Safeguards for Using Viral Vector Systems in Human Gene Therapy: A Resource for Biosafety Professionals Mitigating Risks in Health Care Settings

Abstract

Introduction: Health care workers who work daily with human body fluids and hazardous drugs are among those at the highest risk of occupational exposure to these agents. The Occupational Safety and Health Administration’s (OSHA) Bloodborne Pathogens Standard (29 CFR 1910.1030) prescribes safeguards to protect workers against health hazards related to bloodborne pathogens. Similarly, the United States Pharmacopeia General Chapter 800 (USP <800>), a standard first published in February 2016 and implementation required by December 2019, addresses the occupational exposure risks of health care workers at organizations working with hazardous drugs. With emerging technologies in the field of gene therapy, these occupational exposure risks to health care workers now extend beyond those associated with bloodborne pathogens and hazardous drugs and now include recombinant DNA. The fifth edition of the Biosafety in Microbiological and Biomedical Laboratories ( BMBL) and the National Institutes of Health Guidelines for Research Involving Recombinant or Synthetic Nucleic Acid Molecules (NIH Guidelines) mostly govern work with biohazardous agents and recombinant DNA in a laboratory research setting. When gene therapy products are utilized in a hospital environment, health care workers have very few resources to identify and reduce the risks associated with product use during and after the administration of treatments. Methods: At the Abigail Wexner Research Institute at Nationwide Children’s Hospital, a comprehensive gap analysis was executed between the research and health care environment to develop a program for risk mitigation. The BMBL, NIH Guidelines, World Health Organization Biosafety Manual, OSHA Bloodborne Pathogens Standard, and USP <800> were used to develop a framework for the gap analysis process. Results: The standards and guidelines for working with viral vector systems in a research laboratory environment were adapted to develop a program that will mitigate the risks to health care workers involved in the preparation, transportation, and administration of gene therapies as well as subsequent patient care activities. The gap analysis identified significant differences in technical language used in daily operations, work environment, training and education, disinfection practices, and policy development between research and health care settings. These differences informed decisions and helped the organization develop a collaborative framework for risk mitigation when a gene therapy product enters the health care setting. Discussion: With continuing advances in the field of gene therapy, the oversight structure needs to evolve for the health care setting. To deliver the best outcomes to the patients of these therapies, researchers, Institutional Biosafety Committees, and health care workers need to collaborate on training programs to safeguard the public trust in the use of this technology both in clinical trials and as FDA-approved therapeutics.

An Overview: Genetic Tumor Markers for Early Detection and Current Gene Therapy Strategies

“…[140][141][142][143] Biosafety specialists play an important role in defining and meeting the need for an effective containment framework, mitigation plan, well-managed gene therapy protocol, biosafety strategies, and appropriate procedures in handling gene therapy products for health care personnel. 144 Another important obstacle in the way of successful cancer gene therapy implementation is the hurdle in the utilization of genetic markers in clinical practice. The large and expanding literature on cancer biomarkers asserts that these biomarkers can serve many clinical needs from risk stratification to prognosis, diagnosis, screening, monitoring, drug toxicity assessment, and prediction of therapeutic response, even many markers display promising results in the laboratory but they are not translated from the academic research laboratory in routine clinical care.…”

Gene-Based Therapy: A New Approach to Feline Induced Sterilization?

“…In general, there are some safety concerns about viral usage, i.e., the ability of the viral genome to be incorporated into the receiver species [65] and the possibility that viral shedding occurs in bodily fluids [66] and poses a public health risk. Using nonpathogenic viral vectors with stable genomes or the engineering of nonviral carriers allows for circumventing this issue and mitigating potential safety risks.…”

“…Using nonpathogenic viral vectors with stable genomes or the engineering of nonviral carriers allows for circumventing this issue and mitigating potential safety risks. Nonetheless, further studies are needed to ensure safety during clinical trials and therapy applications [66,67]. Another safety concern relates to the interaction with the receiver organism, both by the accidental activation or inhibition of endogenous gene expression (e.g., driving oncogene expression [44]), the non-specific uptake by non-targeted organs, which could originate unwanted side effects or loss of efficacy [67], or the ability to induce unwanted inflammatory and immune reactions [44].…”

A Changing World in Gene Therapy Research: Exciting Opportunities for Medical Advancement and Biosafety Challenges

“…More detailed methodology for mitigating risks in the clinical setting are discussed elsewhere. [34][35][36] Multiple Revolutions Taking Place Simultaneously Unprecedented levels of success are simultaneously taking place in different disease indications. The major developments are summarized as follows.…”