B Cell Depletion Eliminates FVIII Memory B Cells and Enhances AAV8-coF8 Immune Tolerance Induction When Combined With Rapamycin

Hemophilia A is an inherited coagulation disorder resulting in the loss of functional clotting factor VIII (FVIII). Presently, the most effective treatment is prophylactic protein replacement therapy. However, this requires frequent life-long intravenous infusions of plasma derived or recombinant clotting factors and is not a cure. A major complication is the development of inhibitory antibodies that nullify the replacement factor. Immune tolerance induction (ITI) therapy to reverse inhibitors can last from months to years, requires daily or every other day infusions of supraphysiological levels of FVIII and is effective in only up to 70% of hemophilia A patients. Preclinical and recent clinical studies have shown that gene replacement therapy with AAV vectors can effectively cure hemophilia A patients. However, it is unclear how hemophilia patients with high risk inhibitor F8 mutations or with established inhibitors will respond to gene therapy, as these patients have been excluded from ongoing clinical trials. AAV8-coF8 gene transfer in naïve BALB/c-F8e16−/Y mice (BALB/c-HA) results in anti-FVIII IgG1 inhibitors following gene transfer, which can be prevented by transient immune modulation with anti-mCD20 (18B12) and oral rapamycin. We investigated if we could improve ITI in inhibitor positive mice by combining anti-mCD20 and rapamycin with AAV8-coF8 gene therapy. Our hypothesis was that continuous expression of FVIII protein from gene transfer compared to transient FVIII from weekly protein therapy, would enhance regulatory T cell induction and promote deletion of FVIII reactive B cells, following reconstitution. Mice that received anti-CD20 had a sharp decline in inhibitors, which corresponded to FVIII memory B (Bmem) cell deletion. Importantly, only mice receiving both anti-mCD20 and rapamycin failed to increase inhibitors following rechallenge with intravenous FVIII protein therapy. Our data show that B and T cell immune modulation complements AAV8-coF8 gene therapy in naïve and inhibitor positive hemophilia A mice and suggest that such protocols should be considered for AAV gene therapy in high risk or inhibitor positive hemophilia patients

Common Security of the Czech Republic and Slovakia Airspace by JAS-39 GRIPEN Fighter Aircrafts

Diplomová práce se zabývá problematikou ochrany vzdušného prostoru České republiky a Slovenska nadzvukovými letouny JAS-39 Gripen. První část práce je zaměřena na teoretickou rovinu obrany jako služby v obecném zájmu nehospodářské povahy a na vybrané pojmy z oblasti obrany a bezpečnosti státu. Druhá část se zabývá komparací Armády České republiky a Ozbrojených sil Slovenské republiky se zaměřením na vzdušné síly a možnosti ochrany vzdušného prostoru pomoci nadzvukových bojových letounů obou zemí. Třetí částí je zhodnocení možnosti pořízení a provozování nadzvukových letounů JAS-39 Gripen Vzdušnými silami Ozbrojených sil Slovenské republiky, které vychází z předchozího zkoumání a zároveň přibližuje možnosti zabezpečení společného vzdušného prostoru obou zemí. V poslední části jsou doporučení pro společné zabezpečení vzdušného prostoru obou zemí, vycházející z jednotlivých možností, ale i se stávající bezpečnostní a ekonomické situace.This thesis deals with the airspace protection of Czech Republic and Slovakia by JAS-39 Gripen supersonic aircrafts. The first part is focused on the theoretical level of defense as a service of general non-economic interest and certain terms of defense and national security. The second part deals with the comparsion of the Czech Army and Slovak Army with focuse on options of airspace protection by supersonic fighter aircrafts of both countries. The third part evaluates the possibility of acquisition and usage JAS-39 supersonic aircraft by the Slovak Air Force which is based on previous research and shows how to secure the common airspace of both countries. In the final chapter are recommendations for common airspace security of both countries based on each option, but also on current security and economic situation.153 - Katedra veřejné ekonomikyvelmi dobř

Potential for cellular stress response to hepatic factor VIII expression from AAV vector

Hemophilia A and B are coagulation disorders resulting from the loss of functional coagulation factor VIII (FVIII) or factor IX proteins, respectively. Gene therapy for hemophilia with adeno-associated virus vectors has shown efficacy in hemophilia B patients. Although hemophilia A patients are more prevalent, the development of therapeutic adeno-associated virus vectors has been impeded by the size of the F8 cDNA and impaired secretion of FVIII protein. Further, it has been reported that over-expression of the FVIII protein induces endoplasmic reticulum stress and activates the unfolded protein response pathway both in vitro and in hepatocytes in vivo, presumably due to retention of misfolded FVIII protein within the endoplasmic reticulum. Engineering of the F8 transgene, including removal of the B domain (BDD-FVIII) and codon optimization, now allows for the generation of adeno-associated virus vectors capable of expressing therapeutic levels of FVIII. Here we sought to determine if the risks of inducing the unfolded protein response in murine hepatocytes extend to adeno-associated virus gene transfer. Although our data show a mild activation of unfolded protein response markers following F8 gene delivery at a certain vector dose in C57BL/6 mice, it was not augmented upon further elevated dosing, did not induce liver pathology or apoptosis, and did not impact FVIII immunogenicity

MOESM1 of Evaluation of engineered AAV capsids for hepatic factor IX gene transfer in murine and canine models

Additional file 1: Table S1. Clinical chemistry panel for hemophilia B dog O19. Baseline values obtained prior to vector. Pre refers to blood collected on the day of vector administrations and post and onward refer to time points after vector delivery. Low values are colored blue, values within normal ranges are black, and values above normal ranges are red