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Haematopoietic stem cells (HSCs) are regarded as the prime target for gene therapy of inherited and acquired disorders of the blood system, e.g. X-linked chronic granulomatous disease (X-CGD). The major reason for this is that HSCs posses the ability to self renew as well as the potential to differentiate into all lineage-specific cell types. However, the need to reach and to maintain sufficient therapeutic levels of genetically modified stem cells and their progeny after gene delivery still presents major challenges for current HSC gene therapy approaches. In particular, one of the main limitations for most genetic defects is the lack of a selective growth advantage of gene-modified cells after engraftment. In vitro and in vivo methods have been developed that focus on either positive or negative selection of HSCs. An artificial selection advantage can be conferred to transduced HSCs by incorporating a selection marker in addition to the therapeutic transgene. In the present study, two novel strategies for positive selection of murine gp91phox gene-modified haematopoietic stem cells were developed and tested, bearing in mind that with selective growth advantage, the possibility of uncontrolled proliferation arises. The first strategy to be investigated was based on the homeobox transcription factor HOXB4, which plays an important role in the control of haematopoietic stem cell proliferation and differentiation. Overexpression of a retroviral bicistronic construct containing the therapeutic gene gp91phox and HOXB4 in murine primary bone marrow cells led to a significant 3–4-fold expansion of transduced cells ex vivo. The numbers of transgene-expressing cells increased 2–3-fold after 2 weeks cultivation under cytokine stimulation. Furthermore, the clonogenic progenitor cell assay (CFU assay) demonstrated that the number of colony-forming cells had increased to levels 2-fold higher than those of mock-transduced cells after 1 week of culture, thereby augmenting the presence of a significant number of stem/progenitor cells in the selected cell population. However, in our experiments, HOXB4-overexpressing murine HSCs did not show any repopulating advantage in transplanted recipient mice over control construct-transduced HSCs. These results indicate that selective expansion of gp91phox gene-modified HSCs can be induced by the HOXB4 transcription factor ex vivo but not in vivo. This is possibly dependent on HOXB4 expression levels, which are too low in vivo to achieve selection. The second strategy made use of a chemically inducible dimerizer system consisting of the therapeutic gene gp91phox and a fusion protein, containing sequences from a growth factor receptor signalling domain (epidermal growth factor receptor, EGFR, or prolactin receptor, PrlR) and the drug binding protein FKBP12, as the selection cassette. This strategy aimed to allow inducible selection that could be easily switched off. The activity of these fusion proteins is controlled through the small molecular dimerizer AP20187. Transduction of BaF/3 cells with lentiviral vectors expressing the EGFR construct induced proliferation and led to complete selection within 18 days (99%). However, removing AP20187 could not turn off proliferation. This construct is, therefore, not suitable as a selection cassette for the expansion of gene-modified HSCs due to its oncogenic potential. Transduction of the construct containing the intracellular domain of PrlR caused significant selective expansion of AP20187-treated BaF/3 cells. Following expression in cells, the fusion protein, which lacks membrane-anchoring sequences, mainly localized to the cytoplasm. Evidence was found to indicate that activated STAT5 might be responsible for this effect. Upon expression of the prolactin construct, phosphorylation of STAT5 and its DNA-binding activity to a ß-casein promoter sequence was strongly increased. Importantly, the induced proliferation was reversible after removal of AP20187. Transduced Sca1+ bone marrow cells obtained from C57BL/6-CD45.1 mice could be expanded about 20–100-fold ex vivo in the presence of AP20187 and mSCF without losing progenitor cell features and the capability to contribute to all lineages of the haematopoietic system. To exclude oncogenic outgrowth of one single clone, the polyclonality of selected cells was proven by ligation-mediated PCR (LM-PCR) analysis. In mouse transplantation experiments, ex vivo-expanded cells repopulated the bone marrow of lethally irradiated mice suggesting that the ex vivo expansion took place at the level of haematopoietic stem and/or progenitor cells. Genomic gp91phox sequences were detected in the bone marrow, spleen and peripheral blood cells of transplanted animals, indicating that gp91phox-containing cells most likely contributed to the reconstitution of haematopoiesis in these mice.
NK cells are part of the innate immune system, and are important players in the body’s first defence line against virus-infected and malignantly transformed cells. While T cells recognize neoplastic cells in an MHC-restricted fashion, NK cells do not require prior sensitization and education about the target. In leukemia and lymphoma patients undergoing allogeneic hematopoietic stem cell transplantation not only T cells but also NK cells have been found to mediate potent graft-versus-tumor effects. Hence, autologous or donor-derived NK cells hold great promise for cancer immunotherapy. Since the generation of highly purified NK cell products for clinical applications is labor-intensive and time consuming, established human NK cell lines such as NK-92 are also being considered for clinical protocols. NK-92 cells display phenotypic and functional characteristics similar to activated primary NK cells. While NK-92 cells are highly cytotoxic towards malignant cells of hematologic origin, they do not affect healthy human tissues. NK-92 cells can be expanded under GMP-compliant conditions, and can therefore be provided in sufficient numbers with defined phenotypic characteristics for clinical applications. Safety of NK-92 cells for adoptive immunotherapy was already shown in two phase I/II clinical trials...