The Recombinant DNA Advisory Committee has recently finished investigating gene therapy’s role in the death of 36 year-old Jolee Mohr who had received a protein-based drug called Enbrel that uses the tumor necrosis factor (TNF) for treatment of rheumatoid arthritis. The DNA vector used by the TNF protein is called an adeno-associated virus or AAV that is injected into the infected site to provide the TNF to the defective genes.
The concern with Mohr’s death is possibly attributed to the TNF protein that could have potentially caused the vector to multiply out of control leading to a fungal infection, which compromised her immune system. After her second injection, she was brought to the hospital with flulike symptoms caused by the infection with Histoplasma capsulatum, a common fungus, which was found in many of her vital organs.
Mohr was also taking a drug known as Humira which blocks the tumor necrosis factor (TNF) and ultimately suppress the immune system. The protein produced by the gene therapy is also a TNF-blocker; therefore, the combination could have potentially made her vulnerable to the fungal infection.
Another potential cause was a reaction to the gene therapy vector, adeno-associated virus. Vector DNA was found in low amounts in other tissues, illustrating the vector did not multiply. There is no definitive evidence that disproves the vector as contributing to her death, but it did not actually cause her death.
The Recombinant DNA Advisory Committee announced after intense investigation that it was not the gene therapy that caused Mohr’s death, and the ban was lifted on Enbrel’s use to treat arthritis.
The company responsible for the gene therapy trial is continuing with the trial study, but has increased its monitoring of patients. Those patients who have a fever, as Mohr did, will not be given the second injection.
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