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Panel reports on gene therapy death
Patient's death in July trial likely not result of gene transfer therapy,
according to NIH Recombinant DNA panel


[Published 17th September 2007 06:05 PM GMT]

The cause of death of a patient in a July gene therapy trial was a massive
fungal infection, according to an initial autopsy report presented at the
NIH Recombinant DNA Advisory Committee meeting today (September 17).
Preliminary evidence suggests that adeno-associated virus (AAV), the vector
which delivered the therpay, was not to blame, experts said.

The subject, Jolee Mohr, 36, died from widespread histoplasmosis accompanied
by a hematoma that ruptured her organs, according John Hart, a pathologist
at the University of Chicago who presented the autopsy results. At the time
of her death, she had disseminated histoplasmosis in several organs of her
body.

Although it is highly unlikely that AAV was responsible for the infection,
further tests looking for presence of the expressed protein are needed to
conclusively rule out the possibility, according to speakers at the panel.

"It seems that systemic histoplasmosis was a major contributing event that
led to a lot of things that went downhill," Mark Kay, at the Stanford
University School of Medicine, told The Scientist. "I don't know how people
will spin it, but sounds to me like this was bad result of a medical therapy
that probably was unrelated to gene therapy."

Mohr was part of Targeted Genetics' phase I/II clinical trial of tgAAC94, an
adeno-associated virus (AAV) vector to treat inflammatory arthritis by
inhibiting tumor necrosis factor at joints. Beginning July 2, she reported a
fever, nausea and vomiting and was admitted to the hospital seven days
later. She was transferred to the University of Chicago Medical Center
several days later. A CAT scan revealed a massive retroperitoneal hemorrhage
which eventually punctured the lungs and displaced the organs in the
abdominal cavity. The FDA halted the trial once the adverse effect had been
reported by the clinical trial group. Mohr died on July 24.

Since the death of Jesse Gelsinger, a patient in a gene therapy trial in
1999, the field has been dogged by setbacks.

Carol Kauffman, from the University of Michigan, a speaker on the panel,
said that in addition to histoplasmosis, the autopsy also revealed severe
sepsis and other symptoms often seen in AIDS patients.

There have been 40 known cases of histoplasmosis in patients undergoing
anti-tumor necrosis factor therapy.

Andrea Gawrylewski
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Rayilyn Brown
Board Member AZNPF
Arizona Chapter National Parkinson's Foundation
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