Recombinant FVIIIFc-VWF-XTEN Demonstrates Significant Bioavailability Following Subcutaneous Administration in Hemophilia A Mice
Authors: Drager Douglas , Patarroyo-White Sue , Chao Hoson , Ismail Ayman , Liu Jiayun , Holthaus Amy M , Chhabra Ekta , Kulman John , Schellenberger Volker , Liu Tongyao , Peters Robert 
Published: October 2019

Abstract
All currently marketed Factor VIII (FVIII) molecules are administered intravenously (IV) for the treatment of hemophilia A (HemA). Conventional FVIII prophylaxis requires a dosing interval of three times per week to every other day. This frequent dosing regimen necessitates repeated venous access and is associated with complications such as secondary infection in children with a venous port/catheter. More recently, extended half-life variants of FVIII have been shown in clinical trials to decrease the dosing interval to twice weekly or less frequent IV dosing, which reduces, but does not eliminate, the burden of treatment. A FVIII molecule with further prolonged half-life and subcutaneous (SQ) delivery potential could significantly relieve the treatment burden for HemA patients and improve the adherence rate to FVIII prophylaxis.
Recombinant FVIIIFc-VWF-XTEN has been shown to not bind endogenous VWF, and is able to achieve a 4-fold extension of half-life in hemophilia A mice compared to conventional FVIII, well beyond the approximately 2-fold half-life extension limit demonstrated by other long-acting FVIII variants that bind endogenous VWF. It comprises of two polypeptide chains: 1) a single chain B-domain deleted FVIIIFc-XTEN chain with a XTEN polypeptide inserted at the B-domain region of native FVIII sequence, and 2) a VWF D'D3-XTEN-Fc chain xtend one that n TEN fragemnt o FVIII prophylaxis.ntial rity of the patients depending on the half-life of the FVIII molecule. with a second XTEN polypeptide inserted between D'D3 domain and Fc. The rFVIIIFc-VWF-XTEN protein was produced in HEK293 cells and affinity purified using VIIISelect resin. The pharmacokinetic (PK) profiles of intravenously (IV) and subcutaneously (SQ) administered rFVIIIFc-VWF-XTEN were compared to those of rFVIII in HemA mice. The duration of the in vivo efficacy of rFVIIIFc-VWF-XTEN post-SQ delivery was assessed in a HemA mouse tail vein transection (TVT) bleeding model.
After intravenous dosing in HemA mice, we observed a linear PK profile for rFVIIIFc-VWF-XTEN within the therapeutic dose range (25, 50, 100 IU/kg). The half-life of IV-administered rFVIIIFc-VWF-XTEN was about 37 h, which is more than 4-fold longer than that of rFVIII. In addition, animals that received 25 IU/kg of rFVIIIFc-VWF-XTEN treatment retained 5% of normal FVIII activity at 120 h post-dosing, which suggests the potential for full protection from spontaneous bleeding in this animal model.
When delivered subcutaneously, the bioavailability of rFVIIIFc-VWF-XTEN was 20%, a significant increase compared to the bioavailability of rFVIII (less than 1%). Starting at 24 h post-dosing, subcutaneous administration of rFVIIIFc-VWF-XTEN achieved plasma FVIII levels that were equal to or greater than those attained with rFVIII delivered intravenously at the same dose. In addition, greater than 5% of normal circulating FVIII level was observed at 96 h post SQ administration of rFVIIIFc-VWF-XTEN with a 100 IU/kg dose, which provided 80% protection on survival in mice subjected to tail vein transection injury. These results suggest that rFVIIIFc-VWF-XTEN could enable less frequent FVIII replacement treatment compared to rFVIII even when administered subcutaneously.
The VWF independence of rFVIIIFc-VWF-XTEN enables a 4-fold increase in circulating half-life compared to that of rFVIII. Also, the addition of D'D3 domains and the two XTEN insertions dramatically increases subcutaneous bioavailability to 20%, compared to less than 1% with conventional FVIII. These unique properties of rFVIIIFc-VWF-XTEN make it a potential candidate for both IV and SQ treatments for hemophilia A.

Disclosures
Drager: Biogen: Employment, Equity Ownership. Patarroyo-White:Biogen: Employment, Equity Ownership. Chao:Biogen: Employment, Equity Ownership. Ismail:Biogen: Employment. Liu:Biogen: Employment, Equity Ownership. Holthaus:Biogen: Employment. Chhabra:Biogen: Employment, Equity Ownership. Kulman:Biogen: Employment. Schellenberger:Amunix Operating Inc: Employment. Liu:Biogen: Employment, Equity Ownership. Peters:Biogen: Employment.