@article{10.1172/jci.insight.126243, author = {Su M. Lwin AND Farhatullah Syed AND Wei-Li Di AND Tendai Kadiyirire AND Lu Liu AND Alyson Guy AND Anastasia Petrova AND Alya Abdul-Wahab AND Fiona Reid AND Rachel Phillips AND Maria Elstad AND Christos Georgiadis AND Sophia Aristodemou AND Patricia A. Lovell AND James R. McMillan AND John Mee AND Snaigune Miskinyte AND Matthias Titeux AND Linda Ozoemena AND Rashida Pramanik AND Sonia Serrano AND Racheal Rowles AND Clarisse Maurin AND Elizabeth Orrin AND Magdalena Martinez-Queipo AND Ellie Rashidghamat AND Christos Tziotzios AND Alexandros Onoufriadis AND Mei Chen AND Lucas Chan AND Farzin Farzaneh AND Marcela Del Rio AND Jakub Tolar AND Johann W. Bauer AND Fernando Larcher AND Michael N. Antoniou AND Alain Hovnanian AND Adrian J. Thrasher AND Jemima E. Mellerio AND Waseem Qasim AND John A. McGrath}, journal = {JCI Insight}, publisher = {The American Society for Clinical Investigation}, title = {Safety and early efficacy outcomes for lentiviral fibroblast gene therapy in recessive dystrophic epidermolysis bullosa}, year = {2019}, month = {6}, volume = {4}, url = {https://insight.jci.org/articles/view/126243}, abstract = {BACKGROUND Recessive dystrophic epidermolysis bullosa (RDEB) is a severe form of skin fragility disorder due to mutations in COL7A1 encoding basement membrane type VII collagen (C7), the main constituent of anchoring fibrils (AFs) in skin. We developed a self-inactivating lentiviral platform encoding a codon-optimized COL7A1 cDNA under the control of a human phosphoglycerate kinase promoter for phase I evaluation.METHODS In this single-center, open-label phase I trial, 4 adults with RDEB each received 3 intradermal injections (~1 × 106 cells/cm2 of intact skin) of COL7A1-modified autologous fibroblasts and were followed up for 12 months. The primary outcome was safety, including autoimmune reactions against recombinant C7. Secondary outcomes included C7 expression, AF morphology, and presence of transgene in the injected skin.RESULTS Gene-modified fibroblasts were well tolerated, without serious adverse reactions or autoimmune reactions against recombinant C7. Regarding efficacy, there was a significant (P < 0.05) 1.26-fold to 26.10-fold increase in C7 mean fluorescence intensity in the injected skin compared with noninjected skin in 3 of 4 subjects, with a sustained increase up to 12 months in 2 of 4 subjects. The presence of transgene (codon-optimized COL7A1 cDNA) was demonstrated in the injected skin at month 12 in 1 subject, but no new mature AFs were detected.CONCLUSION To our knowledge, this is the first human study demonstrating safety and potential efficacy of lentiviral fibroblast gene therapy with the presence of COL7A1 transgene and subsequent C7 restoration in vivo in treated skin at 1 year after gene therapy. These data provide a rationale for phase II studies for further clinical evaluation.TRIAL REGISTRATION ClincalTrials.gov NCT02493816.FUNDING Cure EB, Dystrophic Epidermolysis Bullosa Research Association (UK), UK NIHR Biomedical Research Centre at Guy’s and St Thomas’ NHS Foundation Trust and King’s College London, and Fondation René Touraine Short-Exchange Award.}, number = {11}, doi = {10.1172/jci.insight.126243}, url = {https://doi.org/10.1172/jci.insight.126243}, }