Defining the Optimal FVIII Transgene for Placental Cell-Based Gene Therapy to Treat Hemophilia A

• Published in: Molecular therapy. Methods & clinical development 2020-06, Vol.17, p.465-477
• Main Authors: El-Akabawy, Nadia, Rodriguez, Martin, Ramamurthy, Ritu, Rabah, Andrew, Trevisan, Brady, Morsi, Alshaimaa, George, Sunil, Shields, Jordan, Meares, Diane, Farland, Andrew, Atala, Anthony, Doering, Christopher B., Spencer, H. Trent, Porada, Christopher D., Almeida-Porada, Graça
• Format: Article
• Language: English
• Subjects: cell therapy; codon-optimization; ET3; FVIII; gene therapy; hemophilia A; HSQ; placental cells
• ISSN: 2329-0501; 2329-0501
• DOI: 10.1016/j.omtm.2020.03.001

The delivery of factor VIII (FVIII) through gene and/or cellular platforms has emerged as a promising hemophilia A treatment. Herein, we investigated the suitability of human placental cells (PLCs) as delivery vehicles for FVIII and determined an optimal FVIII transgene to produce/secrete therapeutic FVIII levels from these cells. Using three PLC cell banks we demonstrated that PLCs constitutively secreted low levels of FVIII, suggesting their suitability as a transgenic FVIII production platform. Furthermore, PLCs significantly increased FVIII secretion after transduction with a lentiviral vector (LV) encoding a myeloid codon-optimized bioengineered FVIII containing high-expression elements from porcine FVIII. Importantly, transduced PLCs did not upregulate cellular stress or innate immunity molecules, demonstrating that after transduction and FVIII production/secretion, PLCs retained low immunogenicity and cell stress. When LV encoding five different bioengineered FVIII transgenes were compared for transduction efficiency, FVIII production, and secretion, data showed that PLCs transduced with LV encoding hybrid human/porcine FVIII transgenes secreted substantially higher levels of FVIII than did LV encoding B domain-deleted human FVIII. In addition, data showed that in PLCs, myeloid codon optimization is needed to increase FVIII secretion to therapeutic levels. These studies have identified an optimal combination of FVIII transgene and cell source to achieve clinically meaningful levels of secreted FVIII. [Display omitted] Delivering FVIII through engineered cells is a promising approach for providing long-term/permanent hemophilia A treatment. Transducing cells in vitro allows safeguards in production that are not possible with direct vector injection. These studies identify the optimal combination of a FVIII transgene/cell source to achieve clinically meaningful levels of secreted FVIII.