成纤维细胞基因治疗血友病B的临床Ⅰ期试验

本文首次报道了以皮肤成纤维细胞为靶细胞,对血友病B患者实施基因治疗的监床Ⅰ期试验。首先用构建有人凝血因子Ⅸ cDNA的反转录病毒载体(XL-Ⅸ和N2 CMV-Ⅸ)感染血友病B患者皮肤成纤维细胞(HBSF),选择得到表达有人Ⅸ因子蛋白的细胞,而后进行一系列安全性检测,包括细胞连续传代形态观察;染色体分析,软琼脂试验;裸鼠接种试验;胶原过敏试验;内毒素试验等,在确定表达人Ⅸ因子蛋白的细胞的安全性后,大量扩增细胞,最后,细胞用胶原包埋,直接注射到血友病B患者腹部或背部皮下。患者1体内凝血因子IX浓度从71ng/ml上升到约240 ng/ml,至今维持在220ng/ml,持续表达6个月,凝血因子Ⅸ的凝血活性也从2.9％上升到6.3％,该患者的临床症状改善;患者2体内凝血因子Ⅸ浓度亦从130 ng/ml上升到约280 ng/ml,至今维持在220 ng/ml,持续表达5个多月,但活性增加不稳定。两名受试者至今没有发现任何副作用和危害,正在随访之中。我们认为反转录病毒介导的基因转移自体皮肤成纤维细胞,用胶原包埋,皮下移植是安全可靠的,也是简便易行的,从而成功地完成了血友病B基因治疗的临床Ⅰ期试验。     

Stage Ⅰ Clinical Trial of Gene Therapy for Hemophilia B

This paper describes the first human gene therapy trial for hemophilia B. Retroviruses were used to introduce human factor Ⅸ into autologous, primary human skin fibroblasts from the patients. Recombinant retroviral vector containing human FIX cDNA driven by viral LTR promoter (XL-Ⅸ) and double-copy retroviral vector driven by human cytomegalovirus enhancer-promoter (N2CMV-Ⅸ)were constructed. After the safety assessment, including soft-agar test, cell morphology observation, analysis of endotoxin, chromosome karyotype, allergic reaction test, nude mice test, routine pathological test, electromicroscopic analysis, and virus detection by PCR, etc., the engineered cells were pooled and embedded in collagen mixture, autologously injected into the patients respectively. The concentration of human FIX protein of Patient 1 increased from 71 ng/ml to 220 ng/ml, witha maximum level of 245 ng/ml. The expression of FIX has lasted for 6 months at the time of writing. The clotting activity also increased from 2.9%