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Successful engraftment of gene-corrected hematopoietic stem cells in non-conditioned patients with Fanconi anemia.
- Source :
-
Nature medicine [Nat Med] 2019 Sep; Vol. 25 (9), pp. 1396-1401. Date of Electronic Publication: 2019 Sep 09. - Publication Year :
- 2019
-
Abstract
- Fanconi anemia (FA) is a DNA repair syndrome generated by mutations in any of the 22 FA genes discovered to date <superscript>1,2</superscript> . Mutations in FANCA account for more than 60% of FA cases worldwide <superscript>3,4</superscript> . Clinically, FA is associated with congenital abnormalities and cancer predisposition. However, bone marrow failure is the primary pathological feature of FA that becomes evident in 70-80% of patients with FA during the first decade of life <superscript>5,6</superscript> . In this clinical study (ClinicalTrials.gov, NCT03157804 ; European Clinical Trials Database, 2011-006100-12), we demonstrate that lentiviral-mediated hematopoietic gene therapy reproducibly confers engraftment and proliferation advantages of gene-corrected hematopoietic stem cells (HSCs) in non-conditioned patients with FA subtype A. Insertion-site analyses revealed the multipotent nature of corrected HSCs and showed that the repopulation advantage of these cells was not due to genotoxic integrations of the therapeutic provirus. Phenotypic correction of blood and bone marrow cells was shown by the acquired resistance of hematopoietic progenitors and T lymphocytes to DNA cross-linking agents. Additionally, an arrest of bone marrow failure progression was observed in patients with the highest levels of gene marking. The progressive engraftment of corrected HSCs in non-conditioned patients with FA supports that gene therapy should constitute an innovative low-toxicity therapeutic option for this life-threatening disorder.
- Subjects :
- Adolescent
Adult
Bone Marrow Cells cytology
Child
Child, Preschool
Fanconi Anemia genetics
Fanconi Anemia physiopathology
Female
Genetic Vectors genetics
Hematopoietic Stem Cells metabolism
Humans
Infant
Lentivirus genetics
Male
Mutation genetics
Spain epidemiology
Targeted Gene Repair
Transduction, Genetic
Young Adult
Fanconi Anemia therapy
Fanconi Anemia Complementation Group A Protein genetics
Genetic Therapy
Hematopoietic Stem Cell Transplantation
Subjects
Details
- Language :
- English
- ISSN :
- 1546-170X
- Volume :
- 25
- Issue :
- 9
- Database :
- MEDLINE
- Journal :
- Nature medicine
- Publication Type :
- Academic Journal
- Accession number :
- 31501599
- Full Text :
- https://doi.org/10.1038/s41591-019-0550-z