Betibeglogene autotemcel

Betibeglogene autotemcel, sold under the brand name Zynteglo, is a medication for the treatment for beta thalassemia.[1][2] It was developed by Bluebird Bio and was given breakthrough therapy designation by the U.S. Food and Drug Administration in February 2015.[3][4] It was approved for medical use in the European Union in May 2019.[2]

Betibeglogene autotemcel
Clinical data
Trade namesZynteglo
Other namesLentiGlobin BB305, autologous CD34+ cells encoding βA-T87Q-globin gene
License data
Pregnancy
category
Routes of
administration
Intravenous
ATC code
Legal status
Legal status
  • UK: POM (Prescription only) [1]
  • EU: Rx-only [2]
  • In general: ℞ (Prescription only)
Identifiers
UNII
KEGG

The most serious side effect observed is thrombocytopenia (low blood levels of platelets).[2]

Medical usesEdit

Betibeglogene autotemcel is indicated for the treatment of people twelve years and older with transfusion-dependent beta thalassemia (TDT) who do not have a β0/β0 genotype, for whom hematopoietic stem cell (HSC) transplantation is appropriate but a human leukocyte antigen (HLA)-matched related HSC donor is not available.[2]

Betibeglogene autotemcel is made individually for each recipient out of stem cells collected from their blood, and must only be given to the recipient for whom it is made.[2] It is given as an intravenous infusion (drip) and the dose depends on the recipient's body weight.[2]

Before betibeglogene autotemcel is given, the recipient will receive conditioning chemotherapy to clear their bone marrow of cells (myeloablation).[2]

To make betibeglogene autotemcel, the stem cells taken from the recipient's blood are modified by a virus that carries working copies of the beta globin gene into the cells.[2] When these modified cells are given back to the recipient, they are transported in the bloodstream to the bone marrow where they start to make healthy red blood cells that produce beta globin.[2] The effects of betibeglogene autotemcel are expected to last for the recipient's lifetime.[2]

Mechanism of actionEdit

Beta thalassemia is caused by mutations to or deletions of the HBB gene leading to reduced or absent synthesis of the beta chains of hemoglobin that result in variable outcomes ranging from severe anemia to clinically asymptomatic individuals.[5] LentiGlobin BB305 is a lentiviral vector which inserts a functioning version of the HBB gene into a recipient's blood-producing hematopoietic stem cells (HSC) ex vivo. The resulting engineered HSCs are then reintroduced to the recipient.[6][7]

Development historyEdit

In early clinical trials several participants with beta thalassemia, who usually require frequent blood transfusions to treat their disease, were able to forgo blood transfusions for extended periods of time.[8][9][10] In 2018, results from phase 1-2 trials suggested that of 22 participants receiving Lentiglobin gene therapy, 15 were able to stop or reduce regular blood transfusions.[11][12]

In February 2021, a clinical trial[13] of betibeglogene autotemcel in sickle cell anemia was suspended following an unexpected instance of acute myeloid leukemia.[14] The HGB-206 Phase 1/2 study is expected to conclude in March 2023.[13]

HistoryEdit

It was designated an orphan drug by the European Medicines Agency (EMA) and by the U.S. Food and Drug Administration (FDA) in 2013.[2][15] The Food and Drug Administration has also declared betibeglogene autotemcel a Regenerative Medicine Advanced Therapy.[16]

Society and cultureEdit

Legal statusEdit

It was approved for medical use in the European Union in May 2019.[2]

NamesEdit

The international nonproprietary name (INN) is betibeglogene autotemcel.[17]

See alsoEdit

ReferencesEdit

  1. ^ a b c "Zynteglo dispersion for infusion - Summary of Product Characteristics (SmPC)". (emc). 12 May 2020. Retrieved 3 January 2021.
  2. ^ a b c d e f g h i j k l m n "Zynteglo EPAR". European Medicines Agency (EMA). 25 March 2019. Retrieved 16 August 2019. Text was copied from this source which is © European Medicines Agency. Reproduction is authorized provided the source is acknowledged.
  3. ^ "Ten things you might have missed Monday from the world of business". The Boston Globe. 3 February 2015. Retrieved 13 February 2015.
  4. ^ "Lentiviral vectors". Monday, 8 July 2019
  5. ^ Cao, Antonio; Galanello, Renzo (21 January 2010). "Beta-thalassemia". Genetics in Medicine. 12 (2): 61–76. doi:10.1097/GIM.0b013e3181cd68ed. PMID 20098328.
  6. ^ Negre O, et al. (2015). "Preclinical evaluation of efficacy and safety of an improved lentiviral vector for the treatment of β-thalassemia and sickle cell disease" (PDF). Current Gene Therapy. 15 (1): 64–81. doi:10.2174/1566523214666141127095336. PMC 4440358. PMID 25429463.
  7. ^ Thompson A, et al. (2014). "Initial Results from the Northstar Study (HGB-204): A Phase 1/2 Study of Gene Therapy for β-Thalassemia Major Via Transplantation of Autologous Hematopoietic Stem Cells Transduced Ex Vivo with a Lentiviral βΑ-T87Q -Globin Vector (LentiGlobin BB305 Drug Product)". Blood. 124 (21): 549. doi:10.1182/blood.V124.21.549.549.
  8. ^ Cavazzana-Calvo M, Payen E, Negre O, et al. (2010). "Transfusion independence and HMGA2 activation after gene therapy of human β-thalassaemia". Nature. 467 (7313): 318–22. Bibcode:2010Natur.467..318C. doi:10.1038/nature09328. PMC 3355472. PMID 20844535.
  9. ^ Winslow, Ron (8 December 2015). "New Gene Therapy Shows Promise for Lethal Blood Disease". The Wall Street Journal. Retrieved 13 February 2015.
  10. ^ (8 December 2014) bluebird bio Announces Data Demonstrating First Four Patients with β-Thalassemia Major Treated with LentiGlobin are Transfusion-Free Yahoo News, Retrieved 17 May 2015
  11. ^ Thompson, Alexis (19 April 2018). "Gene Therapy in Patients with Transfusion-Dependent β-Thalassemia". New England Journal of Medicine. 378 (16): 1479–1493. doi:10.1056/NEJMoa1705342. PMID 29669226.
  12. ^ Stein, Rob (18 April 2018). "Gene Therapy For Inherited Blood Disorder Reduced Transfusions". NPR. Retrieved 4 March 2019.
  13. ^ a b bluebird bio (2021-06-09). "A Phase 1/2 Study Evaluating Gene Therapy by Transplantation of Autologous CD34+ Stem Cells Transduced Ex Vivo With the LentiGlobin BB305 Lentiviral Vector in Subjects With Severe Sickle Cell Disease". Cite journal requires |journal= (help)
  14. ^ "Bluebird bio Halts Sickle Cell Trials After Leukemia Diagnosis". BioSpace. Retrieved 2021-06-27.
  15. ^ "Autologous CD34+ hematopoietic stem cells transduced with LentiGlobin BB305 lentiviral vector encoding the human BA-T87Q-globin gene Orphan Drug Designations and Approvals". U.S. Food and Drug Administration (FDA). 18 March 2013. Retrieved 8 June 2020.
  16. ^ "bluebird bio Announces Temporary Suspension on Phase 1/2 and Phase 3 Studies of LentiGlobin Gene Therapy for Sickle Cell Disease (bb1111)". Bluebird Bio (Press release). 16 February 2021. Retrieved 2021-06-27.
  17. ^ World Health Organization (2020). "International nonproprietary names for pharmaceutical substances (INN): recommended INN: list 83". WHO Drug Information. 34 (1): 34.