Liver-directed gene therapy corrects cardiovascular lesions in feline mucopolysaccharidosis type I.

Abstract

Patients with mucopolysaccharidosis type I (MPS I), a genetic deficiency of the lysosomal enzyme α-l-iduronidase (IDUA), exhibit accumulation of glycosaminoglycans in tissues, with resulting diverse clinical manifestations including neurological, ocular, skeletal, and cardiac disease. MPS I is currently treated with hematopoietic stem cell transplantation or weekly enzyme infusions, but these therapies have significant drawbacks for patient safety and quality of life and do not effectively address some of the most critical clinical sequelae, such as life-threatening cardiac valve involvement. Using the naturally occurring feline model of MPS I, we tested liver-directed gene therapy as a means of achieving long-term systemic IDUA reconstitution. We treated four MPS I cats at 3-5 mo of age with an adeno-associated virus serotype 8 vector expressing feline IDUA from a liver-specific promoter. We observed sustained serum enzyme activity for 6 mo at ∼ 30% of normal levels in one animal, and in excess of normal levels in three animals. Remarkably, treated animals not only demonstrated reductions in glycosaminoglycan storage in most tissues, but most also exhibited complete resolution of aortic valve lesions, an effect that has not been previously observed in this animal model or in MPS I patients treated with current therapies. These data point to clinically meaningful benefits of the robust enzyme expression achieved with hepatic gene transfer that extend beyond the economic and quality of life advantages over lifelong enzyme infusions.

• Authors: Christian Hinderer, Peter Bell, Brittney L Gurda, Qiang Wang, Jean-Pierre Louboutin, Yanqing Zhu, Jessica Bagel, Patricia O'Donnell, Tracey Sikora, Therese Ruane, Ping Wang, Mark E Haskins, James M Wilson
• Journal: Proceedings of the National Academy of Sciences of the United States of America (Proc Natl Acad Sci U S A) Vol. 111 Issue 41 Pg. 14894-9 (Oct 14 2014) ISSN: 1091-6490 [Electronic] United States
• PMID: 25267637 (Publication Type: Journal Article, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)

Chemical References

• Glycosaminoglycans
• Heparin Cofactor II
• Iduronidase
• Thrombin

Topics

• Animals
• Aortic Valve (metabolism, pathology)
• Cardiovascular Diseases (pathology, therapy)
• Cats
• Dependovirus (genetics)
• Female
• Genetic Therapy
• Genetic Vectors (metabolism)
• Glycosaminoglycans (metabolism)
• Heparin Cofactor II (metabolism)
• Iduronidase (blood, genetics, therapeutic use)
• Liver (metabolism, pathology)
• Male
• Molecular Sequence Data
• Mucopolysaccharidosis I (blood, pathology, therapy)
• Myocardium (metabolism, pathology)
• Thrombin (metabolism)
• Tissue Distribution
• Transduction, Genetic