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Elsevier BV Molecular Therapy - Methods & Clinical Development 32(3)
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    초록·키워드

    Targeted gene editing to restore CD40L expression via homology-directed repair (HDR) in CD34<sup>+</sup> hematopoietic stem and progenitor cells (HSPCs) represents a potential long-term therapy for X-linked hyper IgM syndrome. However, clinical translation of HSPC editing is limited by inefficient long-term engraftment of HDR-edited HSPCs. Here, we ameliorate this issue by employing a small-molecule inhibitor of DNA-PKcs, AZD7648, to bias DNA repair mechanisms to facilitate HDR upon CRISPR SpCas9-based gene editing. Using AZD7648 treatment and a clinically relevant HSPC source, mobilized peripheral blood CD34<sup>+</sup> cells, we achieve ∼60% HDR efficiency at the <i>CD40LG</i> locus and enhanced engraftment of HDR-edited HSPCs in primary and secondary xenotransplants. Specifically, we observed a 1.6-fold increase of HDR-edited long-term HSPCs in primary transplant recipients without disturbing chimerism levels or differentiation capacity. As CD40L is primarily expressed in T cells, we demonstrate T cell differentiation from HDR-edited HSPCs <i>in vivo</i> and in artificial thymic organoid cultures, and endogenously regulated CD40L expression following activation of <i>in-vivo</i>-derived CD4<sup>+</sup> T cells. Our combined findings demonstrate HDR editing at the <i>CD40LG</i> locus at potentially clinically beneficial levels. More broadly, these data support using DNA-PKcs inhibition with AZD7648 as a simple and efficacious addition to HSPC editing platforms.

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