Publications
Molecular therapy : the journal of the American Society of Gene TherapyFeb 2025 DOI:
10.1016/j.ymthe.2025.02.036

A differentiated β-globin gene replacement strategy uses heterologous introns to restore physiological expression

Wallace, Kirby A; Gerstenberg, Trevor L; Ennis, Craig L; Perez-Bermejo, Juan A; Partridge, James R; Bandoro, Christopher; Matern, William M; Andreoletti, Gaia; Krassovsky, Kristina; Kabir, Shaheen; Lalisan, Cassandra D; Churi, Aishwarya R; Chew, Glen M; Corbo, Lana; Vincelette, Jon E; Klasson, Timothy D; Silva, Brian J; Strukov, Yuri G; Quejarro, B Joy; Hill, Kaisle A; Treusch, Sebastian; Grogan, Jane L; Dever, Daniel P; Porteus, Matthew H; Wienert, Beeke
Product Used
Genes
Abstract
β-hemoglobinopathies are common monogenic disorders. In sickle cell disease (SCD) a single mutation in the β-globin (HBB) gene results in dysfunctional hemoglobin protein, while in β-thalassemia, over 300 mutations distributed across the gene reduce β-globin levels and cause severe anemia. Genetic engineering replacing the whole HBB gene through homology directed repair (HDR) is an ideal strategy to restore a benign genotype and rescue HBB expression for most genotypes. However, this is technically challenging because 1) the insert must not be homologous to the endogenous gene and 2) synonymous codon-optimized, intron-less sequences may not reconstitute adequate β-globin levels. Here, we developed an HBB gene replacement strategy using CRISPR-Cas9 that successfully addresses these challenges. We determined that a DNA donor containing a diverged HBB coding sequence and heterologous introns to avoid sequence homology provides proper physiological expression. We identified a DNA donor that uses truncated γ-globin introns, results in 34% HDR, rescues β-globin expression in in vitro models of SCD and β-thalassemia in hematopoietic stem and progenitor cells (HSPCs). Furthermore, while HDR allele frequency dropped in vivo, it was maintained at ∼15%, demonstrating editing of long-term repopulating HSPCs. In summary, our HBB gene replacement strategy offers a differentiated approach by restoring naturally regulated adult hemoglobin expression.
Product Used
Genes

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