Hammoudi Nadjib, Ishikawa Kiyotake, Hajjar Roger J
Cardiovascular Research Center, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
Curr Opin Cardiol. 2015 May;30(3):228-34. doi: 10.1097/HCO.0000000000000159.
The use of adeno-associated virus (AAV) as an efficient, cardiotropic, and safe vector, coupled with the identification of key molecular targets, has placed gene-based therapies within reach of cardiovascular diseases. The purpose of this review is to provide a focused update on the current advances related to AAV-mediated gene therapy in cardiovascular diseases, and particularly in heart failure (HF), wherein gene therapy has recently made important progress.
Multiple successful preclinical studies suggest a potential utility of AAV gene therapy for arrhythmias and biological heart pacing, as well as RNA overexpression. Moreover, AAV-mediated overexpression of several molecular targets involved in HF has demonstrated promising results in clinically relevant large animal models. In humans, a safe and successful completion of a phase 2 clinical trial targeting the sarcoplasmic reticulum calcium ATPase pump with AAV has been reported. Serial studies are ongoing to further prove the efficacy of AAV-mediated sarcoplasmic reticulum calcium ATPase pump gene transfer in human HF.
Significant progress in clinical translation of AAV-mediated cardiac gene therapy has been achieved in recent years. This will prompt further clinical trials, and positive results could open a new era for cardiac gene therapy.
腺相关病毒(AAV)作为一种高效、具有心肌靶向性且安全的载体,再加上关键分子靶点的确定,使得基于基因的心血管疾病治疗成为可能。本综述的目的是重点介绍AAV介导的心血管疾病基因治疗,特别是心力衰竭(HF)方面的最新进展,基因治疗在这一领域最近取得了重要进展。
多项成功的临床前研究表明,AAV基因治疗在心律失常、生物心脏起搏以及RNA过表达方面具有潜在应用价值。此外,AAV介导的几种与HF相关分子靶点的过表达在临床相关的大型动物模型中已显示出有前景的结果。在人类中,已有报道称一项使用AAV靶向肌浆网钙ATP酶泵的2期临床试验安全且成功完成。正在进行系列研究以进一步证明AAV介导的肌浆网钙ATP酶泵基因转移在人类HF中的疗效。
近年来,AAV介导的心脏基因治疗在临床转化方面取得了重大进展。这将促使开展更多临床试验,而阳性结果可能会开启心脏基因治疗的新时代。