We propose a Phase I/II clinical trial to assess the safety and efficacy of transplanting autologous bone marrow CD34+ cells transduced with the EFS-ADA lentiviral vector (LV) following non-myeloablative conditioning with busulfan chemotherapy. Adenosine deaminase (ADA)-deficient severe combined immune deficiency (SCID) has been treated using ?-retroviral (?-RV)-mediated gene transfer to bone marrow CD34+ hematopioetic stem cells (HSC) in recent clinical trials. Stable engraftment of gene-corrected HSC has been achieved with in vivo expression of ADA enzyme activity in blood cells and substantial immune reconstitution in the majority of subjects. However, the pace of lymphocyte recovery is relatively slow and the absolute levels of lymphocytes reached are often sub-normal, and the majority of subjects do not have effective B cell reconstitution and immunoglobulin production. The efficiency of gene transfer to human HSC using??-RV is moderate, limited in part by the relatively low titers of these vectors when made at clinical scale Additionally???-RVs have the potential for causing insertional oncogenesis by insertion of their strong enhancer elements adjacent to cellular proto-oncogenes. Lentiviral vectors (LV) can be configured to have minimal enhancer activity in the transcriptional units and may be safer than ?-RV. Also, LV may transfer genes more efficiently to human HSC in a shorter time of culture preserving stem cell engraftment capacity. This trial will test the hypothesis that: the EFS-ADA lentiviral vector will safely lead to more engrafted, transduced HSC with better immune reconstitution compared to a historical control group in prior trials using ?-retroviral vectors (? RV). This 5-year study will enroll 10 ADA-deficient SCID patients through two sites (UCLA and NIH). Three to four patients will be enrolled annually during a 3-year accrual period and each patient will be followed for two years. There will be a separate study for long-term follow-up for these patients for years 3-15. If successful, this approach may lead to an alternative therapeutic approach to patients with ADA-deficient SCID, and other primary immune deficiencies and blood cell diseases.

Public Health Relevance

This clinical trial will seek to develop better treatments for Primary Immune Deficiency (PID) disorders, using lentiviral vectors to transfer the normal gene to bone marrow stem cells. It will provide first-in-human information on the safety and effectiveness of this combined cell and gene therapy approach and would support the development of better treatments for PID and other blood cell diseases.

Agency
National Institute of Health (NIH)
Institute
National Institute of Allergy and Infectious Diseases (NIAID)
Type
Research Project--Cooperative Agreements (U01)
Project #
1U01AI100801-01
Application #
8332560
Study Section
Special Emphasis Panel (ZAI1-JTS-I (M2))
Program Officer
Griffith, Linda M
Project Start
2012-08-01
Project End
2017-07-31
Budget Start
2012-08-01
Budget End
2013-07-31
Support Year
1
Fiscal Year
2012
Total Cost
$699,125
Indirect Cost
$210,083
Name
University of California Los Angeles
Department
Pediatrics
Type
Schools of Medicine
DUNS #
092530369
City
Los Angeles
State
CA
Country
United States
Zip Code
90095
Kohn, Donald B; Hershfield, Michael S; Puck, Jennifer M et al. (2018) Consensus approach for the management of severe combined immune deficiency caused by adenosine deaminase deficiency. J Allergy Clin Immunol :
Kohn, Lisa A; Seet, Christopher S; Scholes, Jessica et al. (2014) Human lymphoid development in the absence of common ?-chain receptor signaling. J Immunol 192:5050-8
Kohn, Donald B (2014) Eliminating SCID row: new approaches to SCID. Hematology Am Soc Hematol Educ Program 2014:475-80
Carbonaro, Denise A; Zhang, Lin; Jin, Xiangyang et al. (2014) Preclinical demonstration of lentiviral vector-mediated correction of immunological and metabolic abnormalities in models of adenosine deaminase deficiency. Mol Ther 22:607-622