Another player in hemophilia FoB’s: CRXL thinks its Factor V Leiden/Cambridge compound in preclinical development will be usable where NovoSeven is currently used in hemophilia A with inhibitors. According to CRXL’s 2Q07 CC, the FV L/C compound will have a much longer half-life than NovoSeven and will thereby be more practical for chronic prophylactic use. A big question, of course, is what the production cost will be.
Here is a product description from CRXL’s website:
>> Crucell is investigating Protein Factor V–Leiden/Cambridge expressed on our PER.C6® cell line for use as a therapeutic agent against certain bleeding disorders.
...The objective of Crucell’s factor V project is to develop a factor V molecule that can be used to compensate impaired clotting in hemophilia A patients, particularly those having inhibitors.
…The most common bleeding disorder is Hemophilia A, which is an X chromosome-linked genetic disease affecting 1 in 5,000-10,000 males worldwide. Hemophilia A is caused by a deficiency of the blood protein factor VIII, which acts as a co-factor in the clotting system. The clinical picture of hemophilia ranges from a mild to severe bleeding tendency. Males with mild hemophilia may not bleed until after serious injury, trauma, or surgery; people with moderate hemophilia may bleed after injuries and sometimes spontaneously, whereas persons with severe hemophilia A, who are 60% of all hemophilia A cases, may suffer from frequent spontaneous bleeding episodes, often affecting joints or muscles. The severity of the bleeding tendency in hemophilia A correlates well with circulating levels of factor VIII, which are 6% to 40% in mild, 1 to 6% in moderate and less than 1% of normal in severe hemophilia.
Hemophilia A is treated with the prophylactic or therapeutic administration of factor VIII purified from human plasma or obtained as recombinant protein. In particular severe hemophiliacs are at risk to develop neutralizing antibodies, so-called inhibitors, upon administration of factor VIII, which reduces or even completely abolishes the efficacy of the therapy. In severe hemophilia A, inhibitors may develop in up to 30% of the cases. Currently, patients with inhibitors will be subjected to a costly immune tolerance therapy to induce tolerance to exogenous factor VIII, which fails in 20-40% of the cases. Bleeding episodes in patients with persistent inhibitors can be treated with recombinant factor VIIa or any other factor VIII-bypassing agent, but these agents are not suitable for prevention of these episodes. Therefore, there is a medical need for prophylactic treatment in patients with factor VIII-inhibitors, which may be fulfilled with factor V-Leiden/Cambridge.
Factor V-Leiden/Cambridge contains two mutations FV-R306T/R506Q (Leiden/Cambridge), leading to APC resistance, thereby extending the half-life of the activated molecule. It is a pro-coagulant by enhancing thrombin formation. In addition to hemophilia with inhibitors, other indications for factor V-Leiden/Cambridge may include hemophilia without inhibitors, Factor V and Factor V/VIII deficiency, and bleeding disorders not due to deficiency of a clotting factor such as hemorrhagic stroke. <<
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