News came recently of an apparent cure, via gene therapy, of sickle-cell disease in a young patient (whose condition was refractory to hydroxyurea and the other standards of care). Blood-cell diseases are naturally one of the main proving grounds for things like this, since their stem cell populations are in easily localizable tissues and the techniques for doing a hard reset/retransplantation on them are (in some cases) well worked out.
This is an important result, but all such approaches face a possible disconnect as they move forward. As it stands, such gene therapy is a rather expensive and labor-intensive process. Patients are carefully identified and handled one at a time, and there are a limited number of medical centers in the entire world that can operate at this level. The problem is, none of them are particularly close to the great majority of people who actually have sickle cell disease. You can get up to nearly 60% of the worldwide population of sickle cell patients just by counting some regions of India, all of Nigeria, and (even tougher) the Democratic Republic of the Congo. There are sickle-cell populations in many countries because of migration, but most of the births are occurring in sub-Saharan Africa.
Is there any hope that gene therapy and cell replacement could get to the point that you could carry it out at a useful rate in some of the places where it would be needed the most? That’s going to to hard, but this article at Technology Review by Antonio Regalado shows some progress:
In October, (Jennifer) Adair demonstrated a new technology she thinks could democratize access to gene therapy. Tweaking a cell-processing device sold by German instrument maker Miltenyi, she mostly automated the process of preparing blood cells with a gene therapy for HIV that her center is also testing. Cells dripped in one end came out the other 30 hours later with little oversight needed. She even added wheels. Adair calls the mobile lab “gene therapy in a box.”
Adair thinks a key job for the mobile gene-therapy lab is to extend experimental studies to the developing world, including Africa, where most HIV cases are. “We wanted to show that we could make the trial mobile, because we are kidding ourselves that treating someone in Seattle is going to have the same risks and outcomes as in South Africa,” she says.
The many companies that are working on such therapies seem to be paying attention to this sort of work, because it’s not only a possible path to getting clinical trials run (and eventually patients treated) in the regions where most such patients are to be found. Companies are going to be selling such things first to people in the wealthier developed countries, but that’s only the beginning of the story (as it has been with antiretroviral drugs). Everyone in the field needs better and faster to turn these sorts of cell therapies around, just on the research end. The amount of work needed now is a significant bottleneck not only for such therapies that exist (or are close to existing), but for the development of better ones. I spoke about automation in drug discovery last year at Manchester, and about the good sides and bad sides of it. But this sort of thing is an easy call: a lot of intelligent, highly trained people could be doing a lot more with their time if machines were able to pick up more of the load.