笑对人生
(2023-10-31 23:59):
# paper doi: 10.1038/s41591-022-01906-z. Fu B, et al. CRISPR-Cas9-mediated gene editing of the BCL11A enhancer for pediatric β0/β0 transfusion-dependent β-thalassemia. Nat Med. 2022 Aug;28(8):1573-1580.
研究背景:B细胞淋巴瘤/白血病11A蛋白(B-cell lymphoma/leukemia 11A,BCL11A)是一种转录因子,可抑制红系细胞中的γ-珠蛋白和胎儿血红蛋白表达。因此,理论上靶向抑制BCL11A的表达可能使γ-珠蛋白表达抑制解除。地中海贫血(Thalassemia)是由于珠蛋白基因突变、缺失导致的珠蛋白链合成减少或完全缺失所引起的遗传性慢性溶血性疾病。根据临床症状严重程度和是否需要定期输血将地贫分为输血依赖型地贫(TDT)和非输血依赖型地贫(NTDT)。TDT需终身依赖输血,包括重型β地贫、重型Hb E/β地贫、非缺失型HbH病和重型α地贫。人出生后不久胎儿期γ-珠蛋白 (γ-globin)基因沉默表达,成体则主要表达β-珠蛋白 (β-globin),它在红细胞中与a-珠蛋白组成血红蛋白四聚体(HbA : α2β2)运载氧气。过去的研究表明,胎儿血红蛋白(HbF)水平升高可以减轻镰状细胞病 (SCD)和β-地中海贫血的临床严重程度,利用HbF替代功能受损的HbA可能是治疗β地贫的可行方案之一。在2020年,NEJM同期分别发表了两项分别利用CRISPR-Cas9和慢病毒介导的shRNA治疗β-地中海贫血症患者和镰刀状细胞贫血症患者临床试验。第一项是利用CRISPR-Cas9对患者自体CD34+细胞BCL11A的增强子区域(GATA1结合位点)进行编辑,激活γ-珠蛋白表达,最终提高血液中HbF含量。第二项是慢病毒介导的shRNA,在体外特异性靶向敲低患者自体CD34+细胞的BCL11A基因的mRNA。
研究内容:本研究是中国,也是世界首个通过CRISPR基因编辑技术重激活γ珠蛋白治疗β0/β0型重度地中海贫血儿童(两名TDT患者)并获得成功的研究。两名患者体内红细胞数量和总体Hb水平在75天左右达到健康水平。此外,研究还利用scRNAseq分析了两名健康人、一名患者治疗前和两名患者治疗后的PBMC,在单细胞水平验证了他们之间各种细胞类型比例均无显著差异。
CRISPR-Cas9-mediated gene editing of the BCL11A enhancer for pediatric β0/β0 transfusion-dependent β-thalassemia
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Abstract:
Gene editing to disrupt the GATA1-binding site at the +58 BCL11A erythroid enhancer could induce γ-globin expression, which is a promising therapeutic strategy to alleviate β-hemoglobinopathy caused by HBB gene mutation. In the present study, we report the preliminary results of an ongoing phase 1/2 trial (NCT04211480) evaluating safety and efficacy of gene editing therapy in children with blood transfusion-dependent β-thalassemia (TDT). We transplanted BCL11A enhancer-edited, autologous, hematopoietic stem and progenitor cells into two children, one carrying the β/β genotype, classified as the most severe type of TDT. Primary endpoints included engraftment, overall survival and incidence of adverse events (AEs). Both patients were clinically well with multilineage engraftment, and all AEs to date were considered unrelated to gene editing and resolved after treatment. Secondary endpoints included achieving transfusion independence, editing rate in bone marrow cells and change in hemoglobin (Hb) concentration. Both patients achieved transfusion independence for >18 months after treatment, and their Hb increased from 8.2 and 10.8 g dl at screening to 15.0 and 14.0 g dl at the last visit, respectively, with 85.46% and 89.48% editing persistence in bone marrow cells. Exploratory analysis of single-cell transcriptome and indel patterns in edited peripheral blood mononuclear cells showed no notable side effects of the therapy.
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