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2016 ; 127
(10
): 1260-8
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Megakaryocyte- and megakaryocyte precursor-related gene therapies
#MMPMID26787735
Wilcox DA
Blood
2016[Mar]; 127
(10
): 1260-8
PMID26787735
show ga
Hematopoietic stem cells (HSCs) can be safely collected from the body,
genetically modified, and re-infused into a patient with the goal to express the
transgene product for an individual's lifetime. Hematologic defects that can be
corrected with an allogeneic bone marrow transplant can theoretically also be
treated with gene replacement therapy. Because some genetic disorders affect
distinct cell lineages, researchers are utilizing HSC gene transfer techniques
using lineage-specific endogenous gene promoters to confine transgene expression
to individual cell types (eg, ITGA2B for inherited platelet defects). HSCs appear
to be an ideal target for platelet gene therapy because they can differentiate
into megakaryocytes which are capable of forming several thousand anucleate
platelets that circulate within blood vessels to establish hemostasis by
repairing vascular injury. Platelets play an essential role in other biological
processes (immune response, angiogenesis) as well as diseased states
(atherosclerosis, cancer, thrombosis). Thus, recent advances in genetic
manipulation of megakaryocytes could lead to new and improved therapies for
treating a variety of disorders. In summary, genetic manipulation of
megakaryocytes has progressed to the point where clinically relevant strategies
are being developed for human trials for genetic disorders affecting platelets.
Nevertheless, challenges still need to be overcome to perfect this field;
therefore, strategies to increase the safety and benefit of megakaryocyte gene
therapy will be discussed.