摘要
旨在校正X连锁慢性肉芽肿病(CGD)的I / II期临床试验,通过转移基因到造血干细胞(HSC )中已经证明了基因修饰的自体造血干细胞的治疗CGD的潜力。在CGD患者的肝、肺和椎管中出现的治疗抗性细菌和真菌感染的分辨率在所有的试验中都被明确记载下来。然而,由于基因转导的细胞未能长期嫁接,临床上的益处没能随时间的推移得到维持。此外,由于插入诱变激活了促进生长基因并可能诱发髓系恶性肿瘤,在一些治疗的患者中出现了严重的不良反应。这些挫折促进了那些已经进入或即将进入临床的更新颖、安全和有效的载体的开发。与此同时,正在进行的研究不断细化CGD疾病的表型,包括对可能解释CGD基因治疗试验中观察到的独特的植入类型的因素的定义。本文总结性的概述了对CGD的分子病理机制、临床表现的现有认识,并总结了临床基因治疗试验的经验教训、临床前载体设计的进展和CGD的基因治疗的未来前景。
关键词: 慢性肉芽肿病(CGD)、移植物移入、基因疗法、炎症, NADPH氧化酶,原发性免疫缺陷, ROS 。
Current Gene Therapy
Title:Gene Therapy for Chronic Granulomatous Disease: Current Status and Future Perspectives
Volume: 14 Issue: 6
Author(s): Kerstin B. Kaufmann, Maria Chiriaco, Ulrich Siler, Andrea Finocchi, Janine Reichenbach, Stefan Stein and Manuel Grez
Affiliation:
关键词: 慢性肉芽肿病(CGD)、移植物移入、基因疗法、炎症, NADPH氧化酶,原发性免疫缺陷, ROS 。
摘要: Several Phase I/II clinical trials aiming at the correction of X-linked CGD by gene transfer into hematopoietic stem cells (HSCs) have demonstrated the therapeutic potential of gene modified autologous HSCs for the treatment of CGD. Resolution of therapy-resistant bacterial and fungal infections in liver, lung and spinal canal of CGD patients were clearly documented in all trials. However, clinical benefits were not sustained over time due to the failure of gene transduced cells to engraft long-term. Moreover, severe adverse effects were observed in some of the treated patients due to insertional mutagenesis leading to the activation of growth promoting genes and to myeloid malignancy. These setbacks fostered the development of novel safety and efficacy improved vectors that have already entered or are about to enter the clinics. Meanwhile, ongoing research is constantly refining the CGD disease phenotype, including the definition of factors that may explain the unique engraftment phenotype observed in CGD gene therapy trials. This review provides a condensed overview on the current knowledge of the molecular pathomechanisms and clinical manifestations of CGD and summarizes the lessons learned from clinical gene therapy trials, the preclinical progress in vector design and the future perspectives for the gene therapy of CGD.
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Kaufmann B. Kerstin, Chiriaco Maria, Siler Ulrich, Finocchi Andrea, Reichenbach Janine, Stein Stefan and Grez Manuel, Gene Therapy for Chronic Granulomatous Disease: Current Status and Future Perspectives, Current Gene Therapy 2014; 14 (6) . https://dx.doi.org/10.2174/1566523214666140918113201
DOI https://dx.doi.org/10.2174/1566523214666140918113201 |
Print ISSN 1566-5232 |
Publisher Name Bentham Science Publisher |
Online ISSN 1875-5631 |
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