Adstiladrin
nadofaragene firadenovec · IFN-alpha2b (adenovirus, intravesical)Not conducted for rAd-IFN; conducted for excipient Syn3 only (Ames and chromosome aberration, negative)
Genglycos: genotox, carcinogenicity and repro: done or skipped?
pariglasgene brecaparvovec · G6PC (AAV8)
Genotoxicity
Not conducted (low AAV integration risk); vector integration assessed in germline transmission study
“studies were not conducted to evaluate genotoxicity as they expect that the risk of DTX401 insertion is low.”
Carcinogenicity
Not conducted (AAV8 predominantly episomal; no link between AAV integration and hepatic tumors)
“studies were not conducted to evaluate carcinogenicity/tumorigenicity”
Instead of carcinogenicity
Vector integration assessed in Study 13; AAV8 vectors predominantly non-integrating and episomal
“Potential vector integration was assessed in Study #13. Carcinogenicity/Tumorigenicity Studies: Per the Applicant, studies were not conducted to evaluate carcinogenicity/tumorigenicity for the following reasons: • AAV8 vectors are predominantly non-integrating and persist as episomes with low likelihoods of genomic integration.”
Instead of genotoxicity
Not stated in public reviews
Not reported in the public reviews. Reviewers summarise selectively, so this usually means it wasn't discussed publicly, not that it wasn't studied.
DRG histopathology
Minimal neuronal degeneration in cervical or thoracic DRG in male mice at 6.5x10¹³ gc/kg on Day 29
“Minimal neuronal degeneration in the cervical or thoracic dorsal root ganglia (DRG) was observed in male mice administered 6.5 × 1013 gc/kg of DTX401 on Day 29.”
Reproductive & developmental
Embryo-fetal development and germline transmission studies in mice; NOAEL 7.0x10^13 gc/kg; no germline integration
“IV administration of DTX401 at 7 × 1013 gc/kg to pregnant dams at presumed gestational day (GD) 6 resulted in DTX401 DNA detection in placenta but not offspring livers”
Safety pharmacology
Incorporated into 6-month monkey study (respiratory, cardiovascular, neurological); no in vitro studies
“Relevant safety pharmacology endpoints (respiratory, cardiological, and neurological endpoints) were evaluated in Study #11”
Genotox: Ames
Not conducted (low expected risk of vector insertion)
“Per the applicant, studies were not conducted to evaluate genotoxicity as they expect that the risk of DTX401 insertion is low.”
Genotox: in vitro mammalian
Not conducted (low expected risk of vector insertion)
“Per the applicant, studies were not conducted to evaluate genotoxicity as they expect that the risk of DTX401 insertion is low.”
Genotox: in vivo
Not conducted (low expected risk of vector insertion)
“Per the applicant, studies were not conducted to evaluate genotoxicity as they expect that the risk of DTX401 insertion is low.”
Carcinogenicity model
Not conducted; AAV8 vectors predominantly non-integrating and episomal
“AAV8 vectors are predominantly non-integrating and persist as episomes with low likelihoods of genomic integration.”
Carcinogenicity timing
Not conducted: AAV8 vectors predominantly non-integrating and episomal
“Per the Applicant, studies were not conducted to evaluate carcinogenicity/tumorigenicity for the following reasons: • AAV8 vectors are predominantly non-integrating and persist as episomes with low likelihoods of genomic integration.”
hERG / QT
No in vitro safety pharmacology (hERG) studies performed
“No in vitro safety pharmacology studies were performed with DTX401.”
Same question, other gene therapies
Beqvez
fidanacogene elaparvovec · Factor IXNot conducted (classical); vector integration site analysis in dog and NHP liver instead
Casgevy
exagamglogene autotemcel · BCL11A enhancer (CRISPR-Cas9, ex vivo HSC)No conventional studies; specialized on-/off-target editing (GUIDE-seq, in silico, hybrid capture) and chromosomal aberration assessments
Elevidys
delandistrogene moxeparvovec · Micro-dystrophinNot conducted (low-frequency random AAV integration per literature)
Fayuvi
rebisufligene etisparvovec · SGSH (AAV9)Not conducted; weight-of-evidence risk assessment used
Glybera
alipogene tiparvovec · LPL (AAV1)Not conducted (standard tests not relevant); integration studies (LAM-PCR, nrLAM-PCR) instead
Hemgenix
etranacogene dezaparvovec · Factor IXNot conducted as standard battery; integration site analysis (LAM-PCR) in mouse and NHP liver showed low random integration
Imlygic
talimogene laherparepvec · GM-CSF (oncolytic HSV-1)Not conducted (ICH S6(R1))
Itvisma
onasemnogene abeparvovec (intrathecal) · SMN1 (AAV9, intrathecal)Not conducted (single administration, known product characteristics, class safety profile)
Kebilidi
eladocagene exuparvovec · AADCNot conducted (agreed with CHMP; low integration risk in post-mitotic neurons)
Kresladi
marnetegragene autotemcel · ITGB2 (LVV, ex vivo HSC)Integration site analyses only (mouse and human transduced cells); no standard genotoxicity battery
Lenmeldy
atidarsagene autotemcel · ARSA (LVV, ex vivo HSC)Conducted: integration site analysis, in vitro immortalization assay, tumor-prone Cdkn2a-/- mouse; no insertional transformation
Luxturna
voretigene neparvovec · RPE65Not conducted (AAV low integration frequency; limited systemic exposure)
Lyfgenia
lovotibeglogene autotemcel · HBB T87Q (LVV, ex vivo HSC)Insertional mutagenesis assessed: in vitro immortalization (IVIM) assay and integration site analyses; low risk
Otarmeni
lunsotogene parvec · OTOF (AAV, intracochlear)Not conducted (low AAV insertional mutagenesis risk; limited distribution beyond inner ear)
Papzimeos
zopapogene imadenovec · HPV6/11 antigens (gorilla adenovirus)Not conducted (non-integrating, replication-incompetent adenovector; no insertional mutagenesis)
Roctavian
valoctocogene roxaparvovec · Factor VIIINot conducted (literature on AAV); NHP liver integration site analysis: 1.55x10^-3 IS/cell, no clonal expansion
Skysona
elivaldogene autotemcel · ABCD1 (LVV, ex vivo HSC)Standard genotox not relevant; insertional mutagenesis assessed by in vitro immortalization assay and integration site analysis
Strimvelis
autologous CD34+ cells transduced with ADA (no INN) · ADA (gamma-retroviral, ex vivo HSC)Not conducted (conventional assays cannot detect insertional events)
Tudriqev
vusolimogene oderparepvec · GALV-GP + GM-CSF (oncolytic HSV-1)Not conducted (not warranted based on product characteristics and safety profile)
Vyjuvek
beremagene geperpavec · COL7A1 (HSV-1, topical)Not conducted (HSV-1 does not integrate; negligible insertional mutagenesis)
Waskyra
etuvetidigene autotemcel · WAS (LVV, ex vivo HSC)Conventional mutagenicity not conducted; IVIM assay, vector insertion site analysis and VITA performed, no genotoxic potential
Zevaskyn
prademagene zamikeracel · COL7A1 (RV-modified keratinocyte sheets)Not conducted (integration site analysis in transduced RDEB keratinocytes instead; no clonality or oncogene preference)
Zolgensma
onasemnogene abeparvovec · SMN1Not conducted (low random rAAV integration per literature)
Zynteglo
betibeglogene autotemcel · HBB T87Q (LVV, ex vivo HSC)Insertional mutagenesis assessed instead of standard genotox: in vitro immortalization assay (low potential) and integration site analysis (no clonal dominance)