Abstract
Fabry disease is an X-linked metabolic disorder caused by a deficiency ofα-galactosidase A (α-Gal A). Lack of this lysosomal hydrolase results in theaccumulation of galactose-terminal glycosphingolipids in a number of tissues,including vascular endothelial cells. Premature death is predominantly associated withvascular conditions of the heart, kidneys and brain. Historically, treatment has largelybeen palliative. Alternative treatments for many lysosomal storage diseases have beendeveloped, including allogeneic organ and bone marrow transplantation, enzymereplacement therapy, and gene therapy. Significant clinical risks still exist withallogeneic transplantations. α-Gal A enzyme replacement therapy has beenimplemented in clinical trials. This approach has been effective but may havelimitations for long-term systemic or cost-effective correction. As an alternative, genetherapy approaches, involving a variety of gene delivery systems, have been pursuedfor the amelioration of Fabry disease. Fabry disease is a compelling disorder for genetherapy, as target cells are readily accessible and relatively low levels of enzymecorrection may suffice to reduce storage. Importantly, metabolic cooperativity effectsare also manifested in Fabry disease, wherein corrected cells secrete α-Gal A that cancorrect bystander cells. In addition, a broad therapeutic window probably exists, andmouse models of Fabry disease have been generated to assist studies. As an example,in vitro and in vivo studies using α-Gal A-transduced haematopoietic cells from Fabrymice have demonstrated enzymatic correction of recipient cells and dissemination ofα-Gal A upon transplantation, leading to reduced lipid storage in a number ofclinically relevant organs. This corrective enzymatic effect has recently been shown tobe even further enhanced upon pre-selection of therapeutically transduced cells priorto transplantation. This review will briefly detail current gene delivery methods andsummarize results to date in the context of gene therapy for Fabry disease.
Similar content being viewed by others
REFERENCES
Abe A, Gregory S, Lee L, et al (2000) Reduction of globotriaosylceramide in Fabry disease mice by substrate deprivation. J Clin Invest 105: 1563–1571.
Anderson WF (1998) Human gene therapy. Nature 392: 25–30.
Anwer K, Bailey A, Sullivan SM (2000) Targeted gene delivery: A two-pronged approach. Crit Rev Ther Drug Carrier Syst 17: 377–424.
Balague C, Zhou J, Dai Y, et al (2000) Sustained high-level expression of full-length human factor VIII and restoration of clotting activity in hemophilic mice using a minimal adenovirus vector. Blood 95: 820–828.
Benihoud K, Yeh P, Perricaudet M (1999) Adenovirus vectors for gene delivery. Curr Opin Biotechnol 10: 440–447.
Berns K (1996) Parvoviridae: The viruses and their replication. In Fields B, Knipe DM, Howley PM, Chancock RM, eds. Fundamental Virology. Philadelphia: Lippincott-Raven, 1017–1041.
Bishop DF, Calhoun DH, Bernstein HS, Hantzopoulos P, Quinn M, Desnick RJ (1986) Human α-galactosidase A: nucleotide sequence of a cDNA clone encoding the mature enzyme. Proc Natl Acad Sci USA 83: 4859–4863.
Blaese RM, Culver KW, Miller AD, et al (1995) T lymphocyte-directed gene therapy for ADA-SCID: Initial trial results after 4 years. Science 270: 475–480.
Blau CA, Peterson KR, Drachman JG, Spencer DM (1997) A proliferation switch for genetically modified cells. Proc Natl Acad Sci USA 94: 3076–3081.
Bordignon C, Notarangelo, LD, Nobili N, et al (1995) Gene therapy in peripheral blood lymphocytes and bone marrow for ADA-immunodeficient patients. Science 270: 470–475.
Brady RO, Gal AE, Bradley RM, Martensson E, Warshaw AL, Laster L (1967) Enzymatic defect in Fabry disease. N Engl J Med 276: 1163–1167.
Brady RO, Tallman JF, Johnson WG, et al (1973) Replacement therapy for inherited enzyme deficiency: use of purified ceramidetrihexosidase in Fabry's disease. N Engl J Med 289: 9–14.
Budker V, Gurevich V, Hagstrom JE, Bortzov F, Wolff JA (1996) pH-sensitive, cationic liposomes: a new synthetic virus-like vector. Nat Biotechnol 14: 760–764.
Bunting KD, Galipeau J, Topham D, Benaim E, Sorrentino BP (1998) Transduction of murine bone marrow cells with an MDR1 vector enables ex vivo stem cell expansion, but these expanded grafts cause a myeloproliferative syndrome in transplanted mice. Blood 92: 2269–2279.
Burns JC, Friedmann T, Driever W, Burrascano M, Yee JK (1993) Vesticular stomatitis virus G glycoprotein pseudotyped retroviral vectors: concentration to very high titer and efficient gene transfer into mammalian and nonmammalian cells. Proc Natl Acad Sci USA 90: 8033–8037.
Cavazzana-Calvo M, Hacein-Bey S, de St Basile G, et al (2000) Gene therapy of human severe combined immunodeficiency (SCID)-X1 disease. Science 288: 669–672.
Challita PM, Kohn DB (1994) Lack of expression from a retroviral vector after transduction of murine hematopoietic stem cells is associated with methylation in vivo. Proc Natl Acad Sci USA 91: 2567–2571.
Cheng L, Fu J, Tsukamoto A, Hawley RG (1996) Use of green fluorescent protein variants to monitor gene transfer and expression in mammalian cells. Nat Biotechnol 14: 606–609.
Cheung AT, Dayanandan B, Lewis JT, et al (2000) Glucose-dependent insulin release from genetically engineered K cells. Science 290: 1959–1962.
Clackson T (1998) Redesigning small molecule-protein interfaces. Curr Opin Struct Biol 4: 451–458.
Cosset F-C, Takeuchi Y, Battini J-Y, Weiss, RA, Collins MKL (1995) High-titer packaging cells producing recombinant retroviruses resistant to human serum. J Virol 69: 7430–7436.
Crystal RG (1995) Transfer of genes to humans: early lessons and obstacles to success. Science 270: 404–410.
Dang Q, Auten J, Plavec I (2000) Human beta interferon scaffold attachment region inhibits de novo methylation and confers long-term, copy number-dependent expression to a retroviral vector. J Virol 74: 2671–2678.
Dawson G, Sweeley CC (1970) In vivo studies on glycosphingolipid metabolism in porcine blood. J Biol Chem 245: 410–416.
Desnick RJ, Dean KJ, Grabowski G, Bishop DF, Sweeley CC (1979) Enzyme therapy in Fabry disease: Differential in vivo plasma clearance and metabolic effectiveness of plasma and splenic α-galactosidase A isozymes. Proc Natl Acad Sci USA 76: 5326–5330.
Desnick RJ, Ioannou YA, Eng CM (2001) α-galactosidase A deficiency: Fabry disease. In Scriver CR, Beaudet AL, Sly WS, Valle D, eds. The Metabolic and Molecular Bases of Inherited Disease. 8th edition. New York: McGraw-Hill Inc, 3733–3774.
Dongsheng D, Prerna S, Jusan Y, et al (1998) Circular intermediates of recombinant adenoassociated virus have defined structural characteristics responsible for long-term episomal persistence in muscle tissue. J Virol 72: 8568–8577.
Eng CM, Banikazemi M, Gordon RE et al (2001) A phase 1/2 clinical trial of enzyme replacement in Fabry disease: Pharmacokinetic, substrate clearance and safety studies. Am J Hum Genet 68: 711–722.
Erlich S, Miranda SRP, Visser JWM, Dagan A, Gatt S, Schuchman EH (1999) Fluorescence-based selection of gene-corrected hematopoietic stem and progenitor cells from acid sphingomyelinasedeficient mice: Implications for Niemann-Pick disease gene therapy and the development of improved stem cell gene transfer procedures. Blood 93: 80–86.
Fan J-Q, Ishii S, Asano N, Suzuki Y (1999) Accelerated transport and maturation of lysosomal α-galactosidase A in Fabry lymphoblasts by an enzyme inhibitor. Nat Med 5: 112–115.
Grignani F, Kinsella T, Mencarelli A, et al (1998) High-efficiency gene transfer and selection of human hematopoietic progenitor cells with a hybrid EBV/retroviral vector expressing the green fluorescence protein. Cancer Res 58: 14–19.
Greber UF, Webster P, Weber J, Helenius A (1996) The role of the adenovirus protease on virus entry into cells. EMBO J 15: 1766–1777.
Gutgsell NS, Malek TR (1994) Formation of high affinity IL-2 receptors is dependent on a nonligand binding region of the α subunit. J Immunol 153: 3899–3907.
Halene S, Kohn DB (2000) Gene therapy using hematopoietic stem cells: Sisyphus approaches the crest. Hum Gene Ther 11: 1259–1267.
Hanenberg H, Xiao XL, Dilloo D, Hashino K, Kato I, Williams DA (1996) Colocalization of retrovirus and target cells on specific fibronectin fragments increases genetic transduction of mammalian cells. Nat Med 2: 876–882.
Hobbs JR, Hugh-Jones K, Barrett AJ, et al (1981) Reversal of clinical features of Hurler's disease and biochemical improvement after treatment by bone-marrow transplantation. Lancet 2: 709–712.
Hodgson CP, Solaiman F (1996) Virosomes: Cationic liposomes enhance retroviral transduction. Nat Biotechnol 14: 339–342.
Hoogerbrugge PM, Brouwer OF, Bordigoni P, et al (1995) Allogeneic bone marrow transplantation for lysosomal storage diseases. Lancet 345: 1398–1402.
Horwitz MS (1996) Adenoviruses. In Fields B, Knipe DM, Howley PM, Chancock RM, eds. Fundamental Virology. Philadelphia: Lippincott-Raven, 2149–2171.
Inoue N, Russell DW (1998) Packaging cells based on inducible gene amplification for the production of adeno-associated virus vectors. J Virol 72: 7024–7031.
Ioannou YA (2000) Gene therapy for lysosomal storage disorders with neuropathology. J Am Soc Nephrol 11: 1542–1547.
Ioannou YA, Zeidner KM, Gordon RE, Desnick RJ (2001) Fabry disease: Preclinical studies demonstrate the effectiveness of α-galactosidase A replacement in enzyme-deficient mice. Am J Hum Genet 68: 14–25.
Jung S-C, Han IP, Limaye A, et al (2001) Adeno-associated viral vector-mediated gene transfer results in long-term enzymatic and functional correction in multiple organs of Fabry mice. Proc Natl Acad Sci USA 98: 2676–2681.
Kalberer CP, Pawliuk R, Imren S, et al (2000) Preselection of retrovirally transduced bone marrow avoids subsequent stem cell gene silencing and age-dependent extinction of expression of human beta-globin in engrafted mice. Proc Natl Acad Sci USA 97: 5411–5415.
Karlsson S (1991) Treatment of genetic defects in hematopoietic cell function by gene transfer. Blood 78: 2481–2492.
Karp BI, Ali S, Takenaka T, Brady RO, Medin JA (1999) Modification of the human α-galactosidase A (α-Gal A) C-terminus enhances uptake by Fabry patient fibroblasts. FASEB J 13: A1403.
Kay MA, Glorioso JC, Naldini L (2001) Viral vectors for gene therapy: The art of turning infectious agents into vehicles of therapeutics. Nat Med 7: 33–40.
Kotin RM, Linden RM, Berns KI (1992) Characterization of a preferred site on human chromosome 19q for integration of adeno-associated virus DNA by non-homologous recombination. EMBO J 11: 5071–5078.
Ledley FD (1994) Non-viral gene therapy. Curr Opin Biotech 5: 626–636.
Lehrman S (1999) Virus treatment questioned after gene therapy death. Nature 401: 517–518.
Lemansky P, Bishop DF, Desnick RJ, Hasilik A, von Figura K (1987) Synthesis and processing of α-galactosidase A in human fibroblasts. Evidence for different mutations in Fabry disease. J Biol Chem 262: 2062–2065.
Li J, Samulski RJ, Xiao X (1997) Role for highly regulated rep gene expression in adeno-associated virus vector production. J Virol 71: 5236–5243.
Lieber A, Steinwaerder DS, Carlson CA, Kay MA (1999) Integrating adenovirus-adeno-associated virus hybrid vectors devoid of all viral genes. J Virol 73: 9314–9324.
Lorincz M, Herzenburg LA, Diwu Z, Barranger JA, Kerr WG (1997) Detection and isolation of gene-corrected cells in Gaucher disease via a fluorescence-activated cell sorter assay for lysosomal glucocerebrosidase activity. Blood 89: 3412–3420.
Lutzko C, Kruth S, Abrams-Ogg ACG, et al (1999) Genetically corrected autologous stem cells engraft, but host immune responses limit their utility in canine α-L-iduronidase deficiency. Blood 93: 1895–1905.
Malech HL, Maples PB, Whiting-Theobald N, et al (1997) Prolonged production of NAPDH oxidase-corrected granulocytes after gene therapy of chronic granulomatous disease. Proc Natl Acad Sci USA 94: 12133–12138.
Markowitz D, Goff S, Bank A (1988a) A safe packaging line for gene transfer: Separating viral genes on two different plasmids. J Virol 62: 1120–1124.
Markowitz D, Goff S, Bank A (1988b) Construction and use of a safe and efficient amphotropic packaging cell line. Virology 167: 400–406.
Medin JA, Karlsson S (1997a) Viral vectors for gene therapy of hematopoietic cells. Immunotechnology 3: 3–19.
Medin JA, Karlsson S (1997b) Selection of retrovirally transduced cells to enhance the efficiency of gene therapy. Proc Assoc Am Physicians 109: 111–119.
Medin JA, Tudor M, Simovitch R, Quirk JM, Jacobson S, Murray GJ, Brady RO (1996) Correction in trans for Fabry disease: Expression, secretion, and uptake of α-galactosidase A in patientderived cells driven by a high-titer recombinant retroviral vector. Proc Natl Acad Sci USA 93: 7917–7922.
Miao CH, Nakai H, Thompson AR, et al (2000) Nonrandom transduction of recombinant adenoassociated virus vectors in mouse hepatocytes in vivo: Cell cycling does not influence hepatocyte transduction. J Virol 74: 3793–3803.
Miller AD, Garcia JV, von Suhr N, Lynch CM, Wilson C, Eiden MV (1991) Construction and properties of retrovirus packaging cells based on gibbon ape leukemia virus. J Virol 65: 2220–2224.
Miller DG, Adam MA, Miller AD (1990) Gene transfer by retrovirus vectors occurs only in cells that are actively replicating at the time of infection. Mol Cell Biol 10: 4239–4242.
Monahan PE, Samulski RJ (2000) Adeno-associated virus vectors for gene therapy: More pros than cons? Mol Med Today 6: 433–440.
Morsy MA, Caskey CT (1999) Expanded-capacity adenoviral vectors-the helper-dependent vectors. Mol Med Today 5: 18–24.
Nakai H, Storm TA, Kay MA (2000) Increasing the size of rAAV-mediated expression cassettes in vivo by intermolecular joining of two complementary vectors. Nat Biotechnol 5: 527–532.
Nakao S, Takenaka T, Maeda M, et al (1995) An atypical variant of Fabry's disease in men with left ventricular hypertrophy. N Engl J Med 333: 288–293.
Nishi M, Ishida Y, Honjo T (1988) Expression of functional interleukin-2 receptors in human light chain/Tac transgenic mice. Nature 331: 267–269.
Novo FJ, Gorecki DC, Goldspink G, MacDermot KD (1997) Gene transfer and expression of human α-galactosidase from mouse muscle in vitro and in vivo. Gene Ther 4: 488–492.
Ogawa K, Sugamata K, Funamoto N, Abe T, Sato T, Nagashima K, Ohkawa S (1990) Restricted accumulation of globotriaosylceramide in the hearts of atypical cases of Fabry's disease. Hum Pathol 21: 1067–1073.
Ohshima T, Murray GJ, Swaim WD, et al (1997) α-galactosidase A deficient mice: A model of Fabry disease. Proc Natl Acad Sci USA 94: 2540–2544.
Ohshima T, Schiffman R, Murray GJ, et al (1999) Aging accentuates and bone marrow transplantation ameliorates metabolic defects in Fabry disease mice. Proc Natl Acad Sci USA 96: 6423–6427.
Ohsugi K, Kobayashi K, Itoh K, Sakuraba H, Sakuragawa N (2000) Enzymatic corrections for cells derived from Fabry disease patients by a recombinant adenovirus vector. J Hum Genet 45: 1–5.
Parks RJ (2000) Improvements in adenoviral vector technology: Overcoming barriers for gene therapy. Clin Genet 58: 1–11.
Parks RJ, Bramson JL, Wan Y, Addison CL, Graham FL (1999a) Effects of stuffer DNA on transgene expression from helper-dependent adenovirus vectors. J Virol 73: 8027–8034.
Parks RJ, Chen L, Anton M, Sankar U, Rudnicki MA, Graham FL (1996) A helper-dependent adenovirus vector system: Removal of helper virus by Cre-mediated excision of the viral packaging signal. Proc Natl Acad Sci USA 93: 13565–13570.
Parks RJ, Evelegh CM, Graham FL (1999b) Use of helper-dependent adenoviral vectors of alternative serotypes permits repeat vector administration. Gene Ther 6: 1565–1573.
Pawliuk R, Bachelot T, Wise RJ, Mathews-Roth MM, Leboulch P (1999) Long-term cure of the photosensitivity of murine erythropoietic protoporphyria by preselective gene therapy. Nat Med 5: 768–773.
Qasba P, D'Costa J, Limaye A, et al (2000) In vitro gene therapy for Fabry disease using lentiviral vector (HIV-2). Mol Ther 1: S73.
Qin G, Takenaka T, Telsch K, et al (2001) Preselective gene therapy for Fabry disease. Proc Natl Acad Sci USA 98: 3428–3433.
Rosenberg SA, Blaese RM, Brenner MK, et al (2000) Human gene marker/therapy clinical protocols. Hum Gene Ther 11: 919–979.
Ross PC, Hui SW (1999) Lipoplex size is a major determinant of in vitro lipofection efficiency. Gene Ther 6: 651–659.
Russell WC (2000) Update on adenovirus and its vectors. J Gen Virol 81: 2573–2604.
Schiedner G, Morral N, Parks RJ, et al (1998) Genomic DNA transfer with a high-capacity adenovirus vector results in improved in vivo gene expression and decreased toxicity. Nat Genet 18: 180–183.
Schiffmann R, Murray GJ, Treco D, et al (2000) Infusion of α-galactosidase A reduces tissue globotriaosylceramide storage in patients with Fabry disease. Proc Natl Acad Sci USA 97: 365–370.
Schoen P, Chonn A, Cullis PR, Wilschut J, Scherrer P (1999) Gene transfer mediated by fusion protein hemagglutinin reconstituted in cationic lipid vesicles. Gene Ther 6: 823–832.
Simoes S, Slepushkin V, Gaspar R, de Lima MC, Duzgunes N (1998) Gene delivery by negatively charged ternary complexes of DNA, cationic liposomes and transferrin or fusigenic peptides. Gene Ther 5: 955–964.
Sorrentino BP, Brandt SJ, Bodine D, et al (1992) Selection of drug-resistant bone marrow cells in vivo after retroviral transfer of human mdr-1. Science 257: 99–103.
Steinwaerder DS, Lieber A (2000) Insulation from viral transcriptional regulatory elements improves inducible transgene expression from adenovirus vectors in vitro and in vivo. Gene Ther 7: 556–567.
Stripecke R, del Carmen Villacres M, Skelton DC, Satake N, Halene S, Kohn DB (1999) Immune response to green fluorescent protein: Implications for gene therapy. Gene Ther 6: 1305–1312.
Sugimoto Y, Aksentijevich I, Murray GJ, Brady RO, Pastan I, Gottesman MM (1995) Retroviral coexpression of a multidrug resistance gene (MDR1) and human α-galactosidase A for gene therapy of Fabry disease. Hum Gene Ther 6: 905–915.
Sweeley CC, Klionsky B (1963) Fabry disease: Classification as a sphingolipidosis and partial characterization of a novel glycolipid. J Biol Chem 238: 3148–3150.
Takenaka T, Hendrickson CS, Tworek DM, et al (1999a) Enzymatic and functional correction along with long-term enzyme secretion from transduced bone marrow hematopoietic stem/progenitor and stromal cells derived from patients with Fabry disease. Exp Hematol 27: 1149–1159.
Takenaka T, Murray GJ, Qin G, et al (2000) Long-term enzyme correction and lipid reduction in multiple organs of primary and secondary transplanted Fabry mice receiving transduced bone marrow cells. Proc Natl Acad Sci USA 97: 7515–7520.
Takenaka T, Qin G, Brady RO, Medin JA (1999b) Circulating α-galactosidase A derived from transduced bone marrow cells: Relevance for corrective gene transfer for Fabry disease. Hum Gene Ther 10: 1931–1939.
Takiyama N, Dunigan JT, Vallor MJ, Kase R, Sakuraba H, Barranger JA (1999) Retrovirus-mediated transfer of human α-galactosidase A gene to human CD34+ hematopoietic progenitor cells. Hum Gene Ther 10: 2881–2889.
Touraine JL, Malik MC, Perrot H, et al (1979) Fabry's disease: Two patients improved by fetal liver cells. Nouv Presse Med 8: 1499–1503.
Vigna E, Naldini L (2000) Lentiviral vectors: Excellent tools for experimental gene transfer and promising candidates for gene therapy. J Gene Med 2: 308–316.
Vogt VM (1997) Retroviral virions and genomes. In Coffin J, Hughes SH, Varmus HE, Miller AD, eds. Retroviruses. New York: Cold Springs Harbor Laboratory Press, 27–69.
Voss SD, Robb RJ (1995) Receptor for interleukin-2 (IL-2). In Nicola NA, ed. Guidebook to Cytokines and their Receptors. Oxford, New York, Tokyo: Oxford University Press, 31–37.
Wagner JE (1994) Umbilical cord blood transplantation: Overview of the clinical experience. Blood Cells 20: 227–234.
Walkley SU, Thrall MA, Dobrenis K, et al (1994) Bone marrow transplantation corrects the enzyme defect of the central nervous system in a lysosomal storage disease. Proc Natl Acad Sci USA 91: 2970–2974.
Wang AM, Ioannou YA, Zeidner KM, et al (1996) Fabry disease: Generation of a mouse model with α-galactosidase A deficiency. Am J Hum Genet 59: A208.
Wersto RP, Rosenthal ER, Seth PK, Eissa NT, Donahue RE (1998) Recombinant, replicationdefective adenovirus gene transfer vectors induce cell cycle dysregulation and inappropriate expression of cyclin proteins. J Virol 72: 9491–9502.
Whitley CB, Ramsay NKC, Kersey JH, Krivit W (1986) Bone marrow transplantation for Hurler syndrome: Assessment of metabolic correction. Birth Defects 22: 7–24.
Wolfe JH, Sands MS, Barker JE, et al (1992) Reversal of pathology in murine mucopolysaccharidosis type VII by somatic cell gene transfer. Nature 360: 749–753.
Xiao X, Li J, Samulski RJ (1998) Production of high-titer recombinant adeno-associated virus vectors in the absence of helper adenovirus. J Virol 72: 2224–2232.
Ziegler RJ, Yew NS, Li C, et al (1999) Correction of enzymatic and lysosomal storage defects in Fabry mice by adenovirus-mediated gene transfer. Hum Gene Ther 10: 1667–1682.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Sitaskas, C., Medin, J.A. Gene therapy for Fabry disease. J Inherit Metab Dis 24 (Suppl 2), 25–41 (2001). https://doi.org/10.1023/A:1012455421014
Issue Date:
DOI: https://doi.org/10.1023/A:1012455421014