Researchers at the RCCS San Raffaele Scientific Institute in Milan have uncovered that hematopoietic stem cells (HSCs) adapt their lineage commitment during gene therapy based on the specific genetic disease being treated, providing critical insights for advancing gene therapy outcomes.
Hematopoietic stem cell gene therapy (HSC-GT) is a groundbreaking treatment approach that corrects genetic defects within HSCs to restore normal blood cell function. A deeper understanding of how these cells behave in different disease contexts is vital for optimizing treatment effectiveness.
In the study “Long-term lineage commitment in hematopoietic stem cell gene therapy” published in Nature, researchers tracked 53 patients treated with lentiviral HSC-GT for metachromatic leukodystrophy, Wiskott-Aldrich syndrome, and β-thalassemia. Over eight years, they analyzed vector integration sites within HSC clones to understand their contribution to blood cell production.
Results showed that 770 to 35,000 active HSCs sustained long-term blood cell production, with half of the clones demonstrating multilineage potential across conditions. The remaining clones exhibited disease-specific lineage preferences: patients with β-thalassemia saw more red blood cell production, Wiskott-Aldrich syndrome patients had increased immune cell production, and those with metachromatic leukodystrophy generated more myeloid cells. This adaptability means HSCs modify their behavior to address disease-specific needs.
These findings suggest that genetic diseases influence HSC lineage behavior, shaped by factors like patient age, genetic correction extent, and disease-induced stress. Such insights offer promising directions for refining HSC-GT protocols, with the potential to enhance long-term outcomes for patients with inherited blood disorders.

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