C anine a -L-iduronidase (iduronidase) deficiency is a model of the hum an lysosom al storage disorder m ucopolysaccharidosis type I (M PS I). W e used this canine m odel to evaluate the therapeutic potential of hem atopoietic stem cell (H SC ) gene therapy for enzyme deficiencies. In previous studies, iduronidase-deficient dogs infused with autologous marrow cells genetically m odified to express iduronidase had long-term engraftment with provirally marked cells, but there was no evidence of proviral iduronidase expression or clinical im provem ent. The presence of hum oral and cellular imm une responses against iduronidase apparently abrogated the therapeutic potential of H SC gene therapy in these experim ents. To evaluate HSC gene therapy for canine M PS I in the absence of a confounding im m une response, we have now performed in utero adoptive transfer of iduronidase-transduced M PS I m arrow cells into preim m une fetal pups. In three separate experiments, 17 m idgestation fetal pups were injected with 0.5± 1.5 3 10 7 norm al or M PS I allogeneic long-term m arrow culture (LTM C ) cells transduced with neo r -or iduronidase-containing retroviral vectors. Nine norm al and three M PS I pup s survived the neonatal period and demonstrated engraftment of provirally m arked progenitors at levels of up to 12% for up to 12 months. H ow ever, the proportion of provirally m arked circulating leukocytes was , 1% . Neither iduronidase enzyme nor proviral-specific transcripts were detected in blood or m arrow leukocytes of any M PS I dog. Hum oral imm une responses to iduronidase were not detected in neonates, even after ª boostingº with autologous iduronidase-transduced LTM C cells. All M PS I dogs died at 8± 11 m onths of age from com plications of M PS I disease with no evidence of am elioration of M PS I disease. O ur results suggest that iduronidase-transduced prim itive hem atopoietic progenitors can engraft in fetal recipients, contribute to hem atopoiesis, and induce im m unologic nonresponsiveness to iduronidase in M PS I dogs. However, the therapeutic potential of HSC gene transfer in this m odel of iduronidase deficiency appears to be limited by poor m aintenance of proviral iduronidase gene expression and relatively low levels of genetically corrected circulating leukocytes. 1521 OVERVIEW SU M M A RY G enetically m odified H SC s have been proposed as vehicles for gene therapy of single-gene inherited disorders, such as enzym e deficien cies. W e evaluated the ability of H SC s to am eliorate disease sym ptom s in a canine m odel of iduronidase deficien cy. In previous studies adoptive transfer of iduronidase-transduced hem atopoietic progenitors to iduronidase-deficient dogs resu lted in engraftm ent of provirus-positive cells; how ever, no clinical benefit was evident. Im m une responses against the therapeutic iduronidase protein and cells expressing it were detected. The im m une response probably abrogated any potential therapeutic impact of H SC gene therapy. In the work reported here, adoptive transf...