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A Serious Adverse Event after Successful Gene Therapy for X-Linked Severe Combined Immunodeficiency
Abstract
To the Editor: We recently reported (April 18 issue)1 the sustained correction of X-linked severe combined immunodeficiency disease by ex vivo, retrovirally mediated transfer of the γc gene into CD34+ cells in four of five patients with the disease. These results have since been confirmed in four additional patients with typical X-linked severe combined immunodeficiency. Of the first four successfully treated patients, three continue to do well up to 3.6 years after gene therapy, whereas a serious adverse event occurred in the fourth patient. At a routine checkup 30 months after gene therapy, lymphocytosis consisting of a monoclonal population . . .
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“Lentiviral vectors are considered safer than gamma-retroviral vectors in terms of their semi-random integration patterns, as gene integration does not preferentially occur in start regions of active genes (93-95).”
From Scalable Manufacturing of CAR T Cells for Cancer Immunotherapy (2021) · cites this paper as [93]
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“Clearly, lentiviral vector safety will require rigorous testing before clinical trials, as there is potential for similar insertional mutagenesis to that seen with retroviral vectors (47).”
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Vassilopoulos, G., & Russell, D. (2003) · Current Opinion in Genetics and Development · doi:10.1016/s0959-437x(03)00110-2 · Cited by 127
Enhancing and targeting nucleic acid delivery by magnetic force
Plank, C., Anton, M., Rudolph, C., Rosenecker, J., & Krötz, F. (2003) · Expert Opinion on Biological Therapy · doi:10.1517/14712598.3.5.745 · Cited by 127
“This harbours substantial but difficult-to-assess risks including insertional mutagenesis [1].”
BackgroundNew developments in lentiviral vector design, production and purification
Segura, M. M., Mangion, M., Gaillet, B., & Garnier, A. (2013) · Expert Opinion on Biological Therapy · doi:10.1517/14712598.2013.779249 · Cited by 127
“The main advantage of this strategy is to avoid the oncogene activation risk caused by random LVV insertion in the genome [72,73].”
BackgroundRetroviral Integrations in Gene Therapy Trials
Biasco, L., Baricordi, C., & Aiuti, A. (2012) · Molecular Therapy · doi:10.1038/mt.2011.289 · Cited by 106
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Nam, C.-H., & Rabbitts, T. (2006) · Molecular Therapy · doi:10.1016/j.ymthe.2005.09.010 · Cited by 126
A Phase I/II Clinical Trial of β‐Globin Gene Therapy for β‐Thalassemia
Bank, A., Dorazio, R., & Leboulch, P. (2005) · Annals of the New York Academy of Sciences · doi:10.1196/annals.1345.007 · Cited by 125
Use of minicircle plasmids for gene therapy.
Mayrhofer, P., Schleef, M., & Jechlinger, W. (2009) · Methods in molecular biology · doi:10.1007/978-1-59745-561-9_4 · Cited by 125
Mendell, J. R., Connolly, A. M., Lehman, K. J., Griffin, D. A., Khan, S. Z., Dharia, S. D., Quintana-Gallardo, L., & Rodino-Klapac, L. R. (2022) · Molecular Therapy - Methods & Clinical Development · doi:10.1016/j.omtm.2022.02.011 · Cited by 124
Mesenchymal stem cells in preclinical cancer cytotherapy: a systematic review
Christodoulou, I., Goulielmaki, M., Devetzi, M., Panagiotidis, M., Koliakos, G., & Zoumpourlis, V. (2018) · Stem Cell Research & Therapy · doi:10.1186/s13287-018-1078-8 · Cited by 122
“For example, AV expression is transient and often produces a significant host immune response, whereas RV may cause incorporation errors or even oncogene activation [283, 284].”
BackgroundKalman, L. V., Lindegren, M. L., Kobrynski, L. J., Vogt, R. F., Hannon, H., Howard, J. T., & Buckley, R. H. (2004) · Genetics in Medicine · doi:10.1097/01.gim.0000105752.80592.a3 · Cited by 133
Estimating abundances of retroviral insertion sites from DNA fragment length data
Berry, C. C., Gillet, N. A., Melamed, A., Gormley, N. A., Bangham, C. R. M., & Bushman, F. D. (2012) · Bioinformatics · doi:10.1093/bioinformatics/bts004 · Cited by 134
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“Two different gene therapy studies on X-linked SCID (SCID-X1) using retroviral vector integration resulted in leukemia induction in four out of nine subjects with one death [165, 166] and leukemia in one out of ten subjects [167, 168].”
BackgroundBeard, B. C., Dickerson, D. R., Beebe, K., Gooch, C., Fletcher, J., Okbinoglu, T., Miller, D. G., Jacobs, M. A., Kaul, R., Kiem, H., et al. (2007) · Molecular Therapy · doi:10.1038/sj.mt.6300159 · Cited by 121
Review of gene therapies for age-related macular degeneration
Khanani, A. M., Thomas, M. J., Aziz, A. A., Weng, C. Y., Danzig, C. J., Yiu, G., Kiss, S., Waheed, N. K., & Kaiser, P. K. (2022) · Eye · doi:10.1038/s41433-021-01842-1 · Cited by 119
“In 1999, gene therapy for the treatment of severe combined immunodeficiency-X1 ultimately resulted in the death of one patient from unforeseen oncogene activation [4].”
BackgroundGenome-Wide Mapping of PiggyBac Transposon Integrations in Primary Human T Cells
Galvan, D. L., Nakazawa, Y., Kaja, A., Kettlun, C. S., Cooper, L., Rooney, C., & Wilson, M. H. (2009) · Journal of immunotherapy · doi:10.1097/cji.0b013e3181b2914c · Cited by 119
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“This concern is poignantly demonstrated by the subsequent development of leukemia in three children with X-linked severe combined immunodeficiency after an otherwise successful gene therapy trial by use of an MLV-derived vector (36, 37).”
BackgroundMarcucci, K. T., Jadlowsky, J. K., Hwang, W., Suhoski, M. M., Gonzalez, V. E., Kulikovskaya, I. M., Gupta, M., Lacey, S. F., Plesa, G., Chew, A., et al. (2017) · Molecular Therapy · doi:10.1016/j.ymthe.2017.10.012 · Cited by 137
Titeux, M., Pendaries, V., Zanta, M. A., Décha, A., Pironon, N., Tonasso‐Calvière, L., Mejía, J. E., Brice, A., Danos, O., & Hovnanian, A. (2010) · Molecular Therapy · doi:10.1038/mt.2010.91 · Cited by 114
Novel vectors and approaches for gene therapy in liver diseases
Maestro, S., Weber, N. D., Zabaleta, N., Aldabe, R., & González‐Aseguinolaza, G. (2021) · JHEP Reports · doi:10.1016/j.jhepr.2021.100300 · Cited by 143
Metadata
- Authors
- Hacein-Bey-Abina, S., von Kalle, C., Schmidt, M., Le Deist, F., Wulffraat, N., McIntyre, E., Radford, I., Villeval, J.-L., Fraser, C. C., Cavazzana-Calvo, M., & Fischer, A.
- Venue
- New England Journal of Medicine
- Publisher
- Massachusetts Medical Society
- Published
- 2003-01-16
- Volume
- 348
- Issue
- 3
- Pages
- 255-256
- ISSN
- 0028-4793 (ISSN-L)
- 1533-4406
- OpenAlex
- W2323613689
- Cited by
- 1,867
- References
- 0
- Citations by year
- 2026: 29 · 2025: 32 · 2024: 31 · 2023: 25 · 2022: 47 · 2021: 52 · 2020: 46 · 2019: 50 · 2018: 45 · 2017: 63 · 2016: 65 · 2015: 84 · 2014: 87 · 2013: 92 · 2012: 92
- FWCI
- 86.98
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- New England Journal of Medicine (publishedVersion)
- PubMed (publishedVersion)
- FreiDok plus (Universitätsbibliothek Freiburg) (submittedVersion)
- DigitalGeorgetown (Georgetown University Library) (submittedVersion)
- Topics
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Virus-based gene therapy research
- Life Sciences › Immunology and Microbiology › Immunology › Immunodeficiency and Autoimmune Disorders
- Health Sciences › Medicine › Oncology › CAR-T cell therapy research
- Keywords
- X-linked severe combined immunodeficiency, gene therapy, adverse events, gene therapy safety
- MeSH terms
- Chromosomes, Human, Pair 11, DNA-Binding Proteins, Humans, Genetic Linkage, Metalloproteins, Proto-Oncogene Proteins, Retroviridae, Genetic Therapy, Gene Expression, Mutagenesis, Insertional, Severe Combined Immunodeficiency, Lymphocyte Count, Chromosomes, Human, X, Adaptor Proteins, Signal Transducing, Precursor Cell Lymphoblastic Leukemia-Lymphoma, LIM Domain Proteins
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