Dynamics of gene-modified progenitor cells analyzed by tracking retroviral integration sites in a human SCID-X1 gene therapy trial

Author:

Wang Gary P.1,Berry Charles C.2,Malani Nirav1,Leboulch Philippe345,Fischer Alain678,Hacein-Bey-Abina Salima679,Cavazzana-Calvo Marina679,Bushman Frederic D.1

Affiliation:

1. Department of Microbiology, University of Pennsylvania School of Medicine, Philadelphia;

2. Department of Family/Preventive Medicine, University of California San Diego School of Medicine;

3. Commissariat à l'Energie Atomique (CEA), Institute of Emerging Diseases and Innovative Therapies (iMETI), Fontenay-aux-Roses, France;

4. Inserm Unité (U) 962 and University Paris XI, CEA-iMETI, Fontenay-aux-Roses, France;

5. Genetics Division, Brigham & Women's Hospital and Harvard Medical School, Boston, MA;

6. Inserm U768, Paris, France;

7. Université Paris-Descartes, Paris, France;

8. Unité d'Immunologie et Hematologie Pediatriques, Hopital Necker–Enfants Malades, Assistance Publique–Hôpitaux de Paris (AP-HP), Université René Descartes, Paris, France; and

9. Department of Biotherapy, Hôpital Necker–Enfants Malades, AP-HP, Université Paris-Descartes, Paris, France

Abstract

Abstract X-linked severe-combined immunodeficiency (SCID-X1) has been treated by therapeutic gene transfer using gammaretroviral vectors, but insertional activation of proto-oncogenes contributed to leukemia in some patients. Here we report a longitudinal study of gene-corrected progenitor cell populations from 8 patients using 454 pyrosequencing to map vector integration sites, and extensive resampling to allow quantification of clonal abundance. The number of transduced cells infused into patients initially predicted the subsequent diversity of circulating cells. A capture-recapture analysis was used to estimate the size of the gene-corrected cell pool, revealing that less than 1/100th of the infused cells had long-term repopulating activity. Integration sites were clustered even at early time points, often near genes involved in growth control, and several patients harbored expanded cell clones with vectors integrated near the cancer-implicated genes CCND2 and HMGA2, but remain healthy. Integration site tracking also documented that chemotherapy for adverse events resulted in successful control. The longitudinal analysis emphasizes that key features of transduced cell populations—including diversity, integration site clustering, and expansion of some clones—were established early after transplantation. The approaches to sequencing and bioinformatics analysis reported here should be widely useful in assessing the outcome of gene therapy trials.

Publisher

American Society of Hematology

Subject

Cell Biology,Hematology,Immunology,Biochemistry

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