Outcomes of Hematopoietic Stem Cell Gene Therapy for Wiskott-Aldrich Syndrome

Authors

• Roxane Labrosse
• Julia I Chu
• Myriam A Armant
• John K Everett
• Danilo Pellin
• Niharika Kareddy
• Andrew L Frelinger
• Lauren A Henderson
• Amy E O'Connell
• Amlan Biswas
• Jet Coenen-van der Spek
• Alexandra Miggelbrink
• Claudia Fiorini
• Hriju Adhikari
• Charles C Berry
• Vito Adrian Cantu
• Johnson Fong
• Jason Jaroslavsky
• Derin F Karadeniz
• Quan-Zhen Li
• Shantan Reddy
• Aoife M Roche
• Chengsong Zhu
• Jennifer S Whangbo
• Colleen Dansereau
• Brenda Mackinnon
• Emily Morris
• Stephanie M Koo
• Wendy B London
• Safa Baris
• Ahmet Ozen
• Elif Karakoc-Aydiner
• Jenny M Despotovic
• Lisa R Forbes Satter
• Akihiko Saitoh
• Yuta Aizawa
• Alejandra King
• Mai Anh Thi Nguyen
• Vy Do Uyen Vu
• Scott B Snapper
• Anne Galy
• Luigi D Notarangelo
• Frederic D Bushman
• David A Williams
• Sung-Yun Pai

Language

English

Publication Date

10-12-2023

Journal

Blood

DOI

10.1182/blood.2022019117

PMID

37478401

PMCID

PMC10731922

PubMedCentral® Posted Date

7-24-2023

PubMedCentral® Full Text Version

Post-print

Abstract

Wiskott-Aldrich syndrome (WAS) is a rare X-linked disorder characterized by combined immunodeficiency, eczema, microthrombocytopenia, autoimmunity, and lymphoid malignancies. Gene therapy (GT) to modify autologous CD34+ cells is an emerging alternative treatment with advantages over standard allogeneic hematopoietic stem cell transplantation for patients who lack well-matched donors, avoiding graft-versus-host-disease. We report the outcomes of a phase 1/2 clinical trial in which 5 patients with severe WAS underwent GT using a self-inactivating lentiviral vector expressing the human WAS complementary DNA under the control of a 1.6-kB fragment of the autologous promoter after busulfan and fludarabine conditioning. All patients were alive and well with sustained multilineage vector gene marking (median follow-up: 7.6 years). Clinical improvement of eczema, infections, and bleeding diathesis was universal. Immune function was consistently improved despite subphysiologic levels of transgenic WAS protein expression. Improvements in platelet count and cytoskeletal function in myeloid cells were most prominent in patients with high vector copy number in the transduced product. Two patients with a history of autoimmunity had flares of autoimmunity after GT, despite similar percentages of WAS protein-expressing cells and gene marking to those without autoimmunity. Patients with flares of autoimmunity demonstrated poor numerical recovery of T cells and regulatory T cells (Tregs), interleukin-10-producing regulatory B cells (Bregs), and transitional B cells. Thus, recovery of the Breg compartment, along with Tregs appears to be protective against development of autoimmunity after GT. These results indicate that clinical and laboratory manifestations of WAS are improved with GT with an acceptable safety profile. This trial is registered at clinicaltrials.gov as #NCT01410825.

Keywords

Humans, Wiskott-Aldrich Syndrome, Wiskott-Aldrich Syndrome Protein, Hematopoietic Stem Cells, Hematopoietic Stem Cell Transplantation, Genetic Therapy, Eczema

Published Open-Access

yes

Recommended Citation

Labrosse, Roxane; Chu, Julia I; Armant, Myriam A; et al., "Outcomes of Hematopoietic Stem Cell Gene Therapy for Wiskott-Aldrich Syndrome" (2023). Faculty, Staff and Students Publications. 7625.
https://digitalcommons.library.tmc.edu/baylor_docs/7625