Mucopolysaccharidosis type I (MPS IH;Hurler syndrome) is a congenital deficiency of ␣-L-iduronidase, leading to lysosomal storage of glycosaminoglycans that is ultimately fatal following an insidious onset after birth. Hematopoietic cell transplantation (HCT) is a life-saving measure in MPS IH. However, because a suitable hematopoietic donor is not found for everyone, because HCT is associated with significant morbidity and mortality, and because there is no known benefit of immune reaction between the host and the donor cells in MPS IH, gene-corrected autologous stem cells may be the ideal graft for HCT. Thus, we generated induced pluripotent stem cells from 2 patients with MPS IH (MPS-iPS cells). We found that ␣-L-iduronidase was not required for stem cell renewal, and that MPS-iPS cells showed lysosomal storage characteristic of MPS IH and could be differentiated to both hematopoietic and nonhematopoietic cells. The specific epigenetic profile associated with dedifferentiation of MPS IH fibroblasts into
MPS-iPS cells was maintained when MPS-iPS cells
IntroductionThe seminal insight that cells with 2 different enzyme deficiencies can functionally complement each other 1 made possible the use of allogeneic hematopoietic cell transplantation (HCT) to correct the biochemical and clinical phenotype of several fatal nonmalignant enzymatic deficiency disorders, including Hurler syndrome (mucopolysaccharidosis type I-Hurler, MPS IH). 2 In MPS IH the deficiency of ␣-L-iduronidase (IDUA) results in the toxic accumulation of glycosaminoglycans (GAG) heparan sulfate and dermatan sulfate. This in turn leads to progressive cellular and multiorgan dysfunction in viscera, bone, connective tissue, and brain. Untreated, early death is observed usually between 5 and 10 years of age. 3 The sole agent needed for MPS IH correction is the missing IDUA, which after secretion and intercellular transfer is taken up by IDUA-deficient cells through receptor-mediated endocytosis. Weekly doses of intravenous IDUA have been used for mild forms of MPS I. However, because IDUA does not cross the blood-brain barrier efficiently, enzyme replacement therapy alone is not indicated for the severe form of IDUA deficiency, MPS IH. 4 Allogeneic HCT, in contrast, leads not only to donor hematopoietic engraftment and systemic expression of IDUA but also to donor myeloid cells crossing the blood-brain barrier and correcting IDUA deficiency in the brain. [5][6][7][8] Although HCT is a life-saving measure in MPS IH, a suitable HCT donor is not found for everyone. To achieve a cure, children with MPS IH must survive both the disease and its therapy because allogeneic HCT is associated with significant morbidity and mortality from physical and immune injury by both the myeloablative conditioning regimen and the transplantation of an immunologically matched allogeneic cellular graft. [9][10][11] In contrast to some malignancies, 12 in patients with congenital enzymopathies there is no known benefit of immune reaction between the host and the donor cells.Pa...