Peranteau William H, Hayashi Satoshi, Abdulmalik Osheiza, Chen Qiukan, Merchant Aziz, Asakura Toshio, Flake Alan W
The Center for Fetal Research, and.
Division of Hematology, The Children's Hospital of Philadelphia, Philadelphia, PA.
Blood. 2015 Sep 3;126(10):1245-54. doi: 10.1182/blood-2015-03-636803. Epub 2015 Jun 29.
Sickle cell disease (SCD) and thalassemias (Thal) are common congenital disorders, which can be diagnosed early in gestation and result in significant morbidity and mortality. Hematopoietic stem cell transplantation, the only curative therapy for SCD and Thal, is limited by the absence of matched donors and treatment-related toxicities. In utero hematopoietic stem cell transplantation (IUHCT) is a novel nonmyeloablative transplant approach that takes advantage of the immunologic immaturity and normal developmental properties of the fetus to achieve mixed allogeneic chimerism and donor-specific tolerance (DST). We hypothesized that a combined strategy of IUHCT to induce DST, followed by postnatal nonmyeloablative same donor "booster" bone marrow (BM) transplants in murine models of SCD and Thal would result in high levels of allogeneic engraftment and donor hemoglobin (Hb) expression with subsequent phenotypic correction of SCD and Thal. Our results show that: (1) IUHCT is associated with DST and low levels of allogeneic engraftment in the murine SCD and Thal models; (2) low-level chimerism following IUHCT can be enhanced to high-level chimerism and near complete Hb replacement with normal donor Hb with this postnatal "boosting" strategy; and (3) high-level chimerism following IUHCT and postnatal "boosting" results in phenotypic correction in the murine Thal and SCD models. This study supports the potential of IUHCT, combined with a postnatal nonmyelablative "boosting" strategy, to cure Thal and SCD without the toxic conditioning currently required for postnatal transplant regimens while expanding the eligible transplant patient population due to the lack of a restricted donor pool.
镰状细胞病(SCD)和地中海贫血(Thal)是常见的先天性疾病,可在妊娠早期诊断,并且会导致显著的发病率和死亡率。造血干细胞移植是SCD和Thal唯一的治愈性疗法,但受限于缺乏匹配的供体以及与治疗相关的毒性。宫内造血干细胞移植(IUHCT)是一种新型的非清髓性移植方法,它利用胎儿的免疫不成熟和正常发育特性来实现混合异基因嵌合体形成和供体特异性耐受(DST)。我们假设,在SCD和Thal小鼠模型中,采用IUHCT诱导DST,随后进行出生后非清髓性同供体“强化”骨髓(BM)移植的联合策略,将导致高水平的异基因植入和供体血红蛋白(Hb)表达,随后实现SCD和Thal的表型纠正。我们的结果表明:(1)在小鼠SCD和Thal模型中,IUHCT与DST以及低水平的异基因植入相关;(2)采用这种出生后“强化”策略,IUHCT后的低水平嵌合体可增强为高水平嵌合体,并几乎完全被正常供体Hb替代;(3)IUHCT和出生后“强化”后的高水平嵌合体在小鼠Thal和SCD模型中导致表型纠正。这项研究支持了IUHCT联合出生后非清髓性“强化”策略治愈Thal和SCD的潜力,该策略无需目前出生后移植方案所需的毒性预处理,同时由于供体库不受限制,可扩大符合条件的移植患者群体。