Although sickle cell anemia was the first hereditary disease to be understood at the molecular level, there is still no adequate long-term treatment. Allogeneic bone marrow transplantation is the only available cure, but this procedure is limited to a minority of patients with an available, histocompatible donor. Autologous transplantation of bone marrow stem cells that are transduced with a stably expressed, antisickling globin gene would benefit a majority of patients with sickle cell disease. Therefore, the development of a gene therapy protocol that corrects the disease in an animal model and is directly translatable to human patients is critical. A method is described in which unmobilized, highly purified bone marrow stem cells are transduced with a minimum amount of self-inactivating (SIN) lentiviral vector containing a potent antisickling -globin gene. These cells, which were transduced in the absence of cytokine stimulation, fully reconstitute irradiated recipients and correct the hemolytic anemia and organ pathology that characterize the disease in humans. The mean increase of hemoglobin concentration was 46 g/L (4.6 g/dL) and the average lentiviral copy number was 2.2; therefore, a 21-g/L /vector copy increase (2.1-g/dL) was achieved. This transduction protocol may be directly translatable to patients with sickle cell disease who cannot tolerate current bone marrow mobilization procedures and may not safely be exposed to large viral loads.
IntroductionSickle cell disease (SCD) is an autosomal recessive disorder that affects more than 300 000 individuals worldwide and more than 70 000 in the United States. The molecular basis of the disease is an AϾT transversion in the sixth codon of the -globin gene. 1,2 This mutation results in the substitution of a valine residue for glutamic acid on the surface of hemoglobin S (HbS; ␣ 2  2 S ) tetramers. The valine creates a hydrophobic projection that fits into a natural hydrophobic pocket formed on hemoglobin tetramers after deoxygenation. 3,4 The interaction of tetramers results in the formation of HbS polymers/fibers that cause red blood cells (RBCs) to become rigid and nondeformable and to occlude small capillaries. 5-10 These vaso-occlusive events cause severe tissue damage that can result in strokes, splenic infarction, kidney failure, liver and lung disorders, painful crises, and other complications. 11,12 Cycles of erythrocyte sickling also cause the cells to become fragile, and lysis produces chronic anemia. Although sickle cell anemia was the first hereditary disease to be understood at the molecular level, 1,2 there is still no adequate long-term treatment or cure. Current measures focus on induction of fetal hemoglobin to inhibit polymer formation, treatment and prevention of infections, palliative measures to control pain, and surgical treatment of complications. 12 Allogeneic bone marrow transplantation is the only available cure, but this procedure is limited to a minority of patients with an available, histocompatible donor. 13 Autologous trans...