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Eine in vivo Modifizierung von Blutstammzellen wäre für eine Reihe gentherapeutischer Therapieansätze vorteilhaft. Dies würde voraussetzen, dass retrovirale Vektoren gezielt auf Blutstammzellen ausgerichtet werden können. Für dieses sogenannte Zelltargeting bietet sich das vom Milznekrose-Virus von Vögeln (SNV) abgeleitete Vektorsystem an, bei dem die Rezeptorbindungsdomäne des Env-Proteins modifiziert werden kann. Im Rahmen der vorliegenden Arbeit sollte ein SNV-basierter retroviraler Zelltargeting-Vektor entwickelt werden, der einen selektiven Gentransfer in die primären humanen CD34-positiven hämatopoetischen Zellen ermöglicht. Zur weitergehenden Charakterisierung des SNV-Vektorsystems sollte geklärt werden, ob das Env-Protein des SNV ein mit anderen gamma-retroviralen Env-Proteinen vergleichbares R-Peptid aufweist, dessen mögliche Rolle bei viralem Zelleintritt ebenfalls untersucht werden sollte. Um eine Zielzell-Spezifität des SNV-Vektors zu erreichen, wurde die gesamte SU-Domäne des SNV-Env-Proteins mit einem einkettigen Antikörperfragment (scFv) ersetzt, das gegen das CD34 Molekül gerichtet ist,. Mit diesem modifizierten Env gelang es, [(antiCD34-TM)SNV]-Vektorpartikel herzustellen, die spezifisch CD34-positive Zellen transduzierten. Essentiell für die Erzeugung solcher Vektoren war die Etablierung einer stabilen Verpackungszelllinie, die Vektorpartikel mit einem Titer von 2x105 i.E./ml produzierte. In Transduktionsexperimenten mit verschiedenen Zelllinien wurde gezeigt, dass [(antiCD34-TM)SNV]-Vektoren eine deutliche Präferenz für CD34+-Zellen und nicht für CD34--Zellen besitzen, wobei der Unterschied in der Transduktionseffizienz zwischen CD34-positiven und –negativen Zellen um den Faktor 100 lag. [(antiCD34-TM)SNV]-Vektoren waren in der Lage, den Reportergentransfer auch in primäre humane Stammzellen zu bewirken. Hierzu wurde ein Transduktionsprotokoll so optimiert, dass die aus dem Nabelschnurblut isolierten CD34+-Zellen transduziert werden konnten. Der für diese Zielzellen bestimmte Vektortiter betrug bis zu 2x106 i.E./ml. In einem Gemisch von primären CD34+- und CD34--Zellen konnte der Vektor zwischen dem Target- und Nontarget-Zellen unterscheiden. Somit wurde zum ersten Mal nicht nur Spezifität, sondern auch Selektivität des SNV-Vektorsystems demonstriert. Dieses Ergebnis ist für eine Weiterentwicklung des Vektors für die in vivo Anwendung in Rahmen einer Gentherapie eine wichtige Voraussetzungen. Im zweiten Teil der Arbeit wurde der Fusionsvorgang bei Virus-Eintritt näher untersucht. Anlass dafür war die experimentelle Beobachtung, dass das Env-Protein des SNV bei der Virusknospung von einer viralen Protease innerhalb der zytoplasmatischen Domäne proteolytisch gespalten wird. Ein Sequenz-Vergleich des SNV TM-Proteins mit dem MLV TM-Protein ergab Hinweise darauf, dass es sich um die Abspaltung des sogenannten R-Peptides analog zu MLV handeln könnte. Die Expression von SNV-Env- Mutanten mit einem entsprechend verkürzten C-Tail (Env delta R) führte zur Synzytien-Bildung. Die bildung hochfusogener Oberflächenhüllproteine durch die Abspaltung des R-Peptids konnte auch für andere gamma-Retroviren gezeigt werden. Die Synzytienbildung konnte quantitativ unter den Env delta R-Varianten verschiedener gamma-Retroviren in einem etablierten Fusionsassay verglichen werden. Das Env delta R des endogenen Retrovirus des Schweins (PERV) des Typs A erwies sich als potentestes Fusionsagens. Als Folge der Ergebnisse der vorliegenden Arbeit wurde postuliert, dass die Abspaltung des R-Peptides ein allgemeiner Mechanismus bei der Partikelreifung der gamma-Retroviren ist und eine fusionsregulierende Rolle besitzt. Eine Weiterentwicklung fusionsaktiver Env-Varianten als mögliche therapeutische Gene für eine Tumor-Gentherapie ist somit diskutierbar.
Gene therapy (GT) is becoming a realistic treatment option for patients with haemophilia. Outside clinical trials, the complexity and potential complications of GT will pose unprecedented challenges to haemophilia care centres.AIM: To explore the potential use of electronic tools to improve the delivery of GT under real-world conditions.METHODS: Considering the hub-and-spoke model, the GTH working group on GT considered the entire patient pathway and reached consensus on requirements for an integrative software tool to secure documenting and sharing information between treaters, pharmacies and patients.RESULTS: Six steps of the gene therapy process were identified, each requiring completion of the previous step as a prerequisite for entry. The responsibilities of GT dosing and follow-up treatment centres, read/write access rules, and the minimum data set were outlined. Data contributed by patients through mobile devices was also considered.CONCLUSION: Important information needs to be shared between patients and treatment centres in a real-world GT hub-and-spoke model. Collecting and sharing this information in well-organised electronic applications will not only improve patient care but also enable national and international data collection in clinical registries...
The Sleeping Beauty (SB) transposon system is a non-viral gene delivery platform that combines simplicity, inexpensive manufacture, and favorable safety features in the context of human applications. However, efficient correction of hematopoietic stem and progenitor cells (HSPCs) with non-viral vector systems, including SB, demands further refinement of gene delivery techniques. We set out to improve SB gene transfer into hard-to-transfect human CD34+ cells by vectorizing the SB system components in the form of minicircles that are devoid of plasmid backbone sequences and are, therefore, significantly reduced in size. As compared to conventional plasmids, delivery of the SB transposon system as minicircle DNA is ∼20 times more efficient, and it is associated with up to a 50% reduction in cellular toxicity in human CD34+ cells. Moreover, providing the SB transposase in the form of synthetic mRNA enabled us to further increase the efficacy and biosafety of stable gene delivery into hematopoietic progenitors ex vivo. Genome-wide insertion site profiling revealed a close-to-random distribution of SB transposon integrants, which is characteristically different from gammaretroviral and lentiviral integrations in HSPCs. Transplantation of gene-marked CD34+ cells in immunodeficient mice resulted in long-term engraftment and hematopoietic reconstitution, which was most efficient when the SB transposase was supplied as mRNA and nucleofected cells were maintained for 4–8 days in culture before transplantation. Collectively, implementation of minicircle and mRNA technologies allowed us to further refine the SB transposon system in the context of HSPC gene delivery to ultimately meet clinical demands of an efficient and safe non-viral gene therapy protocol.
SIVsmmPBj-derived lentiviral vectors are capable of efficient primary human monocyte transduction, a capacity which is linked to the viral accessory protein Vpx. To enable novel gene therapy approaches targeting monocytes, in this thesis it was aimed to generate enhanced lentiviral vectors that meet the required standards for clinical applications with respect to gene transfer efficiency and safety. The vectors were tested for their suitability in a relevant therapeutic gene transfer approach. At first, it was investigated whether vectors derived from another Vpx-carrying lentivirus reveal the same capacity for monocyte transduction as SIVsmmPBj-derived vectors. A transduction experiment using HIV-2-derived vectors in comparison to PBj-derived vectors revealed a comparable transduction capacity, thus disproving the assumed uniqueness of the PBj vectors. The further generation and analysis of expression constructs for the vpx genes of HIV-2 and SIVmac demonstrated a similar functionality in monocyte transduction as the Vpx of PBj. As VpxPBj, both Vpx proteins facilitated monocyte transduction of a vpx-deficient PBj-derived vector system. For the generation of enhanced SIVsmmPBj and HIV-2 vector systems, only the transfer vectors were optimized, since the packaging vectors available already meet current standards. At first, several modifications were introduced into an available preliminary PBj-derived transfer vector by conventional cloning. The modifications included insertions of cPPT/CTS and WPRE as well as the deletions of the remaining pol sequence, the second exons of tat end rev, and the U3-region within the 3’LTR to generate a SIN vector. Thus, beside safety enhancement, the vector titers were also increased from 9.1x105 TU/ml achieved after concentration with the initial transfer vector up to 1.1x107 TU/ml with the final transfer vector. The PBj vector retained its capability of monocyte transduction when supplemented with Vpx. This conventional method of vector enhancement is time-consuming and may result in only sub-optimal vectors, since it depends on the presence of restriction sites which may not allow deletion of all needless sequences. Moreover, mutations may accumulate during the high number of cloning and amplification steps. Therefore, a new and easier method for lentiviral transfer vector generation was conceived. Three essential segments of the viral genome (5‘ LTR, RRE, ΔU3-3’ LTR) are amplified on the template of the lentiviral wild-type genome and fused by Fusion-PCR. Further necessary elements namely the cPPT/CTS-element, MCS, and PPT are included into the resulting vector by extension of the nucleotide primers used for the PCRs. The amplified and fused vector-scaffold can easily be integrated into a plasmid backbone, followed by insertion of the expression cassette of choice. By applying this approach, two novel lentiviral transfer vectors, based on the non-human SIVsmmPBj and the human HIV-2, were derived. Vector titers achieved for PBj and HIV-2 vectors supplemented with Vpx reached up to 4.0x108 TU/ml and 5.4x108 TU/ml, respectively. The capacity for monocyte transduction was maintained. Thus, safe and efficient, state of the art HIV-2- and PBj-derived vector systems are now available for future gene therapy strategies. Finally, the new vectors were used to set up an approach for gene correction of gp91phox-deficient monocytes for the treatment of X-linked chronic granulomatous disease (xCGD). The administration of autologous, gene-corrected monocytes to counteract systemic and acute infections could lead to a decreased infection load, dissolve granulomas and therefore improve the survival rate of hematopoietic stem cell transplantation (HSCT) which is the current treatment of choice for this disease. First, methods for analysis of gp91phox function were established. Next, they were employed to demonstrate the capacity of monocytes, obtained from healthy humans or mice, for phagocytosis, oxidative burst, and Staphylococcus aureus killing. The in vivo half-life of murine monocytes in the bloodstream and their distribution to specific tissues was determined. Lastly, HIV-1 vectors were used to transfer the gp91phox gene into monocytes from gp91phox-deficient mice. This resulted in the successful restoration of the oxidative burst ability in the cells. In summary, the general suitability of the new vectors for treatment of CGD by monocyte transduction was demonstrated. The results of the mouse experiments provide the foundation for future challenge experiments to evaluate the capability of gene-corrected monocytes to kill off microbes in vivo.
Introduction: Adeno-associated virus (AAV)-based gene therapy for haemophilia presents a challenge to the existing structure of haemophilia centres and requires a rethink of current collaboration and information exchange with the aim of ensuring a system that is fit-for-purpose for advanced therapies to maximise benefits and minimise risks. In Europe, a certification process based on the number of patients and facilities is offered to the haemophilia centres by European Haemophilia Network (EUHANET). Aim and methods: This joint European Association for Haemophilia and Allied Disorders (EAHAD) and European Haemophilia Consortium (EHC) publication describes criteria for centres participating in gene therapy care that require a reassessment of the infrastructure of comprehensive care and provides an outlook on how these criteria can be implemented in the future work of haemophilia centres. Results: The core definition of a haemophilia treatment centre remains, but additional roles could be implemented. A modifiable ‘hub-and-spoke’ model addresses all aspects associated with gene therapy, including preparation and administration of the gene therapy product, determination of coagulation and immunological parameters, joint score and function, and liver health. This will also include the strategy on how to follow-up patients for a long-term safety and efficacy surveillance. Conclusion: We propose a modifiable, networked ‘hub and spoke’ model with a long term safety and efficacy surveillance system. This approach will be progressively developed with the goal of making haemophilia centres better qualified to deliver gene therapy and to make gene therapy accessible to all persons with haemophilia, irrespective of their country or centre of origin.
Introduction: Adeno-associated virus (AAV)-based gene therapy for haemophilia presents a challenge to the existing structure of haemophilia centres and requires a rethink of current collaboration and information exchange with the aim of ensuring a system that is fit-for-purpose for advanced therapies to maximise benefits and minimise risks. In Europe, a certification process based on the number of patients and facilities is offered to the haemophilia centres by European Haemophilia Network (EUHANET). Aim and methods: This joint European Association for Haemophilia and Allied Disorders (EAHAD) and European Haemophilia Consortium (EHC) publication describes criteria for centres participating in gene therapy care that require a reassessment of the infrastructure of comprehensive care and provides an outlook on how these criteria can be implemented in the future work of haemophilia centres. Results: The core definition of a haemophilia treatment centre remains, but additional roles could be implemented. A modifiable ‘hub-and-spoke’ model addresses all aspects associated with gene therapy, including preparation and administration of the gene therapy product, determination of coagulation and immunological parameters, joint.