Adeno-associated virus (AAV) is a small, nonenveloped, single-stranded DNA virus not associated with any known human pathogenesis. As such, AAV is an attractive therapeutic gene transfer vector. AAV gene therapy has been used safely and effectively in clinical trials for multiple indications, such as hemophilia. An AAV drug for the treatment of lipoprotein lipase deficiency was the first AAV-based therapy licensed in Europe (Glybera); however, it has been withdrawn from the market. Other AAV gene therapies, such as those for spinal muscular atrophy, are more promising. Among them, Luxterna, an AAV gene therapy for a type of inherited retinal degeneration, was recently approved by the U.S. Food and Drug Administration.
The AAV capsid is composed of 60 monomers of viral proteins (VP) 1, 2, and 3 in a 1:1:10 ratio. The sequences of VP1 to VP3 overlap, with the sequence of VP3 being common to all sequences, with the VP2 N-terminus extending by approximately 66 amino acids relative to VP3 and the VP1 N-terminus extending by approximately 137 additional amino acids relative to VP2. The region unique to VP1 (VP1u) contains the phospholipase A2 domain, as well as a region responsible for interaction with GPR108, which has recently been identified as an essential host factor for multiple serotypes. The VP3 region forms the capsid surface and has many common features among AAVs. These include a pore at the 5-fold axis of symmetry, essential for DNA packaging during assembly and externalization of VP1/2 N-terminal domains during trafficking; depressions at the 2-fold axis and surrounding the 5-fold pore; and protrusions at the 3-fold axis, often used to engage cell attachment factors, including glycans and the AAV receptor (AAVR).
Systemic AAV (adeno-associated virus) gene therapy is a promising approach to treat inborn errors of metabolism, but questions remain about its efficacy and durability. Studies have shown that tolerogenic ImmTOR nanoparticles coated with rapamycin prevent the formation of neutralizing anti-capsid antibodies, allowing vector re-administration. Here, researchers further demonstrate that ImmTOR mixed with AAV vector also enhances hepatic transgene expression at the initial dose of AAV vector, independent of its effects on adaptive immunity. ImmTOR enhances AAV trafficking to the liver, resulting in increased hepatic vector copy number and transgene mRNA expression. Enhanced transgene expression is achieved by an AAV receptor (AAVR)-independent mechanism that cannot be replicated in vivo with free rapamycin or empty nanoparticles. The multi-pronged mechanism of ImmTOR action makes it an attractive candidate to achieve more efficient transgene expression at the first dose while suppressing the adaptive response to AAV, allowing for repeated dosing.
Expression of AAVR in Huh-7 cells was knocked down by treatment with small interfering RNA (siRNA) specific for AAVR (Figure 1A). Huh-7 cells expressing approximately 20% of normal AAVR (Figure 1A) had a 50% reduction in AAVAnc80-luciferase expression (Figure 1B). However, mixing AAVAnc80-luciferase with ImmTOR restored transduction of Huh-7 cells treated with AAVR siRNA and increased luciferase expression by 35% compared to untreated cells (Figure 1B). These results suggest that ImmTOR may promote AAV transduction of hepatocytes in a manner independent of AAVR. To test this possibility, the researchers performed in vivo studies with AAV4, an AAV serotype that does not use AAVR. While liver transduction with AAV4-GFP alone was inefficient, with very low genome copy numbers observed in recipient mouse hepatocytes and no fluorescence detected above background levels, administration of AAV4-GFP mixed with ImmTOR resulted in higher viral genome copy numbers and detectable GFP fluorescence in hepatocytes of recipient animals (Figure 1C).
Figure 1. ImmTOR restores AAV8-Luc transgene expression after DsiRNA knockdown of AAVR in vitro and enhances AAV4 transduction in vivo. (Ilyinskii P O, et al., 2021)
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