Search

Because of chronic anemia, hypogonadotropic hypogonadism, and iron chelation, pregnancy in homozygous and heterozygous compound beta-thalassemia patients stays a challenge. Pregnancies of transfused beta-thalassemia women registered in the French National Registry, conducted between 1995 and 2015, are described. These pregnancies were compared with pregnancies in healthy women and to data previously published in the literature. Fifty-six pregnancies of 37 women were studied. There were 5 twin pregnancies. Assisted reproductive technologies (ART) were used in 9 pregnancies. Median term at delivery was 39 amenorrhea weeks, and median weight at birth was 2780 g. Cesarean section was performed in 53.6% of the pregnancies. There were 6 thromboembolic events, 6 serious infections, 6 pregnancy-induced hypertensions (PIH), 6 intrauterine growth retardations (IUGR), 5 severe hemorrhages, 4 gestational diabetes, 3 alloimmunizations, 2 heart diseases, and 1 pre-eclampsia. There were 5 infections and 4 osteoporosis in the first year of post-partum. ART and cesarean sections were more often used in the beta-thalassemia group, compared to control subjects. Thromboembolic events, PIH, hemorrhage at delivery, and IUGR were more frequent in the beta-thalassemia group. Time to delivery was not different, but infant weight at birth was significantly smaller in the beta-thalassemia group. In the post-partum period, global maternal complications were more frequent in the beta-thalassemia group. Pregnancy in transfused beta-thalassemia women is safe with rare obstetrical and fetal complications. Cesarean section remains often chosen, and infant weight at birth remains smaller than that in the general population, despite delivery at full term.

PURPOSE To report on the reliability of optical coherence tomography angiography (OCTA) to diagnose fovea plana. METHODS A retrospective, cross-sectional, case-control study included patients with foveal persistence of the inner retinal layers, confirmed by spectral domain OCT, and superficial capillary plexus (SCP) and deep capillary plexus foveal vascularization confirmed by OCTA. A healthy control group was selected. The best-corrected visual acuity was obtained. Spectral-domain OCT was used for measuring the outer nuclear layer thickness, and OCTA determined the foveal avascular zone, SCP, and deep capillary plexus vascular density. RESULTS Optical coherence tomography angiography reliability, based on all parameters, reached 97%, whereas based only on SCP vascular density 91%. The plana group (n = 57) differed significantly from the control group (n = 28) in terms of foveal avascular zone, SCP, and deep capillary plexus foveal vascular density (P 30% or foveal avascular zone

Selective and independent manipulation of microparticles is important for a wide range of applications. Compared to other physical principles, magnetic field is promising due to its ability to penetrate most materials and affect only magnetic objects. However, in most noncontact magnetic manipulation systems, all particles in the workspace are moved simultaneously. This article reports an automatic single-source noncontact magnetic manipulation technique that can selectively extract individual magnetic particles from a population of similar particles and then independently manipulate the extracted particles. We use an electromagnetic needle to create a highly localized magnetic field to achieve the local addressability. The motion of single particles is controlled by adjusting the position of the electromagnetic needle using visual servoing, where two control laws, velocity and position control, have been developed. Experimental results show that a predefined velocity vector can be followed accurately with a directional error of 8.5 $^{\circ }$ and a norm error of 5 $\mu \text{m/s}$ . Similarly, a predefined path can be followed with a position error of 0.5 $\mu \text{m}$ . The capabilities of the proposed method has been demonstrated in four cases: selective extraction of a single particle from a population, separation of two magnetic particles with 10.6 $\mu \text{m}$ initial gap, independent manipulation of four particles, and targeted delivery of two particles onto two separate cells.

Using optical coherence tomography, we found that the extent of retinal detachment is related to preoperative and postoperative choroidal thickness, determined not only subfoveally but also within a central macular area measuring 5 mm in diameter., Purpose: To evaluate the changes in choroidal thickness (CT) before and after a successful pars plana vitrectomy for rhegmatogenous retinal detachment (RD), and to compare the evolution of CT with respect to the extent of RD. Methods: Fifty-four patients were divided into three groups: peripheral macula-on RD (>3 mm from the fovea; 14 eyes); paracentral macula-on RD (fovea-sparing; ≤3 mm from the fovea; 14 eyes); and macula-off RD (involving the fovea; 26 eyes). Choroidal thickness was measured at 1 month (M1) and 3 months (M3) postoperatively, preoperatively in macula-on RDs, with enhanced depth imaging optical coherence tomography, from the nasal side (+2.5 mm) to the temporal side (−2.5 mm) of the fovea. Results: In peripheral macula-on RD, the intereye difference in CTs showed thickening throughout follow-up (subfoveally: preoperatively = 19.6% ± 43.9%, M1 = 22.9% ± 27.5%, M3 = 18.2% ± 35.6%). In paracentral macula-on RD, the intereye difference in CTs showed a thinning throughout follow-up (subfoveally: preoperatively = −7.8% ± 21.9%, M1 =−5.5% ± 26.1%, M3 = −9.3% ± 19.4%), as well as in the macula-off RD (subfoveally: M1 = −14.1% ± 18.7%, M3 = −9.9% ± 15%). Conclusion: The extent of RD was related to the evolution of the CT before and after surgery. Further studies are necessary to clarify the relationship between the changes in CT and the effects of circulatory alterations, vitrectomy, and RD.

Seventy-five percent of patients with beta thalassemia (β-thalassemia) do not have human leukocyte antigen-matched siblings and until recently had no access to a curative treatment. Gene therapy is a promising treatment that can be proposed to these patients. This study estimates its cost and efficacy. In a monocentric retrospective study and cost-efficacy analysis, this study compared the two-year outcomes and costs of patients with β-thalassemia treated by gene therapy and hematopoietic stem-cell transplantation (HSCT). Grade III and grade IV complications, hospitalizations, and length of stay were extracted from the hospital discharge data. Costs were estimated from hospital accounting information and national cost studies. A total of seven patients with β-thalassemia treated between 2009 and 2016 were included, of whom four received gene therapy. Patients treated by gene therapy were older and had fewer complications and hospital admissions. Infectious complications were three times more frequent for patients treated with HSCT than for gene therapy. Average costs were €608,086 for patients treated by gene therapy and €215,571 for HSCT. The total cost of the vector was 48% of the total cost of gene therapy. Gene therapy as a curative alternative for patients lacking human leukocyte antigen-matched donors was costlier but resulted in fewer complications than HSCT.

Purpose: The aim of this study was to estimate the association between preoperative characteristics in subjects with idiopathic epiretinal membrane (ERM) and visual acuity improvement after vitrectomy and create an algorithm for predicting postoperative visual outcome. Methods: In a retrospective, cross-sectional study, we included adults with idiopathic ERM and excluded subjects with low-quality scans, other ocular conditions, and previous surgery except cataract surgery. Baseline characteristics were extracted from medical files, spectral-domain OCT, and OCT angiography. Visual improvement was expressed as a binary variable. Results: Fifty-four subjects were included in the study. Three months postoperatively, 30 subjects improved, 10 remained stable, and 14 deteriorated. Spearman correlation showed no correlation between variables and visual acuity improvement (Conclusion: No variable has a direct predictive role on visual acuity improvement; however, baseline visual acuity, lens status, foveal aspect and spherical equivalent, when combined, provide a predictive model that could serve as a tool for more informed decisions.

Although abnormal structural and functional connectivity in the striatum during neurological disorders has been reported using functional magnetic resonance imaging (fMRI), the effects of cell-type specific neuronal stimulation on fMRI and related behavioral alterations are not well understood. In this study, we successfully combined DREADD-technology with fMRI (chemo-fMRI) to investigate the alterations of spontaneous neuronal activity induced by the unilateral activation of dopamine D1 receptor-expressing neurons (D1-neurons) in the mouse dorsal striatum (DS). We compared the effects of two different DREADD ligands, clozapine (CLZ) and clozapine-N-oxide (CNO), on behavior and fMRI. We found that the effects of CLZ on behavior were more rapid than those of CNO. In fMRI, both systemic CLZ and CNO administrations, which evoked unilateral activations of D1-neurons in DS, increased the fractional amplitude of low frequency fluctuations (fALFF) in the thalamus and bilateral cortex. In addition, we found the increased gamma-band of local field potentials in DS and bilateral cortex after CLZ-evoked unilateral activation of D1-neuron in the striatum. These results provide bases for better interpretation of cell type-specific activity changes in fMRI.

Micromanipulation plays a key role in the development of complex and assembled microsystems. However, current micromanipulation solutions are often limited to small rotation amplitudes and to simple shaped objects (such as cubes). Our approach consists of developing in-hand micromanipulation techniques using dexterous microhands to manipulate arbitrary shaped objects and to perform large rotations. This paper focuses on the trajectory generation of a dexterous microhand to achieve automated repositioning by taking advantage of adhesion forces. The results on the generated trajectories show that adhesion forces can be exploited to enhance the manipulation possibilities. Moreover, experiments show that planed rotations are performed at more than $\text{95}\%$ using an open-loop control. Dexterous micromanipulation is a promising way to perform complex manipulation tasks in microscale.

Summary In African-American patients with sickle cell disease (SCD), APOL1 G1 and G2 variants are associated with increased risk of sickle cell nephropathy (SCN). To determine the role of APOL1 variants in SCD patients living in Europe, we genotyped 152 SCD patients [aged 30·4 (24·3–36·4) years], mainly of Sub-Saharan African ancestry, for APOL1 G1 and G2 and for variants of four genes with kidney tropism (GSTM1, GSTT1, GSTP1, and HMOX1). Homozygous or double-heterozygous APOL G1 and G2 genotypes were strongly associated with end stage renal disease (P = 0·003) and worse Kidney Disease: Improving Global Outcomes stages (P = 0·001). Further, these genotypes were associated in an age-dependent manner with lower estimated glomerular filtration rate (eGFR, P = 0·008), proteinuria (P = 0·009) and albuminuria (P

Anti-doping controls in non-major events are relatively infrequent and athletes that compete only in these events are less likely to be controlled. The French Anti-Doping Agency carried out an anti-doping operation during a regional cycling competition in Guadeloupe. The urine and serum samples were analysed by the French anti-doping laboratory. Out of 42 athletes, 7 were positive for one or more substances prohibited by the World Anti-Doping Agency. Four serum samples contained continuous erythropoietin receptor activator (CERA) and one a recombinant erythropoietin. However, no traces were found in the corresponding urines. One of the athletes positive for CERA was also positive for growth hormone (GH), identified using the GH isoform test. The same serum was negative with the GH biomarkers test, probably because of the brief interval between injection and control (less than a day). The stimulants heptaminol and dimethylbutylamine, as well as the glucocorticoid prednisone and its metabolite prednisolone, were also found. Strikingly, 16.6% of the controlled athletes were using one or more prohibited drugs. These findings indicate that doping is widespread in athletes competing regionally and that CERA is still a popular drug for endurance sports. They underline the need for more controls, particularly blood sampling during non-major competitions. Copyright © 2017 John Wiley & Sons, Ltd.

Introduction Allogeneic hematopoietic stem cell (HSC) transplantation (allo-HSCT) is a treatment option for several monogenic diseases; however, its use is limited by the need for a matched donor and risk of HSCT-related complications. Autologous HSC gene addition does not have some of these limitations and may have similar efficacy with an improved safety profile. Ex vivo gene addition therapy using lentiviral vectors (LVV) is being evaluated in patients with transfusion-dependent β-thalassemia (TDT) using betibeglogene autotemcel (beti-cel, LentiGlobin for TDT) in the HGB-204, -205, -207, and -212 studies, sickle cell disease (SCD) using LentiGlobin for SCD in HGB-205 and -206, and cerebral adrenoleukodystrophy (CALD) using Lenti-D in ALD-102. The safety outcomes following autologous gene modified HSCT in these ongoing studies are summarized. Methods HSCs are collected using disease-appropriate procedures, then CD34+ cells are transduced with LVV encoding disease-specific therapeutic transgenes. After myeloablation with busulfan (SCD, TDT) or busulfan/cyclophosphamide (CALD), patients are infused with LVV-transduced CD34+ HSCs. Patients are followed for two years and offered participation in long term follow-up studies (LTF-303 [NCT02633943] or LTF-304 [NCT02698579]). Results Across all 6 studies, 110 patients have been treated as of most recent analyses (Table 1). Patients have been followed for 2 years follow-up. No patient experienced primary or secondary graft failure. One patient with CALD experienced disease progression and died 22 months after drug product (DP) infusion of disease complications. Two additional patients with CALD withdrew from the study after DP infusion and were referred for allo-HSCT. All other patients with CALD, TDT, and SCD remain alive. Most (107/110) patients had ≥ one grade 3 or 4 adverse event (AE) attributed to conditioning; most common AEs were cytopenia, febrile neutropenia, and stomatitis. Myelodysplastic syndrome was reported in one patient with SCD. After investigation for LVV insertion in malignant cells, the AE was assessed as not related to LentiGlobin insertion or transgene expression. AEs reported as related to the DP are shown in Table 1. There was no GVHD and no clinically relevant clonal dominance or LVV-mediated replication competent lentivirus. Summary Data from 110 patients followed for up to 5 years supports that the safety profile of gene-modified autologous HSCT does not carry the risks of GVHD, graft rejection, and long-term immunosuppression attendant to allo-HSCT. While the safety profile beyond 5-years is still being established, these data suggest that HSC gene therapy may be an acceptable therapy for patients with TDT, SCD, and CALD, particularly in patients at increased risk of complications from allo-HSCT, such as those who lack a suitable donor or are more advanced in age.

Introduction LentiGlobin for SCD GT contains autologous CD34+ hematopoietic stems cells (HSCs) encoding β-globin with the anti-sickling T87Q mutation (βA-T87Q) and is being evaluated in the ongoing Phase 1/2 HGB-206 Study (NCT02140554) in patients with SCD. Levels of GT-derived hemoglobin (HbAT87Q) in 7 initial patients (Group A) were suboptimal but were maintained for ≥ 30 months of follow-up post-treatment, suggesting durable transgene expression. To increase HbAT87Q production, protocol and manufacturing changes were made (Group B; N=2). In addition, HSC collection by plerixafor mobilization and apheresis was instituted in Group C. Objective Provide an update on safety and efficacy of LentiGlobin for SCD in HGB-206 Group C. Methods Adults with severe SCD (including recurrent vaso-occlusive crisis [VOC] and acute chest syndrome [ACS]) were enrolled. CD34+ HSCs were harvested by apheresis following plerixafor mobilization and transduced with BB305 lentiviral vector (LVV). Patients received myeloablative busulfan conditioning, were infused with LentiGlobin drug product (DP) and monitored for adverse events (AEs), Hb fractions, and other parameters. LVV presence in transduced cells (%LVV+) was measured by qPCR of individual colonies from colony-forming unit assays from pre-infusion DP) and post-infusion from CD34+ bone marrow (BM) HSCs and peripheral blood mononuclear cells (PBMCs). Data are shown as median (min-max). Results As of 7 March 2019, 13 Group C patients received DP, with follow-up of 9.0 (1.0-15.2) months. All but 1 patient had neutrophil and platelet engraftment as of the data cut date. Median HbS was ≤50% of total Hb in those with ≥6 months follow-up (n=8; Figure 1). Total unsupported Hb at last visit in patients with ≥6 months of follow-up was 11.5 (10.2-15.0) g/dL, with HbAT87Q levels of 5.3 (4.5-8.8) g/dL. Six of these 8 patients had a history of VOCs or ACS; the annualized VOC+ACS rate decreased from 5.3 (3-14) pre-treatment to 0 (0-2) post-treatment (Figure 2). A decrease in hemolysis markers was also seen post-DP. Most common non-hematologic Grade ≥ 3 AEs were febrile neutropenia (n=10) and stomatitis (n=7). Serious AEs occurred in 6 patients; the most frequent were nausea and vomiting. To date, there have been no cases of DP-related AEs, graft failure, vector-mediated replication competent lentivirus, or clonal dominance. The %LVV+ colonies from PBMCs at 9 months and BM at 12 months post-DP infusion (n=5) were 79.2 (67.0-88.4) % and 81.5 (60.6-88.1) %, respectively, indicating stable engraftment of transduced cells from DP (%LVV+ was 80 [71-88] %). Conclusions Patients in HGB-206 Group C show stable LentiGlobin engraftment, with median total Hb >10 g/dL and median HbS ≤50% of total Hb in those with ≥6 months follow-up. The decrease in SCD-related complications and hemolysis in this cohort demonstrate a strong therapeutic benefit of LentiGlobin in patients with SCD.

PURPOSE To quantify changes in photoreceptor density using adaptive optics fundus camera in patients after retinal detachment (RD) and to correlate them with macular involvement and best-corrected visual acuity. METHODS At 1 and 3 months (M1 and M3) after vitrectomy, 194 patients underwent adaptive optics imagery in both eyes, at 5 locations, that we matched between time points using anatomical landmarks. Twenty-two patients (10 fovea-OFF [OFF] and 12 fovea-ON [ON]) had matched and analyzable adaptive optics images. We used analysis of variance for repeated measures. RESULTS Best-corrected visual acuity (logarithm of the minimum angle of resolution and Snellen equivalent [SE]) was significantly different between OFF and ON RDs at baseline: 2.0 (2.3-0.95) (SE: 20/2000) versus 0 (0.1-0) (SE: 20/20); at M1: 0.35 (0.5-0.1) (SE: 20/40) versus 0.05 (0-0.1) (SE: 20/25); and at M3: 0.25 (0.3-0.1) (SE: 20/32) versus 0 (0-0) (SE: 20/20). We observed that cone density was stable in fellow eyes between M1 and M3 (P = 0.67); decreased in treated eyes than in fellow eyes (P < 0.05); and increased postoperatively in the ON group (P = 0.02) but not in the OFF group (P = 0.97). Visual acuity and RD type were independently correlated with cone density (P = 0.004, P = 0.000). CONCLUSION Postoperative cone density was reduced in OFF RD, but also in the ON group, although the drop recovered during the 3-month follow-up. Cone density was significantly correlated with both visual acuity and type of RD at both time points.

Primary hyperparathyroidism (pHPT) is the third most common endocrine disorder and usually affects patients between 60 and 70 years of age. To our knowledge, this condition has never been studied in young patients with sickle cell disease (SCD). Our objective was to describe the clinical and biological characteristics of pHPT in adult patients with SCD and its management. We conducted a retrospective study that included SCD patients who were diagnosed with pHPT in four SCD referral centers. pHPT was defined by the presence of elevated serum calcium levels with inappropriate normal or increased parathyroid hormone (PTH) serum levels or histopathological evidence of parathyroid adenoma or hyperplasia. Patients with severe renal impairment (GFR &lt, 30 mL/min) were excluded. Twenty-eight patients (18 women, 64%, 22 homozygous genotype, 79%) were included. The median age at pHPT diagnosis was 41 years (interquartile range &ndash, IQR- 31.5&ndash, 49.5). The median serum calcium and PTH concentration were, respectively, 2.62 mmol/L (IQR 2.60&ndash, 2.78) and 105 pg/mL (IQR 69&ndash, 137). Bone mineral density (BMD) revealed very low BMD (&minus, 2.5 SD) in 44% of patients explored (vs. 12.5% among 32 SCD patients matched for SCD genotype, sex, age, and BMI, p = 0.03). Fourteen patients (50%) received surgical treatment, which was successful in all cases, but four of these patients (29%) presented with pHPT recurrence after a median time of 6.5 years. Three of these patients underwent a second cervical surgery that confirmed the presence of a new parathyroid adenoma. These results suggest that SCD is a condition associated with pHPT in young subjects. SCD patients with pHPT have a high risk of very low BMD. A diagnosis of pHPT should be suspected in the presence of mild hypercalcemia or low BMD in SCD patients.

[Background] Depression is the most common psychiatric condition in Huntington’s disease (HD), with rates more than twice those found in the general population. At the present time, there is no established molecular evidence to use as a basis for depression treatment in HD. Indeed, in some patients, classic antidepressant drugs exacerbate chorea or anxiety. Cyclin-dependent kinase 5 (Cdk5) has been involved in processes associated with anxiety and depression. This study evaluated the involvement of Cdk5 in the development and prevalence of depressive-like behaviors in HD and aimed to validate Cdk5 as a target for depression treatment. [Methods] We evaluated the impact of pharmacological inhibition of Cdk5 in depressive-like and anxiety-like behaviors in Hdh+/Q111 knock-in mutant mice by using a battery of behavioral tests. Biochemical and morphological studies were performed to define the molecular mechanisms acting downstream of Cdk5 activation. A double huntingtin/DARPP-32 (dopamine- and cAMP-regulated phosphoprotein 32) knock-in mutant mouse was generated to analyze the role of DARPP-32 in HD depression. [Results] We found that Hdh+/Q111 mutant mice exhibited depressive-like, but not anxiety-like, behaviors starting at 2 months of age. Cdk5 inhibition by roscovitine infusion prevented depressive-like behavior and reduced DARPP-32 phosphorylation at Thr75 in the nucleus accumbens. Hdh+/Q111 mice heterozygous for DARPP-32 Thr75Ala point mutation were resistant to depressive-like behaviors. We identified β-adducin phosphorylation as a Cdk5 downstream mechanism potentially mediating structural spine plasticity changes in the nucleus accumbens and depressive-like behavior. [Conclusions] These results point to Cdk5 in the nucleus accumbens as a critical contributor to depressive-like behaviors in HD mice by altering DARPP-32/β-adducin signaling and disrupting the dendritic spine cytoskeleton., This work was supported by the Ministerio de Economía y Competitividad (Grant No. SAF2015-67474-R;MINECO/FEDER [to SG] and Grant No. SAF2017-88076-R [to JA]), Centro de Investigaciones Biomédicas en Red sobre Enfermedades Neurodegenerativas (Grant No. CB06/05/0054 [to JA]), Agencia de Gestión de Ayudas Universitarias y de Investigación (Grant No. 2017SGR717 [to AC]). and Ramon y Cajal fellowship (Grant No. RYC-2016-19466 [to AG]). J-AG’s laboratory was supported in part by Inserm, the Université Pierre et Marie Curie (Sorbonne Université), the Fondation pour la Recherche Médicale, and the Laboratory of Excellence of Biology for Psychiatry.

Aims: To evaluate the effectiveness and safety of Posterior Sub-Tenon (PST) Triamcinolone Acetonide (TA) injection for persistent macular oedema associated with non-ischemic Central Retinal Vein Occlusion (CRVO) or Branch Retinal Vein Occlusion (BRVO) in non-vitrectomized eye. Methods: Fourteen consecutive eyes of 14 patients characterized by macular oedema lasting more than 3 months and with a visual acuity of less than 20/40 were enrolled. Six eyes presented with BRVO, 8 eyes with CRVO. PST injection of 40 mg TA was performed in topical anaesthesia. All patients were phakic, and followed for at least 6 months. Snellen visual acuity converted to LogMAR units and anatomic responses were evaluated before, and at 1, 3, 6, and 12 (if required) months after injections and re-injection considered. Results: In the BRVO group, mean foveal thickness was 548.2±49.50 μm preoperatively, and 452.8±56.2 μm and 280.8±62.5 μm at 1 and 12 month follow-up, respectively. Statistical analysis showed significant differences between preoperative and postoperative measurements (P

In this paper, different pumped two-phase flow cooling technologies for electronic components are presented. Since electronic components heat dissipation requirements are growing, cooling technologies have evolved from air cooled heat exchanger to technologies involving the use of single or two-phase refrigerants. This review focuses on three technologies that allow dissipation of heat flux over 100 W/cm2: Micro-channels, plate-fin and spray cooling. Macroscopic, microscopic–nanoscopic and hybrid heat enhancements for all three technologies are also presented.

Major depressive disorder (MDD) is a common disorder with a variety of symptoms including mood alterations, anhedonia, sleep and appetite disorders, and cognitive disturbances. Stressful life events are among the strongest risk factors for developing MDD. At the cellular level, chronic stress results in the modification of dendritic spine morphology and density. Here, we study the role of Pyk2 in the development of depressive-like symptoms induced by a model of chronic unpredictable mild stress (CUMS). Pyk2 is a non-receptor calcium-dependent protein-tyrosine kinase highly expressed in the forebrain principal neurons and involved in spine structure and density regulation. We show that Pyk2 knockout mice are less affected to anxiety-like and anhedonia-like phenotypes induced by the CUMS paradigm. Using region-specific knockout, we demonstrate that this phenotype is fully recapitulated by selective Pyk2 inactivation in the amygdala. We also show that in the absence of Pyk2 the spine alterations, PSD-95 clustering, and NMDA receptors changes induced by the CUMS paradigm are prevented. Our results reveal a possible role for Pyk2 in the response to stress and in synaptic markers expression and spine density regulation in the amygdala. We suggest that Pyk2 contributes to stress-induced responses through micro-structural changes and that its deficit may contribute to the resilience to chronic stress A.G. is a Ramón y Cajal fellow (RYC-2016-19466). This work was supported by the NARSAD foundation (young investigator grant 2016 (Ref. 24803) to A.G.) and Ministerio de Ciencia e Innovació n (SAF2015-67474-R; MINECO/FEDER to S.G.). J.-A.G. lab was supported in part by Inserm, the Université Pierre et Marie Curie (UPMC, Sorbonne Université), the Fondation pour la Recherche Médicale, and the Bio-Psy (Biology for Psychiatry) laboratory of excellence. O.A.-M. was funded by the ISCIII/SERGAS thought a research contract “Sara Borrell” (CD14/ 00091). JA lab was supported by the Spanish Ministry of Economy and Competitiveness (MINECO) (SAF-2014-57160R, SAF-2017-88076-R), Fundació Marató TV3 to J.A. and Instituto Carlos III: Centro de Investigación Biomédica en Red sobre enfermedades neurodegenerativas (CIBERNED), and RETICS RD12/ 0019/0002 to J.A.) SI

Summary Background Exercise could be a triggering factor for vaso-occlusive crises in patients with sickle-cell disease. We aimed to investigate whether a patient-adapted training programme of moderate endurance exercise could be safe and beneficial for patients with sickle-cell disease. Methods We did a multicentre, prospective, open-label, randomised controlled trial at four university hospitals in France. Eligible patients were older than 18 years, with an HbSS or S/β0-thalassaemia genotype, and with no severe chronic complications. All patients underwent cardiopulmonary exercise tests (CPETs) on a stationary bicycle with cardiac, pulmonary, laboratory, and muscle parameter evaluations at the start and end of the study period. We randomly assigned patients (1:1) to the training group (three 45-min exercise sessions per week, for 8 weeks) or the control group (no lifestyle changes) using a central computer-generated randomisation list. During baseline evaluation, patients and researchers were masked to group assignment; randomisation was done after completion of the baseline evaluation to minimise bias. The primary outcome was difference in power output at a blood lactate concentration of 4 mmol/L during CPET between baseline and the end of the 8-week training period. Patients were analysed on a per-protocol basis, excluding those who missed more than 20% of the training sessions or had other major protocol violations. This trial is registered with ClinicalTrials.gov, number NCT02571088, and is completed. Findings Between Sept 8, 2014, and Dec 11, 2015, 40 patients were enrolled (20 to each group). After exclusion of seven patients (one pregnancy, one appendicitis, one protocol violation, two lost to follow-up, and two incompatibilities with work schedule), 33 patients were analysed (15 in the training group, 18 in the control group). At the 8-week follow-up, the absolute change from baseline in mean power output at 4 mmol/L blood lactate was 7·2 W (SD 8·7) in trained patients (from 70·4 W [SD 16·2] at baseline to 77·6 W [15·1] at end of intervention) compared with −0·3 W (9·4) in controls (from 66·2 W [13·8] to 65·9 W [15·6]; mean difference between groups 7·3 W [95% CI 0·7–13·8], p=0·031). No adverse events requiring hospital admission occurred in the training group, whereas five occurred in the control group: four (20%) vaso-occlusive crises (one complicated by an acute chest syndrome), and one (6%) viral infection with isolated chest pain (hazard ratio 0·143 [95% CI 0·024–0·827; p=0·029). Interpretation Moderate-intensity endurance-exercise training seems to be safe for adults with sickle-cell disease without severe chronic complications and significantly improved their functional capacity, especially for exercise levels close to those needed for daily activities. Our findings support consideration of endurance-exercise training as a novel therapeutic strategy for patients with sickle-cell disease. Funding Societe Francaise de Cardiologie and Institut National du Sport, de l'Expertise et de la Performance (INSEP).

International audience; In retinal detachment (RD), photoreceptor death and permanent vision loss are caused by neurosensory retina separating from the retinal pigment epithelium because of subretinal fluid (SRF), and successful surgical reattachment is not predictive of total visual recovery. As retinal iron overload exacerbates cell death in retinal diseases, we assessed iron as a predictive marker and therapeutic target for RD. In the vitreous and SRF from patients with RD, we measured increased iron and transferrin (TF) saturation that is correlated with poor visual recovery. In ex vivo and in vivo RD models, iron induces immediate necrosis and delayed apoptosis. We demonstrate that TF decreases both apoptosis and necroptosis induced by RD, and using RNA sequencing, pathways mediating the neuroprotective effects of TF are identified. Since toxic iron accumulates in RD, we propose TF supplementation as an adjunctive therapy to surgery for improving the visual outcomes of patients with RD.

This paper presents the specification, design, and development of the Radial Velocity Spectrometer (RVS) on the European Space Agency’s Gaia mission. Starting with the rationale for the full six dimensions of phase space in the dynamical modelling of the Galaxy, the scientific goals and derived top-level instrument requirements are discussed, leading to a brief description of the initial concepts for the instrument. The main part of the paper is a description of the flight RVS, considering the optical design, the focal plane, the detection and acquisition chain, and the as-built performance drivers and critical technical areas. After presenting the pre-launch performance predictions, the paper concludes with the post-launch developments and mitigation strategies, together with a summary of the in-flight performance at the end of commissioning.

Sickle SCAN™ is a rapid, qualitative, point-of-care lateral flow immunoassay for the identification of AS, AC, SS/Sβ0thal, SC and CC/Cβ0thal phenotype. We evaluated this test under the conditions encountered in the French newborn screening (NBS) program for sickle cell disease: a total of 104 dried blood spots (DBSs) were tested with an HPLC reference method and then with the Sickle SCAN™ device. Sickle SCAN™ identified the hemoglobin (Hb) phenotype correctly on 96% of cases. In the four non-concordant cases, the antibody anti-HbS cross-reacted with HbE (n=2), HbD (n=1) or HbX (n=1). There were no false negative. In order to test Sickle SCAN™'s sensitivity to low levels of HbA and HbS in the presence of high HbF levels, we selected another 21 DBS cards with low percentages of HbA (0.6-4.2%) and HbS (2.0-6.9%). HbA and HbS were always detected when present at levels of more than 1% and 2%, respectively. Sickle SCAN™ appears to be an accurate point-of-care method for the identification of newborns with SCD trait. The device meets the criteria for sickle cell disease NBS programs in endemic countries with poor access to laboratory equipment.

International audience; After reviewing the various motion generation strategies (waypoint sequence, trajectory tracking and path following), this paper suggests that path following is probably the best strategy at small scales. This is illustrated by three examples coming from biomedical applications: endoscopic laser steering, magnetic manipulation of microswimmers and navigation of a surgical tool under anatomical constraints.

β-thalassemia, a hereditary blood disorder caused by defective synthesis of hemoglobin β globin chains, leads to ineffective erythropoiesis and chronic anemia that may require blood transfusions. Sotatercept (ACE-011) acts as a ligand trap to inhibit negative regulators of late-stage erythropoiesis in the transforming growth factor β superfamily, correcting ineffective erythropoiesis. In this phase II, open-label, dose-finding study, 16 patients with transfusion-dependent β -thalassemia and 30 patients with non-transfusion-dependent β-thalassemia were enrolled at seven centers in four countries between November 2012 and November 2014. Patients were treated with sotatercept at doses of 0.1, 0.3, 0.5, 0.75, or 1.0 mg/kg to determine a safe and effective dose. Doses were administered by subcutaneous injection every 3 weeks. Patients were treated for ≤22 months. Response was assessed as a ≥20% reduction in transfusion burden sustained for 24 weeks in transfusion-dependent β-thalassemia patients, and an increase in hemoglobin level of ≥1.0 g/dL sustained for 12 weeks in non-transfusion-dependent β-thalassemia patients. Sotatercept was well tolerated. After a median treatment duration of 14.4 months (range 0.6-35.9), no severe life-threatening adverse events were observed. Thirteen percent of patients reported serious but manageable adverse events. The active dose of sotatercept was ≥0.3 mg/kg for patients with non-transfusion-dependent β-thalassemia and ≥0.5 mg/kg for those with transfusion-dependent β-thalassemia. Of 30 non-transfusion-dependent β-thalassemia patients treated with ≥0.1 mg/kg sotatercept, 18 (60%) achieved a mean hemoglobin increase ≥1.0 g/dL, and 11 (37%) an increase ≥1.5 g/dL, sustained for ≥12 weeks. Four (100%) transfusion-dependent β-thalassemia patients treated with 1.0 mg/kg sotatercept achieved a transfusion-burden reduction of ≥20%. Sotatercept was effective and well tolerated in patients with β-thalassemia. Most patients with non-transfusion-dependent β-thalassemia treated with higher doses achieved sustained increases in hemoglobin level. Transfusion-dependent β-thalassemia patients treated with higher doses of sotatercept achieved notable reductions in transfusion requirements. This trial was registered at ClinicalTrials.gov with the number NCT01571635.

There is an active discussion in the public health community on how to assess and incorporate, in addition to safety and measures of protective efficacy, the full public health value of preventive vaccines into the evidence-based decision-making process of vaccine licensure and recommendations for public health use. The conference "Beyond efficacy: the full public health impact of vaccines in addition to efficacy measures in trials" held in Annecy, France (June 22-24, 2015) has addressed this issue and provided recommendations on how to better capture the whole public health impact of vaccines. Using key examples, the expert group stressed that we are in the midst of a new paradigm in vaccine evaluation, where all aspects of public health value of vaccines beyond efficacy should be evaluated. To yield a wider scope of vaccine benefits, additional measures such as vaccine preventable disease incidence, overall efficacy and other outcomes such as under-five mortality or non-etiologically confirmed clinical syndromes should be assessed in addition to traditional efficacy or effectiveness measurements. Dynamic modelling and the use of probe studies should also be considered to provide additional insight to the full public health value of a vaccine. The use of burden reduction and conditional licensure of vaccines based on collection of outcome results should be considered by regulatory agencies.

β-globin gene disorders are the most prevalent inherited diseases worldwide and result from abnormal β-globin synthesis or structure. Novel therapeutic approaches are being developed in an effort to move beyond palliative management. Gene therapy, by ex vivo lentiviral transfer of a therapeutic β-globin gene derivative (β(AT87Q)-globin) to hematopoietic stem cells, driven by cis-regulatory elements that confer high, erythroid-specific expression, has been evaluated in human clinical trials over the past 8 years. β(AT87Q)-globin is used both as a strong inhibitor of HbS polymerization and as a biomarker. While long-term studies are underway in multiple centers in Europe and in the United States, proof-of-principle of efficacy and safety has already been obtained in multiple patients with β-thalassemia and sickle cell disease.

it MAy AppeAR soMewhAt sensAtionAList to Discuss the woRk of Curacao filmmaker Felix de Rooy under a title such as "Sex and Spirit", but his trilogy suggests that these are the two perspectives through which de Rooy interrogates the nature of his own identity as an artist from the Dutch Antilles and as a postcolonial subject.The three films, Desiree (1981), Almacita di Desolato (1985) and Ava and Gabriel: A Love Story (1990), have in common a female protagonist who is suppressed, repressed or who is attempting to surface from under sexual repression. That the primary subjects are female is in itself significant given that the Caribbean has long privileged the male as the primary mover in the destiny of the region. The fact that de Rooy is openly gay and that Norman de Palm, his partner at the time, is co-producer and screenwriter in the second and third films of the trilogy suggests immediately that both artists are seeking to move beyond categorisation and that they see dominant ideas of masculinity as something in need of interrogation and rethinking. It is also significant that de Palm is a clinical psychologist, and his influence is evident in all three films.1There is no doubt that religion plays an important role in the repressive structures that cause Desiree, in the film of that name, to become "cracked up". Religious bigotry also pushes a community (obviously reluctant to do so) to exert punitive measures on the priestess Solem when she becomes pregnant, thus causing her to go into exile. In Ava and Gabriel, religious bigotry conspires with racism and homophobia to destroy the painter Gabriel, to ostracise Ava and to bring their homosexual friend to the point of near death. But both Almacita di Desolato and Ava and Gabriel also situate their narratives in a time past, and through story structures provide insight into what the filmmakers seem to perceive to be the deep cause of the thread of madness that runs through all three films.Almacita has its original focus on what appears at the onset to be a runaway from a place called San Christophe, a name that resonates with Haiti. The film throughout its discourse references a rich land, external markets, trade with foreign lands and the exploitation of the land's resources, and also suggests that the riches of the soil have led to insurrection and internal strife. This, combined with costuming, hints that the film is loosely set at the time of the Haitian revolution.The story also weaves a mythic tapestry and sets itself up as a dialogue between the past and the physical effects on the present, through the repetition of the line "history is engraved in skin". But the film is also a mythic retelling since it speaks of the intercourse between gods (or the devil) and humans through which the gift of fertility is given to both woman and land; and also involves the promise of a saviour, the child Almacita (the little soul) who as the product of the Alma Sola (force of evil) and the priestess and protector Solem (force of goodness) will unify the conflicting elements of good and evil,2 after Solem has defeated the devil to redeem her child and by extension her land. There is, then, prophecy, trial and fulfilment, and this mythic story structure binds the society together, and through unified belief both heals and enables the community to move beyond the confines of its insularity.What accomplishes this, and indeed the project is similar in Ava and Gabriel, is an interrogation of the force that spirit exerts on the communal psyche and of the way in which the force field of spirit survives in memory and through lineage and is passed down from one generation to the next. Ideas of procreation and generational transmission are linked to ideas of spirit and spirituality from the earliest film, Desiree, which de Rooy produced as a student at New York University.3The idea of children as a force for change and continuity is further delineated at the very beginning of Ava and Gabriel, where the young girl child from Almacita reappears. …

WHILE CARIBBEAN FILMMAKING HAS BEGUN TO FLOURISH, there is little published research. Ex-Isles: Essays in Caribbean Cinema, published in 1992,1 remains the seminal text. Nonetheless, Caribbean filmmakers have been insistent about the need to theorise their filmmaking and to depict the lived spaces and specific experiences of the Caribbean. Films such as Pim de la Parra's Wan Pipel (1976), and Hugh A. Robinson's Bim (1974) which fictionalises political developments of independence politics in Trinidad and Tobago, as well as Euzhan Palcy's Rue Cases-Negres (1983), suggest that initially filmmakers focused on issues of race and identity in their attempts to create counterdiscourses and to localise filmmaking.The development of an indigenous industry in the Francophone Caribbean is usually attributed to Christian Lara because his film Lorque l'herbe (1968) provided the impetus for a wave of filmmaking by native-born filmmakers. These include Jean-Paul Cesaire, Gabriel Glissant and Willy Rambeau. This movement is marked in the first instance by Cesaire's negritude movement. At the Caribbean Tales Festival in Toronto in 2009, Euzhan Palcy spoke movingly about the influence of Cesaire and called him her father.Francophone filmmakers reflect on historic ills in different ways. Raoul Peck's Lumumba: La mort du prophete (1992) is about memory and the ghosting of the past and uses a ghost (Lumumba, voiced by the director himself ) to reconstruct a history of the assassination of the politician whose ascension to power lasted two months. Peck's revolutionary use of archival and home movie footage and the shooting of the film in Brussels give a peculiar quality to the work that Laura Marks has analysed in depth in her book, The Skin of the Film.2 Peck's analyses of power and terrorism in Moloch Tropical (2009) suggest the importance of the haunting of the past in the Caribbean. Hauntology, for example, is evident in Rue Cases-Negres in the shadowy shapes that hover at the back of Medouze's hut and the retained sounds and movements from an African ancestral presence. In her essay in this issue, focusing especially on Peck's 1994 L'homme sur les quais, Meredith Robinson dissects the ways in which Peck revolutionises traditional film techniques to interrogate memory's function in addressing historic trauma.The work of Guy Deslauriers from Martinique is also about the effect of a past in need of exorcism and uses a ghost to narrate the journey through the Middle Passage. Deslauriers, in the making of the film Passage du milieu (1999) and the filming of the political documentary based on the murder of the journalist Andre Aliker (Andre Aliker, 2008), uses filmic devices to probe the residues of history in specific ways. His use of montage techniques, for example, creates a profound sense of the presence of the past in Martiniquan and Caribbean history as a whole. Some of the most evocative scenes image the bodies of slaves as subhuman in their positioning within the cramped space of the ship's hull and juxtapose such atrocities with idyllic scenes of Africa. The narrator insists on the need for remembrance, thereby invoking the persistence of the effects of these traumas. Montage sequences also create conflictual lines that serve to refute imposed authority as in the frenzy of feet dancing to an inner spiritual music from Orisha rituals.Rachel Moseley-Wood also suggests that music and dance are integral to the representation of place and the experiences of the region. Her essay examines and problematises the ways in which Jamaican cinema has shaped reception to cultural products. For her, the exploitation of ghetto-based culture both constructs an often-stereotyped idea and image of Jamaican reality and, paradoxically perhaps, provides for a critique of class-based systems within the city space. Her enquiry plunges her into cultural debates about the ways in which films such as Dancehall Queen (Rick Elgood and Don Letts, 1997) engage with the female body and ideas of 'slackness'. …

International audience; This paper presents a new approach of planar trajectory generation for automated in-hand dexterous manipulation of miniaturized objects. The proposed method aims at improving the efficiency of the previous method [17] to be able to perform real-time in-hand manipulation trajectories generation. The main idea behind this new method is the representation of the configuration space as a set of stable rotations instead ofstable grasps as it is usually done. The consequence of this representation is a more compact space that encapsulates more information. The developed algorithm that uses this approach is able to generate optimal trajectories to manipulate complex objects in less than 0.1 s, which represents a reduction in the processing time between 102 and 105 compared to the previous method.

International audience; BACKGROUND Donor availability and transplantation-related risks limit the broad use of allogeneic hematopoietic-cell transplantation in patients with transfusion-dependent beta-thalassemia. After previously establishing that lentiviral transfer of a marked beta-globin (beta(A-T87Q)) gene could substitute for long-term red-cell transfusions in a patient with beta-thalassemia, we wanted to evaluate the safety and efficacy of such gene therapy in patients with transfusion-dependent beta-thalassemia. METHODS In two phase 1-2 studies, we obtained mobilized autologous CD34+ cells from 22 patients (12 to 35 years of age) with transfusion-dependent beta-thalassemia and transduced the cells ex vivo with LentiGlobin BB305 vector, which encodes adult hemoglobin (HbA) with a T87Q amino acid substitution (HbA(T87Q)). The cells were then reinfused after the patients had undergone myeloablative busulfan conditioning. We subsequently monitored adverse events, vector integration, and levels of replication-competent lentivirus. Efficacy assessments included levels of total hemoglobin and HbA(T87Q), transfusion requirements, and average vector copy number. RESULTS At a median of 26 months (range, 15 to 42) after infusion of the gene-modified cells, all but 1 of the 13 patients who had a non-beta(0)/beta(0) genotype had stopped receiving red-cell transfusions; the levels of HbA(T87Q) ranged from 3.4 to 10.0 g per deciliter, and the levels of total hemoglobin ranged from 8.2 to 13.7 g per deciliter. Correction of biologic markers of dyserythropoiesis was achieved in evaluated patients with hemoglobin levels near normal ranges. In 9 patients with a beta(0)/beta(0) genotype or two copies of the IVS1-110 mutation, the median annualized transfusion volume was decreased by 73%, and red-cell transfusions were discontinued in 3 patients. Treatment-related adverse events were typical of those associated with autologous stem-cell transplantation. No clonal dominance related to vector integration was observed. CONCLUSIONS Gene therapy with autologous CD34+ cells transduced with the BB305 vector reduced or eliminated the need for long-term red-cell transfusions in 22 patients with severe beta-thalassemia without serious adverse events related to the drug product. (Funded by Bluebird Bio and others; HGB-204 and HGB-205 ClinicalTrials. gov numbers, NCT01745120 and NCT02151526.)

Background Osteosclerosis (OSC) is a rarely studied complication of sickle cell disease (SCD). The objective of our study was to determine the prevalence and characteristics of high bone mineral density (BMD) and its radiological features in adult SCD patients. Methods This prospective observational study was conducted from May 2007 to May 2016 in consecutive patients with steady-state SCD at two university hospitals. The BMD of the lumbar spine (L1-L4) and right femoral neck was determined by dual energy X-ray absorptiometry. Clinical, laboratory and radiographic data were recorded. High BMD was defined as a BMD Z-score of at least +2.5 standard deviations at the lumbar spine or hip. The characteristics of the patients with high BMD were compared to those of individuals with low or middle BMD, using multivariate ordinal logistic regression. Results 135 patients (86 women and 49 men) with a median age of 27 (IQR 23-33) years were included. High BMD was diagnosed in 20 (15%) patients with a median age of 33.5 (IQR 28-45) years. The SCD genotypes of these patients were SS in 11, SC in 5, S/beta+ in 3, and S/beta0 in 1. High BMD patients more frequently harbored the S/beta SCD genotype (21% vs 5% in non-high BMD patients; p = 0.047) and were older (p = 0.0007). Compared to patients with low or middle BMD, after adjustment for age and SCD genotype, high BMD patients had a higher prevalence of avascular necrosis history (p = 0.009), higher BMI (p = 0.007), and lower serum resorption marker CTX (p = 0.04), bilirubin (p = 0.02) and parathyroid hormone levels (p = 0.02). There were no differences between groups regarding fracture history, H-shaped vertebrae or other biological variables. Conclusion High-BMD values is a common manifestation in SCD patients, especially in those with the S/beta-thalassemia genotypes. The prevalence of high-BMD in SCD is associated with older age, suggesting that it will be more common in the future because the life span of patients with SCD is increasing thanks to significant progress in SCD treatment.

The risk and clinical significance of cardiac iron overload due to chronic transfusion varies with the underlying disease. Cardiac iron overload shortens the life expectancy of patients with thalassemia, whereas its effect is unclear in those with myelodysplastic syndromes (MDS). In patients with sickle cell anemia (SCA), iron does not seem to deposit quickly in the heart. Our primary objective was to assess through a multicentric study the prevalence of cardiac iron overload, defined as a cardiovascular magnetic resonance T2*8 ECs in the past year, and age older than 6 years. We included from 9 centers 20 patients with thalassemia, 41 with SCA, and 25 with MDS in 2012-2014. Erythrocytapharesis did not consistently prevent iron overload in patients with SCA. Cardiac iron overload was found in 3 (15%) patients with thalassemia, none with SCA, and 4 (16%) with MDS. The liver iron content (LIC) ranged from 10.4 to 15.2 mg/g dry weight, with no significant differences across groups (P = 0.29). Abnormal T2* was not significantly associated with any of the measures of transfusion or chelation. Ferritin levels showed a strong association with LIC. Non-transferrin-bound iron was high in the thalassemia and MDS groups but low in the SCA group (P

Sickle cell disease results from a homozygous missense mutation in the ß-globin gene that causes polymerization of hemoglobin S. Gene therapy for patients with this disorder is complicated by the complex cellular abnormalities and challenges in achieving effective, persistent inhibition of polymerization of hemoglobin S. We describe our first patient treated with lentiviral vector-mediated addition of an antisickling ß-globin gene into autologous hematopoietic stem cells. Adverse events were consistent with busulfan conditioning. Fifteen months after treatment, the level of therapeutic antisickling ß-globin remained high (approximately 50% of ß-like-globin chains) without recurrence of sickle crises and with correction of the biologic hallmarks of the disease. (Funded by Bluebird Bio and others; HGB-205 ClinicalTrials.gov number, NCT02151526 .).

Background LentiGlobin for SCD gene therapy contains autologous CD34+ hematopoietic stem cells (HSCs) transduced with the BB305 lentiviral vector (LVV) encoding β-globin with an anti-sickling substitution (T87Q). Its safety and efficacy are being studied in the ongoing multi-center Phase 1/2 HGB-206 trial (NCT02140554). Initial patients received LentiGlobin drug product (DP) using bone marrow-harvested (BMH) CD34+ HSCs transduced with the BB305 LVV under original manufacturing. All patients had successful engraftment but levels of gene therapy-derived hemoglobin (HbAT87Q) were lower than expected. Despite this, hemolysis markers and the annualized rate of vaso-occlusive crisis (VOCs) plus acute chest syndrome (ACS) were reduced post-infusion. Here, we provide an update on these patients and explore factors that may contribute to the clinical benefit. Data on patients treated more recently are presented separately. Methods Adults with SCD-related complications (previously described) were enrolled in HGB-206. All patients received myeloablative busulfan conditioning before DP infusion. The initial group (Group A; N=7) was treated with DP from BMH HSCs using the original LentiGlobin manufacturing process. The protocol was amended, and 2 patients were subsequently treated in Group B with DP from BMH HSCs. Patient 1 had DP made with original and refined manufacturing processes and patient 2 had DP made only with the refined process. Patients were followed for 2 years in HGB-206 and offered participation in the LTF-303 study for long-term follow-up. Adverse events (AEs), Hb fractions, and additional laboratory and clinical parameters were monitored. Results As of 7 March 2019, the median follow-up post-DP infusion was 35.8 (min-max: 29.8-44.5) months in Group A; it was 17.2 and 20.2 months for Group B patients 1 and 2. There was full hematological recovery with no graft failure. The safety profile of LentiGlobin post-DP infusion was consistent with myeloablative busulfan conditioning and underlying SCD. No cases of Grade ≥ 3 DP-related AEs, veno-occlusive liver disease, vector-mediated replication competent lentivirus or clonal dominance were observed. Three years after LentiGlobin gene therapy, one Group A patient developed myelodysplastic syndrome, reported as unlikely related to LentiGlobin. The patient subsequently received an HLA-haploidentical donor transplant. The annualized rate of VOCs plus ACS from LentiGlobin infusion to last follow-up was reduced by a median of 89 (min-max 10-100) % compared to that in the 2-year interval before enrollment in the 8 patients who had a history of VOC and/or ACS. One Group A patient who had a stroke pre-DP infusion has not had any red blood cell (RBC) transfusions through ~3 years post-DP infusion and no stroke recurrence. Median HbAT87Q levels were 1.0 (min-max 0.7-2.8) g/dL for Group A and 3.4 g/dL for Group B patient 1 at last visit and were stable for up to 3.5 years follow-up (Figure 1A). In several patients, HbF levels increased post-LentiGlobin treatment, peaking at ~2-6 months, and remaining higher at last visit compared to 1-month post-DP infusion. At last visit, the median HbF level was 0.6 (min-max 0.1-1.8) g/dL for all Group A and 0.8 g/dL for Group B patient 1 (Figures 1B and 2). In these patients, the median fraction of anti-sickling Hb (HbAT87Q + HbF + HbA2) was 22.9 (min-max 14.2-29.8) % and 39.4%, respectively. Patient 2 in Group B, who had DP made entirely using refined manufacturing process, had no HbF but produced high levels of HbAT87Q (7.5 g/dL) that contributed to 53.7% of total Hb. Summary In the HGB-206 Group A patients, the modest expression of gene therapy-derived HbAT87Q is accompanied by an induction of HbF. Elevated HbF levels have been shown to be associated with reduced severity of SCD. The resulting 14-30% of anti-sickling Hb observed in Group A patients, while not likely to be curative, showed clinical benefit as suggested by a reduction in the annualized rate of VOC plus ACS. Further, Group A and B patients have maintained HbAT87Q production, demonstrating the durability of gene therapy-derived β-globin gene expression. There have been no Grade ≥ 3 DP-related AEs in LentiGlobin-treated patients with up to 3.5 years of follow-up. Longer follow-up will help determine whether the initial induction of HbF, as is common after myeloablation, will be sustained and continue to contribute to therapeutic anti-sickling Hb levels. Disclosures Walters: Editas Medicine: Consultancy; TruCode: Consultancy; AllCells, Inc: Consultancy. Kwiatkowski:Apopharma: Research Funding; Imara: Consultancy; Celgene: Consultancy; bluebird bio, Inc.: Consultancy, Research Funding; Agios: Consultancy; Terumo: Research Funding; Novartis: Research Funding. Schmidt:German Cancer Research Center, Heidelberg, Germany: Employment; GeneWerk GmbH, Heidelberg, Gemrany: Equity Ownership. Miller:bluebird bio, Inc.: Employment, Equity Ownership. Pierciey:bluebird bio, Inc.: Employment, Equity Ownership. Huang:bluebird bio, Inc.: Employment, Equity Ownership. Ribeil:bluebird bio, Inc: Employment, Equity Ownership. Kanter:Rockpointe: Honoraria; GLG: Consultancy; Guidepoint Global: Consultancy; Novartis: Consultancy, Honoraria; Imara: Consultancy; Sangamo: Consultancy, Honoraria; Modus: Consultancy, Honoraria; Medscape: Honoraria; Peerview: Honoraria; bluebird bio, Inc.: Consultancy; SCDAA: Membership on an entity's Board of Directors or advisory committees; NHLBI: Membership on an entity's Board of Directors or advisory committees; Jeffries: Consultancy; Cowen: Consultancy. Thompson:bluebird bio, Inc.: Consultancy, Research Funding; Celgene: Consultancy, Research Funding; Novartis: Consultancy, Research Funding; Baxalta: Research Funding.

Background β-globin gene transfer into hematopoietic stem cells (HSCs) could reduce or eliminate sickle cell disease (SCD)-related manifestations. LentiGlobin for SCD gene therapy contains autologous CD34+ cells transduced with the BB305 lentiviral vector (LVV), encoding a human β-globin gene with the anti-sickling T87Q mutation (βA-T87Q). The safety and efficacy of LentiGlobin for SCD is being evaluated in the ongoing Phase 1/2 HGB-206 Study (NCT02140554). The initial 7 patients (Group A) were treated with LentiGlobin made from bone marrow harvested HSCs. The protocol was modified to improve HbAT87Q production by including pre-harvest red blood cell (RBC) transfusions, increasing the total busulfan exposure, and using a refined LentiGlobin manufacturing process (Group B, n=2). An additional modification was made for Group C patients where HSC collection by plerixafor mobilization followed by apheresis was instituted. Data from these Group C patients are discussed here. Results from patients in Groups A and B are reported separately. Methods Patients (≥ 18 years) with severe SCD (including those with recurrent vaso-occlusive crisis [VOC] and acute chest syndrome [ACS]) were screened for eligibility. Patients received 240 µg/kg of plerixafor 4-6 hours prior to HSC collection via apheresis. CD34+ cells were transduced with BB305 LVV. Patients underwent myeloablative busulfan conditioning and subsequent LentiGlobin drug product (DP) infusion. Patients were monitored for adverse events (AEs), engraftment, vector copy number (VCN), total hemoglobin (Hb) and HbAT87Q expression, hemolysis markers, and SCD clinical manifestations. Data are presented as median (min-max). Results: As of 7 March 2019, 19 Group C patients, aged 26 (18-36) years, had initiated mobilization/apheresis and 13 patients were treated with LentiGlobin for SCD gene therapy. Median DP VCN, % transduced cells, and CD34+ cell dose in the 13 treated patients were: 3.8 (2.8-5.6) copies/diploid genome (c/dg), 80 (71-88) %, and 4.5 (3.0-8.0) x 106 CD34+ cells/kg, respectively. The median follow-up was 9.0 (1.0-15.2) months. Twelve patients achieved neutrophil and platelet engraftments at a median of 19 (15-24) days and 28 (19-136) days, respectively. As of the data cut-off, engraftment was not yet evaluable in 1 patient at 1-month post-infusion. All patients stopped red blood cell (RBC) transfusions within about 3 months post-LentiGlobin gene therapy. Median total hemoglobin (Hb) and Hb fractions in patients at various time points are shown in Figure 1. Median HbS levels were at or below 50% in all patients with at least 6 months follow-up. The median total Hb at last visit in 8 patients with at least 6 months of follow-up, was 11.5 (10.2-15.0) g/dL, with a corresponding HbAT87Q median contribution of 5.3 (4.5-8.8) g/dL and a median HbS 5.7 (4.8-8.0) g/dL. Of these 8 patients, 6 had a history of VOCs or ACS. The median annualized VOC+ACS rate in these patients was 5.3 (3-14) pre-treatment and decreased to 0 (0-2) post-treatment. One Grade 2 VOC was observed 3.5 months post-treatment. No ACS or serious VOCs were observed in Group C patients' post- treatment. Lactate dehydrogenase, reticulocyte count, and total bilirubin at last visit post-LentiGlobin infusion were 225.0 (130.0-337.0) U/L, 150.0 (42.1-283.0) 109/L, 22.2 (3.42-39.3) µmol/L, respectively, trending towards normalization. The most common non-hematologic Grade ≥ 3 AEs were febrile neutropenia (n=10) and stomatitis (n=7) post-DP infusion. Serious AEs were reported in 6 patients post-LentiGlobin treatment, most common being nausea and vomiting. To date, there have been no DP-related AEs or graft failure, vector-mediated replication competent lentivirus detected, or clonal dominance reported. Longer follow-up and additional patient data will be presented. Summary The safety profile of LentiGlobin gene therapy for SCD remains consistent with single-agent busulfan conditioning and underlying disease. Patients in HGB-206 Group C experienced high-level, sustained expression of gene-therapy derived hemoglobin, with median HbS levels reduced to ~50% and median total Hb levels of 11.5 g/dL at 6 months. The cessation of clinical complications (no ACS or serious VOCs) and decreased hemolysis suggest a strong therapeutic effect after LentiGlobin gene therapy in patients with SCD. Disclosures Kanter: Peerview: Honoraria; NHLBI: Membership on an entity's Board of Directors or advisory committees; Rockpointe: Honoraria; SCDAA: Membership on an entity's Board of Directors or advisory committees; Novartis: Consultancy, Honoraria; Imara: Consultancy; Jeffries: Consultancy; Modus: Consultancy; Guidepoint Global: Consultancy; GLG: Consultancy; Cowen: Consultancy; bluebird bio, Inc: Consultancy; Medscape: Honoraria; Sangamo: Consultancy. Kwiatkowski:Terumo: Research Funding; Novartis: Research Funding; Apopharma: Research Funding; Imara: Consultancy; Celgene: Consultancy; bluebird bio, Inc.: Consultancy, Research Funding; Agios: Consultancy. Schmidt:German Cancer Research Center, Heidelberg, Germany: Employment; GeneWerk GmbH, Heidelberg, Gemrany: Equity Ownership. Miller:bluebird bio, Inc.: Employment, Equity Ownership. Pierciey:bluebird bio, Inc.: Employment, Equity Ownership. Huang:bluebird bio, Inc.: Employment, Equity Ownership. Ribeil:bluebird bio, Inc.: Employment, Equity Ownership. Thompson:Baxalta: Research Funding; Novartis: Consultancy, Research Funding; Celgene: Consultancy, Research Funding; bluebird bio, Inc.: Consultancy, Research Funding. Walters:AllCells, Inc: Consultancy; TruCode: Consultancy; Editas Medicine: Consultancy.

Background LentiGlobin gene therapy contains autologous CD34+ hematopoietic stem cells (HSCs) transduced with the BB305 lentiviral vector (LVV), encoding human β-globin with a T87Q substitution. This substitution confers anti-sickling properties to the gene therapy-derived hemoglobin (HbAT87Q) and allows for its quantification in transduced HSCs. The proof of concept for LentiGlobin gene therapy in patients with transfusion-dependent β-thalassemia (TDT) and sickle cell disease (SCD) was established in the recently completed HGB-205 study (NCT02151526). Herein, we provide the safety and efficacy outcomes and long-term follow-up data for all 7 treated patients, 4 with TDT and 3 with SCD. Methods Patients 5−35 years old with TDT (≥ 100 mL/kg of packed red blood cells [pRBCs]/year) or severe SCD (e.g., ≥ 2 acute chest syndromes [ACS] or ≥ 2 vaso-occlusive crises in the preceding year or the year before regular transfusions) were enrolled. CD34+ HSCs were obtained by mobilization and apheresis in patients with TDT or by bone marrow harvest in patients with SCD. Following collection, cells were transduced with the BB305 LVV. Patients underwent busulfan myeloablative conditioning and were infused with transduced cells. Patients were monitored for engraftment, adverse events (AEs), HbAT87Q levels, and other hematologic and clinical parameters. After 2 years in HGB-205, patients transitioned into the long-term follow-up study, LTF-303 (NCT02633943). Summary statistics are shown as median (min-max). Results As of June 2019, patients with TDT (n=4) and SCD (n=3) had a median follow-up of 49.6 (40.5-60.6) and 28.5 (25.5-52.5) months, respectively. Table 1 shows patient and drug product characteristics and several key efficacy outcomes. All patients achieved HSC engraftment. LentiGlobin safety profile was consistent with busulfan myeloablative conditioning and, in case of SCD, with the underlying disease state. The most common non-hematologic Grade ≥ 3 AEs post-LentiGlobin gene therapy (≥ 2 patients) for patients with TDT were stomatitis (n=4) and increased aspartate aminotransferase (n=2), and for patients with SCD were ACS (n=2) and vaso-occlusive pain (n=2). In all 4 patients with TDT, total Hb and HbAT87Q levels remained generally stable up to 5 years post-LentiGlobin infusion. Three of 4 patients achieved transfusion independence (TI; defined as weighted average Hb ≥ 9g/dL without pRBC transfusions for ≥ 12 months), for an ongoing duration of 56.3 (38.2-57.6) months. Weighted average total Hb during TI was 11.4 (10.5-13.0) g/dL. One patient has been off transfusions for 37.5 months and had total Hb of 7.7 g/dL, which was below the ≥ 9 g/dL requirement to meet the protocol definition of TI. At last visit, HbAT87Q levels in these 4 patients ranged from 6.2-11.2 g/dL, which contributed 73.8-86.8% of the total Hb. The first patient treated with LentiGlobin for SCD experienced one vaso-occlusive pain episode, which developed at 30 months after LentiGlobin gene therapy following a case of acute gastroenteritis with fever and dehydration. The second SCD patient had 2 serious AEs (SAEs) of ACS approximately 6 and 8 months after LentiGlobin gene therapy. The patient resumed chronic pRBC transfusions and hydroxyurea treatment and subsequently experienced 2 SAEs of vaso-occlusive pain; no additional SAEs of vaso-occlusive pain or ACS were reported during the last 16 months of follow-up after LentiGlobin infusion. The third SCD patient had no episodes of vaso-occlusive pain or ACS during 25.5 months of follow-up post-LentiGlobin gene therapy as of the data cut-off. Two patients with SCD who have been off chronic pRBC transfusions, showed improvement in hemolysis markers post-LentiGlobin treatment and stabilization of HbAT87Q expression at approximately 6 months post-LentiGlobin infusion. Total Hb levels for patients with SCD at last visit were 13.0 g/dL (patient 1), 9.4 g/dL (patient 2), and 9.8 g/dL (patient 3), with corresponding HbAT87Q contributions of 47.9%, 7.9%, and 25.8%, respectively. Summary With up to 5 years of follow-up, treatment with LentiGlobin gene therapy was well tolerated and resulted in improvement in hematologic parameters and disease-related symptoms. Further results from the completed study will be presented. Disclosures Hermine: Celgene: Research Funding; Novartis: Research Funding; AB science: Consultancy, Equity Ownership, Honoraria, Research Funding. Brousse:bluebird bio, Inc: Consultancy; AddMedica: Consultancy. El Nemer:Hemanext: Other: Other. Bartolucci:Novartis: Membership on an entity's Board of Directors or advisory committees; AddMedica: Honoraria, Membership on an entity's Board of Directors or advisory committees; Global Blood Therapeutics: Membership on an entity's Board of Directors or advisory committees; Agios: Membership on an entity's Board of Directors or advisory committees; Roche: Membership on an entity's Board of Directors or advisory committees; HEMANEXT: Membership on an entity's Board of Directors or advisory committees. Asmal:bluebird bio, Inc: Employment, Equity Ownership. Whitney:bluebird bio, Inc: Employment, Equity Ownership. Gayron:bluebird bio, Inc: Employment, Equity Ownership. Huang:bluebird bio, Inc.: Employment, Equity Ownership. de Montalembert:AddMedica: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; bluebird bio, Inc: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; Novartis: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees. Ribeil:bluebird bio, Inc: Employment, Equity Ownership. Cavazzana:SmartImmune: Other: Founder.