AAV is a small, non-enveloped DNA virus belonging to the Parvoviridae family, first isolated in 1965 as a contaminant in a monkey adenovirus (Ad) preparation. These viruses were found to be unable to efficiently infect cells without a helper virus (usually adenovirus or any type of herpes virus), leading to their name "adeno-associated virus" and classification into the genus Dependovirus. Due to their co-dependency, AAVs were long considered defective viruses, but subsequent studies overturned this theory, showing that they initiate latent infection in host cells and convert to productive infection under stress. Despite the high seroprevalence of AAVs in humans, they have not been associated with any disease in humans or other species. Different AAVs have been detected not only in primate isolates, but also in avian, goat, bovine, and equine populations.
AAV5 was first isolated from male genital lesions in 1983, becoming the only AAV serotype directly isolated from human tissue. This serotype is considered to be the most genetically divergent of all AAVs, with several unique properties, such as the size and function of its ITR region, the use of herpes simplex virus (HSV) as a helper virus to infect humans, and the use of an atypical endocytic pathway as a viral entry route. Another notable feature of AAV5 is its ability to transduce cells that cannot be transduced by AAV2, which is a unique advantage for gene therapy applications. In addition, AAV5 has been found to use sialic acid as its primary receptor, with platelet-derived growth factor receptor (PDGFR) α and β as co-receptors.
Gene therapy has the potential to treat rheumatic diseases; however, macrophages in joints may impede adeno-associated viral vector-mediated gene delivery. Here researchers demonstrate that in arthritic, but also in healthy, mice administration of agents that influence macrophage activity/number and/or addition of empty decoy capsids substantially improve the efficacy of recombinant adeno-associated viral vector 5 transgene expression in the joint. Pretreatment with triamcinolone acetonide or clodronate liposomes improved luciferase expression within 4 weeks. Similar results were seen when empty bait capsids were added to capsid-containing whole genomes at a 5:1 ratio. In a study that evaluated the duration of expression and examined a combination of the two approaches, researchers observed a synergistic enhancement of gene expression that lasted for at least 12 weeks. Enhanced gene expression was independent of the route of administration of triamcinolone acetonide (intra-articular or intramuscular). In healthy mice, the results showed that the combination significantly improved transgene expression independent of serotype.
All previous experiments were performed in a CIA model in which animals develop severe inflammation in their joints when the vector is administered. Since even healthy synovium contains a significant proportion of macrophages, the researchers next decided to investigate whether empty decoy capsids could enhance gene expression in healthy joints. When empty capsids were added to genome containing particles at 2 different ratios (5:1, 20:1), there was a dose-dependent increase in gene expression (Figure 1). In animals injected with a 5:1 ratio of empty to full capsids, there was an average increase of 4.8-fold, while when a 20:1 ratio of empty to full capsids was used, there was a 20-fold increase.
Figure 1. Addition of empty capsids in 2 different ratios (5:1 and 20:1 empty to full) improves intra-articular rAAV5-luciferase expression in healthy mice. Healthy mice (n=7 mice per group, one joint injected per animal) were injected i.a. with 1.65e10 vg/joint rAAV5-CMV-FLUC. In 2 groups empty capsids were added in different ratios. Luciferase expression was measured weekly until mice were sacrificed after 4 weeks. (Aalbers C J, et al., 2017)
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