Gene Therapy For Scid Pdf Download [UPD]
Retroviruses are commonly employed as the vectors for gene therapy, due to their unique ability to penetrate the cells of the patients. Firstly, after identifying the locus of gene mutation, a healthy replica of the defective gene is prepared. Retroviruses are emptied of their own genome, and the healthy replica of the defective human gene is then inserted into the retrovirus shell.
Gene Therapy For Scid Pdf Download
In this way, the gene therapy can cure the ailment by correcting the root cause of the disease. The additional advantage is that it does not warrant a compatible donor and also almost nullifies the possibility of host versus graft reactions.
The effectiveness of gene therapy means it is now used treat several primary immunodeficiency diseases. However, in recent years, some of these treatments and trials have been halted, due to concerns over the safety of viral vectors.
This has led to many organizations across the world working towards the development of safer gene variants and techniques. It is hoped that the safety issues will be addressed in the near future and more promising gene therapy methods will be made available to treat several types of SCID.
Mutation of the IL2RG gene results in a form of severe combined immune deficiency (SCID-X1), which has been treated successfully with hematopoietic stem cell gene therapy. SCID-X1 gene therapy results in reconstitution of the previously lacking T cell compartment, allowing analysis of the roles of T cell immunity in humans by comparing before and after gene correction.
This multi-omic approach enables the characterization of multiple effects of SCID-X1 gene therapy, including T cell repertoire reconstitution, estimation of numbers of cell divisions between progenitors and daughter T cells, normalization of the microbiome, clearance of microbial pathogens, and modulations in antibiotic resistance gene levels. Together, these results quantify several aspects of the long-term efficacy of gene therapy for SCID-X1. This study includes data from ClinicalTrials.gov numbers NCT01410019, NCT01175239, and NCT01129544.
Several primary immunodeficiencies have been treated successfully by gene correction of hematopoietic stem cells (HSC) with integrating vectors [1,2,3,4,5,6,7,8,9]. This therapeutic strategy has benefited many patients and in addition provides a unique window to study mechanisms associated with immune reconstitution. In X-linked severe combined immunodeficiency (SCID-X1), the first primary immunodeficiency treated successfully by gene transfer, patients harbor mutations in the IL2RG gene, which encodes the common gamma chain, a component of several cytokine receptors important in T and NK cell growth and development [10,11,12]. Patients typically lack these cells before correction [13,14,15], but afterwards show robust T cell and transient NK cell reconstitution accompanied by considerable restoration of immune function [6,7,8,9]. SCID-X1 gene therapy thus provides a unique opportunity to study the consequences of T cell function in previously deficient human subjects.
Clonal structure of T cell populations was investigated by analyzing TCR-beta rearrangements in genomic DNA from peripheral blood CD3+ cells (Fig. 2). CDR3 region nucleotide sequences were conceptually translated into amino acid sequences, and numbers of productive rearrangements quantified (Fig. 2a). All the following analysis focused on T cell clones with productive rearrangements. For healthy adults, productive rearrangements ranged from 18,000 to 27,000 per sample. For healthy children, numbers ranged from 18,000 to 22,000 per sample. For SCIDn2, most samples were close to this range (12,000 to 33,000 per sample; no significant difference in medians). For SCIDn1, results were slightly lower, with four out of five samples between 15,000 and 23,000. The exceptional sample was from subject F107 who only showed 5,000 unique CDR3 sequences. F107 both suffered an adverse event at month 68 and was treated by chemotherapy, and demonstrated a low number of engrafted gene-modified cells at baseline. Patient F110 was also treated by chemotherapy following a serious adverse event at month 33, but was initially treated with a higher dose of gene-modified cells, potentially explaining the higher diversity in this patient.
We present here an initial analysis of the co-development of the microbiome and immune system in patients after gene therapy for SCID. We used targeted sequencing of vector integration sites to model the number of gene-corrected progenitor cells and TCR sequencing to capture the development of the T cell repertoire following therapy. The combination of these data allowed a lower-bound approximation of the number of cell divisions required to progress from a lymphoid progenitor cell to a circulating T cell, a measurement uniquely possible due to the combined analysis. We used shotgun metagenomic sequencing in longitudinal samples to track early-term changes in the gut, oral, and nasopharyngeal microbiome accompanying therapy. In a subset of these timepoints, we purified and sequenced RNA and DNA viruses, revealing clearance of several viruses associated with immune reconstitution.
The TCR-beta CDR3 analysis provided new evidence on how SCID gene therapy patients progressed to healthier phenotypes after successful therapy. After successful reconstitution, their T cell richness, as measured by TCR-beta sequencing, consistently moved from the oligoclonal range to a polyclonal range characteristic of healthy children. Further, their V and J usage generally showed a pattern typical of a healthy and age-typical state. This is concordant with the observed results of healthy immune function in these patients and shows that sequencing metrics of the T cell repertoire correlated with clinical outcomes here. A number of patient repertoires had outgrowths of expanded clones, possibly due to response to antigens. We found lower T cell diversity in SCIDn1 patients than healthy controls, which may indicate a slow but gradual loss of diversity with time after therapy.
This study illustrates some of the uses of multi-omic data in assessing outcome in human gene therapy, including specifying aspects of T cell development and normalization of the microbiota with restoration of T cell function. As more of these studies are carried out, it will be possible to assess more fully the utility of such data. Of particular interest will be any signatures that help forecast outcome and provide new opportunities for initiating therapeutic interventions.
In integrating gene therapy, a piece of DNA that contains a correct version of the CFTR gene would be delivered to an individual's cells. The new copy of the CFTR gene would then become a permanent part of their genome.
Since the discovery of the CFTR gene in 1989, scientists have been trying to find ways to correct the mutations in the gene that cause CF. Although progress was initially slower than anticipated, scientific breakthroughs in the past 10 years have accelerated advances in gene therapy, also known as gene transfer or gene replacement.
Gene therapy is a process in which a new, correct version of the CFTR gene would be placed into the cells in a person's body. Although the mutant copies of the CFTR gene would still be there, the presence of the correct copies would give cells the ability to make normal CFTR proteins.
An advantage of an integrating gene therapy is that it is permanent for the life of the cell. This means that a person with CF might have to receive the gene therapy only once or a few times in their life. A disadvantage is that there may be limited control over where the new copy of the CFTR gene integrates into the genome. The new copy could be inserted into a part of the genome that contains some critical information, like the new page being randomly added to a book and disrupting an important chapter. This means integrating gene therapy could have undesirable side effects, such as increasing the risk of cancer.
A type of integrating gene therapy, known as CAR-T therapy, has already been approved to treat patients with certain kinds of leukemia and lymphoma. Integrating gene therapies to treat CF are being tested in the lab, and a clinical trial to test the safety of this approach in people with CF could happen in the next several years.
In non-integrating gene therapy, a piece of DNA with a correct copy of the CFTR gene is provided to an individual's cells, but the DNA remains separate from the genome and is not permanent. This is like placing a new page between the covers of an existing book without permanently attaching it. Even though the gene therapy does not become part of the genome, the cell can still use the new copy of the CFTR gene to make normal CFTR proteins.
A major advantage of the non-integrating gene therapy approach is that it does not disrupt the rest of the genome, just like adding a new page right under the cover of a book would not disturb the contents of the rest of the book. That means that the risk of side effects, including cancer, is low. A disadvantage of non-integrating gene therapy is that it is not permanent. The effect of the gene therapy might last only for several weeks or months. A person with CF would probably need to be treated with the gene therapy repeatedly for it to be effective.
Non-integrating gene therapy has been approved by the U.S. Food and Drug Administration to treat a rare type of blindness, and it has also been shown to work in studies for hemophilia, a blood clotting disorder. In a clinical trial in England, people with CF were given a dose of a non-integrating gene therapy once per month for a year. The study indicated that the CF gene therapy was safe and resulted in a small improvement in lung function. A clinical trial in the U.S. is currently studying the safety and tolerability of non-integrating gene therapy in people with CF.
Strimvelis (autologous CD34+ cells transduced to express adenosine deaminase [ADA]) is the first ex vivo stem cell gene therapy approved by the European Medicines Agency (EMA), indicated as a single treatment for patients with ADA-severe combined immunodeficiency (ADA-SCID) who lack a suitable matched related bone marrow donor. Existing primary immunodeficiency registries are tailored to transplantation outcomes and do not capture the breadth of safety and efficacy endpoints required by the EMA for the long-term monitoring of gene therapies. Furthermore, for extended monitoring of Strimvelis, the young age of children treated, small patient numbers, and broad geographic distribution of patients all increase the risk of loss to follow-up before sufficient data have been collected. Establishing individual investigator sites would be impractical and uneconomical owing to the small number of patients from each location receiving Strimvelis. 350c69d7ab