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In utero therapy for the treatment of Sickle Cell Disease: taking advantage of the fetal immune system

Research output: Contribution to journalReview articlepeer-review

Alba Saenz de Villaverde Cortabarria, Laura Makhoul, Giovanna Lombardi, John Strouboulis, Eugene Oteng-Ntim, Panicos Shangaris

Original languageEnglish
Article number624477
Pages (from-to)1
Number of pages13
JournalFrontiers in Cell and Developmental Biology
Accepted/In press23 Dec 2020
Published22 Jan 2021

Bibliographical note

Funding Information: PS was funded by an NIHR Clinical Lectureship (CL-2018-17-002) and an Academy of Medical Sciences Starter Grant for Clinical Lecturers (SGL0231023). Publisher Copyright: © Copyright © 2021 Cortabarria, Makhoul, Strouboulis, Lombardi, Oteng-Ntim and Shangaris. Copyright: Copyright 2021 Elsevier B.V., All rights reserved.


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    fcell_08_624477.pdf, 1.64 MB, application/pdf

    Uploaded date:22 Jan 2021

    Version:Final published version

    This article is an open access publication accessible to readers anywhere in the world.

King's Authors


Sickle Cell Disease (SCD) is an autosomal recessive disorder resulting from a β-globin gene missense mutation and is among the most prevalent severe monogenic disorders worldwide. Haematopoietic stem cell transplantation remains the only curative option for the disease, as most management options focus solely on symptom control. Progress in prenatal diagnosis and fetal therapeutic intervention raises the possibility of in utero treatment. SCD can be diagnosed prenatally in high-risk patients using chorionic villus sampling. Among the possible prenatal treatments, in utero stem cell transplantation (IUSCT) shows the most promise. IUSCT is a non-myeloablative, non-immunosuppressive alternative conferring various unique advantages and may also offer safer postnatal management. Fetal immunologic immaturity could allow engraftment of allogeneic cells before fetal immune system maturation, donor-specific tolerance and lifelong chimerism. In this review, we will discuss SCD, screening and current treatments. We will present the therapeutic rationale for IUSCT, examine the early experimental work and initial human experience, as well as consider primary barriers of clinically implementing IUSCT and the promising approaches to address them.

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