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  • BIVV001, a new class of fac...
    Seth Chhabra, Ekta; Liu, Tongyao; Kulman, John; Patarroyo-White, Susannah; Yang, Buyue; Lu, Qi; Drager, Douglas; Moore, Nancy; Liu, Jiayun; Holthaus, Amy M.; Sommer, Jurg M.; Ismail, Ayman; Rabinovich, Deana; Liu, Zhan; van der Flier, Arjan; Goodman, Allison; Furcht, Chris; Tie, Mark; Carlage, Tyler; Mauldin, Randy; Dobrowsky, Terrence M.; Liu, Zhiqian; Mercury, Oblaise; Zhu, Lily; Mei, Baisong; Schellenberger, Volker; Jiang, Haiyan; Pierce, Glenn F.; Salas, Joe; Peters, Robert

    Blood, 04/2020, Letnik: 135, Številka: 17
    Journal Article

    Factor VIII (FVIII) replacement products enable comprehensive care in hemophilia A. Treatment goals in severe hemophilia A are expanding beyond low annualized bleed rates to include long-term outcomes associated with high sustained FVIII levels. Endogenous von Willebrand factor (VWF) stabilizes and protects FVIII from degradation and clearance, but it also subjects FVIII to a half-life ceiling of ∼15 to 19 hours. Increasing recombinant FVIII (rFVIII) half-life further is ultimately dependent upon uncoupling rFVIII from endogenous VWF. We have developed a new class of FVIII replacement, rFVIIIFc-VWF-XTEN (BIVV001), that is physically decoupled from endogenous VWF and has enhanced pharmacokinetic properties compared with all previous FVIII products. BIVV001 was bioengineered as a unique fusion protein consisting of a VWF-DʹD3 domain fused to rFVIII via immunoglobulin-G1 Fc domains and 2 XTEN polypeptides (Amunix Pharmaceuticals, Inc, Mountain View, CA). Plasma FVIII half-life after BIVV001 administration in mice and monkeys was 25 to 31 hours and 33 to 34 hours, respectively, representing a three- to fourfold increase in FVIII half-life. Our results showed that multifaceted protein engineering, far beyond a few amino acid substitutions, could significantly improve rFVIII pharmacokinetic properties while maintaining hemostatic function. BIVV001 is the first rFVIII with the potential to significantly change the treatment paradigm for severe hemophilia A by providing optimal protection against all bleed types, with less frequent doses. The protein engineering methods described herein can also be applied to other complex proteins. •BIVV001 is a novel fusion protein that provides fourfold longer hemostatic control than rFVIII in preclinical hemophilia A models.•BIVV001 has the potential to allow for more optimal, extended protection against all bleeding types in patients with severe hemophilia A. Display omitted