Hemophilia A is a lead candidate for treatment by gene therapy because small increments in the missing secreted protein product, coagulation factor VIII (FVIII), would result in substantial clinical amelioration. Clinically relevant therapy might be achieved by stably delivering a human FVIII cDNA to correct the bleeding disorder. We used the Sleeping Beauty (SB) transposon, delivered as naked plasmid DNA by tail-vein injection, to integrate B-domain-deleted FVIII genes into the chromosomes of hemophilia A mice and correct the phenotype. Since FVIII protein is a neoantigen to these mice, sustaining therapeutic plasma FVIII levels was problematic due to inhibitory antibody production. We circumvented this problem by tolerizing 82% of neonates by a single facial-vein injection of recombinant FVIII within 24 hours of birth (the remaining 18% formed inhibitors). Achievement of high-level (10%-100% of normal) FVIII expression and phenotypic correction required co-injection of an SB transposaseexpressing plasmid to facilitate transgene integration in immunotolerized animals. Linker-mediated polymerase chain reaction was used to clone FVIII transposon insertion sites from liver genomic DNA, providing molecular evidence of transposition. Thus, SB provides a nonviral means for sustained IntroductionHemophilia A is an X-linked, recessive, genetic disorder that is caused by insufficient coagulation factor (F) VIII synthesis resulting in sustained bleeding after trauma or injury. 1 Recombinant FVIII protein is currently used to treat bleeding episodes at the cost of approximately $55 000 per person year and is not available in many parts of the world. 2 Gene therapy for hemophilia has recently been an intense area of study because even modest levels (2%-5% normal) of FVIII or FIX can improve clinical outcomes. Considerable progress has been made in developing both nonviral and viral vectors to this end. Viral vectors have been extremely effective in delivering FVIII and FIX transgenes, in some cases curing animal models of hemophilia A and B, respectively (reviewed in Nathwani et al 3 ).However, problems related to triggering of the host inflammatory response have resulted in cessation of clinical trials with both adenovirus 4 and adeno-associated virus. 5 Accordingly, improved adenoviral vectors are being developed that may be less immunogenic (reviewed in Ritter et al 6 ), and the use of alternative serotypes also has shown promise in adeno-associated virus re-administration. 7 Nevertheless, these kinds of problems, along with large-scale vector production challenges, have fueled intense interest in development of nonviral approaches for the treatment of hemophilia by gene therapy.The benefits of nonviral vectors include simplicity, ease of storage, and amenability to large-scale manufacture. 3,8 They are also potentially less immunogenic than viral vectors, which could allow for safer administration and/or re-administration. Integrating and nonintegrating plasmid-based vectors have been developed and successfully tested...

The results confirm that meniscal transplantation significantly reduces pain, decreases activity-related effusions, and improves function in patients with prior meniscectomy; however, the long-term chondroprotective effects remain unknown.

The incidence of distal biceps tendon ruptures in this study was higher than previously reported.

Gene therapy has the potential to become an effective component of cancer treatment by transferring genes that cause immunomodulation or tumor cell death or that inhibit angiogenesis into tumor cells or tumor-associated stroma. Viral vectors have been the primary gene transfer vehicles used for intratumoral gene transfer to date. Plasmid-based vectors may be safer and more scalable than viral vectors. However, attempts at plasmid-based intratumoral gene transfer have been met with transient expression and poor gene transfer efficiency. Here we report integration and long-term expression of reporter genes in human glial tumors, growing in nude mice, using the Sleeping Beauty (SB) transposon system. A two-plasmid system was used, in which linear polyethylenimine was complexed with a GFP, NEO, or luciferase transposon plasmid and a SB transposase-expressing plasmid. SB-mediated transposition led to chromosomal integration of the NEO transgene in roughly 8% of tumor cells. SB-mediated insertions were cloned from the genomes of glial tumor cells to provide molecular proof of transposase-mediated integration. Luciferase studies showed that SB facilitated long-term expression of the transgene in glial tumors. SB-mediated intratumoral gene transfer is a novel, nonviral technique that could be used to augment conventional therapy for glioblastoma or other cancers.

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