Boubini Jones-Wonni, Amar H Kelkar, Maureen O Achebe
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引用次数: 0
摘要
由于血红蛋白病的发病率和死亡率都很高,人们长期以来一直在寻求治疗方案。基因治疗的总体目标是通过基因添加、基因编辑或基因沉默,改变患者自身的造血干细胞,以克服潜在基因缺陷的有害影响。基因添加是将功能优于异常基因的基因整合在一起;基因编辑是利用分子工具,如锌指蛋白、转录激活剂样效应核酸酶和Cas9蛋白(CRISPR-Cas9)偶联的簇状规则间隔短链色重复序列(Clustered Regularly Interspaced Short Palindromic Repeats coupled with Cas9 proteins),使DNA序列发生特异性断裂,从而破坏基因功能;基因沉默则是通过干扰mRNA转录/蛋白质翻译或表观遗传修饰来抑制基因表达。针对血红蛋白病的大多数基因治疗策略都以红细胞特异性 BCL11A 为靶点,BCL11A 是γ-球蛋白基因座上胎儿血红蛋白抑制的主要调节因子,在出生后不久就会发生胎儿到成人血红蛋白的正常转换。其他目标还包括加入抗镰状球蛋白,如βT87Q或βAS3。对输血依赖型地中海贫血症和镰状细胞病的基因疗法进行了具有里程碑意义的临床试验,结果表明疗效显著,安全性可接受,最近欧洲和美国的监管机构批准了这两种疾病的基因疗法。
A Review of Gene Therapies for Hemoglobinopathies.
Due to the significant morbidity and mortality of hemoglobinopathies, curative options have long been pursued. The overall goal of gene therapy is to modify a patient's own hematopoietic stem cells to overcome the deleterious effects of the underlying genetic defect by gene addition, gene editing, or gene silencing. Gene addition incorporates genes with superior function than the abnormal gene; gene editing takes advantage of molecular tools such as zinc finger proteins, Transcription Activator-Like Effector Nucleases and Clustered Regularly Interspaced Short Palindromic Repeats coupled with Cas9 proteins (CRISPR-Cas9) which allow for sequence-specific breaks in DNA that disrupt gene function; and gene silencing suppresses gene expression by interference with mRNA transcription/protein translation or epigenetic modification. The majority of gene therapy strategies for hemoglobinopathies have targeted erythroid-specific BCL11A, a major regulator of fetal hemoglobin repression at the gamma-globin locus, in the normal fetal-to-adult hemoglobin switch that occurs shortly after birth. Other goals have involved the incorporation of anti-sickling globins, such as βT87Q or βAS3. Landmark clinical trials of gene therapy in transfusion-dependent thalassemia and sickle cell disease have shown remarkable efficacy and acceptable safety and culminated in recent regulatory approvals of gene therapy for both diseases in Europe and the United States.
期刊介绍:
Hemoglobin is a journal in the English language for the communication of research and information concerning hemoglobin in humans and other species. Hemoglobin publishes articles, reviews, points of view
The journal covers topics such as:
structure, function, genetics and evolution of hemoglobins
biochemical and biophysical properties of hemoglobin molecules
characterization of hemoglobin disorders (variants and thalassemias),
consequences and treatment of hemoglobin disorders
epidemiology and prevention of hemoglobin disorders (neo-natal and adult screening)
modulating factors
methodology used for diagnosis of hemoglobin disorders