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Jul 23, 2015
 |  BC Innovations  |  Tools & Techniques

Gene therapy's coming of age

Why gene therapy is hot after more than 20 years of research

After more than 20 years of trial and error in gene therapy, the field is taking off with one product approved in Europe, several poised to enter the market in the U.S., a surge of newcos, and investments of almost $6 billion in the last 18 months. While most experts polled by BioCentury agree that advances in vector technology have laid the groundwork for the recent ramp-up in activity, some say the real catalyst has been the explosion of interest in orthogonal technologies such as CAR T cells and gene editing.

"This is truly a moment in time for gene therapy. It has been a long journey in industry and academia to get to this point," said Annalisa Jenkins, CEO of Dimension Therapeutics Inc.

Since the 1980s, academic researchers have been exploring the idea that adding correct versions of dysfunctional genes to a patient's genome could treat or even cure genetic diseases. The idea seemed simple: engineer inert viruses to insert a therapeutic gene into a cell's nucleus or nuclear DNA, and replace the deficit without causing any pathology.

But the platform wasn't as simple as researchers anticipated, and early clinical trials met with serious problems ranging from limited efficacy to severe immune reactions. Patient deaths in separate gene therapy trials in 1999 and again in 2003 set the field back and led most gene therapy companies to exit the space in the early 2000s.

The consensus was that the vectors - while thought to be harmless - in fact caused the early setbacks.

"People failed to anticipate the immunological consequences of the viral vectors," said Sam Wadsworth, CSO of Dimension.

While the vectors didn't cause viral disease in patients, they were recognized as foreign by the human immune system, he said. That caused two principal problems: First, the vectors were destroyed by the immune response before they could deliver their therapeutic payloads; and second, they stimulated dangerous inflammatory side effects.

There were other complications as well. While early gene therapies focused on indications such as cystic fibrosis (CF), which was thought to be a good candidate as a simple, monogenic disorder, researchers underestimated the complications caused by the disease biology, Wadsworth said. "In CF, the cells you need to target are covered in mucus and inaccessible."

Jeffrey Marrazzo, CEO of Spark Therapeutics Inc., believes "people fell foul to the first pass and picked targets that were driven largely, or even exclusively, by commercial opportunity rather than scientific feasibility. People see this technology as a way to boil the ocean, with every disease a potential candidate, but the reality is that there are limitations and it won't be the best therapeutic modality for every disease."

Although academic and industry researchers have over the years made incremental improvements in vector technology, experts believe a host of other factors also contributed to the recent spurt in the field, including advances in the underlying biology, greater involvement of regulators and the increased trend of academia-industry collaborations, which connected companies with clinical and regulatory knowledge to academic experts with patient access and technological experience.

"The resurgence of gene therapy is due to the continued optimization of the technology, the understanding of the underlying biology and the understanding of the human response to this therapeutic modality," said Nessan Bermingham, CEO of genome editing company Intellia Therapeutics LLC.

But according to Usman Azam, global head of the Cell and Gene Therapies Unit at Novartis AG, the real driver for the surge in interest and investment in gene therapy has been the rapid evolution of chimeric antigen receptor (CAR) T cell and gene editing technologies, which each rely, at least in part, on gene therapy. (See )

In the CAR T cell approach, gene therapy is used ex vivo to modify the antigen receptor gene in patient T cells. That modification redirects the cells to a tumor antigen when they are delivered back into the body. In gene editing, the same vectors used in gene therapy are used to deliver the molecular tools to modify, delete or add DNA sequences into a patient's DNA.

Because of the promising clinical data coming out of CAR T cell trials and the exciting potential of CRISPR/Cas9 as a genome editing tool, Azam thinks industry and investor interest in the related technologies has renewed interest in gene therapy as a whole.

"Over the next couple of years, we are likely to see more approvals in cell and gene therapy that will likely be driven...

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