Session: 801. Gene Editing, Therapy and Transfer II
Hematology Disease Topics & Pathways:
sickle cell disease, Biological, HSCs, Diseases, bioengineering, Therapies, red blood cells, Genetic Disorders, Hemoglobinopathies, Biological Processes, Technology and Procedures, gene therapy, DNA repair, Cell Lineage, erythropoiesis, gene editing, hematopoiesis, transplantation
Base editors cannot generate the T-to-A transversion required to revert the mutant SCD codon (Val, GTG) to wild-type (Glu, GAG). However, ABEs can convert the Val codon to Ala (GCG) to generate the naturally occurring, non-sickling variant hemoglobin “Makassar” (HbG). Hemoglobin Makassar heterozygotes and 1 reported homozygote exhibit normal RBC indices, indicating that the variant is benign. We used protein directed evolution to generate a new ABE (ABE8e-NRCH) that accesses a nearby CACC PAM to convert HbS alleles to HbG efficiently in heterologous cells. To demonstrate therapeutic proof of concept, we electroporated ABE8e-NRCH mRNA and targeting sgRNA or ABE8e-NRCH/sgRNA ribonucleoprotein (RNP) complex into 3 different SCD donor CD34+ hematopoietic stem and progenitor cells (HSPCs). After 48 hours, conversion of the HbS allele to HbG was 58±5% with ABE8e-NRCH mRNA/sgRNA and 34±5% with RNP (n=3). On target editing was maximal at 144 hours: 80±2% with ABE8e-NRCH mRNA/sgRNA and 44±7% with ABE8e-NRCH protein (n=3). The indel rate resulting from inadvertent DSBs was <1%, and missense bystander mutations were not detected. In vitro differentiation of base-edited CD34+ cells generated late stage erythroid cells with 76% HbG/14% HbS protein after editing with ABE8e-NRCH mRNA/sgRNA, and 52% HbG/37% HbS after editing with RNP. The sickling rate of in vitro-generated reticulocytes exposed to hypoxia (2% O2) was 52% in controls derived from unedited CD34+ cells, 16% after editing with ABE8e-NRCH mRNA/sgRNA and 27% after editing with RNP.
To assess base editing in repopulating HSCs, we transplanted ABE8e-NRCH–edited SCD CD34+ cells into NBSGW mice. The editing frequency before transplantation was ~64% for ABE8e-NRCH mRNA/sgRNA and 40% for RNP at 48 hours after electroporation. Mice were euthanized after 16 weeks and base editing was analyzed in human donor-derived cells. Overall editing rates were preserved in repopulating cells: 68%±3% for ABE8e-NRCH mRNA/sgRNA and 36%±3% for RNP (n=4). The editing frequencies were similar in donor cell–derived myeloid, erythroid, and B cell-lineages, indicating that base editing did not alter hematopoietic development. Bone marrow erythroblasts derived from base-edited and control CD34+ HSPCs exhibited similar maturation profiles and enucleation. Erythroblasts generated in vivo from HSPCs from SCD patient exhibited potentially therapeutic levels of HbG protein: 58±3% with ABE8e-NRCH mRNA/sgRNA and 27%±3% with RNP (n=4). Adenine base editor conversion of the HbS allele to the Makassar variant in autologous HSCs represents a new therapeutic approach for SCD.
Disclosures: Yen: Beam Therapeutics: Current equity holder in publicly-traded company, Ended employment in the past 24 months. Henderson: Trilink Biotech: Current Employment. Mccaffrey: Trilink Biotech: Current Employment. Liu: Pairwise Plants: Consultancy, Patents & Royalties; Prime Medicine: Consultancy, Patents & Royalties; Editas Medicine: Consultancy, Patents & Royalties; Beam Therapeutics: Consultancy, Patents & Royalties. Weiss: Rubius Inc.: Consultancy, Current equity holder in private company; Cellarity Inc.: Consultancy, Current equity holder in private company; Novartis: Consultancy, Current equity holder in private company; Esperion Therapeutics: Consultancy, Current equity holder in private company; Beam Therapeuticcs: Consultancy, Current equity holder in private company.