Innovations in RNA Therapy for Hemophilia

Abstract

Given the shortcomings of current factor-based, nonfactor-based, and AAV gene-based therapies, the recent advent of RNA-based therapeutics for hemophilia is changing the fundamental approach to hemophilia management. From siRNA therapeutics that knockdown clot regulators antithrombin, protein S, and heparin cofactor II, to CRISPR/Cas9 gene editing that may personalize treatment, improved technologies have the potential to reduce bleeds and factor use and avoid inhibitor formation. These novel agents, some in preclinical studies and others in early phase trials, have the potential to simplify treatment and improve hemostasis and quality of life. Further, as these therapies arise from manipulation of the coagulation cascade and thrombin generation and its regulation, they will enhance our understanding of hemostasis and thrombosis, and ultimately lead to better therapies for children and adults with inherited. bleeding disorders. What does the future hold? With the development of novel preclinical technologies at the bench, there will be fewer joint bleeds, debilitating joint disease, orthopedic surgery, and improved physical and mental health, not previously possible. In this review, we will identify current limitations of treatment and progress in the development of novel RNA therapeutics, including mRNA nanoparticle delivery and gene editing for treatment of hemophilia.