Optimizing liver health before and after gene therapy for hemophilia A
Year: 2024
Type: review
Abstract: ABSTRACT: Gene therapy for severe hemophilia A uses an adeno-associated virus (AAV) vector and liver-specific promoters that depend on healthy hepatocyte function to achieve safe and long-lasting increases in factor VIII (FVIII) activity. Thus, hepatocyte health is an essential aspect of safe and successful gene therapy. Many people living with hemophilia A have current or past chronic hepatitis C virus infection, metabolic dysfunction-associated steatosis or steatohepatitis, or other conditions that may compromise the efficacy and safety of AAV-mediated gene therapy. In addition, gene therapy may induce an immune response to transduced hepatocytes, leading to liver inflammation and reduced FVIII activity. The immune response can be treated with immunosuppression, but close monitoring of liver function tests and factor levels is necessary. The long-term risk of hepatocellular carcinoma associated with gene therapy is unknown. Routine screening by imaging for hepatocellular carcinoma, preferable every 6 months, is essential in patients at high risk and recommended in all recipients of hemophilia A gene therapy. This paper describes our current understanding of the biologic underpinnings of how liver health affects hemophilia A gene therapy, and provides practical clinical guidance for assessing, monitoring, and managing liver health both before and after gene therapy.
Source: Blood Advances
Institutions: Hemophilia Center of Western Pennsylvania, University of Pittsburgh Medical Center, BioMarin (United States), Weill Cornell Medicine, Indiana University Indianapolis, Indiana University School of Medicine, University of California, San Francisco, University of California San Francisco Medical Center, Children's Hospital of Orange County, University of California, Los Angeles, University of Pennsylvania, University of California San Diego, Icahn School of Medicine at Mount Sinai, MedStar Washington Hospital Center, MedStar Georgetown University Hospital
Language: English
Subfield: Hematology
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $3,000
OpenAlex ID: W4399394683