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12/3/2018 8:23:02 PM

Autologous gene therapy shows promise for sickle cell disease

SAN DIEGO — An adult with sickle cell disease responded positively to autologous gene therapy, providing the first proof that this approach could be effective for sickle cell disease, according to results of a pilot study presented at ASH Annual Meeting and Exposition.

The patient received an infusion of their own stem cells in which researchers had flipped a genetic “switch” of fetal to adult globin by knocking down BCL11A to induce the cells to start producing healthy hemoglobin and stop producing sickle hemoglobin.

“Obviously, you can’t draw large conclusions from [one patient], but in a small study where this is the first demonstration of the proof of principle, it is very encouraging to see the expected result based on our preclinical work of increasing fetal hemoglobin,” Erica B. Esrick, MD, hematologist at Dana-Farber/Boston Children’s Cancer and Blood Disorders Center, told HemOnc Today. “Of course, we’ll need more data from more patients to draw larger conclusions.”

The only current cure for sickle cell disease is a hematopoietic stem cell transplantation from a healthy matching donor. However, many patients lack a matching donor or their transplants fail.

Fetal hemoglobin has been previously found to stop the development of sickle hemoglobin polymers.

The BCL11A protein is a validated repressor of fetal hemoglobin. Recent preclinical research has shown that suppressing the action of BCL11A can reverse sickle cell disease by reactivating fetal hemoglobin production.

Thus, researchers hypothesized that knocking down BCL11A with RNA interference would induce gamma-globulin expression. They genetically engineered a virus to deliver a gene that blocks the BCL11A protein in red blood cells using microRNA to simultaneous increase fetal hemoglobin and decrease sickle hemoglobin.

Murine models showed erythroid-specific expression of microRNA-adapted short hairpin RNAs (shRNAmiR) targeting BCL11A effectively induced fetal hemoglobin in human erythroid cells derived from transduced hematopoietic stem cells, mitigating the hematologic effects of sickle cell disease while avoiding negative effects in the stem cells and B lymphocytes.

“Our gene therapy approach is unique in that it leverages the physiology of the hemoglobin switch to simultaneously increase fetal hemoglobin, which does not sickle, and directly reduce sickling hemoglobin,” study author David A. Williams, MD, president of Dana-Farber/Boston Children’s Cancer and Blood Disorders Center, chief scientific officer and senior vice president of Boston Children's Hospital, and professor at Harvard Medical School, said in a press release. “Other gene therapy trials for sickle cell disease are adding genes that encode fetal hemoglobin or corrected, nonsickling adult hemoglobin, without directly targeting the fetal switch of the sickle hemoglobin gene. We predict this strategy is a very effective way to reduce or even eliminate the sickling of cells.”