a Gene Medicine Group, Nuffield Division of Clinical Laboratory Science, Radcliffe Department of Medicine, University of Oxford , Oxford , UK.
Expert Rev Respir Med. 2019 Aug;13(8):709-725. doi: 10.1080/17476348.2019.1634547. Epub 2019 Jun 27.
: Cystic fibrosis (CF) remains a life-threatening genetic disease, with few clinically effective treatment options. Gene therapy and gene editing strategies offer the potential for a one-time CF cure, irrespective of the mutation class. : We review emerging gene therapies and gene delivery strategies for the treatment of CF particularly viral and non-viral approaches with potential to treat CF. : It was initially anticipated that the challenge of developing a gene therapy for CF lung disease would be met relatively easily. Following early proof-of-concept clinical studies, CF gene therapy has entered a new era with innovative vector designs, approaches to subvert the humoral immune system and increase gene delivery and gene correction efficiencies. Developments include integrating adenoviral vectors, rapamycin-loaded nanoparticles, and lung-tropic lentiviral vectors. The characterization of novel cell types in the lung epithelium, including pulmonary ionocytes, may also encourage cell type-specific targeting for CF correction. We anticipate preclinical studies to further validate these strategies, which should pave the way for clinical trials. We also expect gene editing efficiencies to improve to clinically translatable levels, given advancements in viral and non-viral vectors. Overall, gene delivery technologies look more convincing in producing an effective CF gene therapy.
囊性纤维化 (CF) 仍然是一种危及生命的遗传疾病,临床有效治疗方法有限。基因治疗和基因编辑策略为一次性治愈 CF 提供了可能,而不受突变类型的影响。我们综述了新兴的 CF 基因治疗和基因传递策略,特别是具有治疗 CF 潜力的病毒和非病毒方法。最初,人们预计开发 CF 肺部疾病的基因疗法相对容易。在早期的概念验证临床研究之后,CF 基因治疗进入了一个新时代,创新的载体设计、克服体液免疫系统和提高基因传递和基因校正效率的方法。这些进展包括整合腺病毒载体、载有雷帕霉素的纳米颗粒和肺嗜性慢病毒载体。对肺上皮中的新型细胞类型(包括肺离子细胞)的特征分析也可能鼓励针对 CF 纠正的细胞类型特异性靶向。我们预计临床前研究将进一步验证这些策略,这应为临床试验铺平道路。我们还期望基因编辑效率提高到可转化的临床水平,这得益于病毒和非病毒载体的进步。总的来说,基因传递技术在产生有效的 CF 基因治疗方面看起来更有说服力。