Université de Paris, Imagine Institute, Laboratory of Chromatin and Gene Regulation During Development, INSERM UMR 1163, Paris, France.
Prog Mol Biol Transl Sci. 2021;182:153-183. doi: 10.1016/bs.pmbts.2021.01.025. Epub 2021 Mar 1.
β-hemoglobinopathies are the most common monogenic disorders worldwide and are caused by mutations in the β-globin locus altering the production of adult hemoglobin (HbA). Transplantation of autologous hematopoietic stem cells (HSCs) corrected by lentiviral vector-mediated addition of a functional β-like globin raised new hopes to treat sickle cell disease and β-thalassemia patients; however, the low expression of the therapeutic gene per vector copy is often not sufficient to fully correct the patients with a severe clinical phenotype. Recent advances in the genome editing field brought new possibilities to cure β-hemoglobinopathies by allowing the direct modification of specific endogenous loci. Double-strand breaks (DSBs)-inducing nucleases (i.e., ZFNs, TALENs and CRISPR-Cas9) or DSB-free tools (i.e., base and prime editing) have been used to directly correct the disease-causing mutations, restoring HbA expression, or to reactivate the expression of the fetal hemoglobin (HbF), which is known to alleviate clinical symptoms of β-hemoglobinopathy patients. Here, we describe the different genome editing tools, their application to develop therapeutic approaches to β-hemoglobinopathies and ongoing clinical trials using genome editing strategies.
β-地中海贫血症是全球最常见的单基因疾病,由β-球蛋白基因座的突变引起,导致成人血红蛋白 (HbA) 的产生发生改变。通过慢病毒载体介导的功能性β样球蛋白的添加来校正自体造血干细胞 (HSCs) 的移植为治疗镰状细胞病和β-地中海贫血患者带来了新的希望;然而,每个载体拷贝的治疗基因的低表达通常不足以完全纠正具有严重临床表型的患者。基因组编辑领域的最新进展通过允许对特定内源性基因座进行直接修饰,为治愈β-地中海贫血症带来了新的可能性。双链断裂 (DSB)-诱导核酸酶 (即 ZFNs、TALENs 和 CRISPR-Cas9) 或无 DSB 工具 (即碱基编辑和先导编辑) 已被用于直接纠正致病突变,恢复 HbA 表达,或重新激活胎儿血红蛋白 (HbF) 的表达,已知 HbF 的表达可以减轻β-地中海贫血症患者的临床症状。在这里,我们描述了不同的基因组编辑工具,它们在开发治疗β-地中海贫血症的方法中的应用,以及使用基因组编辑策略的正在进行的临床试验。
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