Long-Term Engraftment and Fetal Globin Induction upon BCL11A Gene Editing in Bone-Marrow-Derived CD34 + Hematopoietic Stem and Progenitor Cells

Abstract

To develop an effective and sustainable cell therapy for sickle cell disease (SCD), we investigated the feasibility of targeted disruption of the <i>BCL11A</i> gene, either within exon 2 or at the GATAA motif in the intronic erythroid-specific enhancer, using zinc finger nucleases in human bone marrow (BM) CD34⁺ hematopoietic stem and progenitor cells (HSPCs). Both targeting strategies upregulated fetal globin expression in erythroid cells to levels predicted to inhibit hemoglobin S polymerization. However, complete inactivation of <i>BCL11A</i> resulting from bi-allelic frameshift mutations in <i>BCL11A</i> exon 2 adversely affected erythroid enucleation. In contrast, bi-allelic disruption of the GATAA motif in the erythroid enhancer of <i>BCL11A</i> did not negatively impact enucleation. Furthermore, <i>BCL11A</i> exon 2-edited BM-CD34⁺ cells demonstrated a significantly reduced engraftment potential in immunodeficient mice. Such an adverse effect on HSPC function was not observed upon <i>BCL11A</i> erythroid-enhancer GATAA motif editing, because enhancer-edited CD34⁺ cells achieved robust long-term engraftment and gave rise to erythroid cells with elevated levels of fetal globin expression when chimeric BM was cultured ex vivo. Altogether, our results support further clinical development of the <i>BCL11A</i> erythroid-specific enhancer editing in BM-CD34⁺ HSPCs as an autologous stem cell therapy in SCD patients.