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Naehrig* S, Chao* CM, Naehrlich L. Cystic Fibrosis. DEUTSCHES ARZTEBLATT INTERNATIONAL 2017; 114:564-574. [PMID: 28855057 PMCID: PMC5596161 DOI: 10.3238/arztebl.2017.0564] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2016] [Revised: 10/09/2016] [Accepted: 05/02/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND Universal screening of newborn babies for cystic fibrosis was launched in Germany on 1 September 2016. Here we present up-to-date information on the diagnosis, treatment, and prognosis of this disease. METHODS This article is based on relevant publications retrieved by a selective search in PubMed, along with guidelines from Germany and abroad and systematic reviews. RESULTS Cystic fibrosis is caused by a gene mutation leading to dysfunction of the cystic fibrosis transmembrane conductance regulator (CFTR) protein. It affects multiple organ systems-the lungs, pancreas, upper airways, liver, intestine, and reproductive organs-to varying degrees. Its incidence among newborn babies in Germany is between 1 in 3300 and 1 in 4800. Its diagnosis requires both clinical evidence (positive newborn screening, sibling[s] with cystic fibrosis, clinical signs) and the demonstration of CFTR dysfunction by an elevated chloride concentration in sweat, and/or two disease-causing mutations, and/or abnormal electrophysiological findings (nasal potential difference measurement, intestinal short-circuit current measurement). Patients should be cared for by specialized cystic fibrosis centers in close cooperation with their primary care physicians. The median life span of patients with this disease has risen steadily to the current value of 40 years. Aside from symptomatic treatment, the first mutation- specific treatments have recently become available. CONCLUSION Early diagnosis and optimized treatment prolong the lives of persons with cystic fibrosis and improve their quality of life. Causally directed treatment for all patients and their effects on the course of disease are now central issues for further research.
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Affiliation(s)
- Susanne Naehrig*
- *Joint and equal first authors
- Medizinische Klinik V (Pneumology), LMU University of Munich, Pneumology, Medizinische Klinik Innenstadt, University of Munich
| | - Cho-Ming Chao*
- *Joint and equal first authors
- Department of Pediatrics, Justus-Liebig-University Gießen
| | - Lutz Naehrlich
- Department of Pediatrics, Justus-Liebig-University Gießen
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202
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van de Laarschot LFM, Drenth JPH. Genetics and mechanisms of hepatic cystogenesis. Biochim Biophys Acta Mol Basis Dis 2017; 1864:1491-1497. [PMID: 28782656 DOI: 10.1016/j.bbadis.2017.08.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Revised: 08/02/2017] [Accepted: 08/03/2017] [Indexed: 12/20/2022]
Abstract
Polycystic liver disease (PLD) is a heterogeneous genetic condition. PKD1 and PKD2 germline mutations are found in patients with autosomal dominant polycystic kidney disease (ADPKD). Autosomal dominant polycystic liver disease (ADPLD) is associated with germline mutations in PRKCSH, SEC63, LRP5, and recently ALG8 and SEC61. GANAB mutations are found in both patient groups. Loss of heterozygosity of PLD-genes in cyst epithelium contributes to the development of hepatic cysts. A genetic interaction network is implied in hepatic cystogenesis that connects the endoplasmic glycoprotein control mechanisms and polycystin expression and localization. Wnt signalling could be the major downstream signalling pathway that results in hepatic cyst growth. PLD in ADPLD and ADPKD probably results from changes in one common final pathway that initiates cyst growth. This article is part of a Special Issue entitled: Cholangiocytes in Health and Diseaseedited by Jesus Banales, Marco Marzioni, Nicholas LaRusso and Peter Jansen.
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Affiliation(s)
| | - J P H Drenth
- Department of Gastroenterology and Hepatology, Radboudumc, Nijmegen, The Netherlands.
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203
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Abstract
Chronic pancreatitis (CP) is a progressive inflammatory disease of the pancreas. The currently available treatment of CP is aimed at controlling symptoms and managing complications. Unfortunately, no specific treatment is available to halt the progression of the disease process because the pathophysiological perturbations in CP are not well understood. In this review, we discuss various therapeutic targets and investigational agents acting on these targets. Among these, therapies modulating immune cells and those acting on pancreatic stellate cells appear promising and may translate into clinical benefit in near future. However, these experimental therapies are mostly in animal models and they do not recapitulate all aspects of human disease. Still they may be beneficial in developing effective therapeutic modalities to curb inflammation in chronic pancreatitis.
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204
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Alapati D, Morrisey EE. Gene Editing and Genetic Lung Disease. Basic Research Meets Therapeutic Application. Am J Respir Cell Mol Biol 2017; 56:283-290. [PMID: 27780343 DOI: 10.1165/rcmb.2016-0301ps] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Although our understanding of the genetics and pathology of congenital lung diseases such as surfactant protein deficiency, cystic fibrosis, and alpha-1 antitrypsin deficiency is extensive, treatment options are lacking. Because the lung is a barrier organ in direct communication with the external environment, targeted delivery of gene corrective technologies to the respiratory system via intratracheal or intranasal routes is an attractive option for therapy. CRISPR/Cas9 gene-editing technology is a promising approach to repairing or inactivating disease-causing mutations. Recent reports have provided proof of concept by using CRISPR/Cas9 to successfully repair or inactivate mutations in animal models of monogenic human diseases. Potential pulmonary applications of CRISPR/Cas9 gene editing include gene correction of monogenic diseases in pre- or postnatal lungs and ex vivo gene editing of patient-specific airway stem cells followed by autologous cell transplant. Strategies to enhance gene-editing efficiency and eliminate off-target effects by targeting pulmonary stem/progenitor cells and the assessment of short-term and long-term effects of gene editing are important considerations as the field advances. If methods continue to advance rapidly, CRISPR/Cas9-mediated gene editing may provide a novel opportunity to correct monogenic diseases of the respiratory system.
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Affiliation(s)
- Deepthi Alapati
- 1 Department of Pediatrics, Nemours, Alfred I. duPont Hospital for Children, Wilmington, Delaware.,2 Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania.,3 Cardiovascular Institute.,4 Penn Center for Pulmonary Biology
| | - Edward E Morrisey
- 3 Cardiovascular Institute.,4 Penn Center for Pulmonary Biology.,Departments of 5 Medicine and.,6 Cell and Developmental Biology, and.,7 Institute for Regenerative Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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206
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Gross O, Kashtan CE, Rheault MN, Flinter F, Savige J, Miner JH, Torra R, Ars E, Deltas C, Savva I, Perin L, Renieri A, Ariani F, Mari F, Baigent C, Judge P, Knebelman B, Heidet L, Lagas S, Blatt D, Ding J, Zhang Y, Gale DP, Prunotto M, Xue Y, Schachter AD, Morton LC, Blem J, Huang M, Liu S, Vallee S, Renault D, Schifter J, Skelding J, Gear S, Friede T, Turner AN, Lennon R. Advances and unmet needs in genetic, basic and clinical science in Alport syndrome: report from the 2015 International Workshop on Alport Syndrome. Nephrol Dial Transplant 2017; 32:916-924. [PMID: 27190345 PMCID: PMC5837236 DOI: 10.1093/ndt/gfw095] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2016] [Revised: 03/21/2016] [Accepted: 03/29/2016] [Indexed: 12/27/2022] Open
Abstract
Alport syndrome (AS) is a genetic disease characterized by haematuric glomerulopathy variably associated with hearing loss and anterior lenticonus. It is caused by mutations in the COL4A3, COL4A4 or COL4A5 genes encoding the α3α4α5(IV) collagen heterotrimer. AS is rare, but it accounts for >1% of patients receiving renal replacement therapy. Angiotensin-converting enzyme inhibition slows, but does not stop, the progression to renal failure; therefore, there is an urgent requirement to expand and intensify research towards discovering new therapeutic targets and new therapies. The 2015 International Workshop on Alport Syndrome targeted unmet needs in basic science, genetics and diagnosis, clinical research and current clinical care. In three intensive days, more than 100 international experts including physicians, geneticists, researchers from academia and industry, and patient representatives from all over the world participated in panel discussions and breakout groups. This report summarizes the most important priority areas including (i) understanding the crucial role of podocyte protection and regeneration, (ii) targeting mutations by new molecular techniques for new animal models and potential gene therapy, (iii) creating optimal interaction between nephrologists and geneticists for early diagnosis, (iv) establishing standards for mutation screening and databases, (v) improving widespread accessibility to current standards of clinical care, (vi) improving collaboration with the pharmaceutical/biotech industry to investigate new therapies, (vii) research in hearing loss as a huge unmet need in Alport patients and (viii) the need to evaluate the risk and benefit of novel (including 'repurposing') therapies on an international basis.
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Affiliation(s)
- Oliver Gross
- Clinic of Nephrology and Rheumatology, University Medicine Goettingen, Goettingen, Germany
| | - Clifford E. Kashtan
- Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Michelle N. Rheault
- Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Frances Flinter
- Department of Clinical Genetics, Guy's and St Thomas’ NHS Foundation Trust, London, UK
| | - Judith Savige
- Melbourne Health, The University of Melbourne, Parkville, VIC, Australia
| | - Jeffrey H. Miner
- Division of Nephrology, Washington University School of Medicine, St Louis, MO, USA
| | - Roser Torra
- Inherited Kidney Diseases, Nephrology Department, Fundació Puigvert, IIB Sant Pau, Universitat Autònoma de Barcelona and REDINREN, Barcelona, Spain
| | - Elisabet Ars
- Inherited Kidney Diseases, Nephrology Department, Fundació Puigvert, IIB Sant Pau, Universitat Autònoma de Barcelona and REDINREN, Barcelona, Spain
| | - Constantinos Deltas
- Molecular Medicine Research Center, Department of Biological Sciences, University of Cyprus, Nicosia, Cyprus
| | - Isavella Savva
- Molecular Medicine Research Center, Department of Biological Sciences, University of Cyprus, Nicosia, Cyprus
| | - Laura Perin
- University of Southern California, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Alessandra Renieri
- Medical Genetics Unit, University of Siena, Siena, Italy
- Genetica Medica, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Francesca Ariani
- Medical Genetics Unit, University of Siena, Siena, Italy
- Genetica Medica, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Francesca Mari
- Medical Genetics Unit, University of Siena, Siena, Italy
- Genetica Medica, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Colin Baigent
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Parminder Judge
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Bertrand Knebelman
- Division de Néphrologie, Hôpital Necker, Assistance Publique-Hôpitaux de Paris, Paris, France
- Université Paris Descartes, Paris, France
| | - Laurence Heidet
- Centre de Référence des Maladies Rénales Héréditaires de l'Enfant et de l'Adulte (MARHEA) Service de Néphrologie Pédiatrique, Clinique Maurice Lamy, Hôpital Necker-Enfants Malades, Paris, France
| | | | - Dave Blatt
- Alport Foundation of Australia, Valentine, NSW, Australia
| | - Jie Ding
- Pediatric Department, Peking University First Hospital, Beijing, China
| | - Yanqin Zhang
- Pediatric Department, Peking University First Hospital, Beijing, China
| | - Daniel P. Gale
- University College London-Centre for Nephrology, London, UK
| | - Marco Prunotto
- Roche Innovation Center Basel, F. Hoffmann-La Roche Ltd, Roche Pharma Research & Early Development, Basel, Switzerland
| | - Yong Xue
- Rare Disease Group-Therapeutic Area, Global Clinical Development, Sanofi Genzyme, Naarden, The Netherlands
| | - Asher D. Schachter
- New Indications Discovery Unit, Translational Medicine, Novartis Institutes for BioMedical Research, Cambridge, MA, USA
| | - Lori C.G. Morton
- Cardiovascular Research, Fibrosis Research, Regeneron Pharmaceuticals, Tarrytown, NY, USA
| | - Jacqui Blem
- Clinical Development, Regulus Therapeutics, San Diego, CA, USA
| | - Michael Huang
- Clinical Development, Regulus Therapeutics, San Diego, CA, USA
| | - Shiguang Liu
- Department of Rare Diseases, Sanofi-Genzyme R&D Center, Framingham, MA, USA
| | | | - Daniel Renault
- Association for Information and Research on Genetic Renal Diseases (AIRG)—France, Paris, France
- Federation of European Associations of patients affected by Genetic Renal Diseases, FEDERG, Brussels, Belgium
| | | | | | | | - Tim Friede
- Department of Medical Statistics, University Medical Center Goettingen, Goettingen, Germany
| | - A. Neil Turner
- Renal Medicine, Royal Infirmary, University of Edinburgh, Edinburgh, UK
| | - Rachel Lennon
- Wellcome Trust Centre for Cell-Matrix Research, Faculty of Life Sciences, University of Manchester, Manchester, UK
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207
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Fajac I, Wainwright CE. New treatments targeting the basic defects in cystic fibrosis. Presse Med 2017; 46:e165-e175. [PMID: 28554723 DOI: 10.1016/j.lpm.2017.01.024] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Revised: 12/13/2016] [Accepted: 01/05/2017] [Indexed: 01/22/2023] Open
Abstract
Cystic fibrosis (CF) is a monogenic autosomal recessive disorder affecting around 75,000 individuals worldwide. It is a multi-system disease but the main morbidity and mortality is caused by chronic lung disease. Due to newborn screening, a multidisciplinary approach to care and intensive symptomatic treatment, the prognosis has dramatically improved over the last decades and there are currently more adults than children in many countries. However, CF is still a very severe disease with a current median age of life expectancy in the fourth decade of life. The disease is caused by mutations in the cystic fibrosis transmembrane conductance regulator (CFTR) gene which encodes the CFTR protein, a protein kinase A-activated ATP-gated anion channel that regulates the transport of electrolytes such as chloride and bicarbonate. More than 2000 mutations have been reported, although not all of these have functional consequences. An enormous research effort and progress has been made in understanding the consequences of these mutations on the CFTR protein structure and function, and this has led to the approval of two new drug therapies that are able to bind to defective CFTR proteins and partially restore their function. They are mutation-specific therapies and available at present for specific mutations only. They are the first personalized medicine for CF with a possible disease-modifying effect. A pipeline of other compounds is under development with different mechanisms of action. It is foreseeable that new combinations of compounds will further improve the correction of CFTR function. Other strategies including premature stop codon read-through drugs, antisense oligonucleotides that correct the basic defect at the mRNA level or gene editing to restore the defective gene as well as gene therapy approaches are all in the pipeline. All these strategies are needed to develop disease-modifying therapies for all patients with CF.
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Affiliation(s)
- Isabelle Fajac
- Université Paris Descartes, Sorbonne Paris Cité, site Cochin, 24, rue du Faubourg-Saint-Jacques, 75014 Paris, France; AP-HP, hôpital Cochin, service de physiologie et explorations fonctionnelles,27, rue du Faubourg-Saint-Jacques, 75014 Paris, France.
| | - Claire E Wainwright
- University of Queensland, St Lucia Queensland 4072,Brisbane, Australia; Lady Cilento Children's Hospital, 501 Stanley St, 4101 Brisbane, QLD, Australia
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208
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Reznikov LR. Cystic Fibrosis and the Nervous System. Chest 2017; 151:1147-1155. [PMID: 27876591 PMCID: PMC5472519 DOI: 10.1016/j.chest.2016.11.009] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Revised: 10/13/2016] [Accepted: 11/02/2016] [Indexed: 12/31/2022] Open
Abstract
Cystic fibrosis (CF) is a life-shortening autosomal recessive disorder caused by mutations in the gene encoding the cystic fibrosis transmembrane conductance regulator (CFTR). CFTR is an anion channel that conducts bicarbonate and chloride across cell membranes. Although defective anion transport across epithelial cells is accepted as the basic defect in CF, many of the features observed in people with CF and organs affected by CF are modulated by the nervous system. This is of interest because CFTR expression has been reported in both the peripheral and central nervous systems, and it is well known that the transport of anions, such as chloride, greatly modulates neuronal excitability. Thus it is predicted that in CF, lack of CFTR in the nervous system affects neuronal function. Consistent with this prediction, several nervous system abnormalities and nervous system disorders have been described in people with CF and in animal models of CF. The goal of this special feature article is to highlight the expression and function of CFTR in the nervous system. Special emphasis is placed on nervous system abnormalities described in people with CF and in animal models of CF. Finally, features of CF that may be modulated by or attributed to faulty nervous system function are discussed.
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Affiliation(s)
- Leah R Reznikov
- Department of Physiological Sciences, University of Florida, College of Veterinary Medicine, Gainesville, FL.
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209
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Solomon GM, Liu B, Sermet-Gaudelus I, Fajac I, Wilschanski M, Vermeulen F, Rowe SM. A multiple reader scoring system for Nasal Potential Difference parameters. J Cyst Fibros 2017; 16:573-578. [PMID: 28465124 DOI: 10.1016/j.jcf.2017.04.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Revised: 03/10/2017] [Accepted: 04/10/2017] [Indexed: 12/15/2022]
Abstract
BACKGROUND Nasal Potential Difference (NPD) is a biomarker of CFTR activity used to diagnose CF and monitor experimental therapies. Limited studies have been performed to assess agreement between expert readers of NPD interpretation using a scoring algorithm. METHODS We developed a standardized scoring algorithm for "interpretability" and "confidence" for PD (potential difference) measures, and sought to determine the degree of agreement on NPD parameters between trained readers. RESULTS There was excellent agreement for interpretability between NPD readers for CF and fair agreement for normal tracings but slight agreement of interpretability in indeterminate tracings. Amongst interpretable tracings, excellent correlation of mean scores for Ringer's Baseline PD, Δamiloride, and ΔCl-free+Isoproterenol was observed. There was slight agreement regarding confidence of the interpretable PD tracings, resulting in divergence of the Ringers and Δamiloride, and ΔCl-free+Isoproterenol PDs between "high" and "low" confidence CF tracings. CONCLUSION A multi-reader process with adjudication is important for scoring NPDs for diagnosis and in monitoring of CF clinical trials.
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Affiliation(s)
- George M Solomon
- Department of Medicine, The Gregory Fleming James Cystic Fibrosis Research Center, University of Alabama at Birmingham, Birmingham, AL, USA.
| | - Bo Liu
- Department of Medicine, The Gregory Fleming James Cystic Fibrosis Research Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Isabelle Sermet-Gaudelus
- Hôpital Necker-Enfants Malades, France; Université Paris René Descartes, Sorbonne Paris Cité, Paris, France
| | - Isabelle Fajac
- Université Paris René Descartes, Sorbonne Paris Cité, Paris, France; AP-HP, Hôpital Cochin, Service de Physiologie et Explorations Fonctionnelles, Paris, France
| | | | | | - Steven M Rowe
- Department of Medicine, The Gregory Fleming James Cystic Fibrosis Research Center, University of Alabama at Birmingham, Birmingham, AL, USA
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210
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Rafeeq MM, Murad HAS. Cystic fibrosis: current therapeutic targets and future approaches. J Transl Med 2017; 15:84. [PMID: 28449677 PMCID: PMC5408469 DOI: 10.1186/s12967-017-1193-9] [Citation(s) in RCA: 99] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Accepted: 04/23/2017] [Indexed: 01/01/2023] Open
Abstract
Objectives Study of currently approved drugs and exploration of future clinical development pipeline therapeutics for cystic fibrosis, and possible limitations in their use. Methods Extensive literature search using individual and a combination of key words related to cystic fibrosis therapeutics. Key findings Cystic fibrosis is an autosomal recessive disorder due to mutations in CFTR gene leading to abnormality of chloride channels in mucus and sweat producing cells. Respiratory system and GIT are primarily involved but eventually multiple organs are affected leading to life threatening complications. Management requires drug therapy, extensive physiotherapy and nutritional support. Previously, the focus was on symptomatic improvement and complication prevention but recently the protein rectifiers are being studied which are claimed to correct underlying structural and functional abnormalities. Some improvement is observed by the corrector drugs. Other promising approaches are gene therapy, targeting of cellular interactomes, and newer drugs for symptomatic improvement. Conclusions The treatment has a long way to go as most of the existing therapeutics is for older children. Other limiting factors include mutation class, genetic profile, drug interactions, adverse effects, and cost. Novel approaches like gene transfer/gene editing, disease modeling and search for alternative targets are warranted.
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Affiliation(s)
- Misbahuddin M Rafeeq
- Department of Pharmacology, Faculty of Medicine, King Abdulaziz University, Rabigh Campus, Jeddah, 21589, Saudi Arabia.
| | - Hussam Aly Sayed Murad
- Department of Pharmacology, Faculty of Medicine, King Abdulaziz University, Rabigh Campus, Jeddah, 21589, Saudi Arabia.,Department of Pharmacology, Faculty of Medicine, Ain Shams University, Cairo, 11562, Egypt
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211
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Brain-Targeted Polymers for Gene Delivery in the Treatment of Brain Diseases. Top Curr Chem (Cham) 2017; 375:48. [PMID: 28397188 DOI: 10.1007/s41061-017-0138-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Accepted: 03/27/2017] [Indexed: 10/19/2022]
Abstract
Gene therapies have become a promising strategy for treating neurological disorders, such as brain cancer and neurodegenerative diseases, with the help of molecular biology interpreting the underlying pathological mechanisms. Successful cellular manipulation against these diseases requires efficient delivery of nucleic acids into brain and further into specific neurons or cancer cells. Compared with viral vectors, non-viral polymeric carriers provide a safer and more flexible way of gene delivery, although suffering from significantly lower transfection efficiency. Researchers have been devoted to solving this defect, which is attributed to the multiple barriers existing for gene therapeutics in vivo, such as systemic degradation, blood-brain barrier, and endosome trapping. This review will be mainly focused on systemically administrated brain-targeted polymers developed so far, including PEI, dendrimers, and synthetic polymers with various functions. We will discuss in detail how they are designed to overcome these barriers and how they efficiently deliver therapeutic nucleic acids into targeted cells.
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212
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Rowbotham NJ, Smyth AR. The patient voice in research - Supporting actor or starring role? J Cyst Fibros 2017; 16:313-314. [PMID: 28285933 DOI: 10.1016/j.jcf.2017.03.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
| | - Alan R Smyth
- School of Medicine, University of Nottingham, United Kingdom.
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213
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Villate-Beitia I, Zarate J, Puras G, Pedraz JL. Gene delivery to the lungs: pulmonary gene therapy for cystic fibrosis. Drug Dev Ind Pharm 2017; 43:1071-1081. [PMID: 28270008 DOI: 10.1080/03639045.2017.1298122] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Cystic fibrosis (CF) is a monogenic autosomal recessive disorder where the defective gene, the cystic fibrosis transmembrane conductance regulator (CFTR), is well identified. Moreover, the respiratory tract can be targeted through noninvasive aerosolized formulations for inhalation. Therefore, gene therapy is considered a plausible strategy to address this disease. Conventional gene therapy strategies rely on the addition of a correct copy of the CFTR gene into affected cells in order to restore the channel activity. In recent years, genome correction strategies have emerged, such as zinc-finger nucleases, transcription activator-like effector nucleases and clustered regularly interspaced short palindromic repeats associated to Cas9 nucleases. These gene editing tools aim to repair the mutated gene at its original genomic locus with high specificity. Besides, the success of gene therapy critically depends on the nucleic acids carriers. To date, several clinical studies have been carried out to add corrected copies of the CFTR gene into target cells using viral and non-viral vectors, some of them with encouraging results. Regarding genome editing systems, preliminary in vitro studies have been performed in order to repair the CFTR gene. In this review, after briefly introducing the basis of CF, we discuss the up-to-date gene therapy strategies to address the disease. The review focuses on the main factors to take into consideration when developing gene delivery strategies, such as the design of vectors and plasmid DNA, in vitro/in vivo tests, translation to human use, administration methods, manufacturing conditions and regulatory issues.
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Affiliation(s)
- Ilia Villate-Beitia
- a NanoBioCel Group, University of the Basque Country (UPV/EHU) , Vitoria-Gasteiz , Spain.,b Biomedical Research Networking Center in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN) , Vitoria-Gasteiz , Spain
| | - Jon Zarate
- a NanoBioCel Group, University of the Basque Country (UPV/EHU) , Vitoria-Gasteiz , Spain.,b Biomedical Research Networking Center in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN) , Vitoria-Gasteiz , Spain
| | - Gustavo Puras
- a NanoBioCel Group, University of the Basque Country (UPV/EHU) , Vitoria-Gasteiz , Spain.,b Biomedical Research Networking Center in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN) , Vitoria-Gasteiz , Spain
| | - José Luis Pedraz
- a NanoBioCel Group, University of the Basque Country (UPV/EHU) , Vitoria-Gasteiz , Spain.,b Biomedical Research Networking Center in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN) , Vitoria-Gasteiz , Spain
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214
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Perry LA, Penny-Dimri JC, Aslam AA, Lee TW, Southern KW. Topical cystic fibrosis transmembrane conductance regulator gene replacement for cystic fibrosis-related lung disease. Paediatr Respir Rev 2017; 22:47-49. [PMID: 27964951 DOI: 10.1016/j.prrv.2016.10.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Accepted: 10/19/2016] [Indexed: 11/29/2022]
Affiliation(s)
- L A Perry
- Monash University, Melbourne, Australia.
| | - J C Penny-Dimri
- Department of Surgery, Monash University, Melbourne, Australia
| | - A A Aslam
- Department of Women's and Children's Health, University of Liverpool, Liverpool, UK
| | - T W Lee
- Leeds Regional Paediatric Cystic Fibrosis Centre, A Floor, Clarendon Wing, Leeds General Infirmary, Leeds, UK
| | - K W Southern
- Department of Women's and Children's Health, University of Liverpool, Liverpool, UK
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215
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Betker JL, Anchordoquy TJ. Nonadditive Effects of Repetitive Administration of Lipoplexes in Immunocompetent Mice. J Pharm Sci 2017; 106:872-881. [PMID: 27887890 PMCID: PMC5657239 DOI: 10.1016/j.xphs.2016.11.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Revised: 11/11/2016] [Accepted: 11/15/2016] [Indexed: 01/01/2023]
Abstract
Repetitive administration is routinely used to maintain therapeutic drug levels, but previous studies have documented an accelerated blood clearance of some lipid-based delivery systems under these conditions. To assess the effect of repetitive administration, non-PEGylated lipoplexes (+/-0.5) were administered 4 times via tail vein injection at 3-day intervals to immunocompetent BALB/c mice bearing 4T1 tumors. This study measured the effect of repeat administration of nontargeted lipoplexes on clearance, cytokine/chemokine response, plasmid distribution, reporter gene expression, and liver toxicity. We do not observe a refractory period or a statistically significant difference in blood clearance between the first administration and subsequent injections of this lipoplex formulation, consistent with the absence of a cytokine/chemokine response. However, we do see a significant effect on both plasmid accumulation and expression, an enhancement of 26-fold and 10-fold in tumor plasmid levels and expression, respectively, after 4 injections as compared to that after a single injection. In addition, in vivo imaging suggests that expression in other organs had diminished rapidly 72 h after each administration, in contrast to relatively constant expression in the tumor. Taken together, the findings indicate that gene delivery to tumors can be dramatically enhanced by employing repetitive administration.
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Affiliation(s)
- Jamie L Betker
- Department of Pharmaceutical Sciences, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado, Aurora, Colorado 80045
| | - Thomas J Anchordoquy
- Department of Pharmaceutical Sciences, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado, Aurora, Colorado 80045.
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216
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Lucarelli M. New era of cystic fibrosis: Full mutational analysis and personalized therapy. World J Med Genet 2017; 7:1-9. [DOI: 10.5496/wjmg.v7.i1.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Revised: 12/19/2016] [Accepted: 02/21/2017] [Indexed: 02/07/2023] Open
Abstract
Despite its apparently simple genetics, cystic fibrosis (CF) is a rather complex genetic disease. A lot of variability in the steps of the path from the cystic fibrosis transmembrane conductance regulator (CFTR) gene to the clinical manifestations originates an uncertain genotype - phenotype relationship. A major determinant of this uncertainty is the incomplete knowledge of the CFTR mutated genotypes, due to the high number of CFTR mutations and to the higher number of their combinations in trans and in cis. Also the very limited knowledge of functional effects of CFTR mutated alleles severely impairs our diagnostic and prognostic ability. The final phenotypic modulation exerted by CFTR modifier genes and interactome further complicates the framework. The next generation sequencing approach is a rapid, low-cost and high-throughput tool that allows a near complete structural characterization of CFTR mutated genotypes, as well as of genotypes of several other genes cooperating to the final CF clinical manifestations. This powerful method perfectly complements the new personalized therapeutic approach for CF. Drugs active on specific CFTR mutational classes are already available for CF patients or are in phase 3 trials. A complete genetic characterization has been becoming crucial for a correct personalized therapy. However, the need of a functional classification of each CFTR mutation potently arises. Future big efforts towards an ever more detailed knowledge of both structural and functional CFTR defects, coupled to parallel personalized therapeutic interventions decisive for CF cure can be foreseen.
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Affiliation(s)
- Marco Lucarelli
- Department of Cellular Biotechnologies and Hematology, Sapienza University of Rome, Laboratory affiliated to Istituto Pasteur Italia - Fondazione Cenci Bolognetti, 00161 Rome, Italy
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217
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Downey GP, Aschner Y. Taking It Off: New Insights into the Role of Tyrosine Phosphorylation-dependent Pathways in the Pathogenesis of Pulmonary Fibrosis. Am J Respir Crit Care Med 2017; 195:418-420. [PMID: 28199155 DOI: 10.1164/rccm.201609-1921ed] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Gregory P Downey
- 1 Department of Medicine National Jewish Health Denver, Colorado.,2 Department of Pediatrics National Jewish Health Denver, Colorado.,3 Department of Biomedical Research National Jewish Health Denver, Colorado.,4 Department of Medicine University of Colorado Denver Aurora, Colorado.,5 Department of Immunology and Microbiology University of Colorado Denver Aurora, Colorado and
| | - Yael Aschner
- 6 Department of Medicine University of Colorado Denver Aurora, Colorado
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218
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Hegde RN, Subramanian A, Pothukuchi P, Parashuraman S, Luini A. Rare ER protein misfolding-mistrafficking disorders: Therapeutic developments. Tissue Cell 2017; 49:175-185. [PMID: 28222887 DOI: 10.1016/j.tice.2017.02.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Revised: 02/02/2017] [Accepted: 02/04/2017] [Indexed: 12/16/2022]
Abstract
The presence of a functional protein at the appropriate location in the cell is the result of the processes of transcription, translation, folding and trafficking to the correct destination. There are numerous diseases that are caused by protein misfolding, mainly due to mutations in the respective gene. The consequences of this misfolding may be that proteins effectively lose their function, either by being removed by the cellular quality control machinery or by accumulating at the incorrect intracellular or extracellular location. A number of mutations that lead to protein misfolding and affect trafficking to the final destination, e.g. Cystic fibrosis, Wilson's disease, and Progressive Familial Intrahepatic 1 cholestasis, result in proteins that retain partial function if their folding and trafficking is restored either by molecular or pharmacological means. In this review, we discuss several mutant proteins within this class of misfolding diseases and provide an update on the status of molecular and therapeutic developments and potential therapeutic strategies being developed to counter these diseases.
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Affiliation(s)
| | - Advait Subramanian
- Institute of Protein Biochemistry, National Research Council, Naples, Italy
| | | | | | - Alberto Luini
- Institute of Protein Biochemistry, National Research Council, Naples, Italy; Istituto di Ricovero e Cura a Carattere Scientifico SDN, Naples, Italy
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219
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Mondejar-Lopez P, Pastor-Vivero MD, Sanchez-Solis M, Escribano A. Cystic fibrosis treatment: targeting the basic defect. Expert Opin Orphan Drugs 2017. [DOI: 10.1080/21678707.2017.1280390] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
| | | | - Manuel Sanchez-Solis
- Cystic Fibrosis Unit, Virgen de la Arrixaca University Hospital, Murcia, Spain
- IMIB Bio-Research Institute, Murcia, Spain
| | - Amparo Escribano
- Pediatric Pulmonology and Cystic Fibrosis Unit, Clinic University Hospital, Valencia, Spain
- University of Valencia, Valencia, Spain
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220
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Nanotechnologies in delivery of mRNA therapeutics using nonviral vector-based delivery systems. Gene Ther 2017; 24:133-143. [DOI: 10.1038/gt.2017.5] [Citation(s) in RCA: 207] [Impact Index Per Article: 29.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Revised: 10/28/2016] [Accepted: 01/03/2017] [Indexed: 12/13/2022]
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221
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Castellani C, Assael BM. Cystic fibrosis: a clinical view. Cell Mol Life Sci 2017; 74:129-140. [PMID: 27709245 PMCID: PMC11107741 DOI: 10.1007/s00018-016-2393-9] [Citation(s) in RCA: 141] [Impact Index Per Article: 20.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Accepted: 09/28/2016] [Indexed: 02/07/2023]
Abstract
Cystic fibrosis (CF), a monogenic disease caused by mutations in the CFTR gene on chromosome 7, is complex and greatly variable in clinical expression. Airways, pancreas, male genital system, intestine, liver, bone, and kidney are involved. The lack of CFTR or its impaired function causes fat malabsorption and chronic pulmonary infections leading to bronchiectasis and progressive lung damage. Previously considered lethal in infancy and childhood, CF has now attained median survivals of 50 years of age, mainly thanks to the early diagnosis through neonatal screening, recognition of mild forms, and an aggressive therapeutic attitude. Classical treatment includes pancreatic enzyme replacement, respiratory physiotherapy, mucolitics, and aggressive antibiotic therapy. A significant proportion of patients with severe symptoms still requires lung or, less frequently, liver transplantation. The great number of mutations and their diverse effects on the CFTR protein account only partially for CF clinical variability, and modifier genes have a role in modulating the clinical expression of the disease. Despite the increasing understanding of CFTR functioning, several aspects of CF need still to be clarified, e.g., the worse outcome in females, the risk of malignancies, the pathophysiology, and best treatment of comorbidities, such as CF-related diabetes or CF-related bone disorder. Research is focusing on new drugs restoring CFTR function, some already available and with good clinical impact, others showing promising preliminary results that need to be confirmed in phase III clinical trials.
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Affiliation(s)
- Carlo Castellani
- Verona Cystic Fibrosis Centre, Piazzale Stefani 1, 37126, Verona, Italy.
| | - Baroukh M Assael
- Adult Cystic Fibrosis Center, Via Francesco Sforza, 20100, Milano, Italy
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222
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Abstract
Cystic fibrosis is an inherited multi-system disease associated with chronic lung infection, malabsorption, salt loss syndromes, male infertility and leading to numerous comorbidities. The landscape in cystic fibrosis care has changed markedly with currently more adult patients than children in many countries. Over 2000 different mutations in the CFTR gene have been reported and the majority are extremely rare. Understanding how CFTR mutations translate to disturbed synthesis or function of the CFTR protein has opened the way to 'personalized' treatments to correct the basic defect. The first 2 drugs have reached the clinic: a CFTR potentiator to augment CFTR channel function, and the combination of this potentiator with a corrector to increase CFTR expression at the cell membrane. To obtain robust correction of CFTR expression at the cell membrane, combinations of correctors with additive efficacy are under investigation. Other mutation type-specific treatments under clinical investigation are premature stop codon-read through drugs and antisense oligonucleotides that correct the basic defect at the mRNA level. Restoring the defective gene by gene editing can already be achieved ex vivo. Mutation agnostic treatments are explored as well: stabilizing CFTR expression at the cell membrane, circumventing the CFTR channel by blocking or activating other ion channels, and gene therapy. Combinations of these therapies can be anticipated. The pipeline of corrective strategies under clinical investigation is increasing continuously and a rising number of pharmaceutical companies are entering the field.
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Affiliation(s)
- Isabelle Fajac
- Université Paris Descartes, Sorbonne Paris Cité, Paris, France; AP-HP, Hôpital Cochin, Service de Physiologie et Explorations Fonctionnelles, Paris, France.
| | - Kris De Boeck
- University Hospital Gasthuisberg, Department of Pediatric Pulmonology, University of Leuven, Belgium.
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223
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Berchel M, Lozach O, Berthe W, Hernot S, Couthon-Gourvès H, Mottais A, Le Gall T, Midoux P, Montier T, Jaffrès PA. Synthetic phospholipids and phospho-bola-amphiphiles for nucleic acid delivery. PHOSPHORUS SULFUR 2016. [DOI: 10.1080/10426507.2016.1212049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- M. Berchel
- CEMCA, UMR CNRS 6521, Université de Brest, IBSAM, Brest, France
| | - O. Lozach
- CEMCA, UMR CNRS 6521, Université de Brest, IBSAM, Brest, France
| | - W. Berthe
- CEMCA, UMR CNRS 6521, Université de Brest, IBSAM, Brest, France
| | - S. Hernot
- CEMCA, UMR CNRS 6521, Université de Brest, IBSAM, Brest, France
| | | | - A. Mottais
- U INSERM 1078, CHRU de Brest Hôpital Morvan, Faculté de Médecine, Université de Brest, Brest, France
| | - T. Le Gall
- U INSERM 1078, CHRU de Brest Hôpital Morvan, Faculté de Médecine, Université de Brest, Brest, France
| | - P. Midoux
- Centre de Biophysique Moléculaire, Orléans cedex 2, France
| | - T. Montier
- U INSERM 1078, CHRU de Brest Hôpital Morvan, Faculté de Médecine, Université de Brest, Brest, France
| | - P. A. Jaffrès
- CEMCA, UMR CNRS 6521, Université de Brest, IBSAM, Brest, France
- Centre de Biophysique Moléculaire, Orléans cedex 2, France
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224
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Bui S, Macey J, Fayon M, Bihouée T, Burgel PR, Colomb V, Corvol H, Durieu I, Hubert D, Marguet C, Mas E, Munck A, Murris-Espin M, Reix P, Sermet-Gaudelus I. Nouvelles thérapeutiques ciblant le canal chlorure dans la mucoviscidose. Arch Pediatr 2016; 23:12S47-12S53. [PMID: 28231894 DOI: 10.1016/s0929-693x(17)30062-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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225
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Mukoviszidose. MED GENET-BERLIN 2016. [DOI: 10.1007/s11825-016-0105-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Zusammenfassung
Die Mukoviszidose gehört mit einer Inzidenz von etwa 1:3300 bis 1:4800 Neugeborenen zu den häufigsten autosomal-rezessiv erblichen Erkrankungen in Deutschland und ist mit einer hohen Morbidität und Mortalität assoziiert. Um die möglichst frühzeitige Einleitung einer Therapie zu ermöglichen, wurde mit der am 1. September 2016 in Kraft getretenen Novellierung der Richtlinie über die Früherkennung von Krankheiten bei Kindern bis zur Vollendung des 6. Lebensjahres durch den Gemeinsamen Bundesausschuss die Einführung eines Screenings auf Mukoviszidose im Neugeborenenalter beschlossen. Ferner konnte durch interdisziplinäre Behandlungskonzepte u. a. in spezialisierten Mukoviszidosezentren die Lebenserwartung in den letzten Jahrzehnten deutlich gesteigert werden. Mit der Entwicklung und zunehmenden Markteinführung mutationsspezifischer Therapien besteht erstmals die Möglichkeit, direkt in die Pathophysiologie der Mukoviszidose einzugreifen.
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226
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Abstract
Cystic fibrosis is a common life-limiting autosomal recessive genetic disorder, with highest prevalence in Europe, North America, and Australia. The disease is caused by mutation of a gene that encodes a chloride-conducting transmembrane channel called the cystic fibrosis transmembrane conductance regulator (CFTR), which regulates anion transport and mucociliary clearance in the airways. Functional failure of CFTR results in mucus retention and chronic infection and subsequently in local airway inflammation that is harmful to the lungs. CFTR dysfunction mainly affects epithelial cells, although there is evidence of a role in immune cells. Cystic fibrosis affects several body systems, and morbidity and mortality is mostly caused by bronchiectasis, small airways obstruction, and progressive respiratory impairment. Important comorbidities caused by epithelial cell dysfunction occur in the pancreas (malabsorption), liver (biliary cirrhosis), sweat glands (heat shock), and vas deferens (infertility). The development and delivery of drugs that improve the clearance of mucus from the lungs and treat the consequent infection, in combination with correction of pancreatic insufficiency and undernutrition by multidisciplinary teams, have resulted in remarkable improvements in quality of life and clinical outcomes in patients with cystic fibrosis, with median life expectancy now older than 40 years. Innovative and transformational therapies that target the basic defect in cystic fibrosis have recently been developed and are effective in improving lung function and reducing pulmonary exacerbations. Further small molecule and gene-based therapies are being developed to restore CFTR function; these therapies promise to be disease modifying and to improve the lives of people with cystic fibrosis.
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Affiliation(s)
- J Stuart Elborn
- School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, and Belfast City Hospital, Belfast, UK.
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227
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Alton EWFW, Beekman JM, Boyd AC, Brand J, Carlon MS, Connolly MM, Chan M, Conlon S, Davidson HE, Davies JC, Davies LA, Dekkers JF, Doherty A, Gea-Sorli S, Gill DR, Griesenbach U, Hasegawa M, Higgins TE, Hironaka T, Hyndman L, McLachlan G, Inoue M, Hyde SC, Innes JA, Maher TM, Moran C, Meng C, Paul-Smith MC, Pringle IA, Pytel KM, Rodriguez-Martinez A, Schmidt AC, Stevenson BJ, Sumner-Jones SG, Toshner R, Tsugumine S, Wasowicz MW, Zhu J. Preparation for a first-in-man lentivirus trial in patients with cystic fibrosis. Thorax 2016; 72:137-147. [PMID: 27852956 PMCID: PMC5284333 DOI: 10.1136/thoraxjnl-2016-208406] [Citation(s) in RCA: 99] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Revised: 06/21/2016] [Accepted: 06/28/2016] [Indexed: 01/03/2023]
Abstract
We have recently shown that non-viral gene therapy can stabilise the decline of lung function in patients with cystic fibrosis (CF). However, the effect was modest, and more potent gene transfer agents are still required. Fuson protein (F)/Hemagglutinin/Neuraminidase protein (HN)-pseudotyped lentiviral vectors are more efficient for lung gene transfer than non-viral vectors in preclinical models. In preparation for a first-in-man CF trial using the lentiviral vector, we have undertaken key translational preclinical studies. Regulatory-compliant vectors carrying a range of promoter/enhancer elements were assessed in mice and human air–liquid interface (ALI) cultures to select the lead candidate; cystic fibrosis transmembrane conductance receptor (CFTR) expression and function were assessed in CF models using this lead candidate vector. Toxicity was assessed and ‘benchmarked’ against the leading non-viral formulation recently used in a Phase IIb clinical trial. Integration site profiles were mapped and transduction efficiency determined to inform clinical trial dose-ranging. The impact of pre-existing and acquired immunity against the vector and vector stability in several clinically relevant delivery devices was assessed. A hybrid promoter hybrid cytosine guanine dinucleotide (CpG)- free CMV enhancer/elongation factor 1 alpha promoter (hCEF) consisting of the elongation factor 1α promoter and the cytomegalovirus enhancer was most efficacious in both murine lungs and human ALI cultures (both at least 2-log orders above background). The efficacy (at least 14% of airway cells transduced), toxicity and integration site profile supports further progression towards clinical trial and pre-existing and acquired immune responses do not interfere with vector efficacy. The lead rSIV.F/HN candidate expresses functional CFTR and the vector retains 90–100% transduction efficiency in clinically relevant delivery devices. The data support the progression of the F/HN-pseudotyped lentiviral vector into a first-in-man CF trial in 2017.
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Affiliation(s)
- Eric W F W Alton
- Department of Gene Therapy, National Heart and Lung Institute, Imperial College London, London, UK.,UK Cystic Fibrosis Gene Therapy Consortium, Oxford, UK
| | - Jeffery M Beekman
- Department of Pediatric Pulmonology, Laboratory of Translational Immunology, Wilhelmina Children's Hospital, University Medical Centre, Utrecht, The Netherlands
| | - A Christopher Boyd
- Centre for Genomic and Experimental Medicine, IGMM, University of Edinburgh, Edinburgh, UK.,UK Cystic Fibrosis Gene Therapy Consortium, Oxford, UK
| | - June Brand
- Centre for Genomic and Experimental Medicine, IGMM, University of Edinburgh, Edinburgh, UK.,Lung Pathology Unit, Department of Airway Disease Infection, NHLI, Imperial College London, London, UK
| | - Marianne S Carlon
- Laboratory for Molecular Virology and Gene Therapy, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Brussels, Belgium
| | - Mary M Connolly
- UK Cystic Fibrosis Gene Therapy Consortium, Oxford, UK.,Gene Medicine Research Group, NDCLS, John Radcliffe Hospital, Oxford, UK
| | - Mario Chan
- Department of Gene Therapy, National Heart and Lung Institute, Imperial College London, London, UK.,UK Cystic Fibrosis Gene Therapy Consortium, Oxford, UK
| | - Sinead Conlon
- Department of Gene Therapy, National Heart and Lung Institute, Imperial College London, London, UK.,UK Cystic Fibrosis Gene Therapy Consortium, Oxford, UK
| | - Heather E Davidson
- UK Cystic Fibrosis Gene Therapy Consortium, Oxford, UK.,Centre for Genomic and Experimental Medicine, IGMM, University of Edinburgh, Edinburgh, UK
| | - Jane C Davies
- Department of Gene Therapy, National Heart and Lung Institute, Imperial College London, London, UK.,UK Cystic Fibrosis Gene Therapy Consortium, Oxford, UK
| | - Lee A Davies
- UK Cystic Fibrosis Gene Therapy Consortium, Oxford, UK.,Gene Medicine Research Group, NDCLS, John Radcliffe Hospital, Oxford, UK
| | - Johanna F Dekkers
- Department of Pediatric Pulmonology, Laboratory of Translational Immunology, Wilhelmina Children's Hospital, University Medical Centre, Utrecht, The Netherlands
| | - Ann Doherty
- UK Cystic Fibrosis Gene Therapy Consortium, Oxford, UK.,Centre for Genomic and Experimental Medicine, IGMM, University of Edinburgh, Edinburgh, UK
| | - Sabrina Gea-Sorli
- Department of Gene Therapy, National Heart and Lung Institute, Imperial College London, London, UK.,UK Cystic Fibrosis Gene Therapy Consortium, Oxford, UK
| | - Deborah R Gill
- UK Cystic Fibrosis Gene Therapy Consortium, Oxford, UK.,Gene Medicine Research Group, NDCLS, John Radcliffe Hospital, Oxford, UK
| | - Uta Griesenbach
- Department of Gene Therapy, National Heart and Lung Institute, Imperial College London, London, UK.,UK Cystic Fibrosis Gene Therapy Consortium, Oxford, UK
| | | | - Tracy E Higgins
- Department of Gene Therapy, National Heart and Lung Institute, Imperial College London, London, UK.,UK Cystic Fibrosis Gene Therapy Consortium, Oxford, UK
| | | | - Laura Hyndman
- UK Cystic Fibrosis Gene Therapy Consortium, Oxford, UK.,Centre for Genomic and Experimental Medicine, IGMM, University of Edinburgh, Edinburgh, UK
| | - Gerry McLachlan
- UK Cystic Fibrosis Gene Therapy Consortium, Oxford, UK.,Roslin Institute & R(D)SVS, University of Edinburgh, Midlothian, UK
| | - Makoto Inoue
- ID Pharme Co. Ltd. (DNAVEC Center), Tsukuba, Japan
| | - Stephen C Hyde
- UK Cystic Fibrosis Gene Therapy Consortium, Oxford, UK.,Gene Medicine Research Group, NDCLS, John Radcliffe Hospital, Oxford, UK
| | - J Alastair Innes
- UK Cystic Fibrosis Gene Therapy Consortium, Oxford, UK.,Centre for Genomic and Experimental Medicine, IGMM, University of Edinburgh, Edinburgh, UK
| | - Toby M Maher
- Fibrosis Research Group, Inflammation, Repair & Development Section, National Heart and Lung Institute, Sir Alexander Fleming Building, Imperial College, London, UK
| | - Caroline Moran
- Department of Gene Therapy, National Heart and Lung Institute, Imperial College London, London, UK.,UK Cystic Fibrosis Gene Therapy Consortium, Oxford, UK
| | - Cuixiang Meng
- Department of Gene Therapy, National Heart and Lung Institute, Imperial College London, London, UK.,UK Cystic Fibrosis Gene Therapy Consortium, Oxford, UK
| | - Michael C Paul-Smith
- Department of Gene Therapy, National Heart and Lung Institute, Imperial College London, London, UK.,UK Cystic Fibrosis Gene Therapy Consortium, Oxford, UK
| | - Ian A Pringle
- UK Cystic Fibrosis Gene Therapy Consortium, Oxford, UK.,Gene Medicine Research Group, NDCLS, John Radcliffe Hospital, Oxford, UK
| | - Kamila M Pytel
- Department of Gene Therapy, National Heart and Lung Institute, Imperial College London, London, UK.,UK Cystic Fibrosis Gene Therapy Consortium, Oxford, UK
| | - Andrea Rodriguez-Martinez
- Department of Gene Therapy, National Heart and Lung Institute, Imperial College London, London, UK.,UK Cystic Fibrosis Gene Therapy Consortium, Oxford, UK
| | | | - Barbara J Stevenson
- UK Cystic Fibrosis Gene Therapy Consortium, Oxford, UK.,Centre for Genomic and Experimental Medicine, IGMM, University of Edinburgh, Edinburgh, UK
| | - Stephanie G Sumner-Jones
- UK Cystic Fibrosis Gene Therapy Consortium, Oxford, UK.,Gene Medicine Research Group, NDCLS, John Radcliffe Hospital, Oxford, UK
| | - Richard Toshner
- Fibrosis Research Group, Inflammation, Repair & Development Section, National Heart and Lung Institute, Sir Alexander Fleming Building, Imperial College, London, UK
| | | | - Marguerite W Wasowicz
- Department of Gene Therapy, National Heart and Lung Institute, Imperial College London, London, UK.,UK Cystic Fibrosis Gene Therapy Consortium, Oxford, UK
| | - Jie Zhu
- Lung Pathology Unit, Department of Airway Disease Infection, NHLI, Imperial College London, London, UK
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228
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Vassaux G, Angelova A, Baril P, Midoux P, Rommelaere J, Cordelier P. The Promise of Gene Therapy for Pancreatic Cancer. Hum Gene Ther 2016; 27:127-33. [PMID: 26603492 DOI: 10.1089/hum.2015.141] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Unlike for other digestive cancer entities, chemotherapy, radiotherapy, and targeted therapies have, so far, largely failed to improve patient survival in pancreatic adenocarcinoma (PDAC), which remains the fourth leading cause of cancer-related death in Europe and the United States. In this context, gene therapy may offer a new avenue for patients with PDAC. In this review, we explore the research currently ongoing in French laboratories aimed at defeating PDAC using nonviral therapeutic gene delivery, targeted transgene expression, or oncolytic virotherapy that recently or will soon bridge the gap between experimental models of cancer and clinical trials. These studies are likely to change clinical practice or thinking about PDAC management, as they represent a major advance not only for PDAC but may also significantly influence the field of gene-based molecular treatment of cancer.
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Affiliation(s)
- Georges Vassaux
- 1 Université de Nice Sophia Antipolis , Nice, France .,2 Laboratoire TIRO , UMRE 4320, CEA, Nice, France
| | - Assia Angelova
- 3 German Cancer Research Center (DKFZ) , Tumor Virology/F010, Heidelberg, Germany
| | - Patrick Baril
- 4 Centre de Biophysique Moléculaire, CNRS UPR4301 and University of Orléans , Orléans, France
| | - Patrick Midoux
- 4 Centre de Biophysique Moléculaire, CNRS UPR4301 and University of Orléans , Orléans, France
| | - Jean Rommelaere
- 3 German Cancer Research Center (DKFZ) , Tumor Virology/F010, Heidelberg, Germany
| | - Pierre Cordelier
- 5 INSERM , UMR1037 CRCT, F-31000 Toulouse, France .,6 Université Toulouse III-Paul Sabatier , F-31000 Toulouse, France
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229
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Massie J, Robinson PJ, Cooper PJ. The story of cystic fibrosis 1965-2015. J Paediatr Child Health 2016; 52:991-994. [PMID: 27586437 DOI: 10.1111/jpc.13309] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 06/19/2016] [Indexed: 12/01/2022]
Abstract
There have been dramatic changes in the care of children with cystic fibrosis (CF) from 1965 to 2015. The initial improvements were the result of incremental gains in medical knowledge and better use of available therapies. Some CF-specific drugs were developed (recombinant human DNase and purified tobramycin for inhalation), but these simply delayed the progression of the lung damage. The discovery of the CF transmembrane conductance regulator gene in 1989 created an explosion of knowledge of airway biology and CF pathophysiology. Now mutation-specific therapy to potentiate mutated CF transmembrane conductance regulator is available for some patients with CF and is transforming their lives. Further advances are eagerly anticipated to benefit all patients with CF.
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Affiliation(s)
- John Massie
- Department of Respiratory and Sleep Medicine, Royal Children's Hospital, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.,Infection, Immunity and Environment Theme, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Phillip J Robinson
- Department of Respiratory and Sleep Medicine, Royal Children's Hospital, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.,Infection, Immunity and Environment Theme, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Peter J Cooper
- Department of Respiratory and Sleep Medicine, Children's Hospital at Westmead, Sydney, New South Wales, Australia
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230
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Affiliation(s)
- P. B. Persson
- Institute of Vegetative Physiology; Charité-Universitaetsmedizin Berlin; Berlin Germany
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231
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232
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Cao H, Wu J, Duan C, Du K, Lee CM, Yeger H, Hu J. Long-Term Expression of the Human CFTR Gene in Mouse Airway via Helper-Dependent Adenoviral Vector Delivery and Transient Immunosuppression. Hum Gene Ther 2016; 27:83-91. [PMID: 26710934 DOI: 10.1089/hum.2015.108] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Sustained expression of the CFTR gene is a major challenge to gene therapy with either viral or nonviral vectors with immune response to vector and transgene products. One strategy to achieve sustained CFTR expression is to modulate the host immune system through transient immunosuppression. In this study, we examined cyclophosphamide (cytoxan), dexamethasone (Dex), and a combination of cyclosporin, methylprednisolone, and azathioprine (combination) for their effects on long-term expression of the human CFTR delivered with helper-dependent adenoviral vectors in mouse airways. We found that cyclophosphamide significantly enhanced long-term expression of the transgenic human CFTR and the reporter gene LacZ by reducing host immune responses. Dex administration greatly reduced neutralizing antibody production but had no effect on transgene expression. Treatment with a combination of cyclosporin A, azathioprine, and methylprednisolone affected neither CFTR gene expression nor inflammation. Our data suggest that transient immunosuppression might be a strategy to improve sustained expression in gene therapy.
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Affiliation(s)
- Huibi Cao
- 1 Program of Physiology & Experimental Medicine, University of Toronto , Toronto, Ontario, Canada
| | - Jing Wu
- 1 Program of Physiology & Experimental Medicine, University of Toronto , Toronto, Ontario, Canada
| | - Cathleen Duan
- 1 Program of Physiology & Experimental Medicine, University of Toronto , Toronto, Ontario, Canada
| | - Kai Du
- 2 Program of Developmental & Stem Cell Biology, Hospital for Sick Children, University of Toronto , Toronto, Ontario, Canada
| | - Chan Mi Lee
- 1 Program of Physiology & Experimental Medicine, University of Toronto , Toronto, Ontario, Canada
| | - Herman Yeger
- 2 Program of Developmental & Stem Cell Biology, Hospital for Sick Children, University of Toronto , Toronto, Ontario, Canada .,3 Department of Laboratory Medicine and Pathobiology, University of Toronto , Toronto, Ontario, Canada
| | - Jim Hu
- 1 Program of Physiology & Experimental Medicine, University of Toronto , Toronto, Ontario, Canada .,3 Department of Laboratory Medicine and Pathobiology, University of Toronto , Toronto, Ontario, Canada
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233
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Alton EWFW, Boyd AC, Davies JC, Gill DR, Griesenbach U, Harrison PT, Henig N, Higgins T, Hyde SC, Innes JA, Korman MSD. Genetic medicines for CF: Hype versus reality. Pediatr Pulmonol 2016; 51:S5-S17. [PMID: 27662105 DOI: 10.1002/ppul.23543] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Revised: 06/14/2016] [Accepted: 06/15/2016] [Indexed: 12/19/2022]
Abstract
Since identification of the CFTR gene over 25 years ago, gene therapy for cystic fibrosis (CF) has been actively developed. More recently gene therapy has been joined by other forms of "genetic medicines" including mRNA delivery, as well as genome editing and mRNA repair-based strategies. Proof-of-concept that gene therapy can stabilize the progression of CF lung disease has recently been established in a Phase IIb trial. An early phase study to assess the safety and explore efficacy of CFTR mRNA repair is ongoing, while mRNA delivery and genome editing-based strategies are currently at the pre-clinical phase of development. This review has been written jointly by some of those involved in the various CF "genetic medicine" fields and will summarize the current state-of-the-art, as well as discuss future developments. Where applicable, it highlights common problems faced by each of the strategies, and also tries to highlight where a specific strategy may have an advantage on the pathway to clinical translation. We hope that this review will contribute to the ongoing discussion about the hype versus reality of genetic medicine-based treatment approaches in CF. Pediatr Pulmonol. 2016;51:S5-S17. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Eric W F W Alton
- UK Cystic Fibrosis Gene Therapy Consortium, Edinburgh, Oxford, London
| | | | - Jane C Davies
- UK Cystic Fibrosis Gene Therapy Consortium, Edinburgh, Oxford, London
| | - Deborah R Gill
- UK Cystic Fibrosis Gene Therapy Consortium, Edinburgh, Oxford, London
| | - Uta Griesenbach
- UK Cystic Fibrosis Gene Therapy Consortium, Edinburgh, Oxford, London.
| | - Patrick T Harrison
- Department of Physiology and BioSciences Institute, University College Cork, Cork, Ireland
| | | | - Tracy Higgins
- UK Cystic Fibrosis Gene Therapy Consortium, Edinburgh, Oxford, London
| | - Stephen C Hyde
- UK Cystic Fibrosis Gene Therapy Consortium, Edinburgh, Oxford, London
| | - J Alastair Innes
- UK Cystic Fibrosis Gene Therapy Consortium, Edinburgh, Oxford, London
| | - Michael S D Korman
- Department of Pediatrics I - Pediatric Infectiology and Immunology - Translational Genomics and Gene Therapy, University of Tübingen, Tübingen, Germany
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234
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Steines B, Dickey DD, Bergen J, Excoffon KJ, Weinstein JR, Li X, Yan Z, Abou Alaiwa MH, Shah VS, Bouzek DC, Powers LS, Gansemer ND, Ostedgaard LS, Engelhardt JF, Stoltz DA, Welsh MJ, Sinn PL, Schaffer DV, Zabner J. CFTR gene transfer with AAV improves early cystic fibrosis pig phenotypes. JCI Insight 2016; 1:e88728. [PMID: 27699238 DOI: 10.1172/jci.insight.88728] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
The physiological components that contribute to cystic fibrosis (CF) lung disease are steadily being elucidated. Gene therapy could potentially correct these defects. CFTR-null pigs provide a relevant model to test gene therapy vectors. Using an in vivo selection strategy that amplifies successful capsids by replicating their genomes with helper adenovirus coinfection, we selected an adeno-associated virus (AAV) with tropism for pig airway epithelia. The evolved capsid, termed AAV2H22, is based on AAV2 with 5 point mutations that result in a 240-fold increased infection efficiency. In contrast to AAV2, AAV2H22 binds specifically to pig airway epithelia and is less reliant on heparan sulfate for transduction. We administer AAV2H22-CFTR expressing the CF transmembrane conductance regulator (CFTR) cDNA to the airways of CF pigs. The transduced airways expressed CFTR on ciliated and nonciliated cells, induced anion transport, and improved the airway surface liquid pH and bacterial killing. Most gene therapy studies to date focus solely on Cl- transport as the primary metric of phenotypic correction. Here, we describe a gene therapy experiment where we not only correct defective anion transport, but also restore bacterial killing in CFTR-null pig airways.
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Affiliation(s)
- Benjamin Steines
- Department of Internal Medicine.,Molecular and Cellular Biology Program, and.,Pappajohn Biomedical Institute, Roy J. and Lucille A. Carver College of Medicine, The University of Iowa, Iowa City, Iowa, USA
| | - David D Dickey
- Department of Internal Medicine.,Molecular and Cellular Biology Program, and
| | - Jamie Bergen
- Departments of Chemical and Biomolecular Engineering, Bioengineering, The Helen Wills Neuroscience Institute, Molecular and Cellular Biology, University of California, Berkeley, California, USA
| | | | - John R Weinstein
- Departments of Chemical and Biomolecular Engineering, Bioengineering, The Helen Wills Neuroscience Institute, Molecular and Cellular Biology, University of California, Berkeley, California, USA
| | - Xiaopeng Li
- Department of Internal Medicine.,Pappajohn Biomedical Institute, Roy J. and Lucille A. Carver College of Medicine, The University of Iowa, Iowa City, Iowa, USA
| | | | - Mahmoud H Abou Alaiwa
- Department of Internal Medicine.,Pappajohn Biomedical Institute, Roy J. and Lucille A. Carver College of Medicine, The University of Iowa, Iowa City, Iowa, USA
| | - Viral S Shah
- Department of Internal Medicine.,Pappajohn Biomedical Institute, Roy J. and Lucille A. Carver College of Medicine, The University of Iowa, Iowa City, Iowa, USA
| | | | | | | | - Lynda S Ostedgaard
- Department of Internal Medicine.,Pappajohn Biomedical Institute, Roy J. and Lucille A. Carver College of Medicine, The University of Iowa, Iowa City, Iowa, USA
| | | | - David A Stoltz
- Department of Internal Medicine.,Molecular and Cellular Biology Program, and.,Pappajohn Biomedical Institute, Roy J. and Lucille A. Carver College of Medicine, The University of Iowa, Iowa City, Iowa, USA
| | - Michael J Welsh
- Department of Internal Medicine.,Molecular and Cellular Biology Program, and.,Molecular Physiology and Biophysics
| | - Patrick L Sinn
- Pappajohn Biomedical Institute, Roy J. and Lucille A. Carver College of Medicine, The University of Iowa, Iowa City, Iowa, USA.,Howard Hughes Medical Institute, and
| | - David V Schaffer
- Departments of Chemical and Biomolecular Engineering, Bioengineering, The Helen Wills Neuroscience Institute, Molecular and Cellular Biology, University of California, Berkeley, California, USA
| | - Joseph Zabner
- Department of Internal Medicine.,Pappajohn Biomedical Institute, Roy J. and Lucille A. Carver College of Medicine, The University of Iowa, Iowa City, Iowa, USA
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235
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Lopes-Pacheco M. CFTR Modulators: Shedding Light on Precision Medicine for Cystic Fibrosis. Front Pharmacol 2016; 7:275. [PMID: 27656143 PMCID: PMC5011145 DOI: 10.3389/fphar.2016.00275] [Citation(s) in RCA: 95] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Accepted: 08/11/2016] [Indexed: 12/15/2022] Open
Abstract
Cystic fibrosis (CF) is the most common life-threatening monogenic disease afflicting Caucasian people. It affects the respiratory, gastrointestinal, glandular and reproductive systems. The major cause of morbidity and mortality in CF is the respiratory disorder caused by a vicious cycle of obstruction of the airways, inflammation and infection that leads to epithelial damage, tissue remodeling and end-stage lung disease. Over the past decades, life expectancy of CF patients has increased due to early diagnosis and improved treatments; however, these patients still present limited quality of life. Many attempts have been made to rescue CF transmembrane conductance regulator (CFTR) expression, function and stability, thereby overcoming the molecular basis of CF. Gene and protein variances caused by CFTR mutants lead to different CF phenotypes, which then require different treatments to quell the patients' debilitating symptoms. In order to seek better approaches to treat CF patients and maximize therapeutic effects, CFTR mutants have been stratified into six groups (although several of these mutations present pleiotropic defects). The research with CFTR modulators (read-through agents, correctors, potentiators, stabilizers and amplifiers) has achieved remarkable progress, and these drugs are translating into pharmaceuticals and personalized treatments for CF patients. This review summarizes the main molecular and clinical features of CF, emphasizes the latest clinical trials using CFTR modulators, sheds light on the molecular mechanisms underlying these new and emerging treatments, and discusses the major breakthroughs and challenges to treating all CF patients.
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Affiliation(s)
- Miquéias Lopes-Pacheco
- Institute of Biophysics Carlos Chagas Filho, Federal University of Rio de Janeiro Rio de Janeiro, Brazil
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236
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Hunter P. The evolution of big ideas. EMBO Rep 2016; 17:1261-3. [DOI: 10.15252/embr.201643096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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237
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Enhanced gene delivery to the lung using biodegradable polyunsaturated cationic phosphatidylcholine-detergent conjugates. Int J Pharm 2016; 511:205-218. [DOI: 10.1016/j.ijpharm.2016.07.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Revised: 07/06/2016] [Accepted: 07/08/2016] [Indexed: 12/31/2022]
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238
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Bednarski C, Tomczak K, vom Hövel B, Weber WM, Cathomen T. Targeted Integration of a Super-Exon into the CFTR Locus Leads to Functional Correction of a Cystic Fibrosis Cell Line Model. PLoS One 2016; 11:e0161072. [PMID: 27526025 PMCID: PMC4985144 DOI: 10.1371/journal.pone.0161072] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Accepted: 07/29/2016] [Indexed: 01/04/2023] Open
Abstract
In vitro disease models have enabled insights into the pathophysiology of human disease as well as the functional evaluation of new therapies, such as novel genome engineering strategies. In the context of cystic fibrosis (CF), various cellular disease models have been established in recent years, including organoids based on induced pluripotent stem cell technology that allowed for functional readouts of CFTR activity. Yet, many of these in vitro CF models require complex and expensive culturing protocols that are difficult to implement and may not be amenable for high throughput screens. Here, we show that a simple cellular CF disease model based on the bronchial epithelial ΔF508 cell line CFBE41o- can be used to validate functional CFTR correction. We used an engineered nuclease to target the integration of a super-exon, encompassing the sequences of CFTR exons 11 to 27, into exon 11 and re-activated endogenous CFTR expression by treating CFBE41o- cells with a demethylating agent. We demonstrate that the integration of this super-exon resulted in expression of a corrected mRNA from the endogenous CFTR promoter and used short-circuit current measurements in Ussing chambers to corroborate restored ion transport of the repaired CFTR channels. In conclusion, this study proves that the targeted integration of a large super-exon in CFTR exon 11 leads to functional correction of CFTR, suggesting that this strategy can be used to functionally correct all CFTR mutations located downstream of the 5' end of exon 11.
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Affiliation(s)
- Christien Bednarski
- Institute for Cell and Gene Therapy, Medical Center–University of Freiburg, Freiburg, Germany
- Center for Chronic Immunodeficiency, Medical Center–University of Freiburg, Freiburg, Germany
| | - Katja Tomczak
- Institute of Animal Physiology, Westphalian Wilhelms-University, Muenster, Germany
| | - Beate vom Hövel
- Institute for Cell and Gene Therapy, Medical Center–University of Freiburg, Freiburg, Germany
- Center for Chronic Immunodeficiency, Medical Center–University of Freiburg, Freiburg, Germany
| | - Wolf-Michael Weber
- Institute of Animal Physiology, Westphalian Wilhelms-University, Muenster, Germany
| | - Toni Cathomen
- Institute for Cell and Gene Therapy, Medical Center–University of Freiburg, Freiburg, Germany
- Center for Chronic Immunodeficiency, Medical Center–University of Freiburg, Freiburg, Germany
- Faculty of Medicine, University of Freiburg, Freiburg, Germany
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239
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Gomes Dos Reis L, Svolos M, Hartwig B, Windhab N, Young PM, Traini D. Inhaled gene delivery: a formulation and delivery approach. Expert Opin Drug Deliv 2016; 14:319-330. [PMID: 27426972 DOI: 10.1080/17425247.2016.1214569] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
INTRODUCTION Gene therapy is a potential alternative to treat a number of diseases. Different hurdles are associated with aerosol gene delivery due to the susceptibility of plasmid DNA (pDNA) structure to be degraded during the aerosolization process. Different strategies have been investigated in order to protect and efficiently deliver pDNA to the lungs using non-viral vectors. To date, no successful therapy involving non-viral vectors has been marketed, highlighting the need for further investigation in this field. Areas covered: This review is focused on the formulation and delivery of DNA to the lungs, using non-viral vectors. Aerosol gene formulations are divided according to the current delivery systems for the lung: nebulizers, dry powder inhalers and pressurized metered dose inhalers; highlighting its benefits, challenges and potential application. Expert opinion: Successful aerosol delivery is achieved when the supercoiled DNA structure is protected during aerosolization. A formulation strategy or compounds that can protect, stabilize and efficiently transfect DNA into the cells is desired in order to produce an effective, low-cost and safe formulation. Nebulizers and dry powder inhalers are the most promising approaches to be used for aerosol delivery, due to the lower shear forces involved. In this context it is also important to highlight the importance of considering the 'pDNA-formulation-device system' as an integral part of the formulation development for a successful nucleic acid delivery.
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Affiliation(s)
- Larissa Gomes Dos Reis
- a Respiratory Technology, Woolcock Institute of Medical Research and Discipline of Pharmacology, Sydney Medical School , Sydney University , Glebe , Australia
| | - Maree Svolos
- a Respiratory Technology, Woolcock Institute of Medical Research and Discipline of Pharmacology, Sydney Medical School , Sydney University , Glebe , Australia
| | - Benedikt Hartwig
- b Evonik Industries, Nutrition and Care AG , Darmstadt , Germany
| | - Norbert Windhab
- b Evonik Industries, Nutrition and Care AG , Darmstadt , Germany
| | - Paul M Young
- a Respiratory Technology, Woolcock Institute of Medical Research and Discipline of Pharmacology, Sydney Medical School , Sydney University , Glebe , Australia
| | - Daniela Traini
- a Respiratory Technology, Woolcock Institute of Medical Research and Discipline of Pharmacology, Sydney Medical School , Sydney University , Glebe , Australia
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240
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Doull I. Cystic Fibrosis Papers of the Year 2015. Paediatr Respir Rev 2016; 20 Suppl:18-20. [PMID: 27475293 DOI: 10.1016/j.prrv.2016.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Studies published in the last year have expanded our knowledge of potential disease modifying agents in the treatment of class II, III and IV CFTR mutations, and included the first report of an efficacious gene therapy for CF. There is also an important message on increasing use of conventional chronic therapies even in milder disease, and the pernicious effect of chronic infection on pulmonary function.
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Affiliation(s)
- Iolo Doull
- Department of Paediatric Respiratory Medicine and Paediatric, Cystic Fibrosis Centre, Children's Hospital for Wales, Cardiff, CF14 4XN, UK.
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241
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De Boeck K, Amaral MD. Progress in therapies for cystic fibrosis. THE LANCET RESPIRATORY MEDICINE 2016; 4:662-674. [DOI: 10.1016/s2213-2600(16)00023-0] [Citation(s) in RCA: 254] [Impact Index Per Article: 31.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Revised: 01/13/2016] [Accepted: 01/14/2016] [Indexed: 12/19/2022]
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242
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Gale C, Morris I. The UK National Neonatal Research Database: using neonatal data for research, quality improvement and more. Arch Dis Child Educ Pract Ed 2016; 101:216-8. [PMID: 26968617 PMCID: PMC4975807 DOI: 10.1136/archdischild-2015-309928] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Accepted: 02/22/2016] [Indexed: 11/24/2022]
Affiliation(s)
- C Gale
- Imperial Clinical Trials Unit, Imperial College London, London, UK
| | - I Morris
- Neonatal unit, University Hospital Wales, Cardiff, UK
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243
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Savant AP, McColley SA. Pediatric Pulmonology year in review 2015: Part 4. Pediatr Pulmonol 2016; 51:754-65. [PMID: 27171478 DOI: 10.1002/ppul.23470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Accepted: 05/02/2016] [Indexed: 11/06/2022]
Abstract
In this article, we highlight cystic fibrosis (CF) research published in Pediatric Pulmonology during 2015. Articles from other journals that reflect similar themes, and those of special importance, are also included. Pediatr Pulmonol. 2016;51:754-765. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Adrienne P Savant
- Division of Pulmonary Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Illinois.,Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Susanna A McColley
- Division of Pulmonary Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Illinois.,Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois.,Stanley Manne Children's Research Institute, Chicago, Illinois
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244
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Marson FAL, Bertuzzo CS, Ribeiro JD. Classification of CFTR mutation classes. THE LANCET RESPIRATORY MEDICINE 2016; 4:e37-e38. [PMID: 27377414 DOI: 10.1016/s2213-2600(16)30188-6] [Citation(s) in RCA: 91] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Revised: 06/07/2016] [Accepted: 06/15/2016] [Indexed: 02/07/2023]
Affiliation(s)
- Fernando Augusto Lima Marson
- Department of Pediatrics, Faculty of Medical Sciences, University of Campinas, 126 Cidade Universitária Zeferino Vaz, Campinas, SP 13083-887, Brazil; Department of Medical Genetics, Faculty of Medical Sciences, University of Campinas, 126 Cidade Universitária Zeferino Vaz, Campinas, SP 13083-887, Brazil.
| | - Carmen Sílvia Bertuzzo
- Department of Medical Genetics, Faculty of Medical Sciences, University of Campinas, 126 Cidade Universitária Zeferino Vaz, Campinas, SP 13083-887, Brazil
| | - José Dirceu Ribeiro
- Department of Pediatrics, Faculty of Medical Sciences, University of Campinas, 126 Cidade Universitária Zeferino Vaz, Campinas, SP 13083-887, Brazil
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245
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Barbeau J, Belmadi N, Montier T, Le Gall T, Dalençon S, Lemiègre L, Benvegnu T. Synthesis of a novel archaeal tetraether-type lipid containing a diorthoester group as a helper lipid for gene delivery. Tetrahedron Lett 2016. [DOI: 10.1016/j.tetlet.2016.05.090] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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246
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Harrison PT, Sanz DJ, Hollywood JA. Impact of gene editing on the study of cystic fibrosis. Hum Genet 2016; 135:983-92. [PMID: 27325484 DOI: 10.1007/s00439-016-1693-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2016] [Accepted: 05/31/2016] [Indexed: 12/30/2022]
Abstract
Cystic fibrosis (CF) is a chronic and progressive autosomal recessive disorder of secretory epithelial cells, which causes obstructions in the lung airways and pancreatic ducts of 70,000 people worldwide (for recent review see Cutting Nat Rev Genet 16(1):45-56, 2015). The finding that mutations in the CFTR gene cause CF (Kerem et al. Science 245(4922):1073-1080, 1989; Riordan et al. Science 245(4922):1066-1073, 1989; Rommens et al. Science 245(4922):1059-1065, 1989), was hailed as the very happy middle of a story whose end is a cure for a fatal disease (Koshland Science 245(4922):1029, 1989). However, despite two licensed drugs (Ramsey et al. N Engl J Med 365(18):1663-1672, 2011; Wainwright et al. N Engl J Med 373(3):220-231, 2015), and a formal demonstration that repeated administration of CFTR cDNA to patients is safe and effects a modest but significant stabilisation of disease (Alton et al. Lancet Respir Med 3(9):684-691, 2015), we are still a long way from a cure, with many patients taking over 100 tablets per day, and a mean age at death of 28 years. The aim of this review is to discuss the impact on the study of CF of gene-editing techniques as they have developed over the last 30 years, up to and including the possibility of editing as a therapeutic approach.
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Affiliation(s)
| | | | - Jennifer A Hollywood
- University College Cork, Cork, Ireland.,The University of Auckland, Auckland, New Zealand
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247
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Perry LA, Penny‐Dimri JC, Aslam AA, Lee TWR, Southern KW. Topical cystic fibrosis transmembrane conductance regulator gene replacement for cystic fibrosis-related lung disease. Cochrane Database Syst Rev 2016; 2016:CD005599. [PMID: 27314455 PMCID: PMC8682957 DOI: 10.1002/14651858.cd005599.pub5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Cystic fibrosis is caused by a defective gene encoding a protein called the cystic fibrosis transmembrane conductance regulator (CFTR), and is characterised by chronic lung infection resulting in inflammation and progressive lung damage that results in a reduced life expectancy. OBJECTIVES To determine whether topical CFTR gene replacement therapy to the lungs in people with cystic fibrosis is associated with improvements in clinical outcomes, and to assess any adverse effects. SEARCH METHODS We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group Trials Register comprising references identified from comprehensive electronic database searches, handsearching relevant journals and abstract books of conference proceedings.Date of most recent search: 05 May 2016.An additional search of the National Institutes for Health (NIH) Genetic Modification Clinical Research Information System (GeMCRIS) was also performed for the years 1992 to 2015.Date of most recent search: 20 April 2016. SELECTION CRITERIA Randomised controlled studies comparing topical CFTR gene delivery to the lung, using either viral or non-viral delivery systems, with placebo or an alternative delivery system in people with confirmed cystic fibrosis. DATA COLLECTION AND ANALYSIS The authors independently extracted data and assessed study quality. Authors of included studies were contacted and asked for any available additional data. Meta-analysis was limited due to differing study designs. MAIN RESULTS Four randomised controlled studies met the inclusion criteria for this review, involving a total of 302 participants lasting from 29 days to 13 months; 14 studies were excluded. The included studies differed in terms of CFTR gene replacement agent and study design, which limited the meta-analysis. One study only enrolled adult males, the remaining studies included both males and females aged 12 years and over.Risk of bias in the studies was moderate. Random sequence generation and allocation concealment was only described in the more recent study; the remaining three studies were judged to have an unclear risk of bias. All four studies documented double-blinding to the intervention, but there is some uncertainty with regards to participant blinding in one study. Some outcome data were missing from all four studies.There were no differences in either the number of respiratory exacerbations or the number of participants with an exacerbation between replacement therapy or placebo groups at any time point. Meta-analysis of most respiratory function tests showed no difference between treatment and placebo groups, but the smallest study (n = 16) reported forced vital capacity (litres) increased more in the placebo group at up to 24 hours. A further study reported a significant improvement in forced expiratory volume at one second (litres) at 30 days after participants had received their first dose of favouring the gene therapy agent, but this finding was not confirmed when combined with at second study in the meta-analysis. The more recent study (n = 140) demonstrated a small improvement in forced vital capacity (per cent predicted) at two and three months and again at 11 and 12 months for participants receiving CFTR gene replacement therapy compared to those receiving placebo. The same study reported a significant difference in the relative change in forced expiratory volume at one second (per cent predicted) at two months, three months and 12 months.One small study reported significant concerns with "influenza-like" symptoms in participants treated with CFTR gene replacement therapy; this was not reported on repeated use of the same agent in a larger recent study.There was no other evidence of positive impact on outcomes, in particular improved quality of life or reduced treatment burden.Two studies measured ion transport in the lower airways; one (n = 16) demonstrated significant changes toward normal values in the participants who received gene transfer agents (P < 0.0001), mean difference 6.86 (95% confidence interval 3.77 to 9.95). The second study (n = 140) also reported significant changes toward normal values (P = 0.032); however, aggregate data were not available for analysis. In the most recent study, there was also evidence of increased salt transport in cells obtained by brushing the lower airway. These outcomes, whilst important, are not of direct clinical relevance. AUTHORS' CONCLUSIONS One study of liposome-based CFTR gene transfer therapy demonstrated some improvements in respiratory function in people with CF, but this limited evidence of efficacy does not support this treatment as a routine therapy at present. There was no evidence of efficacy for viral-mediated gene delivery.Future studies need to investigate clinically important outcome measures.
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Affiliation(s)
| | - Jahan C Penny‐Dimri
- Monash UniversityDepartment of Surgery246 Clayton RdMelbourneVictoriaAustralia
| | - Aisha A Aslam
- University of LiverpoolDepartment of Women's and Children's HealthAlder Hey Children's NHS Foundation TrustEaton RoadLiverpoolUKL12 2AP
| | - Tim WR Lee
- A Floor, Clarendon Wing, Leeds General InfirmaryLeeds Regional Paediatric Cystic Fibrosis CentreGreat George StreetLeedsWest YorkshireUKLS1 3EX
| | - Kevin W Southern
- University of LiverpoolDepartment of Women's and Children's HealthAlder Hey Children's NHS Foundation TrustEaton RoadLiverpoolUKL12 2AP
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Karda R, Buckley SMK, Waddington SN. Gene Therapy with Adeno-associated Virus for Cystic Fibrosis. Am J Respir Crit Care Med 2016; 193:234-6. [PMID: 26829420 DOI: 10.1164/rccm.201510-2024ed] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Rajvinder Karda
- 1 Department of Surgery and Cancer Imperial College London London, United Kingdom
| | - Suzanne M K Buckley
- 2 Gene Transfer Technology Group University College London London, United Kingdom
| | - Simon N Waddington
- 2 Gene Transfer Technology Group University College London London, United Kingdom.,3 Wits/SAMRC Antiviral Gene Therapy Research Unit University of the Witwatersrand Johannesburg, South Africa
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Vidović D, Carlon MS, da Cunha MF, Dekkers JF, Hollenhorst MI, Bijvelds MJC, Ramalho AS, Van den Haute C, Ferrante M, Baekelandt V, Janssens HM, De Boeck K, Sermet-Gaudelus I, de Jonge HR, Gijsbers R, Beekman JM, Edelman A, Debyser Z. rAAV-CFTRΔR Rescues the Cystic Fibrosis Phenotype in Human Intestinal Organoids and Cystic Fibrosis Mice. Am J Respir Crit Care Med 2016; 193:288-98. [PMID: 26509335 DOI: 10.1164/rccm.201505-0914oc] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
RATIONALE Gene therapy holds promise for a curative mutation-independent treatment applicable to all patients with cystic fibrosis (CF). The various viral vector-based clinical trials conducted in the past have demonstrated safety and tolerance of different vectors, but none have led to a clear and persistent clinical benefit. Recent clinical breakthroughs in recombinant adeno-associated viral vector (rAAV)-based gene therapy encouraged us to reexplore an rAAV approach for CF. OBJECTIVES We evaluated the preclinical potential of rAAV gene therapy for CF to restore chloride and fluid secretion in two complementary models: intestinal organoids derived from subjects with CF and a CF mouse model, an important milestone toward the development of a clinical rAAV candidate for CF gene therapy. METHODS We engineered an rAAV vector containing a truncated CF transmembrane conductance regulator (CFTRΔR) combined with a short promoter (CMV173) to ensure optimal gene expression. A rescue in chloride and fluid secretion after rAAV-CFTRΔR treatment was assessed by forskolin-induced swelling in CF transmembrane conductance regulator (CFTR)-deficient organoids and by nasal potential differences in ΔF508 mice. MEASUREMENTS AND MAIN RESULTS rAAV-CFTRΔR transduction of human CFTR-deficient organoids resulted in forskolin-induced swelling, indicating a restoration of CFTR function. Nasal potential differences demonstrated a clear response to low chloride and forskolin perfusion in most rAAV-CFTRΔR-treated CF mice. CONCLUSIONS Our study provides robust evidence that rAAV-mediated gene transfer of a truncated CFTR functionally rescues the CF phenotype across the nasal mucosa of CF mice and in patient-derived organoids. These results underscore the clinical potential of rAAV-CFTRΔR in offering a cure for all patients with CF in the future.
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Affiliation(s)
| | | | - Mélanie F da Cunha
- 2 INSERM U1151, University Paris Descartes, Faculté de Médecine Necker Enfants-Malades, Paris, France
| | - Johanna F Dekkers
- 3 Department of Pediatric Pulmonology, Wilhelmina Children's Hospital, and.,4 Laboratory of Translational Immunology, University Medical Center, Utrecht, the Netherlands
| | - Monika I Hollenhorst
- 2 INSERM U1151, University Paris Descartes, Faculté de Médecine Necker Enfants-Malades, Paris, France
| | - Marcel J C Bijvelds
- 5 Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | | | | | - Marc Ferrante
- 9 Translational Research in Gastrointestinal Disorders, KU Leuven, Flanders, Belgium
| | | | - Hettie M Janssens
- 10 Department of Pediatric Pulmonology, Erasmus University Medical Centre/Sophia Children's Hospital, Rotterdam, the Netherlands; and
| | | | - Isabelle Sermet-Gaudelus
- 2 INSERM U1151, University Paris Descartes, Faculté de Médecine Necker Enfants-Malades, Paris, France
| | - Hugo R de Jonge
- 5 Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Rik Gijsbers
- 1 Molecular Virology and Gene Therapy.,8 Leuven Viral Vector Core, and
| | - Jeffrey M Beekman
- 3 Department of Pediatric Pulmonology, Wilhelmina Children's Hospital, and.,4 Laboratory of Translational Immunology, University Medical Center, Utrecht, the Netherlands
| | - Aleksander Edelman
- 2 INSERM U1151, University Paris Descartes, Faculté de Médecine Necker Enfants-Malades, Paris, France
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Abstract
The field of genome engineering has created new possibilities for gene therapy, including improved animal models of disease, engineered cell therapies, and in vivo gene repair. The most significant challenge for the clinical translation of genome engineering is the development of safe and effective delivery vehicles. A large body of work has applied genome engineering to genetic modification in vitro, and clinical trials have begun using cells modified by genome editing. Now, promising preclinical work is beginning to apply these tools in vivo. This article summarizes the development of genome engineering platforms, including meganucleases, zinc finger nucleases, TALENs, and CRISPR/Cas9, and their flexibility for precise genetic modifications. The prospects for the development of safe and effective viral and nonviral delivery vehicles for genome editing are reviewed, and promising advances in particular therapeutic applications are discussed.
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Affiliation(s)
- Christopher E Nelson
- Department of Biomedical Engineering, Duke University, Durham, North Carolina 27708
- Center for Genomic & Computational Biology, Duke University, Durham, North Carolina 27708
| | - Charles A Gersbach
- Department of Biomedical Engineering, Duke University, Durham, North Carolina 27708
- Center for Genomic & Computational Biology, Duke University, Durham, North Carolina 27708
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina 27708;
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