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Item Preclinical safety and efficacy of an anti–HIV-1 lentiviral vector containing a short hairpin RNA to CCR5 and the C46 fusion inhibitor(Nature Publishing Group, 2014-02-12) Wolstein, Orit; Boyd, Maureen; Millington, Michelle; Impey, Helen; Boyer, Joshua; Howe, Annett; Delebecque, Frederic; Cornetta, Kenneth; Rothe, Michael; Baum, Christopher; Nicolson, Tamara; Koldej, Rachel; Zhang, Jane; Keech, Naomi; Camba Colón, Joanna; Breton, Louis; Bartlett, Jeffrey; An, Dong Sung; Chen, Irvin SY; Burke, Bryan; Symonds, Geoff P.; Department of Medical & Molecular Genetics, IU School of MedicineGene transfer has therapeutic potential for treating HIV-1 infection by generating cells that are resistant to the virus. We have engineered a novel self-inactivating lentiviral vector, LVsh5/C46, using two viral-entry inhibitors to block early steps of HIV-1 cycle. The LVsh5/C46 vector encodes a short hairpin RNA (shRNA) for downregulation of CCR5, in combination with the HIV-1 fusion inhibitor, C46. We demonstrate here the effective delivery of LVsh5/C46 to human T cell lines, peripheral blood mononuclear cells, primary CD4+ T lymphocytes, and CD34+ hematopoietic stem/progenitor cells (HSPC). CCR5-targeted shRNA (sh5) and C46 peptide were stably expressed in the target cells and were able to effectively protect gene-modified cells against infection with CCR5- and CXCR4-tropic strains of HIV-1. LVsh5/C46 treatment was nontoxic as assessed by cell growth and viability, was noninflammatory, and had no adverse effect on HSPC differentiation. LVsh5/C46 could be produced at a scale sufficient for clinical development and resulted in active viral particles with very low mutagenic potential and the absence of replication-competent lentivirus. Based on these in vitro results, plus additional in vivo safety and efficacy data, LVsh5/C46 is now being tested in a phase 1/2 clinical trial for the treatment of HIV-1 disease.