Kruzik Anita, Koppensteiner Herwig, Fetahagic Damir, Hartlieb Bettina, Dorn Sebastian, Romeder-Finger Stefan, Coulibaly Sogue, Weber Alfred, Hoellriegl Werner, Horling Frank M, Scheiflinger Friedrich, Reipert Birgit M, de la Rosa Maurus
Baxalta Innovations GmbH, a member of the Takeda group of companies, Vienna, Austria.
Hum Gene Ther Methods. 2019 Apr;30(2):35-43. doi: 10.1089/hgtb.2018.263. Epub 2019 Mar 29.
Patients with preexisting anti-adeno-associated virus serotype 8 (AAV8) neutralizing antibodies (NAbs) are currently excluded from AAV8 gene therapy trials. Therefore, the assessment of biologically relevant AAV8-NAb titers is critical for product development in gene therapy. However, standardized assays have not been routinely used to determine anti-AAV8-NAb titers, contributing to a wide range of reported anti-AAV8 prevalence rates. Using a clinical NAb assay in a separate study, a higher than expected anti-AAV8-NAb prevalence of about 50% was found in international cohorts. This comparative study has a translational character, confirming the biological relevance of anti-AAV8-antibody titers measured by this assay. The significance of low-titer anti-AAV8 NAbs is shown, along with the relevance of the assay cutoff (1:5) compared with other assays. Importantly, internally standardized reagents and purified AAV8 constructs containing 90% full capsids were used to reduce the effect of empty capsids. It was found that even very low anti-AAV8-NAb titers (<1:5) could efficiently hinder transduction , demonstrating the importance of sensitive NAb assays for clinical applications. The NAb assay was found to be more sensitive than an NAb assay and thus more suitable for patient screening. Additionally, the study showed that anti-AAV8-NAb titers <1:5 were very rare, further supporting the assay. However, assays using a lower cutoff may still be useful to explain potential variances in transgene expression. These findings support the relevance of the higher than expected prevalence of anti-AAV8 NAbs, highlighting the need for strategies to circumvent preexisting anti-AAV8 NAbs.
预先存在抗8型腺相关病毒(AAV8)中和抗体(NAbs)的患者目前被排除在AAV8基因治疗试验之外。因此,评估具有生物学相关性的AAV8-NAb滴度对于基因治疗产品的开发至关重要。然而,标准化检测方法尚未常规用于测定抗AAV8-NAb滴度,导致报道的抗AAV8流行率范围很广。在另一项研究中使用临床NAb检测方法,在国际队列中发现抗AAV8-NAb流行率高于预期,约为50%。这项比较研究具有转化性质,证实了通过该检测方法测得的抗AAV8抗体滴度的生物学相关性。研究显示了低滴度抗AAV8 NAbs的意义,以及与其他检测方法相比该检测方法临界值(1:5)的相关性。重要的是,使用内部标准化试剂和含有90%完整衣壳的纯化AAV8构建体来减少空衣壳的影响。研究发现,即使是非常低的抗AAV8-NAb滴度(<1:5)也能有效阻碍转导,证明了灵敏的NAb检测方法在临床应用中的重要性。发现该NAb检测方法比另一种NAb检测方法更灵敏,因此更适合用于患者筛查。此外,研究表明抗AAV8-NAb滴度<1:5非常罕见,进一步支持了该检测方法。然而,使用较低临界值的检测方法可能仍有助于解释转基因表达中的潜在差异。这些发现支持了抗AAV8 NAbs流行率高于预期的相关性,突出了规避预先存在的抗AAV8 NAbs策略的必要性。
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