Abstract

Hematopoietic stem cell gene therapy requires the use of integrating retroviral vectors in order to stably transmit a therapeutic gene to mature blood cells. Human clinical trials have shown that some vector integration events lead to disrupted regulation of proto-oncogenes resulting in disordered hematopoiesis including T-cell leukemia. Newer vectors have been designed to decrease the incidence of these adverse events but require appropriate pre-clinical assays to demonstrate safety. We have used two distinct mouse serial transplant assays to evaluate the safety of a self-inactivating lentiviral vector intended for use in X-linked severe combined immunodeficiency (XSCID) gene therapy trials. These experiments entailed 28 months of total follow-up and included 386 mice. There were no cases in which the XSCID lentiviral vector clearly caused hematopoietic malignancies, although a single case of B cell malignancy was observed that contained the lentiviral vector as a likely passenger event. In contrast, a SFFV-DsRed γ-retroviral vector resulted in clonal transformation events in multiple secondary recipients. Non-specific pathology not related to vector insertions was noted including T cell leukemias arising from irradiated recipient cells. Overall, this comprehensive study of mouse transplant safety assays demonstrate the relative safety of the XSCID lentiviral vector but also highlight the limitations of these assays.

Highlights

  • Stem cell gene therapy is an experimental approach for treating blood disorders in which autologous hematopoietic stem cells are stably transduced in order to introduce a therapeutic gene into the stem cell as well as its progeny. This approach has been studied for the treatment of a variety of immunodeficiency disorders such as X-linked severe combined immunodeficiency (XSCID) [1,2], ADA-deficiency [3,4,5,6], Wiskott Aldrich Syndrome (WAS) [7], bthalassemia [8] and adrenoleukodystrophy [9] and has resulted in significant clinical benefit in these trials

  • In several of these trials, cases have arisen in which the vector has induced T cell leukemia via insertional activation of cellular proto-oncogenes [10,11,12,13]

  • We have evaluated the safety of a self-inactivating lentiviral vector for XSCID in two different murine, long-term, serial transplant assays

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Summary

Introduction

Stem cell gene therapy is an experimental approach for treating blood disorders in which autologous hematopoietic stem cells are stably transduced in order to introduce a therapeutic gene into the stem cell as well as its progeny This approach has been studied for the treatment of a variety of immunodeficiency disorders such as X-linked severe combined immunodeficiency (XSCID) [1,2], ADA-deficiency [3,4,5,6], Wiskott Aldrich Syndrome (WAS) [7], bthalassemia [8] and adrenoleukodystrophy [9] and has resulted in significant clinical benefit in these trials. A widely utilized approach involves the use of self-inactivating lentiviral vectors that lack enhancer sequences within the vector and include chromatin insulator elements to shield the surrounding chromatin from vector sequences [17] These vectors are currently being used in clinical trials and may offer a safer approach, for XSCID gene therapy [16]

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