New Directions for Sickle Cell Therapy in the Genome Era: Attendee Voting for Research Therapies
National Human Genome Research Institute
National Institutes of Health U.S. Department of Health and Human Services
New Therapies for Sickle Cell Anemia in the Genome Era
Attendees' Votes Among Options for Research on New Therapies for Sickle Cell Disease
Conference attendees were asked to cast votes among approximately 30 priorities that had emerged during the meeting as options for furthering research aimed at developing new, more effective therapies for SCD. All participants were given 100 votes each, which they could then split among any of the possible priorities. Tabulation of those votes is shown below:
Twenty-two (22) percent of all votes were cast in favor of an innovative multidisciplinary Sickle Cell Disease Research Network with a central prospective registry of several thousand well phenotyped patients.
Features of this might include:
DNA/plasma repository, cell lines, mRNA (when both symptomatic and asymptomatic)
Inclusion of environmental, social, cultural, genetic data
Quality of life data
Careful attention to human subjects issues, well consented with recontact possible
Collaborative community partnerships
Open access to materials and data
Longitudinal follow up
Clinical trials database
Ten (10) percent of all votes were cast in favor of bringing new people and disciplines into the field and training the next generation of researchers. This would include integrating genomics, proteomics, and high-throughput screening expertise into sickle cell disease research. It might also include increasing the number of basic, clinical, and social science researchers, as well as nurses and allied health professionals, doing research on sickle cell disease. Possible mechanisms for accomplishing this might include grant supplements and loan repayment programs.
Eight (8) percent of all votes cast were cast in favor of defining the genetic basis of phenotypic variability. Methods to this might include case/control studies and/or studies of monozygotic and dizygotic twins, of sib pairs and of individuals with unusually mild phenotypes. International collaboration would be particularly helpful here.
Five (5) percent of all votes were cast in favor of establishing a working group to define SCD severity by strict standardized criteria. This might include innovative techniques for more precise definition of phenotypes, e.g., for acute chest syndrome and for stroke, as well as the use of laboratory measures.
Four (4) percent of all votes cast were cast for each of the following:
Genomics tools service centers, including such resources as haplotype maps, whole genome arrays, etc.
Target-based compound screens to explore such possibilities as hemoglobin F induction (for which would need improved cell lines that express beta-globin), nitric oxide, antithrombotics/anticoagulants and other agents that might affect adhesion, inflammation, or oxidation
Proteomics and transcriptomics on erythrocytes, reticulocytes, bone marrow, and other tissues
Clinical trials that included an extensive research network, DNA collection, greater involvement of patient advocacy groups, and attention to the psychosocial aspects of SCD
Core resources of biological materials, including such materials as transgenic mice for drug screening, a DNA construct repository, antibodies to sort erythroid progenitors, and cord blood banks for SCD and thalassemia cells
Development of a new model to study hemoglobin F reactivation, especially in adult cells, such as human cell lines that respond to switching agents
To the extent possible, NIH attempting to catalyze more effective care and broader access to care of SCD patients, perhaps through a standardized care model.
Three (3) percent of all votes cast were cast for each of the following:
Building better relationships with international investigators, including in research regarding ethical, legal, social, and cultural aspects of SCD
Community and public education programs
Resources for drug development, e.g., toxicology, non-human primates, and infrastructure for Phase I and II trials, including for drugs that already show promise
New and better gene transfer vectors that are safe and efficient, including non-integrating systems, targeted integration, and homologous recombination.
Two (2) percent of all votes cast were cast for each of the following:
Phenotypic compound screens, applicable to hemoglobin S polymerization and sickling of red blood cells
Genetic modifier screens, for humans, mice, and zebrafish
Biomarkers for disease severity and monitoring of clinical trials
Timely initiation of gene therapy trials
Research into such ethical, legal, and social issues as self-identity, ancestry, race, stigma, discrimination, trustworthiness.
One (1) percent of all votes cast were cast for each of the following:
Education of the public
Better and more accessible animal models - non-human primates, rabbits, rats, mice, zebrafish
Human embryonic stem cell methodologies, including derivation of SS embryonic stem cells.
Less than once (<1) percent of all votes cast were cast for each of the following:
Stem cell purification strategies
Investigation of barriers to research participation
New technologies for understanding the molecular switching mechanism, such as three dimensional imaging of regulatory domains and of the anatomy of regulatory complexes
In vivo selection and amplification systems
Advances in allogeneic transplantation, with improved immune suppression