Cavazzana Marina, Antoniani Chiara, Miccio Annarita
Biotherapy Department, Necker Children's Hospital, Assistance Publique-Hôpitaux de Paris, 75015 Paris, France; Biotherapy Clinical Investigation Center, Assistance Publique-Hôpitaux de Paris, INSERM, Groupe Hospitalier Universitaire Ouest, 75015 Paris, France; INSERM UMR 1163, Laboratory of Human Lymphohematopoiesis, 75015 Paris, France; Paris Descartes, Sorbonne Paris Cité University, Imagine Institute, 75015 Paris, France.
Paris Descartes, Sorbonne Paris Cité University, Imagine Institute, 75015 Paris, France; INSERM UMR 1163, Laboratory of Chromatin and Gene Regulation, 75015 Paris, France.
Mol Ther. 2017 May 3;25(5):1142-1154. doi: 10.1016/j.ymthe.2017.03.024. Epub 2017 Apr 1.
β-Thalassemia and sickle cell disease (SCD) are the world's two most widely disseminated hereditary hemoglobinopathies. β-Thalassemia originated in the Mediterranean, Middle Eastern, and Asian regions, and SCD originated in central Africa. However, subsequent population migration means that these two diseases are now global and thus constitute a growing health problem in many countries. Despite remarkable improvements in medical care for patients with β-hemoglobinopathies, there is still only one definitive treatment option: allogeneic hematopoietic stem cell (HSC) transplantation. The development of gene therapy for β-hemoglobinopathies has been justified by (1) the limited availability of human leukocyte antigen (HLA)-identical donors, (2) the narrow window of application of HSC transplantation to the youngest patients, and (3) recent advances in HSC-based gene therapy. The huge ongoing efforts in translational medicine and the high number of related publications show that gene therapy has the potential to become the treatment of choice for patients who lack either an HLA genoidentical sibling or an alternative, medically acceptable donor. In this dynamic scientific context, we first summarize the main steps toward clinical translation of this therapeutic approach and then discuss novel lentiviral- and genome editing-based treatment strategies for β-hemoglobinopathies.
β地中海贫血和镰状细胞病(SCD)是全球传播最广泛的两种遗传性血红蛋白病。β地中海贫血起源于地中海、中东和亚洲地区,而SCD起源于中非。然而,随后的人口迁移意味着这两种疾病现在已遍布全球,因此在许多国家构成了日益严重的健康问题。尽管β血红蛋白病患者的医疗护理有了显著改善,但仍然只有一种确定性的治疗选择:异基因造血干细胞(HSC)移植。β血红蛋白病基因治疗的发展基于以下几点:(1)人类白细胞抗原(HLA)匹配供体的可用性有限;(2)HSC移植应用于最年轻患者的狭窄窗口期;(3)基于HSC的基因治疗的最新进展。转化医学正在进行的巨大努力以及大量相关出版物表明,基因治疗有可能成为那些既没有HLA基因匹配的同胞兄弟姐妹也没有其他医学上可接受供体的患者的首选治疗方法。在这种动态的科学背景下,我们首先总结这种治疗方法临床转化的主要步骤,然后讨论基于新型慢病毒和基因组编辑的β血红蛋白病治疗策略。