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Muczynski V, Nathwani AC. AAV mediated gene therapy for haemophilia B: From the early attempts to modern trials. Thromb Res 2024; 236:242-249. [PMID: 38383218 DOI: 10.1016/j.thromres.2020.12.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 12/14/2020] [Accepted: 12/23/2020] [Indexed: 02/23/2024]
Abstract
Early gene therapy clinical trials for the treatment of Haemophilia B have been instrumental to our global understanding of gene therapy and have significantly contributed to the rapid expansion of the field. The use of adeno-associated viruses (AAVs) as vectors for gene transfer has successfully led to therapeutic expression of coagulation factor IX (FIX) in severe haemophilia B patients. Expression of FIX has remained stable following a single administration of vector for up to 8 years at levels that are clinically relevant to reduce the incidence of spontaneous bleeds and have permitted a significant change in the disease management with reduction or elimination of the need for coagulation factor concentrates. These trials have also shed light on several concerns around AAV-mediated gene transfer such as the high prevalence of pre-existing immunity against the vector capsid as well as the elevation of liver transaminases that is associated with a loss of FIX transgene expression in some patients. However, this field is advancing very rapidly with the development of increasingly more efficient strategies to overcome some of these obstacles and importantly raise the possibility of a functional cure, which has been long sought after. This review overviews the evolution of gene therapy for haemophilia B over the last two decades.
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Affiliation(s)
- Vincent Muczynski
- Department of Haematology, University College London - Cancer Institute, United Kingdom of Great Britain and Northern Ireland
| | - Amit C Nathwani
- Department of Haematology, University College London - Cancer Institute, United Kingdom of Great Britain and Northern Ireland; Katharine Dormandy Haemophilia and Thrombosis Unit, Royal Free London NHS Foundation Trust, United Kingdom of Great Britain and Northern Ireland; Freeline Therapeutics Ltd., United Kingdom of Great Britain and Northern Ireland.
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2
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Brimble MA, Morton CL, Winston SM, Reeves IL, Spence Y, Cheng PH, Zhou J, Nathwani AC, Thomas PG, Souquette A, Davidoff AM. Pre-Existing Immunity to a Nucleic Acid Contaminant-Derived Antigen Mediates Transaminitis and Resultant Diminished Transgene Expression in a Mouse Model of Hepatic Recombinant Adeno-Associated Virus-Mediated Gene Transfer. Hum Gene Ther 2024. [PMID: 38420654 DOI: 10.1089/hum.2023.188] [Citation(s) in RCA: 0] [Impact Index Per Article: 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] [Indexed: 03/02/2024] Open
Abstract
Liver injury with concomitant loss of therapeutic transgene expression can be a clinical sequela of systemic administration of recombinant adeno-associated virus (rAAV) when used for gene therapy, and a significant barrier to treatment efficacy. Despite this, it has been difficult to replicate this phenotype in preclinical models, thereby limiting the field's ability to systematically investigate underlying biological mechanisms and develop interventions. Prior animal models have focused on capsid and transgene-related immunogenicity, but the impact of concurrently present nontransgene or vector antigens on therapeutic efficacy, such as those derived from contaminating nucleic acids within rAAV preps, has yet to be investigated. In this study, using Ad5-CMV_GFP-immunized immunocompetent BALB/cJ mice, and a coagulation factor VIII expressing rAAV preparation that contains green flourescent protein (GFP) cDNA packaged as P5-associated contaminants, we establish a model to induce transaminitis and observe concomitant therapeutic efficacy reduction after rAAV administration. We observed strong epitope-specific anti-GFP responses in splenic CD8+ T cells when GFP cDNA was delivered as a P5-associated contaminant of rAAV, which coincided and correlated with alanine and aspartate aminotransferase elevations. Furthermore, we report a significant reduction in detectable circulating FVIII protein, as compared with control mice. Lastly, we observed an elevation in the detection of AAV8 capsid-specific T cells when GFP was delivered either as a contaminant or transgene to Ad5-CMV_GFP-immunized mice. We present this model as a potential tool to study the underlying biology of post-AAV hepatotoxicity and demonstrate the potential for T cell responses against proteins produced from AAV encapsidated nontherapeutic nucleic acids, to interfere with efficacious gene transfer.
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Affiliation(s)
- Mark A Brimble
- Departments of, Host Microbe Interactions, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Christopher L Morton
- Departments of, Surgery, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Stephen M Winston
- Departments of, Surgery, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
- Graduate School of Biomedical Sciences, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Isaiah L Reeves
- Departments of, Surgery, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
- Graduate School of Biomedical Sciences, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Yunyu Spence
- Departments of, Surgery, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Pei-Hsin Cheng
- Departments of, Surgery, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Junfang Zhou
- Departments of, Surgery, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Amit C Nathwani
- Research Department of Haematology, UCL Cancer Institute, University College London, London, United Kingdom
| | - Paul G Thomas
- Departments of, Host Microbe Interactions, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Aisha Souquette
- Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Andrew M Davidoff
- Departments of, Surgery, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
- Graduate School of Biomedical Sciences, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
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3
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Mimoun A, Bou-Jaoudeh M, Delignat S, Daventure V, Reyes Ruiz A, Lecerf M, Azam A, Noe R, Peyron I, Christophe OD, Lenting PJ, Proulle V, McIntosh J, Nathwani AC, Dimitrov JD, Denis CV, Lacroix-Desmazes S. Transplacental delivery of therapeutic proteins by engineered immunoglobulin G: a step toward perinatal replacement therapy. J Thromb Haemost 2023; 21:2405-2417. [PMID: 37271431 DOI: 10.1016/j.jtha.2023.05.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Revised: 05/02/2023] [Accepted: 05/21/2023] [Indexed: 06/06/2023]
Abstract
BACKGROUND Transplacental delivery of maternal immunoglobulin G (IgG) provides humoral protection during the first months of life until the newborn's immune system reaches maturity. The maternofetal interface has been exploited therapeutically to replace missing enzymes in the fetus, as shown in experimental mucopolysaccharidoses, or to shape adaptive immune repertoires during fetal development and induce tolerance to self-antigens or immunogenic therapeutic molecules. OBJECTIVES To investigate whether proteins that are administered to pregnant mice or endogenously present in their circulation may be delivered through the placenta. METHODS We engineered monovalent immunoglobulin G (FabFc) specific for different domains of human factor VIII (FVIII), a therapeutically relevant model antigen. FabFc was injected with exogenous FVIII into pregnant severe hemophilia A mice or pregnant mice expressing human FVIII following AAV8-mediated gene therapy. FabFc and FVIII were detected in the pregnant mice and/or fetuses by enzyme-linked immunosorbent assay and immunohistochemistry. RESULTS Administration of FabFc to pregnant mice allowed the maternofetal delivery of FVIII in a FcRn-dependent manner. FVIII antigen levels achieved in the fetuses represented 10% of normal plasma levels in the human. We identified antigen/FabFc complex stability, antigen size, and shielding of promiscuous protein patches as key parameters to foster optimal antigen delivery. CONCLUSION Our results pave the way toward the development of novel strategies for the in utero delivery of endogenous maternal proteins to replace genetically deficient fetal proteins or to educate the immune system and favor active immune tolerance upon protein encounter later in life.
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Affiliation(s)
- Angelina Mimoun
- Institut National de la Santé et de la Recherche Médicale, Centre de Recherche des Cordeliers, CNRS, Sorbonne Université, Université Paris Cité, Paris, France
| | - Melissa Bou-Jaoudeh
- Institut National de la Santé et de la Recherche Médicale, Centre de Recherche des Cordeliers, CNRS, Sorbonne Université, Université Paris Cité, Paris, France
| | - Sandrine Delignat
- Institut National de la Santé et de la Recherche Médicale, Centre de Recherche des Cordeliers, CNRS, Sorbonne Université, Université Paris Cité, Paris, France
| | - Victoria Daventure
- Institut National de la Santé et de la Recherche Médicale, Centre de Recherche des Cordeliers, CNRS, Sorbonne Université, Université Paris Cité, Paris, France
| | - Alejandra Reyes Ruiz
- Institut National de la Santé et de la Recherche Médicale, Centre de Recherche des Cordeliers, CNRS, Sorbonne Université, Université Paris Cité, Paris, France
| | - Maxime Lecerf
- Institut National de la Santé et de la Recherche Médicale, Centre de Recherche des Cordeliers, CNRS, Sorbonne Université, Université Paris Cité, Paris, France
| | - Aurélien Azam
- Institut National de la Santé et de la Recherche Médicale, Centre de Recherche des Cordeliers, CNRS, Sorbonne Université, Université Paris Cité, Paris, France
| | - Remi Noe
- Institut National de la Santé et de la Recherche Médicale, Centre de Recherche des Cordeliers, CNRS, Sorbonne Université, Université Paris Cité, Paris, France
| | - Ivan Peyron
- Laboratory for Hemostasis, Inflammation & Thrombosis, Unité Mixed de Recherche, Institut National de la Santé et de la Recherche Médicale, Université Paris-Saclay, Le Kremlin-Bicêtre, France
| | - Olivier D Christophe
- Laboratory for Hemostasis, Inflammation & Thrombosis, Unité Mixed de Recherche, Institut National de la Santé et de la Recherche Médicale, Université Paris-Saclay, Le Kremlin-Bicêtre, France
| | - Peter J Lenting
- Laboratory for Hemostasis, Inflammation & Thrombosis, Unité Mixed de Recherche, Institut National de la Santé et de la Recherche Médicale, Université Paris-Saclay, Le Kremlin-Bicêtre, France
| | - Valérie Proulle
- Institut National de la Santé et de la Recherche Médicale, Centre de Recherche des Cordeliers, CNRS, Sorbonne Université, Université Paris Cité, Paris, France; Service d'Hématologie Biologique, Hôpital Cochin, AP-HP Centre, Paris, France
| | - Jenny McIntosh
- Deparment of Haematology, UCL Cancer Institute, London, UK
| | - Amit C Nathwani
- Deparment of Haematology, UCL Cancer Institute, London, UK; Katherine Dormandy Haemophilia and Thrombosis Unit, Royal Free London NHS Foundation Trust, London, UK
| | - Jordan D Dimitrov
- Institut National de la Santé et de la Recherche Médicale, Centre de Recherche des Cordeliers, CNRS, Sorbonne Université, Université Paris Cité, Paris, France
| | - Cécile V Denis
- Laboratory for Hemostasis, Inflammation & Thrombosis, Unité Mixed de Recherche, Institut National de la Santé et de la Recherche Médicale, Université Paris-Saclay, Le Kremlin-Bicêtre, France
| | - Sébastien Lacroix-Desmazes
- Institut National de la Santé et de la Recherche Médicale, Centre de Recherche des Cordeliers, CNRS, Sorbonne Université, Université Paris Cité, Paris, France.
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Abstract
The cloning of the factor VIII (FVIII) and factor IX (FIX) genes in the 1980s has led to a succession of clinical advances starting with the advent of molecular diagnostic for hemophilia, followed by the development of recombinant clotting factor replacement therapy. Now gene therapy beckons on the back of decades of research that has brought us to the final stages of the approval of 2 products in Europe and United States, thus heralding a new era in the treatment of the hemophilias. Valoctocogene roxaparvovec, the first gene therapy for treatment of hemophilia A, has been granted conditional marketing authorization in Europe. Another approach (etranacogene dezaparvovec, AMT-061) for hemophilia B is also under review by regulators. There are several other gene therapy approaches in earlier stages of development. These approaches entail a one-off infusion of a genetically modified adeno-associated virus (AAV) engineered to deliver either the FVIII or FIX gene to the liver, leading to the continuous endogenous synthesis and secretion of the missing coagulation factor into the circulation by the hepatocytes, thus preventing or reducing bleeding episodes. Ongoing observations show sustained clinical benefit of gene therapy for >5 years following a single administration of an AAV vector without long-lasting or late toxicities. An asymptomatic, self-limiting, immune-mediated rise in alanine aminotransferase is commonly observed within the first 12 months after gene transfer that has the potential to eliminate the transduced hepatocytes in the absence of treatment with immunosuppressive agents such as corticosteroids. The current state of this exciting and rapidly evolving field, as well as the challenges that need to be overcome for the widespread adaptation of this new treatment paradigm, is the subject of this review.
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Affiliation(s)
- Amit C. Nathwani
- Department of Haematology, UCL Cancer Institute, London, UK
- Katharine Dormandy Haemophilia and Thrombosis Unit, Royal Free London NHS Foundation Trust, London, UK
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Nathwani AC, McIntosh J, Sheridan R. Liver Gene Therapy. Hum Gene Ther 2022; 33:879-888. [PMID: 36082993 DOI: 10.1089/hum.2022.169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Gene therapy is an exciting therapeutic concept that offers the promise of a cure for an array of inherited and acquired disorders. The liver has always been a key target for gene therapy as it controls essential biological processes including digestion, metabolism, detoxification, immunity and blood coagulation. Metabolic disorders of hepatic origin number several hundreds, and for many, liver transplantation remains the only cure. Liver-targeted gene therapy is an attractive treatment modality for many of these conditions. After years of failure, substantial progress in this field in the last decade has resulted in promising clinical efficacy and safety in patients with monogenetic disorders. Glybera was the first liver targeted gene therapy to be approved for patients with lipoprotein lipsase deficiency. Now two more products are on the verge of being approved. Roctavian, the first gene therapy for treatment for hemophilia A, has received a favourable opinion from the European Medicines agency (EMA). Another, Etranacogene dezaparvovec (AMT-061) for hemophilia B is also in the final stages of approval. A number of other liver targeted gene therapy products are at an advanced stage of development, thus heralding a new era of potentially curative molecular medicine. This review explores the recent clinical advances in liver targeted gene therapy as well as the challenges that need to be overcome for the widespread adoption of this new treatment paradigm.
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Affiliation(s)
- Amit C Nathwani
- University College London Cancer Institute, KD:HT Centre, The Royal Free Hospital, Pond Street, London, United Kingdom of Great Britain and Northern Ireland, NW3 2QG;
| | - Jennifer McIntosh
- University College London, London, London, United Kingdom of Great Britain and Northern Ireland;
| | - Rose Sheridan
- Freeline Therapeutics, Stevenage, United Kingdom of Great Britain and Northern Ireland;
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O'Donovan K, Bhatt S, Baccaro A, Fernando D, Smith A, Gbajumo E, Bobrzynski T, McIntosh J, Gore J, Nathwani AC, Chester K, Granger D. The use of a transient transfected expression system to deliver high quality bispecific T-cell engager drug product, NVG-111, to the clinic for a fraction of the cost and time associated with the development and use of a producer cell line. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.e14506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e14506 Background: Bispecific antibodies provide an opportunity to treat a diverse range of disorders because of their ability to simultaneously attenuate several different pathways precisely and effectively, thus overcoming many of the limitations of monoclonal antibodies. The adaptability of bispecifics has facilitated the generation of compelling preclinical data covering a range of malignant and non-malignant disorders. Proof-of-concept early phase clinical trials with bispecific antibodies, including bispecific T-cell engagers (TCE) have been hindered by manufacturing challenges, including a heavy burden in terms of time, quality and costs associated with generating a stable producer cell line. We took a more agile approach, using transient transfection to manufacture a ROR1×CD3 bispecific TCE drug product (DP [NVG-111]) for a first in human, Phase I/II clinical trial. Methods: A HEK293T cell line was expanded into 10-layer cell factories. The cells were transfected with a ROR1xCD3 scFv bispecific antibody (NVG-111) plasmid and incubated. Post incubation, the supernatant containing NVG-111 was clarified by filtration and subjected to solvent/detergent viral inactivation. This was followed by a concentration/buffer exchange step and subsequent DNA reduction using an endonuclease. NVG-111 was captured using a bind/elute Protein A column and the eluate polished on a multimodal anion exchange column in flow through mode to remove residual impurities. The eluate was formulated and concentrated to the target protein concentration, viral and sterile filtered and QC tested. The bulk drug substance was 0.2 µm filtered into Din 2R vials and the DP stored at ≤-65°C pending release. Results: The transient transfection approach resulted in the rapid tech transfer and GMP manufacture of clinical NVG-111 DP. Two batches of DP were manufactured producing 1,971 vials of NVG-111, sufficient to support the Phase I/II clinical trial in patients with advanced Chronic Lymphocytic Leukaemia and Mantle Cell Lymphoma (Clinical Trial.gov NCT04763083). Both batches met the approved specifications for identity, potency, purity/impurities, strength and safety. The exercise took less than 7 months from contract signature to DP in the freezer and cost ̃50% of the more traditional producer cell line approach. Conclusions: We established a novel GMP process in 7 months, using transient transfection to manufacture NVG-111 for Phase I/II trials. The process costed less than the more conventional manufacturing approach of using a producer cell line. The strategy offers a rapid, and very efficient way of reaching a first in human study without a trade-off between time, quality and cost.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Amit C. Nathwani
- University College London Cancer Institute, London, United Kingdom
| | - Kerry Chester
- University College London Cancer Institute, London, United Kingdom
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Granger D, Harrasser M, Evans R, Muczynski V, Chester K, Nathwani AC. A next generation inducible armored CAR to overcome the immunosuppressive tumor microenvironment and enhances cytotoxicity of CAR-T and TILs. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.e14517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e14517 Background: The full potential of CAR-T cells in clinic is limited by the immunosuppressive tumour microenvironment (TME), which induces expression of exhaustion markers and limits the activity of tumour infiltrating lymphocytes (TILs) including CAR-T cells. We developed a next generation inducible Armored CAR platform (aCAR) that releases an anti-PD-1 checkpoint inhibitor upon CAR-T cell activation, limiting payload release exclusively to the TME, thereby reducing the risk of systemic exposure. This differentiated strategy facilitates activation of CAR-T cells and TILs within the TME and has the potential for lower toxicity. Methods: A ROR1-targeting second-generation CAR containing a 41BB-CD3ζ intracellular domain was cloned into a lentivirus transfer vector alongside a prototypic anti-PD1 antibody. The CAR was under the control of a constitutively active promoter, and the PD1 targeting payload was controlled by an inducible promoter that was activated upon engagement of CAR with ROR1 on tumour cells. CAR-T cells were subject to in vitro co-culture assays with target ROR1+ tumour cells and their cytotoxic responses evaluated by flow cytometry. Levels and binding functionality of released payload were analyzed by ELISA and flow cytometry. In vivo xenograft models were performed in NSG mice with tumor growth assessed by bioluminescent imaging (BLI) and caliper measurement of the tumour volume. Results: Non-Armored CAR cells displayed potent and specific cytotoxic responses directed towards ROR1+ TNBC and NSCLC cells lines at different effector to target (E:T) ratios. The results were equivalent or superior to CARs generated with comparator anti-ROR1 antibodies, which may be due to the ROR1 CAR targeting a membrane proximal epitope within the ROR1 frizzled domain. The aCAR cells released measurable levels of anti-PD1 payload within 5 hours of binding to ROR1 on tumors and enhanced the cytotoxic effects at challenging 1:10 E:T ratios. Established PDL1+ TNBC xenograft models using the aCAR cells and comparing with non-Armored CAR cells displayed a qualitative abrogation in tumor growth by BLI, which was confirmed and shown to be significant by caliper measurement of the tumor volume. Continuing the experiment out to 3 months showed a significant survival advantage for the animals receiving aCAR. All other cohorts were terminated by day 70, however 20% of the aCAR cohort survived at day 95. Conclusions: Our next generation inducible aCAR platform enables the release of an immune stimulating payload only in the presence of target tumor cells, enhancing the therapeutic activity of the CAR-T cells and limiting payload exposure to the site of action. This technology provided a significant survival advantage in challenging in vivo xenograft models. This coupled with its potential safety attributes merits further clinical evaluation of this approach.
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Affiliation(s)
| | | | | | | | - Kerry Chester
- University College London Cancer Institute, London, United Kingdom
| | - Amit C. Nathwani
- University College London Cancer Institute, London, United Kingdom
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Shah M, Granger D, Bobrzynski T, Baccaro A, Gore J, Muczynski V, Cook S, Chester K, Batten T, O'Donovan K, Jasani P, Nathwani AC. A sensitive and robust bioanalytical assay for pharmacokinetic analysis of ROR1xCD3 bispecific T cell engager (NVG-111) in a first-in-human study. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.e19505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e19505 Background: Receptor tyrosine kinase-like Orphan Receptor-1 (ROR1) is widely expressed on hematological and solid tumors. NVG-111, a first in class humanized tandem scFv ROR1xCD3 bispecific antibody elicits potent killing of ROR1+ tumor cells in vitro and in vivo. This bispecific T-cell engager (TCE) is being evaluated in a first in human, Phase I trial in patients with relapsed/refractory chronic lymphocytic leukemia (CLL) and mantle cell lymphoma (MCL). The predicted therapeutic dose and steady state serum concentrations of NVG-111 were estimated by allometric scaling using relevant doses from a murine PK study. To assess free drug levels in patients following 21 days of continuous infusion of NVG-111, a bespoke, sensitive pharmacokinetics (PK) assay with high levels of specificity and sensitivity was developed. Methods: Anti-idiotype (anti-ID) antibodies directed to anti-ROR1 (αROR1-ID) and anti-CD3 (αCD3-ID) were generated by mouse immunization or by phage display from customized libraries. A proof-of-concept sandwich ELISA assay was developed using αCD3-ID to capture NVG-111 and detection by biotinylated hROR1-streptavidin-HRP. Gyrolab and Quanterix Simoa high sensitivity ELISA platforms were used to detect NVG-111 by αCD3-ID capture and αROR1-ID detection. The mesoscale discovery electrochemiluminescence assay (MSD-ECLA) was developed using a reversed format; NVG-111 capture with αROR1-ID and detection with αCD3-ID. Results: Allometric scaling predicted a theoretically relevant therapeutic dose and steady state serum concentration of 1ng/mL NVG-111 in humans, which was just at the level of sensitivity of a conventional ELISA under non-matrix conditions. Transferring the format to Quanterix Simoa had limited success due to high background levels in all configurations evaluated. The Gyrolab platform increased sensitivity to 75pg/mL, but suboptimal individual human sera matrix selectivity limited assay validity. Assessment of MSD-ECLA provided the best signal/noise, enhanced human disease and healthy sera selectivity, and a dynamic sensitivity range of 250pg/mL to 32ng/mL, which enabled the development of a GCLP qualified PK assay. The MSD-ECLA assay was employed to measure NVG-111 concentrations in CLL or MCL subjects dosed with 0.3-30µg/day NVG-111. MSD-ECLA detected drug in patients receiving NVG-111, with a range of steady-state serum concentrations (Cavg.ss) of 168-610pg/mL. This was in-line with the predicted drug levels from the single species allometric scaling, albeit with observed levels being marginally lower than expected. Conclusions: Development, custom optimization and validation of a highly sensitive MSD-ECLA PK assay has enabled GCLP-compliant measurement of circulating NVG-111 in CLL or MCL patients treated with at least 10µg/day cIV NVG-111.
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Affiliation(s)
| | | | | | | | | | | | | | - Kerry Chester
- University College London Cancer Institute, London, United Kingdom
| | | | | | - Parag Jasani
- Royal Free London NHS Foundation Trust, London, United Kingdom
| | - Amit C. Nathwani
- University College London Cancer Institute, London, United Kingdom
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Granger D, Bhatt S, Henne P, Baccaro A, Fernando D, Gore J, Gbajumo E, O'Donovan K, Chester K, Nathwani AC. Activity and biophysical properties related to clinical evaluation of a first-in-class EHL ROR1xCD3 T Cell Engager. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.e14505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e14505 Background: NVG-111, a T cell engager (TCE) targeting ROR1 and CD3, is in clinical development for the treatment of Chronic Lymphocytic Leukemia (CLL) and Mantle Cell Leukemia (MCL). This 55KDa molecule consisting of humanised tandem scFvs is administered into patients as a continuous intravenous infusion. The intrinsically short half-life of NVG-111 has its advantages, such as rapid management of CRS by cessation of infusion. Early safety and efficacy clinical data supports the development of an extended half-life (EHL) ROR1xCD3 TCE for ease of administration and convenience for patients, building on the favorable activity and biophysical attributes of NVG-111. A next generation therapy possessing such an EHL has potential to improve patient experience by offering a different drug administration paradigm. Methods: Several formats were designed and evaluated, incorporating different EHL technology solutions by increasing the size and enabling FcRn-mediated recycling. EHL TCEs and non-EHL TCEs were cloned in-format with Fc, HSA, or an HSA binding moiety into a suitable expression vector. The resultant clones were expressed using Expi293 cells and the potency of TCEs were evaluated by co-culture assays using MCL derived JeKo-1 target cells and T cells from healthy donor PBMCs. Cytotoxic responses and T cell activation as determined by CD69 expression were measured by flow cytometry. T cell activation was also assessed by measuring CD3 signalling in a reporter gene assay. Biophysical properties were evaluated by determining the post-purification expression titer, the aggregation profile using analytical SEC, and the impact of stability challenge in formulation buffer and serum on target cell binding and activity. Results: Reformatting NVG-111 into an IgG-like heterodimeric bispecific scFv-Fc resulted in loss of potency, which may be due to a change in geometry of binding and/or poorer target engagement. Activity and expression titer were also deleteriously affected by directly fusing NVG-111 to human serum albumin (HSA), or to an HSA binding moiety. Fusing NVG-111 directly to Fc resulted in maintained potency in cytotoxicity and T cell activation assays, the expression titer of parental NVG-111, and exhibited very low levels of aggregation. Stability studies performed in formulation buffer and in human serum showed that NVG-111-Fc was at least as stable as parent. Furthermore, other studies with this molecular format indicate that the half-life in mice is comparable to a heterodimeric bispecific scFv-Fc. Conclusions: NVG-111 has been successfully engineered into an EHL format that increased the molecular size and has the potential to engage in FcRn-mediated recycling. This format maintains functional activity, is stable, and expresses well with a favorable aggregation profile. Further molecular refinements are being actively evaluated in readiness for IND enabling studies.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Kerry Chester
- University College London Cancer Institute, London, United Kingdom
| | - Amit C. Nathwani
- University College London Cancer Institute, London, United Kingdom
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10
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Jasani P, Townsend W, Asher S, Tayabali S, Tucker D, Cook S, Batten T, Granger D, Shah M, O'Donovan K, Nathwani AC. First-in-human phase I study of a ROR1-targeting bispecific T-cell engager (NVG-111) shows evidence of efficacy in patients with relapsed/refractory CLL and MCL. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.7535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
7535 Background: NVG-111 is a first in class, humanized, tandem scFv ROR1xCD3 bispecific T cell engager that mediates potent killing of ROR1+ tumours by engaging an epitope on the Frizzled domain of ROR1 and redirecting T cell activity via the CD3 binder. Methods: This phase I/II study is evaluating NVG-111 in patients with relapsed/refractory (R/R) CLL and MCL who have received ≥2 prior systemic therapies and have achieved a stable, or partial response to the last line of therapy. NVG-111 was delivered as continuous intravenous (cIV) infusion over 21 days per cycle, with each patient typically receiving 3 cycles of treatment. The first 3 single patient cohorts were subjected to accelerated dose titration (ADT) over a range of 0.3-30µg/day. Dose-escalation steps in the subsequent, multi-patient, cohorts were determined using a continuous reassessment method with overdose control. The primary endpoints are safety and determination of MTD/RP2D. Secondary objectives are pharmacokinetics, pharmacodynamics, immunogenicity and anti-tumor activity, assessed by multicolor flow cytometry to quantitate minimal residual disease (MRD4). Results: As of January 2022, six patients (all males, median age 60 years) had been enrolled to the study; three into each of the ADT cohorts and the remaining into a 30 µg/day flat dosing cohort. Five patients had CLL, and one had MCL, with all subjects remaining on ibrutinib whilst receiving NVG-111. The most common adverse events were Grade 1 lethargy, headaches, nausea, vomiting and thrombocytopenia. All 3 patients exposed to a flat dose of NVG-111 at 30µg/day suffered Grade 1 cytokine release syndrome (CRS) during week 1 of cycle 1. This did not require tocilizumab or dose interruption except in one patient who developed transient, grade 3 immune effector cell–associated neurotoxicity syndrome-like symptoms (ICANS). CRS or ICANS was not observed in subsequent cycles of treatment at this dose level. Response was observed in all 5 evaluable patients who had completed efficacy assessment after 3 cycles of NVG-111. Amongst these, 2 patients had undetectable MRD in the blood with one being MRD negative in the bone marrow. Dose escalation is ongoing, including exploration of step-up dosing. Conclusions: Early data with NVG-111 shows promising efficacy with a predictable and manageable safety profile. Clinical trial information: NCT04763083.
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Affiliation(s)
- Parag Jasani
- Royal Free London NHS Foundation Trust, London, United Kingdom
| | - William Townsend
- University College London Hospitals NIHR Clinical Research Facility, London, United Kingdom
| | - Samir Asher
- University College London, London, United Kingdom
| | | | - David Tucker
- Plymouth University Peninsula Schools of Medicine and Dentistry, Plymouth, United Kingdom
| | | | | | | | | | | | - Amit C. Nathwani
- University College London Cancer Institute, London, United Kingdom
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11
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Brimble MA, Cheng PH, Winston SM, Reeves IL, Souquette A, Spence Y, Zhou J, Wang YD, Morton CL, Valentine M, Thomas PG, Nathwani AC, Gray JT, Davidoff AM. Preventing packaging of translatable P5-associated DNA contaminants in recombinant AAV vector preps. Mol Ther Methods Clin Dev 2022; 24:280-291. [PMID: 35211640 PMCID: PMC8829444 DOI: 10.1016/j.omtm.2022.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 01/16/2022] [Indexed: 11/25/2022]
Abstract
Recombinant adeno-associated virus (rAAV) vectors are increasingly being used for clinical gene transfer and have shown great potential for the treatment of several monogenic disorders. However, contaminant DNA from producer plasmids can be packaged into rAAV alongside the intended expression cassette-containing vector genome. The consequences of this are unknown. Our analysis of rAAV preps revealed abundant contaminant sequences upstream of the AAV replication (Rep) protein driving promoter, P5, on the Rep-Cap producer plasmid. Characterization of P5-associated contaminants after infection showed transfer, persistence, and transcriptional activity in AAV-transduced murine hepatocytes, in addition to in vitro evidence suggestive of integration. These contaminants can also be efficiently translated and immunogenic, revealing previously unrecognized side effects of rAAV-mediated gene transfer. P5-associated contaminant packaging and activity were independent of an inverted terminal repeat (ITR)-flanked vector genome. To prevent incorporation of these potentially harmful sequences, we constructed a modified P5-promoter (P5-HS), inserting a DNA spacer between an Rep binding site and an Rep nicking site in P5. This prevented upstream DNA contamination regardless of transgene or AAV serotype, while maintaining vector yield. Thus, we have constructed an rAAV production plasmid that improves vector purity and can be implemented across clinical rAAV applications. These findings represent new vector safety and production considerations for rAAV gene therapy.
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Affiliation(s)
- Mark A Brimble
- Department of Surgery, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105, USA.,Department of Haematology, University College London (UCL) Cancer Institute, London WC1E 6DD, UK
| | - Pei-Hsin Cheng
- Department of Surgery, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105, USA
| | - Stephen M Winston
- Department of Surgery, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105, USA.,Graduate School of Biomedical Sciences, St. Jude Children's Research Hospital, Memphis, TN 38105, USA
| | - Isaiah L Reeves
- Department of Surgery, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105, USA.,Graduate School of Biomedical Sciences, St. Jude Children's Research Hospital, Memphis, TN 38105, USA
| | - Aisha Souquette
- Department of Immunology, St. Jude Children's Research Hospital, Memphis, TN 38105, USA
| | - Yunyu Spence
- Department of Surgery, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105, USA
| | - Junfang Zhou
- Department of Surgery, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105, USA
| | - Yong-Dong Wang
- Department of Cell and Molecular Biology, St. Jude Children's Research Hospital, Memphis, TN 38105, USA
| | - Christopher L Morton
- Department of Surgery, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105, USA
| | - Marcus Valentine
- Cytogenetics Shared Resource, St. Jude Children's Research Hospital, Memphis, TN 38105, USA
| | - Paul G Thomas
- Department of Immunology, St. Jude Children's Research Hospital, Memphis, TN 38105, USA
| | - Amit C Nathwani
- Department of Haematology, University College London (UCL) Cancer Institute, London WC1E 6DD, UK.,Katharine Dormandy Haemophilia and Thrombosis Centre, Royal Free Hospital, London NW3 2QG, UK
| | - John T Gray
- Vertex Cell and Genetic Therapies, Vertex Pharmaceuticals, Boston, MA 02210, USA
| | - Andrew M Davidoff
- Department of Surgery, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105, USA.,Graduate School of Biomedical Sciences, St. Jude Children's Research Hospital, Memphis, TN 38105, USA
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12
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Abstract
The single most important step on the path to our modern understanding of blood coagulation and haemophilia in the 20th century was taken by British pathologist Robert Gwyn Macfarlane with his 1964 publication 'An enzyme cascade in the blood clotting mechanism, and its function as a biochemical amplifier'. In the same year, Ratnoff and Davie in the USA reached the same conclusion. Macfarlane and Rosemary Biggs had previously, in 1952, discovered factor IX as the factor deficient in haemophilia B. In 1973, Arthur Bloom defined the distinct role of Factor VIII and von Willebrand factor in haemophilia A and von Willebrand's disease respectively. This inspired the efforts of Tuddenham and his group towards the purification of Factor VIII which reached homogeneity in 1982, leading to the cloning of the Factor VIII gene in 1984 in collaboration with US scientists at Genentech, which in turn enabled development of safe recombinant factor concentrates for patients with haemophilia. Brownlee cloned the factor IX gene in 1982 at the Sir William Dunn Institute of Pathology in Oxford. This led eventually to the first successful trial of gene therapy for haemophilia B in 2011 by the Nathwani group at UCL, which built on pioneering work of US groups and was partnered with St Jude in Memphis where Nathwani started the project. This trial has fuelled the current quest for a functional cure of haemophilia A and B. The UK has, therefore, made a rich contribution to advances in haemostasis over the last 60 years, often in partnership with other groups across the world.
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13
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Granger D, Gohil S, Barbarulo A, Baccaro A, Muczynski V, Chester K, Germaschewski F, Batten T, Brown K, Cook S, O'Donovan K, Jasani P, Nathwani AC, Phillips P. NVG-111, a novel ROR1xCD3 bispecific antibody for non-Hodgkin lymphoma. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.7549] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
7549 Background: Receptor tyrosine kinase-like Orphan Receptor 1 (ROR1) is a type I transmembrane protein is highly expressed on an array of haematological and solid tumours. NVG-111 is a humanised, tandem scFv ROR1xCD3 bispecific antibody previously shown to elicit potent killing of tumour cells in vitro and in vivo by engaging a membrane-proximal epitope in the Wnt5a-binding Frizzled domain of ROR1 and redirecting T cell activity. The in vitro potency and pharmacodynamic responses to NVG-111 were assessed to support progression to a first-in-human study. Methods: The potency of NVG-111 in vitro was determined by evaluating the concentration response for cytotoxicity, T cell activation, and cytokine release in co-cultured Jeko-1 and unstimulated human T cells. Comparative data were generated for the marketed CD19xCD3 bispecific antibody, blinatumomab. Potency data for NVG-111 were used together with allometric scaling from murine PK studies to inform planned clinical doses. Results: NVG-111 demonstrated T cell-dependent cytotoxicity, T cell activation and levels of cytokine release similar in potency to blinatumomab. Cytotoxic responses of both NVG-111 and blinatumomab were more potent than T cell activation and cytokine release. Dose response curves for NVG-111 showed a decrease in activity beyond the concentration of maximal response (ie “hook effect”). We hypothesise this is due to receptor saturation, inhibiting synapse formation. NVG-111 has progressed to a Phase 1/2 first-in-human study in patients with debulked, relapsed/refractory chronic lymphocytic leukemia (CLL) and mantle cell lymphoma (MCL), the drug given as add-on to ≥2nd line therapy with a Bruton’s tyrosine kinase inhibitor, or venetoclax. Phase 1 includes escalating doses of 0.3 to 360 µg/day via continuous infusion over 3 cycles (each 21 days on, 7 days off) to establish safety, PK, pharmacodynamics (PD) and recommended phase 2 dose (RP2D). Predicted exposure at 0.3 µg/day is ̃EC20 for cytotoxicity in vitro and below the lowest EC10 for cytokine release. PD biomarkers in the study include systemic cytokines. Phase 2 will study efficacy and safety of the RP2D in CLL and MCL, with primary endpoint complete response rate; other efficacy endpoints include minimal residual disease and progression free survival. Conclusions: NVG-111 shows potent T-cell mediated lymphoma cell cytotoxicity in vitro at concentrations well below those associated with extensive cytokine release. NVG-111 is in an ongoing Phase 1/2 study and may present a novel option for adoptive immunotherapy in patients with non-Hodgkin lymphoma and potentially other cancers. Clinical trial information: 2020-000820-20. [Table: see text]
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Affiliation(s)
| | - Satyen Gohil
- University College London, London, United Kingdom
| | | | | | | | - Kerry Chester
- University College London Cancer Institute, London, United Kingdom
| | | | | | | | | | | | - Parag Jasani
- Royal Free London NHS Foundation Trust, London, United Kingdom
| | - Amit C. Nathwani
- University College London Cancer Institute, London, United Kingdom
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14
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Sia KC, Fu ZY, Calne RY, Nathwani AC, Lee KO, Gan SU. Modification of a Constitutive to Glucose-Responsive Liver-Specific Promoter Resulted in Increased Efficacy of Adeno-Associated Virus Serotype 8-Insulin Gene Therapy of Diabetic Mice. Cells 2020; 9:cells9112474. [PMID: 33202992 PMCID: PMC7696068 DOI: 10.3390/cells9112474] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 11/06/2020] [Accepted: 11/10/2020] [Indexed: 01/02/2023] Open
Abstract
We have previously used a hepatotropic adeno-associated viral (AAV) vector with a modified human insulin gene to treat diabetic mice. The HLP (hybrid liver-specific promoter) used was constitutively active and non-responsive to glucose. In this study, we examined the effects of addition of glucose responsive elements (R3G) and incorporation of a 3' albumin enhancer (3'iALB) on insulin expression. In comparison with the original promoter, glucose responsiveness was only observed in the modified promoters in vitro with a 36 h lag time before the peak expression. A 50% decrease in the number of viral particles at 5 × 109 vector genome (vg)/mouse was required by AAV8-R3GHLP-hINSco to reduce the blood sugar level to near normoglycemia when compared to the original AAV8-HLP-hINSco that needed 1 × 1010 vg/mouse. The further inclusion of an 860 base-pairs 3'iALB enhancer component in the 3' untranslated region increased the in vitro gene expression significantly but this increase was not observed when the packaged virus was systemically injected in vivo. The addition of R3G to the HLP promoter in the AAV8-human insulin vector increased the insulin expression and secretion, thereby lowering the required dosage for basal insulin treatment. This in turn reduces the risk of liver toxicity and cost of vector production.
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Affiliation(s)
- Kian Chuan Sia
- Department of Surgery, National University of Singapore, Singapore 117597, Singapore; (K.C.S.); (Z.Y.F.); (R.Y.C.)
| | - Zhen Ying Fu
- Department of Surgery, National University of Singapore, Singapore 117597, Singapore; (K.C.S.); (Z.Y.F.); (R.Y.C.)
| | - Roy Y. Calne
- Department of Surgery, National University of Singapore, Singapore 117597, Singapore; (K.C.S.); (Z.Y.F.); (R.Y.C.)
- Department of Surgery, University of Cambridge, Cambridge CB2 0QQ, UK
| | - Amit C. Nathwani
- Department of Haematology, UCL Cancer Institute, London WC1E 6DD, UK;
| | - Kok Onn Lee
- Department of Medicine, National University of Singapore, Singapore 119228, Singapore;
| | - Shu Uin Gan
- Department of Surgery, National University of Singapore, Singapore 117597, Singapore; (K.C.S.); (Z.Y.F.); (R.Y.C.)
- Correspondence: ; Tel.: +65-6601-2465
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15
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Abstract
Gene therapy offers the potential for a cure for patients with hemophilia by establishing continuous endogenous expression of factor VIII or factor IX (FIX) following transfer of a functional gene to replace the hemophilic patient's own defective gene. The hemophilias are ideally suited for gene therapy because a small increment in blood factor levels (≥5% of normal) is associated with significant amelioration of bleeding phenotype in severely affected patients. In 2011, the St. Jude/UCL phase 1/2 trial was the first to provide clear evidence of a stable dose-dependent increase in FIX levels in patients with severe hemophilia B following a single administration of adeno-associated viral (AAV) vectors. Transgenic FIX expression has remained stable at ∼5% of normal in the high-dose cohort over a 7-year follow-up period, resulting in a substantial reduction in spontaneous bleeding and FIX protein usage without toxicity. This study has been followed by unparalleled advances in gene therapy for hemophilia A and B, leading to clotting factor activity approaching normal or near-normal levels associated with a "zero bleed rates" in previously severely affected patients following a single administration of AAV vectors. Thus, AAV gene therapies are likely to alter the treatment paradigm for hemophilia A and B. This review explores recent progress and the remaining limitations that need to be overcome for wider availability of this novel treatment of inherited bleeding disorders.
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Affiliation(s)
- Amit C Nathwani
- Department of Haematology, UCL Cancer Institute, Katharine Dormandy Haemophilia and Thrombosis Unit, Royal Free London NHS Foundation Trust, London, United Kingdom; and Freeline Therapeutics Ltd., Stevenage, United Kingdom
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16
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Gohil SH, Evans R, Harasser M, El-Kholy M, Paredes-Moscosso SR, Della Peruta M, Nathwani AC. Ibrutinib enhances the efficacy of ROR1 bispecific T cell engager mediated cytotoxicity in chronic lymphocytic leukaemia. Br J Haematol 2019; 186:380-382. [PMID: 30957227 DOI: 10.1111/bjh.15911] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Satyen H Gohil
- Department of Academic Haematology, UCL Cancer Institute, London, UK
| | - Rachel Evans
- Department of Academic Haematology, UCL Cancer Institute, London, UK
| | - Micaela Harasser
- Department of Academic Haematology, UCL Cancer Institute, London, UK
| | - Mohamed El-Kholy
- Department of Academic Haematology, UCL Cancer Institute, London, UK
| | | | | | - Amit C Nathwani
- Department of Academic Haematology, UCL Cancer Institute, London, UK.,Katherine Dormandy Haemophilia & Thrombosis Centre, Royal Free Hospital, London, UK
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17
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Chan JKY, Gil-Farina I, Johana N, Rosales C, Tan YW, Ceiler J, Mcintosh J, Ogden B, Waddington SN, Schmidt M, Biswas A, Choolani M, Nathwani AC, Mattar CNZ. Therapeutic expression of human clotting factors IX and X following adeno-associated viral vector-mediated intrauterine gene transfer in early-gestation fetal macaques. FASEB J 2018; 33:3954-3967. [PMID: 30517034 PMCID: PMC6404563 DOI: 10.1096/fj.201801391r] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Adeno-associated viral vectors (AAVs) achieve stable therapeutic expression without long-term toxicity in adults with hemophilia. To avert irreversible complications in congenital disorders producing early pathogenesis, safety and efficacy of AAV-intrauterine gene transfer (IUGT) requires assessment. We therefore performed IUGT of AAV5 or -8 with liver-specific promoter-1 encoding either human coagulation factors IX (hFIX) or X (hFX) into Macaca fascicularis fetuses at ∼0.4 gestation. The initial cohort received 1 × 1012 vector genomes (vgs) of AAV5-hFIX (n = 5; 0.45 × 1013 vg/kg birth weight), resulting in ∼3.0% hFIX at birth and 0.6–6.8% over 19–51 mo. The next cohort received 0.2–1 × 1013 vg boluses. AAV5-hFX animals (n = 3; 3.57 × 1013 vg/kg) expressed <1% at birth and 9.4–27.9% up to 42 mo. AAV8-hFIX recipients (n = 3; 2.56 × 1013 vg/kg) established 4.2–41.3% expression perinatally and 9.8–25.3% over 46 mo. Expression with AAV8-hFX (n = 6, 3.12 × 1013 vg/kg) increased from <1% perinatally to 9.8–13.4% >35 mo. Low expressers (<1%, n = 3) were postnatally challenged with 2 × 1011 vg/kg AAV5 resulting in 2.4–13.2% expression and demonstrating acquired tolerance. Linear amplification–mediated-PCR analysis demonstrated random integration of 57–88% of AAV sequences retrieved from hepatocytes with no events occurring in or near oncogenesis-associated genes. Thus, early-IUGT in macaques produces sustained curative expression related significantly to integrated AAV in the absence of clinical toxicity, supporting its therapeutic potential for early-onset monogenic disorders.—Chan, J. K. Y., Gil-Farina I., Johana, N., Rosales, C., Tan, Y. W., Ceiler, J., Mcintosh, J., Ogden, B., Waddington, S. N., Schmidt, M., Biswas, A., Choolani, M., Nathwani, A. C., Mattar, C. N. Z. Therapeutic expression of human clotting factors IX and X following adeno-associated viral vector–mediated intrauterine gene transfer in early-gestation fetal macaques.
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Affiliation(s)
- Jerry K Y Chan
- Reproductive Medicine, KK Women's and Children's Hospital, Singapore, Singapore.,Cancer and Stem Cell Biology Program, Duke-National University of Singapore (NUS) Medical School, Singapore
| | - Irene Gil-Farina
- Department of Translational Oncology, German Cancer Research Center/National Center for Tumor Diseases, Heidelberg, Germany
| | - Nuryanti Johana
- Reproductive Medicine, KK Women's and Children's Hospital, Singapore, Singapore
| | - Cecilia Rosales
- University College London (UCL) Cancer Institute, University College London, London, United Kingdom
| | - Yi Wan Tan
- Reproductive Medicine, KK Women's and Children's Hospital, Singapore, Singapore
| | - Jessika Ceiler
- Department of Translational Oncology, German Cancer Research Center/National Center for Tumor Diseases, Heidelberg, Germany
| | - Jenny Mcintosh
- Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Bryan Ogden
- SingHealth Experimental Medicine Centre, Singapore Health Services Pte, Singapore, Singapore
| | - Simon N Waddington
- Institute for Women's Health, University College London, London, United Kingdom.,Faculty of Health Sciences, Wits/South African Medical Research Council (SAMRC), Antiviral Gene Therapy Research Unit, University of the Witwatersrand, Johannesburg, South Africa; and
| | - Manfred Schmidt
- University College London (UCL) Cancer Institute, University College London, London, United Kingdom.,GeneWerk, Heidelberg, Germany
| | - Arijit Biswas
- Department of Translational Oncology, German Cancer Research Center/National Center for Tumor Diseases, Heidelberg, Germany
| | - Mahesh Choolani
- Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Amit C Nathwani
- University College London (UCL) Cancer Institute, University College London, London, United Kingdom
| | - Citra N Z Mattar
- Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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18
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Jaffer S, Goh P, Abbasian M, Nathwani AC. Mbd3 Promotes Reprogramming of Primary Human Fibroblasts. Int J Stem Cells 2018; 11:235-241. [PMID: 30497130 PMCID: PMC6285286 DOI: 10.15283/ijsc18036] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 04/23/2018] [Accepted: 09/25/2018] [Indexed: 01/31/2023] Open
Abstract
Mbd3 (Methyl-CpG binding domain protein), a core member of NuRD (nucleosome remodelling and deacetylation) is essential for embryogenesis. However, its role in reprogramming of somatic cells into induced pluripotent stem cells (iPSC) remains controversial. Some reports suggest that Mbd3 inhibits pluripotency, whilst others show that it greatly enhances reprogramming efficiency. Our study is the first to assess the role of Mbd3 on reprogramming of primary human fibroblasts using Yamanaka episomal plasmids (Reprogramming factors (RF) under feeder-free conditions. We showed that shRNA-mediated partial depletion of Mbd3 resulted in >5-fold reduction in the efficiency of reprogramming of primary human fibroblasts. Furthermore, iPSC that emerged after knock-down of Mbd3 were incapable of trilineage differentiation even though they expressed all markers of pluripotency. In contrast, over-expression of the Mbd3b isoform along with the Yamanaka episomal plasmids increased the number of fibroblast derived iPSC colonies by at least two-fold. The resulting colonies were capable of trilineage differentiation. Our results, therefore, suggest that Mbd3 appears to play an important role in reprogramming of primary human fibroblasts, which provides further insight into the biology of reprogramming but also has direct implication for translation of iPSC to clinic.
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Affiliation(s)
- Sajjida Jaffer
- Department of Haematology, University College London, Cancer Institute, London,
UK
- Katharine Dormandy Haemophilia and Thrombosis Centre, Royal Free NHS Trust, London,
UK
| | - Pollyanna Goh
- Centre for Paediatrics, Barts and The London Medical School, Blizard Institute, Queen Mary University of London, London,
UK
| | - Mahnaz Abbasian
- Department of Haematology, University College London, Cancer Institute, London,
UK
- Katharine Dormandy Haemophilia and Thrombosis Centre, Royal Free NHS Trust, London,
UK
| | - Amit C Nathwani
- Department of Haematology, University College London, Cancer Institute, London,
UK
- Katharine Dormandy Haemophilia and Thrombosis Centre, Royal Free NHS Trust, London,
UK
- National Health Services Blood and Transplant, Oak House, Reeds Crescent, Watford, Hertfordshire,
UK
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19
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Affiliation(s)
- Gavin Ling
- Katherine Dormandy Haemophilia and Thrombosis Centre; Royal Free London NHS Foundation Trust; London UK
| | - Amit C. Nathwani
- Katherine Dormandy Haemophilia and Thrombosis Centre; Royal Free London NHS Foundation Trust; London UK
| | - Edward G. D. Tuddenham
- Katherine Dormandy Haemophilia and Thrombosis Centre; Royal Free London NHS Foundation Trust; London UK
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20
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Paulk NK, Pekrun K, Zhu E, Nygaard S, Li B, Xu J, Chu K, Leborgne C, Dane AP, Haft A, Zhang Y, Zhang F, Morton C, Valentine MB, Davidoff AM, Nathwani AC, Mingozzi F, Grompe M, Alexander IE, Lisowski L, Kay MA. Bioengineered AAV Capsids with Combined High Human Liver Transduction In Vivo and Unique Humoral Seroreactivity. Mol Ther 2018; 26:289-303. [PMID: 29055620 PMCID: PMC5763027 DOI: 10.1016/j.ymthe.2017.09.021] [Citation(s) in RCA: 117] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Revised: 09/17/2017] [Accepted: 09/20/2017] [Indexed: 01/01/2023] Open
Abstract
Existing recombinant adeno-associated virus (rAAV) serotypes for delivering in vivo gene therapy treatments for human liver diseases have not yielded combined high-level human hepatocyte transduction and favorable humoral neutralization properties in diverse patient groups. Yet, these combined properties are important for therapeutic efficacy. To bioengineer capsids that exhibit both unique seroreactivity profiles and functionally transduce human hepatocytes at therapeutically relevant levels, we performed multiplexed sequential directed evolution screens using diverse capsid libraries in both primary human hepatocytes in vivo and with pooled human sera from thousands of patients. AAV libraries were subjected to five rounds of in vivo selection in xenografted mice with human livers to isolate an enriched human-hepatotropic library that was then used as input for a sequential on-bead screen against pooled human immunoglobulins. Evolved variants were vectorized and validated against existing hepatotropic serotypes. Two of the evolved AAV serotypes, NP40 and NP59, exhibited dramatically improved functional human hepatocyte transduction in vivo in xenografted mice with human livers, along with favorable human seroreactivity profiles, compared with existing serotypes. These novel capsids represent enhanced vector delivery systems for future human liver gene therapy applications.
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Affiliation(s)
- Nicole K Paulk
- Departments of Pediatrics and Genetics, Stanford University, Stanford, CA 94305, USA
| | - Katja Pekrun
- Departments of Pediatrics and Genetics, Stanford University, Stanford, CA 94305, USA
| | - Erhua Zhu
- Translational Vectorology Group, Children's Medical Research Institute, University of Sydney, Sydney, NSW, Australia
| | - Sean Nygaard
- Oregon Stem Cell Center, Oregon Health & Science University, Portland, OR 97239, USA
| | - Bin Li
- Oregon Stem Cell Center, Oregon Health & Science University, Portland, OR 97239, USA
| | - Jianpeng Xu
- Departments of Pediatrics and Genetics, Stanford University, Stanford, CA 94305, USA
| | - Kirk Chu
- Departments of Pediatrics and Genetics, Stanford University, Stanford, CA 94305, USA
| | | | - Allison P Dane
- Department of Haematology, UCL Cancer Institute, London, UK
| | - Annelise Haft
- Oregon Stem Cell Center, Oregon Health & Science University, Portland, OR 97239, USA
| | - Yue Zhang
- Departments of Pediatrics and Genetics, Stanford University, Stanford, CA 94305, USA
| | - Feijie Zhang
- Departments of Pediatrics and Genetics, Stanford University, Stanford, CA 94305, USA
| | - Chris Morton
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, TN 38105, USA
| | - Marcus B Valentine
- Cytogenetic Shared Resource, St. Jude Children's Research Hospital, Memphis, TN 38105, USA
| | - Andrew M Davidoff
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, TN 38105, USA
| | - Amit C Nathwani
- Department of Haematology, UCL Cancer Institute, London, UK; Department of Haematology and Katharine Dormandy Haemophilia Centre & Thrombosis Unit, Royal Free London NHS Foundation Trust Hospital, London, UK; National Health Services Blood and Transplant, Watford, UK
| | - Federico Mingozzi
- Genethon and INSERM U951, Evry, France; University Pierre and Marie Curie, Paris, France
| | - Markus Grompe
- Oregon Stem Cell Center, Oregon Health & Science University, Portland, OR 97239, USA
| | - Ian E Alexander
- Translational Vectorology Group, Children's Medical Research Institute, University of Sydney, Sydney, NSW, Australia
| | - Leszek Lisowski
- Translational Vectorology Group, Children's Medical Research Institute, University of Sydney, Sydney, NSW, Australia; Military Institute of Hygiene and Epidemiology (MIHE), Puławy, Poland
| | - Mark A Kay
- Departments of Pediatrics and Genetics, Stanford University, Stanford, CA 94305, USA.
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21
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Affiliation(s)
- Amit C. Nathwani
- Department of Haematology, University College London Cancer Institute, London, United Kingdom
- Katharine Dormandy Haemophilia and Thrombosis Centre, Royal Free London NHS Foundation Trust, London, United Kingdom
- NHS Blood and Transplant, Watford, United Kingdom
| | - Andrew M. Davidoff
- Department of Surgery, St. Jude Children's Research Hospital, Memphis Tennessee
| | - Edward G. D. Tuddenham
- Department of Haematology, University College London Cancer Institute, London, United Kingdom
- Katharine Dormandy Haemophilia and Thrombosis Centre, Royal Free London NHS Foundation Trust, London, United Kingdom
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22
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Abstract
The best currently available treatments for hemophilia A and B (factor VIII or factor IX deficiency, respectively) require frequent intravenous infusion of highly expensive proteins that have short half-lives. Factor levels follow a saw-tooth pattern that is seldom in the normal range and falls so low that breakthrough bleeding occurs. Most hemophiliacs worldwide do not have access to even this level of care. In stark contrast, gene therapy holds out the hope of a cure by inducing continuous endogenous expression of factor VIII or factor IX following transfer of a functional gene to replace the hemophilic patient's own defective gene.
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Affiliation(s)
- Amit C Nathwani
- Department of Academic Haematology, UCL Cancer Institute, Katharine Dormandy Haemophilia and Thrombosis Centre, Rowland Hill Street, London NW3 2PF, United Kingdom; National Health Service Blood and Transplant, Oak House, Reeds Crescent, Watford, Hertfordshire, WD24 4QN, United Kingdom.
| | - Andrew M Davidoff
- Department of Surgery, St. Jude Children's Research Hospital, 262 Danny Thomas Place Memphis, TN 38105-3678, USA
| | - Edward G D Tuddenham
- Department of Academic Haematology, UCL Cancer Institute, Katharine Dormandy Haemophilia and Thrombosis Centre, Rowland Hill Street, London NW3 2PF, United Kingdom
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23
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Mattar CNZ, Gil-Farina I, Rosales C, Johana N, Tan YYW, McIntosh J, Kaeppel C, Waddington SN, Biswas A, Choolani M, Schmidt M, Nathwani AC, Chan JKY. In Utero Transfer of Adeno-Associated Viral Vectors Produces Long-Term Factor IX Levels in a Cynomolgus Macaque Model. Mol Ther 2017; 25:1843-1853. [PMID: 28462816 PMCID: PMC5542637 DOI: 10.1016/j.ymthe.2017.04.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2017] [Revised: 04/03/2017] [Accepted: 04/03/2017] [Indexed: 01/09/2023] Open
Abstract
The safe correction of an inherited bleeding disorder in utero prior to the onset of organ damage is highly desirable. Here, we report long-term transgene expression over more than 6 years without toxicity following a single intrauterine gene transfer (IUGT) at 0.9G using recombinant adeno-associated vector (AAV)-human factor IX (hFIX) in the non-human primate model we have previously described. Four of six treated animals monitored for around 74 months expressed hFIX at therapeutic levels (3.9%-120.0%). Long-term expression was 6-fold higher in males and with AAV8 compared to AAV5, mediated almost completely at this stage by random genome-wide hepatic proviral integrations, with no evidence of hotspots. Post-natal AAV challenge without immunosuppression was evaluated in two animals exhibiting chronic low transgene expression. The brief neutralizing immune reaction elicited had no adverse effect and, although expression was not improved at the dose administered, no clinical toxicity was observed. This long-term surveillance thus confirms the safety of late-gestation AAV-hFIX transfer and demonstrates that postnatal re-administration can be performed without immunosuppression, although it requires dose optimization for the desired expression. Nevertheless, eventual vector genotoxicity and the possibility of germline transmission will require lifelong monitoring and further evaluation of the reproductive function of treated animals.
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Affiliation(s)
- Citra N Z Mattar
- Obstetrics & Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119077, Singapore.
| | - Irene Gil-Farina
- Department of Translational Oncology, German Cancer Research Center and National Center for Tumor Diseases, 69120 Heidelberg, Germany
| | - Cecilia Rosales
- UCL Cancer Institute, University College London, London WC1E 6BT, United Kingdom
| | - Nuryanti Johana
- Reproductive Medicine, K.K. Women's and Children's Hospital, Singapore 229899, Singapore
| | - Yvonne Yi Wan Tan
- Reproductive Medicine, K.K. Women's and Children's Hospital, Singapore 229899, Singapore
| | - Jenny McIntosh
- UCL Cancer Institute, University College London, London WC1E 6BT, United Kingdom
| | - Christine Kaeppel
- Department of Translational Oncology, German Cancer Research Center and National Center for Tumor Diseases, 69120 Heidelberg, Germany
| | - Simon N Waddington
- Institute for Women's Health, University College London, London WC1E 6BT, United Kingdom; MRC Antiviral Gene Therapy Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 2000, South Africa
| | - Arijit Biswas
- Obstetrics & Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119077, Singapore
| | - Mahesh Choolani
- Obstetrics & Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119077, Singapore
| | - Manfred Schmidt
- Department of Translational Oncology, German Cancer Research Center and National Center for Tumor Diseases, 69120 Heidelberg, Germany
| | - Amit C Nathwani
- UCL Cancer Institute, University College London, London WC1E 6BT, United Kingdom
| | - Jerry K Y Chan
- Reproductive Medicine, K.K. Women's and Children's Hospital, Singapore 229899, Singapore; Duke-NUS Medical School, Singapore 169857, Singapore.
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24
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Yang J, Milasta S, Hu D, AlTahan AM, Interiano RB, Zhou J, Davidson J, Low J, Lin W, Bao J, Goh P, Nathwani AC, Wang R, Wang Y, Ong SS, Boyd VA, Young B, Das S, Shelat A, Wu Y, Li Z, Zheng JJ, Mishra A, Cheng Y, Qu C, Peng J, Green DR, White S, Guy RK, Chen T, Davidoff AM. Targeting Histone Demethylases in MYC-Driven Neuroblastomas with Ciclopirox. Cancer Res 2017; 77:4626-4638. [PMID: 28684529 DOI: 10.1158/0008-5472.can-16-0826] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Revised: 11/28/2016] [Accepted: 06/29/2017] [Indexed: 12/21/2022]
Abstract
Histone lysine demethylases facilitate the activity of oncogenic transcription factors, including possibly MYC. Here we show that multiple histone demethylases influence the viability and poor prognosis of neuroblastoma cells, where MYC is often overexpressed. We also identified the approved small-molecule antifungal agent ciclopirox as a novel pan-histone demethylase inhibitor. Ciclopirox targeted several histone demethylases, including KDM4B implicated in MYC function. Accordingly, ciclopirox inhibited Myc signaling in parallel with mitochondrial oxidative phosphorylation, resulting in suppression of neuroblastoma cell viability and inhibition of tumor growth associated with an induction of differentiation. Our findings provide new insights into epigenetic regulation of MYC function and suggest a novel pharmacologic basis to target histone demethylases as an indirect MYC-targeting approach for cancer therapy. Cancer Res; 77(17); 4626-38. ©2017 AACR.
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Affiliation(s)
- Jun Yang
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, Tennessee.
| | - Sandra Milasta
- Department of Immunology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Dongli Hu
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Alaa M AlTahan
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Rodrigo B Interiano
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Junfang Zhou
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Jesse Davidson
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Jonathan Low
- Department of Chemical Biology and Therapeutics, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Wenwei Lin
- Department of Chemical Biology and Therapeutics, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Ju Bao
- Department of Structural Biology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Pollyanna Goh
- Department of Oncology, University College London Cancer Institute, London, United Kingdom
| | - Amit C Nathwani
- Department of Oncology, University College London Cancer Institute, London, United Kingdom
| | - Ruoning Wang
- Department of Pediatrics, The Ohio State University School of Medicine, The Research Institute at Nationwide Children's Hospital, Center for Childhood Cancer and Blood Disease, Columbus, Ohio
| | - Yingdi Wang
- Yale Cardiovascular Research Center, Yale School of Medicine, New Haven, Connecticut
| | - Su Sien Ong
- Department of Chemical Biology and Therapeutics, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Vincent A Boyd
- Department of Chemical Biology and Therapeutics, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Brandon Young
- Department of Chemical Biology and Therapeutics, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Sourav Das
- Department of Chemical Biology and Therapeutics, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Anang Shelat
- Department of Chemical Biology and Therapeutics, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Yinan Wu
- Department of Structural Biology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Zhenmei Li
- Department of Structural Biology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Jie J Zheng
- Department of Structural Biology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Ashutosh Mishra
- Department of Structural Biology, Department of Developmental Neurobiology and St. Jude Proteomics Facility, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Yong Cheng
- Department of Hematology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Chunxu Qu
- Department of Computational Biology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Junmin Peng
- Department of Structural Biology, Department of Developmental Neurobiology and St. Jude Proteomics Facility, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Douglas R Green
- Department of Immunology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Stephen White
- Department of Structural Biology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - R Kiplin Guy
- Department of Chemical Biology and Therapeutics, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Taosheng Chen
- Department of Chemical Biology and Therapeutics, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Andrew M Davidoff
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, Tennessee
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25
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Abstract
The X-linked bleeding disorder hemophilia causes frequent and exaggerated bleeding that can be life-threatening if untreated. Conventional therapy requires frequent intravenous infusions of the missing coagulation protein (factor VIII [FVIII] for hemophilia A and factor IX [FIX] for hemophilia B). However, a lasting cure through gene therapy has long been sought. After a series of successes in small and large animal models, this goal has finally been achieved in humans by in vivo gene transfer to the liver using adeno-associated viral (AAV) vectors. In fact, multiple recent clinical trials have shown therapeutic, and in some cases curative, expression. At the same time, cellular immune responses against the virus have emerged as an obstacle in humans, potentially resulting in loss of expression. Transient immune suppression protocols have been developed to blunt these responses. Here, we provide an overview of the clinical development of AAV gene transfer for hemophilia, as well as an outlook on future directions.
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Affiliation(s)
- Arthur W Nienhuis
- Division of Experimental Hematology, Department of Hematology, St. Jude Children's Research Hospital, Memphis, TN 38105, USA.
| | - Amit C Nathwani
- Department of Haematology, University College London Cancer Institute, 72 Huntley Street, London WC1E 6BT, UK
| | - Andrew M Davidoff
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, TN 38105, USA
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26
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Abstract
BACKGROUND Polonium-210 ((210)Po) gained widespread notoriety after the poisoning and subsequent death of Mr Alexander Litvinenko in London, UK, in 2006. Exposure to (210)Po resulted initially in a clinical course that was indistinguishable from infection or exposure to chemical toxins, such as thallium. METHODS A 43-year-old man presented to his local hospital with acute abdominal pain, diarrhoea, and vomiting, and was admitted to the hospital because of dehydration and persistent gastrointestinal symptoms. He was initially diagnosed with gastroenteritis and treated with antibiotics. Clostridium difficile toxin was subsequently detected in his stools, which is when he first raised the possibility of being poisoned and revealed his background and former identity, having been admitted under a new identity with which he had been provided on being granted asylum in the UK. Within 6 days, the patient had developed thrombocytopenia and neutropenia, which was initially thought to be drug induced. By 2 weeks, in addition to bone marrow failure, he had evidence of alopecia and mucositis. Thallium poisoning was suspected and investigated but ultimately dismissed because blood levels of thallium, although raised, were lower than toxic concentrations. The patient continued to deteriorate and within 3 weeks had developed multiple organ failure requiring ventilation, haemofiltration, and cardiac support, associated with a drop in consciousness. On the 23rd day after he first became ill, he suffered a pulseless electrical activity cardiorespiratory arrest from which he could not be resuscitated and was pronounced dead. FINDINGS Urine analysis using gamma-ray spectroscopy on day 22 showed a characteristic 803 keV photon emission, raising the possibility of (210)Po poisoning. Results of confirmatory analysis that became available after the patient's death established the presence of (210)Po at concentrations about 10(9)-times higher than normal background levels. Post-mortem tissue analyses showed autolysis and retention of (210)Po at lethal doses in several organs. On the basis of the measured amounts and tissue distribution of (210)Po, it was estimated that the patient had ingested several 1000 million becquerels (a few GBq), probably as a soluble salt (eg, chloride), which delivered very high and fatal radiation doses over a period of a few days. INTERPRETATION Early symptoms of (210)Po poisoning are indistinguishable from those of a wide range of chemical toxins. Hence, the diagnosis can be delayed and even missed without a high degree of suspicion. Although body surface scanning with a standard Geiger counter was unable to detect the radiation emitted by (210)Po, an atypical clinical course prompted active consideration of poisoning with radioactive material, with the diagnosis ultimately being made with gamma-ray spectroscopy of a urine sample. FUNDING UK NHS, Public Health England, and the UK Department of Health.
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Affiliation(s)
- Amit C Nathwani
- Department of Haematology, UCL Cancer Institute, London, UK; Department of Haematology, Royal Free London NHS Foundation Trust Hospital, London, UK; Katharine Dormandy Haemophilia Centre and Thrombosis Unit, Royal Free London NHS Foundation Trust Hospital, London, UK; National Health Services Blood and Transplant, Watford, UK.
| | - James F Down
- Intensive Care Unit, University College London Hospitals NHS Foundation Trust, London, UK
| | - John Goldstone
- Intensive Care Unit, University College London Hospitals NHS Foundation Trust, London, UK
| | - James Yassin
- Intensive Care Unit, University College London Hospitals NHS Foundation Trust, London, UK
| | - Paul I Dargan
- Clinical Toxicology, Guy's & St Thomas' NHS Foundation Trust, London, UK; Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Andres Virchis
- Department of Haematology, Royal Free London NHS Foundation Trust Hospital, London, UK
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27
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Piras BA, McNally DJ, Lockey TD, Nathwani AC, Meagher MM. 100. Evaluation of Ion-Exchange Membranes for the Purification of AAV8 from Culture Media. Mol Ther 2016. [DOI: 10.1016/s1525-0016(16)32909-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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28
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Brimble MA, Zhou J, Morton C, Meagher M, Nathwani AC, Gray JT, Davidoff AM. 547. AAV Preparations Contain Contamination from DNA Sequences in Production Plasmids Directly Outside of the ITRs. Mol Ther 2016. [DOI: 10.1016/s1525-0016(16)33355-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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29
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Abstract
Adeno-associated viral vectors have been developed for the treatment of hemophilia A and B. Derivation of vector particles is achieved after multiplasmid transfection of cells that package the vector genome to yield vector particles. To date, three clinical trials have been performed for hemophilia B. The results of these trials are described. The trial that we conducted with our collaborators has yielded evidence of clinical efficacy for hemophilia B. A vector for treating hemophilia A has been developed and a clinical trial is planned.
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Affiliation(s)
- Arthur W Nienhuis
- 1 Division of Experimental Hematology, Department of Hematology, St. Jude Children's Research Hospital , Memphis, Tennessee
| | - Amit C Nathwani
- 2 Department of Haematology, University College London Cancer Institute , London, United Kingdom
| | - Andrew M Davidoff
- 3 Department of Surgery, St. Jude Children's Research Hospital , Memphis, Tennessee
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30
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Affiliation(s)
- Andrew M Davidoff
- From the Department of Surgery, St. Jude Children's Research Hospital, and the Department of Surgery, University of Tennessee Health Science Center, Memphis (A.M.D.); and the Department of Hematology, University College London Cancer Institute, London (A.C.N.)
| | - Amit C Nathwani
- From the Department of Surgery, St. Jude Children's Research Hospital, and the Department of Surgery, University of Tennessee Health Science Center, Memphis (A.M.D.); and the Department of Hematology, University College London Cancer Institute, London (A.C.N.)
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31
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Piras BA, Drury JE, Morton CL, Spence Y, Lockey TD, Nathwani AC, Davidoff AM, Meagher MM. Distribution of AAV8 particles in cell lysates and culture media changes with time and is dependent on the recombinant vector. Mol Ther Methods Clin Dev 2016; 3:16015. [PMID: 27069949 PMCID: PMC4813606 DOI: 10.1038/mtm.2016.15] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Revised: 01/20/2016] [Accepted: 02/15/2016] [Indexed: 12/26/2022]
Abstract
With clinical trials ongoing, efficient clinical production of adeno-associated virus (AAV) to treat large numbers of patients remains a challenge. We compared distribution of AAV8 packaged with Factor VIII (FVIII) in cell culture media and lysates on days 3, 5, 6, and 7 post-transfection and found increasing viral production through day 6, with the proportion of viral particles in the media increasing from 76% at day 3 to 94% by day 7. Compared to FVIII, AAV8 packaged with Factor IX and Protective Protein/Cathepsin A vectors demonstrated a greater shift from lysate towards media from day 3 to 6, implying that particle distribution is dependent on recombinant vector. Larger-scale productions showed that the ratio of full-to-empty AAV particles is similar in media and lysate, and that AAV harvested on day 6 post-transfection provides equivalent function in mice compared to AAV harvested on day 3. This demonstrates that AAV8 production can be optimized by prolonging the duration of culture post-transfection, and simplified by allowing harvest of media only, with disposal of cells that contain 10% or less of total vector yield. Additionally, the difference in particle distribution with different expression cassettes implies a recombinant vector-dependent processing mechanism which should be taken into account during process development.
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Affiliation(s)
- Bryan A Piras
- Department of Therapeutics Production & Quality, St. Jude Children’s Research Hospital, Memphis, Tennessee, USA
| | - Jason E Drury
- Department of Therapeutics Production & Quality, St. Jude Children’s Research Hospital, Memphis, Tennessee, USA
| | - Christopher L Morton
- Department of Surgery, St. Jude Children’s Research Hospital, Memphis, Tennessee, USA
| | - Yunyu Spence
- Department of Surgery, St. Jude Children’s Research Hospital, Memphis, Tennessee, USA
| | - Timothy D Lockey
- Department of Therapeutics Production & Quality, St. Jude Children’s Research Hospital, Memphis, Tennessee, USA
| | - Amit C Nathwani
- UCL Katharine Dormandy Haemophilia and Thrombosis Centre, Royal Free Hospital, London, UK
| | - Andrew M Davidoff
- Department of Surgery, St. Jude Children’s Research Hospital, Memphis, Tennessee, USA
| | - Michael M Meagher
- Department of Therapeutics Production & Quality, St. Jude Children’s Research Hospital, Memphis, Tennessee, USA
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32
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Caxaria S, Arthold S, Nathwani AC, Goh PA. Generation of Integration-Free Patient Specific iPS Cells Using Episomal Plasmids Under Feeder Free Conditions. Methods Mol Biol 2016; 1353:355-366. [PMID: 25701132 DOI: 10.1007/7651_2015_204] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Reprogramming somatic cells into a pluripotent state involves the overexpression of transcription factors leading to a series of changes that end in the formation of induced pluripotent stem cells (iPSCs). These iPSCs have a wide range of potential uses from drug testing and in vitro disease modelling to personalized cell therapies for patients. While viral methods for reprogramming factor delivery have been traditionally preferred due to their high efficiency, it is now possible to generate iPSCs using nonviral methods at similar efficiencies. We developed a robust reprogramming strategy that combines episomal plasmids and the use of commercially available animal free reagents that can be easily adapted for the GMP manufacture of clinical grade cells.
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Affiliation(s)
- Sara Caxaria
- UCL Cancer Institute, University College London, London, WC1E 6BT, UK
| | - Susanne Arthold
- UCL Cancer Institute, University College London, London, WC1E 6BT, UK
| | - Amit C Nathwani
- UCL Cancer Institute, University College London, London, WC1E 6BT, UK
| | - Pollyanna Agnes Goh
- Centre for Paediatrics, Barts and The London Medical School, Blizard Institute, Queen Mary University of London, London, E1 2AT, UK.
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33
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Pytel KM, Paul-Smith MC, McIntosh J, Chan M, Meng C, Pringle I, Davis L, Inoue M, Hasegawa M, Hyde SC, Gill DR, Nathwani AC, Alton EWFW, Griesenbach U. S117 RSIV. F/HN-mediated gene therapy enables lungs to produce therapeutically relevant levels of FVIII. Thorax 2015. [DOI: 10.1136/thoraxjnl-2015-207770.123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Brimble MA, Reiss UM, Nathwani AC, Davidoff AM. New and improved AAVenues: current status of hemophilia B gene therapy. Expert Opin Biol Ther 2015; 16:79-92. [DOI: 10.1517/14712598.2015.1106475] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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35
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Lheriteau E, Davidoff AM, Nathwani AC. Haemophilia gene therapy: Progress and challenges. Blood Rev 2015; 29:321-8. [DOI: 10.1016/j.blre.2015.03.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Accepted: 03/04/2015] [Indexed: 10/23/2022]
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36
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Affiliation(s)
- Amit C Nathwani
- 1 Katharine Dormandy Haemophilia Centre and Thrombosis Unit , Royal Free NHS Foundation Trust, London NW3 2QG, United Kingdom
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37
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Yang J, AlTahan AM, Hu D, Wang Y, Cheng PH, Morton CL, Qu C, Nathwani AC, Shohet JM, Fotsis T, Koster J, Versteeg R, Okada H, Harris AL, Davidoff AM. The role of histone demethylase KDM4B in Myc signaling in neuroblastoma. J Natl Cancer Inst 2015; 107:djv080. [PMID: 25925418 PMCID: PMC4555638 DOI: 10.1093/jnci/djv080] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Epigenetic alterations, such as histone methylation, modulate Myc signaling, a pathway central to oncogenesis. We investigated the role of the histone demethylase KDM4B in N-Myc-mediated neuroblastoma pathogenesis. METHODS Spearman correlation was performed to correlate MYCN and KDM4B expression. RNA interference, microarray analysis, gene set enrichment analysis, and real-time polymerase chain reaction were used to define the functions of KDM4B. Immunoprecipitation and immunofluorescence were used to assess protein-protein interactions between N-Myc and KDM4B. Chromatin immunoprecipitation was used to assess the binding of Myc targets. Constitutive and inducible lentiviral-mediated KDM4B knockdown with shRNA was used to assess the effects on tumor growth. Kaplan-Meier survival analysis was used to assess the prognostic value of KDM4B expression. All statistical tests were two-sided. RESULTS KDM4B and MYCN expression were found to be statistically significantly correlated in a variety of cancers, including neuroblastoma (R = 0.396, P < .001). Functional studies demonstrated that KDM4B regulates the Myc pathway. N-Myc was found to physically interact with and recruit KDM4B. KDM4B was found to regulate neuroblastoma cell proliferation and differentiation in vitro and xenograft growth in vivo (5 mice/group, two-tailed t test, P ≤ 0.001). Finally, together with MYCN amplification, KDM4B was found to stratify a subgroup of poor-prognosis patients (122 case patients, P < .001). CONCLUSIONS Our findings provide insight into the epigenetic regulation of Myc via histone demethylation and proof-of-concept for inhibition of histone demethylases to target Myc signaling in cancers such as neuroblastoma.
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Affiliation(s)
- Jun Yang
- Department of Surgery (JY, AMA, DH, PHC, CLM, AMD) and Department of Bioinformatics (CQ), St. Jude Children's Research Hospital, Memphis, TN; Yale Cardiovascular Research Center, Yale School of Medicine, New Haven, CT (YW); Department of Oncology, University College London Cancer Institute, London, UK (ACN); Texas Children's Cancer Center, Department of Pediatrics, Baylor College of Medicine, Houston, TX (JMS); Division of Biomedical Research, Foundation of Research and Technology-Hellas, Institute of Molecular Biology and Biotechnology, Ioannina, Greece (TF); Laboratory of Biological Chemistry, Medical School, University of Ioannina, Ioannina, Greece (TF); Department of Oncogenomics, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands (JK, RV); Kinki University Faculty of Medicine, Osaka-Sayama, Osaka, Japan (HO); Molecular Oncology Laboratories, Weatherall Institute of Molecular Medicine, University of Oxford, John Radcliffe Hospital, Oxford, UK (ALH)
| | - Alaa M AlTahan
- Department of Surgery (JY, AMA, DH, PHC, CLM, AMD) and Department of Bioinformatics (CQ), St. Jude Children's Research Hospital, Memphis, TN; Yale Cardiovascular Research Center, Yale School of Medicine, New Haven, CT (YW); Department of Oncology, University College London Cancer Institute, London, UK (ACN); Texas Children's Cancer Center, Department of Pediatrics, Baylor College of Medicine, Houston, TX (JMS); Division of Biomedical Research, Foundation of Research and Technology-Hellas, Institute of Molecular Biology and Biotechnology, Ioannina, Greece (TF); Laboratory of Biological Chemistry, Medical School, University of Ioannina, Ioannina, Greece (TF); Department of Oncogenomics, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands (JK, RV); Kinki University Faculty of Medicine, Osaka-Sayama, Osaka, Japan (HO); Molecular Oncology Laboratories, Weatherall Institute of Molecular Medicine, University of Oxford, John Radcliffe Hospital, Oxford, UK (ALH)
| | - Dongli Hu
- Department of Surgery (JY, AMA, DH, PHC, CLM, AMD) and Department of Bioinformatics (CQ), St. Jude Children's Research Hospital, Memphis, TN; Yale Cardiovascular Research Center, Yale School of Medicine, New Haven, CT (YW); Department of Oncology, University College London Cancer Institute, London, UK (ACN); Texas Children's Cancer Center, Department of Pediatrics, Baylor College of Medicine, Houston, TX (JMS); Division of Biomedical Research, Foundation of Research and Technology-Hellas, Institute of Molecular Biology and Biotechnology, Ioannina, Greece (TF); Laboratory of Biological Chemistry, Medical School, University of Ioannina, Ioannina, Greece (TF); Department of Oncogenomics, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands (JK, RV); Kinki University Faculty of Medicine, Osaka-Sayama, Osaka, Japan (HO); Molecular Oncology Laboratories, Weatherall Institute of Molecular Medicine, University of Oxford, John Radcliffe Hospital, Oxford, UK (ALH)
| | - Yingdi Wang
- Department of Surgery (JY, AMA, DH, PHC, CLM, AMD) and Department of Bioinformatics (CQ), St. Jude Children's Research Hospital, Memphis, TN; Yale Cardiovascular Research Center, Yale School of Medicine, New Haven, CT (YW); Department of Oncology, University College London Cancer Institute, London, UK (ACN); Texas Children's Cancer Center, Department of Pediatrics, Baylor College of Medicine, Houston, TX (JMS); Division of Biomedical Research, Foundation of Research and Technology-Hellas, Institute of Molecular Biology and Biotechnology, Ioannina, Greece (TF); Laboratory of Biological Chemistry, Medical School, University of Ioannina, Ioannina, Greece (TF); Department of Oncogenomics, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands (JK, RV); Kinki University Faculty of Medicine, Osaka-Sayama, Osaka, Japan (HO); Molecular Oncology Laboratories, Weatherall Institute of Molecular Medicine, University of Oxford, John Radcliffe Hospital, Oxford, UK (ALH)
| | - Pei-Hsin Cheng
- Department of Surgery (JY, AMA, DH, PHC, CLM, AMD) and Department of Bioinformatics (CQ), St. Jude Children's Research Hospital, Memphis, TN; Yale Cardiovascular Research Center, Yale School of Medicine, New Haven, CT (YW); Department of Oncology, University College London Cancer Institute, London, UK (ACN); Texas Children's Cancer Center, Department of Pediatrics, Baylor College of Medicine, Houston, TX (JMS); Division of Biomedical Research, Foundation of Research and Technology-Hellas, Institute of Molecular Biology and Biotechnology, Ioannina, Greece (TF); Laboratory of Biological Chemistry, Medical School, University of Ioannina, Ioannina, Greece (TF); Department of Oncogenomics, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands (JK, RV); Kinki University Faculty of Medicine, Osaka-Sayama, Osaka, Japan (HO); Molecular Oncology Laboratories, Weatherall Institute of Molecular Medicine, University of Oxford, John Radcliffe Hospital, Oxford, UK (ALH)
| | - Christopher L Morton
- Department of Surgery (JY, AMA, DH, PHC, CLM, AMD) and Department of Bioinformatics (CQ), St. Jude Children's Research Hospital, Memphis, TN; Yale Cardiovascular Research Center, Yale School of Medicine, New Haven, CT (YW); Department of Oncology, University College London Cancer Institute, London, UK (ACN); Texas Children's Cancer Center, Department of Pediatrics, Baylor College of Medicine, Houston, TX (JMS); Division of Biomedical Research, Foundation of Research and Technology-Hellas, Institute of Molecular Biology and Biotechnology, Ioannina, Greece (TF); Laboratory of Biological Chemistry, Medical School, University of Ioannina, Ioannina, Greece (TF); Department of Oncogenomics, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands (JK, RV); Kinki University Faculty of Medicine, Osaka-Sayama, Osaka, Japan (HO); Molecular Oncology Laboratories, Weatherall Institute of Molecular Medicine, University of Oxford, John Radcliffe Hospital, Oxford, UK (ALH)
| | - Chunxu Qu
- Department of Surgery (JY, AMA, DH, PHC, CLM, AMD) and Department of Bioinformatics (CQ), St. Jude Children's Research Hospital, Memphis, TN; Yale Cardiovascular Research Center, Yale School of Medicine, New Haven, CT (YW); Department of Oncology, University College London Cancer Institute, London, UK (ACN); Texas Children's Cancer Center, Department of Pediatrics, Baylor College of Medicine, Houston, TX (JMS); Division of Biomedical Research, Foundation of Research and Technology-Hellas, Institute of Molecular Biology and Biotechnology, Ioannina, Greece (TF); Laboratory of Biological Chemistry, Medical School, University of Ioannina, Ioannina, Greece (TF); Department of Oncogenomics, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands (JK, RV); Kinki University Faculty of Medicine, Osaka-Sayama, Osaka, Japan (HO); Molecular Oncology Laboratories, Weatherall Institute of Molecular Medicine, University of Oxford, John Radcliffe Hospital, Oxford, UK (ALH)
| | - Amit C Nathwani
- Department of Surgery (JY, AMA, DH, PHC, CLM, AMD) and Department of Bioinformatics (CQ), St. Jude Children's Research Hospital, Memphis, TN; Yale Cardiovascular Research Center, Yale School of Medicine, New Haven, CT (YW); Department of Oncology, University College London Cancer Institute, London, UK (ACN); Texas Children's Cancer Center, Department of Pediatrics, Baylor College of Medicine, Houston, TX (JMS); Division of Biomedical Research, Foundation of Research and Technology-Hellas, Institute of Molecular Biology and Biotechnology, Ioannina, Greece (TF); Laboratory of Biological Chemistry, Medical School, University of Ioannina, Ioannina, Greece (TF); Department of Oncogenomics, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands (JK, RV); Kinki University Faculty of Medicine, Osaka-Sayama, Osaka, Japan (HO); Molecular Oncology Laboratories, Weatherall Institute of Molecular Medicine, University of Oxford, John Radcliffe Hospital, Oxford, UK (ALH)
| | - Jason M Shohet
- Department of Surgery (JY, AMA, DH, PHC, CLM, AMD) and Department of Bioinformatics (CQ), St. Jude Children's Research Hospital, Memphis, TN; Yale Cardiovascular Research Center, Yale School of Medicine, New Haven, CT (YW); Department of Oncology, University College London Cancer Institute, London, UK (ACN); Texas Children's Cancer Center, Department of Pediatrics, Baylor College of Medicine, Houston, TX (JMS); Division of Biomedical Research, Foundation of Research and Technology-Hellas, Institute of Molecular Biology and Biotechnology, Ioannina, Greece (TF); Laboratory of Biological Chemistry, Medical School, University of Ioannina, Ioannina, Greece (TF); Department of Oncogenomics, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands (JK, RV); Kinki University Faculty of Medicine, Osaka-Sayama, Osaka, Japan (HO); Molecular Oncology Laboratories, Weatherall Institute of Molecular Medicine, University of Oxford, John Radcliffe Hospital, Oxford, UK (ALH)
| | - Theodore Fotsis
- Department of Surgery (JY, AMA, DH, PHC, CLM, AMD) and Department of Bioinformatics (CQ), St. Jude Children's Research Hospital, Memphis, TN; Yale Cardiovascular Research Center, Yale School of Medicine, New Haven, CT (YW); Department of Oncology, University College London Cancer Institute, London, UK (ACN); Texas Children's Cancer Center, Department of Pediatrics, Baylor College of Medicine, Houston, TX (JMS); Division of Biomedical Research, Foundation of Research and Technology-Hellas, Institute of Molecular Biology and Biotechnology, Ioannina, Greece (TF); Laboratory of Biological Chemistry, Medical School, University of Ioannina, Ioannina, Greece (TF); Department of Oncogenomics, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands (JK, RV); Kinki University Faculty of Medicine, Osaka-Sayama, Osaka, Japan (HO); Molecular Oncology Laboratories, Weatherall Institute of Molecular Medicine, University of Oxford, John Radcliffe Hospital, Oxford, UK (ALH)
| | - Jan Koster
- Department of Surgery (JY, AMA, DH, PHC, CLM, AMD) and Department of Bioinformatics (CQ), St. Jude Children's Research Hospital, Memphis, TN; Yale Cardiovascular Research Center, Yale School of Medicine, New Haven, CT (YW); Department of Oncology, University College London Cancer Institute, London, UK (ACN); Texas Children's Cancer Center, Department of Pediatrics, Baylor College of Medicine, Houston, TX (JMS); Division of Biomedical Research, Foundation of Research and Technology-Hellas, Institute of Molecular Biology and Biotechnology, Ioannina, Greece (TF); Laboratory of Biological Chemistry, Medical School, University of Ioannina, Ioannina, Greece (TF); Department of Oncogenomics, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands (JK, RV); Kinki University Faculty of Medicine, Osaka-Sayama, Osaka, Japan (HO); Molecular Oncology Laboratories, Weatherall Institute of Molecular Medicine, University of Oxford, John Radcliffe Hospital, Oxford, UK (ALH)
| | - Rogier Versteeg
- Department of Surgery (JY, AMA, DH, PHC, CLM, AMD) and Department of Bioinformatics (CQ), St. Jude Children's Research Hospital, Memphis, TN; Yale Cardiovascular Research Center, Yale School of Medicine, New Haven, CT (YW); Department of Oncology, University College London Cancer Institute, London, UK (ACN); Texas Children's Cancer Center, Department of Pediatrics, Baylor College of Medicine, Houston, TX (JMS); Division of Biomedical Research, Foundation of Research and Technology-Hellas, Institute of Molecular Biology and Biotechnology, Ioannina, Greece (TF); Laboratory of Biological Chemistry, Medical School, University of Ioannina, Ioannina, Greece (TF); Department of Oncogenomics, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands (JK, RV); Kinki University Faculty of Medicine, Osaka-Sayama, Osaka, Japan (HO); Molecular Oncology Laboratories, Weatherall Institute of Molecular Medicine, University of Oxford, John Radcliffe Hospital, Oxford, UK (ALH)
| | - Hitoshi Okada
- Department of Surgery (JY, AMA, DH, PHC, CLM, AMD) and Department of Bioinformatics (CQ), St. Jude Children's Research Hospital, Memphis, TN; Yale Cardiovascular Research Center, Yale School of Medicine, New Haven, CT (YW); Department of Oncology, University College London Cancer Institute, London, UK (ACN); Texas Children's Cancer Center, Department of Pediatrics, Baylor College of Medicine, Houston, TX (JMS); Division of Biomedical Research, Foundation of Research and Technology-Hellas, Institute of Molecular Biology and Biotechnology, Ioannina, Greece (TF); Laboratory of Biological Chemistry, Medical School, University of Ioannina, Ioannina, Greece (TF); Department of Oncogenomics, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands (JK, RV); Kinki University Faculty of Medicine, Osaka-Sayama, Osaka, Japan (HO); Molecular Oncology Laboratories, Weatherall Institute of Molecular Medicine, University of Oxford, John Radcliffe Hospital, Oxford, UK (ALH)
| | - Adrian L Harris
- Department of Surgery (JY, AMA, DH, PHC, CLM, AMD) and Department of Bioinformatics (CQ), St. Jude Children's Research Hospital, Memphis, TN; Yale Cardiovascular Research Center, Yale School of Medicine, New Haven, CT (YW); Department of Oncology, University College London Cancer Institute, London, UK (ACN); Texas Children's Cancer Center, Department of Pediatrics, Baylor College of Medicine, Houston, TX (JMS); Division of Biomedical Research, Foundation of Research and Technology-Hellas, Institute of Molecular Biology and Biotechnology, Ioannina, Greece (TF); Laboratory of Biological Chemistry, Medical School, University of Ioannina, Ioannina, Greece (TF); Department of Oncogenomics, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands (JK, RV); Kinki University Faculty of Medicine, Osaka-Sayama, Osaka, Japan (HO); Molecular Oncology Laboratories, Weatherall Institute of Molecular Medicine, University of Oxford, John Radcliffe Hospital, Oxford, UK (ALH)
| | - Andrew M Davidoff
- Department of Surgery (JY, AMA, DH, PHC, CLM, AMD) and Department of Bioinformatics (CQ), St. Jude Children's Research Hospital, Memphis, TN; Yale Cardiovascular Research Center, Yale School of Medicine, New Haven, CT (YW); Department of Oncology, University College London Cancer Institute, London, UK (ACN); Texas Children's Cancer Center, Department of Pediatrics, Baylor College of Medicine, Houston, TX (JMS); Division of Biomedical Research, Foundation of Research and Technology-Hellas, Institute of Molecular Biology and Biotechnology, Ioannina, Greece (TF); Laboratory of Biological Chemistry, Medical School, University of Ioannina, Ioannina, Greece (TF); Department of Oncogenomics, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands (JK, RV); Kinki University Faculty of Medicine, Osaka-Sayama, Osaka, Japan (HO); Molecular Oncology Laboratories, Weatherall Institute of Molecular Medicine, University of Oxford, John Radcliffe Hospital, Oxford, UK (ALH).
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Pytel KM, Paul-Smith M, McIntosh J, Chan M, Meng C, Pringle I, Davies L, Inoue M, Hasegawa M, Hyde SC, Gill DR, Nathwani AC, Alton EW, Griesenbach U. 171. Production of Therapeutically Relevant Levels of FVIII After Transduction of Lungs With F/HN-Pseudotyped Lentivirus. Mol Ther 2015. [DOI: 10.1016/s1525-0016(16)33776-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Della Peruta M, Badar A, Rosales C, Chokshi S, Kia A, Nathwani D, Galante E, Yan R, Arstad E, Davidoff AM, Williams R, Lythgoe MF, Nathwani AC. Preferential targeting of disseminated liver tumors using a recombinant adeno-associated viral vector. Hum Gene Ther 2015; 26:94-103. [PMID: 25569358 PMCID: PMC4326028 DOI: 10.1089/hum.2014.052] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Accepted: 11/10/2014] [Indexed: 12/18/2022] Open
Abstract
A novel selectively targeting gene delivery approach has been developed for advanced hepatocellular carcinoma (HCC), a leading cause of cancer mortality whose prognosis remains poor. We combine the strong liver tropism of serotype-8 capsid-pseudotyped adeno-associated viral vectors (AAV8) with a liver-specific promoter (HLP) and microRNA-122a (miR-122a)-mediated posttranscriptional regulation. Systemic administration of our AAV8 construct resulted in preferential transduction of the liver and encouragingly of HCC at heterotopic sites, a finding that could be exploited to target disseminated disease. Tumor selectivity was enhanced by inclusion of miR-122a-binding sequences (ssAAV8-HLP-TK-122aT4) in the expression cassette, resulting in abrogation of transgene expression in normal murine liver but not in HCC. Systemic administration of our tumor-selective vector encoding herpes simplex virus-thymidine kinase (TK) suicide gene resulted in a sevenfold reduction in HCC growth in a syngeneic murine model without toxicity. In summary, we have developed a systemically deliverable gene transfer approach that enables high-level expression of therapeutic genes in HCC but not normal tissues, thus improving the prospects of safe and effective treatment for advanced HCC.
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Affiliation(s)
- Marco Della Peruta
- Institute of Hepatology, Foundation for Liver Research, London WC1E 6HX, United Kingdom
- Department of Haematology, UCL Cancer Institute, University College London, London WC1E 6BT, United Kingdom
| | - Adam Badar
- Division of Medicine, UCL Centre for Advanced Biomedical Imaging, University College London, London WC1E 6DD, United Kingdom
| | - Cecilia Rosales
- Department of Haematology, UCL Cancer Institute, University College London, London WC1E 6BT, United Kingdom
- NHS Blood and Transplant, London W1W 8NB, United Kingdom
| | - Shilpa Chokshi
- Institute of Hepatology, Foundation for Liver Research, London WC1E 6HX, United Kingdom
| | - Azadeh Kia
- Department of Haematology, UCL Cancer Institute, University College London, London WC1E 6BT, United Kingdom
| | - Devhrut Nathwani
- Department of Haematology, UCL Cancer Institute, University College London, London WC1E 6BT, United Kingdom
| | - Eva Galante
- Institute of Nuclear Medicine and Department of Chemistry, University College London, London WC1H 0AJ, United Kingdom
| | - Ran Yan
- Institute of Nuclear Medicine and Department of Chemistry, University College London, London WC1H 0AJ, United Kingdom
| | - Erik Arstad
- Institute of Nuclear Medicine and Department of Chemistry, University College London, London WC1H 0AJ, United Kingdom
| | - Andrew M. Davidoff
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, TN 33105-3678
| | - Roger Williams
- Institute of Hepatology, Foundation for Liver Research, London WC1E 6HX, United Kingdom
| | - Mark F. Lythgoe
- Division of Medicine, UCL Centre for Advanced Biomedical Imaging, University College London, London WC1E 6DD, United Kingdom
| | - Amit C. Nathwani
- Department of Haematology, UCL Cancer Institute, University College London, London WC1E 6BT, United Kingdom
- NHS Blood and Transplant, London W1W 8NB, United Kingdom
- Katharine Dormandy Haemophilia Centre and Thrombosis Unit, Royal Free Hospital, London NW3 2QG, United Kingdom
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Nathwani AC, Reiss UM, Tuddenham EGD, Rosales C, Chowdary P, McIntosh J, Della Peruta M, Lheriteau E, Patel N, Raj D, Riddell A, Pie J, Rangarajan S, Bevan D, Recht M, Shen YM, Halka KG, Basner-Tschakarjan E, Mingozzi F, High KA, Allay J, Kay MA, Ng CYC, Zhou J, Cancio M, Morton CL, Gray JT, Srivastava D, Nienhuis AW, Davidoff AM. Long-term safety and efficacy of factor IX gene therapy in hemophilia B. N Engl J Med 2014; 371:1994-2004. [PMID: 25409372 PMCID: PMC4278802 DOI: 10.1056/nejmoa1407309] [Citation(s) in RCA: 905] [Impact Index Per Article: 90.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND In patients with severe hemophilia B, gene therapy that is mediated by a novel self-complementary adeno-associated virus serotype 8 (AAV8) vector has been shown to raise factor IX levels for periods of up to 16 months. We wanted to determine the durability of transgene expression, the vector dose-response relationship, and the level of persistent or late toxicity. METHODS We evaluated the stability of transgene expression and long-term safety in 10 patients with severe hemophilia B: 6 patients who had been enrolled in an initial phase 1 dose-escalation trial, with 2 patients each receiving a low, intermediate, or high dose, and 4 additional patients who received the high dose (2×10(12) vector genomes per kilogram of body weight). The patients subsequently underwent extensive clinical and laboratory monitoring. RESULTS A single intravenous infusion of vector in all 10 patients with severe hemophilia B resulted in a dose-dependent increase in circulating factor IX to a level that was 1 to 6% of the normal value over a median period of 3.2 years, with observation ongoing. In the high-dose group, a consistent increase in the factor IX level to a mean (±SD) of 5.1±1.7% was observed in all 6 patients, which resulted in a reduction of more than 90% in both bleeding episodes and the use of prophylactic factor IX concentrate. A transient increase in the mean alanine aminotransferase level to 86 IU per liter (range, 36 to 202) occurred between week 7 and week 10 in 4 of the 6 patients in the high-dose group but resolved over a median of 5 days (range, 2 to 35) after prednisolone treatment. CONCLUSIONS In 10 patients with severe hemophilia B, the infusion of a single dose of AAV8 vector resulted in long-term therapeutic factor IX expression associated with clinical improvement. With a follow-up period of up to 3 years, no late toxic effects from the therapy were reported. (Funded by the National Heart, Lung, and Blood Institute and others; ClinicalTrials.gov number, NCT00979238.).
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Goh PA, Caxaria S, Casper C, Rosales C, Warner TT, Coffey PJ, Nathwani AC. A systematic evaluation of integration free reprogramming methods for deriving clinically relevant patient specific induced pluripotent stem (iPS) cells. PLoS One 2013; 8:e81622. [PMID: 24303062 PMCID: PMC3841145 DOI: 10.1371/journal.pone.0081622] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2013] [Accepted: 10/23/2013] [Indexed: 12/31/2022] Open
Abstract
A systematic evaluation of three different methods for generating induced pluripotent stem (iPS) cells was performed using the same set of parental cells in our quest to develop a feeder independent and xeno-free method for somatic cell reprogramming that could be transferred into a GMP environment. When using the BJ fibroblast cell line, the highest reprogramming efficiency (1.89% of starting cells) was observed with the mRNA based method which was almost 20 fold higher than that observed with the retrovirus (0.2%) and episomal plasmid (0.10%) methods. Standard characterisation tests did not reveal any differences in an array of pluripotency markers between the iPS lines derived using the various methods. However, when the same methods were used to reprogram three different primary fibroblasts lines, two derived from patients with rapid onset parkinsonism dystonia and one from an elderly healthy volunteer, we consistently observed higher reprogramming efficiencies with the episomal plasmid method, which was 4 fold higher when compared to the retroviral method and over 50 fold higher than the mRNA method. Additionally, with the plasmid reprogramming protocol, recombinant vitronectin and synthemax® could be used together with commercially available, fully defined, xeno-free essential 8 medium without significantly impacting the reprogramming efficiency. To demonstrate the robustness of this protocol, we reprogrammed a further 2 primary patient cell lines, one with retinosa pigmentosa and the other with Parkinsons disease. We believe that we have optimised a simple and reproducible method which could be used as a starting point for developing GMP protocols, a prerequisite for generating clinically relevant patient specific iPS cells.
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Affiliation(s)
- Pollyanna A. Goh
- Research Department of Haematology, University College London Cancer Institute, University College London, London, United Kingdom
- National Health Service Blood and Transplant Unit, National Health Service, London, United Kingdom
| | - Sara Caxaria
- Research Department of Haematology, University College London Cancer Institute, University College London, London, United Kingdom
- National Health Service Blood and Transplant Unit, National Health Service, London, United Kingdom
| | - Catharina Casper
- Reta Lila Weston Institute of Neurological Studies, Institute of Neurology, University College London, London, United Kingdom
| | - Cecilia Rosales
- Research Department of Haematology, University College London Cancer Institute, University College London, London, United Kingdom
- National Health Service Blood and Transplant Unit, National Health Service, London, United Kingdom
| | - Thomas T. Warner
- Reta Lila Weston Institute of Neurological Studies, Institute of Neurology, University College London, London, United Kingdom
| | - Pete J. Coffey
- Ocular Biology and Therapeutics, Institute of Ophthalmology, University College London, London, United Kingdom
| | - Amit C. Nathwani
- Research Department of Haematology, University College London Cancer Institute, University College London, London, United Kingdom
- National Health Service Blood and Transplant Unit, National Health Service, London, United Kingdom
- Katharine Dormandy Haemophilia Centre and Thrombosis Unit, Royal Free Hospital, London, United Kingdom
- * E-mail:
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Cancio MI, Reiss UM, Nathwani AC, Davidoff AM, Gray JT. Developments in the treatment of hemophilia B: focus on emerging gene therapy. Appl Clin Genet 2013; 6:91-101. [PMID: 24159262 PMCID: PMC3805181 DOI: 10.2147/tacg.s31928] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Hemophilia B is a genetic disorder that is characterized by a deficiency of clotting factor IX (FIX) and excessive bleeding. Advanced understanding of the pathophysiology of the disease has led to the development of improved treatment strategies that aim to minimize the acute and long-term complications of the disease. Patients with hemophilia B are ideal candidates for gene therapy, mostly because a small increase in protein production can lead to significantly decreased bleeding diathesis. Although human clotting FIX was cloned and sequenced over 30 years ago, progress toward achieving real success in human clinical trials has been slow, with long-term, therapeutically relevant gene expression only achieved in one trial published in 2011. The history of this extensive research effort has revealed the importance of the interactions between gene therapy vectors and multiple arms of the host immune system at multiple stages of the transduction process. Different viral vector systems each have unique properties that influence their ability to deliver genes to different tissues, and the data generated in several clinical trials testing different vectors for hemophilia have guided our understanding toward development of optimal configurations for treating hemophilia B. The recent clinical success implementing a novel adeno-associated virus vector demonstrated sufficient FIX expression in patients to convert a severe hemophilia phenotype to mild, an achievement which has the potential to profoundly alter the impact of this disease on human society. Continued research should lead to vector designs that result in higher FIX activity at lower vector doses and with reduced host immune responses to the vector and the transgene product.
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Fagone P, Wright JF, Nathwani AC, Nienhuis AW, Davidoff AM, Gray JT. Systemic errors in quantitative polymerase chain reaction titration of self-complementary adeno-associated viral vectors and improved alternative methods. Hum Gene Ther Methods 2013; 23:1-7. [PMID: 22428975 DOI: 10.1089/hgtb.2011.104] [Citation(s) in RCA: 70] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Self-complementary AAV (scAAV) vector genomes contain a covalently closed hairpin derived from a mutated inverted terminal repeat that connects the two monomer single-stranded genomes into a head-to-head or tail-to-tail dimer. We found that during quantitative PCR (qPCR) this structure inhibits the amplification of proximal amplicons and causes the systemic underreporting of copy number by as much as 10-fold. We show that cleavage of scAAV vector genomes with restriction endonuclease to liberate amplicons from the covalently closed terminal hairpin restores quantitative amplification, and we implement this procedure in a simple, modified qPCR titration method for scAAV vectors. In addition, we developed and present an AAV genome titration procedure based on gel electrophoresis that requires minimal sample processing and has low interassay variability, and as such is well suited for the rigorous quality control demands of clinical vector production facilities.
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Affiliation(s)
- Paolo Fagone
- Department of Hematology, St. Jude Children's Research Hospital, Memphis, TN 38105, USA
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Mattar CN, Waddington SN, Biswas A, Davidoff AM, Choolani M, Chan JKY, Nathwani AC. The case for intrauterine gene therapy. Best Pract Res Clin Obstet Gynaecol 2012; 26:697-709. [PMID: 22819290 DOI: 10.1016/j.bpobgyn.2012.06.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2012] [Accepted: 06/12/2012] [Indexed: 01/21/2023]
Abstract
Single-gene disorders can cause perinatal mortality or severe permanent morbidity. Intrauterine gene therapy seeks to correct the genetic defect in the early stages of pathogenesis through delivery of a vector system expressing the therapeutic transgene to the fetus. Advantages of intrauterine gene therapy include prevention of irreversible organ damage, potentially inducing central tolerance and wider bio-distribution, including the brain after delivery of vector. Already, proof-of-cure has been demonstrated in knockout animal models for several diseases. Long-term outcomes pertaining to efficacy and durability of transgene expression and safety are under investigation in clinically relevant non-human primate models. Bystander effects in the mother from transplacental vector trafficking require further assessment. In this chapter, we discuss the candidate diseases amenable to intrauterine gene therapy, current state-of-the-art evidence, and potential clinical applications.
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Affiliation(s)
- Citra N Mattar
- Experimental Fetal Medicine Group, Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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Raj D, Davidoff AM, Nathwani AC. Self-complementary adeno-associated viral vectors for gene therapy of hemophilia B: progress and challenges. Expert Rev Hematol 2012; 4:539-49. [PMID: 21939421 DOI: 10.1586/ehm.11.48] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Therapies currently used for hemophilia involve injection of protein concentrates that are expensive, invasive and associated with side effects such as development of neutralizing antibodies (inhibitors) that diminish therapeutic efficacy. Gene transfer is an attractive alternative to circumvent these issues. However, until now, clinical trials using gene therapy to treat hemophilia have failed to demonstrate sustained efficacy, although a vector based on a self-complementary adeno-associated virus has recently shown promise. This article will briefly outline a novel gene-transfer approach using self-complementary adeno-associated viral vectors using hemophilia B as a target disorder. This approach is currently being evaluated in the clinic. We will provide an overview of the development of self-complementary adeno-associated virus vectors as well as preclinical and clinical data with this vector system.
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Affiliation(s)
- Deepak Raj
- Department of Haematology, University College London Cancer Institute, London, UK
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Nathwani AC, Tuddenham EGD, Rangarajan S, Rosales C, McIntosh J, Linch DC, Chowdary P, Riddell A, Pie AJ, Harrington C, O'Beirne J, Smith K, Pasi J, Glader B, Rustagi P, Ng CYC, Kay MA, Zhou J, Spence Y, Morton CL, Allay J, Coleman J, Sleep S, Cunningham JM, Srivastava D, Basner-Tschakarjan E, Mingozzi F, High KA, Gray JT, Reiss UM, Nienhuis AW, Davidoff AM. Adenovirus-associated virus vector-mediated gene transfer in hemophilia B. N Engl J Med 2011; 365:2357-65. [PMID: 22149959 PMCID: PMC3265081 DOI: 10.1056/nejmoa1108046] [Citation(s) in RCA: 1321] [Impact Index Per Article: 101.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Hemophilia B, an X-linked disorder, is ideally suited for gene therapy. We investigated the use of a new gene therapy in patients with the disorder. METHODS We infused a single dose of a serotype-8-pseudotyped, self-complementary adenovirus-associated virus (AAV) vector expressing a codon-optimized human factor IX (FIX) transgene (scAAV2/8-LP1-hFIXco) in a peripheral vein in six patients with severe hemophilia B (FIX activity, <1% of normal values). Study participants were enrolled sequentially in one of three cohorts (given a high, intermediate, or low dose of vector), with two participants in each group. Vector was administered without immunosuppressive therapy, and participants were followed for 6 to 16 months. RESULTS AAV-mediated expression of FIX at 2 to 11% of normal levels was observed in all participants. Four of the six discontinued FIX prophylaxis and remained free of spontaneous hemorrhage; in the other two, the interval between prophylactic injections was increased. Of the two participants who received the high dose of vector, one had a transient, asymptomatic elevation of serum aminotransferase levels, which was associated with the detection of AAV8-capsid-specific T cells in the peripheral blood; the other had a slight increase in liver-enzyme levels, the cause of which was less clear. Each of these two participants received a short course of glucocorticoid therapy, which rapidly normalized aminotransferase levels and maintained FIX levels in the range of 3 to 11% of normal values. CONCLUSIONS Peripheral-vein infusion of scAAV2/8-LP1-hFIXco resulted in FIX transgene expression at levels sufficient to improve the bleeding phenotype, with few side effects. Although immune-mediated clearance of AAV-transduced hepatocytes remains a concern, this process may be controlled with a short course of glucocorticoids without loss of transgene expression. (Funded by the Medical Research Council and others; ClinicalTrials.gov number, NCT00979238.).
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Affiliation(s)
- Amit C Nathwani
- Department of Haematology, University College London Cancer Institute, London, United Kingdom.
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Denbo JW, Williams RF, Orr WS, Sims TL, Ng CY, Zhou J, Spence Y, Morton CL, Nathwani AC, Duntsch C, Pfeffer LM, Davidoff AM. Continuous local delivery of interferon-β stabilizes tumor vasculature in an orthotopic glioblastoma xenograft resection model. Surgery 2011; 150:497-504. [PMID: 21878236 DOI: 10.1016/j.surg.2011.07.044] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2011] [Accepted: 07/11/2011] [Indexed: 11/19/2022]
Abstract
BACKGROUND High-grade glioblastomas have immature, leaky tumor blood vessels that impede the efficacy of adjuvant therapy. We assessed the ability of human interferon (hIFN)-β delivered locally via gene transfer to effect vascular stabilization in an orthotopic model of glioblastoma xenograft resection. METHODS Xenografts were established by injecting 3 grade IV glioblastoma cell lines (GBM6-luc, MT330-luc, and SJG2-luc) into the cerebral cortex of nude rats. Tumors underwent subtotal resection, and then had gel foam containing an adeno-associated virus vector encoding either hIFN-β or green fluorescence protein (control) placed in the resection cavity. The primary endpoint was stabilization of tumor vasculature, as evidenced by CD34, α-SMA, and CA IX staining. Overall survival was a secondary endpoint. RESULTS hIFN-β treatment altered the tumor vasculature of GBM6-luc and SJG2-luc xenografts, decreasing the density of endothelial cells, stabilizing vessels with pericytes, and decreasing tumor hypoxia. The mean survival for rats with these neoplasms was not improved, however. In rats with MT330-luc xenografts, hIFN-β resulted in tumor regression with a 6-month survival of 55% (INF-β group) and 9% (control group). CONCLUSION The use of AAV hIFN-β in our orthotopic model of glioblastoma resection stabilized tumor vasculature and improved survival in rats with MT330 xenografts.
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Affiliation(s)
- Jason W Denbo
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, TN; Department of Surgery, University of Tennessee Health Science Center, Memphis, TN, USA
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Mattar CNZ, Nathwani AC, Waddington SN, Dighe N, Kaeppel C, Nowrouzi A, Mcintosh J, Johana NB, Ogden B, Fisk NM, Davidoff AM, David A, Peebles D, Valentine MB, Appelt JU, von Kalle C, Schmidt M, Biswas A, Choolani M, Chan JKY. Stable human FIX expression after 0.9G intrauterine gene transfer of self-complementary adeno-associated viral vector 5 and 8 in macaques. Mol Ther 2011; 19:1950-60. [PMID: 21629224 PMCID: PMC3222517 DOI: 10.1038/mt.2011.107] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2010] [Accepted: 03/20/2011] [Indexed: 12/26/2022] Open
Abstract
Intrauterine gene transfer (IUGT) offers ontological advantages including immune naiveté mediating tolerance to the vector and transgenic products, and effecting a cure before development of irreversible pathology. Despite proof-of-principle in rodent models, expression efficacy with a therapeutic transgene has yet to be demonstrated in a preclinical nonhuman primate (NHP) model. We aimed to determine the efficacy of human Factor IX (hFIX) expression after adeno-associated-viral (AAV)-mediated IUGT in NHP. We injected 1.0-1.95 × 10(13) vector genomes (vg)/kg of self-complementary (sc) AAV5 and 8 with a LP1-driven hFIX transgene intravenously in 0.9G late gestation NHP fetuses, leading to widespread transduction with liver tropism. Liver-specific hFIX expression was stably maintained between 8 and 112% of normal activity in injected offspring followed up for 2-22 months. AAV8 induced higher hFIX expression (P = 0.005) and milder immune response than AAV5. Random hepatocellular integration was found with no hotspots. Transplacental spread led to low-level maternal tissue transduction, without evidence of immunotoxicity or germline transduction in maternal oocytes. A single intravenous injection of scAAV-LP1-hFIXco to NHP fetuses in late-gestation produced sustained clinically-relevant levels of hFIX with liver-specific expression and a non-neutralizing immune response. These data are encouraging for conditions where gene transfer has the potential to avert perinatal death and long-term irreversible sequelae.
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Affiliation(s)
- Citra N Z Mattar
- Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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Fagone P, Wright JF, Nathwani AC, Nienhuis AW, Davidoff AM, Gray JT. Systemic Errors in Quantitative Polymerase Chain Reaction Titration of Self-Complementary Adeno-Associated Viral Vectors and Improved Alternative Methods. Hum Gene Ther 2011. [DOI: 10.1089/hum.2011.104] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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