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用于治疗镰状细胞病的临床基因组编辑——简要更新

Clinical genome editing to treat sickle cell disease-A brief update.

作者信息

Zarghamian Parinaz, Klermund Julia, Cathomen Toni

机构信息

Institute for Transfusion Medicine and Gene Therapy, Medical Center - University of Freiburg, Freiburg, Germany.

Center for Chronic Immunodeficiency (CCI), Faculty of Medicine, University of Freiburg, Freiburg, Germany.

出版信息

Front Med (Lausanne). 2023 Jan 9;9:1065377. doi: 10.3389/fmed.2022.1065377. eCollection 2022.


DOI:10.3389/fmed.2022.1065377
PMID:36698803
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9868311/
Abstract

Sickle cell disease (SCD) is one of the most common hemoglobinopathies. Due to its high prevalence, with about 20 million affected individuals worldwide, the development of novel effective treatments is highly warranted. While transplantation of allogeneic hematopoietic stem cells (HSC) is the standard curative treatment approach, a variety of gene transfer and genome editing strategies have demonstrated their potential to provide a prospective cure for SCD patients. Several stratagems employing CRISPR-Cas nucleases or base editors aim at reactivation of γ-globin expression to replace the faulty β-globin chain. The fetal hemoglobin (HbF), consisting of two α-globin and two γ-globin chains, can compensate for defective adult hemoglobin (HbA) and reverse the sickling of hemoglobin-S (HbS). Both disruption of -regulatory elements that are involved in inhibiting γ-globin expression, such as BCL11A or LRF binding sites in the γ-globin gene promoters (), or the lineage-specific disruption of BCL11A to reduce its expression in human erythroblasts, have been demonstrated to reestablish HbF expression. Alternatively, the point mutation in the gene has been corrected using homology-directed repair (HDR)-based methodologies. In general, genome editing has shown promising results not only in preclinical animal models but also in clinical trials, both in terms of efficacy and safety. This review provides a brief update on the recent clinical advances in the genome editing space to offer cure for SCD patients, discusses open questions with regard to off-target effects induced by the employed genome editors, and gives an outlook of forthcoming developments.

摘要

镰状细胞病(SCD)是最常见的血红蛋白病之一。由于其高患病率,全球约有2000万人受影响,因此非常有必要开发新的有效治疗方法。虽然异基因造血干细胞(HSC)移植是标准的治愈性治疗方法,但多种基因转移和基因组编辑策略已证明它们有潜力为SCD患者提供前瞻性治愈方案。几种采用CRISPR-Cas核酸酶或碱基编辑器的策略旨在重新激活γ-珠蛋白表达以替代有缺陷的β-珠蛋白链。由两条α-珠蛋白链和两条γ-珠蛋白链组成的胎儿血红蛋白(HbF)可以补偿有缺陷的成人血红蛋白(HbA)并逆转血红蛋白S(HbS)的镰变。破坏参与抑制γ-珠蛋白表达的调控元件,如γ-珠蛋白基因启动子中的BCL11A或LRF结合位点,或在人类成红细胞中对BCL11A进行谱系特异性破坏以降低其表达,均已证明可重新建立HbF表达。另外,已使用基于同源定向修复(HDR)的方法纠正了基因中的点突变。总体而言,基因组编辑不仅在临床前动物模型中,而且在临床试验中,在疗效和安全性方面都显示出了有前景的结果。本综述简要介绍了基因组编辑领域最近在为SCD患者提供治愈方案方面的临床进展,讨论了所采用的基因组编辑器诱导的脱靶效应相关的未解决问题,并展望了即将到来的发展。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c862/9868311/8b06d47f665d/fmed-09-1065377-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c862/9868311/8b06d47f665d/fmed-09-1065377-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c862/9868311/8b06d47f665d/fmed-09-1065377-g001.jpg

相似文献

[1]
Clinical genome editing to treat sickle cell disease-A brief update.

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[2]
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[3]
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[4]
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[5]
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[6]
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[7]
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[8]
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[9]
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[10]
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引用本文的文献

[1]
Disrupting ZBTB7A or BCL11A binding sites reactivates fetal hemoglobin in erythroblasts from healthy and β-thalassemia/HbE individuals.

Sci Rep. 2025-7-15

[2]
Selecting patients with sickle cell disease for gene addition or gene editing-based therapeutic approaches: Report on behalf of a joint EHA Specialized Working Group and EBMT Hemoglobinopathies Working Party consensus conference.

Hemasphere. 2025-3-13

[3]
Synergizing CRISPR-Cas9 with Advanced Artificial Intelligence and Machine Learning for Precision Drug Delivery: Technological Nexus and Regulatory Insights.

Curr Gene Ther. 2025

[4]
CRISPR/Cas9 System as a Promising Therapy in Thalassemia and Sickle Cell Disease: A Systematic Review of Clinical Trials.

Mol Biotechnol. 2025-1-10

[5]
Comprehensive analysis of off-target and on-target effects resulting from liver-directed CRISPR-Cas9-mediated gene targeting with AAV vectors.

Mol Ther Methods Clin Dev. 2024-11-4

[6]
CRISPR technology in human diseases.

MedComm (2020). 2024-7-29

[7]
Immune modulation permits tolerance and engraftment in a murine model of late-gestation transplantation.

Blood Adv. 2024-9-10

[8]
Current and Future Therapeutics for Treating Patients with Sickle Cell Disease.

Cells. 2024-5-16

[9]
Adeno-associated virus as a delivery vector for gene therapy of human diseases.

Signal Transduct Target Ther. 2024-4-3

[10]
On- and off-target effects of paired CRISPR-Cas nickase in primary human cells.

Mol Ther. 2024-5-1

本文引用的文献

[1]
Base-editing-mediated dissection of a γ-globin cis-regulatory element for the therapeutic reactivation of fetal hemoglobin expression.

Nat Commun. 2022-11-4

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Stem Cells Transl Med. 2022-10-21

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Int J Biol Sci. 2022

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Nat Biotechnol. 2022-12

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J Hematol Oncol. 2022-3-3

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Nat Med. 2022-1

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N Engl J Med. 2022-2-17

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