Dynamics of gene-modified progenitor cells analyzed by tracking retroviral integration sites in a human SCID-X1 gene therapy trial
- G. P. Wang1,
- C. C. Berry2,
- N. Malani1,
- P. Leboulch3,
- A. Fischer4,
- S. Hacein-Bey-Abina5,
- M. Cavazzana-Calvo6, and
- F. D. Bushman1,*
- 1 University of Pennsylvania School of Medicine, Department of Microbiology, Philadelphia, PA, United States;
- 2 Department of Family/Preventive Medicine, University of California, San Diego School of Medicine, San Diego, CA, United States;
- 3 Genetics Division, Brigham & Women's Hospital and Harvard Medical School, Boston, MA, United States;
- 4 Unite d'immunologie et hematologie pediatriques, Hopital Necker Enfants-Malades, AP-HP, Universite Rene Descartes, Paris, France;
- 5 Dept. of Biotherapy, Hopital Necker-Enfants Malades, Assistance Publique - Hopitaux de Paris (AP-HP), Universite Paris-Descartes, Paris, France;
- 6 Institut National de la Sante et de la Recherche Medicale (INSERM), Unite (U) 768, Paris, France
- * Corresponding author; email: bushman{at}mail.med.upenn.edu
Abstract
Severe-combined immunodeficiency (SCID-X1) has been treated by therapeutic gene transfer using gammaretroviral vectors, but insertional activation of proto-oncogenes contributed to leukemia in some patients. Here we report a longitudinal study of gene-corrected progenitor cell populations from eight patients using 454 pyrosequencing to map vector integration sites, and extensive resampling to allow quantification of clonal abundance. The number of transduced cells infused into patients initially predicted the subsequent diversity of circulating cells. A capture-recapture analysis was used to estimate the size of the gene-corrected cell pool, revealing that <1/100th of the infused cells had long term repopulating activity. Integration sites were clustered even at early time points, often near genes involved in growth control, and several patients harbored expanded cell clones with vectors integrated near the cancer-implicated genes CCND2 and HMGA2, but remain healthy. Integration site tracking also documented that chemotherapy for adverse events resulted in successful control. The longitudinal analysis emphasizes that key features of transduced cell populations--including diversity, integration site clustering, and expansion of some clones--were established early after transplantation. The approaches to sequencing and bioinformatics analysis reported here should be widely useful in assessing the outcome of gene therapy trials.
- Submitted December 1, 2009.
- Accepted February 20, 2010.
- Copyright © 2005 American Society of Hematology
