Human Gene Therapy

ABSTRACT

Gene delivery via murine-based recombinant retroviral vectors is currently widely used in gene therapy clinical trials. The vectors are engineered to be replication defective by replacing the structural and nonstructural genes of a cloned infectious retrovirus with a therapeutic gene of interest. The retroviral particles are currently generated in packaging cell lines, which supply all retroviral proteins in trans. Recombination between short homologous regions of the retroviral vector and packaging cell line elements can theoretically generate replication-competent retrovirus (RCR) and hence the Food and Drug Administration (FDA) requires the monitoring of clinical trial subjects for the presence of RCR. Sensitive polymerase chain reaction (PCR) assays have been used for the detection of murine leukemia virus (MLV) nucleotide sequences in peripheral blood mononuclear cells (PBMCs). A novel serological enzyme-linked immunosorbent assay (ELISA) for the detection of anti-MLV specific immunoglobulin (Ig) has been developed to be used as an alternative to the PCR assay. Both assays were used to monitor human immunodeficiency virus (HIV)-positive clinical trial subjects who had received multiple injections of HIV-IT (V), a retroviral vector encoding HIV-1 IIIBenv/rev. Western blot analysis and an in vitro vector neutralization assay were used to characterize further a subset of serum samples tested by ELISA. Results show no evidence of RCR infection in clinical trial subjects. PCR and ELISA assays are discussed in terms of their advantages and limitations as routine screening assays for RCR. The PCR assay is our current choice for monitoring clinical trial subjects receiving direct administration of vector, and the ELISA is our choice for those receiving ex vivo treatment regimens.

Overview summary

A concern regarding gene therapy using retroviral vectors has been the possibility of accidental infection of patients with replication-competent retrovirus (RCR), potentially generated during the vector production. It is unknown if such an infection would have pathogenic consequences, Testing of vector product for RCR is one level of assurance, A second level is to test patients for RCR after treatment, We have developed a polymerase chain reaction (PCR) assay for RCR provirus detection and an enzyme-linked immunosorbent assay (ELISA) assay for anti-retroviral anti-bodies. No evidence of RCR infection was found in 81 human immunodeficiency virus (HIV)-infected patients receiving multiple injections of a retroviral vector.