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Lwin SM, Syed F, Di WL, Kadiyirire T, Liu L, Guy A, Petrova A, Abdul-Wahab A, Reid F, Phillips R, Elstad M, Georgiadis C, Aristodemou S, Lovell PA, McMillan JR, Mee J, Miskinyte S, Titeux M, Ozoemena L, Pramanik R, Serrano S, Rowles R, Maurin C, Orrin E, Martinez-Queipo M, Rashidghamat E, Tziotzios C, Onoufriadis A, Chen M, Chan L, Farzaneh F, Del Rio M, Tolar J, Bauer JW, Larcher F, Antoniou MN, Hovnanian A, Thrasher AJ, Mellerio JE, Qasim W, McGrath JA. Safety and early efficacy outcomes for lentiviral fibroblast gene therapy in recessive dystrophic epidermolysis bullosa. JCI Insight 2019; 4:126243. [PMID: 31167965 DOI: 10.1172/jci.insight.126243] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 04/17/2019] [Indexed: 11/17/2022] Open
Abstract
BACKGROUNDRecessive dystrophic epidermolysis bullosa (RDEB) is a severe form of skin fragility disorder due to mutations in COL7A1 encoding basement membrane type VII collagen (C7), the main constituent of anchoring fibrils (AFs) in skin. We developed a self-inactivating lentiviral platform encoding a codon-optimized COL7A1 cDNA under the control of a human phosphoglycerate kinase promoter for phase I evaluation.METHODSIn this single-center, open-label phase I trial, 4 adults with RDEB each received 3 intradermal injections (~1 × 106 cells/cm2 of intact skin) of COL7A1-modified autologous fibroblasts and were followed up for 12 months. The primary outcome was safety, including autoimmune reactions against recombinant C7. Secondary outcomes included C7 expression, AF morphology, and presence of transgene in the injected skin.RESULTSGene-modified fibroblasts were well tolerated, without serious adverse reactions or autoimmune reactions against recombinant C7. Regarding efficacy, there was a significant (P < 0.05) 1.26-fold to 26.10-fold increase in C7 mean fluorescence intensity in the injected skin compared with noninjected skin in 3 of 4 subjects, with a sustained increase up to 12 months in 2 of 4 subjects. The presence of transgene (codon-optimized COL7A1 cDNA) was demonstrated in the injected skin at month 12 in 1 subject, but no new mature AFs were detected.CONCLUSIONTo our knowledge, this is the first human study demonstrating safety and potential efficacy of lentiviral fibroblast gene therapy with the presence of COL7A1 transgene and subsequent C7 restoration in vivo in treated skin at 1 year after gene therapy. These data provide a rationale for phase II studies for further clinical evaluation.TRIAL REGISTRATIONClincalTrials.gov NCT02493816.FUNDINGCure EB, Dystrophic Epidermolysis Bullosa Research Association (UK), UK NIHR Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trust and King's College London, and Fondation René Touraine Short-Exchange Award.
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Affiliation(s)
- Su M Lwin
- St John's Institute of Dermatology, School of Basic and Medical Biosciences, King's College London, London, United Kingdom
| | - Farhatullah Syed
- Infection, Immunity and Inflammation Programme, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Wei-Li Di
- Infection, Immunity and Inflammation Programme, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Tendai Kadiyirire
- St John's Institute of Dermatology, School of Basic and Medical Biosciences, King's College London, London, United Kingdom
| | - Lu Liu
- The Robin Eady National Diagnostic Epidermolysis Bullosa Laboratory, Viapath, St Thomas' Hospital, London, United Kingdom
| | - Alyson Guy
- The Robin Eady National Diagnostic Epidermolysis Bullosa Laboratory, Viapath, St Thomas' Hospital, London, United Kingdom
| | - Anastasia Petrova
- Infection, Immunity and Inflammation Programme, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Alya Abdul-Wahab
- St John's Institute of Dermatology, School of Basic and Medical Biosciences, King's College London, London, United Kingdom
| | - Fiona Reid
- School of Population Health and Environmental Sciences, King's College London, London, United Kingdom
| | - Rachel Phillips
- School of Population Health and Environmental Sciences, King's College London, London, United Kingdom
| | - Maria Elstad
- School of Population Health and Environmental Sciences, King's College London, London, United Kingdom
| | - Christos Georgiadis
- Infection, Immunity and Inflammation Programme, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Sophia Aristodemou
- The Robin Eady National Diagnostic Epidermolysis Bullosa Laboratory, Viapath, St Thomas' Hospital, London, United Kingdom
| | - Patricia A Lovell
- The Robin Eady National Diagnostic Epidermolysis Bullosa Laboratory, Viapath, St Thomas' Hospital, London, United Kingdom
| | - James R McMillan
- The Robin Eady National Diagnostic Epidermolysis Bullosa Laboratory, Viapath, St Thomas' Hospital, London, United Kingdom
| | - John Mee
- Immunodermatology Laboratory, Viapath, St Thomas' Hospital, London, United Kingdom
| | - Snaigune Miskinyte
- INSERM UMR 1163, Imagine Institute, Université Paris Descartes Sorbonne Cite, Paris, France
| | - Matthias Titeux
- INSERM UMR 1163, Imagine Institute, Université Paris Descartes Sorbonne Cite, Paris, France
| | - Linda Ozoemena
- The Robin Eady National Diagnostic Epidermolysis Bullosa Laboratory, Viapath, St Thomas' Hospital, London, United Kingdom
| | - Rashida Pramanik
- St John's Institute of Dermatology, School of Basic and Medical Biosciences, King's College London, London, United Kingdom
| | - Sonia Serrano
- National Institute for Health Research (NIHR) Biomedical Research Centre, Guy's and St Thomas' Hospitals, London, United Kingdom
| | - Racheal Rowles
- National Institute for Health Research (NIHR) Biomedical Research Centre, Guy's and St Thomas' Hospitals, London, United Kingdom
| | - Clarisse Maurin
- National Institute for Health Research (NIHR) Biomedical Research Centre, Guy's and St Thomas' Hospitals, London, United Kingdom
| | - Elizabeth Orrin
- St John's Institute of Dermatology, School of Basic and Medical Biosciences, King's College London, London, United Kingdom
| | - Magdalena Martinez-Queipo
- St John's Institute of Dermatology, School of Basic and Medical Biosciences, King's College London, London, United Kingdom.,National Institute for Health Research (NIHR) Biomedical Research Centre, Guy's and St Thomas' Hospitals, London, United Kingdom
| | - Ellie Rashidghamat
- St John's Institute of Dermatology, School of Basic and Medical Biosciences, King's College London, London, United Kingdom
| | - Christos Tziotzios
- St John's Institute of Dermatology, School of Basic and Medical Biosciences, King's College London, London, United Kingdom
| | - Alexandros Onoufriadis
- St John's Institute of Dermatology, School of Basic and Medical Biosciences, King's College London, London, United Kingdom
| | - Mei Chen
- Department of Dermatology, University of Southern California, Los Angeles, California, USA
| | - Lucas Chan
- Department of Haematological Medicine, King's College London, The Rayne Institute, London, United Kingdom
| | - Farzin Farzaneh
- Department of Haematological Medicine, King's College London, The Rayne Institute, London, United Kingdom
| | - Marcela Del Rio
- Epithelial Biomedicine Division, Centro de Investigaciones Energéticas Medioambientales y Tecnológicas (CIEMAT); Department of Biomedical Engineering, Carlos III University (UC3M); Instituto de Investigación Sanitaria de la Fundación Jiménez Díaz; Centro de Investigación Biomédica en Red en Enfermedades Raras (CIBERER) U714, Madrid, Spain
| | - Jakub Tolar
- Department of Pediatric Oncology, Hematology and Bone Marrow Transplant, University of Minnesota, Minneapolis, Minnesota, USA
| | - Johann W Bauer
- Department of Dermatology and EB House Austria, University Hospital of the Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Fernando Larcher
- Epithelial Biomedicine Division, Centro de Investigaciones Energéticas Medioambientales y Tecnológicas (CIEMAT); Department of Biomedical Engineering, Carlos III University (UC3M); Instituto de Investigación Sanitaria de la Fundación Jiménez Díaz; Centro de Investigación Biomédica en Red en Enfermedades Raras (CIBERER) U714, Madrid, Spain
| | - Michael N Antoniou
- Department of Medical and Molecular Genetics, King's College London, London, United Kingdom
| | - Alain Hovnanian
- INSERM UMR 1163, Imagine Institute, Université Paris Descartes Sorbonne Cite, Paris, France
| | - Adrian J Thrasher
- Infection, Immunity and Inflammation Programme, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Jemima E Mellerio
- St John's Institute of Dermatology, School of Basic and Medical Biosciences, King's College London, London, United Kingdom
| | - Waseem Qasim
- Infection, Immunity and Inflammation Programme, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - John A McGrath
- St John's Institute of Dermatology, School of Basic and Medical Biosciences, King's College London, London, United Kingdom
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