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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 journalArticle

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

Original languageEnglish
Number of pages27
JournalFrontiers in Cell and Developmental Biology
DOIs
Accepted/In press23 Dec 2020

King's Authors

Abstract

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 is routinely screened for in the first trimester and can be diagnosed prenatally. Among the possible prenatal treatments, in utero stem cell transplantation (IUSCT) shows the most promise. IUSCT is a nonmyeloablative, non-immunosuppressive alternative conferring various unique advantages and may also offer a safer postnatal management. Assumption of fetal immunologic immaturity allows for 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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