Wiskott-Aldrich Syndrome (WAS) is an inherited immunodeficiency caused by mutations in the gene encoding WASP, a protein regulating the cytoskeleton. Hematopoietic stem/progenitor cell (HSPC) transplants can be curative but, when matched donors are unavailable, infusion of autologous HSPCs modified ex vivo by gene therapy is an alternative approach. We used a lentiviral vector encoding functional WASP to genetically correct HSPCs from three WAS patients and re-infused the cells after reduced-intensity conditioning regimen. All three patients showed stable engraftment of WASP-expressing cells and improvements in platelet counts, immune functions, and clinical score. Vector integration analyses revealed highly polyclonal and multi-lineage haematopoiesis resulting from the gene corrected HSPCs. Lentiviral gene therapy did not induce selection of integrations near oncogenes and no aberrant clonal expansion was observed after 20–32 months. Although extended clinical observation is required to establish long-term safety, lentiviral gene therapy represents a promising treatment for WAS.

Hematopoietic Stem/Progenitor cells (HSPCs) are endowed with the role of maintaining a diverse pool of blood cells throughout the human life. Despite recent efforts, the nature of the early cell fate decisions remains contentious. Using single-cell RNA-Seq, we show that existing approaches to stratify bone marrow CD34+ cells reveal a hierarchically-structured transcriptional landscape of hematopoietic differentiation. Still, this landscape misses important early fate decisions. We here provide a broader transcriptional profiling of bone marrow lineage negative hematopoietic progenitors that recovers a key missing branchpoint into basophils and expands our understanding of the underlying structure of early adult human haematopoiesis. We also show that this map has strong similarities in topology and gene expression to that found in mouse. Finally, we identify the sialomucin CD164, as a reliable marker for the earliest branches of HSPCs specification and we showed how its use can foster the design of alternative transplantation cell products.

IntroductionPioneering clinical studies have shown that transplantation of genetically modified hematopoietic stem cells may cure severe genetic diseases such as severe combined immunodeficiencies (SCID), 1,2 chronic granulomatous disease (CGD), 3 and lysosomal storage disorders. 4 Unfortunately, some of these studies showed also the limitations of retroviral gene transfer technology, which may cause severe and sometimes fatal adverse effects. In particular, insertional activation of proto-oncogenes by vectors derived from the Moloney murine leukemia virus (MLV) caused T-cell lymphoproliferative disorders in patients with X-linked SCID 5,6 and premalignant expansion of myeloid progenitors in patients with CGD. 3 Preclinical studies showed that HIV-derived lentiviral vectors are less likely to cause insertional gene activation, 7,8 although they can still interfere with normal gene expression at the posttranscriptional level, as observed in a clinical trial of gene therapy for ␤-thalassemia. 9 The molecular bases of vector-induced genotoxicity and the influence of vector design, transduction protocols, and the patient's genetic background in inducing severe adverse effects are still poorly understood. A better understanding of the interactions between retroviral vectors and the human genome may provide new cues to explain these phenomena and a rational basis for predicting genotoxic risks in gene therapy.A large number of studies have focused on the molecular mechanisms by which mammalian retroviruses choose their integration sites in the target cell genome. After entering a cell, retroviral RNA genomes are reverse transcribed into double-stranded DNA and assembled in preintegration complexes (PICs) containing viral and cellular proteins. PICs translocate to the nucleus and associate with the host cell chromatin, where the viral integrase mediates proviral insertion in genomic DNA. Integration is a nonrandom process, whereby PICs of different viruses recognize components or features of the host cell chromatin in a specific fashion. 10 For HIV and other lentiviruses, the LEDGF/p75 protein has been identified as the main factor tethering PICs to active chromatin, 11 whereas mechanisms underlying integration site selection of other retroviruses remain largely unknown. We recently showed that MLV-derived vectors integrate preferentially in hot spots near genes controlling growth and development of hematopoietic cells and flanked by defined subsets of transcription factor binding sites (TFBSs) and suggested that MLV PICs are tethered to active regulatory regions by basal components of the transcriptional machinery. 12,13 The MLV integrase and long terminal repeat enhancer are the main determinants of the selection of TFBS-rich regions of the genome. 13,14 We used ligation-mediated polymerase chain reaction (LM-PCR) and pyrosequencing to build a genomewide, high-definition map of Ͼ 32 000 MLV integration sites in the genome of human CD34 ϩ hematopoietic progenitor cells (HPCs) and used gene expression profiling, chroma...

SummaryHematopoietic stem/progenitor cells (HSPCs) are capable of supporting the lifelong production of blood cells exerting a wide spectrum of functions. Lentiviral vector HSPC gene therapy generates a human hematopoietic system stably marked at the clonal level by vector integration sites (ISs). Using IS analysis, we longitudinally tracked >89,000 clones from 15 distinct bone marrow and peripheral blood lineages purified up to 4 years after transplant in four Wiskott-Aldrich syndrome patients treated with HSPC gene therapy. We measured at the clonal level repopulating waves, populations' sizes and dynamics, activity of distinct HSPC subtypes, contribution of various progenitor classes during the early and late post-transplant phases, and hierarchical relationships among lineages. We discovered that in-vitro-manipulated HSPCs retain the ability to return to latency after transplant and can be physiologically reactivated, sustaining a stable hematopoietic output. This study constitutes in vivo comprehensive tracking in humans of hematopoietic clonal dynamics during the early and late post-transplant phases.