Hemophilia A is an inherited bleeding disorder due to factor VIII (FVIII) deficiency and is characterized by recurrent bleeding and progressive joint damage. For the last two decades, treatment strategies have expanded from FVIII replacement therapy to include extended half-life products, non-factor therapies, rebalancing agents, and gene therapy. These advances have improved clinical outcomes but also introduced long-term safety considerations that require careful evaluation.

Severe hemophilia A is exceptionally rare among preterm infants. Qwing to immature coagulation system and nonspecific bleeding manifestations, the condition is readily misdiagnosed as other neonatal hemorrhagic disorders, such as vitamin K deficiency, neonatal sepsis and thrombocytopenia. Delayed diagnosis will greatly increase the risk of severe complications, particularly intracranial hemorrhage. Herein, we report a case of genetically confirmed severe hemophilia A in a 34-week preterm infant without family history of hemophilia. Treatment comprised sequential adminnistration of coagulation factor VIII repalcement and emicizumab. We futher analyze the clinical characteristics, diagnostic difficulties and standardized management principles of hemophilia A in preterm infants, so as to improve clinicians' awareness, reduce misdiagnosis and missed diagnosis, and optimize the long-term prognosis of affected infants.

Tumor Electric Field Therapy (TEFT) disrupts mitosis in glioblastoma (GBM), but responses vary markedly among patients. In a retrospective cohort of TEFT-treated GBM, EGFR variant III (EGFRvIII) alteration is associated with shorter progression-free survival, prompting us to investigate a genotype-linked resistance mechanism. TEFT triggers a broadly shared bioenergetic stress response marked by activation of the AMPK-PPARα-CPT1A axis, whereas EGFRvIII primes IDO1 transcription through NF-κB. CPT1A further stabilizes IDO1 by promoting succinylation at lysine 377 through non-canonical LSTase-related activity, thereby limiting TRIM21-dependent ubiquitination and proteasomal degradation. Accumulated IDO1 increases kynurenine production and activates AhR, which upregulates DCLK1 and ARHGEF2 to preserve spindle organization and microtubule dynamics during electric-field exposure. Thus, EGFRvIII converts a general stress-adaptation pathway into a selective cytoprotective program. Genetic or pharmacological disruption of this pathway restores TEFT sensitivity in established and patient-derived GBM cells, organoids, and orthotopic models. Osimertinib suppresses the EGFRvIII-NF-κB-IDO1 arm and enhances TEFT efficacy, while exploratory clinical cases provide preliminary mechanism-informed support for the combination in recurrent EGFR-driven GBM. These findings define a genotype-field convergence mechanism linking metabolic adaptation to mitotic protection and support prospective evaluation of osimertinib plus TEFT.

BACKGROUND Acquired hemophilia A (AHA) is a rare but potentially life-threatening condition caused by autoantibodies against factor VIII. It often presents in older adults and its presentation can range from isolated lab abnormality of prolonged activated partial thromboplastin time (aPTT) without bleeding to mild bleeding or spontaneous vs disproportionate life-threatening bleeding. Delayed diagnosis is frequent due to the rarity of the condition and propensity to attribute bleeding to other common causes, such as falls. CASE REPORT A 92-year-old woman with recurrent ground-level falls presented with severe right lower extremity pain of several weeks' duration. She was not on any anticoagulant or anti-platelet agent. Computed tomography angiography demonstrated bilateral lower extremity intramuscular hematomas. She had 2 prior admissions for falls within 6 months, including a fall leading to intramuscular hematoma, which was conservatively managed without evaluation of coagulopathy. During current admission, prolonged aPTT prompted further workup, revealing low factor VIII activity of 5% and a high factor VIII inhibitor titer of 15.6 Bethesda Units, establishing the diagnosis of acquired hemophilia A. Bleeding control required sequential bypassing agents, corticosteroids, rituximab, cyclophosphamide, and eventually emicizumab. CONCLUSIONS This case highlights how recurrent or disproportionate intramuscular hematomas following even minor trauma, such as a ground-level fall, in the absence of risk factors such as anticoagulant use, may prompt evaluation for underlying coagulopathy such as AHA. Basic coagulation testing including prothrombin time and aPTT can help screen patients who warrant additional coagulopathy evaluation. Timely diagnosis is critical to avoid life-threatening bleeding complications.

Epidermal growth factor receptor variant III (EGFRvIII) is a constitutively active EGFR deletion variant found in a subset of glioblastomas (GB). Its association with stem-like tumor populations is well documented, but the outcome of EGFRvIII expression may vary with the developmental and molecular state of the recipient cell. Here, we used human induced pluripotent stem cell (iPSC)-derived, glial fibrillary acidic protein (GFAP)-negative-induced neural stem cells (iNSCs) to explore how this receptor variant affects a defined neural stem/progenitor background. EGFRvIII was introduced either constitutively by lentiviral transduction or through a doxycycline-responsive Tet-On system. Both experimental approaches were associated with remodeling of the neural stem/progenitor marker profile, with reduced SRY-box transcription factor 2 (SOX2) expression in the inducible model and significant reductions in both SOX2 and nestin in the constitutive model. Constitutive expression was also associated with increased senescence-associated β-galactosidase (SA-β-Gal) activity, while doxycycline induction produced a distinct change in cell-number dynamics at low doxycycline concentration. Thus, in this experimental setting, EGFRvIII was linked to substantial remodeling of the SOX2+/nestin+ marker profile. These observations do not define a differentiation pathway, prove cellular senescence or malignant transformation, or identify the cell of origin of EGFRvIII-positive GB. Rather, they support the view that the cellular response to EGFRvIII should be considered in relation to the specific neural-glioblastoma precursor context.

Hemophilia is an X-linked hereditary bleeding disorder caused by loss-of-function mutations in the genes encoding coagulation factors, leading to excessive bleeding and potentially being life-threatening. Currently, regular treatment for hemophilia is the infusion of recombinant blood coagulation factors. This approach is not only costly but can also give rise to complications such as the development of neutralizing antibodies (Nabs), which impede the therapeutic outcome. Hemophilia is a monogenic disease, making gene therapy a promising curative measure that includes gene addition and gene editing approaches. Adeno-associated virus (AAV) vectors have gained massive attention as the premier delivery vehicle for clinical gene therapy due to their diverse tissue tropisms dictated by the natural and engineered AAV capsids, their excellent safety profile since AAVs do not cause any known human diseases, low immunogenicity, and long-lasting gene expression. Several AAV-based gene addition therapies have been approved for hemophilia B and hemophilia A, and dozens of similar AAV-based clinical trials are underway. Gene editing technologies, like Clustered Regularly Interspaced Short Palindromic Repeats (CRISPR)/CRISPR-associated protein 9 (Cas9), have shown immense potential in the treatment of genetic diseases. CRISPR/Cas9-mediated transgene integration provides critical advantages over regular gene insertion therapy by enabling site-specific, targeted genomic integration rather than random integration. Clinical trials focusing on AAV-CRISPR/Cas9-mediated knock-in of human genes represent the frontier of in vivo genetic medicine, and one such prominent ongoing clinical trial for hemophilia B is designed to insert the human Factor IX gene into hepatocytes. This review outlines recent advances and feasible strategies of CRISPR/Cas9-based genome editing for hemophilia therapy, highlights the potential applications of next-generation gene editing and vector delivery technologies, and offers new insights for the advantages, limitations, and future directions for these novel treatment modalities.

Hemophilia A (HA) is caused by factor VIII (FVIII) deficiency and requires lifelong prophylaxis. Although activated FVIII (FVIIIa)-mimetic antibodies have enabled subcutaneous administration, thereby reducing treatment burden compared with intravenous FVIII replacement, an oral therapy remains a significant unmet need for individuals with HA. Here, we describe Inno8, a novel bispecific single-chain antibody fragment comprising two variable domains of heavy-chain antibodies that bridges coagulation factors IXa and X to mimic FVIIIa function and is engineered for oral delivery. Inno8 was generated from llama and alpaca immunizations and optimized through iterative structure-guided and machine learning-assisted engineering to enhance FVIIIa-mimetic activity, reduce the isoelectric point (pI) to improve oral bioavailability, and extend systemic exposure through site-specific fatty acid conjugation. Formulations containing permeation enhancer SNAC and solubilizing agent niacinamide were evaluated in preclinical models. Procoagulant activity was assessed in HA plasma and whole blood using thrombin generation assays and thromboelastography. Inno8 demonstrated, on average, 90‑fold greater in vitro potency than a sequence‑identical emicizumab analogue. Reducing the pI increased oral exposure ~10-fold in rats, and a tablet formulation containing SNAC and niacinamide demonstrated significant oral bioavailability (0.215% with 4-hour post dose fasting) and a 115-hour half-life in beagle dogs. Together, these findings support Inno8 as a potent, orally deliverable FVIIIa-mimetic and provide a framework for engineering oral, long-acting antibody-based therapies. Inno8 is currently in clinical evaluation, with first-in-human dosing completed (VOYAGER1, NCT06649630). Pending further clinical evaluation, Inno8 may represent an advance in biologics development and a potential non-invasive prophylactic therapy for individuals with HA.

The RapGEF Epac1 has emerged as an important modulator of pro-angiogenic signalling pathways, including VEGF/VEGFR2. However, its specific role in tumor angiogenesis has remained unexplored. Here, we identify endothelial Epac1 as a critical driver of melanoma angiogenesis. Analysis of patient-derived melanomas revealed that Epac1 is markedly upregulated in tumor endothelial cells. Using both global and endothelial-specific Epac1 knockout mouse models, we demonstrate that Epac1 deletion reduced melanoma growth and vascularization following subcutaneous melanoma cell inoculation. Transcriptome profiling of tumor-associated endothelial cells from Epac1-deficient mice showed broad downregulation of pro-angiogenic and YAP/TAZ target genes. This was corroborated in vitro using an Epac1 knockout endothelial cell line, where VEGFR2 expression, YAP/TAZ nuclear translocation, and YAP/TAZ target gene transcription were all suppressed. Consistently, Epac1 deletion impaired VE-cadherin/VEGFR2 interaction, VEGF-dependent nuclear YAP/TAZ and transcriptional activity, and abolished endothelial cell alignment in response to shear stress. Collectively, our results reveal Epac1 as a central modulator of VEGFR2 and YAP/TAZ signalling, integrating angiogenic and mechanosensory cues during melanoma vascularization.