Hemophilia B is a bleeding disorder resulting from factor IX (FIX) deficiency that might be treated with gene therapy. Neonatal delivery would correct the disease sooner than would transfer into adults, and could reduce immunological responses. Neonatal mice were injected intravenously with a Moloney murine leukemia virus-based retroviral vector (RV) expressing canine FIX (cFIX). They achieved 150% to 280% of normal cFIX antigen levels in plasma (100% is 5 g/ mL), which was functional in vitro and in vivo. Three newborn hemophilia B dogs that were injected intravenously with RV achieved 12% to 36% of normal cFIX antigen levels, which improved coagulation tests. Only one mild bleed has occurred during 14 total months of evaluation. This is the first demonstration of prolonged expression after neonatal gene therapy for hemophilia B in mice or dogs. Most animals failed to make antibodies to cFIX, demonstrating that neonatal gene transfer may induce tolerance. Although hepatocytes from newborns replicate, those from adults do not. Adult mice therefore received hepatocyte growth factor to induce hepatocyte replication prior to intravenous injection of RV. This resulted in expression of 35% of normal cFIX antigen levels for 11 months, although all mice produced anti-cFIX antibodies. This is the first demonstration that high levels of FIX activity can be achieved with an RV in adults without a partial hepatectomy to induce hepatocyte replication. We conclude that RV-mediated hepatic gene therapy is effective for treating hemophilia B in mice and dogs, although the immune system may complicate gene transfer in adults.
IntroductionHemophilia B is a sex-linked disorder due to deficiency of factor IX (FIX) activity that affects 1 in 30 000 males. 1 Hepatic gene therapy could result in the continuous secretion of FIX into the blood and improve bleeding symptoms. Achieving more than 10% of normal activity should prevent most spontaneous bleeds, whereas 1% of normal activity should reduce, but not prevent, bleeding. There has been recent success in using hepatic gene therapy to express therapeutic levels of FIX in mice. 2 For example, lentiviral vectors resulted in FIX antigen levels that were 2% to 7% of normal 3,4 ; adeno-associated virus (AAV) vectors resulted in levels that were 10% to 40% of normal [5][6][7][8][9] or 400% of normal 10 ; adenoviral vectors resulted in levels that were 8% of normal 11 or 60% to 4100% of normal [12][13][14][15][16] ; and plasmids resulted in levels that were 7% to 80% of normal. [17][18][19] In addition, intramuscular injection of AAV vectors resulted in 3% to 7% of normal 5,20,21 or 1000% of normal levels, 22 whereas other nonhepatic approaches generally result in lower long-term expression. 2 Gene therapy appears to be less efficacious in large-animal models than in mice. In some cases, lower expression was obtained despite the use of a dose of vector per body weight similar to that used in mice, although in other cases lower expression could be attributed at least in part to the use of ...