Center for Gene Therapy, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA.
Department of Biomedical Engineering, University of Michigan School of Medicine, Ann Arbor, Michigan, USA.
Mol Ther Nucleic Acids. 2014 Apr 29;3(4):e160. doi: 10.1038/mtna.2014.13.
Recent progress suggests gene therapy may one day be an option for treating some forms of limb girdle muscular dystrophy (LGMD). Nevertheless, approaches targeting LGMD have so far focused on gene replacement strategies for recessive forms of the disease. In contrast, no attempts have been made to develop molecular therapies for any of the eight dominantly inherited forms of LGMD. Importantly, the emergence of RNA interference (RNAi) therapeutics in the last decade provided new tools to combat dominantly inherited LGMDs with molecular therapy. In this study, we describe the first RNAi-based, preclinical gene therapy approach for silencing a gene associated with dominant LGMD. To do this, we developed adeno-associated viral vectors (AAV6) carrying designed therapeutic microRNAs targeting mutant myotilin (MYOT), which is the underlying cause of LGMD type 1A (LGMD1A). Our best MYOT-targeted microRNA vector (called miMYOT) significantly reduced mutant myotilin mRNA and soluble protein expression in muscles of LGMD1A mice (the TgT57I model) both 3 and 9 months after delivery, demonstrating short- and long-term silencing effects. This MYOT gene silencing subsequently decreased deposition of MYOT-seeded intramuscular protein aggregates, which is the hallmark feature of LGMD1A. Histological improvements were accompanied by significant functional correction, as miMYOT-treated animals showed increased muscle weight and improved specific force in the gastrocnemius, which is one of the most severely affected muscles in TgT57I mice and patients with dominant myotilin mutations. These promising results in a preclinical model of LGMD1A support the further development of RNAi-based molecular therapy as a prospective treatment for LGMD1A. Furthermore, this study sets a foundation that may be refined and adapted to treat other dominant LGMD and related disorders.
最近的进展表明,基因疗法有朝一日可能成为治疗某些类型的肢带型肌营养不良症(LGMD)的一种选择。然而,针对 LGMD 的方法迄今为止一直专注于针对该疾病隐性形式的基因替代策略。相比之下,尚未尝试开发针对任何八种显性遗传形式的 LGMD 的分子疗法。重要的是,在过去十年中,RNA 干扰(RNAi)疗法的出现为用分子疗法治疗显性遗传的 LGMD 提供了新的工具。在这项研究中,我们描述了用于沉默与显性 LGMD 相关基因的第一个基于 RNAi 的临床前基因治疗方法。为此,我们开发了携带针对突变肌联蛋白(MYOT)的设计治疗性 microRNA 的腺相关病毒载体(AAV6),突变肌联蛋白是 LGMD 1A(LGMD1A)的根本原因。我们最好的针对 MYOT 的 microRNA 载体(称为 miMYOT)在递送后 3 个月和 9 个月时,可显著降低 LGMD1A 小鼠(TgT57I 模型)肌肉中的突变肌联蛋白 mRNA 和可溶性蛋白表达,证明了短期和长期的沉默效果。这种 MYOT 基因沉默随后减少了 MYOT 引发的肌内蛋白聚集体的沉积,这是 LGMD1A 的标志特征。组织学改善伴随着显著的功能纠正,因为 miMYOT 处理的动物表现出腓肠肌重量增加和比目鱼肌特定力的提高,这是 TgT57I 小鼠和显性肌联蛋白突变患者中受影响最严重的肌肉之一。这些在 LGMD1A 临床前模型中的有希望的结果支持进一步开发基于 RNAi 的分子疗法作为 LGMD1A 的一种有前途的治疗方法。此外,这项研究为进一步开发针对其他显性 LGMD 和相关疾病的治疗方法奠定了基础。