Treatment of congenital coagulopathies, from biologic to biotechnological drugs: The relevance of gene editing (CRISPR/Cas).

Congenital coagulopathies have, throughout the history of medicine, been a focus of scientific study and of great interest as they constitute an alteration of one of the most important and conserved pathways of evolution. The first therapeutic strategies developed to address them were aimed at restoring the blood components lost during hemorrhage by administering whole blood or plasma. Later on, the use of cryoprecipitates was a significant breakthrough as it made it possible to decrease the volumes of blood infused. In the 1970' and 80', clotting factor concentrates became the treatment and, from the 1990's to the present day, recombinant factors -with increasingly longer half-lives- have taken over as the treatment of choice for certain coagulopathies in a seamless yet momentous transition from biological to biotechnological drugs. The beginning of this century, however, saw the emergence of new advanced (gene and cell) treatments, which are currently transforming the therapeutic landscape. The possibility to use cells and viruses as well as specific or bispecific antibodies as medicines is likely to spark a revolution in the world of pharmacology where therapies will be individualized and have long-term effects. Specifically, attention is nowadays focused on the development of gene editing strategies, chiefly those based on CRISPR/Cas technology. Rare coagulopathies such as hemophilia A and B, or even ultra-rare ones such as factor V deficiency, could be among those deriving the greatest benefit from these new developments.

Animal Research in Spain: A Study of Public Perception and Attitudes.

Since the time of Hippocrates in the 4th century BC, animal research has been extensively used for various purposes up to the present day. However, the use of animals for research has also been controversial for a long time. We report the findings of a public, online questionnaire-based survey designed to assess the opinions of a sample of Spanish society regarding animal research. Demographic data and opinions were obtained from 806 respondents. The results indicated a high level of acceptance of animal research (73.1%). However, certain factors, such as completing the questionnaire immediately after a reading negative media report (OR = 2.41; 95%CI: 1.64-3.54; p < 0.001), being a woman (OR = 1.77; 95%CI: 1.24-2.53; p = 0.002) or having a non-scientific background (OR = 2.47; 95%CI: 1.76-3.47; p < 0.001), were associated with a tendency towards a more negative opinion. The opinions seemed to be influenced by gender, education level and by protest incidents reported in the media. Our results also indicate that a lot of information regarding animal welfare, such as care and handling protocols, along with legislation was unknown to individuals. Further, a growing popularity of companion species and opposition to animal experimentation for non-biomedical purposes were reflected in the responses obtained. The use of animals for research purposes emerged as a sensitive social issue in terms of concerns about animal ethics and welfare.

The Magic of Proteases: From a Procoagulant and Anticoagulant Factor V to an Equitable Treatment of Its Inherited Deficiency.

Proteostasis, i.e., the homeostasis of proteins, responsible for ensuring protein turnover, is regulated by proteases, which also participate in the etiopathogenesis of multiple conditions. The magic of proteases is such that, in blood coagulation, one same molecule, such as coagulation factor V, for example, can perform both a procoagulant and an anticoagulant function as a result of the activity of proteases. However, this magic has an insidious side to it, as it may also prevent the completion of the clinical value chain of factor V deficiency. This value chain encompasses the discovery of knowledge, the transfer of this knowledge, and its translation to clinical practice. In the case of rare and ultra-rare diseases like factor V deficiency, this value chain has not been completed as the knowledge acquisition phase has dragged out over time, holding up the transfer of knowledge to clinical practice. The reason for this is related to the small number of patients afflicted with these conditions. As a result, new indications must be found to make the therapies cost-effective. In the case of factor V, significant research efforts have been directed at developing a recombinant factor V capable of resisting the action of the proteases capable of inactivating this factor. This is where bioethics and health equity considerations come into the equation.