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Blood, 1 October 2008, Vol. 112, No. 7, pp. 2713-2721.
Prepublished online as a Blood First Edition Paper on May 21, 2008; DOI 10.1182/blood-2008-02-138214.


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GENE THERAPY

Syngeneic transplantation of hematopoietic stem cells that are genetically modified to express factor VIII in platelets restores hemostasis to hemophilia A mice with preexisting FVIII immunity

Qizhen Shi13, Scot A. Fahs2, David A. Wilcox13, Erin L. Kuether13, Patricia A. Morateck2, Nicole Mareno2, Hartmut Weiler2, and Robert R. Montgomery13

1 Department of Pediatrics, Medical College of Wisconsin, Milwaukee; 2 Blood Research Institute, BloodCenter of Wisconsin, Milwaukee; and 3 Children's Research Institute, Children's Hospital of Wisconsin, Milwaukee

Although genetic induction of factor VIII (FVIII) expression in platelets can restore hemostasis in hemophilia A mice, this approach has not been studied in the clinical setting of preexisting FVIII inhibitory antibodies to determine whether such antibodies would affect therapeutic engraftment. We generated a line of transgenic mice (2bF8) that express FVIII only in platelets using the platelet-specific {alpha}IIb promoter and bred this 2bF8 transgene into a FVIIInull background. Bone marrow (BM) from heterozygous 2bF8 transgenic (2bF8tg+/–) mice was transplanted into immunized FVIIInull mice after lethal or sublethal irradiation. After BM reconstitution, 85% of recipients survived tail clipping when the 1100-cGy (myeloablative) regimen was used, 85.7% of recipients survived when 660-cGy (nonmyeloablative) regimens were used, and 60% of recipients survived when the recipients were conditioned with 440 cGy. Our further studies showed that transplantation with 1% to 5% 2bF8tg+/– BM cells still improved hemostasis in hemophilia A mice with inhibitors. These results demonstrate that the presence of FVIII-specific immunity in recipients does not negate engraftment of 2bF8 genetically modified hematopoietic stem cells, and transplantation of these hematopoietic stem cells can efficiently restore hemostasis to hemophilic mice with preexisting inhibitory antibodies under either myeloablative or nonmyeloablative regimens.


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