Jiang Haiyan, Lillicrap David, Patarroyo-White Susannah, Liu Tongyao, Qian Xiaobing, Scallan Ciaran D, Powell Sandra, Keller Tracey, McMurray Morag, Labelle Andrea, Nagy Dea, Vargas Joseph A, Zhou Shangzhen, Couto Linda B, Pierce Glenn F
Avigen, Almeda, CA, USA.
Blood. 2006 Jul 1;108(1):107-15. doi: 10.1182/blood-2005-12-5115. Epub 2006 Mar 7.
Hemophilia A, a deficiency of functional coagulation factor VIII (FVIII), is treated via protein replacement therapy. Restoring 1% to 5% of normal blood FVIII activity prevents spontaneous bleeding, making the disease an attractive gene therapy target. Previously, we have demonstrated short-term activity of a liver-specific AAV2 vector expressing canine B-domain-deleted FVIII (cFVIII) in a hemophilia canine model. Here, we report the long-term efficacy and safety of AAV-cFVIII vectors of serotypes 2, 5, 6, and 8 in both hemophilia A mice and dogs. AAV6-cFVIII and AAV8-cFVIII restored physiologic levels of plasma FVIII activity in hemophilia A mice. The improved efficacy is attributed to more efficient gene transfer in liver compared with AAV2 and AAV5. However, supraphysiologic cFVIII levels correlated with the formation of cFVIII-neutralizing antibodies in these mice. Of importance, hemophilia A dogs that received AAV2-cFVIII, AAV6-cFVIII, and AAV8-cFVIII have persistently expressed therapeutic levels of FVIII, without antibody formation or other toxicities, for more than 3 years. However, liver transduction efficiencies are similar between AAV2, AAV6, and AAV8 serotypes in hemophilia A dogs, in contrast to mice. In summary, this is the first report demonstrating multiyear therapeutic efficacy and safety of multiple AAV-cFVIII vectors in hemophilia A dogs and provides the basis for human clinical studies.
甲型血友病是一种功能性凝血因子VIII(FVIII)缺乏症,通过蛋白质替代疗法进行治疗。恢复至正常血液FVIII活性的1%至5%可预防自发性出血,这使得该疾病成为有吸引力的基因治疗靶点。此前,我们已在血友病犬模型中证明了表达犬B区缺失FVIII(cFVIII)的肝脏特异性AAV2载体的短期活性。在此,我们报告了2型、5型、6型和8型AAV-cFVIII载体在甲型血友病小鼠和犬中的长期疗效和安全性。AAV6-cFVIII和AAV8-cFVIII恢复了甲型血友病小鼠血浆FVIII活性的生理水平。疗效的提高归因于与AAV2和AAV5相比,在肝脏中有更有效的基因转移。然而,在这些小鼠中,超生理水平的cFVIII与cFVIII中和抗体的形成相关。重要的是,接受AAV2-cFVIII、AAV6-cFVIII和AAV8-cFVIII的甲型血友病犬持续表达治疗水平的FVIII,超过3年未形成抗体或出现其他毒性。然而,与小鼠不同,在甲型血友病犬中,AAV2、AAV6和AAV8血清型之间的肝脏转导效率相似。总之,这是第一份证明多种AAV-cFVIII载体在甲型血友病犬中具有多年治疗疗效和安全性的报告,并为人体临床研究提供了依据。