Calif Riverside, Sch Med, Dept Med, Riverside, CA USA. Hepatitis B Fdn, Doylestown, PA USA. Sch Med, Reno, NV USA. Dept Pulm Med, Las Vegas, NV USA. Univ Calif San Diego, Skaggs Sch Pharm & Pharmaceut Sci, La Jolla, CA USA. Loma Linda Univ, Transplant Inst, Loma Linda, CA USA. Robert G Gish LCC, 6022 La Jolla Mesa Dr, San Diego, CA 92037 USA.

Publication: Liver Transplantation; 2024

Abstract: Hemophilia is a genetic disorder that is caused by mutations in coagulation factor VIII (hemophilia A) or IX (hemophilia B) genes resulting in blood clotting disorders. Despite advances in therapies, such as recombinant proteins and products with extended half-lives, the treatment of hemophilia still faces two major limitations: the short duration of therapeutic effect and production of neutralizing antibodies against clotting factors (inhibitor). To overcome these limitations, new hemophilia treatment strategies have been established such as gene therapy, bispecific antibody, and rebalancing therapy. Although these strategies have shown promising results, it is difficult to achieve a permanent therapeutic effect. Advances in the clustered regularly interspaced short palindromic repeat (CRISPR) technology have allowed sustainable treatment by correcting mutated genes. Since genome editing generates irreversible changes in host genome, safety must be ensured by delivering target organs. Therefore, the delivery tool of the CRISPR system is crucial for safe, accurate, and efficient genome editing. Recently, non-viral vector lipid nanoparticles (LNPs) have emerged as safer tools for delivering CRISPR systems than other viral vectors. Several previous hemophilia pre-clinical studies using LNP-CRISPR showed that sufficient and sustainable therapeutic effects, which means that LNP-CRISPR-mediated genome-editing therapy can be a valid option for the treatment of hemophilia. In this paper, we summarize the latest advancements in the successful treatment of hemophilia and the potential of CRISPR-mediated genome-editing therapy using LNPs.