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Arjunan P, Mahalingam G, Sankar P, Kathirvelu D, Suresh S, Rani S, Mohankumar KM, Thangavel S, Marepally S. Base-modified factor VIII mRNA delivery with galactosylated lipid nanoparticles as a protein replacement therapy for haemophilia A. Biomater Sci 2024; 12:5052-5062. [PMID: 39210734 DOI: 10.1039/d4bm00909f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/04/2024]
Abstract
The bleeding disorder hemophilia A (HemA) requires systemic functional factor VIII protein infusions on prophylactic schedules. Recently, chemically modified mRNAs have emerged as promising protein replacement therapies to reduce repeated infusions and improve safety profiles. However, the influence of base modifications on mRNA translation kinetics to specific cell types remains unexplored. In this study, towards developing mRNA therapeutics for haemophilia A, we synthesized chemically modified mRNAs with commercially available base modifications of adenine, guanine, uridine, and cytidine, and evaluated in vitro transcription yield and translation kinetics in hepatic cell lines using reporter eGFP mRNA. Our findings demonstrated that mRNA with N1-methyl pseudouridine (m1Ψ) showed a 5-12-fold increase in translation efficiency in both hepatic and endothelial cell lines. As a proof of concept for developing mRNA therapy for HemA, where FVIII is deficient, we developed a m1Ψ modified functional FVIII mRNA with our liver-targeting lipid nanoparticle (Gal-LNP) system. We evaluated its delivery efficiencies in both hepatic cell lines and the HemA mouse model. The m1Ψ-FVIII mRNA showed high therapeutic efficacy up to 15 days in vivo in the HemA mouse model. Gal-LNPs were found to be safe for systemic administration. Our study reveals that incorporating m1Ψ base modifications on mRNAs could improve therapeutic efficacy in liver- and endothelial-based therapeutics. Optimized mRNA synthesis for superior expression kinetics in hepatic cells and its delivery with liver-targeted nanoparticles may emerge as protein replacement therapies for monogenic liver disorders.
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Affiliation(s)
- Porkizhi Arjunan
- Centre for Stem Cell Research (CSCR) (a unit of inStem, Bengaluru), CMC Campus, Vellore, 632002, TN, India.
- Manipal Academy of Higher Education, Manipal, Karnataka 576104, India
| | - Gokulnath Mahalingam
- Centre for Stem Cell Research (CSCR) (a unit of inStem, Bengaluru), CMC Campus, Vellore, 632002, TN, India.
| | - Priyanka Sankar
- Centre for Stem Cell Research (CSCR) (a unit of inStem, Bengaluru), CMC Campus, Vellore, 632002, TN, India.
| | - Durga Kathirvelu
- Centre for Stem Cell Research (CSCR) (a unit of inStem, Bengaluru), CMC Campus, Vellore, 632002, TN, India.
| | - Sevanthy Suresh
- Centre for Stem Cell Research (CSCR) (a unit of inStem, Bengaluru), CMC Campus, Vellore, 632002, TN, India.
| | - Sandya Rani
- Centre for Stem Cell Research (CSCR) (a unit of inStem, Bengaluru), CMC Campus, Vellore, 632002, TN, India.
| | - Kumarasamypet M Mohankumar
- Centre for Stem Cell Research (CSCR) (a unit of inStem, Bengaluru), CMC Campus, Vellore, 632002, TN, India.
| | - Saravanabhavan Thangavel
- Centre for Stem Cell Research (CSCR) (a unit of inStem, Bengaluru), CMC Campus, Vellore, 632002, TN, India.
| | - Srujan Marepally
- Centre for Stem Cell Research (CSCR) (a unit of inStem, Bengaluru), CMC Campus, Vellore, 632002, TN, India.
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Lam P, Zygmunt DA, Ashbrook A, Bennett M, Vetter TA, Martin PT. Dual FKRP/FST gene therapy normalizes ambulation, increases strength, decreases pathology, and amplifies gene expression in LGMDR9 mice. Mol Ther 2024; 32:2604-2623. [PMID: 38910327 PMCID: PMC11405156 DOI: 10.1016/j.ymthe.2024.06.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 04/12/2024] [Accepted: 06/20/2024] [Indexed: 06/25/2024] Open
Abstract
Recent clinical studies of single gene replacement therapy for neuromuscular disorders have shown they can slow or stop disease progression, but such therapies have had little impact on reversing muscle disease that was already present. To reverse disease in patients with muscular dystrophy, new muscle mass and strength must be rebuilt at the same time that gene replacement prevents subsequent disease. Here, we show that treatment of FKRPP448L mice with a dual FKRP/FST gene therapy packaged into a single adeno-associated virus (AAV) vector can build muscle strength and mass that exceed levels found in wild-type mice and can induce normal ambulation endurance in a 1-h walk test. Dual FKRP/FST therapy also showed more even increases in muscle mass and amplified muscle expression of both genes relative to either single gene therapy alone. These data suggest that treatment with single AAV-bearing dual FKRP/FST gene therapies can overcome loss of ambulation by improving muscle strength at the same time it prevents subsequent muscle damage. This design platform could be used to create therapies for other forms of muscular dystrophy that may improve patient outcomes.
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Affiliation(s)
- Patricia Lam
- Center for Gene Therapy, Abigail Wexner Research Institute, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA
| | - Deborah A Zygmunt
- Center for Gene Therapy, Abigail Wexner Research Institute, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA
| | - Anna Ashbrook
- Center for Gene Therapy, Abigail Wexner Research Institute, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA
| | - Macey Bennett
- Center for Gene Therapy, Abigail Wexner Research Institute, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA
| | - Tatyana A Vetter
- Center for Gene Therapy, Abigail Wexner Research Institute, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA
| | - Paul T Martin
- Center for Gene Therapy, Abigail Wexner Research Institute, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA; Department of Pediatrics, and Department of Physiology and Cell Biology, The Ohio State University College of Medicine, Columbus, OH, USA.
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3
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Yuan R, Wang B, Wang Y, Liu P. Gene Therapy for Neurofibromatosis Type 2-Related Schwannomatosis: Recent Progress, Challenges, and Future Directions. Oncol Ther 2024; 12:257-276. [PMID: 38760612 PMCID: PMC11187037 DOI: 10.1007/s40487-024-00279-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 04/30/2024] [Indexed: 05/19/2024] Open
Abstract
Neurofibromatosis type 2 (NF2)-related schwannomatosis is a rare autosomal dominant monogenic disorder caused by mutations in the NF2 gene. The hallmarks of NF2-related schwannomatosis are bilateral vestibular schwannomas (VS). The current treatment options for NF2-related schwannomatosis, such as observation with serial imaging, surgery, radiotherapy, and pharmacotherapies, have shown limited effectiveness and serious complications. Therefore, there is a critical demand for novel effective treatments. Gene therapy, which has made significant advancements in treating genetic diseases, holds promise for the treatment of this disease. This review covers the genetic pathogenesis of NF2-related schwannomatosis, the latest progress in gene therapy strategies, current challenges, and future directions of gene therapy for NF2-related schwannomatosis.
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Affiliation(s)
- Ruofei Yuan
- Department of Neurosurgery, Beijing Tian Tan Hospital, Capital Medical University, No. 119 South Fourth Ring West Road, Fengtai District, Beijing, 100070, China
| | - Bo Wang
- Department of Neurosurgery, Beijing Tian Tan Hospital, Capital Medical University, No. 119 South Fourth Ring West Road, Fengtai District, Beijing, 100070, China
| | - Ying Wang
- Department of Neural Reconstruction, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Pinan Liu
- Department of Neurosurgery, Beijing Tian Tan Hospital, Capital Medical University, No. 119 South Fourth Ring West Road, Fengtai District, Beijing, 100070, China.
- Department of Neural Reconstruction, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China.
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4
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Ay C, Reinisch A. Gene therapy: principles, challenges and use in clinical practice. Wien Klin Wochenschr 2024:10.1007/s00508-024-02368-8. [PMID: 38713227 DOI: 10.1007/s00508-024-02368-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Accepted: 04/12/2024] [Indexed: 05/08/2024]
Abstract
INTRODUCTION Gene therapy is an emerging topic in medicine. The first products have already been licensed in the European Union for the treatment of immune deficiency, spinal muscular atrophy, hemophilia, retinal dystrophy, a rare neurotransmitter disorder and some hematological cancers, while many more are being assessed in preclinical and clinical trials. OBJECTIVE The purpose of this review is to provide an overview of the core principles of gene therapy along with information on challenges and risks. Benefits, adverse effects and potential risks are illustrated based on the examples of hemophilia and spinal muscular atrophy. RESULTS At present, in-vitro and in-vivo gene addition or gene augmentation is the most commonly established type of gene therapy. More recently, more sophisticated and precise approaches such as in situ gene editing have moved into focus. However, all types of gene therapy require long-term observation of treated patients to ensure safety, efficacy, predictability and durability. Important safety concerns include immune reactions to the vector, the foreign DNA or the new protein resulting from gene therapy, and a remaining low cancer risk based on insertional mutagenesis. Ethical and regulatory issues need to be addressed, and new reimbursement models are called for to ease the financial burden that this new treatment poses for the health care system. CONCLUSION Gene therapy holds great promise for considerable improvement or even cure of genetic diseases with serious clinical consequences. However, a number of questions and issues need to be clarified to ensure broad accessibility of safe and efficacious products.
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Affiliation(s)
- Cihan Ay
- Department of Medicine I, Clinical Division of Haematology and Haemostaseology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
| | - Andreas Reinisch
- Department of Medicine, Division of Hematology & Department for Blood Group Serology and Transfusion Medicine, Medical University of Graz, Auenbruggerplatz 38, 8036, Graz, Austria.
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Wang JH, Gessler DJ, Zhan W, Gallagher TL, Gao G. Adeno-associated virus as a delivery vector for gene therapy of human diseases. Signal Transduct Target Ther 2024; 9:78. [PMID: 38565561 PMCID: PMC10987683 DOI: 10.1038/s41392-024-01780-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 02/08/2024] [Accepted: 02/19/2024] [Indexed: 04/04/2024] Open
Abstract
Adeno-associated virus (AAV) has emerged as a pivotal delivery tool in clinical gene therapy owing to its minimal pathogenicity and ability to establish long-term gene expression in different tissues. Recombinant AAV (rAAV) has been engineered for enhanced specificity and developed as a tool for treating various diseases. However, as rAAV is being more widely used as a therapy, the increased demand has created challenges for the existing manufacturing methods. Seven rAAV-based gene therapy products have received regulatory approval, but there continue to be concerns about safely using high-dose viral therapies in humans, including immune responses and adverse effects such as genotoxicity, hepatotoxicity, thrombotic microangiopathy, and neurotoxicity. In this review, we explore AAV biology with an emphasis on current vector engineering strategies and manufacturing technologies. We discuss how rAAVs are being employed in ongoing clinical trials for ocular, neurological, metabolic, hematological, neuromuscular, and cardiovascular diseases as well as cancers. We outline immune responses triggered by rAAV, address associated side effects, and discuss strategies to mitigate these reactions. We hope that discussing recent advancements and current challenges in the field will be a helpful guide for researchers and clinicians navigating the ever-evolving landscape of rAAV-based gene therapy.
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Affiliation(s)
- Jiang-Hui Wang
- Horae Gene Therapy Center, University of Massachusetts Chan Medical School, Worcester, MA, 01605, USA
- Department of Microbiology and Physiological Systems, University of Massachusetts Chan Medical School, Worcester, MA, 01605, USA
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, VIC, 3002, Australia
- Ophthalmology, Department of Surgery, University of Melbourne, East Melbourne, VIC, 3002, Australia
| | - Dominic J Gessler
- Horae Gene Therapy Center, University of Massachusetts Chan Medical School, Worcester, MA, 01605, USA
- Department of Microbiology and Physiological Systems, University of Massachusetts Chan Medical School, Worcester, MA, 01605, USA
- Department of Neurological Surgery, University of Massachusetts Chan Medical School, Worcester, MA, 01605, USA
- Department of Neurosurgery, University of Minnesota, Minneapolis, MN, 55455, USA
| | - Wei Zhan
- Horae Gene Therapy Center, University of Massachusetts Chan Medical School, Worcester, MA, 01605, USA
- Department of Microbiology and Physiological Systems, University of Massachusetts Chan Medical School, Worcester, MA, 01605, USA
- Department of Medicine, University of Massachusetts Chan Medical School, Worcester, MA, 01605, USA
- Li Weibo Institute for Rare Diseases Research, University of Massachusetts Chan Medical School, Worcester, MA, 01605, USA
| | - Thomas L Gallagher
- Horae Gene Therapy Center, University of Massachusetts Chan Medical School, Worcester, MA, 01605, USA
| | - Guangping Gao
- Horae Gene Therapy Center, University of Massachusetts Chan Medical School, Worcester, MA, 01605, USA.
- Department of Microbiology and Physiological Systems, University of Massachusetts Chan Medical School, Worcester, MA, 01605, USA.
- Li Weibo Institute for Rare Diseases Research, University of Massachusetts Chan Medical School, Worcester, MA, 01605, USA.
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Kadian M, Kok CY, Ravindran D, Passam F, Pasalic L, Kizana E. Focal Anticoagulation by Somatic Gene Transfer: Towards Preventing Cardioembolic Stroke. Heart Lung Circ 2023:S1443-9506(23)00509-7. [PMID: 37316436 DOI: 10.1016/j.hlc.2023.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 05/05/2023] [Indexed: 06/16/2023]
Abstract
Cardioembolic stroke (CS) has emerged as a leading cause of ischaemic stroke (IS); distinguished by thrombi embolising to the brain from cardiac origins; most often from the left atrial appendage (LAA). Contemporary therapeutic options are largely dependent on systemic anticoagulation as a blanket preventative strategy, yet this does not represent a nuanced or personalised solution. Contraindications to systemic anticoagulation create significant unmedicated and high-risk cohorts, leaving these patients at risk of significant morbidity and mortality. Atrial appendage occlusion devices are increasingly used to mitigate stroke risk from thrombi emerging from the LAA in patients ineligible for oral anticoagulants (OACs). Their use, however, is not without risk or significant cost, and does not address the underlying aetiology of thrombosis and CS. Viral vector-based gene therapy has emerged as a novel strategy to target a spectrum of haemostatic disorders, achieving success through the adeno-associated virus (AAV) based therapy of haemophilia. Yet, thrombotic disorders, such as CS, have had limited exploration within the realm of AAV gene therapy approaches-presenting a gap in the literature and an opportunity for further research. Gene therapy has the potential to directly address the cause of CS by localised targeting of the molecular remodelling that serves to promote thrombosis.
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Affiliation(s)
- Megha Kadian
- The Centre for Heart Research, The Westmead Institute for Medical Research, Sydney, NSW, Australia; The University of Sydney, Sydney, NSW, Australia; Faculty of Medicine, The University of Queensland, St Lucia, Qld, Australia
| | - Cindy Y Kok
- The Centre for Heart Research, The Westmead Institute for Medical Research, Sydney, NSW, Australia; Westmead Clinical School, The University of Sydney, Sydney, NSW, Australia
| | - Dhanya Ravindran
- The Centre for Heart Research, The Westmead Institute for Medical Research, Sydney, NSW, Australia; Westmead Clinical School, The University of Sydney, Sydney, NSW, Australia
| | - Freda Passam
- Central Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; The Heart Research Institute, Charles Perkins Centre, Sydney, NSW, Australia
| | - Leonardo Pasalic
- Westmead Clinical School, The University of Sydney, Sydney, NSW, Australia; Department of Haematology, Institute of Clinical Pathology and Medical Research (ICPMR), Sydney Centres for Thrombosis and Haemostasis, Westmead Hospital, Sydney, NSW, Australia
| | - Eddy Kizana
- The Centre for Heart Research, The Westmead Institute for Medical Research, Sydney, NSW, Australia; Westmead Clinical School, The University of Sydney, Sydney, NSW, Australia; Department of Cardiology, Westmead Hospital, Sydney, NSW, Australia.
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7
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Matsunaga W, Gotoh A. Adenovirus as a Vector and Oncolytic Virus. Curr Issues Mol Biol 2023; 45:4826-4840. [PMID: 37367056 DOI: 10.3390/cimb45060307] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 05/30/2023] [Accepted: 05/30/2023] [Indexed: 06/28/2023] Open
Abstract
Adenoviral vectors, both oncolytic viruses and gene delivery vectors, are among the earliest approved and commercialised vectors for gene therapy. Adenoviruses have high cytotoxicity and immunogenicity. Therefore, lentiviruses or adeno-associated viruses as viral vectors and herpes simplex virus as an oncolytic virus have recently drawn attention. Thus, adenoviral vectors are often considered relatively obsolete. However, their high cargo limit and transduction efficiency are significant advantages over newer viral vectors. This review provides an overview of the new-generation adenoviral vectors. In addition, we describe the modification of the fiber knob region that enhances affinity of adenoviral vectors for cancer cells and the utilisation of cancer-cell-specific promoters to suppress expression of unwanted transgenes in non-malignant tissues.
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Affiliation(s)
- Wataru Matsunaga
- Joint-Use Research Facilities, Hyogo Medical University, 1-1 Mukogawa, Nishinomiya 663-8501, Japan
| | - Akinobu Gotoh
- Department of Education for Medical Research Base, Hyogo Medical University, 1-1 Mukogawa, Nishinomiya 663-8501, Japan
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Li X, Le Y, Zhang Z, Nian X, Liu B, Yang X. Viral Vector-Based Gene Therapy. Int J Mol Sci 2023; 24:ijms24097736. [PMID: 37175441 PMCID: PMC10177981 DOI: 10.3390/ijms24097736] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 04/19/2023] [Accepted: 04/20/2023] [Indexed: 05/15/2023] Open
Abstract
Gene therapy is a technique involving the modification of an individual's genes for treating a particular disease. The key to effective gene therapy is an efficient carrier delivery system. Viral vectors that have been artificially modified to lose their pathogenicity are used widely as a delivery system, with the key advantages of their natural high transduction efficiency and stable expression. With decades of development, viral vector-based gene therapies have achieved promising clinical outcomes. Currently, the three key vector strategies are based on adeno-associated viruses, adenoviruses, and lentiviruses. However, certain challenges, such as immunotoxicity and "off-target", continue to exist. In the present review, the above three viral vectors are discussed along with their respective therapeutic applications. In addition, the major translational challenges encountered in viral vector-based gene therapies are summarized, and the possible strategies to address these challenges are also discussed.
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Affiliation(s)
- Xuedan Li
- National Engineering Technology Research Center for Combined Vaccines, Wuhan 430207, China
- Wuhan Institute of Biological Products Co., Ltd., Wuhan 430207, China
| | - Yang Le
- National Engineering Technology Research Center for Combined Vaccines, Wuhan 430207, China
- Wuhan Institute of Biological Products Co., Ltd., Wuhan 430207, China
| | - Zhegang Zhang
- National Engineering Technology Research Center for Combined Vaccines, Wuhan 430207, China
- Wuhan Institute of Biological Products Co., Ltd., Wuhan 430207, China
| | - Xuanxuan Nian
- National Engineering Technology Research Center for Combined Vaccines, Wuhan 430207, China
- Wuhan Institute of Biological Products Co., Ltd., Wuhan 430207, China
| | - Bo Liu
- National Engineering Technology Research Center for Combined Vaccines, Wuhan 430207, China
- Wuhan Institute of Biological Products Co., Ltd., Wuhan 430207, China
| | - Xiaoming Yang
- National Engineering Technology Research Center for Combined Vaccines, Wuhan 430207, China
- Wuhan Institute of Biological Products Co., Ltd., Wuhan 430207, China
- China National Biotech Group Company Limited, Beijing 100029, China
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9
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Hermans C, Gruel Y, Frenzel L, Krumb E. How to translate and implement the current science of gene therapy into haemophilia care? Ther Adv Hematol 2023; 14:20406207221145627. [PMID: 36654740 PMCID: PMC9841832 DOI: 10.1177/20406207221145627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Accepted: 11/28/2022] [Indexed: 01/15/2023] Open
Abstract
Gene-based therapy opens an entirely new paradigm in managing people with haemophilia (PWH), offering them the possibility of a functional cure by enabling continuous expression of factor VIII (FVIII) or factor IX (FIX) after transfer of a functional gene designed to replace the PWH's own defective gene. In recent years, significant advances in gene therapy have been made, resulting in clotting factor activity attaining near-normal levels, as reflected by 'zero bleeding rates' in previously severely inflicted patients following a single administration of adeno-associated viral (AAV) vectors. While this new approach represents a major advancement, there are still several issues that must be resolved before applying this technology in clinical practice. First, awareness, communication, and education about the therapeutic potential and modalities of gene therapy must be further strengthened. To this end, objective, unbiased, transparent, and regularly updated information must be shared, in an appropriate way and understandable language with the support of patients' organizations. Second, healthcare providers should adopt a patient-centred approach, as the 'one size fits all' approach is inappropriate when considering gene therapy. Instead, a holistic patient view taking into account their physical and mental dimensions, along with unexpressed expectations and preferences, is mandatory. Third, the consent procedure must be improved, ensuring that patients' interests are maximally protected. Finally, gene therapy is likely to be first delivered in a few centres, with the highest expertise and experience in this domain. Thus, patients should be managed based on a hub-and-spoke model, taking into account that the key to gene therapy's success lies in an optimal communication and collaboration both within and between haemophilia centres sharing their experiences in the frame of international registries. This review describes recent progress and explains outstanding hurdles that must be tackled to ease the implementation of this paradigm-changing new therapy.
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Affiliation(s)
- Cedric Hermans
- Haemostasis and Thrombosis Unit, Division of Adult Haematology, Cliniques universitaires Saint-Luc, Université catholique de Louvain (UCLouvain), Avenue Hippocrate 10, 1200 Brussels, Belgium
| | - Yves Gruel
- Centre Régional de Traitement de l’Hémophilie, Hôpital Trousseau, CHRU de Tours, Tours, France
| | - Laurent Frenzel
- Laboratory of Cellular and Molecular Mechanisms of Hematological Disorders and Therapeutical Implications, Labex GR-Ex, Imagine Institute, Inserm, Paris Descartes – Sorbonne Paris Cité University, Paris, France
- Hematology unit care, Hemophilia Center, Necker Hospital, Paris, France
| | - Evelien Krumb
- Haemostasis and Thrombosis Unit, Division of Adult Haematology, Cliniques universitaires Saint-Luc, Université catholique de Louvain (UCLouvain), Brussels, Belgium
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10
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Herzog RW, VandenDriessche T, Ozelo MC. First hemophilia B gene therapy approved: More than two decades in the making. Mol Ther 2023; 31:1-2. [PMID: 36528029 PMCID: PMC9840138 DOI: 10.1016/j.ymthe.2022.12.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 12/07/2022] [Indexed: 12/23/2022] Open
Affiliation(s)
- Roland W Herzog
- Herman B Wells Center for Pediatric Research, Indiana University, Indianapolis, IN 46202, USA.
| | - Thierry VandenDriessche
- Department of Gene Therapy & Regenerative Medicine, Vrije Universiteit Brussel (VUB), Brussels, Belgium; Department of Cardiovascular Sciences, Center for Molecular & Vascular Biology, University of Leuven, Leuven, Belgium
| | - Margareth C Ozelo
- Hemocentro UNICAMP, Department of Internal Medicine, School of Medical Sciences, University of Campinas, Campinas, Brazil
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11
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Zygmunt DA, Lam P, Ashbrook A, Koczwara K, Lek A, Lek M, Martin PT. Development of Assays to Measure GNE Gene Potency and Gene Replacement in Skeletal Muscle. J Neuromuscul Dis 2023; 10:797-812. [PMID: 37458043 PMCID: PMC10578240 DOI: 10.3233/jnd-221596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/26/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND GNE myopathy (GNEM) is a severe muscle disease caused by mutations in the UDP-GlcNAc-2-epimerase/ManNAc-6-kinase (GNE) gene, which encodes a bifunctional enzyme required for sialic acid (Sia) biosynthesis. OBJECTIVE To develop assays to demonstrate the potency of AAV gene therapy vectors in making Sia and to define the dose required for replacement of endogenous mouse Gne gene expression with human GNE in skeletal muscles. METHODS A MyoD-inducible Gne-deficient cell line, Lec3MyoDI, and a GNE-deficient human muscle cell line, were made and tested to define the potency of various AAV vectors to increase binding of Sia-specific lectins, including MAA and SNA. qPCR and qRT-PCR methods were used to quantify AAV biodistribution and GNE gene expression after intravenous delivery of AAV vectors designed with different promoters in wild-type mice. RESULTS Lec3 cells showed a strong deficit in MAA binding, while GNE-/-MB135 cells did not. Overexpressing GNE in Lec3 and Lec3MyoDI cells by AAV infection stimulated MAA binding in a dose-dependent manner. Use of a constitutive promoter, CMV, showed higher induction of MAA binding than use of muscle-specific promoters (MCK, MHCK7). rAAVrh74.CMV.GNE stimulated human GNE expression in muscles at levels equivalent to endogenous mouse Gne at a dose of 1×1013vg/kg, while AAVs with muscle-specific promoters required higher doses. AAV biodistribution in skeletal muscles trended higher when CMV was used as the promoter, and this correlated with increased sialylation of its viral capsid. CONCLUSIONS Lec3 and Lec3MyoDI cells work well to assay the potency of AAV vectors in making Sia. Systemic delivery of rAAVrh74.CMV.GNE can deliver GNE gene replacement to skeletal muscles at doses that do not overwhelm non-muscle tissues, suggesting that AAV vectors that drive constitutive organ expression could be used to treat GNEM.
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Affiliation(s)
- Deborah A. Zygmunt
- Center for Gene Therapy, Abigail Wexner Research Institute, Nationwide Children’s Hospital, Children’s Drive, Columbus, OH, USA
| | - Patricia Lam
- Center for Gene Therapy, Abigail Wexner Research Institute, Nationwide Children’s Hospital, Children’s Drive, Columbus, OH, USA
| | - Anna Ashbrook
- Center for Gene Therapy, Abigail Wexner Research Institute, Nationwide Children’s Hospital, Children’s Drive, Columbus, OH, USA
| | - Katherine Koczwara
- Department of Genetics, Yale University School of Medicine, New Haven, CT, USA
| | - Angela Lek
- Department of Genetics, Yale University School of Medicine, New Haven, CT, USA
| | - Monkol Lek
- Department of Genetics, Yale University School of Medicine, New Haven, CT, USA
| | - Paul T. Martin
- Center for Gene Therapy, Abigail Wexner Research Institute, Nationwide Children’s Hospital, Children’s Drive, Columbus, OH, USA
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA
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12
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Hu H, Wang L, Li H, Li H, Chen X, Peng W, Wang J, Zhao Y, Liu M, Li D. Long-term amelioration of an early-onset familial atrial fibrillation model with AAV-mediated in vivo gene therapy. FUNDAMENTAL RESEARCH 2022; 2:829-835. [PMID: 38933375 PMCID: PMC11197581 DOI: 10.1016/j.fmre.2022.05.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 04/05/2022] [Accepted: 05/05/2022] [Indexed: 10/18/2022] Open
Abstract
Atrial fibrillation (AF) is a common cardiac disease with high prevalence in the general population. Despite a mild manifestation at the onset stage, it causes serious consequences, including sudden death, when the disease progresses to the late stage. Most available treatments of AF focus on symptom management or alleviation, due to a lack of fundamental knowledge and the fact that considerable variations of AF exist. With the popularisation of the next-generation sequencing technology, several causal genetic factors, including MYL4, have been discovered to contribute to AF, giving hope to developing its gene therapies. In this study, we attempted to treat a previously established rat AF model, which carried Myl4E11K/E11K loss of function mutation, via overexpression of exogenous wild-type Myl4 by AAV9 vectors. Our results showed that delivery of Myl4 expressing AAV9 to postnatal rat models rescued the symptoms of AF, indicating the therapeutic potential that early gene therapy intervention can achieve long-term effects in treating cardiac arrhythmias caused by gene mutations.
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Affiliation(s)
- Handan Hu
- Shanghai Frontiers Science Center of Genome Editing and Cell Therapy, Shanghai Key Laboratory of Regulatory Biology, Institute of Biomedical Sciences and School of Life Sciences, East China Normal University, Shanghai 200241, China
| | - Liren Wang
- Shanghai Frontiers Science Center of Genome Editing and Cell Therapy, Shanghai Key Laboratory of Regulatory Biology, Institute of Biomedical Sciences and School of Life Sciences, East China Normal University, Shanghai 200241, China
| | - Huiying Li
- Shanghai Frontiers Science Center of Genome Editing and Cell Therapy, Shanghai Key Laboratory of Regulatory Biology, Institute of Biomedical Sciences and School of Life Sciences, East China Normal University, Shanghai 200241, China
- Southern Medical University Affiliated Fengxian Hospital, Shanghai 201499, China
| | - Hailing Li
- The Department of Cardiology, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai 200072, China
| | - Xi Chen
- Shanghai Frontiers Science Center of Genome Editing and Cell Therapy, Shanghai Key Laboratory of Regulatory Biology, Institute of Biomedical Sciences and School of Life Sciences, East China Normal University, Shanghai 200241, China
| | - Wenhui Peng
- The Department of Cardiology, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai 200072, China
| | - Jun Wang
- Department of Pediatrics, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX 77030, United States
| | - Yongxiang Zhao
- National Center for International Biotargeting Theranostics, Guangxi Key Laboratory of Biotargeting Theranostics, Collaborative Innovation Center for Targeting Tumor Theranostics, Guangxi Medical University, Guangxi 530021, China
| | - Mingyao Liu
- Shanghai Frontiers Science Center of Genome Editing and Cell Therapy, Shanghai Key Laboratory of Regulatory Biology, Institute of Biomedical Sciences and School of Life Sciences, East China Normal University, Shanghai 200241, China
| | - Dali Li
- Shanghai Frontiers Science Center of Genome Editing and Cell Therapy, Shanghai Key Laboratory of Regulatory Biology, Institute of Biomedical Sciences and School of Life Sciences, East China Normal University, Shanghai 200241, China
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13
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Prabhakar S, Beauchamp RL, Cheah PS, Yoshinaga A, Haidar EA, Lule S, Mani G, Maalouf K, Stemmer-Rachamimov A, Jung DH, Welling DB, Giovannini M, Plotkin SR, Maguire CA, Ramesh V, Breakefield XO. Gene replacement therapy in a schwannoma mouse model of neurofibromatosis type 2. Mol Ther Methods Clin Dev 2022; 26:169-180. [PMID: 35846573 PMCID: PMC9263409 DOI: 10.1016/j.omtm.2022.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 06/17/2022] [Indexed: 11/25/2022]
Abstract
Loss of function of the neurofibromatosis type 2 (NF2) tumor suppressor gene leads to the formation of schwannomas, meningiomas, and ependymomas, comprising ∼50% of all sporadic cases of primary nervous system tumors. NF2 syndrome is an autosomal dominant condition, with bi-allelic inactivation of germline and somatic alleles resulting in loss of function of the encoded protein merlin and activation of mammalian target of rapamycin (mTOR) pathway signaling in NF2-deficient cells. Here we describe a gene replacement approach through direct intratumoral injection of an adeno-associated virus vector expressing merlin in a novel human schwannoma model in nude mice. In culture, the introduction of an AAV1 vector encoding merlin into CRISPR-modified human NF2-null arachnoidal cells (ACs) or Schwann cells (SCs) was associated with decreased size and mTORC1 pathway activation consistent with restored merlin activity. In vivo, a single injection of AAV1-merlin directly into human NF2-null SC-derived tumors growing in the sciatic nerve of nude mice led to regression of tumors over a 10-week period, associated with a decrease in dividing cells and an increase in apoptosis, in comparison with vehicle. These studies establish that merlin re-expression via gene replacement in NF2-null schwannomas is sufficient to cause tumor regression, thereby potentially providing an effective treatment for NF2.
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Affiliation(s)
- Shilpa Prabhakar
- Department of Neurology and Center for Molecular Imaging Research, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Roberta L. Beauchamp
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Pike See Cheah
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Center for Molecular Imaging Research, Massachusetts General Hospital, 25 Shattuck St, Boston, MA 02115, USA
- Department of Human Anatomy, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, JALAN UNIVERSITI 1 Serdang, 43400 Seri Kembangan, Selangor, Malaysia
| | - Akiko Yoshinaga
- Department of Neurology and Center for Molecular Imaging Research, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02129, USA
| | - Edwina Abou Haidar
- Department of Neurology and Center for Molecular Imaging Research, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Sevda Lule
- Department of Neurology and Center for Molecular Imaging Research, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02129, USA
| | - Gayathri Mani
- Department of Neurology and Center for Molecular Imaging Research, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02129, USA
| | - Katia Maalouf
- Department of Neurology and Center for Molecular Imaging Research, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Anat Stemmer-Rachamimov
- Department of Pathology and Center for Cancer Research, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA
| | - David H. Jung
- Department of Otolaryngology, Massachusetts Eye and Ear and Harvard Medical School, Boston, MA 02114, USA
- Program in Speech and Hearing Bioscience and Technology, Harvard Medical School, Boston, MA 02114, USA
| | - D. Bradley Welling
- Department of Otolaryngology Head and Neck Surgery, Harvard Medical School, Massachusetts Eye and Ear and Massachusetts General Hospital, Boston, MA 02114, USA
- Program in Speech and Hearing Bioscience and Technology, Harvard Medical School, Boston, MA 02114, USA
| | - Marco Giovannini
- Department of Head and Neck Surgery, David Geffen School of Medicine at UCLA and Jonsson Comprehensive Cancer Center (JCCC), University of California Los Angeles, Los Angeles, CA 90095, USA
| | - Scott R. Plotkin
- Department of Neurology and Cancer Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA
| | - Casey A. Maguire
- Department of Neurology, Massachusetts General Hospital and NeuroDiscovery Center, Harvard Medical School, Boston, MA 02114, USA
| | - Vijaya Ramesh
- Department of Neurology and Center for Genomic Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA
| | - Xandra O. Breakefield
- Department of Neurology and Center for Molecular Imaging Research, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA
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14
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Deng L, Liang P, Cui H. Pseudotyped lentiviral vectors: Ready for translation into targeted cancer gene therapy? Genes Dis 2022. [PMID: 37492721 PMCID: PMC10363566 DOI: 10.1016/j.gendis.2022.03.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Gene therapy holds great promise for curing cancer by editing the deleterious genes of tumor cells, but the lack of vector systems for efficient delivery of genetic material into specific tumor sites in vivo has limited its full therapeutic potential in cancer gene therapy. Over the past two decades, increasing studies have shown that lentiviral vectors (LVs) modified with different glycoproteins from a donating virus, a process referred to as pseudotyping, have altered tropism and display cell-type specificity in transduction, leading to selective tumor cell killing. This feature of LVs together with their ability to enable high efficient gene delivery in dividing and non-dividing mammalian cells in vivo make them to be attractive tools in future cancer gene therapy. This review is intended to summarize the status quo of some typical pseudotypings of LVs and their applications in basic anti-cancer studies across many malignancies. The opportunities of translating pseudotyped LVs into clinic use in cancer therapy have also been discussed.
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15
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Chai Z, Zhang X, Dobbins AL, Samulski RJ, Merricks EP, Nichols TC, Li C. Dexamethasone Transiently Enhances Transgene Expression in the Liver When Administered at Late-Phase Post Long-Term Adeno-Associated Virus Transduction. Hum Gene Ther 2022; 33:119-130. [PMID: 34617445 PMCID: PMC8885437 DOI: 10.1089/hum.2021.083] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Glucocorticoids have anti-inflammatory and immunosuppressive functions and have commonly been used for preventing liver toxicity after the systemic application of a high dose of adeno-associated virus (AAV) vector for gene therapy. Clinical studies have reported that glucocorticoids have rescued factor IX (FIX) expression in patients with hemophilia B who showed a reduced FIX expression at 6 to 10 weeks post-AAV vector administration. In this study, we explored whether glucocorticoids could affect transgene expression in AAV targeted livers in animal models. When dexamethasone was applied before AAV9/FIX vector administration in the wild-type C57BL/6 mice, FIX expression was much higher than that of the control mice at any time point. More importantly, FIX expression transiently increased after dexamethasone was administered at week 6 or later post-AAV injection regardless of the various dexamethasone treatments applied. The transient enhancement in transgene expression was observed once there were one to several consecutive dexamethasone treatments completed. A similar result was also achieved in other wild-type BALB/c and hemophilia B mice that were treated with AAV9/FIX and dexamethasone. This mechanism study demonstrated that the administration of dexamethasone did not change either AAV genome copy number or transgene expression at the transcription level but transiently decreased interferon beta (IFN-β) and tumor necrosis factor alpha (TNF-α) expression in the livers of mice at a later time after AAV injection. Next, we studied the effect of dexamethasone on late transgene expression in hemophilia B dogs. Dexamethasone was administered 1 year after AAV9/FIX injection. Inconsistent with the results in mice, no significant change of FIX expression was observed in hemophilia B dogs. In summary, the results from this study indicate that dexamethasone may have various effects on transgene expression in AAV-transduced livers in different species, which provides valuable information about the rational application of dexamethasone in future clinical studies.
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Affiliation(s)
- Zheng Chai
- Gene Therapy Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Xintao Zhang
- Gene Therapy Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Amanda Lee Dobbins
- Gene Therapy Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Richard Jude Samulski
- Gene Therapy Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Department of Pharmacology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Elizabeth P. Merricks
- Department of Pathology and Laboratory Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Blood Research Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Timothy C. Nichols
- Department of Pathology and Laboratory Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Blood Research Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Chengwen Li
- Gene Therapy Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Carolina Institute for Developmental Disabilities, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Correspondence: Dr. Chengwen Li, Gene Therapy Center, University of North Carolina at Chapel Hill, 7007 Thurston-Bowles Building, 104 Manning Drive, CB #7352, Chapel Hill, NC 27599, USA.
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16
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Mao J, Wang Y, Zhang W, Shen Y, Zhang G, Xi W, Wang Q, Ruan Z, Wang J, Xi X. Long-term correction of hemorrhagic diathesis in hemophilia A mice by an AAV-delivered hybrid FVIII composed of the human heavy chain and the rat light chain. Front Med 2022; 16:584-595. [PMID: 35038106 DOI: 10.1007/s11684-021-0844-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 12/29/2020] [Indexed: 12/01/2022]
Abstract
Conventional therapies for hemophilia A (HA) are prophylactic or on-demand intravenous FVIII infusions. However, they are expensive and inconvenient to perform. Thus, better strategies for HA treatment must be developed. In this study, a recombinant FVIII cDNA encoding a human/rat hybrid FVIII with an enhanced procoagulant potential for adeno-associated virus (AAV)-delivered gene therapy was developed. Plasmids containing human FVIII heavy chain (hHC), human light chain (hLC), and rat light chain (rLC) were transfected into cells and hydrodynamically injected into HA mice. Purified AAV viruses were intravenously injected into HA mice at two doses. Results showed that the hHC + rLC protein had a higher activity than the hHC + hLC protein at comparable expression levels. The specific activity of hHC + rLC was about 4- to 8-fold higher than that of their counterparts. Hydrodynamic injection experiments obtained consistent results. Notably, the HA mice undergoing the AAV-delivered hHC + rLC treatment exhibited a visibly higher activity than those treated with hHC + hLC, and the therapeutic effects lasted for up to 40 weeks. In conclusion, the application of the hybrid FVIII (hHC + rLC) via an AAV-delivered gene therapy substantially improved the hemorrhagic diathesis of the HA mice. These data might be of help to the development of optimized FVIII expression cassette for HA gene therapy.
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Affiliation(s)
- Jianhua Mao
- State Key Laboratory of Medical Genomics, Shanghai Institute of Hematology, Collaborative Innovation Center of Hematology, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China.
| | - Yun Wang
- State Key Laboratory of Medical Genomics, Shanghai Institute of Hematology, Collaborative Innovation Center of Hematology, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China.,Shanghai Institute of Hematology, State Key Laboratory for Medical Genomics and Department of Hematology, Collaborative Innovation Center of Systems Biomedicine, Pôle Sino-Français des Sciences du Vivant et Genomique, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Wei Zhang
- State Key Laboratory of Medical Genomics, Shanghai Institute of Hematology, Collaborative Innovation Center of Hematology, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Yan Shen
- Research Center for Experimental Medicine, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Guowei Zhang
- The School of Medicine, Hangzhou Normal University, Hangzhou, 310036, China
| | - Wenda Xi
- Shanghai Institute of Hypertension, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Qiang Wang
- State Key Laboratory of Medical Genomics, Shanghai Institute of Hematology, Collaborative Innovation Center of Hematology, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Zheng Ruan
- State Key Laboratory of Medical Genomics, Shanghai Institute of Hematology, Collaborative Innovation Center of Hematology, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Jin Wang
- Shanghai Institute of Hematology, State Key Laboratory for Medical Genomics and Department of Hematology, Collaborative Innovation Center of Systems Biomedicine, Pôle Sino-Français des Sciences du Vivant et Genomique, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Xiaodong Xi
- State Key Laboratory of Medical Genomics, Shanghai Institute of Hematology, Collaborative Innovation Center of Hematology, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China.
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17
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Ling X, Chang L, Chen H, Gao X, Yin J, Zuo Y, Huang Y, Zhang B, Hu J, Liu T. Improving the efficiency of CRISPR-Cas12a-based genome editing with site-specific covalent Cas12a-crRNA conjugates. Mol Cell 2021; 81:4747-4756.e7. [PMID: 34648747 DOI: 10.1016/j.molcel.2021.09.021] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 06/28/2021] [Accepted: 09/16/2021] [Indexed: 12/26/2022]
Abstract
The CRISPR-Cas12a system shows unique features compared with widely used Cas9, making it an attractive and potentially more precise alternative. However, the adoption of this system has been hindered by its relatively low editing efficiency. Guided by physical chemical principles, we covalently conjugated 5' terminal modified CRISPR RNA (crRNA) to a site-specifically modified Cas12a through biorthogonal chemical reaction. The genome editing efficiency of the resulting conjugated Cas12a complex (cCas12a) was substantially higher than that of the wild-type complex. We also demonstrated that cCas12a could be used for precise gene knockin and multiplex gene editing in a chimeric antigen receptor T cell preparation with efficiency much higher than that of the wild-type system. Overall, our findings indicate that covalently linking Cas nuclease and crRNA is an effective approach to improve the Cas12a-based genome editing system and could potentially provide an insight into engineering other Cas family members with low efficiency as well.
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Affiliation(s)
- Xinyu Ling
- State Key Laboratory of Natural and Biomimetic Drugs, School of Pharmaceutical Sciences, Peking University, 38 Xueyuan Road, Haidian District, Beijing 100191, China
| | - Liying Chang
- State Key Laboratory of Natural and Biomimetic Drugs, School of Pharmaceutical Sciences, Peking University, 38 Xueyuan Road, Haidian District, Beijing 100191, China
| | - Heqi Chen
- State Key Laboratory of Natural and Biomimetic Drugs, School of Pharmaceutical Sciences, Peking University, 38 Xueyuan Road, Haidian District, Beijing 100191, China
| | - Xiaoqin Gao
- State Key Laboratory of Natural and Biomimetic Drugs, School of Pharmaceutical Sciences, Peking University, 38 Xueyuan Road, Haidian District, Beijing 100191, China
| | - Jianhang Yin
- The MOE Key Laboratory of Cell Proliferation and Differentiation, Genome Editing Research Center, School of Life Sciences, Peking University, Beijing 100871, China; Peking-Tsinghua Center for Life Sciences, Peking University, Beijing 100871, China
| | - Yi Zuo
- State Key Laboratory of Natural and Biomimetic Drugs, School of Pharmaceutical Sciences, Peking University, 38 Xueyuan Road, Haidian District, Beijing 100191, China
| | - Yujia Huang
- State Key Laboratory of Natural and Biomimetic Drugs, School of Pharmaceutical Sciences, Peking University, 38 Xueyuan Road, Haidian District, Beijing 100191, China
| | - Bo Zhang
- Department of Medical Research Center, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Jiazhi Hu
- The MOE Key Laboratory of Cell Proliferation and Differentiation, Genome Editing Research Center, School of Life Sciences, Peking University, Beijing 100871, China; Peking-Tsinghua Center for Life Sciences, Peking University, Beijing 100871, China
| | - Tao Liu
- State Key Laboratory of Natural and Biomimetic Drugs, School of Pharmaceutical Sciences, Peking University, 38 Xueyuan Road, Haidian District, Beijing 100191, China.
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18
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Yanazawa K, Sugasawa T, Aoki K, Nakano T, Kawakami Y, Takekoshi K. Development of a gene doping detection method to detect overexpressed human follistatin using an adenovirus vector in mice. PeerJ 2021; 9:e12285. [PMID: 34721976 PMCID: PMC8541302 DOI: 10.7717/peerj.12285] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Accepted: 09/20/2021] [Indexed: 11/27/2022] Open
Abstract
Background Gene doping is the misuse of genome editing and gene therapy technologies for the purpose of manipulating specific genes or gene functions in order to improve athletic performance. However, a non-invasive detection method for gene doping using recombinant adenoviral (rAdV) vectors containing human follistatin (hFST) genes (rAdV<hFST>) has not yet been developed. Therefore, the aim of this study was to develop a method to detect gene doping using rAdV<hFST>. Methods First, we generated rAdV<hFST> and evaluated the overexpression of the hFST gene, FST protein, and muscle protein synthesis signaling using cell lines. Next, rAdV<hFST> was injected intravenously or intramuscularly into mice, and whole blood was collected, and hFST and cytomegalovirus promoter (CMVp) gene fragments were detected using TaqMan-quantitative polymerase chain reaction (qPCR). Finally, to confirm the specificity of the primers and the TaqMan probes, samples from each experiment were pooled, amplified using TaqMan-qPCR, and sequenced using the Sanger sequencing. Results The expression of hFST and FST proteins and muscle protein synthesis signaling significantly increased in C2C12 cells. In long-term, transgene fragments could be detected until 4 days after intravenous injection and 3 days after intramuscular injection. Finally, the Sanger sequencing confirmed that the primers and TaqMan probe specifically amplified the gene sequence of interest. Conclusions These results indicate the possibility of detecting gene doping using rAdV<hFST> using TaqMan-qPCR in blood samples. This study may contribute to the development of detection methods for gene doping using rAdV<hFST>.
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Affiliation(s)
- Koki Yanazawa
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba, Japan
| | - Takehito Sugasawa
- Laboratory of Clinical Examination/Sports Medicine, Division of Clinical Medicines, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Kai Aoki
- Laboratory of Clinical Examination/Sports Medicine, Division of Clinical Medicines, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Takuro Nakano
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba, Japan
| | - Yasushi Kawakami
- Laboratory of Clinical Examination/Sports Medicine, Division of Clinical Medicines, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Kazuhiro Takekoshi
- Laboratory of Clinical Examination/Sports Medicine, Division of Clinical Medicines, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
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19
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Batty P, Lillicrap D. Gene therapy for hemophilia: Current status and laboratory consequences. Int J Lab Hematol 2021; 43 Suppl 1:117-123. [PMID: 34288447 DOI: 10.1111/ijlh.13605] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 04/12/2021] [Accepted: 04/21/2021] [Indexed: 12/19/2022]
Abstract
Since the cloning and characterization of the factor VIII (FVIII) and factor IX genes in the mid-1980s, gene therapy has been perceived as having significant potential for the treatment of severe hemophilia. Now, some 35 years later, these proposals are close to being realized through the licensing of the first clinical gene therapy product. Adeno-associated viral vector-mediated gene therapy for hemophilia A and B has been extensively investigated in preclinical models over the past 20 years, and since 2011, there has been increasing evidence in early phase clinical trials that this therapeutic strategy can provide safe and effective rescue of the hemostatic phenotype in severe hemophilia. As the uptake of hemophilia gene therapy progresses, it is clear that many aspects of the gene therapy process require crucial laboratory support to ensure safe and effective outcomes from his new therapeutic paradigm. These laboratory contributions extend from evaluations of the gene therapy vehicle, assessments of the patient immune status for the vector, and ultimately the performance of assays to determine the hemostatic benefit of the gene therapy and potentially of its long-term safety on the host genome. As with many aspects of past hemophilia care, the safe and effective delivery of gene therapy will require an informed and coordinated contribution from laboratory science.
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Affiliation(s)
- Paul Batty
- Department of Pathology and Molecular Medicine, Queen's University, Kingston, ON, Canada
| | - David Lillicrap
- Department of Pathology and Molecular Medicine, Queen's University, Kingston, ON, Canada
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20
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Zhang W, Michalowski CB, Beloqui A. Oral Delivery of Biologics in Inflammatory Bowel Disease Treatment. Front Bioeng Biotechnol 2021; 9:675194. [PMID: 34150733 PMCID: PMC8209478 DOI: 10.3389/fbioe.2021.675194] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 04/19/2021] [Indexed: 12/11/2022] Open
Abstract
Inflammatory bowel disease (IBD) has been posed as a great worldwide health threat. Having an onset during early adulthood, IBD is a chronic inflammatory disease characterized by remission and relapse. Due to its enigmatic etiology, no cure has been developed at the moment. Conventionally, steroids, 5-aminosalicylic acid, and immunosuppressants have been applied clinically to relieve patients’ syndrome which, unfavorably, causes severe adverse drug reactions including diarrhea, anemia, and glaucoma. Insufficient therapeutic effects also loom, and surgical resection is mandatory in half of the patients within 10 years after diagnosis. Biologics demonstrated unique and differentiative therapeutic mechanism which can alleviate the inflammation more effectively. However, their application in IBD has been hindered considering their stability and toxicity. Scientists have brought up with the concept of nanomedicine to achieve the targeted drug delivery of biologics for IBD. Here, we provide an overview of biologics for IBD treatment and we review existing formulation strategies for different biological categories including antibodies, gene therapy, and peptides. This review highlights the current trends in oral delivery of biologics with an emphasis on the important role of nanomedicine in the development of reliable methods for biologic delivery in IBD treatment.
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Affiliation(s)
- Wunan Zhang
- Advanced Drug Delivery and Biomaterials, Louvain Drug Research Institute, Université Catholique de Louvain, Brussels, Belgium
| | - Cecilia Bohns Michalowski
- Advanced Drug Delivery and Biomaterials, Louvain Drug Research Institute, Université Catholique de Louvain, Brussels, Belgium
| | - Ana Beloqui
- Advanced Drug Delivery and Biomaterials, Louvain Drug Research Institute, Université Catholique de Louvain, Brussels, Belgium
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21
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Huang Y, Huang W, Huang Y, Song P, Zhang M, Zhang HT, Pan S, Hu Y. Cdk5 Inhibitory Peptide Prevents Loss of Neurons and Alleviates Behavioral Changes in p25 Transgenic Mice. J Alzheimers Dis 2021; 74:1231-1242. [PMID: 32144987 DOI: 10.3233/jad-191098] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Accumulation of p25 is thought to be a causative risk factor for Alzheimer's disease (AD). As a cleaved product of p35, p25 binds to cyclin-dependent kinase 5 (Cdk5) and leads to the hyperactivity of Cdk5. Then, Cdk5/p25 phosphorylates many pathological substrates related to neurodegenerative diseases. p25 transgenic (Tg) mouse model recaptures some pathological changes of AD, including tau hyperphosphorylation, neurofibrillary tangles, neuroinflammation, and neuronal death, which can be prevented by transgenic expression of Cdk5 inhibitory peptide (CIP) before the insult of p25. OBJECTIVE In the present study, we would like to know whether adeno-associated virus serotype-9 (AAV9)-mediated CIP can protect neurons after insult of p25 in p25Tg mice. METHODS Administration of AAV9-CIP or control virus were delivered in the brain of p25Tg mice via intracerebroventricular infusions following the induction of p25. Western blotting, immunohistochemistry and immunofluorescence assessment, and animal behavioral evaluation were performed. RESULTS Brain atrophy, neuronal death, tau phosphorylation and inflammation in the hippocampus, and cognitive decline were observed in p25Tg mice. Administration of CIP but not the control virus in p25Tg mice reduced levels of tau phosphorylation and inflammation in the hippocampus, which is correlated with inhibition of brain atrophy and neuronal apoptosis in the hippocampus, and improvement of cognitive decline. CONCLUSION Our results provide further evidence that the neurotoxicity of p25 can be alleviated by CIP.
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Affiliation(s)
- Yaowei Huang
- Department of Neurology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, P. R. China
| | - Wei Huang
- Department of Neurology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, P. R. China.,Department of Neurology, Shunde Hospital, Southern Medical University, Foshan, Guangdong, P. R. China
| | - Yingwei Huang
- Department of Neurology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, P. R. China
| | - Pingping Song
- Department of Neurology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, P. R. China.,Department of Neurology, First Affiliated Hospital, Jinan University, Guangzhou, Guangdong, P. R. China
| | - Melanie Zhang
- Department of Neurobiology Northwestern University, Feinberg School of Medicine, Evanston, IL, USA
| | - Han-Ting Zhang
- Department of Behavioral Medicine & Psychiatry, Physiology & Pharmacology, and Neuroscience, The Rockefeller Neurosciences Institute, West Virginia University Health Sciences Center, Morgantown, WV, USA
| | - Suyue Pan
- Department of Neurology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, P. R. China
| | - Yafang Hu
- Department of Neurology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, P. R. China
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22
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Alhakamy NA, Curiel DT, Berkland CJ. The era of gene therapy: From preclinical development to clinical application. Drug Discov Today 2021; 26:1602-1619. [PMID: 33781953 DOI: 10.1016/j.drudis.2021.03.021] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 12/09/2020] [Accepted: 03/21/2021] [Indexed: 12/16/2022]
Abstract
Three decades of promise have culminated in the development of gene therapies that can be applied to a broad range of human diseases. After a brief history, we provide an overview of gene therapy types and delivery methods, gene editing technologies, regulatory affairs, clinical trials, approved products, ongoing challenges, and future goals. Information on clinical trials of candidates and on approved products for gene therapy developed between 1988 and 2020 is systematically collated. To obtain this global information, we scanned and reviewed more than 46,000 records of clinical trials from 17 clinical trial database providers. The medical benefits of transformative gene therapies are gradually being accepted by payors, and a significant increase in the number of gene therapy clinical trials and approved gene therapy products has resulted.
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Affiliation(s)
- Nabil A Alhakamy
- Department of Pharmaceutics, Faculty of Pharmacy, King Abdulaziz University, Jeddah, Saudi Arabia; Center of Excellence for Drug Research and Pharmaceutical Industries, King Abdulaziz University, Jeddah 21589, Saudi Arabia; Mohamed Saeed Tamer Chair for Pharmaceutical Industries, King Abdulaziz University, Jeddah 21589, Saudi Arabia; Department of Pharmaceutical Chemistry, University of Kansas, Lawrence, KS 66047, USA
| | - David T Curiel
- Department of Radiation Oncology, School of Medicine, Washington University, St. Louis, MO 63108, USA
| | - Cory J Berkland
- Department of Pharmaceutical Chemistry, University of Kansas, Lawrence, KS 66047, USA; Department of Chemical & Petroleum Engineering, University of Kansas, Lawrence, KS 66047, USA.
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23
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Croteau SE, Wang M, Wheeler AP. 2021 clinical trials update: Innovations in hemophilia therapy. Am J Hematol 2021; 96:128-144. [PMID: 33064330 DOI: 10.1002/ajh.26018] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 10/07/2020] [Accepted: 10/12/2020] [Indexed: 01/19/2023]
Abstract
Therapies engineered to prolong clotting factor protein circulation time, manipulate the balance of pro-coagulant and anti-coagulant proteins, or introduce new genetic material to enable endogenous factor protein production dominate the clinical trial landscape of hemophilia. The availability of clotting factor concentrates and the establishment of primary prophylaxis have dramatically improved health outcomes for hemophilia patients. But, the burden of hemostatic therapy remains significant, and many barriers to consistent longitudinal use of prophylaxis exist. Several types of emerging therapeutics including engineered factor concentrates, substitutive therapies, rebalancing therapies, and gene transfer/editing all aim to reduce the challenges of current hemophilia treatment. Emerging treatment options may reduce treatment frequency or need for intravenous administration. They may also introduce new challenges in laboratory assessment of hemostasis. These novel therapies must not introduce significant new health risks and continue to support similar or improved outcomes. The potential ramifications of rebalancing the coagulation cascade, particularly in a stress or inflammatory state, or introduction of new genetic material are not trivial. The focus of this review is to provide an overview of active and recently completed clinical trials as well as emerging preclinical data investigating new therapeutic possibilities for hemophilia patients and potentially other rare bleeding disorders.
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Affiliation(s)
| | - Michael Wang
- University of Colorado Hemophilia and Thrombosis Center Aurora Colorado
| | - Allison P. Wheeler
- Department of Pathology, Microbiology & Immunology Vanderbilt University Medical Center Nashville Tennessee
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24
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Milani M, Annoni A, Moalli F, Liu T, Cesana D, Calabria A, Bartolaccini S, Biffi M, Russo F, Visigalli I, Raimondi A, Patarroyo-White S, Drager D, Cristofori P, Ayuso E, Montini E, Peters R, Iannacone M, Cantore A, Naldini L. Phagocytosis-shielded lentiviral vectors improve liver gene therapy in nonhuman primates. Sci Transl Med 2020; 11:11/493/eaav7325. [PMID: 31118293 DOI: 10.1126/scitranslmed.aav7325] [Citation(s) in RCA: 60] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 01/11/2019] [Accepted: 05/01/2019] [Indexed: 12/13/2022]
Abstract
Liver-directed gene therapy for the coagulation disorder hemophilia showed safe and effective results in clinical trials using adeno-associated viral vectors to replace a functional coagulation factor, although some unmet needs remain. Lentiviral vectors (LVs) may address some of these hurdles because of their potential for stable expression and the low prevalence of preexisting viral immunity in humans. However, systemic LV administration to hemophilic dogs was associated to mild acute toxicity and low efficacy at the administered doses. Here, exploiting intravital microscopy and LV surface engineering, we report a major role of the human phagocytosis inhibitor CD47, incorporated into LV cell membrane, in protecting LVs from uptake by professional phagocytes and innate immune sensing, thus favoring biodistribution to hepatocytes after systemic administration. By enforcing high CD47 surface content, we generated phagocytosis-shielded LVs which, upon intravenous administration to nonhuman primates, showed selective liver and spleen targeting and enhanced hepatocyte gene transfer compared to parental LV, reaching supraphysiological activity of human coagulation factor IX, the protein encoded by the transgene, without signs of toxicity or clonal expansion of transduced cells.
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Affiliation(s)
- Michela Milani
- San Raffaele Telethon Institute for Gene Therapy, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy.,Vita-Salute San Raffaele University, 20132 Milan, Italy
| | - Andrea Annoni
- San Raffaele Telethon Institute for Gene Therapy, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | | | | | - Daniela Cesana
- San Raffaele Telethon Institute for Gene Therapy, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Andrea Calabria
- San Raffaele Telethon Institute for Gene Therapy, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Sara Bartolaccini
- San Raffaele Telethon Institute for Gene Therapy, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Mauro Biffi
- San Raffaele Telethon Institute for Gene Therapy, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Fabio Russo
- San Raffaele Telethon Institute for Gene Therapy, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Ilaria Visigalli
- San Raffaele Telethon Institute for Gene Therapy, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | | | | | | | - Patrizia Cristofori
- San Raffaele Telethon Institute for Gene Therapy, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy.,GlaxoSmithKline R&D UK, Ware SG12 0DP, UK
| | - Eduard Ayuso
- INSERM UMR1089, University of Nantes, CHU de Nantes, 44093 Nantes, France
| | - Eugenio Montini
- San Raffaele Telethon Institute for Gene Therapy, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | | | | | - Alessio Cantore
- San Raffaele Telethon Institute for Gene Therapy, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy. .,Vita-Salute San Raffaele University, 20132 Milan, Italy
| | - Luigi Naldini
- San Raffaele Telethon Institute for Gene Therapy, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy. .,Vita-Salute San Raffaele University, 20132 Milan, Italy
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25
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Zhao X, Jin C, Dong T, Sun Z, Zheng X, Feng B, Cheng Z, Li X, Tao Y, Wu H. Characterization of promoters for adeno-associated virus mediated efficient Cas9 activation in adult Cas9 knock-in murine cochleae. Hear Res 2020; 394:107999. [PMID: 32611519 DOI: 10.1016/j.heares.2020.107999] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 04/30/2020] [Accepted: 05/20/2020] [Indexed: 11/27/2022]
Abstract
CRISPR/Cas9 gene editing enables the treatment of hearing loss in congenitally deaf neonatal mice via both viral and non-viral delivery. While adeno-associated virus (AAV)-mediated gene delivery systems have been shown to be effective tools for gene replacement in the inner ear, application of the AAV-mediated CRISPR/Cas9 gene-editing approach for this purpose is yet to be documented. Based on our previous findings, we focused on the effects of several AAVs delivered via canalostomy injection in adult mice. Among the AAVs examined, AAV8 showed the greatest efficiency and specificity in transducing inner hair cells (IHC). The ability of Cre-expressing AAV8 to activate Cas9 in floxed-Cas9 knock-in (Cas9 KI) mice was further evaluated. We compared the effects of six different promoters (CMV, CAG, hSyn, CaMKIIa, GFAP, and ALB) of AAV8 delivered to the inner ear of adult Cas9 KI mice. Our findings showed that three AAV groups (CMV, CAG and hSyn promoters) infected the inner ear efficiently with different tropisms. Notably, AAVs with CMV, CAG, and hSyn promoters infected diverse cell types in mature murine cochleae, including IHCs. In particular, AAV8-hSyn showed high affinity to IHCs and spiral ganglion neurons (SGN). Neither the AAV8 virus itself (except AAV8-CAG) nor the surgical procedures used caused damage to HCs or impaired normal hearing. Our findings indicated that injection of AAV-Cre into mature inner ear efficiently induces Cas9 activation to achieve safe and efficient gene editing and different constituent promoters confer diverse infection patterns in cochlea, expanding the repertoire of gene-editing tools for regulating gene expression in target cells of the inner ear as part of the collective effort to rescue genetic hearing loss and develop effective gene therapy techniques.
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Affiliation(s)
- Xingle Zhao
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, No.639, Zhizaoju Road, Shanghai, 200011, PR China; Ear Institute, Shanghai Jiaotong University School of Medicine, No.115, Jinzun Road, Shanghai, 200011, PR China; Shanghai Key Laboratory of Translation Medicine on Ear and Nose Disease, No.115, Jinzun Road, Shanghai, 200011, PR China
| | - Chenxi Jin
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, No.639, Zhizaoju Road, Shanghai, 200011, PR China; Ear Institute, Shanghai Jiaotong University School of Medicine, No.115, Jinzun Road, Shanghai, 200011, PR China; Shanghai Key Laboratory of Translation Medicine on Ear and Nose Disease, No.115, Jinzun Road, Shanghai, 200011, PR China
| | - Tingting Dong
- Ear Institute, Shanghai Jiaotong University School of Medicine, No.115, Jinzun Road, Shanghai, 200011, PR China; Shanghai Key Laboratory of Translation Medicine on Ear and Nose Disease, No.115, Jinzun Road, Shanghai, 200011, PR China; Biobank of Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, No.115, Jinzun Road, Shanghai, 200011, PR China
| | - Zhuoer Sun
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, No.639, Zhizaoju Road, Shanghai, 200011, PR China; Ear Institute, Shanghai Jiaotong University School of Medicine, No.115, Jinzun Road, Shanghai, 200011, PR China; Shanghai Key Laboratory of Translation Medicine on Ear and Nose Disease, No.115, Jinzun Road, Shanghai, 200011, PR China
| | - Xiaofei Zheng
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, No.639, Zhizaoju Road, Shanghai, 200011, PR China; Ear Institute, Shanghai Jiaotong University School of Medicine, No.115, Jinzun Road, Shanghai, 200011, PR China; Shanghai Key Laboratory of Translation Medicine on Ear and Nose Disease, No.115, Jinzun Road, Shanghai, 200011, PR China
| | - Baoyi Feng
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, No.639, Zhizaoju Road, Shanghai, 200011, PR China; Ear Institute, Shanghai Jiaotong University School of Medicine, No.115, Jinzun Road, Shanghai, 200011, PR China; Shanghai Key Laboratory of Translation Medicine on Ear and Nose Disease, No.115, Jinzun Road, Shanghai, 200011, PR China
| | - Zhenzhe Cheng
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, No.639, Zhizaoju Road, Shanghai, 200011, PR China; Ear Institute, Shanghai Jiaotong University School of Medicine, No.115, Jinzun Road, Shanghai, 200011, PR China; Shanghai Key Laboratory of Translation Medicine on Ear and Nose Disease, No.115, Jinzun Road, Shanghai, 200011, PR China
| | - Xiang Li
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, No.639, Zhizaoju Road, Shanghai, 200011, PR China; Ear Institute, Shanghai Jiaotong University School of Medicine, No.115, Jinzun Road, Shanghai, 200011, PR China; Shanghai Key Laboratory of Translation Medicine on Ear and Nose Disease, No.115, Jinzun Road, Shanghai, 200011, PR China
| | - Yong Tao
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, No.639, Zhizaoju Road, Shanghai, 200011, PR China; Ear Institute, Shanghai Jiaotong University School of Medicine, No.115, Jinzun Road, Shanghai, 200011, PR China; Shanghai Key Laboratory of Translation Medicine on Ear and Nose Disease, No.115, Jinzun Road, Shanghai, 200011, PR China.
| | - Hao Wu
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, No.639, Zhizaoju Road, Shanghai, 200011, PR China; Ear Institute, Shanghai Jiaotong University School of Medicine, No.115, Jinzun Road, Shanghai, 200011, PR China; Shanghai Key Laboratory of Translation Medicine on Ear and Nose Disease, No.115, Jinzun Road, Shanghai, 200011, PR China.
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26
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Zhu D, Rostami MR, Zuo WL, Leopold PL, Crystal RG. Single-Cell Transcriptome Analysis of Mouse Liver Cell-Specific Tropism and Transcriptional Dysregulation Following Intravenous Administration of AAVrh.10 Vectors. Hum Gene Ther 2020; 31:590-604. [PMID: 32143547 PMCID: PMC7232697 DOI: 10.1089/hum.2019.366] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Accepted: 02/16/2020] [Indexed: 01/20/2023] Open
Abstract
Capitalizing on liver tropism of adeno-associated viral (AAV) vectors, intravenous vector administration is commonly used to genetically modify hepatocytes, a strategy currently in clinical trials for a number of liver-based hereditary disorders. Although hepatocytes are known to exhibit extensive phenotypic heterogeneity influenced by liver zonation and dietary cycle, there is little data available for the tropism capacity, as well as the potential transcriptional dysregulation, of AAV vectors for specific liver cell types. To assess these issues, we employed single-cell RNA sequencing of the mouse liver after intravenous administration of the liver tropic AAVrh.10 vector to characterize cell-specific AAV-mediated transgene expression and transcriptome dysregulation. Wild-type 8-week-old male C57Bl/6 mice under normal feed cycle were randomly divided into three groups and intravenously administered phosphate-buffered saline (PBS), AAVrh.10Null (no transgene), or AAVrh.10mCherry (marker gene). Overall, a total of 46,500 liver cells were sequenced. The single-cell transcriptomic profiles were grouped into three separate clusters of hepatocytes (Ttr-enriched "Hep1," Tat-enriched "Hep2," and Alb-enriched "Hep3") and multiple other cell types. The hepatocyte diversity was driven by glucose and lipid homeostasis signaling. Assessment of the transgene expression demonstrated that AAVrh.10 is primarily Hep1-tropic, with a 10-gene signature positively correlated with AAVrh.10-mediated transgene expression. The transgene expression was less in Hep2 and Hep3 cells with a high receptor tyrosine kinase phenotype. Importantly, AAVrh.10 vector interactions with the liver markedly altered the transcriptional patterns of all cell types, with modified genes enriched in pathways of complement and coagulation cascade, cytochrome P450, peroxisome, antigen processing and presentation, and endoplasmic reticulum protein processing. These observations provide insights into the liver cell-specific consequences of AAV-mediated liver gene transfer, far beyond the well-known organ-specific expression of the vector-delivered transgene.
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Affiliation(s)
- Detu Zhu
- Department of Genetic Medicine, Weill Cornell Medical College, New York, New York, USA
| | - Mahboubeh R. Rostami
- Department of Genetic Medicine, Weill Cornell Medical College, New York, New York, USA
| | - Wu-lin Zuo
- Department of Genetic Medicine, Weill Cornell Medical College, New York, New York, USA
| | - Philip L. Leopold
- Department of Genetic Medicine, Weill Cornell Medical College, New York, New York, USA
| | - Ronald G. Crystal
- Department of Genetic Medicine, Weill Cornell Medical College, New York, New York, USA
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27
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FVIII expression by its native promoter sustains long-term correction avoiding immune response in hemophilic mice. Blood Adv 2020; 3:825-838. [PMID: 30862611 DOI: 10.1182/bloodadvances.2018027979] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Accepted: 02/04/2019] [Indexed: 12/20/2022] Open
Abstract
Here we describe a successful gene therapy approach for hemophilia A (HA), using the natural F8 promoter (pF8) to direct gene replacement to factor VIII (FVIII)-secreting cells. The promoter sequence and the regulatory elements involved in the modulation of F8 expression are still poorly characterized and biased by the historical assumption that FVIII expression is mainly in hepatocytes. Bioinformatic analyses have highlighted an underestimated complexity in gene expression at this locus, suggesting an activation of pF8 in more cell types than those previously expected. C57Bl/6 mice injected with a lentiviral vector expressing green fluorescent protein (GFP) under the pF8 (lentiviral vector [LV].pF8.GFP) confirm the predominant GFP expression in liver sinusoidal endothelial cells, with a few positive cells detectable also in hematopoietic organs. Therapeutic gene delivery (LV.pF8.FVIII) in hemophilic C57/Bl6 and 129-Bl6 mice successfully corrected the bleeding phenotype, rescuing up to 25% FVIII activity, using a codon-optimized FVIII, with sustained activity for the duration of the experiment (1 year) without inhibitor formation. Of note, LV.pF8.FVIII delivery in FVIII-immunized HA mice resulted in the complete reversion of the inhibitor titer with the recovery of therapeutic FVIII activity. Depletion of regulatory T cells (Tregs) in LV-treated mice allowed the formation of anti-FVIII antibodies, indicating a role for Tregs in immune tolerance induction. The significant blood loss reduction observed in all LV.pF8.FVIII-treated mice 1 year after injection confirmed the achievement of a long-term phenotypic correction. Altogether, our results highlight the potency of pF8-driven transgene expression to correct the bleeding phenotype in HA, as well as potentially in other diseases in which an endothelial-specific expression is required.
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28
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Zabaleta N, Hommel M, Salas D, Gonzalez-Aseguinolaza G. Genetic-Based Approaches to Inherited Metabolic Liver Diseases. Hum Gene Ther 2019; 30:1190-1203. [DOI: 10.1089/hum.2019.140] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Affiliation(s)
- Nerea Zabaleta
- Gene Therapy and Regulation of Gene Expression Program, Centro de Investigación Médica Aplicada, IDISNA, Universidad de Navarra, Pamplona, Spain
| | - Mirja Hommel
- Gene Therapy and Regulation of Gene Expression Program, Centro de Investigación Médica Aplicada, IDISNA, Universidad de Navarra, Pamplona, Spain
| | - David Salas
- Gene Therapy and Regulation of Gene Expression Program, Centro de Investigación Médica Aplicada, IDISNA, Universidad de Navarra, Pamplona, Spain
| | - Gloria Gonzalez-Aseguinolaza
- Gene Therapy and Regulation of Gene Expression Program, Centro de Investigación Médica Aplicada, IDISNA, Universidad de Navarra, Pamplona, Spain
- Vivet Therapeutics, Pamplona, Spain
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29
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Gollomp KL, Doshi BS, Arruda VR. Gene therapy for hemophilia: Progress to date and challenges moving forward. Transfus Apher Sci 2019; 58:602-612. [DOI: 10.1016/j.transci.2019.08.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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30
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Sugasawa T, Aoki K, Watanabe K, Yanazawa K, Natsume T, Takemasa T, Yamaguchi K, Takeuchi Y, Aita Y, Yahagi N, Yoshida Y, Tokinoya K, Sekine N, Takeuchi K, Ueda H, Kawakami Y, Shimizu S, Takekoshi K. Detection of Transgenes in Gene Delivery Model Mice by Adenoviral Vector Using ddPCR. Genes (Basel) 2019; 10:genes10060436. [PMID: 31181711 PMCID: PMC6627169 DOI: 10.3390/genes10060436] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 05/15/2019] [Accepted: 06/04/2019] [Indexed: 01/19/2023] Open
Abstract
With the rapid progress of genetic engineering and gene therapy, the World Anti-Doping Agency has been alerted to gene doping and prohibited its use in sports. However, there is no standard method available yet for the detection of transgenes delivered by recombinant adenoviral (rAdV) vectors. Here, we aim to develop a detection method for transgenes delivered by rAdV vectors in a mouse model that mimics gene doping. These rAdV vectors containing the mCherry gene was delivered in mice through intravenous injection or local muscular injection. After five days, stool and whole blood samples were collected, and total DNA was extracted. As additional experiments, whole blood was also collected from the mouse tail tip until 15 days from injection of the rAdv vector. Transgene fragments from different DNA samples were analyzed using semi-quantitative PCR (sqPCR), quantitative PCR (qPCR), and droplet digital PCR (ddPCR). In the results, transgene fragments could be directly detected from blood cell fraction DNA, plasma cell-free DNA, and stool DNA by qPCR and ddPCR, depending on specimen type and injection methods. We observed that a combination of blood cell fraction DNA and ddPCR was more sensitive than other combinations used in this model. These results could accelerate the development of detection methods for gene doping.
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Affiliation(s)
- Takehito Sugasawa
- Laboratory of Laboratory/Sports medicine, Division of Clinical Medicine, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Ibaraki 305-8577, Japan.
| | - Kai Aoki
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba 305-8577, Japan.
| | - Koichi Watanabe
- Faculty of Health and Sport Sciences, University of Tsukuba, Tsukuba 305-8577, Japan.
| | - Koki Yanazawa
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba 305-8577, Japan.
| | - Tohru Natsume
- Molecular Profiling Research Center for Drug Discovery, National Institute of Advanced Industrial Science and Technology (AIST), Tokyo 100-8921, Japan.
| | - Tohru Takemasa
- Faculty of Health and Sport Sciences, University of Tsukuba, Tsukuba 305-8577, Japan.
| | - Kaori Yamaguchi
- Faculty of Health and Sport Sciences, University of Tsukuba, Tsukuba 305-8577, Japan.
| | - Yoshinori Takeuchi
- Nutrigenomics Research Group, Faculty of Medicine, University of Tsukuba, Ibaraki 305-8575, Japan.
| | - Yuichi Aita
- Nutrigenomics Research Group, Faculty of Medicine, University of Tsukuba, Ibaraki 305-8575, Japan.
| | - Naoya Yahagi
- Nutrigenomics Research Group, Faculty of Medicine, University of Tsukuba, Ibaraki 305-8575, Japan.
| | - Yasuko Yoshida
- Department of Medical Technology, Faculty of Health Sciences, Tsukuba International University, 6-20-1 Manabe, Tsuchiura, Ibaraki 300-0051, Japan.
| | - Katsuyuki Tokinoya
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba 305-8577, Japan.
- Japan Society for the Promotion of Science; Kojimachi Business Center Building, Kojimachi, Chiyoda-ku, Tokyo 102-0083, Japan.
| | - Nanami Sekine
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba 305-8577, Japan.
| | - Kaoru Takeuchi
- Laboratory of Environmental Microbiology, Division of Basic Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba 305-8575, Japan.
| | - Haruna Ueda
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba 305-8577, Japan.
| | - Yasushi Kawakami
- Laboratory of Laboratory/Sports medicine, Division of Clinical Medicine, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Ibaraki 305-8577, Japan.
| | - Satoshi Shimizu
- Faculty of Health and Sport Sciences, University of Tsukuba, Tsukuba 305-8577, Japan.
| | - Kazuhiro Takekoshi
- Laboratory of Laboratory/Sports medicine, Division of Clinical Medicine, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Ibaraki 305-8577, Japan.
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31
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Gao J, Bergmann T, Zhang W, Schiwon M, Ehrke-Schulz E, Ehrhardt A. Viral Vector-Based Delivery of CRISPR/Cas9 and Donor DNA for Homology-Directed Repair in an In Vitro Model for Canine Hemophilia B. MOLECULAR THERAPY. NUCLEIC ACIDS 2018; 14:364-376. [PMID: 30690229 PMCID: PMC6356096 DOI: 10.1016/j.omtn.2018.12.008] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 12/16/2018] [Accepted: 12/16/2018] [Indexed: 01/08/2023]
Abstract
Gene therapy represents an attractive alternative to treat hemophilia B. Here we established three hepatocyte-derived cell lines based on Huh7, PLC/PRF/5, and Hep3B cells stably carrying a mutated canine FIX (cFIXmut) transgene containing a single point mutation in the catalytic domain. Based on these in vitro models resembling a commonly used canine large animal model, the tetracycline-controlled transcriptional activator (Tet-on)-inducible CRISPR/Cas9 system and an optimized donor were used to correct mutated cFIX gene through homology-directed repair (HDR). For efficient delivery of designer nuclease and donor DNA, we produced a high-capacity adenovirus vector type 5 (HCAdV5) containing the Tet-on-inducible cFIX-specific CRISPR/Cas9 system and a single-stranded adeno-associated virus type 2 vector (ssAAV2) containing the modified donor. Moreover, we designed a single HCAdV5 delivering all components for HDR. Our amplification-refractory mutation system based on qPCR analysis (ARMS-qPCR) revealed that the single vector application in Huh7-cFIXmut cells resulted in up to 5.52% HDR efficiencies, which was superior to the two-vector strategy. Furthermore the single vector also resulted in increased phenotypic correction efficiencies assayed by ELISA. We conclude that HDR in combination with viral vector delivery holds great promise for the correction of mutated FIX in disease models.
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Affiliation(s)
- Jian Gao
- Institute for Virology and Microbiology, Center for Biomedical Education and Research (ZBAF), Department of Human Medicine, Faculty of Health, Witten/Herdecke University, 58453 Witten, Germany
| | - Thorsten Bergmann
- Institute for Virology and Microbiology, Center for Biomedical Education and Research (ZBAF), Department of Human Medicine, Faculty of Health, Witten/Herdecke University, 58453 Witten, Germany
| | - Wenli Zhang
- Institute for Virology and Microbiology, Center for Biomedical Education and Research (ZBAF), Department of Human Medicine, Faculty of Health, Witten/Herdecke University, 58453 Witten, Germany
| | - Maren Schiwon
- Institute for Virology and Microbiology, Center for Biomedical Education and Research (ZBAF), Department of Human Medicine, Faculty of Health, Witten/Herdecke University, 58453 Witten, Germany
| | - Eric Ehrke-Schulz
- Institute for Virology and Microbiology, Center for Biomedical Education and Research (ZBAF), Department of Human Medicine, Faculty of Health, Witten/Herdecke University, 58453 Witten, Germany
| | - Anja Ehrhardt
- Institute for Virology and Microbiology, Center for Biomedical Education and Research (ZBAF), Department of Human Medicine, Faculty of Health, Witten/Herdecke University, 58453 Witten, Germany.
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32
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Li A, Lee CM, Hurley AE, Jarrett KE, De Giorgi M, Lu W, Balderrama KS, Doerfler AM, Deshmukh H, Ray A, Bao G, Lagor WR. A Self-Deleting AAV-CRISPR System for In Vivo Genome Editing. MOLECULAR THERAPY-METHODS & CLINICAL DEVELOPMENT 2018; 12:111-122. [PMID: 30619914 PMCID: PMC6313841 DOI: 10.1016/j.omtm.2018.11.009] [Citation(s) in RCA: 85] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 11/29/2018] [Indexed: 12/27/2022]
Abstract
Adeno-associated viral (AAV) vectors packaging the CRISPR-Cas9 system (AAV-CRISPR) can efficiently modify disease-relevant genes in somatic tissues with high efficiency. AAV vectors are a preferred delivery vehicle for tissue-directed gene therapy because of their ability to achieve sustained expression from largely non-integrating episomal genomes. However, for genome editizng applications, permanent expression of non-human proteins such as the bacterially derived Cas9 nuclease is undesirable. Methods are needed to achieve efficient genome editing in vivo, with controlled transient expression of CRISPR-Cas9. Here, we report a self-deleting AAV-CRISPR system that introduces insertion and deletion mutations into AAV episomes. We demonstrate that this system dramatically reduces the level of Staphylococcus aureus Cas9 protein, often greater than 79%, while achieving high rates of on-target editing in the liver. Off-target mutagenesis was not observed for the self-deleting Cas9 guide RNA at any of the predicted potential off-target sites examined. This system is efficient and versatile, as demonstrated by robust knockdown of liver-expressed proteins in vivo. This self-deleting AAV-CRISPR system is an important proof of concept that will help enable translation of liver-directed genome editing in humans.
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Affiliation(s)
- Ang Li
- Department of Bioengineering, Rice University, Houston, TX 77030, USA
| | - Ciaran M Lee
- Department of Bioengineering, Rice University, Houston, TX 77030, USA
| | - Ayrea E Hurley
- Department of Molecular Physiology and Biophysics, Baylor College of Medicine, Houston, TX 77030, USA
| | - Kelsey E Jarrett
- Department of Molecular Physiology and Biophysics, Baylor College of Medicine, Houston, TX 77030, USA.,Integrative Molecular and Biomedical Sciences Graduate Program, Baylor College of Medicine, Houston, TX 77030, USA
| | - Marco De Giorgi
- Department of Molecular Physiology and Biophysics, Baylor College of Medicine, Houston, TX 77030, USA
| | - Weiqi Lu
- Department of Bioengineering, Rice University, Houston, TX 77030, USA
| | - Karol S Balderrama
- Department of Molecular Physiology and Biophysics, Baylor College of Medicine, Houston, TX 77030, USA
| | - Alexandria M Doerfler
- Department of Molecular Physiology and Biophysics, Baylor College of Medicine, Houston, TX 77030, USA
| | | | - Anirban Ray
- Department of Bioengineering, Rice University, Houston, TX 77030, USA
| | - Gang Bao
- Department of Bioengineering, Rice University, Houston, TX 77030, USA
| | - William R Lagor
- Department of Molecular Physiology and Biophysics, Baylor College of Medicine, Houston, TX 77030, USA.,Integrative Molecular and Biomedical Sciences Graduate Program, Baylor College of Medicine, Houston, TX 77030, USA
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Abstract
The unprecedented emergence of novel therapeutics for both hemophilia A and B during the last half decade has been accompanied by the promise of even more extraordinary progress in ameliorative and curative strategies for both disorders. Paradoxically, the speed of innovation has created new dilemmas for persons with hemophilia and their physicians with respect to optimizing individual choices from the expanding menu of standard and novel therapies and approaches to symptom or risk reduction, and ultimately, to normalizing the hemophilia phenotype. Among the most disruptive new approaches, challenges remain in the form of the adverse reactions that have been observed with nonfactor therapies, as well as in the uncertain long-term safety profile of potentially curative gene therapy. Together, these challenges have generated uncertainty as to how to adopt novel therapies and treatment strategies across a diverse patient population, creating speed bumps on the hemophilia innovation highway. It is from this perspective that this article discusses the current state of gene therapy and bleeding prophylaxis for hemophilia A and B, as well as prevention and treatment of the factor VIII inhibitor phenotype in hemophilia A. It further posits that these speed bumps may provide important clues to the mechanistic understanding of both symptom manifestation and resilience within the hemophilia phenotype, as well as opportunities to reconsider and reconfigure the current paradigms for symptom prediction and individualized therapeutic decision making.
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Affiliation(s)
- Donna M DiMichele
- Division of Blood Diseases and Resources, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA
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34
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Xu R, Jia Y, Zygmunt DA, Cramer ML, Crowe KE, Shao G, Maki AE, Guggenheim HN, Hood BC, Griffin DA, Peterson E, Bolon B, Cheatham JP, Cheatham SL, Flanigan KM, Rodino-Klapac LR, Chicoine LG, Martin PT. An Isolated Limb Infusion Method Allows for Broad Distribution of rAAVrh74.MCK. GALGT2 to Leg Skeletal Muscles in the Rhesus Macaque. Mol Ther Methods Clin Dev 2018; 10:89-104. [PMID: 30073180 PMCID: PMC6070685 DOI: 10.1016/j.omtm.2018.06.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Accepted: 06/05/2018] [Indexed: 10/28/2022]
Abstract
Recombinant adeno-associated virus (rAAV)rh74.MCK.GALGT2 is a muscle-specific gene therapy that is being developed to treat forms of muscular dystrophy. Here we report on an isolated limb infusion technique in a non-human primate model, where hindlimb blood flow is transiently isolated using balloon catheters to concentrate vector in targeted leg muscles. A bilateral dose of 2.5 × 1013 vector genomes (vg)/kg/limb was sufficient to induce GALGT2-induced glycosylation in 10%-60% of skeletal myofibers in all leg muscles examined. There was a 19-fold ± 6-fold average limb-wide increase in vector genomes per microgram genomic DNA at a bilateral dose of 2.5 × 1013 vg/kg/limb compared with a bilateral dose of 6 × 1012 vg/kg/limb. A unilateral dose of 6 × 1013 vg/kg/limb showed a 12- ± 3-fold increase in treated limb muscles compared to contralateral untreated limb muscles, which received vector only after release into the systemic circulation from the treated limb. Variability in AAV biodistribution between different segments of the same muscle was 125% ± 18% for any given dose, while variability between the same muscle for any given treatment dose was 45% ± 7%. These experiments demonstrate that treatment of muscles throughout the leg with rAAVrh74.MCK.GALGT2 can be accomplished safely using an isolated limb infusion technique, where balloon catheters transiently isolate the limb vasculature, but that intra- and inter-muscle transduction variability is a significant issue.
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Affiliation(s)
- Rui Xu
- Center for Gene Therapy, The Research Institute at Nationwide Children’s Hospital, 700 Children’s Drive, Columbus, OH 43205, USA
| | - Ying Jia
- Center for Gene Therapy, The Research Institute at Nationwide Children’s Hospital, 700 Children’s Drive, Columbus, OH 43205, USA
| | - Deborah A. Zygmunt
- Center for Gene Therapy, The Research Institute at Nationwide Children’s Hospital, 700 Children’s Drive, Columbus, OH 43205, USA
| | - Megan L. Cramer
- Center for Gene Therapy, The Research Institute at Nationwide Children’s Hospital, 700 Children’s Drive, Columbus, OH 43205, USA
- Graduate Program in Molecular, Cellular and Developmental Biology, The Ohio State University, Columbus, OH 43210, USA
| | - Kelly E. Crowe
- Center for Gene Therapy, The Research Institute at Nationwide Children’s Hospital, 700 Children’s Drive, Columbus, OH 43205, USA
- Graduate Program in Molecular, Cellular and Developmental Biology, The Ohio State University, Columbus, OH 43210, USA
| | - Guohong Shao
- Center for Gene Therapy, The Research Institute at Nationwide Children’s Hospital, 700 Children’s Drive, Columbus, OH 43205, USA
| | - Agatha E. Maki
- Center for Gene Therapy, The Research Institute at Nationwide Children’s Hospital, 700 Children’s Drive, Columbus, OH 43205, USA
| | - Haley N. Guggenheim
- Center for Gene Therapy, The Research Institute at Nationwide Children’s Hospital, 700 Children’s Drive, Columbus, OH 43205, USA
| | - Benjamin C. Hood
- Center for Gene Therapy, The Research Institute at Nationwide Children’s Hospital, 700 Children’s Drive, Columbus, OH 43205, USA
| | - Danielle A. Griffin
- Center for Gene Therapy, The Research Institute at Nationwide Children’s Hospital, 700 Children’s Drive, Columbus, OH 43205, USA
| | - Ellyn Peterson
- Center for Gene Therapy, The Research Institute at Nationwide Children’s Hospital, 700 Children’s Drive, Columbus, OH 43205, USA
| | | | - John P. Cheatham
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH 43210, USA
| | - Sharon L. Cheatham
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH 43210, USA
| | - Kevin M. Flanigan
- Center for Gene Therapy, The Research Institute at Nationwide Children’s Hospital, 700 Children’s Drive, Columbus, OH 43205, USA
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH 43210, USA
| | - Louise R. Rodino-Klapac
- Center for Gene Therapy, The Research Institute at Nationwide Children’s Hospital, 700 Children’s Drive, Columbus, OH 43205, USA
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH 43210, USA
| | - Louis G. Chicoine
- Center for Gene Therapy, The Research Institute at Nationwide Children’s Hospital, 700 Children’s Drive, Columbus, OH 43205, USA
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH 43210, USA
| | - Paul T. Martin
- Center for Gene Therapy, The Research Institute at Nationwide Children’s Hospital, 700 Children’s Drive, Columbus, OH 43205, USA
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH 43210, USA
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Zhu H, Wang T, John Lye R, French BA, Annex BH. Neuraminidase-mediated desialylation augments AAV9-mediated gene expression in skeletal muscle. J Gene Med 2018; 20:e3049. [PMID: 30101537 DOI: 10.1002/jgm.3049] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 08/01/2018] [Accepted: 08/01/2018] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Following systemic delivery, AAV9-mediated gene expression is significantly increased in ischemic versus non-ischemic muscle, suggesting that AAV9 is an attractive vector for treating peripheral arterial disease. Potential mechanisms underlying ischemia-augmented expression include: (i) increased vascular permeability and (ii) "unmasking" of endogenous AAV9 receptors. In the present study, we aimed to reconstitute the ischemic induction of AAV9 in vivo, using local injection of histamine (to increase vascular permeability) and neuraminidase (to desialylate cell surface glycans). METHODS Bioassays were performed to optimize the effects of histamine and neuraminidase after intramuscular injection. Histamine and/or neuraminidase were then injected intramuscularly shortly before intravenous injection of an AAV9 vector expressing luciferase. Luciferase expression was serially assessed with bioluminescence imaging. At the end of the study, tissues were harvested for assays of luciferase activity and AAV9 genome copy number aiming to assess AAV-mediated gene expression and transduction, respectively. RESULTS Intramuscular injection of either neuraminidase or neuraminidase plus histamine significantly increased both transduction and gene expression, whereas histamine alone had little effect. Pre-injection with neuraminidase increased AAV9-mediated gene delivery by four- to nine-fold and luciferase activity by 60-100-fold. Luciferase activity in neuraminidase-injected muscle was > 100-fold higher than in any off-target tissue (including heart, liver and brain). CONCLUSIONS The ischemic induction of AAV9-mediated gene expression in muscle can largely be reconstituted by pre-injecting neuraminidase intranmuscularly. This strategy may prove useful in future human gene therapy protocols as a quick and efficient means to selectively target systemically injected AAV9 to localized regions of muscle, thus decreasing the potential for adverse effects in off-target tissues.
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Affiliation(s)
- Hongling Zhu
- Department of Medicine, Division of Cardiovascular Medicine, University of Virginia, Charlottesville, VA, USA
| | - Tao Wang
- Department of Medicine, Division of Cardiovascular Medicine, University of Virginia, Charlottesville, VA, USA
| | - Robert John Lye
- Department of Medicine, Division of Cardiovascular Medicine, University of Virginia, Charlottesville, VA, USA
| | - Brent A French
- Department of Medicine, Division of Cardiovascular Medicine, University of Virginia, Charlottesville, VA, USA.,Department of Biomedical Engineering, University of Virginia, Charlottesville, VA, USA.,Robert M. Berne Cardiovascular Research Center, University of Virginia, Charlottesville, VA, USA
| | - Brian H Annex
- Department of Medicine, Division of Cardiovascular Medicine, University of Virginia, Charlottesville, VA, USA.,Department of Biomedical Engineering, University of Virginia, Charlottesville, VA, USA.,Robert M. Berne Cardiovascular Research Center, University of Virginia, Charlottesville, VA, USA
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36
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Abstract
PURPOSE OF REVIEW Hemophilia is an X-linked blood coagulation genetic disorder, which can cause significant disability. Replacement therapy for coagulation factor VIII (hemophilia A) or factor IX (hemophilia B) may result in the development of high-affinity alloantibodies ('inhibitors') to the replacement therapy, thus making it ineffective. Therefore, there is interest in directing immunological responses towards tolerance to infused factors. RECENT FINDINGS In this review, we will discuss latest advancements in the development of potentially less immunogenic replacement clotting factors, optimization of current tolerance induction protocols (ITI), preclinical and clinical data of pharmacological immune modulation, hepatic gene therapy, and the rapidly advancing field of cell therapies. We will also evaluate publications reporting data from preclinical studies on oral tolerance induction using chloroplast-transgenic (transplastomic) plants. SUMMARY Until now, no clinical prophylactic immune modulatory protocol exists to prevent inhibitor formation to infused clotting factors. Recent innovative technologies provide hope for improved eradication and perhaps even prevention of inhibitors.
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Affiliation(s)
- Alexandra Sherman
- Department Pediatrics, Indiana University, Indianapolis, Indiana, USA
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37
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Development of Methods for the Selective Measurement of the Single Amino Acid Exchange Variant Coagulation Factor IX Padua. MOLECULAR THERAPY-METHODS & CLINICAL DEVELOPMENT 2018; 10:29-37. [PMID: 30003118 PMCID: PMC6039963 DOI: 10.1016/j.omtm.2018.05.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 05/20/2018] [Indexed: 11/21/2022]
Abstract
The description of hyper-functional factor IX (FIX) Padua triggered the development of BAX 335, an AAV8-based hemophilia B gene therapy vector designed to compensate for low FIX protein expression levels by expressing the FIX Padua variant, thereby reducing the exposure to viral vector. The presence of inactive FIX protein at baseline hindered conventional FIX:Ag ELISA from contributing to a more profound understanding of clinical data from the BAX 335 Phase 1/2 study (ClinicalTrials.gov: NCT01687608). By applying phage display technology, a Fab2 mini-antibody selectively binding to FIX Padua was developed and used to establish a FIX Padua-specific ELISA. The assay adequately performed, utilizing human and monkey plasma samples, and enabled the selective quantification of FIX Padua protein in human plasma samples from the BAX 335 trial. The mini-antibody also allowed the development of a chromogenic FIX Padua-specific activity assay, which adequately performed in human and mouse plasma. Collectively, the isolated FIX Padua-specific mini-antibody enabled the development of transgene-product-specific assays, which should improve the monitoring of hemophilia B gene therapies. The approach applied here for FIX Padua could be leveraged to develop variant-specific activity assays for other therapies where highly active enzymes are instrumental in achieving therapeutic levels of the transgene product.
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Abstract
Rapid expansion of therapeutic options have increased the complexity of hemophilia care. Previously, on-demand therapy aimed to reduce morbidity and early mortality; however, now aggressive prophylaxis, particularly in children, encourages an active lifestyle. Accurate diagnosis, recognition of early threats to musculoskeletal health, and optimization of therapy are critical for both males and females affected by hemophilia. The diversity of emerging hemophilia therapies, from modified factor protein concentrates, to gene therapy, to nonfactor hemostatic strategies, provide an exciting opportunity to target unmet needs in the bleeding disorder community.
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39
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Evens H, Chuah MK, VandenDriessche T. Haemophilia gene therapy: From trailblazer to gamechanger. Haemophilia 2018; 24 Suppl 6:50-59. [DOI: 10.1111/hae.13494] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/20/2018] [Indexed: 12/24/2022]
Affiliation(s)
- H. Evens
- Department of Gene Therapy & Regenerative Medicine Faculty of Medicine & Pharmacy Vrije Universiteit Brussel (VUB) Brussels Belgium
| | - M. K. Chuah
- Department of Gene Therapy & Regenerative Medicine Faculty of Medicine & Pharmacy Vrije Universiteit Brussel (VUB) Brussels Belgium
- Department of Cardiovascular Sciences Center for Molecular & Vascular Biology University of Leuven Leuven Belgium
| | - T. VandenDriessche
- Department of Gene Therapy & Regenerative Medicine Faculty of Medicine & Pharmacy Vrije Universiteit Brussel (VUB) Brussels Belgium
- Department of Cardiovascular Sciences Center for Molecular & Vascular Biology University of Leuven Leuven Belgium
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40
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Parente V, Corti S. Advances in spinal muscular atrophy therapeutics. Ther Adv Neurol Disord 2018; 11:1756285618754501. [PMID: 29434670 PMCID: PMC5802612 DOI: 10.1177/1756285618754501] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2017] [Accepted: 10/24/2017] [Indexed: 11/17/2022] Open
Abstract
Spinal muscular atrophy (SMA) is a progressive, recessively inherited neuromuscular disease, characterized by the degeneration of lower motor neurons in the spinal cord and brainstem, which leads to weakness and muscle atrophy. SMA currently represents the most common genetic cause of infant death. SMA is caused by the lack of survival motor neuron (SMN) protein due to mutations, which are often deletions, in the SMN1 gene. In the absence of treatments able to modify the disease course, a considerable burden falls on patients and their families. Greater knowledge of the molecular basis of SMA pathogenesis has fuelled the development of potential therapeutic approaches, which are illustrated here. Nusinersen, a modified antisense oligonucleotide that modulates the splicing of the SMN2 mRNA transcript, is the first approved drug for all types of SMA. Moreover, the first gene therapy clinical trial using adeno-associated virus (AAV) vectors encoding SMN reported positive results in survival and motor milestones achievement. In addition, other strategies are in the pipeline, including modulation of SMN2 transcripts, neuroprotection, and targeting an increasing number of other peripheral targets, including the skeletal muscle. Based on this premise, it is reasonable to expect that therapeutic approaches aimed at treating SMA will soon be changed, and improved, in a meaningful way. We discuss the challenges with regard to the development of novel treatments for patients with SMA, and depict the current and future scenarios as the field enters into a new era of promising effective treatments.
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Affiliation(s)
- Valeria Parente
- Dino Ferrari Centre, Neuroscience Section, Department of Pathophysiology and Transplantation (DEPT), University of Milan, Neurology Unit, IRCCS Foundation Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Stefania Corti
- Neuroscience Section, Department of Pathophysiology and Transplantation (DEPT), University of Milan, Neurology Unit, IRCCS Foundation Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122 Milan, Italy
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41
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Dunbar CE, High KA, Joung JK, Kohn DB, Ozawa K, Sadelain M. Gene therapy comes of age. Science 2018; 359:359/6372/eaan4672. [DOI: 10.1126/science.aan4672] [Citation(s) in RCA: 680] [Impact Index Per Article: 113.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
After almost 30 years of promise tempered by setbacks, gene therapies are rapidly becoming a critical component of the therapeutic armamentarium for a variety of inherited and acquired human diseases. Gene therapies for inherited immune disorders, hemophilia, eye and neurodegenerative disorders, and lymphoid cancers recently progressed to approved drug status in the United States and Europe, or are anticipated to receive approval in the near future. In this Review, we discuss milestones in the development of gene therapies, focusing on direct in vivo administration of viral vectors and adoptive transfer of genetically engineered T cells or hematopoietic stem cells. We also discuss emerging genome editing technologies that should further advance the scope and efficacy of gene therapy approaches.
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42
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CRYSTAL RONALDG, PAGOVICH ODELYAE. THE JEREMIAH METZGER LECTURE NOVEL THERAPEUTIC STRATEGIES OF ALLERGIC AND IMMUNOLOGIC DISORDERS. TRANSACTIONS OF THE AMERICAN CLINICAL AND CLIMATOLOGICAL ASSOCIATION 2018; 129:250-265. [PMID: 30166721 PMCID: PMC6116601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Advances in understanding the immunological basis and mechanisms underlying allergic and immunologic disorders have led to effective but costly long-term and repetitive biologic therapies. Gene therapy is a rapidly advancing technology, in which a single administration of an adeno-associated virus encoding the therapeutic protein or monoclonal antibody may provide effective long-term therapy for allergic and immunologic disorders. In this review, we summarize the recent studies from our laboratory developing gene therapy strategies to treat hereditary angioedema and peanut allergy. The unraveling of the pathogenesis of immune-based disorders, including hereditary deficiencies of components of the immune system and allergic disorders, has led to the development of therapies using parenteral administration of recombinant proteins or monoclonal antibodies (1). While many of these therapies are highly effective, they are limited by the half-life of the therapeutic protein or antibody, requiring repetitive administration of days to weeks (2-15). The focus of recent work in our laboratory has been to solve this problem by substituting protein/monoclonal antibody administration with gene therapy, where current technology allows for a single administration of the gene coding for a protein or antibody to provide persistent expression of effective levels of the therapeutic protein or antibody. Gene therapy is a drug delivery platform which uses genetic material, usually in the form of coding exons of the therapeutic gene, to correct, compensate for, or prevent the development of an abnormal phenotype (16). Originally conceptualized as a strategy to treat rare hereditary disorders, gene therapy is being developed for a wide range of human disorders, including common acquired conditions (17-20). In this review, we will describe how we have adopted gene therapy technology to develop therapies for immune-related disorders, using as examples hereditary angioedema, an inherited autosomal dominant disorder, and peanut allergy, a common acquired allergic disorder.
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Gene Therapy with BMN 270 Results in Therapeutic Levels of FVIII in Mice and Primates and Normalization of Bleeding in Hemophilic Mice. Mol Ther 2017; 26:496-509. [PMID: 29292164 PMCID: PMC5835117 DOI: 10.1016/j.ymthe.2017.12.009] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 11/28/2017] [Accepted: 12/09/2017] [Indexed: 01/22/2023] Open
Abstract
Hemophilia A is an X-linked bleeding disorder caused by mutations in the gene encoding the factor VIII (FVIII) coagulation protein. Bleeding episodes in patients are reduced by prophylactic therapy or treated acutely using recombinant or plasma-derived FVIII. We have made an adeno-associated virus 5 vector containing a B domain-deleted (BDD) FVIII gene (BMN 270) with a liver-specific promoter. BMN 270 injected into hemophilic mice resulted in a dose-dependent expression of BDD FVIII protein and a corresponding correction of bleeding time and blood loss. At the highest dose tested, complete correction was achieved. Similar corrections in bleeding were observed at approximately the same plasma levels of FVIII protein produced either endogenously by BMN 270 or following exogenous administration of recombinant BDD FVIII. No evidence of liver dysfunction or hepatocyte endoplasmic reticulum stress was observed. Comparable doses in primates produced similar levels of circulating FVIII. These preclinical data support evaluation of BMN 270 in hemophilia A patients.
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44
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George LA, Sullivan SK, Giermasz A, Rasko JEJ, Samelson-Jones BJ, Ducore J, Cuker A, Sullivan LM, Majumdar S, Teitel J, McGuinn CE, Ragni MV, Luk AY, Hui D, Wright JF, Chen Y, Liu Y, Wachtel K, Winters A, Tiefenbacher S, Arruda VR, van der Loo JCM, Zelenaia O, Takefman D, Carr ME, Couto LB, Anguela XM, High KA. Hemophilia B Gene Therapy with a High-Specific-Activity Factor IX Variant. N Engl J Med 2017; 377:2215-2227. [PMID: 29211678 PMCID: PMC6029626 DOI: 10.1056/nejmoa1708538] [Citation(s) in RCA: 502] [Impact Index Per Article: 71.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND The prevention of bleeding with adequately sustained levels of clotting factor, after a single therapeutic intervention and without the need for further medical intervention, represents an important goal in the treatment of hemophilia. METHODS We infused a single-stranded adeno-associated viral (AAV) vector consisting of a bioengineered capsid, liver-specific promoter and factor IX Padua (factor IX-R338L) transgene at a dose of 5×1011 vector genomes per kilogram of body weight in 10 men with hemophilia B who had factor IX coagulant activity of 2% or less of the normal value. Laboratory values, bleeding frequency, and consumption of factor IX concentrate were prospectively evaluated after vector infusion and were compared with baseline values. RESULTS No serious adverse events occurred during or after vector infusion. Vector-derived factor IX coagulant activity was sustained in all the participants, with a mean (±SD) steady-state factor IX coagulant activity of 33.7±18.5% (range, 14 to 81). On cumulative follow-up of 492 weeks among all the participants (range of follow-up in individual participants, 28 to 78 weeks), the annualized bleeding rate was significantly reduced (mean rate, 11.1 events per year [range, 0 to 48] before vector administration vs. 0.4 events per year [range, 0 to 4] after administration; P=0.02), as was factor use (mean dose, 2908 IU per kilogram [range, 0 to 8090] before vector administration vs. 49.3 IU per kilogram [range, 0 to 376] after administration; P=0.004). A total of 8 of 10 participants did not use factor, and 9 of 10 did not have bleeds after vector administration. An asymptomatic increase in liver-enzyme levels developed in 2 participants and resolved with short-term prednisone treatment. One participant, who had substantial, advanced arthropathy at baseline, administered factor for bleeding but overall used 91% less factor than before vector infusion. CONCLUSIONS We found sustained therapeutic expression of factor IX coagulant activity after gene transfer in 10 participants with hemophilia who received the same vector dose. Transgene-derived factor IX coagulant activity enabled the termination of baseline prophylaxis and the near elimination of bleeding and factor use. (Funded by Spark Therapeutics and Pfizer; ClinicalTrials.gov number, NCT02484092 .).
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Affiliation(s)
- Lindsey A George
- From the Division of Hematology (L.A.G., B.J.S.-J., A.W., V.R.A.) and the Raymond G. Perelman Center for Cellular and Molecular Therapeutics (L.A.G., B.J.S.-J., A.W., V.R.A., J.C.M.L., O.Z.), Children's Hospital of Philadelphia, the Departments of Pediatrics (L.A.G., B.J.S.-J., V.R.A.) and Medicine (A.C.), Perelman School of Medicine at the University of Pennsylvania, and Spark Therapeutics (A.Y.L., D.H., J.F.W., Y.C., Y.L., K.W., D.T., M.E.C., L.B.C., X.M.A., K.A.H.) - all in Philadelphia; the Department of Pediatrics, Mississippi Center for Advanced Medicine, Madison (S.K.S.), and the Departments of Pathology (L.M.S.) and Pediatrics (S.M.), University of Mississippi Medical School, Jackson; the Departments of Medicine (A.G.) and Pediatrics (J.D.), University of California-Davis Medical School, Sacramento; the Department of Medicine, Sydney Medical School, and the Gene and Stem Cell Therapy Program, Centenary Institute (J.E.J.R.), University of Sydney, and Cell and Molecular Therapies, Royal Prince Alfred Hospital (J.E.J.R.) - both in Camperdown, NSW, Australia; the Department of Medicine, University of Toronto Faculty of Medicine and St. Michael's Hospital, Toronto (J.T.); the Department of Pediatrics, Weill Cornell Medical College, New York (C.E.M.); the Department of Medicine, University of Pittsburgh, Pittsburgh (M.V.R.); and Colorado Coagulation, Laboratory Corporation of America Holdings, Englewood, CO (S.T.)
| | - Spencer K Sullivan
- From the Division of Hematology (L.A.G., B.J.S.-J., A.W., V.R.A.) and the Raymond G. Perelman Center for Cellular and Molecular Therapeutics (L.A.G., B.J.S.-J., A.W., V.R.A., J.C.M.L., O.Z.), Children's Hospital of Philadelphia, the Departments of Pediatrics (L.A.G., B.J.S.-J., V.R.A.) and Medicine (A.C.), Perelman School of Medicine at the University of Pennsylvania, and Spark Therapeutics (A.Y.L., D.H., J.F.W., Y.C., Y.L., K.W., D.T., M.E.C., L.B.C., X.M.A., K.A.H.) - all in Philadelphia; the Department of Pediatrics, Mississippi Center for Advanced Medicine, Madison (S.K.S.), and the Departments of Pathology (L.M.S.) and Pediatrics (S.M.), University of Mississippi Medical School, Jackson; the Departments of Medicine (A.G.) and Pediatrics (J.D.), University of California-Davis Medical School, Sacramento; the Department of Medicine, Sydney Medical School, and the Gene and Stem Cell Therapy Program, Centenary Institute (J.E.J.R.), University of Sydney, and Cell and Molecular Therapies, Royal Prince Alfred Hospital (J.E.J.R.) - both in Camperdown, NSW, Australia; the Department of Medicine, University of Toronto Faculty of Medicine and St. Michael's Hospital, Toronto (J.T.); the Department of Pediatrics, Weill Cornell Medical College, New York (C.E.M.); the Department of Medicine, University of Pittsburgh, Pittsburgh (M.V.R.); and Colorado Coagulation, Laboratory Corporation of America Holdings, Englewood, CO (S.T.)
| | - Adam Giermasz
- From the Division of Hematology (L.A.G., B.J.S.-J., A.W., V.R.A.) and the Raymond G. Perelman Center for Cellular and Molecular Therapeutics (L.A.G., B.J.S.-J., A.W., V.R.A., J.C.M.L., O.Z.), Children's Hospital of Philadelphia, the Departments of Pediatrics (L.A.G., B.J.S.-J., V.R.A.) and Medicine (A.C.), Perelman School of Medicine at the University of Pennsylvania, and Spark Therapeutics (A.Y.L., D.H., J.F.W., Y.C., Y.L., K.W., D.T., M.E.C., L.B.C., X.M.A., K.A.H.) - all in Philadelphia; the Department of Pediatrics, Mississippi Center for Advanced Medicine, Madison (S.K.S.), and the Departments of Pathology (L.M.S.) and Pediatrics (S.M.), University of Mississippi Medical School, Jackson; the Departments of Medicine (A.G.) and Pediatrics (J.D.), University of California-Davis Medical School, Sacramento; the Department of Medicine, Sydney Medical School, and the Gene and Stem Cell Therapy Program, Centenary Institute (J.E.J.R.), University of Sydney, and Cell and Molecular Therapies, Royal Prince Alfred Hospital (J.E.J.R.) - both in Camperdown, NSW, Australia; the Department of Medicine, University of Toronto Faculty of Medicine and St. Michael's Hospital, Toronto (J.T.); the Department of Pediatrics, Weill Cornell Medical College, New York (C.E.M.); the Department of Medicine, University of Pittsburgh, Pittsburgh (M.V.R.); and Colorado Coagulation, Laboratory Corporation of America Holdings, Englewood, CO (S.T.)
| | - John E J Rasko
- From the Division of Hematology (L.A.G., B.J.S.-J., A.W., V.R.A.) and the Raymond G. Perelman Center for Cellular and Molecular Therapeutics (L.A.G., B.J.S.-J., A.W., V.R.A., J.C.M.L., O.Z.), Children's Hospital of Philadelphia, the Departments of Pediatrics (L.A.G., B.J.S.-J., V.R.A.) and Medicine (A.C.), Perelman School of Medicine at the University of Pennsylvania, and Spark Therapeutics (A.Y.L., D.H., J.F.W., Y.C., Y.L., K.W., D.T., M.E.C., L.B.C., X.M.A., K.A.H.) - all in Philadelphia; the Department of Pediatrics, Mississippi Center for Advanced Medicine, Madison (S.K.S.), and the Departments of Pathology (L.M.S.) and Pediatrics (S.M.), University of Mississippi Medical School, Jackson; the Departments of Medicine (A.G.) and Pediatrics (J.D.), University of California-Davis Medical School, Sacramento; the Department of Medicine, Sydney Medical School, and the Gene and Stem Cell Therapy Program, Centenary Institute (J.E.J.R.), University of Sydney, and Cell and Molecular Therapies, Royal Prince Alfred Hospital (J.E.J.R.) - both in Camperdown, NSW, Australia; the Department of Medicine, University of Toronto Faculty of Medicine and St. Michael's Hospital, Toronto (J.T.); the Department of Pediatrics, Weill Cornell Medical College, New York (C.E.M.); the Department of Medicine, University of Pittsburgh, Pittsburgh (M.V.R.); and Colorado Coagulation, Laboratory Corporation of America Holdings, Englewood, CO (S.T.)
| | - Benjamin J Samelson-Jones
- From the Division of Hematology (L.A.G., B.J.S.-J., A.W., V.R.A.) and the Raymond G. Perelman Center for Cellular and Molecular Therapeutics (L.A.G., B.J.S.-J., A.W., V.R.A., J.C.M.L., O.Z.), Children's Hospital of Philadelphia, the Departments of Pediatrics (L.A.G., B.J.S.-J., V.R.A.) and Medicine (A.C.), Perelman School of Medicine at the University of Pennsylvania, and Spark Therapeutics (A.Y.L., D.H., J.F.W., Y.C., Y.L., K.W., D.T., M.E.C., L.B.C., X.M.A., K.A.H.) - all in Philadelphia; the Department of Pediatrics, Mississippi Center for Advanced Medicine, Madison (S.K.S.), and the Departments of Pathology (L.M.S.) and Pediatrics (S.M.), University of Mississippi Medical School, Jackson; the Departments of Medicine (A.G.) and Pediatrics (J.D.), University of California-Davis Medical School, Sacramento; the Department of Medicine, Sydney Medical School, and the Gene and Stem Cell Therapy Program, Centenary Institute (J.E.J.R.), University of Sydney, and Cell and Molecular Therapies, Royal Prince Alfred Hospital (J.E.J.R.) - both in Camperdown, NSW, Australia; the Department of Medicine, University of Toronto Faculty of Medicine and St. Michael's Hospital, Toronto (J.T.); the Department of Pediatrics, Weill Cornell Medical College, New York (C.E.M.); the Department of Medicine, University of Pittsburgh, Pittsburgh (M.V.R.); and Colorado Coagulation, Laboratory Corporation of America Holdings, Englewood, CO (S.T.)
| | - Jonathan Ducore
- From the Division of Hematology (L.A.G., B.J.S.-J., A.W., V.R.A.) and the Raymond G. Perelman Center for Cellular and Molecular Therapeutics (L.A.G., B.J.S.-J., A.W., V.R.A., J.C.M.L., O.Z.), Children's Hospital of Philadelphia, the Departments of Pediatrics (L.A.G., B.J.S.-J., V.R.A.) and Medicine (A.C.), Perelman School of Medicine at the University of Pennsylvania, and Spark Therapeutics (A.Y.L., D.H., J.F.W., Y.C., Y.L., K.W., D.T., M.E.C., L.B.C., X.M.A., K.A.H.) - all in Philadelphia; the Department of Pediatrics, Mississippi Center for Advanced Medicine, Madison (S.K.S.), and the Departments of Pathology (L.M.S.) and Pediatrics (S.M.), University of Mississippi Medical School, Jackson; the Departments of Medicine (A.G.) and Pediatrics (J.D.), University of California-Davis Medical School, Sacramento; the Department of Medicine, Sydney Medical School, and the Gene and Stem Cell Therapy Program, Centenary Institute (J.E.J.R.), University of Sydney, and Cell and Molecular Therapies, Royal Prince Alfred Hospital (J.E.J.R.) - both in Camperdown, NSW, Australia; the Department of Medicine, University of Toronto Faculty of Medicine and St. Michael's Hospital, Toronto (J.T.); the Department of Pediatrics, Weill Cornell Medical College, New York (C.E.M.); the Department of Medicine, University of Pittsburgh, Pittsburgh (M.V.R.); and Colorado Coagulation, Laboratory Corporation of America Holdings, Englewood, CO (S.T.)
| | - Adam Cuker
- From the Division of Hematology (L.A.G., B.J.S.-J., A.W., V.R.A.) and the Raymond G. Perelman Center for Cellular and Molecular Therapeutics (L.A.G., B.J.S.-J., A.W., V.R.A., J.C.M.L., O.Z.), Children's Hospital of Philadelphia, the Departments of Pediatrics (L.A.G., B.J.S.-J., V.R.A.) and Medicine (A.C.), Perelman School of Medicine at the University of Pennsylvania, and Spark Therapeutics (A.Y.L., D.H., J.F.W., Y.C., Y.L., K.W., D.T., M.E.C., L.B.C., X.M.A., K.A.H.) - all in Philadelphia; the Department of Pediatrics, Mississippi Center for Advanced Medicine, Madison (S.K.S.), and the Departments of Pathology (L.M.S.) and Pediatrics (S.M.), University of Mississippi Medical School, Jackson; the Departments of Medicine (A.G.) and Pediatrics (J.D.), University of California-Davis Medical School, Sacramento; the Department of Medicine, Sydney Medical School, and the Gene and Stem Cell Therapy Program, Centenary Institute (J.E.J.R.), University of Sydney, and Cell and Molecular Therapies, Royal Prince Alfred Hospital (J.E.J.R.) - both in Camperdown, NSW, Australia; the Department of Medicine, University of Toronto Faculty of Medicine and St. Michael's Hospital, Toronto (J.T.); the Department of Pediatrics, Weill Cornell Medical College, New York (C.E.M.); the Department of Medicine, University of Pittsburgh, Pittsburgh (M.V.R.); and Colorado Coagulation, Laboratory Corporation of America Holdings, Englewood, CO (S.T.)
| | - Lisa M Sullivan
- From the Division of Hematology (L.A.G., B.J.S.-J., A.W., V.R.A.) and the Raymond G. Perelman Center for Cellular and Molecular Therapeutics (L.A.G., B.J.S.-J., A.W., V.R.A., J.C.M.L., O.Z.), Children's Hospital of Philadelphia, the Departments of Pediatrics (L.A.G., B.J.S.-J., V.R.A.) and Medicine (A.C.), Perelman School of Medicine at the University of Pennsylvania, and Spark Therapeutics (A.Y.L., D.H., J.F.W., Y.C., Y.L., K.W., D.T., M.E.C., L.B.C., X.M.A., K.A.H.) - all in Philadelphia; the Department of Pediatrics, Mississippi Center for Advanced Medicine, Madison (S.K.S.), and the Departments of Pathology (L.M.S.) and Pediatrics (S.M.), University of Mississippi Medical School, Jackson; the Departments of Medicine (A.G.) and Pediatrics (J.D.), University of California-Davis Medical School, Sacramento; the Department of Medicine, Sydney Medical School, and the Gene and Stem Cell Therapy Program, Centenary Institute (J.E.J.R.), University of Sydney, and Cell and Molecular Therapies, Royal Prince Alfred Hospital (J.E.J.R.) - both in Camperdown, NSW, Australia; the Department of Medicine, University of Toronto Faculty of Medicine and St. Michael's Hospital, Toronto (J.T.); the Department of Pediatrics, Weill Cornell Medical College, New York (C.E.M.); the Department of Medicine, University of Pittsburgh, Pittsburgh (M.V.R.); and Colorado Coagulation, Laboratory Corporation of America Holdings, Englewood, CO (S.T.)
| | - Suvankar Majumdar
- From the Division of Hematology (L.A.G., B.J.S.-J., A.W., V.R.A.) and the Raymond G. Perelman Center for Cellular and Molecular Therapeutics (L.A.G., B.J.S.-J., A.W., V.R.A., J.C.M.L., O.Z.), Children's Hospital of Philadelphia, the Departments of Pediatrics (L.A.G., B.J.S.-J., V.R.A.) and Medicine (A.C.), Perelman School of Medicine at the University of Pennsylvania, and Spark Therapeutics (A.Y.L., D.H., J.F.W., Y.C., Y.L., K.W., D.T., M.E.C., L.B.C., X.M.A., K.A.H.) - all in Philadelphia; the Department of Pediatrics, Mississippi Center for Advanced Medicine, Madison (S.K.S.), and the Departments of Pathology (L.M.S.) and Pediatrics (S.M.), University of Mississippi Medical School, Jackson; the Departments of Medicine (A.G.) and Pediatrics (J.D.), University of California-Davis Medical School, Sacramento; the Department of Medicine, Sydney Medical School, and the Gene and Stem Cell Therapy Program, Centenary Institute (J.E.J.R.), University of Sydney, and Cell and Molecular Therapies, Royal Prince Alfred Hospital (J.E.J.R.) - both in Camperdown, NSW, Australia; the Department of Medicine, University of Toronto Faculty of Medicine and St. Michael's Hospital, Toronto (J.T.); the Department of Pediatrics, Weill Cornell Medical College, New York (C.E.M.); the Department of Medicine, University of Pittsburgh, Pittsburgh (M.V.R.); and Colorado Coagulation, Laboratory Corporation of America Holdings, Englewood, CO (S.T.)
| | - Jerome Teitel
- From the Division of Hematology (L.A.G., B.J.S.-J., A.W., V.R.A.) and the Raymond G. Perelman Center for Cellular and Molecular Therapeutics (L.A.G., B.J.S.-J., A.W., V.R.A., J.C.M.L., O.Z.), Children's Hospital of Philadelphia, the Departments of Pediatrics (L.A.G., B.J.S.-J., V.R.A.) and Medicine (A.C.), Perelman School of Medicine at the University of Pennsylvania, and Spark Therapeutics (A.Y.L., D.H., J.F.W., Y.C., Y.L., K.W., D.T., M.E.C., L.B.C., X.M.A., K.A.H.) - all in Philadelphia; the Department of Pediatrics, Mississippi Center for Advanced Medicine, Madison (S.K.S.), and the Departments of Pathology (L.M.S.) and Pediatrics (S.M.), University of Mississippi Medical School, Jackson; the Departments of Medicine (A.G.) and Pediatrics (J.D.), University of California-Davis Medical School, Sacramento; the Department of Medicine, Sydney Medical School, and the Gene and Stem Cell Therapy Program, Centenary Institute (J.E.J.R.), University of Sydney, and Cell and Molecular Therapies, Royal Prince Alfred Hospital (J.E.J.R.) - both in Camperdown, NSW, Australia; the Department of Medicine, University of Toronto Faculty of Medicine and St. Michael's Hospital, Toronto (J.T.); the Department of Pediatrics, Weill Cornell Medical College, New York (C.E.M.); the Department of Medicine, University of Pittsburgh, Pittsburgh (M.V.R.); and Colorado Coagulation, Laboratory Corporation of America Holdings, Englewood, CO (S.T.)
| | - Catherine E McGuinn
- From the Division of Hematology (L.A.G., B.J.S.-J., A.W., V.R.A.) and the Raymond G. Perelman Center for Cellular and Molecular Therapeutics (L.A.G., B.J.S.-J., A.W., V.R.A., J.C.M.L., O.Z.), Children's Hospital of Philadelphia, the Departments of Pediatrics (L.A.G., B.J.S.-J., V.R.A.) and Medicine (A.C.), Perelman School of Medicine at the University of Pennsylvania, and Spark Therapeutics (A.Y.L., D.H., J.F.W., Y.C., Y.L., K.W., D.T., M.E.C., L.B.C., X.M.A., K.A.H.) - all in Philadelphia; the Department of Pediatrics, Mississippi Center for Advanced Medicine, Madison (S.K.S.), and the Departments of Pathology (L.M.S.) and Pediatrics (S.M.), University of Mississippi Medical School, Jackson; the Departments of Medicine (A.G.) and Pediatrics (J.D.), University of California-Davis Medical School, Sacramento; the Department of Medicine, Sydney Medical School, and the Gene and Stem Cell Therapy Program, Centenary Institute (J.E.J.R.), University of Sydney, and Cell and Molecular Therapies, Royal Prince Alfred Hospital (J.E.J.R.) - both in Camperdown, NSW, Australia; the Department of Medicine, University of Toronto Faculty of Medicine and St. Michael's Hospital, Toronto (J.T.); the Department of Pediatrics, Weill Cornell Medical College, New York (C.E.M.); the Department of Medicine, University of Pittsburgh, Pittsburgh (M.V.R.); and Colorado Coagulation, Laboratory Corporation of America Holdings, Englewood, CO (S.T.)
| | - Margaret V Ragni
- From the Division of Hematology (L.A.G., B.J.S.-J., A.W., V.R.A.) and the Raymond G. Perelman Center for Cellular and Molecular Therapeutics (L.A.G., B.J.S.-J., A.W., V.R.A., J.C.M.L., O.Z.), Children's Hospital of Philadelphia, the Departments of Pediatrics (L.A.G., B.J.S.-J., V.R.A.) and Medicine (A.C.), Perelman School of Medicine at the University of Pennsylvania, and Spark Therapeutics (A.Y.L., D.H., J.F.W., Y.C., Y.L., K.W., D.T., M.E.C., L.B.C., X.M.A., K.A.H.) - all in Philadelphia; the Department of Pediatrics, Mississippi Center for Advanced Medicine, Madison (S.K.S.), and the Departments of Pathology (L.M.S.) and Pediatrics (S.M.), University of Mississippi Medical School, Jackson; the Departments of Medicine (A.G.) and Pediatrics (J.D.), University of California-Davis Medical School, Sacramento; the Department of Medicine, Sydney Medical School, and the Gene and Stem Cell Therapy Program, Centenary Institute (J.E.J.R.), University of Sydney, and Cell and Molecular Therapies, Royal Prince Alfred Hospital (J.E.J.R.) - both in Camperdown, NSW, Australia; the Department of Medicine, University of Toronto Faculty of Medicine and St. Michael's Hospital, Toronto (J.T.); the Department of Pediatrics, Weill Cornell Medical College, New York (C.E.M.); the Department of Medicine, University of Pittsburgh, Pittsburgh (M.V.R.); and Colorado Coagulation, Laboratory Corporation of America Holdings, Englewood, CO (S.T.)
| | - Alvin Y Luk
- From the Division of Hematology (L.A.G., B.J.S.-J., A.W., V.R.A.) and the Raymond G. Perelman Center for Cellular and Molecular Therapeutics (L.A.G., B.J.S.-J., A.W., V.R.A., J.C.M.L., O.Z.), Children's Hospital of Philadelphia, the Departments of Pediatrics (L.A.G., B.J.S.-J., V.R.A.) and Medicine (A.C.), Perelman School of Medicine at the University of Pennsylvania, and Spark Therapeutics (A.Y.L., D.H., J.F.W., Y.C., Y.L., K.W., D.T., M.E.C., L.B.C., X.M.A., K.A.H.) - all in Philadelphia; the Department of Pediatrics, Mississippi Center for Advanced Medicine, Madison (S.K.S.), and the Departments of Pathology (L.M.S.) and Pediatrics (S.M.), University of Mississippi Medical School, Jackson; the Departments of Medicine (A.G.) and Pediatrics (J.D.), University of California-Davis Medical School, Sacramento; the Department of Medicine, Sydney Medical School, and the Gene and Stem Cell Therapy Program, Centenary Institute (J.E.J.R.), University of Sydney, and Cell and Molecular Therapies, Royal Prince Alfred Hospital (J.E.J.R.) - both in Camperdown, NSW, Australia; the Department of Medicine, University of Toronto Faculty of Medicine and St. Michael's Hospital, Toronto (J.T.); the Department of Pediatrics, Weill Cornell Medical College, New York (C.E.M.); the Department of Medicine, University of Pittsburgh, Pittsburgh (M.V.R.); and Colorado Coagulation, Laboratory Corporation of America Holdings, Englewood, CO (S.T.)
| | - Daniel Hui
- From the Division of Hematology (L.A.G., B.J.S.-J., A.W., V.R.A.) and the Raymond G. Perelman Center for Cellular and Molecular Therapeutics (L.A.G., B.J.S.-J., A.W., V.R.A., J.C.M.L., O.Z.), Children's Hospital of Philadelphia, the Departments of Pediatrics (L.A.G., B.J.S.-J., V.R.A.) and Medicine (A.C.), Perelman School of Medicine at the University of Pennsylvania, and Spark Therapeutics (A.Y.L., D.H., J.F.W., Y.C., Y.L., K.W., D.T., M.E.C., L.B.C., X.M.A., K.A.H.) - all in Philadelphia; the Department of Pediatrics, Mississippi Center for Advanced Medicine, Madison (S.K.S.), and the Departments of Pathology (L.M.S.) and Pediatrics (S.M.), University of Mississippi Medical School, Jackson; the Departments of Medicine (A.G.) and Pediatrics (J.D.), University of California-Davis Medical School, Sacramento; the Department of Medicine, Sydney Medical School, and the Gene and Stem Cell Therapy Program, Centenary Institute (J.E.J.R.), University of Sydney, and Cell and Molecular Therapies, Royal Prince Alfred Hospital (J.E.J.R.) - both in Camperdown, NSW, Australia; the Department of Medicine, University of Toronto Faculty of Medicine and St. Michael's Hospital, Toronto (J.T.); the Department of Pediatrics, Weill Cornell Medical College, New York (C.E.M.); the Department of Medicine, University of Pittsburgh, Pittsburgh (M.V.R.); and Colorado Coagulation, Laboratory Corporation of America Holdings, Englewood, CO (S.T.)
| | - J Fraser Wright
- From the Division of Hematology (L.A.G., B.J.S.-J., A.W., V.R.A.) and the Raymond G. Perelman Center for Cellular and Molecular Therapeutics (L.A.G., B.J.S.-J., A.W., V.R.A., J.C.M.L., O.Z.), Children's Hospital of Philadelphia, the Departments of Pediatrics (L.A.G., B.J.S.-J., V.R.A.) and Medicine (A.C.), Perelman School of Medicine at the University of Pennsylvania, and Spark Therapeutics (A.Y.L., D.H., J.F.W., Y.C., Y.L., K.W., D.T., M.E.C., L.B.C., X.M.A., K.A.H.) - all in Philadelphia; the Department of Pediatrics, Mississippi Center for Advanced Medicine, Madison (S.K.S.), and the Departments of Pathology (L.M.S.) and Pediatrics (S.M.), University of Mississippi Medical School, Jackson; the Departments of Medicine (A.G.) and Pediatrics (J.D.), University of California-Davis Medical School, Sacramento; the Department of Medicine, Sydney Medical School, and the Gene and Stem Cell Therapy Program, Centenary Institute (J.E.J.R.), University of Sydney, and Cell and Molecular Therapies, Royal Prince Alfred Hospital (J.E.J.R.) - both in Camperdown, NSW, Australia; the Department of Medicine, University of Toronto Faculty of Medicine and St. Michael's Hospital, Toronto (J.T.); the Department of Pediatrics, Weill Cornell Medical College, New York (C.E.M.); the Department of Medicine, University of Pittsburgh, Pittsburgh (M.V.R.); and Colorado Coagulation, Laboratory Corporation of America Holdings, Englewood, CO (S.T.)
| | - Yifeng Chen
- From the Division of Hematology (L.A.G., B.J.S.-J., A.W., V.R.A.) and the Raymond G. Perelman Center for Cellular and Molecular Therapeutics (L.A.G., B.J.S.-J., A.W., V.R.A., J.C.M.L., O.Z.), Children's Hospital of Philadelphia, the Departments of Pediatrics (L.A.G., B.J.S.-J., V.R.A.) and Medicine (A.C.), Perelman School of Medicine at the University of Pennsylvania, and Spark Therapeutics (A.Y.L., D.H., J.F.W., Y.C., Y.L., K.W., D.T., M.E.C., L.B.C., X.M.A., K.A.H.) - all in Philadelphia; the Department of Pediatrics, Mississippi Center for Advanced Medicine, Madison (S.K.S.), and the Departments of Pathology (L.M.S.) and Pediatrics (S.M.), University of Mississippi Medical School, Jackson; the Departments of Medicine (A.G.) and Pediatrics (J.D.), University of California-Davis Medical School, Sacramento; the Department of Medicine, Sydney Medical School, and the Gene and Stem Cell Therapy Program, Centenary Institute (J.E.J.R.), University of Sydney, and Cell and Molecular Therapies, Royal Prince Alfred Hospital (J.E.J.R.) - both in Camperdown, NSW, Australia; the Department of Medicine, University of Toronto Faculty of Medicine and St. Michael's Hospital, Toronto (J.T.); the Department of Pediatrics, Weill Cornell Medical College, New York (C.E.M.); the Department of Medicine, University of Pittsburgh, Pittsburgh (M.V.R.); and Colorado Coagulation, Laboratory Corporation of America Holdings, Englewood, CO (S.T.)
| | - Yun Liu
- From the Division of Hematology (L.A.G., B.J.S.-J., A.W., V.R.A.) and the Raymond G. Perelman Center for Cellular and Molecular Therapeutics (L.A.G., B.J.S.-J., A.W., V.R.A., J.C.M.L., O.Z.), Children's Hospital of Philadelphia, the Departments of Pediatrics (L.A.G., B.J.S.-J., V.R.A.) and Medicine (A.C.), Perelman School of Medicine at the University of Pennsylvania, and Spark Therapeutics (A.Y.L., D.H., J.F.W., Y.C., Y.L., K.W., D.T., M.E.C., L.B.C., X.M.A., K.A.H.) - all in Philadelphia; the Department of Pediatrics, Mississippi Center for Advanced Medicine, Madison (S.K.S.), and the Departments of Pathology (L.M.S.) and Pediatrics (S.M.), University of Mississippi Medical School, Jackson; the Departments of Medicine (A.G.) and Pediatrics (J.D.), University of California-Davis Medical School, Sacramento; the Department of Medicine, Sydney Medical School, and the Gene and Stem Cell Therapy Program, Centenary Institute (J.E.J.R.), University of Sydney, and Cell and Molecular Therapies, Royal Prince Alfred Hospital (J.E.J.R.) - both in Camperdown, NSW, Australia; the Department of Medicine, University of Toronto Faculty of Medicine and St. Michael's Hospital, Toronto (J.T.); the Department of Pediatrics, Weill Cornell Medical College, New York (C.E.M.); the Department of Medicine, University of Pittsburgh, Pittsburgh (M.V.R.); and Colorado Coagulation, Laboratory Corporation of America Holdings, Englewood, CO (S.T.)
| | - Katie Wachtel
- From the Division of Hematology (L.A.G., B.J.S.-J., A.W., V.R.A.) and the Raymond G. Perelman Center for Cellular and Molecular Therapeutics (L.A.G., B.J.S.-J., A.W., V.R.A., J.C.M.L., O.Z.), Children's Hospital of Philadelphia, the Departments of Pediatrics (L.A.G., B.J.S.-J., V.R.A.) and Medicine (A.C.), Perelman School of Medicine at the University of Pennsylvania, and Spark Therapeutics (A.Y.L., D.H., J.F.W., Y.C., Y.L., K.W., D.T., M.E.C., L.B.C., X.M.A., K.A.H.) - all in Philadelphia; the Department of Pediatrics, Mississippi Center for Advanced Medicine, Madison (S.K.S.), and the Departments of Pathology (L.M.S.) and Pediatrics (S.M.), University of Mississippi Medical School, Jackson; the Departments of Medicine (A.G.) and Pediatrics (J.D.), University of California-Davis Medical School, Sacramento; the Department of Medicine, Sydney Medical School, and the Gene and Stem Cell Therapy Program, Centenary Institute (J.E.J.R.), University of Sydney, and Cell and Molecular Therapies, Royal Prince Alfred Hospital (J.E.J.R.) - both in Camperdown, NSW, Australia; the Department of Medicine, University of Toronto Faculty of Medicine and St. Michael's Hospital, Toronto (J.T.); the Department of Pediatrics, Weill Cornell Medical College, New York (C.E.M.); the Department of Medicine, University of Pittsburgh, Pittsburgh (M.V.R.); and Colorado Coagulation, Laboratory Corporation of America Holdings, Englewood, CO (S.T.)
| | - Angela Winters
- From the Division of Hematology (L.A.G., B.J.S.-J., A.W., V.R.A.) and the Raymond G. Perelman Center for Cellular and Molecular Therapeutics (L.A.G., B.J.S.-J., A.W., V.R.A., J.C.M.L., O.Z.), Children's Hospital of Philadelphia, the Departments of Pediatrics (L.A.G., B.J.S.-J., V.R.A.) and Medicine (A.C.), Perelman School of Medicine at the University of Pennsylvania, and Spark Therapeutics (A.Y.L., D.H., J.F.W., Y.C., Y.L., K.W., D.T., M.E.C., L.B.C., X.M.A., K.A.H.) - all in Philadelphia; the Department of Pediatrics, Mississippi Center for Advanced Medicine, Madison (S.K.S.), and the Departments of Pathology (L.M.S.) and Pediatrics (S.M.), University of Mississippi Medical School, Jackson; the Departments of Medicine (A.G.) and Pediatrics (J.D.), University of California-Davis Medical School, Sacramento; the Department of Medicine, Sydney Medical School, and the Gene and Stem Cell Therapy Program, Centenary Institute (J.E.J.R.), University of Sydney, and Cell and Molecular Therapies, Royal Prince Alfred Hospital (J.E.J.R.) - both in Camperdown, NSW, Australia; the Department of Medicine, University of Toronto Faculty of Medicine and St. Michael's Hospital, Toronto (J.T.); the Department of Pediatrics, Weill Cornell Medical College, New York (C.E.M.); the Department of Medicine, University of Pittsburgh, Pittsburgh (M.V.R.); and Colorado Coagulation, Laboratory Corporation of America Holdings, Englewood, CO (S.T.)
| | - Stefan Tiefenbacher
- From the Division of Hematology (L.A.G., B.J.S.-J., A.W., V.R.A.) and the Raymond G. Perelman Center for Cellular and Molecular Therapeutics (L.A.G., B.J.S.-J., A.W., V.R.A., J.C.M.L., O.Z.), Children's Hospital of Philadelphia, the Departments of Pediatrics (L.A.G., B.J.S.-J., V.R.A.) and Medicine (A.C.), Perelman School of Medicine at the University of Pennsylvania, and Spark Therapeutics (A.Y.L., D.H., J.F.W., Y.C., Y.L., K.W., D.T., M.E.C., L.B.C., X.M.A., K.A.H.) - all in Philadelphia; the Department of Pediatrics, Mississippi Center for Advanced Medicine, Madison (S.K.S.), and the Departments of Pathology (L.M.S.) and Pediatrics (S.M.), University of Mississippi Medical School, Jackson; the Departments of Medicine (A.G.) and Pediatrics (J.D.), University of California-Davis Medical School, Sacramento; the Department of Medicine, Sydney Medical School, and the Gene and Stem Cell Therapy Program, Centenary Institute (J.E.J.R.), University of Sydney, and Cell and Molecular Therapies, Royal Prince Alfred Hospital (J.E.J.R.) - both in Camperdown, NSW, Australia; the Department of Medicine, University of Toronto Faculty of Medicine and St. Michael's Hospital, Toronto (J.T.); the Department of Pediatrics, Weill Cornell Medical College, New York (C.E.M.); the Department of Medicine, University of Pittsburgh, Pittsburgh (M.V.R.); and Colorado Coagulation, Laboratory Corporation of America Holdings, Englewood, CO (S.T.)
| | - Valder R Arruda
- From the Division of Hematology (L.A.G., B.J.S.-J., A.W., V.R.A.) and the Raymond G. Perelman Center for Cellular and Molecular Therapeutics (L.A.G., B.J.S.-J., A.W., V.R.A., J.C.M.L., O.Z.), Children's Hospital of Philadelphia, the Departments of Pediatrics (L.A.G., B.J.S.-J., V.R.A.) and Medicine (A.C.), Perelman School of Medicine at the University of Pennsylvania, and Spark Therapeutics (A.Y.L., D.H., J.F.W., Y.C., Y.L., K.W., D.T., M.E.C., L.B.C., X.M.A., K.A.H.) - all in Philadelphia; the Department of Pediatrics, Mississippi Center for Advanced Medicine, Madison (S.K.S.), and the Departments of Pathology (L.M.S.) and Pediatrics (S.M.), University of Mississippi Medical School, Jackson; the Departments of Medicine (A.G.) and Pediatrics (J.D.), University of California-Davis Medical School, Sacramento; the Department of Medicine, Sydney Medical School, and the Gene and Stem Cell Therapy Program, Centenary Institute (J.E.J.R.), University of Sydney, and Cell and Molecular Therapies, Royal Prince Alfred Hospital (J.E.J.R.) - both in Camperdown, NSW, Australia; the Department of Medicine, University of Toronto Faculty of Medicine and St. Michael's Hospital, Toronto (J.T.); the Department of Pediatrics, Weill Cornell Medical College, New York (C.E.M.); the Department of Medicine, University of Pittsburgh, Pittsburgh (M.V.R.); and Colorado Coagulation, Laboratory Corporation of America Holdings, Englewood, CO (S.T.)
| | - Johannes C M van der Loo
- From the Division of Hematology (L.A.G., B.J.S.-J., A.W., V.R.A.) and the Raymond G. Perelman Center for Cellular and Molecular Therapeutics (L.A.G., B.J.S.-J., A.W., V.R.A., J.C.M.L., O.Z.), Children's Hospital of Philadelphia, the Departments of Pediatrics (L.A.G., B.J.S.-J., V.R.A.) and Medicine (A.C.), Perelman School of Medicine at the University of Pennsylvania, and Spark Therapeutics (A.Y.L., D.H., J.F.W., Y.C., Y.L., K.W., D.T., M.E.C., L.B.C., X.M.A., K.A.H.) - all in Philadelphia; the Department of Pediatrics, Mississippi Center for Advanced Medicine, Madison (S.K.S.), and the Departments of Pathology (L.M.S.) and Pediatrics (S.M.), University of Mississippi Medical School, Jackson; the Departments of Medicine (A.G.) and Pediatrics (J.D.), University of California-Davis Medical School, Sacramento; the Department of Medicine, Sydney Medical School, and the Gene and Stem Cell Therapy Program, Centenary Institute (J.E.J.R.), University of Sydney, and Cell and Molecular Therapies, Royal Prince Alfred Hospital (J.E.J.R.) - both in Camperdown, NSW, Australia; the Department of Medicine, University of Toronto Faculty of Medicine and St. Michael's Hospital, Toronto (J.T.); the Department of Pediatrics, Weill Cornell Medical College, New York (C.E.M.); the Department of Medicine, University of Pittsburgh, Pittsburgh (M.V.R.); and Colorado Coagulation, Laboratory Corporation of America Holdings, Englewood, CO (S.T.)
| | - Olga Zelenaia
- From the Division of Hematology (L.A.G., B.J.S.-J., A.W., V.R.A.) and the Raymond G. Perelman Center for Cellular and Molecular Therapeutics (L.A.G., B.J.S.-J., A.W., V.R.A., J.C.M.L., O.Z.), Children's Hospital of Philadelphia, the Departments of Pediatrics (L.A.G., B.J.S.-J., V.R.A.) and Medicine (A.C.), Perelman School of Medicine at the University of Pennsylvania, and Spark Therapeutics (A.Y.L., D.H., J.F.W., Y.C., Y.L., K.W., D.T., M.E.C., L.B.C., X.M.A., K.A.H.) - all in Philadelphia; the Department of Pediatrics, Mississippi Center for Advanced Medicine, Madison (S.K.S.), and the Departments of Pathology (L.M.S.) and Pediatrics (S.M.), University of Mississippi Medical School, Jackson; the Departments of Medicine (A.G.) and Pediatrics (J.D.), University of California-Davis Medical School, Sacramento; the Department of Medicine, Sydney Medical School, and the Gene and Stem Cell Therapy Program, Centenary Institute (J.E.J.R.), University of Sydney, and Cell and Molecular Therapies, Royal Prince Alfred Hospital (J.E.J.R.) - both in Camperdown, NSW, Australia; the Department of Medicine, University of Toronto Faculty of Medicine and St. Michael's Hospital, Toronto (J.T.); the Department of Pediatrics, Weill Cornell Medical College, New York (C.E.M.); the Department of Medicine, University of Pittsburgh, Pittsburgh (M.V.R.); and Colorado Coagulation, Laboratory Corporation of America Holdings, Englewood, CO (S.T.)
| | - Daniel Takefman
- From the Division of Hematology (L.A.G., B.J.S.-J., A.W., V.R.A.) and the Raymond G. Perelman Center for Cellular and Molecular Therapeutics (L.A.G., B.J.S.-J., A.W., V.R.A., J.C.M.L., O.Z.), Children's Hospital of Philadelphia, the Departments of Pediatrics (L.A.G., B.J.S.-J., V.R.A.) and Medicine (A.C.), Perelman School of Medicine at the University of Pennsylvania, and Spark Therapeutics (A.Y.L., D.H., J.F.W., Y.C., Y.L., K.W., D.T., M.E.C., L.B.C., X.M.A., K.A.H.) - all in Philadelphia; the Department of Pediatrics, Mississippi Center for Advanced Medicine, Madison (S.K.S.), and the Departments of Pathology (L.M.S.) and Pediatrics (S.M.), University of Mississippi Medical School, Jackson; the Departments of Medicine (A.G.) and Pediatrics (J.D.), University of California-Davis Medical School, Sacramento; the Department of Medicine, Sydney Medical School, and the Gene and Stem Cell Therapy Program, Centenary Institute (J.E.J.R.), University of Sydney, and Cell and Molecular Therapies, Royal Prince Alfred Hospital (J.E.J.R.) - both in Camperdown, NSW, Australia; the Department of Medicine, University of Toronto Faculty of Medicine and St. Michael's Hospital, Toronto (J.T.); the Department of Pediatrics, Weill Cornell Medical College, New York (C.E.M.); the Department of Medicine, University of Pittsburgh, Pittsburgh (M.V.R.); and Colorado Coagulation, Laboratory Corporation of America Holdings, Englewood, CO (S.T.)
| | - Marcus E Carr
- From the Division of Hematology (L.A.G., B.J.S.-J., A.W., V.R.A.) and the Raymond G. Perelman Center for Cellular and Molecular Therapeutics (L.A.G., B.J.S.-J., A.W., V.R.A., J.C.M.L., O.Z.), Children's Hospital of Philadelphia, the Departments of Pediatrics (L.A.G., B.J.S.-J., V.R.A.) and Medicine (A.C.), Perelman School of Medicine at the University of Pennsylvania, and Spark Therapeutics (A.Y.L., D.H., J.F.W., Y.C., Y.L., K.W., D.T., M.E.C., L.B.C., X.M.A., K.A.H.) - all in Philadelphia; the Department of Pediatrics, Mississippi Center for Advanced Medicine, Madison (S.K.S.), and the Departments of Pathology (L.M.S.) and Pediatrics (S.M.), University of Mississippi Medical School, Jackson; the Departments of Medicine (A.G.) and Pediatrics (J.D.), University of California-Davis Medical School, Sacramento; the Department of Medicine, Sydney Medical School, and the Gene and Stem Cell Therapy Program, Centenary Institute (J.E.J.R.), University of Sydney, and Cell and Molecular Therapies, Royal Prince Alfred Hospital (J.E.J.R.) - both in Camperdown, NSW, Australia; the Department of Medicine, University of Toronto Faculty of Medicine and St. Michael's Hospital, Toronto (J.T.); the Department of Pediatrics, Weill Cornell Medical College, New York (C.E.M.); the Department of Medicine, University of Pittsburgh, Pittsburgh (M.V.R.); and Colorado Coagulation, Laboratory Corporation of America Holdings, Englewood, CO (S.T.)
| | - Linda B Couto
- From the Division of Hematology (L.A.G., B.J.S.-J., A.W., V.R.A.) and the Raymond G. Perelman Center for Cellular and Molecular Therapeutics (L.A.G., B.J.S.-J., A.W., V.R.A., J.C.M.L., O.Z.), Children's Hospital of Philadelphia, the Departments of Pediatrics (L.A.G., B.J.S.-J., V.R.A.) and Medicine (A.C.), Perelman School of Medicine at the University of Pennsylvania, and Spark Therapeutics (A.Y.L., D.H., J.F.W., Y.C., Y.L., K.W., D.T., M.E.C., L.B.C., X.M.A., K.A.H.) - all in Philadelphia; the Department of Pediatrics, Mississippi Center for Advanced Medicine, Madison (S.K.S.), and the Departments of Pathology (L.M.S.) and Pediatrics (S.M.), University of Mississippi Medical School, Jackson; the Departments of Medicine (A.G.) and Pediatrics (J.D.), University of California-Davis Medical School, Sacramento; the Department of Medicine, Sydney Medical School, and the Gene and Stem Cell Therapy Program, Centenary Institute (J.E.J.R.), University of Sydney, and Cell and Molecular Therapies, Royal Prince Alfred Hospital (J.E.J.R.) - both in Camperdown, NSW, Australia; the Department of Medicine, University of Toronto Faculty of Medicine and St. Michael's Hospital, Toronto (J.T.); the Department of Pediatrics, Weill Cornell Medical College, New York (C.E.M.); the Department of Medicine, University of Pittsburgh, Pittsburgh (M.V.R.); and Colorado Coagulation, Laboratory Corporation of America Holdings, Englewood, CO (S.T.)
| | - Xavier M Anguela
- From the Division of Hematology (L.A.G., B.J.S.-J., A.W., V.R.A.) and the Raymond G. Perelman Center for Cellular and Molecular Therapeutics (L.A.G., B.J.S.-J., A.W., V.R.A., J.C.M.L., O.Z.), Children's Hospital of Philadelphia, the Departments of Pediatrics (L.A.G., B.J.S.-J., V.R.A.) and Medicine (A.C.), Perelman School of Medicine at the University of Pennsylvania, and Spark Therapeutics (A.Y.L., D.H., J.F.W., Y.C., Y.L., K.W., D.T., M.E.C., L.B.C., X.M.A., K.A.H.) - all in Philadelphia; the Department of Pediatrics, Mississippi Center for Advanced Medicine, Madison (S.K.S.), and the Departments of Pathology (L.M.S.) and Pediatrics (S.M.), University of Mississippi Medical School, Jackson; the Departments of Medicine (A.G.) and Pediatrics (J.D.), University of California-Davis Medical School, Sacramento; the Department of Medicine, Sydney Medical School, and the Gene and Stem Cell Therapy Program, Centenary Institute (J.E.J.R.), University of Sydney, and Cell and Molecular Therapies, Royal Prince Alfred Hospital (J.E.J.R.) - both in Camperdown, NSW, Australia; the Department of Medicine, University of Toronto Faculty of Medicine and St. Michael's Hospital, Toronto (J.T.); the Department of Pediatrics, Weill Cornell Medical College, New York (C.E.M.); the Department of Medicine, University of Pittsburgh, Pittsburgh (M.V.R.); and Colorado Coagulation, Laboratory Corporation of America Holdings, Englewood, CO (S.T.)
| | - Katherine A High
- From the Division of Hematology (L.A.G., B.J.S.-J., A.W., V.R.A.) and the Raymond G. Perelman Center for Cellular and Molecular Therapeutics (L.A.G., B.J.S.-J., A.W., V.R.A., J.C.M.L., O.Z.), Children's Hospital of Philadelphia, the Departments of Pediatrics (L.A.G., B.J.S.-J., V.R.A.) and Medicine (A.C.), Perelman School of Medicine at the University of Pennsylvania, and Spark Therapeutics (A.Y.L., D.H., J.F.W., Y.C., Y.L., K.W., D.T., M.E.C., L.B.C., X.M.A., K.A.H.) - all in Philadelphia; the Department of Pediatrics, Mississippi Center for Advanced Medicine, Madison (S.K.S.), and the Departments of Pathology (L.M.S.) and Pediatrics (S.M.), University of Mississippi Medical School, Jackson; the Departments of Medicine (A.G.) and Pediatrics (J.D.), University of California-Davis Medical School, Sacramento; the Department of Medicine, Sydney Medical School, and the Gene and Stem Cell Therapy Program, Centenary Institute (J.E.J.R.), University of Sydney, and Cell and Molecular Therapies, Royal Prince Alfred Hospital (J.E.J.R.) - both in Camperdown, NSW, Australia; the Department of Medicine, University of Toronto Faculty of Medicine and St. Michael's Hospital, Toronto (J.T.); the Department of Pediatrics, Weill Cornell Medical College, New York (C.E.M.); the Department of Medicine, University of Pittsburgh, Pittsburgh (M.V.R.); and Colorado Coagulation, Laboratory Corporation of America Holdings, Englewood, CO (S.T.)
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Carvalho M, Sepodes B, Martins AP. Regulatory and Scientific Advancements in Gene Therapy: State-of-the-Art of Clinical Applications and of the Supporting European Regulatory Framework. Front Med (Lausanne) 2017; 4:182. [PMID: 29124055 PMCID: PMC5662580 DOI: 10.3389/fmed.2017.00182] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Accepted: 10/11/2017] [Indexed: 12/21/2022] Open
Abstract
Advanced therapy medicinal products (ATMPs) have a massive potential to address existing unmet medical needs. Specifically, gene therapy medicinal products (GTMPs) may potentially provide cure for several genetic diseases. In Europe, the ATMP regulation was fully implemented in 2009 and, at this point, the Committee for Advanced Therapies was created as a dedicated group of specialists to evaluate medicinal products requiring specific expertise in this area. To date, there are three authorized GTMPs, and the first one was approved in 2012. Broad research has been conducted in this field over the last few decades and different clinical applications are being investigated worldwide, using different strategies that range from direct gene replacement or addition to more complex pathways such as specific gene editing or RNA targeting. Important safety risks, limited efficacy, manufacturing hurdles, or ethical conflicts may represent challenges in the success of a candidate GTMP. During the development process, it is fundamental to take such aspects into account and establish overcoming strategies. This article reviews the current European legal framework of ATMPs, provides an overview of the clinical applications for approved and investigational GTMPs, and discusses critical challenges in the development of GTMPs.
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Affiliation(s)
- Marta Carvalho
- Faculdade de Farmácia, Research Institute for Medicines and Pharmaceutical Sciences (iMed.ULisboa), Universidade de Lisboa, Lisboa, Portugal
| | - Bruno Sepodes
- Faculdade de Farmácia, Research Institute for Medicines and Pharmaceutical Sciences (iMed.ULisboa), Universidade de Lisboa, Lisboa, Portugal
| | - Ana Paula Martins
- Faculdade de Farmácia, Research Institute for Medicines and Pharmaceutical Sciences (iMed.ULisboa), Universidade de Lisboa, Lisboa, Portugal
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Suárez-Amarán L, Usai C, Di Scala M, Godoy C, Ni Y, Hommel M, Palomo L, Segura V, Olagüe C, Vales A, Ruiz-Ripa A, Buti M, Salido E, Prieto J, Urban S, Rodríguez-Frias F, Aldabe R, González-Aseguinolaza G. A new HDV mouse model identifies mitochondrial antiviral signaling protein (MAVS) as a key player in IFN-β induction. J Hepatol 2017; 67:669-679. [PMID: 28527664 DOI: 10.1016/j.jhep.2017.05.010] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Revised: 04/28/2017] [Accepted: 05/06/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND & AIMS Studying hepatitis delta virus (HDV) and developing new treatments is hampered by the limited availability of small animal models. Herein, a description of a robust mouse model of HDV infection that mimics several important characteristics of the human disease is presented. METHODS HDV and hepatitis B virus (HBV) replication competent genomes were delivered to the mouse liver using adeno-associated viruses (AAV; AAV-HDV and AAV-HBV). Viral load, antigen expression and genomes were quantified at different time points after AAV injection. Furthermore, liver pathology, genome editing, and the activation of the innate immune response were evaluated. RESULTS AAV-HDV infection initiated HDV replication in mouse hepatocytes. Genome editing was confirmed by the presence of small and large HDV antigens and sequencing. Viral replication was detected for 45days, even after the AAV-HDV vector had almost disappeared. In the presence of HBV, HDV infectious particles were detected in serum. Furthermore, as observed in patients, co-infection was associated with the reduction of HBV antigen expression and the onset of liver damage that included the alteration of genes involved in the development of liver pathologies. HDV replication induced a sustained type I interferon response, which was significantly reduced in immunodeficient mice and almost absent in mitochondrial antiviral signaling protein (MAVS)-deficient mice. CONCLUSION The animal model described here reproduces important characteristics of human HDV infection and provides a valuable tool for characterizing the viral infection and for developing new treatments. Furthermore, MAVS was identified as a main player in HDV detection and adaptive immunity was found to be involved in the amplification of the innate immune response. Lay summary: Co-infection with hepatitis B and D virus (HBV and HDV, respectively) often causes a more severe disease condition than HBV alone. Gaining more insight into HDV and developing new treatments is hampered by limited availability of adequate immune competent small animal models and new ones are needed. Here, a mouse model of HDV infection is described, which mimics several important characteristics of the human disease, such as the initiation and maintenance of replication in murine hepatocytes, genome editing and, in the presence of HBV, generation of infectious particles. Lastly, the involvement of an adaptive immunity and the intracellular signaling molecule MAVS in mounting a strong and lasting innate response was shown. Thus, our model serves as a useful tool for the investigation of HDV biology and new treatments.
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MESH Headings
- Adaptive Immunity
- Adaptor Proteins, Signal Transducing/deficiency
- Adaptor Proteins, Signal Transducing/genetics
- Adaptor Proteins, Signal Transducing/immunology
- Animals
- Cell Line
- Coinfection/immunology
- Coinfection/pathology
- Coinfection/virology
- Dependovirus/genetics
- Disease Models, Animal
- Genome, Viral
- Hepatitis B/complications
- Hepatitis B/immunology
- Hepatitis B/virology
- Hepatitis B Antigens/metabolism
- Hepatitis B virus/genetics
- Hepatitis B virus/immunology
- Hepatitis D/complications
- Hepatitis D/immunology
- Hepatitis D/virology
- Hepatitis Delta Virus/genetics
- Hepatitis Delta Virus/immunology
- Hepatitis Delta Virus/physiology
- Hepatitis delta Antigens/metabolism
- Humans
- Immunity, Innate
- Interferon-beta/biosynthesis
- Liver/pathology
- Male
- Mice
- Mice, Inbred C57BL
- Mice, Knockout
- Mice, Transgenic
- Models, Immunological
- Signal Transduction/immunology
- Virus Replication
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Affiliation(s)
- Lester Suárez-Amarán
- Gene Therapy and Regulation of Gene Expression Program, Center for Applied Medical Research (CIMA), Pamplona, Spain; Instituto de Investigación Sanitaria de Navarra (IdiSNA), Calle Irunlarrea 3, Pamplona 31008, Spain
| | - Carla Usai
- Gene Therapy and Regulation of Gene Expression Program, Center for Applied Medical Research (CIMA), Pamplona, Spain; Instituto de Investigación Sanitaria de Navarra (IdiSNA), Calle Irunlarrea 3, Pamplona 31008, Spain
| | - Marianna Di Scala
- Gene Therapy and Regulation of Gene Expression Program, Center for Applied Medical Research (CIMA), Pamplona, Spain; Instituto de Investigación Sanitaria de Navarra (IdiSNA), Calle Irunlarrea 3, Pamplona 31008, Spain
| | - Cristina Godoy
- Centro de Investigación Biomédica en red: Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Barcelona, Spain; Liver Pathology Unit, Departments of Biochemistry and Microbiology, Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain; Virology Unit, Department of Microbiology, Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Yi Ni
- Department of Infectious Diseases, Molecular Virology, University Hospital Heidelberg, Heidelberg, Germany
| | - Mirja Hommel
- Gene Therapy and Regulation of Gene Expression Program, Center for Applied Medical Research (CIMA), Pamplona, Spain; Instituto de Investigación Sanitaria de Navarra (IdiSNA), Calle Irunlarrea 3, Pamplona 31008, Spain
| | - Laura Palomo
- Gene Therapy and Regulation of Gene Expression Program, Center for Applied Medical Research (CIMA), Pamplona, Spain; Instituto de Investigación Sanitaria de Navarra (IdiSNA), Calle Irunlarrea 3, Pamplona 31008, Spain
| | - Víctor Segura
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), Calle Irunlarrea 3, Pamplona 31008, Spain; Bioinformatics Unit, Center for Applied Medical Research (CIMA), University of Navarra, Pamplona, Spain
| | - Cristina Olagüe
- Gene Therapy and Regulation of Gene Expression Program, Center for Applied Medical Research (CIMA), Pamplona, Spain; Instituto de Investigación Sanitaria de Navarra (IdiSNA), Calle Irunlarrea 3, Pamplona 31008, Spain
| | - Africa Vales
- Gene Therapy and Regulation of Gene Expression Program, Center for Applied Medical Research (CIMA), Pamplona, Spain; Instituto de Investigación Sanitaria de Navarra (IdiSNA), Calle Irunlarrea 3, Pamplona 31008, Spain
| | - Alicia Ruiz-Ripa
- Centro de Investigación Biomédica en red: Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Barcelona, Spain; Liver Pathology Unit, Departments of Biochemistry and Microbiology, Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain; Virology Unit, Department of Microbiology, Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Maria Buti
- Centro de Investigación Biomédica en red: Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Barcelona, Spain; Liver Pathology Unit, Departments of Biochemistry and Microbiology, Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain; Virology Unit, Department of Microbiology, Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Eduardo Salido
- Department of Pathology, Centre for Biomedical Research on Rare Diseases (CIBERER), La Laguna, S/C Tenerife, Spain
| | - Jesús Prieto
- Gene Therapy and Regulation of Gene Expression Program, Center for Applied Medical Research (CIMA), Pamplona, Spain; Instituto de Investigación Sanitaria de Navarra (IdiSNA), Calle Irunlarrea 3, Pamplona 31008, Spain; Centro de Investigación Biomédica en red: Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Pamplona, Spain
| | - Stephan Urban
- Department of Infectious Diseases, Molecular Virology, University Hospital Heidelberg, Heidelberg, Germany
| | - Francisco Rodríguez-Frias
- Centro de Investigación Biomédica en red: Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Barcelona, Spain; Liver Pathology Unit, Departments of Biochemistry and Microbiology, Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain; Virology Unit, Department of Microbiology, Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Rafael Aldabe
- Gene Therapy and Regulation of Gene Expression Program, Center for Applied Medical Research (CIMA), Pamplona, Spain; Instituto de Investigación Sanitaria de Navarra (IdiSNA), Calle Irunlarrea 3, Pamplona 31008, Spain
| | - Gloria González-Aseguinolaza
- Gene Therapy and Regulation of Gene Expression Program, Center for Applied Medical Research (CIMA), Pamplona, Spain; Instituto de Investigación Sanitaria de Navarra (IdiSNA), Calle Irunlarrea 3, Pamplona 31008, Spain.
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Cho J, Zhang Y, Park SY, Joseph AM, Han C, Park HJ, Kalavalapalli S, Chun SK, Morgan D, Kim JS, Someya S, Mathews CE, Lee YJ, Wohlgemuth SE, Sunny NE, Lee HY, Choi CS, Shiratsuchi T, Oh SP, Terada N. Mitochondrial ATP transporter depletion protects mice against liver steatosis and insulin resistance. Nat Commun 2017; 8:14477. [PMID: 28205519 PMCID: PMC5316896 DOI: 10.1038/ncomms14477] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Accepted: 01/04/2017] [Indexed: 12/31/2022] Open
Abstract
Non-alcoholic fatty liver disease (NAFLD) is a common metabolic disorder in obese individuals. Adenine nucleotide translocase (ANT) exchanges ADP/ATP through the mitochondrial inner membrane, and Ant2 is the predominant isoform expressed in the liver. Here we demonstrate that targeted disruption of Ant2 in mouse liver enhances uncoupled respiration without damaging mitochondrial integrity and liver functions. Interestingly, liver specific Ant2 knockout mice are leaner and resistant to hepatic steatosis, obesity and insulin resistance under a lipogenic diet. Protection against fatty liver is partially recapitulated by the systemic administration of low-dose carboxyatractyloside, a specific inhibitor of ANT. Targeted manipulation of hepatic mitochondrial metabolism, particularly through inhibition of ANT, may represent an alternative approach in NAFLD and obesity treatment. Adenine nucleotide translocase (ANT) 2 promotes ADP/ATP exchange across the mitochondrial inner membrane. Cho et al. show that liver specific Ant2 deletion increases uncoupled respiration and protects mice against fatty liver and obesity-induced insulin resistance.
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Affiliation(s)
- Joonseok Cho
- Department of Pathology, University of Florida College of Medicine, Gainesville, Florida 32610, USA
| | - Yujian Zhang
- Otsuka Maryland Medicinal Laboratories, Rockville, Maryland 20850, USA
| | - Shi-Young Park
- Korea Mouse Metabolic Phenotyping Center, Lee Gil Ya Cancer and Diabetes Institute, Gachon University School of Medicine, Incheon 406-840, Korea
| | - Anna-Maria Joseph
- Department of Aging, University of Florida College of Medicine, Gainesville, Florida 32610, USA
| | - Chul Han
- Department of Aging, University of Florida College of Medicine, Gainesville, Florida 32610, USA
| | - Hyo-Jin Park
- Department of Aging, University of Florida College of Medicine, Gainesville, Florida 32610, USA
| | - Srilaxmi Kalavalapalli
- Department of Medicine, University of Florida College of Medicine, Gainesville, Florida 32610, USA
| | - Sung-Kook Chun
- Department of Surgery, University of Florida College of Medicine, Gainesville, Florida 32610, USA
| | - Drake Morgan
- Department of Psychiatry, University of Florida College of Medicine, Gainesville, Florida 32610, USA
| | - Jae-Sung Kim
- Department of Surgery, University of Florida College of Medicine, Gainesville, Florida 32610, USA
| | - Shinichi Someya
- Department of Aging, University of Florida College of Medicine, Gainesville, Florida 32610, USA
| | - Clayton E Mathews
- Department of Pathology, University of Florida College of Medicine, Gainesville, Florida 32610, USA
| | - Young Jae Lee
- Korea Mouse Metabolic Phenotyping Center, Lee Gil Ya Cancer and Diabetes Institute, Gachon University School of Medicine, Incheon 406-840, Korea
| | - Stephanie E Wohlgemuth
- Department of Animal Sciences, University of Florida College of Medicine, Gainesville, Florida 32611, USA
| | - Nishanth E Sunny
- Department of Medicine, University of Florida College of Medicine, Gainesville, Florida 32610, USA
| | - Hui-Young Lee
- Korea Mouse Metabolic Phenotyping Center, Lee Gil Ya Cancer and Diabetes Institute, Gachon University School of Medicine, Incheon 406-840, Korea
| | - Cheol Soo Choi
- Korea Mouse Metabolic Phenotyping Center, Lee Gil Ya Cancer and Diabetes Institute, Gachon University School of Medicine, Incheon 406-840, Korea.,Endocrinology, Internal Medicine, Gachon University Gil Medical Center, Incheon 405-760, Korea
| | | | - S Paul Oh
- Department of Physiology, University of Florida College of Medicine, Gainesville, Florida 32610, USA
| | - Naohiro Terada
- Department of Pathology, University of Florida College of Medicine, Gainesville, Florida 32610, USA
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Duan D. Dystrophin Gene Replacement and Gene Repair Therapy for Duchenne Muscular Dystrophy in 2016: An Interview. HUM GENE THER CL DEV 2016; 27:9-18. [PMID: 27003751 DOI: 10.1089/humc.2016.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
After years of relentless efforts, gene therapy has now begun to deliver its therapeutic promise in several diseases. A number of gene therapy products have received regulatory approval in Europe and Asia. Duchenne muscular dystrophy (DMD) is an X-linked inherited lethal muscle disease. It is caused by mutations in the dystrophin gene. Replacing and/or repairing the mutated dystrophin gene holds great promises to treated DMD at the genetic level. Last several years have evidenced significant developments in preclinical experimentations in murine and canine models of DMD. There has been a strong interest in moving these promising findings to clinical trials. In light of rapid progress in this field, the Parent Project Muscular Dystrophy (PPMD) recently interviewed me on the current status of DMD gene therapy and readiness for clinical trials. Here I summarized the interview with PPMD.
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Affiliation(s)
- Dongsheng Duan
- Department of Molecular Microbiology and Immunology & Department of Neurology, School of Medicine, and Department of Bioengineering, The University of Missouri , Columbia, Missouri
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Wacker BK, Dronadula N, Zhang J, Dichek DA. Local Vascular Gene Therapy With Apolipoprotein A-I to Promote Regression of Atherosclerosis. Arterioscler Thromb Vasc Biol 2016; 37:316-327. [PMID: 27932352 DOI: 10.1161/atvbaha.116.308258] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Accepted: 11/28/2016] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Gene therapy, delivered directly to the blood vessel wall, could potentially prevent atherosclerotic lesion growth and promote atherosclerosis regression. Previously, we reported that a helper-dependent adenoviral (HDAd) vector expressing apolipoprotein A-I (apoA-I) in carotid endothelium of fat-fed rabbits reduced early (4 weeks) atherosclerotic lesion growth. Here, we tested whether the same HDAd-delivered to the existing carotid atherosclerotic lesions-could promote regression. APPROACH AND RESULTS Rabbits (n=26) were fed a high-fat diet for 7 months, then treated with bilateral carotid gene transfer. One carotid was infused with an HDAd expressing apoA-I (HDAdApoAI) and the other with a control nonexpressing HDAd (HDAdNull). The side with HDAdApoAI was randomized. Rabbits were then switched to regular chow, lowering their plasma cholesterols by over 70%. ApoA-I mRNA and protein were detected in HDAdApoAI-transduced arteries. After 7 weeks of gene therapy, compared with HDAdNull-treated arteries in the same rabbits, HDAdApoAI-treated arteries had significantly less vascular cell adhesion molecule-1 expression (28%; P=0.04) along with modest but statistically insignificant trends toward decreased intimal lesion volume, lipid and macrophage content, and intercellular adhesion molecule-1 expression (9%-21%; P=0.1-0.4). Post hoc subgroup analysis of rabbits with small-to-moderate-sized lesions (n=20) showed that HDAdApoAI caused large reductions in lesion volume, lipid content, intercellular adhesion molecule-1, and vascular cell adhesion molecule-1 expression (30%-50%; P≤0.04 for all). Macrophage content was reduced by 30% (P=0.06). There was a significant interaction (P=0.02) between lesion size and treatment efficacy. CONCLUSIONS Even when administered on a background of aggressive lowering of plasma cholesterol, local HDAdApoAI vascular gene therapy may promote rapid regression of small-to-moderate-sized atherosclerotic lesions.
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Affiliation(s)
- Bradley K Wacker
- From the Department of Medicine, University of Washington School of Medicine, Seattle
| | - Nagadhara Dronadula
- From the Department of Medicine, University of Washington School of Medicine, Seattle
| | - Jingwan Zhang
- From the Department of Medicine, University of Washington School of Medicine, Seattle
| | - David A Dichek
- From the Department of Medicine, University of Washington School of Medicine, Seattle.
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Hartmann J, Croteau SE. 2017 Clinical trials update: Innovations in hemophilia therapy. Am J Hematol 2016; 91:1252-1260. [PMID: 27563744 DOI: 10.1002/ajh.24543] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Revised: 08/18/2016] [Accepted: 08/24/2016] [Indexed: 01/19/2023]
Abstract
A surge in therapeutic clinical trials over recent years is paving the way for transformative treatment options for patients with hemophilia. The introduction of recombinant factor concentrates in the early 1990s facilitated the use of prophylactic replacement as standard care for hemophilia rather than on-demand treatment. This has revolutionized health outcomes for hemophilia patients, enabling participation in physical activities and reducing debilitating, chronic joint damage. Challenges of prophylactic factor infusion include the frequency of infusions needed to maintain factor levels greater than 1%, patient adherence, reliable intravenous access, and development of neutralizing alloantibodies ("inhibitors"). Novel therapeutics seek to improve upon current factor concentrates by several different mechanisms: (1) extending the half-life of circulating exogenous factor protein, (2) replacing the gene necessary for production of endogenous factor protein, (3) employing bispecific antibody technology to mimic the coagulation function of factor VIII, (4) disrupting anticoagulant proteins, such as tissue factor pathway inhibitor (TFPI) or antithrombin (AT3) with antibodies, aptamers, or RNA interference technology. Emerging treatment options may reduce the frequency of (extended half-life products) or eliminate (gene therapy) the need for scheduled factor concentrate infusions, or provide a subcutaneous administration option (bispecific antibody, AT3, and TFPI targeting therapies). In addition, the nonfactor replacement strategies provide a promising treatment option for patients with inhibitors, presently the greatest unmet medical need in hemophilia. This review highlights current and recently completed clinical trials that are driving a paradigm shift in our approach to hemophilia care for patients with and without inhibitors. Am. J. Hematol. 91:1252-1260, 2016. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Jan Hartmann
- Haemonetics Corporation400 Wood RoadBraintree Massachusetts02184
| | - Stacy E. Croteau
- Dana Farber/Boston Children's Cancer and Blood Disorders Center and Harvard Medical School450 Brookline Ave, Dana 3Boston Massachusetts02215
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