Michael Smith Laboratories, University of British Columbia, Vancouver V6T 1Z4, Canada.
Department of Biochemistry and Molecular Biology, University of British Columbia, Vancouver V6T 2A1, Canada.
Sci Transl Med. 2024 Feb 21;16(735):eadh0027. doi: 10.1126/scitranslmed.adh0027.
Antifibrinolytic drugs are used extensively for on-demand treatment of severe acute bleeding. Controlling fibrinolysis may also be an effective strategy to prevent or lessen chronic recurring bleeding in bleeding disorders such as hemophilia A (HA), but current antifibrinolytics have unfavorable pharmacokinetic profiles. Here, we developed a long-lasting antifibrinolytic using small interfering RNA (siRNA) targeting plasminogen packaged in clinically used lipid nanoparticles (LNPs) and tested it to determine whether reducing plasmin activity in animal models of HA could decrease bleeding frequency and severity. Treatment with the siRNA-carrying LNPs reduced circulating plasminogen and suppressed fibrinolysis in wild-type and HA mice and dogs. In HA mice, hemostatic efficacy depended on the injury model; plasminogen knockdown improved hemostasis after a saphenous vein injury but not tail vein transection injury, suggesting that saphenous vein injury is a murine bleeding model sensitive to the contribution of fibrinolysis. In dogs with HA, LNPs carrying siRNA targeting plasminogen were as effective at stabilizing clots as tranexamic acid, a clinical antifibrinolytic, and in a pilot study of two dogs with HA, the incidence of spontaneous or excess bleeding was reduced during 4 months of prolonged knockdown. Collectively, these data demonstrate that long-acting antifibrinolytic therapy can be achieved and that it provides hemostatic benefit in animal models of HA.
抗纤维蛋白溶解药物被广泛用于按需治疗严重急性出血。控制纤维蛋白溶解也可能是预防或减轻血友病 A (HA) 等出血性疾病慢性复发性出血的有效策略,但目前的抗纤维蛋白溶解药物药代动力学特性不理想。在这里,我们使用针对纤溶酶原的小干扰 RNA (siRNA) 构建了一种长效抗纤维蛋白溶解药物,该药物包裹在临床使用的脂质纳米颗粒 (LNP) 中,并对其进行了测试,以确定降低 HA 动物模型中的纤溶酶活性是否可以减少出血频率和严重程度。携带 siRNA 的 LNP 治疗可降低野生型和 HA 小鼠和犬的循环纤溶酶原并抑制纤维蛋白溶解。在 HA 小鼠中,止血效果取决于损伤模型;纤溶酶原敲低可改善隐静脉损伤后的止血,但不能改善尾静脉横断损伤后的止血,这表明隐静脉损伤是一种对纤维蛋白溶解贡献敏感的小鼠出血模型。在 HA 犬中,携带靶向纤溶酶原 siRNA 的 LNP 与氨甲环酸一样有效稳定血栓,氨甲环酸是一种临床用抗纤维蛋白溶解药物,在对 2 只 HA 犬的初步研究中,在长达 4 个月的持续敲低期间,自发性或过度出血的发生率降低。总的来说,这些数据表明可以实现长效抗纤维蛋白溶解治疗,并为 HA 动物模型提供止血益处。