AAV is a non-enveloped Dependoparvovirus belonging to the Parvoviridae family, whose capsid contains 60 subunits of three different proteins (VP1, VP2, and VP3) that share a common C-terminus and are produced by alternative translation of the AAV cap gene. The AAV cap is the major determinant of native AAV cell/tissue tropism and is therefore a key modifiable genetic element for optimizing transduction efficiency. Each capsid subunit has nine variable regions, i.e., peptide loops protruding from the virion surface, that play a role in capsid assembly, genome packaging, cell receptor interactions, and antigenic determinants of anti-capsid cellular and humoral immune responses. Currently, more than 100 different AAV serotypes have been isolated from humans, non-human primates (NHPs), and other species, which display a wide range of tissue and cell tropisms, primarily determined by the primary attachment receptor and co-receptor specificity of each serotype. These different naturally occurring serotypes have been extensively screened for their ability to transduce a variety of target cell types and organs.
One promising application of AAV-based therapeutics is the delivery of gene-editing enzymes to correct defective genes. In preclinical studies, several research groups have reported the effective use of AAV-delivered CRISPR/Cas9 technology to edit genes in animal models to treat diseases such as Duchenne muscular dystrophy, hypercholesterolemia, and urea cycle disorders. Similarly, the use of gene-editing technologies to inactivate and eliminate viral reservoirs that cause persistent/chronic infections has also recently attracted much attention. In fact, recent reports of the elimination of viral genomes using meganucleases and CRISPR/Cas9 in animal models of chronic infection with HSV and HIV, respectively, support the use of AAV vectors to treat chronic viral infections. AAV-mediated delivery of antiviral therapies is not limited to gene-editing enzymes. For example, several research groups have used AAV vectors to deliver other antiviral therapies such as RNA interference molecules and virus-neutralizing antibodies.
Hemophilia is an incurable genetic disease. Although innovative treatments such as gene therapy or bispecific antibody therapies have been introduced, there remains a large unmet need in terms of achieving long-term therapeutic effects and treatment options for patients with inhibitors. Antithrombin (AT) is an endogenous negative regulator of thrombin generation and a potent genome editing target for the sustainable treatment of patients with hemophilia A and B. In this study, researchers developed and optimized lipid nanoparticles (LNPs) to deliver Cas9 mRNA as well as a single guide RNA targeting AT in mouse liver. LNP-mediated CRISPR-Cas9 delivery resulted in inhibition of AT, thereby improving thrombin generation. Both hemophilia A and B mice restored the bleeding-related phenotype. No active off-target, liver-induced toxicity, and significant anti-Cas9 immune response were detected, indicating that LNP-mediated CRISPR-Cas9 delivery is a safe and effective treatment for hemophilia.
A substantial safety concern of LNP-CRISPR is immune response or inflammation. Plasma was analyzed for aspartate aminotransferase (AST) and alanine transferase (ALT), and there were few differences between the groups. Therefore, LNP-CRISPR-mAT administration did not cause liver damage. In addition, the researchers used serum from LNP-injected mice to study systemic anti-Cas9 antibody responses by enzyme-linked immunosorbent assay (ELISA). Repeated LNP-CRISPR-mAT injections did not induce anti-Cas9 immunoglobulin G (IgG) compared to LNP empty treatment (Figure 1). However, when mice were injected intravenously with AAV9-EFS-SpCas9, systemic elevated anti-Cas9 IgG was detected after 6 weeks of treatment (Figure 1). This suggests that repeated LNP-CRISPR injections are a relatively less immunogenic method than continuous AAV-mediated Cas9 expression.
Figure 1. Serum anti-SpCas9 IgG concentrations after repeated injections of LNP-CRISPR-mAT. Mice injected intravenously with AAV9-EFS-SpCas9 (5X1013 vg/kg) were also tested 6 weeks after treatment. (Han J P, et al., 2022)
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