Publication Date:
2010-09-17
Description:
The beta-haemoglobinopathies are the most prevalent inherited disorders worldwide. Gene therapy of beta-thalassaemia is particularly challenging given the requirement for massive haemoglobin production in a lineage-specific manner and the lack of selective advantage for corrected haematopoietic stem cells. Compound beta(E)/beta(0)-thalassaemia is the most common form of severe thalassaemia in southeast Asian countries and their diasporas. The beta(E)-globin allele bears a point mutation that causes alternative splicing. The abnormally spliced form is non-coding, whereas the correctly spliced messenger RNA expresses a mutated beta(E)-globin with partial instability. When this is compounded with a non-functional beta(0) allele, a profound decrease in beta-globin synthesis results, and approximately half of beta(E)/beta(0)-thalassaemia patients are transfusion-dependent. The only available curative therapy is allogeneic haematopoietic stem cell transplantation, although most patients do not have a human-leukocyte-antigen-matched, geno-identical donor, and those who do still risk rejection or graft-versus-host disease. Here we show that, 33 months after lentiviral beta-globin gene transfer, an adult patient with severe beta(E)/beta(0)-thalassaemia dependent on monthly transfusions since early childhood has become transfusion independent for the past 21 months. Blood haemoglobin is maintained between 9 and 10 g dl(-1), of which one-third contains vector-encoded beta-globin. Most of the therapeutic benefit results from a dominant, myeloid-biased cell clone, in which the integrated vector causes transcriptional activation of HMGA2 in erythroid cells with further increased expression of a truncated HMGA2 mRNA insensitive to degradation by let-7 microRNAs. The clonal dominance that accompanies therapeutic efficacy may be coincidental and stochastic or result from a hitherto benign cell expansion caused by dysregulation of the HMGA2 gene in stem/progenitor cells.〈br /〉〈br /〉〈a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3355472/" target="_blank"〉〈img src="https://static.pubmed.gov/portal/portal3rc.fcgi/4089621/img/3977009" border="0"〉〈/a〉 〈a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3355472/" target="_blank"〉This paper as free author manuscript - peer-reviewed and accepted for publication〈/a〉〈br /〉〈br /〉〈span class="detail_caption"〉Notes: 〈/span〉Cavazzana-Calvo, Marina -- Payen, Emmanuel -- Negre, Olivier -- Wang, Gary -- Hehir, Kathleen -- Fusil, Floriane -- Down, Julian -- Denaro, Maria -- Brady, Troy -- Westerman, Karen -- Cavallesco, Resy -- Gillet-Legrand, Beatrix -- Caccavelli, Laure -- Sgarra, Riccardo -- Maouche-Chretien, Leila -- Bernaudin, Francoise -- Girot, Robert -- Dorazio, Ronald -- Mulder, Geert-Jan -- Polack, Axel -- Bank, Arthur -- Soulier, Jean -- Larghero, Jerome -- Kabbara, Nabil -- Dalle, Bruno -- Gourmel, Bernard -- Socie, Gerard -- Chretien, Stany -- Cartier, Nathalie -- Aubourg, Patrick -- Fischer, Alain -- Cornetta, Kenneth -- Galacteros, Frederic -- Beuzard, Yves -- Gluckman, Eliane -- Bushman, Frederick -- Hacein-Bey-Abina, Salima -- Leboulch, Philippe -- AI082020/AI/NIAID NIH HHS/ -- AI52845/AI/NIAID NIH HHS/ -- HL090921/HL/NHLBI NIH HHS/ -- R01 AI052845/AI/NIAID NIH HHS/ -- R01 AI082020/AI/NIAID NIH HHS/ -- England -- Nature. 2010 Sep 16;467(7313):318-22. doi: 10.1038/nature09328.〈br /〉〈span class="detail_caption"〉Author address: 〈/span〉Clinical Investigation Center in Biotherapy, Groupe Hospitalier Universitaire Ouest, Inserm/Assistance Publique-Hopitaux de Paris, Paris 75015, France.〈br /〉〈span class="detail_caption"〉Record origin:〈/span〉 〈a href="http://www.ncbi.nlm.nih.gov/pubmed/20844535" target="_blank"〉PubMed〈/a〉
Keywords:
Adolescent
;
Blood Cells/cytology/metabolism
;
*Blood Transfusion
;
Bone Marrow Cells/cytology/metabolism
;
Child, Preschool
;
Clone Cells/metabolism
;
Gene Expression
;
*Genetic Therapy
;
Genetic Vectors/genetics
;
HMGA2 Protein/genetics/*metabolism
;
Homeostasis
;
Humans
;
Lentivirus/genetics
;
Male
;
MicroRNAs/genetics
;
Organ Specificity
;
RNA, Messenger/analysis/genetics
;
Time Factors
;
Transcriptional Activation
;
Young Adult
;
beta-Globins/*genetics/*metabolism
;
beta-Thalassemia/*genetics/metabolism/*therapy
Print ISSN:
0028-0836
Electronic ISSN:
1476-4687
Topics:
Biology
,
Chemistry and Pharmacology
,
Medicine
,
Natural Sciences in General
,
Physics
Permalink
